Five Theories on the Causes and Mechanisms of Blood Stasis
① Many Diseases are Caused by Blood Stasis
The “Su Wen: On Regulating the Menstrual Cycle” states: “What a person possesses are blood and qi.” It also points out: “When blood and qi are not harmonious, various diseases will arise.” Based on the understanding of predecessors and personal practice, Weng Weiliang proposed the academic thought that “many diseases are caused by blood stasis.” This does not mean that all diseases are due to stasis, but rather that many diseases of a certain type or at a certain stage, especially in the later stages, often exhibit varying degrees of blood stasis. Clinical practice shows that conditions such as qi deficiency, qi stagnation, qi counterflow, blood deficiency, yang deficiency, yin deficiency, fluid deficiency, cold congealing, heat accumulation, phlegm obstruction, and dampness depression can all lead to the occurrence of blood stasis.
② Elderly People are Prone to Blood Stasis
Weng Weiliang believes that aging and disease lead to a decline in bodily functions in the elderly, resulting in weakened qi and blood, and insufficient blood circulation, which leads to stasis. Aging is an inevitable process of human life development, and with the appearance and development of aging, the functions of the organs continuously decline, and the balance of qi and blood, yin and yang gradually diminishes, ultimately leading to “all five organs being deficient, spirit and qi departing, and the body being alone” (from “Ling Shu: On Longevity”). In this process, the deficiency of kidney qi and the weakness of the spleen and stomach are particularly prominent. Weng Weiliang believes that the elderly are often deficient, leading to stasis. The weakened organ functions in the elderly, along with the deficiency of qi, blood, yin, and yang, and the instability of the five emotions, result in insufficient nourishment of the heart and spirit, leading to psychological characteristics such as depression or anxiety, making them prone to emotional injuries. In response to these physiological and psychological characteristics, Weng Weiliang believes that the elderly often experience depression, qi stagnation, and blood stasis. The aging of the organs, meridians, skin, muscles, and bones in the elderly often leads to various chronic diseases or degenerative diseases, which can linger and affect the normal functioning of the organs and the circulation of qi and blood, resulting in various blood stasis syndromes. In light of this, Weng Weiliang believes that the elderly often suffer from diseases, leading to stasis.
③ Chronic Illness Leads to Blood Stasis
Prolonged illness penetrates the meridians, with pathogenic factors obstructing the channels or “long-term illness must lead to deficiency,” resulting in insufficient qi and blood circulation, which leads to stasis. Weng Weiliang has found in long-term clinical practice that many chronic diseases and those that do not heal often relate to blood stasis. Clinically, one can observe symptoms such as stasis pain, stasis heat, stasis bruises, and stasis lumps, with pulse characteristics such as rough, knotty, deep, and slow, or accompanied by bleeding and other manifestations of blood stasis. The appropriate use of blood-activating and stasis-removing herbs often yields good therapeutic effects. Regarding the modern mechanism of “chronic illness leading to stasis,” Weng Weiliang believes it may be due to the prolonged course of the disease and repeated occurrences, leading to a decline in the body’s immune function, slowed blood circulation, and increased blood viscosity, resulting in the internal generation of blood stasis.
④ Rare Diseases Often Involve Blood Stasis
所谓“怪病”是指少见病、无规律可循、现代医学手段尚无法明确诊断且缺乏有效治疗措施的疑难杂症。对于各种怪病常规方法治疗无效时，采用活血化瘀法进行治疗往往能收到意想不到的效果。翁维良在其著作《中医活血化瘀治疗疑难病》中指出：“血瘀是疑难病的根源，疑难病的本质就是血瘀证。临床可以观察到，疑难病无论属于何种类型和处于哪一阶段都存在程度不等的血瘀证候，血瘀证是疑难病临床最常见的病证。”
⑤ Heart Disease Often Involves Blood Stasis
The heart governs the blood vessels, and factors such as qi deficiency, yang deficiency, blood deficiency, qi stagnation, blood cold, blood heat, or phlegm obstruction can excessively affect the cardiovascular system, leading to obstruction of the heart vessels. When the heart vessels are obstructed, the pathways are not open. The heart houses the spirit, and the vessels nourish the spirit; “when the blood vessels are harmonious, the spirit resides.” If the heart vessels are obstructed and the pathways are not open, the spirit is not nourished, leading to a lack of control over the spirit, resulting in anxiety and fear. On the other hand, pain in the heart vessels can easily cause the patient to feel worried, depressed, or anxious, further exacerbating qi stagnation and blood stasis, leading to symptoms such as chest tightness and heart pain. Therefore, patients with heart disease often exhibit symptoms of palpitations, insomnia, sighing, irritability, and anxiety due to emotional stagnation leading to stasis.
Twelve Methods for Activating Blood and Removing Stasis
Weng Weiliang advocates “using unblocking as a supplement” and insists on syndrome differentiation and treatment, combining disease and symptoms to treat cardiovascular diseases. He has achieved significant therapeutic effects in treating difficult and severe cases such as post-interventional restenosis, recurrent myocardial infarction, and sick sinus syndrome, creating new ideas for TCM treatment of cardiovascular diseases. He summarizes the “Twelve Methods for Activating Blood and Removing Stasis” for treating various cardiovascular diseases, such as using warming yang and activating blood for sick sinus syndrome, benefiting qi, activating blood, and promoting diuresis for heart failure and dilated cardiomyopathy, and regulating qi and activating blood for severe angina, providing theoretical and practical basis for treating various cardiovascular diseases from the perspective of blood stasis, promoting the innovative development of TCM theories on qi and blood.
① Benefit Qi and Activate Blood Method
Weng Weiliang places great importance on the role of qi and blood in the occurrence and development of diseases. In clinical syndrome differentiation and treatment, he often draws on Wang Qingren’s experience of treating diseases primarily with qi and blood, emphasizing the importance of identifying and regulating qi and blood, and is adept at using qi-boosting and blood-activating methods, frequently employing ginseng, eleutherococcus, astragalus, codonopsis, and prince ginseng in combination with blood-activating and stasis-removing herbs. His self-formulated qi-boosting and blood-activating prescriptions include Coronary Heart Disease No. 4 Formula (raw astragalus, salvia, chuanxiong, sanqi powder, safflower, red peony) and Coronary Heart Disease No. 5 Formula (corydalis, sanqi powder, raw astragalus, salvia, chuanxiong, safflower, red peony).
② Regulate Qi and Activate Blood Method
Qi is the commander of blood, and blood is the mother of qi. When qi flows, blood flows; when qi stagnates, blood stasis occurs. The Regulate Qi and Activate Blood Method fully reflects the physiological and pathological relationship between qi and blood. The combination of qi-regulating herbs and blood-activating herbs makes full use of the relationship between qi and blood; thus, to activate blood, one must also regulate qi. When qi is unblocked, blood is activated. Weng Weiliang uses blood-activating herbs in conjunction with qi-regulating herbs, often selecting chuanxiong, corydalis, curcuma, sanleng, e zhu, and cyperus, which have both qi-regulating and blood-activating effects, achieving a complete unity of qi and blood. His self-formulated qi-regulating and blood-activating prescription is Coronary Heart Disease No. 3 Formula (salvia, chuanxiong, curcuma, safflower, red peony).
③ Clear Heat and Activate Blood Method
Weng Weiliang believes that heat evil can exacerbate the occurrence and development of blood stasis, and conversely, blood stasis can also transform into heat over time, with both being mutually causal. In terms of pathogenesis, he emphasizes the coexistence of blood stasis and heat depression; in terms of etiology, blood stasis and turbid toxins interpenetrate; in terms of treatment, he combines blood-activating methods with methods to clear heat, open depression, detoxify, clear heat and eliminate dampness, clear the head and eyes, and clear heat and drain fire. Commonly used heat-clearing herbs include coptis, scutellaria, phellodendron, gentian, gardenia, and chrysanthemum. His self-formulated Clear Heat and Activate Blood Formula is San Huang Active Blood Decoction (coptis, scutellaria, phellodendron, salvia, chuanxiong, curcuma, safflower, red peony).
④ Resolve Phlegm and Activate Blood Method
Phlegm and stasis are both yin evils, sharing a common origin and influencing each other. Weng Weiliang believes that dysfunction of the five organs can lead to the internal generation of phlegm and stasis. Phlegm can easily lead to stasis, and stasis can also lead to phlegm, ultimately resulting in the syndrome of phlegm and stasis coexisting. Commonly used phlegm-resolving herbs include dried tangerine peel, white atractylodes, platycodon, trichosanthes, and pinellia. His self-formulated Resolve Phlegm and Activate Blood Decoction is Jian Pi Qu Ping Huo Xue Tang (dried tangerine peel, white atractylodes, poria, salvia, chuanxiong, raw astragalus).
⑤ Warm Yang and Activate Blood Method
Heart qi and heart yang are the driving forces for the normal functioning of the heart and blood. Once the yang qi of the heart is damaged, it is easy to produce pathological products such as phlegm turbidity, water retention, and blood stasis, which can further damage the yang qi. Weng Weiliang believes that the Warm Yang and Activate Blood Method can warm and tonify yang qi, treating the root cause of deficiency, while blood stasis caused by yang deficiency can be improved with blood-activating methods. Commonly used warming yang herbs include red ginseng, galanga, dried ginger, black cardamom, and cinnamon. His self-formulated Warm Yang and Activate Blood Formula includes galanga, cinnamon twig, red peony, curcuma, and prince ginseng.
⑥ Promote Water and Activate Blood Method
Body fluids and blood are both derived from the essence of food and water, with body fluids being an important component of blood. When the circulation of body fluids and blood is obstructed, or when blood deviates from its normal channels and accumulates in the body, it can lead to blood stasis. Therefore, in pathology, water stasis often influences blood stasis. Weng Weiliang often references both water and blood stasis in clinical diagnosis and treatment, achieving good results in treating chronic heart failure, heart valve disease, and other conditions. Commonly used diuretic herbs include poria, coix seed, corn silk, plantago, and lepidium seed.
⑦ Expel Wind and Activate Blood Method
Wind herbs can not only disperse external wind, calm liver wind, and open depression, but also have warming, drying, and activating effects, as well as promoting blood flow and resolving stasis. Weng Weiliang believes that in the clinical treatment of blood stasis syndromes, wind herbs can directly play a role in unblocking blood vessels and dissipating stasis, or they can be combined with blood-activating and stasis-removing herbs to assist in eliminating various factors that cause stasis, indirectly promoting smooth blood flow and achieving blood-activating and stasis-removing effects. Commonly used wind-expelling herbs include gastrodia, uncaria, pueraria, notopterygium, and saposhnikovia.
⑧ Cool Blood and Activate Blood Method
The Cool Blood and Activate Blood Method combines herbs that have both heat-clearing and blood-activating effects to treat the syndrome of “blood heat and blood stasis intermingling,” which is caused by the mutual influence of blood heat and blood stasis. Weng Weiliang believes that in the syndrome of blood heat and blood stasis, both conditions mutually affect each other, causing obstruction and stagnation, which are both pathogenic factors and pathological products. Clinically, it is necessary to pay attention to both cooling blood and activating blood. Commonly used cooling blood herbs include peony root, white atractylodes, silver barberry, qinghao, and white grass root.
⑨ Softening Hardness and Activating Blood Method
Weng Weiliang applies the Softening Hardness and Activating Blood Method for stubborn blood stasis, which is often due to long-term illness. He has achieved good results in treating stubborn diseases and difficult cases in the cardiovascular system and other systems. Softening hardness and activating blood differs from simple blood activation, often using blood-breaking herbs. For patients with significant blood stasis and severe obstruction of the heart vessels, it is necessary to strengthen the power of blood activation and stasis removal, often combining sanleng and e zhu with turtle shell and self-heal to soften hardness, disperse masses, and break blood stasis.
⑩ Unblock and Activate Blood Method
The broad definition of the unblock method includes cold, warm, moist, and tonifying methods, all of which can be used in conjunction with blood-activating and stasis-removing methods. For elderly patients, Weng Weiliang often combines moistening methods with blood-activating and stasis-removing methods, which are widely used in treating both internal injuries and external diseases. For elderly patients with constipation, he often adds herbs such as hemp seed, biota seed, cassia seed, raw rehmannia, and angelica.
⑪ Nourish Yin and Activate Blood Method
Yin fluids are an important component of blood. Sufficient body fluids are necessary for normal blood circulation; conversely, insufficient body fluids cannot support blood, leading to sluggish blood flow and easy formation of blood stasis. Weng Weiliang believes that elderly individuals, due to declining organ function, experience imbalances in yin, yang, qi, and blood, resulting in insufficient body fluids and poor blood circulation. Therefore, for the treatment of the elderly or patients with yin deficiency, he often adds herbs such as adenophora, polygonatum, scrophularia, ophiopogon, schisandra, and yams.
⑫ Nourish Blood and Activate Blood Method
Blood deficiency and blood stasis are closely related. Blood deficiency leads to dry and rough vessels, causing poor blood flow, or blood that deviates from its normal channels becomes stasis. Stasis obstructs the vessels, preventing the organs from receiving nourishment, which can also lead to or exacerbate blood stasis. Weng Weiliang believes that if blood stasis is not resolved, new blood cannot be generated; therefore, treatment must consider both nourishing blood and activating blood, ensuring that nourishing blood does not cause dampness and that activating blood does not harm the upright qi. Commonly used blood-nourishing herbs include salvia, angelica, white peony, cooked rehmannia, donkey-hide gelatin, and jujube.