The method of activating blood and resolving stasis can be categorized based on its strength of action into three types: He Xue Fa (Harmonizing Blood Method, the weakest), Huo Xue Fa (Activating Blood Method, moderately strong), and Po Xue Fa (Breaking Blood Method, the strongest). It can also be classified based on other actions and combinations. Below is an analysis and summary of Zhongjing’s treatment of blood stasis and related formulas. 1. Huo Xue Xing Qi Fa (Activating Blood and Moving Qi Method) is a method that combines Qi-moving herbs with blood-activating herbs to treat conditions caused by Qi stagnation leading to blood stasis or blood stasis obstructing Qi. For example, in the Jin Kui Yao Lue (Essentials of the Golden Chamber), it states: “Postpartum abdominal pain, fullness preventing lying down, use Zhi Shi Shao Yao San (Bitter Orange and Peony Powder).” Zhi Shi breaks Qi stagnation and resolves masses, while Shao Yao activates blood and alleviates pain. In this formula, Zhi Shi breaks Qi stagnation, and when fried black, it can move Qi in the blood; Shao Yao activates blood and alleviates pain; and barley porridge calms the stomach and harmonizes the middle. When Qi and blood are unblocked, symptoms such as abdominal pain and fullness (originally “满”, pronounced “mèn”) are resolved. Another example is the treatment of liver stagnation with Xuan Fu Hua Tang (Inula Flower Decoction). 2. Wen Yang Huo Xue Fa (Warming Yang and Activating Blood Method) is a method that combines warming Yang and dispersing cold herbs with blood-activating herbs. It is mainly used for conditions caused by external cold or internal Yang deficiency leading to blood stagnation. Common warming herbs include Gui Zhi (Cinnamon Twig), Rou Gui (Cinnamon), Fu Zi (Aconite), Gan Jiang (Dried Ginger), and Wu Zhu Yu (Evodia). Formulas such as Huang Qi Gui Zhi Wu Wu Tang (Astragalus and Cinnamon Decoction), Wen Jing Tang (Warming the Menses Decoction), and Zhi Shi Xie Bai Gui Zhi Tang (Bitter Orange, Chinese Chives, and Cinnamon Decoction) from the Jin Kui Yao Lue, as well as Dang Gui Si Ni Tang (Angelica Decoction for Frigid Extremities) and Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang (Angelica Decoction for Frigid Extremities with Evodia and Fresh Ginger) from the Shang Han Lun (Treatise on Cold Damage) belong to this category. 3. Jie Du Huo Xue Fa (Detoxifying and Activating Blood Method) is a treatment that combines heat-clearing and detoxifying herbs with blood-activating herbs. Zhongjing primarily uses this for conditions of internal stasis and toxicity, such as abscesses, yin-yang toxicity, and intestinal abscesses. Heat-clearing and detoxifying herbs include Sheng Ma (Cimicifuga), Gan Cao (Licorice), and Bai Jiang Cao (Patrinia). For example, in cases of intense heat toxicity leading to abscess formation, Chi Xiao Dou Dang Gui San (Red Bean and Angelica Powder) is used. In this formula, Chi Xiao Dou clears heat and detoxifies, promotes pus drainage; Dang Gui activates blood and dispels stasis; and clear liquid cools and detoxifies. For cases of intense Yang toxicity leading to abscess formation, Sheng Ma Bie Jia Tang (Cimicifuga and Soft-Shelled Turtle Decoction) is used to clear heat, detoxify, and disperse stasis. In this formula, Sheng Ma and Gan Cao clear heat and detoxify; Bie Jia and Dang Gui nourish Yin and disperse stasis; Xiong Huang and Shu Jiao detoxify. When intestinal abscesses have formed pus, Yi Ren Fu Zi Bai Jiang San (Job’s Tears, Aconite, and Patrinia Powder) is used to detoxify and drain pus, and activate blood to alleviate pain. The Jie Du Huo Xue Fa is often used in later generations for externally contracted febrile diseases, where heat enters the Ying and blood levels, leading to stasis and heat binding, or for conditions of internal heat toxicity and heat scorching blood stasis. Commonly used herbs include Ban Lan Gen (Isatis), Da Qing Ye (Isatis Leaf), Yin Hua (Honeysuckle), Lian Qiao (Forsythia), Hu Zhang (Japanese Knotweed), Bai Hua She She Cao (Hedyotis), Ban Zhi Lian (Scutellaria), Yu Xing Cao (Houttuynia), and Bai Jiang Cao (Patrinia), and formulas such as Jie Du Huo Xue Tang (Detoxifying and Activating Blood Decoction) have emerged. 4. Xie Re Tong Yu Fa (Draining Heat and Unblocking Stasis Method), also known as the method of draining heat and unblocking the bowels while breaking blood and dispersing stasis, combines heat-draining and bowel-unblocking herbs with blood-breaking and stasis-dispersing herbs. Commonly used heat-draining herbs include Da Huang (Rhubarb), Mang Xiao (Mirabilite), and Gan Sui (Euphorbia). This method can both activate blood and disperse stasis, as well as promote bowel movements, eliminate stagnation, and drain heat. When used appropriately, the therapeutic effect is significant and rapid. For cases of blood stasis in the lower jiao, Zhongjing frequently employs the method of unblocking the bowels and dispersing stasis, such as in the treatment of lower jiao bleeding, where the patient appears manic, with a hard (full) lower abdomen, using Tao He Cheng Qi Tang (Peach Pit Decoction) or Di Dang Tang (Rescue Decoction); for women with “water and blood both congealed in the blood chamber,” and a “lower abdomen full like a drum,” Da Huang Gan Sui Tang (Rhubarb and Euphorbia Decoction); for postpartum abdominal pain with “stagnant blood at the navel,” Xia Yu Xue Tang (Decoction to Disperse Blood Stasis); and for intestinal abscesses with “swelling and hardness in the lower abdomen, painful upon palpation, and pus not yet formed,” Da Huang Mu Dan Tang (Rhubarb and Peony Decoction). The Jie Du Huo Xue Fa and this method are both used to treat conditions of stasis and heat binding, but the former addresses stasis and heat that is widespread throughout the blood, treating it by clearing heat and detoxifying, moving blood and dispersing stasis, transforming stasis into formlessness; while the latter addresses stasis and heat that is localized in the lower jiao, treating it by purging the bowels, breaking blood, and dispersing stasis, allowing the stasis and heat to resolve from below. 5. Huo Xue Li Shi Fa (Activating Blood and Promoting Dampness Method) is used for conditions where dampness obstructs blood flow, leading to stasis; and blood stasis obstructs the flow of fluids, resulting in dampness. This method is suitable for conditions of dampness and stasis binding together. Generally, in blood-activating and stasis-resolving formulas, herbs that promote dampness elimination such as Fu Ling (Poria), Ze Xie (Alisma), Bai Zhu (White Atractylodes), and Yi Yi Ren (Job’s Tears) are added. For cases of female labor jaundice turning into black jaundice with dampness and heat stasis, Zhongjing treats with Shiao Shi Fan Shi San (Niter and Alum Powder), where Niter (fire niter) enters the blood to dispel stasis and activate blood, while Alum transforms dampness and promotes urination. Barley porridge is also used to nourish the stomach Qi. Another example is the treatment of “abdominal pain from various diseases” with Dang Gui Shao Yao San (Angelica and Peony Powder), where Shao Yao is heavily used to restrain the liver, harmonize the Ying, and alleviate pain, while Dang Gui and Chuan Xiong regulate the liver and activate blood, further combined with Fu Ling, Bai Zhu, and Ze Xie to strengthen the spleen and promote dampness elimination. 6. Huo Xue Zhi Xue Fa (Activating Blood and Stopping Bleeding Method) is a method that combines resolving stasis and stopping bleeding, used for treating conditions with internal blood stasis and external bleeding. Various internal and external factors causing blood stasis can lead to blood not following its normal course and overflowing, resulting in various types of bleeding. “If blood stasis does not move, then bleeding does not stop.” The Jin Kui Yao Lue states: “Heart Qi is unstable, leading to vomiting blood and nosebleeds; use Xie Xin Tang (Draining the Heart Decoction).” Chen Xiuyuan noted in the Shen Yi Jiu Fang that: “For treating vomiting blood that does not stop, I use the Jin Kui Draining the Heart Decoction, and it works every time. Its effectiveness lies in the abundance of Da Huang, which moves stasis.” The Xue Zheng Lun (Treatise on Blood Disorders) states: “Da Huang alone is both a Qi and blood herb, stopping bleeding without leaving stasis, making it a marvelous medicine.” Other examples include Chi Xiao Dou Dang Gui San for treating “first blood then stool” and Wang Bu Liu Xing San for treating bleeding from traumatic wounds, which also belong to this category. 7. Sou Ti Tong Luo Fa (Searching and Unblocking Collaterals Method) is a method that uses insect medicines such as Shu Chong (Various Insects), Shui Zhi (Leech), Mei Chong (Fly), Qiang Chong (Scarabaeidae), Feng Fang (Beehive), and Quan Xie (Scorpion) combined with blood-activating and stasis-resolving herbs, mainly used for treating blood stasis obstruction, especially in chronic cases with severe collateral stasis. Ye Tianshi in the Lin Zheng Zhi Nan Yi An believed that insect medicines: “Those that fly ascend, those that run descend, they are agile and swift, capable of chasing and dislodging the stagnant Qi and blood evil.” The Jin Kui Yao Lue states: “Five labors, extreme deficiency and emaciation, abdominal fullness preventing eating, injury from food, injury from worry, injury from drink, injury from sexual activity, injury from hunger, injury from labor, injury from Qi damage, internal blood stasis, skin and flesh disarray, dark eyes, and slow pulse; use Da Huang Jun Chong Wan (Rhubarb and Insect Pill).” This formula is a gentle remedy for chronic blood stasis, using Da Huang, Tao Ren, and Gan Qi to activate blood and resolve stasis, while Jun Chong, Shui Zhi, Mei Chong, and Qiang Chong search and dislodge the evil in the collaterals, enhancing the blood-activating power of Da Huang, Tao Ren, and Gan Qi; Shao Yao and Di Huang nourish blood and replenish Yin; Xing Ren regulates Qi; Huang Qin clears heat; Gan Cao and Bai Mi tonify Qi and harmonize. Because it is made into pills with honey, it is gentle in action, hence called “gentle in the middle”; when blood stasis is resolved, the Ying and Wei flourish, hence called “replenishing deficiency.” 8. Huo Xue Hua Zheng Fa (Activating Blood and Resolving Masses Method) refers to pathological masses that are tangible and palpable, also known as Jie (mass) or Jia Ji (accumulation). The method of activating blood and resolving masses, also known as the method of activating blood and softening hardness, or activating blood and resolving nodules, often uses herbs such as Bie Jia (Soft-Shelled Turtle Shell), Mu Li (Oyster Shell), San Leng (Sparganium), and E Zhu (Curcuma) combined with blood-activating and stasis-resolving herbs. If phlegm and stasis are mutually binding, herbs such as Hai Zao (Sargassum), Kun Bu (Kelp), Bei Mu (Fritillaria), and Xia Ku Cao (Selfheal) are added. The Jin Kui Yao Lue states: “For malaria… if it is not mistaken… this mass is called Jie, named the mother of malaria, treat it urgently with Bie Jia Jian Wan (Soft-Shelled Turtle Pill).” In this formula, Bie Jia is the main herb for treating abdominal masses and accumulations, with cold and heat as the main herbs, while Da Huang, Tao Ren, Dan Pi, Shao Yao, and Zi Wei resolve stasis and unblock stagnation, while Shu Fu, Jun Chong, Beehive, and Cockroach eliminate hardness and kill insects, and Gui Zhi, Sheng Jiang, Fa Xia, Hou Po, Chai Hu, Huang Qin, and Wu Shan (Belamcanda) regulate Qi, transform phlegm and dampness, while Shi Wei, Ting Li Zi, and Qu Mai promote urination, and Ren Shen and E Jiao tonify Qi and blood, with ash from the stove as the main herb for treating masses and accumulations, using clear wine to enhance the medicinal effect. The Jin Kui Yao Lue also states: “For women with a history of masses, if menstruation has not resumed for three months and there is continuous bleeding… use Gui Zhi Fu Ling Wan (Cinnamon and Poria Pill).” This formula uses Gui Zhi and Shao Yao to harmonize the blood vessels, Dan Pi and Tao Ren to resolve stasis and masses, and Fu Ling to strengthen the spleen and tonify Qi, made into pills with honey, and taken in small doses, aiming to resolve masses without harming the upright Qi.
Yangming Interior Excess with Shaoyang Syndrome (Da Chai Hu Tang)
Clinical Combination of Zhen Wu Tang (below)