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Chapter 80 of 81
黄帝内经·灵枢
Overall Paraphrase
The original text of this chapter contains several transmission errors; the following is a paraphrased translation based on the standard received version after textual collation.
The Yellow Emperor asked Qi Bo: "I once ascended a high, clear terrace. When I reached the middle of the steps and turned back to look, then bent forward prostrate, I felt dizzy and my mind became confused. I privately found this strange. I closed my eyes alone and gazed fixedly alone, calming my mind and settling my breath, yet for a long time it did not resolve. I then felt throbbing and vertigo. With hair loose and kneeling upright, I bent forward to look—after a long while it still did not cease, and finally it suddenly stopped on its own. What qi causes this?"
Qi Bo replied: "The refined qi of the five viscera and six bowels all pour upward into the eyes, forming the essence of vision. The socket where essence gathers is called the pupil-orbital area; the essence of bone pours into the pupil; the essence of sinew pours into the dark of the eye; the essence of blood pours into the blood vessels; the essence of qi pours into the white of the eye; the essence of flesh constrains and binds the eyes, wrapping the essence of sinew, bone, blood, and qi, joining with the vessels to form the eye system (the fascial-tendon bundle behind the eyeball connecting to the brain), which connects upward to the brain and emerges posteriorly at the nape. Therefore, when pathogenic qi attacks the nape, and the body happens to be vacuous, the pathogen penetrates deeply and follows the eye system into the brain. When the pathogen enters the brain, the brain turns; when the brain turns, it draws the eye system into spasm; when the eye system is in spasm, the eyes become dizzy and rotate. If the pathogen disturbs the refined qi, the refined qi at the site of injury cannot coordinate with one another; when the refined qi scatters in disorder, vision becomes split—one object seen as two. The eyes are where the refined qi of the five viscera and six bowels converges, and also the place where nutritive and defensive qi (the two kinds of qi in the body responsible for nourishment and protection) and the ethereal and corporeal souls constantly move; spirit qi arises from this. Therefore, when the spirit is overworked, the ethereal and corporeal souls scatter in disorder, and the will and intent become chaotic.
The pupil and the dark of the eye pertain to yin; the white of the eye and red vessels pertain to yang. When yin and yang qi harmonize and flow in mutual relay, vision becomes clear. The eye is the external emissary of the heart, and the heart is where the spirit resides. If the spirit and essence are disordered and cannot properly relay, and one suddenly encounters an extraordinary environment, the spirit, ethereal, and corporeal souls scatter without coordinating—this gives rise to "confusion."
The Yellow Emperor said: "I doubt this principle. Every time I go to the Eastern Garden, I am never not confused, and after I leave, I recover. Is it only the Eastern Garden that fatigues my spirit? Why is this so strange?" Qi Bo said: "It is not so. When the heart has a liking and the spirit has a disliking, and the two emotions suddenly disturb one another, the refined qi becomes disordered and vision becomes chaotic—hence confusion arises. When the spirit and intention shift, recovery follows. Therefore, the milder form is called 'bewilderment,' and the more severe form is called 'confusion.'"
The Yellow Emperor asked: "When a person is forgetful, what qi causes this?" Qi Bo said: "When the qi of the upper part is insufficient and the qi of the lower part is excessive, the stomach and intestines are congested and firm while the heart and lungs are vacuous. Nutritive and defensive qi stay detained in the lower part and, over a long time, cannot ascend to supply the upper part in a timely manner—hence forgetfulness."
The Yellow Emperor asked: "When a person easily becomes hungry yet does not want to eat, what qi causes this?" Qi Bo said: "Refined qi converges on the spleen, and heat lodges in the stomach. Stomach heat makes it easy to digest grain and water; when grain and water are digested, one easily becomes hungry. When stomach qi rebels upward, the gastric duct becomes cold and congested—hence the desire not to eat."
The Yellow Emperor asked: "When one is sick and unable to sleep, what qi causes this?" Qi Bo said: "Defensive qi cannot enter the yin aspect and constantly remains in the yang aspect. When it remains in yang, yang qi becomes full; when yang qi is full, the yang heel vessel (the channel associated with activity and wakefulness) becomes hyperactive. When it cannot enter yin, yin qi becomes vacuous—hence the eyes cannot close, and sleep cannot occur."
The Yellow Emperor asked: "When one is sick and the eyes cannot open to see, what qi causes this?" Qi Bo said: "Defensive qi remains in the yin aspect and cannot move into the yang aspect. When it remains in yin, yin qi becomes abundant; when yin qi is abundant, the yin heel vessel becomes replete. When it cannot enter yang, yang qi becomes vacuous—hence the eyes close and cannot see."
The Yellow Emperor asked: "When a person sleeps excessively, what qi causes this?" Qi Bo said: "Such a person has relatively large stomach and intestines, moist skin, and division of flesh (the intermuscular fascial spaces) that are not smooth and lubricated. When the stomach and intestines are large, defensive qi remains for a relatively long time. When the skin is moist and the division of flesh is not smooth, defensive qi moves sluggishly. Defensive qi normally moves in the yang aspect by day and in the yin aspect by night; when yang qi is exhausted one lies down, and when yin qi is exhausted one wakes. Therefore, when the stomach and intestines are large, defensive qi remains for a long time; when the skin is moist and the division of flesh is not smooth, defensive qi moves sluggishly, remaining in the yin aspect for a long time, and its qi is not clear and brisk—hence one easily wishes to close the eyes, and therefore sleeps excessively. If the stomach and intestines are relatively small, the skin is smooth and relaxed, and the division of flesh is slippery and lubricated, defensive qi remains in the yang aspect for a longer time—hence sleep is reduced."
The Yellow Emperor asked: "If one is not of the ordinary constitution and suddenly sleeps excessively, what qi causes this?" Qi Bo said: "Pathogenic qi is detained in the upper burner (the region above the diaphragm). When the upper burner is blocked and not free-flowing, after eating or drinking hot water, defensive qi remains for a long time in the yin aspect and cannot circulate normally—hence sudden excessive sleepiness."
The Yellow Emperor said: "Excellent. What is the method for treating the conditions caused by these pathogenic qi?" Qi Bo said: "First examine the viscera and bowels, dispel the mild pathogenic factors, and then harmonize the qi. When pathogenic qi is replete, use drainage; when upright qi is vacuous, use supplementation. One must first understand the patient's physical labor or rest and emotional suffering or pleasure, and only after establishing this, select points for treatment. These are the diagnostic and treatment principles proposed by the ancients—academic theory for study and research only, not to be used as medication guidance."
The core of this chapter lies in "the eyes are the essence of the five viscera and six bowels" and the holistic view of "nutritive-defensive qi—yin/yang heel vessels—sleep and wakefulness."
The eye system connects to the brain; spirit qi focuses there: The ancients held that vision is not accomplished by the eye in isolation, but rather the refined qi of the five viscera and six bowels pours upward into the eyes and connects posteriorly to the brain. This "eye system–brain" pathway explains how pathogenic factors attacking the head cause vertigo and visual abnormalities, such as diplopia and visual splitting.
The heart is the abode of spirit; emotion can cause confusion: "Confusion" is connected to the scattering of the spirit, ethereal, and corporeal souls. The emphasis is that sudden emotional conflict or environmental change can disturb refined qi and cause visual disorder, which may resolve after the mind shifts.
The entering and exiting of nutritive-defensive qi between yin and yang determines sleep and wakefulness: Defensive qi moves in the yang aspect by day and in the yin aspect by night. When yang qi is exhausted one lies down; when yin qi is exhausted one wakes. When the yang heel vessel is hyperactive, the eyes open; when the yin heel vessel is replete, the eyes close. Excessive sleeping, reduced sleeping, and sudden excessive sleeping are all related to the movement of defensive qi, the size of the viscera and bowels, and the state of the skin and division of flesh.
Principles of pattern-based treatment: The chapter concludes with the principles of first examining the viscera, dispelling subtle pathogens, harmonizing qi movement, draining when replete and supplementing when vacuous, with attention to physical labor and emotional state—reflecting the Inner Classic's treatment philosophy of individualized therapy and unity of body and spirit.
The Connection Between Vision and the Brain: Modern anatomy confirms that the retina projects through the optic nerve, optic chiasm, and optic tract to the lateral geniculate nucleus and visual cortex. Eye movement systems, the vestibular system, and the brainstem are also related to vertigo and diplopia. The ancient macroscopic understanding of "the eye system connecting upward to the brain" shares directional resonance with the modern visual pathway, though mechanisms cannot be equated.
Sleep and Wakefulness Rhythms: The day-night movement of defensive qi between yin and yang resembles the modern circadian clock and sleep-wake homeostasis. "Yang heel vessel hyperactive then eyes open; yin heel vessel replete then eyes close" can be understood as an ancient model related to eyelid opening and the ascending arousal system. Modern sleep regulation involves the hypothalamus, brainstem, melatonin, light exposure, and numerous other factors—far more complex than the movement and retention of defensive qi.
Gastrointestinal Function and Mental State/Sleep: The discussions of excessive sleeping and easy hunger without desire to eat demonstrate that the ancients already observed associations between gastrointestinal function and mental/sleep states. Modern medicine's brain-gut axis, postprandial somnolence, blood glucose fluctuations, and gastrointestinal hormones may provide partial reference, but "stomach heat digesting grain" and "defensive qi retained in yin" cannot be directly mapped to specific measurable indicators.
Historical Limitations: This chapter attributes forgetfulness, insomnia, excessive sleeping, and visual abnormalities all to disorders of qi movement—an ancient theoretical model. While it offers heuristic value for disease classification and treatment principles, it does not constitute modern diagnostic evidence and cannot replace proper medical care.
Use the eyes with moderation; avoid prolonged visual strain: Prolonged screen time, reading, or tense visual environments can fatigue the spirit and disturb refined qi. Periodically close the eyes or gaze into the distance to allow the eye system and spirit to recover.
Maintain emotional stability; avoid sudden intense stimulation: Sudden joy, aversion, or environmental changes can disturb the spirit. In daily life, one should maintain a calm mind, and when emotional fluctuations occur, first stabilize the breath and spirit.
Follow the circadian rhythm: Engage in moderate activity by day and rest quietly at night to help the body restore its rhythms; avoid long-term sleep deprivation or excessive daytime lying down.
Eat with moderation: Avoid extremes of hunger or fullness; do not immediately consume large amounts of water or sit motionless after meals, as this may affect qi movement.
Balance body and spirit: Both physical labor and rest and emotional suffering and pleasure affect health. In daily life, one must equally attend to mental and physical demands to avoid one-sided exhaustion.
Related Concepts
Further Reading
— Bu Gua
This content is based on classic Chinese medicine texts and is provided solely for the study of traditional culture. It does not constitute any medical diagnosis, medication, or treatment advice. Please consult a qualified healthcare provider if you are unwell.