Wáng Qìngrén 王清 仁 was a famous Chinese physician who lived during the Qing Dynasty (1768–1831) and was renowned for his reformation of Chinese medicine. He did this largely by reinterpreting TCM knowledge about human anatomy by conducting actual autopsies and dissections of the human body, challenging existing theories that were based on classical texts, and by proposing significant anatomical reforms. During the Qing, there were significant advancements in understanding and treating infectious diseases, particularly those categorized as ‘warm diseases’. There was also the beginning of a synthesis of traditional Chinese medical practices with Western medical knowledge following the invention of the microscope and the Germ Theory. This blending led to a more holistic approach to healthcare within China. Wang’s most influential work was the Yilin Gaicuo 医林改错 / Correcting the Errors of the Medical World. This work not only revised anatomical understanding but also emphasized the role of Blood Stasis / Xuè Yū血瘀 in chronic and acute illness. His contributions had a profound and lasting impact on TCM’s clinical direction, especially in internal medicine, surgery, and gynecology.
Blood Stasis
Blood Stasis, also known as Blood Stagnation, is a condition where blood flow becomes sluggish, blocked, or pooled in one area of the body rather than circulating freely. This leads to characteristic fixed, stabbing pains that tend to worsen at night, along with visible signs like dark or purplish discoloration of the face, lips, and tongue as well as various other areas of the body. It can arise from many different causes, including physical trauma, prolonged emotional stress, exposure to cold, or as a consequence of other imbalances including Qi Stagnation or Qi deficiency.
The observable signs of Blood Stasis include the following:
- Static Blood obstructs the Channels, impeding the flow of Qi and Blood. In Chinese medicine theory, it is said that when there is stoppage, there is pain. Consequently, pain is the outstanding feature of Blood Stasis. The pain associated with Blood Stasis differs from the acute pain characterizing Qi Stagnation since it is of fixed location and confined to the locality of the obstruction and the quality of the pain is described as stabbing.
- When static Blood accumulates, it can form masses and swellings.
- When resulting from trauma, it can give rise to local green-blue or purple bruises.
- When occurring internally, it may cause hard swellings that can develop into concretions and accumulations.
- Since static Blood obstructs the Vessels, blood may extravasate when unable to pursue its normal course.
- Periodic bleeding is a common sign of Blood Stasis, particularly in menstrual irregularities and postpartum diseases, and is generally characterized by dark purple, clotted blood.
- The complexion tends to be dark, and the tongue may appear purplish, with dark spots. The pulse may be fine, wiry, tight, or choppy.
- The skin may be rough, dry, and lusterless with red speckles (petechiae) and/or purple macules, both of which are due to subcutaneous bleeding, red thread marks (spider nevi), and prominent, bulging green-blue veins on the abdomen (caput medusae).
The TCM treatment principle for Blood Stagnation is described as activate, invigorate, or move Blood (huó xuè 活血), and to resolve, transform, or expel Stasis (zhú yū 逐瘀). In some cases where more forceful herbs are required, this may be described as ‘break up’ Blood Stasis (pò xuè yū 破血瘀).
Wang’s Five Zhu Yu Formulas are commonly used in Traditional Chinese Medicine to target Blood Stasis in different body regions and the variations include: Xue Fu Zhu Yu Tang (chest), Ge Xia Zhu Yu Tang (below the diaphragm), Shao Fu Zhu Tang (lower abdomen), Shen Tong Zhu Yu Tang (body pain / Channels), and Tong Qiao Huo Xue Tang (head). Let us examine each of these formulas to see how they are differently applied in Chinese medicine.
Because of their ability to move, invigorate, and dispel Stagnation of Blood, these formulas are accompanied by general cautions and contraindications that include a contraindication during pregnancy. Also, they are contraindicated for very weak or deficient patients, especially those with a tendency to loose stools, diarrhea, poor appetite, or chronic digestive weakness. Use with caution during heavy menstrual bleeding. Use caution in patients on anti-coagulant therapy. Contraindicated with hemorrhagic disorders. Monitor signs of Qi and Blood deficiency, particularly an increased tendency to bruise.
Xue Fu Zhu Yu Tang
Xuè Fǔ Zhú Yū Tāng血府逐瘀湯is known as ‘Remove Blood Stasis from the Blood Mansion Decoction’. This formula is available from Mayway Herbs as Plum Flower Stasis in the Mansion of Blood Teapills (item 3345) and Plum Flower Xue Fu Zhu Yu San extract powder (item 3345C).
TCM functions: Invigorate the Blood, Dispel Blood Stasis, Move Liver Qi, and Unblock the Channels and Collaterals.
‘Blood Mansion’ refers to the chest. As such, the formula is indicated for any pain caused by Blood Stasis above the diaphragm including the Lungs, Heart and Vessels, ribs, and intercostal area. Stasis in the chest can also prevent the pure Yang from ascending to the head causing intractable, chronic headache.
TCM presentation: Blood Stasis and Qi Stagnation presenting with chronic sharp, cramping or piercing pain that is fixed in location, worse with pressure and tends to be worse at night. Particularly indicated for pain above the diaphragm including chest pain, costal pain, chronic stubborn headaches, facial pain, jaw pain, pain from slow-healing wounds or broken bones, and for palpable masses. May be accompanied by signs such as chronic hiccups, a choking sensation when drinking, dry heaves, sensation of heat in the chest, palpitations, chronic insomnia, restless sleep, extreme mood swings, irritability, tension and agitation, easily angered, chronic depression, poor memory, and low-grade fever or evening tidal fever. Practitioners should look for a dark or dull facial complexion, dark or purplish lips, sclera, or nails, dark rings under the eyes, purple discoloration or broken blood vessels on the skin, and dry or scaly skin. The tongue may be purple or dark purplish red, possibly with purple or dark spots, or distended and dark sublingual veins. The pulse is commonly wiry, choppy, or tight.
Stasis in the Mansion of Blood Teapills / Xue Fu Zhu Yu San Ingredients
| Tao ren | Prunus persica seed |
Breaks up Blood Statis and invigorates Blood circulation |
| Dang gui | Angelica sinensis root |
Invigorates and harmonizes the Blood and disperses Cold; stops pain due to Blood Stasis |
| Hong hua | Carthamus tinctorius flower | Invigorates the Blood, dispels Blood Stasis; opens the channels, unblocks menstruation and alleviates pain |
| Sheng di huang | Rehmannia glutinosa root-raw | Clears Heat and cools the Blood |
| Huai niu xi | Achranthes bidentata root | Invigorates the Blood and expels Blood Stasis |
| Zhi ke | Citrus aurantium fruit | Promotes the movement of Qi, reduces distention and pressure and resolves hardenings |
| Chi shao | Paeonia lactiflora root | Invigorates the Blood, dispels Blood Stasis an relieves pain |
| Chuan xiong | Ligusticum chuanxiong rhizome | Invigorates the Blood and promotes the movement of Qi |
| Jie geng | Platycodon grandiflorum root | Raises Lung Qi directing the effects of other herbs to the upper body |
| Chai hu | Bupleurum chinense root | Spreads Liver Qi and relieves Stagnation; Raises Pure Yang |
| Gan cao | Glycyrrhiza uralensis root | Moderates spasms and alleviates pain; moderates and harmonizes the harsh properties of other herbs |
Ge Xia Zhu Yu Tang
Gé Xià Zhú Yū Tāng 膈下逐瘀湯is known as ‘Drive Out Blood Stasis Below the Diaphragm Decoction’. This herb formula is available from Mayway Herbs as Plum Flower Stasis in the Lower Chamber Teapills (item 3362) and Plum Flower Ge Xia Zhu Yu San extract powder (item 3362C).
TCM functions of this formula are: Invigorate the Blood, Dispel Blood Stasis, and Move Liver Qi.
TCM presentation: Chronic Blood Stasis and Liver Qi Stagnation below the diaphragm presenting with abdominal pain which may be sharp, cramping or piercing, fixed in location, worse with pressure and a tendency to be worse at night, pain upon palpation in the epigastric or intercostal regions, palpable immobile, firm, nodular abdominal masses with or without pain that may also be visible when lying down. In women, there may be difficult or painful menstruation that improves after clots are expelled, and in men there may be masses in the testicles or prostate with pain referring to the lower abdomen. Intercostal pain, irritability, fatigue, listlessness, weakness, loss of appetite, abdominal distention, gradual weight loss, and mild feverishness at night may also be present. May be accompanied by a dark, dull or sallow facial complexion, dark or purplish lips or sclera, dark rings under the eyes, purple discoloration or broken blood vessels on the skin, and an inquiry about chronic depression may be warranted. The tongue may be purple, possibly with purple or dark spots, or with distended and dark sublingual veins, showing little or no coat. The pulse may be wiry, deep, and/or choppy.
Stasis In The Lower Chamber Teapills / Ge Xia Zhu Yu San Ingredients
| Tao ren | Prunus persica seed | Breaks up Blood Statis and invigorates Blood circulation |
| Dang gui | Angelica sinensis root |
Invigorates and harmonizes the Blood and disperses Cold; stops pain due to Blood Stasis |
| Hong hua | Carthamus tinctorius flower |
Invigorates the Blood, dispels Blood Stasis; opens the channels, unblocks menstruation and alleviates pain |
| Wu yao | Lindera aggregata root |
Promotes the movement of Qi and alleviates pain |
| Mu dan pi | Paeonia suffruticosa root-bark |
Clears Heat and cools and harmonizes the Blood; invigorates the Blood and dispels Blood Stasis |
| Zhi ke | Citrus aurantium fruit |
Promotes the movement of Qi, reduces distention and pressure and resolves hardenings |
| Chi shao | Paeonia lactiflora root |
Invigorates the Blood, dispels Blood Stasis and relieves pain |
| Xiang fu | Cyperus rotundus rhizome |
Spreads and regulates Liver Qi; regulates menstruation and alleviates pain |
| Chuan xiong | Ligusticum chuanxiong rhizome |
Invigorates the Blood and promotes the movement of Qi |
| Ru xiang | Boxwellia carterii resin |
Invigorates the Blood and promotes the movement of Qi; Relaxes the sinews, activates the channels and alleviates pain |
| Mo yao | Commiphora myrrha resin |
Invigorates the Blood, dispels Blood Stasis, alleviates pain and reduces swelling |
| Yan hu suo | Corydalis yanhusuo rhizome |
Invigorates the Blood, circulates Qi; stops pain and disperses extravasation |
| Gan cao | Glycyrrhiza uralensis root |
Moderates spasms and alleviates pain; moderates and harmonizes the harsh properties of other herbs |
Shao Fu Zhu Yu Tang
Shǎo Fù Zhú Yū Tāng 少腹逐瘀湯 is known as Dispel Stasis in the Lower Abdomen Decoction. This formula is available from Mayway Herbs as Plum Flower Stasis in the Lower Palace Teapills (item 3389) and Plum Flower Shao Fu Zhu San extract powder (item 3389C).
TCM functions of this formula are: Invigorates the Blood, Dispels Blood Stasis, Warms the Uterus, Warms the Channels, Dispels Cold.
TCM presentation includes among its symptoms: Blood Stasis and Cold in the lower jiao presenting with lower abdominal pain which is sharp, cramping or piercing, fixed in location, worse with pressure with a tendency to be worse at night and that improves with warmth. There is likely noticeable coldness of the lower abdomen, palpable immobile abdominal masses with or without pain, low back and lower abdominal pain. In women there may be distention during menstruation, dark or purple menstrual blood with dark purple or black clots, difficult menstruation, frequent menstruation, or irregular menstruation. (see “Cold in the Uterus” article) May be accompanied by a dark, purplish, ashen or sallow facial complexion, dark or purplish lips or sclera, dark rings under the eyes, purple discoloration or broken blood vessels on the skin, and chronic depression. The tongue may be pale or purple, possibly with purple or dark spots, or with distended and dark sublingual veins. The pulse may be deep, wiry, thready, and/or choppy.
Stasis In The Lower Palace Teapills/ Shao Fu Zhu Yu San Ingredients
| Dang gui | Angelica sinensis root |
Tonifies Blood, regulates the menses, invigorates and harmonizes the Blood and disperses Cold |
| Pu huang | Typha angustifolia pollen | Stops bleeding by astringing, invigorates Blood and dispels Blood Stasis |
| Chi shao | Paeonia lactiflora root | Invigorates the Blood, dispels Blood Stasis, clears Heat, cools heat the Blood and relieves pain |
| Ru xiang | Boswellia carterii resin | Invigorates the Blood and promotes the movement of Qi, alleviates pain |
| Mo yao | Commiphora myrrha resin | Invigorates the Blood, dispels Blood Stasis, alleviates pain and reduces swelling |
| Yan hu suo | Corydalis yanhusuo rhizome | Invigorates the Blood, circulates Qi; stops pain and disperses extravasation |
| Chuan xiong | Ligusticum chuanxiong rhizome | Invigorates the Blood, promotes the movement of Qi, expels Wind and alleviates pain |
| Rou gui | Cinnamomum cassia bark | Warms the Kidneys, Spleen and Heart, strengthens the Yang and Ming Men Fire, disperses deep Cold, warms the channels, unblocks the channels and vessels, alleviates pain and assists the generation of Qi and Blood |
| Chao xiao hui xiang | Foeniculum vulgare fruit-fried | Warms the Liver and Kidneys, expels Cold, regulates Qi, harmonizes the Stomach and alleviates pain |
| Chao gan jiang | Zingiber officinale rhizome-dried-fried | Warms the Middle, expels Cold and dispels Wind-Dampness seeping into the Lower Jiao |
Shen Tong Zhu Yu Tang
Shēn Tòng Zhú Yū Tāng身痛逐瘀湯 is known as Dispel Stasis from a Painful Body Decoction. This formula is available from Mayway Herbs as Plum Flower The Great Invigorator Teapills (item 3390) and Plum Flower Shen Tong Zhu Yu San extract powder (item 3390C).
TCM functions of this formula are: Invigorate the Blood, Move Qi, Dispel Blood Stasis, and Unblock the Channels and Collaterals.
The TCM presentation includes: Qi and Blood Stagnation in the channels and collaterals resulting from chronic Wind Cold Damp Bi-pain (painful obstruction syndrome) presenting with fixed aches and pains throughout the body that are worse with pressure and tend to be worse at night, including shoulder, arm, low back, leg, foot or hand pain and chronic headaches. In women, there may be irregular menstruation, menstrual pain, post-partum lower abdominal pain, and pain from retention of the placenta. Symptoms may be accompanied by systemic Blood Stagnation signs such as a dark facial complexion, purple discoloration or broken vessels on the skin, and chronic depression. The tongue may be purple, with purple or dark spots, and/or distended and dark sublingual veins. The pulse may be wiry, choppy, or deep.
The Great Invigorator Teapills / Shen Tong Zhu Yu San Ingredients
| Tao ren | Prunus persica seed |
Breaks up Blood Stasis and invigorates Blood circulation |
| Dang gui | Angelica sinensis root | Invigorates and harmonizes the Blood and disperses Cold; Stops pain due to Blood Stasis |
| Hong hua | Carthamus tinctorius flower | Invigorates the Blood, dispels Blood Stasis, opens the channels, unblocks menstruation and alleviates pain |
| Chuan niu xi | Cyathula officinalis root | Invigorates the Blood, dispels Blood Stasis and unblocks the menses; Expels Wind Dampness Bi; Tonifies the Kidneys and Liver and strengthens the tendons and bones |
| Chuan xiong | Ligusticum chuanxiong rhizome | Invigorates the Blood and promotes the movement of Qi |
| Ru xiang | Boswellia carterii resin | Invigorates the Blood and promotes the movement of Qi; relaxes the sinews, activates the channels and alleviates pain |
| Mo yao | Commiphora myrrha resin | Invigorates the Blood, dispels Blood Stasis, alleviates pain and reduces swelling |
| Di long | Pheretima aspergillum | Clears Heat and unblocks and promotes movement in the channels and collaterals; extinguishes Wind and stops spasms |
| Gan cao | Glycyrrhiza uralensis root | Moderates spasms and alleviates pain; Moderates and harmonizes the harsh properties of other herbs |
| Qin jiao | Gentiana macrophylla root | Expels Wind-Dampness, opens the channels and soothes the sinews and collaterals |
| Qiang huo | Notopterygium incisum root & rhizome | Expels Wind-Cold Dampness, unblocks painful obstructions and alleviates pain; guides Qi to the Tai Yang and Du channels |
| Xiang fu | Cyperus rotundus rhizome | Spreads and regulates Liver Qi; regulates menstruation and alleviates pain |
Tong Qiao Huo Xue Tang
Tōng Qiào Huó Xiě Tāng通竅活血湯 is known as ‘Unblocking the Orifices and Invigorating the Blood Decoction’. This formula is available from Mayway Herbs as Plum Flower Tong Qiao Huo Xue Teapills (item 3391).
TCM functions of this formula are: Invigorate the Blood, Dispel Blood Stasis, and Open the Orifices.
TCM presentation of Tong Qiao Huo Xue Tang is: Blood Stasis of the head, face or upper body presenting with sharp, fixed, stubborn headache, vertigo, dizziness, ear ringing, hearing loss, earache or sharp ear pain, chronic nasal blockage, hair loss, or loss of eyebrows. The practitioner should look for a dark or purple complexion, lips or sclera, dark rings around the eyes, swollen or broken blood vessels on the nose and cheeks, dry and scaly skin. Symptoms may be accompanied by general Blood Stagnation signs such as chronic depression, purple nails, and blotchy palms. The tongue may be purple, with purple or dark spots, and/or with distended and dark sublingual veins. The pulse may be wiry, deep, choppy, or thready.
Tong Qiao Huo Xue Wan Ingredients
| Tao ren | Prunus persica seed |
Breaks up Blood Stasis and invigorates Blood circulation |
| Hong hua | Carthamus tinctorius flower | Invigorates the Blood, dispels Blood Stasis, opens the channels, unblocks menstruation and alleviates pain |
| Chi shao | Paeonia lactiflora root | Invigorates the Blood, dispels Blood Stasis, clears Heat, cools the Blood and relieves pain |
| Chuan xiong | Ligusticum chuanxiong rhizome | Invigorates the Blood and promotes the movement of Qi |
| Bai zhi | Angelica dahurica root | Expels Wind, eliminates Dampness, unblocks the nasal passages, dispels Cold and alleviates pain |
| Da zao | Ziziphus jujuba fruit | Moderates and harmonizes the harsh properties of other herbs |
| Sheng jiang | Zingiber officinale rhizome-fresh | Release the Exterior, induces perspiration and disperses Cold; reduces the toxicity of other herbs |
| Shi chang pu | Acorus tatarinowii rhizome | Opens the Orifices, vaporizes Phlegm, and disperses Wind; promotes Blood flow, reduces swelling and alleviates Wind-Damp Bi |
Conclusion
Wang Qingren’s ‘Five Blood Stasis Relieving Formulas’ are particularly valuable when considering an etiology of Blood Stagnation in the assessment of a patient’s condition. Although there is quite a bit of overlap in the construction of these formulas, the focus on the primary location of the Blood Stasis will assist in choosing which formula will be the most applicable.
References
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- “Blood House Soup”, Baidu Encyclopedia, https://baike.baidu.com/item/%E8%A1%80%E5%BA%9C%E9%80%90%E7%98%80%E6%B1%A4/4303517
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- “Wang Qingren and the Reform of TCM Anatomy in the Qing Dynasty”, Traditional Chinese Medicine Network, 2026, https://www.tcmcn.com/wang-qingren-and-the-reform-of-tcm-anatomy-in-the-qing-dynasty/
- Wrinkle, A. et al., A Practitioner’s Formula Guide, Elemental Essentials Press: 2008.
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