bubble_chart Concept

A patient with a bluish complexion is referred to as having a "blue complexion." This is often caused by congealing cold and qi stagnation, leading to the obstruction of meridians and poor circulation of qi and blood. Suwen．Chapter on the Generation of the Five Zang-Organs states: "Colors and flavors correspond to the five zang-organs:... Blue corresponds to the liver and sourness." Lingshu．Chapter on the Five Colors states: "The five colors are assigned to the organs, with blue corresponding to the liver." {|110|}Zhengzhi Zhunsheng{|111|}．Summary of Observing Colors: "The blue color belongs to wood, governs wind, governs cold, governs pain, and is the color of the Jueyin Liver Meridian of the foot." There are various reasons for {|112|}congealing cold and qi stagnation{|113|} and the obstruction of meridians, hence the blue complexion can be further distinguished into bluish-white, bluish-gray, and bluish-purple, among others.

bubble_chart Pattern Analysis

1. Externally Constrained by Cold Pathogen︰The complexion is pale, with aversion to cold accompanied by fever, headache, body pain, absence of sweating, a thin white and moist tongue coating, and a floating and tight pulse. This is caused by external contraction of wind-cold, resulting in the obstruction of defensive yang. Therefore, the pale complexion is accompanied by aversion to cold with fever, absence of sweating, a floating and tight pulse, and other signs of an exterior cold pattern. The treatment should focus on releasing the exterior with pungent-warm herbs, and the formula selected is Ephedra Decoction with modifications for treatment.
2. Internal Cold Congealing︰The complexion is pale and bluish, abdominal pain is sudden and severe, relieved by warmth and aggravated by cold, with reversal cold of hands and feet, bland taste in the mouth without thirst, clear and copious urine, loose and thin stools, white tongue coating, and deep and tight pulse. This is caused by direct attack of external cold or excessive consumption of raw and cold foods, leading to depletion of yang qi and internal exuberance of pudendal coldness, resulting in obstruction of qi and blood. Hence, the pale and bluish complexion is accompanied by sudden abdominal pain, cold limbs, bland taste in the mouth, clear urine, loose stools, and deep and tight pulse, indicating an interior cold pattern. The two conditions—one being exterior cold and the other interior cold—can be differentiated accordingly. Treatment should focus on warming the middle and dissipating cold. The prescription selected is Lesser Galangal and Cyperus Pill combined with Qi-Normalizing Heaven Fragrance Powder for treatment.
3. Kidney Yang Deficiency︰Complexion is bluish-gray, lips are cyanotic, palpitation with shortness of breath, chest oppression, cold body and limbs, scanty urine, and body edema. Tongue texture is dark purple with white slippery coating, and pulse manifestation is weak or intermittent. This syndrome is caused by the decline of heart and kidney yang, inability to propel blood, qi deficiency and blood stasis, failure to warm the body, and retention of water-dampness. Therefore, the bluish-gray complexion is accompanied by symptoms such as palpitation with shortness of breath, chest oppression, cold body and limbs, scanty urine, body edema, cyanotic lips and tongue, and weak or intermittent pulse. The treatment should focus on warming and tonifying the heart and kidney. The recommended formula is True Warrior Decoction combined with modifications of Original-Qi Preserving Decoction.
4. Lung-kidney Yang Deficiency︰The complexion is bluish-purple, with panting and shortness of breath, exhaling more and inhaling less, aggravated by movement, low and timid speech, cold limbs, spontaneous sweating, scanty urine, loose stools, a pale-purple tongue with white and slippery coating, and a weak, floating, and rootless pulse. This syndrome is caused by lung qi deficiency and kidney yang deficiency. Kidney yang deficiency fails to warm and nourish, leading to impaired circulation of qi and blood, and the kidney's inability to grasp and retain qi, resulting in qi failing to return to its origin. Hence, symptoms such as bluish-purple complexion, panting, shortness of breath, exhaling more and inhaling less, low and timid speech, cold limbs, spontaneous sweating, scanty urine, loose stools, and a weak, floating, and rootless pulse appear. The treatment should focus on improving qi reception and relieving dyspnea. The recommended formulas are Ginseng and Walnut Decoction combined with Black Tin Pill.
5. Internal Stirring of Liver Wind︰High fever, cyanotic complexion, most prominent in the glabella, nasal bridge, and around the lips, extreme thirst, convulsions, neck rigidity, upward staring of the eyes, opisthotonos, unconsciousness, red tongue with yellow coating, wiry and rapid pulse, commonly seen in children. This syndrome is caused by excessive pathogenic heat scorching the Liver Meridian, transforming into fire and generating wind. Hence, the cyanotic complexion is accompanied by high fever, extreme thirst, limb convulsions, opisthotonos, unconsciousness, red tongue with yellow coating, wiry and rapid pulse, etc., commonly seen in children. When a child has a high fever, a cyanotic complexion prominently appearing in the glabella, nasal bridge, and around the lips is a precursor to wind stirring. Treatment should focus on clearing heat, cooling the liver, and extinguishing wind. The recommended prescription is Antelope Horn and Uncaria Decoction combined with Peaceful Palace Bovine Bezoar Pill for treatment.

Complexion green indicates cold, pain, static blood, and infantile convulsion. When diagnosing a green complexion, attention should also be paid to its luster. A green complexion that is bright, moist, and subtle is favorable, while a green complexion that is withered and exposed indicates damage to stomach qi. As stated in Suwen, Chapter "Generation of the Five Zang-Organs": "A complexion as green as withered grass indicates death;... a complexion as green as kingfisher feathers indicates life." Suwen, Maiyao Jingwei Lun says: "Green should resemble the luster of jade, not the color of orchids."

bubble_chart Documentation

1. 《Four Examinations Juwei · Inspection》: "The liver thrives in the east, associated with wood and the color green. Wind-cold and pain are the three main ailments. Anger also manifests as green, similar to the color of fright. When green is mixed with black, or green is mixed with red, it indicates a favorable interaction. When green is withered and white, it indicates a harmful interaction. For example, if a spleen disease shows a green color, it means wood is overcoming earth, which is difficult to treat."