《黃帝素問靈樞集註》Vol. 23

The Yellow Emperor inquired of Qibo: "Medical classics state that summer heatstroke leads to autumn malaria, with malarial attacks following fixed temporal patterns. What is the reason for this?" Qibo replied: "The pathogenic qi initially lodges at the Fengfu point (a cervical acupoint at the nape) and descends along the spinal column. The body's defensive qi (Weiqi, the protective yang energy) circulates to Fengfu once daily. As days pass, the pathogen moves down one spinal segment each day, causing progressively later onset times. This occurs because the pathogen first resides along the spine - whenever Weiqi reaches Fengfu, the pores open, allowing the evil qi to invade and trigger symptoms."

"Defensive qi descends one spinal segment daily. After twenty-one days it reaches the coccyx, on the twenty-second day entering the spinal canal to join the Fuchong vessel (a collateral of the Governing Vessel). After nine more days, the pathogen emerges at the Quepen point (supraclavicular fossa) and ascends, causing symptom exacerbation. When the evil penetrates the five zang organs and spreads to the membrane-origin (intervisceral spaces), its deep location and slow movement prevent daily attacks, requiring alternate-day accumulation before manifesting."

The Emperor further asked: "If defensive qi descends segmentally without passing Fengfu, how can pathogens still invade?" Qibo explained: "Fengfu isn't fixed - wherever Weiqi circulates, it opens local pores, making any pathogen-laden segment a new 'Fengfu'."

"Wind disorders and malaria both originate from external pathogens," the Emperor continued, "why does wind persist while malaria intermittently recurs?" Qibo responded: "Wind pathogens remain stationary, whereas malarial evils follow meridians internally, only manifesting when encountering defensive qi."

Consulting Master Shaoshi, the Emperor inquired: "I've heard the eight seasonal winds harm humans differently - winter cold tightens skin and closes pores, summer heat relaxes them. Must seasonal vulnerability coincide with pathogenic attack?" Shaoshi clarified: "Not necessarily. Thief winds (pathogenic factors) strike regardless of season - through open pores they penetrate deeply causing acute illness; through closed pores they linger superficially with gradual onset." The Emperor pressed: "When temperature-balanced pores remain closed, why do some still fall suddenly ill?"

The Yellow Emperor asked his teacher Shaoshi: "Why do people experience varying degrees of illness when exposed to the same pathogenic Qi?" Shaoshi replied: "Are you unaware that the invasion of pathogenic Qi follows certain patterns? Even in daily life, the opening and closing of the body's interstices (the spaces between skin and muscles) operate according to fixed rhythms."

Requesting further explanation, the Emperor received this teaching: "The human body resonates with celestial movements and responds to lunar phases. During the full moon when ocean tides surge westward, our Qi and blood are abundant—muscles become firm, skin tightens, hair grows resilient, interstices close, and metabolic residues adhere to the body surface. Even if encountering evil winds during this phase, their penetration remains shallow."

"Conversely during the waning moon when tides flow eastward, bodily Qi and blood weaken. Defensive Qi (the protective energy against pathogens) diminishes, leaving the physical form empty—muscles slacken, skin loosens, interstices open, hair thins, and metabolic residues shed. Exposure to evil winds during this phase allows deep penetration, causing sudden onset of severe illness."

The Emperor pressed further: "Why do some suffer sudden critical illnesses or deaths?" Shaoshi explained: "Those encountering the 'Three Emptinesses' meet sudden demise, while those embodying the 'Three Fullnesses' remain unharmed by pathogenic Qi. The Three Emptinesses refer to: encountering an inauspicious annual Qi cycle, coinciding with lunar waning, and violating seasonal rhythms—when these three unfavorable conditions converge with exposure to evil winds. Physicians ignorant of this principle are incompetent."

"The Three Fullnesses represent the opposite: flourishing annual Qi cycles, full moon phases, and seasonal harmony. Even exposure to evil winds during these conditions causes no harm." Marveling at this profound theory, the Emperor ordered its preservation in the Golden Cabinet (imperial archives), though noting its application remained individual in scope.

The Emperor pursued deeper inquiry: "Why do certain years witness widespread epidemics?" Shaoshi revealed its connection to climatic changes during the Eight Cardinal Solar Terms (Bazheng). The specific observation method involved monitoring celestial phenomena when the Polestar (Taiyi) aligned with the YeZhe constellation during winter solstice. "If southern winds and rain arrive then, they carry injurious 'thief winds' of deficient evil. Should these arrive at midnight while people sleep undisturbed, few fall ill that year; but daytime arrival exposes active individuals, causing widespread sickness."

"These deficient evils penetrate bones without immediate manifestation. When spring begins and interstices open with rising Yang Qi, western winds may trigger mass outbreaks of disease."

The Lingshu section of the Yellow Emperor's Inner Canon records the pathogenic effects of wind evils:

When the human body is invaded by vacuous wind evils (referring to external pathogenic factors), the clash between two types of evil qi disrupts the smooth flow of qi and blood in the meridians. If people frequently encounter unseasonable wind and rain, this condition is termed "encountering yearly dew" (referring to abnormal climatic conditions that violate seasonal norms). In years with harmonious climates and few evil winds, the populace experiences fewer illnesses and deaths; when years bring frequent evil winds and malignant qi, with imbalanced cold and warmth, the people suffer more sickness and mortality.

The Yellow Emperor inquired how to determine the severity of harm caused by vacuous wind evils. Master Shao replied: On the first day of the lunar new year, if the Great Unity Deity (the deity of the Big Dipper) resides in the Tianliu celestial palace sector, and a northwest wind blows without rain, this foretells many deaths that year. A northern wind at dawn on New Year's Day predicts numerous deaths in spring; if the northern wind persists all day, severe illness mortality may reach sixty percent. Winds from the south are called "drought regions," while those from the west are termed "white bone generals," both portending national calamities. Eastern winds that uproot trees and tear off roofs indicate major disasters for the state; southeastern winds bring springtime deaths. If New Year's Day is warm and windless, grain prices remain low and people enjoy good health; cold, windy conditions correlate with high grain prices and widespread illness. This is the method of predicting annual disease patterns by observing New Year's winds.

If no wind blows on the Chou day of the second month, people easily develop heart and abdominal illnesses. Absence of warmth on the Xu day of the third month brings many cases of alternating chills and fever. Lack of heat on the Si day of the fourth month results in numerous jaundice cases. If cold fails to appear on the Shen day of the tenth month, many sudden deaths occur. The "winds" mentioned here all refer to gale-force winds capable of tearing off roofs, uprooting trees, stirring sand and stones, and penetrating the body's pores.

In the chapter "Great Confusion Discourse," the Yellow Emperor asked Qibo: "When I ascended the Qingling Terrace and turned around midway up the steps, I experienced dizziness. Even crawling forward caused disorientation—why is this?" Qibo explained: The essence qi (Jingqi) of all five zang and six fu organs flows upward to nourish the eyes. The concentrated essence of the eyes forms vision, while the essence of bones constitutes the pupils (Tongzi). When the flow of essence qi becomes abnormal, symptoms like dizziness manifest.

The structure and functions of the eyes are as follows: The Jing (essence) of tendons forms the black pupil, the Jing of blood forms the ocular blood vessels, the Jing of Qi (vital energy) forms the white sclera, and the Jing of muscles forms the fascial tissues surrounding the eyeball. These essential energies connect with blood vessels, ascending to link with the brain and extending backward to the neck region. When external pathogens invade the neck during periods of physical weakness, they can travel along the ocular meridians deep into the brain, causing dizziness and blurred vision.

The eyes serve as the convergence point for the Jing of all five yin and six yang organs, as well as the domain where the defensive Ying-Qi and Wei-Qi (the body's protective systems) interact with the ethereal Hun and corporeal Po souls. Excessive fatigue leads to scattered Shen (spirit) and disordered consciousness. The black pupil belongs to yin, while the white sclera and blood vessels belong to yang - only when yin and yang harmonize can clear vision be maintained. Governed by the heart-mind, which houses the Shen, any disturbance in mental faculties may cause sudden visual hallucinations, manifestations of dispersed Hun and Po souls.

The Yellow Emperor recounted experiencing visions when visiting the Eastern Garden that ceased upon departure, suspecting the location drained his vitality. Qibo explained this phenomenon occurs when sudden encounters between personal desires and spiritual resistance disrupt the flow of Jing and Qi, resulting in visual disturbances - mild cases being called "disorientation" (mi) and severe cases "delusion" (huo).

Regarding forgetfulness, Qibo attributed it to deficient Qi in the upper body and excessive Qi in the lower, where full intestines contrast with weak heart and lungs, causing the defensive energies to stagnate below instead of ascending properly. For those feeling constant hunger yet lacking appetite, he described a condition where Jing accumulates in the spleen while residual heat lingers in the stomach - the heat promotes digestion causing hunger, but rebellious stomach Qi creates gastric coldness that suppresses appetite.

Concerning insomnia, Qibo identified it as Wei-Qi (a yang aspect of defensive energy) failing to enter yin territories, remaining trapped in yang regions. This yang excess coupled with yin deficiency prevents the proper closing of eyes for sleep.

The Yellow Emperor asked Qibo: When the eyes become diseased and lose vision, which Qi is responsible? Qibo replied that this occurs when the defensive Qi (the body's protective energy against external pathogens) becomes stagnant in the yin aspect and cannot circulate to the yang aspect. When defensive Qi lingers in yin, it causes yin energy to become excessive. Excessive yin fills the yin heel vessel (one of the eight extraordinary meridians), while the failure of defensive Qi to enter yang aspects leads to yang deficiency. Consequently, the eyes close.

The Emperor further inquired: Why do some people sleep excessively? Qibo explained: Such individuals have enlarged intestines and stomach, moist skin, and loose muscle texture. An enlarged digestive tract causes defensive Qi to linger too long; moist skin and lax muscles slow its circulation. Defensive Qi flows through yang aspects by day and yin aspects by night—when yang energy exhausts, one sleeps; when yin exhausts, one wakes. Those with large digestive organs retain defensive Qi longer, while their moist skin and slack muscles further delay its movement, causing prolonged stagnation in yin aspects. This makes their Qi impure, resulting in constant drowsiness.

Conversely, people with small digestive tracts, smooth skin, and unobstructed muscle texture retain defensive Qi longer in yang aspects, thus sleeping less.

The Emperor continued: Why do normally light sleepers suddenly become somnolent? Qibo answered: This occurs when pathogenic Qi stagnates in the upper burner (the heart-lung region), blocking its pathways. If one then eats or drinks hot soup, defensive Qi becomes trapped in yin aspects without proper circulation, causing sudden drowsiness.

Regarding treatment, Qibo advised: First regulate the five zang and six fu organs to eliminate minor disorders, then adjust Qi dynamics. Use draining methods for excess conditions and tonifying methods for deficiency. Physicians must first understand the patient's physical and mental state to identify the root cause before treatment.

Discussing abscesses, the Emperor said: I've learned that after the intestines and stomach receive food, the upper burner distributes Qi to warm muscles, nourish joints, and open the interstices. The middle burner emits Qi like dew, filling muscle crevices and permeating minute collaterals. Body fluids harmonize to transform into crimson blood—first filling minute collaterals, then main collaterals, and finally the meridians. When yin-yang energies become abundant, they circulate with respiration following fixed rhythms, mirroring heaven-earth movements endlessly. Treatment requires regulating excess/deficiency—draining for repletion, supplementing for vacuity. When Qi-blood achieves harmony, bodily functions remain normal. I now comprehend the principle of balanced Qi-blood.

This scripture records a dialogue between the Yellow Emperor and Qibo regarding the causes, progression, and critical treatment windows for abscesses (suppurative toxic sores).

Qibo explains: The circulation of Qi and blood in human meridians follows cosmic patterns, just as celestial irregularities cause solar and lunar eclipses, and terrestrial disharmony leads to floods. Similarly, when cold pathogens invade the meridians, they cause blood stagnation and trap defensive Qi (the protective energy against external pathogens), forming abscesses. As cold transforms into heat, it corrodes muscles to form pus. If not drained promptly, the infection gradually damages tendons, bones, and marrow. Should the toxic pus attack the five viscera, death ensues.

When the Yellow Emperor inquires about symptoms and critical periods for various abscesses, Qibo details several common types:

1. Fierce Abscess: Occurs in the throat. Untreated, the suppuration blocks the airway, causing death within half a day. If pus has formed, draining it followed by three days of lard poultices ensures recovery.

2. Life-Cutting Abscess: Appears on the neck with dark red discoloration. Without urgent treatment, it spreads downward to damage the liver and lungs, proving fatal within ten days.

3. Brain-Consuming Abscess: Develops at the nape, depleting marrow. Symptoms include severe neck pain and mental agitation, making it difficult to cure.

4. Flaw Abscess: Forms on shoulders and arms with reddish-black hue. Timely treatment prevents visceral damage. Moxibustion within four to five days ensures healing.

5. Rice-Grain Abscess: Emerges in armpits as hard, red swellings. Requires drainage with slender stone needles and six days of lard application.

6. Well Abscess: Begins chest-sized as bean-sized lesions. Untreated for three to four days, it penetrates the abdominal cavity, becoming fatal within seven days.

Qibo emphasizes that different abscesses progress at varying speeds with distinct danger levels. The key lies in seizing the critical treatment window—early intervention prevents internal transmission of toxins. These discussions embody the Chinese medical principle of "treating disease before it arises," highlighting the importance of addressing illnesses at their initial stages.

This passage systematically describes ancient Chinese medical knowledge regarding the diagnosis and treatment of various carbuncles and abscesses (suppurative infections), organized by affected body regions, characteristic symptoms, prognostic assessments, and therapeutic recommendations.

The text first discusses "sweet abscess" (carbuncles of the chest region), characterized by bluish skin discoloration with millet-like nodules, accompanied by persistent alternating chills and fever. Immediate treatment is emphasized, as neglect could prove fatal within ten years. Next described is "rib-side abscess," noted as a common condition in women requiring moxibustion therapy, with red adzuki bean-sized granulation tissue appearing after rupture.

Detailed symptom profiles are provided for abscesses in specific locations: "thigh-leg abscess" erodes bone with thirty days as the critical treatment window; "sharp abscess" at the coccyx presents as a red, hard mass with the same thirty-day prognosis; while "red application" on the inner thigh progresses more slowly but becomes fatal if untreated within sixty days. Special mention is made of "flaw abscess" at the knee—hard as stone—emphasizing that stone needles must only be applied after softening occurs, as premature intervention causes death.

Other distinctive types are recorded: "rabbit-gnawing" on the calf penetrates to the periosteum; "wandering sluggishness" at the ankle requires repeated stone needle punctures at specific acupoints; foot conditions like "four excesses" and "severe abscess" each follow dangerous progressions. Most critical is "shedding abscess" of the toes (resembling modern gangrene)—when blackish-red discoloration appears, immediate amputation is mandated to prevent certain death.

The concluding dialogue between the Yellow Emperor and Qibo explains the pathological mechanism: when nutritive and defensive Qi (the body's protective systems) stagnate in the channels, blood coagulation and Qi obstruction result, generating persistent high fever that putrefies muscle into pus. However, life can be preserved if treatment prevents the pathogenic toxin from penetrating the bone marrow. This passage collectively demonstrates ancient Chinese medicine's systematic understanding and clinical expertise regarding suppurative infections.

This dialogue between the Yellow Emperor (Huangdi) and Qibo discusses the distinction between two pathological conditions: "yong" (abscess) and "ju" (gangrene).

The Yellow Emperor asks: Why is it called "yong" when the five viscera remain unharmed?

Qibo replies: When excessive pathogenic heat (Xie Qi) descends and invades the muscles and skin, causing the sinews, vessels, bones and marrow to wither—yet without deeply affecting the five viscera and before the Qi and blood are fully depleted—this condition is called "yong."

"Ju," however, represents a more severe pathology. Here the pathogenic heat becomes extremely intense, penetrating deep into the skin and muscles. Not only does it wither the sinews and marrow, but it also internally involves the five viscera, leading to exhaustion of Qi and blood. When ju manifests, it erodes both the affected bones/sinews below and the surrounding healthy muscle tissue. Its characteristic signs include: dark-colored and hardened skin surface at the affected area, which feels thick and rough like the hide on an ox's neck.

By contrast, yong presents with relatively thin and lustrous skin—this being the primary symptomatic difference between the two conditions.

(Note: The final phrase "萓血泣𦸈𧁾臑不则夭" represents ancient phonetic annotations using the fanqie method to indicate pronunciations of rare characters, a practice no longer commonly used in modern times.)