《黄帝内经灵枢集注》Vol. 4

The different flavors of the five grains each first enter the organs they correspond to and favor: sour enters the liver first, bitter enters the heart first, sweet enters the spleen first, pungent enters the lungs first, and salty enters the kidneys first. As the refined essence (jing) and fluids of the grains circulate, the nutritive qi (yingqi) and the defensive qi (weiqi) also flow freely. Afterward, the food is transformed into residue, which is passed downward in turn.

The Yellow Emperor (Huangdi) asked, "How do the nutritive qi and the defensive qi circulate?" Bogao replied, "When food has just entered the stomach, its fine and useful portion is first distributed outward from the upper and lower parts of the stomach to nourish the five zang organs. It then divides into two paths, which form the courses along which the nutritive and defensive qi travel. The part of the refined essence that is abundant and gathered, and has not yet begun to circulate outward, accumulates in the chest. This is called the 'Sea of Qi' (qihai), the place where the body's qi gathers. Qi emerges from the lungs and moves along the throat, so that on exhalation qi goes outward and on inhalation it comes inward. The circulation of the essential qi of heaven and earth is roughly three parts outward for every one part inward. Therefore, if one does not eat, one's strength weakens after half a day, and if one goes a whole day without eating, the qi becomes even more deficient."

The Yellow Emperor (Huangdi) asked, "May you tell me about the five flavors of the five grains?" Boogao replied, "Allow me to explain in detail. Among the five grains, nonglutinous rice is sweet, hemp seed is sour, soybean is salty, wheat is bitter, and broomcorn millet is pungent. Among the five fruits, jujube is sweet, plum is sour, chestnut is salty, apricot is bitter, and peach is pungent. Among the meats of the five domestic animals, beef is sweet, dog meat is sour, pork is salty, mutton is bitter, and chicken is pungent. Among the five vegetables, mallow is sweet, leek is sour, bean leaves are salty, rakkyo (xie) is bitter, and scallion is pungent. The five colors correspond to the five flavors: yellow to sweet, green to sour, black to salty, red to bitter, and white to pungent. Each of these five categories of food has its appropriate flavor."

The so-called five appropriate diets are as follows. When the spleen is ill, it is suitable to eat nonglutinous rice, beef, jujube, and mallow. When the heart is ill, it is suitable to eat wheat, mutton, apricot, and rakkyo. When the kidneys are ill, it is suitable to eat dahuang juan (sprouted soybean), pork, chestnut, and bean leaves. When the liver is ill, it is suitable to eat hemp seed, dog meat, plum, and leek. When the lungs are ill, it is suitable to eat broomcorn millet, chicken, peach, and scallion.

The five prohibitions are these: in liver illness, one avoids pungent flavors; in heart illness, one avoids salty flavors; in spleen illness, one avoids sour flavors; in kidney illness, one avoids sweet flavors; and in lung illness, one avoids bitter flavors. The liver corresponds to green and is suited to sweet flavors, so nonglutinous rice, beef, jujube, and mallow may be eaten, all of which are sweet foods. The heart corresponds to red and is suited to sour flavors, so dog meat, hemp seed, plum, and leek may be eaten, all of which are sour foods. The spleen corresponds to yellow and is suited to salty flavors, so soybean, pork, chestnut, and bean leaves may be eaten, all of which are salty foods. The lungs correspond to white and are suited to bitter flavors, so wheat, mutton, apricot, and rakkyo may be eaten, all of which are bitter foods. The kidneys correspond to black and are suited to pungent flavors, so broomcorn millet, chicken, peach, and scallion may be eaten, all of which are pungent foods.

Chapter Fifty-Seven: Water Distension

The Yellow Emperor asked Qi Bo to explain how to distinguish swelling from water (shuizhong), skin distension (futenzhang), drum-like distension (guzhang), intestinal accumulation (changtan), and stone masses (shijia) and stone water (shuishui). Qi Bo replied that when swelling first begins, the area just above the eyes puffs up slightly, as if the person has just woken from sleep. The pulse at the neck beats visibly, the patient often coughs, the inner thighs feel cold, and the lower legs and feet swell. Then the abdomen enlarges, and the swelling has taken form. When the abdomen is pressed, the depression rises back at once after the hand is lifted, as though water were held inside the belly. This is its characteristic sign.

The Emperor asked how skin distension is recognized. Qi Bo said that it arises when cold qi (qi) lodges between the skin and the flesh. The abdomen swells and the whole body puffs up, and the skin thickens, but the swelling is not hard to the touch. When the abdomen is pressed, a depression remains, and it does not rebound immediately after the hand is released. The color of the abdomen does not change. This is its characteristic sign.

The Emperor then asked what drum-like distension looks like. Qi Bo answered that the abdomen swells and the whole body enlarges to a degree similar to skin distension. The complexion takes on a blue-yellow tinge, and the veins on the abdomen stand out. This is its characteristic sign.

Finally, the Emperor asked about intestinal accumulation. Qi Bo said that cold qi lodges outside the intestines and clashes with defensive qi (weiqi, the qi that guards the body), so that qi cannot circulate normally. Obstruction results, and masses accumulate and attach within the body. Pathogenic qi is thereby generated and gradually forms a growth. At first it is about the size of an egg and gradually enlarges. When fully developed, it resembles a pregnancy. If it persists, it may last more than a year. On pressing, it feels hard, yet when pushed it can shift position, and menstruation still arrives on schedule. This is its characteristic sign.

Chapter Fifty-Eight: Zeifeng (Thieving Wind)

The Yellow Emperor asked: What is shijia (stone mass)? Qi Bo replied: Shijia arises within the bao (uterus, the female reproductive organ). Cold qi lodges at the zimen (cervical os) and closes it, so that qi and blood cannot circulate. Evil blood that should have been expelled remains and stagnates, gradually growing larger until its shape resembles a pregnancy, and the menses fail to arrive on schedule. This illness occurs in women and can be treated by methods that channel and disperse the accumulation so that it can be expelled.

The Yellow Emperor further asked: Can fufzhang (skin distension) and guzhang (drum distension) be treated with acupuncture? Qi Bo replied: First lance the blood vessels at the distended site to release the stagnant blood, and then regulate the jingluo (meridians). When needling, the stagnant blood must be drained.

Chapter Fifty-Eight: Zeifeng (Thieving Wind)

The Yellow Emperor said: You have taught that thieving wind and evil qi harm people and cause illness. Now some people remain constantly in sheltered places, never leaving their houses, yet fall ill suddenly. If they have not been exposed to thieving wind evil, why does this happen?

Qi Bo replied: This is because they were earlier invaded by dampness, which lingered between the blood vessels and the muscles and could not disperse for a long time. Or they once fell and were injured, and the stagnant blood remained in the body without being expelled. Later, if they suffer a sudden emotional disturbance, improper diet, or an imbalance of warmth and cold, the couli (skin interstices) close and become obstructed, and the body's ability to regulate qi and blood is impaired. Once the couli open and they meet wind and cold, the blood and qi become congealed. The wind and cold then interact with the evil already present within, forming hanbi (painful obstruction, the pain of cold blocking the channels). If there is internal heat, the person will sweat, and after sweating one is easily struck by wind. Even without encountering so-called thieving wind evil, illness may arise from the accumulation of these factors.

Huangdi said, "The conditions you have just described are all ones the patient can perceive. But if the patient has neither been struck by pathogenic qi (xie qi) nor been troubled by fright or worry, and yet falls ill suddenly, what is the cause? Could it simply be the work of ghosts and spirits?"

Qi Bo said, "Some pathogenic qi has already lodged in the body long before, but has not yet broken out. Later, the patient develops aversion or admiration in the mind. Emotion and bodily condition then influence each other, causing the blood and qi (xueqi) within the body to fall into disorder, and the two forces clash. At first the cause is very subtle, neither seen nor heard, so it appears to be the work of ghosts and spirits."

Huangdi asked, "Then why do some people recover after an incantation (zhudao)? What is the reason?"

Qi Bo replied, "The ancient wu (shamans) understood how the various diseases overcome one another, and could also discern in advance where a disease arises. Once one knows the cause, one can use incantation to cure the illness."

Lingshu Jizhu (Collected Commentaries on the Lingshu), from the Huangdi Neijing (Inner Canon of the Yellow Emperor), Juan (Fascicle) 16

1. The word mie, in the Zhenjiu Jiayi Jing (Compendium of Acupuncture and Moxibustion), Juan 6, Chapter 12, is written as jian.

2. The two words wu yi are absent from the chapter Tiaoshi (Regulating Diet) in Juan 2 of the Huangdi Neijing Taisu (Grand Basic Questions of the Inner Canon).

3. The word wu yi was originally written as wu se (five colors). Here it has been changed to wu yi according to the chapter Tiaoshi in Juan 2 of the Taisu.

Lingshu Jizhu, Juan 17

Chapter 59, Weiqi Shichang (Disorders of Defensive Qi)

Huangdi asked: when the wei qi (defensive qi, the energy that guards the body and circulates near the surface) stagnates in the abdomen, gathers without dispersing, moves poorly, and becomes lodged without a fixed place, causing fullness in the flanks and stomach, breathlessness, and difficulty breathing, how should it be dispelled?

Bogao replied that when qi gathers in the chest, one treats from above; when it gathers in the abdomen, one treats from below; and when fullness occurs both above and below, one treats from the sides of the body.

Huangdi asked for the specific method. Bogao answered that when qi accumulates in the upper body, one drains the points Renying, Tiantu, and those at the throat; when it accumulates in the lower body, one drains Zusanli and Qijie. When fullness occurs both above and below, one treats both sites together and also needles the point one cun below the lowest rib. In severe cases, the "chicken-foot" technique may be used, meaning multiple needles are applied together in a pattern resembling a chicken's claw.

During diagnosis, needling is forbidden if the pulse is coarse, taut, and wiry, if the pulse qi is cut off so that no pulse can be felt, or if the abdominal skin is extremely tense.

Huangdi said, "Good."

The Yellow Emperor asked Bo Gao, "How can one determine the illnesses of the skin, the flesh, the qi (vital energy), the blood, the sinews, and the bones?"

Bo Gao replied, "When the area between the eyebrows looks dull and lacks luster, the illness lies in the skin. When the lips take on colors such as green, yellow, red, white, or black, the illness lies in the flesh. When yingqi (nutritive qi, the refined qi that circulates within the vessels) stagnates and does not flow smoothly, the illness lies in the blood and qi. When the eyes show colors such as green, yellow, red, white, or black, the illness lies in the sinews. When the ears are dry, blackened, and stained with grime, the illness lies in the bones."

The Yellow Emperor asked, "What forms do these illnesses take, and how should they be treated?"

Bo Gao replied, "The changes of disease are too many to list one by one. Still, the skin has corresponding points of examination, the flesh has key locations between the sinews and muscles, the blood and qi have places where they are conveyed, and the bones have connected orifices."

The Yellow Emperor asked, "Please explain the principles behind this."

Bo Gao said, "The points of examination on the skin correspond to the extremities of the limbs. The key locations of the flesh lie between the muscle divisions of the yang channels of the arms and lower legs, and also between the muscle divisions of the foot Shaoyin channel. Blood and qi are conveyed into the various luo (collateral) vessels, and when blood and qi stagnate, the local area swells and rises. In examining sinew disorders, one does not distinguish Yin-Yang or left and right; one judges where the illness lies according to the signs presented. The orifices connected to the bones are able to receive jing (essence) qi and nourish the marrow of the brain."

The Yellow Emperor asked, "How should these illnesses be treated?"

Bo Gao replied, "Diseases vary in ways that are floating or sinking, deep or shallow, and each differs; they cannot be exhausted, so treatment must follow the location of the illness. When the illness is mild, needle shallowly; when it is severe, needle deeply. When the illness is mild, use fewer needlings; when it is severe, use more. Regulating the qi in step with the changes of the illness is the mark of superior medicine."

The Yellow Emperor asked Bo Gao how to distinguish between a person's plumpness and thinness, their size, their cold and heat, and whether they were elderly, in their prime, young, or still a child.

Bo Gao answered that those over fifty count as elderly, those over twenty as in their prime, those over eighteen as young, and those over six as children.

The Yellow Emperor asked how one judges whether a person is plump or thin.

Bo Gao answered that human physiques fall into three types: "fei," "gao," and "rou." Those whose muscles behind the knee are firm and whose skin is full are of the "fei" type. Those whose muscles behind the knee are soft and whose skin is slack are of the "gao" type. Those whose skin and flesh lie closely together are of the "rou" type.

The Yellow Emperor asked how one judges whether the body is cold or hot.

Bo Gao answered that people of the "gao" type have soft flesh. If their skin texture is coarse and loose, the body tends toward cold; if it is fine and dense, the body tends toward heat. People of the "zhi" type have firm flesh. If their skin texture is fine and dense, the body tends toward heat; if it is coarse and loose, the body tends toward cold.

The Yellow Emperor asked how plumpness and thinness relate to the size of the body.

Bo Gao answered that people of the "gao" type have abundant qi, and since their skin is slack, their abdomen tends to be loose and sagging, and their fat accumulates and hangs downward. People of the "rou" type have broad bodies overall. People of the "zhi" type have compact, slender frames.

The Yellow Emperor asked how the amounts of qi and xue (blood) differ among these three types.

Bo Gao answered that people of the "gao" type have much qi, and abundant qi makes the body run warm, so they tolerate cold well. People of the "rou" type have much xue, and sufficient xue fills out the form, and a full form keeps the condition balanced. People of the "zhi" type have clear xue, and their qi moves smoothly but in small quantity, so their bodies do not readily grow large. These are the features that set them apart from ordinary people.

The Yellow Emperor asked what ordinary people are like.

Bo Gao answered that in ordinary people, skin, flesh, fat, and "gao" show no single prominent feature, and neither qi nor xue predominates in any clear way. Their bodies are neither large nor small but suit their own frames, and this is called "zhongren," the ordinary multitude.

The Yellow Emperor said, "Well said." He then asked how treatment should be carried out.

Bo Gao answered that the practitioner must first determine which physique the patient belongs to, assess the amounts of xue and qi, and judge whether the qi is clear or turbid, and only then apply treatment, without departing from the established methods. Accordingly, people of the "gao" build have loose abdomens and sagging fat, people of the "rou" build are broad both above and below, and people of the "zhi" build, though carrying much fat, do not readily grow large in body.

The Yellow Emperor said: "I believe the fine needle is a very small instrument. Yet the master says that it joins above with Heaven, below with Earth, and in the middle with Man. I feel this seems to overstate the meaning of the needle. I would like to hear the reasoning behind it."

Qi Bo replied: "What could be greater than Heaven? Greater than the needle, there are only the five weapons, that is, the five kinds of arms. Weapons are prepared for death; they are not used to nourish and protect life. Moreover, Man is the most important being between Heaven and Earth, so how could the needle fail to correspond and unite with Heaven, Earth, and Man? In governing the people, one must also rely on the needle to regulate the body. Compared with the five weapons, which of the two is truly smaller?"

The Yellow Emperor asked: When illness arises, if one's emotions swing unpredictably between joy and anger and one's diet is unregulated, and there follow a deficiency of yin qi and an excess of yang qi, with the nutritive qi (yingqi) moving sluggishly, then carbuncles and ulcers (yongju, swellings that form between the skin and the flesh) will develop. When the yin and yang qi fail to communicate, and heat pathogens grip and congeal against one another, they transform into pus. Can the pus be drawn out with a small needle?

Qi Bo replied: Even a sage cannot make an established lesion dissipate on its own. Once a pathogenic qi has formed, it cannot be left to remain within the body. This is like two armies facing each other across a field, banners confronting one another, swords and spears covering the plain. Such a situation does not arise in a single morning or evening. Likewise, to make the common people obey orders and keep prohibitions, and to keep soldiers from the calamity of weapons, cannot be accomplished by a brief lesson. Once the body has come to suffer carbuncles, with pus and blood gathered, has one not strayed very far from the way of nourishing life? Carbuncles and the formation of pus do not descend from heaven, nor do they rise from the earth. They accumulate through subtle changes built up gradually. Therefore the sage treats illness before it shows any trace of form, while the ignorant suffer from it only after its momentum has already taken shape.

The Yellow Emperor asked: When the illness has already become visible, yet I have failed to notice it in time, and when the pus has already formed, yet I still have not detected it, what should be done then?

Qi Bo replied: Once pus has formed, perhaps only one in ten people can preserve their life. Therefore the sage does not allow the illness to reach this stage. Instead, he clearly records good remedies, writing them on bamboo and silk, so that those capable can treat according to them, and passes them down to later generations so the method endures. Doing so is meant to keep people from encountering a situation in which the illness has already become established.

The Yellow Emperor further asked: Once pus and blood are present and the illness is discovered, can a small needle be used to guide treatment?

Qi Bo replied: Small methods used against small illnesses have limited effect, while large methods used against large illnesses easily cause greater harm. Therefore, when pus and blood have already formed, one can only draw out the pus with bianshi (ancient stone needles used for lancing) and bifeng (ancient sharp-edged instruments used to cut open and drain).

The Yellow Emperor asked: Since this approach may cause much harm, can the patient not be preserved? Qi Bo replied: ……

The Yellow Emperor asked, "For a person who is gravely ill and badly injured, can life not be preserved?" Qi Bo replied that it depends on whether the course of the illness is favorable or adverse. The Emperor asked what adverse and favorable mean. Qi Bo said that for those who come for treatment after injury, the first ominous sign is the whites of the eyes turning blue or black with the eyes shrinking; the second is vomiting after taking medicine; the third is abdominal pain with intense thirst; the fourth is difficulty moving the shoulders and neck; and the fifth is a hoarse voice with a complexion that has lost its luster. Without these five signs, the course of the illness is considered favorable.

The Emperor asked, "Every illness has its favorable and adverse aspects. Could you explain them?" Qi Bo said that abdominal distension, fever in the body, and a large pulse are the first ominous sign; a rumbling, distended abdomen, cold limbs, and diarrhea accompanied by a large pulse are the second; nosebleeds that will not stop, with a large pulse, are the third; cough with blood in the urine, a wasted and deformed body, and a fine, taut pulse are the fourth; and cough, emaciation, fever, and a fine, rapid pulse are the fifth. When these signs appear, the patient will not survive beyond fifteen days.

If the abdomen is greatly distended, the extremities are cold, the body is emaciated, and diarrhea is severe, this is the first ominous sign. Abdominal distension with blood in the stool, and a large pulse that is sometimes intermittent, is the second. Cough, blood in the urine, and wasting of the muscles with an agitated pulse is the third. Vomiting blood, chest fullness with pain radiating to the back, and a fine, rapid pulse is the fourth. Cough, vomiting, abdominal distension, and diarrhea containing undigested food, with a pulse on the verge of failing, is the fifth. When these signs appear, the patient will not last even a single day and night. If a physician fails to discern these signs of the illness's course and proceeds to needle treatment, this is called treatment that contradicts the condition of the disease.

The Yellow Emperor said: "Master, your discussion of acupuncture is profound indeed. It corresponds to Heaven and Earth. Looking upward, it examines the patterns of the heavens; looking downward, it measures the features of the earth; within the body, it distinguishes the five zang organs; outside the body, it arranges the six fu organs. It also makes careful provision for the twenty-eight points where the channels meet. Yet acupuncture can cause a person to die, and it cannot bring the dead back to life. Could you alter this, so that acupuncture both corresponds to Heaven and Earth and can restore the dead?"

Qibo replied: "Acupuncture can cause a person to die, but it cannot bring the dead back to life."

The Yellow Emperor said: "I find this unkind, but I still wish to understand the principle behind it. I only ask that this method not be applied to people."

Qibo said: "This is precisely the principle being explained. Things are simply this way. Acupuncture is like a blade or sword, which can kill, or like wine, which can intoxicate. Even without examining a patient, one can understand this."

The Yellow Emperor said: "Please finish explaining the principle."

Qibo said: "The qi that the human body takes in comes from the five grains, and the five grains gather in the stomach. The stomach is where food, fluids, qi, and blood converge. The qi and blood produced by the stomach move through the whole body like clouds. The passages through which the stomach sends qi and blood are the jingsui (the conduits along which the channels carry qi and blood). The jingsui are the principal networks that connect the five zang and six fu organs. When needling, if one inserts the needle against the direction in which qi and blood flow, and so intercepts them, harm will result."

The Yellow Emperor asked: "In needling at various points above and below, is there a fixed number of times to do so?"

Qibo said: "If one needles against the place where grain qi and qi and blood gather and move, the qi and blood will spread through the body like clouds, and the jingsui will send the qi and blood issuing from the stomach on to the five zang and six fu. Intercepting these qi and blood through needling requires caution. If one needles against the course of qi and blood at the Wuli point (an acupoint on the arm), one should stop once it has been reached to a certain degree. Five needlings are sufficient. Each needling at five points will exhaust the qi stored in the five zang. Accumulated over twenty-five needlings, this will exhaust the qi and blood at the corresponding shu points (the acupoints where qi and blood are transported). This is what is called seizing the heavenly qi of the human body (the qi that sustains vital activity). It does not truly cut off a person's life or shorten their lifespan."

The Yellow Emperor said: "Please continue and finish."

Qibo said: "If one peers through a crack in the door at the patient and then inserts the needle, the patient may die at home. If one enters the door and needles only after reaching the hall, the patient may die in the hall."

The Yellow Emperor said: "These methods are well explained, and the principles are clear. I request that they be inscribed on jade tablets and transmitted to later generations as precious canon, established as prohibitions for acupuncture, so that the common people will not dare to transgress them."

Chapter 61: The Five Prohibitions (Wu Jin)

The Yellow Emperor (Huangdi) asked Qi Bo: "I have heard that acupuncture has five prohibitions. What do they refer to?" Qi Bo replied: "They refer to forbidding needling in cases where it is not suitable."

The Yellow Emperor then asked: "I have heard that there are five situations in which acupuncture must not be forcefully applied as an attack." Qi Bo replied: "For those who cannot withstand an attacking treatment, do not use the reducing method, which drains pathogenic qi and diminishes excess qi through needling."

The Yellow Emperor asked: "I have heard that there are five faults in acupuncture." Qi Bo replied: "Whether one uses the reinforcing method, which supports upright qi, or the reducing method, one must not exceed the proper limit."

The Yellow Emperor again asked: "I have heard that there are five adverse patterns in acupuncture." Qi Bo replied: "When the condition of the illness contradicts the pulse, this is called the 'Five Reversals' (wu ni)."

The Yellow Emperor said: "I have heard that there are nine situations suited to acupuncture, which can be used to decide whether to attack the pathogen." The Yellow Emperor again asked: "I have heard that there are five faults in acupuncture." Qi Bo replied: "Both the reinforcing and reducing methods must not exceed the proper limit."

The Yellow Emperor further asked: "I have heard that there are five adverse patterns in acupuncture." Qi Bo replied: "When the condition of the illness contradicts the pulse, this is called the 'Five Reversals.'"

The Yellow Emperor said: "I have heard that there are nine situations suited to acupuncture." Qi Bo replied: "Understanding the theory of the Nine Needles (Jiuzhen) is what is called the 'Nine Suitabilities' (Jiuyi)."

The Yellow Emperor asked, “What are the ‘Five Prohibitions’? Please tell me when acupuncture must not be used.”

Qibo replied, “On Jia or Yi days, do not needle the head, and do not perform ‘Opening the Veil’ inside the ear—the needling method used to treat conditions such as blocked hearing or vision. On Bing or Ding days, do not perform ‘Shaking Away Dust,’ a needling technique, on the shoulders, throat, or Lianquan point. On Wu or Ji days, and at the end of each season, do not needle the abdomen or perform treatments such as removing the nails or draining fluids. On Geng or Xin days, do not needle the joints of the thighs or knees. On Ren or Gui days, do not needle the feet or lower legs. These are the ‘Five Prohibitions.’”

The Yellow Emperor asked, “What are the ‘Five Depletions’?”

Qibo replied, “When the body and muscles have become thin and weak, that is the first depletion. After severe blood loss, that is the second. After profuse sweating, that is the third. After severe diarrhea, that is the fourth. Immediately after childbirth, or after substantial blood loss, that is the fifth. In all these circumstances, draining methods must not be used—that is, treatments such as needling that disperse pathogenic influences.”

The Yellow Emperor asked, “What are the ‘Five Reversals’?”

Qibo replied, “In a patient with a febrile illness, the pulse is initially calm, but after sweating the pulse becomes forceful and agitated: this is the first reversal. In a patient with diarrhea, the pulse is surging and large: this is the second. In a patient with a fixed, unmoving Bi disorder—an illness involving obstruction of Qi and blood, with pain or numbness in the limbs—the muscles are damaged, the body is hot, and the pulse is weak or absent on one side: this is the third. When the illness is severe and the body has grown frail, the body is hot and the face is dry, pale, and withered, followed by the passing of blood clots; if the bleeding is severe, this is the fourth. When alternating chills and fever occur alongside wasting, and the pulse is hard and forceful, this is the fifth. None of these conditions should be treated with draining methods.”

The Yellow Emperor asked: Among the twelve channels, why do the pulses of Hand Greater Yin (the Lung Channel of Hand Greater Yin), Foot Lesser Yin (the Kidney Channel of Foot Lesser Yin), and Foot Bright Yang (the Stomach Channel of Foot Bright Yang) alone beat without stopping?

Qibo replied: This is because they are all connected with the Stomach pulse. The Stomach is where the essence of food and drink gathers for the five zang organs and six fu organs. Its clear, pure essence rises to the Lungs, and Lung Qi then circulates through the Hand Greater Yin Channel. Qi moves with the breath. Thus, with each exhalation the pulse beats twice, and with each inhalation it also beats twice. Since breathing never stops, the pulse naturally never stops.

The Yellow Emperor asked: When Qi passes through the cun-kou (the pulse-taking site at the wrist), why does it travel upward for ten measures and then pause, while traveling downward for eight measures before lying hidden? Along what route does it move back and forth? Why can no end to its movement be seen?

Qibo replied: When Qi leaves the zang-fu organs, it surges forth suddenly, like an arrow shot from a crossbow or water rushing down from a high bank. As it rises to the thenar eminence (the fleshy mound at the base of the thumb), its force gradually weakens. The remaining Qi grows faint and disperses, then reverses direction and rises, so that its movement becomes very subtle.

The Yellow Emperor asked: Why does the Foot Bright Yang Channel pulse?

Qibo replied: Stomach Qi rises to the Lungs. Its vigorous, swift-moving portion surges upward to the head, travels along the throat, and enters the openings of the head and face. It follows the vessels around the eyes into the brain, then emerges at the forehead and temples. From there it descends to the guest host (the area in front of the ear), follows the angle of the jaw, joins the Foot Bright Yang Channel, and descends with it to renying (the pulse beside the larynx in the neck). This is because a branch of Stomach Qi separates off and circulates through the Foot Bright Yang Channel. For this reason, the pulses above and below, and those of Yin and Yang, appear to move in unison.

If a Yang channel is diseased but the Yang pulse is instead fine and weak, or if a Yin channel is diseased but the Yin pulse is instead full and strong, the pulse pattern runs counter to the condition. If the Yin and Yang pulses are both still or both throbbing, as though bound together by a rope and pulling against one another out of coordination, this is a sign of disease.

The Yellow Emperor asked, “Why does a pulse appear along the Foot Shaoyin channel (the Kidney channel of Foot Shaoyin)?”

Qibo replied, “The Chong Mai is the sea of the twelve channels, an important network that gathers and connects them. It and the great network vessel of the Foot Shaoyin channel both begin below the kidneys. They emerge at Qijie, near the groin, where the Qi and blood of the channels gather. They run down the inner thigh, slant into the hollow behind the knee, then follow the inner side of the shinbone alongside the Foot Shaoyin channel. They pass behind the inner ankle and reach the sole of the foot. Another branch of the Chong Mai slants into the ankle, emerges on the top of the foot, enters the space between the big toe and the second toe, and then flows into the network vessels, warming and nourishing the feet and lower legs. This is how the channels normally pulse.”

The Yellow Emperor asked, “Nutritive Qi and Defensive Qi, which circulate inside and outside the channels, flow freely up and down and never cease, like a ring with no beginning or end. If someone is suddenly attacked by pathogenic Qi or exposed to severe cold, the hands and feet become limp and weak, and the flow where the Yin and Yang channels meet and exchange Qi becomes disordered. How can the Qi begin circulating again?”

Qibo replied, “The tips of the limbs are where the Yin and Yang channels meet and where the great network vessels bring Qi together. The Four Streets are the main routes along which Qi flows. So when the network vessels are obstructed, Qi can still travel along those routes. Once the blockage at the tips of the limbs is cleared, Qi gathers again, flows between the channels, and circulates like a ring.”

The Yellow Emperor said, “Well said. This is what is meant by circulation like a ring with no end: its beginning cannot be discerned, and when its course is complete, it begins again.”

Collected Annotations to the Ling Shu of the Yellow Emperor’s Inner Classic, volume 17

Note: The original includes several notes on variant readings. The character chu is suspected to be a graphic error for se, which is used in the sense of “to store up.” According to the Zhaofu Jujingtang edition, zhi was amended to zhi. The note also records variant readings of the characters yi, er, and zhi in the Jia Yi Jing and other editions.

The Yellow Emperor asked Shaoyu, “After the five flavors enter the mouth, each follows its own course and can give rise to corresponding ailments. Sour flavor enters the sinews; taken in excess, it can make urination difficult. Salty flavor enters the blood; taken in excess, it can make a person thirsty. Pungent flavor enters the Qi; taken in excess, it can leave a person feeling hollow and uneasy within. Bitter flavor enters the bones; taken in excess, it can cause nausea and vomiting. Sweet flavor enters the flesh; taken in excess, it can cause inner distress and vexation. I know these effects, but do not understand their causes. I hope you will explain them.”

Shaoyu replied, “After sour flavor enters the stomach, its qi and flavor contract and become astringent. They move upward to the upper and middle burners but cannot pass through them. If they cannot disperse, they remain in the stomach. Once the stomach has settled, they flow downward into the bladder. The bladder’s membrane is thin and soft; when it encounters sour flavor, it contracts and tightens, closing off the passage. The fluids cannot be discharged, so urinary retention occurs. The genital region is where the sinews converge and terminate, so sour flavor tends toward the sinews.”

The Yellow Emperor asked, “Salty flavor tends toward the blood. Why does eating too much make a person thirsty?” Shaoyu replied, “After salty flavor enters the stomach, its qi moves upward to the middle burner and then flows into the vessels, carrying the blood and qi along with it. When blood combines with salty flavor, it becomes congealed. Once it congeals, the fluids in the stomach are drawn in to flush it through. As the fluids are continually drawn away, the stomach becomes depleted. When the stomach is depleted, the throat loses its moisture and dries out. This is why the base of the tongue becomes dry and a person easily feels thirsty.

“The blood vessels are the channels through which the qi and blood of the middle burner flow. Therefore, salty flavor tends toward the blood.”

The Yellow Emperor asked, “Pungent flavor tends toward qi. Why does eating too much make a person feel hollow and oppressed in the chest?” Shaoyu replied, “After pungent flavor enters the stomach, its qi moves to the upper burner. The upper burner receives the qi transformed from food, nourishes the Yang qi in the upper body, and keeps qi and blood circulating.”

The Yellow Emperor again asked, “Pungent flavor tends toward qi. Why does eating too much make a person feel hollow and oppressed in the chest?” Shaoyu replied, “After pungent flavor enters the stomach, its qi moves to the upper burner. The upper burner receives the qi transformed from food and nourishes the upper body. The qi and flavor of pungent foods such as ginger and chives fumigate the body. If Nutritive Qi and Defensive Qi, which circulate inside and outside the vessels, cannot flow freely for a long time, they remain below the heart, making a person feel hollow and oppressed in the chest. Pungent flavor circulates together with qi, so it is also expelled with sweat.”

The Yellow Emperor asked, “Bitter flavor tends toward the bones. Why does eating too much make a person vomit?” Shaoyu replied, “After bitter flavor enters the stomach, none of the qi transformed from the five grains can overcome it. Once bitter flavor enters the lower opening of the stomach, the Three Burners—the pathways through which qi and water circulate within the body—become blocked, causing vomiting. The teeth are the farthest point reached by stomach qi. This is why bitter flavor is said to tend toward the bones: it enters and is then vomited back out, showing that it tends toward the bones.”

The Yellow Emperor asked: Sweetness is associated with the muscles. Why does eating too much of it make a person feel troubled and agitated?

Shaoyu replied: After sweet food enters the stomach, its Qi is weak and cannot rise to the Upper Burner, the part of the body above the diaphragm. It therefore remains in the stomach with the food, making the stomach soft and moist. When the stomach becomes soft, it is prone to slacken; when the stomach Qi slackens, parasites in the intestines become active. Their movement makes a person feel troubled and agitated. The Qi of sweetness also reaches outward to the muscles, which is why sweetness is said to be associated with them.

The Twenty-Five Types of People According to Yin and Yang, Chapter 64

The Yellow Emperor said: I have heard…

The Yellow Emperor said: I have heard that people can be classified according to Yin and Yang. How is this done? Bohgao replied: Between Heaven and Earth, within the Six Directions—the four cardinal points, above, and below—all things depend on the Five Phases (Wood, Fire, Earth, Metal, Water), and human beings correspond to them as well. Thus, by matching people to the Five Phases, they can be divided into twenty-five types. There are also five types of people whose bearing differs from that of ordinary people; I already know about them. I would like to learn more about the appearance and blood-and-Qi characteristics of these twenty-five types. How can they be distinguished, and how can a person’s inner condition be inferred from outward features?

Qibo replied: Your question is thorough. This is a teaching kept secret by our former masters, and even Bohgao did not fully understand it.

The Yellow Emperor rose from his seat and respectfully stepped back, saying: I have heard that to meet someone worthy of receiving a teaching and fail to pass it on is a repeated error; to receive a teaching and then disclose it carelessly is to invite Heaven’s displeasure. I hope to understand it fully and keep it in a golden chest, without daring to spread it indiscriminately.

Qibo said: First establish the Five Phases—Metal, Wood, Water, Fire, and Earth—then distinguish the five colors and the different bodily forms associated with the Five Phases. In this way, all twenty-five types of people can be identified.

The Yellow Emperor said: Please explain the whole teaching to me.

Qibo said: Be sure to take great care. I will now explain it to you.

People of the Wood type correspond to shangjiao in the Five Tones and resemble the Azure Emperor, the deity of the East. They have a blue-green complexion, a small head, a long face, broad shoulders and back, a straight build, and relatively small hands and feet. They are capable and thoughtful, but physically weak, and often wear themselves out worrying over matters. They adapt well to spring and summer but less well to autumn and winter. When affected by external pathogens, they fall ill easily, and the Foot Jueyin channel, associated with the Liver, displays a state described as “tuotuoran.”

Those of the Great Jue type have a long face, broad shoulders and back, a straight build, and relatively small hands and feet. They are capable but prone to much thought and exertion, physically weak, and often burdened by worry over affairs. They adapt well to spring and summer but poorly to autumn and winter; after exposure to pathogens, they fall ill easily, and the Foot Jueyin channel displays a state described as “tuotuoran.” The Great Jue type also corresponds to the left Foot Shaoyang channel, whose Qi is described as “yiyiran.” The Left Jue type corresponds to the right Foot Shaoyang channel, whose state is described as “suisuiran.” Another account says that the Lesser Jue Jue type corresponds to the right Foot Shaoyang channel, whose state is described as “tuituiran”; this type is also called the Right Jue type. The Jue Pan type corresponds to the left Foot Shaoyang channel, whose state is described as “guaguoran.” Terms such as “yiyiran” were used in antiquity to describe the condition of Qi and Blood in the channels.

People of the Fire type correspond to shangzhi in the Five Tones and resemble the Red Emperor, the deity of the South. They have a reddish complexion and broad proportions in certain parts of the body, a relatively flat face, and a small head. Their shoulders and back, hips (the upper thighs), and abdomen are robust, while their hands and feet are relatively small. They walk steadily, think quickly, and sway their bodies as they move; the muscles of their shoulders and back are full. They are spirited, value loyalty over wealth, but are not dependable and are prone to much thought. They observe things keenly, enjoy grooming and adornment, and have an impatient temperament. The original text also says that people of this type do not live long and may die suddenly. They adapt well to spring and summer but poorly to autumn and winter; when exposed to pathogens in autumn and winter, they fall ill easily, and the Hand Shaoyin channel, associated with the Heart, displays a state described as “hehe ran.”

The Zhi Zhi type corresponds to the left Hand Taiyang channel, whose Qi is described as “jijiran.” Another account calls this the Zhi type or the Great Zhi type. The Lesser Zhi type corresponds to the right Hand Taiyang channel, whose state is described as “kank anran.” The Right Zhi type corresponds to the right Hand Taiyang channel, whose state is described as “jiaojiaoran”; another account describes it as “xiongxiongran.” The Zhi Pan type corresponds to the left Hand Taiyang channel, whose Qi is described as “zhizhiyiyiran”; another account calls it the Zhi Zhi type.

People of the Earth type correspond to “upper gong” (the Earth category in the five-tone classification), and their appearance resembles the legendary Yellow Emperor of ancient times. Their complexion tends toward yellow, their faces are round, and their heads are large. Their shoulders and backs are broad and well formed, their abdomens are relatively large, their hips and lower legs are proportionate, and their hands and feet are small. They have full muscles and balanced proportions from head to toe. They walk with steady steps, though they lift their feet lightly. They are composed and glad to help others, dislike power and authority, and are skilled at relying on others.

These people thrive in autumn and winter but are less suited to spring and summer. In spring and summer, they are prone to illness from changes in their surroundings. Their Foot Taiyin (Spleen Channel) has a full, substantial appearance.

People of the great gong type correspond to the left Foot Yangming (Stomach Channel), whose upper section appears gently curved and supple. People of the added gong type also correspond to the left Foot Yangming, whose lower section appears sunken and uneven; another account calls them “people of the multitude.” People of the lesser gong type correspond to the right Foot Yangming, whose upper section appears pivotal and bent. People of the left gong type correspond to the right Foot Yangming, whose lower section appears raised and uneven. Another account calls them “people of the multitude,” while yet another calls them “those above Yangming.”

People of the Metal type correspond to “upper shang” (the Metal category in the five-tone classification), and their appearance resembles the White Emperor, the ancient mythological deity of the west. They have square faces, pale complexions, small heads, relatively narrow shoulders and backs, small abdomens, and small hands and feet. Their bones are prominent, their heels project outward, and their bones are light. Their figures are slender and upright. They are quick-tempered yet calm and resolute, and are suited to serving as officials.

These people thrive in autumn and winter but are less suited to spring and summer. In spring and summer, they are prone to illness from changes in their surroundings. Their Hand Taiyin (Lung Channel) has a full, substantial appearance.

People of the shang type correspond to the left Hand Yangming (Large Intestine Channel), whose upper section appears sharply angular. People of the right shang type correspond to the left Hand Yangming, whose lower section appears loose and extended. People of the great shang type correspond to the right Hand Yangming, whose upper section appears sharply angular; people of the right shang type, in turn, correspond to the left Hand Yangming, whose lower section appears loose and extended. People of the great shang type also correspond to the right Hand Yangming, whose upper section appears prominently raised. People of the lesser shang type correspond to the right Hand Yangming, whose lower section appears orderly and firm.

People of the Water form resemble the Upper Feather form and reflect the appearance of the Black Emperor. Their complexion tends to be dark, their face uneven, and their head large; their cheekbones and jaw are sharply defined, their shoulders small, and their abdomen large. They move their hands and feet frequently, sway as they walk, have long hips, and an open, extended back. They disregard etiquette and know no reverence, and are skilled at deception and dealing with others. In the end, they may meet a violent death. People of the Water form are suited to autumn and winter, but not to spring and summer. If affected by external pathogenic influences in spring or summer, they easily fall ill, and the Qi and Blood of the Foot Shaoyin channel may show signs of persistent sweating.

People of the Great Feather type resemble the right Foot Taiyang channel. Their Taiyang Qi is comparatively abundant, giving them full cheeks. People of the Lesser Feather type resemble the left Foot Taiyang channel. Their Taiyang Qi is comparatively weak, and their bodies appear bent. People of the Zhong type resemble the right Foot Taiyang channel, with Taiyang Qi appearing clean and level in the lower part; another version reads “people of the Jia type.” People of the Zhi type resemble the left Foot Taiyang channel, with Taiyang Qi appearing steady in the upper part. Each of the five bodily types has five variations, making twenty-five differences in all. These differences are why people are easily mistaken for one another.

The Yellow Emperor asked, “If we can make out a person’s bodily form but cannot discern their complexion, what should we do?” Qibo replied, “If bodily form overcomes complexion, or complexion overcomes bodily form, then when the season arrives that corresponds to this overcoming, if the person is also at the corresponding age and is affected by external pathogenic influences, they will fall ill. If they are not cared for in time, they will suffer distress. Those whose bodily form and complexion are in harmony can become prosperous and honored, and live at ease and in happiness.”

The Yellow Emperor then asked, “When bodily form and complexion overcome one another, are there particular ages that call for special care, which can be foreseen?” Qibo replied, “Anyone whose upper and lower parts are out of harmony should take particular care to avoid these ages: seven, sixteen, twenty-five, thirty-four, forty-three, fifty-two, and sixty-one. These are important years of caution in a person’s life, when one should carefully preserve and nourish oneself. If affected by external pathogenic influences at these times, one will easily fall ill and may also suffer distress. In these years, do nothing improper. This is called the ‘year taboo.’”

The Yellow Emperor asked: “Master, you have spoken of the condition of Qi and blood in the channels above and below. How can a person’s physique and strength be judged from this?”

Qibo replied: “When Qi and blood are abundant in the upper part of the Foot Yangming Channel (Stomach Channel), the beard is thick and long. When blood is scant and Qi abundant, the beard is shorter; when Qi is scant and blood abundant, it is sparse. When both Qi and blood are scant, there is no beard, and the wrinkles at the corners of the mouth are more pronounced.

“When Qi and blood are abundant in the lower part of the Foot Yangming Channel, the hair on the lower body is thick and long, sometimes reaching the chest. When blood is abundant and Qi scant, this hair is short and sparse, reaching only to around the navel. The person often lifts the feet high when walking, has little flesh on the toes, and is prone to cold feet. When blood is scant and Qi abundant, the muscles are prone to chilblains. When both Qi and blood are scant, there is no body hair; if any remains, it is sparse and withered. The feet are prone to weakness, cold reversal, and numbness.

“When Qi and blood are abundant in the upper part of the Foot Shaoyang Channel (Gallbladder Channel), the beard is thick and long. When blood is abundant and Qi scant, it is shorter; when blood is scant and Qi abundant, it is sparse. When both Qi and blood are scant, there is no beard. If cold and damp then invade, the person is prone to Bi disorder, in which obstruction of the channels causes pain, numbness, and related symptoms, as well as bone pain and brittle, withered nails. When Qi and blood are abundant in the lower part of the Foot Shaoyang Channel, the hair on the calves is thick and long, and the outer ankles are full. When blood is abundant and Qi scant, the calf hair is shorter, and the skin over the outer ankles is hard and thick. When blood is scant and Qi abundant, the calf hair is sparse, and the skin over the outer ankles is thin and slack. When both Qi and blood are scant, there is no hair, and the outer ankles are lean and without flesh.

“When Qi and blood are abundant in the upper part of the Foot Taiyang Channel (Bladder Channel), the eyebrows are fine, with long hairs growing among them. When blood is abundant and Qi scant, the eyebrows are coarse and unattractive, and the face has many fine lines. When blood is scant and Qi abundant, the face has more flesh. When Qi and blood are in harmony, the complexion is good.

“When Qi and blood are abundant in the lower part of the Foot Taiyin Channel (Spleen Channel), the heels are fleshy and firm. When Qi is scant and blood abundant, the heels are lean and hollow. When both Qi and blood are scant, cramps are likely, along with pain beneath the heels.

“When Qi and blood are abundant in the upper part of the Hand Yangming Channel (Large Intestine Channel), the beard is fine. When blood is scant and Qi abundant, it is coarse and unattractive. The text later repeats the signs of lean, hollow heels, a tendency to cramps, and pain beneath the heels.”

In the upper region traversed by the Hand Yangming channel, abundant blood and Qi produce a thick, fine beard. When blood is scant and Qi plentiful, the beard is sparse and coarse; when both blood and Qi are scant, there is no beard. In the lower region, abundant blood and Qi produce thick, fine underarm hair and a full, warm thenar eminence at the base of the thumb. When both are scant, the hands are thin and cold.

In the upper region traversed by the Hand Shaoyang channel, abundant blood and Qi produce thick, fine, long eyebrows and healthy-looking ears. When both are scant, the ears become dry and dull in color. In the lower region, abundant blood and Qi make the muscles at the palm’s crease full and warm. When both are scant, the hands are cold and thin; when Qi is scant but blood plentiful, the hands are thin, yet the veins are clearly visible.

In the upper region traversed by the Hand Taiyang channel, abundant blood and Qi produce a full beard and well-proportioned facial muscles. When both are scant, the face is thin and its complexion poor. In the lower region, abundant blood and Qi make the palms full; when both are scant, the palms are thin and cold.

The Yellow Emperor asked, “When needling according to the twenty-five bodily constitutions, is there a set principle to follow?” Qibo replied, “Thick, fine eyebrows indicate abundant Qi and blood in the Foot Taiyang channel. Sparse, coarse eyebrows indicate that Qi and blood are scant. A plump, lustrous body indicates abundant Qi and blood. Plumpness without luster indicates excess Qi but insufficient blood. A thin, weak body without luster indicates that both Qi and blood are insufficient. Observe the body carefully and assess the abundance or deficiency of Qi and blood; then treat accordingly. This makes it possible to determine whether the flow of Qi and blood is smooth or contrary.”

The Yellow Emperor’s Qi and blood are scant. If the body is plump and lustrous, this indicates abundant Qi and blood; plumpness without luster indicates excess Qi but insufficient blood; a thin, weak body without luster indicates that both Qi and blood are insufficient. Observe the body carefully and assess the abundance or deficiency of Qi and blood; then treat accordingly. This makes it possible to determine whether the flow of Qi and blood is smooth or contrary.

The Yellow Emperor asked, “How should acupuncture be performed on the body’s Yin and Yang meridians?” Qibo replied, “Feel the cun position at the wrist and the renying pulse at the side of the neck to distinguish and regulate Yin and Yang. Then carefully palpate the meridians to see whether anything is blocked or stagnant. When the meridians are congested and obstructed, the body becomes painful and numb; in severe cases, the limbs may even become unable to move.

“When the meridians are congested, set Qi in motion to warm the affected area. Once Qi and blood are in harmony, the symptoms will subside. If there is congestion in the collateral vessels, with the channels obstructed and blood flow impeded, clear the obstruction so that Qi and blood can circulate again. Thus, when Qi is excessive in the upper body, guide it downward; when Qi is deficient there, support and nourish it so it can recover. Where Qi and blood have stagnated and cannot reach, follow their route back and draw them forward to restore their movement. You must understand the pathways of the meridians to master these methods. When cold and heat evils contend, guide Qi and blood to restore free circulation. If accumulated old blood has not congealed, treat it according to the specific condition.

“You must first understand the twenty-five body types. Only then can you discern where Qi and blood are located and how they are distributed on the left and right, above and below. Once you have mastered this, the essentials of acupuncture will be complete.”

Pronunciation notes: In the relevant character readings, tao is pronounced tāo, jiao is pronounced jiāo, heng is pronounced háng, and zhu is pronounced zhú.

Editorial notes on volumes eighteen and nineteen record several variant readings. For example, the Jia Yi Jing has dui where another text has tuo; the character da was amended to you on the basis of the Zhaofu Jujingtang edition. There are also textual variants involving the readings xiao, lian, and yin. The title of the piece in volume nineteen is “Five Tones and Five Flavors,” chapter sixty-five.

The right Zhi tone is paired with the minor Zhi tone to regulate the upper part of the right Hand Taiyang channel. The left Shang tone is paired with the left Zhi tone to regulate the upper part of the left Hand Yangming channel. The minor Zhi tone is paired with the major Gong tone to regulate the upper part of the left Hand Yangming channel. The right Jue tone is paired with the major Jue tone to regulate the lower part of the right Foot Shaoyang channel. The major Zhi tone is paired with the minor Zhi tone to regulate the upper part of the left Hand Taiyang channel. The many Yu tone is paired with the minor Yu tone to regulate the lower part of the right Foot Taiyang channel. The minor Shang tone is paired with the right Shang tone to regulate the lower part of the right Hand Taiyang channel. The Zhi Yu tone is paired with the many Yu tone to regulate the lower part of the right Foot Taiyang channel. The minor Gong tone is paired with the major Gong tone to regulate the lower part of the right Foot Yangming channel. The Pan Jue tone is paired with the minor Jue tone to regulate the lower part of the right Foot Shaoyang channel. The Shang tone is paired with the upper Shang tone to regulate the right Foot Yangming channel, and also the lower part of the right Hand Taiyang channel. The Zhi Yu tone is paired with the many Yu tone to regulate the lower part of the right Foot Taiyang channel. The minor Gong tone is paired with the major Gong tone to regulate the lower part of the right Foot Yangming channel. The Pan Jue tone is paired with the minor Jue tone to regulate the lower part of the right Foot Shaoyang channel. The Shang tone is paired with the upper Shang tone to regulate the lower part of the right Foot Yangming channel. The Shang tone is paired with the upper Jue tone to regulate the lower part of the left Foot Taiyang channel.

The upper Zhi tone is the same as the right Zhi tone. Its associated grain is wheat, its domestic animal is the sheep, and its fruit is the apricot. It corresponds to the Hand Shaoyang channel and internally to the heart; its color is red, its flavor bitter, and its season summer.

The upper Yu tone is the same as the major Yu tone. Its associated grain is the soybean, its domestic animal is the pig, and its fruit is the chestnut. It corresponds to the Foot Shaoyin channel and internally to the kidneys; its color is black, its flavor salty, and its season winter.

The upper Gong tone is the same as the major Gong tone. Its associated grain is millet, its domestic animal is the ox, and its fruit is the jujube. It corresponds to the Foot Taiyin channel and internally to the spleen; its color is yellow, its flavor sweet, and its season late summer.

The upper Shang tone is the same as the right Shang tone. Its associated grain is broomcorn millet, its domestic animal is the chicken, and its fruit is the peach. It corresponds to the Hand Taiyin channel and internally to the lungs; its color is white, its flavor pungent, and its season autumn.

The upper Jue tone is the same as the major Jue tone. Its associated grain is hemp, its domestic animal is the dog, and its fruit is the plum. It corresponds to the Foot Jueyin channel and internally to the liver; its color is green, its flavor sour, and its season spring.

The major Gong tone is the same as the upper Jue tone, and is used to regulate the upper part of the right Foot Yangming channel. Its associated fruit is the peach. It corresponds to the Hand Taiyin channel and internally to the lungs; its color is white, its flavor pungent, and its season autumn. The upper Jue tone is the same as the major Jue tone. Its associated grain is hemp, its domestic animal the dog, and its fruit the plum. It corresponds to the Foot Jueyin channel and internally to the liver; its color is green, its flavor sour, and its season spring.

Here, “Gong, Shang, Jue, Zhi, and Yu” are the names of the five tones; “Hand Taiyang,” “Foot Yangming,” and the like are the names of the channels. “Upper” and “lower” refer to parts of a channel, while “regulate” means to treat according to the correspondences assigned by musical pitch.

The Great Gong is the same as the Upper Jue, corresponding to the upward movement of the right Foot Yangming channel. The Left Jue is the same as the Great Jue, corresponding to the upward movement of the left Foot Yangming channel. The Lesser Yu is the same as the Great Yu, corresponding to the downward movement of the right Foot Taiyang channel. The Left Shang is the same as the Right Shang, corresponding to the upward movement of the left Hand Yangming channel. The Added Gong is the same as the Great Gong, corresponding to the upward movement of the left Foot Shaoyang channel. The Zhi Pan is the same as the Great Gong, corresponding to the downward movement of the left Hand Taiyang channel. The Pan Jue is the same as the Great Jue, corresponding to the downward movement of the left Foot Shaoyang channel. The Great Yu is the same as the Great Jue, corresponding to the upward movement of the right Foot Taiyang channel. The Great Jue is the same as the Great Gong, corresponding to the upward movement of the right Foot Shaoyang channel.

Right Zhi, Lesser Zhi, Zhi Zhi, Upper Zhi, Pan Zhi; Right Jue, Jue, Upper Jue, Great Jue, Pan Jue; Right Shang, Lesser Shang, Shang, Upper Shang, Left Shang; Lesser Gong, Upper Gong; and the upward movement of the Great Shaoyang channel.

Right Zhi, Lesser Zhi, Zhi Zhi, Upper Zhi, Pan Zhi; Right Jue, Jue, Upper Jue, Great Jue, Pan Jue; Right Shang, Lesser Shang, Shang, Upper Shang, Left Shang; Lesser Gong, Upper Gong, Great Gong, Added Gong, Left Jue, the two Gong; Many Yu, Zhi Yu, Upper Yu, Great Yu, Lesser Yu.

The Yellow Emperor asked, “Do women have no beards because they lack Qi and blood?”

Qibo replied, “The Thoroughfare Vessel and the Conception Vessel both originate in the womb, the area inside the abdomen associated with reproduction. They run upward deep within the body and are major channels through which Qi and blood gather. Where they surface, they travel up the abdomen to the throat, then branch around the lips and mouth. When Qi and blood are abundant, they nourish the skin and warm the muscles. When the blood is especially abundant, it moistens the skin and gives rise to fine body hair. Women generally have relatively more Qi and less blood, and they regularly lose blood through menstruation. The Thoroughfare and Conception Vessels therefore cannot fully nourish the lips, so beards do not grow.

The Yellow Emperor then asked, “Some men injure their genitals, causing their Yin energy to decline. Their sexual organs can no longer become erect or function, yet their beards do not fall out. Why do eunuchs lose their beards? Please explain.”

Qibo replied, “In eunuchs, the Zongjin—the sinews and tissues associated with reproductive function—has been removed, and the Thoroughfare Vessel is also damaged. After blood is lost, it cannot be replenished. The skin and flesh inside the body are left unnourished, and the lips are not moistened. As a result, the beard no longer grows.

The Yellow Emperor asked, “Some people are born with deficient reproductive function and have never been injured or lost blood, yet they also have no beards. Why?”

Qibo replied, “This is due to a congenital deficiency. Their Conception and Thoroughfare Vessels are weak, and the Zongjin has not fully developed. They have relatively abundant Qi but insufficient blood, so the lips are not nourished and beards do not grow.”

The Yellow Emperor said, “How remarkable! The sages understand the myriad things, just as the sun and moon reveal forms through their light and shadows, or a sound rings out when struck: hearing the sound, one can know its shape. If it were not for you, Master, who could grasp the subtle workings of the myriad things? Thus, sages observe a person’s complexion. Someone whose complexion is yellowish-red has more heat within; someone whose complexion is bluish-white has less heat; and someone whose complexion is dark has more blood and less Qi. Those with thick, beautiful eyebrows have more blood in the Taiyang channel; those with thick, long beards have more blood in the Shaoyang channel; and those with well-groomed beards have more blood in the Yangming channel. These are conditions that appear at their corresponding times. In general, the Qi and blood in the body’s channels follow certain patterns: the Taiyang channel usually has abundant blood and little Qi; the Shaoyang channel has abundant Qi and little blood; the Yangming channel has abundant Qi and blood; the Jueyin channel has abundant Qi and little blood; the Shaoyin channel has abundant blood and little Qi; and the Taiyin channel has abundant blood and little Qi. These are constant patterns of Heaven and Earth.”

Chapter Sixty-Six: The Beginning of All Illnesses

The Yellow Emperor asked Qibo, “All illnesses begin through such factors as wind and rain, cold and heat, coolness and dampness, and emotions such as joy and anger. Unrestrained joy and anger damage the internal organs; wind and rain damage the upper part of the body; coolness and dampness damage the lower part. These three kinds of external influences affect different parts of the body. How are they related?”

Qibo replied, “The three kinds of external influences differ: some cause illness from within the body, and others from without. I will explain how this works. When joy and anger are excessive, they damage the internal organs; once the organs are harmed, illness arises internally. When coolness and dampness take advantage of a weakness and invade, illness arises in the lower part of the body. When wind and rain take advantage of a weakness and invade, illness arises in the upper part. These are the three places where illness takes hold. As for the changes caused when these pathogenic influences invade excessively, they are too numerous to count.”

The Yellow Emperor said, “I truly cannot list all these conditions one by one. So I ask you, Master: please explain their principles fully.”

Qibo said, “External pathogenic influences such as wind, rain, cold, and heat cannot harm someone on their own if the body is not weakened. If a person suddenly encounters fierce wind and heavy rain yet does not fall ill, it is because the body is not weakened, so external influences cannot injure it by themselves. The body must be weakened and then encounter a vacuity pathogen wind—a harmful wind that enters when the body is weak. Only when these two forms of weakness come together can the pathogen enter the body. When a person’s healthy Qi is abundant and the muscles are firm, it is difficult for a pathogen to enter.

“When a vacuity pathogen enters the body, the severity of the illness that develops depends on changes in the weather and the person’s constitution, considered together with the degree of deficiency or excess. Pathogens settle in different places, and the resulting illnesses are named according to where they occur. Broadly, they fall into three categories: upper, middle, and external.

“A vacuity pathogen first enters through the skin. When the skin is slack, the interstices—the spaces between the skin’s lines, where the sweat pores are—open, allowing the pathogen to enter among the body hairs. As it penetrates deeper, the hairs stand on end, the person feels waves of cold, and the skin becomes painful.

“If the pathogen remains, it moves into the collaterals, the finer vessels, causing muscle pain that comes and goes. It then enters the larger channels. If it still does not leave, it advances into the channels proper, making the person fearful of cold and easily startled. If it stays longer, it reaches the transport points, where channel Qi enters and leaves. The flow of Qi and blood through the six channels becomes obstructed, causing pain in the joints of the limbs and stiffness in the lower back.

“If the pathogen moves into the hidden Chong vessel, which runs deep within the body, the person feels heavy and suffers pain throughout the body. If it settles in the stomach and intestines, the abdomen becomes distended. When cold predominates, the intestines rumble and undigested food is passed in diarrhea; when heat predominates, loose, mushy stools are passed. A pathogen that settles between the organs and the body surface, in the membranous region known as the membrane-source, can also cause pain throughout the body.

“When a pathogen remains in the vessels and collaterals for a long time, it may gradually form accumulations. It may lodge in the minute vessels, collaterals, channels, transport vessels, hidden Chong vessel, the tendons beside the spine, or the membrane-source outside the stomach and intestines, and extend upward to connect with the slack tendons. There are many places where a pathogen may travel and lodge, too many to list one by one.”

The Yellow Emperor said, “I would like to understand in detail how these accumulations form.”

Qibo replied: “If an accumulation attaches to the Sunluo (the body’s fine collateral vessels), it moves up and down along the Sunluo of the arms and hands. These vessels lie close to the surface and are slack, so they cannot hold the accumulation firmly in place; it therefore wanders back and forth. When fluids gather and seep through the space between the intestines and stomach, they make a watery sound. In cold conditions, the abdomen becomes distended and full, with a thunderlike sensation of pulling, so pain often comes on suddenly.

“If an accumulation attaches to the Yangming channel (a channel closely associated with the stomach and intestines), it lies across the area beside the navel. It grows larger after eating and smaller when hungry. If it attaches to the slack sinews, the symptoms resemble those of an accumulation in the Yangming channel, but pain comes after eating and eases when hungry. If it attaches to the intestinal and stomach Mu Yuan (the region between the internal organs and the body surface, associated with the Mu points), the pain pulls outward to the slack sinews. Pain eases after eating and worsens when hungry.

“If an accumulation attaches to the hidden Chong vessel (a deep vessel that runs through the abdomen), it can be felt pulsing beneath the fingers when pressed. After the hand is lifted, heat arises in the Mu Yuan of the intestines and stomach, and the pain pulls outward to the slack sinews. Pain eases after eating and worsens when hungry. At the same time, heat travels down to both thighs, as if hot soup were being poured over them. If an accumulation attaches to the Lyu sinews (the sinews alongside the spine) behind the intestines, the mass can be felt when hungry but not after eating, and pressing does not reach it. If it attaches to the Shu vessels (vessels associated with the Shu points and the circulation of Qi and blood), they become blocked, fluids cannot descend, and the body’s openings become dry and obstructed. All these are signs of pathogenic Qi entering the body from its surface and progressing downward from above.”

The Yellow Emperor asked: How does an accumulation disease develop, from its first appearance to its final formation?

Qibo replied: When cold pathogenic energy invades, the disease begins; when the circulation of Qi and blood is obstructed, an accumulation eventually forms. Cold makes the flow of Qi and blood in the feet sluggish, then chills the lower legs. When the lower legs are chilled, the blood vessels become congested and blocked. The cold then invades upward into the stomach and intestines, causing the abdomen to swell and feel full. As the abdomen swells, fluids and secretions around the intestines are compressed and gather together. Unable to disperse, they gradually form an accumulation.

If a person suddenly eats or drinks too much, the stomach and intestines become distended. An undisciplined daily routine or excessive exertion can also injure the collateral vessels, the finer branches of the channels. When the Yang collaterals are injured, blood spills outward, causing nosebleeds; when the Yin collaterals are injured, blood spills inward and may cause blood in the stool. If the collaterals of the stomach and intestines are injured, blood spills outside the intestines. When cold is also present outside the intestines, fluids and blood bind together. Once congealed, they cannot disperse, and an accumulation disease forms.

Sudden exposure to external cold, or harm to the body from inner sorrow or anger, can cause Qi to rise in a counterflow. Once Qi counterflows, the six transport pathways—the routes through which channel Qi is distributed and circulated—become blocked. The warming Qi can no longer circulate, and stagnant blood remains in the body, difficult to disperse. The movement of fluids also becomes sluggish; they linger instead of flowing on, and an accumulation forms.

The Yellow Emperor asked: What circumstances cause an accumulation disease through internal factors?

Qibo replied: Sorrow and excessive thought injure the heart; severe cold injures the lungs; anger injures the liver. Drinking to intoxication and then having sex, or being exposed to wind while sweating, injures the spleen. Excessive exertion, or bathing after sex while still sweating, injures the kidneys. These are ways in which illness arises from the three domains within and around the body: internal emotions, external pathogenic influences, and the strain of daily life.

The Yellow Emperor said: Well said. How should it be treated?

Qibo replied: Observe where the pain is, determine the corresponding condition, and distinguish whether the pathogenic influence is excessive or the body’s vital Qi is deficient. Tonify where needed, drain where needed, and follow the natural seasons. This is proper treatment.

Needling means adjusting the method of acupuncture according to each person’s Qi and Blood.

The Yellow Emperor asked Qibo, “I have learned the Nine Needles from you and used them to treat the people. But their Qi, Blood, and constitutions differ. In some people, when the spirit is stirred, Qi moves before the needle; in others, Qi and the needle meet at the same time. In some, Qi begins to move on its own only after the needle is withdrawn; others respond only after several insertions. In some, Qi runs in the opposite direction after the needle is withdrawn; and in others, their illness worsens after several insertions. These six situations are all different. I hope you will explain their causes and how to respond.”

Qibo replied, “In people whose Yang Qi is predominant, the spirit is easily stirred and Qi readily moves.”

The Yellow Emperor asked, “What kind of person has predominant Yang Qi?”

Qibo said, “Such people are spirited and vigorous, speak quickly, and lift their feet high when they walk. The Qi of the Heart and Lungs is relatively abundant, and their Yang Qi flows vigorously and disperses outward. Therefore, when their spirit is stirred, Qi moves first.”

The Yellow Emperor asked, “Why is it that some people with predominant Yang Qi do not have their spirit stirred before the needle?”

Qibo said, “That is because they also have some Yin Qi.”

The Yellow Emperor asked, “How can we tell that they have Yin Qi?”

Qibo said, “People with abundant Yang Qi are often easily pleased; those with abundant Yin Qi are often easily angered. But people who often become angry also tend to let their anger subside easily. That is why I say they have some Yin Qi. In such people, the changes as Yin and Yang join and separate are difficult to grasp, so their spirit is not stirred before the needle.”

The Yellow Emperor asked, “What happens when the body’s Qi meets the needle during acupuncture?”

Qibo replied, “When Yin and Yang are in harmony, the blood and Qi are abundant and flow freely. Once the needle is inserted, Qi begins to move with it and soon meets the needle.”

The Yellow Emperor asked again, “Why does the Qi continue to move on its own after the needle has been withdrawn?”

Qibo replied, “This is because the person has abundant Yin Qi and little Yang Qi. Yin Qi sinks inward, while Yang Qi floats outward. The Yin Qi sunk inside lies deep, so after the needle is withdrawn, the Qi only then follows its course behind the needle, seeming to move on its own.”

The Yellow Emperor asked, “Why does it take repeated acupuncture before there is an effect?”

Qibo replied, “This is because the person has abundant Yin Qi and little Yang Qi. The Qi has sunk inside and is difficult to set in motion, so repeated acupuncture is needed before there is an effect.”

The Yellow Emperor asked again, “Why does the Qi move in reverse after the needle is inserted?”

Qibo replied, “If the Qi moves in reverse, or the condition worsens after repeated acupuncture, this is not due to Yin and Yang Qi rising, sinking, or circulating. It is caused by careless needling that has inflicted harm. This is the practitioner’s error and has nothing to do with the patient’s own body or Qi.”

The Upward Diaphragm, Chapter Sixty-Eight

The Yellow Emperor said, “I understand the upward diaphragm caused by Qi, in which food is brought into the mouth and then vomited back up. But I do not understand the principle behind the downward diaphragm caused by worms, in which food is passed only about a day after eating. Please explain it clearly.”

Qibo replied, “When emotions such as joy and anger are out of balance, eating and drinking are not restrained, and exposure to cold and heat is ill-timed, cold fluids flow into the intestines. When the intestines become cold, the worms become cold as well. The cold worms gather and settle in the lower passage, the lower intestines. This causes the intestines and stomach to swell, prevents the defensive Qi that protects the body from circulating normally, and gives pathogenic Qi the opportunity to lodge there.

“When a person eats, the worms move upward to feed. After they rise, the lower passage is left empty, and pathogenic Qi gains the upper hand, causing the accumulation to remain in place and disperse no further. If the accumulation persists, it forms an abscess, a localized swelling that may produce pus. Once an abscess forms, the lower passage contracts and becomes obstructed. If the abscess forms inside the passage, the pain is deep and pronounced. If it forms outside the passage, the swelling and pain are more superficial, and the skin above the abscess becomes hot.”

The Yellow Emperor asked, “How should an abscess be treated?” Qibo replied, “Press gently around the abscess and observe the direction in which Qi and blood are flowing. First insert the needles shallowly around it, then gradually needle deeper, and finally turn the needles back. Do not needle more than three times. Continue until the pain eases, the surface swelling subsides, and the skin over the abscess feels warm.”

The Yellow Emperor asked again, “How should an abscess be treated?” Qibo replied, “Press gently around the abscess and observe the direction in which Qi and blood are flowing. First needle shallowly around it, then gradually increase the depth, and finally turn the needles back. Do not needle more than three times; determine how deeply to needle according to how deep the illness is. After needling, be sure to apply a warm compress, allowing the heat to penetrate the body, and each day encourage the warmth to seep further inward. In this way, the pathogenic Qi will gradually weaken, and a large abscess will eventually rupture. Also observe dietary restrictions to dispel the pathogenic influence within the body. Keep the mind calm and avoid overexertion so that the Qi dynamic can flow. Then use medicines with salty and bitter flavors to aid digestion and ensure that food waste is properly eliminated.

Chapter Sixty-Nine: Sorrow and Anger Causing Loss of Voice

The Yellow Emperor asked Shaoshi, “When someone suddenly loses their voice because of sorrow and pent-up anger, which passage has become blocked? What has gone wrong with the flow of Qi, preventing the voice from emerging? Please explain the underlying principle.”

Shaoshi replied, “The throat is the passage through which food and fluids pass; the larynx is the passage through which Qi moves up and down. The epiglottis, a structure in the larynx that opens and closes to protect the airway, is the gateway through which the voice emerges. The lips are like the voice’s door panels; the tongue is the pivot of speech; the uvula is the checkpoint through which the voice passes; and the upper rear part of the palate is where breath is dispersed and directed. The transverse bone, a structure in the throat, is governed by Shen (spirit) and controls the movement of the tongue.

“Thus, if the nostrils are clear but the nose keeps running, it is because the upper rear part of the palate cannot open properly and the breath is not being dispersed normally. If the epiglottis is small, nimble, and thin, breath emerges quickly, it opens and closes smoothly, and exhalation is easy. If the epiglottis is large and thick, it is difficult for it to open and close, and breath emerges slowly; as a result, speech is unclear and repetitive. A sudden loss of voice occurs when cold Qi invades the epiglottis, preventing it from producing sound and stopping breath from passing freely. Its opening and closing then become impaired, and the voice can no longer emerge.”

The Yellow Emperor asked, “How should this illness be treated with acupuncture?” Qibo replied, “The Foot Shaoyin channel rises to connect with the tongue, branches through the pubic bone, and finally reaches the epiglottis—the part of the throat that helps with swallowing and speech. Needling two points to release the blood from the vessels there will disperse the turbid Qi. The vessels at the epiglottis connect upward with the Ren Vessel. Needling Tiantu, the point at the center of the front of the neck in the hollow above the breastbone, will relieve the obstruction in the throat.”

Collected Annotations to the Huangdi Neijing Lingshu, Volume 20, “Cold and Heat,” Chapter 70

The Yellow Emperor asked Qibo, “What kind of pathogenic Qi causes cold and heat in the neck and armpits, along with scrofula—lumps and swollen nodes in those areas?” Qibo replied, “These are caused by the toxic cold and heat lodged in shu lou, a kind of tuberculosis or fistula in the neck and armpits. The toxic Qi remains trapped in the channels and cannot disperse, and so the illness develops.”

The Yellow Emperor asked, “How can it be cured?” Qibo replied, “The root of shu lou lies in the zang-fu organs, while its outward signs appear in the neck and armpits. If the pathogenic influence remains only on the surface of the channels, has not yet penetrated and attached itself to the flesh, and has not formed pus and blood at the body’s surface, it is relatively easy to remove.”

The Yellow Emperor asked, “How can pathogenic influence be made to recede?”

Qi Bo replied, “Guide it from its source, drawing pathogenic Qi from within to the surface and allowing it to gradually subside until the symptoms of cold and heat disappear. Carefully examine the course of the meridians, then apply acupuncture. Insert and withdraw the needles slowly to expel the pathogenic Qi. If the affected area is as small as a grain of wheat, one needle can bring an effect, and three can cure it.”

The Yellow Emperor asked again, “How can one judge whether someone will live or die?”

Qi Bo replied, “Lift the eyelids and examine the eyes. If red blood vessels run vertically across the pupil, one such vessel indicates death in about a year; one and a half, in about a year and a half; two, in about two years; two and a half, in about two and a half years; and three, in about three years. If the red blood vessels do not extend downward across the pupil, the condition can still be treated.”

The Seventy-First Chapter: “When Pathogenic Influence Lodges in the Body”

The Yellow Emperor asked Bo Gao, “When pathogenic Qi enters the body, it can sometimes cause a person to sleep with their eyes open and be unable to fall asleep. What kind of Qi causes this?”

Bo Gao replied, “When the five grains enter the stomach, the dregs, fluids, and ancestral Qi—the breath that gathers in the chest—separate into three pathways. Ancestral Qi gathers in the chest, emerges through the throat, passes through the Heart meridians, and drives breathing. Nutritive Qi—the refined Qi that flows within the meridians—carries fluids into the meridians, where they become blood. It nourishes the extremities, flows inward to fill the five Zang organs and six Fu organs, and circulates according to a regular schedule.

“Defensive Qi, which flows outside the meridians and protects the body, arises from vigorous, rapid Qi transformation. It first circulates through the extremities, between the muscles, and beneath the skin, without stopping day or night. During the day it circulates on the body’s exterior; at night it moves within the body, usually entering the five Zang and six Fu organs through the areas traversed by the Foot Shaoyin meridian.

“Now, when disordered Qi lodges in the five Zang and six Fu organs, Defensive Qi remains on the body’s surface, guarding it and circulating externally, unable to enter within. When Defensive Qi stays outside, Yang Qi becomes excessive. This excess obstructs the Yang Qiao vessel, which is associated with the opening and closing of the eyes and the movement of Yang Qi. Defensive Qi then cannot enter the Yin aspect, leaving Yin Qi insufficient. As a result, the person cannot close their eyes and cannot sleep.”

The Yellow Emperor said, “Good. How should it be treated?” Bo Gao replied, “Replenish what is deficient, disperse what is excessive, and harmonize emptiness and fullness so that the channels and collaterals flow freely and pathogenic influences are eliminated. Then take one dose of Banxia Decoction. Once the Yin and Yang energies flow in harmony, the insomnia will soon disappear.”

The Yellow Emperor said, “Good. Is this what is meant by clearing obstructions, opening the channels and collaterals, and harmonizing Yin and Yang? I would like to know the prescription.” Bo Gao replied, “Take eight sheng of running water from a source a thousand li away. Pour and splash it repeatedly ten thousand times, then use five sheng of the clear water. Build a fire with reed fuel and bring the water to a boil. Add one sheng of glutinous millet and five ge of prepared Banxia (a medicinal herb). Simmer over low heat until only one and a half sheng remain, then strain out the dregs. Drink one small cup at a time, three times a day, gradually increasing the dose until the symptoms ease.

When the illness has just begun, one cup is enough to fall asleep; after sweating, the symptoms will disappear. If the illness has lasted longer, three doses will bring a cure.”

The Yellow Emperor asked Bo Gao, “I would like to know how the limbs and joints of the human body correspond to Heaven and Earth.”

Bo Gao replied, “Heaven is round and Earth is square, so the human head is round and the feet are square, matching Heaven and Earth. Heaven has the sun and moon; the human body has two eyes. Earth has nine regions; the human body has nine orifices. Heaven has wind and rain; the human body has joy and anger. Heaven has thunder and lightning; the human body has sounds. Heaven has four seasons; the human body has four limbs. Heaven has five tones; the human body has five Zang organs. Heaven has the six Lü pitches (the six yang pitches among the twelve pitches used in ancient times to establish musical tuning); the human body has six Fu organs. Heaven has winter and summer; the human body has cold and heat. Heaven has ten day names; the human body has ten fingers. The twelve earthly branches, used to mark time, correspond to the ten toes, penis, and testicles of the human body. Women lack these last two, yet can carry and nurture the human form.

Heaven has Yin-Yang; the human body has husbands and wives. A year has 365 days; the human body has 360 joints. Earth has high mountains; the human body has shoulders and knees. It has deep valleys; the human body has armpits and the hollows behind the knees. Earth has twelve waterways; the human body has twelve channels. Earth has veins through which spring water flows; the human body has defensive Qi (vital energy that moves across the body’s surface and protects it). Earth has plants and trees; the human body has fine body hair. Heaven has day and night; the human body has sleep and waking. Heaven has its array of stars; the human body has teeth. Earth has small hills; the human body has small joints. It has rocks; the human body has bones that rise up and are hard. It has forests; the human body has sinews. It has clustered settlements; the human body has masses of raised muscle. A year has twelve months; the human body has twelve joints. Some places on Earth cannot grow plants in any season; likewise, some people cannot bear children. These are the ways in which the human body corresponds to Heaven and Earth.”

The Yellow Emperor asked Qibo, “I would like to understand the methods and principles of acupuncture: How should the needle be inserted? How should one decide how deeply to needle, how long to retain the needle, and when to withdraw it? How does one pierce the skin and open the interstices between the skin and muscles? Where do the channels bend and turn, emerge and enter, or meet? Where does Qi flow outward, gather, move slowly or swiftly, or enter inward? What is the order and distribution of the transport points of the six Fu organs—the points where channel Qi is conveyed and circulated? How do the channels branch and enter the Yin or Yang channels? I want to understand all these principles clearly.”

Qibo replied, “Your Majesty’s questions already cover all the essential points of the Dao of acupuncture.”

The Yellow Emperor said, “Please explain these principles in full detail.”

Qibo said, “The Hand Taiyin channel—that is, the Hand Taiyin Lung channel—begins at the tip of the thumb. It curves inward and follows the border between flesh and skin on the palm side of the hand until it reaches the Taiyuan point, behind the wrist crease. Here, the channel Qi pauses and gathers. The channel then turns outward, travels below the wrist joint, and curves inward again, meeting the collaterals of the Yin channels of the hand at Yuji. The Qi of several vessels converges here. It flows smoothly, passing beneath the raised bone; then it turns outward at the cun-kou, ascends along the forearm to the inner elbow, enters beneath a large tendon, and curves inward. It continues up the inner upper arm, enters the armpit, then turns inward and travels to the Lung. These winding paths of the channels are described by following their course while counting in reverse.

“The vessel of the Heart Governor—that is, the Hand Jueyin Pericardium channel—begins at the tip of the middle finger. It curves inward and ascends along the inner side of the middle finger, pausing in the palm before passing beneath the space between two bones. It turns outward and emerges between two tendons, where bone meets flesh. Here the channel Qi flows smoothly, ascends two cun, then turns outward and travels upward between the two tendons to the inner elbow. It enters beneath a small tendon and pauses where the two bones meet. Then it ascends into the chest and connects internally with the Heart vessel.”

The Yellow Emperor asked: Why does the Hand Shaoyin channel alone have no acupoints? Qibo replied: Shaoyin refers to the heart channel. The heart governs the five zang organs and six fu organs, and is where the spirit resides. When the heart is firm, external pathogenic influences can hardly enter. If they do enter, the heart is injured; when the heart is injured, the spirit scatters, and when the spirit scatters, death follows. Therefore, pathogenic influences that attack the heart usually remain in the heart’s envelope, the tissue that surrounds and protects it. This envelope belongs to the channel that governs the heart, so the heart channel itself has no separate acupoints.

The Yellow Emperor asked: Since the Shaoyin channel alone has no acupoints, does that mean it cannot become diseased? Qibo replied: The Shaoyin channel may become diseased, but the heart itself does not. For this reason, the channel’s acupoint is located only at the end of the prominent bone on the palm side of the wrist. The pathways, bends, and variations in the speed of flow in the other channels resemble the flow of the Hand Shaoyin and heart-governing channels. When selecting acupoints along a channel, the choice should depend on whether its Qi is deficient or excessive and on how quickly it flows: drain pathogenic influence when it is strong, and supplement when the body’s vital force is weak. This dispels pathogenic influence and strengthens true Qi, the body’s upright vital force. This is called following the natural order.

The Yellow Emperor asked: When needling, how should one decide where to treat and whether to supplement or drain? Qibo replied: One must first understand the beginnings and endings of the twelve channels, whether the skin is hot or cold, and whether the pulse is strong or weak, smooth or rough. A smooth, forceful pulse indicates that the illness is worsening. A weak, fine pulse indicates a prolonged illness. A large, rough pulse is often seen with pain or impeded circulation. When the Yin and Yang pulse qualities differ little, the illness is difficult to treat. If heat remains at the beginnings and endings of the channels, the pathogenic influence is still present; as the heat subsides, the illness also improves.

One must also examine the skin on the inner forearm, from the wrist to the elbow, using the hand to assess whether the muscles are firm or slack, their size and texture, and whether they are warm or cold, dry or moist. Then observe the five colors of the eyes to understand the condition of the five zang organs and judge the severity and likely outcome of the illness. The color of the blood vessels can also reveal signs of cold or heat, pain, or impeded circulation.

The Yellow Emperor said, “I still do not understand how to hold the needle and apply it, or how to judge the proper measure for inserting or withdrawing it.” Qibo replied, “When holding the needle, keep your hand steady and your mind calm. First determine whether the patient’s condition is deficient or excessive, then decide how quickly to needle. With your left hand, press beside the bone; with your right, work along the course of the channel. Do not insert the needle rashly or forcefully. For reducing, keep the technique steady and controlled; for tonifying, close the needle opening after withdrawing the needle. Also guide the movement of Qi through needling, so that pathogenic Qi disperses and genuine Qi settles and remains.”

The Yellow Emperor asked, “How should one press the skin and open the interstices—the folds and pores between the skin and muscles?” Qibo replied, “Needle along the divisions between the muscles. For reducing, keep the technique steady and controlled; for tonifying, close the needle opening after withdrawing the needle. Guide the movement of Qi through needling, so that pathogenic Qi disperses and genuine Qi settles and remains.”

The Yellow Emperor asked the same question again. Qibo replied, “Work along the divisions between the muscles. With your left hand, part the skin; insert the needle lightly, then apply it slowly and steadily. Keep your mind focused and undistracted, and the pathogenic Qi can then be removed.”

The Yellow Emperor asked Qibo, “What are the eight hollows of the body for observing?” Qibo replied, “They are used to observe pathogenic influences in the Five Organs.” The Yellow Emperor asked, “How does one observe them?” Qibo said, “When the Lungs or Heart are affected, pathogenic Qi lodges at the two elbows; when the Liver is affected, it flows to the two armpits; when the Spleen is affected, it lodges at the two hips, at the roots of the thighs; when the Kidneys are affected, it lodges in the hollows behind the knees. These eight places are all pivots for the movement of the joints, as well as passageways for genuine Qi and the blood vessels. Pathogenic Qi and stagnant blood should not remain there. If they do, they damage the sinews, collaterals, and joints, preventing the joints from bending and straightening and causing contractions.”

“Penetrating Heaven,” Chapter Seventy-Two

The Yellow Emperor asked Shaoshi, “I have heard that people are divided into Yin and Yang. What is meant by a Yin person, and what is meant by a Yang person?” Shaoshi replied, “Between Heaven and Earth, within the Six Directions, nothing is independent of the Five Phases, and human beings correspond to them as well. People do not fall into only two categories, Yin and Yang; that is simply a broad way of speaking. To describe every kind of person in full would exceed what words can express.”

The Yellow Emperor asked, “Please briefly explain the principles involved. Can worthy and sage people possess all these qualities in their hearts and put them all into practice?”

The Junior Master replied, “There are five types of people: those of Great Yin, Lesser Yin, Great Yang, Lesser Yang, and balanced Yin-Yang. Their conduct differs, as do their sinews and bones, Qi, and blood.”

The Yellow Emperor asked, “Could you describe these differences in detail?”

The Junior Master said, “People of Great Yin are greedy and lack benevolence. They appear modest and composed, like to keep things for themselves, and are unwilling to give. Though calm inside, they do not readily reveal their thoughts or adapt to changing circumstances. In their actions, they are always a step behind others.

“People of Lesser Yin are somewhat greedy and inwardly harsh. When they see someone else lose something, they often seem to regard it as their own gain. They enjoy harming others. When they see someone honored and successful, they grow angry instead. They are eager in their aims, but lack gratitude and a sense of duty.

“People of Great Yang are boastful in their conduct and enjoy talking about grand matters, though they lack the ability to carry them out and speak in empty terms. Their ambitions seem to reach in every direction. They act without regard for right and wrong, often following their own ideas. Even when things go badly, they feel no regret.

“People of Lesser Yang are calculating and like to elevate themselves. A minor official post is enough to make them feel important. They enjoy making connections with people outside their circle, but are unwilling to draw close to those within it.

“People with balanced Yin-Yang live in a steady manner. They feel neither needless fear nor unrestrained joy. They respond gently to the things around them and do not compete with others. They adapt to changing circumstances and remain humble even when their position is high. They discuss matters without forcing a judgment upon them: this is skillful governance.

“In ancient times, those skilled in acupuncture and moxibustion first observed which of these five temperaments a person had, and then treated them accordingly: when Qi was abundant, they used reducing methods; when Qi was deficient, they used tonifying methods.”

The Yellow Emperor asked, “How should people of the five constitutions be assessed and treated?” Shaoshi said, “People of the Greater Yin type have abundant Yin Qi and insufficient Yang Qi. Their Yin blood is relatively turbid, while their defensive Qi circulates smoothly. In ancient times, those skilled in acupuncture and moxibustion first observed a person’s constitution and then treated them accordingly: they drained excess Qi and blood and tonified what was deficient.

The Yellow Emperor asked again, “How should people of the five constitutions be assessed and treated?” Shaoshi said, “People of the Greater Yin type have abundant Yin Qi and insufficient Yang Qi. Their Yin blood is turbid, their defensive Qi circulates poorly, and Yin and Yang are out of balance. Their sinews and vessels are lax, and their skin is thick. Unless a draining method is applied promptly, this condition is difficult to change.

“People of the Lesser Yin type have abundant Yin Qi and little Yang Qi. Their stomach is small and their intestines are large, and the functions of the six bowels are out of balance. The Yangming channels are relatively small, while the Taiyang channels are relatively large, so their condition must be carefully differentiated and treated. These people’s blood is easily depleted, and their Qi readily declines.

“People of the Greater Yang type have abundant Yang Qi and little Yin Qi, and must be treated with care: do not deplete or injure their Yin; instead, drain their excessive Yang Qi. If their Yang Qi is depleted too severely, they may become delirious. If both Yin and Yang Qi are depleted, they may suddenly die and lose consciousness.

“People of the Lesser Yang type have abundant Yang Qi and little Yin Qi. Their channels are relatively small, while their collaterals are relatively large. Their blood tends to remain inside, while their Qi tends to float outside; the Yin aspect is replete and the Yang aspect deficient. If only the collaterals are drained, this may further weaken the body’s vital Qi and hasten the loss of Qi. With insufficient central Qi, the illness is difficult to recover from.

“People with balanced Yin and Yang have harmonized Yin and Yang Qi, and their blood and vessels flow freely. In examination, carefully distinguish Yin from Yang, observe pathogenic Qi and vital Qi, note the person’s expression and bearing, and determine whether there is excess or deficiency. Drain what is excessive and tonify what is deficient. If neither is excessive nor deficient, treat the corresponding channel. This is how to harmonize Yin and Yang and distinguish among people of the five constitutions.”

The Yellow Emperor asked, “If these five types of people are unfamiliar with one another and meet unexpectedly, without knowing one another’s characteristic behavior, how can they determine whether someone is deficient or excessive, and thus decide whether to drain, tonify, or treat by the channels?”

Shaoshi replied, “Ordinary people do not all have constitution types as sharply defined as those of the five constitutions. The five constitution types commonly described are each further divided into five kinds, making twenty-five types in all. The people of the five constitutions are not included among these twenty-five, because their characteristics differ especially markedly from those of ordinary people.”

The Yellow Emperor asked, “How can one distinguish the five types of people?” Shaoshi replied:

People of the Great Yin type, one of the five human temperaments, have a dark, blackish complexion and a quiet, reserved mind. They act modestly and keep a low profile. They are tall, with straight hollows behind the knees, and do not appear stooped. This is what people of the Great Yin type are like.

People of the Lesser Yin type have a cool, aloof appearance and behave secretively. Their inner nature is stubborn and gloomy. When standing, they seem tense and severe; when walking, they seem to bend forward and creep along. This is what people of the Lesser Yin type are like.

People of the Great Yang type carry themselves proudly and stand erect. When they turn, they lean backward and bend their knees. This is what people of the Great Yang type are like.

People of the Lesser Yang type tend to hold their heads high when standing and sway easily as they walk. They often extend their arms and elbows behind them. This is what people of the Lesser Yang type are like.

People whose Yin and Yang are balanced, with harmonized energies and even temperaments, behave gently and calmly and move with composure. Their expression is upright and pleasant, their eyes bright, and they seem modest and courteous. Everyone praises them as exemplary people. This is what people whose Yin and Yang are balanced are like.

Pronunciation notes: The character transcribed as shi is read as zhi qie; the one transcribed as dan is read as zhi ren qie; and the one transcribed as xuan is read as ci lü qie.

Textual notes: In volume twelve, chapter three of the Jia Yi Jing, the character transcribed as mai is written as fei, and xian is written as man. The two characters transcribed as quan mai are missing from the original text and have been restored from the Zhaofu Jujingtang edition; volume five of the Tai Su has yun qi instead. In volume nine of the Tai Su, “Differences in the Course of the Pulse,” the character transcribed as shao is written as qi, “two cun above” is written as “three cun upward,” and shaoyin is written as taiyin. In volume five, chapter seven of the Jia Yi Jing, the character transcribed as yi is written as yi with the meaning “already,” and nei guo is written as rou guo. The character transcribed as bing appears as ju in the Zhaofu Jujingtang edition, and the pronunciation note also gives ju; ju is therefore taken as the correct reading here. In volume one, chapter sixteen of the Jia Yi Jing, the character transcribed as he is written as yi.

In Chapter 1, Section 16 of the Jia Yi Jing, the character “yi” is given as “xuan.” The note on “qi” indicates that the text here contains the character “ju.” The character “he” is given as “yi,” and an additional “zai” appears after “qi.” The phrase “an rong yi” is given as “an qi rong yi.”

Collected Commentaries on the Yellow Emperor’s Inner Classic: The Spiritual Pivot, Volume 21

The Functions of the Officials, Chapter 73

The Yellow Emperor asked Qibo, “I have heard from you much about the Way of the Nine Needles—so much that it cannot be counted. I have examined and organized it, gathering it into a set of guiding principles. I will recite them; please listen and consider their meaning. If anything is incorrect, tell me and help me correct it, so that the right way may be passed down for a long time and later generations may avoid harm. Teach it only to those suited to receive it; do not speak of it to those who are not.”

Qibo bowed twice and said, “I ask to hear the sage ruler’s teaching.”

The Yellow Emperor said, “In applying the principles of acupuncture, one must know the locations of the body’s form, Qi, and blood; distinguish left from right, upper from lower, Yin from Yang, and the exterior from the interior; understand the relative abundance or scarcity of Qi and blood, as well as the places where their movement runs smoothly or against its course, and where they enter, leave, and converge. One must be able to assess and correct imbalances in the body, know how to disperse stagnation, replenish deficiency, and drain excess pathogenic influence. One must also understand the gateways through which Qi enters and leaves above and below, know how Qi moves through the Four Seas, and examine where pathogenic influences are located. Different conditions, such as cold and heat, present in different ways; treatment should therefore select different transport points—points on the body’s surface where the Qi of the channels gathers. One must be skilled at regulating Qi, familiar with the pathways of the channels and their collateral vessels on both sides, and know where they converge.

“When cold and heat contend, one must be able to harmonize them. When deficiency and excess occur together, one must know which to address first and how to unblock the movement of Qi. When Qi and blood on the left and right are out of balance, treatment must target the affected side. Only by understanding whether the movement of Qi follows or opposes its proper course can one know whether a condition is treatable. When Yin and Yang are balanced and neither is unusually dominant, one can determine when the illness began. Examine the course of the condition from beginning to end, distinguish cold from heat, and locate the pathogenic influence; then, even when using the various needling methods, one will not be in danger. Once the distinct functions of the Nine Needles are understood, the art of acupuncture is mastered.”

Mastery of the Five Transporting Points—the Jing-Well, Ying-Spring, Shu-Stream, Jing-River, and He-Sea points—along with the rhythms of inserting and withdrawing the needle, and of flexing and extending the body, makes it possible to treat illness according to established principles. Yin-Yang corresponds with the Five Phases, and each of the five zang organs and six fu organs has its own domain. The four seasons and the winds from the eight directions also each have Yin-Yang qualities and occupy their respective places. These correspond to the Mingtang, the areas of the face used in ancient times to observe complexion and assess the condition of the organs, and are distributed across different color zones. One should observe where pain occurs in relation to the zang and fu organs, note differences between the left and right sides and between upper and lower parts of the body, distinguish cold from heat, and determine which meridian the pathogenic influence occupies.

Careful examination of the skin’s temperature and texture—whether it is smooth or rough—reveals the patient’s affliction. Then distinguish what lies above and below the diaphragm to determine where Qi is located. Once these principles of diagnosis and treatment are understood, needle shallowly, retain the needle, and gradually deepen it; only then can the needle be inserted slowly. If heat is in the upper body, guide it downward to disperse it. If the condition moves from below upward, guide it outward to expel it. If signs of pain are already apparent, treat that area first. When cold is on the body’s surface, retain the needle and use tonification. When cold has entered the interior, apply reducing needling at the He-Sea point.

Conditions unsuitable for acupuncture should be treated with moxibustion. If Qi in the upper body is deficient, raise and invigorate it; if Qi in the lower body is deficient, gradually gather and guide it. When both Yin and Yang are weak, use fire—that is, apply moxibustion. If the limbs are cold and the cold influence is severe, with hollows beside the bones and cold extending above the knees, treat at Xialing Sanli (the Zusanli point). Locate the affected area along the course of the Yin collaterals, then retain the needle. When cold has penetrated deeply into the body, promote the movement of Qi and blood. Where a meridian has sunk in, apply moxibustion; where the collaterals have gathered into firm, tight knots, moxibustion is also appropriate.

If the location of the pain is still unclear, examine below the two Qiao vessels: in men, look at the area corresponding to the Yin region; in women, at the area corresponding to the Yang region. A skilled physician can locate the affected area this way and retain the needle. When cold has penetrated deeply into the body, promote the movement of Qi and blood. Where a meridian has sunk in, apply moxibustion; where the collaterals have gathered into firm, tight knots, treat them with moxibustion as well. This concludes the discussion of acupuncture.

When using acupuncture to treat illness, one must follow certain principles: observe the conditions of the heavens above and examine the Eight Alignments below—the seasonal periods and directions corresponding to the eight divisions of the year—in order to avoid abnormal pathogenic influences. At the same time, observe people’s physical condition, distinguish deficiency from excess, and avoid provoking pathogenic influences. If one mistakenly encounters an unfavorable season, or a year in which the climate’s Qi is deficient, treatment may come too late even when one intends to help, and may instead bring harm. Therefore, one must understand the prohibitions associated with the seasons before discussing the essentials of acupuncture.

Draw on the experience of the ancients and test it against present circumstances; observe subtle changes that are difficult to perceive and understand principles without limit. What shallow practitioners cannot see is precisely what skilled physicians value. The traces of illness are difficult to grasp, seeming as elusive and hard to discern as spirits.

When pathogenic Qi enters the body, it makes a person feel cold and shiver, and the body trembles in response. When Zhengxie—pathogenic Qi that causes illness by contending with the body’s healthy Qi—enters, it often first produces faint changes in the complexion, while the body itself still feels no clear symptoms. The illness seems at once present and absent, as though it exists and yet does not; it appears to have form but remains difficult to detect, so its true condition is hard to judge. A skilled physician therefore treats the Qi as soon as the pathogenic influence shows its first signs, addressing the illness while it is still incipient. A less skilled physician waits until the illness has taken shape before acting, often worsening it and damaging the body.

When needling, a physician must know where the Qi is and guard the needle’s opening. The physician must also understand how to regulate Qi, distinguish where to tonify and where to drain, determine the speed of needling, and select the appropriate points. For draining, use a supple, circular technique, rotating close to the point to set the Qi in motion. Insert the needle quickly and withdraw it slowly to draw out pathogenic Qi. Extend the needle technique and guide the pathogenic influence outward, slightly widening the needle opening; once the Qi has emerged, withdraw the needle swiftly.

For tonifying, use a steady technique, drawing the skin outward so the needle opening aligns with the point. With the left hand, draw the area around the point; with the right, move the skin, rotate gently, and insert the needle slowly. The procedure must be proper, steady, and calm, with sustained concentration. Leave the needle in place briefly. When the Qi has descended, withdraw the needle swiftly, then press the skin to close the outer opening of the needle point so that the true Qi remains within. The key to needling is to remain attentive to the Qi throughout.

Leigong asked the Yellow Emperor, “The Treatise on Needling says that one should teach those who are suited to receive the teaching, and not explain it to those who are not. How can one know whether someone is suited to receive it?” The Yellow Emperor replied, “See whether the person is suited, and teach according to their ability. In this way, they can truly understand its principles.”

Lei Gong asked, “How should work be assigned according to a person’s abilities?”

The Yellow Emperor said, “A person with keen eyesight can be asked to distinguish colors; one with sharp hearing can be asked to distinguish sounds; and one who speaks clearly and quickly can be asked to convey and explain teachings. Someone who speaks calmly and puts others at ease should be allowed to work according to their abilities. In this way, the work can be done well.”

Lei Gong asked again, “How should work be assigned according to a person’s abilities?”

The Yellow Emperor said, “A person with keen eyesight can be asked to distinguish colors; one with sharp hearing can be asked to distinguish sounds; and one who speaks quickly and clearly can be asked to convey and explain teachings. Someone who speaks in a composed, quiet manner, has nimble hands, and thinks carefully can be asked to perform acupuncture and moxibustion, regulate Qi and blood, correct disruptions in their flow, observe changes in Yin-Yang, and apply various treatments in combination.

“Someone with relaxed joints, supple sinews and vessels, and a calm, balanced temperament can be asked to practice daoyin exercises and circulate the breath. Someone whose words are sharp and whose manner is dismissive and hurtful can be asked to treat abscesses and sores with saliva or incantations, and to drive out illness. Someone with hard fingernails, a strong grip, and a tendency to cause harm can be asked to massage accumulations and treat painful obstruction.

“Assigning each person work according to their strengths makes it possible to apply the treatments and establish the physician’s reputation. If the wrong person is chosen, treatment will be difficult to carry out successfully, and the teacher will find it difficult to earn a reputation. Thus it is said: ‘Teach those who are suited to receive instruction, and do not teach those who are not.’ This is what the saying means.

“A person with a strong grip can first be asked to test the pressure on a turtle: place the turtle beneath a vessel, then press down on the vessel from above. After fifty days, the turtle will die. If someone with a gentle touch then presses on it, the turtle will recover as before.”

On Discussing Illness and Examining the Wrist [Chapter 74]

The Yellow Emperor asked Qibo, “I would like to judge illness without looking at the complexion or taking the pulse, by observing only the skin on the inner forearm between the wrist and elbow. How can I understand what is happening inside the body by examining its exterior?”

Qibo replied, “Carefully observe whether the skin on the inner forearm is slack or tense, its size, whether it is smooth or rough, and whether the flesh is firm or weak. From these signs, you can judge the manifestations of illness.”

Observe whether the area above the eye sockets is slightly swollen, as if the person has just woken up. If the pulse on the side of the neck is also throbbing and the person coughs frequently, and pressing the hands or feet leaves a depression that takes a long time to disappear, this belongs to the category of illnesses known as wind-water and skin distension.

If the skin at the cubit area—the diagnostic region between the wrist and elbow—feels smooth and moist, wind pathogen is the cause. If the muscles there are soft and weak, this is “jiexie,” a condition marked by tired, weak limbs. If a person lies quietly in bed yet gradually grows thinner and develops alternating chills and fever, the illness is difficult to treat. Smooth, oily skin at the cubit area also indicates wind pathogen; rough, dry skin indicates skin distension. Skin as rough as the scales of a dried fish shows that fluids have accumulated and overflowed. If the skin at the cubit area is very hot and the pulse is full and restless, this indicates a warm disease. A full, slippery pulse suggests that the illness is about to become evident. If the skin there is cool and the pulse is thin and faint, diarrhea and scant Qi are common. If the skin at the cubit area first burns with heat and then turns cold, this indicates a disorder with alternating cold and heat. If it is cold at first but grows warm after being pressed for some time, this also indicates a disorder with alternating cold and heat.

Heat confined to one part of the elbow indicates heat above the waist; heat confined to the hand indicates heat below the waist. Heat at the front of the elbow indicates heat in the chest; heat behind the elbow indicates heat in the shoulders and back. Heat in the middle of the forearm indicates heat in the waist and abdomen. If the area three or four inches below the back of the elbow is enlarged and hot, this indicates intestinal parasites. Heat in the center of the palm indicates heat in the abdomen; cold there indicates cold in the abdomen. If bluish vessels appear in the pale flesh of the thenar eminence—the raised area at the base of the thumb—this indicates cold in the stomach. If the skin at the cubit area burns with heat while the Renying pulse on the side of the neck is strong, blood loss should be considered. If the cubit area is hard and swollen while the pulse is very thin and faint, with scant Qi and worsening chest oppression, the condition may soon become life-threatening.

A red color in the eyes indicates illness in the heart; white indicates illness in the lungs; blue-green indicates illness in the liver; yellow indicates illness in the spleen; and black indicates illness in the kidneys. If the eyes are yellow but the particular shade cannot be identified, the illness is in the chest.

When examining eye pain, if red blood vessels extend from top to bottom, it is a Taiyang illness; if they extend from bottom to top, it is a Yangming illness; and if they extend from the outer corner of the eye inward, it is a Shaoyang illness. When examining illnesses marked by alternating chills and fever, if red blood vessels extend from above and below toward the pupil, seeing one vessel means the patient will die after one year; one and a half vessels, after a year and a half; two vessels, after two years; two and a half vessels, after two and a half years; and three vessels, after three years.

When examining tooth decay and pain, diagnosis is made by palpating the pulse Qi corresponding to the Yang channels. The location where the pulse Qi is abnormal and hot corresponds to the site of pain: heat on the left indicates illness on the left, and heat on the right indicates illness on the right; heat in the upper part indicates illness in the upper part, and heat in the lower part indicates illness in the lower part.

When examining the blood vessels, a reddish color usually indicates a heat condition; a blue-green color, pain; and a black color, longstanding Bi syndrome, in which the circulation of Qi and blood is obstructed and the limbs become numb and painful. The simultaneous presence of red, black, and blue-green indicates a mixture of cold and heat. Pain throughout the body, a slightly yellow complexion, yellow deposits on the teeth, and yellowing of the nails indicate jaundice. If the patient lies quietly in bed, has dark yellow urine, and has a fine, choppy pulse, they will generally have little desire to eat.

When a person is ill, if the pulse at the cun kou (the wrist) and the renying pulse (at the carotid artery in the neck) are equal in strength and have the same floating or sinking quality, the illness is difficult to cure. A strong pulse at the hand Shaoyin channel in a woman may indicate pregnancy. If an infant is ill and all the hair grows backward, the condition is dangerous. Blue-green vessels visible beside the ear indicate a pulling, tugging pain. If the stool contains red fragments and undigested food, and the pulse is fine while the hands and feet are cold, the illness is difficult to improve. With the same diarrhea, a fine pulse and warm hands and feet indicate that recovery is more likely.

As the seasons change, cold and heat transform into one another. When Yin reaches its height, it turns into Yang; when Yang reaches its height, it turns into Yin. Thus, Yin governs cold and Yang governs heat. When cold reaches its extreme, it becomes heat; when heat reaches its extreme, it becomes cold. This is what is meant by saying that cold can give rise to heat and heat can give rise to cold: it is the law of Yin-Yang transformation.

Thus it is said: exposure to cold pathogens in winter may bring about a febrile illness in spring; exposure to wind pathogens in spring may bring about diarrhea or dysentery in summer; exposure to summer-heat pathogens in summer may bring about intermittent fever and chills—malaria—in autumn; and exposure to dampness pathogens in autumn may bring about coughing in winter. This is the sequence of seasonal illnesses.

Preface to Chapter Seventy, “Piercing the Nodes and True Pathogens.”

Chapter Seventy-Five, “Piercing the Nodes and True Pathogens”

The Yellow Emperor asked Qibo, “I have heard that acupuncture has five essential methods. What are they?” Qibo replied, “There are indeed five: the first is called ‘Shaking Off Dust,’ the second ‘Lifting the Veil,’ the third ‘Removing the Claw,’ the fourth ‘Piercing the Garment,’ and the fifth ‘Resolving Confusion.’”

The Yellow Emperor said, “I do not yet understand what you mean by these five methods.” Qibo replied, “‘Shaking Off Dust’ means needling the channels at the body’s surface to treat disorders of the Yang channels. ‘Lifting the Veil’ means needling the transport points of the six Fu organs to treat disorders of the Fu organs. ‘Removing the Claw’ means needling the collaterals at the joints and limbs. ‘Piercing the Garment’ means needling all the special transport points of the Yang channels throughout the body. ‘Resolving Confusion’ means fully understanding how to regulate Yin and Yang: according to the condition, supplement what is deficient and drain what is excessive, shifting the two sides when either becomes predominant and restoring their balance.”

The Yellow Emperor said, “The ‘Zhen’ai’ chapter mentions ‘Shaking Away Dust.’ You said it is a method of needling the channels at the body’s surface to treat Yang disorders, but I still do not understand what this means. Please explain it in detail.”

Qibo said, “ ‘Shaking Away Dust’ refers to a severe disorder in which Yang Qi rebels upward and congests the chest. The person feels oppressed and agitated in the chest, raises the shoulders while gasping, and breathes with forceful upward surges. The breathing becomes labored, until the person can only sit bent forward. The patient cannot bear the smell of dust or smoke; the breath is obstructed, making it difficult to breathe. The treatment I am about to describe works even faster than shaking dust away.”

The Yellow Emperor said, “Good. Which points should be needled?”

Qibo said, “Needle Tianrong.”

The Yellow Emperor then asked, “For coughing, Qi surging upward, and a constricting, painful sensation in the chest, which point should be needled?”

Qibo said, “Needle Lianquan.”

The Yellow Emperor asked, “Is there a limit to how far the needle should be inserted?”

Qibo said, “When needling Tianrong, do not insert it more than one li (an ancient unit of length, used here to indicate the limit of needling depth). When needling Lianquan, stop once the color of the blood changes.”

The Yellow Emperor said, “Well said.”

The Yellow Emperor asked, “I do not understand ‘opening the darkness’ in the chapter ‘On the Knots of Needling.’ It means that the ears cannot hear and the eyes cannot see. Yet you say that needling the transport points of the fu organs—the points on the body’s surface where the qi of the fu organs flows—can remove disorders of those organs. Which transport point must be needled for this to work? Please explain the principle.”

Qibo replied, “An excellent question. This is the essential principle of needling and the height of the art. It concerns the subtle, wondrous transformations of spirit. Even oral explanation and written records cannot fully convey it. I will first explain the principle of ‘opening the darkness’; its effects are even swifter than restoring hearing and sight.”

The Yellow Emperor said, “Good. Explain it to me in full.”

Qibo said, “This needling is performed at noon. Needle the Tinggong point, in front of the ear, and let the needle response reach the eyes. A sound will then arise in the ear: this is the point being sought.”

The Yellow Emperor asked, “What does it mean for a sound to arise in the ear?”

Qibo replied, “When needling the place where the pathogenic qi is lodged, press both nostrils firmly with your hands and quickly tilt the head back. A sound will then answer at the place being needled.”

The Yellow Emperor said, “Good. This is what is meant by recognizing the location of the illness and needling it without looking directly at it, through a spirit-like sensitivity that accords with the condition.”

The Yellow Emperor then asked, “The chapter ‘On the Knots of Needling’ speaks of ‘removing the claws,’ but you have spoken of needling the joints and the channels in the limbs. Please explain the principle in full.”

Qibo replied, “The lumbar spine is a vital joint of the whole body. The arms and legs, including the lower legs, support the body’s movement. A drooping penis indicates an internal functional disorder and is also connected with the state of Yin essence and the pathways through which fluids circulate. Irregular eating and drinking or emotional disturbance may cause fluids to accumulate within the body and settle lower down, around the testicles, obstructing the flow of blood through the vessels. If the swelling persists and does not subside, it can hinder bending, straightening, and walking. When fluid has clearly accumulated at the affected site and can flow neither upward nor downward, a lance needle—a tool used in ancient times to open and drain pus—can be used to treat it. The lesion has a distinct form that cannot be concealed or covered; hence it is called ‘removing the claws.’”

The Yellow Emperor said, “Good.”

The Yellow Emperor asked, “In Cijie it says ‘stripping away the clothing.’ You also say that one should needle all the extraordinary points along the Yang channels, even though these points have no fixed locations. I would like to hear you explain this in detail.”

Qibo said, “This is caused by an excess of Yang Qi and a deficiency of Yin Qi. When Yin Qi is deficient, heat develops inside the body; when Yang Qi is excessive, the body’s surface also becomes hot. The heat inside and out presses upon one another, making the person feel as though they are holding a charcoal brazier against their chest. The patient cannot bear clothes or bedding near the body, or even a mat touching them. The skin and pores are closed, so sweat cannot emerge. The tongue turns black and scorched, the lips become dry, and the throat parched. The patient cannot tell whether food tastes good or bad.”

The Yellow Emperor said, “Good. How should this be treated?”

Qibo said, “Needle Tianfu and Dazhu three times each, then needle Zhonglu to dispel the pathogenic heat. Tonify the Foot Taiyin and Hand Taiyin channels to promote sweating. Once the heat has subsided, the sweating will lessen too, and the illness will be cured faster than one can take off one’s clothes.”

The Yellow Emperor said, “Good.”

The Yellow Emperor asked, “In Cijie it says ‘dispelling confusion.’ You also say that one must fully understand how to harmonize Yin and Yang, tonify deficiency and drain excess, and transform imbalances of excess and deficiency into one another; only then can confusion be dispelled. What does ‘confusion’ mean here?”

Qibo said, “When the great wind pathogen enters the body, it can leave the blood vessels deficient on one side. The deficient side becomes insufficient and the replete side excessive, throwing the body out of balance. The patient leans and curls up, cannot distinguish east from west or north from south, and at times feels drawn upward or downward, turned around or upside down. The mind becomes disordered, in a state far more severe than ordinary confusion.”

The Yellow Emperor said, “Good. How should this be treated?”

Qibo said, “Drain what is excessive and tonify what is deficient, restoring balance between Yin and Yang. With needling performed in this way, the illness will be cured faster than confusion can be dispelled.”

The Yellow Emperor said, “Good. I will store these teachings in the Chamber of the Numinous Orchid, where I keep the classical texts, and will not transmit them carelessly.”

The Yellow Emperor asked, “I have heard that there are Five Evils in needling. What are the Five Evils?”

Qibo said, “There are five kinds of illness: sores and swellings, large swelling, small localized lumps, fever, and chills. These are called the Five Evils.”

The Yellow Emperor asked, “How should these Five Evils be treated with needles?”

Qibo said, “The methods for treating the Five Evils broadly follow five principles: dispel obstruction and pathogenic heat; disperse swelling and accumulations; warm cold impediment; support and strengthen minor conditions; and be sure to eliminate major pathogenic factors. The specific methods are as follows.”

When needling sores and swellings caused by pathogenic influences, never insert the needle into the most prominent part of the swelling. Regulate the abnormal Qi and Blood and the course of the illness. If the pus cannot be discharged, change the direction of needling and guide the pathogenic influence away from its original location. Once it has left that place and has nowhere to remain, it will gradually disperse. When Qi in a Yin or Yang channel stagnates and forms a sore or swelling, select the Shu point of the corresponding channel—the point where the channel’s Qi is conveyed—to drain the stagnation.

When needling a powerful pathogenic influence, weaken it day by day. Drain and remove the excess Qi until the pathogen becomes deficient; then open the blocked area and needle where the pathogen is located. Once the flesh has softened and the affected area shows no visible signs of illness, adjust the needling method so that Qi and Blood return to normal. When needling a Yang channel, points between the divisions of the muscles may be selected.

When needling a mild, superficial pathogenic influence, gradually strengthen the body’s upright Qi and replenish what is insufficient, so as not to cause harm. First examine the extent of the pathogen, then meet the channel’s Qi at the corresponding area. Needle from near to far until the pathogen has been fully removed. If it remains outside the body’s surface and does not recede, continue guiding it onward until it disperses of its own accord. Points between the divisions of the muscles may be used.

When needling pathogenic Heat, disperse it outward so that it leaves and does not return; then the illness will resolve. During needling, open the pathways and gates so the pathogen can escape, and the patient will recover.

When needling pathogenic Cold, gradually warm it. Insert and withdraw the needle slowly, while guiding the body’s Shen Qi—the subtle Qi that sustains vital activity. Once the opening at the needling site has closed and Qi is no longer escaping, harmonize deficiency and excess so that the body’s upright Qi is preserved.

The Yellow Emperor asked, “Which needles should be used for different kinds of illness?” Qibo replied, “To treat sores and swellings, use the Pi needle, a flat, sharp instrument. To treat powerful pathogenic influences, use the Feng needle, an edged instrument. To treat mild, superficial pathogens, use the Yuanli needle, which has a rounded yet sharp tip. To treat pathogenic Heat, use the Chan needle, an instrument for shallow needling. To treat pathogenic Cold, use the Hao needle, a fine, long instrument.”

Explain the principles behind these needling methods: they correspond to Heaven and Earth and accord with the changes of the four seasons. People live between Heaven and Earth, so the principles of needling can be understood through the patterns of Heaven, Earth, and the seasons. Low-lying, damp ground lies below, while reeds and cattails grow above it. This too can illustrate changes in the human body and its Qi, as well as the situations for which the Yuanli, Chan, and Hao needles are each suited.

Let me explain the principle of “undoing knots.” The human body must respond to Heaven and Earth and accord with the four seasons. Since people take part in the changes of Heaven and Earth, natural phenomena can be used to illustrate the condition of the body. In low-lying, damp places, reeds and rushes grow from the ground. By observing how these plants grow, one can infer the waxing and waning of the body’s form and Qi.

The changes of Yin and Yang appear as cold and heat. When the weather is hot, rain moistens the earth’s surface and the fluid in plant roots diminishes. In the human body, Qi shifts toward the surface: the skin relaxes, the interstices between skin and muscle open, Qi and blood diminish, sweat pours out, and the skin becomes moist. When the weather is cold, the earth freezes and water turns to ice. In the human body, Qi gathers inward: the skin tightens, the interstices close, sweating stops, Qi and blood become abundant, and the muscles grow firm and sluggish.

In such conditions, even someone skilled at directing water cannot sail a boat across ice, and even someone skilled at digging cannot break through frozen soil. Likewise, someone skilled in acupuncture cannot immediately treat cold, numb limbs—limbs that are icy and have impeded circulation of Qi and blood. The blood vessels are congested, rigid, and tightly knotted; their flow is obstructed, and they cannot be softened at once. So the person who directs water must wait until the weather warms, the ice and snow melt, and the frozen earth thaws. Only then can water flow and the ground be dug. The body’s channels are the same.

To treat cold, numb limbs, first use warm compresses to harmonize the channels. Apply warmth to the palms, armpits, elbows, feet, nape, and back, allowing the heat to reach through and Qi and blood to circulate. Then assess the condition: if the vessels are moist and supple, use acupuncture to restore their balance; if they are rigid and tight, puncture them to disperse the congestion. Stop treatment once the movement of Qi descends and becomes unobstructed. This is what is called “undoing knots.”

The essential point of acupuncture is to regulate the movement of Qi (vital energy). The Qi derived from food and drink gathers in the stomach and transforms into nutritive Qi and defensive Qi, each circulating along its own path. Ancestral Qi gathers in the Sea of Qi in the chest, flows downward to the Qi Street, and rises upward to reach the passage of respiration. Thus, when the feet suffer reversal cold, if Ancestral Qi cannot descend, the blood in the vessels congeals and stagnates. Without regulating the movement of Qi, there is no way to treat the condition. The practitioner must first examine whether the channels are deficient or replete, then trace and press them by hand, palpate them, and lightly flick them, observing their responses before inserting the needles. When the six channels are in harmony, this is called freedom from illness; even if illness is present, it will recover on its own. If one channel is replete above and deficient below, with Qi and blood unable to circulate, there must be an overabundance of transverse collaterals—side-running vessels—that obstruct the major channel. Once this is identified, drain away the pathogenic Qi. This is what is called “undoing the knot.”

When the upper body is cold and the lower body hot, first needle the Taiyang channel at the nape and retain the needles for a longer time. After needling, warm and rub the nape and shoulder blades so that the heat gathers and moves downward; stop once the aim is achieved. This is called “pushing upward.” When the upper body is hot and the lower body cold, examine the pulse where the channels are deficient and sunken, and treat the corresponding point. Stop once the Qi has descended. This is called “drawing downward.”

When the whole body is extremely hot and the patient is delirious, seeing, hearing, and saying things that are unreal, examine and treat the Foot Yangming channel and its major collateral: use supplementation if the pulse is deficient, and draining if the blood is abundant and replete. Have the patient lie on their back. Sit at the patient’s head, press the carotid arteries with four fingers of both hands, and hold for a while. Then curl the fingers, press firmly, and move downward to the supraclavicular hollow, repeating the earlier pressing method. Stop once the heat has subsided. This is called “pushing and dispersing.”

The Yellow Emperor asked, “Why can a single channel give rise to dozens of different illnesses—pain, swelling and abscesses, heat, cold, itching, numbness, or loss of sensation—with changes beyond counting?” Qibo replied, “All of these are caused by the invasion of pathogenic Qi.”

The Yellow Emperor asked: One kind of pulse condition can give rise to dozens of illnesses. At times there is pain; at times, boils; at times, fever or chills; at times, itching; and at times, paralysis or loss of sensation. Why does it change in so many ways?

Qibo replied: All these conditions are caused by pathogenic Qi.

The Yellow Emperor asked: I have heard of true Qi, upright Qi, and pathogenic Qi. What is true Qi?

Qibo replied: True Qi is the vital energy people receive from Heaven and Earth. Joined with grain Qi, which is generated from food and drink, it nourishes the whole body. Upright Qi is the normal wind that blows from a particular direction: it is neither a forceful, vigorous wind nor a deficient wind that takes advantage of weakness to invade. Pathogenic Qi is deficient wind that exploits a person’s weakness and harms the body. It penetrates deeply and cannot dissipate on its own. A normal wind penetrates only superficially; after it joins with the body’s Qi, it can disperse by itself. Its force is weak and cannot overcome true Qi, so it recedes on its own.

When deficient pathogenic Qi enters the body, it causes recurring chills, trembling, and raised hairs as the skin’s pores open. If it penetrates more deeply, invading the bones, it causes bone Bi (numbness and pain in the bones); invading the sinews, it causes them to contract and spasm. If it enters the vessels, it obstructs the flow of blood and forms swollen sores. When pathogenic Qi invades the muscles and contends with defensive Qi, the Yang Qi gaining the upper hand causes fever, while the Yin Qi gaining the upper hand causes chills. During chills, true Qi disperses; when it disperses, the body becomes weak, and weakness makes a person more susceptible to cold.

Pathogenic Qi lodged between the skin layers spreads outward, opening the pores and stirring the hairs. As Qi moves back and forth between the skin layers, it causes itching; if the pathogenic Qi remains lodged and does not disperse, it causes numbness. When defensive Qi does not circulate freely, a person loses sensation.

When pathogenic Qi (vital energy) from outside invades one side of the body and penetrates deeply, it lodges between the nutritive Qi and defensive Qi. As these two gradually weaken, the body’s true Qi disperses, leaving the pathogenic Qi to remain on its own. This gives rise to hemiplegia, a condition involving paralysis on one side of the body. If the pathogenic Qi penetrates only shallowly, pain occurs in the channels on one side.

Once pathogenic Qi has penetrated deeply into the body, Cold and Heat bind together. The pathogenic Qi lingers for a long time and attaches itself within the body. If Cold overcomes Heat, the bones become painful and the muscles waste away. If Heat overcomes Cold, the muscles decay and suppurate, eventually damaging the bones as well. When pathogenic Qi penetrates deeply and injures the bones, this is called bone erosion.

If pathogenic Qi attacks the front of a sinew, causing it to bend so that it cannot straighten, and remains there without dispersing, it forms a sinew accumulation—a pathological mass between the sinews. When a mass forms, Qi gathers there, and defensive Qi also remains trapped. If Body Fluids linger and congeal over time, an intestinal accumulation develops: a mass formed within the intestines. This may take several years to develop, and feels soft when pressed by hand.

Once an accumulation has formed, Qi and Body Fluids gather and remain within it. If pathogenic Qi then invades, the coagulation grows progressively more severe, and the parts join and cluster together, forming what the text calls a “xi tumor,” a type of tumorous accumulation. It feels hard when pressed by hand.

If an accumulation penetrates deep into the bones, Qi gathers there too. When bone and pathogenic Qi combine, the condition gradually enlarges and forms a bone abscess. If an accumulation lodges in the muscles, ancestral Qi—the primary Qi that sustains the body’s vital activities—gathers there, while pathogenic Qi remains and does not depart. If Heat is present, pus forms; without Heat, a muscle abscess develops.

The conditions caused by these pathogenic influences do not always arise in fixed locations, but each has its own established name.

Collected Commentaries on the Yellow Emperor’s Inner Classic: Numinous Pivot, Volume 21.