Acupuncture Continuing Education

Blood Stasis & Cardiovascular Disorders

Course Sample

Dispel blood stasis

 

 

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Xue Fu Zhu Yu Tang Overview

Xue Fu Zhu Yu Tang is a Qing dynasty formula introduced by Dr. Wang Qing Ren in his Yi Lin Gai Cuo (Correcting Errors in the Medical Forest) about 300 years ago.

Xue Fu Zhu Yu Tang is based on Tao Hong Si Wu Tang and modified with Qi regulating herbs.

Ingredients of classic Xue Fu Zhu Yu Tang:

Chi Shao         Radix Paeoniae Rubrae         2-12g
Dang Gui         Radix Angelicae Sinensis         3-12
Chuan Xiong         Radix Ligustici Chuanxiong         3-9g
All the herbs above promote blood circulation. The herbs can be differentiated as follows: Chi Shao cools blood heat. Dang Gui nourishes the Blood. Chuan Xiong moves the Qi in the Blood and tends to flow to the body surface and upper body.

Hong Hua         Flos Carthami Tinctorii        3-9g
Tao Ren         Semen Persicae            3-12g
Hong Hua and Tao Ren both break up congealed blood. Hong Hua’s action is faster as well as stronger. Tao Ren’s action is more sustained for a longer period of time and it is able to moisten dryness.

Niu Xi          Radix Achyranthis Bidentatae     3-12g
Niu Xi promotes blood flow downward to the legs, strengthens the Liver and Kidney, and expels wind-damp Bi pain.

Sheng Di Huang     Radux Rehmanniae Glutinosae)     3-15g
Sheng Di Huang cools blood heat, nourishes the Blood, and moderates the Blood regulating  function of the stronger blood regulating  herbs.
 
Chai Hu         Radix Bupleuri             3-6g
Zhi Ke         Fructus Citri Aurantii             3-12g
Jie Geng         Radix Platycodi Grandiflori          3-15g
All the above herbs regulate Qi. Chai Hu regulates Liver Qi, promoting its flow upward and horizontally in the body. Zhi Ke opens the chest and descends the Qi. Jie Geng regulates Lung Qi, opens the Lungs and guides the herbs to the upper body.

Zhi Gan Cao         Honey-Fried Radix Glycyrrhizae Uralensis     3g
Zhi Gan Cao harmonizes the herbs in the formula.

Caution: If a patient is taking blood thinning drugs and their INR blood test is 2.2 or above, use caution with blood regulating and invigorating herbs. INR (international normalized ratio) measures the pathway of blood coagulation. Standard INR results in healthy individuals are typically 0.8 to 1.2. Anticoagulant therapy, usually with warfarin, often targets an INR of 2 to 3. Higher INR values are sought in more aggressive anticoagulant therapies.


Treatment Principle
How to Use Xue Fu Zhu Yu Tang

Xue Fu Zhu Yu Tang is appropriate for conditions with underlying Qi and Blood Stasis. Various conditions such as Liver Yang Uprising, Damp-Heat, etc… may combine with Qi and Blood Stasis. In all cases, the correct application of Xue Fu Zhu Yu Tang is when the root condition emanates from Qi and Blood Stasis.

 

 

 


Xue Fu Zhu Yu Tang
 and
 The Cadiovascular System

 

1) High Blood Pressure

Symptoms: high blood pressure, headache, pain on the neck and shoulder, blurred vision, red face and tongue, full and strong pulses.

Diagnosis: Liver Yang rising, Qi and Blood stagnation.

Treatment Strategy: Settle the Yang and promote blood circulation.

Base formula: Xue Fu Zhu Yu Tang, modified with Tian Ma Gou Teng Yin.

Tian Ma Gou Teng Yin ingredients:

Tian Ma        Rhizoma Gastrodiae Elatae        3-12g
Gou Teng         Ramulus Uncariae Cum Uncis    3-12g
Tian Ma and Gou Teng stop internal wind. Tian Ma is stronger than Gou Teng. Gou Teng tends to flow to the exterior and can release the surface.

Shi Jue Ming        Concha Haliotidis            12-60g
Shi Jue Ming settles the Liver Yang and brightens the eyes.  

Shan Zhi Zi        Fructus Gardeniae Jasminoidis    12g
Huang Qin        Radix Scutellariae Baicalensis    12-15g
Shan Zhi Zi and Huang Qin sedate heat. Shan Zhi Zi clears San Jiao damp-heat, cools the Blood, and promotes blood circulation. Huang Qin sedates the Liver, Gallbladder, and cools Upper Jiao damp-heat.

Sang Ji Shen        Ramulus Sangjisheng            12g
Ye Jiao Teng        Caulis Polygoni Multiflori        15g
Sang Ji Shen and Ye Jiao Teng both expel wind-damp Bi pain for relaxing the Blood vessels. Sang Ji Sheng cools heat. Ye Jiao Teng nourishes Blood and calms the Heart.

Du Zhong        Cortex Eucommiae Ulmoidis        12g
Du Zhong expels wind-damp Bi pain and strengthens the Liver and Kidney.

Fu Shen    Sclerotium Poriae Oocus Pararadicis-part around root     12g
Fu Shen calms the Heart and clears Heart phlegm.

Niu Xi     Radix Achyranthis Bidentatae            12g    
Niu Xi promotes blood flow to lower body, promotes urination, expels wind-damp Bi pain, and strengthens the Liver and Kidney.

 

(1) Liver Yang Rising with Headache and Neck Tension Modified

Tian Ma        Rhizoma Gastrodiae Elatae        3-12g
Gou Teng         Ramulus Uncariae Cum Uncis    3-12g
Tian Ma and Gou Teng stop internal wind. Tian Ma is stronger than Gou Teng. Gou Teng tends to flow to the exterior and can release the surface.

Sang Ji Sheng    Ramulus Sangjisheng            12g
Ye Jiao Teng        Caulis Polygoni Multiflori        15g
Sang Ji Sheng and Ye Jiao Teng both expel wind-damp Bi pain. Sang Ji Sheng cools heat. Ye Jiao Teng nourishes Blood and calms the Heart.

Mu Dan Pi        Cortex Moutan Radicis            12g
Zhi Mu        Rhizoma Anemarrhenae Asphodeloidis    12g
Mu Dan Pi and Zhi Mu cool the heat in the Blood. Mu Dan Pi promotes blood circulation and Zhi Mu also cools the heat in the Qi level.

Shan Zhi Zi        Fructus Gardeniae Jasminoidis    12g
Huang Qin        Radix Scutellariae Baicalensis    12-15g
Shan Zhi Zi and Huang Qin sedate heat. Shan Zhi Zi clears San Jiao damp-heat, cools the Blood, and promotes blood circulation. Huang Qin sedates the Liver, Gallbladder, and cools Upper Jiao damp-heat.

Du Zhong        Cortex Eucommiae Ulmoidis        12g
Du Zhong expels wind-damp Bi pain, relaxes the Blood vessel and strengthens the Liver and Kidney.

Chuan Xiong        Radix Ligustici Chuanxiong            6g
Chi Shao        Rhizoma Anemarrhenae Asphodeloidis    12g
Dan Shen        Radix Salviae Miltiorrhizae            12g
All the herbs above promote blood circulation. Chuan Xiong moves the Qi in the Blood and flows to surface and upper jiao (upper burner) Chi Shao and Dan Shen cool heat in the Blood. Chi Shao promotes blood of blood circulation and Dan Shen calms the Heart and promotes small blood vessel circulation.
 
Chai Hu        Radix Bupleauri            6g
Yu Jin            Tuber Curcumae            12g
Chai Hu and Yu Jin smooth Liver Qi. Chai Hu spreads the Liver Qi and moves the Qi left and right, through the collaterals. Yu Jin cools the heat in the Blood, regulates the Liver and reduces irritability.

Long Dan Cao        Radix Gentianae Longdancao        3-12g
Long Dan Cao clears Liver and Gall Bladder excess damp-heat and heat toxins.

Ge Gen        Radix Puerariae                3-30g
Ge Gen relaxes the muscle and relieves tension.

Yan Hu Suo        Rhizome Corydalis Yanhusuo    3-12g
San Qi            Radix Notoginseng                3-12g
Yan Hu Suo and San Qi promote blood circulation and stop pain. Yan Hu Suo’s main action is stopping the pain and smoothing the Qi. San Qi’s main action is reducing inflammation.

Shi Jue Ming        Concha Haliotidis            12-60g
Long Gu        Os Draconis                9-30g
Zhen Zhu Mu    Concha Margaritaferae        9-30g
Shi Jue Ming Long Gu and Zhen Zhu Mu settle the Liver Yang. The emphasis of Long Gu is settling the Heart Yang while Shi Jue Ming and Zhen Zhu Mu tend to settle the Liver and brighten the eyes.  

 

(2) Yin Deficiency Dryness with empty Heat Modified

Nu Zhen Zi        Fructus Ligustri Lucidi        3-12g
Han Lian Cao    Herba Ecliptae Prostratae        3-12g    
Zhi Mu        Rhizoma Anemarrhenae Asphodeloidis    3-12g
Xuan Shen        Radix scrophulariae Ningpoensis        3-12g
Mai Men Dong    Tuber Ophiopogonis Japonici            3-12g
All the herbs above cool heat and nourish the yin. The herbs can be differentiated as follows:  Nu Zhen Zi and Han Lian Cao nourish the Yin but they are not cloying and therefore do not damage Spleen Qi. Zhi Mu sedates Qi and Yin level heat. Xuan Shen clears toxic heat. Mai Men Dong moistens the Lung, Stomach and Heart Yin.

Di Gu Pi        Cortex Lycii Radicis            3-12g
Bai Wei        Radix Cynanchi Baiwei        3-12g
Mu Dan Pi        Cortex Moutan Radicis        3-12g
Huang Bai        Cortex Phellodendri            3-12g
All the herbs above sedate empty heat. The herbs can be differentiated as follows: Di Gu Pi and Mu Dan Pi address Kidney Yin deficiency steaming bone syndrome. Bai Wei works on a different level of deficient heat, clearing Urinary Bladder heat and promoting urination. Huang Bai cools Lower Jiao damp-heat.    

Long Gu        Os Draconis                9-30g
Zhen Zhu Mu    Concha Margaritaferae        9-30g
Long Gu and Zhen Zhu Mu both settle the Yang. Long Gu’s focus is on descending the Heart Yang while Zhen Zhu Mu tends to settle the Liver Yang.

Tian Ma        Rhizoma Gastrodiae Elatae        3-12g
Gou Teng         Ramulus Uncariae Cum Uncis    3-12g
Tian Ma and Gou Teng stop internal wind. Tian Ma is stronger than Gou Teng. Gou Teng tends to flow to the exterior and can release the surface.

Dan Shen        Radix Salviae Miltiorrhizae        12g
Chi Shao        Radix Paeoniae Rubrae        12g
Chuan Xiong        Radix Ligustici Chuanxiong        6g
All the herbs above promote blood circulation. Dan Shen and Chi Shao cool the heat in the Blood. Dan Shen calms the Heart and Chi Shao promotes blood circulation. Chi Shao’s blood invigorating function is stronger than that of Dan Shen. Chuan Xiong is warm in temperature and moves the Qi in the Blood and tends towards the surface and upper upper jiao.

 

(3) Liver Qi Stagnation with Chest Fullness and Hypochondriac Pain Modified

Chai Hu    Radix Bupleuri                3-6g
Bo He        Mentha Haplocalyx                3-6g
Chai Hu and Bo He regulate Liver Qi. Chai He spreads the Liver Qi up, down, left and right. Bo He regulates the Liver Qi in the surface level and tends towards the upper jiao.

Qing Pi    Pericarpium Citri Reticaulatae Veride    3-12g
Fo Shou    Citri Sarcodactylis Fructus            3-15g
Qing Pi and Fo Shou break up Liver Qi stagnation. Qing Pi reduces pain. Fo Shou harmonizes Liver and Spleen/Stomach Qi.

Xiang Fu    Rhizome Cayperi Rotunda            3-12g
Yan Hu Suo    Rhizome Corydalis Yanhusuo            3-12g
Xiang Fu and Yan Hu Suo promote blood circulation and stop pain. Xiang Fu’s main action is to regulate the Liver Qi and Blood. Yan Hu Suo’s function is mainly analgesic.

Long Gu        Os Draconis                9-30g
Zhen Zhu Mu    Concha Margaritaferae        9-30g
Long Gu and Zhen Zhu Mu both settle the Yang. Long Gu’s focus is on descending the Heart Yang while Zhen Zhu Mu tends to settle the Liver Yang.

Chuan Xiong        Radix Ligustici Chuanxiong        9g
Chi Shao        Radix Paeoniae Rubrae        12g
Dan Shen        Radix Salviae Miltiorrhizae        12g
Chuan Xiong, Chi Shao and Dan Shen promote blood circulation. The herbs can be differentiated as follows: Chuan Xiong is acrid, warm and it flows to surface and moves Qi in the Blood. Chi Shao and Dan Shen are cooling. Chi Shao tends to move the Blood of Blood and Dan Shen promotes circulation in the small blood vessels and calms the Heart.
 
Jie Geng        Radix Platycodi Grandiflori        9-12g
Jie Geng opens the Lungs and directs the herbs to the upper jiao.

 

(4) Qi and Phlegm Stagnation Causing “Brain Fog” and Vertigo Modified

Chuan Xiong        Radix Ligustici Chuanxiong        3-9g    
Dang Gui        Radix Angelicae Sinensis        3-12g
Chi Shao        Radix Paeoniae Rubrae        3-12g
Dan Shen        Radix Salviae Miltiorrhizae        3-12g
All the herbs promote blood circulation. Chuan Xiong and Dang Gui are warming. Chuan Xiong moves the Qi in the Blood and flows upward and to the surface. Dang Gui promotes blood of Blood and nourishes the Blood. Chi Shao and Dan Shen are cooling and cool the Blood. Chi Shao tends to break up congealed blood. Dan Shen calms the Heart and promotes small blood vessel circulation.

Chai Hu    Radix Bupleuri        3-9g
Bo He        Mentha Haplocalyx        3-6g
Chai Hu and Bo He regulate Liver Qi. Chai Hu flows into deeper layers than Bo He and spreads the Liver Qi up, down, left and right. Bo He flows upwards and to the surface.

Jie Geng    Radix Platycodi Grandiflori        12g
Jie Geng opens the Lung Qi and carries the other herbs in the formula to upper body and assists the spread the Liver Qi.

Bai Zhi    Radix Angelicae Dahuricae        3-9g
Ban Xia    Pinelliae Rhizoma Preparatum    3-9g
Bai Zhi and Ban Xia dry phlegm. Bai Zhi has a strong penetrating function, which breaks through phlegm. Ban Xia has a strong and consistent phlegm-drying action.

Ge Gen    Radix Puerariae            3-30g
Ge Gen relaxes and reduces tension in the head and neck muscles.

Chen Pi    Pericarpium Citri Reticulatae        3-6g
Fu Ling    Sclerotium Poariae Cocoa        3-30g
Chen Pi and Fu Ling are an herb pair used to dry phlegm and regulate Qi. Chen Pi’s main action is to regulate Qi and clear phlegm while Fu Ling’s action is draining dampness.

 

 

 

Case Study
A 50 year old female with high blood pressure (170/100mm Hg) complains of frequent  headaches and vertigo. She has been taking Western antihypertensive medications in addition to Chinese herbal formulas, which focus on stopping internal wind, nourishing Yin, and expelling phlegm without any remarkable effect. Recently, she began experiencing a sharp pain in her head, irritability, and her face became red. Her tongue has a red tip with purple dots on the sides and her pulses are wiry and full.

Diagnosis: Liver Yang rising with Qi and Blood stagnation.

Treatment Strategy: Promote blood circulation and descend Liver Yang.

Formula: Xue Fu Zhu Yu Tang with modifications.

Ingredients:

Tao Ren         Semen Persicae            12g
Hong Hua         Flos Carthami Tinctorii        9g
Dang Gui         Radix Angelicae Sinensis        12g
Chi Shao         Radix Paeoniae Rubrae        12g
Chuan Xiong         Radix Ligustici Chuanxiong        9g
Niu Xi         Radix Achyranthis Bidentatae    15g
All the herbs above promote blood circulation. The herbs can be differentiated as follows: Tao Ren and Hong Hua break up congealed blood. Tao Ren’s blood regulating function maintain their effects longer than Hong Hua and it is also able to moisten intestinal dryness. Hong Hua’s effective action is faster and its action of breaking up congealed blood is stronger. Dang Gui nourishes the Blood. Chi Shao cools blood heat. Chuan Xiong moves the Qi in the Blood and tends to flow to the surface and to the upper body. Niu Xi promotes blood flow to the lower body, expels wind-damp Bi pain, strengthens the Liver and Kidney, and promotes urination.
 
Sheng Di Huang     Radux Rehmanniaea Galutinosae    10g
Zhi Zi             Fructus Gardeniae Jasminoidis    12g
Mu Dan Pi         Cortex Moutan Radicis        10g
All the herbs above cool the heat in the Blood. Sheng Di Huang nourishes the Blood, Jing and yin. Zhi Zi clears San Jiao damp heat and calms the Heart. Mu Dan Pi promotes blood circulation.

Ju Hua         Flos Chrysanthemi Morifolli        12g
Ju Hua clears external heat and Liver heat.

Jie Geng         Radix Platycodi Grandiflori        10g
Jie Geng guides the herbs to the upper body and to the surface, opens the Lungs, and raises the Lung Qi.

Gan Cao         Radix Glycyrrhizae Uralensis        5g
Gan Cao harmonizes the ingredients of the formula.

Results of Treatment:

After taking five bags of the herbs for five days, the patient’s headaches ceased. Her red facial complexion and irritability were reduced by about 60% and her blood pressure is 150/90mm Hg. Her tongue no longer exhibits a red tip and the purple dots on the side of the tongue were reduced by about 80%. Her pulses became wiry without being full. The patient was told to continue taking the same formula, adding Huang Qin (Radix Scutellariae Baicalensis) 12g to each bag for three months.

 

2) Lack of Blood Supply Due To:
    - Cervical Vertebrae Degeneration
    - Phlegm Blocking the Carotid Artery

Syndromes: Headaches, vertigo, forgetfulness, shortness breath, blur vision, fatigue, puffy and dark tongue with white coating, wiry and weak pulses.
   
Diagnosis: Qi and Blood stagnation.

Treatment Strategy: To promote Blood and Qi circulation.

Base formula: Xue Fu Zhu Yu Tang modified with Qiang Huo Sheng Shi Tang.

Qiang Huo Sheng Shi Tang ingredients:

Qiang Hou    Rhizoma et Radix Notopterygii    12g
Du Huo    Angelica pubescens            12g
Gao Ben    Rhizoma Et Radix Ligustici        12g
Fang Feng    Radix Ledebouriellae Diaricatae
All the herbs above expel wind-damp Bi pain. The herbs can be differentiated as follows: Qiang Huo tends to flow towards the surface and upper body. Du Huo flows to the inner and lower body. Gao Ben releases the surface, flows upwards and stops vertex headaches. Fang Feng stops spasms from internal wind, releases the surface and expels wind-damp Bi pain function more mildly than Qiang Huo, Du Huo and Gao Ben.

Man Jing Zi    Fructus Viticis                15g
Man Jing Zi cools the heat and stops wind damp hot Bi pain and its cool temperature to harmonize other hot herbs in the formula.
 
Chuan Xiong        Radix Ligustici Chuanxiong        3-9g
Chuan Xiong promotes blood circulation and moves Qi and Blood to the surface and joints.

Zhi Gan Cao    Honey-Fried Radix Glycyrrhizae Uralensis    3g
Zhi Gan Cao harmonizes the other function of ingredients in the formula.

 

 

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