• Philip Niño Tan-Gatue

Qi and Blood: Inseparable

Disclaimer: When I spell Blood with a capital B I am using it in the Chinese Medicine sense.  If I spell blood with a small b, I am using it in the western sense.  This is the standard followed by Maciocia and others.

Love and Marriage

“Love and Marriage” is a song written in 1955 and sung by Frank Sinatra.  I had first heard it while watching the 1980s situation comedy “Married: With Children” as a version of it was used as the show’s theme song.  Don’t bother trying to look for the song in the DVD releases, though.

Anyhow, here are the lyrics used in the show as per marriedwithchildren.wikia.com:

Love and marriage,

“Try, try, try to separate them…”

love and marriage, Go together like a horse and carriage. This I tell ya, brother, you can’t have one without the other. Love and marriage, love and marriage, It’s an institute you can’t disparage. Ask the local gentry and they will say it’s elementary. Try, try, try to separate them, it’s an illusion. Try, try, try and you only come… to this conclusion: Love and marriage…

Whenever I hear this song these days, especially the “we can’t have one without the other” and “try, try , try to separate them, it’s an illusion” phrases, the first things that comes to mind isn’t government and taxes, but the Oriental Medicine concepts of Qi and Blood.  To most westerners, acupuncture is associated with the idea of Qi.  What many people do not realize – and this is even forgotten by many healing professionals themeselves – you can’t have Qi without Blood.

Qi and Blood

Before we go on, it is necessary to clarify some definitions.  Namely, what are Qi and Blood?  Zhu Fanxie defines Qi as:

The invisible basic substance that forms the universe and produces everything in the world through it’s movement and changes. (Zhu, 2002)

Later, Zhu also writes:

The basic element that constitutes the cosmos and, through it’s movements, changes and transformations, produces everything in the world, including the human body and life activities.  In the field of medicine, Qi in its physiological sense is referred to as the basic element or energy which makes up the human body and supports its vital activities… (Qi is) invisible and its existence in the human body can only be perceived through its resultant activities as expressed through organs and tissues (and) it is more frequently used in the sense of functional activities. (Zhu, 2002)

Yup, that’s it.  Qi is often imagined by Westerners to be some sort of mystical energy that is seemingly more acquainted with the spiritual than the physical.  As is evident in the definition, it is quite un-supernatural and is in fact the basis both of the movement and substance of nature.

Medically I had previously written on the topic of Qi as Physiology (link).  Today we link the physiologic aspect of Qi to its anatomic aspect: Blood.

(Blood is) the red fluid circulating through the blood vessels and nourishing the body tissues.

This seems the same as with western medicine at first glance, but let us examine further.

Ergil writes:

In relation to Qi, Blood and Fluids constitutes the yin aspects of the body. (Ergil, 2009)

Here we see a reference to Blood and Fluids being the yin aspect of the body as contrasted to Qi as obviously being yang.  Note the earlier mention of Zhu of the “functional activities” and “movements” of Qi.  Obviously, such a relationship evokes the known relationship of Yin and Yang – which we realize are ancient oriental concepts representing polar opposites.  In this case, anatomy and physiology, matter and energy.

Qi is the Yang, Blood is the Yin

So what what is the relationship between Qi and Blood in Traditional Chinese Medicine?

Chinese Medicine textbooks define this relationship with these four statements:

1) Qi produces the Blood. 2) Qi moves the Blood. 3) Qi controls the Blood. 4) Blood is the mother of Qi. (Zhu and Wang, 2010)

Let’s examine these one at a time:

Qi Produces the Blood

If Qi is the motive force behind organ functions, then the idea that Qi can be interpreted as physiologic function is reinforced.  Blood in both western and oriental medicine has to be produced as a consequence of the functions of organs.  In Traditional Chinese Medicine, since Blood is both the liquid and the nourishment, we see how many organs must work together to process the food we eat and the air we breathe into a the nutrients and oxygen needed to be circulated.  In western medicine, blood is produced from dividing cells in the bone marrow which is stimulated by the hormone erythropoietin, made in the kidneys.  Incidentally, TCM teaches that the Kidneys are related to bone marrow, long before erythropoeitin was discovered.

In TCM, Blood is formed by the Nutrient (Ying) Qi and Body Fluids.  Nutrient Qi is derived from the Food and Water Essence (Gu Qi) produced by the Spleen and Stomach.  The Spleen brings the Nutrient Qi to the Lungs, where they are combined with Qi from the air.  The Pectoral (Zhong) Qi then sends the Blood around the body.  While this scheme doesn’t fit with western medicine, it does provide a consistent framework with which to diagnose and treat using the TCM paradigm. (Zhu 2010) And heck, it works.

Thus, the function of organs leads to the production of Blood.

Qi moves the Blood

Blood  cannot move without Qi pushing it, hence it’s description as a “motive force”.  I recall Professor Wang in Nanjing telling us that (and I translate from the Chinese) “Blood merely follows where Qi leads it.”  Zhu clarifies that:

The circulation of Blood needs the pushing of Heart-Qi, dispersing of Lung-Qi, and free flowing of Liver-Qi.  Therefore, a deficiency of Qi may cause a reduction in the pushing function of Qi; stagnation of Qi may cause the Blood to flow slowly, even to stagnate; a disorder of the movement of Qi may lead the Blood to flow in the wrong direction: there will be symptoms such as red face and eyes, headache, and vomiting of Blood if the Blood goes up with the Qi moving upward; if the Blood flows down while the Qi is sinking epigastric and abdominal distention, vaginal bleeding and dysfunctional uterine bleeding (can occur). (Zhu, 2010)

This quote also illustrates the different pathologies of Qi and Blood.  Most people are aware of the states of deficiency and excess, but are unaware of pathologies of flow.  Qi may slow down, stagnate, accumulate or go in the wrong direction.  In that case, Blood follows through.

Qi controls the Blood

To understand this, we must understand what the Chinese meant by “control”.  Spleen-Qi in Chinese medicine keeps the Blood inside the vessels.  In modern medicine, we know that there is an interaction between the plasma, or fluid inside the vessels, and interstitial fluid, or the fluid in the spaces between muscles and tissues and the sort.  There is a dynamic interaction between the two.  Also, our capillaries, where actual nutrient and gas exchange occurs, are very delicate.  The slightest bump may cause bruising.  The controlling function of Qi relates to these two.  Weak controlling leads to Blood leaking out.  Quoting Zhu:

The Spleen has the function of Keeping the Blood circulating inside the vessels and preventing it from extravasation… (if the Spleen-Qi) cannot control the Blood, and Blood that flows outside the vessels will cause bleeding syndromes. (Zhu, 2010)

And lastly:

Blood is the Mother of Qi

This should be quite obvious by now.  We have seen how the different functions of the organs all contribute to the proper physiology of Blood.  Without proper strength and function, the organs cannot do their jobs, leading to disease.  But what supports the Qi of the organs? Obviously it is the Blood.  Again from Zhu:

Blood is the carrier of Qi, and it provides sufficient nutrition for Qi… If Qi loses it’s carrier, it will lose its root and become collapsed.

In simple terms, organs need nutrition in order to get the energy to function.  Blood brings them that nutrition.  I hope that the reader starts to appreciate the cycle here: Qi (function) keeps Blood going.  Blood keeps Qi going.

Circle of life?

Dr. Wang once told me that (again paraphrased from the Chinese), “If Yin and Yang are separated, then the person dies.”  I remember thinking at first that this sounds like some new age claptrap.  When I began to realize the relationship between Qi and Blood, I also realized how true Dr. Wang’s statement is.  Let me elaborate.

We have established that the relationship between Qi and Blood is a Yang and Yin relationship.  Qi is the Yang to the Blood’s Yin.  To separate Yin and Yang here would be tantamount to separating Blood from the circulation.  Now, let me ask you, the reader – what color is fresh blood from a cut?  What is it’s temperature? Is it solid or liquid?

Next, what happens when it is separated from the Qi (circulation physiology) for a while – what happens to it?  Does it become lighter or darker?  Does it become warmer or cooler?  Does it become solid or liquid?

Considering that Yin is defined as dark, solid and cool, the obvious conclusion with regards to TCM understanding of TCM is upon us.  Separate the Blood from the Qi and the Blood becomes pure Yin and dies.  Separate the Qi from the Blood and it also dies, as there is no more nutrition to keep the body functions going.

Hence, to say that when Yin and Yang is separated, the person dies – this is no longer archaic language.  It is merely another way to state what people have observed for millenia with regards to circulation and blood.

Qi and Blood.  You can’t have one without the other.


Ergil, Marnae and Ergil, Kevin.  Ed.  Pocket Atlas of Chinese Medicine.  Georg Thieme Verlag.  Stuttgart, Germany. 2009

Zhu Bing and Wang Hongcai, Ed. Basic Theories of Traditional Chinese Medicine.  People’s Military Medical Press, Beijing 2010

Zhu, Fanxie.  Classified Dictionary of Traditional Chinese Medicine.  Foreign Languages Press, Beijing, China. 2002

Sinatra Photo by William P. Gottlieb via Library of Congress. Original uploader was We hope at en.wikipedia

#blood #FrankSinatra #Qi

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©2021 by Philip Niño Tan-Gatue, MD, CAc, CMA.