Reading mode

Plain Questions: Discourse on Pain, Chapter Thirty-Nine

Discourse on Pain, Chapter Thirty-Nine · Vernacular Interpretation

Overall Paraphrase

The Yellow Emperor asked: I have heard that one who is skilled in discussing the Way of Heaven can certainly apply the Way of Heaven to human affairs; one who is skilled in discussing antiquity can certainly integrate the experiences of antiquity with the present; one who is skilled in discussing others can certainly verify through comparison with oneself. In this way, principles will not be confused, and essential points can be fully grasped—this is called "understanding." Now I wish to ask you, Sir, whether you can enable me to understand illness through inquiry, to see signs through observation, to palpate the site of disease through touch, and to verify these on my own body, thereby enlightening ignorance and dispelling doubt?

Qi Bo bowed twice and touched his head to the ground before answering: What aspect of principles does Your Majesty wish to ask about?

The Yellow Emperor said: I wish to know—when a person's five viscera suddenly develop pain, what qi causes it?

Qi Bo answered: The qi and blood in the channels and vessels flow without ceasing, circulating through the entire body without stopping. When cold pathogen invades the channels and vessels, it causes qi and blood to stagnate and slow, becoming rough and impeded so that they cannot flow freely. If cold pathogen lodges outside the channels and vessels, then the blood outside the channels diminishes; if it lodges within the channels, then qi is obstructed—therefore sudden pain arises.

The Yellow Emperor asked: Among these pains, some stop suddenly, some are severe and unrelenting, some are so painful that they cannot bear pressure, some stop after pressure is applied, some show no effect from pressure, some have a throbbing sensation under the hand when pressed, some involve the heart and back pulling toward each other in pain, some involve the flanks and lower abdomen pulling toward each other in pain, some involve abdominal pain radiating to the inner thighs, some over time form accumulations, some involve sudden excruciating pain with loss of consciousness followed by revival after a while, some involve pain with vomiting, some involve pain followed by diarrhea, some involve pain with constipation and obstruction. These pains all manifest differently—how should they be distinguished?

Qi Bo said:

When cold pathogen lodges outside the channels, the channels contract and curl upon being affected by cold, and then the network vessels become tense and constrained, pulling on the fine collateral vessels externally—therefore sudden pain arises; upon receiving warmth, the pain immediately stops; if cold pathogen is repeatedly encountered, the pain will persist.
When cold pathogen invades within the channels, it contends with the heat qi inside the body, causing the channels to become full and distended—fullness leads to pain that cannot be pressed. When cold pathogen lodges and heat qi surges upward, the vessels become enlarged and qi and blood become disordered—therefore the pain is severe and cannot tolerate pressure.
When cold pathogen lodges between the stomach and intestines, beneath the membranes and the sources (muyuan), blood cannot disperse normally, and the fine collateral vessels are tensely pulled—causing pain. Pressure allows qi and blood to disperse, so pressing stops the pain.
When cold pathogen lodges in the channels flanking the spine on both sides, deep pressure cannot reach the site of the disease—therefore pressing is of no benefit.
When cold pathogen lodges in the Chong Vessel, which originates at Guanyuan point and ascends straight along the abdomen—when cold qi lodges, the vessel becomes blocked, and when the vessel is blocked, qi follows and surges—therefore palpation reveals a throbbing response under the hand.
When cold pathogen lodges in the channels related to the back Shu points, the pulse becomes rough and impeded; roughness of the pulse leads to blood deficiency, and blood deficiency leads to pain; these back Shu points connect internally to the heart—therefore the heart and back pull toward each other in pain. When pressed, heat qi arrives, and when heat arrives, the pain stops.
When cold pathogen lodges in the Foot Jueyin Liver Channel, which connects with the genitalia and ties to the liver—when cold qi invades the channels, blood movement becomes rough and impeded, and the channels become tense—therefore the flanks and lower abdomen pull toward each other in pain.
When rebellious qi lodges in the inner thighs, cold qi moves upward to affect the lower abdomen, blood movement in the lower part becomes impeded, and the upper and lower parts pull at each other—therefore abdominal pain radiates to the inner thighs.
When cold pathogen lodges between the membranes of the small intestine and within the collateral blood, blood movement becomes rough and impeded and cannot flow into the major channels; qi and blood stagnate and cannot circulate—over time, accumulations form.
When cold pathogen invades the five viscera, causing rebellious qi to drain upward and escape, yin qi is cut off, and yang qi cannot enter within—therefore sudden severe pain with loss of consciousness occurs; when yang qi recovers and qi and blood return, wakefulness is restored.
When cold pathogen invades the stomach and intestines, rebellious qi rushes upward—therefore pain is accompanied by vomiting.
When cold pathogen invades the small intestine, the small intestine cannot properly receive and transform substances—therefore abdominal pain is followed by diarrhea.
When heat pathogen lodges in the small intestine, there is pain in the intestines; severe heat damages fluids, causing thirst, restlessness, and dry, hard stool that is difficult to pass—therefore pain with obstruction and blockage.

The Yellow Emperor said: These are things that can be known through inquiry. What then can be seen through observation?

Qi Bo said: The five viscera and six bowels each have corresponding regions on the face. Observe the changes in the five colors: yellow and red indicate heat, white indicates cold, and blue-black indicates pain—these are what can be seen through observation.

The Yellow Emperor said: What can be detected through palpation?

Qi Bo said: Examining the pulse of the dominant disease, if the pulse is hard, if blood is replete and full, or if it is sunken and depressed, all of these can be known through palpation.

The Yellow Emperor said: Excellent. I understand that many diseases arise from disharmony of qi movement. Anger causes qi to rise, joy causes qi to relax, grief causes qi to dissipate, fear causes qi to descend, cold causes qi to contract, heat causes qi to leak, fright causes qi to become chaotic, overexertion causes qi to be depleted, and pensiveness causes qi to bind. These nine changes in qi movement are different—what diseases do they give rise to?

Qi Bo said:

Anger causes qi to move upward; in severe cases, it leads to vomiting of blood and sunsun (undigested food in stool)—therefore qi rises.
Joy causes qi to become harmonious and the emotions to flow freely; nutritive qi and defensive qi move smoothly—therefore qi relaxes.
Grief causes the heart system to contract, the lungs to spread open, and the upper burner (above the chest and diaphragm) to become blocked; nutritive qi and defensive qi cannot disperse, and heat qi becomes trapped within—therefore qi dissipates.
Fear causes essence qi to retreat; when essence qi retreats, the upper burner becomes blocked, qi returns downward, and the lower burner becomes distended and full—therefore qi descends and does not move.
Cold causes the couli (texture and interstices of the skin and muscles) to close and block, and qi cannot move outward—therefore qi contracts.
Heat causes the couli to open and release, nutritive and defensive qi to flow freely, and profuse sweating—therefore qi leaks.
Fright causes the mind to have nothing to rely upon, the spirit to have nowhere to rest, and thought to have nothing to settle upon—therefore qi becomes chaotic.
Overexertion causes panting and sweating; qi of both interior and exterior disperses and escapes outward—therefore qi becomes depleted.
Pensiveness causes the mind to dwell on something, the spirit to concentrate, and upright qi to stagnate and fail to move—therefore qi binds.

🧠 Deep Understanding

Core Principles 💡

The core academic ideas of this chapter can be summarized in three points:

The early model of "pain due to blockage" and "pain due to malnourishment"
With cold pathogen as the main thread, the chapter repeatedly explains that pain arises primarily from two sources: first, roughness and stagnation of qi and blood with blockage of the channels and vessels—that is, "pain due to blockage"; second, blood deficiency with failure to nourish the channels and vessels—as in "when the pulse is impeded, blood becomes deficient; when blood is deficient, pain arises"—the prototype of the later concept "pain due to malnourishment." Cold is characterized by contraction and congealing, so it most readily produces this pathological state.
The combined three methods of diagnosis for pain syndromes
The Yellow Emperor explicitly proposes "knowable through speech, visible through observation, obtainable through palpation"—that is, the integration of inquiry, observation, and palpation. The chapter not only asks in detail about the nature, location, and accompanying symptoms of pain, but also discusses the five-color observation and pulse palpation, reflecting the relatively systematic diagnostic approach already formed during the era of the Inner Canon.
The "nine qi" pathogenesis of "hundred diseases arising from qi"
The latter half of the chapter categorizes nine factors—anger, joy, grief, fear, cold, heat, fright, overexertion, and pensiveness—into nine abnormal changes of qi movement: rising, relaxing, dissipating, descending, contracting, leaking, becoming chaotic, becoming depleted, and binding. This shows that the ancients already recognized that emotions, external environment, and physical exertion may all cause disease by affecting the qi movement of the entire body, not only through physical injury.

Modern Understanding 🌟

"Pain due to blockage" and "pain due to malnourishment"
From the perspective of modern medicine, the mechanisms by which cold pathogen causes pain are partially connected to cold stimulation leading to vasoconstriction, smooth muscle spasm, local tissue ischemia and hypoxia, and inflammatory factors irritating nerve endings. The ancients used descriptions such as "cold qi lodging outside the channels" and "channels contracting and curling upon cold," which, while lacking microscopic evidence, captured the pathological chain of "cold—contraction—qi and blood failing to move—pain."
The differential significance of pain characteristics
Descriptions in the chapter such as "pressure stops the pain," "pressure is of no benefit," and "severe pain that cannot be pressed" share similar logic with modern clinical physical examination findings concerning tenderness, rebound tenderness, and muscle guarding. For example, severe abdominal pain with guarding often suggests inflammatory or organic lesions, while pain relieved by pressure is more commonly related to deficiency-cold or spasm. However, the ancients could only explain these from the level of qi, blood, cold, and heat, lacking the foundation of modern anatomy and pathology.
The phenomenon of referred pain
"Heart and back pulling toward each other in pain" and "flanks and lower abdomen pulling toward each other in pain" resemble referred pain in modern medicine. The ancients explained such phenomena through channel theory, which has some basis in empirical observation, but channel theory still cannot be fully mapped to modern anatomy.
Emotional pathogenesis and the nine qi
"Anger causes qi to rise," "fear causes qi to descend," "pensiveness causes qi to bind"—these have points of corroboration with modern psychoneuroimmunology and stress response research. Emotions do affect the autonomic nervous system, endocrine function, and digestive function; for example, chronic anxiety can lead to gastrointestinal dysfunction, and outbursts of anger can induce elevated blood pressure. However, the ancients directly attributed emotional changes to the ascending and descending, exiting and entering of "qi"—a theoretical model that cannot be simplistically equated with modern physiology.
Historical limitations
The five-color diagnosis, pulse diagnosis, and other content in this chapter belong to traditional diagnostic methods with some empirical basis, but they lack strict evidence-based foundations, and their sensitivity and specificity are limited—they cannot serve independently as modern diagnostic standards. For descriptions such as "pain so severe that one loses consciousness, with revival upon qi returning," which may encompass conditions such as syncope and shock, the ancients could only explain matters in terms of qi due to their conditions—modern emergency measures should be employed in practice.

Health Preservation Insights ⚡

🌬️ Avoid cold and keep warm: Pay particular attention to keeping the abdomen, lower back, and joints warm; avoid prolonged exposure to cold environments or excessive consumption of raw and cold foods; reduce the invasion of cold pathogen.
🧘 Emotional regulation: Avoid violent anger, excessive fear, and prolonged pensiveness; maintain a peaceful state of mind; joy should have moderation—neither excessive excitement nor excessive suppression.
🏃 Balance work and rest: Avoid overexertion and prolonged sitting or lying; maintain moderate activity to keep qi and blood flowing smoothly.
🍵 Dietary moderation: Protect the stomach and intestines; avoid excessive consumption of raw, cold,辛辣, and drying-heat foods; maintain the transportation and transformation functions of the spleen and stomach.
🩺 Seek medical attention promptly: Pain is an important signal from the body—do not self-press, endure, or simply use hot compresses or massage to replace proper examination. Especially for sudden severe pain, referred pain, or cases accompanied by altered consciousness, seek medical care as soon as possible.

📚 Related Knowledge

Associated Concepts
Cold causes contraction · Pain due to blockage · Pain due to malnourishment · Nine qi pathogenesis · Nutritive and defensive qi · Five viscera and six bowels color diagnostic mapping · The Chong Vessel of the extraordinary vessels · Foot Jueyin Liver Channel · Upper, middle, and lower burners · Sunsun (undigested food diarrhea)
Further Reading
Plain Questions · Discourse on Regulating the Channels — on deficiency-excess pathogenesis and the relationship between qi and blood
Plain Questions · Discourse on Ultimate Truth and Great Essentiality — the nineteen items on pathogenesis
Miraculous Pivot · Original Spirit — correspondence between emotions and the five viscera
Miraculous Pivot · Channels and Vessels — channel pathways and their disorders
Complete Works of Jingyue · Miscellaneous Syndromes · Heart and Abdominal Pain — later development of theory and methods for pain syndromes

— Compiled by Buguā

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