Bleeding

Also blood spillage. The escape of blood from vessels. Bleeding that is not due to external injury is called spontaneous bleeding or spontaneous external bleeding.

Severe bleeding, often referred to as blood desertion or blood collapse, causes qì desertion, resulting in a condition that is called qì deserting with blood. Extravasated blood within the body, sometimes called dead blood, is one form of blood stasis.

Location: Spontaneous bleeding, that is, bleeding from causes other than injury, takes the following forms:

• nosebleed;
• coughing of blood;
• vomiting of blood;
• flooding and spotting (that is, heavy or light bleeding via the vagina outside menstrual periods) or profuse menstruation;
• bloody urine;
• bloody stool;
• spontaneous bleeding of the flesh, the tongue, gums, nipples, or ears.

Pathogenesis

• External injury with damage to the blood vessels.
• Fire-heat: Evil heat resulting from external contractions or fire resulting from the transformation of depressed qì causes frenetic movement of hot blood. Counterflow ascent of fire qì can force blood upward, giving rise to vomiting of blood, expectoration of blood, or nosebleed.
• Yīn vacuity with effulgent fire damaging the vessels. Yīn vacuity with heat is not normally associated with bleeding. However, when the heat is severe (effulgent fire), bleeding may occur.
• Blood stasis: Static blood blocking the vessels and preventing the blood from pursuing its normal courses.
• Qì vacuity: Spleen failing to control the blood (qì failing to contain the blood) gives rise to chronic bleeding (bloody stool, bloody urine, vomiting of blood, nosebleed, flooding and spotting).

Further developments

• Qì and blood vacuity: Bleeding causes blood vacuity, which deprives qì of nourishment, giving rise to dual vacuity of qì and blood, also called qì-blood vacuity. This can, in turn, affect the functioning of the bowels and viscera.
• Blood desertion: Severe bleeding, often referred to as blood desertion, causes qì desertion, resulting in a condition that is called qì deserting with blood (气随血脱 qì suí xuè tuō). In severe cases, qì deserting with blood can cause the severance of yīn and yáng, which bodes death.
• Blood stasis: Extravasated blood, sometimes called dead blood (死血 sǐ xuè), is a consequence of blood stasis.

Treatment: Methods vary according to cause. See blood heat and blood stasis and spleen failing to control the blood.