Blood stasis

Also:

• Blood stagnation (血滞 xuè zhì), a mild form of blood stasis.
• Static blood (瘀血 yū xuè), meaning blood affected by stasis, and in specific blood that has ceased to flow altogether. This refers to a pathologic product as a cause of disease rather than to the pattern.

A disease pattern chiefly characterized by bruises; localized pain of fixed location that refuses pressure; hard abdominal masses; stasis speckles on the tongue; a rough pulse.

Biomedical correspondence: cardiovascular diseases, hepatosplenomegaly, menstrual disorders, heterotopic pregnancy, and postpartum disorders often present as blood stasis patterns.

Description: Blood stasis is the severely reduced movement or stoppage of blood. It manifests in bruises due to external injury and numerous other conditions due to internal pathological processes. The most common signs are pain of fixed location and stabbing pain like the piercing of an awl or the cutting of a knife, exacerbated by pressure, and often more pronounced at night than in the daytime; a purple tongue or purple speckles on the tongue, and rough pulse. Other manifestations include:

• Body surface: Green-blue, purple, or soot-black facial complexion and green-blue or purple lips and nails; prominent green-blue abdominal vessels (caput medusae); purple macules under the skin; varicose veins on the lower limbs; red threads (红缕 hóng lǚ), which are tiny blood vessels appearing as pink lines just under the skin; and encrusted skin (rough dry skin occurring in old age).
• Abdominal masses that are hard and of fixed location (concretions and accumulations).
• Bleeding: Flooding and spotting; tarry stools from bleeding in the digestive tract.
• Women: Painful menstruation, amenorrhea, or flooding and spotting.
• Spirit-mind: Insomnia, fearful throbbing, forgetfulness, feeble-mindedness (dementia), or manic derangement.
• Miscellaneous: Heat effusion, paralysis, or sores.
• Tongue: Green-blue or purple, with stasis macules or stasis speckles. The sublingual network vessels may be green-blue or purple and varicose.
• Pulse: Rough or else bound or intermittent.

Pathomechanisms

• External injury: Bruising is typically due to knocks and falls causing contusion that compresses the flesh and breaks blood vessels to cause extravasation of blood under the skin, which result in bruises (瘀青 yù qīng). Overstretching or overuse of muscles (wrenching) can also cause bruising. People with qì and blood vacuity tend to bruise easily.
• Bleeding: Bleeding causes blood stasis, because once it leaves the vessels it becomes dead blood. Blood stasis can also cause bleeding when it affects damaged vessels that easily break. The bleeding in these cases is often recurrent.
• Heat evil: When heat evil enters the blood, it can boil the blood, causing it to thicken. Static blood and heat can exacerbate each other. Static blood makes heat depressed and unable to disperse, while heat boils the blood to create blood stasis. This mutually conducive relationship is called stasis and heat binding together (瘀热互结 yū rè hù jié).
• Qì stagnation: Qì propels the blood. When qì stagnates, this can give rise to blood stasis. This is often called qì stagnation and blood stasis (气滞血淤 qì zhì xuè yū). Blood stasis slows the movement of qì, giving rise to the same condition.

Stasis

The term stasis is 瘀 yū in Chinese. This character probably developed from 淤 yū, which means silting (of rivers and lakes) by replacing the water radical 氵with the illness signific 疒. Although the term瘀 is not found in the Huáng Dì Nèi Jīng, it appears in the Jīn Guì Yào Luè of the Hàn period. In the early literature, the same concept was variously called blood amassment (蓄血 xù xuè), dried blood (干血 gān xuè), lodged blood (留血 liú xuè), accumulated blood (积血 jī xuè), and dead blood (死血 sǐ xuè), each of which denoted specific phenomena.

• Cold evil: Cold constricts the vessels and slows down the movement of blood. Cold affecting the blood is called blood cold.
• Phlegm: Phlegm obstructs the movement of blood. Phlegm and static blood are both yīn evils that have an obstructive effect. Phlegm-stasis, which is phlegm and stasis obstructing each other (痰瘀交阻 tán yū jiāo zǔ), is discussed under phlegm-rheum further ahead.
• Qì vacuity: When qì is vacuous and does not have the power to move the blood adequately, mild blood stasis can arise. This is often referred to as blood stagnation.
• Blood vacuity: When blood is insufficient, its movement can slow down, giving rise to blood stasis. Blood stasis can also cause insufficiency of the blood, since when static blood is not eliminated, it can prevent new blood from being produced. This is captured in the phrase when old blood does not go, new blood is not engendered (旧血不去, 新血不生 jiù xuè bù qù, xīn xuè bù shēng).

In addition, two sayings are worth remembering: Because enduring illness invariably takes its toll on qì and the blood, it is often said that enduring illness tends to produce stasis (久病多瘀 jiǔ bìng duō yū). Because older people generally do not get enough exercise and are therefore prone to qì vacuity, it is also said that old people tend to have stasis (老人多瘀 lǎo rén duō yū).

Analysis of signs: Blood stasis arising from within the body (not attributable to trauma) affects the bowels and viscera or the channels and network vessels. This accounts for most of the signs discussed below.

• Bruises resulting from trauma.
• Pain: Blood stasis obstructs the flow of qì and blood; when there is stoppage there is pain. Stasis pain is of pain fixed location and refuses pressure, described as being like the piercing of an awl or the cutting of a knife. Pain is often more pronounced at night when blood flow is slower.
• Abdominal masses: Arising in the inner body, blood stasis can cause abdominal masses, which are known as concretions and accumulations. These include what biomedicine calls tumors.
• Bleeding: Blood vessels blocked by static blood often burst giving rise to bleeding. The blood is purple and dull in color, often containing clots. Bleeding in the digestive tract can give rise to black tarry stools. Subcutaneous bleeding gives rise to purple macules and stasis speckles described below. Note that bleeding can also result from qì failing to contain the blood and from blood heat, as well as from external injury, but the accompanying signs are markedly different.
• Blackish stools from bleeding in the digestive tract arising when static blood obstructs vessels and causes them to burst.
• Surface of the body: Prominent green-blue abdominal vessels (caput medusae), encrusted skin, purple macules under the skin; varicose veins on the lower limbs; and red threads (红缕 hóng lǚ, capillary vessels appearing as pale-red lines on the body's surface), which are tiny blood vessels appearing as pink lines just under the skin; encrusted skin (rough, dry, squamous skin) arising when blood stasis develops with blood dryness.
• Women: Static blood occurring in the uterus manifests in painful menstruation with clotted discharge. Severe obstruction can cause amenorrhea (absence of menses). It can also give rise to flooding and spotting for reasons explained above.
• Spirit-mind: When blood stasis obstructs the qì dynamic, it can cause insomnia, fearful throbbing, forgetfulness, and manic derangement.
• Heat effusion: This occurs when blood stasis and heat bind together.
• Paralysis: Static blood or phlegm-stasis blocking the channels can cause paralysis.
• Sores: Static blood obstructing the vessels hampers the movement of qì and blood and deprives the flesh of nourishment, giving rise to sores.
• Facial complexion: Soot-black, green-blue, or purple facial complexion and green-blue or purple lips and nails. This develops when enduring static blood conditions deprive the face of the warming and nourishing action of qì and blood.
• Tongue: Green-blue or purple, with stasis macules or stasis speckles; green-blue or purple and varicose sublingual network vessels. These signs all reflect the sluggish movement of blood.
• Pulse: Rough or else bound or intermittent.

Treatment

Medicinal therapy: Quicken the blood and transform stasis. Commonly used medicinals include peach kernel (Persicae Semen, 桃仁 táo rén), carthamus (Carthami Flos, 红花 hóng huā), Chinese angelica (Angelicae Sinensis Radix, 当归 dāng guī), salvia (Salviae Miltiorrhizae Radix, 丹参 dān shēn), red peony (Paeoniae Radix Rubra, 赤芍药 chì sháo yào), leonurus (Leonuri Herba, 益母草 yì mǔ cǎo), and lycopus (Lycopi Herba, 泽兰 zé lán).

In severe enduring conditions, blood-breaking hardness-dispersing medicinals such as sparganium (Sparganii Rhizoma, 三棱 sān léng), zedoary (Curcumae Rhizoma, 莪朮 é zhú), pangolin scales (Manitis Squama, 穿山甲 chuān shān jiǎ), and ground beetle (Eupolyphaga seu Steleophaga, 蟅虫 zhè chóng) may be used. Where a draining-precipitant action is also required as in heat stasis patterns such as cold damage blood amassment patterns, rhubarb (Rhei Radix et Rhizoma, 大黄 dà huáng), and mirabilite (Natrii Sulfas, 芒硝 máng xiāo) may be added.

Where blood stasis causes bleeding, medicinals that have both a blood-stanching and blood-quickening action such as notoginseng (Notoginseng Radix, 三七 sān qī), typha pollen (Typhae Pollen, 蒲黄 pú huáng), field thistle (Cirsii Herba, 小蓟 xiǎo jì), and madder (Rubiae Radix, 茜草根 qiàn cǎo gēn) are used.

Stasis-dispelling blood-quickening formulas include Peach Kernel and Carthamus Four Agents Decoction (桃红四物汤 táo hóng sì wù tāng), House of Blood Stasis-Expelling Decoction (血府逐瘀汤 xuè fǔ zhú yū tāng), Peach Kernel Qì-Coordinating Decoction (桃仁承气汤 táo rén chéng qì tāng), and Rhubarb and Ground Beetle Pill (大黄蟅虫丸 dà huáng zhè chóng wán).

Acumoxatherapy: Treatment varies according to cause and affected area. Points used to dispel stasis include: CV-17 (Chest Center, 膻中 shān zhōng), BL-17 (Diaphragm Transport, 膈俞 gé shù), SP-10 (Sea of Blood, 血海 xuè hǎi), LI-4 (Union Valley, 合谷 hé gǔ), LR-3 (Supreme Surge, 太冲 tài chōng), LR-2 (Moving Between, 行间 xíng jiān), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), BL-60 (Kunlun Mountains, 昆仑 kūn lún), SP-8 (Earth’s Crux, 地机 dì jī), PC-3 (Marsh at the Bend, 曲泽 qū zé), BL-40 (Bend Center, 委中 wěi zhōng), and Glomus Root (痞根 pǐ gēn). Needle with even supplementation and drainage or bleed with a three-edged needle.

Combined pattern: Qì stagnation and blood stasis; phlegm and stasis obstructing each other; stasis and heat binding together.

Further developments: Qì stagnation; blood vacuity.

See static blood; dispelling stasis and quickening the blood.

Etymology

Chin 血 xuè, blood; 瘀 yū, related to 淤 yū, sediment, silt up.