Lingshu · On Distention

The text

The Yellow Emperor said: When the vessels answer at the inch-opening, how is there distention? Qi Bo said: When the vessel is large, firm, and rough — this is distention. The Yellow Emperor said: How does one know distention of the zang and fu? Qi Bo said: Yin is the zang; yang is the fu. The Yellow Emperor said: When qi makes a person distended, is it in the blood vessels, or within the zang and fu? Qi Bo said: All three are present. Yet they are not the lodging of distention. The Yellow Emperor said: I wish to hear the lodging of distention. Qi Bo said: Distention is always outside the zang and fu; it pushes the zang and fu aside and expands the chest and flanks, distends the skin — therefore it is named distention. The Yellow Emperor said: The zang and fu within the chest, the flanks, and the inner abdomen are like forbidden vessels stored in a casket; each has its next lodging, different names and the same place, within one domain, their qi each unlike. I wish to hear why. The Yellow Emperor said: I have not yet understood the meaning. He asked Qi Bo again: The chest and abdomen are the outer walls of the zang and fu. The chest-center is the palace-city of the heart-governor. The stomach is the great granary. The throat and the small intestine are the passing and sending. The five openings of the stomach are the gates of the lanes and wards. The abyss of fluid and jade-blossom are the roads of the fluids. Thus the five zang and six fu each have their borders; their illnesses each have their shapes. Ying-qi follows the vessels; wei-qi reversing becomes vessel-distention; wei-qi joining the vessels and following the divisions becomes skin-distention. Drain at three-li; if near, once down; if far, three times down; do not ask vacuity or repletion — the work is in swift draining. The Yellow Emperor said: I wish to hear the forms of distention. Qi Bo said: Heart-distention: the heart vexed, short breath, lying unrestful. Lung-distention: vacuous fullness, panting and cough. Liver-distention: fullness below the flanks, pain pulling the lower abdomen. Spleen-distention: readily hiccuping, the four limbs vexed and oppressed, the body so heavy it cannot bear the clothes, lying unrestful. Kidney-distention: the abdomen full, pulling the back, a drawn aching in the waist and hips. Distention of the six fu. Stomach-distention: the abdomen full, pain at the stomach duct, the nose smelling scorched odor, food hindered, stool hard. Large-intestine distention: the intestines sound and ache with a washing noise; in winter, doubly meeting cold, dawn diarrhea of untransformed food. Small-intestine distention: the lower abdomen washes and swells, pulling the waist and aching. Bladder-distention: the lower abdomen full, and qi blocked. Sanjiao-distention: qi filling the skin, light and not firm. Gallbladder-distention: pain and swelling below the flanks, bitterness in the mouth, readily long-sighing. For all these distentions, the Dao is one: clearly know going against and going with, do not lose the count of the needle. Drain vacuity and fill repletion, and the spirit leaves its room; you bring the pathogen and lose the upright; the true cannot settle; what the coarse ruin is called heaven's fate. Fill vacuity and drain repletion, and the spirit returns to its room. To long close its openings — this is called a good craftsman. The Yellow Emperor said: From where is distention born? By what cause does it have being? Qi Bo said: Wei-qi in the body always joins the vessels, follows the divided flesh; its travel has going against and going with; yin and yang follow one another, and so obtain heaven's evenness; the five zang begin by turns; the four seasons have their sequence; the five grains then transform. Then reversing qi is above, ying and wei stay and stop, cold qi reverses upward, the true and the pathogen attack each other, the two qi contend — and so they join and become distention. The Yellow Emperor said: Good. How does one undo the confusion? Qi Bo said: Join it to the true; three joinings and it is obtained. The Emperor said: Good. The Yellow Emperor asked Qi Bo: The discourse on distention says, do not ask vacuity or repletion — the work is in swift draining; if near, once down; if far, three times down. Now there are those who have had it three times and it does not go down. Where is the fault? Qi Bo replied: This speaks of sinking into the flesh-membrane and hitting the qi-points. If you do not hit the qi-points, qi closes within; if the needle does not sink into the membrane, qi does not travel; if you go over and hit the flesh, wei-qi is disordered, yin and yang chase each other. As for distention: when it should be drained and is not drained, qi therefore does not go down. Three times and it does not go down — you must change the road; when qi goes down, it stops; if it does not go down, begin again. Thus you may be complete and safe — how would there be danger? As for distention, you must examine its place; when it should be drained, then drain; when it should be filled, then fill — like a drum answering the drumstick. How would there be one that does not go down?

The line

Qi Bo said: Distention is always outside the zang and fu; it pushes the zang and fu aside and expands the chest and flanks, distends the skin — therefore it is named distention.

The note

Distention is outside the zang and fu; it pushes the zang and fu aside. It is not that the zang grew large. It is qi bracing from without. The walls are space that has been crowded out.