Synopsis of the Golden Chamber, Volume II: Patterns and Treatment of Palpitations, Vomiting Blood, Lower Hemorrhage, Chest Fullness, and Blood Stasis—Chapter Sixteen
Study Notes on Synopsis of the Golden Chamber, Volume II: Patterns and Treatment of Palpitations, Vomiting Blood, Lower Hemorrhage, Chest Fullness, and Blood Stasis—Chapter Sixteen
Overall Paraphrase
Main theme of this passage: Discussing palpitations and fright through pulse diagnosis
At the Cunkou (inch-opening) pulse position, a "moving" yet weak pulse appears: a restless, agitated pulse movement is termed "moving" (dong), which primarily indicates fright (jing) (unease of the mind following a startle); a thin, soft, and feeble pulse is termed "weak" (ruo), which primarily indicates palpitations (ji) (the subjective feeling of an uneasy heartbeat). The ancients used this distinction to differentiate the pulse characteristics of fright and palpitations.
Main theme of this passage: Judging the trend of epistaxis through the eyes
The teacher said: If the pulse is floating, and there is a yellowish halo on the whites of the eyes, nasal bleeding has most likely not yet stopped; when the yellowish halo recedes and the eyes regain clarity, one may know that the nasal bleeding is about to cease. This is an empirical observation of determining whether *epistaxis (nasal bleeding) is resolving, based on changes in the eyes.
Main theme of this passage: Categorizing epistaxis by channel and season
It is further stated: When nasal bleeding occurs from spring through summer, the ancients generally treated it according to the Taiyang (exterior pattern层面 of externally contracted disease); when nasal bleeding occurs from autumn through winter, it was generally treated according to the Yangming (interior heat or gastrointestinal level). This is a preliminary classification of epistaxis according to season and disease location.
Main theme of this passage: Sweating is prohibited for those with epistaxis
For those who habitually have nasal bleeding, the sweating method should not be used lightly. If one mistakenly induces sweating, the ancients believed there would be manifestations such as sunken forehead, urgent pulse, both eyes staring straight without movement, and inability to sleep—signs of damage to both yin blood and yang qi.
Main theme of this passage: Determining the type of hemorrhage through complexion and pulse
When a patient's complexion loses its blood color, without chills or fever, and the pulse is deep and wiry, it is mostly nasal bleeding; when the pulse is floating and weak, and feels as if it is about to expire upon heavy pressure, it is mostly lower hemorrhage; when there is vexation in the heart and coughing, there is a tendency to vomit blood. This is determining the location and tendency of hemorrhage through pulse and symptoms.
Main theme of this passage: Prognosis of vomiting blood
When vomiting blood is accompanied by cough and reversed qi flow, a rapid pulse with heat signs, and inability to lie flat, the ancients considered the condition critical with a very poor prognosis. Those who are fond of alcohol and repeatedly cough are prone to vomiting blood, because excessive drinking generates internal heat that damages the blood vessels.
Main theme of this passage: The Leather pulse and prohibition of sweating in blood loss
At the Cunkou position, the pulse is wiry and large: wiry indicates that yang qi is being diminished; large yet hollow in the center is a "hollow" pulse (kou) (palpated like a scallion stalk—empty in the middle); "diminished" indicates cold, while "hollow" indicates deficiency; when cold and deficiency mutually combat, this pulse is called a "leather" pulse (ge). When women see this pulse, it is mostly associated with miscarriage or incessant vaginal bleeding; when men see this pulse, it is mostly associated with blood loss. Those who have lost blood must not be treated with sweating. If sweating is mistakenly induced, there will be shivering, goosebumps, and trembling of the extremities.
Main theme of this passage: Pattern differentiation of blood stasis
When a patient has chest fullness, withered and dull lips, a bluish-purple tongue, a dry mouth with only the desire to rinse with water but not to swallow, no chills or fever, a pulse that is slightly large yet slow, and a feeling of fullness in the abdomen without actual distension—this indicates the presence of blood stasis (impeded blood circulation or stagnated blood that has left the vessels).
In another case, the patient appears to have heat: vexation in the heart, chest oppression, dry mouth and thirst—yet the pulse does not manifest heat signs. This belongs to the pattern of "yin hiding within"—a false heat manifestation—also caused by blood stasis, which the ancients treated with purgative methods.
Main theme of this passage: Relevant classical formulas and their principles
The classical formulas are recorded in sequence:
- For those afflicted by fire pathogen (heart yang damaged and the spirit floating astray due to mistaken application of fire therapies), the ancients used Cinnamon Twig Decoction minus Peony plus Zedoary, Oyster Shell, and Dragon Bone to Rescue the Reversed (Guizhi Qu Shaoyao Jia Shujiang Juli Longgu Jiuni Tang). Its formula principle is to warm and unblock heart yang, settle and anchor the spirit, and transform phlegm turbidity. The original formula consists of guizhi (cinnamon twig), honey-fried licorice, fresh ginger, oyster shell, dragon bone, jujube, and shujiang (zedoary), among others. The recorded preparation method is to boil the zedoary first, then add the remaining ingredients.
- For palpitations below the heart (xinxia ji) due to retained water, the ancients used Pinellia and Ephedra Pills (Banxia Mafei Wan). The principle is to transform rheum and direct counterflow downward, and to diffuse yang and settle palpitations.
- For incessant vomiting of blood, the ancients used Cypress Leaf Decoction (Baiye Tang). The principle is to warm and secure hemostasis; the "horse manure juice" (matong zhi) in the formula was a special auxiliary substance in ancient times and is no longer used in modern practice.
- For lower hemorrhage with bleeding after stool, the ancients called this "distant blood" (yuan xue)*, and used Yellow Earth Decoction (Huangtu Tang). The principle is to warm the middle and fortify the spleen, nourish blood, and stop bleeding; the original annotation also states this formula treats vomiting blood and epistaxis.
- For lower hemorrhage with bleeding before stool, the ancients called this "near blood" (jin xue), and used Red Adzuki Bean and Angelica Powder (Chixiaodou Danggui San), with the principle of clearing heat and promoting diuresis, activating blood, and stopping bleeding.
- For insufficiency of heart qi with vomiting blood and epistaxis, the ancients used Drain the Heart Decoction (Xiexin Tang). The principle is to use bitter and cold to clear and drain fire-heat, so that when fire-heat is removed, blood does not move recklessly.
The above formulas are all records from ancient literature, provided solely for the study of principles and methods, and do not constitute modern medication guidance.
🧠 In-Depth Understanding
Core Principles 💡
The core of this chapter revolves around pattern differentiation centered on "blood" and "spirit":
- Measuring patterns through the pulse, distinguishing deficiency versus excess in fright and palpitations: A moving pulse indicates fright, a weak pulse indicates palpitations, reflecting the connection between "the heart governs the blood vessels" and "the heart houses the spirit."
- Distinguishing the location and mechanism of hemorrhage: Through complexion, pulse, and the order of stool versus blood, one differentiates epistaxis, lower hemorrhage, and vomiting blood, then further distinguishes distant blood from near blood, reflecting the principle of "seeking the root in treatment."
- Pattern differentiation of blood stasis: Proposing characteristics such as "withered lips, bluish tongue, desire only to rinse the mouth but not swallow, and a feeling of fullness without actual abdominal distension," emphasizing that blood stasis can manifest as false heat or false fullness, and is treated with "attack and precipitate," reflecting the treatment principle of "blood stasis should be drained decisively."
- Prohibition of sweating in blood loss: Repeatedly emphasizing that those who have lost blood must not be treated with sweating, demonstrating the ancients' emphasis on the shared origin of qi, blood, and fluids, and of sweat and blood, avoiding further damage to yang qi and yin blood through erroneous sweating.
- Hemostasis differentiated by warming versus clearing: Cypress Leaf Decoction warms and secures, Yellow Earth Decoction warms the middle and fortifies the spleen, and Drain the Heart Decoction uses bitter and cold to clear and descend—demonstrating that hemostasis cannot rely solely on cold and astringent methods; treatment must be differentiated according to cold, heat, deficiency, and excess.
Modern Perspectives 🌟
- Reference value of blood stasis pattern differentiation: Descriptions such as "withered lips, bluish tongue, desire only to rinse the mouth but not swallow" show some analogy to certain microcirculatory disorders, hemorheological abnormalities, and manifestations of dry mouth without desire to drink seen in autonomic dysfunction in modern medicine, reflecting the ancients' meticulous clinical observation.
- Judging the cessation of epistaxis through a yellowish ocular halo: This is an empirical observation that may relate to the overall systemic state and ocular manifestations after hemorrhage, but it lacks modern evidence-based support; the seasonal classification of epistaxis treatment also tends toward mechanical application and should not be adopted wholesale.
- Modern research on the formulas: Formulas such as Yellow Earth Decoction and Drain the Heart Decoction have shown certain hemostatic, anti-inflammatory, and gastrointestinal-regulating effects in modern pharmacological studies, but their mechanisms of action are complex and they cannot replace standardized diagnosis and treatment.
- Historical limitations: Items such as the "horse manure juice" in Cypress Leaf Decoction and certain absolutist expressions of prognosis are products of historical constraints and should be viewed critically.
Health Insights ⚡
- Avoid excessive alcohol consumption and overindulgence in pungent, drying, and hot foods, so as not to aid internal heat and damage blood vessels.
- Those who are prone to epistaxis, gum bleeding, or easy bruising of the skin should avoid excessive sauna use, vigorous heavy sweating, and prolonged late nights.
- Maintain emotional stability, avoiding sudden fright or prolonged anxiety, which helps settle the mind and spirit.
- Eat with moderation and protect the spleen and stomach so that the source of qi and blood transformation remains abundant.
- If recurrent epistaxis, blood in the stool, vomiting of blood, or purpura of the skin occurs, seek medical attention promptly rather than self-treating.
📚 Related Knowledge
- Related concepts: The hollow pulse and the leather pulse, distant blood and near blood, pattern differentiation of blood stasis, prohibition of sweating in blood loss, Fulonggan (ovendried yellow earth from a hearth), the Drain the Heart Decoction method, the heart governing blood, and the heart housing the spirit.
- Further reading: Synopsis of the Golden Chamber, Volume II, "Patterns and Treatment of Blood Bi, Consumptive Conditions, and Miscellaneous Diseases" and "Patterns and Treatment of Jaundice Diseases"; Treatise on Cold Damage, "Greater Yang Disease Chapter" on the prohibition of sweating in epistaxis; Plain Questions, "Five Viscera Generation" on "all blood belongs to the heart."
This content is based on classical Chinese medical texts and is provided solely for the study of traditional cultural knowledge. It does not constitute any medical diagnosis, medication, or treatment advice. Please consult a healthcare professional promptly if you experience any discomfort.
— Bu Gua
