TCM Book Club Issue 1043
One issue daily, accompanying the growth of TCM practitioners
IIntroduction:How many blood-activating and stasis-resolving formulas do you commonly use? (Editor/Wang Chao)
Blood Activation and Stasis in Women’s Health
Author/Wang Jinliang
The Wang Family Gynecology in Pingyao, Shanxi, has always adhered to the principle that “women’s health is based on blood,” emphasizing that women’s blood “should only be abundant, not deficient; should only flow freely, not stagnate.”
The generation and transformation of blood originate from the spleen and stomach, circulating continuously throughout the body. Its orderly movement within the vessels is smooth; conversely, stagnation leads to stasis. Practitioners believe that “when blood and vessels flow freely, diseases cannot arise.” If blood flow is obstructed or spills out of the vessels, it becomes stasis. The classic texts state: “The pathways of the five organs all emerge from the meridians to circulate qi and blood; when qi and blood are not harmonious, myriad diseases arise.” The “Nanjing” also states: “Stasis is accumulated blood.” Accumulated blood leads to stasis, and when qi and blood are disharmonious, myriad diseases arise, especially in women.
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Stasis Caused by Qi Dysfunction
The “Shoushi Baoyuan” states: “Qi is the commander of blood; when qi moves, blood moves; when qi stops, blood stops. If qi is stagnant for a moment, blood will also be stagnant for a moment.” The “Shen’s Book of Respecting Life” further states: “Qi moves blood; blood follows qi to circulate. When qi is stagnant, blood also becomes stagnant. When qi stagnates and blood coagulates, pain and swelling occur, and various changes arise.” Clinically, qi dysfunction is often accompanied by emotional disturbances. The seven emotions can harm: joy, anger, worry, thought, sadness, fear, and shock. Joy disperses qi, anger causes qi to rise, worry and thought cause qi to bind, sadness dissipates qi, and fear causes qi to descend. When the stimulation from the seven emotions is too strong or prolonged, it inevitably leads to qi stagnation and blood flow obstruction, resulting in blood stasis. The “Lingshu” states: “If internal injury occurs from worry or anger, qi will rebel upwards; when qi rebels upwards, the six channels will not be open, and the meridian qi will not flow, causing blood to coagulate and accumulate, and fluids to stagnate and not disperse, leading to accumulation.” Observing women, their sensitivity to emotional changes can easily lead to qi stagnation and blood stasis, resulting in blood stasis-related conditions.
Throughout a woman’s life, menstruation, pregnancy, childbirth, and lactation all involve the consumption of qi and blood. Qi deficiency leads to insufficient bodily function, inadequate vessel filling, and poor blood flow, which over time results in stasis. The “Yilin Gai Cuo” points out: “When the original qi is deficient, it cannot reach the blood vessels; without qi, blood will stagnate and lead to qi deficiency and blood stasis.” Clinically, qi deficiency and blood stasis are commonly observed.
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Cold and Heat Leading to Stasis
Blood flows with heat and coagulates with cold; this is a physical property. Traditional Chinese Medicine (TCM) holds that cold is a yin pathogen, which tends to constrict and stagnate. When vessels encounter cold, they easily constrict, and blood also tends to coagulate. The “Lingshu” states: “When cold pathogens invade the meridians, blood weeps and does not flow.” “Qi and blood prefer warmth and dislike cold; cold causes blood to weep and not flow, while warmth disperses and eliminates it.” This clearly explains the mechanism of cold-induced stasis. However, heat is a yang pathogen that can scorch and consume fluids. When blood is subjected to heat pathogens, it becomes thick and flows poorly, leading to stasis, which is termed heat stasis. The “Yilin Gai Cuo” states: “Blood subjected to heat will coagulate into clots.” Therefore, both cold and heat can lead to stasis; this is the underlying medical principle.
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Chronic Illness or Hemorrhage Leading to Stasis
TCM believes that chronic illness can lead to stasis. Chronic illness weakens the body’s functions, making it unable to propel blood, resulting in slow blood flow. Or, with prolonged illness, pathogenic factors deepen, obstructing blood flow and leading to severe blood stasis. Clinically, hemorrhagic diseases, external injuries, or internal injuries can cause blood to spill out of the vessels; “yang vessels injured lead to blood spilling externally, while yin vessels injured lead to blood spilling internally.” All of these are considered blood that has deviated from its meridian, and once blood deviates from its meridian, it becomes stasis. The “Neijing” states: “When a person falls or is injured, bad blood remains inside.” Hemorrhage leading to blood stasis is particularly common in gynecology, hence the discussion of blood activation and stasis resolution to stop bleeding.
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Common Symptoms of Blood Stasis in Gynecological Conditions
A woman’s life, including menstruation, pregnancy, childbirth, and lactation, is closely related to the abundance and stagnation of blood. When a woman’s blood sea is full, the Ren meridian is full, and the Chong meridian is abundant, menstruation occurs regularly. If blood is deficient, the blood sea is empty, and there is nothing left to descend, leading to amenorrhea. If blood stasis remains internally, symptoms such as dysmenorrhea, menorrhagia, irregular menstruation, and masses may occur. Blood stasis can also lead to postpartum abdominal pain and persistent lochia.
Common symptoms of blood stasis in gynecology include: pain, zheng jia (masses), bleeding, and fever.
Pain: TCM believes that “where there is flow, there is no pain; where there is pain, there is no flow.” Blood stasis is the obstruction of blood flow and the lack of smoothness in the vessels, which can lead to severe blockage and pain. This pain is often localized and sharp, resembling a stabbing sensation. Common conditions include dysmenorrhea, zheng jia, postpartum abdominal pain, and breast abscesses.
zheng jia accumulation: Blood stasis accumulates, and when the qi and blood do not flow smoothly through the meridians and organs, prolonged accumulation can lead to zheng jia masses. The “Xue Zheng Lun” states: “When blood stasis is in the meridians and organs, it forms zheng jia.” “When qi is stagnant, blood accumulates and forms shapes.” In clinical practice, uterine fibroids, ovarian cysts, endometriosis, and pelvic inflammatory masses fall under this category.
Gynecological bleeding: TCM holds that “if blood stasis does not disperse, new blood cannot settle.” Blood stasis obstructs the vessels, leading to disharmony in the Chong and Ren meridians, preventing blood from returning to the meridian, which is a significant cause of gynecological bleeding. When menstruation is obstructed, blood does not circulate and flows outside the vessels, leading to blood that has deviated from its meridian. Symptoms of blood stasis in women can include accumulation in the uterus leading to menorrhagia. If the placenta does not discharge postpartum, lochia may persist, and blood may not follow the meridian, reversing and causing vomiting or bleeding. When menstruation is obstructed, blood stasis internally blocks, and prolonged stasis can lead to heat, causing fever. Postpartum fever is often related to blood stasis. Symptoms of blood stasis can often be observed in women with a dark purple complexion, bluish lips and tongue with stasis spots, or dry and dull skin, and may even present with a wiry or slippery pulse.
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Diagnosis and Treatment of Gynecological Blood Stasis
The method of blood activation and stasis resolution is a treatment approach in traditional Chinese medicine closely related to the study of qi and blood. It addresses the pathogenesis proposed in the “Neijing” that “blood coagulates, and the vessels do not flow.”
Common methods of blood activation and stasis resolution in TCM include: moving qi and activating blood, suitable for qi stagnation and blood stasis conditions. For example, for dysmenorrhea due to liver qi stagnation or premenstrual syndrome, formulas such as Dan Zhi Ba Wei Xiao Yao San and Ge Xia Zhu Yu Tang are often used.
For severe blood stasis, the method of attacking and expelling blood stasis is used for obvious stasis conditions. For example, for zheng jia masses, formulas such as Tao Hong Cheng Qi Tang, Tao Hong Si Wu Tang, and Di Dang Tang are commonly used.
If stasis has transformed into heat, leading to thick and sticky blood with accompanying fever, treatment should focus on clearing heat and activating blood. Use Jie Du Huo Xue Tang (Lian Qiao, Ge Gen, Chai Hu, Zhi Ke, Tao Ren, Hong Hua, Dan Pi, Chi Shao, Dang Gui, Sheng Di).
For breast abscesses with fever and pus, use Xiao Ru Tang (Dan Shen, Ru Xiang, Mo Yao, Chuan Shan Jia, Jin Yin Hua, Lian Qiao, Zhi Mu, Gua Lou).
If there is blood stasis causing dysmenorrhea, treat with blood activation and pain relief. Formulas such as Shi Xiao San and Huo Luo Xiao Ling Dan (Dan Shen, Dang Gui, Mo Yao, Ru Xiang) are often used.
If cold has caused blood stasis, treat with warming the meridians and dispelling cold to resolve stasis. Commonly used formulas include Shao Fu Zhu Yu Tang (Xiao Hui Xiang, Chao Gan Jiang, Yuan Hu, Wu Ling Zhi, Mo Yao, Chuan Xiong, Dang Gui, Sheng Pu Huang, Guan Gui, Chi Shao). After childbirth, Sheng Hua Tang (Dang Gui, Chuan Xiong, Jiang Tan, Tao Ren, Gan Cao) is recommended.
The method of blood activation and stasis resolution is most commonly used in the treatment of menstrual disorders in women. Blood stasis causing dysmenorrhea often presents as recurrent and severe pain, with clots in the blood. This condition is common in young women with dysmenorrhea, adenomyosis, and endometriosis. Differentiation of cold, heat, deficiency, and excess is essential, and formulas such as Tao Hong Si Wu Tang, Wen Jing Tang, and Shao Fu Zhu Yu Tang can be adjusted according to symptoms.
If menstruation is obstructed and amenorrhea occurs, differentiation of deficiency and excess is necessary. Amenorrhea is often due to blood deficiency, kidney deficiency, or phlegm-dampness with blood stasis. TCM believes that prolonged amenorrhea is often due to deficiency, while sudden amenorrhea is often due to stasis. Deficiency should be tonified and unblocked, while excess can be attacked or warmed. Commonly used formulas include Xia Yu Xue Tang, Wen Jing Tang, and Tao Hong Si Wu Tang. When blood stasis accumulates, if it does not disperse, new blood cannot settle.
Clinically, it is common for stasis to cause prolonged menorrhagia, especially in patients with persistent bleeding. The blood may be dark purple and continuous, often accompanied by lower abdominal pain, and the tongue may show stasis spots. For stasis causing menorrhagia, formulas such as Shi Xiao San and Si Wu Tang can be adjusted, which can have the effect of scraping the uterus with herbal medicine.
For women with irregular menstruation, it is common to see menstruation occurring at irregular intervals, with varying amounts, and prolonged bleeding, often accompanied by abdominal pain, which is often related to blood stasis. Treatment often involves Ba Wei Xiao Yao San with added Dan Shen, Xiang Fu, and Chuan You Jin to promote qi and activate blood.
If a woman experiences insomnia and irritability before menstruation, accompanied by breast distension and poor menstrual flow, this is considered premenstrual tension syndrome. TCM attributes this to liver qi stagnation. Formulas such as Xiao Yao San can be adjusted, or the Fu Qing Zhu Nu Ke formula can be selected, which includes Dang Gui, Chao Bai Shao, Dan Pi, Zhi Zi, Bai Jie Zi, Chai Hu, Huang Qin, Xiang Fu, Chuan You Jin, and Gan Cao).
The method of blood activation and stasis resolution is often used for postpartum conditions in women. Postpartum lochia that does not cease is often due to blood stasis, where new blood cannot settle, leading to prolonged lochia and abdominal pain. Blood activation and stasis resolution should be employed, using the Wang Family Sheng Hua Tang: Dang Gui, Chuan Xiong, Jiang Tan, Yi Mu Cao, Hong Hua, Tao Ren, and Zhi Cao. Postpartum abdominal pain, known as “child’s pillow pain,” is often due to blood stasis. Commonly, lochia may be dark purple with clots. Formulas such as Sheng Hua Tang can be combined with Mu Xiang, Wu Yao, and Yuan Hu to regulate qi, activate blood, and relieve pain. Alternatively, the Fu Qing Zhu Nu Ke formula can be used, which includes Dang Gui, Chuan Xiong, Yi Mu Cao, Dan Pi, Jie Sui Tan, Ru Xiang, and Jiao Shan Zha, which has shown good clinical results.
Women are fundamentally based on blood; when blood stasis accumulates, it leads to zheng jia masses. To eliminate gynecological masses, blood activation and stasis resolution is the first choice. Commonly used formulas include Gui Zhi Fu Ling Wan and Da Huang Zhe Chong Wan. In recent years, for treating zheng jia, a combination of blood activation and stasis resolution, softening hard masses, and promoting dampness and unblocking the meridians has been used, resulting in satisfactory therapeutic effects. The medicinal ingredients include: Dang Gui Wei, Chuan Xiong, Chi Shao, Yuan Hu, Tao Ren, Sheng Juan Bai, Bie Jia, Pao Jia Zhu, Che Qian Zi, Zao Ci, Zhe Bei Mu, Mu Li, San Leng, E Zhu, Chuan Niu Xi, and Gan Cao. This has been clinically applied to ovarian cysts and gynecological inflammatory masses, achieving satisfactory results.
In recent years, for acute and chronic pelvic inflammatory diseases, the method of blood activation and stasis resolution has been selected to enhance treatment efficacy. Common symptoms include: leukorrhea, abdominal pain, and fever, with examination revealing masses. Commonly used herbs include: Sheng Di, Chi Shao, Tao Ren, Hong Hua, Mu Li, Bie Jia, Dan Pi, combined with heat-clearing and detoxifying herbs to improve efficacy.
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