The Eighteen Methods of Activating Blood and Resolving Stasis include: the method of activating blood and clearing heat, activating blood and detoxifying, activating blood and benefiting qi, activating blood and nourishing blood, activating blood and nourishing yin, activating blood and assisting yang, activating blood and regulating qi, activating blood and purging, activating blood and cooling blood, activating blood and stopping bleeding, activating blood and opening orifices, activating blood and promoting urination, activating blood and resolving phlegm, activating blood and unblocking collaterals, activating blood and dispelling wind, activating blood and softening hardness, activating blood and breaking stasis, and activating blood and dispelling cold. These combinations not only reflect a pioneering spirit and open multiple pathways but also comprehensively illustrate the dialectical application of activating blood and resolving stasis in the treatment of blood stasis syndrome, which has significant guiding implications.1. Activating Blood and Clearing Heat, and Activating Blood and DetoxifyingIt is believed that internal heat toxins can cause blood stasis; conversely, stasis can also generate heat and toxins. When blood stasis and heat toxins are intertwined, it manifests as stasis-heat or stasis-toxicity syndrome, which should be treated with a combination of activating blood and resolving stasis with clearing heat or detoxifying. Common herbs for clearing heat include Huang Qin (Scutellaria baicalensis), Huang Bai (Phellodendron amurense), Zhi Mu (Anemarrhena asphodeloides), Da Huang (Rheum palmatum), Yang Ti (Hibiscus sabdariffa), Shi Gao (Gypsum), Di Gu Pi (Lycium barbarum), Qing Hao (Artemisia annua), Chai Hu (Bupleurum chinense), and Lian Qiao (Forsythia suspensa); detoxifying herbs include Yin Hua (Lonicera japonica), Lian Qiao (Forsythia suspensa), Guanzhong (Cynanchum atratum), Zao Xiu (Houttuynia cordata), Pu Gong Ying (Taraxacum mongolicum), Ban Lan Gen (Isatis indigotica), Da Qing Ye (Isatis tinctoria), Sheng Ma (Cimicifuga foetida), and Bai Jiang Cao (Patrinia villosa).In cases of chronic hepatitis or elevated alanine aminotransferase (ALT) due to cirrhosis, using only clearing heat and detoxifying herbs is often ineffective. It is believed that this is related to the interplay of blood stasis and heat toxins, advocating for the combined use of activating blood and resolving stasis with clearing heat and detoxifying methods. Commonly used herbs include Sheng Chuan Jun (Corydalis yanhusuo), Tao Ren (Prunus persica), Di Bie Chong (Eupolyphaga sinensis), Zi Can (Scutellaria baicalensis), Dan Shen (Salvia miltiorrhiza), Yang Ti (Hibiscus sabdariffa), Tian Ji Huang (Hedyotis diffusa), Gang Ren Gen (Hibiscus rosa-sinensis), Chi Bai Shao (Paeonia lactiflora), and Pu Gong Ying (Taraxacum mongolicum). This combination often improves liver function and leads to a significant decrease in ALT levels.Acute episodes of chronic nephritis may present with fever, sore throat, redness and swelling, dry mouth, short and turbid urination, thin yellow tongue coating, and rapid pulse, indicating acute infection with heat toxin symptoms, alongside renal area percussion pain, lower back pain, and edema, indicating blood stasis. For this type of nephritis, which is diagnosed as stasis-heat obstruction, a common formula includes Sheng Di (Rehmannia glutinosa), Dan Shen (Salvia miltiorrhiza), Chi Shao (Paeonia lactiflora), Yin Hua (Lonicera japonica), Lian Qiao (Forsythia suspensa), Mao Gen (Imperata cylindrica), Liu Yue Xue (Hedyotis diffusa), Pu Huang (Typha angustifolia), Huang Bai (Phellodendron amurense), Mu Tong (Akebia quinata), and Yi Mu Cao (Leonurus japonicus), which has shown significant efficacy.The methods of activating blood and clearing heat, as well as activating blood and detoxifying, have been experimentally proven to improve microcirculation in affected areas, facilitating the penetration of anti-infection medications into infected sites, enhancing antibacterial and detoxifying effects. Additionally, they can regulate the body’s response and enhance immune capacity, achieving anti-infection effects based on improved systemic and local blood circulation.It is noted that some herbs possess both activating blood and resolving stasis, as well as clearing heat and detoxifying properties, such as Lei Gong Teng (Tripterygium wilfordii), Kunming Shan Hai Tang (Begonia), Zi Can (Scutellaria baicalensis), Bai Hua She She Cao (Hedyotis diffusa), Hong Teng (Sargentodoxa cuneata), Bai Jiang Cao (Patrinia villosa), and Luo De Da (Dichroa febrifuga), which can effectively treat stasis-heat and stasis-toxicity.2. Activating Blood and Benefiting QiThis method is used for qi deficiency and blood stasis syndrome, presenting symptoms such as palpitations, shortness of breath, fatigue, pale complexion, facial swelling, chest pain, or lateral pain, with a slightly purplish tongue and a soft, weak pulse. In activating blood and resolving stasis formulas, herbs like Dang Shen (Codonopsis pilosula), Huang Qi (Astragalus membranaceus), and Bai Zhu (Atractylodes macrocephala) are often added.For instance, when treating coronary heart disease, it is noted that most cases of angina pectoris and myocardial infarction exhibit varying degrees of heart qi deficiency and blood stasis symptoms, characterized by increased blood viscosity and left ventricular dysfunction. Common prescriptions include Bai Ren (Panax ginseng), Huang Qi (Astragalus membranaceus), Wu Wei Zi (Schisandra chinensis), and Huang Jing (Polygonatum sibiricum) to benefit qi and strengthen the body, enhancing cardiac function; along with Dan Shen (Salvia miltiorrhiza), Gua Lou (Trichosanthes kirilowii), Tan Xiang (Santalum album), Hong Hua (Carthamus tinctorius), Chuan Xiong (Ligusticum chuanxiong), Dang Gui (Angelica sinensis), and Tao Ren (Prunus persica) to activate blood and resolve stasis, acting on blood vessels to increase coronary blood flow. This combination is more effective than using blood-activating herbs alone.3. Activating Blood and Nourishing BloodThis method is used when blood stasis has not been resolved and new blood has not been generated, indicating blood stasis combined with blood deficiency. Tang Rongchuan once stated: “Without nourishing blood, how can stasis be completely resolved? … Both nourishing and purging should be applied; once stasis is resolved, the proper condition will not be harmed.”Experience shows that in cases of blood stasis with anemia, symptoms may include dizziness, pale complexion, pale tongue, and weak pulse. If only activating blood and resolving stasis is used, symptoms may not improve significantly. The method of activating blood and nourishing blood can be expected to enhance efficacy. Common herbs include Dan Shen (Salvia miltiorrhiza), Dang Gui (Angelica sinensis), Shu Di (Rehmannia glutinosa), Chuan Xiong (Ligusticum chuanxiong), Tao Ren (Prunus persica), Niu Xi (Achyranthes bidentata), Ji Xue Teng (Spatholobus suberectus), Chi Bai Shao (Paeonia lactiflora), Long Yan Rou (Dimocarpus longan), E Jiao (Colla corii asini), Shu Wu (Polygonum multiflorum), Gou Qi Zi (Lycium barbarum), Bie Jia (Trionyx sinensis), and Dang Shen (Codonopsis pilosula). This formula has been used to treat several cases of chronic aplastic anemia, resulting in significant improvement in blood counts.4. Activating Blood and Nourishing YinThis method is used for syndromes of yin deficiency with insufficient blood flow, where blood is stagnant and not circulating smoothly, presenting symptoms such as emaciation, dry mouth, red tongue, and little coating. Commonly added herbs include Shu Di (Rehmannia glutinosa), E Jiao (Colla corii asini), Xuan Shen (Scrophularia ningpoensis), Mai Dong (Ophiopogon japonicus), Tian Dong (Asparagus cochinchinensis), and Shi Hu (Dendrobium nobile).Yin deficiency and blood stasis can be seen in tuberculosis patients, where Yue Hua Wan (Yuehua Pill) may be used; in cases of stubborn hepatitis and cirrhosis, Tong You Decoction may be applied; and in coronary heart disease, Sheng Mai Yin and Dan Shen Decoction may be used. In cases of systemic lupus erythematosus, common herbs include Sheng Di (Rehmannia glutinosa), Xuan Shen (Scrophularia ningpoensis), Tian Hua Fen (Trichosanthes kirilowii), Chi Bai Shao (Paeonia lactiflora), Shu Wu (Polygonum multiflorum), Ji Xue Teng (Spatholobus suberectus), Dang Gui (Angelica sinensis), Dan Pi (Moutan cortex), Tian Mai Dong (Ophiopogon japonicus), Shi Hu (Dendrobium nobile), Zhi Bie Jia (Trionyx sinensis), and Zhi Gui Ban (Testudinis Carapax), which have shown significant efficacy.From a hematological perspective, patients with yin deficiency and blood stasis exhibit higher blood viscosity compared to normal individuals. Clinically, after using nourishing yin and activating blood formulas, the whole blood viscosity can significantly decrease, showing better efficacy than using blood-activating and resolving stasis alone.5. Activating Blood and Assisting YangThis method is used for blood stasis with concurrent deficiency of spleen and kidney yang, and internal cold, presenting symptoms such as a pale yellow complexion, purple lips, abdominal distension, limb edema, a preference for warmth and aversion to cold, cold extremities, pale purple tongue or pale tongue with stasis spots, and a deep, slow pulse. Commonly used herbs include Rou Gui (Cinnamomum cassia), Fu Zi (Aconitum carmichaelii), Cong Rong (Cistanche deserticola), Xian Mao (Curculigo orchioides), Xian Ling Pi (Rhizoma Curculigo), Suo Yang (Cynomorium songaricum), and Lu Rong (Cervus nippon) to assist yang, combined with Dan Shen (Salvia miltiorrhiza), Chuan Xiong (Ligusticum chuanxiong), Tao Ren (Prunus persica), Hong Hua (Carthamus tinctorius), and Niu Xi (Achyranthes bidentata) to activate blood and resolve stasis.Experiments have confirmed that using yang-assisting herbs alongside blood-activating herbs not only enhances blood circulation but also stimulates and strengthens multiple systems within the body. This aligns with the principle stated in the “Su Wen” that “blood and qi prefer warmth and dislike cold; cold prevents blood from flowing, while warmth promotes its movement and dispersal.”6. Activating Blood and Regulating QiThis method is used for blood stasis and qi stagnation syndrome. It is believed that qi is the commander of blood, and blood follows qi; when qi is stagnant, blood becomes stasis, but blood stasis can also cause qi stagnation. As noted by Qing Dynasty scholar Wang Yutai, “There is no qi stagnation without blood being harmonized; if blood is not harmonized, qi will become more stagnant.” Therefore, blood-activating and resolving stasis formulas often include qi-regulating herbs.It is noted that qi-regulating herbs and blood-activating herbs often have synergistic effects. For instance, qi herbs in blood include Chuan Xiong (Ligusticum chuanxiong), Yu Jin (Curcuma longa), Jiang Huang (Curcuma zedoaria), E Zhu (Curcuma zedoaria), Yan Hu Suo (Corydalis yanhusuo), Jiang Xiang (Dalbergia odorifera), Ru Xiang (Boswellia carterii), and Mo Yao (Commiphora molmol); while blood herbs in qi include Xiang Fu (Cyperus rotundus), Chai Hu (Bupleurum chinense), Mu Xiang (Aucklandia lappa), Xie Bai (Allium macrostemon), She Xiang (Moschus), Tan Xiang (Santalum album), Chen Xiang (Aquilaria sinensis), Mei Gui Hua (Rosa rugosa), and Ju Hong (Citrus reticulata).For cases of blood stasis and qi stagnation presenting with chest tightness, abdominal distension, and pain from hernias, the combination of activating blood and resolving stasis with the regulation of smooth muscle in different organs can relieve spasms, alleviate pain, expel gas, and improve blood circulation, enhancing the effects of activating blood and resolving stasis.7. Activating Blood and PurgingThis method is used for blood stasis with interior excess. Zhang Zhongjing first proposed the treatment principles for blood stasis and purging, listing formulas such as Tao Ren Cheng Qi Decoction, Di Dang Decoction, Di Dang Pill, and Xia Yu Xue Decoction. The purging and activating blood method is currently commonly used for various acute abdominal conditions, such as appendicitis, pancreatitis, cholecystitis, gallstones, intestinal obstruction, and ectopic pregnancy.Since the six fu organs function through communication, if there is a physical accumulation and stagnation combined with cold and heat, qi and blood can become obstructed, leading to internal heat and stasis, or cold and stasis can combine, causing blockage and preventing normal qi descent, resulting in disease. Commonly, in activating blood and resolving stasis, Sheng Da Huang (Rheum palmatum) and Mang Xiao (Mirabilite) are added; for cold conditions, Fu Zi (Aconitum carmichaelii) and Gan Jiang (Zingiber officinale) are added; for heat conditions, Huang Lian (Coptis chinensis), Dan Pi (Moutan cortex), and Shan Zhi (Gardenia jasminoides) are added to promote the flow of qi and disperse stasis, showing significant efficacy for acute abdominal conditions.8. Cooling Blood and Activating BloodThis method is used for blood heat and blood stasis syndrome. When pathogenic heat penetrates deeply into the blood, it can cause coagulation and stasis, leading to blood stagnation and obstruction, with symptoms such as purplish skin spots, severe bleeding, fever, and mental confusion, with a red or purplish tongue and no coating, and a thin, rapid pulse. It is advisable to use cooling blood, clearing the blood, and activating blood and resolving stasis. Commonly added herbs include Dan Pi (Moutan cortex), Shan Zhi (Gardenia jasminoides), Xi Jiao (Rhinoceros horn), and Sheng Di (Rehmannia glutinosa).It is believed that cooling blood and activating blood can clear blood heat and calm the vessels, allowing stasis to disperse and blood to return to the meridians. Particularly in the treatment of warm diseases, it is advocated to use cooling blood and resolving stasis for severe warm diseases such as septicemia, epidemic hemorrhagic fever, and viral encephalitis at the stage of qi and blood heat, without waiting for the pathogenic heat to penetrate deeply into the blood. When the pathogen first enters the blood, a large dose of Qing Wen Bai Du Decoction combined with Dan Shen to cool blood and resolve stasis can intercept the pathogen early.Clinical observations have shown the following effects: (1) it can control or prevent bleeding, such as epistaxis, hematuria, and subcutaneous bleeding; (2) it reduces or prevents coma and convulsions; (3) it is beneficial for controlling high fever and shortening the duration of illness. Therefore, cooling blood and activating blood is beneficial for clearing heat and preventing the pathogen from entering the blood, which can prevent blood movement and damage yin. These viewpoints further expand the indications for the use of cooling blood and activating blood, and have significant implications for treating acute infectious diseases and shortening the course of illness.9. Activating Blood and Stopping BleedingActivating blood and stopping bleeding methods address various bleeding conditions, which are both a cause of blood stasis and a symptom of it. After bleeding, the blood that has left the meridians may not be expelled from the body, accumulating and becoming stasis, which obstructs the vessels, preventing blood from flowing through the meridians, leading to continuous bleeding; on the other hand, if the speed of blood flow is slow or the blood becomes viscous and altered, stasis can obstruct the vessels, causing blood to overflow outside the meridians. Therefore, Tang Rongchuan stated: “For any case of vomiting or bleeding, regardless of whether the blood is fresh or dark, the first step is to eliminate stasis.”The characteristics of bleeding due to blood stasis include repeated and persistent bleeding, dark purple blood with clots, or fresh blood mixed with dark purple clots, accompanied by stasis pain symptoms, which can be seen in various bleeding conditions in both hematological and non-hematological systems, such as hematemesis, hemoptysis, melena, and menorrhagia. Common prescriptions often include San Qi (Panax notoginseng), Pu Huang (Typha angustifolia), Qian Cao Gen (Rubia cordifolia), Di Yu (Sanguisorba officinalis), Mao Gen (Imperata cylindrica), Da Huang (Rheum palmatum), and Bai Ji (Bletilla striata) in blood-activating and stopping bleeding formulas.10. Activating Blood and Opening OrificesThis method is suitable for stasis-heat obstruction and evil blocking the heart orifices, commonly seen in cases of viral encephalitis, meningitis, severe septicemia, toxic hepatitis, acute cerebrovascular disease, and uremic coma. Yu Genchu once stated: “When heat invades the pericardium, causing mental confusion, it is either phlegm obstructing the heart or stasis blocking the heart orifices.” Due to the internal heat invasion and obstruction of the heart orifices, symptoms may include coma, inability to speak, cyanosis of lips, subcutaneous purpura, cold extremities, or diarrhea with dark stools, with a purple tongue and a hidden pulse. It is urgent to open the orifices, activate blood, and advance treatment. Commonly used herbs include activating blood and resolving stasis formulas combined with Zhi Bao Dan (Zhibao Pill), which can effectively clear the heart orifices, promote mental clarity, and descend turbid yin to facilitate awakening.11. Activating Blood and Promoting UrinationThis method is used for blood stasis combined with water retention, such as ascites and edema, where herbs like Fu Ling (Poria cocos), Ze Xie (Alisma orientale), Che Qian Zi (Plantago asiatica), Chen Hu Lu (Cucurbita moschata), Chong Sun (Cynanchum atratum), and Xu Sui Zi (Plantago asiatica) are added to blood-activating and resolving stasis formulas.12. Activating Blood and Resolving PhlegmThis method is used for blood stasis combined with phlegm, presenting symptoms such as subcutaneous lumps, facial asymmetry, and limb numbness, where herbs like Nan Xing (Arisaema cumingii), Ban Xia (Pinellia ternata), Fu Ling (Poria cocos), Chen Pi (Citrus reticulata), and Bai Fu Zi (Typhonium giganteum) are added to blood-activating and resolving stasis formulas.13. Activating Blood and Unblocking CollateralsThis method is used for blood stasis obstructing the collaterals, such as liver and spleen enlargement, venous obstruction, and hemiplegia, where herbs like Di Long (Lumbricus) and Pao Shan Jia (Manis pentadactyla) are added to blood-activating and resolving stasis formulas.14. Activating Blood and Dispelling WindThis method is used for blood stasis combined with wind, such as joint pain, following the principle of “treating wind by first activating blood; when blood flows, wind will naturally dissipate,” emphasizing the use of blood-activating herbs combined with Feng Feng (Saposhnikovia divaricata), Qin Jiao (Gentiana macrophylla), Du Huo (Angelica pubescens), Chuan Wu (Aconitum carmichaelii), and Jiang Huang (Curcuma longa).15. Activating Blood and Softening HardnessThis method is used for softening hardness and resolving masses, such as thyroid nodules, where blood-activating and resolving stasis formulas are combined with Kun Bu (Ecklonia cava), Hai Zao (Sargassum), and Mu Li (Oyster); for spleen enlargement, herbs like Bie Jia (Trionyx sinensis), Ze Lan (Lycopus lucidus), and Shi Jian Chuan (Lycopus lucidus) are added; for breast fibromas, herbs like Yu Jin (Curcuma longa) and Xiao Jin Dan (Corydalis yanhusuo) are added.16. Activating Blood and Breaking StasisThis method is used for severe blood stasis and dryness, such as hard abdominal masses, where herbs like Shui Zhi (Hirudo) and Meng Chong (Mantis) are used, along with San Leng (Sparganium) and E Zhu (Curcuma zedoaria), and Chuan Shan Jia (Manis pentadactyla) and Shu Fu (Scolopendra) are added.17. Activating Blood and Unblocking YangThis method is used for blood stasis with yang qi not being expressed, such as chest yang obstruction and chest pain, where blood-activating and resolving stasis formulas are combined with Gui Zhi (Cinnamon twig), Ban Xia (Pinellia ternata), Sheng Jiang (Zingiber officinale), Xi Xin (Asarum), Cong Bai (Allium fistulosum), and Xie Bai (Allium macrostemon), and Gua Lou (Trichosanthes kirilowii) are added.18. Fasting and Resolving StasisFasting has a significant therapeutic effect on cardiovascular diseases. It burns off fat and cholesterol in the heart, brain, and blood vessels, eliminating vascular obstructions, thus allowing blood to flow freely throughout the body, making it remarkably effective for treating heart disease, hypertension, hypotension, arteriosclerosis, cerebral thrombosis, and diabetes.This article is excerpted from “Chinese Clinical Medicine”, Volume 7, Issue 1, 2000, Author: Wang Peifang.
