[00:00:00] Welcome to Chinese Medicine in the modern world, a space where ancient wisdom meets today's most complex health challenges. I am Dr. Kelly Smick. Join us as we explore holistic dermatology, chronic inflammation, and root cause healing through the lens of traditional Chinese medicine.

Hello and welcome back today we are gonna be talking about the concept of blood deficiency from a Chinese medicine standpoint and why this makes very real sense potentially for you and your life and health Overall,

Been in clinic for about 25 years, and over the time of working with people with chronic inflammatory conditions, I will see people that occasionally can't hold the change and when they can't hold it, we're always thinking [00:01:00] about why that is. And more often than not, it turns out to be something related to blood deficiency where there's this.

Hole in the bucket and the system cannot hold the change because there's a deficiency and the body just can't stay there. So when the healing's not holding, it's almost always blood deficiency and it is widely overlooked in both the allopathic and Chinese medicine models.

Chronic inflammatory and autoimmune disease, not only a driver of those diseases, but also can just lend itself to you feeling unwell overall. And for the first time in my life as an adult, I am now dealing with this over the past year and a half. And my goodness, it does not feel good. So I've gone down the rabbit hole myself, and I'm gonna talk about.

Practical ways that you can help [00:02:00] yourself out of this and help set yourself up for better wellness overall? So what is blood deficiency and what is it not really? And what are the distinguishing factors here that we need to consider?

Blood deficiency doesn't just mean that you anemic, and for many years this has been one of the cool things in Chinese medicine where we can pick up on symptom patterning. By our differential diagnostic process, looking at how you're feeling and kind of connect the dots of these different things that are going on with you without necessarily having the labs to back it up.

You might not be genuinely anemic, which means your hemoglobin levels are still okay, but you could be tanking in other ways. ferritin is. The marker of your iron stores, and there was a body of research that came out of Korea a few years ago [00:03:00] that showed your ferritin actually needs to be above 70 to do things like regrow hair to.

Lend itself to dealing with non-emergency functions in the body. Hair is a luxury. In Chinese medicine, we say having long, luscious, flowing hair is a sign of surplus chi and blood. And if you're losing too much of it, your hair can have this more withered appearance or it can be falling out kind of specifically in the temporal region.

And my hairdresser was actually the first one to point this out to me. And say, oh yeah, no, this one, it's happening just specifically right here. That usually is something to do with anemia. And then while I went and got labs and no, you're not anemic, your hemoglobin's fine. And I've never traditionally had a problem with my ferritin, which has always been up around a hundred.

And lo and behold, over time, my [00:04:00] ferritin levels were starting to tank and I was having all of these other. You know, quote unquote non-specific symptoms of general malaise and fatigue. in Chinese medicine we know that the blood nourishes the tissues. It moistens the skin and the hair and the joints.

You can have creaky joints and dry skin and brittle hair and nails. it also anchors the nervous system. In Chinese medicine, we say blood anchors the sheen. Which is like our spirit, and there's some auto emotional implications here. So if you're just kind of anxious and overthinking all the time, we can say this is spleen G deficiency, heart blood deficiency.

It has a hand in regulating the immune system and supporting hormone signaling. So. We can clear the inflammation all day long, which is always my first order of business with people who come into me that have chronic inflammatory [00:05:00] conditions. We work on pathogenic load, but if the blood is too weak to hold the changes, you're just more likely to get sick more often.

You still feel wiped out and we need to go in and shore up that piece.

So we can do all of this great work. Somebody comes in to see me and they've got psoriasis or asthma or any number of autoimmune, chronic inflammatory conditions, and we always look to what we call, take people through a period of sort of draining and clearing and backing off the things that are pushing on the immune system Really.

Clearing the decks, I call it. But if there's blood deficiency at play, you're more likely to just kind of relapse and rebound and go back to not feeling well. And if we don't adequately address this next piece of dealing with the blood deficiency, then you just kind of go back out into the world a little better than when we left you.

And this is one of my favorite things about. [00:06:00] The approach, at least kind of the school of thought I've been trained in from a Chinese medicine lens We don't just suppress inflammation, we don't just push it down. We don't just give people anti-inflammatory things. We're looking at where's the inflammation coming from in the first place?

How can we unburden the immune system? How can we get these triggers out of the way to the extent that we're able and then have the immune system off and doing its job so we clear first. Then often we do some recalibrating where we work on the gut. Clear rebalance. And then at the end, if and when necessary, we will go in and tonify this process of tonification, sort of bolsters people and strengthens up the system That leaves you less likely to experience a relapse of these types of things.

And there can be a number of different deficiencies at play, which become more pronounced with age, but blood deficiency is. A very [00:07:00] big piece, and it certainly is a big player when we're treating chronic inflammatory skin diseases. Something like psoriasis, for example, can burn hot for years and years and years, and we can clear and clear and clear and clear.

And It's still stubborn, but over time it kind of quote unquote, burns itself out. So blood deficiency, even if it's part of the picture, isn't usually. Top of mind or first priority when we're looking at treating, it usually comes in a little bit later in the game, a little further down the line.

Once the inflammatory things are a bit more under control, then we go in and nourish the blood. Sometimes they need to be done concurrently, but more often than not, when we're addressing an aspect of blood deficiency, it's at a later stage of treatment or it's in more elderly people. And this is especially true with [00:08:00] women when you approach middle age and your sort of perimenopausal, at least a piece of perimenopause is the fact that a woman that's not put on birth control that has been menstruating regularly every month for her entire life since puberty, has at some point lost a certain amount of blood

Creates problems hormonally from a semi emotional standpoint, certainly from a skin health standpoint, and that needs to be shored up. also concurrently in more elderly people, nourishing and keeping that blood healthy and robust can have them looking more vibrant and glowy. The Chinese medicine concept of blood deficiency is so interesting to me, and I'm always struck by how. The people over [00:09:00] history that came up with the concepts in Chinese medicine just nailed it and how it makes so much sense in the real world and how we're able to make sense of all of these kind of, you know, non-specific symptoms.

People can't seem to make sense out of and point at. A pattern that shows up with different involvement of different organ systems and that there are formulas that can help address these imbalances. So for example, liver blood deficiency is a common pattern in Chinese medicine, and this is gonna show up like potentially weakened visual acuity.

Brittle nails and hair. They say the liver opens into the eyes and controls the nails, and then of course the tendons can feel weak and creaky. And tendons and ligaments are already tissues that don't have a lot of blood flow, so [00:10:00] don't heal particularly quickly. One of the. Old secrets to kung fu masters from China, and how they help people recover from these injuries that people would sustain was from promoting blood flow into tissues that weren't particularly vascular.

So very not interested in icing and constricting the blood flow, but once the acute inflammation is under control, making sure that blood flow is. Established and bolstered so that the tissues can heal so weak, creaky tendons, muscle tightness, and cramping. And in women, PMS, emotional, fragility, and irritability can all have something to do with the liver, blood being deficient.

Now all of the different organs in Chinese medicine have a different relationship to blood. And they say the liver is [00:11:00] the house of the blood. The liver stores the blood, so we know that the blood is being filtered in the liver consistently, and that The hormones are being metabolized and the liver.

The liver has thousands of different physiological functions, but the liver is the storehouse, and this is something that gets depleted over time. When your ferritin starts to tank, it's our storehouse, and when we replete ferritin by whatever means necessary, that it will shore up in the liver. So liver blood deficiency will also show up in our skin and, you know, looking pale or having more dry, flaky, scaly lesions, pale lesions rather than things that are very aggressively red and inflamed.

Then there's the heart. The heart is the master of the blood. It's responsible. Obviously it's the main. [00:12:00] Driver of our circulation. And if there is not enough blood coming from our system, we will have signs of what we call in Chinese medicine, heart blood deficiency. And this will show up like palpitations, anxiety, restlessness and insomnia.

A particular relationship with insomnia, actually heart blood deficiency. Insomnia is more this onset insomnia. It's difficulty falling asleep. We can't settle the she, the spirit can't settle into the body because there's not enough blood. And so there's this overthinking and the mind is going and you have difficulty settling at night.

Emotional vulnerability, quote unquote hypersensitivity, and a reduced sense of joy and safety in the world. The heart's responsible for joy from an emotional level. Then there's the spleen. We say the spleen makes the blood, [00:13:00] the spleen is generating the blood, so it's more spleen T deficiency than blood deficiency because spleens.

Generating the blood that the liver will store and the heart needs to circulate. So if the spleen is weak and the spleen has its own unique function from a Chinese medicine standpoint, that's a little bit in contrast to how we think of it in standard sort of Western physiology. But it's still lines up and makes good pragmatic sense at the end of the day.

When you have spleen sheet deficiency, you're gonna feel fatigued. You're gonna have brain fog. You're going to have weakened digestive capacity, poor focus, easy bruising, and nourishing the spleen is mostly a dietary issue.

So I've touched a little bit on how blood deficiency and its relationship with different organ [00:14:00] systems can impact the mind This is a hot topic for me. If I hadn't found my teacher and learned how to treat all these wild inflammatory diseases, I probably would've focused on mind body medicine, and I am struck over and over and over again.

You know how much people's mental health improves. Once you address whatever imbalances are present in the system and how Chinese medicine has a lens on this where the mind and body aren't separate, but everything is playing into each other, and rather than medicating things away and giving people anti-anxiety medication.

Where's this coming from? What's the real problem? And once that's sorted out and addressed, suddenly magically people don't have this issue anymore. People come into me all the time and they can be depressed or anxious or agitated or rageful and unable to self-regulate [00:15:00] in all manner of ways. And once you get them sorted out, they just feel so much better.

So blood deficiency is one of these things, and. It has such a huge impact on mental health. It's had a big impact on my mental health over the past year. My overall resilience, my feelings of general wellbeing and the big thing, there's a big pattern. We call it spleen and heart deficiency, spleen chi and heart blood deficiency.

There's actually a famous formula for it called ong, and it is designed to treat. overthinking from blood deficiency and it just makes. Such good sense. I say blood anchors the she in this concept of spirit and the body and the spirit is agitated and sort of floating and can't find a home in the system.

That can all sound very esoteric, but it makes good sense [00:16:00] once it has somewhere to rest. Once the system is nourished, overthinking and anxiety calms down and I'd say a good deal of, generalized anxiety disorder and. Chronic unrelenting insomnia and overthinking. in Chinese medicine that famous formula I just referenced is used to treat what they call student syndrome.

And I don't know how many of you have ever been a student, but my goodness, it's not that much fun. You're constantly overthinking. You constantly have a project on the go. You're using your mind constantly day in and day out. And they use this formula to help. nourish the blood, support the spleen, and help people get through periods of considerable mental strain.

So there's a big piece there. Overthinking worry is a big piece. and anxiety, I'd say are the big ones that can benefit from making sure that [00:17:00] you are not blood deficient so in talking about blood deficiency, we need to know why people become blood deficiency. What's happening in the real world here? Some of this Chinese medicine conceptual stuff can get a little lost in the sauce, but 100%, there are reasons these things are happening and then there are practical solutions to figuring it out.

So number one is absorption issues. If you have chronic inflammation in your gut, you are not going to be able to adequately absorb iron from your diet, even if your diet is rich in these types of things. So it doesn't mean that you're undereating, it means often that you're under absorbing and inflammatory conditions in the gut.

Dysbiosis. Permeability issues can all contribute to this.

Absorption issues are, [00:18:00] number one, if you're eating adequate iron, your diet isn't deficient and you still can't hold it.

We need to be looking at. chronic inflammatory gut issues, can be a major driver of these things. I've seen people that are celiac or have Crohn's and just flat out can't get it through your digestive tract, and you need to find another way and deal with the root cause. Number two is chronic stress.

We were just talking a little bit about this idea of student syndrome and our bodies will. Sequester iron in response to stress, we shift into defense mode and not repair mode. iron is sequestered and made unavailable by the body, and it's a protective immune response. The iron might be present in your body, but not accessible because you go into fight or flight and [00:19:00] not nourish and repair and rest.

From a Chinese medicine standpoint, they call it liver chi stagnation, which is indicative of like stress or depression and liver stagnation, impairs blood circulation. You think about. If you're really stressed out and you get cold hands and feet, there's different reasons. We can have cold hands and feet, but in response to stress, we will vasoconstrict and shunt blood away from our extremities in a attempt to deal with the really important things like the heart and the brain.

chronic inflammation in a hyperactive immune system is another big driver of this Chronic inflammation is gonna reduce iron absorption. So. People can come in if your ferritin's really low, but we, need to look for things potentially like high CRP, which [00:20:00] is C-reactive protein and other chronic inflammatory markers.

ESR is one erythrocyte sedimentation rate, can both be indicators that you have a lot of inflammation in your system and when your inflammation's really up, you're gonna have a more difficult time. Absorbing iron. So from a Chinese medicine lens, when we look at high inflammation, we're looking at heat.

And when we have too much heat, it's gonna drive an underlying deficiency. So you need to clear the heat first before the iron can come back online. And that works out in clinic for me because I'm dealing with chronic inflammatory conditions all the time.

More often than not, if people don't have one of these other issues at play, they'll just bounce back. And if there's a hole in the bucket for another reason, we need to boost that up. One of the biggest drivers is heavy or [00:21:00] prolonged menstrual bleeding, and if you are in middle age and have suddenly developed fibroids that you didn't deal with when you were a little younger, like myself, this is the big problem.

If you've lost too much blood that you're kind of past the point of no return, you might benefit from getting an iron infusion because oral supplementation isn't going to be enough to prop you back up. And that's the state that I got into. I'm like, why isn't it working? What's happening? I've always just bounced back.

Everything's cool. But now we're in a place where you are now losing more blood per month than your body can recover from within the appropriate time space. And getting your iron back up from an infusion can be a more effective way to go in the short term until you deal with the other drivers of heavy or prolonged menstruation.

Of course, fibroids and endometriosis aren't the only drivers of heavy inflammation or heavy menstruation. [00:22:00] You could have estrogen dominance, other issues with hormone regulation and Chinese medicine has awesome. Solutions for most of those issues. By the time a fibroid has gotten too big to deal with from an herbal perspective, you do need to seek out other interventions, whether it be surgical or there's some new frequency based treatments on the market.

The next one is overexertion and under recovery, if you are constantly pushing it, you will not be able to bounce back quickly. And we see a real world example of this when we think about women that do things like ultra marathoning where they lose their period, suddenly it's become a non-essential task for the body

You need time to recover. You need a certain amount of body fat. You can't just be driving yourself into the ground all the time and expect to have, healthy blood stores. [00:23:00] And the next one, which I also see a lot of in my clinic, is either acute or post viral illness conditions that I treat have some degree of latent bacterial or viral or even fungal or yeasty or moldy issues, and you can feel really wiped out and the body's busy trying to deal with this issue and it can't build up the stores.

So again, you would want to help deal with any active or latent pathogen that's in the way. Sometimes once that's gone, the system will bounce back on its own and sometimes it needs a little extra support. I wanna touch on diet a little bit here. people are not just anemic because they're, you know, vegan or undernourished.

There can be lots of things that are contributing to this. but in my experience. And in my clinical experience and personal experience, you do not need to be [00:24:00] eating steak to make sure that your levels are up. That's all I have to say about that. It's a whole episode. and then, yeah, getting into the formulas,

There are classic formulas in Chinese medicine to address different manifestations of blood deficiency. And there are many different herbs that we can use depending on exactly how this stuff is showing up. And the herbs, paired with diet and making sure your digestion's on point, you're not losing too much blood, are often.

adequate and can be pretty life changing for people. One of them, the most famous one is called ong. It means four substance decoction. It's got four different ingredients and it nourishes and regulates the blood. This is really good for dry skin, hair loss, dizziness, irregular menstruation, that is a result of blood deficiency and poor recovery.[00:25:00]

And there's another one that is called Ong, and this one is a very famous formula for women. It means eight treasure decoction. So it's Ong these first four substances, and then it's paired with other herbs that tify. Which means they are energy boosters. They work on spleen chi, which like we said before, is the thing that's generating the blood in the first place.

So we'll give you things to build the blood and then we'll start working on the organ that's responsible for building the blood. So it's like a double whammy. And this is a famous formula in China and it's given to a lot of women just. After their menstrual period to help them bring back and build up the stores.

People that give birth lose a lot of QE and blood, no matter if it's vaginal or C-section. And bringing those levels back up can help [00:26:00] combat a lot of what we know as postpartum depression. I'm sure there's a big hormonal shift and a drop, but often that Q and blood loss can leave people feeling really depleted and worn out.

So when blood deficiency signs exist with fatigue and a little bit of digestive weakness, we use this formula called bad genung. And we've already talked a little bit about EP tongue, which means restore the spleen, decoction, It's that famous formula for overthinking, worry, anxiety, heart palpitations.

This is spleen cheat and heart blood deficiency, overthinking, student syndrome, forgetfulness, insomnia, that type of thing. If it started to impact on that level, that formula's really, really quite. Profound and impactful for people. But again, you need to use it in the right circumstances, at the right dosage for the appropriate length of time, at the right time during the cycle.

It's just a [00:27:00] complicated deal.

How are you gonna deal with blood deficiency on your own at home? If you feel like you have some of these symptoms and you wanna get it checked out, I 100% recommend working with a qualified doctor of Chinese medicine. if you wanna go and get your labs done on your own, you wanna be getting a full blood panel.

You wanna get what's called a CBC and diff, and then you wanna be looking at your iron. And there's a number of different tests that can be relevant, but it's not just your hemoglobin. Your ferritin is also really important. You want it above a hundred. Ideally it needs to be above 70 to help you regrow your hair.

Make sure that you ask for those labs if you're not in a more acute or severe situation where you have excessive routine blood loss, which I think indicates getting an iron infusion. You can supplement orally. If you really [00:28:00] have a hole in your bucket, you might want to consider something like an infusion.

But if you're supplementing with iron, you make sure you're taking the proper dosage. I really like a product called Ferra Pro. Mary Ruth makes, an excellent vegan iron, and the idea is to take this, you can take the Mary Ruth stuff kind of every day. If you're taking a higher dose of oral iron, you wanna take it every other day to prevent your body from making too much hepcidin, which is a compound that your liver produces to prevent you from absorbing too much iron.

So the idea is that you. Take it every other night before bed. Take it with some vitamin C and amp up your store over time. Also, you know, the appropriate herbal formulas can be really helpful, and food alone is often insufficient. But you can cook in a cast iron pad.

You can get one of those little iron fish. Make sure [00:29:00] that you know. You can use chat GPT in Google to figure out what are the best vegetable sources of iron and things like adequate rest and stress management. Sleep and recovery are pretty non-negotiable when you're in a really depleted state. And I think a lot of the time we are dismissive over some of the more simple pillars of wellness.

And so, Sleep more o stress and. You know, if you're, if you are blood deficient and you're already stressed out and you're anxious and overthinking, how are you supposed to regulate your own mind? So it can be kind of a vicious cycle, but try to pay attention to allowing your body the time it needs to rest and recover both mentally and physically.

Blood rebuilding often takes more time than clearing, inflammatory things out of the system. We say it takes more time to build a house than to knock one down.

I wanna finish by [00:30:00] saying that blood deficiency is really important for the conditions that I treat for skin and allergies and autoimmunity, actually all chronic conditions. Like I said at the beginning, you're gonna have a tough time holding your results. Once we've got you kind of sorted out, if you've got this hole in your bucket, dear Liza, and.

You wanna shore up the flow, it's gonna help you feel better. It's gonna help you hold your results. It plays into your skin looking nice. If you wanna do it for the vanity, go ahead. Skin, hair and nails. Overall feelings of wellbeing, mental health, autoimmunity, allergies, the lot. really important piece.

If it's a piece for you, you need to get it addressed by someone who knows what they're doing.

Blood deficiency doesn't stop healing from starting. It stops healing from lasting.

i'm on a mission to try and help demystify this Chinese medicine [00:31:00] language and make it applicable for your day-to-day life. I hope you enjoyed Thanks for listening to Chinese Medicine in the Modern World with me, Dr. Kelly Smick. To learn more or explore working together, visit my website@drsmick.com and follow me on Instagram at Dr. Kelly Smick. Be well and I'll see you in the next episode.