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Chapter 58 of 81
黄帝内经·灵枢
The Yellow Emperor asked: "You say that thief wind and evil qi (external pathogenic factors such as wind and cold) injure the human body and cause illness. Yet now there are people who do not leave their sheltered places, nor do they step outside their houses or earthen dwellings, yet they suddenly fall ill—it is not that they failed to avoid thief wind and evil qi, but rather that they never encountered it at all. How is this to be explained?"
Qi Bo replied: Such people all have old injuries first. Either they were previously harmed by dampness, with damp evil lurking hidden within the blood vessels and between the fleshy interstices (gaps between muscles), lingering long without departing; or they once suffered a fall or tumble, and stagnant blood (accumulated blood stasis) accumulated within the body without being dispersed. At this time, if there is suddenly imbalance of joy and anger, improper diet, or disharmony of cold and warmth, the cou li (the passageways of the skin's opening and closing) become blocked and impassable; and when the cou li then open, they encounter wind and cold head-on. The qi and blood congeal, joining together with the latent old evil already hidden within the body, and this develops into cold bi (the painful obstruction syndrome caused by cold congealing and stagnating). If there is heat within the body, there will be sweating, and when sweat emerges, the pores open wide, and wind evil takes advantage of the emptiness to enter—therefore, even without facing thief wind and evil qi directly, there must always be an internal pre-existing cause plus a new triggering factor superimposed before disease manifests.
The Yellow Emperor pressed further: "What you have described are things the patient himself can perceive. Yet there are people who encounter neither evil qi nor emotional disturbances such as fright, fear, or worry, yet suddenly fall ill. What is the reason for this? Could it be a matter of ghosts and spirits?"
Qi Bo replied: This condition is also not caused by ghosts and spirits, but rather because there is latent evil (old evil lying dormant without manifesting) remaining unresolved within the body, combined with feelings of aversion or desires of longing in the heart, causing the blood and qi to become chaotic internally, and the new and old forces of disease to struggle and bind together. The origin of the disease is extremely subtle—invisible to the eye, inaudible to the ear—and therefore it "appears as if ghosts and spirits were at work," when in reality it is merely that the cause of disease is too hidden to perceive.
The Yellow Emperor asked: "Then how is it that some patients can be cured through zhu you (the ancient method of treating illness through prayer and explaining the cause of disease)? What is the principle behind this?"
Qi Bo replied: The reason ancient shaman-physicians could achieve results through zhu you is that they understood the mutual conquest relationships among the hundred diseases (the patterns of mutual constraint between different illnesses) and knew in advance the origins from which diseases arise. Therefore, they could effect cures through the method of prayer and explanation. The key lies in a person's ability to understand principles—not in any power of ghosts or spirits.
The central academic thought of this chapter is the concept of "lurking evil" and the pathophysiological theory of "combined internal and external causation."
The Yellow Emperor raises an extremely sharp question: since externally contracted diseases require "thief wind and evil qi" to invade from outside, why can someone staying at home suddenly fall ill? Qi Bo's answer builds layer upon layer, constructing a complete disease-onset model:
Going even deeper is the idea of "resembling ghosts and spirits yet not being ghosts and spirits." When the cause of disease is extremely subtle—old evil hidden in deep places, emotional changes leaving no trace—people attribute diseases they cannot explain to ghosts and spirits. Qi Bo uses the phrase "invisible to the eye, inaudible to the ear, therefore appearing as if ghosts and spirits" to precisely identify the cognitive error of ancient peoples: it is not that ghosts and spirits are causing harm, but rather that the causal relationships are simply too concealed.
The final discussion on zhu you brings the chapter to a brilliant conclusion: "Knowing in advance the source from which disease arises, one may effect a cure through prayer"—shaman-physicians could cure disease because they grasped the cause of illness ("prior knowledge"), not because their arts connected them to spirits. This effectively pulls "zhu you" out of the mire of mysticism and explains the reason it might actually work: understanding the disease source + psychological suggestion + comprehensive intervention.
What deserves affirmation:
The theory of "lurking evil" finds interesting parallels in modern infectious disease medicine: for instance, latent infections—tuberculosis bacilli, Epstein-Barr virus, varicella-zoster virus (VZV) can remain dormant in the body for long periods and reactivate when immunity drops. Shingles (herpes zoster) is an excellent modern counterpart to the scenario of "old evil remaining without emerging, combined with aversion in the heart and longing in the mind, causing blood and qi to become chaotic internally," precipitating an outbreak. This demonstrates that although the ancients had no concept of microorganisms, they captured the essence of the "latency—reactivation" pattern of disease onset with their term "lurking evil."
The view of "combined internal and external causation" also echoes modern medicine's biopsychosocial model. The ancients recognized that disease is not caused by a single external factor alone, but is the result of interaction between the internal environment (upright qi, emotions, old evil) and the external environment (six excesses, diet, climate). This holistic perspective transcends the mechanical linear thinking of "one cause, one disease."
Historical limitations:
The ancients had no way to know specific pathogens and could only explain disease through abnormalities of "qi" (evil qi, old evil, blood-qi chaos)—a philosophical abstraction rather than precise biological description. The specific techniques of "mutual conquest among the hundred diseases" and zhu you have been lost to history, and among their "curative" effects a considerable share was likely placebo effect—modern research has confirmed that ritualized treatments can provide some relief for functional disorders, but they can never replace evidence-based medicine.
This content is based on classical Chinese medicine texts and is provided solely for the study and reading of traditional cultural heritage. It does not constitute any form of medical diagnosis, prescribing, or treatment recommendation. If you feel unwell, please seek medical attention promptly.