Yvonne Lau, President of Mayway Herbs and Dr. Skye Sturgeon continue to explore Blood pathology in TCM, focusing on deficiency and stagnation and how they present in the body. Learn how Blood connects to deeper systems like marrow, Jing, and immunity, and what these patterns reveal about overall health.
Listen to the podcast, or read the transcript (below)!
SS: Let's talk a bit about pathology of Blood.
We spoke a little bit about red blood cells, which are called erythrocytes. There are other cells in the blood, including white blood cells, which are also called leukocytes. Lymphocytes, which are a particular kind of white blood cell. Reticulocytes, thrombocytes, which have to do with the clotting and everything like that. All of these are derived from bone marrow. And bone marrow is under the direction of the Kidney Yang Qi, because the Kidney Qi fills the Marrow, and so there's a connection there that the Yang Qi is the source of all of these cells that are in the Blood.
The Kidney Essence makes the Marrow, and that contributes to all these cells of the blood. The Blood is an interaction of the postnatal Jing, which is the food Qi and air Qi, and the prenatal Jing, which is stored in the Kidneys. So those are connections that we need to pay attention to when we're looking at problems of the Blood.
Frankly, there are really only two major pathologies of Blood. One is Blood deficiency. And Blood deficiency is going to affect the entire body. You can look at the complexion. There should be a certain glow or certain, not exactly redness in the complexion, but there should be a healthy complexion, and if it's sallow or pale, one of the things you're going to suspect is Blood deficiency. The lips will be pale, the tongue will be pale. And the pulse, which should fill the vessel, can become weak, or thin or frail, which is weak and thin at the same time. And it could also become choppy, because there's not sufficient blood, and so the heart winds up developing arrhythmias due to the lack of blood.
Women's physiology is more dependent on Blood than men because of certain specific problems that women can experience with regard to Blood. If the Liver Blood is deficient, this can cause, for example, amenorrhea or scanty menstruation. And if the Liver Blood is stagnant in that it's not moving correctly like it's supposed to, that can cause dysmenorrhea, and other types of gynecological issues.
The other effects that occur besides difficulties in menstruation can be dizziness, because insufficient blood is getting to the brain, poor memory, likewise blurred vision, because the Liver Blood is not nourishing the eyes, and because of its connection to Shen or Spirit, you can wind up having restless Shen or disturbed Spirit. Which could show up as insomnia or certain kinds of mental fuzziness or confusion. The gynecological problems that are associated with Blood deficiency mainly have to do with anemia, so that means insufficient red blood cells. Now, interestingly, women have usually around 10% fewer red blood cells than men. And consequently, they have about 10% less hemoglobin. And, at least so long as they're menstruating, they're losing blood on a regular basis. So, developing Blood deficiency is quite possible.
Although, women have a greater capacity to produce blood than men do, so mostly this is offset. But to create more blood, you do have to have sufficient iron, and this is one reason why people normally need to eat meat, because meat winds up providing iron in the form that the body can use to create more blood.
When you eat meat, your body secretes more hydrochloric acid in the stomach to denature the protein of that meat. And that fosters greater absorption. Whereas with vegetable sources, you don't need to create as much hydrochloric acid in the stomach, and therefore the amount you can absorb from vegetable sources winds up being less.
YL: Okay, how do men become Blood deficient, then?
SS: So, it's not as common for men to have Blood deficiency, and when I would have a patient that I would think would be Blood deficient, I'm going to think they've got some kind of bleeding going on. I'm going to want to check their urine and their stool for blood. They may have had an injury where they lost blood, or they may have poor nutrition, and so they're not making blood the way they should, or their dietary choices are not sustaining the blood.
We tend to conserve iron. And it is not something that your body wants to get rid of, because it is millions of iron molecules in every red blood cell. So, you tend to conserve iron. But if a man has Blood deficiency, you have to ask yourself, why? What is going on with this person? Their hemoglobin is too low. I'm going to want to look at their muscle mass, want to look at their diet, so on like this.
Okay, so this is the important thing about Blood deficiency. It isn't just anemia. It isn't just red blood cells. It's the capacity of the Blood to function in all of its aspects. It's a capacity to provide nutritive Qi, for sure. But it also has capacity to transport hormones.
So, say you have a thyroid that is not functioning correctly, and it becomes hypothyroid. It's not secreting T4 which is then transformed into T3, which is the active part of the hormone. But that's going to have an effect on this organism. In fact, they eventually will have coma and die, okay? And that's Blood deficiency. You can say, well, it started in the thyroid, yes, but the blood is not providing that hormone that is necessary. Or you can say there is a part of the righteous Qi that is the immune system. And if the immune system is not functioning optimally, then the person is more susceptible to disease. And the person is not able to adapt to changes of conditions, or to fend off viruses that appear. So, all of these things are going to be a part of the aging and ill health process, and it's all Blood deficiency.
And there are tissues in the organs, for instance, a person with kidney disease, the kidneys are no longer functioning. The Kidney Qi, the Kidney Yin, the Kidney Yang are no longer functioning correctly. So you wind up having symptoms of kidney disease, meaning you're not removing the waste products out of the bloodstream that you need to. And what do you do with kidney disease? Do you Tonify the Kidney Yin, or the Kidney Yang, or the Kidney Qi? Actually, a very important component of treating kidney disease is tonifying the Blood. Making the Blood stronger, so that it provides nourishment to the kidneys, because our cells replenish themselves all the time.
The body you have now is not the same body as when you were 8 years old. All the cells are likely to be completely new. Even your bone is new, okay? So, to create this growth, to sustain growth, to sustain the organism, you need to have nourishment from the Blood so that any organ that becomes diseased or becomes damaged, a part of your process should be tonifying Blood, because you want that organ to get the correct nutrition that it needs to replenish itself and restore its function.
The other pathology of Blood is either described as stasis or stagnation, and there are different ways that this is manifested. Stasis basically means not moving or stationary. And so this could be a clot, for instance, that is formed in the blood. That could be due to various reasons why. And you would use herbs that would break the Blood stasis or move Blood, that's the way we describe it.
The other way you get Blood stasis is if there is internal bleeding, where the blood is now outside of the vessels. One easy-to-understand example would be a bruise that forms when you have been hit, or have some sort of a trauma, and you get a bruise. Well, that purple, blue-purple. Red, blue, purple process, yellow included, that occurs with a bruise. It's literally Blood stagnation, where the blood has gotten outside of the vessel, it's not in the vessel anymore, and so that's called blood stagnation. Blood stagnation can also show up in the menstrual cycle, when a woman is forming excess clots. Having clots in your menstrual blood is not uncommon, but there can be a lot of clots, there can be big clots, and you're going to want to treat that as Blood stagnation. And again, you would use herbs that move Blood or break Blood stasis in order to treat that.
One of the problems with the way TCM education is delivered is that you tend to focus on Blood as being red blood cells. And on gynecology. Because that's the most common way that you run into it, and I think the understanding that there's a lot more to Blood is important to take in. And, you know, in the beginning, I had no concept of this at all until I’d have patients come in who had conditions that required a deeper understanding of how the Blood is. The role that blood plays in your overall health, not just your red blood cells and your anemia and what have you, or your gynecological problems.
Especially since the immune system is closely related to Blood. There's an error that occurs. I was told this when I was in school. Your Wei Qi is your immune system. Boom. End of story. And that is patently untrue. Your immune system, the Wei Qi, is the barrier Qi, the barrier immune system. It is your sinuses, your nasal passages, you know, the hair in your nose. These are all part of the Wei Qi. It's how you fend off external pathogens getting in.
But the immune system that occurs once it's past the Wei Qi, when it's in the Qi level, or the Blood level, that's a whole different immunity that we don't really address, and that's closely related to Blood.
YL: That makes sense. And there's no name for that part, like, if we say Wei Qi, or Zheng Qi.
SS: It's a part of the righteous Qi. The Qi that allows your body to function. It's not just fending off external pathogens, because as we know, the disease process can go through the levels, and we don't have a name that's comparable to Wei Qi for how the immune system is engaged at different levels. We don't think of it that way. We don't think of the immune system as being involved, but the white blood cells that are in the blood are, that's how the immune system fights disease once it's past the barrier.
The other part of the Wei Qi is skin. Skin is a part of the Wei Qi. If you break the skin and you get a staph infection, that staph infection is no longer in the Wei Qi. It's in the body now, connected to the Blood, and that staph can now flow to different tissues, and the staph infection, or strep, can damage other organs, just because it broke through the barrier. Broke through the Wei Qi.
YL: So, does TCM have a concept of autoimmune diseases? How would it define or describe autoimmune?
SS: No, no. So, autoimmune is a relatively new idea, and some day I'm going to seek out a competent immunologist, because I don't like it. I don't like this idea that your immune system has gone crazy and it's attacking your healthy tissues. That's disingenuous. Because it's not attacking your healthy tissues. It's attacking a specific thing. A particular tissue or organ. If the immune system has gone crazy, why isn't it attacking everything?
YL: Right. That makes sense.
SS: And my opinion is that, for instance, my friend I've talked to you about before who has the anti-MAG peripheral neuropathy. His immune system is attacking the Schwann cells that create the myelin around the nerves in his peripheral nerves. It's similar to MS. But MS attacks the myelin in the central nervous system. So, why is it attacking his peripheral nervous system and not his central nervous system?
Well, it's because, in my opinion, my theory, is that those cells are expressing this myelin-associated glycoprotein. It expresses it through the membrane of the Schwann cell, and it kind of dangles out there in the bloodstream. And the immune system comes along, and it's checking on everything, hey you're okay, you're okay, you're okay. Wait a minute, what's this? This is the wrong protein. It's damaged in some way. And maybe it's damaged because, what I was talking about earlier, some amino acid was not available when it was making that protein inside that cell. So, it makes the protein, but it's broken, and the protein gets expressed, the immune system comes along and says, oh, this is wrong. I should kill this cell. This is the killer T cell. I should kill this cell so that the other Schwann cells nearby here will make the correct protein and make the correct myelin.
And so, that's what's happening there. Unfortunately, if it's encoded in the DNA or the RNA of those cells, when it replicates, it replicates the broken thing, and it winds up creating another cell with a broken protein, and therefore, it continues, and now you have a disease of the immune system? No. It's the disease of that myelin-associated glycoprotein.
YL: And so, from a TCM standpoint, how would your friend be diagnosed?
SS: I'm not sure that I was able to come up with a TCM diagnosis for him. The way it would get described perhaps as Yin Deficiency, because there is a problem with his structure, his Yin, his cells. And simply Tonifying the Yin won't touch it.
YL: Right, right.
SS: Because it's a specific thing. And that's why I don't like saying it's autoimmune, because it's not specific enough. You know, it's a general idea, autoimmune, the immune system has gone crazy. Well, yeah, but why that? Why that particular problem? So, yeah, I think that it's wrong-headed to think of it that way, and the way it gets treated in Western medicine is they suppress the T cells. So, if I have killer T cells that are attacking a tissue, I have a way of killing those T cells. And so I do, and the idea is that, that problem is gone.
The problem really hasn't gone, but the body's way of cleaning up the problem is now dysfunctional. And the side effects are now the person is susceptible to other diseases, because their immune system does not function the way it's supposed to. Why? Because we've knocked down the number of killer T cells available to fight the disease. The problem is that we have not been able to get inside of the cells and fix broken pieces of DNA and RNA. We depend on the body's innate ability, because there are repair mechanisms inside of the cells that repair DNA and RNA, and maybe that gene is what's broken.
YL: Oh, that makes sense. But let's pretend this is semi-ancient China. You don't have this Western diagnosis. But if you were just evaluating him according to the 8 principles, what would your diagnosis have been then?
SS: Well, the diagnosis is, the doctor said you're gonna die. Because when my friend went to a neurologist, he did all these conductive tests of the nerves and so on like that, and based upon his experience with neurology, the doctor says, what's going on here for you is you have this anti-mag peripheral neuropathy. Well, there's no way to know that in ancient China.
So my friend said, well, what am I going to do about it? The doctor says, hopefully by suppressing the T cells, we can slow the progression, but I'm gonna be honest with you, the prognosis is you'll be in a wheelchair in 6 months. So, my friend discovered what was happening, and that he had no drugs, really, other than some heavy-hitting drug that’s going to kill T cells, and the side effects were you're more susceptible to disease, and all it's going to do is slow the progression. And so, if that's the case, if that were to happen in ancient China, and this person, who was a hardy person, who worked in the fields, went on hikes, went gathering herbs and flowers and things that my friend used to do, started stumbling. And he stumbled, and they would give him a stick. Or a crutch. And eventually, he wouldn't be able to walk. And then he wouldn't be able to use his hands because the peripheral neuropathy was starting to occur in his hands, and he no longer could hold anything. All of these things have happened to my friend. But because of the herbs that I gave him, he took these herbs for about 3 years. It arrested the progression. So, he is actually not in, as bad a shape as his doctor thought he would be. But he's still in bad shape. He can't walk without two ski poles to hold him up and keep him from falling over. He walks like Frankenstein, like clomp, clomp, clomp, and he cannot hold a spoon. And to drink out of a cup, he has to use two hands and hold it like this to drink. [Holds hands out like a cup is between them.]
And so, what would have happened to that person in ancient China? You know, they would have been placed in a chair on a porch under shelter, and they would have died.
YL: Hmm, let's just say this person was wealthy. And then they got some high-level TCM physician to look at them. Would it have been Wind?
SS: Wind. They would have called it Wind. They would have tried – “Was it due to blood deficiency”? Well, that would have been wise to think of it as due to Blood deficiency, in my opinion. But they might have said it's Yang Rising causing Wind. Well, but it's not causing Wind up here, it's causing Wind in the peripheral. And so maybe they would have treated him for Blood deficiency. Blood deficiency caused Wind. Because all Yang Rising has underneath of it either Yin deficiency or Blood deficiency, they might have treated Blood deficiency. Whether it would have been successful or not, it might have depended upon what herbs were available locally.
And, you know, a lot of TCM developed literally out of trial and error. So, if you had sufficient cases of this, where you tried this and tried that, you write down what you did, maybe it worked, maybe it didn't, maybe you shared that with your students, and then they would come up with a similar case, they would try this and that and the other, and eventually, maybe they would have discovered a treatment that would have been effective.
I think Wind would have been the closest thing, especially now, because what is he experiencing now? Tremors. So, you definitely would have been Wind, which is a difficult thing to treat, frankly. Even today with TCM, for Parkinson's, there's no clear path on how you treat that. You try various things, and you hope for the best.
YL: It's interesting that so many of these things really are because of Blood, like you're saying.
SS: Well, it's because so many things are delivered to the tissue through blood. It's not simply amino acids, sugar, and fatty acids, and oxygen. It's not just that. There's all this other stuff that's in blood, that can become dysfunctional and have effects, and different tissues are gonna have different effects, and to me, it all comes back to Jing. That's why I think what's going on is there's something happening inside of those cells that caused the expression of this protein being defective.
YL: I enjoy how you blend the East and West.
SS: And I worked so many years in the hospital, and I thought I was going to become a medical doctor, and so I wouldn't say I'm an expert in Western medicine, but I've had enough exposure to it, and I have enough understanding of the scientific terms and everything. I know what they're trying to do. And they don't have all the answers by any stretch of the imagination, but the commonality is people with illness. And what's going on is that there is a language that is used.
So, you have elbow pain, or you have wrist pain, and they say, you have lateral epicondylitis. And the patient goes, oh, thank God, he knows what's wrong with me. And you go to a TCM doctor, and what they do is they listen to your symptoms you described in English, and they translate it into Chinese. So they say, you have Bi syndrome. Which one is correct?
And really, all they're doing is they're using the language of their medicine to reach an understanding within their paradigm that leads them to selecting treatment modalities that will correct this imbalance. Or not. Maybe it doesn't. You try, and it's based upon your limited knowledge and expertise and skill. And it's the same thing with Western medical doctors. That's why you always get a second opinion if somebody gives you a bad diagnosis.
Let me ask somebody else about this, because they may look at it from a different perspective. Go to a different kind of doctor, they're gonna say, oh, this is not a blood disease at all, this is a neurological disease. Well, okay, and maybe they've got a better approach because of that.
Yeah, so the reason I go back and forth is that it helps me to understand things if I can have a foot in both camps, because I don't think that the problem is different. I just think the approach is different, and which one is going to give me an insight that's going to be valuable to help this patient? I don't have to be right, I just have to be able to help the patient. That's my goal.
YL: This conversation's been super fun. I always learn so much. All right, thanks so much, Skye. Okay, take care. Bye. Bye.
