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Explaining the Four Substances in Chinese Medicine

Explaining the Four Substances in Chinese Medicine

I talk often about the importance of balance in Chinese medicine.

But what, specifically, are we trying to balance? You’ll hear me frequently tossing around terms like Qi stagnation, Qi deficiency, blood deficiency, yin deficiency. What exactly do all these mean?  

Enter what we call the four substances. In Chinese medicine, the four substances power your body by working together. When one of them is out of whack, it will affect the rest. The four substances are Qi, blood, yin and yang.

Everyone has these four substances flowing through their bodies. In perfect health, all four are in perfect balance and flow. But when there’s an issue, blockages and deficiencies of one or some of the four substances occur and manifest in various physical symptoms.

That’s where the idea of imbalance — and the impact it has on the body — comes in. I’ll compare it to an accident that causes a traffic jam. Think about your morning commute when there’s an accident on the highway, and everything gets backed up. When there is an imbalance and your energy flow is stuck, that’s when you’re going to experience problems. Everything becomes stuck, slow-moving and comes to standstill.

Practically, what does that mean with the four substances? Certain imbalances, often referred to as patterns, emerge, and they’re often interconnected. You will tend to have a primary, or dominant, pattern, and secondary ones that are interrelated. So even though you may strongly present with symptoms from one pattern, it doesn’t mean that’s the only pattern you should address.

I’ll dive a little deeper into what the four substances are, as they’re the foundation of understanding Chinese medicine, and what certain patterns can look like.


First, there’s Qi. You’ll hear me talk about Qi A LOT. It’s the vital energy that flows through the body.  Qi can become stuck or deficient. Blood can become stuck or deficient as well. Blood stagnation, however, is usually secondary to another imbalance somewhere. For instance, if your Qi is really stuck, that sometimes causes blood stagnation.

Some typical symptoms that can be experienced with Qi patterns:

Qi stagnation: moodiness, irritability, anger, PMS, bloating, ovulation irregularities, constipation

Qi deficiency:  digestive issues (bloating, burping, loose stools, heartburn), low energy, mid-cycle spotting, weight gain, low sperm motility


Blood nourishes the organs. As I mentioned, blood stagnation is generally secondary to a Qi pattern, so it’s important to take into account all physical symptoms so we as practitioners can figure out where blood stagnation is coming from.

Then there’s blood deficiency. It’s important to note that there are varying degrees of deficiencies, and when I say “blood deficiency,” it doesn’t literally mean you that don’t have enough blood in your body. As for all patterns, you can be kind of blood deficient or very blood deficient.

Some typical blood deficiency symptoms: very cold hands and feet, anxiety, insomnia, very light menstrual flow, constipation


Finally, there are the yin and yang energies. Yin energy interconnects with the yang energy. It’s the more feminine energy, and yang energy is more masculine.

The yin and yang energetics usually become deficient, never in excess. That’s because yin and yang energetics are stored in the kidneys and are always finite in quantity. They are the “savings bank,” or reservoir, for the kidney energy that governs reproduction.

Yin deficiency symptoms: night sweats, hot flashes, hair loss, dry skin, early ovulation, egg quality issues, low sperm count

Yang deficiency symptoms: extreme cold, paleness, chronic diarrhea with undigested foods, recurrent miscarriages, low sex drive, impotence in men

Various patterns play into fertility issues. And there’s hope! From a Chinese medicine perspective, there are always answers as to why someone is struggling to conceive. Even if you have been previously diagnosed with unexplained infertility, there is an explanation and there are answers.  

That’s why I love this medicine: We can identify where your energy is blocked and what your patterns are. And after we resolve those imbalances and remove the blockages, that’s when pregnancy becomes so easily achievable.

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