Broadly speaking, blood disorders refer to diseases related to blood such as bleeding, blood deficiency, blood stasis, etc., while in a narrow sense, they are only confined to the hemorrhagic diseases ,including hematemesis, hemoptysis, epistaxis, hemathidrosis, bleeding of the tongue and gums, hematuria, hematochezia, etc. Bleeding caused by acute or chronic hematopathy, infection, tuberculosis, tumor diseases of the liver, stomach and kidneys or cardiovascular diseases can be differentiated and treated as discussed in this section.

Etiology and Pathogenesis

Physiologically, blood originated from foods and is produced by the spleen, stored by the liver, controlled by the heart, distributed to the lungs, refined by the kidneys and circulates in the vessels.
The cause of blood disorders is either exogenous or endogenous in origin. The common exogenous causative factors are wind, heat, dryness, dampness-heat pestilence, etc. For instance, the exogenous pathogenic agent invades the lungs, impairs its collaterals and forces the blood to go upward adversely, thus epistaxis or hemoptysis ensues. Retention of dampness-heat in the intestinal tract may result in hematochezia, and prolonged affection of wind-cold involving the interior may transform to heat and lead to epistaxis. The common endogenous causative factors are immoderate diet, emotional upset, overstrain, pathological changes after a chronic disease or a febrile disease, etc. For example, over-intake of pungent and greasy foods may induce the retention of dampness-heat and damage the blood vessels, leading to hemoptysis and hematochezia. Emotional upsets may induce the production of fire, during which the collaterals of the stomach may be injured by the hyperactive liver-qi and hematemesis occurs, or liver-fire attacks the lungs and leads to epistaxis and hemoptysis, or heart-fire attacks the small intestine and bladder, resulting in hematuria. Mental stress, overstrain and sexual indulgence may impair the heart, spleen and kidneys; when qi is impaired and deficient and fails to keep blood in the vessels, hematemesis, epistaxis, hematochezia and purpura may appear; and when yin is impaired and deficient leading to hyperactivity of fire, epistaxis purpura and hematuria may occur. Moreover, chronic diseases of febrile disease may induce impairment of qi and yin or retention of blood stasis, resulting in hemorrhage elsewhere. In sum, the chief pathological changes of blood disorders are fire, asthenia (deficiency of qi, yin or yang) and blood stasis. They are interrelated and interchangeable with each other during the process of the disease.

Syndrome Differentiation and Therapeutic Principle

A. Syndrome differentiation
(a) Differentiation of asthenia-syndrome and sthenia-syndrome: Bleeding with fire in origin is usually attributed to sthenia-syndrome, while that with yin yang or qi deficiency to asthenia-syndrome. But there may be transformation and combination of the two syndromes in the development of the disorder.
(b) Differentiation of bleeding position and pathogenesis: Hemoptysis involves bleeding from the lungs, hematemesis from the stomach, hematochezia from the stomach and intestine, hematuria from the kidneys and bladder, while spontaneous bleeding may come from the eye, ear, nose, gum, tongue, muscle, etc. Although bleeding is from the same position, the pathogenesis may be quite different. For example, epistaxis may develop from lung-heat, stomach-heat, liver-heat or deficiency of qi and blood; bleeding from the gum may be due to hyperactivity of stomach-fire or hyperactivity of fire and deficiency of yin; hemoptysis may result from the damage of lungs by dryness-heat of liver-fire; hematemesis may be caused by the retention of the stomach-fire; the attack of liver-fire by the stomach of qi deficiency; hematochezia may develop from the retention of dampness-heat in the intestines or asthenia-cold of the spleen and stomach; hematuria may be due to the retention of dampness-heat in the lower jiao, fire hyperactivity and yin-deficiency or deficiency of the spleen and kidneys.

B. Therapeutic principles
Stopping bleeding, causative treatment and strengthening healthy qi are the key principles for treating blood disorders. Hemostatic therapy serves as a symptomatic treatment for cases of bleeding. Causative treatment deals with the etiology and pathogenesis of the bleeding, such as the therapy of clearing away heat and purging fire for cases with sthenic-fire syndrome, and that of nourishing yin and keeping fire downward for those with asthenic-fire syndrome. The therapy of strengthening healthy qi is employed according to which organ is impaired during the convalescent period, such as tonifying the spleen and stomach, nourishing the liver and kidneys, etc.

Classification and Treatment

A. Epistaxis
(a) Attack of the lungs by heat
Manifestations: Bleeding from the nose, dryness of nose, throat and mouth or fever, dry cough, red tongue with thin yellow coating and rapid pulse.
Therapeutic principles: Clear away lung-heat, cool the blood and stop bleeding.
Prescription: The Modified Decoction of Mori and Chrysanthemi

Folium Mori 10 g
Flos Chrysanthemi 10 g
Radix Platycodi 10 g

Radix Glycyrrhizae 10 g
Rhizoma Imperatae 30 g
Radix Scutellariae 10 g
Cortex Mori Radicis 12 g
Radix Scrophulariae 15 g
Rhizoma Phragmitis 15 g

Remarks: For cases with retention of heat in the lungs but without superficies-syndrome, add Fructus Gardeniae, increase the dosage of Mori Radicis and omit Platycodi. For cases with marked dryness of nose, mouth and throat, add Radix Rehmanniae and Radix Ophiopogonis and increase the dosage of Scrophulariae and Phragmitis.

(b) Hyperactivity of stomach-heat
Manifestation: Bleeding of fresh blood from the nose, dryness of nose and mouth, halitosis, irritability, constipation, swelling and pain of gingiva or bleeding from gum, red tongue with yellow coating and rapid pulse.
Therapeutic principles: Clear away stomach-fire, cool the blood and stop bleeding.
Prescription: The Modification of Jade Maid Decoction

Gypsum Fibrosum (decocted first) 30 g
Radix Scutellariae 10 g

Rhizoma Coptidis 6-9 g
Rhizoma Anemarrhenae 12 g
Radix Achyranthis Bidentatae 12 g
Radix Ophiopogonis 10 g
Radix Rehmanniae 15 g
Rhizoma Imperatae 30 g

To be continued .............