Traditional Chinese Medicine (TCM) believes that the blood in our body originates from the essence of food and water. Food enters the stomach, is transformed and transported by the spleen and stomach, infused into the meridians, and transformed into blood. It is governed by the heart, stored in the liver, regulated by the spleen, circulating through the meridians, nourishing the five organs and six bowels, and moistening the limbs and bones. The ability to see, walk, and grasp, as well as the coordination of the functions of the five organs and six bowels, all depend on the nourishment provided by blood. Therefore, the “Lingshu: Ying Wei Sheng Hui” states: “To nourish life, nothing is more precious than this.”
If due to various internal and external factors, such as Qi stagnation preventing blood flow, Qi deficiency failing to hold blood, or an inability to propel blood vessels, or Yang deficiency causing cold to congeal blood vessels, or external injuries and surgeries leading to poor blood circulation, blood not following its meridian pathways can result in various blood stasis syndromes.
01Diagnosis of Blood Stasis Syndrome
Fixed pain in specific areas, stabbing pain, tenderness upon palpation, skin changes, swelling, cyanosis, a purplish or dark tongue, or the presence of stasis spots, and a thin, choppy pulse, etc. Depending on the location of the blood stasis, various complex symptoms may arise.
Stasis obstructing the brain orifices: stroke, headache, dizziness, confusion, dementia, etc.
Stasis obstructing the chest: chest tightness, heart pain, cyanosis of the lips, etc.
Stasis obstructing the lung collaterals: chest pain, cough, hemoptysis, etc.
Stasis retained in the stomach and intestines: hematemesis, melena, etc.
Stasis obstructing the liver collaterals: hypochondriac pain, masses, distension, etc.
Stasis obstructing the bladder: lower abdominal urgency, manic behavior.
Stasis obstructing the Chong and Ren meridians: dysmenorrhea, irregular menstruation, infertility.
Stasis obstructing the meridians: numbness of limbs, bi syndrome.
Stasis obstructing the vessels: paralysis and loss of function.
02Treatment of Blood Stasis Syndrome
Treatment principle: Activating blood and resolving stasis is the fundamental method.
Of course, in the specific selection of herbs, adjustments need to be made based on the patient’s actual condition.
Commonly used herbs: Tao Ren (Peach Kernel), Hong Hua (Safflower), Dan Shen (Salvia), Chuan Xiong (Ligusticum), Chi Shao (Red Peony), Dan Pi (Moutan Cortex), Jiu Da Huang (Wine-Processed Rhubarb), etc.
For Qi stagnation: often combined with Qi-regulating herbs such as Chai Hu (Bupleurum), Zhi Ke (Bitter Orange), Mu Xiang (Aucklandia), Xiang Fu (Cyperus), Chen Pi (Aged Tangerine Peel), Wu Yao (Lindera), etc.
For Qi deficiency: often combined with Qi-tonifying herbs such as Ren Shen (Ginseng), Dang Shen (Codonopsis), Huang Qi (Astragalus), Bai Zhu (White Atractylodes), etc.
For Yang deficiency with cold congealing: often combined with warming herbs such as Rou Gui (Cinnamon), Gan Jiang (Dried Ginger), Pao Jiang (Processed Ginger), Ai Ye (Mugwort), Gui Zhi (Cinnamon Twig), Xiao Hui Xiang (Fennel), Wu Zhu Yu (Evodia), etc.
03Selection of Blood-Activating and Stasis-Resolving Formulas
(1) Xue Fu Zhu Yu Tang
Ingredients: Tao Ren (Peach Kernel), Hong Hua (Safflower), Dang Gui (Angelica), Chi Shao (Red Peony), Sheng Di (Rehmannia), Chuan Xiong (Ligusticum), Chai Hu (Bupleurum), Jie Geng (Platycodon), Zhi Ke (Bitter Orange), Niuxi (Achyranthes), Gan Cao (Licorice)
Function: Activates blood and resolves stasis, regulates Qi and alleviates pain.
Indications: Blood stasis in the chest causing chest pain, heart pain, headache, pain like a needle prick, heaviness in the chest, or inability to bear weight on the chest, palpitations, insomnia, irritability, dark red tongue with stasis spots, choppy or tight pulse.
In addition to the fixed stabbing pain in the chest as the main symptom, the key points for use should be a dark red tongue or stasis spots on the tongue, and a choppy pulse.
(2) Tong Qiao Huo Xue Tang
Ingredients: Tao Ren (Peach Kernel), Hong Hua (Safflower), Chi Shao (Red Peony), Chuan Xiong (Ligusticum), La Cong (Scallion), Sheng Jiang (Fresh Ginger), Da Zao (Jujube), She Xiang (Musk), Huang Jiu (Yellow Wine)
Function: Activates blood and resolves stasis, opens orifices.
Indications: Persistent headache, fixed pain, sharp like a needle, or history of head trauma or surgery, purple or dark tongue, or stasis spots, choppy pulse;
Variations: Can also add Chang Pu (Acorus), Yu Jin (Curcuma), Bai Zhi (Angelica Dahurica), Xi Xin (Asarum) to warm the meridians and alleviate pain, regulate Qi and open orifices;
For severe headaches, can also add insect-based herbs such as Quan Xie (Scorpion), Wu Gong (Centipede), Di Long (Earthworm), Di Bie Chong (Ground Beetle), etc.
(3) Ge Xia Zhu Yu Tang
Ingredients: Tao Ren (Peach Kernel), Hong Hua (Safflower), Dang Gui (Angelica), Chi Shao (Red Peony), Chuan Xiong (Ligusticum), Dan Pi (Moutan Cortex), Wu Ling Zhi (Flying Squirrel Feces), Yan Hu Suo (Corydalis), Zhi Ke (Bitter Orange), Xiang Fu (Cyperus), Wu Yao (Lindera), Gan Cao (Licorice)
Function: Activates blood and resolves stasis, regulates Qi and alleviates pain.
Indications: Blood stasis in the diaphragm causing masses or abdominal distension, fixed pain, or abdominal heaviness when lying down, purple or dark tongue or stasis spots, choppy pulse;
Can also add Chuan Lian Zi (Toosendan), San Leng (Sparganium), E Zhu (Curcuma) to enhance the ability to soften masses and resolve stasis; if the mass is large and hard causing pain, can combine with Bie Jia (Soft-Shelled Turtle Shell) for softening and resolving stasis.
(4) Shao Fu Zhu Yu Tang
Ingredients: Dang Gui (Angelica), Chuan Xiong (Ligusticum), Chi Shao (Red Peony), Mo Yao (Myrrh), Yan Hu Suo (Corydalis), Pu Huang (Typha), Wu Ling Zhi (Flying Squirrel Feces), Guan Gui (Cinnamon), Xiao Hui Xiang (Fennel), Gan Jiang (Dried Ginger)
Function: Activates blood and resolves stasis, warms the meridians and alleviates pain.
Indications: Blood stasis in the lower abdomen causing pain or distension, or pain without masses, or lower abdominal distension, or low back pain during menstruation, or irregular menstruation with purple or black blood and stasis, or menorrhagia with lower abdominal pain, or cold in the uterus leading to infertility, etc.
(5) Fu Yuan Huo Xue Tang
Ingredients: Chai Hu (Bupleurum), Gua Lou Gen (Trichosanthes Root), Dang Gui (Angelica), Hong Hua (Safflower), Pao Shan Jia (Processed Pangolin Scales), Jiu Da Huang (Wine-Processed Rhubarb), Tao Ren (Peach Kernel), Gan Cao (Licorice)
Function: Activates blood and resolves stasis, soothes the liver and opens the collaterals.
Indications: Blood stasis obstructing the liver collaterals, or pain in the hypochondrium due to trauma, with fixed pain, or masses in the hypochondrium, purple or dark tongue, choppy pulse.
(6) Shen Tong Zhu Yu Tang
Ingredients: Tao Ren (Peach Kernel), Hong Hua (Safflower), Dang Gui (Angelica), Chuan Xiong (Ligusticum), Mo Yao (Myrrh), Wu Ling Zhi (Flying Squirrel Feces), Niuxi (Achyranthes), Di Long (Earthworm), Xiang Fu (Cyperus), Qiang Huo (Notopterygium), Qin Jiao (Gentiana), Gan Cao (Licorice)
Function: Activates blood and resolves stasis, regulates Qi and opens the collaterals.
Indications: Pain in the waist, legs, shoulders, or generalized pain due to blood stasis obstructing the meridians, especially if the pain has persisted for a long time.
(7) Bu Yang Huan Wu Tang
Ingredients: Huang Qi (Astragalus), Dang Gui Wei (Angelica Tail), Chi Shao (Red Peony), Chuan Xiong (Ligusticum), Tao Ren (Peach Kernel), Hong Hua (Safflower), Di Long (Earthworm)
Function: Tonifies Qi, activates blood, and opens the collaterals.
Indications: Qi deficiency and blood stasis leading to sequelae of stroke: hemiplegia, facial droop, slurred speech, drooling, lower limb weakness, fatigue, pale tongue with thin white coating, weak pulse, etc.
(8) Tao Ren Cheng Qi Tang
Ingredients: Tao Ren (Peach Kernel), Da Huang (Rhubarb), Mang Xiao (Sodium Sulfate), Gui Zhi (Cinnamon Twig), Gan Cao (Licorice)
Function: Breaks blood and resolves stasis.
Indications: Blood stasis due to cold accumulation in the lower jiao bladder: lower abdominal urgency, manic behavior, frequent urination, severe thirst, as well as blood stasis causing amenorrhea, dysmenorrhea, choppy or firm pulse.
04Precautions for Using Blood-Activating and Stasis-Resolving Herbs
1. Blood-activating and stasis-resolving herbs are often pungent and dry, which can deplete blood and injure the righteous Qi. Therefore, when using them, they should often be accompanied by herbs that tonify the righteous Qi to ensure that blood stasis is resolved without harming the righteous Qi.
2. Caution should be exercised when using blood-activating and stasis-resolving herbs in cases of excessive menstruation or in pregnant women.
3. When using blood-activating and stasis-resolving herbs, it is important to conduct syndrome differentiation to identify the cause, and to treat the underlying cause of blood stasis.
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