DONGUIBOGAM; Internal Bodily Elements-06. Blood

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Written By Jun Heo(許浚, 1539~1615), Translated by Namil Kim, Wung Seok Cha et al., Published by Ministry of Health & Welfare (Korea)

01 Yin-blood Is Produced from Water-food 陰血生於水穀 음혈은 수곡에서 생긴다

  • ① In the Divine Pivot (靈樞), it is said, “Qi received from the middle energizer and changed into red is called blood.” and “Nutrient is produced from the middle energizer.” Moreover, it is said, “If food enters the stomach, vessels circulate and if water-qi enters in the meridians, blood is produced.”
  • ② In the Inner Classic (內經), it is said, “Nutrient is the essential qi of water-food. It harmonizes the five viscera, disperses into the six bowels, and enters the vessels. In this way, it flows up and down through the vessels, passes through the five viscera and flows into the six bowels.“

02 Blood Becomes the Nutrient 血爲榮혈은 영이 된다

  • ① In the Inner Classic (內經), it is said, “Blood becomes nutrient and controls the inner part of the body. Eyes need blood to see, feet need blood to walk, hands need blood to be able to hold, and fingers need blood to pick up things.”
  • ② Liu Zonghou (劉宗厚) said, “Nutrients are the essence of water-food. It is made by the spleen, led by the heart, kept by
    the liver, spread by the lungs, distributed by the kidneys, and moistens all around the body. Eyes need nutrients to see, ears need nutrients to hear, hands need nutrients to hold, palms of the hand need nutrients to pick things up, feet need nutrients in order to walk, the five viscera need nutrients to produce fluid and humor, the six bowels need nutrients to send fluid and humor into the vessels. If nutrients are deficient, the pulse is rough, and if nutrients are sufficient, the pulse is replete. Because we take nutritious food every day, yang is formed, yin is grown, and fluid and humor change red to become blood. That is why the physique is strong when blood is sufficient and the physique is weak when blood is deficient.”

03 Blood Couples with Qi 血爲氣配혈은 기의 짝이다

Blood is like water and qi is like the wind. Wind blowing over water is the image of blood and qi. Qi leads blood. Therefore, if qi flows, blood flows, if qi stops, blood stops, if qi is warm, blood flows easily, and if qi is cold, blood is rough and has difficulty flowing. If qi does not move for a moment, blood cannot flow. If disease occurs in blood, it can be treated by controlling qi. But if disease occurs in qi, controlling blood is insignificant. That is why qi should be treated first and then blood. This is the meaning of ‘yang first, yin after’.

04 Diagnosis by Pulse Taking 脈法 맥법

  • ① In the Classic of the Pulse (脈經), it is said, “If the pulse is rough ․ soggy ․ weak, it indicates that there is a blood collapse.”
  • ② In the Classic of the  Pulse (脈經), it is said, “Any disease accompanying the loss of blood shows a hollow pulse. The pulse which is sunken and fine is good but if it is floating and large, it is difficult to cure.
  • ③ In the Orthodox Transmission of
    Medicine (正傳), it is said, “A hollow pulse indicates a loss of blood, and a rough pulse indicates a deficiency of blood” also “The pulse, in the case of hematemesis, is always large and hollow. A large pulse indicates fever, and a hollow pulse indicates the loss of blood.”
  • ④ In the Divine Pivot (靈樞), it is said, “If epistaxis does not stop and the pulse is large, it is an unfavorable sign.”
  • ⑤ In the Inner Classic (內經), it is said, “When the pulse beats energetically in the patient with epistaxis and fever, the patient will die.” It is also said, “When the patient has abdominal distension and a bloody stool with a large pulse that stops sporadically, the patient will die.”
  • ⑥ In the Classic of Difficult Issues (難經), it is said, “In the case of hematemesis or epistaxis, the pulse should be sunken and fine, but if it is floating, large, and firm instead, the patient will die.”
  • ⑦ Zhongjing (仲景) said, “If the patient has blood collapse and a replete pulse, it is difficult to cure.”
  • ⑧ Danxi (丹溪) said, “In the case of hematemesis or epistaxis, if the pulse is slippery and rapid, it is difficult to cure.”
  • ⑨ In the case of hematemesis or hemoptysis, if the pulse is small and weak, the patient will stay alive, and if it is replete and large, the patient will die.
  • ⑩ In any kind of loss of blood, if the pulse is large and rapid, it is an unfavorable sign.

05 Heat Damages the Blood 熱能傷血열은 혈을 상하게 한다

  • ① All kinds of heat originate from the heart. If there is excessive heat, it damages the blood. Heat comes out from the heart, therefore a Cleanse Heart Decoction [the prescription is mentioned in the chapter on Fire] must be used for sure. Heat damages blood, therefore a Four Directions Clear Cold Drink [the prescription is mentioned in the chapter on Fire] is
  • ② Zhenheng said, “Every bleeding is a heat syndrome.” This statement coincides with ‘The one who knows the essential point speaks in only a few words.’ Also he said, “If blood meets heat, it flows, and if blood meets cold, it coagulates. Bleeding of the mouth and nose is all yang exuberance with yin deficiency. There is only ascent and no descent. That is why blood follows qi, ascends to the upper orifices and overflows. For treatment, tonify yin and restrain yang. If qi descends, blood returns to the meridians.”
  • ③ If blood meets heat, it overflows, which is the reason for bleeding fresh blood. If blood meets cold, it coagulates and becomes clogged, which is why static blood forms. Static blood is black, fresh blood is red.

06 The Seven Emotions Activate Blood 七情動血 칠정이 혈을 움직인다

  • ① In the Inner Classic (內經), it is said, “Every blood disease belongs to the heart.” “If there is great anger, physique and qi are broken, blood makes a lump in the upper energizer and forms a minor syncope.” and also “Anger induces a qi syncope, and in severe cases, it causes hematemesis.”
  • ② If anger-qi counterflows excessively, it induces the vomiting of blood or sudden jaundice. If it counterflows inside, the liver and lungs contend mutually and then blood overflows through the nose and mouth. Anger-qi stimulates a sudden blood syndrome. In the Classic (經), the statement “Suppress anger in order to preserve yin.” supports this. If anger-qi is not suppressed, the Fire of the five minds moves excessively. Fire carries blood outside the meridian and moves frenetically. In this case, use Preserve Life Rehmannia Powder [prescription is mentioned later].
  • ③ Internal damage caused by the seven emotions is as follows. Sudden joy induces the heart to move and disables its blood production. Sudden anger damages the liver and disables its blood storage. If anxiety is accumulated, it damages the lungs. Excessive thought damages the spleen. If things do not work as desired, the kidneys are damaged. All these can activate blood. Moreover, when the Fire of five minds moves and induces the loss of blood. If it is accompanied with heat, use a Relieve Depression Decoction, if it is accompanied with a deficiency, use Preserve Life Powder [prescriptions are mentioned later]. Minor syncope due to great anger is blood vomiting caused by liver damage due to anger. Soothe the liver using Coptidis Rhizoma (黃連), Cyperi Rhizoma (香附子), Indigo Pulverata Levis (靑黛), Bupleuri Radix (柴胡) and Glycyrrhizae Radix (甘草) and it will be cured automatically.
  • ④ If sudden joy damages the heart, qi becomes relaxed, thus the heart cannot release blood, and there is nothing that the liver can take. If sudden anger damages the liver, qi counterflows, and thus the liver cannot receive blood and blood has no place to return. If sexual overindulgence cause yin-Fire to boil up, blood follows up Fire and moves frenetically outside the meridians.

07 Loss of Blood Caused by Internal Damage 內傷失血 내상으로 인한 실혈

  • ① In the Divine Pivot (靈樞), it is said, “Sudden overeating causes distension and fullness. No moderation in daily life and excessive labor damage the yang collateral vessel. If the yang collateral vessel is damaged, blood overflows outside, and if blood overflows outside, it causes epistaxis. If the yin collateral vessel is damaged, blood overflows inside, and if blood
    overflows inside, it causes hematochezia.”
  • ② If blood comes out from the seven upper orifices, it is an extravasation of blood, and if blood comes out with feces and urine, it is blood discharge.

08 Various Kinds of Loss of Blood 失血諸證 여러 가지 실혈증

  • ① There are various kinds of loss of blood. If blood moves frenetically in the upper energizer, it becomes hematemesis or epistaxis. If blood dries up outside, it becomes a consumptive disease. If blood flows down and does not return, it becomes hematochezia. If heat is accumulated in the bladder, there is difficulty in urination and hematuria, and if it infiltrates the intestines, it becomes intestine wind. If yin is deficient and yang is solid, it becomes flooding; and if dampness and heat are steamed and get blocked, it becomes dysentery or vaginal discharge. If heat is excessive and decayed, it becomes bloody pus; if Fire is excessive in the yin aspect, it becomes sores and ulcers. If dampness stagnates in the blood, it is painful, with itching and forms urticaria; if it stagnates in the skin, it becomes a cold impediment. If blood forms lumps in the upper part, the patient has a poor memory; if blood forms lump in the lower part, the patient becomes insane.
  • ② Blood coming up from the lungs and overflowing through the nose is called epistaxis, and blood coming up from the stomach and overflowing through the mouth is called blood vomiting or hematemesis. Blood spitting is the spitting of blood that comes from the kidneys. Blood coughing is a cough with bloody sputum coming from the lungs. If there is
    blood in sputum, it comes from the kidneys or lungs. Blood in the urine is called hematuria or blood strangury, and blood in feces is called intestinal wind or bloody hemorrhoid.
  • ③ Blood coming out from the pores is called subcutaneous bleeding, blood from the gums is called gum bleeding, blood from the tongue is called bleeding of the tongue, blood from BL40 area is called bleeding in the region of popliteal fossa, and blood from the nine orifices is called nine orifices bleeding.

09 Differentiating Fresh Blood and Old Blood by the Color 辨血色新舊 피의 색으로 새 피와 오래된 피를 구분하는 법

  • ① Fresh new blood is bright red, and old blood is coagulated and black. In the case of a wind syndrome, blood is blue; in a cold syndrome it is black, in a summerheat syndrome it is red, and in a dampness syndrome its color is like soot or the water falling from a thatched roof.
  • ② In a yang syndrome, fresh blood is overflowing. In a yin syndrome, the patient bleeds blood the color of a pig’s liver.
  • ③ If the first feces is brown, the disease is serious; if the second feces is dark brown, the disease is more serious than before; if the third feces is black, the disease is much more serious. The change of the color is caused by the fire that dries blood. It is the same reason with the blood of a sheep left in the sun: it changes into a brown color then becomes gradually black in color as time goes by.

10 Blood Amassment Syndrome 蓄血證 축혈증

  • ① Blood amassment is accumulated static blood.
  • ② If the patient has a heat disease caused by Cold Damage, yellowing body, black feces, madness and poor memory, one has blood amassment.
  • ③ Haicang said, “Poor memory, madness, yellowing body, and black feces mean that the disease is grave. A sense of bloatedness in the lower abdomen and difficulty in urination indicate that the disease is mild.”
  • ④ Vomiting phlegm, thirst, poor vision and hearing, confusion, poor memory, and preferring to gargle with warm water are external evidence of a blood amassment.
  • ⑤ If the disease is mild during the day time and becomes serious in night time, it indicates that the patient has static blood. Moreover, if there is static blood, the patient likes to gargle with water but does not want to swallow it.
  • ⑥ There is the difference in the upper, middle, and lower energizers in blood amassment. Epistaxis, vomiting blood, the spitting of blood, and hematemesis are blood amassment of the upper energizer. Blood lumped in the chest is blood amassment of the middle energizer. Blood accumulated in the lower energizer is blood amassment of the lower energizer. If blood is accumulated in the upper energizer, it causes poor memory. Use a Rhinocerotis Cornu and Rehmannia Decoction (犀角地黃湯) [prescription is mentioned later]. If blood is accumulated in the middle energizer, the patient has chest fullness, yellow body, and a preference for gargling with water without swallowing it. Use a Peach Pit Order Qi Decoction [the prescription is mentioned in the chapter on Cold Damage]. If blood is accumulated in the lower energizer, the patient becomes mad, with black feces, and a solid and painful abdomen. Resist and Endure Decoction or Appropriate
    Resistance Pill [the prescriptions are mentioned in the chapter on Cold Damage] are only effective when all black feces have been purged. In addition, a Raw Rehmannia Decoction widely treats blood amassment of the triple energizer.
  • ⑦ In the Compendium of Medicine (綱目), it is said, “When static blood is dried and coagulated, use Jade for Turbidity Powder. [The prescription is mentioned in the chapter on Uterus].
  • ⑧ To treat blood amassment of the lower energizer, use Persicae Semen (桃仁), Trogopterorum Faeces (五靈脂), Rehmanniae Radix Crudus (生地黃), Rhei Radix et Rhizoma (大黃), AND Glycyrrhizae Radix (甘草) to drain out by diarrhea.
  • ⑨ Myrrha (沒藥), Sappan Lignum (蘇木), Hirudo (水蛭), Tabanus (虻蟲), Trogopterorum Faeces (五靈脂), Persicae Semen (桃仁) (with its tip remaining) break static blood.[B045]
  • ⑩ The fresh juice of garlic chives (韭) has a marvelous effect on treating static blood accumulated in the chest and diaphragm.
  • Raw Rehmannia Decoction 生地黃湯 생지황탕: This decoction treats sunken, fine, and faint pulses, cold skin, fullness below the umbilicus, madness or agitation, black feces, and spontaneous urination. It has a better effect for the old person or child that has weak qi. The composition is as follows. 1 doe of Rehmanniae Radix Crudus (生地黃) juice (if
    it is not prepared, use 2 nyang of Rehmanniae Radix), ½ nyang of Lacca Sinica Exsiccata (乾漆) (stir-baked until there is no smoke), ½ doe of raw Nelumbinis Rhizoma (蓮根) juice (if it is not prepared, use 1.5 doe of common thistle juice), 1 fist of cut fresh Polygoni Tinctori Folium (藍葉) (if it is not prepared, use ½ doe of dried powder), 20 Tabanus (虻蟲) (stir-baked), 10 Hirudo (水蛭) (stir-baked), 1 nyang of Rhei Radix et Rhizoma (大黃) (cut), and ½ nyang of Persicae Semen (桃仁) (ground). Decoct all these drugs with 3 doe of water until 2 doe of decoction remains. Cool the decoction and take
    twice. Take medicine and if blood does not flow downward after a half day, take once more. This medicine is milder than an Resist and Endure Decoction or Appropriate Resistance Pill. For a woman, if you use the Appropriate Resistance Pill, vaginal bleeding may not stop and even be prolonged. That is why we mainly use this medicine.