Qi disease pattern differentiation is the categorization of patterns according to the pathological state of qi. Qi disorders are common and various, and their patterns can be divided into two types: deficiency and stagnation.

Fig. 10-1 Four types of qi deficiency pattern

Qi deficiency pattern is the pattern of genuine qi deficiency with diminished function of internal organs. It is marked by shortness of breath, lassitude, listlessness, spontaneous sweating, pale tongue and weak pulse.

Shortness of breath, lassitude and listlessness are due to insufficiency of genuine qi failing to provide enough energy. Spontaneous sweating is due to failure of weakened defense qi to secure the sweat pores. Pale tongue and weak pulse are the signs of qi deficiency.

Clinically there are heart qi deficiency, lung qi deficiency, spleen qi deficiency, gallbladder qi deficiency, kidney qi deficiency and heart-lung qi deficiency patterns.

Qi sinking pattern is a pattern resulting from failure of qi in its lifting or holding function, marked by dizziness, blurred vision, shortage of qi, lassitude, prolapse* of the anus, prolapse of the uterus or prolapse of stomach, pale tongue with white coating and weak pulse.

This pattern is usually the further worsening of qi deficiency and is mostly due to spleen qi deficiency. Therefore, it usually refers to sunken spleen qi pattern* and because spleen is in the middle energizer, it is also called sunken middle qi pattern*.

Visceroptosis* is caused by inability of deficient qi to lift and maintain the organs in their normal position. With qi deficiency, the clear yang cannot ascend properly to nourish the clear orifices, leading to dizziness and blurred vision. Deficient qi failing to provide power for breathing results in shortage of qi, and failing to provide energy to the body leads to lassitude. Pale tongue with white coating and weak pulse are signs of qi deficiency pattern.

Qi insecurity pattern arises when deficient qi fails to astringe sweat, stool, urine, blood, and sperm. This is manifested by shortage of qi, lassitude, pale complexion, pale tongue and weak pulse; or spontaneous sweating; or sialosis*, or enuresis, interruption of the stream or dribbling of urine after voiding and urinary incontinence; or stool incontinence; or flooding and spotting, or abortion in women; or spermatorrhea, premature ejaculation in men.

Shortage of qi and lassitude are caused by qi deficiency. Pale complexion is caused by qi deficiency failing to warm the skin and failing to carry the waste products away from the skin efficiently. Pale tongue is the result of qi deficiency failing to send blood to the tongue, and weak pulse is the result of qi deficiency failing to provide power for the heart to beat strongly. Deficient qi failing to secure fluid gives rise to spontaneous sweating and sialosis, enuresis, dribbling of urine after voiding and urinary incontinence oi stool incontinence. Failing to secure blood leads to flooding and spotting or abortion in women. Failing to secure sperm gives rise to spermatorrhea or premature ejaculation in men.*

Qi collapse pattern arises when body qi is extremely deficient. This condition is marked by the sudden appearance of profuse sweating, somber pale complexion, cyanotic lips, cold extremities, feeble breathing, even fainting or loss of consciousness with incontinence of urine, pale tongue and hardly perceptible* pulse.

Profuse sweating and feeble breathing are due to lung qi collapse failing to astringe sweat pores and interstices and failing to provide power for normal breathing. Heart qi collapse fails to provide energy for blood circulation leading to somber pale complexion and cyanotic lips. Qi pertains to yang and has warming function. When qi collapses, it fails to reach and warm the limbs, and then cold extremities occur. Collapsed qi is unable to provide power for the brain to function, resulting in fainting or loss of consciousness. Incontinence of urine is due to kidney qi collapse failing to secure and astringe the urine. Pale tongue and hardly perceptible pulse are signs of qi collapse.

There are mainly three stagnation patterns of qi: qi stagnation, qi counterflow and qi block, as shown in Fig. 10-2.

Fig. 10-2 Three types of qi stagnation pattern

Qi stagnation pattern results from stagnation of qi due to emotional upset, pathological products, or qi deficiency of viscera and bowels. It is characterized by intermittent thoracic, hypochondriac, epigastric and abdominal distention or pain, often ameliorated by sighing or belching.

Stagnant qi cannot pass through some places leading to distension or pain. Qi stagnation can be released when qi goes through, and location of qi stagnation is not fixed; therefore, distension and pain caused by qi stagnation can be intermittent and the place can change. Sighing or belching can help qi move through.

Qi counterflow pattern arises when qi moves abnormally upward. This is manifested by cough and dyspnea, or nausea, vomiting, hiccup, belching or even hematemesis. The patient can also have the sensation of gas ascending from the lesser abdomen to the chest or throat with abdominal distension and chest oppression, or headache and vertigo.

Lung qi ascending counterflow results in cough and dyspnea. Stomach qi ascending counterflow leads to nausea, vomiting, hiccup and belching. And liver qi ascending counterflow gives rise to hematemesis or feeling of gas ascending from the lesser abdomen to the chest or throat, with abdominal distension and chest oppression, headache and vertigo.

Qi block pattern is usually caused by emotional upset, external pathogen, phlegm-turbidity, calculi* or worms. It is marked by sudden loss of consciousness with restlessness, trismus and contracture* of limbs, or by colicky pain in the chest and abdomen, or sudden onset of panting with cyanosis, or fecal retention and urinary block.

If the blockage takes place in the chest or abdomen, it gives rise to colicky pain, or sudden onset of panting with cyanosis (heart or /and lung qi block), or fecal retention (intestinal qi block) and urinary retention (bladder qi block). If clear orifices are blocked, sudden loss of consciousness, trismus and contracture of limbs may occur.