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Chapter 28 of 81
黄帝内经·灵枢
Overall Paraphrase
The transmitted text of this chapter contains certain erroneous characters (e.g., "Qi Bo" mistakenly written as "Chui Bo," "Fang Bo," "Jun Bo"; "hiccup" mistakenly written as "noise" or "gaze," etc.). The translation has been corrected according to contextual meaning.
When the Yellow Emperor was dwelling at leisure, he dismissed those around him and inquired of Qi Bo: "I have already heard the classic of the Nine Needles, which discusses the proper and contrary flow of yin and yang, and the matters of the Six Meridians (the six categories of meridians among the twelve human meridians, divided among the three yin and three yang). I have essentially mastered it. Now I wish to hear the 'Oral Inquiries' — those teachings passed down by word of mouth from the ancient masters, not found in written classics." Qi Bo stepped away from his mat and bowed twice, saying: "An excellent question! These are precisely the oral traditions of the ancient masters."
The Yellow Emperor said: "I wish to hear this orally transmitted learning." Qi Bo replied: The occurrence of all diseases arises from external pathogens such as wind, rain, cold, and summer heat; from emotional factors such as yin-yang, joy, and anger; from diet and dwelling; and from great fright and sudden terror. These factors cause separation of blood and qi, disruption of yin and yang, reversal and severance of the meridians (passageways through which qi and blood circulate), obstruction of the vessels, mutual opposition of yin and yang, stagnation of defensive qi (qi that travels outside the vessels and protects the body surface), emptiness of the meridians and vessels, and紊乱 of blood and qi circulation — thus departing from the normal state. These matters are not contained in written classics. Allow me to explain their principles.
The Yellow Emperor asked: "When a person yawns, what qi causes it?" Qi Bo replied: Defensive qi travels through the yang aspects during the day and through the yin aspects at midnight. Yin governs the night, and during the night, people lie down to sleep; yang arises upward, while yin descends downward. Therefore, during the night, yin qi accumulates below, while yang qi has not yet fully entered the interior. Yang qi pulls upward, and yin qi pulls downward. The two qi pull against each other, and so the person repeatedly yawns. When yang qi has fully entered the interior and yin qi is abundant, the person closes the eyes and sleeps. When yin qi is exhausted and yang qi is abundant, the person awakens. Acupuncture treatment: Drain the foot shaoyin meridian (KI), tonify the foot taiyang meridian (BL).
The Yellow Emperor asked: "When a person hiccups, what qi causes it?" Qi Bo replied: After grains enter the stomach, stomach qi rises to the lungs. If there is pre-existing cold qi in the body that contends with the newly entered grain qi, the new and old qi become chaotic, and upright qi and pathogenic qi attack each other. The two qi combine and flow adversely, then emerge upward from the stomach, thus producing hiccups. Treatment: Tonify the hand taiyin meridian (LU), drain the foot shaoyin meridian (KI).
The Yellow Emperor asked: "When a person sobs and sighs, what qi causes it?" Qi Bo replied: This occurs when yin qi is excessive and yang qi is deficient. Yin qi arrives swiftly, while yang qi arrives slowly. Yin qi is hyperactive and yang qi is about to expire, so this produces sobbing and sighing. Treatment: Tonify the foot taiyang meridian (BL), drain the foot shaoyin meridian (KI).
The Yellow Emperor asked: "When a person has cold shivers, what qi causes it?" Qi Bo replied: Cold qi invades the skin; yin qi becomes abundant and yang qi becomes deficient, thus producing trembling chills and cold shivering. Treatment: Tonify all yang meridians.
The Yellow Emperor asked: "When a person belches, what qi causes it?" Qi Bo replied: Cold qi invades the stomach, and counterflow qi disperses upward from below, emerging again through the stomach, thus producing belching. Treatment: Tonify the foot taiyang and foot yangming meridians (BL, ST). Another version says tonify the meiben point (i.e., Cuanzhu, BL-2).
The Yellow Emperor asked: "When a person sneezes, what qi causes it?" Qi Bo replied: Yang qi is harmonized and畅通, fills the chest, and exits through the nose, thus producing sneezing. Treatment: Tonify the ying-spring point of the foot taiyang meridian (Zutonggu, BL-66) and the meiben point (Cuanzhu, BL-2).
The Yellow Emperor asked: "When a person's limbs are lax and without strength, what qi causes it?" Qi Bo replied: When stomach qi is not substantial, then all the vessels become empty; when all the vessels are empty, then the sinews and vessels become lax; when the sinews and vessels are lax and one then forcibly exerts oneself in sexual activity, qi cannot recover, thus producing limb laxity. Treatment: According to the location of the disease, tonify between the muscles and flesh (the intermuscular spaces).
The Yellow Emperor asked: "When a person weeps tears and discharges nasal mucus in sorrow, what qi causes it?" Qi Bo replied: The heart is the sovereign of the five viscera and six bowels; the eyes are where the gathering meridians (where numerous meridians converge) collect, and are also the pathway of the upper fluids; the mouth and nose are the gates of qi. Therefore, when one is sorrowful, mournful, worried, or anxious, the heart-spirit is stirred; when the heart-spirit is stirred, the five viscera and six bowels are all shaken; when shaken, the gathering meridians respond; when the gathering meridians respond, the fluid passages open; when the fluid passages open, tears and nasal mucus flow out together. Fluids serve to nourish the subtle essences and moisten the orifices. Therefore, when the upper fluid passages open, tears flow; when tears flow without cease, the fluids are exhausted; when the fluids are exhausted, the essence cannot nourish; when the essence cannot nourish, the eyes cannot see, and so it is called 'depletion of essence.' Treatment: Tonify the tianzhu point (BL-10, beside the neck on both sides).
The Yellow Emperor asked: "When a person heaves a long sigh, what qi causes it?" Qi Bo replied: Worry and brooding cause the heart's connecting cords (the connective tissue surrounding the heart) to contract; when the heart's connecting cords contract, the qi passageway constricts; when the qi passageway constricts, qi movement is impeded, and so one must heave a long sigh to extend and stretch the qi mechanism. Treatment: Tonify the hand shaoyin meridian (HT), the heart master (hand jueyin meridian, PC), and the foot shaoyang meridian (GB), retaining the needle.
The Yellow Emperor asked: "When a person drools, what qi causes it?" Qi Bo replied: Food and drink all enter the stomach. When there is heat in the stomach, then worms are stirred; when worms are stirred, the stomach becomes relaxed; when the stomach becomes relaxed, the Lianquan point (CV-23, below the tongue, governing fluids) opens, and so drooling occurs. Treatment: Tonify the foot shaoyin meridian (KI).
The Yellow Emperor asked: "When a person has ringing in the ears, what qi causes it?" Qi Bo replied: The ear is where the gathering meridians converge. Therefore, when the stomach is empty and deficient, the gathering meridians become deficient; when the gathering meridians are deficient, they sink downward; when the streaming vessels (vessels of continuous flow) become depleted, thus ringing in the ears occurs. Treatment: Tonify the Kezhuren point (ST-3, Shangguan) and the point where the nail of the thumb meets the flesh (LT-11, Shaoshang).
The Yellow Emperor asked: "When a person involuntarily bites the tongue, what qi causes it?" Qi Bo replied: This occurs when counterflow qi travels upward and the qi of the vessels gathers and arrives. When the shaoyin meridian qi reverses and arrives, one bites the tongue; when the shaoyang meridian qi reverses and arrives, one bites the cheek; when the yangming meridian qi reverses and arrives, one bites the lip. Apply tonification according to the meridian responsible for the disease.
The above twelve types of pathogenic influences are all cases of extraordinary pathogens (abnormal pathogenic qi) traveling through the orifices (openings and cavities of the human body). Wherever pathogenic qi lingers, it is a place where upright qi is insufficient. Therefore, when upper qi is insufficient, the brain and marrow are not fully supplemented, the ears suffer from ringing, the head tends to incline, and the eyes become dizzy; when middle qi is insufficient, bowel and urinary function become abnormal, and there is rumbling in the intestines; when lower qi is insufficient, the lower limbs become weak and cold, and the heart feels vexed. Treatment: Tonify below the outer ankle (near BL-62, Shenmai), retaining the needle.
The Yellow Emperor asked: "How are these conditions treated?" Qi Bo replied: The kidneys govern yawning (take the foot shaoyin meridian, KI); the lungs govern hiccups (take the hand taiyin and foot shaoyin meridians, LU, KI); sobbing and sighing indicate that yin and yang are about to expire, so tonify the foot taiyang meridian and drain the foot shaoyin meridian; for cold shivering, tonify all yang meridians; for belching, tonify the foot taiyin and yangming meridians (SP, ST); for sneezing, tonify the foot taiyang meridian and the meiben point; for limb laxity, tonify between the muscles according to the location; for weeping tears, tonify the tianzhu point (BL-10, beside the neck bilaterally, in the middle region of the head); for long sighs, tonify the hand shaoyin meridian, the heart master (hand jueyin meridian), and the foot shaoyang meridian, retaining the needle; for drooling, tonify the foot shaoyin meridian; for ringing ears, tonify the Kezhuren point (ST-3) and the point where the thumb nail meets the flesh (LT-11, Shaoshang); for self-biting of the tongue, apply tonification according to the meridian responsible for the disease; for dizziness and head inclination, tonify below the outer ankle (BL-62), retaining the needle; for weakened-cold extremities and vexation in the heart, needle two inches above the first interdigital space of the foot (LR-3, Taichong), retaining the needle; another version says below the outer ankle, retaining the needle.
The core academic thought of this chapter can be summarized in three points:
I. "Extraordinary pathogens traveling through the orifices"—profound principles behind minor symptoms 🌿 Twelve seemingly trivial daily symptoms — yawning, hiccups, sobbing, shivering, belching, sneezing, limb laxity, weeping, sighing, drooling, ringing ears, and tongue-biting — are uniformly incorporated into the theoretical framework of "extraordinary pathogens traveling through the orifices." The ancients believed that these symptoms were not insignificant but rather manifestations of extraordinary pathogens (pathogenic qi that does not follow the regular pathways) invading the orifices (the openings of the ears, eyes, mouth, nose, and the interspaces of the meridians). This embodies an important holistic view in the Inner Classic: local symptoms are reflections of systemic qi-mechanism abnormalities.
II. "Wherever pathogens are, there is insufficiency"—the core of pathogenesis 💡 The most incisive statement in this chapter is: "Therefore, wherever pathogens linger, there is insufficiency." The fundamental reason pathogenic qi can remain is that righteousness/qi is deficient at that location. This is not merely a simple metaphor of "pathogens bullying the weak," but rather the concrete expression of the Inner Classic's principle that "when upright qi exists within, pathogens cannot interfere." In almost every pathological explanation of the twelve symptoms, the pattern points to depletion of qi, blood, yin, or yang in a particular meridian or region — yang deficiency causes cold shivering, stomach deficiency causes ringing ears, stomach deficiency causes laxity, and fluid exhaustion causes the eyes to fail in seeing.
III. The three-dimensional diagnostic framework of "upper, middle, and lower qi mechanism" 🩺 At the end of the chapter, the twelve pathogens are subsumed under qi deficiencies at the three层次 level: upper qi insufficiency results in malnutrition of the upper orifices such as the brain, ears, head, and eyes; middle qi insufficiency results in dysfunction of the middle burner such as bowel and urinary irregularities; lower qi insufficiency results in weakened cold lower limbs and heart vexation. This is consistent with the overall thought of the textual cluster in which Ling Shu, Chapter 28 resides: the human body is an interconnected qi-mechanism system, and insufficiency at any level produces symptoms at the corresponding location.
Therapeutically, this chapter primarily employs tonification, supplemented by draining (e.g., draining the foot shaoyin to dispel the excess of yin cold), embodying the basic treatment principle of "deficiency is treated by tonification; excess is treated by drainage." However, it emphasizes tonifying insufficiency — because the essence of the twelve pathogens is insufficiency.
Verifyable observations: The symptoms recorded by the ancients — yawning, sneezing, hiccups, shivering, ringing ears, drooling, tongue-biting — are all extremely common phenomena in clinical practice and daily life, demonstrating that the ancient clinical observations were meticulous and authentic. For example:
Historical limitations: The ancients employed concepts such as yin-yang, defensive qi, gathering meridians, and worm movement to explain these symptoms. These belong to a traditional theoretical framework and cannot be equated with modern pathological mechanisms. For instance, the explanation of "heat in the stomach moves worms, worms move then the stomach loosens, the stomach loosens then the Lianquan opens" — the "worms" refer to parasites believed by ancients to reside in the gastrointestinal tract, an interpretation that is narrow by modern standards. The acupuncture points employed, such as "tonifying Kezhuren and Shaoshang to treat ringing ears," belong to ancient needling experience. Their efficacy lacks modern evidence-based medical support and should not be considered definitive therapeutic methods.
Rational attitude: The value of this chapter lies in its demonstration of systematic thinking about "minor symptoms" — not dismissing yawning as trivial, but placing it within the larger framework of yin-yang qi dynamics. This systems thinking is worthy of reference, but the specific pathological explanations and acupuncture protocols must be critically approached within modern medicine and正规 TCM clinical frameworks.
The insights above are general lifestyle recommendations and do not target any specific disease.
Associated concepts:
Further reading:
This content is based on classical Chinese medicine texts and is provided solely for the study of traditional culture. It does not constitute any medical diagnosis, prescription, medication recommendations, or treatment advice. If you feel unwell, please promptly consult a medical professional.