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Chapter 10 of 14
针灸甲乙经
This volume systematically discusses the patterns of transmission of diseases among the five viscera, treatment of cold and heat disorders, accumulation-type diseases (Fúliáng, Xībēn, Féiqì, Pǐqì, Bēntún), distension disorders, and edema-type diseases (cutaneous edema, tympanites, intestinal polyp, stone concretion, wind edema)—their etiologies, patterns of transmission, and acupuncture and moxibustion treatment principles.
In the section "The Five Viscera Transmitting Disease Manifesting as Cold and Heat", the Yellow Emperor asked Qí Bó: The five viscera interpenetrate with one another, and disease transmission does not follow a fixed order. When one of the five viscera becomes diseased, it transmits to the viscus it overcomes according to the five-phase cycle. If treatment is not given promptly, the pathogenic factor will transmit successively according to the order of five-phase mutual conquest, and eventually all five viscera become diseased, endangering life. Therefore, a physician skilled at discerning yáng patterns (diseases of the exterior and the six bowels) can predict where disease originates; a physician skilled at discerning yīn patterns (diseases of the interior and the five viscera) can determine the time of life or death. The so-called "death occurs when it reaches what it fears"— meaning when the disease reaches the viscus that controls it, the condition becomes most critical.
Wind pathogen is the chief of all diseases. When wind-cold invades the human body, it first causes the fine hairs to stand on end, the skin pores to close, and depressed heat to accumulate—at this point, the sweating method can be used to expel the pathogen externally. If numbness with loss of sensation or swelling with pain appears, methods such as hot medicated application, fire moxibustion, and acupuncture can be used to eliminate it. If treatment is not given early, the pathogen penetrates deeper: first entering the lung, becoming "fèi bì" (lung obstruction), manifesting as cough and reversed qi flow; then transmitting to the liver, becoming "gān bì" (liver obstruction, also called "Jué"), manifesting as hypochondriac pain and vomiting of food; then transmitting to the spleen, becoming "pí fēng" (spleen wind), manifesting as jaundice, heat in the abdomen, heart vexation, and sweating; then transmitting to the kidney, becoming "shàn jiǎ" (also called "gǔ"), manifesting as lower abdominal fullness and pain with sweating; then transmitting to the heart, manifesting as convulsive contraction of sinews and vessels. If still untreated at this point, death typically follows within about ten days. If, after the kidney transmits to the heart, the heart then transmits back to the lung, with alternating chills and fever, the prognosis becomes even more dire. This is the general pattern of disease transmission according to five-phase mutual conquest among the five viscera.
However, acutely fulminant diseases do not necessarily follow this transmission pattern. Emotional imbalances such as worry, fear, grief, joy, and anger can disrupt the order of transmission, leading to violent outbreaks of major illness. Great joy depletes heart qi, allowing kidney qi to take advantage of the weakness and invade; great anger causes liver qi to become reckless and invade what the liver overcomes; great grief allows lung qi to ride in; great fear permits spleen qi to ride in; great worry allows heart qi to ride in. Therefore, there are five categories of disease, and with five-times-five mutual riding, twenty-five variations arise. The so-called "transmission" in this context means "riding in upon weakness."
Regarding the genuine viscera pulse (the critical pulse signs of failing viscera qi), the text describes: the great bones wither, the great flesh sinks in, the chest is full of qi, breathing is labored and difficult—if the genuine viscera pulse appears, the time of death can be predicted. The liver's genuine viscera pulse is taut and acute like pressing a blade's edge or a taut string, with a green-white complexion lacking luster and fine hairs brittle and falling out—death. The heart's genuine viscera pulse is tight and hitting against the fingers like pressing on Job's tears (coix seeds), with a red-black complexion lacking luster. The lung's genuine viscera pulse is large and hollow like a feather brushing against the skin, with a red-white complexion lacking luster. The spleen's genuine viscera pulse is weak and sometimes rapid, sometimes slow, with a green-yellow complexion lacking luster. The kidney's genuine viscera pulse is hard and hitting like snapping on a stone, with a black-yellow complexion lacking luster. Whenever genuine viscera pulses appear, they all indicate untreatable conditions.
Regarding luǒ lì (scrofula, tuberculosis of cervical and axillary lymph nodes), the ancients considered it to be caused by cold-heat toxic qi lingering in the meridians and not dissipating. Treatment should "start from its root in the interior, and guide it to the tips/ends"—that is, begin with the visceral source, guiding the pathogenic factor to disperse from the periphery. Prognosis can be assessed by observing the red vessels in the eyes: red vessels running from top to bottom and penetrating through the pupil—one vessel indicates death within one year, two and a half vessels indicate death within two and a half years, three vessels indicate death within three years. If the vessel does not penetrate through the pupil, the condition can be treated.
The accumulation-type diseases section cites the theory of five accumulations from the Nàn Jīng (Classic of Difficult Issues): Fúliáng (heart accumulation, starting above the navel, large as an arm), Xībēn (lung accumulation, below the right costal margin, shaped like an inverted cup), Féiqì (liver accumulation, below the left costal margin, like an inverted cup with head and feet), Pǐqì (spleen accumulation, in the stomach duct, covering an area large as a platter), and Bēntún (kidney accumulation, originating in the lower abdomen and rushing upward toward the heart and chest like a running pig). The etiologies of these accumulations involve external contraction of cold pathogen, internal injury from emotions, irregular diet, and improper living habits. The core mechanism is qi and blood congealing and stagnating, fluids stopping and accumulating, and becoming accumulation over time.
Regarding distension disorders, the ancients proposed that the site of distension is neither within the blood vessels nor inside the viscera and bowels, but rather outside the viscera and bowels, between the chest, ribs, and skin—pressing upon the viscera and bowels, swelling the chest and ribcage, and causing the skin to become distended and full. Heart distension manifests as heart vexation and short breathing with inability to lie peacefully; lung distension as empty fullness with wheezing and cough; liver distension as fullness and pain below the ribs radiating to the lower abdomen; spleen distension as hiccuping and heaviness of the four limbs; kidney distension as abdominal fullness and distension radiating to the back, with lumbar and thigh pain; stomach distension as abdominal fullness and stomach pain with difficulty in defecation; large intestine distension as intestinal rumbling and pain with diarrhea; small intestine distension as lower abdominal distension radiating to lumbar pain; bladder distension as lower abdominal fullness and difficult urination; sanjião (triple burner) distension as qi fullness within the skin without hardness; gallbladder distension as pain below the ribs, bitter taste in the mouth, and a tendency to sighing. The general treatment principle is to supplement deficiency and drain excess, with Foot Li (ST-36, Zúsānlǐ) being the key point for treating distension.
In the section on edema-type diseases, five conditions are distinguished: water disease, starting with slight swelling below the eyes, pulsation of the neck vessels, swelling of the lower legs, and a large abdomen where pressing releases with the hand rising promptly, as though holding water within; cutaneous edema (fú zhàng), caused by cold qi lodging between the skin layers, where pressing leaves a depression that does not rebound upon release, with no change in skin color; tympanites (鼓胀), manifested as large abdomen and generalized swelling, with greenish-yellow complexion and exposed abdominal veins; intestinal polypoid growth (cháng tán), caused by cold qi lodging outside the intestine and colliding with defense qi, leading to gradual formation of a polyp in the shape of a pregnancy, but with menstruation continuing as normal; and stone concretion (石瘕), caused by cold qi lodging in the uterus with extravasated blood remaining in place, growing daily to the size of a pregnancy, but with cessation of menstruation. These differential diagnostic distinctions demonstrate the ancients' meticulous clinical observation of ascites, edema, and abdominal tumors at various pathological states.
Regarding kidney wind and wind edema, the ancients pointed out that the kidney is the water viscus and governs water; the kidney and lung serve one as root and one as branch, jointly regulating water metabolism. The kidney acts as the "gate of the stomach"—if the gate fails to open and close properly, water accumulates and becomes swelling. The mechanism of facial edema in wind edema lies in the principle that "where pathogenic qi amasses, the qi there must be deficient"—when yīn qi is deficient, yáng pathogen takes advantage and invades, manifesting as shortness of breath, sweating, dry mouth with bitter taste, yellow urine, swelling below the eyes, and inability to lie flat, among a series of signs.
The central academic thought of this volume can be summarized at the following levels:
I. Five-Viscus Transmission and Five-Phase Mutual Conquest
The ancients used the frame-work of five-phase mutual conquest to explain the transmission patterns of disease among the five viscera (Lung metal → Liver wood → Spleen earth → Kidney water → Heart fire). This represents an early medical effort to systematize visceral pathological progression. The statements about "transmission to what it overcomes" and "death upon reaching what it fears" attempt to provide a predictable model for disease evolution. Meanwhile, the text explicitly states that emotional factors (joy, anger, worry, grief, fear) can "cause it not to follow proper order"—that is, disrupt conventional transmission sequences—showing that the ancients already recognized that disease transmission was not a mechanical, linear process.
II. Stages of Disease Progression: From Exterior to Interior
From "when pathogenic qi strikes a person, it begins at the skin" through collateral vessels, the penetrating vessels, the intestines and stomach, and the membrane-like sources [mùyuán], with gradual deepening, ultimately "ceasing and becoming accumulation"—this discussion constructs a spatial pathological model of external pathogens progressing from superficial to deep. This is the classical expression of the Chinese medicine concept of "exterior-interior" and explains why "early treatment" is of vital importance.
III. Onset of Disease Through Deficiency Plus Assault
"Wind, rain, cold, heat—vacuity pathogens alone cannot injure in isolation"; "dual vacuity engaging in combat leads to lodgment in the body"—the text repeatedly emphasizes the interaction between upright qi (internal resistance) and pathogenic qi as causative factors. If the exterior pathogenic qi exists but the body's chi is not deficient, disease will not develop; only when the body's constitution is weakened AND external pathogenic invasion occur simultaneously does disease take shape. This idea resonates with the core concepts of modern immunology.
IV. Qi-Blood Stagnation as the Pathomechanism of Accumulation
The formation of accumulation-type diseases is reduced to a pathological chain: "congealing of cold qi → stasis of blood → stagnation of fluids → accumulations forming over time." Whether from external contraction of cold, internal damage from emotions, or dietary irregularities, ultimate impact on qi-blood movement leads to accumulation. This pathomechanism understanding of "where there is no flow, there is accumulation" laid down the theoretical foundation for later approaches of invigorating blood and dispelling stasis, and softening hardness to dissipate nodules.
V. The Location of Distension Disorders
The ancients located distension in a distinct anatomical spatial concept, "outside the viscera and bowels, within the skin," differentiating it from both the blood vessels and the viscera themselves. Although this understanding does not fully correspond to modern anatomy (it more closely resembles a comprehensive concept integrating fascia, serous cavities, and tissue spaces), it shows a holistic-functional location mindset within pattern differentiation.
Points exhibiting verifiable value:
"Vacuity is the precursor to attack by pathogenic qi" aligns in channel with the immunology observation that "immunocompromised individuals are more susceptible to infection." The text notes, "Those who encounter severe wind and heavy rain yet do not become ill—that is because a truly diminished defensive qi paves the way"— in this is found an early observation of individual susceptibility.
Understanding of disease in stages resembles the modern medical concept of "disease natural history / stages." The sequencing from skin at superficial to deep-level tissues can in some respects correspond with stages of tissue injury seen after an infection following an external route.
The relationship between luǒlì and red vessels in the eye may represent an ancient clinical linkage between cervical lymphatic disorders and microvascular response phenomena detectable in the eyes. The prognosis mapping of descending red vessels breaching the pupil is old experiential, rather than modern systematic, data.
Differential diagnosis of edema-type conditions (water disease, cutaneous edema, tympanites, intestinal polypoid accumulation, stone concretion) showcases remarkably deep clinical observation and systematic attempts divide-and-conquer different abdominal swelling types based on constitutional factors. The differentiation "in 肠蕈 (Benigned Polipoid): menstrual discharge continues; in 石瘕 (Concretion-like lithopedion): menstruation ceases"— although drawn at an era yet formally unminted — displays the separation of disturbance with a larger etiophenomenological center-point.
"The kidney being the gate of the stomach" where it pertains water fluid all forms similar pathophysiologic explanation, distinct from precise modern renal ultrafiltration mechanisms of today. Still, tying kidney functionally to the storage and flow of bodily water is a recognizable observational matrix intellectually sound given forms which catalyze current exploratives of renal-circuit dysfunction and heart/kidney fluid management.
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