Blood is the very essence of life and health, the most vital and desirable of all the humors.  Galen said that blood, or the Sanguine humor, was formed from perfect nourishment, perfectly digested.
     Yet even blood is vulnerable to various imbalances, disorders and pathologies, which can either be quantitative and/or qualitative in nature.
     Quantitatively, blood disorders can be differentiated into those of excess, or plethora, also called congestion or engorgement; and various forms of blood deficiency, or anemia.
     Qualitatively, blood can be corrupted in six basic ways:
     1)  Its vital capacity and function may be reduced or compromised;
     2)  It can be unduly thickened, stagnant, congested or congealed;
     3)  It can be unduly thinned, softened or attenuated;
     4)  It can be subjected to various dystempers;
     5)  It can suffer from various dyscrasias or amalgamations;
     6)  It can suffer from sepsis, or putrefaction.


Blood Excess, or Plethora

     Although an abundant supply of blood is essential for good health, it is possible to get too much of a good thing.  And so, blood is subject to conditions of excess or plethora, like any other humor.
     Causes:  Since blood is formed from the richest, choicest nutrients extracted from food and drink, it is, by its very nature, quite prone to disorders of excess, or plethora.  In our modern affluent society, many consume excessive amounts of heavy, rich food and meat, especially red meat, which tends to generate an overabundance of blood.
     Constitutionally, those of a Sanguine temperament are most predisposed to plethoras of blood.  Excesses of heat and moisture also favor plethoras of blood.
     Accumulation Sites:  The heart, and also the arteries, blood vessels and small capillaries, many of them visible just under the skin, are the primary accumulation sites for blood.  The secondary accumulation sites tend to be organs and tissues that are inherently Sanguine in temperament:  the liver and hepatic portal system; the spleen and pancreas; the veins, uterus and female organs; the kidneys; the skin; and the digestive, respiratory and genitourinary mucosa.
     Signs and Symptoms:  Bleeding disorders, like nosebleeds, gingivitis, rectal or anal bleeding, hemorrhoids;  Skin disorders - blushing, flushed complexion; prominent capillaries, spider nevi, angiomas, hematomas; Pruritis - itching nose; prickling, itching and tingling in the flanks and temples, or on the skin.  Fullness, heaviness - heaviness of body, especially behind eyes; drowsy, sleepy; weak, heavy limbs.  Digestive - sluggish, congested liver, pancreas or spleen.  Genitourinary - constant erection, priapism; excessive menstrual bleeding in women; bright yellow, thick urine.  Pulse - full and robust.  Dreams - of red things, blood flowing, etc...


Blood Deficiency, or Anemia

     Although excesses or plethoras of blood are common, anemia, or a deficiency of blood, poses a much more critical threat to the health and vitality of the individual.  The types of anemia and their causes are many and varied, but they can be broadly differentiated into three categories:
     Dietary defects and nutrient deficiencies:  Since blood is formed from the choicest, richest share of nutrients extracted from food and drink, the best way to ensure an adequate supply of vital, healthy blood is to eat a diet that's sufficiently rich, diverse and complete.  Diets deficient in important blood-building nutritional factors, such as iron, folic acid, vitamin B12 or protein will lead, sooner or later, to anemia.
     An inefficient or unbalanced digestion and metabolism, or pepsis:  Your diet may have no shortcomings or deficiencies of nutrients, but if your Natural Faculty is unable to efficiently digest and assimilate these nutrients, they cannot go to build vital, healthy blood.  A digestion that is atonic and too cold, damp and Phlegmatic will generate an excess of phlegm and a deficiency of blood, which requires a higher level of metabolic heat to generate Or the blood that's generated will be too thin, watery or attenuated.
     Deficiencies or defects in the vital essence, or Radical Moisture:  These usually involve deep-seated defects or deficiencies in the vital sap, or bone marrow and other associated hematopoietic factors that develop slowly and chronically, usually over many years.  Also, since the Sanguine humor is moist in temperament, it requires an adequate fluid intake to nourish and replenish sufficiently.   
     In addition, acute blood deficiencies can be caused by extraordinary feats of physical overexertion, which exhaust the nutrient supply of the blood.  Injuries involving considerable loss of blood, as well as excessive menstrual bleeding in women, can also cause anemia.  In the first case of exhaustion, both the blood and its Vital Force will be depleted.
     The cardinal signs and symptoms of anemia are as follows:  Paleness - pale or pallid complexion; pale tongue, nails, lips, conjunctiva.  Dryness - dry hair; rough dry skin.  Vital Spirits - dizziness, lightheadedness, fatigue, listlessness; fuzzy, blurring vision; shortness of breath; insomnia; low energy.  Female - scanty or irregular menstruation; amenorrhea.  Pulse - thin, fine, thready; sometimes choppy.
     Blood deficiency is felt most acutely by organs and tissues that depend most on an abundant supply of blood.  In addition to the above general signs and symptoms, there are others more specific to blood deficiency localized in a particular organ or tissue:
     Heart:  light, restless, dream-disturbed sleep; palpitations; anxiety; a tendency to be easily startled.
     Liver:  dry eyes, blurred vision, visual floaters; muscular weakness, spasm or cramping.
     Tendons, bones and joints:  stiffness and tightness of tendons, joints, articular structures.  


Vital Disorders of the Blood

     Blood is the physical, humoral vehicle for the energetic vital principles: the Vital Force, Thymos, and Innate Heat.  These vital principles, and the organs of the Vital Faculty that supply them, have a very close, intimate, reciprocal relationship with the blood. 
     Toxins and impurities in the blood will compromise its ability to be an efficient vehicle for these vital principles.  The result is a syndrome commonly called tired blood.  Blood tiredness and toxicity will compromise the functioning of all the major faculties and organ systems of the body in a vicious downward spiral.  And so, Greek Medicine uses herbs and other therapies to cleanse the blood. 
     The cardinal signs and symptoms of tired blood are: fatigue, lassitude, low energy; much sighing and yawning; poor appetite and digestion; a slightly sallow, pallid or pasty complexion; a slightly pale or purplish tongue; and a soft, soggy or feeble pulse. 
     Depending on which vital principle is being affected, tired blood may have three subtle variations:
     If the Vital Force is compromised and slightly stagnant, the circulation of blood won't be as vital and exuberant as it needs to be.  A mild form of cyanosis and blood stasis can set in, producing a slight purplish tinge to the skin, tongue and fingernails.
     If the Innate Heat is compromised, digestion, metabolism and the concoction of the humors will suffer.  The body may also be coldish, vulnerable to chills, and have cold hands and feet.
     If the Thymos is compromised, the immune response will suffer, and there may be increased vulnerability to colds and flu.  There may also be a thin, furtive sweat, even without undue heat or exertion.
     Cyanosis results from a severe depletion of the blood's Vital Force and/or Innate Heat, usually due to a deficient or defective heart and/or lung function, and a consequent deficiency of fresh pneuma.  Purplish discoloration, mainly visible in the lips, tongue and nails, but also in the general complexion, is its cardinal sign.
     With a severe depletion of the Innate Heat, the discoloration will be a bluish purple.  The peripheral circulation will often be poor, resulting in cold hands and feet, and possible tingling and numbness.
     A mild form of cyanosis may be caused by nervous stress and emotional tension, centered mainly in the chest and liver, impeding the free flow of blood and its Vital Force.  Actually, this syndrome is quite similar to that of tired blood with a deficiency and stagnation of the Vital Force; the difference is not so much one of kind as it is one of degree.


Blood Stagnation, or Stasis

     Stagnant blood, or blood stasis, can have many causes.  The principal ones are as follows:
     Chronically stagnant or blocked circulation of the Vital Force is probably the most common cause of stagnant blood, since the Vital Force guides the circulation of the blood.  This is a complication of tired blood that can develop into full-blown blood stagnation.  Nervous tension and emotional repression can also stagnate the Vital Force, leading to blood stagnation.  The liver is often torpid and congested. 
     Extreme or excessive cold can congeal the blood and impede its circulation.  Paradoxically, excess heat and/or dryness can thicken the blood and have the same result, or effect, of stagnating it.
     An excess or plethora of blood, either systemic or localized, can engorge and congest the blood vessels and cause blood stasis.  Conversely, severe blood loss due to dehydration or injury can also cause blood stasis, because there's not enough blood volume and pressure for the heart to pump and circulate properly.
     Hardened arteries with plaque, constriction and stenosis and varicose veins can also impede circulation and stagnate the blood.  Besides dietary excesses and sedentary habits, stress, constipation and smoking are also big contributing factors. 
     Extravasated blood is stagnant blood that has leaked out of the blood vessels that were ruptured at the site of a bruise or injury.  It will usually produce the "black and blue" discoloration of bruising.
     The basic signs and symptoms of blood stagnation are: a purplish tongue, often with dark purple spots or patches; a choppy or short pulse; and a sharp, cutting, stabbing or tearing pain at the location of the stasis.  Blood stagnation can also produce the itching or prickling sensations of "pins and needles", or mortification.
     Blood stagnation may manifest as many different disorders, depending on where it's localized in the body:
     Migraines usually involve inflamed or constricted blood vessels impeding blood circulation in the head.  There's also giddiness, nausea, photophobia, floaters, and heat and inflammation in the head.
     Angina will cause sharp, stabbing pains in the chest or heart, a purple face and tongue, lassitude, palpitations and dyspnea.  These symptoms get worse with exertion.
     With stagnant blood in the liver, the tongue will be purple with dark spots, usually in the liver area.  There can also be purplish spider nevi on the skin in the right upper quadrant of the abdomen,  A sharp, stabbing pain may be felt in the liver area. 
     Stagnant blood in the veins of the hepatic portal system is called portal hypertension.  The digestion and assimilation will be slow and sluggish, and backed up blood in the portal system can cause hemorrhoids. 
     Stagnant blood in the uterus will produce dysmenorrhea with severe cramping and stabbing pains; once the clots are passed, the pain is relieved.  Stagnant blood is the bane of women.
     Blood stagnation in the legs usually involves poor veinous return.  Varicose veins, as well as swelling and edema, are common.  The dorsalis pedis pulse will often be weak. 
     Since blood stagnation is a serious condition, it can easily produce complications, many of which can be life threatening.  Severely stagnant blood will clot, or form embolisms; if a clot or embolism lodges in the heart, brain, lungs or other vital sites, it may prove fatal.
     Ischemia or infarction is an acute or total deprivation of blood supply, caused by severe or acute blood stasis.  Deprived of fresh pneuma and Vital Force, the cells quickly die.  Ischemia of the heart muscle is called a heart attack; ischemia of the brain is called a stroke.  Clots or embolisms may also be involved.  Blood stagnation in sore, tense muscles is muscular ischemia, but it isn't critical or life-threatening.


Uremia and Uric Acid Diathesis

     Uremia is an excess of uric acid in the blood.  Although this condition is linked to the overconsumption of  uric acid forming foods, it also involves urinary debility and devitalized kidneys that can't properly eliminate uric acid from the blood.
     As a metabolic excess condition of the blood, uremia is considered to be a Sanguine condition.  Uric acid is hot, inflammatory and irritating, and also moist, since it involves poor fluid release and urinary function.  It also tends to produce symptoms in Sanguine organs and tissues, especially the genitourinary tract and surrounding areas.
     Uremia is most commonly seen in those of a Sanguine temperament, although not all Sanguines are vulnerable.  Uric acid diathesis is a term used in Greek Medicine to describe a specific constitutional predisposition towards uremia and its complications.
     Uremia may progress rather asymptomatically for a long time.  There may be some urinary catarrh, irritation or inflammation, as well as urinary debility.  The joints may be vaguely stiff and sore, particularly in the knees, hips and lower back.
     When uric acid crystallizes in the joints, often in the big toe, there's acute swelling, pain and inflammation, which is gout.  Since the skin will often try to eliminate the excess uric acid that isn't being passed off via the kidneys, chronic skin conditions involving irritation, inflammation, itching, or damp, foul discharges are commonly seen.


Dystempers of the Blood  

     Dystempers of the blood can involve any of the Four Basic Qualities.  However, the inherent temperament of blood makes it especially prone to excesses of heat and/or moisture. 
     Acute dystempers of the blood will primarily affect its circulation and functional properties.  Chronic dystempers can easily develop into full-blown blood dyscrasias.
     Heat will agitate the blood, and make it caustic and inflammatory, which can cause bleeding disorders, swellings, inflammation, skin rashes and urticaria.  Extreme or chronic heat will also dry and thicken the blood, causing it to stagnate.
     Cold will thicken and congeal the blood, and is one of the causes of stagnant blood.  Cold can also impede the circulation and constrict the vessels.
     Dryness, if severe, can produce dramatic losses of blood volume and hypovolemic shock.  Milder dryness can thicken and stagnate the blood; nosebleeds are common.
     Excess moisture in the blood will dampen its Innate Heat, and hence its Thymos and immunity.  This is a common precursor to putrefaction of the blood, and can happen in damp, humid climates, as well as in those of a languid Sanguine temperament whose abundant blood is apt to be overly indolent and moist.


Dyscrasias of the Blood

     Dyscrasias of the blood fall into two basic categories:  dyscrasias produced as the consequence of chronic or lingering dystempers; and amalgamations of blood with other morbid humors.

     Consumptive dyscrasia of the blood is caused by a long, lingering heat or fever in the blood, or a chronic hectic fever in an internal organ.  These forms of pathological heat can thicken and coarsen the blood, slowly consuming its Radical Moisture, and thereby compromising its ability to moisten and nourish the organs and tissues.  The thickened blood may also stagnate.
     The cardinal signs and symptoms are:  chronic fatigue, restlessness, or malaise; subtle dizziness, vertigo, or mental confusion; a low grade fever or feverishness that is worse in the afternoons and evenings, or from exertion; feverishness accompanied by a rosy glow on the cheeks, ears, center of the chest, palms, and soles; dry skin and chronic thirst; a thin, emaciated, dark red tongue; and a thin, rapid pulse.
     Consumptive dyscrasia of the blood is a chronic condition that can manifest many complications.  These include chronic inflammatory skin conditions - rashes, urticaria, eczema or psoriasis.  In extreme cases, there may also be bleeding, such as vomiting or coughing up blood.  Associated diseases include tuberculosis, consumption, consumptive fevers, prostration, marasmus, and certain forms of insomnia and neuraesthenia.
     Choleric Blood results when morbid yellow bile corrupts or amalgamates with the blood.  Chronic inflammatory conditions, bleeding disorders, gingivitis, excessive menstruation, easy bruising or swelling, rashes and urticaria are possible clinical manifestations.  The tongue may be a bright red, or be reddish around the edges; the pulse is often rapid, forceful and bounding, especially in acute flareups.
     Phlegmatic Blood is the thinning and softening of blood by morbid amalgamation with the Phlegmatic humor.  It often results from a cold, atonic digestion and pepsis that has incompletely concocted the blood.  The blood will be more watery and dilute, and lighter than normal in color. 
     Since this syndrome is basically a thinning of the blood, it could be considered as a type of anemia, except that the dry signs and symptoms will be absent.  Instead, there may be signs of edema and water retention, and congestion of phlegm and lymph.
     Of all the blood dyscrasias, Atrabilious Blood, or the amalgamation of blood with morbid black bile, is the most pathological.  That's because black bile is contrary to blood in all its qualities. 
     Morbid black bile is extremely toxic.  Blood that's been corrupted by it will be a deep, dark red, thick and sluggish, stagnate or clot easily, and stick to blood vessel walls.
     Atrabilious blood is a major cause of stagnant blood, and is also associated with clots and embolisms.  In the arteries, there will be plaque formation, and in the capillaries, dark colored spider nevi.  Besides being thicker and more stagnant, the vital and nutritive properties of the blood will also be seriously compromised.  Atrabilious blood can also stagnate in the hepatic portal system, impairing digestion and assimilation.  Autoimmune disorders like rheumatoid arthritis are also common.  When chronic, atrabilious blood can also create hard swellings and growths, or tumors.


Putrefaction of the Blood

     Being warm and moist in temperament, blood is especially vulnerable to putrefaction; its rich concentration of nutrients makes it a tempting treat for infectious microbes.  Although Sanguines are especially prone to putrefactions of blood, no constitutional types are immune. 
     All putrefactions of the blood will generate heat symptoms and fever.  Depending on the virulence of the infectious agent and the rate and severity of the putrefaction, these can range from a mild feverishness and agitation to full-blown fever and delirium. 
     The fevers generated by putrefaction of the blood are constant; since they allow the sufferer no rest, these fevers can be quite draining to the overall vitality of the organism, and can unsettle the heart and vital spirits. 
     An acute blood fever can be like a powerful, constant bonfire.  But chronic fevers of the blood can be like an old bonfire that has dwindled down to a few glowing embers, a mere shadow of its former self.  This would also be called a consumptive fever - the kind that are associated with consumptive dyscrasias of the blood.  The point to remember is that all blood fevers are constant; the only variables are their intensity, and their stage of progression.
     When blood, either systemically or locally, putrefies, it generally degenerates into two morbid byproducts.  The more rarefied byproduct is morbid yellow bile, and the denser byproduct is morbid black bile, both of which may remain in the blood to corrupt it.  Another byproduct that's commonly generated is pus


Suppuration and Pus

     Pus is a thick, creamy, opaque white or yellowish fluid that's a byproduct of infection.  It consists of serous fluid mixed with the remains of infectious microbes, decomposed tissue, and dead leukocytes.  There are different kinds of pus, each with a different color, texture and opacity. 
     Greek Medicine sees pus primarily as a product of putrefaction and breakdown of the blood.  Like any toxic waste or discharge, pus is ripened or concocted, and usually concentrated and peripheralized by the organism into cysts, abscesses or pustules, which subsequently erupt and discharge their contents.  This process of pus formation and discharge is called suppuration.
Although the presence of pus denotes a morbid putrefaction of the humors, pus isn't totally a bad thing.  The formation, isolation and discharge of pus is a self-protective response of the organism to eliminate noxious, harmful toxins.
     Pus is produced if infection or putrefaction has complicated the healing process.  The thicker and more opaque the pus, the more vigorously the organism is fighting the infection.  Greek physicians called this thick white pus noble pus, or laudable pus, because it usually presaged a successful overcoming of the infection, and the imminent healing of the lesion.
     Pus that is thinner and more transparent, on the other hand, doesn't bode very well, and usually denotes that the infection is, or is becoming, chronic, and that the metabolism and immunity of the  organism in fighting it is weak or compromised.  Greek Medicine considers this form of pus to be more morbid because it isn't being ripened or concocted as vigorously by the metabolic heat of the organism.  This thinner, translucent pus is therefore colder and more Phlegmatic in temperament than the thick, opaque, noble pus, which is warmer and more Sanguine. 
     Sometimes, pus is mixed with blood, which usually denotes that small blood vessels or capillaries in the area have ruptured.  Sometimes, pus may be thin and translucent, with shreds of sloughing or decomposing tissue, and have a strong foetid odor; this kind of pus is generally the most morbid of all.
     Since the formation and discharge of pus is basically a protective cleansing response of the organism, there are cleansing therapies in Greek Medicine that utilize or provoke the suppuration process to draw toxins out of the body.  This provoking of suppuration through the application of vesicants and counterirritants is a type of derivation therapy. 


Differentiation of Bleeding Disorders

     Abnormal bleeding is a clear cause for concern, and often sends patients to see a physician.  The physician, in treating a bleeding disorder, must first understand and address its cause.
     Abnormal heat and choler in the blood will cause its flow to be wild and reckless, producing abnormal bleeding.  In Greek Medicine, we say that the blood boils over.  This type of bleeding is usually associated with fevers, infections, rashes and inflammatory conditions, and other signs of heat.  The bleeding is often profuse and exuberant.
     Blood stagnation or congestion is another common cause of bleeding.  Blood volume and pressure will build up behind the point of stagnation or obstruction, like water behind a dam, until it overflows.  The pressure of this buildup can be enough to rupture a blood vessel.  With blood stasis, the blood tends to be dark and thick, and may have clots.
     Thin, Phlegmatic blood due to a cold, atonic digestion, metabolism and Natural Faculty will seep out of the blood vessels more easily, due to its thinness.  This is seen in some types of excessive menstrual bleeding in women of a cold, pallid, deficient constitution.  The blood will be thin and watery, and the menstruation will be slow and prolonged.
     Excessive dryness can cause delicateness and fragility to thin, sensitive mucosal membranes, making them vulnerable to rupture and bleeding.  This is commonly seen in nosebleeds, and in cracked, bleeding, chapped lips or dry skin.
     A deficiency of normal Melancholic residues in the blood will make proper clotting and wound granulation difficult or impossible.  This is often associated with constitutional predispositions towards abnormal bleeding, as well as a weakness of the spleen.  Excessive menstrual bleeding of a light or bright red color is usually due to this cause.
     And finally, the most direct and obvious cause of bleeding is physical injury, wounding or trauma.  External wounds will cause visible, external bleeding, whereas internal lesions or trauma, if severe enough, will cause internal bleeding or hemorrhage.  The former is quite apparent, whereas the latter can be insidious, stealthy and concealed.  The "black and blue" discoloration of bruising is produced by extravasated blood, which has leaked out of internally ruptured blood vessels beneath the skin. 
     When internal bleeding does produce external, visible signs and symptoms, the blood will usually be:  coughed up from the lungs, which is hemoptysis; vomited up from the upper GI tract, which is hematemesis; or present in the stool.
     Coughing up blood, or hemoptysis, is most commonly seen in chronic, serious respiratory conditions like tuberculosis.
     Vomiting up blood, or hematemesis, is a common sign of a bleeding ulcer in the stomach or upper digestive tract. 
     Blood in the stool will bleed out a blood red color if it is coming from the lower colon and rectum, and will have a black, tarry appearance if it is coming from higher up in the intestinal tract.  Blood in the stool may often be hidden or not readily apparent, in which case it is called occult blood in the stool.


Ripening and Maturation

     Because blood is the first humor to arise in the Second Digestion, it is also the quickest humor to be ripened, concocted and purified of morbid superfluities.  Continuous generation and regeneration on a daily basis is the essence of the Sanguine humor.   Whereas the other humors all take a number of days to ripen, with blood, it's only a day or two.