This article is based on notes from a course in East Asian Medicine I took between April and October 2019, expanded from the standpoint of September 2026. It was originally two separate pieces — one on qi, one on blood and fluids — but the three belong together, so I have combined them. A note at the end sets out what became visible only later.
Three Basic Substances
This article covers two sessions of the course. The second half of the fourth day (July 7, 2019) covered qi; the first half of the fifth (September 8, 2019) covered blood and fluids. Both were Sundays, ten in the morning until three in the afternoon, at Kei.K Aroma Studio in Kanagawa, Japan. The teacher was Masamichi Abe.
East Asian Medicine divides the substances that sustain life into three: qi, blood, and the body’s fluids.
Qi has a yang nature; blood and fluids have a yin nature. All three are produced by the spleen.
The nourishment of the whole body is split in two — qi, which cannot be seen, and blood, which can. This division is the foundation of how East Asian Medicine reads a body.
Western Medicine Sees It as Metabolism
For comparison, the Western side first.
We have to take in energy from outside through food. Five classes of nutrients — carbohydrate, fat, protein, vitamins, minerals — together with air, the movement of fluid, and electrical force, are used to build a body’s own nourishment. The whole sequence is called metabolism.
Metabolism has two halves: anabolism and catabolism.
Catabolism produces usable energy. Food enters through the mouth and passes to esophagus, stomach, duodenum, and small intestine. With gastric acid and pancreatic hormones, carbohydrate is broken down to simple sugars, protein to amino acids, fat to fatty acids and glycerol. Absorption occurs in the small intestine; the portal vein carries it to the liver, where it is processed and sent to the cells. In the cell, oxygen and enzymes carry it through glycolysis, the citric acid cycle, and the electron transport chain to ATP, the form the body can readily use.
Anabolism uses that energy to build. Cells are made from four materials — nucleotides, lipids, proteins, and sugars — and ATP is spent in making them.
What is interesting is the electricity. The pumping of the heart and the signaling of the nerves both run on it. So does the production of ATP, through the proton gradient across the mitochondrial membrane. And the reactive oxygen species implicated in aging and arteriosclerosis arise from a shortage of electrons.
Western medicine reasons from visible substances and from current.
Four Views of Qi
The qi of East Asian Medicine is examined from four angles: original, gathering, nutritive, and defensive.
Original qi is the driving force of life. It is produced from prenatal essence and held in the lower dantian.
Gathering qi drives respiration and pulse. It unites lung and heart, and is produced through breathing.
Nutritive qi nourishes and supports the body. It is the yin aspect of the postnatal essence produced by spleen and stomach.
Defensive qi circulates at the surface and protects. It is the yang aspect of postnatal essence: it warms the skin, maintains temperature, opens and closes the pores, and keeps external pathogens out.
The qi inherited from one’s parents; the qi that drives breath and heart; the qi taken in through food; the qi that protects. In Western terms, you can line these up with genetic background and the uterine environment, respiration and circulation, dietary content, and immunity and homeostasis.
Nutritive qi is the interesting one. It is understood to circle the body fifty times a day, each circuit taking about thirty minutes, passing through the twelve meridians. An acupuncturist inserts a needle from outside precisely to stimulate that flow and get it moving. Though both move through the body, defensive qi runs at the surface while nutritive qi runs within. That is the difference.
Five Functions of Qi
Qi was taught as having five functions.
Propulsion drives growth and development, along with circulation, respiration, digestion, and elimination. All four kinds of qi are involved.
Warming maintains body temperature. Original and defensive qi are involved.
Defense keeps external pathogens out. Defensive qi carries this.
Containment keeps blood from leaking out and regulates the secretion and discharge of sweat, urine, saliva, gastric juice, and intestinal fluid. Defensive qi again.
Transformation converts blood into essence, essence into blood, qi into fluids. Gathering, nutritive, and defensive qi are involved. This corresponds to metabolism and elimination in Western terms.
A problem in any of these shows up as a symptom. A problem in warming and the body will not warm. A problem in defense and you fall ill easily. When containment fails, you bleed easily, or sweat, urinate, or produce mucus excessively.
How It Connects to the Five Elements
Lay qi over the five elements (also called the five phases) and what has been learned so far begins to hold together.
Qi is taken in through the nose as the qi of heaven — breath. The nose belongs to the lung, to metal. Through the mouth as the qi of earth — food. The mouth belongs to the spleen, to earth. And through the eyes and ears as the qi of people — seeing and hearing. The eyes belong to the liver, the ears to the kidney.
Nose and mouth are close to the Western account of metabolism.
The qi of people is what caught my attention. Qi changes through contact with others, and you take that in through eyes and ears. And the state of the organs can be read from the features of the face. This is particular to East Asian Medicine, and useful.
The kidney stores qi. Prenatal and postnatal essence are both held there. Western medicine tracks energy storage in fine detail across cells, liver, fat, and muscle; East Asia looks to the kidney.
Lung and liver circulate it. Nutritive qi moves within the body, defensive qi at its surface.
Qi moves with the rhythms of nature. In daytime, in spring and summer, it gathers outward, into the muscles, for activity. At night, in autumn and winter, it gathers inward, into the viscera, for recovery. Fall out of that rhythm and you cannot get up in the morning, or cannot sleep at night.
Two kinds of trouble arise. Qi deficiency, where there is not enough, and qi stagnation, where it does not circulate well. Deficiency comes from spending qi, from an irregular diet, or from failing to produce enough; as it worsens the body grows cold, colds come easily, the abdomen becomes unsettled. Stagnation comes from worry, stress, and physical tension; it shows as irritability, abdominal distension, a sense of constriction in the throat, and heat trapped in the body.
Blood
Blood passes through three stages before it nourishes the body: production, circulation, and storage with purification.
The spleen plays the largest part in production, making blood from the postnatal essence obtained through food and drink. In an emergency, it can also be made from the prenatal essence one was born with.
Circulation is divided up. Heart and liver push it along, with the lung assisting. The spleen makes the blood robust, the lung keeps the vessels clean, and the kidney manages the water.
Storage and purification are done by liver and gallbladder, while you sleep.
What I found interesting was what makes blood impure. Moving too much, thinking too much, eating irregularly. And beyond that: internal bleeding from injury, and disturbances in the balance of one’s surroundings.
Thinking too much and using the body both lead to impurity. And East Asia holds that blood is purified through sleep. In modern life, sleeping regularly is not easy.
So blood problems tend to appear as one of two things. Blood deficiency, where there is not enough, and blood stasis, where it has grown impure. Deficiency brings forgetfulness, scant menstruation, delayed cycles, insomnia, and heavy dreaming. Stasis brings stabbing pain, a darkened complexion, and dry skin.
The state of the blood appears in visible places. Complexion, muscle tone, skin, hair, nails. Complexion tells you whether fire — the heart — is weakened. Muscle tone hardens when blood circulates poorly. Skin belongs to metal, to lung and large intestine. Hair to water, to the kidney. Nails to wood, to the liver.
Knowing the state of the blood lets you locate which of the phases is in trouble. So Abe said. When blood is full, the hair is alive; when it is short, the hair thins.
Inference from what is visible rather than from a number. This is what is characteristic here.
Fluids
The fluids nourish and moisten the whole body, and regulate temperature. Here East Asian and Western accounts are close. The way of looking, though, is again through concrete signs.
The state of the fluids appears at the body’s surface — the skin — and in the face (eyes, mouth, tongue, nose), in the movement of the joints, in the viscera, and in the brain, in the cerebrospinal fluid. Everything containing fluid is taken as one thing and read through concrete signs.
Fluids also pass through three stages: production, circulation and moistening, and the discharge of what is not needed.
Spleen and stomach play the largest part in production, making fluids from food and drink.
In circulation, part becomes blood and part goes to the lung, and from there spreads through the whole body.
The passage the fluids travel is called the triple burner. It is particular to East Asian Medicine, and it is not an organ with an anatomical form. Its work is to regulate the waterways. The body is divided into three regions — heaven, earth, and humanity — and the triple burner is what connects them.
Abe’s own suggestion was that, since East Asia has no concept of the lymphatic system, the triple burner may correspond to it, or may be close to the course of the vagus nerve. His reasoning was that the triple burner is grouped with the pericardium, which puts it close to the autonomic nervous system, working independently of your intention.
Either way, he said, it is probably in the system because positing an organ with no visible form makes the whole thing usable.
The triple burner has three divisions. The upper burner is above the diaphragm — heart and lung. The middle burner runs from the diaphragm to the navel — spleen and stomach. The lower burner is below the navel — kidney, bladder, small intestine, large intestine.
Lung, kidney, and bladder discharge what is not needed. Sweat leaves through the skin; water gathered from the kidney into the bladder leaves as urine. The body’s water is managed, fundamentally, by the kidney.
It is useful, too, that the state of the body can be read from where in the face things are held up. A runny nose means the lung and the regulation of water are not working together. Tears mean the water regulation between lung and kidney.
When fluids are short: dry skin, dry mouth and throat, cracked lips, constipation, insomnia. When they stagnate: swelling, heaviness in the head or body, poor appetite, a sticky feeling in the mouth.
What surprised me was the observation that swelling from fluid arises far more often from irregular eating than from a humid climate or a damp place.
The Order in Which You Look
At the end of the session on blood and fluids, Abe talked about order.
When you look at a body in East Asian Medicine, take four steps. First, is qi circulating? Then the state of qi, blood, and fluids, and of yin and yang. Then the energy of the five elements. And only at the end, check the organs.
What surprised me was that the organs come last.
Unless you have narrowed things as far as the five elements, going straight to the organs produces confusion. That was the reason.
This leads into pattern differentiation, the subject of the final session.
Note, September 2026
What I learned here about order changed meaning later.
In 2019 I took it as practical advice for avoiding confusion. Look at the detail first and you will get lost — that was about the extent of my understanding.
In the Advanced Rolfing Training in 2025, I learned Jeffrey Maitland’s three questions. Where do you start? What do I do next? How do I know when I’m done? These three amount to the design of a session.
The first of them points at the same place as this.
In Rolfing, body reading comes before any hands-on work. You look at the whole, then decide where to reach. IMAC begins by measuring range of motion. Both enter through the whole and descend into the detail.
Pattern differentiation in East Asian Medicine enters through the whole — is qi circulating — and descends to the organs at the end.
Three traditions from entirely different places held the same order. And all three carry the same warning: start with the detail and you will lose the whole.
In 2019 I wrote about this as something internal to East Asian Medicine. That the order was shared across traditions was not yet visible to me.
One more thing.
I recorded what I was told about nutritive qi circling the meridians and left it there. Fifty circuits a day, thirty minutes each, through twelve meridians. Numbers, written down.
Later it became clear that those twelve meridians are what IMAC measures range of motion against. As I write in the next article, the meridians are arranged by position on the body. What I had been taught as a path along which qi travels turned up in front of me as something measurable.
Related Articles on This Course
East Asian Medicine — A Summary of Six Days Across Six Months of Study
- The Five Elements as a Way of Dividing — The Body Moves Toward Balance on Its Own
- What the Meridians Are — Channels for Qi and Blood, and the Center Line
- Pattern Differentiation as a Procedure — Why You Don’t Start with the Organs