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Qì stagnation

气滞 〔氣滯〕qì zhì

Also qì depression (气郁 qì yù). This term often connotes affect-mind depression as the cause.

A disease pattern chiefly characterized by distension and fullness, glomus and oppression, distending pain or scurrying pain; signs are intermittent, of unfixed location, triggered or exacerbated by emotional factors and relieved by good moods, belching, or passing of flatus.

Biomedical correspondence: Qì stagnation is seen in gastrointestinal neurosis, chronic gastritis, chronic enteritis, ulcers, diseases of the biliary tract, and chronic hepatitis.

Description: Oppression in the chest; distension and pain in the rib-sides or in the stomach duct and abdomen with pain less pronounced than distension. Distension and pain are of unfixed location (sometimes scurrying from one place to another), intermittent, sometimes relieved by sighing, belching, or passing of flatus. When attributable to impaired liver free coursing, they can be triggered or worsened by bad moods. The tongue is pale and the pulse stringlike. Signs vary according to location (see below).

Pathogenesis: Inhibited movement of qì in a part of the body or in a specific bowel or viscus. It is a repletion pattern that stems from the following factors:

Signs vary according to location

The pain associated with qì stagnation is of unfixed location or scurrying, as distinct from pain of fixed location associated with blood stasis. Often, discomfort associated with qì stagnation is temporarily relieved by belching or the passing of flatus.

Affect damage (内伤七情 nèi shāng qī qíng): Mental and emotional problems, traditionally understood as excesses among the seven affects, can affect health in several ways. This is known as affect damage. The most important way in which the seven affects can damage health is when affect-mind depression impairs the liver’s free coursing action causing depressed liver qì. This mechanism is often referred to as binding depression of affect-mind, and the condition that results from it, which is one of the main forms of qì stagnation, is called qì depression. Qì depression manifests as sighing, pain and distension in the chest and rib-side (pain of unfixed location), oppression in the stomach duct, torpid intake, and in some cases vomiting. These signs are accompanied by mental or emotional problems that are the root cause, and intensify in periods of depression. Qì depression can also manifest in the form of abdominal pain, stomach pain, and even lumbar pain. Depressed qì sometimes produces abdominal glomus lump that is soft to the touch and that disperses and reforms periodically. In women, qì depression often manifests in swelling of the breasts and menstrual irregularities. It can combine with phlegm to cause plum-pit qì. Whatever form it takes, qì depression easily turns into fire causing rashness, impatience, irascibility, oppression in the chest and rib-side distension, clamoring stomach, dry mouth with bitter taste, constipation, red tongue with yellow fur and stringlike rapid pulse, and in some cases with headache, red eyes, or tinnitus.

External injury (外伤 wài shāng): Qì stagnation can also arise as a result of internal injury when blows to the chest or abdomen cause pain in the rib-side, cough, panting, and pain and distension in the abdomen and stomach duct.

Evil qì (邪气 xié qì): Qì stagnation can result from the obstructive effect of evils, especially cold and dampness. For example, in cold stagnating in the liver vessel, abdominal pain and distension is attributed to qì stagnation caused by cold evil. See also cold; cold-damp. Dampness can cause qì stagnation, as when dampness obstructing the center burner causes abdominal distension. See dampness; damp depression. Damp-heat can also cause qì stagnation as seen in damp-heat dysentery (manifesting in the form of tenesmus) and damp-heat rib-side pain. Qì stagnation can cause, or be caused by, blood stasis. This dual pathology is observed in amenorrhea, liver fixity, dysphagia-occlusion (噎膈 yē gé), and concretions, conglomerations, accumulations, and gatherings (including strings and aggregations, deep-lying beam etc.), welling-abscess (yōng) and flat-abscess () (including intestinal welling-abscess, effusion of the back, sloughing flat-abscess), and internal obstruction.

Qì vacuity (气虚 qì xū): Qì vacuity can cause qì stagnation, e.g., spleen vacuity causing qì stagnation abdominal distension in greater yīn (tài yīn) disease.

Specific forms: Depressed liver qì; liver-spleen disharmony; liver-stomach disharmony; gastrointestinal qì stagnation.

Further developments: When qì fails to move and becomes stagnant, either blood stagnates and blood stasis arises, or else fluids collect, causing phlegm-rheum or qì swelling. Qì stagnation can also give rise to fire formation and to qì block patterns.

Treatment

Medicinal therapy: Qì stagnation is treated by the methods of rectifying and moving qì. Agents such as cyperus (Cyperi Rhizoma, 香附子 xiāng fù zǐ), costusroot (Aucklandiae Radix, 木香 mù xiāng), bitter orange (Aurantii Fructus, 枳壳 zhǐ ké), and tangerine peel (Citri Reticulatae Pericarpium, 陈皮 chén pí) are especially suitable for gastrointestinal qì stagnation. Unripe tangerine peel (Citri Reticulatae Pericarpium Viride, 青皮 qīng pí), curcuma (Curcumae Radix, 郁金 yù jīn), and toosendan (Toosendan Fructus, 川楝子 chuān liàn zǐ) are appropriate for depressed liver qì or for liver channel qì stagnation. Since most cases of qì stagnation are related to impaired liver free coursing, formulas designed for liver qì stagnation contain liver-coursing qì-rectifying medicinals such as bupleurum (Bupleuri Radix, 柴胡 chái hú). Liver-coursing qì-rectifying formulas include Counterflow Cold Powder (四逆散 sì nì sǎn) and Bupleurum Liver-Coursing Powder (柴胡疏肝散 chái hú shū gān sǎn).

Acumoxatherapy: To rectify qì and move qì, select as main points CV-6 (Sea of Qì, 气海 qì hǎi), CV-17 (Chest Center, 膻中 shān zhōng), PC-6 (Inner Pass, 内关 nèi guān), LI-4 (Union Valley, 合谷 hé gǔ), LR-3 (Supreme Surge, 太冲 tài chōng), TB-6 (Branch Ditch, 支沟 zhī gōu), and GB-34 (Yáng Mound Spring, 阳陵泉 yáng líng quán). To these add further points chosen according to cause. Needle stimulus depends on cause.

See depression pattern; disharmony of qì and blood.

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