Distinguishing and Treating Blood Stasis, Vomiting of Blood, Nosebleeds, Lowering of Blood, and Sore-Carbuncle Diseases: Pulse Patterns and Differentiation
Overall Paraphrase
This chapter focuses on the pulse patterns and syndrome differentiation approaches for blood stasis, vomiting of blood, nosebleeds, blood in the stool, as well as sore-carbuncles and intestinal abscesses.
First, blood stasis: The patient experiences chest fullness and oppression, withered and atrophic lips, a bluish tongue color, and a dry mouth — they only wish to hold water in their mouth to rinse it but are unwilling to swallow. There is no aversion to cold or fever, and the pulse is slightly large and slow. The abdomen is actually not distended, yet the patient claims it feels full — the ancients regarded this as a typical manifestation of internal obstruction by blood stasis. If the patient appears to have heat syndrome, with restlessness in the chest, dry mouth and thirst, yet the pulse does not show heat signs upon examination, this is referred to as yin fu (latent yin) and also belongs to blood stasis. It should be treated with purgative methods. Ancient texts record the use of Xia Yu Xue Tang (Blood Stasis-Dispelling Decoction) (composed of Da Huang/Rhubarb, Tao Ren/Peach Kernel, Zhe Chong/Ground Beetle, etc., with specific preparation and administration methods omitted here).
Regarding bleeding: When blood stasis lodges in the diaphragm region, and if vomiting of blood occurs with black-colored blood, ancient texts prescribe Jie Geng Tang (Platycodon Decoction) (Jie Geng/Platycodon, Gan Cao/Licorice). For relentless vomiting of blood, Bai Ye Tang (Cedar Leaf Decoction) can be used (Bai Ye/Cedar leaves, Gan Jiang/Dried Ginger, Ai Ye/Mugwort leaf; the ancient formula once used Ma Tong Ji/horse urine juice, which is no longer used today). Huang Tu Tang (Yellow Earth Decoction) may also be used (Zao Xin Huang Tu/hearth-center yellow earth, Gan Cao/Licorice, Di Huang/Rehmannia, Bai Zhu/White Atractylodes, Pao Fu Zi/Prepared Aconite, E Jiao/Donkey-hide Gelatin, Huang Qin/Scutellaria, etc.). For unstable heart qi with vomiting of blood and nosebleeds, ancient texts use Xie Xin Tang (Draining the Heart Decoction) (Da Huang/Rhubarb, Huang Lian/Coptis). Bleeding from the lower body falls into two categories: when defecation occurs first followed by bleeding, this is called yuan xue (distant blood), treated with Huang Tu Tang (Yellow Earth Decoction); when bleeding occurs first followed by defecation, this is called jin xue (near blood), treated with Chi Dou Dang Gui San (Red Bean and Angelica Powder) (Chi Xiao Dou/Adzuki Bean, Dang Gui/Angelica Sinensis).
In terms of inspection and pulse diagnosis, the Master said: When the patient has a pale and lustrous-less complexion, no aversion to cold or fever, and a deep and string-like pulse, nosebleeds may occur. When the pulse is floating and weak and upon pressing feels as if about to expire, lower bleeding may occur. When there is restlessness, abdominal fullness, chest oppression with a dry mouth and thirst, vomiting of blood manifest as an intake pattern obstructed due to hardness. The ancients also believed that nosebleeds occurring from spring to summer generally pertain to Taiyang, while nosebleeds occurring from autumn to winter generally pertain to Yangming. When the chi (foot) pulse is floating and the eyes appear hazy with yellowish vision, it indicates that nosebleeds have not yet ceased; when the yellow haze subsides and the eyes become clear, it indicates that nosebleeds have stopped.
Regarding metal-inflicted wounds (jin chuang): A question asks: When the cun-kou pulse is slightly floating and rough, there should be loss of blood or sweating. If there is no sweating, how is this explained? The Master said: If the body has a sore, or has sustained blood loss from knife or axe injury, it is called metal-inflicted wound (jin chuang). When there is no pus, ancient texts prescribe Wang Bu Liu Xing San (Vaccaria Powder) (Wang Bu Liu Xing/Vaccaria Seed, Shuo Huo Xi Ye/Urtica leaf, Sang Gen Bai Pi/Mulberry Root Bark, Gan Cao/Licorice, Huang Qin/Scutellaria, Shu Jiao/Prickly Ash, Hou Po/Magnolia Bark, Gan Jiang/Dried Ginger, Shao Yao/Peony, etc.). When there is pus, Pai Nong San (Pus-Discharging Powder) (Zhi Shi/Immature Bitter Orange, Shao Yao/Peony, Jie Geng/Platycodon, etc.) or Pai Nong Tang (Pus-Discharging Decoction) (Gan Cao/Licorice, Jie Geng/Platycodon, Sheng Jiang/Fresh Ginger, Da Zao/Jujube) is prescribed.
With respect to yin-yin sore (spreading erosive sore): The ancients observed that if an erosive sore spread from the periphery of the mouth toward the four limbs, they considered it treatable; if it spread from the four limbs toward the mouth, they considered it difficult to treat. Ancient texts prescribe Huang Lian Fen (Coptis Powder) (Huang Lian/Coptis, Gan Cao/Licorice) for oral administration and external application.
Finally, sore-carbuncles and intestinal abscesses: When the various pulses are floating and rapid, fever should normally be present. When there is instead a chilly shivering sensation with aversion to cold, and if there is pain in a specific area of the body, a carbuncle swelling may be forming. The method for judging the presence or absence of pus: when pressing on the swollen area by hand, if warmth is perceived, there is pus; if no warmth is perceived, there is no pus. For intestinal abscesses (intestinal carbuncles), should the skin appear rough like fish scales, with abdominal skin taut and tense, soft upon pressure resembling swelling, without any accumulation felt inside the abdomen, absence of body heat, and a rapid pulse, this indicates an abscess inside the intestines. Ancient texts prescribe Yi Yi Fu Zi Bai Jiang San (Coix, Aconite, and Patrinia Powder) (Yi Yi Ren/Coix Seed, Fu Zi/Aconite, Bai Jiang Cao/Patrinia). When there is swelling and rigidity in the lower abdomen, pain upon palpation radiating like strangury, yet urination remains normal, along with periodic fever, spontaneous sweating after the fever subsides, and accompanying aversion to cold, this indicates an abscess outside the intestines. If the pulse is deep and tight, pus has not yet formed, and using purgative methods may lead to bleeding. If the pulse is surging and rapid, pus has already formed, and purgative therapy may be used. Ancient texts prescribe Da Huang Mu Dan Tang (Rhubarb and Moutan Decoction) (Da Huang/Rhubarb, Mu Dan Pi/Moutan Bark, Tao Ren/Peach Kernel, Dong Gua Zi/Winter Melon Seed, Mang Xiao/Mirabilite).
All formulas cited above originate from ancient texts and are provided solely for academic study. They should not be used to prescribe medication by following verbatim instructions.
🧠 Deep Understanding
Core Principles 💡
- Key points for discerning blood stasis: This chapter presents a cluster of signs — "withered lips, bluish tongue, dry mouth with desire only to rinse but not swallow, sensation of fullness without abdominal distention, a pulse slightly large yet slow" — as the basis for identifying blood stasis. The core premise is that blood stasis obstructs qi movement, preventing fluids from ascending; thus the mouth is dry yet there is no desire to drink. Blood stasis pertains to yin, so the pulse does not reveal heat but instead appears slow and rough.
- Different treatments for the same category of bleeding: Whether dealing with vomiting of blood or nosebleeds, there are several principles at play: heat exuberance forcing blood to move recklessly (treated by Xie Xin Tang, through bitter-cold draining fire), mid-jiao deficiency-cold failing to contain blood (treated by Bai Ye Tang and Huang Tu Tang, through warming yang and supplementing qi to arrest bleeding), and internal blood stasis blocking the blood vessels so that blood fails to stay in its pathways (treated by Xia Yu Xue Tang). This embodies the TCM approach of "examining the syndrome to identify the cause."
- Distant blood and near blood: Using whether bleeding follows or precedes defecation to determine the distance of the bleeding site, indicating tendencies toward deficiency-cold or damp-heat, represents an important ancient experience in the differentiation of bleeding from the lower body.
- Pus identification in sores and the staging of intestinal abscesses: The ancients assessed the presence or absence of pus by pressing the swollen area for warmth. For intestinal abscesses, they distinguished intestinal interior from exterior and determined whether pus had formed based on whether the pulse was deep and tight or surging and rapid. In treatment, where pus has not yet formed, therapy leans toward purgation and dispelling stasis; where pus has formed, therapy leans toward expelling pus and eliminating the abscess — illustrating a phased treatment rationale.
- Metal-inflicted wounds and erosive sores emphasize disease progression: Metal-inflicted wounds are treated based on the presence or absence of pus; erosive sores are judged by the direction of spread, reflecting the ancient observational attention to traumatic infections and skin disease progression.
Modern Perspectives 🌟
- Blood stasis from a modern lens: Blood stasis as conceived in TCM may bear some correlation with such modern phenomena as microcirculatory disturbances, abnormal hemorheology, coagulation–fibrinolysis system imbalances, and the accumulation of local inflammatory products. However, "blood stasis" is a syndrome-based concept and cannot be directly equated to specific modern pathophysiological biomarkers.
- Hemorrhagic conditions: Vomiting of blood, nosebleeds, and blood in the stool may involve underlying platelet, coagulation factor, vessel wall, gastrointestinal, or respiratory abnormalities. Ancient pulse diagnostics and inspection methods possess cultural significance, yet cannot replace complete blood counts, coagulation profiles, endoscopy, or imaging studies.
- Sores-carbuncles and intestinal abscesses: Carbuncles resemble skin and soft-tissue infections with abscess formation. Intestinal abscesses, as described in ancient texts — abdominal pain, tense abdominal walls, fever-chill — may correspond to acute abdominal conditions such as appendicitis or intra-abdominal abscesses. Anciently, discerning pus via button pressing carries a certain experiential basis, but modern ultrasound, CT, and blood testing are more reliable. Intestinal abscess falls under acute abdominal pathology and requires prompt medical attention.
- Historical limitations: Ancient formulas once contained Ma Tong Ji (horse urine juice), now obsolete and posing hygiene risks. Insect medicinals such as Zhe Chong (ground beetle) and minerals like Zao Xin Huang Tu (hearth-soil) require standardized processing and rigorous differentiation when used. Drugs within formulas such as Da Huang, Mang Xiao, and Fu Zi possess potent action and should never be self-administered.
- Seasonal and channel attribution: Classifying nosebleeds under Taiyang or Yangming reflects ancient "correspondence between heaven and humankind" thinking; however, such specificity lacks modern empirical validation and should not be mechanistically applied.
Health and Lifestyle Insights ⚡
- Emotional wellbeing: Avoid prolonged anger and anxiety to reduce the risk of qi constraint transforming into fire that forces blood to move recklessly.
- Dietary moderation: Reduce intake of spicy foods, alcohol, and rich or greasy fare to lower the possibility of damp-heat accumulation, which contributes to skin sores and bleeding tendencies.
- Appropriate work and rest: Overexpression of fatigue harms qi and blood, diminishing the body's restorative capacities.
- Trauma protection: Following breaks in the skin, promptly clean and disinfect wounds to prevent infection escalating into sores; if redness, heat, pain, or discharge appear, quickly seek attention — do not compress the area or apply ancient medicinal powders indiscriminately.
- Aligning with the four seasons: With yang qi rising in spring and summer and constraining in autumn and winter, seasonal transitions call for careful adjustment if nosebleeds are triggered by climate.
- Heeding warning signals: For unexplained bleeding, skin ecchymoses, persistent abdominal pain, fevers or chills, promptly turn to professional medical help rather than relying on ancient texts for self-diagnosis.
📚 Relevant Background
- Associated concepts:
- Blood that leaves the vessels (li jing zhi xue): blood that veers from its normal channels and escapes beyond the vessels then forms blood stasis.
- Yin fu (latent yin): pathogenic heat hides in the yin aspect, with pulse evidence lacking heat, while symptoms mimic heat.
- Distant blood / Near blood: identifying site and nature of distal bleeding by examination of sequence relative to defecation.
- Metal-inflicted wounds (jin chuang): wounds caused by knife, axe, or other metallic implements.
- Intestinal abscess (chang yong): ancient collective term for abscess located within, near, or outside of the intestines, overlapping with select acute abdominal conditions in the modern era.
- Yin-yin sore (浸淫疮): archaic classification of certain spreading erosive dermatologic afflictions.
- Further reading:
- Jingui Yaolue — Chapter on Palpitations, Vomiting of Blood, Nosebleed, Hematochezia, Chest Fullness, Blood Stasis, and Pulse Patterns ("惊悸吐衄下血胸满瘀血病脉证治")
- Jingui Yaolue — Sore-Carbuncle, Intestinal Abscess, Erosive and Ulcerative Skin Disease, Pulse Patterns and Treatment ("疮痈肠痈浸淫病脉证并治")
- Suwen — Chapter on Regulating the Channels regarding the circulation and mobilization of qi and blood
- Lingshu — Abscesses and Carbuncles of the ancients' early insights about onset and development of purulent swellings.
Memento: This content derives from foundational Chinese medical classics and serves academic and traditional knowledge exploration only — not constituting any medical diagnosis, medication, or therapeutic recommendation. Should discomfort arise, timely medical attention from a qualified practitioner is essential.
