Lingshu · Pathogenic Qi and the Forms of Zang-Fu Illness

The text

The Yellow Emperor asked Qi Bo: When pathogenic qi strikes a person — how is it? Qi Bo answered: Pathogenic qi strikes a person high. The Yellow Emperor said: Do high and low have a measure? Qi Bo said: From mid-body upward, pathogen strikes it. From mid-body downward, damp strikes it. Therefore it is said: when pathogen strikes a person, it has no constant. If it strikes yin, it flows to the fu; if it strikes yang, it flows to the channels. The Yellow Emperor said: Yin and yang — different names, the same kind; above and below meet one another; the channel networks pass through one another, like a ring with no end. When pathogen strikes a person, sometimes it strikes yin, sometimes it strikes yang; above and below, left and right, there is no constant. Why is this? Qi Bo said: The meetings of all the yang are at the face. It strikes a person just when it rides a vacant time, or when one has newly used strength, or when one eats and drinks and sweat goes out, the interstices open, and pathogen strikes. If it strikes the face, it descends yangming. If it strikes the nape, it descends taiyang. If it strikes the cheek, it descends shaoyang. If it strikes the breast, the back, and the two flanks, it also strikes those channels. The Yellow Emperor said: When it strikes yin — how is it? Qi Bo answered: When it strikes yin, it should begin from the arm and the shin. The arm and the shin: their yin skin is thin, their flesh is moist and glossy; therefore both receive wind, and it wounds the yin alone. The Yellow Emperor said: Does this therefore wound the zang? Qi Bo answered: When the body is struck by wind, it need not move the zang. Thus if pathogen enters the yin channels and the qi of the zang is replete, pathogenic qi enters and cannot lodge as a guest, so it returns it to the fu. Therefore if it strikes yang it flows to the channels; if it strikes yin it flows to the fu. The Yellow Emperor said: When pathogen strikes a person's zang — how is it? Qi Bo said: Grief, worry, and fear wound the heart. A cold form and cold drink wound the lung; the two colds answer one another, inner and outer are both wounded, therefore qi reverses and travels upward. If one has fallen, malign blood remains within; if there is great anger, qi rises and does not descend, accumulates below the flanks — then it wounds the liver. If one has been struck or thrown down, or enters the chamber drunk, sweats and faces the wind — then it wounds the spleen. If one has used strength and lifted the heavy, or entered the chamber beyond measure, sweats and bathes in water — then it wounds the kidney. The Yellow Emperor said: When the five zang are struck by wind — how is it? Qi Bo said: When yin and yang are both touched, pathogen can then go. The Yellow Emperor said: Good. The Yellow Emperor asked Qi Bo: The head and face and the form of the body belong to the bones and join the sinews; they share the same blood and join in qi. When heaven is cold, the ground splits and ice is harsh; in sudden cold, the hands and feet may slacken — yet the face wears no clothes. Why? Qi Bo answered: The twelve channel vessels and the three hundred and sixty-five collaterals: their blood and qi all rise to the face and run to the empty orifices. Their refined yang qi rises and runs to the eyes and becomes sight. Their diverging qi runs to the ears and becomes hearing. Their ancestral qi rises and issues at the nose and becomes smell. Their turbid qi issues from the stomach, runs to the lips and tongue, and becomes taste. The fluids of their qi all rise and steam the face; the skin moreover is thick, the flesh firm — therefore even when heaven is very hot or very cold, it cannot overcome this. The Yellow Emperor said: When pathogen strikes a person, what is the form of the illness? Qi Bo said: When vacant pathogen strikes the body, there is a shivering that moves the form. When upright pathogen strikes a person it is faint: it is first seen in the color, not known in the body; as if there, as if not; as if gone, as if remaining; having form, having no form — no one knows its substance. The Yellow Emperor said: Good. The Yellow Emperor asked Qi Bo: I have heard: see the color and know the illness — this is named bright. Press the pulse and know the illness — this is named spirit. Ask of the illness and know its place — this is named worker. I wish to hear how one sees and knows it, presses and obtains it, asks and exhausts it. How is this done? Qi Bo answered: Color, pulse, and the chi answer one another as drum and mallet, as echo and sound, answer one another; they cannot lose one another. This too is the sign that issues from root and branch, root and leaf. Therefore if the root dies, the leaf withers. Color, pulse, form, and flesh cannot lose one another. Thus to know one is to be a worker; to know two is to be spirit; to know three is to be spirit and also bright. The Yellow Emperor said: I wish to hear it to the end. Qi Bo answered: When the color is green-blue, the pulse is string. When red, the pulse is hook. When yellow, the pulse is flowing. When white, the pulse is hair. When black, the pulse is stone. If one sees the color and does not obtain its pulse, but instead obtains the pulse of what conquers it — then there is death. If one obtains the pulse of what generates it — then the illness is already ending. The Yellow Emperor asked Qi Bo: The forms of illness born of the changes of the five zang — how are they? Qi Bo answered: First settle the answering of the five colors and the five pulses; then the illness can be told apart. The Yellow Emperor said: Color and pulse being settled, how does one tell them apart? Qi Bo said: Attune the slow and urgent, the small and large, the slippery and rough of the pulse, and the change of illness is settled. The Yellow Emperor said: How does one attune them? Qi Bo answered: When the pulse is urgent, the skin of the chi is also urgent. When the pulse is slow, the skin of the chi is also slow. When the pulse is small, the skin of the chi is also diminished and there is little qi. When the pulse is large, the skin of the chi also rushes and rises. When the pulse is slippery, the skin of the chi is also slippery. When the pulse is rough, the skin of the chi is also rough. In all these changes there is the faint and the extreme. Therefore those who are good at attuning the chi do not wait on the cun; those who are good at attuning the pulse do not wait on color. Those who can join them and walk them may be upper workers. The upper worker is complete in ten cases nine; those who walk two are middle workers; the middle worker is complete in ten cases seven; those who walk one are lower workers; the lower worker is complete in ten cases six. The Yellow Emperor said: I ask: the forms of illness of a pulse that is slow or urgent, small or large, slippery or rough — how are they? Qi Bo said: Let me speak the changes of illness of the five zang. A heart pulse urgent in the extreme is tugging and spasm; faintly urgent is heart pain drawing the back, food not descending. Slow in the extreme is manic laughter; faintly slow is a hidden beam, traveling up and down below the heart, at times spitting blood. Large in the extreme is a grating in the throat; faintly large is heart impediment drawing the back, a tendency to tears. Small in the extreme is a tendency to retch; faintly small is wasting-heat. Slippery in the extreme is a tendency to thirst; faintly slippery is heart shan drawing the navel, the lower belly sounding. Rough in the extreme is loss of voice; faintly rough is overflow of blood, linking-reversal, ringing in the ears, illness of the crown. A lung pulse urgent in the extreme is withdrawal; faintly urgent is cold and heat of the lung, sloth, coughing and spitting blood, drawing the lumbar, the back, and the chest, as if the nose had a polyp and would not open. Slow in the extreme is much sweat; faintly slow is wilting and one-sided wind; from the head downward sweat goes out and will not stop. Large in the extreme is swelling of the shin; faintly large is lung impediment drawing the chest and back; rising, one hates the light of the sun. Small in the extreme is discharge; faintly small is wasting-heat. Slippery in the extreme is rushing breath and rising qi; faintly slippery is bleeding above and below. Rough in the extreme is vomiting blood; faintly rough is rat fistula, between the neck, the limbs, and the armpit; the below cannot bear the above, and the answering is a tendency to sourness. A liver pulse urgent in the extreme is harsh speech; faintly urgent is fat-qi below the flank, as if a cup were overturned. Slow in the extreme is a tendency to vomit; faintly slow is water-jia impediment. Large in the extreme is inner abscess, a tendency to vomit and nosebleed; faintly large is liver impediment, yin shrinking, cough drawing the lower belly. Small in the extreme is much drinking; faintly small is wasting-heat. Slippery in the extreme is feasting-shan; faintly slippery is leftover urine. Rough in the extreme is overflowing drink; faintly rough is tugging, cramp, and sinew impediment. A spleen pulse urgent in the extreme is tugging and spasm; faintly urgent is the diaphragm: food and drink enter and come back out, and afterward there is foaming. Slow in the extreme is wilting and reversal; faintly slow is wind-wilting, the four limbs of no use, the heart clear as if there were no illness. Large in the extreme is being struck and thrown down; faintly large is shan-qi, the inner belly large, pus and blood outside the intestines and stomach. Small in the extreme is cold and heat; faintly small is wasting-heat. Slippery in the extreme is feasting-dribbling; faintly slippery is worm-toxin, twisting scorpion, heat in the belly. Rough in the extreme is intestinal feasting; faintly rough is inner feasting, much pus and blood going down. A kidney pulse urgent in the extreme is bone-withdrawal; faintly urgent is sinking-reversal and running piglet, the feet not gathering, unable to go before or behind. Slow in the extreme is a broken spine; faintly slow is a cave — a cave: food does not transform, goes down the throat and comes back out. Large in the extreme is yin wilting; faintly large is stone-water, rising from below the navel to the lower belly, swelling upward to the stomach duct — death, not put in order. Small in the extreme is cave-discharge; faintly small is wasting-heat. Slippery in the extreme is dribbling-feasting; faintly slippery is bone-wilting, sitting and unable to rise; when one rises the eyes have nothing they see. Rough in the extreme is a great abscess; faintly rough is the monthly affair not coming, and sinking hemorrhoid. The Yellow Emperor said: The six changes of illness — how does one pierce them? Qi Bo answered: All that is urgent has much cold; all that is slow has much heat; all that is large has much qi and little blood; all that is small has little of both blood and qi; all that is slippery has yang qi abundant, with faint heat; all that is rough has much blood and little qi, with faint cold. Therefore to pierce the urgent: insert deep and leave it long. To pierce the slow: insert shallow and issue the needle swiftly, to take away the heat. To pierce the large: drain its qi faintly; do not let its blood go out. To pierce the slippery: issue the needle swiftly and insert shallow, to drain yang qi and take away the heat. To pierce the rough: one must strike the vessel, follow its against and with, and leave it long; one must first press and follow it; when the needle has been issued, press the wound swiftly; do not let its blood go out, so as to attune the vessel. All that is small: yin and yang, form and qi, are all insufficient; do not take them with the needle; attune them with sweet medicine. The Yellow Emperor said: I have heard that the qi of the five zang and six fu: what the ying and the transports enter is the joining. By what road do they enter from? Once entered, what do they join and pass? I wish to hear the reason. Qi Bo answered: These are divergences of the yang vessels; they enter within and belong to the fu. The Yellow Emperor said: Do the ying, the transports, and the joining each have names? Qi Bo answered: The ying and the transports put the outer channels in order; the joining puts the inner fu in order. The Yellow Emperor said: How does one put the inner fu in order? Qi Bo said: Take them at the joining. The Yellow Emperor said: Does each joining have a name? Qi Bo answered: The stomach joins at Sanli. The large intestine enters and joins at Juxu Shangliang. The small intestine joins and enters at Juxu Xialiang. The sanjiao joins and enters at Weiyang. The bladder joins and enters at the center of Wei. The gallbladder joins and enters at Yanglingquan. The Yellow Emperor said: How does one take them? Qi Bo answered: To take Sanli, lower the instep and take it. For Juxu, lift the foot and take it. For Weiyang, flex and extend and seek it. For Weizhong, flex and take it. For Yanglingquan, set the knee upright, level it, and go down to the yang of Weiyang and take it. To take the various outer channels, draw them out, extend them, and follow them. The Yellow Emperor said: I wish to hear the illnesses of the six fu. Qi Bo answered: Heat in the face is illness of foot yangming. Blood in the thenar collaterals is illness of hand yangming. When the vessels above the two insteps stand hard or sink, it is illness of foot yangming — this is the stomach vessel. Illness of the large intestine: cutting pain in the intestines, a washing sound; on a winter day, struck again by cold, there is then discharge, pain at the navel, inability to stand long. It shares the signs of the stomach. Take Juxu Shangliang. Illness of the stomach: the belly washes and swells; the stomach duct, facing the heart, aches; it props the two flanks; the diaphragm and throat will not open; food and drink do not descend. Take Sanli. Illness of the small intestine: pain in the lower belly; the lumbar and spine control the testicles and ache; at times there is distress afterward, heat in front of the ear. If the cold is extreme, or if heat is extreme on the shoulder alone, and there is heat between the little finger and the next finger, or if the vessel is sunken — these are its signs. This is illness of hand taiyang. Take Juxu Xialiang. Illness of the sanjiao: qi fills the belly; the lower belly is especially firm; one cannot pass urine; in distress it overflows, water remains, and there is then distention. The sign is at the great collateral outside foot taiyang; the great collateral is between taiyang and shaoyang; it is also seen in the pulse. Take Weiyang. Illness of the bladder: the lower belly swells to one side and aches; if one presses it with the hand, one wishes to pass urine and cannot; heat on the shoulder; or the vessel is sunken; and the outer edge of the little toe, and behind the shin and ankle, are all hot; or the vessel is sunken. Take the center of Wei. Illness of the gallbladder: a tendency to great sighs, bitterness in the mouth, vomiting of stale juices; below the heart it washes and washes, as if someone were about to seize one; in the throat a grating, much spitting. It is at the root and end of foot shaoyang; also look for where its vessel is sunken, and moxa it. For those with cold and heat, take Yanglingquan. The Yellow Emperor said: Does piercing have a Dao? Qi Bo answered: To pierce these one must strike the qi-hollows, not strike the flesh-joints. If one strikes a qi-hollow, the needle is dyed in the lane; if one strikes a flesh-joint, the skin aches. If replenishing and draining are reversed, the illness grows more severe. If one strikes a sinew, the sinew slackens; pathogenic qi does not go out; it contends with the true and is disordered and will not leave; it returns and lodges within. To use the needle without care is to take the with as the against.

The line

The Yellow Emperor said: Yin and yang — different names, the same kind; above and below meet one another; the channel networks pass through one another, like a ring with no end. When pathogen strikes a person, sometimes it strikes yin, sometimes it strikes yang; above and below, left and right, there is no constant. Why is this?

The note

Pathogen strikes a person by yin or by yang. The form of illness is the look left after pathogen has walked. First ask which door it came in by; then ask how the zang and fu received it.