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The Formation of Blood and Its Relationship to the Five Viscera
By Bob Damone From time to time, it is a good idea to revisit basic concepts in order to clarify points of vagueness and to build in new layers of understanding. Toward this end, I have translated and adapted this short passage on blood formation from my favorite textbook on basic theory, Zhong Yi Ji Chu Li Lun (Fundamental Chinese Medical Theory), published by The People's Hygiene Press in 2001. I find myself increasingly drawn towards Chinese sources because of their clarity, accuracy, and comprehensiveness. Note this passage very clearly points out that, according to Chinese medical physiology, the formation of blood involves close coordination between many viscera and bowels; it is not simply created by the spleen. It is not difficult to see the clinical ramifications of these important concepts. The HeartThe heart governs the blood vessels. On one hand, this statement means that the heart is responsible for moving the blood so that substantial nourishment can reach the entire body. The heart ensures that all the viscera and bowels acquire ample nourishment so that they can maintain their normal functions. On the other hand, this statement also indicates that the heat has a role in the formation of blood. The essence of fluid and grain is assimilated via the movement and transformation actions of the spleen. The spleen, by raising the clear, sends this essence upward to the lung and heart. After the lung rejuvenates it, essence of fluid and grain pours into the heart vessels and the heart yang transforms it into fresh red blood. So it said, "blood is the juice of the middle burner. [This juice] flows from the middle burner, and is considered essence. The heart receives it, turns it red, and [it] becomes blood." (Lu Shan Tang Le Bian). This shows that the heart participates in the formation of blood. "Blood comes about through the heart fire's transformation; this is why [it is said] that the heart engenders blood and that blood is ascribed to the heart." (Yi Bian) The LungThe lung governs the qi of the entire body, since it participates in the formation and movement of ancestral qi (Zong Qi). Since qi engenders blood, when qi is effulgent, its blood-engendering function is strong, and when qi is vacuous, its blood-engendering function is weak. It follows that qi vacuity and an inability to engender blood is a common cause of blood debility. By governing the qi of the entire body, the lung enables the viscera and bowels to be exuberant and thereby promotes blood formation. The lung's action of blood formation is mainly accomplished through the aspect of lung function known as "the lung faces the hundred vessels" (fei chao bai mai). Through the combined digestive actions of the spleen and stomach, the finest essence of fluid and grain is assimilated. The nourishing substance, such as construction qi (ying qi), fluid, and humor, that is engendered and transformed through digestion, passes through the channels and assembles in the lung. The essence of fluid and grain cannot become blood until after it has been subject to the gas exchange of respiration, which takes place in the lung. It is evident, then, that the lung plays a vital role in the formation of blood. The SpleenThe spleen is the latter heaven source of the engenderment and transformation of qi and blood. The essence of fluid and grain absorbed by the spleen is the fundamental substance from which blood is formed. If the middle burner is vacuous and weak, it is unable to move and transform the finest essence of fluid and grain; therefore, when the spleen is vacuous, the source of transformation is insufficient, and blood vacuity may result. The LiverThe liver governs coursing and discharge and stores blood. Since "essence and blood originate in the same source", when there is ample liver blood, the kidney stores some of it as essence. It follows that when there is adequate endowment of essence, there will be ample blood. In light of the above, the liver can be considered a blood-producing organ. The KidneyThe kidney stores essence and essence engenders marrow. Essence and marrow are also basic substances from which blood is engendered and transformed. The fountainhead of blood is in the kidney. Early in history, Chinese doctors recognized that bone marrow was a blood-producing substance and that the kidney had a regulating affect on blood formation; furthermore, they recognized that the liver can convert kidney essence into the blood.
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