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Although qi, blood and body fluid have their respective natures, they co-ordinate with, promote and restrain one another in their functional activities. Their close and complicated relationships often manifest in physiology and pathology, and are important in determining treatment on the basis of differentiation of syndromes.

Relation between qi and blood

Both qi and blood are the material foundation for the functional activities of the body. They originate from food essence and from essential qi in the kidney, and their production depends on the functional activities of the lung, spleen and kidney. Qi mainly provides warmth and motive force, whilst blood provides nourishment and moisture. This is described in the Twenty-second Problem of Classic on Medical Problems, "Qi dominates warmth while blood dominates nourishment."

Qi is considered to be yang, while blood is yin. Their relationship may be summarized by the statement: "Qi is the commander of blood and blood is the mother of qi." "Qi is the commander of blood" means that blood cannot be separated from qi in its formation and circulation. The material basis of blood is yin essence, the transformation of which into blood depends on qi. Qi functions well in transforming yin essence into blood if it is abundant. Conversely, this function of qi is weakened if qi is dificient, so deficiency of qi may lead to deficiency of blood. For this reason, when treating disorders resulting from blood deficiency, qi tonics are sometimes added to the prescription.

Since the heart qi dominates blood circulation, the lung qi ensures normal distribution and the liver qi takes charge of the free flow of qi of the entire body, the blood circulation depends on the functional activities of these three organs. This is described as "qi circulation leading to blood circulation." Either weakness in propelling blood due to qi deficiency, or retardation of qi circulation, may cause disorders of blood circulation, or even stagnation of blood. That is why in order to obtain good therapeutic effects in the treatment of blood stagnation, herbs which circulate qi, and qi tonics, are often prescribed in combination with herbs to activate blood circulation and remove stasis.

The controlling function of qi ensures the normal circulation of blood in the vessels and prevents extravasation. Deficiency of qi may impair this function of controlling blood, leading to various types of haemorrhage. This is known as "qi fails to control blood." To stop haemorrhage due to qi deficiency, the method of tonifying qi must be used.

"Blood is the mother of qi" refers to the fact that qi is "attached" to blood, and that qi does not function well in promoting the physiological activities of various parts of the body unless it receives sufficient nourishment from blood. In cases of massive bleeding, there will also be loss of qi, which is known as "qi follows blood in becoming exhausted."

Relation between qi and body fluid

Qi differs from body fluid in nature, form and functional activities. There are similarities between them, however, in their formation, circulation and distribution. Both originate from food essence and circulate throughout the body.

The Formation, distribution and excretion oF body fluid depend upon qi circulation, and cannot be separated from the activities of the qi of zang-fu organs such as the lung, liver, kidney, sanjiao and bladder. Impairment of the activities of the qi of these organs may result in pathological changes, for example, insufficient production or accumulation of body fluid. If the qi of these zang-fu organs is deficient, and unable to exert its controlling function, there may be loss of body fluid. On the other hand, accumulation of body fluid may hinder qi circulation and affect the functions of certain zang-fu organs. Profuse loss of body fluid may also lead to massive dissipation of qi.

Relationship between blood and body fluid

Since both blood and body fluid are liquids and their main function is to nourish and moisten, they are considered yin. Body fluid is an important part of blood, and when it passes out of the vessels, it forms body fluid. As body fluid and blood can be transformed into each other, there is a saying: "Body fluid and blood are of the same origin." Recurrent or severe bleeding may injure body fluid and result in thirst, scanty urination and dry skin.

Severe consumption or loss of body fluid may also affect the source of blood, manifesting as exhaustion of both body fluid and blood. For this reason, it is not advisable to use diaphoretics for haemorrhagic patients. The method of breaking the blood (in which powerful drugs are administered to dissolve blood sludge) or the bleeding method, should be avoided in treating patients with consumption of body fluid due to excessive sweating.

The sixty-first chapter of Miraculous Pivot states: "The first contraindication refers to a patient who is emaciated; the second to a patient after severe loss of blood; the third to a patient after severe perspiration; the fourth to a patient after severe diarrhoea; the fifth to a patient after loss of blood following childbirth. The reducing method is contraindicated in all these circumstances." The same essay also points out that care should be taken in the acupuncture clinic when treating patients who are emaciated due to deficiency of qi, or severe consumption of qi, blood and body fluid.

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