Zhang Xichun's 'Liver-Draining and Stomach-Descending Decoction' for Hematemesis (Mostly Gastric Bleeding)
Xiegan Jiangwei Tang (Liver-Draining and Stomach-Descending Decoction) comes from Zhang Xichun's Yixue Zhongzhong Canxi Lu (Records of Integrating Chinese and Western Medicine). Its composition is: raw Daizheshi (Hematitum) 8 qian (24 g), raw Hang Baishao (Hangzhou White Peony) 1 liang (30 g), raw Shijueming (Haliotidis Concha) 6 qian (18 g, crushed), Gualouren (Trichosanthes Seed) 4 qian (12 g, stir-fried, crushed), Gancao (Licorice) 4 qian (12 g), Longdancao (Gentian Root) 2 qian (6 g), Jing Qingdai (pure Indigo Naturalis) 2 qian (6 g). Decoct in water, strain, and take warm three times daily.
This formula drains the liver and descens counterflow. It is indicated for upward rebellion of liver-gallbladder fire presenting with hematemesis, epistaxis, a wiry, long, forceful pulse on the left, or distending pain under the ribs, or frequent retching. Judging from Zhang Xichun's description, the indication is gastric bleeding caused by peptic ulcer or gastric cancer, with bleeding volume above 500 ml.
In this formula, raw Daizheshi and raw Shijueming are both heavy, settling substances that descend counterflow. Daizheshi also clears liver and pacifies fire, cools the blood and stops bleeding; Shijueming pacifies the liver and clears heat, neutralizes acid and stops bleeding; Hang Baishao softens the liver and relieves pain; Gualouren widens the chest and moistens the intestines; Longdancao drains liver-gallbladder fire; Qingdai clears heat and resolves toxicity, cools the blood and stops bleeding. Combined, they provide symptomatic treatment for regurgitation and hematemesis due to gastric ulcer or gastric cancer.
Some patients with gastric bleeding also present with dry mouth, bitter taste, and constipation; for such cases one may add Chao Zhizi (stir-fried Gardenia) 12 g, raw Dahuang (Rhubarb) 6-15 g (added later), and Mangxiao (Mirabilite) 10-30 g (dissolved in the decoction). Gastric bleeding is an emergency; treatment must dare to use heavy doses, and the doses in Zhang Xichun's formula are indeed substantial.
Besides symptomatic treatment, patients with gastric bleeding should undergo urgent gastroscopy to determine the cause and arrange further treatment. If the bleeding is due to gastric cancer, this formula may briefly relieve symptoms but cannot control the progression of the malignancy; the patient needs further comprehensive treatment under a doctor's assessment.