Clinical Application of Blood-Circulating and Detoxifying Methods – June 20, 1978

Clinical Application of Blood-Circulating and Detoxifying Methods – June 20, 1978

Blood stasis is both a pathological product and a pathogenic factor. When it is considered a pathogen, it is called blood stasis; when it is viewed as a pathology, it is referred to as blood stasis. Any blood that has left the meridians and cannot be expelled from the body, remaining trapped in the tissues and organs, is called blood stasis; even blood that has not left the meridians but is stagnant or congealed in the vessels is also termed blood stasis. This is equivalent to concepts in modern medicine such as circulatory disorders, microcirculatory disorders, and systemic and localized circulatory disorders. Blood stasis is a syndrome, not an independent disease.

1. Causes of Blood Stasis

(1) External pathogenic factors of cold and heat: The "Yellow Emperor's Classic of Internal Medicine" states: "When cold pathogen invades the meridians, blood flow is obstructed." The "Bladder Blood Stasis Syndrome," "Chest Congestion Syndrome," and "Heat Enters the Blood Chamber" in the "Treatise on Cold Damage" are all cases of blood stasis due to accumulated heat, as Ye Tianshi said: "In summer, prolonged heat entering the blood often leads to the most severe blood stasis syndrome."

(2) Psychological factors: The "Yellow Emperor's Classic of Internal Medicine" states: "Great anger causes qi to be exhausted, blood to pool upward, leading to fainting." The "Three Causes, Ultimate Disease Manifestation and Prescription Theory" says: "Due to extreme anger, blood accumulates and does not disperse, causing flank pain—this is all due to blood stasis inside."

(3) Changes in the meridians: The "Ling Shu · Hundred Diseases Begin to Arise" records: "When the yang meridians are injured, blood spills outward; when the yin meridians are injured, blood flows inward."

(4) Abnormalities in the function and structure of the zang-fu organs: such as masses and accumulations, stone masses, etc. The "Golden Treasury Summary" mentions: "After a miscarriage, blood stasis remains in the lower abdomen"; "Postpartum abdominal pain, with dried blood adhering below the navel."

(5) Falls, sprains, injuries, and other external traumas.

2. Clinical Manifestations of Blood Stasis

(1) Pain: Blood stasis can block the flow of qi, resulting in "pain when flow is obstructed." Its characteristic is that the pain is localized and resistant to pressure; the location and area of pain can occur anywhere in the body, such as hepatitis, coronary heart disease, ulcers, colitis, rheumatoid arthritis, menstrual pain in women, etc.—all can fall under this type of pain.

(2) Fever: When blood is blocked and stagnant for a long time, heat builds up, so fever is another hallmark of blood stasis.

① In the early stages of blood stasis, qi and blood stagnate, leading to disharmony between Ying and Wei, causing fever and chills. ② When blood stasis damages yin, yin deficiency heat, low-grade fever, and tidal fever may appear. ③ For some patients with long-term unresolved blood stasis, the fever may alternate between superficial and deep levels, presenting as alternating chills and fever.

(3) Masses: Blood stasis invariably involves blockage of qi flow, so qi stagnation and blood stasis often occur simultaneously and contradict each other. Over time, phlegm, dampness, insects, food, and other substances can adhere to the mass, accumulating into lumps—small ones are called masses, large ones are called tumors. Conditions such as hepatosplenomegaly, uterine fibroids, ovarian cysts, breast hyperplasia, etc., all fall into this category.

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(4) Mental Status and Other Aspects: The "Shanghan Lun" states that the main symptom of bladder blood stasis syndrome is "acute distension in the lower abdomen, with the person behaving like a madman." Tang Rongchuan noted, "Stagnant blood in the heart can also cause forgetfulness," and "When there is blood deficiency, the spirit becomes unsettled; when there is stagnant blood, palpitations may occur as well." He Xiushan further explained, "When heat penetrates the pericardium, it leads to mental confusion—either due to phlegm obstructing the heart or due to blood stasis blocking the heart's orifices." Wang Qingren also mentioned that mania and madness are caused by stagnation of qi and blood.

3. Objective Indicators of Blood Stasis

(1) Inspection: The complexion and skin appear dull and lack luster, sometimes even taking on an antique bronze hue. The skin may show petechiae or patchy discoloration of varying sizes, along with fine rashes, mottled patterns, hemangiomas, tongue spots (bluish-purple), bluish veins under the tongue, and darkened features of the face and eyes.

(2) Auscultation and Olfaction: When blood stasis causes pain, the patient will cry out in agony; if heat enters the bladder, the person may behave like a madman.

(3) Inquiry: History of blood loss, trauma, or surgery, as well as inquiries about pain symptoms.

(4) Pulse Diagnosis: The pulse pattern associated with blood stasis is primarily deep and涩 (rough, constricted). In the "Jin Gui Yao Lue," the phrase "the pulse is large but slow" refers specifically to the "涩 pulse," which can be seen as a vivid depiction of this condition. On the basis of the涩 pulse, other pulses such as结脉 (constricted pulse) and代脉 (alternating pulse) may develop, both of which indicate qi stagnation with blood stasis or qi deficiency with blood stasis.

4. Mechanism of Action of Activating Blood Circulation and Removing Blood Stasis

(1) Inhibition of Tumor Cell Growth: Danshen, Sanleng, Ezhú, Quanxie, Shuizhí, Chuanxiong, Honghua, Guiwei, Chuanshanjia, Nanxing, and other herbs all possess anti-cancer and cancer-suppressing effects. This action corresponds to the traditional Chinese medicine concept of softening hard masses, dispersing nodules, breaking down accumulations, and eliminating pathological products.

(2) Effects on the Cardiovascular System: These herbs dilate blood vessels, increase blood flow, and reduce circulatory resistance. Experimental evidence shows that Compound Danshen Tablets (containing Danshen and Jiangxiang) have these effects. Unlike isoprenaline, they not only dilate coronary arteries but also do not increase heart rate; instead, they slow it down and do not enhance myocardial contraction, thus reducing myocardial oxygen consumption. Animal experiments demonstrate that Danshen has a significant vasodilatory effect on peripheral arterioles, expanding them up to fourfold within five minutes. Additionally, Danshen lowers blood lipids and has a pronounced sedative effect. The Coronary Heart Disease No. 2 formula developed by the Beijing Collaborative Group (containing Chishao, Chuanxiong, Honghua, Jiangxiang, and Danshen) exhibits particularly strong effects in this regard. In single-herb trials, Chishao and Chuanxiong appear to be the most effective, yet still fall short of the Coronary Heart Disease No. 2 compound. Sanqi has a clear effect in increasing coronary blood flow and reducing myocardial oxygen consumption in cases of angina pectoris. Yujin helps reduce plaque formation in coronary vessels. Chuanxiong and Honghua decrease blood flow resistance while increasing blood flow.

(3) Effects on Microcirculation: Herbs that activate blood circulation and remove blood stasis can improve local microcirculation, including enhancing capillary perfusion.

5. Research on Activating Blood Circulation and Removing Blood Stasis

(1) Promoting local blood circulation and improving/regulating microcirculation.

(2) Softening connective tissue and improving its metabolism.

(3) Reducing platelet aggregation, preventing coagulation, and lowering the incidence of thrombosis.

6. Selected Papers on Activating Blood Circulation and Removing Blood Stasis

(1) Department of Surgery, Second People’s Hospital of Chengdu: "A Preliminary Study on the Clinical Efficacy and Mechanism of Action of Blood-Circulating and Blood-Stasis-Removing Medicines in Treating Burns and Scars" demonstrates that these medicines inhibit the excessive collagen synthesis by fibroblasts. From a traditional Chinese medicine perspective, scars should be treated as blood stasis-related conditions, and the proliferation and degeneration of connective tissue, especially collagen, should be included in the category of blood stasis. ("New Journal of Medicine," February 1976)

(2) Collaborative Research Group on Activating Blood Circulation and Removing Blood Stasis, Chinese Academy of Medical Sciences: "Preliminary Experience in Using Blood-Circulating and Blood-Stasis-Removing Methods to Treat Systemic Scleroderma" proves that methods centered on activating blood circulation and removing blood stasis can improve skin microcirculation, gradually softening hardened skin, while simultaneously alleviating other symptoms. ("New Journal of Medicine," February 1976)

(3) Collaborative Research Group on Activating Blood Circulation and Removing Blood Stasis, Chinese Academy of Medical Sciences: "A Preliminary Exploration of the Principles of Treatment through Activating Blood Circulation and Removing Blood Stasis" suggests that applying this method to various diseases such as coronary heart disease, cerebral thrombosis, thromboangiitis obliterans, scleroderma, and scars can lead to reduced pain, warming of affected limbs, softening of the skin, and improvement in functional impairments. Based on this, it is hypothesized that activating blood circulation and removing blood stasis may primarily affect blood circulation, particularly improving local microcirculation.

Furthermore, this approach can also promote the transformation and absorption of proliferative lesions. For example, in cases of chronic hepatosplenomegaly, especially liver enlargement caused by schistosomiasis, the previously overgrown connective tissue significantly decreases or disappears after treatment with blood-circulating and blood-stasis-removing medicines. In experimental animals with formaldehyde-induced arthritis, swelling markedly subsides after administration of these medicines; when histamine is used to induce changes in capillary permeability, blood-circulating and blood-stasis-removing drugs can reduce the leakage of dyes bound to plasma proteins; and when these medicines are combined with heat-clearing and detoxifying agents to treat allergic reactions in guinea pigs sensitized by horse serum, the allergic response can be alleviated. Clinical observations on scleroderma and psoriasis reveal that, while treating these conditions, improvements in microcirculation can be observed through nailfold capillaroscopy, showing significant enhancements in blood supply and capillary morphology. Overall, microcirculation corresponds to the traditional Chinese medicine concepts of "long-term illness entering the collaterals" and "collateral stagnation and depletion," and clinical application of "warming and moistening to unblock the collaterals" and "removing blood stasis to unblock the collaterals" can improve this function.

In addition, the anti-infective effects of blood-circulating and blood-stasis-removing medicines have garnered clinical attention. Experimental studies have demonstrated that Chuanxiong has a significant inhibitory effect on dysentery bacilli and typhoid bacilli. Danshen, Shaoyao, Kusen, Zizhucao, Daji, and other blood-circulating and blood-stasis-removing herbs exhibit varying degrees of antibacterial activity against Staphylococcus aureus, Escherichia coli, dysentery bacilli, and typhoid bacilli. Due to their broad spectrum of action, these traditional Chinese medicines directly or indirectly exert antibacterial effects while acting on other mechanisms. ("New Journal of Medicine," June 1972)