Qi and blood are crucial for human health; when qi flows, blood flows, and when qi stagnates, blood stasis occurs. Many people have experienced blood stasis: despite not having any visible injuries, they find bruises appearing on their bodies, which eventually fade away on their own. This phenomenon is a typical sign of a blood stasis constitution. But what causes this blood stasis constitution?
Three Main Causes of Blood Stasis Constitution
In Traditional Chinese Medicine (TCM), “stasis” refers to accumulated blood. When blood circulation is obstructed, it is termed blood stasis. The primary causes of blood stasis constitution include the following three aspects:
1. Qi Stagnation Leading to Blood Stasis
Under normal circumstances, blood circulates freely within the vessels, primarily relying on the heart’s pumping function. This is similar to how a water pipe operates, where the flow of water is controlled by the opening of a valve.
However, without external force or electrical stimulation, how does the heart initiate its pumping function? It relies on the qi flowing within the body to provide the necessary push, much like water in a pipe requires pressure differences to flow.
Thus, TCM holds that: when qi flows, blood flows; when qi stagnates, blood stasis occurs. If the qi in the body remains stagnant for an extended period, it leads to qi stagnation. Without sufficient qi to propel it, blood stasis naturally forms.
2. Cold Congealing Leading to Blood Stasis
Another common cause of blood stasis is cold congealing. We know that liquids freeze at sufficiently low temperatures. Blood behaves similarly; it can only circulate normally within blood vessels at normal body temperature. If the body is exposed to cold environments or in a cold state, blood circulation slows down, akin to how water freezes in winter, leading to blood clots that obstruct the vessels.
This explains why patients with myocardial infarction or cerebral infarction often have higher incidence and mortality rates in winter.
3. Blood Heat
While cold congealing can lead to blood stasis, blood heat also affects it. Blood is categorized as a yin fluid in the body; when heat damages the yin, the body’s fluids decrease, causing the blood to become concentrated and viscous. This is why individuals with a heat constitution often find it difficult to draw blood, and the blood drawn is typically dark red, blackish, and thick.
Five Blood-Activating Formulas by Ren Wang Qing
Among historical physicians, Ren Wang Qing is renowned for his in-depth research on blood stasis. As a martial artist, he experienced minor injuries, leading many ancient martial artists to have some understanding of blood-activating techniques. Ren Wang Qing documented his insights on blood stasis in his book “Yilin Gai Cuo,” where he established five major “blood-activating decoctions” that address blood stasis from head to toe.
Let’s take a look at these formulas.
1. Xuefu Zhuyu Decoction (Blood Mansion Decoction)
Ren Wang Qing divided the human body into two sections using the diaphragm as a boundary. Above the diaphragm, which includes the lungs and heart, is referred to as the “blood mansion.” The heart and lungs are part of the circulatory system, primarily responsible for blood and qi exchange. Therefore, Ren Wang Qing described, “Above the diaphragm, the entire cavity is filled with blood.”
Xuefu Zhuyu Decoction is formulated to address blood stasis in the blood mansion, where stasis obstructs the circulation and exchange of qi and blood, affecting the normal functioning of the heart and lungs. Common symptoms include chest pain, difficulty bearing weight on the chest, tightness, and restlessness at night, resembling modern conditions like arrhythmia, coronary heart disease, and circulatory system disorders.
The ingredients of Xuefu Zhuyu Decoction include Honghua (Safflower), Shengdi (Rehmannia), Taoren (Peach Kernel), among others, to invigorate blood and resolve stasis, along with Chaihu (Bupleurum) and Jiegeng (Platycodon) to elevate the herbs to the blood mansion, while Niuxi (Achyranthes) guides the blood downward, providing an outlet for the stasis.
Xuefu Zhuyu Decoction: Danggui (Angelica), Shengdi (Rehmannia), Chishao (Red Peony), Chuanxiong (Ligusticum), Taoren (Peach Kernel), Honghua (Safflower), Zhiqiao (Bitter Orange), Chaihu (Bupleurum), Gancao (Licorice), Jiegeng (Platycodon), Chuan Niuxi (Achyranthes).
2. Gexia Zhuyu Decoction (Below Diaphragm Blood-Activating Decoction)
Ren Wang Qing believed that the middle jiao is divided into two systems: the liver and stomach systems, which include the gallbladder, liver, spleen, stomach, and intestines. The function of the spleen in transforming and transporting essence is closely related to the normal rise and fall of qi in the middle jiao.
“Gexia Zhuyu Decoction treats blood stasis in the abdomen.” It addresses conditions such as masses, pediatric abdominal distension, abdominal pain, and chronic diarrhea. Ren noted that “prominent blue veins on the abdomen” are a key feature; regarding kidney and chronic diarrhea, he pointed out that the root cause is excessive blood stasis in the stomach. The interconnected organs in the abdomen share similar functions related to the digestion, absorption, and transportation of food and fluids.
The formula for Gexia Zhuyu Decoction includes Danggui (Angelica), Taoren (Peach Kernel), and also incorporates Wuyao (Lindera), Xiangfu (Cyperus), and Wulingzhi (Flying Squirrel) to target the liver, gallbladder, spleen, and stomach, ensuring the formula’s action is concentrated in the middle jiao of the liver and stomach. Modern applications of Gexia Zhuyu Decoction are often used to treat digestive system diseases, such as late-stage pancreatic cancer, chronic atrophic gastritis, and splenomegaly.
3. Shaofu Zhuyu Decoction (Lower Abdomen Blood-Activating Decoction)
The lower jiao includes the urinary and reproductive systems, including the uterus, ovaries, testes, fallopian tubes, bladder, and ureters, which are part of the pelvic system, primarily responsible for reproductive and urinary functions. Shaofu Zhuyu Decoction was formulated by Ren Wang Qing for blood stasis in the lower abdomen, treating conditions related to menstruation, pregnancy, and childbirth, such as infertility, miscarriage, and abdominal pain.
From the composition of the formula, Shaofu Zhuyu Decoction includes Xiaohui Xiang (Fennel), Ganjing (Dried Ginger), and Yanhusuo (Corydalis) to warm the lower jiao and nourish the uterus, allowing the herbs to reach the lower abdomen. In modern clinical practice, Shaofu Zhuyu Decoction is also commonly used to treat reproductive and urinary system diseases, such as male urethral syndrome, chronic pelvic inflammatory disease, and infertility. Notably, Xiaohui Xiang contains volatile oils that exhibit hormone-like effects, increasing the weight of the fallopian tubes, endometrium, and uterine muscle layer, promoting the reproductive cycle.
Shaofu Zhuyu Decoction: Xiaohui Xiang (Fennel, toasted), Ganjing (Dried Ginger), Yanhusuo (Corydalis), Myrrh, Danggui (Angelica), Chuanxiong (Ligusticum), Guanggui (Cinnamon), Chishao (Red Peony), Shengpuhuang (Pollen), Wulingzhi (Flying Squirrel, toasted).
4. Shentong Zhuyu Decoction (Body Pain Blood-Activating Decoction)
The marrow system, which includes the peripheral nervous system, differs from the brain system, which governs subjective thought and consciousness. The marrow system primarily regulates movement and sensation in the limbs. Conditions related to meridian diseases, bone system diseases, and muscle diseases fall under marrow system disorders.
Ren Wang Qing stated, “All shoulder pain, arm pain, waist pain, leg pain, or generalized pain is collectively termed bi syndrome.” The formula includes Danggui (Angelica), Chuanxiong (Ligusticum), and others to invigorate blood and resolve stasis, along with Qinjiao (Gentiana), Qianghuo (Notopterygium), and Dilong (Earthworm) to promote circulation through the meridians. Niuxi (Achyranthes) in this formula is used for its ability to relax tendons and invigorate blood, thus the entire formula possesses the effects of promoting circulation, invigorating blood, and dispelling wind and dampness.
Shentong Zhuyu Decoction: Taoren (Peach Kernel), Honghua (Safflower), Chuanxiong (Ligusticum), Danggui (Angelica), Wulingzhi (Flying Squirrel), Myrrh, Xiangfu (Cyperus), Chuan Niuxi (Achyranthes), Dilong (Earthworm), Qinjiao (Gentiana), Qianghuo (Notopterygium), Gancao (Licorice).
5. Tongqiao Zhuyu Decoction (Orifice-Opening Blood-Activating Decoction)
Ren Wang Qing emphasized the importance of the cranial cavity in human anatomy, asserting the need to clearly delineate the brain’s functions. He observed the shape and structure of the cranial cavity and proposed that “the spirit and memory reside not in the heart but in the brain,” using the growth process of a child’s fontanelle and the occurrence of lamb’s disease as evidence of the spirit residing in the brain.
The Tongqiao Zhuyu Decoction is primarily used to treat conditions such as hair loss, deafness, and vitiligo affecting the head and face. The formula includes Taoren (Peach Kernel), Honghua (Safflower), Chishao (Red Peony), and the core ingredient Shexiang (Musk), which is essential for the formula’s efficacy.
Tongqiao Zhuyu Decoction treats primarily brain-related diseases, including various mental and neurological disorders. Additionally, as the cranial cavity is directly exposed to the external environment, points like Fengchi and Fengfu become gateways for external pathogens such as wind, cold, toxins, and epidemics to invade, making the brain susceptible to these external evils. The inclusion of Laocong (Scallion), Shengjiang (Fresh Ginger), and Huangjiu (Yellow Wine) in the formula serves to disperse and eliminate these evils, addressing the pathological characteristics of external invasions.
Tongqiao Zhuyu Decoction: Chishao (Red Peony), Chuanxiong (Ligusticum), Taoren (Peach Kernel), Hongzao (Red Date), Honghua (Safflower), Laocong (Scallion), Shengjiang (Fresh Ginger), Shexiang (Musk).
In summary, the development of qi and blood theory, along with the formulation of classic blood-activating and stasis-resolving formulas, represents Ren Wang Qing’s contributions to medicine, leaving valuable TCM experiences for future generations.
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