脾主消磨水谷。化生津液。津液腾溢。水阴四布。口中清和。湛然如露。是以终日不饮。而口不渴。亦终日闭
口。而唾不生。唯脾之津液。不能清和散布。于是凝聚而为唾。是唾者。脾不摄津之故也。知脾不摄津而唾
津。则知脾不摄血而唾血矣。唾津其常耳。而唾血则又甚焉。盖津乃气分之阴液。其源即在胃中。凝而为
唾。其来既近。其伤不多。至于唾血。则出于阴分。内经云。脾为阴中至阴。盖五脏俱属阴经。而脾独名太阴。
以其能统主五脏。而为阴之守也。其气上输心肺。下达肝肾。外灌溉四旁。充溢肌肉。所谓居中央。畅四方
者如是。血即随之。营运不息。所谓脾统血者。亦即如是。世医不识统血之义。几指脾为贮血之器。岂不愚
哉。脾能统血。则血自循经。而不妄动。今其血走泄胃中。为唾而出。是脾之阴分受病。而失其统血之常也。
审系脾经火重。唇口干燥。大便秘结。脉滑实者。宜用泻心汤。加当归生地白芍花粉寸冬枳壳蒲黄甘草。
若是脾经阴虚。脉细数。津液枯。血不宁者。麦冬养荣汤。加蒲黄阿胶。甲己化土汤。加生地花粉人参寸冬
藕节侧柏叶莱菔汁枳壳。皆滋利脾阴之要药。如或七情郁滞。脾经忧虑。伤其血而致唾血者。以脾主思
虑。故每因思虑而伤脾阴。睡卧不宁。怔忡劳倦。饮食不健。宜用归脾汤。以补心脾。再加阿胶柴胡炒栀棕
灰血余。以解郁火。清血分。此治脾兼治心。心脾为思虑所伤者。应手而效。又凡脾经忧抑。则肝木之气。遏
于脾土之中。不能上达。故清阳不升。郁为内热。不须清热。但解其郁。郁升而火不遏矣。逍遥散主之。
脾土阴而用阳。脾经阴虚火郁者。上法略备。又有脾之阳气不旺。无以统运阴血。心战脉弱。四肢清冷。饮
食不健。自汗身热者。用归脾汤。补脾之阳以生血。人参养荣汤。正元丹。皆治之。
亦有清晨唾血。每早初醒。血液满口。唾出即净。明晨又唾。乃卧后血不归经。溢退场门中。实证则由肝不藏
血。必有头痛口渴便闭之证。用当归芦荟丸治之。虚证则由脾不统血。必有怔忡虚烦不眠等症。用归脾
汤。加丹皮山栀棕灰五味治之。此证与肾虚齿衄相似。宜参看之。
高士宗曰。偶然唾血。一哈便出者。不药可愈。谓其血近胃。如先血后便为近血一般。故不药可愈。吾谓亦
宜少用清味之药。可服甲己化土汤。加银花竹茹莱菔汁。丹溪又谓唾血皆属于肾。是混唾咯为一证。而
以肾血之来。其路最深。其证最重。用保命生地散治之。吾谓先唾痰水。唾久然后唾血者。此血来路远。其
证深。可用丹溪法治之。然亦有丹溪法所不能治者。即吾所定诸方。亦有不能尽治。别参吐咳诸门。自有
治法。勿谓予论之不备也。
The Spleen is responsible for the digestion and transformation of food and fluids. It transforms these into Jin-Ye (body fluids). When Jin-Ye becomes abundant and overflows, the Yin-Water distributes to all parts of the body, keeping the mouth clear, harmonious, and moist like dew. Thus, even if one does not drink water all day, the mouth does not feel thirsty; similarly, even if one keeps the mouth closed all day, saliva is not produced. Only when the Spleen's Jin-Ye fails to distribute clearly and harmoniously does it condense to form saliva. Therefore, saliva is caused by the Spleen's failure to control Jin-Ye. Knowing that the Spleen's failure to control Jin-Ye leads to salivation, one can understand that the Spleen's failure to control Blood leads to spitting blood. Spitting Jin-Ye is the normal state, whereas spitting blood is far more severe. This is because Jin-Ye belongs to the Yin-fluids of the Qi-Boundary, and its source lies in the Stomach. When it condenses into saliva, the source is close, and the damage is minimal. However, spitting blood originates from the Yin-Boundary. As stated in the *Nei Jing* (Inner Canon): "The Spleen is the Ultimate Yin within the Yin." Although all five Zang-Organ belong to the Yin-Meridians, only the Spleen is named Taiyin (Greater Yin) because it governs and directs the other four Zang-Organ, serving as the guardian of Yin. Its Qi transports upward to the Heart and Lungs, downward to the Liver and Kidneys, and outward to irrigate the surrounding tissues, filling the muscles. This is what is meant by "dwelling in the center and smoothing the four directions." Blood follows this path, circulating endlessly, which is also the principle behind "the Spleen controls Blood." Physicians of later generations fail to understand the meaning of "controlling Blood," mistakenly regarding the Spleen merely as a vessel storing Blood, which is indeed foolish. If the Spleen can control Blood, Blood will follow the meridians without erratic movement. Now, if Blood leaks into the Stomach and is spat out with saliva, it indicates that the Spleen's Yin-Boundary is diseased and has lost its normal function of controlling Blood.
If the syndrome is determined to be excessive Fire in the Spleen Meridian, characterized by dry lips and mouth, constipation, and a slippery and excess pulse, Xie Xin Tang (Drain the Epigastrium Decoction) should be used, modified with Dang Gui (Angelica Sinensis), Sheng Di Huang (Rehmannia Root), Bai Shao (White Peony Root), Hua Fen (Trichosanthes Root), Cun Dong (Ophiopogon Tuber), Zhi Qiao (Aurantium Fructus), Pu Huang (Typha Pollen), and Gan Cao (Licorice Root). If the syndrome is Spleen Yin Deficiency, characterized by a fine and rapid pulse, dried-up Jin-Ye, and unsettled Blood, Mai Dong Yang Rong Tang (Ophiopogon Nourishing the Constitution Decoction) should be used, modified with Pu Huang and E Jiao (Donkey-Hide Gelatin); or Jia Ji Hua Tu Tang (Wood-Earth Transforming Earth Decoction) should be used, modified with Sheng Di Huang, Hua Fen, Ren Shen (Ginseng Root), Cun Dong, Ou Jie (Lotus Rhizome Node), Ce Bai Ye (Biota Top), Lai Fu Zhi (Radish Juice), and Zhi Qiao. These are essential herbs for nourishing Spleen Yin. If the cause is stagnation of the Seven Emotions, worry affecting the Spleen, damaging Blood and causing spitting blood, since the Spleen governs thought, excessive thinking often damages Spleen Yin, leading to restless sleep, palpitations, fatigue, and poor appetite. In such cases, Gui Pi Tang (Restore the Spleen Decoction) should be used to tonify the Heart and Spleen, further modified with E Jiao, Chai Hu (Bupleurum Root), fried Zhi Zi (Gardenia Fruit), Zong Lu Hui (Palma Ash), and Xue Yu Tan (Charred Human Hair) to resolve stagnant Fire and clear Heat from the Blood-Boundary. This treats the Spleen while simultaneously treating the Heart; conditions where the Heart and Spleen are damaged by excessive thought respond promptly. Furthermore, whenever the Spleen is oppressed by worry, the Qi of the Liver Wood is restrained within the Spleen Earth, unable to ascend, causing Clear Yang to fail to rise and stagnating into internal Heat. At this point, clearing Heat is unnecessary; one need only resolve the stagnation. Once the stagnation lifts, the Fire is no longer restrained. Xiao Yao San (Free and Easy Wanderer Powder) is the primary formula.
The Spleen's substance is Yin, but its function is Yang. For cases of Spleen Yin Deficiency with stagnant Fire, the above methods are largely sufficient. There are also cases where Spleen Yang Qi is not vigorous, unable to control and transport Yin-Blood, presenting with trembling heart, weak pulse, cold limbs, poor appetite, spontaneous sweating, and low-grade fever. Gui Pi Tang should be used to tonify Spleen Yang to generate Blood; or Ren Shen Yang Rong Tang (Ginseng Nourishing the Constitution Decoction) and Zheng Yuan Dan (Upright Origin Pill) may be used.
There are also cases of morning spitting blood, where upon waking each morning, the mouth feels full of blood, which is spat out completely, only to recur the next morning. This occurs because during sleep, Blood fails to return to its vessels and overflows into the oral cavity. Excess syndromes result from the Liver failing to store Blood, necessarily accompanied by headache, thirst, and constipation, treated with Dang Gui Lu Hui Wan (Angelica and Gardenia Pill). Deficient syndromes result from the Spleen failing to control Blood, necessarily accompanied by palpitations, empty irritability, and insomnia, treated with Gui Pi Tang modified with Mu Dan Pi (Moutan Bark), Shan Zhi (Gardenia Fruit), Zong Lu Hui, and Wu Wei Zi (Schisandra Berry). This condition resembles gingival bleeding due to Kidney Deficiency and should be consulted accordingly.
Gao Shizong stated: Occasional spitting blood that is easily expelled with a cough requires no medication and will heal spontaneously. He argued that because the Blood is near the Stomach, similar to "near blood" in hematochezia (blood before stool), it heals without medicine. I believe that mild, bland-clearing herbs should still be used sparingly; one may take Jia Ji Hua Tu Tang modified with Yin Hua (Chrysanthemum Flower), Zhu Ru (Bamboo Shavings), and Lai Fu Zhi. Zhu Danxi claimed that all spitting blood belongs to the Kidney, conflating spitting and coughing blood into one syndrome, arguing that Kidney Blood travels the deepest path and presents the most severe symptoms, treated with Bao Ming Sheng Di San (Life-Preserving Rehmannia Powder). I argue that if one first spits phlegm-water and only after a long time begins to spit blood, the path of the Blood is distant and the condition is deep, so Danxi's method may be applied. However, there are cases that Danxi's methods cannot treat, and even my prescribed formulas may not cure them all. Please refer to the sections on vomiting blood and coughing for other treatment methods. Do not claim that my discussion is incomplete.