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Qì

气 〔氣〕qì

1. Air, gas, vapor, flatus (e.g., belching of putrid qì).

2. Smell.

3. Aura.

4. Environmental forces (e.g., cold; dampness; dryness, etc.)

5. Nature (e.g., the four qì).

6. Anything of a particular nature (e.g., yīn qì).

7. Breath. (e.g., scantness of breath and qì scantness).

8. Any of various dynamic phenomena of the body (e.g., source qì; provisioning qì; defense qì; bowel and visceral qì; channel qì) that are described in terms of the following functions:

  1. Movement: Qì is highly active; human growth and development, as well as all physiological activity and metabolism, are manifestations of the activity of qì. Qì also propels blood, fluid, and essence.
  2. Containment: Under normal circumstances, spillage of blood from the vessels is prevented by the containing function of qì. Hence it is said, Qì contains the blood. This function also prevents excessive loss of fluids through oversecretion of sweat and other fluids or excessive urination.
  3. Transformation: Production of blood and fluids, the distribution of fluids, and the conversion of fluids into sweat and urine are all the result of qì transformation. Implicit in this notion is the movement, or bearing, of qì. Qì bears upward, downward, inward and outward, carrying blood and fluids with it. Combinations of these four movements explain all movement in the body. See qì transformation.
  4. Defense: Qì is the outer defense of the body, and prevents evils from entering.
  5. Warming: The temperature of the human body and the ability of the organs and tissues to perform their functional activities are dependent on the warming action of qì.
  6. Nourishment: Provisioning qì provides nourishment for the body and is involved in the production of blood, which is the main nourishing substance.

9. Strength.

10. Anger.

11. Disease (e.g., leg qì, mounting qì), plum-pit qì.

12. An abbreviation for diseases of qì (qi vacuity, qì stagnation), as appearing in the terms qì block, qì constipation, qì fetus, qì tumor, qì cough, qì accumulation, qì vomiting.

Etymology

Chin 气 qì,mist and clouds, vapor, gas, smell, force. Ancient Chinese natural philosophers inspired by the notion that mist and clouds could change their form, appear from out of the air rapidly, disappear rapidly, or turn into rain, snow, and ice. From this observation, they posited that the whole universe was composed of a single substance, whose dense forms manifest as matter and whose intangible forms explain all movement and activity. They called this substance qì. Medical scholars adopted the notion of qì in their discourse, referring to solids and liquids in the body as yīn qì and that the intangible forces accounting for activity and movement as yáng qì. In medicine, the term qì has many meanings, not just the yáng qì of the body.

Pronunciation

The term is pronounced chee as in cheese, transcribed in Wade-Giles as ch’i, and sometimes written as ki and pronounced as the English key in the Japanese tradition.

Origins of qì

Given the many meanings of the word qì, readers are directed to the qì as the single element to gain a clearer grasp of the origins of the concept and its application in medicine.

Qì in Physiology

Qì (yáng qì) is the driving force of all movement and transformation in the body, its production, its general functions, as well as its various kinds and their specific functions.

Production of Qì

In general terms, the active qì of the body is said to be produced through a combination of the following:

The various types of qì differ in their sources, as will be explained in due course.

Functions of Qì

The functions of qì are to propel substances throughout the body; to retain blood and various fluids in the body and hold organs in their place; to transform food and air from the outside; to provide warmth and nourishment for the body; and to defend the body against invading evils.

Movement (推动 tuī dòng): Qì moves constantly and pervasively. Without pause, it flows through the bowels and viscera, the channels and network vessels, and the body’s various tissues so as to reach all parts of the body. Not only does it move itself, but it also propels blood and fluids. Furthermore, it carries food down the digestive tract; it controls the opening and closing of the bladder.

The ability of qì to move freely and the vigor with which it performs its functions are summed up in the term qì dynamic. There are four basic movements of qì: upward, downward, inward, and outward (discussed shortly). The qì of the viscera mostly bears upward and outward, while that of the bowels mostly bears downward.

The movement of qì is closely related to heart spirit and to emotional and mental states (affect-mind). Qì animates the spirit, and when heart qì is insufficient, there is lassitude of spirit. By moving the blood, qì ensures that the heart spirit is kept nourished. The flow of qì around the body is regulated by the free coursing action of the liver, which is closely related to affect-mind. Deficient free coursing may cause or be caused by mental depression, worry, grief, sorrow, and preoccupation. Individual affects are associated with specific irregularities in the movement of qì. These processes are summed up in Nèi Jīng the as follows:

Retention (固摄 gù shè): Qì contains itself within the body; it contains the blood and fluid; it holds the organs in place. Containment failure is associated with qì vacuity.

Qì transformation (气化 qì huà): Qì is responsible for all material changes that take place in the body. This function is traditionally referred to as qì transformation, the transformative action of qì. This is responsible for the following:

Qì transformation failure is mostly attributed to qì vacuity or the clogging effect of evils. It leads to pathologies of qì, blood, fluid, and essence.

Warming (温煦 wēn xǔ): Qì is responsible for maintaining the natural warmth of the body. The warming action of qì is indispensable for.

The warming power of qì is an essential prerequisite for the movement and transformation of substances in the body.

It should be noted that in pathology when yáng qì fails to perform its warming function, the pattern is classed as yáng vacuity. The term qì vacuity implies a breakdown in the other functions of qì.

Defense (防御 fáng yù): Defense qì is a specific form of qì that flows with lung qì out to the fleshy exterior of the body. It protects against invading evils from the exterior. Once evils invade, defense qì fights them, giving rise to heat effusion. Insufficiency of defense qì to ward off invading evils is often associated with lung qì vacuity.

Nourishment (营养 yíng yǎng): Qì is necessary for all the bowels and viscera and other parts of the body to perform their functions. Generally, only provisioning qì (see below) is accorded the function of nourishing. Provisioning qì flows through the channels and network vessels to provide nourishment for the whole body.

Classification of Qì

Different kinds of qì are labeled according to their origin, location, and function.

Original Qì

Original qì (元气 yuán qì) is the most basic qì of the body itself.

Origin: It is derived from the essential qì that is stored by the kidney. Hence, it has its root in the kidney. Yet since kidney essence is comprised of earlier heaven essence, which is continually nurtured by later heaven essence derived from food and from inhaled air, the production of original qì is associated not only with the kidney, but also with the spleen and lung.

Distribution: Original qì effuses outward via the triple burner and the channel system to reach the bowels and viscera and all other parts of the body. Nowhere does it fail to reach.

Function: Original qì has the dual function of powering human development and reproduction and stimulating the activity of the bowels and viscera, channels and network vessels.

Distinctions: Original qì is also referred to as source qì (原气 yuán qì) or true qì (真气 zhēn qì), although disagreement exists as to whether the three terms are exactly synonymous. Only true qì appears in the Nèi Jīng. In most texts, source qì and original qì are synonymous. In some texts, true qì is a generic term for all forms of qì that power the physiological activity of the body, and hence includes ancestral qì, provisioning qì, defense qì, etc. Such technicalities are of little or no consequence in diagnosis and therapy.

It is important to note that while in ancient philosophy original qì denoted the basic element of the universe, in medicine it denotes that yáng qì drives bodily activity.

Ancestral Qì

Ancestral qì (宗气 zōng qì) is the qì that accumulates in the chest. It powers respiration and the movement of blood.

Origin: It is derived from a combination of the clear qì inhaled by the lung and the essence of grain and water absorbed by the stomach and spleen. For this reason, some consider ancestral qì to be a combination of provisioning qì and defense qì.

Distribution: Ancestral qì concentrates in the upper sea of qì (上气海 shàng qì hǎi), or chest center (膻中 dàn zhōng). It also moves upward through the airways. By the power of the lung’s depurative downbearing action, it is carried downward to the cinnabar field (丹田 dān tián), which is also called the lower sea of qì (下气海 xià qì hǎi) to nourish the essential qì in the kidney. It also passes on downward to the qì street (气街 qì jiē) in the inguinal region and onward to the legs.

Functions: The functions of ancestral qì are as follows:

No medicinals are specifically said to supplement ancestral qì. Medicinals that supplement the heart and lung are used.

Provisioning Qì

Provisioning qì (营气 yíng qì) derives from the essence of grain and water extracted by the spleen and the clear qì inhaled by the lung. It flows alongside the blood inside the vessels, circulating through the twelve main channels as well as the controlling and governing vessels, thereby passing through all the bowels and viscera. Provisioning qì is considered to be yīn in nature, since it is believed to be a component of the blood. As a form of qì, it helps the production of blood. According to traditional theory, provisioning qì is believed to flow not only through the twelve channels but also through the governing (dū) and controlling (rèn) vessels.

Provisioning qì stands in complementary opposition to defense qì. While defense qì is yáng, provisioning qì is yīn and is sometimes referred to as provisioning yīn. Provisioning is supplemented with medicinals that supplement the blood.

Provisioning Qì

The original meaning of the Chinese term for provisioning refers to a military camp (营 yín g). In combination with defense, the terms form a metaphorical pair. Defense is the active function of an army; the camp signifies the support and supply system (food and weapons). In older texts, the term 荣 róng, literally meaning luxuriance, was synonymous with营 yíng.

Some people translate the term as nutrition, probably on the basis that 营养 yíng yǎng is the modern term for nutrition, although, in this term, the word 营 actually means to supply. However, the synonym 荣 róng provides some justification for this this translation.

The translation provisioning qì, suggested by Sabine Wilms, is closest to the original meaning and also covers the idea of nutrition. In Practical Dictionary of Chinese Medicine, it is called construction, which originated with Manfred Porkert.

Defense Qì

Defense qì (卫气 wèi qì) is derived from the essence of grain and water extracted by the spleen and the clear qì inhaled by the lung. It is described as fierce and bold (熛焊 biāo hàn) and flows outside the blood vessels. It is paired with provisioning qì; in this relationship it is yáng, while provisioning qì is yīn.

As to the functions of defense qì, the Líng Shū (Chapter 47) states, Defense qì is that which warms the divided flesh, flushes the skin, keeps the interstices replenished, and controls [their] opening and closing (卫气者, 所以温分肉, 充皮肤, 肥凑理, 司开阖者也 wèi qì zhě, suǒ yǐ wēn fēn ròu, chōng pí fū, féi còu lǐ, sī kāi hé zhě yě). When defense qì is in harmony, the divided flesh is uninhibited, the skin is supple, and the interstices are kept tight and sound (卫气和, 则分肉解利, 皮肤调柔, 凑理致密矣 wèi qì hé, zé fēn ròu jiě lì, pí fū tiáo róu, còu lǐ zhì mì yǐ).

Thus, defense qì has the interrelated functions of warming the body, resisting evils, and controlling the interstices (sweat glands and pores).

Warms: Defense qì warms the bowels and viscera, the flesh, and the skin and body hair and thereby helps to keep the body at the right temperature. Because of its powerful warming influence, particularly in the exterior, it is often referred to as defense yáng.

Resists evils: Defense qì resists the invasion of the exterior by external evils and controls the opening and closing of the interstices.

When external evils invade the body’s exterior, they interact with defense qì in several ways. They obstruct the smooth flow of defense qì, giving rise to aversion to cold or aversion to wind. At the same time, defense qì struggles to resist the external evils, which gives rise to heat effusion. When defense qì is weak, there is sweating; when it is strong, there is no sweating.

In patients whose defense qì is habitually weak, insufficiency of defense qì increases susceptibility to externally contracted disease.

Daily cycle: Defense qì moves through the yáng aspect of the body (the periphery) during the day, and through the yīn aspect of the body (viscera) at night. When defense qì is in the yáng aspect the body is awake; when in the yīn aspect, the body sleeps. Consequently, defense qì is believed to control sleep and waking. Abnormalities of defense qì can cause abnormalities of sleep. When defense qì remains in the yáng aspect for longer than normal, the patient may sleep less. When defense qì remains in the yīn aspect for longer than normal, sleeping time may increase.

The Nèi Jīng states, [A person who has] essence[-spirit vitality] in the daytime sleeps at night (昼精而夜瞑 zhòu jīng ér yè míng), while [A person who has] no essence[-spirit vitality] in the daytime does not sleep at night (昼不精而夜瞑 zhòu jīng ér yè bù míng). A person who has physical and mental energy in the daytime not only sleeps well but also has good resistance to disease. Conversely, daytime lack of energy and poor sleep at night can lower resistance to disease.

Interstices and Divided Flesh

Early Chinese physicians posited the notion of interstices (腠理 còu lǐ), spaces in the flesh by which sweat flowed out. Nowadays, these are loosely equated with sweat glands, ducts, and pores. When the interstices open, sweat flows, and when they close, sweating ceases. Chinese medicine assumes that people in southern China have looser interstices that open more easily than people living in the cooler north.

The divided flesh (分肉 fēn ròu) mentioned in the citation above simply means flesh but alludes to the fact that there are two forms, the white flesh (fat) beneath the skin and the red flesh (muscle) below it.

Bowel and Visceral Qì

Bowel and visceral qì (脏腑之气 zàng fǔ zhī qì) is the qì that powers the activity of the bowels and viscera. It includes lung qì, heart qì, spleen qì, liver qì, stomach qì, etc. It is a combination of earlier heaven qì and later heaven qì.

Channel and Network Vessel Qì

Sometimes simply called channel qì, channel and network vessel qì (经络之气 jīng luò zhī qì), or simply channel qì is the qì that flows through the channels and network vessels. Through the channel system, qì reaches all parts of the body, providing power for their activities.

Yáng Qì as Fire

Yáng qì is understood to function like a fire that warms the body. Superabundance of qì gives rise to fire (气有余便是火 qì yǒu yú biàn shì huǒ). Lesser fire, sovereign fire, and ministerial fire are specific forms of yáng qì in the body.

Lesser fire (少火 shào huǒ) refers to the healthy fire (yáng qì) of the body, which maintains life. It is called lesser fire because it is yáng contained by yīn. It is contrasted with vigorous fire, which is a pathological fire that is not contained by yīn.

Life gate fire (命门之火 mìng mén zhī huǒ), also called true fire of the life gate (命门真火 mìng mén zhēn huǒ), is the basic fire of life. It is now understood to be synonymous with kidney yáng and to live within kidney yīn. It is the basis of sexual and reproductive functions and is intimately involved in growth, development, and aging. It warms and nourishes the five viscera and six bowels, its warming action being especially important for the spleen and stomach to perform their movement and transformation functions.

Sovereign fire (君火 jūn huǒ) refers to the heart fire, the active life force of the heart. The name sovereign fire derives from the statement that the heart holds the office of Sovereign.

Ministerial fire (相火 xiàng huǒ) is the fire that inhabits the life gate, liver, gallbladder, and triple burner. It essentially comes from the life gate and stands in complementary opposition to the sovereign fire in the heart. The sovereign and ministerial fires together warm the bowels and viscera, powering the activity of the body. In insufficiency of liver-kidney yīn, the ministerial fire can become hyperactive, creating a condition known as frenetic stirring of the ministerial fire (相火妄动 xiàng huǒ wàng dòng) also called ascendant hyperactivity of the ministerial fire (相火上亢 xiàng huǒ shàng kàng), which is marked by excessive libido, seminal emission, and premature ejaculation. This condition can also be described as liver-kidney yīn vacuity with vacuity fire flaming upward. Note that because the ministerial fire is said to inhabit the life gate, there is a certain overlap between it and the life gate fire. However, the life gate fire is prone to insufficiency (debilitation of the life gate fire), the ministerial fire is prone to superabundance (frenetic stirring of the ministerial fire).

Distinctions and Relationships Between the Various Kinds of Qì

The many different forms of yáng qì described above have formed part of the received corpus of Chinese medical knowledge from the time of the Nèi Jīng. Since they cannot be isolated from or independently traced in the body, they are all essentially speculative concepts from a modern scientific point of view. How they arise and combine, where they are active, and what functions they perform are not always clear and ultimately depends on the interpretation of classical literature.

Students are advised simply to take note of the distinctions and the relationships but should not worry excessively about points that are not clear. The distinctions are not of great importance in medicinal therapy. Here, qì-supplementing medicinals are not subdivided according to the specific qì they supplement, although channel entry may suggest where the action is focused. Rén shēn (Ginseng Radix) is said to greatly supplement original qì, but medicinals are rarely said to specifically supplement ancestral qì, provisioning qì, or defense qì.

Other Things Called Qì

Many things in Chinese medicine are referred to as qì that are distinct from qì as the active force of bodily function. The use of the word qì usually indicates the gaseous or insubstantial quality of the thing referred to or emphasizes the power of its influence.

Finally, breath and breathing are both commonly referred to in Chinese as qì. Examples include shortness of breath (短气 duǎn qì), rough breathing (气粗 qì cū) and faint breathing (气微 qì wēi). Belching is (嗳气 ǎi qì).

Movement of Qì

The qì of the human body provides the power for all movement and activity in the body. Qì is constantly moving and constantly active in all parts of the body. Understanding the dynamics of the movement of qì within the body is of key importance in grasping the Chinese medical conception of physiological processes.

Qì Dynamic

Reflecting the notion of qì providing the power for all activity within the body, the movement of qì is referred to as qì dynamic. The Chinese term for this 气机 qì jī. The word 机 jī means a pivot or a machine, suggesting the notion of something with the capability and power to move. Qì dynamic is the direction and vigor of qì’s movement and activity.

Four Movements

The movement of qì is discussed in terms of four basic directions: up, down, inward and outward (升、降、出、入 shēng, jiàng, chū, rù), which we refer to collectively in English as the four movements.

These are two pairs of opposites that are analyzable in terms of yīn and yáng. Upward and outward movements are yáng, while downward and inward movements are yīn. Chinese medicine observes that what is high bears downward (高者下降 gāo zhě xià jiàng); what is low bears upward (下者上升 xià zhě shàng shēng); and what is full spills outward (盈者溢出 yíng zhě yì chū); what is empty draws inward (虚者纳入 xū zhě nà rù). Upward, downward, inward, and outward movements are merely abstractions influenced by the yīn-yáng paradigm.

Qì moves in all directions, a fact that is nowhere more apparent than in the channel and network vessel system. However, these four are the most significant movements and can be observed in all physiological processes, as can be seen in the examples below. Note, here, that the qì of an organ not only powers the activity of the organ itself but can move outside the organ. Thus, for example, kidney qì helps the lung to absorb qì.

Lung: The lung has two opposing and complementary movements: diffusion and depurative downbearing. By the upward and outward movement of diffusion, turbid qì is forced out of the body. By the inward and downward movement of depurative downbearing, clear qì is drawn into the lung. Beyond the confines of the lung itself, the diffusion of lung qì helps to spread defense qì to the exterior, while the downbearing of lung qì carries excess fluids down to the kidney.

Spleen and stomach: The stomach governs intake of food. Ingested food passes into the stomach, where it is rotted and ripened, that is, undergoes initial digestion. It is then passed down to the intestines. The downward movement of food is understood in terms of the downbearing of stomach qì.

The spleen extracts and refines the essence of grain and water, which it then transports upward to the lung and heart, during which process it turns into qì, blood, and bodily fluids. These processes are understood in terms of the upbearing movement of spleen qì.

Liver: The liver’s free coursing action ensures the free movement of qì around the body. Belonging to wood among the five phases, the natural movement of liver qì is upward and outward. This is often described as upbearing and effusion (升发 shēng fā). When liver qì’s free coursing becomes excessive, as it does in ascendant hyperactivity of liver yáng, upper body signs such as a red face and eyes and a subjective feeling of heavy head and light feet may appear.

Kidney: The kidney receives fluids sent down to it by the lung. It warms them so that the clear part of them steams upward and returns into circulation. It drains off the turbid part in the form of urine, which is passed to the bladder for discharge from the body. At the same time, the kidney also helps to absorb qì into the body, which assists the depurative downbearing action of the lung. Some cases of panting are explained in terms of a vacuous kidney failing to absorb qì. Thus, the kidney has a dual action: upward and outward (steaming of the fluids) and inward and downward (absorption of qì).

Abnormal Movement

When the movement of qì is normal, this is described as uninhibited qì dynamic (气机不利 qì jī bù lì). Any abnormality in the movement of qì is called qì dynamic disorder (气机失调 qì jī shī tiáo).

Many disturbances of physiological processes are understood in terms of abnormalities in the movement of qì. Virtually every morbid state of the body entails some abnormality of qì dynamic, and in clinical practice requires attention in diagnosis and treatment.

Disturbances of qì dynamic.

Causes of qì dynamic disturbances: All the external evils to a greater or lesser degree affect the movement and activity of qì. Internal causes also affect qì dynamic.

Treatment: Qì stagnation is treated by moving qì (行气 xíng qì), also call rectifying qì (理气 lǐ qì). Qì counterflow is treated by a specific form of rectifying qì called downbearing counterflow and precipitating qì (降逆下气 jiàng nì xià qì), which takes different forms depending on the location of the qì counterflow. Qì fall is treated by supplementing the center (the spleen and stomach) and boosting qì with the addition of medicinals that are especially effective in upbearing yáng and raising the fall (ones that foster the uplifting action yáng qì that correct the pathological downward movement that occurs in qì fall).

Qì in Pathology

Vacuity patterns are qì vacuity and qì fall. Repletion patterns are qì stagnation, qì counterflow, and qì block.

Qì vacuity (气虚 qì xū) is the failure of qì to perform its functions of movement, retention, transformation, and defense. It results from factors such as constitutional insufficiency, damage to qì in enduring disease, and taxation fatigue (an extremely run-down state of the body). The most general of its signs are lack of strength, a tongue that is pale and tender-soft (feels like a baby’s flesh), and a vacuous pulse. Other signs vary depending on which bowels and viscera are affected:

Note that the following two patterns are specific forms of qì vacuity.

Qì vs. Yáng
Qì in its active, diffuse aspect is yáng, as opposed to the material aspect of the body, which is yīn. Hence, this type of qì is often called yáng qì. In pathology, a distinction is made between qì vacuity and yáng vacuity. When qì fails in its moving, transforming, retaining, and defensive actions, the condition is called qì vacuity. In severe cases of qì vacuity, qì fails in its warming action; this manifests in cold symptoms and is called yáng vacuity. Hence, for practical purposes, yáng vacuity is defined as a type of qì vacuity complicated by cold signs or symptoms.

Qì fall (气陷 qì xiàn) is a severe form of qì vacuity in which qì loses its retentive function, resulting in prolapse of the rectum or uterus, miscarriage, murky urine, seminal discharge or vaginal discharge. It is specifically attributed to spleen qì vacuity and hence is often called spleen vacuity qì fall or center qì fall. Besides prolapse, there are other qì vacuity signs.

Qì desertion (气脱 qì tuō) is the sudden loss of qì that occurs when severe sweating, vomiting, diarrhea, or blood loss deprives qì of support and retention. It is called qì desertion because qì is conceived as escaping from the body in the same ways as fluid or blood. This is not a pattern solely affecting qì, since it results from loss of fluids or blood and therefore occurs in combined patterns of qì deserting with liquid and qì deserting with blood. In these patterns, loss of fluids through severe sweating, vomiting, or diarrhea or heavy bleeding is followed by the sudden appearance of low faint breathing, white facial complexion, great dripping sweat, clouded spirit, and a faint pulse on the verge of expiration.

Qì stagnation (气滞 qì zhì) is a disturbance of the smooth flow of qì.

Pathogenesis: It is attributable to numerous causes, including affect-mind disturbance, qì vacuity, and tangible evils such as dampness, phlegm-rheum, static blood, yīn cold, and roundworm.

Signs: The main signs are oppression, distending pain or scurrying pain that fluctuates in intensity and has no fixed location. Depending on the area affected, there may be oppression in the chest, distension and pain in the rib-side, or distension and pain (or scurrying pain) in the abdomen. Distension and pain resulting from qì stagnation in the digestive tract is relieved by belching, rumbling intestines, or passing of flatus. The pulse is usually stringlike.

Affect-mind (emotional) disturbance is the foremost cause of qì stagnation. The liver is especially susceptible to emotional disturbances. Anger, frustration, dissatisfaction, and other emotions affect the liver’s free coursing action. The resulting condition is called depressed liver qì. Qì stagnation arising from depressed liver qì occurs chiefly along the pathway of the liver channel, notably in the chest and rib-sides, where it causes distension and pain. It also tends to affect the spleen and stomach, causing digestive problems.

Qì counterflow (气逆 qì nì) is a form of qì stagnation whereby qì not only fails to flow smoothly in the right direction but moves in the opposite direction instead. In many contexts, the term reversal is the same as counterflow.

Stomach: Stomach qì normally bears downward, sending food down the digestive tract. When it stagnates, it can bear upward, giving rise to nausea, vomiting, belching, or hiccup. Stomach qì ascending counterflow can occur in any stomach disease pattern.

Lung: When the depurative downbearing function of the lung is impaired, lung qì can ascend counterflow, giving rise to cough and panting. Lung qì ascending counterflow manifests in severe cough and panting.

Liver: When the liver’s free coursing action is excessive, there is headache, dizziness, clouding reversal (syncope, fainting), and retching of blood or expectoration of blood. Liver qì ascending counterflow manifests in dizziness, headache, red facial complexion, tinnitus, deafness, pain and fullness in the chest and rib-side.

Counterflow
The term counterflow (逆 nì) has several different meanings. In the case of stomach or lung qì ascending counterflow, it means moving in the wrong direction. In liver qì ascending counterflow, it means an excessive surge in the normal direction. The term also appears in counterflow cold of the limbs (四肢逆冷 sì zhī nì lěng), where it means that yáng qì is insufficient and retreats from the extremities so that there is palpable cold up to the elbows and knees.) In many contexts, reversal (厥 jué) has the same meaning as counterflow, as in reversal cold of the limbs.

Qì Block

Qì block (气闭 qì bì) is any critical condition arising when the qì dynamic of a specific bowel or viscus is severely disrupted, usually involving its orifice. It is usually caused by.

Patterns vary depending on the bowel or viscus affected. Most commonly there is clouded spirit (partial or total loss of consciousness), rough breathing, and reversal cold of the limbs (cold up to the knees and elbows) or gripping pain in the internal organs, and urinary or fecal stoppage. The pulse is replete or sunken, stringlike, and forceful.

Qì’s Relationships

Qì and Blood

Blood is closely related to qì. Blood is a yīn substance; it has form and is still; it nourishes and moistens. Qì is yang; it is formless and moves; it warms and propels. Qì and blood are mutually complementary and interdependent. Hence, it is said that qì is the commander of the blood (气为血之帅 qì wéi xuè zhī shuài); blood is the mother of qì (血为气之母 xuè wéi qì zhī mǔ).

Qì engenders the blood: Qì contributes to the formation of blood both as a constituent and as the agent of production. Provisioning qì, which is derived from the essence of grain and water and from clear qì inhaled by the lung, is a major component of the blood. Furthermore, the work of the spleen and stomach, the heart, and lung in the production of blood relies on their qì. Hence, without qì, blood cannot be created. When qì is effulgent, blood is ample. When qì is insufficient, blood is scant. Hence qì vacuity can give way to dual vacuity of qì and blood, which manifests in shortness of breath, lack of strength, lusterless complexion, dizzy head and vision, and heart palpitation or fearful throbbing. In treatment, both blood vacuity and dual vacuity of qì and blood are treated by combining qì-boosting medicinals with agents that supplement the blood (supplementing qì to engender blood).

Qì moves the blood: Qì propels the blood through the vessels. Blood is still and cannot move on its own; it only moves by the power of qì. When qì moves, blood moves; when qì stops, blood stops. Either qì vacuity or qì stagnation can cause the blood flow to slow down, causing blood stasis. When qì moves in the wrong direction, this can affect the movement of blood. In treatment, abnormalities in the movement of blood usually call for the use of qì-supplementing, qì-moving, qì-downbearing, and/or qì-rectifying medicinals.

Qì contains the blood: The retentive power of qì ensures that blood stays in the vessels and prevents it from extravasating. This action is specifically ascribed to spleen qì. The spleen controls the blood. When spleen qì is vacuous and fails to exert its retentive power, there is bloody urine, bloody stool, or flooding and spotting, which are conditions that are treated by supplementing qì and fortifying the spleen. Furthermore, massive bleeding can give way to qì deserting with blood. If a patient with qì vacuity suffers from bleeding, the qì vacuity can exacerbate the bleeding. For these reasons, the treatment of bleeding combines qì-supplementing medicinals with blood-stanching agents.

Blood bears qì: Qì and blood flow together through the vessels. Qì also flows outside the blood vessels. However, the part of qì that flows in the blood is borne by the blood, which means that its flow is facilitated by the blood. Because of this, when there is massive bleeding, qì can desert with the blood.

Blood nourishes qì: Qì, as all parts of the body, relies on the nourishing action of blood. Because of this relationship, blood vacuity can cause qì vacuity.

Qì and Fluids

Qì is intangible and moves; it is yáng. The fluids are tangible and still; they are yīn. Qì engenders fluids, moves them, and contains them. The fluids bear qì.

Qì engenders the fluids: The fluids are derived from grain and water by the action of spleen and stomach qì. Hence when qì is weak, liquid is scant. In clinical practice, boosting qì can help to increase fluid production.

Qì moves liquid: The distribution and elimination of fluids is reliant on the power of the qì of the spleen, lung, kidney, and triple burner. Qì vacuity involving loss of propelling power or qì stagnation can cause abnormalities in the distribution and elimination of fluids, causing water-damp and phlegm-rheum to arise internally.

Qì contains liquid: Qì holds the fluids in the body and prevents excessive loss of them. Lung and defense qì control sweating, the kidney and bladder qì control the formation and elimination of urine, while spleen and stomach qì control the flow of drool and intestinal humor. When the retentive power of qì fails to contain fluids, the signs are profuse sweating, copious urine, frequent urination, enuresis, urinary incontinence, or drooling from the corners of the mouth. The treatment of such conditions frequently involves supplementing qì.

Liquid bears qì: The qì that flows outside the vessels is borne by the fluids. This is reflected in two pathologies.

Qì and Essence

Essence is understood to be yīn in relation to qì, which is yáng.

Essence transforms into qì: The Leì Jing1 (类经, The Classified Classic) states, Essence transforming into qì means that original qì is formed from essence (精化为气, 谓元气由精而化也 jing1 hua4 wéi qì, weì yuan2 qì you2 jing1 er2 hua4 ye3). For this reason, the health of qì relies on the health of essence. Depletion of essence can cause debilitation of qì.

Qì produces and contains essence: Qì transformation, that is, the transformative action of qì is responsible for the production of essence. The Su4 Wen4 (Chapter 6) states: Qì turns to essence (气归精 qì guī jing1). When essence abounds, qì is exuberant. Conversely, when essence is depleted, qì becomes weak.

Qì’s containing (retentive) action is responsible for storing essence in the bowels and viscera. When qì gathers, essence abounds; when qì is weak, essence disperses. Essence is stored in the kidney by the retentive power of kidney qì. When kidney qì weakens and its retentive power diminishes, there may be seminal emission, seminal efflux, and clear thin white vaginal discharge.

Furthermore, essence’s control over reproduction, development, and aging is reliant on the action of original qì.

Qì in Relation to the Viscera

The lung, spleen, liver, kidney, and heart are all intimately related to qì.

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