Suwen: Chapter 24 on Blood, Qi, and the States of the Body and Mind

Study Notes on "Blood-Qi and Bodily-Mental Disposition," Chapter 24

Overall Paraphrase

The normal physiological constants of excess and deficiency in the blood and qi of the body's meridians are as follows: The Taiyang Meridian (one of the six meridians in traditional Chinese medicine, characterized by relatively abundant yang qi) typically has more blood and less qi; the Shaoyang Meridian typically has less blood and more qi; the Yangming Meridian typically has both abundant qi and blood; the Shaoyin Meridian typically has less blood and more qi; the Jueyin Meridian typically has more blood and less qi; the Taiyin Meridian typically has more qi and less blood. These are the natural constants. The Foot Taiyang and Foot Shaoyin meridians are paired as interior-exterior (mutually coupled); the Foot Shaoyang and Foot Jueyin meridians are paired as interior-exterior; the Foot Yangming and Foot Taiyin meridians are paired as interior-exterior — these are the yin-yang couplings of the foot meridians. The Hand Taiyang and Hand Shaoyin meridians are paired as interior-exterior; the Hand Shaoyang and the Heart Governor (i.e., the Hand Jueyin Pericardium Meridian) are paired as interior-exterior; the Hand Yangming and Hand Taiyin meridians are paired as interior-exterior — these are the yin-yang couplings of the hand meridians.

Once the sites of affliction in the hand and foot yin-yang meridians are known, the ancients held that in treatment, one should generally first remove stagnant blood to relieve suffering, then observe the patient's specific needs, and afterwards apply the methods of draining excess and supplementing deficiency.

To determine the locations of the five viscera's Back-Shu points: First measure the distance between the two nipples and take half of it. Then, using another blade of grass, measure out this half-length, and join the two ends to form an angle. Bring this to the back, aligning the upper corner with Dazhui (the highest point of the spine), and the location corresponding to the two lower corners is Feishu (Lung Shu). Moving down one equal segment yields Xinshu (Heart Shu). Moving down another equal segment, the left corner is Ganshu (Liver Shu), and the right corner is Pishu (Spleen Shu). Moving down one more equal segment yields Shenshu (Kidney Shu). This is the method of measuring for moxibustion and needling of the five viscera's Back-Shu points.

When the body is at ease but the emotions are distressed, illness tends to arise in the blood vessels — moxibustion and acupuncture may be used. When the body is at ease and the emotions are content, illness tends to arise in the muscles — acupuncture and stone needling may be used. When the body is overworked but the emotions are joyful, illness tends to arise in the sinews — hot compresses and daoyin (guiding and stretching exercises) may be used. When the body is overworked and the emotions are also distressed, illness tends to arise in the throat — medicinal treatment may be used. When the body frequently experiences fright and terror, causing obstruction in the meridians, illness tends to manifest as numbness of the flesh — massage and medicated wine may be used. These are the five types of bodily-mental dispositions.

Needling the Yangming Meridian may release both blood and qi. Needling the Taiyang Meridian is appropriate for releasing blood but not qi. Needling the Shaoyang Meridian is appropriate for releasing qi but not blood. Needling the Taiyin Meridian is appropriate for releasing qi but not blood. Needling the Shaoyin Meridian is appropriate for releasing qi but not blood. Needling the Jueyin Meridian is appropriate for releasing blood but not qi.

🧠 In-Depth Understanding

Core Principles 💡

• Qi-Blood Constants and Needling Selections: The differing excesses of qi and blood in the three yin and three yang meridians served as the ancients' important basis for guiding deficiency-excess supplementation and drainage and for choosing needling methods. For example, the Yangming Meridian has abundant qi and blood, hence both may be released; the Taiyang Meridian has more blood and less qi, hence bleeding is appropriate but qi release is avoided; the Shaoyin Meridian has less blood and more qi, hence qi release is appropriate but bleeding is avoided. This reflects the approach of "treating according to the meridian" rather than applying a one-size-fits-all rule.
• Interior-Exterior Pairing: The hand and foot three yin and three yang meridians form six pairs of interior-exterior relationships, such as Foot Taiyang with Foot Shaoyin, and Hand Shaoyang with the Heart Governor. This indicates that the viscera and meridians are internally and externally interconnected. Interior-exterior paired meridians influence each other physiologically and pathologically, and treatment may address the interior through the exterior or the exterior through the interior.
• First Remove Stagnation, Then Regulate Deficiency and Excess: The principle "first remove stagnant blood, thereby eliminating the suffering" means first resolving local stagnation or pathological blood to relieve pain, then applying supplementation or drainage according to deficiency or excess. This carries the embryonic form of "treat the acute condition first, and the chronic condition later."
• Back-Shu Localization Method: Using the half-distance between the nipples and triangular measurement to locate back points reflects the ancient method of using surface landmarks and proportional measurement to determine acupoint locations — an early empirical summary in acupuncture localization.
• Five Bodily-Mental Dispositions: From the five dimensions of bodily exertion or ease, emotional distress or contentment, and the presence or absence of fright, people's states are classified into five categories, with disease sites respectively in the vessels, flesh, sinews, throat, and meridians, and treatment methods respectively being moxibustion/acupuncture, stone needling, hot compress/daoyin, herbal medicine, and massage/medicated wine. This embodies the holistic concept of "unity of form and spirit," emphasizing the close relationship between psychosomatic states and disease occurrence.

Modern Perspectives 🌟

• Qi-Blood Constants Are a Theoretical Model: Statements such as "abundant qi and blood" or "more blood and less qi" in the meridians are not modern anatomical or physiological concepts. They are closer to clinically summarized experiential knowledge used to explain constitutional tendencies and guide needling choices. Modern research has not found biological evidence directly corresponding to these constants.
• Interior-Exterior Relationships Have a Systems-Theory Flavor: The pairing of interior-exterior meridians can be understood as a functional correlation model established by the ancients, bearing some holistic value. However, from a modern medical standpoint, there is no evidence of independent "interior-exterior meridian" pathways or specific structures.
• Bloodletting and Qi/Blood Release Principles Require Caution: Ancient practices such as bloodletting and qi release belong to the therapeutic experience of that era. Modern medicine has an extremely narrow scope for bloodletting, and unprofessional procedures carry risks of infection and injury. This text is intended solely for theoretical study and does not constitute any treatment recommendation.
• Back-Shu Localization Is Early Surface Measurement: This proportional method reflects the ancients' use of body surface landmarks, but its precision is limited. Modern acupuncture point selection has integrated anatomical landmarks and standardized protocols, so there is no need to replicate ancient rough methods.
• The Five Bodily-Mental Dispositions Have a Prototype of Psychosomatic Medicine: The mutual influence between body and emotions shares common ground with contemporary stress-related diseases and psychosomatic medicine. However, the classification is relatively crude and cannot replace modern diagnosis and individualized assessment.

Wellness Implications ⚡

• Balance Work and Rest: Excessive inactivity tends to cause qi and blood stagnation and muscle flaccidity; excessive labor tends to injure sinews and deplete qi. In daily life, maintain moderate exercise, avoid prolonged sitting or lying, and likewise avoid chronic overexertion.
• Emotional Regulation: Those whose bodies are at ease but whose minds are burdened with excessive rumination should especially take initiative to relieve emotional tension. Frequent states of fright or stress can impair the smooth flow of meridian qi and blood. Maintaining emotional stability and regular routines supports overall harmony.
• View Individual Differences Rationally: The ancients believed that individuals differ in their qi-blood tendencies, so daily cultivation need not be forced into uniformity. However, one should not self-diagnose by comparing oneself to "abundant qi and blood" or "more blood and less qi," still less perform self-bleeding, moxibustion, or self-prepared medicated wines.
• Value Psychosomatic Co-Regulation: Body and emotions are not isolated — when physical discomfort arises, pay attention to both lifestyle habits and emotional states; the reverse also applies. If significant symptoms appear, seek professional medical help.

📚 Related Knowledge

• Related Concepts: Three yin and three yang, interior-exterior meridians, Back-Shu points, unity of form and spirit, qi-blood quantities, needling principles, bloodletting therapy, moxibustion and needling, stone needling, hot compress and daoyin, massage, medicated wine.
• Further Reading: Lingshu · Jiuzhen Lun contains similar accounts of qi-blood quantities in the meridians; Lingshu · Beishu is devoted to the back Shu points; Suwen · Yinyang Yingxiang Da Lun discusses the relationship between form and spirit and principles of regulation and treatment.

⚠️ Bugu Note: This content is based on classical texts of traditional Chinese medicine and is provided solely for the study of traditional culture. It does not constitute any medical diagnosis, medication, or treatment advice. If you feel unwell, please seek medical attention promptly.