Indications for Using Blood-Activating, Stasis-Resolving Therapy in Cancer Patients

If it hurts, it is not free-flowing; if it is free-flowing, it does not hurt. This saying is often quoted, and in TCM tumor treatment many physicians make blood-activating and stasis-resolving an important treatment principle. But applying this method to cancer has many hidden dangers.

First, most blood-activating herbs damage the righteous, especially blood-breaking herbs, which can even cause tumor rupture; once a tumor ruptures, the patient easily dies from massive hemorrhage. Second, a considerable number of blood-activating herbs—such as Chishao (red peony), Danshen (Salvia), and Shuizhi (leech)—carry the hidden danger of promoting tumor metastasis, as confirmed by modern pharmacology experiments. If such herbs are used without suitable pairing, the incidence of cancer metastasis is high. Third, prolonged blood-activating treatment easily causes tumor thrombi, an acute complication in tumor patients—generally detached tumor particles blocking blood vessels. Once a tumor thrombus forms, the patient easily dies of a cardiovascular or cerebrovascular accident. Blood-activating herbs that also stop bleeding, such as Sanqi (notoginseng), carry just such a hidden danger.

But many cancer patients present with blood-stasis and cannot avoid blood-activating herbs, so when choosing them for cancer, one must be cautious. Many clinicians are extremely wary of blood-activating herbs; veteran TCM oncologists repeatedly warn against using them freely, especially blood-breaking drugs—likely because of their own treatment failures.

Clinically, when using blood-activating herbs, one must carefully collect signs, tongue presentation, and pulse. Modern tests have found that cancer patients generally have a higher coagulation state, usually showing as an elevated platelet count in blood work. Moderate use of blood-activating herbs benefits such patients, but one should prioritize herbs like Haizao (Sargassum), Kunbu (Ecklonia), Jixueteng (Spatholobus), and Yimucao (Leonurus), which both activate blood and resolve stasis without increasing metastasis risk; use Chishao, Danshen, and Shuizhi cautiously.

Analyzing from the TCM view whether a patient needs blood activation, the tongue diagnosis is key. For blood-stasis patients: prominent bluish veins under the tongue, bluish or purple lips and tongue, and static-blood spots on the tongue are important indications for choosing blood-activating treatment. But out of caution, one should not decide on stasis solely by tongue diagnosis; abdominal diagnosis, pulse diagnosis, and inspection should together determine whether a patient is of the stasis type.

Abdominal diagnosis of static blood focuses on the lower abdomen. Tension, fullness, and lumps in the lower abdomen that are tender on pressure are among the key signs of pelvic and abdominal static blood. For such patients, the intensity of blood activation may be increased; when the patient's righteous qi is still adequate and there is no exterior pattern, stasis-resolving and purgative herbs may be used together. Generally, reproductive tumors and digestive tumors that have progressed to intestinal adhesion or obstruction all show this sign. In addition, even if abdominal palpation does not detect abdominal fullness, the patient's subjective feeling of fullness may indicate internal blood binding.

Static blood in the body must obstruct blood flow, and obstructed blood flow must affect the pulse, so pulse diagnosis is of important reference value in static-blood patients. Wang Kentang held that static blood generally gives a rough (se) pulse. Yumoto Kyushin, summing up years of practice, noted that static-blood patients generally have a pronounced rough pulse on the left hand, milder or normal on the right.

Static-blood patients have many other exterior signs: a preference for holding water in the mouth without swallowing; recurrent macules and papules on the skin; skin like fish scales with crisscross wrinkles—what ancient TCM called skin as dry as fish scales (jijia cuocuo). Such patients warrant moderate blood activation. But activating blood damages blood, and activation can certainly spread the tumor through the bloodstream, so blood-activating herbs must be used with special care, never abused or used long-term.

One further point: many patients today, after achieving results with Western interventional therapy, should not be given blood activation, because blood-activating herbs will certainly undermine the effect of the intervention, while it is uncertain whether TCM tumor control is superior to Western intervention. If the tumor is controlled after intervention, the TCM physician may win the patient more survival time by avoiding blood-activating and stasis-resolving herbs in the prescription.