“The Liver receives Blood and can see, the legs receive Blood and can walk, the hands receive Blood and can grip, the fingers receive Blood and can hold.” — Su Wen
After reading the recent study in JAMA on the success of Xuebijing injection for the treatment of sepsis [See a summary of study findings in the July issue of AT], the above quote from the Su Wen came to mind. As sepsis is a serious condition with high morbidity and is connected to a wide array of medical issues, a successful treatment option is highly exciting.
After examining the herbs that constitute this injectable herbal formula, I was not surprised at its efficacy, as its main therapeutic vector is targeting blood stasis and blood heat. These two clinical patterns are fundamentally rooted in the importance of the TCM concept of blood and its relationship to all aspects of health and vitality. Let’s examine the contents of the injection Xuebijing and explore the basic TCM concepts that explain its potential effectiveness.
A Fingerprint of Xuebijing in Si Wu Tang
The injection Xuebijing is composed of five medicinals: chi shao, chuan xiong, dan shen, hong hua, and dang gui. When first examining Xuebijing, a basic TCM formula came to my mind: Si Wu Tang. The classic formula Si Wu Tang consists of shu di huang, dang gui, bai shao, and chuan xiong. We can see the infrastructure of Si Wu Tang within Xuebijing and in many ways, we could consider the injection a modification of Si Wu Tang.
The fingerprint of Si Wu Tang found within Xuebijing consists of chi shao, chuang xiong and dang gui. Si Wu Tang uses bai shao, rather than chi shao, but we can clearly see the resonance of the classic formula.
Why would chi shao be used as a substitute for bai shao? Bai shao is considered more of a blood tonic, while chi shao invigorates the blood, clears liver fire and cools the blood. When considering a clinical scenario of sepsis, using chi shao makes sense. Chi shao is sour, bitter, and cold, and targets the liver / spleen channels. This action of clearing liver fire and blood heat is directly applicable to the severity of sepsis and its clinical expressions.
Other Herbs in Xuebijing
Xuebijing, while containing a modified blueprint of Si Wu Tang, also uses the medicinal dan shen, which also clears heat and cools the blood. Dan shen is bitter and cold; targets the heart, pericardium and liver channels; and has the diverse actions of invigorating the blood, cooling the blood, dispelling toxins, dissolving swellings, nourishing the blood, and calming the mind. All of these actions clearly contribute to the concept of the systemic symptoms of sepsis.
The medicinal chuan xiong has a wide array of clinical applications related to pathologies of the blood. Two of the most famous two-herb combinations in Chinese medicine are chuan xiong and dang gui to move and nourish blood; and chuan xiong and dan shen to move blood, cool blood and stop pain. The injection Xuebijing contains both of these two combinations.
Dang gui and hong hua can also be considered a fundamental two-herb combination for all issues pertaining to blood pathologies in TCM. Dang gui and hong hua work in harmony to move and nourish blood.
TCM Basis for Xuebijing as a Treatment for Sepsis
When considering all the nuances of how the five herbs contained within Xuebijing can be formulated and customized as needed, based upon the severity and uniqueness of the clinical expression of sepsis, it is no wonder that such a formula would show clinical effectiveness.
On a most fundamental level, leaving out the concept / action of “clearing blood heat,” the simple action of resolving blood stasis found within the clinical vision of TCM can have vast implications in the resolution of almost any clinical scenario.
In Chinese medicine, we say, “Qi is the container of Blood, Blood is the Mother of Qi.” The two substances are inseparable. Keeping this TCM concept in mind clearly explains why a simple five-herb formula such the injection Xuebijing would show promise is the management and treatment of the condition of sepsis.
If the blood moves, qi can be distributed throughout the entire body, which stimulates systemic healing. Even in cases of more blood heat, moving the blood can help other herbs / medications that more directly clear heat work more effectively by ensuring the flow of both blood and qi is strong.
Clinical Relevance
While we must always keep in mind that the JAMA study used an herbal injection over a tea, extract or patent medicine, the potential promising results make sense from a TCM perspective and give clear clues on how TCM practitioners can help treat complex, serious medical issues.
I also found the examination of this herbal injection fascinating, as it shows the importance of always re-examining classical herbal formulas, and understanding how to simply and subtly modify formulas to treat modern expressions of disease.
While the effects of the injection Xuebijing may seem revolutionary, the clinical concepts behind its potential effectiveness are basic, fundamental concepts of Chinese medicine; and show the rich potential clinical applications of Chinese medicine in the modern clinical setting.
