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Chapter 61 of 78
黄帝内经·素问
The Yellow Emperor asked: Why does the Shaoyin channel govern the kidneys? And why do the kidneys govern water and fluids? Qi Bo replied: The kidneys belong to Zhiyin (the place of utmost yin), and the place of utmost yin is precisely where water qi flourishes; the lungs belong to Taiyin, and Shaoyin is also the channel that governs winter. Therefore, the root of water disease lies in the kidneys, while its branch lies in the lungs — both organs can cause water and fluids to accumulate and produce disease.
The Yellow Emperor asked: Why can the kidneys accumulate water and cause disease? Qi Bo replied: The kidneys are like the gate (customs barrier) of the stomach for water metabolism. If the gate does not function properly, water and fluids will stagnate and gather with their kind, spilling upward and downward into the skin, thereby forming 胕肿 (edema/swelling). Edema is the disease produced by the accumulation of water and fluids.
The Yellow Emperor asked: Do all water diseases originate from the kidneys? Qi Bo replied: The kidneys are a yin organ. Earth qi rises and returns to the kidneys, thereby transforming into water and fluids — this is why they are called Zhiyin. If a person exerts themselves forcefully or overworks, this causes kidney sweat to flow outward. When kidney sweat flows out and encounters wind pathogen💨, the sweat can neither return internally to the viscera nor exit externally through the skin. It stops within the Xuanfu (sweat pores), circulates between the skin layers, and gradually transforms into edema. This disease is rooted in the kidneys and is called wind-water (Fengshui). What is called Xuanfu refers to the sweat pores.
The Yellow Emperor asked: What governs the fifty-seven acupoints for treating water disease? Qi Bo replied: The fifty-seven Kidney Shu points are places where yin qi accumulates and where water and fluids exit and enter. Above the sacrum there are five rows with five points each — these are the Kidney Shu points. Therefore, water disease manifests below as edema with a distended abdomen, and above as panting, wheezing, and inability to lie flat. This is disease of both root and branch: when lung qi rebels upward, there is panting and wheezing; when kidney water accumulates, there is edema; when lung qi fails to descend, one cannot lie flat. The lungs and kidneys mutually transport and are afflicted together — this is caused by water qi stagnation. Above Futu (ST32), there are two rows on each side with five points each — these are vital pathways through which kidney qi circulates and where the three yin channels of the foot intersect. Above the ankle, there is one row on each side with six points each — these are the acupoints through which the kidney vessel descends, anciently called Taichong. The above fifty-seven points all belong to the yin collaterals of the internal viscera and are places where water qi tends to accumulate.
The Yellow Emperor asked: In spring, needling should select the luo-collaterals and the interstices between flesh and muscle. Why? Qi Bo replied: Spring belongs to wood, and wood qi begins to take charge; liver qi begins to generate and flourish, and the liver qi tends to be urgent, with wind being rapid in nature💨. The qi of the channels tends to be deeper, and in spring, blood and qi are still scarce and cannot reach deeply, so one selects the luo-collaterals and the interstices between flesh.
The Yellow Emperor asked: In summer, needling should select the excess channels (Shengjing) and the interstices of the skin and flesh. Why? Qi Bo replied: Summer belongs to fire, and fire qi begins to take charge; heart qi begins to grow. The vessels are not yet full and qi is relatively weak, but yang qi floats outward and overflows, hot qi steaming the skin interstices and then reaching the channels. Therefore, one selects the excess channels and skin interstices. Sometimes the pathogen retreats as soon as the needle arrives, because the pathogen is at the superficial level. What is called Shengjing refers to the yang channels.
The Yellow Emperor asked: In autumn, needling should select the jing-river points and shu-stream points. Why? Qi Bo replied: Autumn belongs to metal, and metal qi begins to take charge; lung qi begins to restrain and kill. Metal is about to overcome fire, and yang qi gradually collects into the he-sea points, while yin qi begins to gain advantage. Dampness attacks the human body, but yin qi has not yet reached its extreme and cannot penetrate deeply. Therefore, one selects shu-stream points to drain yin pathogens and he-sea points to weaken yang pathogens. Yang qi begins to decline, so he-sea points are selected.
The Yellow Emperor asked: In winter, needling should select the jing-well points and ying-spring points. Why? Qi Bo replied: Winter belongs to water, and water qi begins to take charge; kidney qi is in its period of storing and closing. Yang qi is declining and scanty, yin qi is firm and flourishing. The Taiyang channel qi lies submerged, and yang vessels likewise hide and sink. Therefore, one selects jing-well points to suppress and descend the rebelling yin qi, and ying-spring points to replenish yang qi. The ancients said, "In winter, select jing-well and ying-spring points, and in spring there will be no frequent nasal discharge or nosebleeds" — this is precisely the principle.
The Yellow Emperor said: You, Sir, have previously discussed the fifty-nine acupoints for treating heat disease. Although I can grasp the general idea, I still cannot distinguish their specific locations. I wish to hear the distribution and rationale of these points. Qi Bo replied: On the head there are five rows with five points each, which serve to disperse the heat pathogen🔥 that rebels upward through the various yang channels. Dazhu (BL11), Ying Shu, Quepen (ST12), and Bei Shu — these eight points serve to drain heat from the chest. Qijie (ST30), Zusanli (ST36), Shangjuxu (ST37), and Xiajuxu (ST39) — these eight points serve to drain heat from the stomach. Yunmen (LU2), Jianyu (LI15), Weizhong (BL40), and Suikong — these eight points serve to drain heat from the four limbs. Beside each of the five zang-organ Shu points there is one point — these ten points serve to drain heat from the five viscera. The above fifty-nine points are all important acupoints associated with the distribution of heat pathogen.
The Yellow Emperor asked: When a person encounters cold pathogen but it transforms into heat disease, why is this? Qi Bo replied: When cold pathogen is excessive, it transforms into heat.
The root-branch structure of the kidneys governing water
This chapter proposes that water metabolism has its "root in the kidneys and branch in the lungs." The kidneys are Zhiyin and govern storing and closing; the lungs are Taiyin and govern dispersing and descending. Water disease is not merely a kidney problem but involves the upper and lower unity of lungs and kidneys, with root and branch interconnected. This provides the classical foundation for later theories such as "the lungs are the upper source of water" and "lungs and kidneys generate each other."
The kidneys as the gate of the stomach
The ancients regarded the kidneys as the gateway for water excretion. This "gate" is not an anatomical valve but a summary of kidney qi's roles in consolidating and driving water excretion. When the gate fails, water-dampness stagnates and spills into the skin, creating edema.
Wind-water pathogenesis: sweating in the wind, Xuanfu obstruction
After excessive exertion, one sweats; encountering wind pathogen then closes the sweat pores. Water cannot escape externally nor return internally, so it stops within the skin layers and forms edema. This emphasizes external wind triggering internal water — one of the origins of the "wind-water" (Fengshui) theory in Chinese medicine.
The fifty-seven water acupoints and region-based point selection
The fifty-seven water-treating points are concentrated in the lower back, abdomen, and lower limbs, closely related to the kidney channel, bladder channel, and the three yin channels of the foot. When water disease involves "lung panting and kidney edema," it is called "both root and branch diseased." This reflects the approach of selecting points by location of water qi stagnation and organ relationships.
Seasonal needling: aligning with the depth of yin and yang
Spring: select luo-collaterals and interstices; Summer: select excess channels and skin interstices; Autumn: select shu-stream and he-sea points; Winter: select jing-well and ying-spring points. The core concept: in spring and summer, yang qi floats outward and pathogens are shallow, so needling is superficial; in autumn and winter, yang qi is stored internally and pathogens are deeper, so deeper points are selected. This embodies "treating according to the season."
The fifty-nine heat acupoints: draining heat by region
When heat pathogen is in the head, chest, stomach, four limbs, or five viscera, corresponding regions of points are selected. This shows that the ancients had already established a framework of "identifying patterns by region and selecting points by region" for heat diseases.
Excessive cold generating heat
When cold pathogen is excessive, yang qi becomes constrained, accumulating and transforming into heat. This is the classic expression of "yin-yang transformation" in Chinese medicine: extreme cold can generate heat.
"Kidneys governing water" does not equal the modern kidney
In modern medicine, the kidneys are indeed the core organs for regulating water-salt balance. However, "kidneys governing water" in Chinese medicine is a systemic concept involving the lungs, spleen, triple burner, bladder, etc., and cannot be directly equated with the modern anatomical kidneys. The ancients abstracted this theory from observing edema, sweating in wind, and other phenomena — systematic in nature but not a description of renal function in the modern experimental medical sense.
"Xuanfu" and the sweat pores/skin barrier
The ancients called sweat pores "Xuanfu," considering them portals for water and sweat to exit and enter. Modern physiology acknowledges that sweat glands, sebaceous glands, and skin microcirculation participate in thermoregulation and water evaporation. However, the notion that "water fluids lodging in the Xuanfu" causes edema cannot be directly mapped to modern skin barrier or microcirculation disorders — it is more of an ancient pathological model.
Rational view of needling point selection
The fifty-nine needling points, fifty-seven points, and seasonal needling methods reflect early observations of how surface stimulation regulates internal organ function. Although modern acupuncture research has found some evidence of nervous system and neuroendocrine regulation, high-quality evidence for the specificity of particular points or the superiority of seasonal needling remains lacking. The points and methods listed here should be regarded as traditional theory rather than modern clinical guidelines.
"Excessive cold generating heat" has reasonable elements but limitations
Cold pathogen lingering and transforming into heat resembles the macroscopic description of immunity declining after chilling, followed by secondary inflammation and fever, as seen in some modern infectious diseases. However, the mechanism of fever in modern medicine involves pathogens, immune responses, and thermoregulatory set-point adjustments. "Excessive cold" is only one trigger and cannot explain all heat diseases.
Avoid sweating in the wind
After vigorous exercise or exertion with heavy sweating, dry the body promptly and change clothes, avoiding prolonged exposure to drafts or cold wind. This is general lifestyle protection, not treatment for any specific disease.
Balance work and rest; nurture kidney qi
Chronic overwork and forceful exertion may deplete kidney qi. Maintain regular routines and avoid long-term overextension.
Adjust activities according to the four seasons
In spring and summer, yang qi flourishes outward — suitable for increasing activity and stretching the body; in autumn and winter, yang qi recedes inward — appropriate to reduce intense expenditure, keep warm, and rest. This aligns with the spirit of "shallow needling in spring, deep point selection in winter."
Pay attention to daily signals of water metabolism
If unexplained edema, panting, urinary abnormalities, or persistent fever occur, seek prompt medical attention at a qualified institution. Do not self-select acupuncture points or use herbs based on ancient texts.
Acupuncture should only be performed by qualified professionals
This chapter involves numerous points and techniques for classical study only. It must not be used as a basis for self-performed acupuncture or procedures on others.
Related Concepts
Further Reading
—— 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, prescription, needling, or treatment advice. Please consult a qualified healthcare provider if you are unwell.