《黃帝素問靈樞集註》Vol. 16

The Yellow Emperor inquired of Shao Yu (an ancient renowned physician): "People differ in the strength of their sinews and bones, the softness of their muscles, the thickness of their skin, and the density of their pores. How do these variations affect their sensitivity to the pain of acupuncture and moxibustion? The thickness and strength of intestines and stomach also vary—how does this influence their response to medicine? I wish to understand these matters in detail."

Shao Yu replied: "Those with strong bones, supple sinews, relaxed muscles, and thick skin endure pain better and have greater tolerance for both acupuncture and moxibustion." The Yellow Emperor pressed further: "How can one determine who can withstand moxibustion?" Shao Yu answered: "Those with dark skin and well-proportioned bones are more resistant to moxibustion." The Emperor then asked: "How can we identify those who cannot tolerate the pain of acupuncture?" Shao Yu explained: "People with tense muscles and thin skin find both acupuncture and moxibustion difficult to endure."

Regarding the speed of recovery from illness, Shao Yu pointed out: "Among those who fall ill simultaneously, those with abundant internal heat (Qi) recover easily, while those dominated by cold struggle to heal." Concerning medicine tolerance, he noted: "People with thick stomach walls, dark complexions, large frames, and robust physiques have strong resistance to medicine, whereas thin individuals with weak stomachs are prone to poisoning."

In the chapter "Heavenly Life Span," the Yellow Emperor asked Qi Bo (another ancient physician): "What constitutes the foundation of human life initially? What sustains it? What loss leads to death, and what preservation ensures survival?" Qi Bo answered: "Life is rooted in the mother's essence and blood (Jing), guarded by the father's Yang Qi. When the spirit (Shen) is lost, death follows; when the spirit is preserved, life continues."

The Emperor inquired: "What is 'spirit' (Shen)?" Qi Bo explained: "When blood and Qi are harmonized, the meridians flow unimpeded, the five viscera are fully developed, the spirit resides securely in the heart, and both the ethereal (Hun) and corporeal souls (Po) are complete—only then is a person truly formed." On differences in lifespan, Qi Bo said: "Those with robust viscera, unobstructed blood vessels, flexible muscles, firm skin, rhythmic Qi circulation, and proper digestive absorption naturally live long. To reach a hundred years, one must have a high nose bridge, a square facial structure, and completely unimpeded pathways for Qi and blood."

This scripture primarily discusses the relationship between the ebb and flow of Qi and blood in the human body and lifespan, along with essential principles of acupuncture treatment.

The Yellow Emperor inquired with Qibo about the patterns governing the waxing and waning of human Qi and blood until death. Qibo meticulously described physiological changes across life stages: At ten years old, the five organs begin to stabilize, Qi and blood flow smoothly, and one enjoys running; at twenty, Qi and blood flourish, muscles develop, and one prefers brisk walking; at thirty, the five organs fully stabilize, muscles become firm, and one favors steady strides; at forty, after reaching peak condition, the organs and meridians begin declining—skin loosens, hair whitens, and one prefers sitting quietly; at fifty, liver Qi (Ganqi) declines and eyesight weakens; at sixty, heart Qi (Xinqi) diminishes, making one prone to melancholy and fond of reclining; at seventy, spleen Qi (Piqi) weakens and skin dries; at eighty, lung Qi (Feiqi) fades, causing mental haziness; at ninety, kidney Qi (Shenqi) exhausts, leaving the organs hollow; at one hundred, all five organs are depleted, the spirit (Shen) disperses, and only the physical form remains before death.

The Yellow Emperor further asked why some fail to reach one hundred years. Qibo explained this stems from insufficiently robust five organs, short nostrils causing rapid breathing, frail constitution, deficient blood and Qi, weak muscles that succumb easily to wind-cold pathogens, feeble Qi and blood, blocked meridians allowing pathogenic Qi intrusion—thus leading to midlife demise.

In another dialogue, the Emperor consulted Bogao about Qi's flow direction, pulse strength variations, and acupuncture principles. Bogao responded: Qi's movement must align with celestial-terrestrial Yin-Yang and the Five Phases' (Wuxing) seasonal transformations; pulse strength indicates Qi-blood excess or deficiency; and acupuncture's crux lies in discerning opportune versus inopportune moments for needling. Citing military strategy as metaphor: "Never attack an enemy at peak momentum," similarly avoid needling during high fever, profuse sweating, chaotic pulses, or when symptoms contradict pulse patterns. When asked how to determine suitable timing, Bogao advised waiting until the illness slightly abates before applying needles.

This scripture primarily discusses two key aspects: the timing of acupuncture treatment and the correspondence between the five flavors of food and the five organs.

Regarding acupuncture timing, master physicians administer needles either before an illness manifests or at its earliest emergence. Mediocre practitioners intervene when the disease hasn't yet peaked, while less skilled ones wait until the illness begins to decline. Incompetent physicians recklessly apply needles during the illness's peak or forcibly treat without considering the patient's constitution and pulse abnormalities. Thus, the text emphasizes achieving optimal results by treating during the illness's decline, noting that the best physicians prevent rather than cure diseases.

The second section details the correspondence between food flavors and organs. The stomach serves as the nutritional source for all organs. After food enters the stomach, its essence (Jing) distributes throughout the body: sour flavors first enter the liver, bitter flavors the heart, sweet flavors the spleen, pungent flavors the lungs, and salty flavors the kidneys. After the food's essence transforms into bodily fluids and circulates, the waste products are eliminated.

The text then categorizes various foods by their flavor properties:

Among the five grains: rice (sweet), sesame (sour), soybeans (salty), wheat (bitter), and millet (pungent).

Among the five fruits: jujube (sweet), plum (sour), chestnut (salty), apricot (bitter), and peach (pungent).

Among the five meats: beef (sweet), dog meat (sour), pork (salty), mutton (bitter), and chicken (pungent).

Among the five vegetables: mallow (sweet), leek (sour), bean leaves (salty), Chinese chives (bitter), and scallion (pungent).

Finally, it prescribes appropriate foods for organ disorders: spleen ailments benefit from rice, beef, jujubes, and mallow; heart conditions respond well to wheat, mutton, apricots, and Chinese chives; kidney disorders improve with soybeans, pork, chestnuts, and bean leaves. These correspondences exemplify the Chinese medical theory of "five flavors entering five organs" in dietary therapy.

On the Relationship Between Dietary Regulation and Illness:

Specific illnesses require particular food pairings: Lung disease patients benefit from millet, chicken, peaches, and scallions. Those with liver conditions should avoid pungent foods, heart disease patients must abstain from salty flavors, spleen disorders contraindicate sour foods, kidney ailments prohibit sweet flavors, and lung illnesses shun bitter tastes.

Following the Five Phases color correspondences: For the liver (associated with green), sweet foods like japonica rice, beef, dates, and mallow leaves are beneficial. For the heart (red), sour foods such as dog meat, sesame, plums, and chives are recommended. The spleen (yellow) responds well to salty foods including soybeans, pork, chestnuts, and bean leaves. The lungs (white) thrive with bitter foods like wheat, mutton, apricots, and Chinese chives. The kidneys (black) require pungent foods such as millet, chicken, peaches, and scallions.

On Differential Diagnosis of Edema Disorders:

The Yellow Emperor asked Qibo how to distinguish between various swelling conditions: water distension, skin distension, drum distension, intestinal tumor, stone concretion, and stone edema. Qibo replied:

Water distension begins with slight eyelid swelling resembling sleepiness, prominent carotid pulsation, coughing, inner thigh chilliness, leg edema, and progressive abdominal enlargement. When pressed, the abdomen immediately rebounds like a water-filled pouch.

Skin distension occurs when cold qi invades between skin layers, manifesting as abdominal bloating, whole-body edema, and thickened skin. Depressed abdominal areas don't rebound quickly, with unchanged skin color.

Drum distension shows equivalent abdominal and whole-body swelling to skin distension, but with bluish-yellow skin and visible abdominal veins.

Intestinal tumors form when cold qi lingers outside the intestines, clashing with defensive qi (Weiqi), causing qi-blood stagnation into masses. Initially egg-sized, they grow pregnancy-like over years. Though hard, they remain movable with normal menstruation.

Stone concretions develop in the uterus when cold qi blocks the cervical os, causing blood stasis. Symptoms resemble pregnancy but with irregular menses. Exclusive to women, they respond to drainage therapies.

When asked about acupuncture treatment for skin and drum distension, Qibo advised first needling distended blood vessels for bloodletting, then regulating the channels, and finally removing pathological vessels.

The Yellow Emperor asked Qibo: "You say that external pathogenic winds and evil qi can harm the human body and cause illness. Yet nowadays some people fall suddenly ill while staying indoors without going outside, not having encountered any evil winds or qi. What is the reason for this?"

Qibo replied: "Such cases usually stem from preexisting hidden imbalances within the body. For instance, someone may have previously suffered from damp invasion, with the damp pathogen lurking between the blood vessels and muscles for a long time without dispersing. Or there might be stagnant blood remaining in the body from traumatic injuries that was never properly resolved. When sudden emotional upheavals, dietary irregularities, or improper responses to temperature changes occur, causing the pores to close and obstruct, exposure to wind-cold at such times will lead to congealing of qi and blood. The old and new pathogens then combine to form cold bi syndrome (a condition characterized primarily by pain). If internal heat causes someone to be exposed to wind after sweating, illness may develop due to these internal triggers even without direct encounter with external pathogens."

The Yellow Emperor pressed further: "The causes you describe would be noticeable to the patients themselves. But some people fall ill suddenly without encountering external pathogens or experiencing emotional disturbances like fright. Could this be due to ghosts and spirits?"

Qibo explained: "This too results from preexisting latent pathogens that haven't manifested, combined with intense hatred or craving in the heart that disrupts qi and blood circulation, causing internal and external pathogens to contend with each other. The causes are subtle and hard to detect—neither visible nor audible—hence appearing as if caused by ghosts and spirits."

The Yellow Emperor asked again: "Then why can some illnesses be cured by zhuyou (ancient shamanic incantation therapy)?" Qibo said: "The shamans of old understood the mutual conquest patterns of various diseases and could first identify the root cause, hence they could heal through incantations. This actually works by regulating the spirit, qi and blood—it's not truly due to intervention by ghosts and spirits."