Chapter 4 Qi Blood Body Fluid

8/3/2019 Chapter 4 Qi Blood Body Fluid

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r:-~~ Chapter 4QI, BLOOD AND BODY FLUID

Qi, blood and body fluid are funda-mental substances which maintain thenormal vital activities of the humanbody. They are the material foundationfor the physiological functions of thezang-fu organs, tissues and merid ians. Qi,blood and body fluid have an independ-ent relationship with the zang-fu organs,the tissues, and the meridians, whilstboth theories together combine to ex-plain the physiological functions of hu-man body.

I. QIAccording to ancient Chinese thought,qi was the fundamental substance consti-

tuting the universe, and all phenomenawere produced by the changes and move-ment of qi. This viewpoint greatly influ-enced the theory of traditional Chinesemedicine. Generally speaking, the word"qi" in traditional Chinese medicine de-notes both the essential substances of thehuman body which maintain its vital ac-tivities, and the functional activities ofthe zang-fu organs and tissues.

Essential substances are the founda-tion of functional activ ities. In th is sense,qi is too rarefied to be seen and its exist-ence is manifested in the functions of thezang-fu organs. A ll vital activities of the

human body are explained by changesand movement of qi.1. Classification and Production of QiCertain qualitative terms diffe ren tia te

qi in the human body according to itssource, function and distribution. Theseterms are: yuanqi (primary qi), zongqi(pectoral qi), yingqi (nutrient qi) andweiqi (defensive qi). In terms of theirsource they may be further classified intocongenital qi and acquired qi. Yuanqi,which is derived from congenital essenceand inherited from the parents, is re-ferred to as congenital qi. After birth,zongqi, yingqi and weiqi are all derivedfrom food essence, and are thereforeknown as acquired qi.Congenital qi and acquired qi aredependent on each other for their pro-duction and nourishment. Yuanqi stimu-lates and promotes the functional ac-tivities of the zang-fu organs and theassociated tissues of the body, which inturn produce acquired qi. Thus yuanqiis the )l1aterial fQund(ltion for the pro-duction of acquired qi. On the otherhand, acquired qi continuously nourish-es and supplements congenital qi. Therelationship is therefore an interdepen-dent one: congenital qi promotes ac-quired qi, which in turn nourishes con-

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CHAPTER 4 QI, BLOOD AND BODY FLUID

2. Functions of QiQi acts extensivelyin the human body

by permeating all parts. There is no place~ does not have qi nor to where qidoes not penetrate. If the movement of qiceases, the vital activities of the humanbody will also cease. Abundant qi is thebasis of good health and weakness of qimay lead to disease. Hence the statementfrom the Eighth Problem of Classic onMedical Problems, "Qi is the root of thehuman body; the stem and leaves woulddry up without a root." Qi, distributed tovarious parts of the body, characteristi-cally functions in the following differentways:1) Promoting function The growthand development of the human body, thephysiological activ ities of the zang-fu andmeridians, the circulation of blood anddistribu tion of body flu id, are all depend-ent on the promoting and stimulatingeffect of qi. Deficiency of qi impairs thispromoting function, and thus producespathological changes such as retardedgrowth and development, hypofunctionof the zang-fu organs and meridians, im-paired blood circulation, dysfunction intransforming and distributing body fluid ,and production of phlegm dampness inthe interior.2) Warming function The normaltemperature of the body is maintainedand readjusted by the warm ing functionof qi. According to the Twenty-secondProblem of Classic on Medical Problems,"Qi dominates warming." The forty-seventh chapter of Miraculous Pivot says:"Wei (defensive) qi warms up the mus-

cles " Insufficiency of yang qi may im-pair its warming effect. giving rise toaversion to cold, and cold sensations ofthe four limbs.3) Defensive function Qi defends thebody surface against exogenous patho-gen ic facto rs. The seventy-second chap terof Plain Questions therefore states: 'Theexistence of the antipathogenis qi in theinterior prevents the pathogenic factorfrom invading." Qi also combats patho-genic factors once disease occurs, andbrings about recovery by eliminating theinvading pathogenic factors.4) Checking function Qi checks, con-trols and regulates certain bodily sub-stances and metabolic products. For in-stance, qi controls blood by keeping itcirculating in the vessels, and checkssweating , u rination and seminal emission.If this checking function of qi is im-paired, spontaneous sweating, incontin-ence of urine, premature ejaculation andspermatorrhoea may occur.5) Qihua (activities of qi) Qihua hastwo meanings. Firstly it refers to theprocess of mutual transformation amongessence, qi, body fluid and blood. Accord-ing to the fifth chapter of Plain Questions,"Essence is transformed into qi." In hisannotation of the same chapter, WangBing, a physician in the Tang Dynastysays: 'The activities of qi produce es-sence; a harmonious supply of food es-sence enables the body to grow." Thesestatements explain the mutual transfor-mation of essence and qi.Secondly, qihua implies certain func-tional activities of the zang-fu organs.According to the eighth chapter of Plain


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54 CHINESE ACUPUNCTURE AND MOXIBUSTIONQuestions,"The bladder stores body fluid,which is then excreted by the activities ofqi." The activities of qi here refer to thefunction of the bladder in dischargingUrIne.6) Nourishing function This refers toyingqi-the nutrient substance formedfrom food. Ying (nutrient) qi, which cir-culates in the blood vessels, is a part ofblood and provides nourishment to thewhole body.Although these six functions of qi aredifferent, they cooperate with and sup-plement each other.

II. BLOODBlood is a red liquid circulating in thevessels, and is a vital nutrient substancein the body.

1. Formation and Circulation of BloodAs the fundamental substances re-quired in blood formation originate

from food essence produced by thespleen and stomach, these two organsare regarded as the source of qi andblood. The thirtieth chapter of Mirac-ulous Pivot holds: "When the middleenergizer receives food essence it willtransform it into red fluid which iscalled blood."The seventy-first chapter of the samebook also says: "Ying (nutrient) qiflows into the vessels to be transformedinto blood." Essence and blood may alsotransform into each other. The bookZhang's General Medicine states: "If

blood is not consumed, it turns intoessence in the kidney; if essence doesnot leak out, it is transformed intoblood in the liver." Taking food essence.- ------------------------and kidney essence as the material basis,blood is formed by the functlon-ifac-tiviHes of zang-fu organs such as thespleen, stomach, heart, lung, liver andkidney.

After being formed, blood normallycirculates in the vessels throughout thebody, and is acted upon jointly by theheart, liver and spleen. The heart domi-nates the blood and vessels, and the pro-pelling force of heart qi is the basis ofblood circulation. The spleen qi controlsblood and prevents extravasation. Theliver promotes the free flow of qi, storesblood and regulates its volume. The coor-dination of these three organs ensurescontinuous blood circulation in the ves-sels throughout the body. Dysfunction ofany of them may cause abnormal bloodcirculation. Deficiency of heart qi, forinstance, may lead to stagnation of heartblood. Dysfunction of the spleen in con-trolling blood may lead to bloody stools,uterine or subcutaneous bleeding, and ec-chymoses.

2. Functions of BloodBlood circulates throughout thebody, passing through the five zang and

six fu organs in the interior, and theskin, muscles, tendons and bones on theexterior. In this way blood nourishesand moistens the various tissues andorgans of the body. The Twenty-secondProblem of Classic on Medica l Problems


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CHAPTER 4 QI, BLOOD AND BODY FLUID 55

dream-disturbed sleep.eneralises this function of blood, say-ing: "Blood dom inates nourishment andmoisture." The nourishing and moisten-ing function of blood manifests clearlyin the movement of the eye and fourlimbs. According to the tenth chapter ofPlain Questions, "When the liver receivesblood, it gives rise to vision; when thefeet receive blood they are capable ofwalking; when the palms receive bloodthey are capable of holding; and whenthe fingers receive blood they are ca-pable of grasping."

The forty-seventh chapter of Mi-raculousPivot says: "When the blood is inharmony. . . the tendons and bones willbe strong and the joints will functionsmoothly." Insufficiency of blood mayimpair its nourishing and moisteningfunction, and give rise to symptoms suchas impaired vision, dryness of the eyes,motor impairment of the joints, numb-ness of the four limbs and dryness anditchiness of the sk in.

Blood is the material foundation formental activ ities. A sufficient blood sup-p ly ensures clear consciousness and a vig-orous spirit. The twenty-sixth chapter ofPlain Questions states: "Qi and blood arethe foundation for human mental activi-ties." The thirty-second chapter of Mirac-ulousPivot says: "Harmonious circulationof blood ensures a vigorous spirit." Thesequotations expla in the close re la tionshipbetween blood and mental activities. De-fic iency of blood, therefore , may producementa l disorders. An example is deficien-cy of heart or liver blood which mayresult in mental restlessness, w ith symp-toms such as palpitation, insomnia and

III. BODY FLUIDBody fluid is a collective term for all

the normal fluids of the body. These aresaliva, gastric juice, intestinal juice andthe liquids in the joint cavities, as well astears, nasal discharge, sweat and urine.

1. Formation and Distributionof Body Fluid

Body fluid is formed from food anddrink after their digestion and absorptionby the spleen and stomach. The distribu-tion and excretion of body fluid prin-cipally rely on the spleen's function oftransportation, the lung's function of dis-persing and descending and regulatingwater passages, and the kidney's functionof controlling urination and separatingthe clear and the turbid. Of these threeorgans, the kidney is the most important.The twenty-first chapter of Pla in Ques-tions explains the formation and distribu-tion of body fluid by saying: "After foodenters the stomach, the qi of food essenceand water is transmitted to the spleen,which spreads it to the lung. The lungregulates the water passages and trans-mits the qi of water to the bladder below.The qi of water then spreads in fourdirections and travels along the merid iansof the five zang organs." When talkingabout the triple energizer as the pathwayof body fluid, the eighth chapter of PlainQuestions states: 'The triple energizer isthe irrigation official who builds water-


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56 CH INESE ACUPUNCTURE AND MOXIBCSTIONways. "In addition, fluids sent downwardsfrom the stomach continue to be ab-sorbed by the small and large intestines.A part of the fluid, after passing throughthe spleen, lung and triple energizer, isexcreted from the skin and hair as sweat.Another part of the fluid is sent down-wards to the bladder via the waterways ofthe triple energizer, and excreted fromthe body as urine, with the assistance ofthe qi of the kidney and bladder. Actedupon by all these zang-fu, body fluidreaches the skin and hair on the exterior,and penetrates the zang-fu in the interior,thus nourishing all the tissues and organs.throughout the body.

To conclude, the formation, distribu-tion and excretion of body fluid is acomplicated process resulting from thecoordinated activities of many of thezang-fu organs, especially the lung,spleen and kidney. Pathological changesof these organs may consequently affectthe formation, d istribution and excretionof body fluid. For example, if there isinsufficient formation or excessive loss,body fluid may be damaged or consumed.A disturbance in distribution of bodyfluid may lead to its accumulation, resu lt-ing in retained fluid and oedema, orthe formation of phlegm. Pathologicalchanges of body fluid may, in turn, im-pair the functions of many zang-fu or-gans, for example invasion of the heartby retained water produces palp itations;retention of fluid in the lung results incough with asthmatic breathing; drynessof the lung due to consumption of bodyfluid leads to unproductive cough; dry-

ness of the stomach causes thirst; anddryness of the intestines leads to consti-pation.2. Functions of Body Fluid (Jingye)Body fluid moistens and nourishes

various parts of the body. There are no-ticeable differences, however, in the na-ture, form and location of different typesof body fluid. Clear and thin fluids arereferred to as "jing," whilst thick andheavy fluids are known as "ye." "JingO,isdistributed on the muscular surface, andhas the function of warming and nourish-ing the muscles and moistening the skin."Ye" is stored in the joints and orificesand has the function of moistening thejoints, strengthening the brain and mar-row and nourishing the orifices. As both"jingO,and "ye" are normal fluids in thebody and are derived from the samesource-the qi of food essence-theymay be transformed into each other.Generally they are referred to togetherby the term "jingye" (body fluid).

IV. THE RELATIONSHIPBETWEEN QI, BLOOD AND

BODY FLUIDAlthough qi, blood and body fluidhave their respective natures, they coor-dinate with, promote and restrain oneanother in their functional activities.

Their close and complicated re la tionshipsoften manifest in physiology and pathol-ogy, and are important in determiningtreatment on the basis of differentiation


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CHAPTER 4 QI, BLOOD AND BODY FLUID 57

of syndromes.

1. The Relationship Between Qiand BloodBoth qi and blood are the material

foundation for the functional activ ities ofthe body. They originate from food es-sence and from essential qi in the kidney,and their production depends on thefunctional activities of the lung, spleenand kidney. Qi mainly provides warm thand motive force, whilst blood providesnourishment and moisture. This is des-cribed in the Twenty-second Problem ofClassic on Medical Prob lems, "Qi dom-inates warmth while blood dominatesnourishment." Qi is considered to beyang, while blood is yin. Their relation-ship may be summarized by the state-ment: "Qi is the commander of blood andblood is the mother of qi." "Qi is thecommander of blood" means that bloodcannot be separated from qi in its forma-tion and circulation. The material basisof blood is yin essence, the transforma-tion of which into blood depends on qi.Qi functions well in transform ing yin es-sence into blood if it is abundant. Con-versely, this function of qi is weakened ifqi is deficient, so deficiency of qi maylead to deficiency of blood. For this rea-son, when treating disorders resultingfrom blood deficiency, qi tonics aresometimes added to the prescription.Since the heart qi dominates blood circu-lation, the lung qi ensures normal distri-bution and the liver qi takes charge of thefree flow of qi of the entire body, theblood circulation depends on the func-

tional activities of these three organs.This is described as "qi circulation lead-ing to blood circulation." Either weak-ness in propelling blood due to qi defi-ciency, or retardation of qi circulation,may cause disorders of blood circulation ,or even stagnation of blood. That is whyin order to obtain good therapeutic ef-fects in the treatment of blood stagna-tion, herbs which circulate qi, and qitonics, are often prescribed in combina-tion with herbs to activate blood circula-tion and remove stasis. The controllingfunction of qi ensures the normal circu-lation of blood in the vessels and preventsextravasation. Deficiency of qi may im-pair this function of controlling blood,leading to various types of haemorrhage.This is known as "qi fails to controlblood." To stop haemorrhage due to qideficiency, the method of tonifying qimust be used."Blood is the mother of qi" refers tothe fact that qi is "attached" to blood, andthat qi does not function well in promot-ing the physio logical activ ities of variousparts of the body unless it receives suffi-cient nourishment from blood. In casesof massive bleeding, there will also beloss of qi, which is known as "qi followsblood in becoming exhausted."

2. The Relationship Between Q iand Body Fluid

Qi differs from body fluid in nature,form and functional activities. There aresimilarities between them, however, intheir formation, circulation and distribu-tion. Both originate from food essence


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58 CHINESE ACUPUNCTURE AND MOXIBUSTIONand circulate throughout the body.The formation, distribution and excre-tion of body fluid depend upon qi circu-lation, and cannot be separated from theactivities of the qi of zang-fu organs suchas the lung , liver, k idney, triple energizerand bladder. Impairment of the activitiesof the qi of these organs may result inpathologica l changes, for example, insuf-ficient production or accumulation ofbody fluid. If the qi of these zang-fuorgans is deficient, and unable to exert itscontrolling function, there may be loss ofbody fluid. On the other hand, accumula-tion of body fluid may hinder qi circula-tion and affect the functions of certainzang-fu organs. Profuse loss of bodyflu id may also lead to massive dissipationof qi.

3. The Relationship Between Bloodand Body Fluid

Since both blood and body fluid areliquids and their main function is tonourish and moisten, they are consideredyin. Body fluid is an important part ofblood, and when it passes out of thevessels, it forms body fluid. As body fluidand blood can be transformed into each

other, there is a saying: "Body fluid andblood are of the same origin." Recurrentor severe bleeding may injure body fluidand result in thirst, scanty urination anddry skin. Severe consumption or loss ofbody fluid may also affect the source ofblood, manifesting as exhaustion of bothbody fluid and blood. For this reason, itis not advisable to use diaphoretice forhaemorrhagic patients. The method ofbreaking the blood (in which powerfuldrugs are administered to dissolve bloodsludge) or the bleeding method, shouldbe avoided in treating patients with con-sumption of body fluid due to ex-cessive sweating. The sixty-first chapterof Miraculous Pivot states: "The first con-traindication refers to a patient who isemaciated; the second to a patient aftersevere loss of blood; the third to a patientafter severe perspiration; the fourth to apatient after severe diarrhoea; the fifth toa patient after loss of blood followingchildbirth. The reducing method is con-traindicated in all these circumstances."The same essay also points out that careshould be taken in the acupuncture clinicwhen treating patients who are emaciateddue to deficiency of qi, or severe con-sumption of qi, blood and body fluid.

Chapter 4 Qi Blood Body Fluid

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