bubble_chart Concept

The pattern of blood-heat with blood stirring refers to the presence of heat in the blood aspect, or pathogenic heat invading the blood aspect, scorching the blood vessels, and forcing the blood to move recklessly, resulting in clinical manifestations such as hemoptysis, hematemesis, bloody stool, and disturbance of mental activity. It is often caused by external contraction of pathogenic heat, emotional stagnation, or dietary preferences.

The main clinical manifestations include hemoptysis, hematemesis, hematuria, bloody stool, skin rashes, fever, irritability, palpitations, or agitation and mania, thirst with a desire to drink, constipation, dark urine, a red and deep tongue texture, and a thin, rapid pulse.

The blood heat pattern is commonly seen in diseases such as "wind-warmth," "spring warmth," "summerheat warmth," "dysentery," "hematemesis," "epistaxis," and "bloody stool." This syndrome should typically be differentiated from the "pattern of blood heat transforming into dryness," "pattern of blood heat complicated by dampness," and "pattern of yin deficiency and blood heat."

bubble_chart Differentiation and Treatment

The pattern of blood-heat with blood stirring manifests differently across various diseases due to differences in disease cause and location of disease, each presenting unique clinical features and requiring distinct treatment approaches that must be carefully analyzed. This syndrome often arises from external pathogenic invasion, injury to the blood vessels; or excessive emotional stress leading to five minds transforming into fire; or excessive alcohol consumption and indulgence in spicy foods, causing heat accumulation in the stomach and intestines, as mentioned in Linzheng Zhinan Yi'an‧hematemesis: "Alcohol-induced heat damages the stomach, all of which can stimulate blood movement," or from overexertion leading to exuberance of heart fire, transferring heat to the small intestine; or from chronic illness Rebing, resulting in liver and kidney yin deficiency and frenetic stirring of ministerial fire, all of which can lead to heat damaging the blood vessels, "blood boils with heat," forcing blood to move recklessly and causing bleeding. Zhang Jing-yue stated: "Movement is often caused by fire, excessive fire forces blood to move recklessly," with treatment focusing on cooling blood and stopping bleeding as the fundamental principle. The pattern of blood-heat with blood stirring, whether presenting as hematemesis, epistaxis, hemoptysis, bloody stool, or hematuria, is characterized by bright red bleeding, a red tongue, and a rapid pulse, accompanied by fever, irritability, or restlessness and mania, thirst with a desire to drink, constipation, dark urine, and rashes. In warm febrile diseases, the pattern of heat entering the blood phase presents with severe heat, scorching body heat, dysphoria, unconsciousness with delirious speech, or convulsions, hematemesis, epistaxis, bloody stool, widespread macula and papule over the body, a deep crimson tongue texture, and a fine, rapid or slightly rapid pulse, characterized by blood movement and consumption. The blood aspect pattern often results from unresolved nutrient aspect pattern progressing to the blood aspect, or from qi aspect pathogenic heat directly entering the blood. Pathogenic heat entering the blood is more severe than in the nutrient aspect, often representing the most critical stage in the progression of warm febrile diseases, treated by clearing heat and cooling blood, using Rhinoceros Horn and Rehmannia Decoction (Qianjin Yaofang).

The pattern of blood-heat with blood stirring varies in specific treatment due to differences in disease cause and location of disease. For example, in cases of epistaxis and gingival hemorrhage, presenting with epistaxis, gingival hemorrhage, visible macula and papule, fever, irritability, thirst, a crimson tongue with yellow coating, and a rapid pulse, treatment should focus on clearing lung heat, cooling blood, and stopping bleeding, using Rhinoceros Horn and Rehmannia Decoction (Qianjin Yaofang). In cases of hematemesis, presenting with copious bright red hematemesis, body heat, head distension, red eyes, flushed face with coarse breathing, severe constipation, scanty dark urine, a crimson red tongue with dry yellow coating, and a rapid pulse, treatment should focus on clearing stomach fire, cooling blood, and stopping bleeding, using Jade Lady Decoction (Jingyue Quanshu) combined with Ten-Ash Powder (Shiyao Shenshu). For bloody stool, presenting with severe constipation, bright red blood in stool, body heat with sweating, thirst for cold drinks, flushed face with coarse breathing, severe constipation, scanty dark urine, a red tongue with dry yellow coating, and a deep, rapid, and forceful pulse, treatment should focus on resolving dampness and heat, cooling blood, and stopping bleeding, using Heart-Draining Decoction (Jingui Yaolue) combined with Ten-Ash Powder (Shiyao Shenshu). For hematuria, presenting with bright red hematuria, high fever with dysphoria, thirst for cold drinks, visible macula and papule on the body, or epistaxis, severe constipation or bloody stool, a crimson red tongue with dry yellow coating, and a rapid pulse, treatment should focus on clearing stomach fire, cooling blood, and stopping bleeding, using Rhinoceros Horn and Rehmannia Decoction (Qianjin Yaofang). Although the pattern of blood-heat with blood stirring involves bleeding, it presents differently across various diseases, requiring treatment based on the specific characteristics of each condition.

In warm febrile diseases, the pattern of blood-heat with blood stirring often leads to two possible disease mechanisms: first, prolonged unresolved pathogenic heat deeply penetrating the lower energizer, scorching liver blood and kidney essence, transforming into dryness and damaging yin, leading to true yin depletion and inability of body fluids and blood to nourish, presenting with dry mouth and teeth, dry skin or cutaneous pruritus, a withered tongue with sunken eyes, flushed cheeks, wriggling of limbs, or even convulsions, intense palpitations, a dry crimson tongue with scant coating, and a large, weak pulse, treated by generating fluids and rescuing yin, using Pulse-Restoring Decoction (Wenbing Tiaobian). Second, excessive pathogenic heat overwhelming healthy qi, leading to sudden collapse of healthy qi externally, with body fluids unable to be retained, presenting with sudden cessation of body heat, profuse sweating, pale complexion, short breath, dysphoria, and a fine, short, and rapid pulse, treated by tonifying qi to stabilize collapse, using Pulse-Reinforcing Powder ("Discussion on Cold Damage Diseases Inside and Outside").

bubble_chart Differentiation of Similar Patterns

Pattern of blood heat transforming into dryness and pattern of blood-heat with blood stirring: Both exhibit signs of blood heat, and are interconnected in terms of disease cause and mechanism of disease. Heat and dryness easily damage fluids and consume blood, and excessive or prolonged blood stirring can easily lead to blood dryness. Clinically, dryness-heat is often seen together. In terms of disease cause, the pattern of blood heat transforming into dryness is often due to heat in the blood aspect causing blood stirring and damage to yin, or misuse of sweating, vomiting, or purgative methods leading to deficiency of essence and blood, resulting in the body losing nourishment. It often occurs in individuals with constitutional yin deficiency, yang exuberance, or the elderly and physically weak. Clinical manifestations include fever, dry mouth and throat, irritability, rashes and convulsions, dry and dull hair, cutaneous pruritus, scaly skin, emaciation, scanty urine, dry stools, and possible blood stirring. The tongue texture is deep red with dry and scanty coating, and the pulse is thin and rough. The pattern of blood heat transforming into dryness: 1. The dryness is prone to transform into wind, manifesting as wriggling of limbs, or even convulsions, palpitations, and convulsions leading to mania; 2. The pathogenic heat is excessive, attacking healthy qi, or prolonged consumption of yin and blood fails to restrain yang, leading to sudden collapse of healthy qi. The pattern of blood-heat with blood stirring is often caused by exposure to pathogenic heat, five minds transforming into fire, excessive consumption of alcohol and spicy foods, or overexertion, leading to heat invading the blood aspect. Clinical manifestations include fever, hemoptysis, rashes, epistaxis, and mental dysphoria. The pattern of blood-heat with blood stirring must exhibit signs of blood stirring, while the pattern of blood heat transforming into dryness is mainly characterized by yin deficiency and dryness, making them easy to distinguish.

Pattern of blood heat complicated by dampness and pattern of blood-heat with blood stirring: Both syndromes belong to blood heat. In terms of disease cause, the pattern of blood heat complicated by dampness is often caused by exposure to dampness-heat pathogens, or improper diet, excessive consumption of alcohol and rich foods, combined with pre-existing blood heat. Although there are signs of blood heat, clinical manifestations also include signs of dampness, such as heaviness of the head and body, dry mouth without desire to drink, abdominal distension and fullness, and poor appetite. The tongue coating is yellow and greasy, and the pulse is often soggy, slippery, and rapid. It is often accompanied by dampness encumbering the spleen, leading to spleen qi deficiency, manifesting as lack of strength and poor appetite, or dampness and fire combining to form phlegm clouding the orifices, with clinical manifestations including mental dysphoria, mania, unconsciousness, and delirious speech. The pattern of blood-heat with blood stirring is often caused by exposure to pathogenic heat, consumption of spicy foods, or overexertion, leading to heat invading the blood aspect and scorching the blood vessels, resulting in reckless movement of blood. Clinical manifestations include blood stirring, pathogenic heat, loss of blood, and damage to yin, often accompanied by dry mouth and lips, dry eyes, and skin itching. Thus, although both syndromes exhibit blood heat, the former shows signs of dampness exuberance and spleen deficiency, while the latter shows signs of blood stirring and yin consumption, making them distinguishable.

Pattern of yin deficiency and blood heat and pattern of blood-heat with blood stirring: For details, see the "Differential Diagnosis" section under the entry for pattern of yin deficiency and blood heat.

bubble_chart Documentation

• Zhubing Yuanhou Lun‧Small Bloody Stool Syndrome: "The heart governs the blood and is connected with the small intestine. If there is heat in the heart, it accumulates in the intestines, leading to small bloody stools."
• Shenghui Fang‧Treatments for Hematuria: "Hematuria is caused by guest heat in the bladder; blood seeps into the bladder. Blood becomes reckless when heated; thus, due to heat, it disperses and seeps into the bladder, causing hematuria."
• Jisheng Fang‧Vomiting and Nosebleeds: "The reckless movement of blood is always caused by heat, as blood becomes reckless when heated and rises with qi, leading to vomiting and nosebleeds."
• 《Hejian Liushu‧Shangyi》: "When heart fire is excessive, blood becomes excessive, and heat rises with qi, leading to blood overflow."
• Both blood and qi are hot: Rumen Shiqin‧Hemoptysis‧Nosebleeds, Hemoptysis: "For both men and women, hemoptysis, nosebleeds, coughing blood, and coughing pus-blood, one can take three pills, Coptis Detoxification Decoction, and Diaphragm-Cooling Powder."
• Jingyue Quanshu‧Treatment of Hematemesis: "In treating blood syndromes, one must understand the essentials, and the cause of blood movement is only fire and qi."
• Hebei Chinese Medicine, 1995, (17): 24～26: Mr. Zhang, male, 35 years old, first consultation on May 23, 1993, high fever and thirst, body temperature 40℃, unconsciousness, static blood spots on the chest and abdomen, continuous epistaxis, red tongue with yellow coating, wiry and rapid pulse. Western medicine treatment was ineffective, so he sought Chinese medicine treatment. The syndrome was classified as reckless blood movement due to blood heat, and the treatment should focus on clearing heat and removing toxins, cooling blood and stopping bleeding. The prescription used was Rhinoceros Horn and Rehmannia Decoction with modifications: Rhinoceros Horn 10g (substituted with buffalo horn, take infused), Unprocessed Rehmannia Root 50g, Moutan Bark 20g, Red Peony Root 15g, Raw Gypsum 50g, Acorus 15g, Lotus Rhizome Node 5 pieces, Sanqi Powder 5g (take infused), Fresh Lalang Grass Rhizome 50g. Decoction taken with water, two doses reduced the fever and blood loss, severe constipation, added Rhubarb Rhizome 10g (to be decocted later), three doses later the fever subsided, bleeding stopped, bowel movements normalized, and consciousness returned to normal.