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Chapter 32 of 81
黄帝内经·灵枢
Overall Paraphrased Meaning
The Yellow Emperor asked: I would like to hear your explanation—why is it that a normal person who does not eat will die after seven days? What is the principle behind this?
Bo Gao replied: Allow me to explain the reasons for this.
The Stomach (the organ that receives and initially decomposes food) has a circumference of one chi and five cun, a diameter of five cun, and a length of two chi and six cun. It is curved and coiled, and can hold three dou and five sheng of water and grain. Normally, it is considered full when it retains two dou of grain and one dou and five sheng of water. The Upper Burner (the region above the chest diaphragm, governing diffusion and distribution) distributes the essential qi of the water and grain in the stomach outward—this essential qi is swift, agile, and rapid in movement; the Lower Burner (the region below the navel, governing excretion and permeation) irrigates and nourishes the various intestines downward.
The Small Intestine has a circumference of two cun and a half, a diameter of eight and one-third fen, and a length of three zhang and two chi. It can hold two dou and four sheng of grain and six sheng, three he, and two-thirds of a he of water. The Hui Intestine (i.e., the middle segment of the large intestine) has a circumference of four cun, a diameter of one and one-third cun, and a length of two zhang and one chi. It can hold one dou of grain and seven and a half sheng of water. The Guang Intestine (i.e., the rectal segment) has a circumference of eight cun, a diameter of two and two-thirds cun, and a length of two chi and eight cun. It can hold nine sheng, three he, and one-eighth of a he of grain.
The total length of the stomach and intestines amounts to five zhang, eight chi, and four cun, with a combined capacity of nine dou, two sheng, one he, and two-thirds of a he of water and grain. This is the total capacity of the stomach and intestines for holding water and grain.
However, the actual state of a healthy person (one free from disease) is not that the stomach and intestines are simultaneously full. When the stomach is full, the intestines are empty; when the intestines are full, the stomach is empty. Between the stomach and intestines there is a pattern of alternating fullness and emptiness—when one side is full, the other is empty, and this alternation continues. It is precisely because of this alternating fullness and emptiness that qi movement can circulate properly upward and downward, the five viscera can remain stable, blood and vessels can flow harmoniously, and spirit can abide peacefully within. Therefore it is said, spirit (the vital vitality of a person) has water-grain essential qi as its material foundation.
Therefore, the stomach and intestines should retain two dou of grain and one dou and five sheng of water. A healthy person has bowel movements twice daily, each time expelling two and a half sheng, for a total of five sheng per day. Over seven days, this accumulates to five times seven, or three dou and five sheng—exactly the amount that would completely empty the water and grain retained in the stomach and intestines. Thus, if a normal person neither eats nor drinks, death occurs within seven days because the essential qi and jin-ye (the collective term for normal bodily fluids) produced from water and grain have been completely exhausted.
The core medical principle of this chapter is to elucidate a fundamental proposition: Human life activity depends on the continuous nourishment of water-grain essential qi, and the rhythmic alternation of fullness and emptiness in the stomach and intestines is the dynamic mechanism that sustains this process.
Bo Gao first uses anatomical data to list the dimensions and capacities of the stomach, small intestine, hui intestine, and guang intestine, then points out that "the healthy person is not like this"—healthy individuals do not have all digestive organs simultaneously filled, but rather the stomach is full while the intestines are empty, and the intestines are full while the stomach is empty, alternating in sequence. This rhythmic alternation of emptiness and fullness enables:
Finally, Bo Gao uses calculations of defecation volume to demonstrate the reason for "death in seven days": eliminating five sheng daily, over seven days the total is three dou and five sheng, which exactly matches the amount normally retained in the stomach and intestines. When water and grain are exhausted and essential qi and jin-ye are consequently depleted, life cannot be sustained. Although this deduction is based on the measurement standards of that era, the underlying reasoning follows rigorous logic of material-energy conservation: there must be intake for output; output requires input; balance between input and output sustains life, while the severance of both leads to death.
From the perspective of modern physiology, this chapter demonstrates the ancient physicians' efforts to understand the digestive system through actual anatomical observation. The descriptions of intestinal segments (stomach, small intestine, hui intestine, guang intestine) correspond to modern anatomical divisions of the stomach, small intestine, colon, and rectum, indicating that ancient medical practitioners were not purely speculative but had a foundation in empirical observation.
However, there are significant discrepancies between the ancient measurements and modern anatomical data. Taking the small intestine as an example, the text records "length of three zhang and two chi" (approximately seven-plus meters in modern units), whereas modern anatomy shows the adult small intestine to be approximately 5–7 meters—roughly close in value but still with differences. The stomach capacity cited as "three dou and fivee sheng" converts to a value far greater than the modern understanding of normal gastric capacity. These differences primarily stem from the different measurement standards between ancient and modern times, as well as observational methods and post-mortem changes (such as relaxation-induced distention).
The assertion of "death in seven days" is an empirical summary based on observed experience. Modern medicine holds that a person who completely abstains from food but continues drinking water may survive considerably longer than seven days, depending on factors such as body fat reserves, basal metabolic rate, and environmental temperature. If completely abstaining from both food and water, survival time is considerably shorter. Therefore, "seven days" should be understood as an empirical conclusion drawn from conventional observation rather than an absolutely precise physiological constant.
The concept of alternating fullness and emptiness holds significant methodological value. Modern physiology similarly recognizes coordinated rhythmic activities among different segments of the digestive tract—when the stomach is emptying, the intestines may be conducting digestion and absorption; when the intestines are emptying, the stomach begins receiving new food. This "orderly alternation" ensures the continuity and efficiency of the digestive process. Although the ancients did not have concepts such as "gastrointestinal peristaltic waves" or "migrating motor complex," they accurately encapsulated this dynamic equilibrium in the four characters "more empty, more full," demonstrating a high level of systems thinking.
Moderation in eating, avoiding excessive fullness: This chapter emphasizes the natural rhythm of "when the stomach is full, the intestines are empty; when the intestines are full, the stomach is empty." If one overeats at every meal or eats continuously, the stomach and intestines remain perpetually in a state of "fullness," disrupting this rhythm. Daily eating should be regular and moderate, leaving periods of "emptiness" for the stomach and intestines so that qi movement has space to circulate freely.
Chew thoroughly and eat slowly to reduce the stomach's burden: The capacity and decomposing ability of the stomach are limited. Thorough chewing and slower eating facilitate smoother downward transmission of water and grain and promote the full generation of essential qi.
Maintain regular bowel habits: Unimpeded defecation is an important link in sustaining the cycle of "alternating fullness and emptiness." If one suppresses the urge to defecate, the intestines remain in a prolonged state of "fullness," affecting the entire digestive rhythm and the ascending-descending movement of qi. Cultivating regular bowel habits represents foundational care for the stomach and intestines.
Spirit is rooted in water and grain: This chapter concludes by stating that "spirit is the essential qi of water and grain." In modern life, many people experience low spirits and poor concentration due to dieting, picky eating, or irregular eating habits—manifestations of insufficient water-grain essential qi. Proper eating is not merely physical nurturance but constitutes the foundation of spiritual nourishment.
Associated Concepts:
Further Reading:
This content is based on classical Chinese medicine texts and is provided solely for cultural heritage study and contemplation. It does not constitute any form of medical diagnosis, medication, or treatment advice. Please consult a qualified healthcare professional in case of illness.