Steam off the rice: what Qi really is

Breath and grain

If you look at the character again, there are really two things living in it, the vapour and the rice, which is to say breath and food, and I don’t think this is a poetic accident at all, because Chinese medicine says that the Qi you run on every single day comes from exactly these two places.

There is the air you breathe in, which the Lungs gather in the chest, and there is the food you eat, which the Spleen and Stomach break down and lift up, and somewhere in the middle of you the two of them meet and become the Qi that carries you through an ordinary day, through the school run and the emails and the shopping and the long evening when you finally sit down.

The air itself has a name in the old texts, 大氣, da qi, which means something like the great Qi, the big Qi all around us, and it is still the everyday word for the atmosphere in Chinese today, so every time you breathe in you are taking a little of the great Qi of the sky and making it your own. (It is easy to mix it up with de qi, 得氣, which sounds almost the same but means something quite different: the dull, heavy, spreading feeling you sometimes get when an acupuncture needle finds its place.)

So when a woman sits in front of me and tells me she is exhausted, and has been exhausted for longer than she can remember, I usually ask about her breath and about her plate before I ask about almost anything else. Does she breathe all the way down into her belly, or only into the top of her chest, quick and shallow, as if she is always slightly in a hurry? Does she eat warm food, sitting at a table, or cold food standing at the kitchen counter, or nothing at all until three in the afternoon? The answers are very often half of the diagnosis already, before I have touched the pulse.

A conversation, not a fuel

In my book I describe Qi as something close to what we would now call the body’s signalling network, all the hormones and nerve impulses and chemical messengers, the whole quiet traffic that lets one part of the body know what is happening in another part, without either of them needing to think about it, and Qi is a kind of umbrella word for all of that conversation going on inside you all the time.

When it flows well, the messages arrive when they should. You feel hungry, and then you feel full. You feel tired at night and awake in the morning, more or less, and your period comes and goes without too much of a fight.

When it is blocked, something is trying to get through and it simply can’t, and you feel it as tension sitting under the ribs, or a headache that builds and builds through the afternoon, or an irritation that is completely out of proportion to the small thing that set it off. The message is there, it just can’t land.

And when it is deficient, there is not much left to send at all. The voice goes quieter, the hands and feet stay cold even in a warm room, and an ordinary flight of stairs starts to feel like a hill you would rather not climb.

You don’t need to believe in anything in particular to notice these things. Most of the women I see already know them very well in their own bodies, they just haven’t had a name for them.

One small word, many meanings

If you listen to Chinese being spoken for half an hour, you will hear Qi everywhere, hidden inside ordinary words, and I find this tells you more about what Qi means than any definition I could give you.

• 天氣, tiānqì: the weather, literally the Qi of the sky.
• 空氣, kōngqì: air, the Qi of empty space.
• 生氣, shēngqì: to be angry, literally to produce Qi, and anyone who has felt anger rise up from the belly into the face knows exactly why.
• 脾氣, píqì: temper, which is literally Spleen Qi, so when someone has a bad temper, in Chinese it is their Spleen that is speaking.
• 力氣, lìqi: physical strength, the Qi in your muscles.
• 運氣, yùnqi: luck, Qi that is moving your way.
• 客氣, kèqi: politeness, the careful Qi you keep for a guest.
• 氣味, qìwèi: smell, the Qi that travels from a thing to your nose.

And inside the body there are many kinds of Qi as well: Yuan Qi, the original Qi you were born with, Gu Qi, the Qi that comes from food, Zong Qi, the gathering Qi of the chest where breath and food meet, Ying Qi that nourishes from the inside, and Wei Qi that guards the surface of the body like a warm coat, plus the Qi of each organ, each with its own direction and its own job. It is one word, but it is never just one thing.

Gas that carries messages

Here is something that still makes me smile, as a former scientist. The character for Qi literally means gas, vapour, steam, and for a long time Western medicine thought that gases in the body were mostly passengers, oxygen coming in, carbon dioxide going out, and that was more or less the end of the story. Then, in the 1980s and 1990s, researchers found that our own cells make small amounts of gas on purpose, and use it to send messages.

These are called gasotransmitters, and there are three main ones that we know about so far: nitric oxide, carbon monoxide in tiny amounts, and hydrogen sulphide, the same gas that gives rotten eggs their smell. Unlike most hormones and nerve signals, which need special doors to get into a cell, these gases simply drift through the cell walls wherever they are needed, and they help to relax and open the blood vessels, calm or quicken nerves, and settle inflammation. The discovery that nitric oxide is a messenger in the blood vessels won a Nobel Prize in 1998, and it is one of the reasons I write in my book that some of the effects of acupuncture may be carried, at least in part, by this kind of quiet gas signalling around the needle.

But I don’t want to make Qi smaller than it is by saying it is nitric oxide, because it isn’t, or not only. Think of all the messengers the body uses, the hormones in the blood, the neurotransmitters jumping between nerves, the electrical impulses, the immune signals, the gases drifting through the tissues, and then think of the fact that all of them are always moving, always arriving and leaving and being answered. Qi, as I understand it after many years of putting my hands on people, is not any one of those messengers. It is the movement itself. It is the communicating, the whole living conversation, and not the words.

The commander and the mother

There is an old saying in Chinese medicine that I repeat to my clients more often than almost anything else: 氣為血之帥，血為氣之母, Qi is the commander of Blood, and Blood is the mother of Qi.

Qi is the commander because it is what makes Blood move, and what keeps it inside the vessels where it belongs, and what helps to make it in the first place, out of the food we eat. When Qi is weak, Blood moves sluggishly, hands and feet go cold, bruises appear from nowhere, periods can become heavy because there is not enough Qi to hold the Blood in. When Qi is stuck, Blood gets stuck behind it, and that is where a lot of the sharp, fixed, stabbing pains come from, the ones that sit in one place and don’t move.

And Blood is the mother of Qi, because Blood nourishes Qi and gives it somewhere to live, a kind of anchor. Without enough Blood, Qi has nothing to hold on to and it starts to float, and you feel it as anxiety that comes from nowhere, as a racing mind at three in the morning, as that strange feeling of being tired and wired at the same time, which so many of the women I see describe almost word for word.

What I love is how well this sits with what we know now. Blood quite literally carries gas. Every red blood cell is full of haemoglobin, which picks up oxygen in the lungs and lets it go in the tissues that need it most, and carries carbon dioxide back the other way, and the two gases even help each other to load and unload. So the mother carries the breath of the sky into every corner of the body, and the movement, the commanding, keeps her going round. The old doctors couldn’t see a red blood cell, but they understood the relationship very well.

Gathering and scattering

The old philosophers took it further than medicine. Zhang Zai, a thinker from the eleventh century whose ideas run quietly underneath a lot of my book, said that everything is Qi, the mountain and the river and the body and even the thought you are having right now, and that when Qi gathers, things take shape, and when it scatters again, they dissolve back into a great emptiness and, in time, become something else.

I find this surprisingly practical in the treatment room. A knot in the shoulder that has been there for years is, in a way, Qi that has gathered too tightly and forgotten how to let go. A tiredness that never really lifts, no matter how much you sleep, is Qi that has scattered too far and can’t find its way back. And treatment, whether it is with needles or with my hands or with herbs, is mostly about helping Qi gather where it is needed and loosen where it has got stuck.

The grass and the music

There is a second character I love very much, and it brings me to herbs. The character for medicine, in the sense of a remedy that you take, is 藥, pronounced yào, and at the top of it sits 艹, the sign for grass and plants, and underneath sits 樂, which means music. The same character, read a little differently, as lè, also means joy.

So you can read the word for medicine as plants placed on top of music, herbs resting over harmony, a remedy as the thing that brings the body back into tune and, if it goes well, back into some kind of joy.

I want to be honest with you about what the scholars say, because I spent fifteen years as a scientist before I came to this work and the habit doesn’t really leave you. In the oldest dictionary of Chinese characters, written almost two thousand years ago, 藥 is explained very plainly as a plant that cures illness, and the music part is listed as a hint for the sound of the word, how to say it, rather than for its meaning. A lot of Chinese characters are built like that, with one part for the sense and one part for the sound.

But Chinese writers have been noticing the music inside medicine for centuries, and I don’t think they were wrong to notice it, because a sound is never chosen in a completely empty room. The old classics speak about health as harmony, about the five organs as five notes, and about a good physician as someone who listens before anything else. And when I adjust a herbal formula every ten or twelve days, it really does feel a lot like tuning an instrument, one string is too tight, another has gone slack, and you listen, and you adjust, and then you listen again.

The modern simplified character, 药, has lost the music. The grass is still there on top, but 樂 has been replaced by a simpler sign for the sound. I am glad the old form still lives on in Hong Kong and Taiwan, and in the books I learned from.

What this means for you

You don’t need to learn a single Chinese character to get something from Chinese medicine, but I think it helps a little to know what it is we are actually listening for when you lie on the couch and I have my fingers on your wrists.

It is not a battery that is either full or empty. It is more like a conversation, and I am asking whether it is flowing, or stuck, or running thin. It is the steam off the rice, and I am asking whether there is enough breath and enough nourishment for it to rise. And it is music, and I am asking whether the whole body is playing more or less in tune, or whether one part has been straining over the rest for far too long.

When the Qi comes back, you usually feel it before anyone could measure anything. You breathe a little lower. You get hungry again, properly hungry. Something in the eyes switches back on. That, for me, is the sound of a body finding its own note again.