Qì block

Also internal block (内闭 nèi bì).

Key signs: Depending on bowels and viscera affected, signs include sudden clouding collapse; asphyxiation; gripping pain; cold limbs; urinary and fecal stoppage.

Description: Qì block is a severe, even life-threatening blockage of qì in the bowels and viscera or in the channels and network vessels. It is usually caused by heat, damp-heat, phlegm, or other evils penetrating deeply into the bowels and viscera or the channels and network vessels, causing blockage of the clear orifices. Qì block patterns variously manifest in sudden clouding collapse; asphyxiation; gripping pain; cold limbs; urinary and fecal stoppage, depending on the location. However, they usually involve obstruction of the orifices of the heart. Hence, qì block is observed in several disease patterns of the heart and in diseases such as severe externally contracted diseases with vigorous fever, child fright wind, tetanic disease, wind stroke, epilepsy, and yīn-yáng block and repulsion patterns. Qì block characterized by clouded spirit is usually treated with orifice-opening medicinals.

Note: In certain pre-modern texts, qì block may refer specifically to dribbling urinary block due to qì vacuity or qì stagnation.

Pathomechanisms

• Heat, damp-heat, phlegm, static blood, stones, or roundworm causing obstruction that affects the qì dynamic.
• Can be triggered by great anger, sudden fright, external injury, or excessive worry and preoccupation disrupting the qì dynamic.

Analysis of signs: The manifestations of qì block vary according to location.

• When heart qì is blocked, there is clouding collapse, clouding reversal, or clouded spirit sometimes delirious speech.
• When lung qì is blocked, there is rapid panting and asphyxiation, as may be seen in chest impediment (胸痹 xiōng bì) and chest bind (结胸 jié xiōng).
• When bladder qì is blocked, urine ceases to flow (urinary stoppage).
• When large intestine qì is blocked, there is constipation.
• When there is yīn-yáng repulsion, the continuity of qì flow is disrupted, hence there is reversal cold of the limbs and a hidden pulse.
• Tongue: Usually dull with a thick fur, reflecting obstruction of qì, blood, and fluids.
• Pulse: Usually sunken, replete, and forceful, reflecting the obstruction of qì in the interior.

Diseases (or patterns) in which qì block arises: The following are the main diseases in which block patterns marked by clouded spirit arise.

• Externally contracted febrile disease patterns, such as heat entering the pericardium, phlegm clouding the heart spirit, or summerheat stroke.
• Tetanic disease, that is, diseases marked by pronounced spasm, such as clenched jaw, convulsion of the limbs, and arched-back rigidity. Tetanic diseases include lockjaw.
• Child fright wind, arising when externally contracted heat evil in infants and children grows so intense that it unleashes a process of extreme heat engendering wind, causing clenched jaw, convulsions, and arched-back rigidity. Fright wind occurs in children. It corresponds to tetanic disease in adults.
• Wind stroke, commonly attributed to liver wind stirring internally combining with phlegm and marked by hemiplegia, deviated eyes and mouth, and sluggish speech, often following sudden clouding collapse.
• Epilepsy, a disease classically characterized by brief episodes of loss of consciousness, foaming at the mouth, and clenched jaw, after which the patient returns to normal.
• Yīn-yáng block and repulsion patterns with reversal cold of the limbs.

Block patterns are often contrasted with desertion patterns. Block patterns are severe repletion patterns, while desertion patterns are severe vacuity patterns. Wind stroke, for example, can take the form of either a block pattern or a desertion pattern. Wind stroke block patterns are characterized by clenched jaw and clenched hands, while desertion patterns are marked by open mouth, limp hands, open eyes, and enuresis.

Treatment: Depends on affected organs and causes.

Typical Pathoconditions

Qì block patterns can be distinguished by their chief pathomechanisms and clinical features as follows: wind stroke block patterns; clouded spirit; fright wind; fecal block; urinary stoppage; deafness; loss of voice.

Wind stroke (中风 zhòng fēng): Signs include sudden clouding collapse, clenched jaw, clenched fists, and in some cases convulsions or abdominal fullness, distension, and oppression. The pulse is replete and forceful.

Medicinal therapy: Treat by insufflating Gate-Freeing Powder (通关散 tōng guān sǎn) into the nose to make the patient sneeze and to open up the mouth. Gate-Opening Powder (开关散 kāi guān sǎn) can be rubbed on the teeth to help to free the jaws. For phlegm-drool congestion and distension and fullness in the chest and diaphragm, Drool-Thinning Powder (稀涎散 xī xián sǎn) can be insufflated. For clouded spirit-affect due to internal phlegm-heat congestion, use Bovine Bezoar Heart-Clearing Pill (牛黄清心丸 niú huáng qīng xīn wán).

Acumoxatherapy: Needle with drainage at LI-4 (Union Valley, 合谷 hé gǔ), GV-26 (Human Center, 人中 rén zhōng), ST-6 (Cheek Carriage, 颊车 jiá chē), SI-3 (Back Ravine, 后溪 hòu xī), PC-8 (Palace of Toil, 劳宫 láo gōng), PC-6 (Inner Pass, 内关 nèi guān), and KI-1 (Gushing Spring, 湧泉 yǒng quán).

Clouded spirit (神昏 shēn hūn): Clouded spirit other than due to wind stroke may be due to heat block, damp block, or phlegm block. Heat block is marked by clouded spirit and is accompanied by agitation, raving and hallucination, high fever, vexation and thirst, red face and lips, dry yellow tongue fur, and rapid stringlike pulse. It can be treated with Bovine Bezoar Heart-Clearing Pill (牛黄清心丸 niú huáng qīng xīn wán). Dampness block is marked by periodic clouding of the spirit with laziness to move, eyes open or closed with aversion to light, generalized heat failing to surface, thirst with no desire to drink, thick slimy tongue fur, and a sorry rapid pulse. It can be treated with Patchouli, Officinal Magnolia Bark, Pinellia, and Poria Decoction (藿朴夏苓汤 huò pò xià líng tāng) minus cardamom (Amomi Fructus Rotundus, 白豆蔻 bái dòu kòu) and officinal magnolia bark (Magnoliae Officinalis Cortex, 厚朴 hòu pò), plus asarum (Asari Rhizoma et Radix, 细辛 xì xīn), white mustard (Sinapis Alba Semen, 白芥子 bái jiè zǐ), and talcum (Talcum, 滑石 huá shí). Phlegm block is marked by coma with phlegm-drool congestion, a green-blue grimy complexion, a tongue fur that is white or gray, slimy, and moist, and a slippery sunken pulse. This is treated with Phlegm-Abducting Decoction (导痰汤 dǎo tán tāng) plus bamboo sugar (Bambusae Concretio Silicea, 天竹黄 tiān zhú huáng), acorus (Acori Tatarinowii Rhizoma, 石菖蒲 shí chāng pú), curcuma (Curcumae Radix, 郁金 yù jīn), bamboo sap (Bambusae Succus, 竹沥 zhú lì), and Storax Pill (苏合香丸 sū hé xiāng wán).

Fright wind (惊风 jīng fēng): Acute fright wind occurs in unabating high fever when signs such as limb reversal, convulsions and, in severe cases, arched-back rigidity, clenched jaw, upward staring eyes, coma, and dripping perspiration appear. The tongue is dry red or crimson and the pulse is stringlike. This can be treated first with Gate-Opening Powder (开关散 kāi guān sǎn) followed by Purple Snow Elixir (紫雪丹 zǐ xuě dān) taken with Antelope Horn and Uncaria Decoction (羚角钩藤汤 líng jiǎo gōu téng tāng).

Fecal block (便闭 biàn bì): Constipation due to cold is characterized by white face and cold limbs, absence of thirst, long voidings of clear urine, and cold pain around the umbilicus. It can be treated with Spleen-Warming Decoction (温脾汤 wēn pí tāng). Constipation due to heat congestion is characterized by generalized heat, vexation and agitation, thirst, abdominal fullness and pain that refuses pressure. This is treated with Major Qì-Coordinating Decoction (大承气汤 dà chéng qì tāng). Constipation due to blood stasis is marked by black stool and inhibited urination, and is treated with Peach Kernel Qì-Coordinating Decoction (桃核承气汤 táo hé chéng qì tāng).

Urinary stoppage (小便不通 xiǎo biàn bù tōng): Urinary block due to cold can be treated with Warming and Freeing Decoction (温通汤 wēn tōng tāng). When due to damp-heat pouring downward, it can be treated with Eight Corrections Powder (八正散 bā zhèng sǎn), when due to obstruction by stones, with Stone-Expelling Decoction (排石汤 pái shí tāng), and when due to the lung failing to regulate the waterways, with Lung-Clearing Drink (清肺饮子 qīng fèi yǐn zi) or Poria Five Powder (五苓散 wǔ líng sǎn) plus apricot kernel (Armeniacae Semen, 杏仁 xìng rén), rice-paper plant pith (Tetrapanacis Medulla, 通草 tōng cǎo), and Northern astragalus (Astragali Radix Septentrionalis, 北芪 běi qí).

Deafness: (耳聋 ěr lóng) Counterflow ascent of qì due to anger causing qì to congest in the upper body and block the ear orifices. Deafness due to contraction of external wind with headache is treated with Saposhnikovia Sage-Inspired Powder (防风通圣散 fáng fēng tōng shèng sǎn). Deafness due to stirring yīn vacuity fire can be treated with Anemarrhena and Phellodendron Eight-Ingredient Pill (知柏八味丸 zhī bǎi bā wèi wán) plus polygala (Polygalae Radix, 远志 yuǎn zhì), and acorus (Acori Tatarinowii Rhizoma, 石菖蒲 shí chāng pú). Deafness due to great noise, shouting, or fright can be treated with Gallbladder-Clearing Decoction (清胆汤 qīng dǎn tāng).

Loss of voice (失音 shī yīn): For loss of voice due to wind-cold external block, use Inula Powder (金沸草散 jīn fèi cǎo sǎn) plus oroxylum (Oroxyli Semen, 木蝴蝶 mù hú dié) and tinospora root (Tinosporae Radix, 金果榄 jīn guǒ lǎn). For loss of voice due to wind-heat external block, use Platycodon Decoction (桔梗汤 jié gěng tāng) plus silkworm (Bombyx Batryticatus, 白僵蚕 bái jiāng cán), cicada molting (Cicadae Periostracum, 蝉蜕 chán tuì), sterculia (Sterculiae Lychnophorae Semen, 胖大海 pàng dà hǎi), mint (Menthae Herba, 薄荷 bò hé), and belamcanda (Belamcandae Rhizoma, 射干 shè gān).

See bladder qì block; qì block deafness; wind stroke; fright wind; phlegm reversal.