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บทที่ 29 จาก 81
黄帝内经·灵枢
Huang Di said: I have heard that the former teachers have some insights kept in their hearts, not written on bamboo tablets. I wish to hear about them and remember them, to follow and practice them. At the top, one can govern the people; at the bottom, one can nurture oneself. This ensures that the common people have no illness, the superiors and inferiors live in harmony and affection, grace flows downward, descendants have no worries, and it is passed on to later generations without end. May I hear about it?
Qi Bo said: What a profound question! Governing the people and nurturing oneself, governing others and governing oneself, handling small matters and large matters, governing a state and managing a household — there is no case that can be well managed by violating principles. Only "following" (shun) will do. What is called "following" here refers not only to the inverse or normal flow of yin-yang pulse signs and qi movement — the common people all wish to follow their own wishes as well.
Huang Di asked: How does one follow?
Qi Bo said: When entering a state, first ask about local customs; when entering a household, first ask about taboos; when ascending the hall, first ask about etiquette; when facing a patient, first ask about what he likes and dislikes and what suits him.
Huang Di asked: How does one follow the patient's likes and dislikes?
Qi Bo said: For conditions such as internal heat and wasting-thirst, cooling is suitable; for conditions with cold in the interior, warming is suitable. If there is heat in the stomach, food is easily digested, causing the person to feel suspended and easily hungry, with the skin above the navel warm. If there is heat in the intestines, the stool is yellow and like thin gruel, with the skin below the navel cool. If there is cold in the stomach, there is abdominal distension; if there is cold in the intestines, there is borborygmus and sun xie — that is, diarrhea with undigested food. If there is cold in the stomach and heat in the intestines, then there is both distension and diarrhea; if there is heat in the stomach and cold in the intestines, then the person is easily hungry with pain and distension in the lower abdomen.
Huang Di asked: The stomach likes cold drinks, and the intestines like warm drinks. These are opposite. How does one follow this? Moreover, these kings, dukes, and great men — the rulers who eat meat — are arrogant and willful, despising others, and cannot be forcibly restrained. To restrain them goes against their wishes; to follow them without guiding them will worsen the disease. What should be done? Where does one begin?
Qi Bo said: It is human nature that no one hates death and loves life. Tell him the harms, explain to him the benefits, guide him with what is suitable, and open his mind with what he suffers from. Even if there is an unreasonable person, would there be anyone who does not listen?
Huang Di asked: How is it specifically regulated and treated?
Qi Bo said: In spring and summer, first treat the branch (biao), then treat the root (ben); in autumn and winter, first treat the root, then treat the branch.
Huang Di asked: When the likes and dislikes of cold and heat are opposite, how does one follow them?
Qi Bo said: In following such conditions, food, drink, clothing, and covering should also be appropriate to cold and warmth: in cold weather, one should not shiver from cold; in hot weather, one should not sweat from heat. In diet, hot food should not scorch, cold food should not be icy. When cold and warmth are moderate, the correct qi can be preserved, and evil qi will not be summoned.
Huang Di said: The chapter Ben Zang holds that according to the body's form, limbs, joints, and muscles, one can measure the size of the five zang and six fu organs. Now if a king, duke, great man, or a ruler on the throne comes to ask, who can examine the body before answering?
Qi Bo said: The body's form, limbs, and joints are the external covering of the organs — it is not only through observing the face.
Huang Di said: I already know the manifestations of the five zang qi on the face. How are observation and examination conducted through the limbs and joints?
Qi Bo said: Among the five zang and six fu, the lung is at the uppermost like a canopy. Broad shoulders and a sunken throat depression can be externally examined for it. Huang Di said: Good.
Qi Bo said: Among the five zang and six fu, the heart is the master. The supraclavicular fossa (que pen) is the passage of vessel qi. When the sternum area is full, one can examine the chest. Huang Di said: Good.
Qi Bo said: The liver acts as the general, responsible for examining the external. If one wishes to know whether it is firm, look at the size of the eyes. Huang Di said: Good.
Qi Bo said: The spleen is responsible for protection, taking in water and grain. Look at the good and bad conditions of the lips and tongue, and one can determine good or bad fortune. Huang Di said: Good.
Qi Bo said: The kidney is responsible for the external, attending to hearing afar. Look at the quality of the ears, and one can know its nature. Huang Di said: Good. I wish also to hear the external examination of the six fu.
Qi Bo said: Among the six fu, the stomach is the sea of water and grain. When the cheeks are broad, the neck is thick, and the chest is open, the five grains can be contained. Long depth of the nasal passages examines the large intestine. Thick lips and long philtrum examine the small intestine. Large lower eyelids indicate boldness of the gallbladder qi. Exposed nostrils indicate that the bladder is prone to leakage. A raised central ridge of the nose indicates that the san jiao function is normally constrained. These are the methods for externally examining the six fu. When the upper, middle, and lower portions are even, the organs are at peace.
"Following" (shun) as the guiding principle: This chapter unifies governing a state, managing a household, and nurturing the body under the single word "following." Following does not mean blindly catering — it means conforming to human nature, seasonal timing, disease tendency, and the likes and dislikes of the organs, avoiding "treatment by going against."
Asking what is suitable: Before diagnosis and treatment, one first understands the patient's subjective likes and dislikes, especially cold-heat preferences. 🌡️ But the ancients particularly pointed out that stomach and intestinal heat-cold conditions may be opposite — such as stomach heat with intestinal cold, or stomach cold with intestinal heat — so one cannot only look at surface preferences.
Root and branch sequence and the four seasons: In spring and summer, yang qi rises outward, so one first treats the branch and later the root; in autumn and winter, yang qi is stored within, so one first treats the root and later the branch. This embodies time-appropriate strategies.
Inferring the internal by examining the external (si wai chuai nei): Manifestations of the body's form, limbs, joints, and five sensory organs imply the state of the organs. For example, the lungs are examined at the shoulders and throat, the heart at the supraclavicular fossa, the liver at the eyes, the spleen at the lips and tongue, and the kidneys at the ears. Each of the six fu also has corresponding external indicators. This reflects the holistic and body-mirroring thought in the Nei Jing.
Valuing the patient's subjective experience: The line "when facing the patient, ask what suits him" resonates with the modern "patient-centered care" philosophy. Understanding the patient's habits and cold-heat preferences helps build trust and communication.
Communication and persuasion methods: "Tell him the harms, speak to him the benefits, guide him with what is suitable, and open his mind with his suffering" is similar to modern health education, informed consent, and motivational interviewing — emphasizing rational communication rather than force.
Historical limitations: Inferring organ function from exterior body shape belongs to the early observational practice of "inferring the internal from the external." It demonstrates value in holistic thinking, but it lacks precision in modern anatomy and physiology and clinical validation — hence it should not be relied upon as a diagnostic basis. Models such as stomach heat or intestinal cold also require objective testing for confirmation.
Seasonal treatment thinking: Statements such as treating branch versus root in different seasons reflect ancient summarization of the relationship between climate and the body — but any specific application requires modern evidence and should not be applied mechanically.
Moderation in cold and warmth: Daily food and clothing should avoid extremes. 🌿 Hot food should not burn, cold food should not be icy. Cold-warm moderate, health is preserved, diminishing external irritation.
Following the seasons: In winter, keep warm; in summer, avoid profuse sweating; adjust activity, rest, and protection with the seasons to maintain a balance between internal and external.
Communication before coercion: In family and personal management, borrow the idea of "tell him the harms, speak to him the benefits" — explaining gains and losses and guiding with appropriate methods rather than simple prohibition — this makes acceptance more likely.
Understanding one's own sensations but not self-diagnosing: Being aware of personal preferences in hot/cold and food is a part of self-observation, but it cannot substitute medical evaluation or justify self-administered treatments.
Related concepts: Root/branch sequence, cold-heat likes and dislikes, inferring internal from external examination, external signs of the five zang and six fu, sun xie (undigested-food diarrhea), xiao dan (wasting-thirst), san jiao
Further reading: Ling Shu · Ben Zang, Ling Shu · Wu Se, Su Wen · Ben Biao Bing Chuan Lun, Su Wen · Yin Yang Ying Xiang Da Lun
Bu Gua warm reminder: This content is based on classical traditional Chinese medicine texts and is provided for traditional culture study and research only. It does not constitute any medical diagnosis, medication prescription, or treatment advice. If you feel unwell, please seek medical attention promptly.