灵枢经·邪气藏府病形 Evil Qi and the Disease Patterns of the Viscera and Bowels

Huangdi asked Qibo: 'How does evil qi strike a person?' Qibo replied: 'When evil qi strikes a person, it strikes high.'

Huangdi said: 'Is there a fixed measure to this high and low?' Qibo said: 'Above the midpoint of the body, it is evil qi that strikes; below the midpoint of the body, it is dampness that strikes. Hence it is said that when evil qi strikes a person, there is no constant rule — if it strikes the yin, it flows into the bowels; if it strikes the yang, it flows into the channels.'

Huangdi said: 'Yin and yang, though differing in name, belong to the same category; above and below they meet together, and the channels and network vessels interconnect like a ring without end. Yet when evil qi strikes a person, sometimes it strikes the yin, sometimes the yang, sometimes above, sometimes below, sometimes to the left, sometimes to the right, with no constant pattern — what is the reason for this?'

Qibo said: 'All the meeting points of the yang channels lie in the face. When evil qi strikes a person, it does so at a time when the body is vacuous, or when one has just exerted great physical effort, or after eating and drinking so that sweat is released — at such times the interstices of the skin open, and the evil qi strikes in. If it strikes the face, it descends into the Yangming; if it strikes the nape of the neck, it descends into the Taiyang; if it strikes the cheek, it descends into the Shaoyang. If it strikes the chest, the back, or the two rib-sides, it likewise enters their respective channels.'

Huangdi said: 'How does it strike the yin?' Qibo replied: 'When evil qi strikes the yin, it invariably begins from the arm or the shin. Now, on the arm and the shin, the skin over the yin aspect is thin and the flesh moist and glossy; hence, although both the yin and yang aspects are equally exposed to wind, it is the yin alone that is injured.'

Huangdi said: 'Does this, then, necessarily injure the viscera?' Qibo replied: 'When the body is struck by wind, this does not necessarily disturb the viscera. Thus, when evil qi enters a yin channel, if the qi of its associated viscus is replete, the evil qi enters but cannot lodge there, and so it returns instead to the corresponding bowel. Hence, when the yang is struck, the evil flows into the channels; when the yin is struck, the evil flows into the bowels.'

Huangdi said: 'How does evil qi strike a person's viscera?' Qibo said: 'Sorrow, anxiety, fear, and fright injure the heart. Exposure of the body to cold combined with drinking cold beverages injures the lung, for when the two colds affect each other, both the interior and exterior are injured, and so the qi rebels and moves upward. If one has suffered a fall, malign blood lodges within; or if one has been overcome by great rage, the qi rises and does not descend, accumulating below the rib-side — this injures the liver. If one has been struck or has fallen, or has entered the bedchamber while intoxicated, and then sweats while exposed to wind, this injures the spleen. If one has exerted great force in lifting a heavy weight, or has entered the bedchamber to excess, and then sweats and bathes in water, this injures the kidney.'

Huangdi said: 'How does wind strike the five viscera?' Qibo said: 'Only when both yin and yang are affected together can the evil qi make its way in.' Huangdi said: 'Excellent.'

Huangdi asked Qibo: 'The head and face, and the body as a whole, are joined by bone and linked by sinew, and share in the same blood united with qi. Yet when the weather turns cold, so cold that the earth cracks and ice forms, and the sudden chill causes the hands and feet to grow numb and sluggish, the face alone is left uncovered by clothing and yet is unharmed — why is this?' Qibo replied: 'The twelve channel vessels and the three hundred and sixty-five network vessels all send their blood and qi upward to the face, coursing through its open orifices. Their essential yang qi rises to the eyes and becomes vision; their branch qi courses to the ears and becomes hearing; their ancestral qi rises out through the nose and becomes smell; their turbid qi issues from the stomach and courses to the lips and tongue, becoming taste. The fluids carried by this qi all rise to steam and warm the face, and since the skin there is also thick and the flesh firm, even when the weather is extremely cold, it cannot overcome the face.'

Huangdi said: 'When evil qi strikes a person, what are the forms of the resulting illness?' Qibo said: 'When vacuous evil strikes the body, it causes shivering and trembling that disturbs the physical form. When true evil strikes a person, it is subtle — it first appears in the complexion, without being felt in the body, as if present, as if absent, as if lost, as if preserved, having form yet without form, so that none can discern its true nature.' Huangdi said: 'Excellent.'

Huangdi asked Qibo: 'I have heard that to see the complexion and thereby know the disease is called clarity of vision; to press the pulse and thereby know the disease is called spiritual perception; to ask about the illness and thereby know its location is called skill. I wish to hear how one comes to know by seeing, to grasp by pressing, and to exhaust the matter by questioning — how is this done?'

Qibo replied: 'Now the complexion, the pulse, and the skin of the forearm (chi) correspond to one another just as the drumstick corresponds to the drum's sound, or the form to its shadow — they cannot fail to correspond. This is likewise the manifestation of root and branch, root and leaf: when the root dies, the leaves wither. The complexion, the pulse, the bodily form, and the flesh cannot fail to correspond to one another. Thus, one who knows how to read one of these is a skilled practitioner; one who knows two is a spiritually perceptive practitioner; one who knows all three possesses both spiritual perception and clarity of vision.'

Huangdi said: 'I wish to hear this in full.' Qibo replied: 'When the complexion is green-blue, the pulse is string-like; when red, the pulse is hook-like; when yellow, the pulse is intermittent; when white, the pulse is feather-like; when black, the pulse is stone-like. If one observes the complexion but finds a pulse that does not correspond to it, and instead finds a pulse belonging to the phase that overcomes it, the patient will die; but if one finds a pulse belonging to the phase that generates it, the illness will resolve.'

Huangdi asked Qibo: 'What are the forms of disease produced by transformation and change within the five viscera?'

Qibo replied: 'One must first establish the correspondence of the five colors and the five pulses; only then can the disease be distinguished.'

Huangdi said: 'Once the complexion and pulse have been established, how does one go about distinguishing the disease?'

Qibo said: 'By examining whether the pulse is moderate or tense, small or large, slippery or rough, the transformation of the disease can be determined.'

Huangdi said: 'How does one examine this?' Qibo replied: 'When the pulse is tense, the skin of the chi (forearm) is likewise tense; when the pulse is moderate, the skin of the chi is likewise relaxed; when the pulse is small, the skin of the chi is likewise diminished and the qi scant; when the pulse is large, the skin of the chi likewise swells and rises; when the pulse is slippery, the skin of the chi is likewise slippery; when the pulse is rough, the skin of the chi is likewise rough. In all these transformations, there are degrees, some slight and some severe. Thus one who is skilled in examining the chi need not wait to examine the cun; one who is skilled in examining the pulse need not wait to examine the complexion. One who can bring all three together and apply them in unison may be called a superior practitioner — a superior practitioner cures nine out of ten. One who applies two of the three is a mediocre practitioner — a mediocre practitioner cures seven out of ten. One who applies only one is an inferior practitioner — an inferior practitioner cures six out of ten.'

Huangdi said: 'May I ask what are the forms of disease corresponding to the pulse being moderate or tense, small or large, slippery or rough?'

Qibo said: 'Allow your servant to speak of the disease transformations of the five viscera. When the heart pulse is extremely tense, this causes convulsions with tetany; when only somewhat tense, this causes heart pain radiating to the back, and inability to swallow food. When extremely moderate (slack), this causes maniacal laughter; when only somewhat moderate, this causes fu-liang, a mass lodged below the heart that moves up and down, with occasional spitting of blood. When extremely large, this causes obstruction of the throat; when only somewhat large, this causes heart impediment radiating to the back, with frequent tearing of the eyes. When extremely small, this causes frequent retching; when only somewhat small, this causes wasting-thirst disease. When extremely slippery, this causes frequent thirst; when only somewhat slippery, this causes heart mounting-disorder radiating to the navel, with rumbling in the lower abdomen. When extremely rough, this causes loss of voice; when only somewhat rough, this causes overflow of blood, linking reversal, ringing in the ears, and epilepsy.'

When the lung pulse is extremely tense, this causes epilepsy; when only somewhat tense, this causes cold and heat in the lung, with lassitude, coughing and spitting of blood, radiating to the lower back, spine, and chest, and sometimes nasal polyps obstructing the breath. When extremely moderate, this causes profuse sweating; when only somewhat moderate, this causes wilting weakness — wilting weakness combined with hemilateral wind, with sweat pouring from the head downward without cease. When extremely large, this causes swelling of the shin; when only somewhat large, this causes lung impediment radiating to the chest and back, with the patient rising and averting the eyes from sunlight. When extremely small, this causes diarrhea; when only somewhat small, this causes wasting impediment. When extremely slippery, this causes panting with rising qi; when only somewhat slippery, this causes bleeding from both the upper and lower orifices. When extremely rough, this causes vomiting of blood; when only somewhat rough, this causes 'rat lump' swellings between the neck and the armpit, in which the lower part cannot bear the weight of the upper, and one is prone to soreness in response.

When the liver pulse is extremely tense, this causes malicious speech; when only somewhat tense, this causes 'fat qi' — a mass below the rib-side like an overturned cup. When extremely moderate, this causes frequent vomiting; when only somewhat moderate, this causes water-conglomeration impediment. When extremely large, this causes internal welling-abscess, with frequent vomiting and nosebleed; when only somewhat large, this causes liver impediment, retraction of the genitals, and coughing radiating to the lower abdomen. When extremely small, this causes excessive thirst and drinking; when only somewhat small, this causes wasting-thirst disease. When extremely slippery, this causes protruding mounting-disorder; when only somewhat slippery, this causes involuntary urination. When extremely rough, this causes overflow-fluid disease; when only somewhat rough, this causes convulsive spasm and sinew impediment.

When the spleen pulse is extremely tense, this causes convulsions with tetany; when only somewhat tense, this causes obstruction of the diaphragm, in which food and drink, once swallowed, are brought back up, followed by the discharge of frothy fluid. When extremely moderate, this causes wilting weakness and reversal; when only somewhat moderate, this causes wind wilting, in which the four limbs cannot be used, though the mind remains clear as though there were no illness. When extremely large, this causes sudden collapse as though struck down; when only somewhat large, this causes mounting-qi disorder, with a large accumulation of pus and blood within the abdomen, outside the intestines and stomach. When extremely small, this causes cold and heat; when only somewhat small, this causes wasting-thirst disease. When extremely slippery, this causes protruding stranguria; when only somewhat slippery, this causes parasitic toxin from roundworms and other worms with heat in the abdomen. When extremely rough, this causes intestinal protrusion; when only somewhat rough, this causes internal protrusion, with copious discharge of pus and blood.

When the kidney pulse is extremely tense, this causes bone epilepsy; when only somewhat tense, this causes sinking reversal and running-piglet disorder, in which the feet cannot be drawn back and neither urination nor defecation can be accomplished. When extremely moderate, this causes a broken-feeling in the spine; when only somewhat moderate, this causes 'hollow-flux,' in which food is not digested and passes straight down the throat and out again. When extremely large, this causes impotence; when only somewhat large, this causes stone-water disease, in which swelling rises from the navel down to the lower abdomen in a heavy, sluggish manner, and up to the stomach cavity — when it reaches this point, it is fatal and beyond treatment. When extremely small, this causes hollow-flux diarrhea; when only somewhat small, this causes wasting-thirst disease. When extremely slippery, this causes stranguria and protrusion; when only somewhat slippery, this causes bone wilting, in which the patient cannot rise once seated, and upon rising the eyes see nothing. When extremely rough, this causes large welling-abscess; when only somewhat rough, this causes amenorrhea and sunken hemorrhoids.

Huangdi said: 'For these six transformations of disease, how should one needle?' Qibo replied: 'In all cases of tenseness, there is generally cold; in moderateness, there is generally heat; in largeness, there is generally abundant qi but scant blood; in smallness, both blood and qi are scant; in slipperiness, the yang qi is exuberant, with a slight degree of heat; in roughness, there is abundant blood but scant qi, with a slight degree of cold. Therefore, when needling tenseness, insert the needle deeply and retain it long. When needling moderateness, insert the needle shallowly and withdraw it swiftly, so as to dispel the heat. When needling largeness, drain the qi only slightly, without letting blood escape. When needling slipperiness, withdraw the needle swiftly after a shallow insertion, so as to drain the yang qi and dispel the heat. When needling roughness, one must strike precisely into the vessel, and, following whether the qi runs contrary or accordant, retain the needle for a long time; one must first press and trace along the vessel, and once the needle has been withdrawn, press upon the site of the disorder so as to prevent blood from escaping, thereby harmonizing the vessel. In all cases of smallness, the yin, yang, physical form, and qi are all insufficient, and one should not treat with the needle, but should regulate instead with sweet-flavored medicinals.'

Huangdi said: 'I have heard that regarding the qi of the five viscera and six bowels, the Ying and Shu points lead in to become the He point. By what pathway does the qi enter, and once entered, how does it connect and pass through? I wish to hear the reason for this.' Qibo replied: 'This refers to the branch of the yang vessel that enters within and belongs to the bowels.'

Huangdi said: 'Do the Ying, Shu, and He points each have their own distinct function?' Qibo replied: 'The Ying and Shu points treat the exterior channels, while the He points treat the internal bowels.'

Huangdi said: 'How does one treat the internal bowels?' Qibo said: 'By selecting the He point.'

Huangdi said: 'Do the He points each have their own particular name?' Qibo replied: 'The He point of the stomach is Zusanli; the He point of the large intestine enters at Shangjuxu; the He point of the small intestine enters at Xiajuxu; the He point of the triple burner enters at Weiyang; the He point of the bladder enters at the center of Weizhong; the He point of the gallbladder enters at Yanglingquan.'

Huangdi said: 'How are these points located?' Qibo replied: 'To locate Sanli, lower the instep and take the point; to locate Juxu, raise the foot and take the point; to locate Weiyang, bend and extend the leg and search for the point; to locate Weizhong, bend the leg and take the point; to locate Yanglingquan, have the patient sit with the knee held upright, level with it, and take the point below, on the yang side toward Weiyang; to locate all the points of the exterior channels, extend and stretch the limb and follow it to find the point.'

Huangdi said: 'I wish to hear of the diseases of the six bowels.' Qibo replied: 'Heat in the face indicates disease of the foot Yangming; a congested network vessel over the thenar eminence indicates disease of the hand Yangming; a sunken, taut vessel over the two insteps indicates disease of the foot Yangming — this is the stomach vessel.'

In disease of the large intestine, there is cutting pain within the intestines, with loud rumbling sounds. If in winter one is further affected by cold, diarrhea results, with pain centered at the navel, and one is unable to stand for long. Its signs are shared with those of the stomach; select Shangjuxu.

In disease of the stomach, there is distension of the abdomen, and pain in the stomach cavity centered below the heart, radiating up to affect the two rib-sides; the diaphragm and throat fail to communicate, and food and drink cannot descend. Select Sanli.

In disease of the small intestine, there is pain in the lower abdomen, with pain in the lower back and spine pulling toward the testicles, and at times urgent difficulty in defecation; there is heat in front of the ear, or else severe cold, or heat concentrated solely on the shoulder, and heat between the little finger and the finger next to it; a sunken vessel is also a sign of this condition. This is disease of the hand Taiyang; select Xiajuxu.

In disease of the triple burner, there is fullness of qi in the abdomen, with the lower abdomen especially hard, inability to urinate, and urgent distress; if the condition overflows, water is retained, producing distension. Its sign lies in the great network vessel on the outer aspect of the foot Taiyang, this great network vessel lying between the Taiyang and Shaoyang, and it also appears in the vessel there; select Weiyang.

In disease of the bladder, there is swelling and pain to one side of the lower abdomen; when pressed with the hand, it produces an urge to urinate that cannot be satisfied; there is heat on the shoulder, or a sunken vessel there, and heat over the outer border of the little toe and behind the ankle of the shin, or a sunken vessel there; select the center of Weizhong.

In disease of the gallbladder, there is frequent sighing, bitterness in the mouth, vomiting of stale fluid, an uneasy fluttering sensation below the heart, and a fear as though someone were about to seize the patient, with frequent hawking and spitting in the throat. The condition lies at the root and tip of the foot Shaoyang; one should also examine its vessel, and where it is sunken, apply moxibustion; where there is cold and heat, select Yanglingquan.

Huangdi said: 'Is there a proper method to needling these points?' Qibo replied: 'In needling these, one must strike precisely into the qi aperture, and must not strike into the flesh at the joints. If one strikes the qi aperture, the needle moves as though traveling through an open lane; if one strikes the flesh at the joints, the skin becomes painful. If supplementing and draining are reversed, the illness will only grow worse. If one strikes a sinew, the sinew becomes slack, the evil qi fails to be expelled, and, contending in disorder with the true qi without being dispelled, it instead returns and lodges within the body. This is the result of applying the needle without due care, turning what should accord into what instead opposes.'