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RESEARCH on TRADITIONAL FORMULAS
BLOOD MANSION FORMULA
(Xue Fu Zhu Yu Tang) [Download PDF Version]
Chinese Classics in the Modern Clinic, by William R. Morris, L.Ac, OMD,
reprinted from View from the Summit, Volume 1, Number 2
When qi and blood are in harmony, the blood can nourish and foster heart spirits, yin and yang are balanced, the four limbs and hundreds of bones are moistened and the viscera and bowels are nourished.
These statements of fact capture the essence of wide-ranging virtues of the Blood Mansion Formula, which regulates and harmonizes qi and blood. |
INGREDIENTS:
Persica seed (Tao Ren)
Carthamus flower (Hong Hua)
Angelica sinensis root (Dang Gui)
Cyathula root (Chuan Niu Xi)
Raw Rehmannia root (Sheng Di Huang)
Red Peony root (Chi Shao)
Aurantium (mature) fruit (Zhi Ke)
Ligusticum wallichi rhz (Chuan Xiong)
Platycodon root (Jie Geng)
Buplerum root (Chai Hu)
Licorice root (Gan Cao)
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FORMULA ORIGIN
Wang Qing-Ren authored Blood Mansion Formula in 1830. His contribution to the development of qi-blood theory and attempts to correct mistakes in the traditional medical literature using dissection procedures gained him notoriety when his inaccuracies were revealed. For example, he thought the entire chest cavity above the diaphragm to be an organ that stores blood. Nonetheless, his work Corrections on the Errors of Medical Works remains influential.
ASPECTS OF FORMULA FUNCTION
The foundations of Blood Mansion are tao hong si wu tang and si ni san. Tao hong si wu tang is a blood quickening formula that is the result of adding Persica seed and Carthamus flower to Dong Quai Four (si wu tang), which supplements blood. Frigid Extremities powder (si ni san) releases heat that is bound at the interior by qi constraint.
The combination of these formulas quickens blood and courses qi, coordinating the relationship between qi and blood and therefore yin and yang. In addition, the upward and downward movement of qi and blood are coordinated. Bupleurum and Platycodon both have upbearing functions while Cyathula and Aurantium have downbearing functions.
This is truly an eloquent push to generate the co-mingling of yin and yang, qi and blood. Blood Mansion contains medicinals that dissolves phlegm, quickens, nourishes and cools blood, nourishes essence, and regulates qi. It is useful for any of these patterns taking place in conjunction with or leading to blood stasis, which is the primary focus of the formula.
ETIOLOGY OF BLOOD STASIS
Any events that disrupt the harmonious interplay between blood and qi may cause blood stasis; these may include physical or emotional trauma, and sedentary lifestyles. Chronic diseases engender blood stasis, which can obstruct and hinder the free flow of the network vessels (luo mai). Repletion patterns may result in blood stasis, whether it is external or internal pathogens such as phlegm, food stagnation, or stagnant qi. The free flow of qi and blood are hindered. In addition, vacuities of qi, blood yin, or yang may lead to blood stasis, especially when these vacuities involve the heart. Blood mansion is useful for those patterns related to blood and yin deficiency, qi and phlegm stagnation—for conditions such as qi and yang vacuity, it should be combined with other formulas.
DIAGNOSIS OF BLOOD STASIS
History
Any of the following information extracted when taking the history are cause to consider confirmation of blood stasis: masses and swelling, infertility, scanty periods, delayed periods, breakthrough bleeding, dark purple menstrual blood and blood clots, dysmenorrhea, frequent abdominal pain, cirrhosis of liver, anemia, post-miscarriage retention of placenta, headache, chest pain, hypochondriac pain, endless hiccups, dysphoria, palpitations, insomnia, irritability, running a low grade fever at dusk, surgeries, accidents, injuries, and profound emotional trauma. Pain may be sharp and stabbing or oppressive if the blood stasis is bound with phlegm. Diseases of strange and sudden onset such as sudden blindness may respond to blood quickening strategies.
Visual
Visual signs of blood stasis may include the following: greenish blue vessels, spider nevi, sublingual vein engorgement, transverse capillary lines inside the lower eyelid, clots in the menstruate, blackness in the face, scaled skin, dark red lips, dark red dental gum, deep red tongue with ecchymoses, dark purple tongue with stasis speckles, dark purple lips or dark eyes.
Palpatory
The use of palpatory methods may reveal dry rough skin, pressing pain and resistance
in the abdomen,1 or palpable internal water accumulation using percussive methods. Pulses may have any of the following findings: rough, fine, sunken and slow, sunken and rough, skipping, bound or intermittent.
Lab
Whenever any of the following findings are present in the lab work, confirmation of blood stasis should be sought: elevated viscosity, lengthened sedimentation rate or elevated K value, increased fibrinogen, increased agglutination of red blood cells, hyperlipidemia, chyle in the serum, and elevated bilirubin may all be signs of blood stasis. Imaging methods may also reveal accumulations and conglomerations—these are serious findings and referral is indicated.
BIOMEDICAL CONDITIONS FOR WHICH BLOOD MANSION MAY BE APPROPRIATE WITH AN APPROPRIATE DIFFERENTIAL DIAGNOSIS
Immune disorders
These include cancer, heart disease, multiple sclerosis, lupus and immune deficiency disorders.
Gynecology
These include uterine contractions, dysmenorrhea, fibroids, and breakthrough bleeding.
Cardiovascular conditions
These may include coronary heart disease, rheumatic valvular heart disease, arrhythmia, palpitation, hypertension, cor pulmonale, cerebral thrombosis, thromboangitis obliterans, hyperlipidemia and arteriosclerosis. It is also useful for prevention of cerebrovascular accidents.2
Pain
These patterns are typically characterized by sharp boring sensations. They may include headache, chest pain, spasms and hypochondriac or any pain that is marked by stagnation of qi stagnation and blood stasis. If phlegm is bound with the blood stasis, it may be oppressive and dull.
Mental-emotional conditions
This are a wide range of clinical and subclinical entities that respond to the treatment of blood stasis. These conditions may include mania,3 schizophrenia, insomnia, and restlessness confusion, fixations and mild phobias, or worse, severe depression or obsessions. Modified versions Blood Mansion have been effective for the treatment of nightmares followed by sudden awakening with palpitations and anger.4 In addition, Blood Mansion is often recommended successfully when “shen calming” or other treatment strategies fail to resolve an emotional or mental condition. This is possibly one of the most important formulas in the entire formulary.
New uses
Restless leg syndrome, episodic hypersomnolence, and uterine bleeding.5
Senior practitioner experience
Traumatically induced low back pain resulting in radiating pain down the leg and constipation.
CASE STUDY
A 47-year-old male patient presented with the chief complaint of chronic headaches two to three times a week ever since a head injury in a car accident two years previous. All cranial nerve tests, MRI, and EEG were normal. The headaches were always in the right temporal region and were dull most of the time with occasional piercing qualities. It tended to be worse in the afternoon with “flushing of heat” and a red face. Other problems that were revealed during the course of the initial interview included depression and anxiety. These were worse in the morning and were alleviated upon arising and moving around.
PULSE: wiry, 3rd position (cubit) on the right side is deep, short and slippery
TONGUE: pink body, thin yellow coat, bubbles on the surface
ANALYSIS: The injury was apparently the cause of the headaches, suggesting blood stasis. The temporal component suggests the shao yang region and the dull headaches suggest dampness or phlegm. The afternoon flushing of heat suggests yin vacuity, although in this instance, it may be caused by blood stasis.
PULSE AND TONGUE: The right pulse deep, short and slippery suggests yang constraint. The position is related to kidney yang and the san jiao, the short quality suggests blockage or constraint. The slippery is a yang quality with a fast arrival and departure. The tongue also suggests an aspect of yang obstruction since the coat is yellow and yet also has bubbles, which are a sign of yang vacuity with a normal tongue coat.
DIAGNOSIS: blood stasis
TREATMENT PRINCIPLE: resolve blood stasis
Upon administration of Blood Mansion, the right pulse became normal. Over a period of six weeks the headaches reduced to once a week and the depression-anxiety reduced from eight to four on a ten-to-one scale (ten the worst). After six months, the headaches were no longer a problem. At one year checkup, the headaches were seldom, with only two that year. Quickening the blood and upbearing the clear released constraint of yang qi in the san jiao. Blood Mansion formula contains a form of si wu tang with blood cooling agents—this formula nourishes yin and blood. The flushing of heat in the afternoon was addressed from three points of possible etiology with this formula: yin vacuity, blood vacuity, and blood stasis. The uses of Blood Mansion are many, and this case demonstrates the value of this formula for complex case scenarios. |
FOOTNOTES:
1 Teresawa et al. The Presentation of Diagnostic Criteria for “Yue Xue” (Stagnated Blood) Confirmation. International Journal of Oriental Medicine. Volume 14 number 4, pp 194.
#2 Fruehauf, Heiner, Treatment of Stroke and Post Stroke Syndrome, Journal Of Chinese Medicine #44, 1/94, pp. 30-32
3 Flaws, Bob, The Chinese Medical Treatment of Mania Due to External Injury to the Brain http://chinesemedicalpsychiatry.com/articles/article_mania.html
4 Flaws, Bob and Chase, Charles, Recent TCM Research from China (Blue Poppy Press, 1994), pp. 55-57
5 Rao, Ying-liang New Uses of Xue Fu Zhu Yu Tang (Blood Mansion Dispel Stasis Decoction), #4, 1996, p. 53 http://www.bluepoppy.com/press/download/articles/newuses.html
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