Lurking Pathogens 10
Enter the Qì level
In our last installment, we looked at the map of the Four Levels and their associated patterns (shō) and detailed the patterns in the Wèi (Defensive) level. Continuing on, let’s look at the Qì level. Because the Qì level is complex, we will split the discussion into two separate posts.
Qì level patterns
The Qì level is one of the most common zones for Lurking Pathogens (LP) to lodge. Because of its scope, ranging through all three burners, all of the Fǔ organs, and the Shàoyáng/Triple Burner aspect, it offers not only plenty of space for the pathogen to hide, but also numerous exits from which the evil Qì can be ushered out. Since the Qì level encompasses the Spleen, it is the locus for many of the common chronic digestive complaints which present in the clinic, as well as chronic fatigue, dampness and aching muscles. The complaints may have an intractable quality, coming and going, with dramatic flares or unexplained fevers. Maciocia (2015) quotes an axiom that “no one dies in the Qì level,” indicating that the pathology is seldom life-threatening. However, gradual weakening of the Zhèng Qì from its protracted struggle with the LP can debilitate the patient until the pathogen falls to the Yíng level, making the Qì level in many respects the most crucial battleground on which to fight. If the LP is on the Qì level, one must prevent its further penetration, and if it is on the Yíng or even Xuè levels, one must attempt to push the pathogen back into the Qì level, where it can then be expelled.
In Warm Disease theory, the Qì level has numerous associated patterns. Heat patterns can affect the Lung and/or Stomach, Large Intestine, and Gallbladder. Damp or damp heat patterns can target the Spleen and Triple Burner. For purposes of treatment with the modified Japanese Meridian Therapy (JMT) model, two of the five shō apply here: Lung and Spleen, corresponding to the rough separation of syndromes into heat and damp-heat (a common device, see for example Liu, 2005; Maciocia, 2022; and Maclean et al., 2018). Confounding pathologies such as phlegm may be addressed by point selection.
Lung [Yīn] Shō
Lung [Yīn] shō involves the lower or more internal aspect of the Lung, indicated by coughing, dyspnea and chest pain along with disappearance of exterior signs and appearance of interior signs. It correlates with Lung heat patterns in TCM and Warm Disease models, with the associated spread to the Yángmíng organs of Stomach and Large Intestine. Because the Lung shō involves the Spleen, the shō can be seen as a Tàiyīn - Yángmíng pattern in its entirety. It may spread to the Gallbladder as well, though perhaps not often enough to merit a subtype pattern. It is associated with pathogenic heat and dryness, and in later stages may present as a deficiency heat syndrome after the thin fluids have been consumed. Because the Lung governs Qì, it may also lead to dual Qì and Yīn deficiency.
The root treatment points emphasize the treatment principles of clearing Qì level heat and generating fluids, for which cold acrid and sweet herbs are usually prescribed, as well as some bitter agents to clear heat and downbear the Lung. The Fire point, LU-10 (yú jì), which corresponds to bitterness (Ikeda, 2004), may be used here; bitter herbs are known to be drying but this is less of a concern with acupuncture. LU-6 (kǒng zuì) is a useful option, as it clears Lung heat but also moistens. LU-5 (chǐ zé) as the Water point is frequently indicated for Lung heat. It is also said to be moistening (Yue, 2021), in resonance with the salty taste, and, as noted above, carries a strong downbearing energy. If the pathogen is closer to the Wèi level, LU-7 (liè quē) can be added to vent outward; it may also be seen to help in nourishing Yīn due to its association with the Ren Mai. LU-9 (tài yuān), the Earth point with its sweet taste can be used in cases where the Qì and/or Yīn have become depleted.
Spleen points can vary with the presentation. SP-2 (dà dū) can be used along with LU-10 (yú jì), or SP-9 (yīn líng qúan) with LU-5 (chǐ zé) to emphasize the bitter or salty nature of those points. SP-6 (sān yīn jiāo) or SP-3 (taì bái) can be employed to aid in nourishing fluids or boosting Qì in cases of deficiency presentations.
One potential consequence of heat in the Lung is the dessication of any fluid that has been trapped in the upper jiao by the shutdown of the Lung’s diffusing and downbearing functions. This may cause stuck phlegm to develop. In cases such as this, LU-5 (chǐ zé) is preferred because of its relation to the salty taste which softens hardness; this echoes the salty sea vegetables, shells and pumice which are used for this purpose in Chinese herbalism. SP-9 (yīn líng qúan) may be added, as well as SP-5 (shāng qiū), with its acrid resonance.
Yang meridian points can be assigned based on the manifestations. LI-2 (èr jiān) and/or ST-44 (nèi tíng), the Water points, can help to clear heat. LI-11 (qū chí) is well known as a heat-clearing point and can be used with Large Intestine heat bind along with ST-25 (tiān shū) and ST-37 (shàng jù xū). ST-40 (fēng lóng) is preferred for transforming phlegm.
Points: Root treatment: LU-10 (yú jì), LU-6 (kǒng zuì), LU-5 (chǐ zé) (heat), LU-9 (tài yuān) (deficiency); SP-2 (dà dū), SP-9 (yīn líng qúan) (heat), SP-6 (sān yīn jiāo), SP-3 (taì bái) (deficiency). Yang points: LI-2 (èr jiān), ST-44 (nèi tíng), LI-11 (qū chí) (Stomach and Intestine heat); ST-37 (shàng jù xū), ST-25 (tiān shū) (heat bind constipation); ST-40 (fēng lóng) (phlegm).
In the next installment, we will continue by looking at Spleen patterns.
Note: this newsletter is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Ikeda, M. (2004). Herb flavor properties and meridian therapy. North American Journal of Oriental Medicine, 11(31), 7-8.
Liu, G. (2005). Warm pathogen diseases: A clinical guide. Eastland Press.
Maciocia, G. (2022). The practice of Chinese medicine: The treatment of diseases with acupuncture and Chinese herbs. (3rd Edition). Elsevier Health Sciences (US).
Maclean, W., Lyttleton, J., Bayley, M., & Taylor, K. (2018). Clinical handbook of internal medicine: The treatment of disease with traditional Chinese medicine. Eastland Press.
Yue, H. (2019) Explanations of the channels and points, vol.1 (M. Brown, Trans.). Purple Cloud Press.