《黃帝素問靈樞集註》Vol. 12

The Yellow Emperor inquired of Qibo: When food and drink enter through the mouth and are transported to the stomach and intestines, they differentiate into five distinct bodily fluids. In cold weather or when wearing thin clothing, they primarily form urine and Qi (vital energy); in hot weather or when heavily clothed, they mainly transform into sweat; when grief disrupts the movement of Qi, tears are produced; stomach heat causing gastric relaxation generates saliva; and when pathogenic Qi invades internally, obstructing Qi movement, it leads to edema. While I recognize these phenomena, I don't understand their underlying principles—I wish to hear your explanation.

Qibo replied: All food and drink enter through the mouth and are divided into five flavors, each transported to its corresponding organ. The body's fluids follow their own pathways—the Sanjiao (collective term for the Upper, Middle, and Lower Burners) distributes Qi to warm the muscles and nourish the skin, forming the thin, fast-moving "Jin" (lucid fluids), while the thicker, slower-moving substances are called "Ye" (turbid fluids). In hot weather, the pores open, causing sweat to emerge; when cold lingers in the muscle interstices, it gathers into frothy accumulations that cause pain. In cold weather, the pores close, preventing the expulsion of damp Qi, which then descends to the bladder, forming urine and Qi.

Among the five Zang and six Fu organs, the heart is the ruler, the ears govern hearing, the eyes oversee observation, the lungs act as the prime minister, the liver as the general, the spleen as the defender, and the kidneys govern the exterior. Thus, the fluids of all five Zang and six Fu organs seep upward to the eyes. When grief disrupts Qi movement, the heart vessels tense, lifting the lungs and causing fluids to overflow. Since the heart vessels and lungs cannot remain elevated indefinitely, their alternating rise and fall result in coughing and weeping.

Stomach heat accelerates digestion, causing frequent gastric movement and relaxation, which in turn drives stomach Qi upward, leading to drooling. The refined essence of the five grains blends into a creamy substance—part of it seeps into the bones to nourish the marrow and brain, while the rest descends to the genitals. If Yin and Yang fall out of balance, these fluids flow abnormally downward, depleting the marrow. Excessive loss leads to weakness, manifesting as lower back pain and leg soreness.

If the pathways of Yin-Yang Qi become blocked, the "Four Seas" (where Qi and blood converge) stagnate, the Sanjiao fails to excrete, and fluids cannot transform normally, food residues accumulate in the stomach and intestines, particularly congesting the Lower Burner without seeping into the bladder. This results in distension of the Lower Burner, with water overflowing to form edema. These are the normal and abnormal processes of the five transformations of bodily fluids.

(Next, the relationship between the five sense organs and the five Zang organs is explained.) The ears reflect the state of the kidneys, the eyes that of the liver, the mouth that of the spleen, the nose that of the lungs, and the tongue that of the heart. By observing changes in these sensory organs, one can assess the health of the five Zang organs. When the essence-Qi of the five Zang is abundant, the sense organs appear bright and lustrous; if their functions are impaired, the corresponding sensory organs manifest abnormal changes.

The Yellow Emperor inquired of Qibo: "I have heard that by observing the five sense organs (eyes, ears, nose, tongue, and mouth), one can diagnose the changes in the five qi colors. These five colors are the external manifestations of the five zang organs' functions and also correspond to the changes of the four seasons. I would like you to explain in detail how to observe these five external manifestations."

Qibo replied: "The five sense organs are indeed the observation windows of the five zang organs."

The Emperor pressed further: "Please elaborate on these principles in detail so that we may establish them as diagnostic standards." Qibo explained: "The pulse manifestations appear at the qi opening on the wrist, while the facial complexion manifests in the mingtang (bright hall) area of the nose. With the changing of the four seasons, the face correspondingly displays the five normal qi colors of green, red, yellow, white, and black. When pathogenic factors penetrate deeply into the zang-fu organs, one must regulate the internal functions."

The Emperor asked again: "Is observing only the mingtang area of the nose sufficient for judging facial complexion?" Qibo supplemented: "One must comprehensively observe the condition of all five sense organs, as well as the forehead and the area between the eyebrows. The nose should be full and broad, the cheeks plump and lustrous, the jawline well-defined, and the ear auricles extended outward. Those possessing these characteristics indicate abundant qi and blood, with firm muscles, making them suitable for acupuncture treatment."

The Emperor continued his inquiry about the specific correspondences of the five sense organs. Qibo explained in detail: "The nose reflects the lungs, the eyes reflect the liver, the lips reflect the spleen, the tongue reflects the heart, and the ears reflect the kidneys. By observing changes in these organs, one can assess the health of the internal organs: lung disease manifests as rapid breathing with flaring nostrils; liver disease shows as greenish discoloration at the eye corners; spleen disease appears as yellowish lips; heart disease presents with curled tongue and reddish cheekbones; while kidney disease manifests as darkened cheekbones and forehead."

The Emperor pursued further: "What are the normal pulse manifestations and facial complexions? And how do abnormalities appear?" Qibo answered: "If the five sense organs appear indistinct in contour, with a narrow forehead, low nasal bridge, sunken cheeks, ears pressed close to the head, and receding jawline—such individuals, even if temporarily free from illness, are fundamentally weak, let alone when actually sick."

Finally, the Emperor asked: "Can the changes in qi colors in the mingtang area determine the relative positions of the five zang qi within the body?" Qibo affirmed: "The five zang organs each have fixed positions within the body, and their qi movements accurately correspond to specific areas on the face."

(In Chapter 38 of "Contrary and Accordant, Fat and Lean")

The Yellow Emperor again consulted Qibo about the Dao of acupuncture: "Having heard your explanations of many acupuncture theories, I find these principles flexible and variable, without absolutely fixed patterns. May I ask whether this knowledge was obtained through repeated practice or through observing the laws of all things?"

Qibo replied: "The medical Dao of sages must accord with both the movement patterns of heavenly Dao and the characteristic changes of earthly principles."

This passage records the Yellow Emperor's inquiry to Qibo about adjusting acupuncture techniques according to individual constitutional differences. Qibo provides detailed explanations on the essential principles of needling for various body types.

For robust individuals with thick muscles (the "stout type"), their Qi and blood are abundant, and their skin is tough. Such people typically have broad shoulders, thick backs, dark skin, viscous blood, and relatively slow circulation of Qi and blood, often exhibiting acquisitive tendencies. When needling them, insert the needles deeply with longer retention time, and moderately increase the number of needle insertions.

For thin and weak individuals, their skin is thin, blood color pale, muscles scant, and speech soft. Their blood is clear and thin, with rapid Qi-blood circulation. Apply shallow insertion and quick withdrawal of needles to avoid damaging Qi or depleting blood.

For those with average constitution (the "normal type"), adjust techniques based on skin color—whether dark or fair. If their facial features are upright and dignified with harmonious Qi and blood, apply standard needling methods.

For strong-boned individuals (the "solid-boned type"), there are two approaches: those with calm dispositions have slow Qi-blood circulation and viscous blood—apply deep insertion with retained needles; those with fiery temperaments have rapid Qi-blood circulation and thin blood—use shallow insertion with quick withdrawal.

For infants, due to their delicate muscles and weak Qi-blood, employ fine needles (hao needles) with shallow insertion and quick withdrawal, allowing up to two treatments per day.

Qibo illustrates the principles with two metaphors: Just as releasing water from high ground requires no effort to drain completely ("like releasing water from a height"), when blood is thin and Qi turbid, rapid draining techniques would exhaust Qi. Conversely, like digging channels to divert water ("like cutting channels to guide a torrent"), when blood is turbid and Qi stagnant, swift draining methods can unblock meridians.

These methods all follow the natural therapeutic principles of human constitution, just as craftsmen cannot work without rulers and compasses. Physicians too must adhere to these fundamental laws.

The Yellow Emperor asked: "What are the directional patterns of meridian circulation?" Qibo replied: "The three hand yin meridians (Hand Taiyin Lung Meridian, Hand Jueyin Pericardium Meridian, Hand Shaoyin Heart Meridian) flow from the internal organs toward the hands; the three hand yang meridians (Hand Yangming Large Intestine Meridian, Hand Shaoyang Triple Burner Meridian, Hand Taiyang Small Intestine Meridian) move from the hands toward the head; the three foot yang meridians (Foot Yangming Stomach Meridian, Foot Shaoyang Gallbladder Meridian, Foot Taiyang Bladder Meridian) descend from the head to the feet; while the three foot yin meridians (Foot Taiyin Spleen Meridian, Foot Jueyin Liver Meridian, Foot Shaoyin Kidney Meridian) ascend from the feet toward the abdomen."

The Emperor further inquired: "Why does only the Foot Shaoyin Kidney Meridian exhibit downward movement?" Qibo explained: "This isn't entirely accurate. The Chong Mai (one of the Eight Extraordinary Meridians) serves as the sea where qi and blood from all five zang and six fu organs converge, upon which all internal organs depend. Its ascending branch emerges from the Hang Sang point above the throat, permeates the yang meridians, and infuses vital essence (Jing). The descending branch connects with the major collateral of the Foot Shaoyin Kidney Meridian, emerges at the Qijie point, follows the inner thigh into the popliteal fossa, then courses downward along the medial tibia. Its bifurcations include a descending branch paralleling the Kidney Meridian that permeates the three yin meridians, and an anterior branch that travels along the dorsum of the foot to the interdigital spaces, nourishing muscles through collateral networks. When these collaterals become congested, numbness occurs in the foot dorsum, potentially leading to qi-blood counterflow and cold limbs."

The Emperor asked: "How does one discern meridian circulation patterns?" Qibo responded: "Through diagnostic questioning to elicit symptom descriptions, verified by pulse palpation. Only by confirming normal pulse rhythms can one comprehend the directional laws of meridian flow." The Emperor marveled: "The medical wisdom of sages is profoundly subtle! Bright as sun and moon, yet precise to the finest detail—who but you, Master, could elucidate this so clearly?"

In the Blood Collaterals Discourse section, the Emperor inquired about pathogenic qi outside regular meridians. Qibo answered: "This stems from abnormal blood circulation in the collaterals (Xue Luo)." The Emperor then posed seven clinical questions: Why does bloodletting sometimes cause fainting? Why does blood sometimes spurt forth? Why is some blood dark and viscous? Why is some serum thin as broth? Why does swelling occur after needling? Why does either excessive or insufficient bleeding cause facial pallor? Why do some patients tolerate substantial blood loss without adverse reactions?

Qibo elaborated: "In patients with exuberant meridian qi but blood deficiency, bloodletting induces qi collapse and syncope; those with both qi and blood exuberance but yin predominance exhibit smooth, spurting blood; chronic yang qi stagnation produces dark, viscous blood; recently consumed water that hasn't blended with blood yields thin, broth-like serum, while those who haven't drunk water retain stagnant blood, making it turbid. These phenomena all correlate intimately with qi-blood circulation states."

This passage discusses the principles and precautions regarding Qi and blood circulation in traditional Chinese acupuncture therapy.

When Yin Qi (the Yin energy within the body) accumulates in the Yang meridians, Qi and blood will stagnate in the collateral vessels (smaller branches of meridians). If bloodletting is performed in this state before the blood emerges, the Qi may escape first, leading to swelling. If blood is forcibly drained when Yin and Yang energies have just met but not yet harmonized, it will cause both energies to dissipate, resulting in internal-external imbalance and the patient's complexion turning pale. Excessive bloodletting without change in complexion but accompanied by restlessness indicates that needling the collateral vessels has depleted the Yin meridians, with Yin Qi leakage causing discomfort.

When Yin and Yang energies harmonize to form bi syndrome (a condition of obstructed Qi and blood), the Qi and blood internally overflow into the main meridians while externally pouring into the collateral vessels. In this state where both Yin and Yang are in excess, even substantial bloodletting won't cause deficiency.

The Yellow Emperor asked how to identify such conditions. Qibo replied: Observe the blood vessels - those that are thick, hard, red, and unfixed in position, ranging from needle-thin to chopstick-thick. Targeting such vessels for bloodletting is safe. Moderation is key, as excess can cause problems.

The Yellow Emperor further inquired why needles sometimes get stuck in muscles. Qibo explained: Internal heat energy adheres to the needle, heating it and causing it to stick to muscle tissue, making the needle difficult to rotate.

Regarding the discussion of Yin-Yang clarity and turbidity:

The Yellow Emperor noted that while the twelve human meridians correspond to twelve rivers with distinct water clarity levels, human Qi and blood should be uniform - how does this correspondence work? Qibo responded that if everyone's Qi and blood were identical, the world would be perfectly peaceful. The Emperor clarified he meant individual variations. Qibo answered: Even within one person, Qi mechanisms can become disordered, just as there will always be restless individuals in society - the principle is analogous.

Qibo elaborated: The Qi produced from consuming the Five Grains (food) is relatively turbid, while the Qi absorbed from heaven and earth through breathing is clearer. Clear Qi infuses the Yin meridians, while turbid Qi enters the Yang meridians. The clearer aspects within turbidity ascend through the throat, while the turbid aspects within clarity descend. When clear and turbid Qi interfere with each other, it's called "disordered Qi."

The Yellow Emperor asked how to distinguish the clear Qi in Yin meridians from turbid Qi in Yang meridians. Qibo explained: Generally, clear Qi ascends to the lungs while turbid Qi descends to the stomach. The clearer aspects in the stomach emerge through the mouth, while the turbid aspects in the lungs flow into the meridians, ultimately accumulating in the Qi Sea (Dantian area). The text doesn't specify which Yang meridian contains the most turbid Qi when the Emperor inquires.

This passage explains the movement patterns of clear and turbid Qi within the human meridian system and their therapeutic principles. The Hand Taiyang Meridian (Small Intestine Channel) primarily receives turbid Qi, while the Hand Taiyin Meridian (Lung Channel) mainly receives clear Qi. The clear Qi ascends to nourish the five sense organs and seven orifices, while turbid Qi descends to circulate through various meridians.

All Yin meridians typically transport clear Qi, with the sole exception being the Foot Taiyin Meridian (Spleen Channel) which receives turbid Qi. The Yellow Emperor inquired about treatment methods, to which Qibo replied: Clear Qi flows smoothly while turbid Qi moves sluggishly—this represents the natural behavior of Qi. Therefore, when needling Yin meridians, one should insert the needle deeply and retain it, whereas Yang meridians require shallow insertion with swift withdrawal. When encountering situations where clear and turbid Qi interfere with each other, adjustments must be made according to specific circumstances.

The term "悗空" includes phonetic annotations—"悗" is pronounced as "mèn" (meaning "stuffy") and "空" as "kǒng" (meaning "opening"). This content originates from the annotated compilation of Volume 12 in the Lingshu section of the Yellow Emperor's Inner Classic.