Library

(Tu xue, hematemesis, is equivalent to ou xue, vomiting blood. The old distinction that silent expulsion is called "tu" and noisy expulsion is called "ou" is unnecessary.)
Blood expelled from the mouth was traditionally considered to be blood from the Wei Fu (Stomach Organ). Zhang Jingyue argued that what comes out of the mouth differs between the Yan (Pharynx) and the Hou (Larynx/Throat). The Hou is the upper orifice of the Fei Zang (Lung Organ) and serves as the general pathway for the clear qi of the five Zang organs; therefore, blood from all organs can exit through the Hou via this clear pathway, not just from the Lung. The Yan is the upper orifice of the Stomach and serves as the general pathway for the turbid qi of the six Fu organs; thus, blood from all organs can also exit through the Yan via this turbid pathway, not just from the Stomach.
The Qi of the five Zang organs is derived from the Stomach; consequently, diseases of the five Zang organs will also affect the Stomach. For instance, anger causing Qi rebellion leading to hematemesis is a manifestation of Gan Bing (Liver Disease). Ministerial Fire flaring upward causing hematemesis is a manifestation of Shen Bing (Kidney Disease). Since this blood all exits from the Wei Wan (Epigastrium), it follows that blood exiting via the Hou belongs only to the five Zang organs, whereas blood exiting via the Yan includes not only the six Fu organs but potentially others.
Examining Zhang Jingyue’s theory, it is highly accurate, yet how should one differentiate them? Generally, when blood originates from the Gan and Shen, it often pours forth like a bucket being overturned, surging like tidal waves. This is caused by the sudden outbreak of Lei Long Zhi Huo (Thunder Dragon Fire) attacking the Stomach. Blood from the Liver, Kidney, and Stomach all erupt simultaneously; at this moment, there is irregular breathing, a face resembling drunkenness, and mental restlessness. After a short while, as the fire subsides and clarity returns, the complexion becomes pale and breathing stabilizes, and the bleeding gradually stops. If the condition is due to Wei Huo (Stomach Fire) arising independently, the intensity is not as violent, and the volume of blood lost will not be as excessive.
Regarding the color of the blood: initially vomited blood is bright red and loose. After a pause of one or two hours, if vomiting recurs, the blood becomes slightly purplish and coagulated. If vomiting continues over a long period, the blood turns black and forms clots. If hematemesis persists, the first blood expelled comes from the Upper Jiao (Upper Burner) and is near in location, appearing bright red. Subsequent blood comes from the Middle and Lower Jiao, distant in location, appearing dark red. The residual blood remaining after vomiting ceases appears pale, sugar-colored, or pinkish-red.

When Fire destroys Metal, the Fei Ye (Lung Lobes) become dry and wrinkled, causing itching. Itching leads to Ke Sou (Coughing); this may occur without phlegm, hence it is named Gan Ke (Dry Cough). Frequent coughing damages the Fei Luo (Lung Collaterals), causing blood to emerge. Sou (cough with phlegm) involves phlegm containing thread-like streaks of blood, which is also blood from the Lung Collaterals. These conditions vary in severity. If the syndrome is caused by Heat obstruction in the Lung, it is mild and will heal spontaneously with Qing Huo (Clearing Fire). If prolonged coughing causes Lung damage, it is severe; the treatment principle focuses on Bao Fei (Protecting the Lung), using E Jiao (Donkey-Hide Gelatin) as the Jun Yao (Sovereign Drug), combined with Bai Ji (Bletilla Rhizome), Yi Ren (Coix Seed), Sheng Di Huang (Rehmannia Root), Gan Cao (Licorice Root), Zhi Geng (Platycodon Root), Ju Hong (Tangerine Peel), and Bei Mu (Fritillaria Bulb) prepared into pills for holding in the mouth to dissolve.
One must also observe the sputum. If the sputum resembles agate in chunks and originates from the Wei Kou (Stomach opening), it is easy to treat. If it is merely trace amounts originating from within the Fei Zang (Lung Organ), it indicates Lung Yin deficiency with insufficient blood, forced out by Fire. Even small amounts will appear, gradually leading to Lung exhaustion and forming Lao Bing (Consumption/Tuberculosis), which is difficult to treat. Coughing up white blood guarantees death. (White blood refers to blood that is pale red, resembling flesh or lung tissue.) A Xian Mai (Wiry Pulse) with Qi Chuan (Asthma/Dyspnea), Hoarse Voice (Sheng Si), and Yan Tong (Sore Throat) indicates an untreatable condition.