Qi deficiency

Qi (气) is the working capacity of a body: the ability to hold things up, keep things in, warm them, and move them along. Chinese medicine never describes it as a substance you could isolate in a jar. It describes it by what falters when there is not enough, which is why the classical picture of this pattern is a list of functions running at half power rather than a list of complaints.

The word translated as deficiency is 虚 xū, vacuity — not enough, as against 实 shí, repletion, which is too much of something. That fork is the oldest one in the tradition and it decides everything downstream. Two people can be equally exhausted; if one is empty and the other congested, the suggestions run in opposite directions.

Two organ networks are named most often. The spleen (脾 pí) here is not the anatomical organ of that name: it is the whole business of turning food into usable substance, and it is the first thing named when meals are skipped, eaten cold, or eaten standing up. The lung (肺 fèi) governs the qi of the chest and the defensive layer at the surface, which is why one pattern shows up both as a voice that fades and as catching everything going round.

That sentence is more than two thousand years old, and it is the whole argument for looking at the ground before looking at what has grown on it. It is also why this pattern is the one our practitioners name most often in the reports they write for people in their thirties and forties.

The people who write to us about this pattern rarely open with the word tired. They describe a budget. There is a certain amount available in the morning, it is spent by two in the afternoon, and anything unplanned comes out of tomorrow.

• Tiredness that is worse after exertion and better after rest. This is the line that separates it from yin deficiency, where rest does not help much.
• A voice that runs out. An hour of talking is tiring in a way that is hard to explain to anyone.
• Sweating on the least effort, or on none at all, usually across the upper body — the classics call it 自汗 zì hàn, spontaneous sweat.
• Appetite is normal, but a full meal brings heaviness and a wish to sit down.
• Loose or unformed stools, particularly first thing in the morning.
• Bruises that appear without a remembered knock.
• Every cold going round arrives, stays a fortnight, and leaves a cough behind.

None of it is dramatic, which is exactly why it goes unexamined for years. It is also why it answers to unglamorous things: eating at the same times, sleeping before eleven, walking rather than sprinting.

We ask for one photograph in daylight because the tongue is the only internal surface a person can photograph. In this pattern it is fairly consistent.

Tooth marks are the sign readers find most striking, because they can check for them in a mirror a second after reading the words. On their own they prove nothing. The tongue is one of four classical sources — looking, listening, asking, feeling — and the thirty questions carry the rest of the weight.

Nothing below is a rule. It is what the people we write for report, set against what the tradition says about the same pattern.

What tends to make it heavier

• Skipping breakfast, or eating it walking to something.
• Raw and cold food as the default setting: salads, smoothies, iced drinks with every meal.
• Long stretches of over-thinking. The classics name worry as the emotion that specifically wears at the spleen.
• Exercising to exhaustion, especially before eating.
• A fortnight of short nights, or an illness that was never allowed to finish.

What tends to ease it

• Warm cooked food, eaten sitting down, at roughly the same times each day.
• Congee (粥 zhōu) in the morning — rice simmered long in a lot of water, the oldest convalescent food in China, and the one that asks least of digestion.
• Walking until you are warm rather than until you are spent.
• Sleeping before eleven, which the tradition counts as the hour the body starts rebuilding.
• One rest day a week that is not spent catching up on everything else.

The tradition calls this 药食同源 yào shí tóng yuán — medicine and food share one origin. The kitchen and the herbal shelf are two ends of one continuum rather than two different worlds. For an empty pattern the list runs to things that are mildly sweet, warm, and cooked a long time.

• 山药 shān yào, Chinese yam — steamed, or dropped into congee.
• 大枣 dà zǎo, jujube — two or three split open and simmered with fresh ginger.
• 小米 xiǎo mǐ, millet, cooked loose as a morning porridge.
• 黄芪 huáng qí, astragalus — a few food-grade slices simmered in chicken broth. In northern China this is a soup ingredient, not a supplement.
• 党参 dǎng shēn, codonopsis, the everyday soup root that stands in for ginseng in ordinary cooking.
• Pumpkin, sweet potato, chestnut, and broth cooked long enough to go slightly sticky.

Portions are ordinary portions, nothing is measured out, and none of it replaces a meal or anything a clinician has asked you to do. The full list, with what each item is traditionally associated with, is on the food as medicine page.

The point paired with an empty pattern is 足三里 Zúsānlǐ, Stomach 36, on the outside of the shin roughly a hand below the kneecap. It is the most pressed point in China by a wide margin, and the old line about it is about maintenance rather than rescue: 若要安，三里常不干, if you want to be well, keep Sanli moist. That referred to a blistering moxibustion once kept open at the point, which nobody should do now — the pressing version is the part that survived.

Thirty to sixty seconds of steady thumb pressure, both legs, once or twice a day. Where it is and how hard to press, and the rules that apply to pressing anything, are written out in full.

Patterns are descriptions, not boxes, and in practice they run into one another. This is the one that most often sits underneath something else.

• Left long enough it loses warmth as well as capacity, and is then read as yang deficiency — the same emptiness, plus cold.
• Because the spleen also moves fluid, a spleen running below capacity is the usual ground beneath dampness.
• Qi builds blood, so a long shortage often shows up beside blood deficiency: pale, dizzy on standing, awake at three.
• Yin deficiency is the one it is confused with most, because both are exhausting. The separator is heat, and whether rest helps.

A reading normally names one leading pattern and, where there is one, the pattern sitting beside it. Five names are not a taxonomy of people. They are a vocabulary for describing what a body is doing this year.

None of that means Chinese medicine has nothing to say afterwards. It means the first question belongs to someone who can examine you, order a blood count, and put a stethoscope on your chest. We will still be here.