The pattern of spleen failing to govern blood refers to a complex symptom and sign primarily characterized by bleeding symptoms, caused either by spleen qi deficiency and sinking of middle qi failing to govern blood, or by spleen yang deficiency failing to govern blood. It is often due to overstrain internal damage impairing spleen qi.

The clinical manifestations of the pattern of spleen failing to govern blood are divided into two groups of symptoms: one is bleeding, such as bloody stool, epistaxis, hypermenorrhea, menorrhagia, and metrostaxis; the other is the simultaneous presence of symptoms of spleen qi deficiency, spleen yang deficiency, and sinking of middle qi. If there is spleen qi deficiency, symptoms include poor appetite, epigastric distension, loose stool, fatigue, shortness of breath, pale complexion, emaciation, and weak pulse. If there is spleen yang deficiency, symptoms include fear of cold, cold limbs, abdominal pain, diarrhea, limb edema, or clear and thin leukorrhea in women. If there is sinking of middle qi, clinical manifestations include a heavy sensation in the epigastrium and abdomen, chronic diarrhea or prolonged dysentery, prolapse of the rectum or uterine prolapse, or prolapse of other organs.

The pattern of spleen failing to govern blood is mainly seen in conditions such as "bloody stool," "menorrhagia and metrostaxis," and other bleeding disorders.

The pattern of spleen failing to govern blood should be differentiated from "spleen deficiency with sinking syndrome" and "pattern of deficiency of both heart and spleen."

bubble_chart Differentiation and Treatment

The bleeding symptoms seen in the pattern of spleen failing to control blood are generally lower body bleeding such as bloody stool, menorrhagia, and metrostaxis, as well as subcutaneous and gingival bleeding. Xiezheng Lun states: "This syndrome is similar to vomiting blood and nosebleeds in that they are all blood disorders, but in one case, the qi rises, while in the other, the qi descends."

1. If bloody stool is observed with the pattern of spleen failing to control blood, there are two disease causes: one is due to insufficient spleen qi, leading to failure of qi to control blood; the other is due to insufficient spleen yang, causing the spleen to fail to control blood. In cases of insufficient spleen qi and failure of qi to control blood, the bloody stool is mixed with feces or appears after defecation. Systemic symptoms include poor appetite, abdominal distension, fatigue, pale complexion, shortness of breath, spontaneous sweating, pale tongue, and weak pulse, all indicative of insufficient spleen qi. Treatment should focus on tonifying middle qi to control blood. For acute and heavy bleeding, Angelica Blood-Tonifying Decoction (Neiwaishang Bianhuo Lun) can be used to tonify qi and generate blood. For mild and chronic bleeding, a dual tonification of qi and blood can be applied, using Eight Precious Ingredients Decoction (Zhengti Leiyao).
2. In cases of middle energizer deficiency with cold, insufficient spleen yang, and the spleen failing to control blood, the bloody stool appears after defecation, with dark or black stool, loose stool, abdominal pain, cold limbs, mental fatigue, dull complexion, pale lips and tongue, and weak pulse, indicating insufficient spleen yang. Xiezheng Lun states: "This syndrome is due to the middle palace failing to hold, causing blood to flow uncontrollably." Oven Yellow Earth Decoction (Jingui Yaolue) is the main treatment.
3. If spleen failing to control blood manifests as menorrhagia and metrostaxis, or excessive menstrual flow that does not stop, "although it is a blood disorder, it is actually due to qi deficiency." "The treatment should focus on treating the spleen, whether due to overstrain damaging the spleen, or excessive thinking, hunger, or fullness injuring the spleen, leading to spleen deficiency and failure to control blood" (Xiezheng Lun·Beng Dai). Treatment should aim to tonify qi to control blood, using Returning to Spleen Decoction (Jisheng Fang), Eight Precious Ingredients Decoction (Zhengti Leiyao), Ten Major Tonics Decoction (Hejiju Fang), or Quansheng Huoxue Decoction (from Shenshi Zunsheng Shu), all of which can be selected.

bubble_chart Differentiation of Similar Patterns

1. Spleen deficiency sinking syndrome and pattern of spleen failing to control blood: The scope of spleen deficiency sinking syndrome is relatively broad, including chronic diarrhea, prolonged dysentery, prolapse of internal organs, as well as hemorrhagic conditions such as menorrhagia and metrostaxis, and bloody stool, all of which can be encompassed within spleen deficiency sinking syndrome due to the sinking of middle qi and failure of clear yang to rise. The bloody stool, menorrhagia, and metrostaxis caused by spleen failing to control blood are actually manifestations of the sinking of spleen qi. The bleeding pattern caused by spleen failing to control blood, in addition to bloody stool, menorrhagia, and metrostaxis, also include chronic bleeding from the skin, nose, and gums due to the failure of qi to control blood.
2. Pattern of deficiency of both heart and spleen and pattern of spleen failing to control blood: The pattern of deficiency of both heart and spleen is often caused by excessive contemplation, which depletes heart blood, or by overstrain and dietary injury, or by lack of proper care after illness, leading to injury of spleen qi, reduced production of qi and blood, and insufficiency of heart blood, resulting in a complex symptom and sign of heart blood deficiency combined with spleen qi deficiency or spleen yang deficiency. In addition to symptoms such as palpitation, forgetfulness, insomnia, poor appetite, fatigue, shallow yellow complexion, pale tongue, and weak pulse, it can also lead to menstrual irregularities, menorrhagia and metrostaxis, and subcutaneous bleeding due to spleen deficiency and failure to control blood. In the case of a simple pattern of spleen failing to control blood, apart from bleeding and spleen deficiency symptoms, the symptoms of heart blood insufficiency are not very obvious. However, prolonged bleeding can lead to dual deficiency of qi and blood, and symptoms of deficiency of both heart and spleen may also appear.

bubble_chart Documentation

1. Xiezheng Lun．bloody stool》: "The method of treating diseases: adverse rising treated by inhibition, treating fallen by raising, vomiting and nosebleed must descend qi, bleeding must be raised. Raising is not only about tonifying middle and replenishing qi, but also about lifting and dispersing, all of which are considered raising." Also: "Whenever the middle earth cannot control blood,... Zhongjing used warm medicines along with clear medicines, knowing that the reason blood is not calm is often due to fire disturbance. Whenever qi is excessive, it rises; when qi is deficient, it sinks. Nowadays, doctors only use warming and tonifying lifting medicines, which, although they grasp the method of treating qi deficiency, have not grasped the method of treating blood disturbance."