Vomiting Blood the Moment He Got Tired, the Blood Scattered and Thin? Doctor Xue Lizhai’s Approach
Patient search terms: sudden vomiting of blood / vomiting blood when exhausted / vomiting blood after overwork / blood that comes out scattered / blood mixed with phlegm / very heavy periods / periods so heavy they cause anemia
Medical terms: hematemesis (upper gastrointestinal bleeding) · spleen failing to control blood · qi failing to hold blood · spleen-lung qi deficiency · blood disorders
Opening scene: in the middle of a fortune-telling, the man suddenly ran out and vomited blood
Today’s story takes place on a summer day in the Ming dynasty — the records say it was the year xinchou — at the home of a certain official surnamed Tu in Jiaxing, Zhejiang. There was a gathering going on.
💬 Note from Doctor Luo: Ancient gatherings were quite interesting. Besides eating and chatting, people often invited someone to read the stars and fortunes. That day they had invited a star reader (xing shi) — a master who read the heavens and talked about fate. His name was Zhang, given name Songgu.
Everyone was gathered around him listening to his reading of their fortunes, when suddenly — in the middle of his discourse — this Mr. Zhang stood up, walked out into the courtyard, and vomited up two mouthfuls of blood.
The whole room was terrified.
Who was the patient? Fortune-teller Zhang, with an old complaint that flared up whenever he got tired
Everyone rushed over to ask what was wrong. Mr. Zhang, however, was perfectly calm. He waved his hand and said: No problem, no problem — this is an old illness. It always happens.
💬 Note from Doctor Luo: He explained: “This condition of mine flares up whenever I’m exhausted (yu lao ji zuo). As soon as I overwork myself or push too hard, I vomit one or two mouthfuls of blood and then it passes.” But the guests were still shaken: a man sits there perfectly fine telling fortunes, then suddenly spits up blood — who wouldn’t be alarmed? As luck would have it, Doctor Xue Lizhai was at the gathering too — a physician who had once served as director of the Imperial Medical Academy, and who now practiced among the people after retiring. Everyone urged him to take a look at Mr. Zhang.
Doctor Xue Lizhai asked a question that surprised everyone. He didn’t rush to feel the pulse. Instead he asked: “What did the blood you vomited look like?”
The key question: was the blood in clots, or scattered?
Doctor Xue Lizhai analyzed: this is the lung qi injured by overwork. You think too much, read too much, worry too much — and you overwork yourself — and that injures the lung qi. Once the lung qi is injured, what happens to the blood?
💬 Note from Doctor Luo: Doctor Xue Lizhai shared an important piece of experience in reading blood: in acute, urgent bleeding, the blood forms clots — when a person is struck by an acute illness and bleeds suddenly, the blood congeals into lumps. But with chronic deficiency — when the lung qi has been damaged — the blood that comes out is scattered, because it is mixed with saliva and the body’s fluids and cannot congeal. So he asked Mr. Zhang to bring him the vomited blood for inspection — and sure enough, it was not in lumps at all; it was loose, mixed with phlegm.
This single test completely won Mr. Zhang over: “You can even tell me what my vomited blood looks like without seeing it? Then please, treat me!”
The prescription: Buzhong Yiqi Tang as the base, plus six “side dishes”
The formula Doctor Xue Lizhai wrote had Buzhong Yiqi Tang (Supplement the Middle and Boost Qi Decoction) as its main body — the classic formula that supplements the qi of the spleen and stomach and lifts the qi upward. Then he added several herbs: mai dong (ophiopogon), wu wei zi (schisandra), shan yao (Chinese yam), shu di huang (prepared rehmannia), fu shen (poria with hostwood), and yuan zhi (polygala).
💬 Note from Doctor Luo: Each of these additions has its own logic. Mai dong nourishes yin and generates fluids — whenever Doctor Xue Lizhai used Buzhong Yiqi Tang and wanted a little yin-nourishing, he added mai dong. Wu wei zi supplements the lungs and kidneys, astringes the qi of the lungs and kidneys, and also nourishes yin. Shan yao is white in color and enters the lungs, sweet in flavor and enters the spleen, and its slippery juice enters the kidneys — it supplements all three organs at once. Shu di huang greatly supplements the kidney channel. The pairing of shan yao with shu di huang follows the path of Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill).
And what about fu shen and yuan zhi? They settle the spirit and calm the heart qi — herbs specifically for the emotions and for excessive thinking. Mr. Zhang’s illness came from over-thinking; his spirit was scattered, so the spirit had to be anchored and nourished.
💬 Note from Doctor Luo: Notice the structure of this formula: tonifying qi herbs together with fu shen and yuan zhi carries the idea of Gui Pi Wan (Spleen-Restoring Pill); shan yao and shu di huang carry the idea of Liuwei Dihuang Wan. In a word, it is all about supporting the upright qi: supplement the qi of the spleen and stomach fully, lift the middle qi upward, then add a little yin-nourishing, kidney-tonifying, spirit-settling medicine. This is a very complete formula for supporting the body’s foundation.
One dose did it: the next morning, Mr. Zhang came to thank him in person
The medicine worked with astonishing speed — he recovered right away. The next day, Mr. Zhang came to pay his respects to Doctor Xue Lizhai.
💬 Note from Doctor Luo: Mr. Zhang said with great feeling: “I’ve been through an awful lot in my life! Every time this flared up before, I took Si Wu Tang (Four Agents Decoction, a blood-nourishing formula) plus huang lian (coptis) and zhi zi (gardenia) — I reasoned that vomiting blood surely meant heat, so I should clear heat. And what was the result? The more I bled, and the more exhausted I became. But yesterday, with your medicine — just one small spoonful (yi bi) of your powder — the vomiting stopped at once, and my spirits returned to normal! How is that possible?”
What is “yi bi”? Doctor Luo Dalun took a moment to explain.
💬 Note from Doctor Luo: In ancient times, medicines were often ground into powder to save on herbs. To measure out the powder, doctors used a small tool shaped like a dagger (bi); a full scoop of it was called one “bi” — essentially a dosage unit. When Mr. Zhang said “one bi of your medicine stopped the bleeding at once,” he meant that a single small scoop of the powder had done the job.
The principle explained: the spleen controls blood, the lungs govern qi — loosen the rope and the bag flies away
Mr. Zhang asked: “I tried nourishing the blood and clearing heat — neither worked. Why did your formula work at once?”
Only then did Doctor Xue Lizhai explain the principle in full: the spleen controls blood; the lungs govern qi.
💬 Note from Doctor Luo: This is one of the most important concepts in Chinese medicine. When spleen qi is sufficient, it can restrain and hold the blood, keeping it obediently traveling inside the “pipes” of the body — the channels and vessels — and keeping it unified and contained. When spleen qi becomes deficient, the holding power is lost, and the blood begins to leak out and run wild. That is why it is called the spleen controls blood (pi tong xue).
The analogy Doctor Xue Lizhai used — which Doctor Luo Dalun says his own teachers used in medical school, it is so vivid — goes like this:
💬 Note from Doctor Luo: Imagine a rope tied to a bag full of sand. Swing the rope in your hand and the bag spins in a circle around you — the rope is the spleen qi, and it controls the bag. As long as you don’t let go, no matter how the bag spins, it can’t fly away. But once the spleen qi is deficient, your grip loosens, and the bag goes flying off with a whoosh. When the spleen qi is too weak to hold the blood, blood runs everywhere — the cause of a great many bleedings lies right here.
Now for the lungs: the lungs govern qi — each breath controls the body’s qi mechanism and pushes the qi and blood through the channels. When lung qi is insufficient, the qi is weak; and the qi of the spleen and the lungs are bound together. Mr. Zhang read fortunes and studied the stars every day — a life of the mind — and he was too tired, too worn down; overwork injured his spleen and lungs. That is why his blood ran wild and escaped.
💬 Note from Doctor Luo: Here is the crucial point: your condition is deficiency — it has nothing whatsoever to do with heat! That’s why clearing heat with huang lian and zhi zi made it worse and worse. You assumed bleeding always means heat, but there is another kind of bleeding: the deficient kind. Your blood escaped because you are deficient. Use a formula that supplements the qi of the spleen and lungs to hold the blood in place, and the illness naturally resolves.
Ending: the fortune-teller “changed careers” on the spot and begged to become Doctor Xue’s disciple
Mr. Zhang was completely convinced — and he made a decision on the spot: “I’m giving up fortune-telling!” He brought his son along and said to Doctor Xue Lizhai: “What you do — healing people — is far more useful than telling fortunes. Let father and son both become your disciples!”
💬 Note from Doctor Luo: Doctor Xue Lizhai was very modest. He said: “My little knowledge (a tube-peeping view, as he put it) is already published in the world. If you want to learn, just read my books.” And so he sent him off to study his writings. All because of one episode of vomiting blood, this fortune-teller was so won over by Doctor Xue Lizhai’s skill that he “changed careers” on the spot and wanted to study medicine — which tells you how accurate Doctor Xue’s diagnosis was and how fast his medicine worked.
Doctor Luo’s modern reading: very heavy periods are often spleen-lung qi deficiency
The story is over — but what does this case mean for us today? Doctor Luo Dalun reminds us especially: bleeding from spleen-lung qi deficiency is extremely common now — especially in women.
💬 Note from Doctor Luo: In ancient times, coughing and vomiting blood were common. Today people see a doctor early and get treated, so those are rarer. But blood in the urine, blood in the stool, and extremely heavy menstrual periods — these bleedings are very common. The causes vary: heat (pathogenic heat, blazing liver fire), blood stasis, great cold with severe spleen yang deficiency — but one very large category is qi deficiency, specifically spleen-lung qi deficiency.
How heavy can a woman’s period get? Heavy enough to cause anemia: drowsy and exhausted all day, poor memory, palpitations, cold hands and feet — and a menstrual flow so heavy it interferes with work and life.
💬 Note from Doctor Luo: How do you tell whether it’s qi deficiency? Look at the tongue — a swollen tongue with teeth marks on the sides, and a pale tongue body, not a bright red one. When you see that, consider qi deficiency. For those with spleen qi insufficiency in particular, the Gui Pi Wan approach works: nourish heart blood, settle the spirit, supplement spleen qi, and help the body contain the blood. I’ve handled many such cases, and the results are immediate — once the spleen is strong and the source of transformation is replenished, the body feels better at once and the bleeding stops. Many middle-school and college-age girls today think and worry too much, draining their heart and spleen; the spleen and lungs gradually weaken, can no longer hold the blood, and their periods become extremely heavy. This is exactly that category.
In closing: health comes first — don’t exhaust your upright qi away
This case carries one more very plain reminder.
💬 Note from Doctor Luo: I think the fortune-teller was right to change careers — fortune-telling takes a great deal of mental energy; it drains your spirit every single day. In the modern world, there are so many people who, like him, injure their spleen and lungs through overwork. Remember: health is always the number one priority. Don’t push yourself too hard; don’t keep wounding your own upright qi. Medicine can help you for a while — but if you take the medicine and then keep driving yourself at full speed every day, your upright qi will be hurt all over again. Balance of work and rest is the proper way to live and work.
The idea that the spleen controls blood is easy to grasp with the rope-and-sandbag image: the moment the spleen’s grip loosens, blood starts escaping in all directions. This condition really is common in the clinic — read this case carefully, and you’ll have a solid foundation for understanding many otherwise puzzling bleedings.
Adapted from Doctor Luo Dalun’s lecture on the medical cases of Doctor Xue Lizhai. The case is recorded in Records of the Xue Family Medical Cases (《薛氏医案》·《内科摘要》) by Xue Ji (Ming dynasty).