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Capítulo 29 de 81
黄帝内经·灵枢
The Yellow Emperor said: I have heard that the ancient teachers held certain insights in their hearts, not inscribed on wooden tablets. I wish to hear them and commit them to memory, to follow and practice them. In this way, above I may govern the people, and below I may nourish myself; the common people may be free from disease, superiors and inferiors may live in harmony and mutual affection, grace may flow downward, descendants may have no worries, and it may be passed down to later generations without end. May I hear this?
Qí Bó said: How profound is this question! Governing the people and nourishing oneself, governing others and governing oneself, handling the small and handling the great, ruling a state and managing a household—none can be well managed by going against reason; only "following in accordance" (shùn) is required. What is called shùn here refers not only to the inverse and favorable movements of yīn and yáng pulse signs and qì dynamics; the common people also all wish for their own wishes to be followed.
The Yellow Emperor asked: How does one follow them?
Qí Bó said: On entering a state, first ask about local customs; on entering a household, first ask about what is taboo; on entering a hall, first ask about proper ritual; when facing a patient, first ask about his likes, dislikes, and what brings him ease.
The Yellow Emperor asked: How does one follow the patient's likes and dislikes?
Qí Bó said: Where there is heat inside with diabetes-like wasting conditions, cooling and coldness is appropriate; where there is cold pathogen inside, warming is appropriate. When there is heat in the stomach, food is easily digested, making a person feel a hollow sensation with a racing heart and easy hunger; the skin above the navel feels hot. When there is heat in the intestines, the stool is yellow and watery like thin gruel, and the skin below the navel feels cool. When there is cold in the stomach, there is abdominal distension; when there is cold in the intestines, there is borborygmus with diarrhea containing undigested food—that is, lienteric diarrhea. When the stomach is cold and the intestines have heat, there is both distension and diarrhea; when the stomach has heat and the intestines are cold, a person is prone to hunger and has lower abdominal pain.
The Yellow Emperor asked: The stomach likes cold drinks, and the intestines like warm drinks—the two are opposed. How does one follow them both? Moreover, those noble lords and meat-eating rulers are arrogant and willful, despising others; they cannot be forcefully prohibited. Prohibiting goes against their intention; following them without guidance makes the condition worse. What should be done? Where does one begin?
Qí Bó said: In the common nature of human beings, none hate death more than they love life. Inform them of the harm, speak to them of the benefits, guide them with what is suitable, and persuade them by addressing that which causes them suffering. Even if there are those who are utterly unreasonable, who would not then listen?
The Yellow Emperor asked: How, then, does one specifically treat and regulate?
Qí Bó said: In spring and summer, first treat the branch, then the root; in autumn and winter, first treat the root, then the branch.
The Yellow Emperor asked: When one encounters mutually opposing preferences for cold and heat, how does one follow them?
Qí Bó said: Following this kind of condition, food, drink, and clothing must also be appropriate in cold and warmth—neither shivering cold nor sweating heat. With respect to food and drink, hot should not burn, cold should not be icy, and warmth and coolness should be moderate. Thus the upright qì is preserved, and one does not attract pathogenic qì.
The Yellow Emperor said: The Běn Zàng chapter holds that the size of the five zàng and six fǔ can be estimated from the body form, limbs, and muscles. But now when noble lords, or rulers on the throne or seated at court, come to inquire on seasonal diseases, those minor afflictions of the hourly and daily seasonal decline—who is able to palpate the body and then answer?
Qí Bó said: The body form and limbs are the external covering of the zàng-fǔ; one does not observe only from the face.
The Yellow Emperor said: The manifestation of the five zàng qì on the face I already understand. How, then, does one observe through the limbs and joints?
Qí Bó said: Among the five zàng and six fǔ, the lung is highest above like a canopy—broad shoulders and a sunken throat area can be externally assessed. The Yellow Emperor said: Good.
Qí Bó said: Among the five zàng and six fǔ, the heart rules; the quē pén (supraclavicular fossa) is the passage of pulse qì. When the sternal region is substantial, the chest can be assessed. The Yellow Emperor said: Good.
Qí Bó said: The liver is the general, responsible for external inspection and observation. To know whether it is firm, look at the size of the eyes. The Yellow Emperor said: Good.
Qí Bó said: The spleen governs guarding and protection, responsible for receiving water and grain. Look at the condition of the lips and tongue to discern fortune and misfortune. The Yellow Emperor said: Good.
Qí Bó said: The kidney governs the exterior, responsible for hearing afar. Looking at the quality of the ears reveals its nature. The Yellow Emperor said: Good. I wish to hear the external signs of the six fǔ.
Qí Bó said: Among the six fǔ, the stomach is the sea of water and grain. With broad cheekbones, a thick neck, and a wide open chest, the five grains can be contained. Deep nasal passages assess the large intestine; thick lips and a long rén zhōng assess the small intestine; large lower eyelids indicate thriving gallbladder qì; flaring nostrils indicate a tendency for the bladder to leak; a prominent nasal bridge indicates proper restraint for the triple burner. These are the methods for assessing the six fǔ. When the upper, middle, and lower portions are proportionate and balanced, the zàng-fǔ are at ease and well.
"Shùn" as the General Principle: This chapter unifies governing the state, managing the family, and nourishing oneself under the single word "shùn". Shùn is not blind accommodation but rather following human feelings, seasonal rhythms, the dynamics of disease, and the preferences of the zàng-fǔ, while avoiding contrary treatment.
Ask What Brings Comfort (wèn suǒ biàn): Before diagnosing and treating, first understand the patient's subjective likes and dislikes, especially preferences regarding cold and heat. 🌡️ However, the ancients specifically pointed out that the stomach and intestines may have opposite cold-heat preferences, such as stomach heat with intestinal cold or stomach cold with intestinal heat, so one cannot merely look at the surface preference.
Branch-root Sequence and the Four Seasons: In spring and summer, the yang qì tends outward; one first treats the branch, then the root. In autumn and winter, the yang qì is stored within; one first treats the root, then the branch. This reflects a time-oriented approach to treatment.
External Inspection to Infer Internal States (sī wài chuǎi nèi): Through the body form, limbs, facial features, and other external signs, one deduces the state of the zàng-fǔ. For instance, the lung is assessed by the shoulders and throat, the heart by the supraclavicular fossa, the liver by the eyes, the spleen by the lips and tongue, and the kidney by the ears. The six fǔ likewise have corresponding external signs. This embodies the holistic and holographic views of the Nèi Jīng.
Emphasis on Patient Subjective Experience: The principle of "asking the patient what brings comfort" aligns closely with today's "patient-centered" care philosophy. Understanding the patient's lifestyle, habits, and preferences regarding cold and heat builds trust and improves communication.
Communication and Persuasion Methods: Approaches such as "warn them of their losses, tell them of their benefits, guide them with what is comfortable, and reason with them through what pains them" resemble modern health education, informed consent, and motivational interviewing, emphasizing rational communication rather than coercion.
Historical Limitations: Inferring zàng-fǔ function from surface body shape is part of ancient observational epistemology. It carries intellectual value in the holistic frame, but lacks modern anatomical-physiological precision and clinical validation. It should not be used as a basis for diagnosis. Models of "stomach heat" or "intestinal cold" also require objective verification through modern examinations.
Seasonal Treatment Ideas: Statements about variable branch/root priority across the seasons reflect ancient empirical thinking; specific applications need contemporary evidence-based verification and should not be mechanically applied.
Moderation in cold and warmth: Food and clothing should avoid extremes. 🌿 Do not burn with heat, do not ice the belly with cold, and keep hot–cold moderate to protect the body's upright qì and reduce external insults.
Following the Seasons: In winter, protect against cold; in summer, avoid excessive sweating; adjust activity, clothing, and rest in line with seasonal changes to maintain inner–outer balance.
Communication Before Imposing: In the family and in self-management, we can borrow the notion of "warn them of the loss, tell them of the gain"—explaining harm and guiding the advisable way is better than brute prohibition in getting people on board.
Self-Awareness Without Self-Diagnosis: Knowing one's cold–hot preferences and dietary leanings is good self-observation, but would not suffice for self-diagnosis or self-medication.
Relating Concepts: Branch-before-root strategies, hot–cold affinity, external-internal correspondence, six/five external signs, watery diarrhea with undigested food, wasting–thirst, triple burner
Further Reading: Líng Shū · Běn Zàng, Líng Shū · Wǔ Sè, Sù Wèn · Biāo Běn Bìng Chuán Lùn, Sù Wèn · Yīn Yáng Yìng Xiàng Dà Lùn
Bǔ Guā warm note: This content is based on ancient classical medical literature and is provided solely for cultural heritage study and appreciation. It does not constitute any form of medical diagnosis, drug prescription, or treatment advice. Please seek timely professional care if unwell.