The patient, a Buddhist monk surnamed Shi, was 40 years old. On December 19, 2022, his disciple contacted me on his behalf to report his condition. He had a history of multiple prior gastric hemorrhages and of diabetes. He had been hospitalized for examination and treatment at the University of Hong Kong-Shenzhen Hospital (patient no. AJ2589192) and Shenzhen Second People Hospital (inpatient/outpatient no. 9825661), diagnosed with splenomegaly and pancytopenia, etiology to be determined.
Recently he bled from the stomach again: at first black stools, then hematemesis, having vomited some six or seven bowls of blood. He was dizzy, universally fatigued, with cold limbs, difficult breathing, chest oppression, a spinning sensation on exertion, and was bedridden. Because the epidemic was severe recently, he dared not go to hospital and turned to me for help.He was already taking Yunnan Baiyao on his own to stop the bleeding, but with poor effect; the bleeding would not stop, and his condition was critical. I therefore advised his disciple to give him medicine every half hour: each time, one capsule of Yunnan Baiyao and 1–2 g of Bletilla striata (Baiji) powder, taken with water. At the same time, prepare a Du Shen Tang (Lone Ginseng Decoction): decoct 10–30 g of red ginseng (Hongshen) and sip it little by little, frequently. Start with 10 g red ginseng; if no side effects appear after taking it (flushing of the face and ears, palpitations, shortness of breath, etc.), gradually increase the dose up to a maximum of 30 g.Once hematemesis ceased and the stools turned yellow, switch to four times daily Yunnan Baiyao, four capsules each time, and four times daily Baiji powder, 1–2 g each time, taken with water. Maintain this for a week, then halve both. Once strength had recovered somewhat, change Du Shen Tang to modified Guipi Tang.Modified Guipi Tang formula: raw Huangqi (Astragalus) 50 g, Dangshen (Codonopsis) 30 g, Huangjing (Polygonatum) 30 g, Lingzhi (Ganoderma) 30 g, Fuling (Poria) 10 g, Baizhu (Atractylodes) 10 g, Danggui (Angelica) 10 g, Longyanrou (Longan aril) 10 g, Muxiang (Aucklandia) 10 g, Yuanzhi (Polygala) 10 g, Suanzaoren (Ziziphus seed) 6 g, Xianhecao (Agrimonia) 50 g, Jiaomaiya (parched barley sprout) 30 g, Mohanlian (Eclipta) 30 g, Nüzhenzi (Ligustrum fruit) 10 g, Shayuanzi (Astragalus complanatus seed) 10 g, Tusizi (Cuscuta seed) 10 g.Following my regimen of small, frequent doses for three days, the patient hematemesis stopped, his stools turned yellow, and his strength improved somewhat. He then adjusted the medication as instructed and entered the consolidation phase.Let me explain why I medicated the patient this way. Gastric hemorrhage is a life-threatening critical condition, and stopping the bleeding by conventional dosing is very difficult. If Yunnan Baiyao and Baiji are given in one large dose, the patient is especially prone to thrombosis, which can trigger sudden cardiac death. Giving small doses frequently ensures continuous medicinal effect while avoiding the side effects of high-dose hemostatics. Thus the therapeutic effect is ideal with few side effects. Clinically difficult major illnesses must be treated flexibly according to the actual situation.Although the cause of this patient gastric hemorrhage was investigated by both the University of Hong Kong-Shenzhen Hospital and Shenzhen Second People Hospital, no clear cause has been found to date—it is a difficult, complicated case. In TCM it can be classified as overthinking injuring the spleen, a pattern of the spleen failing to govern the blood. Hence, after emergency hemostasis, I treated him with Guipi Tang. The prescription I drew up combines Guipi Tang, Danggui Buxue Tang and Erzhi Wan, with additions of Xianhecao, Shayuanzi and Tusizi, and uses Jiaomaiya to open the appetite, improve eating, and promote recovery.