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.
Huai Hua is slightly cold. Its functions of clearing heat and cooling blood are not as strong as that of the other two herbs, but it has a stronger function of stopping bleeding than Huai Jiao. It is an important herb for treating dysentery and hemorrhoids. Since it enters the Liver meridian, and the flower has a tendency to ascend and disperse constrained heat, it can cool the Liver and clear heat in the head at the same time.
Huai Jiao is colder than Huai Hua, and its functions of clearing heat and reducing fire are also stronger. Since it moves downwards, it is very effective for treating hemorrhoids and is often added to creams for topical use. Like Huai Hua, it also has the function of clearing heat in the Liver.
Di Yu is bitter, sour and cold. Not only does it cool the blood and stop bleeding, it also contracts and holds the blood. It treats bleeding in the Lower-Jiao and is used for colitis and menorrhagia. As it is also able to reduce swelling and stop pain, it is suitable for treating external hemorrhoids.
Fresh herbs
Fresh herbs can cool the blood and stop bleeding. As they are considered stronger in cooling blood and clearing heat, they are more effective for treating bleeding conditions than dry herbs. Commonly used fresh herbs are Xiao Ji ( Cirsii herba), Bai Mao Gen ( Imperatae rhizoma), Huai Hua ( Sophorae flos) and Di Yu ( Sanguisorbae radix).
San Qi ( Notoginseng radix)
San Qi is a very effective herb for stopping bleeding due to stagnation of blood. It is sweet, slightly bitter and warm, and enters the Liver and Stomach meridians. Sweetness can slow down the development of a critical situation, warmth can unblock meridians and bitterness can purge congealed blood. San Qi is effective in breaking up congealed blood and harmonizing it. As soon as the congealed blood has disappeared, the blood turns back to its normal pathway and the bleeding will stop. If the blood circulates properly, the swelling is reduced and the pain stops.
Since San Qi can treat bleeding due to blood stagnation, and can stop bleeding without the side effect of causing new blood stagnation, it is widely used in the treatment of trauma, wounds, skin ulcers, carbuncles, epistaxis, hematemesis, uterine bleeding, blood in the urine and intestinal hemorrhage. It can be used internally and topically.
Qian Cao Gen ( Rubiae radix), Sheng Pu Huang ( Typhae pollen), Xue Yu Tan ( Crinis carbonisatus) and Hua Rui Shi ( Ophicalcitum)
These herbs treat bleeding due to stagnation of blood.
All these substances have the function of promoting blood circulation and stopping bleeding. They are particularly used when the bleeding is caused by obstruction of congealed blood, such as in menorrhagia caused by hysteromyoma, and heavy bleeding due to retained placenta after labor.
Ai Ye ( Artemisiae argyi folium), Pao Jiang (quick-fried Zingiberis rhizoma preparatum) and Zao Xin Tu ( Terra flava usta)
These three substances treat bleeding due to internal cold.
Ai Ye is warm and aromatic, and enters the Liver, Spleen and Kidney meridians. It is able to warm the interior, expel cold, stop bleeding and alleviate pain. Its function focuses on the blood level of the Lower-Jiao. It is effective in treating menorrhagia, uterine bleeding during pregnancy, and uterine bleeding due to hysteromyoma when there is cold in the Lower-Jiao and in the blood. This herb can also be used topically.
Ai Ye is also used in moxibustion. It is the substance from which the moxa sticks are made. It can penetrate the skin and meridians, warm the Qi and blood, and expel internal cold.
Pao Jiang is bitter and warm, enters the Spleen and Liver meridians and also enters the blood level. Like Ai Ye, it can warm the interior, stop bleeding and alleviate pain, but its function focuses on the Middle-Jiao. It is especially effective for treating bleeding due to Spleen-Yang and Qi deficiency failing to control the blood. Such bleeding may be located in the stomach, intestines and uterus.
Zao Xi Tu is warm and astringent, and enters the Spleen and Stomach meridians. It warms the interior and stops bleeding in both the Middle- and Lower-Jiao, such as bleeding from the stomach, intestines and uterus. Moreover, it binds up the intestines and stops diarrhea. It is more suitable for conditions of Spleen-Yang deficiency, such as chronic colitis, which manifests as abdominal pain and cramp, diarrhea, intestinal hemorrhage, cold hands and feet, and a pale complexion.
Deputy: Treat the cause of bleeding
Zhi Mu ( Anemarrhenae rhizoma), Sheng Di Huang ( Rehmanniae radix), Nu Zhen Zi ( Ligustri lucidi fructus) and Han Lian Cao ( Ecliptae herba)
These herbs are able to cool the blood, reduce heat and nourish the Yin. They can be used alone or in combination for treating bleeding due to Yin deficiency with empty-fire in the blood. Zhi Mu and Sheng Di Huang are stronger in cooling the blood and should not be used for too long, otherwise they may cause blood stagnation.
Nu Zhen Zi and Han Lian Cao are more gentle. Not only can they be used for a longer period of time without the blood stagnation side effect of Zhi Mu and Sheng Di Huang, they can also be used in generating the Yin of the Kidney without cloying, sticky side effects.
Huang Qin ( Scutellariae radix), Huang Lian ( Coptidis rhizoma) and Huang Bai ( Phellodendri cortex)
Huang Qin, Huang Lian and Huang Bai are bitter and cold. They can strongly clear heat and reduce fire. They are used for treating excess heat in the body.
Huang Qin particularly reduces heat in the Lung and Large Intestine, Huang Lian in the Heart and Liver, and Huang Bai in the Kidney and Bladder.
When the heat spreads in the entire body, these three herbs are often used together for a short period to powerfully reduce the excess heat.
Huang Qi ( Astragali radix) and Zhi Gan Cao ( Glycyrrhizae radix preparata)
Huang Qi is sweet and warm, and enters the Lung and Spleen meridians. It can tonify the Spleen-Qi and Lung-Qi, and has an ascending tendency. It is often used in a chronic bleeding condition due to Spleen deficiency that fails to control the blood.
Zhi Gan Cao is sweet in nature and primarily enters the Spleen meridian. It can tonify the Qi, slow down pathological development, ease the muscles and tendons, and stabilize the Qi and blood. It tonifies the Qi without the side effect of stimulating the Qi, and is particularly suitable in a crucial bleeding condition when the Qi and blood are too weak to bear strong tonification.
Bai Shao Yao ( Paeoniae radix lactiflora) and E Jiao ( Asini corii colla)
These two substances can tonify the blood and are often used in chronic bleeding conditions. Unlike many tonifying herbs that can move the blood, Bai Shao Yao and E Jiao tonify and stabilize the blood because Bai Shao Yao is sour and E Jiao is sweet. They can either tonify the blood or stop the bleeding.
Assistant: Harmonize internal organs and smooth the blood circulation; reduce the side effect of herbs that stop bleeding; tonify and ascend the Spleen-Qi, control the blood, reduce the speed of bleeding; stabilize the Qi and blood
Mu Dan Pi ( Moutan cortex), Dan Shen ( Salviae miltiorrhizae radix) and San Qi ( Notoginseng radix)
These herbs are used to promote blood circulation and disperse congealed blood. A small amount of Mu Dan Pi, Dan Shen or San Qi can be used as corrective assistants in formulas that stop bleeding. They promote blood circulation and also disperse and dissolve the congealed blood, a side effect caused by herbs that have cold, sour, astringent and descending properties.
Fang Feng ( Saposhnikoviae radix), Jing Jie Sui ( Schizonepetae flos) and Huai Hua ( Sophorae flos)
These herbs are dispersing and ascending in nature. They are used as assistants to disperse the restrained Qi and heat and calm the wind, which is produced by the high speed of bleeding, physical tension and mental stress, and the rapid development of pathological conditions.
Huang Qi ( Astragali radix), Sheng Ma ( Cimicifugae rhizoma) and Chai Hu ( Bupleuri radix)
These herbs can tonify and ascend the Spleen-Qi, control the blood and reduce the speed of bleeding.
In clinical practice and in laboratory trials, it has been shown that Huang Qi is able to tonify the Spleen-Qi and ascend the Qi, and can be used to control the blood in a bleeding condition. This function can be enhanced by a small amount of Sheng Ma and Chai Hu.
Zhi Gan Cao ( Glycyrrhizae radix preparata)
Zhi Gan Cao is sweet in nature and primarily enters the Spleen meridian. It reduces tension that is caused by the high speed of bleeding, physical and mental stress, and the rapid development of pathological conditions. As it eases the muscles and tendons, and stabilizes the Qi and blood, it can slow down the speed of bleeding in a crucial bleeding condition.
Envoy: Harmonize the herbs in the formula
Zhi Gan Cao ( Glycyrrhizae radix preparata)
Zhi Gan Cao can harmonize the functions and properties of herbs in a formula.
Examples of classical formulas
Shi Hui San (Ten Partially-Charred Substances Powder) 
Source: Shi Yao Shen Shu 
Composition
Da Jì ( Cirsii japonici herba seu radix)
Xiao Ji ( Cirsii herba)
He Ye ( Nelumbinis folium)
Ce Bai Ye ( Platycladi cacumen)
Bai Mao Gen ( Imperatae rhizoma)
Qian Cao Gen ( Rubiae radix)
Zhi Zi ( Gardeniae fructus)
Da Huang ( Rhei rhizoma)
Mu Dan Pi ( Moutan cortex)
Zong Lü Pi ( Petiolus trachycarpi)
Herbs in the formula are without exact dosage as this is not recorded in the source book. They should be applied in even dosage.
Analysis of the formula
This formula is used to cool the blood and stop bleeding. It is used for acute bleeding in any part of the body. The cause is internal heat, which injures the blood vessels and pushes blood moving upwards and leaving its normal pathway.
In this formula:
• The chief herbs are Da Jì, Xiao Ji, Ce Bai Ye, Qian Cao Gen and Bai Mao Gen. These herbs are able to cool the blood and stop bleeding, and treat the cause and manifestations.
• The deputies are Zong Lü Pi, Zhi Zi and Da Huang. Zong Lü Pi is astringent and is able to stabilize the blood and assist the chief herbs to stop bleeding; Zhi Zi and Da Huang clear the heat and can therefore reduce the intensity of bleeding.
• Mu Dan Pi serves as assistant. On the one hand, it plays the role of helping assistant together with Da Huang to cool the blood and dissolve congealed blood; on the other hand, as corrective assistant, it disperses the congealed blood and regulates the blood circulation. It thus prevents blood stagnation, a side effect caused by all the cold herbs.
• He Ye is another assistant. It can clear heat and assist the chief herbs. It can also ascend the clear Qi of the Middle-Jiao so as to prevent Qi stagnation due to the cold and astringent nature of the chief and deputy herbs.
Commentary on strategies
This formula treats the manifestation rather than the cause of the syndrome. This can be seen in the special treatment of the herbs.
• First of all, the herbs in the formula are all partially charred. Through this process, the herbs gain astringent properties that can enhance the strength of stopping bleeding.
• Second, the partially charred herbs are ground to a fine powder, sealed in an earthenware container and buried in the earth for a night. This procedure reduces any fire nature that the herbs may have developed from the charring process, which is inappropriate for bleeding conditions.
• Third, before ingestion, the herbal powders are mixed with sweet radish juice and Chinese ink, which is made from charred cypress and pine with cooked sticky rice. This enhances their ability to stop bleeding.
• Since acute bleeding is unexpected, the formula is prepared and kept for emergency use. Chinese ink and radish are usually available in the home. These particular procedures are devised to meet treatment need in acute, unexpected situations.
• These procedures suggest wider possibilities in unexpected bleeding conditions: people may quickly burn plants to black and put the powder on the wound to stop bleeding, at the same time taking fresh vegetables to clear heat.
Ke Xue Fang (Coughing of Blood Formula) 
Source: Dan Xi Xin Fa 
Composition
Qing Dai ( Indigo naturalis) 6 g
Zhi Zi ( Gardeniae fructus) 9 g
Gua Lou Gen ( Trichosanthis radix) 9 g
Hai Fu Shi ( Pumex) 9 g
He Zi ( Chebulae fructus) 6 g
Analysis of the formula
This formula is able to clear fire, transform phlegm, preserve the Lung and stop cough and bleeding. It is used for treating a syndrome where the excess Liver-fire attacks the Lung, injures the blood vessels and ascends the Qi. The symptoms are coughing blood, blood in the sputum, thick sputum that is difficult to expectorate, a bitter taste in the mouth, irritability, sharp pain in the chest and hypochondria, red cheeks, constipation, a red tongue with a yellow coating and a wiry and rapid pulse.
In this formula:
• Qing Dai and Zhi Zi are chief. They drain the excess Liver-fire and cool the blood to reduce the aggression of the Liver.
• Hai Fu Shi and Gua Lou Gen are deputies. Hai Fu Shi is able to remove sticky and thick sputum and Gua Lou Gen can eliminate phlegm-heat in the Lung. Both move downwards and treat the disorder of the Lung.
• He Zi serves as assistant and is used to preserve the Lung-Qi that is dispersed widely by the intense cough.
Commentary on strategies
• The combination of herbs in this formula suggests that when bleeding occurs in the upper part of the body, the substances that move downwards and inwards should be used.
• Although the bleeding manifests in the Lung, the Liver-fire should be drained primarily in order to recover the function of the Lung.
Huai Hua San (Sophora Japonica Flower Powder) 
Source: Ben Shi Fang 
Composition
Huai Hua ( Sophorae flos) 12 g
Ce Bai Ye ( Platycladi cacumen) 12 g
Jing Jie Sui ( Schizonepetae flos) 6 g
Zhi Ke ( Aurantii fructus) 6 g
Analysis of the formula
This formula can cool the intestines, stop bleeding, disperse wind and regulate Qi. In this way it treats intestinal wind syndrome that is caused by wind-heat or damp-heat accumulation in the intestines that blocks the Qi and injures the blood vessels. The manifestations are fresh red blood before or after defecation, blood in the stool, bleeding due to hemorrhoids, a red tongue and a wiry and rapid pulse. The sign of wind in the intestines is quick-spreading blood drops before defecation.
In this formula:
• The fragrant Huai Hua is used as chief. It can regulate and ascend the Qi, clear the heat, cool the blood and stop bleeding in the intestines.
• Ce Bai Ye, as deputy, helps Huai Hua to cool the blood and stop bleeding. It can also promote wound healing and relieve pain.
• Jing Jie Sui, as assistant, can disperse the restrained Qi and heat in the intestines and stop bleeding.
Commentary on strategies
This formula suggests several strategies.
• When the bleeding manifests in the lower part of the body, herbs that move upwards should be selected in the formula.
• Herbs that clear heat and herbs that disperse heat should be used together.
• When heat disturbs the blood, light and gentle herbs should be selected to ascend the clear Qi and disperse the constrained heat and Qi without the likelihood of the blood being forced to move.
When the herbs fulfill these conditions, the wind calms down and the bleeding in the intestines stops. Although there are only four herbs in the formula, each has more than two functions or properties to suit the syndrome. It is a perfect example of herb selection.
Xiao Ji Yin Zi (Cirsii Decoction) 
Source: Ji Sheng Fang 
Composition
Xiao Ji ( Cirsii herba) 15 g
Ou Jie ( Nelumbinis nodus rhizomatis) 9 g
Chao Pu Huang (dry-fried Typhae pollen) 9 g
Sheng Di Huang ( Rehmanniae radix) 30 g
Hua Shi ( Talcum) 15 g
Mu Tong ( Mutong caulis)* 9 g
Dan Zhu Ye ( Lophatheri herba) 9 g
Zhi Zi ( Gardeniae fructus) 9 g
Dang Gui ( Angelicae sinensis radix) 6 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 6 g
Analysis of the formula
This formula cools the blood, stops bleeding, promotes urination and treats blood Lin syndrome, a type of painful urinary dysfunction that is caused by heat accumulation in the Lower-Jiao and heat injuring the blood vessels. The manifestations are urgent, frequent, painful urination, blood in the urine, a red tongue and a rapid pulse.
In this formula:
• Xiao Ji is used as chief to treat the cause and manifestations of bleeding.
• Ou Jie and Pu Huang, the deputies, stop bleeding as well as regulating the blood to prevent the formation of congealed blood.
• Hua Shi, Zhi Zi, Mu Tong and Dan Zhu Ye serve as assistants. They clear the heat and increase urination in order to eliminate damp-heat in the Lower-Jiao.
• Dang Gui serves as corrective assistant to tonify the blood and stimulate the blood circulation to prevent blood stagnation caused by the cold herbs.
• Sheng Di Huang, another corrective assistant, is used to nourish the Yin that is injured by heat or by the herbs that drain the dampness and promote urination.
• Zhi Gan Cao is used as envoy to moderate the nature of the cold herbs and to harmonize the herbs in the formula.
Commentary on strategies
• This formula focuses on cooling blood and stopping bleeding, while at the same time increasing urination and leaching out damp-heat to treat the cause of bleeding.
• The herb that prevents blood stagnation is used in the group of cooling herbs; the herb that tonifies the Yin is used in the group of draining herbs.
The combinations fit the syndrome perfectly and therefore the formula can have effective results in treatment.
Si Seng Wan (Four-Fresh Pill) 
Source: Fu Ren Liang Fang 
Composition
Sheng He Ye (raw Nelumbinis folium) 9 g
Sheng Ai Ye (raw Artemisiae argyi folium) 9 g
Sheng Ce Bai Ye (raw Platycladi cacumen) 12 g
Sheng Di Huang ( Rehmanniae radix) 15 g
Analysis of the formula and commentary on strategies
This formula can cool blood and stop bleeding, and is used to treat nose bleeds and vomiting of blood caused by heat in the blood.
• One of the strategies shown in this formula is using the fresh herbs He Ye, Ce Bai Ye and Sheng Di Huang. As fresh herbs they have a stronger function of cooling the blood and stopping bleeding.
• The second strategy is using fresh Ai Ye as assistant because it can promote blood circulation and prevent blood stagnation caused by cold herbs. Although it is pungent and warm, its function is very gentle, and it can warm the blood without the side effect of moving the blood vigorously.
• In addition, the aromatic smell of He Ye and Ai Ye is used to disperse the restrained Qi and heat, which may arise in the process of clearing and descending the heat.
Huang Tu Tang (Yellow Earth Decoction) 
Source: Jin Kui Yao Lue 
Composition
Zao Xin Tu ( Terra flava usta) 30 g
Gan Cao ( Glycyrrhizae radix) 9 g
Gan Di Huang ( Rehmanniae glutinosae radix) 9 g
Bai Zhu ( Atractylodis macrocephalae rhizoma) 9 g
Fu Zi ( Aconiti radix lateralis preparata)* 9 g
E Jiao ( Asini corii colla) 9 g
Huang Qin ( Scutellariae radix) 9 g
Analysis of the formula
This formula can warm the Spleen-Yang and stop bleeding. It is used for treating bleeding due to deficiency of Spleen-Yang and Spleen-Qi. The manifestations are blood in the stools, uterine bleeding, vomiting of blood, or having purpura, cold limbs and a wan complexion, a pale tongue with a white coating and a deep, thready and slow pulse.
In this formula:
• The chief is the warm and astringent Zao Xin Tu. It is used in a large amount to warm the Middle-Jiao directly and to stop bleeding.
• Gan Cao, as deputy, tonifies the Spleen-Qi and harmonizes the Qi movement and blood circulation to help the chief in stopping the bleeding.
• Fu Zi and Bai Zhu, as assistants, warm the Yang and expel cold to enhance the ability of the chief to stop bleeding.
• Gan Di Huang and E Jiao also serve as assistants to tonify the blood and stop bleeding.
• Huang Qin is used as a corrective assistant in the formula to reduce heat and prevent bleeding caused by the hot Fu Zi.
Commentary on strategies
This formula shows several features.
• Combination of very hot, pungent herb with sweet herbs: The violent moving ability of Fu Zi is moderated by the sweet Gan Di Huang and E Jiao; the cloying nature of Gan Di Huang and E Jiao can be reduced by Fu Zi and Bai Zhu. This combination can sufficiently spread warmth in the Middle-Jiao, strengthen the Spleen and tonify blood in a steady and balanced way.
• Combination of cold herbs with warm herbs: This considers both the syndrome and the nature of blood. It is a perfect example of treating bleeding due to internal cold.
