Chapter Eleven. Herbs that regulate the Blood
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1. What are the causes of Blood stagnation? What are the indications for herbs that promote the Blood circulation?
Herbs that promote the Blood circulation are used for treating syndromes of Blood stagnation. There are different degrees of Blood stagnation. In a mild case, the Blood moves more slowly than it should. If the situation does not change, the Blood stagnates. In a severe case, congealed Blood may be complicated with Phlegm, Heat or Cold, and forms a solid mass that blocks the Blood circulation.
Blood stagnation is caused by several factors. First, both Heat and Cold can lead to Blood stagnation. Heat consumes the Blood and makes it thicker so that the movement of the Blood slows; Cold contracts Blood and lets the Blood circulation slow down. Secondly, Qi stagnation caused by emotional disturbance, stress, anger, excessive pondering or depression over a long period of time can directly result in Blood stagnation. Thirdly, trauma or fracture may directly cause Blood stagnation in the locality. Moreover, Wind, Dampness and Cold that remain for too long in the meridians can also cause Blood stagnation. Accumulation of Phlegm, water, food or parasites in the body for a long period of time may also lead to Blood stagnation. Finally, if the Qi and Blood are deficient, they are not able to promote the Blood circulation so they will also lead to Blood stagnation.
The main symptoms of Blood stagnation are localized pain of a deep, colicky or sharp nature that worsens at night. In severe cases, a solid, immobile mass can be found. Patients who suffer from stagnation of Blood for a long time may have symptoms such as a dark complexion, purple lips and nails, dry skin, amenorrhea, psychiatric disorders, fragile nails and hair. The tongue body is purple with purple spots at the tip or border, and the pulse is wiry and choppy.
In clinical practice, the syndrome of stagnation of Blood can be found in diseases such as myocardial infarction, angina pectoris, acute cholecystitis, biliary ascariasis, acute pancreatitis, acute appendicitis or intestinal obstruction, trauma, strain, sequelae of cerebrovascular accident, rheumatic fever and rheumatoid arthritis, as well as different tumors.
2. What are the characteristics of herbs that promote the Blood circulation?
The Blood circulation needs certain conditions. Blood prefers slight warmth and needs an unobstructed pathway. Too much Cold or Heat may cause pathological changes. Cold can freeze the Blood and results in stagnation. Heat consumes Blood and makes it thicker, so also causes stagnation. Meanwhile, Heat lets the Blood move faster and leave its normal pathway, causing bleeding.
Herbs that promote Blood circulation have the following characteristics according to the physiologic and pathological characteristics of Blood.
Pungent, aromatic and slightly warm
Pungency has a moving ability, aromatic smell can penetrate turbidity and reach the deep layers of the body, and warmth may accelerate the actions of the pungent and aromatic properties. Most herbs that promote the Blood circulation are pungent and slightly warm. Such herbs are Chuan Xiong ( Chuanxiong rhizoma), Ji Xue Teng ( Spatholobi caulis et radix), Hong Hua ( Carthami flos), Su Mu ( Sappan lignum), Yan Hu Suo ( Corydalidis rhizoma), Wu Ling Zhi ( Trogopterori faeces), Ru Xiang ( Olibanum) and E Zhu ( Curcumae rhizoma).
Pungent, bitter and slightly cold
Since pungency is able to activate the Blood, and bitterness and Cold can clear Heat and prevent Blood consumption from Heat, these herbs are especially suitable for treating Heat in the Blood and Blood stagnation no matter which pathological factor is the initial cause. The commonly used herbs are Dan Shen ( Salviae miltiorrhizae radix), Yu Jin ( Curcumae radix), Yi Mu Cao ( Leonuri herba) and Chi Shao Yao ( Paeoniae radix rubra).
Pungent, bitter and salty
If congealed Blood exists in the body for a long period of time, it becomes a hard clot or solid mass, and special herbs must be applied to promote Blood circulation as well as to reduce, disperse or dissolve congealed Blood. Since pungency has a dispersing nature, and bitterness and saltiness are able to soften hardness, these properties are often found in herbs that break up or drive out congealed Blood. Such herbs are San Leng ( Sparganii rhizoma), E Zhu ( Curcumae rhizoma), Ru Xiang ( Olibanum), Mo Yao ( Myrrhae), Wa Leng Zi ( Arcae concha), Shui Zhi ( Hirudo), Mang Chong ( Tabanus)* and Zhe Chong ( Eupolyphaga seu opisthoplatia)*.
Entering the Heart, Pericardium, Liver and Gall Bladder meridians
The Heart governs the Blood and promotes the Blood circulation. The Liver regulates the amount of Blood in the Blood circulation. As the Pericardium and Gall Bladder are externally–internally related to the Heart and Liver, most of the herbs that promote Blood circulation enter these meridians. Such herbs are Chuan Xiong, Dan Shen, Yue Ji Hua ( Rosae chinensis flos), Tao Ren ( Persicae semen) and Hong Hua.
Herbs are divided into different degrees according to the strength of promoting the Blood circulation and removing congealed Blood
Herbs that invigorate the Blood and promote the Blood circulation
These are used for the syndrome of Blood stagnation. The commonly used herbs are Chuan Xiong, Dan Shen, Yue Ji Hua, Yan Hu Suo ( Corydalidis rhizoma) and Hong Hua.
Herbs that dissolve and dissipate congealed Blood
These are used to treat more severe or chronic syndromes of Blood stagnation, in which the Blood becomes thicker and blood clots are formed. The commonly used herbs are Wu Ling Zhi, Dan Shen, Yu Jin, Ze Lan ( Lycopi herba), Yi Mu Cao ( Leonuri herba) and Yue Ji Hua.
Herbs that open the meridians and collaterals and dissolve congealed Blood
These are used to treat chronic Blood stagnation when the meridians and collaterals are blocked for a long period of time. They are particularly used in chronic Bi syndrome. The commonly used herbs are Si Gua Luo ( Luffae fructus), Wang Bu Liu Xing ( Vaccariae semen) and Lu Lu Tong ( Liquidambaris fructus).
Herbs that break up and drive out congealed Blood
These are used to treat severe Blood stagnation, in which a solid and immobile mass is formed. The commonly used herbs are Tao Ren, Ru Xing, Mo Yao, San Leng ( Sparganii rhizoma) and E Zhu.
Herbs that soften hardness and break up or drive out congealed Blood
These are used to treat a solid mass that is formed by congealed Blood, Phlegm, Dampness, Cold or Heat and toxin. The commonly used herbs are Mu Li ( Ostrea concha), Wa Leng Zi ( Arcae concha), Shui Zhi ( Hirudo), Zhe Chong ( Eupolyphaga seu opisthoplatia)* and Mang Chong ( Tabanus)*.
Relieving pain
The pathology of pain in TCM is blockage of the Qi and Blood. Chronic, deep and stubborn pains especially are caused by Blood stagnation; herbs that promote Blood circulation are able to reduce Blood stagnation and open up the meridians, thus relieving pain. The herbs that are particularly effective for relieving pain are Yan Hu Suo, Chuan Xiong, Wu Ling Zhi and Pu Huang ( Typhae pollen).
Topical usage
Trauma directly causes stagnation of Blood, manifesting as pain, swelling or bleeding in the locality. Herbs that promote Blood circulation are the main part of the treatment when the bleeding has stopped. These herbs can be used not only orally but also topically, such as in lotions, ointments, tinctures and plasters. The commonly used ones are Tao Ren, Hong Hua, Ru Xiang, Chuan Xiong and Dan Shen.
Usage for Bi syndrome
When Wind, Dampness, Cold or Heat invades the meridians, they block the Qi and Blood circulation. Herbs that promote Blood circulation can enhance the actions of the other herbs of expelling Exterior pathogenic factors. In chronic Bi syndrome, there is always Blood stagnation, so the herbs that regulate the Blood are often used in formulas. The commonly used herbs are Chuan Xiong, Su Mu ( Sappan lignum), Chuan Niu Xi ( Cyathulae radix) and Jiang Huang ( Curcumae longae rhizoma).
3. What precautions should be observed when using herbs that promote the Blood circulation?
Herbs that promote the Blood circulation should not be used during pregnancy, in bleeding conditions or during profuse menstruation. Because these herbs are pungent, they let the Blood circulate quickly, and break up congealed Blood or soften hardness. These actions may cause miscarriage and cause heavier bleeding.
Herbs that promote Blood circulation can be used with caution in the following conditions.
Heavy menstruation, miscarriage and bleeding caused by stagnation of Blood
There is a saying: ‘If the congealed Blood is not removed, the new Blood is impossible to grow. If the congealed Blood is not removed, the Blood cannot turn back to the normal pathway in the bleeding conditions.’ Herbs that promote the Blood circulation can be used for the purpose of stopping bleeding, such as that seen in ectopic pregnancy, pregnancy with metropolypus or uterus myomatosus, adenomyosis or bleeding of a tumor. However, the dosage and course of treatment must be controlled by experienced practitioners.
Patients with weak Spleen and Stomach
As all herbs that promote Blood circulation are quite strong in taste and easily injure the Stomach, the herbs should be taken after meals, especially in patients with chronic Bi syndrome, who have already used Western medicine for a long time, or whose Stomach has been injured too.
Patients with weakness of Qi
Herbs that invigorate the Blood circulation may also activate the Qi movement and these actions can consume the Qi. The herbs should not be used alone when patients suffer from Qi deficiency. The side-effect of herbs that move the Blood is manifested as tiredness after using these herbs. In this situation, herbs that strengthen the Qi and Blood should also be used.
Selecting proper herbs from the strength scale to treat a specific case of Blood stagnation
It is very important to select the correct herbs from the strength scale to treat syndromes of Blood stagnation. If the stagnation is severe, and the applied herbs are too gentle, the congealed Blood will not be eliminated. If the Blood stagnation is mild but the prescribed herbs are very strong, the Qi and Blood can be injured.
The proper herbs should be selected according to the condition and constitution of the patient, the location and nature of the stagnation of Blood, and considering the duration of the disease.
4. What are the characteristics of Chuan Xiong ( Chuanxiong rhizoma)?
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