Cargando...
Capítulo 35 de 81
黄帝内经·灵枢
Holistic Paraphrase
The Yellow Emperor asked: From the presentation of the Cunkou pulse (the radial artery pulse at the wrist, the primary site for pulse diagnosis in Chinese medicine), how can one determine distension disease? Qi Bo replied: If the pulse is large, firm, and rough, it indicates distension disease.
The Yellow Emperor then asked: How does one know whether it is distension of the zang (solid organs) or the fu (hollow organs)? Qi Bo said: The yin pulse corresponds to the zang organs, and the yang pulse corresponds to the fu organs. The Yellow Emperor further inquired: When qi causes a person to develop distension, does it reside in the blood vessels or within the zang-fu organs? Qi Bo replied: Both the blood vessels and the zang-fu organs contain qi, but the place where distension settles is elsewhere.
The Yellow Emperor said: I wish to hear about the place where distension settles. Qi Bo explained: What is called distension is all located outside the zang-fu organs. It displaces the zang-fu organs, expands outward toward the chest and ribs, and causes the skin to swell, hence the name "distension." The Yellow Emperor then asked: The zang-fu organs lie within the chest and abdominal cavity, like precious objects stored in cases and cabinets, each with its own order and position. They have different names but share the same region, and the qi within them differs from one to another. I wish to hear the rationale behind this.
Qi Bo explained: The chest and abdomen are the outer enclosure of the zang-fu organs; the Danzhong (the pericardium's outer perimeter, the meeting point of qi) is the palace city of the heart ruler; the stomach is the Great Granary (the storehouse for water and grain); the throat and small intestine are the passageways for transporting water and grain; the five orifices of the stomach are like lanes and gateways; the Lianquan and Yuying are the pathways through which fluids and essence travel. Therefore, the five zang organs and six fu organs each have their boundaries, and their diseases also manifest accordingly.
Nutritive qi (qi that circulates within the vessels and has a nourishing function) travels along the meridians and vessels; when Defensive qi (qi that circulates outside the vessels and has warming and protective functions) moves in a reversed and disordered manner, it can form vessel distension; when Defensive qi merges into the meridians and travels between the muscles and flesh (fascial layers), it can form skin distension. In ancient times, it was proposed to needle Zusanli (ST 36) with reducing method — one needling for cases of recent onset, three needlings for cases of longer duration — and it was said, "Regardless of deficiency or excess, the physician should be swift in draining the pathogenic factor." But this was an early experience; later text provides further pattern differentiation.
The Yellow Emperor said: I wish to hear the specific manifestations of the various distensions. Qi Bo said:
Distension of the six fu organs:
These distension diseases share the same underlying principle; the key lies in understanding the normal and reversed movement of qi, and in ensuring that needling supplementation and drainage are not mistaken. If one erroneously applies reducing method to deficiency and supplementation to excess, the spirit qi will leave its dwelling place, inviting pathogenic qi and harming the righteous qi; the true qi can no longer settle. This is the error of crude practitioners and can be called injuring life. Correct supplementing deficiency and draining excess allows the spirit qi to return to its place, and long-term nurturing of the vacuous regions is what characterizes a good physician.
The Yellow Emperor asked: How does distension arise? What causes it? Qi Bo said: In the normal state, Defensive qi travels alongside the vessels and follows the muscles and flesh; its movement has reversed and normal directions, yin and yang coordinate with each other, and it harmonizes with nature; the five zang organs assume their periods of dominance, the four seasons proceed in order, and the five grains transform to generate qi and blood. If there is reversed qi in the lower burner, causing nutritive and defensive qi to stall and halt, and cold pathogen ascends counterflow, the righteous qi and pathogenic qi attack each other — the two qi contend — and thus combined, distension forms.
The Yellow Emperor asked: How can doubts be resolved? Qi Bo said: One must comprehensively examine the righteous qi, pathogenic qi, and the location of the disease — these three aspects — to arrive at correct understanding.
The Yellow Emperor pressed further: Earlier it was said, "Regardless of deficiency or excess, the physician should be swift in draining; for recent cases, one needling; for distant cases, three needlings." Now, after three needlings, the distension still does not subside. Where does the fault lie? Qi Bo replied: This refers to the necessity that needling must penetrate deeply into the fascial depths (the fascial interspaces between muscles) and accurately hit the qi points (the acupoints where meridian qi is infused). If one fails to hit the qi points, qi becomes internally blocked; if the needle does not penetrate into the fascial depths, qi cannot move; if the needling is too shallow and only reaches the muscles, it will instead cause defensive qi to become chaotic, and yin and yang will pursue and interfere with each other. For distension disease, when draining is indicated but not performed, qi will not descend; if after three attempts it still does not descend, one must change the needling path, and only stop when qi descends; if it still does not descend, one can further adjust to achieve complete success — how could there be danger in that? In treating distension disease, one must carefully examine the manifestations; when draining is indicated, drain; when supplementation is indicated, supplement. Like the striker of a drum immediately responding to the mallet, how could it not resolve?
At its core, this chapter clearly defines distension as a condition primarily involving "qi accumulating outside the zang-fu organs." It is not simply a solid accumulation in one zang organ or one fu organ, but rather a state of fullness and distension formed in the chest, ribs, skin, and fascial layers due to disordered qi movement.
Regarding pathogenesis, the chapter emphasizes: "Nutritive and defensive qi stall and halt; cold pathogen ascends counterflow; righteous qi and pathogenic qi attack each other; the two qi contend. " This indicates that distension is not caused by a single factor but by obstruction of righteous qi movement, participation of external cold or internal cold, and contention of qi — a recognition clearly imbued with the concept of ascending, descending, exiting, entering of qi movement.
In terms of pattern differentiation, the chapter lists in detail the distension of the five zang organs and distension of the six fu organs, showing that ancient physicians had already observed that when different zang-fu organs are diseased, the locations of distension and accompanying symptoms each have distinctive characteristics. For example, liver distension localizes beneath the ribs, gallbladder distension involves a bitter mouth and frequent sighing, and bladder distension presents with lower abdominal fullness and difficult urination — reflecting the diagnostic approach of "what is internal must manifest externally."
Regarding treatment principles, this chapter contains a valuable evolution of thought: the earlier text states, "Regardless of deficiency or excess, the physician should be swift in draining," but the later text, through the Yellow Emperor's questioning, suggests that not all distension can be resolved simply by draining — one must hit the qi points, penetrate the fascial depths, and "drain when draining is indicated, supplement when supplementation is indicated." This indicates that early experience may have leaned toward draining pathogenic factors, while the later text emphasizes pattern-based supplementation and drainage and precise needling — reflecting the self-correction and enrichment of Chinese medicine's own theoretical understanding.
At the level of symptoms, the abdominal distension, rib pain, wheezing, cough, bitter mouth, and difficulty urinating described in the chapter bear certain similarities to conditions in modern medicine such as gastrointestinal gas accumulation, functional bloating, chronic obstructive pulmonary disease, hepatobiliary disorders, and urinary retention. However, Chinese medicine's "distension" is a syndrome complex centered on the concept of "qi stagnation," and cannot be simply equated with any one modern disease.
The ancients used "qi" to explain distension — this is a theoretical model. Modern understanding may approach some phenomena through gastrointestinal motility dysfunction, changes in smooth muscle tone, increased tissue interstitial fluid, neural regulatory disorders, among others. But concepts such as "defense qi counterflow" and "cold qi ascends counterflow" remain traditional formulations that cannot be fully mapped to modern indicators.
The discussion of "hitting the qi points" and "penetrating the fascial depths" in needling aligns in some ways with modern emphasis on acupoint localization, needling depth, and fascial layers in acupuncture practice. Yet terms like "qi points" and "fascial depths" belong to the traditional meridian theory and cannot be completely explained by anatomical structures.
It must be objectively noted that "regardless of deficiency or excess, the physician should be swift in draining" in this chapter represents an early clinical experience, which was later revised to pattern-based supplementation and drainage. Descriptions such as "smelling a burnt odor from the nose" and "frequent sighing" can serve as textual records of ancient clinical observation, but should not be over-interpreted outside their context.
Note from Bua: This content is based on classical texts of traditional Chinese medicine and is provided solely for cultural study and research. It does not constitute any medical diagnosis, medication advice, or treatment recommendation. In case of discomfort, please seek timely medical attention from a qualified professional.