Hemoptysis

Blood sometimes comes out in saliva then it oozes out from parts of the mouth, sometimes it comes out when blowing the nose and coughing and oozes from the throat area, and sometimes it comes out when coughing and oozes out of the tube. It happens that blood comes out when vomiting, then it oozes from the esophagus or from the stomach or from the liver, and sometimes it comes out with a cough and oozes from the chest and lungs. Bleeding from the chest is not as dangerous as bleeding from the lungs, because bleeding from the chest goes away quickly, and if it does not go away, it does not have the harmfulness of an ulcer in the lungs. The latter often turns into an ulcer with a fistula, which constantly forms again and is accompanied by hemoptysis.

The immediate cause of all this is a wound due to some external circumstance, for example, a blow or fall on the chest, on the liver or on the abdominal obstruction, or from something cutting, or persistent cough, from screaming, from raising the voice without gradualness, or from irritation. Therefore, such hemoptysis is often observed in people possessed by demons and in people who get irritated for any reason. Sometimes hemoptysis occurs from violent vomiting, especially in people predisposed to it, and sometimes it begins after taking acute laxatives or pungent foods like garlic and onions, or from fear or grief that makes the blood pungent, or from sleeping on an uneven bed, or from a leech stuck to the inside of the throat, as well as from some connecting cause.

Such a cause is either rooted in the vessels, or is located outside the vessels. The reason rooted in the vessels is either rupture, or splitting, or opening and expansion due to the pungency of the juice, or relaxation, or corroding by the pungent juice, or the thinness of the vessels, facilitating the leakage of blood. Often, the passages between the parts of the tube and the arteries become wider than normal, allowing blood to leak into the tube.

As for the causes outside the vessels, it is either a wound or an ulcer from a wound or from corrosion and decay, if something has ruptured in the organ. Sometimes hemoptysis occurs due to a bloody tumor in the breastGfrom which blood seeps. Such a tumor is benign, because it is bloody and exudes matter, and does not retain it, and the matter in it is not thick. All these causes, with the exception of leeches, are also found in the lungs. These connecting causes have causes that precede them, such as the abundance of blood matter, which arises either from eating abundantly and stopping exercise, or from the quantity of blood exceeding the natural supply. This happens, as we established in the Book of General Issues, as a result of cessation of physical exercise or as a result of delayed bleeding during menstruation, with a kidney injury or with a cut of any organ. This also happens due to attracting blood matter to certain organs due to its increased movement or due to the presence of winds in the vessels that tear them, especially in lean people; This happens to them often. The cause of excess blood flow is the predisposition of the organs containing blood, which arises from the cold, compressing them and making it difficult for them to expand, so that these organs, subject to the compelling force, do not stretch, but rupture. This also happens from heat, external or internal, or from dryness. Any of these qualities predisposes the vessels, condensing and drying them out, to rupture from the most insignificant reason and, among other things, from moisture, which loosens them and expands their mouths. This also happens from contact with something that tears, corrodes or causes rotting.

When an overflow of blood occurs, then nature begins to drive matter in the direction where it is possible, since the organs in this side are more adapted to the eruption of excess or are closer to the place of their eruption, and expels it by hemoptysis or effusion from the kidney cones or in the form menstruation or nosebleeds. If the vessels are strong and are not freed from blood, then sudden death occurs due to the outpouring of blood in the cavities of the vessels.

A person who experiences hemoptysis is at risk of developing an ulcer in the lungs, because hemoptysis most often occurs from a wound, and a wound easily turns into an ulcer. If, after the cessation of hemoptysis, it begins again, then it can be feared that this secondary hemoptysis is due to the ulcer into which the original wound has turned.

It often happens that the patient coughs up blood, which, when bleeding from the nose, goes from the head to the lungs. When blood oozes from the lung area during hemoptysis, there is a twofold danger associated with this: the danger of excessive bleeding and the danger that the wound in the lungs will turn into an ulcer. Not all hemoptysis is dangerous, but only those that cannot be stopped, or those that cause fever. Hemoptysis is often the reason for curing a tumor in the liver or spleen.

Signs. Blood that is close to the larynx is coughed up with a slight cough, while blood that is far from the larynx is coughed up. with a strong cough. The further away the blood, the stronger the cough that accompanies hemoptysis. When they lie on the side where the cause of the disease is rooted, the amount of blood expectorated increases. You should first look carefully to see if the blood that the patient is coughing up is coming from the nose. This is recognized by the fact that nosebleeds in this patient are habitual and occur frequently, and heaviness in the head after bleeding is replaced by lightness. Signs of a nosebleed include, for example, redness of the face and eyes, lightning in front of the eyes, and blood that does not foam and comes out all at once.

And a sign of bleeding from the flesh of the lungs due to a wound or ulcer is that the blood foams, that it flows intermittently and that there is no pain. Such bleeding is less in quantity than bleeding from a vessel, but it is more dangerous and malignant in its consequences. Sometimes patients with pleurisy and pneumonia cough up foamy blood if they have a fiery heat in their lungs, causing the blood to boil. Sometimes foamy blood comes from the pulmonary tube, but it appears with expectoration of sputum and a slight cough; however, the amount of discharge is also not large and there is some sensation of pain.

The substance expectorated from the vessels of the tube does not foam; it is hotter and thicker in composition than the blood in the lungs, and more similar to healthy blood, although not as thick as the blood in the chest. Signs of bleeding from the chest are black color, density and thickness of the blood due to the distance from the chest to the throat, as well as some foaminess and scale and a feeling of pain in the chest, indicating the location of the disease; this is reinforced by the fact that the pain intensifies when lying on the sore spot; The cause of pain is the abundance of nerves in the chest organs. Blood is released little by little, not continuously; hemoptysis is accompanied by a strong cough that lasts until it ends.

A sign of hemoptysis from a ruptured vessel is an abundance of blood, and a sign of corrosion is that hemoptysis was preceded by causes that cause corrosion, for example, ingestion of caustic substances and the descent of caustic catarrhs, as well as the presence of fever and expectoration of pus and films or particles of the lung, and expectoration the phlegm is like meat juice. The blood comes out little by little at first, then sometimes it breaks out all at once, and the patient coughs up a fair amount of blood of a bad color.

Signs of opening of the mouths of blood vessels from overflow are a complete absence of pain and the fact that expectoration causes a feeling of relief and well-being; At first, less blood comes out than at the beginning of hemoptysis from rupture or opening of blood vessels, but in most cases there is more of it than with hemoptysis from corrosion. A sign that blood is leaking from the tumor is a small amount of it and the presence of signs of inflammation of the lungs and other organs.

Treatment. If a patient coughs up blood constantly, then you need to monitor the degree to which his body is filled with juices. Whenever overflow is noticed, he should be bled as soon as possible, especially if his chest is naturally narrow or he is overcome by a persistent cough. It is best to direct the blood in such patients to the lower half of the body, first opening the jugular vein, and then opening the basil. If women experience the expiration of menstruation at such a time, and in sufficient quantity, then their hemoptysis stops, just as it sometimes occurs when menstruation is delayed. You should beware of everything that sets the blood in motion, for example, intoxicating drugs and foods, jumping, screaming, irritation, copulation, deep breaths: you should not talk a lot, look at anything red, drink a lot of wine and go to the bathhouse often. A person suffering from hemoptysis should avoid opening medicines, for example, celery, sabur, sesame, wine and old cheese, because they are harmful to such patients, while fresh is beneficial. Suitable food for them is everything that glues and clogs, everything that grows together, and everything that cools the blood and prevents it from boiling. This includes boiled milk for its adhesive properties, and cow's buttermilk for its astringent properties, as well as butter, fresh, unsalted cheese, astringent fruits and a type of small plum with astringent properties. Freshly squeezed oil from unripe olives is sometimes used to flavor food such large ones. Alum water is very beneficial for them. As for bleeding from the body of the lungs itself, the patient is given dry healing medicines to drink, for example, clay or bloodstone with plantain juice and vinegar diluted with water.

As for treatment measures, in addition to diet, you should quickly bleed the basil from the side where, as is suspected, the disintegration of the whole occurred; Bloodletting is done with a narrow incision and blood is taken several times, at intervals of three hours or so, taking into account the patient’s state of strength. Bloodletting diverts blood in another direction and also prevents the formation of tumors and wounds. Such patients have their limbs rubbed and bandaged tightly, starting from top to bottom, and they are prohibited from doing everything mentioned above. The air in their room should be balanced and they should lie on their side or sit almost upright so that some parts of the chest do not press on others. Sometimes it helps to give them vinegar diluted with water: it prevents bleeding and clears the chest and lungs of blood if it lingers there, but does not thicken it. They also drink cold and adhesive potions, for gluing here is the first thing that should be done; if, along with gluing, cleansing also occurs, then this is the limit of what is desired. Flea plantain helps such patients with its cooling effect when severe thirst is felt.

It is often necessary to add substances that cause numbness to medications, and this is done for two reasons: firstly, to calm the blood and make it liquid, and, secondly, to euthanize the patient so that he stops moving. We will also mention general medications for various types of hemoptysis at the end of this paragraph. If hemoptysis occurs as a result of catarrh and the catarrh is not very acrid and not yellow-billed, you immediately bleed from the vessels of the legs and bandage his legs, going down from top to bottom, and also rub them with hot olive oil or other hot oils, for example, mad cucumber oil or like him, but the head is not oiled at all.

Such patients are fed food in the form of wheat stew with something tart. These tart condiments are made  from fruits or something similar. If they are weak, they are fed bread soaked in vinegar diluted with cold water; Sharp enemas are also used to divert matter from the head area, especially if bleeding cannot be allowed due to some obstacle. You should try to cool your head as much as possible without making strenuous efforts to moisturize it. One of the useful remedies for such a patient is to give him amber cakes to drink. And if everything that we mentioned does not work, then it is inevitable to treat catarrh and delay it by shaving the head, using medicinal bandages with pigeon feces, which are applied and removed, depending on need.

Galen says that one woman had bleeding from catarrh, and he gave her a sharp enema. He did this mainly because it was impossible to use bloodletting, since the patient had been coughing up blood for four days and was very weak. Galen fed her harira and slightly astringent fruits, and she had not eaten anything for a long time, and anointed her head with a medicine made from pigeon feces; he allowed the patient to go to the bathhouse because of this medicine and did not anoint her head with oil so as not to moisten it. Then he gave her fresh teryak to drink to put her to sleep. This is teryak with strong opium, which puts you to sleep, stops the tickling from coughing and somewhat calms the flow of matter, thickening it. And on the second day after this treatment, Galen did not force the patient to move, but, on the contrary, left her to lie calm and motionless, although it was necessary to cleanse her lungs, and the most he did with her was rubbing her limbs; in addition, he again gave her a drink of fresh teriya, less than the day before: his goal was to gradually accustom the patient to honey in order to cleanse her lungs. After this he left her alone, then began to rub her again and then gave her barley water and some bread to revive her strength. On the fourth day, he gave this woman old teriyak with a lot of honey in order to greatly cleanse her lungs, and in the following days he nourished her properly, applying the convalescent regimen to her. At the same time, from time to time he smeared her head with wax ointment with tapsia and did not allow her to go to the bathhouse. This is an excellent method of treatment, and teryak should be kept for two to four months: it lulls and delays catarrh. Oil should not be brought near the head of such patients; When using medications that cause redness, it is necessary to shave the head, even for women. It is also impossible to avoid loosening the stomach, for example, with kukaya pills, if there is an abundance of matter; this should be done  after bloodletting and then continuously use medications that cause redness.

In case of hemoptysis due to opening or rupture of a vessel, the cause of which is overflow, the patient should, as far as possible, not feed; on the contrary, let him fast for three days, limiting himself during this time to eating a small amount of something viscous every day. If there is no loss of strength, then nutrition, if possible, is postponed until the fourth day, and if there is a fear that strength will drop, and a serious fear at that, then the patient is fed with substances that produce juice that is moderately warm or cold, and at the same time glues and imparts viscosity, and also having the property of binding and, especially, thickening the blood. Examples include harissa with cow feet, animal heads, soft-boiled eggs, noodles, especially those cooked with lentils, or lentils with jujube. If it is possible not to feed highly nutritious food, then they do so, limiting themselves to barley water, especially boiled with lentils, jujube or quince, or bread soaked in cold water or in something sour or sour, and all this should be cold in practice. Cow buttermilk, if the illness has prolonged, is useful for its astringent properties and coldness. Boiled milk is useful in this case due to its adhesive properties and stickiness, but unboiled milk increases the amount of blood and is harmful.

Fish from reservoirs with rocky bottoms is very helpful for such patients. It is appropriate that the food of such patients or those who will be discussed below should be cold in fact. Fresh, unsalted cheese is very beneficial for them. And if you feed such a sick person and others like him with meat, then choose meat that has little blood, dry and light, such as the meat of doves, khat and turkey, boiled with astringent and tart substances. One of the proven measures to stop hemoptysis is chewing purslane and swallowing its juice; sometimes this stops the hemoptysis immediately. Fruits that are useful are quince and apples, astringent and tart, fresh jujube, as well as the seeds of myrtle, Syrian horns and what is similar to them. Sometimes for such patients a snack is prepared from printed and Armenian clay with acacia gum and a small amount of camphor.

When the bleeding stops and the illness reaches the fourth day, the patient should be intensively nourished and strengthened. Start, for example, with bread soaked in water, or with the heads and legs of animals and their brains. If hemoptysis occurs as a result of the opening and rupture of a vessel due to the acuteness of the blood, then it is treated as follows: do what follows in relation to the deviation of the blood to the extremities, in the opposite direction from the lungs, and remove the yellow bile, and then strongly cool and moisturize it. They also use astringents and adhesives, barley water, crayfish, pumpkin, Andromache medicine and Galen medicine.

If hemoptysis began as a result of the opening of blood vessels, then the drugs that should be used are astringent and tart and at the same time adhesive, just as with the previous type of hemoptysis, adhesive, adhesive and, moreover, astringent drugs were required. And medicines that are useful for hemoptysis due to vasodilation are, for example, pomegranate flower, pomegranate flower calyxes, sumac, squeezed tarasis juice, squeezed juice of grape stems, acorns, buckthorn leaves, amber, acacia, khudad, squeezed rose juice, squeezed juice “ shepherd's staff", tartar, squeezed juice of unripe grapes and hiyufastidas. Sometimes these substances and what is made from them are strengthened with alum, ink nuts, sabur and wormwood and form complex medicines; lozenges intended for diseases of this kind are sometimes prepared from the medicines mentioned. Often these medicines are boiled in clean water or in some squeezed juices and the decoction is drunk, and sometimes medicinal dressings are made from them. To these medicines and in general to all the mentioned medicines for hemoptysis, as well as to chest medicines, they mix, for example, celery, azhgon, anise, sumbul, ramik, or add to them substances that cause numbness, for example, mandrake root bark, henbane, poppy soporific . They also add adhesives, such as gum, incense seeds, Samos star, bamboo concretions, plantain seeds, flea plantain mucilage and its seeds, squeezed purslane juice, quince seed mucilage. And if expectorated blood oozes from the tumor, then the method of treatment is to bleed, empty and then bring the tumor to maturity. Such hemoptysis is not treated with astringents, because this entails great danger; on the contrary, it should be treated as pneumonia is treated.

As for hemoptysis resulting from corrosion, its treatment is difficult, difficult and seemingly hopeless, for it is healed and the ulcer heals only when the disorder of nature disappears, and this happens only during a period during which the ulcer either hardens or rots . However, sometimes it is beneficial if the corrosive principle is not allowed to strengthen and the hot juice is removed. Often yellow bile and thick matter are removed simultaneously using, for example, agaric pills; if you need to strengthen this medicine, strengthen it and try to calm the tickling cough with medicine from the seeds; one hopes it will be of some benefit. In general, the treatment of such patients consists of cleansing through defecation, bloodletting and other measures, as well as nutrition with substances that produce good chyme. Sometimes frankincense, myrrh, great plantain, purslane seed, marshmallow root, “star” cakes with the addition of half a part of opium, as well as complex medicines that Paul speaks of and which are mentioned in the Pharmacopoeia, heal corrosive ulcers. The most useful of their medicines are those that include bloodstone, dragon's blood, amber, sandarac, printed clay and in general everything that dries, glues and splices.

As for bleeding from the chest, it is treated with medicinal bandages and medicines in which there is a rarefied substance, or they are given with them a rarefied substance mixed with them, we have already mentioned these medicines, so that the medicine can reach the chest; Mountain basil juice combines both of these properties. If it is suspected that the cause of hemoptysis is heat, then all the mentioned drugs are suitable, and if it is suspected that the cause is cold, which caused hemoptysis in the manner mentioned above, then its treatment, as Galen says, is as follows: if hemoptysis affects a young man, then he is treated, opening the blood on the first day and on the second day, and also rub the patient’s limbs and bandage them as should be done to stop any bleeding. Then he is fed some stew and a proper medicinal bandage with waxy thapsia ointment is placed on his chest. In the evening, the bandage is removed so that the warming does not exceed the desired degree, then the patient is again fed the stew and given medicines from the seeds. On the third day, this bandage with wax ointment is applied to the chest for three hours, then it is removed and the patient is given barley water and isfidbaj with duck meat. When the nature of the lung becomes balanced and the danger that a tumor will form has passed, the patient’s lungs are cleansed with old, full-fledged teriyak and gradually accustom him to donkey milk and, in general, to the regimen of coughing up blood. Galen claims that all such patients whom he captured on the first day recovered, but the others had different conditions. We have also seen patients who benefited from this or a similar method of treatment.

If it is assumed that the cause of hemoptysis is moisture and relaxation of the respiratory muscles, then substances with drying, warming and astringent properties are used: aromatic rush root, mastic, toasted cumin, mountain mint, kalkadis, beaver stream and saffron, which are given to swallow; sometimes moderately astringent drugs are mixed with them, such as chestnut, and sometimes complex drugs mentioned in the Pharmacopoeia are made from them. If they think that the cause of hemoptysis is dryness: and this happens most rarely, then known moisturizing agents are used, such as oils, milk of various animals and squeezed juices after taking general measures to divert the matter in the opposite direction. The appropriate bloodletting and other treatment measures in this case are smaller and weaker than what is done in other cases. When the cause is a blow to the liver, it is treated with such powders. Inscription: Chinese rhubarb ten, lakka five, Armenian clay five; They drink one and a half dirhams of this in crushed form at a time.

As for general medicines, simple medicines are written down in Book Two, under well-known headings. The medicine suitable for this case is bloodstone: if you grind it hard, turning it into a kind of dust, and drink one bowl with something astringent, or with squeezed juices, it brings the greatest benefit. Chewing purslane and swallowing its juice sometimes immediately stops hemoptysis. The juice of cucumber and its usar, especially with something adhesive and very astringent when swallowed little by little, as well as burnt deer antler when mixed with other medicines, are very useful, as is mint juice. Willow fruits in the amount of one dirham, coriander flowers three dirhams with cold water are also useful; drink morning and evening.

Corals also help a lot, as does Samos clay. They say that in Greek it is called “star of the earth”; it appears to be something other than talcum powder. And one more thing: they take the blood of a kid until it hardens, and give it to drink half a cue for three days in a row. They also give myrtle seeds or big plantain seeds two dirhams in an infusion of big plantain or in squeezed rose juice; this is extremely useful. Quince is also useful, especially fried. They also give kid rennet with rose water and other infusions, and they say they also give hare rennet and the rennet of other animals with a decoction of ink nuts or with basil juice, especially for chest hemoptysis, or printing clay, which is replaced by Samian clay with a small amount of vinegar.

They also eat sukutun. It is tenacious, but one person in the book he compiled claims that it is a type of basil that grows between rocks, and that it is ground and eaten with salt, and in Mosul it is supposedly called wild mandrake or wild apple. However, this is a controversial issue. This medicine is given to drink with an equal amount of starch. One of the useful remedies against hemoptysis is drinking Yemeni alum. They are extremely useful, especially with egg yolks that are warmed but not completely thickened. And one more thing: fish glue also helps if you give it to drink. If the situation has become difficult, then sometimes they give a quarter of a dirham of henbane seeds to drink with water sweetened with honey.

Medicines that inhibit hemoptysis should be given with tart wine so that they go away better, unless, of course, there is a fever. For fever, these medicines are given in some other squeezed juice.

For long-standing, chronic hemoptysis, use Nabatean leek seeds and myrtle seeds in equal quantities; this medicine is drunk up to two dirhams with squeezed juice of the “shepherd’s staff”. Either they take the squeezed juice of a Syrian leek, one uqiya, half a glass of vinegar and give the patient something to drink in the morning, or they give him a burnt sponge with a small amount of nabiz. Galen treated hemoptysis with terjak and mithridate, as well as medicines with a pleasant smell, which strengthen the nature in its desire to preserve blood and close wounds, as well as “star” lozenges and the medicine of Andromache. Centaury combines the inhibition of hemoptysis and cleansing of the lung; feverish patients should be given it with water, and others with wine. Saklabs treat hemoptysis with a decoction of centaury root.

For drinking medicines, give squeezed juice of large plantain, two dirhams, squeezed juice of cowwort, two dirhams, squeezed juice of purslane, squeezed juice of fresh rose stems, one uqiya; they are crushed without sprinkling with water, and the juice is filtered, but not boiled, but a little printed clay is diluted in it and given to drink.

Or they take the squeezed juice of rose stems and dilute the squeezed juice of hiyufastidas or bloodberry and deer antler in it and give it to drink. The following types of flatbreads are used: they take equal parts of acacia, pomegranate flowers, red rose, squeezed salsify juice, acorn husks, and incense peels. And one more thing: they take arsenic, luffah root bark, clay from Buheira, incense, akakiya, purslane seeds, mountain basil seeds, pomegranate flowers, camphor and prepare cakes from all this. At a time they drink two dirhams per half qi of water or tart wine or mountain basil juice. And one more thing: they take soporific poppy seeds, printed clay, hiyufastidas and camphor and give it to drink with mountain basil juice. And they also give you the flatbreads that Ibn Sarafiyun mentions; These are flatbreads made with almond tree gum. As for the oils used to lubricate the breasts, in summer it is quince oil, and in winter it is spikenard oil.

Excellent cakes: they take clay from Buheira, corals, “Samian star” and dry rose, two parts each, amber, gum, starch, one part each, mix and turn into cakes. Those with a fever drink four misqals at a time in astringent squeezed juices, and those who do not have a fever drink wine, especially astringent wine.

Common medicinal dressings include dressings made with barley flour, crushed frankincense and acacia with egg white.

When you stop the bleeding, then turn to healing the wound and try to prevent the formation of a tumor. a- the healing of wounds is achieved by gluing and astringent agents known to you, and the formation of a tumor is prevented by prohibiting abundant nutrition, diverting matter to the limbs and cooling the chest. The patient should swallow diluted vinegar several times; he should avoid the things mentioned above also after the hemoptysis has stopped and the doctor has attended to the wound healing.

As for the water that such patients drink, it should be rain water or water in which Armenian clay or roses were soaked. Ferrous water, in which iron has been quenched, is very useful due to its astringent properties. If there is any fear that the blood will thicken in the lungs, then the patient should be given vinegar diluted with water first, except in cases where there is a cough; then you should beware of vinegar. To thin the blood, half a dirham of turmeric and croton with some leek juice and a spoonful of sikanjubin are sometimes prescribed, and in this case, from complex medicines they give the following: boiled fenugreek two dirhams, aristolochia dirham, myrrh three dirhams, iris oil dirham, black pepper one, henbane one , roses two dirhams. All this is turned into flat cakes, dried in the shade and given to drink with fennel juice. They also take hare rennet or water with fig wood ash and thyme, or satara with honey, or cause laxation with evacuations from among the simple medicines that we talked about in Book Two, and the complex medicines mentioned in the Pharmacopoeia.