1. Overview
Blood deficiency syndrome (Xue Xu Zheng) refers to a condition characterized by insufficient blood in the body, leading to systemic weakness due to the failure of blood to nourish the limbs, organs, and meridians. This condition often arises from internal injuries due to overwork, excessive worry, depletion of yin blood, weakness of the spleen and stomach, insufficient generation of qi and blood, or excessive blood loss. It can also occur after prolonged illness or in the later stages of warm diseases.
The main clinical manifestations include: pale or sallow complexion, pale lips, dizziness, palpitations, insomnia, numbness in the hands and feet, scanty menstruation in women, delayed menstrual cycles, and in severe cases, amenorrhea. The tongue is pale, and the pulse is thin, weak, and deep.
Blood deficiency syndrome is commonly seen in conditions such as “palpitations,” “deficiency fatigue,” “dizziness,” “headache,” “spasms,” “hemorrhagic disorders,” “constipation,” “fever,” “irregular menstruation,” “amenorrhea,” and “infertility.”
This syndrome should typically be differentiated from “yin deficiency syndrome” and “blood collapse syndrome.”
2. Differentiation of this Syndrome
Blood deficiency syndrome can manifest in various diseases, each with distinct clinical features and treatment methods that must be analyzed accordingly.
For instance, in cases of palpitations with blood deficiency syndrome, the clinical presentation is characterized by palpitations, dizziness, insomnia with vivid dreams, pale complexion, fatigue, a pale red tongue, and a weak pulse. This is often due to excessive worry, overstrain on the heart and spleen, prolonged illness leading to deficiency, insufficient qi and blood, or excessive blood loss, resulting in the heart being unable to function properly. Treatment should focus on nourishing blood, calming the heart, and tonifying qi, using formulas such as Gui Pi Tang (归脾汤) or Zhi Gan Cao Tang (炙甘草汤).
If blood deficiency syndrome occurs in cases of deficiency fatigue, the clinical manifestations primarily reflect symptoms of heart and liver blood deficiency: (1) Heart blood deficiency, characterized by palpitations, forgetfulness, insomnia with vivid dreams, pale complexion, pale tongue, and a thin or irregular pulse. This is often due to congenital insufficiency, weak essence and blood, excessive worry damaging heart blood, or failure to regulate after a major illness, leading to deficiency of yin blood. Treatment should focus on nourishing blood and calming the spirit, using formulas such as Yang Xin Tang (养心汤) or Gui Pi Tang (归脾汤); (2) Liver blood deficiency, characterized by dizziness, tinnitus, flank pain, restlessness, irregular menstruation, amenorrhea, and in severe cases, skin dryness and pale complexion, with a pale tongue and thin, wiry pulse. This is often due to emotional stagnation, depletion of liver blood, or excessive blood loss, leading to deficiency of yin blood. Treatment should focus on nourishing blood and supporting the liver, using Si Wu Tang (四物汤) with modifications.
In cases of dizziness with blood deficiency syndrome, the clinical presentation typically includes dizziness that worsens with exertion, pale complexion, pale lips and nails, often accompanied by fatigue, shortness of breath, palpitations, and insomnia. This is often due to prolonged illness leading to deficiency of both heart and spleen, or heat illness damaging yin blood, resulting in blood deficiency that fails to nourish the body, leading to insufficient blood supply to the brain, or blood deficiency causing internal heat that disturbs the clear orifices. Treatment should focus on tonifying qi and nourishing blood, using Gui Pi Tang (归脾汤) with modifications.
In cases of headache with blood deficiency syndrome, the clinical manifestations include headache and dizziness, with a dull pain that worsens with exertion, palpitations, insomnia, fatigue, and poor appetite. This is often due to prolonged illness leading to deficiency of the righteous qi, excessive blood loss, insufficient middle qi, and failure of clear yang to rise, resulting in insufficient nourishing blood to the brain. Treatment should focus on tonifying qi and blood, using Ba Zhen Tang (八珍汤) with modifications.
If blood deficiency syndrome occurs in cases of constipation, the clinical manifestations include hard stools, difficulty in defecation, pale complexion, pale lips and tongue, dizziness, palpitations, and a thin pulse. This is often due to prolonged illness leading to deficiency, aging, postpartum blood loss, or blood deficiency leading to insufficient moisture in the large intestine. Treatment should use Run Chang Wan (润肠丸).
If blood deficiency syndrome occurs in hemorrhagic diseases, the clinical manifestations include epistaxis, gingival bleeding, and even skin bleeding, with pale complexion, dizziness, palpitations, and fatigue. This is often due to excessive blood loss leading to deficiency of both blood and qi, resulting in the inability of qi to contain blood, hence blood loss is unceasing. Treatment should focus on tonifying qi and containing blood, using Ren Shen Gui Pi Tang (人参归脾汤).
If blood deficiency syndrome occurs in febrile diseases, the clinical manifestations include fever that is more severe at night and milder during the day, palpitations, fatigue, pale complexion, pale tongue, and a thin, rapid pulse. This is often due to prolonged illness leading to deficiency of heart and liver blood, or the spleen failing to generate blood, or excessive blood loss. Treatment should focus on clearing heat and nourishing blood, using Dang Gui Bu Xue Tang (当归补血汤).
In summary, although the syndrome is the same, its manifestations vary in different diseases, and clinical differentiation and treatment should be based on the characteristics of each disease.
Blood deficiency syndrome is more common in women, as menstruation and pregnancy are fundamentally reliant on blood. Clinical manifestations include delayed menstruation, scanty menstrual flow, pale color, thin consistency, and lower abdominal pain, and in severe cases, amenorrhea. It can also lead to infertility and miscarriage. Elderly individuals often present with blood deficiency syndrome, primarily related to aging and insufficient blood, with clinical manifestations of fatigue, pale complexion, palpitations, insomnia, dizziness, tinnitus, or constipation.
Blood is yin, and qi is yang; blood is the mother of qi, and qi is the commander of blood. The two are interdependent and mutually supportive. Qi warms the skin, generates essence and blood, and regulates blood flow; while blood carries yang qi and nourishes the muscles and skin. Their relationship is close, thus blood deficiency syndrome often accompanies two conditions in its pathogenesis: first, blood deficiency fails to carry qi, leading to qi deficiency, resulting in symptoms of both qi and blood deficiency, such as pale complexion, palpitations, insomnia, shortness of breath, fatigue, spontaneous sweating, pale and tender tongue, and weak pulse. Second, due to chronic blood loss or sudden large blood loss, leading to empty blood sea and insufficient true yin, resulting in blood collapse syndrome, with symptoms of pale complexion, cold extremities, dizziness, and a weak pulse. Due to excessive blood loss, the qi loses its attachment, leading to symptoms of qi following blood collapse, such as pale complexion, cold sweat, cold skin, cold extremities, and even fainting, with a weak or thin pulse. Treatment should follow the principle that “visible blood cannot be quickly replenished, while invisible qi should be urgently stabilized,” focusing on tonifying qi and stabilizing collapse to prevent the loss of yang.
3. Differentiation of Similar Syndromes
(1) Yin Deficiency Syndrome vs. Blood Deficiency Syndrome
Both are deficiency syndromes; blood is yin, and essence, fluids, and liquids are also yin, and “essence and blood share the same source,” “fluids and blood share the same source.” Yin deficiency syndrome has a broader scope than blood deficiency syndrome.
From the perspective of etiology, blood deficiency syndrome arises from weakness of the spleen and stomach, insufficient transformation, emotional stagnation, depletion of yin blood, prolonged illness, or excessive blood loss. Blood deficiency fails to nourish the head, leading to dizziness; fails to nourish the face, leading to pale or sallow complexion and pale lips; insufficient nourishing blood leads to palpitations and insomnia; blood deficiency fails to nourish the tendons and vessels, leading to numbness in the hands and feet; insufficient blood in the sea of blood leads to irregular menstruation or amenorrhea; blood deficiency fails to nourish the tongue, leading to a pale tongue; and insufficient blood flow leads to a weak pulse.
Yin deficiency syndrome, on the other hand, is often caused by prolonged illness leading to insufficient yin, heat illness damaging fluids, or excessive sweating, vomiting, or purging. Yin deficiency generates internal heat, leading to symptoms such as five hearts heat, afternoon tidal fever; internal heat forcing fluids to leak out leads to night sweats; internal deficiency of fluids leads to dry mouth and thirst, dry throat and eyes, dry cough with little phlegm, and dry stools; and yin deficiency with excess heat leads to a red tongue with little or no coating and a thin, rapid pulse.
In summary, the main distinction between blood deficiency syndrome and yin deficiency syndrome lies in the emphasis on “color” in blood deficiency syndrome, characterized by pale complexion, pale lips, and lackluster nails; while yin deficiency syndrome emphasizes “heat,” characterized by heat in the palms and soles, tidal fever, and night sweats, which can aid in differentiation.
(2) Blood Collapse Syndrome vs. Blood Deficiency Syndrome
Both belong to the category of internal blood deficiency. Blood collapse syndrome is more severe than blood deficiency syndrome and can be a further development of blood deficiency syndrome or caused by sudden large blood loss. Due to the interdependence of yin and yang, damage to yin can affect yang; excessive blood loss leads to qi losing its attachment, resulting in simultaneous collapse of blood and qi. Therefore, after blood collapse, symptoms of qi following blood collapse often appear, such as pale complexion, cold extremities, spontaneous sweating, weak breath, and a weak or thin pulse, even leading to fainting. This is clearly different from the manifestations of blood deficiency syndrome, making it easy to distinguish.
4. Selected Literature
“Dan Xi Xin Fa – Palpitations” states: “Palpitations are due to blood deficiency; palpitations occur at all times, and those with less blood are more likely to experience them.”
“Zheng Yin Mai Zhi – Volume 1” states: “Symptoms of heat in the blood division manifest as calm during the day and fever at night, with dry lips and mouth, and not drinking water; this is a symptom of heat in the blood division. The cause of heat in the blood division arises after heat illness, with heat lurking in the blood, or due to deficiency of yin blood, leading to excess heat in the blood.”
“Zheng Zhi Hui Bu – Upper Orifices” states: “Blood is paired with qi; qi is adorned by blood. In cases of vomiting, epistaxis, and postpartum blood loss, the liver cannot contain the nourishing qi, causing blood to lose its path and leading to dizziness due to blood deficiency.”
“Zheng Zhi Hui Bu – Blood Disorders” states: “Those with blood deficiency exhibit symptoms of coolness in the morning and heat in the evening, heat in the palms and soles, dry skin and nails, pale lips, and women with irregular menstruation; treatment should focus on tonifying.”
This article is authored by Yan Hongchen and Xu Yonggui, selected from the compilation edited by Yao Naili, “Differential Diagnosis of TCM Syndromes.” All rights reserved by the relevant rights holders. This public account is used solely for academic exchange. If there is any infringement, please contact the editor for prompt removal.
