Volume Five: Blood Stasis

Volume Five: Blood Stasis

Hematemesis, epistaxis, and rectal bleeding all involve blood that has left its normal channels. Any blood that has exited its normal pathways is completely separated from the blood that nourishes the entire body⁽¹⁾ and cannot re-enter. If the blood has already entered the stomach, it can be allowed to be vomited or passed through the bowels. If it remains within the meridians and has not yet entered the stomach, urgent measures must be taken to eliminate it—either by converting it into urine or expelling it through the stool—ensuring that no residual blood remains, as any leftover blood can lead to further complications. This blood, once inside the body, cannot mix with healthy blood and instead obstructs the formation of new blood, making the removal of blood stasis a crucial priority in all blood-related conditions. Some people believe that clotted blood is not truly stagnant blood, and that black blood is not truly stagnant blood, but this view is incorrect. When blood first leaves its normal channels, it is still considered clear blood and fresh blood, but it is nonetheless blood that has left its normal pathways. Over time, however, the blood turns purple. For example, when skin is beaten, the initial injury causes redness and swelling, indicating that the blood has just left its normal channels and is still fresh. After several days of beating, the color turns blue-black, showing that the blood has been away from its normal channels for a long time and has turned purple-black. Even though this blood is now purple-black within the meridians, it is still considered clear blood and not clotted blood, meaning it can still move with qi and eventually enter the intestines, being expelled through vomiting or defecation. If it were truly clotted blood, it would remain within the meridians and could never enter the intestines. As for clotted blood, it enters the intestines, stays there briefly, and then immediately coagulates. One can observe this phenomenon by watching pigs and sheep being slaughtered, where the blood in the collection basin quickly coagulates. Therefore, regardless of whether the blood is clear, congealed, or black, removing blood stasis should always be the top priority in cases of hematemesis or epistaxis. Moreover, once blood stasis exists, corresponding symptoms will inevitably arise, and physicians should treat according to these symptoms without hesitation.

When blood stasis affects the heart, it can cause chest pain, dizziness, mental confusion, and even loss of consciousness. Whether in postpartum women or patients with hematemesis, such symptoms indicate a critical condition, requiring urgent reduction of blood stasis while protecting the heart. Treatment options include Gui Xiong Shi Xiao San combined with Amber, Cinnabar, and Musk, or Gui Xiong Tang adjusted with Xue Jie and Frankincense powder, both of which are effective.

If blood stasis affects the lungs, it can cause coughing, shortness of breath, smoke coming from the nose, and blackening of the eyes and mouth. In such cases, Shen Su Yin can be used to protect the lungs and remove blood stasis, which is a critical emergency. Many deaths from hematemesis are caused by blood stasis blocking the airways and causing lung weakness and shortness of breath; this formula is the most reliable solution. If the lungs are already congested and blocked, there is no need to further strengthen them—simply remove the blood stasis to ensure unobstructed airflow, allowing the patient to survive. Ting Li Da Zao Tang combined with Su Mu, Pu Huang, Wu Ling Zhi, and Tong Bian can be used for this purpose.

When blood stasis affects the meridians and internal organs, it can cause widespread pain throughout the body. Because it blocks the flow of qi, it creates stagnation and pain—pain implies blockage. Fo Shou San combined with Peach Kernel, Safflower, Xue Jie, Xu Duan, Qin Jiao, Chai Hu, Bamboo Shoots, and Licorice can be used to treat this condition, or Xiao Chai Hu Tang combined with Gui, Shao, Peach Kernel, Safflower, and Large Thistle can also be effective.

If blood stasis affects the upper burner, it can cause hair loss, bone and chest stiffness, and blurred vision⁽²⁾. Tong Qiao Huo Xue Tang can be used to treat this condition, or Xiao Chai Hu Tang combined with Gui, Shao, Peach Kernel, Safflower, and Large Thistle can also be effective.

If blood stasis affects the middle burner, it can cause abdominal and flank pain, as well as stabbing pain around the waist and navel. Xue Fu Zhu Yu Tang can be used to treat this condition, or Xiao Chai Hu Tang combined with Xiang Fu, Ginger Yellow, Peach Kernel, and Rhubarb can also be effective.

If blood stasis affects the lower burner, it can cause flank pain, lower abdominal distension, and painful bowel movements. Shi Xiao San combined with Vinegar Military and Peach Kernel can be used to treat this condition, or Ge Xia Zhu Yu Tang can also be effective.

If blood stasis affects the interior, it can cause thirst. This is because blood and qi are inherently inseparable; when blood stasis occurs internally, qi cannot flow freely and cannot carry water and fluids upward, leading to thirst. Once the blood stasis is removed, the thirst disappears. Si Wu Tang combined with Zao Ren, Dan Pi, Pu Huang, San Qi, Flower Powder, Yun Ling, Zhi Ke, and Gan Cao, or Xiao Chai Hu Tang combined with Peach Kernel, Dan Pi, and Niu Xi can both be used to treat this condition. Wen Jing Tang uses warming herbs to remove blood stasis, making it suitable for long-term blood stasis. Various formulas can be selected and used as appropriate.

If blood stasis affects the skin and subcutaneous tissues, it can cause disharmony between the defensive and nutritive qi, leading to fever and chills. The skin and subcutaneous tissues are located in the semi-external, semi-internal zone, serving as the pathway for qi and blood exchange. When blood stasis occurs here, it harms the defensive qi, causing chills, and harms the nutritive qi, causing heat. Thus, the alternating sensation of cold and heat resembles malaria. Xiao Chai Hu Tang combined with Peach Kernel, Safflower, Dang Gui, and Jing Jie can be used to treat this condition.

If blood stasis affects the muscles, it can cause intermittent fever and spontaneous sweating. The muscles are governed by the Yangming channel, and when Yangming's dry qi interacts with blood stasis, it creates a hot and humid environment. The resulting symptom is akin to the White Tiger syndrome, treated with Xi Jiao Di Huang Tang combined with Peach Kernel and Safflower. Alternatively, Xue Fu Zhu Yu Tang combined with fried Rhubarb can also be effective.

If blood stasis accumulates in the meridians and internal organs, it can form masses or lumps. These masses may either gather or disperse; when qi stagnates, they gather and take shape, while when qi disperses, they disappear. Once they have gathered, the method of resolving them is to disperse the qi, which can be achieved with Jiu Qi Wan. For those located in the chest and diaphragm, add Platycodon, Zhi Ke, Gua Lou, Ginger, and Licorice; for the right side, add Su Zi, Sang Pi, and Chen Pi; for the left side, add Qing Pi, Oyster Shell, and Dang Gui; for the middle burner, add Hou Pu, Zhi Ke, Fang Ji, Bai Shao, and Licorice; for the lower abdomen, add Orange Core, Small Cumin, Lychee Core, Betel Nut, Chuan Lian Zi, and Wu Ling Zhi. When qi disperses, blood disperses accordingly, preventing the formation of new masses. However, once the masses have dispersed, there is concern about their reformation, so the method of harmonizing qi and blood should be employed. At this point, the mass itself is dispersed and resides within the blood, but once qi is harmonized, it will not reform. Xiao Yao San combined with Dan Pi and Xiang Fu can be used for this purpose, or Gui Pi Tang combined with Chai Hu and Yu Jin Zi can also be effective. Masses tend to accumulate and rarely disperse; when blood is abundant but qi is scarce, qi cannot overcome blood and thus fails to disperse, or the mass may simply be composed of blood alone, or blood mixed with water, or long-term accumulation of blood may turn into phlegm and water, where water is essentially qi. Masses are always formed by the binding of qi and blood, requiring the breaking of this bond through blood and qi to eliminate them. This is a major problem, and 110 cannot be tolerated. Even for those who are frail and have accumulated problems over a long period, it is still advisable to combine attack and support to achieve victory. For attacking blood masses, use Di Dang Tang, Xia Yu Xue Tang, or Dai Di Dang Wan. For attacking phlegm and water, use Shi Zao Tang. If both blood and water need to be attacked, use Da Huang Gan Sui Tang or secret formulas to transform qi. External treatments include applying Guan Yin Relief Balm.

When blood stasis accumulates in the meridians and internal organs and battles against qi, it undergoes fermentation and decay, eventually turning into pus. Further details on purulent discharge from the throat, bowels, and wounds will be discussed separately and will not be elaborated here.

When blood stasis accumulates in the meridians and internal organs and is exposed to fire-like qi, it becomes dried blood. Qi is the yang energy of the kidneys; when yin is deficient and yang is excessive, the qi merges with the heart fire, making the qi stronger and the fire fiercer. When blood stasis is subjected to this fiery qi, it turns into dried blood, characterized by bone-steaming fever, rough skin, and flaking scales—this is known as dried blood fever. Those afflicted with this condition require treatment with Zhong Jing Da Huang Ao Chong Wan. Since it is dried blood, it is completely isolated from normal blood circulation and cannot be treated with ordinary blood-circulating medicines. Therefore, special methods involving insects that feed on blood are used to erode the dried blood. If the dried blood is not removed, new blood will lack vitality, and if the dried blood persists, new blood will have no chance of survival. Thus, although many symptoms of weakness may appear, the primary goal remains to remove the dried blood. If one lacks the courage to do so, supplementary medications can be given alongside this pill to help stabilize the condition.

When blood stasis accumulates in the meridians and internal organs and is affected by changes in wind qi, it gives rise to tuberculosis worms. Qi is generated from the water of the kidneys, so when qi moves, it becomes moist. Wind is generated from the yang energy of the liver, so when wind moves, it becomes hot. Moisture and heat stimulate each other, transforming blood stasis into worms—this is what we call tuberculosis worms. It’s similar to how grass decays into fireflies or grains turn into insects. The distinguishing features include fluctuating facial colors—sometimes red, sometimes white, sometimes green, sometimes yellow—ulcers on the lips and mouth, hoarseness, itching in the throat, restless dreams, cloudy semen, dry tongue, alternating chills and fevers, foul-smelling breath, loss of taste, attraction to passing people (4), frequent anger, nightmares about deceased ancestors, palpitations, coughing, or the presence of lumps in the abdomen, small nodules on both sides of the brain, or eating beans and smelling fragrant odors. Additionally, one can use frankincense to fumigate the back of the hand and the palm, causing hair to grow up to an inch long within moments; if one maintains good spirits every morning and experiences mild warmth in the limbs after noon, with a pale complexion, all these are signs of tuberculosis worms, treated with Yue Hua Wan. Eating eel meat is beneficial both for nourishment and for killing tuberculosis worms. Alternatively, one can burn eel bones to ash, grind turtle shells into powder, and decoct ginseng, Dang Gui, Bai Shao, and Bai Wei Tang to supplement deficiencies and kill worms, working together. If one focuses solely on killing worms, Jin Chan Wan can also be taken intermittently, and Jin Xian Frog can be consumed as well. Black cats can be used to roast the liver into powder, taking it on an empty stomach at dawn on the fifth day of the month, which is highly effective in eliminating tuberculosis worms and can replace otter liver. Otter claws can be ground into powder and added to wine, targeting tuberculosis worms residing in the lung lobes, especially those who cough up blood and have hoarse voices—this can all be treated.

Tuberculosis worms are the most mysterious creatures born from blood, and after death, they become demonic beings (5), infecting family members and spreading the disease of corpse transmission. If three people are infected, the worms cannot be eradicated. The symptoms of corpse transmission are no different from those of the infected person themselves. According to the "Jin Jian," one should take Corpse Transmission General Pill, as recorded in "Dan Xi Xin Fa." Although this pill is not mentioned in "Dan Xi Xin Fa," the name "General" suggests that it contains large quantities of rhubarb, indicating its effectiveness. When corpse transmission worms invade the human body, urgently

The reasoning is logical, with detailed discussions on pathogenesis and symptoms, and the prescriptions and dosage adjustments are summaries of the author's clinical practice, providing valuable references for readers. Only the discussion on tuberculosis worms warrants some debate—for instance, the claim that "blood stasis transforms into worms, which are tuberculosis worms," and the assertion that "fumigating the back of the hand with frankincense and rubbing the palm, causing hair to grow up to an inch long within moments, can be used as a diagnostic criterion for this disease" lack factual basis. Similarly, the statement that "tuberculosis worms spread through corpse transmission, and if three people are infected, the worms cannot be eradicated" is also inappropriate.