Library

Student asked: "The Prefect suddenly fell seriously ill, vomiting several sheng of blood. His fingertips were slightly cold, there was a sensation of obstruction in his throat, and his voice was difficult to produce. The safety or danger of his condition depends on medical treatment. Some advocate using warming and tonifying herbs such as Renshen (Ginseng Radix) and Ejiao (Donkey-hide Gelatin); others advocate using cooling blood herbs such as Shengdi (Rehmanniae Radix) and Xuanshen (Scrophulariae Radix); still others advocate using fire-descending herbs such as Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma). Opinions are scattered and hard to follow. I implore you, Master, to clearly explain the rationale so as to enlighten my ignorance."

I replied: "Throughout history, discussions on hemorrhagic diseases have been mixed into the category of 'phlegm-fire', hence the explanations often miss the point. Let me explain it to you in detail. Blood diseases can be new or old, mild or severe, but all originate from 'fire'. However, fire differs in being either Yang fire or Yin fire, and the treatment methods are consequently vastly different. Although the Prefect had a history of previous hemorrhage, that was merely a type of injury with a relatively light root cause. Since entering spring this year, he has suddenly vomited several bowls of blood, indicating that the bleeding is violent. The Classic says: 'Acute illness is not Yang' (sudden acute conditions usually do not belong to pure Yang heat syndromes). Therefore, although it involves fire, it is clearly not Yang fire. Yang fire refers to the fire of the Five Elements, which is a constant and enduring phenomenon in heaven and earth; how could it be so violent? If it were violent, it could be subdued by the water of the Five Elements and would not appear so violent. Only the 'Dragon-Thunder Fire' lies hidden within the Yin aspect. When it has not yet moved, one does not know it is fire; once it erupts, it is violently uncontrollable, causing Yin blood to overflow upwards. The nature of Dragon-Thunder Fire requires dark clouds to gather around before it can ascend. If the sky is clear and sunny, it retreats and remains inactive. Therefore, any use of cooling blood and clearing fire medications follows the common method of using water to control fire. Applied to Yin fire, this invariably exacerbates its destructive power.

The general principle of treatment should favor warming and tonifying. However, the subtle nuances within warming and tonifying must be thoroughly understood beforehand. The Classic states: 'The Shaoyin meridian winds around the root of the tongue,' meaning the Kidney meridian encircles the base of the tongue. It also states: 'Hemoptysis belongs to the Kidney.' Understanding that Yin fire arises from within the Yin, the blood expectorated comes out in clots, which differs from the Yang fire seen in coughing consumptive diseases where blood is mixed with phlegm. This principle has never been elucidated before. Only Zhang Zhongjing of the Han Dynasty, the Sage among physicians, issued a warning in his Treatise on Cold Damage: 'Mistakenly inducing sweating in Shaoyin disturbs the channel blood, leading to exhaustion below and reversal above, which is difficult to treat.' Later generations simply read the text without discussing the rationale behind 'exhaustion below and reversal above.' They did not know that 'exhaustion below' refers to the depletion of Yin blood at the lower part, and 'reversal above' refers to the counterflow of Yin Qi to the upper part. Qi and Blood mutually support and attach to each other. Without Blood, Qi scatters without control; without Qi, Blood coagulates and fails to flow. Thus, when Yin fire moves, Yin Qi cannot help but rush upward; as Yin Qi rushes upward, Yin blood inevitably overflows upwards. As Yin blood overflows, the lower part becomes exhausted. Once blood overflows, the Qi accompanying it scatters in the chest and cannot return to its original position, which is called 'reversal above'. Yin Qi counterflows only up to the neck and cannot reach the highest position of clear Yang, resulting in sensations of throat obstruction, palpitations, tinnitus, and chest discomfort. But is it merely obstruction and discomfort? If Yin Qi resides in the upper part for a long time, it will inevitably trigger the Dragon-Thunder Fire below to respond. Bleeding will not stop until blood is exhausted, nor will it stop until Qi reversal is resolved. This is likely why Zhang Zhongjing judged it as 'difficult to treat.' He said only 'difficult to treat,' not 'untreatable.' Zhang Zhongjing did not establish specific treatment methods because he had another work, *Shu Bing Lun* (Treatise on Sudden Diseases), consisting of sixteen volumes, specifically discussing sudden acute illnesses, which has since been lost and transmitted nowhere. I now open this door widely for you: the primary principle of treatment is to strengthen the Yang Qi of the Spleen. Strengthening the Yang Qi of the Spleen yields three benefits: First, when the Yang Qi in the Spleen is vigorous, like a clear sunny day, the Dragon-Thunder Fire will lie dormant. Second, when the Yang Qi in the Spleen is vigorous, the Yin Qi obstructing the chest will dissipate like no dust remaining in the vast sky. Third, when the Yang Qi in the Spleen is vigorous, the transformation and transportation of food and fluids into essence will regenerate the depleted blood below. Moreover, Earth Qi must first evaporate soil moisture to form wetness, then rise to become clouds. If the soil is dry and lacks moisture, Earth Qi is isolated within, and how can Heaven's Qi remain clear? Current formularies only record methods for treating Yang fire. Regarding Dragon-Thunder Fire, they have only the name but no treatment. They erroneously cite cases of chronic cough leading to consumption with blood in sputum (Yang syndromes) and dare not use strengthening the Spleen as a precursor. They fail to consider that even if hemoptysis is accompanied by coughing, it is merely a cough caused by Qi counterflow and reversal; once Qi descends, the cough ceases. How much more so for those who originally had no cough? Ancient formulas for treating Dragon-Thunder Fire often used Guizhi (Cinnamon Twig) and Fuzi (Aconite Lateralis Radix Praeparata) to guide fire back to its source. However, applied to acute massive hemorrhage, this can be used temporarily but not chronically. The already depleted blood may not be able to restrain the fierce nature of the drugs, and the unmoved blood might be disturbed by nourishing agents. Ultimately, treating Dragon-Thunder Fire relies entirely on 'collecting and storing,' just as dragons hide and thunder rests in autumn and winter. If collecting and storing medications are ineffective, slightly using drying and acrid agents as guides to demonstrate the principle of similar energies attracting each other is acceptable. Since we advocate collection and storage, how dare we casually use drying and acrid agents? The Prefect has a history of damage and hemorrhage. Facing this situation where both upper and lower aspects are deficient, under strict regulations, and with human desires running wild, he is anxious and fears failure. This adds worry and fear to his劳伤 (labor-induced injury). Fear injures the Kidney, causing the blood of Shaoyin to overflow unexpectedly, which is initially no different from what Zhang Zhongjing described as 'mistakenly inducing sweating in Shaoyin disturbing the blood.' Furthermore, the Liver governs planning and loves free flow. During winter, when Kidney Qi was not stored, it had already been drawn upon by Liver Wood. Now that spring is approaching, Liver Wood occupies the position of the Azure Dragon and controls Thunder. Riding this authority, it acts. Thus, while the celestial Dragon-Thunder has not yet moved, the internal Dragon-Thunder of the body moves first, causing blood to surge violently. Who knows what blood will be available to sustain him during the twelve months of spring and summer, the time of vigorous Dragon-Thunder activity? Major illnesses require major medicines. The so-called major medicine is to align with the seasonal growth of spring and summer, while keeping the mind silent and still like autumn and winter. The ancients used the term 'fleeing to Zen' (Tao Chan), which is very apt. If it is called 'fleeing,' what must the state of mind be? In the future, when encountering this disease, you must prioritize strengthening the Earth element. When Earth is thick, turbid Yin will not ascend, and blood disorders will cease. All things take Earth as their root; Yuan Qi (Original Qi) takes Earth as its dwelling. This cannot be neglected."

Mr. Hu Youchen said: "Hemorrhagic diseases are very common in today's world. The preceding four cases have elucidated infinite profound meanings with earnest instruction. This article details the origins and course of Yin fire, particularly making up for a gap in knowledge that has existed for millennia."