What to Do When Blood Stasis is Ineffective for Dark Purple Tongue?

Chinese Medicine Book Club Issue 3413

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IIntroduction: In clinical practice, a dark purple tongue generally symbolizes blood stasis, but Yang deficiency can also lead to a dark purple tongue. How can we differentiate whether the dark purple tongue is primarily due to blood stasis or Yang deficiency? Today, let us learn together how Master Pan distinguishes the pathogenesis from the dark purple tongue.

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Experience in Treating Dark Purple Tongue from Yang DeficiencyAuthor/Pan WenkuaiDark purple tongue is generally treated based on blood stasis, and in recent years, microcirculation examinations have revealed that the papillae of a dark purple tongue show stasis of blood, microvascular expansion, and aggregation of blood cells, confirming a close relationship between microcirculation stasis and a dark purple tongue. Furthermore, based on my 30 years of experience, clinical observations have shown that while a dark purple tongue indeed indicates pathological blood flow slowing and stasis, it also harbors the pathogenesis of Yang deficiency where Qi fails to move blood, especially in the cold winter season when Yang deficiency is more common. Therefore, I primarily use methods to warm Yang and open the meridians, rather than employing blood-activating and stasis-eliminating techniques, and I have frequently achieved effective results. Here, I briefly describe this diagnostic and treatment experience.How can we discern the presence of Yang deficiency from a dark purple tongue?I will identify it from four aspects:1. The purple dark tongue is either the entire tongue or localized.If it is due to blood stasis, there are often stasis spots or purple spots, and the entire tongue shows uneven shades of dark purple, while Yang deficiency typically presents as a uniformly dark purple tongue, with a bluish hue indicating hypoxia.2. The sublingual veins are either tortuous and engorged or merely show blue veins.In cases of blood stasis, the sublingual veins are mostly engorged and extend to the tip of the tongue, while in Yang deficiency, the blue veins often start in the middle of the tongue, extending straight forward, with the ends not reaching the tip of the tongue, appearing conical with a thin top and thick bottom when viewed from above.3. The tongue surface.Blood stasis often presents with a clean coating and a relatively dry texture, while Yang deficiency is more likely to show a thin, moist coating.4. Accompanying symptoms throughout the body.Blood stasis may show signs of heat due to stagnation, while Yang deficiency mostly presents with symptoms of deficiency-cold.Among these four aspects, the first two are the primary symptoms, while the latter two are secondary symptoms, and a comprehensive judgment can help differentiate them. In fact, in tongue diagnosis, the “Tongue Diagnosis and Differentiation” has already stated that “a pale purple tongue with a bluish hue and moistening with blue-black veins indicates cold evil directly entering the Yin channels.”It is just that in clinical practice, this comparison has not been detailed.Distinguishing whether a purple tongue belongs to blood stasis or Yang deficiency is aimed at determining the main treatment principles.For blood stasis syndrome, one should use blood-activating and stasis-eliminating methods, while for Yang deficiency syndrome, the main approach should be to warm Yang and open the meridians, possibly combining with blood-activating techniques, but generally, stasis-eliminating herbs should not be included.Warming Yang and opening the meridians is a combination of warming Yang, benefiting Qi, and assisting circulation. Warming Yang and benefiting Qi addresses the essence of Yang deficiency, serving as a method to support the righteous and solidify the foundation, promoting the recovery of Yang Qi, leading to the resolution of various symptoms, while assisting circulation is merely an auxiliary strategy, relying on the dispersal of stagnation to alleviate symptoms.Thus, I primarily use Huang Qi (Astragalus), Rou Gui (Cinnamon), Xi Xin (Asarum), and Chuan Xiong (Ligusticum) as the four herbs.

Huang Qi is a key herb for warming Yang and benefiting Qi, not only having the effect of tonifying Yang and dispersing, but also enhancing the heart’s contraction ability, improving blood circulation. In clinical practice, roasted Huang Qi is often used instead of raw Huang Qi, and it is used as the main herb, with a dosage of 20-30 grams; Rou Gui warms the middle and tonifies Yang, its warming nature is even stronger than Huang Qi, and it is often used for kidney Yang deficiency, but its dispersing power is inferior to Huang Qi, so in clinical practice, Gui Zhi (Cinnamon Twig) is often used instead of Rou Gui to enhance its ability to open the meridians. If Yang deficiency is more severe, Fu Zi (Aconite) can be combined with Gui Zhi, rather than using Rou Gui alone. This aligns with Zhang Jingyue’s principle that “Yang deficiency should be tonified and warmed, and herbs like Gui, Fu, and Gan Jiang are suitable.” Moreover, the combination of Gui and Fu can also act on the circulatory system, having a cardiotonic effect, which can benefit both the heart and kidney organs; Xi Xin is warm in nature, but does not have warming Yang effects; rather, it relies on its pungent flavor to disperse, having the ability to warm, open, and promote upward movement. Therefore, I use it to assist circulation, and it must be used in conjunction with Ren Shen (Ginseng), Huang Qi, Rou Gui, and Fu Zi; using Xi Xin alone only has the function of unblocking, without warming and tonifying effects, which may instead deplete Qi and injure Yang; Chuan Xiong is a key herb for Qi in the blood, excelling in promoting Qi and activating blood. Among the four herbs mentioned above, the first two are selected for supporting the righteous and warming Yang, while the latter two are used for assisting circulation. They can complement each other. Not only that, these four herbs also share a commonality, which is that they all have the ability to uplift and disperse, which can prevent or improve the downward descent of Yang Qi due to deficiency, and promote the movement of Qi and blood upwards to open the tongue meridians, alleviating the dark purple condition. Therefore, often only 3-5 doses are needed for the dark purple tongue to show improvement.From this, it can be seen that for a dark purple tongue, one should also differentiate the main and secondary aspects based on Qi and blood. If the true nature is not understood, and the purple tongue is treated solely with blood-activating and stasis-eliminating herbs like Tao Ren (Peach Kernel) and Cheng Qi (Purgative), then the Yang deficiency will not be resolved, and the purple tongue will be difficult to eliminate. Understanding the pathogenesis allows for the avoidance of stasis-eliminating herbs while still resolving the purple stasis, which is indeed a profound understanding of the disease’s causes and mechanisms, and is the essence of treating a dark purple tongue based on differentiation.

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The tongue coating can also have false appearances; one must be aware of the changes.

In clinical practice, is a yellow greasy coating purely “damp-heat”? No!

—Copyright Statement—

• This article is excerpted from the “Journal of Traditional Chinese Medicine” (1994) |Author/Pan Wenkuai |Recommended by/Yun Chong |Editors/Ju Ye, Si Han.

• The copyright of this article belongs to the rights holder. For educational exchange only, please do not use medications indiscriminately.

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