Blood vacuity

A disease pattern chiefly characterized by pale lips; pale or withered-yellow complexion; dizziness; heart palpitation; insomnia; scant menstruation; pale tongue; and fine pulse.

Description: Decline in the blood’s ability to provide nourishment manifesting in white lusterless or withered-yellow complexion; pale lips and nails; dizzy head and vision; heart palpitation; insomnia; numbness and tingling; hypertonicity of the sinews; and in some cases, dry hair and dry skin. In women, there may be scant menstruation, delayed menstruation, or amenorrhea. The tongue is pale with white fur; the pulse is fine and forceless.

Pathogenesis: Insufficiency of the blood preventing it from adequately performing its nourishing functions. This results from the following factors:

• Inadequate production of blood: This is the most common cause of blood vacuity. Blood is primarily produced by the spleen and stomach. When the spleen and stomach are weak, they fail to produce enough blood. Blood vacuity in such cases is accompanied by qì vacuity, the dual pattern being called dual vacuity of qì and blood. Kidney essence is also a component of the blood, so depletion of kidney essence can also lead to blood vacuity. Furthermore, a decline in the qì transformation of the heart, lung, and liver can also lead to insufficient blood production.
• Loss of blood, as through vomiting of blood, nosebleed, profuse menstruation or flooding (heavy nonmenstrual bleeding via the vagina), or bleeding from external injury. This is sometimes referred to as blood collapse.
• Enduring illness or taxation of the spirit can cause wear and tear on the blood.
• Blood stasis (see below) can lead to blood vacuity. when static blood does not go, new blood is not engendered (瘀血不去, 新血不生 yū xuè bù qù, xīn xuè bù shēng), causing generalized blood vacuity.

Blood’s relationships

• Heart, liver, spleen, and kidney: The blood is governed by the heart, stored by the liver, and produced by the spleen. Furthermore, kidney essence can transform into blood.
• Yīn: Blood belongs to yīn. Yīn vacuity includes blood vacuity but is distinguished by the presence of heat signs.
• Wind: Blood vacuity can also severely aggravate wind in wind-cold-damp impediment (bì) patterns. This is reflected in the treatment principle to treat wind, first treat the blood; when blood moves, wind naturally disappears (治风先治血，血行风自灭 zhì fēng xiān zhì xuè; xuè xíng fēng zì miè).
• Sweat: Blood and sweat are both fluid substances. So, severe insufficiency of the blood can affect the body’s ability to produce sweat, while excessive sweating can cause insufficiency of the blood. Hence it is said, When blood is despoliated, there is no sweat ; when sweat is despoliated, there is no blood (夺血者无汗, 夺汗者无血 duó xuè zhě wú hàn, duó hàn zhě wú xuè).

Analysis of signs

• General signs: A lusterless white or withered-yellow complexion and pale lips, tongue, eyelids, and nails.
• Liver blood vacuity: Numbness and tingling of the limbs and hypertonicity of the sinews arising when liver blood fails to nourish the sinews and vessels; in women, scant menstruation, delayed menstruation, amenorrhea arising when blood fails to nourish the uterus.
• Heart blood vacuity: Heart palpitation; insomnia; profuse dreaming; and forgetfulness.
• Upper body: Dizzy head and vision; dry eyes.
• Hair and skin: Dry. See Specific Forms below.
• Tongue: White.
• Pulse: Fine and forceless.

Specific forms: There are two specific forms:

• Blood dryness (血燥 xuè zào) is blood vacuity marked by signs of dryness. This occurs when essence-blood is depleted in old age or when nutritional disturbances or static blood binding internally reduce the nutritive power of the blood. Blood dryness manifests in emaciation, rough dry skin, in serious cases encrusted skin, itchy skin, brittle nails, lusterless hair, hard stool, and dry tongue. It is often called (血燥生风 xuè zào shēng fēng) when it causes itching.
• Blood collapse (亡血 wáng xuè) is severe loss of blood as by vomiting of blood, nosebleed, bloody stool, or bloody urine.

Treatment

Medicinal therapy: Supplement the blood. Blood-supplementing medicinals include Chinese angelica (Angelicae Sinensis Radix, 当归 dāng guī), cooked rehmannia (Rehmanniae Radix Praeparata, 熟地黄 shú dì huáng), white peony (Paeoniae Radix Alba, 白芍药 bái sháo yào), flowery knotweed (Polygoni Multiflori Radix, 何首乌 hé shǒu wū), ass hide glue (Asini Corii Colla, 阿胶 ē jiāo), and eclipta (Ecliptae Herba, 墨旱莲 mò hàn lián). Spirit-quieting blood-nourishing medicinals used to treat heart blood vacuity include salvia (Salviae Miltiorrhizae Radix, 丹参 dān shēn), spiny jujube (Ziziphi Spinosi Semen, 酸枣仁 suān zǎo rén), and longan flesh (Longan Arillus, 龙眼肉 lóng yǎn ròu). These medicinals may be combined with spleen-fortifying medicinals to treat heart-spleen blood vacuity. Liver-nourishing medicinals use to treat liver blood vacuity include lycium berry (Lycii Fructus, 枸杞子 gǒu qǐ zǐ), mulberry (Mori Fructus, 桑椹 sāng shèn), and spatholobus (Spatholobi Caulis, 鸡血藤 jī xuè téng). Blood-supplementing formulas include Four Agents Decoction (四物汤 sì wù tāng) for insufficiency of liver blood and menstrual irregularities, Celestial Emperor Heart-Supplementing Elixir (天王补心丹 tiān wáng bǔ xīn dān) for insufficiency of yīn-blood and disquieted spirit, and Spleen-Returning Decoction (归脾汤 guī pí tāng) for heart-spleen blood vacuity.

Acumoxatherapy: General blood-supplementing points are LR-3 (Supreme Surge, 太冲 tài chōng), LR-13 (Camphorwood Gate, 章门 zhāng mén), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), BL-17 (Diaphragm Transport, 膈俞 gé shù), BL-20 (Spleen Transport, 脾俞 pí shù), and BL-21 (Stomach Transport, 胃俞 wèi shù). Needle with supplementation and moxa.

Combined patterns: Blood vacuity can occur in conjunction with qì vacuity, yīn vacuity, and blood stasis.

Further developments: Blood vacuity engendering wind; blood dryness engendering wind.