Blood statis as a pathological product
Blood stasis (Yu Xue) is a pathological product formed when blood stops flowing normally, either pooling within the vessels or escaping from them. Once formed, it becomes a secondary pathogenic factor that can cause new diseases and block the generation of healthy new blood.
Key Properties
Body Layers
Xue (Blood)
Yū Xuè
Blood Stasis (as Pathological Product)
Nature & Properties
Thermal Nature
Variable
Yin-Yang
Yin
Vulnerable Organs
Heart
The Heart governs the blood vessels; blood stasis in the Heart causes chest pain (chest bi syndrome), palpitations, and cyanosis of lips and nails
Liver
The Liver stores blood and ensures its smooth flow; Liver blood stasis causes hypochondriac pain and abdominal masses
Uterus
The Uterus is particularly susceptible; blood stasis causes dysmenorrhea, irregular periods, dark clotted menstrual blood, and masses
Lungs
Blood stasis in the Lungs causes chest pain and hemoptysis (coughing blood)
Spleen
The Spleen controls blood within the vessels; Spleen dysfunction can lead to blood escaping and forming stasis
Educational content · Consult qualified TCM practitioners for diagnosis and treatment
Overview
Blood stasis (瘀血, Yū Xuè) is one of the most important pathological products in Traditional Chinese Medicine. Unlike primary pathogens that directly cause disease, blood stasis is a secondary pathogenic factor—it forms as a result of other disease processes, then becomes capable of causing new pathological changes itself.
Think of blood stasis like a traffic jam: when blood flow is disrupted, it accumulates and stagnates. This stagnant blood loses its normal nourishing function and instead becomes an obstruction that blocks the smooth flow of Qi and fresh blood. As the classical texts state, "if stagnant blood cannot be dispelled, new blood will not be generated." This creates a vicious cycle where old, stagnant blood prevents the body from producing healthy new blood.
Blood stasis can form through several mechanisms: blood that moves too slowly and congests within the vessels; blood that has escaped from the vessels (离经之血, lí jīng zhī xuè) due to trauma or hemorrhage and cannot be reabsorbed; or blood that has become polluted or thickened. Modern research has found correlations between blood stasis syndrome and conditions like hypercoagulability, thrombosis, and inflammation.
Historical Context
The concept of blood stasis has ancient origins in Chinese medicine. References to "congealed blood" (凝血) and "malignant blood" (恶血) appear in the Huang Di Nei Jing (circa 200 BCE), establishing the foundational understanding that stagnant blood causes disease.
Zhang Zhongjing's Jin Gui Yao Lue (circa 220 CE) provided the first systematic treatment protocols, with over 30 references to blood stasis and numerous formulas like Gui Zhi Fu Ling Wan and Tao He Cheng Qi Tang that remain in use today. The diagnostic criteria in Chapter 16 still guide modern practitioners.
The Qing dynasty physician Wang Qingren (1768-1831) revolutionized blood stasis theory in his Yi Lin Gai Cuo (Corrections of Errors in the Medical Forest), creating the famous "Zhu Yu Tang" (stasis-expelling) formula family. His anatomical studies led to deeper understanding of how blood stasis causes disease. Tang Rongchuan's Xue Zheng Lun further systematized blood stasis theory. Standard diagnostic criteria were established in China in 1982, with WHO definitions following later.
Defining Characteristics
Obstructive
阻滞Blood stasis physically blocks the vessels and channels, obstructing the flow of Qi, blood, and body fluids. This creates the characteristic fixed, stabbing pain that worsens with pressure.
Substantial/Tangible
有形Unlike Qi stagnation which is intangible, blood stasis is a material substance that can form palpable masses, lumps, and tumors. The classic text states: "if the belly is lumpy, there must be tangible blood."
Fixed Location
固定不移Blood stasis tends to remain in one location, causing pain and masses that are fixed rather than moving. This distinguishes it from Qi stagnation, where pain tends to move around.
Blocks New Blood
瘀血不去新血不生Old stagnant blood prevents the generation of healthy new blood, leading to blood deficiency over time. This is why chronic blood stasis often presents with signs of both stasis and deficiency.
Night Aggravation
夜间加重Blood stasis pain characteristically worsens at night when Yang Qi is at its lowest and blood circulation naturally slows.
Entry Routes
Blood stasis is primarily generated internally rather than entering from outside. It forms through several pathways:
- Qi stagnation: When Qi stagnates, blood movement slows and eventually congeals
- Qi deficiency: Insufficient Qi lacks the power to push blood through the vessels
- Cold congealing: Cold causes vessels to contract and blood to congeal
- Heat scorching: Excessive heat thickens the blood and damages vessels
- Trauma: Physical injury causes blood to leak from vessels and accumulate
- Chronic illness: Long-standing disease "enters the blood level" and creates stasis
Progression Pattern
Body Layers Affected
Xue (Blood)Blood stasis typically progresses through predictable stages:
Early stage: Mild blood flow impairment with vague discomfort, slight purple discoloration, and minor symptoms. At this stage, stasis may be reversible with gentle blood-moving treatment.
Established stasis: Clear signs develop including fixed stabbing pain, visible purple discoloration of tongue and skin, and palpable masses. The condition becomes more entrenched.
Chronic stasis: Long-standing blood stasis blocks new blood generation, leading to concurrent blood deficiency—dry scaly skin ("skin like fish scales"), lusterless hair, and progressive weakness. Stasis may also generate heat and toxins over time.
As Ye Tianshi observed: "Initial illness affects the Qi; prolonged illness affects the Blood." This progression from superficial to deep explains why chronic diseases often involve blood stasis.
Clinical Relevance
Blood stasis is one of the most clinically significant pathological products in modern TCM practice, relevant to numerous conditions:
Cardiovascular disease: Blood stasis is considered central to coronary heart disease, angina, and myocardial infarction. Research shows blood stasis syndrome accounts for nearly 80% of coronary artery disease cases in TCM diagnosis. "Activating blood circulation" herbs have demonstrated anticoagulant and anti-inflammatory effects.
Pain conditions: Fixed, stabbing pain that worsens at night typically indicates blood stasis, whether from trauma, surgery, or chronic disease. Blood-moving therapies are essential for trauma rehabilitation and chronic pain.
Gynecology: Blood stasis is implicated in dysmenorrhea, endometriosis, uterine fibroids, and infertility. The Uterus's relationship with the Penetrating and Conception Vessels makes it particularly susceptible to stasis.
Oncology: Classical texts link blood stasis to tumor formation. Modern integrative approaches often include blood-moving herbs alongside conventional cancer treatment.
Stroke recovery: The formula Bu Yang Huan Wu Tang exemplifies the principle of treating Qi deficiency blood stasis in post-stroke rehabilitation.
Common Manifestations
Stabbing, Fixed Pain
Pain that feels like needles pricking, stays in one location, refuses pressure, and typically worsens at night. This is the hallmark symptom of blood stasis.
Masses and Lumps
Palpable fixed masses that don't move—including abdominal lumps, tumors, and localized swellings. External trauma produces visible bruising (hematomas).
Purple-Dark Complexion
Darkened or purplish discoloration of the face, especially around the eyes, lips, and nails. The skin may appear dull, dark, or have purple spots.
Dark Bleeding with Clots
Any bleeding (menstrual, urine, stool) tends to be dark purple-black in color and contains clots rather than flowing freely.
Rough Scaly Skin
Chronic blood stasis causes the skin to become dry, rough, and scaly—described classically as 'skin like fish scales' (肌肤甲错). The skin loses its normal moisture and luster.
Varicose/Distended Veins
Visible distension of superficial veins, particularly the sublingual veins which become dark, tortuous, and engorged.
Mental-Emotional Symptoms
Forgetfulness, irritability, and in severe cases, mania or altered consciousness when blood stasis affects the Heart and brain.
Tongue Manifestations
The tongue provides crucial diagnostic information for blood stasis:
- Tongue body: Purple or dark purple coloration, either throughout or in patches. May appear bluish or dusky rather than healthy pink-red.
- Stasis spots: Purple or dark red spots (瘀点, yū diǎn) or patches (瘀斑, yū bān) on the tongue surface
- Sublingual veins: The veins under the tongue become distended, tortuous, and darkened—this is one of the most reliable signs of blood stasis
- Tongue shape: May appear slightly swollen if dampness accompanies stasis
Pulse Manifestations
Several pulse qualities indicate blood stasis:
- Choppy pulse (涩脉, sè mài): The classic blood stasis pulse—feels rough, uneven, and hesitant, like a knife scraping bamboo. Reflects obstructed blood flow.
- Wiry pulse (弦脉, xián mài): Taut like a guitar string, indicating constraint and obstruction
- Deep pulse (沉脉, chén mài): Found only with pressure, suggesting the pathology is deep in the interior
- Knotted or Intermittent pulse (结代脉, jié dài mài): Irregular rhythm with missed beats, seen when blood stasis affects the Heart
- Fine/Thin pulse (细脉, xì mài): Thin and weak, reflecting blood deficiency that often accompanies chronic stasis
Common Pathogen Combinations
Phlegm and Blood Stasis Intertwined
Combined with Phlegm as a pathological productTwo substantial pathogens combining to form stubborn obstruction. Phlegm impedes Qi and blood movement; stasis prevents fluid metabolism, generating more phlegm. Results in firm masses, nodules, numbness of limbs, difficult movement, or stroke symptoms. Common in tumors and cardiovascular disease.
Heat and Blood Stasis
Combined with Fear as a pathogenHeat enters the blood level, scorching fluids and making blood viscous, while also damaging vessels and causing bleeding. Presents with fever, dark purple skin lesions, restlessness, and bleeding with dark clotted blood. Seen in severe febrile diseases and inflammatory conditions.
Cold Congealing Blood Stasis
Combined with Cold as a pathogenCold contracts the vessels and congeals blood flow. Presents with cold limbs, pain relieved by warmth, pale or purple-blue discoloration, and stasis signs that worsen in cold weather. Common in painful menstruation and peripheral vascular conditions.
Dampness and Blood Stasis
Combined with Dampness as a pathogenDampness is heavy and obstructive; when combined with blood stasis, creates stubborn conditions that are difficult to resolve. Heavy, fixed pain; swelling; and lingering symptoms that respond slowly to treatment.
Differentiation from Similar Pathogens
Blood Stasis vs. Qi Stagnation: Qi stagnation causes distending pain that moves around and is relieved by sighing or belching. Blood stasis causes stabbing pain that is fixed in location and refuses pressure. Qi stagnation has no visible color changes; blood stasis shows purple discoloration.
Blood Stasis vs. Blood Deficiency: Both can cause pale complexion and dry skin. However, blood stasis shows purple-dark discoloration, fixed pain, and masses—none of which appear in pure blood deficiency. Blood deficiency presents with pale color, dizziness, and palpitations without the stabbing pain or purple tongue.
Blood Stasis vs. Phlegm Accumulation: Both form masses, but phlegm masses tend to be softer and more mobile, while blood stasis masses are firm and fixed. Phlegm produces a greasy tongue coating; blood stasis produces purple tongue discoloration.
Yu Xue (瘀血) vs. Xue Yu (血瘀): An important technical distinction—Yu Xue refers to blood stasis as a pathological product (etiological concept), while Xue Yu refers to the pathological state of impaired blood circulation (pathomechanism concept).
Treatment Principles
The fundamental principle is "activate blood circulation and transform stasis" (活血化瘀, huó xuè huà yū). However, treatment must address the underlying cause:
- Qi stagnation causing stasis: Regulate Qi and invigorate blood (理气活血)
- Qi deficiency causing stasis: Tonify Qi and transform stasis (益气化瘀)
- Cold congealing blood: Warm the channels and dispel stasis (温经散瘀)
- Heat in the blood: Cool blood and transform stasis (凉血化瘀)
Treatment intensity is graded by severity: mild cases use gentle blood-harmonizing methods; moderate cases require active blood invigoration; severe chronic cases need forceful blood-breaking and stasis-expelling approaches. The principle "old blood must be removed before new blood can be generated" guides the importance of clearing stasis, but care must be taken not to damage righteous Qi in the process.
Representative Formulas
Xue Fu Zhu Yu Tang
Blood Mansion Stasis-Expelling Decoction - The classic formula for Qi stagnation with blood stasis, especially in the chest. Moves Qi and blood throughout the body.
Bu Yang Huan Wu Tang
Tonify Yang to Restore Five-Tenths Decoction - For Qi deficiency with blood stasis, particularly post-stroke. Combines strong Qi tonification with blood invigoration.
Gui Zhi Fu Ling Wan
Cinnamon Twig and Poria Pill - Classical formula from Jin Gui Yao Lue for blood stasis in the lower abdomen, especially gynecological masses and painful menstruation.
Tao He Cheng Qi Tang
Peach Pit Decoction to Order the Qi - Purges heat and breaks blood stasis in the lower burner. For severe blood stasis with heat signs.
Shao Fu Zhu Yu Tang
Lower Abdomen Stasis-Expelling Decoction - Warms and moves blood stasis in the lower abdomen. For cold-type gynecological blood stasis.
Representative Points
Geshu
The 'Blood Meeting Point' - Master point for all blood disorders. Essential for transforming blood stasis throughout the body.
Xuehai
'Sea of Blood' - Invigorates blood and dispels stasis, particularly effective for skin conditions and gynecological blood stasis.
Sanyinjiao
Meeting of Three Yin - Moves blood in the lower body, regulates menstruation, and addresses blood stasis in gynecological conditions.
Taichong
Regulates Liver Qi to promote blood circulation. Combined with Hegu LI-4 ('Four Gates') to powerfully move Qi and blood.
Qihai
'Sea of Qi' - Tonifies and moves Qi to support blood circulation. Important when Qi deficiency underlies blood stasis.
Classical Sources
Huang Di Nei Jing (黄帝内经)
Ling Shu - Baibing Shisheng凝血蕴里而不散，津液涩渗，着而不去而积皆成矣
When congealed blood accumulates internally without dispersing, body fluids become sluggish and stagnant, adhering and not leaving - thus accumulations are formed.
Jin Gui Yao Lue (金匮要略)
Chapter 16 - On Blood Stasis Patterns病人胸满，唇痿舌青，口燥，但欲漱水不欲咽，无寒热，脉微大来迟，腹不满，其人言我满，为有瘀血
When the patient has chest fullness, withered lips, blue tongue, dry mouth with desire to rinse but not swallow, no fever or chills, slow and slightly large pulse, abdomen not distended yet patient feels fullness - this indicates blood stasis.
Yi Lin Gai Cuo (医林改错)
Blood Stasis Chapter肚腹结块，必有形之血
When there are lumps in the abdomen, there must be tangible [stagnant] blood.
Xue Zheng Lun (血证论)
Tang Rongchuan离经之血，虽清血鲜血，亦是瘀血...旧血不去，则新血断然不生
Blood that has left the vessels, even if it is clear and fresh blood, is still stasis blood... If old blood is not removed, new blood certainly cannot be generated.
Modern References
Korean Studies on Blood Stasis: An Overview
Comprehensive review of 211 studies on blood stasis, examining clinical and preclinical research on coagulopathy, inflammation, and blood-activating herbs.
Blood Stasis Syndrome Accelerates the Growth and Metastasis of Breast Cancer
Research demonstrating correlations between blood stasis syndrome and tumor microenvironment in breast cancer models.
A Direct Relationship Between Blood Stasis and Fibrinaloid Microclots
Recent research proposing that fibrinaloid microclots provide a molecular explanation for the traditional concept of blood stasis.
瘀血证治 (Blood Stasis: Diagnosis and Treatment)
Comprehensive clinical text by National Master of Chinese Medicine on blood stasis patterns and treatment.