Disturbance of Qi and Blood
III. Disturbance of Qi and Blood
This refers to a pathological change which results in the impairment and insufficiency of qi and blood, and the respective disorders for their physiological functions as well as the imbalance of their inter-depending-supporting functions. The life activities of the body are accomplished mainly by the qi, blood, and body fluids which are transported and distributed to the whole body via the meridians and vessels to nourish the viscera, tissues,and organs. Physiologically, qi and blood are the material basis on which all the viscera, meridians, and organs carry on their physiological activities; pathologically, the derangement of qi and blood is bound to affect all kinds of physiological functions of the body, leading to the occurrence of disease. Thus, Chapter 62 in Plain Questions states: "When qi and blood are disharmonious, diseases may arise. " Rational Knowledge Based on a Thorough Inquiry of Medical Rules states: "The blood and qi work in coordination with each other. When qi is warm, the blood is warm; when qi is cold,the blood is cold.
When qi is ascending, the blood is ascending; when qi is descending, the blood is descending. When qi is stagnant, the blood is stagnant; when qi is retarded, the blood is retarded. When qi is clear, the blood is clear. When qi is thick, the blood is thick, too."
Much like the pathological mechanism of prosperity and decline of the genuine-qi and the evil-qi, the pathological mechanism of derangement of qi and blood is not only the pathological basis for the diseases of the viscera and meridians, but also the foundation for analyzing and studying physiological changes of diseases in clinical practice. This condition consists of the disturbance of qi, disturbance of blood, and disturbance of qi and blood interaction.
1. Disturbance of Qi
This condition may be summarized into the following two aspects: The first one is deficient qi due to an insufficient production of qi or an over-consumption of qi. The second is that certain hypofunctioning and abnormal movements of qi lead to the pathological state of qi's activities, with such manifestations as qi stagnation, reversed flow of qi, qisinking, qi block, or qi collapse.
1) Deficiency of Qi
Deficiency of qi refers to a pathological state where there is an impairment of primordial qi, a hypofunctioning of the viscera and meridians, and a lowered body resistance against diseases. It is caused mostly by an insufficient production of qi due to an innate insufficiency, acquired malnutrition, or overstrain. It may also occur whenever prolonged illness, hypofunctioning, or weakness of the spleen, lung, and kidney lead to the consumption of vital energy. Since the qi is closely related to the blood and body fluids, deficient qi exerts an influence on them, and there appears a shortage of formation, slow-circulation, or loss of blood and body fluids, thus leading to various pathological changes of blood and body fluids.
The following symptoms are characteristics of this condition- a tendency to perspire,susceptibility to common cold due to the lack of consolidation of defense-qi, lassitude the four limbs due to lack of nourishment, listlessness, dizziness, and vertigo due to failure of the clear yang in ascending. Deficient qi fails to propel blood circulation smoothly,the vessels are not full, and the pulse tends to be feeble, or weak and thready; the retention of water and disturbances in its distribution further lead to the formation of phlegmor excessive fluid. Over-abundant water may even cause a further series of deficient syndromes.
2) Disturbance of Activity of Qi
This refers to pathological changes in which the disturbance of functional activities the entire body or of certain viscera results from failures in the ascending, descending,exiting, and entering movement of qi in the course of disease.
The qi of the human body has four basic patterns of motion, ascending, descend-
ing ,exiting ,and entering ,which form the basic process in the contradictory movement of the viscera and meridians, yin and yang,and qi and blood. Functional activities of the viscera and meridians ,and inter-connecting relationships among them are all dependent on these motions to maintain their relative balance. Thus, Treatise on Ascending, Descending, Exiting, and Entering, a Chapter of Jottings for Reading Medical Books states:"The muscles ,tendons ,and bones of the human body have their vertical and transverse interstitial spaces between the skin and the flesh, through which qi exits,enters, ascends ,and descends. So-called ascending and descending denotes the pathways in which the interior qi circles around ; so-called exiting and entering implies the pathways in which the interior qi and exterior qi inter-connect. The interior qi refers to qi of the body;while the exterior refers to the air. "
These motions of the functional activities of qi maintain the coordination and balance in the viscera,meridians,qi and blood,and yin and yang. If these basic patterns of motion are disrupted, the viscera, meridians, interior and exterior, four limbs, and nine orifices will be affected, leading to various pathological changes. Thus, Jottings for Reading Medical Books says: "The motions of ascending ,descending ,exiting,and entering are the laws of the heaven and the earth, the motive power of everything, the guiding principle of all diseases ,the root of life and death. "In general ,pathological mechanisms of the disturbance of functional activities of qi may be summarized as follows : qi stagnation (obstruction of qi flow),reversed flow of qi (overactive qi in its ascending movement or inactive qi in its descending movement),qi sinking (insufficiency of ascending strength of qi or excess of descending strength of qi),qi blockage (obstruction of qi in its exiting), and qi collapse (outside exhaustion of qi due to its failure in retaining inside).
a. Qi stagnation
This refers to a pathological state which the functional activity of qi is stagnated,and the flow of qi is obstructed. Stagnant qi appears most commonly in cases of the depression of the seven emotions or the stagnation of phlegm and dampness, retention of food,or blood stasis,which impedes the travel of qi and produces obstruction of functional activities of qi on either a local or systemic basis. This results in disturbances of certain viscera and meridians.The pathological reflections of qi stagnation are usually manifested in a blockage of a particular meridian qi ,obstruction of blood circulation, and accumulation of water,which
further develops into the syndrome of blood stasis and that of fluid-retention. For example,qi stagnation and blood stasis may lead to obstruction of blood circulation,since obstruction causes pain,there may also appear a sensation of swelling and distension,localized pain, or slow, hesitant pulse. The formation of phlegm, fluid-retention, or edema also are possible symptoms of stagnant qi, since disturbance in body fluids metabolism,hampers the transportation, transformation, and distribution of water-fluid. All of these lead, in turn, to a series of disturbances of the viscera; particularly common in clinical practice are the malfunctioning of lung-qi, qi stagnation due to depression of the liver,and stagnation of spleen and stomach-qi.
b. Reversed flow of qi
This signifies a pathological state in which the qi of the viscera will flow upward
when its ascending and descending movement is abnormal. It is usually the result of impaired emotions, improper intake of cold and warm food, or retention of phlegm-turbidity. An abnormal upward flow of the qi of the lung, stomach and liver is most common.For example, if the lung fails to perform its depurative descending, the flow of qi becomes adverse, resulting in coughing, hiccups, or asthma. The failure of descending of stomach-qi causes adverse rising of stomach-qi, giving rise to nausea, vomiting, belching, or hiccups. The rushing up of liver-qi, and ascendant hyperactivity of liver-yang,may lead to pain and distension in the head, flushed face, congestive eyes and irritability.The upsurge of liver-qi due to emotional irritation, or rushing up of liver-qi due to excessive exasperation, may make blood flow upward following the reversed flow of qi, resulting in hemoptysis, haematemesis, or even fainting due to disturbing and misting the clear orifices. Thus, Chapter 3 in Plain Questions states: "Excessive anger may cause impairment of physique, and exhaustion of qi, and lead to accumulation of blood in the upper part of the body, resulting in emotional syncope. " If one is irritated suddenly by fear and fright, liver and kidney-qi may flow upward along the Chong Meridian, leading to the syndrome of "running piggy," as if the sensation of a forcible impulsive movement comes up from the lower abdomen to the chest and pharynx a jumping sensation below the umbilicus like a running piggy starting to move.
In general, reversed flow of qi occurs most commonly in cases of excess syndrome,but does occur occasionally with the deficiency syndromes. Failure of lung-qi in depurative descending due to its weakness, or failure of kidney in receiving qi, may cause reversed flow of lung-qi; failure of stomach-qi in descending due to its weakness may also lead to counter-flow of stomach-qi
c. Qi sinking
Qi sinking is a pathological mechanism of qi deficiency, and points to a pathological changes that is characterized chiefly by the failure of qi in performing its ascending function. The fixed locations of the body's internal organs fully depends on the ascending function and normal movement of qi. Therefore, when qi is deficient, the middle-qi sinks, and the ascending function of fixing the location of internal organs is weakened, causing viseeroptosis.
Qi sinking occurs most commonly in cases of further development of qi deficiency.
Its main causes are a poor physique, protracted illness, or consumption of spleen-qi, which impede the upward flow of the clear-yang. Symptoms ofsinking of the middle-qi include gastroptosis, nephroptosis, and prolapse of the uterus and rectum. As "the human body gains the qi extracted from the diets," the growth and transformation of qi are dependent on the spleen. Spleen-qi is in charge of rising, thus deficient spleen-qi may lead to qi sinking. For this reason, the syndrome of visceroptosis is often accompanied by distension and heaviness in the abdominal and lumbar regions, frequent desire for micturition, shortness of breath, lassitude and feeble voice, and a thready weak pulse.
d. Qi blockage and qi collapse
These denote the critical pathological changes characterized by blockage or collapse due to disturbance of qi in its exiting and entering movements. Clinically, they appear most commonly in severe cases of syncope or collapse.
Qi blockage refers to the pathological state in which syncope or coma suddenly occurs when the external blockage of turbid evil, or excessive depression of qi, leads to obstruction of qi in its exiting and entering movements, resulting in the blocking of clear orifices. For example, syncope due to closure is often caused by the turbid and unclean pathogen; syncope due to excessive heat occurs in the course of exogenous heat disease; and qi syncope results from sudden mental trauma. All of these conditions are caused by obstruction of qi in its exiting movement.
Qi collapse refers to the state in which depletion of the genuine-qi produces a sudden exhaustion of functional activities of the human body. It occurs in cases in which the genuine-qi is unable to resist the evil-qi; it also occurs when a critical deficiency of the genuine-qi causes the outward depletion of qi due to the failure of qi to remain inside. It appears most commonly in cases of massive bleeding and profuse sweating, which result in qi collapse following depletion of blood and body fluid. Therefore, the qi deficiency is the main pathological mechanism of various deficiency syndromes.
2. Disturbance of Blood
This condition generally is manifested in two aspects: First, insufficient production of blood or over-consumption of blood, or low nourishment function of blood, leads to the pathological changes of blood deficiency. Second, the pathological changes of blood stasis, over-heat of the blood, and hemorrhage are caused by disturbance of blood circulation due to retarded, accelerated, or deranged blood circulation.
1) Blood Deficiency
This refers to a pathological state in which insufficient blood or a decreased nourishing function of blood causes malnutrition of the viscera and all the vessels. This deficiency may be due to a massive loss of blood without sufficient replenishment, or it may occur when a deficiency of the spleen and stomach leads to malnutrition, and the ability of these organs to transform food essence into blood is decreased. The deficiency also may appear
in cases of chronic consumption due to prolonged illness.
Only when blood supplies enough nourishment for the viscera, meridians, tissues,
and organs, can the normal physiological function be maintained. Thus, blood which is insufficient is unable to nourish the tissues and organs of the body. The lack of nourishment may cause the body to hypofunction, which, in clinical practice, is often marked by pathological changes of weakness in the systemic or local regions, pallor, pale lips, tongue and nails, dizziness and giddiness, continuous violent palpitation, shortness of breath,lassitude, numbness of the hand and feet, stiff joints, dry eyes, or blurred vision.
2) Blood Stasis
This refers to a state of retarded blood circulation, or the unsmoothed flow of blood,or even the congealment of blood. It is frequently caused by one of the following: obstruction of blood circulation due to qi stagnation; retarded circulation of blood due to qi deficiency; blocking of the vessels due to phlegm-turbidity; congealment of blood as a result of cold-evil; or consumption of body fluids and blood due to invasion of heat-evil.Therefore, blood stasis is the pathological result in the course of stagnation of blood.However, having been produced, it further impedes the blood vessels and causes secondary pathological changes of blood, and it is therefore considered to be a kind of pathological factor.
Since the pathological mechanism mainly results from the unsmoothed flow of blood,stagnation of blood in the viscera and meridians may cause obstruction of the vessels, and lead to pain. These conditions are characterized by fixed pains that do not respond to either warm or cold applications, and even the formation of swelling masses, known in TCM as mass and unstable gatherings in the abdomen. These may simultaneously be accompanied by a dull complexion, dry scaly skin, dark-purplish lips and tongue, ecchyrmosis and spider nevus, etc.
In addition, blood stasis may, in turn, aggravate the obstruction of qi, thus resulting in a vicious circle of blood stasis leading to qi stagnation, and vice versa.
3) Over-Heat of the Blood
This refers to a pathological state in which excess heat in the blood phase accelerates blood circulation or causes hemorrhage. The syndrome of over-heat of the blood may de velop in Several ways. Exogenous warm-heat evil may invade the blood phase, and exogenous cold-evil may be transformed into pathogenic heat to injure the blood system when it attacks the body. In clinic, pathological changes of nutrient phase and blood phase in the course of warm-heat diseases are attributable to this kind of condition. In addition, overheat of the blood may develop from prolonged emotional depression that the excessive five emotions turn into fire, and exuberant internal fire accumulates in the blood phase.
Since blood circulates when warmed, over-heat of the blood results in accelerated circulation, and damages yin-fluid of the blood, injures the vessels, and causes the blood to escape from the vessels. Hence, its pathological symptoms are characterized by the typical symptoms of heat, consumption of blood, and injury of yin, as well as hemorrhage.
4) Extravascular Flow of Blood
This refers to hemorrhage, and a pathological state in which the injury of the vessels, or failure of qi to control blood, may lead to extravascular flowing of blood. Bleeding usually occurs as a result of an adverse flow of qi, scorching of the vessels by excessive fire, or external injury to the vessels. Since blood vessels distribute over the entire body, bleeding may occur at any region. The symptoms vary with the location of the hemorrhage. For example, if the lung is injured, the patient may cough up blood; if the stomach vessels are injured, there may be haematemesis or hematochezia; if the vessels of the large intestine are injured, hematochezia will occur; blood in the urine appears when the vessels the urinary bladder or urethra are injured; menorrhagia or uterine hemorrhage indicate injury to the Chong and Ren Meridians ; and injury of vessels of the nose may cause epistaxis, etc.
Hemorrhage may occur when impairment of spleen-qi due to prolonged illness or
0ver-strain may produce insufficiency of the middle qi, and a failure of the spleen to command blood. This may further be manifested by the failure of blood to circulate in the vessels. Leaking of blood in the muscle and skin may lead to subcutaneous hemorrhage,leaking of blood in the stomach and intestine causes blood in the stool, seepage of blood in the bladder causes hematuria. Unconsolidation of the Chong and Ren Meridians due to qi deficiency may cause menorrhagia or uterine bleeding.
Excessive loss of blood leads to a deficiency of both qi and blood, as well as a decline of the function of the viscera and tissues. Sudden loss of large amounts of blood may cause the syndrome of qi collapse following massive bleeding, and death may result from the "divorce of yin from yang. "
3. Disturbances of Qi and Blood Interaction
Qi pertains to yang and blood pertains to yin, and there is interdependence between them. Thus, the blood will be influenced by a deficiency of qi or a failure of qi in its ascending, descending, exiting, and entering movements. For example, deficiency of qi may lead to lack of blood formation, resulting in insufficiency of blood. Deficiency of qi may cause the decrease of the promoting and warming function, giving rise to stagnation of blood. Deficiency of qi also may bring about a lowered commanding function, leading to hemorrhage.
A stagnation of qi leads to blood stasis. Derangement of the activities of qi produces an upward rush or sinking of blood following qi, resulting in haematemesis, epistaxis in the upper part, blood in the stool, or uterine bleeding in the lower part. Similarly, deficiency of blood.also leads to insufficiency of qi, blood stasis to qi stagnation, depletion of blood to collapse of qi. Clinically, disturbances of qi and blood interaction are mainly summarized into the following categories: qi stagnation and blood stasis, failure of qi to control blood, qi collapse following massive bleeding, deficiency of both qi and blood, and insufficient qi and blood to nourish the meridians.
1) Qi Stagnation and Blood Stasis
This refers to a pathological state in which a retardation of the flow of qi leads to disturbance of blood circulation and results in blood stasis. This condition is frequently caused by a blocking of activities of qi due to the internal injury caused by abnormal emotions. It also may appear in cases of external injury from sprains.
This condition is closely related with disturbance of liver function. The liver dominates the conducting and dispersing function and stores blood. If it fails to perform its conducting and dispersing function due to depressed qi, a blocking of activities of qi results in distension, fullness and pain in the chest, and hypochondria. The cti is the commander of blood, and flow of qi leads to circulation of blood. Qi stagnation may cause coagulation of blood, or obstruction of the meridians and vessels, thus causing pain, ecchy mosis, and mass and unstable gatherings in the abdomen. The heart, on the other hand,dominates the blood vessels and propels blood circulation. When the physiological funetior of the heart is abnormal, blood stasis often occurs, which then leads to qi stagnation.
2) Failure of Qi to Control Blood
This refers to a pathological state in which weakness of qi causes the decrease of physiological functions in commanding blood, and failure of blood to circulate in the vessels brings about bleeding in various regions of the body. Such a condition is closely related to the deficiency and impairment of spleen-qi and deficient the middle-Qi sinking due to deficient qi gives rise to the leaking of blood in the lower part of the body, known as qi sinking followed by leaking of blood. Failure of qi in its commanding function may produce the escape of blood from the vessels. The characteristic symptoms are recta bleeding, blood in the urine, uterine hemorrhage, and rupturing of blood vessels beneath the skin, forming ecchymosis.
3) Qi Collapse Following Massive Bleeding
This refers to a pathological state in which massive bleeding is often accompanied by simultaneous or subsequent collapse of qi, with the result of deficient or exhausted qi and blood. It is often caused by a great loss of blood from external injury, or metrorrhagia or hemorrhage following childbirth. Since blood is the carrier of qi, its depletion may lead to the collapse of qi. Qi collapse causes prostration of yang, so the flesh and skin lack warmth and consolidation, with the symptom of profuse cold sweating. Yang-qi is unable to reach the limbs, and cold hands and feet appear. Collapse of qi and blood results in a failure to nourish the head and eyes, bringing about syncope. The blood vessels lack in their ability to supplement and propel qi and blood, thus there may be hollow pulse, or a weak thready pulse.
4) Deficiency of Both Qi and Blood
This condition refers to a pathological state in which the body is hypo-functioned by deficiency of both qi and blood, resulting in malnutrition of the tissues and organs. It may occur most commonly in cases of impairment of both qi and blood caused by the consumption of prolonged illness. Its pathological changes result from loss of blood leading to exhaustion of qi, or deficiency of qi causing the decrease of production of blood. Clinically, manifestations of insufficiency of both qi and blood are presented simultaneously, and the symptoms may include pallor or withered yellowish complexion, feeble breath, apathy, general lassitude, asthenia, emaciation, palpitation, insomnia, dry skin, and numbness of the limbs.
5) Qi and Blood Failing to Nourish the Meridians
This refers to a pathological state in which deficiency or disharmony of qi and blood leads to the hypofunctioning of qi and blood interaction, and immediately hinders their ability to nourish the meridians, tendons, flesh, and skin, thus creating a failure of the limbs and tendons in the movement or abnormal sensation of the fresh and skin. This is usually caused by disharmony between qi and blood, or by disharmony between nutrientqi and defense-qi because of an invasion of the wind-evil due to deficient blood, or by wind-evil directly attacking the collaterals. The symptoms of this condition are numbness of the trunk and limbs, or impairment of motion, dry skin, itching, or even dry, scaly skin.
