《黄帝内经灵枢集注》Vol. 5

At the passage on taking the pulse, juan 4, section 2 of the Jiayi jing reads “hold.”

6. The character “coarse”: juan 4, section 2 of the Jiayi jing reads “unblemished.”

7. The character “left”: the original reads “right”; changed to “left” on the basis of juan 12, section 6 of the Jiayi jing.

8. The character “valve”: the original reads “debate”; changed to “valve” on the basis of the Zhaofu Jujingtang edition.

9. The character “channel”: omitted from the original; supplied on the basis of the Zhaofu Jujingtang edition.

10. The character “limb”: the “Five Sections of Needling” chapter in juan 22 of the Taisu reads “branch.” The same applies below.

11. The character “dust”: the original reads “shake”; changed to “dust” on the basis of the Zhaofu Jujingtang edition.

12. The character “hong”: the Zhaofu Jujingtang edition has the character composed of the food radical and “hong.”

13. The character “ask”: the original reads “hear”; changed to “ask” on the basis of the Zhaofu Jujingtang edition.

14. The character “good”: the “Five Sections of Needling” chapter in juan 22 of the Taisu reads “speech.”

15. The character “blood”: the “Five Sections of Needling” chapter in juan 22 of the Taisu reads “water.”

16. The character “brittle”: the “Five Sections of Needling” chapter in juan 22 of the Taisu reads “deceitful.”

17. The character “blue-green”: the “Five Sections of Needling” chapter in juan 22 of the Taisu reads “dark blue.”

18. The character “skin”: the “Five Sections of Needling” chapter in juan 22 of the Taisu reads “flesh.”

19. The two characters “bianrong”: the “Treatise on the Six Qi” chapter of the Ling Shu reads “partial guest.”

20. The character “liu”: section 9 of juan 11 of the Jiayi jing reads “tumor.” The same applies to “intestinal liu” below.

21. The character “ju”: judging by the text’s conventions, this should read “tumor.” The same applies to “flesh ju” below.

Collected Annotations to the Yellow Emperor’s Inner Classic: Numinous Pivot, juan 22: “The Circulation of Defensive Qi,” chapter 76.

The Yellow Emperor asked Qibo, “I would like to understand how Defensive Qi, which moves along the body’s surface and protects the body, circulates inside and outside the body and alternates between them. How does it come together?”

Bogaō replied: A year has twelve months, and a day is divided into twelve double hours. Zi and Wu correspond to the meridian, while Mao and You correspond to the parallel. The celestial bodies make one circuit through the twenty-eight lunar lodges, with seven lodges in each quarter, making twenty-eight in all. The lodges from Fang to Bi belong to Yang, and those from Mao to Wei belong to Yin. Yang corresponds to daytime, and Yin to nighttime. Thus, Defensive Qi circulates through the whole body fifty times over the day and night: twenty-five times through the Yang regions by day, and twenty-five times through the Yin regions by night, passing through the five zang organs.

At dawn, its circulation through the Yin regions ends, and Yang Qi emerges from the eyes. When the eyes open, Defensive Qi rises to the head and descends along the neck and nape to the Foot Taiyang channel, then travels down the back to the tip of the little toe. One branch runs from the outer corner of the eye along the Hand Taiyang channel to the outer side of the little finger. Another runs from the outer corner of the eye along the Foot Shaoyang channel to the space between the fourth and little toes. A further branch descends along the course of the Hand Shaoyang channel to the little finger. Another branch rises to the area in front of the ear, joins the vessels of the jaw, and then flows into the Foot Yangming channel, descending to the top of the foot and entering the spaces between the five toes. A branch from below the ear descends along the Hand Yangming channel, enters the space between the thumb and index finger, and continues to the palm.

When Defensive Qi reaches the feet, it enters the soles and emerges below the inner ankles. It then circulates through the Yin regions and eventually reunites at the eyes, completing one circuit. The text’s statement that it “circulates through the whole body fifty times” divides its movement through the Yang and Yin regions according to day and night; the passage that follows describes in detail its route through the channels.

Thus, each time the Sun passes through one lunar mansion—a region of the sky defined by the ancient star divisions—the Qi of the human body circulates throughout the body once and another eight-tenths of a cycle. When the Sun passes through two mansions, the body’s Qi circulates three and six-tenths cycles; through three mansions, five and four-tenths cycles; through four mansions, seven and two-tenths cycles; through five mansions, nine cycles; through six mansions, ten and eight-tenths cycles; and through seven mansions, twelve and six-tenths cycles. When the Sun passes through fourteen mansions, the body’s Qi circulates twenty-five cycles, with a remainder.

Once the Yang Qi has completed its course, it enters the Yin aspect, where the Yin Qi takes over. As Yin Qi begins to enter the body, it usually flows through the Foot Shaoyin channel into the kidneys, then from the kidneys to the heart, from the heart to the lungs, from the lungs to the liver, from the liver to the spleen, and finally from the spleen back to the kidneys, completing a cycle.

Therefore, each time the Sun passes through one mansion at night, the body’s Qi circulates among the five viscera once and another eight-tenths of a cycle. As during the day, it completes twenty-five cycles over the course of the night, then joins with the eyes again. Over one full day-and-night cycle, the Yin and Yang Qi together leave a remainder of two-tenths of a cycle. The remainder in the Yang Qi’s circulation through the whole body and that in the Yin Qi’s circulation through the five viscera are also each two-tenths. This is why people sometimes wake early and sometimes go to sleep late: these remainders have yet to complete their course.

The Yellow Emperor asked: “Wei Qi, the defensive energy that circulates through the interior and exterior, and the upper and lower parts of the body, moves back and forth without fixed times. How should we observe its movement and then perform acupuncture?”

Bo Gao replied: “Day and night divide each day, and the length of daylight differs across the four seasons. Spring, autumn, winter, and summer therefore each follow their own corresponding patterns. In general, dawn marks the start of the day, and the end of night, when the sky grows light, is the time to begin counting. A full day and night thus comprises one hundred ke, with twenty-five ke equal to half a day. The cycle of time continues without interruption until sunset. Then the standard for counting is adjusted according to the length of day and night, and the right time for acupuncture is determined accordingly. Observe carefully when Qi moves, and treatment can succeed. If the moment is missed, or if one observes at odds with Qi’s movement, many illnesses will be difficult to cure.

“So, when needling an excess condition, insert the needle as Qi arrives; when needling a deficiency condition, wait until Qi has receded. This means that one must grasp when Qi is flourishing or waning, assess deficiency and excess, and then needle accordingly. Therefore, observe carefully where Qi is located and choose the right time to insert the needle. This is called ‘meeting the right time.’

“If the illness is in the Three Yang channels—the hand and foot Yang channels—one must wait until Wei Qi moves into the Yang aspect before needling. If the illness is in the Three Yin channels—the hand and foot Yin channels—one must wait until Wei Qi moves into the Yin aspect before needling.”

With each quarter-hour marked by the water clock, the body’s Qi moves through the Taiyang channel; at the second quarter-hour, it moves through the Shaoyang channel; at the third, through the Yangming channel; and at the fourth, into the Yin division, the region associated with the Yin channels. At the fifth quarter-hour, Qi returns to the Taiyang channel; at the sixth, it reaches the Shaoyang; at the seventh, the Yangming; and at the eighth, the Yin division. The sequence then repeats: at the ninth quarter-hour Qi reaches the Taiyang channel, at the tenth the Shaoyang, and at the eleventh the Yangming, while the fourth position remains the Yin division. Thus, the cycle repeats every four quarter-hours.

At the twenty-fifth quarter-hour, Qi moves through the Taiyang channel. This is the pattern for half a day’s circulation. From the mansion Fang to the mansion Bi, the Sun passes through fourteen lunar mansions. According to the text, as the Sun reaches each corresponding mansion, the body’s Qi moves along with it: as the Sun passes through one mansion, the body’s Qi in turn passes through the three Yang channels and the Yin division, in an unending cycle.

The general pattern is this: when the Sun passes through a given lunar mansion, the body’s Qi moves through the Taiyang channel; for each mansion the Sun traverses, the body’s Qi moves in succession through the three Yang channels and the Yin division. The movements of Heaven and Earth share a common cycle, turning and returning without end. In one day and night, the water clock marks one hundred quarter-hours.

From the day of the winter solstice, Taiyi—a deity named in ancient astronomy, calendrics, and divination—resides in the Palace of Hibernating Leaves for forty-six days. On the following day, it moves to the Palace of Heavenly Retention for forty-six days, then to the Palace of Granaries and Gates for forty-six days, the Palace of Yinluo for forty-five days, the Upper Heaven Palace for forty-six days, the Palace of Dark Authority for forty-six days, the Palace of Granaries and Fruit for forty-six days, and the Palace of Xinluo for forty-five days. It then returns to the Palace of Hibernating Leaves, and the winter solstice comes around again.

Taiyi travels through one palace each day. Starting from the Palace of Hibernating Leaves, where it resides on the winter solstice, it proceeds in order; after the ninth day, it returns to the first palace, and the cycle continues without end. Whenever Taiyi moves to another palace, the celestial signs respond with wind and rain. If wind and rain occur on that very day, they foretell a good harvest, peace among the people, and fewer illnesses. If they come too early, rainfall will be excessive; if they come too late, drought is likely.

An anomaly at Taiyi’s position on the winter solstice concerns the ruler; one on the spring equinox concerns the prime minister; one on the day Taiyi occupies the central palace concerns officials; one on the autumn equinox concerns military commanders; and one on the summer solstice concerns the people. An “anomaly” means that, while Taiyi occupies one of the five palaces, a violent wind arises, breaking trees and lifting sand and stones. One should judge status, fortune, and misfortune according to those governed by each palace, and make predictions by observing the direction from which the wind blows.

A wind blowing from the direction where Taiyi resides is called a “substantial wind.” It signifies growth and nourishes all things. A wind blowing from the opposite direction is called an “insubstantial wind.” It harms the human body and signifies killing and injury. One must therefore watch carefully for insubstantial winds and avoid them. The sage evades winds of evil influence as if dodging flying arrows and stones; in this way, harmful Qi cannot injure the body.

Therefore, once the Great One (Taiyi, an ancient concept representing the center of the celestial movements) moves into the Central Palace and takes up residence there, it surveys the winds arriving from the eight directions and uses them to divine good and ill fortune.

The wind from the south is called the “Great Weak Wind.” Once it enters the body, it injures the Heart internally and affects the vessels externally, chiefly bringing Heat pathogen. The wind from the southwest is called the “Intriguing Wind.” It injures the Spleen internally and affects the muscles externally, readily leaving a person weakened. The wind from the west is called the “Firm Wind.” It injures the Lung internally and affects the skin externally, chiefly bringing Dryness pathogen. The wind from the northwest is called the “Breaking Wind.” It injures the Small Intestine internally and affects the Hand Taiyang channel externally. When the channel Qi becomes disordered, it may spill outward; when the channel pathways become blocked, the Qi may congeal and fail to flow, potentially causing sudden death. The wind from the north is called the “Great Firm Wind.” It injures the Kidney internally and affects the bones and the back muscles beside the spine externally, chiefly bringing Cold pathogen. The wind from the northeast is called the “Fierce Wind.” It injures the Large Intestine internally and affects the flanks, armpits, and joints of the limbs externally. The wind from the east is called the “Infant Wind.” It injures the Liver internally and affects the sinews and their junctions externally, chiefly subjecting the body to Dampness. The wind from the southeast is called the “Weak Wind.” It injures the Stomach internally and affects the muscles externally, readily making the body feel heavy.

These winds from the eight directions cause illness only when they enter through places where the body is weak. When three factors of weakness coincide, they may bring on an acute illness or even sudden death. When “two are replete and one is deficient,” disorders such as persistent urinary dribbling and alternating chills and fever may arise. If the person is also in a rainy, damp environment, they may develop atrophy syndrome, in which the limbs become weak and difficult to move. Thus, the sages avoid pathogenic wind as they would flying arrows and stones. If a person is struck by pathogenic wind while in a state of threefold deficiency, they may suddenly collapse or become paralyzed on one side of the body.

The theory of the nine needles is vast and profound. I have heard my teacher explain it, yet I still do not fully understand. Where did the nine needles come from, and why were they named this way?

Qibo replied: The nine needles take their model from the great numbers governing the movement of Heaven and Earth, beginning with one and ending with nine. The first takes its model from Heaven, the second from Earth, the third from humanity, the fourth from the four seasons, the fifth from musical pitch, the sixth from the laws and measures, the seventh from the stars, the eighth from the wind, and the ninth from the open country.

The Yellow Emperor asked: How do the needles correspond to the number nine?

Qibo replied: The sages worked out the numbers of Heaven and Earth from one to nine and used them to divide the Nine Regions—the ancient division of the space of Heaven and Earth into nine areas. They then multiplied nine by nine to obtain eighty-one, which they used to determine the number of the Yellow Bell, the foundational pitch in ancient musical theory. The number and design of the needles correspond to these same principles of number.

The first corresponds to Heaven. Heaven belongs to Yang. Among the five Zang organs, the Lung corresponds to Heaven. The Lung covers the five Zang and six Fu organs; the skin is associated with the Lung and also belongs to the Yang aspect of the body. Thus, this needle should have a large head and a sharp tip, so that it does not pierce too deeply and can disperse Yang Qi.

The second corresponds to Earth. The part of the human body that corresponds to the ground is the flesh. Thus, this needle should have a hollow shaft and a rounded, blunt tip, so that it does not injure the flesh. If the flesh is injured, Qi will be depleted.

The third corresponds to humanity. The human body depends on the blood vessels to sustain life. Thus, this needle should have a relatively thick shaft and a rounded, blunt tip, so that it can press against the vessels without piercing deeply. In this way, it guides Qi as it moves and allows pathogenic Qi to be expelled on its own.

The fourth corresponds to the four seasons. Seasonal influences and winds from the eight directions may invade the meridians and cause stubborn, long-lasting illnesses. Thus, this needle should have a hollow shaft and a sharp tip, so that it can drain pathogenic heat and release stagnant blood, allowing these chronic illnesses to be expelled.

The fourth needling method corresponds to “time.” Here, “time” refers to the pathogenic influences of the four seasons and the winds from the eight directions invading the channels and collaterals. When they remain there for a long time, they create stubborn illnesses. Treatment calls for a hollow needle with a sharp tip, which can draw out pathogenic heat and blood and expel the entrenched illness-causing influences.

The fifth needling method corresponds to “sound.” Here, “sound” refers to the boundary between winter and summer, marked by Zi and Wu, where Yin and Yang divide. When cold and heat contend and the two kinds of Qi bind together, abscesses filled with pus form. Treatment calls for a needle with a tip like a sword’s edge, so that large amounts of pus can be drained.

The sixth needling method corresponds to “pitch.” “Pitch” refers to harmonizing Yin and Yang with the four seasons so that they accord with the twelve channels. When a lurking pathogenic influence enters the channels, it can cause sudden attacks of Bi disease—pain, numbness, and similar symptoms caused by obstruction in the channels. The needle tip should therefore be rounded and sharp like a fine hair, with the middle of the shaft slightly thicker, to drive out the suddenly arising pathogenic influence.

The seventh needling method corresponds to “stars.” “Stars” refers to the seven openings of the human body: the two eyes, two ears, two nostrils, and mouth. When a pathogenic influence enters the channels and remains in the network vessels, it causes pain and Bi disease. Treatment calls for a needle with a tip as fine as a mosquito’s mouthpart. Insert it steadily and slowly, then leave it in gently for a longer time to restore the body’s vital Qi and expel both the true and the pathogenic influences. After removing the needle, the patient should also be nursed back to health.

The eighth needling method corresponds to “wind.” “Wind” refers to the eight joints of the thighs and arms. When unruly winds from the eight directions injure a person, they penetrate deep into the spaces between the bones, the joints of the lower back and upper back, and the spaces between the skin’s fine patterns. This creates severe Bi disease. The needle should therefore have a long shaft and a sharp tip, enabling it to dispel pathogenic Bi influences lodged deep within and far from the surface.

The ninth needling method corresponds to “wilderness.” “Wilderness” refers to the meeting points of the body’s joints and the spaces between the skin. When an excessive pathogenic influence spreads throughout the body, like wind and water mingling, it causes severe Bi disease. The needle should therefore have a long shaft and a sharp tip, to dispel pathogenic Bi influences lodged deep within and far from the surface.

“Number nine” refers to the “wild,” the area between the body’s joints and beneath the skin. Evil Qi spreads and flows through the body like wind stirring water, but when it reaches this area, it cannot pass the major joints. For this purpose, the ninth kind of needle was made. Its tip resembles a straight needle shaft, with a slightly rounded point. It is used to draw out great Qi that has become lodged at the joints and cannot pass through.

The Yellow Emperor asked, “Are there set measurements for the lengths of the needles?” Qibo replied:

The first kind is called the chān needle, used for shallow needling. Modeled on the jin needle, its end is cut off by one and a half inches, leaving a sharply pointed tip. It is one inch and six fen long, and is mainly used to treat heat conditions of the head and body.

The second kind is called the yuán needle, or round-headed needle. Modeled on the xu needle, it has a tubular shaft and a blunt, rounded tip. It is one inch and six fen long, and is mainly used to treat Qi disorders in the boundaries between the muscles.

The third kind is called the dī needle, used for pressing. Its tip resembles the point of a millet grain, and it is three and a half inches long. It is mainly used to press the channels and vessels, draw forth channel Qi, and guide evil Qi out of the body.

The fourth kind is called the fēng needle, or bladed needle. Modeled on the xu needle, it has a tubular shaft and a sharp end. It is one inch and six fen long, and is mainly used to bleed heat conditions in sores and swellings.

The fifth kind is called the pí needle, or broad-bladed needle. Shaped like a sword point, it is two and a half fen wide and four inches long. It is mainly used to treat large sores and swellings, as well as abscesses caused by heat evils struggling within the body.

The sixth kind is called the yuánlì needle. Modeled on the máo needle, it has a slightly thick tip and a slender shaft, making it suitable for deep needling. It is one inch and six fen long, and is mainly used to treat sores and swellings, and bì conditions in which the flow of Qi and blood is obstructed, causing pain or numbness in the limbs.

The seventh kind is called the háo needle, or fine needle. Shaped like a fine hair, it is one inch and six fen long. It is mainly used to treat cold, heat, pain, and bì conditions in the channels and vessels.

The eighth kind is called the long needle. Modeled on the qí needle, it is seven inches long and is mainly used to treat evil Qi that has penetrated deep into the body and bì conditions located deep within.

The ninth kind is called the great needle. Modeled on the fēng needle, it has a slightly rounded tip and is four inches long. It is mainly used to draw out great Qi that has become lodged at the joints and cannot pass through.

The forms of the nine kinds of needles have now been described. These are the prescribed measurements for their sizes and lengths.

The Yellow Emperor asked, “How do the human body and the Nine Fields correspond to one another?”

Qibo replied, “The left foot corresponds to the Beginning of Spring, and its associated days are Wuyin and Jichou. The left flank corresponds to the Spring Equinox and to the day Yimao. The left hand corresponds to the Beginning of Summer and to the days Wuchen and Jisi. The chest, throat, and head correspond to the Summer Solstice and to the day Bingwu. The right hand corresponds to the Beginning of Autumn and to the days Wushen and Jiwei. The right flank corresponds to the Autumn Equinox and to the day Xinyou. The right foot corresponds to the Beginning of Winter and to the days Wuxu and Jihai. The waist, buttocks, and lower orifices correspond to the Winter Solstice and to the day Renzi. The six viscera and the three organs below the diaphragm correspond to the central region.

“These are all days that require special avoidance, especially the days when Taiyi resides and the WU and Ji days. Carefully observe where the Eight Directions (the directions of the eight seasonal nodes) lie. If a carbuncle or swelling appears on the left, right, upper, or lower part of the body corresponding to one of these directions, do not make an incision to drain it on the day associated with that part. Such a day is called a ‘Heavenly Taboo Day’—a day to avoid in accordance with the timing of Heaven.

“Different states of body and mind make illness more likely to arise in different parts of the body, and each calls for a different treatment. When the body is at ease but the mind is troubled, illness is likely to affect the vessels; moxibustion or acupuncture may be used. When the body is weary but the mind is cheerful, illness is likely to affect the sinews; it may be treated with warming applications, stretching, and similar methods. When both body and mind are at ease and cheerful, illness is likely to affect the muscles; needles or stone lancets may be used. When both body and mind are distressed, illness is likely to affect the throat; sweet-tasting medicines may be used. Frequent shock and fear can obstruct the sinews and vessels, possibly causing numbness and loss of sensation; massage and medicinal wine may help.

“The symptoms that reveal changes in the Qi of the five viscera are these: disturbances of Heart Qi commonly cause belching; disturbances of Lung Qi commonly cause coughing; disturbances of Liver Qi commonly cause excessive speech; disturbances of Spleen Qi commonly cause repeated swallowing; and disturbances of Kidney Qi commonly cause yawning.

“The symptoms that reveal changes in the Qi of the six bowels are these: Gallbladder Qi is associated with anger; when Stomach Qi is disordered, it may rise upward and cause hiccups; dysfunction of the large and small intestines may cause diarrhea; when the Bladder loses its ability to restrain urination, there may be involuntary urination; and when fluids overflow in the Lower Burner, edema may occur.”

Each of the five flavors enters a different organ: sour enters the liver, pungent the lungs, bitter the heart, sweet the spleen, salty the kidneys, and bland the stomach. This is the correspondence between the five flavors and the internal organs.

When Jing and Qi gather in different organs, they give rise to different emotions: when they gather in the liver, there is worry; in the heart, joy; in the lungs, sorrow; in the kidneys, fear; and in the spleen, apprehension. These are the emotional changes that arise when Jing and Qi accumulate excessively in the five organs.

Each of the five organs has a climate it dislikes: the liver dislikes wind, the heart heat, the lungs cold, the kidneys dryness, and the spleen dampness. These are the external conditions disliked by the Qi of the five organs.

Each organ governs a bodily fluid: the heart governs sweat, the liver tears, the lungs nasal mucus, the kidneys saliva, and the spleen drool—the thicker fluid in the mouth. These are the bodily fluids associated with the five organs.

The Qi of each organ has its own aversion: the heart dislikes heat, the lungs cold, the kidneys dryness, and the spleen dampness. The heart, lungs, kidneys, and spleen are each unsuited to these climatic extremes.

Each of the five organs governs a bodily fluid: the heart governs sweat, the liver tears, the lungs nasal mucus, the kidneys saliva, and the spleen drool. These are the sources of the five fluids.

Five kinds of prolonged exertion damage different parts of the body: prolonged looking damages the blood, prolonged lying down damages Qi, prolonged sitting damages the muscles, prolonged standing damages the bones, and prolonged walking damages the sinews. These are the harms caused by the five forms of sustained exertion.

Each of the five flavors has a particular effect: sour acts on the sinews, pungent on Qi, bitter on the blood, salty on the bones, and sweet on the muscles. This is called the “five directions of action.”

The dietary prohibitions for five kinds of illness are as follows: when the sinews are ill, one should avoid sour flavors; when Qi is ill, pungent flavors; when the bones are ill, salty flavors; when the blood is ill, bitter flavors; and when the muscles are ill, sweet flavors. Even if one craves these foods, one should not eat too much, but should exercise restraint. This is called the “five restraints.”

The patterns of onset for five kinds of illness are as follows: Yin illnesses arise in the bones, while Yang illnesses arise in the blood. The five flavors can be used to regulate changes in Qi. Yang illnesses tend to occur in winter, and Yin illnesses in summer.

When the five kinds of pathogenic Qi enter the body, they can cause different disorders. If pathogenic Qi enters the Yang aspect, it may cause mania; if it enters the Yin aspect, it may cause blood impediment, a disorder in which the movement of Qi and blood is obstructed and the limbs become numb. When pathogenic Qi enters the Yang aspect and transforms, it may cause epilepsy; when it enters the Yin aspect and transforms, it may cause loss of speech. When pathogenic Qi from the Yang aspect enters the Yin aspect, the patient appears quiet; when pathogenic Qi from the Yin aspect moves outward into the Yang aspect, the patient is prone to joy and anger.

Disorders associated with the five organs include the following: when the heart is afflicted by pathogenic influences, mania may result; when pathogenic Qi enters the Yin aspect, it may cause blood impediment; when it enters the Yang aspect and transforms, it may cause epilepsy; and when it enters the Yin aspect and transforms, it may cause loss of speech. When pathogenic Qi from the Yang aspect enters the Yin aspect, the patient appears quiet; when pathogenic Qi from the Yin aspect moves outward into the Yang aspect, the patient is prone to joy and anger.

The five zang organs each store different aspects of mental activity: the heart stores Shen (spirit), the lungs store Po (corporeal soul), the liver stores Hun (ethereal soul), the spleen stores intention, and the kidneys store Jing (essence) and resolve. In traditional Chinese medical theory, these terms refer respectively to the mind, perception, instinctive activity, thought, and will.

Each of the five zang organs governs a part of the body: the heart governs the vessels, the lungs the skin, the liver the sinews, the spleen the muscles, and the kidneys the bones.

The six channels differ in the relative abundance of Qi and blood. The Yangming channels have abundant Qi and blood; the Taiyang channels have abundant blood and little Qi; the Shaoyang channels have abundant Qi and little blood; the Taiyin and Jueyin channels have abundant blood and little Qi; and the Shaoyin channels have abundant Qi and little blood. Accordingly, needling each channel calls for particular care in drawing blood and dispersing Qi. Needling the Yangming channels may release both blood and Qi. When needling the Taiyang, Taiyin, and Jueyin channels, blood may be released, but Qi should not be harmed. When needling the Shaoyang and Shaoyin channels, Qi may be dispersed, but blood should not be harmed.

The three Yin-Yang channel pairs of the foot are interior-exterior pairs: Foot Yangming pairs with Foot Taiyin, Foot Shaoyang with Foot Jueyin, and Foot Taiyang with Foot Shaoyin. These are the paired Yin and Yang channels of the foot. The hand likewise has three pairs: Hand Yangming pairs with Hand Taiyin, Hand Shaoyang with Hand Jueyin (the Heart Master, or Pericardium channel), and Hand Taiyang with Hand Shaoyin. These are the paired Yin and Yang channels of the hand.

Notes on pronunciation and textual variants: “tong” is the reading for one variant character, and “di” for another. One version has “bu zhen” where another reads “jin zhen.” “Cou” is the reading for “wu zou,” while the “Huangdi Neijing Suwen” reads “wu jin” where another version has “wu cai.” Variant readings and emendations in the classic text have been established with reference to editions such as the “Huangdi Neijing Taisu” and the “Zhenjiu Jiayi Jing.”

5. The graph “san” originally read “er.” It has been emended on the basis of “Wei Fifty Cycles” in juan 12 of the Taisu.

6. The graph “er” originally read “si.” It has been emended on the basis of “Wei Fifty Cycles” in juan 12 of the Taisu.

7. The graph “er” originally read “si.” It has been emended on the basis of “Wei Fifty Cycles” in juan 12 of the Taisu.

8. The phrase “bu yi qi” appears in juan 1, chapter 9 of the Jiayi jing as “wu ji qi.” The graph “qi” should be read together with the following text.

9. The graph “bing” was missing from the original text. It has been supplied on the basis of “Wei Fifty Cycles” in juan 12 of the Taisu.

10. The graph “yi” originally read “er.” It has been emended on the basis of the Zhaofu Jujingtang edition.

11. The phrase “ri xing ban du” appears in juan 1, chapter 9 of the Jiayi jing as “jian ri zhi du ye.” The following eighteen graphs are also added there: “From Ang to Xin, it likewise makes fourteen conjunctions; when the water has descended fifty ke, the day’s cycle is complete.”

12. “Shang tian” originally read “tian guan.” It has been emended on the basis of “Nine Palaces and Eight Winds” in juan 28 of the Taisu.

13. The graph “han” originally read “han” (with the meaning “sweat”). It has been emended on the basis of “Nine Palaces and Eight Winds” in juan 28 of the Taisu.

14. The graph “zai” originally read “you.” It has been emended on the basis of the Zhaofu Jujingtang edition.

15. The graph “gu” originally read “liu.” It has been emended on the basis of chapter 2 of juan 5 of the Jiayi jing.

16. In the Zhaofu Jujingtang edition, the graph “qi” reads “gu.”

17. The graph “jian” originally consisted of the two graphs “xiao da.” It has been emended on the basis of the Zhaofu Jujingtang edition.

18. The graph “shou” originally read “mao.” It has been emended on the basis of the Zhaofu Jujingtang edition.

19. The passage containing the graph “xing” reads “wu xing zhi ye” in chapter 2 of juan 6 of the Jiayi jing.

20. In the Zhaofu Jujingtang edition, the graph “duo” reads “shao.”

Huangdi Neijing Lingshu Jijie, juan 23: “Treatise on the Year’s Dew,” chapter 79.

The Yellow Emperor asked Qibo, “The medical classics say that if someone is exposed to summer heat, they will develop malaria in autumn. Why does malaria recur at regular intervals?”

Qibo replied, “The pathogenic influence enters at Fengfu, an acupoint at the back of the neck, then travels down along the spine. The Defensive Qi, the body’s protective vital energy, converges at Fengfu once each day and night. On the following day, the Defensive Qi moves down one section of the spine, so the malaria attack begins later each day. The pathogenic influence first remains in the back. Each time the Defensive Qi reaches Fengfu, the interstices—the spaces between the skin and muscles, including the pores—open. Once they open, the pathogenic influence takes the opportunity to enter and the illness breaks out. This is why the attacks grow progressively later.

“Each day, the Defensive Qi moves down one section from Fengfu. After twenty-one days, it reaches the coccyx, the end of the tailbone. On the twenty-second day, it enters the interior of the spine and flows into the Hidden Chong Vessel, a channel concealed deep within the body. After traveling for another nine days, it emerges at Quepen, the hollow above the collarbone. From then on, the pathogenic influence moves upward and the illness gradually worsens. It surges through the body and attacks the Five Zang organs, while also spreading sideways to involve the Muyuán, the deep region between the organs. Because its route is long and its position deep, the pathogenic influence moves slowly and cannot cause an attack each day. The attack comes only the next day, after it has accumulated.”

The Yellow Emperor asked, “Each time the Defensive Qi reaches Fengfu, the interstices open and the pathogenic influence takes the opportunity to enter. But if the Defensive Qi moves down one section every day, it will no longer reach Fengfu exactly. What happens then?”

Qibo replied, “The location of Fengfu is not fixed. Wherever the Defensive Qi meets the pathogenic influence, the interstices will open. The section where the Qi comes to rest is Fengfu.”

The Yellow Emperor said, “Well explained. Wind pathogen and malaria pathogen belong to the same category. Yet wind pathogen often remains in the body, while malaria breaks out only at regular intervals and subsides in between. Why is this?”

Qibo replied, “Wind pathogen remains where it first lodged. Malaria pathogen, by contrast, travels downward along the channels and surges through the organs deep inside the body. The malaria attack therefore occurs only when the Defensive Qi reaches the place corresponding to the pathogenic influence.”

The Yellow Emperor said, “Well explained.”

The Yellow Emperor asked Shaoshi: “I have heard that the climate of the four seasons and the winds from the eight directions affect the human body. When the weather is cold, the skin contracts and the interstices (the textures and pores between skin and muscle) close. When the weather is hot, the skin relaxes and the interstices open. Do harmful external winds and pathogenic influences enter the body because of this? Or can they injure people only when the untimely, deficiency-exploiting pathogenic influences of the eight directions arise?”

Shaoshi replied: “That is not so. Harmful external winds and pathogenic influences do not attack the body only at particular times, but they do enter when the interstices are open. If they penetrate deeply, they reach far into the body; the illness is severe and comes on suddenly. If they invade while the interstices are closed, they enter only shallowly and remain at the body’s surface, so the illness develops slowly and late.”

The Yellow Emperor asked again: “Sometimes the cold and heat are moderate, and the interstices are not open, yet a person suddenly falls ill. Why?”

Shaoshi replied: “Does Your Majesty not know that pathogenic influences also take advantage of a person’s vulnerability? Even in ordinary times, the opening and closing, relaxing and tightening of the interstices are always changing.”

The Yellow Emperor asked: “Can you explain this to me?”

Shaoshi said: “Human beings are linked with Heaven and Earth and respond to the movements of the sun and moon. When the moon is full, the sea’s waters swell in the west. The body’s Qi and blood are abundant, the muscles full, the skin firm, and the body hair strong. The interstices are closed, and grime on the skin clings firmly and does not come away easily. Even if a person encounters a harmful external wind then, its pathogenic influence penetrates only shallowly and does not go deep.

“When the moon wanes, the sea’s waters swell in the east. The body’s Qi and blood are weak, the defensive Qi (the Qi that protects the body and repels external pathogenic influences) disperses, and the body loses its protection. The muscles diminish, the skin slackens, the interstices open, the body hair becomes weak, the surface textures of the skin grow thin, and grime comes away easily. If a person encounters a harmful external wind then, its pathogenic influence can penetrate deeply, and the illness comes on suddenly.”

The Yellow Emperor asked, “Why do some people suddenly die or fall gravely ill?” The Lesser Master replied, “When the Three Deficiencies come together, people are prone to sudden illness or even death. When the Three Abundances are present, pathogenic influences have difficulty harming them.”

The Yellow Emperor asked him to explain the Three Deficiencies. The Lesser Master said, “A person’s vital force is in a year of decline; the month’s influence is depleted; the season is out of harmony; and then the person is struck by a harmful wind—an abnormal wind that may cause illness. These are the Three Deficiencies. Thus, a physician who does not understand the Three Deficiencies will diagnose and treat carelessly.”

The Yellow Emperor then asked him to explain the Three Abundances. The Lesser Master said, “A person’s vital force is in a year of strength; the month’s influence is abundant; and the season is in harmony. Even if that person is struck by a harmful wind or other pathogenic influence, they will not suffer serious harm.”

The Yellow Emperor praised this clear and thorough account, asked that it be treasured in the Golden Casket—a case for preserving important documents—and named it “The Three Abundances.” Yet this account concerns only the condition of an individual.

The Yellow Emperor then asked, “Why do some illnesses spread widely among people in the same year?”

The Yellow Emperor asked, “Why do people suffer from the same illnesses each year? What causes this?”

Shao Shi replied, “This follows the pattern of changes in the vital energies of the eight directions. To observe this pattern, one usually looks to the day of the Winter Solstice. Taiyi, an ancient name for a deity used to mark the direction of the heavens and the season, is then in the Palace of Hibernating Things, the direction associated with the Winter Solstice. When Taiyi arrives, the heavens must respond with wind and rain.

“If wind and rain come from the south, they are deficient winds—winds out of season that can readily harm people—and they injure the human body. If they arrive in the middle of the night, the people are asleep and escape their attack, so fewer fall ill that year. If they arrive during the day, people are less on their guard and more easily struck by deficient winds, so more fall ill.

“Deficient pathogenic influences enter the bones but do not immediately manifest at the body’s surface. When the Beginning of Spring arrives, Yang energy grows strong and the interstices between skin and muscle open, giving the influences an opportunity to penetrate. If a wind from the west blows on the day of the Beginning of Spring, the people are struck by deficient winds once more. The two pathogenic influences interact, causing the Qi in the channels to stagnate and become disordered.

“Years in which people are struck by this kind of wind and rain are called ‘years of encountering the dew.’ When the year is harmonious, there are fewer harmful winds, and fewer people fall ill or die. When a year brings many harmful winds and pathogenic influences, and cold and heat are out of balance, many people fall ill and deaths increase.”

The Yellow Emperor asked: When pathogenic winds from deficiency attack the body as its vital energy is weakened, are there patterns in how many people are harmed and how severely? How can we observe and judge this?

Shao Shi replied: On the first day of the first lunar month, if Taiyi, an ancient star deity, is in the Tianliu Palace, and a northwest wind blows without rain, many people will die. If a north wind blows at dawn on that day, many people will die in spring. If it blows only at dawn, many people will fall ill—about three in ten. If a north wind blows at midday, many people will die in summer; if it blows in the evening, many will die in autumn. If the north wind blows all day, as many as six in ten may die of serious illness.

On the first day of the first lunar month, a wind from the south is called “Zaoxiang”; one from the west is called “Baigu.” These foretell disaster for the state and the deaths of many people. If a wind from the east is strong enough to lift roofs and scatter sand and stones, great disaster will befall the state. A wind from the southeast foretells deaths in spring.

If the weather is mild and windless on the first day of the first lunar month, grain prices will be low and few people will fall ill. If the weather is cold and windy, grain prices will be high and many people will fall ill. These are the signs used to observe the year’s prospects and judge whether the wind will harm people.

If there is no wind on a day marked Chou in the second lunar month, people are prone to illnesses of the heart and abdomen. If the weather is not warm on a day marked Xu in the third lunar month, illnesses involving alternating chills and fever are likely. If the weather is not hot on a day marked Si in the fourth lunar month, febrile illnesses known as dan may occur. If the weather is not cold on a day marked Shen in the tenth lunar month, people are prone to sudden death. The winds referred to here are all strong enough to lift roofs, break trees, and scatter sand and stones, making people’s body hair stand on end and their pores open.

The character “xi” is pronounced “qi ni qie.”

The Yellow Emperor asked Qibo, “I once climbed the Qingling Terrace. When I reached the middle of the steps, I looked back. As I crawled farther upward, I suddenly felt confused and disoriented. I wondered about it in private and felt a quiet doubt, so I closed and opened my eyes on my own, steadied my spirit, and regulated my breathing. After a long time, I still did not understand what was happening, while my head and eyes began to spin and grow dizzy. I let my hair down, knelt upright, and lowered my head to look. After a long time, the dizziness still had not stopped, but then it suddenly went away on its own. What kind of Qi caused this?”

Qibo replied, “The essence of the five zang organs and six fu organs is all conveyed upward to the eyes, forming the eyes’ essential Qi. The eyes are where this essential Qi gathers: the essence of the bones forms the pupils; the essence of the sinews forms the irises; the essence of the blood forms the eye’s vessels; the essence of Qi forms the whites of the eyes; and the essence of the flesh forms the eyelids and the tissues surrounding and supporting the eyeballs. Within these tissues, the essences of the sinews, bones, blood, and Qi come together and connect with the channels. The channels extend upward to the brain and emerge behind, at the nape of the neck.

“So when pathogenic Qi attacks the nape and the body is also weakened, if the invasion goes deep, it can travel along the connections of the eyes and enter the brain. When pathogenic Qi enters the brain, the brain spins. As it spins, it pulls on the vessels of the eyes and makes them tense. When those vessels tense, a person feels that everything before their eyes is spinning, and becomes dizzy. If pathogenic Qi injures the eyes’ essential Qi, preventing it from harmonizing and joining together, it becomes scattered. When the essential Qi is scattered, objects appear doubled, and a person sees two images.

“The eyes are where the essence of the five zang and six fu organs gathers. They are also where Nutritive Qi, Defensive Qi, the hun, and the po regularly circulate, and where spirit Qi arises and becomes manifest. Therefore, when the spirit is exhausted, the hun and po become scattered, and the mind and intentions grow confused. The pupils and irises correspond to Yin; the whites of the eyes and the red vessels correspond to Yang. Only when Yin and Yang combine and circulate can the eyes see clearly.

“The eyes are governed by the heart-mind, and the heart is the dwelling place of the spirit. So when spirit Qi and essential Qi become disordered, the eyes can no longer move normally. When someone suddenly sees strange sights, it is because the spirit, hun, and po have become scattered and can no longer work in harmony. This is called ‘bewilderment.’”

The Yellow Emperor said, “I suspect the matter is like this. Whenever I go to the Eastern Garden, I often become confused; after leaving the garden, the confusion disappears. Is it only in the Eastern Garden that my spirit becomes fatigued? Why is this so strange?”

Qibo said, “It is not so. A person’s heart may be drawn to something, while the spirit may recoil from it. When the two suddenly interfere with one another, Jing and Qi become disordered and perception is thrown into confusion, so the person feels bewildered. Once the spirit’s activity returns to normal, the confusion disappears. A mild case is called being lost; a severe one is called bewilderment.”

The Yellow Emperor asked, “What movement of Qi causes people to forget things easily?”

Qibo said, “Qi in the upper part of the body is deficient, while Qi in the lower part is excessive. The intestines and stomach are full, while the heart and lungs are weak. When the heart and lungs are weak, Nutritive Qi and Defensive Qi—the Qi that circulates within and around the body and sustains its vital activity—remain in the lower part. After a long time, they fail to rise at their proper times, and so the person forgets things easily.”

The Yellow Emperor asked, “What movement of Qi causes people to feel hungry easily but have no desire to eat?”

Qibo said, “Jing and Qi gather in the spleen, while heat remains in the stomach. Heat in the stomach makes food digest quickly, and so the person feels hungry easily. When stomach Qi flows upward in counterflow, the area around the stomach’s upper opening is cold, and so the person has no desire to eat.”

The Yellow Emperor asked, “What movement of Qi causes people who are ill to be unable to sleep?”

Qibo said, “Defensive Qi cannot enter the Yin aspect—the body’s inner, Yin side—and remains in the Yang aspect, the body’s outer, Yang side. When Defensive Qi remains in the Yang aspect, Yang Qi becomes abundant; when Yang Qi is abundant, the Yang Heel Vessel, a channel associated with bodily activity and sleep, becomes vigorous. Defensive Qi cannot enter the Yin aspect, and Yin Qi is therefore deficient, so the eyes cannot close and the person cannot sleep.”

The Yellow Emperor asked, “What movement of Qi causes people with an eye ailment to be unable to see?”

Qibo said, “Defensive Qi remains in the Yin aspect and cannot circulate to the Yang aspect. When Defensive Qi remains in the Yin aspect, Yin Qi becomes abundant; when Yin Qi is abundant, the Yin Heel Vessel, a channel associated with bodily activity and sleep, becomes full. Defensive Qi cannot enter the Yang aspect, and Yang Qi is therefore deficient, so the eyes close.”

The Yellow Emperor asked, “Why are some people especially prone to sleep?”

Qi Bo replied, “This is because their stomach and intestines are large, their skin is rough and tight, and the spaces between their muscles are not sufficiently relaxed. When the stomach and intestines are large, Defensive Qi (the Qi that circulates through the body’s interior and exterior and maintains its protective functions) stays in place longer. Rough, tight skin and unrelaxed muscles also slow its circulation.

“During the day, Defensive Qi generally circulates on the body’s exterior; at night, it circulates within. When Yang Qi has completed its course, a person falls asleep; when Yin Qi has completed its course, the person wakes. Large stomach and intestines, rough, tight skin, and unrelaxed muscles slow the circulation of Defensive Qi and keep it inside the body longer. Its circulating Qi is then insufficient, and the person easily becomes drowsy and sleeps a great deal. By contrast, when the stomach and intestines are small, the skin is smooth and relaxed, and the muscles are supple, Defensive Qi stays on the body’s exterior longer, so the person is less prone to drowsiness.

“The Yellow Emperor asked again, ‘If this is not someone’s usual condition, but they suddenly become excessively sleepy, what kind of Qi causes it?’

“Qi Bo replied, ‘Evil Qi lodged in the Upper Burner (the region above the diaphragm) blocks it and prevents it from flowing freely. After eating or drinking hot soup, Defensive Qi then remains inside the body for a long time and cannot circulate normally, causing the person to become suddenly and excessively sleepy.’

“The Yellow Emperor asked, ‘Well said. How should this Evil Qi be treated?’

“Qi Bo replied, ‘First examine the relevant viscera, remove any mild pathogenic influence, and then regulate the movement of Qi. When Qi is excessive, use draining; when Qi is deficient, use supplementation. Before treatment, you must understand the patient’s physical condition and whether their emotional state is troubled or at ease, and then determine the appropriate method.’”

The Yellow Emperor said: I have heard that after the stomach and intestines receive food and drink, the qi generated in the Upper Burner—the part of the body above the diaphragm that governs breathing and qi—warms the muscles, nourishes the bones and joints, and opens the interstices, the textures and pores between the skin and muscles. The qi generated in the Middle Burner—the part between the chest and abdomen that governs digestion and absorption—is like dew. It rises to the ravines, the hollows between the muscles, and seeps into the minute vessels. The fluids harmonize and, through transformation, become red blood. When blood and qi are in harmony, the minute vessels fill first and then flow into the connecting vessels. Once these are full, the flow enters the main channels.

When the Yin and Yang channels are full, qi and blood circulate with the breath. Their movement follows established channel pathways and rhythms, flowing without end in accord with the movement of Heaven and Earth, never ceasing. In diagnosis and treatment, one must respond to deficiency and excess: draining is used for excess patterns. Excessive draining can deplete the body’s vital qi; needling too abruptly can weaken qi; and retaining the needles can disrupt the proper sequence of qi and blood circulation. Drain excess patterns and supplement deficient ones. Yet excessive supplementation can also leave qi and blood in surplus. Only when blood and qi are harmonized can the body and its qi activity remain normal.

I already understand the states in which blood and qi are harmonious or disordered. But I still do not know how abscesses and sores arise, when they form or disperse, or how to judge the severity of the illness and whether death is near or far. How can these things be predicted? Can you tell me?

Qibo said: “The unceasing course of the meridians accords with the measures of the celestial movements and conforms to the patterns of the earth’s movements. Thus, when the stars in the heavens move out of order, the sun and moon may draw near and obscure one another, producing solar and lunar eclipses. When the earth’s pathways fall into disorder, waterways overflow, plants cannot grow, and the five grains cannot reproduce. When roads are blocked, people cannot travel back and forth, and residents of streets, lanes, and settlements are scattered elsewhere. The movement of Blood and Qi is the same. Let me explain why.

“Blood vessels and the Qi of nutritive and defensive systems—which moves within and outside the vessels—circulate without pause, corresponding above to the stars and below to the movement of the meridians. When Cold pathogen invades the channels and collaterals, the blood congeals. When the blood congeals, the vessels become obstructed. Once they are obstructed, defensive Qi gathers there and cannot resume its normal course, giving rise to a carbuncle or swelling. When Cold Qi remains pent up for a long time, it transforms into Heat. If the Heat becomes excessive, it decays the flesh; when the flesh decays, pus forms. If the pus cannot drain, the sinews and vessels ulcerate. This damages the bones, and damage to the bones depletes the marrow. When pathogenic Qi cannot escape through the spaces between the joints, Blood and Qi are exhausted; the sinews, bones, and flesh lose their nourishment, and the meridians deteriorate and leak. Pathogenic Qi then scorches the Five Viscera. When the Five Viscera are damaged, the person dies.”

The Yellow Emperor said, “I would like to learn in detail about the forms of carbuncles and deep abscesses—suppurative conditions occurring on the body’s surface or within it—and their associated taboo dates and names.” Qibo said:

“When a carbuncle or deep abscess develops in the throat, it is called a ‘Ravaging Abscess.’ If left untreated, it will suppurate. If the pus cannot drain, it will block the throat, and the person may die within half a day. If it has already suppurated, drain the pus and apply ointment made from pig fat, then take it cold. It will heal in three days.

“When a carbuncle or deep abscess develops in the neck, it is called a ‘Fated Abscess.’ The swelling is large and red-black in color. If it is not treated promptly, Heat pathogen will descend and invade Yuanye, the deep hollow of the armpit; it will damage the Ren Vessel, which runs along the front of the body, and scorch the Liver and Lungs internally. The person will die after more than ten days.

“When Yang Qi is greatly excessive and the brain is depleted, with the illness lodged in the neck and nape, the condition is called ‘Brain Melting.’ The patient’s complexion is dull, and the neck and nape ache as if pierced by needles. If the patient feels distressed and agitated, there is no hope of saving them.”

A disease affecting the shoulder or upper arm (nao) is called “Cici Yong.” The affected area is red and black and must be treated promptly; otherwise, it will cause sweating that reaches the feet. It generally does not damage the five viscera. After an abscess has been present for four or five days, it may be treated with moxibustion.

A disease affecting the armpit, where the area is red and hard, is called “Miju.” Treat it with a stone lancet—a stone needle used in ancient times for puncturing. The lancet should be thin and long. After opening and draining the area with it, apply pig fat ointment. It should heal within six days; do not cover the affected area. If the abscess is hard and does not rupture, it is called “Madao Xieying” and must be treated promptly.

A disease affecting the chest is called “Jingju.” It resembles a soybean and develops within three or four days. Without prompt treatment, it will spread downward into the abdomen; left untreated, it will cause death within seven days. If it heals within six days, do not cover the affected area. An abscess that is hard and does not rupture is also called “Madao Xieying” and must be treated promptly.

A disease affecting the chest is called “Jingju.” It resembles a soybean and develops within three or four days. Without prompt treatment, it will spread downward into the abdomen; left untreated, it will cause death within seven days.

A disease affecting the breast is called “Ganju.” It is bluish-green and resembles a grain, and is often accompanied by alternating chills and fever. Treat it promptly and dispel the chills and fever. Without prompt treatment, it will cause death after ten years; pus will emerge from the affected area only after death.

A disease affecting the flank is called “Baici,” a condition found in women. It may be treated with mugwort moxibustion. In severe cases, it develops into a large abscess, with new flesh the size of a red bean growing inside. Take one sheng each of lingcao roots, chop them, and boil them in one dou and six sheng of water. When the liquid has reduced to three sheng, it is ready. Then force the patient to drink it, dress them in thick clothing, and have them sit over the pot in which the medicine was boiled so that the steam envelops them. Sweat should reach the feet, and the illness will then be cured.

A disease affecting the thighs and lower legs is called “Gu Jing Ju.” Its outward signs are inconspicuous, but the abscess invades the bone. Without prompt treatment, it will cause death within thirty days.

A disease affecting the buttocks is called “Ruiju.” The affected area is red, hard, and swollen, and must be treated promptly. Force the patient to drink the medicine, dress them in thick clothing, and have them sit over the pot in which it was boiled so that the steam envelops them. Sweat should reach the feet, and the illness will then be cured.

A disease affecting the thighs and lower legs is called “Gu Jing Ju.” Its outward signs are inconspicuous, but the abscess invades the bone. Without prompt treatment, it will cause death within thirty days.

A disease affecting the buttocks is called “Ruiju.” The affected area is red, hard, and swollen, and must be treated promptly. Left untreated, it will cause death within thirty days.

When it develops on the inner thigh, it is called “Red Spreading.” If not treated promptly, the patient will die after sixty days. If it develops between the two thighs and is left untreated, death will follow in ten days.

When it develops at the knee, it is called “Hard Abscess.” It resembles a large abscess, but the skin does not change color. The patient alternates between chills and fever, and the affected area is as hard as stone. Do not lance it at once with a stone lancet: piercing it while it is still hard can cause death. Wait until it softens, then treat it with a stone lancet; only then is there a chance of survival.

If any abscess or suppurating sore develops at a joint and corresponds with lesions elsewhere in the body, it cannot be treated. If it develops on the outer side of the body, death follows after one hundred days; if on the inner side, after thirty days.

When it develops on the lower leg, it is called “Rabbit Bite.” The redness and swelling extend all the way to the bone, so it must be treated at once. Without treatment, it can be fatal.

If it develops at the inner ankle and corresponds with other lesions, it cannot be treated. If it develops on the outer side, death follows after one hundred days; if on the inner side, after thirty days.

When it develops on the lower leg, it is called “Rabbit Bite.” The redness and swelling extend all the way to the bone, so it must be treated at once. Without treatment, it can be fatal.

When it develops at the inner ankle, it is called “Wandering Slackness.” It resembles an abscess, but the skin does not change color. Treat the associated transport points—the acupuncture points where the channels’ Qi gathers—repeatedly with a stone lancet, and control the chills and fever; then it will not be fatal.

When it develops on the top or sole of the foot, it is called “Fourfold Spread.” It resembles a large abscess. If not treated promptly, the patient will die after one hundred days.

When it develops on the side of the foot, it is called “Severe Abscess.” It is small, at first resembling a swelling about the size of a little finger. It must be treated at once, with the blackened tissue removed. If the swelling does not subside but instead grows, and no treatment is given, death will follow after one hundred days.

When it develops on a toe, it is called “Shedding Abscess.” The affected area is red and black, and the condition cannot be cured; if it is not red and black, it will not be fatal. If the pain is unbearable, it must be cut away at once, or the patient will die.

The Yellow Emperor asked, “You have spoken of abscesses and suppurating sores. How can they be distinguished?” Qibo replied, “When Nutritive Qi and Defensive Qi—the two kinds of Qi that circulate within the body and protect it—become lodged in the channels, the blood congeals and flows poorly. When the blood does not circulate freely, Defensive Qi is obstructed as well. Qi and blood then accumulate and stop moving, producing heat. If the heat persists without abating, it grows intense and causes the flesh to decay; the decayed flesh turns to pus. Yet this pathogenic influence does not penetrate deep within: it does not scorch the marrow or damage the Five Viscera. For this reason, the condition is called an ‘abscess.’”

The Yellow Emperor asked, “What is called a yong?” Qi Bo replied, “The heat is intense and does not recede for a long time. When the pathogenic heat becomes excessive, it causes the flesh to decay, and pus forms after the flesh has decayed. However, the condition has not spread into the deeper tissues, the marrow has not withered and burned, and the five zang organs have not been harmed. This is why it is called a yong.”

The Yellow Emperor then asked, “What is called a ju?” Qi Bo replied, “The pathogenic heat is extremely strong and penetrates downward into the skin, exhausting the sinews and marrow. It also invades the five zang organs and depletes Qi and blood. The sinews and bones beneath the sore, along with the surrounding healthy flesh, are completely destroyed. This is why it is called a ju. The surface of a ju is dusky in color and hard in texture, like the skin on a cow’s neck. The surface of a yong, by contrast, is thinner and glossy. These are the signs by which a yong and a ju can be distinguished.”

Pronunciation and meaning note: “yao” is pronounced like “meo” and refers to a color that is dusky and dull. The other entries in the pronunciation notes mainly indicate how words are pronounced. The entries that follow are textual collation notes recording differences in wording among different editions.

11. “Remain”: Scroll 11, chapter 9 of the Jiayi Jing reads “flow.”

12. “Join”: Scroll 26, “Carbuncles and Sores,” of the Taisu reads “contain.”

13. “Cold food”: Scroll 26, “Carbuncles and Sores,” of the Taisu reads “do not eat cold food.”

14. “Qi”: The base text originally reads “remain”; this has been changed to “Qi” on the basis of Scroll 26, “Carbuncles and Sores,” of the Taisu.

15. “If not treated promptly”: These words were missing from the base text and have been added on the basis of Scroll 11, chapter 9 of the Jiayi Jing.

16. “Moxibustion”: It is suspected that this should read “for a long time.”

17. “Not”: This character was missing from the base text and has been added on the basis of Scroll 11, chapter 9 of the Jiayi Jing.

18. “Defense”: Scroll 11, chapter 9 of the Jiayi Jing reads “Qi.”

19. “Above”: Scroll 11, chapter 9 of the Jiayi Jing reads “appearance.”