Hematemesis

General

Clinical Manifestations
Treatment Principle
Herb Formulas
Points	SJ-5, SP-1, UB-17, UB-18 HT-7, LU-10 Moxa LIV-12

Wei Stage: Summerheat And Dampness With Liver And Gall Bladder Heat

Clinical Manifestations	Hematemesis Red eyes Sore throat Mouth, tongue and lip ulcerations Urinary difficulty Diarrhea Papules Sores Prickly Heat Ocular pain Dark urine Chest pain Hemoptysis Epistaxis Oliguria with dark urine Scanty urine Swelling of the throat Fever Thirst Irritability Nausea Vomiting Lassitude due to Summerheat T: Normal C: Yellow and greasy P: Soggy and rapid
Treatment Principle	Clear Heat Relieve toxicity Promote urination Eliminate Summerheat Tonify Qi Cool the Blood
Herb Formulas	Bi Yu San
Points

Qi Stage: Gall Bladder Heat

Clinical Manifestations	Alternating chills and fever Bitter taste in mouth Thirst Dry throat Rib pain (doesn't like touch) Hypochondriac pain Nausea Vomiting Hematemesis Hypogastric pain and distension T: Red C: Yellow P: Rapid and wiry
Treatment Principle	Relieve Gall Bladder Heat Pacify the Liver and Gall Bladder
Herb Formulas	Liang Ge San
Points	GB-34, Lanweixue, LI-11, LIV-2, LIV-3, LIV-4, LIV-13, LIV-14

Xue Stage: Excess Heat Causes Bleeding

Clinical Manifestations	Hematemesis (acute, violent vomiting of fresh Blood) High fever Red face Red eyes Red lips Dry mouth Thirst Restlessness Irritability Insomnia Confusion of mind Delirium Mania Dark yellow urine Excessive skin rashes all over body Hemoptysis Epistaxis Hemafecia Hematuria Constipation or Sticky, dark, tarry stools T: Deep red, dry or Scarlet with red spots on the edges or Purple red C: None P: Rapid or Thready and rapid or Thready and feeble or Flooding, big and rapid
Treatment Principle	Cool the Blood Dispel Heat and Toxins from the Xue Stage Promote Blood Circulation
Herb Formulas	Xi Jiao Di Huang Tang  modified Si Sheng Wan For the post-acute phase with Qi and Yin Deficiency and Blood Stagnation: Zhu Ye Shi Gao Tang  modified For severe bleeding precipitating collapse of Yang: + Shen Fu Tang Chinese Patent Medicines: Niu Huang Qing Huo wan Sheng Tian Qi Pian Yun Nan Bai Yao
Points	DU-14, DU-26, LI-11, PC-3, PC-9, UB-40 With unrelenting fever: + Bleed Shixuan With spasms or convulsions: + DU-12, LI-4, LIV-3 With a severe headache: + Taiyang To clear Heat and Toxins: Bleed the Jing Well points, DU-14, LI-11, ST-44 To promote Blood circulation: SP-10, UB-17 To treat hemafecia: SP-1, ST-25, ST-37 To restore consciousness: DU-26, K-1 To nourish Yin: KI-3, SP-6 To calm the Shen: HT-7 Ear: Stomach, Duodenum, Shenmen, Lungs, Heart Adrenal, Subcortex

Severe Fire In The Qi And Xue Stages

Clinical Manifestations	Intense fever Strong thirst Dry heaves Severe, stabbing headache Extreme irritability Delirious speech (severe) Rash (severe) Epistaxis (severe) Maculae Mania Convulsions Lips chapped, dark and scorched Coma Hematemesis Extreme coldness of the extremities Restlessness Spasms or convulsions Blurred vision T: Dark red C: Dry or prickly P: Deep, thin and rapid or Floating, large and rapid
Treatment Principle	Clear Heat Relieve toxicity Cool the Blood Drain Fire Stop bleeding
Herb Formulas	Qing Wen Bai Du Yin
Points

Spleen And Stomach Qi Deficiency

Clinical Manifestations	Vomiting of small quantities of pink or Blood tinged saliva, pale or fresh red Blood, or purplish or dark, clotted Blood Intermittent, dull abdominal pain, which is relieved by warmth and pressure and is worse with Cold and when the patient is tired or run down Waxy pale or Sallow complexion Fatigue Weakness Dizziness Light-headedness Anorexia Four limbs feel tired and heavy Abdominal and epigastric distention after eating Easily satiated Nausea Maybe acid regurgitation or vomiting Loose stools or Diarrhea Sticky, tarry black stools Occult hemafecia Shortness of breath on exertion Spontaneous sweating Maybe heavy menstruation Maybe bruising easily T: Pale and flabby - may have teethmarks C: White P: Even, forceless and deficient or Thready and weak or Moderate
Treatment Principle	Strengthen the Spleen Benefit Qi
Herb Formulas	Bu Zhong Yi Qi Tang modified Yi Qi He Wei Jiao Nang Chinese Patent Medicines: Bu Zhong Yi Qi Wan With Blood Deficiency and Cold: Shi Quan Da Bu Wan For bleeding: + Sheng Tian Qi Pian Yun Nan Bai Yao
Points	REN-6, REN-12, SP-1, SP-4, SP-6, ST-36, UB-20, UB-21 With Kidney Yang Deficiency: + UB-23 LIV-13, REN-12, SP-3, SP-5, SP-6, ST-36, UB-20 Ear: Spleen, Stomach, Large Intestine, Small Intestine, Adrenal, Subcortex, Shenmen

Spleen Not Governing Blood

Clinical Manifestations	Mild bleeding of dark, purplish Blood or, less commonly, red Blood preceding or following defecation or Black, tarry, sticky stools or occult Blood discovered in testing Intermittent dull abdominal pain, alleviated by pressure Easily satiated Nausea Waxy, sallow or pale complexion Anorexia Fatigue Weakness Four limbs feel tired and heavy Physical and mental exhaustion Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose or unformed stools or Diarrhea Shortness of breath Spontaneous sweating Dizziness Light-headedness Palpitations Functional Uterine Bleeding Purpura Epistaxis Hemafecia Hematuria Menorrhagia Metrorrhagia T: Pale and flabby - may have toothmarks With Blood Deficiency: Pale and thin C: White P: Thready and weak or Moderate
Treatment Principle	Strengthen the Spleen Benefit Qi Nourish the Blood Stop bleeding
Herb Formulas	Bu Zhong Yi Qi Tang modified Gui Pi Tang Gui Pi Tang + Jiao Ai Tang For persistent bleeding: Gu Chong Tang  modified Chinese Patent Medicines: Bu Zhong Yi Qi Wan Sheng Tan Qi Yun Nan Bai Yao
Points	DU-20, REN-6, REN-12, SP-1, SP-4, SP-6, ST-25, ST-36, UB-20, UB-25 SP-1, SP-3, ST-36, UB-20 Ear: Spleen, Stomach, Large Intestine, Small Intestine, Subcortex, Adrenal, Shenmen

Spleen Yang Deficiency

Clinical Manifestations	Spitting light red blood Chronic poor appetite Loose stools Weakness Facial pallor Abdominal bloating and/or pain relieved by warmth and pressure Maybe insomnia Sallow complexion Anorexia (maybe with vomiting) Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools or watery stools containing undigested food Shortness of breath Pain in the epigastrium with cold sensations (pain is relieved by warmth) Cold limbs Feeling chilled Frequent, clear urination Mental fatigue Maybe scanty urine with edema Maybe clear, watery vaginal discharge T: Pale with teethmarks C: Thin and white P: Deep and weak or Soft or Deep and thready
Treatment Principle	Warm the Center Dispel Cold Strengthen the Spleen Guide the Blood to the vessels
Herb Formulas	Huang Qi Jian Zhong Tang Huang Tu Tang Li Zhong Tang With Dampness in the Lower Jiao and Dryness in the Upper Jiao: Lian Li Tang Chinese Patent Medicines: Li Zhong Wan With severe Cold: Fu Zi Li Zhong Wan With bleeding: + Sheng Tian Qi Pian + Yun Nan Bai Yao
Points	Moxa or moxa needle LIV-13, REN-12, SP-3, SP-5, SP-6, ST-36, UB-20 Moxa or moxa needle LIV-13, PC-6, REN-12, SP-4, ST-36, UB-20 For abdominal pain: Moxa or moxa needle REN-6

Stomach Cold In Children

Clinical Manifestations	Diarrhea with watery stools Nausea and vomiting No thirst Anorexia Abdominal and/or epigastric fullness (likes pressure) Abdominal pain Gastrointestinal weakness Pale face Frequent urination Tends toward fatigue May have cold limbs May have headache with fever Body aches Epistaxis Hematemesis Shortness of breath Lassitude Epigastric pain All Blood from bleeding is pale Maybe scanty urine with edema Edema Insomnia Hemoptysis Intestinal bleeding Chronic bleeding Hemafecia Uterine bleeding Rectal bleeding Profuse menstrual flow Chest fullness and pain Hypochondriac pain that shoots toward the Heart Intolerance of Cold Rigid focal distention in the Heart region Excessive production or drooling of foamy saliva Emaciation T: Pale, may be moist C: White or None P: Deep, weak and slow or Deep and thready or Big and weak
Treatment Principle	Warm the Middle Jiao Dispel Cold Strengthen the Spleen and Stomach Tonify Qi
Herb Formulas	Ding Yu Li Zhong Tang
Points

Stomach Fire

Clinical Manifestations	Vomiting, possibly violent, of red, brown or purple blood or Blood mixed with undigested food Constipation or dry stools or Black, tarry stools Burning Heat and pain in the epigastrium Abdominal and epigastric distention Irritating thirst: drinks copious fluids and prefers cold drinks Excessive appetite: hungry again quickly after eating (as if food vanishes) Swelling, pain, ulceration and bleeding of gums Foul breath Belching A bitter taste in the mouth Toothache Irritability Restlessness Maybe vomiting right after eating Vomiting acid or undigested food Heartburn Maybe scanty, red urine T: Red and dry C: Thick, yellow and dry P: Slippery, big, Excess and rapid or Wiry and rapid
Treatment Principle	Clear and Purge Stomach Fire Stop bleeding
Herb Formulas	San Huang Xie Xin Tang Shi Hui San San Huang Xie Xin Tang  modified + Shi Hui San With Yin Deficiency: Yu Nu Jian With severe Blood loss precipitating Collapse of Yang: Shen Fu Tang Chinese Patent Medicines: With Damp-Heat: Huang Lian Jie Du Wan With constipation: Niu Huang Qing Huo Wan With Toxic Heat: Bei Jing Niu Huang Jie Du Pian With bleeding: + Sheng Tian Qi Pian + Yun Nan Bai Yao
Points	LI-4, PC-4, PC-8, REN-12, SP-4, ST-44, ST-45 With epigastric pain: + ST-21, ST-34 With nausea: + PC-6 With constipation: + ST-25, ST-37 With Yin Deficiency: + UB-21 , UB-23 With Shao Yang Fu: + GB-39, SJ-5, ST-25 LIV-13, PC-6, REN-12, SP-4 For Heat: + LI-4, LI-11 For Fire: + ST-44 For bleeding: + UB-17 LI-4, LI-11, PC-6, PC-8, ST-6, ST-34, ST-36, ST-43, ST-44, ST-45, UB-21 Ear: Stomach, Duodenum, Liver, Large Intestine, Adrenal, Subcortex Shenmen

Blood Stagnation In The Stomach

Clinical Manifestations	Vomiting of dark, purplish, coffee ground like material Sharp, stabbing epigastric pain with fixed location Pain is severe after eating Dislike of pressure and Heat on epigastrium Right-sided hypochondriac pain Pain predominates over distention or Pain but no distention Epigastric rumbling Stools with Blood like tar (melaena) May be abdominal or epigastric lumps or masses Dark or purplish spider naevi or broken vessels on the trunk and around the inner ankles and knees Dark, ashen, sallow or purplish complexion Dark, purplish lips and conjunctiva Dark rings around the eyes Maybe irregular menstruation with dark, purple Blood or clots T: Dark purple with purple spots or dots P: Wiry and choppy or Thready and choppy or Wiry
Treatment Principle	Invigorate the Blood Adjust Qi Transform Stagnation Stop pain
Herb Formulas	Xue Fu Zhu Yu Tang  modified Dan Shen Yin modified Shi Xiao San modified With Heat: Da Huang Huang Qin Xie Xin Tang  modified With Cold and Deficiency: Huang Tu Tang Chinese Patent Medicines: Xue Fu Zhu Yu Wan For mild cases with Blood Deficiency: Tao Hong Si Wu Wan For bleeding: + Sheng Tian Qi Pian Yun Nan Bai Yao
Points	Ahshi points over the epigastrium, PC-4, PC-6, REN-12, SP-4, SP-10, ST-21, UB-17, UB-21 For severe pain: + LI-4, LIV-5 With irritability or depression: + LIV-3, Yintang  or LIV-1, Yintang SP-4, SP-6, SP-10, ST-21, ST-34, UB-17 PC-6, SP-4, SP-6, ST-36, UB-17 Ear: Stomach, Duodenum, Large Intestine, Small Intestine, Liver, Adrenal, Subcortex, Shenmen

Damp-Heat Injuring The Stomach

Clinical Manifestations	Sallow or pale complexion Anorexia Four limbs feel tired and heavy Physical and mental exhaustion Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose or unformed stools Shortness of breath Dizziness Palpitations Functional Uterine Bleeding Purpura Epistaxis Hemafecia Hematuria Menorrhagia Metrorrhagia T: Pale and flabby - may have teethmarks C: White P: Thready and weak
Treatment Principle	Benefit Qi Conserve Blood
Herb Formulas	Gui Pi Tang  modified Bu Zhong Yi Qi Tang modified Gui Pi Tang + Jiao Ai Tang Chinese Patent Medicines: Gui Pi Wan
Points	SP-1, SP-3, ST-36, UB-20 For Deficiency type uterine bleeding: DU-20, LI-11, REN-4, SP-4, SP-10, SP-14, UB-17

Food Stagnation In The Stomach

Clinical Manifestations	Vomiting of fresh red Blood or undigested, blood streaked food material The hematemesis may be provoked by a particularly large or indigestible meal Epigastric and abdominal fullness, distention and pain worse with pressure and eating and which is alleviated by defecation, belching or vomiting Belching with rotten food smell Foul flatulence Acid regurgitation Heartburn Detests food or Vomits after eating Anorexia Unformed stools or Diarrhea or Knotted constipation or Black, tarry, sticky stools T: Pink C: Thick and greasy, maybe yellow P: Slippery, maybe rapid
Treatment Principle	Clear Food Conduct Stagnation
Herb Formulas	Bao He Wan modified For severe Food Stagnation with Heat, start with a dose or two of: Tiao Wei Cheng Qi Tang Chinese Patent Medicines: Bao He Wan For bleeding: + Sheng Tian Qi Pian Yun Nan Bai Yao
Points	LI-10, PC-6, REN-12, SP-4, ST-36, ST-40 With Spleen Deficiency: + UB-20 With abdominal pain: + SP-8, ST-34 With borborygmus: + SP-5 With constipation: + SJ-6, ST-37 LIV-13, LIV-14, PC-6, REN-11, REN-12, SP-4, ST-21, ST-36, ST-44 Epigastric pain due to Food Stagnation in the Stomach: 1. LIV-13, PC-6, REN-12, ST-36, ST-44 2. LIV-13, ST-21, ST-44 3. PC-6, REN-11, ST-36 4. PC-6, REN-10, REN-12, SP-4, ST-21, ST-36 Vomiting due to Food Stagnation in the Stomach: PC-6, REN-12, SP-4, ST-25, ST-36 Ear: Spleen, Stomach, Intestines, Liver, Abdomen

Stomach Yin Deficiency With Fire

Clinical Manifestations	Vomiting of fresh, red Blood that may be either copious or scant No appetite or Famished but with no desire to eat or Indeterminate gnawing hunger Persistent, dull, nagging epigastric pain Heartburn Morning nausea Abdominal distention after meals Black, sticky or tarry, dry stools Irritability with low grade fever Maybe dry retching or Hiccups Thirst Dry skin, hair and mucous membranes Tendency toward constipation or pellet-like stools Facial flushing Malar flush Nightsweats Five-Sole-Heat With Kidney Yin Deficiency: Dizziness Tinnitus Low back and knee weakness and pain T: Red or Slightly red with a peeled center or Red and dry C: Little and dry or Peeled in the center or Shiny P: Thready and rapid
Treatment Principle	Nourish Yin Clear Heat Nourish the Stomach Cool the Blood Stop bleeding
Herb Formulas	Yu Nu Jian modified Chinese Patent Medicines: With Stomach Qi and Yin Deficiency: Gu Ben Wan With marked Deficient Heat: Zhi Bai Ba Wei Wan With Stomach Qi and Yin Deficiency: Sheng Mai San Wan With Kidney Yin Deficiency: Liu Wei Di Huang Wan With bleeding: + Yun Nan Bai Yao + Sheng Tian Qi Pian
Points	KI-3, REN-12, SP-6, ST-36, UB-21 With hemafecia: KI-3, KI-6, REN-4, REN-12, SP-6, ST-25, ST-36, UB-20, UB-21, UB-23, UB-25 Ear: Stomach, Kidney, Large Intestine, Distal Segment Rectum, Shenmen, Sympathetic With hematemesis: KI-3, KI-6, REN-4, REN-12, SP-6, ST-36, UB-20, UB-21, UB-23 Ear: Stomach, Duodenum, Adrenal, Esophagus, Shenmen, Subcortex

Liver Qi Stagnation Attacks The Stomach

Clinical Manifestations	Abdominal pain and distention Flank pain and distention Epigastric pain and distention Hypochondriac pain Maybe hematemesis Maybe hemoptysis Chest distention Vomiting Regurgitation of sour fluids Epigastric pain (worse when emotionally upset) Belching with acid regurgitation Nausea Vomiting Anorexia Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: Thin and white P: Wiry or Tight
Treatment Principle	Soothe the Liver Harmonize the Stomach Regulate Qi Stop pain
Herb Formulas	Chen Xiang Jiang Qi Tang
Points	LIV-3, LIV-14, PC-6, REN-12

Liver Qi Stagnation With Blood Blockage Below The Diaphragm

Clinical Manifestations	Abdominal masses which are visible when lying down Piercing hypochondriac pain Irritability Indigestion Constipation Dysmenorrhea Amenorrhea Chronic diarrhea Hematemesis Daybreak diarrhea Palpable abdominal masses Irregular menstruation Breast distention Abdominal tumors Hypochondriac distention T: Purple with purple spots on the side C: Normal P: Wiry, choppy and tight
Treatment Principle	Invigorate the Blood Dispel Blood Stasis Move Qi Alleviate pain Stop bleeding
Herb Formulas	Ge Xia Zhu Yu Tang
Points

Liver Fire

Clinical Manifestations	Severe, splitting headaches with dizziness Sudden tinnitus or Sudden deafness Flushed face Red, swollen, painful eyes Irascibility with violent angry outbursts Dry mouth Bitter taste in mouth Thirst Vomiting sour or bitter liquid Insomnia Restlessness Constipation or dry stools Maybe rib pain In severe cases: Mania Hemoptysis Hematemesis Epistaxis Liver Fire Attacks the Lungs: Hemoptysis Rib pain which is severe when coughing Liver Fire Attacks the Stomach: Hematemesis T: Red tip and edges C: Thick, yellow, dry and rough P: Wiry, Excess and rapid
Treatment Principle	Clear the Liver Purge Fire
Herb Formulas	Long Dan Xie Gan Tang
Points	GB-12, GB-34, GB-37, LIV-2, UB-18, UB-19

Liver Fire Attacking The Stomach

Clinical Manifestations	Vomiting of fresh red or purple Blood or Vomitus stained with Blood or Vomitus containing Blood clots Episodes will often be associated with stress or emotional turmoil Hypochondriac distention and pain Insomnia Restlessness Emotional problems Irritability Dream disturbed sleep A quick temper Pounding temporal headaches Red, sore eyes Chest pain A bitter taste in the mouth T: Deep red or Red edges C: Yellow or None P: Wiry and Rapid
Treatment Principle	Reduce Liver Fire Stop bleeding
Herb Formulas	Jia Wei Xiao Yao San Long Dan Xie Gan Tang  modified Chinese Patent Medicines: Long Dan Xie Gan Wan For bleeding: + Sheng Tian Qi Pian Yun Nan Bai Yao
Points	LIV-2, LIV-13, PC-8, REN-12, SP-4, ST-19, ST-21, ST-36, ST-44 With severe bleeding: + PC-4 With nausea: + PC-6 With epigastric pain: + ST-34 With hypochondriac pain: + GB-34, LIV-14 LIV-13, PC-6, REN-12, SP-4 For Liver Fire: + LIV-2, LIV-4 Ear: Liver, Stomach Shenmen, Large Intestine, Lungs, Adrenal, Subcortex

Liver Yin Deficiency With Liver Yang Rising

Clinical Manifestations	Steaming bone disorder Afternoon fever Tidal fever Night sweats Spontaneous seminal emissions Irritability Heat and pain in the knees (maybe with weakness) Atrophy and weakness of the knees and legs Red face Restless fever Hematemesis Sore knees Sore lower back Maybe hemoptysis May be constant hunger Maybe constipation Hot flashes Restlessness Fidgeting Insomnia with frequent dreams Productive bloody cough Easily angered Nightmares Sore feet with flaccidity Tinnitus Burning sensation over Kidneys Dizziness or vertigo Five Sole Heat Cough T: Red C: Little or None P: Thready, Excess and rapid in the Chi position
Treatment Principle	Nourish Yin Descend Fire
Herb Formulas	Da Bu Yin Wan
Points

Qi And Blood Stagnation Due To Traumatic Injury

Clinical Manifestations	Bruising, swelling and pain accompanying traumatic injuries Fractures Torn sinews Bleeding due to laceration
Treatment Principle	Invigorate the Blood Dispel Blood Stasis Promote the movement of Qi Reduce swelling Alleviate pain and bleeding
Herb Formulas	Qi Li San
Points

Blood Heat

Clinical Manifestations	High fever Confusion of mind Delirium (mania) Dark yellow urine Excessive skin rashes all over body Hemorrhage Hematemesis Hemoptysis Epistaxis Hemafecia Hematuria T: Deep red, dry or purple red. C: None P: Rapid or Thready and rapid or Thready and feeble
Treatment Principle	Clear Heat Cool the Blood Invigorate the Blood
Herb Formulas	Da Huang Zhi Xue Jiao Nang
Points

Toxic Fire

Clinical Manifestations	Pain Swelling in the joints Fever Chills Headache Fatigue Severe muscle aches Conjunctivitis Hemorrhages Jaundice Kidney and Liver dysfunction Hematemesis T: Red C: Slimy or greasy yellow P: Floating and rapid End-stage: Dementia Confusion Memory loss Delusions Eventually, complete neurological breakdown
Treatment Principle	Cool the Blood Clear Heat Relieve Toxicity
Herb Formulas	Liang Xue Bai Du Tang Lu Dou Gan Cao Tang
Points

Phlegm-Damp Retention In Ther Channels And Collaterals

Clinical Manifestations	Swelling of the affected area Hardening of the affected area Stomach ache with tenderness Pain in the affected area Hematemesis with purplish discharge No change in skin color in the early stages T: Dark C: White and smooth P: Choppy
Treatment Principle	Warm Cold Dissolve Phlegm Disperse Dampness Dispel Stagnation Open the channels and collaterals
Herb Formulas	Xiao Jin Dan
Points

Obstruction Of The San Jiao By Fire Toxin

Clinical Manifestations	High fever Irritability Fidgeting Dry mouth Dry throat Incoherent speech Insomnia Dark urine Deep-rooted boils Maculae Carbuncles Hematemesis Hemoptysis Palpitations Furuncles Tinnitus Purpura Red face Rashes Deep-rooted boils Red eyes Itchy skin Fidgeting Dry lips Delirium Dysentery with fever Jaundice Epistaxis Hematuria Cloudy mind Diarrhea T: Red C: Yellow P: Rapid and forceful
Treatment Principle	Clear Heat Drain Fire Relieve toxicity from all three Jiaos Relieve inflammation Stop bleeding Purge Damp-Heat Purge the Gallbladder
Herb Formulas	Huang Lian Jie Du Tang
Points