Xue Xu 血虛 - TCM Blood Vacuity Pattern

Blood vacuity (or xue xu) pertains to hypofunction of the TCM (traditional Chinese medicine) spleen, liver, kidney, and heart functions. In TCM, blood is governed by the heart, stored by the liver, and generated and controlled by the spleen. But these “organs” in TCM typically differ from the meaning of the same terms in Western biomedicine.

In TCM, blood is derived mostly from the gu qi (food qi) produced by the spleen. The spleen sends gu qi upwards to the lungs which, in turn, propels qi to the heart where it is transformed into blood. This transformation is assisted by yuan (source) qi. At the same time, the kidneys store jing (essence) which produces marrow (which, in modern biomedicine is known to contribute to the manufacture of blood).

When a patient presents at clinic with a blood vacuity pattern, he or she may exhibit pale complexion, pale lips, nails, and/or conjunctiva, dizziness, palpitations, insomnia, and/or limb numbness. The patient may also experience bodily weakness or fatigue. Their redial pulse will be weak and thread (thin) and the tongue is pale. A woman may experience amenorrhea or hypomenorrhea with pale colored menstrual blood.

In order to nourish blood, the TCM practitioner supplements the spleen and kidneys and also courses liver qi to ensure the free movement of qi which, in turn, circulates blood. A basic formula to treat blood vacuity is Si Wu Tang (Four Gentleman Decoction), but a practitioner may use any number of variations on that formula in order to account for other concurrent, overlapping patterns.

Patients sometime mistakenly interpret a TCM diagnosis of blood vacuity to mean that they have anemia. This is not necessarily the case in as much as there are many types of anemia described in modern biomedicine. But there may be some parallels.
As the following table shows, the primary overlap between iron-deficiency anemia, a not uncommon form of anemia, and TCM blood vacuity pattern is a pale complexion. Easy fatigue, as well as the listed TCM tongue picture and shortness of breath may be associated with qi vacuity in TCM. Tachycardia and palpitations are not necessarily the same thing. One could have palpitations (a rather strong sensation of the heart-beat) absent tachycardia (clinically rapid heart-beat). It’s possible that a diagnosis of iron deficiency anemia could correspond to a TCM pattern of qi and blood vacuity, but not always.

Signs & Symptoms Comparison: Iron-Deficiency Anemia vs. TCM Blood Vacuity Pattern

Western Biomedicine
          Traditional Chinese Medicine
Abnormal paleness, lack of skin color
Pallor or sallow complexion; pale lips & nails
Low energy or easy fatigue
Weak and thready pulse (indicates depletion pattern)
Increased heart-rate
Palpitations
Sore or swollen tongue
Pale tongue
Dizziness
Dizziness
Shortness of breath
Blurred vision or visual floaters
Headache
Insomnia
Irritability
Numbness of the limbs
Desire to eat odd substances (e.g., dirt)
Amenorrhea, delayed menstruation, or hypomenorrhea

If there is TCM heart involvement, the patient may also experience restlessness, agitation, and forgetfulness. If the spleen fails to produce adequate blood factors, one might experience lack of appetite and mental fatigue. If liver blood is affected, soft-tissue spasms might be part of the picture.

So what causes blood vacuity pattern? The causes can be several, but not uncommonly we think of blood vacuity pattern evolving from excessive blood loss (e.g., traumatic injury, long-term, heavy menstruation) and where the blood is not replaced, or as a result of inadequacy of blood factors and components required in blood formation due to impairment of the TCM spleen and functions. Blood vacuity could also exist secondary to blood stasis. Blood stasis is a pattern in which blood fails to move (becomes static) and which may even result in the formation concretions or conglomerations, (i.e., masses). When this happens, static blood is retained and new blood cannot be properly formed.

Whereas iron-deficiency anemia is treated with supplemental iron in Western biomedicine, blood vacuity pattern in TCM is treated with herbal formulas which are not generally high in iron. While this may seem paradoxical, it should be understood that first, the relevant TCM herbal formulas are meant to bolster or augment the body’s blood-generating functions. Second, in China, herbs for blood vacuity are often ingested along with iron-rich foods. This is why, for example, a treatment plan for a female with blood vacuity might include Su Wu Tang, Ba Zhen Tang, Bu Zhong Yi Qi Tang, or other TCM formula that contains some medicinals to supplement blood-forming functions, along with the suggestion to the patient that she add some red meat, pork, poultry, spinach or other iron-rich food to her diet. This is an example of incorporating dietary therapeutics into a TCM treatment plan.













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