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Clearing Heat and Activating Blood Method
Combining blood-activating herbs with heat-clearing herbs, suitable for conditions of blood heat and blood stasis.
Heat toxins can cause blood to congeal and form stasis, while stasis can also generate heat and toxins, leading to stasis-heat.
Commonly seen in various traumatic inflammations, viral infections, chronic ulcers, allergic inflammatory conditions, connective tissue diseases, hemorrhagic diseases, tumors, and other difficult syndromes.
In cases of infection with fever, excessive use of cold herbs often leads to blood being chilled and congealed; thus, treatment should involve “using cool herbs for warm diseases, supplemented with blood-activating and stasis-resolving substances to avoid the risk of ice accumulation”;
In heat-clearing and detoxifying formulas, adding herbs such as Dan Shen (Salvia miltiorrhiza), Dan Pi (Moutan Cortex), Tao Ren (Peach Kernel), and Chi Shao (Red Peony) can enhance efficacy and prevent the formation of blood stasis.
When blood stasis leads to fever, it is classified as internal injury fever, which develops slowly and lingers, often resistant to treatment; the degree of fever varies depending on the location of blood stasis.
Clinically, formulas such as Xian Fang Huo Ming Yin, Qing Ying Tang, Xi Jiao Di Huang Tang, Qing Xuan Yu Re Tang, and Xi Ze Tang are used for differential treatment, effectively resolving stasis and promoting blood flow.
Xi Ze Tang is an empirical formula for treating chronic hepatitis B.
It consists of Guang Xi Jiao (Water Buffalo Horn Substitute), Ze Lan (Lycopus), Cang Zhu (Atractylodes), Xian Ren Dui Zuo Cao (Hedyotis), Tu Fu Ling (Smilax), Ping Di Mu (Pseudostellaria), and Bai Jiang Cao (Patrinia), functioning to clear heat, detoxify, and activate blood.
The pathological process of hepatitis B is similar to the transmission patterns of warm diseases such as warm epidemic and damp-warm, with the pathogenic factor entering from the outside.
Initially, symptoms often include chills and fever, indicative of Wei-level symptoms; as the condition progresses, symptoms of Qi, Ying, and Blood levels appear sequentially.
Chronic hepatitis B, which does not resolve over time, is often due to damp-heat toxins invading the Ying and Blood, characterized by its lingering nature and tendency to spread.
If treated from the Qi level, using herbs to soothe the liver and regulate Qi, and clear Qi and drain heat may be effective, but the results are often short-lived, and the disease is prone to recurrence.
Xi Ze Tang, primarily composed of Guang Xi Jiao (Water Buffalo Horn Substitute), Ze Lan, and Cang Zhu, clears the Ying and detoxifies, drains heat and expels dampness, while Bai Jiang Cao assists Xi Jiao and Ze Lan in cooling the blood and detoxifying; Xian Ren Dui Zuo Cao, Tu Fu Ling, and Ping Di Mu assist Cang Zhu in expelling dampness and resolving stagnation.
All herbs work together to achieve the effects of clearing the Ying, draining heat, expelling dampness, detoxifying, and activating blood.
Guang Xi Jiao (Water Buffalo Horn Substitute) and Cang Zhu have special efficacy for chronic hepatitis B.
Guang Xi Jiao (Water Buffalo Horn Substitute) not only cools the blood but also detoxifies; clinical findings show it is effective for patients with HBsAg positive hepatitis B and those with persistently elevated alanine aminotransferase levels;
Cang Zhu is a bitter and warm herb, essential for drying dampness; when used with Xi Jiao, it cools the blood without causing cold congealment, dries dampness without generating heat, and is adept at eliminating damp-heat evils from the Ying level.
After treatment with Xi Ze Tang, if the condition improves and HBsAg turns negative, to prevent recurrence, it is common to modify Xi Ze Tang into pill form and continue for 1-2 more treatment courses to consolidate the efficacy.
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Warming Channels and Activating Blood Method
Combining blood-activating herbs with warming interior herbs, suitable for conditions of cold congealing blood stasis.
Blood and Qi prefer warmth and dislike cold; warmth promotes flow, while cold causes congealment. Cold is a Yin evil, which has a constricting nature, capable of suppressing Yang and causing blood to congeal, leading to irregular circulation of blood and Qi.
The warming channels and activating blood method can restore Yang and dispel cold, thus promoting the resolution of stasis, and is indicated for conditions caused by internal cold evil or Yang deficiency with Yin congealment, leading to blood stagnation and symptoms such as cold extremities, thin and weak pulse, headaches, chest pain, abdominal pain, pale tongue with white coating.
Warming herbs such as Fu Zi (Aconite), Rou Gui (Cinnamon), Gui Zhi (Cinnamon Twig), Xian Ling Pi (Gynostemma), Xian Miao (Epimedium), and Ba Jiu Tian (Morinda) combined with blood-activating herbs can enhance the efficacy of activating blood and resolving stasis, while also stimulating and strengthening multiple systems in the body.
Thus, it often yields good results for difficult syndromes associated with congestive heart failure, sick sinus syndrome, coronary heart disease angina, chronic renal failure, pituitary insufficiency, stubborn asthma, scleroderma, infertility, and other functional deficiencies.
Common formulas include Shao Fu Zhu Yu Tang, Hua Yu Zan Yu Tang, Wen Jing Tang, and Dang Gui Si Ni Jia Wu Zhu Yu and Sheng Jiang Tang.
Hua Yu Zan Yu Tang is an empirical formula for treating male reproductive diseases.Male reproductive diseases are not only related to the kidneys but also to the liver.
The liver is Yin in nature and governs the smooth flow of Qi; it prefers to be unimpeded and dislikes stagnation. If emotional distress occurs, leading to liver Qi stagnation, prolonged Qi stagnation can cause blood flow to be obstructed, resulting in “the Yin organs not functioning”.
The kidneys and liver often influence each other physiologically and pathologically; the kidney’s storage and discharge depend on the liver’s smooth flow, while kidney essence deficiency can lead to liver blood insufficiency or Qi stagnation.
Therefore, warming the channels, tonifying the kidneys, activating blood, and soothing the liver are effective approaches for treating male reproductive diseases.
Hua Yu Zan Yu Tang uses Chai Hu (Bupleurum) and Zhi Qiao (Bitter Orange) to regulate Qi, while the Dang Gui Si Wu Tang activates blood and resolves stasis, balancing both Qi and blood, focusing on the liver; Shu Di Huang (Rehmannia) nourishes kidney essence, while Zi Shi Ying (Amethyst) tonifies kidney Yang, balancing Yin and Yang, focusing on the kidneys;
adding Jie Geng (Platycodon) and Niu Xi (Achyranthes) to promote urination and unblock the blood vessels, relieving liver Qi stagnation and resolving blood stasis, thus invigorating kidney Qi.
Used for treating male reproductive diseases such as impotence, infertility, premature ejaculation, testicular swelling and pain, and scrotal atrophy, especially effective for those with long-term use of kidney tonics that have become excessive.
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Activating Blood and Stopping Bleeding Method
Combining blood-activating herbs with hemostatic herbs, which have opposing yet complementary effects, suitable for blood stasis with bleeding.Whenever there is bleeding, there must be stasis of blood stagnating within the body; if stasis is not resolved, blood cannot flow through the meridians, leading to recurrent bleeding. Simply using hemostatic methods often proves ineffective.One must eliminate stasis to allow blood to return to its normal path, thus stopping bleeding naturally.Clinically observed symptoms such as coughing up blood, with purple-black or bright red clots, or blood in stools resembling lacquer, or hematuria with pain, or profuse bleeding from the skin, all indicate blood stasis with bleeding.Treatment should involve activating blood to stop bleeding, such as using hemostatic powders (e.g., Tu Da Huang (Rhubarb), Sheng Pu Huang (Cattail Pollen), Bai Ji (Bletilla)), to treat bleeding from gastric and duodenal ulcers; using Hua Rui Shi San to treat hemoptysis, hematochezia, and hematuria;using leech powder orally for cerebellar hematoma; using Sheng Pu Huang and San Qi to treat retinal hemorrhage;using Guan Zhong (Cynanchum) and Yi Mu Cao (Leonurus) to treat functional uterine bleeding; using Ma Bo (Morus) and Sheng Pu Huang externally for bleeding from the tongue, all embody the principle of activating blood and stopping bleeding.Difficulties in the hematopoietic system, such as aplastic anemia, leukemia, and thrombocytopenia, are often related to blood stasis; the recurrent bleeding seen in these diseases is a clear indication of blood stasis at work.Conditions such as liver and spleen enlargement, anemia, and systemic failure are also related to blood stasis, with internal stasis being a major cause of liver and spleen enlargement.Severe anemia and systemic failure resemble the TCM condition of Xu Lao, due to blood loss and sluggish circulation leading to blood stasis, resulting in the organs and meridians being deprived of nourishment, thus causing Xu Lao.I commonly use the method of activating blood and resolving stasis to treat difficult hematopoietic system diseases, focusing on differential diagnosis for cases with mixed deficiency and excess, cold and heat, and appropriately adding herbs such as Dan Shen (Salvia), Ji Xue Teng (Spatholobus), Dang Gui (Angelica), Tao Ren (Peach Kernel), Hong Hua (Carthamus), Chi Shao (Red Peony), San Leng (Sparganium), and E Zhu (Curcuma) for blood activation and stasis resolution;for cases with obvious blood stasis, I use the modified Dang Gui Si Wu Tang for treatment.This formula embodies the principle of resolving stasis while nourishing blood, combining tonification and purging, attacking without harming, and tonifying without congealing, achieving the effect of activating blood without harming the righteous Qi, and stopping bleeding without leaving stasis.If blood counts are low, I add Sheng Ma (Cimicifuga) to raise Yang, and Hu Zhang (Polygonum) to resolve stasis and lower turbidity; these two herbs work together to elevate and clear, stimulating the growth of Qi and blood;for cold limbs and weak Yang, I add Bu Gu Zhi (Psoralea), Rou Gui (Cinnamon), Lu Jiao (Deer Antler), and Niu Gu (Bone Marrow) to warm and tonify kidney Yang, stimulating bone marrow regeneration;for poor appetite and abdominal distension, I add Cang Bai Zhu (Atractylodes) and Tan Xiang (Sandalwood) and Sheng Mai Ya (Barley Sprout) to strengthen the spleen and stomach, promoting drug absorption, embodying the principle of “treating the middle jiao when there is damage above and below”.
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Activating Blood and Unblocking Collaterals Method
Combining blood-activating herbs with those that unblock collaterals, suitable for conditions of collateral obstruction due to stasis.
External factors such as the six excesses, internal injuries from emotional distress, dietary strain, and fatigue can all lead to Qi and blood stagnation, harming the meridians. When Qi and blood stagnate in the meridians, circulation becomes obstructed, leading to organ dysfunction.
Initially, Qi stagnation manifests as distension and pain without a clear form; over time, blood injury enters the collaterals, presenting as sharp pain with a clear form.
Due to collateral obstruction, residual blood stasis can lead to stubborn pain, accumulation, malaria, internal hernias, and other difficult syndromes.
I often use warm and pungent herbs such as Gui Zhi (Cinnamon Twig), Xiao Hui Xiang (Fennel), Wei Ling Xian (Clematis), and Qiang Huo (Notopterygium) in combination with blood-activating herbs.
These herbs can direct other herbs to the disease site to exert their effects, and most warm and pungent herbs have the properties of promoting Qi, warming the blood vessels, and facilitating the movement of Qi and blood, which is beneficial for eliminating Qi stagnation and blood stasis, and resolving collateral obstruction.
For chronic conditions with deepening collateral disease and hardened blood, general warm and pungent herbs may not be effective.
I follow Ye Tian Shi’s method of “using insects and ants to swiftly move and fly, allowing the flying ones to rise and the walking ones to descend, preventing blood from congealing and allowing Qi to circulate” by using leeches, scorpions, bee hives, and other insects to search and eliminate stasis in the collaterals, loosening the root of the disease.
Clinically, I often use blood-activating herbs as the base formula, supplemented with Jiang Can (Silkworm), Chan Yi (Cicada), and Bai Zhi (Angelica) to treat allergic rhinitis;
combined with Gui Zhi, Di Long (Earthworm), and Da Huang (Rhubarb) for treating multiple stenosing arteritis;
supplemented with Wu Ling Zhi (Flying Squirrel), Xiao Hui Xiang, and Rou Gui for treating women’s dysmenorrhea and infertility;
and I have created a formula called Xiao Liu Wan (Leech, Oyster, and Corydalis) for treating vascular tumors.
Long Ma Ding Tong Dan is used for stubborn pain, derived from Wang Qing Ren’s “Long Ma Zi Lai Dan”, originally used for treating epilepsy and paralysis.
After long-term clinical validation, I modified the formula composition and expanded the treatment scope, naming it “Long Ma Ding Tong Dan”, which has been used for over 30 years.
It has effectively treated over 2000 cases of rheumatoid arthritis, rheumatoid arthritis, gouty arthritis, cervical spondylosis, shoulder periarthritis, degenerative arthritis, Raynaud’s disease, and lumbar muscle strain, with satisfactory results.
Long Ma Ding Tong Dan consists of Ma Qian Zi (Strychnos), Wu Gong (Scorpion), Di Long (Earthworm), Quan Xie (Scorpion), and Zhu Sha (Cinnabar).
Ma Qian Zi is bitter, cold, and toxic, with effects of activating blood, unblocking collaterals, stopping pain, and reducing swelling; when stir-fried, its toxicity is reduced. Combined with Wu Gong for breaking blood and unblocking collaterals, and Quan Xie for dispelling wind and stopping pain, along with Di Long, which is adept at moving, it achieves the effects of activating blood vessels, resolving blood stasis, dispelling wind-dampness, and stopping pain.
Experimental studies have shown that Long Ma Ding Tong Dan has a strong analgesic effect on somatic pain, acting quickly and maintaining a long duration, making it a new type of compound analgesic.
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Activating Blood and Resolving Phlegm Method
Combining blood-activating herbs with phlegm-resolving herbs, suitable for conditions of phlegm-stasis intermingling.
It has long been said that “strange diseases often involve phlegm”; in fact, body fluids and blood share the same source. When the body loses its normal state, fluids can congeal into phlegm, and blood can congeal into stasis, leading to the intermingling of phlegm and stasis.
Clinically observed conditions such as coronary heart disease, hyperlipidemia, cerebrovascular disease, senile dementia, urinary stones, asthma, rheumatoid arthritis, and epilepsy often exhibit signs of phlegm-stasis intermingling.
Commonly used phlegm-resolving herbs include Ban Xia (Pinellia), Nan Xing (Arisaema), Chen Pi (Tangerine Peel), and Bai Jie Zi (White Mustard Seed).
Clinically, Sheng Ban Xia (Raw Pinellia) is especially commonly used; it can be used in medicine after washing with water, and when unprocessed, it is often combined with a small amount of ginger to mitigate its toxicity, achieving remarkable results in treating difficult diseases.
For example, using Sheng Ban Xia with Huang Lian (Coptis), Zhu Ru (Bamboo Shavings), and Sha Ren (Amomum) to treat stubborn vomiting; combining with Gan Jiang (Dried Ginger), Xi Xin (Asarum), and Wu Wei Zi (Schisandra) for treating cold-induced asthma; or pairing with Dan Shen, Chuan Xiong, and Jiang Xiang for treating epilepsy, each achieving satisfactory results.
“Strange diseases often involve stasis” and “strange diseases often involve phlegm” influence each other, so treatment must consider both, with pulse and tongue diagnosis guiding differential treatment.
If the patient is overweight, with a greasy and turbid tongue coating, sweet and sticky mouth, and a pulse that is deep, wiry, and slippery, treatment should focus on resolving phlegm, using formulas like Huang Lian Wen Dan Tang or Gua Lou Xie Bai Ban Xia Tang for modification;
If the patient has a dark complexion, cyanotic lips, purple tongue, masses and accumulations, and a pulse that is deep, slow, and rough, treatment should focus on activating blood, selecting formulas like Dang Gui Si Wu Tang or Xue Fu Zhu Yu Tang for modification.
If using Ban Xia, Fu Ling (Poria), Chen Pi, Zhi Qiao, Jie Geng, Dan Shen, Chuan Xiong, and Jiang Xiang to resolve phlegm, activate blood, and unblock the meridians for treating coronary heart disease angina;
using Tong Qiao Huo Xue Tang combined with Huang Lian Wen Dan Tang to activate blood, calm the spirit, resolve phlegm, and open the orifices for treating senile dementia; using Hu Zhang, Shan Zha (Hawthorn), Jue Ming Zi (Cassia Seed), and Cang Bai Zhu to expel phlegm turbidity from the blood for treating hyperlipidemia; or using Xue Fu Zhu Yu Tang with Bai Jie Zi and Gan Sui for treating urinary stones with hydronephrosis.
▶This article is excerpted from “Learning Clinical Practice from Renowned Teachers Series – Yán Déxīn”, authored by Yán Déxīn, published by China Medical Science and Technology Press, June 2010.Cover image source: Public Image Library.