Deepest layer in the four-layer diagnosis. Latest phase of febrile disease. The pathogenic heat has penetrated into the blood layer damaging Heart, Liver and Kidneys (organs of Xue).

Symptoms

• Blood overflows causing strong bleeding (all orifices: mouth, nose, anus, etc.).
• Fever continues.
• May produce wind: spasmodic movement of hands and feet; stiffness of the nape, opisthotonus (arching the spine backward), trismus (clenching of the jaw)
• Severe symptoms of shen: strong agitation, mental confusion,
• Symptoms of severe Yin injury: wasting, emaciation (pathological wasting, muscles are consumed), loss of teeth, atrophied gums.

Treatment is very difficult.