Blood Stasis or Xue Yu (Xu = Blood; Yu = Stasis) is an important pathology of many disease processes in TCVM. Simply put, it means the flow of Blood is slowed down and brought to a static state. Normally, Blood is stored in the Liver and propelled by the Heart Qi to flow through the body. If Blood circulation is Stagnant or slowed down by certain factors, it will lead to retention of Blood in any part of the body or overflow of blood out of the vessels, resulting in Blood Stasis. Blood Stasis frequently occurs in long-term chronic illnesses. Blood Stasis, due to various etiologies may be the root of many age-related disharmonies. It can also be commonly observed after surgery or external traumatic injuries. Liver (in TCVM) is the most frequently affected organ by Blood Stasis. Other affected organs are the Heart, Lung, Stomach, and Intestines.
Blood Stasis vs. Blood Stagnation
Although Blood Stasis and Blood Stagnation share the same concept of Blood, they are different in terms of the degree and progression process. Blood Stagnation is the milder form of impaired Blood flow, and is a pathological process that inevitably leads to Blood Stasis, thus, it is a concept of etiology. Blood Stasis, on the other hand, is a concept of pathogenesis, which refers to a pathological product where Blood is no longer free-flowing and has lost its normal physiological function.
DIAGNOSIS OF BLOOD STASIS
1. Causes: Qi Stagnation, Qi Deficiency, Blood Deficiency, Yin Deficiency, Cold, Heat, Phlegm, or trauma. (See page 3, Figure 1, Table 1)
2. Common concomitant Western medical conditions: chronic arthritis, cardiovascular disorders, bleeding disorders,
hepatosplenomegaly, abdominal/skin masses, and paresis/paralysis.
3. Pattern Identification:
a. Pain - locally fixed, sharp and continuous pain. The pain is aggravated by pressure and is not relieved by massage. It may worsen during nighttime and improve with movement/mild exercise (that helps the blood circulate). On the contrary, pain from Stagnant Qi is usually an intermittent and moving pain that does not have a fixed location.
b. Bleeding - all types of hemorrhage or blood loss involving bruises and injuries that are hard to contain or recurrent intermittently. This is due to static Blood obstructing the vessels, causing Blood to extravasate into the surrounding tissues. Blood is characterized by dark color or clotted blood.
c. Skin/hair coat – because Blood is Stagnated, there are often signs of skin Dryness as Blood fails to supply nourishment to the body surface, in particular when Blood Stasis is chronic. Indications of Blood Stasis include: dry skin with dandruff and lackluster hair coat that may fall out easily without growing back, may also see pigmentation, red speckles, purpura, petechial, thickening or lichenification of the skin.
d. Tongue – the body of the tongue is purple-bluish, or has dark blue or purple spots. Dark, crooked or elongated and thick sub-lingual veins are generally an indication of Blood stasis. TCVM organs involved in Blood stasis can be determined from the region of the tongue affected, as taught in Chinese tongue diagnosis. For example, purple-bluish color or dark spots on the sides of the tongue indicate Blood stasis in the Liver; on the tip is Heart; in the center is Stomach.
e. Pulse – the classic pulse is unsmooth and tight or choppy (thin and rough with an irregular rhythm like scraping the bamboo surface lightly with a knife). Blood Stasis in the Liver shows a wiry or firm pulse; Blood Stasis in the Heart shows a choppy or knotted pulse; Blood Stasis due to a Deficiency pattern may have a deep, weak and choppy pulse.
f. Masses/tumors – TCVM holds that masses or tumors are the result of Blood Stasis and/or Phlegm accumulation. Larger or firmer fixed masses or tumors are associated with Blood Stasis, particularly intra-abdominal masses.
4. Western laboratory findings may show:
a. Increase or decrease in hematocrit or packed cell volume
b. Increase or decrease in red blood cell counts
c. Increase or decrease in platelet counts
d. Increase in albumin or total protein
e. Increase in cholesterol or triglycerides
CAUSES OF BLOOD STASIS
1. Qi Stagnation – It is the most common cause of Blood stasis. Blood and Qi are like Yin and Yang. Qi provides energy to move Blood through the vessels and holds the Blood within them. Conversely, Blood is essential in the formation of Qi and provides transportation for Qi into all areas of the body. Thus, Qi is the commander of Blood, and Blood is the mother of Qi. Any significant disturbance of these actions can cause the impedance of Qi flow, Blood will then Stagnate and cease flowing, thus Blood Stasis is formed. Common causes of Qi Stagnation include emotional causes, injuries, exogenous pathogenic factors, Phlegm, Qi Deficiency, and Blood Deficiency.
2. Qi Deficiency – If Qi is depleted then it cannot propel Blood in the vessels, Blood flows slowly and becomes static, thus leading to Blood Stasis. If Deficient Qi fails to control Blood, Blood will escape from the blood vessels, causing hemorrhage and Blood Stasis. Commonly seen in chronic illnesses, consumptive diseases, physical overexertion, or improper diets; Blood Stasis is characterized by tiredness, physical weakness and lack of appetite.
3. Blood Deficiency – Blood Deficiency often leads to Blood Stasis, just as water in the river becomes more stagnant when the water level becomes low. Also, because Blood is essentially needed for the formation of Qi, Deficient Blood causes Qi Deficiency, which then leads to Blood Stasis. This is commonly seen in patients with blood loss, anemia, arrhythmias, or heart failure.
4. Yin Deficiency – Since Blood is a part of all Yin in the body, long-term Yin Deficiency leads to false Heat and Dryness, which makes Blood viscous, causing unsmooth circulation, and thus Blood stasis. Skin conditions are often involved; dry and scaly skin is usually seen; the hair coat is rough and lusterless. Skin issues characterize as non-inflamed, non-Heat, with sudden onset of itchiness that that does not abate with scratching.
5. Exogenous or Interior Cold – Blood flows with warmth and congeals with Cold. Invasion of exogenous Cold in the vessels or Interior Cold from Yang Deficiency gives rise to vasoconstriction, which slows down blood circulation and congeals the blood, thus forming Blood Stasis in some parts of the body, particularly the gastrointestinal tract, causing severe abdominal pain or colic, or causing intractable Bi Syndrome when it obstructs the Channels and collaterals/vessels.
6. Blood Heat – Although Blood flows with warmth, if Heat is too excessive, it consumes Body Fluid and dries the Blood, causing Blood to condense and stop flowing, thus Blood Stasis; Extreme Heat in the Blood can scorch the vessels and drive Blood outside the vessels causing hemorrhage and Blood Stasis. Commonly seen in autoimmune disorders, immune-mediated skin problems, high fever, etc.
7. Dampness/Phlegm – Dampness and/or Phlegm obstruct Qi movement and Stagnate the Channels, disturbing the smooth flow of Blood, thus causing Blood Stasis. When Phlegm and Blood Stasis interact with each other, it often causes major disease, such as tumor/mass, malignancy or hemiplegia. It also causes disease to take a turn for the worse.
8. Traumatic injury – Any kind of trauma, such as accidents, surgery or physical injuries causes local Stagnation of Qi and Blood in the body. When it cannot be removed or addressed timely, it will lead to Blood Stasis. Local bruising or hematoma externally or internally following an injury is a typical sign of Blood Stasis.
SIDE EFFECTS AND CONTRAINDICATIONS
1. Blood invigorating herbs (especially those that are very active in moving Blood or breaking Blood Stasis) can easily weaken Qi and Blood. Therefore, use with caution in patients with weak Qi and/or Blood, especially in patients with weak Spleen and Stomach Qi.
2. If Qi is consumed and patients feel tired after taking a Blood invigorating formula, adjust the dosage and add a Qi tonic formula such as Si Jun Zi Tang, if needed.
3. Blood activating formulas should be given with or after meals, especially in patients with a sensitive stomach, as they can easily injure the Stomach and Spleen.
4. As most Blood invigorating herbs actively influence blood coagulation and thrombolysis, concurrent use with blood thinners or anticoagulant drugs should be closely monitored.
5. Blood invigorating herbs or formulas are contraindicated for all bleeding disorders and pregnant animals. Embryo/Fetus is considered as ‘Stasis’ in TCVM.
FOOD THERAPY FOR BLOOD STASIS
Food therapy recommendations for this pattern aim to increase foods that promote circulation to remove Blood Stasis, as well as to avoid foods that can impair circulation (i.e. Cold foods)
Below is a list of recommended foods that invigorate and circulate Blood:
1. Warm food: Shrimp, oats, mustard leaf, peach, hawthorn fruit, chestnuts, vinegar, ginseng, black pepper, turmeric
2. Cool food: Crab, mung bean, asparagus, eggplant, kelp, celery, banana
3. Neutral food: Black fungus (wood ear mushroom), potato, Shiitake, kidney bean
1. Neeb, G. R. Blood stasis China's classical concept in modern medicine. Edinburgh: Churchill Livingstone/Elsevier, 2007.
2. Chen K, Shi Z. Shi Yong Xue Yu Zheng Xue (translated: Practical Guide to Blood Stasis). Beijing: People’s Medical Publishing House Co., 1999. [in Chinese]
3. Jiang S. Xue Yu Lun (translated: Theory of Blood Stasis). Beijing: China Medical Science Press, 2001. [in Chinese]
4. Maciocia, G. The Practice of Chinese Medicine: The treatment of diseases with acupuncture and Chinese herbs. 2nd Ed. Edinburgh; New York: Churchill Livingstone, 1994: 420-425.
5. Xie H, Preast V. Xie’s Veterinary Acupuncture. Ames, Iowa: Blackwell Publishing, 2007:134-204.
6. Xie H, Preast V. Xie’s Chinese Veterinary Herbology. Ames. IA: Wiley-Blackwell, 2010: 565-567.
7. Liu J, Peck G. Chinese Dietary Therapy. Edinburgh: Churchill Livingston, 1995.