Vomiting Half a Bowl of Blood and Collapsing? Doctor Zhang Xichun’s Five-Herb Rescue When Yin and Yang Are on the Verge of Separation
Patient search terms: vomiting large mouthfuls of blood / coughing blood, blood in the phlegm / half a bowl of blood at a time / collapsing after vomiting blood / face hot and cheekbones flushed / racing pulse with no root Medical terms: vomiting blood (tu xue) · extreme liver-kidney deficiency · yin and yang on the verge of separation (bleeding tendency) · blood disorders (xue zheng)
The opening: blood vomiting until she collapsed — one hope left for the family
One spring, a thirty-year-old young wife began to vomit blood. It started as a cough with streaks of blood in the phlegm — then it turned into large mouthfuls of blood, two or three times a day and night, sometimes half a bowl at a single gush. After two days, she could no longer hold on: her spirit and strength were spent, her mind began to drift, and she told her family her heart felt “shaky, as if about to fall at any moment.” By the time Doctor Zhang Xichun was summoned, her cheekbones were flushed red, her face burning hot — it was plain to everyone that she was slipping away.
💬 Note from Doctor Luo: This patient was Doctor Zhang Xichun’s niece by clan (tang zhi nü), married into the Wang family of the neighboring village. Her husband was a xiaolian — a provincial graduate, roughly the rank of a ju ren — who taught at a private school away from home for a year at a time. The household was entirely on her shoulders: managing the family, wearing herself out with worry. On top of that she had a naturally frail constitution and had never been robust. Overwork of the heart plus an inherently weak body — that was the soil in which the illness grew. When the yang energy of spring began to rise (in spring, yang qi ascends), the blood rose with it, riding upward, and came out as vomiting blood.
The pulse: no root in the lower positions — a sentence that made knees go weak
Doctor Zhang Xichun placed his fingers on her wrist: the left pulse was floating and stirring (fu er dong), the right pulse floating and soft (fu er ru) — both had floated up to the surface; press down on the two chi positions (the lower positions, which govern the kidneys and ming men) and there was no root at all. The rate was more than five beats per breath. His diagnosis: extreme deficiency of the liver and kidney (gan shen xu ji).
💬 Note from Doctor Luo: The two chi positions govern the kidney and the ming men (the gate of life). Press down and find no root — the kidney is exhausted to the extreme. When kidney water is this deficient, it can no longer unite with yang; the yin and yang aspects can no longer hold each other, and they are about to separate. In health, yin and yang embrace each other; now yin can no longer hold yang, and the yang drifts upward — which is why the face turns red and burns. This kind of bleeding is actually the sign of yang qi fleeing upward (yang dong). At this point, whether the blood comes from the lungs or from the stomach no longer matters; delay even a little longer and the person’s life is in danger — Doctor Zhang Xichun put it as “danger within an instant” (wei zai qing ke).
The prescription: unlike any hemostatic formula — just five herbs
Most doctors treating vomiting blood reach for herbs that soothe the liver, supplement the spleen, and astringe to stop the bleeding, and the formula tends to be complicated. Doctor Zhang Xichun’s formula this time was so simple it made people doubt it — yet the doses were shockingly heavy: five herbs, each at one liang (about 30 g):
Raw Huai yam (sheng huai shan yao) one liang, raw Huai rehmannia (sheng huai di huang) one liang, prepared Huai rehmannia (shu huai di huang) one liang, cornus fruit (shan yu rou) one liang, raw hematite (sheng zhe shi) one liang.
💬 Note from Doctor Luo: Why this composition? Doctor Zhang Xichun’s reasoning was that this illness had gone far beyond ordinary weakness. If the medicine missed the mark by even a little — if it was the slightest bit off-target — the patient would soon be gone. So he went straight for the core: first supplement the essence with herbs that build the root, then steer the force toward nourishing yin, and finally use hematite to press the qi downward so it cannot float up. The herbs were decocted over a fast fire into two small bowls and taken warm in two portions.
Before the medicine even reached her lips: another gush of blood, then sudden silence
Just as the decoction was finished — before she had drunk a drop — the patient vomited blood again. And then, after vomiting, her eyes suddenly closed and her breathing stopped. It was as if she had ceased to breathe at all; she was entirely unaware, completely unconscious, hovering at the edge of collapse. The family’s hearts nearly stopped with fright.
Doctor Zhang Xichun felt her pulse: it was still beating. He was certain she would wake. Sure enough, after four or five minutes her breathing gradually resumed.
💬 Note from Doctor Luo: This is the composure of a physician who has seen critical cases many times. The pulse is still there — then life is still there. At this point the prepared medicine was given in two portions — and from that moment on, she never vomited blood again. Doctor Zhang Xichun had the original formula repeated for one more dose; from the third dose, he added Lu dang shen (codonopsis, 3 qian, about 9 g) to supplement the qi and tian dong (asparagus root, 4 qian, about 12 g) to nourish yin and generate fluids. Codonopsis paired with asparagus root — supplementing qi and nourishing yin together — is in fact the same thinking as Sheng Mai San (Pulse-Generating Powder), just without the ophiopogon. After a few more doses, her body gradually returned to its former state.
Aftercare: a bowl of yam paste with a pinch of hematite powder
The medicine stopped, but the restoration was not finished. Doctor Zhang Xichun instructed: grind raw Huai yam into fine powder, take 8 qian (about 24 g) each time, cook it into a smooth, porridge-like tea, add a little sugar, and each day take this bowl of yam paste together with 5 fen of raw hematite powder (a little over one gram, about 1.5 g) — taken as a nourishing snack to complete the recovery.
💬 Note from Doctor Luo: The yam paste nourishes the spleen and stomach; the hematite powder presses down rebellious qi. One supplements, one descends — the foundation is slowly rebuilt. An illness this grave, resolved by a few doses of medicine and a bowl of paste — Doctor Zhang Xichun was truly remarkable. The most brilliant stroke in this case is the accuracy of the diagnosis: at this moment, is stopping the bleeding more important, or saving the life? It is extremely easy to misjudge — with that much blood lost, everyone’s first instinct is to stop the bleeding. But Doctor Zhang Xichun seized on “upright qi deficiency” as the root: if there is no strength to restrain, the yang floats up, and the blood cannot be held; fill the upright qi, fill the yin, the yang is contained, and the blood stops of its own accord. That is the eye of a master — in ordinary cases he soothes the liver, supplements the spleen, and astringes to stop bleeding, but at the critical moment he instantly changes approach and supports the upright, adapting to circumstances on the spot.
Three of the five herbs hide the ancestor of a famous formula
Among those five herbs are three old friends: Huai yam (shan yao), prepared rehmannia (shu di huang), and cornus (shan yu rou). Doctor Luo points out that these three appear constantly in Doctor Zhang Xichun’s case records — they were the core of his method for treating deficiency-wasting diseases. In his later years, whenever he treated a person worn down by deficiency, he led with these three as the main force, and the doses were never small — Huai yam was never less than one liang.
💬 Note from Doctor Luo: The prototype of these three herbs comes from Zhang Zhongjing’s Jin Gui Shen Qi Wan (Kidney Qi Pill from the Essentials from the Golden Cabinet — also called the Eight-Ingredient Pill): its principal tonics are prepared rehmannia with Huai yam and cornus, joined by a few draining herbs and a small amount of cinnamon and prepared aconite — a formula that warms yang, moves water, and circulates the qi. In the Song dynasty, the great pediatrician Qian Yi removed the cinnamon and aconite; what remained, six herbs, became the Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill). So even in the Six-Ingredient Pill, the core tonic is still prepared rehmannia. The ancients said it plainly: these herbs supplement the essence of the five viscera — and that formulation is exactly right! Many people assume they are merely yin-nourishing herbs, but it cannot be reduced to that.
Separating “essence” from “yin” makes the prescription precise
Doctor Luo takes the point deeper. Yin-nourishing herbs are things like raw rehmannia (sheng di), glehnia (sha shen), ophiopogon (mai dong), Solomon’s seal (yu zhu), and dendrobium (shi hu) — cool and moistening in nature, working to nourish the body’s fluids. But yin also includes the blood of the meridians, the fluids — and if you want to treat precisely, you must look at essence (jing) on its own. Essence is the fundamental substance from which yin and yang are generated: the congenital essence inherited from one’s parents, combined with acquired essence, sealed and stored in the kidneys and the five viscera. It is the source substance of life itself, and it transforms into yin and yang.
💬 Note from Doctor Luo: With essence-supplementing herbs, if you add herbs that warm yang, the power of essence to generate qi increases; if you add yin-nourishing herbs, the yin-nourishing effect increases — it all depends on which direction you steer the medicine. Why are the Kidney Qi Pill and the Six-Ingredient Rehmannia Pill so classic? Because they grasp hold of the concept of “essence.” Applied to these three herbs: prepared rehmannia supplements the essence of the liver and kidney (mainly the kidney), cornus supplements the essence of the heart, liver, and kidney, and Huai yam supplements the essence of the lung, spleen, and kidney — three herbs that together replenish the essence of all five viscera. That is why the ancients said the Six-Ingredient Pill is a formula that supplements the essence of the five viscera — the description is remarkably precise.
Doctor Zhang Xichun deliberately wrote “raw Huai yam” and “prepared Huai rehmannia” in the formula because he set great store by geo-authentic (daodi) herbs. “Huai” refers to the ancient Huaiqing Prefecture — today’s Wen County area of Jiaozuo, Henan, where the dark, lumpy “lu” soil produces both yam and rehmannia, along with achyranthes (niu xi) and chrysanthemum (ju hua), together known as the “Four Great Huai Herbs” (Huai yam, Huai rehmannia, Huai achyranthes, Huai chrysanthemum). These three essence-supplementing herbs form the base, and the addition of raw Huai rehmannia (sheng di) — which nourishes yin and cools the blood — steers the essence-supplementing force in the direction of nourishing yin, so that the yin-nourishing effect emerges.
💬 Note from Doctor Luo: In this situation, if a doctor followed the generic line — “the patient has yin deficiency” — and prescribed glehnia, ophiopogon, Solomon’s seal, dendrobium — it would not have worked. Why? The illness is critical, yin and yang are about to separate; the medicine must strike directly at the core, using herbs that supplement essence, that build the root. If it is even slightly off-target, the patient is lost. This “correct treatment” (zheng zhi) that shows deep command of both medicine and materia medica is what masters do. Doctor Zhang Xichun learned this from the two great formulas, Kidney Qi Pill and Six-Ingredient Rehmannia Pill, and in his later years treated deficiency by leading with these three herbs — a line of thinking he inherited from Zhang Zhongjing.
Saying it plainly: the finer the split between essence and yin, the more accurate the dose
Doctor Luo added a few final words of counsel: many TCM practitioners today say that cornus nourishes yin, prepared rehmannia nourishes yin, Huai yam nourishes yin — but he urges everyone to try, as far as possible, to keep “essence” (jing) and “yin” separate. Essence is the fundamental substance from which yin and yang are born; to fold it into the category of yin does it something of an injustice. Once separated, the logic is clear: essence-supplementing herbs paired with yang-warming herbs help essence generate qi; paired with yin-nourishing herbs they strengthen the yin-nourishing effect. The direction is unambiguous — the finer the distinction, the more precise the prescription.
💬 Note from Doctor Luo: Doctor Luo notes that this is his personal way of thinking, and he welcomes discussion with fellow practitioners of Chinese medicine. Reading Doctor Zhang Xichun’s cases, he often finds himself striking the table in admiration — why has no one since Zhang Xichun matched his level? Because the gap in skill is too wide. To be able, as he was, to change approach in an instant at the critical moment, to diagnose accurately, and to adapt flexibly — that is the true eye of a master. One can only hope that today’s practitioners, when they meet difficult, miscellaneous, or critical cases, can summon this same ability. It is worth learning from.
Based on Doctor Luo Dalun’s narration of Doctor Zhang Xichun’s case records, from Yi Xue Zhong Zhong Can Xi Lu (Records of Integrating Chinese and Western Medicine).