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Chapter 29 of 81
黄帝内经·灵枢
The Yellow Emperor said: I have heard that the former teachers hold certain insights in their hearts, not written on bamboo tablets. I wish to hear them and commit them to memory, so that I may follow and practice them—above, to govern the people; below, to nourish oneself; to keep the populace free from illness, to foster harmony and affection between high and low, to let blessings flow downward, to leave descendants without worries, and to pass this on to later generations without end. May I hear it?
Qi Bo said: How profound is your question! To govern the people and to nourish oneself, to regulate others and to regulate oneself, to handle the small and the great, to rule a state and to manage a household—none can be well managed by going against principle. Only "according with" (shun) will do. What is meant by "according with" here is not merely the inverse or compliant flow of yin-yang pulses and qi movement—the common people also all wish to have their desires fulfilled.
The Yellow Emperor asked: How does one accord with the people?
Qi Bo said: Upon entering a state, first ask about its local customs; upon entering a household, first ask about its taboos; upon entering a hall, first ask about its etiquette; and when facing a patient, first ask about his likes, dislikes, and what suits him.
The Yellow Emperor asked: How does one accord with the patient's likes and dislikes?
Qi Bo said: When there is heat in the body, as in wasting-thirst disorders, coldness is appropriate; when cold pathogens are deep within, warmth is appropriate. When there is heat in the stomach, food is readily digested, causing a feeling of hunger with an unsettled heart—the skin above the navel feels hot. When there is heat in the intestines, the stool becomes yellow and slushy, and the skin below the navel feels cool. When there is cold in the stomach, abdominal distension results; when there is cold in the intestines, there is borborygmus and undigested-food diarrhea. When the stomach is cold and the intestines are hot, both distension and diarrhea appear; when the stomach is hot and the intestines are cold, there is rapid hunger and pain in the lower abdomen.
The Yellow Emperor asked: The stomach prefers cold drinks while the intestines prefer warm drinks—these two are opposed. How does one accord with both? Furthermore, the nobles and lords who feast on meat are arrogant and willful, treating others lightly, and cannot be forcefully restrained. To forbid them would go against their will; to follow without guidance would aggravate their illness. What is to be done? Where should one begin?
Qi Bo said: It is human nature to loathe death and delight in life. If you inform them of the harms, speak to them of the benefits, guide them with suitable methods, and awaken them to their own suffering—even for the most unreasonable person, who would not comply?
The Yellow Emperor asked: How specifically should one regulate and treat?
Qi Bo said: In spring and summer, first treat the branch (manifestation), then the root; in autumn and winter, first treat the root, then the branch.
The Yellow Emperor asked: When cold and heat preferences are contrary to each other, how does one accord with the patient?
Qi Bo said: In such circumstances, food, drink, and clothing should all be appropriately warm or cool: when cold, do not let the patient shiver; when hot, do not let the patient sweat. In matters of diet, hot should not burn and cold should not be icy. When cold and warmth are properly balanced, the upright qi is preserved and evil qi is not invited.
The Yellow Emperor said: The chapter Ben Zang holds that by observing the body's shape, limbs, and muscles, one can infer the size of the five zang and six fu organs. But now, when nobles and sovereigns in court come to ask questions, who dares to palpate their bodies before answering?
Qi Bo said: The body's shape and limbs are the external covering of the zang-fu organs—one should not observe solely from the face.
The Yellow Emperor said: I already understand the manifestations of the five zang qi on the face. How does one observe through the limbs and trunk?
Qi Bo said: Among the five zang and six fu, the lung resides highest, like a ceremonial canopy. Broad shoulders and a sunken throat allow external measurement. The Yellow Emperor said: Good.
Qi Bo said: The five zang and six fu take the heart as their sovereign. The supraclavicular fossa is the passage of vessels and qi. When the chest bone area is ample, one can measure the chest and anterior thorax. The Yellow Emperor said: Good.
Qi Bo said: The liver acts as general, presiding over outward observation. To know whether it is firm, observe the size of the eyes. The Yellow Emperor said: Good.
Qi Bo said: The spleen governs protection and receives water and grain. Observing the lips and tongue and their preferences reveals auspicious or inauspicious conditions. The Yellow Emperor said: Good.
Qi Bo said: The kidney governs the exterior and is responsible for distant hearing. Observing the quality of the ears reveals its nature. The Yellow Emperor said: Good. May I hear about the external signs of the six fu organs?
Qi Bo said: Among the six fu organs, the stomach is the sea of water and grain. Wide cheekbones, a thick neck, and an open chest allow the five grains to be accommodated; deep and long nasal passages measure the large intestine; thick lips and a long philtrum measure the small intestine; large lower eyelids indicate a bold gallbladder; flaring nostrils indicate that the bladder is prone to leakage; a prominent ridge down the center of the nose indicates that the sanjiao's containing function is normal. These are the methods for measuring the six fu. When the upper, middle, and lower parts are well proportioned, the zang-fu organs are healthy.
"According with" (Shun) as the general principle: This chapter unifies governing a state, managing a household, and nourishing oneself under the single word shun (according with). To accord is not blind appeasement, but aligning with human dispositions, seasonal rhythms, disease dynamics, and the preferences of the zang-fu organs—avoiding going against them in treatment.
Asking what is suitable (wen suo bian): Before diagnosis and treatment, one should first understand the patient's subjective preferences, especially cold and heat sensitivities. 🌡️ Yet the ancients specifically noted that stomach and intestinal preferences may contradict each other—such as stomach heat with intestinal cold, or stomach cold with intestinal heat—so one cannot blindly follow surface preferences.
Root and branch sequence with the four seasons: In spring and summer, when yang qi floats outward, treat the branch first and the root second; in autumn and winter, when yang qi is stored within, treat the root first and the branch second. This reflects the approach of adapting to the seasons.
Inferring internal from external (si wai chuai nei): Through the body's shape, limbs, and facial features, one infers the state of the internal organs. For example, the lung is measured by the shoulders and throat, the heart by the supraclavicular fossa, the liver by the eyes, the spleen by the lips and tongue, and the kidney by the ears; the six fu also have corresponding external signs. This reflects the holistic and holographic thinking of the Nei Jing.
Valuing the patient's subjective experience: The instruction to "ask the patient what is suitable" resonates with the modern patient-centered approach. Understanding lifestyle habits and thermal preferences helps build trust and communication.
Communication and persuasive methods: The phrase "inform them of harms, speak of benefits, guide by suitability, awaken by suffering" resembles modern health education, informed consent, and motivational interviewing—emphasizing rational communication over coercion.
Historical limitations: Inferring organ function from body surface features belongs to the ancient observational method of "inferring internal from external." While it carries holistic thinking value, it lacks the precision of modern anatomy and physiology and clinical validation, and should not serve as a diagnostic basis. Models such as stomach heat or intestinal cold also require objective examination to corroborate.
Seasonal treatment concepts: Ideas such as root-branch sequencing in spring/summer versus autumn/winter represent empirical observations of seasonal influences on the human body, but their concrete application requires modern evidence rather than mechanical application.
Moderate cold and warmth: Daily diet and clothing should avoid extremes. 🌿 Hot should not burn and cold should not be icy—moderate temperatures help preserve upright qi and reduce external irritation.
Following the four seasons: Keep warm in winter, avoid excessive sweating in summer, and adjust routines and protection according to seasonal changes to maintain inner-outer balance.
Communication before coercion: In family and self-management, one may borrow the principle of "informing of harms, speaking of benefits, guiding by suitability," using reasoned explanation of consequences and suitable methods instead of simple prohibition—this is more readily accepted.
Beware of self-diagnosis: Understanding one's own cold/heat sensitivities and dietary preferences is part of self-observation, but it should not ground self-diagnosis or self-medication.
Related concepts: Root-branch sequence, cold and heat preferences, inferring internal from external, external signs of the five zang and six fu, sun-xie (undigested-food diarrhea), xiao-dan (wasting-thirst), sanjiao
Further reading: Ling Shu·Ben Zang, Ling Shu·Wu Se, Su Wen·Biao Ben Bing Chuan Lun, Su Wen·Yin Yang Ying Xiang Da Lun
Bu Gua Note: This content is based on classical Chinese medicine texts, intended solely for the study of traditional culture—it does not constitute any medical diagnosis, prescription, or treatment advice. Please seek medical care promptly when unwell.