《黄帝内经灵枢集注》Vol. 3

When the qi of the Shaoyin channel (jing) arrives, a person bites their own tongue. When the qi of the Shaoyang channel arrives, they bite their cheeks. When the qi of the Yangming channel arrives, they bite their lips. One must first examine where the main pathological change lies and then apply supplementation, that is, use needling and similar methods to support the deficient channel qi.

All of these twelve abnormal manifestations arise when pathogenic qi invades the body's orifices and hollow spaces (kong qiao, kong qiang). Wherever pathogenic qi lodges, righteous qi (zheng qi) tends to be deficient. When upper qi is deficient, the brain is not full, the ears tend to ring, the head feels tilted, and the eyes grow dim. When middle qi is deficient, the functions of urination and defecation change, and the intestines tend to gurgle. When lower qi is deficient, there is weakness, cold limbs, and vexation in the heart. One may supplement the Liu point (liu xue) located below the outer ankle.

The Yellow Emperor asked, "How should these be treated?" Qi Bo answered:

Yawning belongs to the kidney channel, and one should treat the foot Shaoyin channel. Hiccup belongs to the lung channel, and one should treat the hand Taiyin channel and the foot Shaoyin channel. Xi (a sobbing sound) results from the separation and blockage of yin and yang qi, so one supplements the foot Taiyang channel and drains the foot Shaoyin channel. Shivering from cold calls for supplementing all the yang channels. Yi (belching) calls for supplementing the foot Taiyin channel and the Yangming channel. Sneezing calls for supplementing the foot Taiyang channel and the area at the root of the eyebrows. Duo (drooping of the body or head) should be treated according to the location of the symptom, using supplementation in the spaces between the muscles. Tears call for supplementing the Tianzhu (Heavenly Pillar) channel and the sides of the neck, as well as the foot Taiyin and Yangming channels. The sides of the neck lie on either side of the midline of the head. Sighing calls for supplementing the hand Shaoyin channel and the Xinzhu (Pericardium) channel, and draining the Liu point of the foot Shaoyang channel. Drooling calls for supplementing the foot Shaoyin channel. Tinnitus calls for supplementing the Kezhuren (Guest-Host) point and the point on the thumb nail where it meets the flesh of the finger. Biting one's own tongue calls for examining where the main pathological change lies and then applying supplementation. Blurred vision and a tilted head call for supplementing the Liu point below the outer ankle. Weakness, cold limbs, and vexation in the heart call for needling the Liu point two cun above the space between the big toe and the second toe. Another account says to needle the Liu point below the outer ankle.

Source: Huangdi Neijing Lingshu Jizhu (Collected Commentaries on the Spiritual Pivot of the Yellow Emperor's Inner Classic), Volume 10.

Collation notes: One passage was supplemented from the Jiayi Jing (Systematic Classic of Acupuncture and Moxibustion). Following the usual convention, the word "bing" (illness) is suspected to be missing a character after it. The title of the work and further collation remarks appear at the end.

Collation Notes: Following the usual practice, the character after "illness" (bing) may have been dropped, possibly "er" (and). Note 3: the character "xiao" (small) is written as "shao" (few) in the Taisu (Plain Basics), chapter 30, "Xi Nu" (Joy and Anger). Note 4: the character "ci" (next), as originally written, has been corrected to the homophone "ci" (to pierce) according to the Zhaofu Juyi Hall edition. Note 5: the character "sui" (year), as originally written, has been corrected to "yue" (to retch) according to the first entry in volume 12 of the Jiayi Jing (Classic of Acupuncture and Moxibustion). Note 6: the character "jing" (neck) appears as "xiang" (nape) in the Taisu, volume 27, "Shi Er Xie" (Twelve Pathogenic Factors). Note 7: the character "liu" (to stay), in the Zhaofu Juyi Hall edition, is written as the homophone "liu" (to drip).

Lingshu Jizhu (Annotated Commentary on the Spiritual Pivot), Volume 11, Shi Chuan (Transmission from Teachers), Chapter 29

The Yellow Emperor said: "I have heard some insights from my former teachers. I have kept them in my heart and never written them into medical prescriptions. I hope to hear these principles, commit them to memory, and act upon them. Above, I wish to govern the common people; below, I wish to nourish my own body. I want the people to be free of illness, for people to live in harmony and mutual affection, for benevolence and grace to spread widely, and for my descendants to be free of worry. I also wish to pass these principles on to later generations without end. Will you explain them to me?"

Qi Bo replied: "This is a profound question. Governing the common people and nourishing oneself, governing others and governing oneself, handling small matters and great ones, governing a state and governing a household: in every case, one can achieve good order without going against the principles of things, and the key lies only in accord, or shun. The shun spoken of here refers not only to the adverse or favorable flow of Yin-Yang, the jingluo (meridians), and the circulation of qi. The common people, too, hope that their wishes will be accorded."

The Yellow Emperor asked, "How should one accommodate the condition of the patient?" Qi Bo replied, "On arriving in a state, one must learn its customs. On entering a household, one must learn its taboos. On ascending the hall and entering the chamber, one must understand proper etiquette. And when facing the patient, one must ask what they find most comfortable."

The Yellow Emperor asked, "How can the patient be made to feel at ease?" Qi Bo replied, "For those with internal heat who show signs of emaciation, wasting, and thirst, which is called xiaodan (wasting-thirst disorder), cooling methods are suitable. For those whose bodies tend toward cold, warming methods are suitable. When there is heat in the stomach, food is digested quickly, leaving a feeling as though the heart were suspended, with constant hunger, and the skin above the navel feels hot. When there is heat in the intestines, the stool is yellow and loose like thin porridge, and the skin below the navel feels cold. When there is cold in the stomach, there is abdominal distension. When there is cold in the intestines, there is borborygmus, and food is passed without being digested. Cold in the stomach with heat in the intestines causes both distension and diarrhea. Heat in the stomach with cold in the intestines causes easy hunger, along with pain and fullness in the lower abdomen."

The Yellow Emperor asked, "Those with heat in the stomach are prone to hunger and should take cooling foods, while those with cold in the intestines should take warm drinks. The needs of the two are opposite. How should they be treated? Moreover, nobles and great lords are accustomed to privilege and indulge their desires, and they are not easily persuaded to heed others. To forbid them by force would go against their wishes, yet to indulge them would worsen the illness. What should be done? And what should be done first in treatment?"

Qi Bo replied, "No person fears death or cherishes life less. Explain to them the harms their conduct will bring, tell them of the benefits, guide them toward methods suited to their own condition, and let them understand the suffering the illness causes them. Even the unreasonable, how could they refuse to listen entirely?"

The Yellow Emperor asked, "What exactly is the treatment?" Qi Bo replied, "In spring and summer, treat the superficial manifestations first and then the root. In autumn and winter, treat the root first and then the superficial manifestations."

The Yellow Emperor asked, "When the needs of the stomach and intestines are opposed, how should they be adjusted?" Qi Bo replied, "Diet and clothing should both be fitted to the cold and warmth. In cold weather, do not let the person suffer from chill. In hot weather, do not let them become so overheated that they sweat. Food should not be too hot, lest it scald, nor too cold. When cold and heat are moderate, the body's qi can remain harmonious, and it is then less easily invaded by pathogenic influences."

The Yellow Emperor said: "The chapter Benzang (Fundamental Viscera) has already explained that one can judge the size of the zang and fu organs from a person's body form, limbs, joints, and musculature. When nobles, great ministers, or the ruler attend court today, who could touch and press their bodies and answer on that basis?"

Qibo replied: "Body form, the limbs, joints, and musculature are external evidence for observing the viscera. One need not look only at the face."

The Yellow Emperor said: "I already understand how the qi of the five zang appears in the face. How, then, can one observe the condition of the viscera from the limbs and the form of the body?"

Qibo replied: "The lung covers and coordinates the qi of the five zang. Features such as broad shoulders and a hollow throat can be used to observe the condition of the lung."

The Yellow Emperor said: "Good."

Qibo said: "The heart governs the five zang and six fu. The quepen (the hollow above the collarbone) is the pathway for observing the related outward features. The original text is missing a character here, and the sentences that follow are also hard to read."

The Yellow Emperor said: "Good."

Qibo said: "The liver is like a general. It is responsible for planning and responding to the outside world. To know whether liver qi is strong, one can observe the size of the eyes."

The Yellow Emperor said: "Good."

Qibo said: "The spleen is responsible for defense, and it also transforms the grain and water taken in so that the body can use them. Observing the state of the lips and tongue reveals the condition of the spleen."

The Yellow Emperor said: "Good."

Qibo said: "The kidney is responsible for perceiving the outside world and enables a person to hear at a distance. Observing the state of the ears reveals the condition of the kidney and a person's innate disposition."

The Yellow Emperor said: "Good. Please explain how to observe the six fu."

Qibo said: "The stomach is the sea where water and grain gather among the six fu. If the cheeks are broad, the neck thick, and the chest open, this usually indicates a capacity to hold a large amount of food and drink. A long nasal passage allows observation of the large intestine. Thick lips and a long philtrum (renzhong) allow observation of the small intestine. A broad wocan (the area beneath the eye, sometimes called the lying silkworm) indicates that gallbladder qi is strong. Flared nostrils allow observation of the bladder. A raised central ridge of the nose allows observation of the sanjiao (the Triple Burner, the fu responsible for directing the movement of fluids and qi). These are the methods for observing the six fu. When the upper, middle, and lower portions of the body are well proportioned, the zang and fu are stable and healthy."

The character pronounced bian is read in the level tone (píng).

Chapter title: Juéqì (Decisions on Qi), Chapter Thirty.

"The Yellow Emperor said: 'I have heard that the human body contains six things: jing (essence), qi (vital energy), jin (fluids), ye (humors), xue (blood), and mai (vessels). I had thought they were all one qi under different names. Now they are described as six separate kinds, and I do not understand the principle behind this.'

Qi Bo said: 'When the essential qi of father and mother unite, the body is formed. The jing comes into being before the body does, and this is what is called jing.

'What is called qi? When the Upper Jiao (the upper part of the body, which governs the dispersal of breath) opens and flows freely, it sends out the nourishment transformed from the five grains. This warms the skin, fills the body, and moistens the hair, like mist and dew nourishing all things. This is what is called qi.

'What is called jin? When the couli (the texture between skin and muscle) loosens and releases, sweat pours out in quantity. This is what is called jin.

'What is called ye? After food and drink enter the body and the qi is abundant, moistening fluids are carried to the bones, lubricating the joints so that they can bend and extend. They also nourish the marrow of the brain and keep the skin supple. This is what is called ye.

'What is called xue? The Middle Jiao (the middle part of the body, which governs digestion and transformation) receives the refined nutrients produced from food and drink. Through transformation they become red. This is what is called xue.

'What is called mai? The vessels bind and guide the yingqi (the nutritive qi that circulates within the vessels), so that it follows the vessel pathways and does not scatter. This is what is called mai.'

The Yellow Emperor said: 'Each of these six has its times of abundance and decline. The qi may be plentiful or scarce, the marrow of the brain may be full or depleted, and the blood and vessels may be clear or turbid. How can these conditions be distinguished?'

Qi Bo said: 'When jing and qi decline and fail, one becomes deaf. When qi declines and fails, one's sight becomes unclear. When jin and ye decline and fail, the couli open and leak, and sweating does not stop. When ye is depleted, the joints become stiff and difficult to move, the complexion turns dry and withered, the marrow of the brain diminishes, the calves feel weak, and there is often ringing in the ears. When xue declines and fails, the complexion becomes pale and withered and loses its luster. When the mai qi declines and fails, the pulse feels empty. These are the corresponding signs.'

The Yellow Emperor asked: 'What are the respective functions of these six, and how do their importance compare?'

Qi Bo said: 'Each of the six governs its own domain, and their importance and functions differ. Yet the nourishment produced from food and drink, together with the stomach, is the foundation on which all of them depend.'

Huangdi asked Bogao, "I would like to understand how the six fu organs convey food and drink (shuiguo), and how large and long the stomach and intestines are, and how much each can hold."

Bogao replied, "I will describe in detail how deep, how far, and how long the path that food travels is. From the lips to the teeth is nine fen (a unit of length, about one-tenth of a cun), and the mouth is two and a half cun wide. From the teeth back to the huiyan (the flap that covers the entrance to the windpipe during swallowing) is three and a half cun deep, and it can hold at most five ge (a unit of volume). The tongue weighs ten liang (a unit of weight), is seven cun long, and two and a half cun wide. The throat gate (the entrance to the throat) weighs ten liang and is two and a half cun wide, and the distance from it to the stomach is one chi and six cun."

The stomach curls and coils upon itself. When stretched out, it measures two chi and six cun in length and one chi and five cun in width, with a diameter of five cun, and it can hold at most two dou and five sheng. The small intestine is attached to the spine at its back, coils leftward in layers, and leads to the ileum (huichang). Its outer side is attached to the navel. It loops and coils sixteen times, is two and a half cun wide, has a diameter slightly less than eight fen, and measures three zhang and three chi in length. The ileum lies at the navel and loops leftward, coiling in layers before it descends, then turns back and coils sixteen more times. It is four cun wide, has a diameter slightly less than one cun, and measures two zhang and one chi in length. The large intestine (guangchang) lies against the spine and receives the ileum. It loops leftward and coils up and down. At its widest it is eight cun across, its diameter is slightly more than half of two cun, and it measures two chi and eight cun in length.

From the entrance to the exit of the stomach and intestines, the total length is six zhang, four cun, and four fen, and the path coils around itself thirty-two times in all.

Chapter 32: Pingren Juegu (The Ordinary Person Who Abstains from Food)

Huangdi asked, "I want to know why a person who eats nothing dies within seven days."

Bogao replied, "Let me explain the reason. The stomach is one chi and five cun wide, has a diameter of five cun, and is two chi and six cun long. It lies horizontally in a curve and can hold three dou and five sheng of food and drink. Normally the stomach holds two dou of food and one dou and five sheng of fluid, which fills it exactly. The shangjiao (upper burner, the region above the diaphragm associated with breath and the transformation of qi) transports qi and extracts the jing (refined essence) from food and drink. The light, smooth portion of this essence then flows downward into the xiajiao (lower burner, the region below the navel associated with excretion and fluid movement) and irrigates the sections of the intestines."

The small intestine is two and a half cun in girth and a little over eight fen in diameter, and it measures three zhang and two chi in length. It can hold two dou and four sheng of grain and a little over six sheng of water. The ileum, the final section of the small intestine, is four cun in girth and a little over one cun in diameter, and it measures two zhang and one chi in length. It can hold one dou of grain and seven and a half sheng of water. The large intestine (guang chang) is eight cun in girth and a little over two cun in diameter, and it measures two chi and eight cun in length. It can hold a little over nine sheng of grain.

The stomach and intestines together measure five zhang, eight chi, and four cun in length, and they can hold a little over nine dou and two sheng of food and water. This is the total quantity of food and water that the stomach and intestines can contain.

In ordinary people, the stomach and intestines are never full at the same time. When the stomach is full, the intestines are empty, and when the intestines are full, the stomach is empty. Fullness and emptiness alternate between the two, so that qi (qì) can circulate upward and downward, the five viscera remain stable, the blood and vessels flow smoothly, and the shen (shén, spirit) can settle in its place. What is called "shen" is the essential qi (jīng qì) that is transformed from food and water.

For this reason, the stomach and intestines should normally retain two dou of grain and one dou and five sheng of water. An ordinary person defecates twice a day, about two and a half sheng each time, for a daily total of five sheng. Over seven days this comes to three dou and five sheng, and the food and water held in reserve will then be exhausted. An ordinary person who goes seven days without eating or drinking dies because the essential qi of food and water and the bodily fluids have all been depleted.

Chapter Thirty-Three: "On the Seas" (Hai Lun)

Huangdi asked Qi Bo: "I have heard you discuss the methods of needling, and everything you describe involves the ying qi, the wei qi, blood, and qi. The twelve channels (the main pathways of the human meridian system) connect internally with the zang-fu organs and externally link the limbs and joints. Do you also relate them to the 'Four Seas'?"

Qi Bo replied: "The human body also has Four Seas, and the twelve channel-waters. The twelve channel-waters all flow into the sea. The sea is divided into east, west, south, and north, which is why it is called the Four Seas."

Huangdi asked: "How does the human body correspond to the Four Seas?"

Qi Bo said: "The human body has the Sea of Marrow, the Sea of Blood, the Sea of Qi, and the Sea of Grain and Water. These four correspond to the Four Seas of heaven and earth."

Huangdi said: "To relate the human body to the Four Seas of heaven and earth is profound indeed. Could you explain specifically how they correspond?"

Qi Bo replied: "One must first clarify Yin and Yang, interior and exterior, and the locations where the qi and blood of the channels are transported, and only then can the Four Seas be determined."

Huangdi asked: "How is this determined?"

Qi Bo said: "The stomach is the Sea of Grain and Water. Its related points of transport run upward to the Qi Street and downward to Zusanli. The Chong Channel (the important vessel that gathers and connects the twelve channels) is the Sea of the Twelve Channels; its related points run upward to Dazhu and downward to Juxu Shanglian and Juxu Xialian. The Chest Center (Danzhong, where the qi of the chest gathers) is the Sea of Qi; its related points run upward to the area above and below the pillar bone and forward to Renying. The brain is the Sea of Marrow; its related points run upward to the crown of the head and downward to Fengfu."

Huangdi asked: "When these Four Seas fall out of balance, what are the benefits, harms, successes, and failures?"

Qi Bo replied: "If one follows their regularity, one survives; if one goes against it, one declines. If one understands how to regulate them, there is benefit; if one does not, there is harm."

Huangdi asked: when the qi of the Four Seas becomes excessive or deficient, what manifestations appear?

Qibo replied: When the Sea of Qi (qihai), the gathering place of the zong qi (ancestral qi), is in excess, a person feels fullness in the chest, breathes with difficulty, and has a flushed complexion. When it is deficient, the person becomes short of breath and speaks without strength. When the Sea of Blood (xuehai), where blood gathers, is in excess, a person often feels that the body has grown larger, yet feels vexed in the heart and cannot say exactly what is wrong. When it is deficient, the person often feels the body has shrunk and likewise cannot identify where the illness lies. When the Sea of Grains (shuigu zhi hai), that is, the stomach, which receives and ripens food and drink, is in excess, the abdomen becomes distended. When it is deficient, the person feels hungry yet cannot eat. When the Sea of Marrow (suihai), where brain marrow gathers, is in excess, a person feels light and vigorous, and may move beyond their usual limits. When it is deficient, the person experiences dizziness, tinnitus, aching calves, and vertigo. In severe cases vision blurs, the person becomes listless and fatigued, and wants only to lie down.

Huangdi asked: I already understand the manifestations of excess and deficiency in the Four Seas. How should they be regulated and treated?

Qibo replied: Examine carefully and observe closely the shu points (transport points) of each channel, where channel qi is infused and conveyed, and regulate them according to whether the condition is excess or deficiency. Do not violate the contraindications of treatment. When regulation is appropriate, a illness that is proceeding in harmony can recover. When the course of illness is adverse and disordered, it will worsen.

Huangdi said: Good.

Chapter 34: Five Disorders (Wuluan)

Huangdi asked: The twelve meridians (jingmai) correspond to the Five Phases (wuxing) and are also assigned to the four seasons. What causes them to become disordered, and how can they be restored to normal?

Qibo replied: The Five Phases each have their proper sequence, and the four seasons each have their assigned correspondences. When the qi of the channels accords with these, they are harmonized. When it runs counter to them, they become disordered.

Huangdi asked: What is meant by accord?

Qibo replied: The twelve meridians correspond to the twelve months of the year, and the twelve months are in turn assigned to spring, summer, autumn, and winter. The qi of the four seasons differs from one another. When the ying qi (nutritive qi) and wei qi (defensive qi), which circulate within and outside the vessels respectively, are coordinated, when yin and yang are in balance, and when clear qi and turbid qi do not interfere with each other, this is accord, and it brings stability.

The Yellow Emperor asked, "What is meant by the disorder of qi movement?" Qi Bo replied, "When clear qi (qi) lingers in the yin regions and turbid qi lingers in the yang regions, when ying qi (nutritive qi) flows along the channels in its proper course while wei qi (defensive qi) runs in reverse, and when clear and turbid qi intersect and disturb the chest, this is called 'great dismay' (da men), meaning confusion of qi movement and discomfort in the chest. When the disorder lies in the heart, one becomes agitated and taciturn, bowing the head and lying quietly. When it lies in the lungs, one pants while leaning forward or back, breathes rapidly, and presses a hand to the chest as one exhales. When it lies in the intestines and stomach, huoluan (sudden violent vomiting and diarrhea, a gastrointestinal illness described in ancient texts) arises. When it lies in the arms and shins, the limbs turn cold. When it lies in the head, jueni (reversal, the obstruction of qi and blood) occurs, bringing a heavy head, dizziness, and collapse."

The Yellow Emperor asked, "In treating the five kinds of qi disorder with acupuncture, is there a fixed method?" Qi Bo replied, "One must understand how to guide qi back onto its proper course, and also how to draw it away from the place of disorder. To grasp these principles thoroughly is an essential method of nurturing the body." The Yellow Emperor said, "Well said. Please tell me the specific methods." Qi Bo replied, "When the disorder lies in the heart, select the shu points of the Hand Shaoyin (Heart) channel and the Heart Master (Hand Jueyin Pericardium) channel. When it lies in the lungs, select the ying point of the Hand Taiyin (Lung) channel and the shu point of the Foot Shaoyin (Kidney) channel. When it lies in the intestines and stomach, select points on the Foot Taiyin (Spleen) and Foot Yangming (Stomach) channels, and if qi still fails to descend, add Zusanli (ST36). When the disorder lies in the head, select Tianzhu and Dazhu, and if these prove ineffective, add the ying and shu points of the Foot Taiyang (Bladder) channel. When the disorder lies in the arms or legs, first prick the luo (collateral) vessels to let blood, then select the ying and shu points of the Hand Yangming, Foot Yangming, and Shaoyang channels. The ying and shu points are specific acupoints along the channels, and they may be chosen according to the course of the channels and the location of the illness."

The Yellow Emperor asked, "How should the tonifying and reducing methods be carried out?" Qi Bo replied, "Inserting the needle slowly and withdrawing it slowly is called guiding qi. Tonification and reduction here do not concern the increase or decrease of physical form, but rather the harmonizing of jing (essence) and qi so that they return to balance. These conditions do not arise simply from excess evil qi or deficient upright qi, but from disordered qi moving in opposing directions."

The Yellow Emperor said, "This principle is truly credible, and the exposition is clear and plain. Please have it inscribed on jade tablets and name it Zhi Luan (Governing Disorder)."

Chapter Thirty-Five: Discourse on Distension

The Yellow Emperor asked how, from the cunkou (the radial pulse at the wrist), one could recognize a distension disorder (zhang bing). Qi Bo replied that a pulse that is large, hard, and choppy indicates distension.

The Emperor then asked how to tell whether the distension lies in the zang (yin organs) or the fu (yang viscera). Qi Bo replied that yin belongs to the zang and yang belongs to the fu. The Emperor further asked whether the qi that causes distension resides in the blood vessels or within the zang-fu organs. Qi Bo answered that qi circulates in all of these places, but none of them is where the distension truly lodges. When the Emperor asked where the distension is located, Qi Bo explained that it arises outside the zang-fu organs. The qi presses outward against the organs, fills the chest and flanks, and swells the skin, which is why it is called "distension" (zhang).

The Emperor observed that the zang-fu organs lie within the chest, flanks, and abdomen like precious objects stored in a box, each with its own position and name yet all within one region, and that the qi in each differs. He asked for an account of the principles involved. Qi Bo replied that the chest and abdomen are the outer space in which the organs are housed. The Danzhong (the region between the chest and the heart and lungs) is the palace governed by the heart. The stomach is the taicang, the granary that stores food and drink. The throat and small intestine serve as the channels of transport. The five orifices of the stomach (the passages connecting it to the outside) resemble the gates and lanes of a town. The Lianquan and Yuying (points in the mouth associated with the circulation of body fluids) are the pathways through which fluids move. Therefore, each of the five zang and six fu has its own boundaries, and when illness arises, each displays its own distinct signs.

Nutritive qi (yingqi), the refined qi that flows within the vessels, circulates along the channels. Defensive qi (weiqi), the qi that guards the body, may become disordered and obstructed within the vessels, producing distension of the vessels. When defensive qi gathers outside the vessels and moves along the grain of the muscles, it produces distension of the skin. For treatment, one may apply the draining method at Zusanli (ST36). When the affected site is near, drain once; when it is farther, drain three times. Whether the pattern is deficient or excess, the essential point is to drain promptly.

The Yellow Emperor asked, "Please tell me the manifestations of the various distention disorders." Qi Bo replied:

People with heart distention feel vexed in the chest and short of breath, and cannot sleep even when lying down. Those with lung distention feel fullness in the chest and abdomen yet a sense of emptiness, accompanied by wheezing and coughing. Those with liver distention experience fullness and pain beneath the ribs, with the pain pulling down toward the lower abdomen. Those with spleen distention often retch, feel restless and uncomfortable in the limbs, and their bodies feel heavy, so that even their clothing feels unbearable. They cannot rest peacefully when lying down. Those with kidney distention have abdominal fullness that pulls toward the back, a stuffy sense of discomfort, and pain in the lower back and thighs.

Among the distention disorders of the six fu organs (liufu), stomach distention presents as abdominal fullness and pain in the epigastric region, a foul, scorched smell perceived in the nose, obstructed eating, and difficult defecation. Large intestine distention brings intestinal rumbling and abdominal pain, with abdominal fullness pulling toward the back and pain in the lower back and thighs. If cold pathogen also invades in winter, diarrhea appears in which food is expelled without having been digested. Small intestine distention presents as fullness in the lower abdomen, with pain pulling toward the lower back. Bladder distention presents as lower-abdominal fullness, obstructed flow of qi (qi), and difficulty urinating. Triple Burner (sanjiao) distention is qi distention lodged between the skin and flesh, which feels soft and light rather than firm when pressed. Gallbladder distention presents as pain and fullness beneath the ribs, bitterness in the mouth, and frequent sighing.

Although these distention disorders present differently, the key to treating them shares common principles. One must clearly distinguish the deficiency or excess of the illness and the smooth or counterflow movement of qi, and the number and method of needling must not be mistaken. If a deficiency pattern is mistaken for excess and drained, or an excess pattern is mistaken for deficiency and supplemented, the shen (shen) will scatter and the upright qi will be harmed. Pathogenic qi then takes advantage of the weakness and invades, and the illness becomes difficult to stabilize. Such harm comes from carelessness in medical skill and can even endanger life. Only one who can supplement what is deficient, drain what is excess, settle the shen back in its proper place, and promptly close the needle holes left by insertion deserves to be called a good physician.

The Yellow Emperor asked, "How does distension disease (zhang bing) arise, and what causes it?" Qi Bo replied: Wei qi (Defensive Qi) circulates within the body, normally joined with the channels (jing mai) and moving along the spaces between the muscles. Its movement has both smooth and reversed courses, and it coordinates with yin and yang. Only in this way can it accord with natural law, so that the five viscera (wu zang) operate in sequence, the qi of the four seasons change in order, and food and drink are properly transformed. If reversed qi (jue ni zhi qi) stagnates in the lower part of the body, the movement of ying qi (Nutritive Qi) and wei qi is obstructed, cold qi rises counter-currently, and zheng qi (upright qi) and xie qi (pathogenic qi) clash and collide with one another. Together they form distension disease.

The Yellow Emperor said, "Well said. How can one clarify the doubts within this?" Qi Bo replied: One must compare the condition of the illness with the actual circumstances and judge by combining three aspects; only then can a conclusion be reached. The Yellow Emperor said, "Good."

The Yellow Emperor then asked Qi Bo: The Discourse on Distension (Zhang Lun) states that in treating distension disease, whether it is a deficiency or an excess pattern, the practitioner should promptly use draining (xie fa). For points close to the affliction, one needles once; for points farther away, one needles three times. Now, after needling three times, there is still no effect. Where is the error? Qi Bo replied: This describes needling that has penetrated the rou huang (the deep membranous region) and struck a qi xue (qi cavity). If the qi xue was not struck, pathogenic qi remains trapped inside the body. If the needle did not enter the rou huang, qi cannot circulate. If the needle passes beyond the intervening muscle layer, wei qi becomes disordered, and yin and yang qi chase one another.

In treating distension, if the draining that is needed is not performed, qi will not descend. If three needlings still show no effect, the path of insertion must be changed, and one continues until qi descends, then stops. If qi still does not descend, treatment must begin again. Only in this way can the condition be thoroughly addressed, and where would the danger lie? In treating distension, one must examine carefully: drain where draining is required, supplement where supplementation is required, and perform the technique correctly. The response will then follow as promptly as a drumstick striking a drum. How could there be a case that cannot be treated?

Notes: The collation note explains that the character meaning "to hear" (wen) was originally written with the character meaning "to ask" (wen) and was corrected according to the Zhaofu Jujingtang edition. The character ji (hungry) appears as yin (drink) in the Jiayi Jing, juan 6, section 2. The three characters mai tuo zhe ("those whose pulse has failed") were missing from the original text and were supplied from the Jiayi Jing, juan 1, section 12. A further collation note at the end, marked "tangben gai" (emended per the Tangben text), also concerns an emendation.

The Yellow Emperor asked Qi Bo: "When water and food enter the mouth and then pass into the stomach and intestines, the jinye (body fluids) they produce divide into five kinds. When the weather is cold and one's clothing is thin, the fluids turn into urine and qi. When the weather is hot and one's clothing is heavy, they turn into sweat. When one is sorrowful and the qi gathers and stagnates, they turn into tears. When there is heat in the stomach and the stomach qi is slack, they turn into saliva. And when pathogenic qi counterflows from within, the qi becomes blocked and cannot pass, and this blockage forms edema. I know these phenomena, but I do not understand how they come about. Please explain the principles behind them."

Qi Bo replied: "Water and food both enter through the mouth, and the five flavors each flow into their corresponding zangfu (viscera). The jinye likewise circulate along their own paths. The Sanjiao (Triple Burner, the passageways that connect the viscera and conduct fluids and qi) distributes the qi. If the movement of qi is obstructed and does not flow smoothly, edema will form. As for why edema arises, the Yellow Emperor still wishes to hear the principles behind it."

Qibo said: Water and food both enter through the mouth, and the five flavors each go to their corresponding organs. The fluids likewise follow their own channels. The Sanjiao (Triple Burner), the passages that move qi and water, distributes qi so that the muscles are warmed and the skin is filled out. This portion of fluid is called jin. When fluid is obstructed and stagnates without moving, it is called ye.

When the weather is hot and one wears thick clothing, the couli (the texture of the skin and the sweat pores) open, so one sweats. When cold lingers between the muscles and gathers into foam, pain results. In cold weather the couli close, so qi and dampness cannot circulate normally. Fluid then flows downward into the bladder and becomes urine, accompanied by the release of gas.

Among the five zang and six fu organs, the heart is the ruler. The ears are responsible for hearing and the eyes for seeing. The lungs assist the heart, the liver is like a general, the spleen bears the duty of defense, and the kidneys govern the exterior of the body. The fluids of the five zang and six fu all moisten upward into the eyes. When a person is sad, qi gathers in the heart and the xijin (the vessels connected to the heart) tighten. When they tighten, the lungs are lifted, and fluid overflows upward. The xijin and the lungs cannot remain lifted permanently. They rise and fall in turn, which is why a person coughs and weeps. When there is internal heat, the stomach digests grain, and as food is digested, the "insects" in the intestines and stomach move up and down with it. When the intestines and stomach are full and distended, the stomach loosens. A loosened stomach causes qi to rise, which is why one spits saliva.

Fluids produced from the five grains are blended into gao (a thick liquid formed from the refined essences of food). It penetrates inward into the bone cavities, nourishes the brain and marrow, and then flows down to the inner thighs. When yin and yang are out of balance, the fluid overflows and flows downward into the genitals, and the marrow diminishes accordingly. If too much flows downward, a person becomes weak, and weakness brings pain in the lower back and back, and aching in the calves.

When the channels through which yin and yang qi circulate are blocked, the sihai (the "four seas," the regions of the body where qi, blood, and fluid converge) become obstructed. The Sanjiao cannot clear its passages, so fluid cannot be transformed and circulated properly, and grain and water stagnate together in the intestines and stomach. When fluid separates from the ileum (a section of the large intestine) and remains in the lower burner (the lower abdomen), it cannot seep into the bladder. This causes distension in the lower burner, and when fluid overflows, edema forms. This is how the fluids, divided into five categories, may either circulate normally or fall into disorder.

Wuyue Wushi, Chapter 37

The Yellow Emperor asked Qi Bo, "I have heard that in needling diagnosis there are 'five officers and five inspections,' by which one can observe the qi of the five viscera. The qi of the five viscera is the sign that the viscera manifest outwardly, and it corresponds to the expressions of the five seasons. I wish to know where these signs appear."

Qi Bo replied, "The five officers are the windows through which one observes the condition of the five viscera." The Yellow Emperor said, "Please tell me exactly where these signs appear, so that I may take them as a constant method." Qi Bo said, "The pulse appears at the qikou (the place on the wrist where the pulse is taken), and the complexion appears at the Mingtang (the center of the face, around the region of the nose). The five colors appear in sequence, corresponding to the five seasons, and each has its normal form. When the qi of the jingmai (meridians) enters the five viscera, the disorder should then be treated from within the zangfu (organs and bowels)."

The Yellow Emperor said, "Well said. Do we look only at the Mingtang for the complexion of the five viscera?" Qi Bo said, "Once the condition of the five officers has been clarified, one must also observe the Quexing (the area between the eyebrows and the forehead). When the forms of these regions are developed, they can then be used to examine the Mingtang. If the Mingtang is broad, the sheltering regions on either side of the face show outwardly, the facial contour is upright and its foundation rises high, and the complexion is clear and calm and the body is spacious, one may regard this person as likely to live to a hundred years. When such a condition is seen, needling treatment is often effective. Such a person has abundant qi and blood and firm flesh, and therefore can withstand a strong course of needle therapy."

The Yellow Emperor asked, "Please speak of the five officers." Qi Bo replied, "The nose is the external indicator of the lungs, the eyes are the external indicator of the liver, the lips are the external indicator of the spleen, the tongue is the external indicator of the heart, and the ears are the external indicator of the kidneys."

The Yellow Emperor said, "Since the five officers are the external indicators of the five viscera, what can be observed through them?" Qi Bo said, "They are used to examine the five viscera. Therefore, when the lungs are diseased, one pants and the nostrils flare; when the liver is diseased, the corners of the eyes turn blue-green; when the spleen is diseased, the lips turn yellow; when the heart is diseased, the tongue curls and shortens and the cheekbones flush red; when the kidneys are diseased, the cheekbones and the complexion turn dark."

Huangdi asked: How do the qi of the five zang organs appear in the pulse? How do the five colors appear? When a person's normally healthy complexion shows certain changes, how can one tell that it is declining? Qi Bo replied: The contours of the five sense organs are unclear, the forehead is narrow and sunken, the Mingtang (the nose) is small, the Bibi (the concealed areas between the brows and eyes and along the sides of the face) is indistinct, the "walls" of the face are low, the walls have no foundation beneath them, and the corners of the forehead droop and slant outward. When these features appear, a person may look normal at ordinary times, yet already show signs of decline. How much more so once illness has set in!

Huangdi further asked: When the five colors appear on the Mingtang, if the facial walls are low, have no foundation beneath them, and the corners of the forehead droop and slant outward, then such a person, though seeming normal at ordinary times, may already be declining. How much more so once illness has set in!

Huangdi asked: The five colors appear on the Mingtang, and through them one can observe the qi of the five zang. Then, do the left and right sides and the upper and lower regions of the face each correspond to particular images? Qi Bo replied: The five zang and six fu organs have their respective positions within the body, and the left, right, upper, and lower regions of the face are likewise arranged according to fixed correspondences.

Chapter 38: On Reversal and Compliance, Fullness and Thinness

Huangdi asked Qi Bo: I have heard from you about the way of acupuncture. There is a great deal of it, and it has been explained in detail. Some of what you have taught seems to accord with actual practice, while at other times it seems difficult to grasp. The principles you rely on are also not always clear and firm. Did you master these principles through broad study, or did you arrive at them by carefully observing things and then comprehending them in your own mind?

Qi Bo replied: The sage seeks principle by aligning with Heaven above, with Earth below, and with human affairs in between. There must also be clear methods for establishing measures and standards. Only what has been tested and verified against these standards may be transmitted. Thus a carpenter may not set aside his rule and judge length by feel, nor begin work without his ink line and level. A craftsman may not draw a circle without a compass, nor a square without a carpenter's square. One who knows how to act according to these methods can grasp the principles of nature. This is an easily practiced teaching, and it is the constant way of grasping the patterns of reversal and compliance in things.

Huangdi asked: What, then, counts as accordance with nature? Qi Bo replied: When one opens a channel for water at a low place, no great effort is needed, and the water drains away completely. When one digs ditches and clears the flow along the lay of the land, the river course becomes unobstructed. This explains that the movement of qi may be smooth or stagnant, that blood may be clear or turbid, and that the circulation of qi and blood may proceed in either reversed or normal directions.

The identical sentence that appears again at the end likewise explains the smoothness or stagnation, the clarity or turbidity, and the reversal or compliance of the circulation of qi and blood.

The Yellow Emperor asked: People differ in complexion, some fair and some dark, and in build, some stout, some slight, some tall, and some short. Are there different standards for needling each of them?

Qi Bo replied: For a person who is robust, large in frame, abundant in blood and qi, and firm in the skin, once pathogenic qi has invaded, the needle should be inserted deeply and retained for a longer time. This is the needling method for a stout person. Some people have broad shoulders and armpits, thin muscles at the neck, thick skin of a dark complexion, and full lips. Their blood is dark and turbid, and their qi moves slowly and sluggishly. Such people are strongly inclined toward taking and giving. In needling them, the insertion should be deep, the needle should be retained, and the number of needlings should be increased appropriately.

The Yellow Emperor asked: How should a thin person be needled?

Qi Bo replied: A thin person has thin skin, a pale complexion, little muscle, thin lips, and a soft voice. Their blood is relatively clear and their qi moves smoothly, yet their qi is easily dispersed and their blood is easily damaged. In needling, the insertion should be shallow and the needle should be withdrawn quickly.

The Yellow Emperor asked: How should an ordinary person be needled?

Qi Bo replied: Treatment should be differentiated according to complexion. For a person of upright, sincere, and sturdy appearance, blood and qi move in balance and qi flows smoothly. In needling, one should follow the usual measures and not exceed them.

The Yellow Emperor asked: How should one needle a person who is strong and has firm bones?

Qi Bo replied: Such a person has firm muscles and loose joints. If the body is heavy, qi moves sluggishly and the blood is turbid, so the needle should be inserted deeply, retained, and applied more times. If the body is vigorous and strong, qi moves smoothly and the blood is clear, so the needle should be inserted shallowly and withdrawn quickly.

The Yellow Emperor asked: How should an infant be needled?

Qi Bo replied: An infant has soft, fragile muscles, little blood, and weak qi. A fine needle should be used, inserted shallowly, and withdrawn quickly, and needling once in the morning and once in the evening each day is sufficient.

The Yellow Emperor asked: For a person whose blood and qi accumulate like deep water and need to be drained, how should needling be done?

Qi Bo replied: Such a person's blood is clear but the qi is turbid. If a rapid draining method is applied, the qi will be exhausted.

The Yellow Emperor further asked: For a person whose blood and qi are obstructed like flowing water and need to be cleared, how should needling be done?

Qi Bo replied: Such a person's blood is turbid and the qi moves sluggishly and with difficulty. If a rapid draining method is applied, the meridians will be made to flow freely.

Chapter 39: On the Blood Collaterals (Xueluo Lun)

The Yellow Emperor asked about the direction and sequence in which the jingmai (meridians) circulate. Qi Bo replied that the three yin meridians of the hand emerge from the viscera (zangfu). The Yellow Emperor then asked what should be done when the meridians are obstructed and the blood and qi become stagnant. Qi Bo said that if the blood is turbid and the flow of qi and blood is impeded, one should promptly let blood to drain the stagnation, so that the meridians are restored to free passage.

The Yellow Emperor again asked about the ascending and descending courses of the meridians. Qi Bo replied that the three yin meridians of the hand run from the viscera to the hand, the three yang meridians of the hand run from the hand to the head, the three yang meridians of the foot run from the head to the foot, and the three yin meridians of the foot run from the foot to the abdomen.

The Yellow Emperor asked why the pulse of the Shaoyin meridian seems to run downward on its own. Qi Bo said this is not so. The Chong mai (Penetrating Vessel) is the sea where the qi and blood of the five zang and six fu organs converge, and all of them receive nourishment from it. Its upward portion reaches the hangsang (the upper throat) and spreads to the yang meridians, pouring in essence (jing) and qi. Its downward portion flows into the great collateral of the Shaoyin meridian and branches out from the qijie (the meridian crossing near the groin). It descends along the inner thigh to the popliteal fossa, then runs hidden along the inner side of the shinbone and divides behind the inner ankle. One branch runs alongside the Shaoyin meridian and nourishes the three yin meridians. The other emerges hidden near the dorsum of the foot, runs down the top of the foot, enters between the big toes, and spreads to the minor collaterals to warm the muscles.

Therefore, if the branch collateral is blocked, the pulse at the dorsum of the foot will be faint. Without that pulsation, the flow of qi and blood is obstructed, and the limbs become cold. The Yellow Emperor asked how this could be verified. Qi Bo replied that one may question the patient about their condition and feel the pulse by palpation to confirm it. If the pulse at the dorsum of the foot indeed does not beat, one can judge from this the direction and reversal of the meridians' flow. The Yellow Emperor sighed, "The sage's account of the medical art is as clear as the sun and moon, and it penetrates even the subtlest details. Were it not for you, Master, who could have made these principles so plain?"

The Yellow Emperor said, "I want to understand the abnormal pathogenic qi that strays from the meridians (jingmai) and does not travel along their courses." Qi Bo replied, "You are speaking of the xueluo (blood vessels), the fine, visible vessels that run near the surface, outside the meridians."

The Yellow Emperor then asked, "When the xueluo are pricked with a needle, some people faint. Why? Sometimes the blood spurts out like an arrow. Why? Sometimes the blood that flows is scant, dark, and turbid. Why? Sometimes it runs clear and carries something like a watery fluid. Why? After the needle is withdrawn, the area swells. Why? Sometimes the complexion turns pale no matter how much blood is lost. Why? Sometimes the complexion does not change after the needle is withdrawn, yet the person feels oppressed and restless. Why? And some people lose a great deal of blood without showing any weakness. Why? I would like to know the reasons."

Qi Bo said, "When the qi within the vessels is abundant but the blood is insufficient, needling scatters the qi, and once the qi is dispersed, one may faint. When both blood and qi are abundant and yin qi is in excess, the blood flows freely, so it spurts out when needled. When yang qi has accumulated for a long time without being released, the blood turns dark and turbid, and so it does not spurt easily.

"If one has just drunk water, the fluid seeps into the xueluo and has not yet merged with the blood, so the blood that flows out when needled is mixed with clear fluid. If the cause is not recent drinking, then fluid has lingered in the body for a long time, and this produces swelling.

"When yin qi gathers in the yang aspect and qi stagnates in the xueluo, the blood has not yet flowed out when the needle is inserted, but the qi disperses first, and the local area swells. If yin and yang qi have only just come together and are not yet harmonized, and needling is used to drain them, both yin and yang qi are damaged, and the interior and exterior lose their coordination. This is why the complexion turns pale.

"When bleeding is heavy after needling but the complexion does not change and the person feels oppressed, it is because needling the xueluo has weakened the qi of the meridians. The meridians are connected to the yin aspect, and when yin qi is depleted, one feels restless. If yin and yang qi come together and form bi syndrome (a condition in which the movement of qi and blood is obstructed), pathogenic factors overflow into the meridians and flow outward into the xueluo. At this stage both yin and yang qi are in excess, so even heavy bleeding does not leave the person weak."

The Yellow Emperor asked, "How should one examine and distinguish this condition?"

Qi Bo replied, "If the blood vessels are full and firm, raised crosswise and reddish, with their position shifting up and down, and if they are as small as needles or as large as sinews, then one should lance them and let out the blood according to their size and location. Treated this way, the outcome will be sound. Therefore the depth and measure of needling must not be wrong. If the measure is lost, the result will be the opposite of what was intended, and each error will bring its own consequences."

The Yellow Emperor asked, "After the needle is inserted, why does the flesh cling to it?"

Qi Bo replied, "Heat qi travels along the needle and warms it. Once the needle is warm, the flesh clings to it, so when the needle is withdrawn, it feels tight and resistant."

Chapter 40: The Clear and Turbid in Yin and Yang

The Yellow Emperor said, "I have heard that the twelve regular channels of the human body correspond to the twelve jing waters, the twelve great rivers of ancient times. These waters differ in color, and their currents are sometimes clear and sometimes turbid. If everyone's blood and qi were the same, how would these differences correspond to them?"

Qi Bo replied, "If each person's blood and qi were the same, then all people under heaven would be the same. Where would difference or disorder come from?"

The Yellow Emperor said, "I am asking about one person, not about all people under heaven."

Qi Bo replied, "Within a single person, there can be qi that is out of harmony. Among the multitude under heaven, there are also people whose qi is disordered. The principles behind the two are the same."

The Yellow Emperor said, "I wish to know how the qi of the body is divided into clear and turbid."

Qi Bo replied, "Qi transformed from food, drink, and grain tends to be turbid, while qi drawn in through breathing tends to be clear. Clear qi flows into the yin, and turbid qi flows into the yang. The relatively clear part of the turbid qi rises as far as the throat, while the relatively turbid part of the clear qi moves downward. When clear and turbid qi mix together, this is called 'disordered qi.'"

The Yellow Emperor asked, "The qi of the yin is relatively clear and the qi of the yang is relatively turbid. Yet turbid qi contains clear portions, and clear qi contains turbid portions. How are they to be distinguished?"

Qi Bo replied, "In summary, clear qi rises and enters the lungs, while turbid qi descends into the stomach. The clear qi within the stomach rises and exits through the mouth. The turbid qi within the lungs descends into the channels and gathers in the qihai (the Sea of Qi), the place where qi collects in the body."

Huangdi asked, "Of the twelve channels, all of which are yang channels, which yang channel receives the most turbid qi (zhuó qì)?" Qi Bo replied, "The Hand Taiyang channel alone receives the turbid qi within yang qi. The Hand Taiyin channel alone receives the clear qi (qīng qì) within yin qi. Clear qi moves upward to the orifices of the head and face, namely the eyes, ears, mouth, and nose. Turbid qi moves downward and enters the various channels. Most yin channels receive clear qi, but the Foot Taiyin channel alone receives the turbid qi within it."

Huangdi asked, "How should this be treated?" Qi Bo replied, "Clear qi moves smoothly, while turbid qi moves sluggishly. This is the normal state of qi. Therefore, when needling a yin channel, the needle should be inserted deeply and retained for a while. When needling a yang channel, the needle should be inserted shallowly and withdrawn quickly. If clear and turbid qi are intermingled, the Foot Taiyin channel should be repeatedly regulated according to the condition."

Huangdi asked again, "How should this be treated?" Qi Bo replied, "Clear qi moves smoothly, while turbid qi moves sluggishly. This is the normal state of qi. Therefore, yin channels are needled deeply and retained, and yang channels are needled shallowly and withdrawn quickly. When clear and turbid qi are intermingled, an appropriate number of needle manipulations is used to bring them into harmony."

Chapter 41: Yin-Yang (yīnyáng) Corresponds to the Sun and Moon

Huangdi asked, "I have heard that heaven is yang and earth is yin, and that the sun is yang and the moon is yin. How are these correspondences expressed in the human body?" Qi Bo replied, "The region above the waist corresponds to heaven, and the region below the waist corresponds to earth, so heaven is yang and earth is yin. The twelve channels of the feet correspond to the twelve months of the year. The moon corresponds to water, so the lower body is yin. The ten fingers of the hands correspond to the ten Heavenly Stems (tiāngān). The sun governs fire, so the upper body is yang."

The Yellow Emperor asked how these correspondences take shape in the meridians. Qi Bo replied that the branch Yin corresponds to the first month, when yang qi begins to sprout, and governs the left-foot Lesser Yang (shaoyang) channel. The branch Wei corresponds to the sixth month and governs the right-foot Lesser Yang channel. The branch Mao corresponds to the second month and governs the left-foot Greater Yang (taiyang) channel, while the branch Wu corresponds to the fifth month and governs the right-foot Greater Yang channel. The branch Chen corresponds to the third month and governs the left-foot Yangming (yangming) channel, and the branch Si corresponds to the fourth month and governs the right-foot Yangming channel. Because the Lesser Yang and Greater Yang qi meet at the front of the body, this is called Yangming, or "bright yang."

The branch Shen corresponds to the seventh month, when yin qi begins to rise, and governs the right-foot Lesser Yin (shaoyin) channel. The branch Chou corresponds to the twelfth month and governs the left-foot Lesser Yin channel. The branch You corresponds to the eighth month and governs the right-foot Greater Yin (taiyin) channel, and the branch Zi corresponds to the eleventh month and governs the left-foot Greater Yin channel. The branch Xu corresponds to the ninth month and governs the right-foot Terminal Yin (jueyin) channel, and the branch Hai corresponds to the tenth month and governs the left-foot Jueyin channel. Because the two yin qi meet and reach their end, this is called Jueyin, or "terminal yin."

The stem Jia governs the left-hand Lesser Yang channel and the stem Ji the right-hand Lesser Yang channel. The stem Yi governs the left-hand Greater Yang channel and the stem Wu the right-hand Greater Yang channel. The stem Bing governs the left-hand Yangming channel and the stem Ding the right-hand Yangming channel. Because two fire qi join together, this is also called Yangming. The stem Geng governs the right-hand Lesser Yin channel and the stem Gui the left-hand Lesser Yin channel. The stem Xin governs the right-hand Greater Yin channel and the stem Ren the left-hand Greater Yin channel.

Therefore the yang channels of the feet belong to Lesser Yang within yin, and the yin channels of the feet belong to Greater Yin within yin. The yang channels of the hands belong to Greater Yang within yang, and the yin channels of the hands belong to Lesser Yin within yang. Above the waist belongs to yang, and below the waist belongs to yin.

When the channels are divided by the five viscera, the heart belongs to Greater Yang within yang, and the lungs belong to Lesser Yin within yang.

Chapter 42: On the Transmission of Disease

The positions of the five zang organs within the Yin-Yang scheme are as follows: the heart belongs to Greater Yang (Taiyang) within Yang, the lungs belong to Lesser Yin (Shaoyin) within Yang, the liver belongs to Lesser Yang (Shaoyang) within Yin, the spleen belongs to Utmost Yin (Zhiyin) within Yin, and the kidneys belong to Greater Yin (Taiyin) within Yin.

The Yellow Emperor asked: when treating according to these patterns, what should one do? Qi Bo replied: in the first, second, and third months, a person's Qi (vital energy) circulates on the left side, so the Yang channels of the left foot should not be needled. In the fourth, fifth, and sixth months, the Qi circulates on the right side, so the Yang channels of the right foot should not be needled. In the seventh, eighth, and ninth months, the Qi circulates on the right side, so the Yin channels of the right foot should not be needled. In the tenth, eleventh, and twelfth months, the Qi circulates on the left side, so the Yin channels of the left foot should not be needled. Here "Yang" and "Yin" refer to the Yin-Yang properties of the meridians, and "needling" refers to acupuncture treatment.

The Yellow Emperor said: among the Five Phases, the east corresponds to Jia and Yi, which are Wood, and Wood Qi is at its height in spring. Spring is associated with the color green and governs the liver, and the liver channel is the Foot Jueyin channel. By this reasoning, in spring one should avoid the Yin channels of the left foot. Yet the earlier statement says something different. Why is this?

Qi Bo replied: what is discussed here is the regularity of the movement of Yin and Yang in Heaven and Earth, not a fixed sequence in which the four seasons are matched one-to-one with the Five Phases. Yin and Yang are only names without fixed form, so they can be divided into ten categories, further subdivided into hundreds, thousands, and even tens of thousands of categories. This is the principle the passage conveys.

Chapter 42: On the Transmission of Disease

The Yellow Emperor said: I have learned the Nine Needles from you, and I have also privately studied many methods of treatment. Some use guided breathing (daoyin) and the circulation of Qi, qiaomo (a massage-like manipulation), moxibustion, fomentation with heated objects, needling, cauterization by fire (ruo), or the taking of medicine. May one choose and persist with just one of these methods, or should all of them be used?

Qi Bo replied: each of these treatments is meant for different people and different conditions. They are not all to be applied to every person.

The Yellow Emperor said: "This is what is meant by guarding the mind-spirit (shen) and not letting it go astray, so that the principles of all things become thoroughly connected. Now I have grasped the essentials of Yin-Yang (yinyang), the principles of fullness and emptiness, the faults that arise when the movement of qi (qi) goes astray, and the illnesses that can be treated. I would like to hear further how diseases change, how pathogenic qi transmits from one part of the body to another, and the conditions in which the illness is so severe that it cannot be saved."

Qi Bo replied: "That is a crucial question! When the principles are clear, it is like waking at dawn, bright and lucid. When they are hard to grasp, it is like the dimness of night, obscured and confused. If one can comprehend these principles and put them into practice, the spirit (shen) will come into accord with them, and once they are fully carried out, the spirit will naturally grasp their essential meaning. The principles of nourishing life and keeping the spirit vigorous can be written on bamboo slips and silk, yet they cannot be passed directly on to one's descendants."

The Yellow Emperor asked: "What does it mean to be as clear as waking at dawn?" Qi Bo answered: "It means understanding the principles of Yin-Yang so thoroughly that doubts dissolve, like the clarity of one who has sobered up from wine."

The Yellow Emperor asked again: "What does it mean to be as obscured as the darkness of night?" Qi Bo answered: "It means a state of drowsy silence and blurred form, in which even the hair and the texture of the skin lose their normal condition. Upright qi (zhengqi), the qi that sustains the body's normal vital activity, becomes reversed and disordered, while pathogenic qi spreads outward and flows along the blood vessels. When this strong pathogenic qi invades the internal organs, it causes abdominal pain and then sinks downward. A pattern like this may prove fatal and cannot be reversed."

The Yellow Emperor asked: "When strong pathogenic qi invades the internal organs, how does the illness develop?" Qi Bo answered: "The disease begins in the heart, passes to the lungs after one day, to the liver after three more days, and to the spleen after five days. If it still has not healed after another three days, death follows. In winter it kills at midnight; in summer, at noon."

"The disease begins in the lungs, passes to the liver after three days, to the spleen after one more day, and to the stomach after five days. If it still has not healed after another ten days, death follows. In winter it kills at sunset; in summer, at sunrise."

"The disease begins in the liver, passes to the spleen after three days, to the stomach after five days, and to the kidneys after three more days. If it still has not healed after another three days, death follows. In winter it kills at sunset; in summer, at breakfast time."

The disease first arises in the spleen. After one day it passes to the stomach, after two more days to the kidneys, and after three more days to the spine and bladder. If it has not healed after ten days, the patient dies. In winter it strikes in the stillness of deep night; in summer it strikes in the evening, after a late meal.

The disease first arises in the stomach. After five days it passes to the kidneys, after three more days to the spine and bladder, and after five more days it travels upward to the heart. If it has still not healed after two more days, the patient dies. In winter it strikes at midnight; in summer it strikes when the shadows begin to slant westward.

The disease first arises in the kidneys. After three days it passes to the spine and bladder, after three more days it travels upward to the heart, and after three more days it passes to the small intestine. If it has still not healed after three more days, the patient dies. In winter it strikes at dawn; in summer it strikes between morning and afternoon.

The disease first arises in the bladder... [The source text is incomplete here. Only the fragment "half, summer, the sun begins to decline" survives, and its meaning cannot be recovered.]

The disease first arises in the kidneys. After three days it passes to the spine and bladder, after three more days it travels upward to the heart, and after three more days it passes to the small intestine. If it has still not healed after three more days, the patient dies. In winter it strikes at dawn; in summer it strikes between morning and afternoon.

The disease first arises in the bladder. After five days it passes to the kidneys, after one more day to the small intestine, and after another day to the heart. If it has still not healed after two more days, the patient dies. In winter it strikes at the crowing of the rooster; in summer it strikes in the afternoon.

Diseases spread step by step in these orders, and each carries its own deadline, so acupuncture must not be applied. Only when the disease skips one organ in its transmission, or passes through two, three, or four organs, may acupuncture be used.

Chapter 43: Excess Evils Cause Dreams (Yin Xie Fa Meng)

The Yellow Emperor (Huangdi) asked: When external evil qi spreads and flows widely, what effects does it produce?

Qi Bo replied: When an external evil enters the body and has no fixed place to lodge, it stirs among the viscera and cannot settle. It travels along with ying qi (nourishing qi) and wei qi (defensive qi), and it also disturbs the hun and po (the ethereal and corporeal souls), so a person sleeps uneasily and often dreams. When evil disturbs the fu (bowel) qi, the qi at the body's surface becomes excessive while the qi within becomes deficient. When evil disturbs the zang (viscera) qi, the qi within becomes excessive while the qi at the surface becomes deficient.

The Yellow Emperor asked: Can an excess or deficiency of qi be seen in dreams?

Qi Bo replied: When yin qi predominates, a person dreams of crossing a great river and feels fear; when yang qi predominates, a person dreams of a great fire blazing fiercely. When Yin-Yang qi both predominate within the body...

The Yellow Emperor asked, "When Yin Qi is in excess or deficient, can this be revealed in dreams?" Qi Bo replied that when Yin Qi is in excess, one dreams of wading through great waters and feels fear. When Yang Qi is in excess, one dreams of a great fire burning. When Yin and Yang are both in excess, one dreams of fighting with other people. When the Qi of the upper body is in excess, one dreams of flying, and when the Qi of the lower body is in excess, one dreams of falling. When one is extremely hungry, one dreams of seeking things, and when one has eaten too much, one dreams of giving things away to others. When Liver Qi is in excess, one easily becomes angry in dreams. When Lung Qi is in excess, one dreams of fear, weeping, or soaring. When Heart Qi is in excess, one dreams of laughing loudly or of being frightened. When Spleen Qi is in excess, one dreams of singing and playing music while feeling the body heavy and unable to rise. When Kidney Qi is in excess, one dreams that the waist and spine have come apart and no longer connect to one another. For these manifestations of excess, once the pattern of illness becomes apparent, the draining method (xie fa) should be used, and the symptoms will quickly subside.

When evil Qi (xie qi) invades the Heart, one dreams of hills and smoke and fire. When it invades the Lungs, one dreams of soaring, or sees strange metal objects. When it invades the Liver, one dreams of mountains, forests, and trees. When it invades the Spleen, one dreams that the parts of the body are not connected to one another.

When evil Qi invades the Heart, one dreams of hills and smoke and fire. When it invades the Lungs, one dreams of soaring, or sees strange metal objects. When it invades the Liver, one dreams of mountains, forests, and trees. When it invades the Spleen, one dreams of hills, great marshes, collapsing houses, and wind and rain. When it invades the Kidneys, one dreams of approaching a deep abyss or of sinking into water. When it invades the Bladder, one dreams of walking about in all directions. When it invades the Stomach, one dreams of eating and drinking. When it invades the Large Intestine, one dreams of open fields. When it invades the Small Intestine, one dreams of villages, marketplaces, and great roads. When it invades the Gallbladder, one dreams of lawsuits and disputes, or of cutting open one's own body. When it invades the genitals (yin qi), one dreams of sexual union between men and women. When it invades the neck (xiang), one dreams of being beheaded. When it invades the lower leg (jing), one dreams of walking without being able to advance, or of being in a deep cellar or a garden. When it invades the thighs and arms (gu gong), one dreams of performing bows, kneeling, and rising. When it invades the bladder and reproductive region (bao zhi), which is associated with urination, one dreams of urinating. For these manifestations of Qi deficiency, once the pattern of illness becomes apparent, the supplementing method (bu fa) should be used, and the symptoms will quickly subside.

The Yellow Emperor said: The occurrence of all kinds of diseases must arise from external factors such as dryness, dampness, cold, summerheat, wind, and rain, and may also be related to Yin-Yang imbalance, changes in joy and anger, diet, and living environment. When these factors combine with the Qi of the human body, specific symptoms and conditions are formed; once pathogenic Qi enters the corresponding organs, the disease then acquires a name. I already understand these principles. But for many diseases, the symptoms are often milder and the spirit better in the morning, the condition is relatively stable during the day, worsens toward evening, and becomes more severe at midnight—what is the reason for this?

Qibo said: This is brought about by the movement of the Qi of the four seasons.

The Yellow Emperor said: Please explain the Qi of the four seasons.

Qibo said: In spring it generates and rises, in summer it grows and flourishes, in autumn it gathers and contracts, and in winter it stores and hides—this is the normal condition of the Qi of nature, and the human body also corresponds to it. If one divides a day into four seasons, early morning corresponds to spring, noon to summer, sunset to autumn, and midnight to winter. At early morning, the Qi of the human body begins to rouse, while the Qi of pathogenic factors is weak, so disease symptoms are reduced. At noon, the Qi of the human body is abundant, and when abundant it can overcome pathogenic Qi, so the condition is stable. Toward evening, the Qi of the human body begins to weaken, and pathogenic Qi begins to become apparent, so the condition worsens. At midnight, the Qi of the human body is stored inward, and pathogenic Qi seems to remain alone within the body, so the condition is most severe.

The Yellow Emperor asked: If the changes in the condition during these periods are the opposite, what is the reason?

Qibo said: This is because the disease does not follow the changes of the Qi of the four seasons; rather, a certain organ alone bears and dominates the disease. At this time, when the season arrives that the Qi of that organ cannot overcome, the condition worsens; when the season arrives that it can overcome, the condition improves.

The Yellow Emperor asked: How should it be treated?

Qibo said: Treat it in accordance with the natural seasons, and one can anticipate the changes in the condition. Those who follow this principle are skillful physicians; those who violate it are physicians of crude skill.

Huangdi said, “Good. I have heard that acupuncture has the ‘Five Changes,’ which are used to correspond to the Five Shu (transport) points. I would like to know the specific correspondences.”

Qibo said, “Humans have five viscera, and each of the five viscera has five changes. These changes correspond respectively to the Five Shu points, so altogether there are five groups and twenty-five transport points, used to correspond to the five seasons.”

Huangdi said, “Please explain the five changes.”

Qibo said, “The liver is a male viscus (a yang-category viscus in yin-yang classification), corresponding to the color green, spring, the jue tone, the sour flavor, and jia-yi days. The heart is a male viscus, corresponding to red, summer, bing-ding days, the zhi tone, and the bitter flavor. The spleen is a female viscus (a yin-category viscus), corresponding to yellow, late summer, wu-ji days, the gong tone, and the sweet flavor. The lung is a female viscus, corresponding to white, the shang tone, autumn, geng-xin days, and the pungent flavor. The kidney is a female viscus, corresponding to black, winter, ren-gui days, the yu tone, and the salty flavor. These are the Five Changes.”

Huangdi asked, “How do the Five Changes combine with the Five Shu points?”

Qibo answered, “Visceral manifestations correspond to winter; in winter, needle the Jing-Well points. Colors correspond to spring; in spring, needle the Ying-Spring points. The seasons correspond to summer; in summer, needle the Shu-Stream points. Tones and sounds correspond to late summer; in late summer, needle the Jing-River points. Flavors correspond to autumn; in autumn, needle the He-Sea points. This is how the Five Changes combine with the Five Shu points.”

Huangdi asked, “How do the Yuan-source points of the various channels combine so as to make up the six transport points?”

Qibo answered, “The Yuan-source points themselves do not correspond to the five seasons; therefore, combine them with the channels so that the number of points matches, thereby forming six groups and thirty-six transport points.”

Huangdi asked, “Why is it said that the viscera correspond to winter, the seasons to summer, tones and sounds to late summer, flavors to autumn, and colors to spring? Please explain the reasoning.”

Qibo said, “For diseases in the viscera and bowels, select the Jing-Well points; when pathological changes are reflected in the complexion, select the Ying-Spring points; when the condition is sometimes mild and sometimes severe, select the Shu-Stream points; when pathological changes are reflected in the voice, select the Jing-River points. When the qi and blood of the channels are congested and full, or when disease lies in the stomach, or when illness arises from improper diet, select the He-Sea points. Therefore it is said that flavors correspond to the He-Sea points. These are the Five Changes.”

Chapter 45: External Inference (Waichuai) (Chapter title. “Waichuai” means inferring internal conditions from external manifestations.)

The Yellow Emperor said, “I have heard the Nine Needles in nine chapters and received its instruction personally, and I have somewhat grasped its meaning. The way of the Nine Needles begins at one and ends at nine, yet I have not mastered its essential doctrine. It is so small that there is nothing it cannot penetrate, and so great that there is nothing it cannot encompass; it is too deep to fathom and too high to be covered; its transformations are elusive, and its flow overflows without limit. I know that it accords with the Way of Heaven, human affairs, and the changes of the four seasons, but I wish to gather its subtlest principles and bind them into a single whole—may I?”

Qi Bo said, “A penetrating question! This is not only so for the way of needling; governing a state is likewise so.”

The Yellow Emperor said, “I wish to hear the way of needling, not affairs of state.”

Qi Bo said, “In governing a state, the root also lies in the Dao. If one does not understand the Dao, how can one integrate the great and small, the deep and shallow, the manifold and complex into a unity?”

The Yellow Emperor said, “Please tell me the doctrine fully.”

Qi Bo said, “It is like the sun and moon, water and mirror, drum and echo. The sun and moon shine, and when illuminating things they do not lose their shadows; water and mirror reflect things and do not miss their forms; when a drum sounds, the echo responds to the sound and does not fall behind it. As soon as a thing moves, they respond accordingly; thus they can grasp the true condition of things.”

The Yellow Emperor said, “How subtle this doctrine is! Its bright clarity, like the radiance of sun and moon, cannot be obscured by anything. The reason it can see clearly is that it does not violate the changes of Yin-Yang. By combining all circumstances and observing them, then carefully diagnosing and verifying, one can recognize and master them, just as clear water and a bright mirror reflect things and accurately reveal their forms.

“If the five tones cannot be distinguished, the five colors cannot be clearly discerned, and the Qi of the five zang organs is disturbed and unsettled, then inner and outer will influence each other. The changes within the body and their outward manifestations respond to one another, like drum and drumstick, sound and echo, shadow and body. Therefore, by observing the exterior to infer the interior, or observing the interior to infer the exterior—this is the utmost of Yin-Yang change and the guiding principle of Heaven and Earth’s movement. I request that these principles be treasured in the Linglan Chamber (the place in the Yellow Emperor’s palace where classical texts were kept), and I dare not let them leak out.”

Note: “Nine Needles” in the original refers to the nine kinds of needles used in ancient acupuncture; here sun and moon, water and mirror, and drum sound are used as analogies to explain that diagnosis should keenly observe internal and external changes and infer bodily conditions accordingly.

Huangdi Neijing Lingshu Jizhu* (Collected Commentaries on the Spiritual Pivot of the Yellow Emperor's Inner Classic), Juan 14

Chapter 46: Wu Bian (Five Changes)

The Yellow Emperor asked Shaoyu: "I have heard that when any disease first arises, it is always caused by external pathogenic factors such as wind, rain, cold, and summer heat. The pathogenic qi follows the fine body hairs into the couli (the striations between skin and muscle). Some of it retreats, and some of it lingers. Some of it causes wind swelling and sweating, some causes xiaodan (a wasting disorder marked by thirst, excessive eating, and frequent urination), some causes alternating chills and fever, some forms lingering bi (painful obstruction) that does not heal, and some forms jiju (accumulations). The pathogenic qi changes and intrudes into the body in countless ways, producing more illnesses than can be counted. I wish to know the reason. Among people who fall ill at the same time, some contract one disease and others contract another. Does Heaven send wind to people in different ways?"

Shaoyu replied: "Heaven produces wind without partiality toward the common people. The movement of wind is fair and upright. Those who offend it are harmed, and those who avoid it are not endangered. Wind does not seek out a particular person. It is the person who offends it."

Editorial notes

On the first note, the Taisu (Plain Questions of the Great Simplicity), Juan 5, "Yin-Yang He" (Union of Yin and Yang), has the two characters sheng yu ("arises from") at this point. This matches the phrasing yue sheng yu shui ("the moon arises from water") earlier in the text.

The second note concerns the word yang (Yang). The original reads yin (Yin), but the Taisu, Juan 5, "Yin-Yang He," shows yang, and the text has been corrected accordingly.

The third note concerns zao (early). The Jiayi Jing (Classic of Acupuncture and Moxibustion), Juan 2, Chapter 1, has wan (late) here, which means the opposite.

The fourth note concerns the number. The Zhaofu Jujing Tang edition gives shiwu (fifteen) at this point.

The fifth note concerns qin shou qi diao (personally receive its adjustment). The Taisu, Juan 19, "Zhi Yao Dao" (Knowing the Essential Way), writes the character for shou (to transmit) as the character for shou (to receive). On this basis, the sentence may originally have read qin shou qi ci (personally receive its words), meaning to hear the other party's words directly.

The Yellow Emperor asked: why do people who fall ill from the same wind at the same time develop different symptoms? Shaoyu replied that this is a good question, and he would explain it with the example of a carpenter. A carpenter sharpens his axe and chisel and then uses them to cut and shape wood. Even within a single tree, the wood varies: some parts are hard and hard to cut into, while others are brittle, and their bark splits easily. Where the trunk meets the branches, the axe may even chip. If hardness and brittleness differ within one tree, they differ even more between trees, whose wood, bark thickness, and sap content all vary.

Some trees flower and leaf early. When spring brings frost and fierce wind, their blossoms fall and their leaves wither. Prolonged sun and drought leave thin-barked, brittle branches low in sap, so their leaves dry up. Continuous rain softens thin-barked trees rich in sap, causing their bark to rot and seep. A sudden strong gale can break branches of both hard and brittle trees. When autumn frost and fierce wind arrive, the roots may loosen and the leaves fall. Each kind of tree suffers harm in its own way, and people are no different.

The Yellow Emperor asked how the comparison between people and trees should be understood. Shaoyu answered that when a tree is damaged, the branches usually suffer first, and whether a branch is hard or brittle determines whether it is easily harmed. People often fall ill for a similar reason: when their bones, joints, skin, and couli (the texture of the skin and its pores) are not firm, external pathogenic influences linger in these weak spots and cause disease.

The Yellow Emperor then asked what signs reveal a person prone to fengjue (wind reversal, a sudden collapse with cold limbs) and to lu han (persistent, uncontrolled sweating that seeps continuously). Shaoyu replied that people whose muscles are not firm and whose couli is loose are the ones most prone to wind disorders.

The Yellow Emperor (Huangdi) asked what signs might identify people prone to fengjue (wind reversal) and to unceasing sweating. Shaoyu replied that people whose muscles are not firm and whose couli (skin texture and sweat pores) are loose are prone to wind disorders. The Emperor then asked how to judge whether the muscles are firm. Shaoyu answered that if the muscles behind the knee are soft and lack clear lines, if the musculature is coarse and the skin is not fine-grained, then the couli are loose. This describes people whose muscles are soft throughout the body.

The Emperor next asked about the signs of those prone to xiaodan (an ancient category of disease marked by wasting, thirst, and related conditions). Shaoyu replied that people whose five viscera (wuzang) are all weak are prone to xiaodan. The Emperor asked how one could know that the viscera are weak. Shaoyu explained that weak people often have a hard, unyielding side, and that such people, being rigid, tend to anger, while a weak body is easily harmed. The Emperor asked how one could observe whether a person is weak or rigid. Shaoyu described thin skin, firm but deep-set eyes, a direct and upward-lifted gaze, and a strong temperament. Because such people are rigid, they readily become angry. Anger drives the qi upward, where it accumulates in the chest. The blood and qi then become disordered and stagnant, the skin and muscles swell, and the flow of the blood vessels is obstructed. Stagnation generates heat, and this heat consumes the muscles and skin, producing xiaodan. This passage describes people who are quick-tempered and rigid in disposition but whose musculature is thin and weak.

The Emperor then asked about the signs of those prone to hanre (chills and fever). Shaoyu replied that people with small bones and weak musculature are prone to hanre. The Emperor asked how to judge the size of the bones, whether the muscles are firm or fragile, and whether the complexion is abnormal. Shaoyu explained that the cheekbones (quanggu) indicate the size of the bones: large cheekbones generally signal large bones, and small cheekbones signal small bones. Thin skin, muscles that do not form solid masses, arms that are limp and weak, and a grayish face whose color differs from that of the forehead, with localized areas that appear murky and unusual, are all further diagnostic signs. In addition, people with thin arm muscles have insufficient marrow (suise), which is why they are prone to hanre.

The Yellow Emperor asked: How can one tell whether a person is prone to bi (impediment, a disorder in which wind, cold, dampness and other pathogenic factors obstruct the channels)? Shaoyu replied: People whose skin texture is coarse and loose, and whose flesh is not firm, are prone to bi.

The Yellow Emperor (Huangdi) further asked: Does bi arise in the upper or the lower part of the body, and can its specific location be determined? Shaoyu replied: To know whether the disorder lies high or low, one must observe each part of the body separately.

The Yellow Emperor asked: How can one tell whether a person is prone to changchong jiju (accumulations in the intestines, masses that gather and harden within the stomach and bowels)? Shaoyu replied: People whose skin is thin and lacks moisture, and whose flesh is soft, damp and unsubstantial, have weak intestinal and stomach function. When the stomach and intestines are weak, pathogenic qi tends to linger there. When that qi injures the spleen and stomach and the cold and heat within them fall out of balance, the qi gradually invades and stagnates, and a large accumulation forms.

The Yellow Emperor said: I have already understood the various forms of disease, and I wish to know the timing of their onset. Shaoyu replied: One must first determine the yunqi (annual cycles of qi) of the year before the timing of onset can be judged. When yunqi is in excess, disease tends to erupt; when yunqi is in decline, illness tends to become grave. Even if yunqi has not declined, if the year brings clashing and overcoming, or free flow, changes, disease will certainly arise. This is called disease arising from differences in bodily form, and it is the guiding principle of the wubian (five transformations).

Chapter 47, Benzang (Fundamental Viscera)

The Yellow Emperor asked Qibo: "When a person has clashing and free-flowing qi, disease must arise. Does this mean that disease arises from differences in bodily form, and that this is the guiding principle of the five transformations?"

Pronunciation notes: the first rare character is read kuan, the second wu, the third ru, and the fourth lu.

The Yellow Emperor asked Qibo: The blood, qi, and jing and shen (essence and spirit) of a person are the foundation that sustains life and runs through a whole lifetime. The jingmai (meridians) circulate blood and qi, harmonize Yin-Yang, nourish the sinews and bones, and keep the joints flexible. Weiqi (defensive qi) warms the muscles, fills out the skin, keeps the couli (the textures and gaps between skin and muscle) tight, and governs the opening and closing of the body's surface as its defense. Zhiyi (intention and will) unifies the spirit, gathers the hun (ethereal soul) and po (corporeal soul), regulates adaptation to cold and heat, and keeps joy and anger in balance.

When blood and qi are harmonized, the meridians flow smoothly, Yin and Yang are nourished and covered, the sinews and bones are strong, and the joints are supple. When weiqi is harmonized, the muscles are relaxed and agile, the skin is soft, and the couli are firm. When intention is calm, the spirit is focused, the hun and po are settled, regret and anger do not arise, and the five zang organs are not invaded by pathogenic qi. With cold and heat in balance, the six fu organs can digest food and grain and move fluids, wind and bi (obstruction syndromes, in which blocked channels cause pain and numbness) do not take hold, the meridians stay open, and the limbs and joints remain steady. This is the normal, balanced state of the human body.

The five zang organs store the jing and shen, blood and qi, and the hun and po; the six fu organs digest food and grain and move fluids. These functions are what humans receive from Heaven and Earth, and everyone has them, regardless of whether they are dull or clever, worthy or unworthy. Yet some people live out their natural span, their blood, qi, and hun and po are not disturbed by evil influences, and they remain vigorous even at a hundred years old. Such people are not easily harmed even when they meet wind, rain, sudden cold, or intense heat. Others, however, stay mostly inside sealed rooms, free of fear and anxiety, and still fall ill. Why is this? The Yellow Emperor wishes to hear the principles behind it.

Qibo replied: This is a profound question. The five zang organs take part in the movements of Heaven and Earth, accord with Yin-Yang, correspond to the four seasons, and function in step with the changing seasons. The five zang differ in size, height, firmness or fragility, and whether they are upright or askew. The six fu differ in size, length, thickness, whether their form is solid and straight, and whether their function is slow or urgent. Taken together, these aspects present twenty-five kinds of variation, each with its own good or poor, auspicious or inauspicious qualities. I will now explain the principles behind them.

A small heart means a settled interior, so the person is not easily harmed by external pathogenic influences (waixie), but is prone to injury from worry. A large heart means the person is not easily harmed by worry, but is readily invaded by external pathogens. When the heart sits high, the lung's qi becomes congested, causing vexation and forgetfulness, and the person is slow to heed others' advice. When the heart sits low, organ qi (zangqi) tends to leak outward, the person catches cold easily, and words can startle them. A firm heart keeps organ qi settled and its guardianship secure, while a fragile heart is prone to xiaodan (a wasting-and-thirst disorder, akin to diabetes) and to excess heat in the middle burner (zhongjiao). An upright heart keeps the qi mechanism (qiji) in good order and is not easily injured. If it is tilted, the person cannot focus on tasks and cannot hold fast to their duties.

A small lung means the person drinks little water. Even without wheezing or shortness of breath, such a person is prone to xiaodan and to excess heat in the middle burner. A large lung means the person drinks much water and is prone to xiongbi (chest obstruction, with a blocked and painful chest), houbi (throat obstruction, with swelling and pain in the throat), and qi reversal. A high lung makes qi surge upward, producing shoulder-raising breath and cough. A low lung presses on the benbu (the region near the diaphragm that the ancients called the chest-diaphragm area), and pain beneath the ribs readily arises. A firm lung is not prone to cough or qi reversal, while a fragile lung is prone to xiaodan and easily injured. An upright lung keeps qi flowing in harmony and is not easily injured. If it is tilted, pain on one side of the chest results.

A small liver keeps organ qi settled, so disorders beneath the ribs are uncommon. A large liver crowds the stomach and throat, and when it presses on the throat, the person feels discomfort in the chest and diaphragm, along with pain beneath the ribs. A high liver lifts qi upward to support the chest, pressing on the ribs and causing vexation. This is called xiben (a disorder of rising breath and chest oppression). A low liver presses on the stomach, leaving the area beneath the ribs seeming empty, and an empty rib-side readily admits pathogens. A firm liver keeps organ qi settled and is not easily injured, while a fragile liver is prone to xiaodan and easily injured. An upright liver keeps qi flowing and is not easily injured. If it is tilted, pain beneath the ribs results.

A small spleen keeps organ qi settled and is not easily invaded by external pathogens. A large spleen often causes pain from accumulation in the flank-muscle region beside the ribs, so the person cannot walk briskly. A high spleen causes that flank-muscle region to pull on the lowest rib (jixie), producing pain. A low spleen presses on the large intestine, leaving the viscera prone to pathogenic invasion. A firm spleen keeps organ qi settled and is not easily injured, while a fragile spleen is prone to xiaodan and easily injured. An upright spleen keeps qi flowing and is not easily injured. If it is tilted, the abdomen becomes distended.

Those with small kidneys have Qi (vital energy) that is stored securely and steadily, so they are not easily injured. Those with large kidneys are prone to lower back pain, find it difficult to bend forward or lean backward, and are vulnerable to invasion by external pathogenic factors. People whose kidneys sit high often feel pain in the back and spine and have difficulty bending and straightening. Those whose kidneys sit low often suffer pain in the lower back and buttocks and may also develop huoshan (an ancient term for groin hernias and similar conditions). Those with firm kidneys rarely suffer lower back or back pain, while those with fragile kidneys are prone to xiaodan (an ancient term for conditions such as emaciation and excessive thirst). People whose kidneys are well formed and upright have harmonious, free-flowing function and are not easily injured, whereas those with tilted kidneys often have pain in the lower back and buttocks. These twenty-five variations in form are all constitutional traits and common ailments that people tend to exhibit.

The Yellow Emperor asked, "How can one know these conditions?" Qi Bo replied, "Those with reddish complexions and fine skin texture have small hearts, while those with coarse skin texture have large hearts. Those in whom the sternum does not show a marked protrusion have hearts that sit high. Those whose sternum is small and short and projects upward have hearts that sit low. Those with long sternums have firm hearts, while those whose sternum is thin and frail have fragile hearts. Those whose sternum runs straight down without projecting upward have hearts in an upright position, whereas those whose sternum leans to one side have hearts that are tilted.

Those with pale complexions and fine skin texture have small lungs, while those with coarse skin texture have large lungs. Those with broad shoulders, an outward-thrust chest, and a hollow throat have lungs that sit high. Those whose armpits are drawn in and whose flanks are splayed have lungs that sit low. Those with broad, thick shoulders and backs have firm lungs, while those with thin shoulders and backs have fragile lungs. Those with thick backs and chests have lungs in an upright position, whereas those with sparse, uneven flanks have tilted lungs.

Those with bluish complexions and fine skin texture have small livers, while those with coarse skin texture have large livers. Those with broad chests and ribs that protrude outward have livers that sit high. Those whose flanks are drawn in and whose ribs appear slight have livers that sit low. Those with well-proportioned chests and flanks have firm livers, while those with frail ribs have fragile livers. Those whose chest and abdomen are balanced and well coordinated have livers in an upright position, whereas those whose ribs protrude to one side have tilted livers.

Those with yellowish complexions and fine skin texture have small spleens, while those with coarse skin texture have large spleens. Those whose lips turn upward have spleens that sit high, while those whose lips droop downward have spleens that sit low. Those with firm lips have firm spleens, while those with broad but unfirm lips have fragile spleens. Those whose upper and lower lips are well proportioned have spleens in an upright position, whereas those whose lips lean to one side have tilted spleens."

The lips that are yellowish in color with fine texture indicate a small spleen; coarse texture indicates a large spleen. An upturned upper lip indicates that the spleen sits high, while a slack, drooping lower lip indicates that it sits low. Firm lips indicate a firm spleen, whereas broad lips that lack firmness indicate a fragile one. When the upper and lower lips are well proportioned, the spleen is properly positioned; when one side of the lips is raised, the spleen is askew.

The ears that are dark in color with fine texture indicate small kidneys; coarse texture indicates large kidneys. Ears set high indicate kidneys that sit high, while a hollow behind the ears indicates kidneys that sit low. Firm ears indicate firm kidneys, and thin ears that lack firmness indicate fragile kidneys. Well-formed ears that lie in front of the jaw hinge (the joint of the lower jaw) indicate properly positioned kidneys, whereas an ear set higher on one side indicates kidneys that are askew. So long as these physical features remain stable in step with the condition of the corresponding organs, a person will be at peace; when they decline, illness comes easily.

The Yellow Emperor (Huangdi) said: "Well said. But this is not what I wished to ask. I want to know why some people seem not prone to illness and live out their natural span; even when they harbor deep worry, extreme fear, and unease, their bodies are not weakened, and severe cold or heat cannot harm them. Others dwell constantly in sheltered rooms, free of fear and anxiety, yet still fall ill. What is the reason?"

Qi Bo replied: "The five zang organs and six fu organs are where pathogenic qi lodges. People whose five zang are all small suffer fewer illnesses, but their spirit tends to be worn down and their sorrow runs deep. People whose five zang are all large are slow in their affairs and are not easily disturbed by worry. When all five zang sit high, a person tends to favor lofty conduct; when they all sit low, a person tends to place himself beneath others. Those whose five zang are all firm seldom fall ill, while those whose five zang are all fragile fall ill easily. Those whose five zang are all properly positioned handle affairs smoothly and win the trust of others; those whose five zang are all askew have crooked intentions, are prone to stealing, deal unfairly with others, and speak inconsistently."

Huangdi said, "I wish to understand the correspondences between the six bowels (liufu) and the parts of the body."

Qi Bo replied, "The lung is paired with the large intestine, and the large intestine corresponds to the skin. The heart is paired with the small intestine, and the small intestine corresponds to the vessels (mai). The liver is paired with the gallbladder, and the gallbladder corresponds to the sinews. The spleen is paired with the stomach, and the stomach corresponds to the flesh. The kidney is paired with the Triple Burner (Sanjiao) and the bladder, and the Triple Burner and bladder correspond to the interstices (couli), the striations between skin and muscle, and to the fine body hair."

Huangdi asked, "How are these correspondences concretely manifested?"

Qi Bo said, "The lung responds to the skin. When the skin is thick, the large intestine is also thick; when the skin is thin, the large intestine is also thin. When the skin is slack and the abdomen broad, the large intestine is coarse and long; when the skin is taut, the large intestine contracts and is short. When the skin is smooth, the large intestine runs straight; when the skin fits closely against the muscles, the large intestine tends to become blocked.

"The heart responds to the vessels. When the skin is thick, the vessels are also thick; when the vessels are thick, the small intestine is thick. When the skin is thin, the vessels are also thin; when the vessels are thin, the small intestine is thin. When the skin is slack, the vessel courses are also loose; when the vessel courses are loose, the small intestine is coarse and long. When the skin is thin and the vessel courses are fine, the small intestine is fine and short. When the collaterals of the yang channels wind about in many bends, the small intestine tends to become blocked.

"The spleen responds to the flesh. When the flesh is firm and abundant, the stomach wall is thick; when the flesh is lean and thin, the stomach wall is thin. When the flesh is both small and thin, the stomach is not solid. When the distribution of flesh does not match the body's build, the stomach sits low; when the stomach sits low, the lower passage cannot easily gather and open freely. When the flesh is not firm, the stomach stays slack; when no fine striations accumulate on the flesh, the stomach contracts; when many fine striations accumulate on the flesh, the stomach tends to become blocked. When the stomach is blocked, the upper passage cannot easily gather and open freely.

"The liver responds to the nails. When the nails are thick and yellowish, the gallbladder is thick; when the nails are thin and reddish, the gallbladder is thin. When the nails are hard and greenish-blue, the gallbladder is tense; when the nails are soft and flushed, the gallbladder is slack. When the nails are flat, straight, white, and without striations, the gallbladder runs straight; when the nails are poorly shaped, black, and heavily striated, the gallbladder tends to become blocked."

The kidneys correspond to the bones. People with fine skin texture and thick skin tend to have a robust Sanjiao (the visceral system linking the upper, middle, and lower burners) and bladder (pangguang), while those with coarse texture and thin skin tend to have weaker Sanjiao and bladder function. People whose skin is loose in texture show a relaxed condition of the Sanjiao and bladder, whereas those with taut skin and no body hair show a more urgent condition. People with long, coarse body hair have Sanjiao and bladder pulse patterns that run straight, while those with sparse body hair are prone to stagnation in these organs.

The Yellow Emperor (Huangdi) then asked: since skin thickness, the presence or absence of body hair, and hair coarseness all vary, the Sanjiao and bladder should show corresponding signs, and he wished to know what diseases these conditions lead to. Qi Bo replied that by observing the outward signs that correspond to the body's interior, one can understand the state of the inner organs and so judge which diseases may arise.

Pronunciation notes: the character for "buttocks" is read as "kao," the character for "shin" is read as "qiao," and the character for "in" or "at" is read as "wu."

Lei Gong asked the Yellow Emperor: "I have been fortunate to receive your instruction in studying the Nine Needles and Sixty Chapters, reading it diligently morning and evening. Some of the bamboo slips have their binding cords broken, and some are crusted with dirt. I keep reciting them, yet I have not fully grasped their meaning. The chapter Waichuai says that the many details must be 'bound together into one,' and I do not understand what this means. Things are so large they have no outer limit and so small they have no inner part. Their greatness and smallness have no end, and their heights and depths have no fixed bounds. How can they be gathered together?

"Human talent and ability vary in strength, and the range, depth, and shallowness of human thought differ. Not everyone can comprehend principles that are broad and profound. Even I, who study with such effort, worry that what I learn will be lost to later generations and cannot be passed on to my descendants. I ask: how can these principles be gathered together?"

The Yellow Emperor said: "An excellent question! This is content that our former teachers strictly forbade passing on privately. To transmit it, one must cut the arm and smear blood on the lips to swear an oath. If you wish to learn, why not first observe a period of fasting?"

Lei Gong bowed twice, rose, and said: "Please allow me to do as you instruct." He then fasted and lodged in retreat for three days, after which he requested: "Today coincides with a time of pure yang. I am willing to receive the teaching under oath."

The Yellow Emperor then entered the purification chamber with him, cut their arms to draw blood, and the two smeared blood on their lips to form a covenant. The Yellow Emperor personally made the invocation: "Today coincides with a time of pure yang. We transmit these medical prescriptions through the rite of smearing blood. Whoever dares to break this oath shall suffer calamity in return." Lei Gong bowed again and said: "I accept your instruction."

The Yellow Emperor then grasped Lei Gong's left hand, handed him the book with his right hand, and said: "Be vigilant. I will explain it to you."

All principles of acupuncture begin with the channels (jingmai). One must understand the routes and measures of the circulation of channel Qi. In needling the five zang organs within and the six fu organs without, one must carefully observe the circulation of Weiqi (defensive Qi). Weiqi is a factor closely tied to the arising and transformation of many diseases. In needling, one must regulate vacuity and repletion until they are harmonized. One must also drain the stagnant blood in the blood vessels, and once those vessels are cleared, there is no danger.

Lei Gong said: "These are principles I have already mastered. I know the measures of channel circulation, and I know to needle the five zang internally and the six fu externally, to observe Weiqi, to regulate vacuity and repletion, and to drain the blood vessels. But I still do not know how to gather these principles together."

The Yellow Emperor said: "Gathering the principles of a medical prescription is like tying a sack shut. If a sack is filled but not tied, its contents will spill out. If medical methods are shaped but not gathered together, the mind's understanding cannot follow them."

Lei Gong said: "Please allow me to explain these principles to people of shallow learning, so that they will not seek too much, but will instead gather the content well."

The Yellow Emperor said: "If one has not yet learned everything and hastens to gather and organize it, one may become a skilled physician, but not one capable of teaching all under Heaven."

Lei Gong said, "I would like to hear you explain what makes a physician truly skilled." The Yellow Emperor replied, "The pulse at the cunkou (Cunkou, the wrist pulse) reflects conditions within the body, while the pulse at the renying (Renying, the neck pulse) reflects conditions at the surface. When the two correspond, arriving and departing in harmony, and their size is as even as a straightened cord, the person is called a ping ren, a healthy person. In spring and summer the renying pulse is slightly stronger, and in autumn and winter the cunkou pulse is slightly stronger. These are normal variations.

When the renying pulse is twice as large as the cunkou pulse, the illness lies in the foot Shaoyang channel. If the pulse also feels agitated, the illness lies in the hand Shaoyang channel. When it is three times as large, the illness lies in the foot Taiyang channel, and if agitated, in the hand Taiyang channel. When it is four times as large, the illness lies in the foot Yangming channel, and if agitated, in the hand Yangming channel. A full pulse indicates heat, an empty pulse indicates cold, a tight pulse indicates pain or bi (bi, painful obstruction), and a pulse that alternates between interrupted and irregular indicates that the illness fluctuates between mild and severe. A full pulse calls for draining treatment, and an empty pulse calls for supplementing treatment.

For pain and bi obstruction, treatment should follow the channel that corresponds to the diseased pulse. When the illness lies in the fenrou (the muscle spaces between the flesh), treatment may be given at the corresponding site. When the pulse is intermittent, the practitioner may lance the blood vessels and combine this with herbal medicine. When the pulse qi sinks, moxibustion may be applied. When the pulse is neither full nor empty, treatment follows the channel to which it belongs. This is called jing ci (jing ci, needling along the channels).

When the renying pulse reaches four times the strength of the cunkou pulse and is both large and rapid, this is called yiyang (yiyang, overflowing yang). It signals that yang qi is congested and escaping outward, which is called waige (waige, external rejection). The condition is critical and difficult to save. In examination, one must carefully trace the beginning and end of the disorder, distinguish cold from heat, and use this to verify the condition of the zang-fu organs."

When the pulse at the wrist (Cunkou, the site where the pulse is taken) is one times stronger than the pulse at the neck (Renying, the carotid site on the side of the neck), the disease lies in the foot Jueyin channel. If it is one times stronger and the pulse is also agitated, the disease lies in the hand Xinzhu channel. When the Cunkou pulse is two times stronger, the disease lies in the foot Shaoyin channel, and if it is also agitated, it lies in the hand Shaoyin channel. When it is three times stronger, the disease lies in the foot Taiyin channel, and if it is also agitated, it lies in the hand Taiyin channel.

When the pulse qi is excessive, there may be abdominal distension, interior cold, and failure to digest food. When the pulse qi is deficient, there may be interior heat, loose stools that are watery and formless, weakness with little qi, and changes in urine color. A tense and urgent pulse usually signals pain and painful obstruction. A pulse that is irregular and intermittent indicates pain that comes and goes. For an excessive pulse, the drainage method should be used. For a deficient pulse, the tonification method should be used. For a tense pulse, needling should come first, followed by moxibustion. For an intermittent pulse, the luo (collateral) vessels should be treated first, and then the condition should be regulated. When the pulse qi has sunk, only moxibustion should be used. Sinking means that qi and blood are stagnant within the vessels, that there is stasis inside, and that the blood has been chilled, which is why moxibustion is appropriate. When the pulse is neither excessive nor deficient, treatment should follow the corresponding channel.

When the Cunkou pulse is four times stronger, it is called Neiguan (an interior barrier pulse). It presents as a forceful, rapid, and tense pulse, and the prognosis is dangerous and difficult to treat. One must carefully examine the course of the illness from beginning to end, observing the changes between cold and heat, in order to determine which zang or fu organ is affected.

Only after the shu points of the channels that regulate the circulation of ying qi have been cleared may the great principles of pulse diagnosis be taught. The great principles state: for an excessive pulse, use only the drainage method; for a deficient pulse, use only the tonification method; for a tense pulse, use both needling and moxibustion together with medicinal herbs; for a pulse whose qi has sunk, use only moxibustion; and for a pulse that is neither excessive nor deficient, treat according to the corresponding channel. Treating according to the channel includes administering medicines as well as needling and moxibustion. For a rapid pulse, gentle and soothing methods of guiding and relaxing should be used. For a large but weak pulse, the patient should rest quietly and avoid exertion and strain.

Lei Gong asked the Yellow Emperor: "In diagnosing the five colors, do we rely only on the Mingtang of the nose? I still do not understand the reasoning behind this." The Yellow Emperor said: "The Mingtang refers to the nose. The Que refers to the space between the two eyebrows. The Ting refers to the forehead. The Fan refers to the two sides of the cheeks. The Bi refers to the area near the ear gates. These regions should be square and broad. When viewed from ten paces away, their outlines should still be clearly visible. A person with such features will certainly live to be a hundred years old."

Lei Gong said: "The outwardly visible parts of the five sense organs are the sides of the cheeks, and the Ermen (Ear Gate) is the area in front of the ears. The face between these two points should be square and broad. Anyone whose five sense organs can still be clearly made out from ten paces away will surely live beyond a hundred years."

Lei Gong asked: "How should one examine what the five sense organs reveal?"

The Yellow Emperor said: "The Mingtang (Bright Hall, the central area of the face around the bridge of the nose) rises in a high, level form. The regions corresponding to the five viscera are arranged across the center of the face, and those corresponding to the six bowels are distributed on either side. The upper forehead corresponds to the Queting (Court Yard, the forehead region), and the lowest extremity corresponds to the Wanggong (Royal Palace, the area of the lower face). When the five viscera are settled and the chest is in harmony, the face shows its original healthy color without signs of illness, and the Mingtang is moist and bright, how could the condition of the five sense organs fail to be discerned?"

Lei Gong asked: "If the complexion is hard to discern, could you explain the situation in detail?"

The Yellow Emperor said: "When the five colors appear, each shows in its corresponding region of the face. If the bones of the corresponding area are sunken, illness is difficult to avoid. If a sickly color appears in its corresponding region, even a severe illness may not prove fatal."

Lei Gong asked: "How should one judge illness from the five colors shown by the five sense organs?"

The Yellow Emperor said: "Blue-green and black indicate pain, yellow and red indicate heat, and white indicates cold. This is the method of diagnosing illness from the complexion of the five sense organs."

Lei Gong further asked: "How should one determine whether the illness is worsening or easing?"

The Yellow Emperor said: "One must examine both the interior and the exterior of the body. When feeling the Cunkou (the inch pulse, the pulse at the wrist), if the pulse is slippery, small, tight, and deep, the illness is worsening and lies within the body. When the Renying (the pulse at the neck artery) is forceful and the pulse is tight and superficial, the illness is worsening and lies on the body's surface. A superficial and slippery Cunkou pulse indicates that the illness is gradually worsening, while a deep and slippery Renying pulse indicates that it is gradually easing. A deep and slippery Cunkou pulse indicates that the interior illness is gradually worsening, while a slippery, full, and superficial Renying pulse indicates that the exterior illness is gradually worsening. If the superficial or deep quality of the pulse and the relative strength of Renying and Cunkou are similar, the illness will be hard to cure.

"When illness lies in the five viscera, a deep and large pulse means recovery will be easy, while a small pulse is a contrary sign. When illness lies in the six bowels, a superficial and large pulse means recovery will be easy. A forceful and tense Renying pulse indicates contraction of cold pathogens, while a forceful and tense Qikou (another name for the Cunkou pulse) indicates injury from food and drink."

Lei Gong asked, "When judging the severity of an illness from the complexion, how should one look?"

The Yellow Emperor replied, "When the complexion appears coarse yet has luster, the illness is light. When the color is dark, dull, and withered, the illness is grave. If the color spreads upward, the illness is worsening. If the color recedes downward, dispersing like clouds and mist, the illness has begun to mend. The five colors (green-blue, red, yellow, white, and black) each correspond to different organs and regions of the body, and each has external and internal aspects. When the color spreads from outside inward, the illness is progressing from exterior to interior. When it emerges from within outward, the illness is progressing from interior to exterior. For illnesses arising internally, one should first regulate the Yin aspect and then the Yang aspect. If this order is reversed, the illness will worsen. For illnesses arising in the Yang aspect, one should first treat the exterior and then the interior. If this order is reversed, the illness will also worsen."

"If the pulse is slippery, large, intermittent, and long in its forceful movement, the pathogenic influence has come from outside. When the patient seems to see things before the eyes and at the same time feels aversion toward certain things in the heart, this is a sign that Yang Qi (vital energy) is excessive and gathering together. It can be altered through treatment."

Lei Gong asked, "I have heard that wind is the beginning of all illnesses, and that reversal (jue), in which the flow of qi and blood runs counter, with cold extremities and similar signs, is caused by cold and dampness. How can one distinguish them?"

The Yellow Emperor replied, "Generally, observe the Que Zhong (the region between the eyebrows, just above the root of the nose). When the color is pale and moist, it is commonly seen in wind disorders. When the color is deep and turbid, it is commonly seen in bi (obstruction) disorders, in which the flow of qi and blood is blocked, causing pain and numbness of the limbs. When the color appears in a lower position, it is commonly seen in jue reversal disorders. This is the general rule, but one must also combine the different colors to judge the illness."

Lei Gong asked, "How can one distinguish illnesses caused by cold and dampness in a person?"

The Yellow Emperor replied, "Generally, observe the Que Zhong. When the color is pale and moist, it is commonly seen in wind disorders. When the color is deep and turbid, it is commonly seen in bi disorders. When the color appears in a lower position, it is commonly seen in jue reversal disorders. This is the general rule, but one must also judge the illness by the colors."

Lei Gong asked, "When a person appears to have no illness yet dies suddenly, how can this be foreseen?"

The Yellow Emperor said, "A person in whom a great pathogenic qi has invaded the organs may die suddenly without any obvious symptoms."

Lei Gong asked again, "When the illness has slightly improved yet the person dies suddenly, how can this be foreseen?"

The Yellow Emperor said, "If redness appears on both cheekbones, about the size of a thumb, the person may die suddenly even though the illness seems slightly better. If a black patch the size of a thumb appears at the center of the forehead, the person may also die suddenly, appearing to have no illness."

Lei Gong bowed again in thanks and said, "Well said! Can one tell when death will occur?"

The Yellow Emperor said, "By observing the complexion, one can estimate the approximate time."

Lei Gong said, "You have explained this extremely well! I hope you will tell me the whole principle."

The Yellow Emperor said, "The 'ting' (courtyard) of the face corresponds to the head and face. The area above the 'que' (gate) between the brows, called 'que shang,' corresponds to the throat. The area 'que zhong' between the brows corresponds to the lungs. The area just below the nose and above the upper lip, called 'xia ji,' corresponds to the heart. The region below this corresponds to the liver, and the left side of the liver's region corresponds to the gallbladder. Further down corresponds to the spleen. The area above the corners of the forehead corresponds to the stomach, and the central area corresponds to the large intestine. The two sides of the large intestine correspond to the kidneys, and the area opposite the kidneys corresponds to the navel. Above the tip of the nose corresponds to the small intestine, while below the tip corresponds to the bladder and uterus. The cheekbones correspond to the shoulders, the area behind the cheekbones to the arms, and the area below the arms to the hands. The area above the inner corners of the eyes corresponds to the chest and breasts. Following the cheek muscles upward corresponds to the back. The area along the lower jaw corresponds to the thighs. The center of the face corresponds to the knees, the area below the knees to the calves, and the area beneath the calves to the feet. The wider parts of the cheeks correspond to the inner thighs, and the bends correspond to the kneecaps. These are the regions on the face that correspond to the five zang and six fu organs and to the limbs, and each has its own proper place."

The physician must master these correspondences before judging the organs by the principle of Yin-Yang. Use the changes of Yin to regulate Yang, and the changes of Yang to regulate Yin. Once each region's assignment is clear, diagnosis can be made with confidence, and one must also distinguish left from right before one can be said to have mastered the medical art. The correspondences differ between men and women, so judgments must take Yin-Yang into account. Only the physician who carefully observes whether the face is lustrous or withered is truly skilled.

When the complexion is dark, dull, and turbid, the disease lies within. When the color is floating, bright, and moist, the disease lies on the exterior. Yellow and red signs point to wind evils. Green and black signs must be interpreted together with the left and right regions. A physician who grasps these diagnostic principles, distinguishes the differences between the male and female regions, and examines closely whether the complexion is moist or withered, may truly be called a good physician.

Heavy, murky complexion indicates that the illness lies within the body, while a superficial, lustrous complexion indicates that it lies on the body's surface. Yellow and red tones are mostly associated with wind disorders, green and black tones with pain, and white tones with cold disorders. A yellow tone that is smooth and glossy like ointment suggests pus; an intense red suggests blood; severe pain may lead to spasm and contraction of the sinews and vessels; and when cold pathogens are very strong, the skin loses sensation.

Each of the five colors corresponds to particular parts of the body. Whether a color appears superficial or deep indicates how shallow or deep the illness lies. Whether its luster is moist or dull and dark indicates whether the illness is progressing favorably. Whether the color is dispersed or gathered suggests whether the illness is recent or long-standing. Whether it appears in the upper or lower part of the face indicates where the illness is located. In examination, one must concentrate the mind fully in order to understand the course of the illness and to distinguish new ailments from old. Examination of complexion must not be carried out carelessly. A deep, dark, dull color usually signals a more serious condition, whereas a color that is indistinct and lacks luster may not signify a grave illness if it is not intense. If the color is scattered and has not yet gathered, the pathogenic factor has not yet congealed into a mass and may manifest as pain from Qi stagnation.

Kidney Qi affects the heart. When the heart falls ill first, the kidney responds afterward, and the complexion shows corresponding changes. In men, a disease color at the "Mianwang" (the center of the nose) may indicate lower abdominal pain. If the color lies toward the lower part, it may indicate testicular pain; if it is round and straight, it may indicate penile pain. A color located higher or lower on this area also corresponds to a specific site of illness. Such signs may be seen in conditions such as húshàn (fox hernia) and shànyīn, ancient terms for scrotal and hernia-type disorders. In women, a disease color at the Mianwang may indicate ailments of the bladder or uterus. A dispersed color mainly indicates pain, while a gathered color mainly indicates accumulations. The roundness or squareness of the color, as well as its left or right position, must be judged together with its shape and location. If the color extends downward along the face to the chin, it may indicate a reproductive disorder; if its luster is smooth like ointment, it may be linked to a sudden intake of unclean food. A color on the left side indicates an illness mostly on the left, and a color on the right side indicates one mostly on the right. When pathogenic Qi produces colors that gather and scatter irregularly and take improper shapes, the color displayed on the face can indicate the location of the illness.

The five colors of green, black, red, white, and yellow each show upright, full, and distinct forms. If a red color deviates from its normal appearance, its shape may resemble a large leaf. If it appears at the Mianwang, it suggests that the illness may manifest in the near future. A color with a sharp upper end indicates that the illness is rising, and one with a sharp lower end indicates that it is descending. Colors on the left and right sides are judged by the same principle.

The five colors correspond to the five viscera: green belongs to the liver, red to the heart, white to the lung, yellow to the spleen, and black to the kidney. The liver is joined with the sinews, the heart with the vessels, the lung with the skin, the spleen with the flesh, and the kidney with the bones.

Chapter Fifty: On Courage (Lun Yong)

The Yellow Emperor (Huangdi) asked Shaoyu: "Suppose several people are standing or walking side by side, all of the same age and wearing clothing of the same thickness. Suddenly they meet a fierce wind and rain. Some fall ill and some do not, and sometimes they all fall ill while at other times none do. What is the reason?"

Shaoyu replied: "Which aspect is it that you most want to know?" The Yellow Emperor said: "I wish to understand all of it."

Shaoyu said: "In spring there are the green winds, in summer the yang winds, in autumn the cool winds, and in winter the cold winds. The winds of each season have their own character, and the illnesses they provoke differ accordingly."

The Yellow Emperor asked: "What kinds of people do the winds of the four seasons make ill?"

Shaoyu said: "People with thin skin and soft, weak flesh. Those with a yellow complexion cannot withstand the vacuous wind of spring, those with a white complexion cannot withstand the vacuous wind of summer, those with a green complexion cannot withstand the vacuous wind of autumn, and those with a red complexion cannot withstand the vacuous wind of winter."

The Yellow Emperor asked: "Do people with a black complexion never fall ill?"

Shaoyu said: "If a person with a black complexion has thick skin and firm flesh, they are usually not harmed by the vacuous winds of the four seasons. But if their skin is thin and their flesh is not firm, and their complexion does not match the corresponding constitution, then in late summer (the transitional period between summer and autumn) they will fall ill when they meet a vacuous wind. Those with thick skin and firm flesh generally do not fall ill when they meet a vacuous wind in late summer. However, if they are repeatedly attacked by cold pathogens so that both the interior and exterior are affected, they will also fall ill."

The Yellow Emperor said: "Good."

The Yellow Emperor went on: "Whether a person can endure pain or cannot is not the difference between courage and cowardice. A brave person sometimes cannot endure pain: they step forward without hesitation when facing a hard task, yet stop when they feel pain. As for the timid person..."

The Yellow Emperor said: "Whether a person can endure pain depends not on courage or cowardice. Some brave warriors charge forward at the first sign of danger but stop when they meet pain. Some timid people are frightened at the mere report of danger yet remain unmoved when they actually encounter pain. Some brave warriors are unafraid of danger and do not flinch from pain. Some timid people, upon meeting danger or pain, roll their eyes and glance sideways. They are so frightened they cannot speak, their breath becomes disordered and their composure is lost, and their complexion changes, as if they were about to die one moment and recovered the next. I have seen such cases, but I do not understand the reason, and I would like to hear the principle behind them."

Shaoyu said: "Whether one can bear pain depends on the thickness of the skin, on whether the muscles are firm or fragile, and on whether they are relaxed or taut. It is not a difference between courage and cowardice."

The Yellow Emperor said: "I want to know what causes courage and cowardice."

Shaoyu said: "The eyes of the brave are deep and steady, their brows are upright and well formed, and the texture of their Triple Burner (Sanjiao, the functional regions of the upper, middle, and lower body in Chinese medicine) runs horizontally. Their temperament is upright, and their livers are large and firm, with ample and expansive gallbladder qi. When they become angry, their momentum is vigorous and their chests swell. Liver qi rises and gallbladder qi fills them. The corners of their eyes split open and their gaze lifts, their body hair stands on end, and their complexion turns greenish. This is how bravery arises.

"The timid have large eyes that lack restraint. Their Yin and Yang are out of balance, and the texture of their Triple Burner runs vertically. Their frames are short, the ligaments of their livers are slack, and their gallbladder qi is insufficient and dispersed. Their intestines and stomach protrude, and the regions beneath their ribs are hollow. Even when they are extremely angry, their qi is not enough to fill the chest. Although liver and lung qi rise, they soon weaken and sink, so the anger cannot be sustained. This is how timidity arises."

Back Shu Points (Dorsal Transporting Acupoints)

Huangdi asked Qi Bo: "I would like to understand which of the shu points (acupoints) of the five zang organs lie on the back."

Qi Bo replied: "The great shu point of the chest lies at the end of the zhugu (the upper tip of the scapula). The lung shu lies between the third jiao (vertebral segment), the heart shu between the fifth jiao, the diaphragm shu between the seventh jiao, the liver shu between the ninth jiao, the spleen shu between the eleventh jiao, and the kidney shu between the fourteenth jiao. All of these points lie on either side of the spine, about three cun (finger-widths) from it. To confirm a point, press the corresponding location; if the pain eases when pressed, that is the proper shu point. Moxibustion (burning mugwort to warm the point) may be used for treatment, but needling should not be. When qi is excessive, use the reducing method; when qi is deficient, use the reinforcing method. When using moxa to reinforce, do not blow on the flame; let it go out on its own. When using moxa to reduce, blow on the fire vigorously and move the moxa from point to point until the fire goes out."

The Yellow Emperor said: The five zang organs store essence, spirit, the hun and po souls; the six fu organs receive food and drink and transform them through digestion. The qi of the body connects internally to the five zang and externally to the joints of the four limbs. The qi that circulates outside the channels and floats along the surface of the body is called weiqi (defensive qi), while the essential qi that moves within the channels is called yingqi (nutritive qi). Yin and yang qi accompany one another, flowing through the interior and exterior without end, circulating in a deep and dense manner. Who could thoroughly investigate it?

Nevertheless, each of the yin and yang channels has its own biao (branch) and ben (root), along with the places where excess and deficiency reside. One who can distinguish the twelve yin and yang channels will know where disease arises; one who can perceive where excess and deficiency lie will be able to judge the depth, shallowness, height, and lowness of the site of illness. One who understands the key points where the qi of the six fu organs gathers and moves will comprehend how to loosen stagnation in the qi mechanism and will grasp the gateways where the channel qi connects. One who can discern whether the pathogenic qi is replete and the zheng qi (righteous qi) is weak, as manifested in firmness or softness, will know where to supplement and where to drain. One who understands the relationship between the root and branch of the six channels will no longer be confused by the various pathological changes.

Qi Bo said: "The Holy Sovereign's discourse is indeed broad. Let me try to set out its meaning as clearly as I can.

The root point of the Foot Taiyang channel lies five cun above the heel, and its branch point is at the Mingmen, where the two connecting vessels meet. Here "Mingmen" refers to the eyes. The root point of the Foot Shaoyang channel lies between the Qiaoyin points, and its branch point lies in front of the Chuanglong; "Chuanglong" refers to the ears. The root point of the Foot Shaoyin channel lies within three cun above or below the inner ankle, and its branch points are the back shu points and the two vessels beneath the tongue. The root point of the Foot Jueyin channel lies about five cun above Xingjian, and its branch point is at the back shu points. The root point of the Foot Yangming channel is at Lidui, and its branch points are Renying, the sides of the cheeks, and the front of the neck. The root point of the Foot Taiyin channel lies four cun in front of and above Zhongfeng, and its branch points are the back shu points and the root of the tongue. The root point of the Hand Taiyang channel lies behind the outer ankle, and its branch point lies one cun above the Mingmen. The root point of the Hand Shaoyang channel lies two cun above the space between the ring finger and the little finger, and its branch points are the upper corner behind the ear and the outer corner of the eye. The root point of the Hand Yangming channel lies in the middle of the elbow bone and rises to Bieyang, and its branch point is where the lower face meets the cheeks and neck. The root point of the Hand Taiyin channel is at Cunkou, and its branch point is where the pulse can be felt beneath the armpit. The root point of the Hand Shaoyin channel lies at the end of the Ruigu, and its branch points are the back shu points. The root point of the Hand Jueyin pericardium channel lies two cun above the space between the two tendons behind the palm, and its branch point lies three cun below the armpit.

When examining these sites, deficiency of qi in the lower part produces cold limbs, while excess of qi in the lower part produces fever. Deficiency of qi in the upper part produces dizziness, while excess of qi in the upper part produces fever and pain. Therefore, where qi is excessive and full, one should drain it by needling or similar methods to reduce it; where qi is deficient, one should guide and support it so that it is restored. The shu points are the places where channel qi pours in and out. The needling treatment described here is applied according to whether the channel qi is in excess or deficiency."

Where are the qi thoroughfares (qijie), the important sites where meridian qi gathers and circulates through the body? They are found in the chest, abdomen, head, and lower legs. In the head, meridian qi gathers in the brain. In the chest, it gathers at the ying region on the front of the chest and at the shu points (shuxue) on the back. In the abdomen, it gathers at the shu points on the back and at the Penetrating Vessel (chongmai), whose pulse can be felt on either side of the navel. In the lower legs, meridian qi gathers at the qijie, at the Chengshan point, and at the areas above and below the ankle.

Needling these sites requires filiform needles. Before inserting a needle, the practitioner must first press on the point and hold the pressure briefly, until the hand can sense the corresponding change, and only then begin needling. The conditions treated here include headache, dizziness with falling, abdominal pain, sudden abdominal distension and swelling, and newly formed masses. When the pain wanders from place to place, the condition is relatively easy to cure. When a mass is painless, it is harder to cure.

The Yellow Emperor (Huangdi) asked Shaoyu: People differ in the strength of their sinews and bones, in whether their muscles are firm or slack, in the thickness of their skin, and in the density of their couli (the texture of the skin and the openings of the sweat pores). How do these differences affect the pain produced by acupuncture, bian stone needles, and moxibustion? People also differ in the thickness of their stomach and intestines and in whether these are firm or fragile, so how would this affect their ability to withstand poisonous drugs? Please explain in detail.

Shaoyu replied: Those with strong bones, weak sinews, slack muscles, and thick skin tolerate pain better. This holds for the pain of acupuncture and bian stones, and it also holds for moxibustion.

The Yellow Emperor asked: How can one tell whether a person can endure moxibustion? Shaoyu replied: People with dark complexions and strong bones can generally endure moxibustion well.

The Yellow Emperor asked: How can one tell whether a person can endure the pain of acupuncture and bian stones? Shaoyu replied: People with firm muscles and thin skin cannot endure the pain of acupuncture and bian stones, and the same is true of moxibustion.

The Yellow Emperor asked: When people suffer the same illness or the same injury, some recover quickly, some recover slowly, and some do not recover at all. What is the reason for this? Shaoyu replied: When people sustain the same injury, those whose bodies run warm recover more readily, while those whose bodies run cold find recovery more difficult.

The Yellow Emperor further asked: How can one tell whether a person can withstand poisonous drugs? Shaoyu replied: Those with thick stomachs, dark complexions, large bones, and sturdy bodies can generally withstand poisons well. Those with lean bodies and weak stomachs find them harder to withstand.

Chapter 54: Tiannian (Natural Life Span)

The Yellow Emperor asked Qi Bo: When a human being first comes into existence, what establishes its foundation, and what protects it? What causes death when lost, and what must be obtained for life to continue?

Qi Bo replied: The mother forms the foundation, and the father provides protection. Losing shenqi (spirit-qi) brings death, and possessing it allows life to continue.

The Yellow Emperor asked: What is shenqi? Qi Bo replied: When the blood and qi are in harmony, when yingqi (nutritive qi) and weiqi (defensive qi) circulate smoothly, when the Five Zang Organs have matured and taken form, when shen dwells securely in the heart, and when the hun and po (ethereal and corporeal souls) are complete, one becomes a whole person.

The Yellow Emperor asked: People's lifespans differ. Some die young, some live long, some die suddenly, and some suffer illness for years. I would like to understand the reasons behind this.

Qi Bo replied: If the five zang organs are solid, the blood vessels are harmonious, the muscles are supple and relaxed, the skin is tight, and the ying qi (nutritive qi) and wei qi (defensive qi), the two kinds of qi that circulate through the body and sustain life, move normally, if the breath is calm and slow and the qi follows its regular rhythm, and if the six fu organs (the organs that digest food and transmit water and grain) process food properly and the jinye (bodily fluids) are distributed as they should, then a person will live long.

The Yellow Emperor asked: How does a person come to live to one hundred before dying?

Qi Bo replied: The nasal passages of such a person are deep and long, the facial contours are high and upright, and the ying qi and wei qi flow unobstructed. The "three sections and three miles" (ancient regions of the face used to observe physical form and complexion) are full and prominent, the bones are tall and well-formed, the muscles are full, digestion is sound, and the fluids are distributed normally. Such a person can live to one hundred and pass away naturally, in peace.

The Yellow Emperor asked: Could you explain how a person's qi moves from vigor to decline and finally to death?

Qi Bo replied: At age ten, the five zang organs have begun to stabilize and the xue qi (blood and qi) flows freely, but the qi tends toward the lower body, so a child delights in running. At twenty, the xue qi begins to flourish and the muscles are growing, so a young adult enjoys brisk walking. At thirty, the five zang organs are firmly developed, the muscles are firm, and the blood vessels are full, so a person prefers a measured, unhurried pace.

At forty, the five zang organs, the six fu organs, and the twelve jing channels (meridians) have all reached fullness and are beginning to level off. The skin's texture starts to loosen, the appearance gradually fades, and the hair begins to whiten. Although the xue qi remains abundant, it no longer moves readily, so a person prefers to sit. At fifty, liver qi begins to decline, the liver lobes thin, bile diminishes, and eyesight starts to weaken. At sixty, heart qi declines, a person becomes prone to worry and sorrow, the xue qi moves sluggishly, and so a person prefers to lie down.

At seventy, spleen qi weakens and the skin dries out. At eighty, lung qi is feeble and the po (the corporeal soul, associated with instinctive bodily functions) disperses, so speech becomes prone to error. At ninety, kidney qi is exhausted, and the channels of the other four zang organs are also empty. By one hundred, all five zang organs are weakened, the shen qi (spirit qi) has departed, and only the physical form remains, and then a person dies.

When a person reaches this age, if the body can no longer remain full and substantial, the skin withers and dries. At eighty, lung qi (Qi) weakens and the po (the corporeal soul, the spiritual aspect tied to the body's perceptual activity) disperses, so speech often goes astray. At ninety, kidney qi is exhausted, and the other four viscera and the channels are all empty. At one hundred, the five viscera are all weakened, the spirit qi (Shen Qi) has departed, and only the physical form remains, which then dies.

The Yellow Emperor (Huangdi) asked: Why do some people die before reaching their natural span of life?

Qi Bo replied: People of this kind have viscera that are not firm, breathing passages that are neither deep nor long, and chests that expand outward, so their breath is rapid and shallow. Their bodily foundation is weak, their blood vessels are thin, their blood volume is low, and their muscles are not firm. They are often struck by wind and cold, their blood and qi are insufficient, and their channels are not clear. Within the body, upright qi (zheng qi) and the pathogenic qi of disease strike and disturb one another, so the movement of qi becomes disordered, and they die before reaching their natural span of life.

Chapter 55: Reversal and Compliance (Nishun)

The Yellow Emperor asked Boggao: "I have heard that qi has reversal and compliance, that the pulse has strength and decline, and that acupuncture has fundamental principles. Could you explain these to me?"

Boggao replied: "The reversal and compliance of qi describe how the human body accords with the changes of Heaven and Earth, Yin-Yang, the four seasons, and the Five Phases. The strength and decline of the pulse serve to judge whether blood and qi are deficient and weak, or full and in excess. The fundamental principles of acupuncture require clear knowledge of when an illness may be needled, when it is not yet suitable for needling, and when it can no longer be needled."

The Yellow Emperor asked: "How should these conditions be examined?"

Boggao replied: "The Art of War says: Do not meet an enemy whose momentum is at its height, and do not attack an army whose formation is orderly. The Acupuncture Classic says: Do not needle when heat is at its peak, do not needle when a person is sweating profusely, do not needle when the pulse is disordered and unclear, and do not needle a person whose illness and pulse present contradictory signs."

Huangdi asked: how can one tell when acupuncture is appropriate? Bo Gao (Bo Gao) answered: a superior physician treats illness before it arises. The next best treats it before the pathogenic influence has grown fierce, and the one after that treats it once the illness has begun to recede. A physician of lesser skill needles only after the pathogenic influence has just invaded the body, or while the illness is at its height, and may even treat when the signs and the pulse contradict each other. Therefore it is said that when the illness is at its height, one should not rashly harm the body. Wait until the illness has declined, and the needling will easily succeed. This is why it is said that the superior physician regulates illness that has not yet appeared and does not wait until it has fully formed.

Phonetic Glosses

The first character, feng, is read with the fanqie "pu-meng" (pu-meng qie). The second character, he, is read with the fanqie "hu-mu" (hu-mu qie).

Chapter 56: Five Flavors (wuwei)

Huangdi said: I would like to hear how the qi of the grains, with its five flavors, enters the Five Zang organs and what effect it has on each. Bo Gao answered: the stomach is where the Liufu (six fu organs) and Wuzang (five zang organs) converge. Water and grain both enter the stomach, and all the Liufu and Wuzang receive their qi from it...