Blackouts and Dizziness Upon Standing Up: It's Not Just "Anemia" — Differentiate Between Blood Deficiency and Qi Sinking

At the moment you squat down and stand back up, your vision goes black and the world spins. Some people recover after a few seconds, while others need to hold onto a wall for a while. Many people habitually attribute this to "anemia" or "low blood pressure." However, from the perspective of traditional Chinese medicine (TCM) pattern differentiation, this seemingly identical moment may actually reflect two entirely different constitutional states. One is "blood failing to carry qi," and the other is "qi failing to govern blood." One leans toward insufficiency of yin and blood, the other toward sinking of middle qi. The treatment principles for the two differ in terms of "supplementing" versus "lifting."

I. When Both Experience Blackouts Upon Standing, What Roles Do Qi-Blood Deficiency and Failure of Clear Yang to Rise Respectively Play?

In TCM, there is a subtle metaphor for this symptom: the body is like a well, and qi and blood are the water in the well. When you look up at the sky, the well water needs to be full enough and clear enough to reflect the "light" upward. The moment of squatting and standing up is like suddenly pulling up the well rope. If the well water is insufficient, all you bring up is a bucket of mud, and the head naturally goes dark. This "mud" may be due to blood deficiency, or qi deficiency with weak propulsion, or phlegm-dampness causing mischief. These three pathways lead to the same destination by different routes.

In TCM clinical practice, there is a core distinguishing point for blackouts and dizziness upon squatting and standing—it is closely related to the redistribution of qi and blood during postural changes. From a squatting to an upright position, qi and blood need to rise to nourish the head and eyes within an extremely short period. If this process is delayed, it indicates insufficient "upward force" of qi and blood. Upward force depends on two conditions: first, whether the source is sufficient; second, whether the passageway is unobstructed. Source problems mostly belong to blood deficiency or yin deficiency; passageway problems mostly belong to qi deficiency with weak propulsion, or phlegm-dampness obstructing the channels and collaterals.

The question then arises: why do some people only experience slight blackouts upon standing from a squat, while others experience severe vertigo or even cold sweats? The key lies not in the degree of "blackness," but in the accompanying sensations. Simple blackouts that resolve after rest are mostly related to blood deficiency; blackouts accompanied by vertigo, nausea, vomiting, palpitations, and shortness of breath are typical manifestations of failure of clear yang to rise and turbid yin to descend. This involves the spleen and stomach's ascending-clearing function and the liver and gallbladder's free coursing and discharging. The focus of treatment is entirely different.

Blood Deficiency Constitution: Mainly Black Vision, With Less Vertigo

When people with blood deficiency squat and stand up, the first thing they feel is "blackness before the eyes," like a television signal suddenly cutting out, followed by gradual recovery. During recovery, there is rarely a pronounced spinning sensation; more often, there is a feeling of heavy-headedness and light-footedness, or a floating sensation in the body. These individuals usually have a pale or sallow complexion, pale nails, and women often experience scanty or delayed menstruation. From the perspective of TCM pathogenesis, the heart governs the blood vessels and the liver stores blood. When blood is deficient, the heart loses its nourishment and liver blood is insufficient, so the brain orifices do not receive adequate blood nourishment. When posture changes, the blood vessels cannot fill in time, resulting in a brief "blackout."

The core location of blood deficiency is the heart, liver, and spleen. The heart governs blood and propels blood circulation; the liver stores blood and regulates blood volume distribution; the spleen governs blood and is the source of qi and blood generation. The action of squatting and standing is an instant test of the liver's blood-storing function—the liver must release stored blood into the peripheral circulation within an extremely short time to maintain cerebral blood supply. If liver blood is insufficient, this regulatory process becomes sluggish, and black vision is the "alarm sound of liver blood regulation failure."

In terms of disease nature, blood deficiency belongs to "insufficiency" among deficiency patterns, without obvious cold or heat bias. However, long-term blood deficiency may evolve into yin deficiency. The biggest difference between yin deficiency and blood deficiency is that yin deficiency is accompanied by internally generated deficiency heat, manifesting as heat in the palms and soles, dry mouth and throat, and night sweats, while blood deficiency is more characterized by a lusterless complexion, dizziness, and blurred vision. Both can cause blackouts upon squatting and standing, but blood deficiency leans toward "material depletion," while yin deficiency leans toward "dual loss of both material and function."

In terms of disease progression, simple blood deficiency advances relatively slowly and can often improve with regular routines and dietary adjustments. However, if left unchecked, prolonged liver blood insufficiency may affect the nourishment of kidney essence—TCM holds that "liver and kidney share the same source." Depletion of liver blood may gradually consume kidney yin, leading to dual deficiency of essence and blood. At this stage, blackouts upon squatting and standing become more severe, accompanied by soreness and weakness of the lower back and knees, tinnitus, and other signals of deep depletion.

Qi Deficiency with Qi Sinking Constitution: Blackness and Dizziness Occur Together, With More Pronounced Vertigo

The characteristics of people with qi deficiency are markedly different from those with blood deficiency. When squatting and standing up, they not only experience black vision, but also feel as if the entire body has lost its supporting force. Vertigo is accompanied by palpitations, shortness of breath, sweating, and may even require them to squat down again immediately for relief. These individuals usually speak with a low voice, tire easily, experience pronounced drowsiness after meals, and have loose stools or weak defecation. TCM holds that qi is the driving force for blood circulation. When qi is insufficient, blood moves sluggishly. In particular, when clear qi fails to rise, the head does not receive the nourishment of clear yang, resulting in dizziness.

The core location of qi deficiency with qi sinking is the spleen and lungs. The spleen governs ascending clarity, transporting the refined substances transformed from food and drink upward to the head and eyes; the lungs govern the qi of the entire body, connect with all blood vessels, and assist the heart in propelling blood circulation. At the moment of squatting and standing, the spleen's ascending-clearing function must "push" qi and blood upward within an extremely short period. If spleen qi is weak and lifting is powerless, it is like a faucet with insufficient water pressure—no water flows from a high position. This sensation is not just "inability to see clearly," but more of "inability to stand steadily."

From the perspective of disease nature, qi deficiency belongs to "functional decline" among deficiency patterns and is often accompanied by cold signs—qi pertains to yang, and qi deficiency leads to insufficient warming, so these people often fear cold, have cold hands and feet, and are more prone to cold sweats and pallor than those with blood deficiency. When both qi and blood are deficient, the above two patterns may overlap, but the key to pattern differentiation is whether the bias is toward "material depletion" or "insufficient motive force," which determines whether subsequent treatment focuses on "adding water" or "increasing pressure."

In terms of disease progression, if qi deficiency with qi sinking is overlooked for a long time, there may gradually appear a sensation of visceral prolapse on top of blackouts upon squatting and standing—such as lower abdominal bearing-down distension or a heavy sinking sensation in the stomach—which are extensions of insufficient middle qi and weak lifting. At this stage, blackouts upon squatting are no longer an isolated symptom, but an alarm signal of overall qi mechanism sinking. Treatment should focus on fortifying the middle burner and lifting clear yang.

II. Another Overlooked Category: Phlegm-Dampness Obstruction Type "Vertigo" Even Accompanied by Nausea

Apart from blood deficiency and qi deficiency, there is another category of people with blackouts upon squatting who are easily misdiagnosed as having "hypoglycemia" or "cervical spondylosis." Their characteristics are: they usually feel dizzy and heavy-headed as if wrapped in a damp towel; upon squatting and standing, the vertigo is intense and often accompanied by nausea, vomiting, chest oppression, and a sticky, greasy sensation in the mouth, with a thick white or yellow, greasy tongue coating. These people tend to be overweight, or have a diet rich in fatty, sweet, and rich foods, and do not like exercise. In TCM, this is called "internal obstruction of phlegm-dampness and failure of clear yang to rise."

The mechanism of phlegm-dampness obstruction is completely different from deficiency patterns. Qi and blood are not actually insufficient; rather, the pathways are blocked by phlegm-dampness—just as a river has abundant water, but silt accumulates and the flow is impeded. At the moment of squatting and standing, qi and blood need to surge rapidly to the head and face, but phlegm-dampness acts like a wet rag blocking the passage. Clear yang cannot rise, and turbid yin cannot descend, resulting in vertigo, nausea, and vomiting—manifestations of "turbid qi clouding the upper orifices."

In terms of disease location, phlegm-dampness mainly remains in the middle burner (spleen and stomach) and the gallbladder meridian of foot-shaoyang. When spleen transportation and transformation fail, dampness is generated; dampness accumulates into phlegm, and phlegm-turbidity follows the chaotic movement of qi mechanism to harass the clear orifices above. The gallbladder meridian courses along the side of the head; when gallbladder qi fails to descend and phlegm-heat harasses upward, it can also trigger rotational vertigo. This is fundamentally different from the dizziness of simple deficiency patterns—phlegm-dampness type blackouts are often accompanied by a feeling of head distension and heaviness rather than emptiness and softness. A thick, greasy tongue coating is an important identifying sign.

In terms of disease nature, phlegm-dampness is a yin pathogen that easily obstructs the qi mechanism. When stagnant for a long time, it may transform into heat, forming phlegm-heat harassing upward. In such people, blackouts upon squatting are often aggravated in humid weather or after consuming raw, cold foods, because external dampness triggers internal dampness and further stagnates the qi mechanism. If phlegm-dampness combines with liver wind—commonly known as "wind-phlegm harassing upward"—the vertigo becomes more intense and may even cause unsteady gait.

In terms of disease progression, if the phlegm-dampness problem is not fundamentally addressed, relying solely on rest or simple supplementation may backfire. TCM speaks of the "admonition against treating excess with tonics," meaning that for seemingly deficient dizziness, if the root cause is phlegm-dampness obstruction, blindly consuming nourishing, cloying foods such as red dates or longan will instead aggravate dampness stagnation and make the vertigo more frequent. This is precisely why blackouts upon squatting cannot all be treated as "blood deficiency" requiring supplementation.

III. Why Does the Same Problem Require Supplementing for Blood Deficiency, Lifting for Qi Deficiency, and Unblocking and Descending for Phlegm-Dampness?

The question returns again—same experience of squatting and standing, same black vision and vertigo—why does TCM say the treatment methods are completely different? The core lies in the difference in "pathomechanism." Blood deficiency means the water source has decreased; you need to store water in the well. Qi deficiency means the water pump pressure is insufficient; you need to strengthen the pump force. Phlegm-dampness means the pipeline is blocked; you need to dredge the silt. The directions are different or even opposite—this is a vivid manifestation of TCM's "same disease, different treatments."

For people with blood deficiency, the focus of care is on "quiet nourishment" rather than "heavy supplementation." In daily diet, appropriately incorporating some dark-colored ingredients—such as mulberry, black sesame, and pork liver—is consistent with the traditional concept of "nourishing the corresponding organ with similar shapes and entering the blood with similar colors." However, note that all food ingredients can only serve as part of a regular diet and cannot replace balanced nutrition. What truly needs to be done is to adjust daily routine—the liver meridian is in command during the night. Chronic sleep deprivation most severely consumes liver blood. Ensuring regular sleep is more important than eating anything.

For people with qi deficiency, the focus of care is on "reducing expenditure" and "lifting." Reducing expenditure means minimizing unnecessary physical exertion and avoiding excessive sweating exercise, because sweat is the fluid of the heart and qi escapes with sweat; after heavy sweating, qi becomes even more deficient. The key to lifting lies in the spleen and stomach—in TCM clinical practice, ingredients with ascending properties, such as Astragalus (huangqi) and Codonopsis (dangshen), are commonly used. Adding them in moderation to soups can be helpful, but they must be used under the guidance of a licensed TCM practitioner based on pattern differentiation, and should not be self-administered in large amounts or long-term.

For people with phlegm-dampness, the general direction of care is "unblocking" and "resolving." Reduce intake of greasy, raw, and cold foods, and avoid prolonged exposure to humid environments. Exercise is especially important for phlegm-dampness constitution—through moderate activity, promote the flow of qi and blood, help the spleen restore its transportation and transformation function, and phlegm-dampness will gradually subside. However, the type and intensity of exercise vary from person to person and should be progressive; avoid overexertion to prevent damaging healthy qi.

In fact, clinically there are also complex states such as dual deficiency of qi and blood, qi deficiency with concurrent phlegm-dampness, and others. In these cases, a single-direction treatment approach is insufficiently comprehensive and requires a licensed TCM practitioner to conduct an overall analysis in conjunction with tongue and pulse manifestations. The charm of TCM lies not in fixed formulas, but in identifying the dynamic proportions of "qi, blood, phlegm, and deficiency" in each body, and seizing the current primary contradiction to adjust the direction of care.

IV. Facing Blackouts Upon Squatting, How Can You Tell Which State You Lean Toward?

Rather than being anxious, it is better to learn self-observation. Next time you squat and stand up, pay attention to three details: does the blackout occur "gradually darkening like drawing curtains" or "instantaneous total blackness"? After recovery, is your "mind clear but body weak" or "still dizzy and nauseated"? Normally, is your "complexion pale and you fear cold" or "complexion sallow and mouth sticky"? These three observation angles are simplified clues for distinguishing blood deficiency, qi deficiency, and phlegm-dampness.

From the perspective of causes, people with long-term sleep deprivation and excessive rumination are more prone to blood deficiency—because rumination damages the spleen, and when the spleen fails to generate blood, liver blood becomes insufficient. Meanwhile, people who sit for long periods, move little, or over-diet are more likely to have qi deficiency with sinking—because "stillness causes qi to contract," and excessive stillness slows the movement of qi and blood, gradually weakening middle qi. As for phlegm-dampness, it is closely related to irregular diet, excessive consumption of raw, cold, sweet, and greasy foods, and lack of exercise.

In terms of disease location, blood deficiency settles in "heart and liver blood insufficiency," qi deficiency in "spleen and lung qi weakness," and phlegm-dampness in "spleen and stomach stagnation." The disease natures are respectively "deficiency with depletion," "deficiency with sinking," and "excess with underlying deficiency." In terms of disease progression, blood deficiency manifests as gradual consumption, qi deficiency as chronic sinking, and phlegm-dampness as paroxysmal obstruction. These terms may seem complex, but the core is a single sentence—is your body signaling "insufficient blood," "insufficient qi pressure," or "blocked channels"?

Black vision and vertigo the moment you squat and stand up are actually the body performing a rapid self-check. TCM never views this signal as an isolated event, but as a microcosm of the overall state of qi movement. Regardless of which state you lean toward, do not self-diagnose and "prescribe" for yourself; instead, bring these observations to a regular medical institution and consult a TCM practitioner, letting professional judgment point out the path for clear yang to rise. Have you ever considered that the brief darkness every time you squat and stand might not just be the body "short-circuiting," but rather a reminder that you should stop and see—which qi has failed to keep up with your pace?

References:

1. Official website of the National Administration of Traditional Chinese Medicine: https://www.satcm.gov.cn/

2. World Health Organization strategic document on traditional medicine: https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine

3. TCM Ancient Literature Database: https://tcmdata.cintcm.com/

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