“Qi” in Chinese Medicine: How A Biological Phenomenon Turned A Metaphysical Mystery

he dogma "qi flows in meridians", or "energy flows in channels" as phrased in the TCM community in the West, is the deity worshiped in today's standardized acupuncture world. No one dares think about replacing the qi or energy with a different entity, or to coin a new meridian or delete an existing one. But the ancient Chinese physicians prior to Huangdi Neijing era did so in their daily clinic practice as prosaically as they did grocery shopping.

So what is "qi"? The acupuncture history in China can be condensed into a process of how to understand the meaning of qi (气) and its relationship with blood (血), and how and where they are circulating in the body.

All Started from "Blood"

The anatomy/physiology-based Chinese medicine began with blood. In the era of sharp stone-bleeding medicine (prior to 400 BC), no one talked about "qi" yet. Blood alone was recognized in blood vessels: when sharp stone cuts the body, blood comes out which can result in a cure.

What Is Qi in Bian Que Medicine

Around 350s BC before the Chinese medicine classic Huangdi Neijing came into place, Bian Que (BQ)(扁鹊) (407 – 310 BC), the earliest known Chinese physician, had already established diagnosis technique by measuring pulse rate on a blood vessel (artery) over breathing rate.

In Chinese language, the most basic meaning of the word "qi" (气) is air or the vapor form of a substance. Breathing (inhale and exhale) takes air (qi) in or out, so the location for pulse palpation was called qi-pulse (气脉) which means "the location of blood vessel where pulse beating is perceivable". One of the locations for pulse palpation is at the radial side of the wrist between the tendons of the brachioradialis and flexor carpiradialis,where the radial artery lies superficially and thus makes the pulse more easily detectable.

Thus, measuring pulse rate over the rate of breathing (air flowing into and out of lung) got the Chinese word 气 (qi = air) related to blood and blood vessels.

Blood: The Foundation of BQ Medicine

The foundation of BQ medicine is "blood". It is "blood" that enables a physician to do diagnosis (by palpation on arteries) and to do treatment (bleeding primarily the veins and capillary blood vessels by sharp stones, or prick the wall of artery vessels with needles).

It is generally believed that during the period from 150 BC to 100 AD, several people with their name unknown systematically summarized the medical ideas available at the time primarily from BQ medicine. Their works resulted in the classic text Huandi Neijing.

The Chinese physicians by Neijing era knew very well what blood (血) and blood vessel (血脉) are: "The vessels are where blood resides" (夫脉者, 血之府也) (SW 17). In Chinese language, blood vessel including arteries and veins is called "血脉"or simply just "脉"(Mai = vessel).

The Power of Blood Coming from Food

Gradually, Chinese physicians started to refer blood as 血气 (qi of blood): "Grains enter stomach, blood vessels get open thus qi of blood starts to flow" (谷入于胃，脉道以通，血气乃行) (LS 10). At this point, qi was still an undetachable attribute of the blood: the power of blood that pushes artery blood vessels to beat when there is air in and out on the condition that there is food going into stomach.

The key point here is: qi is by no means something that can be separated from blood; blood and the power of blood are one entity flowing in the blood vessels.

The Beating of Artery and Breathing Determines Life or Death

The Chinese doctors at that time not only noticed that the blood has a power to push blood vessel pulsate or beat when qi (air) being kept breathing in and out through lung, they also noticed that the artery blood vessels will stop to beat when there is no air coming in or going out via lung (when breathing ceased and the heart stopped to beat, that is, the death comes). So they knew blood and air are closely related and can not be separated.

Theyfurther observed that strength of qi (the power of blood pushing arteries to beat) or presence or absence of qi can be used to diagnose health conditions and for prognosis of the life or death of a patient.

The Beat of Heart and Respiration

One of the most easily noticeable "qi of blood" observed by Chinese physicians of Huandi Neijing era is located an inch below the left-side nipple where the beating of the chest under the cloth is visible: ...出于左乳下，其动应衣 (SW18). The Chinese physicians called this qi "zong qi"( 宗气). They also knew that zong qi leaves the body from throat when breathing (expiration): 宗气积于胸中，出于喉咙，and the flow of zong qi passes through heart and blood vessels, thus respiration is carried out (宗气...以贯心脉, 而行呼吸焉) (LS 71).

Today we know that the beating of the chest those Chinese physicians in Neijing era observed is the beating of heart. The heart is a section of blood vessel, greatly dilated, peach-shaped with a thicken wall.

It is so amazing that the Chinese physicians millennia ago could make such a scientific observation of the human body about breathing and its relationship with blood movement.

The Construct of BQ Medicine with Blood and Qi

The key ideas of Bianque (BQ) medicine can be summed as below:

• Blood flows in blood vessels;
• Qi of blood is closely related to the breathing which brings air (气=qi) into body through Lung;
• Qi of blood pushes blood vessel to beat, which makes pulse diagnosis possible;
• Palpation of the pulse helps a physician predict a patient's life or death: 故人有三部，部有三候，以决死生，...此决死生之要，不可不察也(SW 20).
• Pulse palpation is performed at 3 locations (三部) on arteries at ankles, wrists and head;
• By bringing air (qi) in or out, lung pushes blood into blood vessels that run all over the body (肺潮百脉).

Unintended Separation of Qi from Blood

Gradually, Chinese physicians sometimes also use the phrase "气血" interchanged with the phrase "血气". This was where confusion began because "气血" in Chinese has multiple meanings. It can mean "blood that has power of qi", but can also mean "qi and blood" where qi and blood are separated things.

Development of Misconception

This unintended separation of "qi" from "blood" eventually led to today's misconception that qi flows in somewhere else other than blood vessels. This misconception has been greatly strengthened and spread into the West since 1930s, thanks to a French whose name is Soulie de Morant, and who translated Chinese words "blood vessel" into "meridian" and "qi" into "Energy" (Soulié de Morant, 1957; Kendall D, 2008).

Misconception Not Happened until 1300s

In China, at least until 1200s - 1300s, the separating qi from blood had not happened yet. The "qi" still meant "the power of blood causing pulsation" in Chinese physicians' eyes. Chinese medicine scholar Yang Shiying 杨士瀛 (1208-1274) of South Song Dynasty says (1264): "The pulse is caused by blood; The breathing takes qi (air) in; The blood vessel will not pulsate by itself unless powered by qi from breathing" (脉者,血也; 息者,气也; 脉不自动, 气实使之).

Liu Wansu 刘完素 (1110-1209), one of the four most famous Chinese Medicine scholar in Jin Dynasty, states : "We may separately talk about 'qi', 'blood' or 'vessel', but in a big picture, there is nothing but blood vessels which transport qi and blood, that's all" (分而言之，曰气，曰血，曰脉；统而言之，惟脉运行气血而已).

Truth Replaced with Myth

"Blood and qi is transported through blood vessels" is an anatomical / physiological truth identified by Neijing era's Chinese doctors 2000 years ago. Ironically, modern history replaced the scientific truth with an esoteric myth of "energy flows in meridians" (Soulier M, 1957; Kendal D, 2008).

Who should take the blame for this probably the fanciest irony in the acupuncture and Chinese medicine history?

References

Kendall D, Energy – Meridian Misconceptions of Chinese Medicine 2008

Soulié de Morant, Georges. L'Acuponcture Chinoise. 3 volumes, Paris, 1957. (French) Zmiewski, P (Ed).

Lingshu 10, Jing Mai Vessesls (经脉)

Lingshu 71, Xie Ke (邪客)

Suwen 17, 脉要精微论

Suwen 18, 平人气象论

Suwen 20，三部九候论

Liu Wansu 刘完素, 素问病机...原脉论(1186)

Yang Shying杨士瀛, 1264, 医脉真经