bubble_chart Concept

Qi sinking pattern is a general term for a series of symptoms caused by congenital deficiency and postnatal maladjustment, resulting in the depletion of original qi, abnormal ascending and descending of qi movement, characterized by the sinking of middle qi and the inability to lift. It belongs to a common type of qi deficiency pathology, often seen in internal damage Zabing.

The main clinical manifestations of this syndrome are: shortness of breath, lack of strength, mental fatigue, reluctance to speak, abdominal distension and fullness, chronic diarrhea, prolapse of rectum, prolapse of uterus, pale and swollen tongue texture, and weak and slow pulse.

This syndrome is scattered in diseases such as "diarrhea," "stomach pain," "prolapse of rectum," and "prolapse of uterus."

Qi sinking pattern should be differentiated from "qi collapse pattern," "pattern of clear yang failing to ascend," "qi deficiency pattern," and "kidney qi insecurity pattern."

bubble_chart Differentiation and Treatment

In clinical practice, the manifestations of qi sinking pattern vary due to differences in the cause and location of the disease. For example,

1. this syndrome can be seen in "chronic diarrhea" caused by persistent diarrhea, often due to dietary overstrain, internal damage to the spleen and stomach, stomach deficiency leading to inability to digest food, spleen deficiency leading to inability to transport and transform, long-term depletion of original qi, sinking of middle qi, and dysfunction of the large intestine in transmission and transformation, resulting in loss of control over retention. Symptoms include thin stools, persistent chronic diarrhea, uncontrolled diarrhea, stools leaking with flatus, accompanied by mental fatigue, anorexia, slight abdominal distension and fullness, pale tongue texture, thin and greasy coating, deep and thin, soggy and weak pulse. Treatment should focus on warming yang and stemming collapse, replenishing original qi, with formulas such as Chebula Fruit Powder (Jingui Yaolue) or Immortal Organ-Nourishing Decoction(Hejiju Fang) modified.
2. In cases of "epigastric pain" due to deficiency, this syndrome can also be seen, often caused by irregular diet, overthinking damaging the spleen, failure of spleen qi to ascend, leading to inability to transport and transform the essence of water and grains to nourish the zang-fu organs and the limbs, resulting in sinking of middle qi. Symptoms include emaciation, epigastric distension and pain, mainly distension, worsening after eating, visceral prolapse, accompanied by dizziness, blurred vision, mental fatigue, lack of strength, pale tongue, thin and weak pulse. Treatment should focus on tonifying qi, strengthening the spleen, and raising middle qi, with formulas such as Middle-Tonifying Qi-Replenishing Decoction(Piwei Lun) modified.
3. This syndrome is also seen in "prolapse of rectum," often due to depletion of original qi in the elderly, difficulty in defecation with straining, and relaxation of the large intestine due to fistula disease. Symptoms include prolapse of rectum after defecation, inability to retract spontaneously, prolapse recurring after retraction, sallow complexion, fatigue, pale and swollen tongue, thin pulse. Treatment should focus on replenishing original qi, lifting and raising the prolapse, with formulas such as Middle-Tonifying Qi-Replenishing Decoction plus ginseng and reed rhizome.
4. "Prolapse of uterus" is also caused by sinking of middle qi failing to ascend, often seen in women with multiple pregnancies, or those who strain excessively during labor or overwork. Due to insufficient original qi, damage to the uterine vessels, and relaxation of all tendons, symptoms include slight abdominal distension and fullness, uterine prolapse, accompanied by shallow yellow complexion, lack of strength, etc. Treatment should focus on tonifying qi and cultivating original qi, lifting the uterus and its appendages, with formulas such as Middle-Tonifying Qi-Replenishing Decoction plus green tangerine peel and gardenia.

Qi sinking pattern is a clinical manifestation in the pathological process of qi deficiency. It is commonly seen in individuals with weak constitution, thin and tall body shape, or those with irregular diet, excessive sexual activity, or multiple pregnancies. It is generally more common in middle-aged and elderly individuals. In women, insufficient original qi often affects the Chong and Ren meridians, as Chong is the Sea of Blood and Ren governs the uterus. Impaired nourishment of Chong and Ren meridians, sinking of middle qi, leads to loss of support for the uterine vessels, resulting not only in "prolapse of uterus" but also in symptoms such as slight abdominal distension and fullness, menorrhagia and metrostaxis, threatened abortion, and habitual abortion. Qi sinking pattern is rare in children but not absolute, and clinically it can also be seen in cases of spleen deficiency chronic diarrhea or sunken fontanel like a pit.

Qi sinking pattern mainly manifests as failure of spleen qi to ascend and sinking of middle qi, thus it is closely related to the spleen and stomach. However, qi belongs to yang, and failure of spleen qi to ascend can further lead to spleen yang deficiency, resulting in retention of water-dampness, phlegm-fluid retention, and other conditions. Sinking of middle qi can further affect the kidneys, leading to insecurity of kidney qi and symptoms such as enuresis and urinary incontinence. This syndrome, due to sinking of middle qi and spleen deficiency leading to impaired transportation and transformation, results in deficiency of the middle energizer's source of transformation, leading to blood deficiency due to failure of qi to generate blood, and symptoms of dual deficiency of qi and blood such as vertigo and palpitation. At the same time, due to sinking of middle qi and insufficient original qi, failure of qi to control blood can lead to bleeding, such as bloody stool and hypermenorrhea.

bubble_chart Differentiation of Similar Patterns

1. Qi collapse pattern and qi sinking pattern: Both develop from qi deficiency, with the pathological basis being "qi deficiency." Qi collapse pattern is often seen in sudden illnesses or the advanced stages of chronic sexually transmitted diseases, caused by the decline of original qi, or following significant blood loss, leading to qi collapse following blood loss. Symptoms include profuse sweating, listlessness, shortness of breath, pale complexion, a flaccid and unextended tongue, urinary incontinence, and a faint, thready pulse. Qi collapse pattern is a clinical manifestation of various qi deficiency conditions in critical stages. The key points for differentiation are:
   1. Although both conditions are based on qi deficiency, this syndrome is mainly seen in chronic diseases, while qi collapse pattern is not only seen in the advanced stages of chronic sexually transmitted diseases but also in acute conditions, such as the pattern of qi collapse following bleeding or the pattern of collapse in apoplexy.
   2. The mechanism of disease in qi collapse pattern is the exhaustion of original qi and the collapse of healthy qi, while the mechanism in this syndrome is the insufficiency of original qi and the failure of spleen qi to ascend, leading to the sinking of middle qi.
   3. The tendency of disease in qi collapse pattern is critical and severe, primarily manifesting as systemic healthy qi exhaustion, including profuse sweating, pale complexion, listlessness, open mouth and relaxed hands, and incontinence of urine and stool. In contrast, this syndrome has a slow and prolonged tendency, mainly manifesting as the inability of middle and lower energizer original qi to ascend, seen in symptoms like abdominal distension and fullness, prolapse of the rectum, and diarrhea.
   4. Qi collapse pattern urgently requires tonifying qi to stabilize collapse and rescue the critically ill immediately. If treatment is delayed, the prognosis is poor. This syndrome, however, should be treated by raising middle qi gradually.
2. Pattern of clear yang failing to ascend and qi sinking pattern: Both are disorders of qi movement and manifest as a decline in the ascending function of qi. However, the pattern of clear yang failing to ascend mainly refers to the failure of turbid yin to descend. Clear yang and turbid yin are a pair of contradictions in pathological changes, often influencing each other. The pattern of clear yang failing to ascend primarily presents with upper energizer symptoms, such as dizziness, blurred vision, tinnitus, and deafness, as well as middle and lower energizer symptoms like epigastric distension and fullness, and loose stools. However, the pattern of clear yang failing to ascend is mainly characterized by the failure of yang qi to ascend, with turbid yin failing to descend as a secondary aspect, often presenting as a complex pattern of deficiency and excess. It can also manifest as an excess pattern due to phlegm-turbidity obstructing the middle, leading to chest and gastric stuffiness, nausea, vomiting, and vertigo. In contrast, qi sinking pattern is mainly due to the failure of spleen qi to ascend and the sinking of middle qi, presenting primarily with middle and lower energizer symptoms, and is purely a deficiency pattern.
3. Qi deficiency pattern and qi sinking pattern: Both are deficiency pattern. Qi sinking pattern often evolves from qi deficiency pattern, with a causal relationship between the two. Qi deficiency pattern mainly refers to the insufficiency of original qi throughout the body, zang-fu organ functional decline, which can vary in clinical manifestations depending on the affected area. Qi sinking pattern, while it may include symptoms of qi deficiency pattern such as mental fatigue, lack of strength, and shortness of breath due to insufficient original qi, is more prominently characterized by the sinking of middle qi and the inability of original qi to ascend, seen in symptoms like lower abdominal distension and fullness, diarrhea, prolapse of the rectum, and uterine prolapse. Therefore, the pathological location is mainly in the middle and lower energizers. Differentiation should be based on these points.
4. Kidney qi insecurity pattern and qi sinking pattern: Both are deficiency pattern and can present with lower energizer symptoms such as diarrhea and lower abdominal distension and fullness. However, kidney qi insecurity pattern can develop from qi sinking pattern, with spleen qi deficiency affecting kidney qi deficiency, leading to spleen-kidney qi deficiency and the inability to secure the kidney gate. There is a certain connection in the mechanism of disease between the two. However, the syndrome of kidney gate insecurity can manifest as spleen-kidney deficiency with symptoms like "diarrhea before dawn," which differs from the chronic diarrhea seen in qi sinking pattern. It can also present with urinary incontinence, enuresis, and increased nocturia in the elderly due to insufficient kidney qi and the inability to secure the lower gate. Additionally, it can manifest as seminal emission, spermatorrhea, and turbid urine due to kidney qi deficiency and the inability to secure the essence gate. Therefore, the key points for differentiation are: 1) The pathological location of kidney qi insecurity pattern is mainly in the lower energizer kidney, while qi sinking pattern is in the middle energizer spleen and stomach. 2) The clinical manifestations of kidney qi insecurity pattern are mainly due to the inability of kidney qi to warm and assist transportation, leading to dysfunction in qi transformation and the inability to secure the lower gate, often accompanied by soreness and weakness in the lower back and knees. In contrast, qi sinking pattern is mainly characterized by the failure of spleen qi to ascend and the sinking of middle qi, often accompanied by mental fatigue and anorexia.

bubble_chart Documentation

1. Lingshu．Kouwen Chapter: "Insufficient middle qi leads to changes in urination and defecation."
2. Zhubing Yuanhou Lun．Dysentery Diseases: "Prolapse of rectum condition: Prolapse of rectum refers to the protrusion of the anus, often caused by prolonged dysentery leading to large intestine deficiency and cold. The anus is a reflection of the large intestine; when the large intestine is deficient and damaged by cold dysentery, the qi descends and rushes downward, causing the anus to protrude, hence termed prolapse of rectum."
3. Zhubing Yuanhou Lun．Women's Miscellaneous Diseases Conditions: "Prolapse of uterus and descent condition: Damage to the uterine collaterals and uterine deficiency cold cause the qi to rush downward, leading to prolapse of the uterus, termed descent. It can also occur due to excessive exertion during childbirth, causing the yin to descend. Diagnosis shows the Shaoyin pulse floating and moving; floating indicates deficiency, and moving indicates palpitations, hence the descent."
4. Jingyue Quanshu．Lin Syndrome: "Lin syndrome resembling white turbidity is a sign of sinking middle qi and unsecured life gate."
5. Jingyue Quanshu．New Formulas Eight Tactical Arrays: "Original-Qi Lifting Decoction: Treats qi deficiency sinking, menorrhagia, blood collapse, yang exhaustion, and other critical conditions." 《Medical Golden Mirror．Gynecology Essentials: "After menstruation, if a woman continues to drip without stopping, it is called menstrual fistula disease; if menstruation suddenly becomes profuse and does not stop, it is called menstrual collapse. Additionally, there are cases of worry damaging the spleen, leading to spleen deficiency and inability to control blood; and cases of sinking middle qi, leading to inability to secure blood..."