Cargando...
Capítulo 46 de 81
黄帝内经·灵枢
Textual Revision Notes Several textual errors occurred in the original text during its transmission. The following translation is based on the standard edition of Lingshu·Wubian with corrections: "股理" (gu li) should be "腠理" (cou li, striae and interstices of skin and muscles); "烟肉" (yan rou) should be "䐃肉" (jiong rou, muscular prominences); "消瘴" and "消津" (xiao zhang, xiao jin) should be "消瘅" (xiao dan, wasting-thirst disorder); "戏汗" (xi han) should be "漉汗" (lu han, drenching sweat); "吴" (wu) should be "矣" (yi).
Overall Paraphrase
The Yellow Emperor asked Shaoyu: I have heard that when various diseases first arise, they are mostly caused by external pathogens such as wind, rain, cold, and heat, which enter through the body hair into the couli (the striae and interstices of the skin and muscles). After entering, some retreat on their own, some remain lodged, some cause wind-edema with sweating, some cause xiaodan (a disorder of internal heat consuming fluids), some cause hanre (fever and chills), some cause liubi (numbness and pain of the limbs and joints), and some cause jiju (abdominal masses). The strange pathogens spread everywhere, too numerous to count. Why is it that when people fall ill at the same time, some suffer from this disease and others from that? Could it be that Heaven's wind is partial toward certain people? Why is the difference so great?
Shaoyu replied: The wind generated by Heaven is not partial to any one person; it operates with fairness and uprightness. Those who offend against it fall ill; those who avoid it remain safe. It is not that the wind intentionally pursues a particular person, but rather that the person himself offends against it.
The Yellow Emperor asked: When people encounter wind at the same time and fall ill simultaneously, yet their diseases differ—what is the reason for this?
Shaoyu said: An excellent question! Allow me to use the analogy of a craftsman. A craftsman sharpens his axe and blade to cut wood. The shaded and sunny sides of trees differ in hardness and brittleness; hard places are not easily cut into, while fragile places have loose bark, and where the grain intersects with knots, the axe blade may even be notched. Within the same tree, hardness and brittleness already differ—hard parts are strong, fragile parts are easily damaged—let alone trees of different species, where bark varies in thickness and sap in quantity, making the differences even greater.
Let me further use five situations of trees being harmed as analogies: Trees that flower and leaf early, when encountering spring frost and violent wind, will have their flowers fall and leaves wither; trees that have long been exposed to scorching sun and severe drought—those with brittle wood and thin bark—will have branches with little sap and withered leaves; under prolonged overcast and continuous drenching rain, trees with thin bark and much sap will have their bark rot and seep moisture; when sudden violent wind arises, rigid and brittle trees will have branches snap and trunks damaged; when autumn frost and swift wind arrive, rigid and brittle trees will have roots shaken and leaves fall. These five situations each have different causes and manifestations of injury—how much more so could this apply to humans?
The Yellow Emperor asked: How can humans be compared to trees?
Shaoyu replied: When trees are injured, the damage mostly occurs on the branches; if the branches are firm and resilient, they are not easily harmed. That humans frequently fall ill is also because their bones, joints, skin, and couli are not solid, thereby becoming places where pathogenic qi lodges, which is why they tend to fall ill frequently.
The Yellow Emperor asked: How can one diagnose a person susceptible to fengjue lu han (wind-induced qi reversal with drenching sweat)?
Shaoyu replied: If the muscles are not solid and the couli are loose, the person is prone to wind disorders.
The Yellow Emperor asked: How does one diagnose incomplete muscle solidity?
Shaoyu replied: The jiongrou (muscular prominences) are not solid, lacking clear striations; the texture is coarse, the skin is not compact, and the striae are lax. This is stated in terms of the general condition of the muscles throughout the body.
The Yellow Emperor asked: How does one diagnose a person susceptible to xiaodan?
Shaoyu replied: A person whose five viscera are all weak tends to suffer from xiaodan.
The Yellow Emperor asked: How does one know the five viscera are weak?
Shaoyu replied: People with weak five viscera often possess a steadfast nature; the steadfast are prone to anger, and the weak viscera within are easily injured.
The Yellow Emperor asked: How does one diagnose such weakness accompanied by stubbornness?
Shaoyu replied: Such people have thin skin, deep-set eye sockets, long and upright eyebrows, and a firm will; firmness leads to frequent anger, anger causes qi to ascend adversely, congestion easily accumulates in the chest, blood-qi becomes rebellious and stagnant, the skin and muscles lose nourishment and become lax, the blood vessels do not flow smoothly, and they transform into heat🔥; heat scorches the skin and flesh, hence xiaodan takes form. This indicates that the person is fierce and resolute in temperament but weak in musculature.
The Yellow Emperor asked: How does one diagnose a person susceptible to hanre?
Shaoyu replied: Those with small bones and weak muscles tend to suffer from hanre.
The Yellow Emperor asked: How does one diagnose the size of bones, the firmness of muscles, and disparities in complexion?
Shaoyu replied: The cheekbone (zygoma) is the external hallmark of bone structure. Large cheekbones indicate large bones; small cheekbones indicate small bones. Thin skin and scanty flesh, weak and flaccid arms, dull and murky complexion on the chin that is inharmonious with the normal complexion of the forehead—this stands out as different, and these are the signs. Moreover, a person with thin flesh on the arms lacks abundant essence and marrow, and is therefore prone to developing hanre.
The Yellow Emperor asked: How does one diagnose a person susceptible to bi syndrome?
Shaoyu replied: Those with coarse skin striae and incomplete firmness of the flesh are prone to bi syndrome.
The Yellow Emperor asked: Are there differences in the higher or lower locations where bi syndromes occur?
Shaoyu replied: To identify the higher or lower location, one must examine the corresponding areas separately.
The Yellow Emperor asked: How does one diagnose a person susceptible to intestinal accumulation?
Shaoyu replied: Those with thin skin lacking luster and flesh that is not firm but moist have compromised stomach and intestine function; if stomach and intestine function is compromised, pathogenic qi easily lodges, and accumulation forms. When cold and heat within the spleen and stomach are not balanced, pathogenic qi gradually invades; when essence qi and pathogenic qi accumulate and lodge, larger masses are formed.
The Yellow Emperor said: I know the forms of disease; I would like to hear about the relationship between onset of disease and time.
Shaoyu replied: First, determine the ascendance or decline of the year's qi depending on the yun-qi (five circuits and six qi) system, thereby recognizing the appropriateness or avoidance of seasonal factors; when the seasonal qi is high, disease arises easily, and when the seasonal qi is low, the prognosis is graver; even if it is not a year of decline or depletion, if there is overcoming and pressing in that year, disease will certainly occur. This is the principle of disease arising according to body constitution, with the discipline of the five variations.
The core of this chapter is that constitution determines the tendency toward disease. When people are exposed to the same external pathogens and some develop this disease while others develop that one, the crucial factor lies not in "Heaven's wind being partial," but in whether each person's own bones, joints, skin, striae, viscera, muscles, and skeleton are strong. This resonates with the repeated emphasis in the Huangdi Neijing that "where pathogenic qi gathers, qi must be deficient": external pathogens are only conditions, whereas weak internal links remain the fundamental cause of disease.
Shaoyu uses the analogy of the "carpenter felling a tree": using the same axe to cut different trees—or even different parts of the same tree—yields different results, the reason being variations in the hardness, brittleness, thickness, and thinness of the wood. The same applies to humans: those with loose striae tend to suffer wind disorders; those with weak five viscera coupled with firmness and excessive anger tend to suffer xiaodan; those with small bones and weak muscles tend to suffer hanre; those with coarse striae and incomplete musculature tend to suffer bi syndrome; those with lusterless skin and weak stomach-intestine function tend to suffer jiju. These five categories form the framework for "five variations."
The final passage also incorporates the dimension of time: the occurrence of disease is related not only to body constitution but also to the ascendance and decline of the year's yun-qi and whether seasonal qi is high or diminished, showing an old holistic grasp of the relationship between "constitution, season, and disease."
This passage is an important source of the constitution theory in traditional Chinese medicine. Its proposals about "individual susceptibility" and "weak links determining disease type" resonate with concepts in modern preventive medicine such as "risk factors" and "individualized risk assessment." For example, a weak skin barrier, low muscle mass, chronic mental tension, and weakened gastrointestinal function may indeed influence susceptibility to certain diseases.
At the same time, historical limitations should be recognized: observations recorded in phrases such as "large cheekbones indicate large bones" and "the lower-jaw color differs from forehead color" derive from empirical intuition and lack support from modern anatomy or laboratory examinations; conditions such as xiaodan, hanre, bi, and jiju are essential summary descriptions used in ancient observations and not simply equivalent to any modern disease. In Bugu's view, this material is worthy of consideration as cultural understanding and as reference points for the observation of constitution, but it must not be treated as a modern diagnostic criterion.
Bugu Note: This content is based on ancient classical texts of Traditional Chinese Medicine and is intended purely for learning, research, and cultural appreciation of traditional heritage; it is not intended to constitute any diagnosis, medication advice, or therapeutic recommendations; in cases of ill health, please seek prompt professional medical attention.