素问·腹中论 Discourse on the Abdomen

Huangdi asked: There is a disease in which the heart and abdomen are full and distended, such that if one eats in the morning one cannot eat in the evening. What disease is this? Qibo replied: It is called drum distension. Huangdi said: How is it treated? Qibo said: Treat it with chicken-dung wine (ji shi li) — one dose brings improvement, two doses cure it. Huangdi said: Why does it sometimes recur? Qibo said: This is because of immoderate eating and drinking, so the disease recurs from time to time. Even though the disease may have been cured, when the immoderation returns, the disease should return as well, because qi gathers and collects in the abdomen.

Huangdi said: There is a disease in which the chest and rib-sides are propped up and full, hindering food intake. When the disease arrives, the patient first smells a fishy, rank odor, discharges a clear fluid, first spits blood, has cold limbs, dizziness, and from time to time bleeds from the front or back passage. What is this disease called, and how is it contracted? Qibo said: This disease is called blood exhaustion (xue ku). It is contracted in youth, from a great loss of blood, or from entering the bedchamber while intoxicated, whereby the qi is exhausted and the liver is injured, so that the menses diminish and cease to come. Huangdi said: How is it treated, and by what method? Qibo said: Use four parts cuttlefish bone and one part madder root, combined together and formed into pills with sparrow eggs, the size of small beans; take five pills before meals, washed down with a broth of salted fish, to benefit the intestines and the injured liver.

Huangdi said: There is a disease in which the lower abdomen is swollen and full, with roots fixed above and below, left and right. What disease is this, and can it be treated? Qibo said: The disease is called fu liang (hidden beam). Huangdi said: How is fu liang contracted? Qibo said: It wraps around a great mass of pus and blood, lodged outside the intestines and stomach; it cannot be treated — if one treats it, pressing and palpating it will bring death. Huangdi said: Why is this so? Qibo said: Below, it presses upon the yin region and pus and blood must descend; above, it presses upon the stomach duct and gives rise to a diaphragm obstruction, forming an abscess beside the stomach duct. This is a chronic disease and difficult to treat. If it is located above the navel, it is contrary and dangerous; if located below the navel, it is compliant. Do not disturb it or forcibly attack it — this is discussed in the treatise on needling methods. Huangdi said: There are people whose body, thighs, and shanks are all swollen, with pain encircling the navel. What disease is this? Qibo said: This disease is also called fu liang; it is rooted in wind. Its qi overflows into the large intestine and lodges in the huang, the membrane source, whose origin lies below the navel; hence the pain encircles the navel. It must not be disturbed — to disturb it brings on a disease of water and difficult urination.

Huangdi said: Master, you have repeatedly said that in cases of heat in the center and wasting in the center, one should not take rich, fatty foods, fragrant herbs, or mineral drugs — mineral drugs bring on mania, and fragrant herbs bring on manic frenzy. Yet those who suffer heat-in-the-center and wasting-in-the-center disorders are all wealthy and eminent people; now if I forbid them rich food, this goes against their inclinations, and if I forbid fragrant herbs and mineral drugs, the disease will not be cured. I wish to hear your explanation. Qibo said: The qi of fragrant herbs is rich and fine, and the qi of mineral drugs is fierce; the qi of both is urgent, swift, hard, and forceful. Therefore, unless a person is of calm heart and harmonious temperament, these two should not be taken. Huangdi said: Why is it that these two should not be taken? Qibo said: The heat qi of the disease is swift and fierce, and the qi of these drugs is likewise so; when the two meet, they are liable to injure the spleen internally. The spleen belongs to earth and is averse to wood; for one who takes these drugs, the crisis should be reassessed on the days jia and yi.

Huangdi said: Good. There is a disease in which the chest is swollen, the neck aches, the chest is full, and the abdomen is distended. What disease is this, and how is it contracted? Qibo said: It is called jue ni, reversal counterflow. Huangdi said: How is it treated? Qibo said: If moxibustion is applied, it causes loss of voice; if the stone lancet is applied, it causes mania; one must wait until the qi is balanced, and only then can it be cured. Huangdi said: Why is this so? Qibo said: The yang qi is doubled above, being in excess above; if moxibustion is applied, the yang qi is driven into the yin, and entering the yin it causes loss of voice; if the stone is applied, the yang qi becomes deficient, and being deficient it causes mania. One must wait until the qi is united and balanced before treating, so that the patient may be made whole.

Huangdi said: Good. How does one know that a woman is pregnant? Qibo said: The body shows signs of illness, yet the pulse shows no pathogenic sign.

Huangdi said: When there is heat disease accompanied by pain, what is the cause? Qibo said: Heat disease pertains to the yang pulses, arising from the movement of the three yang. At the ren ying pulse point, if it is once as large as normal, it is shaoyang; if twice as large, it is taiyang; if three times as large, it is yangming, entering into the yin. Now when yang enters into yin, the disease is located in the head and abdomen, causing distension and fullness together with headache. Huangdi said: Good.