《黃帝內經素問補註釋文》Vol. 18

The sour taste enters the liver, the pungent taste enters the lungs, the bitter taste enters the heart, the salty taste enters the kidneys, and the sweet taste enters the spleen. The liver corresponds to Wood, so it is associated with sourness; the lungs correspond to Metal, so they are associated with pungency; the heart corresponds to Fire, so it is associated with bitterness; the kidneys correspond to Water, so they are associated with saltiness; and the spleen corresponds to Earth, so it is associated with sweetness. The Taisu also records that “the bland taste enters the stomach.” Thus, each of the five tastes has its own destination. According to the Discourse on the Utmost Truth (Zhizhen Yaolun), after the five tastes enter the stomach, each goes first to the organ with which it corresponds: sourness to the liver, bitterness to the heart, sweetness to the spleen, pungency to the lungs, and saltiness to the kidneys.

When the Qi of the Five Zang organs is out of balance, different symptoms appear. An imbalance in heart Qi causes hiccups: the heart belongs to Fire, whose flames rise upward with smoke billowing after them. The heart does not tolerate turbid Qi, so it expels it through hiccups. An imbalance in lung Qi causes coughing: the lungs belong to Metal, which is hard and makes a sound; when pathogenic Qi invades the lungs, coughing occurs. An imbalance in liver Qi causes excessive speech: the liver belongs to Wood, which spreads and extends like branches. Speech requires winding expression, so speaking is associated with the liver. An imbalance in spleen Qi causes swallowing: the spleen belongs to Earth, which can contain and receive all things, as though drawing them inward; this is why swallowing occurs. An imbalance in kidney Qi causes yawning and sneezing: the kidneys belong to Water, which flows downward while its vapor rises. When the movement of Qi in the stomach becomes obstructed, yawning results. When Taiyang Qi flows smoothly and fills the heart, then emerges through the nasal passages, sneezing results.

An imbalance in stomach Qi causes rebellious Qi, hiccups, and fear. The stomach is where food and drink gather, and the kidneys are linked to the stomach. If the passage between the stomach and kidneys becomes blocked, Qi flows upward in the wrong direction. The stomach receives food and drink; if cold Qi in the stomach clashes with cold foods, hiccups result. Excess cold Qi causes hiccups, while excess heat Qi causes fear. Why is this so? Heat in the stomach weakens kidney Qi, making a person afraid. A later passage says, “When Jing and Qi converge in the kidneys, fear arises.”

Disorders of the large and small intestines cause diarrhea; when fluids overflow in the Lower Burner—the area of the organs in the lower part of the body—edema forms. The large intestine is the Fu organ that transports waste for excretion, while the small intestine is the Fu organ that receives and holds food…

Qi, referring to the Qi of the relevant zang-fu organs, has become weak, and the function that transports food and drink is no longer regulated. Diarrhea therefore occurs.

The Lower Burner, one of the body’s Three Burners and responsible for the excretion of fluids, is where fluids are diverted downward. When the movement of Qi is obstructed and fluids cannot be properly discharged, they overflow and produce water disease.

When the Bladder’s Qi transformation is impaired, it can cause urinary retention, in which urination is obstructed. When the Bladder loses its ability to regulate, there is involuntary urination.

The Bladder is the fu organ that stores fluids, which are discharged from it. When the Foot Sanjiao vessel, the channel of the foot associated with the Three Burners, is replete, it constrains the Lower Burner and blocks its passage, so urine cannot be passed. When the Foot Sanjiao vessel is weak and cannot constrain the Lower Burner, involuntary urination occurs. The Ling Shu Jing says: “The Foot Sanjiao is a collateral vessel of the Foot Taiyang channel. It runs alongside the main Foot Taiyang channel, enters and connects with the Bladder, and constrains the Lower Burner. When replete, it blocks the passage and causes urinary retention; when weak, it causes involuntary urination.”

The Gallbladder governs anger.

The Gallbladder’s function is to judge fairly and decisively, without bias or partiality. Its disposition is firm and resolute, so it is associated with anger. The “Treatise on the Six Nodes and the Manifestations of the Zang” says: “The functions of the eleven zang-fu organs all depend on the Gallbladder.”

These are the five patterns of illness. The vital essences of the five zang organs combine with one another: when vital essence combines in the Heart, joy results.

Here, “vital essence” refers to the essence of Fire. When Lung Qi is weak, the Heart’s vital essence takes advantage of this weakness and combines with it, giving rise to joy. The Ling Shu Jing says: “Unrestrained joy damages the Po.” The Po is the spirit of the Lungs. This is the Qi of Heart Fire combining with Lung Metal.

When vital essence combines in the Lungs, grief results.

When Liver Qi is weak, Lung Qi takes advantage of this weakness and combines with it, giving rise to grief. The Ling Shu Jing says: “Grief and sorrow, when held within, damage the Hun.” The Hun is the spirit of the Liver. This is the Qi of Lung Metal combining with Liver Wood.

When vital essence combines in the Liver, worry results.

When Spleen Qi is weak, Liver Qi takes advantage of this weakness and combines with it, giving rise to worry. The Ling Shu Jing says: “Worry that cannot be dispelled damages the Yi.” The Yi is the spirit of the Spleen. This is the Qi of Liver Wood combining with Spleen Earth.

When vital essence combines in the Spleen, fear results.

This scripture says that this condition is also associated with hunger. When Kidney Qi is weak, Spleen Qi takes advantage of this weakness and combines with it, producing fear. The Ling Shu Jing says: “Fear that cannot be dispelled damages the Jing.” Jing is the spirit of the Kidneys. This is the Qi of Spleen Earth combining with Kidney Water.

When vital essence combines in the Kidneys, terror results.

When Heart Qi is weak, Kidney Qi takes advantage of this weakness and combines with it, producing terror. The Ling Shu Jing says: “Excessive alarm and anxious thought damage the Shen.” Shen is the Heart’s governing spirit. This is the Qi of Kidney Water combining with Heart Fire. Here, “startled apprehension” means fearful unease.

In all these cases, the body’s upright Qi is insufficient, allowing the Qi of other zang organs to take advantage of the weakness and combine with it. Thus the text continues:

These are the five patterns of combined illness: when the zang organs are weak, their Qi combines with one another.

Each of the five zang organs has something it dislikes: the Heart dislikes heat.

Heat causes the Qi of the vessels to scatter and become turbid.

The Lungs dislike cold, and the Liver dislikes wind.

The lungs are vulnerable to cold, which can obstruct the flow of Lung Qi. The liver is vulnerable to wind, which can dry and tighten the sinews and vessels. The spleen is vulnerable to dampness, which can weaken the muscles and cause swelling. The kidneys are vulnerable to dryness, which can deplete Kidney Jing.

The Xin Jiaozheng (“Newly Revised Text”) notes that, according to Yang Shangshan, the standard account says, “The lungs abhor dryness.” Here, however, it says that “the lungs abhor cold” and “the kidneys abhor dryness.” This is because the lungs correspond to autumn, and cold begins near the end of autumn, so the lungs are more strongly affected by it; cold is therefore called the concluding Qi of autumn. The kidneys correspond to winter, and dryness has already reached its end before winter begins, so the kidneys are less affected by it; dryness is therefore called the initial Qi of winter. These are the “Five Aversions.”

The fluids produced by the Five Zang organs differ from one another. The heart’s fluid is sweat, which is released through the skin and its pores. The lungs’ fluid is nasal discharge, which moistens the nasal passages. The liver’s fluid is tears, which flow into the eyes. The spleen’s fluid is saliva, which gathers in the mouth and on the lips. The kidneys’ fluid is spittle, which is produced between the teeth. These are the “Five Fluids.”

Each of the Five Flavors has a particular affinity, and people with the corresponding ailments should avoid eating too much of it. Pungent flavor affects Qi, so when Qi is diseased, one should not eat too much pungent food. Here, “diseased” means that one’s strength is weakened and cannot be sustained. Salty flavor affects the blood, so when the blood is diseased, one should not eat too much salty food. Bitter flavor affects the bones, so when the bones are diseased, one should not eat too much bitter food. The Xin Jiaozheng, citing Huangfu Shian, explains that salty flavor first enters the kidneys, which are linked with the Triple Burner. Although the blood vessels pertain to the liver and heart, they are also the channels through which the Middle Burner circulates; hence salty flavor is said to enter and affect the blood. Bitter flavor enters the heart. Water and Fire support one another, and the Qi of the bones is connected with the heart; hence bitter flavor is said to affect the bones.

Sweet flavor affects the muscles, so when the muscles are diseased, one should not eat too much sweet food. Sour flavor affects the sinews, so when the sinews are diseased, one should not eat too much sour food. These flavors each make the movement of their corresponding Qi faster, so they should not be eaten in excess; too much can aggravate the illness. When ill, one should avoid consuming these foods in excess. These are the “Five Prohibitions.”

The Xin Jiaozheng further notes that the “Five Prohibitions” in the Taisu are: in liver disease, avoid pungent flavor; in heart disease, avoid salty flavor; in spleen disease, avoid sour flavor; in lung disease, avoid bitter flavor; and in kidney disease, avoid sweet flavor. These are also called the “Five Restraints.” Yang Shangshan explains that even if people crave a particular food, they must not eat too much of it, but should exercise restraint.

The five categories of illness each arise in different parts of the body. Yin illness arises in the bones; Yang illness arises in the blood; Yin illness also arises in the flesh. The bones and muscles belong to Yin and are still in nature, so Yang Qi tends to gather there. The blood vessels belong to Yang and are active in their movement, so Yin Qi takes advantage of an opening to enter.

Yang disorders often flare up in winter, while Yin disorders often flare up in summer. In summer, Yang Qi is abundant, so Yin disorders flare up then; in winter, Yin Qi is abundant, so Yang disorders flare up then. Each illness arises in keeping with the side that is relatively weaker within the body. This is called the “Five Outbreaks.”

Five kinds of pathogenic Qi disturb the body. When pathogenic Qi enters the Yang aspect, it causes mania; when it enters the Yin aspect, it causes impediment disease, in which the movement of Qi and blood is obstructed and the limbs become numb or painful. When pathogenic Qi lodges in the Yang channels, heat surges in the limbs, causing mania. When it enters the Yin channels, the Qi and blood of the six channels become congealed and blocked, causing impediment disease. The character “qi” here is read as “se,” meaning rough and obstructed flow.

When pathogenic Qi binds in the Yang aspect, it can cause summit disease, an illness affecting the head; when it binds in the Yin aspect, it causes loss of voice. Bound in the Yang aspect, the channel Qi flows with urgency, so the illness manifests in the head. Bound in the Yin aspect, the channel Qi cannot circulate, leaving the person unable to speak.

The New Collation says: The Nanjing holds that an excess of Yang Qi causes mania, while an excess of Yin Qi causes epilepsy. Chao Yuanfang says that pathogenic Qi entering the Yin aspect causes epilepsy. The Maijing says that Yin attached to Yang causes mania, while Yang attached to Yin causes epilepsy. Sun Simiao says that pathogenic Qi entering the Yang aspect causes mania, while entering the Yin aspect causes blood impediment. When pathogenic Qi transforms in the Yang aspect, it causes epilepsy and convulsions; when it transforms in the Yin aspect, it causes pain and loss of voice. Quan Yuanqi, however, says: When pathogenic Qi has entered the Yin aspect and then passes into the Yang aspect, it grows strong, afflicts the zang-fu organs, and prevents the body’s upright Qi from rising and nutritive Qi from circulating throughout the body. When pathogenic Qi and upright Qi contend, epilepsy breaks out. If pathogenic Qi has entered the Yang aspect and then passes into the Yin aspect, it afflicts the zang-fu organs and leaves the person unable to speak; this shows that pathogenic Qi has overcome upright Qi. Since the various authorities give different explanations, they are all recorded here.

When Yang Qi enters the Yin aspect, a person becomes calm; when Yin Qi reaches the Yang aspect, a person becomes angry. Illness arises wherever pathogenic Qi goes. The word “zhi” means “to go.” The New Collation says that, according to Quan Yuanqi, Yang Qi entering the Yin aspect makes a person calm, while leaving it makes the person fearful. The Qianjin Fang says that when Yang Qi enters the Yin aspect, the patient becomes calm; when Yin Qi reaches the Yang aspect, the patient becomes angry.

This is called the “Five Disorders.” The phrase “the manifestations of the Five Evils” refers to the appearance of an autumn pulse in spring, a winter pulse in summer, a spring pulse in late summer, a summer pulse in autumn, and a late-summer pulse in winter. These are all called “Yang disorders arising from Yin,” and their symptoms include a tendency toward anger; they are difficult to treat. The pulse manifestations of the five kinds of pathogenic Qi are all alike. The illness is severe and difficult to save.

The New Collation says: The phrase “Yang disorders arising from Yin, with a tendency toward anger” has already appeared earlier. Its repetition here does not fit the sense of the passage and may result from the misordering of an ancient text.

Among the vital essences stored by the Five Zang, the heart stores Shen (spirit).

The numinous awareness that arises when Jing (essence) and Qi (vital energy) gather and transform is called “Shen” (spirit). The Lingshu Jing says that the joining of two kinds of Jing and Qi is called “Shen.”

The lungs store the Po. The “Po” is the function by which Jing and Qi assist the body’s physical activity. The Lingshu Jing says that what enters and leaves together with Jing and Qi, acting upon the body, is called the “Po.”

The liver stores the Hun. The “Hun” is an auxiliary function of Shen and Qi. The Lingshu Jing says that what moves back and forth along with Shen and Qi is called the “Hun.”

The spleen stores intent. “Intent” is the ability to remember things without forgetting them. The Lingshu Jing says that what is held in the heart as a recollection is called “intent.”

The kidneys store will. “Will” is focused thought that does not shift elsewhere. The Lingshu Jing says that when an intention is retained, it is called “will.” The kidneys receive the Jing and Qi of the five Zang organs and six Fu organs. They are the root of original Qi, the source from which life is generated, and the gateway of the stomach. Thus, when kidney Qi is sufficient and will and intent are strong, the activities of life can flow freely. The Newly Collated Edition quotes Yang Shangshan: “There are two kidneys. The left kidney stores will; the right, the Gate of Life, stores Jing.”

The above describes what each of the five Zang organs stores. Each has its own domain: the heart governs the vessels, which enable nutritive Qi to circulate and pulse in time with breathing; the lungs govern the skin, which covers the sinews and flesh and wards off external pathogenic influences; the liver governs the sinews, which connect and support the joints, allowing the body to move under the direction of Shen and Qi; the spleen governs the flesh, which covers and protects the sinews and bones and also enables defensive Qi to circulate; the kidneys govern the bones, strengthening the sinews and bones, generating marrow, and supporting the body.

The above describes what each of the five Zang organs governs, as well as the harm that five kinds of excessive exertion inflict on the body: looking for a long time depletes blood; lying down for a long time depletes Qi; sitting for a long time damages the flesh; standing for a long time damages the bones; walking for a long time damages the sinews. More specifically, prolonged looking is exertion of the heart, prolonged lying the lungs, prolonged sitting the spleen, prolonged standing the kidneys, and prolonged walking the liver.

The above describes the injuries caused by the five kinds of exertion, along with the correspondences between the pulses of the five Zang organs and natural forms: the liver pulse is taut, supple yet forceful, straight and long; the heart pulse is hook-shaped, full as it arrives and gradually weakening as it recedes; the spleen pulse is intermittent, supple and faint; the lung pulse is fine and light, floating and empty like a feather; the kidney pulse is stony, deep and solid like a stone submerged in water.

The above describes the pulses of the five Zang organs.

The chapter “Forms of Blood, Qi, and the Body” says: In general, the Taiyang channel has much blood and little Qi; the Shaoyang channel generally has little blood…

The Yangming meridian (the name of a channel) generally has abundant Qi and Blood; the Shaoyin meridian generally has little Blood and abundant Qi; the Jueyin meridian generally has abundant Blood and little Qi; and the Taiyin meridian generally has abundant Qi and little Blood. These are the usual proportions of Qi and Blood between Heaven and Earth. According to the principles of acupuncture, excess should be drained away.

[Editorial note in the new collation] The Jia Yi Jing, in its chapter “The Twelve Channels and Rivers,” records: the Yangming meridian has abundant Qi and Blood; insert the needle to a depth of four fen and retain it for ten breaths. The Taiyang meridian has abundant Qi and Blood; insert to five fen and retain for seven breaths. The Shaoyang meridian has little Blood and abundant Qi; insert to four fen and retain for five breaths. The Taiyin meridian has abundant Blood and little Qi; insert to three fen and retain for four breaths. The Shaoyin meridian has little Blood and abundant Qi; insert to two fen and retain for three breaths. The Jueyin meridian has abundant Blood and little Qi; insert to one fen and retain for two breaths.

The proportions of Qi and Blood in the Taiyang and Taiyin meridians differ here from those given in the Suwen. The chapter “Differences in the Forms, Natures, Blood, and Qi of the Twenty-Five Yin-Yang Types” agrees with the Suwen. Perhaps Huangfu Mi had doubts about this, so he preserved both versions.

The Foot Taiyang and Foot Shaoyin meridians are interiorly and exteriorly paired; so are the Foot Shaoyang and Foot Jueyin meridians, and the Foot Yangming and Foot Taiyin meridians. Together, these are called the Yin-Yang meridians of the foot. The Hand Taiyang and Hand Shaoyin meridians are interiorly and exteriorly paired; so are the Hand Shaoyang and the Heart Master meridian (that is, the Hand Jueyin meridian), and the Hand Yangming and Hand Taiyin meridians. Together, these are called the Yin-Yang meridians of the hand.

Once you understand the disorders that commonly arise in the Yin-Yang meridians of the hands and feet, treatment should begin by removing blood from vessels that are abnormally full and prominent. Then assess what the condition requires: drain what is excessive and supplement what is deficient.

Note: “Begin by removing blood” means bloodletting only when the vessels are found to be full and conspicuously abnormal. It does not mean that bloodletting should routinely precede acupuncture.

To locate the back-shu points—the points where the Qi of the organs and viscera is conveyed to the back—first measure the distance between the nipples. Take three quarters of that distance and use a grass stem as a measuring tool, then shape it into a triangle so that its upper angle aligns with Dazhui, the point below the seventh cervical vertebra on the spine. The positions indicated by the two lower angles are the Feishu points.

Note: “Measure” means to take a measurement. In other words, use a grass stem to measure three quarters of the distance between the nipples and shape it into a triangle, with its sloping side equal to its horizontal side. Align the top angle with Dazhui on the spine; the two lower angles then indicate the Feishu points.

Move downward by one such distance to find the Xinshu points.

Note: This means aligning the triangle’s top angle with the third vertebra on the spine.

Move one increment farther down: the point at the left corner is Ganshu (the back-shu point of the liver), and the point at the right corner is Pishu (the back-shu point of the spleen). Move down one more increment to locate Shenshu (the back-shu point of the kidneys). This is how to locate the back-shu points of the five zang organs and determine the measurements for acupuncture and moxibustion.

The Lingshu Jing and the Zhonggao both say that Feishu is beside the third vertebra, Xinshu beside the fifth, Ganshu beside the ninth, Pishu beside the eleventh, and Shenshu beside the fourteenth. If we use the method in this classic of measuring the points with a blade of grass, a person whose body proportions match the measurements would have Feishu roughly beneath the two corner points of the first increment, Xinshu beneath those of the second, and the seventh vertebra beneath those of the third. The points beside the seventh vertebra are Geshu, yet this classic says that the left corner is Ganshu and the right corner is Pishu. This clearly differs from the accounts in the Zhonggao and other books. Farther down, beneath the two corner points of the fourth increment, would be roughly the ninth vertebra. Ganshu lies beside the ninth vertebra, but this classic identifies the points there as Shenshu. The origin of this account remains unclear.

When the body is at ease but the mind is burdened, illness arises in the vessels; treatment is by moxibustion and acupuncture.

Here, “body” refers to the physical body, and “will” to the mind. More precisely, the mind’s faculties each have their own functions; taken broadly, “body and will” is a general term for the body and mind. “The body is at ease” means that it is not greatly exerted; “the will is burdened” means that one is deep in thought and worry. When the body is not exerted, the sinews and bones receive too little activity. When the mind is burdened, the circulation of nutritive Qi and defensive Qi becomes disordered, and Qi and blood do not flow freely. Illness therefore arises in the vessels. Acupuncture and moxibustion aim to reduce excess and supplement deficiency. One should also first clear blood vessels obstructed by stasis, then proceed with treatment. This is the meaning of the earlier statement that one should first remove the blood in which pathogenic influences have gathered, then observe the patient’s suffering and needs, and afterward reduce what is excessive and supplement what is deficient.

When the body is at ease and the mind is joyful, illness arises in the flesh; treatment is by needles and stone probes.

Here, “the will is joyful” means being happy and free from sorrow. When the body is not exerted and the mind is joyful, the texture of the muscles becomes compact and the Qi pathways become full. Defensive Qi then stagnates and fails to flow freely, so illness arises in the muscles. When defensive Qi stagnates and becomes congested, acupuncture can drain it. If pus and blood have gathered, a stone probe is used to pierce the area and let them out. A stone probe is a needle made of stone; today, a lance needle may also be used. “Lance” is pronounced “pee.”

Whenever physical activity exceeds its proper limits, it causes strain and injury. Excessive exertion harms the body, and illness arises from this.

“Wen” refers to applying medicinal heat compresses; “yin” refers to Daoyin, a health practice that regulates the breath through bodily movement.

When the body is overworked and the mind is distressed, illness arises in the throat and can be treated with various medicines.

Prolonged toil and deep worry can cause sorrow to make Liver Qi flow into the Spleen. The Liver is paired with the Gallbladder, and the throat is governed by Gallbladder Qi, so illness arises in the throat. The “Treatise on the Five Kinds of Qi” in the Basic Questions says, “When Jing Qi gathers in the Liver, it gives rise to sorrow.” The “Treatise on Unusual Illnesses” in the Basic Questions says, “The Liver is the commander among the organs, while the Gallbladder makes decisions; the throat is governed by the Gallbladder.” The New Collation notes that, according to the Jia Yi Jing, “throat” should read “exhaustion,” and “all medicines” should read “sweet medicines.”

Repeated shocks to the body can obstruct the channels and vessels. The illness manifests as numbness and loss of sensation, and can be treated with massage and fermented medicinal preparations—medicines made with wine or taken mixed with wine.

Shock causes the Qi of the vessels to become disordered, while fear prevents Shen Qi from being gathered and contained. When the Qi of the vessels is disordered and Shen Qi wanders, the channels and vessels become obstructed, resulting in numbness and loss of sensation. Massage can open blockages and harmonize Yin-Yang. Fermented medicinal preparations can support healthy Qi, dispel pathogenic influences, harmonize the middle burner, and regulate the movement of Qi. Prescriptions should therefore follow these principles. “Loss of sensation” means that the body cannot respond or function normally; in severe cases, it develops into numbness, obstruction, and pain.

These are what are called the “Five Patterns of Mind and Body.” When needling the Yangming channel, both blood and Qi should be allowed to flow out. When needling the Taiyang channel, blood should flow out while healthy Qi is retained. When needling the Shaoyang channel, Qi should flow out while blood is retained. When needling the Taiyin channel, Qi should flow out while blood is retained. When needling the Shaoyin channel, Qi should flow out while blood is retained. When needling the Jueyin channel, blood should flow out while healthy Qi is retained.

This explains the needling principles for the relative amounts of Qi and blood in the three Yang and three Yin channels mentioned earlier. The New Collation notes that the Tai Su says to let both blood and Qi flow out when needling the Yangming and Taiyin channels. Yang Shangshan’s commentary explains that although Yangming and Taiyin are paired as exterior and interior, both channels have abundant Qi and blood, so both should be drained. If this account is followed, Taiyin, like Yangming, has abundant blood and Qi. Earlier accounts differ on whether Taiyin has “abundant blood and scant Qi” or “abundant Qi and scant blood,” making the matter difficult to determine. A close reading of the Tai Su’s instruction to drain both blood and Qi shows that neither of the first two accounts is entirely correct: Taiyin should be the same as Yangming. In addition, the passage beginning “When needling Yangming” should follow the earlier phrase “drain excess and supplement deficiency”; it should not be placed between the “Five Patterns of Mind and Body” chapter and the “Method for Measuring Medicinal Herbs.”

“Treatise on Preserving Life in Accordance with the Treasure of Life” in the Basic Questions

The Yellow Emperor asked: Heaven covers all things, and Earth supports all things; nothing is lacking among them. Of all that exists, nothing is more precious than the human being. People are born from the Qi of Heaven and Earth and grow in accordance with the order of the four seasons.

The virtue of Heaven and Earth spreads downward, and the qi of the Earth changes and stirs. When the virtue and qi of Heaven and Earth come together, the myriad things are brought into being. The Zhouyi says, “The qi of Heaven and Earth mingle and fill all things; from this, the myriad things transform, arise, and flourish.” This is the principle it describes. Through warmth, coolness, cold, and heat, the myriad things grow and are stored away; as the seasons alternate in their course, life takes shape.

Rulers and common people alike wish to preserve their bodies. Though their social standing differs, they share the same regard for life. Thus, the desire to live and aversion to death are common to all classes.

When people fall ill, they often do not understand their condition. Pathogenic qi remains in the body and gradually penetrates deeper, sometimes reaching the marrow. The Yellow Emperor was troubled by this and pondered it repeatedly.

The Yellow Emperor asked, “I wish to use acupuncture to remove these illnesses. What should I do?”

When deviant qi enters the body, at first it leaves only slight signs in the complexion. Whether a disorder has already formed inside the body is difficult to discern, so people do not know the precise state of their illness. If the pathogenic qi remains and does not depart, it gradually penetrates deeper. When it takes advantage of the body’s weakness and attacks, it can reach the marrow. The Yellow Emperor was concerned about the people’s illnesses and therefore asked for an explanation of acupuncture treatment.

Qibo replied, “Salt is salty in taste and makes vessels grow damp and seep.” This means that salt’s bitter, astringent taste can penetrate and moisten things. Salt comes from water, whose nature is to moisten and flow downward; its salty taste also has a draining, seeping quality, so it can make moisture leak from vessels. Anything hollow within and able to contain something may be called a “vessel.” On the body’s surface, the corresponding part is the scrotum; within the body, it is the bladder.

If this disorder is related to the Five Viscera, it may be described as Heart qi lying dormant in the Kidneys, where it remains and does not depart. The Kidneys belong to Water and correspond to the salty taste; the Heart belongs to Fire and corresponds to the bitter taste. Bitter taste corresponds to sweat, while salty taste tends toward the bladder. Fire is controlled by Water, so the outside of the scrotum becomes moist as if sweating, and fluids continue to seep away. In general, salty qi makes things damp in cloudy weather; in the earth it disperses and rises; in the human body it makes the scrotum moist and the skin peel.

“When the wiry pulse breaks off and the voice becomes hoarse and impaired” refers to a person whose scrotal fluids are seeping away and whose pulse is wiry but discontinuous. On examination, the voice should be heard to be hoarse and abnormal. This is because Liver qi has been injured. Damage to Liver qi leaves Lung qi insufficient; the Lungs govern the voice, so the voice becomes hoarse.

“When the branches and leaves of a tree spread out, its leaves begin to sprout…”

“Fu” means to spread out or disperse. Here it refers to Wood Qi spreading outward and nourishing the parts under its charge; illness then develops within the lung lobes. Why? Because Wood Qi has a dispersing quality. The Treatise on the Qi of the Healthy Person says, “The true Qi of the viscera spreads through the Liver.” The Liver, in turn, corresponds to Wood.

When the illness becomes severe, the voice turns yue (a rough, unpleasant sound). Here, yue means a voice that is hoarse and unclear. This occurs because there is deteriorated blood stored in the lungs.

When a person displays these three signs, this is called a “damaged Fu.” “Fu” refers to the chest cavity, since the lungs lie within the chest; “damaged” means that the chest cavity has been harmed and illness has arisen as a result. The Baopuzi says that Zhang Zhongjing once opened the chest cavity and placed a red cake inside. This suggests that the chest cavity could be opened to remove pathogenic influences. The three signs referred to here are: a wiry pulse that breaks off, abnormal sounds from the lung lobes, and a voice that is rough and unclear, like yue.

Toxic drugs cannot treat it, and short needles cannot be applied. These disorders damage the skin and muscles, causing Blood and Qi to contend, and the blood turns black.

The pathogenic influence has broken down inside the lungs, so toxic drugs cannot treat it. It is not in the surface channels, so short needles cannot reach it. Treatment therefore requires damaging the skin and muscles to attack the illness. Deteriorated blood has contended with Lung Qi for a long time, so when the blood becomes visible, it appears black.

The New Corrected Edition says: A close reading shows that Qibo’s answer does not match what the Yellow Emperor asked. According to the Taishu, the original text reads: “Salt tastes salty; its Qi makes moisture seep from a vessel. When a string is about to break, its sound becomes hoarse and ruined; when wood grows old and rotten, its leaves fall. When illness becomes severe, the voice becomes yue. When a person displays these three signs, this is called a damaged Fu. Toxic drugs cannot treat it, and short needles cannot be applied; this is because the skin and muscles are damaged and Blood and Qi contend.”

In this passage from the Taishu, three characters differ from those in the text here, and the commentary gives the passage a very different meaning. Yang Shangshan explains: To understand subtle changes in an illness, one must know how to observe its signs. When salt is placed in a vessel and moisture seeps out, seeing the moisture tells you that the salt is salty. Hearing a hoarse sound tells you that the strings of a zither or lute are about to break. Seeing leaves fall tells you that the wood has decayed and declined. These three signs of decline are cited as an analogy for the voice becoming yue, a sign that the illness is severe. If someone makes a yue sound, it is like these three signs: the Fu has already deteriorated. When the Fu in the chest deteriorates, the illness is severe. Since the illness is severe, needles and medicines cannot cure it: the skin, flesh, Blood, and Qi can no longer work in harmony.

On closer examination, Yang Shangshan’s commentary connects coherently with the exchange between the Yellow Emperor and Qibo. Wang Bing’s explanation of the passage “Salt tastes salty; its Qi makes moisture seep from a vessel,” though profound...

As for the passage “the strings are stopped, the sound breaks off, the wood becomes hoarse, the leaves spread and emerge in unusual ways,” it does not connect with the Yellow Emperor’s questions before or after it. On examination, Yang Shangshan’s interpretation seems more plausible.

The Yellow Emperor said, “When I think of these painful conditions, my mind becomes confused and unsettled, and I suffer even more. Now the illness cannot be changed. If the people hear these words, they will think we are harming and injuring them. What should we do?”

“Destroy” means to harm, while “injure” means to damage or rob. The Yellow Emperor feared that these statements might seem unkind and make the people uneasy.

Qibo said, “People are born from the earth, but their lives depend on Heaven. When the Qi of Heaven and Earth come together, a human being comes into being.”

The human body takes shape with the help of the myriad things, so it is said that people are born from the earth. Human life is bestowed by Heaven, so it is said that life depends on Heaven. Only when the De and Qi of Heaven and Earth converge can human beings come into being. The Jingling Scripture says: “What Heaven bestows on people is called De; what Earth bestows on them is called Qi. De spreads and Qi joins; from this, people are born.” De is the function of the Dao, and Qi is the basis of life.

“When people follow the four seasons, Heaven and Earth become their parents.”

When people follow the four seasons, harmonize their breath, and use this to nourish life, Heaven and Earth continually nurture them; hence they are called their parents. The Treatise on Regulating the Spirit in Accordance with the Four Qi says: “The Yin-Yang changes of the four seasons are the foundation of the growth of all things. Therefore, the sages nourish Yang in spring and summer and nourish Yin in autumn and winter, following the root of life and entering into the cycles of growth and transformation together with all things.”

“One who understands the patterns of the myriad things may be called a Son of Heaven.”

One who understands the fundamental patterns of the myriad things can receive the nourishment of Heaven and Earth. Such a person is therefore called a “child of Heaven,” that is, a Son of Heaven.

“Heaven has Yin and Yang; people have twelve joints.”

Here, “joints” refers to the solar terms. The body’s external changes correspond to the twelve months of the year, while its interior corresponds to the twelve meridians.

“Heaven has cold and heat; people have deficiency and excess.”

Cold and heat each follow patterns of waxing and waning, while deficiency and excess describe different states of the human body. Thus, changes in human deficiency and excess correspond to changes in Heaven’s cold and heat.

“Those who can understand the changes of Yin and Yang between Heaven and Earth do not go against the four seasons. Those who understand the principles of the twelve solar terms cannot be deceived, even by the wise and perceptive.”

“Constant” is the meaning of jing here. The passage says that those who consistently follow the Dao of Yin and Yang between Heaven and Earth to nourish the body accord with the patterns of growth and change through the four seasons. Those who understand how the twelve solar terms progress and change will neither disregard nor defy these patterns, even if they are wise and perceptive.

“Those who can grasp the changes in the Qi of the eight directions, understand the alternation of the Five Phases as they overcome and restrain one another, and know the patterns of change between deficiency and excess can act independently and respond as circumstances require. When they open their mouths to breathe or make sounds and sighs, they can perceive even the subtlest changes, as though every autumn hair were before their eyes.”

“Cun” means keeping the mind and spirit focused, with one’s thoughts continually present. “Da” means to understand and see clearly. “Qu” means opening the mouth and exhaling. “Yin” means chanting or sighing.

“Seeing even the finest hairs” means being able to discern the smallest things; it describes careful observation. The “eight movements” refer to the winds of the eight seasonal divisions: the four beginnings, the two equinoxes, and the two solstices. The “five conquests” are the ways the Qi of the Five Phases restrains one another. “Coming into season” refers to the time when a particular Phase governs; “transformation” refers to the change that occurs once its Qi arrives. When these three conditions are understood, their corresponding effects become clear, swift as a shadow following a body or an echo following a sound. These are marvelous functions that manifest and move of themselves; they are not powers of ghosts, spirits, or the supernatural that can be summoned or commanded. The New Collation cites Yang Shangshan as saying that “qu” is pronounced like “zhe” and means showing the teeth and exhaling outward.

The Yellow Emperor asked: Human beings have physical forms and cannot be separated from Yin and Yang. When the Qi of Heaven and Earth comes together, it also forms the Nine Fields, the ancient division of the regions of the heavens and the earth. The year is divided into four seasons; months have different lengths, and days have different durations. All things come into being at the same time, too numerous to count. Changes in the fullness and emptiness of Yin and Yang, as well as such actions as opening the mouth to exhale and sighing, all differ from one another. I would like to ask about the principles behind them. Please explain the essentials of needling.

Qibo replied: When Wood meets Metal, it is cut down; when Fire meets Water, it is extinguished; when Earth meets Wood, it is loosened; when Metal meets Fire, it is melted and damaged; when Water meets Earth, it is blocked. Things in general follow this pattern, though their transformations are too numerous to exhaust.

“Da” means to penetrate or pass through. Although the things of the world are too many to count, they can all be understood by analogy with the Qi of the Five Phases, which restrain one another and prevail over one another in turn.

Thus there is a way of needling that is as if suspended high in the world and displayed in the open, visible to everyone. Yet ordinary people use it in their daily lives without understanding its subtlety. The way of needling has five essentials. Although people often encounter them, they do not understand their true significance. The following passage explains these five points in order. The New Collation notes that the version by Quan Yuanqi reads “eat one’s fill.” Its commentary says that foolish people do not understand Yin and Yang or the subtlety of needling: they eat their fill all day yet cannot grasp its benefits. The Taishu instead reads “food and drink,” and Yang Shangshan’s commentary says that although the people all make use of this method, they do not grasp its essential meaning.

The first is to regulate the spirit. One must keep the mind and spirit unified, without idle thoughts or restless impulses. Thus, when inserting the needle, the hand should be as steady as if gripping a fierce tiger, while the spirit remains undistracted. This means settling the spirit and concentrating the mind. The New Collation cites Yang Shangshan as saying that understanding these five points and applying them to the nurturing of life can lead to longevity. The hun, spirit, intent, po, and will…

When people maintain emotional calm, their inner Shen and Qi are not harmed. If grief is not excessive, the Hun remains unharmed, the Liver is less likely to become ill, and one can pass through autumn in peace. If there is no fright or anxious worry, the Shen remains unharmed, the Heart is less likely to become ill, and one can pass through winter in peace. If there is no distress and gloom, the Yi remains unharmed, the Spleen is less likely to become ill, and one can pass through spring in peace. If joy is not excessive, the Po remains unharmed, the Lungs are less likely to become ill, and one can pass through summer in peace. If there is no great anger, the Zhi remains unharmed, the Kidneys are less likely to become ill, and one can pass through late summer—the final month of summer—in peace. In this way, the five excessive emotions do not arise in the heart; Shen and Qi remain clear, one’s temperament remains settled, and the five spirits each rest in the organ that houses them. Thus one can extend one’s years and live a long life.

Second, understand how to nourish the body

Knowing how to nourish your own body follows the same principle as knowing how to care for others. The “Treatise on the Correspondence of Yin and Yang” says: “Those who practice acupuncture must use their own understanding to comprehend the patient; only then can they apply it without danger.” This is what it means.

The New Corrected Edition notes that the Taishu writes “body” as “form.” Yang Shangshan explains that moderation in food and sexual relations, and timely protection against wind, cold, heat, and damp, nourish the body from within and prevent the sort of external harm that befell Shan Bao, who concerned himself only with inner cultivation. Treating others with kindness and generosity, and engaging with the troubles of the world without being burdened by them, nourishes the body from without and prevents the sort of harm that befell Zhang Yi, who was damaged by living among the powerful and privileged. When both inner and outer aspects are fully nourished, one need not deliberately seek life, yet can live long; one need not force oneself to pursue longevity, yet can attain a great age. This is the highest level of bodily cultivation for a needle practitioner.

The Xuanyuan Emperor, Laozi, said: “The highest skill is to nourish the spirit; next is to nourish the body.” Wang Bing’s commentary focuses on regulating the spirit and nourishing the body during acupuncture, taking a narrower view. Yang Shangshan’s interpretation is more appropriate. If one insists that all five points mentioned earlier refer to requirements for acupuncture, then the passage below, “understanding the true use of toxic medicines,” is also not interpreted by Wang Bing as referring only to acupuncture.

Third, understand the true use of toxic medicines

Medicines used to drive out pathogenic influences must be applied appropriately and in accordance with the condition. This is likely the orthodox way of treatment.

Fourth, know the appropriate sizes of stone probes

The ancients used stone probes as needles, so this passage mentions stone probes rather than listing the nine types of needles individually. They should be selected in a size suited to the needs of the condition.

The New Corrected Edition notes that Quan Yuanqi says stone probes were an ancient external treatment. They had three names: needle-stone, stone probe, and chan-stone—an ancient stone needle used for puncturing. In fact, all three names refer to the same thing.

In ancient times, iron had not yet been smelted, so needles were made of stone. This is why they were called “needles.” To make them, artisans ground the stone to a sharp edge and shaped each one to a suitable size according to the illness. The Yellow Emperor made the Nine Needles to replace stone lancets. Physicians in high antiquity adapted their methods to local conditions. People in the east were prone to sores, swellings, and accumulations, so stone lancets originated there.

Fifth, one must understand how to examine the zang-fu organs and the blood and Qi.

Yang is called the fu (the six fu organs), and Yin is called the zang (the five zang organs). The “Treatise on Greater Yin and Greater Yang” says: the Taiyang channel has abundant blood and little Qi; the Shaoyang channel has little blood and abundant Qi; the Yangming channel has abundant Qi and little blood. The Shaoyin channel has little blood and abundant Qi; the Jueyin channel has abundant blood and little Qi; and the Taiyin channel has abundant Qi and little blood. Therefore, when needling the Yangming channel, regulate both blood and Qi. When needling the Taiyang channel, regulate the blood while avoiding injury to the Qi. When needling the Shaoyang channel, regulate the Qi while avoiding injury to the blood. When needling the Taiyin and Shaoyin channels, regulate the Qi while avoiding injury to the blood. When needling the Jueyin channel, regulate the blood while avoiding injury to the Qi. Only by precisely understanding the relative amounts of blood and Qi in each channel can tonification and reduction be carried out fully.

The five methods have now been established, each with its appropriate order of use. When an illness calls for a particular method, that method should be used first.

The general principles of needling today are to use tonification for deficiency and reduction for excess; these are familiar to physicians. As for following the patterns of Heaven and Earth and adapting treatment to changes in the illness, adjusting its course as an echo answers a sound and as a shadow follows its form—this refers to an effect that comes swiftly and closely tracks the changes in the illness. An effect that follows like a shadow or answers like an echo does not mean that spirits are summoning or directing it. It arises naturally when the physician responds to the illness with appropriate treatment.

The Yellow Emperor asked, “I would like to hear the principle behind this.” Qibo replied, “For needling to be truly effective, one must first settle the spirit and focus the mind, keeping the heart calm and undisturbed. This is the essential point of needling.”

Only after the condition of the five zang organs has been discerned and the nine pulse positions of the channels have all been examined should needling be undertaken.

First assess the pulse of the five zang organs, then complete the examination of the nine positions. Only after finding that a pulse is excessive or insufficient should one focus on how to needle.

If the different pulses have not yet been distinguished, and abnormal signs among the five zang organs have not been identified, first determine whether the body’s internal condition corresponds to its outward appearance. Do not use your own build, strength or weakness, or sensations of cold and heat as a standard for judging the patient’s body and Qi, imagining that the patient is the same as you. This point will be discussed further below.

Only by mastering the principles governing the circulation of Qi and blood can they be applied in treating others. “Wan” means to ponder something repeatedly until one has mastered it. The Treatise on the Root and Branch of Disease Transmission says, “Carefully and skillfully master…” The Treatise on the Distinction between Yin and Yang also says, “The Yin and Yang should not be discussed with the crowd,” meaning that changes in Yin and Yang cannot be deliberated with everyone. This passage is similar. The editorial notes point out that it comes from the Treatise on the Distinction between Yin and Yang; attributing it here to the Treatise on the Root and Branch of Disease Transmission is an error.

The human body can be deficient or replete: “Do not approach the five deficiencies; do not keep away from the five repletions.” When a deficiency pattern has not yet flared up, one should not treat it rashly. When a repletion pattern flares up, one should not withdraw or delay treatment. Once the illness truly breaks out, the interval is so brief that there is not even time for a blink.

Whether a person is deficient or replete is not determined by how near or far the illness is from us, but by blood and Qi becoming abundant or depleted in an instant. Before the illness breaks out, it is like clouds hanging low before one’s eyes, visible for a long time. Once it erupts, however, it vanishes like lightning: before one can point to it, the change has already passed. This is the difference between an illness that develops slowly and one that comes on swiftly. The editorial notes point out that the Jia Yi Jing has “shun,” meaning “to blink,” at this point; the Quan Yuanqi edition and the Tai Su have “xun,” pronounced like “Shun.”

When needling, the hand’s movements must be focused, as though the whole mind were on this one task. The needle should gleam, and its movements should be even and steady. The Needle Classic says, “Focus your attention on its form, listen and observe its movement and stillness, and thereby judge whether it is upright or deviant.” This is what the passage means. “The needle gleams and moves evenly” means that its shaft is clean and bright, and that it moves steadily up and down.

Quiet the mind, focus on observing and reasoning out what is happening, and examine changes in the harmonious state of the channels: this is called “mingming.” “Mingming” means that changes in blood and Qi leave no visible trace. The practitioner must therefore observe the breath with a quiet mind, weigh the situation according to principle, and examine changes in the harmonious state of the channels. Even with careful attention and close observation during needling, it remains impossible to see clearly what form these changes take or to describe what they look like.

The editorial notes point out that the Treatise on the Eight Correct Directions and the Spirit’s Illumination says, “Observe the mingming.” This refers to changes in the body, Qi and blood, and nutritive and defensive Qi that do not show outwardly, though the physician alone can perceive them. The physician considers together the day’s warmth and cold, the waxing and waning of the moon, and the rising and sinking of the Qi of the four seasons, then judges and treats accordingly, often sensing changes in advance. Yet these changes do not appear outwardly, which is why this is called “observing the mingming.”

One can see the forms called “wuwu” and “jiji.” From the outside, it is as though one sees birds flying back and forth, yet does not know who is driving them. “Wuwu” describes the arrival of Qi; “jiji” describes the moment when needling has taken effect. The proper insertion of the needle and the retreat of deviant Qi are like seeing birds pass through the air without knowing what force drives them. The physician can see only the fullness and emptiness of Qi and blood in the channels and use these as a basis for judgment, without knowing what force calls forth and sets these changes in motion.

When Qi lies dormant, it is like a crossbow at rest; when Qi is set in motion, it is like the crossbow’s mechanism releasing the bolt.

Before responding to acupuncture, Qi and blood lie still, like a bow laid flat. Once the needle stimulates them, they spring into action as swiftly as a crossbow firing.

The Yellow Emperor asked, “What counts as deficiency, and what counts as excess? Qi and blood lie still at first, yet when stirred they move as swiftly as a crossbow firing. Can deficiency and excess be judged by how long the needle is retained or by the number of breaths? How should their signs be understood?”

Qibo replied, “When needling a deficiency pattern, wait for Qi and blood to become full. When needling an excess pattern, wait for the excess pathogen to subside and the Qi dynamic to become deficient. The key is to recognize the appropriate response when Qi arrives beneath the needle; there is no need to make the number of breaths a fixed standard.

“When the channel Qi has reached the needle, wait for it attentively. Do not let the moment pass, and do not change your method arbitrarily.

“Keep the needle’s depth clearly in mind, and give equal care to illness located near or far. Work as cautiously as if standing at the edge of a deep abyss, and as firmly as if gripping a tiger. Keep your attention focused, undistracted by anything else.”

This passage says that the channels needled may lie at different depths, but tonifying deficiency and draining excess both require focused attention. A commentator adds: “When needling an excess pattern, wait until Yin Qi is abundant before withdrawing the needle. When needling a deficiency pattern, wait until Yang Qi is abundant and warmth is felt beneath the needle before withdrawing it. ‘When the channel Qi has arrived, wait attentively and do not let it pass’ means not to alter the needling method arbitrarily. ‘Keep the depth in mind’ means to distinguish whether the illness is located inside or outside. ‘Give equal care to near and far’ means to attend just as closely to the arrival of Qi, whatever the depth of the illness. To be as if at the edge of a deep abyss is to avoid carelessness; to be as if gripping a tiger is to work with force. Keeping the mind undistracted means quietly observing the patient without looking around.”