《黃帝內經素問補註釋文》Vol. 28

The Yellow Emperor asked: When someone has an abscess in the stomach, how should the pulse be examined?

Qibo replied: In such cases, examine the stomach pulse. The stomach pulse should normally be deep and fine. If it is deep and fine, this indicates that the flow of Qi is in disorder.

The stomach is where food and drink are received, so by ordinary principles its Qi and blood should be abundant. A deep, fine pulse instead goes against the normal state.

“Reversal” means that the Renying pulse, felt on the side of the neck beside the throat, is especially forceful. A forceful Renying pulse indicates heat. A deep, fine pulse shows cold; cold obstructs Yang Qi, making the Renying pulse appear forceful. The Renying pulse belongs to the Yangming channel, so its forcefulness manifests as heat.

The Renying pulse is also the stomach pulse, because the stomach channel descends along the throat and enters the supraclavicular hollow. When the stomach pulse is disordered and forceful, pathogenic heat gathers at the entrance to the stomach and cannot disperse. An abscess then forms in the stomach region. Qi and blood are already abundant, and pathogenic heat presses inward; cold and heat combine and congeal into an abscess.

The Yellow Emperor said: Good. Why do some people feel restless whenever they lie down?

Qibo replied: If the Five Zang organs are damaged, or if vital essence and Qi have taken hold somewhere within the body, a person cannot lie peacefully. Those nearby should not dismiss the person’s suffering as unimportant.

When the Five Zang organs are damaged, or when vital essence and Qi formed from food and drink have lodged somewhere and are supporting the body, a person may lie down for a time. But because the cause of the illness has injured the Five Zang organs, the suffering hangs over the person and cannot be ignored.

The Yellow Emperor asked again: Why can some people not lie on their backs?

Qibo replied: The lungs are the “cover” of the Five Zang organs. Situated above them, the lungs spread out like leaves and cover the other four organs. When Lung Qi is congested, the pulse becomes large; with a large pulse, a person cannot lie on their back. If the lungs are distended, lying on the back makes the breath short and worsens wheezing, so the person cannot remain in that position. This is also discussed in the chapter “Strange and Constant Yin-Yang.”

There is a kind of jue disorder, a condition caused by disordered and counterflowing Qi. On examination, the pulse in the right hand is deep and tight, while the pulse in the left hand is floating and slow. Where does the root of this condition lie?

Here, “not so” means that the pulse is “not deep.” The New Collation notes that the Jia Yi Jing reads “not recognized.”

Qibo said: In winter, the pulse in the right hand should naturally be deep and tight; this accords with the seasons. A floating and slow pulse in the left hand, however, goes against the seasonal pattern. When this abnormal pulse appears on the left, the illness is mainly in the kidneys, though the lungs are also involved to some extent, and it will cause lower back pain.

In winter, a floating and slow pulse on the left is associated with the lungs, since a floating pulse is a lung pulse. That is why the illness is said to involve the lungs to some extent. The lower back is governed by the kidneys, so kidney illness causes lower back pain.

The Yellow Emperor asked: Why do you say this?

Qibo replied: The Shaoyin channel—here, the Kidney channel of Foot Shaoyin—runs through the kidneys and connects with the lungs. Since the pulse now shows the characteristics of a lung pulse, the kidneys may be affected; this is why kidney illness causes lower back pain.

A floating and slow pulse on the left does not mean that a lung pulse has truly appeared. Rather, the Qi of the left kidney is deficient, and the pulse cannot sink; it therefore takes on the appearance of a lung pulse. This indicates that the illness is in the kidneys.

The Yellow Emperor said: Good. In one kind of illness, an abscess forms on the neck. Some cases are treated with a stone lancet, others with acupuncture and moxibustion, and both methods cure the condition. What is the principle behind the treatment?

The methods used differ, yet the outcome is the same: recovery. The Yellow Emperor is asking about the principle that explains this.

Qibo replied: The illness has the same name, but its circumstances differ.

Although both conditions are called neck abscesses, the state of the skin and the interior of the affected area is not the same. The degree of stagnation in the Qi and blood varies, so the treatment should vary as well.

If an abscess contains stagnant, decayed tissue, it is appropriate to open it with a needle and remove the tissue. If Qi is abundant and blood has gathered, it is appropriate to pierce and drain it with a stone lancet. This is what is meant by treating the same illness in different ways according to the particular circumstances. A stone lancet was an ancient stone tool used to pierce large abscesses and drain the pus; later, a sharp needle was often used instead.

The Yellow Emperor asked: There is a kind of illness in which a person becomes angry and delirious. How does it arise?

The New Collation notes that the Taisu reads “prone to anger” in place of “anger and delirium.”

Qibo replied: This illness is caused by Yang Qi.

The Yellow Emperor asked: Why does Yang Qi make a person go mad?

Qibo said: When Yang Qi is suddenly frustrated and becomes constrained, unable to flow freely, it can easily make a person angry. This illness is called Yang Jue, a disorder caused by Yang Qi becoming disordered and constrained.

In other words, Yang Qi has been repressed and can no longer circulate freely. People with this condition are often easily angered, usually because they have suffered a sudden blow or setback and cannot find emotional release. The ancients called a disorder caused by disordered, excessively agitated Yang Qi Yang Jue.

The Yellow Emperor asked, “How can this condition be recognized?”

Qibo replied, “The Yangming pulse normally beats visibly, while the Taiyang and Shaoyang pulses generally do not. If a pulse that is usually still begins to beat, and does so rapidly and forcefully, that is a sign by which to judge the illness.”

This passage refers to pulses in the neck that beat continuously. The Yangming pulse usually beats beside the laryngeal prominence, in the area of the Renying and Qishe points. If the Shaoyang pulse beats, it does so below the angle of the jaw, in the area of the Tianchuang and Tianyou points. If the Taiyang pulse beats, it does so in the hollows in front of the large tendons on either side at the back of the neck, in the area of the Tianzhu and Tianrong points. A place that ordinarily should not beat strongly may indicate illness if it does.

The “New Collation” says that Wang Bing’s annotated edition places Tianchuang on the Shaoyang channel and Tianrong on the Taiyang channel. However, the Jia Yi Jing records Tianchuang as the point where the qi of the Taiyang channel emerges, and Tianrong as the point where the qi of the Shaoyang channel emerges. Since the attributions are reversed, the Jia Yi Jing should be followed.

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

Qibo replied, “Reduce the patient’s food intake, and the illness will improve. Food entering the body nourishes the Yin and increases Yang qi, so reducing food intake will bring the illness to a halt.”

When food intake decreases, qi also weakens. Thus, moderating the diet allows the condition to ease on its own. The “New Collation” says that both the Jia Yi Jing and the Tai Su write “diminish their food” in place of “take away their food.”

The patient should also be given a drink prepared by decocting sheng tieluo—the flakes of raw iron. The “New Collation” says that the Jia Yi Jing writes “iron flakes” in place of “iron filings,” and “make it a drink” in place of “take it after meals,” meaning that the medicine is to be taken after eating.

Raw iron flakes have the effect of directing qi downward. The character “luo” may be a copying error. Iron flakes taste pungent and are mildly warm and neutral in nature; they are chiefly used to direct qi downward. They are sometimes called “iron syrup” among the people, but they are not molten iron.

The Yellow Emperor asked, “Good. There is a kind of illness in which the patient feels feverish, tired, and weak, sweats as though just bathed, fears the wind, and is short of breath. What is this illness?”

Qibo replied, “This illness is called wine-wind.”

That is, it is an illness caused by exposure to wind after drinking alcohol. The “Treatise on Wind” calls wind exposure after drinking “leakage-wind,” so this illness is also known by that name. Excessive drinking makes Yang qi predominant and loosens the interstices of the skin, opening its pores. When Yang qi is predominant, the sinews and vessels become slack, causing tiredness and weakness. When the interstices are loose, wind pathogens can enter easily. When the pores are open, qi leaks outward, so the patient sweats as though bathing. Wind pathogens attack the skin and its interstices; excessive sweating then weakens the body, while Heat pathogens steam the Lungs. This produces symptoms such as fear of wind and shortness of breath. The illness is brought on by drinking alcohol.

This is called “wine-induced wind disease,” a wind disorder brought on by drinking alcohol. The Yellow Emperor asked, “How should it be treated?” Qibo replied, “Use ten parts each of water plantain and white atractylodes, and five parts of deer-herb. Combine them, then take an amount that can be pinched between three fingers after a meal.”

White atractylodes tastes bitter and is warm yet balanced in nature. It treats severe wind disorders and stops sweating. Deer-herb tastes bitter and is cold yet balanced in nature. It treats wind-dampness and weakness of the sinews and vessels. Water plantain tastes sweet and is cold yet balanced in nature. It treats wind-dampness and boosts Qi. This formula is assembled according to the effects of its ingredients, so the medicine is taken after a meal. “After eating” means taking the medicine after a meal.

“The deep and fine pulse feels like a needle beneath the fingers. When it is gently stroked and carefully pressed, a pulse whose Qi gathers feels firm. A broad pulse is wide in form.” This describes how to examine the pulse: a pulse that lies deep and is fine feels like a needle beneath the fingers. Gently stroke it and press carefully; if its Qi gathers, it feels firm. A broad pulse has a wide form.

The “Upper Classic” explains how the body’s Qi activity connects with Heaven; the “Lower Classic” discusses changes in illness; the “Golden Coffer” concerns judging life and death. “Measuring and assessing” means palpating and evaluating the pulse, while “the unusual and the constant” concerns special illnesses. “Unusual” refers to certain special illnesses that do not lead to death according to the patterns of the four seasons. “Constant” refers to illnesses that develop in accordance with seasonal change and may even prove fatal.

The “New Collation” cites Yang Shangshan as saying: “After an illness arises, its course changes and, when the corresponding season arrives, the patient dies. This is ‘constant.’ Changes in the illness due to joy or anger, or its sequential transmission from one stage to the next, fall under ‘unusual.’”

“Measuring” means exploring the principles of the pulse by palpation. “Assessing” means determining where the illness lies, then gauging its course in relation to the four seasons.

Sentences that begin with “what is meant by” usually explain something left unclear earlier. Here, however, these lines do not fit the meaning of the surrounding passages and seem to explain a different section of the classic. The “New Collation” suggests that the received text lacks the seventh and eighth chapters, and that these lines may originally have belonged to the missing text before being misplaced here. The ancient text is fragmentary, and some passages have been joined incorrectly.

Treatise on Unusual Illnesses

The Yellow Emperor asked, “Why is it that a pregnant woman becomes unable to speak at nine months?”

“Carrying a second body” means that one body is within another—in other words, pregnancy. “Mute” means unable to speak. At nine months of pregnancy, the Qi of the Foot Shaoyin Kidney channel nourishes the fetus. If the related Qi channels become obstructed, speech may become impossible.

Qibo replied, “This is caused by an obstruction of the network vessels of the womb network.”

Here, “obstruction” means that the network vessels are blocked. It does not mean that the primordial Qi that sustains life has been severed.

The Yellow Emperor asked, “Why do you say this?”

Qibo replied, “The womb network is connected to the Kidneys. The Foot Shaoyin Kidney channel passes through the Kidneys and connects with the root of the tongue. When this happens, the person becomes unable to speak.”

Foot Shaoyin is the Kidney channel. The Qi of the Kidney channel cannot nourish the root of the tongue, so the tongue cannot produce speech normally.

The Yellow Emperor asked, “How should this condition be treated?” Qibo replied, “It does not need treatment. Wait until the tenth month, and it will return to normal.”

By the tenth month of pregnancy, the fetus leaves the uterine network—the channels that surround and connect the fetus—and the network becomes unobstructed again. Qi in the Kidney channel rises to nourish the body, which then returns to its former state. The statement “it does not need treatment” means that this condition usually resolves on its own as the pregnancy progresses.

The Acupuncture Methods says, “Do not diminish what is deficient, and do not increase what is excessive; otherwise, illness will develop.” Here, “illness” refers to a danger that can arise if a longstanding condition is treated in a way that runs counter to it: the fetus may die in the womb and remain undelivered, making the condition prolonged and difficult to resolve.

The New Collation notes that, according to the Jia Yi Jing and the Tai Su, the four characters meaning “and then regulate it” do not appear here. The version annotated by Quan Yuanqi explains that “not treating” means a pregnant woman may become hoarse and feel heavy in the body during the ninth month, making treatment inadvisable. After a full-term birth in the tenth month, her body returns to normal. Therefore, the words “and then regulate it” were probably copied into the main text by mistake from Quan Yuanqi’s commentary and should be removed.

“Do not diminish what is deficient” means that a pregnant woman who is frail and thin should not be treated with needles or stone lancets. In the ninth month of pregnancy, her sinews and bones are fatigued and her strength is depleted; her body feels heavy, and she has difficulty eating, so she becomes thin. Needles and stone lancets should not be used to further injure her body. “Do not increase what is excessive” means that, with a fetus already in the womb, using draining methods would cause Jing and Qi to leak out. Pathogenic Qi could then take advantage of the resulting weakness and become dominant on its own, producing illness.

When the uterine network is constricted and Kidney Qi cannot flow freely, draining methods will also deplete Kidney Jing. As the body’s fluids and essence are exhausted, the fetus becomes difficult to protect: it may die in the womb and remain undelivered. Pathogenic Qi then grows dominant on its own, and illness develops.

The Yellow Emperor asked, “Someone has distension beneath the ribs, with Qi surging upward, and the condition has persisted for two or three years without improving. What illness is this?” Qibo replied, “This illness is called ‘breath accumulation.’ It does not interfere with eating, and it should not be treated with moxibustion or acupuncture. It should be treated over a long period with guiding exercises and medicine; medicine alone cannot cure it.”

There is no obvious mass in the abdomen, but Qi surges upward and causes distension beneath the ribs that persists for years. Because the upward surging of Qi makes breathing difficult, the condition is called “breath accumulation.” The pathogenic Qi is not in the Stomach, so eating is unaffected. Moxibustion heats the interior and may cause Qi to transform and generate wind; acupuncture drains Qi from the channels and may instead cause weakness. For this reason, neither moxibustion nor acupuncture should be used. Guiding exercises can help Qi and blood circulate, while long-term use of medicine can disperse stagnation within the body. If one relies on medicine alone without guiding exercises, medicine cannot cure the condition by itself.

The Yellow Emperor asked, “Someone has swelling in the hips, thighs, and lower legs, as well as pain around the navel. What illness is this?” Qibo replied, “This illness is called ‘hidden beam.’”

Fu Liang is named for a disease arising in the Chongmai (the vessel that begins below the kidneys and runs through the abdomen, among other areas). The Chongmai connects with the collateral vessels of the Foot Shaoyin Kidney channel. It begins below the kidneys, emerges at Qijie, runs obliquely along the inner thigh to the hollow behind the knee, then descends along the inner lower leg, passes behind the inner ankle, and enters the sole of the foot. One branch of the Chongmai runs upward from three inches below the navel, near the Guanyuan acupoint, ascends along the abdomen, and eventually joins the throat.

The patient may therefore develop swelling of the body and thighs, with swelling encircling the navel and pain around it. This illness is called “Fu Liang.” “Encircling” means that the pain goes around the navel in a circular pattern.

This is one of the sources of illness caused by pathogenic Wind. The disease Qi spills into the large intestine and lodges in the “Huang,” the deeper tissues inside the abdomen. The source point of the Huang lies below the navel, so pain occurs around the navel.

The “large intestine” mentioned here may also refer to the ileum. Why? The Ling Shu Jing records that the ileum lies to the right of the navel, coils and turns back on itself, folds repeatedly, and then descends; the colon lies close to the spine and receives what comes from the ileum. On this account, this passage should call it the “ileum,” rather than simply the “large intestine.” However, both the large intestine and the ileum are associated with the Lung, so the name “large intestine” is used for both on the basis of this association.

This illness must not be treated recklessly with draining medicines. If it is improperly purged, fluid metabolism may become disordered and urination may become difficult. The Chongmai begins below the kidneys, and its ascending branch starts from the Baozhong, the abdominal area associated with reproduction, and rises near Guanyuan. If the illness is violently attacked with medicine, the movement of fluids may be damaged, causing difficulty and discomfort in urination. This exchange describes a particular illness and matches the account in “Discourse on the Abdomen” in the Su Wen, so it is repeated here.

The Yellow Emperor asked: “When someone’s Chi pulse beats very rapidly and the tendons are tense, what illness does this indicate?”

“Tense tendons” here refers to the two tendons at the wrist, behind the palm, where the Chi pulse is located. The “Discourse on the Essentials of the Pulse” says that the outer side of the Chi pulse reflects the kidneys, while the inner side reflects the abdomen. A rapid, tense Chi pulse indicates Heat. Heat would ordinarily make the tendons slack, but in this person the tendons at the Chi position are instead taut, which is why the Yellow Emperor asks what illness this indicates. The Ling Shu Jing says that Heat makes the tendons slack, while Cold makes them contract.

Qibo replied: “This is what is called ‘Zhen Jin.’ A person with this illness will certainly have tension in the abdomen; if white or black is also seen, the illness will worsen.”

Tension in the abdomen means that the tendons beside the navel and in the kidney area are taut. The inner side of the Chi pulse can be used to assess the abdomen, so tension in the tendons at the Chi position indicates that the abdomen will also be tense. “Seeing a color” here refers to the complexion, or to a color observed…

When the five colors appear on the face, white indicates a cold condition, and black also indicates a cold condition. The appearance of both white and black suggests that the illness will become more severe.

The Yellow Emperor asked: “Some people suffer from headaches that do not get better for many years. What causes this, and what is the condition called?”

A headache would not ordinarily last longer than a month. Since it had persisted for years without improvement, the Yellow Emperor found this strange and asked about it.

Qibo replied: “This happens when someone has been struck by an extremely severe cold pathogen, which has penetrated deep into the bone marrow. The brain is governed by the marrow. When the Qi of the brain becomes disordered and flows counter to its proper course, it causes headaches, and the teeth also hurt.”

The brain governs the marrow, while the teeth are the extremities of the bones. When the brain’s Qi becomes disordered and a cold pathogen also enters the bones, headaches and toothaches result. This condition is called “counterflow reversal,” a category of disorders in which the movement of Qi runs counter to its proper course.

The Yellow Emperor said: “Well said.”

A commentator adds: “In the earliest stages of human development, the brain forms first; only after the brain has formed does the bone marrow develop. The teeth are produced by the bones.”

The Yellow Emperor asked: “Some people find that their mouth tastes sweet. What is this condition called, and how does it arise?”

Qibo replied: “This is a sign that the Qi of the five Zang organs is overflowing upward. It is called ‘Spleen Heat,’ a disorder caused by heat in the Spleen. ‘Heat’ here means feverish heat. When the Spleen is hot, the other four organs are affected as well, and the Qi of all five Zang organs overflows upward. Because the root of the illness lies in heat in the Spleen, it is called ‘Spleen Heat.’”

After the five flavors enter the mouth, they are stored in the Stomach. The Spleen then distributes their refined Qi and fluids. When fluids accumulate in the Spleen and Stomach, the mouth tastes sweet.

Heat in the Spleen causes fluids to gather within the Spleen and Stomach. After food is digested, the remaining refined Qi overflows upward. Since the mouth is connected to the Qi of the Spleen, the person experiences a sweet taste. The accumulation of fluids in the Spleen and Stomach also indicates excessive dampness there. This condition is caused by eating rich, sweet, and fatty foods.

The New Collation notes that the Tai Su has “bring about” where this text has “arise.” People with this condition often eat sweet and greasy foods. Greasy foods generate heat in the body, while sweet foods tend to cause distention in the Middle Burner. As a result, the Qi of the Spleen and Stomach overflows upward; over time, this may develop into wasting-thirst, a disorder marked chiefly by thirst and excessive drinking.

Eating greasy foods tightens the interstices—the spaces between the skin and muscles and the pores—so Yang Qi cannot discharge outward, and heat develops inside the body. Sweetness has a moderating nature and can also cause Qi to flow counter to its proper course, producing distention. When there is heat inside the body, it rises upward, bringing thirst and a dry throat. Distention in the Middle Burner means that Qi has accumulated after the Spleen and Stomach have carried out their work. This excess then causes the Spleen’s Qi to overflow upward, which is why the condition may develop into wasting-thirst.

The Treatise on the Correspondence of Yin and Yang says: “Pungent and sweet flavors can disperse and belong to Yang.” The Ling Shu Jing says: “Eating too much sweet flavor makes the chest feel oppressed.” The point here is that distention in the Middle Burner may go on to cause the disorders described above. The New Collation also notes that the Jia Yi Jing reads “wasting-heat” at this point, rather than “wasting-thirst.”

For treatment, use lan to remove old, stagnant Qi that has accumulated in the body.

Orchid refers to lan grass. The Shennong Bencao Jing says that lan grass tastes acrid, has a hot or neutral nature, and can promote urination.

“Dispel what is inauspicious” means that lan grass can drive away unpleasant odors. “Long-standing” means accumulated over time. Here, it says lan grass can eliminate odors that have built up over a long period, such as those produced when rich, fatty foods stagnate and fail to digest. This is because acrid flavors disperse. The “Treatise on the Correspondence of the Qi of the Zang Organs with the Seasons” says, “Acrid flavors can disperse.”

The New Collation (a note on the textual emendation made by later scholars) says: “On consulting the Bencao, I find that lan grass is recorded as having a neutral nature; it does not say that it is hot.”

The Yellow Emperor asked, “Someone has a bitter taste in the mouth, and Yanglingquan, an acupoint on the Gallbladder Channel, is selected for treatment. What is this condition called, and how does it arise?” Qibo replied, “This condition is called Gallbladder Heat. The character dan can also mean heat. Gallbladder bile tastes bitter, which is why the mouth becomes bitter.”

The New Collation says: “Neither the text of Quan Yuanqi nor the Taisu contains the six characters ‘bitter taste in the mouth; select Yanglingquan.’ Judging from the surrounding context, these words may be mistaken.”

The Liver is like a general in the body: after plans are formed, the Gallbladder must make the decision. The throat corresponds to the Gallbladder, as though it were the Gallbladder’s messenger. The “Treatise on the Secret Canon in the Orchid Chamber” says, “The Liver is the office of the general, from which plans and deliberations arise; the Gallbladder is the office of impartial judgment, from which decisions are made.” The Liver and Gallbladder are paired and their Qi circulates between them, so after plans are formed, the Gallbladder makes the decision. The throat corresponds to the Gallbladder, which is why it is called the Gallbladder’s messenger.

The New Collation says: “The Jia Yi Jing records: ‘The Gallbladder is the storehouse of pure essence. The decisions of the Five Zang organs all depend on the Gallbladder, and the throat is its messenger.’ This suggests that the wording of the present passage may be mistaken.”

A person in this condition often deliberates but finds it hard to decide. The Gallbladder Qi is therefore weak and rises upward, overflowing and causing a bitter taste in the mouth. For treatment, select the Gallbladder’s Mu point and Shu point. Mu points are on the chest and abdomen; Shu points lie on either side of the spine on the back. The Gallbladder’s Mu point is on the outer side of the ribs below the breast, about five fen beneath Qimen. Its Shu point is on the back, one and a half cun to either side beneath the tenth vertebra.

The treatment method is given in the chapter “Yin and Yang: The Twelve Officials as Agents of One Another.” This means that the method was originally recorded in that chapter, which has since been lost.

The Yellow Emperor asked, “Someone suffers from urinary difficulty or frequent urination, passing urine dozens of times a day. This indicates that the Zheng Qi is deficient. Yet the body is hot as charcoal, the neck and chest feel as though they are blocked, the Qi Kou (the pulse at Renying) is agitated and forceful, and breathing is rapid, with Qi surging upward. This, in turn, indicates an excess of pathogenic Qi. Does this condition arise because Yang Qi is excessive at the body’s surface and Yin Qi is deficient, giving rise to signs of excess Yang Qi?”

The New Collation says: “On close examination, this passage consists of fifteen characters, which earlier editions treated as part of the classic text. But neither the Jia Yi Jing nor the Taisu contains it. Further examination suggests that it is a commentary by Quan Yuanqi, later copied by mistake into the classic text. It is now restored to the commentary.”

The Taiyin pulse is as fine and weak as a strand of hair. This indicates deficiency. Where, then, does this illness arise, and what is it called?

This passage discusses a critical illness and its pulse signs.

“Long” refers to difficulty urinating, and “urination” means passing urine. The patient cannot urinate freely, yet urinates repeatedly. The body is as hot as burning charcoal, and the neck and chest feel blocked, with rapid breathing and Qi rising upward. In theory, this illness belongs to the Hand Taiyin Lung channel, so the pulse should be forceful and rapid. Yet the Hand Taiyin pulse is instead as faint as a strand of hair. Here, the Taiyin pulse is the pulse at the wrist on the thumb side, at the cun opening, which the ancients used to observe the Qi of the five viscera.

Qibo said, “The illness is in Taiyin, but its force is greatest in the Stomach, and it also involves the Lung. The illness is called ‘Jue’ and cannot be cured.”

The commentary explains that rebellious Lung Qi affects Stomach Qi, causing the Renying pulse—the pulse on either side of the throat—to beat restlessly and strongly. The patient also has wheezing and Qi counterflow, which is why the Lung is said to be involved. But the symptoms show that the illness is very severe, while the Taiyin pulse is faint and fine. This contradiction indicates a grave disorder of the visceral Qi, so the condition is described as “fatal Jue, incurable.”

The Yellow Emperor asked, “What is meant by ‘five excesses and two deficiencies’?” Qibo replied, “The five excesses are five signs of disease Qi in excess; the two deficiencies are two signs of disease Qi that are deficient. The illness shows five excesses externally, while also having two deficiencies internally. It can therefore be understood neither as purely an exterior condition nor as purely an interior one, and its prognosis is extremely poor.”

The “five excesses” are: first, the body is hot as charcoal; second, the neck and chest feel blocked and resistant; third, the Renying pulse is restless and strong; fourth, wheezing; and fifth, Qi rising upward. The “two deficiencies” are: first, difficulty urinating; second, a Taiyin pulse faint and fine as a hair. In the original passage, the list of “two deficiencies” includes the phrase “frequent urination,” meaning that the patient urinates repeatedly; it then gives the faint, fine Taiyin pulse as the other sign. The patient has five signs of excess on the outside and deficiency within. Since neither the exterior nor the interior can be treated straightforwardly by supplementation or draining, the condition is judged critical.

The Yellow Emperor then asked, “What is the name of the illness a person is born with, called dianji—a disorder of the head or crown of the head—and where does it come from?”

Qibo replied, “All illnesses arise from wind, rain, cold, and heat; from imbalances of Yin and Yang; and from changes in the emotions, such as joy and anger.”

How can this illness arise when the fetus has only just formed and has not yet been attacked by external pathogens? Could it be that pathogenic Qi had already harmed the fetus, causing the illness?

“Crown” refers to the top of the head—that is, the head.

Qibo replied: This illness is called “fetal illness.” It takes shape while the mother is pregnant. At the time, the mother suffered a great fright, causing her Qi to surge upward and preventing it from descending. The vital essence gathered in one place, so after the child was born, an illness of the head would arise.

The “vital essence” spoken of here refers to the essence of Yang.

The Yellow Emperor asked: There is an illness in which the face and eyes become swollen, as if from edema. On examination, the pulse is large and tight, yet the body feels no pain and has not become thin. The patient cannot eat and has little appetite. What is this illness called?

“Swollen” describes swelling of the face and eyes, with an unusual complexion as well. “Large and tight” describes a pulse like a taut bowstring: a large pulse indicates abundant Qi, while a tight pulse indicates Cold. Cold has invaded the body, yet the patient feels no pain, which is unusual. That is why the Yellow Emperor asked about it in particular.

Qibo replied: The illness has its root in the Kidneys and is called “Kidney Wind.”

A pulse like a bowstring, large and tight, indicates that the Qi of exhaustion has accumulated inside the body and Cold has also invaded. The Qi of exhaustion and Cold contend with each other and thereby generate Wind. The pathogenic Wind attacks the Kidneys, which is why the illness is called “Kidney Wind.”

If someone with Kidney Wind cannot eat and is easily frightened, then fright will weaken the Heart Qi, and the person will die. The point is that the Kidneys belong to Water and the Heart belongs to Fire. When Wind afflicts Kidney Water and Heart Fire is weakened, both Water and Fire are damaged, making the illness critical.

The Yellow Emperor said, “Well said.”