Aetiology Pathology and Treatment of Blood Stasis PDF

AETIOLOGY, PATHOLOGY AND TREATMENT OF BLOOD STASIS
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Copyright Giovanni Maciocia
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Why are we discussing Blood stasis?
Blood stasis is a major pathogenic factor that is responsible for

very many serious diseases. It is a pathogenic factor that is
particularly frequent in chronic Western diseases, in
inflammatory diseases and in autoimmune diseases.
Moreover, Blood stasis is present in major Western diseases

such as cancer, heart disease and stroke. In all these diseases,
Blood stasis is frequently (but not always) combined with
Phlegm.
Another reason Blood stasis is so important is that the Blood-

invigorating herbs have a very interesting pharmacology (see
later slide).
I think one reason Blood stasis may be underestimated is

terminology, i.e. using the term “Blood-moving” herbs which
seems to imply that they simply “move” Blood. This will also
be discussed soon.
I will first discuss the aetiology, pathology, diagnosis and treatment
of Blood stasis in general. After that, I will discuss the treatment of
certain diseases but only when they are caused by Blood stasis. The
diseases discussed are:
Chest Bi
Goitre
Benign Prostatic Hyperplasia
Erectile dysfunction
Endometriosis
Myoma
Infertility
Cancer
Please note that these diseases will be discussed only in the context
of Blood stasis.
When these diseases are caused by Blood stasis they share certain
common characteristics, which are:
Chronic stage
Hardness, masses
Pain (but not always)
Dark colour, purple
Purple tongue (but not always)
Wiry, Choppy or Firm (Confined, Lao) pulse
For each of the above diseases, Blood stasis is only one of the
patterns, there are many others, e.g. Dampness in Benign Prostatic
Hyperplasia, Kidney deficiency in Erectile Dysfunction, Phlegm in
infertility, etc.
BLOOD STASIS
Blood stasis is a common and damaging pathogenic factor that is at the

root of many serious diseases.
A characteristic of Blood stasis is that it can only occur after a prolonged

period of time: thus, it is always a relatively serious pathogenic factor
and one that leads to more serious diseases than Qi stagnation: for
example, coronary heart disease, abdominal masses, tumours, high blood
pressure, stroke, etc.
By definition, Qi stagnation cannot, by itself, cause any of the above

problems. Thus, whenever we see signs of Blood stasis, we know that
the condition is one of long duration and the prognosis is less good than
that for Qi stagnation.
Blood stasis occurs after a prolonged time, but there are two
exceptions: surgery and trauma from accidents.
Much more important than Qi stagnation.

1. AETIOLOGY
Blood stasis never arises independently (like Qi stagnation) but is always the
consequence of other conditions, usually after a long period of time. Thus,
there are no aetiological factors (diet, emotions, etc.) that give rise to Blood
stasis directly and by themselves. The following are the conditions leading to
Blood stasis, with the main organs involved:
• Qi stagnation – Liver and Heart
• Internal Cold – Uterus, Stomach and Heart
• Heat or Fire – Stomach, Intestines, Heart, Liver, Uterus
• Qi deficiency – Stomach and Heart
• Blood deficiency – Uterus, Heart and Liver
• Phlegm – Stomach, Intestines and Uterus

QI STAGNATION
INTERNAL COLD
HEAT OR FIRE
BLOOD STASIS
PHLEGM
QI DEFICIENCY
BLOOD
DEFICIENCY
QI STAGNATION
INTERNAL COLD
HEAT OR FIRE
PHLEGM
QI DEFICIENCY
BLOOD
DEFICIENCY
2. PATHOLOGY
Blood is related to Qi and to Body Fluids. It is related to Qi first of all because

Blood itself is a (dense) form of Qi and secondly because it relies on Qi for its
movement. “Qi is the commander of Blood; when Qi moves, Blood moves.
Blood is the mother of Qi; where Blood goes, Qi goes”.
On the other hand, Blood is part of Body Fluids and is formed from them (with
the participation of Gu Qi). Thus, both Qi and Body Fluids pathology may
play a role in Blood stasis.
Qi is commander of
Blood
Blood Body
Qi
Blood is mother
Fluids
of Qi
For example, Qi stagnation is a very common cause of Blood stasis
Qi is commander of Blood
Qi Blood
Qi Blood
Qi stagnates, Blood stagnates
A pathology of Body Fluids, such as Phlegm, may also lead to

Blood stasis.
Blood Body Phlegm Blood stasis

Fluids
Interchange between Blood and Body Fluids pathology

Body Fluids
Another pathology of Body Fluids leading to Blood stasis
occurs when Heat or Fire condense the Body Fluids and make
the blood more dense, leading to Blood stasis.
Body Blood BLOOD

HEAT Fluids
Condenses STASIS
Body Fluids
a) QI STAGNATION
This is the most common cause of Blood stasis: since Qi is the commander of
Blood and Blood relies on the pushing action of Qi for its movement, any Qi
stagnation may lead to Blood stasis after some time.
Liver-Qi stagnation is the most common cause of Blood stasis but other organs
may also be involved and Qi stagnation in an organ may induce Blood stasis in
another.
For example, Heart-Qi stagnation may also lead to Heart-Blood stasis; Liver-Qi
stagnation may lead to Liver-Blood stasis and this, in turn, to Heart-Blood
stasis. Liver-Blood stasis may also influence the Uterus and the Intestines.
LIVER
HEART HEART-
LIVER-QI HEART-QI
STAGNATION BLOOD
STAGNATION
STASIS
UTERUS
Leads to Blood stasis in

INTESTINES
b) INTERNAL COLD
Internal Cold may be full or empty. Full Cold arises from invasion of
external cold and it may settle in the Stomach, Intestines or Uterus where it
may last for some years. Eventually, it will inevitably injure the Yang and
lead to Yang deficiency so that it will become Empty Cold. Empty Cold
may also arise independently from a Yang deficiency usually of the Spleen
and/or Kidneys.
EXTERNAL FULL EMPTY

COLD COLD Injures Yang COLD
YANG EMPTY
XU COLD
Both Full Cold and Empty Cold obstruct the movement of Qi and Yang
and may lead to Blood stasis; this also occurs because Cold congeals
Blood.
Full Cold occurs usually in the Stomach, Intestines and Uterus, while
Empty Cold may occur in these organs as well as in the Heart,
Stomach, Spleen and Kidneys; in all these cases and organs Blood
stasis may result.
Cold in the Uterus is a very common cause of Blood stasis.
COLD BLOOD STASIS

Cold congeals Blood
c) HEAT or FIRE
Heat or Fire injure and condense the body fluids and therefore Blood
since Blood is part of body fluids. This may occur in the Heart, Liver,
Stomach, Lungs, Intestines and Uterus.
Body Blood
FIRE Fluids BLOOD STASIS
Fire dries up Body Fluids which

leads to condensation of Blood
d) QI DEFICIENCY
Qi deficiency may lead to Blood stasis because deficient Qi fails to move

and transport: this leads to Qi stagnation and Blood stasis. There is a
formula precisely for this situation (Bu Yang Huan Wu Tang Tonifying
Yang to Restore Five [-Tenths] Decoction).
This affects the Heart, Lungs, Spleen and Kidneys.
QI
QI XU STAGNATION BLOOD STASIS
e) BLOOD DEFICIENCY
Blood deficiency may lead to Blood stasis because Blood is the mother of Qi,
when Blood is deficient, Qi is also usually deficient, Qi fails to move Blood
and Blood stasis ensues. A simultaneous Blood deficiency and stasis is more
common in women. This may result, for example, in periods that are scanty
but dark with clots.
This affects the Heart, Liver and Uterus.
BLOOD QI
XU
QI XU
STAGNATION
BLOOD STASIS
f) PHLEGM
There is an interaction between Phlegm and Blood stasis as both are

pathologies of Body Fluids. Phlegm is a pathological accumulation of turbid
fluids, while Blood stasis is a pathological accumulation of Blood; given the
interchange between Blood and Body Fluids, Blood stasis and Phlegm interact
with and aggravate each other.
Phlegm aggravates rather than cause Blood stasis.
A simultaneous condition of Blood stasis and Phlegm is common in the elderly

and it is a particular pernicious combination leading to serious diseases which
are difficult to treat, in particular cancer, heart disease and stroke.
BLOOD
Body Blood PHLEGM
Fluids STASIS
Aggravate each other

Interaction between Blood stasis and Phlegm
Phlegm
BODY
BLOOD
FLUIDS
BLOOD
PHLEGM STASIS Coronary thrombus with atheroma
Blood stasis
CONSEQUENCES OF BLOOD STASIS
Blood stasis can itself become a cause of disease.

- Blood deficiency
- Bleeding
- Dryness
- Qi deficiency
1. First of all, it may induce Blood deficiency: in fact, when stagnant Blood
obstructs the Blood vessels, Qi stagnates, this may not manufacture Blood
properly and Blood deficiency ensues.
FIRST
CONSEQUENCE
BLOOD BLOOD
QI STAGNATION QI DEFICIENCY DEFICIENCY
STASIS
2. Secondly, when stagnant Blood obstruct the blood vessels, new Blood cannot
occupy its rightful place and leaks out giving rise to haemorrhages: thus, in an
apparent paradox, Blood stasis may cause (or at least aggravate) bleeding. This
happens frequently in menorrhagia.
NEW BLOOD
New blood cannot enter blood vessels

Obstructs blood vessels
BLOOD STASIS BLOOD UTERUS

VESSELS
Haemorrhage
SECOND
CONSEQUENCE
3. Thirdly, Blood stasis may cause dryness: this happens because Blood is
part of Body Fluids and when Blood stagnates for many years, Body Fluids
cannot be properly produced and dryness ensues: that is why a dry skin and
nails may be due to Blood stasis rather than Blood deficiency (usually in the
elderly). Da Huang Bie Chong Tang addresses this situation, i.e. it treats
dryness deriving from Blood stasis.
BODY
STAGNANT
FLUIDS
BLOOD
BLOOD STASIS BODY

DRYNESS
FLUIDS
Impairs metabolism of body fluids
THIRD
CONSEQUENCE
Dryness from Blood stasis
4. Fourthly, Blood stasis may lead to Qi deficiency.
Blood is Mother of Qi
Obstructs Blood production
QI
BLOOD
BLOOD STASIS
DEFICIENCY DEFICIENCY
FOURTH
CONSEQUENCE
May aggravate Blood stasis as deficient Qi fails to

move Blood
Two forces in Blood:
Propelling force = Heart, Lungs, Liver.
Containing force (preventing bleeding): Spleen, Kidneys.
Please note how the containing force does not depend only on
the Spleen, but also the Kidneys especially in gynaecology.
Note also how the propelling force does not depend only on
the Liver, but also Heart and Lungs. Remember that the
Lungs control the blood vessels.
Pathogenic factors in the elderly
BLOOD STASIS: swellings, abdominal masses, tumours, purple lips,

nails and nose, dry hair and skin, dry mouth, dark and scaly skin, dark
macules, dark scales, dark rings under eyes, protruding umbilicus, fever,
pain, bleeding, hard abdomen, itching, rigidity of joints, excessive
dreaming, poor memory, swollen fingers and toes, adhesions after
surgery, Wiry pulse, Purple tongue.
PHLEGM: poor memory, greasy skin and hair, masses, tingling or

numbness, dizziness, dark ring under eyes, greasy by the side of the eyes,
dull complexion, obesity, swollen face, sweaty genitals, axillae, palms
and soles, swollen fingers and toes, thick thumbs, flaccid skin and
muscles, excessive salivation, slight foam at corners of mouth, lethargy,
Swollen tongue, Slippery or Wiry pulse.
Cross-reference of pathogenic factors of the elderly and diseases
PHLEGM BLOOD STASIS WIND
Heart disease
Angina
Arteriosclerosis
Thrombosis
Atheroma
Hypertension
Cancer
Stroke
Cholesterol
Chronic bronchitis
Cancer
Diabetes
Chronic nephritis
Prostatic
hyperplasia/cancer
Parkinson’s disease
Alzheimer
Trigeminal neuralgia
Dizziness
Blood stasis in the elderly
• Heart: palpitations, chest pain, feeling of oppression in the chest,

depression, anxiety, mental confusion.
• Liver: depression, liver disease, carcinoma of liver.
• Stomach, Spleen and Intestines: epigastric and abdominal pain,

abdominal distension and fullness, constipation, blood in stools
• Lungs: breathlessness, asthma, chest pain, tightness of the chest, dry

throat
• Kidneys: abdominal distension, fullness and pain, painful urination,

dysuria, oliguria.
• Skin: dark moles, dark macules, dark scales, dry skin.

Blood stasis in Zangfu
Liver: hypochondrial pain, purple nails and lips, dark

complexion, painful periods with dark clots, purple sides of the
tongue, pulse Wiry, Choppy or Firm. Dr Yan De Xin has many
mental-emotional symptoms: depression, suspicious, jealousy,
agitation, prone to anger, violent.
Heart: purple lips, palpitations, chest pain, tightness of the

chest, tongue purple on chest area, dark-distended sublingual
veins pulse choppy, Firm or Knotted.
Lungs: a feeling of oppression of the chest, coughing up dark

blood, tongue purple in the front third, dark-distended
sublingual veins.
Stomach, Intestines: epigastric and abdominal pain, abdominal

distension and fullness, constipation, blood in stools.
3. DIAGNOSIS
DIAGNOSIS OF BLOOD STASIS: Observation

• Swellings, lumps, masses, tumours
• Purple
• Purple tongue
• Dark complexion
• Purple, dark lips
• Dry nails and hair (Da Huang Bie Chong Tang)
• Bleeding
• Maculae
• Rigidity
• Dark moles
• Skin not elastic, lustreless, dark, scaly, dry
• Dark eye sockets
• Purple nose bridge
• Purple venules
• Umbilicus bulging out
• Enlarged ends of fingers and toes
• Adhesions and scars

• Dry, white hair
• Dark lips
• Dark chin
• Dark spots on sclera
Modern Chinese doctors propose an interesting method for determining
the biological age of a person by the number of brown macules on their
body. As these are typical of old age, the more brown macules there are,
the higher the biological age of the patient (they indicate Blood stasis).
These spots were called “old age spots” (lao nian ban 老年斑) or
“longevity spots” (shou ban 寿斑 )
75% of people aged 60-79 and 89% of those aged 80-90 have them
Geriatric Blood stasis symptoms
• Otosclerosis= Phlegm/Blood stasis

• Macular degeneration (vascular, lack of blood nourishment): Blood stasis
• Dry eyes: Blood stasis (could be)
• Poor memory: Blood stasis (could be)
• Macules: Blood stasis
• Dry skin: Blood stasis (could be)
• Hair loss: Blood stasis
Note how in many of these symptoms, it would be natural to think of

deficiency first:
Otosclerosis (deafness): Kidney deficiency

Macular degeneration: Liver deficiency
Dry eyes: Liver-Yin deficiency
Poor memory: Kidney deficiency
Dry skin: Lung-Yin deficiency
Hair loss: Kidney deficiency
Otosclerosis is a disease of the bones of the inner
ear. These are the malleus, incus and stapes, and
are also known in aggregate as the "ossicles".
The ossicles become knit together into an
immovable mass, and do not transmit sound as
well as when they are more flexible
Phlegm/Blood stasis
Macular degeneration occurs when the eye's

macula - the center of the retina where the best
vision is located - degenerates. Blood vessels can
grow abnormally underneath the retina. Blood and
other fluids leak out, causing the layers of the retina
to separate. A patient with macular degeneration
sees a dark blur in the centre of their view. Often,
straight lines look wavy, or color vision is dim.
(Blood stasis)
The gross pathology of Alzheimer's dementia consists in toxic levels of
amyloid protein build up in the brain which destroy those regions next to
the accumulation sites.
There are characteristic silk-like senile plaques and neurofibrillary

tangles and threads that accumulate within the grey matter of the cerebral
cortex and cerebral nerve cells of Alzheimer's patients. Composed of
amyloid fibers, Alzheimer's patients are unable to break these fibers
down.
The accumulation of these fibers leads then to the production of the brain
lesions characteristic of Alzheimer's disease. The plaques accumulate to
neurotoxic levels, compressing those nerve fibers that lie in their path,
effectively destroying these regions of the brain.
In advanced cases, these amyloid fibers will aggregate around blood

vessels, causing a structural weakening to occur in the vessels and a
subsequent leakage of blood serum into the cerebral space.
Neurofibrillary tangles in Alzheimer’s
(Phlegm and Blood stasis)
Amyloid plaques in Alzheimer’s

(Phlegm)
Symptoms that in the elderly look like Kidney deficiency but may be
due to Blood stasis or Jing stasis
• Impotence (erectile dysfunction)

• White hair
• Dizziness
• Poor memory
• Blurred vision
• Premature ejaculation
Poll no. 1
In the elderly, what is worse?
a) Kidney-Yin deficiency
b) Combination of Blood stasis and Phlegm

BLOOD STASIS and TONGUE
Tongue: Degree of increasing Blood stasis
Normal Distended-dark sublingual Purple sides Whole tongue Purple

veins
CLINICAL MANIFESTATIONS OF BLOOD STASIS IN GYNAECOLOGY
Primary manifestations:
• Dysmenorrhea
• Large, dark clots (this feature alone indicates Blood stasis)
• Purple tongue (use the tongue to gauge the degree of Blood stasis)
Secondary manifestations:
• Period that starts and stops
• Brownish discharge before or after menses
• Pulse – “Firm” (“Lao” 牢 = prison; confined)
Superficial
Firm is similar to Wiry
but is not felt at the Middle
superficial level
Deep
Purple Tongue
YANG
DEFICIENCY HEAT
COLD (Pale tongue) (Red tongue)
Cold congeals Blood Heat condenses Blood
BLOOD
STASIS
BLUISH- REDDISH-
PURPLE PURPLE
Purple Tongue
Purple is one of the pathological colours of the tongue body. Chinese

books regularly say that in Qi stagnation the tongue is purple. I do not
agree with this statement because the tongue body colour reflects the
condition of Blood rather than of Qi. Therefore, a purple body colour,
in my opinion always indicates Blood stasis.
In general, it takes a relatively long time for a tongue to become purple
and therefore, a purple tongue usually indicates a chronic condition.
The only two exceptions to this are trauma and surgery, after which the
tongue becomes purple in a matter of days or hours.
It is important to remember that the purple colour is not always
obvious as it is often quite subtle. As a rule of thumb, I would say that
if a tongue is not of a normal colour, not pale nor red, the chances are
that it might be subtly purple.
It is important to be able to recognise a purple colour because it is
clinically very significant. A purple colour always indicates Blood
stasis which potentially causes serious diseases, e.g. coronary heart
disease, cancer, and stroke.
As indicated earlier tongue diagnosis allows us not only to diagnose
the pathology but also to assess the degree of the severity of such
pathology. In the case of a purple tongue, it allows us not only to
diagnose Blood stasis but also to ascertain its degree of severity. For
example, a tongue may be only slightly purple which means that the
Blood stasis is mild. By contrast, if a tongue is deeply purple it
indicates that the Blood stasis is severe.
Very slightly purple, more Severely purple, more

on the left side on the right side
There are two pathological purple colours: bluish-purple and reddish-
purple, the former indicating Blood stasis associated with Cold and/or
Yang deficiency, and the latter associated with Heat. Therefore, the
bluish-purple tongue develops from a pale tongue, while the reddish-
purple tongue develops from a red tongue.
Bluish-purple Reddish-purple
Severely Bluish-Purple, more so on the left side.
This patient had a large myoma.
Areas of Blood stasis (Partially Purple tongue)
Just as in the case of the pale and red tongues, a tongue may also be
partially purple in a specific area. The three areas that are commonly
partially purple are: the sides, the chest area and the centre.
Purple sides indicate Blood stasis in the Liver or, in women, in the
uterus.
A purple colour in the chest area indicates Blood stasis in the heart or
lungs (in the sense of Western pathology) or in the breast in women.
A purple colour in the centre indicates Blood stasis in the Stomach.
Purple sides Purple chest/breast area Purple centre
(Blood stasis in (Blood stasis in chest/breast – (Blood-stasis in
Liver/Uterus) lung, heart, breast) the Stomach)
Bluish-Purple Bluish-Purple
Reddish-Purple Bluish-Purple
Bluish-Purple
Reddish-Purple
Reddish-Purple Reddish-Purple
Bluish-Purple Reddish-Purple
Bluish-Purple Bluish-Purple
Poll no. 2
Of these two tongues, which is worse?
a b
Sublingual Veins
Observation of the tongue should always include observation of the

veins under the tongue. Under normal circumstances the veins are not
distended, not dark, and one can barely see their outline.
Although a purple colour of the veins under the tongue is clinically

very significant, other abnormalities may also be observed, such as, for
example, the veins being distended and shiny.
When the veins under the tongue are purple it indicates the early stages
of Blood stasis. The sublingual veins, therefore, become purple before
the rest of the tongue. A purple colour of the veins under the tongue
gives an early indication of Blood stasis particularly in the upper and
middle burners.
In modern China, doctors also correlate the appearance of the

sublingual veins with modern diseases such as hypertension and
arteriosclerosis.
Distended and dark = Blood Stasis
Early indication of Blood stasis in upper burner, Lungs, Heart, but also in
the Liver
• Too thin = Yin Xu

• Distended = Qi Xu
• Swollen, white-sticky = Dampness and Blood stasis (Bi syndrome)
• Reddish, shiny = Damp-Heat
• Yellowish = Turbid Dampness steaming upwards
• White-slippery = Cold-Dampness
• Dark-dry veins: severe Yin Xu with Empty Heat
Normal sublingual veins Dark sublingual veins

Sublingual veins slightly dark Sublingual veins dark and
distended
Sublingual veins very dark

on the left side
Yellowish shiny sublingual veins: Very slightly purple sublingual veins
Damp Heat on the right side
Sublingual veins in relation to modern diseases
Dark-Purple veins: Blood stasis in heart and/ or

lungs; in some cases it can indicate hardening of
arteries in the brain.
Distended-dark and crooked veins: hardening

of the arteries, high blood pressure. If veins
also stick out a lot and look like earthworms,
the disease is severe.
Dark nodules on veins: small nodules like

rice or wheat grains indicate hardening of
arteries and heart disease.
Tongue diagnosis in cancer
There is no tongue picture that conclusively points to cancer. I have

seen extremely pathological tongues in relatively healthy people and
surprisingly healthy tongue in cancer patients: however, these are rare
exceptions.
First of all, we must remember the three pathological factors that are
present in cancer: Blood stasis, Phlegm and Toxic Heat.
Therefore in cancer, the tongue may be Purple (Blood stasis), Swollen
(Phlegm) or Red with thick-yellow coating and red points (Toxic
Heat). It may have only one of these features or a combination of them
or all of them. In particular, in my experience, in malignant tumours
there is nearly always a combination of Blood stasis and Phlegm.
Purple (also swollen) Swollen Red with thick coating

The tongue is an important factor to diagnose the combination of
Blood stasis and Phlegm.
Blood stasis: purple, stiff.

Phlegm: swollen, sticky coating.
Purple, swollen Purple, swollen, sticky coating
Purple, swollen Purple, swollen

Blood stasis in women (purple sides)
In women, purple sides (Liver area) may indicate Blood stasis in the
uterus. As Blood stasis in the uterus is very common, purple sides in
women usually indicate Blood stasis in the gynaecological system rather
than in the Liver itself.
It is important to remember, however, that the tongue may NOT be purple
in women if the Blood stasis is relatively mild. In other words, a woman
may display all the symptoms of Blood stasis in the uterus (painful
periods with dark menstrual blood and dark clots) without the tongue
being purple.
Moreover, the degree of severity of the purple colour of the tongue in
women is directly correlated to the severity of Blood stasis. We can
identify four stages of Blood stasis according to the tongue:
1. Normal body colour
2. Purple veins underneath the tongue
3. Purple sides
4. Whole tongue purple
Blood stasis in women
Four degrees of severity of Blood stasis
1. Normal body colour 2. Purple veins underneath
3. Purple sides 4. Whole body Purple

Bluish-Purple sides, Swollen
Bluish-purple body with large blue areas on the sides.
Bluish-purple; dry; long, deep cracks; only patches of yellow, thick, rootless coating, Swollen.
Reddish-purple (worse on sides); thick, yellow coating.
Reddish-purple; red tip; swollen (especially on the tip); stiff; thin, white rootless coating; peeled
patches on the root.
Chest/breast area
The “chest” area is on the sides of the tongue, between the centre part
and the tip.
The chest area reflects a pathology of three organs: heart, lungs or
breast in women.
Changes in this area to look for are:

1) Changes in colour (usually purple or red)
2) Changes in body shape (usually swollen or with teeth marks)
3) Red points
lung/heart
breast
It is important to differentiate between changes in the sides due to
the Liver, Spleen or chest.
Liver Stomach and Spleen Chest area
Liver Stomach and Spleen Chest area

Differentiation between Liver, Stomach/Spleen and chest areas
Thin, long band= Broad band, middle section = Chest

Liver ST/ SP
Breast
Purple chest area (Blood stasis in chest – lung, heart, Purple Sides (Blood stasis in Liver/ Uterus)
breast)
The chest area reflects pathologies of the lungs, heart or breast but
in a Western medical sense. A change in the chest area may
involve a change in colour or body shape.
How to differentiate when a change in the chest area indicates a

problem of the lungs or heart or of the breasts in women? A
change in the chest area indicates a pathology of the breast in
women rather that of lungs/heart:
1) In the absence of an obvious lungs/heart pathology

2) Especially when it is unilateral
Dark macules
Dark lips
Examples of lung pathology manifesting in the chest area are chronic asthma
or chronic emphysema (in which case the chest area would be swollen and
possibly purple). An example of heart pathology is chronic coronary heart
disease (in which case the chest area would be purple).
As the area on the sides between the centre and the tip reflects the condition
of heart/ lungs/ breast, I shall call this the “chest area”.
Swollen chest area Purple chest area

Apart from a purple colour and a swelling, other possible changes
in the breast area are teeth marks that are confined only to the
breast area, red points or the absence of coating of the breast area.
• Teeth marks only in the breast area indicate usually a problem in

the breast in women (possible carcinoma) occurring against a
background of severe Qi deficiency
• Red points in the breast area indicate Toxic Heat in the Lungs or
breast
• The absence of coating in the breast area indicates a possible
problem in the breasts in women occurring against a background of
Yin deficiency.
Teeth marks Teeth marks Red points breast No coating breast

breast area on breast area on area on right area left side
left right
In conclusion, as far as the Heart is concerned, we can say that the tip
reflects a pathology of the Heart in a Chinese sense, i.e. problems of the
Shen, while the chest area reflects a pathology of the heart in a Western
sense (e.g. coronary heart disease)
Heart Chinese sense (Shen) = tip Heart Western sense (chest area)
In this case: Heart-Heat In this case: Heart-Blood stasis
The same area on the sides that reflects the Liver, in women also reflects the
Uterus (especially when it is purple)
The sides indicate the state of the Liver but when they are Purple, in women,
they may indicate Blood stasis in the Uterus
Uterus Sides (LIV)
LIV-Heat a) Liver-Blood Stasis

b) Blood stasis in the Uterus
DIAGNOSIS OF BLOOD STASIS: Interrogation
• A history of chronic illness with repeated bouts
• Pain bu tong, ze tong; tong, ze bu tong 不通则痛，通则不
痛
• Poor memory*
• Irregular period, painful periods, hesitant start
• Fever (rare, often in cancer)
• Mental restlessness, agitation
• Thirst with desire to gargle without swallowing
• Abdominal pain
• Aggravation at night Do not misinterpret this list: it does not mean that
each of these symptoms is always due to Blood
• Stiffness stasis.
• Excessive dreaming
• Itching
• Dry mouth (no desire to drink but to rinse with water)
• Numbness
Shang Han Lun, line 237: “When in Yang Ming syndrome, the
patient is forgetful, there must be Blood stasis. The reason for
this is that there has been Blood stasis for a long time which
affects memory. Use Di Dang Tang Appropriate Decoction.”
Shui Zhi
Meng Chong
Tao Ren
Da Huang
Notice how poor memory, which we would usually attribute

to a Kidney (or Heart) deficiency, may be due to Blood stasis.
In other words, the brain is affected not because Blood is
deficient and does not reach but because Blood is stagnant
and it therefore cannot perform its nourishing action.
DIAGNOSIS OF BLOOD STASIS: Palpation
• Hardness of abdomen
• Stiffness of joints, rigidity
• Dry skin
• Pulse Wiry, Choppy or Firm.
Both hard, taut, full
WIRY (XIAN) FIRM (LAO)

4. TREATMENT
TREATMENT PRINCIPLES AND METHODS
BEN-BIAO and XU-SHI
Blood stasis is always the Manifestation (Biao) of a condition because

it arises from other conditions such as Qi stagnation, Cold, Heat, etc.
Blood stasis is a Full condition by definition. Thus, the question arises
how to approach a patient who suffers from Blood stasis (Full-Biao)
but also from an underlying condition that is the Ben (which, itself,
may be Xu or Shi).
The Ben of Blood stasis may be a Deficiency (of Qi or Blood) or a

Fullness (Qi stagnation, Cold, Heat or Phlegm).
Thus, treating Ben consists in either tonifying Qi and Blood or in

moving Qi, scattering Cold, clearing Heat or resolving Phlegm.
QI XU
BEN
BLOOD XU
BLOOD
QI
STASIS
STAGNATION
COLD
BEN BIAO
HEAT
PHLEGM
Since Blood stasis is always a chronic condition, generally speaking one
needs to treat both Ben and Biao simultaneously. However, especially
when herbal medicine is used, the question arises whether one should start
with a formula that treats the Biao i.e. invigorate Blood but modified to
treat the Ben as well, or start with a formula to treat the Ben modifying it
to treat the Biao, i.e. to invigorate Blood.
The answer is: in more acute cases when the symptoms and signs of Blood
stasis predominate, start with a modification of a formula to invigorate
Blood and eliminate stasis; in more chronic cases when the symptoms and
signs of Blood stasis are less pronounced, start with a modification of a
formula that treats Ben.
My personal inclination, however, is always to clear pathogenic factors

first, i.e. in the case, invigorate Blood and eliminate stasis.
Formula to treat
Biao, i.e. Modified to treat BEN
invigorate Blood BIAO
Ben
Formula to treat Modified to treat

BIAO
Ben
BEN Biao
TERMINOLOGY
I use the terms “invigorate Blood” but also “moving Blood”.

There is a problem with both terms. “Moving Blood” may give
the impression that these herbs literally “move” Blood around
the body. That may even give the impression that, should the
patient have a thrombus in a blood vessels, these herbs may
detach it so that it goes around the blood vessels. This is not the
case.
Bensky uses the term “invigorate Blood” to eliminate the above

misunderstanding. “Invigorate Blood” is a good term but
“invigorate” may also suggest to “tonify” (Blood).
The Chinese term is the best! It is huo Xue qu yu 活血祛瘀

which translates as “enlivening Blood and eliminating stasis.”
Sometimes they are also called huo Xue hua yu 活血化瘀,

i.e. “to invigorate Blood and transform stasis.”
Huo 活 suggests “live”, “living”, “lively” so “enlivening” would
be a translation of it. It has the radical “water” on the left.
Qu 祛 suggests “to dispel”, “to drive away”, “to remove”.

Interestingly it has shi, i.e. “altar” on the left, originally “to
dispel spirits.”
Yu 瘀 means “stasis” but also “hematoma”. It has the radical for

“disease” on the outside.
“Enlivening” is a good description of what these herbs do, i.e.

they “enliven” Blood, they change the nature of Blood, they do
not “move” it around.
As we will see, it is actually what they do also from the

perspective of modern biomedical research.
The ancient texts used many other terms for “Blood stasis”.
The Nei Jing used the term e xue, “malign Blood”: 恶血
Zhang Zhong Jing called it liu xue “stagnant Blood” 留血 or

gan xue “dry Blood” 干血.
Zhao Yuan Fang called it ji xue “accumulated Blood”: 积血
Zhu Dan Xi called it si xue “dead Blood”: 死血
Zhang Jing Yue called it ning xue “coagulated Blood”: 凝血

HERBAL TREATMENT
Invigorating Blood is such an important method of treatment in gynaecology and other

disorders that Tang Zong Hai, author of the “Discussion on Blood Syndromes” (1884),
said: “In Blood syndromes one must always eliminate stasis of Blood”.
There are many herbs that eliminate stasis of Blood such as
Hong Hua Flos Carthami tinctorii

Nearly always used together
Tao Ren Semen Persicae
Yi Mu Cao Herba Leonari heterophylli Important gynaecological ones
Wu Ling Zhi Excrementum Trogopteri
E Zhu Rhizoma Curcumae zedoariae
Yu Jin Tuber Curcumae
Ze Lan Herba Lycopi lucidi
San Leng Rhizoma Sparganii stoloniferii
Pu Huang Pollen Typhae
Chi Shao Radix Paeoniae rubrae In Clearing Heat category
Mu Dan Pi Cortex Moutan radicis
Chuan Xiong Radix Ligustici Chuanxiong
Dan Shen Radix Salviae miltiorrhizae
Very common, important ones
Yan Hu Suo Rhizoma Corydalis Yanhusuo
Ji Xue Teng Radix et Caulis Jixueteng
San Qi Radix Notoginseng
Si Gua Luo Fasciculus vascularis Luffae
Mo Yao Myrrha Enter channels
Ru Xiang Gummi Olibanum
Chuan Niu Xi Radix Cyathulae
Wang Bu Liu Xing Semen Vaccariae segetalis
Lu Lu Tong Fructus Liquidambaris taiwanianae
Chuan Shan Jia Squama Manitis pentadactylae
Di Bie Chong (also called Tu Bie Chong) Eupolyphaga seu Opisthoplatia
Su Mu Lignum Sappan
The overwhelming majority of the above herbs belong to the category of herbs that
invigorate Blood; there are, however, herbs in other categories which also invigorate
Blood.
Stopping-bleeding category
Qian Cao Gen Radix Rubiae cordifoliae
Cooling-Blood category
Chi Shao Radix Paeoniae rubrae
These last two herbs are extremely important invigorating-Blood herbs.

The invigorating-Blood herbs can be sub-divided in many sub-
categories. Every Chinese book has a different classification.
1) Herbs that invigorate Blood

Yu Jin Tuber Curcumae Opens the Shen’s orifices, depression
Mo Yao Myrrha
Wang Bu Liu Xing Semen Vaccariae segetalis.
2) Herbs that invigorate Blood and eliminate stasis

Yi Mu Cao Herba Leonori heterophylli
Chuan Niu Xi Radix Cyathulae
Su Mu Lignum Sappan
3) Herbs that break-up Blood and eliminate stasis
The term “break-up Blood” implies that these herbs are stronger than the
“invigorating Blood” herbs and they are used when there are Blood-stasis
masses. In such masses one must use “breaking Blood” herbs.
The herbs are listed here in ascending order of strength. Herbs that break
up Blood should be used with care and sparingly. Also, a standing
recommendation is that they be used in a small dose, no more than 6
grams per day. Di Bie Chong is slightly toxic and I personally confine its
use to cases of carcinoma.

Nearly always used together
Shui Zhi Hirudo seu Whitmania
Meng Chong Tabanus bivittatus
Di Bie Chong Eupolyphaga seu Opisthoplatia
A different classification of the Blood-invigorating herbs differentiates four
groups: herbs that invigorate and nourish Blood, herbs that invigorate Blood
and promote healing of tissues, herbs that dispel stasis and scatter Blood, and
herbs that break up Blood, listed here in ascending order or strength. The
four categories of herbs are as follows:
1) Herbs that invigorate and nourish Blood

Dan Shen Radix Salviae miltiorrhizae, Ji Xue Teng Radix et Caulis
Jixueteng, Dang Gui Radix Angelicae sinensis.
2) Herbs that invigorate Blood and promote healing of tissues

Ru Xiang Gummi Olibanum, Mo Yao Myrrha, Di Bie Chong Eupolyphaga
seu Opisthoplatia.
3) Herbs that dispel stasis and scatter Blood

San Leng Rhizoma Sparganii stoloniferii, E Zhu Rhizoma Curcumae
zedoariae (same as “breaking-Blood” herbs).
4) Herbs that break-up Blood

Shui Zhi Hirudo seu Whitmania, Meng Chong Tabanus bivittatus, Di Bie
Chong Eupolyphaga seu Opisthoplatia.
Dang Gui Radix Angelicae sinensis
Body (shen)
Tail (wei)
There are other ways of classifying Blood-invigorating herbs
According to nature (hot or cold)
Hot
Ji Xue Teng Radix et Caulis Jixueteng
Cold
Yu Jin Tuber Curcumae
Di Bie Chong Eupolyphaga seu Opisthoplatia
Herbs that invigorate Blood and stop bleeding

Qian Cao Gen Radix Rubiae cordifoliae
Su Mu Lignum Sappan
Wu Ling Zhi Excrementum Tragopteri
These few herbs are very important as they have the unique function of
simultaneously invigorating Blood and stopping bleeding. They are therefore
important in gynaecology when we want to invigorate Blood in a woman but
her periods are heavy.
Herbs that invigorate and cool Blood

These two herbs are very widely used in gynaecology to cool and invigorate
Blood simultaneously.
Blood-invigorating herbs that particularly influence menstruation

Wang Bu Liu Xing Semen Vaccariae segetalis
Su Mu Lignum Sappan
Yan Hu Suo and Wu Ling Zhi are particularly indicated for menstrual pain.
Blood-invigorating herbs that affect the breasts and the Luo channels
Some Blood-invigorating herbs are also said to “penetrate the breast Luo”
[tong ru Luo 通乳络]: they move Qi and Blood and remove obstructions
from the Luo channels.
Used in gynaecology for breast problems.
These herbs are:

Ju Hong Medulla Citri reticulatae
Mu Tong Caulis Mutong
Lou Lu Radix Rhapontici seu Echinops
Tong Cao Medulla Tetrapanacis papyriferi
In particular, the Luo channels of the Stomach, Liver, Ren Mai and
Chong Mai make up the breast and the network of glandular lobules and
milk ducts resembles the network of Luo channels. The Chong Mai
exerts a particular influence on the breast because it affects all Luo
channels.
A number of herbs have a particular action in removing obstructions from

the Luo Mai of the breast, an expression which attempts to translate the
concise but descriptive Chinese terms tong ru luo 通乳络, literally
“penetrating the breasts Luo [channels]”.
All these herbs will have an action in moving Qi and Blood in the Chong
Mai because of the relation between this channel and the Luo Mai and blood
vessels.
The main herbs that have this function are:
Ju Hong Medulla Citri reticulatae

Mu Tong Caulis Mutong
Caulis Akebiae
Note: we cannot use Caulis Mutong but we

can use Caulis Akebiae. In Europe you
cannot use either of them

Lou Lu Radix Rhapontici seu Echinops
Tong Cao Medulla Tetrapanacis papyriferi

ANTI-CANCER HERBS
a) CANCER HERBS ACCORDING TO PATTERN
STASIS OF BLOOD
Ru Xiang, Mo Yao, San Leng, E Zhu, Di Bie Chong, Wang Bu Liu Xing, Ze
Lan, Shi Jian Chuan, Shui Zhi, Ban Mao.
PHLEGM
Hai Ge Ke, Tian Nan Xing, Zhi Shan Jia, Ban Xia, Bai Jie Zi, Fu Ling, Yi
Yi Ren, Zhe Bei Mu, Gua Lou, She Gan, Huang Yao Zi.
TOXIC HEAT
Bai Hua She She Cao, Ban Zhi Lian, Ban Bian Lian, Tu Fu Ling, Shan Dou
Gen, Xia Ku Cao, Da Qing Ye, Ku Shen, Qing Dai, Ban Lan Gen, Qi Ye Yi
Zhi Hua, Yu Xing Cao, Ma Chi Xian, Shi Shang Bai, Huang Qin, Huang
Lian, Huang Bai, Bai Tou Weng, Pu Gong Ying.
DAMPNESS
Sha Ren, Mu Xiang, Ze Xie, Xiang Fu, Fu Shou, Tu Fu Ling, Shan Zha,
Shen Qu, Zhi Ke, Zhi Shi, Bian Dou, Pei Lan, Gui Zhi.
SHUI ZHI Hirudo
Taste and energy: salty, bitter, neutral
Channels: Liver
Actions: break up Blood, eliminate stasis
Indications: oedema, cancer
DI BIE CHONG Eupolyphaga

Taste and energy: salty, cold
Channels: Liver
Actions: break up Blood, eliminate stasis
Indications: Liver cancer
BAN MAO Mylabris
Taste and energy: pungent, cold
Channels: Small Intestine, Large Intestine, Liver
Actions: expel Toxin, invigorate Blood, break-up Blood.
Indications: cancer
Common pairs of herbs that invigorate Blood
Dang Gui – Chuan Xiong
Tao Ren – Hong Hua
Pu Huang – Wu Ling Zhi (Shi Xiao San)
Ru Xiang – Mo Yao
San Leng – E Zhu
Da Huang – Di Bie Chong
Dan Shen – Mu Dan Pi

PHARMACOLOGY OF BLOOD-INVIGORATING HERBS
Blood-invigorating herbs have a complex pharmacology which makes them

some of the most useful herbs in the Chinese pharmacopoeia. The
pharmacological actions of these herbs may be summarized as follows:
• They improve the dynamics of blood flow and dilate the peripheral, coronary,
cerebral, renal and mesenteric arteries.
• They improve microcirculation. Disturbance of microcirculation causes many
diseases such as coronary heart disease, angitis, endometriosis, chronic
hepatitis, hepatic cirrhosis and scleroderma.
• They improve concentration, coagulation and accumulation of blood and
prevent thrombosis by inhibiting accumulation of platelets.
• They influence connective tissues and can treat diseases of these tissues such
as skin warts, burn scars and adhesions.
• They readjust cellular and humoral immunity.
• They have an analgesic effect.
• They increase uterine contractions.
• They combat inflammation and bacterial infection.
Hence the inadequate terminology of herbs that “move Blood”

The method of invigorating Blood is often combined with other methods of
treatment according to the condition. The main treatment methods combined
with invigorating Blood are:
• Move Qi
• Tonify Qi
• Nourish Blood
• Warm the menses and scatter Cold
• Clear Heat
• Move downwards
• Transform Water and resolve Phlegm
• Open the orifices
• Soften hardness
• Nourish Yin
Move Qi
Qi stagnation is the most common cause of Blood stasis. When Qi

stagnation causes Blood stasis we need to use a formula that moves
Qi and invigorates Blood.
Examples of formulae that move Qi and invigorate Blood are:
Yue Ju Wan Gardenia-Chuanxiong Pill (Cang Zhu, Chuan Xiong,

Xiang Fu, Shen Qu, Shan Zhi Zi)
Jin Ling Zi San Fructus Toosendan Powder (Chuan Lian Zi, Yan
Hu Suo)
Chai Hu Shu Gan Tang Bupleurum Relaxing the Liver Decoction

(Chai Hu, Chen Pi, Chuan Xiong, Zhi Ke, Bai Shao, Xiang
Fu, Gan Cao)
Dan Shen Yin Salvia Decoction (Dan Shen, Tan Xiang, Sha Ren)
Move Qi
Xue Fu Zhu Yu Tang

Blood-Mansion Eliminating Stasis Decoction
Ge Xia Zhu Yu Tang

Eliminating Stasis below the Diaphragm Decoction
Fu Yuan Huo Xue Tang

Restoring the Origin and Invigorating Blood Decoction
(Dang Gui, Tao Ren, Hong Hua, Shan Jia, Da Huang, Tian Hua Fen,
Chai Hu, Gan Cao)
Three Treasures and Women’s Treasure: Break into a Smile, Release

Constraint, Stir Field of Elixir.
Chai Hu Shu Gan Yue Ju Wan Ge Xia Zhu Yu

Tang Tang
Tonify Qi
Qi deficiency may also lead to Blood stasis. This would be Qi
deficiency of the Spleen, Stomach, Heart or Lungs.
Si Mo Tang
Four Milled [Herbs] Decoction
(Ren Shen, Bing Lang, Chen Xiang, Wu Yao)
Bu Yang Huan Wu Tang

Tonify Yang to Restore Five [Tenths] Decoction
(Huang Qi, Dang Gui, Chuan Xiong, Chi Shao, Tao Ren, Hong
Hua, Di Long). This formula is used for the sequelae of Wind-
stroke.
Huang Qi Si Wu Tang
Astragalus Four Substances Decoction
(Huang Qi, Ren Shen, Bai Zhu, Fu Ling, Bai Shao, Gan Cao,
Sheng Jiang, Dang Gui, Sheng Di Huang, Chuan Xiong, Jin Yin
Hua)
Nourish Blood
It is often necessary to nourish Blood when invigorating it either

because Blood Xu may be at the root of Blood stasis or because the
latter may cause the former. This happens because stagnant Blood
obstructs the channels and blood vessels and prevents new Blood from
taking its rightful place.
Another reason for nourishing Blood when invigorating it is that many

Blood-invigorating herbs are pungent and may therefore injure Blood
and Yin. Thus, some Blood tonics may be added to Blood-
invigorating formulae whether there are signs of Blood deficiency or
not.
The combination of nourishing and invigorating Blood means that

Blood tonics will not cause cloying and Blood-invigorating herbs will
not injure Blood or Yin.
Tao Ren Shao Yao Tang
Persica-Paeonia Decoction
(Tao Ren, Bai Shao, Chuan Xiong, Dang Gui, Gui Zhi, Gan Qi, Gan Cao)
Si Wu Tang
Four Substances Decoction (which can be classified as a Blood-invigorating
formula)
Wen Jing Tang

Warming the Menses Decoction
Dang Gui Shao Yao San

Angelica-Paeonia Powder
(Dang Gui, Bai Shao, Fu Ling, Bai Zhu, Ze Xie, Chuan Xiong)
Warm the menses and scatter Cold
Used when there is Blood stasis deriving from Cold obstructing the Uterus.
Herbs that warm the Uterus are:
Gui Zhi Ramulus Cinnamomi cassiae

Xiao Hui Xiang Fructus Foeniculi vulgaris
Wu Zhu Yu Fructus Evodiae rutaecarpae
Gan Jiang Rhizoma Zingiberis officinalis
Fu Zi Radix lateralis Aconiti carmichaeli preparata
Ai Ye Folium Artemisiae argyi
Rou Gui Cortex Cinnamomi cassiae.
The use of herbs that warm the menses greatly helps to invigorate Blood when
stasis of Blood derives from Cold in the Uterus.
Examples:
Gui Zhi Ramulus Cinnamomi cassiae and Wu Zhu Yu Fructus Evodiae
rutaecarpae within Wen Jing Tang Warming the Menses Decoction.
The use of Pao Jiang Rhizoma Zingiberis officinalis recens (fried) within
Sheng Hua Tang Generating and Resolving Decoction and that of Gan Jiang
Rhizoma Zingiberis officinalis, Rou Gui Cortex Cinnamomi cassiae and Xiao
Hui Xiang Fructus Foeniculi vulgaris within Shao Fu Zhu Yu Tang Lower
Abdomen Eliminating Stasis Decoction are other examples of this method.
Formulae:
Wen Jing Tang
Warm the Menses Decoction
Sheng Hua Tang

Generating and Resolving Decoction
(Dang Gui, Chuan Xiong, Tao Ren, Pao Jiang, Zhi Gan Cao)
Shao Fu Zhu Yu Tang

Lower Abdomen Eliminating Stasis Decoction
(Chao Xiao Hui Xiang, Gan Jiang, Yan Hu Suo, Dang Gui, Chuan Xiong, Mo
Yao, Rou Gui, Chi Shao, Pu Huang, Chao Wu Ling Zhi)
Women’s Treasure: Warm the Menses

Wen Jing Tang
Gui Zhi Ramulus Cinnamomi cassiae Warming the
Wu Zhu Yu Fructus Evodiae rutaecarpae Menses
Decoction
Pao Jiang Rhizoma Zingiberis Sheng Hua Tang

officinalis recens Generating and
Resolving
Decoction
Shao Fu Zhu Yu
Gan Jiang Rhizoma Zingiberis officinalis
Rou Gui Cortex Cinnamomi cassiae
Tang Lower
Xiao Hui Xiang Fructus Foeniculi Abdomen
vulgaris Eliminating
Stasis Decoction
Clear Heat
Blood stasis may be associated with Cold or with Heat. When Blood
stasis derives from Cold, the tongue is Bluish-Purple; when it derives
from Heat, the tongue is Reddish-Purple.
Jie Du Huo Xue Tang

Resolving Toxin and Invigorating Blood Decoction
(Lian Qiao, Chai Hu, Sheng Di Huang, Tao Ren, Zhi Ke, Ge Gen, Dang
Gui, Chi Shao, Hong Hua, Gan Cao).
Xian Fang Huo Ming Yin

Immortals’ Formula for Sustaining Life
(Jin Yin Hua, Gan Cao, Zhe Bei Mu, Tian Hua Fen, Dang Gui Wei, Chi
Shao, Ru Xiang, Mo Yao, Fang Feng, Bai Zhi, Chuan Shan Jia, Chen Pi).
Reddish-Purple Bluish-Purple
Move downwards
Blood stasis is treated by moving downwards when there is

constipation or dry stools. However, moving-downward herbs are
also used simply to invigorate Blood in severe cases as Da Huang by
itself invigorates Blood (especially if fried).
Please note that we can only invigorate Blood when the tongue has a
relatively thick coating (not, for example, when the coating is
missing).
Tao He Cheng Qi Tang

Persica Moving Qi Downwards Decoction
(Tao Ren, Da Huang, Gui Zhi, Mang Xiao, Zhi Gan Cao)
Da Huang Zhe Chong Wan

Rheum-Eupolyphaga Pill
(Da Huang, Tu Bie Chong, Tao Ren, Gan Qi, Qi Cao, Shui Zhi, Meng
Chong, Huang Qin, Xing Ren, Sheng Di Huang, Chi Shao, Gan Cao).
Transform Water and resolve Phlegm
Invigorating Blood is combined with transforming Water and

resolving Phlegm when Blood stasis is combined with Phlegm.
The combination of Blood stasis and Phlegm is particularly
pernicious because it may cause serious diseases such as coronary
heart disease, cancer or stroke. The combination is more common
in the elderly. The tongue is purple and swollen.
Gui Zhi Fu Ling Wan

Cinnamomum-Poria Pill
(Gui Zhi, Fu Ling, Chi Shao, Mu Dan Pi, Tao Ren)
Open the orifices
The invigorating-Blood method is combined with opening the

orifices when these are obstructed by Phlegm. The orifices are
the eyes, nose, ear, mouth, the two lower orifices (anus and
urethra).
However, there are also the orifices of the Shen which can be
obstructed, causing serious mental-emotional problems such as
OCD, panic attack, mania, psychosis (which may also occur in
mild degrees).
Tong Qiao Huo Xue Tang

Opening the Orifices and Invigorating Blood Decoction
Gui Shen Tang

Restoring the Mind Decoction
TONG QIAO HUO XUE TANG
Chi Shao Radix Paeoniae rubra

Chuan Xiong Rhizoma Chuanxiong
Hong Hua Flos Carthami
Cong Bai Bulbus Allii fistulosi
Da Zao Fructus Jujubae
Sheng Jiang Rhizoma Zingiberis recens
She Xiang Moschus
GUI SHEN TANG
Restoring the Mind Decoction
Ren Shen Radix Ginseng 15g

Bai Zhu Rhizoma Atractylodis macrocephalae 30g
Ba Ji Tian Radix Morindae officinalis 30g
Fu Shen Sclerotium Poriae pararadicis 15g
Zi He Che Placenta Hominis 6g
Ban Xia Rhizoma Pinelliae preparatum 9g
Chen Pi Pericarpium Citri reticulatae 3g
Bai Jie Zi Semen Sinapis albae 9g
Shi Chang Pu Rhizoma Acori tatarinowii 3g
Zhu Sha Cinnabaris 3g
Mai Men Dong Radix Ophiopogonis 6g
Bai Zi Ren Semen Platycladi 6g
Zhi Gan Cao Radix Glycyrrhizae uralensis preparata 3g
Soften hardness
Softening hardness is combined with invigorating Blood in

the case of masses which may be from Blood stasis or Blood
stasis and Phlegm
Di Dang Tang
Appropriate Decoction
(Shui Zhi, Meng Chong, Tao Ren, Da Huang)
Fu Yuan Huo Xue Tang

Recovering the Origin and Invigorating Blood Decoction
(Dang Gui, Tao Ren, Hong Hua, Chuan Shan Jia, Da Huang,
Tian Hua Fen, Chai Hu, Gan Cao).
Poll no. 3
One cannot invigorate Blood if the patient has Yin deficiency:
True or false
Nourish Yin
Many people think that nourishing Yin is contradictory to
invigorating Blood and also to resolving Phlegm as both are a
pathology of Body Fluids and therefore we should nourish Body
Fluids. However, this is not true. We should remember that
Blood stasis and Phlegm are an accumulation of pathological
fluids, while Yin deficiency is a deficiency or physiological
fluids.
Indeed, in the elderly, a combination of Yin deficiency and Blood

stasis and/or Phlegm is common. This is manifested by a tongue
that is purple and without coating.
There is no specific formula for invigorating Blood and

nourishing Yin. One can either adapt a nourishing-Yin formula
with invigorating Blood herbs or vice versa.
Reddish-Purple
without coating
Opening the Luo channels and invigorating Blood
This method is used when the Luo channels are obstructed with
stagnant Blood causing pain in the joints and rigidity.
Huo Luo Xiao Ling Dan

Miraculously Effective Pill to Invigorate the Luo Channels
(Dang Gui, Dan Shen, Ru Xiang, Mo Yao)
Shen Tong Zhu Yu Tang

Painful Body Eliminating Stasis Decoction
(Qin Jiao, Chuan Xiong, Tao Ren, Hong Hua, Gan Cao, Qiang Huo,
Mo Yao, Dang Gui, Wu Ling Zhi, Xiang Fu, Chuan Niu Xi, Di Long)
Invigorating Blood and stop bleeding
This method is used when there is Blood stasis and bleeding. This is
common in gynaecology.
San Qi Shi Xiao San

Notoginseng Breaking into a Smile Powder
(San Qi, Wu Ling Zhi, Pu Huang).
Women’s Treasure: Invigorate Blood and Stem the Flow.

BLOOD STASIS IN UTERUS
Blood stasis in the Uterus is very common and is the cause of many
gynaecological complaints such as painful periods, infertility, myomas,
menorrhagia.
Clinical manifestations
Painful periods with dark blood and large-dark clots, pre-menstrual
abdominal pain, hesitant start to the periods, period starts and stops, period
starting or ending with a brownish discharge, infertility, myoma,
amenorrhoea,. Tongue Purple on the sides. Pulse Wiry (especially on the
Uterus position on the left chi) or Firm (Lao).
Poll no. 4
Of these two tongues, which is worse?
a b
Treatment principle
Invigorate Blood, eliminate stasis, pacify the Liver and the
Chong Mai, regulate the periods.
Acupuncture
SP-4 Gongsun (on the right) and P-6 Neiguan (on the left) [Chong
Mai], LIV-3 Taichong, G.B.-34 Yanglingquan, BL-17 Geshu, SP-
10 Xuehai, SP-6 Sanyinjiao, KI-14 Siman, ST-29 Guilai.
SHAO FU ZHU YU TANG
Xiao Hui Xiang Fructus Foeniculi vulgaris 6g

Gan Jiang Rhizoma Zingiberis officinalis 2g
Rou Gui Cortex Cinnamomi cassiae 1.5g
Yan Hu Suo Rhizoma Corydalis Yanhusuo 6g
Mo Yao Myrrha 6g
Pu Huang Pollen Typhae 6g
Wu Ling Zhi Excrementum Trogopteri 4.5g
Dang Gui Radix Angelicae sinensis 9g
Chuan Xiong Radix Ligustici Chuanxiong 4.5g
Chi Shao Yao Radix Paeoniae rubra 6g
GE XIA ZHU YU TANG
Dang Gui Radix Angelicae sinensis 9 g

Chuan Xiong Rhizoma Chuanxiong 3 g
Chi Shao Radix Paeoniae rubra 6 g
Hong Hua Flos Carthami tinctorii 9 g
Tao Ren Semen Persicae 9 g
Wu Ling Zhi Excrementum Trogopteri 9 g
Yan Hu Suo Rhizoma Corydalis 3 g
Xiang Fu Rhizoma Cyperi 3 g
Zhi Ke Fructus Aurantii 5 g
Wu Yao Radix Linderae 6 g
Mu Dan Pi Cortex Moutan 6 g
Gan Cao Radix Glycyrrhizae uralensis 9 g
Prescription
EMPIRICAL PRESCRIPTION by Dr Zhu Nan Sun
Dan Shen Radix Salviae miltiorrhizae 6g

Chi Shao Radix Paeoniae rubra 6g
Chai Hu Radix Bupleuri 4.5g
San Leng Rhizoma Sparganii stoloniferii 6g
E Zhu Rhizoma Curcumae zedoariae 6g
Shi Jian Chuan Herba Salviae chinensis 6g
Liu Ji Nu Herba Artemisiae anomalae 6g
Mu Dan Pi Cortex Moutan radicis 6g
Chuan Lian Zi Fructus Meliae toosendan 3g
Ru Xiang Gummi Olibanum 4.5g
Di Long Pheretima aspergillum 3g
Xue Jie Sanguis draconis 4.5g
Women’s Treasure remedy
STIR FIELD OF ELIXIR
Wu Yao Radix Linderae strychnifoliae

Gan Cao Radix Glycyrrhizae uralensis
Xiang Fu Rhizoma Cyperi rotundi
Zhi Ke Fructus Citri aurantii
Bai Shao Radix Paeoniae alba
Variation of Ge Xia Zhu Yu Tang

Prescriptions
a) Wen Jing Tang if due to Cold (strictly speaking it is for Full Cold but it
can be used for Empty Cold)
b) Tao Hong Si Wu Tang
c) Ge Xia Zhu Yu Tang
d) Shao Fu Zhu Yu Tang
e) Gui Zhi Fu Ling Wan (for masses)
f) Sheng Hua Tang (for retention of lochiae)
g) Shi Xiao San (for heavy and/or painful period)
Women’s Treasure remedies

Stir Field of Elixir [Ge Xia Zhu Yu Tang]
Harmonizing the Moon [Gui Zhi Fu Ling Wan]
Invigorate Blood and Stem the Flow [Tao Hong Si Wu Tang]
Warm the Menses [Wen Jing Tang]
ACUPUNCTURE
The main points to move Liver-Blood and

eliminate stasis of Blood are the same as
those that eliminate stagnation of Liver-Qi,
i.e. LIV-3 Taichong, G.B.-34 Yanglingquan,
LIV-14 Qimen. BL-17
LIV-14
These points should be needled with
KI-14
reducing or even method. ST-29
In addition, two points which specifically

invigorate Blood are BL-17 Geshu (with
needle, no moxa) and SP-10 Xuehai. SP-10
In gynaecology: Chong Mai (SP-4 and P-6)

GB-34
with KI-14, LIV-3.
Other points: P-6 Neiguan, SP-6 Sanyinjiao.

LIV-3
LIVER-3 TAICHONG 太冲
Su Wen, chapter 1
“When a girl is 14, Tian Gui arrives, the Ren Mai is open, the
Taichong Vessel is flourishing, menstruation begins and she
can conceive.”
In this passage, therefore the Chong Mai is called the “Liver-3

Vessel”: this point is closely identified with the Chong Mai due to
its descending branch reaching this point.
Whenever we use this points, therefore, we activate the Chong Mai
and invigorate Blood (although we may also subdue rebellious Qi).
The gynaecological effect of this point is due to its being a Chong
Mai point.
.
Spleen-10 Xuehai 血海
Actions
• Regulate Qi and Blood
• Regulates the Blood Chamber
• Makes Blood return to the channels
• Conducts Blood Back to Sea of Blood
Indications
Menorrhagia, irregular periods, painful periods, amenorrhea,
Blood Lin, skin rashes (from Blood deficiency and/ or Blood
Heat).
Discussion BLOOD
SP-10 pertains to the Spleen channel: the Spleen is
the Post-natal source of Blood and gathers Blood
(i.e. holds Blood in the vessels).
The Heart governs Blood, the Liver stores Blood WATER

and the Kidneys play a role in making Blood.
The points KI-10, LIV-8 and SP-9 (all Water points)

create like a tide of Yin which then passes through
the Blood (another name is Xuexi 血郗 , i.e. Xi-cleft
of Blood). SP-10 can hold Blood and stops bleeding
by making Blood return to the channels.
Therefore SP-10 affects the channels of Spleen,

Liver and Kidneys.
LIV-8 ... KI-10 SP-9
Thus, SP-10 has a wide-ranging action on Blood as

it can nourish Blood (with reinforcing method or
moxa), hold Blood (in bleeding, reinforcing
method), cool Blood and invigorate Blood (the last
two with reducing method).
An Explanation of Acupuncture Points (Qing dynasty) 经穴解
Spleen and Kidney diseases: Lou in women, irregular menstruation,
Beng due to irregular diet, overwork, Qi deficiency: 7 moxa cones.
Spleen diseases: Qi that rebels upwards causing abdominal distention.

Use this point with reducing method to subdue rebellious Qi and with
reinforcing method to nourish Blood.
Great Dictionary of Chinese Acupuncture

Irregular menstruation, painful periods, amenorrhea, menorrhagia, skin
eruptions, itching, Lin disease, Qi rebelling in abdomen. This point
invigorates Blood of the Spleen and treats abdominal distention.
Jia Yi Jing: amenorrhoea, Qi rebelling in abdomen causing abdominal

distention.
Acupuncture treatment for Blood Stasis in gynaecology
The best time is during phase 1 or 4
Invigorate Blood
during the menses
Points
SP-10, BL-17, SP-6
Chong Mai: KI-14 + LIV-3
Normal/ scanty Heavy periods:

periods:
do not use too many
more abdominal points abdominal points
THE CHONG MAI IN BLOOD STASIS
CHONG MAI POINTS
Opening point: SP-4 Gongsun
Coupled point: P-6 Neiguan
Starting point: Ren-1 Huiyin

CHONG MAI POINTS
All Kidney points from KI-11 Henggu to KI-21

Youmen.
ST-30 Qichong
Ren-1 Huiyin
BODY AREAS INFLUENCED
Throat, face, head
Chest, heart, breasts
Uterus, lumbar spine, abdomen
Big toe, feet, medial aspect of legs
Channels influenced: Spleen, Stomach, Liver, Kidneys, Heart, Small

Intestine, Large Intestine.
CHONG MAI
SP-4 Gongsun and P-6 Neiguan
KI-13 Qixue: tonify the Kidneys, strengthen the Uterus,

nourish Jing
KI-14 Siman: invigorate Blood, move Qi, resolve
Phlegm
KI-16 Huangshu: harmonize Heart and Kidneys,
connect Heart and Kidneys, subdue rebellious Qi
KI-21 Youmen: subdue rebellious Qi
LIV-3 Taichong: invigorates Blood of Chong Mai.
Treat Chong Mai in phases 4 and 1.

CLINICAL SIGNIFICANCE OF THE VARIOUS NAMES OF THE CHONG MAI
The Chong Mai is variously called the:

“Sea of Blood”
“Sea of the 12 Channels”
“Sea of the 5 Yin and 6 Yang Organs”
SEA OF BLOOD
Ling Shu chapter 33
Although the Chong Mai is the Sea of Blood it is referred to as the “Sea of
the 12 Channels”: “The Chong Mai is the Sea of the 12 Channels; its
upper Transporting [Shu] point is BL-11 Dashu and its lower Transporting
points ST-37 Shangjuxu and ST-39 Xiajuxu.”
Therefore, the points BL-11 Dashu and the pair ST-37 Shangjuxu and ST-
39 Xiajuxu are the upper and lower points of the Sea of Blood
respectively.
PATHOLOGICAL SYMPTOMS OF THE SEA OF BLOOD
It is obvious that the Sea in this passage refers to the Sea of Blood because:
1. It is mentioned in the same breath as the Sea of Qi, Sea of Food and Sea of
Marrow
2. The passage refers to the “transporting” (shu) points of this Sea as BL-11,
ST-37 and ST-39; these are the points of the Sea of Blood.
Ling Shu chapter 33
“When the Seas function harmoniously there is life; when they function
against the normal flow there is disease...When the Sea of Blood is in
excess, the person has the feeling of the body getting bigger and the person
is unable to pin-point the trouble; when the Sea of Blood is deficient, the
person has the feeling of the body getting smaller and is unable to pin-
point the trouble.”
The above symptoms of Fullness and Emptiness of the Sea of Blood are rare
and not clinically important. It is unclear how the above points (BL-11, ST-37
and ST-39) are connected to the Chong Mai or why they are points of the Sea
of Blood.
The most important aspect of the Chong Mai as the Sea of Blood is in
gynaecology.
The Chong Mai has a deep influence on the gynaecological system because:
• it originates from between the Kidneys
• it is responsible for the 7-year cycles of women
• it is responsible for the transformation of Kidney-Jing into menstrual

blood
• it flows through the Uterus
CLINICAL NOTE
To invigorate Blood of the Chong Mai in gynaecology, one needs to use
the opening and coupled points (SP-4 Gongsun and P-6 Neiguan)
together with KI-14 Siman and LIV-3 Taichong.
The Blood of the whole body relies on the Chong Mai for its movement
and circulation. The Chong Mai controls all the Blood Luo channels,
which are the deep level of the Luo channels, an energetic level that is
connected with Blood and blood vessels.
The Chong Mai affects all of these channels through its opening and
coupled points (SP-4 and P-6). As these channels are involved in Blood
stasis, the Chong Mai can be used to treat Blood stasis anywhere in the
body.
The Chong Mai influences the movement of Qi and Blood in the whole body.
Yang Shang Shan says: “Under the umbilicus is the Motive Force [Dong
Qi] in between the two kidneys which governs human life and is the root of
the 12 channels: this is the Sea of Blood of the Chong Mai, the Sea of the 5
Zang and 6 Fu and of the 12 channels. It oozes into the Yang, irrigates the
Jing...it is the Motive Force below the umbilicus and in the uterus. It
moves upwards and downwards, it is the Chong Mai.”
The “Lei Jing” has an interesting summary of the energetic sphere of action
of the Chong Mai and explains more in depth the meaning of this vessel's
being the “Sea of the 12 Channels”: “The Chong Mai is the Sea of the 12
Channels [Sea of Blood], it goes upwards to connect with Bl-11 Dashu and
downwards to connect with ST-37 Shangjuxu and ST-39 Xiajuxu. The
Chong Mai goes down to ST-30 Qichong and up to connect with the Kidney
channel. It goes up the eyes and head and down to the feet; it goes to the
back [in the lumbar spine] and to the front in the abdomen. It goes into the
Interior in the rivers and valleys [the big and small muscles of the
abdomen] and into Exterior in the skin and muscles. It therefore connects
with both Yin and Yang and both Interior and Exterior...100 diseases
originate from the Chong Mai because it is the most 'penetrating' [of the
channels]. It controls the Qi and Blood of the 12 Channels which nourish
the whole body and for this reason it is called the Sea of the 5 Zang and 6
Fu.”1
1. Classic of Categories, p. 281.

The Chong Mai’s control of all the Blood-Luo channels explains the
connection between disharmony of Blood in the Uterus and the development
of muscular pains, something which often occurs after childbirth. It also
explains why women often suffer external invasions during menstruation.
The depletion of Blood in the Chong Mai induces an emptiness of the

Blood-Luo channels: this affects the superficial Luo channels and
therefore the space between skin and muscles becomes empty and prone
to invasion of external pathogenic factors.
As we have seen above, the Chong Mai controls all Luo channels and
it goes to the Exterior of the body.
Chong Mai Sea of Blood Superficial

Blood depleted Luo Luo
Cou Li space
depleted depleted
THE BLOOD-LUO CHANNELS
YANG
If we think for example of
the cross-section of a limb,
the levels of Luo channels
are as follows: TB
LUO CHANNEL
SI LI
Superficial and
Minute Luo channels DEEP LUO
DEEP LUO
Luo channel proper HE LU
LUO CHANNEL
Main channel
P
Deep (Blood) Luo channel
YIN
We can relate the three layers in the channel network to the three types
of Qi:
- On the surface = Wei-Qi level

- In the centre = Qi and Ying-Qi level
- In the Interior = Blood level.
COU LI - WEI LEVEL Superficial Luo
WEI LEVEL Luo channel
QI LEVEL Main channel
BLOOD LEVEL Deep Luo channel

THE LUO AND MAIN CHANNELS
The 12 Main channels are situated between the Yang and Yin Luo. It is
through the Yin and Yang Luo channels that Ying and Wei Qi and Qi and
Blood of the main channels spread in all directions, permeate and irrigate the
Zangfu. It is also through the Luo channels that the essence of the Zangfu is
transported to the main channels and, through them, to the whole body.
Superficial Yang Luo

Y
Yang Luo
A
Main Yang channel N
G
Deep-Blood Yang Luo
Deep-Blood Yin Luo

Main Yin channel Y
I
Yin Luo
N
Superficial Yin Luo
BLOOD STASIS IN THE LUO CHANNELS
Blood stasis in the Luo channels may derive from Qi stagnation, or Cold
or Heat obstructing the Luo channels. Blood stasis takes a long time to
come about and is therefore only seen in chronic diseases.
The Deep Luo channels are related to Blood, in particular, this layer of the
Luo channels is responsible for the circulation of Blood and is therefore
affected by Blood stasis in chronic diseases.
We can therefore say that practically all Blood stasis in the body occurs in
the Deep Luo channels.
THE LUO CHANNELS AND BLOOD STASIS
The Deep Luo channels easily suffer from Blood stasis, especially the Yin
Luo. As the Luo channels are like a net occupying the body cavities, and
because they transport Qi and Blood between the Yang Luo, Yin Luo and
Main channels, in chronic diseases, they are easily affected by Blood
stasis.
Blood stasis may occur in the Luo channels through invasion of pathogenic
factors, a change in the composition or quality of Blood due to Cold or
Heat, or due to traumatic injury.
BLOOD
Ye Tian Shi mentions:
“The Liver Luo causes stasis”

“The Gall-Bladder Luo causes bloody vaginal discharge”
“Injury to the Liver and Spleen Luo causes Blood stasis”
“Blood stasis affects the Stomach Luo.”
Thus the saying:
“In the beginning of a disease the main channels and Qi are affected; at
the chronic stage Blood and the Luo are affected.”
“Luo” here refers to Deep-Blood Luo.

Therefore, all Luo points, but particularly those of the Yin channels can be
used to invigorate Blood and eliminate Blood stasis in chronic diseases.
The most important one of all the Yin Luo points is SP-4 Gongsun because it is
the master point of the Chong Mai.
- LU-7 Lieque: retention of lochiae, retention of dead foetus, inability to

speak after childbirth.
- SP-4 Gongsun: abdominal pain, irregular periods, retention or placenta/lochiae.
- HE-5 Tongli: chest pain, pain heart region.
- BL-58 Feiyang: swollen and painful haemorrhoids.
- KI-4 Dazhong: irregular periods.
- LIV-5 Ligou: swelling and pain of the testicles, painful periods,

irregular periods.
- Ren-15 Jiuwei: chest pain, pain radiating from the heart to the back.
- LIV-3 Taichong: abdominal pain, irregular/painful periods.

THE CHONG MAI IN GYNAECOLOGY
The Chong Mai is the Sea of Blood and its pathology is at the root of many
gynaecological problems. The three Blood pathologies that affect the Chong
Mai are:
1) Blood deficiency
When there is Blood deficiency, the woman may suffer from
amenorrhoea or scanty periods.
2) Blood Heat
When there is Blood Heat, the periods may be very heavy.
3) Blood stasis
When there is Blood stasis the periods will be painful and the menstrual blood will
be dark with clots.
Blood stasis in the Uterus is the pathology of the Chong Mai, therefore, when
this occurs, the Chong Mai is used to invigorate Blood.
The points to use are the opening and coupled points (SP-4 and P-6) together
with KI-14 Siman and LIV-3 Taichong.
5. DISEASES
Erectile dysfunction
Benign prostatic hyperplasia
Chest Bi
Goitre
Hyperthyroidism
Endometriosis
Myoma
Cancer
Please note that we will discuss these diseases only in connection

with Blood stasis
5. DISEASES
ERECTILE DYSFUNCTION
ED may be caused by stasis of Jing which is similar to Blood

stasis. Jing stasis is a pathology that pertains exclusively to men’s
genital system. It is a pathology of the Room of Sperm just as
Blood stasis is a pathology of the Uterus in women.
In this context, “stasis of Jing” refers more to “sperm” than to
“Jing”, hence my translation of Jing Shi as “Room of Sperm”
rather than “Room of Jing”.
The pathology of stasis of Jing is related to the Kidneys and Liver
primarily. One characteristic of stasis of Jing is that it may cause
pain: for example, penis pain, scrotal pain or perineal pain.
Please note how Phlegm and stasis of Jing (or Blood) may give
rise to the same pathology, e.g. Peyronie’s disease or prostatic
hyperplasia. Of course, Phlegm and stasis of Jing also frequently
occur simultaneously in men’s genital problems.
STASIS OF JING
Stabbing pain lumbar region WOMEN MEN
pain in perineum KIDNEYS KIDNEYS
hypogastric pain
pain in testis and/or penis TIAN GUI TIAN GUI
erectile dysfunction
premature ejaculation
priapism Uterus –
Blood Room of Jing
prostatic hyperplasia
Chamber
premature greying of hair
itching or pain pubic region
abnormal sperm BLOOD JING STASIS IN
Peyronie’s disease STASIS ROOM OF
IN SPERM
Purple tongue UTERUS
Choppy or Firm pulse.
Looking at the clinical manifestations of Phlegm and stasis of Jing in men’s
genital system, there are some important observations to make.
1) Some of the manifestations of Phlegm and of stasis of Jing (or Blood) are
the same, i.e. prostatic hyperplasia, Peyronie’s disease, impotence,
priapism. This means that each of these manifestations may be due to
either Phlegm of stasis of Jing. For example, in benign prostatic
hyperplasia, if the prostate is large and soft on palpation and there is no
pain, this is due to Phlegm: if the prostate is hard on palpation and there is
perineal pain, this is due to stasis of Jing (or Blood). Of course, in many
cases, prostatic hyperplasia is due to both Phlegm and stasis of Jing (or
Blood).
2) It is interesting to note that premature greying of the hair may be a sign of
stasis of Jing. In other words, premature greying of the hair may be due to
a decline of Kidney-Jing but, interestingly, also to stasis of Jing, i.e. the
Jing fails to nourish the hair not because it is deficient but because it is
stagnant.
In ED, it is important to differentiate Full from Empty conditions and
the main pathogenic factors involved. Two of the patterns are Blood
stasis and Jing stasis.
Full Empty
Dampness Heart-Blood deficiency

Phlegm Heart- and Gall-Bladder-Qi deficiency
Blood stasis Kidney-Yang deficiency
Stasis of Jing Liver-Blood deficiency
Kidney-Yin deficiency
In Full conditions pathogenic factors obstruct the process that leads to an
erection.
Blood stasis affects the penis through the Liver channel and the Chong Mai.
Blood and Jing stasis (usually deriving from emotional stress and overwork)
also obstruct the Luo Mai of the penis and in particular the Blood (Deep) Luo
Mai, making erection difficult.
Dampness and Phlegm (usually deriving from irregular diet) obstruct the Luo
Mai of the penis and prevent erection. Dampness or Phlegm affecting the penis
usually stems from the Spleen, Kidney and Liver channels.
STASIS OF JING WITH PHLEGM
Impotence, pain in the testis and perineum, hypogastric pain, premature
greying of hair, abnormal sperm (motility, shape, etc.), feeling of
oppression of the chest, urethral discharge. Tongue: Purple and Swollen
with a sticky coating.
Pulse: Firm-Slippery.
Treatment principle
Invigorate Blood and Jing, eliminate stasis, resolve Phlegm.
Acupuncture
SP-4 Gongsun with P-6 Neiguan, KI-14 Siman, ST-28 Shuidao, Ren-3
Zhongji, BL-34 Xialiao, LIV-5 Ligou, LIV-3 Taichong, SP-10 Xuehai, ST-40
Fenglong, SP-9 Yinlingquan, Ren-9 Shuifen, BL-22 Sanjiaoshu. All with
reducing or even method.
Herbal therapy
Prescription
HUO XUE TONG JING TANG
Invigorating Blood and Penetrating the Jing Decoction
Explanation
This formula invigorates Blood and the Jing.
Three Treasures remedy

CLEAR THE ROOT
Clear the Root resolves Phlegm, drains Fire and invigorates Blood in the
genital system.
HUO XUE TONG JING TANG
Invigorate Blood and Penetrate the Jing Decoction

He Shou Wu Radix Polygoni multiflori preparata 6 g
Yi Mu Cao Herba Leonuri 6 g
Ji Xue Teng Caulis Spatholobi 6 g
Chuan Niu Xi Radix Cyathulae 6 g
Gou Qi Zi Fructus Lycii chinensis 6 g
Xue Jie Resina Demonoropis 6 g
Pu Huang Pollen Typhae 6 g
Wang Bu Liu Xing Semen Vaccariae 6 g
QI STAGNATION AND BLOOD STASIS
ED, low sperm count, poor motility, distension and discomfort of testis, pain
in perineum, hypogastric pain, prostatic hypertrophy, Purple tongue.
Acupuncture: SP-4 Gongsun and P-6 Neiguan (Chong Mai), LIV-3

Taichong, SP-10 Xuehai, BL-17 Geshu, KI-14 Siman, ST-30 Qichong.
Herbal therapy
Prescription
GE XIA ZHU YU TANG
Three Treasures: Stir Field of Elixir

BENIGN PROSTATIC HYPERPLASIA
The Blood stasis that contributes to causing BPH lies in the Deep Luo within
the prostate. There are two levels of Luo channels: the Superficial Luo which
lie on the exterior of the Main channels, and the Deep (or Blood) Luo which
lie in the interior of the Main channels. It is in the Deep Luo that Blood
stasis occurs.
DEEP (BLOOD) LUO

Blood stasis in the prostate is located in the Deep (Blood) Luo of the
prostate. Herbs which “penetrate the Luo” (tong Luo):
Superficial Luo
Luo channel
Main channel
Deep Luo channel

BLOOD STASIS in mens’ genital pathology
Blood stasis resulting from stagnation of Liver-Qi and Liver-Blood and

from stasis of Jing is another factor in the pathology of benign prostatic
hyperplasia.
The clinical manifestations of Blood stasis in men’s genital system are:
• Stabbing pain lumbar region • prostatic hypertrophy

• pain in perineum • abnormal sperm, blood in sperm
• hypogastric pain • Peyronie’s disease
• pain in testis and/or penis • Purple tongue
• priapism • Choppy, Wiry or Firm pulse.
Blood stasis in the prostate occurs in the prostate’s Blood Luo Mai.
One therefore needs herbs that “penetrate the Luo Mai” (tong Luo) such as:
Lu Lu Tong Tong Cao Ju Luo Si Gua Luo Lou Lu

BLOOD STASIS MEN’S GENITAL SYSTEM
decreased urinary flow
nocturia
hypogastric pain
pain in the perineum
the prostate feels hard on rectal examination
Tongue: Purple.
Pulse: Wiry, Choppy or Firm. Prostate pulse Wiry.
Treatment principle
Invigorate Blood and eliminate stasis, soften hardness.
Left
Pulse
Cun
Guan Slippery: Dampness or Phlegm

Chi Wiry: Blood or Jing stasis
Prostate
Acupuncture
LIV-3 Taichong, SP-10 Xuehai, BL-17 Geshu, KI-14 Siman, SP-4 Gongsun on
the left and P-6 Neiguan on the right (Chong Mai), Ren-2 Qugu, BL-32 Ciliao,
BL-34 Xialiao.
Herbal therapy
Prescription
HU PO SI WU TANG
Succinum Four Substances Decoction
Explanation
This formula invigorates Blood, eliminates stasis and soften hardness.
Prescription
DAI DI DANG TANG
Surrogate Keeping out Decoction
Explanation
This formula invigorates Blood and soften hardness. It is especially suitable if
there is Heat in the Stomach and Intestines with dry stools.
Three Treasures remedies

Stir Field of Elixir and Clear the Root.
HU PO SI WU TANG
Succinum Four Substances Decoction
Hu Po Succinum 6 g
Shu Di Huang Radix Rehmanniae preparata 6 g
Bai Shao Radix Paeoniae alba 6 g
Chuan Niu Xi Radix Cyathulae 6 g
Dan Shen Radix Salviae milthiorrizae 6 g
Chuan Shan Jia Squama Manitis Pentadactylae 6 g
Rou Gui Cortex Cinnamomi 3 g
Wang Bu Liu Xing Semen Vaccariae 6 g
DAI DI DANG TANG
Surrogate Keeping out Decoction
Da Huang Radix et Rhizoma Rhei 9 g

Mang Xiao Natrii Sulfas 6 g
Sheng Di Huang Radix Rehmanniae 12 g
Shan Jia Squama Manitis 6 g
Rou Gui Cortex Cinnamomi 3 g
CHEST BI
Channels
The most important channels in the
pathology of Chest Bi Syndrome are the
Lung, Heart, Pericardium and Great
Luo channel of the Stomach.
From the point of view of channels, when Chest Bi Syndrome manifests

with chest pain, both the Heart and the Pericardium organs are involved
(and especially the latter).
Whilst as an organ the Pericardium is the outer covering of

the Heart and its functions are the same as those of the
Heart, from the point of view of channels, the Pericardium
channel is quite distinct from the Heart channel and, on a
physical level, has a different sphere of action, influencing
the area at the centre of the thorax and invigorating Blood.
The Nei Jing often refers to the Pericardium as the
“centre of the thorax”. The Pericardium channel goes
to the centre of the thorax and this area, called Shan
Zhong, is under the influence of the Pericardium.
Chapter 35 of the “Ling Shu” says:
“The centre of the thorax [shan zhong] is the palace of the Pericardium [Xin
Zhu]”.
Hence the important action of P-6 Neiguan on the chest and of the point Ren-17
Shanzhong to affect the Pericardium channel. In particular, P-6 Neiguan is
important to invigorate Blood.
Being in the centre of the chest, the Pericardium influences the Zong Qi and
therefore both Heart and Lungs. The Pericardium in this area acts as the
agent of propulsion for the Qi and Blood of both Heart and Lungs; for this
reason, Pericardium patterns are characterized by clinical manifestations
along the chest channels, causing tightness, distension, oppression or pain of
the chest.
Thus, whilst in terms of organ functions the Pericardium is obviously

closely related to the Heart, in terms of channels, it is exteriorly-
interiorly related to the Triple Burner channel, the Pericardium being
Yin and the Triple Burner Yang. Moreover, the Pericardium is related
to the Liver (Jue Yin) and the connection with the Liver is another
reason why it invigorates Blood.
HEART-BLOOD STASIS
Pricking pain in the chest which is fixed and worse at night, palpitations.
Tongue: Purple, especially in the chest

area or on the sides in correspondence
with the chest area (see right).
Pulse: Deep and Choppy.
Treatment principle
Invigorate Blood, eliminate stasis, invigorate the Luo
channels, stop pain.
Acupuncture
BL-13 Feishu, BL-14 Jueyinshu, BL-15 Xinshu, Ren-17 Shanzhong, Ren-14
Juque, P-4 Ximen, P-6 Neiguan, ST-40 Fenglong, SP-10 Xuehai, BL-17
Geshu, Du-12 Shenzhu, Du-11 Shendao, Du-10 Lingtai, S.I.-11 Tianzong.
Explanation
- BL-13 is used to stimulate the descending of Qi and to invigorate Blood by
moving Qi.
- BL-14, Ren-17, BL-15 and Ren-14 are the Back-Shu and Front-Mu points of
Pericardium and Heart respectively. In acute cases they are used with reducing
method. These are the main points. Ren-17 is needled horizontally downwards. If
the chest pain extends towards the left side, this point can be needled horizontally
towards the heart.
- P-4 is the Accumulation point and as such stops pain and is specifically indicated
in acute syndromes.
- P-6 is the Luo point and opening point of the Yin Wei Mai. It opens the chest,
moves Qi and Blood and removes obstructions. It should be needled with reducing
method.
- ST-40 opens the chest (in combination with P-6) and it subdues rebellious Qi.
- SP-10 invigorates Blood.
- BL-17 invigorates Blood and relaxes the diaphragm.
- Du-12-11-10 move Qi and Blood in the chest.
- S.I.-11 invigorates Blood in the chest and it is chosen when the chest pain extends
to the scapula.
Herbal therapy
Prescription
XUE FU ZHU YU TANG
Blood Mansion Eliminating Stasis Decoction
Explanation
This formula invigorates Heart-Blood and eliminates stasis of Blood in the Upper
Burner.
Prescription
TAO HONG SI WU TANG Variation
Persica-Carthamus Four Substances Decoction Variation
Explanation
This prescription is used when Phlegm and Heat accompany the stasis of Blood in
the chest. The symptoms would be a feeling of oppression of the chest, a feeling
of heat, thirst and a Red tongue.
Prescription
CHEN XIANG JIANG QI SAN plus XUAN FU HUA TANG
Aquilaria Subduing Qi Powder plus Inula Decoction
Explanation
These two formulae together move Qi, invigorate Blood, resolve Phlegm
and restore the descending of Lung-Qi.
The three formulae for Chest Bi Syndrome from Blood stasis are compared
and contrasted in the table below.
Modifications
- If there are signs of Blood-Heat add Mu Dan Pi Cortex Moutan and Chi
Shao Radix Paeoniae rubra
- If there are signs of Cold add one or two of the following herbs: Chuan
Xiong Rhizoma Chuanxiong, Wu Ling Zhi Excrementum Trogopteri, Mo
Yao Myrrha or Yan Hu Suo Rhizoma Corydalis.
Three Treasures remedy

Red Stirring
Red Stirring invigorates Heart-Blood and eliminates stasis in the Upper
Burner.
TAO HONG SI WU TANG Variation
(Chest Bi, Heart-Blood stasis)
Persica-Carthamus Four Substances Decoction Variation

Shu Di Huang Radix Rehmanniae preparata 12 g
Bai Shao Radix Paeoniae alba 6 g
Chuan Xiong Radix Chuanxiong 6 g
Huang Lian Rhizoma Coptidis 3 g
Dan Nan Xing Rhizoma Arisaematis preparatum 6 g
Zhu Ru Caulis Bambusae in Taeniam 6 g
San Qi Radix Notoginseng 3 g
Dan Shen Radix Salviae miltiorrhizae 9 g
Jiang Huang Rhizoma Curcumae longae 3 g
CHEN XIANG JIANG QI SAN
Aquilaria Subduing Qi Powder
Chen Xiang Lignum Aquilariae resinatum 3 g

Sha Ren Fructus Amomi 4 g
Zhi Gan Cao Radix Glycyrrhizae uralensis preparata 3 g
Sheng Jiang Rhizoma Zingiberis recens 3 slices
XUAN FU HUA TANG

Inula Decoction
Xuan Fu Hua Flos Inulae 9 g

Su Geng Radix Perillae frutescentis 6 g
Yu Jin Radix Curcumae 6 g
Si Gua Luo Fructus Luffae retinervus 6 g
Formulae for Heart-Blood stasis
FORMULA DIFFERENTIATION
XUE FU ZHU YU TANG Heart-Blood stasis

TAO HONG SI WU TANG Heart-Blood stasis with Phlegm-Heat
Variation
CHEN XIANG JIANG QI Qi stagnation, Blood stasis, Phlegm,
TANG plus XUAN FU HUA rebellious Qi (cough, breathlessness)
TANG
Case history
A 74-year-old man had been suffering from what had been diagnosed as
angina pectoris for 1 year. The attacks were elicited by exercise, cold and
eating. The pain in the chest was quite severe. He also complained of a
feeling of heaviness in the legs. He looked generally quite strong and had
no other symptoms. His voice and his spirit were strong. His tongue was
Reddish-Purple with a yellow coating and his pulse was Wiry and Full.
Diagnosis
First of all, the condition is clearly one of Fullness as evidenced by his
strong voice and spirit, strong body, Full pulse and tongue with coating. As
for the chest pain, this is due to stasis of Blood in the chest. Stasis of Blood
is evident from the character of the pain, the purple colour of the tongue-
body and the Wiry pulse. The feeling of heaviness in the legs is due to
Dampness infusing downwards.
Treatment principle
The treatment of principle used was to invigorate Blood in the chest.
This patient was treated with acupuncture only with good results.
Acupuncture
The main points used were aimed at invigorating Blood and eliminating
stasis. These were:
P-6 Neiguan, P-4 Ximen, ST-40 Fenglong, Ren-17 Shanzhong and BL-14
Jueyinshu with even method.
ST-40 was used not for its capacity of resolving Phlegm but because, in
combination with P-6, it relaxes the chest and regulates the ascending and
descending of Qi in the chest.
Comparison of Phlegm and stasis of Blood in Chest Bi from symptoms,
tongue and pulse.
PHLEGM STASIS OF BLOOD
Symptoms Oppression of the chest Pain in the chest
Tongue Swollen body, sticky Purple body

coating
Pulse Slippery Choppy or Wiry

GOITRE 瘿
“Goitre” is not a “disease” in a Western sense but simply a clinical sign:

hypo- or hyper-thyroidism, by contrast, are “diseases” in a Western sense.
Nevertheless, “Goitre” is a “disease” in the context of Chinese medicine.
In Chinese, goitre is called Ying [瘿]. Ancient books mentioned:
Qi Ying You Ying Tu Ying Lao Ying Shi Ying

(Qi Goitre) (Worry (Earth (Exhaustion (Stone
Goitre) Goitre) Goitre) Goitre)
Blood stasis
Other books classified goitre into “Stone Ying”, “Sand Ying”, “Exhaustion
[Lao] Ying”, “Worry Ying” and “Qi Ying”.
The book “Treatise on the Three Categories of Aetiology of Diseases” (San Yin
Ji Yi Bing Zheng Fang Lun) has a different classification of goitre:
“Goitre that feels hard and tough and does not move is called Stone Ying
[Blood stasis]. A goitre that does not change the colour of the skin is called
Muscle Ying. That with exposed sinews is called Sinews Ying. That with
exposed vessels is called Blood Ying. That which changes size according to
emotions is called Qi Ying.”
“In all five types of goitre do not break [Blood] as this may cause a massive
discharge of pus and blood and untimely death.”
Qi Muscle Sinews Blood Stone

Blood stasis
The goitre swelling in itself always indicates Phlegm: indeed, a soft
goitre is a classic example of lump from Phlegm. However, this may
combined with Qi stagnation or Blood stasis.
The following are indications regarding the feel of the goitre lump in
relation to patterns:
Soft goitre with indistinct edges, varying Large, soft and smooth mass:
in size with emotional state: Phlegm
Qi stagnation and Phlegm
Hard, nodular mass that is immovable Small or medium-size goitre, relatively

and grows rapidly, dark skin over mass: soft, slippery under the finger:
Phlegm with Blood stasis Liver-Fire (with Phlegm)
Herbal treatment
Prescription
HAI ZAO YU HU TANG
Sargassum Jade Flask Decoction
Hai Zao Sargassum

Kun Bu Thallus Laminariae seu Ekloniae
Hai Dai Herba Zosterae marinae
Zhe Bei Mu Fructus Fritillariae thunbergii
Ban Xia Rhizoma Pinelliae
Du Huo Radix Angelicae pubescentis
Qing Pi Pericarpium Citri reticulatae viride
Chen Pi Pericarpium Citri reticulatae
Lian Qiao Fructus Forsythiae suspensae
Gan Cao Radix Glycyrrhizae
Explanation
This formula moves Qi, resolves Phlegm, soften hardness, dissolves
masses and invigorates Blood.
HYPERTHYROIDISM
Blood stasis
Mental restlessness, feeling of heat, weight loss, nervousness, fatigue,
insomnia, skin flushing, itching all over the body, palpitations, exophthalmos,
goitre that is hard and nodular.
Tongue: Purple.
Pulse: Wiry-Rapid.
Treatment principle
Invigorate Blood, eliminate stasis, calm the Mind.
Acupuncture
P-6 Neiguan, LIV-3 Taichong, BL-17 Geshu, SP-10 Xuehai, SP-6 Sanyinjiao,
SP-4 Gongsun with P-6 Neiguan (Chong Mai).
Explanation
All the above points invigorate Blood.
Prescription
TONG QIAO HUO XUE TANG

Hong Hua Flos Carthami
Lao Cong Herba Allii fistulosi
Sheng Jiang Rhizoma Zingiberis recens
Shi Chang Pu Rhizoma Acori
Da Zao Fructus Jujubae
Explanation
This formula invigorates Blood with a specific action on the head
region. Please note that I have replaced She Xiang (musk) in the
original formula with Shi Chang Pu.
Three Treasures
Red Stirring
Red Stirring (a variation of Xue Fu Zhu Yu Tang) invigorates Heart-
Blood
ENDOMETRIOSIS
• Dysmenorrhoea (97%)
• pelvic pain (62%)
• lower backache radiating to the anterior thigh
• heavy periods
• irregular bleeding
• Infertility (47%)
• Dyspareunia (59%)
• pain sometimes accompanied by nausea and vomiting or diarrhoea
• pain on defecation (68%)
• rectal pressure
• tender and enlarged ovaries
• pelvic nodularities and thickenings
• Fatigue (64%)
Clinical manifestations (Endometriosis Association USA)
• Dysmenorrhoea (96.2%)
• Dyspareunia (59.6%)
• heavy periods or irregular bleeding (65.3%)
• Infertility (44%)
• pain sometimes accompanied by nausea and vomiting (57.7%)
• diarrhoea (79%)
• dizziness, headaches with period (59%)
• Fatigue (82.1%)
• Low-grade fever (29.4%)
• low resistance to infection (39.1%)
• no symptoms (2.6%)
This is a section through an enlarged 12 cm ovary showing a cystic cavity
filled with old blood with formation of an endometriotic, or "chocolate", cyst.
The hemorrhage from endometriosis into the ovary may give rise to a large
"chocolate cyst" so named because the old blood in the cystic space formed by
the hemorrhage is broken down to produce much hemosiderin and a brown to
black colour.
10/19/2018 copyright 2006 Free template from brainybetty.com ALL RIGHTS RESERVED. 201
BIAN
ZHENG “BLOOD STASIS”
辨证
BIAN BING “PAINFUL PERIODS”
辨病
“ABDOMINAL MASSES”
“Abdominal masses” could only be diagnosed by ancient Chinese

doctors on palpation when masses are palpable.
A large, palpable myoma is a good example of an abdominal

mass from Blood stasis.
Abdominal masses from Blood stasis must be treated by “breaking Blood”
copyright 2006 Free template from

Normal pelvis
copyright 2006 Free template from brainybetty.com ALL RIGHTSRESERVED.
10/19/2018 204
ENDOMETRIOSIS – TREATMENT PRINCIPLE
Treat Biao and Ben, i.e. invigorate Blood and tonify the Kidneys. Invigorating
Blood only is not enough, one must “break” Blood. It is also necessary to
regulate the menses according to the 4 phases
Must warm the Uterus even if there are no specific signs of Cold in order
to ensure the growth of Yang in phases 3 and 4. Obviously not if there
Liver-Fire or Damp-Heat.
Use Tong Xia 通下 method (penetrating downwards) to stop pain
To stop pain, calming the Heart is also important

TREATMENT STRATEGY
Treat Ben by tonifying the Kidneys (Yang or Yin). Important to tonify the
Kidneys in phases 2 and 3.
Treat Biao by breaking Blood in phases 4 and 1
Acupuncture treatment to promote ovulation:
a) Ren-3 Zhongji, SP-6 Sanyinjiao, KI-12 Dahe.
b) Ren-3 Zhongji, SP-6 Sanyinjiao, Ren-4 Guanyuan, Zigong.

Start when cervical secretion appears.
copyright 2006 Free template from

HARMONIZING THE MOON
Shu Di Huang Radix Rehmanniae preparata
Chuan Xiong Radix Chuanxiong
Yan Hu Suo Rhizoma Corydalis
E Zhu Rhizoma Curcumae
San Leng Rhizoma Sparganii stoloniferi
Ze Lan Herba Lycopi
Gui Zhi Ramulus Cinnamomi cassiae
Fu Ling Poria
Mu Dan Pi Cortex Moutan
Lu Lu Tong Fructus Liquidambaris
Huang Bai Cortex Phellodendri
Yi Yi Ren Semen Coicis
Tu Si Zi Semen Cuscutae
Qian Cao Gen Radix Rubiae
Pattern: Blood stasis in the Lower Burner, Dampness in the Lower Burner, Kidney deficiency.
Action: Invigorate Blood, dissolve masses, drain Dampness, tonify the Kidneys.
Indications: Abdominal masses, endometriosis, endometrial ovarian cysts, fibroids, painful
periods, heavy periods.
Tongue: Purple sides.

Pulse: Wiry or choppy.
Classical Antecedent: Gui Zhi Fu Ling Wan Cinnamon Twig and Poria Pill
HARMONIZING THE MOON
IN A NUTSHELL: invigorate Blood, eliminate stasis and dissolve masses in

gynaecological problems. Endometriosis.
CLASSICAL ANTECEDENT: Gui Zhi Fu Ling Wan Cinnamomum-Poria

Pill.
DIFFERENCES FROM CLASSICAL ANTECEDENT:

• Stronger “breaking” Blood action.
Bluish-purple sides Bluish-purple root

BLOOD STASIS, KIDNEY-YANG DEFICIENCY AND DAMPNESS
mid-cycle hypogastric pain possibly abdominal masses
scanty or heavy periods abdominal pain
Painful periods lower backache
dark blood with clots vaginal discharge
feeling cold
Tongue: Swollen, Pale with Purple sides, sticky

coating.
Pulse: Deep-Weak-Slippery-Wiry.
Phase 1 Phase 2 Phase 3 Phase 4
YANG
YIN
Menstrual Post-menstrual phase Mid-cycle phase (about Pre-menstrual phase

phase: (about 7 days): Warm 7 days): Warm and (about 7 days):
invigorate and tonify Kidney- tonify Kidney-Yang, Invigorate Blood,
Blood, Yang, tonify Spleen- tonify Spleen-Qi, eliminate stasis,
eliminate Qi. You Gui Wan resolve Dampness. You resolve Dampness.
stasis. Gui (Unicorn Pearl) Gui Wan (Unicorn Gui Zhi Fu Ling Wan
Zhi Fu Ling Pearl) (Harmonizing the
Wan Moon)
(Harmonizing
the Moon)
MYOMA
SYMPTOMS
- Very heavy and prolonged menstrual periods, clots

- Pain in the back of the legs
- Pelvic pain or pressure
- Pain during sexual intercourse
- Pressure on the bladder with a frequent need to urinate, incontinence, or the
inability to empty the bladder
- Pressure on the bowel which can lead to constipation, bloating or feeling of
fullness
- An enlarged abdomen which may be mistaken for weight gain or
pregnancy
- Bleeding between periods
- Sudden, severe pain due to a pedunculated fibroid
However, most of the above symptoms and signs appear only when the
myoma is large. In many cases, there are no symptoms and no pain.
ABDOMINAL MASSES
积聚 JI JU
症瘕 ZHENG JIA
积 Ji
聚 Ju
Masses from Blood stasis
症 Zheng
Masses from Qi stagnation
瘕 Jia
ABDOMINAL MASSES 积聚
Nan Jing, chapter 35
How to distinguish between Ji [积] and Ju [聚]? Ji [masses] are Yin and
Ju [masses] are Yang. Yin is deep and hidden; Yang is superficial and
moves. When Qi accumulates it gives rise to Ji [masses]; when Qi
gathers it gives rise to Ju [masses].
Ji [masses] originate from the 5 Zang; Ju [masses] originate from the 6

Fu. Ji [masses] are made of Yin Qi and have a fixed location and pain,
and have boundaries above and below, and edges to the right and left
[i.e. they have clearly defined borders]. Ju [masses] are made of Yang Qi
and seem to start from nowhere, without a boundary above and below
and with a moving pain.
Note that we would say the opposite about having boundaries, i.e. a
benign lump would have boundaries (e.g. a benign breast cyst) and a
malignant one would not (e.g. breast carcinoma).
Abdominal masses are called Ji Ju [积聚]. Ji indicates actual
abdominal masses which are immovable; if there is an associated
pain, its location is fixed. These masses are due to stasis of Blood.
I call them "Blood masses".
Ju indicates abdominal masses which come and go, do not have a

fixed location and are movable; if there is an associated pain, it too
comes and goes and changes location. Such masses are due to
stagnation of Qi. I call them "Qi masses".
Actual abdominal lumps therefore pertain to the category of

abdominal masses and specifically Ji masses, and are due to Blood
stasis. I call them “Blood masses”.
Another name for abdominal masses was Zheng Jia [癥瘕], Zheng
being equivalent to Ji, i.e. actual, fixed masses and Jia to Ju, i.e.
non-substantial masses from stagnation of Qi.
Zheng Jia is normally used in referring to abdominal masses that

generally occur only in women; but they do occur in men as well,
though rarely.
The “Su Wen” in chapter 60 says: “Diseases of the Ren Mai...in

women are masses [Jia Ju] below the waist.”
In this context, the “Su Wen” uses the term Jia-Ju, i.e. non-
substantial masses from Qi stagnation.
The “Prescriptions of the Golden Cabinet” [Jin Gui Yao Lue] by
Zhang Zhong Jing says: “Ji masses arise from the Yin organs and
they cannot be moved; Ju masses arise from the Yang organs, they
come and go, the pain has no fixed location, and they are easier to
treat.”
The “General Treatise on the Aetiology and Symptoms of Diseases”

(AD 610) says: “Abdominal masses are due to cold and heat not
being regulated [i.e. exposure to extremes of weather], irregular diet
and stagnation of the Qi of the Yin organs. If they do not move they
are called Zheng; if they are movable they are called Jia. ‘Jia’
implies the meaning of ‘false’: this is because these masses can come
and go and are not actual masses.”
Since the time of the Tang dynasty eight types of women’s abdominal
masses were described, i.e. yellow, green, dry, blood, fat, fox, snake
and turtle mass.
ABDOMINAL MASSES – 积聚 JI JU
Abdominal masses are called Ji Ju. Ji indicates actual abdominal
masses which are immovable; if there is an associated pain, their
location is fixed. These masses are due to stasis of Blood. I call
them "Blood masses".
Ju indicates abdominal masses which come and go, do not have a

fixed location and are movable; if there is an associated pain, it too
comes and goes and changes location. Such masses are due to
stagnation of Qi. I call them "Qi masses". Actual abdominal lumps
therefore pertain to the category of abdominal masses and
specifically Ji masses, i.e. Blood masses.
Another name for abdominal masses was Zheng Jia, Zheng being
equivalent to Ji, i.e. actual, fixed masses and Jia to Ju, i.e.
non-substantial masses from stagnation of Qi. Zheng Jia are
specific to women.
Zheng Jia is normally used in referring to abdominal masses that

generally occur only in women; but they do occur in men as well,
though rarely.
癥瘕 ZHENG JIA
IMPORTANCE OF BIAN BING 辨病
BIAN BING
ABDOMINAL
MASSES ZHENG JIA
MYOMA
BENG LOU
Metrorrhagia, heavy periods,

long bleeding, trickling, dark
clots
辨证 : BLOOD STASIS (BIAN ZHENG)

TREATMENT PRINCIPLES
My approach is to concentrate on the Biao and “attacking” pathogenic

factors, i.e. invigorate Blood, dissolve masses, resolve Phlegm (if
present), soften masses.
The myoma is a mass from Blood stasis and therefore the treatment
principle is to use herbs that “break” Blood to dissolve masses. The
main ones are:
E Zhu – San Leng – Ze Lan
Other “attacking” herbs that dissolve masses include:

Ban Zhi Lian (Herba Scutellariae barbatae)
Shi Jian Chuan (Radix Salviae chinensis)
Shan Ci Gu (Bulbus Shancigu)
The use of softening herbs is important. These should always be added to a
formula for myomas. When choosing a softening herb, one can combine the
softening action with its other actions appropriate to the pattern. For example,
Chuan Shan Jia invigorates Blood, Yi Yi Ren resolves Dampness and Phlegm,
Mu Li, Bie Jia and Gui Ban nourish Yin, Xia Ku Cao resolves Toxic Heat and
enters the Liver, Zhe Bei Mu resolves Phlegm, etc.
SOFTENING HERBS
Yi Yi Ren
Zhe Bei Mu
Hai Zao
Kun Bu
Hai Dai
Chuan Shan Jia
Xia Ku Cao
Gui Ban
Mu Li
Jiang Can
Bie Jia
Wa Leng Zi
PATTERNS IN MYOMAS
1. BLOOD STASIS FROM QI STAGNATION

Hard myomas, painful periods with dark blood with clots, irregular periods,
pre-menstrual tension, abdominal distension, irritability, tongue Purple on the
sides, Wiry pulse.
GUI ZHI FU LING WAN plus: E Zhu, San Leng, Xiang Fu, Yi Yi Ren, Hai Zao.
2. BLOOD STASIS FROM COLD

Hard myomas, painful periods with crampy pain and desire for hot-water bottle,
feeling cold during the period, late cycle, Pale-Bluish tongue, Tight pulse.
GUI ZHI FU LING WAN plus: E Zhu, San Leng, Xiao Hui Xiang, increase Gui Zhi,
Yi Yi Ren, Hai Zao
3. BLOOD STASIS WITH PHLEGM
Relatively soft myoma, often single, feeling of heaviness of the abdomen,
vaginal discharge, obesity, painful periods, Swollen tongue, Slippery-Wiry
pulse.
4. BLOOD STASIS, QI AND BLOOD DEFICIENCY

Hard myomas, long-time, painful and heavy periods, irregular periods, tiredness,
blurred vision, dizziness, Pale tongue with Purple sides, Weak-Choppy pulse.
5. BLOOD STASIS, KIDNEY-YANG DEFICIENCY

Hard myomas, long-time, heavy periods, tiredness, backache, frequent urination,
feeling cold, cold limbs, dizziness, tinnitus, Pale with slightly Bluish sides, Weak
pulse.
MYOMA ACUPUNCTURE TREATMENT
REN MAI: LU-7 (right), KI-6 (left)

CHONG MAI: SP-4 (right), P-6 (left)
Can use Ren Mai in phases 2 and 3 and Chong Mai in phases 4 and 1.
Chong Mai is essential to treat Blood stasis.
LOCAL-ADJACENT POINTS
Zigong (3 cun lateral to Ren-3)
Tituo (4 cun lateral to Ren-4)
ST-28 Shuidao, ST-29 Guilai
BL-32 Ciliao KI-14 Siman
DISTAL POINTS
- Blood stasis: SP-10, BL-17, LIV-3
- Qi stagnation: Ren-6, G.B.-34, LIV-3
- Phlegm: SP-9, ST-40, BL-22, Ren-9, ST-28
- Cold: ST-29, Zigong, Ren-4 (warm box)
MYOMA - STUDY
Journal of Chinese Medicine, no.51 , May 1996.

"30 cases of uterine myoma treated primarily by acupuncture" by Hu Zhenxia
and Chen Zuolin.
30 women with myoma ranging from 1.3 x 1.4 x 1.8 cm to 8.1 x 10.5 x 9 cm.
- Cure: disappearance of myoma

- Significantly effective: myoma reduced by more than 1.5 cm.
- Effective: myoma reduced by up to 1.5 cm.
- Ineffective: myoma not reduced or reduced less than 0.3 cm.
MYOMA – CHINESE STUDY
Pattern Cure Sign. Improv Ineffective Total %

Improv
Blood stasis 1 4 10 4 19 79%
Qi deficiency 0 2 7 2 11 82%
with Blood
stasis
Total 1 6 17 6 30
MYOMA - STUDY
Journal of Chinese Medicine, no.51 , 1996.

"Xu Shou Tian's experience in the treatment of myomas" by Hao Ning.
Five treatment principles:

1. Invigorate Blood and pacify the Liver (LIV-Blood stasis and Qi stagnation)
2. Invigorate the Blood and clear the Uterus (LIV-Blood stasis and Damp-Heat
in Uterus)
3. Invigorate Blood and tonify the Spleen (Blood stasis and SP-Qi Xu)
4. Invigorate Blood and strengthen the Kidneys (Blood stasis and KI-Xu)
5. Invigorate Blood and resolve Phlegm (Blood stasis and Damp- Phlegm in
Uterus)
HERBAL TREATMENT OF MASSES
In Chinese medicine, masses may form from Phlegm or from Blood

stasis. Masses from Phlegm are usually soft and painless while masses
from Blood stasis feel hard on palpation and may be painful (not
always).
To dissolve masses from Blood stasis it is necessary to:
• Invigorate Blood, “break’ Blood
• Soften hardness
• Dissolve masses
The main herbs that soften masses are as follows:
Gui Ban Plastrum Mu Li Concha Kun Bu Thallus

Testudinis Ostreae Eckloniae
Hai Zao Herba Zhe Bei Mu Bulbus Jiang Can Bombyx

Sargassi Fritillariae thunbergii batrycatus
Chuan Shan Jia Xia Ku Cao Spica Wa Leng Zi Yi Yi Ren Semen
Squama Manitis Prunellae Concha Arcae Coicis
Pentadactylae
The herbs that “dissolve” masses or nodules are also found scattered in
various categories. Herbs that “break Blood” are used to dissolve masses
from Blood stasis, e.g. E Zhu Rhizoma Curcumae and San Leng Rhizoma
Sparganii stoloniferi.
Examples of herbs that dissolve masses or nodules are as follows:
Mu Li Concha Bie Jia Carapax Lou Lu Radix Xuan Shen Radix

Ostreae Trionycis Rhapontici Scrophulariae
Yu Jin Radix Tu Bie Chong E Zhu Rhizoma San Leng Rhizoma
Curcumae Eupolyphaga/ Curcumae Sparganii stoloniferi
Steleophaga
Zhe Bei Mu Bulbus Fu Shi Pumex Huang Yao Zi Radix

Fritillariae thunbergii Dioscoreae bulbiferae
FORMULAE THAT INVIGORATE BLOOD AND DISSOLVE MASSES
GUI ZHI FU LING WAN

Cinnamomum-Poria Pill
Gui Zhi, Fu Ling, Chi Shao, Mu Dan Pi, Tao Ren.
DA HUANG ZHE CHONG WAN

Rheum-Eupolyphaga Pill
Da Huang, Tu Bie Chong, Tao Ren, Gan Qi, Qi Cao, Shui Zhi, Meng
Chong, Huang Qin, Xing Ren, Sheng Di Huang, Bai Shao, Gan Cao.
TAO REN SAN (From Fu Ren Liang Fang, 1237 by Chen Zi Ming)
Persica Powder
Shui Zhi, Wu Zei Gu, carp, Yuan Hua Flos Daphni genkwa, Zhi Ke, Dang
Gui, Chuan Niu Xi, Chi Shao, Nao Sha Sal Ammoniac, Gui Zhi, Tao Ren.
TAO REN WAN

Persica Pill
Da Huang, Meng Chong Tabanus bivittatus (toxic), Shui Zhi, Tao Ren.
FORMULAE THAT INVIGORATE BLOOD AND DISSOLVE MASSES
CHUAN SHAN JIA SAN

Pangolin Powder
Chuan Shan Jia, Bie Jia, Chi Shao, Da Huang, Gan Qi Lacca sinica exsiccata,
Gui Zhi, Chuan Xiong, Yuan Hua Flos Daphni genkwa, Dang Gui, She Xiang
(musk)
PENG E MAO SAN

Gui Zhi, Dang Gui, E Zhu, Chi Shao, Bing Lang, Zhi Ke, Mu Xiang, Kun Bu,
Hu Po, Tao Ren, Bie Jia, Da Huang.
XIANG LENG WAN

Aucklandia-Sparganium Pill
Qing Pi, Mu Xiang, Zhi Ke, San Leng, E Zhu, Chuan Lian Zi, Xiao Hui Xiang,
Ding Xiang, E Zhu.
GONG ZHENG TANG
E Zhu, San Leng, Dang Gui, Tao Ren, Chuan Shan Jia, Wang Bu Liu Xing,
Chuan Niu Xi, Xiang Fu, Xu Duan, Xia Ku Cao, Kun Bu, Yi Yi Ren.
XIAO LIU FANG
San Leng, E Zhu, Mu Li, Chai Hu, Xiang Fu, Qing Pi, Xia Ku Cao,
Pu Gong Ying, Da Huang, Dan Shen, Wa Leng Zi, E Jiao.
GUI ZHI FU LING WAN Modifications

Gui Zhi, Fu Ling, Chi Shao, Mu Dan Pi, Tao Ren.
- Dang Gui (in every case).
- Break Blood, dissolve masses: E Zhu, San Leng.
- Soften hardness: Yi Yi Ren, Kun Bu, Hai Zao, Zhe Bei Mu, Xia Ku Cao.
- Move Qi: Xiang Fu.
- Move downwards: Da Huang (thick-yellow coating, dry stools).
- Phlegm: Zhe Bei Mu, Ban Xia, Dan Nan Xing.
- Heat, Toxic Heat: Xia Ku Cao, Pu Gong Ying.
- Spleen-Qi Xu: Huang Qi, Bai Zhu.
- Kidney-Yang Xu: Xu Duan, Tu Si Zi.
- Yin Xu: Bie Jia, Sheng Di Huang.
INFERTILITY
Blood Stasis obstructs the Uterus and its channels and it prevents the
proper functioning of Ren and Chong vessels so that conception
cannot occur.
Please note that Blood stasis is extremely common in women. That

is because the Lower Burner houses the uterus which stores Blood.
One could say that in men, the Lower Burner is “empty” while in
women it is “full” (because of the Uterus).
The clinical manifestations of Blood stasis are:
- Painful periods
- Dark-large clots
- Period that starts and stops
- Periods that starts or ends with a brown discharge
- Purple tongue (in advanced cases)
- Wiry, Choppy or Firm pulse
In the case of Full conditions, fertilization cannot occur because
pathogenic factors obstruct the Uterus and the Ren and Chong
vessels. Such pathogenic factors may be:
Cold
Blood-Heat
Damp-Phlegm
Blood stasis
STASIS OF BLOOD IN INFERTILITY
dark blood with clots
Irregular and painful periods
mental restlessness
irritability
manic behaviour
abdominal pain
Tongue: Purple.
Pulse: Wiry, Firm or Choppy.

Treatment principle
Invigorate Blood, eliminate stasis, pacify the Liver and the Chong Mai,
regulate the periods.
Acupuncture
LIV-3 Taichong, G.B.-34 Yanglingquan, BL-17 Geshu, SP-10 Xuehai, SP-
6 Sanyinjiao, Ren-6 Qihai, Ren-4 Guanyuan, SP-4 Gongsun (on the right)
and P-6 Neiguan (on the left) [Chong Mai], KI-14 Siman, ST-29 Guilai.
All with reducing or even method.
SHAO FU ZHU YU TANG
Xiao Hui Xiang Fructus Foeniculi vulgaris 6g

Gan Jiang Rhizoma Zingiberis officinalis 2g
Rou Gui Cortex Cinnamomi cassiae 1.5g
Mo Yao Myrrha 6g
Wu Ling Zhi Excrementum Trogopteri 4.5g
Dang Gui Radix Angelicae sinensis 9g
Chuan Xiong Radix Ligustici Chuanxiong 4.5g
Chi Shao Yao Radix Paeoniae rubra 6g
GE XIA ZHU YU TANG

Chi Shao Radix Paeoniae rubra 6 g
Wu Ling Zhi Excrementum Trogopteri 9 g
Yan Hu Suo Rhizoma Corydalis 3 g
Wu Yao Radix Linderae 6 g
Mu Dan Pi Cortex Moutan 6 g
Gan Cao Radix Glycyrrhizae uralensis 9 g
Prescription
EMPIRICAL PRESCRIPTION by Dr Zhu Nan Sun
Dan Shen Radix Salviae miltiorrhizae 6g

Chi Shao Radix Paeoniae rubra 6g
Chai Hu Radix Bupleuri 4.5g
San Leng Rhizoma Sparganii stoloniferii 6g
E Zhu Rhizoma Curcumae zedoariae 6g
Shi Jian Chuan Herba Salviae chinensis 6g
Liu Ji Nu Herba Artemisiae anomalae 6g
Mu Dan Pi Cortex Moutan radicis 6g
Chuan Lian Zi Fructus Meliae toosendan 3g
Ru Xiang Gummi Olibanum 4.5g
Di Long Pheretima aspergillum 3g
Xue Jie Sanguis draconis 4.5g
Women’s Treasure remedy
STIR FIELD OF ELIXIR
Wu Yao Radix Linderae strychnifoliae

Gan Cao Radix Glycyrrhizae uralensis
Xiang Fu Rhizoma Cyperi rotundi
Zhi Ke Fructus Citri aurantii
Bai Shao Radix Paeoniae alba
Variation of Ge Xia Zhu Yu Tang

AETIOLOGY AND PATHOLOGY OF CANCER IN CHINESE MEDICINE
EMOTIONS Qi stagnation BLOOD STASIS
IRREGULAR Derangement of T
DIET Stomach and Spleen PHLEGM U
M
O
U
TOXINS TOXIC HEAT
R
S
XU CONDITION
OVERWORK, Weakness of Zangfu,

OLD AGE Zheng Qi Xu
BLOOD STASIS IN CANCER
Blood stasis is a common cause of masses that are usually hard on
palpation and may be painful (not always). They are more common
in the Lower Burner. Blood stasis is the long-term result of various
pathologies that may lead to it. These may be: Qi stagnation, Cold,
Heat, Qi Xu, Phlegm.
Corresponds to malignant tumours of internal organs especially

stomach, lungs, intestines, uterus and breast.
When there are masses from Blood stasis one must by definition use
herbs that “break Blood” such as E Zhu, San Leng, Di Bie Chong, Ze
Lan.
Gui Zhi Fu Ling Wan Cinnamomum-Poria Pill is the representative

formula for masses from Blood stasis.

Aetiology Pathology and Treatment of Blood Stasis PDF

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AETIOLOGY, PATHOLOGY AND TREATMENT OF BLOOD STASIS

Blood stasis is a major pathogenic factor that is responsible for

Moreover, Blood stasis is present in major Western diseases

Another reason Blood stasis is so important is that the Blood-

I think one reason Blood stasis may be underestimated is

Blood stasis is a common and damaging pathogenic factor that is at the

A characteristic of Blood stasis is that it can only occur after a prolonged

By definition, Qi stagnation cannot, by itself, cause any of the above

Much more important than Qi stagnation.

• Qi stagnation – Liver and Heart

• Internal Cold – Uterus, Stomach and Heart

• Heat or Fire – Stomach, Intestines, Heart, Liver, Uterus

• Qi deficiency – Stomach and Heart

• Blood deficiency – Uterus, Heart and Liver

• Phlegm – Stomach, Intestines and Uterus

Blood is related to Qi and to Body Fluids. It is related to Qi first of all because

Qi stagnates, Blood stagnates

A pathology of Body Fluids, such as Phlegm, may also lead to

Blood Body Phlegm Blood stasis

Interchange between Blood and Body Fluids pathology

Body Blood BLOOD

Leads to Blood stasis in

EXTERNAL FULL EMPTY

Cold in the Uterus is a very common cause of Blood stasis.

COLD BLOOD STASIS

Fire dries up Body Fluids which

Qi deficiency may lead to Blood stasis because deficient Qi fails to move

This affects the Heart, Lungs, Spleen and Kidneys.

This affects the Heart, Liver and Uterus.

There is an interaction between Phlegm and Blood stasis as both are

Phlegm aggravates rather than cause Blood stasis.

A simultaneous condition of Blood stasis and Phlegm is common in the elderly

Aggravate each other

Blood stasis can itself become a cause of disease.

New blood cannot enter blood vessels

BLOOD STASIS BLOOD UTERUS

BLOOD STASIS BODY

May aggravate Blood stasis as deficient Qi fails to

Propelling force = Heart, Lungs, Liver.

Containing force (preventing bleeding): Spleen, Kidneys.

BLOOD STASIS: swellings, abdominal masses, tumours, purple lips,

PHLEGM: poor memory, greasy skin and hair, masses, tingling or

PHLEGM BLOOD STASIS WIND

• Heart: palpitations, chest pain, feeling of oppression in the chest,

• Liver: depression, liver disease, carcinoma of liver.

• Stomach, Spleen and Intestines: epigastric and abdominal pain,

• Lungs: breathlessness, asthma, chest pain, tightness of the chest, dry

• Kidneys: abdominal distension, fullness and pain, painful urination,

• Skin: dark moles, dark macules, dark scales, dry skin.

Liver: hypochondrial pain, purple nails and lips, dark

Heart: purple lips, palpitations, chest pain, tightness of the

Lungs: a feeling of oppression of the chest, coughing up dark

Stomach, Intestines: epigastric and abdominal pain, abdominal

DIAGNOSIS OF BLOOD STASIS: Observation

• Skin not elastic, lustreless, dark, scaly, dry

• Dark eye sockets

• Purple nose bridge

• Umbilicus bulging out

• Enlarged ends of fingers and toes

• Adhesions and scars

• Otosclerosis= Phlegm/Blood stasis

Note how in many of these symptoms, it would be natural to think of

Otosclerosis (deafness): Kidney deficiency

The Chinese term is the best! It is huo Xue qu yu 活血祛瘀

Sometimes they are also called huo Xue hua yu 活血化瘀,

The Nei Jing used the term e xue, “malign Blood”: 恶血

Zhang Zhong Jing called it liu xue “stagnant Blood” 留血 or

Zhao Yuan Fang called it ji xue “accumulated Blood”: 积血

Zhu Dan Xi called it si xue “dead Blood”: 死血

Zhang Jing Yue called it ning xue “coagulated Blood”: 凝血