Blood heat pattern refers to a general term for clinical manifestations such as damage to yin, bleeding, and heat disturbing mental activity due to heat in the blood aspect or pathogenic heat invading the blood aspect. It is often caused by external contraction of pathogenic heat, emotional stagnation, or dietary preferences.

The main clinical manifestations include: irritability, or restlessness and mania, thirst without desire to drink, fever aggravated at night, as well as macules, epistaxis, hematuria, bloody stool, hypermenorrhea or menorrhagia and metrostaxis in women, a crimson tongue texture, and a thin, rapid pulse.

Blood heat pattern is commonly seen in diseases such as "warm febrile disease," "blood pattern," "advanced menstruation," "menorrhagia and metrostaxis," "running yellow sores," and "sores and ulcers."

This syndrome should usually be differentiated from "pattern of blood dryness" and "blood heat blood stasis pattern."

bubble_chart Differentiation and Treatment

Blood heat pattern can appear in various diseases, but in warm febrile disease, the concept of "heat entering nutrient-blood" is not entirely the same as in other diseases. The clinical manifestations have certain characteristics, and the treatment methods also differ, requiring detailed analysis.

1. In warm febrile disease, there are two types of symptom and sign manifestations of blood heat pattern: one is the nutrient aspect pattern, with symptoms such as fever that worsens at night, mild thirst, restlessness and insomnia, faint macula and papule, and in severe cases, unconsciousness and delirious speech, a crimson tongue texture, and a thin, rapid pulse, characterized by damage to nutrient yin and disturbance of mental activity. This is due to pathogenic heat transmitting inward from the qi aspect to the nutrient aspect, or reverse transmission from the defense aspect, representing a severe stage of inward invasion of pathogenic factors in warm febrile disease. Bingchuan nutrient aspect indicates that healthy qi is insufficient, pathogenic qi has deeply penetrated, invading the pericardium, disturbing mental activity, or affecting the Jueyin Liver Meridian. Treatment should focus on "eliminating heat in the nutrient aspect through the qi aspect," clearing the nutrient aspect and discharging heat, using Nutrient-Clearing Decoction(Wenbing Tiaobian). The other is the blood aspect pattern, with symptoms such as severe heat, unconsciousness and delirious speech, or convulsions, hematemesis, epistaxis, bloody stool, macula and papule, a deep crimson tongue texture or a peeled tongue coating, and a weak, rapid or thin, hurried pulse, characterized by damage to yin, stirring wind, stirring blood, and consuming blood. This often results from unresolved nutrient aspect pattern transmitting to the blood aspect, or pathogenic heat from the qi aspect directly entering the blood aspect. Pathogenic heat entering the blood aspect is more severe than heat in the nutrient aspect, representing the most critical stage in the development of warm febrile disease, affecting the heart, liver, and kidneys. This is clearly different from conditions such as heat toxin in the blood aspect in surgical sore and ulcer yang pattern. Treatment should focus on clearing heat and cooling blood, using Rhinoceros Horn and Rehmannia Decoction(Beiji Qianjin Yaofang); or cooling the liver and extinguishing wind, using Antelope and Uncaria Decoction(Tongsu Shanghan Lun); or nourishing yin and blood, pacifying the liver and extinguishing wind, using Modified Pulse-Restoring Decoction(Wenbing Tiaobian), Major Wind-Stabilizing Pearl(Wenbing Tiaobian).
2. If blood heat pattern is present in hemorrhagic diseases (blood pattern), whether hematemesis, epistaxis, hemoptysis, bloody stool, or hematuria, the common features are bright red bleeding, a red tongue, and a rapid pulse. This is often caused by external contraction of wind-heat-dryness pathogens, heat damaging the lung collaterals; or excessive consumption of spicy foods, accumulating heat in the stomach and intestines; or emotional stagnation, five minds transforming into fire; or excessive fatigue, exuberance of heart fire, transferring heat to the small intestine; or chronic illness leading to liver and kidney yin deficiency, frenetic stirring of ministerial fire. "Blood boils when exposed to heat," heat damages the blood vessels, forcing blood to flow recklessly, "yang collateral damage causing external bleeding, yin collateral damage causing internal bleeding." Zhang Jing-yue said: "Movement is often caused by fire, and excessive fire forces blood to flow recklessly." Treatment should focus on cooling blood and stopping bleeding as the basic principle. However, due to differences in disease cause and location, specific treatments may vary.
   1. For example, in cases of hemoptysis, treatment should focus on nourishing yin and moistening the lungs, cooling blood and stopping bleeding, using Lily Bulb Metal-Securing Decoction(Yifang Jijie citing Zhao Ji'an's formula);
   2. for epistaxis and hematemesis, treatment should focus on clearing stomach fire, cooling blood and stopping bleeding, using Jade Lady Decoction(Jingyue Quanshu) with modifications, or clearing the liver and draining fire, using Gentian Liver-Draining Decoction(Lanshi Micang) with modifications;
   3. for bloody stool, treatment should focus on clearing heat and dispelling dampness, harmonizing the nutrient aspect and stopping bleeding, using Rice Beans and Angelica Powder(Jingui Yaolue) combined with Sanguisorba Powder(Renzhai Zhizhi Fang);
   4. for hematuria, treatment should focus on clearing the heart and reducing fire, using Small Thistle Decoction(Jisheng Fang) with modifications. Or nourishing yin and clearing away fire, cooling blood and stopping bleeding, using Anemarrhena, Phelloendron and Rehmannia Pill(Yifangkao) with modifications.
3. If the rooted boil worsens and the inward invasion of toxins occurs, it manifests as a diffuse swelling at the primary lesion site, rapidly spreading, with dark red skin, accompanied by high fever, shivering, dysphoria, restlessness, and even unconsciousness, convulsions, a crimson tongue, yellow and dry coating, and a rapid and strong pulse. This is caused by the spread of toxins, entering the blood aspect, and attacking the zang-fu organs. Treatment should focus on cooling the blood, clearing heat, and removing toxins. The prescription used is the Five-Ingredient Toxin-Eliminating Decoction (Yizong Jinjian) combined with Rhinoceros Horn and Rehmannia Decoction (Beiji Qianjin Yaofang) with modifications.

Women's menstrual blood pseudocyesis pregnancy is always based on blood, hence blood heat pattern occurs more frequently in women. It is often caused by internal heat in the body, excessive consumption of spicy foods, exposure to pathogenic heat, excessive anger leading to qi depression transforming into fire, or yin deficiency with internal heat, etc., resulting in heat disturbing the Chong and Ren meridians, forcing blood to flow recklessly. The main manifestations include early menstruation, heavy menstrual flow, dark red or purple color, thick and sticky, or even menorrhagia and metrostaxis that does not stop, irritability, thirst with a preference for cold drinks, severe constipation, and yellow urine. Those with yin deficiency and blood heat often also experience feverish feeling in palms and soles in the afternoon, and flushed cheeks.

In warm febrile diseases, the mechanism of disease progression in the blood aspect pattern often accompanies two situations: one is due to pathogenic heat in the blood, consuming liver blood and kidney essence, leading to true yin depletion and body fluids exhaustion. Symptoms include dry and wrinkled skin, parched lips and atrophic tongue, sunken eyes and confused gaze, flushed cheeks, reversal cold of limbs, palpitations, or unconsciousness and somnolence, a crimson tongue with little or no coating, and a thin and rapid pulse, indicating yin exhaustion. The second situation is due to yin impairment affecting yang, where pathogenic heat can also damage yang and consume qi, hence yang exhaustion often follows yin exhaustion. Thus, after high fever with profuse sweating, sudden massive blood loss, or severe vomiting and diarrhea, it is easy to trigger yang exhaustion. Symptoms include a pale complexion, profuse cold sweat, fear of cold and curled-up lying, cold limbs, mental confusion, weak breath, and a faint pulse on the verge of disappearing, indicating yang qi on the verge of collapse. It is crucial to urgently rescue the collapsing yang, as saving a fraction of yang qi can provide a glimmer of vitality.

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1. pattern of blood dryness and blood heat pattern: Both heat and dryness are prone to consume and damage body fluids and blood. They are closely related in terms of disease cause and mechanism, often appearing together as dryness-heat, hence sharing some similarities in clinical manifestations, but also having distinctions. In terms of disease cause, blood heat pattern is mostly caused by exposure to pathogenic heat, or the stagnation of seven emotions transforming into fire, or indulgence in rich, sweet, and spicy foods that foster fire and accumulate heat, leading to heat invading the blood aspect. Due to excessive heat in the blood aspect disturbing the heart-mind, symptoms such as irritability and even manic agitation can be seen. Pathogenic heat in the blood aspect, with blood being yin, results in fever that worsens at night. The consumption of yin-blood leads to dry mouth. Excessive heat consumes blood, preventing it from filling the vessels, hence the pulse becomes thin and rapid. When pathogenic heat is excessive in the blood aspect, it forces the blood vessels, leading to symptoms such as nosebleeds, hematemesis, hematuria, and subcutaneous bleeding. The pattern of blood dryness is mostly caused by aging and chronic illness leading to the decline of essence and blood; or by blood heat causing dryness, internal binding of blood stasis, resulting in blood failing to nourish. In terms of the mechanism of blood heat causing dryness,
   1. one is the scorching by pathogenic heat, causing the blood to concentrate and form stasis, with static blood binding internally, leading to scant and dry blood that fails to nourish, thus forming blood dryness.
   2. The other is excessive heat consuming blood and damaging yin, leading to deficiency of fluids and blood, with heat scorching the blood to dryness. It can be seen that blood heat is the direct pathological factor causing dryness, and blood dryness is the result of the pathological development of blood Rebing. Clinical manifestations are characterized by muscle wasting, scaly skin, skin itching, scales, dry and lusterless nails and hair, severe constipation, dry tongue without moisture, and a thin and choppy pulse.
   The two are not difficult to distinguish.
2. Blood heat blood stasis pattern and blood heat pattern: Both syndromes belong to the category of blood heat. Blood heat blood stasis pattern, also known as blood heat binding syndrome, is mostly caused by exposure to external pathogens, or emotional internal damage, or dysfunction of zang-fu organs, or the stagnation of static blood transforming into heat, leading to the binding of blood heat. Clinically, it generally presents with symptoms such as headache like being pricked, fever, or bleeding, or masses, dark red tongue, and rapid pulse. If blood heat binds in the stomach and intestines or lower energizer, it may also present with delirious speech, abdominal distension and fullness with pain and refusal to press, dry stool, black and easy to pass; or spasmodic pain in the lower abdomen, free urination, and the person being manic or frenzied (blood accumulation pattern). In women, heat entering the uterus, binding with blood, presents with hard fullness in the lower abdomen or chest and flanks, chills and fever similar to malaria, delirious speech at night, and cessation of menstruation. It can be seen that only when there are both blood stasis pattern and blood heat pattern manifestations can it be considered as blood heat binding syndrome. It is obviously different from simple blood heat pattern and can be distinguished.

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bubble_chart Documentation

1. Shengji Zonglu‧Epistaxis Chapter: "Loss of blood, when exposed to heat, becomes exuberant and overflows; when exposed to cold, it coagulates and stagnates. The gallbladder receives stomach heat, which ascends along the vessels and moves to the brain. Thus, when the yang collaterals overflow, blood flows recklessly, manifesting as nosebleeds (衄) in the nose and as bleeding from sweat pores (衊). These two are different, and this is the fault of heat reversal causing blood to overflow."
2. Jisheng Fang‧Vomiting and Nosebleeds: "The reckless movement of blood is always caused by heat. Blood, when exposed to heat, becomes thin and overflows. When both blood and qi are hot, blood follows the rising of qi, leading to vomiting and nosebleeds."
3. Zhengzhi Huibu‧Blood Pattern: "For those with blood heat, symptoms include vomiting, nosebleeds, coughing, spitting blood, and bloody urine, with fever in the afternoon. In women, menstruation comes early. The pulse is wiry and rapid. The method should be to cool it."
4. 《Yibian‧Miscellaneous Syndromes》: "Blood follows the movement of qi. When qi is cold and moves slowly, blood becomes sluggish and stagnant. When qi is hot and moves swiftly, blood boils and surges. Blood belongs to yin and cannot move without yang, so it coagulates when encountering cold. Qi belongs to fire and is either deficient or excessive, so it burns when encountering qi."
5. Zabing Yuanliu Xizhu‧Volume 17: "Blood heat should be cleared and cooled. Heat causes abscesses, sores, gingival hemorrhage, epistaxis, swollen gums, bleeding on the tongue, swollen tongue, red urine, menorrhagia, early menstruation, heat entering the uterus, wandering erysipelas, and sudden redness, swelling, and pain in the eyes. The method should be to use sour-cold, bitter-cold, salty-cold, and acrid-cool herbs to eliminate excess heat."