Whether you've had April showers or are experiencing May ones, rain is a great metaphor for Dampness in the body. Just as rain collects and congests traffic (Qi or Blood stagnation) it can also flood and eventually swamp an area (Damp Stagnation). Damp Stagnation can be likened to standing swamp that breeds bacteria.

In TCM, when Dampness collects over time, Heat develops and dries Fluids. The Dampness then congeals to form Phlegm. Phlegm is a more serious condition that can cause such conditions as cough, wheezing, nausea, vomiting, loss of appetite, GERD, scrofula, goiter, arthritis and lymphadenitis, or it can lead to major diseases like cancer, stroke, atherosclerosis, plaque in the arteries, coma, lockjaw, contracted limbs, cerebral vascular accident, and seizures. While Phlegm is a secondary pathogen, it is considered “the mother of 100 diseases” by the Yuan dynasty physician, Wang Gui. In Ayurvedic medicine, it is called kapha, or the mucus humour.

In general, Fluid (Damp) Stagnation is often associated with Qi Deficiency or low energy. It is accompanied by a general appearance of edema or tissue swelling, especially seen on the abdomen, face, enlarged glands, nodules and/or any other puffy, swollen areas of the body. The tongue reflects generalized edema by appearing enlarged, swollen, scalloped on the sides, and very moist. The pulse feels “slippery,” gliding or “rolling,” whichever description aptly describes its manifestation.

Phlegm has the following characteristics:

1. Yin in nature, and as such, can injure Yang Qi
2. Heavy in nature: feels like a weight or oppression/heaviness in limbs, head, chest, or whole body
3. Gives rise to lumps and masses: these are soft, movable nodules and not usually painful; swollen joints, goiter, scrofula, cysts
4. Sticky and obstructive: it can appear as such in the stools, throat, nausea, vomit, or in the channels (numbness); if there’s phlegm in the throat, this is enough to determine the existence of phlegm (especially if this occurs in the morning or after meals and if the tongue is swollen)
5. Moves and changes: phlegm often moves with Liver Yang or Liver Wind, causing such issues as strokes, or hypertension
6. Interacts with Blood Stasis (mainly in the elderly); when the two interact, it causes major diseases and death. As well, Phlegm aggravates and harbors Blood stasis (both together create dark nails, a dark complexion, purple lips, and a purple and swollen tongue)
7. Damages the Spleen and especially, the Stomach
8. Easily mixes with other pathogenic factors
9. Is the origin of other diseases: when symptoms don’t fit, think of Phlegm as Phlegm conditions are complicated and a strange group of symptoms

Pulse: Slippery and/or wiry

Tongue body: Swollen – where the tongue is swollen indicates the location of Phlegm

Tongue coat: Sticky

Combinations of body and coat:

• swollen body, sticky coat: phlegm
• swollen body, sticky coat without root and partially peeled: Phlegm and Stomach Yin Deficiency
• swollen body, sticky coat, deep cracks: Phlegm and Yin deficiency
• swollen body, sticky coat, deep crack in heart area: Phlegm misting the Shen
• swollen body, no coat, slightly purple: phlegm and Blood stasis
• swollen body, no coat: Phlegm and Yin Deficiency
• swollen body, dry, yellow inside stomach crack: Phlegm Fire in Stomach
• swollen body and red: Phlegm Heat

Frankly, if you’ve got to spit out mucus from your throat first thing in the morning or after eating meals, you’ve got phlegm.

Dampness vs. Phlegm

Phlegm always affects the Spleen but it accumulates in the Lungs. However, because it moves and changes, it can be found anywhere in the body, such as:

Phlegm in the Lungs: cough, wheezing, stifling sensation in the chest, pain in the ribs

Damp Phlegm Obstructing the Lungs: chronic cough coming in bouts, profuse white sputum which is easy to expectorate, white-pasty complexion, stuffiness of the chest, feeling “clogged up,” shortness of breath, dislike of lying down, slippery or weak-floating and fine pulse and thick-sticky white tongue coating.

Phlegm Heat in the Lungs: barking cough, profuse yellow or green or dark sputum which is foul-smelling, shortness of breath, asthma, stuffiness of the chest, slippery, rapid, full pulse and red tongue body with a thick-sticky yellow coating

Phlegm in the Stomach: nausea, vomiting, loss of appetite, epigastric distention

Phlegm in the Channels: scrofula, goiter, lymphadenitis

Turbid Phlegm blocking the Heart orifices: wind stroke, coma, lockjaw, contracted limbs, CVA, seizures

Upper Warmer Symptoms: edema in top part of body such as face and hands, congestion in the head and/or chest

Middle Warmer Symptoms: sound of abdominal fluid, damp abdomen, ascites, edema in the middle part of the body

Lower Warmer Symptoms: Edema in lower part of body, such as the legs and ankles, pitting

Is Damp Stagnation Hot or Cold?

Dampness and Phlegm always appear with either Heat or Cold. If with Heat, there’ll be other signs of Heat along with a yellow tongue coat and yellowish excretions and secretions; if with Cold, there’ll be other signs of Cold along with a white tongue coat and clear to white excretions and secretions.

Causes for Damp Stagnation

Dampness and Phlegm are always pathologies of the Qi mechanism. While it is primarily caused by deficient Spleen Qi or Yang failing to transform and transport Body Fluids, it may also be created by deficient Kidneys unable to control the Fluids and/or Liver Qi Stagnation failing to facilitate the transportation and transformation functions of the Spleen. As well, it may be caused by the invasion of pathogenic influences such as External Wind-Cold that interferes with the Lung’s function of dispersing and descending. Here are several other factors that can cause Damp stagnation and Phlegm to develop:

Pathogenic Influences: Phlegm easily combines with other pathogens to create many conditions such as:

• Wind-Phlegm
• Dry-Phlegm
• Phlegm-Fire
• Phlegm with Qi Stagnation
• stone Phlegm (chronic swelling of the glands or nodules on the vocal chords)
• food Phlegm
• shock Phlegm
• wine Phlegm
• Phlegm obstructing the Heart
• Lung Deficiency with Phlegm
• Phlegm-Fire in the Lungs
• turbid Phlegm in the Lungs
• Phlegm obstructing the Lung Qi
• Phlegm-Fluids in the Lungs
• Spleen Qi Deficiency with Phlegm
• Phlegm obstructing the middle burner
• Phlegm-Fire in the center
• Phlegm-Fluids in the center
• Liver-Wind harboring Phlegm
• Phlegm-Heat in the Liver channel
• Liver Qi Stagnation and Phlegm
• Liver Blood Deficiency and Phlegm
• Kidney Yang Deficiency with Phlegm
• Kidney Yin Deficiency with Phlegm

Emotions: Any emotional excess can eventually lead to Damp Stagnation and Phlegm

Diet: High consumption of cold foods and/or drinks; raw foods; dampening foods like fried and fatty foods, dairy, sugar, tofu, soy milk, alcohol, and flour products

Lifestyle Habits: Irregular eating habits, overwork, inactivity, excessive or long-term use of many pharmaceuticals such as antibiotics and antidepressants

In Part II we will discuss treatments and therapies for Damp Stagnation. However, if you feel stagnant just by reading all of this, guess what I’m going to suggest that you do? That’s right! Immediately get up and MOVE! Movement is one of the great keys to circulating everything in the body. It can be exercise, but if you do what you love at the same time, it also smoothes emotions and nourishes you, preventing further stagnation. 

Moxibustion, commonly called “moxa,” is one of the methods used in Traditional Chinese Medicine (TCM) where the downy fluff of the leaves of Artemisia vulgaris (mugwort) is burned directly on or near the skin of specific areas of the body. Mugwort is a member of the Asteraceae family. There are many subspecies in China, Japan and the US. It has analgesic, detoxifying, blood-moving and anti-parasitic properties. In moxibustion, mugwort is processed into a fine wool that can be shaped into cones or formed into rolls that burn quickly at a low temperature.

Moxibustion therapy may be even older than acupuncture, with its origins perhaps stemming from an accidental burn from a spark while sitting near an open campfire. At some time over the course of thousands of years, someone is likely to have experienced the relief of chronic symptoms such as arthritic or rheumatic conditions as a result of the exposure to heat. Moxa has been found to be effective for immuno-compromised, deficient diseases. I don’t think there is another treatment modality that surpasses the benefits that moxa can impart for deficiency diseases, especially diseases caused by a hypo-metabolic, Yang-deficient condition.

Types of Moxa

While there are many ways to use moxa, they all can be divided into two categories: direct and indirect. Direct moxibustion is when a small amount of the herb is burned directly on the skin over selected acupoints or areas of the body. Indirect moxibustion uses moxa rolled into sticks burnt and moved over specific points or areas of the body. For the purposes of the general use recommended in this article, I recommend using only indirect moxibustion. 

Another method that is a step between between indirect and direct moxibustion is the use of stick-on moxa. These are individual pre-formed moxa cones fastened to an adhesive base. When lit and applied to the body, these are burned all the way down, depending on the sensitivity of the patient. Because the moxa herb burns out a few millimeters above the skin, it is not likely to cause a burn or blister in most individuals. (There are several different brands of stick-on moxa cones, but the one that I prefer is Chosei-Kyu, Ibuki stick-on moxa.)

Direct, semi-direct stick-on moxa, or indirect moxa produces degrees of sensation depending on the method and intention of the user. One can use moxa to create a generally warming sensation. Or, one can allow it to burn until one briefly feels a sharp zing, which is considered to be energetically the most powerful approach for moxa.

Uses for Moxibustion

From a TCM perspective, both acupuncture and moxibustion exert therapeutic effects through the vascular and neurologic circulatory systems. However, “moxibustion gives as well as moves,” while acupuncture with needles only “moves.” When treating deficient people only with needles, they may be too weak to mount a strong positive response. However, when treating with moxibustion, it not only stimulates circulation but it gives energy in the form of heat to the areas where it is applied.

Moxa is one of the most effective methods to relieve spasm and pain.  There is an active debate between those in the West who advocate ice to prevent and relieve pain and TCM practitioners who feel that moxa is more permanently effective. Personally, I’ve found the latter to be true but if in doubt, one can first apply an ice pack to treat acute pain and later use moxibustion to effect a more lasting result.

Stomach 36

I believe that just as the medicinal properties of common herbs and weeds found in our environment is our birthright, I believe that the use of at least a handful of common acupoints falls into the same category. Today I'd like to introduce you to the most important acupoint on the body, Stomach 36. It is called Tsu San Li, translated as “Leg Three Miles.” The name comes from the ancient belief that one exhausted from walking such a long distance that they don’t feel they can take another step, can stimulate this point and go another three miles. This belief is so firmly entrenched in Chinese and Japanese folklore that in Japan, where walking long distances was simply the way that people got around, one is cautioned to not undertake such an arduous journey with another who did not first stimulate their Stomach 36 point.

Stomach 36 has so many uses that it is sometimes called ”the point of 100 diseases.” It increases energy, stimulates the immune system, warms the body, treats diseases of the legs, waist, nervous and uro-genital systems, allergic and respiratory diseases and generally physical and mental weakness. While moxibustion on this point may be used on someone with mild hypertension, it is contraindicated for use in acute hypertension.

Finding Stomach 36

To accurately locate Stomach 36, measure four fingers of one hand from the bottom of the knee-cap along the outside margin of the fibula. You should notice a depression at this spot and that is Stomach 36. In general each point should be stimulated for approximately 5 to 10 minutes and there should be a reddening of the skin in the area. Watch a demonstration of moxa on Stomach 36 here.

Doing Moxa at Home

Moxibustion can be self-applied. Before beginning, be sure you are in a well ventilated space. Have a match, lighter or candle to ignite the moxa stick, a non-flammable plate to periodically tap the ashes onto, and a bit of tinfoil to wrap around the tip to snuff it out upon completion of the session. The unused portion of the moxa cigar can be reused until it can no longer be held.

After briefly teaching them how to treat themselves, I commonly send my patients home with a moxa stick and directions on how to warm up Stomach 36 or some other select acupoint. This works wonders on patients undergoing severely debilitating treatments such as chemo-radiation therapy. It not only revives the patient’s energy, but with increased circulation and vitality, their body is better able to utilize the intended benefits of such therapies. This can be done once or twice a week and more often if one is suffering from a disease associated with chronic weakness and deficiency.

In moxibustion, burns can occur accidentally or in a some instances deliberately. Believe it or not, this only makes for a stronger treatment. Not that one should begin by inflicting blisters with the early attempts at self-moxibustion, but if by chance one occurs, the immune response that occurs over a small point has a generally positive effect on the immune system overall. A blister should just be kept clean and covered until it naturally heals.

Where to purchase moxa

Llhasa OMS carries all forms of moxa.

Moxa is even available from Ebay. 

Chosei-Kyu, Ibuki stick on moxa.  These are found online and can even be purchased on Amazon at http://amzn.to/13rwqSW

Moxa rolls are also available from various sources including Amazon at http://amzn.to/13rxmH2

If you want to try the nearly smokeless moxa cigars you can find these at http://amzn.to/13rxmH2. The only drawback I see from these is that, being charcoal of the herb, it takes a little longer to light. I recommend using a candle to ignite these.

In Part I we learned about the many signs and symptoms of Cold Stagnation and its effects on physical and mental health. In this segment we’ll cover how to treat and prevent Cold Stagnation. You may be most interested in herbs and formulas that treat this condition, but first I’ll cover other therapies integral to preventing and treating this issue.

Therapies for Cold Stagnation

Diet Therapy:

Foods to Eat: All cooked foods, warm drinks; spices added to food; animal protein (except crabmeat and shellfish); cooked and spiced vegetables and fruits 

Foods to Avoid: Refrigerated foods and drinks; raw foods (including salads); iced drinks; frozen yogurt, ice cream, popsicles, etc.; most fruit and vegetable juices; melons, bananas; crabmeat and shellfish (except shrimp); soy milk and tofu

Emotional Therapy: Appropriate expression and release of emotions

Lifestyle Therapies: Dress warmly and adequately for the weather; cover neck with a high collar or scarf; cover lower back, waist and midriff

Other Therapies: As with Blood Stagnation, moxibustion is the main therapy for Cold Stagnation, although other heat applications may be used such as hot stones, hot packs, warming herbal patches, ginger fomentations, and so forth.

Herbal Therapy: Herbs for Cold Stagnation tend to come from the “Herbs That Warm the Interior” or “Herbs that Tonify Yang” categories. In Western herbalism this can include stimulants along with certain adaptogens. These herbs have a warm to hot energy and generally pungent and/or sweet flavor. If there is also Wind or Dampness involved, then herbs that resolve Wind-Cold or disperse Cold Damp are also used. Take these herbs with cooked, warm food or as warm teas. Examples of herbs used for Cold Stagnation follow:

• cayenne pepper
• pippali long pepper
• anise seed
• horseradish root
• cloves
• prickly ash
• bayberry bark
• ginger, especially dried
• cinnamon
• garlic
• black pepper
• fenugreek
• damiana
• dipsacus
• cuscuta

Kitchen medicine: Many kitchen spices are warming in energy, which disperse Cold Stagnation, such as ginger, cinnamon, cloves, black pepper and garlic.

Formulas for Cold Stagnation

Stagnation of Cold in the Upper Warmer

Aconite Combination (Si Ni Tang)

• *Prepared aconite (fu zi, Aconitum carmichaeli) 9-12 g 
• Dry ginger  (gan jiang, Zingiberis officinalis) 6-9 g 
• Baked Licorice (zhi gan cao, Glycyrrhiza uralensis) 9-12 g 
• *Substitute for aconite: cinnamon bark, rou gui

Properties and Actions:

a) For Yang exhaustion of the Lesser Yin (Xiao Yin) stage.

b) For Yang Deficiency caused by excessive perspiration.

Indications: This formula can be used for collapse of vital functions and cardiac failure. Symptoms include: cold extremities, fear of cold, fatigue and exhaustion, diarrhea with undigested food in the stool, nausea and vomiting, abdominal pain and lack of thirst. This formula was originally indicated for individuals who were inappropriately prescribed diaphoretics.

Pulse: Deep and weak

Tongue: Pale or dark purplish-blue

Contraindications: Avoid if there is Excess Heat or Yin Deficiency.

Stagnation of Cold in the Middle Warmer

Ginseng and Ginger Combination or Regulate the Middle Pill (Li Zhong Wan)

• Dry ginger (gan jiang, Zingiber officinalis) 9 g 
• Ginseng (ren shen, Panax ginseng) 9 g 
• White atractylodes (bai zhu, Atractylodes alba) 9 g 
• Baked licorice (zhi gan cao, Glycyrrhiza uralensis) 9 g 

Preparation: Grind the ingredients into a powder. Warm honey until it is liquid. Stir the herb powder into the honey until it is a thick doughy consistency. Roll into balls about half the size of a lime. Take two or three daily before meals. A single dose of pills should equal to about 6-9 grams of the powdered herb. It can also be taken as a decoction. The pill is often taken with rice congee. Unless it is an acute case, codonopsis (dang shen) can be doubled in amount and substituted for ginseng (ren shen).

Properties and Actions:

a) Tonic, warms and tonifies Spleen and Stomach Yang

b) Strengthens digestion and raises digestive metabolism

Indications: It may be considered for symptoms of deficiency such as diarrhea with watery stool, nausea and vomiting, no particular thirst, loss of appetite, abdominal pain.

Pulse: Deep and thin

Tongue: Pale tongue with white coat

Note: This formula is often combined with either or both 6 g of cinnamon bark (rou gui) and 6 g of prepared aconite (fu zi) to make it stronger and warmer; this is Aconite, Ginger and Ginseng Combination (Fu Zi Li Zhong Wan). It is particularly useful for vegetarians, who through eating too much cold, raw food, have injured the Spleen Yang and seriously weakened their digestive metabolism.

Contraindications: Avoid if there is Excess Heat or Yin Deficiency.

Stagnation of Cold in the Lower Warmer

Rehmannia Eight Combination (Jin Gui Shen Qi Wan or Ba Wei Di Huang Wan)

• Prepared aconite (fu zi, Aconitum praeparata) 10-15 g 
• Cinnamon twigs (gui zhi, Cinnamomum cassia) 6-9 g 
• Prepared Rehmannia (shu di huang, Rehmannia glutinosa) 20-30 g 
• Cornus (shan zhu yu, Cornus officinalis) 10-15 g 
• Dioscorea (shan yao, Dioscorea opposita) 10-15 g 
• Water Plantain (ze xie, Alisma plantago-aquatica) 9-12 g 
• Moutan Peony (mu dan pi, Paeonia suffruticosa) 6-9 g 
• Poria (fu ling, Poria cocos) 9-12 g 

Properties and Actions:

a) Tonifies Yang

b) Warms the Kidneys and lower extremities

Indications: For symptoms of Kidney Yang Deficiency with lower backache, coldness in the lower extremities, impotence, spermatorrhea, prostatic hypertrophy, frequent urination, nocturia, cough, asthma, persistent diarrhea, dysuria, spasms of the lower abdomen. It can be considered for diabetes mellitus and insipidus, hyperaldosteronism, Addison’s disease, hypothyroidism, arteriosclerosis, hypertension, edema, cystitis, chronic nephritis, kidney stones, albuminaria, chronic bronchitis, edema, chronic diarrhea, rectal prolapse, chronic gonorrhea, arthritis, menopausal problems, eczema, senile pruritis, vaginal itching, urticaria, neurasthenia, cataracts, glaucoma, keratitis.

Pulse: Sunken, slow and weak

Tongue: White

Contraindications: Avoid if there is Excess Heat, Yin Deficiency or gastrointestinal weakness.

Stagnation of Cold in Liver Channel

Warm the Liver Decoction (Nuan Gan Jian)

• Angelica sinensis (dang gui) 6-9 g
• Lycii berries (gou ji zi, Fructus lycii) 9 g 
• Fennel seeds (xiao hui xiang, Foeniculi vulgaris) 6 g 
• Cinnamon bark (rou gui, Cinnamomi cassiae) 3-6 g 
• Lindera root (wu yao, Linderae strychnifoliae) 6 g 
• Aquilaria wood (chen xiang, Lignum aguilariae) 6 g 
• Poria (fu ling, Poria cocos) 6 g 
• Fresh ginger (sheng jiang, Zingiberis officinalis) 3-5 slices 

Preparation: Take warm. Saussurea (mu xiang) is often substituted for the harder to obtain aquilaria, which is also known as Lignum vitae. This formula is particularly indicated for hernial disorders for which fennel seed is a near specific.

Contraindications: Avoid if there is Excess Heat, Yin Deficiency or gastrointestinal weakness.

Cold Invading the Large/Small Intestine

Magnolia and Hoelen Combination (Wei Ling Tang)

• Alisma (ze xie, Alisma plantago-aquatica) 2.5 g 
• Poria (fu ling, Poria cocos) 2.5 g
• Polyporus (zhu ling, Polyporus umbellatus) 2.5 g 
• Cinnamon twig (gui zhi, Cinnamomum cassia) 2 g 
• White Atractylodes (bai zhu, Atractylodes alba) 2.5 g 
• Black Atractylodes (cang zhu, Atractylodes lancea) 2.5 g 
• Magnolia bark (hou po, Magnolia officinalis) 2.5 g 
• Citrus peel (chen pi, Citrus reticulata) 2.5 g 
• Licorice (gan cao, Glycyrrhizae uralensis) 1 g 
• Fresh ginger (sheng jiang, Zingiberis officinale) 1.5 g 
• Jujube dates (da zao, Zizyphus jujuba) 3-5 pcs

Properties and Actions:

a) Eliminates Dampness of the Spleen (relieves bloating)

b) Carminative, restores the function of the Stomach and assists digestion.

Indications: Abdominal bloating and fullness, loss of appetite, dull heavy feeling in the head and body, watery diarrhea, decreased urination.

Pulse: Slippery and thready

Tongue: White with a greasy coat

Contraindications: Avoid if there is Excess Heat, or Yin Deficiency.

Cold Obstruction of the Channels

Frigid Extremities Decoction (Si Ni Tang)

• *Prepared Aconite (fu zi, Aconitum carmichaeli) 6-9 g
• Dry ginger (gan jiang, Zingiber officinale) 4.5 g 
• Honey baked licorice (zhi gan cao, Glycyrrhiza uralensis) 6 g 
• *Substitute cinnamon twig for the aconite

Properties and Actions:

a) Metabolic Stimulant, stimulates Yang

b) Warms and counteracts internal Cold

Indications: Aversion to cold, coldness in the hands and feet, coldness in the Stomach and Spleen, vomiting, diarrhea, lethargy, abdominal pain, lack of thirst.

Pulse: Thin, deep and faint

Tongue: White, moist coat

Variation: By adding 6-9 g of ginseng (ren shen), the formula has wider tonic properties, tonifying Yin, Blood and Qi. Both these formulas are appropriate for both the Xiao Yin and Jue Stages as well.

Note: This is the basic metabolic stimulant formula.

Contraindications: Avoid if there is Excess Heat or Deficient Yin.

Ayurvedic Compounds for Cold Stagnation

Trikatu is used for Internal Cold Stagnation and to dry mucus. It consists of equal parts powdered black pepper, pippali long pepper and ginger mixed with honey. A teaspoon is taken 2 or 3 times daily to lessen mucus and treat upper respiratory allergies.

Sito Paladi Churna is a traditional household formula used to treat the symptoms of the common cold. It consists of equal parts sugar, bamboo manna, pippali long pepper, cardamom seeds, cinnamon bark and ginger. It is warming, anti-mucus and clears Dampness.

Western Thompsonian Herbal Formula for Cold Stagnation

Composition Powder

• 4 parts bayberry bark powder
• 2 parts white pine bark powder
• 2 parts powdered ginger root (dried)
• 1/2 part cayenne pepper
• 1/2 part cloves powder

A teaspoon of this can be taken in hot or warm water three or four times daily. While this helps induce perspiration in someone with the first sign of a cold or flu (followed a half hour later with a bowl of thin porridge such as rice cream or oatmeal if the patient is weak), this formula may also be taken in smaller doses to move Cold Stagnation. As well, it may be modified with cinnamon bark and licorice.

Years ago when I worked in Cleveland, I’d stare out the office window at a sunny spring day. Ecstatic to finally have warm weather, I’d rush out at lunchtime without a coat – it looked warm after all – only to find it was still cold. It’s behaviors like this that are one of the reasons why the winter-into-spring turning point of the seasons is one of the two most vulnerable times of year for colds and flu.

For this reason, I’m choosing to discuss Cold Stagnation in this blog. In April, there is often still a chill in the air. While we want it to be warm outside and so dress more lightly, generally it’s still frigid, particularly with wind, and so this is one of the times of year when cold can penetrate or congest more easily.

Coldness

Cold itself tends to contract like ice. It causes a person to hunch over or curl up in order to minimize exposed body surface and maintain inner warmth. With lack of heat, activity in all forms slows.

Coldness is characterized by:

• lowered metabolism
• feelings of coldness, severe chills, aversion to cold and craving of warmth
• pale complexion, anemia, poor circulation, low blood pressure
• weakness, lethargy, slowness, somnolence
• poor digestion, poor appetite
• lowered immunity
• diarrhea or loose stools, frequent and copious clear urination, night time urination
• fluid retention, no thirst or sweating
• weak senses
• timidity, soft voice, quietness
• few body odors
• clear to white mucus, stools, urine or vaginal secretions
• achy pain in the joints
• frigidity, impotence, infertility
• all hypo-conditions such as hypothyroidism, hypo-adrenalism or hypoglycemia

Signs of Cold Stagnation

Coldness impedes circulation, causes contraction and slows activity internally. If there’s Cold in the body, eventually it leads to other forms of stagnation or it depletes the inner fires. Cold Stagnation can be acute or chronic. If acute, it usually causes severe pain; if it’s chronic, you may not even be aware of its presence except for perhaps feelings of coldness in the affected area.

Cold Stagnation is sometimes called “Full Cold.” Full Cold only exists a short time because it quickly consumes the Yang, turning into Yang Deficiency (Empty Cold) instead. Pain from Cold Stagnation is generally severe, but not fixed or stabbing, and it’s alleviated by warmth and pressure. Cold Stagnation often combines with Damp to form Cold-Damp Stagnation as well.

Pulse and Tongue:

Pulse: The pulse is slow (less than 60 BPM); deep and tight. Fewer than four beats per complete breath (60 beats/minute) indicates Cold:

• slow and empty designates Yang Deficiency
• slow and full indicates Cold Stagnation.

Tongue: pale with a thick white coat (acute); pale with a thin white coat (chronic)

Cold Stagnation in the Upper Warmer:

Feelings of coldness in the head, arms, chest and back; pale complexion.

Cold Stagnation in the Middle Warmer:

“Cold” indigestion; anorexia; diarrhea

Cold Stagnation in the Lower Warmer:

Cold abdomen, legs, and/or feet; impotence; frigidity

Cold Obstruction in the Channels:

Pain in the joints and/or muscles with feelings of coldness

Stagnation of Cold in the Liver Channel:

In men: straining of the testes or contraction of the scrotum; fullness and distension of the bladder area with pain that refers to the scrotum and testes

In women: shrinking of the vagina; pain alleviated by warmth

Cold Obstructing the Large and/or Small Intestines:

Abdominal pain alleviated by heat and pressure; loose stools or diarrhea; if the Cold invades the Large or Small intestines, the pain is sudden and severe; diarrhea with pain; feeling of cold and cold sensation in abdomen

This is an acute condition from the invasion of Exterior Cold into the Large Intestine that occurs usually from sitting on cold and wet surfaces for prolonged periods, exposure to very cold weather, or from having the abdomen insufficiently covered.

This happened to our son one day when he was about 8 years old. He had been playing outdoors von a cool day when suddenly, he ran inside and rolled on the floor, holding his abdomen and crying with pain. When I felt the area, it as cool to the touch and so I applied heart. Very quickly the pain dispersed.

Cold Invading/Obstructing the Stomach:

Sudden pain in the epigastrium, feelings of coldness with preference for warmth, vomiting of clear fluid, worse after drinking cold fluids that are then vomited

Cold Invading/Obstructing the Uterus:

Infertility; miscarriage; leucorrhea; pain and cold feeling before or during period in the lower abdomen referring to the waist and back with the pain alleviated by warmth; scanty dark red menstrual blood with clots

Causes for Cold Stagnation

Factors that can lead to Cold Stagnation are:

Pathogenic Influences: Wind-Chill invading the skin, channels, Stomach, Intestines, or Uterus.

Emotions: Inward behavior, passivity and dullness can all be signs of Cold Stagnation.

Diet: Excessive intake of cold drinks and foods, including the following:

• Refrigerated foods and drinks
• Raw foods, including salads
• Iced drinks
• Frozen yogurt, ice cream, popsicles, etc.
• Most fruit juices
• Melons
• Bananas
• Crabmeat and shellfish
• Soy milk and tofu

Lifestyle Habits: Not wearing sufficient clothing for the weather, bear midriffs, standing or sitting in cold environments (like concrete floors and basements).

In Part II, we will discuss treatments and therapies for Cold Stagnation. However, if you feel cold just by reading all of this, I suggest you immediately get up and – you got it: MOVE! While you certainly may be tired of reading this repeated suggestion by now, movement is still one of the great keys not just to circulating Qi and Blood, but also to warming the body and dispersing Cold Stagnation.

In my previous blog, I discussed the little-known use of ragweed for allergies. Another herb that can give over-the-counter antihistamines a run for their money is butterbur (Petasites hybridus). About 20 percent of Americans complain of allergies each year, often interfering with normal work and recreational activities. Butterbur, like ragweed, is a member of the Asteraceae family whose abundant pollen wreaks annual havoc on those who are sensitive to them.

A study published in August 2005 in Phytotherapy Research looked at 330 patients who suffered from sporadic hay fever. The study divided the participants into three groups: the first took 8 mg of butterbur extract three times a day; the second took 180 mg of fexofenadine (Allegra), a common antihistamine, each morning, and the last took a placebo.

At the end of the study, both groups receiving active treatment reported a significant reduction in the nasal congestion and itchy, watery eyes most commonly experienced with hay fever. Most strikingly, there was almost no difference between taking an antihistamine or the butterbur extract, except that some taking the antihistamine complained of drowsiness.

Since antihistamines and butterbur work in different ways, study author Dr. Andreas Schapowal of the Allergy Clinic in Landquart, Switzerland, feels that combining the two drugs would be effective. However, no study has investigated how butterbur works in combination with any other drug.

Butterbur: Antispasmodic and anti-inflammatory properties find use in migraines, allergies

The active ingredients in butterbur extracts are petasin and isopetasin. Petasin reduces spasms in smooth muscle and vascular walls, while isopetasin acts on the system that reduces inflammation. Together, the two act as an effective anti-inflammatory drug with potential in treating many ailments. These anti-spasmodic and anti-inflammatory properties have been demonstrated in pharmacological and experimental systems. Butterbur regulates calcium channels and inhibits the synthesis of the enzymes lipoxygenase and cyclooxygenase.

 Efficacy and tolerability of butterbur was demonstrated in two randomized, double-blind and placebo-controlled clinical trials with more than 300 adult patients and in one open trial in 108 children and adolescents.

Petasin also provides an inhibitory action on the leukotriene and histamine. The former is responsible for the allergic reactions in human body, when the blood vessels are dilated and get permeable causing such symptoms as rhinitis and sneezing. The latter causes inflammation and provokes the symptoms of asthma and hay fever. Therapeutic effects of petasin are applicable for such conditions as kidney stones, menstrual cramps, urinary disorders, and gastrointestinal problems (ulcers in particular) associated with muscle spasms and inflammation. In addition, petasin is known to provide hypotensive actions and strenghthen cardiac tissue.

Medical studies have proved that butterbur extract helps both in prevention and treatment of migraine, especially in severe cases and with fewer side effects (e.g. sedative) than in typical headache preparations. This action is supposedly achieved by relieving pressure on blood vessels and affecting calcium channels. An important feature of the herb's anti-migraine action is that it can be used in adolescents and even children. A study published in January 2005 showed that butterbur extract could help to prevent and reduce migraine symptoms better than placebo.

A few studies have implied that the extract may also be useful in treating asthma, bronchitis, and other respiratory disorders. "Three randomized, placebo-controlled studies of the butterbur extract, Ze 339, in peer-reviewed journals should convince anybody of the efficacy and safety of the medication in allergic rhinitis," said Schapowal.

Astralagin and isoquercitrin are flavonoid glycosides found among the other important chemicals in the herb. They provide anti-depressant properties for the human central nervous system.

Also, anti-oxidant and properties associated with butterbur have been noted in several studies.

The most common pharmaceutical form butterbur is being released in is the supplement called Petadolex. These are the butterbur gelcaps produced for relieving migraine symptoms. There are no recorded adverse reactions to the use of butterbur. However, older studies that have not been duplicated showed that butterbur leaf extract may have caused cancer in animals. Therefore it has gradually faded from human use. The compound responsible for this toxic effect, the pyrrolizidine alkaloid, has since been identified, and newer butterbur supplements are made from only the leaves of a plant (roots contain higher levels of the alkaloid) specially developed to be low in the compound. Now experts say that the herb is safe for use. Due to the risk of PA toxicity, butterbur should only be consumed processed and purchased from the authorized dealers. The raw extract should be avoided.

Historical use of butterbur

Butterbur has a long history of use, possibly dating back to ancient times. Related to comfrey and coltsfoot, it was used to treat asthma and sinus infections. In the 16th century it was described as a “plague flower,” presumably because it may have been found effective in treating this disease. Native Americans used butterbur root for inflammation, hay fever and headaches, much as it is used today.

The size of the leaves made it useful as a head cover, which gave the butterbur its derived generic name. Petasus is a Greek word for a broad felt hat worn by shepherds, hence Petasites is the name of the genus. The plant's common name “butterbur” refers to another function of the leaves: they were used to wrap butter for preserving it and keeping it cool. In some cultures seeds of butterbur are believed to have love divination properties and are used for rituals by young women.

Butterbur is native to Europe as far north as Scandinavia, and is also naturally found in some parts of Asia and North America. It is considered invasive and due to its space and light-consuming habits, butterbur grows with no other plants around its leaves. Favoring clay and sandy loam, it is found in meadows, shades by the waterways, flood plains, marshes, and other damp areas.

The rhizome of the plant is considered to possess most of the beneficial properties associated with butterbur.  It contains bitter resinous juice and has an unpleasant taste. Leaves are used for herbal extracts intended to manage allergies.

Useful links

http://www.naturalhomecures.com/members/allergiestreatment.html 

 http://butterburherb.com/en/index.php 

 http://www.chinese-herbs.org/butterbur/ 

In Part 1 we learned about the many signs and symptoms of Blood Stasis and its effects on health. Now, we’ll cover how to treat and prevent Blood Stasis. Of course you’ll be immediately interested in the herbs and formulas to use, but first I’ll cover other therapies that are integral, even essential, to preventing and treating this issue.

Note that because Blood Stasis is frequently an underlying factor in many health problems, it’s important to not only focus on moving Blood but also on resolving the causative factors. Further, because there’s an interdependent relationship between Blood and Qi, it’s important to promote the movement of Qi when moving Blood and vice versa.

Therapies for Blood Stasis

Diet Therapy

Eat: A balanced diet of protein, complex carbs and fats of cooked foods and warm drinks.

Avoid: Raw and cold foods and iced foods and drinks (review the list in Part 1). As an example of the power of diet in moving Blood Stasis, a patient I treated didn’t tell me about her menstrual pain, but when she changed her diet and stopped cold and raw foods, her menstrual pain went away!

Emotional Therapy

Express and release your emotions appropriately; work with your limiting patterns.

Lifestyle Therapies

Enjoy movement and exercise such as brisk walking, jogging, running, swimming; yoga, tai chi, and qi gong. Those with Blood Deficiency should avoid hot tubs and saunas, particularly during or right after menses, as these further deplete the Blood. If there’s Internal Cold, hot tubs and saunas are fine IF immediately followed by a cold plunge or shower to lock the heat in (otherwise it dissipates your body heat, which depletes Yang over time).

Other Therapies

Moxibustion is one of the best techniques to move localized Blood Stasis and to warm the Interior. Other warm applications such as hot stones, heat lamps, hot water bottles, heating herbal patches and warming liniments, massage, dermal hammer, or cupping also apply. Buffing, the application of a gentle power tool covered with a cotton cover and gently moved across the skin is fabulous to increase localized skin circulation.

Herbal Therapy

In TCM, Blood-moving herbs are divided into four groups according to their ascending order of strength:

ACTION                                                                    HERB

 Harmonize the Blood                                       white peony root

Promote the movement of Blood                        vaccaria seed

Dispel Blood Stasis                                          red peony root

Break up Blood Stasis                                      turmeric root, peach seed

In general, an herb may be termed “Blood invigorating,” a generic term for moving Blood. In Western herbalism, herbs that move Blood are considered emmenagogues. Most Blood-moving herbs have a warm energy with an acrid and bitter flavor. All enter the Liver organ and meridian along with other possible organs and channels.

Contraindications

 Blood-moving herbs should be avoided during pregnancy and menses; in those who have a tendency toward excessive menstrual bleeding; in people who bleed easily; and anyone on blood-thinner medications (Warfarin, Coumadin, etc.).

Blood-moving Herbs

• Angelica (Angelica archangelica)
• Vervain (Verbena officinalis)
• Lovage (Ligusticum levisticum)
• Corydalis (Corydalis formosa)
• Tien qi (Panax notoginseng)
• Turmeric (Curcumae longa)
• Motherwort (Leonurus cardiaca)
• Bugleweed (Lycopus virginicus, L. lucidi, ze lan)
• Peach seed (Prunus persica, tao ren)
• Safflower (Carthamus tinctorius, hong hua)
• Saffron (Crocus sativus, fan hong hua)
• Calendula (Calendula officinalis)
• Frankincense (Boswellia carterii, ru xiang)
• Myrrh (Commiphora myrrha, mo yao)
• Blue Cohosh (Caulophyllum thalictroides)
• Rue (Ruta graveolens)
• Szechuan lovage root (Ligusticum chuanxiong)
• Red sage root (Salvia miltiorrhizae)
• Corydalis (Corydalis yanhusuo)
• Red peony (Paeonia veitchii)
• Achyranthes (Achyranthes bidentata, niu xi)
• Vaccaria seed (Vaccaria segetalis, wang bu liu xing)
• Dang gui (Angelica sinensis)
• White peony (Paeonia lactiflora, bai shao)

Blood-moving Formulas

Many formulas move the Blood. However, there are four main blood-moving formulas, one for each Warmer and one for the collaterals and channels.

Upper Warmer

Decoction for Removing Blood Stasis in the Chest (Xue Fu Zhu Yu Tang)

This formula is for pain in the head and/or chest due to Blood Stasis or poor circulation. The pain could be chronic, fixed and piercing. Other symptoms include irritability, insomnia, emotional upset, and increased body temperature, especially in the afternoon. The pulse is hesitant, or wiry and tight, and the tongue is dark red with purple spots.

• Persica (tao ren)                          9-12 g
• Carthamus (hong hua)                   6-9 g
• Angelica sinensis (dang gui)            6-9 g
• Ligusticum (chuan xiong)                3-6 g
• Red peony (chi shao yao)               6-9 g
• Cyathula (chuan niu xi)                  6-9 g
• Bupleurum (chai hu)                      3-6 g
• Platycodon (jie geng)                    3-6 g
• Bitter orange (zhi ke)                     6-9 g
• Licorice (gan cao)                         3-6 g

Middle Warmer

Decoction to Remove Blood Stasis below the Diaphragm (Ge Xia Zhu Yu Tang)

This formula is used for masses below the diaphragm, fixed abdominal pain, hypochondriac pain, irritability, indigestion, constipation, abdominal tumors, and menstrual issues.

• Angelica sinensis (dang gui)           6-9 g
• Ligusticum (chuan xiong)               6-9 g
• Persica (tao ren)                          6-9 g
• Safflower (hong hua)                    6-9 g
• Lindera (wu yao)                          6-9 g
• Corydalis (yan hu suo)                   3-9 g
• Cyperus (xiang fu)                        3-6 g
• Red peony (chi shao yao)               6-9 g
• Moutan peony (mu dan pi)              6-9 g
• Bitter orange (zhi ke)                     3-6 g
• Licorice (gan cao)                         1-3 g
• Pteropus excrement (wu ling zhi)      6-9 g

Lower Warmer

Decoction for Removing blood Stasis in the Lateral Abdomen (Shao Fu Zhu Yu Tang)

This formula treats abdominal pain with no lumps, or with lumps but no pain, abdominal distention, back pain during menses, irregular menses with purplish-black blood and clots, uterine bleeding with abdominal pain, dysmenorrhea, and amenorrhea.

• Angelica sinensis (dang gui)          6-9 g
• Ligusticum (chuan xiong)              3-6 g
• Red peony (chi shao yao)             6-9 g
• Fennel (xiao hui xiang)                  3-6 g
• Corydalis (yan hu suo)                  3-6 g
• Myrrh (mo yao)                           3-6 g
• Cinnamon bark (rou gui)                3-6 g
• Dry ginger (gan jiang)                    3-6 g
• Bulrush pollen (pu huang)              6-9 g
• Pteropus excrement (wu ling zhi)    6-9 g

Channels and Collaterals

Decoction to Relieve Muscle Ache (Shen Tong Zhu Yu Tang)

This formula treats general body and limb aches and pains including the muscles of the neck, back, legs, shoulder or whole body due to Qi Stagnation and Blood Stasis in the channels. It also treats rheumatoid arthritis and arthralgia.

• Persica (tao ren)                           6-9 g
• Carthamus (hong hua)                    6-9 g
• Angelica sinensis (dang gui)             6-9 g
• Ligusticum (chuan xiong)                 3-6 g
• Notopterygium (qiang huo)               3-6 g
• Gentiana (qin jiao)                          3-6 g
• Earthworm (di long)                        3-6 g
• Myrrh (mo yao)                              3-6 g
• Cyperus (xiang fu)                           1-3 g
• Cyathula (chuan niu xi)                     6-9 g
• Licorice (gan cao)                            3-6 g
• Pteropus excrement (wu ling zhi)        6-9 g

Primavera by Sandro Botticelli, circa 1482

Spring conjures images of life renewed, flowery blooms, love and mating. But for one in five people, it means shutting the windows, missed days at work, and the annual pilgrimage to the local pharmacy to pick up allergy medications, antihistamines, decongestants, combination allergy medicines, and anti-inflammatory medications all with a list of possible adverse reactions, precautions and contraindications. The fact that none offers a cure but only relief is of no matter, because when allergies strike it is relief that is so desperately sought.

Common Ragweed, Ambrosia artemisiifolia

If it is relief that you are after, there is an herb that, for many, effectively relieves hay fever-like allergy symptoms within 15 minutes after ingesting. Believe it or not, it happens to be the highly invasive weed, ragweed (Ambrosia artemisiifolia et spp.). Ragweed is ubiquitous in most parts of the country and ironically is itself responsible for 90% of pollen-induced allergies in the United States. Ragweed is also commonly known as ambrosia or bursage. Ragweed is a member of the Asteraceae family, noted for plants that cause allergic reactions in many. Ragweed is the probably the worst and most notorious of all pollen-caused allergies. In fact, with global warming, there is an increase of pollen generated and a concomitant increase in the prevalence and severity of respiratory allergies.

The great founder of 18^th century homeopathy, Samuel Hahnemann (1755-1843), would love ragweed because it lends proof to a fundamental homeopathic principle, which is “like cures like.” While inhaling ragweed pollen causes mild to severe reactions in those who are sensitive, ingesting 5 to 15 drops of a 5:1 strength herbal extract made from the pre-flowering dried leaves relieves hay fever-like symptoms, not only to ragweed pollen but to all tree pollens, cat and dog dander, mites and mold.

The "like treats like" principle has some possible scientific support. In an attempt to find an easier, more efficient and hopefully cheaper alternative to weekly allergy shots, Dr David Skoner of Allegheny General Hospital discovered that putting liquid drops or a rapidly dissolving tablet of an allergen under the tongue controlled Ragweed allergies enough to negate the need for weekly appointments for allergy shots. He posits that the allergens under the tongue travel directly to lymph nodes where the immune system makes the anti-allergen response to lessen sensitivity, “just like the shots did.” Said Dr. Skoner. This was recently reported in Pittsburgh based WTAE Action News on February 28, 2013.

Santa Cruz County, Calif., happens to be rife with a number of allergy causing pollens, chief of which is from the invasive Acacia tree species. As we age, our immune system eventually wears down; in my case, I notice more that my eyes are more frequently itchy, attested to by the number of OTC eye drops I’ve collected. My friend and colleague Ben Zappin introduced me to some of his ambrosia tincture. He said it is also extremely effective against cat dander. Having two cats and two members of my family who don’t feel it is safe to visit because of cat allergies, I decided to give ambrosia a try. It only took 30 drops of the extract to provide within 15 minutes, complete symptomatic relief for an entire day. I now use it on an as needed basis.

How do we know about ragweed's actions on allergies? In fact very little is known either scientifically or by herbalists about the use of Ragweed for hay fever. It is not mentioned in any of the many herbal texts that I have dating back to the 19th century with the exception of William Cooke’s Physio-Medical Dispensatory where it is described as a stimulating astringent for dysentery, leucorrhea, periodic fevers, and other abnormal discharges with no mention of its use for hay fever symptoms.

In his book Medicinal Plants of the Pacific West, the late herbalist Michael Moore, who personally was close to the traditional Central American native uses of medicinal herbs, describes a standard one- to two-ounce infusion of the flowering herb used for head colds, allergies and moderate histamine reactions.

A more extensive discussion is in herbalist Mathew Wood’s Earthwise Herbal. Wood makes the distinction between allergic symptoms to goldenrod (Solidago spp.) and ragweed and describes how a “nip of the leaf, taken at the time of the allergy, will almost always abort such an (allergic) attack,” with characteristic symptoms of “sneezing, runny nose, bloodshot eyes, swollen capillaries in the eyes, itching of nose and eyes, and in long-term reactions of bronchial congestion.” He offers an energetic description: bitter, pungent and slightly astringent. Wood recommends that the fresh leaves fresh be tinctured 1:2 in 95% alcohol watered down to 70%. He recommends giving only one drop initially to determine sensitivity. If there is no adverse reaction or an improvement in symptoms, five to 10 drops be given every two to three hours as recommended by the early 20^th-century Eclectic herbalist John William Fyfe or 15-20 drops by the contemporary herbalist 7Song.

Herbalist Susun Weed writes in her blog post on ragweed: “The (H)ungarian author (Weixl-Várhegyi László) claims that the he harvests the young plants early, while they are small and eats the plant leaves raw and also dries the rest and makes a powder from it to preserve it for later use for culinary purposes.”  This author claimed to receive this information from a pastor in 1973. Weed also mentions an online discussion where participants shared their personal experiences consuming ragweed tincture and tea with promising results.

I found an interesting reference to it on the Pacific School of Herbal Medicine’s Clinical Tidbits page. There it is stated how it is “well known to herbalists, both mainstream and Californian Native/Hispanic.” The article describes how it slows "copious fluid discharge from the eyes and nose usually within fifteen minutes.” 

Why "Ambrosia?"

Why is this herb, generally considered noxious and invasive, given the name “Ambrosia,” a name whose Greco-roman origins means “food of the gods?”  No one seems to know for sure, but a little known fact offers a clue. It seems that giant ragweed (A. trifida) is a highly nutritious and edible plant suitable for human consumption. The seeds of giant ragweed are 47% crude protein, much higher than any cultivated grain. Furthermore, the plants produce a prodigious amount of seed. According to Roger Wells, a certified wildlife biologist and national habitat coordinator for Quails Unlimited, the seeds contain “the highest amount of metabolizable calories, more even than corn, soybeans, wheat, or any other grain that we know.” Giant ragweed is native to America and has excellent soil-binding qualities. Based on studies in Kentucky of archeological sites,  it was cultivated and nurtured some 2,000 years ago for its nutritional seeds by Native American people living in the Mississippi Valley. Perhaps the name “Ambrosia” may refer to these highly nutritious properties of giant ragweed.

How to Make a Ragweed Tincture

With spring being just a few weeks away, many of you may want to make your own Ambrosia tincture. Following is a recipe I found and intend to follow with my initial explorations using this herb:

1. Trim several flowering tops off the ragweed plants and pack them tightly into a wide mouthed glass jar.
2. Fill the jar with the highest proof vodka or liquor you can obtain such as Everclear.
3. Label the jar with the date and name of the tincture using a marker and scotch tape.
4. Store the jar with ragweed and vodka in a cool, dark place for six weeks.
5. Strain and bottle for use.

The above is adapted from Making a Ragweed Tincture.

After briefly covering the five stagnations in January (Parts 1 and 2) and Qi stagnation in February (Parts 1 and 2), it makes sense to cover Blood stasis next. Qi and Blood are intricately connected in many ways, which means that tonifying or moving one, tonifies or moves the other. So now that we’ve gotten your Qi moving, your Blood is probably flowing better, too. However, Blood stasis can appear by itself and eventually cause Qi to stagnate. And you definitely don’t want your blood to stagnate – it can be MOST uncomfortable!

Blood Stasis

When Blood doesn’t circulate freely, it stagnates. This can occur as sluggish circulation, localized coagulations or fixed masses. Blood stasis tends to be more severe than Qi stagnation partly because it is a substantial fluid in the body. When Qi stagnates, pain is like rush-hour traffic – it comes and goes and changes location and severity – but when Blood congests, pain is like a major traffic accident with trauma, injuries and stabbing sensations.

Signs of Blood Stasis

Generally, three or more signs need be present to identify Blood stasis, but any of the following indicate its presence. While severe pain that is fixed and stabbing is a major sign, it’s possible to have Blood stasis without any pain at all.

• Severe pain that is stabbing or boring in nature and fixed in location
• Purple lips, nails, or tongue
• Masses that are fixed and don’t move
• Bleeding with dark blood and dark clots; larger clots
• Dark to dusky complexion and bluish/purplish skin discolorations (such as bruises; varicose veins; spider veins; dark vasculature; areas of trauma and spots on the skin or mucous membranes such as liver spots); rough scaly dry skin; dry hair
• On palpation, any hard masses; may be painful to the touch

Pulse and Tongue:

• Pulse: rough and “difficult” (like scraping bamboo with a knife), choppy (thready, slow, short and irregular), knotted (slower than 60 BPM with occasional irregular pauses), or accelerated (faster than 80 BPM with irregular pauses)
• Tongue: purple, blue-purple, purple spots; sub-lingual veins (under the tongue) tend to be engorged and purple

Blood Stasis in the Upper Warmer

Purple or blue discolorations, stabbing pains in the head or chest, immobile lumps, masses, tumors, or clots

Blood Stasis in the Heart

Stabbing or pricking pain in the chest, stuffiness of the chest, purple tip or sides of tongue front, distended sub-lingual veins toward front of tongue

Blood Stasis in the Lungs

Stuffiness of the chest, immobile masses, purple tip or sides of tongue front, distended sub-lingual veins toward front of tongue

Blood Stasis in the Middle Warmer

Immobile lumps, masses, tumors, or clots in the middle abdomen

Blood Stasis in the Stomach

Vomiting of dark blood, dark blood in stools, epigastric pain, purple tongue especially in the center and distended sub-lingual veins in the center

Blood Stasis in the Lower Warmer

Severe menstrual pain, dark menstrual blood possibly with larger clots, immobile lumps, masses, tumors, or clots in the lower abdomen

Blood Stasis in the Liver

Purple nails, painful periods with dark menstrual blood possibly with dark, larger clots, PMS pain, purple tongue especially on the sides, and distended sub-lingual veins near the rear

Blood Stasis in the Intestines

Dark blood in the stools, severe abdominal pain, purple tongue at the rear and distended sub-lingual veins at the rear

Blood Stasis in the Uterus

Menstrual pain, pre-menstrual pain, dark menstrual blood with dark and larger clots, abdominal masses, purple tongue and distended sub-lingual veins at the root

Causes for Blood Stasis

Several factors can lead to Blood stasis:

Qi Stagnation: This is the most common cause. Qi moves Blood; if Qi stagnates, then Blood congeals.

Deficient Qi: A deficiency of Qi over time makes it too weak to move Blood.

Heat in the Blood: Heat in the Blood can cause it to coagulate and stagnate.

Deficient Blood: A deficiency of Blood over time causes a deficiency of Qi, which then can’t move Blood so it stagnates.

Internal Cold: Coldness slows the circulation of Blood, which then can congeal. In fact, many people who feel “cold” are actually experiencing poor blood circulation. This especially happens with the elderly or infirm.

Pathogenic Influences: If External Wind invades and pushes deeper into the body, it can cause Internal Cold. As well, External Wind-Cold or Wind-Damp or the congealing actions of warm pathogen diseases can cause Blood to congest.

Dampness and Phlegm: Dampness and/or Phlegm can slow or even obstruct circulation, leading to Blood stasis.

Trauma: Injuries, accidents and other traumas cause Blood stasis, either locally or internally.

Emotions: Any long-term suppressed or unexpressed emotion stagnates the Qi, which in turn can congeal the Blood. As well, restlessness, or irritability and the need to “break out” may be signs of Blood stasis. Some esoteric traditions teach that the personality and karma are carried in the blood. Perhaps this could account for the reason why people with heart transplants often have a personality change for the first two months!

Also, keep in mind that emotions cause chemicals to be released, which then dock on receptor sites of cells to create changes in the body. According to Candace Pert (Molecules of Emotions: The Science Behind Mind-Body Medicine, Simon and Schuster, NY, 1999), these chemicals of emotion don’t just occur in the brain but exist everywhere in the body. These are produced directly at a cellular level when the neuropeptides bind with receptors, and your heart holds every single neuropeptide receptor. This means it’s very possible that emotions are carried through our blood stream, affecting its volume, flow and quality.

Diet: A diet rich in raw foods, salads and/or fruit, foods eaten directly out of the refrigerator or freezer (like milk, yogurt, ice cream, popsicles, or frozen yogurt), cold drinks (such as iced water or iced tea and juices) and cold-energied foods (such as soy milk, tofu, watermelon, bananas, crabmeat, shellfish) cause Coldness, which congests the blood. Hot, spicy foods, caffeine, and alcohol cause Heat in the Blood. If there’s also Qi stagnation avoid Qi-stagnating foods (listed here). If there is deficient Blood, then inadequate intake of food in general and protein in particular can lead to deficient Blood, which eventually causes Blood stasis.

Lifestyle Habits: External injuries, traumas, and accidents directly cause Blood stasis. Other causes include: insufficient dressing for the weather, such as including bare neck, back and midriff causes Cold to penetrate and lodge in the Interior; insufficient activity/movement causes Qi to stagnate, which in turn causes Blood stasis; and overuse of hot tubs and saunas thins the blood, possibly leading to deficient Blood and from there, Blood stasis, or disperses the Yang, causing Internal Coldness and then Blood stasis.

What is the Difference Between Qi Stagnation and Blood Stasis?

Blood Pathologies

 Blood stasis can be involved in such conditions as joint or muscle pain, tumors, gynecological disorders, cancer, fibroids, arthritis, intractable pain, angina, abdominal masses, heart disease, coronary artery disease, migraines, Reynaud’s, intercostal neuralgia, pain due to external injuries, Peyronie’s disease, emotional instability, insomnia, irritability, restlessness, vertigo, tinnitus, constipation, incontinence of urine, hard palpable masses, lumps and tumors, eczema, urticaria, dry, rough and itchy skin, abscesses and other skin diseases or sores, severe pain in the muscles, numbness or paralysis of the limbs, joints, muscles and nerves, angina pectoris, gastritis, ulcers, hepatitis, cholecystitis, pancreatitis, polycystic ovaries, infertility and more.

Hidden Pathology

 Blood stasis is often considered a “silent killer” because it can be the hidden pathology behind other issues. Any long-term condition that can’t be resolved generally has blood stasis involved.

In Part II we will discuss treatments and therapies for Blood stasis. However, if you feel stagnant just by reading all of this, I suggest you immediately get up and MOVE, just as for Qi stagnation, as that’ll get your blood circulating, too!

Before there was any understanding of biochemical constituents, traditional herbal healing systems relied on flavors as indicators of medicinal properties. (Determining the properties and quality of an herb by its taste, color, texture, etc., is called “organoleptic” assessment.) Traditional herbalists have long associated corrective and potent therapeutic value intrinsic to the flavors, as follows:

Sweet – nourishing, tonic
Pungent or spicy --- metabolically stimulating and warming
Salty – affecting body fluids
Sour – Promoting digestion (as with fermented foods)
Bitter – clearing, detoxifying

To these, Ayurveda adds “astringent” as a sixth flavor, while Traditional Chinese Medicine (TCM) adds “bland” another extra “non-flavor,” so to speak.

Flavors are perceived by taste receptors (taste buds) located on the upper surface of the tongue, soft palate, upper esophagus and epiglottis. The taste receptor cells send information to gustatory areas of the brain that influence our predilection or repugnance to certain foods.

Today, we know that the flavors are generally identified with known biochemical constituents. The bitter taste usually elicits a strong repugnance with the intention to protect us from non-nourishing and possibly poisonous substances. Biochemistry associated with the bitter flavor happens to include a large number of constituents with known therapeutic value such as alkaloids, bitter glycosides and so forth.

However, could it be that the bitter flavor itself, apart from its associated constituents, possesses its own intrinsic therapeutic value?

The well known traditional herbal principle of flavors may have found scientific vindication with this recent paper published in the Journal of the Federation of American Societies for Experimental Biology (FASEB) entitled “Extraoral Bitter Taste Receptors as Mediators of Off-target Drug Effects.” Here, a novel hypothesis offers a possible explanation as to why many drugs seem to affect conditions and diseases other than the ones which they are intended to treat:

“(W)e propose that any drug with a bitter taste could have unintended actions in the body through stimulation of extraoral type 2 taste receptors (T2Rs). T2Rs were first identified in the oral cavity, where they function as bitter taste receptors. However, recent findings indicate that they are also expressed outside the gustatory system, including in the gastrointestinal and respiratory systems. . . Bitter-tasting compounds can have specific physiological effects in T2R-expressing cells. . . . If our hypothesis is confirmed, it would offer a new paradigm for understanding the off-target actions of diverse drugs and could reveal potential new therapeutic targets.”

T2R taste receptors found in the gastrointestinal system may provide a rationale as to why and how bitter flavored herbs (often called “bitters” as they are sold in innumerable alcoholic beverages throughout the world) can be used to treat different physiological diseases. T2Rs found in the respiratory smooth muscle system affect breathing and bronchodilation, which may substantiate at least one aspect of how bitter tasting herbs such as wild cherry bark and elecampane are effective for asthma and other chronic and acute respiratory diseases.

Of course, the authors of this study did not set out to make a statement regarding the efficacy of the flavors associated with herbs, but their research may provide supporting evidence for how the flavor of an herb may direct its effects.

From an herbalist’s perspective, a drug may be viewed in terms of its pharmacological action and its overall metabolically heating or cooling energy. There are many implications with all of this; for example, we may not only understand off-label benefits of certain drugs, but we can also appreciate how certain drugs such as antibiotics, corticosteroids and others, while good for a specific disease, may be especially contraindicated and harmful for some patients more than others.

In Part 1 we learned about the many signs and symptoms of Qi stagnation and its far reaching affects on physical and mental health. In this segment we’ll cover how to treat and prevent Qi stagnation. Of course you’ll be immediately interested in the herbs and formulas to use, but first I’ll cover other therapies since they are integral, even essential, to preventing and treating this issue.

Therapies for Qi Stagnation:

Diet Therapy:

Foods to Eat: Foods that decongest and aid the Liver include vegetables, bitter foods and dark leafy greens such as kale, collards, dandelion, mustard, beet and mustard greens. Lemon juice also helps decongest the liver. A good morning liver cleanse is a fresh squeezed lemon in water with 1 or 2 teaspoons of olive oil and a couple of “00” sized capsules of cayenne pepper. This is followed with fennel seed tea.

Foods to Avoid: Avoid fried, fatty and oily foods, nuts and nut butters, avocados, cheese and dairy, chips of all kinds, turkey and red meats, alcohol, spicy foods, caffeinated foods and drinks, coffee, black tea, cocoa, colas and chocolate, recreational drugs and stimulants.

Emotional Therapy: Turning the “vices” of the Liver into “virtues” helps smooth Liver Qi Stagnation. The Liver’s vices are anger and frustration; its virtues are benevolence, forgiveness, esteem, respect and kindness. Ever hear of that saying, “Do acts of kindness?” Such actions actually cultivate the positive aspects of the Liver and help Qi flow smoothly and regularly. There are many ways to do this; choose ones that express and release emotions in constructive ways and cause no harm to you or others. Above all, do not repress or stuff your emotions, as this is what helped create these physical symptoms in the first place. Of course my new book, Metaphor-phosis: Transform Your Stories from Pain to Power, is a perfect tool to help you do this!

Lifestyle Therapies: To rebalance the Liver, go to sleep by 11 PM at the latest, move regularly through walking, dancing, swimming, cycling, jogging, exercise, hiking (especially in the woods), Tai Chi, Qi Gong, yoga or another physical activity and regular exercise, and engage in creative projects as this releases pent-up Liver energy and moves Qi. For computer work (and other electronic tools) and desk jobs, be sure to move and/or stretch for five minutes every 30 – 60 minutes. 

Other Therapies: Participate in regular life activities, sex and exercise as regularity of habits helps regulate Qi. Go to sleep by 11 pm at the latest since the Wood Element time of the Liver and Gallbladder does its major work from 11 pm – 3 am (if there’s also Deficient Kidney Yin, go to bed by 9 - 9:30 PM). Find work and jobs you enjoy and are fulfilling. Alternate work with rest and play as over-working can cause this pattern. Do cupping (especially over the back), dermal hammer where needed, breathing exercises, abdominal massage, massage therapies, singing and wear a haramaki around the waist to keep the kidneys warm, the “mother” of the Liver.

Herbal Therapy: Finally - herbal therapy for Qi stagnation! This encompasses so many herbs and formulas that we can’t cover them all here, but I’ll give you enough juicy ones to start exploring. First of all, herbs that move Qi are those that help it move smoothly, regularly and in the right direction. In Western herbalism this includes carminatives. Examples include:

• Bupleurum (Bupleurum falcatum; chai hu)
• Citrus peels (Pericarpium citri reticulatate; chen pi, qing pi, zhi ke, zhi shi, fo shou)
• Cyperus (sedge root, Cyperus spp. Especially C. rotundus, xiang fu)
• Chinese rose buds (Rosae rugosa; mei gui hua)
• Mint (Menthae haplocalycis; bo he)
• Fennel seed (Foeniculi fructus; xiao hui xiang)
• Saussurea (Aucklandiae lappa; mu xiang)
• Aquilariae (aloeswood; Aquilaria sinensis; chen xiang)
• Persimmon calyx (Calyx Diospyros kaki; shi di)
• Sandalwood (Santalum album; tan xiang)
• Lindera (Lindera spp.; wu yao)
• Chinese garlic (garlic chive; Allium macrostemon; xie bai)
• Cumin (Cuminum cyminum)
• Vitex (V. Agnus-castus)
• Areca peel (Arecae pericarpium; da fu pi)
• Melia (Sichuan chinaberry, Sichuan pagoda tree; Melia toosendan; chuan lian zi)

Qi-regulating herbs tend to be aromatic, warm and acrid or bitter in energy, treating symptoms of pain that comes and goes, and/or changes location and severity; distention, stifling feelings in the chest, belching, nausea, vomiting, wheezing, acid regurgitation, loss of appetite, diarrhea or alternating diarrhea or constipation, pain in the flanks or under the ribs, depression, mood swings, and hernias.

Qi-moving herbs are rarely used alone; rather they are combined with others based upon the nature of the condition being treated. Typically, they are combined with Blood-moving herbs as Qi and Blood are intricately intertwined. For this reason, when one tonifies Qi, it’s important to tonify Blood and when one moves Qi, it’s also important to move Blood.

Kitchen medicine: For quick use around the home, I find citrus peel tea to be very effective to move Qi. While the Chinese use mandarin orange peels, in Italy I was surprised with lemon peel tea after one dinner. As well, rose buds make a wonderful jam, delighting the senses and spirit as well as moving Qi. Fennel seeds, normally found mixed with sugar and taken after dinner in Indian restaurants, are great as a tea, eaten raw or toasted and cooked with vegetables and meats.

Caution: Because Qi-moving herbs tend to be warming and drying, use with caution in those with Deficient Blood or Yin, or Excess Heat; because they are dispersing, use with caution if there’s Deficient Qi.

Qi-Moving Formulas:

There are lots of formulas that move the Qi and many are available in Chinese patent teapill form, which are easy to find and take. Because bupleurum is one of the major Qi-moving herbs, there are literally dozens of formulas based on this herb alone. Perhaps one of the best known is Bupleurum and Dang Gui Formula (Xiao Yao San) and its variation, Bupleurum and Peony Combination (Jia Wei Xiao Yao San). These two formulas treat most symptoms of Liver Qi stagnation. The first is more warming while the second also clears Heat.

Bupleurum and Dang Gui Formula (Rambling Powder, Xiao Yao San,or in Planetary Formulas: Bupleurum Calmative):

• Bupleurum (chai hu), 6-9g
• Dang gui (dang gui), 6-9g
• White peony (bai shao), 9-12g
• White atractylodes (bai zhu), 6-9g
• Poria (fu ling), 9-15g
• Mint (bo he), 1-3g
• Fresh ginger (shen jiang), 1-3g
• Baked licorice (zhi gan cao), 3-6g

Bupleurum and Peony Formula (Jia Wei Xiao Yao San):

Add to the above formula:

• Gardenia fruit (zhi zi), 1-3g
• Moutan peony (mu dan pi, tree peony), 3-6g

Uses: Both formulas regulate the function of the Liver and Spleen, move Liver Qi stagnation and replenish Blood. They are used for anemia, costal pain, headache, mouth and throat dryness, dizziness, lassitude, loss of appetite, irregular menses, leukorrhea, uterine bleeding, PMS, mood swings, depression, breast distention, chronic hepatitis, and alternating chills and fevers as in shao yang stage diseases.

Other Bupleurum Formulas to Consider:

• Minor Bupleurum (Xiao Chai Hu Tang)
• Major Bupleurum Formla (Da Chai Hu Tang)
• Bupleurum and Chih Shih Formula (Frigid Extremities Powder or Si Ni San)
• Bupleurum and Cinnamon Combination (Chai Hu Gui Zhi Tang)
• Bupleurum and Dragon Bone Combination (Chai Hu Jial Long Gu Mu Li Tang)
• Bupleurum and Schizonepeta Formula (Shih Wei Pai Tu Tang)
• Bupleurum Formula (Yi Gan San)

More Useful Qi-Moving Formulas:

• Pinellia and Magnolia Combination (Ban Xia Hou Pu Tang)
• Powder to Disperse Vital Energy in the Liver (Chai Hu Shu Gan San)
• Pills of Tangerine Seed (Ju He Wan)

Happy Spring to you! May your Qi flow smoothly and your energy rise with the sap in trees!