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Chapter 47 of 81
黄帝内经·灵枢
Overall Paraphrase
The Yellow Emperor asked Qi Bo for guidance: Human blood qi and spirit are the foundation that sustains life and circulates throughout the body. The function of the meridians is to transport blood qi, nourish yin and yang internally and externally, moisten sinews and bones, and lubricate the joints. The function of wei qi (the qi that circulates on the body surface, with warming and defensive functions) is to warm and nourish the muscles, fill and moisten the skin, enrich the interstices (the spaces between skin and muscle), and govern the opening and closing of the sweat pores. The function of zhiyi (the regulatory capacity of consciousness and intention) is to govern spiritual activity, restrain the ethereal and corporeal souls, adapt to cold and heat variations, and harmonize joy and anger emotions.
Therefore, when blood qi is harmonious and smooth, the meridians flow without obstruction, yin and yang are nourished internally and externally, sinews and bones are strong and powerful, and joints are clear and agile. When wei qi is harmonious and smooth, the muscles are relaxed and supple, the skin is soft and moist, and the interstices are fine and compact. When zhiyi is harmonious and smooth, the spirit is focused, the ethereal and corporeal souls are stable, no regret or anger arises, and the five viscera are less susceptible to attack by pathogenic qi. When cold and heat are properly regulated, the six bowels can digest food and water normally, diseases such as wind-bi do not occur, the meridians are unobstructed, and the limbs and joints are at ease. This is the normal state of health and balance in the human body.
The function of the five viscera is to store spirit, blood qi, and the ethereal and corporeal souls; the function of the six bowels is to digest food and water and distribute body fluids. These are endowments received from heaven by all people, and whether foolish or wise, worthy or unworthy, there is no difference. However, some people are able to live out their full natural lifespan,不受 pathogenic diseases, and remain undiminished at one hundred years of age. Even when encountering wind and rain, sudden cold, or intense heat, they cannot be harmed. Others never leave a tightly sheltered room and experience no fright or trauma, yet they still cannot avoid illness—why is this? I wish to hear the reasoning behind it.
Qi Bo replied: This question is profound indeed! The five viscera correspond with heaven and earth, match with yin and yang, connect with the four seasons, and resonate with the rhythms of the five phases. The five viscera themselves differ in size, height, firmness, fragility, uprightness, and inclination; the six bowels also differ in size, length, thickness, straightness or curvature, and slowness or rapidity. These twenty-five variations are each different—some favorable, some unfavorable, some auspicious, some inauspicious. Allow me to explain the principles.
A small heart means the spirit is calm and external pathogens find it difficult to harm it, but it is susceptible to injury from grief and worry; a large heart means grief and worry find it difficult to harm it, but it is susceptible to attack by external pathogens. A high-positioned heart causes lung qi to become congested and full, making a person agitated, forgetful, and difficult to guide with words; a low-positioned heart causes visceral qi to spread outward, making one susceptible to cold and easily frightened. A firm heart means visceral qi is stable and internally secure; a fragile heart makes one susceptible to consumptive thirst (internal heat diseases of the wasting type) and internal heat syndrome.
An upright heart means blood qi is harmonious and smooth with little susceptibility to disease; an inclined heart means the mind is unsettled, the will is not focused, and one lacks firm opinions. A small lung means one drinks little water and is not susceptible to panting; a large lung means one drinks much water and is susceptible to chest-bi, throat-bi, and rebellious qi. A high-positioned lung causes qi to rebel upward, raising the shoulders when panting and coughing; a low-positioned lung presses against the cardia, causing pain below the ribs. A firm lung means little susceptibility to coughing and rebellious qi; a fragile lung makes one susceptible to consumptive thirst and easily harmed by external pathogens. An upright lung is harmonious and beneficial, difficult to harm; an inclined lung causes pain on one side of the chest. A small liver means visceral qi is stable with no diseases below the ribs; a large liver presses against the stomach and pushes upward against the throat, causing discomfort in the diaphragm and pain below the ribs. A high-positioned liver pushes upward against the diaphragm, causing fullness in the flanks and rapid breathing; a low-positioned liver presses against the stomach, leaving the area below the ribs empty, and when this area is empty it is easily attacked by pathogens. A firm liver means visceral qi is stable and difficult to harm; a fragile liver makes one susceptible to consumptive thirst and easy injury. An upright liver is harmonious and beneficial, difficult to harm; an inclined liver causes pain below the ribs. A small spleen means visceral qi is stable and not easily attacked by pathogens; a large spleen causes a sensation of something accumulating below the ribs with pain, making rapid walking impossible. A high-positioned spleen pulls on the lower ribs causing pain; a low-positioned spleen presses downward on the large intestine, making one easily attacked by pathogens. A firm spleen means visceral qi is stable and difficult to harm; a fragile spleen makes one susceptible to consumptive thirst and easy injury. An upright spleen is harmonious and beneficial, difficult to harm; an inclined spleen makes one susceptible to fullness and distension. A small kidney means visceral qi is stable and difficult to harm; a large kidney makes one susceptible to low back pain, inability to bend or extend, and easy attack by pathogenic qi. A high-positioned kidney causes back pain with inability to bend or extend; a low-positioned kidney causes heavy and painful sensations in the lower back, inability to bend or extend, and susceptibility to fox-hernia (a type of hernia). A firm kidney means no low back or back pain; a fragile kidney makes one susceptible to consumptive thirst and easy injury. An upright kidney is harmonious and beneficial, difficult to harm; an inclined kidney causes pain in the lower back and sacrum.
These twenty-five variations above are the internal causes of diseases to which people are commonly susceptible in daily life.
The Yellow Emperor asked: How can these differences be known? Qi Bo said: If the skin color is red and the texture is fine and dense, the heart is small; if the texture is coarse and loose, the heart is large. If the sternum is not prominent, the heart is positioned high; if the sternum is short and elevated, the heart is positioned low. If the sternum is long, the heart is firm; if the sternum is weak and thin, the heart is fragile. If the sternum hangs straight without elevation, the heart is upright; if the sternum leans to one side, the heart is inclined. If the skin color is white and the texture is fine and dense, the lung is small; if the texture is coarse and loose, the lung is large. If the shoulders are broad, the chest thick, and the throat deeply recessed, the lung is positioned high; if the axillae are drawn in and the flanks spread open, the lung is positioned low. If the shoulders and back are thick and solid, the lung is firm; if the shoulders and back are thin and weak, the lung is fragile. If the back and chest are thick and solid, the lung is upright; if the two flanks are separated and asymmetric, the lung is inclined. If the skin color is green and the texture is fine and dense, the liver is small; if the texture is coarse and loose, the liver is large. If the chest is broad and the ribs are elevated, the liver is positioned high; if the flanks are drawn in and the ribs lie low, the liver is positioned low. If the chest and flanks are well developed, the liver is firm; if the ribs are weak and soft, the liver is fragile. If the chest and abdomen are well proportioned, the liver is upright; if the ribs on one side are elevated, the liver is inclined. If the skin color is yellow and the texture is fine and dense, the spleen is small; if the texture is coarse and loose, the spleen is large. If the lips turn upward, the spleen is positioned high; if the lips droop and are relaxed, the spleen is positioned low. If the lips are firm and solid, the spleen is firm; if the lips are large but not firm, the spleen is fragile. If the lips are even and well-proportioned above and below, the spleen is upright; if the lips are slanted, the spleen is inclined. If the skin color is black and the texture is fine and dense, the kidney is small; if the texture is coarse and loose, the kidney is large. If the ear helices are prominent and elevated, the kidney is positioned high; if the area behind the ears is sunken, the kidney is positioned low. If the ear helices are firm, the kidney is firm; if the ear helices are thin and not firm, the kidney is fragile. If the ear helices are in an upright position close to the gums, the kidney is upright; if one ear helix is elevated on one side, the kidney is inclined.
If these variations above are maintained in a good state, the body remains at ease; if there is decline, one becomes susceptible to illness.
The Yellow Emperor said: Well spoken. But this is not yet what I wish to ask. I want to know: Some people never become ill and live out their full natural lifespan. Even with deep grief and great fear, they cannot be harmed; severe cold and intense heat cannot injure them either. Yet others never leave a tightly sheltered room and experience no fright or stimulation, yet they still cannot avoid illness—why is this?
Qi Bo said: The five viscera and six bowels are the places where pathogenic qi lodges. Allow me to explain the reasons. If all five viscera are small, one has fewer illnesses but is easily prone to grief and anxiety; if all five viscera are large, one acts with calm and deliberation and is not easily troubled by grief. If all five viscera are positioned high, one tends to aspire upward and aim high; if all five viscera are positioned low, one is content to remain lowly and has a humble disposition. If all five viscera are firm, one is not easily affected by illness; if all five viscera are fragile, illness never leaves the body. If all five viscera are upright, one has a peaceful disposition and gains the trust of others; if all five viscera are inclined, one's mind is devious and prone to greed, unable to treat others fairly, and one's speech is inconsistent and changeable.
The Yellow Emperor said: I wish to hear about the correspondence between the six bowels and the external body.
Qi Bo replied: The lung pairs with the large intestine, and the large intestine corresponds externally to the skin. The heart pairs with the small intestine, and the small intestine corresponds externally to the blood vessels. The liver pairs with the gallbladder, and the gallbladder corresponds externally to the sinews. The spleen pairs with the stomach, and the stomach corresponds externally to the muscles. The kidney pairs with the triple burner and bladder, and the triple burner and bladder correspond externally to the interstices and body hair.
The Yellow Emperor asked: How exactly is this correspondence manifested?
Qi Bo said: The lung corresponds to the skin. If the skin is thick, the large intestine is thick; if the skin is thin, the large intestine is thin. If the skin is loose and the abdominal circumference is large, the large intestine is large and long; if the skin is taut, the large intestine is tight and short. If the skin is smooth, the large intestine is straight; if the skin and flesh adhere closely without separation, the large intestine is tangled and obstructed. The heart corresponds to the blood vessels. If the skin is thick, the vessels are thick, and if the vessels are thick, the small intestine is thick; if the skin is thin, the vessels are thin, and if the vessels are thin, the small intestine is thin. If the skin is loose, the vessels are relaxed, and if the vessels are relaxed, the small intestine is large and long; if the skin is thin and the vessels are fine, the small intestine is small and short. If the yang meridians have many curves, the small intestine is tangled and obstructed. The spleen corresponds to the flesh. Where the muscle mounds are firm and large, the stomach is thick; where the muscle mounds are thin and small, the stomach is thin. If the muscle mounds are small and thin, the stomach is not firm; if the flesh is disproportionate to the body, the stomach is positioned low, and when the stomach is positioned low, the lower orifice of the stomach has poor constraint. If the flesh is not firm, the stomach is slack; if the flesh lacks fine granular texture, the stomach is contracted. If the granular texture of the flesh is prominent, the stomach is tangled and obstructed, and when the stomach is tangled, the upper orifice of the stomach has poor constraint. The liver corresponds to the nails. If the nails are thick and yellow in color, the gallbladder is thick; if the nails are thin and red in color, the gallbladder is thin. If the nails are hard and green in color, the gallbladder is contracted; if the nails are soft and red in color, the gallbladder is slack. If the nails are straight and white without markings, the gallbladder is straight; if the nails have irregular shape and are dark with many markings, the gallbladder is tangled and obstructed. The kidney corresponds to the bones. If the texture is fine and dense with thick skin, the triple burner and bladder are thick; if the texture is coarse and loose with thin skin, the triple burner and bladder are thin. If the interstices are loose, the triple burner and bladder are slack; if the skin is taut without body hair, the triple burner and bladder are contracted. If the body hair is lustrous, fine, and coarse, the triple burner and bladder are straight; if the body hair is sparse, the triple burner and bladder are tangled and obstructed.
The Yellow Emperor said: Thickness, thinness, beauty, and ugliness all have observable external forms. I wish to hear about the diseases they correspond to.
Qi Bo replied: By observing the external manifestations of correspondence, one can infer the internal state of the viscera and bowels, and thereby know the diseases afflicting them.
Associated Concepts:
Further Reading:
This content is based on ancient Chinese medical classics and is provided solely for the study and appreciation of traditional culture. It does not constitute any medical diagnosis, medication prescription, or treatment advice. Please seek medical attention promptly if you experience any discomfort.