Understanding Stasis Patterns
Blood stasis, or 血瘀 xue yu, is one of the most frequently seen patterns in Chinese medicine. Unfortunately, Westerners, even students and professional practitioners of Chinese medicine, may conflate Chinese blood stasis patterns with biomedical circulatory disorders like coronary artery disease and deep venous thrombosis. While there is some overlap of blood stasis with certain cardiovascular diseases, the causes, diagnosis, and treatments are rarely equivalent. Cultivating an authentic Chinese understanding of blood stasis, in order to accurately identify and treat this pathology, demands a thorough knowledge of the technical terminology and linguistics associated with blood stasis.
In English, we often see the terms “stagnation” and “stasis” being used interchangeably, but the Chinese terms 滞 zhi (stagnation) and 瘀 yu (stasis) have separate meanings and origins. While stagnation refers to qi or food in Chinese medicine, stasis only implies a pathology of the blood. Furthermore, the character for stagnation combines the radical portion meaning “water” with a radical which denotes something tied or fettered, while the ideograph for stasis utilizes the disease radical together with a component indicating “silt”—i.e., debris which has accumulated along a waterway, hindering its flow.
In other words, qi stagnation describes a sluggishness of flow that requires a motive force to restore normal patency, while static blood refers to particles of pathological blood that must be dissolved and dissipated for free movement of blood in the vessels. The distinction between a pathology of constrained movement and force versus the substantive blockage of static blood is obvious in the differences in how qi stagnation and blood stasis are diagnosed. Specifically, the identification of qi stagnation relies heavily on patients’ reporting subjective sensations of distending, pulling, and scurrying pain, while blood stasis is most reliably identified through a visual confirmation of dead blood or a physical palpation of hard, fixed masses.
Quickening the Blood
The treatment methods for blood stasis include moving blood, transforming stasis, dispelling stasis, breaking blood, and quickening the blood. Moving blood and quickening the blood are general treatment methods for eliminating static blood, whereas transforming stasis, dispelling stasis, and breaking blood describe methods of varying intensity, ranging from the gentleness of transforming stasis to the aggressively attacking method of breaking the blood. Clinicians must understand how to select the appropriate medicinal based on the severity of the stasis and the action of the medicinal on blood stasis.
Quickening the blood is a specialized Chinese medical term for the general management of blood stasis. Often, when the treatment methods are stated, “quicken the blood” is followed by another two-character treatment method, “dispel stasis” or “break the blood”, for example. In Chinese, the character for quicken is 活 huo, which means “to live”, “to survive”, or “lively”. When one considers that static blood is occasionally referred to as “dead blood”, the concept implied by 活 huo is to animate or enliven particles of static blood. Translator Nigel Wiseman cleverly tapped the ancient, biblical meaning of quick, as in the quick and the dead, to convey in English a double meaning of enlivening dead blood and promoting an unencumbered and quicker flow of blood.
Clinical Points
Although qi stagnation and blood stasis may occur in tandem, distinguishing between a formless stagnation of qi and a blockage of flow by substantive stasis is a fundamental clinical skill.
Qi stagnation may be effectively achieved using body acupuncture, while static blood is better treated by 刺络 ci luo pricking the network vessels or using cupping, moxibustion, or gua sha*.
The term quickening the blood emphasizes the fact that Chinese treatment only targets malign or dead blood, differentiating Chinese management of blood stasis patterns from Western anti-coagulant medications which may cause pathological hemorrhaging.
In accordance with the statement of fact “enduring disease enters the network vessels”, patients with long-standing diseases should always be assessed for stasis in the network vessels.
More recent trends in geriatric medicine have posited blood stasis as the primary pattern of aging.
Clinical practice should clearly differentiate transforming stasis, dispelling stasis, and breaking the blood based on the severity of the stasis, with transforming treating mild conditions, dispelling used for moderate levels of stasis, and breaking blood employed when stasis is severe and/or intractable.
*Gua sha is a term comprised of two characters, one meaning “to scrape” and 痧 sha which references cholera and measles. The latter ideograph encloses the ideograph for “sand”, which is also pronounced sha, within the disease radical. The implication of the second character is the treatment of acute diseases, especially those that cause some form of induration or papule to form in or on the skin.