There are three factors affecting the blood humor production by liver:

1. hepatic equable heat (normal hepatic temperament),

2. proper and equable food and beverages from temperamental point of view, and

3. adequate maturation of Chylos by stomach.

These will make the body being fed and kept warm and moist.

From the perspective of Iranian traditional medicine, anemia is directly related to the liver and physical faculties.

Based on Iranian traditional medicine observations, the basic mechanism of anemia is nutritive faculty dysfunction. Therefore, anemia could be associated with both endogenous and exogenous factors classified below.

4.2.1. Food

Eating disorders may induce anemia based on their quality and quantity aspects. Malnutrition or taking unsuitable foods for blood humor may cause anemia.

4.2.2. Drugs and Toxins

Some drugs and toxins may cause body temperament to become cool or desiccated. This status prevents blood humor production and may cause anemia.

4.2.3. Blood Loss

Sometimes anemia is caused by bleedings such as menorrhagia, hemorrhoids bleedings, wet cupping, dysentery, etc.

4.2.4. Psychological Factors

Depression, horror and the like may interfere with blood humor production through nutritive faculty.

4.2.5. Gastric Disorders

Gastric disorders such as gastric intemperaments, inflammations, and digestive disorders may lead to disturb chylos production. This will make liver incapable of producing excellent blood humor and so anemia occurs.

4.2.6. Hepatic Diseases

Hepatic disorders are classified into two groups.

4.2.6.1. Hepatic Primary Diseases

Hepatic disorders such as intemperaments, inflammations, obstructions (Sodad), as well as liver asthenia can lead to hepatic dysfunction. Then anemia will happen as a result of imperfect blood humor production.

4.2.6.2. Hepatic Secondary Diseases

Many different factors influence a healthy liver; one of the most important factors is proper functioning of related organs.

Stomach, kidney, spleen, and gall bladder disorders affect the liver and may cause the most common secondary hepatic diseases, which lead to anemia. For instance, Jorjani mentioned in his book, Zakhireh Kharazmshahi: “people who suffers from congenital spleen enlargement, are susceptible to liver asthenia, which follows by ascites”.

Uterus, bowel, lung, and the like may interfere with the liver function but with less significance. For example, severe menstruation absorbs the blood from the liver and makes its temperament cold. On the other hand, amenorrhea may lead to abnormal blood humor production in the liver

By Yarjou S, Sadeghpour O, Nazem E, Emami AH.