Diagnosis and Treatment of Upper Gastrointestinal Bleeding in TCM
Upper gastrointestinal bleeding refers to bleeding from the esophagus, stomach, duodenum, the jejunum after gastrojejunostomy, the pancreas, or the biliary tract above the ligament of Treitz. Clinically it is mainly detected through hematemesis and melena. Patients losing less than 500 mL have mild bleeding, with black stools, dizziness, palpitations, and chills, and no significant change in hemoglobin. Patients losing 500–1000 mL have moderate bleeding, with loose black stools, hematemesis, vertigo or syncope, palpitations, and a rapid pulse, with hemoglobin of 70–100 g/L. Losses exceeding 1000 mL are severe bleeding: patients have frequent hematemesis and melena, vertigo and palpitations, dry mouth, scanty urine, falling blood pressure, cold limbs, sweating, and even coma, with a faint, fine pulse.
The causes of upper gastrointestinal bleeding are complex—some due to tumors, others to other diseases. Whatever the cause, once upper gastrointestinal bleeding occurs, the urgent priority is to stop the bleeding and rapidly restore the patient's strength, then treat the underlying cause. Upper GI bleeding is usually a signal of a serious disease; patients who can should undergo gastroscopy as soon as possible to identify the cause.
TCM has many formulas and herbs for upper GI bleeding, but skill is needed to make them work well. I once read a case record: a Republican-era physician treated an elderly monk with GI bleeding using Yunnan Baiyao, but in an unusual way. He had the patient take 0.5 g every half hour. With such frequent small doses, although the total dose was small, the hemostatic effect was excellent.
I have repeatedly tried this hemostatic method and it has consistently worked. But I myself prefer to decoct Bletilla (baiji) as a tea or take Bletilla powder, 1–3 g each time, every half hour to hour; the hemostatic effect is quite marked. Bletilla stops bleeding faster than Yunnan Baiyao. But whether using Yunnan Baiyao or Bletilla, one must closely watch for thrombotic symptoms. Patients with preexisting cerebral thrombosis or coronary heart disease need even closer observation for adverse reactions. Usually, while treating gastric bleeding, a proton-pump inhibitor (such as omeprazole or lansoprazole) should also be used to suppress acid; without acid suppression, bleeding is hard to stop with hemostatic drugs alone.
When should the dose of hemostatics be reduced or stopped? Watch the patient's stools closely: if stools change from black to yellow, bleeding has stopped. At that point, hemostatics may be taken according to the package insert to consolidate the effect.
Patients who have lost too much blood decline rapidly. At such times, consider giving Duzhen Tang (Lone Ginseng Decoction) for emergency rescue; in it, ginseng may be used at up to 30 g per day. Ginseng may also be ground to a fine powder and swallowed, 1–3 g each time, frequently; this often rapidly restores strength. Once strength recovers, consider treating according to the specific underlying cause to control the disease causing the upper GI bleeding.