Blood stasis (血瘀) refers to the obstruction and stagnation of blood flow, indicating various clinical syndromes caused by the sluggish movement or accumulation of blood, or the retention of blood outside the meridians within the body. Blood stasis is also known as stasis blood, and has been referred to in historical literature as evil blood (恶血), stored blood (蓄血), accumulated blood (积血), dead blood (死血), and bleeding blood (衄血). Over two thousand years ago, the Huangdi Neijing (《内经》) emphasized the importance of blood stasis, with numerous discussions, such as in the Suwen: Miao Ci Lun (《素问·缪刺论》) stating: “When a person falls, evil blood remains inside, causing fullness and distension in the abdomen, unable to move forward or backward.” The Ling Shu: Xie Qi Zang Fu Bing Xing (《灵枢·邪气脏腑病形》) also states: “When there is a fall, evil blood remains inside.” This introduced the theory that labor injuries and cold pathogens can lead to the retention of evil blood. Later, Zhang Zhongjing in the Shang Han Lun (《伤寒论》) and Jin Kui Yao Lue (《金匮要略》) directly introduced the term blood stasis and discussed stored blood and blood clots, establishing the viewpoint of stasis heat and internal clumping. Qing Dynasty physician Ye Tianshi advocated for the use of insect-based methods to open the meridians for treating dry blood and dead blood, paving new paths for treatment. Wang Qingren’s Yilin Gai Cuo (《医林改错》) laid the foundation for the theory of qi deficiency and blood stasis, establishing the principles of tonifying qi and invigorating blood, and designed representative formulas such as Tong Qiao Huoxue Decoction (通窍活血汤), Xue Fu Zhu Yu Decoction (血府逐瘀汤), and Ge Xia Zhu Yu Decoction (膈下逐瘀汤), as well as the Qi and Blood Tonifying formula, Bu Yang Huan Wu Decoction (补阳还五汤). Tang Rongchuan’s Xue Zheng Lun (《血证论》) was the first monograph dedicated to blood stasis, proposing the theory of dispelling stasis and generating new blood, making significant contributions to the study of blood stasis. To this day, the theory of blood stasis has gradually improved in aspects such as principles, methods, formulas, and medicines. Blood stasis is a pathological product, including both blood that has left the meridians and blood that has not. Blood that has left the meridians refers to blood that has extravasated from the vessels and stagnated in the organs and tissues, while blood that has not left the meridians refers to blood that is sluggish and retained within the vessels. Blood stasis, also known as stored blood, leads to the obstruction of qi and blood circulation, resulting in the generation of new blood stasis. Blood stasis is both a pathological product and a secondary pathogenic factor, often forming a pathological vicious cycle.
Diseases caused by blood stasis are mostly of a solid nature, with strong aggregation, and the pathogenic sites are fixed and immovable. Initially, blood that has left the meridians may appear clear, but over time it turns purple-black, easily leading to coagulation and stasis pain. 1. Mechanism of Blood Stasis Formation Qi is the commander of blood; when qi moves, blood moves; when qi stagnates, blood stasis occurs. Therefore, the deficiency or excess of qi is most related to the pathogenesis of blood stasis. Blood stasis is a disease of the blood system; the heart governs blood, and the movement of blood is driven by the heart. The spleen governs blood, overseeing its generation and regulation. The liver stores blood and regulates its storage and adjustment, thus the mechanism of blood stasis formation is most closely related to the heart, liver, and spleen. (1) Mechanism of Unextracted Blood Stasis Formation Unextracted blood stasis, also known as stagnant blood, occurs when blood flows slowly and stagnates within the meridians. As stated in the Jin Kui Yao Lue: “Internal clumping leads to blood stasis,” which can be caused by emotional distress, liver qi stagnation, and qi stagnation, leading to obstruction of the vessels, especially when the heart and lung qi is deficient. Thus, the Ling Shu: Xie Ke Pian (《灵枢·邪客篇》) states: “Therefore, the ancestral qi accumulates in the chest, exits through the throat, connects to the heart vessels, and facilitates breathing.” If the ancestral qi is deficient, blood circulation becomes weak and stagnant, as stated in the Ling Shu: Ci Jie Zhen Xie Lun (《灵枢·刺节真邪论》): “If the ancestral qi does not descend, the blood in the vessels coagulates and stagnates.” Additionally, cold invading the meridians can cause the vessels to contract and tighten, leading to blood stagnation, as stated in the Su Wen: Ju Tong Lun (《素问·举痛论》): “Cold qi enters the meridians and causes stagnation, leading to tears and inability to move,” and the Su Wen: Tiao Jing Lun (《素问·调经论》) states: “If cold remains, blood coagulates and stagnates, leading to obstruction of the vessels.” Other factors, such as evil heat invading and causing blood clots, can also lead to stasis heat and obstruction. (2) Mechanism of Extracted Blood Stasis Formation Extracted blood stasis refers to blood that has extravasated from the vessels and stagnated in specific areas of the body. This can occur due to excessive emotional distress, qi and blood surging upwards, causing blood to overflow outside the vessels, leading to symptoms such as epistaxis and hematemesis, and in severe cases, sudden fainting, such as in cases of great collapse or convulsions. As stated in the Ling Shu: Bai Bing Shi Sheng Pian (《灵枢·百病始生篇》): “If the yang vessels are injured, blood overflows outside.” Additionally, irregular lifestyle or improper diet, excessive exertion can also lead to rectal bleeding or hematuria, as stated in the Ling Shu: Bai Bing Shi Sheng Pian: “If the yin vessels are injured, blood overflows inside.” In summary, various forms of bleeding can eventually lead to blood stasis. Other factors, such as improper hemostasis, cold obstruction, and trauma, are also important mechanisms for the formation of extracted blood stasis. Furthermore, excessive heat can force blood to overflow, leading to blood stasis. 2. Characteristics of Diseases Caused by Blood Stasis Firstly, diseases caused by blood stasis are extremely widespread. Li Zhen in his work Yixue Rumen (《医学入门》) pointed out long ago: “Everyone knows that all diseases arise from qi, but few realize that blood is the origin of all diseases. Conditions such as cold, heat, spasms, pain, rashes, itching, forgetfulness, mania, anxiety, fullness, pain, constipation, and women’s menstrual disorders, all relate to blood pathology.” (Volume 5: Internal Injury: Blood) This emphasizes the significant importance of blood pathology. Blood stasis can affect all organs and tissues of the body, posing great harm to human health. Secondly, the pathogenesis of blood stasis primarily involves the obstruction of qi and blood movement. Blood stasis, as a secondary pathogenic factor, mainly obstructs the flow of qi and blood, which can lead to qi counterflow or the formation of new blood conditions.
In severe cases, the lack of movement of qi and blood can lead to organ malnourishment, resulting in qi deficiency, and even both qi and blood deficiency. Therefore, when treating blood stasis, in many cases, it is necessary to consider tonifying qi, both to promote blood circulation and to address qi deficiency. Additionally, blood stasis obstructs the movement of qi; for example, if the heart is affected, it may manifest as heart qi obstruction; in the lungs, it may present as lung qi stagnation; in the liver, it may lead to liver qi stagnation and blood clots; in the stomach, it may cause stomach qi to rebel, resulting in hematemesis. In summary, qi stagnation leads to blood stasis, blood stasis leads to qi obstruction, and qi stagnation further leads to new blood stasis, creating a reciprocal causal relationship. Furthermore, blood stasis has a characteristic of solidity (fixed and immovable). Therefore, it often causes stabbing pain and swelling; if blood stasis forms between the meridians and organs, it can lead to masses. Over time, blood stasis, when subjected to qi and fire, can develop into dry blood, presenting characteristics such as darkening of the eyes. Additionally, blood stasis can not only cause disease but can also become a secondary pathogenic factor, remaining in the body and leading to secondary causes of disease. For instance, if blood stasis does not dissipate, new blood cannot be generated, leading to secondary blood deficiency; if blood stasis obstructs the vessels, blood circulation may deviate from its normal path, resulting in bleeding; if phlegm combines with stasis, prolonged accumulation can lead to masses.
The relationship between qi, blood, and water is disrupted; blood stasis and qi stagnation can lead to water retention, resulting in edema. Furthermore, blood stasis leads to qi stagnation, and qi stagnation exacerbates blood stasis, creating a pathological relationship between qi and blood. Thus, the Su Wen: Yu Ji Zhen Zang Lun (《素问·玉机真脏论》) states: “When the vessels are obstructed, qi cannot circulate.” Tang Rongchuan’s Xue Zheng Lun: “All forms of stasis obstruct the pathways of qi and block the movement of qi.” (Volume 2: Hematemesis) Prolonged blood stasis can also lead to deficiency of the righteous qi, specifically leading to qi deficiency, yin deficiency, and yang decline, even affecting the five organs and six bowels. From a Western medical perspective, prolonged illness often leads to blood stasis, with the primary pathological essence being the obstruction of blood circulation, particularly microcirculation. Specifically, it manifests as stagnant blood, ischemia, bleeding, thrombosis, and edema. The main mechanism involves the obstruction of blood circulation leading to dysfunction of nerve nutrition and metabolic disorders, resulting in a series of secondary pathological developments, such as degeneration, exudation, atrophy, and hyperplasia of local tissues. This demonstrates that blood stasis has extensive and profound damage to the human body. Therefore, early warning of blood stasis syndromes holds significant value.
Significance of Blood Stasis Warning The manifestations of blood stasis are extremely complex and diverse, but can be categorized into two main types: tangible blood stasis and intangible blood stasis. Tangible blood stasis and intangible blood stasis are relative terms; in essence, from a microscopic perspective, both are tangible blood stasis, each with varying degrees of substantive pathological changes, thus absolute intangible blood stasis does not exist. Prolonged illness leads to stasis; any disease, over time, will exhibit signs of stasis. For example, in prolonged jaundice, the yellowing becomes increasingly dull, with hardness and fullness under the ribs, red spots on the skin, spider veins, and a dark tongue, indicating blood stasis obstructing the vessels. Similarly, in cases of trauma, persistent pain becomes fixed and stabbing, with darkening of color, indicating internal blood stasis. Furthermore, emotional distress, qi and blood stagnation, over time can lead to stabbing pain in the ribs, darkening of the nails, and dark circles under the eyes, indicating signs of qi and blood stasis. Particularly, diseases related to qi and phlegm are most prone to stasis; whether it is qi stagnation, qi depression, or qi deficiency, all can easily lead to stasis. Qi stagnation and blood stasis are the most commonly seen stasis conditions in clinical practice, presenting with liver qi stagnation, discomfort in the ribs, irritability, and a dark purple tongue as initial signs. Qi deficiency and blood stasis present with fatigue, shortness of breath, and a dark purple tongue as symptoms. Phlegm combined with stasis, also known as phlegm-stasis combined evil, arises from the same source, as both are the result of the congealing of fluids and blood, thus phlegm and stasis often affect each other. Clinically, once phlegm and stasis combine with evil, they create a pathological relationship, indicating that the disease becomes difficult to resolve. For instance, in manic-depressive disorders, prolonged symptoms may include manic speech, anxiety, insomnia, and a dark purple tongue, indicating phlegm-stasis combined evil, which is a difficult-to-treat condition. The signs of phlegm-stasis combined evil include signs of blood stasis (such as a dark tongue or stasis spots, a rough pulse, fixed or stabbing pain) and signs of phlegm (such as nausea indicating stomach phlegm, fullness indicating chest phlegm, palpitations indicating heart phlegm, cough with phlegm indicating lung phlegm, swelling or numbness indicating channel phlegm, diarrhea indicating intestinal phlegm, forgetfulness or dementia indicating brain phlegm). Additionally, blood cold and blood heat can also easily form blood stasis combined syndromes; when blood encounters cold, it coagulates, leading to symptoms such as pain that decreases with heat, and typically presents with cold limbs, pale and dark complexion, and a slow pulse, indicating blood cold stasis. Conversely, blood heat stasis is caused by warm heat evils entering the interior and congealing with the nutritive blood, clinically presenting with high fever, delirium, bleeding, purpura, a crimson tongue, and a rapid pulse, indicating the ominous signs of stasis heat. Predecessors have placed great importance on the early signs of blood stasis. For instance, Tang Rongchuan believed that blood stasis obstructs the skin, with cold and heat being its signs; blood stasis in the muscles presents with fever and spontaneous sweating as its markers. Blood stasis in the upper jiao presents with hair loss as its precursor, while blood stasis in the middle jiao is characterized by stabbing pain in the abdomen, and blood stasis in the lower jiao presents with stabbing pain in the lower abdomen and black stools as its signs. Blood stasis in the interior presents with thirst as a precursor symptom, as the internal presence of blood stasis obstructs the movement of qi, preventing the upward transport of fluids, leading to thirst, termed blood thirst (《血证论·卷五·瘀血》). Zhou Xuehai in his Reading Medical Essays: Blood Stasis and Internal Heat (《读医随笔·瘀血内热》) stated: “If one feels a segment of heat in the abdomen like boiling water… it is neither real fire nor internal heat, but rather the result of blood stasis… Additionally, if there is a sensation of heat rising from the chest and abdomen to the throat, it is due to liver and spleen stagnation causing blood to surge upwards… If there is a constant sensation in the heart area like spicy pepper or painful swelling, or a bloody smell in the throat, it indicates blood stasis accumulating in that area… In general, when blood stasis first arises, the pulse often appears wiry and rapid, and those who are thirsty are easier to treat, as there is still vitality; while those with a short and rough pulse are difficult to treat, as there is no vitality left.” Through the words of these physicians, the early signs of blood stasis can be recognized, indicating that although the early signs of blood stasis are varied, they can be understood and follow certain patterns. Discussing the significance of tangible and intangible blood stasis warnings. 1. Early Signs of Tangible Blood Stasis Generally, the nature of pain is stabbing, the location is fixed, the tongue appears dark or has stasis spots, and there is night fever with thirst but no desire to drink, all of which are signs of blood stasis. If the complexion appears dark, lips and nails are cyanotic, skin is rough, and the pulse is deep and slow, these are signs of prolonged stasis, often indicating a poor prognosis. (1) Early Signs of Blood Stasis Obstructing the Vessels Blood stasis obstructing the vessels is a common condition, and its early signs follow certain patterns. For instance, Wang Qingren in his Yilin Gai Cuo (《医林改错·上卷》) stated: “Visible veins are not muscles; if they are deep in the skin, they are blood vessels; if the blood vessels appear blue, it indicates internal blood stasis.” Blood stasis obstruction includes stasis in the heart vessels, brain vessels, lung vessels, and the vessels of the limbs. Blood stasis obstructing the brain vessels presents with early signs of progressive forgetfulness, especially forgetting names, transient dizziness, and transient aphasia. Blood stasis obstructing the heart vessels presents with chest tightness and transient left chest pain after exertion or emotional discomfort. Early signs of blood stasis obstructing the limbs include numbness in the fingers and toes, discoloration, or coldness, commonly seen in blood bi and pulse bi, including early signs of thrombotic vasculitis, lower limb varicose veins, and vascular malformations. (2) Ominous Signs of Blood Stasis Attacking the Interior This primarily involves blood stasis attacking important internal organs such as the heart, brain, and lungs, indicating a more dangerous condition, such as: 1. Ominous Signs of Blood Stasis Attacking the Heart: This often occurs in postpartum women and those with a history of bleeding. Symptoms such as dizziness and confusion indicate that blood stasis is about to attack the heart. If symptoms progress to coma, unresponsiveness, shortness of breath, palpitations, cyanosis of the lips and face, this indicates a critical condition of blood stasis attacking the heart. This often occurs when postpartum blood stasis has not been resolved, and external pathogens invade the interior, leading to diseases such as puerperal fever, which corresponds to modern medical conditions such as postpartum sepsis and infectious shock, or toxic psychosis. In severe cases, sudden mania may occur, presenting as seeing ghosts, laughing or cursing, or being mute, primarily due to retained lochia causing infection, leading to blood rushing to the heart and disturbing the spirit. These diseases correspond to modern medical conditions such as postpartum sepsis and infectious shock. 2. Ominous Signs of Blood Stasis Drying the Brain: Those with a history of brain injury or infection may present with forgetfulness or mania as early signs of blood stasis drying the brain. If symptoms progress to not recognizing relatives, mania, or coma, this indicates a critical condition of blood stasis drying the brain. Blood stasis drying the brain often occurs as a sequela of brain injury or infectious mental illness, with a generally poor prognosis. 3. Ominous Signs of Blood Stasis Attacking the Lungs: Blood stasis attacking the lungs often occurs due to blood stasis and heat toxins attacking the lungs. Patients with blood stasis may present with shortness of breath and wheezing as early signs of blood stasis attacking the lungs. If symptoms progress to wheezing, coughing, palpitations, shortness of breath, nasal congestion, and blackening of the eyes, this indicates a critical condition of blood stasis attacking the lungs. Due to the severity of blood stasis attacking the lungs, it is crucial to pay attention to the emergence of early warning signs. For instance, in cases of postpartum retained lochia and blood rushing upwards, this is particularly serious, as stated in the Chen Su’an’s Gynecology Supplement (《陈素庵妇科补解·产后众疾门》): “Postpartum shortness of breath is due to blood rushing upwards to the lungs,” indicating that shortness of breath is a sign of blood stasis attacking the lungs. 2. Early Signs of Intangible Blood Stasis Intangible blood stasis refers to unextracted blood stasis, with pathological changes primarily occurring in the vessels, especially the microvessels (including capillaries, primarily affecting microcirculation). The progression of the disease occurs imperceptibly, often belonging to latent diseases, and its early signs are often obscure and lack specificity, but certain patterns can still be discerned, such as: (1) Microvascular Stasis Signs: This includes stasis in the capillaries, iris, sublingual vessels, and facial vessels, with early signs of vascular dilation and darkening, indicating potential risks for conditions such as chest bi, stroke, bi syndrome, purpura, ulcers, gangrene, lupus erythematosus, tumors, etc. (including Western medical conditions such as cardiovascular diseases, respiratory diseases such as pulmonary heart disease, coronary heart disease, cerebral arteriosclerosis, tumors, scleroderma, Raynaud’s disease, rheumatoid arthritis, lupus erythematosus, and chronic liver and kidney diseases, as well as various neuralgia and peripheral neuritis). (2) Skin Stasis Signs: The skin may appear dry, cracked, discolored, and scaly, indicating internal blood stasis, which has implications for conditions such as stroke, chest bi, tumors, lupus erythematosus, etc. (including coronary artery disease, cerebral thrombosis, scleroderma, neurodermatitis, psoriasis, etc.). If the skin shows signs of darkening or roughness, it indicates the presence of dry blood or dead blood. (3) Forgetfulness: Forgetfulness is an early warning symptom of stagnant conditions, mania, epilepsy, and blood accumulation, especially forgetting names, indicating early signs of blood stasis in the brain vessels, highlighting the importance of early detection of microcirculation disorders in cerebrovascular diseases and mental illnesses. (4) Darkening of Color: This first appears around the eyes, mouth, nose, forehead, and cheeks, presenting as darkening and yellowing of the eyes, often indicating early signs of accumulation, masses, distension, and amenorrhea, including modern medical conditions such as tumors, cirrhosis, and scleroderma.
(5) Hair Loss: Hair loss and premature graying are early symptoms of blood stasis in the brain vessels, thus holding certain predictive value for stroke. Additionally, hair loss can also be a precursor symptom for conditions such as lupus erythematosus, Raynaud’s disease, and scleroderma, but it is not specific and should be considered as a reference. (6) Menstrual Irregularities: Irregular menstruation and amenorrhea are early signs of phlegm and blood stasis, kidney yin and yang imbalance, excessive fire combined with stasis, and liver and kidney deficiency combined with stasis (including endocrine diseases such as Cushing’s syndrome, acromegaly, familial obesity, hyperthyroidism, etc.). (7) Dry Mouth: Dry mouth and throat are early signs of systemic blood stasis, also known as blood thirst. As Tang Rongchuan stated: “If blood stasis is present internally, it leads to thirst; this is because blood and qi are inherently inseparable, and the presence of blood stasis obstructs qi, preventing the upward transport of fluids, leading to thirst, termed blood thirst.” The characteristic is that although the mouth is dry, there is no desire to drink, or only a small amount of water is consumed due to qi dysfunction. This is a sign of conditions such as lupus erythematosus, swelling, dry syndrome, typhoid blood stasis, and warm diseases with heat entering the nutritive blood. (8) Night Fever: Night fever or afternoon fever is also a sign of systemic blood stasis, as blood stasis obstructs qi transformation, leading to insufficient yin and excessive virtual fire, resulting in night fever and afternoon fever, also known as stasis heat, but it is not a specific sign of blood stasis; its predictive value is significant only when accompanied by other symptoms of blood stasis.
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