100 Days to Learn TCM Internal Medicine - Second Edition

Author: Xia Xiang
Publisher:
Publish Date: 2006-10-01
Features:
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, overflowing into the orifices of the mouth and nose or exiting through the lower orifices, or seeping into the skin, the condition falls under this category. The bleeding discussed in this article primarily focuses on common internal medical 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 injury, emotional disturbances, or overexertion. Since the heart governs blood, the spleen controls blood, the liver stores blood, and the lungs dominate qi, bleeding is often linked to the heart, spleen, liver, or lungs. In actuality, the condition is often caused by fire, where excessive fire forces blood to flow uncontrollably; or by qi deficiency, where insufficient qi fails to control blood. Pathological changes involve external pathogens invading and damaging meridians, leading to bleeding, especially when heat pathogens are involved. Dietary injury can generate damp-heat, which, when retained internally, scalds blood vessels, forcing blood to flow uncontrollably and causing symptoms like epistaxis, hematemesis, or 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 stir internal fire and reverse qi upward, forcing blood to flow uncontrollably. Overexertion can damage qi, causing qi deficiency to fail in controlling blood, leading to epistaxis, hematemesis, hematochezia, or purpura. If yin is damaged, yin deficiency with internal heat arises, forcing blood to flow uncontrollably, resulting in epistaxis, hematuria, or 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 can be seen in various internal medical conditions, such as peptic ulcers, bronchiectasis, or thrombocytopenia.
[Pattern Differentiation]
1. Stomach fire surging upward
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: Intense stomach heat inflames upward, forcing blood flow, causing hematemesis, hemoptysis, and epistaxis with bright red blood. Stomach heat consumes stomach fluids, leading to thirst and constipation. Stomach fire surging to the head and face causes flushedness. Red tongue, yellow coating, and strong rapid pulse indicate intense stomach heat.
2. Pathogen invasion by external heat
Symptoms: Hemoptysis, epistaxis, or hematochezia. Dry mouth and throat, possibly accompanied by fever, slight cough with little phlegm, or constipation and abdominal pain. Red tongue with little coating, rapid pulse.
Analysis: External pathogens like wind-heat or dryness invade, entering the interior and damaging meridians, causing hemoptysis, epistaxis, or 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 unspread, leading to slight cough with little phlegm. Heat damages fluids, causing dry mouth, nose, and throat. If intestinal damp-heat accumulates, transformation is impaired, causing constipation and abdominal pain due to blocked qi flow. Red tongue, little coating, and rapid pulse indicate internal pathogenic heat.
3. Yin deficiency with internal heat
Symptoms: Often hemoptysis, epistaxis, or 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, dry mouth, and restlessness. Red tongue with little coating, thin and rapid pulse.
Analysis: Yin deficiency with internal heat, with excessive internal fire burning meridians, causing hemoptysis, epistaxis, or hematuria.