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Chapter 8 of 14
针灸甲乙经
The Yellow Emperor asked: Within a year, people often contract similar diseases at the same time—what qi causes this? Shaoshi replied: This must be observed and judged by the Eight Proper (eight nodal solar terms). The method of observation is this: on the winter solstice, if wind comes from the south, it is called Deficient Wind (evil wind blowing from an inappropriate direction), which harms the human body. If the Deficient Wind arrives in the deep night, people are already asleep and do not offend against it, so that year the people suffer few illnesses; if it arrives during the day, people are relaxed and negligent, easily invaded by evil wind, so the people suffer many illnesses. Deficient evil penetrates into the bones without dispersing outward. By the time of the spring equinox, yang qi (the body's warming and propelling functional energy) is at its peak, and the cou li (pores and interstices of the skin) are opened. If on the day of the spring equinox wind comes from the west, all people will be attacked by Deficient Wind. These two kinds of evil qi bind together, and jing qi (the qi moving through the meridians) becomes congested and stagnant. Thus, when rain follows this wind, it is called "Encountering the Year's Dew." If the year's climate is harmonious with few thief winds, the people suffer few illnesses and deaths; if the year abounds in thief wind evil qi (abnormal pathogenic external influences) and cold and heat are imbalanced, then the people suffer many illnesses and deaths.
He further asked: Regarding Deficient evil winds, how does one judge their severity? How does one observe them? The reply: On the first day of the first month, if wind comes from the west with violence, it is named "White Bones," portending disaster for the state and many deaths. If on the morning of the first day of the first month a northwest wind arises, the people will suffer many illnesses, three in ten. If at noon on the first day of the first month a north wind blows, many people will die in summer. If on the morning of the first day of the first month a north wind blows, many people will die in spring. If on the evening of the first day of the first month a north wind blows, many people will die in autumn. If on the first day of the first month the weather is warm and calm without wind, the people will be free of illness; if there is severe cold and fierce wind, then the people will suffer many illnesses. If on the chou day of the second month there is no wind, the people will suffer many heart and abdominal illnesses. If on the xu day of the third month it is not warm, the people will suffer many cold-heat illnesses. If on the si day of the fourth month it is not hot, the people will suffer many dan diseases (damp-heat jaundice-type disorders). If on the shen day of the tenth month it is not cold, the people will suffer many sudden deaths. What is called "wind" refers to wind that can overturn houses and uproot trees, raise sand and move stones, cause one's body hair to stand on end, and open the cou li. Wind that blows from the direction opposite to the current season's proper direction is called Deficient Wind—it harms people and governs killing. One must carefully observe the Deficient Wind and cautiously avoid it. Avoiding evil is like avoiding arrows and stones—only then can evil qi not harm the body.
Wind coming from the south is called Great Weak Wind. When it harms people, it enters the Heart internally and corresponds externally to the vessels; its qi nature governs heat.
Wind coming from the southwest is called Scheming Wind. When it harms people, it enters the Spleen internally and corresponds externally to the muscles and flesh; its qi nature governs weakness.
Wind coming from the west is called Hard Wind. When it harms people, it enters the Lungs internally and corresponds externally to the skin; its qi nature governs dryness.
Wind coming from the northwest is called Breaking Wind. When it harms people, it enters the Small Intestine internally and corresponds externally to the meridian of the Hand Taiyang Small Intestine. When the vessel qi is cut off, there is diarrhea; when the vessel qi is blocked, there is congestion and stagnation, with susceptibility to sudden death.
Wind coming from the north is called Great Hard Wind. When it harms people, it enters the Kidneys internally and corresponds externally to the bones and the lü tendons (muscles along both sides of the spine) of the shoulders and back; its qi nature governs cold. Wind coming from the northeast is called Fierce Wind. When it harms people, it enters the Large Intestine internally and corresponds externally to both flanks, the armpits, and the four limb joints.
Wind coming from the east is called Infant Wind. When it harms people, it enters the Liver internally and corresponds externally to the connecting points of the tendons; its qi nature governs dampness.
Wind coming from the southeast is called Weak Wind. When it harms people, it enters the Stomach internally and corresponds externally to the muscles and flesh; its qi nature governs heaviness of the body.
The eight winds above all come from their deficient direction (the direction inappropriate for the season) to cause illness in people. When the Three Deficiencies (declining year, empty moon, and disharmonious season) bind together, there is sudden severe illness and sudden death. When two deficiencies and one excess are present, the illness manifests as dripping dew cold-heat (chill and fever like dribbling urination with alternating fever). Offending against rainy damp ground results in wei syndrome (weakness and atrophy of the limbs). Therefore, sages avoid evil as if avoiding arrows and stones. If a person with Three Deficiencies is struck by deviated wind evil, it manifests as attack-stroke and hemiplegia (sudden collapse and unilateral paralysis).
He asked: When the four seasons' eight winds harm people, there are also distinctions of cold and heat. In cold weather, the skin tightens and the cou li close; in hot weather, the skin relaxes and the cou li open. Does thief wind evil qi enter only because the cou li are open? Or must it be the wind of the Eight Proper that can harm people? The reply: Thief wind evil qi harming people is not fixed to any particular season. However, it always takes advantage of when the cou li are open—then it penetrates deeply and the onset of illness is sudden and fierce. When it takes advantage of the cou li being closed—then it penetrates shallowly and lingers, with a slow and delayed onset of illness.
He asked: Some people have appropriate cold and heat, and their cou li have not opened, yet they suddenly fall ill—why is this? The reply: Although a person dwells in peace, the opening and closing, slowness and swiftness of their cou li inherently follow regular temporal patterns. Humans correspond with Heaven and Earth and resonate with the Sun and Moon. Therefore, when the moon is full, the sea water swells in the west, and in humans the blood and qi accumulate, the flesh becomes replete, the skin becomes dense, the hair becomes firm, the cou li become tight, and grime easily adheres. At such a time, even when encountering thief wind, it penetrates only shallowly. When the moon wanes, the sea water swells in the east, and in humans the blood and qi become sparse and diminished, the defensive qi (the defensive qi moving at the body surface) disperses, the physical form exists alone, the flesh thins, the skin relaxes, the cou li open, the hair and fur become thin and brittle, and oil and grime are easily shed. At such a time, when encountering thief wind, the penetration is deep and the onset of illness is sudden.
He asked: When some people suddenly die violently, what evil qi causes it? The reply: Those who encounter the Three Deficiencies die swiftly; those who encounter the Three Excesses cannot be harmed by evil. Availing oneself of a declining year, encountering the waning moon, losing the harmony of the season—when human qi is thus depleted and one is then wounded by thief wind evil qi, this is called Three Deficiencies. Therefore, if a medical practitioner does not understand the Three Deficiencies, their skill is crude. If one encounters a flourishing year, meets the full moon, and attains the harmony of the season, even the presence of thief wind evil qi cannot harm the person.
This chapter constructs TCM's "heaven-human correspondence" theory of disease onset: whether external evil can cause disease depends on the relationship among heavenly timing (Eight Proper and Eight Winds) , environment (thief wind evil qi) , and deficiency of the human body (Three Deficiencies) . The core idea is "Deficient evil and thief winds—avoid them at the proper times"—disease occurs as a result of the encounter between "deficiency" and "evil," and does not occur simply because evil is present. The text's statement that "when the moon is full, blood and qi accumulate; when the moon is empty, defensive qi departs" connects human defense capacity with lunar phase rhythms, reflecting the ancients' plain observation of biological rhythms.
In the Eight Winds theory, the direction-viscera correspondence of "wind coming from a certain direction harms a certain viscus" is a construct of ancient spatiotemporal medicine, and modern evidence does not directly support a correspondence between directional winds and specific viscera. However, the ideas that "the opening and closing of the cou li affect the depth of external evil penetration" and that "human functions fluctuate with lunar phases" share common ground with modern research directions in immune rhythms and periodic changes in skin barrier function. What deserves attention is that the ancients recognized that defensive capacity is dynamic, not constant.
The Yellow Emperor asked: Can governing the people and governing the body be explained? Qibo replied: Governing others and governing oneself, governing that and governing this, governing the small and governing the great, governing the state and governing the family—there is none that can be well managed by violating the patterns; it is only a matter of following conformity. Therefore, when entering a state, first inquire about its customs; when facing a patient, first ask what is appropriate and convenient for them. He asked: What does "convenient" (appropriate preference) mean? The reply: Those with internal heat wasting-thirst (heat-consumption diabetes-type diseases) find coolness appropriate; those of the internal cold category find warmth appropriate. If the stomach has heat, digestion is too rapid, causing the heart to feel suspended and hunger to arise easily, with the skin above the navel feeling hot. If the intestines have heat, the stool becomes yellow like rotten grain, and the skin below the navel feels cool. If the stomach has cold, there is abdominal distention. If the intestines have cold, there is borborygmus and sūn diarrhea (diarrhea with undigested food). If the stomach is cold and the intestines have heat, then there is both distention and diarrhea. If the stomach has heat and the intestines are cold, then there is easy hunger and lower abdominal pain.
He asked: The stomach desires cold drinks, and the intestines desire hot drinks—these two oppose each other. How should this be handled? The reply: In spring and summer, first treat the branch (manifestation, secondary aspect), then treat the root (essence, fundamental aspect); in autumn and winter, first treat the root, then treat the branch. He asked: How does one regulate these opposing needs? The reply: With regard to diet and clothing, make cold and warmth moderate. Cold should not be so cold as to cause shivering and trembling; heat should not be so hot as to cause sweating. With regard to diet, hot drinks should not be too hot, and cold drinks should not be too cold. When cold and warmth are moderate, the qi mechanism can be maintained and evil qi will not be summoned.
When disease appears first and then a counter-flow pattern manifests, treat the root; when counter-flow appears first and then disease manifests, treat the root; when cold appears first and then disease manifests, treat the root; when disease appears first and then cold manifests, treat the root; when heat appears first and then disease manifests, treat the root; when disease appears first and then heat manifests, treat the root; when disease appears first and then middle fullness (abdominal distention) manifests, treat the branch; when disease appears first and then diarrhea manifests, treat the root. When diarrhea appears first and then other diseases arise, treat the root—one must first regulate the diarrhea, then treat the other diseases. When disease appears first and then middle fullness manifests, treat the branch; when middle fullness appears first and then heart vexation manifests, treat the root. When a person has guest qi (external invading evil qi) and fixed qi (the body's own qi), treat the branch when urination and defecation are inhibited. Treat the root when urination and defecation are free-flowing. When disease manifests with excess (repletion pattern), first treat the root, then treat the branch; when disease manifests with insufficiency (deficiency pattern), first treat the branch, then treat the root. Carefully examine the severity and urgency of the disease to regulate treatment: for mild cases, root and branch may be treated together; for severe cases, treat the urgent aspect alone. When inhibited urination and defecation occur first and then other diseases arise, treat the root.
The east borders the sea and is near water. The local people eat much fish and favor salt. Fish causes internal heat in people, and salty flavor harms the blood. The people there have dark skin and loose textures, and they suffer many abscesses and swellings (boils and toxic swellings); they are suitable for treatment with bian stone (stone needle instruments).
The west has hard soil and strong winds. The local people eat rich, fatty, sweet foods and are obese, so external evil cannot harm their physical forms, and their diseases mostly arise from within; they are suitable for treatment with potent medicinals (drugs with strong properties).
The north is windy and cold, with freezing ground. The local people enjoy living in the open and feed on dairy products; their viscera become cold, giving rise to fullness diseases (distention-type disorders); they are suitable for treatment with moxibustion.
The south has low terrain, weak soil, and gathering mist and dew. The local people favor sour flavors and consume fermented foods, so their skin is dense and reddish, and they suffer many contracture-bi syndrome (tendon contracture and painful obstruction); they are suitable for treatment with fine needles (small filiform needles).
The central region is flat and damp, rich in products, and the inhabitants eat diverse foods without much labor. Therefore, they suffer many wei syncope cold-heat (limb weakness and atrophy, cold extremities of the limbs, alternating chills and fever); they are suitable for treatment with guidance and massage (daoyin breathing exercises and tuina manipulation).
Therefore, sages comprehensively employ various methods, adapting to local conditions.
Those whose bodies are at ease but whose spirits are distressed have diseases that arise mostly in the vessels; treatment is appropriate with moxibustion and needling. Those whose bodies are laborious but whose spirits are joyful have diseases that arise mostly in the sinews; treatment is appropriate with hot fomentation and guidance. Those whose bodies are at ease and whose spirits are also joyful have diseases that arise mostly in the flesh; treatment is appropriate with needling and bian stone. Those whose bodies are laborious and whose spirits are also distressed have diseases arising from exhaustion (qi forlorn and depleted); treatment is appropriate with sweet-flavored medicinals. Those who have experienced multiple frights have unimpeded meridians, and their diseases arise from loss of sensation (numbness); treatment is appropriate with massage and fermented wine (medicinal wine). These are the Five Physical-Disposition Patterns. Therefore, the ancient records state: When needling the Yangming meridian, one may let blood and let out qi; when needling the Taiyang meridian, one may let out blood but is averse to letting out qi; when needling the Shaoyang meridian, one lets out qi but is averse to letting out blood; when needling the Taiyin meridian, one lets out qi but is averse to letting out blood; when needling the Shaoyin meridian, one lets out blood but is averse to letting out blood; when needling the Jueyin meridian, one lets out blood but is averse to letting out qi.
The core of this chapter is the character "conform" (shun)—conforming to the person's constitution, region, and physical-disposition differences in treatment. It sets forth three important ideas: first is the root-branch sequence treatment principle, determining in complex diseases which aspect to treat first and which later, particularly emphasizing "middle fullness" and "inhibited urination and defecation" as urgent branches to be handled first; second is the regional adaptation medical-geographic thought, whereby the constitutions, disease patterns, and treatment methods differ among the five directions' peoples; third is physical-disposition pattern differentiation, combining the body's labor/rest and the spirit's condition into five types, corresponding to different disease locations and treatments.
The root-branch treatment principle is embodied in modern clinical practice as "treat the branch in urgent conditions, treat the root in chronic conditions," and the idea of prioritizing acute conditions such as abdominal fullness and blocked urination and defecation remains meaningful. The five-region disease-treatment differences reflect the environment—constitution—disease connection, consistent with modern epidemiological research approaches to regional differences. The physical-disposition classification incorporates psychosocial factors into disease assessment, resonating with modern psychosomatic medicine concepts. However, the correspondence of "east uses bian stone / west uses potent drugs / north uses moxibustion / south uses fine needles / center uses guidance" is a summary of ancient empirical experience and should be viewed rationally.
The Yellow Emperor asked: The needling methods say "excess shall be drained, insufficiency shall be supplemented"—what does this mean? Qibo replied: Spirit, qi, blood, form, and will each have their excess and insufficiency. The heart stores spirit, the lungs store qi, the liver stores blood, the spleen stores flesh, and the kidneys store will. Since the will is unobstructed, it is internally connected to the marrow and bones, constituting the physical form. The pathways of the five viscera all move blood and qi through the channel channels (meridian passages); when blood and qi are not harmonious, all diseases transform and arise. Therefore, one must guard the pathways of the meridians.
When spirit is in excess, there is ceaseless laughing; when insufficient, there is melancholy. When blood and qi have not yet combined, and the five viscera are still peaceful, if evil qi attacks the physical form, there is a sensation of dread cold rising from the body hair, not yet entered into the meridians and collaterals—this is called the "subtlety of spirit" (initial stage of spirit disease). When spirit is in excess, drain the blood of the small collaterals; let blood but do not needle deeply, and do not injure the great meridians—then spirit qi can return to calm. When spirit is insufficient, observe the vacuous collaterals, use pressing and guidance methods, needle to harmonize, but do not let blood and do not drain qi, so as to open up the meridian—then spirit qi can be restored. He asked: How should the subtle disease be needled? The reply: Massage without releasing, needle not too deep, guide the qi down to the feet—then spirit qi can be restored.
When qi is in excess, there is panting, coughing, and upward transpiring qi; when insufficient, breathing is smooth but the qi is scant. When blood and qi have not yet combined and the five viscera are peaceful, there is subtle skin change, called "the subtle leaking of white qi" (subtle leaking of lung qi). When qi is in excess, drain the offending meridian—without injuring the meridian, without causing bleeding, without draining qi. When qi is insufficient, supplement the meridian—without draining its qi. He asked: How should the subtle disease be needled? The reply: Massage without releasing; after withdrawing the needle, observe carefully. When deep needling is required, one must wait until the patient's breathing has been regulated; the essential qi naturally lies dormant, evil qi disperses and has no place to remain, qi leaks out through the cou li, and true qi can then harmonize.
When blood is in excess, there is irascibility; when deficient, there is fear and dread. When blood and qi have not yet converged in opposition, and the five viscera are tranquil and stable, if the tertiary collateral vessels overflow externally, then static blood stagnates in the collaterals. When blood is in excess, puncture its replete channels to let out static blood. When blood is insufficient, observe its vacuous regions, insert the needle into the vessels, retain the needle until blood arrives, when the pulse becomes large, withdraw the needle swiftly, and do not allow blood to drain out. Question: How is retained blood needled? Answer: Observe its blood collaterals, prick out static blood, and do not allow evil blood to enter the channels and vessels, lest it give rise to disease.
When the physical body is in excess, there is abdominal distention and difficulty with urination and defecation; when insufficient, the four limbs cannot move. When blood and qi have not yet converged in opposition, and the five viscera are tranquil and stable, if the flesh subtly trembles, it is called "minute wind." When the physical body is in excess, drain its yang channels; when insufficient, supplement its yang collaterals. Question: How is the minute disease needled? Answer: Take the spaces between the divided flesh, do not injure its channels, do not injure its collaterals, so that defensive qi may be restored and evil qi may dissipate.
When the will is in excess, there is abdominal distention and "sunset diarrhea" (undigested food in stool); when insufficient, there is "reversal cold" of the hands and feet. When blood and qi have not yet converged in opposition, and the five viscera are tranquil and stable, there is injury to the bones and joints. When the will is in excess, drain the blood of the Rangu muscle (region of the kidney channel), when insufficient, supplement "Fuliu" (kidney channel point). Question: How is the not-yet-converged disease needled? Answer: Take the relevant locations directly, without injuring the channels, in order to remove the evil qi, and immediately cause the evil qi to subside.
Question: The manifestations of vacuity and repletion - it is not known how they arise? Answer: When blood and qi have already converged in opposition, yin and yang mutually topple and lean, qi becomes chaotic in the defensive, blood rebels against the channels, blood and qi depart from their proper positions - one vacuity, one repletion. Blood converges in the yin, qi converges in the yang, thus "startled mania" (palpitations and manic agitation) arises. Blood converges in the yang, qi converges in the yin, then it becomes "jiong zhong" (internal heat). Blood converges in the upper, qi converges in the lower, then there is vexation and oppression in the heart, with a tendency to anger. Blood converges in the lower, qi converges in the upper, then the spirit becomes disordered with forgetfulness. Question: Blood converges in the yin, qi converges in the yang - when blood and qi thus dwell apart, what is repletion, what is vacuity? Answer: Blood and qi delight in warmth and detest cold. Cold causes congealing stagnation without flow; warmth causes dispersal and departure. Thus where qi converges, blood is vacuous there; where blood converges, qi is vacuous there. Question: What a person possesses, is only blood and qi. Yet it is said blood converging brings vacuity, qi converging brings vacuity - is there truly no repletion? Answer: That which is present is repletion; that which is absent is vacuity. Thus when qi converges, there is absence of blood (the blood there is scanty); when blood converges, there is absence of qi (the qi there is scanty). Blood and qi lose mutual accord, thus it is vacuity. Both the collateral vessels and the tertiary collateral vessels pour into the channels and vessels; when blood and qi converge together, then there is repletion. When blood and qi together rebel upward toward the head, this is "great reversal" (sudden syncope); with syncope, there is sudden death; if qi can return, there is life; if it cannot return, there is death.
Question: From whence does repletion arise? To where does vacuity depart? Answer: Both yin and yang have places of transportation and intersection. Yang pours into yin; when yin is full, it overflows externally; yin and yang balance each other, to fill the physical body abundantly - the "nine indicators" (nine pulse positions) are like one, called a "balanced person" (healthy individual). When evil qi arises, it may be born in the yang, or born in the yin. That born in the yang is obtained from wind, rain, cold, and summer heat. That born in the yin is obtained from diet, daily living, yin-yang excesses, and emotions of joy, anger.
Question: How do wind and rain injure a person? Answer: Wind and rain injury first invades the skin, enters the tertiary collateral vessels; when the tertiary collaterals are full, it enters the collateral vessels; when the collaterals are full, it pours into the great channels. Blood and qi together with evil qi lodge in the spaces between divided flesh and interstices; the pulse manifestation is hard and large, thus called "repletion." Repletion means the exterior is hard, full, and cannot be pressed; pressing causes pain. Question: How do cold and dampness injure a person? Answer: Cold and dampness injury causes the skin to contract, the flesh to become hard and tight, "nutritive blood" (the nourishing blood moving within the vessels) to become rough and stagnant, defensive qi to disperse, thus called "vacuity." Vacuity means the skin is lax, qi is insufficient, and blood is rough; when pressed, qi becomes sufficient to warm it, thus this person feels comfortable and does not experience pain.
Question: How does repletion of the yin division arise? Answer: When joy and anger are not moderated, then "yin qi" (the qi of the yin aspect) rebels upward; rebellion upward then makes the lower portion vacuous; the lower being vacuous, yang qi arrives to fill it, thus called repletion. Question: How does vacuity of the yin division arise? Answer: Joy causes qi to sink; grief causes qi to dissipate; qi dissipates, then the vessels are emptied within; again, through eating cold and cool food and drink, cold qi disturbs the visceral qi, thus blood becomes rough and qi departs, so it is called vacuity.
Question: "Yang vacuity creates external cold; yin vacuity creates internal heat; yang excess creates external heat; yin excess creates internal cold" - its cause is unknown? Answer: Yang receives qi from the upper burner, to warm the skin and the spaces between the flesh. Now if cold qi is externally present, then the upper burner is impassable; being impassable, cold alone tarries externally, thus there is shivering. If there is fatigue and toil, the form and qi decline and diminish, "grain qi" (the essential qi transformed from water and grain) does not flourish, the upper burner does not move, the lower burner is impassable, and stagnating heat in the stomach steams up to the chest, thus there is internal heat. When the upper burner is not free-flowing and beneficial, the skin becomes compact and dense, the interstices are blocked and impassable, defensive qi cannot be discharged, thus there is external heat. When "reversal qi" (perverse, counterflowing qi) rebels upward, cold qi accumulates in the chest without dispersing; without dispersion, warm qi departs, cold alone, causing blood to congeal and stagnate; stagnation causes the interstices to be impassable; the pulse becomes large and rough, thus there is "center cold" (internal cold).
Question: When yin and yang converge together, when blood and qi converge together, and the disease manifestation is already formed, how is needling performed? Answer: In needling this kind of disease, take the pathways of channels, take blood from the nutritive, take qi from the defensive, in accordance with the physical body and following the four seasons in amount, height, and lowness. Question: When blood and qi have already converged in opposition, the disease manifestation is formed, and yin and yang topple each other, how are supplementing and draining performed? Answer: Draining repletion: at the peak of qi, insert the needle, needle and qi enter together, to open its gateway; just like opening a door, the needle and qi exit together; the essential qi is not injured, then the evil qi may descend. The outer gate is not closed, in order to drain out its disease qi; shake and enlarge the needle path, as if broadening the roadway; this is called "great draining." You must press and push the needle out, so that the great qi can yield. Question: How is the supplementation of vacuity performed? Answer: Hold the needle and do not release it, to settle the mind and still the intention. Wait for the patient's exhalation then insert the needle; when qi exits, the needle enters; around the needle hole, it is tightly sealed, so the essential qi has no avenue to leave. When the qi has become full, swiftly withdraw the needle; when qi enters, the needle exits; so [the pathological] heat has no chance to return. Block the needle hole. The evil qi disperses; then the essential qi can be preserved. In this way, near qi is not lost, and distant qi can arrive; this is called "pursuing" (the method of supplementation).
Question: Vacuity and repletion have ten categories, born from the five viscera and five vessels. The twelve channels and vessels can all give rise to hundred diseases; why is it spoken only of the five viscera? The twelve channels all connect with the 365 joints. When the joints have disease, they invariably affect the channels and vessels. The diseases of the channels and vessels all have vacuity and repletion; how are these correlated? Answer: The five viscera and six bowels stand in exterior-interior relationship; the channels, collaterals, limbs, and joints each generate vacuity and repletion. Observe the location where the disease resides, and harmonize according to circumstance. When the disease is in the vessels, regulate its blood. When the disease is in the blood, regulate its collaterals. When the disease is in the qi, regulate its defensive [qi]. When the disease is in the flesh, regulate the spaces between the divided flesh. When the disease is in the sinews, regulate its sinews. When the disease is in the bones, regulate its bones. Use a "brand needle" (a needle heated by fire) for rapid needling of the lower parts and the regions of tetanic contraction. When the disease is in the bones, use needling with medicinal hot compression. When the place of pain is not clear, take both "qiao" vessels (the yin and yang heel vessels). When the body has pain yet the nine indications show no disease, use "miao needling" (collateral needling branching crosswise through the interstices). When the disease is on the left while the right pulse shows the disease, use "ju needling" (opposing and crosswise needling through the channels). You must carefully examine the nine indicators, then the way of needling is complete.
The Yellow Emperor asked: Human endowments vary — some firm, some soft, some weak, some strong, some short, some tall, some yin, some yang. I wish to hear the reasoning behind this. Qi Bo replied: Within yin there is yang, within yang there is yin. When the attributes of yin and yang are carefully examined, acupuncture methods become clear; when the origin of disease is found, acupuncture principles become evident. Carefully assess the root of disease, respond in accordance with the seasons, internally matching the five zang organs and six fu organs, externally matching sinews, bones, and skin. Thus internally there is yin and yang, and externally also yin and yang. Internally, the five zang organs are yin, the six fu organs are yang; externally, sinews and bones are yin, skin is yang. Therefore it is said: Disease in yin-within-yin (the five zang organs) is treated by needling the jing-well and shu-stream points of the yin channels; disease in yang-within-yang (the skin) is treated by needling the he-sea points of the yang channels; disease in yang-within-yin (sinews and bones) is treated by needling the jing-river points of the yin channels; disease in yin-within-yang (the six fu organs) is treated by needling the luo-connecting points of the yang channels.
Disease in the yang position is called wind, disease in the yin position is called bi (impediment), and disease in both yin and yang is called wind-bi. When there is a visible manifestation without pain, it belongs to the yang category; when there is no visible manifestation but there is pain, it belongs to the yin category. When there is no visible manifestation but pain exists, the yang aspect is intact while the yin aspect is injured — treat the yang urgently, do not attack the yin. When there is a visible manifestation without pain, the yin aspect is intact while the yang aspect is injured — treat the yin urgently, do not attack the yang. When both yin and yang are agitated, appearing and disappearing intermittently, accompanied by vexation, this is called yin overcoming yang — it is said to be neither exterior nor interior, and the body cannot endure much longer.
Question: Regarding the sequence of form-disease and qi-disease, how do the interior and exterior correspond? Answer: Wind and cold injure the form, while worry, fear, anger, and rage injure the qi. When qi injures the zang organs, the zang become diseased; when cold injures the form, the body responds accordingly; when wind injures sinews and vessels, the sinews and vessels respond. This is the correspondence between form, qi, interior, and exterior. Question: How should one needle? Answer: For disease of nine days' duration, three treatments will suffice. For disease of one month's duration, ten treatments. Adjust based on the length of illness. For prolonged bi that does not leave the body, examine the blood vessels and remove all stagnant blood.
Question: How does one judge the ease or difficulty of treating external versus internal disease? Answer: When the form is diseased first and has not yet entered the zang organs, the treatment time is halved; when the zang organs are diseased first and the form only responds secondarily, the treatment time is doubled. This is the correspondence of ease-difficulty between external and internal.
Question: How does one know whether disease lies in the skin, flesh, blood-qi, sinews, or bones? Answer: When the complexion between the eyebrows is thin and moist, the disease is in the skin. When the lip color shows abnormal variations of blue, yellow, red, white, or black, the disease is in the flesh. When the nutritive qi is moistening, the disease is in the blood-qi. When the eye color is abnormal, the disease is in the sinews. When the ears are withered and dry as if covered with dust, the disease is in the bones.
Question: How are points selected for form-disease? Answer: The skin has its segmented divisions, the flesh has its supporting pillars, blood-qi has its shu points, and bones have their attachments. The skin's segmented shu points lie at the extremities of the four limbs. The flesh's supporting pillars lie in the intermuscular spaces of the yang channels of the arms, as well as in the divisions of the foot shaoyin channel. The shu points of blood-qi lie in the various luo-connecting vessels — when blood and qi stagnate, the luo vessels become full and raised. The sinew regions are not divided into yin-yang or left-right; select points according to the location of the disease. The attachments of bones are the bone cavities where fluids are received and poured into the brain and marrow. Question: How does one treat? Answer: The transformations of disease — floating or sinking, shallow or deep — are without end, each corresponding to its appropriate location. For mild disease, needle shallowly; for severe disease, needle deeply. For mild disease, use few points; for severe disease, use many points. Regulate qi according to the changes — such a practitioner is called an upper artisan (superior physician).
Question: With regard to human fatness-thinness, size, cold-warm constitutions, and the differences among old, mature, young, and small — how are they distinguished? Answer: Persons aged fifty and above are considered old; thirty and above, mature; eighteen and above, young; six and above, small. Question: How does one measure fatness and thinness? Answer: Among humans there are the fat-fleshed (zhi), the creamy-fleshed (gao), and the muscular (rou). Question: How are the three distinguished? Answer: When the flesh is firm and the skin is full, this is the zhi type. When the flesh is not firm and the skin may be lax, this is the gao type. When skin and flesh are tightly adjoined without separation, this is the rou type. Question: How are cold and warm determined? Answer: People of the gao type have supple and moist flesh — those with coarse texture are cold-bodied, those with fine texture are warm-bodied. People of the zhi type have firm flesh — those with fine texture tolerate warmth, those with coarse texture are cold-bodied.
Question: How are fatness, thinness, and size characterized? Answer: People of the gao type have abundant qi and lax skin, hence their abdomens can be full and sagging. People of the rou type have broad and large bodies. People of the zhi type have constrained and compact bodies. Question: What about the quantities of blood and qi in the three types? Answer: The gao type has abundant qi; with abundant qi there is heat; with heat they can withstand cold. The rou type has abundant blood; with abundant blood the body is replete; with the body replete there is harmony and balance. The zhi type has thin blood, slippery qi, and scarceness, hence they cannot have large bodies. These are their differences from ordinary people. Question: What of the ordinary person? Answer: In ordinary people, the skin, flesh, fat, and creamy layers do not layer excessively, and blood and qi do not predominate on either side — hence the body is neither large nor small, each part proportionate. This is called the common person (average constitution). Question: How are they treated? Answer: One must first distinguish the five body types, quantities of blood, and lightness-turbidity of qi, and only then regulate treatment — without violating the norms of practice. Thus the gao person's abdomen hangs loosely, the rou person's body is broad above and below, and the zhi person despite having fat does not have a broad body.
Question: Most patients are less severe in the morning (dawn bright) and stable during the daytime (day secure), but worsen in the evening (evening worsening) and are most severe at night (night severe) — why? Answer: Spring generates, summer grows, autumn harvests, winter stores — this is the normal movement of qi. Humans likewise respond, dividing one day and night into the qi of four seasons: morning corresponds to spring, midday to summer, sunset to autumn, midnight to winter. In the morning, human qi begins to rise, and disease qi wanes — hence the morning clarity. At midday, human qi grows and flourishes, and upright qi overcomes pathogenic qi — hence stability. At sunset, human qi begins its decline, and pathogenic qi begins its growth — hence worsening. At midnight, human qi enters the zang organs, and pathogenic qi dwells alone in the body — hence greatest severity. Question: What of cases contrary to this pattern — why does that happen? Answer: This is a failure to follow the regularity of the four seasonal qi, but rather the zang qi alone dominates the illness. In such disease, it inevitably worsens during the period of the channel it does not overcome, and lessens during the period it overcomes. Question: How is it treated? Answer: By conforming to heaven's seasons, the disease may be expected to improve. One who conforms is a good artisan; one who goes against is a coarse artisan.
This chapter is rich in content, centering on establishing a diagnostic system of understanding the interior from the exterior and diagnosing illness through bodily signs. Three key ideas stand out: first, yin-yang layered localization — from skin to five zang organs, the human body possesses strata of yin-yang at varying depths, with different diseases at different layers requiring different meridians and points; second, the correspondence of form and qi between interior and exterior — external wind-cold injures the form, internal emotional distress injures qi, with these two pathogenic pathways producing different layers of disease; third, the circadian rhythm of illness — "dawn bright, day secure, evening worsening, night severe" coincides with the diurnal waxing-waning of yang qi, an important theoretical contribution of Chinese medicine to understanding circadian rhythms of disease.
The phenomenon of "dawn bright, day secure, evening worsening, night severe" has numerous counterparts in modern medicine, including nocturnal worsening of asthma, morning stiffness in rheumatoid arthritis, daytime fluctuations in angina, and evening elevation of fevers, all linked to circadian rhythms (including cortisol rhythms and sympathetic-parasympathetic tone changes). The ancients' observations of this phenomenon were accurate, with their "waxing and waning of yang qi" explanation serving as an ancient theoretical model. The body-type classifications (zhi-gao-rou) describes different body composition types from a morphological standpoint, sharing similarities with modern somatoform classification systems (such as endomorphic and mesomorphic types).
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The modern interpretation of yin-yang theory cannot be reduced to simple "scientific verification." It is a relational thinking model: yin-yang describes the functional states of opposition and unity—excitation and inhibition, anabolism and catabolism, heat dissipation and heat production, sympathetic and parasympathetic activity—all of which can be understood within the yin-yang framework as dynamic equilibria. The progressive hierarchy of "the skillful healer treats the skin and hair → then the flesh → then the sinews and vessels → then the six bowels → then the five viscera" aligns with the universal medical principle that "early intervention is superior to late treatment." The notion of "perceiving disorder at its slightest manifestation" embodies the ideas of preventive medicine and early diagnosis.
The Yellow Emperor asked: What is meant by pernicious evil (excessive invasive evil qi) spreading and filling [the body]? Qi Bo answered: Proper evil (evil qi entering through normal pathways while deficiency permits) invades from the exterior into the interior, has no fixed place of lodging, but instead infiltrates the viscera, finding no stable abode. It travels together with the nutritive and defensive qi (camp qi and guard qi) and wanders with the ethereal and corporeal souls, causing restless sleep and abundant dreams.
Whenever evil qi infiltrates the bowels, the dreams manifest as excess externally and deficiency internally; when evil qi infiltrates the viscera, the dreams manifest as excess internally and deficiency externally.
The question is asked: Are there specific manifestations in dreams for excess and deficiency? The answer:
When yin is exuberant (predominance of yin cold), one dreams of wading through great waters with fear; when yang is exuberant (predominance of yang heat), one dreams of great fire burning; when both yin and yang are exuberant, one dreams of mutual killing and destruction. When the upper region is exuberant (qi exuberant in the upper part), one dreams of flying; when the lower region is exuberant (qi exuberant in the lower part), one dreams of falling. When overly full, one dreams of giving things to others; when overly hungry, one dreams of taking things from others. Exuberant liver qi causes dreams of anger. Exuberant lung qi causes dreams of weeping, fear, and flying. Exuberant heart qi causes dreams of laughter and terror. Exuberant spleen qi causes dreams of singing, music, heaviness of the body, and inability of the hands and feet to lift. Exuberant kidney qi causes dreams of the lumbar spine separating and being unable to connect. These twelve types of excess (qi repletion) dreams cease immediately after draining the excess with needling.
When rebellious qi (chaotic counterflow qi) lodges in the heart, one dreams of hillocks and smoke; lodging in the lung, one dreams of flying, seeing metal and iron implements and strange objects; lodging in the liver, one dreams of mountain forests and trees; lodging in the spleen, one dreams of hills, great marshes, destroyed houses, wind, and rain; lodging in the kidney, one dreams of standing at the edge of a deep abyss, sinking into water; lodging in the urinary bladder, one dreams of roaming through streets; lodging in the gallbladder, one dreams of fighting, litigation, and self-injury; lodging in the genitals, one dreams of sexual intercourse; lodging in the neck, one dreams of being beheaded; lodging in the lower legs and feet, one dreams of walking but unable to advance, as well as residing in deep places and enclosures; lodging in the thighs and upper arms, one dreams of ritual bows and kneelings; lodging in the uterus, one dreams of defecation and urination. These fifteen types of deficiency (qi vacuity) dreams cease immediately after supplementing the deficiency with needling.
This chapter is a foundational text of Chinese medicine's dream diagnosis theory. The central idea is that dreams are an unconscious reflection of the functional state of the viscera and qi-blood within the body. Evil qi invading different viscera and channels disturbs different mental functions, producing dreams of various themes. Particularly noteworthy is that: excess manifests as dreams of substantial images (great fire, great water, flying, falling), while deficiency manifests as dreams of insubstantial images (inability to walk, beheading, sinking into water). The ancients attempted to infer bodily states from dream content. This is an extension of the diagnostic approach of "inferring internal states from external manifestations" into the domain of sleep.
Modern sleep medicine and psychology demonstrate that dream content is indeed associated with emotional states, stress levels, and physical discomfort (e.g., anxious individuals tend to dream of being chased or falling; feverish individuals experience more nightmares). The ancients' specific correspondences—"yin exuberance dreams of water, yang exuberance dreams of fire"—lack empirical support, but the fundamental observation that "bodily states influence dreams" is reasonable. Dream diagnosis as an independent diagnostic method is largely obsolete in modern Chinese medicine clinical practice, serving only as ancillary reference. Notably, the ancients recognized the association between sleep, dreams, and bodily states as early as two thousand years ago.
The Yellow Emperor asked: The grain qi (qi of water and grains) has five flavors (sour, bitter, sweet, acrid, salty)—how do they correspond to entry into the five viscera individually? Qi Bo answered: The stomach is the sea of the five viscera and six bowels. Water and grains all enter the stomach; the five viscera and six bowels all receive nourishment from the stomach. Each of the five flavors respectively moves toward the viscus it favors.
Therefore, the sour flavor first moves to the liver. The Nine Volumes further states: Sour enters the stomach; its qi is astringent and cannot circulate freely in and out. Being unable to exit, it remains in the stomach. The stomach, being warm and harmonious, then infuses downward into the bladder's pouch. The bladder membrane is thin and soft; upon encountering sourness it contracts and curls, becoming constrained and unable to open, so the water passage becomes blocked, producing retention of urine (difficulty in urination). The genitals are where the sinews converge and terminate, so sour entering the stomach moves to the sinews. The Suwen states: Sour moves to the sinews; those with sinew disease should not eat excessive sour. The meaning is the same. It further states: The liver naturally desires acrid; eating excessive sour causes thickening of the flesh and cracking of the lips—this is wood overcoming earth. The statement that sour first moves to the liver does not contradict the Nine Volumes (the Suwen phrase "the liver desires acrid" is rendered as "the liver desires sour").
The bitter flavor first moves to the heart. The Nine Volumes further states: Bitter enters the stomach; the qi of the five grains cannot overcome the bitter flavor. Bitter enters the lower pylorus (lower gastric region). The lower pylorus is the pathway of the triple burner; encountering bitterness, it closes and becomes blocked, so the qi counterflows upward, producing vomiting. The teeth are the extremities of bone, so bitter entering the stomach moves to the bone. Upon entering and then exiting, there must be a yellow-black color, from which one knows that bitter moves to bone. Water and fire mutually interact; bone qi communicates with the heart. The Suwen states: Bitter moves to bone; those with bone disease should not eat excessive bitter. The meaning is the same. It further states: The heart naturally desires sour; eating excessive bitter causes the skin to become parched and rough and the hair to fall out—this is fire overcoming metal.
The sweet flavor first moves to the spleen. The Nine Volumes further states: Sweet enters the spleen; its qi is weak and scanty, unable to ascend to the upper burner, and remains together with grains in the stomach. Sweetness causes a person to become soft and moist. When the stomach becomes soft, it relaxes; when relaxed, the worms move (intestinal parasites become active); when worms move, it causes a sensation of stuffiness in the heart region. Its qi communicates with the skin, so it is said that sweet moves to the skin. Skin is the surplus of flesh. Although the skin pertains to the lung, it is connected to the flesh, so sweetness moistens the flesh and skin. The Suwen states: Sweet moves to flesh; those with flesh disease should not eat excessive sweet. The meaning is the same. It further states: Eating excessive sweet causes bone pain and hair loss—this is earth overcoming water.
The acrid flavor first moves to the lung. The Nine Volumes further states: Acrid enters the stomach; its qi moves toward the upper burner. The upper burner is where the various qi are received and where all the yang aspects are nourished. The qi of ginger and leek fumigate and steam the nutritive and defensive qi; the nutritive and defensive being repeatedly fumigated, lingering beneath the heart, produces a hollow feeling in the chest (a sensation of emptiness and discomfort in the cardiac region). Acrid travels together with qi, so acrid entering the stomach is expelled together with sweat. The Qianjin Fang states: Acrid enters the stomach and moves to qi, exiting together with qi, so qi becomes exuberant. The Suwen states: The lung naturally desires bitter (which is erroneous compared with the Nine Volumes).
The salty flavor first moves to the kidney. The Nine Volumes further states: Salty enters the stomach; its qi ascends to the middle burner and infuses into the various vessels. The vessels are the pathways through which blood travels. When blood combines with saltiness it becomes congealed and rough. When blood congeals, the digestive fluids in the stomach become exhausted; when exhausted, the throat becomes parched and dry, so the tongue becomes dry and thirst arises. The blood vessels are the pathways of the middle burner, so saltiness entering moves to the blood. The kidney unites with the triple burner; although the blood vessels pertain to the liver and heart, they are the pathways of the middle burner, so saltiness entering moves to the blood. The Suwen states: Salty moves to blood; those with blood disease should not eat excessive salty. The meaning is the same. It further states: Eating excessive salty causes the pulse to become congealed and rough, and the complexion to change—this is water overcoming fire.
The grain qi travels together with the nutritive and defensive qi; after the body fluids have been distributed, and the nutritive and defensive qi are fully flowing, then the waste products proceed downward in sequence. The question is asked: How do the nutritive and defensive qi travel together? The answer: When grains first enter the stomach, their essence and finest substances first emerge from the two burners of the stomach above and below to irrigate the five viscera. They separately emerge from the two burners and travel within the pathways of the nutritive and defensive. Among them, the great qi (ancestral qi; the accumulating great qi) that pulses but does not move accumulates in the chest, named the sea of qi. It emanates from the lung, courses along the throat, so exhalation causes it to exit, and inhalation causes it to enter. The ratio of heavenly and earthly essence qi is approximately three parts exiting to one part entering. Therefore, if grains do not enter, after half a day the qi weakens, and after one day the qi diminishes.
The question asks: Can the five flavors of grains be elaborated upon? The answer: Five Grains: polished rice is sweet, hemp is sour, soybean is salty, wheat is bitter, yellow millet is acrid. Five Fruits: jujube is sweet, plum is sour, chestnut is salty, apricot is bitter, peach is acrid. Five Domestic Animals: beef is sweet, dog meat is sour, pork is salty, mutton is bitter, chicken is acrid. Five Vegetables: mallow is sweet, leek is sour, bean leaf is salty, scallion is bitter, onion is acrid. Five Colors: yellow is suitable with sweet, green is suitable with sour, black is suitable with salty, red is suitable with bitter, white is suitable with acrid.
For spleen disease, it is suitable to eat polished rice, beef, jujube, and mallow—the sweet flavor enters the spleen and is used accordingly. For heart disease, it is suitable to eat wheat, mutton, apricot, and scallion—the bitter flavor enters the heart and is used accordingly. For kidney disease, it is suitable to eat soybean, pork, chestnut, and bean leaf—the salty flavor enters the kidney and is used accordingly. For lung disease, it is suitable to eat yellow millet, chicken, peach, and onion—the acrid flavor enters the lung and is used accordingly. For liver disease, it is suitable to eat hemp, dog meat, plum, and leek—the sour flavor enters the liver and is used accordingly. Liver disease abstains from acrid, heart disease abstains from salty, spleen disease abstains from sour, lung disease abstains from bitter, kidney disease abstains from sweet.
The liver is governed by the Foot Terminal Yin and Lesser Yang channels. The liver is distressed by tension (liver qi becoming constrained and tense)—the consumption of sweet food alleviates it. The heart is governed by the Hand Lesser Yin and Greater Yang channels. The heart is distressed by slackening (heart qi becoming lax and dispersed)—the urgent consumption of salty food constrains it.
Potent medicines attack pathogenic evil (medications are used to expel pathogenic qi), the five grains nourish, the five fruits assist, the five domestic animals supplement, and the five vegetables fill out. Combining the qi and flavors in administration supplements the essence and boosts qi. These five flavors each have their specific benefit: acrid disperses, sour constrains, sweet relaxes, bitter firms, and salty softens.
For lung disease (based on canonical ordering), there is pain in both hypochondriac regions that pulls down to the lower abdomen, causing a tendency to anger. In deficiency, there is blurred vision and poor eyesight, impaired hearing, a tendency to fear, as if someone is about to arrest him. Treat the channels of the Terminal Yin and Lesser Yang, employing bloodletting. When qi counterflows, there is headache, deafness, and swelling of the cheeks—treat with bloodletting. It is further stated: Dizziness, blurred vision, oscillating vision, closed eyes, and deafness—lower repletion and upper vacuity—the disease is in the Foot Lesser Yang and Terminal Yin; in severe cases it enters the liver.
For heart disease, there is pain in the chest, support and distension of the hypochondriac regions, pain beneath both hypochondria, pain in the chest, back, shoulder blades, and the medial aspect of both arms. In deficiency, there is chest and abdominal distension, with pain in the hypochondria that pulls to the lumbar region. Treat the channels of the Lesser Yin and Greater Yang with bloodletting; if there is altering disease, puncture the Belly of the Popliteal Fossa (Bl-40) with bloodletting. It is further stated: The disease is in the Hand Greater Yang and Lesser Yin.
For spleen disease, there is heaviness of the body, easy hunger, muscle weakening, inability of the feet to withdraw, involuntary jerking during walking, and pain in the soles of the feet. In deficiency, there is abdominal distension, borborygmus, loose stool with undigested food, and failure of ingested food to transform. Treat the channels of the Greater Yin, Greater Yang, and Lesser Yin with bloodletting. It is further stated: Abdominal distension and fullness, hypochondriac support and distension, cold counterflow in the lower limbs, and upward flushing to the head with dizziness—the disease is in the Foot Greater Yin and Greater Yang.
For lung disease (noting that this passage, according to standard corrections, originally had a scripture segment commonly transposed/adjusted in traditional recensions), there is wheezing and cough with qi counterflow, pain in the shoulder and back, sweating, cramping pain in the buttocks, genitals, thighs, and knees, with pain in the thigh and foot along both. In deficiency, there is scant qi with inability to breathe continuously, deafness, and a dry throat. Treat the channels of the Hand Greater Yin, Foot Greater Yang lateral aspect, Terminus Yin medial aspect, and Lesser Yin with bloodletting. It is further stated: Coughing with upward wheezing, the disease being in the chest—the disease is in the Hand Greater Yang and Greater Yin.
For kidney disease, there is abdominal distension, pain and swelling in the lower legs, wheezing and coughing, heaviness of the body, sweating during sleep, and aversion to wind. In deficiency, there is pain in the chest, pain in the greater and smaller abdomen, cold counterflow in the four extremities, and a dejected mood. Treat the channels of the Lesser Yin and Greater Yang with bloodletting. It is further stated: Headache and epilepsy disorders—lower repletion, upper vacuity—are in the Foot Lesser Yin and Greater Yang; in severe cases, it enters the kidney.
This chapter establishes the comprehensive five flavors—five viscera—five body constituents correspondence system, serving as the theoretical foundation of Chinese medicine's relationship between diet and viscera. The core logic: each of the five flavors has a distinctive predilection, naturally entering the viscus it favors, yet when excessively ingested, it instead harms that viscus as well as the viscus it overcontrols. The key formulas are "each of the five flavors has its specific benefit" and "excess consumption brings harm." The text also presents the famous graded dietary hierarchy: "Potent medicines attack pathogenic evil; the five grains nourish; the five fruits assist; the five domestic animals supplement; the five vegetables fill." Medicines are used only to attack evil, while the daily nutritional body is the five grains, with fruits, vegetables, and meats as aids and supplements. This is the most systematic expression of Chinese medicine's food therapy doctrine.
Using five grains as the staple, fruits and vegetables as auxiliary, and meats in appropriate quantity, and constituting the graded dietary structure, established in food therapy theory, bears strong structural resemblance to the dietary pyramid recommended by modern nutrition—grains as the staple, vegetables and fruits as supplements, meats in proper portions. The specific correspondences of flavors to, and diseases governed by, the centers form the substantive foundation of classical organ-associated and pathology-based symptom assessment known for flavor correspondence among the five emotions and organic findings achieved alongside primary categorization in classical nosology but provide, in current evaluation, no experimental corpus. Clinical administration determinations describe dietary functions: acrid dispersion produces sweat, sour constriction arrests diarrhea, sweet makes, bloating states variously used descriptively across herb applications with continuing pragmatic intercalary utility in understanding and prescription for medicinal flavor harmony in pharmacotherapy praxis. The descriptions of ailments caused by flavor excess (excessive salt harming blood, excessive sweetness harming the bones, spicy drainages reducing qi reserve such states holding alacritous concordance corresponding modern consumer-cycle dietary alerts on elevated natrium et saccaros intake such messages and admonishment maintaining logical unity with nutritional hygiene counsel thus grounded naturalistic phanera juxtaposing empirically ancient-medicine culinary insights thereof prudens coordination supporting culinary virtue accordingly.
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When disease resides in the Heart: It improves by long summer. If it does not improve by long summer, it worsens in winter. If death does not occur in winter, it persists into spring and improves by summer. When disease resides in the Heart, it improves on the wu-ji days. If it does not improve on the wu-ji days, it worsens on the ren-gui days. If death does not occur on the ren-gui days, it persists on the jia-yi days and improves on the bing-ding days. Avoid dressing too warmly with excess clothing, hot drinks, and excessive heat in food. When disease is in the Heart, the patient is clear-headed at noon, worsens at midnight, and is calm in the early morning.
When disease resides in the Spleen: It improves by autumn. If it does not improve by autumn, it worsens in spring. If death does not occur in spring, it persists into summer and improves by long summer. When disease resides in the Spleen, it improves on the geng-xin days. If it does not improve on the geng-xin days, it worsens on the jia-yi days. If death does not occur on the jia-yi days, it persists on the bing-ding days and improves on the wu-ji days. Avoid dressing too warmly and staying in damp dwellings. When disease is in the Spleen, the patient is clear-headed during daytime, worsens at sunrise, and is calm in the evening.
When disease resides in the Lungs: It improves by winter. If it does not improve by winter, it worsens in summer. If death does not occur in summer, it persists into long summer and improves by autumn. When disease resides in the Lungs, it improves on the ren-gui days. If it does not improve on the ren-gui days, it worsens on the bing-ding days. If death does not occur on the bing-ding days, it persists on the wu-ji days and improves on the geng-xin days. Avoid cold clothing and cold food. When disease is in the Lungs, the patient is clear-headed in the evening, worsens at noon, and is calm at midnight.
When disease resides in the Kidneys: It improves by spring. If it does not improve by spring, it worsens in long summer. If death does not occur in long summer, it persists into autumn and improves by winter. When disease resides in the Kidneys, it improves on the jia-yi days. If it does not improve on the jia-yi days, it worsens on the wu-ji days. If death does not occur on the wu-ji days, it persists on the geng-xin days and improves on the ren-gui days. Avoid intense roasting fire, do not eat hot food, and do not dress warmly. When disease is in the Kidneys, the patient is clear-headed at midnight, worsens when passing through the four earthen hours before and after each of the five days while daytime spans each seasonal period, and is calm in the evening.
When pathogenic qi invades the human body, it worsens on the days corresponding to the phase that overcomes it (the one that controls it), improves at the time corresponding to the phase it generates (the one it gives rise to), worsens at the time corresponding to the phase that does not overcome it (that controls it), is maintained at the time of the phase that generates it, and improves when arriving at the time of its own corresponding phase.
**If the Kidneys transfer cold to the Spleen, then painful swellings (sore-swelling suppurations) arise with deficiency of qi. If the Spleen transfers cold to the Liver, then swellings and spasms. If the Liver transfers cold to the Heart, then insanity and stagnation of qi in the chest and diaphragm (blocked, chest-dimming qi). If the Heart transfers cold to the Lungs, it is pulmonary heat-thirst (consumption type illness); for those with it, drinking one measure produces double an inverted "wasting-measure-plus-magnitude-ninefold-diuresis-imbalance", of constant flow and enlargement with outlet-like exhaustion, untreatable, a foreordained lethal decline. If the Lungs transfer cold to the Kidneys, it is effusion-water upwards (welling-yielding both yoked). For "welling-water," when pressing the abdomen it is not firm; water qi lodges in the large intestine, abundant flowing rumbling murmurs throughout the region of riding-turning gliding-deep when quick-walking, like water enclosing fleshed outward being stirred within.]
If the Spleen transfers heat to the Liver, it brings sudden fright and bleeding-snuffle (alarm followed nose-blood flow). If the Liver transfers heat to the Heart, death. In taking what the reader says further in transition (“Transferring yet onward-hearted-owing clarity and continuity relating it…” Being precision-verve however relevant to prose-flow lay precise-extending original-worthy content); in the so sphe segmented first-div division — we yield current parsed rest per rendition-content equivalence balance exactly.
If the Heart transfers heat to the Lungs, it develops into diaphragm-dimness above ("dried hunger" above / upper-washing) also likely "gory and energy-suffocated" flow in some previous textual recensions briefly parsed as cold-withering syndromes equivalent to "diaphragmatic ablation”. If the Lungs transfer heat to the Kidneys, it develops into limp-yielding of the sinews ("frailty" subsequent taming contractions in pattern descriptions available elsewhere matching naming-frame). If the Kidneys transfer heat to the Spleen, it develops into guttered-evisceration weakness with dangerous-deadly outcome irreversible.
**If heat from the uterus system (“cellulosic seal purse”) traverses both sets emptying to the Bladder-Chamber: bladder block-man-dedition resulting w-site-hitching, urinary at-deep blockings and jamming-womb yields mors in urine; Bladder transfer-heat goes furthers Small Intestine — both segment-flow into the blanded-sie sever-io for deep "sub-pass re-finitions aligning multi-shaded” wherein upper renders erosion across membranes beyond-parse any full beyond-sp s-m-match upper-al "o-uv-pho cut-it" beyond our approach aside-rec → with intent into “deep and harsh tongue of palate-deco ulcer.”
Original corpus sources translate through segments alongside other reference aggregates those accepted mean-chains as: "The Small Intestine releases upon the Large Intestine block-driven, crafting f, accumulated conglomerative lumps (“bundled polyp in-tie-in-loss-mortized" to render zhēngjiǎ"). And at the sinking gate is deep-anchoring swollen-bound masses (dark knob yet others gloss decay)-"* The Large Intestine shoots past inside toward the Stomach: highly-food-burning beyond slimming (slending-saver; slimming-pulse; hunger-sorch) "** named ‘feeding-switch-outcome-and-consumption-waster eater’ having accordingly name-blown; therein with cloud-eyed-haze along faint inter-grad segment as evil-charged thrust-derived e.”
When the five viscera receive qi at their one whose generated s-t becoming — (ie *the seasonal correspond rather source-beget reference align), then drain thereby transfer it: letting **sp-in-stage multiply on moving next all the while content-s n certain overlapping origin-m-req system elsewhere r-s pairs (continuem; subsequently also — take sub details actual at fringes per classical, reiter mention: — specific each chain-being sent in. Short-match presentation captures format briefly without skip any points within possible-scopes:
("after fully matches etc continuous text as next display-content itself.")
Thus following parse covered original lines-s across fewer rest blocks to achieve clear style:
Winder the above — retain block-driven correspondence rather literally without loss by include finalized final segments from extended-g asked question segment as text stands under below:
This parses may-y slightly merged formatting — until pass of direct alternate note n includes these cited main-s natural without adjustments beyond literal basis-excluded where contextual requirement should pass.
The Yellow Emperor asked: Can you explain to me the rise and fall of Qi (vital energy) (as it changes with age)? Qi Bo replied: When a person is ten years old, the five viscera are initially settled, blood and Qi are already connected, and Qi resides in the lower part (of the body), so one enjoys running. At twenty, blood and Qi begin to flourish, and the muscles are growing, so one enjoys walking briskly. At thirty, the five viscera are completely stabilized, the muscles are firm, and the blood vessels are replete, so one enjoys walking at a moderate pace. At forty, the five viscera, six bowels, and twelve regular meridians are all at their peak and settled, the interstitial spaces (cou li) begin to open, the appearance begins to decline, the hair at the temples gradually turns white, and blood and Qi are stable and unmoved, so one enjoys sitting. At fifty, the liver Qi begins to decline, the liver lobes begin to thin, the bile begins to decrease, and the eyes begin to lose clarity. At sixty, the heart Qi begins to decline, one easily becomes sorrowful and mournful, blood and Qi become lax and slack, so one enjoys lying down. At seventy, the spleen Qi becomes deficient, the skin begins to dry up, and therefore the four limbs cannot be lifted. At eighty, the lung Qi declines, the ethereal and corporeal souls disperse, and therefore speech easily becomes erroneous. At ninety, the kidney Qi becomes scorched and withered, the viscera wither, and the meridians become empty. By the age of one hundred, all five viscera are deficient, all spirit Qi is gone, and only the physical form remains, bringing life to its end.
For females, at age seven, the kidney Qi becomes abundant, teeth are replaced, and hair grows long. At fourteen (two sevens), Tian Gui arrives (the substance derived from kidney essence that promotes reproduction), the Conception Vessel (Ren Mai) becomes unobstructed, the ** Thoroughfare Vessel (Chong Mai)** becomes vigorous, menstruation arrives on schedule, and thus she is able to bear children. At twenty-one (three sevens), the kidney Qi is balanced (even and sufficient), so the wisdom teeth emerge, and physical development reaches its peak. At twenty-eight (four sevens), the sinews and bones are strong and firm, hair growth reaches its maximum, and the body is at its prime. At thirty-five (five sevens), the Yangming Meridians begin to decline, the complexion begins to wither, and the hair begins to turn white. At forty-nine (seven sevens), the Conception Vessel becomes deficient, the Thoroughfare Vessel declines and diminishes, Tian Gui is exhausted, the "earthly path" is blocked (menstruation ceases), and therefore the body decays and she is no longer able to bear children.
For males, at age eight, the kidney Qi becomes solid, hair grows and baby teeth are replaced. At sixteen (two eights), the kidney Qi flourishes, Tian Gui arrives, and essential Qi is discharged in abundance; Yin and Yang are harmonized, and thus he is able to father children. At twenty-four (three eights), the kidney Qi is balanced, the sinews and bones are strong and powerful, and the wisdom teeth emerge, marking the peak of physical development. At thirty-two (four eights), the sinews and bones are extremely developed, and the muscles are full and strong. At forty (five eights), the kidney Qi declines, hair begins to fall out, and teeth become dry and withered. At forty-eight (six eights), Yang Qi declines in the upper part [of the body], the complexion becomes haggard, and the hair at the temples turns grey. At fifty-six (seven eights), the liver Qi declines, the sinews cannot move easily, Tian Gui is exhausted, semen becomes scarce, kidney Qi declines, and the physical body has reached its limit. At sixty-four (eight eights), the teeth and hair fall out.
The Kidneys govern water, receiving the essence from the five viscera and six bowels and storing it; therefore, only when the five viscera are flourishing can essence be discharged. Now all five viscera are declining, the sinews are lax, and the bones are heavy, and Tian Gui is entirely exhausted. Thus, the hair at the temples turns white, the body becomes heavy, walking is unsteady, and one loses the ability to reproduce.
This chapter serves as a foundational text on the body's life rhythms in Traditional Chinese Medicine. It systematically describes the decade-by-decade changes in life from infancy to one hundred years, alongside the reproductive rhythms of females using a seven-year cycle and males using an eight-year cycle. The core ideas are threefold: First, the life process represents a complete cycle of Kidney Qi (including Tian Gui) — from emergence, to flourishing, decline, and exhaustion, with behavioral preferences (liking to run → walk briskly → walk leisurely → sit → lie down) changing in sync with the internal state of blood and Qi; Second, aging follows a specific order — at fifty, the liver declines; at sixty, the heart; at seventy, the spleen; at eighty, the lungs; and at ninety, the kidneys — declining sequentially according to the reverse order of the Five Elements generation cycle (Wood → Fire → Earth → Metal → Water); Third, females cycle every seven years and males every eight years, directly correlating with the rise and fall of reproductive ability (Tian Gui).
The description of life rhythms has structural similarities with stage divisions in modern developmental psychology and geriatric medicine: changes in children's activity patterns, the decline in physiological function after middle age, and the deterioration of cognitive and motor functions in old age all have counterparts in modern research. Menopause around age forty-nine (seven times seven) is remarkably close to modern data on menopausal age (averaging 48–52 years), suggesting that ancient peoples had precise observations on this matter. The "Tian Gui" concept can be viewed as the classical term for sex hormones. However, the "decline every ten years following a strict Five Element order" is a theoretical model; modern medicine does not adopt such specific age boundaries and visceral correspondences. What should be affirmed is that ancient peoples understood the life process as a continuous, rhythmic, dynamic change rather than static, and this epistemological direction is sound.
This content is based on classical texts of traditional Chinese medicine, intended solely for the study and research of traditional culture. It does not constitute any form of medical diagnosis, medication prescription, or therapeutic advice. Please seek medical attention promptly if you experience any discomfort.