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The Heart governs Blood and houses the Shen (Spirit). When deficient, it manifests as mental restlessness and insomnia. The spirit becomes weak. In severe cases, the Five Fluids dry up. Night fever and night sweats occur. The Spleen controls Blood and transforms fluids. When deficient, the lips and mouth become dry and cracked. Body fluids fail to reach the throat. In severe cases, the flesh of the tongue dries up. The skin becomes rough and scaly like fish scales. The Liver stores Blood and governs the Tendons. When deficient, Blood fails to nourish the Tendons. This leads to tendon twitching and muscle fasciculation. In severe cases, whole-body spasms occur. The hands and feet exhibit clonic jerking (convulsions). As for the tender redness on both malar eminences, pale lips, and sallow complexion, these are particularly obvious signs of Blood deficiency. Treatment must distinguish whether the disease is caused by deficiency or whether deficiency is caused by disease. If the disease is caused by deficiency, nourishing Blood is the priority. One may assist with methods to moisten dryness and clear fire, or assist with methods to extinguish wind and subdue Yang, adjusting according to the favorable course of the condition. If deficiency is caused by disease, eliminating the pathogen is essential. Once the pathogen is removed, the deficient body will recover. One must absolutely not abruptly administer harsh tonics, lest the tonics retain the pathogen, causing the pathogenic factor to linger and not depart.

Excess patterns refer to Stagnant Blood (Yu Xue) and Accumulated Blood (Xu Xue). Stagnant Blood accumulates gradually. Accumulated Blood forms suddenly. If Stagnant Blood is in the Cou Li (interstices between skin and muscle), there is alternating chills and fever. If Stagnant Blood is within the muscles, there is tidal fever and night sweats. If Stagnant Blood is in the meridians, there is body pain and tendon contraction. If Stagnant Blood is in the San Jiao (Triple Burner): in the Upper Jiao, there is stabbing pain in the chest, diaphragm, shoulders, and arms; heat in the heart region; and a purple-dark tongue. In the Middle Jiao, there is wandering pain in the epigastrium and abdomen; stabbing pain and bi-syndrome (numbness/obstruction) between the waist and umbilicus. In the Lower Jiao, there is distension, fullness, and stabbing pain in the lower abdomen; free passage of stool but black in color like lacquer. As for developing into swelling or abdominal distension, forming consumptive diseases or drum-distension (ascites), these indicate especially deep and severe Stagnant Blood. However, Accumulated Blood is caused by external pathogens striking the body. Factors such as the Six Exogenous Pathogens, seasonal epidemics, dog bites, and snake bites can all cause sudden accumulation. As stated in the *Nei Jing* (Inner Canon), Accumulated Blood in the upper part leads to forgetfulness; Accumulated Blood in the lower part resembles madness. All these should be treated primarily by resolving Stagnant Blood. For mild cases, unblock the collaterals. For severe cases, break up Blood stasis. For cold-type stasis, use warming and unblocking methods. For heat-type stasis, use cooling and unblocking methods. Once the stasis resolves, new Blood generates naturally. In female patients, one must examine carefully, fearing that pregnancy might be present in ambiguous cases.
[Commentary by Rongzhai]: I believe the concept of "Blood Excess Syndrome" cannot be established. Moreover, what is described in this section is entirely "Blood Stasis," which cannot be viewed as "Blood Excess," nor can it be seen as the counterpart to Blood Deficiency in terms of "Blood Excess." I previously felt that the modern term "Congestion" also cannot be mechanically equated with Blood Excess. Here, Stagnant Blood and Accumulated Blood are essentially pathological states of Blood; the so-called "Excess" refers to "obstructive excess," not "abundant/fullness." This point should be clearly understood in thought.