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Fig. 10-3 Types of blood disease patterns

There are deficiency patterns and stasis patterns as well as blood heat and blood cold patterns in blood disorders as shown in Fig. 10-3.

Blood Deficiency Patterns
血虚证类

There are two main deficiency patterns of blood disease: blood deficiency and blood collapse.

Blood deficiency pattern arises when blood is deficient and therefore fails to nourish the organs and tissues. This pattern is marked by pale or sallow complexion, pale lips and nails, dizziness, dimmed vision, palpitation, numbness of the extremities and fine pulse.

Clinically, there are liver blood deficiency pattern, heart blood deficiency pattern, and heart-liver blood deficiency pattern.

Blood collapse pattern is a critical pattern occurring in cases of acute massive bleeding, marked by pallor, dizziness, palpitations, faint and short breathing, cold extremities and perhaps mental confusion, pale tongue, hollow pulse or hardly perceptible pulse.

Blood collapse failing to nourish the face results in pallor, failing to nourish the head results in dizziness, confusion and even fainting, failing to nourish the heart causes palpitation, failing to nourish the lungs gives rise to short breathing, failing to nourish the face and tongue gives rise to pallor and pale tongue. Yang qi collapse after bleeding gives rise to cold extremities. Collapsed blood is unable to fill in the vessels, resulting in hollow pulse or hardly perceptible pulse.

Blood Stasis Pattern
血瘀证

Blood stasis pattern is marked by formation of a visible painful and tender purple mass, or abdominal mass with stabbing pain and tenderness, or bleeding of dark purple blood with clots, dark purple tongue, and fine choppy or irregular pulse.

If blood stasis takes place under the skin or in the muscles, it may form a mass which is visible. Purple is the color of static blood. Blood mass impairs the surrounding tissue and therefore causes pain. Pressure on the blood mass causes more damage to the surrounding tissue, hence, tenderness occurs. If blood stasis occurs in the abdomen, it causes abdominal mass with pain and tenderness. Stabbing pain is the characteristic of blood stasis. Static blood causes blood to flow out of the vessels, resulting in bleeding of dark purple blood with clots, as can occur in menstruation in women. Dark purple tongue and fine choppy or irregular pulse are signs of blood stasis.

Blood Cold Pattern
血寒证

Blood cold pattern arises when congealing cold and qi stagnation inhibit blood movement. This condition is commonly manifested by cold pain of the extremities with dark purple skin or cramps* in the lesser abdomen that are relieved by warmth and exacerbated* by cold, delayed menstruation and dark purple menstrual discharge with blood clots, white tongue coating and sunken, slow and choppy pulse.

This pattern is usually caused by either externally contracted cold or deficiency cold.

Cold congeals and leads to cramps, and cold inducing blood stasis results in cold pain which can be relieved by warmth and exacerbated by cold; blood cold causes blood to flow slowly, giving rise to dark purple skin color. Extremities and lesser abdomen are apt to be affected by cold; therefore, blood cold is usually manifested by cold pain of the extremities and lesser abdomen with dark purple skin. Delayed menstruation and dark purple menstrual discharge with blood clots are due to cold congealing in the uterus. White tongue coating and sunken, slow and choppy pulse are signs of internal cold.

Blood Heat Pattern
血热证

Blood heat pattern occurs when exuberant pathogenic heat enters the blood aspect and makes the blood flow frenetically. This condition is manifested by fever, nose-bleeds, vomiting of blood, expectoration* of blood, bloody stool, skin eruptions, or advanced periods with profuse bright-red menstrual discharge, vexation, or even delirium* and convulsions, deep crimson tongue and rapid string-like pulse.

Heat in the body gives rise to fever. Heat in the blood makes the blood flow frenetically resulting in various bleeding: heat impairing lung collateral causes hemoptysis, impairing stomach collaterals causes hematemesis, impairing kidney or bladder collaterals causes hematuria*, impairing large intestine collaterals causes hematochezia, impairing thoroughfare and conception vessels causes advanced, bright and profuse menstruation, and impairing nasal collaterals causes epistaxis. Heat harasses heart spirit causing vexation, or even delirium. When interior wind is stirred up by heat, convulsions may occur.

Physically, qi and blood depend on each other for their existence and promote each other for their functions. Pathologically, qi and blood affect each other; a blood disorder may involve qi and vice versa, resulting in dual disease of qi and blood. Pattern differentiation of dual disease of qi and blood means that the practitioner must categorize patterns according to the pathological state associated with both qi and blood. Dual disease of qi and blood has many patterns, such as pattern of dual deficiency of qi and blood, pattern of qi failing to control the blood*, and pattern of qi collapse following bleeding*.