

From [Fanlore on the topic](https://fanlore.org/wiki/Hanahaki_Disease):

> The Hanahaki Disease trope was popularized with the Japanese shoujo
> manga,「花吐き乙女」(Hanahaki Otome), or The Girl Who Spit Flowers by Naoko Matsuda
> (松田奈緒子), which was released in 2009. The symptoms of the disease are
> summarized to strong pain, having flowers blooming in the heart and lungs,
> and then throwing them up.
>
> However, among East Asian (Japanese and Korean especially) fans and
> creators, the concept of flower regurgitation due to unrequited love dates
> to before Hanahaki Otome's release. Its true origins are currently unknown.

* * *

Can anyone find an instance earlier than 2009, and maybe find the earliest?

Why am I asking? Because [TVTropes is talking about
it.](https://tvtropes.org/pmwiki/discussion.php?id=qm0j15eo2tkdba6oiyal71q6)

Expect your answers to go there...

And, [KnowYourMeme](https://knowyourmeme.com/search?q=Hanahaki) isn't giving
me anything about Hanahaki Disease.

[Urban Dictionary's
entry](https://www.urbandictionary.com/define.php?term=Hanahaki%20Disease) is
like, from 2018? Way too late.


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Oldest instance of Hanahaki Disease?