《黃帝內經素問補註釋文》Vol. 24

End of Volume 24 of the Huangdi Neijing Suwen: Annotated and Supplemented Edition

Annotated by Wang Bing (styled Qixuanzi), Grand Master of the Imperial Stables of the Tang dynasty. Collated by Lin Yi and others, Chamberlain for Splendid Happiness and Editor of the Imperial Library of the Song dynasty. Errors corrected a second time by Sun Zhao, Acting Director of the Agricultural Colonies in the Ministry of Personnel of the Song dynasty.

Chapter on Discussing Pain

The Yellow Emperor asked: "I have heard that one who speaks well of the Way of Heaven must find its confirmation in the human body; one who speaks well of antiquity must match the principles of the past against present circumstances; and one who speaks well of people must include himself in the examination. When these are achieved, the principles cause no confusion, and one grasps the essentials and patterns of things. This is what is called clear understanding and thorough comprehension."

The annotation explains: To speak well of the Way of Heaven means to explain how the changes of the four seasons, warm, cool, cold, and hot, and the patterns of growth, flourishing, harvest, and storage are reflected in the human form, in Qi (vital energy) and blood, and in the five viscera, and to distinguish good from bad within them. Hence the text says, "find its confirmation in the human body." To speak well of antiquity means to compare what the sages of high antiquity chose and rejected in nurturing life with the principles of nurturing life today, and so to discuss success and failure, gain and loss. Hence the text says, "match against the present." To speak well of people means to explain how the human form and joints support one another, how sinews and vessels are linked, and how skin and flesh enclose the five viscera and six bowels. The five viscera, in turn, depend on the seven spirits (the mental and spiritual activities associated with the five viscera) to function. Once Qi is severed and Shen (spirit) departs, a person dies. One should therefore understand that this outward body cannot last forever without decay, and should quietly turn inward to reflect on oneself. Oneself and others are no different, hence the text says, "include himself in the examination." Only one who can do these things has grasped the essentials and patterns of the principles, free of doubt and deeply aware of their ultimate truth.

The Yellow Emperor continued: "Now I ask you, Master, whether the principles can be explained so that they are clearly heard, plainly seen, and even verified by the hand. Can people use their own bodies to confirm them, so that the ignorant are enlightened and doubts are dispelled? May I ask whether you can explain them to me in this way?"

The annotation says that "enlightening the ignorant" means opening the ears and eyes of those who are in the dark, and "dispelling doubt" means removing the perplexity of those who are uncertain. That is, the principles are set out clearly one by one so that people can observe them and examine them by touch. The word for "verify by hand" means to follow along and feel.

Qi Bo bowed and touched his head to the ground, and replied: "What principle is it that you wish to ask about?" The annotation says that this is a request for the Yellow Emperor to state where he wishes the discussion to begin.

The Yellow Emperor said: "I wish to know what causes sudden pain in the five viscera."

Qi Bo replied: "The Qi and blood in the channels flow without ceasing, circulating in cycles with no rest. When cold Qi enters the channels, it makes the flow of Qi and blood slow and sluggish, so that it does not move freely. If cold Qi lingers outside the channels, the blood decreases; if it lingers inside the channels, the Qi cannot flow through. Therefore a person suddenly feels pain."

The Yellow Emperor asked: "Some pains begin suddenly..." The original text breaks off here.

Some kinds of pain stop on their own. Some are severe and continue for a long time; some are severe and cannot bear pressure; some stop when pressed; and some do not respond to pressure. In some cases, Qi in the abdomen pulses and can be felt beneath the hand. In others, pain pulls between the heart and the back, or between the ribs and the lower abdomen. Sometimes abdominal pain extends to the genital area and the inner thighs. Some pain persists for a long time and gradually forms a mass. Some begins suddenly and intensely, causing fainting and loss of consciousness, followed by waking after a while. Some pain is accompanied by vomiting; some is followed by diarrhea; and some occurs with constipation and an inability to pass stool. How should these different kinds of pain be distinguished?

Qibo replied: When Cold Qi lodges outside the channels, the channels become chilled. Chilled channels contract and tighten; this draws on the smaller collateral vessels outside them, causing sudden pain. When warmth arrives, the pain stops at once.

The channels encircle the body on both sides. When they are chilled, they contract and tighten, so Defensive Qi—the Qi that moves outside the channels and provides protection—cannot flow freely. This draws on the smaller collateral vessels outside the channels. As Defensive Qi cannot enter, Cold Qi presses close to the channels, making them tense and unable to relax. This causes pain. When warmth arrives, Defensive Qi begins to move again, Cold Qi withdraws, and the pain stops. “Jiong” means warmth; “zhi yi” means that the pain has stopped.

If a person is repeatedly exposed to Cold pathogens, the pain persists for a long time because Cold Qi has accumulated and is difficult to disperse.

When Cold Qi lodges inside the channels and clashes with warm Qi, the channels become distended. Their distension causes pain, and the area cannot bear pressure.

The reason severe pain cannot bear pressure is explained later: Cold Qi becomes stagnant, while warm Qi gathers and rises from within. The channels fill and swell, and Qi and blood are thrown into disorder. The pain is therefore severe, and pressure cannot be tolerated. Since the channels are already swollen and Qi and blood are disordered, pressing them causes the pathogenic Qi to attack inward, so they cannot be pressed.

When Cold Qi lodges between the intestines and stomach, beneath the Moyuan—the membranes between the diaphragm and the deeper tissues—blood cannot disperse. The smaller collateral vessels tighten and pull, causing pain. Pressure allows the blood and Qi to disperse, easing the pain. The “blood” referred to here is the blood in the smaller collateral vessels between the diaphragmatic membranes. When the collateral vessels become full, they tighten and pull, causing pain. Pressing with the hand disperses the Cold Qi and relaxes the smaller vessels, so the pain stops.

When Cold Qi lodges in the channels beside the spine, the force of pressing cannot reach deep enough, so pressure has no effect.

The meridians on either side of the spine are arranged as follows: the Governor Vessel runs along the midline, while the Foot Taiyang meridians (the Foot Taiyang Bladder Meridian) run on both sides. The Governor Vessel travels within the spine, whereas the Foot Taiyang meridians pass through the back’s muscles and tendons. For this reason, even deep, forceful pressure cannot reach the meridians. Pressing down the middle bends the spinal joints; pressing on either side contracts and tightens the back muscles and tendons. Both bending the spine and tightening the muscles obstruct the movement of defensive Qi. Cold can then gather and remain in the body more easily, so this kind of pressure does no good.

When cold invades the Chong Vessel (one of the Eight Extraordinary Vessels, originating below the kidneys and ascending through the abdomen), the vessel becomes blocked. This blockage also obstructs the Qi of the Foot Shaoyin Kidney Meridian, causing it to surge upward and become congested. The result is labored breathing, with a pulse of Qi that can be felt beneath the hand when it rests on the chest or abdomen. The Chong Vessel passes through Guanyuan (an acupuncture point three inches below the navel). Saying here that it ascends from Guanyuan means that it passes this point as it travels upward through the abdomen; it does not mean the Chong Vessel originates at Guanyuan. It actually begins below the kidneys and ascends in a direct course to the throat. The Chong Vessel runs alongside the Foot Shaoyin Kidney Meridian, so a blockage in the Chong Vessel also affects the Qi of the Kidney Meridian, causing labored breathing and a pulse felt beneath the hand.

When cold invades the back’s Shu vessels (meridians connecting the back with the internal organs), the blood vessels become sluggish and obstructed. This impedes the flow of blood, leading to blood deficiency, which in turn causes pain. The back’s Shu vessels connect with the Heart, so the pain radiates to the Heart region. When the affected area is pressed and rubbed, warmth arrives and the pain stops. The back Shu point referred to here is the Heart Shu, which belongs to the Foot Taiyang meridian. All the back Shu points connect with the internal organs, which is why the scripture says this point connects with the Heart and the pain radiates between them. As pressure brings warmth into the area, Heart Qi spreads outward and the pain eases.

When cold invades the Jueyin meridian (the Liver Meridian), it disrupts the movement of the blood, causing it to become sluggish and the meridian to contract. The Jueyin meridian circles the genitalia and connects with the Liver, so pain in the ribs and lower abdomen draws from one region to the other. The Foot Jueyin Liver Meridian enters the pubic hair region, circles the genitalia, reaches the lower abdomen, then ascends through the Liver and diaphragm and spreads across the ribs. When the meridian contracts, it therefore pulls on both the ribs and lower abdomen, causing pain.

When rebellious Qi remains in the inner thigh, cold rises and affects the lower abdomen, while the blood vessels in the lower part of the body become sluggish. The resulting pain draws from one area to the other, causing abdominal pain that extends into the inner thigh. This too is caused by Qi in the Jueyin Liver Meridian: the meridian ascends along the inner thigh, enters the pubic hair region, circles the genitalia, and reaches the lower abdomen. This is why the scripture says that rebellious Qi remains in the inner thigh while cold rises to affect the lower abdomen.

When cold remains between the small intestine and the membrane-source region, in the collateral vessels and in the blood, the blood congeals and stagnates, unable to flow into the main channels. Qi and blood therefore accumulate and cease to circulate; over time, masses form. In other words, when cold congeals the blood, accumulations develop.

When cold invades the five viscera, it throws the movement of Qi into disorder and drives it upward. Yin is depleted, while Yang has not yet recovered, so a person may suddenly feel pain, faint, and lose consciousness. Once the movement of Qi resumes, the person can awaken. In other words, cold pathogens obstruct the Qi of the five viscera and impede its circulation; when Qi begins to flow again, the symptoms ease. ○ The New Collation says: In the detailed commentary, “obstructing the Stomach” may have been intended as “obstructing and clouding.”

When cold remains in the intestines and Stomach, the movement of Qi becomes disordered and surges upward, causing pain and vomiting. Cold pathogens lodged in the intestines and Stomach prevent Yang from moving downward, so it instead rebels upward. If the cold does not disperse, it causes pain; when Yang rebels upward, it causes vomiting.

When cold remains in the small intestine, the small intestine cannot gather and receive food and fluids, resulting in diarrhea and abdominal pain. The small intestine is the receiving organ, which takes in food from the Stomach. When it is filled with cold pathogens, it cannot retain and accumulate its contents, so the cold passes downward into the ileum. The ileum, also called the large intestine, transports and excretes the contents. Since these cannot remain there, diarrhea and abdominal pain result.

When heat remains in the small intestine, the intestines become painful and the intense heat makes a person parched with thirst. The intestines grow hard and dry, making defecation difficult; pain and blockage follow. Heat pathogens consume the fluids, so the stool becomes dry and hard.

The Yellow Emperor asked, “You say that illness can be understood by asking questions. What can be discerned by observation?” Qibo replied, “This refers to observing the complexion. Each of the five viscera and six bowels corresponds to a particular area of the face. A yellow or red complexion indicates heat; when there is heat inside the body, the complexion turns yellow or red. A pale complexion indicates cold. When Yang is insufficient, blood cannot rise to nourish the face, so the complexion becomes pale. A blue or black complexion indicates pain. When blood is heated and congeals, its circulation is impeded, and the complexion turns blue-black.”

The Yellow Emperor then asked, “What can be discovered by touch?” Qibo replied, “The vessels corresponding to the principal symptoms can be examined. Whether they are hard, congested, or sunken, this can all be detected by touch.” The Yellow Emperor said, “Good. I understand. All illnesses arise from changes in Qi. The movement of Qi may be deficient or excessive, rebellious or orderly, slow or rapid; any of these states can cause illness. That is why I asked these questions.”

Anger makes Qi surge upward; joy makes Qi flow smoothly; grief diminishes Qi; fear makes Qi sink downward; cold makes Qi contract; heat makes Qi leak outward; fright throws Qi into disorder. The New Collation notes that the Taishu writes “worry” instead of “fright.”

Exertion depletes Qi, while excessive thought causes Qi to stagnate. These nine changes in Qi are different from one another. What illnesses do they cause?

Qibo replied: Anger makes Qi flow in the wrong direction. In severe cases, it causes vomiting of blood and diarrhea in which undigested food is passed. The New Collation notes that the Jia Yi Jing and the Taishu write “food counterflow after eating” instead of “undigested-food diarrhea.” This is what is meant by Qi surging upward.

When a person becomes angry, Yang Qi surges upward against its proper course, while Liver Qi encroaches on Spleen Qi. In severe cases, this causes vomiting of blood and diarrhea. How can we tell? When someone is angry, the face turns red; in severe cases, it turns blue-green. The Lingshu Jing says, “If great anger does not cease, it will damage the will.” This shows that anger makes Qi surge upward in counterflow, unable to descend.

With joy, Qi and blood harmonize, the mind and will feel at ease, and Ying Qi and Wei Qi flow freely, so Qi becomes relaxed. When the Qi channels are harmonious, the mind and will feel at ease; when Ying and Wei flow freely, the movement of Qi becomes calm and unhurried.

With grief, the vessels of the Heart contract, while the lobes of the Lungs spread open and lift upward. This blocks the upper Jiao (the upper part of the body, associated mainly with the functions of the Heart and Lungs), preventing Ying and Wei Qi from dispersing. Heat then remains in the body, so Qi is diminished.

“Spreading the lobes” refers to the Lung lobes opening out like a covering. The New Collation notes that the Jia Yi Jing and the Taishu write “the two Jiao are blocked” instead of “the upper Jiao is blocked.” Wang Bing’s commentary explains “the Lung spreads its lobes and lifts them” as meaning that the Lung lobes open out like a covering, but the New Collation considers this explanation perhaps not entirely apt. Quan Yuanqi says that grief damages the Heart; when the Heart vessels contract, they affect the Lungs, and Lung Qi then draws the other channels into counterflow. As a result, the Lung lobes spread and lift upward. If so, how can “the Lung spreads” be explained as the Lung lobes opening out like a covering?

With fear, Jing Qi retreats. When Jing Qi retreats, the upper Jiao becomes blocked. Once the upper Jiao is blocked, Qi flows back; when Qi flows back, the lower Jiao becomes distended. Qi therefore cannot move normally.

With fear, Yang essence—the vital essence formed from Yang Qi—retreats and cannot flow downward. The upper Jiao is therefore blocked. Since the upper Jiao is blocked, Qi cannot descend; Yin Qi in the lower Jiao also turns back instead of dispersing, and gathers to form distension. Yet when the upper Jiao is blocked and Qi in the lower Jiao turns back, each remains trapped in its own place, so Qi cannot move. The New Collation notes that, on close examination, “Qi does not move” here should read “Qi moves downward.”

With cold, the interstices close and Qi cannot move, so Qi contracts. “Cou” refers to the places where fluids seep out; “li” refers to the points where the skin’s lines meet; “close” means to shut tightly; “Qi” refers to Wei Qi; “move” means to circulate; and “contract” means to draw inward.

When the body is chilled, the defensive Qi that protects the body’s surface sinks inward. The skin’s texture and the channels through which sweat is released therefore close. Qi can no longer circulate, and the defensive Qi gathers inside the body instead of dispersing outward.

The Newly Revised Text says: A check of the Jia Yi Jing shows that “Qi does not circulate” is written as “the nutritive and defensive Qi do not circulate.”

When the body is hot, the interstices of the skin open. The nutritive and defensive Qi flow freely, and sweat pours out, carrying Qi with it.

People feel at ease when Yang Qi unfolds and discomfort when Yin Qi contracts. Thus, when the body is hot, the skin’s interstices open and the nutritive and defensive Qi circulate freely. Fluids seep outward, and sweat pours out.

When a person is startled, the heart spirit loses its support, the spirit has nowhere to settle, and thoughts cannot be steadied. The movement of Qi is therefore thrown into disorder.

Qi rushes outward and consequently loses its harmony. The Newly Revised Text says: A check of the Tai Su shows that “startled” is written as “worried.”

When a person is exhausted, they pant and sweat. Qi both inside and outside the body is depleted outward, so Qi is diminished.

Excessive labor and physical fatigue make Qi move rapidly, causing panting. When Qi moves rapidly, Yang Qi disperses toward the body’s surface, and sweating follows. Both panting and sweating cause Qi inside and outside the body to move beyond its normal bounds, and Qi is therefore harmed.

When a person broods, the heart remains attached to something and the spirit concentrates on what is being considered. Upright Qi becomes stuck and cannot circulate, so Qi becomes constrained.

When the mind is fixed on one thing and cannot let go for a long time, Qi too comes to a standstill. The Newly Revised Text says: A check of the Jia Yi Jing shows that the two characters “returns to normal” are written as “stops.”

Treatise on the Abdomen

The Yellow Emperor asked: Some people have fullness and distension in the chest and abdomen. They eat in the morning but cannot eat again by evening. What illness is this?

Qibo replied: This illness is called “drum distension,” a condition in which the abdomen swells and takes on the shape of a drum.

There is fullness and distension in the chest and abdomen, the person cannot eat again, and the abdomen is shaped like a drum; hence the name “drum distension.” The Newly Revised Text says: A check of the Tai Su shows that “drum” is written as “grain.”

The Yellow Emperor asked: How should it be treated?

Qibo replied: Treat it with chicken-dropping medicinal wine, made using chicken feces. One dose will bring improvement, and two doses will cure the illness.

According to the ancient Materia Medica, chicken droppings are not said to treat drum distension; it states only that they strongly promote urination and are slightly cold in nature. The formula mentioned here should be used according to the method current at the time: soak the medicinal substance in a liquid decoction and take it.

The Yellow Emperor asked: Some people recover at the time, but later the illness returns. Why?

Here, “returns” means that the illness occurs again, with the symptoms appearing as before.

Qibo replied: This happens because eating and drinking have not been regulated, so the illness sometimes returns. Even if the condition improves for a time, it may recur later because pathogenic Qi has gathered in the abdomen.

Irregular eating and drinking can damage the stomach. The Stomach Channel runs downward through the abdomen, so people who eat and drink without restraint are prone to repeated illness, and pathogenic Qi may gather in the abdomen.

The Yellow Emperor asked: There is a disease in which the chest and both flanks feel distended and full, making it difficult to eat. When the illness occurs, the person first notices a fishy, foul odor, then clear fluid flows out. First there is vomiting of blood, the limbs grow cold, and the vision becomes dizzy and blurred. At times there is bleeding from the front or rear orifice. What is this disease called, and how does it arise?

Here, “clear fluid” means a watery, transparent liquid, also called clear nasal discharge: a cold, watery fluid flowing from the nasal passages. “Dizziness” means blurred vision or a spinning sensation. “Blood from the front or rear” means bleeding from the front or rear orifice.

Qibo replied: This disease is called “Blood Dryness.” It arises when someone loses a great deal of blood while young, or has sexual intercourse after becoming drunk, causing Jing and Qi to be depleted and the liver to be injured. As a result, menstrual flow becomes scant or stops altogether.

Heavy blood loss is called “blood depletion.” This includes prolonged uterine bleeding, nosebleeds, and vomiting blood. After drinking heavily, the blood vessels become full and heat can readily arise in the body. Having sexual intercourse at that time greatly depletes the essence in the marrow, so the Jing and Qi in the kidneys become exhausted. The liver governs the storage of blood, and excessive blood loss also injures the liver. In men, seminal fluid becomes scant; in women, menstruation becomes irregular or ceases.

The Yellow Emperor asked: How should it be treated, and what method should be used? Qibo replied: Take four parts cuttlebone and two parts lǘrú, combine them, and make pills the size of a sparrow’s egg or a small bean. Take five pills at a time. Take the medicine first, then eat, and wash it down with abalone broth to help the bowels pass freely.

A new textual note says: Some versions read “injury to the middle.” “Cuttlefish” is pronounced “ze,” and “lǘrú” is pronounced “juru.”

The commentary explains: “Eat afterward” means to take the medicine first and eat later. According to the records in the ancient Materia Medica Classic, cuttlebone, lǘrú, and the other ingredients do not appear to treat Blood Dryness. But the method described in the text addresses the cause and root of the illness. Having sexual intercourse after drunkenness and exertion depletes the Jing and Qi in the kidneys, causing menstruation to become scant or stop; stagnant, unhealthy blood may also remain in the body. When Jing and Qi are exhausted, the penis may fail to become erect and seminal fluid may be insufficient. When unhealthy blood stagnates, it obstructs the blood and congeals within the body. This is why the four medicines above are used. The ancient Materia Medica Classic records that cuttlebone tastes salty, is cool and neutral in nature, and is nontoxic; it chiefly treats women’s blocked menstruation. Lǘrú tastes pungent, is cold and neutral in nature, and is slightly toxic; it can disperse unhealthy blood. Sparrow eggs taste sweet, are warm and neutral in nature, and are nontoxic; they chiefly treat men’s …

For disorders in which a man’s penis is weak and cannot become erect, medicine can be used to warm it and strengthen Jing and Qi, thereby aiding reproduction. Abalone is pungent in nature and flavor, has a fishy, foul smell, and is warm and neutral in nature. It is non-toxic and chiefly treats stagnant blood, blood impediment—numbness and similar symptoms caused by impaired circulation in the vessels—and pathogenic factors in the limbs that cannot disperse. Judging from the meaning of the classic, the formula’s effects are roughly as described. Prescribe treatment accordingly.

The Revised Text says: A comparison with the Jia Yi Jing and the Tai Su shows that they write “lü ru,” not “lu ru.” A close reading of Wang Bing’s notes on its nature and flavor indicates that “lü ru” is the correct form, so the character “lü” should be changed to “lü.” In addition, the Materia Medica says that cuttlefish bone is cold in nature, whereas Wang Bing’s commentary says it is slightly warm; the Materia Medica says that sparrow eggs are sweet, whereas Wang Bing’s commentary says they are sour. The accounts differ.

The Yellow Emperor asked: There is a disorder in which the lower abdomen is distended and full, and it feels as though something is rooted there in every direction, from top to bottom and from left to right. What disorder is this? Can it be treated?

Qibo replied: This disorder is called “Fuliang.”

Fuliang is one kind of heart accumulation, a disorder caused by pathogenic factors gathering in the heart.

The Revised Text says: On close examination, the Fuliang described here differs greatly from the Fuliang among the heart accumulations. It is not unusual for the same disorder name to refer to different conditions; this is one such case.

The Yellow Emperor asked: How does Fuliang arise?

Qibo replied: This is a disorder outside the intestines and stomach, enclosing a large amount of pus and blood. It cannot be treated. If one repeatedly presses hard while treating it, the patient will die.

The Yellow Emperor asked: Why is that?

Qibo replied: If the lesion extends downward, it presses on the genital region, causing pus and blood to drain downward. If it extends upward, it approaches the stomach opening, producing a disorder around the diaphragm and forming an internal abscess beside the stomach opening.

The lesion lies where the Thoroughfare Vessel and the Girdling Vessel pass. The Girdling Vessel begins near the lower ribs, circles the body, and runs horizontally below the navel. The Thoroughfare Vessel connects with the network vessels of the Foot Shaoyin channel. It begins below the kidneys, extends outward to Qijie near the groin, and ascends along the inner thigh. One branch runs upward from a point three inches below the navel, passes near the Guanyuan point, travels up along both sides of the abdomen, and converges at the throat. Thus, when illness arises in these areas, it causes distension and fullness in the lower abdomen, with a rooted feeling in every direction. The lesion is firm and full above and below, like a beam concealed inside the body; hence it is called “Fuliang.”

The lesion encloses a large amount of pus and blood and lies outside the intestines and stomach. Pressing it causes pain and distress that are difficult to bear, so repeated forceful pressure may lead to death. The Thoroughfare Vessel has a branch that descends and connects with the genital region, while its ascending branch runs up along the abdomen. Therefore, if the lesion extends downward, it presses on the genital region; if it extends upward, it approaches the stomach opening. Pressure on the genital region causes pus and blood to drain out. When the lesion approaches the stomach, its pathogenic influence rises to affect the diaphragm and forms an internal abscess beside the stomach opening. Why does this happen? Because a large amount of pus and blood has already accumulated within…

This is due to a cause outside the stomach and intestines. “Give birth” should be read as “emerge”; it was written incorrectly during copying. ○ The New Collation says: According to a comparison with the Taishu, “beside the stomach” should read “to make the stomach.”

This is a chronic illness that is difficult to treat. If the affected area is above the navel, the condition is adverse; if it is below the navel, it is favorable. Do not move the affected area; instead, repeatedly drain the pus and blood.

If there is a great deal of pus and blood inside the abdomen, an affected area above the navel will gradually damage the heart, so the condition is adverse. Below the navel, it is somewhat farther from the heart and can still be treated gradually, so the condition is favorable. “Following” means favorable; “repeatedly” means many times; “remove” means eliminate. The meaning is that the affected area must not be moved; the pus and blood should simply be drained repeatedly.

This passage appears in the “Acupuncture Methods” section.

That scripture has since been lost.

The Yellow Emperor asked: Someone has swelling throughout the body, the hip region, the thigh, and the lower leg, along with pain around the navel. What illness is this? Qibo replied: It is called “Fu Liang” (“Hidden Beam”).

These twenty-six characters were misplaced in the “Treatise on Unusual Illnesses.” Without this passage, the discussion that follows would lack its basis. ○ The New Collation says: On close examination, this passage has no commentary; its complete version appears in the “Treatise on Unusual Illnesses” in the next volume.

This is the source of wind evil.

The four characters “this is the source of wind” originally belonged to this chapter, and also appear in the “Treatise on Unusual Illnesses.”

The illness Qi spills into the large intestine and lodges in the Huang, the loose tissue between the chest and abdomen. The Huang’s source point lies below the navel, which is why there is pain around the navel. The affected area must not be moved; if it is moved, urination will become difficult. This also relates to the Chong vessel, which begins in the womb and ascends through the abdomen. The area below the navel referred to here is the “Bo Yang,” about one and a half inches below the navel. The Lingshu Jing says: “The Huang’s source point is called Bo Yang.” (“Bo” is pronounced bó; “yang,” yāng.)

The Yellow Emperor asked: Master, you have often said that people with the illnesses called “heat in the middle” and “wasting in the middle” must not consume rich and strongly flavored foods, fragrant herbs, or mineral medicines. Mineral medicines can bring on mania, and fragrant herbs can bring on madness.

Excessive drinking and urination are called “heat in the middle”; excessive eating and urination are called “wasting in the middle.” Excessive elation is called mania, and a tendency toward anger is called madness. “Fragrant” refers to pleasant-smelling, fine-tasting things.

People with heat in the middle and wasting in the middle are mostly wealthy and eminent. Forbidding them rich and strongly flavored foods goes against their wishes; forbidding fragrant herbs and mineral medicines means their illness cannot be cured. I would like to hear the reasoning behind this.

Heat in the middle and wasting in the middle are both illnesses caused by Spleen Qi rising and overflowing, brought on by sweet, rich, and fatty foods. Therefore, rich and strongly flavored foods and fragrant herbs must be avoided. The “Treatise on Assessing Deficiency and Excess” says that when treating wasting-thirst illness, wealthy people who regularly eat rich and strongly flavored foods are prone to developing this kind of illness. The “Treatise on Unusual Illnesses” also says: After the five flavors enter the mouth, they are stored in the stomach, and the Spleen transports them…

The Spleen governs the transformation and transportation of Jing and Qi, as well as bodily fluids. When the Jing, Qi, and fluids in the Spleen become imbalanced, a person may experience a sweet taste in the mouth. This is often caused by regularly eating sweet, rich foods. Rich, fatty foods tend to generate internal heat, while sweetness tends to obstruct the movement of Qi. When Qi surges upward, this can develop into wasting-thirst disease, marked chiefly by thirst and excessive drinking. This is the condition being described.

The wealthy and powerful often indulge themselves and pursue pleasure, finding it difficult to restrain their appetite. Forcing them to give up these foods would go against their wishes; allowing them to continue might worsen their illness. The Yellow Emperor considered the matter difficult to resolve and asked about it. Here, “gao” refers to rich, fatty meat; “liang” to refined grains; “stone medicines” to mineral-based drugs; “ying” to dairy products; and “fragrant herbs” to aromatic medicinal plants. The wealthy and powerful often consume these five kinds of things, and they are difficult to forbid.

Qibo said: “Though fragrant herbs smell pleasant, stone medicines have potent properties. Both act swiftly and forcefully, so they are unsuitable for people who are not even-tempered and composed.

“When the Spleen’s Qi becomes congested and excessive, it can cause illness. The strong, rich fragrance of these herbs can increase the burden on the Spleen. Their heat-clearing effects are often rapid, and their potent properties may further intensify internal heat. But if a person is even-tempered and composed, breathes steadily, does not contend with external things, and is broad-minded and at ease, their spirit will not become agitated or pressured, and they will be less likely to suffer internal injury from fear. For this reason, people who are not sufficiently even-tempered and composed should not take these two kinds of medicine. Here, “forceful and sharp” describes a medicine with strong, piercing effects; “firm and vigorous” describes one whose effects are solid, enduring, and fierce, and do not readily subside.”

The Yellow Emperor asked, “If these two kinds of medicine are unsuitable, why is that?”

Qibo replied, “The heat within the body is urgent and powerful, and the medicines act with the same urgency and intensity. When the two meet, they may injure the Spleen.”

The Spleen belongs to Earth, and Earth is vulnerable to Wood. A person taking these medicines should be watched especially closely on the days of Jia and Yi. If the heat is strong, Wood Qi may take advantage of the weakness and become active. If the person is not even-tempered and composed, they may become repeatedly agitated and angry. Recurrent anger allows the heat, aided by Wood Qi, to further injure the Spleen. Jia and Yi belong to Wood, so on those days one should watch for the Spleen’s condition to worsen or be triggered.

The Yellow Emperor said, “Good. There is a disease in which the front of the chest swells, the neck hurts, the chest feels oppressed and full, and the abdomen is distended. What is this disease, and how does it arise?” “Ying” refers to the front of the chest; “jing” to the front of the neck; and “xiong” to the area between the chest and the breast.

Qibo replied, “This disease is called counterflow reversal.” It arises when the movement of Qi becomes disordered and reverses, which is why it is called counterflow reversal.

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

Qibo replied, “Treatment with moxibustion may cause the person to lose their voice; treatment with stone needles may cause them to become delirious. One must wait until the Qi has gathered to a sufficient degree before treating.”

“Stone” refers to using a stone needle to pierce the skin as a treatment.

The Yellow Emperor asked, “Why is this?” Qibo replied, “When Yang Qi is excessive and concentrated in the upper body, moxibustion will use heat to further strengthen it, causing Yang Qi to enter the Yin aspect. When Yang Qi enters the Yin aspect, the person loses their voice. If a stone needle is used to drain it, Yang Qi disperses outward. Once it has dispersed, the body becomes deficient, and the person may become manic.”

Moxibustion here means using the heat produced by burning mugwort to stimulate the body. Stone needles were ancient instruments used to pierce the skin, release pathogenic influences, or regulate Qi and blood.

“If treatment is given after the Qi dynamic has come back into balance, both sides of the body can be kept intact.” Here, “come back into balance” means that Yin and Yang Qi have become harmonized again. If treatment is given after they have harmonized on their own, both can be preserved. But if moxibustion or a stone needle is used before that happens, one side may become excessive and the other deficient, potentially causing loss of voice or mania.

The Yellow Emperor said, “Well said. How can one tell that a pregnant woman is about to give birth?” Qibo replied, “There are signs of illness in the body, but no abnormal pathogenic signs in the pulse.”

Here, “illness” means the cessation of menstruation. According to pulse diagnosis, if the pulse at the chi position—the site near the elbow side of the wrist used to assess the condition of the lower body—is intermittent or stops altogether, this may indicate that menstruation has ceased. If menstruation is obstructed and the chi pulse has also disappeared, one can diagnose amenorrhea. But if there are signs of amenorrhea while the pulse remains normal, this indicates pregnancy. That is why it is said that there are signs of illness in the body, but no abnormality in the pulse.

The Yellow Emperor asked, “What causes fever accompanied by pain in the lower legs?” Qibo replied, “Fever is a manifestation of the Yang pulse and results from the activity of Qi in the Three Yang channels. If the Renying pulse—the pulse at the carotid artery used to assess the strength of Yang Qi—is twice as strong as usual, the illness is in Shaoyang; if it is three times as strong, the illness is in Taiyang; if it is four times as strong, the illness is in Yangming. When Yangming enters the Yin aspect, the illness appears in the head and abdomen, with abdominal fullness and headache.”

The Yellow Emperor said, “Well said.”

The New Collation adds: The account in the Treatise on the Six Nodes and Manifestations of the Zang Organs is the same as this one. However, after “When the Renying pulse is three times as strong, the illness is in Yangming,” the Jia Yi Jing does not include the words “Yangming enters the Yin aspect.”