《黃帝內經素問補註釋文》Vol. 29

Supplementary Annotations to the Basic Questions of the Yellow Emperor’s Inner Classic, Volume 29, “Yi Wu”

Annotated by Wang Bing, also known as Qixuanzi, an official in charge of imperial horses in the Tang dynasty; collated by Lin Yi and others, who served as palace officials in the Song dynasty; and with errors further corrected by Sun Zhao, a Song dynasty official in the Ministry of Revenue.

“Treatise on Extraordinary Diseases”

When the pulse Qi of the Liver, Kidney, and Lung, the three zang organs, is full and replete, abscesses and swellings may form—localized conditions marked by redness, swelling, and pain. “Full” here means that the pulse Qi is abundant and firm; “swelling” refers to an abscess. This occurs when the Qi of the zang-fu organs is full and replete.

A Lung abscess causes shortness of breath and distension in both flanks. The Lung stores Qi and governs breathing. A branch of the Lung channel runs horizontally from the Lung system and emerges below the armpit, which accounts for the shortness of breath and distension in both flanks. The editors note that in the Jia Yi Jing, the terms for Lung abscess, Liver abscess, and Kidney abscess are all written as “yong.”

A Liver abscess causes distension in both flanks, fright when lying down, and difficulty urinating. The Liver channel runs up the inner thigh, enters the pubic region, circles the genitals, reaches the lower abdomen, then ascends through the Liver and diaphragm and spreads through the flanks. This explains the distension in the flanks and difficulty urinating. The Liver governs fright, so the person is easily startled when lying down.

A Kidney abscess causes distension from below the flank down to the lower abdomen. The editors note that the Jia Yi Jing has “below the flank.” The original text’s “below the foot” should read “below the flank,” since it makes no sense to say that distension extends from below the foot to the lower abdomen.

The lower legs may differ in thickness, while the thighs and lower legs become swollen. The person walks with a limp and is prone to hemiplegia, a loss of normal movement on one side of the body.

The Chong Mai is the sea of the channels, where the Qi and blood of the channels converge. Together with the collaterals of the Foot Shaoyin Kidney channel, it begins below the Kidneys and descends to Qijie, near the groin. It runs obliquely down the inner thigh into the hollow behind the knee, then follows the inner side of the shin alongside the Foot Shaoyin channel, passes behind the inner ankle, and enters the sole of the foot. Its ascending portion rises from a point three inches below the navel. This accounts for the symptoms described above. If the Qi and blood undergo changes, hemiplegia may also develop.

When the Heart pulse is full and large, epilepsy, convulsions, and muscular spasms may occur. The Liver Qi then flows downward, and heat presses within the body. The sinews are deprived of nourishment and the blood is depleted, causing epilepsy, convulsions, and muscular spasms.

When the Liver pulse is fine, small, and tight, epilepsy, convulsions, and muscular spasms may also occur. The Liver nourishes the sinews and stores blood within the body. When the Liver Qi is affected by cold, these symptoms arise. A fine, small, and tight pulse indicates cold.

A rapid, suddenly changing Liver pulse indicates that the patient has been frightened. The word “wu” means to gallop or move swiftly, describing a pulse that comes on suddenly and quickly. Yang Qi is pressed within the body, causing fright.

If the pulse cannot be felt for a time and the person is unable to speak, no treatment is needed; the condition will resolve on its own. When Liver Qi rebels and becomes blocked, the pulse Qi cannot flow through. Once the rebellion subsides, the pulse Qi resumes its flow.

The Heart vessel network is distributed between the ribs and runs behind the throat. When the Qi of the vessels cannot reach this area, loss of voice may occur. If the loss of voice is only temporary, no treatment is needed; it will improve on its own.

When the Kidney, Liver, and Heart pulses are all fine and rapid, with no palpable beat, this indicates jia (abdominal masses). A fine, rapid pulse shows that Cold is severe; the absence of a palpable beat shows that the blood is not flowing freely. When blood flow is obstructed and Cold invades, the blood congeals inside the body and forms jia.

When the Kidney and Liver pulses are both deep and hidden, this indicates stone water—a condition involving hard accumulations of fluid in the abdomen. The Liver vessel enters the genital region and passes through the lower abdomen; the Kidney vessel runs along the spine and connects with the Bladder. When both the Liver and Kidney are diseased, the Qi of the organs and bowels steams and surges against the Thoroughfare vessel. The Thoroughfare vessel connects, below the Kidneys, with the womb (here referring to the Bladder and other organs in the lower abdomen). This prevents fluids from circulating and being discharged normally, so they become firmly congealed into masses. The Kidneys govern water, and water freezes in winter; water has its source in the Kidneys. The nature of the Kidneys is like that of water, and their pulse is deep and hidden. Thus Qi gathers and sinks, a condition called stone water.

The Newly Revised Commentary says: “From ‘the Kidney and Liver pulses are both deep’ through ‘both are fine and wiry, and indicate a tendency to be startled’—in the Quan Yuanqi edition, this passage originally appeared in the ‘Treatise on Reversal Disorders.’ Wang Bing moved it here.”

When the Kidney and Liver pulses are both floating, this indicates wind water—edema caused by Wind disrupting the movement of fluids. A floating pulse indicates Wind; the lower burner governs fluids, and Wind invades the lower burner, hence the name wind water.

When the Kidney and Liver pulses are both weak, this indicates a fatal condition. The Kidneys are the root of the Five Organs, and the Liver governs the generation of life. Weakness in both means that the root of life and its vitality are both failing, so the prognosis is poor.

When the Kidney and Liver pulses are both fine and wiry, this indicates a tendency to be easily startled. A fine, wiry pulse shows that both the Liver and Kidneys are deficient.

When the Kidney pulse is large, rapid, and deep, and the Liver pulse is likewise large, rapid, and deep, this indicates shan (a disorder caused by Cold congealing). Shan forms when Cold gathers and congeals. A deep pulse indicates that the pathogenic influence is firmly bound; a rapid pulse indicates pain. When Cold invades, Qi becomes obstructed and congeals, causing gripping pain and forming shan.

A forceful, slippery, and rapid Heart pulse indicates Heart shan; a deep, forceful Lung pulse indicates Lung shan. These conditions are all caused by Cold invading the organs and bowels.

When the three Yang pulses are rapid, this indicates jia; when the three Yin pulses are rapid, this indicates shan. Cold in the Greater Yang channel causes the blood to congeal and form jia; Cold in the Greater Yin channel causes Qi to gather and form shan.

When the two-Yin pulse is rapid, this indicates xianjue (convulsions and loss of consciousness); when the two-Yang pulse is rapid, this indicates a fright disorder. “Two Yin” refers to Lesser Yin, and “two Yang” refers to Yangming.

The Newly Revised Commentary says: “From ‘rapidness in the three Yang indicates jia’ through this passage—in the Quan Yuanqi edition, it originally appeared in the ‘Treatise on Reversal Disorders.’ Wang Bing moved it here.”

When the Spleen pulse feels full and forceful on the outer side of the arm, yet deep, this indicates changpi (an intestinal disorder involving diarrhea or dysentery); if it persists for a long time, it will improve on its own. “Full and forceful on the outer side” here means that the pulse beats strongly on the outer side of the arm.

When the Liver pulse is fine and moderate, this indicates changpi, which is relatively easy to treat. This pulse shows that Spleen Qi is encroaching on the Liver, but the condition is mild, so it is easy to treat.

When the Kidney pulse is fine, clearly beating, and deep, this indicates changpi accompanied by blood in the stool. A fine pulse indicates insufficient Yin Qi; a clearly beating pulse indicates Yang encroaching, with Heat lodged in the lower burner.

This is why bleeding occurs below.

If the body becomes feverish while bleeding below, the patient will die. This is because Yin Qi has already weakened and been exhausted.

Disorders of the heart and liver can also cause intestinal bleeding. The liver governs the storage of blood, and the heart nourishes the blood, so disorders of either organ may lead to bleeding below.

Even when the heart and liver are both diseased, treatment may still be possible. The heart belongs to Fire, and the liver to Wood; Wood generates Fire, so their concurrent illness still follows a generative relationship.

A fine, deep, and rough pulse is characteristic of intestinal bleeding. Fine, deep, and rough pulses at the heart and liver positions also indicate intestinal bleeding.

If the patient has a fever, they will die; death follows seven days after the fever appears. Intestinal bleeding accompanied by fever shows that Fire Qi can no longer remain within the body or sustain the heart. Instead, it disperses outward, making the illness critical. The number associated with Fire is seven, hence the prediction of death after seven days.

A deep, forceful, and rough pulse at the stomach position, with the pulse bulging prominently on the outer side; and a fine, hard, and rapid pulse at the heart position—these are all signs of partial paralysis in the area of the diaphragm, in which one side of the body becomes weakened and loses normal function.

“Bulging on the outer side” means that the pulse is not prominent at the usual cun and chi positions used for diagnosis, but is clearly felt on the outer side of the arm.

In men, illness begins on the left; in women, it begins on the right. The left belongs to Yang and the right to Yin, which accounts for this difference. The Treatise on the Correspondence of Yin and Yang and the Manifestations of the Four Seasons says, “Left and right are the pathways along which Yin and Yang circulate.” This is the principle being described.

If the patient has not lost their voice and can still move their tongue, the condition can be treated, and they will be able to get up after thirty days.

If a patient with partial paralysis around the diaphragm loses their voice and cannot speak, this indicates internal damage to the kidneys and the uterine vessels, which connect to the womb. The uterine vessels are connected to the kidneys. The kidney channel ascends from the kidneys, passes through the liver and diaphragm, enters the lungs, and then follows the throat to the root of the tongue. Thus, when Qi is cut off internally, the patient loses their voice and cannot speak.

If the illness progresses according to the left-right pattern and the patient also loses their voice, treatment will take three years before they can get up. “According to the left-right pattern” means that the illness begins on the left in men and on the right in women.

A person under twenty years of age will die after three years. This is because the Five Zang organs have only just become established, while Qi and blood are vigorous. Newly established organs are easily damaged, and vigorous Qi and blood are easily depleted. Since the organs are vulnerable and the body’s resources are excessively consumed, death follows after three years.

If the pulse arrives forcefully and strongly, accompanied by vomiting blood and fever, the patient will die. Nosebleeds are usually a deficiency condition, and the pulse should not ordinarily be forceful. If it is forceful instead, this shows that Qi has become extremely excessive, so the prognosis is grave.

A pulse that arrives like a suspended hook and floats at the surface is commonly found in patients with nosebleeds.

When the pulse arrives like panting, the condition is called sudden collapse. “Like panting” means that the pulse suddenly becomes rapid and forceful, then quickly weakens, like a person’s breathing during a bout of panting.

The signs of sudden collapse are clouded consciousness and an inability to converse with others.

When the pulse arrives like rapid fluttering, it causes sudden fright. A rapid pulse indicates heat; heat agitates the Qi of the liver and heart within the body, causing fear and alarm.

It will heal on its own after three or four days.

A rapid pulse indicates that the Wood Qi in the heart vessels has been depleted by Fire Qi. This illness does not arise from the liver itself, nor has it joined with pathogenic Qi, so it will begin to subside after three days and disappear by the fourth. This is because three is the generating number of Wood.

A pulse that floats and overlaps is like waves rising and crossing one another. Each new wave presses over the one before it; it comes on abruptly, and its beats are irregular.

If the pulse floats and overlaps while also beating rapidly—more than ten beats in the space of one inhalation and one exhalation—this indicates that the Qi in the channels is deficient. When the pulse appears only faintly, death will follow in about ninety days. A pulse like fire consuming firewood indicates that the heart’s Jing has been depleted; death comes when the vegetation withers. The flames of a wood fire flicker unsteadily, take no fixed shape, and soon go out. (“Flame” is pronounced yǐniàn.)

A pulse like scattered leaves indicates deficient Liver Qi; death comes when the leaves fall. It is like leaves drifting apart in the wind, their shapes uncertain. The New Collation notes that, according to the Jia Yi Jing, “scattered leaves” here should read “clustered thorns.”

A pulse like a “visiting guest.” A “visiting guest” means that the pulse Qi is obstructed yet still surges. This indicates deficient Kidney Qi; death comes around the time jujube blossoms fall. An obstructed yet surging pulse means that it appears and then stops, only to disappear again. “Suspended” describes something hanging that sways once and then vanishes.

A pulse like a ball of mud indicates deficient Stomach Jing; death comes when the elm seeds fall. It is like a bead rolling, and this pulse is called “nine-mud.”

A pulse like a piece of wood laid crosswise indicates deficient Gallbladder Qi; death comes when the grain ripens. The pulse is long and hard, like a crossbar lying beneath the fingers.

A pulse like a taut string indicates deficient womb Jing. The patient often talks excessively and will die at the time of the Frost’s Descent; if they do not talk excessively, the condition can be treated. The womb vessels connect with the kidneys, and the Kidney vessels pass through the root of the tongue. When Kidney Qi is deficient, the patient should be unable to speak. If they instead talk excessively, this shows that the true Qi has been severed within the body and has left the kidneys to return outward to the tongue; this is therefore a sign of impending death.

A pulse like interwoven lacquer markings. “Interwoven lacquer” means that the pulse arrives in alternating patterns from the left and right sides. When it appears only faintly, death will follow in about thirty days. This alternating movement means that the pulse runs like interlaced lacquer patterns, reversing and crossing from side to side in disorder. The New Collation notes that, according to the Jia Yi Jing, “interwoven lacquer” here should read “interwoven thorns.”

A pulse like a gushing spring, floating and swelling within the flesh, indicates deficient Qi in the Taiyang channel. When Qi is scant and food has no flavor, death comes when the chive blossoms open. It is like water surging from a spring, flowing outward without returning.

A pulse like crumbling earth cannot be felt when pressed; this indicates deficient Qi in the flesh.

When the five colors first appear as black and white, then become mottled and jumbled, this is a sign of death.

The “Collapsing Earth” pulse feels large, hollow, and soft when taken superficially. When pressed, the pulse can no longer be felt.

The New Collation says: On checking the Jia Yi Jing, “Collapsing Earth” is written as “Abandoned Earth.”

When the pulse comes, it feels like a suspended urn. “Suspended urn” means that when the pulse is taken superficially with a light touch, it feels larger. This shows that the Qi received by the Twelve Shu points—the acupoints connected to the Qi of the zang-fu organs—is insufficient. When Water Qi congeals, the patient will die.

This pulse is like an urn suspended in the middle of the forehead.

The New Collation says: In the Quan Yuanqi edition, “suspended urn” is written as “suspended apart.” Quan Yuanqi’s commentary explains: “Suspended apart” means that the pulse is out of accord with the flesh.

When the pulse comes, it feels like an overturned knife. The “Reclining Knife” pulse feels small and rapid when taken superficially; when pressed, it feels firm, large, and rapid. This indicates that the five zang organs are congested with heat, while cold and heat Qi have gathered in the kidneys. A person with this pulse will be unable to sit or stand, and will die at the beginning of spring.

“Congested” means accumulated; “mature” means hot.

When the pulse comes, it feels like a smooth, rounded pellet, gliding unpredictably beneath the fingers. “Gliding unpredictably” means that when pressed, the pulse cannot be found. This shows that the Qi received by the Large Intestine is insufficient. The patient will die when the jujube tree puts out new leaves.

When the pulse comes, it feels like a flower. The patient is easily startled and unwilling to sit, lie down, walk, or stand, and often turns an ear to listen. This shows that the Qi received by the Small Intestine is insufficient. The patient will die in late autumn.

“Pulse like a flower” means that the pulse is as weak as a flower and difficult to locate precisely. The Small Intestine channel ascends into the ear, which is why the patient often turns an ear to listen.

Explanation of the Pulses

The swelling and pain in the lower back and buttocks described for the Taiyang channel occur because the first lunar month corresponds to Taiyang and begins with the Yin branch; Yin belongs to Taiyang.

“Hip” refers to the flesh of the buttocks. The first lunar month is when the Qi of the Three Yang begins to arise, and the months begin with the Yin branch. The Three Yang are called Taiyang, hence the phrase “Yin is Taiyang.”

In the first lunar month, Yang Qi begins to rise upward, but Yin Qi remains strong, and Yang Qi has not yet fully taken its place in the seasonal order. Although the first lunar month is when the Three Yang begin to arise, the weather is still cold. Thus Yin Qi remains strong and Yang Qi has not yet taken its place in the seasonal order. “Place” refers to the position in which something takes effect according to the season.

This is why swelling and pain occur in the lower back and buttocks.

It is because the Taiyang channel reaches the lower back, enters and passes through the buttocks, then runs past the hip pivot near the hip joint.

Weakness on one side of the body and a limping gait arise because, in the first lunar month, Yang Qi begins to dissolve the frozen ground, and the Qi of the earth also begins to emerge outward.

“Partial deficiency” means that after exposure to cold in winter, the Qi on one side becomes deficient, causing weakness and limping on that side.

This is because the Taiyang channel runs down along the inner rear edge of the thigh, joins the hollow behind the knee, then descends along the calf, passes behind the outer ankle, and follows the Jinggu bone—a bone on the outer side of the foot—to the outer side of the little toe.

The New Collation gives a detailed account of the channel’s route as described by Wang Bing, and argues that the reference to the “inner thigh” does not fit. On checking the Jia Yi Jing…

Yang Qi circulates through the body but does not flow along the inner side of the thigh. “Inner thigh” is a corruption of “outer thigh” and should read “the posterior border of the outer thigh.”

The stiffness of the neck, with tension extending upward into the back, occurs when a large amount of Yang Qi surges upward and contends with other forms of Qi, causing the neck to stiffen. In severe cases, the tension also extends into the back. This is because the meridian emerges from the brain and sends a branch downward through the neck and back.

Tinnitus occurs when Yang Qi surges powerfully upward. This is because one branch of the meridian passes from the crown of the head above the ear.

In severe cases, this may lead to madness or illness at the crown of the head. This happens when Yang Qi gathers entirely in the upper body while Yin Qi is depleted below, leaving deficiency below and excess above. The result may be madness or an illness affecting the crown. The meridian ascends to the forehead, meets at the crown, enters the brain’s network vessels, and then sends out a branch that runs from the crown to above the ear. The crown of the head is called the “summit.”

When floating Yang surges upward, it can cause deafness, because these disorders are all related to Qi. This is also because the meridian reaches the ear.

When pathogenic Qi penetrates deep into the body, it can cause loss of voice. This occurs because, after Yang Qi reaches its height, it turns and declines. When Yang Qi is abundant and penetrates inward, it presses on the Bao Luo and Kidney Luo, obstructing the movement of Qi and causing loss of voice. The Bao Luo vessel connects with the kidneys, and the Kidney channel passes along both sides of the root of the tongue; this is why the person loses their voice and cannot speak.

If the body’s Jing Qi is damaged and the movement of Qi becomes disordered, the person may lose their voice and become paralyzed. This is due to Kidney deficiency. “Fei” means disability or paralysis. The Kidney channel and the Chong Mai emerge together from Qijie, the meeting point of the channels near the groin. They run obliquely down the inner thigh to the hollow behind the knee, then pass along the inner side of the lower-leg bone and behind the inner ankle before entering the sole of the foot. Thus, when Kidney Qi is damaged and its movement is impaired, the person may lose their voice and become paralyzed in the feet. This is why the condition is attributed to Kidney deficiency.

The “New Collation” points out that Wang Bing’s commentary says, “The Kidney vessel and the Chong Mai emerge together.” But on consulting the Jia Yi Jing, the wording here should be “the Kidney Luo,” not “the Kidney vessel.” Wang Bing also refers to the “Kidney Luo” in his commentaries on the “Discourse on Flaccidity,” “Discourse on Strange Diseases,” and “Discourse on Major Abnormalities.” Therefore, the word “vessel” here should be corrected to “Luo.”

When the Shaoyin channel fails to arrive, counterflow reversal occurs. Shaoyin refers to the Kidney channel. If Kidney Qi is depleted from within, the Shaoyin channel can no longer flow normally. When the Shaoyin channel fails to arrive, Taiyin Qi counterflows upward.

The heart and rib-side pain attributed to the Shaoyang channel refers to an excess of Shaoyang Qi. An excess of Shaoyang reflects an abnormality in Heart Qi. When Heart Qi becomes disordered and counterflows, it causes Shaoyang Qi to become excessive. Heart Qi should act outward through Wood Qi to restrain Lung Metal; therefore, an excess of Shaoyang is also related to Heart Qi.

In the ninth month, Yang Qi gradually wanes and Yin Qi grows strong, so pain may arise in the heart and along the ribs.

The Foot Shaoyang channel runs along the inner side of the ribs and emerges at Qijie, a point near the groin. The Heart Master channel—the Hand Jueyin Pericardium channel—runs through the chest and then emerges by the ribs. This is why such pain occurs. The ninth lunar month corresponds to the Xu month, when Fire Qi enters its tomb. Hence the saying that Yang Qi wanes and Yin Qi grows strong in the ninth month.

“Unable to turn over” means that Yin Qi causes all things to gather in and become still. Once gathered in, they no longer move, so a person too may find it difficult to turn over. “In severe cases, there may be leaping” means that the person may twitch or jump.

In the ninth month, all things decline, plants wither, and Qi shifts from Yang toward Yin. As Yin Qi grows stronger, Yang Qi retreats downward and is stored away; hence the reference to leaping. Another explanation is that the Foot Shaoyang channel runs along the outer thigh, passes the outside of the knee, descends in front of the fibula to Juegu, the point above the outer ankle, then passes in front of the ankle and runs along the top of the foot. When Qi is abundant, it can make a person twitch.

The “shivering cold” associated with the Yangming channel means waves of chill accompanied by trembling. Yangming corresponds to the hour of Wu, which is the fifth lunar month. In the fifth month, Yang Qi is strong, but Yin Qi has also begun to appear. This is therefore called “Yin within flourishing Yang.”

Yang Qi is strong and flourishing in the fifth month. At the summer solstice, a single measure of Yin Qi begins to rise while Yang Qi retreats downward; hence the phrase “Yin within flourishing Yang.” Though Yang Qi is strong, Yin Qi is beginning to arrive, so a person may feel waves of chill and tremble. The statement that Yang Qi descends and Yin Qi rises means that Yin Qi begins to arrive even while Yang Qi is flourishing.

The swelling of the lower legs and inability to bend or straighten the thighs also arise because Yang is flourishing and Yin is just beginning to grow in the fifth month. Yang Qi begins to decline then, as a measure of Yin Qi rises and starts to contend with it. This leads to swelling of the lower legs and difficulty bending or straightening the thighs.

This is because the Foot Yangming channel descends from the thigh, passes through Futu, a point on the front of the thigh, reaches the knee, and runs down the outer side of the lower leg. It then passes over the top of the foot and enters between the middle toe and the second toe. A branch of the channel separates three inches below the knee and descends to the space between the outer sides of the middle and second toes. This is why these symptoms occur.

The upward rush of panting breath and the formation of edema arise because Yin Qi first moves downward and then upward. As it rises, pathogenic Qi lodges between the Zang and Fu organs, producing water. Here, “Zang” refers to the Spleen and “Fu” to the Stomach. The Foot Taiyin channel runs from the foot up to the abdomen, while the Foot Yangming channel runs from the head down to the foot. At this time, Yin Qi descends slightly and then rises again; hence the phrase “Yin Qi descends and then rises again.” As Yin Qi rises once more, the Yin Qi that had descended cannot disperse. It remains lodged between the Spleen and Stomach and transforms into water.

Chest pain and shortness of breath arise when water Qi lodges between the Zang and Fu organs. Water belongs to Yin, and Yin Qi stays within the body, causing chest pain and shortness of breath.

When water remains in the lower part of the body, Qi becomes stagnant in the upper part. When Qi stagnates above, the lungs become distended, causing chest pain and shortness of breath.

The severe illness marked by cold hands and feet, aversion to other people, and alarm at the sound of wooden instruments arises because Yang Qi and Yin Qi clash with each other. Water and fire oppose one another, which is why the person becomes frightened and unsettled.

The desire to shut oneself away alone, with the doors and windows closed, arises because Yin and Yang clash. Yang Qi has been depleted while Yin Qi is abundant, so the person wants to close the doors and remain alone, away from noise.

The desire during an attack to climb to a high place and sing, then strip off one’s clothes and run about, also arises because Yin and Yang are contending. The pathogenic influence moves outward and gathers in the Yang aspect, causing the person to run about unclothed.

The New Corrected Edition says: “From ‘the severe illness marked by cold limbs’ to this point, the material corresponds to the earlier Treatise on the Explanation of the Yangming Pulse.”

When a pathogenic influence enters the Sunmai (the finer network vessels), it can cause headache, nosebleed, and abdominal swelling. This is because Qi of the Yangming gathers upward, affecting the Sun network vessels in the upper body and the Taiyin channel, which produces these symptoms.

The illness of the Taiyin channel causes abdominal distension because Taiyin corresponds to Zi (the Rat branch). In the eleventh month, the Qi of all things is stored within, so abdominal distension is said to occur. Yin Qi is at its height, and Taiyin Qi begins at Zi; hence it is called “Zi.” The Taiyin channel enters the abdomen, belongs to the Spleen, and connects with the Stomach, so illness of this channel causes abdominal distension.

Qi surging upward toward the Heart and producing belching arises because Yin Qi is abundant and surges upward into the Yangming channel. The network vessels of the Yangming connect with the Heart, which is why Qi surging toward the Heart produces belching.

According to the Ling Shu Jing, the course of the Foot Yangming channel does not reach the Heart. But the “Taiyin Pulse” says that a branch of the Taiyin channel leaves the Stomach, passes upward through the diaphragm, and enters the Heart. Judging from the course of the channels, the network vessel referred to here must be this branch, which connects with the Yangming.

The New Corrected Edition says: “Wang Bing holds that the course of the Foot Yangming channel does not reach the Heart. However, according to the Jia Yi Jing, the Yangming channel extends upward to the Heart, follows the throat, and emerges at the mouth. Thus, the original statement that the Yangming network vessel connects with the Heart and causes belching has a basis. How, then, could Wang Bing say that the Yangming channel does not reach the Heart?”

Vomiting after eating occurs because too much food has accumulated and overflows upward. This is related to the channel’s belonging to the Spleen and connecting with the Stomach, then passing upward through the diaphragm and following the throat.

The feeling of relief after defecating or passing gas, as though the illness has eased, arises because in the eleventh month Yin Qi declines and moves downward while Yang Qi is about to arise. Thus, after defecating or passing gas, one feels relieved, as if the illness has lessened.

The illness of the Shaoyin channel causes lower back pain because Shaoyin corresponds to the Kidneys. In the tenth month, all things …

Damage to Yang Qi causes lower back pain.

Shaoyin refers to the Kidney meridian. The lower back is governed by the Kidneys, so pain occurs there.

Vomiting, coughing, Qi surging upward, and shortness of breath arise when Yin Qi is below and Yang Qi is above. Yang Qi floats upward without support, producing these symptoms. This happens because the Kidney meridian runs upward through the diaphragm and liver region and enters the lungs.

The word “sese” in the original text may be a scribal error. The New Collation suggests that the word may have been written incorrectly.

Being unable to stand or sit for long, and having one’s vision dim or disappear upon standing, occurs because the Yin and Yang Qi of all things have not yet settled and lack a governing force. When autumn Qi first arrives and a light frost begins to fall, all things are about to wither. Yin and Yang Qi within the body are damaged, causing dim and blurred vision.

Shortness of breath and a tendency toward anger occur because Yang Qi is not circulating normally. When its movement is disrupted, it cannot extend outward. The Liver Qi should be functioning, but it too fails to circulate normally, and so anger arises easily. This condition of irritability is called “Jianjue.”

Feeling afraid, as if someone were coming to seize you, occurs when autumn Qi arrives but all things have not yet fully withered. Yin Qi gradually declines, while Yang Qi enters the Yin aspect. Yin and Yang Qi contend with one another, causing fear.

An aversion to the smell of food occurs because Stomach Qi is insufficient, making one unwilling to smell food.

A dark complexion, like the color of earth, occurs because autumn Qi damages the body from within and changes the complexion.

Coughing up blood occurs when the Yang meridian is damaged. Yang Qi has not yet risen fully, but the vessels are already full. When the Qi in the vessels becomes overfull, it triggers coughing, and blood consequently flows from the nose.

The jueyin-related condition called tuishan, a type of scrotal swelling, and swelling in women’s lower abdomen occur because jueyin corresponds to the third lunar month. At this time, Yin remains within Yang Qi. Pathogenic Qi lodges in the body, giving rise to tuishan and lower abdominal swelling.

This happens because the jueyin meridian runs along the inner thigh, enters the pubic region, circles the genitals, and reaches the lower abdomen.

Pain in the lower back and spine that makes it impossible to bend forward or straighten up is likened to the third month, when all things stir into growth and their branches and leaves flourish, as though they could only bend downward and not rise upward.

Tuizheng, hernia, and distension of the skin occur because Yin Qi is also abundant, causing the channels to swell and become obstructed. This gives rise to tuizheng, hernia, and related symptoms. When the illness is severe, the throat becomes dry and the body feels hot because Yin and Yang Qi contend with one another and generate heat, drying the throat.

This chapter does not follow the thread of the surrounding passages. It offers a separate account of the origins of illness caused by the meridians. Its account broadly resembles the circulation of the meridians described in the Lingshu Jing, though the specific references differ. The New Collation notes that many of this chapter’s explanations agree with those in the Jiayi Jing.

Illnesses caused by “stirring” may occur in slightly different parts of the body, but overall they do not differ greatly.

“On the Essentials of Needling”

The Yellow Emperor asked, “I would like to hear the essentials of acupuncture.”

Qibo replied, “Pathogenic influences may be shallow or deep, and needling may likewise be shallow or deep. In every case, needle the corresponding region and do not go beyond the proper depth.

Here, ‘Dao’ refers to the pathways through which Qi circulates. Needling too deeply damages the interior; needling too shallowly allows pathogenic Qi to stagnate at the body’s surface. If the needle goes too deep, it harms the interior. If it does not go deep enough, and one then recklessly supplements Qi elsewhere, Qi gathers at the surface and stagnates. Once Qi has stagnated, pathogenic influences can take advantage of the weakness and enter.

Needling to an improper depth can itself become a serious harm: it disturbs the Five Zang organs internally and may later bring on a severe illness. “Thief” means causing harm unseen; “stirring” means disturbing. Needling too shallowly causes stagnation at the surface, while needling too deeply damages the interior. Surface stagnation and internal injury are the very beginnings of a severe illness taking shape; this is why it is said that a serious illness may arise later.

Thus, illness may be located in the fine body hairs or in the Couli—the skin’s texture and the spaces between the skin and flesh. It may also be in the skin, flesh, vessels, sinews, bones, or marrow. The fine hairs growing on the skin are called “hao”; the skin’s texture is called “couli.” Both are visible parts of the body’s surface.

Therefore, when needling the fine hairs and Couli, one must not injure the skin. If the skin is injured, the Lung will be disturbed internally. When the Lung is disturbed, Wen Nue may arise in autumn, with bouts of cold and shivering.

The Zhen Jing says that there are five methods of needling, corresponding to the Five Zang organs. The first is called “half needling”: insert the needle shallowly and withdraw it quickly, leaving only a tiny wound, as though plucking out a hair. This method draws Qi from the skin region and corresponds to the Lung. However, the needling described here for the fine hairs and Couli should be even shallower than half needling: the depth should be like piercing only to the root of a hair. The Lung corresponds to the skin and is in its season of flourishing in autumn. Thus, when the Lung is disturbed, Wen Nue may arise in autumn, with bouts of cold and shivering. “Su” is the pronunciation of the character used here.

When needling the skin, one must not injure the flesh. If the flesh is injured, the Spleen will be disturbed internally. When the Spleen is disturbed, abdominal distension, irritability, and loss of appetite may occur during the final eighteen days of each of the four seasons, for a total of seventy-two days.

The Spleen corresponds to the flesh and flourishes in the final part of each season. The Spleen channel runs along the front of the inner thigh into the abdomen, connects with the Spleen and links to the Stomach, then ascends through the diaphragm, passes alongside the throat, connects with the root of the tongue, and spreads beneath it. A branch also leaves the Stomach, ascends through the diaphragm, and enters the Heart. Thus, injury to the flesh can affect the Spleen. When the Spleen is disturbed, abdominal distension, irritability, and loss of appetite may occur during the final part of each season.

This describes a condition of food preference, in which someone favors a particular kind of food. “The months of the four seasons” refers to the third, sixth, ninth, and twelfth months. In the final twelve days of each month, Houtu, the deity representing Earth among the Five Phases, resides and governs. These periods total eighteen days.

When needling muscle, do not damage the vessels. If a vessel is injured, it affects the Heart from within. When the Heart is affected, heart pain will arise in summer.

The Heart is paired with the vessels and flourishes in summer. The Heart’s own Qi and the Shaoyin vessel are both connected to the Heart: the Shaoyin vessel begins in the Heart and links to the Heart system; the Pericardium vessel, also called the Heart Master vessel, begins in the chest and links to the Pericardium. The Treatise on the Pulse of the Normal Person says, “The true Qi of the zang organs communicates with the Heart.” Thus, an injury to the vessels affects the Heart, and when the Heart is affected, heart pain arises in summer.

When needling the vessels, do not damage the sinews. If the sinews are injured, they affect the Liver from within. When the Liver is affected, fever will arise in spring, and the sinews will become slack.

The Liver is paired with the sinews and flourishes in spring. The Needle Classic says that fever causes the sinews to relax. Thus, an injury to the sinews affects the Liver, and when the Liver is affected, fever arises in spring and the sinews become slack. “Slack” means loose or relaxed.

When needling the sinews, do not damage the bones. If the bones are injured, they affect the Kidneys from within. When the Kidneys are affected, abdominal distension and lower back pain will arise in winter.

The Kidneys are paired with the bones and flourish in winter. The lower back is where the Kidneys reside, so an injury to the bones affects the Kidneys, and when the Kidneys are affected, lower back pain arises in winter. One branch of the Kidney vessel runs upward from the Kidneys, passing through the Liver and diaphragm, which is why abdominal distension also occurs.

When needling the bones, do not damage the marrow. If the marrow is injured, it will waste away and become depleted, causing aching in the lower legs, bodily fatigue and weakness, and symptoms that persist for a long time.

Marrow is the substance that nourishes the bones. The Needle Classic says, “When the Sea of Marrow is insufficient, there is dizziness within the brain, ringing in the ears, aching in the lower legs, and blurred vision.” Thus, injury to the marrow causes the brain marrow to waste away and become depleted, with aching in the lower legs and bodily fatigue and discomfort that persist for a long time.

“Wasting and depletion” refers to the gradual wasting away and depletion of the marrow and brain. “Unsettled discomfort” describes a bodily unease that is difficult to define precisely: one can say it is neither strong nor weak, neither hot nor cold, and it is hard to put into words. The wasting and depletion of the brain marrow result from emptiness within the bones.