TCM and Anemia


TCM and Anemia


By Dr. Hong-Yen Hsu



Anemia appears as a decrease in the erythrocyte count or in the hemoglobin content within the erythrocytes. The skin, eyelids, conjunctivas, and lips of anemic individuals become pale. Subjective symptoms include somatic fatigue, excessive somnolence, and episodes of vertigo, palpitation, tinnitus, heavy-headedness, deteriorated vision, and stiff shoulders. Sometimes fever, eructation, vomiting, hiccupping, and difficulty inbreathing may also occur. In severe cases, syncope, limbic chills, oliguria, and edema may occur.


Western medicine divides anemia into the following types:

  1. acute hemorrhagic anemia, which is caused by copious hemorrhaging;
  2. chronic hemorrhagic anemia, which is caused by continuous hemorrhaging, such as that associated with menstruation, gastric ulcer, duodenal ulcer, and hemorrhoids;
  3. iron-deficiency anemia, due to an inadequate supply of iron, which leads to hemoglobin impairment and reduction;
  4. pernicious anemia, which is usually seen in cases of malnutrition or in pregnant or postpartum women, and is caused by vitamin B12 or folic acid deficiency, which impairs the bone marrow's production of red corpuscles;
  5. hemalytic anemia, which results from erythrocytic rupture due to hereditary and exogenous defects and is often accompanied by jaundice and cholelithiasis; and
  6. aplastic anemia, caused by a variety of etiological factors which lead to a hematopoietic bone-marrow disorder characterized by panhematopenia, hemorrhaging, and infections.

The word "anemia" is not found in ancient Chinese medical literature, though its manifestations are often associated with chlorosis or with blood, qi, or visceral deficiencies. According to the visceral theory of traditional Chinese medicine, the heart controls blood circulation, the spleen governs the blood, and the liver stores the blood. Anemia, therefore, is closely related to disorders of the heart, liver, spleen, and kidneys.


If the liver is unable to store blood, hemoptysis, nose bleeds, and menorrhalgia will result. Since the spleen helps digest food, absorb nutrients, and generate qi and blood, spleen deficiency will cause blood deficiency and chronic hemorrhaging.


As the storehouse of vital essence and the control center for bone-marrow production, the kidneys are crucial to the proper functioning of the body. If kidney essence is exhausted, the deficient bone marrow will be unable to regenerate a sufficient number of blood cells. If kidney yang is deficient, it cannot warm and nourish the other organs, and, as a result, the heart, spleen, and liver will become deficient. This, in turn, will impair the regeneration of blood.


Based on the patient's symptoms and the associated conformation, the following formulas are commonly used in the treatment of anemia.

  1. Qi and blood deficiency is frequently observed in patients with chronic hemorrhagic anemia, iron-deficiency anemia, hemolytic anemia, and aplastic anemia. Characterized by slow onset; dizziness; palpitation; shortness of breath; fatigue; weakness; pale or sallow complexion; pale tongue; and soft, floating, and thready pulse, qi and blood deficiency is commonly treated with Ginseng Nutritive Combination or Dang Gui and Ginseng Eight Combination.
  2. Spleen and kidney yang deficiency is observed in patients with pernicious, hemalytic, or aplastic anemia. Characterized by a prolonged disease course, fatigue, taciturnity, aching waist, weak legs, aversion to cold, cold limbs, spontaneous perspiration, edema, impotence and emission in men, irregular menstruation in women, loose stools, pale complexion, pale tongue with a thin, white coating, and a submerged and slow or submerged and thready pulse, spleen and kidney yang deficiency is treated with Major Four Herbs Combination combined with Eucommia and Rehmannia Formula.
  3. Liver and kidney yin deficiency is observed in patients with aplastic or pernicious anemia. Characterized by dizziness, tinnitus, lower back pain, lassitude, weak legs, hot sensation in the palms and soles or low· fever in the afternoon, dry mouth, night sweats, insomnia, menorrhagia, red tongue, and a thready, rapid pulse, liver and kidney yin deficiency is usually treated with Dioscorea and Rehmannia Combination combined with Ligustrum and Eclipta Formula. To treat fever and pronounced bleeding, gelatin, sanguisorba, anemarrhena, buffalo horn, and biota top can be added.
  4. Spleen qi deficiency is marked by a sallow, pale complexion, lassitude, listlessness, dizziness, poor appetite, palpitation, loose stools, pale tongue, and a weak or thready pulse. It is usually treated with Ginseng and Longan Combination or Vladimiriae and Cardamom Combination. If chills and cold limbs are present, prepared aconite and baked ginger can be added. For severe anemia, blood transfusion and other radical therapies may be needed.
  5. Fire due to yin deficiency is usually present in the patients with pernicious or aplastic anemia. Characterized by dizziness, tinnitus, hot sensation in the palms and soles, irritability, night sweats, dry mouth and throat, a tendency to develop excess blood heat-induced hemorrhages, red tongue with scant saliva, and a thready, rapid pulse, fire due to yin deficiency can be treated with Chin-chiu and Turtle Shell Formula combined with Lycium, Chrysanthemum, and Rehmannia Formula.

Other Formulas Commonly Used for the Treatment of Anemia

  1. Dang Gui Four Combination is comprised of tang-kuei, cnidium, rehmannia, and peony. Tang-kuei contains vitamin B12 and folic acid, both of which are depleted in anemic patients. Tang-kuei together with cnidium has the effect of dispersing blood stagnancy. Rehmannia has hematonic and strengthening effects. Together, these four herbs tonify the blood and improve peripheral circulation. Dang Gui Four Combination is commonly used in the patients with weakness due to blood loss or in women with an anemic predisposition, irregular menstruation, autonomic nervous system imbalance, palpitation, dry skin, and weak pulse.
  2. Ginseng and Dang Gui Ten Combination is a combination of the blood-tonifying Dang Gui Four Combination and the qi tonifying Major Four Herbs Combination, with the additional ingredients of cinnamon and astragalus. Ginseng and Dang Gui Ten Combination supplements blood and qi, while strengthening the body. It is highly recommended for patients with consumptive diseases and those with anemia marked by decreased appetite, pallor or sallow complexion, weak legs and knees, fatigue, and a weak, thready pulse.



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