Tuesday, November 03, 2009
Part 2. Qi in Chinese Medicine
Marty Eisen, Ph.D.
In part 1
of this series, the universal concept of Qi was introduced. Then, the various types of bodily Qi, used in traditional Chinese medicine to explain health and disease, were defined. Here the functions of Qi and its relation with the Chinese Organs and various substances in the body will be discussed.
4. Functions of Qi
The following are six observed functions of Qi.
5. Movement of Qi
- Transforming ---Kidney and Bladder Qi transform fluids and urine, respectively. Spleen Qi transforms fluids into food Qi, which is transformed into Blood (the Chinese concept discussed below) by Heart Qi.
- Holding --- Lung Qi holds sweat. Spleen Qi hold Blood and fluids in the blood vessels. Kidney and Bladder Qi hold urine.
- Raising ---Spleen Qi raises the organs.
- Protecting --- Lung Qi protects the body from external pathogenic factors.
- Warming --- Spleen Qi and, especially, Kidney Qi warm the body.
The internal organs perform specific functions, normally in relation to a specific type of Qi. In order to perform these functions, the various types of Qi have to flow in appropriate directions. The Liver controls the smooth flow of Qi in all directions. The movement of Qi is based on directions and can be described by: ascending, descending, entering and exiting. 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 entering indicates the inward movement of Qi. The following examples illustrate this directional flow.
The Lungs cause the Qi to descend directing it downwards to enter the Kidney and Bladder. The Kidneys receive the Lungs’ Qi, while Kidney Qi ascends to the Lungs. The Lungs control exhalation and the Kidneys inhalation. Furthermore, Liver Qi flows upward to help balance the downward flow of Lung Qi. Spleen Qi ascends to the Lungs and Heart, while Stomach Qi descends. Thus, the clear Qi obtained by the transformation of the Spleen ascends and the Stomach sends the unrefined part of the food to the Small Intestine for further processing.
Some organs perform movements in all four directions. Lung Qi moves in and out during breathing. However, when disseminating nutritional essence to the body, Lung Qi ascends, but descends when liquefying waste is to be sent to the Kidneys. Qi exits the Yin organs to flow in the corresponding meridians, while Qi enters the yang organs from their Yang meridians. Qi can also enter and exit the body from acupoints.
Besides the basic four movements, Qi movement is sometimes described as gathering (entering into a location) and dispersing (leaving to a different location). The terms expanding and contracting are also used, but these are just examples of exiting and entering.
6. Qi Pathology
There are four different types:
7. Blood and Qi
- Deficient Qi --- The Lungs, Spleen and Kidneys are prone to this condition.
- Sinking Qi --- Deficient Qi, especially Spleen Qi, can lead to sinking, which can cause prolapsed organs.
- Stagnant Qi --- Qi does not move. Liver Qi is susceptible to this condition.
- Rebellious Qi --- This occurs when Qi moves in the wrong direction. For example, when Stomach Qi ascends instead of descending, nausea, vomiting, or belching can occur.
In Chinese medicine Blood (Xue) is not the same as in Western medicine. Of course, Blood is a dense form of “Qi’. However, Blood is derived from Qi in two ways:
(i) Food Qi, produced by the Spleen, is sent upward to Lungs, and Lung Qi pushes it to the Heart, where it is transformed into Blood. The transformation requires the assistance of the Original Qi stored in the Kidneys.
(ii) Kidney Essence produces Marrow, which generates Bone Marrow which also forms Blood.
Note that although Essence plays an important role in the formation of Blood, it is nourished and replenished by the Blood. The blood–forming function of the bone marrow was introduced during the Qing dynasty, before this concept appeared in western physiology!
After a massive loss of Blood, one can develop signs of Qi deficiency, such as, breathlessness, sweating and cold limbs. Qi depletion, such as after heavy, prolonged sweating, can lead to signs of Blood deficiency, such as, palpitations, pallor, numbness and dizziness.
Nutritive Qi is closely related to the Blood and flows with it in the blood vessels and the channels. Four aspects of the close relationship between Blood and Qi are:
(a) Qi generates the Blood (See 7 (i).)
(b) Qi moves the Blood --- This relationship is contained in the sayings “When Qi moves, Blood follows” and “If Qi stagnates, Blood congeals”. Lung Qi infuses Qi into the blood vessels to assist the pushing action of the Heart.
(c) Qi holds the Blood --- This action is a function of Spleen Qi. The saying “Qi is the commander of Blood” is often used to summarize the above three aspects.
(d) Blood nourishes Qi --- Qi relies on the Blood for nourishment. Moreover, Blood provides a material and “dense” basis, which prevents Qi from “floating”, and giving rise to the symptoms of the disease pattern of Empty-Heat (1). These two aspects are often summarized by the saying “Blood is the mother of Qi”.
8. Qi and Body Fluids
Body Fluids in Chinese medicine are called “Jin Ye”. The character "Jin" means “moist” or “saliva” and so can be interpreted as anything liquid or fluid. The word "Ye" means fluids of living organisms. There are two types of Body Fluids:
--- These fluids are quick-moving, clear, light, thin and watery, and they circulate in the exterior of the body (skin and muscles) with the Wei Qi. They are controlled by the Lungs, which disseminate them to the skin aided by the Upper Burner, which controls their transformation and movement towards the skin. They moisten and partially nourish skin and muscles. The Jin is manifested as sweat, tears, saliva, mucous and parotid secretions. They are also a
component of the fluid part of Blood.
--- These fluids are the more turbid, dense, heavy and slower moving fluids, which circulate in the interior of the body with the Ying (Nutritive) Qi. They are under control of (transformed by) Spleen and Kidneys. They are moved and excreted by Middle and Lower Burners. They lubricate the joint cavities; nourish and lubricate the spinal cord and brain, bone marrow and the "orifices of the sense organs" i.e. eyes, ears, nose and mouth
Production of Jin Ye (Body Fluids) --- Body Fluids arise from food and drink. They enter the Stomach from which they are transformed and separated into pure and impure parts by the Spleen. The Spleen sends the pure part upward to the Lungs and the impure part downward to the Small Intestines. The Small Intestine separates the impure part into a pure and impure part. The pure part of this second separation goes to the Bladder and the impure part to the Large Intestine, where some of the water is re-absorbed. The Bladder, aided by the Qi from the Kidney, further transforms and separates the fluids it receives into pure and impure parts. The pure part is sent upwards to the exterior of the body, where it forms sweat. The impure part is flows downwards and is transformed into urine. The Lungs disperse part of the pure part to the space under the skin and the remainder down to the Kidneys. The Kidneys vaporize some of the fluids they receive and send it back up to moisten the Lungs.
9. Organs and Transformation and Movement of Qi
Chapter 5 of the book Plain Questions states: “Water and fire are symbols of Yin and Yang.” This means that water and fire represent opposite aspects. Based on the properties of water and fire, everything in the natural environment may be classified as either Yin or Yang. Those with the properties of fire, such as heat, movement, brightness, upward and outward direction, excitement and potency, pertain to Yang. Those with the properties of water, such as coldness, stillness, dimness, downward and inward direction, inhibition and weakness, pertain to Yin. Accordingly, within the field of Chinese medicine different functions and properties of the body are classified as either Yin or Yang. For example, the Qi of the body, which has moving and warming functions, is Yang, while the Qi of the body, which has nourishing and cooling functions, is Yin. Yin Qi is sometimes called “Water” and Yang Qi, “Fire”. Qi condenses to form the material body and is Yin. When Qi disperses, it moves and is Yang.
These Yin and Yang aspects of Qi are the basis of Chinese physiology. The proper transformation of Qi allows birth, movement, growth and reproduction to take place. The movement and transmutation of Qi depend on the function of Chinese organs and will be described below.
The motive force for the transformation of Qi is the Fire stored in the Gate of Vitality or Life Gate (Ming Men), an area between the Kidneys. Historically, the Life Gate’s location has been postulated in several different places. Its Fire is referred to as the “Minister Fire’. This Fire supplies heat for all bodily functions and for the Kidney Essence. The Ming Men Fire and the Essence provide another example of the Yin-Yang concept. The Fire depends on the Jing
to provide the biological substances for all life processes. Jing relies on the Ming Men Fire for the motive force and heat that transforms and moves the various physiological substances. Without the Ming Men Fire, Jing would be a cold and inert, incapable of nurturing life. This relationship is summarized by the expressions “Qi is transformed into Essence“and “Essence is transformed into Qi”. Gathering Qi flows down to the Life Gate to provide Qi and Ming Men Fire flows up to the Lungs to provide heat.
Mutual Assistance of Heart and Kidney
The Heart is in the upper Jiao and corresponds to the element Fire. It is Yang in nature, and relates to movement. The Kidneys are in the lower Jiao and correspond to Water. They are Yin in nature and relate to non-movement. These two elements represent the Yin and Yang of all the organs (Fire and Water). Heart Fire is called Imperial Fire. Heart Yang descends to warm Kidney Yin, Kidney Yin ascends to nourish Heart Yang. The Heart and Kidneys are constantly communicating. If Kidney Yin is deficient it can’t rise to nourish the Heart Yin, which leads to hyperactive Heart Fire (insomnia, restlessness, anxiety, flushed cheeks, night sweats, red tongue with no coat and a midline crack). If the Fire of the Heart does not descend to the Kidneys, Heart Heat develops which can damage Kidney Yin and so Water cannot rise. Kidney Yang becomes deficient and edema results. The ascending and descending of Kidney and Heart Qi also affects other organs. If Kidney Yin does not nourish Liver Yin, Liver Qi may ascend too much, causing headaches and irritability. If Heart Qi does not descend, Lung Qi may also fail to descend, causing coughing or asthma. Heart and Kidney Qi provide the Fire and Water necessary for the functions of the Spleen and Stomach in digestion, transformation and transportation.
Spleen and Stomach
Spleen Qi normally ascends to the Heart and Lungs to direct the pure food essence up to these two organs, where it is transformed into Qi and Blood. Stomach Qi normally descends to send the impure part of food, left after the Spleen’s transformation, down to the intestines. If Spleen Qi does not rise diarrhea can occur. After some time, Qi and Blood deficiency will occur, since insufficient food essences will be transported to the Lungs and Heart. Prolapse of various organs and hemorrhoids can also ensue, since the rising of Spleen Qi lifts and keeps the organs in place.
Liver and Lungs
Qi flows smoothly when the ascending of Liver Qi and the descending of Lung Qi are balanced.
If Liver Qi does not ascend and extend, it can stagnate in may different areas of the body causing feelings of constriction or distention. Stagnate Liver Qi can also invade the Stomach, causing epigastric pain, nausea and vomiting, or the Spleen, causing diarrhea. It can go downwards to the Bladder, resulting in distention of the hypogastrium and slight retention of urine.
Excessive rising of Liver Qi to the head causes headaches and irritability. It can also affect the Lungs preventing Lung Qi from descending, causing coughing or asthma.
If Lung Qi does not descend, fluids will not be carried to the Kidneys and Bladder, resulting in urinary retention or edema of the face. Lung Qi may also stagnate in the chest, causing coughing or asthma.
Transformation of Qi by the Triple Burner (San Jiao)
The Triple Burner is a Yang organ and has been historically defined in several different ways (1). The three divisions of the Triple Burner in the Table 1 are based on the functions of the pertaining organs and not on their location. It ensures the correct movement of all types of Qi. If it malfunctions, Qi, Blood and Fluids will not flow harmoniously and they will overflow, routes will be blocked and Qi will stagnate.
1. Maciocia, G. Foundations of Chinese Medicine. Churchill Livingstone, New York, 1989.
2. Changguo, W., (Compiler). Basic Theory of Traditional Chinese Medicine, Publishing House of Shanghai Univ. of