Su Wen: Ju Tong Lun Pian Di San Shi Jiu

Ju Tong Lun (Treatise on Pain) Chapter 39 · Vernacular Interpretation

Overall Paraphrase

The Yellow Emperor asked: I have heard that those who are skilled in discussing the Way of Heaven can surely apply it to human affairs; those skilled in discussing antiquity can surely integrate ancient experience with the present; those skilled in discussing others can surely verify it against themselves. In this way, principles are not mistaken, and the essential points can be fully grasped—this is what is called "illumination." Now I wish to ask you, Master, whether you can enable me to understand illness through inquiry, perceive signs through observation, locate the disease through palpation, and verify it upon my own body—thereby enlightening my ignorance and resolving my doubts?

Qi Bo bowed twice and touched his head to the ground before answering: Which aspect of the Way would you like to ask about?

The Yellow Emperor said: I wish to know what qi causes sudden pain in the five zang-organs of a person?

Qi Bo replied: The qi and blood in the meridians and vessels flow without ceasing, circulating through the body without stopping. When cold pathogens invade the meridians, they cause the qi and blood to stagnate and move sluggishly, becoming astringent and unable to flow freely. If cold remains outside the meridians, the blood outside the vessels diminishes; if it lodges within the meridians, then the qi mechanism becomes blocked—hence sudden pain occurs.

The Yellow Emperor asked: Among these pains, some stop suddenly, some are severe and unrelenting, some are so intense that pressure cannot be tolerated, some are relieved by pressure, some are unaffected by pressure, some show a throbbing sensation under the fingers when pressed, some involve the heart and back pulling each other in pain, some involve the hypochondrium and lower abdomen tugging each other, some involve abdominal pain radiating to the inner thigh, some over time form accumulations and masses, some involve sudden intense pain with loss of consciousness resembling death followed by recovery after a while, some are accompanied by vomiting, some are followed by diarrhea after abdominal pain, and some involve pain with severe constipation. These pain patterns are all different—how should they be distinguished?

Qi Bo said:

• When cold remains outside the vessels, the vessels contract and curl due to cold, and then the vessel structures become tense and constrained, pulling on the fine collateral vessels outward—hence sudden pain. When warmth is applied, the pain stops immediately. If cold is repeatedly encountered, the pain persists.
• When cold invades the interior of the meridians, it struggles with the heat qi within the body, causing the meridians to become full and distended. Fullness causes pain that cannot bear pressure. Cold remains while heat rushes upward, making the vessels engorged and the qi and blood chaotic—hence intense pain that cannot tolerate pressure.
• When cold lodges between the intestines and stomach, beneath the membrane-source (huang), the blood cannot disperse properly, and the fine collateral vessels constrict and pull, causing pain. Pressure can disperse the qi and blood, so pressing stops the pain.
• When cold lodges in the meridians beside the spine, deep pressure cannot reach the site of disease—hence pressing is of no benefit.
• When cold lodges in the thoroughfare vessel (chong mai), which originates at the Guan-yuan point, ascends along the abdomen straight upward—cold remaining causes the vessel to be blocked; when the vessel is blocked, the qi follows and surges, so palpation reveals a throbbing response under the hand.
• When cold lodges in the meridians related to the back shu-points, the vessels become astringent and sluggish. Sluggish vessels cause blood deficiency, and blood deficiency causes pain. These back shu-points connect internally to the heart, so the heart and back pull each other in pain. When pressed, heat arrives; when heat arrives, the pain stops.
• When cold lodges in the foot reverting yin liver meridian, this meridian connects the genitals and binds to the liver. When cold invades the meridian, the blood moves sluggishly and the vessels become tense—hence the hypochondrium and lower abdomen tug at each other in pain.
• When rebellious qi lodges in the inner thigh, cold affects the lower abdomen from above, the blood below becomes astringent and sluggish, and the upper and lower parts pull at each other—hence abdominal pain radiating to the inner thigh.
• When cold lodges between the small intestine's membrane-source and the collateral blood, the blood becomes astringent and cannot flow into the great meridians. Qi and blood remain stagnant and cannot circulate—over time, accumulations and masses form.
• When cold invades the five zang-organs, the rebellious qi escapes upward, yin qi is severed and blocked, and yang qi cannot enter within—hence sudden intense pain with loss of consciousness resembling death. When yang qi recovers and qi and blood return, consciousness is regained.
• When cold invades the stomach and intestines, rebellious qi rushes upward—hence pain accompanied by vomiting.
• When cold invades the small intestine, the small intestine cannot properly receive and transform—hence abdominal pain followed by diarrhea.
• When heat lodges in the small intestine, there is pain within the intestines. Heat damages fluids, causing thirst, agitation, and dryness—the stool becomes hard and dry, difficult to pass—hence pain with blockage and non-passage.

The Yellow Emperor said: These are things that can be understood through inquiry. What, then, can be seen through observation?

Qi Bo said: The five zang- and six fu-organs each have their corresponding regions on the face. Observe the changes of the five colors: yellow and red indicate heat, white indicates cold, and blue-black indicates pain. This is what can be observed through inspection.

The Yellow Emperor said: What can be detected through palpation?

Qi Bo said: Examine the pulse of the dominant disease. If the pulse is hard and firm, if the blood is full and replete, or if it is sunken and depressed—all of these can be known through palpation.

The Yellow Emperor said: Excellent. I now know that many diseases arise from qi mechanism disturbance. Anger causes qi to rise, joy causes qi to slacken, grief causes qi to diminish, fear causes qi to descend, cold causes qi to contract, heat causes qi to escape, shock causes qi to become chaotic, overexertion causes qi to be consumed, and brooding causes qi to bind. These nine qi changes are different—what diseases do they trigger?

Qi Bo said:

• Anger causes qi to rebel upward, and in severe cases leads to vomiting of blood and sun-xie (diarrhea with undigested food)—hence qi rises.
• Joy causes qi to become harmonious and the emotions to be舒畅, and the nutritive and defensive qi flows freely—hence qi slackens.
• Grief causes the heart system to tighten, the lung lobes to spread open, and the upper burner (above the diaphragm) to become blocked. The nutritive and defensive qi cannot be distributed, and heat becomes trapped within—hence qi diminishes.
• Fear causes the essential qi to retreat. When essential qi retreats, the upper burner becomes blocked, qi returns downward, and the lower burner becomes distended and full—hence qi descends and fails to move.
• Cold causes the cou-li (skin and muscle textures) to close and block, and qi cannot move outward—hence qi contracts.
• Heat causes the cou-li to open and drain, the nutritive and defensive qi to flow freely, and profuse sweating—hence qi escapes.
• Shock causes the heart-spirit to have nothing to cling to, the spirit to have nowhere to rest, and thinking to have no stability—hence qi becomes chaotic.
• Overexertion causes panting and sweating; the qi of both the interior and exterior disperses outward—hence qi is consumed.
• Brooding causes the heart to have something fixed upon it, the spirit to be focused on one thing, and the upright qi to remain stagnant and fail to move—hence qi binds.

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🧠 In-Depth Understanding

Core Principles 💡

The core academic thought of this chapter can be summarized into three points:

1. An Early Model of "Pain Due to Blockage" and "Pain Due to Malnourishment"
   Using cold pathogens as the main thread, the chapter repeatedly explains that pain arises from two main sources: first, qi and blood stagnation with the vessels blocked, i.e., "pain due to blockage"; second, blood deficiency failing to nourish, with the vessels losing support, as in "the vessels become astringent, then blood becomes deficient; blood deficiency then causes pain"—the prototype of the later concept of "pain due to malnourishment." Cold is characterized by constriction and congelation, so it is the most likely cause of this pathological state.

2. The Three-Combined Diagnostic Method for Pain Pattern Differentiation
   The Yellow Emperor explicitly proposes "knowable through speech, visible through observation, and obtainable through palpation"—that is, the combined use of inquiry, inspection, and palpation. The chapter details the nature, location, and accompanying symptoms of pain, and also discusses five-color inspection and pulse palpation, reflecting a comparatively systematic diagnostic approach already formed during the Nei Jing era.

3. The Nine-Qi Pathomechanism of "All Diseases Arising from Qi"
   The latter half of the chapter categorizes the nine factors—anger, joy, grief, fear, cold, heat, shock, overexertion, and brooding—into nine abnormal changes in qi movement: rising, slackening, diminishing, descending, contracting, escaping, chaotic, consumed, and binding. This shows that ancient people already recognized that emotions, environmental factors, and rest/overwork can all cause disease by affecting the movement of qi throughout the body, not just through physical injury.

Modern Perspectives 🌟

• "Pain Due to Blockage" and "Pain Due to Malnourishment"
  From a modern medical standpoint, the mechanism by which cold causes pain shares certain similarities with cold-induced vasoconstriction, smooth muscle spasm, local tissue ischemia and hypoxia, and inflammatory factors stimulating nerve endings. The ancients described this with "cold qi residing outside the vessels" and "the vessels contracting when cold," which, while lacking microscopic evidence, captured the pathological chain of "cold—contraction—qi and blood failing to move—pain."

• Diagnostic Significance of Pain Characteristics
  The chapter's descriptions of "pain stops with pressure," "pressure is of no benefit," and "severe pain that cannot be pressed" bear logical resemblance to modern clinical physical examination concepts such as tenderness, rebound tenderness, and muscle guarding. For example, severe abdominal pain with guarding often suggests inflammatory or organic lesions, while pain relieved by pressure is more often associated with deficiency-cold or spasm. However, the ancients could only explain these at the level of qi, blood, cold, and heat, lacking the foundations of modern anatomy and pathology.

• Referred Pain Phenomena
  Descriptions such as "the heart and back pull each other in pain" and "the hypochondrium and lower abdomen tug at each other" are similar to what modern medicine calls referred pain. The ancients explained these through meridian connections, which reflect a certain empirical observational basis, but meridian theory cannot yet be fully mapped onto modern anatomy.

• Emotional Pathogenesis and the Nine Qis
  Statements like "anger causes qi to rise," "fear causes qi to descend," and "brooding causes qi to bind" find resonance with modern psychoneuroimmunology and stress response research. Emotions indeed affect autonomic nervous system function, endocrine regulation, and digestive function—for example, chronic anxiety can lead to gastrointestinal dysfunction, and outbursts of anger can trigger elevated blood pressure. Yet the ancients attributed emotional changes directly to the rising and descending movement of qi, which is a theoretical model and cannot be simplistically equated with modern physiology.

• Historical Limitations
  The five-color diagnosis and pulse diagnosis are traditional diagnostic methods with some empirical foundation, but they lack rigorous evidence-based support, and their sensitivity and specificity are limited. They cannot serve as standalone modern diagnostic criteria. Descriptions such as "pain to the point of death with loss of consciousness, then consciousness returns when qi recovers" may include conditions such as syncope or shock; given the limitations of the time, the ancients could only explain these through qi mechanism—but modern emergency care should be applied in actual practice.

Health Preservation Insights ⚡

• 🌬️ Avoid cold and keep warm: Pay special attention to keeping the abdomen, lower back, and joints warm; avoid prolonged exposure to cold environments or excessive consumption of raw and cold foods, reducing invasion by cold pathogens.
• 🧘 Regulate emotions: Avoid outbursts of anger, excessive fear, and prolonged brooding; maintain a calm and balanced state of mind. Joy should have measure—neither overexcitement nor excessive suppression.
• 🏃 Balance work and rest: Avoid overexertion, prolonged sitting, and prolonged lying down; maintain moderate activity to keep qi and blood flowing smoothly.
• 🍵 Regulate diet: Protect the stomach and intestines; avoid excessive consumption of raw, cold, spicy, and drying-heat foods; maintain the transformative functions of the spleen and stomach.
• 🩺 Seek medical attention promptly: Pain is an important signal from the body. Do not self-press, endure, or simply substitute hot compresses or massage for proper medical examination. Especially for sudden severe pain, referred pain, or pain accompanied by altered consciousness, seek medical help as soon as possible.

📚 Related Knowledge

• Related Concepts
  Cold dominates contraction · Pain due to blockage · Pain due to malnourishment · Nine-qi pathomechanism · Nutritive and defensive qi · Color-diagnosis regions of the five zang- and six fu-organs · The thoroughfare vessel among the extraordinary vessels · Foot reverting yin liver meridian · Upper, middle, and lower burners · Sun-xie

• Further Reading
  Su Wen, Tiao Jing Lun—On deficiency-excess pathomechanisms and the relationship between qi and blood
  Su Wen, Zhi Zhen Yao Da Lun—The nineteen pathomechanisms
  Ling Shu, Ben Shen—The correspondence of emotions with the five zang-organs
  Ling Shu, Jing Mai—Meridian pathways and pathologies
  Jing Yue Quan Shu, Za Zheng Mo, Xin Fu Tong—Later development of pain pattern theory

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— Arranged by Bu Gua

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