Abnormalities of Defensive Qi

The Yellow Emperor said: When defensive qi stagnates in the abdomen, accumulating and moving unsmoothly, with binding and stagnation having no fixed location, it causes fullness in the flanks, fullness in the stomach, panting, difficulty in expiration, and rapid breathing. What method is used to remove it? Bo Gao said: When defensive qi accumulates in the chest, treatment is taken from the upper part; when it accumulates in the abdomen, treatment is taken from the lower part; when there is fullness in both upper and lower parts, treatment is taken from the sides. The Yellow Emperor said: What is the method of selecting points? Bo Gao replied: For accumulation in the upper part, use reducing method at Renying, Tiantu, and the throat; for accumulation in the lower part, use reducing method at Zusanli and Qijie; for fullness in both upper and lower parts, select points from both upper and lower, and additionally at one cun below the costal region; for severe cases, use the chicken-foot needling technique (multiple needles inserted together like a chicken claw). On examination, if the pulse is large and stringlike and urgent, or if the pulse is completely absent, and if the abdominal skin is extremely tense, needling should not be used. The Yellow Emperor said: Well spoken.

The Yellow Emperor asked Bo Gao: How can one know the disorders of the skin, flesh, qi and blood, sinews, and bones? Bo Gao said: When the luster between the eyebrows is thin and moist, the disorder is in the skin; when the lip color appears green, yellow, red, white, or black, the disorder is in the flesh; when the nutritive qi is moist and smooth, the disorder is in blood and qi; when the eye color appears green, yellow, red, white, or black, the disorder is in the sinews; when the ears are dry as if covered with dust, the disorder is in the bones. The Yellow Emperor said: What are the forms of these disorders, and what is the method of point selection and treatment? Bo Gao said: The changes of various disorders are countless, yet the skin has divisions, the flesh has supports, the blood and qi have points of transport, and the bones have connections. The Yellow Emperor said: I wish to hear the reasoning behind this. Bo Gao said: The divisions of the skin, their qi transports to the extremities of the four limbs; the supports of the flesh are in the spaces between the divisions of flesh along the yang channels of the arms and legs, and in the spaces between the divisions of flesh along the foot shaoyin channel; the transport points of blood and qi are transported to the various collateral vessels; if blood and qi stagnate and accumulate, the collateral vessels become full and protrude; the sinews have no yin or yang division, no left or right distinction, and are treated according to the location of the disorder; the connections of the bones are where the bone pores receive nourishment to fill the brain and marrow. The Yellow Emperor said: What is the method of point selection and treatment? Bo Gao said: The changes of disorders, their floating and sinking, shallow and deep, cannot be exhausted; each is at its own location. For mild disorders, needle shallowly; for severe disorders, needle deeply. For mild disorders, use few needles; for severe disorders, use many needles. Harmonize qi and blood according to the disorder, and this is called a superior physician.

The Yellow Emperor asked Bo Gao: In people, regarding obesity, thinness, warmth, and cold, as well as old age, adulthood, youth, and childhood, how are they distinguished? Bo Gao replied: People aged fifty and above are called elderly, those aged twenty and above are called adults, those aged eighteen and above are called youths, and those aged six and above are called children. The Yellow Emperor said: By what standard are people’s obesity and thinness measured? Bo Gao said: People have the zhi type, the gao type, and the rou type. The Yellow Emperor said: How are these three types distinguished? Bo Gao said: When the muscles behind the knee are firm and the skin is full, it is the zhi type. When the muscles behind the knee are not firm and the skin is loose, it is the gao type. When the skin and muscles are tightly bound without separation, it is the rou type.

The Yellow Emperor said: What about the body’s warmth and cold? Bo Gao said: For the gao type, if the flesh is moist and the texture is coarse, the body is cold; if the texture is fine and dense, the body is hot. For the zhi type, if the flesh is firm and the texture is fine and dense, they are hot; if the texture is coarse, they are cold. The Yellow Emperor said: What about their obesity and thinness? Bo Gao said: For the gao type, qi is abundant and the skin is loose, so the abdomen can be broad and sagging. For the rou type, the body’s external form is broad. For the zhi type, the body is relatively thin and small. The Yellow Emperor said: What about the amount of qi and blood in these three types? Bo Gao said: For the gao type, qi is abundant; abundant qi generates heat, and those who are hot can endure cold. For the rou type, blood is abundant, nourishing the physical form; nourishing the physical form balances qi and blood. For the zhi type, the blood is clear, qi is smooth and scanty, so the physical form cannot be large. This is their difference from ordinary people. The Yellow Emperor said: What about ordinary people? Bo Gao said: In ordinary people, the skin, flesh, and fat cannot be increased, and blood and qi cannot be excessive in any part; thus their physical form is neither large nor small, each corresponding to their body, and they are called ordinary people.

The Yellow Emperor said: Well spoken. What is the method of treatment? Bo Gao said: One must first distinguish these three physical types, the amount of blood, and the clarity of qi, and then regulate and treat them, ensuring that treatment does not deviate from the normal pattern. Thus, for the gao type, the abdomen is broad and sagging; for the rou type, the upper and lower body forms are broad; for the zhi type, although there is fat, the physical form cannot be large.