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Chapter 59 of 81
黄帝内经·灵枢
Holistic Paraphrase
The Yellow Emperor asked: When Wei Qi (the yang qi of the body responsible for defense and warming) stagnates within the abdomen, accumulating without dispersal, its movement becoming disordered, unable to reach its proper positions—causing the chest and flanks to feel distended and supporting-full, the stomach duct to feel oppressed and stuffy, with wheezing and reversed qi ascent—how should this be treated?
Bo Gao replied: If Wei Qi accumulates in the chest, select points from the upper region; if it accumulates in the abdomen, select points from the lower region; if both upper and lower are full and distended, select points from the two lateral regions.
The Yellow Emperor pressed for specific point selection methods. Bo Gao said: For accumulation in the upper region, drain (using reducing needling technique) Renying (ST 9), Tiantu (CV 22), and the throat region; for accumulation in the lower region, drain Zusanli (ST 36) and Qijie (around Chongyang, ST 42); for distension in both upper and lower regions, select points from both regions simultaneously, and additionally needle one cun below the hypochondrium tip; for severe cases, use the chicken-foot needling technique (a method where one needle is inserted at multiple angles for through-needling). During examination, if the pulse appears large and wiry-tight, or if the pulse is exhausted and non-arriving, or if the abdominal skin is taut and tense, needling is contraindicated. The Yellow Emperor said: Good.
The Yellow Emperor further asked Bo Gao: How does one determine whether a disease resides in the skin, flesh, qi and blood, sinews, or bones?
Bo Gao replied: If the area between the two eyebrows shows thin coloration with reduced luster, the disease is in the skin; if the lip color manifests abnormal changes of blue, yellow, red, white, or black, the disease is in the muscles; if nutritive qi (the refined substances that circulate within the vessels) leaks outward and appears moist, the disease is in the qi and blood; if the eye color manifests abnormal changes of blue, yellow, red, white, or black, the disease is in the sinews; if the ear concha appears withered and dry, accumulating dust and grime, the disease is in the bones.
The Yellow Emperor asked: How are the disease manifestations identified, and how should points be selected for treatment?
Bo Gao said: Diseases change in myriad ways and cannot be fully enumerated, but the skin has its subdivisions, the flesh has its pillars, qi and blood have their infusion points, and the bones have their connections.
The Yellow Emperor asked Bo Gao to elaborate.
Bo Gao explained: The subdivisions of the skin infuse into the four extremities' tips. The pillars of the flesh lie between the arms and the muscles along all yang channels, as well as between the muscles of the Foot Shaoyin channel. The infusion of qi and blood lies in the collateral vessels—where qi and blood lodge, the collaterals become engorged and raised. The subdivisions of the sinews—regardless of yin or yang channels, regardless of left or right—are determined by directly observing the location of pain. The connections of the bones refer to the bone apertures (foramina in the skeleton) that receive essence-qi and guide it upward to fill the brain and marrow.
The Yellow Emperor asked: How should treatment be applied?
Bo Gao replied: Disease changes manifest with varying degrees of superficiality and depth, which cannot be fully encompassed—administer treatment according to each location. For mild disease, needle superficially; for severe disease, needle deeply; for chronic disease, use fewer points; for acute severe disease, use more points—regulate according to the changes. One who can accomplish this is called a superior practitioner (a highly skilled physician).
The Yellow Emperor asked Qi Bo (some versions say Bo Gao): People vary in fatness, thinness, size, and cold-warmth status, among the categories of aged, adult, youth, and child—how are these distinguished?
Bo Gao replied: Those fifty years and above are aged; those twenty years and above are adults; those eighteen years and above are youth; those six years and above are children.
The Yellow Emperor asked: How is fatness versus thinness determined?
Bo Gao replied: There are three body constitution types: fat (adipose), lard (lanugo), and fleshy. Those with inner thigh muscles lacking firmness yet skin that is replete and full are of the fat (adipose) type; those with thighs not firm yet skin that is lax and loose are of the lard type; those with skin and muscle tightly adhered without separation are of the fleshy type.
The Yellow Emperor asked: How is the cold-warmth status of the body determined?
Bo Gao replied: Lard-type individuals have supple and moist muscles—those with coarse texture are cold, those with fine texture are hot. Fat-type individuals have firm muscles—those with fine texture are hot, those with coarse texture are cold.
The Yellow Emperor asked: How about the relative fatness, thinness, and size of the three types?
Bo Gao replied: Lard-type individuals have abundant qi and loose, pendulous skin, thus they tend to have sagging abdomen and drooping fatty tissue. Fleshy-type individuals have bodies that are broad, large, and full. Fat-type individuals have compact, constricted, and small frames.
The Yellow Emperor asked: How do the three types differ in qi and blood?
Bo Gao replied: Lard-type individuals have abundant qi—abundant qi generates heat, and heat enables tolerance of cold. Fleshy-type individuals have abundant blood—abundant blood gives the physique fullness, and fullness brings qi and blood into harmony. Fat-type individuals have thin blood with slippery yet scarce qi, therefore their physiques cannot be large. These are the distinctions between the three types and ordinary people.
The Yellow Emperor asked: What about ordinary people?
Bo Gao replied: Ordinary people have skin, flesh, fat, and lard that are balanced without any excess, their blood and qi are not hyperabundant in either direction; hence their physiques are neither large nor small, with every part proportionate and coordinated—these are called ordinary people (the multitude).
The Yellow Emperor said: Good. How are they treated?
Bo Gao replied: One must first discriminate the three body constitution types, understand the abundance or scarcity of blood and the clarity or turbidity of qi, then administer treatment accordingly, employing methods that never deviate from established principles. Thus: Lard-type individuals have protruding abdomens with pendulous flesh; fleshy-type individuals are broad and large in both upper and lower body; fat-type individuals, though plump, do not appear bloated.
1. The "Three-Burner Differentiated Treatment" Principle for Wei Qi Disharmony Wei Qi should normally "course through the interstices of the skin, between the flesh, fumigate the membranes between viscera, and disperse through the chest and abdomen," functioning in disciplined flow. Once it accumulates without moving, stagnates and becomes dysregulated, it manifests as a qi-stagnation excess pattern. Bo Gao's proposal—"for accumulation above, treat above; for accumulation below, treat below; for both upper and lower distension, treat laterally"—embodies the classic principle consistent throughout the Inner Canon: "for disease above, treat below; for disease below, treat above; for disease in the middle, treat laterally"—guiding according to dynamic potential. Wherever qi movement becomes congested, divert and dissolve it nearby, enabling Wei Qi to restore its functions of "moving between the flesh and warming the entire body." This resonates conceptually with modern understanding of "impaired qi movement" in functional abdominal distension and gastrointestinal motility disorders.
2. The Diagnostic System of External Correspondences to the Five Viscera Through the color and form changes of the glabella area (governed by the lung's association with skin/hair), lips (the spleen's association with flesh) , eyes (the liver's association with sinews) , ears (the kidney's association with bones) , and leakage of nutritive qi (the heart's governance of blood vessels) , the depth of disease localization is determined. This establishes a "external manifestation—internal viscera—disease location" correspondence diagnostic framework, whose core logic is: visceral essence-qi manifests upward on the external orifices; loss of nourishment at the orifices reflects pathological changes in the corresponding layer (skin, flesh, sinew, bone, vessel) .
3. The Tripartite Body Constitution Classification—an Early Description of "Body Composition" The "fat (zhi), lard (gao), fleshy (rou)" trichotomy is, in fact, a rudimentary observation of body fat distribution and muscular firmness:
Simultaneously, by correlating skin texture coarseness/fineness to cold and heat constitutional tendencies, it connects morphology to function (qi and blood abundance, cold-heat tolerance) to construct an operable framework for both constitutional classification and treatment principles.
Empirically Substantiated Reasonable Core:
Historical Limitations:
This content is based on classical Chinese medical texts and is provided exclusively for the learning and study of traditional culture. It does not constitute any form of medical diagnosis, prescription, or therapeutic recommendation. Kindly consult a qualified healthcare professional if you experience discomfort.