《黃帝內經素問補註釋文》Vol. 20

Volume 20 of the Huangdi Neijing Suwen Buzhu Shiwen (Supplementary Annotations and Explanatory Text to the Huangdi Neijing Suwen) was annotated by Wang Bing of the Tang dynasty, collated by Lin Yi and others of the Song dynasty, and corrected for errors by Sun Zhao. Its chapter “Tongping Xushi Lun” (Comprehensive Discussion of Deficiency and Excess) is devoted to the meaning of deficiency and excess and to the principles of diagnosis and treatment.

The Yellow Emperor asked: What is meant by deficiency and excess? Qi Bo replied: When pathogenic Qi is exuberant, this is “excess”; when the body’s essential Qi is depleted and snatched away, this is “deficiency.” The term “snatched away” means that essential Qi diminishes, as though it had been taken away. The Yellow Emperor then asked about the concrete manifestations of deficiency and excess, that is, about the general conditions of deficiency and excess in the five zang. Qi Bo said: Qi deficiency mostly manifests as Lung deficiency; when Qi movement rebels upward, coldness of the feet may be seen. If the disease does not arise at its corresponding time, there is still vitality; if it occurs exactly at its corresponding time, the condition is dangerous. Here “not at its time” refers to the period before and after the year’s governing season, while “at its time” refers to the very time of the year’s governing season. The same principle applies to the other zang and fu; all five zang are inferred according to this.

The Yellow Emperor asked: What is meant by “double excess”? Qi Bo replied: In a major heat disease, when heat is abundant in the Qi aspect and the pulse is full, this is called double excess. The Yellow Emperor asked: How should one treat a condition in which both channels and network vessels are replete? Qi Bo replied: When both channels and network vessels are replete, the Cunkou pulse is tense and the cubit pulse is relaxed; both should be treated. Thus a slippery pulse is favorable and an astringent pulse is adverse; “pulse tension” refers to the pulse opening. The changes of deficiency and excess all arise from the principle that the myriad things follow their own kind. Therefore, when the five zang, bones, and flesh are smooth and fluent, life can be long. When the vitality of the myriad things is flourishing, they are smooth and fluent; when they decay and die, they become dry and rough. Hence astringency is adverse and slipperiness is favorable; “favorable” means compliant.

The Yellow Emperor asked: What about deficiency of luo Qi with excess of channel Qi? Qi Bo replied: When luo Qi is deficient and channel Qi is excessive, the pulse opening is hot and the cubit region is cold. In autumn and winter this is adverse; in spring and summer it is favorable, and treatment should be directed to the place of the principal disease. In spring and summer Yang Qi is exuberant, so heat at the pulse opening and cold in the cubit is considered favorable. The twelve channels and fifteen luo vessels, according to left and right, each have their excesses and deficiencies; the physician should seek out where the disease signs are and appropriately apply acupuncture and moxibustion. This is why it is said, “treat the one that governs the disease.”

The Yellow Emperor asked: What about channel deficiency and luo fullness? Qi Bo replied: When the channels are deficient and the luo vessels are full, the cubit region is hot and full while the pulse opening is cold and astringent. This condition is often dangerous in spring and summer, but the patient may live in autumn and winter. In autumn and winter Yang Qi descends, so heat in the cubit and cold at the pulse opening are considered favorable. The Yellow Emperor asked how such diseases should be treated. Qi Bo proposed: For luo fullness and channel deficiency, moxibustion may be used to regulate the Yin aspect, together with acupuncture, in order to regulate deficiency and excess in the channels and luo and restore the free flow of Qi and blood.

When the Yang channels are full and the collateral vessels are empty, one should needle the Yin channels and apply moxibustion to the Yang channels. This is because the Yin aspect governs the collateral vessels, while the Yang aspect governs the channels.

The Yellow Emperor asked, “What is meant by ‘double depletion’—a doubling of weakness?”

This question follows up on the earlier discussion of “double excess.”

Qibo replied, “When the pulse Qi is deficient and the pulse at the cubit position is deficient, this is called double depletion.”

This means that the pulses at both the inch and cubit positions are deficient. The New Collation notes that, according to the Jia Yi Jing, the original text should read, “When the pulse is deficient, the Qi is deficient, and the cubit is deficient, this is called double depletion.” One instance of “deficient” was omitted, and the word “upper” was added. Wang Bing’s commentary says “the pulses at both the inch and cubit positions are deficient,” which leaves out Qi deficiency. In light of the earlier statement that “in heat disease, when the Qi is hot and the pulse is full, this is double excess,” the passage should mean that when both the pulse and Qi are excessive, this is double excess; when both the pulse and Qi are deficient, this is double depletion. It does not mean that deficiency at only the inch and cubit pulse positions constitutes double depletion.

The Yellow Emperor asked, “How should it be treated?”

Qibo replied, “Qi deficiency means that the movement of Qi has no regular pattern. When the pulse at the cubit position is deficient, walking will make a person feel alarmed and unsteady.”

When the pulse at the inch position is deficient, its beats have no regular rhythm. When the pulse at the cubit position is deficient, walking feels unsteady and weak. The New Collation quotes Yang Shangshan as saying that Qi deficiency means the received central Qi is unstable. Wang Bing’s explanation, “When the inch position is deficient, the pulse moves irregularly,” is incorrect. Pulse deficiency means that the pulse does not conform to the normal state of the Taiyin pulse. Why is this so? The Qi mouth is an important site for examining the pulse, located where the Hand Taiyin channel pulsates.

With a pulse of this kind, a slippery pulse indicates survival, while a rough pulse indicates death.

The Yellow Emperor asked, “What if cold Qi suddenly surges upward and the pulse is full and forceful?”

Earlier, in heat disease, hot Qi and a full pulse were described as double excess; a slippery pulse indicated a favorable course and survival, while a rough pulse indicated an unfavorable course and death. If cold Qi surges upward and the pulse is full and forceful, does this also count as double excess? And how should the relation between a slippery or rough pulse and survival or death be judged?

Qibo replied, “If the pulse is replete and slippery, the person will survive; if the pulse is replete and counterflowing, the person will die.”

Here, “counterflowing” means that the pulse’s movement is disordered. The New Collation considers Wang Bing’s interpretation of “counterflowing” as “rough” highly inappropriate. Classical texts are often concise and use parallel expressions across passages: the earlier phrase “slippery and following” shows that slippery means favorable; here, “counterflowing” therefore indicates a pulse that is not following its proper course. But “counterflowing” cannot simply be interpreted as “rough.”

The Yellow Emperor asked, “What if the pulse is replete and full, the hands and feet are cold, and the head is hot?”

Qibo replied, “The person may survive in spring or autumn, but will die in winter or summer.”

This is a generalization. Cold hands and feet in summer are not necessarily a disease; the body may instead be showing the climatic state of winter. If winter’s signs appear in summer, the person may die in winter. Likewise, a replete and full pulse with a hot head in winter is not necessarily a disease; the body may instead be showing the climatic state of summer. If summer’s signs appear in winter, the person may die in summer. The principle that winter and summer correspond to one another, discussed earlier, can also be used to infer the reverse.

If none of these illnesses show signs of impending death, they may flare up in spring or autumn. The patient’s survival or death is therefore connected to the seasons. This passage refers to the first month of each season.

A floating, rough pulse together with fever is fatal.

The New Collation says: According to the Jia Yi Jing, this passage should be moved here. In older editions it appears later, after the passage beginning, “The Yellow Emperor asked: How can one determine the measures of bodily form, bones, pulses, and sinews?” The questions and answers in the two passages are unrelated. Wang Bing recognized that their order was confused but did not correct it. Huangfu Shian had already moved this passage here, and it is now likewise brought forward from its later position.

The Yellow Emperor asked, “What happens when the whole body is swollen and distended?”

Qibo replied, “In someone whose whole body is swollen and distended, the pulse is tense, large, and hard; the skin on the chi region—the inner forearm between the wrist and elbow—is rough and sluggish, and it does not respond to pressure.”

“Swollen and distended throughout the body” means that the four limbs, the body’s form, and the internal organs are all distended.

The New Collation says: According to the Jia Yi Jing and the Tai Su, the word “rough” here is written as “full.”

The Yellow Emperor asked, “What signs indicate that this condition will resolve favorably and the patient will live, and what signs indicate that it will turn against them and they will die?”

Qibo replied, “A favorable sign is warmth in the hands and feet; an unfavorable sign is coldness in the hands and feet.”

The Yellow Emperor asked, “What happens when a nursing infant has a fever and a suspended, fine pulse?”

“Suspended” describes a pulse that beats as if hanging.

Qibo replied, “If the hands and feet are warm, the infant will live; if they are cold, the infant will die.”

The New Collation says: According to the Tai Su, the original text does not include the word “hands.” Yang Shangshan explains that warmth in the feet shows that Qi can descend, so the infant will live. Cold feet show that Qi cannot descend; this is an adverse sign and leads to death.

The Yellow Emperor asked, “When a nursing infant has been exposed to wind and develops a fever, wheezing, and shoulders that rise with each breath, what will the pulse be like?”

Qibo replied, “With wheezing and shoulders rising with each breath, the pulse will be replete and large. If its force is relaxed, the infant will live; if it is tense, the infant will die.”

Here, “relaxed” means that the pulse’s force is loose and easy; “tense” means that it is drawn taut like a bowstring. These terms do not refer to how quickly the pulse beats. The Treatise on the Correct Principles of Cold Damage says, “A relaxed pulse is the pulse of wind-stroke.” Thus, after an infant has been exposed to wind, a relaxed pulse means the infant will live, while a tense pulse means the infant will die.

The Yellow Emperor asked, “What happens when someone has intestinal disease with bloody stools?”

Qibo replied, “If the body is warm, the patient will die; if the body is cold, the patient will live.”

Warmth indicates that the blood has been damaged, so the patient will die. Coldness indicates that the nutritive Qi, which sustains the body’s nourishment and circulation, is still present, so the patient will live.

The Yellow Emperor asked, “What happens when someone has intestinal disease and passes white froth?”

Qibo replied, “If the pulse is deep, the patient will live; if it is floating, the patient will die.”

This is a Yin illness accompanied by a Yang pulse. Because the pulse contradicts the illness, the patient will die.

The Yellow Emperor asked, “What happens when someone has intestinal disease and passes pus and blood?”

Qibo replied, “If the pulse is suspended and fading, the patient will die; if it is slippery and large, the patient will live.”

The Yellow Emperor asked, “What happens when someone with intestinal disease has no fever and no suspended, fading pulse?”

Qibo replied, “A slippery and large pulse indicates that the patient may live; a suspended and rough pulse indicates that the patient may die. The condition and prognosis must also be judged according to the state of the internal organs.”

When the Liver pulse appears on a Geng or Xin day, which belongs to Metal, the patient will die. When the Heart pulse appears on a Ren or Gui day, which belongs to Water, the patient will die; when the Lung pulse appears on a Bing or Ding day, which belongs to Fire, the patient will die; when the Kidney pulse appears on a Wu or Ji day, which belongs to Earth, the patient will die; and when the Spleen pulse appears on a Jia or Yi day, which belongs to Wood, the patient will die. This is called predicting the course of an illness according to the days associated with the Five Zang organs.

The Yellow Emperor asked, “What is the pulse of dianji, a term used in ancient times for certain mental or episodic disorders?” Qibo replied, “If the pulse is strong and smooth, the illness will improve on its own after a long time. If the pulse is small, hard, and rapid, the patient will die and cannot be saved.”

A small, hard, and rapid pulse indicates that Yin and Yang are out of balance. The illness belongs to Yang, yet the pulse shows Yin; therefore, the patient will die and cannot be saved. The New Editorial Correction says: Chao Yuanfang held that a deep, small, rapid, and forceful pulse means the patient will die and cannot be saved; a small, firm, and rapid pulse is likewise incurable.

The Yellow Emperor asked, “For dianji, how can we tell whether the pulse is deficient or replete?” Qibo replied, “A deficient pulse can be treated; a replete pulse means the patient will die. This is because the pulse contradicts the illness.”

The Yellow Emperor asked, “How can we judge deficiency and repletion in xiaodan, a wasting disorder marked by such symptoms as weight loss, excessive thirst, and excessive eating?” Qibo replied, “If the pulse is replete and large, the illness can still be treated, even if it has lasted a long time. If the pulse is hollow, small, and hard, it cannot be treated once the illness has lasted a long time.”

After a prolonged illness, Qi and Blood have already weakened, so the pulse should not still be replete and large. For this reason, such a case cannot be treated. The New Editorial Correction says: On close examination of the text, the original says, “Replete and large: treatable even after a long illness,” while the commentary explains this as “incurable.” The Jia Yi Jing, the Tai Su, and the version by Quan Yuanqi all read “treatable.” Chao Yuanfang also says that a rapid and large pulse means the patient will live, while a small and floating pulse means the patient will die. He further says that a deep and fine pulse means the patient will live, while a replete, firm, and large pulse means the patient will die. “Dan” in xiaodan is pronounced like “dan” in cinnabar; “firm” describes an illness that has become entrenched.

The Yellow Emperor asked, “How are the measures for bodily proportions, bones, pulses, and sinews determined?” The commentary says that these subjects, along with the measures for the sinew channels, pulses, and bones, are all fully recorded in the Ling Shu Jing. This question should also stand at the beginning of the relevant chapter of the Ling Shu Jing and may have been misplaced. It is incorrect to place it at the beginning of the “On Reversal and Compliance” chapter of the Su Wen.

The Yellow Emperor said, “In spring, treat the channels and collaterals promptly; in summer, treat the acupoints of the channels promptly; in autumn, treat the six Fu organs promptly. In winter, when the movement of Qi is blocked, use medicines and use acupuncture and stone needles sparingly.”

“Promptly” means urgently, without delay. “Blocked” refers to the closure of the gateways through which Qi enters and leaves. The instruction to use needles and stone needles sparingly does not mean that abscesses and ulcers should also receive less treatment. Although the movement of Qi is blocked in winter, abscesses and ulcers can become severe, with pus forming inside the body. If it is not drained promptly, the sinews and bones will decay. Therefore, even in winter, abscesses and ulcers should be opened and pathogenic influences cleared with needles and stone needles.

Abscesses and ulcers can change rapidly, leaving no time for delay. Thus, they may still be treated with needles and stone needles in winter. If pus is not drained during the brief interval in which the illness changes, the sinews and bones inside the body will decay, and the disease may even penetrate the internal organs.

When the location of an ulcer (carbuncle) is hard to determine, and pressing on it reveals no distinct lump, while the pain appears and disappears suddenly, needle three points beside the Hand Taiyin channel, then needle two points on each side of the Ying vessels—the channels near the collar at the neck.

This describes a case in which there are signs of a carbuncle or deep abscess, but its exact location is unclear, so pressing the area reveals no distinct lump. The pain comes and goes, showing that its location shifts. Six points may be selected beside the Hand Taiyin channel, in the area of points such as Qihu on the chest, where the Foot Yangming channel passes. The Ying vessels also belong to the Foot Yangming channel. They are named for their position near the collar, with one on each side; needle two points on each side.

For a carbuncle in the armpit accompanied by a high fever, needle the Foot Shaoyang channel five times. If the fever still does not subside, needle the Hand Jueyin channel three times. Needle three times at the areas connected to the channels and collaterals of the Hand Taiyin channel, and at the junction of the large bones.

“The junction of the large bones” refers to the shoulder. The Jianzheng point lies in the hollow of the bone seam behind the Jianyu point.

If a carbuncle suddenly develops, with tendons and channels tightening and muscles aching along the course of a channel, unceasing sweating, and insufficiency of the Bao Qi (Qi deficiency in the lower burner), treatment should be given at the relevant channel’s Shu points.

If a carbuncle suddenly develops, with tendons and channels tightening and pain between the muscles along the course of a vessel, accompanied by unceasing sweating and insufficiency of the Bao Qi, tonification or reduction may be applied at the channel’s Jing points and Shu points. The New Collation notes that these two passages were originally scattered through the chapter and have now been moved here so that related material appears together.

For sudden abdominal fullness that does not lessen when pressed, select the Luo point of the Taiyang channel. Here, “Taiyang” refers to the Hand Taiyang channel. Zhongwan, the Stomach’s Mu point—a point where the Qi of an organ gathers on the abdomen—is where the channel Qi of Hand Taiyang, Hand Shaoyang, and Foot Yangming converge. This is why it is said to arise from the channels and collaterals and also to be the Stomach’s Mu point. The Zhonggao also says that Zhongwan is the Stomach’s Mu point, located between the Zhegu (the lower end of the sternum) and the navel.

The New Collation points out that the Jia Yi Jing reads, “Take the Luo point of the Taiyang channel and the condition will resolve,” and does not include the words “the Stomach’s Mu point” or the like. Yang Shangshan’s commentary, however, takes this to refer to the Foot Taiyang channel. The accounts differ, and it is not possible at present to determine which is correct.

The Shu points of the Shaoyin channel lie three cun beside the spine. Needle five times on each side, using a Yuanli needle, a type of needle with a rounded tip suited to deep insertion.

This passage refers to selecting Shu points of the Foot Shaoyin channel, three cun beside the spine, and needling five times on each side. “Shaoyin Shu” refers to the Shenshu points beside the spine, below the fourteenth vertebra. The New Collation says that the Jia Yi Jing also records that, after needling, one should wait about the time it takes to eat a meal and observe the patient while they stand for a long time. If the condition has not improved, examine the areas traversed by the Yang channels and needle several more times.

Cholera (sudden severe vomiting and diarrhea) may be treated at Zhishi (Chamber of Will), an point beside the Shaoyin meridian's shu points. The New Collation notes that Yang Shangshan held that cholera should be treated by needling five points beside the shu points.

The points of the Foot Yangming meridian, along with the three points lateral to them above, may also be used. Here "Foot Yangming" refers to Weishu (Stomach Shu point). When taking Weishu, one should also take the point lateral to the Shaoyin shu, the third point counting upward, which is Weicang (Granary of the Stomach).

For treating fright-epilepsy and palpitations from fright, five mai points may be needled: Yanglingquan (Spring Mound of the Yang Mound), located in the hollow on the outer side of the knee.

Five needles are inserted at each Hand Taiyin point, and five sites are needled on the Foot Taiyang meridian. Beside the luo point of the Hand Shaoyin, one point is taken; on the Foot Yangming, one point is taken; and at five cun above the ankle, three needles are inserted. The Foot Taiyang point here is Chengshan (Mountain Support), the Hand Taiyin point is Yuji (Fish Border), located behind the joint at the base of the thumb on the inner side, where the vessel can be seen. The point beside the Hand Shaoyin luo is Zhizheng (Branch Correct), located five cun above the wrist, between the upper edge of the ulna and the muscle. Zhizheng is the luo point of the Hand Taiyang; its channel branches off here and runs to the Hand Shaoyin. The Foot Yangming point taken is Jiexi (Stream Ravine), located in the depression at the ankle joint. The point five cun above the ankle is Guangming (Bright Light), the luo point of the Foot Shaoyang.

The Inner Canon, the Mingtang, the Zhonggao, and the Tujing all describe in detail the use of these points for treating cholera. The New Collation observes that another commentary holds that none of these points treat cholera, and the reason for this discrepancy is still unclear. Moreover, according to the Jiayi Jing and the Taisu, the relevant passage concerns fright-epilepsy, so Wang Bing's annotation of cholera may be a mistake.

In general, for conditions such as xiaodan (wasting-thirst, a category of diabetes-like disorders), pujī (sudden collapse or being struck down), pianku (hemiplegia), weijue (flaccid limbs with cold extremities), qi fullness, and upward-rushing qi, if the patient is wealthy and corpulent, the cause is mostly overindulgence in rich, fatty, and sweet foods. Obstruction of the chest and diaphragm, with blockage above and below, is a disease caused by sudden grief. Sudden fainting with deafness and blockage on one side results from qi surging violently within the body. If the illness is not caused by internal injury or external wind, but instead by emaciation from stagnant pathogenic qi, this indicates long-lingering stagnation. Limping in the feet belongs to diseases caused by cold, wind, or dampness.

"Xiao" (wasting) means internal dissipation, and "dan" (heat) means latent heat. "Jue" (reversal) means rising qi. "Gao" refers to fat and grease, and "liang" refers to fine grains. "Zhi" means the foot. Rich, fatty, and sweet foods readily generate heat within the body, and sweets readily cause fullness in the middle burner. Therefore, excess internal heat develops into wasting-thirst. Hemiplegia, qi fullness, and qi reversal are also all disorders of qi movement. "Reversal" means going against the norm, unlike the condition of a healthy person.

Treatise on Taiyin and Yangming (Taiyin Yangming Lun Pian)

Worry and brooding cause the mechanism of qi (qi ji) to become blocked and sluggish, so the chest and diaphragm become congested, the breath is stifled, the channels of qi are interrupted, and the upper and lower parts of the body fail to communicate. When qi stagnates within the body, the passage of urine and feces may also become unsmooth. This happens because the qi of the zangfu organs cannot circulate normally, the channels of excretion are obstructed, and the qi cannot disperse outward.

When external wind invades the body and lingers, the yang qi within is affected and transforms into heat. This heat pathogen scorches the muscles, causing them to waste and thin, so the skin clings tightly to the sinews and bones. When dampness predominates in the feet, the sinews lose their flexibility; when cold predominates in the feet, the sinew channels become tight and spasmodic. When wind, dampness, and cold predominate, the weiqi (protective qi, the qi that guards the body) gathers and flows poorly, causing muscle pain, so the legs become lame and the person cannot walk.

The Yellow Emperor (Huangdi) asks: Are jaundice, sudden pain, epilepsy, jue ni (reversal, in which qi moves in the wrong direction and the limbs turn cold), and mania all caused by long-standing disorder of qi movement? What results when the functions of the five zang organs are disturbed and the six fu organs are blocked? Are headache, tinnitus, and obstruction of the nine orifices (the two eyes, two ears, two nostrils, the mouth, and the anterior and posterior yin orifices) caused by the intestines and stomach?

The qi and blood of the three yang channels of the foot flow downward from the head to the feet. If reversal persists and qi and blood cannot flow downward, they accumulate in the upper burner (the region above the diaphragm), producing jaundice, sudden pain, mania, and qi counterflow. Improper diet, or excessive vomiting and diarrhea, blocks the six fu organs and disturbs the balance of the qi of the five zang organs. When the intestines and stomach are obstructed, qi cannot move smoothly; when qi is not smooth, upper and lower, and internal and external, influence one another, so headache, tinnitus, and blockage of the nine orifices appear.

The Yellow Emperor asks: Taiyin and Yangming stand in interior-exterior relation, corresponding to the spleen and the stomach. Why do the disorders of spleen and stomach differ?

The spleen and stomach both belong to the Earth phase, but one is a zang and the other a fu, and their diseases present differently. For this reason the Yellow Emperor asks about the cause.

Qi Bo replies: The positions of yin and yang differ, deficiency and excess alternate over time, and reversal and smoothness also shift. Some diseases arise from within and others from without, and since the paths of onset differ, the names of the diseases differ as well.

The spleen is a yin zang and the stomach is a yang fu. The qi of the yang channels flows downward, while the qi of the yin channels flows upward. The qi of the yang channels runs along the surface of the body, while the qi of the yin channels runs within. Therefore their paths of circulation differ, and the diseases they suffer carry different names.

The Xinjiao Zheng (New Collation) cites Yang Shangshan, who says: In spring and summer, Yangming tends toward excess and Taiyin toward deficiency; in autumn and winter, Taiyin tends toward excess and Yangming toward deficiency. This is the alternation of deficiency and excess. In spring and summer, Taiyin is reversed and Yangming is smooth; in autumn and winter, Yangming is reversed and Taiyin is smooth. This is the alternation of reversal and smoothness.

The Yellow Emperor said: I would like to hear how these two conditions differ in their manifestations. Qi Bo replied: Yang belongs to the heavenly qi (tianqi) and governs the exterior of the body; Yin belongs to the earthly qi (diqi) and governs the interior. This is what is meant by Yin and Yang occupying different positions.

Therefore, the nature of Yang is fullness, and the nature of Yin is emptiness. This is what is meant by Yin and Yang alternately being full and substantial, and alternately being empty and depleted.

For this reason, when a person encounters harmful winds (zei feng) or vacuous evils (xu xie), meaning the abnormal qi of the four seasons that can harm the body and cause disease, the Yang aspect is usually affected first. If eating and drinking are not regulated and daily routines do not follow the proper timing, the Yin aspect is usually affected first. This is what is meant by diseases arising sometimes from within and sometimes from without.

When an evil invades the Yang aspect, it passes into the six fu organs (liu fu): the gallbladder, stomach, large intestine, small intestine, bladder, and triple burner (sanjiao). When an evil invades the Yin aspect, it passes into the five zang organs (wu zang): the heart, liver, spleen, lungs, and kidneys. When the evil enters the six fu organs, the body becomes feverish and sleep is not restful at the proper times; upward movement brings panting and shouting. When the evil enters the five zang organs, the abdomen becomes distended and the qi becomes blocked; downward movement brings diarrhea with undigested food (sun xie), and over a long period it can develop into dysentery (chang pi), a category of illness marked by bloody or purulent stools. This is what is meant by different routes of onset and different names for the disease.

The throat governs breathing and connects with the heavenly qi; the pharynx governs eating and drinking and connects with the earthly qi. Therefore the Yang aspect is easily affected by wind evils, and the Yin aspect is easily affected by damp evils. This is because qi of the same kind responds to one another.

The qi of the Yin channels travels upward from the feet to the head, then descends along the arms to the fingertips. The qi of the Yang channels travels upward from the hands to the head, then descends to the feet. This is what is meant by alternating reverse and forward movement. The Lingshu Jing (Spiritual Pivot Classic) states: the three Hand Yin channels run from the viscera toward the hands; the three Hand Yang channels run from the hands toward the head; the three Foot Yang channels run from the head toward the feet; and the three Foot Yin channels run from the feet toward the abdomen. Because each channel runs in a different direction, some move in reverse and some in forward order.

Thus it is said: when a disease of a Yang channel progresses upward to its extreme, it turns and moves downward; when a disease of a Yin channel progresses downward to its extreme, it turns and moves upward. This describes the general pattern only. The pulse of the Foot Shaoyin kidney channel, however, runs downward, unlike the qi of the other Yin channels.

Therefore, those injured by wind evils are affected first in the upper part of the body, and those injured by damp evils are affected first in the lower part. Yang qi has the nature of rising upward, so it is easily affected by wind; Yin qi has the nature of moistening and descending, so it is easily affected by dampness. Both are due to the principle that like things combine with like.

The Yellow Emperor asked: when the spleen is diseased and the limbs cannot move, what is the principle behind this? Qi Bo replied: all four limbs must obtain grain-and-water essence from the stomach, but the stomach qi cannot reach the limb channels directly. The Xin Jiaozheng (New Collation), a commentary by Song dynasty editors, notes that in the Taisu (Plain Essentials), the phrase zhi jing (reaching the channels) is written as jing zhi (channels reaching). Yang Shangshan explains: the stomach nourishes the limbs with grain and water, but cannot send this nourishment to them directly; it must rely on the spleen to transport and deliver the refined essence and fluids of food to the limbs, so that the limbs can receive their nourishment. The spleen qi distributes and transforms the essence of food and drink, and only then can the limbs receive nourishment. Now, when the spleen is diseased, it cannot carry fluids on behalf of the stomach, so the limbs do not receive the nourishment of grain-and-water qi, and therefore their movement fails.

Gu qi (grain-derived qi) grows weaker and scantier by the day. The channels and vessels (mai dao) do not flow smoothly, the sinews, bones, and muscles cannot receive qi to nourish them, and so the limbs cannot move normally.

The Yellow Emperor (Huangdi) asked: Why does the spleen not govern a season on its own?

The liver governs spring, the heart governs summer, the lung governs autumn, and the kidney governs winter. These four organs each have a corresponding season, but the spleen has no season of its own.

Qi Bo replied: The spleen belongs to Earth and occupies the center. At the turning of the four seasons it assists each of the other four organs in turn, governing for eighteen days at the end of each season, and so it does not govern any single season alone. The spleen's function regularly relies on the stomach and receives the essence of water and grain from within the stomach. Earth nourishes and gives life to all things, and its action pervades heaven and earth, above and below. From head to foot the body is affected by it, so its influence cannot be confined to one season.

The word zhi here means "to govern." The word zhu means that the spleen's function regularly relies on, or attaches to, the stomach. Earth qi lodges in each of the four seasons and holds sway for eighteen days at the end of each. In this way each of the Five Phases (Wood, Fire, Earth, Metal, Water) governs for seventy-two days, and together they make up one year. Externally, Earth corresponds to the four seasons; internally, in the body, it corresponds to the hands and feet.

The Yellow Emperor asked: The spleen and stomach are joined only by a single membrane. Why, then, can the spleen move the fluids (jin ye)?

The New Collation (xin jiaozheng) notes that the Taisu (Taisu) reads "yi mu xiang ni" here. Yang Shangshan (Yang Shangshan) explains that the spleen belongs to yin and the stomach to yang, that the spleen lies within and the stomach without, and that their positions differ, so the text speaks of the two as opposing one another.

Qi Bo replied: The Foot Taiyin channel (zu taiyin jing), which is the spleen channel, belongs to the three yin channels. Its collaterals connect with the stomach and return to the spleen, and it also links to the throat. This is why the Foot Taiyin can distribute qi among the three yin channels. The Yangming channel belongs to the exterior, and the stomach is the fu organ paired with the spleen in an interior-exterior relationship. The stomach is also where the five zang and six fu organs receive water and grain, and it is responsible for sending qi on to the three yang channels. Each of the five zang and six fu organs follows its own channels and receives the qi of water and grain from the Yangming channel, which is why the stomach can distribute fluids.

If the four limbs do not receive the qi of water and grain, qi grows weaker day by day. If the yin channels do not flow freely, the sinews, bones, and muscles lose their nourishment, and the limbs cannot move normally. This passage again confirms that the spleen governs the four limbs.

Chapter on Explaining the Yangming Pulses (Yangming Mai Jie Pian)

The Yellow Emperor asked: When the Foot Yangming channel (the stomach channel) falls ill, the patient dislikes seeing people and seeing fire. Hearing the sound of wooden objects frightens him, while the sound of bells and drums does not startle him. Why is it specifically the sound of wood that causes fright? Please tell me the reason.

The previous chapter said that when evil qi enters the six fu organs, the body becomes feverish, sleep is irregular, and there may be wheezing and rapid breathing. The Yangming channel is the stomach channel. The symptoms described here differ from those in the previous chapter, showing fright at the sound of wood instead, so the Yellow Emperor asks about the difference.

Qi Bo replied: The Yangming channel is the stomach channel. The stomach belongs to Earth, so when it hears wood...

"Sounds accompanied by fear arise because Earth Qi (tuqi) is averse to Wood Qi (muqi)." The Book of Yin-Yang (Yinyang Shu) says: "Wood overcomes Earth, so Earth Qi is averse to Wood Qi."

The Yellow Emperor asked: "Good. But what is the reason for aversion to Fire?" Qi Bo replied: "The Yangming channel governs the muscles. When Qi and blood are abundant and pathogenic Qi invades, fever arises. When the heat is intense, one comes to dislike fire."

The Yellow Emperor asked: "What is the reason for aversion to other people?" Qi Bo replied: "When the Qi of the Yangming channel rises against its normal flow, one pants and feels vexed in the chest. In such vexation one comes to dislike others, because heat pathogens accumulate within the body and make a person irritable." The New Collation (Xinjiao Zheng), citing the Explanations of the Pulse (Maijie), adds that when patients wish to shut themselves in a room alone, it is because Yin and Yang are contending, Yang Qi is excessively exuberant outward, and Yin Qi is exhausted, so they want only to be left alone.

The Yellow Emperor asked: "Some people die after panting, while others panting in the same way survive. Why is this?" Qi Bo replied: "If the adverse flow of Qi affects the Five Zang organs, death follows; if it affects only the channels, the person survives." The channels (jingmai) are the pathways along which Qi and blood circulate. The Five Zang, also called the "Five Shen Repositories" (wushenzang), are the organs that store jing and shen. When the adverse flow spreads to the Five Zang and death follows, it is because the shen has dispersed.

The Yellow Emperor asked: "When the illness is severe, some people strip off their clothes and run, climb heights and sing, and sometimes go several days without eating. They can scale walls and climb onto roofs, places they could never normally reach. Why does illness enable them to do these things?"

Qi Bo replied: "Yin and Yang are contending, and Yang Qi is excessively exuberant outward. The four limbs are where the Qi of all the Yang channels converges. When Yang Qi is vigorous, the limbs become full and strong, and so one can climb to heights." The New Collation, citing the Explanations of the Pulse, likewise explains this phenomenon by the outward excess of Yang Qi.

The Yellow Emperor asked: "Why does one strip off clothing and run?" Qi Bo replied: "The heat within the body is too intense, so one removes one's clothes and wishes to run."

The Yellow Emperor further asked: "Why does one speak nonsense, curse others without distinguishing between intimate and distant, and also sing?" Qi Bo replied: "Excessive Yang Qi causes a person to speak nonsense, to curse others without distinguishing kin from strangers, and to lose the desire to eat. Without the desire to eat, one wanders about aimlessly."

The Foot Yangming Stomach channel descends through the diaphragm, connects with the stomach, and links with the Spleen. The Foot Taiyin Spleen channel enters the abdomen, connects with the Spleen, and links with the Stomach, then ascends through the diaphragm, follows the throat to the root of the tongue, and spreads beneath the tongue. Therefore, when the Qi of the Spleen and Stomach channels becomes diseased, the manifestations described above appear.