Blood Stasis is a unique concept in traditional Chinese medicine (TCM). It is both a product of dysfunction from various pathological factors and a cause of numerous disorders. There is not only a characteristic pain associated with Blood Stasis, but there are also possible abnormal effects in blood circulation, some of which can become quite serious leading to debilitation and death. Let us take a look at this complex phenomenon.
Blood Theory in TCM
Blood (Xuè 血) is one of the Vital Substances in traditional Chinese medicine (TCM). While there is significant overlap between the TCM concept and modern biomedicine, it serves a definitive role in both the physiology and pathology in TCM. The primary function of Blood in TCM is that of nourishing every cell in the entire body. Blood is considered a dense and material form of Qi, and Blood has a complex interrelationship with Qi. Blood is derived by the actions of the Spleen Qi, Lung Qi, Heart Qi, and Kidney Jing, and it is stored in the Liver. Since it is an aqueous fluid, it also provides moisture (or water) to cells. In Chinese medicine physiology, since Blood connects every cell, tissue, and organ of the body, and since the Mind is considered inseparable from the body, Blood is determined to be the material foundation of the Mind/Shen.
TCM Pathology
There are four disorders or syndromes (zhèng 症) that involve Blood.
Blood deficiency (xuè xū 血虛)
Usually caused by an underlying Spleen Qi deficiency failing to produce sufficient blood. Xue xu mainly affects the Liver and Heart and consequently creates symptoms such as pale complexion, dizziness, dysfunction in a woman’s menstrual cycle and/or mental/emotional issues such as poor memory or anxiety. In patients with long standing blood deficiency, there may be fatigue, dryness, and skin conditions.
Blood loss/bleeding (chū xiě 出血)
Usually the result of either traumatic injury, Qi deficiency failing to hold the blood in the vessels, or Heat in the Blood (either Excess Heat, Yin deficiency Heat, or Liver Heat.) Symptoms include nose bleeds, coughing blood, vomiting blood, excessive menstrual blood (menorrhagia), or blood in the urine or stool. In cases of blood loss, consideration may be given to disorders of the blood clotting cascade/coagulation. Many of the coagulation factors may be dysfunctional or missing, and attention must be paid to genetic disorders or vitamin/co-factor deficiencies.
Blood Heat (xuè rè 血熱)
Due to Heat in the Liver Blood, xue re is a common etiology of many skin disorders that include itching, redness, and warm skin around lesions. Blood Heat in the Heart may be implicated in mouth ulcers and certain mental disorders such as those presenting with pressured speech, racing thoughts, and irritability.
Blood Stasis (xuè yū 血瘀) (also referred to as Blood Stagnation)
This is the most complex pathology and warrants a longer discussion. It is best understood as the stoppage of the normal flow of blood through an artery or vein. It may also mean a slackening or arrest of the blood current in the vessels. This would not be due to a lessening of the heart's beat, but presumably to some abnormal resistance of the capillary walls including inflammation, which may be a result of many causes. In addition, when capillary walls have been damaged and the blood has leaked outside the vessels (extravasation) into tissues, interstitial spaces, or organs, this pooling of blood becomes ‘stagnant’ because it is no longer circulating in the vessels.
When it occurs outside of the vessels, this is termed as a contusion or bruise when it is visible on the skin, or a hematoma when it has occurred in deeper tissues or organs. This extravasation is naturally removed from the body through the action of the immune system via inflammation, vasoconstriction, and the actions of various white blood cells, which absorb the detritus, followed by tissue and collagen repair, and removal of the breakdown products of hemoglobin (which is responsible for the characteristic and changes of color of the injured area). When pain is present, it is due to a characteristic of the immune response whereby some leukocytes release chemical mediators such as prostaglandins and bradykinin, which sensitize nerve endings and increase their responsiveness to stimuli, along with swelling that can create pressure on nearby nerves, which amplifies the sensation of pain.
Blood Stasis also refers to a thrombus, i.e. a blood clot, which is a semisolid aggregation of the constituents of blood, namely red blood cells (erythrocytes), white blood cells (leukocytes), platelets, and fibrin that form a ‘plug’ in or out of the vessels that result when there is an injury to the tissues or cells of an organism. The coagulation process is intended to stop and prevent further bleeding. This injury can be caused by trauma, smoking, hypertension, or a multitude of diseases in the body, especially when inflammation is a part of the presentation, i.e., COVID-19 or streptococcus infections. While the coagulation process is intended to stop and prevent further bleeding, dysfunction of the normal status of blood is implicated in several gynecological conditions such as menorrhagia and endometriosis.
Within a vessel, the result may be ischemia, which is a constriction or obstruction of the vessel. The result may be impairment, dysfunction, or death of cells, tissue, or organs downstream from the vasoconstriction. If a thrombus that becomes dislodged from the cell walls of the vessel in which it occurs and moves within the vessels, it is termed as an embolus. As emboli travel through blood vessels, they can lodge in locations where the lumen of the vessel is no longer able to accommodate the size of the clot. Not only can this blockage elicit sharp pain, it can also cause dysfunction, severe damage, or death due to the cessation of the delivery of vital oxygen to post-blockage cells. When a thrombus occurs in the venous system, mostly from deep vein thrombosis in the lower limbs, this can result in a pulmonary embolism. When a thrombus occurs in the arterial system, a cerebral stroke or myocardial infarction may result, although other organs can be similarly affected.
Another type of Blood Stasis is a microthrombus, first described in 2021 as a result of research into COVID-19. They are significantly smaller than a thrombus. They are abnormal, persistent microclots in the bloodstream that form when the endothelial lining of vessels is damaged, and the resultant inflammation triggers uncontrolled fibrin and platelet aggregation. Due to their small size, they can obstruct microvasculature (arterioles, capillaries, venules), disrupt oxygen and nutrient delivery to tissues, and contribute to a range of chronic and post-infectious symptoms. Endothelial injury can be caused by viral components, autoimmune attacks, or vascular stress. Damaged endothelium releases pro-coagulant factors promoting platelet adhesion and fibrin formation. Symptoms that have been associated with microthrombi include fatigue, brain fog, vision changes, numbness, dizziness, chronic venous insufficiency, peripheral artery disease, and retinal microvascular damage. The damage attributed to microthrombi is often systemic rather than localized and can affect multiple organ systems. Besides being implicated in Long COVID, research suggests they may also be linked to other chronic conditions, including autoimmune diseases, diabetes, arthritis, and certain cancers.
Potential Causes of Blood Stasis According to TCM
Traumatic injury
Traumatic injury is included in the concept of bì zhèng 痹症, (painful obstruction of the Channels), where there is injury to the Channels and Vessels. Injuries include: strain and sprains, blunt force, accidents, surgery, puncture wounds, and many others where there is bleeding or extravasation of blood. If this blood remains in the body, it will coagulate and become stagnant.
Externally acquired pathogens
Wind-cold, Wind-dampness, and Wind-heat can cause congealing or dryness throughout the body. These external pathogenic influences may combine with or develop into Dampness and/or Phlegm that can cause obstruction of the Channels and/or Vessels, which may result in Blood Stasis. In addition, any one of these factors may engender inflammation and injury in Blood Vessels and/or Zang Fu.
Qi deficiency
Qi deficiency impairs the function of Qi to propel the blood in the Vessels. Blood does not flow smoothly or normally, causing stagnant blood. If the Spleen Qi is deficient, then this function of the Spleen may fail to control Blood and Blood will leak from the Blood Vessels and may result in Blood Stasis.
Qi stagnation
Even though the Heart is responsible for the emotions in TCM, the Liver is assigned the ‘handling’ of them. Any of the seven emotions can result in Liver Qi stagnation. If Liver Qi is stagnant, Liver Blood can become stagnant. Fluid retention and blockage of the vessels can occur and hinder the smooth flow of Qi and the movement of Blood.
Fluid depletion
Any depletion of Jīn yè (津液 Fluids), Yin deficiency, pathogenic Heat scorching Fluids, blood loss, or dehydration factors such as excessive sweating, vomiting, diarrhea, or inadequate water intake can make Blood viscous, causing impaired circulation and the stagnation of Blood.
Heat in the Blood
Heat in the Blood, whether due to exogenous Heat pathogens, Heat from Yang rising, or Yin deficient Heat can result in insufficient fluid in the Blood. The Blood can become abnormally viscous causing impaired Blood circulation and along with the inflammatory factors of Heat that damage the Vessels can result in stagnant Blood.
Cold in the Blood
External or Interior Cold or Yang deficiency can cause the constriction of Blood Vessels, which can cause Blood to become congealed, which can impair the ability of Blood to circulate smoothly and lead to Blood Stasis.
Symptoms and Clinical Signs of Blood Stasis
- The patient may complain of general or localized pain. When local, the pain is usually ‘stabbing’ and fixed in one location. Pain that moves or pain that comes and goes is more likely to be Qi Stagnation and may be exacerbated by palpation or become worse at night or with rest.
- The patient may reference areas of numbness and paresthesia (pins and needles or burning sensation), especially in the limbs.
- The patient may present with palpable masses or lumps, either internally or near the surface of the body. There may also be localized swelling.
Other symptoms and signs:
- Diffuse masses due to bleeding, which may be a result of trauma.
- Bleeding of any kind where the blood is dark purple and accompanied by clots.
- Dark purple spots on the skin, mucous membranes, or tongue.
- Dark blood and clots if there is bleeding.
- Cyanosis. A dark complexion; purple lips and/or nails.
- Tongue Signs: Look for a purple tongue. It may be red purple if there is Heat and blue purple if there is Cold. There may be purple or red spots (ecchymoses and petechiae) on an otherwise normal tongue.
- Pulse Character: Feel for a wiry (Xuan Mai) or choppy (Se Mai) pulse that may be slightly rapid if there is Heat or slightly slow if there is Cold. Pulses that are knotted (Jie Mai), regularly intermittent (Dai Mai), or irregularly intermittent (Cu Mai) may warrant investigation by a cardiologist.
TCM Treatment Principles
Blood Stasis can occur for many reasons. Some are obvious and some are insidious. Generally, it is a secondary pathogenic influence, and the presentation can be complex. This means that, irrespective of the reason, when treating Blood Stasis, the underlying etiology must also be treated along with the Blood Stagnation. In other words, treatment must address not only the stasis, but the primary agent that led to its formation. Similarly, because of the interdependent relationship between Blood and Qi, when one desires to invigorate the blood, it is often helpful to simultaneously promote the movement of Qi. Additionally, since the Zheng Qi aspect of the immune system uses the Blood to repair injured tissue, it may be wise to tonify Qi and Blood. Fortunately, many of the herbs in the Regulate and Invigorate Blood category include these attributes in their profile.
The category in Bensky’s Materia Medica of Invigorate the Blood (活血 huó xuè ) is one of the largest in the text, comprised of nearly 40 entries. The herbs in this category are wide-ranging and are often chosen based on their secondary actions. Be sure to consider the secondary actions when choosing an herb to treat the patient’s presentation.
Herbs that Harmonize Blood (和 血 hé xuè) are those that both tonify the blood and have a gentle invigorating effect. This should include several herbs that can be found in the section, Herbs that Tonify (Nourish) the Blood.
The Blood Invigorating herbs have little or no tonification effects, but the vocabulary is fairly indicative of their relative strength of action, even though there are no obvious or clear-cut subdivisions. First, are herbs that ‘promote the movement of Blood’ (行血 xíng xuè), followed by those that either ‘resolve or transform’ stasis (化 瘀 huà yū), although some authors prefer ‘dispel stasis’ (祛瘀 qū yū). Finally, the strongest acting herbs are termed those that ‘break up blood stasis’ (破血瘀 pò xuè yū). These herbs can potentially injure the Blood and Yuan Qi and therefore are indicated for short-term use.
Cautions and Contraindications
- Blood-invigorating herbs should be used with extreme caution for women with hypermenorrhea.
- During pregnancy, mild to moderate herbs that invigorate blood circulation may be used only if necessary; while herbs that eliminate and break up blood stasis are contraindicated.
Potential Herb-Drug Interactions
Herbs that invigorate Blood and eliminate Blood Stasis have a wide variety of pharmacological effects. This means there may be theoretical or actual clinical herb-drug interactions. Check the monographs for each herb in the Materia Medica resources listed in the Reference section. Another excellent source of information about the toxicology of herbs is the American Herbal Products Association’s Botanical Safety Handbook monographs. However, practitioners who practice due diligence by educating themselves about the medications that their patients are using and being aware of herb-drug interactions should not fear using these very valuable herbal medicines.
Antihypertensive medications: Since some Invigorate Blood Herbs dilate the blood vessels, there may be a potentiating effect when combined with antihypertensive drugs and cause syncope and/or hypotension.
Antiplatelets and anticoagulant drugs: Herbs that treat blood stasis may enhance the actions of antiplatelet and anticoagulant medications and prolong bleeding or increase bruising.
Analgesics: Some of the herbs in this category may have analgesic effects that may cause drowsiness, which may enhance the sedative effect of many drugs and alcohol. Before driving a vehicle or operating machinery, caution is indicated until the effects of the herbs are known.
Blood-moving herbs have great therapeutic value since they can have positive effects on the cardiovascular system and the immune system, and some herbs offer anti-coagulant, anti-platelet, analgesic, anti-inflammatory and antibiotic pharmacological effects.
For a range of TCM formulas that are applicable to use for Invigorating the Blood see the chart on our website. Here’s a link.
References
- American Dragon, https://www.americandragon.com
- Bensky, D. et al., Chinese Herbal Medicine Materia Medica, 3rd ed., Eastland Press: 2004.
- Biology Insights, “What Are Microclots and Why Do They Matter?”, biologyinsights.com - https://biologyinsights.com/
- Botanical Safety Handbook, American Herbal Products Association, https://www.ahpa.org/store_category.asp
- Chen, J. & Chen, T., Chinese Herbal Formulas and Applications, Art of Medicine Press: 2009.
- Deng,T. Practical Diagnosis
- Drugs.com, https://drugs.com
- Fourie-Basson, W., “Scientists Uncover Hidden Blood Patterns in Long COVID”, Stellenbosch University, November 2025. ScienceTech Daily, https://scitechdaily.com/scientists-uncover-hidden-blood-pattern-in-long-covid/
- Maciocia, G., Diagnosis in Chinese Medicine: A comprehensive guide, Churchill Livingstone: London 2004.
- Maciocia, G., The Practice of Chinese Medicine: The Treatment of Diseases with Acupuncture and Chinese Herbs, Churchill Livingstone: London 1994.
- Maciocia, G., The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists, Churchill Livingstone: London 1989.
- Pharmacopoeia of the People’s Republic of China, State Pharmacopoeia Commission of the PRC, People’s Medical Publishing House, Beijing, 2020
- Rodgers, K., et al., “Exploring the Role of the Immune System in Regulating Chronic Pain”, Clinical Chemistry, June 2022 https://academic.oup.com/clinchem/article/68/6/863/6596445
- Sacred Lotus, https://www.sacredlotus.com.
- Webmd, https://www.webmd.com/.
- Xie, Z., On the Standard Nomenclature of Traditional Chinese Medicine, Foreign Language Press, Beijing 2003.
