Spleen not governing blood is the pattern name used when the function of keeping blood inside the vessels - attributed in classical texts to the spleen - is described as failing, so that bleeding occurs without heat, force or injury to account for it.
The recorded features are: bleeding that is slight, repeated, prolonged and pale rather than bright and forceful; bruising that appears readily or without a remembered knock; pinpoint red or purple spots in the skin; nosebleeds and bleeding gums; blood in the stool, dark or fresh; unusually heavy or prolonged menstrual bleeding, or bleeding between periods; together with the qi-deficiency picture of tiredness, a poor appetite, loose stools, a sallow complexion, a pale tongue and a weak pulse. Bleeding from above - vomiting blood - and bleeding from below are discussed under the same classical heading.
The classical texts did not know of platelets, clotting factors or vessel wall integrity; the spleen here is a functional role, not the anatomical organ. The same presentation is shared by immune thrombocytopenia, thrombocytopenia from medicines, alcohol or liver disease, inherited and acquired clotting factor disorders, von Willebrand disease, leukaemia and myelodysplasia, vitamin K deficiency, disseminated intravascular coagulation, and the effect of anticoagulant or antiplatelet medicines. Heavy menstrual bleeding carries its own large differential - fibroids, adenomyosis, polyps, endometrial disease, thyroid disease, the perimenopause, and an intrauterine device.
The lines this library does not cross: rectal bleeding is investigated rather than named, at any age, because colorectal cancer sits inside the same symptom; blood in the stool with iron-deficiency anaemia in a man, or in a woman after the menopause, is a gastrointestinal referral; black tarry stools or vomiting blood is an emergency; bleeding after the menopause needs the endometrium assessed; widespread pinpoint spots with fever, or with a severe headache and a stiff neck, is an emergency; and anyone taking an anticoagulant or antiplatelet medicine who notices unusual bleeding should contact the clinician who ordered it rather than change anything alone. Some medicinals used in this tradition affect bleeding or interact with anticoagulants, which is worth raising with a clinician.
Whether the approaches described as strengthening the spleen so that it contains the blood change bleeding outcomes is not established.
脾不统血是古典术语，指文献归于脾的「统血」作用被描述为失职，于是出现没有热象、没有外力、也没有外伤可以解释的出血。
记载中的表现包括：出血量不多但反复、迁延、色淡，而不是鲜红有力；容易青紫，或没有磕碰也出现瘀斑；皮下针尖样红紫斑点；鼻衄与齿衄；大便带血，色暗或色鲜；月经量过多或经期延长，或非经期出血；同时兼见气虚那一组：疲乏、纳差、便溏、面色萎黄、舌淡、脉弱。古典文献把上部的呕血与下部的便血放在同一个讨论里。
古典文献不知道血小板、凝血因子，也不知道血管壁完整性；这里的脾是功能角色，不是解剖器官。同样的表现也见于免疫性血小板减少症、药物或酒精或肝病引起的血小板减少、先天与获得性凝血因子异常、血管性血友病、白血病与骨髓增生异常、维生素 K 缺乏、弥散性血管内凝血，以及抗凝药与抗血小板药的作用。月经过多另有庞大的鉴别清单：肌瘤、腺肌病、息肉、内膜病变、甲状腺疾病、围绝经期，以及宫内节育器。
本库不让的几条线：任何年龄的直肠出血都要查而不是命名，因为结直肠癌就在这同一个症状里；男性或绝经后女性的大便带血合并缺铁性贫血，属消化科转诊；柏油样便或呕血是急症；绝经后出血需要评估子宫内膜；广泛针尖样斑点伴发热，或伴剧烈头痛与颈项强直，是急症；正在服用抗凝药或抗血小板药的人若出现异常出血，应当联系开药的医生，而不是自行调整。这一传统里有些药材会影响出血或与抗凝药相互作用，值得向医生提出。
所谓健脾摄血之法是否改变出血结局，未被证实。
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