bubble_chart Concept

Qi deficiency pattern refers to a general term for systemic weakness symptoms caused by the decline in the function of the zang-fu organs and insufficient original qi. This syndrome is often caused by factors such as old age, post-illness, dietary overstrain leading to internal damage, or congenital insufficiency. It falls under the category of deficiency pattern.

The main clinical manifestations of this syndrome include: mental fatigue and lack of strength, shortness of breath, faint and low voice, reluctance to speak due to shortage of qi, poor appetite, or a pale complexion, dizziness and blurred vision, palpitations and spontaneous sweating, a pale tongue, and a weak, thin pulse.

Qi deficiency pattern can be seen in various conditions involving the deficiency of zang-fu organs, especially in "five zang-organs deficiency pattern", "insecurity of the exterior and defensive qi", and "wheezing syndrome".

This syndrome should be differentiated from "yang deficiency pattern" and "qi sinking pattern".

bubble_chart Differentiation and Treatment

In clinical practice, apart from the common symptoms of mental fatigue, lack of strength, and shortness of breath, this syndrome can manifest differently depending on the affected zang-fu organs.

1. For example, in cases of lung qi deficiency, due to the decline in the lung's function of governing qi, the dispersing and descending functions are impaired, leading to symptoms such as shortness of breath, mental fatigue, reluctance to speak, weak cough, difficulty in expectorating phlegm, fear of wind, spontaneous sweating, and susceptibility to common cold. The treatment should focus on tonifying the lung and replenishing qi, using Lung-Nourishing Decoction(Yonglei Qianfang) with modifications.
2. In cases of spleen qi deficiency, due to the decline in the spleen's function of governing transportation and transformation, the distribution of nutrients is hindered, leading to symptoms such as poor appetite, mental fatigue, lack of strength, abdominal distension and fullness, and sloppy diarrhea. The treatment should focus on tonifying the spleen and replenishing qi, using Ginseng, Poria and White Atractylodes Powder(Hejiju Fang) with modifications.
3. In cases of heart qi deficiency, due to the decline in the heart's function of governing blood and vessels and storing the spirit, the heart qi cannot promote blood circulation and gather the spirit, leading to symptoms such as pale complexion, mental fatigue, shortness of breath, forgetfulness, and palpitation. The treatment should focus on tonifying and replenishing heart qi, using Milkwort Root Decoction (Zhengzhi Zhunsheng) with modifications.
4. In cases of liver qi deficiency, due to the decline in the liver's function of governing the free flow of qi, the generation of liver qi is affected, leading to symptoms such as shortness of breath, irritability, palpitation due to fright, timidity, and bitter taste in the mouth. The treatment should focus on tonifying qi, benefiting the mind, and strengthening the liver and gallbladder, using Spirit-Tranquillizing Mind-Stabilizing Pill(Yixue Xinwu) with modifications.
5. In cases of kidney qi deficiency, due to the decline in the kidney's function of storing essence and receiving qi, the kidney essence cannot transform into qi to nourish the body, leading to symptoms such as soreness and weakness of the lower back and knees, vertigo, tinnitus, shortness of breath upon exertion, seminal emission, enuresis, and clear and profuse urine. The treatment should focus on tonifying and replenishing kidney qi, using Major Original-Qi Tonifying Decoction(Jingyue Quanshu) or Ginseng and Gecko Powder (from the "Clinical Formula Handbook of Chinese Medicine") with modifications.

Of course, due to the interconnections between the zang-fu organs, the pathological changes of the five zang organs can also intersect and influence each other. From the holistic perspective of clinical pattern identification, manifestations such as "heart-spleen qi deficiency," "lung-spleen qi deficiency," "spleen-stomach qi deficiency," "heart-gallbladder qi timidity," and "lung-kidney deficiency" can occur, indicating simultaneous involvement of zang and fu organs.

There are also cases where qi deficiency leads to "weakness of the exterior defense," where the defense qi cannot secure the exterior, and the striae and interstices are not tight, allowing external pathogens to invade, leading to symptoms such as fear of wind, spontaneous sweating, susceptibility to common cold, and goosebumps. The treatment should focus on replenishing qi and consolidating the exterior, using Jade Screen Powder(Danxi Xinfa) with modifications.

In cases of qi deficiency seen in "wheezing syndrome," initially, it is mainly lung qi deficiency, manifesting as cough, wheezing, and shortness of breath, with the same treatment principles and formulas as lung qi deficiency pattern. Later, it is mainly lung-spleen qi deficiency, manifesting as panting, shortness of breath, poor appetite, and loose stool. The treatment should focus on banking up earth to generate metal, treating both the lung and spleen, using Middle-Tonifying Qi-Replenishing Decoction(Piwei Lun) with modifications.

Finally, it is mainly lung-kidney qi deficiency, manifesting as wheezing with shoulder lifting, more exhalation than inhalation, worsening panting upon exertion, sweating, cold limbs, and symptoms of kidney failing to receive qi. The treatment should focus on benefiting the kidney to receive qi and calming the lung to relieve wheezing, using Golden Chamber Kidney Qi Pill(Jingui Yaolue) or Ginseng and Walnut Decoction(Jisheng Fang) with modifications.

In clinical practice, this syndrome should be differentiated based on the characteristics of different constitutions and ages. Generally, it can be divided into two situations:

1. One is kidney qi deficiency, often due to congenital insufficiency, weak constitution, insufficient primordial essence, and empty marrow sea. The kidney, being the innate foundation, stores essence and transforms it into qi to nourish the body. Kidney deficiency leads to a lack of root and foundation, unable to nourish essence and generate bones, resulting in slow development, delayed growth of teeth and hair, low intelligence, poor appetite, soft bones, listlessness, sallow complexion, and emaciation in children. In adults, it can lead to symptoms such as soreness of the lower back, vertigo, tinnitus, and impotence.
2. The second is spleen-stomach qi deficiency, which is mostly caused by postnatal imbalance, improper diet, overstrain, and the inability of the spleen and stomach to generate and transform qi. The stomach governs reception and digestion of food, while the spleen governs transportation and transformation. When food is ingested and transformed, the source of qi and blood is continuous, leading to a strong and robust body. Li Dong-yuan believed that improper diet harms the stomach, and overstrain harms the spleen. He proposed: "The sufficiency of original qi depends on the spleen and stomach qi being unharmed, which then nourishes the original qi. If the stomach qi is inherently weak and food intake is excessive, the spleen and stomach qi will be damaged, and the original qi cannot be replenished, leading to the onset of various diseases." (Piwei Lun．"On Spleen-Stomach Deficiency and Its Transformation"), emphasizing that insufficient spleen-stomach qi is the key to causing qi deficiency pattern. At the same time, it explains that spleen-stomach qi deficiency is one of the root causes of other diseases.

Therefore, those with congenital deficiencies or postnatal imbalances are more prone to this syndrome. However, the two can be mutually causal and should not be completely separated. In clinical diagnosis, the primary and secondary aspects should be identified. It should also be noted that during the hot summer, excessive sweating can easily deplete original qi. Suwen．Cizhi Lun states: "Qi deficiency with body heat results from summerheat injury." Thus, symptoms such as sweating, shortness of breath, and mental fatigue with lack of strength may be observed in this syndrome.

In the course of disease progression, this syndrome can manifest various complications.

1. For example, due to qi deficiency leading to poor circulation, symptoms such as "qi deficiency abdominal distension and fullness" may appear, characterized by abdominal distension and fullness, mental fatigue, shortage of qi, and loose stools;
2. due to qi deficiency leading to external pathogen invasion, symptoms such as "qi-deficiency fever" may appear, characterized by susceptibility to common cold fever, fluctuating fever intensity, mental fatigue, and shortness of breath;
3. due to qi deficiency leading to impaired spleen function and internal accumulation of phlegm-dampness, symptoms such as "qi deficiency phlegm cough" may appear, characterized by cough, shortness of breath, copious and sticky phlegm, anorexia, and mental fatigue;
4. due to qi deficiency leading to poor distribution of body fluids, it can cause the body's zang-fu organs, muscles, skin, and hair to lose their warmth and nourishment, leading to symptoms such as "qi failing to warm," characterized by emaciation, mental fatigue, lack of strength, dull skin and hair, low body temperature, and reduced resistance to disease;
5. due to qi deficiency leading to inability to transform water, affecting the qi transformation functions of the lungs, spleen, kidneys, and triple energizer, symptoms such as "qi deficiency water flooding" may appear, characterized by edema, difficulty in urination, dribbling, and ischuria;
6. due to qi failing to control blood, symptoms such as "failure of qi to control blood" may appear, characterized by epistaxis, hemoptysis, hematemesis, hematuria, bloody stools, subcutaneous purpura, prolonged menstrual bleeding, menorrhagia, and metrostaxis;
7. due to the common origin of qi and blood and the mutual rooting of yin and yang, qi deficiency leading to inability to generate and transform blood, affecting blood production, symptoms such as "deficiency of both qi and blood" may appear, characterized by dizziness, blurred vision, dull complexion, shortage of qi, reluctance to speak, palpitations, poor appetite, thin pulse, and pale, swollen tongue texture;
8. due to prolonged qi deficiency leading to severe depletion of original qi, symptoms such as "sinking of middle qi," "deficiency of both qi and yin," and "collapse of original qi" may also appear.

These will not be detailed here. In summary, many diseases evolve from this syndrome, and clinical differentiation should be based on the root and branch, sequence, and deficiency and excess.

bubble_chart Differentiation of Similar Patterns

1. Yang deficiency pattern and qi deficiency pattern: Both are manifestations of systemic deficiency pattern, and the clinical lesion sites are often similar. However, qi belongs to yang, and yang transforms qi. Yang deficiency refers to the deficiency of yang qi, so the two have a cause-and-effect relationship. From the perspective of disease cause and mechanism of disease: Both are caused by insufficient endowment, dietary overstrain, internal damage, or factors such as aging and post-illness, leading to the deficiency of original qi, zang-fu organ functional decline, resulting in deficiency pattern. However, the invasion of cold pathogens easily damages yang and obstructs the movement of yang qi, which is another important factor leading to yang deficiency pattern. From a clinical perspective: Both have symptoms such as mental fatigue, lack of strength, shortness of breath, reluctance to speak, low voice, spontaneous sweating, and pale tongue. However, qi deficiency pattern is mainly characterized by "deficiency" with no obvious cold signs, while yang deficiency pattern must have the signs of "deficiency-cold," which is the key point of differentiation between the two. Qi deficiency pattern may show loose striae and interstice, fear of wind, while yang deficiency pattern is characterized by yang qi failing to warm and evaporate, leading to cold limbs; qi deficiency pattern shows a weak and thin pulse, while yang deficiency pattern shows a deep and thin or thin and slow pulse; qi deficiency pattern may present with weak urination or enuresis, loose stools, while yang deficiency pattern shows clear and long urination, loose stools, and in severe cases of spleen-kidney yang deficiency, symptoms such as diarrhea with undigested food, undigested food in stool, and edema may appear. It can be seen here that the further development of qi deficiency can lead to yang qi deficiency, and yang qi deficiency must have certain manifestations of qi deficiency. From the perspective of treatment principles: The treatment principle for qi deficiency pattern is tonifying qi, while yang deficiency pattern should be treated by warming yang and replenishing qi.
2. Qi sinking pattern and qi deficiency pattern: Both are deficiency pattern due to insufficient original qi. Qi sinking pattern is another clinical manifestation of qi deficiency pathology, specifically reflecting the inability of qi to ascend, which is related to the spleen, stomach, kidney, bladder, large intestine, and the Chong and Ren meridians' zang-fu organs and meridian/channel qi's inability to ascend. Therefore, qi sinking pattern not only has some manifestations of qi deficiency pattern but also prominently features the sinking of middle qi, unsecured lower gate, and the inability of original qi to ascend. The key points of differentiation between the two are: First, both have manifestations of qi deficiency due to insufficient original qi and decline in organ function, but qi sinking pattern is mainly characterized by the sinking of middle qi and the inability of original qi to ascend; second, qi deficiency pattern is a systemic clinical manifestation, and its symptoms vary depending on the zang-fu organ location of the disease, but qi sinking pattern mainly involves the spleen and stomach's sinking of middle qi, with the lesion site focused on the middle and lower energizer, often presenting symptoms such as lower abdominal prolapse, rectal prolapse, uterine prolapse, menorrhagia, and metrostaxis; third, qi deficiency pattern is mainly treated by tonifying qi, while qi sinking pattern is mainly treated by lifting original qi.

bubble_chart Documentation

1. Suwen-Tongping Xushi Lun："When pathogenic qi is exuberant, there is repletion; when essential qi is depleted, there is vacuity."
2. Zhubing Yuanhou Lun-Qi Disease Various Manifestations: "Shortness of breath manifestation: In a normal person without cold or heat, if shortness of breath is insufficient for respiration, the body is replete. Repletion means qi is exuberant; exuberance leads to counterflow qi failing to move freely, hence shortness of breath. Also, when the lung is vacuous, qi becomes scant and insufficient, also causing shortness of breath, where the person's qi is faint, constantly appearing as if lacking sufficient qi for breathing."
3. Suwen-Cangqi Fashi Lun： "Liver disease... when vacuous, the eyes are blurred with nothing visible, the ears hear nothing, prone to fear, as if someone is about to capture them." "Heart disease... when vacuous, the chest and abdomen are enlarged, with pain radiating from the hypochondrium to the waist." "Spleen disease... when vacuous, the abdomen is distended with intestinal rumbling, undigested food diarrhea." "Lung disease... when vacuous, there is scant qi unable to sustain respiration, deafness and dry throat." "Kidney disease... when vacuous, there is pain in the chest, large and small abdominal pain, clear inversion, and unhappiness."
4. Jingyue Quanshu-New Formulas Eight Tactical Arrays: "For all cases of qi vacuity, supplementing the upper is appropriate, such as Ginseng, Astragalus Root and the like. For essential vacuity, supplementing the lower is appropriate, such as Prepared Rehmannia Root, Barbary Wolfberry Fruit and the like. For yang vacuity, supplementing with warmth is appropriate, such as Cinnamon, Aconite, Dried Ginger and the like. For yin vacuity, supplementing with coolness is appropriate, such as Ophiopogon, Peony Root, Unprocessed Rehmannia Root and the like."