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Most times when there is bleeding, the first thing that comes to mind is to stop the bleeding.

Yes, Chinese medicine has herbs that function to stop bleeding, but it also take certain other factors into consideration. One of the most important questions is “Why is there bleeding?” There are three main reasons:

1. Blood is hot and runs amok (Replete Fire)
2. Yin gradually deficient and results in deficient fire (Deficient Fire)
3. Spleen Qi is weak and unable to keep blood in the vessels. (Deficient Qi)

In the first instance, the treatment principle would be to clear the fire. In the other do, it would be to tonify the relevant deficiencies.

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Below is my outline of treatment methods for different types of bleeding:

1. 紫斑

This is a classic case. Blood shows on the skin as blots of purple-green. It may most probably be due to a reduction in platelet activity, but chinese medicine has its own way of seeing it. The issue here is: how do we solve this using chinese herbs?

We’ll use the three reasons outlined above to treat the problem.

1. For hot blood run amok, the treatment principle is to “clear heat, cool blood and stop the blood.” 十灰散 is used here. What’s prominent here is that blood effuses in large quantity, from all the possible orifices.
2. For cases of yin-deficient fire, the treatment principle is of course to stop the blood, but the focus is also on nurturing yin. 茜根散 and 六味地黄丸 are used here. Note that part of the treatment include tonification.
3. For cases of qi-deficient vessel leakage, the treatment principle is tonification in its entirety. 归脾汤 is used. But once again, herbs that stop blood is added, you can’t run away from that.

Next is blood coming out of the lower two orifices.

2. 便血

The root of the problem is seen as either:

1. damp-heat in the intestines causing hot blood: use 地榆散 and 槐角丸.
   • The former is basically 地榆 and 茜草 to stop the blood; 栀芩连 to clear intestinal heat; and 茯苓 to clear the damp.
   • The latter is adds on blood and qi herbs (当归、炒枳壳、防风). The rest are similar, i.e. 槐角、地榆 to stop blood, and 黄芩 to clear intestinal heat.
2. Inability to rein in the blood in the intestines:
   1. 脾气虚: use 归脾汤
   2. 脾阳虚: use 黄土汤

Note: There is no 阴虚火旺 case here.

3. 尿血

The root of the problem is seen as either:

1. Damp-heat in the lower jiao (bladder mainly) causing hot blood: use 小蓟饮子.
2. Inability to rein in the blood in the urine:
   1. 脾气虚: use 归脾汤
   2. 肾气虚: use 无比山药丸
3. Yin-deficient fire: Use 知柏地黄丸

Note: once again, you see how important tonification is even in the case of bleeding. Many times, it’s the lack that is causing bleeding.

Next, let’s look at vomiting vs. coughing blood. There must be some kind of injury in the stomach (in the case of vomiting blood) and the lungs (in the cases of coughing blood).

4. 吐血

Something wrong in the gastrointestinal tract.

1. The first method is just to cool the upper gastrointestinal tract while stopping blood.
   1. For plain vanilla type stomach heat: Use 泻心汤 (to clear gastro heat) plus 十灰散 (to stop blood)
   2. For stomach heat with liver manifestations: Use 龙胆泻肝汤 plus herbs that stop blood.
2. The second method is to tonify while stopping blood:
   • Use 归脾汤 (to build blood and qi) plus other herbs that stop blood. For more severe cases of deficiency, 独参汤 is recommended.

5. 咳血

Something bleeding in the lungs. How to deal with it? In all the cases, there’s heat in the lungs and we have to get rid of it. We use different formula combinations depending on what we see as cause for the heat.

1. For heat due to external pathogenic factors, which manifest as dryness and loss of moisture, use 桑杏汤. I see this formula as a simple way of relieving heat; perhaps relief from heat will reduce the inflammation that I assume exists.
2. For heat related to liver fire, which is very much tied to a person’s personality and constitutional type, use 泻白散 for clearing lung heat and 黛蛤散 to clear liver fire and get rid of phlegm.
3. For heat due to weak kidney yin, we see once again a condition tied to a person’s personality and constitutional type. This person produces very little phlegm, and manifests yin-deficient symptoms. The interesting thing here is that 六味地黄丸 is not thrown in as the standard solution. Instead 百合固金汤 is used to treat the yin-deficient symptoms.

6. 鼻血

Bleeding from can come from hot blood, yin-deficiency and/or spleen qi deficiency.

For hot blood, there are three possible causes, and i think it depends very much on your body’s constitution:

1. lung fire and dryness: use 桑菊饮
2. stomach fire: use 玉女煎
3. liver fire: use 龙胆泻肝汤

For spleen deficiency: use 归脾汤

For kidney yin deficiency: use 知柏地黄丸
7. 齿血

The classic approach would present two categories of gum bleeding.

1. The first is the plain-vanilla type, where heat in the stomach is to be cleared: 清胃散 is recommended. If you notice, the bulk of the herbs have a cooling effect on the blood (生地、牡丹皮、当归全). It’s only 黄连 here that works to clear stomach heat.
   • Of course, we get smarter with time. 写心汤 is added on to 清胃散. This helps to clear the heat and kill the bad guys.
2. The second is the deficiency type, where kidney yin has to be strengthened too: 玉女煎 is recommended. In the original formula, 熟地黄 is recommended and together with 麦冬，they help to build kidney yin. From the herbs used to clear heat (石膏、知母), we also see a case of strong fire.
   • The contemporary solution is more focused on nurturing kidney yin. So, as with yin-deficient type bloody skin problems (see above), we use 茜根散 and 六味地黄丸 to pump up on the kidney yin.