One Hundred Days to Learn Traditional Chinese Medicine Internal Medicine - (Second Edition)

Author: Xia Xiang
Publisher:
Publish Date: 2006-10-01
Features:
2 Bleeding refers to various internal and external hemorrhages, as well as purpura and acute disseminated intravascular coagulation. When blood does not follow its normal course and overflows from the mouth, nose, or orifices, or seeps out of the skin, the condition falls under this category. The bleeding discussed in this article primarily focuses on common internal bleeding emergencies, including hemoptysis, hematemesis, hematochezia, hematuria, and epistaxis. If bleeding is treated promptly, by clarifying the source and stopping the flow, the prognosis is generally good. Bleeding falls under the category of "blood disorders" in Traditional Chinese Medicine.
[Pathogenesis]
The causes of bleeding are numerous, primarily attributed to external heat, dietary imbalances, emotional disturbances, or overexertion. Since the heart governs blood, the spleen controls blood, the liver stores blood, and the lungs dominate qi, bleeding disorders are often linked to the heart, spleen, liver, or lungs. In cases, bleeding is often due to fire, where excessive heat forces blood to run rampant. In cases, it is usually due to qi deficiency, where insufficient qi fails to control blood. Pathological changes involve external pathogens invading and damaging blood vessels, particularly when heat pathogens are involved. Dietary imbalances can lead to the generation of damp-heat, which, when retained internally, scalds blood vessels, forcing blood to flow and causing symptoms like epistaxis, hematemesis, and hematochezia. Overindulgence in spicy and rich foods can damage the spleen and stomach, weakening their function of transporting and controlling blood, leading to blood overflowing from vessels. Extreme emotions can cause internal fire to flare up and qi to reverse upward, forcing blood to run rampant. Overexertion can damage qi, resulting in qi deficiency that fails to control blood, leading to epistaxis, hematemesis, hematochezia, and purpura. If it damages yin, it can cause yin deficiency with internal heat, forcing blood to run rampant and leading to epistaxis, hematuria, and purpura.
[Diagnostic Key Points]
1. General bleeding volume is relatively large, or the condition is acute.
2. May include hemoptysis, hematemesis, hematochezia, hematuria, epistaxis, or subcutaneous bleeding.
3. Bleeding disorders can be seen in various internal diseases, such as peptic ulcers, bronchiectasis, and thrombocytopenia.
[Pattern Differentiation]
1. Stomach Fire Surging Up
Symptoms: Hematemesis, hemoptysis, and epistaxis. Large bleeding volume, bright red blood, flushed face, thirst, and constipation. Red tongue with yellow coating, strong and rapid pulse.
Analysis: Excessive stomach heat flares up, causing heat to force blood to flow, leading to hematemesis, hemoptysis, and epistaxis, with bright red blood. Stomach heat consumes stomach fluids, causing thirst and constipation. Stomach fire surges to the head and face, causing flushedness. Red tongue, yellow coating, and strong rapid pulse indicate excessive stomach heat.
2. Pathogen Heat Invasion
Symptoms: Hemoptysis, epistaxis, or hematochezia. Dry mouth and throat, possibly accompanied by fever, mild cough with little phlegm, or constipation and abdominal pain. Red tongue with little coating, rapid pulse.
Analysis: External pathogens like wind-heat and dryness invade, entering the interior and damaging blood vessels, causing hemoptysis, epistaxis, and hematochezia. If wind-heat invades the exterior, the body surface is obstructed, causing fever and sore throat. If heat invades the lungs, lung qi is unventilated, causing mild cough with little phlegm. Heat damages fluids, causing dry mouth, nose, and throat. If intestinal damp-heat accumulates, leading to impaired transformation, constipation occurs, and blocked qi flow causes abdominal pain. Red tongue, little coating, and rapid pulse indicate internal pathogen heat.
3. Yin Deficiency with Internal Heat
Symptoms: Commonly hemoptysis, epistaxis, and hematuria. Small bleeding volume but recurrent and difficult to heal, bright red blood, often accompanied by dizziness, tinnitus, heat in palms and soles, or night sweats with fever. Red tongue with little coating, thin and rapid pulse.
Analysis: Yin deficiency with internal heat, where fire flares up internally, scalds blood vessels, causing hemoptysis, epistaxis, and hematuria.