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Qì-aspect pattern
气分证 〔氣分證〕qì fèn zhèng
A disease pattern chiefly characterized by heat effusion with aversion to heat rather than to cold; thirst; a red tongue with yellow fur, and a forceful rapid pulse. If the lung is affected, there is cough. If the heart spirit is affected, there is vexation and agitation. Great heat in the q aspect is marked by vigorous heat, great thirst, great sweating, and a large surging pulse. If the intestines are affected there is constipation. If the gallbladder channel is affected, there is alternating heat effusion and aversion to cold, rib-side pain, and bitter taste in the mouth.
Description: Heat effusion with aversion to heat rather than to cold; heart vexation; thirst; sweating; short voidings of reddish urine; red tongue with yellow fur; a rapid pulse. This pattern indicates that evil has begun to penetrate the interior, and hence is sometimes called initial-stage qì-aspect heat.
As it advances further, signs depend on the affected area:
- Evil heat congesting the lung: Cough, panting, rough breathing, expectoration of thick yellow phlegm, and chest pain.
- Evil heat harassing the chest and diaphragm: Heart vexation and anguish in the heart (心中懊憹 xīn zhōng ào nóng); fidgetiness whether sitting and lying (agitation); in some cases, scorching heat in the chest and diaphragm.
- Great heat in the qì aspect: Vigorous heat; great thirst; great sweating; large surging pulse. Equivalent to yáng brightness (yáng míng) channel pattern.
- Evil heat binding in the intestines: Late afternoon tidal heat effusion; constipation or thin watery diarrhea (
heat bind with circumfluence
); abdominal distension, fullness, hardness, and pain that refuses pressure. In severe cases, evil heat harasses the heart spirit, causing delirious speech or even manic derangement. Equivalent to the yáng brightness (yáng míng) bowel pattern. - Heat depressed in the gallbladder channel: Alternating aversion to cold and heat effusion (as in malarial disease); rib-side pain; bitter taste in the mouth; heart vexation; dry retching; a pulse that is stringlike and rapid. This is equivalent to lesser yáng (shào yáng) disease in cold damage.
Pathogenesis: Warm heat disease evil entering the bowels and viscera, giving rise to exuberant yáng heat. This arises in one of two ways:
- Evil heat in the defense aspect failing to resolve and passing inward into the qì aspect.
- Warm heat evil directly invading the qì aspect.
Analysis of signs:
- Exuberant heat: Heat effusion with aversion to heat rather than to cold and sweating.
- Spirit-mind: Heart vexation and anguish in the heart (severe vexation); delirious speech or manic derangement of the spirit-mind.
- Damage to liquid: Thirst and short voidings of reddish urine; constipation.
- Lung qì ascending counterflow: When depurative downbearing is impaired, cough and panting are observed.
- Tongue: Red with yellow fur, reflecting heat.
- Pulse: Rapid, reflecting heat.
Qì-aspect patterns are more varied than the patterns of other aspects. However, their common features are heat effusion without aversion to cold, thirst, and a yellow tongue fur, as well as the absence of defense-, provisioning-, or blood-aspect signs.
Comparison: Cold damage disease theory recognizes heat patterns arising when exterior evils transform into heat and enter the interior. However, while cold evil remains lodged in the exterior for some time before it transforms into the heat and enters the interior, warm evil falls inward and transforms into (more intense) heat far quicker.
Treatment
Medicinal therapy: Initial-stage qì-aspect heat can be treated using zhī zǐ chǐ tāng (栀子豉汤 Gardenia and Fermented Soybean Decoction); evil heat congesting the lung, using má xìng gān shí tāng (麻杏甘石汤 Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction); great heat in the qì aspect with bái hǔ tāng (白虎汤 White Tiger Decoction); evil heat binding in the intestines, with dà chéng qì tāng (大承气汤 Major Qì-Coordinating Decoction) and xiǎo chéng qì tāng (小承气汤 Minor Qì-Coordinating Decoction); heat depressed in the gallbladder channel, with hāo qín qīng dǎn tāng (蒿芩清胆汤 Sweet Wormwood and Scutellaria Gallbladder-Clearing Decoction).
Acumoxatherapy: Needle