难经第23－29难

Holistic Paraphrase

Difficulty 23: Length of the Channels and the Beginning and End of Their Flow

Question: Can the lengths of the three yin and three yang channels of the hands and feet be explained clearly?

Answer: The three yang channels of the hand (Hand-Yangming Large Intestine, Hand-Taiyang Small Intestine, Hand-Shaoyang Sanjiao) run from the hand to the head, each side being five chi long, with six channels on the left and right combined, totaling three zhang.
The three yin channels of the hand (Hand-Taiyin Lung, Hand-Shaoyin Heart, Hand-Jueyin Pericardium) run from the hand to the chest, each side being three chi five cun long, with six channels on the left and right combined, totaling two zhang one chi.
The three yang channels of the foot (Foot-Yangming Stomach, Foot-Taiyang Bladder, Foot-Shaoyang Gallbladder) run from the foot to the head, each side being eight chi long, with six channels on the left and right combined, totaling four zhang eight chi.
The three yin channels of the foot (Foot-Taiyin Spleen, Foot-Shaoyin Kidney, Foot-Jueyin Liver) run from the foot to the chest, each side being six chi five cun long, with six channels on the left and right combined, totaling three zhang nine chi.
The two Qiao vessels of the feet (Yin Qiao and Yang Qiao) run from the feet toward the eyes, each side being seven chi five cun long, with two channels on the left and right combined, totaling one zhang five chi.
The Du Channel and Ren Channel each measure four chi five cun, totaling nine chi.
The total length of all the above channels is sixteen zhang two chi—such is the number for the lengths of the channels.

Question: Where do the twelve channels and fifteen collateral vessels begin, and where do they end?

Answer: The function of the channels (the main pathways through which qi and blood circulate in the human body) is to move blood and qi, penetrate yin and yang, and thereby nourish the entire body. They originate from the Middle Burner (where the spleen and stomach reside, the source of qi and blood transformation), first entering the Hand-Taiyin Lung Channel, then transmitting to the Hand-Yangming Large Intestine Channel; the Hand-Yangming channel transmits to the Foot-Yangming Stomach Channel, then to the Foot-Taiyin Spleen Channel; the Foot-Taiyin channel transmits to the Hand-Shaoyin Heart Channel, then to the Hand-Taiyang Small Intestine Channel; the Hand-Taiyang channel transmits to the Foot-Taiyang Bladder Channel, then to the Foot-Shaoyin Kidney Channel; the Foot-Shaoyin channel transmits to the Hand-Jueyin Pericardium Channel, then to the Hand-Shaoyang Sanjiao Channel; the Hand-Shaoyang channel transmits to the Foot-Shaoyang Gallbladder Channel, then to the Foot-Jueyin Liver Channel; the Foot-Jueyin channel then returns to the Hand-Taiyin Lung Channel, completing a cycle.
The fifteen collateral vessels all attach to their respective primary channels, flowing like a ring without beginning or end, mutually transporting and irrigating, and ultimately converging at Cunkou (the radial pulse area at the wrist) and Renyin (the carotid pulse area at the neck), where they are used to judge the hundred diseases and determine life and death.

The scripture says: "Understand the beginning and end, and yin and yang can be determined." What does this mean?

Answer: Beginning and end are the guiding principles of the pulse. The yin and yang qi of Cunkou and Renyin interconnect through "mutual dispatch," flowing like a ring with no end, and therefore it is called the "beginning." What is called the "end" refers to the qi of the three yin and three yang channels being severed; severance leads to death. At death, each shows different manifestations, and therefore it is called the "end."

Difficulty 24: Signs of Exhaustion of Qi in the Three Yin and Three Yang Channels

Question: When the qi of the three yin and three yang channels of the hands and feet has already been severed, what manifestations appear? Can fortune or misfortune be determined?

Answer:

• Exhaustion of the Foot-Shaoyin Kidney Channel qi: then the bones wither. Shaoyin corresponds to winter, and its pulse lies hidden within, nourishing the bone marrow. If the bone marrow loses nourishment, the muscles cannot attach to the bones; when bones and flesh do not adhere to each other, the muscles become soft and contract; when the muscles soften, the teeth appear longer and dry, and the hair loses its luster. This is a sign of death of bone first. It worsens on yang (wu) days and death occurs on yin (ji) days.
• Exhaustion of the Foot-Taiyin Spleen Channel qi: then the channel can no longer circulate to the lips and mouth. The lips are the root of the muscles. If the channel does not circulate, the muscles are not moist and lustrous; if the muscles are not moist and lustrous, then the philtrum (the groove in the center of the upper lip) becomes full; when the philtrum is full, the lips turn outward; lips turning outward are a sign of death of flesh first. It worsens on jia days and death occurs on yi days.
• Exhaustion of the Foot-Jueyin Liver Channel qi: then the sinews contract and tighten, pulling the testicles upward and curling the tongue. Jueyin is the liver channel, and the liver is paired with the sinews; the sinews gather at the genitals (external reproductive organs) and connect with the root of the tongue. Therefore, when the channel does not circulate, the sinews contract, pulling the testicles and tongue, causing tongue curling and testicular retraction. This is death of sinews first. It worsens on geng days and death occurs on xin days.
• Exhaustion of the Hand-Taiyin Lung Channel qi: then the skin and body hair become scorched. Taiyin pertains to the Lung, which moves qi to warm and nourish the skin and hair. If qi cannot circulate, the skin and hair become scorched; when skin and hair are scorched, body fluids are depleted; when body fluids are depleted, the skin and joints are injured; when skin and joints are injured, the skin becomes parched and the hair breaks. This is death of hair first. It worsens on bing days and death occurs on ding days.
• Exhaustion of the Hand-Shaoyin Heart Channel qi: then the vessels become blocked; when the vessels are blocked, blood does not flow; when blood does not flow, the complexion loses its luster, so the face turns black like smoke and ash. This is death of blood first. It worsens on ren days and death occurs on gui days.
• When the qi of all three yin channels is exhausted: then the eyes become dizzy and rotating, and close; closed eyes indicate that the spirit has lost its hold, so this is death of will first, characterized at death by closed eyes.
• When the qi of all six yang channels is exhausted: then yin and yang separate from each other; when yin and yang separate, the interstices (texture of skin and muscles) open and release, and terminal sweat pours out profusely, with sweat droplets as large as linked beads, turning on the skin without flowing down—this is death of qi first. If this sign appears in the morning, death may occur in the evening; if it appears in the evening, death may occur the following morning.

Difficulty 25: The Numerical Question of Twelve Channels and Five Organs and Six Bowels

Question: There are twelve channels, but the five organs and six bowels together number only eleven—what is the extra channel?

Answer: The extra channel results from the Hand-Shaoyin Heart Channel and the Heart Ruler (the Pericardium) being counted separately. The Heart Ruler and the Sanjiao stand in exterior-interior relationship to each other; both have names and functions but no concrete form, so it is said that there are twelve channels.

Difficulty 26: The Three Extra Collaterals Among the Fifteen

Question: There are twelve channels and fifteen collaterals—which are the three extra collaterals?

Answer: There are the Yang Collateral, the Yin Collateral, and the Great Collateral of the Spleen. The Yang Collateral is the collateral of the Yang Qiao channel, and the Yin Collateral is the collateral of the Yin Qiao channel. Thus, there are fifteen collaterals in total.

Difficulty 27: Why the Eight Extraordinary Channels Are Not Constrained by the Twelve Channels

Question: Among the vessels, there are the Eight Extraordinary Channels, which are not bound by the twelve channels—why is this?

Answer: There are the Yang Wei channel, Yin Wei channel, Yang Qiao channel, Yin Qiao channel, Chong channel, Du channel, Ren channel, and Dai channel. These eight vessels are not constrained by the twelve channels, and are therefore called the Eight Extraordinary Channels.

Question: There are twelve channels and fifteen collaterals, twenty-seven in all, with qi flowing upward and downward in sequence—why are only the eight vessels not constrained by the twelve channels?

Answer: The sages designed ditches and canals to channel water, guarding against unexpected events. When heavy rain falls from heaven, the ditches and canals fill to overflowing, and at such times water may overflow and run chaotically, which even the sages cannot restrain. Similarly, when the qi and blood of the collateral vessels overflow, the various channels can no longer restrain them, and they therefore spill into the extraordinary channels.

Difficulty 28: Origins and Pathways of the Eight Extraordinary Channels

Question: Since the Eight Extraordinary Channels are not constrained by the twelve channels, where do they each originate and how do they continue?

Answer:

• Du Channel: originates from the lower extreme point (perineum), ascends within the spinal column, reaches Fengfu (occipital region), and enters the brain.
• Ren Channel: originates below Zhongji (inside the lower abdomen), ascends past the pubic hair, travels upward within the abdomen, passes through Guanyuan, and reaches the throat.
• Chong Channel: originates at Qichong (inguinal region), runs parallel to the Foot-Yangming Stomach Channel, ascends flanking the navel, and disperses in the chest.
• Dai Channel: originates at the floating ribs (lowest ribs on the lateral chest), encircles the body once.
• Yang Qiao Channel: originates in the heel, ascends along the lateral malleolus, and enters Fengchi (nape region).
• Yin Qiao Channel: also originates in the heel, ascends along the medial malleolus, reaches the throat, and intertwines with the Chong channel.
• Yang Wei and Yin Wei Channels: serve as networks maintaining the entire body, but they only store overflowing qi and blood and cannot irrigate all channels in circulation like a ring. The Yang Wei channel arises from the junction of the yang channels, and the Yin Wei channel arises from the junction of the yin channels.
  This is like the sages designing ditches and canals—when they overflow, the water flows into deep lakes, and the sages can no longer restrain or redirect it. When the qi and blood of the body's channels are abundant and thriving, they overflow into the eight vessels and no longer return to re-circulate, making it impossible for the twelve channels to further restrain them. If the extraordinary channels accumulate pathogenic qi, it can produce swelling and heat, which may be treated by pricking with bian stones.

Difficulty 29: Disease Manifestations of the Eight Extraordinary Channels

Question: When the Eight Extraordinary Channels suffer disorders, what are the manifestations?

Answer:

• Yang Wei channel maintains the yang aspect of the body; Yin Wei channel maintains the yin aspect. When yin and yang can no longer mutually maintain each other, one feels lost and forlorn, mentally absent, with fatigue and weakness throughout the body, unable to control oneself.
• Yang Wei disorder: suffers from alternating chills and fever.
• Yin Wei disorder: manifests as pain similar to heart pain.
• Yin Qiao disorder: the lateral yang channels become relaxed while the medial yin channels become contracted and tense.
• Yang Qiao disorder: the medial yin channels become relaxed while the lateral yang channels become tense and contracted.
• Chong channel disorder: qi rushes upward counterflow, with internal abdominal cramping.
• Du channel disorder: rigidity of the spine, possibly extending to fainting.
• Ren channel disorder: suffers from internal binding and accumulation in the abdomen—in men, it may manifest as seven hernias, and in women as abdominal masses.
• Dai channel disorder: abdominal distension, flaccid weakness of the lower back, as if sitting in water.

These are the main manifestations of diseases in the Eight Extraordinary Channels.

🧠 Deep Understanding

Core Principles 💡

1. Channel lengths represent a "map of qi and blood in the human body"
Difficulty 23 records in detail the lengths of the twelve regular channels, the qiao vessels, and the du and ren channels, totaling sixteen zhang two chi. This is not an anatomical measurement but rather a model constructed by the ancients using "proportional measurements" combined with yin-yang numerology, intended to illustrate that the body's qi and blood have a complete, measurable circulatory pathway. It reflects early traditional Chinese medicine's systematized understanding of the human body progressing "from points to lines, from lines to networks."

2. Channel circulation is "like a ring without end"
The twelve channels begin from the Hand-Taiyin Lung Channel, progressing in order based on exterior-interior pairing, organ interrelation, and yin-yang continuity, ultimately returning to the Hand-Taiyin. This sequence became the theoretical foundation for later understanding of qi and blood circulation, disease transmission, and acupuncture point selection. The fifteen collateral vessels further strengthen connections between exterior-interior channel pairs.

3. "Beginning and end" relates to judgment of life
Cunkou and Renyin are key diagnostic sites, and the ancients believed they could determine yin-yang excess and deficiency and the progression or regression of disease. "End" refers to the exhaustion of qi in the three yin and three yang channels, which has specific manifest changes. Difficulty 24 enumerates the changes in sensory organs and tissues when each channel's qi is exhausted, reflecting the diagnostic principle that "anything present internally must manifest externally."

4. Heart Ruler and Sanjiao "have names but no form"
Difficulty 25 proposes that the Heart Ruler (Pericardium) and Sanjiao have names but no concrete form, yet functionally stand in exterior-interior relationship. This reflects the characteristic of traditional Chinese medical viscera theory that emphasizes "function over anatomical entity"—the organs are not merely anatomical structures but designations for functional systems.

5. The Eight Extraordinary Channels form a "storage and regulatory system"
Difficulties 27 and 28 use the "ditch-lake" analogy: the twelve regular channels resemble main channels and ditches, while the Eight Extraordinary Channels resemble deep lakes. When qi and blood in the parent pathways overflow, they flow into the extraordinary channels for storage; when regular channels become depleted, the extraordinary channels can supply back. This is a high-level general representation of the extraordinary channels' "regulatory, controlling, and maintaining" functions.

6. Extraordinary channel disease manifestations highlight each channel's characteristics
Difficulty 29 summarizes the most significant pathological manifestations of diseases associated with each of the Eight Extraordinary Channels. These descriptions have been used in later tradition for patient differentiation in gynecology, encephalopathies, lumbar and lower limb disorders, and emotional/spiritual ailments.

Modern Perspectives 🌟

• Channel length and circulation: modern research cannot identify anatomical structures that precisely correspond to "sixteen zhang two chi," yet certain phenomena, such as propagated sensation along channels, lower electrical resistance at acupoints, and correlations between acupoints and connective tissue, suggest that traditional channel theory may correspond to functional pathways involving the coordinated action of nervous, vascular, fascial, and other systems. Its value lies more in offering a systematically integrated worldview of the human body's connections.
• Manifestations of channel-qi exhaustion: manifestations in Difficulty 24—such as "withered bones," "soft flesh," "everted lips," "curled tongue and retracted testes," "a face black as soot," and "terminal sweat like linked pearls"—bear some resemblance to certain physical signs seen in modern end-of-life or critical conditions, reflecting careful observation of agonal phenomena in antiquity. However, predictions based on the Heavenly Stems and Earthly Branches (e.g., "worse on wu days, death on ji days" or "if seen at dawn, death before dusk") are deductions derived from Generative and Overcoming interactions of the Five Phases and lack clinical reproducibility. They must be viewed as historical limitations and must not be used to predict death or determine prognoses.
• Having names but no form: the "formlessness" of the Pericardium and Sanjiao does not imply they do not exist; it emphasizes their functional dimensions. Modern Chinese medicine continues to research the Sanjiao's roles in qi transformation and water passage from pathophysiological perspectives.
• Eight Extraordinary Channels: theories of the extraordinary channels remain widely applied in acupuncture, gynecology, neurology/encephalopathy, and health cultivation (wellness)—such as the relationship of the Du and Ren vessels to the spine and brain, and the Dai channel's relation to the lumbar region and abdomen. However, ancient methods such as "pricking swollen heat with bian stones," without proper attention to sterility and qualified application, must not attract unguided self-experimentation, and any such procedure must not be attempted without professional supervision.

Wellness Insights ⚡

• Follow qi-blood circulation; avoid prolonged sitting or lying: the qi and blood of the twelve channels circulate without rest, but fixed posture for long periods slows the flow of qi and blood in a particular region. Moderate, adaptable activities—Baduanjin or tai chi, walking—all bless blood and qi with unobstructed progression throughout the day.
• Maintain warmth of the abdomen and lower back and feet: the Dai channel wraps the lower abdomen and lumber in a ring; the Qiao channels arise from the heels. Being subject to cold and having dampness or insufficiency through heat management affects them. Keeping warm—protecting against cold, wet living, and damp shoes and socks—strengthens their normal activity.
• May emotions rest in peace of quiet even-temperedness; raise autonomy from dejection, free-floating anxiety or low energy. Whether loss, instability of attention or musing, irritability correlates with the description of the Yin and Yang Wei failing to sustain each other. Sustaining peaceful personality, ongoing due sociability, good deep daily rhythms—these take psychological resolve dramatically before perturbation.
• Restraint in diets with exact regularity mitigates "rebellious qi and inner urgency." Activities foreshadow irritability or abdominal fullness, spastic obstruction in retching gases in unbalanced habits. A disciplined mealtimes alternative, thorough gnaw effect; secure proper digestion capacity rhythm, avoiding hunger pang also glut. Avoid self medical attention unrelated routines. Also potential strain aggravated in symptom phrases common, attention beyond expectation. Any interpretation of diet must firmly delineate that cannot treat.
• All above belong to universal wellness insights, not views persisting into consideration for diagnostics. Involuntarily unaimed caution. Some interpretation generally varies significantly must formulate ordinary wellness lifestyle—not clinician, only by interpretive educational commentary, any detail fails when replacing pro-diagnose medical contact. By user encounter only that they safeguard approach healthcare: do diagnosis- intercession for symptoms complex appears in record at cross ends—must cannot administer in lieu.

📚 Related Knowledge

Related Concepts

• Twelve Regular Channels: hand three yin, hand three yang, foot three yin, foot three yang compose the trunk pathways of qi and blood circulation.

• Fifteen Collateral Vessels: the twelve channel collateral blood vessels plus the Ren collateral, Du collateral, and the Great Collateral of the Spleen; this section at Difficulty 26 also explains them through the perspective of the Yang collateral, Yin collateral, and Spleen's great collateral.

• Eight Extraordinary Channels: Du cell, Ren Ma circuit, Chong maong, Dai function, Yang Qiao transport v, Yin,Q. Ying-Cho + Yang wy.+0. Suiy& interstinal alternate balance storage manage channels.

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• Pericardium and Sanjiao: have names although no structures, appear pair function, essence body explanation is function focus aspect characteristic seen through viscrous doctrinen.

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Extended Reading

• 《Lingshu·Meridian Vessels》: Detailed pathways and pathologies of the twelve primary meridians and fifteen collateral vessels.
• 《Lingshu·Measurement of Vessels》: Meridian lengths and measurement methods.
• 《Lingshu·Beginning and End》: Principles of beginning and end, yin-yang, and acupuncture techniques.
• 《Suwen·Treatise on Diagnostic Essentials and Meridian Termination》: Signs and prognoses of qi exhaustion in each meridian.
• 《Suwen·Discussion on Bone Hollows》: Pathways of the Du, Ren, and Chong vessels, among others.
• 《A-B Classic of Acupuncture and Moxibustion》: Systematic compilation of meridians, acupoints, and the eight extraordinary vessels.
• 《Classic of Difficult Issues》, Difficult Issues 30–47: Further discussion of the viscera, Triple Burner, nutritive and defensive qi, Cunkou pulse, and related topics.

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This content is based on classic ancient Chinese medical texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication guidance, or treatment advice. If you feel unwell, please seek medical attention promptly.