II. Removing Stasis

II. Removing Stasis

After the bleeding has stopped, some of the blood that has already moved within the meridians cannot return to its original course. If it accumulates in the back, spine, chest, and diaphragm, or if it gathers in the flanks, ribs, and lower abdomen, it will cause pain due to stagnation. When it flows into the limbs, it results in swelling and pain; when it lingers in the muscles and skin, it gives rise to chills and fever. In all cases of blood stasis, qi flow is obstructed and vital energy is impeded. Over time, this can develop into bone-steaming, dry blood, or tuberculosis, so it must be eliminated promptly. Moreover, once blood stasis lodges in the meridians, new blood cannot circulate smoothly and will eventually leak out through vomiting or other means. Therefore, removing blood stasis is the key principle in treating blood disorders. The Huairuishi Powder is used to transform stagnant blood into fluid and expel it without harming the true qi of the five organs, making it an excellent remedy for eliminating blood stasis. If Huairuishi is unavailable, Sanqi, Yujin, Taoren, Niuxi, and vinegar-fried Dahuang can also swiftly clear the stasis. However, if old blood is not removed, new blood will never form; and if new blood does not form, old blood cannot be eliminated on its own either. It’s like saying that if the way of the noble person does not flourish, the way of the petty person will not disappear either. One must understand that eliminating blood stasis allows new blood to continuously form, leaving no room for old blood to linger, forcing it to be expelled—either by being transformed and excreted in the urine or by being carried down into the large intestine. Huairuishi transforms blood stasis into urine, while Vinegar-Dahuang Powder expels blood stasis through the stool. Yet, merely removing blood stasis without generating new blood is like trying to defeat the enemy without having a commander or eliminate evil without relying on righteousness. How can one truly eradicate blood stasis without replenishing the blood? Therefore, the treatment should employ Shengyu Tang to tonify the blood, adding Taoren, Danpi, Honghua, Zhike, Xiangfu, Yunling, and Gancao to balance tonification and drainage. Once the stasis is cleared and the body’s righteous qi remains unharmed, this is the essence of treating blood stasis. However, there are also cases where warming herbs are appropriate. According to the Inner Canon, blood prefers yin and dislikes cold; cold causes it to congeal and fail to flow, whereas warmth dispels it. Furthermore, when heat is trapped in the yin aspect, cooling herbs are ineffective, and it is necessary to adopt a “following treatment” approach (8) to draw yang out of yin. For example, Zhang Zhongjing’s Baiye Decoction is the primary treatment for cold-induced blood stasis and also serves as a follow-up therapy for blood stasis lodged in the yin aspect. However, these three herbs are purely warming; if encountering severe fire-related symptoms, they may not be suitable. In such cases, a small amount of mild herbs can be added to adjust the formula, combining it with Siwu Tang, or even using Xiaoxin Tang directly as a counteragent (9). This concludes the general discussion on treating blood stasis. Nevertheless, blood stasis can accumulate in different parts of the body—upper, middle, and lower—and each location has its own specific characteristics. To effectively treat it, one must first identify the exact location of the stasis and then tailor the treatment accordingly, ensuring that no detail is overlooked. For instance, if blood stasis affects the upper burner, symptoms such as chest, back, and shoulder pain, numbness, and fullness will appear, requiring the use of Xuefu Zhuyu Tang or Renshen Xiefei Tang combined with Sanqi, Yujin, and Jingjie to clear the stasis in the upper burner. If blood stasis affects the middle burner, abdominal distension and flank pain will occur. The Belt Meridian encircles the navel and connects to the Blood Chamber; for women, it is associated with pregnancy, while for men, it helps to bind the body together, serving as the conduit for blood. No blood-related condition exists without involvement of the Belt Meridian, so when blood stasis accumulates in this area, it must be removed to restore the Belt Meridian’s function. Since the Belt Meridian is part of the middle burner, treatment should focus on the spleen. As seen in Zhang Zhongjing’s Shenzhu Tang, treating the spleen is equivalent to treating the Belt Meridian. When the Belt Meridian is affected by blood stasis, Jiaji Huatu Tang combined with Taoren, Danggui, and Jianghuang should be used. For severe lower back pain, add Luojiaojian; for severe flank and abdominal pain, add Puhuang and Lingzhi. If blood stasis affects the lower burner, causing pain below the waist and distension in the lower abdomen and flanks, it indicates that the liver is involved, possibly due to accumulated blood in the blood sea. In such cases, Xiongshixiao San should be used. For those with constipation, add Dahuang. Zhang Zhongjing’s major formulas for clearing blood stasis include Didang Tang and Taoren Chengqi Tang, both of which are intensely bitter and cold, designed to break down and expel blood stasis. There are also cases where warming herbs are appropriate, such as Shenghua Tang and Niuxi San, primarily used in gynecology to treat postpartum lochia and retained placenta. Although men and women differ physiologically, their blood is fundamentally the same, and lower burner blood stasis is common to both sexes, so these formulas often prove effective. Moreover, the lower burner is inherently yin, whereas upper burner stasis tends to be yang and hot, thus avoiding warming herbs; lower burner stasis, however, is mostly yin and cold, so postpartum women prefer warming herbs and avoid cold ones because their blood resides in the lower burner. Understanding this, it becomes clear that using warming herbs to treat lower burner blood stasis is particularly appropriate. However, one must still determine whether the stasis is caused by cold or heat before applying warming herbs; if the Blood Chamber is overheated, it remains a case for Taoren Chengqi Tang. Additionally, when blood stasis spreads to the limbs, causing pain and swelling, it is advisable to remove the stasis, reduce the swelling, and use Xiao Diaotang combined with Zhimu, Yunling, Sangpi, and Niuxi to treat it. If blood stasis invades the muscles and skin, obstructing the circulation of nutritive qi and defensive qi, resulting in chills and fever resembling malaria but not quite, along with bone-steaming, night sweats, and persistent coughing, then Xiao Chaihu Tang combined with Danggui, Taoren, Danpi, and Baishao should be used. For severe cold, add Aisui and Xixin; for severe heat, add Huaifen, Fengge, Qinghao, and Zhimu; for cough with phlegm and fire, add Guashuang, Xingren, Cundong, Wuwei, Yunling, and Zhimu; for water rising up, add Tinglizǐ. Xiao Chaihu Tang originally functions to disperse liver qi from the middle burner upward, allowing liver qi to flow freely and nourishing the muscles and skin while balancing the nutritive and defensive qi. Now, adding ingredients that remove blood stasis shifts the focus toward eliminating stasis, making it especially effective for those whose blood stasis obstructs the nutritive and defensive qi. In summary, blood stasis located between the zang-fu organs will eventually turn into dry blood and become a source of tuberculosis. Blood stasis located in the body’s exterior will either lead to partial atrophy or result in abscesses and pus. Blood stasis located in the muscles and skin will turn into bone-steaming, hair falling out and breaking, and limbs becoming emaciated. All these untreatable conditions ultimately stem from improper removal of blood stasis. Therefore, anyone treating blood disorders must prioritize eliminating blood stasis, as detailed in the section on blood stasis.