《黃帝素問靈樞集註》Vol. 11

Huangdi (the Yellow Emperor) inquired of his teacher Qibo: "I've heard you hold precious medical insights in your heart, yet they remain unwritten. I wish to learn this wisdom to govern the people and nurture myself, bringing health to the populace, harmony to households, transmitting virtue to future generations, and ensuring our descendants live without worry. Would you impart this knowledge?"

Qibo praised this as a profound question, pointing out that whether governing a nation or treating illness, handling major affairs or minor matters, the key lies in the principle of "alignment" — not only aligning with the Qi (vital energy) and blood flow patterns of the Yin-Yang meridians but also understanding the living habits and desires of the people. When Huangdi pressed for specific methods, Qibo offered four essential principles: When entering unfamiliar territory, learn local customs; when visiting others' homes, understand their taboos; when entering chambers, observe proper etiquette; when treating patients, inquire about their comfort preferences.

Addressing specific clinical scenarios: Those with heat syndromes (like wasting-thirst disorders) prefer coolness, while cold syndrome patients favor warmth. Stomach heat causes rapid hunger (burning sensation), intestinal heat leads to yellow, turbid stools resembling porridge; stomach cold brings abdominal distension, intestinal cold causes borborygmus and diarrhea. Stomach cold with intestinal heat results in distension plus diarrhea, whereas stomach heat with intestinal cold manifests as quick hunger with lower abdominal pain. Huangdi raised a challenging case: When a patient's stomach requires cool foods while their intestines need warmth — especially with willful nobility who disregard medical advice — how should one proceed?

Qibo provided a humanistic solution: All people fear death and seek life. Explain the dangers of their condition patiently, illustrate the benefits of proper care, guide them toward suitable lifestyles, and clarify consequences of improper behavior. Even the most arrogant individuals will comply with such counsel. Treatment should align with seasonal rhythms: In spring and summer, address surface symptoms before root causes; in autumn and winter, strengthen foundations first then treat manifestations. For contradictory cold-heat needs, regulate through clothing warmth and food temperature — avoiding chills or excessive sweating, ensuring hot foods never scald and cold foods never freeze the teeth. Only through such balanced warmth and coolness can Zheng Qi (upright energy) be properly nourished.

In this dialogue from the Yellow Emperor's Inner Classic: Spiritual Pivot, the Yellow Emperor and Qibo discuss methods for diagnosing the health of internal organs by observing external physical characteristics.

The Yellow Emperor asks Qibo: Ancient physicians assessed the size of the five zang and six fu organs by examining limb muscles, but how should one diagnose nobles who cannot be physically examined? Qibo replies that limb joints are actually the "lids" covering the organs, and observing them yields more accurate results than merely examining facial features.

Qibo then elaborates on the external indicators corresponding to each zang organ:

• The lungs resemble a canopy (protective cover), observable through broad shoulders and a recessed throat area
• The heart, as the ruler, manifests through the clavicles (quepen) as its passageway, assessable via the sternum (huagu)
• The liver governs strategy - its strength can be judged by eye size
• The spleen manages defense - lip and tongue coloration reveal digestive function
• The kidneys govern hearing - their condition is discernible through ear health

For the six fu organs:

• The stomach resembles an ocean - a broad jaw and thick neck indicate its capacity
• Long nasal passages correlate with large intestine function
• Full lips and a long philtrum reflect small intestine condition
• Prominent under-eye bags (tear troughs) show abundant gallbladder qi
• Flared nostrils relate to bladder health
• A high nasal bridge corresponds to triple burner (sanjiao) function

The Yellow Emperor further inquires about distinctions between the six vital substances: essence (jing), qi, fluids (jin), humors (ye), blood, and vessels. Qibo explains:

• Jing: The foundational life force formed through the union of male and female vital essences
• Qi: Nutrient substances dispersed from the upper burner (heart-lung region), mist-like nourishment for the body
• Jin: Sweat excreted through pores
• Ye: Lubricating fluids that nourish joints and replenish marrow

(The original text's subsequent explanations about blood and vessels are not fully presented)

These discussions exemplify Chinese medicine's diagnostic principle of "inferring the interior by observing the exterior," systematically outlining both the manifestations of internal health and the generation/function of fundamental bodily substances.

The text describes in detail the various bodily fluids and gastrointestinal structures within the human body.

The Yellow Emperor (Huangdi) and Qibo discuss the functions and manifestations of six vital bodily fluids: Jing (essence), Qi (vital energy), thin fluids, thick fluids, blood, and vessels. Deficiency in these fluids produces distinct symptoms: insufficient Jing-Qi causes deafness; depleted primordial Qi leads to blurred vision; lack of thin fluids results in open pores with profuse sweating; deficiency of thick fluids causes stiff joints, withered complexion, diminished brain marrow, sore calves, and tinnitus; severe blood loss manifests as pale, lusterless skin and weak pulse.

Qibo explains that these six fluids each govern specific regions and functions, yet all depend on nourishment from food and the stomach—this "great sea" that stores sustenance. Just as the five grains form an oceanic source, the stomach serves as the vessel containing these nutrients.

The text then meticulously details digestive tract measurements: from lips to teeth measures nine fen (0.9 Chinese inches); the oral cavity spans two and a half cun (2.5 Chinese inches) wide. From teeth to epiglottis extends three and a half cun deep, with capacity for five ge (approximately half a liter). The tongue weighs ten liang (about 375g), measuring seven cun long and two and a half cun wide. The pharynx also weighs ten liang, two and a half cun wide. The distance to the stomach totals one chi six cun (16 Chinese inches).

The stomach itself, when fully extended, measures two chi six cun long, with maximum width of one chi five cun and diameter of five cun—capable of holding up to two dou five sheng (about 25 liters). The small intestine adheres to the spine's left side, coiling in overlapping loops. Its ileum section attaches above the navel with sixteen convolutions, two and a half cun wide, over eight fen in diameter, spanning three zhang three chi (33 Chinese feet).

The ileum coils leftward around the navel before descending, featuring sixteen reverse bends—four cun wide, over one cun in diameter, extending two zhang one chi (21 Chinese feet). The colon (lower large intestine) receives ileal contents along the spine, distributed vertically on the left side—eight cun wide, over two cun in diameter, two chi eight cun long. These measurements outline the complete pathways and spatial dimensions for food's journey through the digestive system.

The Huangdi Neijing: Lingshu records detailed measurements of the human digestive system. The stomach has a circumference of one chi five cun, a diameter of five cun, and a length of two chi six cun. It curves horizontally and can hold three dou five sheng of food and water, typically retaining two dou of food and one dou five sheng of water. After digestion, the refined essence (Jing) is absorbed into the upper burner (the heart-lung region), while the coarse residues descend to the lower burner (the kidney-bladder region) to nourish the intestines.

The small intestine has a circumference of two cun and a half, a diameter slightly over eight fen, and a length of three zhang two chi. It can hold two dou four sheng of food and six sheng three ge of water. The large intestine measures four cun in circumference, slightly over one cun in diameter, and two zhang one chi in length, holding one dou of food and seven sheng and a half of water. The rectum has a circumference of eight cun, a diameter slightly over two cun, and a length of two chi eight cun, containing nine sheng three ge and one-eighth of food. The entire digestive tract spans five zhang eight chi four cun in total length and can hold over nine dou two sheng one ge of food and water combined.

In a healthy person, the digestive system operates in rhythmic alternation: when the stomach is full, the intestines are empty, and vice versa. This cyclical movement ensures the smooth flow of Qi, the proper functioning of the five zang organs, harmonious blood circulation, and stable Shen (spirit). The so-called "Shen" (spiritual activity) is derived from the refined essence of food. A healthy person defecates twice daily, expelling two and a half sheng each time, totaling five sheng per day. Over seven days, three dou five sheng are expelled, completely emptying the body's stored food and fluids. This explains why a healthy person dies after seven days without food or drink—because both the essence (Jing) and bodily fluids are depleted.

In another discussion, the Yellow Emperor inquires of Qibo about the relationship between acupuncture therapy and the theory of the "Four Seas" in the human body. Qibo explains that the body, like the earth, has four "seas": the Sea of Marrow (brain), the Sea of Blood (Chong Mai), the Sea of Qi (Danzhong, the center of the chest), and the Sea of Food and Water (stomach). These four seas correspond to the four seas of nature (east, south, west, and north), while the twelve primary channels resemble twelve rivers that ultimately flow into these "seas." This theory aligns the human body with the natural world, embodying the holistic view of the correspondence between heaven and humanity.

The Yellow Emperor (legendary ancient ruler and progenitor of Chinese medicine) consulted his medical teacher Qibo about the correspondence between the human body and the cosmos. Qibo explained that the body contains four vital "seas": the stomach as the sea of water and grain (digestive system), the Chongmai (Thoroughfare Vessel) as the sea of the twelve meridians (convergence point of Qi and blood), the Danzhong (chest center) as the sea of Qi (central hub of thoracic energy), and the brain as the sea of marrow (reservoir of vital essence). Each sea possesses specific infusion points (crucial junctures for Qi-blood circulation).

The Emperor inquired about the manifestations of balance and imbalance in these seas. Qibo responded: When the Qi sea (Danzhong) is excessive, one experiences chest oppression and ruddy complexion; when deficient, shortness of breath and reluctance to speak. An overactive blood sea (Chongmai) creates sensations of bodily expansion, while deficiency brings feelings of shrinkage. The water-grain sea (stomach) in excess causes abdominal distension, yet when insufficient leads to hunger without appetite. An overflowing marrow sea (brain) produces hyperactive energy, whereas deficiency manifests as dizziness, tinnitus, weak legs, blurred vision, lethargy and fatigue.

When asked about regulation methods, Qibo advised: One must precisely locate each sea's infusion points, regulate excess/deficiency conditions, and avoid harmful interventions. Following these natural principles restores health, while violating them inevitably worsens conditions.

Regarding the "five disorders" (Qi-blood disturbances), Qibo elucidated: The twelve meridians correspond to the Five Phases (Wood, Fire, Earth, Metal, Water) and four seasons. When meridian flow harmonizes with seasonal Qi, this represents "order" (normal function); disharmony creates "chaos" (pathological disorder). Just as the twelve meridians correspond to twelve months, the seasonal Qi variations require corresponding adjustments in the defensive Ying-Wei energies (the body's protective system) to maintain health.

When the Yin and Yang energies within the human body are harmonized, and the clear (Qing) and turbid (Zhuo) Qi do not interfere with each other, the body maintains a healthy and orderly state. The Yellow Emperor asked: "What circumstances can cause the Qi and blood to become disordered?" Qibo replied: "If the clear Qi becomes stagnant in the Yin aspect while turbid Qi occupies the Yang aspect instead, even though the nourishing Qi (Yingqi) flows properly through the meridians, the defensive Qi (Weiqi) moves counterflow. When clear and turbid energies conflict within the chest, this creates the severe condition known as 'Great Man' (Da Man)."

Disordered Qi and blood manifest different symptoms according to affected areas: disturbance in the heart causes restlessness and silent depression; lung disruption leads to labored breathing requiring knee support; gastrointestinal disorder results in cholera-like vomiting and diarrhea; extremity disturbance makes limbs cold; while head disruption brings dizziness or even fainting. When the Emperor inquired about treatments for these five disorders, Qibo detailed specific methods: for heart disturbances, use the Shu-stream point Shenmen (HT-7) of the Heart Meridian; for lung issues combine the Ying-spring point Yuji (LU-10) of the Lung Meridian with Taixi (KI-3) of the Kidney Meridian; for gastrointestinal problems select Zusanli (ST-36); for head disorders employ Tianzhu (BL-10) and Dazhu (BL-11); and for limb conditions first perform bloodletting at affected collaterals before needling relevant meridian points. The therapeutic approach emphasizes slow needle insertion/withdrawal to guide Qi flow, maintaining Jing (essence) integrity regardless of supplementation or drainage techniques.

Regarding distension disorders, Qibo noted: A large, hard and choppy pulse at the cun position characterizes distension. This condition neither resides purely in blood vessels nor entirely within organs, but rather occupies the interstitial spaces between viscera and body surface. Like objects pressing within a chest cavity, it causes abdominal distension and taut skin—this unique spatial relationship gives rise to the term "distension" (Zhang) itself.

The internal organs of the human body are like precious vessels, each with its fixed position and name. Though they reside together within the chest and abdominal region, their respective Qi (vital energy) movements exhibit distinct characteristics. The Yellow Emperor inquired about the principles behind this, and Qibo explained in detail:

The chest and abdomen function like an outer protective wall for the organs. The Danzhong (pericardium region) serves as the inner palace of the heart, the stomach acts as a granary, while the throat and small intestine handle transportation. The five openings of the stomach (such as the cardia and pylorus) resemble the gates of an alleyway, and the Lianquan and Yuying (salivary gland-related areas) are pathways for bodily fluids. Each of the five zang and six fu organs has its boundaries, and their pathologies manifest with unique features.

When the Ying Qi (nutritive energy) flows along the meridians while the Wei Qi (defensive energy) moves countercurrently, vessel distension occurs. If the Wei Qi merges with the meridians and travels through muscle interstices, it results in cutaneous distension. In treatment, the Zusanli point is needled to drain pathogenic factors—once for superficial conditions, three times for deeper afflictions, always draining swiftly regardless of deficiency or excess patterns.

The text then describes symptoms of various distension disorders: Heart distension manifests as irritability, shortness of breath, and insomnia; lung distension shows chest oppression with cough and panting; liver distension involves hypochondriac pain radiating to the lower abdomen; spleen distension causes frequent belching and heavy limbs; kidney distension brings fullness in the waist and abdomen with referred pain to the back and thighs. Among the six fu organ distensions: stomach distension accompanies gastric pain and foul breath; large intestine distension produces borborygmi and diarrhea; small intestine distension leads to lower abdominal dragging pain; bladder distension results in difficult urination; triple burner distension appears as puffy skin; gallbladder distension features hypochondriac pain with bitter taste.

Qibo summarizes the treatment principles: One must thoroughly understand the laws of Qi movement's normal and reverse flow, applying precise needling techniques. Mistreatment depletes healthy Qi, while correct supplementation and drainage allow the Shen (spirit) to return to its proper place. The root of distension disorders lies in abnormal Wei Qi circulation—when it should flow smoothly through muscle interstices but instead becomes chaotic, compounded by cold pathogens moving countercurrently and clashing with upright Qi, ultimately forming distension patterns.

(Note: The acupuncture methods mentioned require professional practitioner application—this translation serves only as explanatory text.)

The Yellow Emperor said: "Excellent! Then how does one resolve diagnostic uncertainties?" Qibo replied: "One must verify the pulse signs against the patterns of the body's genuine Qi (vital energy) circulation. When these three elements—the pulse, the Qi, and the disease manifestations—are in agreement, a definitive diagnosis can be made."

The Emperor continued: "Well said!" Then he further inquired of Qibo: "The chapter 'On Distension' states that in treating distension disorders, one need not distinguish between deficiency and excess patterns—the crucial point lies in swiftly draining the pathogenic factors. For mild cases, apply drainage once; for severe cases, drain three times. Yet nowadays some patients show no improvement even after three drainage treatments. Where does the problem lie?"

Qibo explained: "This occurs when the needle fails to reach the Qi points (crucial acupoints where Qi and blood converge). If the needle misses these points, the pathogenic Qi remains trapped internally. If the insertion isn't deep enough, the Qi mechanism cannot flow freely. If one mistakenly needles the muscle layer, it disrupts the circulation of defensive Qi (the body's protective energy), causing conflict between Yin and Yang energies. When treating distension, if drainage isn't properly applied when indicated, the pathogenic factors naturally cannot be expelled."

"When three drainage treatments prove ineffective, one must modify both the needling locations and techniques until the pathogenic Qi is successfully discharged. Should this still fail, restart the entire therapeutic process—only then can absolute certainty be achieved. How could any case remain incurable? In treating distension disorders, one must meticulously examine the pulse signs, draining when drainage is called for and supplementing when supplementation is required. Just as a drumstick striking a drum inevitably produces resonance, how could there possibly be no therapeutic effect?"