"Regardless of food, drink, or habitation, if the daily habits of life are out of proportion, this can all lead to a failure of the movement of blood, and blood stasis. Hence, poor blood is responsible for a plethora of diseases."
- Wang Ken-Tang, Zheng Zhi Zhun Sheng
In my last article, I discussed the importance of taking the traditional Chinese medicine (TCM) concept of blood stasis into account when dealing with chronic joint pain. In this installment, I'd like to continue this topic and elaborate further on signs and manifestations of blood stasis, discuss the thermal nature of blood-invigorating medicinals, introduce two Ayurvedic herbs which can be integrated into TCM protocols for blood stasis, and discuss ways to use the TCM medicinal herbs lu rong and lu jiao jiao to more effectively target chronic degenerative joint issues.
Accurately identifying blood stasis signs in chronic joint issues is very important, and many of the signs and manifestations of blood stasis are not typically discussed. Besides the standard indications of a purple tongue and choppy pulse, the following signs are important indicators of blood stasis: chronic pain, dry/cracked nails and hair, varicose veins, dark complexion/dark circles under the eyes, excessive dreaming, symptoms aggravated at night, dry, flaky skin with tough texture, surgery, irregular menstruation and clots during the menses, chronic low-grade fever, fever at night, depression, poor concentration and memory, and tight, stiff muscles and ligaments.
It is important to examine for any of these signs and symptoms in cases of chronic joint pain. If more than one is present, it is very likely that blood stasis is a complicating factor. Also, due to joint pain often being a chronic, recalcitrant issue, blood stasis becomes a significant pathogenic factor de facto even when other signs and symptoms are not present or when symptoms wax or wane.
The following quote from Wu Kun,1551-1620 (Six Chapters on Acupuncture Methods) offers an interesting viewpoint on this idea: "How to treat impure blood: the pathogen invades the collaterals and from there also the channels. Eventually, it accumulates in the blood vessels. Its hot or cold nature has not developed yet; it behaves like the breaking waves: sometimes they come, sometimes they depart. Therefore, the symptoms are not always present. The treatment must seize and stop the pathogen. After it has been stopped, it will accumulate in one place and then needs to be discharged together with the static blood. If it stays in the channels for a longer period of time, blockage with bi syndrome will develop."
Another important idea to take into consideration when treating blood stasis is the thermal nature of blood-invigorating medicinals. For example, some warm medicinals for moving the blood are chuan xiong, dang gui, ji xue teng, yan hu suo, ze lan, hong hua, e zhu, ru xiang and jiang huang. This can be utilized more effectively when blood-stasis syndromes occur with concomitant cold signs or symptoms which are exacerbated by cold weather.
Other blood-moving medicinals have a cool thermal nature, like dan shen, yu jin, yi mu cao, chi shao, mu dan pi and chuan shan jia. These can be utilized more effectively when blood-stasis syndromes occur with accompanying heat signs or have symptoms which are exacerbated by warm weather.
These medicinals can also be combined in various ways and with various other medicinals to completely address the patient's unique pattern(s). Two Ayurvedic herbs which can easily be integrated with any of the above TCM medicinals are manjishtha (Rubia cordifolia) and guduchi (Tinospora cordifolia).
Manjishtha means "bright red" and reflects its affinity for treating issues related to blood stasis. It has been used extensively in Ayurvedic medicine for a broad spectrum of blood-related disorders such as chronic skin conditions, excessive bleeding, gynecological issues and mental/emotional issues. Manjishtha has a bitter, sweet and astringent taste (rasa), a cooling energy (virya) and a predilection for the blood (rakta), muscle (mamsa) and bone (asthi) tissue. It also destroys toxins (visaghna) and scrapes waste accumulations from the channels (lekhaniya). Considering these factors, it is easy to see how manjishtha can be integrated in TCM protocols for invigorating and cooling the blood, as well as dissolving phlegm. Manjishta functions much like mu dan pi and chi shao and works extremely well when combined with these medicinals in chronic hard-to-treat conditions relating to blood stasis and phlegm leading to chronic bi syndromes.
Another Ayurvedic medicinal which can effectively be integrated into TCM blood-stasis protocols is guduchi. It has a bitter and pungent taste (rasa), a warm energy (virya) and a sweet postdigestive effect (vipaka). Guduchi has an affinity for the blood (rakta), muscle (mamsa), fat (meda), nerve (majja) and reproductive (shukra) tissues. Guduchi's bitter taste clears heat, while its warm energy moves the blood and destroys toxic metabolites caused by chronic tissue/joint inflammation. Guduchi is also considered an amavataghna (a reliever of gout or arthritis).
Once again, upon reviewing these indications, it is easy to see how guduchi, much like manjistha,can be intelligently integrated into TCM protocols involving chronic bi syndromes complicated by blood stasis and phlegm. The sweet postdigestive effect (vipaka) also nourished the qi and blood to help prevent blood-invigorating medicinals from depleting the patient, as well as to prevent deficiency states which can result in further blood stasis. Guduchi therefore treats both the root and the stem of the disease process; thus it is given the name of amrita or "life giver." It is considered a powerful rejuvenative substance or rasayana and can be used in almost any disease state involving complicated excess and deficiency states.
The medicinal lu rong (deer-antler velvet) also falls into this category of rejuvenating medicines. Deer antler has long been used in TCM to deeply supplement the kidneys and liver, and modern research has confirmed its powerful ability to stimulate joint cartilage, heal bones and stimulate growth of red and white blood cells. Lu rong has the more supplementing actions, while lu jiao jiao without the "velvet" has slightly less supplementing, but more blood-invigorating ability. Therefore, these two medicinals can be combined in almost any chronic bi syndrome involving blood stasis and kidney/liver vacuity. Lu rong and lu jiao jiao can also be helpful when protracted courses of blood-invigorating and/or phlegm-dissolving medicinals are administered, as these can often deplete qi and blood if used long-term without modification.
I hope this article has revealed more ways to more effectively evaluate and treat chronic bi syndromes. In part three, we will examine the complications of blood stasis combined with phlegm in chronic bi syndromes and explore ways to combine herbs and supplements to resolve this complex and difficult to treat pattern.
