Library

General Principles: Why does blood run recklessly among the nine pathways? It is solely due to emotional depression generating heat pathogens; treating according to the affected meridians and clarifying deficiency and excess, once qi flows smoothly, blood will naturally return to normal circulation.

Pulse Diagnosis: For patients with hematemesis (vomiting blood), if the pulse is slippery, small, or weak, prognosis is good; if the pulse is excessive or large, prognosis is fatal.

The *Neijing* states: The clear part becomes Ying (Nutrient) Qi, and the turbid part becomes Wei (Defensive) Qi. Ying circulates within the vessels, while Wei circulates outside the vessels. Ying refers to the essence of water and grain, which harmonizes with the five Zang organs and distributes to the six Fu organs, thus entering the vessels. Ying belongs to Yin Blood; it is infused in the Heart, governed and transformed by the Spleen, stored in the Liver, disseminated by the Lung, and transported and excreted by the Kidney. It irrigates the whole body and nourishes all vessels, from which all meridians grow and develop. However, what governs blood is Qi. Qi primarily moves blood, and blood primarily moistens the body; therefore, when Qi moves, blood moves, and when Qi stops, blood stops. This follows the principle of Yang generating Yin and growing, like a husband leading and a wife following. If Qi is injured, myriad symptoms arise; thus, Qi disorder causes blood to run recklessly resulting in hematemesis or epistaxis, Qi depletion leads to consumptive disease, blood descending results in hematochezia, heat sinking causes dark urine, and seeping into the intestines and stomach results in intestinal wind. Yin deficiency with Yang pulsation leads to metrorrhagia and metrostaxis. These are all due to Qi deviating from its proper course and blood suffering from leakage and overflow. Those who wish to nourish Yin must first know the way to nourish Yang.

Chao Yuanfang stated: Hematemesis occurs when heat is abundant and blood is deficient. Heat attacks the blood, and since blood tends to scatter and run recklessly when heated, combined with rebellious Qi causing blood to rise with Qi, hematemesis results. Alternatively, after a full meal, if the interior of the Spleen and Stomach is cold and unable to digest food, suddenly vomiting the damaged matter causes Qi and Blood to clash, injuring the Lung and Stomach, also leading to hematemesis. If chronic coughing causes Qi rebellion, accompanied by facial and ocular edema and hematemesis, this indicates Lung deficiency and damage; treat with Baizhi Yin (Cypress Branch Drink) or Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction).

Epistaxis (nosebleed) is caused by heat accumulation in the five Zang organs. Blood follows Qi, circulating through the organs; when cold and heat are harmonized and do not deviate from the norm, there is no congestion nor overflow. Blood coagulates when cold and scatters when heated. When heat attacks blood, blood scatters with Qi and overflows from the nasal cavity. Additionally, due to cold damage or plague, where Yang meridians are diseased and cannot vent, heat toxins accumulate in the five Zang organs, causing bleeding from the nose. Treat with Longdan Wan (Gentian Pill), Baipi Tang (Cypress Bark Decoction), or Jiahuang San (Gelatin and Rhubarb Powder).

Hematochezia (blood in stool) is caused by heat accumulation in the Large Intestine and damage. Once organ Qi is injured, Wind pathogens enter spontaneously, or there is accumulated heat, accumulated cold, damp-heat hidden in the Spleen and Stomach, or malnutrition-dietary injury to the organs. Consequently, malnutrition-heat and cold-dampness interact, disturbing Qi and Blood, causing stagnation and flow internally, condensing without returning, and seeping into the intestines, resulting in hematochezia. Abdominal distension with internal cold attacking can also cause hematochezia. Furthermore, wind-cold invading the Spleen and Stomach due to deficiency, or blood stasis in the intestines, may result in damp-toxin discharge resembling bean curd dregs. Malnutrition damaging the organs can also cause bloody stools. If heat accumulates in the Upper Jiao (Heart and Lungs) and flows into the Large Intestine, it also causes hematochezia.

Excessive blood loss: Spleen heat inevitably causes thirst; prolonged deficiency leads to blood deficiency, manifesting as sallow complexion and black hair loss. Treat with Wubei Wan (Chinese Gall Pill).

Hematuria (blood in urine): The Heart governs blood and pairs with the Small Intestine. Blood circulates through meridians and organs. If heat gathers in the Bladder, blood seeps into the bladder sac, causing blood in urine. Treat with Huofu Dan (Fire Mansion Pill). For excess heat, use Qingxin Lianzi Yin (Clear Heart Lotus Seed Drink); for deficiency heat, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill).

(Preface: For conditions of blood overflowing, leaking, and various forms of reckless accumulation, treatment should initially employ agents that move blood and break stasis, such as Dahuang (Rhubarb Root) and Taoren (Peach Kernel), to curb their aggressive nature before differentiating and treating further. Skilled physicians always treat hemorrhagic and reckless accumulation conditions first with strong purgatives. One might ask: After losing blood, how can a deficient body withstand purgation? The answer is: Since blood has run recklessly and lost its original path, if one does not remove the accumulation and promote drainage, allowing recklessness to become the norm, how can one control it? Moreover, what leaves departs, and what generates regenerates.)

Supplementary Notes:
The *Neijing* states: Rebellious Qi in the Yangming Meridian causes wheezing, coughing, body heat, fright, epistaxis, and hematemesis. It also states: If the Spleen transmits heat to the Liver, it causes fright and epistaxis. If heat from the Bao (Uterus/Bladder area) transfers to the Bladder, it causes strangury and hematuria. In children, hematemesis is due to rebellious Ying and Wei Qi. When Ying and Wei assist each other and follow the proper path, any excess leads to reckless flowing of blood and fluids; if the channel is broken eastward, it flows east; if westward, it flows west. Qi drives blood, and this is its natural tendency.

[Attached Formulas]
Baizhi Yin (Treats hematemesis and epistaxis): Ginkgo Branch (Dried Cypress Branch) and Lotus Root Node (Dried), ground into powder, mixed with honey, taken with boiling water. Another prescription adds Baishao (White Peony Root) and Xijiao juice (Rhino Horn Juice).
Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction): Xijiao (Rhino Horn), Chishao (Red Peony Root), Danpi (Moutan Cortex), Shengdi (Rehmannia Root).
Longdan Wan (Stop Bleeding): Huanglian (Coptis Rhizome), Danshen/Danchao (Gentian Root - note: text says Dancao/Gentian).
Kupi Tang (Cypress Bark Decoction): Baipi (Cypress Leaf/Bark), Zhizi (Gardenia Fruit), Gancao (Licorice Root).
Jiahuang San (Treats bleeding from mouth, nose, ears): Ejiao (Donkey-hide Gelatin, 1 liang), Puhuang (Pollen Typhae, 5 qian), taken with Shengdi juice (Rehmannia Root Juice).
Wubei Wan: Chinese Gall (Wubeizi) ground into powder, made into pills with honey, size of mung beans. Infants take 10 pills on an empty stomach with rice soup.
Huofu Dan: See section on Heat Syndromes.
Qingxin Lianzi Yin: Huangqin (Scutellaria Root), Mendong (Ophiopogon Tuber), Guopi (Phellodendron Bark), Gancao (Licorice Root), Cheqianzi (Plantago Seed), Shilian (Lotus Seed), Fuling (Poria), Huang [missing character, likely Huangqi or Huangbai], Chaihu (Bupleurum Root). Add Renshen (Ginseng) for deficiency.