Lingshu · When Pathogen Is a Guest

The text

The Yellow Emperor asked Bo Gao: When pathogenic qi is a guest in a person, it sometimes makes the eyes not close and sleep not come. What qi makes it so? Bo Gao said: When the five grains enter the stomach, their dregs, fluids, and ancestral qi divide into three tunnels. Thus ancestral qi gathers in the chest, goes out at the throat, threads the heart vessel, and so travels the breath. Ying qi wrings out the fluids, pours them into the vessels, transforms them into blood, so as to nourish the four extremities, and inwardly pours into the five zang and six fu, answering the marks of the water-clock. Wei qi issues its fierce qi, swift and abrupt, and first travels among the four extremities, the divisions of the flesh, and the skin, without rest. By day it travels in yang; by night it travels in yin. It always starts from the interval of the foot shaoyin, and travels through the five zang and six fu. Now reversal-qi lodges as a guest in the five zang and six fu; then wei qi alone defends the outside, traveling in yang, and cannot enter yin. Traveling in yang, yang qi is abundant; when yang qi is abundant, the yang qiao sinks, and it cannot enter yin. Yin is vacant — therefore the eyes do not close. The Yellow Emperor said: Good. How is it treated? Bo Gao said: Supplement what is insufficient; drain what has surplus; attune vacancy and repletion, so as to open the road and send the pathogen away. Drink one draft of the pinellia decoction; when yin and yang have already opened, sleep arrives at once. The Yellow Emperor said: Good. This is what is meant by cutting the silt of a blocked ditch, the channels and networks greatly opened, yin and yang in accord. I wish to hear the formula. Bo Gao said: For the decoction take eight sheng of water that has flowed more than a thousand li; toss it ten thousand times; take five sheng of the clear and boil it. Fuel the fire with reed; when it boils, put in one sheng of glutinous millet and five ge of prepared pinellia; cook slowly until it is reduced to one sheng and a half; discard the dregs; drink one small cup of the juice, three times a day, increasing a little, taking awareness as the measure. Thus if the illness is newly arisen, as soon as the cup is turned over one sleeps, and when sweat goes out it is finished. If it is of long standing, three drinks and it is finished. The Yellow Emperor asked Bo Gao: I wish to hear how the limbs and joints of the person answer heaven and earth. Bo Gao answered: Heaven is round, earth is square; the person's head is round and the feet are square, answering this. Heaven has sun and moon; the person has two eyes. Earth has nine provinces; the person has nine orifices. Heaven has wind and rain; the person has joy and anger. Heaven has thunder and lightning; the person has voice and sound. Heaven has four seasons; the person has four limbs. Heaven has five tones; the person has five zang. Heaven has six pitches; the person has six fu. Heaven has winter and summer; the person has cold and heat. Heaven has ten days; the person has ten fingers of the hands. The earthly branches are twelve; the person has ten toes of the feet, and the stalk and pendant answer them. A woman lacks two joints, so as to hold a human form. Heaven has yin and yang; the person has husband and wife. The year has three hundred and sixty-five days; the person has three hundred and sixty joints. Earth has high mountains; the person has shoulders and knees. Earth has deep valleys; the person has armpits and the hollows of the knees. Earth has twelve channel-waters; the person has twelve channel vessels. Earth has spring-veins; the person has wei qi. Earth has grass and moss; the person has fine hairs. Heaven has day and night; the person has lying down and rising. Heaven has the ranked stars; the person has teeth. Earth has small hills; the person has small joints. Earth has mountain stones; the person has high bones. Earth has forests and trees; the person has gathered sinews. Earth has clustered towns; the person has clustered flesh. The year has twelve months; the person has twelve joints. Earth has four seasons that do not grow grass; the person has those without children. This is how the person and heaven-and-earth answer one another. The Yellow Emperor asked Qi Bo: I wish to hear the numbers of holding the needle, the principle of inserting the needle, the meaning of releasing and holding, and how one parts the skin and opens the interstices. The bendings of the vessels, the places of going out and in: where does it reach and go out, where does it reach and stop, where does it reach and go slowly, where does it reach and go quickly, where does it reach and enter? The transports of the six fu upon the body — I wish to hear them all, the places of the small sequences of parting: parting and entering yin, diverging and entering yang. By what road do they travel? I wish to hear their ways fully. Qi Bo said: What your Majesty asks is the needle-Dao complete. The Yellow Emperor said: I wish to hear it through to the end. Qi Bo said: The vessel of the hand taiyin goes out at the tip of the thumb, bends inward, and follows the border of the white flesh. It reaches behind the root joint, at Taiyuan, and stays there to pool. It bends outward, rises below the root joint, bends inward, and meets the various yin networks at Yuji. Several vessels pour together; their qi is slippery and sliding; it travels hidden under the crowding bone, bends outward, goes out at the inch-opening and travels, rises to the inner ridge of the elbow, enters under the great sinew, bends inward, rises along the yin of the upper arm, enters below the armpit, bends inward, and runs to the lung. This is the bending of counting against the stream while traveling with it. The vessel of the heart-governor goes out at the tip of the middle finger, bends inward, follows the inner ridge of the middle finger upward, stays in the palm, travels hidden between the two bones, bends outward, goes out between the two sinews, at the border of bone and flesh. Its qi is slippery and sliding. Two inches upward it bends outward, travels out between the two sinews, rises to the inner ridge of the elbow, enters under the small sinew, stays at the meeting of the two bones, rises into the chest, and inwardly networks the heart vessel. The Yellow Emperor said: The vessel of the hand shaoyin alone has no transport. Why is that? Qi Bo said: Shaoyin is the heart vessel. The heart is the great governor of the five zang and six fu, the lodging of the essence-spirit. Its store is firm; pathogen cannot be received there. If it is received, the heart is injured; if the heart is injured, the spirit leaves; if the spirit leaves, there is death. Therefore all pathogens that are in the heart are in the wrapping-network of the heart. The wrapping-network is the vessel of the heart-governor — therefore it alone has no transport. The Yellow Emperor said: If shaoyin alone has no transport, does it not fall ill? Qi Bo said: Its outer channel falls ill and the zang does not fall ill. Therefore one takes only its channel at the tip of the sharp bone behind the palm. The going out and in and the bendings of the remaining vessels, the slowness and swiftness of their travel, are all like the travel of the hand shaoyin and the heart-governor. Therefore these root transports are all taken according to the vacancy and repletion, the swiftness and slowness, of the qi. This is called draining by the surge, supplementing by the decline. In this way pathogenic qi is able to leave, and true qi is firm. This is called following the sequence of heaven. The Yellow Emperor said: Holding the needle, releasing and holding — how is it? Qi Bo said: You must first clearly know the root and tip of the twelve channel vessels, the cold and heat of the skin, the abundance and decline, the slipperiness and astringency, of the pulse. If the pulse is slippery and abundant, the illness advances day by day. If it is vacant and fine, it has been held a long time. If it is large and astringent, it is painful impediment. If yin and yang are as one, the illness is hard to treat. If root and tip are still hot, the illness is still present. If the heat has already waned, the illness has also left. Hold the forearm; observe whether the flesh is firm or brittle, large or small, slippery or astringent, cold or warm, dry or damp. Then look at the five colors of the eye, so as to know the five zang and decide death and life. Look at the blood vessels; observe their color, so as to know cold and heat, pain and impediment. The Yellow Emperor said: Holding the needle, releasing and holding — I have not yet grasped the meaning. Qi Bo said: The Dao of holding the needle wants uprightness and correctness, calm and quiet. First know vacancy and repletion, then travel swift or slow. The left hand holds the bone; the right hand follows it. Do not let the flesh seize it. To drain, want uprightness and correctness; to supplement, you must close the skin. Assist the needle and guide the qi; the pathogen is able to overflow and seep away; true qi is able to dwell. The Yellow Emperor said: How does one part the skin and open the interstices? Qi Bo said: Follow the divisions of the flesh. With the left, part the skin; insert slightly and slowly keep it upright. Watch that the spirit does not scatter, and pathogenic qi is able to leave. The Yellow Emperor asked Qi Bo: A person has eight hollows. By what does one assess each? Qi Bo answered: By them one assesses the five zang. The Yellow Emperor said: How does one assess? Qi Bo said: When lung and heart have pathogen, their qi remains at the two elbows. When the liver has pathogen, its qi flows to the two armpits. When the spleen has pathogen, its qi remains at the two thighs. When the kidney has pathogen, its qi remains at the two hollows of the knees. All these eight hollows are chambers of the hinges, where true qi passes and blood networks wander. Pathogenic qi and malign blood must not be allowed to stay. If they stay, they injure sinew, network, bone and joint; the hinges cannot bend and stretch — therefore the illness is spasm.

The line

The Yellow Emperor asked Bo Gao: When pathogenic qi is a guest in a person, it sometimes makes the eyes not close and sleep not come. What qi makes it so?

The note

A guest is one who stays for a while. Eyes that will not close: wei qi cannot enter yin. When the guest pathogen takes the place of night, the host cannot sleep.