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Sha Yuantai said: The medical classics state that all pain is caused by Qi (vital energy) dysfunction, and a hundred diseases arise from Qi. Zhang Hezi said: The normal Qi of heaven and earth brings peace in its constant state, but disturbance arises when it changes. Humans align with the Qi of heaven and earth; if the Five Movements and Six Qi invade from outside, and the Seven Emotions clash within, then sages cherish Qi as if it were a supreme treasure, while ordinary people exploit external things and thereby damage the internal Taihe (Great Harmony) Qi. This is what Xuanyuan (Yellow Emperor) and Qibo referred to when they said, "All pain is due to Qi, and all diseases arise from Qi," leading to the theory of nine different types of Qi movements. Qi is fundamentally one, but becomes nine due to different stimuli: anger, joy, sorrow, fear, cold, heat, fright, thought, and fatigue.

Generally, anger causes Qi to ascend; severe anger leads to rebellious Qi, which may result in hematemesis or undigested food diarrhea, representing Qi ascending. Joy causes Qi to relax; joy brings harmony to Qi and the mind, allowing Ying (nutritive) and Wei (defensive) Qi to flow freely, thus relaxing Qi. Sorrow causes Qi to dissipate; sorrow tightens the Heart vessels and expands the lungs, blocking the Upper Jiao (Upper Burner), preventing Ying and Wei Qi from dispersing, causing heat to stagnate in the middle, thus dissipating Qi. Fear causes Qi to sink; fear causes Essence to retreat, closing the Upper Jiao, causing Qi to return and distend the Lower Jiao, thus impeding Qi descent. Cold causes Qi to contract; cold closes the interstices (pores), obstructing Qi movement, thus contracting Qi. Heat causes Qi to leak; heat opens the interstices, allowing Ying and Wei Qi to flow freely with profuse sweating, thus leaking Qi. Fright causes Qi to become chaotic; fright leaves the Heart without support, the Spirit without refuge, and thoughts without focus, thus chaotic Qi. Fatigue causes Qi to consume; fatigue leads to panting and sweating, with internal and external Qi escaping, thus consuming Qi. Thought causes Qi to knot; thought fixes the mind on one object, causing Zheng Qi (Upright Qi) to remain stagnant, thus knotting Qi.

I have examined the details of diseases caused by these Qi disturbances, which are diverse. For instance, anger can cause hematemesis, undigested food diarrhea, Jian Jue (Frying Syncope), Bo Jue (Thinning Syncope), Yang Jue (Yang Syncope), chest fullness, and hypochondriac pain. Because Qi rebels and cannot descend, it causes wheezing, thirst, and vexation, potentially developing into Xiao Dan (wasting-thirst), Fei Qi (abdominal mass), sudden blindness, sudden deafness, flaccid tendons, or carbuncles and sores on the exterior. Joy can cause incessant laughter, dry and brittle hair, internal disease, failure of Yang Qi to secure, and even mania in severe cases. Sorrow can cause retraction of the genitals; Qi gathers in the Lung, damaging Liver Wood; excessive Metal damages the Lung itself. Fear damages the Kidney (Water); Qi gathers in the Kidney, damaging Heart Fire; excessive Water damages the Kidney itself. Thought damages the Spleen (Earth); Qi gathers in the Spleen, damaging Kidney Water; excessive Earth damages the Spleen itself. Cold damages the Form (Yin); if Cold overcomes Heat, Yang is diseased, and excessive Cold damages Yin. Heat damages Qi (Yang); if Heat overcomes Cold, Yin is diseased, and excessive Heat damages Yang. These factors can treat each other; thus, sorrow can treat anger by evoking pity; joy can treat sorrow by entertaining with playful words; fear can treat joy by frightening with talk of death; anger can treat thought by provoking with insults; thought can treat fear by distracting with planning. These five methods require cunning and unusual tactics to move the senses. Only those with talent and insight can use them.

Zhu Danxi said: Cold Qi, stagnant Qi, and rebellious Qi are all caused by the Lung suffering from Fire pathogenic factors. Qi has the nature of flaming upward, rising without descending, steaming the clear passages, and potentially becoming severe illness. The *Ju Fang* (Standard Prescriptions) often uses acrid, aromatic, drying, and hot herbs to add fire to fire; who bears the blame? Saying Qi disorders cannot be treated with tonification is a secular view. Although Qi disorders present with fullness and blockage, seemingly difficult to tonify, one must consider that deficiency of Zheng Qi prevents circulation, allowing pathogenic stagnation to persist. The classics say: "In the strong, Qi moves and the disease resolves; in the weak, Qi stagnates and disease forms." If Qi is weak, without tonification, how can it move? Qi belongs to Yang and does not inherently involve cold. The sensation of cold accompanying ascending Qi is due to hyperactivity causing harm, requiring control. Excess Qi becomes Fire. The sensation of cold rising from below is not true cold but rather Qi originating from the Liver, carrying Ministerial Fire, with severe Kidney heat; extreme Fire resembles Water, indicating Hyperactive Yang and Deficient Yin.

Yu Jiayan said: Abundant muscle indicates flourishing Blood, which is excellent. However, flourishing Blood can lead to Qi decline over time, creating imbalance. Qi and Blood sustain each other; why the imbalance? When Qi dominates, Blood flows; when Blood dominates, Qi fails to flow. This is not true Qi deficiency but apparent deficiency due to stagnation. Therefore, Qi-tonifying herbs should be avoided, while Qi-consuming herbs may be used. Tonifying Qi makes it more stagnant; consuming Qi aids its flow, eventually restoring Blood's regulation.

The *San Yin Fang* discusses diseases caused by the Seven Qi most extensively. Joy, anger, worry, thought, sorrow, fear, and fright are the Seven Qi injuries. Symptoms include phlegm stuck in the throat like cotton, impossible to cough up or swallow. Siqi Tang (Four Qi Decoction) powder mixed with honey and ginger juice for lozenges is suitable, along with Wuchen Tang (Black Sink Decoction) and various Seven Qi Decoctions from *Ju Fang*, selected based on excess or deficiency. Severe anger causing disease presents with blue-yellow complexion or hypochondriac distension; Chenxiang Jiangqi San (Aucklandia Descending Qi Powder), Muxiang Tiaoqi San (Costus Regulating Qi Powder), or Siqi Tang plus Zhike (Bitter Orange) and Muxiang are used, adding Renshen (Ginseng) and Shichangpu (Acorus) for deficiency. Phlegm-stagnation in obese individuals requires Erchen Tang (Two-Cured Decoction), Cangzhu (Atractylodes), and Xiangfu (Cyperus) to dry and open. Stagnation-fire-dryness in thin individuals requires Su Zi (Perilla Seed), Shanzhi (Gardenia), Danggui (Angelica), Shaoyao (Peony), and Danpi (Moutan) to descend and moisten. Elderly chest-diaphragm Qi stagnation with fullness, pain, or anorexia, even with rapid/slippery/large pulses, should be treated as deficiency; avoid Qi-consuming herbs. Lizhong Wan (Regulate the Middle Pill) or Liujunzi Tang (Six Gentlemen Decoction) plus Muxiang and Sharen is appropriate. For Qi failing to return to its source, Buguzhi (Psoralea) is primary, assisted by Baizhu (Atractylodes) and Chenxiang (Agarwood). For all cold Qi and women's Blood-Qi attacking heart/abdomen pain, Wuchen Tang is fastest. Women, being Yin-predominant and emotionally volatile, may experience chest oppression, flank pain, abdominal masses, irregular menstruation, dizziness, vomiting, or alternating chills/fever. Use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) or Su Zi Jiangqi, Chenxiang Jiangqi, Simo, or Limo Decoctions. Qi rising from the left indicates Liver Fire; stabbing pain indicates Fire, requiring Zhike in fire-descending formulas. Qi depression pain uses Muxiang Tiaoqi San. Worry-phlegm stagnation uses Daotan Tang (Phlegm-Expelling Decoction) plus Xiangfu and Wuyao. Blood stasis pain uses Taoren (Peach Kernel), Honghua (Safflower), and Guitou (Angelica Head). Food accumulation/cold-phlegm stabbing in flanks/back resistant to treatment uses Shenbao Wan. Chronic Qi knots unresponsive to herbs first take Chenxiang Huaqi Wan to open, followed by Liujunzi Tang delivering Jiangqi San. Sudden anger syncope with unconsciousness requires Suhexiang Wan (Styrax Pill). Acute vs. chronic Qi disorders differ: acute anger injuring Yin with hyperactive Yang syncope needs acrid-aromatic Qi-breaking herbs to open Yin closure. Chronic depression with non-circulating Qi and disharmonious Ying/Wei needs acrid-warm knot-resolving herbs to harmonize Ying/Wei.

Zhike benefits Lung Qi but damages high Chest Qi if overdosed. Qingpi clears Liver Qi but damages True Qi if overdosed. Muxiang regulates meridians and clears Lung, directing Upper Jiao Qi downward; contraindicated for Minsterial Fire rushing up. Sharen awakens Spleen Qi and ascends, allowing stagnant Qi to descend. Baidoukouwarms Lung Qi and descends, allowing Yang Qi to ascend. Xiangfu relieves stagnant Qi; Chenpi drains rebellious Qi. Wuyao, Zisu, and Chuanxiong scatter Qi, releasing turbidity via sweat. Houpo drains Stomach Qi; Qianhu pushes down old Qi; Binglang drains high Qi and drops turbidity, suitable for tenesmus with accumulation. Huoxiang's fragrance ascends Stomach Qi. Chenxiang regulates ascending/descending Qi. Nao She (Camphor/Musk) scatters True Qi. Su Zi and Xingren descend Qi and moisten dryness, suitable for stagnation-fire. Doukou, Dingchen, Tan, and She are acrid-hot, scattering depression-qi, suitable for acute depression but contraindicated for prolonged heat. Strong constitution with Qi stagnation/stabbing pain uses Zhike and Wuyao, adding Muxiang if ineffective. Obese Qi-stabbing uses Erchen Tang plus Houpo and Zhike. Qi-deficiency with weak pulse uses Yigong San plus Zhike and Muxiang.

Shiwan said: The world claims Qi disorders cannot be tonified, yet *Ju Fang* prescriptions like San Yin Seven Qi, Simo, and Limo contain Renshen. Does this not aid Qi pathology? Ancients used Ginseng not solely for tonification. In Ju Fang Seven Qi, Gui (Cinnamon) and Banxia (Pinellia) are primary; Ginseng guides Qi to disperse stagnation, not for tonification. In San Yin Seven Qi, purely acrid-dispersing, one dose of Ginseng merely assists Qi-moving herbs without harming Qi. Simo/Limo rely on Ginseng for endurance, not tonification.

[Diagnosis] A deep pulse indicates Qi disorder. Deep-slippery indicates Qi with Phlegm-Fluid. Extreme deep implies hidden pulse; choppy/weak is hard to treat, caused by Great Qi stagnation. Generally, deep-solid-strong pulses suit acrid-dispersion; deep-weak pulses suit warming-nourishment. Qi warms; treatment always involves acrid-warm knot-resolving.

Wang Shishan treated a widow, 40+, with wandering Qi body pain, back/hypochondriac distension/pain, recurring monthly, relieved by vomiting food, anorexia, bedridden. Liuiqi Yin and Erchen Tang worsened it. Pulse was fine, rapid, weak right side. Diagnosis: Worry/thought damaged Spleen, Qi depressed. Treatment: Tonify Spleen, scatter depression. Renshen 3 qian, Huangqi 2 qian, Danggui 1.5 qian, Chuanxiong 0.8 qian, Xiangfu, Huanglian, Gancao, Ganjiang, Sharen 0.5 qian each. After relief, pills of Renshen, Huangqi, Chuanxiong, Xiangfu, Shanzhi, Gancao, Shenqu cured her.

Feichou treated a woman with rising deficient fire, suppressed anger causing epigastric fullness, reduced appetite, acid belching, alternating cold/heat in head/extremities, lower abdominal pain, amenorrhea >6 months. Pulse vague, rapid, weak. Qi-breaking/blood-moving herbs failed. Diagnosis: Suppressed anger injured Liver; Liver Fire attacked Spleen Earth; Central Qi failed to distribute, dispersing with Liver Fire. Qi rises from dampness; dampness dries from fire. Sun dispels yin-mists; True Fire settles steaming. Pot on fire cooks food; digestion empowers Spleen/Stomach; Central Qi returns, symptoms resolve. Treatment: Shengliao Bawei Wan doubled with Guizhi and Fuzi. Cold/heat resolved in 10 days. Intermittent Yigong San improved appetite. Regulation led to menstruation and cure.