Ever feel like you’re stuck? Whether it’s on an idea, job tasks, or daily life, sometimes we feel as if things are getting stagnant. Stagnation comes from an obstruction, perhaps due to fatigue, frustration, lack of communication, stress, or uncertainty. If the flow of Qi is no longer free and flowing, there is Stagnation. Sometimes this Stagnation can reflect as pain, though this is not always the case. While any organ can experience stagnation, the most common are Liver, Stomach and Large Intestines. It occurs most commonly in the Liver as the one of the Liver’s jobs is to insure a smooth and harmonious flow of Qi. Invasion of the channels by Cold, Wind, Damp, Heat, Summer Heat or Phlegm can lead to stagnation. Additionally, Deficiency in the vital substances of organs such as Blood, Qi, Yin, or Yang can lead to Qi Stagnation.

It’s important to note that Blood and Qi are dependent on each other. The old adage is that “Qi moves the Blood and Blood carries the Qi.  The motive force of Qi moves the Blood, and the nourishing aspect of Blood helps to create Qi. Blood Stagnation occurs when there isn’t enough Qi to move the Blood. Cold, Trauma, Heat, Qi Stagnation, and Qi Deficiency can all cause Blood Stagnation.

The Stomach Qi moves the food to the Middle Jiao. The Spleen’s Qi  holds the food there while the Stomach’s fire “cooks” the food. The Spleen then transforms and transport the vital energy of the food, the Gu Qi, to the Upper Jiao where is undergoes further refinement and transformation.  Stomach Qi Stagnation occurs when the downward flow of Qi to the Stomach is disrupted. This causes a disturbance in the normal process of digestion and can lead to lack of appetite, vomiting, or indigestion. Vomiting is the presenting complaint when this occurs.

The Large Intestine received waste materials and moved it through the rest of the digestive track. When the movement of Qi is obstructed, it causes Large Intestine Stagnation. This is usually occurs in coincidence with other issues. It will cause constipation.

Hypothetical Cases

Case 1

Species: Iguana iguana (Iguana)
Age: 9 years
Gender: F

Clinical Diagnosis (conventional): Hepatic Lipidosis

Conventional Indications:

The patient presented with a history of inappetence, lethargy and in general a failure to thrive. On examination, there was evidence of moderate dehydration. There was cranial coelomic cavity distention, lethargy and irritability as well as abnormal posturing suggesting abdominal pain. Clinical pathology revealed an elevation in alanine aminotransferase (ALT) as well as aspartate aminotransferase (AST) and bile acids. Endoscopic examination of the coelomic cavity revealed that the liver appeared enlarged with rounded edges.

Traditional  Indications:

The patient demonstrated an abnormal posture on examination. Her skin lacked vibrant color.

TCVM Diagnosis: 

Phlegm Syndrome with Liver Qi Stagnation and Spleen Qi Deficiency

TCVM Assessment:

• Inappetence, lethargy-Spleen Qi Deficiency
• Coelomic cavity distenstion/Abdominal pain-Qi Stagnation
• Elevated ALT, AST-Liver
• Enlarged liver with rounded edges-Liver, Phlegm, Stagnation (which includes Qi)

Treatment Principles:

• Move Liver Qi
• Resolve Phlegm
• Tonify Qi, strengthen the Spleen
• Drain Damp
• Clear Heat

Acupoint  Prescription:

ST-36, ST-40, ST-44, BL-18, BL-19, BL-20, GB-34, LIV-3, LIV-13

• ST-36-Tonify Qi, He-sea point: clear Damp and Heat, Master point for the abdomen
• ST-40-Resolve Phlegm
• ST-44-Ying-stream point: Clears Heat and Damp-Heat
• BL-18-Back-Shu Association point for the Liver
• BL-19-Back-Shu Association point for the Gall Bladder
• BL-20-Back-Shu Association point for the Spleen
• GB-34-Earth point on GB channel, He-sea point, resolve Damp and Heat, aids in descending the Liver Qi
• LIV-3-Shu-stream and Yuan Source point for the Liver. Resolves Stagnation, tonifies
• LIV-13- Front-mu Alarm point for the Spleen, Influential point for the Yin Intersection of the Liver and Gall Bladder Channels. Beneficial for Liver over-regulating Spleen.

Chinese Herbal Prescription:

Chai Hu Shu Gan

• Moves Liver Qi Stagnation, moves Blood, stops pain. Harmonizes the Liver and Spleen.
• Dose at 200mg /kg PO BID

Wei Ling San

• Drains Damp, strengthens the Spleen, harmonizes the Spleen and Stomach. Helps to regulate Qi in the Middle Jiao.
• Dose at 300mg/kg PO BID

Food Therapy

• Ensuring an appropriate diet is key for this condition
• Foods to supplement include marrow soup, chicken, dandelion greens, cilantro, white fish

Case 2

Species: Lagomorph 
Breed: Mini lop
Age: 8 years
Gender: N

Clinical Diagnosis (conventional): Anorexia, Colic

Conventional Indications:

The patient presented with a history of anorexia for 3 days. Subsequently the patient demonstrated no stool and a painful abdomen as evidenced by abdominal splinting and tooth grinding. The history revealed that the rabbit was being fed a low fiber diet. He was recently added to this household.

Traditional  Indications:

Bright, alert and responsive. The pet was in good flesh (BCS 5/9).  There was moderate discomfort on palpation of the abdomen in the flank region. Additionally, there was evidence of much gas and fecal matter in the colon.

TCVM Diagnosis: 

Liver Qi Stagnation and Stagnation of Qi in the Large Intesting.

TCVM Assessment:

• Recently rehomed-Liver Qi Stagnation
• Pain on palpation of the abdomen with splinting-Qi Stagnation, generally Liver
• Constipation-This may come from a number of causes such as Qi Stagnation, Qi Deficiency, Blood Deficiency. Here the history and the presence of abdominal pain along with no signs of Deficiency support Qi

Treatment Principles:

• Resolve Stagnation
• Help Large Intestine Qi move
• Resolve constipation
• Improve appetite

Acupoint  Prescription:

LIV-1, LIV-3, LIV-14, CV-17, HT-7

• LIV-1-Promote the function of the Liver in directing the smooth flow of Qi and Blood.
• LIV-3- Promote the function of the Liver in directing the smooth flow of Qi and Blood.
• LIV-14-Relieve abdominal pain
• CV-17-Relieve abdominal pain
• HT-7-Calm the mind

Chinese Herbal Prescription:

Xiao Zhang San

• Breaks down Qi Stagnation
• Especially beneficial in cases of colic and bloat.
• Dose at 0.1g/kg PO BID

Food Therapy

• Immediately begin to feed appropriate high fiber diet. Force feed if necessary to avoid hepatic lipidosis.
• Add foods such as dill, fennel, ginger, plantain, basil, carrot, and turmeric.

 Edited by Greg Todd, DVM, CVA and Alex Kintz-Konegger, DVM, CVA, CVTP. Hypotherical Cases by Greg Todd, DVM, CVA