Poor Circulation

What is Poor Circulation?

Poor circulation means that blood is not reaching part of the body, usually the legs and feet, as well as it should. It is a descriptive phrase and not a medical diagnosis, and it can come from several different problems in the arteries, veins or small vessels.^[1]

The most important cause to rule out is peripheral artery disease (PAD), a progressive disease in which fatty plaque narrows the arteries to the limbs. It is common, affects roughly 200 million people worldwide, and is linked to a higher risk of heart attack and stroke.^{[1, 2]}

Common symptoms

The classic symptom of PAD is leg pain or cramping during walking that settles with rest, called claudication. Some people have no symptoms at all, while others progress to pain at rest, sores that do not heal, or tissue loss in the feet.^[1]

• Cold, pale or bluish feet or hands
• Numbness or tingling in the toes or fingers
• Hair loss, thin shiny skin or slow-growing nails on the legs
• Hands or fingers that turn white and then blue in the cold (a pattern called Raynaud's phenomenon, covered on its own page)

Causes and risk factors

Narrowing of arteries by atherosclerosis is the most common cause of poor circulation in the legs, and smoking, diabetes, high blood pressure and high cholesterol are its major risk factors.^[3] Prevalence rises steadily with age.^[3]

Other causes include blood vessels that overreact to cold or stress, as in Raynaud's phenomenon, and weak vein valves that let blood pool in the legs.^{[1, 4]} Because the causes differ, the cause has to be found before any treatment is chosen.

How it is diagnosed and treated conventionally

PAD is diagnosed with an ankle-brachial index, which compares blood pressure at the ankle with the arm. A value below 0.90 indicates the disease.^[2]

Treatment aims to protect the heart and brain as well as the legs. Recommended care includes cholesterol-lowering statins, antiplatelet medicines, blood pressure control, and, for people with diabetes, certain diabetes medicines.^[2] Supervised walking exercise and structured home-based walking both improve walking ability, and procedures to reopen arteries are generally kept for symptoms that do not respond to exercise.^[2] In one pooled analysis, supervised exercise improved walking distance more than unsupervised exercise.^[5]

Why Poor Circulation calls for a whole-person approach

Reduced blood flow rarely has a single cause. Artery disease, blood sugar, blood pressure, smoking, activity level and the way small vessels respond to cold and stress all play a part, so care that looks at only one of them can miss the others.^{[2, 3]}

This is why a physician should look for artery disease first. Complementary care is then aimed at the person's symptoms, comfort, activity and daily habits.

Artery risk factors

Smoking, diabetes, high blood pressure and high cholesterol are the best-established drivers of PAD, and treating them is a core part of medical care.^{[2, 3]}

Walking and physical activity

Regular walking is one of the best-supported treatments for leg symptoms from PAD.^[2] Pain with walking can discourage activity, which is one reason pain relief and guidance on staying active matter.

Vessel reactivity and cold sensitivity

Some people have fingers and toes that clamp down too strongly in the cold, as in Raynaud's phenomenon. Calcium channel blockers have clear evidence of benefit for secondary Raynaud's, while for most other treatments the evidence is limited or conflicting.^[4]

Inflammation and oxidative stress

Inflammation and oxidative stress are studied as part of how vessels are damaged. In one randomized trial in people with diabetes and mild leg artery disease, markers of inflammation and oxidative stress changed in the group receiving acupuncture plus hydrotherapy, although that trial was not blinded.^[6]

Acupuncture for Poor Circulation

What the research shows

The research on acupuncture for poor circulation is limited. A 2005 systematic review of complementary therapies for PAD found acupuncture among the options studied and concluded there was no evidence beyond reasonable doubt that it helps.^[7]

A more recent randomized trial of 126 people with type 2 diabetes and mild leg artery disease compared 15 weeks of acupuncture plus hydrotherapy exercise with a control group. The treated group improved on leg blood flow, some physical function measures and a walking questionnaire, and gains held at six weeks. Because acupuncture was combined with exercise, and neither participants nor staff were blinded, the trial cannot show what acupuncture alone contributed.^[6]

For cold, color-changing fingers, a meta-analysis of 6 trials (272 people) found acupuncture associated with more remission and fewer daily attacks in Raynaud's syndrome. The authors rated the evidence as very low quality with a high risk of bias.^[8] A separate review of secondary Raynaud's found only one acupuncture trial and no clear benefit for treatments other than certain drugs.^[4]

How acupuncture may work

Researchers propose that acupuncture may affect blood vessel tone, nerve signaling and inflammation. One review suggests acupuncture may trigger release of nerve peptides that widen blood vessels and have anti-inflammatory effects.^[9] An older review noted that studies of acupuncture and blood flow disagree with each other.^[10] These are proposed explanations, not settled facts.

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes, with several visits and a reassessment. The trial above gave a 30-minute session every two days for 15 weeks.^[6]

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, pain or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[11] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, have a pacemaker (relevant to electroacupuncture), or have numb feet or open sores, since healing and sensation may be reduced.

Ayurvedic medicine for Poor Circulation

The Ayurvedic view

In Ayurveda, cold, painful or discolored limbs with reduced blood flow are described in terms of Vata, the principle said to govern movement, becoming blocked by vitiated blood. The classical conditions Vatarakta and Raktavrita Vata are the ones most often compared to circulatory disorders.^{[12, 13]} These are traditional categories, not biomedical diagnoses.

Therapies that may be used

Care is individualized and traditionally combines:

• Diet and daily routine intended to calm Vata, with warm, regular meals and gentle daily movement
• Warm herbal oil massage of the limbs
• Herbs and classical formulas, prescribed individually by a qualified practitioner
• Panchakarma procedures in selected cases

Panchakarma is not appropriate during pregnancy, acute illness or frailty, or when ulcers, infection or suspected severe artery blockage have not been medically assessed.

What the research shows

The research on Ayurveda for circulatory problems is very limited. We found no placebo-controlled trials of Ayurvedic treatment for PAD. One study of at least 30 people with a condition the authors compared to PAD gave two classical guggulu formulas and reported improvement in both groups, but it had no placebo group and was small.^[12]

A 2024 observational study of 25 people with chronic venous insufficiency, a vein condition, reported improved symptom scores with a bark extract of Terminalia arjuna. It had no control group.^[13] Studies like these cannot show that a treatment caused the change.

Herbal medicine for Poor Circulation

Herbs and formulas that have been studied

Several herbal products have been tested for the leg pain of PAD or for cold hands and feet. Ginkgo biloba and Padma 28, a Tibetan herbal formula, have been tested in trials for intermittent claudication.^{[7, 14]} Chinese formulas such as Danggui Sini Tang and Buyang Huanwu Tang have been tested for Raynaud's phenomenon.^[15]

What the research shows

The evidence is limited and of low quality. A 2013 Cochrane review of 14 ginkgo trials (739 people) found no evidence of a clinically significant benefit for walking distance in PAD, and noted that publication bias may have inflated the effect.^[16] An earlier review had been more positive.^[7]

A Cochrane review of 5 trials (365 people) of Padma 28 found longer walking distances in the short term but rated the evidence very low quality and called the clinical importance questionable.^[14]

For cold hands and feet, a meta-analysis of 14 trials (974 people) found herbal medicine reduced cold hypersensitivity and Raynaud's symptoms, but all studies had a high risk of bias.^[17] A review of 8 trials (674 people) of Chinese herbs for primary Raynaud's reached a similar conclusion: possibly helpful, but inconclusive because of weak methods.^[15]

Safety and herb-drug interactions

People with poor circulation often take blood thinners or antiplatelet medicines, and several herbs can add to bleeding risk. Case reports describe bleeding when warfarin was combined with ginkgo, dan shen, dang gui, ginger, garlic and ginseng, and ginkgo has caused bleeding when combined with aspirin.^{[18, 19]} Herbs can also interact with blood pressure and diabetes medicines.^[19]

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, or have surgery planned. Transdermal medication therapy, an herbal preparation applied to the skin, is also offered, and has not been studied for circulation.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine describes cold limbs and fixed pain as stagnation of qi and blood, or as cold and yang deficiency in the channels. Researchers measure things that loosely parallel this picture, such as blood vessel reactivity, skin temperature, blood flow and inflammatory markers.^{[9, 17]}

Ayurveda's Vata and blocked-blood concepts describe cold, dry, painful limbs. No study has shown that a dosha or a pattern corresponds to a specific biological process, or to narrowed arteries.

How this care fits with your medical care

Integrative care for poor circulation is complementary. We do not diagnose the cause of reduced blood flow, so new cold, painful or discolored limbs, or sores on the feet, need medical evaluation first. Keep your physician, vascular specialist and any prescribed medicines, and do not stop or change them without your prescriber.

For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Please bring your diagnosis, any ankle-brachial index or imaging results, a full list of medicines and supplements, and your blood sugar, blood pressure and cholesterol results if you have them.

When to seek urgent medical care

Sudden or severe loss of blood flow to a limb is an emergency, and PAD itself raises the risk of heart attack and stroke.^[1]

• A suddenly cold, pale, painful or numb arm or leg
• Pain in the foot or leg at rest, especially at night
• A sore, blackened skin or an infection on the toes or foot that is not healing
• Chest pain, shortness of breath, face drooping or sudden weakness on one side
• A leg that is suddenly swollen, red and painful

If any of these occur, call 911 or go to the nearest emergency department.