The concept of “Qi Stagnation and Blood Stasis” in Traditional Chinese Medicine (TCM) refers to a pathological state where the flow of Qi is obstructed (Qi stagnation), leading to impeded blood circulation (blood stasis). Qi stagnation and blood stasis often interact as causes and effects, forming a vicious cycle.
1. Etiology and Pathogenesis
1. Causes of Qi Stagnation:
– Emotional distress (such as prolonged depression or anger) leads to liver dysfunction and Qi stagnation.
– Irregular diet and imbalance between work and rest can cause spleen and stomach Qi stagnation.
– External pathogens (such as cold or phlegm-damp) obstruct the flow of Qi.
2. Causes of Blood Stasis:
– Prolonged Qi stagnation leads to poor blood circulation and the formation of blood stasis.
– Trauma or surgery can directly damage blood vessels, causing blood to extravasate and form stasis.
– Cold can condense blood vessels (cold nature constricts), while heat can scorch body fluids and thicken blood, leading to blood stasis.
2. Clinical Manifestations
– Pain: Distending pain (Qi stagnation), stabbing pain (blood stasis), with fixed pain that resists pressure.
– Masses: Localized lumps (such as fibroids or cysts) or superficial ecchymosis.
– Tongue and Pulse: Dark purple tongue or presence of stasis spots, twisted sublingual veins; pulse is choppy, wiry, or knotted.
– Other: Dull complexion, dry and flaky skin, menstrual irregularities in women (dark purple menstrual blood, clots, dysmenorrhea), chest and hypochondriac distension, irritability.
3. Key Points of Differentiation
1. Distinguishing the primary and secondary roles of Qi stagnation and blood stasis:
– Qi stagnation predominant: Distending pain is prominent, worsens with emotional fluctuations, pulse is wiry.
– Blood stasis predominant: Stabbing pain and masses are prominent, tongue is dark purple, pulse is choppy.
2. Distinguishing concurrent syndromes:
– Concurrent cold congealing: Pain worsens with cold, alleviates with warmth.
– Concurrent damp-heat: Localized redness, swelling, heat, and pain, tongue coating is yellow and greasy.
– Concurrent phlegm-damp: Obesity with phlegm, tongue coating is thick and greasy.
4. Treatment Principles
Move Qi and invigorate blood, resolve stasis and relieve pain, flexibly combine based on the location of the disease and concurrent syndromes.
5. Common Formulas and Medicinal Herbs
1. Classic Formulas
– Xuefu Zhuyu Decoction (血府逐瘀汤) from “Yilin Gai Cuo”:
Indications: Chest and hypochondriac Qi stagnation and blood stasis (such as coronary heart disease, intercostal neuralgia).
Ingredients: Tao Ren (Peach Kernel), Hong Hua (Safflower), Dang Gui (Angelica Sinensis), Chuan Xiong (Ligusticum Chuanxiong), Chi Shao (Red Peony), Chai Hu (Bupleurum), Zhi Ke (Bitter Orange), Niu Xi (Achyranthes Bidentata), etc.
– Ge Xia Zhu Yu Decoction (膈下逐瘀汤) from “Yilin Gai Cuo”:
Indications: Abdominal blood stasis (such as dysmenorrhea, pelvic inflammatory disease, liver and spleen enlargement).
– Chai Hu Shu Gan San (柴胡疏肝散) combined with Si Wu Tang (桃红四物汤): Regulates liver Qi + invigorates blood and resolves stasis.
2. Patent Medicines
– Xuefu Zhuyu Wan, Yuanhu Zhitong Pian, Compound Danshen Pian, Gui Zhi Fu Ling Wan.
3. Single Herbs
– Qi-moving herbs: Chai Hu (Bupleurum), Xiang Fu (Cyperus), Zhi Ke (Bitter Orange), Qing Pi (Green Tangerine Peel).
– Blood-invigorating herbs: Chuan Xiong (Ligusticum Chuanxiong), Yan Hu Suo (Corydalis), Dan Shen (Salvia), Hong Hua (Safflower), Tao Ren (Peach Kernel), San Qi (Notoginseng).
– Stasis-resolving herbs: E Zhu (Curcuma), San Leng (Sparganium), Bie Jia (Soft-shelled Turtle Shell) (used for masses and accumulations).
6. Daily Care Recommendations
1. Emotional Regulation: Avoid depression and anger, maintain smooth liver Qi.
2. Diet:
– Recommended: Hawthorn, black fungus, onion, rose tea (to regulate Qi and invigorate blood).
– Avoid: Raw and cold foods, greasy foods (which exacerbate Qi stagnation and blood stasis).
3. Exercise: Moderate aerobic exercise (such as Ba Duan Jin, Tai Chi) to promote Qi and blood circulation.
4. Prevent Cold and Keep Warm: Avoid cold pathogens that can worsen blood stasis.
7. Cautions
– Pregnant women should use blood-invigorating and stasis-resolving herbs with caution to avoid miscarriage.
– Those with deficiency should combine with Qi-tonifying and blood-nourishing herbs (such as Huang Qi (Astragalus), Dang Gui (Angelica Sinensis)) to avoid depleting Zheng Qi.
– Stubborn blood stasis (such as tumors) requires a combination of TCM and Western medicine treatment.
By accurately differentiating the severity of Qi stagnation and blood stasis, adjusting medication according to constitution and concurrent syndromes, and combining lifestyle interventions, one can effectively improve the state of Qi stagnation and blood stasis. If symptoms are complex or persistently worsen, timely medical consultation is recommended.