《黃帝內經素問補註釋文》Vol. 27

The Yellow Emperor asked, “Why are there cold and hot forms of jue syndrome—a disorder in which Qi becomes disordered and surges upward?”

A commentary says, “‘Jue’ refers to Qi moving upward in a counterflow. People mistakenly came to identify it with beriberi, and wrote extensively about prescriptions and theories for treating it.

Qibo replied, “When Yang Qi is weak in the lower part of the body, cold jue develops; when Yin Qi is weak there, hot jue develops.”

Here, “Yang” means the three Yang channels of the foot; “Yin” means the three Yin channels of the foot; and “lower” refers to the feet.

The Yellow Emperor asked, “Hot jue presents as heat. Why does it always begin at the soles of the feet?”

Yang Qi governs the exterior, while jue syndrome arises within. That is why the Yellow Emperor asked this.

Qibo replied, “The Yang channels begin on the outer sides of the five toes, while the Yin channels converge on the soles and gather at the centers of the feet. Therefore, when Yang Qi is excessive, the soles become hot.”

This is a general description: the Foot Taiyang channel begins at the outer tip of the little toe; the Foot Shaoyang channel begins between the little toe and the next toe; and the Foot Yangming channel begins at the middle toe and the tip of the big toe. These channels travel upward along the Yang side of the foot. The three Yin channels of the liver, spleen, and kidneys converge on the sole and gather at its center. When Yin Qi is insufficient, the soles become hot.

A note by the reviser of the text states that in the Jiayi Jing, “Yang Qi begins at the foot” is written as “Yang Qi passes along the foot.” The character “begins” should be “passes along.”

The Yellow Emperor asked, “Cold jue presents as cold. Why does it always begin at the five toes and extend upward as far as the knees?”

Yin Qi governs the interior, while jue syndrome arises on the exterior. That is why the Yellow Emperor asked this.

Qibo replied, “The Yin channels begin on the inner sides of the five toes, converge below the knees, and gather above them. Therefore, when Yin Qi is excessive, cold extends from the five toes up to the knees. This cold does not enter from the body’s surface; it arises within.”

This too is a general description: the Foot Taiyin channel begins on the inner side of the big toe; the Foot Jueyin channel begins at the three tufts of hair at the tip of the big toe; and the Foot Shaoyin channel begins below the little toe and runs diagonally to the center of the sole. The three channels travel upward along the inner side of the foot, pass along the inner thigh, and enter the abdomen. Thus, they are said to converge below the knees and gather above them.

The Yellow Emperor asked, “What kind of imbalance causes cold jue?”

Qibo replied, “The anterior yin is where the ancestral sinews—the point at which all the sinews converge—…” The original text breaks off here.

The Taiyin channel (Spleen channel) and the Yangming channel (Stomach channel) meet at the anterior genital region. The ancestral sinews—that is, the area where the sinews gather, associated with the movement of the sinew channels—lie on either side below the navel and connect with the anterior genital region. This is why the anterior genital region is said to be where the ancestral sinews gather. Taiyin refers to the Spleen channel, and Yangming to the Stomach channel. Since both channels lie close to the ancestral sinews, this is said to be where Taiyin and Yangming meet.

The New Collation says: According to the Jia Yi Jing, the text here reads, “The anterior genital region is where the many sinews of the Jueyin channel gather.” Quan Yuanqi likewise held that the anterior genital region belongs to the Jueyin channel. This differs from Wang Bing’s commentary and represents another interpretation.

In spring and summer, Yang Qi is relatively abundant and Yin Qi relatively scant; in autumn and winter, Yin Qi flourishes while Yang Qi declines.

This is the natural order of things.

This person has a strong constitution, yet in autumn and winter has depleted their Jing and Qi through sexual excess. Qi from the lower body surges upward and disturbs the body; Jing and Qi cannot recover, so they leak downward, while pathogenic Qi takes the opportunity to rise.

“Constitution” refers to the physical body. “Depleted through sexual excess” means that excessive desire has worn down the Jing and Qi.

Pathogenic Qi remains lodged inside the body.

The New Collation says: According to the Jia Yi Jing, the text here reads, “Pathogenic Qi invades the body.”

Yang Qi weakens and can no longer nourish the channels. As it is progressively depleted, Yin Qi becomes dominant, causing cold hands and feet. The Yellow Emperor asks: How does heat reversal arise?

This question traces the condition back to its cause.

Qibo replies: When alcohol enters the Stomach, it fills the network vessels, while the main channels are relatively empty. The Spleen’s role is to distribute fluids for the Stomach. When Yin Qi is weak, Yang Qi takes advantage of the deficiency and enters. Once Yang Qi moves inward, the Stomach’s function becomes disordered. When the Stomach is disordered, Jing and Qi are depleted; when Jing and Qi are depleted, the limbs are no longer nourished.

The anterior genital region is where the Taiyin and Yangming channels meet. A disorder there therefore leads to the depletion of Jing and Qi. When Jing and Qi inside the body are insufficient, the limbs lack enough Qi to nourish them.

Such a person must often become drunk, or have sexual intercourse after drinking and eating to fullness. Qi gathers in the Spleen and cannot disperse. The Qi of alcohol clashes with the Qi of food, producing intense heat inside the body. Heat then spreads throughout the body, and the urine turns reddish from internal heat. The forceful, rapid effect of the alcohol gradually weakens Kidney Qi, leaving Yang Qi dominant on its own; the hands and feet therefore become hot.

Having sex after drinking and eating to fullness depletes the body’s Jing and Qi and weakens it internally, allowing pathogenic heat to take advantage of the deficiency. Kidney Qi consequently weakens, and with Yang flourishing while Yin is deficient, the hands and feet become hot.

The Yellow Emperor asks: Reversal disorders sometimes cause abdominal distension, sometimes make a person suddenly lose consciousness, and sometimes even...

What does it mean when an illness suddenly strikes, but its effects appear only half a day later, or are not noticed until the following day?

Here, “sudden” means that the onset is abrupt. The patient suddenly becomes dazed and unconscious, unable to recognize the people around them. Some also call this condition “corpse-like fainting” (shijue): a sudden loss of consciousness in which the body becomes insensible, as if dead.

Qibo replied: When Yin Qi is abundant in the upper body, the lower body becomes weak. When the lower body is weak, the abdomen becomes distended. When Yang Qi is abundant in the upper body, the Qi below surges upward, and pathogenic Qi rises with it. When pathogenic Qi surges upward, it disrupts Yang Qi; when Yang Qi is thrown into disorder, the person loses consciousness.

Here, “Yin” refers to the Qi of the Foot Taiyin channel.

The Newly Corrected Edition says: “On checking the Jia Yi Jing, the five characters meaning ‘Yang Qi is abundant above’ appear there as two characters meaning ‘abdominal distention’; the reading in the Jia Yi Jing should be adopted.” Why? The Jia Yi Jing also says: “When the Yang pulse sinks downward and the Yin pulse contends upward, corpse-like fainting occurs.” Given this, how can the text say both that Yin Qi is abundant above and that Yang Qi is abundant above?

Consider Zhang Zhongjing’s account as well: When the Shaoyin pulse fails to reach, Kidney Qi is weak, and Jing, blood, and Qi rush upward in haste into the chest and diaphragm. The ancestral Qi then gathers instead, and blood congeals below the heart. Yang Qi withdraws downward, heat settles in the inner thighs, and it struggles against Yin Qi, causing the body to lose sensation. This is corpse-like fainting. Zhang Zhongjing says that Yang Qi withdraws downward, which shows that Yang Qi is not abundant above. We can therefore conclude that the reading in the Jia Yi Jing should be adopted.

Wang Bing’s commentary identifies “Yin” as Foot Taiyin, but this explanation is not sufficiently comprehensive. The Treatise on Needle Counterflow says that pathogenic Qi invades the collateral vessels of five channels: Hand Shaoyin, Hand Taiyin, Foot Shaoyin, Foot Taiyin, and Foot Yangming. All five collateral vessels converge in the ear and connect upward to the left corner of the forehead. When the Qi and blood of all five collaterals are depleted, the person’s whole body pulses, yet the body itself has no sensation. The person looks like a corpse, which is why some call this corpse-like fainting. How, then, can “Yin” here be explained as referring only to Foot Taiyin?

The Yellow Emperor said: Good. I would like to hear the symptoms and manifestations of counterflow disorders in each of the six channels.

The Yellow Emperor asked for a detailed account of counterflow disorders in each channel in order to answer the question raised earlier.

Qibo said: Counterflow in the Taiyang channel, also called the Greater Yang, causes swelling and heaviness in the head, an inability to walk, and sometimes dizziness followed by a fall.

The Greater Yang is the Taiyang channel. The Foot Taiyang vessel begins at the inner corner of the eye, travels upward to the forehead, and meets at the crown. One branch runs from the crown to the upper corner of the ear. The main channel enters the brain from the crown and connects with it, then emerges and descends along the back of the neck. It runs beside the spine along the inner edge of the shoulder blades to the lumbar region, enters the muscles beside the spine, connects with the Kidneys, and belongs to the Bladder. One branch descends from the lumbar region, passes through the buttock, and enters the hollow behind the knee; another branch runs from the inner edge of the shoulder blade…

The channels of the Foot Taiyang meridian descend and penetrate the Spleen, pass through the hip joint, and run down the outer rear edge of the thigh, joining at the hollow behind the knee. They then descend through the inner side of the calf, emerge behind the outer ankle, follow Jinggu (a bone on the outer side of the foot), and reach the outer tip of the little toe. These are the external symptoms that appear when the Qi of the Foot Taiyang meridian becomes disordered. In some editions, the character “swelling” is written as “heel,” referring to the back of the foot.

When the Qi of the Foot Yangming meridian becomes disordered, episodes of mania may occur, with a desire to run and shout. The abdomen becomes distended, making it impossible to lie flat; the face turns red and hot, and hallucinations and incoherent speech may also appear.

The Foot Yangming meridian begins beside the nose, joins at its root, and runs down along the outer sides of the nose. It enters the upper gums, then turns back, runs alongside the mouth and around the lips, and joins at the Chengjiang point. It then follows the jaw backward, passes the angle of the jaw, and emerges at the Daying point. From there it runs upward along the cheek to the front of the ear, passes the Kerenzhu point, follows the hairline, and reaches the forehead. A branch descends from the area in front of Daying to the Renying point, follows the throat into the supraclavicular fossa, passes down through the diaphragm, connects with the Stomach, and links with the Spleen. The main channel descends from the supraclavicular fossa, runs down along the inner side of the breast, passes beside the navel, and enters the Qijie area. Another branch begins at the lower opening of the Stomach, runs down along the abdominal wall to Qijie, and joins the main channel. The meridian then descends along the thigh to the Futu point, enters the kneecap, and runs down the outer side of the lower leg. It passes over the dorsum of the foot and reaches the inner side of the middle toe. Another branch separates three cun below the knee and descends to the outer side of the middle toe. A further branch runs from the dorsum of the foot into the big toe and reaches its tip. These are the symptoms that appear when the Qi of the Foot Yangming meridian becomes disordered. In some editions, the character “madness” is written as “summit.”

When the Qi of the Foot Shaoyang meridian becomes disordered, sudden deafness may occur, along with swelling and heat in the cheeks, pain in the ribs and flanks, and an inability to move the lower leg freely.

The Foot Shaoyang meridian begins at the outer corner of the eye and ascends to the temple. It then descends behind the ear and runs along the neck, in front of the Hand Shaoyang meridian. At the shoulder, it crosses behind the Hand Shaoyang meridian and enters the supraclavicular fossa. One branch enters the ear behind it, then emerges and runs to the front of the ear, reaching a point behind the outer corner of the eye. Another branch begins below the outer corner of the eye and joins the Hand Shaoyang meridian near Daying, below the cheek. It passes the Jiache point, runs along the neck, and joins the main channel in the supraclavicular fossa. From there, the meridian descends into the chest, passes through the diaphragm, connects with the Liver, and belongs to the Gallbladder. It runs down along the inner side of the ribs and flanks, emerges at Qijie, circles the pubic hair, and runs horizontally into the hollow of the hip joint. A direct branch descends from the supraclavicular fossa, passes through the armpit and chest, crosses the lower rib—the lowest of the ribs—and joins the meridian at the hip. The channel then runs down the outer side of the thigh, passes the outer side of the knee, and enters the area in front of the fibula. It reaches the Juegu point, descends past the front of the outer ankle, runs along the dorsum of the foot, and reaches the tip of the fourth toe. These are the symptoms that appear when the Qi of the Foot Shaoyang meridian becomes disordered.

When Qi in the Greater Yin channel becomes disordered and flows counter to its course, the abdomen becomes distended and full, bowel movements become difficult, and appetite is lost. Eating then brings on vomiting, and it becomes impossible to lie down comfortably.

The Foot Greater Yin channel (the Spleen channel) begins at the tip of the big toe and ascends past the knee and along the front of the inner thigh. It enters the abdomen, belongs to the Spleen, and connects with the Stomach. It then ascends through the diaphragm, passes alongside the throat, connects with the root of the tongue, and spreads beneath it. A branch separates from the Stomach, ascends through the diaphragm, and flows into the Heart. Thus, when Qi in the Greater Yin channel becomes disordered and flows counter to its course, the symptoms described above arise.

When Qi in the Lesser Yin channel becomes disordered and flows counter to its course, the mouth becomes dry, the urine turns reddish, the abdomen becomes distended and full, and the Heart hurts.

The Foot Lesser Yin channel (the Kidney channel) ascends along the back of the inner thigh and passes through the spine. It belongs to the Kidney and connects with the Bladder. Its direct pathway ascends from the Kidney, passes through the Liver and diaphragm, and enters the Lungs. It travels up along the throat and passes beside the root of the tongue. A branch emerges from the Lungs, connects with the Heart, and flows into the chest. Thus, when Qi in the Lesser Yin channel becomes disordered and flows counter to its course, the symptoms described above arise.

When Qi in the Reverting Yin channel becomes disordered and flows counter to its course, the lower abdomen becomes swollen and painful, the abdomen becomes distended, urination and bowel movements become difficult, there is a desire to lie down, the knees bend, the genitals contract and swell, and the inner sides of the lower legs feel hot.

The Foot Reverting Yin channel (the Liver channel) ascends from one inch above the inner ankle, passes over the ankle, then rises another eight inches and crosses out beyond the Greater Yin channel. It continues upward along the inner hollow of the knee and the inner thigh, enters the pubic hair, then descends to encircle the external genitals and reaches the lower abdomen. It passes alongside the Stomach, belongs to the Liver, connects with the Gallbladder, and ascends through the diaphragm. Thus, when Qi in the Reverting Yin channel becomes disordered and flows counter to its course, the symptoms described above arise. One other version reads “the outer sides of the lower legs feel hot” instead of “the inner sides of the lower legs feel hot”; this is a copying error in which “inner” and “outer” were written incorrectly.

When pathogenic Qi is excessive, use the reducing method; when the body’s upright Qi is weak, use the reinforcing method. When neither is excessive nor weak, treat by selecting points along the channels. “Neither excessive nor weak” means that pathogenic Qi has not yet become strong and upright Qi has not become weak. In this situation, determine how long to retain the needles and how many breaths to count during needling according to the methods for treating the points and channels.

When Qi in the Greater Yin channel becomes disordered and flows counter to its course, the lower leg becomes tense and cramped, and Heart pain radiates to the abdomen. Treatment should target the primary symptoms. The Foot Greater Yin channel begins at the tip of the big toe, follows the inner side of the toe, passes in front of the inner ankle, ascends along the inner side of the lower leg and behind the shinbone, then continues along the front of the inner knee and thigh into the abdomen. A branch separates from the Stomach, passes through the diaphragm, and flows into the Heart. This is why the lower leg becomes tense and cramped and Heart pain radiates to the abdomen. The Greater Yin channel runs on both the left and right sides. Observe which side is affected, then treat it; this is why treatment is directed at the primary symptoms.

Newly revised commentary: In the Quan Yuanqi edition, the passage from “When Greater Yin and Reverting Yin flow counter to their course” to the end of the chapter appears in volume nine. Wang Bing moved it to this location.

When Qi in the Lesser Yin channel becomes disordered and flows counter to its course, there is a hollow distention in the abdomen, changes in vomiting, and watery diarrhea, among other symptoms. Treatment should target the primary symptoms. This is because the Lesser Yin channel ascends from the Kidney, passes through the Liver and diaphragm, enters the Lungs, and travels up along the throat.

When Qi in the Reverting Yin channel becomes disordered and flows counter to its course, the sinews and vessels contract, the lower back hurts, the abdomen feels hollow and distended, urination is blocked, and speech becomes confused.

Quan Yuanqi says, “Delirious speech is confused muttering that occurs when Qi is deficient.” Here, “zhan” is pronounced “yan.”

The key to diagnosis and treatment is to determine which channel the primary illness lies in. The Jueyin channel runs upward along the inner thigh, enters the pubic hair, circles the genitals, then travels upward along the back of the throat and connects with the root of the tongue. This is why these symptoms occur.

The New Collation says: According to the Jia Yi Jing, the Jueyin channel does not connect with the root of the tongue. Wang Bing says that it does in his commentaries on “Needling Heat,” “Needling Lumbar Pain,” and the three passages here. Yet he does not say so in his commentaries on “Wind” and “Bi Syndrome,” so his statements are inconsistent. The Jia Yi Jing should be taken as authoritative.

When the Qi of all three Yin channels becomes disordered and flows upward, neither urine nor stool can pass, and the hands and feet become cold. If this continues for three days, the person will die. This is because the Qi of all three Yin channels has been cut off, and death follows after three days.

When the Qi of the Taiyang channel flows upward against its proper course, the person may become rigid and collapse, vomit blood, and often have nosebleeds. The key to diagnosis and treatment is this: the Taiyang channel begins at the inner corner of the eye, runs along the back, and connects with the brain. This is why these symptoms occur. “Jiang” is pronounced “juliangqie,” and “pu” is pronounced “fu.”

When the Qi of the Shaoyang channel flows upward against its proper course, the joints become difficult to move. This means the person cannot turn at the waist while walking, or turn the head.

This happens because the Shaoyang channel runs down along the neck, passes around the edge of the pubic hair, then crosses into the hollow at the root of the thigh. This is why these symptoms occur.

If an intestinal abscess develops and convulsions also occur, the condition cannot be treated and the person will die. The Foot Shaoyang channel passes through the diaphragm, connects with the liver, and belongs to the gallbladder. It runs along the inner side of the ribs and passes through Qijie, a region near the groin. An intestinal abscess causes the channel’s Qi to be cut off, making the condition untreatable; if convulsions then occur as well, the person will die.

When the Qi of the Yangming channel flows upward against its proper course, the person may have labored breathing, cough, and fever, and may be easily frightened. Nosebleeds and vomiting blood may also occur. This is because the Yangming channel runs along the throat into Quepen, the hollow above the collarbone, then passes downward through the diaphragm, belongs to the stomach, and connects with the spleen. This is why these symptoms occur.

When the Qi of the Hand Taiyin channel flows upward against its proper course, the chest and abdomen become distended and full, the person coughs, and often vomits frothy saliva. The key to diagnosis and treatment is this: the Hand Taiyin channel begins in the middle burner, runs downward to connect with the large intestine, loops back around the opening of the stomach, then passes upward through the diaphragm and belongs to the lungs. This is why these symptoms occur.

When the Qi of the Hand Jueyin Pericardium channel and the Hand Shaoyin Heart channel flows upward against its proper course, the person may have heart pain that extends to the throat and fever. In severe cases, the person will die and cannot be treated. The Hand Jueyin channel begins in the chest and emerges to belong to the pericardium. A branch of the Hand Shaoyin channel runs upward from the heart network and passes on either side of the throat. This is why these symptoms occur.

When the Qi of the Hand Taiyang channel flows upward against its proper course, the person may become deaf, shed tears, and be unable to turn the head; the waist also cannot bend forward or backward. The key to diagnosis and treatment is this: one branch of the Hand Taiyang channel emerges from Quepen, runs upward along the neck to the cheek, reaches the outer corner of the eye, then turns back and enters the ear. Another branch runs upward from the cheek to the cheekbone and reaches the nose…

The disease pattern extends upward to the inner corner of the eye, causing deafness and tearing. The neck cannot turn, and the lower back cannot bend forward or backward. These symptoms do not seem to match the pathways of the meridians; the passage may have been misplaced in an ancient text.

When Qi in the Hand Yangming and Hand Shaoyang meridians flows upward in counterflow, it can cause throat obstruction—swelling, blockage, and pain in the throat—along with throat swelling and convulsions. Treatment should focus on the meridians that govern these conditions. A branch of the Hand Yangming meridian runs from the supraclavicular hollow upward to the neck. A branch of the Hand Shaoyang meridian rises from the center of the chest, passes out through the supraclavicular hollow, and then reaches the neck. This accounts for the symptoms described above.

The New Collation states: “In the Quan Yuanqi edition, the character chi is written as jing, meaning convulsions.”