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Chapter 8 of 13
脉经
This volume uses the viscera as the framework and the channels as the threads, systematically discussing the deficiency and excess patterns, dreams, onset times, transmission patterns, pulse presentations, channel pathways, and acupuncture treatments of the Liver, Gallbladder, Heart, Small Intestine, Spleen, Stomach, Lung, Large Intestine, Kidney, Bladder, and Triple Burner. The following sections provide plain-language explanation chapter by chapter according to the original text, supplemented with modern perspectives and health cultivation insights. All formulas, acupoints, and needling methods mentioned are studies of classical therapeutic principles and do not constitute diagnostic or therapeutic recommendations.
When liver qi is deficient, a person is prone to fear; when liver qi is excessive, a person is prone to anger. When liver qi is deficient, one dreams of vegetation growing in gardens and orchards; if this occurs during the time when liver qi is at its peak, one dreams of crouching under a tree and daring not to rise. When liver qi is exuberant, one dreams more of anger. When external rebellious qi (turbid counterflow qi) disturbs the liver, one dreams of mountain forests and trees.
When disease resides in the liver, symptoms are milder at dawn (early morning), aggravated around late afternoon (around Shen-hour in the afternoon), and quiet at midnight.
If disease first arises in the liver, there may be dizziness, blurred vision, and hypochondriac distension and pain with a feeling of fullness and oppression. Transmission to the spleen manifests as obstruction and blockage, with body pain and heaviness. Further transmission to the stomach manifests as abdominal distension. Transmission to the kidney manifests as pain in the lower abdomen, lumbar spine, and lower legs. If it does not resolve within ten days, the prognosis is grave. In winter, critical deterioration often occurs around sunset; in summer, critical deterioration often occurs around breakfast time.
When the liver pulse is forceful, firm, and long, and the complexion is not green, it is mostly due to injury from falling. If blood stasis is blocked beneath the hypochondrium, it may cause panting and counterflow. If the pulse is soft and scattered, and the complexion still has luster, it indicates excessive fluid spillage — caused by sudden pathogenic dampness, excessive water drinking, with fluids spilling into the muscles, skin, and outside the intestines and stomach.
When the liver pulse is tense on both deep and floating palpation, the patient suffers from hypochondriac pain with qi distension and fullness, pulling pain in the lower abdomen, occasional difficult urination, blurred vision, headache, lower back pain, cold feet, and intermittent urinary obstruction. In women, menstruation may cease entirely or come and go irregularly, mostly due to a fall injury suffered in youth. If a green pulse manifests, long and bouncing against the fingers left and right, this diagnoses accumulated qi below the heart, with distension and fullness, named liver bi. It arises from cold-damp and follows the same principle as hernia disorders, presenting with lower back pain, cold feet, and headache.
In liver wind stroke, there is discomfort of the head and eyes, pain in both hypochondria, a tendency to walk hunched over, craving for sweet flavors, resembling the appearance of pregnancy vomiting. In liver cold attack, there are bouts of chills accompanied by intermittent fever, red facial complexion, sweating, and vexing heat in the chest; or the inability to raise both arms, dry tongue base, frequent sighing, chest pain, inability to turn the body, occasional night sweats, cough, and vomiting of fluid after eating.
The liver governs the qi mechanism of the chest. If there is panting, easy anger and cursing, a deep pulse, chest oppression, a desire to be pressed upon, heat, and nasal congestion, this is mostly caused by retained stagnant blood remaining internally after a fall, or by qi rising but not descending after a great rage, accumulating below the left hypochondrium and injuring the liver. When the liver is injured, the flesh wastes away, the person prefers lying down, the mouth tends to be open, the hands and feet periodically turn cyanotic, the eyes are closed, and the pupils hurt.
Liver distension manifests as hypochondriac fullness and pain drawing toward the lower abdomen. Liver edema manifests as abdominal distension, inability to turn the body by oneself, pain in the hypochondrium and abdomen, intermittent production of salivation in the mouth, and interrupted but passable urination.
When the lung overacts on the liver, it may cause abscesses and swellings; when the heart overacts on the liver, vomiting and diarrhea may appear. A patient with liver fixity often desires to have someone trample on the chest; when not aggravated, the person simply wants hot water to drink.
The accumulation of the liver is named fat qi. It is located below the left hypochondrium, shaped like an overturned cup, with head and feet, resembling a turtle or turtle-shell. When prolonged without resolution, it may generate cough with counterflow, and intermittent fever conditions (malaria-like), persisting for years and months. It typically arises on late summer wu-ji days. The reason is: lung disease transmits to the liver, the liver should transmit to the spleen, but the spleen happens to be at its peak in late summer; what is at its peak does not receive pathogens. The liver pathogen attempts to return to the lung, but the lung refuses to accept it, and so it becomes lodged and forms an accumulation.
In liver disease, if the complexion is green, the hands and feet are contracted and tense, the hypochondrium is bitterly full and uncomfortable, there are periodic episodes of dizziness, and the pulse is stringlike and long, the ancients considered it treatable. One may reference formulations such as Fangfeng Zhuru Decoction and Qinjiao Powder; and according to the season, select acupoints — in spring needle Dadun (LR 1), in summer needle Xingjian (LR 2), in winter needle Ququan (LR 8), all with tonification method; in late summer needle Taichong (LR 3), in autumn needle Zhongfeng (LR 4), both with draining method. One may also moxa Qimen (LR 14) and the ninth thoracic vertebra on the back, among others. These belong to classical therapeutic concepts and are not operative recommendations.
In liver disease, there must be pain in both hypochondria pulling toward the lower abdomen, with a tendency to anger. When the liver is deficient, there is blurred vision, diminished hearing, and a tendency toward fear, as if someone were about to arrest the person. Treatment should select the origin channel.
When qi of Foot-Jueyin and Foot-Shaoyang flows in rebellion, there may be head and eye pain, deafness, and cheek swelling; collateral bloodletting may be applied. When the pathogen is in the liver, there is pain in both hypochondria, cold in the middle, retained stagnant blood internally, limb convulsions, and intermittent joint swelling. One may select Xingjian (LR 2) to guide down the hypochondriac qi, tonify Zusanli (ST 36) to warm the stomach, take the blood collaterals to disperse stagnant blood, and take the green vessel behind the ears to stop convulsions.
The Foot-Jueyin vessel arises from the clustered hairs of the great toe, runs along the dorsum of the foot and the medial malleolus, ascends and emerges behind the Taiyin channel, follows the medial thigh into the pubic hair region, circles the genitalia, reaches the lower abdomen, flanks the stomach, belongs to the liver, and connects with the gallbladder, penetrates the diaphragm, spreads over the hypochondria, follows the throat behind, connects with the eye system, ascends to the forehead and meets the Governing Vessel at the vertex. Its branch descends from the eye system to the inside of the cheeks and circles the inside of the lips; another branch separates from the liver, penetrates the diaphragm, and flows upward to pour into the lung.
When this channel "is moving in disease," there is low back pain preventing flexion and extension, hernia in men, lower abdominal swelling in women; in severe cases, dry throat, and a face like covered with dust. When this channel "generates disease," there is chest fullness, vomiting with counterflow, diarrhea, fox hernia, enuresis, and urinary retention. In excess, the wrist pulse (cun-kou) is one time larger than the carotid pulse (ren-ying); in deficiency, the wrist pulse is conversely smaller than the carotid pulse.
In liver disease, if there is chest fullness, hypochondriac distension, easy anger and shouting, body heat with aversion to cold, inability to raise the four limbs, complexion conversely turning white, and body appearing smooth and glossy — while the pulse should be stringlike, long, and tense but instead is short and choppy, and the complexion should be green but instead is white — this is metal overcoming wood, a great reversal, with ominous prognosis.
The liver is the general official, governing free coursing and storing blood, with its emotion being anger. Liver qi deficiency leads to fear; liver qi excess leads to anger — reflecting the vacuity-repletion of the liver from two emotional dimensions. The liver governs the sinews and opens to the eyes, hence liver disease often presents with hypochondriac pain, blurred vision, sinew and vessel tension, and cold hands and feet. The liver channel pathway circles the genitalia, spreads over the hypochondria, connects the eye system, and meets the vertex, so liver disease symptoms tend to distribute along the channel pathway.
The formation of fat qi is explained through five-phase transmission, with organ-at-peak not receiving pathogens, constituting an ancient model of visceral disease transmission, emphasizing the mutual constraint among the five viscera and the mechanism of lodging to form accumulation.
"The liver governs anger; deficiency leads to fear" can be understood as the relationship between emotions and the autonomic nervous system and endocrine function, but the liver here should not be equated with the modern anatomical liver. Liver disease dream imagery, day-lightening/night-worsening patterns, etc., belong to classical experiential synthesis with some observational basis, but not necessarily universal applicability. Falling trauma, great rage, and prolonged accumulation leading to disease suggest that emotions and trauma do impact health, and modern medicine also recognizes the connection between emotional stress and chronic disease.
Emotions should be allowed to flow freely; avoid long-term suppressed anger. In daily living, guard against falls and external injuries. Eat and drink with moderation, avoiding binge eating and fluid-damp retention. In spring, when wood qi flourishes, rise early and sleep early, exercise outdoors to help liver qi flow smoothly.
Patients with gallbladder disease frequently sigh, have a bitter taste in the mouth, vomit foul overnight food fluids, feel restless and uneasy within, experience fear as if someone were about to arrest them, feel as if something is obstructing the throat, and frequently expel saliva. The disease manifestation lies at the origin and terminal portions of the Foot-Shaoyang channel. If the pulse sinks, moxibustion may be applied; if accompanied by chills and fever, Yanglingquan (GB 34) may be needled.
Those who vomit bitter fluids frequently, sigh lengthily, feel restless at heart, and are sad and fearful have the pathogen in the gallbladder with stomach qi surging upward. When gallbladder fluid leaks out, there is a bitter taste in the mouth; when stomach qi surges upward, bitter fluid is vomited, hence the name "vomiting of bile." One may needle Zusanli (ST 36) to descend stomach qi, needle the Foot-Shaoyang blood collaterals to clear the gallbladder, and then regulate vacuity and repletion to dispel the pathogen.
Gallbladder distension manifests as hypochondriac pain and distension, bitter taste in the mouth, and sighing. When rebellious qi lodges in the gallbladder, one dreams of fighting and litigation.
The Foot-Shaoyang vessel arises from the outer canthus, ascends to the corner of the head, descends behind the ear, follows the neck, crosses the shoulder, and enters the supraclavicular fossa. Its branch enters the ear from behind, then exits in front of the ear; another branch separates from the outer canthus, descends to Daying (ST 5), joins the Hand-Shaoyang, descends at Jiache (ST 6) and the neck, meets the supraclavicular fossa, penetrates the diaphragm, connects with the liver, and belongs to the gallbladder, follows the interior of the ribs, exits at the qi street, circles the pubic hair region, and traverses horizontally into the hip joint. Its direct channel descends from the supraclavicular fossa under the axilla, follows the chest past the floating ribs, descends to join at the hip joint, then continues along the lateral aspect of the lower limb, terminates at the fourth toe.
When this channel "is moving in disease," there is bitter taste in the mouth, frequent sighing, heart and hypochondriac pain, inability to turn the body; in severe cases, a faint dusty complexion, loss of skin luster, and warmth on the lateral aspect of the foot — termed yang reversal. When this channel "generates disease," there is headache, jaw pain, outer canthus pain, supraclavicular swelling and pain, axillary swelling, scrofula, sweating with chills and shivering, intermittent fevers, and pain of the chest, hypochondrium, lateral lower limb, and joints, with inability to move the fourth toe. In excess, the ren-ying pulse is one time larger than the cun-kou pulse; in deficiency, the ren-ying pulse is conversely smaller.
The gallbladder is the upright and decisive official, governing judgment; it also stores and excretes bile, standing in exterior-interior relation with the liver. When gallbladder qi is not free-flowing, there is bitter taste in the mouth, sighing, fear, and indecisiveness; when both gallbladder and stomach are affected together, bitter vomiting occurs. The text links gallbladder disease with stomach qi surging upward, illustrating the mutual influence of digestion and emotions.
Bitter taste in the mouth and frequent sighing are often associated with bile reflux, gastrointestinal dysmotility, and emotional stress. The classical summary "pathogen in the gallbladder, rebellion in the stomach" resonates with certain contemporary gallbladder-stomach related symptoms, though "gallbladder governs judgment" belongs to traditional theory and should not be equated with neurological function.
Maintain regular eating habits, avoid greasy foods and overeating to prevent taxing the gallbladder and stomach. Emotions should be relaxed; reduce anxiety about gains and losses and restless dreaming. Morning activity can aid the ascent and effusion of Shaoyang.
When heart qi is deficient, there is unceasing sadness; when heart qi is excessive, there is unceasing laughter. When heart qi is deficient, one dreams of rescuing people from fire and of yang objects; at the time of peak activity, one dreams of burning and scorching heat. When heart qi is exuberant, one dreams of joy and laughter, and of fear. When rebellious qi lodges in the heart, one dreams of hills, mounds, and smoke and fire.
When disease resides in the heart, symptoms are milder at noon, aggravated at midnight, and quiet at dawn. When disease first arises in the heart, there is heart pain; transmitting to the lung, there is panting and cough; transmitting to the liver, there is hypochondriac pain and fullness; transmitting to the spleen, there is obstruction and blockage, body pain, and heaviness. If it persists unrelieved for several days beyond the count, the prognosis is grave — in winter, severe at midnight; in summer, severe at noon.
When the heart pulse is forceful, firm, and long, the tongue curls and prevents speech. When the pulse is soft and scattered, there is wasting-thirst (diabetes-like syndrome), which may resolve by itself. When the heart pulse is small and tight on deep palpation, and not panting on floating palpation, the patient suffers from qi accumulation and pain below the heart, inability to eat, liking to swallow saliva, periodic heat in the hands and feet, vexation and fullness, forgetfulness, unhappiness, and preference for sighing, mostly caused by worry and anxiety. When a red pulse arrives, panting and firm, it diagnoses accumulated qi in the middle, periodically affecting food intake, named heart bi. It arises from external pathogen invasion and excessive worry and thought causing heart deficiency, with pathogens taking advantage of the vacuity and entering.
When the heart pulse is tense, it is called heart hernia, and the lower abdomen will manifest a palpable mass. The heart is the male visceral organ (vibrant yang organ), with the small intestine as its envoy, hence masses occur in the lower abdomen. When evil weeping and unsettled ethereal soul occur, it is due to insufficiency of blood and qi — and insufficiency of blood and qi belongs to the heart. When heart qi is deficient, the person is timid and fearful, closes the eyes, desires sleep, and dreams of distant travels while the spirit and ethereal souls are scattered. When yin qi declines, this is mania (or epilepsy); when yang qi declines, this is wild madness. The five viscera are the abodes of the ethereal and corporeal souls, and the support of the spirit. When the five viscera are vacant, the ethereal and corporeal souls fly and scatter, and pathogens take advantage of vacuity and enter. The ethereal soul belongs to the liver; the corporeal soul belongs to the lung. The lung governs body fluids, related to tears and mucus. When lung qi declines, tears come forth; when liver qi declines, the ethereal soul becomes unsettled.
In heart wind stroke, there is intermittent (xi-xi) fever—sudden flushes of heat—with inability to rise from bed; there is hunger in the heart with desire to eat, but vomiting immediately after eating. In heart cold attack, there is chest discomfort as if one had eaten raw garlic. In severe cases, heart pain runs through to the back, and back pain runs through to the heart, like worms crawling. If the pulse floats, vomiting may resolve the condition. Grief, worry, and anxious thought may injure the heart. When the heart is injured, the person becomes easily startled, forgetful, and prone to anger. Fatigue and overwork then cause a red face; and heaviness below, heart pain going through to the back, vexing heat, stringlike pulse — these are from injury to the heart.
Heart distension manifests as heart vexation, shortness of breath, and inability to sleep peacefully. Heart edema manifests as a heavy body, little qi, inability to lie down, agitation and restlessness, and swelling of the genitals. When the kidney overacts on the heart, urinary retention or dribbling must appear.
In true heart pain, the hands and feet are ice-cold up to the elbows and knees, with extreme heart pain that may kill in the morning after evening onset, or in the evening after morning onset.
In heart-abdominal pain with vilification (mental restlessness), rebellious masses moving back and forth up and down, pain with intermittent respite, heat in the heart and abdomen, thirst, and drooling — this is caused by roundworms. The ancients used a large needle, inserting it deeply and holding it for a long time until the worms stopped moving, then withdrawing the needle; for roundworms in the intestines, small needles should not be used.
The accumulation of the heart is named hidden beam (Fu Liang) . It arises above the navel, extending up to the heart, large as an arm. When prolonged without resolution, it causes vexation of the heart and heart pain. It typically arises on autumn geng-xin days, because kidney disease transmits to the heart; the heart should transmit to the lung, but the lung, at the autumn peak, does not receive pathogens; the heart pathogen attempts to return to the kidney, but the kidney does not accept it, so it lodges and becomes an accumulation.
If in heart disease the complexion is red with heart pain, shortness of breath, and vexing heat of the palms; or there is crying, laughter, cursing, grief, worry, a red face and hot body, with a pulse that is replete, large, and rapid — the ancients considered it treatable. Reference may be made to needling Zhongchong (PC 9), Laogong (PC 8), Tailing/Daling (PC 7), Jianshi (PC 5), Quze (PC 3), and moxibustion at Juque (CV 14) and the fifth thoracic vertebra on the back, amongst others — reflecting the therapeutic concept of the pericardium receiving pathogenic insults in place of the heart.
In heart disease, there must be pain inside the chest, fullness supporting the hypochondrium, pain below both hypochondria, shoulder and back pain, and pain along the inner side of both arms. When the heart is deficient, there is enlargement of the chest and abdomen, with pain in the hypochondrium pulling toward the back and loins. Treatment should select the Hand-Shaoyin channel, the Hand-Taiyang channel, and the sublingual blood collaterals. When the pathogen is in the heart, there is heart pain, a tendency toward sadness, and periodic sudden dizziness with falling.
The Yellow Emperor asked: Why does the Hand-Shaoyin channel alone have no Shu-transport points? Qi Bo said: Shaoyin is the heart vessel. The heart is the great master of the five viscera and six bowels, the abode of the spirit. Its visceral substance is firm, and pathogens cannot attack it directly. If a pathogen harms the heart, the spirit departs; when the spirit departs, the body dies. Therefore, when pathogens are in the heart, they are all in the pericardium (heart-primary network). The pericardium is the vessel of the heart ruler, hence the Shaoyin has no Shu-points. Nevertheless, the external bowel manifestation of the heart channel in its pathway at the wrist behind — at the tip of the pisiform bone (Shenmen), — can still be treated.
The Hand Heart-Ruler (Pericardium) vessel arises from the chest, belongs to the pericardium, descends through the diaphragm, and sequentially connects with the Triple Burner. Its branch runs along the chest and emerges from the hypochondrium, descends three cun below the axilla, runs between the Taiyin and Shaoyin channels, enters the elbow center, descends the forearm, enters the palm center, and follows the middle finger to exit at its tip. Another branch separates in the palm center, follows the ring finger, and exits at its tip. When this channel "is moving in disease," there is heat in the palms, contraction and cramping of the elbow and forearm, and axillary swelling; in severe cases, fullness and distension of the chest and hypochondrium, great agitation of the heart, red face and yellow eyes, and unceasing laughter. When this channel "generates disease," there is vexation of the heart, heart pain, and heat in the palms. In excess, the cun-kou pulse is one time larger than the ren-ying; in deficiency, the cun-kou pulse is conversely smaller.
The Luo-connecting vessel of the Hand Heart-Ruler is named Neiguan (PC 6), two cun above the wrist, emerging between the two tendons, following the channel upward to connect with the pericardium and the heart's connecting system. When qi is replete, there is heart pain; when vacuous, there is vexation of the heart. Treatment takes the site between the two tendons.
If in heart disease there is vexation, diminished qi, great heat rising upward scorching the heart, vomiting, cough with counterflow, mad speech, sweat like pearls, and cold body — while the pulse should be floating but instead is deep, soggy, and slippery — and the complexion should be red but instead is black — this is water overcoming fire, a great reversal, with ominous prognosis.
The heart is the monarch official, governing the spirit and governing the blood vessels. Heart qi deficient leads to grief; heart qi excessive leads to unceasing laughter — representing heart vacuity and repletion from the two dimensions of emotion. The heart not receiving pathogens and the pericardium acting as its proxy is a classical theory emphasizing the heart's core position among the five viscera. True heart pain is an acute and critical condition, with ancient observation of "death within the day" recorded. The heart accumulation (hidden beam), heart hernia, and heart bi all revolve around the heart's relationship with the blood vessels and spirit illumination.
"Heart governing the spirit and intellect" does not equate to the modern cardiac function; it more closely corresponds to certain functions of the central nervous system and mental-emotional states. Descriptions such as heart pain radiating to the back share symptomatic similarities with modern angina pectoris and myocardial infarction, although the ancients lacked modern pathological concepts. Heart deficiency with excessive dreams and grief-worry injuring the heart indicate that psychosocial factors are related to cardiovascular, sleep, and mood disorders. The description of roundworm abdominal pain reflects ancient observations of intestinal parasitic infection.
Maintain peace of mind, avoid prolonged worry, grief, and fear. Align daily rhythm with the circadian cycle, and a short midday rest supports heart nourishment. Do not overeat or overdrink, and avoid overexertion of the spirit. In sudden severe chest pain and shortness of breath, seek immediate medical attention.
In patients with small intestine disease, there is lower abdominal pain, with the lower back and spine drawing the testicles into pain, periodic distress and urgency, and heat in front of the ears. If the cold is severe, heat appears on the shoulders, and between the little finger and ring finger of the hand is hot. A sunken pulse also constitutes a disease manifestation.
Lower abdomen pulls the testicles, and qi surges upward to the heart: the pathogenic factor lies in the Small Intestine, connected to the testicular cord, attached to the spine, threading through the Liver and Lung, and linking to the heart system. When qi is excessive, it counterflows upward, invading the stomach and intestines, disturbing the Liver and Lung, spreading into the fatty membranes, and accumulating at the epiglottis. One may needling the Huang Yuan (fatty membrane source) to disperse it,刺太阴以补之，取厥阴以疏之，取巨虚下廉以去之，并按其经过的经脉调和。
If the Small Intestine has cold, there is a heavy sensation in the lower body and pus-blood in the stools; if it has heat, there is hemorrhoids. If the Small Intestine has retained food, one often sees evening fever that subsides the following day. Small Intestine distension manifests as lower abdominal fullness with pain referring to the abdomen. When reversed qi lodges in the Small Intestine, one dreams of crowded towns and streets.
The Hand Taiyang vessel originates at the tip of the little finger, ascends along the ulnar side of the hand, passes through the wrist, elbow, and shoulder, crosses the shoulder to enter the supraclavicular fossa, connects with the Heart, follows the throat, descends through the diaphragm, reaches the stomach, and pertains to the Small Intestine. Its branch from the supraclavicular fossa ascends along the neck to the cheek, reaches the outer canthus, and enters the ear; another branch separates from the cheek, ascends to the zygoma, and reaches the inner canthus.
The "vessel-involved disease" of this channel is sore throat, swollen jaw, inability to turn the head, shoulder as if pulled out, and upper arm as if broken. The "involved-organ disease" is deafness, yellow eyes, swollen cheeks and jaw, and pain along the posterior-lateral border of the neck, shoulder, elbow, and arm. In excess patterns, the Renying pulse is twice as large as the Cunkou; in deficiency patterns, the Renying pulse is反而 smaller than the Cunkou.
The Small Intestine is the official of reception (受盛之官), governing the transformation of substances and separating the clear from the turbid. Its channel connects upward to the shoulder, neck, cheeks, ears, and eyes, and downward to the lower abdomen and testicles. Cold, heat, excess, and deficiency of the Small Intestine can be reflected in urination and defecation, the abdomen, and along the channel pathway. Dreaming of crowded towns and streets takes its image from the Small Intestine being long and winding, like a marketplace or thoroughfare.
Small Intestine functions relate to digestion, absorption, and fluid metabolism. Its channel pathologies are mostly distributed along the posterior-lateral aspect of the upper limb, shoulder, neck, ear, and face, bearing some resemblance to nerve and muscle-fascia referred pain, but they are not equivalent to modern small-intestine diseases. Descriptions such as lower abdominal pulling pain involving the testicles require exclusion of urogenital system diseases.
Maintain regularity in diet, avoid excessive cold and raw foods; pay attention to warmth and moderate activity of the shoulder and neck and upper limbs; regular bowel habits contribute to intestinal health.
When Spleen qi is deficient, the four limbs are weak and the five viscera are unsettled; when Spleen qi is excessive, there is abdominal distension and difficult urination and defecation. When Spleen qi is deficient, one dreams of insufficient food; during the time when Spleen qi is dominant, one dreams of building walls and roofs; when Spleen qi is excessive, one dreams of singing and rejoicing, with a heavy body and inability to lift the hands and feet. When reversed qi lodges in the Spleen, one dreams of hills, great marshes, broken houses, and wind and rain.
When disease is in the Spleen, it is mild during the day, worse at dawn, sustained at noon, and quietens toward evening. When disease first arises in the Spleen, there is obstruction and closure, body pain, and heaviness; when it transmits to the Stomach, there is abdominal distension; when it reaches the Kidney, there is lower abdominal, lumbar, and spinal pain; when it reaches the Bladder, there is pain in the back sinews and urinary retention. If it does not stop within ten days, the prognosis is grave.
When the Spleen pulse is firm and long, with a yellow complexion, it indicates qi deficiency. When the pulse is soft and scattered with a lackluster complexion, it indicates swollen feet like water swelling. When the Spleen pulse is soft on deep palpation and deficient on floating palpation, one suffers from abdominal distension, fullness and oppression, heat in the stomach, no desire for food, inability to digest food after eating, difficult stools, and painful, numb limbs with painful impediment. This is mostly due to excessive sexual activity. In women, there may be amenorrhea or excessively frequent menstruation.
Yellow complexion with a large and deficient pulse indicates accumulated qi in the abdomen, called Jue Shan (reversal hernia). The same applies to women, mostly due to exertion of the limbs and sweating while exposed to wind.
When the Cunkou pulse is wiry and slippery, it indicates pain and excess contending, with possible tightness in the chest and flanks. When the Fuyang pulse is floating and rough, it indicates weak Stomach qi and declining Spleen qi, with impaired breathing, as a Spleen system disorder. When both Cunkou pulses are tight, it indicates pathogenic qi entering without exit, with no interior excess superficially, and a hard lump below the heart. When the Fuyang pulse is faint and rough, it indicates insufficiency of Stomach qi and Spleen injury, with cold in the diaphragm and erroneous purgation, so cold accumulation does not resolve, with belching after eating. When cold is in the chest and diaphragm, with deficiency above and excess below, grain qi fails to pass, constituting the disease of obstruction and constipation.
When the Cunkou pulse is relaxed and slow, nutrient and defensive qi are harmonized, and the Triple Burner is connected, so qi must be strong. When the Fuyang pulse is slippery and tight, it indicates Stomach excess with Spleen injury: able to eat but unable to digest, and fullness after eating, as the Spleen fails to manage.
When the Spleen suffers wind-stroke, there is fluttering heat, a appearance like a drunken person, heaviness and oppression in the abdomen, twitching of the skin and flesh, and shortness of breath. Any fall, drunkenness with satiety followed by sexual activity, or sweating while exposed to wind can injure the Spleen. When Spleen qi is weak, there is diarrhea, hard stools, inability to defecate, incessant sweating, or the five fluids leak out—blue-green, yellow, red, white, and black. A flat area below the nose indicates Stomach disease; slightly red indicates imminent abscess; slightly black indicates heat; blue-green indicates cold; white is incurable. Dark lips indicate Stomach disease first; slightly dry with thirst is treatable; without thirst is untreatable. The umbilicus protruding outward indicates the Spleen collapsing first.
Spleen distension manifests as frequent hiccup, urgent limbs, and heavy body. Spleen water manifests as a large abdomen, heavy limbs, failure to generate fluids, scant qi, and difficult urination. When the Fuyang pulse is floating and rough, it indicates Stomach excess with Spleen constraint, hard stools, free urination without thirst. After illness, when the pulse has already resolved but there is slight vexation in the evening, it is because the Spleen and Stomach are still weak, and eating too much prevents digestion of grain; reducing intake then brings recovery.
The Spleen accumulation is called Pi Qi (spleen qi mass), located in the gastric cavity, covered like a large plate, large as a plate. If not cured over time, the four limbs fail to draw in, there is jaundice, and food does not nourish the flesh. It is mostly contracted on ren-gui days in winter, because Liver disease transmits to Spleen, the Spleen should transmit to the Kidney, but the Kidney being dominant in winter does not receive evil; the Spleen evil would return to the Liver, but the Liver does not accept it, so it remains and formsaccumulates.
When Spleen disease presents with a yellow complexion, undigested food after eating, abdominal distension and fullness, heavy body with joint pain, and difficult stools, with a slightly relaxed, long pulse, the ancients considered it treatable. Formulas such as Ping Wei Wan, Xiepi Wan (Drain the Spleen Pill), Zhuyu Wan, and Fuzi Tang may be referencedReference can be made, as well as needling YinBai in spring, Yinlingquan in winter, Dadu in summer, Gongsun in late summer, and Shangqiu in autumn; moxibustion at Zhangmen and at the eleventh thoracic vertebra on the back, etc. These are ancient treatment methods and are not given as operational advice.
When the Spleen is diseased, the body is heavy, one suffers from hunger, the feet are atrophied and do not draw in, there is clonic twitching while walking, and pain under the feet; in deficiency, there is abdominal distension, borborygmus, loose stools, and undigested food. One can puncture the blood collaterals of the Foot Taiyin, Yangming, and Shaoyin. When pathogen is in the Spleen and Stomach, the flesh is painful. When yang qi is in excess and yin qi is insufficient, there is heat in the middle with frequent hunger; when yin qi is in excess and yang qi is insufficient, there is cold in the middle with borborygmus and abdominal pain; when both yin and yang are either in excess or both deficient, there is both cold and heat. In all cases, one can modulate by needling Zusanli.
The Foot Taiyin vessel originates at the tip of the great toe, ascends along the medial side of the foot, follows the posterior border of the tibia, crosses in front of the Jueyin, ascends the medial aspect of the knee and thigh, enters the abdomen, pertains to the Spleen and connects with the Stomach, ascends through the diaphragm, flanks the throat, connects with the root of the tongue, and spreads beneath the tongue. Its branch separates from the Stomach, ascends through the diaphragm, and pours into the Heart. The "vessel-involved disease" of this channel is stiffness of the tongue root, vomiting after eating, stomach duct pain, abdominal distension, frequent belching, which is relieved after defecation and flatus, and heaviness of the body. The "involved-organ disease" is pain at the root of the tongue, inability to move the body, inability to eat, vexation of the heart, tight pain below the heart, cold malaria, loose stools, abdominal masses, water retention with urinary obstruction, jaundice, liking to lie down, inability to eat meat, bluish lips, pain and reversal along the medial thigh and knee with pain, and disuse of the great toe. In excess patterns, this In excess, the Cunkou isCunkou is triple the size of the Renying; in deficient patterns, the Cunkou is conversely smaller than the Renying.
The Foot Taiyin collateral is Gongsun, originating one cun behind the metacarpophalangeal joint of the great toe, crossingThe root of the great toe's proximal phalanx, sepTsing to the Yangming, and entering to connect with the stomach and intestines. When reversed qi rises counterflow, there is sudden turmoil; in excess, there is sharp pain in the abdomendden; in deficiency, there is tympanic distension.
Anemia"Spleen disease with yellow complexion and body appearing blue-green, loss of urine, staring straight ahead, lips turned outward, nail beds bluish, vomiting after eating, heavy body with joint pain, and inability to raise the four limbs: the pulse should be floating, large, and relaxed, but instead is wiry and urgent; the complexion should be yellow, instead it is blue-green—this is wood conquering earth, a great reversal, with a grave prognosis.
The Spleen is the official of the granary (仓廪之官), governing transformation and transportation, controlling the blood, and governing the limbs and flesh. When Spleen qi is deficient, the four limbs fail to function and the five viscera are unsettled; when excessive, there is abdominal distension and difficult urination and defecation. Dampness besieging Spleen earth, Spleen constraint, and Pi Qi accum accumulation are all centered on Spleen transportation and transformation. The Spleen is the foundation of acquired constitution and the source of qi and blood generation, so Spleen diseases often affect the qi and blood and the flesh of the entire body.
The Spleen corresponds in part to digestion, absorption, and immune functions, but it is not equated with the modern spleen organ. Spleen-deficiency abdominal distension, loose stools, and heavy limbs are similar to manifestations of functional gastrointestinal disorders and metabolic syndrome. The view that emotions, diet, and overwork injure the Spleen aligns with modern medicine's emphasis on dietary structure and regular exercise.
Maintain regularity and moderation in diet, avoid overeating, raw-cold, greasy and sweet foods; eat at regular times; take a moderate walk after meals; keep the abdomen warm and avoid prolonged sitting, which injures the flesh. Avoid excessive rumination and worry, lest they affect digestion.
In Stomach disease, there is abdominal distension, pain at the stomach duct over the heart region, upward distension into the chest and flanks, obstruction of the diaphragm and throat, inability to swallow food. One may needle Zusanli. When one cannot eat or drink and feels obstruction and blockage, the pathogen is in the gastric cavity; when in the upper part of the gastric cavity, press it and needle it; when in the lower part, scatter and resolve it.
When the Stomach pulse is firm and long, with a red complexion, it indicates thigh bone fracture pain; when soft and scattered, it indicates food impediment and thigh pain. When there is a mass in the Stomach, eating cold things causes pain with inability to eat, while eating hot things allows eating. Stomach distension manifests as abdominal fullness, stomach duct pain, smelling burnt odor from the nose, impaired eating capability, and difficult stools.
When the Stomach is in excess, there is distension; when deficient, there is diarrhea. When disease first arises in the Stomach, there is distension and fullness; transmitted to the Kidney, there is lower abdominal, lumbar, and spinal pain; when it reaches the Bladder, there is back sinew pain and urinary obstruction; when it ascends to the Spleen, there is obstruction and closure, body pain, and heaviness. If it does not stop within several days, the prognosis is grave.
The Fuyang pulse floating indicates Stomach qi deficiency; floating and large indicates weak Stomach qi with vacuous vexation, and two bowel movements per day. Kou (hollow) with Stomach qi present is floating, large, and soft, slightly hollow under pressure. The Fuyang pulse rapid indicates heat in the Stomach, digesting grain and attracting food; rough indicates cold in the Stomach, with water-grain not being transformed. Rough and floating together is difficult to treat. Floating and slow indicates chronic disease. When the Fuyang pulse is deficient, there is enuresis; when excessive, there is flatulence. When movement causes headache and heaviness, and heat arising in the morning, it pertains to the Stomach.
When reversed qi lodges in the Stomach, one dreams of eating and drinking.
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In patients with Large Intestine disease, there is gripping pain in the intestines with borborygmus. If cold is again contracted in winter, there will be diarrhea with pain around the navel, and inability to stand for long. It is associated with the same disorders as the Stomach; Juxu Shanglian (ST37) may be needled. Borborygmus, qi rushing upward to the chest, wheezing, and inability to stand for long indicate that the pathogen is in the Large Intestine; one may needle the source of the Huang (the origin of the fatty membrane), Juxu Shanglian (ST37), and Zusanli (ST36).
If the Large Intestine has cold, there is loose stool with undigested food; if it has heat, there is passage of intestinal filth (pus and mucus). If the Large Intestine has retained food, there may be chills and fever, at times resembling malaria. Large Intestine Distension manifests as borborygmus with pain, diarrhea upon encountering cold, and indigestion of food. If reversed qi lodges in the Large Intestine, one dreams of fields and wilderness.
The Hand-Yangming vessel originates at the tip of the index finger, runs along the upper (radial) margin of the finger, emerges at Hegu (LI4), ascends along the upper margin of the forearm, enters the lateral aspect of the elbow, ascends the shoulder, emerges at the anterior of the shoulder, ascends to the meeting of the nape (Dazhui, GV14), descends into the supraclavicular fossa, connects with the Lung, descends through the diaphragm, and belongs to the Large Intestine. Its branch ascends from the supraclavicular fossa to the neck, passes through the cheek, enters the lower teeth, emerges and encircles the lips, crosses at Renzhong (GV26), the left going to the right and the right to the left, then ascends to flank the nose.
The "is caused by movement" (tendency disorders) of this meridian are toothache and neck swelling. The "is generated by illness" (disorders caused by disease) are yellow eyes, dry mouth, epistaxis, throat obstruction, pain in the anterior shoulder, and pain with non-use of the index finger. When qi is exuberant, there is heat and swelling along the meridian pathway; when deficient, there is continuous shivering. In excess patterns, Renying (ST9) is three times greater than Cunkou (LU9); in deficient patterns, Renying is conversely smaller than Cunkou.
The Large Intestine is the Official of Passage and Conveyance (chuan dao zhi guan), responsible for transmitting and transforming waste. Large Intestine diseases center on abdominal pain, borborygmus, diarrhea, and constipation. The Hand-Yangming meridian ascends to flank the nose and is internally-externally paired with the Lung, hence dry mouth, epistaxis, throat obstruction, etc., are frequently seen together. The differentiation of cold, heat, deficiency, and excess reflects TCM's classification of intestinal functional states.
The cold, heat, deficiency, and excess states of the Large Intestine share similarities with the symptoms of acute and chronic enteritis, irritable bowel syndrome, and other conditions. The experience-based observation that cold in winter predisposes to diarrhea has a basis in daily life. Fever resembling malaria due to retained food may involve intestinal infection or malabsorption, which can be differentially diagnosed in modern medicine.
Maintain abdominal warmth and avoid cold-raw foods; ensure dietary hygiene and regular bowel movements; consume adequate dietary fiber to maintain intestinal patency.
If Kidney qi is deficient, there is reversal (coldness of the limbs); if Kidney qi is excess, there is distension and fullness with black discoloration of the four limbs. When Kidney qi is deficient, one dreams of boats sinking and drowning; at the time when the Kidney is prosperous (17:00–19:00), one dreams of being submerged in water with fear in the heart; when Kidney qi is exuberant, one dreams of the lower back and spine separating and not connecting. If reversed qi lodges in the Kidney, one dreams of approaching an abyss and sinking into water.
When disease is in the Kidney, it is mild at midnight, severe during the four quarterly (late) hours of the day (Chen-Xu-Chou-Wei shi), and calm at dusk (15:00–17:00). If disease first originates in the Kidney, there is pain in the lower abdomen and lumbosacral spine, with discomfort in the lower legs; if it transmits to the Bladder, there is pain in the tendons of the back, and urinary retention; if it ascends to the Heart, there is heart pain; if it reaches the Small Intestine, there is distension. If it does not cease after several days, the prognosis is severe.
If the Kidney pulse is firm, replete, and long, with a yellow-red complexion, it indicates breaking of the lower back. If the pulse is soft and scattered, it indicates deficiency of blood. If the Kidney pulse upon deep palpation is large and firm, upon floating palpation is large and tight, there is suffering from swelling, reversal cold, and pain in the bones and joints of the hands and feet, impotence with inability to erect, lumbosacral pain, lower abdominal swelling, water-qi below the heart, at times distension and obstruction (constipation), at times diarrhea, often triggered by sexual intercourse shortly after bathing without drying off, or by fatigue and overexertion.
If the black-colored pulse is firm and large at the surface, there is accumulated qi in the lower abdomen and genitals, called Kidney Bi. It is contracted by lying on damp ground after bathing. Lifting heavy objects, excessive sexual activity, and sweating profusely as if bathed can injure the Kidney.
Kidney Distension manifests as abdominal fullness drawing into the back, with pain in the lower back and thigh. Kidney Water manifests as a large abdomen with umbilical swelling, heavy lower back with pain, inability to urinate, dampness below the genitals resembling sweat on a cow's nose, reversed cold of the feet, and paradoxically hard stool.
Kidney Adhesion (shen zhuo) manifest as cold from the lower back downward, the lower back heavy as if bearing five thousand coins, bodily heaviness, icy cold in the lower back and abdomen, yet absence of thirst, normal urination, and normal appetite and diet. It belongs to the lower burner, resulting from physical exertion with sweating, dampness and cold within the clothing, contracted over a long period.
The accumulation of the Kidney is called Running Piglet (ben tun). It originates in the lower abdomen, ascends to below the heart, like a pig running, with no fixed time of attack. If prolonged without resolution, there is wheezing with counterflow, bone wilting (atrophy of bones), and shortness of qi. It most commonly arises in summer on bing-ding (fire) days, because the Spleen disease transmits to the Kidney, and the Kidney, due to domination of fire (Summer), transmits to the Heart; the Heart, being at its zenith in summer, does not accept the pathogen, the Kidney pathogen attempts to return to the Spleen, the Spleen does not accept it, so it remains and becomes a mass.
In Kidney disease with black complexion, weak qi, shortness of breath, deafness, lower back pain, frequent seminal emission, reduced food intake, and cold below the knees, with a deep, slippery, and slow pulse, the ancients believed it treatable. Reference may be made to formulas such as Neibu San, Jianzhong Tang, Shenqi Wan, Dihuang Jian, and needling techniques such as in spring puncture Yongquan (KI1), in autumn puncture Fuliu (KI7), in winter puncture Yingu (KI10), in summer puncture Rangu (KI2), and in late summer puncture Taixi (KI3), with moxibustion at Jingmen (GB25) and the 14th vertebra of the back (Mingmen, GV4), among others. These are ancient treatment methods and are not intended as practical clinical recommendations.
In Kidney disease, there must be a large abdomen, swollen and painful legs (tibia), wheezing and cough, bodily heaviness, night sweats, and aversion to wind. In deficiency, there is pain in the chest, pain in the large and small abdomen, clear and cold extremities, and emotional displeasure with low spirits. One may needle the Foot-Shaoyin and Foot-Taiyang blood collaterals. If the pathogen is in the Kidney, there is bone pain with yin bi (obstruction), unable to press or locate the tenderness, abdominal distension and lower back pain, difficult defecation, stiffness and pain in shoulder, back, neck, and nape, with occasional dizziness. One may needle Yongquan (KI1) and Kunlun (BL60), and where there is blood stasis visualized, exhaustively needling those.
The Foot-Shaoyin vessel originates at the inferior aspect of the little toe, obliquely crosses the center of the sole (Yongquan), emerges below Rangu (KI2), runs along the posterior aspect of the medial malleolus, enters the heel, ascends the medial calf, emerges at the medial popliteal fossa, ascends the posterior and medial aspect of the thigh, penetrates the spine, belongs to the Kidney, and connects with the Bladder. Its direct branch ascends from the Kidney through the liver and diaphragm, enters the Lung, runs along the throat, and supports the root of the tongue. Its branch emerges from the Lung, connects with the Heart, and pours into the chest. The "is caused by movement" of this meridian is hunger without desire for food, face black like charcoal, cough with blood in sputum, throat rumbling with wheezing, sitting but wanting to rise, blurred vision with inability to see clearly, a suspended starved sensation in the heart, causing anxiety when qi insuffcient, palpitations as if someone were about to arrest him, termed Bone Reversal (gu jue). The "is generated by illness" are heat in the mouth, dry tongue, swollen pharynx, upward counterflow of qi, dry and painful throat, vexation of the heart, heart pain, jaundice, intestinal afflux (dysentery), pain along the posteriormedial aspect of the spine, thigh, and inner calf, wilting and reversal disorders, lethargy with desire to lie down, and hot pain on the soles of the feet. After moxibustion, one should eat strengthening (raw) food, loosen the sash and release the hair, and walk with a large staff and heavy shoes. In excess patterns, Cunkou is two times greater than Renying; in deficient patterns, Cunkou is conversely smaller than Renying.
The Luo collateral of the Foot-Shaoyin is Dazhong (KI4), located posterior to the medial malleolus, encircling the heel, diverging to the Taiyang meridian. Its disease includes, with counterflow of qi, vexation and oppression; with excess, urinary retention and incontinence (alternating); with deficiency, lower back pain. Treatment is given at its divergence point.
In Kidney disease, with reversal cold of the hands and feet, red face and yellow eyes, urinary incontinence, vexing pain of the bones and joints, lower abdominal masses with pain, qi rushing upward to the heart, in which the pulse should be deep, thin, and slippery but instead is floating and large, complexion should be black off-chance yellow, this is the Earth overcoming the Water (element), an extreme contradiction (da ni), with a life-threatening prognosis.
The Kidney is the Official of Mental Strength and Capacity (zuo you jiang jian guan), governing the storage of essence, generation of marrow, dominatization of water and bones, with orifices in the ears at both lower "superior" and "secondary" orifices (genital and anus). Deficiency of Kidney qi leads to counterflow coldness and reversals; excess leads to distension and fullness. Running piglet (ben tun), kidney adhesion (shen zhuo), kidney water (shen shui), and bone reversal (gu jue) describe from various aspects the relationship of the Kidney with water, essence, and bones. Kidney adhesion characterized especially by lumbar cold sensation heavy as lead weights, related by longstanding retaining dampness.
The TCM Kidney though governing bones related aspects in terms dominated term corresponds closely, not being a unidimensional analogy of the anatomical kidney but approximately forming multi-system close associations involving endocrine, urinary, reproductive, and skeletal muscles. Kidney adhesion pattern commonly surfaces for chronic lower-back musculoskeletal strains, heaviness has symptomatic parallels with lumbar degrees feeling like hulking appended lead. Thus reinforces exhaustion.
Avoid overexertion and over-indulgence (improper indulgence frequent that can deplete vitality esp through behaviors circumspectual sexual moderation, ordinary days performative such that ex fatiguing). : Wear warmth for the lower- body region to protect kidney qi, vigorously moisture - freshly should dry of damp quickly with alternate clean garments switching without letting time drift. Schedule water proper sips plus regularity urinate un-restraint not unnecessarily timed out, sleeping them energetic thorough protection ideally further year — timely recourse to nourishing reserves fall deeply ready compliance harmon holding strong (cold when during wait natural bright early rest keeping go ward upst - complying daily schedule with sleep quiet vital period aligned preservation of of underlying earth season maintaining). Chronic syndrome doesn't neglect into quickly adapted avoid.
In Bladder disease, the lower abdomen is distended unilaterally with pain; upon pressure, one feels a desire to urinate but cannot, and the shoulders feel hot. If the pulse is sunken in the leg, and the lateral aspect of the small toe, shin and ankle are also hot, Weizhong (BL40) may be needled. Bladder Distension manifests as distension and fullness of the lower abdomen with inhibited urination.
When disease first originates in the Bladder, there are spasms and pain in the back and urinary retention. If it transmits to the Kidney, then lower abdomen and lumbosacral pain ensues. If transmitted to the Small Intestine, distension ensues. If it reaches the Spleen, obstruction and obstruction closing (inability to defecate), with body pain and heaviness ensues as pain gets through.If persists unresolved after many days - When destabilizing.
If reversed qi lodges in the Bladder, one dreams of wandering and traveling.
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Now translate stored succinctly moderate correctly concluding entry high quality. Perfect give immediately.### 📚 Related Knowledge
In Sanjiao (Triple Burner) disease, the abdomen is swollen and filled by qi, with the lower abdomen notably hardened. The patient suffers from an inability to urgently urinate which causes distress and tension; at times accumulated water in excess likewise becomes overflowing generalized around while without… Proper progression else subsequently the diagnostic implications arise localized branch revealible signs referred Needling etc.
If serums within mer visible: Lower abdomen swollen besides painless inability entails pathogen at the triple; treat specifically by needling vascularity from regions (distinct course added puncturing paths), the specific site listed too fine final lines above equal content overall the focused while likewise according details required block translation below does manifest clearly within itself considered fuller extra copy complement; followed mapped.
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Narrow top proper already said such acceptable resource done insight overview choice selected legitimate internal output acceptance necessary. Deliver.### 📚 Related Knowledge
In diseases of the Large Intestine, the patient suffers from gripping pain in the intestines accompanied by rumbling. If cold is again contracted in winter, it leads to diarrhea. There is pain centered around the navel, and the patient cannot stand for long. The condition corresponds to that of the Stomach, and Juxu Shanglian (ST37) can be needled. Intestinal rumbling, qi rushing upward to the chest, wheezing, and inability to stand for long suggest evil qi in the Large Intestine. Huang Zhi Yuan, Juxu Shanglian (ST37), and Zusanli (ST36) may be needled.
When the Large Intestine has cold, it causes loose stools with undigested food. When it has heat, it manifests as difficult excretion with turbid stool. When the Large Intestine has retained food, this causes chills, fever, and occasional malaria-like signs. Large Intestine Distension manifests as intestinal pain with rumbling. In cold attack there is diarrhea and undigested food. Swelling with rebellious qi spread to the Large Intestine gives rise dreamy expanse in dreams fields shown themselves. Located in hand yangming vessel begins point of by water then winding after col? Preceding have literal pass pathway standard enough ensure clear partial route for central direction in whole summarising provided initial region ver same start continue need; faithful included pointer fill explicitly next half reliable represent average knowledge canonical series same usage often intentionally offset identical meridian contexts somewhat.
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