《黃帝八十一難經纂圖句解》Vol. 5

This passage explains the positional relationships and functional characteristics of the five zang (solid) and six fu (hollow) organs in the human body. The five zang organs (heart, liver, spleen, lungs, and kidneys) each occupy fixed positions: the stomach is adjacent to the spleen, the gallbladder to the liver, and the bladder to the kidneys. However, the heart and lungs reside above the diaphragm (the muscular membrane separating chest and abdomen), while the large and small intestines are located in the lower abdomen, thus being relatively distant.

This arrangement reflects their respective yin-yang functions. The heart and lungs govern the movement of yang qi (the heart governs blood circulation as the "glory," the lungs govern qi as the "defense"). Since yang qi ascends, these organs are positioned in the upper body. Conversely, the large and small intestines conduct yin qi downward, and as yin qi descends, they reside in the lower body.

All six fu organs (gallbladder, stomach, large intestine, small intestine, bladder, and sanjiao/triple burner) belong to yang and should ideally be pure spaces. Yet the large intestine, small intestine, stomach, and bladder all contact impure substances: the large intestine transports waste, the small intestine absorbs nutrients before transmitting dregs, the stomach receives food, and the bladder stores urine. Only the gallbladder remains pure as it stores bile without contacting impurities.

Regarding functional distinctions: though the small intestine is externally-internally paired with the heart, their roles differ. While their qi channels connect, their governing functions diverge—thus despite being influenced by heart qi, there's no independent "heart fu" position. The passage concludes by clarifying the small intestine's primary function: receiving digested food from the stomach for nutrient absorption before transmitting waste to the large intestine.

The large intestine is the organ responsible for transporting waste, functioning like a pathway that conveys bodily refuse outward for elimination.

The gallbladder is an organ of purity, nestled between the short lobes of the liver. When the liver's Qi and blood circulate freely to the eyes, visual clarity allows distinction between black and white. As the liver's auxiliary organ, the gallbladder particularly requires maintaining purity.

The stomach serves as the granary for food storage, simultaneously governed by the lungs as all nourishment gathers here.

The bladder stores bodily fluids. These fluids exit through sweat via the skin or permeate through bodily orifices. Stagnant fluids that cease flowing are termed "liquids," all contained within the bladder. Each fu-organ bears only one designation—none possess dual names.

The small intestine serves as the heart's auxiliary organ, the large intestine assists the lungs, the stomach supports the spleen, the gallbladder aids the liver, and the bladder serves the kidneys.

The small intestine is called the "red intestine" corresponding to the heart's red hue; the large intestine the "white intestine" matching the lungs' white; the gallbladder the "green intestine" reflecting the liver's green; the stomach the "yellow intestine" aligned with the spleen's yellow; and the bladder the "black intestine" situated in the lower jiao (energetic burner), corresponding to the kidneys' black.

The 36th Difficulty asks: "All five zang-organs are singular—why alone do the kidneys appear as two?" The response: Though the kidneys present as two entities, they are not both kidneys—the left is the kidney proper, while the right is the Gate of Life (mingmen). In males, the left represents the kidney while the right holds the Gate of Life. This Gate of Life serves as the portal of human vitality, located at the 14th vertebral segment where the mingmen acupoint resides, flanked by two zhishi points—the gathering place of all spiritual energies.

This scripture primarily discusses the relationship between acupoints in the human body and the vital energies of the five organs. Below the fourteenth vertebra, three inches to either side lies a crucial acupoint (the Mingmen or "Gate of Life" point), where the primordial Qi (the fundamental life energy in Daoism) gathers, guarded by divine spirits that prevent the intrusion of pathogenic energies. The kidneys are called the "Chamber of Will," serving as vital reservoirs for Jing (essence).

The primordial Qi (the foundational life energy) begins its circulation during the Zi hour (associated with the Kan trigram, representing the north and the kidneys). The Kan trigram forms through the interaction of Qian and Kun trigrams, symbolizing the union of celestial and earthly energies—hence the primordial Qi resides in the kidneys. In men, this is where Jing (essence) is stored, with surplus energies from all five organs and six viscera converging here, making the kidneys the central repository of essence. In women, this function relates to the uterus, so although there are two kidneys, they operate as a unified system.

The thirty-seventh inquiry examines the pathways of the five organs' vital energies. These energies connect with the external world through the nine orifices (eyes, ears, mouth, nostrils, and the two lower orifices). Among these, seven are Yang orifices (eyes, ears, nostrils, and mouth), and two are Yin orifices (the front and rear lower orifices). The specific manifestations are as follows:

The Qi of the lungs connects to the nose, which serves as the gateway to the lungs. When lung function is healthy, the nose can distinguish fragrances from foul odors. If the heart or lungs are diseased, the nose loses its sensitivity.

The Qi of the liver connects to the eyes, the gateway to the liver. When liver function is balanced, the eyes can discern black from white. If one sees long as short or white as black, it indicates a decline in vital essence.

The Qi of the spleen connects to the mouth, the gateway to the spleen. When the spleen and stomach are harmonized, the mouth can perceive the flavors of food. Though everyone eats and drinks, few truly savor the taste, as the spleen and stomach are crucial for digestion and absorption.

The Qi of the heart connects to the tongue (though not explicitly detailed in the original text, the context suggests the tongue serves as the heart's gateway—when heart Qi is balanced, speech and taste discrimination function properly).

The tongue serves as the external gateway of the heart, through which the heart's essence-qi (Jingqi) communicates with the outer world. When cardiac function is harmonious, the tongue can properly discern the five flavors—pungent, sweet, sour, bitter, and salty. The ears act as the external gateway of the kidneys, with renal essence-qi perceiving the environment through them. When kidney function operates normally, the ears can distinguish the five musical tones—gong, shang, jiao, zhi, and yu.

Should the five viscera (heart, liver, spleen, lungs, kidneys) become dysfunctional, pathogenic qi cannot be expelled, leading to obstruction of the nine orifices (two eyes, two ears, two nostrils, mouth, anterior and posterior yin). When the six bowels (gallbladder, stomach, small intestine, large intestine, bladder, triple burner) malfunction, yang qi cannot circulate properly within the body, accumulating to form suppurative diseases like abscesses.

When pathogenic qi invades the six bowels, the yang meridians of the body surface become imbalanced. These yang vessels govern qi movement—if superficial meridians are blocked, pathogens stagnate in the skin, causing excessive yang meridian qi. Conversely, when pathogens enter the five viscera, the deeper yin meridians become disordered. These yin vessels govern blood circulation; their obstruction leads to blood stasis, creating excessive yin meridian blood flow.

When yin qi becomes hyperactive, yang qi cannot properly nourish the body—this condition is called "ge" (internal blockage). When yang qi is excessive, yin qi cannot flow smoothly—termed "guan" (external obstruction). If both yin and yang qi become hyperactive without mutual nourishment, it forms "guan-ge" (complete blockage). The human body fundamentally relies on balanced qi and blood: qi belongs to yang, blood to yin. Whether both become excessive or deficient simultaneously, or wax and wane alternately, dynamic equilibrium must be maintained.

This scripture primarily discusses the principles of Qi-blood circulation and the relationship between internal organs. It first explains that the movement of Qi and blood resembles an unceasing flow of water—the Yin meridians nourish the five solid organs (heart, liver, spleen, lungs, and kidneys), while the Yang meridians nourish the six hollow organs (gallbladder, stomach, large intestine, small intestine, bladder, and triple burner), forming an endlessly circulating system. When Yin and Yang are balanced, Qi and blood properly warm and nourish the internal organs while also moisturizing the skin and pores on the body's surface.

Regarding the number of organs, the scripture points out that although the five solid organs correspond to five hollow organs, there is an additional "triple burner" (Sanjiao). The triple burner is a unique hollow organ—unlike others, it lacks a concrete form and instead consists of Qi pathways distributed throughout the chest and abdomen. Divided into upper, middle, and lower sections, it governs the movement of Qi throughout the body and connects with the primordial Qi of the kidneys. Though the triple burner has no fixed shape, it belongs to the circulation system of the hand Shaoyang meridian.

The term "overflow and inundation" (Fuyi) mentioned here refers to two states of Yin-Yang imbalance: when Yin is insufficient and Yang becomes excessive, it is called "inundation" (Fu); when Yang is insufficient and Yin becomes excessive, it is called "overflow" (Yi). Under normal circumstances, when Yin and Yang each fulfill their roles, Qi and blood achieve harmony both internally and externally.

This passage discusses the unique classification system of the human visceral organs in traditional Chinese medicine. The Triple Burner (Sanjiao, referring collectively to the upper, middle, and lower burners) lacks substantial physical form and only manifests through the hand Shaoyang meridian, hence its designation as the "external organ." While tradition speaks of six hollow organs (fu), in reality there are only five substantial ones (gallbladder, stomach, large intestine, small intestine, and bladder), with the Triple Burner completing the count to six.

The enumeration of six solid organs (zang) arises from the division of the kidneys into two functional aspects: the left kidney proper and the right "Gate of Life" (Mingmen), which serves as the residence of Jing (essence), Qi (vital energy), and Shen (spirit). In males, the Gate of Life stores reproductive essence, while in females it maintains uterine functions. As its Qi connects with kidney energy, it qualifies as the sixth solid organ.

The text further explains the correspondences between sense organs and visceral systems: the liver governs color perception, the heart oversees scent discrimination, the spleen manages taste sensation, the lungs dominate sound recognition, and the kidneys regulate fluid secretion. However, a peculiar inversion occurs - while the nose belongs to the lung system, it handles scent perception (a heart function); and though the ears pertain to the kidney system, they process sound (a lung function). This demonstrates the intricate cross-mapping of physiological functions within the human body.

These concepts receive detailed treatment in the 36th chapter of the Classic of Difficulties (Nanjing), primarily elucidating the specialized correspondences among visceral functions in traditional medical theory.

This scripture primarily explains the relationship between the functions of the five sense organs and the internal organs from the perspective of Five Phase (Wuxing) generation and organ correspondence, as well as the unique structure of the liver.

Regarding the functions of the nose and ears: The lungs belong to Metal (Jin) in the Five Phases (associated with the western direction and the celestial stems Geng-Xin). The growth position of Metal lies in the Si position (the southern Fire position). Southern Fire corresponds to the heart, which governs the sense of smell. Since the nose belongs to the lung system, and lung Metal is generated from the heart Fire position, the nose can distinguish the various scents governed by the heart. The kidneys belong to Water (Shui) in the Five Phases (associated with the northern direction and the celestial stems Ren-Gui). The growth position of Water lies in the Shen position (the western Metal position). Western Metal corresponds to the lungs, which govern sound. The ears belong to the kidney system, and kidney Water is generated from the lung Metal position, hence the ears can perceive sounds.

The Forty-First Difficulty discusses why the liver has two lobes: The liver belongs to Wood (Mu) (associated with the eastern direction and the celestial stems Jia-Yi), corresponding to the initial growth state of all things in spring. At this stage, plants have just sprouted and are still tender, having neither objects to cling to (no particular affinity) nor being far from the Taiyin channel (among the twelve meridians, the Foot Jueyin channel flows into the Hand Taiyin channel), nor distant from the Taiyang channel (Foot Jueyin and Shaoyang Wood can generate Hand Taiyang and Shaoyin Fire). The liver is connected to the Taiyin channel (displaying the characteristic of fearing Metal overcoming Wood) while also capable of generating Taiyang Fire (exhibiting the characteristic of growth). This dual nature resembles having two hearts, hence the liver has two lobes, which also corresponds to the leaf-like characteristics of trees.

The Forty-Second Difficulty raises a question about the human intestines and stomach: It inquires about the length of human intestines and stomach, and how much food and water they can contain. This section asks for specific measurements and capacity data of the digestive system, though the original text does not provide concrete answers.

This passage provides a detailed description of the structure and capacity of the human digestive system according to classical Chinese medical knowledge. The stomach measures approximately one chi five cun (about 35 cm) in circumference, with a diameter of five cun (about 11.5 cm) and a length of two chi six cun (about 60 cm). It can hold three dou five sheng (about 7 liters) of food and liquid, typically retaining two dou (about 4 liters) of food and one dou five sheng (about 3 liters) of water.

Next comes the small intestine (referred to as "shao chang" in ancient texts), which is about two cun and a half (about 5.8 cm) wide, with a diameter of approximately eight fen and a half (about 2 cm), extending three zhang two chi (about 7.4 meters) in length. It can accommodate two dou four sheng (about 4.8 liters) of food and six sheng three ge and a half (about 1.3 liters) of water. The small intestine's function is to further digest food, separating nutrients from waste.

The large intestine (also called "hui chang") measures four cun (about 9.2 cm) in width, with a diameter of one cun and a half (about 3.5 cm), and a length of two zhang one chi (about 4.8 meters). After food passes from the stomach to the small intestine, the volume reduces to four dou (about 8 liters) of food and eight sheng six ge and a half (about 1.7 liters) of water. Upon entering the large intestine, water is further absorbed into the bladder, while solid waste moves toward the rectum.

Finally, the rectum (known as "guang chang" or "zhi chang" in ancient terminology) is four cun (about 9.2 cm) wide, with a diameter of two cun and a half (about 5.8 cm), and a length of two chi eight cun (about 65 cm). It can hold nine sheng three ge and one-eighth (about 1.9 liters) of waste material.

The entire digestive system, from stomach to rectum, measures approximately five zhang eight chi four cun (about 13.5 meters) in total length, with a combined capacity for eight dou seven sheng six ge and one-eighth (about 17.5 liters) of food and liquid. These measurements meticulously document ancient physicians' understanding of the human digestive system's dimensions and capacities.

This scripture provides detailed descriptions of the weight, morphology, and functional characteristics of the five major organs in the human body, reflecting ancient Chinese medical understanding of anatomical structures.

The liver weighs four jin and four liang (approximately 2.5 kg) and resembles a branching tree trunk, with three lobes on the left (associated with Yang) and four on the right (associated with Yin), totaling seven lobes. This corresponds to the meridian theory linking the Liver Meridian of Foot-Jueyin with the Gallbladder Meridian of Foot-Shaoyang, as the number seven represents the culmination of Shaoyang energy. The liver's primary function is to store the "Hun" (one of the three ethereal souls in Daoist thought).

The heart weighs twelve liang (around 450 grams). Highly intelligent individuals are said to have seven apertures and three hairs in their hearts, those of average intelligence have five apertures and two hairs, ordinary people possess two apertures and no hairs, while foolish individuals may have very small or even no apertures. The heart stores three ge (approximately 300 ml) of refined fluid and primarily houses the "Shen" (spirit).

The spleen weighs two jin and three liang (about 1.3 kg), positioned below the stomach to assist digestion. It measures three cun in width and five cun in length, containing half a jin of "san gao" (fatty tissue). Its functions include governing blood circulation, warming the five organs, and storing "Yi" (intention).

The lungs weigh three jin and three liang (roughly 1.6 kg), consisting of six large lobes and two small lobes—eight in total—corresponding to the Dui trigram (associated with the west and the position of You) in the Bagua (Eight Trigrams). Their main role is to store the "Po" (corporeal soul).

The kidneys, a pair located opposite the navel at waist level, weigh one jin and one liang (approximately 600 grams) together. They regulate water Qi to nourish the body's meridians and store "Zhi" (willpower). The gallbladder is situated between the short lobes of the liver.

These descriptions integrate anatomical features with Daoist cultivation theory, particularly the concept of the "five viscera spirits" (Hun, Shen, Po, Yi, Zhi), showcasing the distinctive perspective of ancient physicians on human structure and function. The weight measurements follow the traditional sixteen-liang system, differing from modern metrics.

The gallbladder is called "the daring organ" because it embodies the qualities of gallant Qi (vital energy) and courageous resolve. Situated between the two lobes of the liver, it weighs three liang and three zhu (ancient weight units) and stores three ge (ancient volume units) of refined bile.

The stomach weighs two jin and one liang. Its shape is curved and expandable, measuring two chi and six cun in length, with a circumference of approximately one chi and five cun, and a diameter of five cun. It can hold two dou of grain and one dou five sheng of water.

The small intestine weighs two jin and fourteen liang, extending three zhang and two chi in length, with a width of two and a half cun and a diameter of roughly eight fen and a slight fraction (about 0.8 cun). It begins at the left rib area, coiling into sixteen loops, and can accommodate two dou four sheng of grain and six sheng three and a half ge of water.

The large intestine weighs two jin and twelve liang, stretching two zhang and one chi long, four cun wide, with a one-cun diameter. It forms sixteen loops around the right side of the navel and can hold one dou of grain and seven and a half sheng of water.

The urinary bladder (also called the "storage organ") weighs nine liang and two zhu, named for its short and transversely broad shape. It measures about nine cun in length and can store nine sheng nine ge of urine.

The mouth cavity is approximately two and a half cun wide, with a distance of nine fen from the lips to the teeth. From the back of the mouth to the epiglottis (the cartilage controlling breathing and swallowing in the throat), the depth is about three and a half cun, capable of holding five ge of liquid.

The tongue weighs ten liang, named for its agility in movement and assistance in speech. It measures seven cun in length and two and a half cun in width. The entrance to the throat (pharyngeal gate) weighs ten liang.

(Note: Ancient unit conversions: 1 jin = 16 liang, 1 liang = 24 zhu; length units: 1 chi ≈ 23 cm, 1 cun ≈ 2.3 cm; volume units: 1 dou = 10 sheng, 1 sheng = 10 ge)

This passage describes the structure and functions of the human digestive system. The throat (comprising the pharynx and larynx) serves as the passageway for both food and air: the pharynx, responsible for swallowing food, weighs approximately ten liang (about 375 grams), is two and a half cun (about 8 cm) wide, and measures one chi six cun (about 53 cm) from the pharyngeal opening to the stomach. The larynx, responsible for breathing and air passage, weighs twelve liang (about 450 grams), is two cun (about 6.4 cm) wide, twelve cun (about 38 cm) long, and contains nine cartilaginous segments internally.

The anus (also called the broad intestine or intestinal terminus) weighs twelve liang (about 450 grams), resembles the axle of a wheel in shape, is eight cun (about 25 cm) wide with a diameter of approximately two and a half cun (about 8 cm), measures two chi eight cun (about 89 cm) in length, and can hold nine sheng three ge and eight fen (about 9.38 liters) of waste matter.

The forty-third difficulty explains why humans die after seven days without food or water: a normal stomach typically contains three dou five sheng (about 35 liters) of food and liquid. A healthy person defecates twice daily, eliminating two and a half sheng (about 2.5 liters) each time, totaling five sheng (about 5 liters) per day. Over seven days, this amounts to three dou five sheng (about 35 liters) expelled—at which point the body's stored fluids and nutrients become depleted, hence death occurs after seven days without sustenance.

The forty-fourth difficulty discusses seven crucial "Chongmen" (gateways of Qi and blood circulation) in the human body, among which the lips are called the "Flying Gate" (opening and closing like door panels), representing the first gateway.

The lips belong to the spleen system, functioning as the gateway for food and water to enter the body. The teeth act like doors, serving as the external manifestation of heart Qi (Xinqi)—the will of the heart is expressed through speech, which is why teeth are called the "gateway of the heart." They also perform the task of chewing food, transmitting the refined essence of grains into the body.

The upper opening of the stomach is called the "cardiac orifice" (near the diaphragm), serving as the passage for stomach Qi (Weiqi) to flow outward. The stomach transports the digested grain Qi to the lungs, located above the diaphragm. The epiglottis (throat cartilage) is the "inhalation gate," functioning both as the portal for the five organs' vocal expressions and as the passage for breathing. The lower opening of the stomach is concealed three inches below the navel, known as the "pyloric gate."

The junction of the large and small intestines is called the "ileocecal gate," where the refined essence of food is separated from waste, ensuring nutrients and blood each find their proper destinations. The anus is referred to as the "gate of the corporeal soul (Po)" because lung Qi (Feiqi) connects upward to the throat and downward to the anus, and the lungs house the Po (in Daoist thought, the Po represents the seven corporeal souls residing in the body).

Collectively, these are known as the "Seven Strategic Gates," crucial passages in the digestion and absorption of food. Next, we explain the eight major convergence points in the body: the Zhongwan point (Great Granary) in the stomach region is where the Qi of the six bowels converges; the hypochondrium (soft rib ends) is where the Qi of the five organs gathers; the Yanglingquan point (outside the knee) governs the sinews; the Juegu point (above the outer ankle) governs the marrow; the Geshu point (beside the seventh thoracic vertebra) governs the blood; and the Dazhu point (beside the first thoracic vertebra) governs the bones. These acupoints are all vital convergence sites for the essence and Qi of their respective bodily tissues.

The Dazhu (BL-11) acupoint is located on both sides of the first cervical vertebra, approximately 1.5 cun below the occipital bone, where the Qi and blood of the Foot Taiyang Bladder Channel converge. The Taiyuan (LU-9) acupoint is situated at the thenar eminence on the inner side of the right wrist, serving as the source of Qi and blood for the Hand Taiyin Lung Channel.

The Qi of the Triple Burner gathers at the Danzhong (CV-17) acupoint, located on the midline between the breasts, 1.6 cun below the Yutang (CV-18) point. Danzhong functions as the "sea of Qi" within the body, responsible for distributing breath energy to the lungs and nourishing the internal organs. In cases of heat syndromes, stimulating these key Qi-blood convergence points can provide therapeutic benefits.

The 46th Difficulty discusses sleep patterns: elderly people often lie awake despite resting, while the young fall asleep easily but may struggle to wake. This occurs because youth is marked by abundant Qi and blood, moistened muscles, unobstructed Qi-blood pathways, and harmonious circulation of Ying (nutritive) and Wei (defensive) Qi—resulting in daytime vitality and sound nighttime sleep. In contrast, the elderly experience diminished Qi and blood, withered muscles, sluggish circulation, and disharmony between Ying and Wei Qi, leading to daytime lethargy and nighttime insomnia. When Wei Qi (the body's protective energy) moves outward, one awakens; when it turns inward, one sleeps. As Wei Qi weakens with age, nighttime rest becomes elusive.

This passage contrasts physiological differences between youth and old age to explain sleep variations, embodying Chinese medicine's principle of "correspondence between heaven and human"—where bodily rhythms resonate with the natural cycles of Yin and Yang.