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In today’s context, whenever blood activation and stasis resolution are mentioned, almost all TCM practitioners immediately think of the famous Qing Dynasty physician Wang Qingren and his series of stasis-resolving formulas, especially the Xuefu Zhuyu Decoction, which is not only listed as one of the top ten famous formulas in TCM but is also hailed as the “First Formula for Activating Blood and Resolving Stasis.” Regarding Xuefu Zhuyu Decoction, it belongs to the category of contemporary formulas. So, is there also a “First Formula for Activating Blood and Resolving Stasis” in the classical formula system? Indeed, there is, but purely from the perspective of its medicinal composition, it may not seem to be related to activating blood and resolving stasis; however, it is indeed quietly and effectively performing the task of “activating blood and resolving stasis.”
What is this formula known as the “First Formula for Activating Blood and Resolving Stasis” in the classical system? It is the Danggui Shaoyao San (Danggui and Peony Powder) from the “Treatise on Febrile and Miscellaneous Diseases.” If one were to say that Danggui Shaoyao San can activate blood and resolve stasis, many might not believe it. This is because the formula does not contain commonly used blood-activating herbs like Tao Ren (Peach Kernel) or Hong Hua (Safflower), and almost all mainstream formula texts do not explain that Danggui Shaoyao San can activate blood and resolve stasis. However, some scholars have pointed out that Danggui Shaoyao San has the effects of “smoothing the liver, strengthening the spleen, activating blood, resolving stasis, and promoting dampness” [1].
The concept of blood stasis originated in the “Huangdi Neijing” (Yellow Emperor’s Inner Canon) and was formally named in the “Jinkui Yaolue” (Essentials of the Golden Chamber). Scholars have summarized the blood-activating and stasis-resolving methods of the medical sage Zhang Zhongjing into eight aspects, represented by different formulas: Qi-moving and blood-activating method, represented by Zhi Shi Shao Yao San; blood-activating and damp-resolving method, represented by Danggui Shaoyao San; blood-activating and water-dispelling method, represented by Dahuang Gansui Decoction; harmonizing and stasis-resolving method, represented by Xiao Chai Hu Decoction; blood-activating and detoxifying method, represented by Dahuang Mudanpi Decoction; heat-clearing and stasis-resolving method, represented by Taoren Chengqi Decoction; blood-activating and stasis-breaking method, represented by Xia Yuxue Decoction; and deficiency-replenishing and blood-activating method, represented by Dahuang Chuan Chong Wan [2]. It is evident that Danggui Shaoyao San indeed falls within the category of blood activation and stasis resolution. Why is it said that Danggui Shaoyao San is the first formula for activating blood and resolving stasis by Zhang Zhongjing? This is because among Zhang Zhongjing’s formulas for activating blood and resolving stasis, Danggui Shaoyao San has the most balanced medicinal properties, the highest frequency of use, the broadest clinical application, and the greatest safety.
So, what are the components of Danggui Shaoyao San? It consists of six medicinal herbs: Danggui (Angelica Sinensis) 3 liang, Shaoyao (Paeonia Lactiflora) 1 jin, Fuling (Poria) 4 liang, Baizhu (Atractylodes Macrocephala) 4 liang, Zexie (Alisma) 0.5 jin, Chuanxiong (Ligusticum Chuanxiong) 0.5 jin. According to the original intention of Zhang Zhongjing, the preparation method is as follows: first, these six herbs are ground into a powder, and each time, take a “fangcun chi” (approximately 3 grams in modern terms), add Huangjiu (yellow wine) and decoct. The modern common dosage for Danggui Shaoyao San is: Danggui 9g, Shaoyao 48g, Fuling 12g, Baizhu 12g, Zexie 24g, Chuanxiong 10g, decocted in water. If one needs to enhance the blood-activating and stasis-resolving effects, they can use wine-prepared Danggui. In this formula, Shaoyao is the monarch herb, primarily playing the role of nourishing blood, softening the liver, alleviating pain, promoting blood circulation, and facilitating urination; Chuanxiong and Zexie are the minister herbs, mainly functioning to activate blood, dispel stasis, and promote water metabolism; Danggui, Baizhu, and Fuling are the assistant herbs, primarily nourishing and activating blood, drying dampness, and promoting urination [1]. The compatibility of the entire formula is interlinked, like an endless loop, where Danggui pairs with Shaoyao to nourish blood and soften the liver; Danggui pairs with Chuanxiong to nourish and activate blood; Danggui pairs with Baishao (White Peony) for dynamic balance; Chuanxiong pairs with Chishaoyao (Red Peony) to promote blood circulation and break stagnation; Shaoyao pairs with Baizhu to soften the liver, strengthen the spleen, and promote water metabolism; Baizhu pairs with Fuling to strengthen the spleen and promote water metabolism; Baizhu pairs with Zexie to elevate the clear and descend the turbid [3].
At first glance, the six herbs in Danggui Shaoyao San seem almost incapable of activating blood and resolving stasis, but from the compatibility of the entire formula and the preparation method, one can discover the underlying principles. The main herbs responsible for activating blood and resolving stasis in the formula are Danggui and the Danggui-Chuanxiong pair. In fact, Danggui alone can activate blood and resolve stasis. Some practitioners have found that raw Danggui, charred Danggui, and wine-prepared Danggui all possess the ability to activate blood and resolve stasis and improve blood stasis conditions; however, the effect of wine-prepared Danggui in activating blood and resolving stasis is superior to that of raw and charred Danggui [4]. This is why Zhang Zhongjing emphasized the “wine-prepared” method in this formula. If this decoction method is not followed, one can enhance the blood-activating and stasis-resolving effects simply by using wine-prepared Danggui.
Moreover, some practitioners have found that in studying the medicinal characteristics of modern famous physician Zhang Xichun, the most frequently used blood-activating and stasis-resolving herbs in the “Zhongzhong Canxi Lu” (Medical Records of Traditional Chinese Medicine) are Danggui, Sanqi (Notoginseng), and Jineijin (Chicken Inner Gold) among eight herbs [5]. From the combination of Danggui and Chuanxiong, pharmacological and metabolomic results show that the overall effect of the Danggui-Chuanxiong pair in activating blood and resolving stasis is superior to that of each herb alone; the blood-activating and stasis-resolving effect of Chuanxiong alone is superior to that of Danggui [6]. This may be related to the presence of ligustrazine in Chuanxiong.
Therefore, there is no need to doubt that Danggui Shaoyao San is indeed the representative formula for activating blood and resolving stasis, as well as regulating the liver and spleen by the medical sage Zhang Zhongjing. Moreover, modern clinical research has found that its clinical effects exceed expectations. Modern pharmacological studies have shown that Danggui Shaoyao San possesses anti-inflammatory properties, enhances learning and memory abilities, improves blood rheology, reduces blood viscosity and red blood cell aggregation, inhibits uterine smooth muscle spasms, protects liver cells, has anti-aging effects, promotes placental development, regulates endocrine functions, stabilizes pregnancy, resolves stasis, relieves spasms, alleviates pain, modulates immunity, and regulates endocrine functions [7]; as well as inhibiting uterine smooth muscle contractions, protecting the reproductive system, acting on the hypothalamic-pituitary-ovarian axis, improving microcirculation, lowering blood lipids, improving memory, and exhibiting anti-myocardial ischemia pharmacological effects [8].
In fact, the significance of Danggui Shaoyao San lies not only in its original and pharmacological effects but also in its clinical applications. According to the “Treatise on Febrile and Miscellaneous Diseases,” the uses of Danggui Shaoyao San are relatively simple, mainly for obstetrics and gynecology, “for women who are pregnant, abdominal pain,” and “various abdominal diseases in women.” However, through the exploration and discovery by later generations of physicians, its clinical applications have been broadened. Modern clinical practice has found that Danggui Shaoyao San and its modified formulas can be widely used for gynecological diseases, male diseases, urinary system diseases, circulatory system diseases, neurological diseases, digestive system diseases, otorhinolaryngological diseases, dermatological diseases, and many other conditions. Danggui Shaoyao San harmonizes the liver and spleen, primarily focusing on liver regulation, thus it can be considered for treatment of diseases along the liver meridian, applicable to both genders, such as female breast diseases and male reproductive system diseases; additionally, Danggui Shaoyao San can activate blood and resolve stasis, making it suitable for treating various diseases caused by internal blood stasis [1].
Clinically, Danggui Shaoyao San can be used for late menstruation, amenorrhea, primary dysmenorrhea, functional uterine bleeding, endometritis, ovarian cysts, habitual miscarriage, blocked fallopian tubes, abdominal distension during pregnancy, edema during pregnancy, acute appendicitis during pregnancy, acute viral hepatitis during pregnancy, postpartum urinary retention, uterine fibroids, uterine prolapse, and breast hyperplasia; chronic prostatitis, male infertility, epididymitis, testicular hydrocele, varicocele; nephroptosis, kidney stones, hydronephrosis, nephrotic syndrome, bladder stones; coronary heart disease angina, pulmonary heart disease with heart failure, deep vein thrombosis; vascular headache, traumatic brain syndrome, cerebral thrombosis; liver function damage from HIV HAART therapy, ascites due to liver cirrhosis, gastric ulcers, superficial gastritis, chronic cholecystitis, habitual constipation, chronic ulcerative colitis, adhesive incomplete intestinal obstruction, tuberculous peritonitis, irritable bowel syndrome, esophageal adhesions, gastric ptosis; central serous chorioretinopathy, acute angle-closure glaucoma, central retinal vein occlusion, chloasma, acne, seborrheic alopecia, herpes zoster, drooping eczema, cystic changes in thyroid adenoma, facial nerve paralysis, sciatica, gout, hypersomnia, insomnia, Meniere’s disease, parasitic anemia, and over 60 other diseases [1].
The modern clinical applications of Danggui Shaoyao San still have much room for exploration. Relevant clinical practices and studies indicate that Danggui Shaoyao San can also be used to treat abdominal pain during pregnancy, dementia in the elderly, threatened miscarriage, autonomic nervous dysfunction, dysmenorrhea, abdominal pain, chronic pelvic inflammatory disease, idiopathic edema, pyelonephritis with hydronephrosis [7]; abnormal fetal position, edema during pregnancy, leukorrhea, headache; chronic pelvic inflammatory disease, hydrosalpinx, uterine bleeding after IUD insertion, pregnancy-induced hypertension, adnexitis, gynecological abdominal pain, infertility, abnormal fetal position, fetal movement instability, premenstrual syndrome; dizziness; plantar fasciitis, benign prostatic hyperplasia [8], and other diseases.
Additionally, clinical studies have found that the application range of Danggui Shaoyao San often corresponds to the pathogenesis of “blood stasis and water retention, liver and spleen disharmony,” reflecting the traditional TCM concept of “carefully adhering to pathogenesis and treating different diseases with the same method.” Danggui Shaoyao San and its modifications can be clinically used to treat nephrotic syndrome, diabetic nephropathy, chronic glomerulonephritis, chronic renal failure, renal cysts, urinary stones, hydronephrosis, chronic heart failure, acute myocardial infarction, irritable bowel syndrome, chronic gastritis, portal hypertension due to liver cirrhosis, menopausal headaches in women, cervical vertigo, hypertension, premature ovarian failure, endometriosis, hydrosalpinx, polycystic ovary syndrome, varicocele, benign prostatic hyperplasia in the elderly, knee osteoarthritis, orthodontic pain, macular edema, anemia, and other diseases [9].
Through the summarization and analysis of the clinical applications of Danggui Shaoyao San, it can be said that it can treat at least over 100 diseases in modern clinical practice, truly embodying the concept of “Danggui Shaoyao Treats Hundreds of Diseases”. It can be said that among the various formulas under the blood stasis theory of the medical sage Zhang Zhongjing, in a comprehensive evaluation, few would dare to claim that any formula is superior to Danggui Shaoyao San. As long as it aligns with the pathogenesis, it can effectively address the condition, making it a formidable counterpart to Xuefu Zhuyu Decoction. Xuefu Zhuyu Decoction uses Tao Ren and Hong Hua; Danggui Shaoyao San uses Danggui and Chuanxiong, both of which can exert excellent blood-activating and stasis-resolving effects. As the saying goes, “Once blood stasis is resolved, hundreds of diseases disappear.” Whether it is Xuefu Zhuyu Decoction or Danggui Shaoyao San, they each have their own indications and missions; in summary, they are both remarkable formulas for activating blood and resolving stasis, and as long as the treatment aligns with the condition, they can achieve remarkable results.
References[1] Zhong Xiangen, Zheng Zian. Zhang Zhongjing’s Renowned Formulas (Volume of Jinkui Yaolue) [M]: Beijing: China Medical Science and Technology Press, 2013.[2] Li Xiujin, Sun Fengsheng. Zhang Zhongjing’s Methods for Activating Blood and Resolving Stasis and Their Applications in Gynecology [J]. Shandong Journal of Traditional Chinese Medicine, 1993, 12(4): 14-16.[3] Li Jiaxi. Research on the Compatibility Patterns and Formula-Syndrome Correlation of Danggui Shaoyao San [D]. Nanjing: Nanjing University of Traditional Chinese Medicine, 2009: 1-68.[4] Zhong Lijia. Research on the Mechanisms of Blood-Activating and Stasis-Resolving Effects of Raw Danggui, Charred Danggui, and Wine-Prepared Danggui Based on Metabolomics [D]. Lanzhou: Gansu Agricultural University, 2016: 1-99.[5] Liu Tingwei. Research on Blood-Activating and Stasis-Resolving Methods in “Zhongzhong Canxi Lu” [D]. Shanghai: Shanghai University of Traditional Chinese Medicine, 2020: 1-91.[6] Li Weixia. Research on the Efficacy Substances and Compatibility Mechanisms of the Danggui-Chuanxiong Pair [D]. Nanjing: Nanjing University of Traditional Chinese Medicine, 2014: 1-177.[7] Chen Jifan. Jinkui Yaolue (2nd Edition) [M]. Beijing: People’s Health Publishing House, 2011.[8] Li Fei. Formulary Studies (2nd Edition) [M]. Beijing: People’s Health Publishing House, 2011.[9] Zhang Mingyue, Li Liqi. Progress in Clinical Application Research of Danggui Shaoyao San [J]. Practical Journal of Traditional Chinese Medicine, 2022, 38(12): 2243-2246.