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All About Blood Stagnation

There is a broad category in the TCM Materia Medica (list of healing substances) called Herbs that Regulate the Blood. This class is further divided into Herbs That Stop Bleeding and Herbs That Invigorate the Blood.

The herbs that Invigorate the Blood are herbs for treating Blood Stasis (Blood which isn't moving properly). Dan Bensky and Andrew Gamble say in the Chinese Herbal Medicine Materia Medica, Revised Ed., "In general, the problems associated with blood stasis in Chinese medicine are understood in modern biomedicine as either hematological disorders (including hemorrhage, congestion, thrombosis, and local ischemia) or local tissue changes." (pp. 265-266)

Herbs that invigorate the Blood differ in their strengths and in just how much stasis they can correct. Also in their exact functions. There is no standardized terminology for reporting this, and Bensky and Gamble point out that even different sections of the same book may use different terminology. But, there are 4 general categories that will show up in a variety of books. These are in ascending order, herbs that harmonize the Blood, herbs that move Blood, herbs that dispel Blood Stasis, and herbs that break (or crack) Blood Stasis.

Of the substances that break Blood Stasis, the strongest aren't herbs at all. They are a leech (Hirudo seu Whitmania, aka Shui Zhi) and a wingless cockroach (Eupolyphaga seu Opisthoplatia, aka Tu Bie Chong, aka "land soft-shelled turtle" in a literal English translation of the Chinese). The leech contains hirudin and heparin; its not known what the cockroach contains that could account in part for its properties.

For those a little leery of the leech and cockroach routes, Tuber Curcumae (Yu Jin), Rhizoma Curcumae Longae (Jiang Huang), and Rhizoma Curcumae Ezhu (e zhu) also have Blood Stasis breaking properties, can dissolve abdominal masses, and have Qi moving properties as well. (p. 294) Some readers are familiar with the more common English names of Tuber Curcumae and Rhizoma Curcumae Longae: Turmeric tuber and turmeric rhizome. Turmeric is found in the spice section of supermarkets. (Note: Pregnant women need to be careful even about herbs and spices found in the supermarket. Some of these need to be used cautiously or not at all in pregnancy.)

Bensky and Gamble elaborate some on the types of conditions that herbs that Invigorate the Blood are used for. They get used a lot for pain due Blood Stasis. When one starts to study TCM in depth, one quickly realizes that TCM can be meticulous in describing different facets of and quality as well as quantity of pain in order to arrive at the correct analysis. The pain associated with Blood Stasis is a sharp, boring pain. As Bensky and Gamble put it, "The pain associated with blood stasis is rather precisely localized and feels deep, colicky, or sharp. It may be of long duration." (p. 265) This is not a pain which is spread out, vague, or diffuse - like in "my whole lower abdomen feels uncomfortable and bad." One knows exactly where this pain is located. It's boundaries are relatively sharp, and it goes deep. One may even hear the description "It feels like an awl (knife, screw, etc.) has been driven in and is being twisted." Bensky and Gamble report, "The most common types are lower abdominal pain, chest pain, pain from trauma, and pain from internal bleeding. When pain is very localized, well-defined in its boundaries, and sharp, suspect and rule in or rule out pain due to Blood Stasis. (Note: When doing acupressure or massage, one may encounter areas like this. Pain also can be due to Qi Stagnation, but if a point is encountered that is particularly sore and the pain is especially sharp and boring, consider the possibility of Blood Stasis. This pain may be due to other things, including Qi Stagnation, but consider the possibility of Blood Stasis.)

Bensky and Gamble also report that herbs that Invigorate the Blood get used to treat abscesses and ulcers. They say, "In Chiense medicine it is believed that stagnation and stasis of qi and blood are often involved in the pathogenesis of ulcers, abscesses, a variety of necrotic inflmmation such as skin slough due to a colorless, painless, flat, slow-healing suppurative inflammation of the soft tissues (ju), and Intestinal abscesses (chang yong). This last diagnosis often overlaps with appendicitis in modern biomedicine." (p. 265)

Herbs that Invigorate the Blood also get used in treating abdominal masses. "The modern medical diagnoses of hepatomegaly, splenomegaly, abdominal or pelvic tumors of various etiologies, and some varieties of abdominal or pelvic cysts often fall under the rubric of immobile abdominal mass." (p. 265) The terms splenomegaly and hepatomegaly refer to an abnormal enlargement of the spleen and liver. These can occur due to a variety of Western-defined causes - infection (mononucleosis, hepatitis, tuberculosis, etc.), cirrhosis of the liver, problems in arteries, problems in ducts, leukemia, thrombosis, stenosis, injury, rheumatoid arthritis (Felty's syndrome), etc. In TCM there are other things besides Blood Stasis that can trigger abnormal swelling or enlargement of the spleen or liver (Qi Stagnation, Damp Heat). But in cases of abnormal enlargement of the spleen or liver, consider the possibility of Blood Stasis as a cause or the enlargement or a symptom of the enlargement (congestion/ blockage can create Blood Stasis), and rule in or out. Also consider that Blood Stasis rarely occurs alone (except in cases due to trauma). I mean somebody slips on a banana peel, falls down, and gets a bruise or breaks a bone, or is in a car wreck, there's obviously no other underlying TCM syndrome giving rise to the Blood Stasis. Cases of surgery (another possible cause of Blood Stasis) don't count because obviously there's an underlying imbalance or the person wouldn't need surgery to begin with. Always ask what else needs to be treated besides the Blood Stasis and ask what's causing the Blood Stasis. In addition to trauma the following also can trigger Blood Stasis: Qi Stagnation, Qi Deficiency, Hot Blood, Blood Deficiency, and Interior Cold. See Maciocia, Foundations of Chinese Medicine, p. 194 for more info on the possible causes of Blood Stasis.) One looks at the entire picture.

Note for students: "The Liver stores Blood ... when a person moves, Blood goes to the channels, when at rest it goes to the Liver." (Maciocia, Foundations, p. 78) When you're asleep or resting, the Blood collects and is stored in the Liver. When you're active, the Blood is sent out to nourish and moisten the muscles. The Liver has a lot of control over the volume of Blood in the body. There are people who have blood volume problems. Lab technicians have problems finding veins and getting blood samples from these people. The people themselves tend to suffer from feeling weak, fainting, etc. "When the Blood flows to the appropriate places in the body at the appropriate times, it will nourish the necessary tissues, and therefore give us energy." (Maciocia, p. 78) When someone has Blood volume problems, suspect and rule in or out Liver Blood Deficiency. Keep in mind that Liver Blood Deficiency can trigger Blood Stasis which can manifest as headaches, some cases of fainting, etc. Liver imbalance isn't the only thing that can cause or contribute to Blood volume problems, but it's the most common underlying Root.

Also, Blood volume problems "indirectly influences our resistance to external pathogenic factors. If this Liver function is normal, the skin and muscles will be well nourished by Blood and be able to resist attacks of exterior pathogenic factors." (Maciocia, p. 78) Remember the question why some people are so much more susceptible to Exterior Pernicious Evils than others are? The number one cause is weak Protective Qi. Yang Deficiency and generalized debility also can be a cause. Add to this a consideration that Liver Blood may be Deficient, and indirectly causing the increased susceptibility.

Victoria Dragon

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