Shen Shaogong: The condition of xue yu zheng (blood stasis syndrome) has a broader scope than yu xue zheng (stasis blood syndrome). The symptoms arising from blood circulation obstruction are called xue yu zheng. Yu xue zheng refers to blood that has left the meridians, or has overflowed from the meridians or is lodged in the skin or has seeped out of the skin, which is a more specific syndrome. For example, in gynecology, symptoms such as dark menstrual blood and dysmenorrhea are indicative of yu xue zheng. Within yu xue zheng, there are several classifications, which we also refer to as the three generations of huo xue hua yu (activating blood and resolving stasis). The naming is flexible, and it can be called whatever one wishes.
First Generation of Activating Blood and Resolving Stasis Herbs:
Dan Shen (Salvia miltiorrhiza) 30g, Chi Shao (Red Peony Root) 10g, Ze Lan (Lycopus lucidus) 10g, Ji Xue Teng (Spatholobus suberectus) 40g, Shen Jin Cao (Herba Asari) 10g, Lu Lu Tong (Liquidambar orientalis) 10g.
In the first generation of huo xue hua yu herbs, we have Dan Shen 30g, Chi Shao 10g, Ze Lan 10g, Ji Xue Teng 40g, Shen Jin Cao 10g, and Lu Lu Tong 10g.
Dan Shen is generally used at 30g. Some people ask me, “Teacher Han, if this person has a lot of bleeding, I am afraid to use 30g of Dan Shen, can I use 10g instead?” Yes, you can use a smaller amount, or if you are worried about bleeding, you can omit it.
Chi Shao 10g: It has the effect of activating blood, resolving stasis, and alleviating pain. Moreover, Chi Shao can also lower transaminases. When liver function is poor and transaminases are elevated, Chi Shao should be used, and the dosage can be increased to 20g or 30g, which is very effective for liver diseases. However, Chi Shao is slightly sour, so if the patient experiences acid reflux, it should be used in smaller amounts. If there is no acid reflux, Chi Shao can be used in larger amounts, up to 20g. It can also help reduce transaminases in cases of jaundice; if transaminases are very high, then Chi Shao can be used in larger amounts.
Ze Lan: Ze Lan has the effects of activating blood, resolving stasis, and promoting urination to eliminate dampness. It is especially effective in treating gynecological diseases, as Ze Lan can activate blood, resolve stasis, and open the meridians. Additionally, Ze Lan can also treat angina pectoris when blood vessels are obstructed.
Ji Xue Teng 10g: Ji Xue Teng has the effect of nourishing blood and invigorating blood.
Shen Jin Cao 10g: Shen Jin Cao can also traverse the fine meridians. It is particularly effective for cases of blocked or hardened fallopian tubes, which can lead to infertility. It can help to open the fallopian tubes.
Lu Lu Tong 10g: People often ask where mushrooms and black fungus grow. They grow on damp, decaying wood, right? They do not grow on good wood, do they? It is said that women often develop cysts and tumors in the ovaries and uterus, similar to decaying wood, which is damp and obstructed. Healthy wood does not grow anything, right? This indicates obstruction.
I suddenly understood! The fact that these women develop such conditions indicates that they are obstructed, with qi and blood not flowing smoothly, and dampness accumulating. Therefore, when treating gynecological diseases, it is essential to open the meridians, dry dampness, and resolve phlegm. I later applied this story in my clinical practice, and the results were indeed good. Once the meridians are opened, these conditions do not develop, just like traffic; when there is a jam, no one can pass, but when it is cleared, everyone can go quickly. If it is blocked, not even one vehicle can pass; this is the principle. Gynecological diseases are like this; currently, there are many such cases. One reason is that women may have one child, and some may undergo abortions. After an abortion, they may not expel everything, or the medical abortion may not be complete. Additionally, repeated abortions can lead to uterine congestion. When they are pregnant, hormone levels are relatively high, and if you forcibly terminate the pregnancy, it is like interrupting something that is already in progress, leading to instability and poor fetal development, making it easier for them to develop issues.
Therefore, the prevalence of women’s diseases and gynecological conditions has increased significantly. There is often only one child, and factors such as IUDs and artificial abortions are all related. Do you understand? So when using these herbs, our professor shared a story that has its reasoning.
In gynecology, I particularly like to use Ji Xue Teng, Shen Jin Cao, and Lu Lu Tong. Once they are unblocked, they do not get sick. When they are blocked, dampness accumulates, and unwanted growths develop. Now, many women have pelvic fluid accumulation, right?
Gynecological inflammation can also lead to pelvic fluid accumulation, and Western medicine’s anti-inflammatory drugs do not resolve it. Do you know why there is fluid accumulation? It is because inflammation has caused obstruction, leading to slow seepage and accumulation, which does not get absorbed! This is simply called “leakage.” Right? The area is blocked, so it leaks. Therefore, I emphasize the importance of opening the meridians. In cases of pelvic fluid accumulation, add Bai Hua She She Cao (Oldenlandia diffusa) to the formula.
If a patient undergoes an ultrasound and shows abdominal inflammation, for example, if the fallopian tubes are blocked or there is inflammation in the uterus leading to pelvic fluid accumulation, add Bai Hua She She Cao 30g and Chao Ting Li Zi (Stellaria media) 10-30g to promote lung function and eliminate dampness, allowing the fluids to be cleared.
In Beijing, if you want to use Chao Ting Li Zi 30g, you must have a name stamp; just having a stamp is not enough. In Beijing, if the dosage of leeches exceeds 5g, you need to sign. If you want to use 30g of Chao Jiao Ren (Ziziphus jujuba), you need to sign if you want to use 60g; they are very strict about this. Right? This means that if you exceed the dosage and something happens, it is your responsibility. Therefore, I want to emphasize that there is a role for activating blood, resolving stasis, and unblocking the meridians. Simply using herbs for activating blood and resolving stasis is not enough. If you say you are using San Leng (Sparganium) and E Zhu (Curcuma zedoaria) without unblocking the meridians, the effect will still be poor. When activating blood and resolving stasis, it is essential to use herbs that unblock the meridians; only then can gynecological inflammation and fluid accumulation improve.
There was a girl whose one fallopian tube was removed due to an ectopic pregnancy, and the other was blocked with fluid. She wanted to get pregnant, but the Western doctor told her, “Your chances of getting pregnant are almost zero.” Then she came to me, desperately wanting to conceive. I couldn’t tell her she couldn’t get pregnant! I cleverly comforted her. I said, “For someone like you, there is hope, but I don’t know when it will happen. I am not a fortune teller.” Right? Then the patient asked, “Can you give me an estimate?” I said, “At least six months.” If I can’t treat you in six months, I won’t treat you anymore. In gynecology, I say, “Especially for amenorrhea, I will treat you for a maximum of one year. If I can’t help you in a year, I won’t treat you anymore.” Why? If my skills are not sufficient, I will refer you to someone else.
Then about five and a half months later, she came back, sitting there sighing, saying, “Oh, Doctor Han, it has been almost six months, why am I not pregnant yet?” I said, “What can we do?” After saying that, about two weeks later, she came back and said, “Doctor Han, I am really pregnant.” She was overjoyed, and when she checked, she was indeed pregnant. She later gave birth to a beautiful son and sent me a photo of him.
This shows that even in uncertain situations, you can encourage the patient. After all, I was not sure if I could help her. You see, she had one fallopian tube removed, and the other was blocked with fluid, and I was using these herbs I just mentioned to activate blood, resolve stasis, and unblock the meridians, and promote fluid elimination.
Moreover, I want to tell you that for blocked fallopian tubes and adhesions, I recommend not to keep trying to unblock them. Why? Because with different adhesions, the more you try to unblock them, the more they adhere, and the area becomes larger. Do you understand? After unblocking once, do not try to unblock again; you need to use TCM. I tell patients, “You have already passed the point of blockage; do not try to unblock again. If it is not smooth, I will adjust your treatment.” After six months, she got pregnant and solved the problem. If she cannot conceive, she can consider artificial insemination or other options. The more you try to unblock, the more painful it becomes because it cannot pass, which can worsen the condition. I want to emphasize this point.
Another example is a woman who had been married for three years without conceiving, and her mother-in-law was unhappy and wanted her husband to divorce her. Then her uncle brought this patient to me for treatment. She said, “I am so worried; I am about to get divorced. Doctor Han, can you help me?” I said, “I can help you.” She said, “If you can help me, please write a note for me to show my mother-in-law, saying not to divorce yet, I will first seek treatment, and the doctor said it can be cured.”
This is something I have never done before. You diagnose the patient and say, “You can get pregnant, or else you will get divorced.” How do you treat it? I am a person who tends to be optimistic. I said, “This condition can be treated with TCM.” I wrote a note, and she took it back. Then she brought her husband’s test results, and I saw that her husband’s sperm motility was just over 50%, which was barely acceptable.
I said, “Your husband also has issues; he needs to come for treatment as well. I can extend your treatment time.” She asked, “How long will it take?” I said, “At least three months.” While she was writing down the treatment plan, I also wrote down the treatment for her husband. I said, “I have become the mediator for your family.” In total, this person took 45 doses of herbal medicine and then became pregnant. I still have the herbal formula for this patient. Why? Because of depression.
I want to tell everyone that those who cannot conceive are often very anxious and depressed, under a lot of pressure. Therefore, for such patients, you must address their psychological issues. The more anxious and tense they are, the harder it is for them to conceive. Why? Because of hormonal imbalances. Therefore, if someone comes to me wanting to get pregnant, I first tell them, “Your body is not well; you cannot conceive right now.” I inform them that they cannot conceive. Then they ask, “When can I conceive?” I say, “In three months.” First, we need to adjust your body. This is called a delaying tactic.
Additionally, I subtly suggest to them, “Do not think about getting pregnant for now; focus on adjusting your body.” I have found that many people conceive within three months. Why? Because when their attention is diverted, they think, “Oh! If I cannot conceive for now, then I will just do what I need to do,” and many patients have had success. This is a tip I want to share with you. Next time, if someone is eager to conceive, tell them, “You need to adjust your body first.” Once they shift their focus, they often conceive quickly.
This girl took 45 doses and did not come to see me. I thought she might have switched to someone else and was not coming back. Then a girl came in and said, “Do you remember so-and-so?” Of course, I remember. Because I remember these two cases very clearly. I asked, “What happened?” She said, “I am pregnant now!” She was very happy and came to introduce me to her child. I said, “Victory!” These two patients were unexpected; one had not conceived for three years, and the other had issues with both fallopian tubes, and I did not expect them to conceive.
This illustrates that through effort and cooperation between the patient and the doctor, anything is possible, and good outcomes can occur. If the patient is always thinking negatively, thinking, “Oh, I cannot live like this, what if I have an ectopic pregnancy?” then they will not conceive. I said, “If you keep thinking about bad things, good things will not come. You must stay positive.” Ah! As long as you give patients confidence, that is the first step.
Second Generation of Activating Blood and Resolving Stasis Herbs:
Hong Hua (Carthamus tinctorius) 5-10g, Su Mu (Sappan wood) 10g, San Qi (Notoginseng) powder 3-6g, San Leng (Sparganium) 10g, E Zhu (Curcuma zedoaria) 10g.
For the second generation, if the patient has amenorrhea or scanty menstruation, I will use stronger herbs for activating blood and resolving stasis. For example, I can use San Qi in small amounts, 3g, which has the effect of nourishing and activating blood. At 6g, it has the effect of activating blood and resolving stasis but will not break the blood. Moreover, our San Qi powder is particularly noted for caution in pregnant women.
I tell you, during pregnancy, if there are signs of miscarriage, San Qi powder can be used at 1.5-3g. After taking it, it can help treat the signs of miscarriage and protect the fetus. Yunnan Baiyao and San Qi powder can be used; I have treated this before, and after protecting the fetus, there are no issues, but do not exceed 3g. Generally, use 1.5g. One packet of San Qi powder is 3g, so you can give her half a packet at a time, and she can take it once or twice a day.
Su Mu 10g: If the patient has blood circulation issues and abdominal distension, use Su Mu. This herb activates blood, resolves stasis, and alleviates pain, and can be used for angina pectoris and abdominal pain. This herb has a warming effect.
Hong Hua 5-10g: If the effect of Su Mu is not satisfactory, use Hong Hua. If the menstrual flow is still very scanty, start with 5g, and if that does not work, increase to 10g.
For example, a woman I saw yesterday said, “I have taken Hong Hua and used leeches, but the effect is not good.” I said, “You are a stubborn case, and it is difficult to treat.” She wanted to conceive, and I treated a woman who was 49 years old and still wanted to conceive, but her menstruation was normal. She flew from Guangzhou every time to see me, but I received a message on my phone that I did not know who sent it. It said, “Zhu Xiaobao was born safely, weighing so many grams.” Who sent me this? I do not know if it was this woman because I had treated her for about six months.
Use Hong Hua 5-10g. This herb has the effect of activating blood and breaking blood. If you want to conceive, do not use this herb, as it can lead to miscarriage. Therefore, I always ask, “What type of infertility is more difficult? It is those who want to conceive but have scanty menstruation; using this herb is not a problem. Use other herbs like Ji Xue Teng, Su Mu, and Dan Shen, which are almost ineffective, so for those with scanty menstruation, you must use Hong Hua. However, if you are concerned about them wanting to conceive, this herb can easily cause miscarriage. What do you do? I thought of a way: when the patient starts menstruating, I give them 10g for four or five days, then stop. This way, you cannot say I caused a miscarriage, right? But it can still help regulate menstrual flow, so I always write Hong Hua (in a package), and instruct them to use it right when menstruation starts, not before. This is clear, right? That is why I package 10g of Hong Hua.
Additionally, for women with scanty menstruation, I suggest they drink red wine every night, about 50-100ml. Some people may experience bleeding when they drink red wine, as they are very sensitive, so for those with scanty menstruation, they should drink red wine. They should drink it gradually. Moreover, red wine is the essence of grains, has a calming and sedative effect, and drinking red wine can improve skin condition and warmth. So, for those with scanty menstruation who want to conceive, when menstruation starts, give them this herb.
San Leng and E Zhu are both pungent herbs. I generally use one of them; if one does not work, I use both. However, when using them, inform the patient to take them after meals, as these herbs can be irritating and may cause vomiting if taken on an empty stomach. For example, E Zhu can be used for dysmenorrhea and scanty menstruation. Sometimes I use San Leng, E Zhu, and Hong Hua together, and for those with insufficient menstruation, it can be very stubborn. E Zhu can also be used for esophageal cancer, especially for those with swallowing difficulties.
I tell you, I generally use San Leng, E Zhu, and Hong Hua together; for mild amenorrhea, it can be effective in one or two weeks, but for stubborn cases, it may take two to three months without effect, which is very difficult to treat. Therefore, I now observe the patient’s condition. I generally start with Hong Hua when menstruation begins; if menstruation does not come, I will use San Leng, E Zhu, and Hong Hua together. Some patients have gone through a full cycle of treatment without improvement, but after taking just three doses of your herbs, they may feel better. If menstruation can come within a month, it is easier to adjust; if it does not come for two to three months, it becomes very difficult to adjust, and they may not even respond to Western medicine. Do you understand? Therefore, you need to understand the severity of the patient’s condition. This is the category of huo xue hua yu that I use more frequently, about 95% of the time.
Third Generation of Activating Blood and Resolving Stasis Herbs:
The third generation consists of insect-based herbs. I use insect-based herbs very cautiously in clinical practice because modern people are very sensitive; some may have allergies, and if they are allergic, the effects can worsen, so I rarely use them.
Di Long (Earthworm): For numbness in the feet or hands, or for patients with hypertension, Di Long can lower blood pressure, unblock the meridians, and relieve asthma. If a person is allergic, using Di Long may worsen their asthma. What do you do? I write a note saying “package”. Sometimes, to be cautious, I write “package”. First, use 5g, and tell them not to take Di Long the first time; add it the second time and see how they feel. If they feel uncomfortable after taking it, remove it.
I treated an elderly man in his 50s with pulmonary fibrosis. He had used Western medicine and hormones, but it was ineffective, and he was severely short of breath. However, I told you, “I will not use insect-based herbs the first time; generally, I will use them in the third or fourth treatment.” I used Hong Hua because pulmonary fibrosis causes the lungs to harden, and his lung function was severely reduced, so I needed to invigorate blood and unblock the meridians. I used Hong Hua, and the effect was quite good. He said, “I still feel a bit short of breath.”
I was bold and decided to try; I prescribed 5g of Di Long and told him, “You package it.” I instructed him not to drink it the first day, but to drink it the next day for comparison. He said, “After taking it the next day, I felt worse and had more difficulty breathing.” I said, “Then you cannot take it.” Later, I continued to adjust his treatment, and the results were quite good.
Shui Zhi (Leech): This is similar; animal-based herbs are all foreign proteins, which can have both good and bad effects. Shui Zhi is used for activating blood, breaking stasis, and unblocking the meridians. It is especially effective for numbness in the limbs and for amenorrhea, especially in overweight women. Sometimes, if the above herbs are ineffective, I will add Shui Zhi 3-6g, generally using 5g. However, this herb has a strong odor; after boiling, it can be unbearable, so I grind it into powder and put it in capsules. When using capsules, 3g is sufficient; if making a decoction, use 5g, and let the patient take it warm, not too hot, as it may cause vomiting. Therefore, it is essential to have the patient take it at least 40 minutes after a meal.
Tuyuan 10g: However, Teacher Shen rarely uses this now. He said, “This herb comes from the soil, and it can sometimes easily grow mold.” Therefore, I do not use it now. I used to be quite bold and used all insect-based herbs, including centipedes. Once, I used three insect-based herbs, and Teacher Shen saw it and scolded me, saying, “You are quite bold; I do not use three insect-based herbs simultaneously.” He said, “Insect-based herbs can be toxic, and if patients have allergic reactions, it can lead to serious consequences for you.”
I was scolded by Teacher Shen, so I became more cautious. Now, I sometimes use just one insect-based herb, such as Shui Zhi, or I may use Di Long with Hong Hua. I will use one insect-based herb; or use Di Long with Hong Hua; or just use Hong Hua. Do you understand? Therefore, when patients need treatment, observe their reactions. Now, in clinical practice, many people have heel pain, which can be due to bone spurs or postnatal wind-cold. Therefore, in addition to using Di Long and Shui Zhi, you must also use Chuan Duan (Euphorbia) and Sheng Du Zhong (Eucommia) and Sang Ji Sheng (Mulberry Mistletoe) to warm the kidney and unblock the blood. Simply using insect-based herbs is not enough; after using them, the condition may return to normal after a while, so you must also tonify kidney yang.
Chuan Duan: This herb is particularly effective for the lower back and legs. Use Chuan Duan 10g, Sheng Du Zhong 10g, Sang Ji Sheng 10g, and Chao Bai Zhu (Atractylodes macrocephala) 10-30g. This is specifically for treating lower back pain, and soaking feet in a decoction of Chao Bai Zhu is effective for heel pain and leg numbness. Why? Because as people age, their feet are the first to show signs of aging, and the twelve meridians originate from the feet, so soaking the feet can invigorate the meridians. After soaking, patients feel very comfortable, especially those who are sensitive to cold and numbness in their feet. Using one insect-based herb is sufficient, so I want to emphasize that doctors must be cautious. The first time you use it, if you are not sure, you can package it. Ask the patient if they feel any discomfort after taking the medicine. If not, you do not need to package it next time. This is the principle of being a doctor; you must be cautious! This is about blood stasis.
