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The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Yin deficiency with Yang pulse palpitation is called Bing (sudden severe uterine bleeding)." It also states: "Injury to the Yang collaterals causes blood to overflow externally; injury to the Yin collaterals causes blood to overflow internally." Furthermore, it states: "The Spleen controls the blood; the Liver stores the blood."

The etiology of persistent metrorrhagia includes: damage to the Spleen and Stomach failing to control blood and return it to its source; fire in the Liver channel causing blood to flow downward due to heat; wind in the Liver channel causing blood to move recklessly due to wind; anger stirring up Liver fire causing blood to boil due to heat; stagnation in the Spleen channel injuring blood so it does not follow its normal pathway; or excessive grief injuring the Bao Luo (uterine collaterals), leading to sudden lower bleeding.

Treatment methods: For Spleen and Stomach deficiency, use Liujunzi Tang (Six Gentlemen Decoction) added with Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Chaihu (Bupleuri Radix); for Spleen and Stomach Qi sinking, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Jiu Chao Shaoyao (Wine-fried Paeoniae Radix Alba) and Shanzhi (Gardeniae Fructus); for Liver channel blood heat, use Siwu Tang (Four Substances Decoction) added with Chaihu, Shanzhi, Lingzhi (Poria), and Baizhu (Atractylodis Macrocephalae Rhizoma); for Liver channel furious fire, use Xiaochaihu Tang (Minor Bupleurum Decoction) added with Shanzhi, Shaoyao, and Danpi (Moutan Cortex); for Spleen channel stagnant fire, use Guipi Tang (Restore the Spleen Decoction) added with Shanzhi, Chaihu, and Danpi; for grief injuring the Bao Luo, use Sijunzi Tang (Four Gentlemen Decoction) added with Chaihu, Shengma (Cimicifugae Rhizoma), and Shanzhi. Therefore, Mr. Li Dongyuan and Mr. Zhu Danxi stated: "For all lower bleeding syndromes, one must use Sijunzi Tang to achieve success." This statement is profound. If there is massive hematemesis after a major bleed, do not rely solely on pulse diagnosis; instead, urgently use Dushen Tang (Single Ginseng Decoction) for rescue. Symptoms such as fever, tidal fever, cough, and rapid pulse indicate false heat pulses caused by deficient Yuan Qi (Original Qi); particularly, herbs like Renshen (Ginseng Radix et Rhizoma) should be used. These conditions invariably arise from prior damage to the Spleen and Stomach; thus, although the pulse may be flooding (Hong Da), if the presence of Wei Qi (Stomach Qi) indicates receptivity to tonification, recovery is possible. If cold-cooling herbs are mistakenly used, further damaging the vital energy of the Spleen and Stomach, the blood will fail to return to its source even more.

Clinical Cases (Attached: Hematemesis and other symptoms)

A woman nearing seventy years old had chronic Liver and Spleen disorders. During exacerbations, she suffered from anorexia, chest and diaphragm discomfort, epigastric pain, diarrhea, or dysuria. I treated her with Xiaoyao San (Free Wanderer Powder) added with Shanzhi, Fushen (Poria with Hostwood), Yuanzhi (Polygalae Radix), and Muxiang (Aucklandiae Radix), resulting in a cure. Later, due to worry over her widowed daughter, she intermittently vomited dark purple blood. Before each episode, she felt fatigued and irritable with heat. I added 3 fen of Chao Hei Huanglian (Charred Black Coptidis Rhizoma) and 2 fen of Wuzhuyu (Evodiae Fructus) to the previous prescription, achieving a cure in one dose. Later, due to anger, she vomited a large amount of bright red blood, became restless and thirsty, approaching death. This was blood depletion; the treatment principle required tonifying Qi. I prescribed Renshen 1 liang, Lingzhi, Baizhu, and Danggui each 3 qian, Chenpi (Citri Reticulatae Pericarpium) and Pao Hei Ganjiang (Charred Black Zingiberis Rhizoma) each 2 qian, Zhi Cao (Prepared Licorice Root) and Muxiang each 1 qian. One dose stopped the bleeding immediately. Belief in medicine has the power to revive the dead; one should not resign oneself to fate.

A sixty-four-year-old woman suffered from chronic anger, headache with alternating chills and fever, and intermittent breast pain in spring. Taking Liqi Yin (Flowing Qi Decoction) worsened her condition, and she experienced intermittent bleeding resembling menstruation. After experiencing great fright, she lost her appetite, slept restlessly at night, and had swollen breasts and burning pain in both hypochondria. In the afternoon, her face turned red. I diagnosed this as Liver and Spleen stagnant fire causing blood dryness. I first administered Xiaoyao San added with 1 qian of Jiu Chao Hei Longdan (Wine-fried Charred Black Gentianae Radix) and 1.5 qian of Shanzhi. After two doses, swelling and pain subsided instantly; after two more doses, they disappeared completely. Then, using Guipi Tang added with Chao Shanzhi and Beimu (Fritillariae Thunbergii Bulbus), all symptoms resolved.

A woman suffered from chronic Bing (metrorrhagia) with emaciation. She could only smell fishy odors when food approached her mouth, salivated excessively, and felt abdominal distension after eating small amounts. This was Xue Ku (Blood Withering), a disorder of Lung, Liver, Spleen, and Stomach deficiency. Using Bazhen Tang (Eight Treasures Decoction) and Wuzeiyu Gu Wan (Cuttlefish Bone Pill) concurrently for two months restored her menstruation, and after over a hundred doses, she recovered fully.

A woman with an irritable temperament developed hematemesis and fever after suffering from Luoli (scrofula), with distending pain in both hypochondria worsening in the late afternoon. I diagnosed this as anger injuring the Liver, with both Qi and Blood deficient. I prescribed Xiaoyao San in the morning, doubling the dosage of Chao Hei Shanzhi, Huangbai (Phellodendri Cortex), Beimu, Jiegeng (Platycodonis Radix), Maidong (Ophiopogonis Tuber), and Wuweizi (Schisandrae Fructus). In the evening, I sent Diwan (Rehmannia Pill) with Guipi Tang. All symptoms resolved.

A woman accustomed to hard labor lost her appetite after the death of her son. She suddenly vomited a large amount of blood which stopped spontaneously, but thereafter vomited small amounts upon exertion, exhibiting signs of Zhai (consumptive disease) and extreme fatigue. I prescribed Buzhong Yiqi Tang in the morning and Guipi Tang sending Diwan in the afternoon, resulting in a cure.

A young woman with chronic emotional stagnation presented with chest fullness, poor appetite, hematemesis, and a red face. She was cured using Diwan and Guipi Tang added with Shanzhi, Beimu, and Shaoyao.

A woman presented with yellow or red complexion, intermittent pain in the waist or below the umbilicus, limb fatigue, irritability, and restlessness. Her menstruation began with chills and fever, a sensation of binding in the hypochondria, and bleeding volume like Bing. This was attributed to Spleen and Stomach deficiency, sinking of Yuan Qi, and combined with Minister Fire and damp-heat. I used Buzhong Yiqi Tang added with Fangfeng (Saposhnikoviae Radix), Shaoyao, and Chao Hei Huangbai, interspersed with Guipi Tang to regulate and tonify the source of transformation, allowing the blood to return to its vessels.

A woman suffered from prolonged Bing due to anger, presenting with a greenish-yellow or red complexion. This indicated Liver Wood overacting on Spleen Earth, causing Blood deficiency. I used Xiaochaihu Tang combined with Siwu Tang to clear Liver fire and generate Liver blood, followed by Guipi Tang and Buzhong Yiqi Tang to benefit Spleen Qi and generate Liver blood, leading to recovery. If this syndrome were due to Wind-Heat in the Liver channel causing blood instability, one could use Fangfeng alone made into pills, taken with decoctions for accompanying symptoms; or if due to Fire moving in the Liver channel causing blood instability, use Tiao Qin (Scutellariae Radix) fried into pills, taken with decoctions for accompanying symptoms. Both methods are effective.

A woman with an impatient temper experienced, upon anger, either pain in the Taiyang meridian, ears, neck, throat, teeth, chest, or breasts, or chest fullness with acid regurgitation, vomiting, diarrhea, and poor appetite, along with continuous menstruation. These are all Liver Fire syndromes. When the Liver itself is diseased, external symptoms appear; when Earth is oppressed, internal symptoms arise. If self-disease symptoms appear, use Siwu Tang added with Baizhu, Lingzhi, Chaihu, Chao Shanzhi, and Chao Longdan; if internal symptoms arise, use Sijunzi Tang added with Chaihu, Shaoyao, Shenqu (Massa Medicata Fermentata), Wuzhuyu, and Chao Huanglian. Symptoms gradually improved. Only the continuous menstruation indicated Heat in the Blood level with still-deficient Spleen Qi. I used Xiaoyao San with doubled Baizhu, Lingzhi, and Chenpi, concurrently administering Buzhong Yiqi Tang added with Jiu Chao Shaoyao for regulation.

Qian Shi, wife of the Qian family, aged fifty, suffered from Bing in the Xin-Chou year, unresponsive to various medicines. In the Ren-Yin year, August, she had body heat, limb pain, dizziness, rhinorrhea, expectoration, and poor appetite. Others treated it as Fire, worsening her condition until she fasted, lying weakly on her pillow with barely any respiration. Her brother, returning from Zhejiang, diagnosed Spleen and Stomach deficiency-cold and prescribed one dose of Bawei Wan (Eight-Treasure Pill) material, urging urgent decoction. Due to long-standing stomach weakness, swallowing was difficult initially, but by the next morning, she requested several spoons of porridge. After another dose, intake doubled, heat decreased, and pain stopped. Concurrent use of Bawei Wan led to good recovery. In the Gui-Mao autumn, due to labor and emotional stress, Bing recurred in the Jia-Chen spring and summer. On June 20th, she had chest fullness, fever, back pain, immobility of the waist, depressed spirit, and conflicting diagnoses of internal injury or summerheat. Bleeding boiled like water, accompanied by hematochezia, irritability, thirst, and inability to eat. By July 13th, she suffered day and night from dizziness and confusion, intermittently. Desperate, I examined her pulse: flooding without limit, but weak upon pressure. This was rootless Fire, true cold inside and false heat outside. I prescribed Shiquan Dabu Tang (Complete Great Tonifying Decoction) added with Fuzi (Aconiti Lateralis Radix Praeparata) for one dose. Dizziness stopped, she drank three to four spoons of porridge, and bleeding gradually decreased. Daily consumption of Bawei Wan led to complete recovery. The Qian family women faced critical illnesses twice, life hanging by a thread. Thanks to my brother's distant rescue, solving their desperate plight, his prescriptions were miraculous. His knowledge is unsurpassed. I, a commoner, harbor gratitude and await future recompense. Jia-Cao late autumn, cousin Fang Qian bows and writes.

Gui Dahua’s household member experienced irregular menstruation, Bing with fainting, fever, and insomnia. Some attributed it to Blood Heat causing reckless movement and prescribed cold agents, worsening the condition. Others attributed it to fetal injury and prescribed hemostatics, which were ineffective. Respectfully inviting the Master for diagnosis, he said: "This is Spleen Qi deficiency, unable to control and hold; the method is to tonify the Spleen, and the blood will stop naturally." I used Buzhong Yiqi Tang added with Pao Jiang (Prepared Ginger). Within a few doses, efficacy was seen. However, she suffered from sleeplessness and palpitations all night. Taking Babu Tang (Eight Substance Decoction) separately was ineffective. Consulting the Master, he said the approach was mixed. I then prescribed Guipi Tang added with Pao Jiang to tonify Heart and Spleen, resulting in recovery. I record this summary to attach to medical cases, enabling future patients to have a model to follow. Jia-Cheng early winter, junior disciple Gui Dahua bows and writes.