Today, we continue discussing the basic pathogenesis of Qi in the human body, following yesterday’s discussion on Qi deficiency. Today, we will focus on Qi mechanism imbalance. The Qi mechanism in the human body is fundamentally characterized by the processes of rising, descending, entering, and exiting. Qi mechanism imbalance refers to an abnormal pathological state of Qi movement, and it is one of the most fundamental pathologies in the human body. The Huangdi Neijing (Yellow Emperor’s Inner Canon) states that all diseases arise from Qi, and the scope of Qi mechanism imbalance is very broad, which can be summarized into four categories: Qi stagnation, Qi disorder, Qi obstruction, and Qi collapse. Let us discuss each of these categories.
First, Qi stagnation (Qi zhi). This refers to a pathological state where the movement of Qi is obstructed or stagnant. In milder cases, the speed of Qi movement is slower than normal, while in more severe cases, Qi movement may come to a complete standstill. Qi stagnation is also known as Qi depression (Qi yu) or simply depression (yu). It is important to distinguish that Qi stagnation generally refers to any condition where Qi movement is hindered and accumulates, while Qi depression specifically refers to Qi stagnation caused by emotional distress, particularly when the liver fails to perform its normal function of smooth flow and regulation. Qi depression is a type of Qi stagnation.There are several causes of Qi stagnation:
1. Emotional repression leading to the obstruction of organ Qi, such as when sorrow and worry cause Qi to become blocked and stagnant.
2. External pathogenic factors such as phlegm, blood stasis, dampness, food accumulation, and parasitic toxins obstructing the organs and meridians, leading to Qi stagnation and illness. For example, water retention can obstruct lung Qi, while abdominal distension can result from dietary indiscretion leading to Qi stagnation in the abdomen.
3. External pathogens from the six excesses invading the body and obstructing lung Qi. For instance, as mentioned in the Suwen (Plain Questions), cold can close the pores, preventing Qi from moving, resulting in Qi accumulation.
4. Qi deficiency leading to insufficient Qi movement, resulting in Qi stagnation. For example, the Suwen discusses that overexertion can lead to a decline in Qi, causing the middle burner (zhong jiao) to be obstructed, which can lead to Qi stagnation in the stomach. The main symptoms of Qi stagnation include distension, fullness, pain in the affected area, and symptoms that may vary in intensity and frequency. Different organs and meridians may exhibit different symptoms based on the location and functional impairment of the Qi stagnation. For instance, stomach distension may present with abdominal fullness, stomach pain, foul breath, and constipation, while gallbladder distension may present with rib pain, bitter taste in the mouth, and a tendency to sigh.
Qi is the driving force and commander of blood and body fluids; therefore, Qi stagnation can often lead to blood stasis or fluid accumulation, resulting in conditions such as blood stasis, phlegm, and dampness. For example, extreme anger can lead to Qi stagnation, causing blood stasis in the head, which may result in fainting. This is often depicted in media as someone fainting due to Qi obstruction. Additionally, stagnation in the Sanjiao (Triple Burner) can lead to fluid accumulation and edema.
Second, Qi disorder (Qi luan). This term refers to the chaotic movement of Qi, indicating that the direction and location of Qi movement are abnormal or reversed. Qi disorder manifests in various complex forms but can generally be summarized by the disruption of the normal processes of rising, descending, entering, and exiting. In the Huangdi Neijing, Qi disorder is described as the abnormal rise and fall of Yin and Yang, clear and turbid Qi, and the chaotic movement of Qi in the organs and meridians. The main manifestations of organ Qi disorder include the abnormal rise and fall of Qi, which can be categorized into Qi counterflow and Qi sinking.
Qi counterflow (Qi ni) refers to pathological changes caused by excessive upward movement or insufficient downward movement of Qi. Each organ has its physiological characteristics, and thus its pathological rules. For example, under normal conditions, the lungs descend while the liver ascends, the heart descends while the kidneys ascend, and the stomach descends while the spleen ascends. In pathological conditions, the lungs, heart, and stomach may fail to descend properly, leading to counterflow, while the Qi of the liver and kidneys may rise excessively, causing disease.
Qi sinking (Qi xian) refers to a pathological state where Qi descends excessively or fails to rise adequately. Qi sinking generally occurs on the basis of Qi deficiency, or it can be seen as a specific manifestation of Qi deficiency. Although Qi sinking can occur in any organ, it is most commonly seen in the spleen and kidneys.
Third, Qi obstruction (Qi bi) refers to a severe pathological state where the Qi mechanism is completely blocked or obstructed in important organs. In fact, Qi obstruction occurs when conditions such as Qi stagnation or Qi disorder develop to a severe degree, leading to significant impairment of life activities. Common symptoms include loss of consciousness, respiratory distress, inability to urinate or defecate, and cold extremities. This condition is critical and requires immediate life-saving intervention; otherwise, it can be fatal.
Fourth, Qi collapse (Qi tuo) refers to an extreme state of Qi deficiency, bordering on the complete loss of Qi, also known as collapse. This is a critical condition that typically occurs in the late stages of severe illness or just before death, where Qi, blood, and body fluids are unable to maintain their integrity, leading to significant loss and depletion. The body’s vital functions are at risk of failure. Since Yang Qi and Yin essence are interdependent and transform into each other, during Qi collapse, excessive depletion and loss of vital energy often present with symptoms such as profuse sweating, vomiting, diarrhea, and severe bleeding. Therefore, it is said that Qi can escape with blood and body fluids. The specific symptoms of Qi collapse include pale complexion, profuse sweating, cold extremities, dizziness, fainting, inability to close the mouth, weakness in maintaining posture, complete body weakness, incontinence, inability to speak, and a pulse that is faint to the point of being nearly absent. Previously discussed symptoms of loss of Yin and Yang, such as profuse sweating and fainting, also belong to the category of Qi collapse. In summary, regardless of the involvement of Qi, blood, organs, or meridians, any extreme decline in Qi can lead to severe conditions of Qi collapse.