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Also blood-quickening stasis-dispelling agents; blood-quickening agents; stasis-transforming agents. Blood-quickening stasis-transforming medicinals are medicinals that treat blood stasis.

Blood stasis refers to the inhibited movement or non-movement of blood. It is caused by cold, heat, qì stagnation, qì vacuity, or external injury. blood stasis due to external injury manifests in bruises (often described as painful stasis swelling). blood stasis due to any other cause (cold, heat, qì stagnation, or qì vacuity) can manifest in pain, abdominal masses (concretions and accumulations), menstrual pain (dysmenorrhea), amenorrhea, or flooding and spotting.

Blood-quickening medicinals are hot-warm or cold-cool in nature. Many are acrid and some are bitter in flavor. They mostly enter the liver channel; some enter the heart channel (the heart governs the blood and liver stores it).

Note that we translate 活血huó xuè as to quicken the blood. This translation closely reflects the Chinese meaning. Quicken means to enliven and to speed up.

Subcategories

• Blood-quickening pain-relieving agents are blood-quickening medicinals that treat pain due to blood stasis.
• Blood-quickening menses-regulating agents are blood-quickening medicinals that regulate menstruation disturbed by blood stasis.
• Blood-quickening injury-healing agents are blood-quickening medicinals that mainly disperse swelling and relieve pain due to blood stasis arising from external injury.
• Blood-quickening concretion-dispersing agents are blood-quickening medicinals that disperse concretions and transform accumulations, i.e., treat various kinds of abdominal masses due to blood stasis.

Properties

Nature: Both hot-warm and cold-cool. blood stasis arises when cold causes the blood to congeal, or when heat boils and condenses it. Hence both hot-warm and cold-cool agents can be used depending on the underlying presence of cold or heat.

Flavor: Mostly acrid; many are also bitter.

Channel entry: All enter the liver channel, several also enter the heart channel, and some additionally enter various other channels.

Toxicity: Some blood-quickening concretion-dispersing medicinals are slightly or highly toxic.

Actions

Blood-quickening stasis-transforming agents have different intensities of action. In terminology, we distinguish between different intensities of action.

Mild action is referred to as harmonizing blood (和血hé xuè) or harmonizing provisioning (和营hé yíng).

Moderate action is referred to as quickening the blood, transforming stasis, dispelling stasis, or dispersing stasis.

Powerful action is referred to as breaking blood, breaking stasis, or expelling stasis.

Indications

Blood stasis

Blood stasis is the inhibited movement or non-movement of blood. It can develop in the channels and vessels, as well as in the bowels and viscera. Causes of blood stasis include cold, heat, qì stagnation, qì vacuity, and external injury.

Terminology sometimes reflects different gradations of severity. Blood depression refers to a mild condition, blood stagnation to a moderately severe condition, and blood stasis to a more severe condition. However, this distinction is not always consistently maintained in the literature.

Pathomechanisms

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.

Qì vacuity: When qì is vacuous and does not have the power to move the blood adequately, blood stasis can arise.

Heat: When heat evil enters the blood, it can boil the blood, causing it to thicken.

Cold: Cold causes the blood to move more slowly than normal.

Phlegm turbidity: Phlegm turbidity can block the vessels, thereby causing blood stasis.

External injury: The bruising, pain, and swelling seen in external injuries is generally due to blood stasis.

Main Signs

Pain that is usually stabbing and of fixed location, refuses pressure, and is most severe at night.

Swellings and lumps: On the body’s surface, swellings and lumps due to external injury usually appear green-blue or purple in color. Masses within the body are hard and do not disperse when pressed or move when pushed.

Bleeding: Bleeding can occur when vessels are blocked and the blood is forced to extravasate. Bleeding associated with blood stasis is characterized by a dark purple coloration, sometimes with clots. Black tarry stools are a sign of internal bleeding due to blood stasis.

Body surface signs: The complexion is either green-blue or purple or else soot-black. The lips and nails may also appear green-blue or purple. The tongue may bear purple called stasis speckles. There may be purple patches under the skin. prominent green-blue veins on the abdomen (called caput medusae in Western medicine), spider nevi, varicose veins, and encrusted skin are also signs of blood stasis.

Gynecological conditions: Menstrual pain, amenorrhea, and flooding and spotting.

Tongue: Green-blue or purple body with stasis speckles; green-blue or purple varicose veins under the tongue.

Pulse: Rough or bound (slow, irregularly interrupted pulse).

Applications

Modern applications: In modern clinical practice, blood-quickening stasis-transforming medicinals treat coronary heart disease and thrombosis, although conditions thus diagnosed in biomedicine are not necessarily traditionally ascribed to blood stasis.

Blood-quickening pain-relieving agents treat any pain due to blood stasis: headache, chest pain, rib-side pain, pain in the heart region and abdomen, menstrual pain, postpartum stasis obstruction abdominal pain, impediment (bì) pain, and pain from knocks and falls.

Blood-quickening menses-regulating agents treat gynecological problems attributed to blood stasis, including menstrual irregularities, amenorrhea, menstrual pain, persistent flow of lochia, and postpartum stasis obstruction abdominal pain. They can also be used for pain in the chest and abdomen, for concretions, conglomerations, accumulations, and gatherings, for injuries due to knocks and falls, and for painful swollen welling-abscesses and sores.

Blood-quickening injury agents treat pain and swelling due to blood stasis caused by external injuries (bone fractures, damage to sinews, pain and swelling from knocks and falls, and incised wounds).

Blood-quickening concretion-dispersing agents are powerful blood-breaking stasis-expelling medicinals that disperse concretions and transform accumulations. They are used for enduring and severe blood stasis giving rise to concretions, conglomerations, accumulations, and gatherings. In gynecology, they are often used for amenorrhea due to blood stagnation, but they seldom used for menstrual irregularities, menstrual pain, postpartum stasis obstruction abdominal pain.

Combinations With Other Categories

Blood-quickening stasis-transforming medicinals are often combined with medicinals of other categories, depending on the cause and manifestations of the blood stasis.

Blood-Quickening Medicinals in General

In general, these can be combined with medicinals of other categories as follows to treat specific conditions:

• Qì stagnation: Qì and blood are closely related. Qì stagnation can cause blood stasis, and blood stasi can cause qì stagnation. The effect of blood-quickening stasis-transforming medicinals can be greatly enhanced by the addition of qì-moving medicinals.
• Cold: Cold is a major cause of blood stasis. For patterns of congealing cold with blood stasis, add interior-warming medicinals to enhance the therapeutic action.
• Heat: Blood stasis can also arise when heat scorches and condenses the blood. For blood stasis due to heat, blood-quickening stasis-transforming medicinals are combined with agents that clear heat and cool the blood.
• Impediment (bì). Blood stasis often arises in wind-cold-damp impediment patterns, when evils congest the channels and thereby affect the flow of qì and blood. impediment complicated by blood stasis is usually treated by combining blood-quickening stasis-transforming medicinals with wind-damp–dispelling medicinals.
• Sores and welling-abscesses: Welling-abscesses and many other kinds of sores arise when heat toxin binds with blood. Treat them by combining blood-quickening stasis-transforming medicinals with agents that clear heat and resolve toxin.
• Concretions and conglomerations: For these, blood-quickening stasis-transforming medicinals are often combined with agents that soften hardness and disperse binds.

Blood-Quickening Pain-Relieving Agents

These can be combined with medicinals of other categories to treat stasis pain associated with different conditions as follows:

• Depressed liver qì: When treating pain due to blood stasis that is related to binding depression of liver qì, combine blood-quickening pain-relieving medicinals with agents that course the liver and rectify qì.
• External injuries: Combine with blood-quickening injury medicinals.
• Gynecological diseases: Combine with blood-quickening menses-regulating medicinals.
• Concretions and accumulations (abdominal masses): Combine with blood-quickening concretion-dispersing medicinals.
• Swollen sores and welling abscesses: Combine with medicinals that resolve toxin and disperse swellings.

Blood-Quickening Menses-Regulating Agents

• Depressed liver qì: For blood stasis associated with binding depression of liver qì, combine blood-quickening pain-relieving medicinals with agents that course the liver and rectify qì.
• Qì and/or blood vacuity: Use blood-quickening medicinals that harmonize and nourish the blood. Combine these with agents that supplement qì and nourish the blood.
• Stasis and heat binding together: When blood stasis and heat are present together and exacerbate each other, it is important to use cold-natured blood-quickening menses-regulating medicinals. Combine these with agents that clear heat and cool the blood.
• Congealing cold with blood stagnation: Use blood-quickening menses-regulating medicinals that are acrid-dispersing and warm-freeing.

Blood-Quickening Injury Agents

• Pain: Combine with blood-quickening pain-relieving medicinals.
• Bone fractures and damage to sinews: Combine with medicinals that join sinews and bones, and ones that strengthen the sinews and bones.
• Incised wounds: Combine with medicinals that transform stasis, stanch bleeding, and engender flesh.

Blood-Quickening Concretion-Dispersing Agents

• Qì stagnation and congealing phlegm: Concretions and accumulations often arise when blood stasis develops from qì stagnation and congealing phlegm. Hence blood-quickening concretion-dispersing medicinals are often combined with agents that move qì or break qì, as well as with agents that transform phlegm and soften hardness.
• Vacuity: Concretions and accumulations develop gradually in patients suffering from vacuity. Hence, treatment usually requires the use of supplementing medicinals. These also help to prevent the harshness and dryness of blood-breaking concretion-dispersing medicinals from damaging right qì.

Warnings

Do not use to treat profuse menstruation or blood vacuity amenorrhea. Medicinals of this category wear and stir the blood, i.e., damage the blood and cause it to move. Therefore, these medicinals are inappropriate for the treatment of profuse menstruation or blood vacuity amenorrhea.

Do not use in pregnancy. Many stasis-dispelling medicinals, including all those that disperse concretions, have the effect of hastening delivery and aborting the fetus, and should therefore not be used in pregnancy. Traditionally, these medicinals were used for difficult delivery and for retained placenta. Modern biomedical methods are safer and more effective for dealing with these conditions.

Use with care in right qì vacuity. These medicinals easily damage right qì; use them with care in weak patients.

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