A DISCUSSION ON THE TRADITIONAL CHINESE MEDICINE
CONCEPT OF QI AND BLOOD STAGNATION
E. F. BLOCK IV
JULY 2007
Updated February 2011

INTRODUCTION

Much of traditional Chinese medicine (TCM) is empirical in nature and based upon the limited knowledge available at the time of conceptualization as to the state of physiology and anatomy of the human body. The knowledge base from which the philosophy of TCM has developed expanded into recent times as the practice, teaching and cataloging of TCM continued throughout the history of the Chinese people. Modern science has given us much information as to the detailed anatomy and physiology of the human body only in recent times. Thus, the terms created to define the physiological concepts of TCM may seem a bit antiquated and na´ve in some descriptive respects. However, it is to be noted that TCM has always ascribed a role for the emotions and thought of people as affects their health from very early on in the development of TCM concepts. The western sciences are only now beginning to detail these same mental and emotional aspects of the human condition in relation to the etiology of disease and their effects upon health.

This work will endeavor to bring together the best of both worlds, East and West, and offer an explanation of what Qi stagnation and Blood stasis actually is and how any clinical treatment may be derived to speed recovery and return to health, in regards to these conditions.

DISCUSSION

It is always good to start things off with a description of what is being discussed. Since we are discussion Qi stagnation (QS) and Blood stasis (BS), either separately or in combination, a brief TCM (1) and western medicine (WM) description of each condition follows.

TCM Qi Stagnation - the clinical manifestations of Qi stagnation are:

  1. Distension in the chest, epigastrium or abdomen
  2. Distending pain that moves from place to place
  3. Abdominal masses that appear and disappear
  4. Abdominal distension and pain that is not relieved by a bowel movement
  5. Premenstrual tension, dysmenorrhea
  6. Mental depression, mood swings, a gloomy feeling, frequent sighing
  7. Headache, irritability
  8. Constipation with small round stools

TCM Qi Stagnation Tongue signs are: normal body color or slightly red on the sides with severe Qi Stagnation. TCM Pulse signs are: wiry.

WM has no concept of anything like Qi Stagnation as such.

TCM Blood Stasis - the clinical manifestations of Blood Stasis are:

  1. Dull/dark complexion, purple lips, purple nails, purple petechiae, purple venules
  2. Pain that has the quality of boring in, fixed and stabbing and may be worse at night
  3. Abdominal masses that do not move
  4. Bleeding with dark blood and dark clots

TCM Blood Stasis Tongue signs are: purple. TCM Pulse signs are: choppy or fine.

WM (2) Blood Stasis clinical manifestations are:

  1. Polycythemia - thrombotic disorders as myocardial infarction, stroke, peripheral vascular disease and deep vein thrombosis; an increase in blood viscosity that leads to reduced blood flow, splenomegaly, hepatomegaly, acne rosacea, urticaria, leg ulcers, loss of vision
  2. Essential Thrombocythemia - spontaneous bruising, epistaxis, mucosal bleeding, thrombotic occlusion of arteries, myocardial infarction, stroke, gangrene, intestinal infarction, splenic atrophy
  3. Platelet Defects - easy bruising, epistaxis, intestinal bleeding, persistent menorrhagia, mucous membrane bleeding in the mouth
  4. Vascular and Nonthrombocytopenic Purpura - easy bruising, epistaxis, excessive bleeding after surgery or during menstruation; result of scurvy (Vitamin C deficiency)
  5. Disorders of Blood Coagulation
    • Coagulation factor defects - hemarthrosis with hotness, redness swelling and pain and muscle cuff atrophy; compression neuropathy, cerebral hemorrhage; intrarenal bleeding & hematuria, intestinal bleeding and obstruction
    • Vitamin K Deficiency- newborn hemorrhagic disease, hemorrhage
    • Thrombophilia - venous thrombosis, arterial thrombosis
    • Disseminated Intravascular Coagulation - loss of hemostasis and excessive bleeding, fever, acidosis, hypoxia and hypotension, excessive petechiae

Criteria utilized in making a TCM diagnosis of Qi stagnation and Blood stasis take into account the quality of pain, the time of pain, the area of pain and the response of pain to pressure and temperature.

  1. Quality of the Pain
    • Boring Pain - an excess condition, this is pain that feels as if the point of sharp implement is being pushed into the tissue at a fixed location. It may occur anywhere and it is due to BS.
    • Colicky Pain - an excess condition, this is pain that results from the spasmodic and cramping of smooth muscle in the intestinal tract and uterus. It is typical of BS or Cold.
    • Cutting Pain - an excess condition, this is very sharp pain that feels like a knife being drawn through the tissue. It usually occurs in the lower abdomen and is due to BS.
    • Distending Pain - an excess condition, this is pain that is accompanied by a sensation of distension (bloating) and is typical of QS, especially of the Liver. This distension may be felt upon palpation when the area feels distended like a drum, especially on the abdomen.
    • Pushing Pain - an excess condition, this is pain accompanied by a feeling that something is pushing outwards in the epigastrium or hypochondrium that is due to severe QS.
    • Spasmodic Pain - an excess or deficiency condition, this is pain accompanied by the sensation of voluntary (striated) muscle spasm in the limbs and tendons. It may be due to Liver QS (excess) or Liver Blood deficiency (deficiency).

  2. Time of the Pain
    • Daytime - usually due to a dysfunction of Qi or Blood
    • Night time - it is due to BS
    • Intermittent - it is due to QS
    • Continuous - it is due to BS
    • Pain after eating - it is due to QS or BS
  3. Area of the Pain
    • Localized Pain - BS
    • Moving Pain - QS
  4. Response of Pain to Pressure and Temperature
    • Aggravated by pressure - QS and BS
    • Ameliorated by pressure - a deficiency condition
    • Alleviated by warmth - Cold or Yang deficiency
    • Alleviated by cold - excess Heat

The TCM Differentiation of Zang-Fu Pain versus Channel Pain

Here we distinguish between the differentiation of pain due to the involvement of the Zang-Fu with their respective channel(s) and that due to pain in just the channel(s) alone. Most pains due to sprains, trauma or Bi syndromes (due to Wind, Cold or Dampness) involve the channels only. Thus, most pain inside of the body proper, apart from deep trauma, involves the Zang-Fu and their respective channel(s). Channel pain rarely derives from Zang-Fu disharmonies. The two most important diagnostic factors when confronted with pain then are:

  1. Pain that is derived from excess or deficiency condition(s)
  2. Pain that involves the channel(s) only or the Zang-Fu and the channel(s)

The TCM diagnosis of Qi Stagnation (3)

  1. Causes - mental and emotional disturbances, dietary irregularities, contraction of external evils, external injury (trauma)
  2. Pattern Identifications
    • Chest and hypochondrium - local distension and pain
    • Gastrointestinal - painful distension in the abdomen
    • Abdominal lump glomus - soft to the touch and disperses and reforms periodically
    • Liver channel - breast distension
    • Large Intestine - tenesmus
  3. Concomitant Western conditions - gastrointestinal neurosis, chronic gastritis, chronic enteritis, ulcers, diseases of the biliary tract, chronic hepatitis
  4. Treatment
    • Herbal - si ni san (Counterflow Cold Powder), chai hu shu gan san (Bupleurum Liver-Coursing Powder)
    • Acupuncture - Lv2, Lv3, Lv14, LI4, LI11, SJ6, GB34, St36

The TCM diagnosis of Blood Stasis (4)

  1. Causes - trauma, hemorrhage, QS, Qi deficiency, blood cold, blood heat
  2. Pattern Identification
    • Pain - locally fixed and stabbing
    • Masses and Swellings - trauma yields blood accumulations that may turn into concretions internally or bruises in the skin (green-blue or purple)
    • Bleeding - static blood obstructs the vessels and blood coming into the area may then extravasate into the surrounding tissues due to the blockage. Recurrent bleeding is a sign of BS, particularly in menstrual irregularities, and is characterized by dark purple and clotted blood in menstrual discharge.
    • General signs - the complexion tends to be dull and dark. The tongue is dark and purple, with speckles. The Pulse is fine and rough. The skin may be dry, rough and lusterless with red speckles and purple macules. There may be spider nevi and caput medusae on the abdomen. When BS overwhelms the Heart, there may be raving, delirious speech and mania. Static blood obstructing the vessels may cause internal water accumulations by restricting the free flow of fluids.
  3. Concomitant Western conditions - cardiovascular disorders, hepatosplenomegaly, menstrual irregularities, heterotopic pregnancy, postpartum diseases.
  4. Treatment
    • Herbal - tao hong si wu tang (Peach Kernel and Carthamus Four Agents Decoction), xue fu zhu yu tang (Dwelling Place of Blood, Stasis-Expelling Decoction), tao ren cheng qi tang (Peach Kernel Qi-Infusing Decoction), da huang zhe chong wan (Rhubarb and Wingless Cockroach Pill).
    • Acupuncture - stasis transforming: Lv1, Lv2, Lv3, UB60, LI11, Sp1, Sp6, Sp8, Sp10, Pc5; mental/emotional disturbances: Ht7, Pc7, Du26.

Qi stagnation over a long period of time (relative and different for each person but we are talking about many hours and days) is able to lead to a condition where the Qi cannot move the Blood and this causes the Blood to stagnate (pool) or congeal (coagulate). This pattern is most commonly seen in cases of Liver Qi Stagnation that is due to emotional and mental issues. If Blood becomes deficient in some way, this eventually will lead to Qi deficiency as Qi is said to move with Blood. Then, if the deficient Qi fails to move the Blood, Blood stasis ensues. This is a pattern seen commonly after childbirth, excessive menstrual bleeding and hemorrhage due to trauma. In the case of physical trauma, both Qi and Blood stagnate in the same location due in part to the disruption of vascular integrity and subsequent extravasation of "blood" into the surrounding tissues. Stagnation can also occur in the channels and the Zang-Fu depending upon the type and severity of injury. Thus, we have 3 distinct types of stagnation/stasis that needs to clarified. They are trauma that is due to: 1. direct physical injury 2. emotional and mental state disharmony and excess 3. obstruction of the channel(s).

At this point, I would like to continue with a detailed description, from a Western science view, of the sequence of events subsequent to direct physical trauma in tissue. "A wound is a type of physical trauma wherein the skin is torn, cut or punctured (an open wound) or where a blunt force trauma causes a contusion (a closed wound)". (5) Wound healing is arbitrarily divided into 4 phases that grade into one another sequentially: inflammation, proliferation, maturation and remodeling.

The inflammatory process starts immediately upon rending the structural integrity of the tissue(s) involved and the blood vessels & nerves that goes to and comes from the area of trauma. The exposure of extracellular matrix (ECM) components from the edges of the cut vessels and the surrounding ECM to blood platelets, causes the platelets to begin a cascade of events that results in the formation of a clot in order to stem the extravasation of blood. The release of "blood" into the surrounding tissue(s) causes an imbalance in osmotic pressures between the tissue and the blood fluid within the vessels that results in tissue swelling. A net movement of water into the area of tissue contaminated with "blood" components is what causes the swelling as the tissue does not normally have the same types of proteins found in whole blood, i.e., albumin. Red Blood Cells (RBC) rupture and thereby release hemoglobin into the area of trauma. This adds to the osmotic imbalance and ultimately causes the discoloration of the tissue(s). Platelets also release factors that cause the tissue to increase in temperature and cause the dilation of blood vessels into and out of the area. Thus, the area becomes reddened and warm to the touch. White Blood Cells (WBC) become active and release cytokines that cause the recruitment of other WBC to the area, begin phagocytosis of cellular & protein debris and rid the area of invading bacteria. Finally, WBC release factors that stimulate adjacent tissue cells to divide and migrate into the area and begin the proliferative phase of wound healing.

The proliferative phase of wound healing is a complicated series of carefully orchestrated sequential processes that rebuilds the normal structure of the vessels, nerves and tissue(s). These processes are characterized by angiogenesis (blood vessel formation), collagen deposition, granulation tissue formation, and epithelialization (covering with skin). With angiogenesis, endothelial cells lining the vessels near to the cut edges proliferate and grow new blood vessels to serve the area of injury. In fibroplasia, tissue fibroblasts grow and form a new provisional ECM by secreting collagen and fibronectin. With granulation tissue formation, tissue fibroblasts repair the basal membrane and tissue cells proliferate and migrate into the area to form the normal tissue structure. In epithelialization, epithelial cells proliferate and crawl across the wound bed to cover the area and provide for passive defense and retard tissue desiccation.

In the maturation phase, the wound is made smaller by the action of myofibroblasts. These cells are stimulated to arise from tissue fibroblasts and attach themselves to the edges of the wound. They then begin the process of contraction and close the wound with the formation of a scar. When their role in concluded, they undergo apoptosis (cell death).

In the remodeling phase, the scar is reduced and the ECM is incorporated into the overall pattern of structure as determined by tensegrity forces exerted upon the tissue.

The repair of nerve tissue, in most cases trauma of the compressed or cut axons, is likewise a complicated series of sequential events that leads to the complete recovery of function as a best-case scenario. This process occurs in concert with blood vessel repair and wound healing. Nerve repair involves both the regeneration and elongation of the axon and the surrounding fascicles. Re-myelination of the transected area may also need to be accomplished. Neurotmesis (nerve cutting) is the most severe type of nerve injury. This kind of injury results from a disruption in the continuity of the axons and all supporting structures, including the epineurium. Injury involves a separation of the nerve ends such that axon regeneration from the proximal end may be unable to reach the distal end. This injury usually involves an open wound with nerve deficits as numbness and loss of sensation. Surgical repair is required for any return of function. The time required for return of function after repair depends on the location of the lesion and other variables as nerves regenerate slowly, progressing 1-1.5 mm/d or 1 in/mo. A very detailed account may be found here (6). Nerve injuries are associated with a burning pain and a tingling sensation occurs with regenerating nerves.

Large gaps, usually those greater than 15-30 mm, cannot be crossed reliably by axons. This is usually because proliferating Schwann cells (responsible for myelination) or fibroblasts grow between the severed nerve ends and form a physical barrier. Alternatively, if suitable tissue is not found within a set distance, the axon sprouts stop proliferating and take residence in non-neural tissue, forming a neuroma. Neuromas can occur in any situation in which an axon or collateral sprout remains in non-neural tissue and are usually very painful.

Now, we move to an area of discussion that is fraught with cultural bias and in most cases complete ignorance - that of the role of emotional and mental state in the etiology of disease. The same may be said concerning the obstruction of the channel(s). Almost nothing is said in TCM about the cause of Qi stagnation obstructing the channel(s).

In TCM, abnormal emotions and mental over-activity (usually as worry) are listed as internal evils that directly cause the obstruction of Qi & Blood and the disruption of the Zang-Fu (7). The clinical manifestations and pathology of certain organs was found to be associated with specific emotional derangements and excesses, for example: anger injures the Liver, joy injures the Heart, grief and melancholy injure the Lungs, worry injures the Spleen, fear & fright injures the Kidneys. It is the effect of the emotional outburst upon the flow of Qi that is paramount. Anger is said to cause Qi to rise up, joy causes it to move more slowly, grief drastically consumes it, fear causes it to decline, fright causes it to be deranged and worry causes it to stagnate. The subsequent derangement of Qi due to prolonged emotional excess is what then causes the stasis of Blood in the relevant organ(s).

The work of Greenwood (8) attempts to bring together TCM concepts with those of Western Psychology in order to explain the origin of Qi and Blood stagnation. He suggests that the root of stagnation lies in the attempt of the mind to control existential anxiety through strategies of energy containment. It is the process of containment that leads to Qi stagnation and subsequent Blood stasis. Pain is due to some kind of stagnation, weakness is due to deficient Qi and numbness to deficient Blood.

The pain and numbness due to Qi and Blood stagnation is the direct affect of the processes that lead to the reduction of nutrient(s) and the build up of toxins & waste products in the immediate area of nerve tissue, i.e., peripheral neuropathy. The swelling and obstruction caused by the influx of water, blood proteins, cellular debris and WBCs, as well as the injury itself, have the effect of reducing the normal flow of fluid from the blood vessels into the tissues and back into blood circulation (90%) and through the lymphatic system (10%) (9). The injury and obstruction reduces the efficiency of lymphatic return due to the severing of lymph channels and local osmotic imbalances. Downstream from the site of injury, the lymph nodes swell and the WBCs therein keep pace with the influx of waste and debris. The integrity of the lymph vessels are repaired along with the rest of the injured tissue and are an integral part of wound healing.

TCM describes the cause of certain diseases as the obstruction of the channel(s) due to sprains, trauma and Painful Obstruction Syndromes (due to Wind, Cold or Dampness) (10). However, all the information published in English that I have been able to find merely describes the result of obstruction of the channels but not what directly causes or just exactly what is obstruction of the channels, most disconcerting to say the least! The treatments for this condition are stated as to move channel Qi & Blood and unblocking the channel(s). The TCM system of channels is stated to: 1. transport Qi & Blood and the regulate the balance of Yin & Yang of the whole body 2. resist pathogens and reflect symptoms & signs 3. transmit needling sensation and regulate excess & deficiency conditions (11). How are we to understand the underlying Western physiology of this condition of obstruction of the channel(s)? Blood moves in the blood vessels, interstitial fluid derives from the blood and either moves into the vessels again or becomes lymph after transiting the tissues. The concept of Qi in TCM is completely deduced and has no "real" basis. What are the channels? For any concept concerning these topics, the only Chinese espoused philosophy that is relevant is that of Medical QiGong (12).

The contribution of the TCM conditions of Dampness to the etiology and pathogenisis of QS & BS are well known (17). In the USA today, it seems that chronic blood vessel inflammation is responsible for many of the dieases of today (18). Chronic conditions of BS will need to be looked at for any contributing factors due to TCM Dampness.

The TCM treatment of Qi Stagnation and Blood Stasis involves the use of Acupuncture, Herbal Formulae, Tui Na and Moxibustion.

ACUPUNCTURE (13)

  1. Sp1 - invigorates the Spleen and is useful for cases of stagnation
  2. Sp4 - moves Qi and Blood in the legs, especially when combined with St30 & St31
  3. Sp8 - the main function is to move stagnant Blood & relieve pain, especially in the lower abdomen & legs
  4. St30 - is a point on the Chong Mai, moves stagnant Blood in the body in general. Combined with Sp4, Pc6 & Ren6, it helps improve circulation in the legs & feet
  5. St31 - strengthens and moves Qi & Blood to treat problems in the lower extremity. It is useful in blocked arterial circulation in the leg when combined with Sp4, Pc6, St31, St36 & St41
  6. Pc6 - main function is to move stagnation of Qi, Blood & Phlegm and to calm irregularity of Qi
  7. LI4 - promotes Qi & Blood circulation in the Yangming channel and disperses painful obstruction; with Lv3, activates Qi & Blood and ensures their smooth flow throughout the body
  8. SJ6 - used with St36 to strengthen Spleen Qi to dispel Dampness
  9. Ren6 - along with Ren4 represents the lower Dan Tian, it is helpful in dispersing stagnant Qi

HERBS AND HERBAL FORMULAE (14)

  1. Individual Herbs
    • yan hu suo (Corydalis) - one of the strongest herbs available to relieve pain and reduce inflammation
    • ge gen (Pueraria root)- has demonstrated remarkable effectiveness in relieving headache pain
    • bai zhi (Angelica dahuricae root)- effective in treating frontal headache
    • qin jiao (Gentiana macrophylla root) - has anti-inflammatory activity
    • cao wu (Aconiti kuznesoffii root) & chuan wu (Aconiti carmichaeli root) - demonstrate exceptional anti-rheumatic, anti-inflammatory, analgesic & anti-pyretic functions
    • bai shao (White Peony) - relieves spasms, cramps & pain of muscle
    • gan cao (Licorice) - relieves spasms, cramps & pain of muscle
  2. Herbal Formulae
    • xiong zhi shi gao tang (Cnidium, Angelica and Gypsum Decoction)- treatment of headache pain due to Wind-Heat
    • chuan xiong cha tiao san (Cnidium & Tea Formula) - treatment of headache due to Wind-Cold
    • wu zhu yu tang (Evodia Combination) - relieves vertex headache due to Cold and is used to treat migraine
    • huang lian shang qing wan (Coptis, Phellodendron & Mint Formula) - treatment of headache due to Heat
    • qiang huo sheng shi tang (Notopterygium & Du Huo Combination) - treats headache due to Wind & Dampness
    • tian ma gou teng yin (Gastrodia & Gambir Combination) - treatment of headache secondary to Liver Yang rising
    • you gui wan (Eucommia & Rehmannia Formula) - relieves headache by tonifying Kidney deficiency
    • ba zhen tang (Dang Gui & Ginseng 8 Combination) - relieves headache by tonifying Qi & Blood deficiency
    • ban xia bai zhu tian ma tang (Pinellia & Gastrodia Combination) - relieves headache due to Phlegm stagnation
    • wu yao shun qi san (Lindera Formula) - treats shoulder pain
    • ge gen tang (Pueraria Formula) - treats stiff neck due to Cold
    • du huo ji sheng tang (Du Huo & Loranthus Combination) - relieves acute back pain due to Wind & Dampness
    • gui zhi shao yao zhi mu tang (Cinnamon & Anemarrhena Combination) - treats musculo-skeletal & joint pain due to Wind-Heat
    • ji sheng shen qi wan (Cyathula & Plantago Formula) - treats musculo-skeletal & joint pain due to Cold
    • yi yi ren tang (Coix Combination) - treats musculo-skeletal & joint pain due to Dampness
    • san bi tang (Du Huo & Astragalus Combination) - treats musculo-skeletal & joint pain due to deficiency of Qi & Blood
    • gui zhi fu ling wan (Cinnamon & Hoelen Formula) - treats internal bleeding after trauma
    • tao ren cheng qi tang (Persica & Rhubarb Combination) - treats subcutaneous bleeding with severe swelling & pain

TUI NA (15)

It is the stated purpose of Tui Na to promote Qi circulation and activate Blood stasis by strengthening the Spleen & Stomach and soothing the Liver to regulate Qi. Kneading manipulation, pressing manipulation and pushing manipulation with one-finger meditation are applied to UB20, UB21, St36 and Ren12 in order to improve the function of the Spleen/Stomach and promote the circulation of Qi & Blood. Pressing and kneading Lv13, Lv14, UB18, UB19 is used to disperse stagnant Liver Qi. Grasping slightly GB21 has the immediate effect of promoting Qi circulation to activate dissipation of BS. Various manipulations are applied near to local areas of pain and trauma in order to stimulate Qi circulation and activate BS in the channel(s).

MOXIBUSTION (16)

The functions of moxabustion are:

  1. to warm the channels and expel Cold
  2. to induce the smooth flow of Qi and Blood
  3. to strengthen Yang from collapse
  4. to prevent disease and promote health. The acrid odor of Artemisia vulgaris can travel through the channels to regulate Qi and Blood. Moxabustion is applied to the various acupuncture points according to the differentiation of syndromes and locale affected.

Some acupuncture points are contraindicated with the use of needles (like zhongkui & zhongjian) and are used exclusively with Tui Na or Moxibustion.

CONCLUSIONS

The first stagnation is almost invariably that of QS. This results from either physical trauma or emotional/mental disturbance. The second stagnation is BS that is the result of QS or in rare cases causes QS. The area of QS is diffuse while that of BS is well defined. The continued presence of QS will eventually cause BS. Untreated BS in time will start to interfere with the smooth flow of Qi. QS and BS are very much tied together!

REFERENCES

  1. Maciocia, G., 2004, "Diagnosis in Chinese Medicine: A Comprehensive Guide", pg 929-931, Churchill Livingstone
  2. Forbes, C. D. and Jackson, W. F., 2003, "Color Atlas and Text of Clinical Medicine", Third Edition, pg 423-444, Mosby
  3. Wiseman, N., and Ellis, A., 1996, "Fundamentals of Chinese Medicine", Revised Edition, pg 146, Paradigm Publications, Brookline, Massechusetts
  4. Ibid, pg 148
  5. Wikipedia, http://en.wikipedia.org/wiki/Wound
  6. Subhas, C.G. and Littman, T. A, 2006, "Hand, Nerve Injury Repair", eMedicine, Web MD, http://www.emedicine.com/plastic/topic451.htm
  7. Deng, L., et. al., 1987, "Chinese Acupuncture and Moxibustion, Revised", pg 258, Foreign Languages Press, Beijing
  8. Greenwood, M. T., 2004, "Psychosomatic Compartmentalization: The Root of Qi and Blood Stagnation", Paradox Publishing, http://members.shaw.ca/paradoxpublishing/pdf/articles/aama/vol-13-1-qiBloodStag.pdf
  9. Lymph Notes, http://www.lymphnotes.com/article.php/id/151/
  10. Maciocia, G., 2004, "Diagnosis in Chinese Medicine: A Comprehensive Guide", pg 61-62, Churchill Livingstone
  11. Deng, L., et. al., 1987, "Chinese Acupuncture and Moxibustion, Revised", pg 258, Foreign Languages Press, Beijing
  12. Johnson, J. A., 2000, "Chinese Medical QiGong Therapy: A Comprehensive Clinical Text", International Institute of Medical QiGong, Pacific Grove, CA
  13. Parameswaran, P. G., 2001, "Ischemic Foot Treated With Acupuncture", Medical Acupuncture, Vol. 14, No. 2
  14. Chen, J. K., 2000, "Herbal Alternatives to Drugs in Pain Management, Part II", Acupuncture Today, July, Vol. 01, Issue 07
  15. Zuo, Y. F., Editor, 2002, "Chinese Tui Na", pg 31-33, Shanghai University of TCM Press, Shanghai
  16. Deng, L., et. al., 1987, "Chinese Acupuncture and Moxibustion, Revised", pg 262, Foreign Languages Press, Beijing
  17. Block, E. F., 2007, http://diamondhead.net/dampness.htm
  18. http://en.wikipedia.org/wiki/Inflammation, http://www.nhlbi.nih.gov/health/dci/Diseases/vas/vas_whatis.html

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