Sometimes just nourishing the blood is not enough.  In spite of a good diet and adequate digestion, I often get patients complaining of poor circulation accompanied by symptoms like a weak pulse, cold intolerance, or cold fingers and toes.  Again, it is important to first determine underlying medical conditions that may be causing the symptoms, such as iron deficiency anemia, hypothyroidism, cardiac weakness, vitamin B-12 deficiency etc.  Once you have addressed those areas, you can work to directly improve the circulation with herbs.  In fact, it is very common for my patients to have circulation or blood problems that are not clearly defined by blood tests.  It is equally common for me to see patients with various forms of fatigue and anemia who do not respond, for example, to simple iron supplements. 

In such cases, the choice of herbs for treating poor circulation now depends on herbal differential diagnosis.  Weakness, coldness, congestion, restriction and deficiency are among the major contributing factors, and any or all may be present.  The patient or doctor must identify which factor is most prominent, which will help in developing the proper treatment protocol, which usually involves mixing herbs from several groups.

TCM analysis tells us that Qi or vital energy deficiency can cause poor circulation because the Qi pushes the blood.  If this factor is predominant, the patient will present with weakness, fatigue, a slow, weak pulse and low digestive energy.  I use astragalus root, ginseng root, salvia root, dang gui root, shou wu root and white atractylodes rhizome in these cases.  According to TCM theory the astragalus, white atracylodes and ginseng strengthen the vital force (Qi), and the dang gui and shou wu root nourish and regulate the blood.  Scientific studies show that these herbs help dilate and/or regulate peripheral vessels and improve capillary circulation (DeFeudis, 1991).

If the problem is a consequence of coldness, which slows the blood flow, it is first necessary to differentiate between interior and exterior coldness.  In our discussion of diet we mentioned that exterior or weather-related cold (low exterior temperatures) moves the blood to the interior areas of the body.  Symptoms include cold limbs, cold intolerance, tendency to shiver, joint pain, and sometimes, low back and musculoskeletal pain, all related to a Yang deficiency.  I treat this according to the TCM principle, “Use heat to treat coldness.” Herbs from the warming group like dry ginger, cinnamon bark, and prickly ash bark are usually very effective.  Do not use these herbs by themselves as long-term treatment.  Unless the coldness is very superficial and short-lived, there is usually another causative condition, such as low energy or blood deficiency, which requires treatment to resolve the circulatory problem permanently.  In these cases, I use herbs to treat the underlying condition in combination with the warming group herbs. 

If the coldness has penetrated to the interior of the body the patient will present with cold hands and feet, combined with symptoms such as poor digestion, abdominal pain, fatigue, nausea and reduced appetite.  In these cases, I use fresh ginger, black pepper, trikatu, ginseng root, white atractylodes and licorice root.

A final possible cause of poor circulation is the form of interior tension called Liver Qi restriction in TCM.  This common condition is seen in patients presenting with tension, a rapid wiry pulse, cold fingers and toes, and a red tongue.  Two major herbs for this condition, often prescribed together are bupleurum root and scute root.  You can also use blue citrus peel (qing pi or C.  reticulata), xiang fu rhizome (Cyperus rotundus) and zhi ke fruit (Citrus aurantium).  Calming herbs like ashwaghanda root and scullcap tincture have somewhat similar actions.

Moving the Blood

According to TCM, when the blood flow is impeded the condition is known as blood congestion.  If the blood actually stops moving, the condition is termed blood stasis.  These concepts correspond very closely to the Western medicine stages of blood coagulation, especially platelet stickiness, in which platelets stick together to prevent bleeding.  Chinese researchers have investigated this process in detail, and have developed commercial herbal formulas to promote blood circulation and inhibit platelet aggregation.  These formulas are used in China to treat and prevent strokes and heart attacks (reported in Dharmananda, 1994).
 
Because blood stagnation also inhibits tissue repair and removal of waste products, herbs that move the blood can be used to treat a wide variety of health problems, including slow healing, chronic inflammation, poor memory, and some forms of headache and vertigo.  We have listed some important blood moving herbs in the blood-moving group, with the most important being dang gui root, prickly ash bark, salvia root and carthamus flower.  Other herbs that have similar but minor properties include garlic bulb, bilberry, evening primrose oil and turmeric root (reported in Duke, 1997).

When blood congestion progresses, it can lead to pain syndromes including menstrual cramps, Reynaud’s syndrome, and even life-threatening thrombosis.  The same herbs are used to treat these ailments, but using the stronger ones like persica seed (tao ren or Prunus persica), carthamus flower, red peony root (chi shao / Peonia rubra), prickly ash bark, and E zhu root (Curcuma zedoaria).

 If the congestion progresses to the stage of what TCM doctors call “mass formation,” more powerful and potentially toxic “herbs” are used, such as anteater scales (chuan shan jia / Manis pentadactyla) and/or dried leech (shui zhi or Hirudo nipponia). 

Warning: All moving blood treatments are contraindicated in pregnancy and patients taking blood-thinning medication. Excess use or use with some painkillers can increase chances of stomach bleeding.  If there is any uncertainty, discontinue use, or, under professional supervision only, add herbs from the vessel-strengthening group to help reduce chances of bleeding.