《黃帝內經素問補註釋文》Vol. 16

The Huangdi Neijing Suwen: Supplementary Annotations and Commentary on the Text, end of juan sixteen (part two)

Wang Bing, known as Qixuanzi and an official in charge of imperial stables during the Tang dynasty, composed the subcommentary. Lin Yi and others, officials of the Song dynasty, collated and revised the text. Sun Zhao, a Song dynasty official in the Ministry of Revenue, later corrected errors and textual corruptions.

Treatise on the Three Regions and Nine Indicators

The Yellow Emperor asked: “I have heard you speak of the methods of the nine needles. Their contents are numerous, broad, and profound—too many to count. I hope to hear their essential principles, so that I may pass them down to later generations, inscribe them in my marrow, and conceal them in my liver and lungs. I will seal the vow by drinking blood and will never disclose them lightly.”

“Sealing the vow by drinking blood” means drinking blood as an oath.

“To make these principles accord with the Way of Heaven, they must have a beginning and an end. Above, they should correspond to the movements of the sun, moon, and stars; below, they should accord with the four seasons and the Five Phases. The waxing and waning, the succession and transformation of Yin and Yang through the four seasons, should also be reflected in the human body. How do these principles work? I hope to hear the method.”

“Heavenly light” refers to the sun, moon, and stars. “Calendar cycles” refers to the calendar and paths by which the sun and moon move through the heavens, including the twenty-eight lunar mansions and the division of the celestial circuit into 365 degrees. The human body, blood and Qi, and the movement of nutritive and defensive Qi within the body must accord with seasonal changes and correspond to the movements of the sun and moon. The Big Dipper and the North Pole revolve in the heavens, while the positions of the ecliptic and equator also differ. In winter, the sun travels along the ecliptic farther south, so Yin Qi is greater; in summer, it travels farther north, so Yang Qi is vigorous. Among the Qi of the four seasons and the Five Phases, the Qi governing the season is called “sovereign,” and the Qi that assists it is called “ministerial.” Sovereign Qi is primary, and ministerial Qi is secondary.

Qibo replied: “What a subtle question! This is the most fundamental numerical principle between Heaven and Earth, and it links together the deepest and most subtle truths. That is why I call it a subtle question. The ‘ultimate number’ is the numerical principle carried to its furthest limit.”

The Yellow Emperor said: “I hope to hear how Heaven and Earth’s ultimate numbers correspond to the human body, blood, and Qi, and how they can be used to understand and determine life and death. What should one do in practice?”

Qibo replied: “The ultimate numbers of Heaven and Earth begin with one and end with nine.”

Nine is an odd number, so nine is the highest number in the reckoning of Heaven and Earth.

“One represents Heaven, three represents Earth, and three represents humanity. Combine the three of Heaven, Earth, and humanity: three multiplied by three makes nine, corresponding to the Nine Regions.”

The Erya says: the area outside a walled town is called the suburbs; beyond the suburbs is the cultivated district; beyond that, pastureland; beyond pastureland, woodland; beyond woodland, open country; and beyond open country, the wilderness. Here, successive zones from near to far illustrate the extent of the “regions.” [Textual note: Wang Bing cites the Erya as evidence, though his wording may differ from that of the surviving text. Related material appears in the commentary on the earlier “Treatise on the Six Sections and Manifestations of the Organs.”]

The human body therefore has three regions—upper, middle, and lower—and each region has three sites where the pulse can be felt. By examining these pulses, one can assess whether life is in danger, distinguish among various illnesses, bring deficiency and excess into balance, and dispel pathogenic influences and disease.

The “three regions” refer to the upper, middle, and lower parts of the body, not to the cun, guan, and chi positions at the wrist. The body’s channels pass through these three regions, so observing the pulses at these sites makes it possible to assess the state of life. When needling, applying reinforcing or reducing techniques can dispel illness and pathogenic influences.

The Yellow Emperor asked, “What are the three regions?” Qibo replied, “There are the lower, middle, and upper regions, each with three sites for examination. These three sites are Heaven, Earth, and Human. During examination, the fingers must press the pulse and guide the practitioner’s attention; only then can it be accurately understood.”

This passage says that pulse diagnosis must be learned from a teacher. The Treatise on the Four Errors states: “When one has not completed one’s studies under a teacher, one may carelessly practice all manner of irregular techniques, present mistaken words as the true path, change their names to boast of oneself, and use the stone lancet at will. In the end, this will bring harm upon oneself.” This is a warning to practitioners. The Book of Rites says: “Do not make arbitrary judgments about matters in doubt; only when the evidence is conclusive may a judgment be made.”

The Heaven position of the upper region is the pulsating artery on either side of the forehead. It lies at the temples and can be felt under the fingers. It corresponds to the passage of Qi in the Hand Shaoyang and Foot Shaoyang channels.

The Earth position of the upper region is the pulsating artery in the cheeks. It lies on either side below the nostrils, near Juliao, an acupoint on the face, and can be felt under the fingers. It corresponds to the passage of Qi in the Hand Yangming and Foot Yangming channels.

The Human position of the upper region is the pulsating artery in front of the ear. It lies in the hollow before the ear and can be felt under the fingers. It corresponds to the passage of Qi in the Hand Shaoyang channel.

The Heaven position of the middle region is the Hand Taiyin channel, or lung pulse. It lies at the cun-kou on the back of the hand, at the Jingqu acupoint, and can be felt under the fingers.

The Earth position of the middle region is the Hand Yangming channel, or large-intestine pulse. It lies at the bony hollow between the thumb and index finger, at the Hegu acupoint, and can be felt under the fingers.

The Human position of the middle region is the Hand Shaoyin channel, or heart pulse. It lies at the Shenmen acupoint on the end of the prominent bone at the wrist, and can be felt under the fingers. In the Treatise on Holding the Needle and Advancing or Withdrawing in the Ling Shu Jing, someone asks, “If the Shaoyin channel has no Shu point, does that mean the heart cannot become ill?” The reply is, “The channel of Shaoyin itself may become ill, while the organ need not be ill; therefore one need only take the channel at the end of the prominent bone at the wrist.” This is precisely the point being discussed here.

The Heaven position of the lower region is the Foot Jueyin channel, or liver pulse. It lies in a hollow one and a half cun below the testicles, just outside the edge of the pubic hair, at the Wuli acupoint. The patient should lie down while the point is located; a pulse can be felt under the fingers. For women, the Taichong acupoint is used instead. It lies in a hollow two cun behind the base joint of the big toe.

The Earth position of the lower region is the Foot Shaoyin channel.

This describes the kidney pulse. It lies behind the inner ankle, in the hollow above the heel bone, around the Taixi point. The pulse beats here and can be felt by pressing a finger against it.

The lower section’s “human” position is used to examine the Foot Taiyin pulse, the spleen pulse. The spleen pulse lies on the inner thigh, in the area of the Jimen point, about five li straight down from the upper edge of the muscle shaped like a fish’s belly, between the tendons. The muscles here are broad and thick; the pulse can be felt only by pressing firmly through a thin layer of clothing. To examine Stomach Qi, one should feel the Chongyang point on the top of the foot. The pulse beats at this point and can be felt with a finger.

The New Corrected Edition says: In the old text, the passage from “upper section, Heaven” to this point was placed at the end of the chapter, where it did not connect with the surrounding discussion. In the arrangement of the Huangdi Zhenjiu Jiayi Jing, this passage concerns the three sections and nine indicators and belongs here, so it has been moved from the end of the chapter to this location.

Thus, the lower section’s “Heaven” position is used to examine the Liver, since the Foot Jueyin pulse passes through it; the “Earth” position examines the Kidneys, since the Foot Shaoyin pulse passes through it; and the “human” position examines the Qi of the Spleen and Stomach, since the Foot Taiyin pulse passes through it. The Spleen and Stomach are connected by a membrane, so examining the Spleen also takes the Stomach into account.

The Yellow Emperor asked, “How is diagnosis carried out in the middle section?” Qibo replied, “The middle section is also divided into Heaven, Earth, and human. The ‘Heaven’ position is used to examine the Lungs, because the Hand Taiyin pulse passes through it. The ‘Earth’ position is used to examine the Qi in the chest, because the Hand Yangming pulse passes through it. The text says that the intestines and Stomach are examined together, so this position is also used to examine the chest. The ‘human’ position is used to examine the Heart, because the Hand Shaoyin pulse passes through it.”

The Yellow Emperor then asked, “How is the upper section examined?” Qibo replied, “The upper section is also divided into Heaven, Earth, and human. The ‘Heaven’ position is used to examine the Qi at the corners of the head, since it lies in that area. The ‘Earth’ position is used to examine the Qi of the mouth and teeth, since it is near them. The ‘human’ position is used to examine the Qi of the ears and eyes, since it lies in front of the ear and the pulse Qi reaches the outer corner of the eye.”

Each of the three sections has its own Heaven, Earth, and human positions, making nine indicators in all. The New Corrected Edition says: The text beginning “Three make Heaven” also appears in the Treatise on the Six Nodes and the Manifestations of the Organs, where the related explanation has already been repeated.

Each of the three sections is divided into Heaven, Earth, and human, making nine in all. These nine divisions correspond to the Nine Regions, and the Nine Regions correspond to the nine zang organs. This arrangement is intended to correspond to the utmost number in the cycles of Heaven and Earth.

Thus, the spirit storehouses and the bodily storehouses together make nine storehouses.

The “spirit storehouses” are the liver, which stores the Hun; the heart, which stores the Shen; the spleen, which stores intention; the lungs, which store the Po; and the kidneys, which store will. Since the Hun, Shen, intention, Po, and will all depend on the spirit Qi, these are called the five spirit storehouses. The “bodily storehouses” are hollow organs that open outward like vessels, are not sealed shut, and can contain external things. There are four: the head and its corners, the ears and eyes, the mouth and teeth, and the chest.

When the Five Viscera have deteriorated, the complexion will certainly show an abnormality. Once this abnormal “death color” appears, death will follow. Here, “Heaven” refers to signs of abnormality such as the death color. The complexion is the outward expression of spirit Qi, while the viscera and bowels are where spirit Qi resides. So when spirit Qi departs, the viscera and bowels deteriorate; when they deteriorate, the complexion becomes abnormal, showing that death is approaching.

The Yellow Emperor asked, “How should one examine a patient’s condition?” Qibo replied, “First assess whether the patient’s body is stout or thin, then regulate the excess or insufficiency of Qi within. If Qi is excessive, drain it; if Qi is deficient, supplement it.” To assess is to estimate the body’s build. Draining what is excessive and supplementing what is deficient accord with the natural Way. Laozi said, “The Way of Heaven diminishes what is in excess and replenishes what is insufficient.”

“First clear stagnant blood from the vessels, then treat the condition. Whatever symptoms the patient reports, the aim of treatment is to bring Qi and blood into harmony and the pulse into balance.” When the vessels are full and firm, this indicates that pathogenic Qi is lodged there. One should therefore first use needles to release the stagnant blood, and then regulate the condition. “Regardless of the illness” means that one does not take the patient’s account of excess or deficiency as the basis for treatment, but instead uses the harmony of pulse Qi as the standard for assessment and treatment.

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

Qibo replied, “When the body is strong but the pulse is weak, and Qi is so depleted that breathing is impaired, the situation is dangerous.” The body and the Qi and pulse are out of balance with one another, so the patient’s life is in peril. The Treatise on the Jade Mechanism and True Storehouses says that a condition is treatable when the body and Qi are in proportion. Here, the pulse Qi is insufficient while the body appears excessively robust; the two do not support one another, so the condition is grave. “Dangerous” here means close to death, though life may still be sustained. The Treatise on the Needle and the Will says that when Qi is abundant, the body is full; when Qi is deficient, the body is weak. This is normal; the reverse is pathological. Here, the weak pulse and depleted Qi show that Qi is weak, while the robust build shows that the body is strong. The body is strong but Qi is weak, so life is in danger.

All should be interpreted as “death.”

A person whose body is emaciated, whose pulse is forceful, and who has abundant Qi in the chest will die.

This is because the Qi of the body is deficient while the Qi of the pulse is excessive, so death follows. When the body is emaciated and the pulse forceful, abundant Qi in the chest does not alter the fact that the vital essence stored in the body has already been damaged. Hence it is said that death will follow. In all such cases, the body and Qi are out of proportion.

A person whose body and Qi are in proportion can survive; when the pulses in the three regions and five viscera are out of harmony, illness follows.

“Compare” means to assess and verify, while “classify” means to arrange into categories. If, after comparing and classifying the pulses one by one, they are found to be out of harmony—that is, not in accordance with what is normal—illness follows.

If the pulses at all the Three Regions and Nine Indicators are out of harmony, death follows.

“Out of harmony” means that the pulse indicators do not resemble one another. In diagnosis, there are seven ways in which the indicators may differ; these are described below:

“When the pulses above and below, left and right, respond to one another, beating up and down like a pestle pounding grain, the illness is severe. When the pulses above and below, left and right, do not correspond and beat too fast to count, death follows.”

The Three Regions and Nine Indicators comprise eighteen pulse locations, divided among the upper and lower regions and the left and right sides. “Like a pestle pounding grain” means that the pulse is large and rapid, moving up and down like a pestle. The Treatise on the Essence and Subtlety of the Pulse says that a forceful pulse indicates worsening illness, which is why this passage describes the condition as severe. “Too fast to count” means more than ten beats in one breath—that is, one inhalation and one exhalation. The Pulse Method says that two beats during an inhalation and two during an exhalation are normal; three is called “departing from the normal rhythm,” four “loss of essence,” five “death,” and six “life coming to an end.” Here, the pulse indicators do not correspond, and they beat too fast to count—more than ten times per breath. Five beats per breath already means death; how much more so when there are ten?

Even if the pulses in the middle region seem harmonious when considered alone, they will still indicate death if they do not correspond to the pulses of the other viscera. If the pulses in the middle region are weaker, death will also follow.

There are six pulse locations in the middle region, three on each side. Since the pulses in the upper and lower regions already fail to correspond, harmony in the middle region alone cannot last. If the pulses in the middle region are weaker than those in the upper and lower regions, this likewise indicates that Qi is declining, and death follows in either case. “Reduced” means diminished or weakened.

〔The New Collation states: The older edition contains the eight characters “If the indicators in the middle region are reduced, death follows.” These characters appear both in Quan Yuanqi’s edition and in the A-B Classic, whose commentary also explains “reduced.” Their absence from the main text suggests they were accidentally omitted after Wang Bing’s commentary.〕

A person whose inner corners of the eyes are sunken will die.

This refers to the Taiyang channel. The pulse Qi of the Taiyang channel begins at the inner canthus, the corner of the eye nearest the bridge of the nose. Sunken inner corners of the eyes indicate that the Qi of the Taiyang channel has been severed, and so death follows. The Taiyang channel is singled out because it governs the Qi of all Yang.

The Yellow Emperor asked, “How can one determine where an illness has arisen?”

Qibo replied, “Observe the nine pulse positions—the nine places on the body where the pulse is examined. If the pulse is unusually small, large, rapid, or slow in just one position, or if one position alone feels excessively hot, cold, or sunken, this indicates illness. There are seven kinds of disharmony in the pulse that may appear during examination. These are called the ‘Seven Diagnostic Signs.’ To ‘see the Seven Diagnostic Signs in the pulse’ means to compare the pulse positions with one another. If one position is found to be especially abnormal, the illness is judged by that distinctive finding.

“During the examination, press with the left hand five cun above the ankle, then flick at the ankle with the right hand. The same method can be used on either side of the hands and feet. Above the wrist is the Hand Taiyin pulse; above the ankle is the Foot Taiyin pulse. The Foot Taiyin pulse corresponds to the muscles and reflects the condition of the lower body; the Hand Taiyin pulse corresponds to Qi and reflects the condition of the middle body. The statements below that ‘when the muscles waste away and the body cannot move, death follows,’ and that ‘when the pulse in the middle becomes alternately sparse and rapid, death follows,’ refer to these conditions.”

Note: Here, the “Seven Diagnostic Signs” are methods for observing abnormalities in the pulse. Wording in the classic concerning pressing and flicking differs among editions. Textual scholars believe it should be understood according to the Jia Yi Jing and the version with Quan Yuanqi’s commentary: press with the left hand five cun above the ankle and flick at the ankle with the right hand. Quan Yuanqi’s commentary states that the point lies above the inner ankle and is associated with the Kidneys and the Gate of Life, so it can be used to judge fortune and misfortune.

“If the response to the flick extends beyond five cun and feels like a faint, gentle wriggling, this indicates that there is no illness and that the breath is harmonious.

“If the response is swift and the pulse feels turbid and disordered under the hand, this indicates illness. If the response is sluggish, this also indicates illness. ‘Hunhun’ means disordered; ‘xuxu’ means sluggish.

“If the response does not reach five cun and there is no reaction after flicking, death will follow. This is because the breath has been cut off and cannot respond.

“Thus, those whose muscles waste away and whose bodies cannot move will die. When the nourishment produced from food declines, the muscles seem to waste away and be depleted. The body’s original Qi has also been exhausted, so the body cannot move. When both original Qi and the vital essence derived from food have declined, death is near. Here, ‘qu’ means to move or walk.

“When the pulse in the middle becomes alternately sparse and rapid, death will also follow. A pulse that alternates between sparse and rapid shows that the breath has already become disordered and weakened.

“If the pulse has an intermittent quality combined with a hook-shaped quality, the illness is in the connecting vessels. ‘Hook-shaped’ refers to the pulse commonly seen in summer. Summer Qi moves through the connecting vessels, which is why the illness is said to be located there. When pathogenic influences invade the connecting vessels, the flow through the channels becomes obstructed, and the pulse therefore becomes intermittent.”

This passage explains the methods of diagnosing conditions and prognoses through pulse examination in traditional Chinese medicine, divided into three main sections:

The first section discusses the coordination of the "Nine Positions Pulse Patterns." In normal pulse conditions, the upper and lower pulses should be harmonious. If a delay occurs in one position—measured by one pulse cycle—it indicates illness; a delay of two cycles signifies worsening conditions, while three cycles denote critical danger. Here, "delay" refers to the lack of synchronization in pulse patterns.

The second section details how to determine life or death by observing the pulse patterns of the five zang and six fu organs. The meridians should align with seasonal changes, and each organ has its normal pulse pattern. The appearance of "True Visceral Pulses" (pulses completely devoid of stomach qi) signals fatal conditions. Specific descriptions of the five True Visceral Pulses include: the liver pulse feeling taut like a knife's edge, the heart pulse hard like rolling coix seeds, the spleen pulse erratic in speed, the lung pulse large and floating like feathers, and the kidney pulse rapid like stones being flicked. These pulse patterns all indicate the exhaustion of stomach qi, with death predicted to occur during the corresponding Five Phases' restraining cycle—for example, liver disease leading to death on Geng-Xin days (Metal overcoming Wood).

The final section focuses on symptoms of qi exhaustion in the Foot Taiyang Bladder Meridian: patients lose the ability to bend or extend their legs, and at death, their eyes roll upward. It describes the meridian's pathway in detail, starting from the inner canthus, traversing the crown of the head, the nape, and both sides of the spine down to the outer feet. Annotations note that only the symptoms of Foot Taiyang qi exhaustion are recorded here, while descriptions of other meridians may be incomplete. It also discusses textual variations of the term "penetrating the buttocks" across different medical texts.

The Yellow Emperor asked, “What does the association of winter with Yin and summer with Yang have to do with the time of death?”

Qibo replied, “If the pulses at all nine diagnostic positions are deep and fine, barely perceptible and almost cut off, this indicates that Yin Qi predominates. It is therefore a sign of winter, and death is likely to come around midnight. If the pulses are forceful and agitated, and breathing is rapid and frequent, this indicates that Yang Qi predominates. It is therefore a sign of summer, and death is likely to come around noon.

“Yin and Yang Qi have no fixed positions. When things reach an extreme, they turn into their opposite. The lines of the Qian and Kun hexagrams in the Book of Changes say that when Yin Qi reaches its extreme, ‘dragons fight in the wild’; when Yang Qi reaches its extreme, ‘the overreaching dragon has cause for regret.’ Thus, when Yin or Yang Qi is at its height, a person with a failing pulse may die around midnight or noon.

“For this reason, people suffering from alternating chills and fever may die at dawn. This, too, is a case of change following an extreme. At dawn, Wood Qi governs, and Wood Qi corresponds to wind. The Treatise on the Vital Qi’s Connection with Heaven says that exposure to dew and pathogenic wind can cause alternating chills and fever. This suggests that the illness results from an invasion of pathogenic wind, and that the patient may become critically ill and die at dawn, when wind is in season.

“People with internal heat or a febrile illness may die at noon, because this is when Yang Qi reaches its peak.

“People with wind disease may die at sunset, because sunset corresponds to the hour of You, which is opposed to the hour of Mao.

“People with water disease may die around midnight, when Water Qi governs.

“If the pulse alternates between sparse and dense, or between slow and rapid, the patient may die during one of the four periods of Chen, Xu, Chou, or Wei. These periods belong to Earth, and they are when Spleen Qi is especially active. If Spleen Qi has already been exhausted, the patient may die at one of these times.

“When the body and its muscles have wasted away, the patient will die even if the pulses at all nine diagnostic positions seem harmonious. This shows that the body is out of balance with the breath and Qi. The muscle loss and inability to move described earlier are also examples of this condition: even if the pulse is calm and harmonious, survival is unlikely.

“If signs from the seven diagnostic patterns—indicators of critical pulse conditions—appear, but the pulses at all nine positions accord with the seasons, death is not inevitable. In other words, if the nine pulses follow the seasonal changes in Qi, the patient may survive even when some signs from the seven diagnostic patterns are present.

“The cases said here not to be fatal refer to wind disease and menstrual disorders. Their pulses may resemble the critical pulses described among the seven diagnostic patterns, but they are not actually the same. The pulse in wind disease is large and rapid; in menstrual disorders it is small and weak. Though these patterns bear some resemblance to the seven diagnostic signs, their prognoses differ, so death is not inevitable.

“If the signs described by the seven diagnostic patterns are truly present and the pulse has also become disordered and failing, the patient will die even if all nine pulses accord with the seasons.

“In such cases, the patient will inevitably make the sounds of hiccupping and belching as death approaches. This is because the vital essence in the Stomach has been exhausted, and the spirit Qi can no longer remain settled in the Heart. These signs therefore appear at the end of life.”

The “Treatise on Manifestations of the Five Qi” says: “When the Qi of the Heart surges upward, hiccups occur; when the Qi of the Stomach surges upward, belching occurs.”

One must carefully ask when the illness first began, what caused it, and how it has progressed to the present. Here, “fang” means correct or proper. In other words, one must trace the illness to its cause and understand how it has developed.

Then examine and palpate the pulses separately, observing whether the pulses in the channels and collaterals are superficial or deep, and whether they flow upward or downward, in the proper direction or against it. A pulse that is forceful and rapid usually indicates no illness, because the righteous Qi is strong. A slow pulse indicates illness, because the righteous Qi is insufficient. If the pulse has no coming and going and barely moves, the patient will die, because the Qi of the spirit has dispersed. If the skin clings to the bones and the body is dry and emaciated, the patient will also die, because the bones have withered.

The Yellow Emperor asked, “If the illness can be treated, what should be done?”

Qibo replied, “If the illness is in the channels, treat the corresponding channel and locate the affected area. If it is in the Sunluo (the fine branches that extend from the channels and collaterals), treat the Sunluo and pierce them to release any blood that has stagnated there.”

The Corrected Edition says: According to the Jiayi Jing, the original reads, “If the illness is in the collaterals, treat the blood in the collaterals”; it does not include the word “Sun.”

When bodily pain results from a disorder of the blood vessels, treat the corresponding channels and collaterals. The Lingshu Jing says that the channels run within the body; their transverse branches are called collaterals, and the fine branches that extend from the collaterals are called Sunluo. From this we can see that Sunluo are branches that extend sideways from the channels.

The Corrected Edition says: According to the Jiayi Jing, the original does not contain the words “blood disorder.”

If pathogenic Qi lodges in vessels that do not follow their usual course and are out of alignment with the channels, treat it with “cross needling” (a needling method for disorders involving interlaced collaterals). Here, “extraordinary pathogenic Qi” refers to abnormal, tangled pathogenic Qi that does not travel along the channels. In cross needling, if the illness is on the left, needle the right; if it is on the right, needle the left.

If pathogenic Qi remains lodged, the patient grows thinner over time, and the affected area has not shifted, first nourish the patient according to the severity of the illness and the person’s physical condition, then apply the needles.

When the upper body is replete and the lower body deficient, examine the pulses carefully and look for places where the collaterals are congested. Pierce them to release stagnant blood and restore the free flow of Qi and blood. “Congested” means that blood has stagnated within the collaterals; once the stagnant blood is released, the channels can flow freely. Earlier, the text says to remove stagnant blood from the blood vessels before harmonizing and restoring them. Here it further explains that when the collaterals are congested, the stagnant blood should likewise be cleared first.

The Corrected Edition says: In the scripture, the phrase “so that it may be opened” should read “to free the Qi,” according to the Jiayi Jing.

When the pupils are turned upward, this indicates that the Qi of the Taiyang channel is insufficient; when both eyes roll upward, it indicates that the Qi of the Taiyang channel has been severed. These are crucial signs for determining life and death, and must be observed carefully.

This passage again describes the signs that the Qi of the Taiyang channel is about to be exhausted or has already been severed.

Needles inserted into the fingers and at a point five finger-widths above the outer side of the wrist should be left in place for a while.

This passage is misplaced text—that is, it was put in the wrong position when the scripture was compiled.