Chapter Twelve. Syndrome of bleeding and formula composition
CHAPTER OUTLINE
This chapter introduces the principles, methods and strategies for the composition of formulas that can stop bleeding. They are used to treat various bleeding conditions and are used to treat the manifestation rather than the cause of the syndrome.
Bleeding exists in different conditions. All kinds of factors that directly injure the blood vessels can cause bleeding, such as in trauma and injury. For internal diseases, bleeding may occur when certain functions – particularly of the Heart, Liver and Spleen – are disturbed, because the Heart governs the blood, the Liver regulates the blood and the Spleen holds the blood in its pathway. Among the dysfunctions of these organs, heat in the blood, cold in the blood and stagnation of blood are the main direct causes of bleeding, because:
• heat can stimulate the blood and force the blood to leave its normal pathway
• cold can slow the blood circulation and lead to blood stagnation, thus the blood behind the stagnation is not able to follow its normal pathway
• blood stagnation can cause bleeding directly when the blood behind the stagnation is forced to find a new pathway, such as in different types of tumor
• weakness of Spleen-Qi from poor nutrition and chronic diseases may fail to control the blood and cause chronic bleeding.
Syndrome of bleeding
Manifestations
Main symptoms
Bleeding caused by trauma or injury, nose bleeds, gum bleeding, retinal bleeding, coughing out or vomiting blood, blood in the urine or stool, heavy menstruation and purpura. The amount of blood loss can be large or small; the color can be red, dark-red, purple-red or pinkish; the quality can be thin or thick.
Secondary symptoms
In chronic conditions: pale complexion, dizziness, general weakness, shortness of breath, cold sensation of the body, or irritability, thirst, insomnia, palpitations, warm palms.
Tongue
In acute conditions: red or purple tongue body with a white or yellow coating.
In chronic conditions: pale with teeth marks and a white coating.
Pulse
In acute conditions: slippery, forceful and rapid.
In chronic conditions: weak, thready, rapid or slow.
Associated disorders in western medicine
Bleeding caused by injury; acute or chronic blood diseases such as thrombocytopenia, anemia, leukemia, allergic purpura; diseases that lead to a bleeding condition, such as bronchiectasis, bleeding due to infection or abscess of the lung, gastric ulcer, duodenal ulcer, colitis, dysentery, hemorrhoids, urinary tract infection, stones in the urinary tract and bladder, dysfunctional uterine hemorrhage, hysteromyoma, heavy uterine bleeding due to retained placenta.
Analysis of the syndrome
Bleeding occurs when the blood vessels are injured. No matter which region is involved, the reasons are mainly pathogenic heat, cold, Spleen-Qi deficiency or obstruction of Qi and blood in the related regions.
• Heavy bleeding with a red color indicates the presence of heat.
• Chronic bleeding of small amount and with a pinkish color indicates deficiency of Qi.
• Purple-red or dark-red color of the blood with pain indicates blood stagnation or cold in the blood.
• Nose bleeds and coughing blood are related to the Lung.
• Vomiting blood is related to the Stomach.
• Blood in the stool is related to the Large Intestine.
• Bleeding of swollen gums with a foul smell in the mouth is related to excess heat in the Stomach.
• Slight bleeding of gums with loose teeth is related to empty-heat in the Kidney.
• Retinal bleeding is related to up-flaring of Liver-fire with stagnation of blood in the Heart.
• Blood in the urine is related to the Bladder and Small Intestine.
• Purpura or chronic bleeding indicates weakness of the Spleen-Qi.
If the loss of blood is excessive, Qi and Yang scatter because they lose their carrier.
• When Qi and blood are weak, the patient may feel dizzy and weak with a pale complexion, and shortness of breath.
• When Yang is too weak to warm the body, a cold sensation arises. A pale tongue and a weak, thready pulse may be present. At the compensation stage, the pulse may be rapid and floating, but hollow.
If there is heat in the blood, it consumes Yin.
• Heat may push the blood and disturb the functions of the Heart and Liver. Patients may present with irritability, thirst, insomnia and palpitations, a red tongue and a rapid and thready pulse.
(See Figure 12.1 on page 295.)
Treatment principle: Stop bleeding in time, treat the cause of bleeding and regulate the internal organs
Herb selection principles and formula composition strategies
• First, herbs that directly stop bleeding should be used. These herbs are sour, astringent or partially charred, and they enter those meridians where bleeding is present.
• Second, herbs that treat the cause of bleeding should be selected.
• Third, herbs that disperse the constrained Qi should be used to prevent new stagnation of blood, which may be caused by the herbs that stop bleeding.
CAUTIONS
1. Select treatment sequence according to the intensity of bleeding:
Herbs that stop bleeding are particularly used for relatively acute conditions in order to control the bleeding in time. They treat the manifestation rather than the cause of the syndrome. However, after bleeding stops, even when bleeding still exists, herbs that treat the causes can be applied.
2. Send patients to hospital in a severe bleeding condition:
Although the formulas that stop bleeding are effective in treating many kinds of bleeding conditions, patients should be sent to hospital immediately when heavy bleeding may bring danger to the patients. If it is impossible to reach a hospital in a short time, a large dose of Ren Shen ( Ginseng radix) should be applied together with the herbs that stop bleeding in order to hold the Qi so as to control the blood and stop bleeding on the way to the hospital.
3. Choose herbs according to the location of bleeding:
If the bleeding is in the upper part of the body, herbs that have dispersing and ascending properties should not be used, or used only in combination with descending herbs. If the bleeding is in the lower part of the body, herbs that have a descending tendency should not be used.
4. Use for only a short period of time:
Since the herbs that stop bleeding have sour, astringent and cold properties, they may cause blood stagnation and complicate the syndrome. Formulas that stop bleeding should not be used for a long period of time.
5. Caution in using tonifying and warming herbs:
Since tonifying and warming herbs can strengthen the Qi and stimulate the Yang, they may overstimulate the blood and make bleeding heavier in a severe bleeding condition when Qi is unable to hold the blood. They should therefore be used with caution and their dosages should be gradually increased after the bleeding stops or slows down.
6. Prevent blood stagnation:
Stopping bleeding suddenly may cause blood stagnation because most of the herbs that stop bleeding are sour, astringent and cold. As soon as the bleeding stops, herbs that treat or prevent congealed blood should be used.
Structure of the formula and selection of herbs
Chief: Directly stop bleeding by using sour, astringent and charred herbs; tonify Qi to hold the blood; stop bleeding by treating the cause and symptoms together
Bai Ji ( Bletillae tuber)**, Ou Jie ( Nelumbinis nodus rhizomatis), Zong Lü ( Stipulae trachycarpi fibra) and Hua Rui Shi ( Ophicalcitum)
Since sour and astringent substances have an inward moving tendency, these substances can stop bleeding. They treat the symptom of bleeding rather than the cause and are often used in different bleeding conditions as a first aid procedure.
Zao Xin Tu ( Terra flava usta) and Long Gu ( Mastodi fossilium ossis)
These astringent substances can directly reverse the abnormal leakage of blood. They treat the symptom of bleeding rather than the cause and they are used as a first aid procedure.
Partially charred herbs
In traditional Chinese medicine, it is believed that partially charred herbs can directly and effectively stop bleeding. After being charred, herbs gain astringent properties that can help stabilize blood and stop bleeding. In clinical practice, many herbs are partially charred for this purpose. Commonly used partially charred herbs are Da Jì ( Cirsii japonici herba seu radix), Xiao Ji ( Cirsii herba), Pu Huang ( Typhae pollen), Ou Jie ( Nelumbinis nodus rhizomatis), Zong Lü ( Stipulae trachycarpi fibra) and Xue Yu Tan ( Crinis carbonisatus).
Ren Shen ( Ginseng radix)
In a very severe bleeding condition, if it is impossible to reach a hospital in time, or the speed of blood loss is faster than that of the blood transfusion, a large dose of Ren Shen should be applied together with herbs that stop bleeding. It can hold the Source-Qi in order to hold the blood.
Da Jì ( Cirsii japonici herba seu radix) and Xiao Ji ( Cirsii herba)
These herbs can treat bleeding caused by heat. Da Jì and Xiao Ji are sweet and cold, and enter the Liver and Heart meridians. The fresh or raw herbs are able to cool blood and stop bleeding.
Da Jì is colder than Xiao Ji and has a stronger action in reducing heat, cooling blood and stopping bleeding. It is used for bleeding caused by heat, such as in pulmonary tuberculosis, gastric ulcer, menorrhagia or diseases of the liver.
Xiao Ji is not as cold, and its function of cooling blood and stopping bleeding is not as strong as that of Da Jì. It is particularly effective in reducing heat in the Lower-Jiao and in treating bleeding caused by damp-heat in the Lower-Jiao, such as in acute urinary tract infection, cystitis and pyelonephritis.
If they are charred, these herbs gain astringent properties, and can stabilize blood and stop bleeding. In clinical practice, they are often used together to enhance their actions of stopping bleeding.
Xiao Ji ( Cirsii herba) and Bai Mao Gen ( Imperatae rhizoma)
Xiao Ji and Bai Mao Gen are sweet and cold. Both can cool blood and stop bleeding. They can also promote urination and eliminate damp-heat from the Lower-Jiao. They are especially effective in treating blood in the urine caused by damp-heat, which injures the blood vessels and disturbs the local blood circulation in the Lower-Jiao.
Xiao Ji enters the Heart and Liver meridians. Besides cooling the blood and stopping the bleeding, it can also promote urination and reduce edema. Bai Mao Gen enters the Lung and Stomach meridians. Compared with Xiao Ji, it has a weaker function of cooling the blood and stopping the bleeding in the Lower-Jiao. The characteristic of Bai Mao Gen is that it not only stops bleeding in the Lower-Jiao, but also in the Upper-Jiao, such as nose bleeds and coughing blood. It also generates body fluids and relieves thirst. It is more suitable for situations where patients suffer from thirst, dry mouth and nose, and, at the same time, have blood in the urine, such as in acute urinary tract infection, nephritis and after a febrile disease.
Huai Hua ( Sophorae flos), Huai Jiao ( Sophorae fructus) and Di Yu ( Sanguisorbae radix)
These three herbs are bitter and cold, and their moving tendency in the body is downward. They enter the Liver and Large Intestine meridians. They are effective for clearing heat in the Lower-Jiao, cooling blood and stopping bleeding, and are used in the treatment of colitis, dysentery and hemorrhoids. In clinical practice, they are often used together to increase this therapeutic effect.
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