灵枢经·百病始生 The Origin of the Hundred Diseases

Huangdi asked Qibo: 'Now, the hundred diseases, in their beginning, all arise from wind and rain, cold and summer-heat, clear coolness and dampness, and joy and anger. When joy and anger are not moderated, they injure the viscera; when wind and rain assail the body, they injure the upper regions; when clear coolness and dampness assail the body, they injure the lower regions. The three regions are each injured by different categories of cause — I wish to hear how they converge.' Qibo said: 'The qi of the three regions each differ: some diseases arise from yin, others from yang. Allow me to explain the pattern. When joy and anger are not moderated, they injure the viscera, and when the viscera are injured, disease arises from yin. When clear coolness and dampness take advantage of a deficiency, disease arises from the lower region. When wind and rain take advantage of a deficiency, disease arises from the upper region. These are what is called the three regions. As for the excessive overflow of these pathogenic influences once they take hold, their manifestations cannot be exhausted by counting.'

Huangdi said: 'Indeed, I cannot count them all — this is precisely why I ask my former teacher; I wish to hear the whole of this Way.' Qibo said: 'Wind and rain, cold and heat, cannot by themselves harm a person unless there is a deficiency present; evil qi alone cannot injure the body. Thus, when a person suddenly encounters a fierce wind or violent rain and yet does not fall ill, it is because there is no deficiency present, and so the evil qi cannot injure him by itself. This must always depend upon a vacuous, thieving wind meeting with a body that is itself deficient — when the two deficiencies meet one another, the evil is then able to lodge in the body. Where two fullnesses meet one another, the flesh of most people remains firm and resistant. Whether the body is struck by vacuous, thieving evil depends on the season of Heaven together with the condition of the body itself; weighing deficiency against fullness together, serious disease is thereby formed. The qi of disease has a fixed lodging place, and it is named according to where it settles — above, below, in the center, or on the exterior — and thus is divided into three regions.'

Thus, when vacuous, thieving evil strikes a person, it begins in the skin. When the skin is lax, the interstices open; once open, the evil enters through the body hair, and once entered, it presses inward and deepens; as it deepens, the body hair stands erect, and when the hair stands erect there is a chilled, shivering sensation, and so the skin becomes painful. If it lingers and does not depart, it is transmitted and lodges in the network vessels; while in the network vessels, there is pain in the flesh and muscles, so that the pain comes and goes intermittently. If it is not expelled, the great channels then take over as its lodging place; if it lingers and does not depart, it is transmitted and lodges in the channels; while in the channels, one shivers with cold and is easily startled. If it lingers and does not depart, it is transmitted and lodges at the transport points; while at the transport points, the six channels fail to communicate with the four limbs, so the joints of the limbs ache and the lower back and spine become stiff. If it lingers and does not depart, it is transmitted and lodges in the Hidden-Chong Vessel; while in the Hidden-Chong Vessel, the body feels heavy and aches all over. If it lingers and does not depart, it is transmitted and lodges in the intestines and stomach; while in the intestines and stomach, there is rumbling and distension of the abdomen. Where cold predominates, there is intestinal rumbling with diarrhea of undigested food and failure to digest food; where heat predominates, there is sloppy, mushy stool. If it lingers and does not depart, it is transmitted and lodges outside the intestines and stomach, in the space of the membrane-source, the fatty membranes, where it settles into the vessels; if it remains there without departing, it accumulates over time and forms a mass. It may settle in the grandchild vessels, or in the network vessels, or in the channel vessels, or at the transport points, or in the Hidden-Chong Vessel, or in the sinews alongside the spine, or in the membrane-source between the intestines and stomach, extending upward to connect with the slack sinews. The excessive overflow of evil qi in this way cannot be exhaustively described.

Huangdi said: 'I wish to hear fully how each of these comes about.' Qibo said: 'When the evil settles in the grandchild vessels and forms a mass, the mass moves back and forth, upward and downward, for the grandchild vessels are slight and shallow, floating and lax, unable to grip and hold the mass in place; hence it travels back and forth between the intestines and stomach. Water gathers and seeps in, pouring and irrigating, producing a sloshing sound; where cold is present, there is bloated fullness with rumbling that radiates through the abdomen, and so there is intermittent, sharp pain. When it settles in the Yangming channel, it lodges beside the navel; when the person eats to fullness, it grows larger, and when hungry, it grows smaller. When it settles in the slack sinews, it resembles a mass of the Yangming, so that eating to fullness brings pain and hunger brings ease. When it settles in the membrane-source between the intestines and stomach, there is pain that extends outward to connect with the slack sinews; eating to fullness brings ease, and hunger brings pain. When it settles in the Hidden-Chong Vessel, palpation reveals it pulsing beneath the hand, and when the hand is released, hot qi descends into both thighs as though hot water were being poured over them. When it settles in the sinews alongside the spine, behind the intestines, the mass becomes apparent when hungry and disappears when full, so that it cannot be found on palpation. When it settles at the transport points, there is blockage and obstruction so that fluids fail to descend, and the body's orifices become dry and congested. This is how evil qi passes from the exterior into the interior, and travels from above to below.'

Huangdi said: 'From the very beginning of a mass's formation to its full development, how does this occur?' Qibo said: 'A mass, at its beginning, arises from exposure to cold; through reversal of qi it becomes a fully formed mass.' Huangdi said: 'How does it become a mass?' Qibo said: 'Reversal qi first produces a distressed feeling in the feet; this distress produces coldness in the shins; coldness in the shins causes the blood vessels to congeal and become rough; when the blood vessels congeal and become rough, cold qi ascends and enters the intestines and stomach; once it enters the intestines and stomach, there is bloated distension; and this bloated distension causes the fluid and froth outside the intestines to be forced together and unable to disperse, so that over time a mass is formed. If a person suddenly eats and drinks to excess, the intestines become full; if rising and resting are not regulated, and if one exerts oneself with excessive force, the network vessels become injured. When the yang network vessels are injured, blood overflows to the exterior, and overflowing blood causes nosebleed; when the yin network vessels are injured, blood overflows internally, and this causes bleeding from the stool. When the network vessels of the intestines and stomach are injured, blood overflows outside the intestines; if there is cold outside the intestines, the fluid and froth contend with the blood there, and the two combine and congeal together, unable to disperse, and a mass is thereby formed. If a person is suddenly struck by cold from without, or is internally injured by worry and anger, the qi rebels upward; when qi rebels upward, the six transport points fail to communicate, warming qi cannot circulate, congealed blood accumulates within and cannot disperse, and bodily fluids become rough and seep out, settling in place without departing — and thus a mass is fully formed in every case.'

Huangdi said: 'What of disease that arises from yin?' Qibo said: 'Worry and excessive contemplation injure the heart; doubled exposure to cold injures the lung; rage and anger injure the liver; entering the bedchamber while intoxicated, and sweating while exposed to wind, injures the spleen; excessive physical exertion, or entering the bedchamber and sweating profusely thereafter, injures the kidney. These are the diseases produced within the three regions, both internal and external.'

Huangdi said: 'How does one skillfully treat these conditions?' Qibo answered: 'Examine the location of the pain in order to know its correspondence, and determine whether there is surplus or deficiency. Where supplementation is called for, supplement; where drainage is called for, drain; and never act contrary to the proper timing of Heaven — this is what is called the perfection of treatment.'