The Subtle Effects of Qi Imbalance: Insights into Pain and Disease

The Yellow Emperor asked: “I have heard that those who are skilled in discussing the way of Heaven can apply its principles to human nature. Those who are adept at discussing the past and present can bridge ancient wisdom with current realities. Those who are skilled in talking about others can also connect their observations to their own experiences. Only through such understanding can one eliminate doubt, grasp the truth, and achieve a deep, thorough comprehension of the medical way. I now wish to ask you about diagnostic methods that are tangible, visible, and experiential—methods that will help me break through ignorance and resolve confusion. Could you share your insights with me?”

Qi Bo respectfully bowed and asked: “What principles do you wish to inquire about?”
The Yellow Emperor replied: “I would like to know about sudden pains in the five organs. What kind of evil Qi causes such pain?”

Qi Bo answered: “The Qi and blood circulating through the meridians of the body flow continuously and without interruption. When cold Qi invades the meridians, it causes blood to stagnate, becoming thick and blocked. If the cold Qi attacks outside the meridians, it reduces blood flow; if it invades the meridians themselves, it causes blockages, leading to sudden pain.”

The Yellow Emperor asked: “Sometimes the pain stops suddenly; sometimes it is intense and unrelenting; other times, the pain is so severe that it cannot be touched; and sometimes, pressing or massaging alleviates it. How can we differentiate these various pains?”

Qi Bo explained: “When cold Qi invades the meridians from the outside, it causes the pulse to constrict. This constriction leads to sharp, sudden pain in the finer vessels. The pain will subside with heat but will return if exposed to further cold. When cold Qi penetrates deeper into the meridians, it clashes with the heat within. This causes the meridians to become overly full, leading to intense, unrelenting pain that should not be touched.

When cold Qi invades the stomach and intestines, it causes the blood to stagnate, and the smaller vessels become tight, causing pain. Massaging the area can help release the stagnant blood and alleviate the pain. However, when cold Qi invades the governing vessel, even deep pressure cannot reach the source of the pain, making it ineffective.

If cold Qi invades the chong vessel, which begins at the Guan Yuan point and rises through the abdomen, the energy flow is obstructed, and the pulse becomes blocked, causing localized pain in the abdomen. Cold Qi affecting the back channels will cause blood and Qi to stagnate, leading to pain, which can be relieved with heat from hand pressure.

Cold Qi entering the liver’s meridian will affect the ribs and lower abdomen, causing a pain that radiates between these areas. The energy in the lower abdomen can also cause pain to radiate to the groin. If the cold Qi penetrates into the small intestine, the Qi will stagnate and, over time, form small intestine Qi stagnation.

If cold Qi reaches the five organs, it causes reversal of Qi flow, leading to sudden, excruciating pain, and potentially unconsciousness. If the Yang Qi returns, the person may regain consciousness. In cases of cold invading the stomach and intestines, the reverse Qi flow leads to abdominal pain and vomiting. Cold Qi in the small intestine will cause a lack of digestion, resulting in diarrhea and abdominal pain.”

The Yellow Emperor asked: “Can these conditions be diagnosed through questioning or visual observation?”
Qi Bo responded: “Each of the five organs and six bowels has a corresponding area on the face. By observing the colors of the face—yellow and red indicate heat, white indicates cold, and blue and black indicate pain—we can diagnose the condition visually.”

The Yellow Emperor inquired further: “Can palpation help diagnose these conditions?”
Qi Bo replied: “Yes, it depends on the pulse. A firm pulse indicates excess, while a sunken pulse suggests deficiency. These can be detected through palpation.”

The Yellow Emperor said: “That makes perfect sense! I have also heard that many diseases arise from imbalances in Qi. For example, extreme anger causes Qi to rise, excessive joy leads to Qi dispersal, deep sorrow causes Qi to dissipate, fear causes Qi to descend, cold causes Qi to contract, heat causes Qi to leak, excessive shock causes Qi to become chaotic, overwork leads to Qi depletion, and overthinking causes Qi stagnation. How do these nine changes in Qi each lead to illness?”

Qi Bo explained: “Extreme anger causes Qi to rise, which in severe cases can result in vomiting blood or diarrhea, leading to what we call ‘Qi reversal.’ Excessive joy smooths the Qi, allowing the defensive and nutritive Qi to flow freely, hence the term ‘Qi smooth.’ Excessive sorrow can cause a sense of urgency in the heart, leading to chest congestion and the inability of the Qi to disperse, causing internal heat stagnation, which is known as ‘Qi dissipation.’ Fear causes a depletion of essence and weakens the upper burner, causing obstruction in the Qi flow. The lower burner becomes swollen, which is called ‘Qi descent.’

Cold causes the pores to close, preventing the defensive Qi from circulating, which is known as ‘Qi contraction.’ Heat causes the pores to open too widely, allowing excessive sweating, referred to as ‘Qi leakage.’ Excessive worry leads to palpitations, as the mind becomes unsettled, which is termed ‘Qi disturbance.’ Overwork depletes both the internal and external Qi, leading to shortness of breath and exhaustion, called ‘Qi depletion.’ Overthinking causes stagnation in the mind, leading to stagnation in Qi and its inability to flow, hence ‘Qi stagnation.'”