灵枢经·大惑论 Discourse on Great Confusion

Huangdi asked Qibo, saying: 'I once ascended the Terrace of Clear Coolness (Qingleng Tai), and midway up the stairway I turned to look back, then found myself creeping forward on hands and knees, overcome with confusion. I privately found this strange and secretly wondered at it within myself. I closed my eyes and looked again, calmed my heart and settled my qi, but for a long time the confusion did not resolve. My vision reeled and spun; I let my hair hang loose and knelt for a long while, bowing my head to look down, yet even after a long time the disorder did not stop. It came upon me suddenly as I climbed — what qi causes this to happen?' Qibo replied: 'The essence qi of the five viscera and six bowels all ascends to pour into the eyes and becomes their essence. The nest of this essence forms the eye itself; the essence of the bones forms the pupil; the essence of the sinews forms the black of the eye; the essence of the blood forms the network vessels binding the eye's socket; the essence of qi forms the white of the eye; and the essence of the flesh and muscles forms the surrounding enclosure. Together these wrap and gather the essence of sinew, bone, blood, and qi, and join with the vessels to form the eye-system (muxi). Above, this system attaches to the brain; behind, it emerges at the nape of the neck. Hence when evil qi strikes the nape and meets with a deficiency in the body, it penetrates deeply and follows the eye-system inward into the brain. Once it enters the brain, the brain is set spinning; when the brain spins, it pulls the eye-system taut; and when the eye-system is drawn taut, the eyes grow dizzy and everything seems to whirl. When evil strikes the essence itself, and the places struck no longer correspond evenly to one another, the essence scatters; and when the essence scatters, vision divides, so that one sees two objects where there is only one. The eyes are the essence of the five viscera and six bowels, the place where nutritive qi, defensive qi, and the hun and po souls constantly circulate, and where the spirit qi is generated. Hence when the spirit is overtaxed, the hun and po scatter and the will and intent fall into disorder. This is why the pupil and the black of the eye are patterned on yin, while the white of the eye and its red vessels are patterned on yang; only when yin and yang combine and are transmitted together does clear vision result. The eyes are the emissary of the heart, and the heart is the lodging place of the spirit. Hence when the spirit and essence fall into disorder and no longer turn properly, and one suddenly perceives things in unaccustomed places, the essence, spirit, hun, and po scatter and no longer cohere with one another — this is what is called confusion (huo).'

Huangdi said: 'I have suspected this might be so. Whenever I go to the East Garden, I am invariably overcome with confusion, and once I leave it, all returns to normal. Is it that the East Garden alone taxes my spirit? Why should it be so peculiar?' Qibo said: 'It is not so. When the heart delights in something while the spirit finds something distasteful, and the two suddenly clash, the essence qi falls into disorder and vision goes astray — hence confusion arises, and only when the spirit shifts does it return to normal. This is why a mild case is called disorientation (mi), while a severe case is called confusion (huo).'

Huangdi said: 'What qi causes a person to be forgetful?' Qibo said: 'When the qi of the upper body is insufficient while the qi of the lower body has a surplus, the intestines and stomach are replete while the heart and lung are deficient. When they are deficient, the nutritive and defensive qi linger below and, for a long time, fail to ascend at their proper time — hence the person becomes forgetful.'

Huangdi said: 'What qi causes a person to be easily hungry yet have no appetite for food?' Qibo said: 'The essence qi has converged upon the spleen, while heat qi lingers in the stomach. When the stomach is heated it digests grain quickly, and because the grain is digested quickly the person becomes hungry easily. When the stomach qi rebels upward, the stomach duct turns cold, and hence the person has no appetite for food.'

Huangdi said: 'What qi causes a person, when ill, to be unable to sleep?' Qibo said: 'The defensive qi is unable to enter yin and instead lingers constantly in yang. When it lingers in yang, the yang qi becomes full; when the yang qi is full, the Yang Springing Vessel (yangqiao) becomes excessive. Since the defensive qi cannot enter yin, the yin qi becomes deficient — hence the eyes will not close in sleep.'

Huangdi said: 'What qi causes a person's eyes to be afflicted so that they cannot see?' Qibo said: 'The defensive qi lingers in yin and is unable to move into yang. When it lingers in yin, the yin qi becomes exuberant; when the yin qi is exuberant, the Yin Springing Vessel (yinqiao) becomes full. Since the defensive qi cannot enter yang, the yang qi becomes deficient — hence the eyes remain closed.'

Huangdi said: 'What qi causes a person to sleep excessively?' Qibo said: 'In such a person the intestines and stomach are large, the skin is damp, and the interstitial flesh does not separate readily. When the intestines and stomach are large, the defensive qi lingers there for a long time; when the skin is damp and the interstitial flesh fails to separate readily, the qi's movement is slowed. Now, the defensive qi ordinarily travels through yang by day and through yin by night; hence when the yang qi is exhausted one sleeps, and when the yin qi is exhausted one wakes. Thus when the intestines and stomach are large, the defensive qi lingers long as it travels; when the skin is damp and the interstitial flesh fails to separate readily, its movement is slow. Having lingered long in yin, its qi grows turbid rather than clear, so the person longs to close the eyes — hence excessive sleep results. When, by contrast, the intestines and stomach are small, the skin is smooth and relaxed, and the interstitial flesh separates freely, the defensive qi lingers long in yang — hence the person sleeps little.'

Huangdi said: 'What of cases outside this ordinary pattern, where a person suddenly begins to sleep excessively — what qi causes this?' Qibo said: 'Evil qi lingers in the upper burner, and the upper burner becomes closed and impassable. After eating, or after drinking hot broth, the defensive qi lingers long in yin and fails to move — hence the person suddenly sleeps excessively.'

Huangdi said: 'Good. How should one treat all these various evils?' Qibo said: 'First address the viscera and bowels, eliminating their minor faults; afterward regulate the qi, draining what is excessive and supplementing what is deficient. One must first clearly ascertain whether the patient's body and will are at ease or in distress, and only once this is settled should one proceed to needle.'