this is cold from deficiency affecting the middle qi and results in the failure of the spleen qi to govern the blood. this is accompanied by ascendant liver yang which induces the upward-movement of uncon-trolled blood and causes incessant vomiting or spitting up of blood or nosebleeds.

although this pattern involves an aspect of ascendant yang, examination should reveal a clear predominance of spleen qi deficiency which is failing to govern the blood. this will include such characteristic signs of cold from deficiency of the middle qi as a wan complexion, a pale tongue with a thin coating, and a deficient, rapid, and forceless pulse.