by Eric Brand

Xue Jie (Daemonoropis Resina) is a fascinating substance. Also known as Dragon’s Blood, Xue Jie has been used for hundreds of years in many different cultural contexts. Xue Jie is a tree resin that has been used as a medicine, incense, and dye since ancient times. It was recorded in Greece by Dioscorides and appeared for the first time in Chinese medicine in the Lei Gong Pao Zhi Lun (Master Lei’s Treatise on Drug Processing), written in the Northern and Southern Dynasties period (420-589 CE). It later appeared in the Tang Ben Cao (Tang Materia Medica), the first Imperial textbook on materia medica.

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Xue Jie is used for a diverse range of purposes. In Chinese medicine, it is said to quicken the blood, stanch bleeding, and engender flesh. It is a major medicinal in traumatology and is also used to treat bleeding in the upper GI tract. Beyond injuries and bleeding, if we look at its applications in modern Chinese medical gynecology, we find that Xue Jie is an incredibly important medicinal in empirical formulas to treat endometriosis.

The importance of Xue Jie in endometriosis is evident when examining modern Chinese textbooks on TCM gynecology. Its claim to fame lies in expelling old blood stasis so that new blood can be engendered; in fact, its Chinese name literally means “exhausted (spent) blood.” Looking at the treatments for endometriosis relative to traditional TCM disease categories such as painful menstruation or concretions and conglomerations (zheng jia), we see that the formulas selected for the same patterns are consistent but nearly all the endometriosis formulas add in Xue Jie. Thus, clearly the experts in China know something about Xue Jie that most of us do not.

Consider the following section on endometriosis that I translated from a major TCM gynecology textbook. Xue Jie is present as an addition to nearly every formula. Maybe I’m just a nerd but I find this fact fascinating.

Pathomechanisms of Endometriosis

Endometriosis has been extensively researched by the TCM community. Although it was not a traditional disease on its own, modern practitioners have generally established an understanding of its pathomechanisms according to TCM. Blood stasis is by far the most common explanation for endometriosis, although researchers in Taiwan have also explored the notion of heat in the liver channel based upon microscopic examination of inflamed endometrial tissue. Various pathomechanisms that may be involved in endometriosis are outlined below.

Obstruction of the qì dynamic: Internal damage from the seven affects causes liver depression and qì stagnation; when the qì dynamic is inhibited, the chōng and rèn channels lose harmony and the channels become obstructed.

Static blood collecting internally: This pathomechanism refers to blood that has left the channels to collect in the inner body. The static blood may have a variety of causative factors. If cold evil invades, it may congeal the blood to form stasis. Additionally, blood stasis due to qì stagnation or damage to the chōng and rèn channels are potential causes of this pathomechanism.

Phlegm-damp brewing and binding: Qì stagnation or static blood can cause the fluids to be poorly distributed and transformed. The fluids congeal and gather to form phlegm-damp, which then binds with static blood.

Kidney yáng vacuity detriment: When kidney yáng is insufficient, the body is deprived of warmth, the movement of qì and blood is inhibited, and the fluids fail to be distributed and transformed. The chōng and rèn channels lack free flow and fullness, which allows the basic progression of the disease to occur.

Treatment

Clinically, treatment is generally based upon pattern identification, although disease identification is also commonly used as a basis for determining treatment in endometriosis. The presence of blood stasis is notable throughout the discussion.
Treatment based on disease identification: For an approach utilizing “disease identification as the basis for determining treatment,” a variety of empirical formulas may be used. Examples include xuè jié sǎn (Dragon’s Blood Powder) and yì wèi qū yū fāng (Stasis-Dispelling Formula for Endometriosis).

Xuè Jié Sǎn (Dragon’s Blood Powder)
xuè jié (血竭 dragon’s blood, Daemonoropis Resina) (powdered) 2 g
pú huáng (蒲黄 typha pollen, Typhae Pollen) 15 g
sān léng (三棱 sparganium, Sparganii Rhizoma) 9 g
é zhú (莪朮 curcuma rhizome, Curcumae Rhizoma) 9 g
chuān liàn zǐ (川楝子 toosendan, Toosendan Fructus) 9 g
chái hú (柴胡 bupleurum, Bupleuri Radix) 6 g
qīng pí (青皮 unripe tangerine peel, Citri Reticulatae Pericarpium Viride) 6 g
shān zhā (山楂 crataegus, Crataegi Fructus) (raw) 10 g
yán hú suǒ (延胡索 corydalis, Corydalis Rhizoma) 9 g

If menstruation is scant, use raw pú huáng (Typhae Pollen) and add dān shēn (Salviae Miltiorrhizae Radix), chì sháo (Paeoniae Radix Rubra), rǔ xiāng (Olibanum), and mò yào (Myrrha). If there is profuse menstruation with clots, remove é zhú (Curcumae Rhizoma), sān léng (Sparganii Rhizoma), and chuān liàn zǐ (Toosendan Fructus), and use stir-fried pú huáng (Typhae Pollen); in addition, add wǔ líng zhī (Trogopteri Faeces), xiān hè cǎo (Agrimoniae Herba), yì mǔ cǎo (Leonuri Herba), and sān qī (Notoginseng Radix). For spleen vacuity, add dǎng shēn (Codonopsis Radix) and bái zhú (Atractylodis Macrocephalae Rhizoma).

Yì Wèi Qū Yū Fāng (异位祛瘀方Stasis-Dispelling Formula for Endometriosis)
sān léng (三棱 sparganium, Sparganii Rhizoma) 9 g
é zhú (莪朮 curcuma rhizome, Curcumae Rhizoma) 9 g
chuān shān jiǎ (穿山甲 pangolin scales, Manis Squama) 12
shuǐ zhì (水蛭 leech, Hirudo) 9 g
sū mù (苏木 sappan, Sappan Lignum) 12 g
zhè chóng (蟅虫 ground beetle, Eupolyphaga seu Steleophaga) 12 g
lù lù tōng (路路通 liquidambar fruit, Liquidambaris Fructus) 9 g
xià kū cǎo (夏枯草 prunella, Prunellae Spica) 12 g

This base formula may be modified based on five major patterns:

1) Stasis-obstruction from congealing cold-damp: Add 9 g of fù zǐ (Aconiti Radix Lateralis Praeparata) and 4.5 g of guì zhī (Cinnamomi Ramulus). If menstruation is inhibited, add 9 g each of dāng guī (Angelicae Sinensis Radix) and hóng huā (carthamus). For intense abdominal pain, add 12 g of yán hú suǒ (Corydalis Rhizoma), 6 g each of pú huáng (Typhae Pollen) and wǔ líng zhī (Trogopteri Faeces), and 9 g each of bái zhǐ (Angelicae Dahuricae Radix) and chuān wū (Aconiti Radix).

2) Qì stagnation and blood stasis: Add 9 g each of chuān liàn zǐ (Toosendan Fructus), yù jīn (Curcumae Radix), and wū yào (Linderae Radix). For abdominal distention, add 9 g of zhǐ qiào (ké) (Aurantii Fructus) and 12 g of dà fù pí (Arecae Pericarpium).

3) Pronounced damp-heat: Add 4.5–9 g of dà huáng (Rhei Radix et Rhizoma), 9 g of huáng bǎi (Phellodendri Cortex), 30 g each of dà xuè téng (Sargentodoxae Caulis) and bài jiàng cǎo (Patriniae Herba).

4) Qì vacuity with blood stasis: Add: 15 g of dǎng shēn (Codonopsis Radix), huáng qí (Astragali Radix), and shān yào (Dioscoreae Rhizoma). For cases with profuse menstruation, add 12 g of xiān hè cǎo (Agrimoniae Herba) and 9 g of ē jiāo (Asini Corii Colla).

5) Kidney vacuity with stasis-obstruction: For patients tending to kidney yáng vacuity, add 9 g each of lù jiǎo (Cervi Cornu) and xiān máo (Curculiginis Rhizoma), and 12 g each of yín yáng huò (Epimedii Herba) and hú lú bā (Trigonellae Semen). For kidney yīn vacuity cases, add 9 g of shān zhū yú (Corni Fructus) and 12 g each of nǚ zhēn zǐ (Ligustri Lucidi Fructus) and shēng dì huáng (Rehmanniae Radix Exsiccata seu Recens). For severe aching in the lumbus, add 15 g of dù zhòng (Eucommiae Cortex) and 12 g each of sāng jì shēng (Taxilli Herba) and processed gǒu jǐ (Cibotii Rhizoma).

For patients with interior repletion and endometrial tissue proliferation in the pelvic region, the empirical formulas Internal Endometriosis Pills I & II may be used. These formulas use ground medicinals formed into pills with vinegar. The first uses a 2:2:1 ratio of dà huáng (Rhei Radix et Rhizoma), biē jiǎ (Trionycis Carapax), and hǔ pò (Succinum). This formula is taken twice a day at a dose of 2.5 g per time. It should be taken on an empty stomach and should not be taken during menstruation. Three months constitutes one course of treatment. The second formula is similar, but uses two parts of táo rén (Persicae Semen) in addition to the ingredients above. The medicinals are mixed with vinegar and then roasted and formed into pills; each dose is 3.5 g and the pills are taken twice a day. Again, three months constitutes one course of treatment.

Additionally, enema therapy is sometimes used, particularly in cases with intense pain and tissue proliferation in the pelvic cavity.

Enema therapy: The following formulas may be prepared for use as retention enemas. Following a bowel movement, a 100–150 ml concentrated solution of one of the formulas below may be inserted rectally before bed. These enema therapies should be stopped during menstruation.

The formula ingredients are:
1) Sān léng (Sparganii Rhizoma) 9 g, é zhú (Curcumae Rhizoma) 9 g, lù fēng fáng (Vespae Nidus) 12 g, chì sháo (Paeoniae Radix Rubra) 12 g, and zào jiǎo cì (Gleditsiae Spina) 12 g. (Shanghai Journal of Chinese Medicine, 1995)

2) Bái huā shé shé cǎo (Oldenlandiae Diffusae Herba) 12 g, bài jiàng cǎo (Patriniae Herba) 12 g, zǐ cǎo (Arnebiae/Lithospermi Radix) 20 g, dān shēn (Salviae Miltiorrhizae Radix) 12 g, and huáng bǎi (Phellodendri Cortex) 12 g. (Chinese Journal of Integrated Chinese and Western Medicine, 1993)

3) Dà xuè téng (Sargentodoxae Caulis) 15 g, bài jiàng cǎo (Patriniae Herba) 15 g, sān léng (Sparganii Rhizoma) 9 g, é zhú (Curcumae Rhizoma) 9 g, yán hú suǒ (Corydalis Rhizoma) 9 g, mǔ dān pí (Moutan Cortex) 9 g, bái huā shé shé cǎo (Oldenlandiae Diffusae Herba) 15 g, zǐ cǎo (Arnebiae/Lithospermi Radix) 15 g, and huáng bǎi (Phellodendri Cortex) 9 g. (Shanghai Journal of Chinese Medicine, 1982).

Basic principles of treatment: In general, treatment should be modified depending on the presentation of each patient. Issues of pain, fertility, and underlying patterns must be attended to. In general, the period of time between cycles and before menstruation should be utilize quickening, transforming, attacking, or breaking methods of treatment. By contrast, treatment during menstruation often involves regulating the menses and stanching bleeding. After menstruation, the need to supplement must be assessed.

Clinically, the most common patterns of endometriosis are: 1) qì stagnation with blood stasis, 2) congealing cold with blood stasis, 3) phlegm-damp with blood stasis, 4) depressive heat with blood stasis, and 5) kidney vacuity with blood stasis.

Qì Stagnation with Blood Stasis

Treatment Method: Rectify qì and quicken the blood, transform stasis and relieve pain.

Medicinal Therapy: Use the formula gé xià zhú yū tāng (Infradiaphragmatic Stasis-Expelling Decoction) from the Yī Lín Gǎi Cuò (“Correction of Errors in Medical Classics”), with the addition of xuè jié (Daemonoropis Resina).

Gé Xià Zhú Yū Tāng (膈下逐瘀汤 Infradiaphragmatic Stasis-Expelling Decoction)
dāng guī (当归 Chinese angelica, Angelicae Sinensis Radix)
chuān xiōng (川芎 chuanxiong, Chuanxiong Rhizoma)
chì sháo (赤芍 red peony, Paeoniae Radix Rubra)
táo rén (桃仁 peach kernel, Persicae Semen)
hóng huā (红花 carthamus, Carthami Flos)
zhǐ qiào (ké) (枳壳bitter orange, Aurantii Fructus)
yán hú suǒ (延胡索 corydalis, Corydalis Rhizoma)
wǔ líng zhī (五灵脂 squirrel’s droppings, Trogopteri Faeces)
wū yào (乌药 lindera, Linderae Radix)
xiāng fù (香附 cyperus, Cyperi Rhizoma)
mǔ dān pí (牡丹皮 moutan, Moutan Cortex)
xuè jié (血竭 dragon’s blood, Daemonoropis Resina)
gān cǎo (甘草 licorice, Glycyrrhizae Radix)

Congealing Cold with Blood Stasis

Treatment Method: Warm the channels and transform stasis, quicken the blood and relieve pain.

Medicinal Therapy: Use the formula shào fù zhú yū tāng (Lesser Abdomen Stasis-Expelling Decoction) from the text Yī Lín Gǎi Cuò (“Correction of Errors in Medical Classics”).

Shào Fù Zhú Yū Tāng (少腹逐瘀汤Lesser Abdomen Stasis-Expelling Decoction)
xiǎo huí xiāng (小茴香 fennel, Foeniculi Fructus)
gān jiāng (干姜 dried ginger, Zingiberis Rhizoma)
yán hú suǒ (延胡索 corydalis, Corydalis Rhizoma)
mò yào (没药 myrrh, Myrrha)
dāng guī (当归 Chinese angelica, Angelicae Sinensis Radix)
chuān xiōng (川芎 chuanxiong, Chuanxiong Rhizoma)
ròu guì (肉桂 cinnamon bark, Cinnamomi Cortex)
chì sháo yào (赤芍药 red peony, Paeoniae Radix Rubra)
pú huáng (蒲黄 typha pollen, Typhae Pollen)
wǔ líng zhī (五灵脂 squirrel’s droppings, Trogopteri Faeces)

For patients with yáng vacuity manifesting in sloppy stool and fear of cold, you should add bǔ gǔ zhī (Psoraleae Fructus), yín yáng huò (Epimedii Herba), and ròu dòu kòu (Myristicae Semen).

Phlegm-Damp with Blood Stasis

Treatment Method: Transform stasis and disperse phlegm, soften hardness and dissipate binds.

Medicinal Therapy: Use the formula fù tòng níng (Quiet Women’s Pain) from the Tianjin Journal of Chinese Medicine, 1995.

Fù Tòng Níng (妇痛宁Quiet Women’s Pain)
xuè jié (血竭 dragon’s blood, Daemonoropis Resina) 3 g
sān léng (三棱 sparganium, Sparganii Rhizoma) 9 g
é zhú (莪朮 curcuma rhizome, Curcumae Rhizoma) 9 g
chuān shān jiǎ (穿山甲 pangolin scales, Manis Squama) 10 g
biē jiǎ (鳖甲 turtle shell, Trionycis Carapax) 15 g
zào jiǎo cì (皂角刺 gleditsia thorn, Gleditsiae Spina) 15 g
hǎi zǎo (海藻 sargassum, Sargassum) 10 g
kūn bù (昆布 kelp, Laminariae/Eckloniae Thallus) 10 g
yì yǐ rén (薏苡仁 coix, Coicis Semen) 15 g
bèi mǔ (贝母 fritillaria, Fritillariae Bulbus) 10 g

This formula is modified during different phases of the menstrual cycle. When the principle issue is painful menstruation, add wū yào (Linderae Radix), niú xī (Achyranthis Bidentatae Radix), and lù lù tōng (Liquidambaris Fructus) prior to menstruation. If the main problem is profuse menstruation, before and during menstruation add pú huáng (Typhae Pollen), huā ruǐ shí (Ophicalcitum), and sān qī (Notoginseng Radix). If the primary issue is menstrual irregularities and infertility, add appropriate Chinese medicinals to regulate the menstrual cycle. Three months constitutes one course of treatment.

Depressive Heat with Blood Stasis

Treatment Method: Resolve heat, transform stasis, and relieve pain.
Medicinal Therapy: Combine the formulas xiǎo chái hú tāng (Minor Bupleurum Decoction) and táo hé chéng qì tāng (Peach Kernel Qì-Infusing Decoction) from the Jīn Guì Yào Lǜe (“Essential Prescriptions of the Golden Coffer”), and add bài jiàng cǎo (Patriniae Herba), dà xuè téng (Sargentodoxae Caulis), and mǔ dān pí (Moutan Cortex).

Xiǎo Chái Hú Tāng (小柴胡汤 Minor Bupleurum Decoction) plus Táo Hé Chéng Qì Tāng (桃核承气汤 Peach Kernel Qì-Infusing Decoction) (modified)
chái hú (柴胡 bupleurum, Bupleuri Radix)
huáng qín (黄芩 scutellaria, Scutellariae Radix)
jiāng bàn xià (姜半夏 ginger pinellia, Pinelliae Tuber cum Zingibere Praeparatum)
rén shēn (人参 ginseng, Ginseng Radix)
zhì gān cǎo (炙甘草 mix-fried licorice, Glycyrrhizae Radix cum Liquido Fricta)
shēng jiāng (生姜 fresh ginger, Zingiberis Rhizoma Recens)
dà zǎo (大枣 jujube, Jujubae Fructus)
táo rén (桃仁 peach kernel, Persicae Semen)
dà huáng (大黄 rhubarb, Rhei Radix et Rhizoma)
guì zhī (桂枝 cinnamon twig, Cinnamomi Ramulus)
gān cǎo (甘草 licorice, Glycyrrhizae Radix)
máng xiāo (芒硝 mirabilite, Natrii Sulfas)
mǔ dān pí (牡丹皮 moutan, Moutan Cortex)
dà xuè téng (大血藤 sargentodoxa, Sargentodoxae Caulis)
bài jiàng cǎo (败酱草 patrinia, Patriniae Herba)

In addition to the base formula above, chuān liàn zǐ (Toosendan Fructus) and yán hú suǒ (Corydalis Rhizoma) may be added to further discharge heat, rectify qì, quicken the blood, and relieve pain. For profuse menstruation or incessant dribbling of blood, add pú huáng (Typhae Pollen), qiàn cǎo (Rubiae Radix), and xuè jié (Daemonoropis Resina).

Kidney Vacuity with Blood Stasis

Treatment Method: Supplement the kidney and boost qì, quicken the blood and transform stasis.

Medicinal Therapy: Use the empirical formula xiān róng hé jì (Epimedium and Cistanche Combination Formula).

Xiān Róng Hé Jì (仙蓉合剂Epimedium and Cistanche Combination Formula)
yín yáng huò (淫羊藿 epimedium, Epimedii Herba)
ròu cōng róng (肉苁蓉 cistanche, Cistanches Herba)
hé shǒu wū (何首乌 flowery knotweed, Polygoni Multiflori Radix)
tù sī zǐ (菟丝子 cuscuta, Cuscutae Semen)
niú xī (牛膝 achyranthes, Achyranthis Bidentatae Radix)
dān shēn (丹参 salvia, Salviae Miltiorrhizae Radix)
sháo yào (芍药 peony, Paeoniae Radix)
é zhú (莪朮 curcuma rhizome, Curcumae Rhizoma)
chuān liàn zǐ (川楝子 toosendan, Toosendan Fructus)
yán hú suǒ (延胡索 corydalis, Corydalis Rhizoma)
dǎng shēn (党参 codonopsis, Codonopsis Radix)
huáng qí (黄芪 astragalus, Astragali Radix)

For severe abdominal pain, add shī xiào sǎn (Sudden Smile Powder) and xuè jié (Daemonoropis Resina). For sloppy stool, add bā jǐ tiān (Morindae Officinalis Radix) and roasted mù xiāng (Aucklandiae Radix).