Tong Qiao Huo Xue Tang

What Tong Qiao Huo Xue Tang is for

This is the formula for skin that has lost its normal colour because the Blood has stopped moving in the head and face: a dusky or purple cast, dark patches, dark circles, and the thickened, sluggish skin of long-standing facial stasis. It moves the Blood and uses aromatic opening herbs to carry that action to the face.

The colour is wrong rather than the surface broken. The face carries a dusky or purple cast, dark patches sit where circulation has failed, and the skin may look thickened and dull around the nose. The discolouration is long-standing and unresponsive to ordinary treatment, and the skin can lose its normal tone and sensation. There is no acute redness or infection, only a face that has been under-supplied for a long time.

Tao Ren, Hong Hua, Chi Shao and Chuan Xiong move the Blood and open the vessels, and Chuan Xiong also carries the action upward. She Xiang is used in a tiny dose because it is strongly aromatic: it opens the orifices and reaches the head, which is what allows a Blood-moving action to work on the face. Sheng Jiang and Cong Bai open the surface so the action arrives there, and Da Zao supports the middle. Opening and moving together is why it reaches a region the larger body-stasis formulas do not.

It is a short-course formula for long-standing facial stasis without marked deficiency, and it is contraindicated in pregnancy because the moving and opening herbs are strong. It is not for acute facial redness or infection, and it does not reverse depigmentation directly, so vitiligo needs proper assessment rather than being treated as a pigmentation problem alone. She Xiang is a controlled substance in many places, and the formula requires a practitioner.

Actions

• Invigorates Blood and dispels stasis
• Opens the orifices and reaches the head
• Improves facial circulation and colour
• Relieves fixed head pain from stasis

Properties

• Taste and temperature: Predominantly pungent and aromatic with a warm quality. Pungent and warm move Blood and open the orifices, aromatic substances reach the head.
• Organs: Heart, Liver
• Channels: Heart, Liver

The pattern behind it

The pattern is Blood stasis in the head and face. The stasis prevents proper circulation to the surface of the head, producing dusky colour, fixed pain and loss of normal skin colour. The formula moves the Blood and uses aromatic opening herbs to reach that region, which is why it is used for facial stasis rather than general stasis.

Composition

The herbs in Tong Qiao Huo Xue Tang, with their role and dose.

Patterns it treats

How the formula is built

The formula moves Blood and opens the way for it. Tao Ren, Hong Hua, Chi Shao and Chuan Xiong break the stasis; She Xiang, Cong Bai and Sheng Jiang open and carry the action to the head and face. That combination of opening and moving is why it reaches a region the larger body-stasis formulas do not.

Skin conditions it is used for

Where this formula appears in the skin conditions of the library.

Preparation and use

Decocted in water, traditionally taken with a little wine, in short courses.

Modifications

• If the stasis is very fixed, the moving group is increased cautiously.
• If the person is depleted, tonic support is added.
• If Heat is present, cooling herbs are added and the warming reduced.
• For chronic facial discolouration, the course is repeated with review.

Timing

Taken warm, traditionally in the evening, in short courses of three to six doses.

Duration

Short course: traditionally three to six doses taken with reassessment, and repeated only under supervision.

Diet while taking it

Avoid cold and raw food, since Cold congeals Blood.

Safety

Interactions

The Blood-moving herbs may add to anticoagulant and antiplatelet medication. She Xiang is a potent substance used only in very small doses under supervision.

Pregnancy

Contraindicated. She Xiang is a powerful opening substance and the Blood-moving herbs are strong, so the formula is unsuitable in pregnancy.

Breastfeeding

Use only under professional guidance.

Children

Used only with professional supervision.

Before you use it

Recorded from the classical record and rewritten in this project's own words. Educational only: not a prescription. She Xiang is a controlled substance in many places and the formula requires a practitioner.

General safety references

General references for herbal hepatotoxicity and herb-drug interactions; they are not specific to this formula.

• Review article: Herbal hepatotoxicity - an update on traditional Chinese medicine preparations. Alimentary Pharmacology & Therapeutics, 2014. PMID: 24844799.
• Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs, 2009. PMID: 19719333.
• Warfarin and food, herbal or dietary supplement interactions: a systematic review. British Journal of Clinical Pharmacology, 2021. PMID: 32478963.

Selected PubMed records

Real PubMed records for the modern, non-TCM discussion of this formula. They are references, not a claim that the formula is proven for any skin condition.

• Tongqiao Huoxue Decoction for the treatment of acute ischemic stroke: A Systematic Review and meta-analysis.. Journal of ethnopharmacology, 2022. PMID: 34600074.

Origin and history

Yi Lin Gai Cuo (医林改错, Corrections of Errors among Physicians) by Wang Qingren, Qing dynasty, 1830.

Wang Qingren built a series of stasis formulas in 1830, each for a region of the body. This one is for the head, and its use of musk reflects the idea that only an aromatic, opening substance can carry a Blood-moving action through the dense region of the head.

Classical record

Related formulas

Evidence note

No controlled trial of this treatment in skin conditions was identified for this entry. What is described here rests on the classical and later materia medica record and on traditional clinical use, not on controlled trial evidence, and it is not a prediction of benefit. Where skin-specific research does exist it is linked above.