In Chinese philosophy, Qi is a word used to describe life energy, a vital essence that is essential to growth, form, matter and movement, as well as immaterial aspects of our being, the most profound being the concept of the spirit. Qi is the creator of all living things and carries the role of maintaining life (Cheng, 2006, pp. 51–54). Fundamentally, Qi energy is what allows all living things to follow the Tao. The Tao is loosely translated as It is translated as “way”, “route”, “path” “principle”, “doctrine”, “to lead”, “to flow” (Danylova, 2014). It is Qi energy that both propels us on our Tao and maintains our course. Even when Qi is depleted or out of balance, it remains fundamentally life-giving. Nature is adaptable, allowing for the ebbs and flows in the health of Qi energy. Aggressive Energy is the exception to that principle — and it is a serious one.  

When Aggressive Energy forms, the same life-giving Qi energy described above becomes polluted, tainted and poisonous. This is the only instance in which Qi energy becomes a destructive force. It is not simply depleted or out of balance — it has transformed into a perverted energy. Natural order has broken down. This is a situation that must be addressed immediately, and the Aggressive Energy, or AE, must be cleared from the body in order for any future treatments to be truly effective. If we do not clear AE, we are setting ourselves up for the risk of spreading that polluted energy further into the system (Worsley, 2012, p. 175). Aggressive Energy will not only cause imbalance and disharmony in body, mind and spirit; it will affect the officials (zang-fu) which will then affect overall health. When we needle a patient who has AE, we potentially spread contaminated Qi energy via the Ke cycle. This is a dangerous situation. Left untreated, Aggressive Energy is one of only two known causes of premature organ failure and death in this medicine.  

Causes

Though we cannot pinpoint just when Aggressive Energy arises, we do know that Qi energy can become contaminated via several means. Quite often, we live in a manner that goes against natural order in some way: pushing ourselves too hard, working too much, not sleeping, resting or playing enough. In other words, when we repeatedly and prolongedly exhaust ourselves without proper rest, recovery and balance we run the risk of developing AE. Living against nature can also include substance abuse, extreme or  prolonged stress, severe emotional suppression, physical trauma, major surgical or dental procedures, and/or sudden shock or trauma. Often there is no clear cause, and that is acceptable. The cause matters far less than the treatment. It is worth mentioning that just because patients live in our modern lifestyle of go-go-go, it does not mean that everyone develops AE. The only way to know if a patient has AE is to test for it. Aggressive Energy will not show in pulse readings or symptoms, and we cannot assume someone has it by hearing their stories of stress, illness, shock or trauma. We must test for it (Worsley, 2012, pp. 175–178).  

How It Moves

Aggressive Energy first develops in one of the predominant yin officials, or, also termed, one of the zang organs. Because each yin official (zang organ) is Mother to the next yin official along to the Sheng cycle, the affected official will attempt to manage the perverse, polluted Qi energy rather than pass it along to its child. When AE builds up to overflowing, that official will pass it along the Ke cycle to the grandchild. It then affects the pure Qi energy of the grandchild, while still retaining some of the AE. When AE has affected two officials (yin organs), we say that we have one leg of AE. At this point, the patient is not well. If it travels to the next official along the Ke cycle, we have two legs and three officials affected. This patient is quite ill. Aggressive Energy can continue to travel along the Ke cycle to then have three legs, affecting four officials, but it is unlikely that we would see this patient. It is more likely that they have died or are dying once three legs of AE have developed. The Su Wen, chapter 65 describes this concept:  

“The transferring sequence of the disease is as following: when the heart disease is contracted, the patent will have heartache; in about one day, the disease will transfer to the lung, and cough will occur; on the third day, the disease will transfer to the liver, fullness and pain in the hypochondria of the patient will occur; on the fifth day, the disease will transfer to the spleen, retention of feces and the pain and heaviness of the body will occur; if the disease lasts for another three days, the patient will die” (Wang et al., 1997, pp. 307)  

Because there is no way to detect AE other than checking for it, it is important to check for and treat AE at the onset of treatments with any patient (Worsley, 2012, pp. 175–177). 

How to Test

The only way to know if Aggressive Energy is present is to check for it. There is no shortcut, no clinical intuition that replaces the test. If AE is detected when testing for it, fortunately, the test is also the treatment.

Here is the procedure:   

1. Measure and mark all of the predominantly yin Associated Effect Points (AEPs, or back shu points) on the back. These will include the points for the Lung, Heart, Heart Protector, Liver, Spleen and Kidney:

• Points III 13, 14, 15, 18, 20, and 23. In TCM language: points UB 13, 14, 15, 18, 20, 23. Precision in marking these points is of utmost importance. Even a 1-2mm error will compromise the test.  

1. Insert needles to no more than one fen in depth. The needle must hang down on insertion; this is your confirmation of correct depth. Insert all needles, with one exception: III 15, the Heart point (UB15), is always left until last and inserted on its own after all other needles have been removed. 
2. Between the actual points and the spine, insert a check needle (quality control needle) in a non-point. Use one check needle for each of the three areas of the back - in other words, one check needle for each jiao. It doesn’t matter whether you place the check needle on the left or right side. One will do. The check needle is your control; some people's skin is reactive and will redden with palpation alone, and the check needle allows you to distinguish that from a true Aggressive Energy response.  
3. Then wait 2-5 minutes. If Aggressive Energy is present, the skin surrounding the needle will become red. Compare the reaction to the check needle. If the redness around the actual point is deeper in color or larger in diameter than the check needle site, Aggressive Energy is present. If the reaction in the actual point and the check needle point is the same, it is not AE.  
4. IF NEGATIVE: If no redness appears within a couple of minutes, the needles can be removed.  
5. IF POSITIVE: Wait until the redness has fully cleared before removing the needles. Waiting until all of the redness has cleared is the treatment for AE. The needles provide an outlet to drain the AE from the official. If there is redness at the check needle(s), you can remove all needles after the redness has matched that of the check needle. This can take time. If the patient  becomes lightheaded or is otherwise unable to sit up for the entire time, gently guide and help him/her lie on their side, making sure the needles are not disturbed. It is important to wait until AE has fully drained. If not, it will build up again and potentially spread. Be patient; the clearing is the treatment.  
6. Once you have tested for and cleared (if present) AE in Lung, Heart Protector, Liver, Spleen and Kidney, you may test the Heart.  
7. All needles have been removed at this point. Place the needles in the AEP (back shu) point of the Heart, at III-15 (UB15), inserting at a depth of one fen. The needles should hang down upon insertion- this is how you know you are at the correct depth. Place a check needle in a non-acupuncture point between the spine and the needles for the Heart. Wait 2-5 minutes. It is rare for the Heart to develop AE due to the role of the Heart Protector, but we must check it every time we test for AE. Follow the instructions from #5-6, above.  
8. Assess the patient and plan for further treatments to support the balance and health of the officials.  

Since we cannot know if a patient has Aggressive Energy, it is important to check for it and clear it, if present, at the very first acupuncture visit. Check for it in every new patient. Once a patient is under regular treatment and AE has been cleared, you do not need to keep repeating the test. If, however, the patient undergoes additional illness or trauma during the course of your continued and regular care, it could be that they have developed AE. Check for it again if this is evident AND the patient’s condition is clearly deteriorating, despite the treatments you’ve been providing (Worsley, 2012, pp. 175– 178). Most often, continued and regular care will help the patient maintain the balance and harmony needed to remain healthy.