bubble_chart Concept

The pattern of both qi and blood deficiency refers to a clinical manifestation where the body's original qi is insufficient, the source of transformation is scarce, and qi fails to generate blood, leading to deficiencies in both "qi" and "blood." This results in an insufficient material basis for the body's life activities and a decline in the functions of the zang-fu organs. This syndrome is often caused by dietary overstrain, internal damage, prolonged illness, or loss of blood and qi.

The clinical manifestations of this syndrome mainly include: mental fatigue, lack of strength, shortness of breath, dizziness, blurred vision, palpitations, insomnia, pale and dull complexion, numbness in the hands and feet, pale nails, or scanty menstruation with light color and thin quality, menorrhagia, fistula disease, a pale and tender tongue, and a weak and thin pulse.

The pattern of both qi and blood deficiency is commonly seen in "deficiency fatigue," "vertigo," "palpitation severe palpitation," "atrophy-flaccidity disease," "insomnia," "menstrual irregularities," and various bleeding disorders.

This syndrome should be differentiated from the "pattern of qi and yin deficiency" and the "pattern of qi deficiency and blood stasis."

bubble_chart Differentiation and Treatment

Clinically, the pattern of both qi and blood deficiency can be observed in the progression of various diseases characterized by qi deficiency or blood deficiency. Due to differences in disease cause, mechanism of disease, and location of disease, the manifestations vary.

1. For instance, in the disease of "deficiency fatigue," this syndrome often results from postnatal disharmony and prolonged illness leading to malnutrition, which damages the spleen and stomach, resulting in insufficient generation and transformation of qi and blood. Symptoms include mental fatigue, lack of strength, shortness of breath, spontaneous sweating, reduced appetite, dizziness, palpitation, emaciation, pale tongue with thin coating, and a fine, soft pulse. Treatment should focus on regulating the spleen and stomach and supplementing both qi and blood, preferably using Eight Precious Ingredients Decoction(Zhengti Leiyao) with modifications. If the deficiency of qi and blood leads to loose striae and interstice, making it easy for external pathogens to invade, Jingui Yaolue·blood impediment deficiency fatigue abnormal pulse syndrome and treatment states: "For deficiency fatigue with various deficiencies and wind qi causing numerous diseases, Dioscorea Pill is the main treatment." Symptoms include emaciation, mental fatigue, shortness of breath, palpitation, susceptibility to common cold, or limb pain and numbness. Treatment should aim to reinforce healthy qi and eliminate pathogenic factors, using Dioscorea Pill with modifications.
2. In cases of "vertigo" due to dual deficiency of qi and blood, often caused by excessive contemplation and inherent spleen-stomach weakness leading to insufficient qi and blood to nourish the head and eyes, symptoms include dizziness, blurred vision, worsening with slight overstrain, pale complexion, lackluster lips and nails, mental fatigue, lack of strength, dream-disturbed sleep, anorexia, loose stools, pale tongue, and fine pulse. Treatment should focus on tonifying and nourishing qi and blood and strengthening the middle earth, using Returning to Spleen Decoction(Jisheng Fang) or Middle-Tonifying Qi-Replenishing Decoction(Piwei Lun) with modifications.
3. This syndrome can also be seen in "palpitation severe palpitation," often due to worry and contemplation damaging the heart and spleen, leading to consumption of qi and blood and failure of blood to nourish the heart. Symptoms include palpitation, severe palpitation, forgetfulness, insomnia, mental fatigue, lassitude, poor appetite, pale tongue, and fine pulse. Treatment should aim to supplement both qi and blood and treat the heart and spleen simultaneously, using Returning to Spleen Decoction with additions such as cinnabar and dragon's teeth.
4. Similarly, "insomnia" can also result from dual deficiency of qi and blood. Leizheng Zhicai·insomnia states: "Contemplation damages the spleen, leading to spleen blood deficiency and chronic insomnia." Symptoms include dream-disturbed sleep, easy awakening, insomnia, palpitation, head distension, forgetfulness, mental fatigue, lack of strength, dull complexion, pale tongue with thin coating, and fine, weak pulse. Treatment should focus on tonifying qi to generate blood and calming the spirit, using Returning to Spleen Decoction or Heart-Nourishing Decoction(Zhengzhi Zhunsheng) with modifications.
5. In cases of "atrophy-flaccidity disease" due to dual deficiency of qi and blood, often caused by pathogenic heat damaging qi and consuming fluids, leading to failure of yangming generation and transformation, resulting in inability to nourish the four limbs and moisten all tendons, which govern the bones and facilitate joint movement. Additionally, spleen-stomach weakness often leads to insufficient liver blood storage, and since the liver governs the tendons, insufficient liver blood fails to nourish the tendons, leading to flaccidity. Symptoms include flaccid and weak limbs, muscle wasting, reduced appetite, mental fatigue, lack of strength, or dizziness and blurred vision, heavy body, bitter taste in the mouth, pale red tongue with thin yellow greasy coating, and fine, wiry pulse. Treatment should focus on tonifying the middle and replenishing qi, nourishing blood and pacifying the liver, using Middle-Tonifying Qi-Replenishing Decoction, or modified Four Ingredients Decoction(《醫學正傅》) with modifications.
6. This syndrome can also be seen in various hemorrhagic diseases, such as "bloody stool," often due to spleen-stomach deficiency and damage, spleen failing to control blood, failure of qi to control blood, leading to internal bleeding. Symptoms include black tarry stools, epigastric distension and discomfort, dizziness, mental fatigue, pale complexion, pale tongue, and fine pulse. Treatment should focus on tonifying qi to control blood, using Returning to Spleen Decoction with modifications.

The pattern of both qi and blood deficiency is commonly seen in the middle and late stages [third stage] of chronic diseases. Individuals with inherent qi deficiency or blood deficiency, or those with chronic hemorrhagic diseases, are particularly prone to this syndrome. It is more common in women than in men.

This syndrome also has distinct characteristics in different medical specialties.

1. In gynecology, such as menstrual irregularities, menorrhagia and metrostaxis, vaginal bleeding during pregnancy, agalactia, etc., the mechanism of disease mainly reflects the failure of qi to generate blood and the failure of qi to control blood, characterized by scanty, pale, thin, and white features. If menstrual irregularities are present, whether in the early or late stage [third stage], symptoms such as scanty menstrual flow, pale color, clear and thin menstrual discharge, anorexia, and pale complexion may be observed; if amenorrhea occurs, it often starts with scanty, pale, and thin menstrual flow, gradually leading to amenorrhea, accompanied by emaciation and a shallow yellow complexion; if fistula disease is present, symptoms such as fistula discharge, continuous dripping, pale color, thin consistency, and a pale and puffy complexion may be observed; if vaginal bleeding during pregnancy occurs, symptoms such as lower abdominal sagging, slight vaginal bleeding, pale red color, thin consistency, and a pale complexion may be observed; if agalactia is present, symptoms such as scanty and pale milk, clear and thin or no milk, non-distended and soft breasts, and a pale complexion may be observed.
2. In the field of surgery, this syndrome is characterized by a slow onset and a prolonged course, with sores and ulcers that are swollen but do not ulcerate, swelling that is not high but flat, roots that are not tight but scattered, carbuncles that are not painful but numb, pus that is not thick but putrid, wound surfaces that are not lustrous but dull, and wound openings that do not close and are difficult to heal.
3. In pediatrics, due to the delicate and tender constitution of children, their qi and blood are not yet fully developed, Jingmai is not yet flourishing. If postnatal spleen and stomach regulation is improper, leading to damage of the spleen and stomach and insufficiency of qi and blood, diseases often linger and do not heal. This syndrome is often seen in pediatric conditions such as infantile malnutrition with accumulation, five retardation, and five kinds of flaccidity. Clinically, it manifests as slow growth and development, poor appetite, emaciation, complexion shallow yellow, delayed intelligence, sparse hair, pale lips, weak limbs, and low crying sounds. In prevention and treatment, while tonifying and replenishing qi and blood, emphasis should be placed on strengthening the spleen and stomach, regulating diet, and aiding their generation and transformation.

The main pathological changes of this syndrome are located in the spleen and stomach. Since qi and blood are interdependent and mutually nourishing, this syndrome is generally caused by prolonged qi deficiency, leading to blood deficiency; it can also be caused by excessive loss of blood depleting qi. However, qi belongs to yang and blood belongs to yin, and further development can lead to the "pattern of both yin and yang deficiency," where spleen disease extends to kidney disease, transforming from qi and blood deficiency to yin-yang deficiency. Due to differences in patients' constitutions and the nature of the pathological changes, two different outcomes, cold and heat, may occur during the evolution of this syndrome.

• One is the heat transformation of this syndrome, where blood deficiency damages yin, resulting in symptoms of both qi deficiency and yin deficiency with effulgent fire, manifesting as "deficiency of both qi and yin." For example, "palpitation" can evolve from heart and spleen qi and blood deficiency to heart and spleen qi and yin deficiency, presenting symptoms such as severe palpitation and irregular pulse.
• The other is the cold transformation of this syndrome, where qi deficiency damages yang, extending from the spleen to the kidney, manifesting as "deficiency of both spleen and kidney." For example, "edema" can evolve from spleen and stomach qi and blood deficiency to spleen and kidney deficiency edema.

These two outcomes are particularly prominent in patients with inherent yin deficiency or yang deficiency. The emergence of this syndrome often leads to a decline in the body's resistance to disease, making it susceptible to external pathogens or complications with phlegm, food stagnation, and blood stasis. Clinically, it manifests as a complex deficiency/excess condition, so attention must be paid to concurrent symptoms during pattern identification. For new contractions, the principle of "treating the acute symptoms first" should be followed, eliminating external pathogens before treating the root cause. If there are concurrent symptoms, both reinforcing healthy qi and eliminating pathogenic factors should be considered, ensuring that both are addressed to avoid the risk of retaining pathogens.

bubble_chart Differentiation of Similar Patterns

1. Pattern of qi and yin deficiency and pattern of both qi and blood deficiency: Both are deficiency pattern, one involving both qi and yin, and the other involving both qi and blood. From a clinical diagnostic perspective, both can present symptoms of qi deficiency such as mental fatigue, lack of strength, and shortness of breath. Blood deficiency and yin deficiency can both manifest as symptoms of nutrient-yin depletion, but blood deficiency primarily manifests as insufficient nutrient-blood, with symptoms such as dizziness, blurred vision, pale eyelids, lips, and nails, palpitations, numbness in the hands and feet, a pale tongue, and a thin pulse. Yin deficiency, on the other hand, primarily manifests as yin deficiency with effulgent fire, with symptoms such as dizziness, blurred vision, tinnitus, afternoon fever, flushed cheeks, sore throat, vexing heat in the chest, palms, and soles, a red tongue with little coating, and a thin, rapid pulse. These are the key points for differentiation. Although qi and blood deficiency can evolve into a pattern of qi and yin deficiency, this is only a correlation in the mechanism of disease. The pattern of qi and yin deficiency is commonly seen in the late stage (third stage) of febrile sexually transmitted diseases and in internal damage Zabing, while this syndrome is mainly seen in internal damage Zabing.
2. Pattern of qi deficiency and blood stasis and pattern of both qi and blood deficiency: Both involve both qi and blood, but the former is a pattern of deficiency complicated by excess, while the latter is a deficiency pattern. Pattern of qi deficiency and blood stasis refers to the condition where qi deficiency leads to insufficient original qi, resulting in the inability to promote blood circulation, leading to disharmony between nutrient and defensive qi, Jingmai or zang-fu organ stasis. For example, qi deficiency can lead to Bi disease, with symptoms such as numbness in the hands and feet; qi deficiency can also lead to wind stirring and meridian stasis, resulting in apoplexy, facial deviation, and paralysis of the hands and feet; spleen and stomach qi deficiency can lead to malnourishment of the zang-fu organs and obstructed blood circulation, resulting in chest pain, hypochondriac pain, abdominal distension and fullness, dull pain with tenderness, fixed location, and abdominal mass disease. These symptoms differ from those of pattern of both qi and blood deficiency, which include numbness in the hands and feet without insensitivity, and abdominal distension and fullness with a preference for pressure. Of course, pattern of qi deficiency and blood stasis can also present with characteristics such as petechiae on the tongue, ecchymosis on the body, and abdominal masses, which are not seen in pattern of both qi and blood deficiency. These should be used for differentiation. It must be understood that if pattern of both qi and blood deficiency progresses from deficiency to stasis, it will manifest as pattern of qi deficiency and blood stasis, indicating a certain connection in the mechanism of disease.

bubble_chart Documentation

1. Suwen-Tiaojing Lun: "The way of the five zang-organs all originates from the meridians, which circulate blood and qi. If blood and qi are not harmonious, various diseases will arise and transform."
2. Zhubing Yuanhou Lun‧Deficiency Fatigue Various Disease Manifestations "Blood and qi are what nourish and sustain the body. In people with deficiency fatigue, the essence and marrow are withered and exhausted, blood and qi are deficient and weak, unable to fully nourish the skin and muscles, hence they become emaciated." "The stomach is a fu-organ, responsible for containing water and grains; the spleen is a zang-organ, responsible for digesting water and grains. If the spleen and stomach are warm and harmonious, they can digest. Now, with deficiency fatigue, blood and qi are weak and diminished, the spleen and stomach are cold and weak, hence they cannot digest grains."
3. Jingyue Quanshu‧Insomnia: "There are those with inherently weak constitutions, or due to overexertion, or due to post-illness, this is insufficiency, suitable for nourishing blood and tranquilizing the spirit. For those who cannot sleep after illness or postpartum women, this is all due to blood and qi deficiency, and the insufficiency of the heart and spleen zang-organs. Even if there is phlegm-fire, it is not suitable to overly attack, treatment should still focus on supplementation, or assisted with phlegm-clearing and fire-reducing medicines."
4. Xiezheng Lun‧Yin-Yang Water Fire Qi Blood Theory: "One yin and one yang mutually support each other, and moreover, what moves blood is qi, what holds qi is blood. Qi is yang, abundant qi means abundant fire; blood is yin, blood deficiency means water deficiency, one is two, two are one. One must deeply understand this principle, and then manage blood and regulate qi, harmonize yin and yang, can be adept and resourceful."
5. Jingyue Quanshu‧Blood Pattern: "The spleen controls blood, spleen qi deficiency then cannot contain, the spleen transforms blood, spleen qi deficiency then cannot transport and transform, thus blood has no governance, and thus collapses and runs recklessly."