Blood pattern identification

The process of diagnosing a morbid condition as a disease pattern of the blood.

Blood Signs and Diseases

Blood signs relate mostly to the complexion, condition of the skin, sensations of the flesh, and appearance of blood vessels. They include abdominal masses, which are considered a disease entity.

Pale-white facial complexion (面色蛋白 miàn sè dàn bái): A complexion lacking in color (as distinct from a bright-white or somber-white facial complexion). It is a sign of blood vacuity or dual vacuity of qì and blood.

Withered-yellow facial complexion (面色萎黄 miàn sè wěi huáng): A facial complexion the color of dry leaves. It is a sign of qì and blood vacuity that arises when the spleen fails to produce sufficient qì and blood.

Pain of fixed location (痛有定处 tòng yǒu dìng chù): Pain that is always in the same place. It is associated with blood stasis and external injuries. Pain due to blood stasis, referred to as stasis pain (瘀痛 yū tòng), is often described as stabbing pain (刺痛 cì tòng) or pain like the piercing of an awl (痛如锥刺 tòng rú zhuī cì). In the abdomen, it takes the form of gripping pain (绞痛 jiǎo tòng). Duller pain of fixed location also occurs in impediment (bì) patterns with prevalence of cold and dampness (cold impediment and damp impediment).

Bruises (瘀青 yù qīng): Local purple or green-blue coloring of the skin resulting from blood stasis caused by external injury.

Encrusted skin (肌肤甲错 jī fū jiǎ cuò): Coarse, dry, squamous skin. It is usually a sign of blood stasis with yīn vacuity and is often seen in sick elderly patients.

Stasis speckles on the tongue (舌有瘀点 shé yǒu yū diǎn): Small purple speckles on the upper or lower surface of the tongue. They are a sign of blood stasis.

Red thread marks (红缕赤痕 hóng lǚ chì hén): Small red markings on the surface of the skin composed of red thread-like lines up to a few millimeters long radiating from a central point. Red threat marks are a sign of blood amassment creating distension. They are called spider nevi in biomedicine.

Maculopapular eruption (斑疹 bān zhěn): Eruption of macules or papules. Macules are colored (usually red) patches that are not elevated above the surface of the skin and vary in size. A papular eruption is a rash, papules being elevations of the skin resembling like grains of millet in shape and size (or larger). Papular eruptions most commonly occur in externally contracted heat (febrile) diseases and indicate heat penetrating blood-provisioning.

Numbness and tingling of the limbs (肢体麻木 zhī tǐ má mù): Also called insensitivity (不仁 bù rén). Reduced or abnormal sensation in the skin and flesh. It is mainly attributed to liver blood vacuity depriving the network vessels of nourishment. Other causes include wind-cold entering the network vessels; qì stagnation and blood stasis; liver wind stirring internally; wind-phlegm obstructing the network vessels; and damp-heat.

Hypertonicity of the sinews (筋脉拘挛 jīn mài jū luán): Also called hypertonicity of the limbs (四肢拘急 sì zhī jū jí). Tension in the sinews marked by inhibited bending and stretching. It is attributed to liver blood vacuity; cold-damp; damp-heat; external contraction of wind-cold; exuberant heat; yáng collapse and humor desertion.

Abdominal mass (腹中有肿块 fù zhōng yǒu zhǒng kuài): Also called glomus lump (痞块 pǐ kuài). Any palpable lump in the abdomen. Abdominal mass and glomus lump are symptom names. As diseases, they are called concretions, conglomerations, accumulations, and gatherings.

Bleeding (出血 chū xuè): Bleeding results from (1) damage to the vessels by external injury; (2) blood stasis blocking the vessels so that pressure of blood flow causes them to burst; (3) blood heat causing increased pressure in the vessels (frenetic movement of hot blood); and (4) qì failing to retain the blood in the vessels (spleen failing to control the blood). Bleeding due to the last three causes includes nosebleed, vomiting of blood, expectoration of blood, flooding and spotting, bloody urine, and bloody stool. In older texts, the term spontaneous external bleeding (衄血 nǜ xuè) referred to bleeding of the flesh, bleeding from the ears, bleeding of the gums, bleeding from the nipple, bleeding of the tongue, and especially to nosebleed, the most common form. In modern texts, 衄血 nǜ xuè mostly refers to nosebleed, and in such cases we translate it as such.

Blood Patterns

Below is a brief description of the major blood disease patterns, with links to entries that provide more detail.

Simple Patterns

Blood vacuity (血虚 xuè xū): Pale lips; pale or withered-yellow complexion; dizzy head and flowery vision; heart palpitation and insomnia; pale tongue; and fine pulse. It is caused by loss of blood; failure of spleen qì to produce blood; enduring illness or taxation of the spirit; blood stasis preventing new blood from being engendered.

Blood dryness (血燥 xuè zào) is a variant form of blood vacuity that occurs when essence-blood is depleted in old age or when nutritional disturbances or stating blood binding internally reduce the nutritive power of the blood. Blood dryness manifests in emaciation, rough dry skin, in serious cases encrusted skin, brittle nails, lusterless hair, hard stool, and dry tongue.

Blood stasis (血瘀 xuè yū): Localized stabbing pain that refuses pressure, hard lumps, stasis speckles on the tongue. It is caused by qì stagnation or qì vacuity preventing adequate propulsion of the blood; phlegm or cold obstructing the blood; heat boiling the blood; damage to the vessels through external injury.

Blood heat (血热 xuè rè): Acute copious bleeding with bright colored blood; maculopapular eruptions; sores; vexation and agitation. It is caused by externally contracted heat; heat that arises when external evils transform into heat as they pass into the exterior; heat that arises when depressed qì transforms into fire; or vacuity heat attributable to yīn vacuity.

Blood cold (血寒 xuè hán): Localized severe cold pain relieved by warmth, possibly with swelling and green-blue or purple coloration of the skin. It is caused by externally contracted cold evil or vacuity cold arising internally.

Bleeding (出血 chū xuè): Bleeding is attributable to several causes: external injury; blood stasis; qì vacuity; blood heat (see above). When not attributable to external injury, it takes the form of nosebleed; coughing of blood; vomiting of blood; bloody urine; bloody stool; flooding and spotting; spontaneous external bleeding from the flesh.

Combined Patterns

Dual vacuity of qì and blood (气血两虚 qì xuè liǎng xū): Qì vacuity preventing blood from being produced or blood vacuity preventing qì from being produced. The signs are dizziness, scantness of breath, laziness to speak, lack of strength, spontaneous sweating, heart palpitation, insomnia, pale-white or withered-yellow facial complexion, pale nails, pale tongue, and a pulse that is fine and weak.

Qì vacuity and blood stasis (气虚血瘀 qì xū xuè yū): Lassitude of spirit and lack of strength; scantness of breath; laziness to speak; spontaneous sweating; with stabbing pain of fixed location in the chest and rib-side and possibly glomus lump under the rib-side; or hemiplegia. It arises when qì is insufficient to propel the blood adequately, causing blood to stagnate.

Qì stagnation and blood stasis (气滞血瘀 qì zhì xuè yū): Qì stagnation causing blood stasis. Distending pain or scurrying pain in the chest and rib-side; impatience, agitation, and irascibility; glomus lump under the rib-side with stabbing pain that refuses pressure and worsens at night. In women, it can take the form of menstrual pain with dark-purple clotted menstrual flow, and a pulse that is stringlike and rough. It arises when qì stagnates and cannot propel the blood adequately, giving rise to blood stasis, which in turn exacerbates the qì stagnation.

Qì deserting with blood (气随血脱 qì suí xuè tuō): Severe blood loss giving rise to qì desertion when the mutually complementary relationship of blood and qì breaks down. The bleeding may be attributable to external injury, digestive tract bleeding, flooding in women, or massive bleeding after childbirth. The signs are bleeding followed by the sudden appearance of somber-white complexion, great dripping sweating, reversal cold of the limbs, hasty panting or faint breathing, clouded spirit, and a fine pulse on the verge of expiration.

Dual vacuity of essence and blood (精气亏损 jīng qì kuī sǔn): Dizziness; tinnitus; lassitude of spirit; forgetfulness; thinning and loss of hair; scant semen in men; menstrual irregularities in women; and infertility of either sex. It is usually caused by enduring illness damaging liver blood and kidney essence.

Qì failing to contain blood (气不摄血 qì bù shè xuè): This is the same as spleen failing to control the blood. It can be regarded as a general qì pattern (rather than a spleen qì pattern) or, since it involves both qì and the blood, as a combined pattern.

Blood running counterflow with qì (血隋气逆 xuè suí qì nì): When qì ascends counterflow, it can carry blood with it. This happens with liver qì. The liver stores the blood and its qì upbears and effuses. When liver yáng is hyperactive, liver qì upbears more strongly than normal, which is called ascending counterflow. Liver qì ascending counterflow carries blood with it and can give rise to vomiting of blood or to clouding reversal.

Blood stasis causing liquid to collect (血瘀津停 xuè yū shuǐ tíng): Also called blood stasis causing water to collect (血瘀水停 xuè yū shuǐ tíng). Blood stasis causing obstruction of qì dynamic, which in turn hampers the movement of fluids, or water-rheum causing obstruction of qì dynamic, which in turn hampers the movement of blood. The resulting condition manifests in blood stasis signs on the one hand and phlegm-rheum or water swelling on the other.