《黄帝八十一难经纂图句解》Vol. 2

Women are Yin by nature, so the pulse at the cun position is usually relatively deep and weak. If instead it is floating, this indicates that Yang Qi is excessive and the illness is located in the limbs. The limbs are the source of the Yang channels. Thus, when a woman’s pulse shows a predominance of Yang, the illness is said to be in the limbs. If this pulse appears at the cun position on the left hand, the illness is on the left side of the body, in the hand and foot; if it appears on the right, the illness is on the right side. This determines the location of the illness from the position where the pulse is felt.

The Twentieth Difficulty says that the classics mention a pulse that is “concealed and hidden”—that is, the pulse Qi lies latent and does not manifest. Where must it be hidden for it to be called concealed and hidden? Here, the term describes Yin and Yang pulses encroaching upon and lying latent within one another.

The division between Yin and Yang is not limited to the cun position being Yang and the chi position being Yin. The surface of the flesh also belongs to Yang, while its deeper layers belong to Yin. A Yang pulse may appear in a Yin region, and a Yin pulse may appear in a Yang region. A Yin pulse may lie concealed in a Yang region, and a Yang pulse may lie concealed in a Yin region.

When a pulse is in a Yin region but shows the qualities of a Yang pulse, this is called “Yang encroaching on Yin.” The deep flesh at the chi position belongs to the Yin region. If the pulse at the chi position is floating, slippery, and long, a Yang pulse has appeared in a Yin region. This indicates that Yin is deficient and insufficient, allowing Yang Qi to enter the Yin aspect. The original text also calls this condition “Yang covering”—that is, the Yang pulse covers or bears down upon the Yin region.

If a floating, slippery, and long pulse is present at the chi position, while the pulses at the cun and guan positions are instead deep, short, and rough, then a Yin pulse lies concealed within the Yang region. This is called “Yin concealed within Yang.”

When a pulse is in a Yang region but shows the qualities of a Yin pulse, this is called “Yin encroaching on Yang.” The cun position and the surface of the flesh belong to the Yang region. If a deep, short, and rough Yin pulse is found there instead, a Yin pulse has appeared in a Yang region; this is called “Yin overflowing.” The original text also describes this condition as “Yin concealed within Yang.”

When the pulse appears in a Yang position but shows the qualities of a Yin pulse, it means that Yin Qi is encroaching upon Yang Qi.

The site of the cun pulse and the surface of the muscles both belong to Yang positions. If a pulse there instead feels deep, short, or choppy—qualities of a Yin pulse—then a Yin pulse has appeared in a Yang position. This is called “Yin overflow.”

Sometimes the pulse is floating, slippery, and long. This indicates that Yang Qi is concealed within the Yin aspect.

If the pulses at the cun and guan positions are already deep, choppy, and short, while the pulse at the chi position is floating, slippery, and long, this is Yang concealed within Yin.

Excessive Yang Qi is called “replete Yang” and can cause mania.

A pulse that is floating, slippery, and long, while also forceful and rapid, is called replete Yang. The patient may therefore speak wildly and incoherently, boast about grand achievements, consider themselves exceptionally wise and capable, behave recklessly, or even remove their clothes and climb to a high place.

Excessive Yin Qi is called “replete Yin” and can cause epilepsy.

If the pulse at the chi position is already deep, short, and choppy, and is also forceful and full, this is called replete Yin. The patient may stiffen and collapse, eyes closed and unresponsive. When Yin reaches its extreme, Yang returns; after some time, the patient wakes. This condition is called “epilepsy.”

When Yang Qi is lost, the patient may see apparitions.

The loss of Yang means that Yang Qi is insufficient. The pulse at the cun position becomes extremely faint, and the patient may experience visions, as if seeing apparitions.

The loss of Yin Qi can cause blindness.

Here, “Yin” refers to Jing Qi. When Yin Qi is lost, the Qi of the Five Viscera can no longer nourish the eyes, and the patient becomes blind and unable to see. An extremely faint pulse at the chi position may also indicate the loss of Yin Qi.

The Twenty-First Difficulty says:

The text states that when a person’s body is ill but the pulse is not, this is called “life.”

An ill body means that the person is emaciated, their muscles are weak, or their hands and feet are numb and without sensation. If the pulse shows no clear abnormality, and its movement remains orderly with each breath, without obvious irregularity or interruption, the diagnosis is life.

When the pulse is ill but the body is not, this is called “death.”

An ill pulse means that, on examination, the pulse rate is sometimes too fast and sometimes too slow. According to this account, even if the patient has not yet developed symptoms such as chills or fever, they may die despite appearing healthy.

Why is this so? How should we explain the difference between life and death?

The answer is: when the body is ill but the pulse is not, this does not mean that the patient is truly free of illness.

A person may show symptoms such as bodily pain even when the pulse has no obvious abnormality. The claim that “the pulse and breath are not diseased” does not mean the body is free of illness; it means that changes in the pulse do not yet correspond to the rate of breathing. This is the general principle for assessing the relationship between pulse and breath.

The text describes the pulse as blood and the breath as Qi (vital energy). The pulse does not move by itself; it is driven by Qi. When the speed of breathing does not correspond to the speed of the pulse, this condition arises.

The Twenty-Two Difficulties says: The classic mentions “what is set in motion” and “the illnesses that arise.” Why are abnormal movement of the pulse and the illnesses that follow classified as two different kinds of illness?

“What is set in motion” refers to abnormal changes in Qi. Qi belongs to Yang, and Yang Qi protects the body. When pathogenic influences attack Yang Qi, Qi is affected first, and the abnormality appears in the pulse. This is called “what is set in motion.”

“The illnesses that arise” refers to illnesses manifested in the blood. Once Qi is diseased, it can affect the blood. Blood belongs to Yin and nourishes the body. If blood is obstructed and can no longer moisten the body, symptoms follow.

Thus, when pathogenic influences invade the Qi level, the movement of Qi becomes disordered and the pulse also turns abnormal. When they affect the blood level, illness in Qi extends to the blood; the flow of blood becomes congested, producing corresponding symptoms. This explains how Qi and blood affect one another in a disease process that begins with Qi and then involves blood.

Qi drives movement, keeping its activity in continuous circulation. Blood nourishes, moistening the body and preventing it from becoming dry. Stagnant Qi that cannot flow freely is a sign that illness has first arisen in Qi. When Qi and blood are affected by heat, their movement may become disordered, congested, or uncontrolled; this is why the condition is called “what is set in motion.”

When a deviant wind, an abnormal external pathogenic wind, invades the channels, Qi and blood stagnate and can no longer flow freely. Blood becomes congested and fails to nourish the body, giving rise to disorders of the blood aspect.

Qi first enters the blood aspect and is then further attacked by a deviant wind. The blood consequently becomes congested and cannot nourish the body, leading to illness. Symptoms of abnormal Qi and blood circulation in the channels therefore appear first, followed by the resulting disorder. In other words, Qi first undergoes change in the channels, and only afterward does a disorder of the blood aspect arise.

Question twenty-three: Can you explain the lengths and number of the channels of the three Yin and three Yang of the hands and feet—that is, the three Yin and three Yang channels of the hands, and the three Yin and three Yang channels of the feet?

Answer: The three Yang channels of the hands run from the hands to the head, and each is five chi long. Counting both sides, the six channels together measure three zhang.

The Hand Taiyang channel begins at the tips of the little fingers on both hands, runs up the arms, and passes in front of the ears. Each side is five chi long, for a total of one zhang. The Hand Yangming channel begins beside the index fingers of both hands, runs up the arms, and ends at the nose. The channel on the left connects to the right side, and the channel on the right to the left; each is five chi long, for a total of one zhang. The Hand Shaoyang channel begins beside the ring fingers of both hands, runs up the arms, and ends in front of the ears. Each side is five chi long, for a total of one zhang. Together, the three channels measure three zhang.

The three Yin channels of the hands run from the hands to the center of the chest, and each is three chi and five cun long. With one channel on each side, the six channels together measure two zhang and one chi.

The three Yin meridians of the hand are each three chi and five cun long, making seven chi for both hands combined. The Hand Shaoyin meridian begins in the heart, descends to connect with the small intestine, then rises past the lungs. It emerges below the armpit and runs along the arm to the tip of the little finger. The Hand Taiyin meridian begins in the Middle Burner, the area between the chest and abdomen, descends to connect with the large intestine, then loops back past the stomach and belongs to the lungs. It emerges below the armpit, passes down through the elbow, reaches the Cunkou, the pulse point at the wrist, passes through the Yuji, the raised area at the base of the thumb, and continues to the tip of the thumb. The Hand Jueyin meridian begins in the chest, belongs to the pericardium, which protects the heart, and connects with the Sanjiao, the upper, middle, and lower burners of Chinese medicine. It emerges below the ribs beside the armpit, runs along the upper arm into the elbow, then descends to the tip of the middle finger beside the little finger. The three Yin meridians of the hands measure two zhang and one chi in total on both sides.

The three Yang meridians of the foot run from the feet toward the head, each measuring eight chi; together, the six meridians measure four zhang and eight chi. The Foot Taiyang meridian begins at the outer side of the little toe on each foot, runs upward behind the knee, passes along the back to the head, and descends to the inner corner of the eye; the two sides together measure one zhang and six chi. The Foot Yangming meridian begins at the tip of the second toe beside the big toe, runs upward along the foot, passes the knee and back to the head, and continues to the inner corner of the eye; the two sides together measure one zhang and six chi. Another account gives the Foot Yangming meridian as beginning at the tip of the second toe beside the big toe, running upward along the foot, passing two cun to either side of the navel, and ending at the hairline at the temple; the two sides together measure one zhang and six chi. The Foot Shaoyang meridian begins at the tip of the second toe beside the little toe, runs upward along the outer sides of both knees, enters the lower flank, and continues upward to the outer corner of the eye; the two sides together measure one zhang and six chi. Thus, the three Yang meridians of the feet measure four zhang and eight chi in total on both sides.

The three Yin meridians of the foot run from the feet to the chest, each measuring six chi and five cun. Among the six meridians, the six-chi portions total three zhang and six chi, and the five-cun portions total three chi, for an overall length of three zhang and nine chi.

Together, the two feet have six Yin channels, hence the phrase “six times six make three zhang and six chi.” The channel Qi of the Foot Taiyin Channel (Spleen Channel) begins on the inner side of the big toe, travels upward along the inner foot, and meets the Foot Jueyin Channel (Liver Channel) before continuing into the abdomen. It connects with the Spleen, links to the Stomach, and reaches the root of the tongue. It is seven chi and five cun long, or one zhang and five chi on both sides combined.

The channel Qi of the Foot Jueyin Channel begins above the hair at the base of the big toenail. It travels upward across the top of the foot, passes in front of the inner ankle, and, higher up at the lower leg, turns behind the Foot Taiyin Channel. It then continues along the abdomen to the pubic region, encircles the external genitalia, reaches the lower abdomen, runs alongside the Stomach, and connects with the Liver and Gallbladder. It continues upward along the throat into the neck, reaches the crown of the head, connects with the eyes, and emerges above the forehead. Its total length is six chi and five cun, or one zhang and three chi on both sides combined.

The channel Qi of the Foot Shaoyin Channel (Kidney Channel) begins beneath the little toe, runs diagonally toward the center of the sole, and travels upward along the inner lower leg and thigh. It passes through the spine, connects with the Kidneys and Urinary Bladder, then passes through the Liver and enters the Lungs. It ascends along the throat and runs alongside the root of the tongue. Its total length is six chi and five cun, or one zhang and three chi on both sides combined. Thus, these three pairs of channels have a combined length of three zhang and nine chi.

The two Qiao vessels in the body—channels that ascend from the feet and are associated with movement of the lower limbs—are each seven chi and five cun long from foot to eye, or one zhang and five chi on both sides combined.

The body has Yin and Yang Qiao vessels, four in total when both feet are counted. The Yang Qiao vessel begins at the middle of the heel, travels upward along the outer ankle, and reaches Fengchi, a point at the back of the neck. The Yin Qiao vessel also begins at the middle of the heel. It is a collateral branch of the Foot Shaoyin Channel (Kidney Channel), passing behind the navicular bone before ascending along the inner ankle. It continues straight up the inner thigh, enters the genital region, and travels upward through the abdomen to the chest. It enters the supraclavicular fossa, passes in front of the Renying point, enters the inner side of the neck, connects with the inner corner of the eye, and joins the Foot Taiyang Channel. The Yin Qiao vessel is seven chi and five cun long, or one zhang and five chi on both sides combined.

The Governing Vessel (Du Mai), which runs along the midline of the back, and the Conception Vessel (Ren Mai), which runs along the midline of the abdomen, are each four chi and five cun long. Together, they measure nine chi.

The Governing Vessel begins at the Shu point below the lower extremity, runs upward inside the spine, and enters and connects with the brain. It is four chi and five cun long. The Conception Vessel begins below Zhongji, rises past the pubic hair, runs upward along the abdomen to the Guanyuan point, and then reaches the throat. It too is four chi and five cun long. The Governing and Conception Vessels therefore measure nine chi altogether.

The channels throughout the body have a total length of sixteen zhang and two chi: the three Yang channels of the hands are three zhang long; the three Yin channels of the hands, two zhang and one chi; the three Yang channels of the feet, four zhang and eight chi; the three Yin channels of the feet, three zhang and nine chi; the Heel Vessels of both feet, one zhang and five chi; and the Governing and Conception Vessels together, nine chi. The total is sixteen zhang and two chi. These are the stated lengths of the twelve channels.

The meaning of the twelve channels is explained in the first question of the Difficult Classic (Nanjing).

There are fifteen collateral vessels. Each channel has one collateral vessel. In addition to the twelve collaterals of the channels, there are the Yang collateral, the Yin collateral, and the Spleen’s great collateral, making fifteen in all.

The meaning of the twelve channels is explained in the first question of the Difficult Classic (Nanjing).

Where do the channels and collaterals begin, and where do they end?

The channels circulate Qi and blood and connect Yin and Yang. They are pathways that nourish the whole body.

The channels begin in the Middle Burner, the middle region of the chest and abdomen. Its location is roughly between the nipples, at the point called Shanzhong, also known as the Sea of Qi. This is where Qi is said to arise.

The Hand Taiyin channel (Lung channel) connects with the Hand Yangming channel (Large Intestine channel). The Yangming channel then connects with the Foot Yangming channel (Stomach channel) and the Foot Taiyin channel (Spleen channel). From the Foot Taiyin channel, the route proceeds to the Hand Shaoyin channel (Heart channel) and the Hand Taiyang channel (Small Intestine channel). The Hand Taiyang channel then leads to the Foot Taiyang channel.

The flow of Qi and blood ends when it reaches the liver. Once the daily cycle is complete, it begins again the next day in a set sequence, starting from the lungs.

The human body has fifteen collateral channels, all rooted in the twelve primary channels. They connect with and relate to one another, forming a continuous cycle of circulation.

The flow of Qi and blood through the channels has no fixed beginning or end. Their ends join together, the cycle repeats, and Qi and blood flow between the primary and collateral channels.

The flow through the channels converges at the cun-kou, the pulse-taking point at the wrist. By examining the pulse there, one can assess various illnesses and determine their likely outcomes, including life or death and good or ill fortune. The cun-kou is where the pulse Qi gathers; its pulse belongs to the Hand Taiyin Lung Channel. Illness in any of the five viscera or six bowels will be reflected in the pulse Qi, so the condition can be inferred from it.

Over the course of a year, Yin and Yang rise and fall and meet at the Start of Spring. Within a day, they meet at a particular time. The body’s nutritive Qi and defensive Qi—the vital energies that circulate inside and outside the channels—also travel throughout the body and converge at the Hand Taiyin Lung Channel. According to this classic, the channels circulate for 13,500 breaths each day and assemble at the cun-kou and renying, a pulse-taking point on the side of the neck. The renying is on the left and belongs to Shaoyin; it, too, is a place where the Qi and blood of the channels gather. The commentator considers “assembling at the cun-point and qikou” a more suitable reading for the passage below, and invites readers to judge.

The classic says: “When the end and beginning of the channels’ circulation are understood, the patterns of Yin and Yang are established.”

The movement of Yin Qi begins at the lungs and ends at the liver. By distinguishing it from the Yang channels, one can identify where an illness originates; by distinguishing it from the Yin channels, one can infer the time limit of life and death.

What does this mean?

Once Yin-Yang is established, the movement of Yin and Yang Qi within the human body is established as well.

Yin Qi begins in the Lung and travels to the Liver, where it comes to an end; its course differs from that of Yang Qi. To understand where illness comes from, one must distinguish Yin from Yang. To determine the time remaining before life and death, one must also distinguish Yin from Yang.

What does this mean? What is the principle behind it?

Answer: “Beginning” and “ending” refer to the governing pattern of the pulse’s movement. The pulse’s subtle changes are exceedingly mysterious and must be observed with care. There are established principles for examining the pulse, and one must begin with Yin-Yang. Thus, the guiding principle of the pulse’s movement lies in the passage of Yin and Yang Qi from beginning to end, and from end to beginning.

The cun position—the pulse position at the wrist—is the Qi mouth, the place where the body’s pulse Qi is observed. Yin and Yang Qi meet there each morning and circulate in an unending cycle; this is why it is called the “beginning.”

Yin and Yang Qi begin meeting at the cun position in the early morning, then circulate in a continuous cycle; this is why it is called the “beginning.” The base text reads “cun.” Here, “Renying” has been emended to “Qi mouth.”

“Ending” refers to the severance of the pulse Qi of the Three Yin and Three Yang channels. When pulse Qi is severed, death follows, and each channel has corresponding outward signs; this is why it is called the “ending.”

When the pulse Qi of the Foot Shaoyin channel (Kidney channel) is severed, the teeth become elongated and dry, while the muscles grow slack and waste away toward the back. When the pulse Qi of the Foot Taiyin channel (Spleen channel) is severed, the muscles swell and the skin turns back on itself. When the pulse Qi of the Foot Jueyin channel (Liver channel) is severed, the tongue curls up. When the pulse Qi of the Hand Taiyin channel (Lung channel) is severed, the skin becomes dry and the body hair breaks off. When the pulse Qi of the Hand Shaoyin channel (Heart channel) is severed, the complexion turns black, like pear skin. Severance of the three Yin channels is marked by blurred vision and dim sight; severance of the six Yang channels is marked by sweat pouring out in beads. These are the signs that appear when the pulse Qi comes to an end. Once pulse Qi is severed, death follows.

The collation notes for Volume Three of A Pictorial and Phrase-by-Phrase Explanation of the Huangdi’s Eighty-One Difficulties Classic record suspected errors and omissions in the main text, along with variant readings in different annotated editions:

1. Judging from the meaning, “foot” should apparently be “take.”

2. For the character “mixed,” Ding’s annotation to Difficulty Sixteen in the Collected Annotations reads “follow.”

3. Judging from the meaning, the character “not” should apparently be “gate wood,” though the wording of the original note is uncertain.

4. For the phrase “the Liver and Kidneys are below, the Spleen,” Yu’s annotation to Difficulty Sixteen in the Collected Annotations reads “the Liver and Kidneys govern the lower region.”

5. Judging from the pattern of the preceding text, “this” should apparently be “Liver.”

6. Before “good taste,” the Original Meaning and the Collected Annotations both include the two characters “good thought.” The Collected Annotations also adds seven characters: “The Spleen, in terms of its role in the emotions, is thought.”

7. For the character “yawn,” the Original Meaning reads “frequent yawning.”

8. Judging from the pattern of the preceding text, “half pain” should be “firm and painful.”

9. Judging from the meaning, the character “king” should apparently be “five.”

10. The character “cubit” is suspected to be “large.”

11. For the character “can,” both the Original Meaning and the Collected Annotations read “closed.”

12. Judging from the meaning, the character “at” should apparently be “madness.”

13. The original reads “Taiyang”; it has been changed to “large intestine” based on the meaning.

14. Before the character “therefore,” the Original Meaning and the Collected Annotations both include four characters: “Earth governs the central palace.”

15. The original reads “at”; it has been changed to “left” based on the meaning.

16. For the character “diagnose,” the Original Meaning and the Collected Annotations read “knotted.”

17. The character “flourishing” is suspected to have been omitted after “Qi.”

18. After the character “flourishing,” the Original Meaning and the Collected Annotations both include four characters: “this is its normal state.”

19. After the character “although,” the Original Meaning and the Collected Annotations both include the character “time.”

20. The original reads “not”; it has been changed to “great” based on the meaning.

21. The character “each” is suspected to be “combine.”

22. The original has the character “』” in place of “two”; it has been corrected according to the Original Meaning and the Collected Annotations.

23. The original reads “now”; it has been changed to “person” based on the meaning.

24. The original reads “eye”; it has been changed to “day” based on the meaning.

25. “Favorable time” is suspected to be “Gen time”; the commentaries to Difficulties Thirty and Thirty-Seven also read “Gen time.”

26. The original reads “Spleen”; it has been changed to “morning” according to the Original Meaning and the Collected Annotations.

27. After the character “morning,” the Original Meaning and the Collected Annotations both include the character “cause.”

“Twenty-Four Difficulties” discusses the signs that appear when the Qi of the three Yin and three Yang channels in the hands and feet is cut off, and how these signs can be used to judge good or ill fortune and life or death.

When the Qi of the Foot Shaoyin Kidney Channel is cut off, the bones become withered. Foot Shaoyin belongs to the Kidneys and corresponds to the Qi of winter. Kidney Qi is stored deep within and circulates, warming and nourishing the bone marrow. When the marrow is no longer warmed and nourished, the muscles can no longer cling closely to the bones. Once the flesh and bones separate, the muscles become slack and atrophied, making the teeth seem longer; they gradually dry out and lose their luster. The teeth are regarded as the surplus of the bones. When Kidney Qi declines and is exhausted, the hair also loses its luster.

The brain is where the marrow gathers. The kidneys govern the bones and also the bone marrow. Hair is nourished by the brain and marrow, so its flourishing or withering reflects the condition of the brain and marrow. Now the bone marrow has dried up, and the hair has consequently lost its luster.

Hair that has lost its luster indicates that the bones decline first.

Hair without luster is a sign that the bones decline first.

The illness worsens on the day of Wu and ends in death on the day of Ji.

Wu and Ji both belong to Earth, while the kidneys belong to Water. Earth overcomes Water, which is why the illness worsens on the day of Wu and ends in death on the day of Ji.

When the Qi of the Foot Taiyin channel (the Spleen channel) is exhausted, the pulse Qi can no longer nourish the lips.

Foot Taiyin is the Spleen channel. The Spleen corresponds to the muscles, and the flourishing of Spleen Qi appears in the lips. Once Spleen Qi is exhausted, the blood vessels can no longer nourish the lips.

The lips are the fundamental sign of the muscles.

The Spleen’s vitality appears as a moist, pale ring around the lips, and Spleen Qi nourishes the muscles. Once the Qi and blood of the lips and muscles are exhausted, the blood vessels can no longer nourish the lips. The lips are the fundamental sign of the muscles: within, Spleen Qi nourishes the muscles; outwardly, it appears in the lips.

When the blood vessels can no longer nourish the muscles, the muscles lose their softness and luster.

When the blood vessels cease nourishing the muscles, they become coarse and rough, losing their moisture.

When the muscles become coarse and dry, swelling appears.

When the muscles are swollen and full, the lips turn outward.

Lips that turn outward indicate that the muscles decline first.

Lips that turn outward and lose their texture are a sign that the muscles are declining and the Qi is exhausted.

The illness worsens on the day of Jia and ends in death on the day of Yi.

Jia and Yi belong to Wood, while the Spleen belongs to Earth. Wood overcomes Earth, which is why the illness worsens on the day of Jia and ends in death on the day of Yi.

When the Qi of the Foot Jueyin channel (the Liver channel) is exhausted, the sinews contract and become rigid, pulling on the genitals, while the tongue also curls and contracts.

Foot Jueyin is the Liver channel. The Liver governs the sinews, and all human movement depends on their strength. The Liver channel connects upward to the tongue and downward to the genitals. When Liver Qi is exhausted, the sinews contract and become rigid, the tongue curls up, and the genitals contract as well.

Here, Jueyin refers to the Liver pulse.

The Foot Jueyin channel belongs to the Liver.

The Liver corresponds to the sinews.

The Liver’s essence and Qi nourish the sinews.

The sinews gather and connect at the genitals.

The vertical sinew above and below the transverse bone between the pubic hairs is called the “ancestral sinew” (zongjin), the sinew network gathered in the reproductive region. The sinews and vessels therefore converge at the genitals.

The Liver corresponds to the sinews, and the Liver’s Jing-Qi nourishes them. The sinews and vessels gather at the genitals and connect to the root of the tongue. The Liver channel runs to the root of the tongue; if the Liver channel does not receive sufficient Qi and blood to nourish it, the sinews contract and become tense.

When the sinews contract and become tense, the testicles and tongue contract. A curled tongue and contracted testicles are signs that the sinews are about to decline. The illness worsens on a Geng day and may prove fatal on a Xin day. Geng and Xin belong to Metal, while the Liver belongs to Wood. According to the Five Phases theory of mutual overcoming, Metal overcomes Wood; this is how the scripture explains the course of the illness.

When the Qi of Hand Taiyin (the Lung channel) is cut off, the skin and hair become withered and scorched. The Lung corresponds to the skin, and the luster of the hair is also related to Lung Qi. The Lung’s Jing-Qi nourishes the skin and body hair, keeping them warm and moist. When Lung Qi cannot nourish them, they become withered and scorched.

Once the skin and body hair are withered and scorched, the body’s fluids are depleted. The interstices—the skin’s texture and sweat pores—open and discharge sweat. This fluid is called “Jin”; fluid that seeps into the orifices and nourishes the body is called “Ye.” When the skin and body hair are withered and scorched, Jin and Ye are depleted as well.

As Jin and Ye are depleted, the skin and joints are damaged. The skin becomes shriveled, and the hair breaks off. Broken hair indicates that the hair has begun to decline first.

When the feathers fall out or break, this is called the sign of “hair dying first.”

The illness worsens on the day of Bing and ends in death on the day of Ding. Bing and Ding correspond to Fire, while the lungs correspond to Metal. Fire overcomes Metal, so according to this system, lung disease worsens on Bing day and ends in death on Ding day.

When the Qi of the Hand Shaoyin channel—the channel of the heart—becomes severed, the vessels can no longer flow freely. The heart governs the vessels; when heart Qi is severed, the blood vessels also become obstructed. When the vessels are obstructed, blood can no longer circulate. When the blood stops flowing, the complexion loses its luster. Blood nourishes the body and gives the face a healthy glow; when it no longer circulates, the body’s color loses its luster.

A dark complexion, yellow-black like pear skin, is therefore called the sign of “blood dying first.” When the heart’s blood disperses, the face no longer receives its nourishment and appears yellow-black.

The illness worsens on the day of Ren and ends in death on the day of Gui. Ren and Gui correspond to Water, while the heart corresponds to Fire. Water overcomes Fire, so according to this system, heart disease worsens on Ren day and ends in death on Gui day.

When the Qi of all the three Yin channels of the hands and feet becomes severed, the person becomes dizzy and confused, and the eyes close. Here, “dizzy” means disoriented and seeing darkness, while “closed” means shut. The vessels of the five organs are all connected to the three Yin channels and converge at the eyes. When the Qi of the three Yin channels is severed, dizziness and closed eyes result.

Closed eyes indicate a loss of consciousness.

All five human emotions are Yin in nature. The Liver governs anger, the Heart governs joy, the Spleen governs thought, the Kidneys govern fear, and the Lungs govern grief. When the Qi of the Three Yin channels has been cut off, the Five Zang organs also lose their ability to regulate the emotions. A person then no longer feels joy, anger, thought, grief, or fear; all five emotions disappear. This is called “loss of the will.”

In people who have lost the will, the mind and will are often the first to decline and perish.

When Yin and Yang separate, a person becomes forlorn and loses awareness. Here, “death” refers to dizziness and blurred vision. To determine whether the five emotions are declining and perishing, one need only observe whether the eyes are dizzy and confused.

When the Qi of all six Yang channels has been cut off, Yin and Yang separate from one another. The six Yang channels are the three Yang channels of the hand and the three Yang channels of the foot. The three Yang channels of the hand connect with the Qi of Heaven and are therefore called Yang; the three Yang channels of the foot connect with the Qi of Earth and are therefore called Yin. When the Yin and Yang Qi between Heaven and Earth are cut off from one another and no longer flow, this is called separation.

When Yin and Yang separate, the interstices of the skin—the skin’s texture and the passages through which sweat flows—open up, and fluids seep out. Once Yin and Yang are cut off from each other, the interstices gape open and cannot close.

At this point, terminal sweat appears: beads of sweat cling to the body like a string of pearls but do not run or disperse. The interstices are the pores. Once the pores have opened, sweat congeals on the skin like attached pearls and does not flow outward.

Sweat that appears but does not flow is a sign that Qi is about to be exhausted. A person with this condition usually dies that same day: if it appears in the morning, death comes by evening; if it appears in the evening, death comes the following morning.

The Second Chapter: The General Number of the Channels and Networks

The Twenty-Fifth Difficulty asks: “The human body has twelve channels. The Five Zang organs and the Six Fu organs together account for only eleven channels. What is the remaining channel?”

The Five Zang and Six Fu organs amount to eleven channels. There is one more channel; which channel is it?

There are twelve channels. The Hand Shaoyin channel runs directly to the heart itself; the Heart Governor channel is another channel associated with the heart.

Each of the five zang organs has one channel, making five in all. The heart has two additional channels, bringing the total to twelve. The Hand Shaoyin channel corresponds to the heart itself and belongs to sovereign Fire; the Hand Heart Governor channel corresponds to the pericardium and belongs to ministerial Fire.

The Heart Governor channel and the Triple Burner channel are interior and exterior counterparts. The Heart Governor channel is the Hand Jueyin channel, and the Triple Burner channel is the Hand Shaoyang channel. The two channels are paired as interior and exterior counterparts.

The pericardium and the Triple Burner both have names, but neither has an independently visible form. The pericardium lies outside the fatty membrane around the heart, with fine, threadlike fascia connecting it to the heart and lungs. For a detailed account of the Triple Burner, see Difficulty Thirty-One. This is why they are said to “have a name but no form.”

Thus, when the channels are said to number twelve, the count includes the Hand Heart Governor channel together with the channels of the five zang and six fu organs.

Difficulty Twenty-Six says:

There are twelve channels and fifteen collateral vessels. What are the three additional collateral vessels?

Each channel has one collateral vessel, so the twelve channels should have only twelve collateral vessels. Yet the count is given as fifteen. What are the three additional ones?

Answer: The additional collateral vessels are the Yang Collateral, the Yin Collateral, and the Great Collateral of the Spleen.

The Yang Collateral is the collateral vessel of the Yang Qiao Vessel, and the Yin Collateral is the collateral vessel of the Yin Qiao Vessel. The text says that the Yang Qiao channel is at the outer ankle of the left foot, with its collateral vessel at the inner ankle of the right foot; the Yin Qiao channel is at the inner ankle of the right foot, with its collateral vessel at the outer ankle of the left foot.

The Great Collateral of the Spleen begins at the spleen and is called Dabao; its acupuncture point is below the navel.

Thus, the collateral vessels of the twelve channels, together with the Yang Collateral, the Yin Collateral, and the Great Collateral of the Spleen, make fifteen collateral vessels in all.

The “extraordinary vessels” are another kind of channel. The word “extraordinary” suggests something scattered or not paired. The Eight Extraordinary Vessels do not belong to the Twelve Regular Channels, nor are they paired according to Yin and Yang or the interior and exterior as the regular channels are. They follow their own routes, which is why they are called “extraordinary.”

The eight vessels are: the Yang Linking Vessel, which links the Yang vessels; the Yin Linking Vessel, which links the Yin vessels; the Yang Heel Vessel and the Yin Heel Vessel. “Heel” suggests agility and quickness, and these two vessels are associated with foot movement during walking. The Penetrating Vessel runs through the body from top to bottom, reaching the feet below and the head above, and connects the Qi and blood of the Twelve Channels. It is therefore called “the sea of the Twelve Channels.” The Governing Vessel presides over the Yang vessels; the Conception Vessel is the foundation of the body’s growth and nourishment; and the Belt Vessel, like a belt around the waist, binds the other vessels and coordinates their movement.

These eight vessels are not governed by the Twelve Regular Channels. Each follows its own route, and so they are called the Eight Extraordinary Vessels. Together, the Twelve Regular Channels and the fifteen network vessels form twenty-seven channels through which Qi flows; they work together and circulate throughout the body. The scripture then asks: why are the Eight Extraordinary Vessels not governed by the regular channels?

The sages built ditches and cleared waterways to keep water flowing freely, and to prepare for times when its force might become abnormal. By comparing them to ditches and waterways, the passage explains that the extraordinary vessels have their own routes and can regulate the circulation of the channels.

There are twenty-four watercourses on the earth, corresponding to the body’s twenty-four meridians. The sages of antiquity also dug channels beyond these watercourses as a metaphor for the Eight Extraordinary Vessels—the eight vessels that regulate the Qi and blood of the meridians without being governed by the twelve regular meridians. Channels can clear the flow of water and provide for unexpected needs.

When it rains, the channels fill. In a heavy rain, mist spreads in every direction and the channels overflow. At that point, the sages make no further arrangements, allowing the water to flow naturally.

This is a metaphor for how, when the Qi and blood of the Eight Extraordinary Vessels are abundant, they overflow and move along other pathways, beyond the regulation of the twelve regular meridians.

The Twenty-Eighth Difficulty asks: Since the Eight Extraordinary Vessels are not governed by the twelve regular meridians, where do they begin, and how do they connect and continue?

The answer: The Governing Vessel is one of the extraordinary vessels. It begins at the Shu point at the lower extreme—that is, the Changqiang point, near the coccyx, where the Governing Vessel starts. It meets the vessels along the spine, travels upward inside the spinal column to the Fengfu point at the back of the neck, and then enters the brain.

The Conception Vessel is another extraordinary vessel. It begins below the Zhongji point. Zhongji lies four cun below the navel; the Qugu point below it is where the Conception Vessel starts.

The pathway extends upward to the edge of the pubic hair.

The Central Pole vessel runs upward from deep in the lower abdomen and outward to the edge of the pubic hair. It then ascends along the inside of the abdomen, passes through the Guanyuan acupoint, located three cun below the navel, and continues to the throat.

The Penetrating vessel, one of the Eight Extraordinary Vessels, begins at the Qichong acupoint, near the groin, where the Qi and blood of the Foot Yangming Stomach channel converge, and runs alongside the Foot Yangming Stomach channel. The Qichong acupoint lies on either side of the pubic hair in the lower abdomen, two cun from the midline; it is where the channel’s Qi emerges. The Penetrating vessel ascends on both sides of the navel and spreads through the chest.

The Girdling vessel, one of the Eight Extraordinary Vessels, begins at the lower flanks beneath the ribs and encircles the body like a belt.

The Yang Heel vessel, one of the Eight Extraordinary Vessels, begins at the heel, ascends along the outer ankle, and enters the Fengchi acupoint, in a hollow at the hairline on the back of the neck.

The Yin Heel vessel, one of the Eight Extraordinary Vessels, also begins at the heel. It ascends along the inner ankle to the throat, where it meets and connects with the Penetrating vessel.

The Yang Linking vessel and Yin Linking vessel, extraordinary vessels that link and connect the channels throughout the body, …

These two “linking vessels” are the guiding channels that bind together and govern Yin-Yang, overseeing the Yin and Yang vessels. They belong to the Eight Extraordinary Vessels. Like the collateral vessels, the Eight Extraordinary Vessels are distributed throughout the body, but they function differently from the twelve primary channels: when Qi and blood are abundant, they can flow into the extraordinary vessels and accumulate there, but they do not circulate and nourish the whole body as the twelve primary channels do.

Thus, the Yang Linking Vessel begins where the various Yang channels meet, while the Yin Linking Vessel begins where the various Yin channels converge.

The sages built ditches to clear the flow of water. When the ditches overflow, the water runs into deep lakes. Such is the force of water that even the sages cannot restrain or control it. The ditches and deep lakes serve here as an analogy: the Eight Extraordinary Vessels are like channels that store water, receiving Qi and blood when they are abundant.

When Qi and blood are vigorous in the body’s channels, they too flow into the Eight Extraordinary Vessels and follow separate pathways, so they are not constrained by the twelve primary channels. If pathogenic Qi invades the extraordinary vessels and accumulates there, swelling and fever may result; stone lancets can be used to treat these conditions. Stone lancets were tools made of stone and used in ancient times to puncture and treat illnesses.

Question Twenty-Nine asks: What happens when the Eight Extraordinary Vessels become diseased?

Answer: The Yang Linking Vessel governs all the Yang channels.

The Yin Linking Vessel, which links and maintains the Yin channels, belongs to Yin. It can connect and sustain all the Yin channels.

When the Yin and Yang channels cannot support one another, the Yang channels cannot govern the other Yang channels, and the Yin channels cannot govern the other Yin channels. A person then feels despondent and loses resolve. Here, “despondent” means frightened: after being startled, the mind and spirit become unsettled and cannot remain calm or self-possessed.

“Rongrong” describes a sluggish state: the body moves slowly and cannot gather itself or maintain its own stability.

The Yin Heel Vessel, which regulates the activity of the Yin channels in the lower limbs, becomes ill when the pulse Qi of the Yin channels grows exuberant and disperses into it. In illness of the Yin Heel Vessel, the Yin side is slack while the Yang side is tense. Here, “slack and tense” refers to differing degrees of deficiency and excess in the channels. The Yin Heel Vessel runs along the inner ankle; when it is ill, the pulse Qi becomes tense as it rises from the inner ankle, while the outer ankle side is slack. Symptoms also include rigidity in the feet and blockage of the Five Network Vessels, the five collateral vessels.

The Yang Heel Vessel, which regulates the activity of the Yang channels in the lower limbs, becomes ill when the pulse Qi of the Yang channels grows exuberant and disperses into it. In illness, the Yin side is slack while the Yang side is tense. The Yang Heel Vessel runs along the outer ankle; when it is ill, the pulse Qi is tense on the outer ankle side and slack on the inner ankle side. Symptoms also include running wildly without stopping.

Illness of the Penetrating Vessel, which is related to the circulation of Qi and blood throughout the body, may cause Qi to surge upward and the abdomen to contract painfully. When Kidney Qi is insufficient and damages the Penetrating Vessel, Qi swells and surges upward, causing abdominal pain.

Illness of the Governing Vessel, which runs along the midline of the back, may cause stiffness in the spine and back and disordered Qi movement. Because the Governing Vessel runs along the spine, stiffness of the back is one of its symptoms.

Illness of the Conception Vessel, which runs along the midline of the front of the body, causes a sensation of obstruction and discomfort inside the abdomen. Men may suffer from the “seven hernias”: hammer hernia, coiled hernia, cold hernia, mass hernia, attached hernia, wolf hernia, and Qi hernia. Deficiency of Qi and blood, or imbalance between cold and heat, may cause obstruction inside the abdomen.

Women may develop masses and accumulations in the abdomen. The commentary explains these as accumulations resembling the shapes of various things and lists eight kinds: snake accumulation, fat accumulation, green accumulation, yellow accumulation, dry accumulation, blood accumulation, fox accumulation, and turtle accumulation.

The Belt Vessel, which encircles the waist and abdomen and constrains the other channels, becomes ill.

The abdomen feels distended and full. The lower back feels slack and weak, as if sitting in water.

When the Yang Linking Vessel (Yangwei Mai) is affected, symptoms such as alternating chills and fever may occur. When the Yin Linking Vessel (Yinwei Mai) is affected, one often feels pain in the heart. These are all signs that the Eight Extraordinary Vessels—the eight special vessels outside the Twelve Regular Meridians—have been affected.

Nutritive Qi, Defensive Qi, and the Triple Burner

When Nutritive Qi (Ying Qi), which nourishes the body, circulates, does it always travel alongside Defensive Qi (Wei Qi), which protects the body?

The text explains that people obtain Qi from food and drink. After food enters the stomach, it is conveyed to the five Zang organs and six Fu organs. The stomach is where food and drink gather. The refined Qi of food enters the stomach and spreads to the liver, nourishing the sinews. When water enters the stomach, its refined Qi flows and fills the body, then is sent upward to the spleen. The spleen disperses this refined Qi, sending it upward to the lungs and downward to the bladder; from there, it is distributed to the five Zang organs and six Fu organs.

After food enters the stomach, its refined Qi is conveyed to the liver, where it nourishes the sinews and vessels. The Qi of food enters the stomach, and the Qi of the kidneys returns upward to the heart; refined Qi nourishes the sinews and vessels. After water enters the stomach, the refined Qi in the fluids flows and spreads, rising to the spleen. The spleen’s Qi then disperses this refined Qi, sending it upward to the lungs and downward to the bladder.

The five viscera and six bowels all receive the Qi produced from food.

The five viscera and six bowels all obtain grain Qi from food.

The pure, clear part of grain Qi becomes nutritive Qi (the refined Qi that nourishes the body and circulates within the vessels).

The stomach transforms food into the refined essence of grain and water, then sends it upward to the heart, where it is transformed into blood. Blood belongs to nutritive Qi, so the pure, clear part of grain Qi becomes nutritive Qi.

The dense, turbid part becomes defensive Qi (Qi that protects the body and circulates outside the vessels).

The stomach transforms food into Qi and sends it upward to the lungs. The lungs govern Qi, and Qi belongs to defensive Qi; therefore, the more turbid part of grain Qi becomes defensive Qi.

Nutritive Qi circulates within the vessels.

Nutritive blood belongs to Yin, and Yin governs the interior; therefore, nutritive Qi circulates within the blood vessels.

Defensive Qi circulates outside the vessels.

Defensive Qi belongs to Yang, and Yang governs the exterior; therefore, defensive Qi circulates outside the blood vessels.

Nutritive Qi circulates in a continuous cycle without pause.

Nutritive Qi and defensive Qi circulate continuously, without ever stopping.

After completing fifty circuits, nutritive Qi meets again within the body.

Defensive Qi circulates outside the vessels.

Defensive Qi belongs to Yang, and Yang governs the exterior; therefore, defensive Qi circulates outside the blood vessels.

Nutritive Qi circulates in a continuous cycle without pause.

Nutritive Qi and defensive Qi circulate continuously, without ever stopping.

After fifty circuits, the two Qi meet again.

Over the course of one day and night, nutritive Qi and defensive Qi each make fifty circuits. At the hour of Gen (the early morning period) on the following day, they meet again in the Hand Taiyin channel (the Hand Taiyin Lung Channel).

Yin and Yang pass through one another.

Yin and Yang interpenetrate and flow without end.

They are like a circle, with neither beginning nor end.

From this we can understand that nutritive Qi and defensive Qi circulate in one another’s company.

The Thirty-First Difficulty asks:

What are the Three Burners (upper, middle, and lower burners)?

From where do they receive and form themselves?

What gives rise to them?

Where do they begin?

And where do they end?

What parts of the body are generally treated when regulating them?

Can these principles be understood?

The Triple Burner (Sanjiao) is the passage through which food and fluids circulate. It is also called the “official in charge of draining waterways,” responsible for ensuring that fluids flow: they enter through the Upper Burner, circulate through the Triple Burner, and are discharged through the Lower Burner. The Triple Burner is also where Qi circulates, gathers, and disperses.

The area between the breasts, in the center of the chest, is called the Sea of Qi. Another view holds that the point three cun below the navel is also a Sea of Qi, associated with the circulation and cessation of Qi.

The Upper Burner lies below the heart and diaphragm, near the upper opening of the stomach. It receives food and drink but does not discharge them outward. Its associated point is Shanzhong, in the hollow between the breasts, about 1.6 cun below Yutang. Shanzhong is called the “official who serves as envoy,” overseeing the circulation of Qi, harmonizing Yin-Yang, and enabling the expression of emotions, thereby giving rise to joy.

The Middle Burner lies within the epigastric region, neither above nor below. It ripens and breaks down food and drink—that is, it digests them and transforms them into Qi and blood. Its associated points are one cun to either side of the navel, called Tianshu.

The Lower Burner lies near the upper opening of the bladder. It separates the clear from the turbid in food and drink: the clear portion becomes urine, while the turbid portion becomes stool; it then conveys both outward for excretion. Its associated point is one cun below the navel, called Yinjiao.

Together, these are known as the “Triple Burner.”

The Qijie (a point on the Foot Yangming Stomach Channel) is a passage through which Qi and blood flow. It lies in the lower abdomen, two cun to either side of the midpoint of the pubic hairline. This point is where the Qi and blood of the Foot Yangming Channel emerge. The Foot Yangming Stomach Channel transforms food and drink into Qi, while the Triple Burner governs the Qi of the upper, middle, and lower regions. Thus Qijie is said to be where Qi gathers.

Another text writes the name as “Qichong.” This sentence is not from Bian Que’s original text; it was probably added by Lüshi when recording it later, noting that another text used this wording. Qichong is the root of the twelve channels and the place where the Qi and blood moving through the various channels gather. This interpretation also makes sense.

The Correspondences of the Zang-Fu Organs, Part Five

The Twenty-Second Difficulty asks: Are the five zang organs all the same size? They are all located in the abdomen, so why are only the heart and lungs above the diaphragm?

The answer: The heart governs blood, and the lungs govern Qi. Blood is the basis of nutritive Qi, while Qi is the basis of defensive Qi. The heart is like a sovereign: it dwells high and can direct the whole body. The heart generates blood, which nourishes the body. The lungs are like a canopy and are also positioned high. The lungs govern Qi, which protects the body. Blood and Qi depend on one another and circulate up and down; together they are called nutritive and defensive Qi. They travel through the channels and collaterals, circulating among the twelve channels and fifteen collaterals, so that nutritive Qi flows throughout the body.

For this reason, the heart and lungs are above the diaphragm. They govern blood and Qi and connect with the Qi of Heaven, so they are located above the diaphragm.

The Twenty-Third Difficulty says: The liver is green, corresponding to the Wood of Jia and Yi in the East.

The lungs are white in color, symbolizing the Geng and Xin Metal of the West.

When the liver encounters water, it sinks; when Wood encounters water, however, it rises. Wood is the Qi received by the liver, so in principle the liver should rise when it encounters water. The lungs rise when they encounter water; Metal is the Qi received by the lungs, so in principle the lungs should sink when they encounter water. Why, then, do liver-Wood and lung-Metal behave differently, rising or sinking, when they encounter water?

The liver is not composed purely of Wood Qi. The East corresponds to Jia and Yi Wood, and the liver belongs to Wood, but the Qi it receives is not of a single kind. Yi corresponds to the jue tone among the Five Tones and is also Yin, while Jia is Yang. Though Yi belongs to Wood, it also carries the nature of Metal, so it is not a purely Wood tone. This results from the interweaving of the Yin-Yang Qi of Wood and Metal.

In terms of Yin-Yang relations, Jia is Yang Wood and Yi is Yin Wood; Geng is Yang Metal and Xin is Yin Metal. Yi is the Yin and yielding aspect of Geng, while Geng is its Yang and firm aspect. Viewed in terms of the broader Yin-Yang relationship, this is the interweaving of Yin and Yang between Jia and Yi, and Geng and Xin.

Using the relationship between husband and wife as a metaphor, Jia and Yi Wood fear the Geng and Xin Metal of the West. Thus Yi is compared to a younger sister who marries Geng. Yi is the Yin and yielding wife, and Geng the Yang and firm husband. The metaphor describes how Wood and Metal unite with and constrain one another.

Jia is Yang. When the text says that it “releases its subtle Yang,” it means that Jia’s Yang Qi is somewhat loosened. Yi is Yin and also contains the nature of Metal, so it absorbs subtle Yin Qi. Jia, in its own nature, is also receptive to Metal’s nature.

In addition, the liver-Wood follows the Yin course for much of its cycle. According to the seasonal sequence of the Five Phases—prosperity, flourishing, rest, and decline—Wood begins receiving Qi in the seventh month and gradually grows through the tenth. The period from the seventh to the twelfth month largely follows the Yin course. Wood reaches the stage of lin’guan in the first month and peaks at diwang in the second; only then is Yang Qi flourishing. This is why the text says that the liver sinks when it encounters water.

Yi Wood joins with Geng Metal and follows its nature, so when the Liver encounters Water, it sinks.

The Lung is not purely Metal. The West corresponds to Geng and Xin; the Lung belongs to Metal, but its Qi is not purely the Qi of Metal. Xin corresponds to the Shang tone, one of the Five Tones associated with Metal. Geng is Yang and Xin is Yin; Xin also carries a Fire quality. Fire is Yang and Metal is Yin, so Yin and Yang are interwoven within the Lung’s Qi.

Bing Fire is firm and Yang, while Xin Metal is yielding and Yin. Geng and Xin Metal in the West fear the Bing and Ding Fire of the South. Thus it is said that Xin marries Bing and becomes his wife: Bing is Yang, Xin is Yin, and Yin is the yielding partner.

Broadly speaking, Lung Metal embodies Yin and Yang: Geng is Yang and Xin is Yin. More specifically, their relationship resembles that of husband and wife. Geng and Xin Metal fear Fire, so Xin is described as Geng’s younger sister, given in marriage to Bing Fire. Xin is Yin, Bing is Yang, and Bing is the husband. “Explaining its subtle Yin” means describing the faint Yin Qi represented by Xin. Xin Metal and Bing Fire join like a married couple, and the nature of the Lung’s Metal Qi also inclines toward Fire.

For a period in its cycle, the Lung’s movement also follows the Yang path. According to this account, Metal Qi receives its Qi in the first lunar month and begins to flourish in the fourth; until before the sixth month, it mostly follows the Yang path. In the seventh month it reaches official rank, and in the eighth it reaches its peak, then turning to the Yin path. Thus Bing and Xin join, and Xin follows the nature of Bing Fire, so when the Lung encounters Water, it rises and floats. The Lung floats as it comes into being, then sinks once it has matured.

The Liver sinks as it comes into being, yet rises once it has matured. Why is this?

Thus, Xin returns to Geng. Geng belongs to pure Metal, while Xin carries the nature of Fire. When the Lung first comes into being, it has a floating aspect; when mature, it shifts to a sinking aspect. This shows that once the Fire nature carried by Xin fades, the nature of Metal belonging to Geng is restored.

Yi returns to Jia. Jia belongs to pure Wood, while Yi carries the nature of Metal. When the Liver first comes into being, it has a sinking aspect; when mature, it shifts to a floating aspect. This shows that once the Metal nature carried by Yi fades, the nature of Wood belonging to Jia is restored.

The Thirty-Fourth Difficulty:

Do the Five Viscera each have their own sounds, colors, odors, and flavors, and can these patterns be discerned?

Can the principles governing the sounds, colors, odors, and flavors of the Liver, Heart, Spleen, Lung, and Kidneys be understood?

Answer: There are ten transformations.

If we discuss only the Five Viscera, there are five transformations. If we include the Six Bowels as well, there are ten.

For example, the Liver’s color is green. The five colors of the Five Viscera arise from transformations of Wood Qi. The Five Viscera nourish one another through Qi, and each manifests the color corresponding to its associated Phase. The Liver is the essence of Wood Qi and belongs to the Qi of the Zhen trigram; its color is green, and its direction is east.

The Liver’s odor is rank. This odor forms when Wood undergoes the transformation of Fire.

The Liver’s flavor is sour. Earth receives Wood’s flavor and manifests it as sourness. Because Wood bends and straightens, it produces sourness. Sourness has a contracting effect.

The Liver’s sound is a shout. Metal is paired with Wood, and the sound they produce is a shout.

The Liver’s fluid is tears. Water Qi moves and nourishes the child of Liver Wood, thereby producing tears.

The Heart’s color is red. Wood Qi spreads out color, and when it reaches the Heart, which belongs to Fire, the color appears as red.

The Heart’s odor is scorched. The transformations of the Five Viscera’s odors correspond to the Five Phases; when Fire Qi is abundant, a scorched, bitter odor appears.

The transformation of the five scents depends on Fire. Each of the five viscera has a corresponding scent. When Fire-Qi is strong, scorched and bitter scents appear.

The Spleen’s flavor is sweet. The Spleen governs sweetness and can also receive all the different flavors. Fire belongs to Earth; when Fire is strong, it dries Earth, which is expressed as bitterness. Bitter flavor dries dampness and promotes discharge.

The sound corresponding to the Spleen is singing. Metal and Earth correspond to one another like a mother and child meeting. When sound is voiced, it becomes song.

The Spleen’s fluid is saliva. When fluids circulate to the Spleen, they appear as saliva.

The Spleen’s color is yellow. When the color spread by Wood-Qi reaches Earth, it becomes yellow.

The Spleen’s scent is fragrant. Fire transforms and generates Earth, and the scent corresponding to Earth is fragrance.

The Spleen’s flavor is sweet. The Spleen belongs to Earth, whose inherent flavor is sweetness. Sweetness has a moderating, soothing effect. Each of the five flavors nourishes the viscera corresponding to its nature; when a flavor returns to the Spleen itself, it appears as sweetness.

The Spleen’s sound is singing. Metal and Earth generate one another, like a mother and child meeting; the sound they produce becomes song.

The Spleen’s fluid is saliva. When fluids circulate to the Spleen, they appear there as saliva.

The Lung’s color is white. When the color spread by Wood-Qi reaches the Lung, it becomes white.

The Lung’s scent is rank. When the scent governed by Fire transforms into Metal, it appears as a rank odor.

The Lung’s flavor is pungent. Among the flavors received by Earth-Qi, the Lung corresponds to pungency. Pungency disperses and opens the flow.

The sound corresponding to the Lung is weeping. The production of the five tones is associated with Metal. Metal-Qi produces different sounds, and each of the five viscera expresses distinct sounds according to its nature. The Lung belongs to Metal, which corresponds to the Shang tone. Autumn tends to give rise to sorrow, so in emotional terms the Lung corresponds to grief and weeping.

The Lung’s fluid is nasal mucus. When fluids circulate to the Lung, they appear there as nasal discharge.

The Kidney’s color is black. When the color spread by Wood-Qi reaches the Kidney, it becomes black.

The Kidney’s scent is putrid. When the scent governed by Fire transforms into Water, it appears as a putrid odor.

At this point, the scripture says that the Kidney’s flavor “belongs to Metal,” and uses “Metal’s Shang tone” and “autumn sorrow” to explain the Lung’s connection with grief and weeping. It then says, “Its fluid is nasal mucus,” meaning that the Lung’s fluid is nasal discharge.

The fluid conveyed by Water manifests in the lungs as nasal mucus.

The color associated with the Kidneys is black.

The color bestowed by Wood Qi manifests as black when it reaches the Kidneys.

The odor governed by the Kidneys is putrid.

The odor governed by Fire becomes putrid when it circulates into Water.

The flavor governed by the Kidneys is salty.

Earth receives and forms the various flavors; when it reaches Water, it becomes the salty flavor that moistens and flows downward. Salt softens things, so salty flavor is said to have a softening effect.

The sound associated with the Kidneys is groaning.

Water is the mother of Wood, and Wood is the child of Water. The child is influenced by the mother’s Qi, and so gives voice to a delicate, soft groan.

The body fluid governed by the Kidneys is saliva.

The saliva in the mouth is transformed from Water Qi. Water Qi circulates through the five body fluids, pouring them into the five viscera, so each organ has its own fluid. In the Kidneys, this fluid manifests as saliva.

The above describes the sounds, colors, odors, and flavors associated with the five viscera. In general, the five sounds, five colors, five tones, and five fluids harmonize with and nourish one another.

Where do the seven kinds of spirit Qi stored in the five viscera each reside?

Answer: Each of the five viscera stores its corresponding spirit Qi. “Store” means the place where a person’s spirit Qi dwells and takes up residence. Together, the five viscera are like a house; “store” also carries the sense of lodging or keeping something within. A person’s spirit Qi resides in the different viscera.

Thus, the Liver stores the Hun. The Hun is the part that moves and acts along with the spirit Qi; the Hun stored by the Liver assists a person’s spirit Qi.

The Lungs store the Po. The Po is the part that accompanies essence Qi as it enters and leaves; the Po stored by the Lungs assists a person’s essence Qi.

The Heart stores the Shen (spirit). The Heart is where clarity of spirit resides. The Shen stored by the Heart is the function of spiritual awareness formed through the transformation of essence Qi.

The Spleen stores intention and wisdom. What the mind holds in focus and reflects upon is called “intention”; intention governs thought. The capacity to judge right from wrong is the beginning of wisdom; wisdom governs memory.

The Kidneys store essence and will. When Yin and Yang Qi interact and combine to form the body, this is called “essence.” The will is the direction toward which the mind’s intent is inclined.

End of Volume Four of Collected Diagrams and Explanations of the Sentences in the Huangdi’s Classic of Eighty-One Difficulties.

The following textual notes record several suspected errors in the original and the grounds for emending them. Some characters were corrected on the basis of context; others were checked against the commentaries B enyi and Jizhu, as well as notes in other classical works. For example, “mao” was changed to “luan,” “fei” to “zhongshi,” and the Suwen chapter “On Prohibitions Against Acupuncture,” together with Wang Bing’s commentary, was cited to explain the phrase “the stomach serves as a marketplace”: the stomach is like a market, where the five flavors converge. “Ming” was also changed to “gu,” and “shangyi” to “zhong shier.” Some readings remain uncertain and are marked as doubtful or possibly erroneous; other wording does not fit the sense and may have been corrupted during copying.

Chapter Thirty-Five discusses the locations of the five zang organs and six fu organs. Each of the five zang organs has a fixed position. The six fu organs lie close to one another: the stomach is near the spleen, the gallbladder near the liver, and the bladder near the kidneys. Why, then, are the heart and lungs far from the large and small intestines?

The heart and lungs lie above the diaphragm, while the large and small intestines lie below it. The text says that the heart governs blood, which is called “nutritive”; the lungs govern Qi (vital energy), which is called “defensive.” The heart and lungs circulate Yang Qi, so they are located in the upper part of the body. The upper part corresponds to Heaven, and Heaven belongs to Yang.

The large and small intestines transport and move Yin Qi downward, so they are located in the lower part of the body. The lower part corresponds to Earth, and Earth belongs to Yin. The heart and lungs circulate Yang Qi, while the large and small intestines circulate Yin Qi; this is why they are far apart.

The six fu organs all belong to Yang, and Yang corresponds to Qi. The three Yang channels of the hands and feet are the channels through which Qi flows. Therefore, the six fu organs are said to be located in a cool, clear place.

Why say that the gallbladder is a clear and cool organ, when the large intestine, small intestine, stomach, and bladder all receive and convey water and grain—that is, food and drink?

Answer: It is correct to call these organs “Fu,” or storehouses, because each has its own role in transporting or storing things. But it is incorrect to say that the small intestine is simply the heart’s Fu. Although the small intestine corresponds to the heart and the two are paired as interior and exterior, their functions differ. Their Qi is connected, but they govern different affairs. So even though the small intestine shares Qi with the heart, they cannot for that reason be treated as having the same location and function. It is therefore inaccurate to call the small intestine the heart’s Fu.

The scriptures call the small intestine the “Fu that receives and holds.” This means that it takes up the stomach’s work: it receives the food residue passed on from the stomach, continues its digestion, and then conveys it to the large intestine.

The large intestine is the “Fu that conveys and conducts the way.” This means it transports feces and carries them along the intestinal tract for excretion.

The gallbladder is the “clear and pure Fu.” It lies between the short lobes of the liver. The liver’s Qi connects with the eyes; when the eyes are clear and balanced, they can distinguish black from white. The gallbladder is the liver’s Fu and is by nature quiet and still.

The stomach is the “Fu of water and grain.” Like a storehouse, it receives and gathers food and drink.

The bladder is the “Fu of fluids.” Among the body’s fluids, those that disperse and become sweat, moistening the skin and the spaces between its tissues, are called “Jin”; those that seep into the body’s openings and remain there without circulating are called “Ye.” The bladder is where these fluids are stored.

A Fu should not have two names. Therefore, the small intestine cannot be called both its own Fu and the heart’s Fu. It is also inaccurate to call the small intestine the heart’s Fu and the large intestine the lung’s Fu.

The six fu organs each have one name; they should not have two. It is incorrect to say that they have two names.

The small intestine is the fu organ of the Heart, paired with it. The large intestine is the fu organ of the Lung, the stomach of the Spleen, the gallbladder of the Liver, and the urinary bladder of the Kidney.

The small intestine is also called the “red intestine”: in the Five Phases, the Heart corresponds to red, so the small intestine is symbolized by that color. The large intestine is also called the “white intestine” because the Lung corresponds to white; the gallbladder is called the “green intestine” because the Liver corresponds to green; the stomach is called the “yellow intestine” because the Spleen corresponds to yellow; and the urinary bladder is called the “black intestine” because the Kidney corresponds to black. The bladder is also located in the lower burner, the region of the organs in the lower part of the body, and is associated with its functions.

The Thirty-Sixth Difficulty says: “Each of the five zang organs has one. The Liver, Spleen, Lung, and Heart each have one organ. Why does the Kidney alone have two?”

Answer: The two “Kidneys” are not both Kidneys. The one on the left is the Kidney; the one on the right is the Gate of Life, or Mingmen, an organ concept associated with the root of life.

In men, the left side is the Kidney and the right side is the Gate of Life. The Gate of Life is called the gate of human life. It is also said to correspond to ministerial fire, the fire at the right wrist’s proximal pulse that supports sovereign fire and drives physiological activity. It is where the spirits, essence, and vital energy reside.

The Gate of Life has an acupuncture point on the back at the level of the fourteenth vertebra. The point Zhishi has two locations, one on each side below the fourteenth vertebra, each three cun from the spine. The spirit guards the Gate of Life, preventing pathogenic influences from entering Zhishi. “Abode” means dwelling place: the spirits, essence, and vital energy reside there.

The Gate of Life is also where the source Qi, the fundamental Qi of the body’s vital activity, gathers.

“Original” (yuan) means the primordial beginning, the source. Original Qi arises from the position of Zi, which belongs to the Kan trigram. Kan represents the Original Qi of father and mother: Qian symbolizes Heaven and the father, while Kun symbolizes Earth and the mother. Kan’s first and third six-line positions come from Kun, and its nine-line position in the middle comes from Qian. In other words, Qian and Kun join to form Kan, so Original Qi is stored in the kidneys.

Thus, in men, the kidneys store Jing.

When the vital energies of the five viscera and six bowels are abundant, they flow into and gather in the kidneys. The kidneys receive and store these energies. Each of the five viscera has its own Jing, which is sent to the kidneys according to the body’s needs. The kidneys are where vital energy gathers and is regulated, and where the body stores it.

In women, the womb receives Jing. From this, we can understand that there is one kidney.

The thirty-seventh question asks:

Where does the Qi of the five viscera arise?

Where does it reach?

Can these principles be explained?

The answer: The Qi of the five viscera connects with the nine orifices in the upper part of the body. The nine orifices are the two ears, the two eyes, the mouth, the two nostrils, and the anterior and posterior openings. Seven are Yang orifices and two are Yin orifices; the five viscera are linked to these passages.

Thus, Lung Qi connects to the nose. The nose is the Lung’s orifice, through which the Lung’s vital essence passes.

When the nose functions properly, it can distinguish fragrant from foul smells. The Qi of the five viscera connects with the nose, which is associated with the Heart and Lungs. If the Heart or Lungs are ill, the nose’s function may also be affected. When Lung Qi is harmonious, the nose functions normally and can distinguish fragrant from foul smells.

Liver Qi connects to the eyes.

The eyes are the openings of the Liver, through which the Liver’s essence and Qi rise to the eyes.

When the eyes function normally, they can distinguish white from black. Only when the eyes are clear can one see the myriad things, distinguish colors, and judge length. If one mistakes long for short or white for black, the eyes’ essence and Qi have grown weak. The Liver’s essence and Qi reach the eyes; when their function is balanced, they can distinguish white from black.

The Spleen’s Qi reaches the mouth. The mouth is the opening of the Spleen, through which the Spleen’s essence and Qi take effect.

When the mouth functions normally, it can discern the flavors of grains and food. Everyone eats and drinks, but few can truly distinguish the flavors. The Spleen and Stomach are like a sea that holds food and drink. When they are balanced, the mouth functions normally and can taste the food.

The Heart’s Qi reaches the tongue. The tongue is the opening of the Heart, through which the Heart’s essence and Qi take effect.

When the tongue functions normally, it can distinguish the Five Flavors: pungent, sweet, sour, bitter, and salty. When the Heart’s Qi is balanced, the tongue functions normally and can distinguish the Five Flavors.

The Kidney’s Qi reaches the ears. The ears are the openings of the Kidneys, through which the Kidneys’ essence and Qi take effect.

When the ears function normally, they can distinguish the Five Tones: gong, shang, jue, zhi, and yu. When the Kidney Qi is balanced, the ears function normally and can distinguish the Five Tones.

When the functions of the Five Zang organs are out of balance, the body’s nine orifices become obstructed. When the Five Zang are out of balance, pathogenic Qi cannot be expelled outward, and the nine orifices become blocked.

When the functions of the Six Fu organs are out of balance, Qi and blood stagnate and congeal, forming yongju—swellings between the skin and flesh that suppurate.

When pathogenic Qi enters the Six Fu, the Yang channels become disordered. The Six Fu belong to Yang, as do the channels in the outer layers of the flesh. As pathogenic Qi moves through the Six Fu, it disrupts the harmony of these channels. When the Yang channels are disordered, Qi stagnates and gathers, forming yongju.

When the Yang vessels are out of harmony, Qi remains at the body’s surface. Yang belongs to Qi and governs the exterior. If the vessels above the surface muscles are out of balance, pathogenic Qi lingers between the skin and cannot disperse. Once Qi has stagnated, the Yang vessels become excessive.

When pathogenic Qi enters the five Zang organs, the Yin vessels fall out of harmony. The five Zang organs belong to Yin, as do the vessels deep within the muscles. When pathogenic Qi enters the Zang organs, the deep vessels become disordered. Yin belongs to Blood and governs the interior. When the Yin vessels are out of harmony, Blood stagnates between the muscle fibers. Once Blood has stagnated, the Yin vessels become excessive.

When Yin Qi becomes excessive, Yang Qi cannot properly nourish the body. This is called “separation” (ge). Separation means obstruction: Yin Qi within blocks Yang Qi, preventing it from reaching the body’s surface. Hence it is called “separation and resistance.”

When Yang Qi becomes excessive, Yin Qi cannot properly nourish the body. This is called “closure” (guan). Closure means blockage: Yang Qi at the body’s surface blocks Yin Qi, preventing it from circulating outward. Hence it is called “closure.”

When both Yin and Yang are excessive and cannot nourish one another, this is called “closure and separation.” A lack of coordination between the body’s interior and exterior is the illness of closure and separation. The body depends on Qi and Blood: Qi belongs to Yang, and Blood belongs to Yin. Illness can result when both Qi and Blood are excessive, when both are deficient, or when one is excessive and the other deficient.

The Jing says that Qi circulates through the five Zang organs but does not nourish the six Fu organs. Why is this?

Answer: The circulation of Qi is like flowing water; it never stops.

Question: Qi flows only through the five zang organs, not through the six fu organs. Why?

Answer: The flow of Qi is like running water: it continues day and night without a moment’s pause.

Thus, the Yin channels nourish the five zang organs. Since the zang organs belong to Yin, the Yin channels flow through them. The Yang channels nourish the six fu organs. Since the fu organs belong to Yang, the Yang channels flow through them.

Qi and blood circulate back and forth like a ring with no beginning or end, making it difficult to determine where they start or finish. Over the course of a day and a night, Qi and blood reach the liver; on the following day, at the time of Gen (the Chou hour, approximately one to three in the morning), they begin to flow from the lungs again.

Qi and blood do not undergo “overturning” or “overflow.” When Yin Qi is deficient and Yang takes advantage of the deficiency to enter, this is called “overturning”; when Yang Qi is deficient and Yin takes advantage of the deficiency to emerge, this is called “overflow.” The text also calls Qi entering the forearm pulse area “overturning,” and Qi rising to the fish border (the palm-side area at the base of the thumb) “overflow.” Now that Yin and Yang each remain in their proper place, there is no danger of overturning or overflow.

When the Qi of Yin and Yang does not overturn or overflow, the body’s Qi can warm the internal organs gently and moisten the interstices (the skin’s texture and pores), keeping them supple.

The Measures of the Zang and Fu: Section Sixty

Thirty-Eighth Difficulty

Question: There are only five zang organs, but six fu organs. Why?

Answer: There are six fu organs because the Triple Burner is included among them.

The Triple Burner has a branch of original Qi (the fundamental Qi underlying the body’s vital activity). Original Qi was discussed in the previous section: the Triple Burner joins with the kidneys. The kidneys are the root of original Qi, while the Triple Burner is its branch and governs the Qi of the body.

The center of the chest, between the nipples, is the Sea of Qi, where the Qi of the whole body gathers and is governed. It lies in the Upper Burner, one of the Three Burners, which refers to the region above the diaphragm. There is also the Sea of Qi acupoint, located two cun below the navel and belonging to the Lower Burner. The Sea of Qi helps sustain the Qi of the whole body.

The Three Burners have a name but no independently formed substance. What is called the Three Burners consists only of the fascia attached to the upper, middle, and lower parts of the stomach. Hence the name “Three Burners,” though they have no fixed form of their own.

The meridian of the Three Burners belongs to the Hand Shaoyang channel, a Shaoyang meridian of the arm.

The Three Burners have no internal organ as a tangible structure; they have only one meridian, called the Hand Shaoyang channel. The upper, middle, and lower parts of the stomach are named the Three Burners, but the Three Burners have no independent form. For this reason, they are called the “external fu.”

Thus, the Six Fu are in fact the Five Fu plus the Three Burners, together called the Six Fu.

The Thirty-Ninth Difficulty says:

“The scriptures say there are five fu: the gallbladder, stomach, large intestine, small intestine, and bladder. The zang number six. Why?”

The zang comprise the liver, heart, spleen, lungs, and kidneys, as well as the Gate of Life, which is associated with the kidneys and regarded as the dwelling place of the spirit.

Answer: The Six Fu are the Five Fu with the Three Burners added; in substance, there are still only five organs.

The zang are said to number six because the Gate of Life is counted alongside the kidneys. The kidneys are on the left, and the Gate of Life is on the right. The Gate of Life is the dwelling place of the spirit: in men, it stores Jing; in women, it is associated with the womb, the organ that nurtures the fetus. This account is explained in detail in the Thirty-Sixth Difficulty.

The Qi of the Gate of Life connects with the Qi of the kidneys. So when the Gate of Life is counted as well, the zang are called the Six Zang.

If the zang number six, why do the fu number only five?

Each of the five zang organs is paired with one fu organ, so together the five zang organs have five corresponding fu organs. The Triple Burner is also counted as a fu organ, but it is not one of the fu organs paired with the five zang organs. It corresponds to the pericardium (the organ tissue that envelops and protects the heart) and is not paired with any of the five zang organs. Thus, in addition to the five fu organs, there is the Triple Burner. Since it is not a regular fu organ paired with a zang organ, the count remains five.

The Forty-First Difficulty says: “The liver governs color.” The liver belongs to Wood. Since the flowers and leaves of trees can display many colors, the liver is said to govern color.

“The heart governs smell.” The heart belongs to Fire, which can transform things. The five odors arise from this transformative action, so the heart is said to govern them.

“The spleen governs taste.” The spleen belongs to Earth and governs sweetness. Since the spleen receives and takes in all the different flavors, it is said to govern taste.

“The lungs govern sound.” The lungs belong to Metal. When metal objects are struck, they make a sound, so the five tones are all associated with the lungs.

“The kidneys govern fluids.” The five bodily fluids all originate from Water, and the kidneys govern Water, so they are said to govern fluids.

The nose is the lungs’ outward correspondence—a bodily part through which the condition of an internal organ can be observed. Although the lungs govern sound and the nose belongs to the lungs, the nose cannot hear; instead, it distinguishes pleasant from unpleasant odors. The ears are the kidneys’ outward correspondence. Although the kidneys govern fluids and the ears belong to them, the ears do not secrete fluids; instead, they hear sounds. Why is this?

The lungs belong to Metal in the west. In the generative cycle of the Five Phases, Metal begins to flourish in Si, which belongs to Fire in the south; among the five zang organs, the heart belongs to Fire. The heart governs odors, so although the nose belongs to the lungs, it can distinguish pleasant from unpleasant smells. This explanation draws on the directions and generative relationships of the Five Phases to account for the connection between the nose, heart, and lungs.

Fire corresponds to the heart. The south belongs to Fire, and among the five viscera, the heart also belongs to Fire.

The heart governs the five odors. The nose can therefore distinguish fragrance from stench. The nose belongs to the lungs, and the lungs belong to Metal. Metal arises in the position occupied by the heart’s Fire, so the nose can discern the odors governed by the heart.

The kidneys correspond to the water of the north and belong to the northern Ren and Gui water. Water begins to grow at the Shen position, which belongs to the Metal of the west. Of the western positions Shen, You, and Xu, Shen is where Metal Qi reaches the stage of official service. Metal corresponds to the lungs; the west belongs to Metal, and among the five viscera, the lungs also belong to Metal.

The lungs govern sound, so the ears can hear. The ears belong to the kidneys. Kidney Water arises in the position occupied by Lung Metal, so the ears can hear sound.

The Forty-First Difficulty: The liver alone has two lobes. What principle does this correspond to?

Answer: The liver belongs to the Jia and Yi Wood of the east. Wood corresponds to spring, the season when plants and trees sprout and grow. When things first begin to grow, they are still small and tender, like the first shoots emerging from a plant’s roots, not yet fully grown.

At their beginning, all things stand apart and have not yet drawn close to one another; they are near Greater Yin. The Qi and blood of the twelve meridians flow in sequence: after the Foot Jueyin Liver Meridian, they flow into the Hand Taiyin Lung Meridian. That is why the liver is said to be near Greater Yin. It is also not far from Greater Yang: the Foot Jueyin belongs to Wood, and Wood generates Fire. Fire corresponds to the Hand Taiyang and Hand Shaoyin, so the liver is said to be not far from Greater Yang.

The liver corresponds to Greater Yin, reflecting the concern that Metal may overcome Wood; it also corresponds to Greater Yang, reflecting Wood’s generation of Fire. Thus it is said to have two intentions. That is why the liver has two lobes, much like the leaves of a tree.

The liver is classified as Wood and corresponds to Water.

Question 42 asks: How long are the intestines and stomach, and how much water and food can they hold?

What are the respective lengths of the intestines and stomach, and how much water and food can they hold?

The stomach has a circumference of one chi and five cun. The word “stomach” here conveys the sense of enclosing and containing; the passage says that the distance around it is about one chi and five cun. Its diameter is five cun, and it is two chi and six cun long. Curving and coiling, it can hold three dou and five sheng of water and food. It normally retains two dou of grain and one dou and five sheng of water. The water and food retained in the stomach are then passed on to the small intestine.

The small intestine has a circumference of two cun and five fen. Here, “small intestine” refers to the intestinal tract through which the stomach’s contents pass and from which waste is expelled. It is about eight and a half fen in diameter, three zhang and two chi long, and can hold two dou and four sheng of grain and six sheng and three ge and a half of water.

The large intestine is also called the winding intestine, a name it gets from its twisting, winding course. It has a circumference of four cun, a diameter of one cun and five fen, and is two zhang and one chi long. After the water and food in the stomach pass into the small intestine, four dou of grain and eight sheng and six ge and a half of water remain; they are then passed on to the large intestine.

The human body takes in one dou of food and seven and a half sheng of water. Together, the food and water amount to three dou and five sheng in the stomach. After passing into the small intestine, four dou and eleven of the grain remain, while the water is reduced by eight sheng, six ge, and half a ge. It then passes into the large intestine, where the amounts of water and grain are each reduced by one dou and twelve compared with their quantities in the stomach. At this point, the water enters the bladder, while the grain passes to the anus and is expelled.

The broad intestine—that is, the rectum where the anus is located—is four cun wide, two and a half cun in diameter, and two chi and eight cun long. It receives the grain passed on from the large intestine and expels it. Its capacity is nine sheng, three ge, and one-eighth of a ge.

Thus, the stomach, small intestine, large intestine, and broad intestine have a combined length of five zhang, eight chi, and four cun, and hold a total of eight dou, seven sheng, six ge, and fourteen one-eighth ge. These are the total length of the intestines and stomach and the quantity of food and water they can contain.

The liver weighs four jin and four liang. In shape, it resembles a structure with branches: it has three lobes on the left and four on the right, seven in all. The liver pertains to Foot Jueyin and is paired with Foot Shaoyang. According to this account, the number associated with Foot Shaoyang corresponds to seven, so the liver has seven lobes. The liver governs the storage of the hun (in traditional Chinese medicine, the hun is a form of mental activity associated with the liver).

The heart weighs twelve liang and has seven openings and three fine strands within it.

The most intelligent people have seven apertures in the heart; some accounts say they have nine apertures and three hairs. People of middling intelligence have five apertures and two hairs; those of lesser intelligence have three apertures and one hair. Ordinary people have two apertures and no hairs; dull-witted people have one aperture; and the very dull-witted have a tiny aperture in the heart. There is also a kind of person who spends their whole life deluded and confused. Though they have a heart, it has no aperture, so the spirit has no gateway through which to enter or leave, making it difficult for them to attain bodily form and karmic retribution.

The essence stored in the heart amounts to about three ge. Its main function is to store Shen (spirit)—that is, to gather and shelter the spirit. For a related explanation, see the thirty-fourth difficulty in the Nanjing (Classic of Difficulties).

The spleen weighs two jin and three liang. The word “spleen” carries the meaning of assisting. Located below the stomach, it supports the stomach Qi and governs the reception of water and grain (food and drink). Here, the spleen is said to weigh three jin and three liang.

The spleen is flat and broad, about three cun across and five cun long. It contains scattered fatty tissue amounting to about half a jin. The spleen encloses the blood, warms the five organs, and governs the storage of Yi (intention). For a related explanation, see the thirty-fourth difficulty in the Nanjing.

The lungs weigh three jin and three liang. They have six large lobes and two small lobes, eight lobes in all. The word “bo” in the description of the lungs conveys the sense of breath being abundant and vigorous. The lungs belong to Metal, which corresponds to the You position. Since the You position has eight gates, the lungs have eight lobes in correspondence with it. The lungs govern the storage of Po (instinctive awareness). For a related explanation, see the thirty-fourth difficulty in the Nanjing.

There are two kidneys, located in the lower back opposite the navel. “Kidney” carries the meaning of guiding: the kidneys guide water Qi to flow into the various channels. Each kidney weighs one jin and one liang, and governs the storage of Zhi (will). For a related explanation, see the thirty-fourth difficulty in the Nanjing.

The gallbladder lies between the shorter lobes of the liver.

The gallbladder: The word for gallbladder also means “courage.” It refers to having ample gallbladder Qi and acting decisively. The gallbladder lies between the two lobes of the liver. It weighs three liang and three zhu and contains three ge of refined fluid.

The stomach weighs two jin and one liang. It bends and flexes; its internal form winds and turns, allowing it to expand. It is two chi and six cun long, one chi and five cun wide, and five cun in diameter. It can hold two dou of grain and one dou and five sheng of water.

The small intestine weighs two jin and fourteen liang. It is three zhang and two chi long, two cun and a half wide, and slightly more than eight fen in diameter. It loops from the left side, winding in successive coils through sixteen bends. It can hold two dou and four sheng of grain and a little more than six sheng and three ge of water.

The large intestine weighs two jin and eleven liang. It is two zhang and one chi long, four cun wide, and one cun in diameter. It lies to the right of the navel and loops in coils through sixteen bends. It can hold one dou of grain and seven and a half sheng of water.

The urinary bladder weighs nine liang and two zhu.

The urinary bladder, an organ that stores urine, has a name in which “pang” means horizontal and “guang” means broad: its form is short and broad across. It is also called the “pao,” meaning empty, because its hollow interior receives fluids. It weighs nine liang and two zhu.

It is nine cun long and nine cun wide, measuring nine cun in total, and can hold nine sheng and nine ge of urine.

The opening of the bladder is two and a half cun wide.

The distance from the lips to the teeth is nine fen. From the mouth to the epiglottis, the structure that helps cover the airway during swallowing, is three and a half cun deep and can hold at most five ge. When water and food are swallowed, the epiglottis covers the airway so that breathing is not obstructed.

The tongue weighs ten liang, is seven cun long and two and a half cun wide. It can extend freely or become stiff and sluggish, and is involved in speech and the production of voice.

The pharyngeal opening, the entrance to the throat, weighs ten liang, is two and a half cun wide, and is one chi and six cun from the stomach. The pharynx is a passage for swallowing and an important route for the movement of breath; the scripture says it governs Earth Qi.

The throat weighs twelve liang, is two cun wide and one chi and two cun long, and has nine sections. Its interior is hollow. It is a passage for breath and connects to the lungs; the scripture says it governs Heaven Qi.

The anus weighs twelve liang.

The anus was called “the anus” by the ancients because its shape resembles a chēgāng, the cylindrical part at the center of a wheel. It is also called the “broad intestine” or the “limb intestine.” It weighs twelve liang.

The anus is eight cun wide, a little over two cun in diameter, and two chi and eight cun long. It can hold nine sheng, three ge, and one-eighth of a ge of grain. See the earlier passage for the related commentary.

The Forty-Third Difficulty asks: If a person neither eats nor drinks, why do they die after seven days?

The answer: The stomach normally contains two dou of grain and one dou and five sheng of water.

A person has no other means of support; life depends on food and drink. The stomach is where food and water are received and stored. Under ordinary conditions, it holds a total of three dou and five sheng.

A person in good health uses the toilet twice a day. Each time, they pass two and a half sheng; twice a day, that amounts to five sheng. Over seven days, they therefore pass a total of three dou and five sheng of food and water, exhausting what the stomach had stored.

Thus, when an ordinary person dies after seven days without food or drink, it is because the food and water, along with the body’s fluids, have all been depleted.

In the term “Seven Passage Gates,” “passage” means a route for movement in and out. The Seven Passage Gates are the seven openings through which the Qi of the organs and bowels, and food and drink, pass.

The lips are the Flying Gate. The lips belong to the Spleen and can open, close, and move. Food enters through them and is then conveyed into the body, so they are called the Flying Gate.

The teeth are the Door Gate. The ancients believed that thoughts in the heart take the form of speech, which comes out through the mouth; therefore, they called the mouth and teeth the gates through which the Qi of the heart enters and leaves. The teeth also chew and grind the grains, allowing food to proceed into the body, so they are also called the Door Gate.

The stomach is the Diaphragm Gate. Here, “diaphragm” is the interpretation of the term “fen.” Qi rises from the stomach and conveys the Qi of food and drink. Since the lungs lie above the diaphragm, the passage between the stomach and lungs is called the Diaphragm Gate.

The epiglottis is the Inhalation Gate. It is the part of the throat that controls the passage of breath and sound, and is therefore called the gate through which the Five Organs produce sound. Related material also appears in The Forty-One Difficulties.

The lower opening of the stomach is the Hidden Gate. “Great Granary” refers to the stomach. Its lower opening lies three cun below the navel and is concealed, so it is called the Hidden Gate.

The meeting point of the large and small intestines is the Barrier Gate. “Meeting” means joining together. The ancients believed that food and drink are separated here, so that their refined essence and waste each go to their proper destination; hence it is called the Barrier Gate.

The lower extremity is the Po Gate. The Po Gate refers to the anus. According to ancient medical theory, lung Qi communicates upward with the throat and downward with the anus. Since the lungs store the Po, the anus is called the Po Gate.

Together, these are called the Seven Passage Gates.

The Forty-Five Difficulties asks: “What are the ‘Eight Convergences’ spoken of in the classic? That is, where do the organs, bowels, sinews, bones, marrow, blood, vessels, and Qi each converge?”

The answer: The bowels converge at the Great Granary. The Great Granary refers to the stomach.

The place where the Stomach Channel of Foot-Yangming, the Small Intestine Channel of Hand-Taiyang, the Triple Burner Channel of Hand-Shaoyang, and the Conception Vessel converge is called Zhongwan, also known as Great Granary. It is the Front-Mu point of the Stomach—a point on the body’s surface where the Qi of an organ or bowel gathers. The Stomach transforms food and drink into Qi, which nourishes the six bowels; for this reason, Zhongwan is called the “meeting point of the bowels.”

The meeting point of the organs is at the seasonal ribs.

“Seasonal ribs” is a name for the lower floating ribs. At their tips is a point that serves as the Front-Mu point of the Spleen. The Liver Channel of Foot-Jueyin and the Kidney Channel of Foot-Shaoyin converge there, so it is called the “meeting point of the organs.”

The meeting point of the sinews is at Yanglingquan.

Yanglingquan lies on the outer side below the knee. It is a point where the channel Qi of the Gallbladder Channel of Foot-Shaoyang emerges.

The meeting point of the marrow is at Juegu.

Juegu is the name of a bone. The Juegu point lies above the outer ankle, where the Yangfu point is located; it is also where the channel Qi of the Gallbladder Channel of Foot-Shaoyang emerges.

The meeting point of the blood is at Geshu.

There are two Geshu points, one on either side of the spine below the seventh thoracic vertebra, each one and a half cun from the spine. They are points where the channel Qi of the Bladder Channel of Foot-Taiyang emerges.

The meeting point of the bones is at Dazhu.

The Dazhu points lie on either side of the first vertebra below the neck. They are points where the channel Qi of the Bladder Channel of Foot-Taiyang emerges.

The meeting point of the blood is at Geshu. There are two Geshu points, one on either side of the spine below the seventh thoracic vertebra, each one and a half cun from the spine. They are points where the channel Qi of the Bladder Channel of Foot-Taiyang emerges.

The meeting point of the bones is at Dazhu. The Dazhu points lie on either side of the first vertebra below the neck, each one and a half cun from the spine. They are points where the channel Qi of the Bladder Channel of Foot-Taiyang emerges.

The meeting point of the vessels is at Taiyuan.

Taiyuan lies at the wrist pulse on the side of the thenar eminence. It is a point where the channel Qi of the Lung Channel of Hand-Taiyin emerges.

The meeting point of Qi is in the Triple Burner, between the breasts.

The Upper Burner lies below the heart, beneath the diaphragm and above the Stomach. Its back-shu point lies in the chest, in the hollow between the breasts, one cun and six fen below the Yutang point. This is the Danzhong point. The “space between the breasts” mentioned here refers to Danzhong. Qi spreads from Danzhong and is carried downward by the Lungs to the various organs. Danzhong serves like a ministerial official and is where the Sea of Qi is located.

When a heat illness arises within the body, the corresponding meeting point of Qi may be selected for treatment.

If the heat illness is internal, select from the body’s surface the meeting point corresponding to the symptoms, and use it to regulate the illness.

Older people have difficulty falling asleep after lying down. Even when they do sleep, they often rest uneasily. Young people usually fall asleep easily and do not wake repeatedly. Why is this? Why do older people and young people have opposite patterns of sleep?

The scripture explains that young people have abundant blood and Qi. Their skin and muscles are nourished, the pathways through which Qi and blood circulate are clear, and nutritive Qi and defensive Qi—the two forms of Qi that sustain the body’s functions and protect it—circulate regularly. As a result, they are alert during the day and sleep soundly at night.

Older people’s blood and Qi have weakened, their skin and muscles are no longer well nourished, and the pathways of nutritive and defensive Qi have become sluggish, so these forms of Qi no longer circulate at their proper times. As a result, older people have less energy during the day and find it difficult to fall asleep at night.

From this, we can understand why older people are prone to insomnia. A person wakes when defensive Qi circulates at the body’s surface and sleeps when it enters the body. As Qi weakens with age, defensive Qi circulates abnormally at night, making it difficult to sleep soundly.