bubble_chart Concept

Cyanotic lips refer to the appearance of a deep bluish-purple or light bluish-purple color on the lips. Jingui Yaolue records a symptom of "cyanotic lips," which is considered a critical condition. Later medical texts have less discussion on this symptom.

bubble_chart Pattern Analysis

1. Spleen Yang Deficiency︰Bluish-purple lips, poor appetite, loose stools, abdominal distension and fullness after eating, cold hands and feet, pale tongue with white coating, deep and weak pulse. The location of disease is in the spleen. The spleen's brilliance manifests in the lips. When spleen yang is weak, clear yang cannot ascend to nourish the lips, leading to bluish-purple lips over time. If cold invades the shaoyin, with severe pudendal coldness and decline of the life gate fire, yang qi fails to circulate, resulting in bluish-purple lips. The difference between the two is that bluish-purple lips due to spleen yang deficiency are milder than those caused by cold invading the shaoyin. The former is accompanied by symptoms of weak spleen yang, such as abdominal distension and fullness, poor appetite, loose stools, and cold hands and feet. The latter presents with reversal cold of hands and feet, dark complexion, panting upon exertion, and a watery-slippery tongue coating, indicating severe pudendal coldness and kidney yang deficiency. For spleen yang deficiency, treatment should focus on warming and activating spleen yang, using the formula Aconite Middle-Regulating Decoction. For cold invading the shaoyin, treatment should aim to warm the kidney and dissipate cold, using the formula Cold-Extremities Decoction.
2. Cold Invasion of Shaoyin︰Lips bluish with slight purple, complexion dark and sallow, cold hands and feet, dizziness, or panting upon exertion, or soreness and weakness in the waist and knees, deep and tight pulse, pale tongue texture, and watery slippery coating. $Spleen yang deficiency with bluish-purple lips and cold invasion of Shaoyin with bluish-purple lips! The former has the location of disease in the spleen, as the spleen's brilliance manifests in the lips. When spleen yang is weak, clear yang cannot ascend to nourish the lips, leading to bluish-purple lips over time. If cold invades Shaoyin, pudendal coldness is excessive internally, the life gate fire declines, and yang qi fails to circulate, resulting in bluish-purple lips. The difference between the two is that spleen yang deficiency with bluish-purple lips is milder than cold invasion of Shaoyin, presenting with abdominal distension and fullness, reduced appetite, loose stools, and cold hands and feet—signs of weak spleen yang. Cold invasion of Shaoyin, however, shows reversal cold of hands and feet, dark and sallow complexion, panting upon exertion, and watery slippery coating—signs of excessive pudendal coldness and kidney yang deficiency. For spleen yang deficiency, treatment should focus on warming and activating spleen yang, with the prescription choice being Aconite Middle-Regulating Decoction. For cold invasion of Shaoyin, treatment should focus on warming the kidney to dissipate cold, with the prescription choice being Cold-Extremities Decoction.
3. Turbid Phlegm Obstructing Lung︰Bluish-purple lips, accompanied by cough, wheezing, and phlegm rattling, or even gasping with raised shoulders and inability to lie flat, with thick, yellow turbid phlegm or clear, thin phlegm; slippery or rapid pulse; tongue coating yellow and greasy or white, slippery, thick, and greasy. This is due to chronic cough and wheezing with phlegm disorders, where lung qi fails to descend and purify, leading to fluid accumulation and phlegm production; spleen deficiency fails to transport and transform, resulting in dampness stagnation and phlegm formation. "The lung is the container of phlegm," and turbid phlegm accumulates in the lungs, obstructing lung qi, preventing the vessels from distributing properly, hence manifesting as bluish-purple lips. It is characterized by accompanying cough, wheezing, phlegm rattling, and a thick, greasy tongue coating. For a yellow, greasy tongue coating and slippery, rapid pulse, treatment should focus on clearing heat and resolving phlegm, purifying the lung and descending qi, using Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) with fine tea, combined with Fritillaria and Trichosanthes Fruit Powder. For pale-purple lips accompanied by chest tightness, treatment should aim to regulate qi and resolve stasis, using Trichosanthis Fruit Longstamen Onion Bulb Pinellia Decoction.
4. Qi Stagnation and Blood Stasis︰Bluish-purple lips, complexion dark red or pale bluish, chest tightness or occasional stabbing pain, or fullness and discomfort in chest and hypochondrium, shortness of breath, flusteredness, deep and sluggish pulse, dark tongue with ecchymosis, thin coating. Mostly caused by emotional distress, qi movement stagnation, prolonged illness leading to qi entering blood, static blood obstructing collaterals, preventing qi and blood from nourishing the upper body, hence manifesting as bluish-purple lips. The characteristics of this syndrome are: chest tightness, chest pain, or fullness and discomfort in chest and hypochondrium, lips turning from pale purple to deep purple, sluggish pulse, dark tongue with ecchymosis. Turbid phlegm obstructing the lung can be differentiated into phlegm-heat and phlegm-dampness; white greasy coating, slippery but not rapid pulse, treatment should focus on warming and resolving phlegm-dampness, strengthening the spleen and clearing the lung, with the formula Ling Gan Jiang Wei Xin Ren Tang (Poria, Licorice, Ginger, Asarum, and Bitter Apricot Seed Decoction). Qi stagnation and blood stasis can be further divided into qi stagnation predominance and blood stasis predominance; deep purple lips are always accompanied by chest stabbing pain, sluggish pulse, dark tongue, etc., treatment should focus on invigorating blood and resolving stasis, with the formula Taoren Honghua Siwu Tang (Peach Kernel, Carthamus and Four-Ingredient Decoction) combined with Shixiao San (Sudden Smile Powder).

The symptom of cyanotic lips is often a sign of critical illness, which is an external manifestation of the decline of yin-yang, qi, and blood in the internal organs. Therefore, it is often accompanied by symptoms of functional decline in the zang-fu organs. Deficiency leads to stagnation, which can form a pattern of deficiency complicated by excess; excess can damage the condition, transforming into a deficiency pattern within excess. Thus, pure excess is rare, and conditions combining deficiency and excess are more common. In clinical practice, treatment should be based on the relative severity of deficiency and excess.

bubble_chart Documentation

1. Xingse Waizhen Jianmo: "When a woman is in labor, or during a difficult delivery, if one wishes to know the signs of life or death, good or bad fortune, observe the woman's face. If it turns blue, her lips blue, her tongue blue, and she uncontrollably vomits copious amounts of frothy saliva, both mother and child will die."
2. Four Examinations Juewei．Pediatric Inspection: "Blue color in the lips indicates wind-cold interaction, leading to fright and spleen injury."