Herbs 6 - Stop Bleeding (Week 11 post midterm)

Which formula includes fu hai shi (pumice)?

Options:

a. Coughing up Blood Formula (ke xue fang)

b. Arborvitae Twig Decoction (bai ye tang)

c. Sanguisorba Powder (di yu san)

d. Yellow Earth Decoction (huang tu tang)

e. Small Thistle Drink (xiao ji yin zi)

Correct Answer: a. Coughing up Blood Formula (ke xue fang)

Pai's Insight: Fu Hai Shi serves as pumice—it possesses "sucking string power" and actively absorbs phlegm from the Lungs. All herbs present in Ke Xue Fang are classified as cool or neutral; there is nothing of a warmer nature. Pai noted: "Nothing is on warmer side."

Which formula incorporates dan zhu ye (lophatherum)?

Options:

a. Sanguisorba Powder (di yu san)

b. Ten Partially-Charred Substances Powder (shi hui san)

c. Sophora Flower Powder (huai hua san)

d. Small Thistle Drink (xiao ji yin zi)

Correct Answer: d. Small Thistle Drink (xiao ji yin zi)

Pai's Insight: Xiao Ji Yin Zi contains the main components of Dao Chi San (Mu Tong, Dan Zhu Ye, Zhi Gan Cao) aimed at alleviating Heart heat via the Small Intestine. This formula is effective for treating painful urinary dribbling with blood. Sheng Di Huang's purpose here is to cool the blood rather than primarily nourish yin. Pai emphasized: "Sheng Di is not to nourish yin but to cool the blood."

What must be done for Ten Partially-Charred Substances Powder (shi hui san) to alter its warm quality from the charring preparation?

Options:

a. Because most herbs are yin tonifying, they enhance cooling ability

b. The charring process increases astringency without affecting the basic cooling nature

c. The formula is defatted

d. The formula is placed outdoors overnight

e. Rice wine is added to introduce a cooling element

Correct Answer: d. The formula is placed outdoors overnight

Pai's Insight: Post-charring, the powdered herbs must be left outside overnight to absorb the yin energy from the earth. This procedure converts the herbs from warm/hot to cool/cold. "You want to transform the heat into cold. You want to transition the yang actively into yin nature." This step, largely forgotten now, was crucial for the formula's cooling properties. Pai observed: "Some of you may have seen this—the herbs circulated on the internet. Everything in the United States is modified."

Which formula features zao xin tu (furnace soil)?

Options:

a. Yellow Earth Decoction (huang tu tang)

b. Coughing up Blood Formula (ke xue fang)

c. Arborvitae Twig Decoction (bai ye tang)

d. Gelatin and Mugwort Decoction (jiao ai tang)

Correct Answer: a. Yellow Earth Decoction (huang tu tang)

Pai's Insight: Zao Xin Tu is the primary herb—this is charred earth collected from wood-burning stove walls. Once a year, the wall is rotated and the dark charcoal powder—"frost from hundreds of different plants" (百灶霜)—is obtained. This formula addresses Spleen yang deficiency bleeding. Pai recounted a Cultural Revolution story where a woman suffering severe menstrual bleeding was saved by kitchen ashes—the same principle applies to Zao Xin Tu.

Which formula is the earliest documented instance of the Four-Substance Decoction (si wu tang)?

Options:

a. Four Substance Decoction with Peach Pit and Safflower (tao hong si wu tang)

b. Tonify the Middle and Augment the Qi Decoction (bu zhong yi qi tang)

c. Gelatin and Mugwort Decoction (jiao ai tang)

d. Yellow Earth Decoction (huang tu tang)

Correct Answer: c. Gelatin and Mugwort Decoction (jiao ai tang)

Pai's Insight: Jiao Ai Tang represents the first written record of Si Wu Tang being formed (Dang Gui, Chuan Xiong, Bai Shao, Gan Di Huang)—800 years before the formula received its formal title. Zhang Zhong-Jing was the first to recognize the value of this combination and is regarded as the grandfather of all herbal formulas as well as the saint of medicine. Pai noted: "Most core formulas, whether relating to qi, blood, yin, or yang, stem from ZZJ."

Which formula contains fu zi (prepared aconite)?

Options:

a. Arborvitae Twig Decoction (bai ye tang)

b. Sanguisorba Powder (di yu san)

c. Small Thistle Drink (xiao ji yin zi)

d. Yellow Earth Decoction (huang tu tang)

e. Coughing up Blood Formula (ke xue fang)

Correct Answer: d. Yellow Earth Decoction (huang tu tang)

Pai's Insight: Fu Zi is among the warming herbs in Huang Tu Tang designed to enhance yang and tonify qi, aiding the Spleen in regulating blood. Pai noted: "Fu Zi, Bai Zhu, Gan Cao—all of these aid in boosting the yang and tonifying qi for better control." Huang Qin is included to prevent the warming herbs from causing an excess of heat in the body, similar to the role of Shao Yao in Gui Zhi Tang.

Every herb in this formula is directed to the liver channel.

Options:

a. Tonify the Middle and Augment the Qi Decoction (bu zhong yi qi tang)

b. Gelatin and Mugwort Decoction (jiao ai tang)

c. Four Substance Decoction with Peach Pit and Safflower (tao hong si wu tang)

d. Yellow Earth Decoction (huang tu tang)

Correct Answer: b. Gelatin and Mugwort Decoction (jiao ai tang)

Pai's Insight: Jiao Ai Tang specifically addresses blood, as all components direct to the Liver channel—the organ responsible for blood storage. This feature differentiates it from formulas emphasizing circulation (Heart) or qi (Spleen). Pai noted: "When we see both Ren and Chong indicated, it signals a blood issue." This formula is effective for deficiency and cold in the Penetrating and Conception vessels.

According to Formulas and Strategies, what diagnosis is treated by Gelatin and Mugwort Decoction (jiao ai tang)?

Options:

a. Stagnation and excess bleeding of the Spleen and Liver channels

b. Injury and deficiency of the Penetrating and Conception vessels

c. Injury and deficiency of the Spleen and Liver channels

d. Stagnation and excess condition bleeding of the Penetrating and Conception vessels

Correct Answer: b. Injury and deficiency of the Penetrating and Conception vessels

Pai's Insight: The blood appears pale, thin, and without clots, contrasting sharply with hot bleeding patterns. This showcases the cold-deficient state of the patient. In Zhang Zhong-Jing's time, women were marrying at 15, bearing three kids by 20, continuously cold and undernourished. The formula is designed to warm the vessels, restoring the natural cycle. Pai emphasized: "Calms the fetus' indicates that the issue originates from the mother, not the child."

Which formula incorporates dang gui (Chinese angelica)?

Options:

a. Arborvitae Twig Decoction (bai ye tang)

b. Yellow Earth Decoction (huang tu tang)

c. Small Thistle Drink (xiao ji yin zi)

d. Coughing up Blood Formula (ke xue fang)

e. Sanguisorba Powder (di yu san)

Correct Answer: c. Small Thistle Drink (xiao ji yin zi)

Pai's Insight: Dang Gui is included in Xiao Ji Yin Zi to gently move blood and maintain a balance between invigorating and stopping stagnation. Pai observed that this assists in avoiding stasis while also halting bleeding. The formula comprises two warm herbs (Dang Gui and Chao Pu Huang), while the remainder consists of cool or cold herbs. Pai stated: "2 warm herbs; the overall formula leans towards the cooler side."

Which formula repeats the inclusion of fu zi (prepared aconite)?

Options:

a. Sophora Flower Powder (huai hua san)

b. Ten Partially-Charred Substances Powder (shi hui san)

c. Sanguisorba Powder (di yu san)

d. Yellow Earth Decoction (huang tu tang)

Correct Answer: d. Yellow Earth Decoction (huang tu tang)

Pai's Insight: Fu Zi is unique to Huang Tu Tang among the stop bleeding formulas. It warms Kidney yang to bolster the Spleen’s capacity to control blood. This formula employs a balanced approach: warming herbs restore functionality, nourishing herbs tackle blood loss, and a single cooling herb (Huang Qin) prevents overheating. Pai remarked: "Huang Qin serves the same purpose as Shao Yao in Gui Zhi Tang."

The text recommends using the urine of a 12-year-old boy for:

Options:

a. Gelatin and Mugwort Decoction (jiao ai tang)

b. Yellow Earth Decoction (huang tu tang)

c. Arborvitae Twig Decoction (bai ye tang)

d. Coughing up Blood Formula (ke xue fang)

Correct Answer: c. Arborvitae Twig Decoction (bai ye tang)

Pai's Insight: The urine of boys (a yin fluid sourced from a yang individual) was utilized as a "Trojan horse" for delivering herbs. This principle is echoed in other classical preparations. Pai remarked that young boys symbolize "pure yang body"—their rapid energetic growth leads to observable differences between boys and girls. Some traditional families continue to rely on this concept. In Taiwan, he encountered a request to sleep with a bridegroom prior to the wedding to harness a young boy's yang to amplify the groom's yang qi.

This constitutes the second formula established by Zhang Zhong-Jing addressing bleeding during pregnancy:

Options:

a. Yellow Earth Decoction (huang tu tang)

b. Arborvitae Twig Decoction (bai ye tang)

c. Coughing up Blood Formula (ke xue fang)

d. Gelatin and Mugwort Decoction (jiao ai tang)

Correct Answer: d. Gelatin and Mugwort Decoction (jiao ai tang)

Pai's Insight: The first being Gui Zhi Fu Ling Wan (for blood stasis). Jiao Ai Tang addresses deficiency and cold. Pai emphasized: "Calms the fetus' signifies that the trouble originates from the mother, not the child." In historical context, mothers were already frail and cold by age 15—they lacked the time to recuperate. Pai noted: "2000 years ago, mothers were already bound to marriage with two children, cold, and impoverished by the age of 15. No chance to rest."

Which of the following is absent as an ingredient in Ten Partially-Charred Substances Powder (shi hui san)?

Options:

a. Gardeniae Fructus (zhi zi)

b. Nelumbinis Folium (he ye)

c. Platycladi Cacumen (ce bai ye)

d. Cirsii Japonici Herba sive Radix (da ji)

e. Moutan Cortex (mu dan pi)

f. Angelica Sinensis Radix (dang gui)

Correct Answer: f. Angelica Sinensis Radix (dang gui)

Pai's Insight: Shi Hui San is composed of ten partially-charred herbs: Da Ji, Xiao Ji, He Ye, Ce Bai Ye, Bai Mao Gen, Qian Cao Gen, Mu Dan Pi, Zong Lu Pi, Zhi Zi, and Da Huang. It illustrates the "shadow of Yin Chen Hao Tang"—Da Huang and Zhi Zi expel heat and promote downward movement, aiming at heat + blood stagnation rather than damp-heat jaundice. Pai noted: "In this scenario, it's about heat stagnation. Here, it's heat coupled with blood stagnation."

Which formula has the strongest correlation with the Lung?

Options:

a. Gelatin and Mugwort Decoction (jiao ai tang)

b. Arborvitae Twig Decoction (bai ye tang)

c. Yellow Earth Decoction (huang tu tang)

d. Coughing up Blood Formula (ke xue fang)

Correct Answer: d. Coughing up Blood Formula (ke xue fang)

Pai's Insight: Every herb in Ke Xue Fang is directed to the Lung channel. Fu Hai Shi (pumice) acts to absorb phlegm akin to a sponge. He Zi (chebula) consolidates Lung Qi. This formula effectively treats coughing accompanied by blood-streaked sputum resulting from Liver fire attacking the Lungs. Pai remarked: "Nothing is on warmer side"—all five herbs are cool or neutral. Qing Dai (indigo) is identifiable as the only blue-greenish powder present.

What is the most effective response for someone experiencing urgent massive bleeding today?

Options:

a. Administer shi hui san

b. Call 911

c. Assess the pulse and determine the diagnosis

d. Donate blood for them

Correct Answer: b. Call 911

Pai's Insight: In the current era, massive bleeding constitutes a medical emergency necessitating immediate hospital intervention. Herbal formulas like Shi Hui San served as ancient alternatives prior to the existence of modern medicine. Pai stated: "Today, this remedy is ineffective. In cases of massive bleeding, going to the hospital is essential." Ancient practitioners lacked blood transfusions, surgeries, or imaging technology—relying solely on herbs and hope. When bleeding occurred, patients would gradually weaken until massive bleeding from stool or vomit, at which point families prepared for funerals.

Which formula contains gan jiang (dried ginger)?

Options:

a. Yellow Earth Decoction (huang tu tang)

b. Arborvitae Twig Decoction (bai ye tang)

c. Coughing up Blood Formula (ke xue fang)

d. Sophora Flower Powder (huai hua san)

Correct Answer: b. Arborvitae Twig Decoction (bai ye tang)

Pai's Insight: Bai Ye Tang incorporates warming herbs to halt bleeding. This formula consists of Gan Jiang and additional warm herbs. Pai pointed out that bleeding can arise from both cold and heat—these formulas cater to cold-deficient patients unable to retain blood within the vessels. The last three formulas (Huang Tu Tang, Jiao Ai Tang, and similar) reflect various causes of bleeding.

Which formula combines huang qin, huang lian, and zhi zi together?

Options:

a. Yellow Earth Decoction (huang tu tang)

b. Sophora Flower Powder (huai hua san)

c. Ten Partially-Charred Substances Powder (shi hui san)

d. Sanguisorba Powder (di yu san)

Correct Answer: d. Sanguisorba Powder (di yu san)

Pai's Insight: Di Yu San includes Huang Qin, Huang Lian, and Zhi Zi—three cold, bitter herbs known for clearing heat and draining damp from the intestines. Pai indicated: "Di Yu and Qian Cao Gen provide astringency. The others facilitate downward movement." This formula aims to tackle damp-heat in the lower bowel, leading to sticky, smelly, unformed stool with bleeding. Pai described: "Stool does not maintain form, appearing as either loose or pebble-like. It is sticky, odorous, filthy, with an incorrect color."

Which formula incorporates a warm herb?

Options:

a. Sanguisorba Powder (di yu san)

b. Coughing up Blood Formula (ke xue fang)

c. Small Thistle Drink (xiao ji yin zi)

d. Ten Partially-Charred Substances Powder (shi hui san)

Correct Answer: c. Small Thistle Drink (xiao ji yin zi)

Pai's Insight: Xiao Ji Yin Zi includes Dang Gui (warm) and Chao Pu Huang (neutral-warm), making it the solitary formula among these choices with warm herbs. The remainder is largely composed of cool/cold ingredients. Pai noted: "2 warm herbs; overall formula is on cooler side." The warm herbs maintain a balance as the majority of the formulation cools the blood. Furthermore, this recipe contains the core of Dao Chi San to alleviate Heart heat through the Small Intestine.

Which formula does not consist of zhi zi (gardenia)?

Options:

a. Coughing up Blood Formula (ke xue fang)

b. Ten Partially-Charred Substances Powder (shi hui san)

c. Yellow Earth Decoction (huang tu tang)

d. Sanguisorba Powder (di yu san)

e. Small Thistle Drink (xiao ji yin zi)

Correct Answer: c. Yellow Earth Decoction (huang tu tang)

Pai's Insight: Huang Tu Tang comprises Zao Xin Tu, Sheng Di, E Jiao, Bai Zhu, Fu Zi, Gan Cao, and Huang Qin—but excludes Zhi Zi. Pai clarified that Huang Qin serves a role comparable to Shao Yao in Gui Zhi Tang—it stops the warming herbs from generating excessive heat in the body. The formula targets Spleen yang deficiency bleeding, not indications of heat requiring Zhi Zi.

According to Formulas and Strategies, what diagnosis is accurately assigned to Yellow Earth Decoction (huang tu tang)?

Options:

a. Liver heat from constraint disturbing the Penetrating and Conception vessels

b. Injured and deficient Penetrating and Conception vessels

c. Spleen yang deficiency

d. Ascendant Liver yang

Correct Answer: c. Spleen yang deficiency

Pai's Insight: Huang Tu Tang addresses bleeding due to Spleen yang deficiency—the Spleen's inability to regulate blood, prompting uncontrolled upward (vomiting, nosebleeds) or downward (bloody stool, uterine bleeding). Pai summarized: "Bleeding from every site, simply delineated. This signifies spleen or even kidney yang deficiency symptoms." The formula enhances yang so the Spleen can restore control. Blood may appear dark or pale, with cold extremities, a pale complexion, and a pale tongue exhibiting a white coating.