Blood

血〔血〕xuè [xiě / xiě]

Blood is the red fluid that flows through the vessels and nourishes the whole body. As a liquid substance, it forms part of the body’s yīn humor. Blood is chiefly produced from nutrients absorbed from ingested food. However, its production is partly dependent on essence, hence it is said, essence and blood are of the same source.

Blood considered yīn in relationship to yáng qì is often referred to as yīn blood (阴血 yīn xuè), although the Chinese term can also refer to yīn and blood, which we write as yīn-blood in English.

Blood in Physiology

Production of Blood

According to traditional theory, all five viscera play a role in blood production. However, the roles of the spleen and kidney are paramount.

Role of the Spleen

Blood is composed of fluids and provisioning qì. Fluids are produced by the spleen, and provisioning qì is produced from a combination of the essence of grain and water and from the clear qì inhaled by the lung.

Because both fluids and provisioning qì depend mainly on the spleen for their production, the spleen is said to be the source of qì and blood formation.

Role of the Lung

The lung contributes to the production of one of blood’s chief components, provisioning qì.
According to one statement in the Nèi Jīng, blood production is completed in the lung.

Role of the Heart

According to a traditional theory that does not appear in the Nèi Jīng, blood is turned red by the action of heart-fire.

Role of the Kidney and Liver

Blood production relies on kidney yáng’s ability to warm the spleen and the liver’s upbearing and effusing action, which stimulates the spleen and heart. The liver’s role in blood production is the least of all the viscera.

Kidney essence is the root of original qì, which powers the activity of the bowels and viscera. Liver qì bears upward and effuses, stimulating the activity of the spleen and heart, thus helping to stimulate blood production.

Finally, essence can be transformed into blood. Essence and blood are understood to be mutually convertible. Hence, it is said that essence can engender blood, and blood can engender essence (精能生血, 血能生精 jīng néng shēng xuè, xuè néng shēng jīng). This is often also expressed as essence and blood are of the same source (精血同源 jīng xuè tóng yuán). According to some medical scholars of the past, the transformation takes place in the liver.

Traditional and Modern Statements on Blood Production
Nèi Jīng: The Nèi Jīng contains several statements on the formation of blood. Unfortunately, they are not fully consistent with each other and lack in specificity. Líng Shū (Chapter 30) states, The center burner receives qì and extracts the juice, and transforms it so that it turns red. This is blood. This suggests that blood is produced in the center burner. Líng Shū (Chapter 71) states, Provisioning qì strains off the fluid, pours it into the vessels, and transforms it into blood. This suggests that blood is made from fluids by provisioning qì and that it forms in the vessels. Líng Shū (Chapter 18) states, The center burner… strains the waste, steams the fluids, transforms their essence, pours them up into the lung vessel so that they transform into blood, which is offered to the body to give it life. Nothing is more precious than this; hence, it is singularly able to move through the channel tunnels. It is called provisioning qì. This suggests that blood is formed in the lung vessels and that blood is the same as provisioning qì. Líng Shū (Chapter 81) states, The intestines receive grain… the center burner emits qì like a mist, which rises and pours into the ravines and valleys, seeping into the grandchild vessels. The fluids harmonize so that they transform and turn red, becoming blood. When the blood is in harmony, it first fills the grandchild vessels, which overflow into the network vessels. When the network vessels are all full, they overflow into the channel vessels. This suggests that blood forms in the grandchild vessels (the smallest of the vessels). These quotations concur in recognizing that blood is mainly produced from the essence of grain and water. The last three statements concur that blood is formed in the vessels but differ as to whether the locus of production is the lung vessel or the grandchild vessels (the smallest network vessels). The second quotation suggests that provisioning qì is the agent of blood production. The third quotation, furthermore, suggests that provisioning qì is actually blood. There has been disagreement about this latter point over history, but the received view is that they are separate. Later views: Medical scholars over the centuries have emphasized the role of the heart in blood production. This is largely because of the idea that the heart is responsible for turning blood red. The Lǚ Shān Táng Lèi Biàn (侣山堂类辨 Classified Analysis of the Lǚ Shān Hall, published in 1663) states, Blood is the juice of the center burner, it flows into the center to become essence and is supplied to the heart, which turns it red and makes it into blood. This notion is most likely attributable to the influence of the five-phase association between the heart and the color red. In addition, there have been ideas concerning the role of the kidney and the essence it stores in the production of blood. For example, the Zhāng Shì Yī Tōng (張士醫通 Zhāng’s Clear View of Medicine, published in 1695) states, When qì is not worn away, it returns essence to the kidney as essence; when essence is not discharged, it returns essence to the liver producing clear blood; when blood does not drain away, it returns essence to the heart, where through transformation by fire it becomes true blood. Modern Slants on Blood Production: Textbook writers in modern China have been eager to interpret traditional statements on blood production as being in conformity with modern medicine, in particular with the notion that red blood cells (also known as erythrocytes) are produced in the bone marrow and, after entering the bloodstream, are oxygenated when passing through the lung. Marrow: In the modern literature, assertions are to be found that blood is produced in the marrow, which belongs to the kidney. This is not a traditional notion since it is not attested in premodern literature and obviously comes from the biomedical theory that erythrocytes are produced in the marrow. Chinese medicine does state that blood and essence are mutually convertible, but there is no traditional theory about the marrow being involved in blood production. Oxygenation in the lung: Certain modern texts have suggested that when blood enters the lung, it is infused with clear qì (air). The first quotation from the Nèi Jīng given above suggests that the production of blood is completed in the lung. However, there is nothing in traditional theory that suggests that clear qì (air) or a specific part of it known to modern science as oxygen, vital to physiological processes, is absorbed into the blood in the lung and carried by the blood to all parts of the body. In the qì paradigm, which provides Chinese medical theory with so much of its explicatory power, qì is something separate from the blood. This is quite different from oxygen, which is a substance that relies on the blood to enter and pervade the body. According to the received understanding, inhaled air contributes to the production of provisioning qì, which in turn contributes to the production of blood. Implicit in this is a recognition of the importance of air in the production of blood. However, this is a far cry from the modern medical understanding of the physiological processes involved. Given the traditional notion that kidney essence is the potential of human life, it is not surprising that medical scholars of the past should have linked it to the production of basic substances like original qì and blood. The idea that kidney essence can be converted into blood can be simply accounted for by the clinical observation that kidney vacuity often gives rise to blood vacuity.

Traditional and Modern Statements on Blood Production

Nèi Jīng: The Nèi Jīng contains several statements on the formation of blood. Unfortunately, they are not fully consistent with each other and lack in specificity.

Líng Shū (Chapter 30) states, The center burner receives qì and extracts the juice, and transforms it so that it turns red. This is blood. This suggests that blood is produced in the center burner.

Líng Shū (Chapter 71) states, Provisioning qì strains off the fluid, pours it into the vessels, and transforms it into blood. This suggests that blood is made from fluids by provisioning qì and that it forms in the vessels.

Líng Shū (Chapter 18) states, The center burner… strains the waste, steams the fluids, transforms their essence, pours them up into the lung vessel so that they transform into blood, which is offered to the body to give it life. Nothing is more precious than this; hence, it is singularly able to move through the channel tunnels. It is called provisioning qì. This suggests that blood is formed in the lung vessels and that blood is the same as provisioning qì.

Líng Shū (Chapter 81) states, The intestines receive grain… the center burner emits qì like a mist, which rises and pours into the ravines and valleys, seeping into the grandchild vessels. The fluids harmonize so that they transform and turn red, becoming blood. When the blood is in harmony, it first fills the grandchild vessels, which overflow into the network vessels. When the network vessels are all full, they overflow into the channel vessels. This suggests that blood forms in the grandchild vessels (the smallest of the vessels).

These quotations concur in recognizing that blood is mainly produced from the essence of grain and water. The last three statements concur that blood is formed in the vessels but differ as to whether the locus of production is the lung vessel or the grandchild vessels (the smallest network vessels). The second quotation suggests that provisioning qì is the agent of blood production. The third quotation, furthermore, suggests that provisioning qì is actually blood. There has been disagreement about this latter point over history, but the received view is that they are separate.

Later views: Medical scholars over the centuries have emphasized the role of the heart in blood production. This is largely because of the idea that the heart is responsible for turning blood red. The Lǚ Shān Táng Lèi Biàn (侣山堂类辨 Classified Analysis of the Lǚ Shān Hall, published in 1663) states, Blood is the juice of the center burner, it flows into the center to become essence and is supplied to the heart, which turns it red and makes it into blood. This notion is most likely attributable to the influence of the five-phase association between the heart and the color red.

In addition, there have been ideas concerning the role of the kidney and the essence it stores in the production of blood. For example, the Zhāng Shì Yī Tōng (張士醫通 Zhāng’s Clear View of Medicine, published in 1695) states, When qì is not worn away, it returns essence to the kidney as essence; when essence is not discharged, it returns essence to the liver producing clear blood; when blood does not drain away, it returns essence to the heart, where through transformation by fire it becomes true blood.

Modern Slants on Blood Production: Textbook writers in modern China have been eager to interpret traditional statements on blood production as being in conformity with modern medicine, in particular with the notion that red blood cells (also known as erythrocytes) are produced in the bone marrow and, after entering the bloodstream, are oxygenated when passing through the lung.

Marrow: In the modern literature, assertions are to be found that blood is produced in the marrow, which belongs to the kidney. This is not a traditional notion since it is not attested in premodern literature and obviously comes from the biomedical theory that erythrocytes are produced in the marrow. Chinese medicine does state that blood and essence are mutually convertible, but there is no traditional theory about the marrow being involved in blood production.

Oxygenation in the lung: Certain modern texts have suggested that when blood enters the lung, it is infused with clear qì (air). The first quotation from the Nèi Jīng given above suggests that the production of blood is completed in the lung. However, there is nothing in traditional theory that suggests that clear qì (air) or a specific part of it known to modern science as oxygen, vital to physiological processes, is absorbed into the blood in the lung and carried by the blood to all parts of the body. In the qì paradigm, which provides Chinese medical theory with so much of its explicatory power, qì is something separate from the blood. This is quite different from oxygen, which is a substance that relies on the blood to enter and pervade the body.

According to the received understanding, inhaled air contributes to the production of provisioning qì, which in turn contributes to the production of blood. Implicit in this is a recognition of the importance of air in the production of blood. However, this is a far cry from the modern medical understanding of the physiological processes involved.

Given the traditional notion that kidney essence is the potential of human life, it is not surprising that medical scholars of the past should have linked it to the production of basic substances like original qì and blood. The idea that kidney essence can be converted into blood can be simply accounted for by the clinical observation that kidney vacuity often gives rise to blood vacuity.

Functions of the Blood

The function of blood is to supply nourishment and moisture to all the organs and tissues of the body. The Nàn Jīng (22nd Difficult Issue) states, The blood governs nourishing (血主濡之 xuè zhǔ rú zhī). In addition, blood has the function of bearing qì.

Nourishment

In clinical practice, blood is important for the health of the bowels and viscera and the body in general. It is of special importance for the eyes and sinews, both governed by the liver, which has an intimate connection with the blood. It is important for the hair, which is the surplus of the blood, for the skin, and for essence-spirit.

Hair, skin, and flesh: The blood has a special relationship with the hair, which is expressed as the hair is the surplus of the blood (发为血之余 fà wéi xuè zhī yú). Insufficiency of blood can lead to dry, lusterless hair. Note that the hair is also understood to be the bloom of the kidney. In reality, the condition of the hair reflects the state of the blood and the state of the kidney. Dry hair is generally understood to reflect blood vacuity, while premature graying and hair loss are understood to reflect kidney vacuity.

Although, according to the Nèi Jīng, the skin is associated with the lung, its health is also dependent on the blood. Dry skin is often a sign of blood dryness, a specific form of blood vacuity that manifests in dryness signs.

Normal sensations are dependent on the blood. Blood vacuity is a major cause of numbness and tingling in the limbs.

Heart Blood and Liver Blood
The heart and the liver are said to have their own blood (heart blood and liver blood). This means not that there is a specific portion of the body’s blood that belongs to these organs, but the blood in general in relation to these viscera. The terms are meaningful especially in the pathological context. Heart blood vacuity, for example, refers to blood vacuity that specifically affects the heart and manifests in signs of heart disease. Similarly, blood vacuity with inhibited bending and stretching is described as liver blood failing to nourish the sinews.

Heart Blood and Liver Blood

The heart and the liver are said to have their own blood (heart blood and liver blood). This means not that there is a specific portion of the body’s blood that belongs to these organs, but the blood in general in relation to these viscera. The terms are meaningful especially in the pathological context. Heart blood vacuity, for example, refers to blood vacuity that specifically affects the heart and manifests in signs of heart disease. Similarly, blood vacuity with inhibited bending and stretching is described as liver blood failing to nourish the sinews.

Eyes, sinews, and nails (liver ): Blood is especially important for the eyes and sinews, which are both governed by the liver. The Sù Wèn (Chapter 10) states,.

The liver receives blood and can see, the legs receive blood and can walk, the hands receive blood and can grip, the fingers receive blood and can hold (肝受血而能视, 足受血而能步, 掌受血而能握, 指受血而能摄 gān shòu xuè ér néng shì, zú shòu xuè ér néng bù, zhǎng shòu xuè ér néng wò, zhǐ shòu xuè ér néng shè).

In clinical practice, the relationship of the blood to the eyes, sinews, and nails is apparent when blood becomes insufficient.

Blood failing to nourish the eyes gives rise to dizzy head and vision, blurred vision, and night blindness.
Blood failing to nourish the sinews gives rise to loss of strength and agility in the limbs; in severe cases internal wind stirs and gives rise to various kinds of spasm, such as tension in the joints inhibiting bending and stretching, tremor of the extremities, and twitching of the flesh.
Blood failing to nourish the eyes gives rise to dry, brittle, lusterless nails.

Essence-spirit (heart ): Essence-spirit (精神 jīng shén) is essentially the same as spirit, which denotes the entity stored by the heart, the principle of consciousness, including awareness of the outside world and inner emotional and thought responses. The term essence-spirit itself hints at the understanding that the spirit is dependent on all the essential substances of the body, specifically qì, blood, and essence in the narrower sense as the entity stored by the kidney. An intimate relationship exists between essence and blood. Hence, the blood is also intimately related to essence-spirit. Heart blood vacuity and liver blood vacuity often manifest in heart palpitation, insomnia and profuse dreaming. Severe blood loss can result in vexation and agitation, abstraction, and clouded spirit. Líng Shū (Chapter 18) states, The blood is spirit qì (血者, 神气也 xuè zhě shén qì yě). The Líng Shū (Chapter 32) states, When the blood and vessels are in harmony and uninhibited, essence-spirit resides (血脉和利, 精神乃居 xuè mài hé lì, jīng shén nǎi jū).

Uterus: Ample supplies of blood are necessary for normal menstruation. When blood is insufficient, there is scant menstruation, pale menstrual flow, or amenorrhea.

Bearing Qì

The qì of the body is an active diffuse substance. Although it can pervade matter, liquid substances enable it to move more easily. Blood is understood to bear or carry qì, i.e., facilitate its smooth movement, rather like the way in which oil facilitates the movement of moving parts in a machine. Hence it is said that blood bears qì (血载气 xuè zài qì). In clinical practice, the fact that both blood vacuity and blood stasis can cause qì stagnation reflects how impairment of blood’s ability to bear qì gives rise to qì stagnation.

Movement of Blood

Blood circulates endlessly around the body in the vessels by the propelling action of qì. Ancestral qì, in particular, is considered to play an important role because it drives the lung and the heart.

It is often said that when qì moves, blood moves (气行则血行 qì xíng zé xuè xíng). When its propelling function becomes excessive, blood flow is accelerated. When the propelling function of qì is deficient, blood flow slows down, giving rise to blood stasis. When the retentive function of qì fails, blood can extravasate.

In addition, the movement of blood is intimately related to the heart, the lung, the spleen, and the liver.

Heart: The heart governs the vessels, and heart qì maintains a normal heartbeat. Hence it is the fundamental motor force of the blood. As Lǐ Chān points out in the Yī Xué Rù Mén (Gateway to Chinese Medicine, published 1575), When the human heart moves, blood moves through all the channels (人心动则血行诸经 rén xīn dòng zé xuè xíng zhū jīng).

Components of the Blood and Viscera Involved in Its Production
Four Components	Five Viscera
Essence of grain and water Fluids Provisioning qì Essence	Spleen Lung Heart Kidney Liver

Lung: The lung governs the qì of the whole body. Since qì is the force that propels the blood, the lung also plays a role in the movement of blood. The lung’s specific connection with the blood is highlighted by the statement that the lung assembles the hundred vessels.

Spleen: The spleen is said to control the blood, which means that it keeps the blood in the vessels and prevents it from extravasating.

Liver: The liver stores blood, thereby regulating the amount of blood in circulation. Together with the spleen it helps to prevent extravasation of blood. Furthermore, the liver governs free coursing, ensuring the smooth flow of qì, and hence also the smooth flow of blood, around the body.

In short, the propulsion of blood is attributed to the action of qì (heart, lung, and liver), while the retention of blood in the vessels is attributed to the spleen’s function of controlling the blood and the liver’s function of storing the blood. The liver, by its free-coursing and blood-storing functions, performs a dual action in controlling the movement of blood.

Affected by cold and heat: The movement of blood is affected by cold and heat. The Sù Wèn (Chapter 62) states, Qì and blood like warmth and are averse to cold. When there is cold, they are rough and cannot flow… (气血者, 喜温而恶寒, 寒则涩而不能流… qì xuè zhě, xǐ wēn ér wù hán, hán zé sè ér bù néng liú…). On the other hand, blood flow is also affected by heat. Heat causes the blood to move faster burst out of the vessels. This is called frenetic movement of hot blood or blood heat, which is discussed below.

Blood in Pathology

Pathologies of the blood can be summarized under these four headings: blood vacuity, blood stasis, blood heat, and blood cold.

Blood Vacuity

Blood vacuity (血虚 xuè xū) is the failure of blood to perform its nourishing and moistening function that arises when blood is insufficient in quality or fails to contain adequate nutrients.

It is most commonly caused by excessive bleeding or by insufficient production of blood resulting from reduced food intake or to impaired splenic movement and transformation.

The signs are a lusterless or withered-yellow complexion, dry hair, and dry skin. The tongue is pale, and the pulse is fine. In severe cases there may be hypertonicity of the sinews causing stiffness in the limbs or there may dizziness or clouded vision. Blood vacuity with pronounced dryness signs is called blood dryness (血燥 xuè zào).

Blood stasis (血瘀 xuè yū) is the sluggish movement or nonmovement of blood.

Pathogenesis: It arises in the following situations:

when knocks and falls damage the blood vessels, allowing blood to extravasate and coagulate;
when qì stagnates and fails to propel the blood or when qì is vacuous and does not have the power to move the blood;
when fluids are scant, the blood becomes thick and slows down;
when phlegm obstructs the flow of blood;
when cold evil congeals the blood;
when heat evil enters the blood, it causes frenetic movement of the blood that in turn causes blood to extravasate and coagulate (see blood heat below).

Signs: Blood stasis manifests in many ways:

When resulting from knocks and falls, there is local swelling and bruising.
When blood stasis arises internally, there may be stabbing pain of fixed location and abdominal masses.

Other specific signs:

bleeding with purplish black clotted blood, as from external injuries or in the menstrual discharge, when static blood obstructs the vessels, causing them to burst;
incrusted skin (hard, dry, scaly skin) resulting from severe internal blood stasis;
prominent green-blue abdominal veins (caput medusae) in patients suffering from a severely distended abdomen, often referred to as drum distension (ascites), resulting from blood stasis in the abdomen;
varicose veins in the legs;
amenorrhea.

The tongue, pulse, and facial complexion can reflect blood stasis anywhere in the body:

The tongue has stasis speckles and may also be purple in color; the sublingual vessels may be prominent, appearing deep purple in color.
The pulse is rough and sometimes fine.
In severe cases, the facial complexion is soot-black, the lips are green-blue or purple.

Blood heat (血热 xuè rè), also called frenetic movement of hot blood, is a condition in which heat scorches the vessels and causes extravasation of blood.

Pathogenesis: Blood heat develops as a result of heat arising in febrile disease, but also in miscellaneous diseases.

Signs: .

expectoration of blood (from the lung);
retching of blood (from the stomach);
bloody stool or urine;
nosebleed;
profuse menstruation, and flooding and spotting;
a pulse that is rapid or racing.

Blood Cold

Blood cold (血寒 xuè hán) is any repletion cold pattern in which congealing cold and stagnant qì inhibit the movement of blood and cause blood stasis.

When cold enters the channel vessels and bowels and viscera, there is hypertonicity of the sinews and cold pain in the affected area. One example of this is cold stagnating in the liver vessel, which presents as cold pain on the pathway of the liver channel, usually in the lesser abdomen and genitals, and sometimes retracted scrotum. When cold congeals in the uterus, there is scant or delayed menstruation, or in severe cases amenorrhea and infertility.

Exposure to subzero temperatures causes cold to congeal in the vessels, giving rise to frostbite, which manifests in cold pain, numbness, swelling, green-blue or purple coloration of the skin, and in severe cases ulceration of the affected area (fingers toes, face, and ears).

Blood’s Relationships

Blood and Qì

Blood is closely related to qì. Blood is a yīn substance; it has form and is still; it nourishes and moistens. Qì is yang; it is formless and moves; it warms and propels. Qì and blood are mutually complementary and interdependent. Hence, it is said that qì is the commander of the blood (气为血之帅 qì wéi xuè zhī shuài); blood is the mother of qì (血为气之母 xuè wéi qì zhī mǔ).

Qì engenders the blood: Qì contributes to the formation of blood both as a constituent and as the agent of production. Provisioning qì, which is derived from the essence of grain and water and from clear qì inhaled by the lung, is a major component of the blood. Furthermore, the work of the spleen and stomach, the heart, and lung in the production of blood relies on their qì. Hence, without qì, blood cannot be created. When qì is effulgent, blood is ample. When qì is insufficient, blood is scant. Hence qì vacuity can give way to dual vacuity of qì and blood, which manifests in shortness of breath, lack of strength, lusterless complexion, dizzy head and vision, and heart palpitation or fearful throbbing. In treatment, both blood vacuity and dual vacuity of qì and blood are treated by combining qì-boosting medicinals with agents that supplement the blood (supplementing qì to engender blood).

Qì moves the blood: Qì propels the blood through the vessels. Blood is still and cannot move on its own; it only moves by the power of qì. When qì moves, blood moves; when qì stops, blood stops. Either qì vacuity or qì stagnation can cause the blood flow to slow down, causing blood stasis. When qì moves in the wrong direction, this can affect the movement of blood. In treatment, abnormalities in the movement of blood usually call for the use of qì-supplementing, qì-moving, qì-downbearing, and/or qì-rectifying medicinals.

Qì contains the blood: The retentive power of qì ensures that blood stays in the vessels and prevents it from extravasating. This action is specifically ascribed to spleen qì. The spleen controls the blood. When spleen qì is vacuous and fails to exert its retentive power, there is bloody urine, bloody stool, or flooding and spotting, which are conditions that are treated by supplementing qì and fortifying the spleen. Furthermore, massive bleeding can give way to qì deserting with blood. If a patient with qì vacuity suffers from bleeding, the qì vacuity can exacerbate the bleeding. For these reasons, the treatment of bleeding combines qì-supplementing medicinals with blood-stanching agents.

Blood bears qì: Qì and blood flow together through the vessels. Qì also flows outside the blood vessels. However, the part of qì that flows in the blood is borne by the blood, which means that its flow is facilitated by the blood. Because of this, when there is massive bleeding, qì can desert with the blood.

Blood nourishes qì: Qì, as all parts of the body, relies on the nourishing action of blood. Because of this relationship, blood vacuity can cause qì vacuity.

Blood and Fluids

Blood and fluids are both liquid in form; they both nourish and moisten the body. By contrast to qì, they possess form and are still, and are thus yīn in nature. Fluids and blood are interdependent.

The relationship between fluids and blood is often described as liquid and blood are of the same source (津血同源 jīn xuè tóng yuán). This has two meanings:

Fluids and blood are both derived from the essence of grain and water by the action of the spleen.
Fluids and blood are mutually convertible: Fluids can seep into the vessels and combine with provisioning qì to become blood; blood can seep out of the vessels to become fluids.

Blood and fluid pathologies are interrelated. When there is excessive loss of blood, fluid seeps into the vessels to compensate for the loss, giving rise to depletion of fluids outside the vessels that manifests in dry mouth, dry pharynx, scant urine and dry skin. Conversely, loss of fluids as through great vomiting, great diarrhea, or great sweating can cause fluid to seep out of the blood to compensate for the loss. For this reason, the Líng Shū states, When blood is despoliated, there is no sweat; when sweat is despoliated, there is no blood (夺血者无汗, 夺汗者无血 duó xuè zhě wú hàn, duó hàn zhě wú xuè). In either case, blood is reduced in volume and becomes thicker. This gives rise to desiccated liquid and blood dryness (津枯血燥 jīn kū xuè zào) or liquid depletion and blood stasis (津亏血瘀 jīn kuī xuè yū). As a result, in massive bleeding, it is inappropriate to use the sweating method of treatment. In liquid depletion, it is inappropriate to use bloodletting or to use powerful stasis-dispelling medicinals.

Blood and Essence

The blood also has a close affinity with essence. The essence of grain and water (i.e., later heaven essence) is the source both for producing blood and for replenishing kidney essence. Hence, it is said that blood and essence are of the same source. The term essence-blood (精血 jīng xuè) emphasizes this notion of the shared origin of essence and blood.

Blood in Relation to the Viscera

The lung, spleen, heart, kidney, and liver are all intimately related to the blood.

Spleen: The spleen produces fluids and qì, including provisioning qì. Fluids and provisioning qì are the chief components of the blood.
Lung: The lung vessel, according to some traditional statements, is the place where blood production is completed.
Heart: The heart governs the blood. It is traditionally said to turn the constituents of the blood red.
Kidney: The kidney stores essential qì. Essence and blood are of the same source; they are understood to be mutually enhancing and mutually convertible.
Liver: The liver stores blood. Furthermore, liver qì bears upward and effuses, stimulating the activity of the spleen and heart, thus helping to stimulate blood production.

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