灵枢经·卫气失常 Disorders of Defensive Qi

Huangdi said: "When defensive qi lingers within the abdomen, contracting into an accumulation that fails to move, stagnating and pent up without a constant place, causing a person to feel fullness in the rib-sides and stomach, panting and gasping with rebellious breath — how can this be dispelled?" Bogao said: "When the qi accumulates in the chest, treat it from above; when it accumulates in the abdomen, treat it from below; when both above and below are full, treat it from the sides."

Huangdi said: "How is this treated?" Bogao replied: "When the accumulation is above, drain Renying (ST-9), Tiantu (CV-22), and the points within the throat. When it is below, drain Zusanli (ST-36) and Qichong (ST-30). When both above and below are full, treat both above and below together, along with the point one cun below the free rib. In severe cases, use the chicken-foot needling technique (three oblique insertions radiating out like a fowl's foot). But if on examination the pulse is large, wiry, and taut, or intermittent and failing to arrive, or if the skin of the abdomen is extremely tense, one must not needle." Huangdi said: "Good."

Huangdi asked Bogao: "How does one know whether an illness is located in the skin, the flesh, the qi and blood, the sinews, or the bones?" Bogao said: "When a thin, glossy color appears above the two eyebrows, the disease is in the skin. When the lips show a green-blue, yellow, red, white, or black color, the disease is in the muscles and flesh. When the nutritive qi appears moist and glistening, the disease is in the blood and qi. When the eyes show a green-blue, yellow, red, white, or black color, the disease is in the sinews. When the ears appear scorched and withered, coated with dust and grime, the disease is in the bones."

Huangdi said: "What are the forms these diseases take, and how are they treated?" Bogao said: "The transformations of the hundred diseases are too numerous to count in full; yet the skin has its regions, the flesh has its pillars, the qi and blood have their transport points, and the bones have their attachments." Huangdi said: "I wish to hear the reasons for this." Bogao said: "The regions of the skin are conveyed to the four extremities. The pillars of the flesh are found between the muscle divisions of the yang channels of the arms and legs, and in the muscle divisions along the Foot Shaoyin channel. The transport points of the qi and blood are conveyed to the various network vessels; where qi and blood linger and collect, there they become abundant and rise up prominently. The regions of the sinews have no fixed yin or yang, no fixed left or right, but wherever they are found, one may observe the location of the disease there. The attachments of the bones are the bone-hollows through which nourishment is received and by which the brain and marrow are nourished."

Huangdi said: "How, then, is treatment applied?" Bogao said: "The transformations of disease — floating or sunken, deep or shallow — cannot be exhaustively investigated, yet each has its proper location. When the illness is mild, needle shallowly; when severe, needle deeply. When mild, use few needles; when severe, use many. One regulates the qi according to these transformations — this is what is called a superior physician."

Huangdi asked Bogao: "People differ in being fat or thin, large or small, warm or cold in constitution, and in being old, robust, young, or small — how does one distinguish these categories?" Bogao replied: "A person past fifty years of age is called old; past twenty, robust; past eighteen, young; and past six, a child."

Huangdi said: "How does one measure and know whether a person is fat or thin?" Bogao said: "Among people there are those who are fei (sturdy-fat), those who are gao (soft-fat), and those who are rou (fleshy)." Huangdi said: "How does one distinguish these?" Bogao said: "One whose flesh at the back of the knee is firm and whose skin is full is fei. One whose flesh at the back of the knee is not firm and whose skin is loose is gao. One whose skin and flesh do not separate from each other is rou."

Huangdi said: "What of the warmth or coldness of the body?" Bogao said: "In the gao type, the flesh is soft and moist; if the texture is coarse, the body is cold, and if the texture is fine, the body is hot. In the zhi (firm-fat) type, the flesh is firm; if the texture is fine, the body is hot, and if the texture is coarse, the body is cold."

Huangdi said: "What of their fatness, thinness, largeness, and smallness?" Bogao said: "In the gao type, there is abundant qi and the skin is loose and slack, so the abdomen hangs loosely and the flanks droop. In the rou type, the body and frame are ample and large. In the zhi type, the body is compact and small."

Huangdi said: "What of the relative amounts of qi and blood in these three types?" Bogao said: "The gao type has abundant qi; abundant qi produces heat, and heat allows one to withstand cold. The rou type has abundant blood, which fills out the form, and a filled-out form is well balanced. The zhi type has clear, thin blood and scant, slippery qi, and so cannot grow large. These are what distinguish such people from the ordinary run of people."

Huangdi said: "What of the ordinary person?" Bogao said: "In the ordinary person, the skin, flesh, zhi, and gao do not exceed one another, and the blood and qi are not excessively abundant in either; hence the form is neither too small nor too large, but each part is proportionate to the body as a whole — such a person is called an ordinary person."

Huangdi said: "Good. How, then, should treatment be applied?" Bogao said: "One must first distinguish the three body types, the relative abundance of blood, and the clarity or turbidity of qi, and only afterward regulate accordingly, so that treatment does not depart from its constant norms. Thus the gao type has a loosely hanging abdomen and drooping flanks; the rou type is ample and large both above and below; and the zhi type, although fatty, cannot grow large."