Blood heat

Also frenetic movement of hot blood (血热妄行 xuè rè wàng xíng).

A disease pattern chiefly characterized by acute copious bleeding with bright-red blood; maculopapular eruptions; sores; vexation and agitation.

Description: Red eyes and tongue; heart vexation, agitation, insomnia, and in severe cases manic derangement or clouded spirit with delirious speech; nosebleed, coughing of blood, vomiting of blood, bloody urine, bloody stool, profuse menstruation, flooding and spotting; sores or welling-abscesses; generalized heat effusion more pronounced at night; thirst without great intake of fluids; short voidings of yellow urine. The tongue is crimson. The pulse is rapid or racing.

Diseases: Bleeding; warm disease; sores.

Biomedical correspondence: anaphylactoid and thrombocytopenic purpura; aplastic anemia; leukemia.

Pathogenesis: Fire-heat causing the blood to move frenetically and in severe cases causing blood to extravasate. The fire-heat takes the form of either

• warm-heat evil heat entering provisioning-blood in warm heat disease or heat resulting from the transformation of cold evil entering the interior; or
• fire resulting from the transformation of depressed qì caused by excesses of the seven affects, from yīn vacuity, or from excessive consumption of hot, acrid, drying foods.

Analysis of signs

• Bleeding: Heat forcing the blood to move more quickly causes extravasation. This is called frenetic movement of hot blood. It can manifest in vomiting of blood, coughing of blood, nosebleed, bloody stool, and bloody urine; or flooding and spotting. More under bleeding.
• Maculopapular eruption: In warm disease, intense provisioning heat can cause macules, which are attributable to subcutaneous bleeding, or rashes (papular eruptions) when it thrusts outward at the fleshy exterior.
• Blood stasis: When the blood is boiled by heat, blood stasis can develop. This can exacerbate the tendency to bleeding.
• Spirit: Blood heat can harass the spirit, causing vexation and agitation or manic derangement.
• Damage to yīn humor: Thirst and short voidings of yellow urine. If yīn blood is affected, there may be itchy skin.
• Tongue: A crimson tongue (i.e., deep-red tongue body) reflects the severity of the heat.
• Eyes: Red eyes reflect congestion in the small vessels of the eyes.
• Pulse: A rapid or racing pulse reflects the increased movement due to heat.

Specific forms

• Heat entering provisioning-blood in warm-heat disease: Generalized heat that is more pronounced at night; heart vexation and sleeplessness; thirst; faint maculopapular eruptions; red or crimson tongue; and a pulse that is rapid and fine. In severe cases, there is clouded spirit with delirious speech, frenetic movement of hot blood (vomiting of blood, nosebleed, blood in the stool, or pronounced macules), and a deep crimson tongue.
• Frenetic movement of hot blood in miscellaneous disease: Vomiting of blood; expectoration of blood; bloody stool; bloody urine; nosebleed; profuse menstruation; advanced menstruation; and flooding and spotting. Bleeding is often profuse, and the blood is either bright red or purple-black in color. General signs include heart vexation, thirst, red or deep-red tongue, and a rapid pulse.

Further development: Blood stasis; damage to yīn-blood.

Treatment

Medicinal therapy: Cool the blood, clear heat, and resolve toxin using medicinals such as dried/fresh rehmannia (Rehmanniae Radix Exsiccata seu Recens, 生地黄 shēng dì huáng), fresh imperata (Imperatae Rhizoma Recens, 鲜茅根 xiān máo gēn), arnebia/lithospermum (Arnebiae/Lithospermi Radix, 紫草 zǐ cǎo), moutan (Moutan Cortex, 牡丹皮 mǔ dān pí), red peony (Paeoniae Radix Rubra, 赤芍药 chì sháo yào), typha pollen (Typhae Pollen, 蒲黄 pú huáng), sanguisorba (Sanguisorbae Radix, 地榆 dì yú), and field thistle (Cirsii Herba, 小蓟 xiǎo jì).

Among commonly used formulas, Rhinoceros Horn and Rehmannia Decoction (犀角地黄汤 xī jiǎo dì huáng tāng) treats blood heat with generalized signs such as clouded spirit, delirious mania, red or crimson tongue, and maculopapular eruptions, whereas Field Thistle Drink (小蓟饮子 xiǎo jì yǐn zi) is a general blood-cooling blood-stanching formula.

Acumoxatherapy: The following points are considered to clear heat and cool the blood: KI-2 (Blazing Valley, 然谷 rán gǔ), LR-2 (Moving Between, 行间 xíng jiān), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), SP-10 (Sea of Blood, 血海 xuè hǎi), PC-7 (Great Mound, 大陵 dà líng), HT-7 (Spirit Gate, 神门 shén mén), PC-3 (Marsh at the Bend, 曲泽 qū zé), and BL-17 (Diaphragm Transport, 膈俞 gé shù). Needle with drainage or with even supplementation and drainage. For exuberant heat, prick and bleed with a three-edged needle. When blood heat scorches the vessels causing extravasation of the blood, points such as PC-7 (Great Mound, 大陵 dà líng), PC-4 (Cleft Gate, 郄门 xī mén), LU-6 (Collection Hole, 孔最 kǒng zuì), LU-9 (Great Abyss, 太渊 tài yuān), KI-3 (Great Ravine, 太溪 tài xī), LR-3 (Supreme Surge, 太冲 tài chōng), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), SP-1 (Hidden White, 隐白 yǐn bái), and ST-44 (Inner Court, 内庭 nèi tíng) can be drained to clear heat and stanch bleeding.