The Three Treasures Newsletters
AUTUMN 2003
QI STAGNATION
This newsletter will discuss the aetiology, pathology, patterns
and treatment of Qi stagnation. Qi stagnation is one of the most
common pathological situations encountered in practice and this
newsletter is aimed partly at clarifying certain misconceptions
about Qi stagnation. The misconceptions regarding Qi stagnation
that I would like to expose are:
| • |
Qi stagnation is common but over-diagnosed |
| • |
Qi stagnation does not affect
the Liver only but many other organs |
| • |
Qi stagnation is often secondary to Liver-Blood deficiency
or a Kidney deficiency |
These three theses will be clear as the discussion
unfolds.
AETIOLOGY
The aetiological factors of Qi stagnation are
essentially only two, i.e. emotional or dietary.
EMOTIONS
Emotional stress is the major cause of Qi stagnation:
whatever the emotion, they all upset the proper flow of Qi in the
Qi mechanism and lead to Qi stagnation. In fact, Qi stagnation is
the first result of emotional stress on the body; after some time,
other pathogenic factors will gradually form, such as Fire, Phlegm-Fire
or Blood stasis. Each emotion has a certain effect on Qi (e.g sadness
depletes Qi, worry knots Qi, etc), but, after a short time they
all lead to some Qi stagnation, even those that deplete Qi.
Anger
The term "anger" should be interpreted
very broadly to include several other allied emotional states, such
as resentment, repressed anger, feeling aggrieved, frustration,
irritation, rage, indignation, animosity, or bitterness.
Any of these emotional states can affect the Liver, if they persist
for a long time, causing stagnation of Liver-Qi if the anger is
repressed or rising of Liver-Yang or blazing of Liver-Fire if the
anger is expressed.
Anger may affect also the Stomach (if one gets angry at meal times
or the Intestines (if one gets angry after meals).
Finally, anger, like all other emotions, also affects the Heart.
Worry
Worry knots Qi, which means that it causes stagnation
of Qi, and it affects both Lungs and Spleen.
Worry, like all other emotions, affects the Heart too and initially
it may cause stagnation of Qi of the Heart manifesting with sadness,
an uncomfortable sensation in the chest, palpitations; the Heart
pulse would feel very slightly Overflowing (compared to the other
positions).
Pensiveness
Pensiveness consists in brooding, constantly
thinking about certain events or people (even though not worrying),
nostalgic hankering after the past and generally thinking intensely
about life rather than living it. In extreme cases, pensiveness
leads to obsessive thoughts. In a different sense, pensiveness also
includes excessive mental work in the process of one's work or study.
Pensiveness affects the Spleen and, like worry, it knots Qi.
Sadness and Grief
Sadness includes the emotion of regret, as when
someone regrets a certain action or decision in the past and the
Mind is constantly turned towards that time. Sadness and grief affect
the Lungs and Heart. The Lungs govern Qi and sadness and grief deplete
Qi.
Although sadness and grief deplete Qi and therefore lead to deficiency
of Qi, they may also, after some time, lead to stagnation of Qi,
because the deficient Lung-and Heart-Qi fail to circulate properly
in the chest. This may cause symptoms of Qi stagnation in Lungs
and Heart such as an uncomfortable sensation of the chest, a slight
breathlessness, palpitations, a feeling of lump in the throat, and
a pulse that is very slightly Tight or Wiry on both cun positions.
Shock
Mental shock scatters Qi and affects Heart and
Kidneys. It causes a sudden depletion of Heart-Qi, makes the Heart
smaller and may lead to palpitations, breathlessness and insomnia.
It is often reflected in the pulse with a so-called "Moving"
quality, i.e. a pulse that is short, slippery, shaped like a bean,
rapid and gives the impression of vibrating as it pulsates.
Shock also "closes" the Heart or makes the Heart smaller.
This can be observed in a bluish tinge on the forehead and a Heart
pulse which is Tight and Fine.
Guilt
Guilt is an extremely common emotion and cause
of disease in the West. Guilt affects the Heart and Kidneys and
it causes Qi to stagnate. It may cause stagnation of Qi in the chest,
epigastrium, or abdomen.
PATHOLOGY
Qi stagnation is essentially a disruption of
the Qi mechanism (Qi Ji) which means that it does not affect only
the Liver but the Qi of any organ taking part in the Qi mechanism:
it therefore affects the whole body Qi mechanism. What is the Qi
mechanism? It is simply the flow of Qi in all organs of the body
and all cavities, joints, skin, muscles, Fat, Membranes, etc. Implicit
in the Qi mechanism is the flow of Qi in the proper direction in
each place or organ: the flow of Qi in and out of organs, in and
out of cavities, in and out of joints, in and out of the cou li,
in and out of the mo yuan membrane, from Exterior to Interior and
vice versa, etc. relies on a smooth flow and a flow in the right
direction: from this point of view, the Qi mechanism is like a vast
system of roads and motorways where traffic needs to be regulated
by one-way streets.
Two essential movements of Qi need to be coordinated: the ascending
and descending of Qi, and the entering and exiting of Qi. Thus,
each organ's Qi should flow in a certain direction to ensure the
smooth functioning of the Qi mechanism, as follows:
| I. |
Stomach-Qi flows downwards |
| II. |
Spleen-Qi flows upwards |
| III. |
Liver-Qi flows in all directions |
| IV. |
Lung-Qi flows downwards |
| V. |
Kidney-Qi flows downwards in some respect (sends turbid
fluids down, holds Qi down) and upwards in others (sends vapour
from fluids upwards to Lungs). |
| VI. |
Heart-Qi flows downwards |
| VII. |
Intestines-Qi flows downwards |
| VIII. |
Triple Burner Qi, like the Liver, also flows in all directions.
More specifically, the Upper Burner Qi flows upwards, the
Middle Burner Qi both upwards (to Lungs) and downwards (to
Intestines and Bladder/Kidneys), while the Lower Burner Qi
flows downwards |
Thus, the smooth movement of Qi in the Qi mechanism
relies on the proper ascending and descending of Qi in various organs
and structures and also entering and exiting of Qi in and out of
various structures, as outlined above.
The Triple Burner and Qi mechanism
The intricate movement of Qi in the Qi mechanism
and its influence on the fluids metabolism is closely dependant
on the Triple Burner which is also prone to Qi stagnation.
Together with Liver-Qi, the Triple Burner controls the smooth and
proper movement of Qi in all three Burners: in the Upper Burner,
Qi goes up and exits and is under control of the Lungs; in the Middle
Burner Qi goes up and down and in and out and is under the control
of Stomach and Spleen; in the Lower Burner, Qi mostly descends and
exits and is under the control of the Kidneys, Bladder and Intestines.
The Triple Burner assists all the other organs in their functions
an, in particular, it makes sure that all passages (of Qi or fluids)
are open, that the various types of Qi flow smoothly, that the Yuan
Qi emerges from between the Kidneys and assumes different forms
in different places, and that wastes are excreted smoothly. Because
of the Triple Burner's influence on Qi movement all over the body,
it, like the Liver, is easily prone to Qi stagnation and for this
reason, some of its points are important to move Qi (e.g. TB-6 Zhigou).
Stomach and Spleen as the axis
In the Qi mechanism and Triple Burner's passage-ways,
the Stomach and Spleen occupy a central place, they are the
central axis (Earth in the Centre), through which Qi passes on its
way up or down from or to the Upper and Lower Burner. Thus, the
ascending of Spleen-Qi and descending of Stomach-Qi are crucial
to the smooth and proper flow of Qi and therefore metabolism of
fluids too.
Liver and Lungs as outer wheel
The Liver and Lungs in coordination also
play a crucial role in the smooth and proper flow of Qi in the Qi
mechanism. If Stomach and Spleen are the centre, the axis, Liver
and Lungs are the outer wheel and they are also coordinated like
Stomach and Spleen are. The Liver is on the left (functionally,
not anatomically) and its Qi ascends, and the Lungs are on the right
and their Qi descends: the ascending of Liver-Qi on the left and
descending of Lung-Qi on the right, complements and integrates the
ascending and descending of Spleen-and Stomach-Qi in the centre.
The Heart and Kidneys as the root
Finally, the relationship and coordination between
Heart and Kidneys completes the picture of Qi transformation.
If the Stomach and Spleen are the axis and the Liver and Lungs the
outer wheel, the Heart and Kidneys are like the root, the vertical
axis along which Heart-Qi descends and Kidney-Qi ascends: this represent
the harmonious meeting of Fire (descending) and Water (ascending).
CONSEQUENCES OF QI STAGNATION
Qi is like a gas and when it stagnates, it is
compressed: this may generate Heat and lead to Fire (of the Liver
or Heart, usually), or it may eventually lead to Blood stasis. Since
the free-flow of Liver-Qi plays an important role in the fluid metabolism,
Qi stagnation may also lead to Dampness and eventually Phlegm. Hence,
the consequences of Qi stagnation are:
| I. |
Blood stasis |
| II. |
Heat |
| III. |
Dampness |
| IV. |
Phlegm |
CLINICAL MANIFESTATIONS
The general manifestations of Qi stagnation are
a feeling of distension; if there is pain, it is a pain accompanied
by a feeling of distension and moving from place to place; a fluctuation
of symptoms according to the emotional state, depression, moodiness,
irritability, gloominess; and sighing. There are the general manifestation
of Qi stagnation; others depend on the organ involved.
LIVER
Clinical manifestations:
a) Feeling of distension of hypochondrium or chest, sighing, hiccup.
b) Melancholy, depression, moodiness, fluctuation of moods.
c) Nausea, vomiting, epigastric pain and distension, belching, abdominal
distension, loose stools.
d) Unhappy, wound-up, a feeling of lump in the throat, difficulty
in swallowing.
e) Irregular periods, painful periods, pre-menstrual tension, breast
distension.
Tongue: tongue-body colour may not change: in severe cases,
it may be red on the sides.
Pulse: Wiry, especially on the left.
Although we normally talk about Liver-Qi stagnation and stagnant
Liver-Qi invading the Stomach or Spleen, we should differentiate
Liver-Qi stagnation (or depression) from Liver-Qi
rebelling horizontally: in the former case, the Liver has lost
its free-flow and Qi stagnates, it does not move properly and accumulates;
in the latter case, Liver-Qi is over-active and rebels horizontally
towards the Stomach and Spleen. Thus, in the case of Liver-Qi stagnation,
Liver-Qi is underactive and stagnating, in the case of Liver-Qi
rebelling, Liver-Qi is overactive.
The symptoms of Liver-Qi rebellious are a feeling of distension
in hypochondrium, epigastrium, chest, breasts in women, or abdomen.
It often invades the Stomach and Spleen preventing Stomach-Qi from
descending (causing nausea, hiccup, belching and vomiting) and Spleen-Qi
from ascending (causing loose stools). Liver-Qi rebellious may be
due to anger. The pulse is Wiry, which it may be only on the left.
The symptoms of Liver-Qi stagnation are very pronounced on
the mental-emotional level: depression, moodiness, gloominess, unhappiness,
despondency. On a physical level, there is also a feeling of distension
of the hypochondrium, chest, epigastrium or abdomen, but also a
feeling of oppression (men) in these areas. These symptoms are cause
by a lack of free flow of Liver-Qi and therefore its stagnation.
The pulse is also Wiry but it feels slightly different than the
Wiry pulse of Liver-Qi rebellious; it is Wiry but it also lacks
a wave and feels reluctant.
LIVER-QI STAGNATION
Treatment principle: Soothe the Liver,
move Qi, eliminate stagnation.
Three Treasures remedy:
i) Release Constraint
ii) Freeing Constraint (Women's Treasure)
iii) Break into a Smile
LIVER-QI REBELLIOUS
Treatment principle: Soothe the Liver,
move Qi, eliminate stasis, subdue rebellious Qi.
LIVER-QI STAGNATION WITH LIVER-BLOOD DEFICIENCY
Liver-Qi stagnation is often the result of Liver-Blood
deficiency. We can deduce this whenever a patient has clear symptoms
of Liver-Qi stagnation but the pulse is not Wiry and the tongue
is normal or even Pale. This is due to Liver-Blood failing to hold
Liver-Qi which stagnates. This is much more common in women: indeed,
in women, this situation is more the rule than the exception.
Treatment principle: Soothe the Liver, move Qi, eliminate
stagnation, nourish Liver-Blood.
Women's Treasure remedy: Freeing the Moon.
STOMACH
Qi stagnation in the Stomach is often caused
by rebellious Liver-Qi but it may also arise independently. The
aetiology is usually emotional problems at meal times, i.e. getting
angry at meal times or eating in a hurry, eating while worried and
under stress at work, going straight back to work after eating,
or even eating at one's desk while working, eating too fast, etc.
Clinical manifestations: Bad digestion, a feeling of fullness,
pain and distension of the epigastrium, belching, nausea. Tongue:
may not change. Pulse: Wiry or Tight on the right guan.
Treatment principle: Restore the descending of Stomach-Qi,
move Qi, eliminate stagnation, calm the Mind.
Three Treasures remedy: Open the Heart.
INTESTINES
This nearly always occurs with Liver-Qi and/or
Spleen-Qi stagnation and is due to dietary irregularity with stress.
Clinical manifestations: Abdominal distension, fullness and
pain, constipation with bitty stools.
Three Treasures remedy: Break into a Smile, Smooth Passage.
LUNGS
The Lungs are affected by worry and pensiveness
which knot Qi and lead to Qi stagnation. They are also affected
by sadness and grief which initially deplete Qi in the chest; after
some time, this will lead to Qi stagnation in the chest. Stagnation
of Lung-Qi in the chest (and throat where the Lung channel flows)
is an important pathogenic factor in several conditions: goitre,
plum-stone syndrome, some upper digestive problems (such as oesophagitis),
some respiratory problems such as breathlessness, some voice problems
such as hoarse voice, breast lumps and breast cancer.
Clinical manifestations: Sighing, slight breathlessness,
a feeling of tightness or oppression of the chest, a feeling of
lump in the throat, difficulty in swallowing (or a feeling of difficulty
of swallowing), sour regurgitation, belching, burning in the oesophagus
at night, depression, crying, sadness, easily affected by other
people's influence, a feeling of energy rising in the chest.
Tongue: unchanged. Pulse slightly Tight on the Lung position,
without wave if due to sadness.
Treatment principle: Resolve the descending of Lung-Qi, calm
the Mind and the Corporeal Soul (po).
Three Treasures remedy: Open the Heart.
HEART
Qi stagnation of the Heart occurs from emotional
problems such as sadness, worry and grief. However, since all emotions
affect the Heart, it is not surprising that any emotion may cause
Heart-Qi stagnation. This may also be due to shock or guilt.
Clinical manifestations: Palpitations, slight breathlessness,
a feeling of oppression and tightness under the heart region, sadness,
depression, anxiety, a vague mental restlessness, an uncomfortable
feeling in the throat from energy rising ("heart in throat"),
upper digestive problems (such as oesophagitis).
Tongue: slightly red tip. Pulse: slightly Overflowing or
Tight in Heart position (compared to other positions).
Treatment principle: Restore the descending of Heart-Qi,
calm the Mind, tonify the Heart.
Three Treasures remedy: Open the Heart.
Table 1. lists the main remedies for Qi stagnation.
| Remedy |
Pattern |
Disease |
Notes |
| Release Constraint |
Liver-Qi stagnation |
Depression |
The remedy for mental depression
from Qi stagnation |
| Freeing Constraint |
Liver-Qi stagnation |
Pre-menstrual syndrome |
Pre-menstrual syndrome of Full type from
Liver-Qi stagnation |
| Freeing the Moon |
Liver-Qi stagnation, Liver-Blood deficiency |
Pre-menstrual syndrome |
Pre-menstrual syndrome of Full/Empty
type |
| Free Flow |
Liver-Qi stagnation |
Painful periods |
|
| Free-Flowing Sea |
Liver-Qi stagnation, Liver-Blood deficiency,
Kidney deficiency |
Pre-menstrual syndrome |
Pre-menstrual syndrome of the Empty type |
| Break into a Smile |
Liver-Qi stagnation |
Abdominal pain |
The remedy for abdominal pain from Qi
stagnation |
| Freeing the Sun |
Liver-Qi stagnation, Liver-Heat |
Various |
|
| Smooth Passage |
Liver-Qi stagnation, Spleen-Qi
deficiency, Dampness in the Lower Burner |
Irritable bowel syndrome |
Lower Burner |
| Soothe the Centre |
Liver-Qi stagnation, Spleen-Qi
deficiency, Dampness in the Middle Burner |
Epigastric disturbance |
Middle Burner |
| Open the Heart |
Stagnation of Qi of the Lungs
and Heart |
Chest discomfort |
Chest |
|
Researched by Joanna Wyndham, B. Sc., Lic. Ac.
Written by Giovanni Maciocia
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