As we move out of the hibernation of winter and into the warmer days of spring, it is extremely important for clinicians to examine the concepts of qi stagnation and blood stasis. Depending upon climate and location, patients will tend to live more sedentary lives during the winter season. This tendency can lead to the common TCM patterns of qi stagnation and blood stasis. Clinicians should consider this seasonal influence upon each patient's constitution and underlying pattern presentations, and keep this in mind as acupuncture protocols are administered.
While qi stagnation is a common concept in TCM diagnostics, in this column I focus on the concept of blood stasis due to the influence of the colder winter season, and explore how clinicians can help patients view the spring season as a time for movement.
Fundamental Concepts
The following concepts are fundamental in Chinese medicine and should always be considered as we phase from the winter season into the spring season: Qi is the commander of Blood, when Qi moves, Blood moves. Blood is the Mother of Qi, where Blood goes, Qi goes."
In almost all traditions of natural medicine, the spring season is seen as a time of reawakening, transformation and cleansing. Over the colder, more sedentary months of winter, the circulatory and lymphatic systems tend more toward sluggishness and stagnation due to less activity; while at the same time individuals tend to eat a diet richer in heavy, fatty, cloying foods.
The spring season is therefore a time to move and reawaken the mind / body to invigorate the qi and blood, allowing for natural cleansing and transformation. It is common for Western herbal traditions to administer "alternatives" and "blood cleansers" such as red clover, burdock, milk thistle, prickly ash, and yellow dock, as well as bitters formulas during the spring season as a way to stimulate the circulation of blood / lymph and help "cleanse the liver."
Acupuncturists can keep this concept in mind when treating and examining patients who live in colder climates to investigate whether any constitutional issues / underlying patterns are being potentially influenced by blood stasis.
Blood stasis is typically caused by the following mechanisms: qi stagnation; internal / external cold, heat or fire; phlegm; qi vacuity and blood vacuity. Let's focus on the influence of qi stagnation and how we use acupuncture and physical activity during the spring season to help bring patients back into harmony with their body and the seasons. Two key acupoints clinicians should keep in mind during the end of winter / beginning of spring are Ren 6 and Sp 10.
Ren 6 (Qi Hai — Sea of Qi)
Ren 6, along with Ren 4, are referred to as the "Dantian" - the area of the body where the deepest energy is stored and incubated in the body. The traditional actions of Ren 6 include fostering original qi ; tonifying qi; nourishing the kidneys and fortifying yang; rescuing collapse of yang; and regulating and harmonizing blood. This last action of "regulating and harmonizing the blood" is our primary concern here.
Acupuncturists can use Ren 6 to help move / invigorate the qi and blood after the more stagnant months of winter, especially in the combination of Ren 6 + Liv 3 + LI 4 + Sp 10. Ren 6 and this combination should always be considered during the winter / spring seasonal transition.
Clinicians can add various parts of this combination to move any stagnant qi and blood, which may be an underlying issue contributing to the unique presenting pattern(s) of the patient. In particular, Ren 6 can be used to invigorate and move qi, as well as warm the yang, especially when used with heated needle moxibustion. This technique alone is incredibly important for stimulating health and vitality during the winter / spring months.
In cases which reveal underlying issues of heat, Ren 6 can be used without moxibustion to circulate the qi, allowing heat to dissipate and clear when combined with heat-clearing points such as LI 11, St 44 or Liv 2. I also always use Ren 6 in chronic cases of skin disorders based on the idea of "Qi is the commander of Blood."
Sp 10 (Xuehai — Sea of Blood)
The name of Sp 10 hints at the overall applications of this important point. Its actions include invigorating the blood and dispelling stasis; cooling the blood; harmonizing menstruation; and benefiting skin disorders.
I have always found the saying in Chinese medicine, "If blood stasis is not transformed, new blood cannot be generated," very inspiring for the spring season. For new ideas or new levels of health and vitality to be achieved during the spring season, we must move and clear any stasis or stagnation. Sp 10 is a pre-eminent point for this.
I always include Sp 10 when using the Four Gates combination of Liv 3 + LI 4 to more deeply move the blood while stimulating the generation of new, healthy blood. The combination of Ren 6 + Sp 10 is a powerful two-point combination which is also important during both the winter and spring seasons. Ren 6 moves and warms the qi mechanism, while Sp 10 moves / invigorates the Blood. In many ways, the combination of Ren 6 + Sp 10 is a perfect representation of "Qi is the commander of Blood, when Qi moves, Blood moves. Blood is the Mother of Qi, where Blood goes, Qi goes."
Clinical Takeaway
I hope this article emphasizes the importance of using acupuncture to stimulate the movement of qi / blood to harmonize the patient with the seasons; and help clear any stagnation which may prevent new growth and expansion so important during the spring season.
Keep in mind that it is also important to focus on physical activity during this seasonal transition. I always strongly encourage patients to become more physically active as winter phases into spring, suggesting such daily activities as walking, running, weight training, tai qi, yoga, or hiking. No amount of acupuncture can replace the role of daily exercise! We must also focus on nutrition and the seasonal influence of the diet. In a similar fashion to exercise, no amount of acupuncture can replace a healthy diet.
Remember to inspire patients to see spring as a time to move, expand, transform, and clear stagnation from all aspects of their lives. This is often the key to deeper transformation.
Over my almost 30 years in clinical practice, I have used Chai Hu Long Gu Mu Li Tang extensively for a wide array of clinical presentations ranging from chronic headaches to anxiety, insomnia, and prescription drug withdrawal symptoms if these situations fit the appropriate patterns – all with extremely positive clinical outcomes.
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