because it may quickly turn into interior Heat. Heat may damage the Blood-Connecting channels
and cause bleeding, especially from the lungs, stomach or intestines.
Pathology
There are four main pathological conditions involved in bleeding:
Qi Deficiency
Heat
Empty-Heat
Stasis of Blood.
The first two conditions are the most common ones.Qi Deficiency
One of the functions of Qi is to control Blood, holding it in the vessels. If Qi is deficient it may
fail to hold Blood in the vessels and lead to bleeding. This is a deficient type of bleeding and is
due to Spleen-Qi deficiency. This does not mean, of course, that Qi deficiency always leads to
bleeding. Bleeding from Qi deficiency is often (but not exclusively) characterized by a
downward movement, i.e. as a form of sinking of Spleen-Qi. Thus, it often causes bleeding from
the lower orifices. Typical examples would be excessive menstrual bleeding or bleeding in the
stools or urine from deficient Spleen-Qi not holding Blood.
Bleeding from Qi deficiency is characterized by a fresh appearance and bright-red colour of the
blood and is of course accompanied by symptoms and signs of Qi deficiency.
Heat
Heat causes bleeding by invading the Blood portion and damaging the Blood-Connecting
channels. Heat makes the Blood reckless and causes it to extravasate.
Bleeding from Heat may be upwards or downwards. For example, excessive menstrual bleeding
and bleeding in the stools or bladder mentioned above may also be caused by Heat in the Blood.
Bleeding upwards is usually typical of Blood-Heat. An example is bleeding from the nose and
vomiting or coughing of blood. This type of bleeding is associated with Qi rebelling upwards,
"carrying" Fire with it and injuring the Blood-Connecting channels upwards.
In bleeding from Heat the blood may be bright-red or dark-red and the flow is usually profuse.