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Capítulo 10 de 14
针灸甲乙经
This volume systematically discusses the patterns of transmission of diseases of the five viscera, treatment of cold- and heat-type diseases, accumulation-type diseases (Fúliáng, Xībēn, Féiqì, Pǐqì, Bēntún), distension diseases, and edematous diseases (skin distension, drum distension, intestinal masses, stone tumors, wind edema), including their etiology, transmission, and acupuncture treatment methods.
In the section "The Five Viscera Transmit Disease and Manifest Cold-Heat", the Yellow Emperor asks Qi Bo: The five viscera are interconnected, and disease transmission does not follow a fixed order. When one of the five viscera is diseased, it transmits to the viscus it overcomes according to the five-element cycle. If not treated in time, the pathogenic qi will transmit sequentially according to the five-element overcoming order, eventually causing all five viscera to become diseased, threatening life. Therefore, a physician skilled in discerning yang syndromes (diseases of the exterior and the six bowels) can infer where the disease originated; a physician skilled in discerning yin syndromes (diseases of the interior and the five viscera) can determine the time of death or survival. The phrase "death occurs when reaching the one it is restrained by" refers to the point when the disease transmits to the viscus that overcomes it—at this point, the condition is grave.
Wind pathogen is the chief of all diseases. When wind-cold pathogenic qi invades the human body, it first causes the body hair to stand on end, the skin pores to close, and stagnation with fever. At this stage, sweating therapy may be used to expel the pathogen. If symptoms of numbness, swelling, or pain appear, methods such as hot compresses, moxibustion, and needling may be used to eliminate them. If not treated early, the pathogen will penetrate deeper: first entering the lung to become "lung bi" (lung impediment), with cough and qi counterflow; then transmitting to the liver to become "liver bi" (also called "jue"/reversal), with hypochondriac pain and vomiting of food; then transmitting to the spleen to become "spleen wind," with jaundice, heat in the abdomen, restlessness, and sweating; then transmitting to the kidney to become "shanjia" (hernia-like accumulation, also called "gu" / venom), with lower abdominal fullness, pain, and sweating; then transmitting to the heart, causing the sinews to contract and spasm. If still not treated, death may occur within approximately ten days. If after the kidney transmits to the heart, the heart then transmits back to the lung, with alternating chills and fever, the prognosis is even worse. This is the general pattern of disease transmission according to the five-element overcoming sequence of the five viscera.
However, acutely fulminant diseases do not necessarily follow this transmission pattern. Emotional dysregulation—worry, fear, grief, joy, anger—can disrupt the transmission order and cause major diseases to erupt abruptly. Great joy leaves the heart qi vacuous, allowing kidney qi to take advantage; great anger causes liver qi to become transversely aggressive, attacking what it overcomes; great grief allows lung qi to attack; great fear allows spleen qi to attack; great worry allows heart qi to attack. Therefore there are five categories of disease, and five times five gives twenty-five variations. "Transmission" means "taking advantage."
Regarding the genuine visceral pulse (critical pulse patterns revealing the exhaustion of the five viscera' genuine qi), the text describes: When the large bones are withered, the major flesh sunken, the chest congested, with difficult wheezing, the appearance of the genuine visceral pulse enables prediction of the time of death. The liver's genuine visceral pulse—taut and urgent like pressing on a knife blade, like plucking a lute string—with a green-white, lusterless complexion and withered body hair, is fatal; the heart's genuine visceral pulse—tight and pounding like pressing on coix seeds—with a red-black, lusterless complexion, is fatal; the lung's genuine visceral pulse—large and vacuous like a feather brushing the skin—with a red-white, lusterless complexion, is fatal; the spleen's genuine visceral pulse—weak and sometimes sparse, sometimes frequent—with a green-yellow, lusterless complexion, is fatal; the kidney's genuine visceral pulse—pounding and hard like flicking a stone—with a black-yellow, lusterless complexion, is fatal. Whenever the genuine visceral pulse is seen, it indicates an untreatable condition.
Regarding scrofula (cervical and axillary lymphatic tuberculosis-type conditions), the ancients believed it results from cold-heat toxic qi remaining in the meridians and failing to disperse. Treatment should "proceed from its root, guide its branches"—that is, address the visceral source and guide the pathogenic qi to dissolve at the periphery. Prognosis can be assessed by observing the red vessels within the eye: red vessels running downward from above to penetrate the pupil—one vessel portends death in one year, two and a half vessels portend death in two and a half years, three vessels portend death in three years; those not penetrating the pupil are treatable.
The section on accumulation-type diseases cites the "five accumulations" theory from the Nàn Jīng (Classic of Difficulties): Fúliáng (heart accumulation, arising above the navel, as large as the forearm), Xībēn (lung accumulation, below the right hypochondrium like an overturned cup), Féiqì (liver accumulation, below the left hypochondrium like an overturned cup with head and feet), Pǐqì (spleen accumulation, covering the stomach cavity as large as a plate), Bēntún (kidney accumulation, arising from the lower abdomen rushing toward the heart and chest like a running pig). The causes of these accumulations involve external cold pathogen invasion, emotional internal damage, improper diet, and irregular daily living, with the core mechanisms being qi and blood stagnation, fluid arrest, and accumulation over time.
Regarding distension diseases, the ancients proposed that distension locates not within the blood vessels, nor within the viscera and bowels, but rather outside the viscera and bowels, between the chest, hypochondria, and skin—compressing the viscera and bowels, swelling the chest and hypochondria, and distending the skin. Heart distension manifests as restlessness, shortness of breath, and inability to lie peacefully; lung distension as vacuous fullness, wheezing, and cough; liver distension as full, painful hypochondria spreading to the lower abdomen; spleen distension as hiccups and heaviness of all four limbs; kidney distension as abdominal fullness pulling the back, with pain in the lower back and buttocks; stomach distension as abdominal fullness and stomach pain with difficult defecation; large intestine distension as intestinal rumbling, pain, and diarrhea; small intestine distension as lower abdominal distension pulling the lower back; bladder distension as lower abdominal fullness and difficult urination; triple burner distension as qi fullness within the skin without hardness; gallbladder distension as hypochondriac pain, bitter taste, and a tendency to sigh. The general treatment principle is to supplement deficiency and drain excess, with Zúsānlǐ (ST-36) as the key point for treating distension.
The section on edematous diseases differentiates five conditions: Water disease (beginning with slight swelling below the eyes, moving neck vessels, swelling of the lower legs and ankles, abdominal distension—pressing leaves a depression that rebounds immediately, like containing water); skin distension (cold qi lodged between the skin layers, pressing leaves a depression that does not rebound, skin color unchanged); drum distension (large abdomen overall body swelling, bluish-yellow complexion, engorged abdominal veins); intestinal accumulation of masses (cold qi lodging outside the intestine and contending with defensive qi, slowly forming growths like pregnancy, but menstruation continues normally); stone tumor (cold qi lodging in the uterus, stagnant blood accumulating, growing daily like pregnancy, menstruation ceases). These differential diagnoses demonstrate the ancients' meticulous clinical observation of different pathological states including ascites, edema, and abdominal tumors.
Regarding kidney wind and wind edema, the ancients noted that the kidney is the water viscus and governs water; the kidney and lung—one acting as root and the other as branch—jointly regulate water metabolism. The kidney is "the gate of the stomach"; when the gate fails to function properly, water accumulates and causes swelling. The mechanism of wind-edema facial swelling lies in the principle that "where pathogenic qi converges, the vital qi is inevitably deficient"—when yin is deficient, yang pathogen takes advantage, presenting as shortness of breath, sweating, dry mouth and bitter taste, yellow urine, swelling below the eyes, and inability to lie flat, among other manifestations.
The core academic thought of this volume may be summarized on several levels:
I. Transmission Among the Five Viscera and Five-Element Generation/Overcoming
The ancients used the five-element overcoming cycle as a framework to explain disease transmission among the five viscera (metal lung → wood liver → earth spleen → water kidney → fire heart), reflecting early efforts to systematize visceral pathological processes in Chinese medicine. Discourses on "transmission to the one being overcome" and "death upon reaching the one by which it is restrained" attempt to provide a predictable model for disease progression. At the same time, the text clearly indicates that emotional factors (joy, anger, worry, grief, fear) can "prevent transmission in the regular sequence"—that is, disrupt the normal order of transmission—demonstrating that ancient physicians recognized disease transmission is not a mechanical, linear process.
II. Stage-by-Stage Progression from Exterior to Interior
Beginning with "pathogenic invasion starting from the skin," progressing to the collateral vessels, the penetrating vessels of the spine (Fúchōng), the stomach and intestines, and the membrane source (Mùyuán), layer by layer deepening, ultimately "dwelling and forming accumulation"—this discourse constructs a spatial pathological model of the pathogen proceeding progressively from the shallow to the deep. This is the classic formulation of the "exterior-interior" concept in Chinese medicine, also explaining why "early treatment" is critically important.
III. Pathogenesis Based on Interaction of Insufficient Upright Qi and Pathogenic Attack
"Wind, rain, cold, and heat—without deficiency pathogen, they cannot harm alone" and "two deficiencies colliding, then lodging in the body"—these statements repeatedly emphasize the interplay between upright qi (internal resistance) and pathogenic qi (disease-causing factors). Mere presence of external pathogenic factors without internal deficiency will not cause disease; only when physical weakness coincides with pathogenic invasion does disease form. This thought resonates with modern immunology's core concepts.
IV. Pathomechanism of Accumulation as Stagnation of Qi and Blood
The formation of accumulation-type diseases is attributed to a pathological chain: "cold congealing → blood stasis → fluid arrest → congealing over time forming accumulation." Whether exogenous cold invasion, emotional internal injury, or dietary irregularities, they ultimately produce accumulation by affecting qi and blood movement. This pathomechanism understanding of accumulation-from-obstruction provided the theoretical foundation for later treatment methods of invigorating blood and transforming stasis, and softening hardness and dissipating masses.
V. Distinctive Location of Distension Affection
The ancients located distension "outside the viscera and bowels, within the skin"—a unique conceptual anatomical space distinguished from blood vessels and the viscera and bowels themselves. While this understanding does not entirely correspond to modern anatomy (closer to a comprehensive concept encompassing fasciae, serous cavities, and interstitial spaces), it yet embodies evidence-based functional localization thinking.
Aspects that may be validated or meriting deeper consideration:
"Two deficiencies colliding" accords with the viewpoint in immunology that "immune-compromised individuals are more susceptible to infection." The text's statement that "encountering violent wind or torrential rain without developing illness—because no deficiency pathogen exists with which to contend alone" is essentially an ancient observation of individual susceptibility.
The recognition of staged disease transmission aligns conceptually with the "natural history of disease staging" in modern medicine. Particularly, the description of transmission from skin to deeper tissues bears certain correspondence to the clinical process of externally contracted diseases progressing from the surface to the interior.
The relationship between scrofula and red vessels inside the eye may reflect ancient clinical observation of the correlation between cervical lymphatic tuberculosis and vascular changes in the eye. The prognostic judgments attached to red vessels descending into the pupil belong to ancient empirical observation, differing from modern medical standards.
The differential diagnosis of edematous diseases (water disease, skin distension, drum distension, intestinal masses, stone tumors) demonstrates keen clinical observation of abdominal swelling from various etiologies. The differentiation between "stone tumors with irregular menstruation" and "intestinal masses with regular menstruation" in fact approaches the distinction between gynecological tumors and intestinal lesions—remarkably refined under ancient diagnostic conditions.
While "the kidney is the gate of the stomach" and water metabolism is understood in broadly different terms than modern nephron filtration theory, the ancients' directional judgment that connects the kidney to core water metabolism regulation remains evocative.
Historical limitations requiring indication:
The use of genuine visceral pulse for predicting death, specific expressions like "dies in that many days/years," represent ancient empirical generalizations lacking reproducible statistical foundation. Modern clinical practice should not apply them mechanically.
The corresponding relationships between the five accumulations and seasonal stems/earthly branches (e.g., "contracted on autumn gēng-xīn days") are built upon the theory of five-element generation/overcoming with celestial stems and earthly branches, belonging to the domain of ancient philosophical extrapolation, lacking evidential foundations. They should be regarded as representing historical modes of understanding rather than objective regularities.
Correspondences such as "number of red vessels inside the eye and time of death" reflect ancient numerology-influenced thinking and are not relied upon in modern clinical practice.
The twenty-nine locations specified for moxibustion treatment of cold-heat disorders reflect clinical experience of that period but lack systematic validation under modern research methods.
Submit to four seasons, skillfully avoid pathogens 🍃: The text's emphasis that "wind is the chief of the hundred diseases" suggests daily attention to wind protection and warmth—avoiding sweating against the wind, and especially ambient preserving of yang qi in cold seasons. This is generic living protection, not targeting any specific disease.
Balance the emotions, letting the water settle 🧘: Emotional excess—melting joy, explosion of anger, grief overwhelming, flooding fear, intense worry—disrupts the currents of qi within the body, allowing "two deficiencies colliding" to lead to disease. Psychological balance in daily life, emotional equilibrium rather than extreme tides, is a foundational principle of traditional health cultivation.
Moderation in food and regularity in daily life 🍚: The fu that accumulates root in hours of "sudden, voracious eating"—surgency of the appetite, extremes of guzzling, or heaping irregular meals—as well as day-and-night reversals from a disciplined rhythmic schedule ("sunrise work, sunset rest"). In our hours, nourishment means rhythmic moderation, truly modest volumes, and attention to protecting the spleen-stomach's tasks of transformation and conduction.
Attend to early months, keep lookout from above 🌿: The text reiterates that “if one does not treat” the pathogen pushes deeper layer by layer. This invites giving attention and caretaking at the first whisper of disharmony—the most urgent moment is the moment something constellates—indeed not lurking for the illness fully to trope before seeking to redeem as fully as possible what first arose one inch beneath the shell.
Safeguard both spleen-kidney governance in water meta-metabolism 💧: As this volume insists that kidneys oversee all water and spleens govern and connect drainage paths for dampness—humbly we might quack from measure to what common moderations matter here: temper consumption of sodden, sap-laden good fluids; from taste ask less saline; and rest from rhythmic constraint the water crossings whether excretion remains composed or feels pressed. Belongs this counsel more piece-rainbow discipline in daily holding general metabolic poise nonetheless healthy for ordinary persons.
This content is based on classical Chinese medical texts, intended solely for traditional cultural learning and research; it does not constitute any medical diagnosis, medication, or treatment recommendation; if you feel unwell, please seek medical attention promptly.