《黃帝素問靈樞集註》Vol. 20

The Yellow Emperor inquired of Qibo: "What pathogenic influences cause those cold-heat scrofulous swellings (lymph node tuberculosis) in the neck and armpits?" Qibo replied: "These are all caused by the cold-heat toxic qi of rat-scrofula (lymph node tuberculosis) that has become stagnant in the meridians and cannot be expelled."

The Yellow Emperor pressed further: "How should this be treated?" Qibo explained: "The root of rat-scrofula lies in the internal organs, while symptoms manifest in the neck and armpits. If the toxic qi remains floating in the meridians without penetrating deeply into the muscles—manifesting only as external suppuration and bleeding—it's relatively easy to treat. The specific method is: address the root cause through regulation while simultaneously treating the external symptoms, allowing the cold-heat pathogenic qi to gradually dissipate. Apply needles slowly along the meridian pathways—for small toxic qi the size of wheat grains, one treatment will show effect, and three treatments can effect a cure."

The Yellow Emperor asked further: "How to determine the prognosis?" Qibo said: "Observe the blood vessels in the patient's eyes—if a blood vessel runs vertically through the pupil, one vessel indicates death within one year, one and a half vessels indicate eighteen months, and so on. If no blood vessel traverses the pupil, the condition is still treatable."

In another passage, the Yellow Emperor asked Bogao: "When pathogenic qi invades the human body, why does it cause insomnia?" Bogao explained: "After food enters the stomach, it divides into three pathways—the ancestral qi (great qi of the chest) passes through the throat to govern respiration via the heart vessels; the nutritive qi (nourishing qi) transforms into blood to nourish the whole body; while the defensive qi (protective qi) circulates swiftly along the body's surface. During daytime, defensive qi moves in the yang meridians, while at night it enters the yin meridians. If pathogenic qi obstructs the five zang organs, defensive qi can only circulate externally and cannot enter yin, resulting in excessive yang qi that causes insomnia."

Huangdi (the Yellow Emperor) inquired of Bogao: "Why do some people suffer from insomnia?" Bogao explained that this occurs due to insufficiency of yin qi (vital energy). When yin qi is deficient, one cannot sleep. Huangdi asked about treatment methods, to which Bogao replied that the approach should involve supplementing deficiency and draining excess, harmonizing the yin-yang balance, unblocking the meridians, and expelling pathogenic qi. One may take Banxia Tang (Pinellia Decoction), a formula that regulates yin and yang—after drinking it, sleep will come naturally.

Bogao detailed the preparation of Banxia Tang: Take eight sheng of flowing water from a thousand li away, stir it vigorously ten thousand times, then collect five sheng of the clear upper portion. Boil it with reed stalks as fuel, then add one sheng of glutinous millet and five ge of pinellia (banxia). Simmer slowly until reduced to one and a half sheng. Remove the dregs and take one small cup per dose, three times daily. For recent cases, sleep will come immediately after drinking, accompanied by slight sweating; chronic cases will recover after three doses.

Huangdi then asked how the human body corresponds to heaven and earth. Bogao responded: "Heaven is round and earth is square—thus the human head is round and feet are square. Heaven has sun and moon, humans have two eyes; earth has nine regions, humans have nine orifices; heaven has wind and rain, humans have joy and anger; heaven has thunder, humans have voices; heaven has four seasons, humans have four limbs; heaven has five tones, humans have five zang organs; heaven has six pitch standards, humans have six fu organs; heaven has winter and summer, humans experience chills and fever; heaven has ten suns (ancient legend speaks of ten suns in the sky), humans have ten fingers; the year has twelve months, humans have twelve major joints; earth has high mountains, humans have shoulders and knees; earth has deep valleys, humans have armpits and popliteal fossae; earth has twelve great rivers, humans have twelve primary meridians; earth has springs, humans have protective qi (wei qi); earth grows grass, humans grow body hair; heaven has day and night, humans have activity and rest; heaven has stars, humans have teeth; earth has small hills, humans have small joints; earth has rocks, humans have protruding bones; earth has forests, humans have sinews and membranes; earth has cities, humans have muscles; the year's twelve months correspond to human's twelve major joints; earth has seasons without vegetation, humans have those unable to bear children. All these demonstrate the correspondence between the human body and heaven-earth."

Huangdi inquired of Qibo about the art of acupuncture, asking: "I wish to understand the methods of needle handling, the principles of needle insertion, the application of reinforcing and reducing techniques, how to stretch the skin to penetrate the interstices, as well as the patterns of meridian pathways—where they originate, where they terminate, where they flow slowly or rapidly, and how they connect with the transport points of the six bowels. Please explain in detail the branching and merging of meridians—how they diverge into yin channels and separate into yang channels—what exactly are these circulatory pathways?"

Qibo replied: "Your questions have already encompassed the essential principles of acupuncture." Huangdi earnestly requested: "Please explain them to me in detail."

Qibo then elaborated: The pathway of the Hand Taiyin Lung Meridian begins at the tip of the thumb, bending inward along the palmar side at the border of the white flesh, passing through the Taiyuan point (where the radial artery pulses at the wrist). Here, the qi and blood gather momentarily before flowing outward, bending upward below the wrist joint, then turning inward to converge with multiple yin meridians at the thenar eminence (the fleshy mound at the base of the thumb). After the qi and blood of multiple meridians gather here, they flow smoothly, diving beneath the wrist bone before emerging again at the cunkou (pulse diagnosis location). From there, they ascend along the arm to the inner side of the elbow, entering beneath the large tendon, bending inward to travel up the inner arm to the armpit, then turning inward to connect with the lungs. This describes the winding path of the meridian in its normal flow.

Next, he explained the pathway of the Pericardium Meridian: It begins at the tip of the middle finger, bending inward along the inner side of the finger, pausing briefly in the palm before diving between two bones. Emerging outward between two tendons, it travels along the boundary between bone and flesh. The qi flows smoothly here, ascending two inches before emerging again between two tendons to reach the inner elbow, entering beneath the small tendon. After pausing briefly where two bones meet, it finally enters the chest cavity to connect with the heart.

Huangdi pressed further: "Why does the Hand Shaoyin Heart Meridian alone lack transport points (acupuncture points)?" Qibo explained: "The Shaoyin Heart Meridian directly connects to the heart. The heart is the sovereign of the five zang and six fu organs, the dwelling place of shen (spirit), hun (ethereal soul), and po (corporeal soul). This organ's structure is firm, making it difficult for external pathogens to invade. If pathogenic qi truly enters, it damages the heart directly. When the heart is damaged, the shen scatters, and scattered shen leads to death. Therefore, all pathogenic qi that might harm the heart actually lodges in the pericardium (the protective membrane surrounding the heart). The pericardium constitutes the Heart Governor Vessel (Pericardium Meridian), hence the Hand Shaoyin Heart Meridian itself requires no transport points."

Huangdi asked further: "If the Hand Shaoyin Heart Meridian has no transport points, does that mean it cannot become diseased?" Qibo responded: "When the surrounding meridians become diseased, the heart itself remains unaffected. For treatment, one need only select points at the sharp bone (styloid process of the ulna) on the back of the hand. The pathways and qi-blood flow patterns of other meridians all follow principles similar to those of the Hand Shaoyin Heart Meridian."

The circulation of meridians follows its own patterns, so the selection of acupuncture points must be based on the deficiency or excess of Qi (vital energy) and blood, as well as the speed of their movement. This is what we call "draining the excess by following its momentum, and supplementing the deficient by taking advantage of its weakness." Only in this way can pathogenic factors be expelled and genuine Qi be stabilized—this is the principle of following natural laws.

The Yellow Emperor asked: What are the essential principles of needle manipulation? Qibo replied: First, one must thoroughly understand the starting and ending points as well as the pathways of the twelve meridians, observe the changes in the skin's temperature, and assess the strength, weakness, smoothness, or roughness of the pulse. If the pulse is smooth and strong, it indicates the disease is progressing; if the pulse is weak and thin, the illness has been prolonged; if the pulse is broad and sluggish, it signifies painful obstruction (Bi syndrome). When the Yin and Yang pulses are identical, the condition is difficult to treat. If there is still fever at the starting and ending points of the meridians, it means the pathogenic factors remain; if the fever subsides, the illness will improve.

By palpating the patient's Chi skin (the wrist area), one can discern the firmness or softness of the muscles, their size, smoothness or roughness, temperature, and moisture. Simultaneously, observing the five colors in the eyes allows one to assess the state of the five organs and predict life, death, fortune, or misfortune. Examining the color of the blood vessels helps determine conditions such as cold, heat, pain, or obstruction.

The Yellow Emperor said: I still don't fully grasp the principles of needle manipulation. Qibo explained: When holding the needle, one must be upright and steady, with a calm and focused mind. First, discern deficiency and excess, then decide the speed of needle manipulation. The left hand stabilizes the bone position, while the right hand follows the meridian to locate the point—never use excessive force. For draining techniques, the needle must be inserted straight and level; for supplementation techniques, the skin must be closed afterward to guide the flow of Qi, dispersing pathogenic factors and restoring genuine Qi to its proper place.

The Yellow Emperor asked: How does one penetrate the skin and open the interstices (Couli)? Qibo replied: Follow the gaps between the muscles, use the left hand to separate the skin, and insert the needle gently and slowly, maintaining unwavering focus. This way, pathogenic factors can be expelled.

The Yellow Emperor asked Qibo: The human body has eight hollows (the two elbows, two armpits, two inner thighs, and two knee hollows)—what do they correspond to? Qibo answered: They can be used to diagnose the condition of the five organs. When pathogenic factors affect the lungs or heart, they linger in the elbows; when the liver is affected, they flow to the armpits; when the spleen is affected, they remain in the inner thighs; and when the kidneys are affected, they stay in the hollows behind the knees. These eight hollows are crucial pathways for Qi and blood circulation. Pathogenic factors and stagnant blood cannot linger here, or they will damage the bones, joints, and tendons, leading to restricted movement and spasmodic conditions.

(Note: The characters "泌," "扞," and "痀" at the end are ancient phonetic annotations, pronounced as "bing mei qie," "ku han qie," and "yin ju" respectively.)

In the dialogue between the Yellow Emperor and Master Shao, they discussed the relationship between five personality types and Yin-Yang constitutions. Master Shao pointed out that all things in heaven and earth follow the principles of the Five Phases and Yin-Yang, and humans are no exception. Human constitutions are not simply divided into Yin and Yang but can be further categorized into five archetypes.

The first type is the Taiyin (Great Yin) person—greedy and unkind, outwardly humble but inwardly treacherous, fond of hoarding wealth yet unwilling to give. They are indecisive, always slow to act, harboring dark thoughts while maintaining a calm facade.

The second type is the Shaoyin (Lesser Yin) person. Though less greedy, they are cruel and malicious. They secretly rejoice at others' misfortunes and grow resentful when others succeed. Such people are harsh and uncharitable, devoid of compassion.

The third type is the Taiyang (Great Yang) person—boastful and fond of empty talk, making grand claims without real ability. They act recklessly, disregarding consequences, and remain self-righteous even in failure, never reflecting on their mistakes.

The fourth type is the Shaoyang (Lesser Yang) person, who becomes arrogant over minor achievements. They thrive on socializing but lack deep connections, always eager to show off in front of others.

The fifth type, the Yin-Yang balanced and harmonious person, is the most ideal. They are even-tempered and non-contentious, adapting smoothly to changing circumstances. Even in positions of high status, they remain humble. This state is called "perfect governance" (zhizhi). Ancient physicians skilled in acupuncture tailored their treatments according to these five constitutions.

In terms of treatment, Taiyin individuals suffer from excessive Yin Qi and sluggish blood circulation, requiring draining techniques. Shaoyin types are prone to digestive disorders, while Taiyang individuals, with their excessive Yang Qi, must be carefully treated to avoid further depleting their Yin. Physicians emphasized the need to apply specific methods according to each constitution.

This passage discusses traditional Chinese medicine's classification and diagnostic methods for assessing the balance of Yin-Yang in the human body. It categorizes people into five constitutional types: the Great Yin (Taiyin) type, Lesser Yin (Shaoyin) type, Great Yang (Taiyang) type, Lesser Yang (Shaoyang) type, and the Harmonious Yin-Yang (Yin-Yang Heping) type.

The text first explains that excessive outward dissipation of Yang Qi (Yang collapse) may lead to mania, while severe simultaneous loss of both Yin and Yang can cause sudden death. Individuals with Lesser Yang constitution possess abundant Yang Qi but deficient Yin Qi, characterized by fine meridians yet prominent collaterals, with blood concentrated internally and Qi flowing externally. For this type, solely draining the collaterals may cause Qi collapse, resulting in middle Qi deficiency that becomes difficult to treat.

Those with Harmonious Yin-Yang constitution exhibit balanced Qi and blood. Diagnosis requires careful observation of their Yin-Yang state, the waxing and waning of pathogenic and righteous Qi, and external manifestations to determine whether the condition is excess (Shi) or deficiency (Xu). Excess conditions require draining, deficiency conditions require tonifying, while balanced conditions without clear excess or deficiency should be regulated through the meridian system. These represent fundamental methods for harmonizing Yin-Yang and differentiating the five constitutional types.

The Yellow Emperor inquired how to distinguish these five types of people. Master Shao replied: Ordinary people don't fall into these five categories, as each type displays distinctive characteristics:

Great Yin type: Dark complexion, humble demeanor, tall stature but slightly hunched back.

Lesser Yin type: Lean appearance, cunning personality, restless when standing, walks as if bending forward.

Great Yang type: Head held high with chest out, body leaning backward.

Lesser Yang type: Prefers looking upward when standing, sways when walking, often holds arms and elbows backward.

Harmonious Yin-Yang type: Composed movements, serene and pleasant expression, gentle gaze, universally regarded as virtuous individuals.

These constitutional classifications reflect ancient Chinese medical thought that diagnoses internal Yin-Yang states through external observations, providing important clinical references for pattern differentiation.