Author: Zhu Sha, Guangdong Pharmaceutical Association, First Affiliated Hospital of Guangzhou Medical University
Wang Qingren (1768-1831), courtesy name Xuncheng, was a notable physician from Yahuqiao, Yutian County, Zhili Province (now Yutian County, Hebei Province) during the Qing Dynasty. Wang Qingren was a physician with innovative ideas, and over 42 years, he authored the book “Yilin Gai Cuo,” correcting many errors in previous TCM texts, marking a milestone in the development of Traditional Chinese Medicine (TCM). He emphasized two clinical treatment principles: tonifying Qi and activating blood, and resolving blood stasis, based on which he developed dozens of formulas for activating blood and resolving stasis, among which Xuefu Zhuyu Decoction is one of the most widely known. Xuefu Zhuyu Decoction can be refined into various forms such as pills, granules, tablets, oral liquids, and capsules through modern processes, and is widely used in clinical practice. It has been referred to as the “vascular scavenger” by later physicians, showing good effects on the maintenance of the cardiovascular system.
Formula Analysis and Functions
PSM China
Xuefu Zhuyu Decoction consists of eleven herbs: Tao Ren (Peach Kernel), Hong Hua (Safflower), Dang Gui (Angelica Sinensis), Chuan Xiong (Ligusticum Chuanxiong), Chi Shao (Red Peony Root), Sheng Di Huang (Rehmannia Root), Chai Hu (Bupleurum), Zhi Ke (Bitter Orange), Niuxi (Achyranthes Bidentata), Jie Geng (Platycodon Root), and Gan Cao (Licorice) (composed of Tao Hong Si Wu Decoction + Si Ni San + Jie Geng, Niuxi). In this formula, Tao Ren breaks blood stasis and moistens dryness, while Hong Hua activates blood and resolves stasis to relieve pain, serving as the monarch herbs. Chi Shao and Chuan Xiong assist the monarch herbs in activating blood and resolving stasis; Niuxi excels in dispelling stasis and unblocking meridians, guiding the stasis downward, serving as the minister herbs. Dang Gui nourishes and activates blood, dispelling stasis and generating new blood; Sheng Di Huang clears heat and cools the blood to eliminate stasis heat, working with Dang Gui to nourish blood and moisten dryness, ensuring that dispelling stasis does not harm the righteous Qi; Zhi Ke smooths the Qi stagnation in the chest; Jie Geng promotes lung Qi and, in combination with Zhi Ke, facilitates the upward and downward movement of Qi, allowing Qi to move and blood to flow; Chai Hu smooths the liver and regulates Qi, serving as an assistant herb. Gan Cao harmonizes the other herbs, serving as a guiding herb.
This formula has the effects of activating blood, resolving stasis, promoting Qi movement, and relieving pain. It is used for conditions caused by Qi stagnation and blood stasis, such as chest pain, chronic headaches, stabbing pain with a fixed location, internal heat and irritability, palpitations and insomnia, irritability, and anger.
Experience and Main Symptoms
PSM China
Wang Qingren once said: “Only the blood stasis in the blood mansion is difficult to distinguish,” he carefully observed and explored experiences, summarizing the main symptoms of Xuefu Zhuyu Decoction into ten categories.
01
Headache and Chest Pain
Xuefu Zhuyu Decoction is quite effective for certain headaches and chest pains. Wang Qingren stated: “For those with headaches, if there are no exterior or interior symptoms, no Qi deficiency, phlegm, or fluid retention, and the symptoms come and go, and a hundred formulas are ineffective, one dose of this formula will cure it.” He also said, “If there is sudden chest pain, and previous treatments (referring to Mu Jin San, Gua Lou Xie Bai Bai Jiu Decoction, Xiao Xian Xiong Decoction, etc.) are ineffective, one dose of this formula will stop the pain immediately.”
02
Lantern Disease
Wang Qingren said: “Cool outside, heat inside, hence the name Lantern Disease, due to blood stasis. It is considered false heat; the more you tonify, the more stasis you have, and if it is real fire, the more you cool, the more it condenses. Three doses of blood can activate heat and reduce it.” He also said: “Every night, internal heat combined with skin heat, one dose of this formula can cure it; for severe cases, two doses are needed.”
03
Chest Inability to Bear Weight, Chest Bearing Heavy Objects, and Food Stuck in the Right Lower Chest
Chest inability to bear weight means needing to expose the chest while sleeping, and covering it makes it impossible to sleep. Chest bearing heavy objects means that the chest must be pressed down while lying down; otherwise, it is difficult to sleep peacefully. Food stuck in the right lower chest refers to a sensation of obstruction when swallowing. Emotional disorders can easily lead to Qi stagnation and blood stasis, hence using Xuefu Zhuyu Decoction can lead to improvement.
04
Liver Qi Disease
Being irritable for no reason is clearly due to stasis in the collaterals and disharmony between the liver and stomach. Since there is stasis in the blood mansion, the treatment should prioritize dispelling stasis. Wang Qingren said: “You cannot treat it with Qi; this formula is effective.”
05
Choking on Water
Wang Qingren said: “The epiglottis is blood coagulated, unable to cover the Qi gate, hence choking on water.” He stated: “Using this formula is extremely effective.”
06
Hiccups and Dry Heaving
Hiccups and dry heaving belong to the stomach’s failure to harmonize and descend. This is attributed to blood stasis in the chest mansion, causing abnormal Qi movement. Symptoms such as stabbing pain and fullness may also be present. Wang Qingren said: “At the first sign of hiccups, use this formula quickly,” and “If there are no other symptoms, but only dry heaving due to blood stasis, using this formula will resolve the blood and stop the vomiting immediately.”
07
Distress and Irritability
Distress refers to a feeling of confusion in the heart, overthinking, and suspicion. Wang Qingren said: “Even small matters cannot be resolved.” Irritability refers to a normally gentle temperament becoming unusually irritable when ill, indicating liver Qi stagnation and blood stasis in the blood mansion.
08
Palpitations and Anxiety
Palpitations and anxiety are severe symptoms of heart distress. The “Su Wen: Bi Lun” states: “Heart distress means the pulse is not smooth, and if anxious, the heart beats irregularly…” The irregular heartbeat is due to obstruction in the pulse vessels, leading to a lack of nourishment for the heart spirit. Wang Qingren said: “Using Gui Pi (Pill) and (Zhu Sha) An Shen (Pill) is ineffective; it is necessary to dispel the stasis in the blood mansion.”
09
Insomnia with Many Dreams, Nocturnal Crying in Children
Restless nights, excessive dreaming, insomnia, and nocturnal crying in children are primarily characterized by an inability to sleep peacefully at night. Daytime is Yang, while nighttime is Yin, and blood also belongs to Yin; therefore, blood stasis symptoms are often milder during the day and more severe at night or in the evening.
10
Night Sweats
Night sweats occur due to blood stasis in the blood mansion, with fever at night, leading to sweating upon waking in the morning. Wang Qingren said: “Sweating after waking is called spontaneous sweating; sweating upon waking is called night sweats. Night sweats deplete one’s Qi and blood, which is an ancient and unchanging conclusion. There are cases where using Qi tonics to stabilize the exterior and nourish Yin to reduce fire is ineffective and even worsens the condition, not realizing that blood stasis can also cause spontaneous and night sweats.”
Modern Applications
PSM China
According to relevant statistics, Xuefu Zhuyu Decoction can be used to treat various diseases in internal medicine, surgery, gynecology, pediatrics, dermatology, orthopedics, ophthalmology, otolaryngology, and andrology, achieving significant therapeutic effects.
Part01
Cardiology
01
Coronary Heart Disease Angina
Some physicians used this formula to treat 80 cases of coronary heart disease angina patients, finding significant improvements in blood lipid and blood rheology indicators, with a total effective rate of 97.50%.
02
Hypertension
Some physicians used this formula in combination with Western medicine to treat elderly patients with refractory hypertension, achieving significant efficacy.
03
Atrial Fibrillation
Some physicians used this formula with modifications in combination with Dabigatran to treat 80 cases of blood stasis type non-valvular atrial fibrillation patients for 4 weeks, finding significant improvements in clinical symptoms.
Part02
Psychiatry and Neurology
01
Trigeminal Neuralgia
Some physicians used acupuncture combined with Chai Hu Shu Gan San and this formula to treat trigeminal neuralgia, effectively alleviating related symptoms and local pain, preventing frequent recurrences of the disease, safely and effectively.
02
Migraine
Some physicians summarized that using this formula with modifications in clinical practice for treating migraines yielded significant results.
03
Post-Stroke Depression
Some physicians used this formula in combination with Western medicine, finding it significantly alleviated patients’ depression and improved their quality of life.
04
Post-Stroke Hemiplegia
Some physicians used this formula combined with acupuncture at the Jiaji points to treat 94 patients, resulting in significant improvements in limb motor function and quality of life.
05
Schizophrenia
Some physicians used this formula with modifications for treatment, and symptoms such as agitation and mood swings disappeared, with no recurrence during a six-month follow-up.
06
Depression
Some physicians used Jia Wei Xiao Yao Wan combined with Xuefu Zhuyu Wan to treat 58 cases of depression patients, achieving significant efficacy with a total effective rate of 91.38%.
Part03
Respiratory Medicine
01
Pulmonary Fibrosis
Research indicates that this formula can significantly improve the first-second forced expiratory volume and forced vital capacity in patients with idiopathic pulmonary fibrosis, effectively improving their quality of life and delaying the pathological progression of the disease.
02
Pulmonary Heart Disease
Some physicians used this formula with modifications to treat acute exacerbations of chronic pulmonary heart disease, finding significant improvements in clinical symptoms and cardiopulmonary function.
03
Chronic Bronchitis
Some physicians used this formula combined with San Zi Yang Qin Tang, finding it improved clinical efficacy and shortened the time for clinical symptom improvement.
04
Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD)
Some physicians used this formula with modifications combined with Er Chen Tang to treat 150 cases of phlegm-stasis obstructive lung disease type AECOPD patients, finding it reduced serum inflammatory factor levels and improved lung function and blood viscosity, safely and effectively.
Part04
Gastroenterology
01
Reflux Esophagitis
Some physicians used this formula with modifications to treat reflux esophagitis accompanied by depression, achieving rapid effects, satisfactory efficacy, and low recurrence rates.
02
Liver Fibrosis
Some physicians believe that this formula combined with interferon can effectively control the progression of liver fibrosis in patients, improving portal vein blood flow, with a low incidence of adverse reactions.
03
Fatty Liver
Some physicians found that this formula with modifications significantly improved liver function and reduced blood lipids in patients with non-alcoholic fatty liver disease.
Part05
Gynecology and Obstetrics
01
Chronic Pelvic Inflammatory Disease
Some physicians observed that using Chinese medicine enema combined with this formula with modifications for treating chronic pelvic inflammatory disease was reliable, improving patients’ daily quality of life, shortening treatment time, and reducing recurrence rates.
02
Dysmenorrhea
Some physicians pointed out that this formula combined with Vitamin B6 significantly improved symptoms in 120 cases of dysmenorrhea patients, enhancing clinical efficacy.
03
Endometriosis
Some physicians used Chinese medicine retention enema combined with Jia Wei Xuefu Zhuyu Decoction to treat 86 cases of endometriosis patients, achieving a total effective rate of 95.35%, significantly improving clinical efficacy, hormone levels, and reducing recurrence rates.
04
Breast Hyperplasia
Some physicians used this formula to treat 40 cases of breast hyperplasia patients, achieving significant clinical efficacy, with reductions in breast pain and lump grading.
05
Medical Abortion
Xuefu Zhuyu Wan can significantly improve the success rate of medical abortion within three days, reduce the incidence of intrauterine residuals, shorten vaginal bleeding time, and lower the risk of severe hemorrhage due to incomplete abortion.
06
Ectopic Pregnancy
Some physicians used this formula in combination with Mifepristone to treat ectopic pregnancy, finding it effectively shortened the time for symptom improvement, reduced adverse reactions, improved hormone levels, and shortened hospital stays, with minimal impact on long-term fertility.
07
Uterine Fibroids
Some physicians used this formula with modifications to treat 30 cases of patients, finding significant reductions in hormone levels and fibroid volume, with a total effective rate of 93.85%.
08
Adenomyosis
Some physicians used Dan Huang Qu Yu capsules combined with Xuefu Zhuyu Wan for cyclical treatment of 196 patients, with clinical observations indicating an effective rate of 84.6%.
Part06
Andrology
01
Impotence
Some physicians used this formula with modifications for treatment, and after one month of medication, the condition was nearly cured.
02
Prostatitis
Some physicians treated 66 cases of chronic prostatitis patients with this formula with modifications, finding significant clinical effects.
03
Oligospermia
Some physicians used this formula with modifications, and after two months of treatment, patients’ semen analysis returned to normal.
04
Acute Epididymitis
Some physicians found that early application of dexamethasone combined with Xuefu Zhuyu capsules for treating acute epididymitis significantly improved efficacy and reduced the rate of residual epididymal nodules.
Part07
Otolaryngology
01
Tinnitus
Some physicians used this formula with modifications, and patients reported that tinnitus in both ears had disappeared upon follow-up.
02
Chronic Hypertrophic Rhinitis
Some physicians used this formula combined with Xiao Yao San for treatment, and follow-up nasal endoscopy showed significant reduction in bilateral inferior turbinate hypertrophy, with good elasticity and no edema or dryness in the nasal mucosa.
03
Vocal Cord Polyps
Some physicians used this formula combined with Er Chen Tang for treatment, and upon follow-up, patients reported significant improvement in hoarseness and disappearance of discomfort, with follow-up laryngoscopy showing smooth surfaces of both vocal cords, slight congestion, and edema, with normal closure and movement.
04
Chronic Pharyngitis
Some physicians used this formula with modifications for treatment, and all symptoms were resolved, with no recurrence during a six-month follow-up.
05
Otitis Media
Some physicians used Xuefu Zhuyu oral liquid combined with Western medicine treatment, achieving a total effective rate of 95%.
Part08
Dermatology
01
Alopecia
Some physicians used this formula with modifications, and patients’ hair began to regrow, becoming denser than before, with no further significant hair loss during follow-up.
02
Postherpetic Neuralgia
Some physicians used this formula combined with Yunnan Baiyao to treat 132 patients, finding rapid improvement in pain symptoms, safely and effectively.
03
Multiple Common Warts
Some physicians used Xuefu Zhuyu oral liquid for treatment, and the long-standing condition was completely cured, with no recurrence during a two-year follow-up.
04
Nodular Prurigo
Some physicians used Xuefu Zhuyu oral liquid for treatment, and all skin rashes gradually disappeared, with no recurrence during a two-year follow-up.
05
Chloasma
Some physicians used Shen Ling Bai Zhu Wan combined with Xuefu Zhuyu oral liquid for treatment, and after three months, the total effective rate was 90.0%.
Part09
Ophthalmology
01
Vitreous Hemorrhage
Research shows that using this formula can change blood viscosity, improve retinal microcirculation, and promote the absorption of stasis, thereby improving patients’ vision.
02
Retinal Vein Occlusion
Research found that using this formula with modifications can regulate vision and retinal microcirculation, accelerating the absorption of retinal hemorrhage and exudation, quickly restoring vision.
Part10
Oncology
01
Multiple Myeloma (MM)
Some physicians used this formula combined with Bortezomib + Dexamethasone (VD) chemotherapy to treat 46 cases of MM patients, finding improvements in blood indicators and bone metabolism regulatory factors, with confirmed efficacy and safety.
02
Lung Cancer
Network pharmacology confirms that this formula may inhibit the growth, senescence, apoptosis, and metastasis of lung cancer cells through key targets related to lung cancer such as TP53, BCL2, and AKT, acting on various signaling pathways in the tumor pathway (hsa05200) such as cAMP, VEGF, and MAPK to induce cell cycle arrest, apoptosis, infiltration, growth, recurrence, and metastasis in lung cancer cells.
03
Cancer Pain
Research shows that this formula can significantly improve the control rate of cancer pain, markedly enhancing patients’ quality of life, with significantly better effects than conventional analgesics alone.
04
Glioma
Research shows that this formula has good effects in prolonging the survival time of glioma patients, improving immune function, and alleviating blood stasis conditions.
05
Cervical Cancer
Research shows that Xuefu Zhuyu granules combined with radiotherapy have good efficacy for cervical cancer, reducing adverse reactions to radiotherapy and lowering tumor marker levels.
Part11
Others
Xuefu Zhuyu Decoction is also commonly used in clinical practice for treating rheumatic heart disease, chest pain from chest contusions and costochondritis, cerebral thrombosis, hyperlipidemia, thromboangiitis obliterans, neuroses, post-concussion headaches, dizziness due to blood stasis and Qi stagnation, as well as lower limb arteriosclerosis, intestinal adhesion abdominal pain, surgical pain, oral leukoplakia, neurogenic urinary retention, hyperthyroidism, childhood purpura, infertility, menopausal syndrome, etc.
Usage Precautions
PSM China
1. Those without blood stasis, excessive menstruation, bleeding tendencies, and pregnant women should not take this formula.
2. Please use under the guidance of a physician; avoid eating spicy and cold foods while taking it.
Author’s Profile
Zhu Sha, Chief Chinese Medicine Pharmacist at the First Affiliated Hospital of Guangzhou Medical University, Chief Chinese Medicine Pharmacist, mainly engaged in drug dispensing and quality management, skilled in the identification of common Chinese medicinal materials, and guidance on dietary therapy and medicinal cuisine.
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Review Expert: Guangdong ProvincePharmaceutical Association, First Affiliated Hospital of Guangzhou Medical University, Ye Yingxia
References
[1] National Pharmacopoeia Commission. Pharmacopoeia of the People’s Republic of China, 2020: 894-897.
[2] Lv Shuanghong, Wang Henghe. Progress in Clinical Application Research of Xuefu Zhuyu Decoction. Hunan Journal of Traditional Chinese Medicine, 2020, 36(10): 200-202.
[3] Li Xincun. Exploration of Clinical Application of Xuefu Zhuyu Decoction. New Chinese Medicine, 2017, 49(1): 218-220.
[4] Chen Jianshe, Gao Ziyang. Examples of Clinical Application of Xuefu Zhuyu Decoction. Modern Distance Education of Traditional Chinese Medicine, 2017, 15(10): 135-136.
[5] Qi Jinling. Clinical Observation of Xuefu Zhuyu Decoction in the Treatment of Uterine Fibroids and Its Effect on Hormone Levels. Journal of Liaoning University of Traditional Chinese Medicine, 2016(2): 151-153.
[6] Zhang Linjing, Yan Zhanfeng, Jiao Lulu, et al. Application of Xuefu Zhuyu Decoction in Otolaryngological Diseases. China Medical Herald, 2020, 17(19): 120-122+139.
[7] Shi Weili, Zhang Jingsi, Hu Yaqiong, et al. Progress in Clinical Application and Mechanism Research of Xuefu Zhuyu Decoction in Preventing and Treating Vascular-Related Diseases. Chinese Journal of Integrated Traditional and Western Medicine, 2013, 33(5): 712-716.
[8] Lu Yongpan. Clinical Study of Xuefu Zhuyu Decoction Combined with Laser Photocoagulation in the Treatment of Retinal Vein Occlusion. New Chinese Medicine, 2019, 51(7): 97-98.
[9] Zhao Yongbo, Zhang Qiuyue, Han Yingjun, Bai Xiaoling. Clinical Observation of Dan Huang Qu Yu Capsules Combined with Xuefu Zhuyu Wan in the Treatment of Adenomyosis. China Practical Medicine, 2009, 4(04): 169.
[10] Zhang Ling. Clinical Observation of Xuefu Zhuyu Oral Liquid in the Treatment of Menopausal Syndrome in 60 Cases. Industrial and Enterprise Medical Journal, 2009, 22(1): 36-37.
[11] Huang Hui, Pan Hui, Zhong Guangjun, et al. Efficacy Observation of Xuefu Zhuyu Capsules in the Treatment of Acute Epididymitis. Evaluation and Analysis of Hospital Medication in China, 2016, 16(08): 1048-1050.
[12] Gao Xiang. Efficacy Study of Auxiliary Use of Xuefu Zhuyu Wan in Medical Abortion. Practical Gynecology and Endocrinology Electronic Journal, 2019, 6(08): 62+65.
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