Blood cold pattern refers to a general term for clinical manifestations such as blood vessel stagnation and contraction caused by the invasion of the blood aspect by the evil of pudendal coldness or the loss of warmth due to qi deficiency.

The main clinical manifestations include: limb numbness, dull skin, cold hands and feet, aversion to cold, colicky pain in the heart and abdomen, pain relief with heat, delayed menstruation, dysmenorrhea, and a thin and slow pulse.

Blood cold pattern is commonly seen in diseases such as "frostbite disease," "cold in the middle," "digital gangrene," "abdominal pain," and women's "menstrual irregularities."

This syndrome should usually be differentiated from "blood stasis pattern."

bubble_chart Differentiation and Treatment

The blood cold pattern can appear in various diseases,

1. such as in frostbite disease, where it often occurs in exposed areas like fingers, toes, ears, and nose. Initially, the local skin turns pale, with cold pain and numbness, followed by dark red swelling, or cyanotic patches, pain, itching, etc. This is caused by the invasion of cold pathogens into the skin, damaging the blood vessels, leading to stagnation of qi and blood. Waike Zhengzong says: "Chilblain is formed by the severe cold of the weather, causing the freezing of qi and blood." Treatment should focus on warming the interior and dissipating cold, harmonizing the nutrient and defense systems. The prescription used is Cinnamon Twig and Chinese Angelica Decoction ("Chinese External Medicine") taken with yellow wine.
2. If it appears in the disease of cold in the middle, the clinical manifestations include sudden shivering, a bluish face, teeth clenching, vomiting, diarrhea, abdominal pain, cold limbs, or spasms in the hands and feet, with a faint pulse on the verge of disappearing. This is caused by a weak constitution, external contraction of cold from the environment, or internal exposure to cold from diet. Treatment should focus on warming the interior and dissipating cold, regulating and tonifying qi and blood. The prescription used is Ginseng and Aconite Decoction(Furen Liangfang) taken with yellow wine.
3. If the blood cold pattern appears in digital gangrene, it often manifests as a dull complexion, preference for warmth and fear of cold, numbness in the affected limb, cramping pain in the calf, dark red or cyanotic and cold toes, muscle atrophy, thickened toenails, severe pain, sleeplessness, a purplish tongue, and a wiry, thin, slow, and choppy pulse. This is mostly caused by insufficient liver and kidney, external contraction of cold pathogens, leading to cold coagulation and blood stagnation, blocking the meridians. Treatment should focus on warming the interior and dissipating cold, invigorating the blood to unblock collaterals. The prescription used is Yang-Harmonizing Decoction(Waike Quansheng Ji) combined with Peach Kernel, Carthamus and Four-Ingredient Decoction(Yizong Jinjian‧Gynecology Essentials).
4. If the blood cold pattern appears in abdominal pain, it is characterized by stabbing pain (or distending pain) in the lower abdomen radiating to the testicles, even extending to the ribs, accompanied by cold limbs, fear of cold, a white and slippery tongue coating, and a deep, wiry, or slow pulse. This is caused by cold in the lower energizer, compounded by the contraction of cold pathogens, leading to cold coagulation in the liver meridian. Treatment should focus on warming the liver and dissipating cold. The prescription used is Meridian-Warming Decoction(Jingui Yaolue) with modifications.

The blood cold pattern often occurs in the elderly and physically weak, as the primordial yang gradually declines with age, and the blood loses its warmth, commonly presenting with listlessness, a dull complexion, calf cramps, muscle soreness, cold limbs, and fear of cold. In women, the blood cold pattern mainly manifests as delayed menstruation, scanty and unsmooth flow, dark and clotted blood, or amenorrhea, dysmenorrhea, or postpartum lochia not clearing, cold pain in the lower abdomen, uterine cold infertility, etc.

Cold is a yin pathogen, with a coagulating nature. When cold Xieke invades the blood vessels, the blood coagulates and stagnates, blocking the collaterals, thus forming the syndrome of cold guest blood stasis, and in severe cases, leading to abdominal mass disease.

bubble_chart Differentiation of Similar Patterns

1. Blood stasis pattern and blood cold pattern: Both syndromes have symptoms of blood vessel stagnation and are closely related in terms of disease cause and mechanism of disease, but there are certain differences. In terms of disease cause, blood cold pattern is often caused by constitutional yang deficiency, with cold Xieke invading the blood vessels, leading to sluggish circulation of qi and blood. Blood cold is one of the disease causes of blood stasis, while blood stasis pattern is the result of the further development of blood cold pattern. The distinction between the two lies in the fact that blood cold pattern not only exhibits cold signs such as physical coldness, cold limbs, pain that prefers warmth, and pain relief with warmth, but also symptoms of static blood such as stabbing pain, fixed pain, and even abdominal mass disease, ecchymosis on the tongue, and deep, slow pulse. These symptoms are clearly different from those of pure blood stasis pattern, making them easy to differentiate.

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bubble_chart Documentation

1. Suwen-Jutong Lun："When cold qi enters the meridians and lingers, it stagnates and fails to move. If it lodges outside the vessels, the blood becomes deficient; if it lodges within the vessels, the qi becomes obstructed, thus causing sudden pain."
2. Zhengzhi Huibu‧blood pattern》："Those with blood cold exhibit symptoms such as numbness, fatigue, dull skin, cold hands and feet, aversion to cold in the chest and abdomen, and abdominal mass pain that alleviates with heat. In women, menstruation is delayed and painful, with a fine and slow pulse. The treatment should focus on warming."
3. 《Luoshi Huiyue Yijing‧Jingmai section："All cases of blood cold and blood deficiency result in delayed menstruation. Why does the blood become cold? It is not only due to external cold entering the pudendum or internal injury from consuming cold foods, but also due to insufficient yang qi, which prevents the body fluids from being adequately replenished, thus causing the menstruation to not arrive on time."