Qi Blood and Fluids Three Humours of Chinese Medicine

Qi Blood and fluids -- Three Humours of Chinese Medicine

Qi, Blood and Body Fluids are the most basic substances that constitute the human body and maintain its functional activities. They are, on the one hand, the products of the functional activities of the Zang and Fu Organs of the body, and on the other hand, the material basis of these functional activities. As TCM holds that the life process is, in fact, a process of the metabolism of these substances, this is regarded as the true meaning of the Zang and Fu Organs. In other words, the viscera are produced and maintained by the activities of these substances. Therefore, disorders of the viscera can be generalized as those of these substances. Generally speaking, Qi is an essential substance that is full of vigor and flows fast. Blood is the red liquid circulating in the vessels and nourishing the whole body, and Body Fluids are a general term for all the water necessary for life. Qi is attributed to Yang, because it is mobile and functions to move and warm; while the Blood and Body Fluids are attributed to Yin because they are motionless and function to nourish and moisten the human body. In this sense, Qi is also named Yang Qi and the Blood and Body Fluids, Yin Fluids of the body. 1. Qi Concept of Qi Qi was originally a philosophic concept. The ancients believed that the world changes and things in the world can transform from one to another, so when they tried to explain the world with a common substance, they determined that the substance must have two properties: invisibility and motion. As it is invisible or has no certain shape, it can create various kinds of things; and as it is moving, things in the world are always changing and may transform from one to another. Air, the original meaning of Qi, is just such a substance which cannot be seen but the movement of which, as wind, can be felt. This was extended to mean that the most basic substance of the world, and its movement and change can explain the generation, development and change of all things in the world. The ancient Chinese philosophy holds that Qi is this most basic substance constituting the world. Accordingly, TCM also believes that Qi is the most fundamental substance in the construction of the human body and in the maintenance of its life activities. As a whole, Qi in the cosmos takes two patterns of existence, diffused Qi and coagulated Qi. The former is more vigorous, cannot be detected directly and exists everywhere. The latter is manifested as various kinds of things that can be seen or that have certain shapes. In order to survive, coagulated Qi must communicate with diffused Qi and its generation as well as its ending results from movement of the diffused Qi. That means, when the diffused Qi coagulates, it creates substantial matter, while if it separates, the matter disappears. Therefore, any substantial matter can be regarded as a special process of the movement of Qi, and life, in essence, is the course of Qi's ascending, descending, exiting and entering movements in given conditions. Man depends on nature for his production and growth and must observe the common laws of the world. As everything in the world comes from the interaction of Heaven Qi and Earth Qi, man must breathe to absorb Heaven Qi and eat to absorb Earth Qi. The food Essence transformed and transported by the Spleen must be sent up to the Lung to combine with fresh air to produce the nutrients necessary for man's life activities. Qi of the human body also has two patterns of existence. The coagulated Qi is manifested as various visible or structural components of the body, such as viscera, body figure, sense organs, Blood, Body Fluids and Essence; the diffused Qi is manifested as the Qi that flows in the body, but takes no certain form, such as Nutritive Qi, Defensive Qi, Primordial Qi and Pectoral Qi. 2. Formation of Qi Qi of the human body comes from the combination of three kinds of Qi, Primordial Qi inherited from parents, the fresh air inhaled by the Lung and the refined food Essence transformed by the Spleen. Primordial Qi is derived from the Congenital Essence of the parents and is the primary substance to produce an embryo. So it forms the basis of the human body and its life activities. Without Congenital Essence, there can be no human body. After birth, the congenital Essence is stored in the Kidney to promote development and to control the reproductive activity of the human body. The refined food Essence is generated by the food which is taken in after birth and is distributed all over the body to produce nutrients and Qi and Blood under the action of the Spleen and Stomach. Fresh air is inhaled by the Lung after birth and is the main source of Qi of the human body. From the process of formation of Qi, we can see that Qi of the human body is closely related to the functional activities of the Kidney, the Spleen and Stomach, and the Lung, in addition to the congenital constitution, food and nutrients, and the environment. Only when these organs function properly can the Qi of the body flourish. Conversely, dysfunction of any of these organs will influence the formation of Qi and the physiological function of Qi. For example, dysfunction of the Lung will weaken respiration, leading to failure of fresh air to be inhaled and the turbid Qi of the body to be exhaled, with the resultant inadequate formation of Qi. The transformation and transportation of the Spleen and Stomach play a particular role in the formation of Qi, for man relies on the nutrients transformed and transported by the Spleen and Stomach for his life after birth. On the one hand, the Spleen sends up nutrients to the Lung to be dispersed, on the other, it sends down nutrients to the Kidney to supplement Kidney Essence. So, hypofunctioning of the Spleen and Stomach influences all three elementary substances that produce Qi. 3. Functions of Qi Generally speaking, Qi of the human body has five functions: pushing, warming, defending, controlling and steaming. 1) Pushing Qi is a vigorous substance that flows fast in the human body. So it promotes the growth and development of the body, the movement, distribution and discharge of Blood and Body Fluids, and the functional activities of Zangfu Organs. After birth, the Genuine Qi (Zhang QI) generated from Kidney Essence determines the growth and development of the human body. After middle age, Genuine Qi gradually declines, so a person grows old. If his Genuine Qi is deficient, a person's development will be poor. The physiological functions of Zangfu Organs and Channels and Collaterals of the human body all depend on the pushing of Qi as well as the nourishing of Blood. The vigor and the ascending, descending, entry and exit movements of Qi play a very important role in promoting the functional activities of Zangfu Organs and Channels and Collaterals. Any organ is a place where the activities of Qi take place, so the physiological effect is in fact, the manifestation of Qi's movements. For example, the respiration of the Lung is actually carried out by the dispersing and descending effects of Lung Qi. Therefore, when Qi is deficient, hypofunctioning of Zangfu Organs will ensue. For instance, deficient Lung Qi often leads to feeble breathing, a lower voice, lassitude, weak pulse, etc. Qi also promotes the generation, distribution and discharge of the Blood and Body Fluids. As Yin substances, Blood and Body Fluids depend on Qi's activities to be generated. In other words, generation of these substances relies on the activities of Qi of the Spleen and the Stomach, the Lung and the Kidney. Besides, Qi is a vigorous substance, so it can activate the flow of Blood and Body Fluids, as well as transform them into various secretions and excretions. For this reason, Qi Deficiency often leads to an impeded flow of Blood or stagnation of Blood, or retention of Body Fluids in the body, which, in turn, causes Phlegm or edema. 2) Warming Qi, as a Yang substance, is rich in heat, which can warm Zangfu Organs, Channels, skin, and muscles and tendons, to maintain normal body temperature and the normal functional activities of these organs and tissues. Motion produces heat, so the heat carried by Qi is in fact, a result of the constant movement of Qi, and the body temperature is maintained by the constant movement of Qi. In addition, Qi's warming function contributes to the movement of Blood and Body Fluids. The ancients observed that water in a river would flow in warm weather and freeze in cold weather, so they drew the conclusion that the warming effect of Qi must be an imperative condition for the free flow of Blood and Body Fluids within the body. Pathologically, disorders of Qi in its warming function are mainly manifested as two kinds: one is a cold manifestation due to Deficiency of Qi, which results mostly from the deficient Qi failing to produce adequate Heat to warm the body, marked by aversion to cold and a desire for warmth, cold limbs, lower body temperature and sluggish flow of Blood and Body Fluids. The other is the manifestation of Heat due to stagnation of Qi, which is usually caused by sluggish flow of Qi in a local area. 3) Defending The defensive ability of the body results from the combined action of a number of physiological functions, of which the function of Qi plays a particularly important role. The defensive effect of Qi mainly indicates that Qi can prevent the invasion of external pathogenic factors into the body. Generally speaking, external pathogens invade the body through either the skin or the nose and mouth. Defensive Qi functions to protect the body surface, and control the opening and closing of the pores, so it can prevent the invasion of external pathogens. If the defensive function of Qi is deficient, the resistance of the body against the invasion of these factors will be weakened, and as a result, susceptibility to such diseases as the common cold are likely to occur. 4) Controlling Qi has the function of controlling the flow of Blood and Body Fluids to prevent extravasation or unnecessary loss of Body Fluids. Qi can keep the Blood flowing within the vessels to avoid extravasation, control the amount and time limit of such secretions as sweat, urine, gastric juice, and saliva to prevent their excessive loss, and control emission to avoid its excessive discharge. When Qi is deficient, Yin Fluids will be profusely lost. For example, failure of Qi to control Blood will cause various kinds of bleeding; inability of Qi to control Body Fluids will cause spontaneous sweating or profuse sweating, incontinence of urine or profuse urine; and failure of Qi to control emission will cause nocturnal emission, premature ejaculation, or seminal emission. The controlling effect of Qi and the pushing effect of Qi are opposite and supplement each other. On the one hand, Qi promotes the distribution and discharge of Blood and Body Fluids; on the other, Qi controls the flow of these Yin substances to prevent their unnecessary loss. Only when these two opposite aspects are harmonized can the normal flow and discharge of the Yin substances and the metabolism of Blood and water be maintained. 5) Transforming This refers to various conversions occurring along with the movement of Qi. It includes the changes of Qi during its movement and the generation and metabolism of Essence, Blood and Body Fluids and their transformation. That is to say, any changes of substances can be considered the result of the transforming effect of Qi, such as transformation of Food into nutrients and wastes, that of wastes into feces, that of nutrients into Qi and Blood, that of Body Fluids into sweat and urine, and the discharge of urine and feces. As the transforming effect of Qi in the human body is a process in which the metabolism of the substances take place, it forms the essence of life. Although the above mentioned five functions of Qi differ from each other, they are all based on the basic property of Qi, or the vigorous and nutritive nature of Qi. 4. Basic patterns of Qi's movement

Qi flows throughout the whole body because of its strength and vigor. The movement of Qi is called Mechanism of Qi, which can be generalized as four aspects: ascending, descending, entering and exiting movements, which are based on directions. Ascending refers to the upward movement of Qi from a lower area; descending means the downward flow of Qi from an upper area. Exiting means the outward movement of Qi, and entry indicates the inward movement of Qi. Although the activities of the human body are multiple, they can all be summarized as these four aspects. For example, the dispersing effect of the Lung is a manifestation of the exit and ascent of Qi, while its descending effect is a manifestation of the descending and entering movements of Qi. The physiological function of Zangfu Organs is often reflected on their Qi's ascent, descent., entry and exit movements. Take the

Movement of spleen and stomach Qi Spleen and Stomach for example. The food that enters the Stomach is separated as nutrients and wastes after digestion. The nutrients are then absorbed and transported to each part of the human body through the activities of Spleen Qi, which is mainly marked by ascent and exit. On the other hand, Stomach Qi functions downward to send down the wastes as well as urine and stools, indicating that it goes downward in physiological conditions.

Kidney Qi Take the Kidney for another example; the Kidney is located in the Lower Jiao, but Genuine Qi manufactured by Kidney Essence has to go upward so that It can be distributed all over the body. This is a manifestation of ascent. On the other hand, the Kidney can assist the Lung by its receiving function, so it also has the manifestation of descent.

The ascent, descent, exit and entry movements of Qi are of prime importance in human life. The Kidney Essence, the food Essence transported and transformed by the Spleen and Stomach and the fresh air inhaled by the Lung, will not be distributed over the body to perform their physiological functions if they do not make ascent, descent, entry and exit movements. Entry, exit, ascending and descending movements of Qi must be kept in harmony. In other words, the two opposite aspects should be balanced. A free flow of Qi as well as balancing the ascent, descent, and exit and entry movements of Qi are known as the harmony of activities of Qi. Once this harmony is destroyed, disharmony of the activities of Qi will ensue, which mainly consists of five states: adverse upward flow of Qi, collapse of Qi, escape of Qi and obstruction of Qi in its outward passage.

The adverse upward flow of Qi refers to excessive ascent or insufficient descent of Qi, which affects the Liver, the Lung and the Stomach in most cases. As Liver Qi tends to go up, any induction factors may cause uprising of Liver Qi; Lung Qi and Stomach Qi, in a normal case, tend to go downward, so when the pathway for descent is obstructed, their Qi will go upward instead. The former case is a result of excessive ascent of Qi, while the latter is a result of inadequate descent of Qi. Collapse of Qi results mostly from excessive descent or inadequate ascent of Qi, which occurs mainly in the Spleen. As Spleen Qi functions upward to send up nutrients, it may sink if it is deficient. Escape of Qi indicates inability of Qi to be kept within the body which leads to excessive loss of Qi, which often follows profuse sweating or severe hemorrhage. Obstruction of Qi in going outward is usually caused by an attack of noxious gases which obstruct the pathways for Qi in the Interior of the body to go out. Such a case is marked by sudden occurrence of coma or syncope. The last type is stagnation of Qi, meaning impeded flow of Qi in the whole body or in a local area. 5. Classification of Qi As the most basic substance that constitutes the world, Qi can be used to name everything in the world, so it is hard to classify it. However, Qi mentioned here is something concrete, or Qi that is different from Blood and Body Fluids. That means, it is not a gen eral term for all the components of the body, but substance that has a certain distribution and function. Clinically, the following four kinds of Qi are most the commonly mentioned. 1) Primordial Qi Primordial Qi is also named Genuine Qi. It is manufactured by Kidney Essence and functions as the primary motive force for the growth and development of the human body, as well as the functional activities of Zangfu Organs. After being manufactured, it goes through the whole body by the way of the San Jiao to promote the life activities. The main function of Primordial Qi is to initiate and promote the vital activities. The growth and development of the human body, and the functional activities of Zangfu Organs all depend on Primordial Qi. Therefore, when Primordial Qi is sufficient, the functional activities of Zangfu Organs will be strong and the constitution will be good. However, if Primordial Qi is deficient due to a congenital defect or improper feeding after birth, the functional activities of the whole body will become weakened. It must be pointed out that the mutability of Primordial Qi is not only determined by the congenital Essence, but also determined by the acquired Essence or the Food Essence sent down to the Kidney. So congenital Deficiency of Primordial Qi can be corrected to some extent by supplementing the acquired Essence, or by strengthening the function of the Spleen and Stomach to promote the production of Food Essence. Long-standing diseases, which often consume the Essence of the human body, may lead to Deficiency of Primordial Qi. 2) Pectoral Qi Pectoral Qi is also termed Great Qi. It accumulates in the thorax where Qi of the whole body converges. So the thorax is also known as "the sea of Qi".

Pectoral Qi is generated by the combination of the food Essence the Spleen transports and transforms and the fresh air in haled by the Lung. Therefore, the functional states of the Spleen and the Lung directly influence the formation of Pectoral Qi. Pectoral Qi is distributed in the thorax after its formation, then to the Blood vessels and the respiratory tract. Its main functions are twofold: first, it can assist the Lung in breathing. As Lung Qi serves as the force for breathing and voice, speaking, voice and respiration are all closely related to the quality of Pectoral Qi. Usually, clear speech, a strong voice and moderate and rhythmic respiration indicate strong Pectoral Qi, while unclear speech, a feeble voice and shallow breathing or shortness of breath are signs of Deficiency of Pectoral Qi. Second, Pectoral Qi can assist the Heart in activating the flow of Blood. So, circulation of Qi and Blood and the pulsation of vessels can reflect its condition. Generally speaking, when Pectoral Qi is sufficient, the pulse will be moderate and forceful, and the Heart will beat rhythmically and evenly. If Pectoral Qi is deficient, the pulse will be swift, irregular, feeble or scattered. Pectoral Qi is usually considered a link connecting the functional activities of the Heart and those of the Lung. In the clinic, Deficiency of Pectoral Qi in most cases indicates Deficiency of Lung Qi leading to Deficiency of Heart Qi and ensuing Blood Stasis. For example, when a patient suffering from chronic bronchitis develops pulmonary Heart disease, which is marked by shortness of breath, a low voice, palpitation, a purplish face, running or intermittent pulse, etc. , he or she can be diagnosed as having deficient Pectoral Qi. 3) Nutritive Qi Nutritive Qi is the Qi flowing in the Blood vessels. It is so named because it is rich in nutrients. As it exists together with the Blood in the vessels, they are often collectively named Ying Blood (Ying means Nutritive Qi here). Nutritive Qi is formed by the combination of the nutritious part of the food Essence transported by the Spleen and fresh air inhaled by the Lung. After its formation, Nutritive Qi is sent to the Channels to flow in the order of the Twelve Regular Channels. The main functions of Nutritive Qi are to generate Blood and to nourish the whole body. In TCM, Blood consists mainly of two parts: Nutritive Qi and Body Fluids. The Nutritive Qi can absorb Body Fluids from refined food and carry it to the vessels to form Blood. So Nutritive Qi has the function of generating Blood. Moreover, all Zangfu Organs, Channels and tissues depend on the nourishment of Nutritive Qi for their existence and functional activities. As Nutritive Qi, compared with Defensive Qi, belongs to Yin it functions chiefly to nourish the physique of the body. 4) Defensive Qi Defensive Qi is Qi that functions to defend the human body. It is also named Defensive Yang, because it belongs to Yang compared with Nutritive Qi. Defensive Qi comes from refined food that is vigorous and flows fast, and fresh air inhaled from Heaven. Being vigorous, Defensive Qi cannot tolerate the control of the vessels, so it flows out of the vessels. The distribution of Defensive Qi has two features: the flow following Nutritive Qi and free flow. The former indicates that Defensive Qi also goes along the Twelve Regular Channels, while the latter indicates that Qi is distributed all over the body. The main functions of Defensive Qi include three aspects: First, protecting the body surface from the invasion of external pathogens. Defensive Qi permeates the muscular striae and the skin to control opening-closing of the muscular striae, so it acts as a defense against the invasion of external pathogens. If Defensive Qi is deficient, diseases due to the attack of external pathogens are likely to occur. Second, warming and nourishing Zangfu Organs, skin and hair, muscles, etc. , to maintain the normal body temperature and ensure the normal activities of the organs and tissues. When Defensive Qi fails to warm due to its Deficiency, cold symptoms may be exhibited. On the other hand, stagnation of Defensive Qi will produce Heat and give rise to Heat manifestations. For example, when a Cold pathogen attacks the superficial areas of the body, fever and chills often occur. The fever is related to the stagnation of Defensive Qi, while the chills are due to failure of Defensive Qi to produce its warming effects. Three, controlling the opening and closing of the sweat pores. Sweat is derived from Body Fluids and Blood, but its discharge depends on the function of Defensive Qi. When the striae of muscles are tightly closed due to an attack of external pathogens, Defensive Qi will be unable to go outward, so there is fever and absence of sweating. When Defensive Qi is deficient, spontaneous sweating will occur. Both Nutritive and Defensive Qi are mainly derived from refined food transported by the Spleen and Stomach. Nutritive Qi flows in the vessels while Defensive Qi flows out of the vessels. Coordination of the two maintains a normal sweat discharge and a normal body temperature. If this coordination is destroyed, abnormal sweating or fever with chills will ensue.

1 . Blood Blood is a thick red liquid circulating in the Blood vessels. It has a strong nourishing effect on the human body and serves as one of the basic substances constituting the human body. The vessels through which Blood circulates are also named the House of Blood. Under normal conditions, Blood circulates in the vessels so that it can reach each part of the body and produce its nourishing effect. In the case of extravasation of Blood, the Blood will fail to nourish the body; thus it is called extravasated Blood or dead Blood. Although Blood in appearance is similar in TCM and Western medicine, it cannot be regarded in the same manner. In TCM, Blood is a Yin substance, so it depends on Qi to be generated and distributed. And Blood Deficiency is not equal to anemia. In most cases in TCM, anemia should be diagnosed as Deficiency of both Qi and Blood. 1-1. Formation of Blood Blood is mainly composed of Nutritive Qi and Body Fluids, which come from the refined food transformed and transported by the Spleen and Stomach. So the Spleen and Stomach are also known as "the source of Qi and Blood", and the quality of the nutrients taken in, as well as the functional states of the Spleen and Stomach, influence directly the formation of Blood. The Essence stored in the Kidney can also be transformed into Blood by two methods. First, Kidney Essence and Liver Blood can be transformed into each other so that the Blood of the whole body is supplemented. Second, Kidney Essence supplies bones with marrow, which not only nourishes the bones but also generates Blood 1-2. Function of Blood The main function of Blood is to nourish the whole body. Blood circulates ceaselessly through the vessels, by which it is carried to Zangfu Organs internally and to the skin, muscles, tendons and bones externally, to both nourish and moisten. Compared with Qi, Blood is a Yin substance which functions to support the body physique. Therefore, it serves as a Nutritive substance of the body. When the Blood is sufficient, there is a rosy and bright face, strong and well-developed muscles, and lustrous skin and hair. On the other hand, Deficiency of Blood will lead to withered hair and skin, atrophy and convulsion of tendons, thin muscles and weak Zangfu Organs. Blood is also regarded as the material basis for mental activities, which are controlled by the Heart. As the Heart is in charge of Blood and vessels, the mental activities controlled by the Heart mainly take Heart Blood for their material basis. For this reason, sufficient Blood often exhibits as full vigor, perfect consciousness, keen perception, etc., while Deficiency of Blood usually leads to listlessness, insomnia, dream-disturbed sleep, dysphoria, or even vagueness of the Mind and other mental disorders. 1-3. Circulatiou of Blood Blood, pertaining to Yin, is motionless in nature. It depends on Qi for its movement. But the circulation of Blood also requires the controlling of Qi in order to avoid extravasation. Therefore, coordination between the pushing action and controlling action of Qi maintains the normal flow of Blood. When the pushing action is excessive or the controlling action is too weak, the flow of Blood will be accelerated, or even will cause bleeding. Conversely, when Qi fails to propel or the controlling action of Qi is too excessive, the flow of Blood will become sluggish, or even develop into Blood Stasis. The circulation of Biood is related to the functional activities of all Five Zang Organs. The Heart controls the Blood of the whole body both by beating to give impetus to the Blood flow and by linking up the vessels. The Lung, which has the function of controlling Qi, helps the Heart to propel the Blood flow. In other words. the descending effect of the Lung can help send down Blood and the dispersing effect of the Lung can assist the outward flow of Blood. The Liver can maintain the free flow of Qi, so it also acts as one of the forces for the circulation of Blood. As for the control of the Blood flow, Spleen Qi and the Liver's Blood storage play an important role. Therefore, when Spleen Qi is deficient, bleeding will ensue as a result, while when the Liver fails to store Blood and regulate the distribution of Blood, bleeding will also occur. The Cold and Heat of Blood also influence its circulation. Free flow of Blood depends on a certain temperature. Blood Heat, for example, may cause bleeding because the Heat will speed up the Blood flow, or cause Blood Stasis because the Heat may consume Body Fluids of the Blood and give rise to increased viscosity of Blood. Blood Cold, as a result of the contracting nature of Cold, will also impede the flow of Blood, causing Blood Stasis. 2. Body Fluids Body Fluids is a general term for all the normal fluids of the human body, including the fluid existing in Zangfu Organs and tissues and the secretions and excretion of the human body. Like Qi and Blood, Body Fluids are also essential substances constituting the human body. 2-1. Formtlon, distributlou and discharge of Body Fluids This is a rather complicated process involving the functional activities of a number of Zangfu Organs. Body Fluids are derived from the food and water taken in; their formation relies on the absorption of the water and nutrients of the food through the actions of the Stomach, the Small intestine and the Large intestine. To be exact, the Stomach absorbs part of the nutrients from food through its primary digesting action; the Small intestine separates nutrients from wastes to absorb the majority of the nutrients and fluid, and the large intestine absorbs the surplus of the food residues to form feces. The fluid absorbed by the Stomach, the Small intestine and the Large intestine is then sent to the Spleen to be distributed to the whole body. The distribution of Body Fluids depends on the action of tbe Lung, the Spleen and the Kidney and the San Jiao is necessary as the passageway. In other words, the Spleen can send Body Fluids up to the Lung so that they can be further distributed to other parts of the body. Besides, the Spleen can also distribute Body Fluids directly to other parts of the body. Therefore, the Spleen plays a very important role in the distribution of Body Fluids, and failure of the Spleen in transformation and transportation is considered the most important reason behind the occurrence of Phlegm, water retention and edema. The Lung has the effect of regulating the metabolism of Body Fluids. Through its dispersing effect, Body Fluids can be sent to moisten the skin and muscles and be transformed into sweat to be discharged while through its descending effect, Body Fluids can be sent down to the Bladder and other parts of the lower body. Disturbance of the Lung's dispersing and descending action will certainly cause disturbance of the distribution and discharge of Body Fluids, giving rise to Phlegm, edema, or urine disorders. The Kidney exerts its influence on Body Fluids in two ways: first, its Yang Qi warms up Yang Qi of the whole body to promote the distribution and discharge of Body Fluids; secondly, it controls the formation and discharge of urine is the most important means of discharging Body Fluids. In brief, the formation of Body Fluids mainly depends on the transformation and transportation of the Spleen and Stomach; their distribution depends on the Spleen and the Lung, and their discharge depends on the Lung and the Kidney. 2-2. Functions of Body Fluids As liquid substances, Body Fluids function to moisten and nourish the human body. Compared with Blood, the nourishing effect of Body Fluids is not so strong. To be exact, when distributed in the body surface, they moisten the muscles, skin and hair; when permeating through the body orifices, they moisten and protect the nose, eyes, ears and mouth when infiltrating the vessels, they nourishes and smooth the vessels as the basic component of Blood when pouring into the internal organs, they nourish and moisten them; and when seeping into the joint cavities, marrow cavity and skull, they lubricate the joints, nourish and moisten the bone marrrow, spinal cord and the brain. When Body Fluids are deficient, these areas or organs will become dry or withered. 3. Connections Between Qi, Blood and Body Fluids As the basic substances of the human body, Qi, Blood and Body Fluids are closely related to each other. They are all derived from food Essence and assist, depend on, and are transformed into each other. 3-1. Connection between Qi and Blood The relation of Qi and Blood can be generalized as having two aspects: Qi as the commander of Blood, and Blood as the mother of Qi. As the commander of Blood, Qi has three main functions. One, generating Blood. This means that the generation of Blood depends on Qi's activities for its production. Blood is composed of Body Fluids and Nutritive Qi, which is produced by food through the functional activities of Spleen Qi and Stomach Qi. During this process, it is Qi's activities that transform the food into food Essence, then into Nutritive Qi and Body Fluids and ending in the formation of Blood. Without Qi's activities, there would be no Blood. So Qi can generate Blood. When Qi is vigorous, it can generate adequate Blood. On the other hand, Deficiency of Qi will cause Blood Deficiency due to decline of its action of generating Blood. Clinically, Qi- invigorating drug are often added to Blood-nourishing formulas to promote the generation of Biood. Two, propelling the circulation of Blood. This means that Blood, a Yin substance which is motionless in nature, depends on Qi for its movement. To be exact, Heart Qi moves Blood by maintaining the beating of the Heart, Lung Qi pushes Blood outward through its dispersing effect and sends down Blood through its descending effect, and the Liver's dispersing and discharging effects help to regulate the free flow of Blood. When Qi is deficient and hasn't enough power to propel, the Blood flow will become sluggish or Blood Stasis will occur. If Qi's ascent, descent, or entry and exit movements are destroyed, Blood Flow will also be disturbed. For example, adverse upward flow of Qi will cause Blood to flow upward excessively, giving rise to distending pain of the head, blood, shot eyes, red face, or even hematemesis and coma. Therefore, Blood flow disorders are usually treated both with drugs regulating Blood and drugs regulating flow of Qi. Third, controlling the flow of Blood. This means that Qi functions to keep Blood flowing within the vessels to prevent extravasation, which is mainly performed by Spleen Qi. If Qi fails to control Blood flow, various kinds of bleeding will occur. Clinically, bleeding due to Qi Deficiency must be treated by strengthening the Spleen so that Blood flow can be controlled. Blood as the mother of Qi has two meanings: Qi attaching to Blood and Blood supplying Qi. Qi is a vigorous substance and prone to flee easily, so it must attach itself to Blood so that it can reach all of its distribution points to perform its normal function. This is also a manifestation of mutual restriction of Yin and Yang, or the motionless nature of Blood restricting the moving nature of Qi. By Blood supplying Qi is meant that Blood nourishes Qi or serves as the material basis of Qi. Clinically, a severe hemorrhage often gives rise to escape of Qi due to the failure of Blood to carry Qi, and Blood Deficiency often leads to Qi Deficiency. 3-2.Relationship between Qi and Body Flulds The relations of Qi and Body Fluids is very similar to those of Qi and Blood. The generation, distribution and discharge of Body Fiuids depend on Qi and its activities. On the other hand, Qi also relies on Body Fluids to be carried, and Body Fluids are where Qi exists, moves and changes. Qi can generate Body Fluids. Body Fluids comes from food and drink, which are transformed into both refined and waste material through the activities of the Spleen and Stomach. The liquid that has been refined, or Body Fluids, is then distributed to each part of the body by the Spleen. When the Spleen and the Stomach function properly, Body Fluids can be adequately generated on the other hand, Deficiency of Spleen Qi or Stomach Qi will lead to inadequate formation of Body Fluids, causing Deficiency of both Qi and Yin Fluids. Qi can distribute and transform Body Fluids. Body Fluids are substantial and motionless in nature. So their distribution and discharge depend on the propulsion of Qi and the activities of Qi. As a result of the ascent, descent, and entry and exit movements of Qi of the Spleen, the Lung and the Kidney, Body Fluids are distributed all over the body to perform their moistening effect. All the metabolized Body Fluids must be transformed into sweat, urine or steam to be discharged, so the transforming effect of Qi plays an important part in the discharge of Body Fluids. Failure of Qi to propel and transform due to its Deficiency or to stagnation of Qi can give rise to retention of Body Fluids, leading to edema, Damp or Phlegm, which is known as inability of Qi to propel and transform Body Fluids. Qi can control Body Fluids. This means that Qi can control the flow and discharge of Body Fluids to prevent their excessive loss. For example, Defensive Qi can prevent excessive sweating by controlling the closing and opening movements of the sweat pores. If Defensive Qi is deficient, spontaneous sweating will occur as a result; Kidney Qi controls the opening and closing of the Bladder, so Deficiency of Kidney Qi often leads to profuse and frequent urine, enuresis and incontinence of urine. For such cases, drugs consolidating Qi must be adopted to obtain effectiveness. Body Fluids carry Qi. Qi is also attached to Body Fluids. When too much Body Fluids are lost, Qi will escape. Excessive vomiting or diarrhea, for example, will impair Qi, leading to Deficiency of Qi, which is often accompanied by lassitude, a symptom of Qi Deficiency. 3-3. Relationship between Blood and Body Fluids Blood and Body Fluids are from the same source and their functions are similar. So they can be transformed into each other and are closely related to each other. Both Blood and Body Fluids are derived from food Essence, hence they are said to have "a common source'. Body Fluids are an important component of Blood, and Body Fluids in the vessels can go out of the vessels to make up Body Fluids of the body and vice versa, so Blood and Body Fluids usually influence each other under pathologic conditions. When excessive loss of Blood occurs, Body Fluids that are out of the vessels can enter the vessels to compensate for the loss in the same way, when there is excessive consumption of Body Fluids, the Fluids in the vessels can also go out of the vessels to increase those Body Fluids. Therefore, for patients with excessive bleeding, diaphoretic should be avoided; while for patients with Deficiency of Body Fluids, the practice of removing Blood Stasis with drastic drugs is not indicated. 4. Discussion of Difficult Points 4-1. Difference between Qi and Essence QI Qi and Essence Qi are two frequently used terms in TCM, and they are often used interchangeably because they have many things in common. But they have different meanings. In the very beginning, both Qi and Essence Qi were used to imply the basic substance of the world. Afterwards, only Qi was used in this sense and Essence Qi was limited to the following meanings: First, a substance that is extremely minute. As Essence literally suggests, Essence Qi is one kind of refined substance which is used to create or form more advanced things. In ancient China, there was the saying that "Essence Qi produces man and turbid Qi produces animals". As the Essence stored in the Kidney is the basis of the growth and development of the human body, it is also called Essence Qi. Second, a substance that is nutritive. The ancients believed that things of high quality must be more useful than those of lower quality. So compared with the raw materials or food, the nutrients of the body such as the Blood, Body Fluids and the Qi of the human body, can all be said to be Essence Qi. For example, we often say the main function of the five Zang Organs is to store Essence Qi, which here means the nutritive substances that are necessary for the life activities of the human body. Third, a substance that is useful. Man depends on the nourishment of both Heaven Qi and Earth Qi, but not everything in nature is useful for human beings. Only the things that can support human life are what the human body requires. So in TCM, we call these useful substances from nature Essence Qi of the Heaven aid the Earth. Food is essential to the human body, but only the nutritive parts of the food share the name of Essence Qi of Food and Drinks. Currently, Essence Qi basically has only the above three meanings. 4-2. Why doesn't TCM stress tlte concrete process of the formation of Blood As mentioned in this chapter, Blood, according to TCM theory, is formed in two ways: combination of Nutritive Qi and Body Fluids which enter the vessels together under the action of Nutritive qi, and the production of Blood from the Essence stored in the kidney. During the process of the formation of Blood, the Spleen, which produces Nutritive Qi and the Body Fluids, the Kidney, which stores Essence and food which serves as the source of Nutritive Qi and Body Fluids are the main contributing factors. As for how Nutritive Qi combines with Body Fluids to produce Blood or how Kidney Essence transforms into Blood, TCM gives no exact answers. Why? This question is related to the characteristics of TCM theories. We know that the theories of TCM originate from clinical practice and their value is that they can be guides to that clinical practice. This is quite different from theories in Western medicine which are based on anatomical or analytical methods. In TCM, answers to questions are necessary only to the extent that they can guide clinical practice. In the clinic, strengthening the Spleen to enhance its transforming and transporting effects and to produce more Nutritive Qi and Body Fluids, and to nourish Kidney Essence to promote the transformation of the Blood have long been proved to be the most effective way for treating a Blood Deficiency. No matter how carefully the formation of Blood is analyzed, as long as it cannot guide clinical practice, it is not useful in TCM, and therefore, further exploration is not required. 4-3. What is the significance of stressing the relationship between Qi and Blood? In Western medicine, there is no concept such as Qi. So blood disorders, including inadequate production of the blood as in aplastic anemia, and leukopenias are treated as only relative diseases of blood. But in TCM, which stresses the existence of Yin and Yang in the human body, Qi and Blood have close relations, which are known as Qi being the master of Blood, and Blood being the master of Qi. This kind of relation not only determines the understanding of TCM of the formation and the circulation of Blood, but also influences the diagnosis and treatment of Biood disorders. For example, Blood Deficiency may be caused by Qi Deficiency which cannot generate Blood, since Qi is the motive force for Blood generation. In the treatment of such Blood Deficiency, supplementing Qi plays an even more important role than nourishing Blood. Bleeding, for another example, may be the result of Qi Deficiency because Qi controls Blood flow, so such bleeding should be treated by strengthening Qi. Patients with anemia niay be misdiagnosed only as having Blood Deficiency in the clinic, because one may take blood in Western medicine and Blood in TCM as the same. Anemia is a disease caused by reduction of the oxygen carried by the hemoglobin, while Blood Deficiency in TCM means a morbid state which is caused by loss of Blood and results in the decline of the nourishing effect of the Blood. In fact, most anemia patients present the symptoms of both Qi Deficiency and Blood Deficiency in accordance with TCM theory, and are treated mainly by supplementing qi.