Qì-rectifying agents

Also qì-moving agents. Qì-rectifying medicinals restore normal qì dynamic, i.e., the normal movement and activity of qì, in the treatment of qì stagnation and qì counterflow patterns.

To understand the significance of rectifying qì, we first need to understand the concept of qì. The word qì originally denoted mist, cloud, or vapor. Observation of phenomena referred to as qì prompted ancient Chinese philosophers to posit the notion that the whole universe was composed of a single substance called qì. According to this notion, qì in its primal form is a diffuse and powerfully active substance that is yáng in nature. This substance can condense to form the material, yīn aspect of the world. All activity within the material world is powered by diffuse forms of qì. The duality of diffuse and condensed qì reflects the influence of the doctrine of yīn and yáng on the qì paradigm.

Physicians carried the notion of qì over into medicine. They called the material basis of the body yīn qì, and the diffuse, active substance that they understood to power bodily functions yáng qì. The activities of this yáng qì include moving blood, fluids, and food; containing blood and fluids; transforming substances; warming the body; defending the body against external evils; and nourishing the body. Qì stagnation and qì counterflow, which are the morbid states treated by qì rectification, refer to breakdowns in the movement of qì.

Yáng qì is normally diffuse and active. When it stagnates, it becomes less active and fails to perform its propelling function adequately. Depending on the location of the stagnation, the movement of blood, fluids, or food may be affected. In severe cases, qì stagnation can develop into qì counterflow, that is, the movement of qì in the wrong direction. This primarily affects the downward movement of lung qì called depurative downbearing and the downward movement of stomach qì that carries food down the digestive tract. These conditions are known as counterflow ascent of lung qì and counterflow ascent of stomach qì respectively.

Medicinals that rectify qì are generally acrid and dispersing. Because qì shares with yáng the quality of warmth, medicinals that rectify qì are largely warm in nature. As to bearing, those that downbear counterflow and precipitate qì are downsinking.

Properties

Nature: Mostly warm; some are cold.

Flavor: Acrid and aromatic; some are bitter.

Channel entry: All enter the spleen and/or stomach. Most enter other channels too.

Actions

Qì-rectifying medicinals treat qì that is not moving adequately (qì stagnation) or qì that is moving in the wrong direction (qì counterflow). A powerful qì-rectifying action is described as breaking qì. Qì-rectifying medicinals that specifically treat counterflow qì are described as downbearing qì or, when they act more forcefully, as precipitating qì.

The action of qì-rectifying medicinals can be explained by their flavor and nature. Most of them are acrid, warm, and aromatic. The acrid flavor moves and disperses; the bitter flavor courses and discharges. Medicinals with a warm nature are freeing and moving, and aromatic agents tend to be mobile and penetrating.

Because qì-rectifying medicinals enter numerous channels, they have many different actions:

• Rectifying qì and fortifying the spleen, to treat qì stagnation resulting from spleen vacuity.
• Downbearing counterflow and checking vomiting, to treat counterflow ascent of stomach qì and specifically vomiting.
• Downbearing counterflow and calming panting, to treat counterflow ascent of lung qì and specifically panting.
• Coursing the liver and resolving depression, to treat binding depression of liver qì.
• Rectifying qì and loosening the chest, to treat qì stagnation in the chest.
• Dispersing accumulation and abducting stagnation, to treat accumulation and stagnation of food in the digestive tract.
• Moving qì and relieving pain, to treat qì stagnation giving rise to pain.
• Moving qì and dispersing distension, to treat qì stagnation giving rise to distension.
• Breaking qì and dispersing binds, to treat qì stagnation giving rise to binds and blood stasis.

Indications

The qì dynamic is most closely related to the spleen, stomach, liver, and lung. Numerous factors, including excessive cold or warmth, affect damage (joy, anger, anxiety, thought, sorrow, fear, and fright), phlegm-rheum, static blood, external injury, and dietary irregularities can impair the upbearing of spleen qì and the downbearing of stomach qì, the free coursing of the liver, and the diffusion and downbearing of the lung.

When the qì dynamic is inhibited, the result is qì stagnation or qì counterflow. Qì stagnation is the failure of qì to move freely. It manifests in sensations such as oppression, distension, fullness, and pain of an unfixed location. Qì counterflow is the movement of qì counter to its normal direction. It usually refers to the upward movement of qì that should move downward, specifically to counterflow ascent of stomach qì, which manifests in nausea and vomiting, belching, or hiccup; and counterflow ascent of lung qì, which manifests in cough and panting.

Depressed liver qì (also called liver depression and qì stagnation, or binding depression of liver qì) arises when the free coursing function of the liver is impaired. It manifests in emotional disturbance, in particular anger and depression, distending pain in the rib-sides, distension and pain in the breasts, mounting qì pain, menstrual irregularities, and concretions, conglomerations, accumulations, and gatherings (the traditional types of abdominal masses).

Depressed liver qì invariably causes spleen-stomach qì stagnation, and often allows dampness to gather and transform into phlegm. Examples of medicinals that treat binding depression of liver qì include qīng pí (Citri Reticulatae Pericarpium Viride), xiāng fù (Cyperi Rhizoma), and chuān liàn zǐ (Toosendan Fructus).

Spleen-stomach qì stagnation and qì counterflow are characterized by oppression, distension, pain in the stomach duct and abdomen, belching, acid swallowing, no thought of food or drink, nausea and vomiting, and constipation or diarrhea with ungratifying defecation and a sagging sensation after defecation. These patterns are treated with qì-rectifying spleen-fortifying medicinals, such as chén pí (Citri Reticulatae Pericarpium) and mù xiāng (Aucklandiae Radix).

Congestions of lung qì with oppression or pain in the chest, cough, and panting. This is treated with medicinals that rectify qì and loosen the chest.

Qì-rectifying medicinals address disorders of the spleen, stomach, liver, and lung. They are also used to treat problems arising from or exacerbated by those disorders, such as damp turbidity, water swelling, phlegm-rheum, food stagnation, and blood stasis.

Combinations

Qì-rectifying medicinals are often combined with agents of other categories, depending on the location of qì stagnation and on the presence of evils.

• Spleen-stomach qì stagnation due to accumulation and stagnation of food and drink: Combine with food-dispersing medicinals, such as shān zhā (Crataegi Fructus), shén qū (Massa Medicata Fermentata), and mài yá (Hordei Fructus Germinatus).
• Spleen-stomach qì stagnation due to qì vacuity: Combine with center-supplementing qì-boosting medicinals, such as bái zhú (Atractylodis Macrocephalae Rhizoma) and shān yào (Dioscoreae Rhizoma).
• Spleen-stomach qì stagnation due to damp-heat: Combine with heat-clearing dampness-drying medicinals, such as huáng qín (Scutellariae Radix), huáng lián (Coptidis Rhizoma), and huáng bǎi (Phellodendri Cortex).
• Spleen-stomach qì stagnation due to cold-damp encumbering the spleen: Combine with bitter warm dampness-drying medicinals, such as bái dòu kòu (Amomi Fructus Rotundus) and shā rén (Amomi Fructus).
• Depressed liver qì due to insufficiency of liver blood: Combine with blood-nourishing liver-emolliating medicinals, such as bái sháo (Paeoniae Radix Alba).
• Depressed liver qì due to contraction of cold in the liver channel: Combine with liver-warming cold-dispersing medicinals, such as wú zhū yú (Evodiae Fructus) and xiǎo huí xiāng (Foeniculi Fructus).
• Depressed liver qì with blood stasis: Combine with blood-quickening stasis-dispelling agents such as táo rén (Persicae Semen) and hóng huā (Carthami Flos).
• Lung qì congestion due to external evils settling in the lung: Combine with lung-diffusing exterior-resolving medicinals, such as má huáng (Ephedrae Herba).
• Lung qì congestion due to phlegm-rheum obstructing the lung: Combine with phlegm-dispelling rheum-transforming medicinals, such as bàn xià (Pinelliae Rhizoma) and tiān nán xīng (Arisaematis Rhizoma).

Warning

Qì-rectifying medicinals are acrid, warm, aromatic, and dry, so they easily damage qì and yīn. Use with care in insufficiency of qì and yīn.