Pathogenic Qi and the Manifestations of the Viscera and Bowels

Huangdi asked Qibo, "How does pathogenic qi invade the human body?" Qibo replied, "When pathogenic qi invades the human body, it usually first attacks the upper part." Huangdi asked, "Is there a standard for high and low locations?" Qibo said, "When the upper body is affected, it is due to wind evil; when the lower body is affected, it is due to dampness evil. Therefore it is said: pathogenic qi invades the human body without a fixed location. If pathogenic qi invades the yin channels, it will flow into the six fu-organs; if it invades the yang channels, it will flow into the meridians."

Huangdi asked, "The yin and yang channels have different names but are of the same essence; they meet above and below, interconnect with each other like an endless ring. When pathogenic qi invades the human body, sometimes it attacks the yin channels, sometimes the yang channels, above and below, left and right, without fixed regularity. What is the reason for this?" Qibo said, "All the yang channels converge on the face. When pathogenic qi invades the human body, it often does so when the righteous qi is weak, and after exertion or labor, or after eating and sweating, when the interstices are open and susceptible to evil. When pathogenic qi attacks the face, it descends to the Foot Yangming Stomach Channel; when it attacks the nape of the neck, it descends to the Foot Taiyang Bladder Channel; when it attacks the cheeks, it descends to the Foot Shaoyang Gallbladder Channel. If pathogenic qi attacks the chest, back, or flanks, it also enters their respective channels."

Huangdi asked, "When pathogenic qi invades the yin channels, what is the situation?" Qibo replied, "When pathogenic qi invades the yin channels, it often starts from the arms and lower legs. The skin on the inner sides of the arms and lower legs is thin, and the flesh is moist, so although they all experience wind evil, only the yin channels are damaged." Huangdi asked, "Will this harm the five zang-organs?" Qibo said, "When the body experiences wind evil, it does not necessarily disturb the zang-fu. Therefore, when pathogenic qi invades the yin channels, if the qi of the five zang-organs is substantial, the pathogenic qi cannot stay after invasion and returns to the six fu-organs. Hence, when pathogenic qi invades the yang channels, it flows into the meridians; when it invades the yin channels, it flows into the six fu-organs."

Huangdi asked, "How does pathogenic qi invade the five zang-organs?" Qibo said, "Worry and fear harm the heart. Cold in the body and drinking cold water harm the lungs, because the two cold evils interact, causing both internal and external injury, so qi rebels upward. Falling from a height causes blood stasis to remain in the body; if there is great anger, qi rebels upward and does not descend, accumulating under the ribs, this harms the liver. If one is struck or falls, or indulges in sexual intercourse after drunkenness, and sweats and then is exposed to wind evil, this harms the spleen. If one exerts strength in lifting heavy objects, or indulges excessively in sexual activity, and sweats and then bathes in cold water, this harms the kidneys." Huangdi asked, "When the five zang-organs experience wind evil, what is the situation?" Qibo said, "Only when both yin and yang are affected by pathogenic qi can it invade the five zang-organs." Huangdi said, "Well said."

Huangdi asked Qibo, "The head and face, along with the whole body, are all connected by bones, bound by sinews and vessels, and nourished by blood and essential qi. When the weather is cold, the earth freezes and cracks, with icy snow and bitter cold, sudden severe cold can make the hands and feet feel weak and slack, yet the face does not need to be covered by clothing. Why is this?" Qibo replied, "The twelve meridians and three hundred and sixty-five collateral vessels all send their blood and qi upward to the face and then to the orifices. Among them, the clear yang qi ascends to the eyes, enabling vision; the divergent channel qi ascends to the ears, enabling hearing; the ancestral qi emerges from the nose, enabling smell; the turbid qi arises from the stomach and travels to the lips and tongue, enabling them to distinguish the five flavors. The fluids transformed by these qi all ascend and steam the face, and the skin of the face is thick and the flesh firm, so even when the weather is extremely cold, it cannot harm the face."

Huangdi asked, "When pathogenic qi invades the human body, what are the symptoms of its onset?" Qibo said, "When deficient evil harms people, the body shivers and trembles with cold. When proper evil harms people, the symptoms are mild, first manifesting in the complexion, with little obvious sensation in the body, as if present and as if absent, as if visible and as if hidden, having form yet being formless, so no one can know its specific condition." Huangdi said, "Well said."

Huangdi asked Qibo, "I have heard that observing the patient's complexion can reveal the disease is called 'clarity'; palpating the patient's pulse can reveal the disease is called 'spirit'; inquiring about the patient's condition can reveal the disease location is called 'skill'. I wish to hear how one can know the disease through looking at the complexion, grasp the disease through palpating the pulse, and thoroughly understand the disease through inquiry. How is this done?" Qibo replied, "The correspondence between complexion, pulse, and the skin of the forearm is like a drumstick striking a drum and the sound echoing back, without error. It is also like the relationship between the root and branches of a tree; if the root dies, the leaves wither. Complexion, pulse, and muscular form must not deviate from each other. Therefore, mastering only one of these can be called 'skill'; mastering two can be called 'spirit'; mastering all three is 'spirit' and 'clarity'." Huangdi said, "I wish you would explain this to me in detail." Qibo replied, "If the complexion is green, the pulse should be string-like; if the complexion is red, the pulse should be hook-like; if the complexion is yellow, the pulse should be intermittent; if the complexion is white, the pulse should be hairy; if the complexion is black, the pulse should be stony. If a certain complexion is seen but the corresponding pulse is not felt, and instead a mutually restraining pulse is encountered, death will occur; if a mutually generating pulse is encountered, the disease will be cured."

Huangdi asked Qibo, "When diseases arise from the five zang-organs, how do their pathological changes manifest?" Qibo replied, "First, the correspondence between the five colors and the five pulses must be established, and then the disease can be distinguished." Huangdi asked, "Once the complexion and pulse are determined, how is differentiation made?" Qibo said, "By examining whether the pulse is slow, rapid, small, large, slippery, or rough, the nature of the pathological changes can be determined."

Huangdi asked, "How is this examined?" Qibo replied, "If the pulse is rapid, the skin of the forearm is also tense; if the pulse is slow, the skin of the forearm is also relaxed; if the pulse is small, the skin of the forearm is also thin and lacking qi; if the pulse is large, the skin of the forearm is also raised and full; if the pulse is slippery, the skin of the forearm is also smooth; if the pulse is rough, the skin of the forearm is also rough. All these changes have mild and severe distinctions. Therefore, one skilled in examining the forearm skin does not need to wait for the wrist pulse; one skilled in examining the pulse does not need to wait for the complexion. One who can integrate and apply all three can become a superior physician, and a superior physician can cure nine out of ten. One who can apply two of them is a middling physician, and a middling physician can cure seven out of ten. One who can apply only one is a lower physician, and a lower physician can cure six out of ten."

Huangdi asked, "Please tell me the corresponding pathological forms for the pulses being slow, rapid, small, large, slippery, and rough." Qibo said, "Allow me to speak of the diseases of the five zang-organs. If the heart pulse is extremely rapid, there are convulsions of the hands and feet; if slightly rapid, there is heart pain radiating to the back, with inability to eat. If extremely slow, there is manic laughter; if slightly slow, there is a fuliang disorder, located below the heart, moving upward and downward, with occasional spitting of blood. If extremely large, there is a sensation of obstruction in the throat; if slightly large, there is heart bi radiating to the back, with easy tearing. If extremely small, there is frequent belching; if slightly small, there is a disease of rapid digestion and hunger. If extremely slippery, there is frequent thirst; if slightly slippery, there is heart hernia, radiating to the navel, with borborygmus in the lower abdomen. If extremely rough, there is loss of voice; if slightly rough, there is blood spillage, cold extremities in the limbs, tinnitus, and disorders of the crown of the head."

"If the lung pulse is extremely rapid, there is manic disease; if slightly rapid, there is lung cold-heat, with fatigue and weakness, coughing and spitting blood, radiating to the lower back, chest, and back, or nasal polyps causing obstructed breathing. If extremely slow, there is profuse sweating; if slightly slow, there is wilting disorder and hemilateral wind, with incessant sweating below the head. If extremely large, there is swelling of the lower legs; if slightly large, there is lung bi, radiating to the chest and back, with aversion to seeing sunlight when rising. If extremely small, there is diarrhea; if slightly small, there is wasting-thirst disorder. If extremely slippery, there is rapid breathing and qi rebelling upward; if slightly slippery, there is bleeding from above and below. If extremely rough, there is vomiting of blood; if slightly rough, there is rat fistula disorder, occurring between the neck and armpits, with the lower part unable to bear the weight of the upper part, often feeling soreness and weakness."

When the pulse of the liver is extremely rapid, it indicates foul speech; when slightly rapid, it indicates fat qi disease, with accumulation below the ribs, like an inverted cup. When extremely slow, it indicates easy vomiting; when slightly slow, it indicates water mass bi disease. When extremely large, it indicates internal abscess, with easy vomiting and nosebleeds; when slightly large, it indicates liver bi, with contraction of the genitals, and coughing that pulls on the lower abdomen. When extremely small, it indicates excessive drinking; when slightly small, it indicates wasting-thirst disease. When extremely slippery, it indicates tui hernia; when slightly slippery, it indicates enuresis. When extremely rough, it indicates overflow edema; when slightly rough, it indicates spasms, sinew contraction, and sinew bi.

When the pulse of the spleen is extremely rapid, it indicates spasms of the hands and feet; when slightly rapid, it indicates diaphragm center disease, where food enters and is then vomited, with white frothy stool. When extremely slow, it indicates wilting reversal; when slightly slow, it indicates wind wilting, with the four limbs unable to move, but the mind clear, as if without disease. When extremely large, it indicates being struck and falling; when slightly large, it indicates hernia, with large pus and blood inside the abdomen outside the intestines and stomach. When extremely small, it indicates cold and heat; when slightly small, it indicates wasting-thirst disease. When extremely slippery, it indicates tui retention; when slightly slippery, it indicates worm toxin, roundworms, and abdominal heat. When extremely rough, it indicates intestinal tui; when slightly rough, it indicates internal tui, with much discharge of pus and blood.

When the pulse of the kidney is extremely rapid, it indicates bone epilepsy; when slightly rapid, it indicates deep reversal and running piglet, with the feet unable to draw in, and the bowels and bladder blocked. When extremely slow, it indicates spinal pain as if broken; when slightly slow, it indicates hole disease; hole disease means food is not digested and pours straight out from the throat. When extremely large, it indicates impotence; when slightly large, it indicates stone water disease, with distention from below the navel to the lower abdomen, extending upward to the stomach duct, classified as incurable. When extremely small, it indicates hole diarrhea; when slightly small, it indicates wasting-thirst disease. When extremely slippery, it indicates retention and tui; when slightly slippery, it indicates bone wilting, unable to stand when sitting, and unable to see when standing. When extremely rough, it indicates large abscess; when slightly rough, it indicates absence of menstruation, or internal hemorrhoids.

Huangdi asked: For these six types of pulse changes, how should needling treatment be applied? Qibo replied: All rapid pulses mostly indicate cold patterns; slow pulses mostly indicate heat patterns; large pulses indicate abundant qi and scant blood; small pulses indicate both qi and blood are scant; slippery pulses indicate yang qi is vigorous, with slight heat; rough pulses indicate abundant blood and scant qi, with slight cold. Therefore, in needling diseases with rapid pulses, insert deeply and retain the needle for a long time; in needling diseases with slow pulses, insert shallowly and withdraw quickly to drain the heat; in needling diseases with large pulses, lightly drain the qi, but do not let blood out; in needling diseases with slippery pulses, withdraw quickly and insert shallowly to drain the yang qi and remove the heat; in needling diseases with rough pulses, must hit the channel, follow the direction of the qi’s flow, retain the needle for a long time, first palpate and press along the channel, and after withdrawing the needle, immediately press the needle hole to prevent blood from flowing out, so as to harmonize the channel qi; for all diseases with small pulses, yin and yang, form and qi are all insufficient, do not use needling, but use sweet-flavored medicinals to tonify and supplement.

Huangdi said: I have heard that the channel qi of the five zang and six fu, from the places where the ying and shu points enter, are called he points. What path do they enter through? After entering, which parts do they connect to and pass through? I wish to hear the rationale. Qibo replied: This is the entering of the yang channels’ collateral vessels into the interior, connecting and belonging to the six fu. Huangdi asked: Do the ying, shu, and he points each have names? Qibo said: The ying and shu points govern diseases of the external channels; the he points govern diseases of the internal six fu. Huangdi asked: In treating diseases of the internal six fu, how are points selected? Qibo said: Select the he points. Huangdi asked: Do the he points each have names? Qibo said: The he point of the stomach channel is at Zusanli, the he point of the large intestine channel is at Juxu Shanglian, the he point of the small intestine channel is at Juxu Xialian, the he point of the triple burner channel is at Weiyang, the he point of the urinary bladder channel is at Weizhong, and the he point of the gallbladder channel is at Yanglingquan. Huangdi asked: How are these points manipulated when selecting them? Qibo said: When selecting Zusanli, make the dorsum of the foot low and flat to take it; when selecting Juxu, lift the foot to take it; when selecting Weiyang, flex and extend the lower limb to locate it; when selecting Weizhong, flex the knee to take it; when selecting Yanglingquan, straighten the knee properly, aligning the area below the knee with the outer side of Weiyang to take it; when selecting points on the various external channels, stretch and extend the limb to take the point.

Huangdi said: I wish to hear about the diseases of the six fu. Qibo replied: Heat on the face indicates disease of the Foot Yangming channel; blood vessels on the thenar eminence of the hand indicate disease of the Hand Yangming channel; a firm or sunken pulse on the dorsum of both feet indicates disease of the Foot Yangming channel; this is the channel of the stomach. When the large intestine is diseased, there is severe pain in the intestines and gurgling sounds. If cold is encountered again in winter, there will be diarrhea, pain around the navel, inability to stand for long, and it is diagnosed together with stomach disease; treatment selects points at Juxu Shanglian. When the stomach is diseased, there is abdominal distention, pain in the stomach duct directly at the heart area, upward pulling to both ribs, blockage of the diaphragm and throat, inability to swallow food; treatment selects points at Zusanli. When the small intestine is diseased, there is pain in the lower abdomen, pain in the lower back and spine pulling the testicles, a frequent urgent sensation of needing to defecate or urinate, heat in front of the ear, or extreme cold, or marked heat only on the shoulder, as well as heat between the little finger and ring finger, or a sunken pulse; these are the signs of small intestine disease. This is the disease of the Hand Taiyang channel; treatment selects points at Juxu Xialian. When the triple burner is diseased, there is abdominal qi distention, the lower abdomen is especially hard, urinary retention is difficult and urgent, water overflows and then stagnates, thus forming distention. Diagnosis is on the large collateral of the Foot Taiyang channel on the outside; the large collateral lies between Foot Taiyang and Foot Shaoyang, and the pulse may also show abnormality; treatment selects points at Weiyang. When the urinary bladder is diseased, there is swelling and pain on one side of the lower abdomen, pressing it makes one want to urinate but unable to pass, heat on the shoulder, or a sunken pulse, as well as heat on the outside of the little toe, the shin bone, and behind the ankle, or a sunken pulse; treatment selects points at Weizhong. When the gallbladder is diseased, there is frequent sighing, bitter taste in the mouth, vomiting of stored bile, a pounding sensation in the heart as if afraid someone is about to catch him, a gurgling sound in the throat, and frequent spitting of saliva. Diagnosis is at the beginning and end of the Foot Shaoyang channel; also observe where the pulse is sunken and use moxibustion; if there are cold and heat symptoms, select points at Yanglingquan.

Huangdi said: Is there a rule for needling? Qibo replied: When needling these sites, one must hit the qi points, and not hit the muscles or bone joints. When the qi point is hit, the needle tip feels like wandering in an empty lane; when muscles or bone joints are hit, the skin will be painful; if the supplementing and draining methods are reversed, the disease condition will become more severe. Hitting the sinew causes the sinew to relax, the pathogenic qi cannot be expelled, and instead struggles with the true qi, becoming chaotic and not leaving, but rather returns and accumulates internally. If the use of the needle is not careful, it turns a proper treatment into a perverse one.