Exploring Blood and Immunity in TCM
There is often a tendency in TCM education to equate the TCM concept of Wèi Qì (衞氣) with the immune system and this leads to oversimplification and misunderstanding. In traditional Chinese medicine, while there are obvious areas of conceptual overlap, the biomedical “immune system” must also include other facets of Qi plus aspects of the TCM concepts of Blood, Yang, Yin, Jing, and Marrow to be properly understood. In this article, I want to explore a more complete understanding of how to assess the condition of a patient’s blood by providing insight into the use of a common laboratory test, i.e., the Complete Blood Count (CBC) with Differential.
In TCM theory, True Qi (Zhēn Qì 真氣) is comprised of Defensive Qi (Wèi Qì 衛氣) and Nutritive Qi (Yíng Qì 營氣). Defensive Qi is located in the Exterior, under the skin, and circulates outside of the Channels. Nominally under the control of the Lungs, it originates from Essence (Jīng 精) and Original Qi (Yuán Qì 原氣) and is transformed by Kidney Yang (Shèn Yáng 腎陽). Defensive Qi corresponds to barrier immunity in the biomedical model, which is the first line of defense to protect the body from disease. Nutritive Qi is closely related to Blood (Xuè 血) providing nourishment to all cells, organs and tissues in the body and flows in the channels of acupuncture and the arterial, venous, and lymphatic vessels.
Aspects of Blood are derived from both Pre- and Post-Natal Essence and consequently depend on the Qi of the Spleen/Stomach and Kidney, and specifically to the Kidney’s connection with Bone Marrow. Blood also depends on the Lung to infuse Qi into the vessels and assist the Heart in moving the Blood. In fact, the Blood is considered a very dense form of Qi, while also a type of Yin. The relationship of Blood and Qi is fourfold: Qi generates Blood, Qi moves Blood, Qi holds Blood in the vessels, and Blood nourishes Qi. This last aspect points directly to Blood as the source of major facets within the biomedicine concept of active immunity, both innate and adaptive. In addition, one should remember the dependence on the quality of Blood influencing healthy Spleen and Lung Qi, along with the role of the Kidney Yang in filling the Marrow.
In our March 2022 Newsletter, the medical description of the immune system was described in some detail within the article, “TCM Heat and Inflammation”. I strongly recommend it for context. One key to understanding the immune system is that it is delivered via the circulatory system, including the lymphatic system. Additionally, the cells that comprise blood and lymph, viz. erythrocytes, leukocytes, lymphocytes, reticulocytes, and thrombocytes are derived from bone marrow.
What is Blood?
Blood represents about 7% of an adult’s body weight and the average person has around 11 liters of blood circulating in their heart and arterial, venous, and lymphatic vessels. Around 54% of blood and 99% of lymph is plasma, which is 92% water. Red blood cells (RBCs/ erythrocytes) comprise 42-45% of blood; platelets (thrombocytes) and white blood cells (WBCs/ leukocytes) encompass about 1%. Lymph does not contain RBCs or platelets. The non-aqueous portion of plasma includes plasma proteins (albumin, globulin, and fibrinogen), glucose, minerals (electrolytes), fatty acids (including triglycerides), cholesterol, enzymes, hormones, antibodies, and waste products including carbon dioxide, urea, and lactic acid. Some components of plasma are dissolved within the aqueous solution, while many are transported by specialized plasma proteins (polypeptides). Blood is in continual contact with every cell to provide nourishment, communication, and information, while also removing waste.
Importantly, in the context of immunity, the blood contains leukocytes, lymphocytes (also found in lymph), antibodies, complement proteins, and many other chemical mediators including histamines, prostaglandins, thromboxanes, cytokines, and leukotrienes, all of which play a significant role in operating the human immune system. Obviously, the quality of the blood in all its aspects is a vital component in immunity.
Classically, a TCM diagnosis of Blood Deficiency requires among its signs and symptoms a pale or sallow complexion, pale lips, dizziness, poor memory, blurred vision, insomnia, a pale and slightly dry tongue, and a choppy, fine, or frail pulse. In women, there may also be various gynecologically related symptoms. Treating Blood Deficiency calls for tonifying Qi and Blood and assessing any Liver excess and/or Kidney deficiencies. However, these signs and symptoms point mostly to anemic conditions where either the number of RBCs or the amount of hemoglobin is inadequate for optimum health. In assessing the immune function, it is necessary to gather additional information about blood, especially the quantity and activity of leukocytes.
Complete Blood Count with Differential
The best informative tool for monitoring the quality of blood is a common laboratory test, the Complete Blood Count (CBC) with Differential. The Differential, in particular, provides insight into the number and activity of the leukocytes involved in the immune system. In some states, acupuncturists, naturopaths, and chiropractors can order this test, but in many cases, the test must be ordered by a medical doctor. However, anyone can read and interpret the results, which provide a wealth of information.
Since each laboratory may use slightly different technology or procedures, one should rely on the reference ranges provided by the lab. Bear in mind that “normal ranges” are a statistical analysis that represents the average values in a population of people plus two standard deviations from the mean, which means that 95% of “normal” values (i.e., not representing pathology) are found in the reference range.
The CBC is composed of a quantitative analysis, a “count” of cells per standard volume of the major cell types plus indices that provide additional information. Specifically, the CBC test reveals the amount of RBCs, hemoglobin, hematocrit, reticulocytes, platelets, WBCs, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration. The differential distinguishes the amount of various WBCs, i.e., leukocytes and lymphocytes. See the highlighted section for the various tests conducted and what the information provides.
Incorporating Blood as a Strategy to Improve Immune Function
Understanding the relationship between blood and immunity within the clinical practice of a TCM herbalist is another tool to support your choices for constructing herbal formulas for your patients. Additionally, there is a tremendous amount of scientific research that has been conducted with Chinese herbs and immunity. This can be accessed via Google Scholar or perhaps from your local library, via PubMed/Medline. Here you will find that the same herbs that traditionally belong to the Tonify Qi and Blood categories also have been found to possess effects that are anti-inflammatory, immunomodulating, promoting leukocytic and lymphocytic activity, and phagocytosis. (A few examples of this research are listed in the References below.)
Consequently, when considering how to utilize herbal strategies to improve the immune function in our patients, many time-tested formulas will prove helpful. The classic example is Jade Screen Teapills/ Yu Ping Feng San which focuses on supporting the Spleen and Lung Qi and stabilizing the Exterior. Then, in order to tonify the Qi and Blood, consideration should be given, at minimum, to Dang Gui Bu Xue San. However, Zhi Gan Cao Tang Wan, Nu Ke Ba Zhen San/ Women’s Precious Teapills, and Shi Chuan Da Bu Wan/ Ten Flavor Teapills will provide a more comprehensive approach to tonifying both Qi and Blood. To promote the Kidney Yang Qi while Nourishing Liver and Kidney Yin and Blood, Ba Ji Yin Yang Teapills or Maway’s newest product, Majestic Yang Teapills/ Xiong Wei Da Bu Wan are recommended.
In conclusion, when there is a desire to build a patient’s immunity, the wise practitioner will not only tonify the Wei Qi, but will also augment the Zhen Qi, Blood, Yang, Yin, Jing, and Marrow. These physiological substances work together to support not only the immune function, but a patient’s overall health.
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- Blood Differential Test, https://www.healthline.com/health/blood-differential
- “Complete Blood Count”, https://my.clevelandclinic.org/health/diagnostics/4053-complete-blood-count
- “Anti-inflammatory and immunomodulatory effects of Paeonia lactiflora Pall., a traditional Chinese herbal medicine”, Frontiers in Pharmacology February 2011, Ethnopharmacology Section, Dong-Yi He and Sheng-Ming Dai, https://doi.org/10.3389/fphar.2011.00010
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- “Interpreting the Complete Blood Count and Differential”, https://www.elitelearning.com/resource-center/laboratory/interpreting-the-complete-blood-count-and-differential/
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- “Effects of ten traditional Chinese herbs on immune response and disease resistance of Sciaenops ocellatus (Actinopterygii: Perciformes: Sciaenidae)”, Pan, T., et al., Acta Ichthyologica ET Piscatoria, 2013 - researchgate.net
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- “A Chinese Herbal Decoction, Danggui Buxue Tang, Prepared from Radix Astragali and Radix Angelicae Sinensis Stimulates the Immune Responses”, Qiu, T., et al., Planta Medica 2006; 72(13): 1227-1231
- “Comparative study on adjuvanticity of compound Chinese herbal medicinal ingredients”, Wang, D., et al., Vaccine, Volume 23, Issue 28, 25 May 2005, https://doi.org/10.1016/j.vaccine.2005.02.011
- A Practitioner’s Formula Guide, Wrinkle, A. et al., Elemental Essentials Press: 2008.
- "Effect of two Chinese herbs (Astragalus radix and Scutellaria radix) on non-specific immune response of tilapia, Oreochromis niloticus." Yin, G., et al., Aquaculture 253, no. 1-4 (2006): 39-47. fhs-afs.net
About the Author
|Skye Sturgeon is the Quality Assurance Manager and Special Consultant for Mayway, USA. Skye was the former Chair of Acupuncture & East Asian Medicine and core faculty member at Bastyr University, core faculty member and Faculty Council Chair at the American College of Traditional Chinese Medicine, and President and Senior Professor of the Acupuncture & Integrative Medicine College, Berkeley. Before making Chinese medicine his career choice, Skye held various positions in the Natural Foods Industry for 12 years and prior to that was a clinical biochemist and toxicologist.|