Discussion on Great Confusion

Huangdi asked Qibo: "I once climbed a high, clear and cold terrace. While walking up the steps, I turned back to look, then crawled forward, and felt confused. I privately found this strange and was inwardly perplexed. Sometimes I closed my eyes, sometimes I opened them. I calmed my mind and steadied my breath, but even after a long time, I could not resolve it. I felt dizzy and lightheaded alone. I loosened my hair, knelt upright, and looked downward for a long time without the dizziness stopping. Suddenly it resolved on its own. What qi caused this?"

Qibo replied: "The essence qi of the five viscera and six bowels all ascend and pour into the eyes, thereby forming the visual function of the eyes. The hollow where essence qi gathers is the eyes. The essence of the kidneys forms the pupils, the essence of the liver forms the black of the eyes, the essence of the heart forms the blood vessels, the essence of the lungs forms the white of the eyes, and the essence of the spleen forms the eyelids. They wrap and gather the essence qi of sinews, bones, blood, and qi, combining with the channels to form the ocular system. This connects upward to the brain and emerges backward from the middle of the neck. Therefore, when a pathogenic factor attacks the neck, and because the body is weak, the evil qi penetrates deeply and follows the ocular system into the brain. Entering the brain causes the brain to turn, and the brain turning pulls the ocular system tight. The tightness of the ocular system results in dizziness and spinning vision. When the evil qi attacks the essence qi, the attacked essence qi cannot harmonize with each other, and the essence qi scatters. Scattering of essence qi produces double vision, and double vision causes one to see two objects. The eyes are the place where the essence qi of the five viscera and six bowels gathers, and also the place where the nutritive qi, defensive qi, hun soul, and po soul constantly move. It is where the spirit qi arises. Therefore, when the spirit is fatigued, the hun and po souls disperse and the will becomes disordered. Hence, the pupils and black of the eyes belong to yin, and the white of the eyes and red vessels belong to yang. Thus, when yin and yang combine with each other, the eyes become bright. The eyes are governed by the heart. The heart is where the spirit dwells, so when the spirit scatters, the eyes cannot turn. When suddenly seeing an unusual place, the spirit, hun, and po souls scatter and cannot harmonize, so it is called confusion."

Huangdi said: "I suspect this is indeed the case. Every time I go to the Eastern Garden, I never fail to feel confused, and upon leaving, I return to normal. Is it only I who exhaust my spirit because of the Eastern Garden? Why is this so strange?"

Qibo replied: "It is not so. When the heart has something it likes, and the spirit has something it detests, and they suddenly interfere with each other, it causes the essence qi to scatter and vision to become disordered, so confusion arises. When the spirit shifts, recovery occurs. Therefore, mild cases are disorientation, and severe cases are confusion."

Huangdi said: "People who are prone to forgetfulness—what qi causes this?"

Qibo replied: "When the upper qi is insufficient and the lower qi is excessive, the intestines and stomach are full while the heart and lungs are deficient. Deficiency of the heart and lungs causes the nutritive and defensive qi to stagnate in the lower part of the body. Over time, they cannot ascend in a timely manner, so forgetfulness occurs."

Huangdi said: "People who are prone to hunger but do not want to eat—what qi causes this?"

Qibo replied: "Essence qi concentrates in the spleen, and heat lingers in the stomach. Stomach heat digests grains, so grain digestion leads to hunger. When stomach qi rebels upward, it causes the stomach duct to become deficient and cold, so the person does not want to eat."

Huangdi said: "Inability to lie down after illness—what qi causes this?"

Qibo replied: "When the defensive qi cannot enter the yin division and constantly remains in the yang division, remaining in the yang division causes yang qi to become full. Fullness of yang qi causes the yang qiaomai to become exuberant. Being unable to enter the yin division causes yin qi to become deficient, so the eyes cannot close."

Huangdi said: "Inability to see after illness—what qi causes this?"

Qibo replied: "When the defensive qi remains in the yin division and cannot move to the yang division, remaining in the yin division causes yin qi to become full. Fullness of yin qi causes the yin qiaomai to become replete. Being unable to enter the yang division causes yang qi to become deficient, so the eyes close."

Huangdi said: "People who like to sleep—what qi causes this?"

Qibo replied: "Such people have large intestines and stomachs and moist skin, and the spaces between their muscles are not smooth. Large intestines and stomachs cause the defensive qi to linger for a long time; moist skin causes the spaces between muscles to be unsmooth, so defensive qi moves slowly. The defensive qi normally moves in the yang division during the day and in the yin division at night. Therefore, when yang qi is exhausted, one sleeps; when yin qi is exhausted, one wakes. Thus, with large intestines and stomachs, the defensive qi lingers for a long time; with moist skin and unsmooth intermuscular spaces, movement is slow. Lingering in the yin division for a long time, the defensive qi is not clear and sharp, so one wants to close the eyes, hence the liking for sleep. As for those with small intestines and stomachs, smooth and relaxed skin, and smooth and open intermuscular spaces, the defensive qi lingers in the yang division for a long time, so they sleep little."

Huangdi said: "When it is not the normal condition, but suddenly one likes to sleep—what qi causes this?"

Qibo replied: "When a pathogenic factor lingers in the upper burner, the upper burner becomes blocked and obstructed. If one then eats food or drinks soup, the defensive qi lingers in the yin division for a long time and cannot move, so one suddenly likes to sleep."

Huangdi said: "Good. How should one treat these pathogenic conditions?"

Qibo replied: "First, clarify the affected viscera, eliminate the mild disease, and then regulate its qi. For qi excess, use draining; for qi deficiency, use supplementation. One must first understand the patient's physical and mental joys and sufferings, and after determining this, select the treatment method."