The concept of stasis (yuxue) originated in the Huangdi Neijing and was named in the Jinkui Yaolue. When discussing methods for invigorating blood and resolving stasis, many practitioners of Traditional Chinese Medicine (TCM) might first think of the Qing Dynasty physician Wang Qingren, as many of his formulas are deeply rooted in the philosophy of invigorating blood and resolving stasis. However, tracing back through history, we find that Zhang Zhongjing employed methods for invigorating blood and resolving stasis over a thousand years earlier than Wang Qingren. Zhang Zhongjing’s focus was primarily on the differentiation of syndromes in the six meridians of Febrile Diseases, making blood-invigorating and stasis-resolving methods merely a branch of his overall thinking. Scholars have categorized Zhang Zhongjing’s methods for invigorating blood and resolving stasis into eight aspects: Qi-moving and blood-invigorating methods, represented by the formula Zhi Shi Shao Yao San (Zhi Shi and Peony Powder); Blood-invigorating and damp-resolving methods, represented by Dang Gui Shao Yao San (Dang Gui and Peony Powder); Blood-invigorating and water-dispelling methods, represented by Da Huang Gan Sui Tang (Rhubarb and Euphorbia Decoction); Harmonizing and stasis-resolving methods, represented by Xiao Chai Hu Tang (Minor Bupleurum Decoction); Blood-invigorating and detoxifying methods, represented by Da Huang Mu Dan Pi Tang (Rhubarb and Moutan Decoction); Heat-clearing and stasis-resolving methods, represented by Tao He Cheng Qi Tang (Peach Pit Decoction to Order Qi); Blood-invigorating and stasis-breaking methods, represented by Ge Xia Yu Xue Tang (Blood Stasis Below the Diaphragm Decoction); and Deficiency-replenishing and blood-invigorating methods, represented by Da Huang Zhi Chong Wan (Rhubarb and Insect Pill).1. Di Dang Tang
When it comes to Zhang Zhongjing’s blood-invigorating and stasis-resolving formulas, the first one that comes to mind is Di Dang Tang. Why? Because Di Dang Tang is the formula Zhang Zhongjing used to treat severe cases of Taiyang Blood Accumulation Syndrome. According to the Shang Han Lun (Treatise on Cold Damage), section 124 states, “In Taiyang disease, after six or seven days, if the exterior symptoms persist, the pulse is weak and deep, and there is no chest binding, if the person is delirious, it indicates heat in the lower jiao, and the lower abdomen is hard and full. If urination is free, then blood will be expelled, as this is due to the Taiyang following the meridian, with stasis heat inside. Di Dang Tang is the main treatment for this.” Since Di Dang Tang is derived from Tao He Cheng Qi Tang, some believe it is simply Tao He Cheng Qi Tang with the licorice, mirabilite, and cinnamon removed, and the dosages of rhubarb and peach kernel reduced, with the addition of leeches and flies. However, this explanation is somewhat forced. The medicinal principles of Di Dang Tang and Tao He Cheng Qi Tang are fundamentally different. Tao He Cheng Qi Tang is based on peach kernel and cinnamon, combined with the Gui Zhi Cheng Qi Tang to invigorate blood and resolve stasis while also addressing heat accumulation; whereas Di Dang Tang is based on leeches and flies to break blood, open meridians, and resolve stasis, combined with methods to clear heat, resolve stasis, and invigorate blood.Di Dang Tang primarily uses leeches and flies as the monarch herbs, which mainly function to expel evil blood, break stasis, and clear accumulations; peach kernel serves as the minister herb, primarily breaking blood, invigorating circulation, moistening dryness, and generating new blood; rhubarb acts as the assistant herb, primarily clearing heat evil, pushing out the old, and guiding stasis downward. With these four simple herbs, Di Dang Tang has become Zhang Zhongjing’s premier formula for invigorating blood and resolving stasis.Why do modern physicians hesitate to use this formula? The main reason lies in the leeches and flies. The Shennong Bencao Jing states: leeches “treat evil blood and stasis, breaking blood accumulations,” while flies “expel stasis blood, break blood accumulations, and hard lumps.” Together, they form a powerful combination that can penetrate the blood and break down hard accumulations, with a strong attacking force. Coupled with the heat-clearing properties of rhubarb and the blood-invigorating effects of peach kernel, the power of invigorating blood and resolving stasis is significantly enhanced. Of course, this formula can still be used boldly if it matches the syndrome.2. Gui Zhi Fu Ling WanWhy are more and more people being diagnosed with fibroids and cysts? What should one do if they have fibroids or cysts but do not want surgery? Today, I would like to share a classic blood-invigorating and stasis-resolving formula from Zhang Zhongjing that can both attack and tonify, specifically targeting fibroids and cysts! In TCM, the primary cause of most fibroids and cysts is blood stasis. Blood is responsible for metabolizing waste in our bodies; if there is blood stasis, the metabolic function of blood will be affected, leading to the accumulation of waste in the body, which over time forms fibroids and cysts. So why are these issues becoming more common as people’s lives improve?The main reasons are twofold: first, modern people experience significant stress and often have negative emotions, which can disrupt the qi mechanism of the organs, leading to blood stasis; second, many people enjoy consuming cold foods in summer to cool off, such as iced drinks and ice cream. Summer is a season when yang energy is meant to disperse, and consuming so many cold foods suppresses the yang energy, causing cold to accumulate in the body, which can also lead to blood stasis. If someone is diagnosed with fibroids or cysts and does not want surgery, what should they do? The great physician of the Han Dynasty, Zhang Zhongjing, left us a valuable classic formula called Gui Zhi Fu Ling Wan. The Jinkui Yaolue records that it is specifically used to treat “zheng diseases,” referring to various lumps in the body, including fibroids, cysts, and nodules.Gui Zhi Fu Ling Wan contains few herbs but is very sophisticated. First, it uses Gui Zhi as the monarch herb to warm and open the meridians, dispelling cold from the body and restoring blood flow; then it uses Fu Ling to strengthen the spleen and resolve dampness, preventing water dampness from obstructing the movement of qi and blood; next, it adds Tao Ren and Chi Shao, both of which have strong blood-invigorating and stasis-resolving properties, acting as the main force to break through blocked areas and promote smoother circulation of qi and blood; finally, it adds Mu Dan Pi to clear heat and prevent prolonged stagnation of qi and blood, which can lead to fire. Overall, Gui Zhi Fu Ling Wan is specifically designed to regulate blood stasis caused by cold evil, and can be adjusted based on differentiation for conditions such as uterine fibroids, ovarian cysts, and varicose veins in the lower limbs.3. Dang Gui Shao Yao SanIn contemporary times, whenever blood-invigorating and stasis-resolving formulas are mentioned, people often first think of the blood-fortifying and stasis-resolving Xue Fu Zhu Yu Tang by the Qing Dynasty physician Wang Qingren, which is not only listed as one of the top ten famous formulas in TCM but is also hailed as the “number one blood-invigorating and stasis-resolving formula” in modern times. In comparison, is there a corresponding “number one blood-invigorating and stasis-resolving formula” among the classic formulas? Indeed, there is one. However, from the composition of this formula, it may not seem to be blood-invigorating and stasis-resolving, yet it indeed performs the function of “invigorating blood and resolving stasis.” This formula is Dang Gui Shao Yao San, which comes from Zhang Zhongjing’s Shang Han Lun and is regarded as the “number one blood-invigorating and stasis-resolving formula” among classic formulas.Many may doubt that Dang Gui Shao Yao San can invigorate blood and resolve stasis, as it does not contain commonly used blood-invigorating herbs like peach kernel or safflower, and almost all mainstream formula texts do not annotate that Dang Gui Shao Yao San can invigorate blood and resolve stasis. However, some scholars have pointed out that Dang Gui Shao Yao San has the effects of “soothing the liver, strengthening the spleen, invigorating blood, and resolving stasis, and benefiting dampness.”It is evident that Dang Gui Shao Yao San indeed falls within the category of blood-invigorating and stasis-resolving formulas. Why is Dang Gui Shao Yao San considered the first among Zhang Zhongjing’s blood-invigorating and stasis-resolving formulas? Because it has the most balanced properties, the highest frequency of use, the broadest clinical application, and the greatest safety among Zhang Zhongjing’s blood-invigorating and stasis-resolving formulas.What are the components of Dang Gui Shao Yao San? It consists of six herbs: Dang Gui, Shao Yao, Fu Ling, Bai Zhu, Ze Xie, and Chuan Xiong. According to Zhang Zhongjing’s original intention, the preparation method is to first grind these six herbs into a powder, and when used, take a small amount and decoct it with yellow wine, three times a day. The modern common dosage for Dang Gui Shao Yao San is: Dang Gui 9g, Shao Yao 48g, Fu Ling 12g, Bai Zhu 12g, Ze Xie 24g, Chuan Xiong 10g, decocted in water. If one wishes to enhance the blood-invigorating and stasis-resolving effects, they can use wine-prepared Dang Gui.The formula’s meaning is as follows: Shao Yao serves as the monarch herb, nourishing blood, softening the liver, alleviating pain, promoting blood circulation, and benefiting urination; Chuan Xiong and Ze Xie serve as minister herbs, invigorating blood and resolving stasis, and promoting urination and dampness; Dang Gui, Bai Zhu, and Fu Ling serve as assistant herbs, nourishing and invigorating blood, and drying dampness. The entire formula is intricately linked, like an unbroken chain. Dang Gui pairs with Shao Yao to nourish blood and soften the liver; Dang Gui pairs with Chuan Xiong to nourish and invigorate blood; Dang Gui pairs with Bai Shao to balance movement and stillness; Chuan Xiong pairs with Chi Shao to promote blood and break stagnation; Shao Yao pairs with Bai Zhu to soften the liver, strengthen the spleen, and promote urination; Bai Zhu pairs with Fu Ling to strengthen the spleen and promote urination; Bai Zhu pairs with Ze Xie to elevate the clear and descend the turbid.At first glance, the six herbs in Dang Gui Shao Yao San do not seem to have blood-invigorating and stasis-resolving properties. However, from the overall composition and preparation method, the underlying principles can be discerned. The primary herbs that invigorate blood and resolve stasis in the formula are Dang Gui and the Dang Gui-Chuan Xiong pair. In fact, Dang Gui alone can invigorate blood and resolve stasis. Some practitioners have found that when studying the blood-invigorating effects of Dang Gui, the effects of raw, charred, and wine-prepared Dang Gui show that wine-prepared Dang Gui is superior to raw and charred Dang Gui in terms of blood-invigorating effects. This is why Zhang Zhongjing emphasized the use of “wine-prepared Dang Gui” in this formula.Moreover, researchers studying the medicinal characteristics of modern physician Zhang Xichun found that in the Yixue Zhongzhong Canxi Lu, the most frequently used blood-invigorating and stasis-resolving herbs include Dang Gui, San Qi, Ji Nei Jin, and others. From the perspective of the Dang Gui-Chuan Xiong pair, pharmacological and metabolic studies have shown that the overall blood-invigorating and stasis-resolving effects of the Dang Gui-Chuan Xiong pair are superior to those of the individual herbs; the blood-invigorating effects of Chuan Xiong alone are superior to those of Dang Gui. This may be related to the presence of Chuanxiongzine in Chuan Xiong.Therefore, Dang Gui Shao Yao San is representative of Zhang Zhongjing’s methods for invigorating blood and resolving stasis, as well as regulating the liver and spleen. Moreover, modern clinical studies have found its clinical effects to be beyond imagination. Modern pharmacological research has shown that Dang Gui Shao Yao San possesses anti-inflammatory properties, enhances learning and memory, improves blood rheology, reduces blood viscosity and red blood cell aggregation, inhibits uterine smooth muscle spasms, protects liver cells, exhibits anti-aging effects, promotes placental development, regulates endocrine functions, stabilizes pregnancy, resolves stasis, relieves spasms, alleviates pain, modulates immunity, regulates endocrine functions, and inhibits uterine smooth muscle contractions, protecting the reproductive system, affecting the hypothalamic-pituitary-ovarian axis, improving microcirculation, lowering blood lipids, enhancing memory, and exhibiting anti-myocardial ischemia effects.The significance of Dang Gui Shao Yao San lies not only in its original and pharmacological effects but also in its clinical applications. According to the Shang Han Za Bing Lun, the uses of Dang Gui Shao Yao San are relatively simple, primarily used for gynecological conditions such as “Women in pregnancy, abdominal pain (jiao: abdominal cramping), and various abdominal diseases in women.” However, through the continuous exploration of later physicians, it has been found that Dang Gui Shao Yao San and its modified versions can be widely applied to gynecological diseases, male diseases, urinary system diseases, circulatory system diseases, neurological diseases, digestive system diseases, otorhinolaryngological diseases, dermatological diseases, and many other conditions. Dang Gui Shao Yao San harmonizes the liver and spleen, primarily focusing on liver regulation, thus it can be used to treat any diseases along the liver meridian, applicable to both men and women, such as female breast diseases and male reproductive system diseases. Additionally, Dang Gui Shao Yao San can invigorate blood and resolve stasis, making it effective for various diseases caused by internal blood stasis.Dang Gui Shao Yao San can be clinically 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, breast hyperplasia; chronic prostatitis, male infertility, epididymitis, testicular hydrocele, varicocele; nephroptosis, kidney stones, bladder stones; coronary heart disease angina, pulmonary heart disease with heart failure, deep vein thrombosis; vascular headache, traumatic brain syndrome, cerebral thrombosis. The HAART therapy for AIDS-related liver dysfunction, cirrhosis with ascites, 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, stagnant eczema, thyroid adenoma cystic degeneration, facial nerve paralysis, sciatica, gout, hypersomnia, insomnia, Meniere’s disease, parasitic anemia, and over a hundred other diseases.In the comprehensive evaluation of various formulas under Zhang Zhongjing’s theory of invigorating blood and resolving stasis, if Dang Gui Shao Yao San is considered second, no one dares to claim the first place. As long as it matches the pathological mechanism, it can generally hold its ground. It can be said that Zhang Zhongjing’s Dang Gui Shao Yao San is truly a formula that stands on par with the later famous blood-invigorating and stasis-resolving formula Xue Fu Zhu Yu Tang.
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