Circulatory Disorders: the Yin and Yang

There is a saying in Chinese medicine:  Where there is free flow there is no pain.  Where there is pain there is no free flow.

Before pain happens there is a circulatory disturbance of qi or blood. The energetic movement of blood being propelled through the vessels is a manifestation of yang energy. The containment of blood within the vessels is a manifestation of the yin energy. Thus the balancing of both energetics is important for vitality and wellness.

Not only organic processes influence blood circulation. Emotions can also influence movement in the vessels and meridians. In Chinese medicine, it is believed that every emotion correlates with an organ, marked by a specific type of feeling, thought, and character. Emotions can even be seen, not just felt. Think of the purple or red face of an angry person. Fear can turn hair and complexion white or pale. The eyes can become dark with sorrow or grief.

It is easy to see the effects of emotions on the surface, and maybe not as easy to discern the effects on our bodies. Whether excess of deficient, emotional health requires healthy expression of the all of our emotions. These are joy, anger, grief, worry, and fear.

The physician Xu Chunfu 徐春甫 (1520–96) was one of the earliest physicians to openly recognize that stagnation, or constraint, could be correlated to unhealthy emotional states, which had the effect of knotting up the flow of blood, qi, and bodily fluids. He was noted to say that “constraint is a disorder of the seven emotions. Therefore, eight or nine out of ten patients suffer from it. … Chronic constraint manifests in innumerable types of disease” (Xu Chunfu, 1557, p.211).

Stagnation of Qi and Blood

As a clinician it is vital to differentiate between qi and blood stagnation. Qi stagnation is milder, with pain that comes and goes like the wind, and may involve other intermittent symptoms like itching, cramping, or shaking/tremors.

Sometimes this pain is odd as if there is something stuck inside the tissues or muscles, or may simply feel full and distended. The lump in the throat feeling is an example. This is also a type of qi stagnation.

One 17th century physician, Ye Tianshi, elucidated on this phenomenon of feeling a type of discomfort but no palpable change in tissues, by saying “stagnation, whether present in the body or the organ systems must have visible manifestations of tension. Qi by its nature has no form but in the course of constraint the qi gathers together. This gathering together makes it appear to possess a form even if in reality it has no material substance” (Ye Tianshi, 1999, 1776, p.173).

When qi stagnation goes unresolved, it often transforms into blood stagnation, a worser condition. Blood stagnation is marked by pain that is more severe and takes on the characteristics of stabbing, cramping, and deep tension. Migraine is an example of blood stagnation, where as a tension headache is akin to qi stagnation.

In the case of blood stagnation, there may be a palpable mass or constriction of the tissues, since blood is a substance and when qi stagnation transforms into blood stagnation, the tissues can become congested, tight, and even inflamed.

Herbs and acupuncture are prescribed according to channels and organs, and a treatment plan is then formulated that will help to resolve and move the qi and/or blood. These issues are often not that easy to diagnose, yet when successful the outcomes can be very successful.


Xu Chunfu 徐春甫, Systematic Great Compendium of Medicine Past and Present (古今醫統大全) (Beijing: Kexue chubanshe, 1557), p.211.

Ye Tianshi 葉天士, “Linzheng Zhinan Yi’an 臨證指南醫案 (A Compass of Clinical Patterns Based on Case Histories],” in Huang Yingzhi 黃英志 (ed.), Ye Tianshi yixue quanshu 葉天士醫學全書 (The Complete Medical Works of Ye Tianshi) (Beijing: Zhongguo zhongyiyao chubanshe, 1999, 1766), p.173.