《黃帝內經素問補註釋文》Vol. 26

Supplementary Annotations and Explanatory Text to the Plain Questions of the Yellow Emperor’s Inner Classic, Volume 26

Commentary by Wang Bing, the Tang dynasty Taipu Director, styled Qixuanzi; collated and edited by Lin Yi and others, Song dynasty Guanglu Minister and Director of the Secret Pavilion; errors and omissions further corrected by Sun Zhao, Song dynasty Director of the Ministry of Revenue’s Agricultural Section.

Treatise on Bi Disorders

The Yellow Emperor asked, “How do bi disorders arise?”

“An” means “what”; here, the question asks what causes bi disorders.

Qibo replied, “When Wind, Cold, and Dampness evils arrive together and combine, they cause bi disorders—illnesses in which pathogenic influences obstruct the channels, collaterals, sinews, and bones. Though all are bi disorders, they do not manifest in the same way. When Wind predominates, it is called wandering bi; when Cold predominates, painful bi; when Dampness predominates, fixed bi.”

Wind is Yang in nature and mainly invades the Yang aspect of the body, causing wandering bi, in which pain shifts from place to place. Cold mainly invades the Yin aspect, causing painful bi, marked by pronounced pain. Dampness invades the skin, flesh, sinews, and vessels; because the pathogenic influence is sticky and lingers, it causes fixed bi. Thus, bi disorders arise from Wind, Cold, and Dampness evils.

The Yellow Emperor asked, “Why are there also five kinds of bi disorders?”

Wind, Cold, and Dampness can each predominate and produce three kinds of bi disorders. What, then, determines the five kinds?

Qibo replied, “If these evils are encountered in winter, they cause bone bi; in spring, sinew bi; in summer, vessel bi; during the period of utmost Yin, flesh bi; and in autumn, skin bi.”

Winter corresponds to bones, spring to sinews, summer to vessels, and autumn to the skin; the period of utmost Yin corresponds to the flesh. Each season therefore gives rise to bi in its corresponding tissue. “Utmost Yin” here refers to the months of Wu and Ji, and also includes the three months when Earth’s influence is seasonally strong.

The Yellow Emperor asked, “How do bi disorders enter the five Zang and six Fu organs?”

Bi of the skin, flesh, sinews, bones, and vessels arises when pathogenic influences are encountered in the corresponding season. Why, then, does bi sometimes lodge in the internal organs?

Qibo replied, “Each of the five Zang organs corresponds to a particular tissue. When bi persists despite prolonged treatment, it enters the tissue associated with that organ and then affects the organ itself.”

The Liver corresponds to the sinews, the Heart to the vessels, the Spleen to the flesh, the Lung to the skin, and the Kidney to the bones. When bi persists, it may pass from the corresponding tissue into its associated organ.

Thus, if bone bi does not resolve and the person is exposed to pathogenic influences again, they enter the Kidney; if sinew bi persists and there is renewed exposure, they enter the Liver; if vessel bi persists, the Heart; if flesh bi persists, the Spleen; and if skin bi persists, the Lung. The claim that bi disorders invade their corresponding Zang and Fu organs refers to cases in which the patient is again exposed to Wind, Cold, and Dampness evils during the season in which the illness began.

Here, “the proper time” refers to the months when the Qi of each of the five viscera is in season: Liver Qi is strongest in spring, Heart Qi in summer, Lung Qi in autumn, Kidney Qi in winter, and Spleen Qi in the months when the seasons change. “Resonance” means a responsive correspondence.

When a Bi pathogen invades the five viscera, it produces different symptoms.

Lung Bi, in which a Bi pathogen invades the lungs, causes a person to feel oppressed and distressed, with fullness and distension in the chest, shortness of breath, and vomiting. This is because Lung Qi corresponds to breathing. The lung channel also passes by the entrance to the stomach, which explains these symptoms.

Heart Bi, in which a Bi pathogen invades the heart, obstructs the vessels. When a person feels oppressed, there may be a throbbing sensation beneath the heart, near the pit of the stomach. Qi may suddenly surge upward, causing shortness of breath and a dry throat, and hiccups may occur easily. When rebellious Qi surges upward, the person may also feel afraid.

The heart corresponds with the vessels, so when a pathogen invades, the vessels become obstructed. The pathogen stirs things up inside the body, causing oppression and distress. The Hand Jueyin Pericardium channel and the Hand Shaoyin Heart channel are both connected with the chest, the network of vessels linked to the heart, and the lungs. For this reason, when a person feels oppressed, they may sense throbbing and fullness beneath the heart, followed by a sudden upward surge of Qi that causes shortness of breath and a dry throat. When Heart Qi is out of order, hiccups may result; when there is fullness beneath the heart, hiccupping can also release the Qi. If rebellious Qi suddenly surges upward and attacks the heart, the person feels afraid because the heart’s spirit has been disturbed and become unsettled.

Liver Bi, in which a Bi pathogen invades the liver, causes a person to wake easily in fright while sleeping at night, to feel thirsty often, and to urinate frequently. There may also be a pulling sensation in the lower abdomen, as if the person were pregnant.

Liver Qi is in season in spring and readily responds to the Qi of fright and fear, so a person may wake in alarm while sleeping at midnight. The liver channel passes along the inner thigh, through the genital region and lower abdomen, then by the stomach, along both sides of the body, and up to the throat. This explains the thirst, frequent urination, and pulling sensation in the lower abdomen, as if pregnant.

Kidney Bi, in which a Bi pathogen invades the kidneys, makes a person prone to abdominal distension. The buttocks seem to bear weight in place of the heels, and the back seems to take the place of the head; the body curls up and is difficult to straighten.

The kidneys are the gateway to the stomach. If this gateway does not function smoothly, Stomach Qi cannot move normally, so abdominal distension is likely. “The buttocks in place of the heels” means that the feet are contracted and difficult to move. “The back in place of the head” means that the body is curled over. “Heel” refers to the back of the foot. The kidney channel begins beneath the little toe, runs diagonally to the sole, passes behind the inner ankle, along the heel and up the inner side of the lower leg, then ascends through the back and connects with the kidneys and bladder. Another branch rises from the kidneys, passes through the liver and diaphragm, and enters the lungs. When Kidney Qi is deficient and attacked by a pathogen, the body can no longer stretch out.

A supplementary note in the New Collation says: “Rangu” (“Blazing Valley”) appears in another version as “Rangu” (“Blazing Bone”).

Spleen impediment, a painful obstruction caused by pathogenic influences affecting the spleen and disrupting the circulation of Qi and blood, makes the limbs feel sluggish and weak. It can also cause coughing and the vomiting of saliva; in severe cases, the upper body becomes blocked and obstructed.

The spleen belongs to Earth and is vigorous in all four seasons. It is externally connected with the limbs, so spleen impediment makes them feel sluggish. The spleen channel begins in the foot and runs upward along the back of the lower leg, passing the knee and thigh. Its meridian enters the abdomen, connects with the spleen and stomach, then travels upward through the diaphragm and alongside the throat. This is why coughing and the vomiting of saliva occur. Spleen Qi also nourishes the lungs, and the stomach connects with the throat; as a result, the upper body becomes blocked and obstructed.

Intestinal impediment, a painful obstruction in which pathogenic influences disrupt the normal activity of the intestines, causes frequent drinking without the ability to pass the fluid. Qi in the abdomen surges and struggles in labored bursts, and at times there is diarrhea in which food passes undigested (known as “meal diarrhea”).

The large intestine meridian enters the supraclavicular fossa, the hollow above the collarbone, connects with the lungs, then passes downward through the diaphragm and belongs to the large intestine. The small intestine meridian also enters the supraclavicular fossa and connects with the heart. It runs down along the throat, passes through the diaphragm, reaches the stomach, and belongs to the small intestine. When pathogenic Qi affects the small intestine, its meridian can no longer pass downward through the diaphragm. With the meridian blocked, the intestines cannot properly transform and transport food and fluids, while stomach Qi accumulates heat. The person therefore drinks a great deal but cannot readily pass the fluid. Yang Qi and pathogenic Qi in the intestines and stomach surge and struggle against one another in labored bursts. At times the intestines briefly function freely, but because intestinal Qi cannot transform and transport properly, food is discharged before it has been fully digested.

Bladder impediment, a painful obstruction caused by wind, cold, and dampness affecting the bladder and reproductive organs, causes pain felt deep within the lower abdomen and bladder when pressed, as if hot water were being poured over them. Urination becomes difficult and sluggish, and clear nasal discharge flows from the upper body.

The bladder is the fu organ that stores fluids, and the reproductive organs lie within it. The lower abdomen corresponds to the location of Guanyuan, an important acupuncture point below the navel, and contains the reproductive organs. The bladder meridian begins at the inner corner of the eye, travels up to the forehead, meets at the crown of the head, and then enters to connect with the brain. It emerges at the back of the neck, runs along the inner edges of the shoulder blades and on either side of the spine to the lower back, then enters and connects with the kidneys and belongs to the bladder. A branch descends from the lower back, passes through the buttocks, and reaches the hollow behind the knee. If the reproductive organs are affected by wind, cold, and dampness, the meridian’s flow is obstructed. Qi and blood in the Foot Taiyang Bladder Meridian can no longer flow smoothly down to the feet. Consequently, the lower abdomen and bladder feel painful deep inside when pressed, as if hot water were being poured over them, and urination becomes difficult and sluggish. When urination is obstructed and the meridian cannot flow downward, pathogenic Qi rises and disturbs the brain, causing clear nasal discharge to flow from the nostrils. Here, “pour” means to drench.

A textual note states that in the Quan Yuanqi edition, the words “deep inside, painful” are written as “both thighs,” meaning the thighs on either side.

Yin Qi refers to the spirit Qi stored within the Five Zang organs. It is said to remain stored or to perish because when a person is calm and undisturbed by pathogenic influences, spirit Qi can rest peacefully within the body. But when a person becomes restless and is also affected by pathogenic influences, spirit Qi is damaged and disperses, losing the place where it can remain stored; this is why it is called “perishing.” The passage concerns impediment disorders caused by pathogenic influences affecting the Five Zang organs.

Eating too much damages the stomach and intestines.

The Five Zang organs are injured by agitation, and the Six Fu organs are harmed by food and drink. Both refer to use exceeding proper limits. Going against the body’s nature invites the invasion of pathogenic influences. The discussion here concerns impediment disorders that arise when pathogenic influences affect the Six Fu: these are illnesses caused by obstruction in the channels and network vessels, which disrupts the flow of Qi and blood.

When Qi moves erratically and breathing becomes rapid, the impediment disorder gathers in the lungs. When Qi moves erratically along with worry and preoccupation, it gathers in the heart. When Qi moves erratically and involuntary urination occurs, it gathers in the kidneys. When Qi moves erratically and weakness and exhaustion arise, it gathers in the liver. When Qi moves erratically and the muscles are deprived of nourishment, it gathers in the spleen. Here, “excessive Qi” refers to Qi moving abnormally. It follows the regions governed by each organ and lodges there, forming an impediment disorder.

〔New Commentary on the Revised Text: From the passage above, “when impediment pathogens invade the Five Zang,” through this section, the text belonged to “Treatise on Yin and Yang” in the Quán Yuánqǐ recension. Wáng Bīng rearranged it and placed it here.〕

If an impediment disorder of any kind persists without improvement, the pathogenic influence can go on to invade deeper within the body. Unable to disperse from the body’s surface, it gradually penetrates inward.

When wind pathogen is predominant, this kind of impediment disorder is often easier to cure. The Yellow Emperor asked, “Why do impediment disorders sometimes cause death, sometimes cause pain that lasts a long time, and sometimes prove easy to cure?” Qí Bó replied, “Those in which the pathogen invades the Five Zang organs result in death. Those in which it lodges between the sinews and bones cause pain that lasts a long time. Those in which it lodges in the skin are easy to cure.”

A pathogenic influence that enters the Five Zang can cause death because it damages the body’s spirit Qi. When it lodges between the sinews and bones, the pain lasts a long time because the pathogen is deep and fixed in place. When it remains in the skin, the disorder is easier to cure because the pathogen is relatively superficial. The depth of invasion differs, and so does the severity of the illness.

The Yellow Emperor then asked, “What happens when a pathogenic influence invades the Six Fu?” Qí Bó replied, “Improper diet and living conditions are also fundamental causes of this kind of illness.”

The climates of different regions vary in warmth and coolness, and in elevation. The qualities of their local products also differ, being firm or yielding. Yet when diet and daily habits exceed proper limits, they damage the Six Fu. The “Treatise on the Correspondence of Yin and Yang” says, “When the cold or warmth of food and drink is unsuitable, it harms the Six Fu.”

〔New Commentary on the Revised Text: According to the Treatise on Cold Damage, local products differ in their qualities, and dietary and living habits also vary from place to place. Each of the Six Fu has a corresponding back transport point, where channel Qi is conveyed and where acupuncture points are located. When wind, cold, or damp pathogens enter these points, and diet or daily habits are also out of balance, the pathogens enter along the points and lodge in the corresponding Fu.〕

The “transport points of the Six Fu” referred to here are the back transport points. The Gallbladder transport point lies beside the tenth vertebra; the Stomach transport point beside the twelfth; the Triple Burner transport point beside the thirteenth; the Large Intestine transport point beside the sixteenth; the Small Intestine transport point beside the eighteenth; and the Bladder transport point beside the nineteenth. Locate these points according to the individual’s body proportions. They all lie beside the spine, about one cun and five fen from it, measured using the patient’s own body proportions.

It is the place where the Qi of the Foot Taiyang channel is conveyed and emerges.

The New Collation says: On close examination, the Shu points of the six bowels are all located on either side of the corresponding vertebrae. This commentary says only “beside the vertebrae,” using abbreviated wording.

The Yellow Emperor asked, “How should acupuncture be used to treat these illnesses?”

Qibo replied, “Each of the five zang organs has a Shu point, and each of the six fu organs has a He point. Along the course of each channel are points where channel Qi emerges. Treat the places through which the pathogenic influence has passed, and the illness will be cured.”

The New Collation says: In the Jia Yi Jing, the character “follow” is written as “treat.”

The Shu point of the Liver is called Taichong; that of the Heart, Tailling; that of the Spleen, Taibai; that of the Lung, Taiyuan; and that of the Kidney, Taixi. These are all places where the Qi of the channels gathers and flows inward.

Taichong is between the big toe and second toe, in the depression about two inches behind the first metatarsophalangeal joint.

The New Collation says: According to the commentary on “Treatise on Lower Back Pain,” Taichong lies behind the base joint of the big toe, in the depression about two inches between the two bones on the inner side of the foot, where a pulse can be felt. The needle may be inserted three fen and retained for the time it takes to breathe ten times; three cones of moxa may be applied.

Tailling is in the depression between the two tendons behind the palm. The needle may be inserted six fen and retained for the time it takes to breathe seven times; three cones of moxa may be applied.

Taibai is on the inner side of the foot, in the depression below the navicular bone. The needle may be inserted three fen and retained for the time it takes to breathe seven times; three cones of moxa may be applied.

Taiyuan is in the depression behind the palm. The needle may be inserted two fen and retained for the time it takes to breathe twice; three cones of moxa may be applied.

Taixi is in the depression behind the inner ankle and above the heel bone, where a pulse can be felt. The needle may be inserted three fen and retained for the time it takes to breathe seven times; three cones of moxa may be applied.

The He point of the Stomach channel is Zusanli; that of the Gallbladder channel is Yanglingquan; that of the Large Intestine channel is Quchi; that of the Small Intestine channel is Xiaohai; that of the Sanjiao channel is Weiyang; and that of the Bladder channel is Weizhong.

Zusanli is three inches below the knee, between the two tendons on the outer side of the shinbone. The needle may be inserted one cun and retained for the time it takes to breathe ten times; three cones of moxa may be applied.

Yanglingquan is below the knee, in a depression on the outer side of the shinbone. The needle may be inserted six fen and retained for the time it takes to breathe ten times; three cones of moxa may be applied.

Xiaohai is in a depression on the outer edge of the large bone on the inner side of the elbow, five fen from the tip of the elbow. With the elbow bent…

The ancient text says: Once the acupoint has been located precisely, the needle may be inserted two fen, measured by the patient’s own body proportions, and retained for seven breaths. If using moxibustion, apply five cones. Quchi is on the outer side of the elbow, at the end of the crease formed when the elbow is bent, in the hollow between the bones. The needle may be inserted five fen and retained for seven breaths; moxibustion may be applied with three cones.

Weiyang is on the outer side of the hollow behind the knee, between two tendons. The needle may be inserted seven fen and retained for five breaths; moxibustion may be applied with three cones. To locate it, bend and straighten the knee to determine the position. Weizhong is at the center of the transverse crease behind the knee, where a pulse can be felt. The needle may be inserted five fen and retained for seven breaths; moxibustion may be applied with three cones.

The New Corrected Edition says that, according to the Annotations on Acupuncture Techniques, Weizhong lies in the bend behind the knee when the knee is flexed; the other accounts are the same. The passage in the classic, “Along the course of the channels, each has its own point where Qi emerges; treat wherever they pass, and the illness will be cured,” means that each place traversed by a channel has a point where Qi and blood emerge. Treating along the channel’s course can cure the illness. “Pass” refers to the places through which the channels travel.

The New Corrected Edition also notes that Wang Bing identifies Weiyang as the He-Sea point of the Sanjiao, a point where the channel Qi gathers, which differs from the account in the Jia Yi Jing. The Jia Yi Jing calls Weiyang the lower auxiliary Shu point of the Sanjiao and a collateral of the Foot Taiyang channel. According to the Sanjiao channel itself, its He-Sea point is Tianjing on the Hand Shaoyang channel. Among the He-Sea points of the six Fu organs, the others are all identified with points where their own channels enter; only the Sanjiao is not assigned a point on its own channel. Wang Bing’s account is therefore mistaken. Wang Bing relies on the Jia Yi Jing’s statement that “the Sanjiao joins at Weiyang.” However, the Jia Yi Jing also identifies Shanglian of the upper Juxu as the He-Sea point of the Large Intestine and Xialian of the lower Juxu as that of the Small Intestine, which differs from the account here that assigns Quchi and Xiaohai as their He-Sea points. Tianjing should therefore be taken as the He-Sea point of the Sanjiao channel.

The Yellow Emperor asked: Can the Qi of Ying and Wei also cause people to develop impediment disease? Qibo replied: Ying Qi is the refined Qi produced from food and drink. It harmonizes and nourishes the Five Zang organs, spreads to the six Fu organs, and only then enters the channels.

The Correct Theory says: “When grain enters the stomach, the pathways of the channels begin to flow; when water enters the channels, blood is formed.” The Ling Shu Jing says that the movement of Ying Qi depends on the grain one takes in. The New Corrected Edition notes that some editions write “treasure” instead of “substance.” After food and drink enter the stomach, the Qi they produce is conveyed to the lungs; its refined portion rises and flows through the pathways of the channels. Thus, the refined Qi produced from food and drink combines with Ying Qi and circulates along the channels.

Ying Qi therefore flows up and down along the channels, connecting the Five Zang organs and linking the six Fu organs. Because it circulates within the vessels, it can reach every part of the body.

Wei Qi is a vigorous form of Qi produced from food and drink. It moves rapidly and freely but cannot enter the vessels.

The “robust Qi” mentioned here refers to Qi that moves along the surface and is abundant. Because it is abundant and superficial, it moves rapidly and freely, and cannot enter the vessels.

Thus, Wei Qi moves through the skin and between the boundaries of the muscles—that is, outside the vessels. It warms the membranes of the huang (the membranes between the five zang organs and within the diaphragm) and spreads through the chest and abdomen. Abundant and superficial, Wei Qi can disperse through the open spaces of the chest and abdomen and warm the huang membranes, allowing the movement of Qi to flow freely. The character huang is pronounced “huang,” as in “wasteland.”

When Wei Qi moves contrary to its proper course, illness arises; when it moves in its proper course, the illness is cured. Wei Qi does not combine with pathogenic Wind, Cold, and Dampness, so it does not produce Bi syndrome, a condition caused by Wind, Cold, and Dampness obstructing the channels and muscles.

The Yellow Emperor asked: In Bi syndrome, some cases involve pain and others do not; some involve numbness and loss of sensation, others aversion to cold, heat, dryness, or dampness. What causes these differences?

Qibo replied: Pain occurs when Cold is predominant. Cold enters the body, and so pain arises.

Wind, Cold, and Dampness lodge between the boundaries of the muscles, pressing and constricting them, and forming a pathogen resembling foam. When exposed to Cold, the pathogen congeals and compresses the muscles. The muscles are torn apart by this pressure, and pain follows. Thus, the presence of Cold causes pain.

Numbness and loss of sensation without pain occur when the illness has lasted a long time and the pathogen has penetrated deeply. The movement of nutritive Qi and defensive Qi becomes sluggish, and the channels are intermittently obstructed, so Qi and blood cannot flow freely.

The New Textual Correction says: In the Jia Yi Jing, this passage reads “no pain” rather than “no free flow.” A close reading of the Jia Yi Jing shows that this passage discusses two conditions: “no pain” and “loss of sensation.” Since “no pain” is mentioned again later, the passage is clearly explaining that absence of pain can indicate a more severe condition.

When the skin does not receive nourishment from Qi and blood, it becomes numb and loses sensation. “Loss of sensation” means that the skin has become insensible and cannot tell whether it is feeling anything.

Signs of Cold appear when Yang Qi is deficient and Yin Qi is abundant. Yin Qi also assists the pathogen, so the person feels cold. The illness originates in Wind, Cold, and Dampness, and Yin Qi further strengthens it.

Signs of heat appear when Yang Qi is abundant and Yin Qi is deficient, allowing the pathogenic Qi to gain the upper hand. Yang Qi is then troubled by Yin Qi, producing heat Bi syndrome. “Encounter” means to meet—in this case, to meet Yin Qi. Because Yin Qi cannot overcome Yang Qi, signs of heat appear. The New Textual Correction says: In the Jia Yi Jing, the character for “encounter” is written as “mount upon.”

Profuse sweating and moist skin occur when the Dampness encountered is severe. Yang Qi is deficient and Yin Qi is abundant; the two kinds of Qi respond to one another, causing sweating and dampness of the skin. This refers to the mutual correspondence of the interior and the body surface, which respond to one another.

The Yellow Emperor asked: Sometimes Bi syndrome involves no pain. Why is this?

Qibo replied: When Bi syndrome occurs in …

When pathogenic factors invade the bones, the body feels heavy. When they invade the vessels, the blood congeals and stops flowing. When they invade the sinews, the limbs bend and cannot be straightened. When they invade the muscles, they become numb and insensible. When they invade the skin, the person becomes sensitive to cold. When all five conditions occur together, there is, paradoxically, no pain. In the various forms of impediment disorder—illnesses in which Qi and blood are obstructed, causing numbness and pain in the limbs—cold causes contraction and stiffness, while heat brings relaxation. “Worm” describes the sensation of something crawling beneath the skin; “looseness” refers to the sinews and vessels becoming slack and unable to pull against one another. The New Collation says that, according to the Jia Yi Jing, “worm” should read “tense.”

Treatise on Flaccidity

The Yellow Emperor asked: “All five of the zang organs can cause flaccidity. Why is this?”

Flaccidity means that the limbs are weak and powerless, and cannot move normally.

Qibo replied: “The lungs govern the body’s skin and body hair; the heart governs its vessels; the liver governs its sinew membranes.” The New Collation says that, according to the Quan Yuanqi edition, “membranes” refers to the sinew membranes beneath the skin and above the muscles. “The spleen governs the body’s muscles, and the kidneys govern its bones and marrow. Each of the five zang organs governs a different part of the body, so when flaccidity develops, it appears in the part governed by the affected organ.

“Thus, heat in the lungs scorches the lung leaves and deprives the skin and body hair of nourishment, leaving them weak, contracted, and thin. This leads to flaccidity and paralysis, especially weakness of the feet and difficulty straightening the legs to walk. Here, ‘paralysis’ refers to the feet cramping and being unable to straighten for walking. The word for ‘paralysis’ is pronounced ‘bi,’ also pronounced ‘qie.’

“When the heart Qi is hot, the Qi and blood in the channels below become disordered and surge upward. Once they do, the channels below are left empty, causing vessel flaccidity, a weakness due to the vessels being deprived of nourishment. The knee joints feel as though they have been broken; the legs and shins become slack and powerless, unable to support the body.

“When heart fire blazes, it rises unchecked. The fire flares upward, while the kidney channel, which ordinarily flows downward, is scorched and driven upward against its natural course. Yin becomes disordered, and fire burns within. Yin rises to obstruct the upper body, while Yang sinks and cannot remain in its proper place. The heart Qi is connected to the blood vessels, so this results in vessel flaccidity. Kidney Qi governs the feet, so the knee joints feel as though they have been broken and can no longer lift and support the limbs. The sinews of the legs and shins also become slack and cannot support the body.

“When the liver Qi is hot, bile leaks outward, making the mouth bitter. As the sinew membranes dry out, the sinews contract and cramp, producing sinew flaccidity, a weakness caused by the sinews being deprived of nourishment. Bile tastes bitter, and the gallbladder lies between the liver’s lobes. When the liver is hot, bile seeps out, causing bitterness in the mouth. The liver governs the sinew membranes; pathogenic heat dries them out, after which they contract and cramp, giving rise to sinew flaccidity. The Classic of Difficulties says that the gallbladder lies between the liver’s lobes.

“When the spleen Qi is hot, the fluids in the stomach are depleted, causing thirst. The muscles become numb and insensible, producing flesh flaccidity, a weakness caused by the muscles being deprived of nourishment.

The spleen and stomach are connected by a membrane. When the Spleen Qi is overheated, fluid from the stomach leaks away and is depleted, causing dry mouth and thirst. The spleen governs the muscles. When pathogenic heat enters the body, the muscles lose their normal nourishment and become numb and insensitive; this can develop into flesh atrophy, a wasting and weakening of the muscles.

When Kidney Qi is overheated, the lower back and spine become weak and difficult to straighten or lift. The bones become withered and the bone marrow diminishes, leading to bone atrophy. The kidneys govern the lower back, and the Kidney channel runs upward along the inner thigh and through the back, belonging to the kidneys. That is why overheated Kidney Qi weakens the lower back and spine. The kidneys govern the bones and generate marrow. When pathogenic heat damages the kidneys, the bones wither and the marrow diminishes, resulting in bone atrophy.

The Yellow Emperor asked, “How does this illness arise?” Qibo replied, “The lungs are chief among the five zang organs and also cover the heart. They occupy a high position, with their lobes distributed throughout the chest cavity; this is why they are called chief among the five zang organs and the covering of the heart.

“When something is lost, or something desired cannot be obtained, the Qi of the lungs may become noisy. When this happens, the lungs become hot and their lobes dry and wither. When the heart’s intentions cannot unfold freely, the movement of Qi becomes constrained. The lungs store Qi; when Qi is constrained and its movement impeded, breathing becomes rapid and noisy. The lungs then become hot, and their lobes dry and wither.

“Thus, when the five zang organs are affected by heat in the lungs and the lung lobes wither, wasting and difficulty walking can occur. This is what is meant here. The lungs circulate nutritive Qi and defensive Qi and regulate Yin-Yang; therefore, the scripture says that heat affecting the five zang organs through the lungs can cause wasting and difficulty walking.

“Excessive grief can sever the network vessels of the heart protector. Once these vessels are severed, Yang Qi surges within the body; during an episode, there is a sensation of collapse below the heart, and blood is repeatedly passed in the urine. Grief causes the heart vessels to contract, while the lung lobes lift and expand. This obstructs the upper burner, the area above the diaphragm, preventing nutritive Qi and defensive Qi from circulating normally. Heat then remains in the body, causing the network vessels of the heart protector to be severed and Yang Qi to surge inward. During an episode, there is bleeding below the heart and repeated blood in the urine. Here, ‘collapse below the heart’ refers to bleeding within the heart protector; ‘urination’ means passing urine.

“The Corrected Edition says: According to Yang Shangshan, ‘network vessels of the womb’ refers to the network vessels surrounding the heart. A close examination of the scripture and its commentaries shows that the character written as ‘womb’ in this phrase should be read as ‘womb’; some received editions instead have ‘flesh.’

“Thus, the Treatise on the Root Cause says: ‘When the major channels are empty, the illness first manifests as muscle impediment, then transforms into vessel atrophy.’ The Treatise on the Root Cause is the title of an ancient medical classic; ‘major channels’ refers to the principal meridians. Bleeding from the heart protector and blood in the urine leave the principal meridians depleted. When the Qi of the channels is deficient and empty, pathogenic heat can attack defensive Qi, making defensive Qi excessive and nutritive Qi weak. Muscle impediment—numbness and altered sensation in the muscles—appears first, then gradually develops into vessel atrophy. This is why the text says it ‘transforms into vessel atrophy.’

“Thoughts have no end, desires cannot be fulfilled, the mind races outward, and sexual activity is excessive; the ancestral…”

When the sinews become slack and weak, this can develop into sinew wilting, and there may also be a continuous discharge of white fluid.

If someone gives free rein to every desire of the heart, repeatedly indulging in sexual release and exhausting the body, the sinews will be damaged. This can lead to sinew wilting and may also cause a continuous discharge of white fluid. This refers to a steady flow of whitish fluid resembling semen: in men it may pass along with the urine, while in women it may flow continuously from the genitals. Thus, the Lower Classic, an ancient medical text, says, “Sinew wilting arises in the Liver and results from sexual overexertion.” Here, “exertion within” means that sexual activity depletes Yin essence until Jing and Qi are exhausted.

Prolonged exposure to damp surroundings, work that regularly involves water, or living in a damp, low-lying place can cause dampness to saturate the muscles. They then become numb and lose sensation, developing into flesh wilting. Living near damp ground for many years or working in water makes a person especially vulnerable to dampness. The illness worsens over time and is more pronounced in people whose constitutions are easily affected. The Spleen governs the muscles and does not tolerate dampness. When pathogenic dampness lingers in the muscles, it prevents defensive Qi—the Qi that protects the body—from nourishing them, and flesh wilting develops. The Lower Classic says, “Flesh wilting comes from living in damp places.” The Great Treatise on the Correspondences of Yin and Yang also says that dampness from the ground can enter the body and damage the skin, muscles, and sinews. This refers to pathogenic dampness harming the muscles.

Someone may travel long distances, become exhausted, and then encounter intense heat. Thirst further depletes the body. Heat then damages Yin internally and lodges in the Kidneys. The Kidneys belong to Water; when Water cannot restrain Fire, the bones become frail and withered, and the bone marrow is depleted. The feet grow weak and can no longer support the body: this is bone wilting. “Yang Qi attacks inward” means that pathogenic heat depletes the Yin in the abdomen. “Water cannot overcome Fire” means that heat lodges in the Kidneys, and Water is too weak to restrain it.

For this reason, the Lower Classic says, “Bone wilting arises from great heat.” The Kidneys cannot endure dryness and heat. When pathogenic heat invades them, it scorches the bones, leaving them withered and weak.

The Yellow Emperor asked, “How can these illnesses be distinguished?” Qibo replied, “When the Lungs are hot, the complexion turns pale and the hair becomes dry and brittle. When the Heart is hot, the complexion turns red and the vessels become full. When the Liver is hot, the complexion turns bluish green and the nails wither. When the Spleen is hot, the complexion turns yellow and the muscles twitch. When the Kidneys are hot, the complexion turns black and the teeth wither. By observing each organ’s color and the parts it governs and nourishes, one can identify the corresponding disorder.”

The Yellow Emperor then asked, “I understand what you have said. But medical texts say that, to treat wilting disorders, one should focus on the Yangming channel. Why is this?” Qibo replied, “Yangming is the fundamental source of nourishment for the Five Zang organs and the six Fu organs. Yangming refers to the Stomach channel. The Stomach is where food and drink gather, and it governs the nourishment of the ancestral sinews. The ancestral sinews, gathered in the lower part of the body and linking the sinews and channels, bind the bones together and allow the joints to move freely.”

The Zongjin—the sinews that gather in the genital region, connect the bones, and affect the movement of the joints—refers to the firm sinew between the pubic hair, above and below the transverse bone. It connects upward with the chest and abdomen, runs downward through the hips and buttocks, passes through the back and abdomen, and extends upward to the head and nape. Hence it is said that the Zongjin governs the binding of the bones and makes the joints move freely. The waist is an important joint of the body and governs bending and extension, so it is called the “mechanism.” (The pronunciation of “hip” is kuan; “buttocks” is pronounced ku’ao.)

The Chong Mai, one of the body’s meridians, is the sea of the meridians. The Ling Shu Jing says, “The Chong Mai is the sea of the twelve meridians.” It governs the distribution of Qi and blood, which irrigate the ravines and valleys—the gaps and hollows between the muscles—and it joins the Yangming meridian at the Zongjin. This suggests that the sinews standing upright on either side, above and below the transverse bone, are the Zongjin. The Chong Mai ascends along the abdomen, passing on both sides of the navel, each side five fen from the body’s midline. The Yangming meridian also ascends on either side of the navel, each side one cun and five fen from the midline. The Zongjin meridian lies between them; therefore, it is said that the Chong Mai and Yangming meridian meet at the Zongjin. Since the Chong Mai is the sea of the twelve meridians, it governs irrigation of the ravines and valleys. Where large groups of muscles gather is called a “valley”; where smaller groups gather is called a “ravine.” The New Collation records that the phrase “the Zongjin meridian lies between them” also appears in some versions as “the Zongjin gathers in the middle.”

The Yin and Yang meridians converge at the Zongjin and meet at Qijie, the place near the groin where the pulse beats. Among them, the Yangming meridian plays the primary role. All the meridians belong to the Daimai and connect with the Dumai. The Zongjin gathers at the center of the transverse bone, converging there from above and below. Thus it is said that the Yin and Yang meridians converge at the Zongjin: the Zongjin gathers from both sides below the navel toward the transverse bone, with the Yangming meridian assisting on the outside and the Chong Mai in the middle. This is why the text says they “meet at Qijie” and that the Yangming meridian plays the primary role. The Daimai begins at the lower ribs, encircles the body, and connects with the Dumai. The Dumai begins at Guanyuan, an acupuncture point below the navel, and runs up and down along the abdomen. Hence it is said that all the meridians belong to the Daimai and connect with the Dumai. The Dumai, Ren Mai, and Chong Mai all begin together but follow different routes, so the scripture sometimes mentions them in overlapping ways.

Therefore, when the Yangming meridian is weak, the Zongjin becomes slack and the Daimai cannot draw it taut. As a result, both feet become weak and limp and cannot function normally.

The Yangming meridian descends from Quepen, the hollow above the collarbone, passes along the inner side of the breast, and runs down on either side of the navel to Qijie. One of its branches emerges from the lower opening of the stomach, descends along the inner wall of the abdominal cavity to Qijie, and joins the main channel. It then continues downward, passes through the thigh, reaches Futu, an acupuncture point on the front of the thigh, and enters the kneecap, then descends…

It runs down the outer side of the shin, passes over the top of the foot, and enters the cleft on the inner side of the middle toe. Another branch separates from the main channel three cun below the knee, descends, and enters the cleft on the outer side of the middle toe. This channel belongs to the Yangming channel.

When Qi in the Yangming channel is deficient, the zongjin—the tendons gathered in the lower body that govern the movement of the sinews—becomes slack. The dai channel, which encircles the waist and abdomen, can no longer draw in and restrain them. The legs and feet then become weak and powerless, and cannot function normally. Here, “draw in” means to pull or guide.

The Yellow Emperor asked, “How should this be treated?” Qibo replied, “Tonify its Ying points, which are among the points where the Qi and Blood of a channel flow; free the flow through its Shu points, where the Qi and Blood of a channel are conveyed; and regulate deficiency and excess so that the movement of Qi and Blood becomes smooth again. Let the sinews, vessels, bones, and flesh each receive treatment at the season suited to them, and the illness will be cured.”

The Yellow Emperor said, “Well said.”

“To receive treatment at the proper season” means to nourish each organ according to the time when it is strongest: the Liver is in season on Jia and Yi days, the Heart on Bing and Ding days, the Spleen on Wu and Ji days, the Lungs on Geng and Xin days, and the Kidneys on Ren and Gui days. This follows the pattern of the Five Phases’ Qi. The phrase “the month for receiving Qi” refers to the season when each of the five organs receives the corresponding Qi in accordance with the time of year.