Class 6~7: Herbs and Formulas That Stop Bleeding

1. Class 6~7: Herbs and Formulas That Stop Bleeding Xianhui Li and Cui Han

2. Herbs • Pollen Typhae (Pu huang) • Herba Agrimoniae (Xian he cao) • Radix Notoginseng (San qi) • Rhizoma Bletillae (Bai ji) • Hb Cephalanoplos (Xiao ji) • Hb seu Rx Cirsii japonici (Da ji) • Radix Sanguisorba (Di yu) • Flos Sophorae (Huai hua) • Radix Rubiae (Qian cao gen) • Cacumen Biotae (Ce bai ye) • *Folium Artemisiae Argyi (Ai ye) • Terra Flava Usta (Fu long gan) • Lignum Dalbergiae (Jiang xiang) • Nodus Nelumbinis Rhizomatis (Ou jie) • Recept Nelumbinis (Lian fang) • Rhizoma Imperatae (Bai mao gen)

3. Pu huang (Pollen Typhae ) • Taste and Property: Sweet, acrid, and neutral • Meridian Tropism: Heart, spleen and liver • Actions: stops bleeding, invigorates blood and removes blood stasis, promotes urination • Application: • For external bleeding associated with traumatic injury, and various forms of internal bleeding such as uterine bleeding, vomiting blood, nosebleed, coughing of blood, blood in the rine, blood in the stool, or subcutaneous bleeding. This herb has an astringent nature. Used with long gu, ai ye for prolonged menses or irregular uterine bleeding • For chest pain, postpartum abdominal pain, and menstrual pain due to blood stasis, used with wu ling zhi, i.e. shi xiao san, used with yi mu cao, dang gui for bleeding postpartum • For hot painful urinary dribbling, used with xiao ji, bai mao gen for blood urine associated with painful urinary dribbling due to damp-heat in the bladder. • Dosage: 3-9g • Cautions & contraindications: use with caution during pregnancy

4. Xian he cao (Herba Agrimoniae ) • Taste and Property: Bitter, astringent and neutral • Meridian Tropism: Lung, spleen and liver • Actions: restrains leakage of blood and stops bleeding, alleviates diarrhea and dysenteric disorders, kills parasites • Application: • Used for various types of bleeding, it can be used for bleeding due to heat, cold, excess, or deficiency depending its particular combination with other herbs. Used with huai hua for bloody stools, with bai mao gen for bloody urine, used with ou jie for nose bleeding, used with ce bai ye for vomiting of blood, used with e jiao for beeding with yin and blood deficiency • For chronic diarrhea and disorders, as this herb has a restraining nature, used with di yu together • For trichomonas vaginitis and tapeworm, used topically for trichomonas vaginitis • Dosage: 6-12g • Cautions & contraindications: not for those with active pathogens

5. San qi (Radix Notoginseng ) • Taste and Property: Sweet slightly bitter, warm • Meridian Tropism: Liver and stomach • Actions: stops bleeding and transforms blood stasis, reduces swelling alleviates pain • Application: • For internal and external bleeding, it can stop bleeding without causing blood stasis. Used with bai ji for nosebleed and blood urine or in the stool • For traumatic injuries, used for swelling and pain due to falls fractures contusions and sprains • Dosage: 3-9g • Cautions & contraindications: use with caution during pregnancy

6. Bai ji (Rhizoma Bletillae) • Taste and Property: Bitter, sweet, cool • Meridian Tropism: Lung, liver and stomach • Actions: Restrains leakage of blood and stops bleeding, reduces swelling and generates flesh • Application: • For bleeding from lungs and stomach, which includes vomiting blood, coughing of blood, and nosebleed. Also for bleeding associated with traumatic injury, usually applied locally. Used with pi pa ye, bai bu • Topically for sores, ulcers, and chapped skin. It can be used whether or not the sore has ulcerated, as it reduces the swelling of sores and helps accelerate the healing of ulcers. Especially useful for chronic, nonhealing ulcers, used with zao jiao ci, jin yin hua, ru xiang • Dosage: 3-15g

7. Xiao ji (Herba Cephalanoplos ) • Taste and Property: Sweet and cool • Meridian Tropism: Heart and liver • Actions: Cool blood, arrest bleeding, detoxicate and subdue swelling • Application: • Bleeding due to blood heat. This herb can both cool blood to stop bleeding and promote diuresis, so it is specially useful for hematuria. Often used together with Hua Shi, Pu Huang, Mu Tong, etc. • Carbuncles due to toxic heat: It can be used alone by oral use or by external application • Dosage:10-15g or 30-60g (fresh)

8. Da ji (Hb seu Rx Cirsii japonici ) • Taste and Property: Sweet, bitter and cold • Meridian Tropism: Cools blood and arrests bleeding, dissipates stagnated blood to subdue swelling • Application: • Coughing blood, epistaxis, hematuria, etc. This herb can be used to treat as kinds of bleeding due to blood heat, used alone or with Xiao Ji and Ce Bai Ye • Carbuncles or furuncles: This herb can also dissipate blood stasis, detoxicate and subdue swelling. Used raw for this purpose. • Hypertension and hepatitis: This herb can lower blood pressure and relieve jaundice • Dosage: 10-15g. Fresh one 30-60g

9. Di yu (Radix Sanguisorba ) • Tastes and Property: Bitter, sour and slightly cold • Meridian Tropism: Liver, stomach and large intestine • Actions: Cools blood to stop bleeding, detoxicates and promotes healing of a wound • Application: • Hematemesis, epistaxis, hematuria, bleeding in hemorrhoids, metrostaxis and metrorrhagia. This herb is cold and bitter and tends to act downwards, so it can cool blood, purge heat, astringe and arrest bleeding, especially effective on the bleeding in the lower part of the body. For hematochezia, often used together with Huai Hua. For metrostaxis and metrorrhagia, used with Sheng Di, Huang Qin and Pu Huang. For intractable bloody dysentery, often used with Huang Lian, Mu Xiang and Ke Zi. • Burns, eczema and ulcers of the skin: This is one of the most important herb for burns. It can be used in powder with sesame oil. • Dosage: 10-15g • Attentions: External application of Di Yu Products should be avoided to patients with large area of burns because some ingredients of the herb may be absorbed by the body to cause liver poisoning

10. Huai hua (Flos Sophorae ) • Tastes and Property: Bitter, cool • Meridian Tropism: Liver, and large intestine • Actions: Cools blood and stops bleeding, cools the liver. • Application: • For damp-heat patterns of the LI when bleeding is present. For bleeding hemorrhoids and bloody dysenteric disorders. Also used for coughing of blood, nosebleed, or uterine bleeding, used with jing jie, zhi ke, i.e. huai hua san. • For red eyes, headache, and dizziness due to liver heat. • Dosage: 10-15g • Attentions: used with caution in those with cold from deficiency of the spleen and stomach

11. Qian cao gen (Radix Rubiae ) • Tastes and Property: Bitter, cold • Meridian Tropism: Liver, and heart • Actions: Cools blood and stops bleeding, remove blood stasis. • Application: • For any bleeding due to heat, used with ce bai ye. Used with hai piao xiao for excessive uterine bleeding • For the pain associated with blood stasis, especially chest and flank pain. Also used for retained lochia, pain from trauma, joint pain or the early stages of carbuncles • Dosage: 9-15g • Attentions: used with caution in those with cold from deficiency of the spleen and stomach, any fire from yin deficiency

12. Ce bai ye (Cacumen Biotae ) • Tastes and Property: Bitter, astringent, slight cold • Meridian Tropism: Liver, lung and LI • Actions: Cools blood and stops bleeding, stops cough and expels phlegm, promotes healing of burns • Application: • For any bleeding due to heat, it may also be used with warming herbs for bleeding associated with cold patterns • For lung heat patterns with cough and accumulation of phlegm, especially important in cases of viscous, difficult to expectorate sputum streaked with blood • Used topically in powdered form for the early stages of burns over a small to moderate surface area. • Dosage: 6-15g

13. Ai ye (Folium Artemisiae Vulgaris) • Taste and Property: bitter, acrid, warm • Meridian Tropism: Liver, spleen and kidney • Actions: dispels cold dampness, stops pain due to cold, stops bleeding, calms fetus • Applications: • For prolonged menstrual bleeding and uterine bleeding due to cold from deficiency. Used with gan jiang. Also for restless fetus, lower abdominal pain, and vaginal bleeding, as in threatened miscarriage. Used with e jiao, i.e. jiao ai tang. used with wu zhu yu, xu duan, i.e. ai fu nuan gong wan, Also used for infertility due to a cold womb. • Decocted and applied as an external wash for a variety of skin problems marked by dampness and itching. Used with di fu zi, bai xian pi for a variety of itching skin lesions due to cold dampness • Dosage: 3-9g • Attention: used with caution with heat from yin deficiency

14. Fu long gan (Terra Flava Usta ) • Tastes and Property: acrid, warm • Meridian Tropism: Spleen and stomach • Actions: Warms the blood and stops bleeding, stops vomiting and diarrhea • Application: • For bleeding associated with patterns of cold from deficiency, especially for stomach and intestines, used with dang gui, ai ye, and rou gui. • For vomiting associated with stomach cold as well as morning sickness, used with sheng jiang zhu ru • For chronic spleen deficiency diarrhea, used with fu zi, gan jiang, bai zhu, i.e. huang tu tang • Dosage: 15-30g • Attention: not for bleeding due to yin deficiency or vomiting due to heat

15. Jiang xiang (Lignum Dalbergiae ) • Categories: herbs that invigorate blood • Tastes and Property: acrid, warm • Meridian Tropism: liver, stomach and spleen • Actions: disperses stasis, stops bleeding, promotes the movement of qi and blood and arrests pain • Application: • For internal injuries due to trauma, fractures, sprains, or contusions. Applied topically, alone or with other herbs, to stop bleeding from lacerations, used with ru xiang, mo yao together • for epigastric and abdominal pain due to stagnant qi in the spleen and stomach, or chest pain due to blood stasis, used with dan shen • Dosage: 9-15g

16. Ou jie (Nodus Nelumbinis Rhizomatis ) • Tastes and Property: sweet, astringent, neutral • Meridian Tropism: lung, stomach and liver • Actions: stops bleeding and removes blood stasis • Application: • Used for many types of bleeding, it is astringent and reduces stasis. Most often used for bleeding associated with heat in the lungs or stomach with vomiting or coughing of blood used with bai mao gen or bai ji, qian cao, also used for chronic bleeding when it combined with other appropriate substances • Dosage: 9-15g

17. Lian fang (Recept Nelumbinis ) • Tastes and Property: bitter, astringent, warm • Meridian Tropism: Spleen, liver and kidney • Actions: disperses blood stasis and stops bleeding, dispels summerheat and dampness • Application: • For uterine bleeding and blood in the urine, used with yi mu cao for excessive menstruation or excessive uterine bleeding • For diarrhea in children due to summerheat with dampness, also used for dampness causing rashes, such as eczema • Dosage: 4.5-9g

18. Bai mao gen (Rhizoma Imperatae ) • Tastes and Property: sweet, cold • Meridian Tropism: lung, stomach and small intestine, bladder • Actions: cools the blood and stops bleeding, clears heat and promotes urination, clears heat from stomach and lungs • Application: • For chaotic movement of hot blood such as nosebleed, vomiting blood, coughing of blood and blood in the urine, used with ou jie, xiao ji • For hot painful urinary dribbling and other heat patterns with edema and urinary difficulty used with shi wei for hesitating urination, used with yin chen, zhi zi for dampheat, especially where there is also jaundice • For nausea and thirst due to stomach heat, or wheezing due to lung heat, used with lu gen, ge gen together • Dosage: 9-15g

19. Formulas • Formulas that clear heat and stop bleeding: • Ten Partially-charred Substances Powder (shi hui san) • Four-Fresh Pill (si sheng wan) • Sophora Japonica Flower Powder (huai hua san) • Cephalanoplos Decoction (xiao ji yin zi) • Formulas that tonify and stop bleeding • Yellow Earth Decoction (huang tu tang) • *Ass-hide Gelatin and Mugwort Decoction (jiao ai tang)

20. Shi hui san (Ten Partially-charred Substances Powder ) Ingredients: da ji, xiao ji, he ye, ce bai ye, bai mao gen, qian cao gen, zhi zi, da huang, mu dan pi, zong lu pi

21. Actions and indications of the formula • Actions • Cools blood and stops bleeding. • Indications • Liver or stomach fire injured blood: vomiting, spitting, or coughing up blood. These symptoms usually occur as acute bleeding disorders with sudden oneset.

22. Analysis of Formula • Da ji, xiao ji, he ye, ce bai ye, bai mao gen, qian cao gen, • Cool the blood and stop the bleeding • zong lu pi • It is astringent and stop bleeding. • Zhi zi • Clear heat and drain fire, conducting the liver heat downward and draining it through the urine • Da huang • Conducts the liver and stomach heat downward and drains it through the stool • Mu dan pi • Together with da huang cool the blood and eliminate blood stasis. This enables the formula to clear heat and stop the bleeding without causing stasis of blood

23. Modern application and attention • Modern application: • Pulmonary tuberculosis, bronchiectasis, acute hemorrhagic esophagitis or gastritis, bleeding peptic ulcer, hemorrhagic febrile disease, and functional uterine bleeding • Attention: • Not be used for deficient or cold type hemorrhage

24. Si sheng wan (Four-Fresh Pill ) Ingredients: sheng ce bai ye, xian di huang, sheng he ye, sheng ai ye

25. Actions and indications of the formula • Actions • Cools blood and stops bleeding. • Indications • Heat in the blood: vomiting, spitting, or coughing of blood or nosebleeds, particularly of bright-red blood. Accompanying signs and symptoms include a dry mouth and throat, a red or deep-red tongue and a wiry, rapid or forceful, wiry and rapid pulse.

26. Analysis of Formula • Chief: ce bai ye • Cools the blood and stops bleeding. • Depute: sheng di huang • Clears heat and cools the blood, nourish yin • Assistant and envoy: he ye, ai ye • Stop bleeding, harmonize the blood by warming and moving the flow blood in the channels to prevent stasis

27. Modern application and modifications • Modern application: • Pulmonary tuberculosis, bronchiectasis, peptic ulcer, acute gastritis, hypertention, functional uterine bleeding, gingivitis, and periodontitis • Modifications: • To strengthen the formula, add ou jie, bai mao gen, da ji, xiao ji • For severe coughing or spitting of blood, add huang lian, da huang, qian cao gen, san qi

28. Huai hua san (Sophora Japonica Flower Powder ) Ingredients: huai hua, ce bai ye, jing jie sui, zhi ke

29. Actions and indications of the formula • Actions • Cools intestines and stops bleeding, disperses wind, and promotes the movement of qi. • Indications • Bright-red bleeding from the rectum during defecation which typically precedes the passage of stool, blood in the stools, hemorrhoids with either bright-red or dark-red bleeding, a red tongue body, and a wiry, rapid or soggy, rapid pulse.

30. Analysis of Formula • Chief: huai hua • Clears damp heat from the intestines, relieves toxicity, cools the blood and stops bleeding. • Depute: ce bai ye, jing jie sui • Ce bai ye: clears heat and cools the blood, dry dampness without injuring yin • Jing jie sui: disperses wind and enters the blood level to stop the bleeding • Assistant: • Zhi ke: promotes the movement of qi and thereby relaxes the intestines

31. Modern application and modifications • Modern application: • Amebic dysentery, ulcerative colitis, hemorrhoids, anal fissure, and rectal prolapse • Modifications: • To strengthen the formula, substitute jing jie tan for jing jie sui • For severe heat in the large intestine, add huang lian, huang bai • For chronic bleeding causing blood deficiency, add dang dui

32. Xiao ji yin zi (Cephalanoplos Decoction ) Ingredients: xiao ji, ou jie, chao pu huang, sheng di huang, mu tong, hua shi, zhi zi, dang gui, zhi gan cao

33. Actions and indications of the formula • Actions • Cools intestines and stops bleeding, promotes urination, and unblocks painful urinary dysfunction. • Indications • Bloody, painful urinary dysfunction (with blood in the urine and urinary frequency, urgency, burning, and pain) or simple blood in the urine, accompanied by thirst, irritability, a red tongue with a thin, yellow coating, and a rapid, forceful pulse.

34. Analysis of Formula • Chief: xiao ji,, sheng di huang • cools the blood and stops bleeding. • Depute: ou jie, pu huang • Assist the chief herb and also reduces stasis, thereby enabling the formula to stop bleeding without causing stasis. • Assistant: sheng di huang, hua shi, mu tong, dan zhu ye, zhi zi, dang gui • Sheng di huang: nourish the yin and clear heat, also assistant in cooling the blood and stopping the bleeding • Hua shi: clear heat, promote urination, and unblock painful urinary dusfunction • Mu tong, dan zhu ye, zhi zi clear and drain fire and heat from the heart, lungs and three jiao, eliminating the heat by conducting it downward • Dang gui: nourishes and harmonizes the blood, prevents blood stasis • Envoy: zhi gan cao • Relieves spasmodic pain and harmonizes the middle jiao, and reconciles the disparate actions of the other herbs in the formula

35. Modern application and modifications • Modern application: • Acute urinary tract infection, renal calculi, renal tuberculosis, polycystic kidneys, renal cysts, sickle cell disease, hydronephrosis, and benign prostatic hypertrophy • Modifications: • For injury of the qi and yin, omit mu tong and hua shi, add dang shen, huang qi, e jiao • For severe pain, add: hu po • For acute urinary infection, add shi wei, pu gong ying, huang bai

36. Huang tu tang (Yellow Earth Decoction ) Ingredients: zao xin tu, sheng di huang, e jiao, bai zhu, gan cao, fu zi, huang qin

37. Actions and indications of the formula • Actions • Warms the yang, strengthens the spleen, nourishes the blood, and stops bleeding. • Indications • Blood in the stool, vomiting or spitting up blood, nosebleeds, or abnormal uterine bleeding of pale-red blood accompanied by cold extremities, a wan complexion, a pale tongue with a white coating, and a submerged, thin, and forceless pulse.

38. Analysis of Formula • Chief: zao xin tu • warms the middle, harmonizes the stomach, restrains the intestiens, and stops the bleeding by stabilizing the lower ber. • Depute: bai zhu, fu zi • Warm the yang and strengthen the spleen, thereby restoring the ability of the spleen and stomach qi to govern the blood. • Assistant: sheng di huang, e jiao, huang qin • Sheng di huang, e jiao, nourish the yin and blood and stop bleeding • Huang qin: prevents heat developing from the use of warm acrid ingredients • Envoy: zhi gan cao • Harmonizes the middle jiao, and the actions of the other herbs in the formula

39. Modern application and modifications • Modern application: • Chronic hemorrhagic gastritis and peptic ulcer • Modifications: • For more severe hemorrhaging, add: san qi, bai ji, ai ye • For severe qi deficiency, add: dang shen

40. Jiao ai tang (Ass-hide Gelatin and Mugwort Decoction ) Ingredients: ai ye, e jiao, sheng di huang, dang gui, chuan xiong, shao yao, gan cao

41. Actions and indications of the formula • Actions • Nourishes the blood, stops bleeding, regulates menstruation, and calms fetus • Indications • Abdominal pain with uterine bleeding, excessive menstruation, menstruation with constant spotting, post partum bleeding, or bleeding during pregnancy. The blood is pale and thin without clots, and is accompanied by weakness and soreness of the lower back, a dull complexion, a pale tongue with a thin, white coating, and a thin, frail pulse.

42. Analysis of Formula • Chief: e jiao, ai ye • E jiao: tonifies the blood and stops bleeding • Ai ye: warms the womb, calms the restless fetus, and stops bleeding. • Depute: sheng di huang, dang gui, chuan xiong, bai shao • tonify the blood, invigorate the blood and regulate the menses • Warm the yang and strengthen the spleen, thereby restoring the ability of the spleen and stomach qi to govern the blood. • Assistant: zhi gan cao • Harmonizes the actions of the other herbs in the formula

43. Modern application and modifications • Modern application: • Functional uterine bleeding, threatened miscarriage, post partum uterine bleeding, bleeding peptic ulcer, and bleeding hemorrhoids • Modifications: • For qi deficiency: add dang shen, huang qi, • For bleeding during pregnancy with lower back pain, omit chuan xiong, add bai zhu, du zhong, sang ji sheng • For spleen deficiency failing to govern the blood, combine with gui pi tang