Plain Questions: Chapter 46 on Disease Capacity

Chapter 46 on Disease Capacity · Modern Vernacular Translation

Overall Paraphrase

Diagnosis of Stomach-Well Abscess

The Yellow Emperor asked: When a person suffers from a stomach-well abscess (swelling and suppuration in the gastric region), how should it be examined? Qi Bo said: In diagnosing this condition, one should examine the stomach pulse, which should be deep and fine. Deep and fine indicates counterflow of qi; counterflow of qi causes the Renying pulse (the pulsation at the side of the neck, regarded by the ancients as the stomach pulse) to become extremely full and replete; fullness and repletion indicate the presence of heat. Renying belongs to the stomach pulse. When qi flows counter-current and is replete, heat accumulates at the stomach opening without dissipating, thus forming a stomach-well abscess.

Restlessness and Inability to Lie Supine

The Yellow Emperor said: Good. Some people cannot sleep peacefully—why? Qi Bo said: When the five zang organs are injured or damaged, one must wait until essence-qi has something to return to before becoming tranquil; therefore one cannot speculate about the pathogenesis without a basis. The Yellow Emperor asked: When a person cannot lie supine, why? Qi Bo said: The lung is the canopy of the five zang organs. When lung qi is exuberant, the pulse becomes large; when the pulse is large, one cannot lie supine. The relevant discussion is found in Qi Heng Yin Yang.

Jue Disorder and Lower Back Pain

The Yellow Emperor asked: There is a patient with jue disorder (a condition caused by chaotic counterflow of qi), whose right pulse is deep and tight, left pulse floating and slow—where exactly does the disease lie? Qi Bo said: In winter, when examining the pulse, the right pulse should naturally be deep and tight; this is in accordance with the four seasons. The left pulse being floating and slow is contrary to the four seasons.Abnormality of the left pulse indicates disease in the kidneys, also involving the lungs, and should manifest as lower back pain. The Yellow Emperor asked: Why is this said? Qi Bo said: The Foot-Shaoyin Kidney Meridian traverses the kidneys and connects with the lungs. Now that the lung pulse is seen and the kidneys are consequently affected, kidney disease manifests as lower back pain.

Neck Abscess and Different Treatments for the Same Disease

The Yellow Emperor said: Good. Among those suffering from neck abscesses, some are treated with bian stones (ancient stone medical tools), others with acupuncture and moxibustion, and both can achieve cure—what is the reasoning? Qi Bo said: This is a case of the same disease name but different levels of severity. When the abscess qi has settled without forming pus, it is appropriate to use acupuncture to drain and disperse it; when qi is exuberant and blood gathers, it is appropriate to use bian stones to discharge blood. This is what is meant by "different treatments for the same disease."

Mania from Anger and Yang Reversal

The Yellow Emperor asked: There are those who suffer from mania with anger—where does this disease come from? Qi Bo said: It is born from yang. The Yellow Emperor asked: Why does yang cause one to become manic? Qi Bo said: When yang qi is suddenly obstructed and thwarted, making it difficult to flow freely, the person becomes prone to anger; the disease is named yang reversal. The Yellow Emperor asked: How is it recognized? Qi Bo said: The Yangming Meridian frequently pulsates; the Taiyang and Shaoyang meridians normally do not pulsate. If those that should not pulsate now pulsate rapidly and urgently, this is a sign of yang reversal. The Yellow Emperor asked: How is it treated? Qi Bo said: Reduce food intake and it will suffice. Food enters the yin aspect and can augment yang qi, therefore reducing food is sufficient. Have the patient take sheng tie luo (iron filings) decocted for drinking; the ancients believed that sheng tie luo could direct qi downward and subdue reversal. (This is a therapeutic method recorded in ancient texts, provided for scholarly study only, not as medication guidance.)

Wine Wind

The Yellow Emperor said: Good. Some people have fever, lassitude and weakness, sweating as if drenched, aversion to wind, and shortness of breath—what disease is this? Qi Bo said: The disease is called wine wind. The Yellow Emperor asked: How is it treated? Qi Bo said: Take zexie (Alisma) and zhu (Atractylodes) at ten parts each, and mifeng (Herba Lycopi) at five parts, grind together into powder. Take three finger-pinches each time, after meals. (This is a record of an ancient formula, provided for scholarly study only, not as medication guidance.)

The Meaning of Ancient Medical Classics

What is called a deep and fine pulse feels as fine as a needle under the fingers. In palpation and pulse-taking, "gathered" means firm and hard, "broad" means the pulse is large. The Shang Jing discusses the communication of qi with heaven; the Xia Jing discusses the transformations and changes of disease; the Jin Gui is about determining life and death; the Kui Du is about palpation and measurement;The Qi Heng discusses unusual diseases. What is meant by "qi" (unusual) refers to strange diseases that do not follow the pattern of the four seasons in determining death; what is meant by "heng" (constant) refers to ordinary diseases that follow the four seasons in determining death. What is meant by "kui" (assess) is the act of palpating and seeking, that is, cutting and seeking the principle of the pulse; what is meant by "du" (measure) is that after obtaining the disease location, one uses the four seasons to measure and evaluate it.

---

🧠 Deep Understanding

Core Principles 💡

• Using the Pulse to Assess Disease, Emphasizing Qi Movement in Normal and Reversed Directions: The pathogenesis of stomach-well abscess is summarized as "qi counterflow—heat accumulation—blood decay forming abscess," reflecting the Neijing approach of explaining local lesions through the ascending, descending, entering, and exiting movements of qi.
• Different Treatments for the Same Disease: Both for neck abscess, due to different disease momentum and depth of pathogenic factors, acupuncture drainage and bian stone bloodletting are respectively employed, emphasizing pattern differentiation rather than mere disease identification.
• Four Seasons, Meridians, and Disease Location Determination: In winter, a floating and slow left pulse is "contrary to the four seasons," and by combining this with the Foot-Shaoyin Kidney Meridian's pathway of "traversing the kidneys and connecting to the lungs," the disease is inferred to be in the kidneys but manifesting as lower back pain. This reflects the integration of four-season pulse methodology and meridian pattern differentiation.
• Emotional Disorders Viewed Through Yang Qi: Mania with anger and yang reversal are explained as a model of sudden obstruction of yang qi, accumulating and unable to disperse; food can also "increase qi in the yang aspect," hence the ancients advocated reducing food intake and using sheng tie luo to direct qi downward and subdue reversal. This is an early Chinese medical model of emotional and mental abnormalities viewed through yang qi stagnation.
• Wine Wind Viewed Through Damp-Heat Injuring Qi: Alcohol is hot and damp; after excessive drinking, one may present with body heat, sweating as if bathed, aversion to wind, and shortness of breath. The ancients believed this to be wine-heat damaging the spleen and lungs, depleting qi and impairing consolidation.
• The Classification Concept of Ancient Medical Classics: The enumeration at the end of the chapter of the ShangJing, Xia Jing, Jin Gui, Kui Du, and Qi Heng reveals that early medical literature already possessed functional classifications such as "qi communicating with heaven," "transformations of disease," "determining life and death," and "pulse-taking and measurement."

Modern Perspectives 🌟

• Pulse Diagnosis Experience Is Instructive but Cannot Replace Modern Examination: For instance, "excessive fullness of Renying indicates heat" can be understood as the ancients observing the phenomenon of increased carotid pulsation during febrile or inflammatory conditions, but this does not equate to being able to confirm a stomach-well abscess by pulse diagnosis alone. Modern medicine requires imaging, laboratory tests, and other modalities.
• "Different Treatments for the Same Disease" Aligns with Modern Individualized Medicine: Neck abscesses are treated with different external therapies according to disease severity, similar to how modern surgery addresses different stages of infection differently. However, operations such as bian stone therapy and acupuncture must be performed by trained professionals and must not be imitated independently. -Keep the changes.

Traditional Health Guidelines ⚡

• Emotions Should Be Released Rather Than Suppressed: When encountering mental stimulation, irritability, or agitation, it is advisable to remove oneself from the triggering environment, practice deep breathing, or engage in moderate exercise, avoiding the accumulation of anger that may lead to illness.
• Moderation in Diet, Especially in Alcohol Consumption: Avoid overeating and binge drinking; particularly reduce intake of strong spirits and drinking on an empty stomach. After drinking, one should not expose oneself to wind, cold, or engage in strenuous labor.
• Align with the Four Seasons in Daily Routine: In winter, one should go to bed early and rise late, reducing excessive dissipation and protecting the latent storage of yang qi.
• Do Not Self-Treat Skin Abscesses, Fever, or Sweating Abnormalities: If such conditions occur, seek medical attention; one should not independently perform bian stone, acupuncture, or herbal treatments based on ancient records.

---

📚 Related Knowledge

• Related Concepts: Renying pulse method, different treatments for the same disease, yang reversal, wine wind, four-season pulse method, Kui Du Qi Heng, Foot-Shaoyin Kidney Meridian.
• Further Reading: Plain Questions: Essential Subtleties of the Pulse (chapter 17), Plain Questions: On Strange Diseases (chapter 47), Miraculous Pivot: Abscesses and Ulcers (chapter 81), Miraculous Pivot: Meridians (chapter 10), Plain Questions: On the Communication of Vital Qi with Heaven (chapter 3).

— Bu Gua This content is based on ancient Chinese medical classics and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, prescription, or treatment advice. Please seek medical attention in a timely manner if you experience discomfort.