Chapter Eleven. Syndrome of blood stagnation and formula composition
CHAPTER OUTLINE
This chapter introduces the principles, methods and strategies for the composition of formulas that regulate blood circulation and remove congealed blood. They are used to treat blood stagnation.
If the physiological conditions are not fulfilled, the blood may stagnate. There are different degrees of blood stagnation. In a mild case, the blood moves slower than it should. If the situation does not change, blood stagnates. In a severe case, congealed blood may be complicated by phlegm, heat or cold, and forms a solid mass that blocks the circulation.
The main manifestation of blood stagnation is localized pain of a deep, sharp and piercing nature. Patients who have suffered from stagnation of blood for a long period of time may have such symptoms as a dark complexion, purple lips and nails, fragile nails and hair, and dry skin, and some may suffer from mental confusion. In women, menstruation disorders may be present.
Blood stagnation is caused by several factors:
• Heat may overstimulate the blood circulation, hasten its speed and even cause bleeding.
• Heat can consume the fluid in the blood and make the blood thicker so that the blood movement becomes slower.
• Cold may freeze the blood, allow the circulation to slow down and eventually cause stagnation.
• Blood stagnation is often the result of Qi stagnation, which is frequently caused by emotional disturbance, such as stress, anger, brooding or depression for a long period.
• Trauma or fracture may cause blood stagnation directly in the local area.
• Wind, dampness and cold that lodges in the meridians can also cause blood stagnation, as can accumulation of phlegm, water, food and parasites in the body for a long period of time.
• If the Qi and blood are deficient, they will not be able to promote the blood circulation, and this too will lead to blood stagnation.
CAUTIONS
1. Caution during pregnancy and in bleeding conditions:
Herbs that promote the blood circulation are pungent; they can make the blood circulate quickly, break up congealed blood or soften hardness. These actions may harm the fetus, causing miscarriage and heavier bleeding.
2. Use with caution in patients with weakness of the Spleen and Stomach and deficiency of Qi:
Formulas that promote blood circulation are quite strong in action and have strong smells and tastes that can easily injure the Stomach and place an extra burden on the Spleen. These formulas should therefore be taken after meals, especially in patients with a sensitive stomach. Moreover, since these formulas are very active in stimulating the blood circulation, they may also consume Qi and patients may feel tired. They should be applied with caution, especially among patients who are already suffering from Qi deficiency.
3. Select appropriate herbs from the strength scale to compose a formula for treating a specific syndrome of blood stagnation:
If the stagnation is severe and the applied herbs are too gentle, the congealed blood cannot be eliminated. If the blood stagnation is mild but the prescribed formula is very strong, the Qi and blood can be injured. Thus, appropriate herbs should be selected from the strength scale to compose a formula for treating a specific syndrome of blood stagnation. Furthermore, appropriate herbs should be selected according to the condition and constitution of the patient, the location and nature of the stagnation and the duration of the disease.
4. Be careful when using these herbs together with anticoagulants from western medicine.
Syndrome of blood stagnation
Manifestations
Main symptoms
Localized pain of a deep, sharp and piercing nature, worsening in the night, and a palpable, solid, immobile mass in severe cases.
Secondary symptoms
Dark complexion, purple lips and nails, fragile nails and fragile and dry hair, dry skin, amenorrhea, dysmenorrhea, irregular menstruation, mental confusion and mental disorders.
Tongue
A purple tongue with purple spots on the tip or border.
Pulse
Wiry and choppy.
Associated disorders in western medicine
Rheumatic arthritis, rheumatoid arthritis, trauma, strain, myocardial infarction, angina pectoris, sequelae of cerebrovascular accident, chronic hepatitis, cirrhosis of the liver, enlarged spleen, various tumors, as well as psychiatric disorders.
Analysis of the syndrome
• Pain is the first and most important sign of blood stagnation. Different from distending pain due to Qi stagnation, blood stagnation is manifested as a localized, deep, sharp pain.
• When congealed blood is formed and the blood circulation has become slow, the patient may have a dark complexion, purple lips and nails, and menstruation becomes irregular.
• When the blood is not able to nourish the body, dry skin, brittle nails, fragile and dry hair may be present.
• If the blood stagnation stays for a long period of time, in severe cases congealed blood may be complicated by phlegm, heat or cold. These can eventually form a solid mass. The masses can be tumors or enlarged, hard organs.
• Since the blood cannot circulate smoothly, a choppy pulse can be felt, and a purple tongue with purple spots can be observed, especially on the tip or border, the region of the Heart and Liver.
(See Figure 11.1 on page 284.)
Treatment principle: Activate the blood circulation, promote Qi movement and remove congealed blood
Herb selection principles and formula composition strategies
• First, herbs that are pungent, aromatic and slightly warm, enter the Heart, Pericardium, Liver and Gall Bladder meridians, and can stimulate the blood circulation are selected.
• If there is heat in the blood with blood stagnation, the first priority is to select pungent, bitter and slightly cold herbs that enter the Heart, Pericardium, Liver and Gall Bladder meridians, and can circulate the blood and clear heat.
• In the condition of stagnation of congealed blood for a long period of time, the first priority is to select pungent, bitter and salty herbs that can particularly soften hardness, along with herbs that promote blood circulation.
• Second, herbs that regulate the Qi in order to promote blood circulation are often used.
• Third, herbs that eliminate phlegm and dampness or expel the wind from meridians are also often used to assist the herbs that promote blood circulation and Qi movement.
• Herbs that can warm the interior and tonify the weakness of the internal organs are often used in a deficiency syndrome.
• Herbs that nourish the blood and Yin and herbs that tonify the Qi are often used in chronic conditions of blood stagnation.
• Finally, herbs that protect the Stomach from the side effects of harsh herbs that strongly stimulate the blood are often prescribed.
Structure of the formula and selection of herbs
Chief and deputy: Regulate the blood circulation and remove congealed blood by selecting appropriate herbs according to their strength and working region
A number of herbs can directly circulate the blood and remove congealed blood. In a formula, one or two herbs in reasonably large dosages are chosen as chief. They act directly against the cause of the stagnation and they reach to the affected region. To prevent side effects and to enhance the ability of the chief, herbs that move the blood should be chosen as deputies.
For convenience, the chief and deputy substances are discussed together in the following groups according to their strength of function, their nature and their particular influence on a certain region.
(A). Selection according to strength in function and nature
Chuan Xiong ( Chuanxiong rhizoma), Yan Hu Suo ( Corydalidis rhizoma), Hong Hua ( Carthami flos) and Yue Ji Hua ( Rosae chinensis flos)
These herbs can invigorate blood and promote blood circulation. They are warm in nature. The herbs in this group are used widely in different types of disorder caused by blood stagnation. Most are effective for relieving pain and some can be used topically.
Chuan Xiong is pungent and warm, and enters the Liver, Gall Bladder and Pericardium meridians. Chuan Xiong is a very effective herb to invigorate the blood and to promote the blood circulation. It is characterized by fast-moving speed and strength. As it moves upwards, downwards, inwards and outwards, and can reach every part of the body, it is regarded as the herb that moves the Qi in the blood. In a formula, it is often selected to promote blood circulation and stop pain caused by Qi and blood stagnation complicated by cold, such as headache on the lateral side of the head, intercostal neuralgia, chest pain, pain from trauma, pain in the joints, dysmenorrhea, amenorrhea and irregular menstruation. Since Chuan Xiong is very effective, it is often used as chief. In combination with other herbs, it can be used in syndromes of excess, deficiency, cold or heat.
Although Chuan Xiong is effective in promoting blood circulation, it can lead the Qi and blood to ascend rapidly and therefore it should be used with caution in patients who suffer from syndromes of Liver-Yang ascending, up-flaring of Liver-fire or Heart-fire, such as hypertension, glaucoma and cerebrovascular accident. Moreover, since this herb is warm and very pungent, a large dosage may consume the Yin and Qi, and patients with Yin deficiency or with a weak constitution should not use this herb in large dosage.
Yan Hu Suo is pungent, warm and slightly bitter. It is characterized by entering the Qi and blood level, and promoting the Qi movement and blood circulation. It is an excellent herb to relieve pain and this effect is stable and strong. In clinical practice, it can be used as a single herb, and in Chinese medicine it is considered to be a painkiller. If this herb is fried with a little vinegar, pain relief is even stronger. Yan Hu Suo is slightly poisonous and therefore should not be used for too long. It is recommended for use in a formula where it can obtain assistance from other herbs, especially in the treatment of a chronic condition of blood stagnation.
Hong Hua is pungent and warm, and enters the Heart and Liver meridians. It is able to invigorate the blood and promote the blood circulation. If a small dosage is applied, it can regulate the blood circulation; if a large dosage is applied, it can break up the congealed blood and stop pain. It can be used as chief or deputy in a formula for different types of blood stagnation, such as endometriosis, amenorrhea, dysmenorrhea, irregular menstruation and infertility. Since it can strongly move the blood, it may cause bleeding or make bleeding heavier, thus the dosage and treatment course should be controlled carefully. During menstruation, this herb should be used in a smaller dosage or should be stopped for 3 days to avoid heavy menstrual bleeding.
As well as treating menstruation disorders, Hong Hua is one of the commonly used herbs for treating trauma as it is effective for reducing swelling and pain. In these cases, it can be used both orally and topically.
Yue Ji Hua is sweet and warm. It has a fragrant smell and enters the Liver meridian. It regulates not only the blood circulation, but also the Liver-Qi movement. It is often used as deputy in a formula to harmonize Qi and blood of the Liver and it particularly treats menstruation disorders.
Dan Shen ( Salviae miltiorrhizae radix) and Chi Shao Yao ( Paeoniae radix rubra)
These herbs are cold in nature and can invigorate blood. They promote blood circulation, relieve pain and can also be used topically.
Dan Shen is bitter and slightly cold, and enters the blood level of the Heart and Liver meridians. It is able to promote the blood circulation, cool the blood, calm the mind and eliminate irritability. It is especially suitable for treating the syndrome of blood stagnation complicated by heat. The syndrome is often caused by stress and emotional disturbance, which lead to stagnation of Liver-Qi or generation of heat in the Liver and Heart. It is selected in formulas to treat chest pain, hypochondriac pain, heartburn, depression, irritability, insomnia and restlessness. It is also an important herb for treating gynecological disorders due to heat and blood stagnation, such as dysmenorrhea, irregular menstruation, premenstrual tension syndrome and menopause syndrome.
Chi Shao Yao is sour, bitter and slightly cold. It is characterized by reducing the excess heat in the blood and regulating the blood circulation. It can also reduce swelling and pain and is often used in formulas to treat abscesses, furunculosis, appendicitis, intestinal obstruction and dysmenorrhea. It can be used topically to treat pain and swelling due to trauma.
Wu Ling Zhi ( Trogopterori faeces), Ze Lan ( Lycopi herba), Yue Ji Hua ( Rosae chinensis flos), Dan Shen ( Salviae miltiorrhizae radix), Yu Jin ( Curcumae radix) and Yi Mu Cao ( Leonuri herba)
The herbs in this group can be selected as chief and deputies to dissolve congealed blood; they can also stimulate blood circulation. They are mainly used to treat the more severe or chronic syndromes of blood stagnation where the blood becomes thicker and blood clots are formed, such as in atherosclerosis, hyperlipemia, thrombosis, endometriosis, adhesions in chronic infection and after surgical operations.
The herbs that are warm in nature are Wu Ling Zhi, Ze Lan and Yue Ji Hua; the herbs that are cold in nature are Dan Shen, Yu Jin and Yi Mu Cao. They can be used when cold or heat respectively is in the blood.
Wu Ling Zhi is bitter, sweet and warm. The strong point of this substance is that it can dissolve congealed blood in a gentle but constant way. As it is effective for removing congealed blood without the side effect of injuring the normal part of the blood, it is used for chronic diseases when the congealed blood is not easily removed in a short period of time. Wu Ling Zhi can also promote blood circulation and stop pain. It is often prescribed in formulas for treating gynecological disorders and liver diseases.
Ze Lan is pungent and bitter, and enters the Liver and Spleen meridians. It is slightly warm and is able to promote blood circulation and open obstructions. It is characterized by removing congealed blood without the side effect of injuring the normal blood, and it is especially suitable for treating stagnation of blood caused by cold in the Lower-Jiao and in blood. As it is an aromatic herb and is able to spread the Liver-Qi and the Spleen-Qi, it is an excellent herb to treat stagnation of Liver-Qi and blood in both excess and deficiency conditions. It is often used as deputy in the formula to treat menopause syndrome, irregular menstruation, premenstrual tension syndrome, depression, liver disease and chronic urinary tract infection.
Yue Ji Hua is sweet and warm, has a fragrant smell and enters the Liver meridian. It not only regulates the blood circulation, but also dissolves congealed blood. Moreover, it can regulate the Liver-Qi. This herb is often used as deputy in a formula to regulate Qi and blood, and to reduce congealed blood in a gentle way. It is often used for menstruation disorders and liver diseases.
Dan Shen is bitter and cold, and primarily enters the Heart meridian. It cools the blood and moderates the speed of blood circulation. It is especially effective for clearing heat in the Heart and promoting the blood circulation in the chest. It is often selected in a formula to treat heat and blood stagnation in the chest, manifested as irritability, restlessness, palpitations, insomnia and chest pain. Dan Shen can also remove congealed blood, and is used for treating more severe conditions, such as myocardial infarction, angina pectoris, atherosclerosis, hyperlipemia and thrombosis. It is also used to treat hepatosplenomegaly because it can soften the organs, reduce their size and improve their functions.
Yu Jin primarily enters the Liver meridian, on which its function focuses. It is pungent, bitter and cold, and is able to invigorate the Liver-blood. Because of the high speed of its action, it is regarded as the herb that moves the Qi in the blood and is considered as the herb that is able to break up congealed blood. Moreover, Yu Jin can cool the blood and stop bleeding. Together with other herbs, it can be used as chief or deputy in a formula to break up and remove congealed blood and stop bleeding. It is used for dysmenorrhea, mastopathy, liver cirrhosis and tumors, as well as bleeding due to Liver heat.
As well as the above-mentioned functions, this herb has other functions that can be used as a reference in selecting herbs in a formula. It is an aromatic herb, and is able to penetrate damp-heat, clear damp-heat and promote bile secretion. It can be used as deputy in a formula when there is damp-heat in the Upper- and Middle-Jiao, the symptoms of which are fullness in the chest and epigastric region, jaundice and reduced appetite, such as in malaria and hepatitis. In addition, Yu Jin can spread the Liver-Qi, clear the Liver-heat and eliminate irritability. It can be selected to treat headache and a tight sensation in the chest caused by Qi and blood stagnation and damp-heat obstruction.
Yi Mu Cao specifically treats stagnation of blood in the Lower-Jiao and is often used as deputy to treat gynecological disorders, such as dysmenorrhea, amenorrhea and irregular menstruation. It is used frequently to clear heat and remove congealed blood from the Lower-Jiao, thus it is often used in acute and chronic infections and inflammations in that region, such as cervicitis and adnexitis.
Tao Ren ( Persicae semen), Hong Hua ( Carthami flos), Yu Jin ( Curcumae radix), Ru Xiang ( Olibanum) and Mo Yao ( Myrrhae)
The substances in this group are able to break up congealed blood . They are also used to treat severe and chronic blood stagnation when congealed blood is present in the body for a long period of time. The congealed blood becomes a hard clotted or solid mass, such as a tumor or swollen glands. These substances are used in trauma when there is acute and severe blood stagnation with pain. They are pungent, salty or bitter in property.
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