A Nutritional-Psychiatry and Biochemical Consideration of "Ki-Ketsu-Sui" (Qi, Blood, and Fluid) Patterns in Kampo Medicine: Examining Six Patterns

Abstract

Background: Psychiatric pathophysiology increasingly appears to involve systemic energy-metabolism ab normalities, chronic low-grade inflammation, oxidative stress, and nutrient imbalances. Kampo has long or ganised mind-body disturbances as imbalances of qi, blood, and fluid (ki-ketsu-sui), framing somatic comp laints such as fatigue, low motivation, and hot flushes along an axis distinct from operational diagnostic cri teria. These patterns are semi-objectified through additive diagnostic scores, allowing each constituent sym ptom to be read through nutritional medicine and biochemistry.

Objective: This review maps six patterns, qi deficiency, qi stagnation, qi counterflow, blood deficiency, bl ood stasis, and fluid retention, and the symptoms constituting their diagnostic scores onto nutritional psych iatry and biochemistry, presenting the author’s working hypotheses and clarifying their relevance for multi disciplinary teams and the limits of the evidence.

Main Text: The author frames the principal mechanisms as working hypotheses. Qi deficiency reflects red uced mitochondrial adenosine triphosphate production; qi stagnation, chronic inflammation, a kynurenine-pathway shift, and reduced monoamine synthesis against stalled methylation metabolism; qi counterflow, s ympathetic overactivity and vasomotor dysregulation, with possible reactive hypoglycaemia and catechola mine involvement; blood deficiency, declining tissue function from depletion of iron and protein; blood sta sis, microcirculatory impairment with suggested endothelial dysfunction, oxidative stress, and chronic low-grade inflammation; and fluid retention, abnormal fluid distribution and interstitial accumulation with poss ible hypoproteinaemia and membrane-transport involvement. Methylation stagnation is proposed as a shar ed hub, whereby functional qi stagnation may progress to circulatory blood stasis and utilisation-type bloo d deficiency. Diagnostic scores, assessment items, foods, and combination patterns are tabulated.

Conclusion: These correspondences are not established criteria but working hypotheses requiring validatio n; they nonetheless offer a shared language for assessing physical signs and considering individualised corr ection of deficiencies such as iron, B vitamins, and protein. In moderate-to-severe depression or where suic idal ideation is present, pharmacotherapy and psychotherapy take priority, and nutritional measures remain adjunctive to standard psychiatric care.