What Xue Fu Zhu Yu Tang is for
The skin shows colour that should have cleared. Patches are purplish or dusky, firm to the touch and tender, and they fade slowly or not at all. Bruises last far longer than they should and settle into a hard dark centre. A boil that has hardened rather than settled behaves in the same way. The explanation is Blood that has stopped moving and pooled, so the tissue is congested, discoloured and slow to repair.
The colour is the marker: a dull purple or brownish red that does not blanch fully when pressed, with a defined edge. The tissue is firm and slightly nodular, and the tenderness sits in one spot rather than spreading. The skin around it can look dusky as well. Old injuries, slow bruises and hardened lesions all show this, and the surface is neither hot nor weeping, which is what separates stasis from active inflammation.
Tao Ren, Hong Hua, Chi Shao, Chuan Xiong and Niu Xi break the Blood that has settled, and that is what restores colour to the tissue. Chai Hu, Zhi Ke and Jie Geng restore the Qi movement that should be driving the Blood, so it does not pool again in the same place. Dang Gui and Sheng Di Huang protect the Blood from being consumed by all that breaking, and Gan Cao holds the middle. The patches soften, the colour fades and bruises clear in the normal time.
It is not a formula for early or acute inflammation. Hot, red, swollen, spreading skin is a Heat or Damp-Heat picture, and moving Blood hard would make it worse. Because it breaks Blood strongly, it is contraindicated in pregnancy and during heavy bleeding, and it needs care with anticoagulant medication. A hardened or discoloured patch that is changing should be assessed medically before it is read as stasis.
Actions
- Invigorates Blood and dispels stasis
- Moves Qi and alleviates pain
- Opens the chest and disperses stagnation
- Courses the Liver and resolves constraint
- Guides herbs and Blood downward
Properties
- Taste and temperature: Predominantly pungent and bitter with a sweet undertone. The pungent quality moves Qi and Blood, the bitter directs downward and clears stasis-Heat, and the sweet harmonises and nourishes so the moving herbs do not damage the Blood.
- Organs: Heart, Liver
- Channels: Heart, Liver, Lung, Stomach
The pattern behind it
The pattern is Blood stasis with Qi stagnation. Qi is what moves Blood, so when Qi is constrained the Blood slows and pools, and once pooled it produces fixed pain and colour change. The formula addresses both: it breaks the standing stasis and restores the Qi movement that prevents it from reforming, while the nourishing herbs protect the Blood that all that breaking could otherwise consume.
Composition
The herbs in Xue Fu Zhu Yu Tang, with their role and dose.
| Role | Herb | Dose | Properties | Why it is there |
|---|---|---|---|---|
| Tao Ren | 12 g | Neutral, Bitter, sweet | Breaks Blood stasis, particularly where the stasis is fixed and the pain is sharp. | |
| King | Hong Hua | 9 g | Warm, Pungent | One of the chief Blood-moving herbs, used to open the vessels and disperse stasis. |
| King | Chi Shao | 6 g | Slightly cold, Bitter | Cools and moves Blood together, which suits stasis that has begun to generate Heat. |
| Chuan Xiong | 5 g | Warm, Pungent | Moves Qi and Blood at once, addressing both sides of the stagnation. | |
| Niu Xi | 9 g | Neutral, Bitter, sour | Moves Blood downward, which is why the formula is said to guide the Blood down and out of the chest. | |
| Dang Gui | 9 g | Warm, Sweet, pungent | Nourishes Blood while keeping it moving, so the breaking does not leave the person depleted. | |
| Sheng Di Huang | 9 g | Cold, Sweet, bitter | Nourishes Yin and cools the Blood, balancing the warming moving herbs. | |
| Envoy | Jie Geng | 5 g | Neutral, Bitter, pungent | Opens the chest and guides the other herbs upward to the region of the stasis. |
| Zhi Ke | 6 g | Slightly cold, Bitter, pungent, sour | Moves Qi downward in the chest, relieving the fullness that accompanies the stasis. | |
| Envoy | Chai Hu | 3 g | Slightly cool, Pungent, bitter | Courses the Liver and moves Qi, addressing the constraint that allowed the stasis to form. |
| Gan Cao | 3 g | Neutral, Sweet | Harmonises the formula and supports the middle. |
Patterns it treats
Blood Stagnation
Purplish, firm, tender patches and bruises that fade slowly, on skin that is neither hot nor weeping. Blood has stopped moving and pooled, so the tissue is congested and discoloured, and the colour does not clear in the normal time.
How the formula is built
The design is a pincer. Tao Ren, Hong Hua, Chi Shao, Chuan Xiong and Niu Xi attack the Blood that has stopped moving; Chai Hu, Zhi Ke and Jie Geng restore the Qi movement that should have kept it going and open the chest so the Blood can descend; and Dang Gui with Sheng Di Huang protect the Blood from being over-consumed in the process. Gan Cao holds the middle together. That is why the formula is used for fixed pain rather than for general poor circulation.
Skin conditions it is used for
Where this formula appears in the skin conditions of the library.
Preparation and use
Decocted in water and taken warm, in two divided doses through the day.
Modifications
- If the pain is severe and fixed, the Blood-breaking herbs are increased.
- If Qi constraint dominates, Chai Hu and Zhi Ke are increased.
- If the person is depleted, the nourishing herbs are increased so the moving does not exhaust them.
- Where Cold is part of the picture, warming herbs are added, since Cold congeals Blood.
Timing
Taken warm in two divided doses through the day.
Duration
Typically two to four weeks then reassessed. Acute post-traumatic pain may settle in three to seven days; chronic cases may need four to eight weeks with periodic review.
Diet while taking it
Avoid cold and raw food while taking it, since Cold congeals Blood and works against the formula.
Safety
Contraindications
Avoid in pregnancy and during heavy bleeding, since the formula strongly moves and breaks Blood. Avoid in acute skin inflammation that is red, hot and spreading, and in anyone who is actively bleeding.
Interactions
This is the most important caution for this formula: multiple herbs have Blood-moving effects and may add to anticoagulant and antiplatelet medicines such as warfarin, heparin, aspirin, clopidogrel, rivaroxaban or apixaban, increasing bleeding risk.
Pregnancy
Contraindicated. Tao Ren and Hong Hua are the chief herbs and are classically contraindicated in pregnancy because they break Blood stasis and may provoke uterine contractions, and Niu Xi is also classically listed as unsuitable.
Breastfeeding
Use only under professional guidance because of the strong Blood-moving action.
Children
Used in children only with professional supervision and adjusted dose.
Before you use it
Recorded from the classical record and rewritten in this project's own words. Educational only: not a prescription, and it should be used under professional supervision.
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.
Origin and history
Yi Lin Gai Cuo (医林改错, Corrections of Errors among Physicians) by Wang Qingren, Qing dynasty, 1830 CE.
Wang Qingren (1768 to 1831) was a Qing dynasty physician from Yutian county who dissected bodies and rewrote anatomy as he found it, then built formulas around the idea that many chronic illnesses come from Blood stasis. Xue Fu Zhu Yu Tang is his best-known formula, published in Yi Lin Gai Cuo in 1830, and the long list of symptoms he associated with it shows how broadly he applied the stasis idea: chest pain, headache, palpitations, poor sleep and more.
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.
Common questions
Why does a stasis formula contain Qi-moving herbs?
Because Qi moves Blood. If the constraint that slowed the Blood is left in place, the stasis reforms, so the formula moves both together.
Is it suitable for any dark bruise?
No. It suits fixed, dark, tender and slow-resolving marks with a purple tongue. A fresh red, hot or spreading lesion is a different pattern and this formula would not be appropriate.
Can it be taken with blood thinners?
Only with medical advice. Several herbs in the formula may add to anticoagulant and antiplatelet medication and increase bleeding risk.
How long is it used for?
Usually two to four weeks before reassessment. Acute pain may settle within a week; chronic pain may need longer with periodic review.