Blood tonic formulas are indicated for conditions of Blood deficiency. Blood deficiency is most closely associated with the heart, liver and spleen. Symptoms include atrophy, dizziness, pale lips and claws, palpitations, insomnia, pale tongue and thin pulse, or women with irregular menstruation, low volume and pale color, or closed menstruation. Blood tonic herbs such as Radix Rehmanniae, Radix Angelicae Sinensis, Radix Paeoniae Alba, Radix Longan, etc. are commonly used. According to the needs of the disease and the characteristics of the herbs, appropriate formulas are composed with blood-activating and blood-stasis-removing, qi-supplementing, or qi-regulating products. The representative formulas are Si Wu Tang, Angelica Sinensis Blood Tonic Soup and Gui Shen Tang. In this paper, we intend to discuss the method of combining blood tonics with modern medical research. 1, with qi tonic medicine “Thirty Treatises on Medicine” is called: “blood is not alone, rely on qi to give birth to the recognition”, so the treatment of blood deficiency prescriptions, often in the blood tonic discretion with qi tonic products, to help biochemical, so that Yang Sheng Yin long, qi flourishing blood. As the “Treating Blood” says
Blood deficiency
The blood is generated by nourishing its qi.” The formula such as angelica tonic blood soup, Sheng Gui Tang, etc. The choice of qi tonic, mostly ginseng, astragalus, atractylodes, licorice, etc. is commonly used [1]. For example, the “Materia Medica for Truth” said: “Blood is a tangible thing, must rely on the invisible gas as the master, so ginseng,
Astragalus is the most blood-generating medicine”. The famous formula of blood tonic, danggui blood tonic soup with astragalus and angelica, and bajhen tang with ginseng and rehmannia, all follow the principle of vitality and blood, yang and yin, and are representatives of the formula of “tonic qi and blood”. For example, Zhu Danxi’s San Huang Blood Tonic Soup (Huang Qi, Angelica Sinensis, Bai Shao, Sheng Di Huang, Shu Di Huang) and Sheng Gui Tang (Ginseng, Huang Mao, Angelica Sinensis, Bai Shao, Shu Di, Chuan Xiong) are also the application of the principle of “tonifying qi and generating blood”. If the blood is deficient due to blood loss, then we should focus on the use of qi tonics, which are used to strengthen the vital energy in order to consolidate the blood, as the saying goes: “The visible blood cannot be generated quickly, but the invisible qi should be fixed urgently”. Modern research shows that the biological mechanism of “tonifying Qi to produce blood” is to induce fibroblasts, bone marrow stromal cells and splenocytes to secrete high levels of hematopoietic growth factor-like active substances, promote the proliferation and differentiation of hematopoietic stem cells and progenitor cells, and thus promote the production of blood cells; by tonifying Qi, it can also correct the decline in body function that accompanies blood deficiency, thus promoting bone marrow hematopoiesis. By tonifying Qi, we can also correct the decline in body functions associated with Blood deficiency, thus promoting the recovery of bone marrow hematopoietic function and the normalization of peripheral blood cells [2-4]. Ginseng and Astragalus can promote and regulate the proliferation and differentiation of bone marrow hematopoietic stem/progenitor cells to promote bone marrow hematopoiesis; in combination with Angelica, ginseng and astragalus can raise the level of erythropoietin (EPO) and stimulate the growth, differentiation and proliferation of hematopoietic cells, thus exerting their function of “blood tonic”, showing the synergistic effect of qi tonic and blood tonic. It shows the synergistic effect of qi tonic and blood tonic. For acute blood loss, combining blood tonics with qi tonics is more effective than nourishing and tonifying blood alone [5]. The Jing Yue Quan Shu points out that “all human qi and blood is like a source of water, if it is abundant, it is fluid, but if it is less, it is stagnant. Therefore, blood deficiency and blood stagnation are often the cause and effect of each other, the Ying blood is blocked by silt and the blood stagnation is increased by deficiency. The nature of the blood tonic is mostly Yin and soft, so if the blood tonic is used alone, it will easily hinder the blood flow. Therefore, blood tonic should not be purely Yin and soft nourishing products, with a small amount of blood invigorating and siltation or blood tonic and blood invigorating effect of drugs, tonic and can pass, not only can transform siltation and new, but also can unblock the meridians, and can make tonic but not stagnant, for blood deficiency and blood stagnation is particularly necessary. For example, in the “Secret Formula of the Immortal’s Teaching for the Treatment of Injuries” by Tang Lin Dao Ren, the medicine of Si Wu Tang, which uses Shu Di, Bai Shao, Angelica Sinensis and Chuan Xiong, was originally used to treat bruises and injuries, blood stagnation and swelling pain. Modern studies have shown that herbs that invigorate blood and resolve stagnation can promote the repair and oxygenation of the bone marrow microenvironment, enhance the ability of hematopoietic stromal cells to adhere to hematopoietic cells, strengthen the interaction between stromal cells and hematopoietic cells, and mediate the regulation of the cell cycle and the cell cycle protein CDK, thus regulating and promoting the differentiation and proliferation of hematopoietic cells; they can also affect apoptosis regulatory genes and protect bone marrow hematopoietic cells [6-9]. The combination of blood tonics and blood activators has a synergistic effect in promoting hematopoiesis and improving the microenvironment of bone marrow, which reveals to a certain extent the scientific connotation of “blood tonics must activate blood”. 3, with warm Yang medicine “Yinhai Guide” said “Yang deficiency can not produce blood, so blood should be warm rather than cold.” Insufficient yin blood, blood vessels can not be filled; Qi is weak, unable to stimulate the blood vessels, therefore, warming Yang medicine with blood tonics can not only encourage the growth of Qi and blood, but also warm the blood vessels, smooth blood flow. Therefore, the combination of warming Yang and blood tonics can not only encourage the growth of Qi and Blood, but also warm the Blood vessels and unblock the Blood flow. The combination of warming Yang and blood tonics in blood tonics, going back to its origin, should be preceded by the combination of Sheng Di and Agaricus with Gui Zhi and Ginger in the Treatise on Typhoid Fever. The combination of all the medicines makes the blood vessels full with sufficient yin blood, and the heart vessels open with sufficient yang energy. In this way, the Qi and blood are sufficient, Yin and Yang are harmonized, and the palpitation is fixed and the pulse is restored. Some studies have shown that “warming the Yang and benefiting the Blood can indeed reduce the abnormally high levels of γ-IFN and INF-α in CAA patients, regulate the disordered immune status, and relieve the excessive inhibition of hematopoietic cells by excessive negative regulatory factors, thus exerting a blood-supplementing effect, and its efficacy is significantly better than that of the yin and soft nourishing and benefiting the Blood [10]. 4, with spleen-strengthening drugs “Su Wen – Decisive Qi Chapter” said: “The middle jiao receives qi to take juice, changes and red is called blood”. If the spleen and stomach are weak, the water and grain do not transform the essence, which will lead to deficiency of blood. Therefore, if blood tonics are combined with products that strengthen the spleen and benefit the stomach to cultivate the middle earth and nourish the latter, the blood will have a source of biochemistry. It is common in clinical practice that some patients with blood deficiency not only have difficulty in using pure yin blood tonic alone, but also often have symptoms such as abdominal and celiac distension, less food and dullness, which is called “deficiency without tonic”. The reason for this is that the spleen and stomach are deficient in qi and weakened in function, plus the blood tonic is mostly yin and soft and nourishing, which is more likely to stagnate the spleen and hinder the stomach. For example, in the formula of Gui Shen Tang, Astragalus and Longan tonify the spleen and benefit the qi; Mu Xiang regulates the qi and awakens the spleen; roasted licorice tonifies the qi and strengthens the spleen; ginger and jujube harmonize the spleen and stomach for biochemical purposes. The spleen is strong and the blood is biochemical, the name of the formula is to return to the spleen, which means here. 5, with the kidney to benefit the essence of the medicine “the source of diseases” cloud: “the kidney collects essence, essence, the blood is made of”. If the yin essence is insufficient, the marrow sea is empty, then the Ying blood is getting deficient. And the liver collects blood
The Liver collects Blood, the Kidney collects Essence, and the E and K are of the same origin, and the Essence and Blood transform each other. Therefore, in the formula of blood tonic, it is advisable to use discretionary kidney and essence products, so that the essence is full and blood is born. The Black Pill, which benefits the essence and blood, is formulated with deer antler and angelica, etc.; the Grand Tonic Decoction, which treats the weakening of Yin and Blood, the Small Ying Decoction, which treats the deficiency of Blood and Yin, and the Guei Kidney Pill, which treats the weakening of essence and Blood, are all formulated with angelica, rehmannia, wolfberry, yam and dulcimer. The above formulae of blood tonics are based on the theory that “essence can produce blood”. Clinical studies have found that the formula of tonifying the marrow and benefiting essence to generate blood, which is composed of deer antler, bone marrow fat, Shu Di Huang and Xian Ling Spleen, can improve the vitality of SOD and GSH-PX in CAA patients, reduce the content of free radicals, relieve the attack of free radicals on the cell system in bone marrow tissue, increase the number of endoplasmic reticulum of bone marrow erythrocytes, strengthen the cell detoxification function and increase the number of epithelial-like cells in the bone marrow microenvironment. This improves the hematopoietic function of bone marrow by increasing the number of epithelial-like cells in the bone marrow microenvironment [11]. The experimental study showed that this formula significantly promoted the repair of bone marrow hematopoietic cells and hematopoietic microenvironment structure in CAA mice, and increased the level of peripheral blood erythropoietic cells, granulopoietic cells, and megakaryopoietic cells [12]. The composition of the formula, which is composed of Shu Di Huang, Zi He Che, Radix Angelicae Sinensis, Ginseng and Salviae Sinensis, has significant efficacy in renal erythropoietin deficiency caused by various factors, or renal anemia caused by some toxic substances in the plasma of uremia interfering with the production and metabolism of erythrocytes, indicating that the method of Yi Jing Sheng Sheng Blood is indeed effective in renal anemia [13]. 6. Conclusion The formula is composed of drugs, which are selected on the basis of dialectical legislation to form a formula with the appropriate combination of drugs. Through reasonable combination, the original function of drugs can be enhanced or changed, their bias can be regulated, their toxicity can be controlled, and their adverse effects on human body can be eliminated or slowed down, so that the drugs with different characteristics can play a comprehensive role, which means that “drugs have individual expertise and formulas have combined use”. In order to establish the method of blood tonic formula and make the formula more reasonable and effective, it is necessary to fully consider the mechanism and factors influencing the transformation of blood in the Ying and Blood, as well as the causes and pathological changes of blood deficiency and the priority of the disease, to distinguish the priorities and allocate the appropriate drugs, so that “the ruler and subjects are in order, and they are in harmony with each other”, so as to form a strict structure and effective blood tonic formula. This is the only way to compose a blood tonic formula with a rigorous structure and effective treatment. The above-mentioned blood tonics can be used singularly or in combination, but they should always be appropriate to the condition of the evidence. It is important to grasp the principles of formula making and to understand the rules of formula compounding and drug compounding techniques to improve clinical efficacy and to create new prescriptions.