Lol hxangd jil (Blood Syndromes)
Overview
In Miao medicine, Lol hxangd jil refers to what is broadly classified as “blood syndromes,” meaning pathological bleeding from various parts of the body. This concept closely corresponds to what Traditional Chinese Medicine (TCM) also refers to as “blood syndromes.” In Miao medical theory, this is considered a major disease category and encompasses multiple subtypes, such as:
Wo luo hxang (hemoptysis, coughing blood)
Xiu luo hxang (hematochezia, blood in stool)
Xiu wo hxang (hematuria, blood in urine)
Ga guo mian luo hxang (gingival bleeding)
Nei luo hxang (epistaxis, nosebleed)
Hxang fa luo tu hxang (dysfunctional uterine bleeding)
Yang dai dang gang luo hxang (postpartum hemorrhage)
Hxang du (ecchymosis or subcutaneous bleeding)
In Traditional Chinese Medicine, blood syndromes are typically caused by pathogenic heat damaging the blood vessels, blood stasis obstructing meridians, or qi deficiency failing to contain blood within its normal pathways. These imbalances result in blood extravasation, manifesting as bleeding from the mouth, nose, anus, or urinary tract, or as purpura on the skin.
From the perspective of Western medicine, hemorrhagic disorders may involve:
Respiratory diseases, such as bronchiectasis and pulmonary tuberculosis, leading to hemoptysis;
Digestive system disorders, such as portal hypertension due to cirrhosis, or bleeding from gastric and duodenal ulcers;
Urinary tract diseases, including glomerulonephritis, nephrolithiasis, ureteral calculi, and renal tumors;
Hematologic diseases, such as leukemia and idiopathic thrombocytopenic purpura, which may present with bleeding in the skin, mucous membranes, or internal organs.
These conditions can be treated by applying Miao medicine’s principles of syndrome differentiation and (used in traditional contexts) for Lol hxangd jil.
Hu hou jil peng · Miao Medical Symptoms
The hallmark symptom of Lol hxangd jil is bleeding, often accompanied by dizziness, palpitations, shortness of breath, cold sweats, cold limbs, pallor, and restlessness. Proper classification, bleeding site identification, and etiological understanding are crucial for (used in traditional contexts). In Miao medicine, bleeding is regarded as a major pathology and is classified into five primary sub-syndromes (hemoptysis, hematemesis, hematochezia, epistaxis, gingival bleeding), further subdivided into thirteen specific types:
Hematochezia due to internal injury
Hematochezia caused by damp-heat toxins
Hematochezia resulting from heat syndrome
Hematochezia arising from cold syndrome
Hemoptysis due to lung heat
Hemoptysis caused by liver fire
Hematemesis from stomach heat
Hematemesis from liver fire
Epistaxis resulting from lung heat
Epistaxis due to stomach heat
Epistaxis caused by liver fire
Gingival bleeding from stomach heat
Gingival bleeding due to deficiency fire
Ai duojiang · Etiology
This disorder is mainly attributed to external pathogenic factors injuring qi, blood, and fluids. Miao communities, often residing deep in mountainous regions, are frequently exposed to attacks by wild animals or venomous insects. Injuries from farm tools or accidental falls during labor are also common, leading to lacerations, bleeding, fractures, infections, and in severe cases, life-threatening conditions.
Geng duomeng · Pathogenesis
When qi is impaired, blood becomes compromised; when blood is injured, qi becomes affected in turn. Blood and fluids are interdependent—blood cannot be produced without fluids, and fluids cannot nourish the body without blood. Most cases originate from trauma (e.g., tools or falls) or infection by damp-heat or toxic heat, all of which injure qi, blood, and fluids, ultimately resulting in bleeding.
I. Ngo1 hxangd (Hemoptysis)
In Miao medicine, hemoptysis is called Wo luo hxang, also known as An wo luo hxang. It refers to the expectoration of fresh red blood from the lungs or airways, often mixed with mucus. Preceding or concurrent symptoms may include coughing or chest tightness. Classified as a major disease in Miao medicine, hemoptysis is further divided into two subtypes based on etiology: “heat-toxic hemoptysis” and “liver-fire hemoptysis.”
The condition is usually caused by wind toxins or heat toxins invading the lungs, or by excessive internal heat damaging the blood. Wind and heat toxins enter through the mouth and nose, first attacking the lungs and disturbing the movement of qi and blood. As a result, heated blood and obstructed airflow trigger retrograde blood flow and bleeding. Severe cases of heat toxicity can damage both blood and fluids, worsening the condition.
Key Points in Diagnosis
Diagnostic Criteria
The defining feature of this condition is bleeding from the lungs or trachea expelled by coughing. The blood is bright red and may appear foamy, mixed with sputum, or in streaks within the phlegm. Patients often have a history of chronic cough, dyspnea, or lung consumption (a term similar to pulmonary tuberculosis).
Relevant Examinations
Diagnostic support may include chest CT, X-ray, bronchography, bronchoscopy, sputum culture, erythrocyte sedimentation rate (ESR), exfoliative cytology, and sputum smear analysis.
Differential Diagnosis
Wo hxang (Hematemesis)
While both Wo luo hxang (hemoptysis) and Wo hxang (hematemesis) involve the expulsion of blood through the mouth, their origins and clinical features differ.
In Wo luo hxang, the source is the lungs or airways. It is accompanied by coughing, with bright red, frothy blood often mixed with sputum. Prodromal signs include chest oppression and throat itchiness. This condition is commonly associated with diseases such as Feng le pu·la na, An o a luo you, and Lai xiu di.In contrast, Wo hxang stems from the stomach or esophagus. The expelled blood is dark, may contain food remnants, and is typically preceded by nausea, vomiting, and gastric discomfort. Black stools are also common. This is often seen in conditions like Xiu diao fang and Meng chong dang.
Hsongb nais pob (Pulmonary Abscess)
In its early stages, this condition usually presents with symptoms of wind-heat attacking the exterior. As it progresses to suppuration, high fever, cough, thirst, and chest pain emerge. The patient may expectorate foul-smelling purulent sputum, sometimes mixed with blood and pus. The tongue is red with greasy yellow coating, and the pulse is surging and rapid—typical signs of internal heat.
In contrast, Wo luo hxang involves blood-streaked sputum or blood mixed with mucus, without the purulence and fetor characteristic of pulmonary abscess.
Syndrome Classification and Differentiated Treatment
1. Kaidlo Woluo Xiang (Hemoptysis due to Heat Toxin)
Symptoms (Mengli Duo): Coughing with yellow sputum mixed with bright red blood, dry mouth, dry tongue, chest pain, and fever.
Meridian Association (Xingleng): Heat-related disease, affecting the heat meridians.
Treatment Principle (Jiahe Meng): Clear heat and moisten the lungs (xu ga kai ren fu nai bo), cool the blood and stop bleeding (she xiang dang xiang).
Prescription and Formula Explanation (Ou Duo Xijia, Gang’ou):
Medicinal Functions:
2. Hule Jiong Kai Woluo Xiang (Hemoptysis due to Liver Fire)
Symptoms (Mengli Duo): Coughing with bright red blood in the sputum, chest and hypochondriac pain, irritability, constipation, scanty yellow urine.
Meridian Association (Xingleng): Heat-related disorder.
Treatment Principle (Jiahe Meng): Clear heat and moisten the lungs (xu ga kai ren fu nai bo), cool and activate the blood (she xiang wei xiang).
Prescription and Formula Explanation (Ou Duo Xijia, Gang’ou):
Woxiang (Ld hxangd) – Hematemesis
In Miao medicine, “Woxiang” refers to the vomiting of blood, where blood is expelled from the mouth, but originates from the stomach rather than the lungs. This blood is usually dark red or purplish and often contains undigested food remnants. It is distinct from hemoptysis (Woluo Xiang), where blood is coughed up. Prior to vomiting blood, the patient typically experiences chest or stomach discomfort, nausea, and the stools are often black. Woxiang is a major syndrome in Miao medicine, with two subtypes: Stomach Heat Hematemesis and Liver Fire Hematemesis. Common causes include invasion of damp-heat or wind-heat toxins, such as from eating unclean food, excessive consumption of raw, cold, or spicy food, or alcohol abuse, which inflames the stomach and forces blood upwards. Overwork or emotional distress can also damage the stomach and intestines, leading to vomiting blood.
Diagnostic Essentials
1. Diagnostic Criteria:
Blood is expelled through vomiting and originates from the stomach or esophagus. It is often mixed with food and gastric contents, usually dark or purplish red, though it can also be bright red. Stools tend to be dark red or black. Preceding symptoms include nausea, gastric discomfort, dizziness. Many patients also report stomach pain, belching, acid reflux, hypochondriac pain, jaundice, or food retention.
2. Auxiliary Examinations:
Diagnostic tools include occult blood testing of vomitus and stool, barium meal X-ray of the upper digestive tract, gastroscopy, and abdominal ultrasound. Blood tests, coagulation profiles, tourniquet test, and bone marrow cytology can help determine whether the condition stems from a hematologic disorder.
Differential Diagnosis
1. Woluo Xiang (Hemoptysis)
Though both hemoptysis and hematemesis involve blood from the mouth, their sources differ. Hemoptysis comes from the lungs and bronchi, involves bright red blood, often with frothy sputum, and is preceded by chest tightness and throat irritation. It is associated with conditions like Fenglepula Na, An’e Aroyou, and Laixiudi.
Hematemesis originates from the stomach or esophagus, the blood is darker and may contain food debris, often preceded by nausea, vomiting, or epigastric discomfort. Stools are black. Common associated conditions include Xiutiaofang and Mengchongdang.
2. Neiluoxiang (Khongd nais lol hxangd – Epistaxis)
Nasal bleeding presents with bright red blood in small amounts and no food residue. It is typically caused by local nasal or nasopharyngeal disorders.
Syndrome Classification and Differentiated Treatment
1. Budou Kai Woxiang (Stomach Heat Hematemesis)
Symptoms (Mengli Duo): Abdominal distention and pain, nausea, vomiting of blood (bright or dark purple), large volume of vomited blood, poor appetite, bitter taste in the mouth, constipation or black stools, scanty yellow urine.
Meridian Association (Xingleng): Stomach-related heat syndrome.
Treatment Principle (Jiahe Meng): Nourish yin, purge fire, cool the blood, activate blood circulation.
Prescription and Formula Explanation (Ou Duo Xijia, Gang’ou):
Medicinal Functions:
Niuxi (Niuxi): Cold, sour-bitter; promotes blood circulation, clears heat and detoxifies.
Baimaogen (Baimaogen): Cold and sweet; cools blood and stops bleeding.
Shihu (Shihu): Slightly cold and sweet; nourishes yin, clears heat, benefits the stomach.
Xiaoji (Xiaoji): Cold and bitter; nourishes blood and essence, cools blood and stops bleeding.
Mudanpi (Mudanpi): Cold, sweet-bitter; nourishes yin and cools the blood.
Jiusang Gege Lieli (Achyranthes Root, Niuxi, 15g)
Yang Gaji (Imperata Root, Baimaogen, 30g)
Lang Fang You (Dendrobium Stem, Shihu, 15g)
Wobu Ba Na (Small Thistle, Xiaoji, 20g)
Mudan Pi (Moutan Bark, Mudanpi, 15g)
Decoction taken orally.
Jia Jia Shan (Chinese Gentian Root, Longdancao, 20g)
Zhen Lu (Gardenia Fruit, Zhizi, 15g)
Jiangjia E Dong (Ophiopogon Root, Maidong, 20g)
Jiu Bi You (Cloud Herb, Yiduoyun, 15g)
Wobu Ba Liu (Large Thistle, Daji, 30g)
Decoction taken orally.
Yang Di Ga (Xingye Shashen): Slightly cold and sweet; a heat-natured herb that enters the heat meridians. It clears heat, nourishes yin, moistens the lungs, and stops coughing.
Zhen Mang (Xingren): Cold, bitter, slightly toxic; enters the heat meridians to suppress cough and relieve dyspnea.
Zhidou Wogang (Sangbaipi): Cold and sweet; a heat herb that purges the lungs, relieves asthma, promotes diuresis, reduces swelling, and supports liver and kidney health.
Xiang Xue (Niubangzi): Cold and bitter; clears wind and heat, disperses lung qi, and stops coughing.
Gannu Jingyan (Yanjingdou): Cold and bitter; resolves exterior heat, ventilates the lungs, and relieves cough.
Yang Di Ga (Apricot Leaf and Glehnia Root, Xingye Shashen, 20g)
Zhen Mang (Apricot Kernel, Xingren, 15g)
Zhidou Wogang (Mulberry Root Bark, Sangbaipi, 20g)
Xiang Xue (Great Burdock Fruit, Niubangzi, 15g)
Gannu Jingyan (Rock Cowpea, Yanjingdou, 12g)
Decoction taken orally.
2. Hule Kai · Luoxiang (Hematemesis due to Liver Fire)
Symptoms (Mengli Duo): Profuse vomiting of blood, bitter taste in the mouth, chest oppression, hypochondriac pain, vivid dreams, irritability, headache, dizziness with tinnitus, red eyes.
Meridian Association (Xingleng): Heat disease affecting the heat meridians.
Treatment Principles (Jiahe Meng): Clear liver fire, clear stomach heat, stop bleeding.
Prescription & Formula Explanation (Ou Duo Xijia, Gang’ou):
Woba Yang (Prunella vulgaris, Xia Ku Cao) 20 g
Bang Wuwu (Wild Chrysanthemum Flower, Ye Ju Hua) 20 g
Owu (Thousand‑Mile Light, Qian Li Guang) 20 g
Boba Liu (Large Thistle, Da Ji) 30 g
Zhen Lu (Gardenia Fruit, Zhi Zi) 15 g
Decoction taken orally.
Herbal Actions:
Xia Ku Cao (Prunella vulgaris): Cold, bitter–slightly pungent; enters the heat meridians to clear liver fire.
Ye Ju Hua (Wild Chrysanthemum): Cold, bitter; clears heat and detoxifies via heat, gallbladder, and half‑exterior meridians.
Qian Li Guang (Thousand‑Mile Light): Cold, bitter; enters cold meridians to clear heat, detoxify, cool blood, and reduce swelling.
Da Ji (Large Thistle): Cold, sweet; enters cold meridians to cool blood, stop bleeding, and resolve toxins.
Zhi Zi (Gardenia Fruit): Cold, bitter; enters heat meridians to drain fire, clear heat and dampness, and detoxify.
3. Xud ghad lo1 hxangd (Hematochezia)
In Miao medicine, hematochezia is called Xud ghad lo1 hxangd or Kailuo lo1 hxang. It denotes blood in the stool—whether streaked, mixed, or appearing before/after defecation—commonly from excess internal heat. Etiologies include qi–blood deficiency after chronic illness, overwork, or weakened bowel lining allowing blood to leak into the gut. Two subtypes are recognized: Cold‑Meridian Hematochezia and Heat‑Meridian Hematochezia. Heat toxins entering via the mouth can accumulate in the GI tract, injure stomach qi and blood, and drive blood downward. Alternatively, prolonged weakness of the bowel’s qi–blood containment can lead to bleeding.
【Diagnostic Essentials】
Diagnostic Criteria
Bright or dark red blood in the stool—sometimes tar‑like black. Bleeding may precede or follow defecation. Many patients report epigastric pain, hypochondriac distension, diarrhea, or dysentery history.
Auxiliary Examinations
Occult blood tests of vomitus or stool, barium‑meal radiography, fiberoptic GI endoscopy, and abdominal ultrasound help localize bleeding. CBC, coagulation profile, tourniquet test, and bone‑marrow cytology can exclude hematologic causes.
【Differential Diagnosis】
Mongb gangb ghab jud ghad (Hemorrhoids)
Bleeding during or after defecation; bright red blood; often with anal pain or foreign‑body sensation. Anorectal examination reveals internal or external hemorrhoids.
Xud ghad xud dongf hxangt (Dysentery)
Bloody, purulent stools with abdominal pain, tenesmus, and anal burning; may begin with fever and chills.
Differentiation within Xud ghad lo1 hxangd:
Jin Xue (Proximal Bleeding): Bleeding before stool passage indicates anorectal or colonic origin.
Yuan Xue (Distal Bleeding): Bleeding after stool indicates gastric or small‑intestinal origin.
Chang Feng (Intestinal Wind): Wind‑heat invasion → bright red, clear blood in stool; a true heat syndrome.
Zang Du (Organ Toxin): Damp‑heat stagnation injures the blood layer → dark, turbid blood in stool; damp‑heat predominant.
Syndrome Classification and Differentiated Treatment
1. Yinben Luoxiang (Cold‑Meridian, Internal‑Injury Hematochezia)
Symptoms (Mengli Duo):
– Blood in the stool, vague abdominal pain, pale complexion, easy fatigue, quiet speech, loose or soft stools.
– Bleeding typically appears after defecation; stool may be black. No bleeding before the stool. Poor appetite and limb weakness are common.
Meridian Association (Xingleng):
– Cold‑meridian disorder.
Treatment Principles (Jiahe Meng):
– Strengthen the spleen, warm the middle, stop bleeding.
Prescription & Formula Explanation (Ou Duo Xijia, Gang’ou):
Jia Meng Qiang—Mu Xiang (Costus Root, Mu Xiang) 15 g
Bei Jia—Pao Shen (Prepared Ginseng, Pao Shen) 20 g
Jia Long Gei—Xu Chang Qing (Stellera Root, Xu Chang Qing) 15 g
Jia Ji Gei—Xian He Cao (Agrimony, Xian He Cao) 18 g
Decoction, taken orally.
Herbal Actions:
Mu Xiang (Costus Root, Mu Xiang): Warm and bitter; enters cold meridians; moves qi, harmonizes the middle, alleviates pain, and stops bleeding.
Pao Shen (Prepared Ginseng, Pao Shen): Neutral and sweet; tonifies qi and blood, stops bleeding.
Xu Chang Qing (Stellera Root, Xu Chang Qing): Hot and aromatic; enters cold and half‑exterior meridians; detoxifies, regulates qi, and unblocks collaterals.
Xian He Cao (Agrimony, Xian He Cao): Cold and bitter‑astringent; enters heat meridians; invigorates blood and stops bleeding.
Combined, these herbs strengthen the spleen, warm the middle burner, tonify blood, and arrest bleeding.
2. Woshe Yangjin Luoxiang (Heat‑Meridian, Damp‑Heat‑Toxin Hematochezia)
Symptoms (Mengli Duo):
– Bleeding appears before defecation; bright red blood.
– Marked abdominal pain, burning sensation at the anus, bitter taste in the mouth.
– Bowel movements vary from dry to loose; thirst with desire for cold drinks.
Meridian Association (Xingleng):
– Heat‑meridian hematochezia.
Treatment Principles (Jiahe Meng):
– Clear heat, resolve toxicity, astringe to stop bleeding.
Prescription & Formula Explanation (Ou Duo Xijia, Gang’ou):
Wo Diu—Yu Xing Cao (Houttuynia, Yu Xing Cao) 30 g
Wo Na—Ji Cai (Shepherd’s Purse, Ji Cai) 20 g
Dou—Guang Zhong (Inula, Guang Zhong) 20 g
Decoction, taken orally.
Herbal Actions:
Yu Xing Cao (Houttuynia, Yu Xing Cao): Cold and pungent‑sour; enters heat meridians; clears heat and resolves toxicity.
Ji Cai (Shepherd’s Purse, Ji Cai): Slightly warm and sweet; astringent; enters heat meridians; cools blood and stops bleeding.
Guang Zhong (Inula, Guang Zhong): Cold and bitter; enters heat meridians; clears heat, relieves toxicity, and reduces swelling.
Together, they clear heat and toxins, astringe the bowel, and arrest bleeding.
3. Kaijing Xud ghad Luoxiang (Heat‑Meridian Hematochezia)
Symptoms (Mengli Duo):
– Acute onset with profuse bleeding.
– Blood is bright red, purple, or tar‑black and viscous.
– Flushed complexion, irritability, intense thirst.
Meridian Association (Xingleng):
– Heat‑meridian disorder.
Treatment Principles (Jiahe Meng):
– Clear heat and cool the blood.
Prescription & Formula Explanation (Ou Duo Xijia, Gang’ou):
Wo Hui Qiu—Da Huang (Rhubarb, Da Huang) 10 g
Nuo Du Jia Kai Du—Shui Huang Lian (Coptis Rhizome, Shui Huang Lian) 3 g
Wo Jiu Ou—San Qi (Notoginseng, San Qi) 10 g
Zhen Lu—Zhi Zi (Gardenia Fruit, Zhi Zi) 10 g
Yang Ga Ji—Bai Mao Gen (Imperata Root, Bai Mao Gen) 50 g
Decoction, taken orally.
Herbal Actions:
Da Huang (Rhubarb, Da Huang): Cold and bitter; enters heat meridians; clears heat, detoxifies, cools blood, and stops bleeding.
Shui Huang Lian (Coptis Rhizome, Shui Huang Lian): Cold and bitter; enters heat meridians; clears heat and drains dampness.
San Qi (Notoginseng, San Qi): Cold and bitter; enters heat meridians; invigorates blood and stops bleeding.
Zhi Zi (Gardenia Fruit, Zhi Zi): Cold and bitter; enters heat meridians; drains fire, clears heat, and relieves toxicity.
Bai Mao Gen (Imperata Root, Bai Mao Gen): Cold and sweet; enters heat meridians; clears heat and cools blood.
This combination powerfully clears heat, cools the blood, and arrests bleeding.
4. She Jing Xud ghad Lo1 hxangd (Cold‑Meridian Hematochezia)
Symptoms (Mengli Duo): Palpitations, shortness of breath, mental fatigue, limb weakness, frequent pale‑clear urination, mild to moderate blood in the stool (sometimes heavy in a single episode), pale‑pink or light‑red blood, pale complexion, chronic course. Some patients develop postprandial low‑grade fever, facial flushing, bitter taste, and dry mouth.
Meridian Association (Xingleng): Cold‑meridian disorder.
Treatment Principles (Jiahe Meng): Tonify qi, nourish blood, arrest bleeding, stabilize collapse.
Prescription & Formula Explanation (Ou Duo Xijia, Gang’ou):
Wo Bu Tao Xue — Xue Ren Shen (Grafted Ginseng, Xue Renshen) 30 g
Wo Li Liao — Shi Wei (Pyrrosia Leaf, Shi Wei) 30 g
Hong Mang Sang — Mian Hua Gen (Cotton Root, Mianhuagen) 30 g
Lang Yue — Wen Mu Cao (Herba Moslae, Wenmu Cao) 20 g
Decoction, taken orally.
Herbal Actions:
Xue Renshen (Grafted Ginseng, Xue Renshen): Warm and bitter; enters cold meridians; tonifies qi, secures blood, nourishes yin, stops sweating.
Shi Wei (Pyrrosia Leaf, Shi Wei): Cold and slightly sweet‑bitter; enters heat meridians; cools blood and arrests bleeding.
Mian Hua Gen (Cotton Root, Mian Hua Gen): Warm and sweet; enters cold meridians; tonifies qi, raises yang.
Wen Mu Cao (Herba Moslae, Wen Mu Cao): Slightly cold and bitter; enters heat meridians; astringes to stop bleeding.
Together, these herbs tonify qi and blood while astringing the bowel to stop bleeding.
4. Xuwoxiang (0b wal hxangt) – Hematuria
In Miao medicine, Xuwoxiang refers to blood in the urine, equivalent to hematuria in TCM and Western medicine. Miao theory does not subdivide by etiology but recognizes two patterns: Heat‑Meridian Hematuria and Cold‑Meridian Hematuria. The urine appears yellow with streaks of blood. Usually considered a minor syndrome, it arises from internal injury due to trauma or invasion by wind‑cold, damp‑heat, or water toxins, which damage vessels and disrupt qi–blood circulation. If qi and blood ascend, bleeding may appear in the orifices; if they descend, hematochezia or hematuria results.
Diagnostic Essentials
Diagnostic Criteria:
– Presence of blood, blood streaks, or clots in the urine without urethral pain.
Auxiliary Examinations:
– Urinalysis, urine occult‑blood test, cystoscopy.
Differential Diagnosis
Diongxeb Wal ed Nul (Lin Syndrome): Blood in the urine with urethral pain and burning. Stone‑Lin presents with interrupted flow, colicky lumbar‑abdominal pain, and sandy residue in the urine—absent in Xuwoxiang.
1. Heat‑Meridian Hematuria
Symptoms (Mengli Duo): Yellow, scalding urination with bright‑red blood, irritability, intense thirst, flushed face, oral ulcers, insomnia, dizziness, tinnitus, fatigue, soreness in the loins and abdomen.
Meridian Association (Xingleng): Heat‑meridian disorder.
Treatment Principles (Jiahe Meng): Clear heat, reduce fire, cool blood, stop bleeding.
Prescription & Formula Explanation (Ou Duo Xijia, Gang’ou):
Zhen Lu — Tao Ren (Peach Kernel, Tao Ren) 15 g
Da Ke Shao — Chi Shao (Red Peony Root, Chi Shao) 15 g
Sou Dang Suo — Yi Dian Hong (Rubia Cordifolia, Yi Dian Hong) 20 g
Dai Deng — Tian Hu (Jewel Grass, Tian Hu) 30 g
Yang La Zhu — Pu Huang (Cattail Pollen, Pu Huang) 20 g
Decoction, taken orally.
Herbal Actions:
Tao Ren (Peach Kernel, Tao Ren): Cold and bitter; enters heat meridians; invigorates blood, unblocks collaterals, detoxifies.
Chi Shao (Red Peony Root, Chi Shao): Cold and sour‑bitter; enters heat meridians; cools blood, disperses stasis, promotes urination.
Yi Dian Hong (Rubia Cordifolia, Yi Dian Hong): Cold and slightly sour‑bitter; enters heat meridians; clears heat and stops bleeding.
Tian Hu (Jewel Grass, Tian Hu): Cold and bitter; enters heat meridians; clears heat and arrests bleeding.
Pu Huang (Cattail Pollen, Pu Huang): Neutral and slightly sweet; enters both meridians; promotes urination and stops bleeding.
This formula clears heat, cools blood, arrests bleeding, and facilitates urination.
2. Cold‑Meridian Hematuria
Symptoms (Mengli Duo): Frequent urination with blood streaks, sallow complexion, fatigue, dizziness, tinnitus, weak voice, soreness of loins and back, cold extremities.
Meridian Association (Xingleng): Cold‑meridian disorder.
Treatment Principles (Jiahe Meng): Tonify deficiency, astringe leakage.
Prescription & Formula Explanation (Ou Duo Xijia, Gang’ou):
Ga Jiong Jia Nuo — Yang Que Hua (Vaccaria Seed, Yang Que Hua) 20 g
Kai Ou — Huang Jing (Polygonatum, Huang Jing) 20 g
Wo Yong Geng — Lu Xian Cao (Carpesium, Lu Xian Cao) 15 g
Dou Dun — Du Zhong (Eucommia Bark, Du Zhong) 20 g
Decoction, taken orally.
Herbal Actions:
Yang Que Hua (Vaccaria Seed, Yang Que Hua): Warm and slightly sweet; enters cold meridians; tonifies qi and nourishes yin.
Huang Jing (Polygonatum, Huang Jing): Warm and sweet; enters cold meridians; tonifies qi and fluids, strengthens spleen, nourishes yin.
Lu Xian Cao (Carpesium, Lu Xian Cao): Warm and pungent‑sweet; enters cold meridians; tonifies kidney, secures leakage.
Du Zhong (Eucommia Bark, Du Zhong): Warm and sweet; enters cold meridians; tonifies liver and kidney, nourishes blood, invigorates circulation.
This combination tonifies qi and yin, astringes leakage, and stops bleeding.
5. Ghab hgox hmid lol hxangd (Gingival Bleeding)
In Miao medicine, gingival bleeding is called Ghab hgox hmid lol hxangd, literally “blood seeping from between the teeth.” It is attributed to ascending stomach fire that causes the gums to become red, swollen, painful, and bleed bright red blood. Patients often also experience halitosis and constipation. This syndrome is divided into two types: Stomach‑Heat Gingival Bleeding and Deficiency‑Fire Gingival Bleeding.
Diagnostic Essentials
Diagnostic Criteria
– Bright red blood seeping from the gums or interdental spaces.
– After ruling out trauma, this finding confirms the diagnosis.
Auxiliary Examinations
– Complete blood count, coagulation panel (five tests), liver and renal function tests to guide (used in traditional contexts).
Differential Diagnosis
Woluo Xiang (Ld hxangd) – Hemoptysis
Both hemoptysis and gingival bleeding involve oral bleeding, but their sources differ. In Woluo Xiang, bleeding originates in the lungs or trachea; the blood is bright red, often frothy or mixed with sputum, and accompanied by chest tightness or throat itch prior to coughing. It is associated with conditions such as Fenglepula Na, An’o Aroyou, and Laixiudi. In contrast, Ghab hgox hmid lol hxangd stems from the gums and interdental spaces; blood is bright red and accompanied by swollen, painful gums, halitosis, and constipation.
Syndrome Classification & Differentiated Treatment
Budou Kai mi Luoxiang (Stomach‑Heat Gingival Bleeding)
Symptoms (Mengli Duo): Bright red gingival bleeding, red swollen painful gums, halitosis, constipation, dry mouth with craving for cold drinks, scanty yellow urine.
Meridian Association (Xingleng): Heat‑meridian disorder.
Treatment Principle (Jiahe Meng): Clear stomach fire and drain heat.
Doubi Houhaqiang (Three‑Needle Flower, Sankezhen) 20 g
Lang Fang You (Dendrobium Stem, Shihu) 15 g
Boba Liu (Large Thistle, Daji) 20 g
Decoction, taken orally.
Prescription & Explanation (Ou Duo Xijia, Gang’ou):
Herbal Actions:
Sankezhen (Three‑Needle Flower): Cold and bitter; enters heat meridians to clear heat, dry dampness, purge fire, and detoxify.
Shihu (Dendrobium Stem): Slightly cold and sweet; enters heat meridians to nourish yin, dispel heat, and generate fluids.
Daji (Large Thistle): Cool and sweet‑bitter; enters heat meridians to cool blood, reduce swelling, disperse stasis, and detoxify.
Kai Xiu mi Luoxiang (Deficiency‑Fire Gingival Bleeding)
Symptoms (Mengli Duo): Gum swelling with mild pain, gingival bleeding, tooth looseness, sticky sensation in the mouth.
Meridian Association (Xingleng): Heat‑meridian disorder.
Treatment Principle (Jiahe Meng): Clear heat and detoxify, cool blood and stop bleeding.
Prescription & Explanation (Ou Duo Xijia, Gang’ou):
Herbal Actions:
Peilan: Cold and pungent‑sweet; enters heat meridians to cool blood and stop bleeding.
Jiuliguang (Thousand‑Mile Light): Cold and bitter; enters heat meridians to clear heat and detoxify.
Baimaggu (White Horse Bone): Cold, bitter‑slightly pungent; enters heat meridians to clear heat, drain dampness, reduce swelling, and dispel toxins.
Dou Yueli (Herba Agastachis Seu Pellucidae, Peilan) 20 g
Wo Owu (Thousand‑Mile Light, Jiuliguang) 20 g
Dou Ye Gei (White Horse Bone, Baimaggu) 30 g
Decoction, taken orally.
6. Khongd nais lo1 hxangd (Epistaxis)
In Miao medicine, nasal bleeding is termed Khongd nais lo1 hxangd, literally “blood escaping internally.” It is attributed to heat toxins injuring the lung and stomach, causing hot qi to rise, damage vessels, and result in nasal hemorrhage.
Etiologies:
Lung Heat: Invasion by wind‑heat or dry heat.
Stomach Fire: Accumulated stomach heat from irregular diet.
Liver Fire: Excessive liver fire rising.
Epistaxis in Miao theory is classified as a heat disease and divided into three types: Lung‑Heat Epistaxis, Stomach‑Heat Epistaxis, and Liver‑Fire Epistaxis.
Diagnostic Essentials
Diagnostic Criteria
As long as nasal bleeding is present and trauma or retrograde menstruation in women can be ruled out, the condition can be diagnosed as epistaxis.
Auxiliary Examinations
To identify the source of bleeding, tools such as anterior rhinoscopy, nasal endoscopy, CT, or MRI may be used.
In cases with large blood loss or suspected hematological disorders, a complete blood count is required.
If the patient is taking anticoagulants or has suspected coagulation disorders, a coagulation function panel should be performed.
Differential Diagnosis
Woluo Xiang (Ld hxangd) – Hemoptysis
Though both hemoptysis and epistaxis may involve nasal bleeding, they differ in etiology and presentation.
Woluo Xiang originates in the lungs and trachea. Bleeding is typically associated with coughing, and the blood is bright red, sometimes frothy. Symptoms such as chest tightness and throat itching often precede the episode. It is commonly seen in diseases like Fenglepula Na, An’o Aroyou, and Laixiudi.
Khongd nais lo1 hxangd (epistaxis), on the other hand, is due to pathogenic heat damaging the lung and stomach, causing heat to rise and rupture blood vessels, leading to nasal bleeding.
Syndrome Classification & Differentiated Treatment
Hulepu Kai·Neiluo Xiang (Lung-Heat Epistaxis)
Symptoms (Mengli Duo): Bright red nasal bleeding, dry nasal cavity, dry mouth without sputum, itchy cough, dry stools, may include chills and fever.
Meridian Association (Xingleng): Heat-meridian disorder.
Treatment Principle (Jiahe Meng): Clear the lungs and cool blood to stop bleeding.
Prescription & Explanation (Ou Duo Xijia, Gang’ou):
Zhidou Wugang (Mulberry Leaf, Sangye) 20g
Wodou (Sweet Wormwood, Qinghao) 20g
Zhenlu (Cape Jasmine Fruit, Zhizi) 15g
Yangji (Imperata Root, Baimaogen) 30g
Jiangjia E’dong (Ophiopogon Root, Maidong) 20g
Decoction, taken orally.
Herbal Actions:
Sangye (Mulberry Leaf): Cold, bitter; enters heat meridians to tonify liver and kidney.
Qinghao (Sweet Wormwood): Cold, bitter; clears heat and cools blood.
Zhizi (Cape Jasmine Fruit): Cold, bitter; purges fire, detoxifies, clears damp-heat.
Baimaogen (Imperata Root): Cool, sweet; clears heat and stops bleeding, especially cooling blood.
Maidong (Ophiopogon Root): Cold, sweet-slightly bitter; nourishes yin and generates fluids.
The combined formula clears lung heat, cools blood, and stops bleeding.
Budou Kai·Neiluo Xiang (Stomach-Heat Epistaxis)
Symptoms (Mengli Duo): Bright red nasal bleeding, burning and dry nasal cavity, dry mouth with bitter taste, irritability, preference for cold drinks.
Meridian Association (Xingleng): Heat-meridian disorder.
Treatment Principle (Jiahe Meng): Clear heat and dampness, cool and invigorate blood.
Prescription & Explanation (Ou Duo Xijia, Gang’ou):
Yixiu (Gypsum, Sheng Shigao) 50g
Zhenlu (Cape Jasmine Fruit, Zhizi) 20g
Yanggelonggei (Lophatherum Leaf, Zhuye) 15g
Jiusang Gage Lieli (Achyranthes Root, Niuxi) 15g
Decoction, taken orally.
Herbal Actions:
Shigao (Gypsum): Cold, bland; clears stomach fire.
Zhizi (Cape Jasmine Fruit): Cold, bitter; purges fire, detoxifies.
Zhuye (Lophatherum Leaf): Cold, bland; clears heat and alleviates irritability.
Niuxi (Achyranthes Root): Cold, sour-bitter; invigorates blood, removes stasis, clears heat and toxins.
Hulejiong Kai·Neiluo Xiang (Liver-Fire Epistaxis)
Symptoms (Mengli Duo): Profuse nasal bleeding, bright red blood, accompanied by dizziness, headache, chest tightness, distending pain under the ribs, bitter mouth, irritability, red eyes, scanty yellow urine, dry stools.
Meridian Association (Xingleng): Heat-meridian disorder.
Treatment Principle (Jiahe Meng): Clear liver fire, cool and stop bleeding.
Prescription & Explanation (Ou Duo Xijia, Gang’ou):
Herbal Actions:
Chishao (Red Peony Root): Cold, bitter; reduces swelling, relieves pain, clears liver fire.
Zhizi (Cape Jasmine Fruit): Cold, bitter; purges fire, detoxifies.
Sankezhen (Three-Needle Flower): Cold, bitter; clears heat and dries dampness.
Sheng Dihuang (Raw Rehmannia Root): Cold, bitter; nourishes yin and enriches blood.
Dake Shao (Red Peony Root, Chishao) 20g
Zhenlu (Cape Jasmine Fruit, Zhizi) 20g
Doubi Houhaqiang (Three‑Needle Flower, Sankezhen) 15g
Daijialiao (Raw Rehmannia Root, Sheng Dihuang) 20g
Decoction, taken orally.
VII. Lot dlait·hxangd diok (Purpura)
In Miao medicine, purplish-blue patches or petechiae appearing on the skin are referred to as “Lot dlait·hxangd diok”, also known as “Ghost Stamp.” These usually appear on the inner sides of the upper or lower limbs and are considered a manifestation of serious internal illness. Based on clinical manifestations, they are classified into four types: wind-heat in the hot meridian, blood-heat in the hot meridian, qi deficiency in the cold meridian, and blood deficiency in the cold meridian. The condition is often caused by a weak constitution and external invasion of wind or heat toxins, which damage qi and blood. When such toxins enter the body, they first harm the qi and blood, leading to qi stagnation and blood stasis. This results in purplish-blue patches appearing on the skin surface. In Miao medical theory, deep red color indicates internal heat, while purplish-blue marks signify blood stasis.
[Key Points in Diagnosis]
Diagnostic Criteria
Typical symptoms include petechiae or purplish-blue ecchymoses on the limbs and trunk, which may merge into larger patches in severe cases. These lesions do not fade when pressed and tend to recur.
Related Examinations
Complete blood count (CBC), coagulation profile, tourniquet test, and bone marrow cytology can help determine whether the condition is a hemorrhagic disease caused by a hematologic disorder.
[Differential Diagnosis]
Gangb xint bul (Eczema)
Both Lot dlait·hxangd diok and eczema present with skin lesions. However, if pinpoint hemorrhages occur in eczema, differential diagnosis is necessary. Lot dlait·hxangd diok features purpura located beneath the skin, which do not blanch on pressure and are not raised. In contrast, eczema presents with raised lesions that blanch when pressed, have a noticeable texture, and are often itchy and recurrent.
Dix cet ves (Acne)
Acne usually presents as small bumps on the face, chest, and back, with a central plug that can be squeezed to release white, grain-like material. It is common during adolescence. Lot dlait·hxangd diok is typically chronic and recurrent, with petechiae hidden under the skin, non-blanching, and without raised texture.
[Syndrome Classification and Treatment]
Wind-Heat Type Purpura in the Hot Meridian
Symptoms (Meng li duo): Sudden onset of purplish-blue ecchymoses, mostly on the lower body—especially the legs and buttocks—or red patches of varying size, sometimes merging into large areas. Accompanied by general discomfort, fever, poor appetite, mild facial swelling, itching, joint pain, nausea, vomiting, abdominal pain, bloody stool, and hematuria.
Meridian (Xing leng): Hot meridian, heat-type disease.
Treatment Principle (Jia he meng): Dispel wind and clear heat, cool blood, and stop bleeding.
Prescription and Explanation (Ou duo xi jia, gang ou):
Explanation of Medicinal Properties:
Jingjie Sui: Warm in nature, pungent in taste, hot-type herb, enters cold, quick, and lateral meridians; dispels wind, activates meridians, and stops bleeding.
Jinyinhua: Cold in nature, sweet in taste, cold-type herb, enters hot meridian; clears heat and detoxifies, cools the blood, and stops bleeding.
Shengdi Huang: Cold in nature, bitter in taste, cold-type herb, enters hot meridian; nourishes yin and replenishes blood.
Chishao: Cold in nature, bitter in taste, cold-type herb, enters hot meridian; cools blood, disperses stasis, reduces swelling and pain, clears liver and purges fire.
Difuzi: Cold in nature, bitter in taste, cold-type herb, enters hot meridian; clears heat and dispels dampness.
Baimaogen: Cold in nature, sweet in taste, cold-type herb, enters hot meridian; clears heat, cools blood, and astringes to stop bleeding.
Jingjie Sui (Schizonepetae Spica) – 20g
Lonicerae Flos ( Jin Yinhua) – 20g
Rehmanniae Radix, Shengdi Huang – 10g
Paeoniae Radix Rubra, Chishao – 15g
Kochiae Fructus, Difuzi – 15g
Imperatae Rhizoma, Baimaogen – 20g
Decoction for oral administration.
2. Blood-Heat Type Purpura in the Hot Meridian
Symptoms (Meng li duo): Persistent high fever, dark purplish petechiae or ecchymoses in spots or patches that may merge. Accompanied by symptoms such as epistaxis, bright red blood in urine, abdominal pain, hematochezia, facial flushing, restlessness, and agitation.
Meridian (Xing leng): Hot meridian, heat-type disease.
Treatment Principle (Jia he meng): Clear heat and detoxify, cool the blood, and stop bleeding.
Prescription and Explanation (Ou duo xi jia, gang ou):
Mahoniae Caulis ( Shidagonglao) – 20g
Elephantopi Herba (Baimagu) – 15g
Hibisci Mutabilis Folium ( Mufurong) – 20g
Gypsum Fibrosum (Sheng Shigao) – 30g
Rhei Radix et Rhizoma Praeparata (Tudahuang) – 20g
Decoction for oral administration.
Explanation of Medicinal Properties:
Mahoniae Caulis: Cold in nature, bitter in taste, cold-type herb, enters hot meridian; clears fire and detoxifies.
Elephantopi Herba: Cold in nature, bitter and slightly pungent, cold-type herb, enters hot meridian; clears heat and drains dampness, reduces swelling and eliminates toxins.
Hibisci Mutabilis Folium: Cold in nature, sweet with slight bitterness, cold-type herb, enters hot meridian; clears heat and detoxifies, cools the blood and stops bleeding.
Gypsum Fibrosum: Cold in nature, sweet and bland in taste, cold-type herb, enters hot meridian; clears stomach heat.
Rhei Radix et Rhizoma Praeparata: Cold in nature, bitter and astringent in taste, cold-type herb, enters hot meridian; cools the blood and stops bleeding.
3. Qi-Deficiency Type Purpura in the Cold Meridian
Symptoms (Meng li duo): Recurrent appearance of purpura with lighter coloration, chronic course. Accompanied by fatigue in the limbs, pale complexion, shortness of breath, reluctance to speak, and aversion to cold.
Meridian (Xing leng): Cold meridian, cold-type disease.
Treatment Principle (Jia he meng): Tonify qi and nourish blood, activate blood and resolve stasis.
Prescription and Explanation (Ou duo xi jia, gang ou):
Gossypii Radix (Mianhuagen) – 20g
Imperatae Rhizoma (Baimaogen) – 15g
Polygonati Rhizoma (Huangjing) – 20g
Rosae Laevigatae Fructus (Jinyingzi) – 10g
Decoction for oral administration.
Explanation of Medicinal Properties:
Gossypii Radix: Warm in nature, sweet in taste, hot-type herb, enters cold meridian; unblocks meridians and dispels dampness.
Imperatae Rhizoma: Hot in nature, sweet in taste, hot-type herb, enters cold meridian; clears heat, promotes urination, cools the blood and stops bleeding.
Polygonati Rhizoma: Neutral in nature, sweet in taste, dual-meridian herb, enters both hot and cold meridians; tonifies qi and nourishes yin, enhances physical strength.
Rosae Laevigatae Fructus: Neutral in nature, sour, sweet, and astringent in taste, dual-meridian herb, enters both hot and cold meridians; tonifies kidneys, promotes fluid production, astringes and stops bleeding.
4. Blood-Deficiency Type Purpura in the Cold Meridian
Symptoms (Meng li duo): Recurrent appearance of bluish-purple ecchymoses on the skin, often seen on the lower limbs. May be accompanied by dizziness, tinnitus, fever, night sweats, pale-red facial complexion, and sensations of heat in the palms and soles.
Meridian (Xing leng): Cold meridian, cold-type disease.
Treatment Principle (Jia he meng): Nourish yin and reduce internal fire, cool the blood and stop bleeding.
Prescription and Explanation (Ou duo xi jia, gang ou):
Imperatae Rhizoma ( Baimaogen) – 20g
Phyllanthi Urinaria Herba (Yexiazhu) – 20g
Cirsii Japonici Herba (Daji) – 20g
Lilii Bulbus (Baihe) – 30g
Lysimachiae Herba (Gongcai) – 15g
Decoction for oral administration.
Explanation of Medicinal Properties:
Imperatae Rhizoma: Hot in nature, sweet in taste, hot-type herb, enters cold meridian; clears heat, cools the blood, and stops bleeding.
Phyllanthi Urinaria Herba: Clears heat and detoxifies, eliminates dampness and reduces swelling.
Cirsii Japonici Herba: Hot in nature, sweet in taste, hot-type herb, enters cold meridian; detoxifies, cools the blood, and stops bleeding.
Lilii Bulbus: Hot in nature, sweet with slight bitterness, hot-type herb, enters cold meridian; clears the heart and calms the spirit.
Lysimachiae Herba: Hot in nature, sweet in taste, hot-type herb, enters cold meridian; clears heat and eliminates dampness.
Preventive Care and Health Maintenance
Maintain dietary moderation. Consume light, easily digestible, and nutrient-rich foods. Avoid spicy, greasy, and heavy foods. Abstain from smoking and alcohol. Follow a regular routine and balance work with rest.
Manage emotional well-being. Avoid extreme emotional fluctuations such as excessive joy or grief, and strive to maintain a stable mood.
Ensure adequate daily rest. Patients with severe symptoms should stay in bed and be closely monitored for any changes in condition. If symptoms such as pallor, cold limbs, weak pulse, and profuse sweating occur, prompt measures should be taken to （helps maintain） deterioration.
In cases of massive or frequent hematemesis, temporarily refrain from eating and focus on symptomatic (used in traditional contexts). Address the underlying disease in a timely manner.
Commentary
The Miao people traditionally live in deep mountainous forests where they frequently face threats from wild animals, venomous insects, or injuries from farming tools and falls. In Miao medicine, qi, blood, and water are considered essential for maintaining human health, and closely relate to life, aging, illness, and death. Qi and blood are the fundamental roots of life, originating from the same source: “Injury to qi inevitably harms blood, and injury to blood also damages qi.” Qi and water are interdependent: “Injury to qi harms water, and injury to water harms qi.” Water is the origin of blood, and blood contains water: “Without water, blood cannot be generated; without blood, water cannot be nourished.” This condition is often caused by external pathogens damaging the qi, blood, and water. Treatment should primarily focus on stopping the bleeding.
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