Bleeding is a symptom that needs to consider its underlying medical condition when making diagnosis and giving treatment. Abnormal bleeding can occur in different medical conditions and present with different clinical characteristics. TCM physicians will consider the bleeding site, characteristics of bleeding, primary condition, and accompanying signs to identify a disharmony pattern as clinical diagnosis. Below are TCM diagnostic criteria for bleeding symptoms. Characteristics of bleeding and accompanying signs are important for determining the internal disharmonies.

Heat stirring blood vessels

This usually occurs in the early stage of a bleeding problem. Acute onset, the bleeding is quite heavy, the blood looks bright red and thick in texture, or dark-red patches on the skin, the accompanying signs are fever, irritability, thirst, constipation, yellowish urine, a hot sensation during urination, and a red tongue with yellow coating.

Yin deficiency creating virtual fire

The bleeding starts gradually, lasts a long period of time or recurrence, the accompanying signs are hot flushes in the evening, mouth dryness, warm palms and soles, irritability, red cheeks, night sweats, dizziness, ear ringing, lumbar soreness, knee weakness, and a red tongue with little coating.

Qi deficiency failing to retain blood

Individuals usually have a prolonged bleeding condition. The bleeding starts gradually, lasts a long period of time, and the blood looks thin in texture. The accompanying signs include pale or swallow complexion, fatigue, general weakness, dizziness, ear ringing, insomnia, sweating, breath shortness, palpitations, a pale and bulky tongue with teeth marks on the margin, and a weak and thready pulse.

Blood stasis obstruction

Beside the above characters, there may have fixed or localized pain, the blood looks dark-red in color or clotted, dark-purplish spots or patches on the skin, a dull complexion, abdominal mass, a dark-purplish tongue and hesitant pulse.

Bleeding and the Internal Organs

Bleeding sites are closely linked up with the functional states of certain organs and their corresponding meridians. Identifying the major involved organs will help determine what specific functions need to be restored.

Bleeding sites	Major involved organs
Nose bleeding	Lungs, stomach and liver
Gum bleeding	Stomach and kidneys
Conjunctiva bleeding	Lungs
Tongue bleeding	Heart
Coughing up blood	Lungs
Vomiting blood	Stomach and liver
Blood in the stool	Stomach and intestines
Blood in the urine	Heart, liver and kidneys
Blood in the semen	Kidneys and liver
Uterine bleeding	Kidneys and spleen
Bleeding under the skin	Spleen

Illustration of TCM internal organs