灵枢：百病始生第六十六

Overall Paraphrase

The Yellow Emperor asked Qi Bo: The onset of all diseases originates from wind, rain, cold, summer heat, cold-damp, as well as emotional factors such as joy and anger. Unrestrained joy and anger will injure the five viscera; wind and rain pathogens injure the upper part of the body; cold-damp pathogens injure the lower part of the body. The qi of these three regions each harms different targets. I wish to hear the essential principles behind this.

Qi Bo replied: The qi of the three regions are each different—some arise from within (yin), some arise from without (yang). Let me explain the principles. Unrestrained joy and anger injure the viscera and bowels; when the viscera and bowels are injured, disease arises from within. Cold-damp pathogens take advantage of deficiency to invade, and disease arises in the lower part. Wind and rain pathogens take advantage of deficiency to invade, and disease arises in the upper part—this is the pattern of disease onset from the three regions. As for pathogens spreading and proliferating within the body, their transformations are manifold and cannot be fully enumerated.

The Yellow Emperor said: I truly cannot enumerate them one by one, so I ask you, my teacher, hoping to thoroughly understand the principles. Qi Bo said: Wind, rain, cold, and heat—these external pathogens cannot injure a person alone if they do not encounter weakness in the body. Those who suddenly encounter violent winds and torrential rains yet do not fall ill do so because their upright qi is not deficient; therefore pathogens cannot attack the body alone. For disease to occur, it must be that vacuous pathogens (external pathogens that take advantage of deficiency to enter) encounter weakened upright qi in the body—when the two deficiencies meet, only then can the pathogen injure the physical body. If the external pathogen is excessive and the body's upright qi is also replete, when the two repletions meet, people with firm muscles will not easily fall ill. Whenever one is attacked by vacuous pathogens, it depends on the state of the heavenly climate and the condition of the body's upright qi; referencing the comparison of vacuity and repletion, only then can major disease form. Pathogens have fixed places where they lodge and remain; they are named according to where they stay, whether upper, lower, inner, or outer—divided into three aspects.

Therefore, when a vacuous pathogen attacks the human body, it first begins from the skin. When the skin is relaxed, the interstices (pores and sweat gland openings) open wide; when the interstices open wide, the pathogen enters through the body hair; after entering, it gradually penetrates deeper; after deep penetration, the body hair stands on end; when body hair stands on end, there is aversion to cold and shivering, hence skin pain. When the pathogen lingers without departing, it transmits to the collateral vessels (fine blood vessels). When in the collaterals, the muscles ache with pain that comes and goes, and the major channels (larger meridians) will receive the pathogen in its stead. If it lingers without departing, it transmits to the meridian vessels. When in the meridians, there is aversion to cold with shivering and a tendency toward fright. If it lingers without departing, it transmits to the transporting vessels (where viscera qi pours into the body surface). When in the transporting vessels, the qi of the six channels fails to reach the four limbs, the four limbs and joints ache, and the lower back and spine feel stiff and uncomfortable. If it lingers without departing, it transmits to the Penetrating Vessel in its deep layer (the deep Chong channel). When in this deep vessel, the body feels heavy and there is whole-body pain. If it lingers without departing, it transmits to the stomach and intestines. When in the stomach and intestines, there is rumbling sound in the abdomen and abdominal distension; if cold qi predominates, then there is intestinal rumbling, thin watery diarrhea, and undigested food; if heat qi predominates, then the stool is loose, like congee. If it lingers without departing, it transmits to the outside of the stomach and intestines—to the interpleural membranes (the membranous layers between the viscera)—where it lodges in the blood vessels. Lingering without leaving, over time it settles and forms accumulations. The pathogen may lodge in the minute collateral vessels (the finest blood vessels), or in the collateral vessels, or in the meridian vessels, or in the transporting vessels, or in the deep Penetrating Vessel, or in the sinews beside the spine, or in the membranes of the stomach and intestines, extending upward to connect with the slackening sinews (fascia within the abdomen). The pathogen spreads and proliferates, and cannot be fully discussed one by one.

The Yellow Emperor said: I wish to thoroughly understand the reasons. Qi Bo said: When a pathogen lodges in the minute collateral vessels and forms accumulations, the accumulation can move back and forth, up and down, lingering in the areas where the arm's minute collaterals are distributed. Because the minute collaterals are superficial and lax, they cannot constrain the accumulation to fix it in place, so the accumulation moves back and forth between the stomach and intestines. Fluids seep and pour into it, producing a splashing sound. If there is cold qi, then the abdomen distends like a drum, with thunder-like rumbling and pulling pain, hence frequent severe pain. When the pathogen lodges in the Yang Brightness channel, the accumulation is at the sides of the navel; it enlarges after eating and shrinks when hungry. When the pathogen lodges in the slackening sinews, the manifestations resemble accumulation in the Yang Brightness channel—pain after eating, comfort when hungry. When the pathogen lodges in the membranes of the stomach and intestines, the pain extends outward to connect with the slackening sinews; it is comfortable after eating and painful when hungry. When the pathogen lodges in the deep Penetrating Vessel, pressing with the hand can feel a throbbing response under the fingers; when the hand is released, heat descends to both thighs like boiling water being poured. When the pathogen lodges in the sinews beside the spine, behind the intestines, the accumulation is visible when hungry but cannot be seen when full, and pressing cannot detect it either. When the pathogen lodges in the transporting vessels, the vessels become blocked and impassable, fluids cannot descend, and the orifices become dry and obstructed. This is the process of pathogens transmitting from the exterior to the interior, from the upper to the lower.

The Yellow Emperor asked: From initial onset to final formation, what is the process of accumulations? Qi Bo said: Accumulations initially arise from contraction of cold pathogens; after cold reversal (yang qi declining with cold qi ascending) occurs, accumulations then form.

The Yellow Emperor asked: How exactly do accumulations form? Qi Bo said: The qi of cold reversal first causes weakness and limpness in the feet; when the feet are weak and limp, the calves become cold; when the calves are cold, the blood vessels become congealed and sluggish; when the blood vessels are congealed, cold qi ascends to invade the stomach and intestines; entering the stomach and intestines causes abdominal distension; when the abdomen is distended, the fluids and juices outside the intestines are compressed and gather without dispersing, and over time accumulations form. Sudden excessive eating and drinking causes the stomach and intestines to become full and distended; irregular daily routines or excessive exertion injure the collateral vessels. When the yang collaterals (superficial collaterals on the body surface) are injured, blood overflows outward—with external bleeding manifesting as nosebleed. When the yin collaterals (deep collaterals within the body) are injured, blood overflows internally—with internal bleeding manifesting as blood in the stool. When the collaterals of the stomach and intestines are injured, blood spills outside the intestines; if there is cold qi outside the intestines combining with fluids and juices, the cold qi interacts and binds with the spilled blood, fusing and congealing so that they cannot disperse, thus forming accumulations. Sudden contraction of external cold, or internal injury from worry and anger, causes qi to rebel upward; when qi rebels upward, the transport points of the six channels become impassable, warming qi cannot circulate, congealed blood becomes wrapped and bound and cannot disperse, fluids become sluggish and seep, lodging without leaving—in all such cases accumulations form.

The Yellow Emperor asked: What about diseases that arise from within (yin)? Qi Bo said: Excessive worry and pensiveness injure the heart. Repeated exposure to cold injures the lung. Intense anger and indignation injure the liver. Drinking wine to intoxication followed by sexual activity, with sweating and exposure to wind, injures the spleen. Excessive exertion, or bathing in sweat after sexual activity, injures the kidney. These are the diseases arising from the three regions—inner, outer, and upper/middle/lower.

The Yellow Emperor said: Well spoken. Then how should they be treated? Qi Bo replied: Examine where the pain is located to determine the corresponding location of the disease, analyze the vacuity and repletion, the excess and insufficiency—when supplementation is needed, supplement; when draining is needed, drain. Do not go against the movements of the heavenly seasons. This is the highest level of treatment.

This content is based on the classic traditional Chinese medicine text, provided solely for cultural study and research. It does not constitute any medical diagnosis, medication, or treatment advice; if you feel unwell, please seek medical attention promptly.