Vomiting Blood Whenever Heat Rises? Doctor Zhang Xichun’s Case of Liver Qi Rampaging Against the Stomach

Search terms this page answers: vomiting blood / throwing up blood / stomach bleeding / coughing up blood when I feel hot inside / vomiting blood every day / vomiting blood for over a year that won’t heal / vomiting blood after getting angry / stomach trouble from bad mood

Medical terms: vomiting blood (upper gastrointestinal bleeding) · liver qi rampage and liver fire invading the stomach · stomach qi rebelling upward · blood disorders (xue zheng)

Opening: a 35-year-old businessman, vomiting blood for a year

In the old medical books, vomiting blood (tu xue) was a major chapter — if you wrote a complete medical compendium and left vomiting blood out, the book simply wasn’t complete.

💬 Note from Doctor Luo: Vomiting blood is basically stomach bleeding or esophageal bleeding — modern medicine calls it upper gastrointestinal bleeding. Today we can do an endoscopy and stop the bleeding under direct vision, and while that works, there are still tricky cases, so this has always been a rather dangerous condition.

Today’s patient is Zhang Huanqing, only 35 years old, living in Sanyizhuang, Special District No. 1, Tianjin, and also a merchant. His vomiting blood had already gone on for a year without healing.

The cause: a narrow, impatient temperament, plus a mind worn down by worry

When Doctor Zhang Xichun wrote up the cause of this illness, his very first line was “narrow and hasty by nature” (bing xing bian ji). The word “bian” (褊) has the clothing radical — it originally meant clothing cut too tight — and he used it to describe someone a little small-minded and quick-tempered.

💬 Note from Doctor Luo: Doctor Zhang Xichun didn’t mince words — he wrote the patient’s character flaws right at the top, and this was surely what the patient told him himself: “I’m a bit small-minded; when something happens I can’t let it go, and I get angry easily.” He treated that temperament as a major cause of the disease.

A hasty temper alone wasn’t enough. The man was a merchant — every day he was plotting how to make money, how to source his goods; his mind was overtaxed (lao xin) — and overtaxing the mind does two things: it drains heart blood, and it easily leaves the liver qi constrained. Mental strain was the foundation of the illness, and then he ran into unpleasant affairs (fu yi zhi shi) — things that went against his wishes. That became the final trigger, and the disease erupted.

The illness: when heat surged upward, out came one or two mouthfuls of blood

When it first started, he vomited a great deal of blood, continuously. Later he consulted quite a few doctors and the amount gradually decreased — sounds like improvement, doesn’t it? In fact the root was never removed: he still vomited blood once or twice every single day. Whenever he felt heat in his chest, the heat surged upward and he spat out one or two mouthfuls of blood.

💬 Note from Doctor Luo: One or two mouthfuls doesn’t sound like much — but try it every single day, for a whole year. The longer the illness ran, the thinner he became, until finally he was bedridden; when someone helped him sit up for a while, he panted slightly. Fortunately his appetite stayed fair and he could still eat — that’s what carried him through to this point. His stools were also loose, two or three times a day — all of these are signs of insufficient upright qi.

The secret in the pulse: a taut string on the left, an “empty pot” on the right

Doctor Zhang Xichun took his pulse: left position wiry and long, weak under pressure; right position large and hollow (kou).

• A wiry (xian) pulse is the liver pulse — people with constrained liver qi often have a pulse like a taut zither string;
• Weak under pressure means upright qi is insufficient;
• A hollow (kou) pulse is the pulse of heavy blood loss — pressing it feels empty, like pressing down on an empty pot.

💬 Note from Doctor Luo: Here’s a real pulse-reading lesson: the left guan position corresponds to the liver, and the right guan position corresponds to the spleen and stomach. When a person’s liver qi is constrained and rampaging across to subdue the spleen-earth, the left guan pulse turns wiry, like a string; and the right guan — the spleen and stomach position — becomes unusually large and raised, even bulging upward — that is liver fire surging upward, forcing stomach qi to rebel upward. When you take a pulse, you must feel both hands’ guan positions.

What did Doctor Zhang Xichun think? Liver qi rampage — it knocked a hole in the stomach wall

Doctor Zhang Xichun’s judgment was clear: this patient had liver qi rampage — liver qi surging upward, forcing stomach qi to fail to descend — and in the end the stomach wall broke open and bled. Because the causative factor never left, no matter how hard the body tried to recover, it couldn’t; the bleeding spot simply never healed.

The deepest root of it all: emotional distress had damaged the spleen and stomach.

💬 Note from Doctor Luo: As we see it today, most stomach diseases are tied to emotional distress. In modern terms, the digestive system contains hundreds of millions of neurons that can sense emotion — your gloom, your anger, your anxiety all show up in your digestive tract. The ancients summed up this entire physiological mechanism in one phrase — “liver qi rampage attacking the spleen-earth” — and that is remarkable wisdom. Unfortunately, gastroenterology today has separated emotion from the stomach; there is no “regulate the emotions to treat digestive disease” approach, and that missing link still hasn’t been restored. It’s a genuine loss.

Prescription (part one): why not raw hematite — and who is this chi shi zhi?

By Doctor Zhang Xichun’s usual habit, when stomach qi rebels upward and the qi mechanism runs upward, he would commonly use sheng zhe shi (raw hematite) to press it downward. But this time he did not — because this patient’s stools were already loose, several times a day; using raw hematite to push downward with force would only make the stools looser still.

Instead he chose another herb: chi shi zhi (red halloysite), one and a half liang.

💬 Note from Doctor Luo: Chi shi zhi is a mineral — a kind of kaolin clay. It is warm and gentle, and it astringes and secures — when pathogenic qi is not fierce, upright qi has declined, and there is long-term draining diarrhea, you use it to bind the intestines. Zhang Zhongjing already used it in several formulas in the Treatise on Cold Damage and Miscellaneous Diseases (such as Peach Blossom Decoction, tao hua tang) — so this herb entered the pharmacopeia very early. The montmorillonite powder (Smecta) hospitals give children for diarrhea today is also a kaolin clay, extremely close to chi shi zhi — but remember: only use it when pathogenic qi is not fierce. If dysentery or damp-heat in the intestines is at its height and you stop the diarrhea with it, you will trap the pathogen inside the body.

Doctor Zhang Xichun’s insight was this: chi shi zhi only works when used in large doses — then it can force stomach qi to descend, while its astringent power binds the stools. And there is more — when an external wound has an ulcer that keeps oozing, chi shi zhi applied topically makes the wound surface close up. He reasoned: your stomach keeps bleeding, so there must be ulcerated places inside; chi shi zhi can astringe and promote tissue regeneration, helping the broken places heal sooner. One herb, many jobs — even more suitable here than raw hematite.

Prescription (part two): astringing on one side, soothing on the other

• Sheng huai shan yao (dried Chinese yam), one liang: tonifies the spleen and stomach and supports upright qi — a man too weak to sit up without panting cannot recover unless upright qi is restored;
• Shan yu rou (cornus fruit): one of Doctor Zhang Xichun’s most trusted herbs. It has great power to secure primordial qi (yuan qi) — whenever he faced qi on the verge of collapse, he reached for shan yu rou. It is sour and astringent — and vomiting blood is a loss of qi and blood, precisely what needs astringing. At the same time it tonifies the liver channel and liver yin, and within its astringency it carries a quality of smooth regulation — it can tonify the liver and soothe it, and when liver deficiency has produced stagnant qi and blood with pain, it excels at opening that up — tonifying and freeing at once;
• Bai shao (white peony): softens and constrains the liver; paired with shan yu rou, it tonifies on one side and soothes on the other. Once the liver is pacified, it no longer rampages and bursts — and only then can the spleen and stomach rest easy;
• Sheng long gu (raw dragon bone) and sheng mu li (raw oyster shell), six qian each: astringe liver qi and the qi mechanism, settle and press downward, and keep liver fire from surging up;
• Sheng di huang (fresh rehmannia): nourishes yin and clears deficient heat — every time he vomited blood he felt a surge of heat rising; that heat was very likely deficient heat born of insufficient liver yin;
• Gan cao (licorice), two qian: harmonizes the formula.

💬 Note from Doctor Luo: Look at how Doctor Zhang Xichun prescribes — it is exquisitely precise. In his own words, every herb is like a general — he knows exactly which general to send out, for which battle, at which moment. To treat stomach bleeding he has the herb that astringes and stops bleeding, the herb that supports upright qi, the herb that softens the liver, the herb that settles and presses down, the herb that nourishes yin — each at its own post.

The finishing touch: Guang san qi powder, taken in the strained decoction

Once the decoction was ready, the patient also took Guang san qi powder, two qian (6 grams — divided into two doses, 3 grams each), sent down with the medicine.

💬 Note from Doctor Luo: The most miraculous thing about san qi (notoginseng) is its two-way regulation — when there is blood stasis it invigorates circulation and dissolves stasis; when there is bleeding it stops the bleeding. Doctor Zhang Xichun was extraordinarily skilled with san qi and understood it deeply; much of what we say about san qi today traces back to him. Doctor Luo has been promoting san qi for about ten years now, and in that decade it has become widely known and used.

One question naturally arises: in Doctor Zhang Xichun’s book it is always written Guang san qi — why “Guang”? The producing area of san qi used to be the border region of Yunnan and Guangxi — in Guangxi there was a place called Tianzhou, and the san qi grown there was called “tian qi” — “the qi of Tianzhou.” In Doctor Zhang Xichun’s day Guangxi produced san qi, so everyone used Guang san qi. Later, Yunnan’s cultivation grew and Guangxi’s gradually declined; with the rise of Yunnan Baiyao and other products, nearly all san qi today comes from Yunnan — Yunnan san qi works perfectly well.

💬 Note from Doctor Luo: Yunnan san qi genuinely has excellent effects. Doctor Luo once visited the san qi producing areas in Wenshan, Yunnan, in person, and formed deep friendships with the growers there — san qi truly is a fine thing. The migration from Guang san qi to Yunnan san qi is itself a small piece of the history of Chinese materia medica.

Five doses, and a year of vomiting blood came to a stop

How did the medicine work? After two doses, the bleeding stopped. The wheezing leveled (he had panted the moment he sat up); the stools were no longer so frequent; the pulse was calmer than before. Only a lingering sensation of heat in the chest remained.

Doctor Zhang Xichun adjusted the formula: sheng di huang raised to one liang (30 g — a generous dose, for nourishing yin), and one liang of shu di huang (cooked rehmannia) added — shu di huang tonifies kidney essence; paired with sheng di huang it nourishes yin and blood. When kidney essence is full and fluids are nourished, the heat of yin deficiency naturally eases. With both kidney essence and liver channel tonified, the foundation was secure and the yin-deficiency heat was relieved.

After three more doses, every complaint was cured.

💬 Note from Doctor Luo: Look at that — a whole year of vomiting blood, and with Doctor Zhang Xichun it took five doses altogether, and it was completely healed. That is what it means to meet a great physician — every herb precisely matched, the effect immediate. We should earnestly study scholarship like Doctor Zhang Xichun’s. And for ordinary people, at minimum we should know this: the root of stomach bleeding is often tied to emotional disharmony — regulating your emotions is protecting your stomach.

Doctor Luo’s closing note: even America’s top hospitals are studying Chinese medicine

Speaking of the link between emotion and disease, Doctor Luo once told a true story: at the Mayo Clinic — one of America’s top-ranked hospitals — there is a Doctor He Jian, a Chinese man and a close friend of Doctor Luo’s. When he came back to China he said: the Mayo Clinic gathers the top achievers of American Western medicine — and he discovered all of them were studying Chinese medicine — the moment they saw him, a Chinese man, they happily started discussing TCM with him.

💬 Note from Doctor Luo: Those authorities said: the ideas of Chinese medicine are exceptionally advanced — the human body moves with time; the four seasons are each different, and even the timing of taking medicine matters. They said: “We learn these concepts from Chinese medicine, fill them with Western medical knowledge, and build a more advanced medicine — that is the future direction of medicine.” Doctor He told Doctor Luo: “Doctor Luo, Chinese medicine is currently leading the development of medicine worldwide.” You see — the theoretical system our ancestors built is in fact remarkably complete. For a disease like vomiting blood, the ancients immediately considered constrained liver qi and emotional distress. That is the wisdom of Chinese medicine — and it is the lesson we most need to restore today.

Adapted from Doctor Luo Dalun’s explanation of Doctor Zhang Xichun’s case records. Source: Records of Chinese Medicine with Western Reference (《医学衷中参西录》), published in installments 1918–1934.