《黃帝八十一難經纂圖句解》Vol. 4

This scripture passage explains methods for diagnosing the exhaustion of visceral essence and Qi by observing external bodily manifestations, focusing particularly on the signs of Qi depletion in the Kidney Channel of Foot-Shaoyin and the Spleen Channel of Foot-Taiyin.

Regarding manifestations of Kidney Channel (Foot-Shaoyin) essence depletion: The kidneys govern bones and generate marrow. When kidney Qi (Shen Qi) is exhausted, the marrow loses its warming nourishment, leading to symptoms of bone desiccation. Specific signs include the separation of muscles from bones, gum recession making teeth appear elongated and dry without luster, and hair losing its moisture. These symptoms indicate the exhaustion of the skeletal system. According to the Five Phases (Wuxing) theory of mutual generation and restraint, the kidneys correspond to Water, and Earth overcomes Water. Thus, the condition worsens on Wu days (Earth days) and may culminate in death on Ji days (also Earth days).

Regarding manifestations of Spleen Channel (Foot-Taiyin) essence depletion: The spleen governs muscles, and its essence manifests in the lips. When spleen channel Qi is exhausted, blood vessels fail to nourish the lips, resulting in muscles losing their luster and becoming rough, with the lip muscles slackening and turning outward. Since spleen channel essence outwardly manifests in the lips, these symptoms indicate the functional collapse of the spleen.

This scripture discusses the method of diagnosing internal organ disorders by observing external symptoms in traditional Chinese medicine, along with the application of the Five Phases mutual conquest theory in disease prognosis.

When muscles swell to the point of everted lips with lost texture, it indicates the complete failure of muscular function. Lip eversion signifies muscle necrosis. According to the Five Phases theory, the condition worsens on Jia days (associated with Wood) and death may occur on Yi days (also Wood), because Wood overcomes Earth (the spleen belongs to Earth).

When the Qi of the Foot Jueyin Channel (Liver Channel) becomes exhausted, symptoms include tendon contractions, retracted testicles, and a curled tongue. This occurs because the liver governs tendons, which converge in the genital region and connect to the tongue root. When liver Qi fails to nourish the tendons, these manifestations appear. Following the Five Phases conquest cycle, the condition deteriorates on Geng days (Metal) with possible death on Xin days (also Metal), as Metal overcomes Wood (the liver belongs to Wood).

Exhaustion of the Hand Taiyin Channel (Lung Channel) manifests as withered skin and hair. Since the lungs govern skin and body hair, lung Qi exhaustion leads to desiccated skin, loss of bodily fluids, joint damage, and ultimately brittle, falling hair. These are the external signs of complete lung function failure.

According to the theory of Five Phase mutual conquest, when a patient's lung disease worsens on a Bing day (associated with Fire), death will occur on the following Ding day (also Fire). Since Fire conquers Metal and the lungs belong to Metal, the flourishing of Fire on these days exacerbates the condition.

When the Qi and blood of the Heart Meridian of Hand Shaoyin become exhausted, the blood vessels lose their patency. As the heart governs all blood vessels throughout the body, the depletion of heart Qi prevents proper blood circulation. Without blood flow, the body loses its luster and healthy coloration—the complexion turns yellowish-black like a pear, indicating the failure of blood's vital functions.

Similarly, heart diseases that worsen on Ren days (associated with Water) will lead to death on Gui days (also Water), because Water conquers Fire and the heart belongs to Fire.

When the Qi and blood of all three Yin meridians (Liver, Heart, Spleen, Lung, and Kidney channels) become exhausted, symptoms include dizziness and tightly closed eyes. This occurs because the essence-Qi (Jing-Qi) of all five zang organs converges in the eyes—the exhaustion of the three Yin meridians thus impairs vision. Tightly closed eyes signify the loss of one's spiritual will (Shen), with all emotional functions including joy, anger, grief, and pleasure having ceased.

When the Qi and blood of all three Yang meridians (Gallbladder, Small Intestine, Stomach, Large Intestine, Bladder, and Triple Burner channels) become exhausted, the separation of Yin and Yang occurs. At this stage, the skin pores open widely, and cold sweat flows continuously like unbroken strings of pearls—a clear sign of Yang Qi's imminent exhaustion. Observing these symptoms allows one to recognize the approaching end of life.

This passage primarily explains the composition and characteristics of the human meridian system. Regarding diagnosis: if a fatal condition is detected during morning pulse reading, the patient may pass away that same evening; if detected in the evening, death may occur by next morning. Such critical conditions often prove fatal within the day.

Concerning the meridian system: The human body contains twelve primary meridians. Each of the five zang organs (heart, liver, spleen, lungs, kidneys) and six fu organs (stomach, large intestine, small intestine, triple burner [sanjiao], bladder, gallbladder) corresponds to one meridian, totaling eleven. The additional meridian consists of the separate pathways of the Hand Shaoyin Heart Meridian and the Heart Governor (pericardium). The heart holds special status with two meridians: the Hand Shaoyin Heart Meridian represents "sovereign fire," while the Hand Heart Governor (pericardium) represents "ministerial fire." The pericardium and triple burner share an exterior-interior relationship—though named, they lack concrete form, resembling instead a fine membranous network enveloping the heart and lungs.

Regarding the connecting vessels: each of the twelve primary meridians has one connecting vessel, supplemented by the Yang Heel vessel (right inner ankle), Yin Heel vessel (left outer ankle), and the Great Connecting Vessel of the spleen (originating from the spleen's Dabao point), totaling fifteen connecting vessels. The Yang Heel vessel runs opposite to the primary meridians' direction at the right inner ankle, while the Yin Heel vessel does the same at the left outer ankle.

Finally, the discussion turns to the Eight Extraordinary Vessels: these eight unique pathways (including the Conception [Ren] and Governing [Du] vessels) differ from the twelve primary meridians by not directly connecting to zang-fu organs, instead crisscrossing the body like a web. The term "extraordinary" (qi) here denotes their distinctive, unconventional nature.

This scripture explains the extraordinary "Eight Extraordinary Vessels" system within the human body. Beyond the twelve primary meridians, there exist eight special vessels: the Yang Linking Vessel (which connects all yang qi in the body), the Yin Linking Vessel (which connects all yin qi), the Yang Heel Vessel (governing agile movement through yang channels), the Yin Heel Vessel (governing agile movement through yin channels), the Thrusting Vessel (the central convergence of qi and blood throughout the body), the Governing Vessel (commanding all yang meridians), the Conception Vessel (responsible for human growth and development), and the Belt Vessel (a girdle-like meridian that binds all vessels together).

These eight vessels follow unconventional pathways, hence their designation as "extraordinary." Just as the earth has twenty-four major waterways (corresponding to the body's twenty-four meridians), the sages additionally dug irrigation channels (analogous to the Eight Extraordinary Vessels) to regulate water flow. When heavy rains come (symbolizing abundant qi and blood), these channels divert the floodwaters (qi and blood) to prevent overflow. At such times, even the main rivers (the twelve primary meridians) cannot restrain these diversions and must allow them to flow naturally.

The text concludes with a question: Since these eight vessels are not constrained by the twelve primary meridians, where do they begin and end? This inquiry suggests that, though extraordinary, these vessels still follow their own inherent patterns and have distinct starting and ending points.

The Governing Vessel (Du Mai) is the first of the eight extraordinary meridians in the human body. It originates at the Changqiang point (the tip of the coccyx) and ascends internally along the spinal column. This meridian passes upward through the Fengfu point (located three cun above the posterior hairline) before finally entering the brain.

The Conception Vessel (Ren Mai) is the second extraordinary meridian. It begins below the Zhongji point (located four cun below the navel, with the Qugu point beneath it serving as Ren Mai's starting point), follows the edge of the pubic hair, ascends along the inner abdomen to the Guanyuan point (three cun below the navel), and ultimately reaches the throat region.

As the third extraordinary meridian, the Thoroughfare Vessel (Chong Mai) originates at the Qichong point (located two cun lateral to each side of the lower abdomen, belonging to the Foot Yangming meridian). It ascends bilaterally along the navel and disperses throughout the chest area.

The Belt Vessel (Dai Mai), the fourth extraordinary meridian, begins at the hypochondrium (where the lower rib margin meets the hip bone). It encircles the waist like a belt, hence its name "Belt Vessel."

The Yang Heel Vessel (Yangqiao Mai), the fifth extraordinary meridian, starts at the heel and ascends along the Zhongchong point of the external malleolus before terminating at the Fengchi point (located in the depression at the posterior hairline) behind the neck.

The Yin Heel Vessel (Yinqiao Mai), as the sixth extraordinary meridian, also originates at the heel. It ascends along the Zhaohai point of the internal malleolus to the throat region, where it intersects and connects with the Thoroughfare Vessel.

The final two extraordinary meridians are the Yang Linking Vessel (Yangwei Mai) and Yin Linking Vessel (Yinwei Mai), which function like cords binding yin and yang, governing all the body's yin and yang meridians. These two vessels form a network that maintains the integrity of the entire meridian system.

(Note: The eight extraordinary meridians differ from the twelve primary meridians and play crucial roles in regulating Qi and blood while connecting the zang-fu organs in traditional Chinese medicine. The mentioned acupoints represent important energetic nodes in meridian theory, with each vessel's pathway reflecting traditional medical understanding of the body's energy circulation patterns.)

This passage explains the circulation patterns and pathological manifestations of the Eight Extraordinary Vessels (distinct from the twelve primary meridians) in the human channel system. When Qi (vital energy) and blood become excessively abundant in the regular meridians—much like water overflowing from irrigation ditches into lakes—the surplus flows into these extraordinary vessels. Unlike the twelve primary meridians that circulate continuously, these eight vessels function as reservoirs that temporarily store excess Qi and blood.

The Yang Linking Vessel (which connects all yang meridians) originates where the yang channels converge, while the Yin Linking Vessel (connecting all yin meridians) begins at the intersection of yin channels. The ancients used the analogy of constructing ditches: when channels reach capacity, water naturally flows into deep lakes—a fundamental principle even sages cannot forcibly alter.

When pathogenic Qi invades the Eight Extraordinary Vessels, stagnation of Qi and blood causes swelling and feverish sensations. In such cases, ancient stone needles (bian stones) were used to puncture and release blood for treatment.

Dysfunction of the Linking Vessels manifests differently: if the Yang Linking Vessel fails to connect yang meridians or the Yin Linking Vessel cannot bind yin channels, symptoms like mental confusion, limb weakness, and sluggish movements occur—as if the body loses its structural support.

Pathology in the Yin Heel Vessel (governing the inner leg) presents as inner (yin) tension with outer (yang) laxity, potentially progressing to leg rigidity and channel obstruction. Conversely, Yang Heel Vessel (controlling the outer leg) disorders show outer tension with inner slackness, often accompanied by restlessness and insomnia. Here, "slackness-tension" reflects varying manifestations of deficiency and excess states.

The Chong Mai (one of the Eight Extraordinary Vessels) manifests illness through rebellious Qi and abdominal tension. This occurs when deficient kidney Qi damages the Chong Mai, with rebellious Qi causing abdominal distension and internal urgency manifesting as abdominal pain.

The Du Mai (the vessel running along the spine) manifests illness through spinal rigidity and cold limbs. Since the Du Mai courses along the vertebral column, these symptoms arise when it becomes disordered.

The Ren Mai (the midline vessel along the body's front) manifests illness through internal stagnation of Qi and blood. In men, this appears as seven types of hernia (including □-type, disc-type, cold-type, mass-type, attached-type, wolf-type, and Qi-type hernias). In women, it manifests as eight types of abdominal masses (tumor-like growths including snake-type, fat-type, green-type, yellow-type, dry-type, blood-type, fox-type, and turtle-type accumulations). These conditions stem from deficient Qi-blood and disharmony between cold and warm influences.

The Dai Mai (the girdling vessel encircling the waist) manifests illness through abdominal distension and a weak, waterlogged sensation in the lumbar region as if sitting in water.

The Yangwei Mai (the vessel linking all yang energies) manifests illness through alternating chills and fever, as it governs defensive exterior functions. The Yinwei Mai (the vessel linking all yin-blood) manifests illness through heart-region pain, as it governs nutritive blood while the heart governs the blood vessels.

The above describes symptomatic manifestations when the Eight Extraordinary Vessels become disordered.

Regarding nutritive-defensive Qi and the triple burner: The 30th Difficulty states that nutritive Qi (nourishing energy) and defensive Qi (protective energy) normally circulate together. Nutritive Qi nourishes all bones and the nine orifices, while defensive Qi acts like a guard - moving along the body's surface by day and retreating inward by night to protect the organs.

The body's essence-energy originates from food and drink. After entering the stomach (the sea of water and grain), essence-energy distributes to the five zang and six fu organs: Food Qi entering the stomach sends refined essence to the liver to nourish sinews; kidney Qi ascends to the heart, infusing essence into the blood vessels; fluids entering the stomach send essence upward to the spleen, which transmits it to the lungs before descending to the bladder. Thus all five zang and six fu organs receive essence nourishment.

The five viscera and six bowels of the human body all rely on the Jing (essence) and Qi (vital energy) from food for nourishment. After digestion, the clear portion transforms into Rong Qi (nutritive essence): the stomach sends the refined essence of water and grains upward to the heart, where the heart transforms it into blood—this refined essence is Rong Qi. The turbid portion transforms into Wei Qi (defensive energy): the stomach converts the grains into Qi and sends it upward to the lungs, which govern the movement of Qi—this energy is Wei Qi.

Rong Qi circulates within the blood vessels because Rong blood belongs to Yin, and Yin governs internal nourishment. Wei Qi circulates outside the blood vessels because Wei Qi belongs to Yang, and Yang governs external defense. These two energies cycle endlessly within the body, completing fifty full circuits in one day and night. At Yin time (3–5 a.m.) the next day, they reunite at the Hand Taiyin Lung Meridian. The Yin and Yang energies interpenetrate like an endless circle with no beginning or end, which is why Rong and Wei Qi always move in tandem.

Regarding the Sanjiao (three energy centers—upper, middle, and lower): Where do they obtain their energy? How are they generated? Where do they begin and end? And which key areas should be regulated during treatment? In truth, the Sanjiao serves as the pathway for the movement of water and grains, functioning like an official managing waterways. Fluids enter through the upper Jiao and exit through the lower Jiao, marking both the beginning and end of Qi circulation.

To be specific: The upper Jiao is located below the heart and above the diaphragm, at the upper opening of the stomach. Its primary function is to receive and not disperse, and its key regulatory point is the Danzhong (CV-17) acupoint between the breasts (this point is the sea of Qi and regulates emotions). The middle Jiao is situated in the stomach cavity, neither too high nor too low, and its main role is to decompose and digest food.

This passage primarily discusses the three burners (collective term for upper, middle, and lower burners) in the human body, the functional positions of the heart and lungs, and the Five Phase attributes of the liver and lungs.

Regarding the three burners: The Tianshu acupoint is located one inch lateral to the navel on both sides, governing digestion and absorption by transforming food into Qi (vital energy) and blood. The lower burner sits above the bladder, responsible for separating the clear from the turbid—turning the clear into urine and the turbid into feces for elimination. The Yinjiao acupoint, one inch below the navel, also belongs to the three burners system. The administrative center of the three burners is at the Qijie acupoint (located two inches lateral to the midline in the lower abdominal hairline), where the Qi of the Foot Yangming Stomach Channel emerges, governing the movement of primordial Qi throughout the body.

Concerning heart-lung positioning: While all five solid organs reside in the abdominal region, only the heart and lungs remain above the diaphragm. This is because the heart governs blood as the nutritive (Ying) system, and the lungs govern Qi as the defensive (Wei) system. As blood and Qi circulate together through the body's channels, with the heart and lungs serving as their primary directors while also connecting with celestial Qi, their elevated position is physiologically significant.

On liver-lung attributes: The liver corresponds to blue-green, symbolizing the Wood phase of the East; the lungs correspond to white, representing the Metal phase of the West. Interestingly, while the liver tissue itself sinks in water, liver Qi (Wood) paradoxically rises when encountering water. Conversely, lung tissue floats in water—a manifestation of Five Phase characteristics.

Note: Ying-Wei refers to the body's nutritive and defensive systems; Qijie is a crucial acupoint where channel Qi and blood converge; the three burners represent a unique concept in Chinese medicine governing food transformation, water metabolism, and Qi circulation.

This passage explains the profound principles behind the metal-wood mutual restraint relationship in traditional Chinese medicine's Five Phases theory, using the metaphor of marital union to illustrate the transformations of organ Qi.

The lungs belong to metal, yet they don't contain pure metal Qi. Within the Five Phases framework, the eastern direction's heavenly stems Jiǎ and Yǐ represent wood (corresponding to the liver), while the western Gēng and Xīn represent metal (corresponding to the lungs). Here, the heavenly stems further differentiate yin and yang aspects: Jiǎ is yang wood, Yǐ is yin wood; Gēng is yang metal, Xīn is yin metal. Interestingly, Yǐ wood inherently contains metallic qualities, while Xīn metal carries fiery attributes, demonstrating how the Qi of the Five Phases interpenetrates one another.

The marital metaphor illustrates this: Yǐ wood (yin wood) is like a younger sister marrying Gēng metal (yang metal) to become his wife, because wood fears metal's restraining influence and thus proactively seeks union. Similarly, Xīn metal (yin metal) will marry Bǐng fire (yang fire) to resolve their mutual restraint. This "marriage" dynamic allows inherently conflicting phases to coexist harmoniously.

Regarding the liver specifically: although it belongs to wood, its growth cycle is dominated by yin energy (from the seventh to twelfth lunar months), with yang energy flourishing only during the first and second months. Moreover, Yǐ wood naturally contains metallic qualities, which explains why liver Qi actually descends when encountering water—much like a wife yielding to her husband's nature.

Similarly, the lungs' metal aspect isn't pure either, as Xīn metal contains fiery attributes. This intricate interplay of yin-yang and mutual containment among the Five Phases constitutes the very mystery that enables the balanced movement of Qi within the human body.

This scripture primarily employs the Five Phases (Wuxing) theory to explain the characteristics and interrelationships of the five zang organs in the human body.

Regarding the lungs, the text states that Xin metal (the lungs belong to metal, with Xin representing yin metal) harmonizes with Bing fire (the heart belongs to fire), akin to a marital relationship. The nature of lung metal inherently favors fire, so from the first to the sixth lunar month, when yang energy is strong, lung qi also flourishes. From the seventh to the eighth month, as yin energy gradually increases, lung qi transforms into yin. Thus, when the lungs encounter water, they float, but when overheated, they sink.

The liver, in contrast, belongs to wood. Yi wood (yin wood) carries a metallic quality, so liver qi initially sinks when emerging but rises when heated. This illustrates how Xin metal ultimately returns to the nature of Geng metal (yang metal), and Yi wood reverts to the nature of Jia wood (yang wood).

The Thirty-Fourth Difficulty discusses the sensory attributes—sound, color, smell, and taste—associated with the five zang organs:

• The liver, belonging to wood, corresponds to the color green, emits a rancid odor (similar to animal scents), tastes sour, produces a shouting sound, and secretes tears ("weeping" refers to tear fluid).
• The heart, belonging to fire, corresponds to red, carries a scorched smell, and tastes bitter.

These characteristics are deduced based on the principles of mutual generation and restraint among the Five Phases. For example, liver wood generates heart fire, so the heart's attributes follow those of the liver. The sour taste of wood arises from its astringent nature, while the bitter taste of fire stems from its upward-flaming quality. This theory systematically correlates the body's organs with the natural attributes of the Five Phases, forming a comprehensive framework of correspondences.

The spleen corresponds to the sweet flavor, just as fire generates earth (the Five Phases' generative cycle). However, earth (the spleen) in turn exhibits bitterness, which reflects its drying and excretory nature. The sound of the spleen manifests as speech, akin to how metal (the lungs) meeting fire (the heart) produces the sound of spoken words. The fluid of the spleen is sweat, just as the interaction of water and fire generates steam that rises as sweat.

The color of the spleen is yellow, like the hue of wood (the liver belongs to wood) reflected upon the earth (the spleen belongs to earth). The scent of the spleen is fragrant, as fire transforms earth to produce fragrance. The flavor of the spleen is sweet, and sweetness harmonizes all flavors, gently circulating the five tastes to nourish the five organs. Each flavor corresponds to its respective organ, while the spleen itself governs sweetness. The sound of the spleen also manifests as singing, like the harmonious resonance of metal (the lungs) and earth (the spleen) in their mother-child relationship. Another fluid of the spleen is saliva (涎), which is the expression of water fluids within the spleen.

The color of the lungs is white, as the hue of wood transmitted to the lungs appears white. The scent of the lungs is pungent, reflecting the transformation of fire qi into metal (the lungs). The flavor of the lungs is spicy, as pungency disperses and moistens. The sound of the lungs is weeping, because the metallic sound among the five tones corresponds to the lungs, and the melancholy of autumn (the metal season) manifests as crying. The fluid of the lungs is nasal mucus, which is the expression of water fluids in the lungs.

The color of the kidneys is black, as the hue of wood transmitted to the kidneys appears black. The scent of the kidneys is putrid, reflecting the transformation of fire qi into water (the kidneys). The flavor of the kidneys is salty, because the earth flavor transmitted to water descends and becomes salty, and salt softens hardness. The sound of the kidneys is groaning, like a child’s whimper to its mother. The fluid of the kidneys is saliva, as all oral fluids originate from water fluids, which branch out to nourish the five organs, manifesting as saliva in each.

The above describes the system of sounds, colors, scents, and flavors corresponding to the five organs. In summary, the five sounds, five colors, five tones, and five fluids mutually nourish and cycle. Someone might ask: Why do the five organs house seven types of spiritual entities (hun, po, shen, yi, zhi, etc.), each with its own dwelling? The answer is: The term "dwelling" refers to the residence of the body’s spiritual qi. Specifically: The liver stores the hun (ethereal soul), which follows the shen (spirit) in its movements and is called the assistant of the po (corporeal soul), much like a prime minister assisting the ruler.

The lungs house the Po (魄, corporeal soul, referring to the instinctive physical movements of the body): The Po moves in and out along with Jing (精, essence) and Qi (炁, vital energy). The lungs govern the Po, serving as the auxiliary vessel that supports the movement of essence. Just as essence requires the lungs as its container to carry and facilitate its circulation.

The heart houses the Shen (神, spirit, referring to mental consciousness): The heart is the dwelling place of divine awareness. It governs the Shen, which is the functional manifestation transformed from essence. In other words, essence is converted within the heart into the activities of mental consciousness.

The spleen houses Yi (意, intention) and Zhi (智, wisdom): Memories and thoughts generated in the heart are called "Yi," which governs reasoning and judgment—the beginning of discernment between right and wrong. "Zhi" governs memory storage. The spleen simultaneously carries these two psychological functions.

The kidneys house Jing (精, essence) and Zhi (志, will): The essences of male and female unite and merge to form new life, which is "Jing." Meanwhile, the firm determination formed in the heart is called "Zhi" (will). The term "Shi Xin" (士心, scholar's heart) refers to the goals and aspirations pursued by the heart.

This passage comes from Volume 4 of the Huangdi Bashiyi Nanjing Zuantu Jujie (Annotated Diagrams and Explanations of the Yellow Emperor's Classic of Eighty-One Difficulties). It systematically explains the relationship between the five organs and mental activities, forming the foundational framework of the "Five Organs House the Spirit" theory in Traditional Chinese Medicine. Here, "Jing" serves both as the material basis of life and participates in mental activities, reflecting TCM's holistic view of the unity of body and mind.