not move, Wei-Qi (being Yang in nature, hence warm) cannot flow through and starts to accumu-late, leading to Heat.’
A more accurate account of diagnosis and treat-ment was developed by Zhang Zhong-Jing in the third century (Han dynasty): in his book ‘Shang Han Za Bing Lun’ (known today as ‘Shang Han Lun’
and ‘Jin Kui Yao Lüe’), he used the term ‘Yu Xue’
(Blood stasis) for the first time. But the term Xu Xue (Blood amassment, which is Blood stasis with Heat) is also mentioned in relation to impaired blood flow. For example: ‘If the patient is forgetful, then Blood stasis is evident.’ (‘Shang Han Lun’, clause 237). In the twentieth century, this reference has led to the successful treatment of senile demen-tia and sequelae of apoplexy with Blood invigorat-ing medicinals. After Zhang Zhong-Jinvigorat-ing, it was not until 1500 years later that the term Yu Xue was to be established as an official description of a syndrome.
(All relevant passages are translated in Chapter 10).
First hints of a link between Blood stasis and gynaecological disorders are given by the Sui dynasty practitioner Chao Yuan-Fang, who ascribed dysmenorrhoea as ‘static Blood’ (Ji Xue) and ‘confluent Blood’ (Liu Xue).
In the subsequent Tang dynasty (seventh to tenth centuries) Blood stasis was mentioned using Although Wang Qing-Ren was not the first to
notice the concept of Blood stasis, he certainly con-tributed the most towards its development.
Findings from the Stone Age of the first acupuncture needles made from bones and of stone splints point towards their use for blood letting and the therapeutic removal of blood clots, which marks a pre-stage of Blood stasis therapy.
Written records can be traced back to as early as the ‘Nei Jing’, the Yellow Emperor’s classic work, dating from the Warring States dynasty (475–
221 bc). Mentioned within the ‘Nei Jing Su Wen’
are ‘poor Blood’, blocked vessels, clotted arteries, coagulated Blood etc. The condition is classified into four aetiological factors: trauma, Cold-induced coagulation, emotional causes, notably fits of anger, and chronic exhausting diseases. It is described literally as: ‘Injury resulting from fall produces poor Blood in the interior, which is hard to clear.’ (Chapter 58 ‘Ling Shu’: Thievish Wind) This citation refers to acute Blood stasis with the formation of haematomata. But there are also ref-erences to chronic Blood stasis due to disturbed blood circulation and coagulation (Chapter 81:
Abscesses): ‘If Ying-Qi and Wei-Qi (Nutritive and Defensive energy) stagnate in the channels and vessels,1Blood will clot and not move. If this does
1 I intentionally prefer the more general term ‘blood vessel’ (German: ‘Ader’ – Translator’s note) to other anatomical terms like vessel, vein, artery and so on, particularly if there are no distinctions made in the Chinese source texts with regard to channels and blood
vessels (Qi – Ader and Blutader in German –
Translator’s note). If information that is missing in the source language is translated into a clearly defined term that suggests different information, then, in my opinion, this is an interpretation that comes close to falsification.
THEORY AND BACKGROUND KNOWLEDGE 10
a variety of names: the famous Taoist doctor Sun Si-Miao developed new Blood invigorating for-mulas for Blood amassment (Xu Xue) and Blood that is not moving (Xue Bu Xing); also Wang Tao, author of the ‘Wai Tai Mi Yao’ (Medical Secrets of an Official), developed Blood invigorating formulas for internal and external injuries. In the period of the first millennium, when Chinese medicine evolved into many new theories and schools of thought, when specialized branches such as gynaecology and paediatrics emerged, further progress was achieved in diagnosis and treatment of Blood stasis. Chen Wu-Ze, in his great book ‘San Yin Ji Yi Bing Fang Lun’ (Treatise on the Three Cate-gories of Disease Causes, 1174), undertook pioneer-ing work in the classification of diseases accordpioneer-ing to aetiology; he followed Zhang Zhong-Jing’s ideas (in the ‘Shang Han Lun’) and went into greater detail in his elaborations on the treatment of Blood amassment (for translation see Section 3).
Li Dong-Yuan (Jin dynasty, twelfth and thir-teenth centuries) applied Dang Gui (Angelica Sinensis) and other Blood invigorating medicinals in his prescriptions. His later contemporary Zhu Dan-Xi (Yuan dynasty, under Mongolian rule, thir-teenth and fourthir-teenth centuries) referred to Blood stasis as ‘dead Blood’ (Si Xue) and enhanced the theory of stagnation (Yù, fourth tone),2 which often leads to Blood stasis. Thus he concluded:
‘As long as Qi and Blood flow together harmo-niously, the ten thousand diseases will not appear.
But as soon as stagnation arises, disease will be the result. It is for this reason that many diseases afflicting man are derived from stagnation.’ He then utilized Blood invigorating medicinals like Chuan Xiong (Ligusticum) to treat stagnation of Blood.
In the Qing dynasty (seventeenth century), under Manchurian rule, the most substantial progress in Blood stasis research was eventually achieved: Wang Ken-Tang’s encyclopaedic work
‘Zheng Zhi Zhung Sheng’ (Standard Manual for Diagnosis and Treatment, 1602) includes a separate chapter about Blood amassment (Xu Xue), also containing the treatment of Blood stasis (for trans-lation see Section 3).
His contemporary, the great scholar Zhang Jing-Yue, who would also publish his monumental complete works 20 years later on, elaborated on the treatment of three degrees of severity for Blood stasis in the chapter on masses (Ji): ‘If Blood accumulates or becomes ‘knotted’, then it [stasis]
should be broken up or disseminated, using Tao Ren (Persica), Hong Hua (Carthamus), Su Mu (Sappan) etc. . . . If Blood moves hard [literally
‘rough’], it should be moved using Niu Xi (Achyranthis), Yi Mu Cao (Leonuri) etc. . . . If Blood is deficient and stagnant, it should be invig-orated and tonified, using Dang Gui (Angelica), Chuan Xiong (Ligusticum), Niu Xi (Achyranthis), Shou Di (Rehmanniae Praeparata) etc.’
At the time of the last dynasty, further progress into the investigation of infections was spurred on by the school of ‘febrile diseases’ (Wen Bing Xue).
One of its protagonists was the great Ye Tian-Shi (eighteenth century), who was also an excellent clinician, as can be seen from his case study reports. He further developed the theories on Blood stasis by pointing out the purple tongue colour in stasis, and by examining the concept in the ‘Nei Jing’ claiming that chronic disease always leads to impaired flow of Blood, for which he then also created treatment plans. (Some of his case studies on Blood stasis are presented in Chapter 9.)
Finally, in the nineteenth century, Wang Qing-Ren appeared. After having studied the classics, he came to the conclusion that post-mortem exam-inations, which were still frowned upon, had to be encouraged in order to further medical knowl-edge. Having examined many corpses, where blood could be found in all parts of the body, he deduced that diseased blood could lead to illness anywhere in the body. He then went on to spe-cialize in the treatment of Blood stasis and its sequelae. His complete anatomical and clinical experiences were eventually published in his book
‘Yin Lin Gai Cuo’ (Corrections of Mistakes in the Medical World), which more than any other classic contributed profoundly to the theory and practice of Blood stasis. Even though his anatomical views have been outdated for a long time, his prescrip-tions and contribuprescrip-tions on the treatment of apoplexy are still in wide use today. (For a com-plete translation see Section 3.)
2 For details see Glossary (Appendix 1): Blood stagnation, Blood stasis and Blood amassment.
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History and development of Blood stasis and its pathological mechanisms 11
Wang’s contemporary Lin Pei-Qin, a learned practitioner who focused on clinical experience, described nearly all the methods of treatment for Blood stasis at that time. (Excerpts are also included in Section 3, ‘Classical texts’.) Later on, at the end of the nineteenth century, Tang Zhong-Hai devoted his life to the specific treatment of bleedings and conditions related to Blood, also including Blood stasis. (All relevant passages are translated in Chapter 11.)
Zang Xi-Chun, who died in 1933, contributed to the treatment of Blood stasis in modern times.
Most notably, he emphasized the Blood invig-orating function of San Qi (Notoginseng) and the combination of E Zhu and San Leng (Curcuma and Spargani). He conceived some prescrip-tions noted for the treatment of apoplexy, like Huo Luo Xiao Ling Dan (Wondrous Channel-invigorating Pill). (Some of his case studies
are mentioned in different sections of this book.)
Since the 1960s, there have been major advances in scientific research on Blood stasis, its diagnosis and treatment, particularly in pharmacology, haemorheology, oncology and vascular diseases.
There are still various concepts to classify in the aetiology of Blood stasis. However, it must be noted – as mentioned in the introduction – that TCM aetiology is not strictly causal-analytical, i.e.
it is not always possible to make a definite divid-ing line between cause and effect. This becomes immediately clear with Blood stasis: many of its causes arise together with Blood stasis or they may be the result, for instance long-term Blood stasis may lead to Qi deficiency, but Qi deficiency may also cause Blood stasis. To the practitioner, however, it is more relevant to know whether Qi deficiency is present, and to treat it as well.
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