Spleen failing to control blood

Also:

• Qì failing to contain blood (气不摄血 qì bù shè xuè), when viewed as a qì pattern rather than a spleen pattern
• Spleen failing to envelop blood (脾不裹血 pí bù guǒ xuè)

A disease pattern chiefly characterized by chronic bleeding (bloody stool, bloody urine, vomiting of blood, nosebleed, purple macules, profuse menstruation, flooding and spotting); qì and blood vacuity signs.

Description: Chronic bleeding (notably bloody stool, bloody urine, profuse menstruation, flooding and spotting bleeding gums; less commonly, vomiting of blood, nosebleed, purple macules under the skin); reduced eating; sloppy stool; lassitude of spirit and lack of strength; scantness of breath or shortness of breath; laziness to speak; lusterless pale-white or withered-yellow facial complexion; pale tongue; a pulse that is fine and weak.

Diseases: Bleeding; flooding and spotting.

Pathogenesis: Insufficiency of spleen qì manifesting in reduced power to hold blood in the vessels. This results from:

• enduring spleen qì vacuity;
• less commonly, taxation fatigue damaging the spleen.

Analysis of signs

• Bleeding: Bloody stool, bloody urine, profuse menstruation, or flooding and spotting, or less commonly nosebleed, bleeding gums, vomiting of blood, or spontaneous bleeding of the flesh.
• Spleen qì vacuity: Reduced eating, sloppy stool, lassitude of spirit and lack of strength, scantness of qì and laziness to speak, and a lusterless complexion.
• Tongue: Pale.
• Pulse: Weak.

Note: Spleen failing to control the blood is not the only cause of bleeding. There are three other causes: (a) external injury; (b) frenetic movement of hot blood, which results from warm-heat disease evils or heat arising internally; and (c) static blood blocking the vessels causing the blood to extravasate. Note that upper-body and outer-body bleeding are more commonly attributable to frenetic movement of hot blood. Spleen failing to control the blood usually manifests in lower-body bleeding rather than upper-body bleeding. However, lower-body bleeding such as bloody urine, bloody stool, profuse menstruation, and flooding and spotting can be due to spleen failing to control the blood, frenetic movement of hot blood, or static blood.

Treatment

Medicinal therapy: Treat by boosting qì to contain blood. This can be combined with spleen warming where signs of spleen yáng vacuity are present. Commonly used medicinals that boost qì and contain the blood include codonopsis (Codonopsis Radix, 党参 dǎng shēn), astragalus (Astragali Radix, 黄芪 huáng qí), and licorice (Glycyrrhizae Radix, 甘草 gān cǎo). Concurrent spleen yáng vacuity calls for addition of spleen-warming medicinals such as oven earth (Terra Flava Usta, 伏龙肝 fú lóng gān), blast-fried ginger (Zingiberis Rhizoma Praeparatum, 炮姜 páo jiāng), and aconite (Aconiti Radix Lateralis Praeparata, 附子 fù zǐ). Yellow Earth Decoction (黄土汤 huáng tǔ tāng) warms the spleen and enhances blood management and is used where spleen vacuity bloody stool is accompanied by cold signs. Spleen-Returning Decoction (归脾汤 guī pí tāng), which not only nourishes the heart and spleen but also boosts qì and contains the blood, is more suitable for flooding and spotting. Since the spleen failing to control blood is pathomechanically the same as qì failing to contain qì, boosting qì represents the basis of treatment. However, given the danger that bleeding may lead to blood vacuity, addition of blood-nourishing medicinals such as dried rehmannia (Rehmanniae Radix, 干地黄 gān dì huáng) and ass hide glue (Asini Corii Colla, 阿胶 ē jiāo) is advisable. If bleeding gives rise to signs of disquieted heart spirit such as heart palpitation and insomnia, blood-nourishing spirit-quieting medicinals such as spiny jujube (Ziziphi Spinosi Semen, 酸枣仁 suān zǎo rén) and polygala (Polygalae Radix, 远志 yuǎn zhì) can be added. Addition of blood-quickening medicinals may be indicated where blood stasis occurs in the course of enduring bleeding.

Acumoxatherapy: Base treatment mainly on SP, ST, CV, and back transport points. Main points: BL-20 (Spleen Transport, 脾俞 pí shù), BL-21 (Stomach Transport, 胃俞 wèi shù), CV-12 (Center Stomach Duct, 中脘 zhōng wǎn), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), SP-3 (Supreme White, 太白 tài bái), and SP-1 (Hidden White, 隐白 yǐn bái); needle with supplementation and add moxa. For bloody stool, add CV-4 (Pass Head, 关元 guān yuán), and BL-35 (Meeting of Yáng, 会阳 huì yáng). For flooding and spotting, add CV-4 (Pass Head, 关元 guān yuán), CV-6 (Sea of Qì, 气海 qì hǎi), and SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo). For spleen yáng vacuity, add large amounts of moxa.