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Capítulo 62 de 81
黄帝内经·灵枢
The Yellow Emperor asked: The human body has twelve meridians. Why is it that only the Hand Taiyang Meridian, the Foot Yangming Meridian, and the Foot Shaoyin Meridian exhibit continuous pulsation that can be palpated on the body surface?
Qi Bo replied: The pulsation of the Foot Yangming Meridian originates from the Stomach. 🌿 The Stomach is the Sea (ultimate source) of nourishment for the five viscera and six bowels. The clear qi (the refined essence of water and grain) transformed by the Stomach ascends and infuses into the Lungs. The Lung qi then circulates along the Hand Taiyin Meridian, and its rhythm of movement is synchronized with respiration — with every exhalation, the pulse beats twice; with every inhalation, the pulse also beats twice. Breathing never ceases, so the pulse never stops beating either.
The Yellow Emperor further asked: When the qi passes through Cunkou (the radial artery pulsation site at the wrist), why is it so forceful when rising upward, yet so subtle and faint when sinking downward? Through which pathway does it travel back and forth? I cannot grasp the reasoning behind this.
Qi Bo replied: When the qi departs from the five viscera, its initial movement is as sudden as the release of a crossbow bolt, as rapid as water pouring over a dike. After it surges upward to reach the Yuji (the thenar eminence of the palm), its force begins to decline; the remaining qi, having dissipated, then flows back in reverse. This is why the pulsation on the return path is faint and weak.
The Yellow Emperor asked: What is the cause of the pulsation of the Foot Yangming Meridian?
Qi Bo replied: The Stomach qi ascends and infuses into the Lungs. Within it, the agile and forceful portion (the swift and intense component) surges upward to the head, travels along the throat, enters the empty orifices (the apertures of the head and face), follows the eye system (the tissue connecting the posterior eye to the brain), enters and links with the brain, then emerges from the Hang Sang (nasopharynx), descends past Ker Zhuren (near ST 7), follows the Ya Che (mandible region), and merges with the Foot Yangming Meridian. It then descends further and joins Renying (the carotid pulsation site) — following the same path. This is the route by which the Stomach qi branches off toward the Yangming Meridian. Therefore, whether at the upper location (Renying) or the lower location (Cunkou), their pulsations remain coordinated and consistent. Thus, if a yang meridian is diseased yet the yang pulse becomes smaller, it is a rebellious pattern; if a yin meridian is diseased yet the yin pulse becomes larger, this is also a rebellious pattern. If both yin and yang pulses are calm, but only one location moves alone, like measuring a tilt with a rope, this is a manifestation of disease.
The Yellow Emperor asked: What is the cause of the pulsation of the Foot Shaoyin Meridian?
Qi Bo replied: The Chong Mai is the Sea of the Twelve Meridians (the gathering place of qi and blood of all the meridians). Together with the great collateral of the Foot Shaoyin Meridian, it originates below the Kidneys, emerges from Qi Jie (the inguinal region), descends along the medial aspect of the thigh, obliquely enters the popliteal fossa (behind the knee), then follows the medial side of the tibia, running parallel with the Foot Shaoyin Meridian. It descends further, entering posterior to the medial malleolus and then into the sole of the foot. Its separate branch obliquely enters the ankle region, emerges and ascends to the dorsum of the foot, enters between the great toes, and pours into the various collateral vessels, serving to warm and nourish the feet. This is the reason this location frequently manifests as pulsation.
The Yellow Emperor further asked: The circulation of Nutritive qi and Defensive qi connects upward and downward, passing through one another like an unbroken ring with no end. Now if a person suddenly encounters pathogenic qi or suffers from extreme cold, leading to slackness and weakness of the hands and feet, so that the pathways of yin and yang in the meridians, as well as the meeting points of their mutual infusion, all lose their proper order — from where then can the qi return and re-establish its flow?
Qi Bo replied: The four extremities are the meeting points of the yin and yang meridians and are where the great collaterals of qi reside. The Four Streets (the four gatherings of qi: head, chest, abdomen, and shins) are the major thoroughfares for qi passage. Therefore, even if the small collaterals are blocked, the large meridians can still course freely. Though the extremities are slack and without movement, qi can still converge through the Four Streets, mutually infusing and circulating, still operating like an unbroken ring without end.
The Yellow Emperor said: Well spoken! This is what is meant by "like a ring with no end" — not know where it begins, ending then beginning again. This is precisely the principle conveyed.
The central inquiry of this chapter is the principle of vascular pulsation and the pathways of qi and blood circulation, unfolding across three levels:
Level One: The linkage mechanism of Stomach qi — Lung qi — respiration — pulse. Qi Bo traces the primary driving force of pulse movement back to the Stomach. The Stomach transforms water and grain into essential essence, which ascends to the Lungs. The Lungs govern qi and regulate respiration; when Lung qi moves along the meridians, it follows respiratory rhythm, forming the pattern of "two pulses per exhalation, two pulses per inhalation." This establishes the complete chain of "Stomach → Lungs → Pulse → Respiration," illustrating that the pulse is not merely a reflection of cardiac activity, but within the framework of Chinese medicine, it embodies the rise and fall of Stomach qi — the origin of the later maxim "the pulse takes Stomach qi as its root."
Level Two: The relationship between the Chong Mai and the pulsation of the Foot Shaoyin. The Chong Mai, known as the "Sea of the Twelve Meridians," originates below the Kidneys, and its pathway closely overlaps with the Foot Shaoyin Meridian, particularly in its course descending along the medial thigh and leg. This explains why a distinct pulsation can be palpated posterior to the medial malleolus (near KI 3 — Taixi); essentially it is where the Chong Mai travels. The key function of the Chong Mai here is to "warm the foot and leg," pouring qi and blood into the collateral network of the foot.
Level Three: The Four Streets theory and the safeguard mechanics of circulation. When cold causes obstruction of the collaterals at the extremities, impeding the flow of qi and blood, Qi Bo introduces the concept of the Four Streets (head, chest, abdomen, and shins). These streets are the major channels for qi movement, equivalent to "main highways," whereas the collaterals at the extremities are equivalent to "branch roads." When the branch roads become blocked, the main highways remain passable; qi can regroup at the Four Streets and perpetuate the "ring without end" flow. This demonstrates the Chinese medical insight into the redundancy and compensatory capacity inherent in the system of qi and blood circulation.
The modern view of "the Stomach as the Sea of the Five Viscera and Six Bowels" : Through a modern physiological lens, the digestive system is indeed the fundamental basis of energy supply for the whole body. Glucose, amino acids, fatty acids and other nutrients are absorbed through digestion and distributed through the bloodstream, which bears a functional correspondence to the description of "Stomach qi infusing the Lungs, the Lungs facing all the vessels." The ancients — although without precise knowledge of blood circulation — nonetheless captured the core logic of "digestion/absorption → energy delivery → whole-body supply."
The observational value of "two pulse beats per breath" : This record indicates that more than two thousand years ago, ancient observers had already recognized a relatively stable relationship between respiration and heart rate (about four beats per breathing cycle, i.e., a respiratory-to-cardiac ratio of roughly 1:4). Modern physiology confirms that such respiratory sinus arrhythmia (accelerated heart rate during inhalation, decelerated during exhalation) is a normal phenomenon — the ancient observation was accurate.
The systematic thinking of "Four Streets" theory : The concept of four streets resonates with the modern medical notion of collateral circulation — when one pathway is obstructed, the body compensates through alternative routes. To be sure, the ancients conceptualized this in terms of meridian/qi theory rather than vascular anatomy; still, its emphasis on systemic compensation is commendable.
Historical limitations : The attribution of the three pulsation sites (Hand Taiyang, Foot Yangming, Foot Shaoyin) to the Stomach qi and Chong Mai — rather than to cardiac pumping and arterial anatomy — reflects the pre-anatomical framework of ancient Chinese medicine. The ankle pulse (corresponding to Foot Shaoyin) corresponds to the posterior tibial artery; the neck pulse corresponds to the common carotid artery; the wrist pulse corresponds to the radial artery. These are all sites where a major artery runs superficially, rather than manifestations of "Chong Mai" or "Stomach qi" literally themselves. The ancients' depiction of the pathway of blood movement (e.g., "qi departing the viscera, suddenly like a crossbow bolt") was an imaginative construct rather than an accurate representation of hemodynamics.
Protecting Stomach qi as the root of health 💡: Since "the Stomach is the sea of the five viscera and six bowels," attention should be given to dietary moderation — avoiding extremes of hunger and overeating, not indulging in gluttony — as this safeguards the source of qi and blood production. This constitutes general dietary and lifestyle guidance and is not in reference to treating any specific condition.
The relationship between breathing and qi-blood flow : The ancients emphasized that pulse movement is governed by respiratory rhythm, implying that steadiness of breathing rhythm significantly influences the normal circulation of qi and blood. In daily life, maintaining calm, even, and deep breathing — avoiding rapid and shallow patterns — is advisable as general breath-regulation advice.
Keep the extremities warm 🔥: The text mentions "when meeting extreme cold, the hands and feet become slack," revealing awareness that cold pathogens obstruct circulation at the extremities. Practically, keeping the hands and feet warm, especially avoiding prolonged exposure to low temperatures during cold seasons, supports smooth qi and blood flow. This is purely general lifestyle protection.
Moderate physical activity promotes circulation 💨: The Four Streets theory suggests the body houses compensatory circuits. Moderate physical movement stimulates qi and blood flow, maintaining meridian stay-open patency — a general lifestyle recommendation.
Associated concepts:
Further related readings:
This content is based on classical Chinese medical texts and is intended solely for cultural and traditional learning. It does not constitute medical diagnosis, medication advice, or treatment recommendations; please consult a qualified healthcare professional when unwell.