Suwen · The Three Regions and Nine Assessments

The text

The Yellow Emperor asked: I have heard of the nine needles from you, Master — many, broad, and great, more than can be counted. I wish to hear the essential Dao, to give it to sons and grandsons, to hand it down to later ages, to write it in the bone marrow, to store it in the liver and lung, to receive it with smeared blood and not dare to leak it rashly — so that it joins the Dao of heaven, must have ending and beginning, answers above to the lights of heaven, the stars, and the marks of the calendar, and matches below the four seasons and the five phases, noble and base taking turns, winter yin and summer yang. How does the person answer to this? I wish to hear the method. Qi Bo replied: Subtle indeed is your question. This is the utmost number of heaven and earth. The Emperor said: I wish to hear the utmost number of heaven and earth, how it joins the human form, how blood and qi communicate, how death and life are decided. How is this done? Qi Bo said: The utmost number of heaven and earth begins in one and ends in nine. One is heaven, two is earth, three is the person. Triple these, and three threes are nine, answering to the nine wilds. Therefore the person has three regions; each region has three assessments, by which one decides death and life, settles the hundred illnesses, attunes vacuity and repletion, and removes pathogenic affliction. The Emperor said: What is meant by the three regions? Qi Bo said: There is a lower region, a middle region, and an upper region. Each region has three assessments. The three assessments are heaven, earth, and the person. One must point and lead them, and only then take them as true. Upper region, heaven: the moving pulses at both sides of the forehead. Upper region, earth: the moving pulses at both cheeks. Upper region, person: the moving pulses in front of the ears. Middle region, heaven: the hand-taiyin. Middle region, earth: the hand-yangming. Middle region, person: the hand-shaoyin. Lower region, heaven: the foot-jueyin. Lower region, earth: the foot-shaoyin. Lower region, person: the foot-taiyin. Thus in the lower region, heaven is used to assess the liver, earth to assess the kidney, the person to assess the qi of spleen and stomach. The Emperor said: How is the assessment of the middle region? Qi Bo said: It too has heaven, it too has earth, it too has the person. Heaven is used to assess the lung, earth to assess the qi of the chest, the person to assess the heart. The Emperor said: What does the upper region assess? Qi Bo said: It too has heaven, it too has earth, it too has the person. Heaven is used to assess the qi of the temples and corners of the head, earth to assess the qi of the mouth and teeth, the person to assess the qi of the ears and eyes. Each of the three regions has its heaven, its earth, its person. Three complete heaven, three complete earth, three complete the person. Three threes joined are nine. Nine divides into the nine wilds; the nine wilds are the nine zang. Thus there are five spirit-zang and four form-zang, joined as nine zang. When the five zang have already failed, the color must be withered; withered, there must be death. The Emperor said: How does one assess? Qi Bo said: One must first measure whether the form is fat or thin, and thereby attune the vacuity and repletion of the qi. If replete, drain it; if vacuous, fill it. One must first remove what is in the blood vessels, and only then attune. Do not ask after the illness; take the level as the term. The Emperor said: How does one decide death and life? Qi Bo said: A flourishing form and a fine pulse, little qi not enough to breathe — this is in danger. A thin form and a large pulse, much qi in the chest — this is death. When form and qi obtain one another, there is life. When the comparisons are not attuned, there is illness. When the three regions and nine assessments have all lost one another, there is death. When the pulses above and below, left and right, answer one another like pestles pounding in turn, the illness is severe. When above and below, left and right, have lost one another and cannot be counted, there is death. If the assessment of the middle region is attuned alone, yet has lost the other zang, there is death. If the assessment of the middle region is diminished, there is death. If the eyes are sunken inward, there is death. The Emperor said: How does one know where the illness is? Qi Bo said: Examine the nine assessments. That which is alone small is illness; that which is alone large is illness; that which is alone hurried is illness; that which is alone slow is illness; that which is alone hot is illness; that which is alone cold is illness; that which is alone sunken is illness. With the left hand, press five cun above the ankle on the foot; let the right hand flick at the ankle. If the answering goes more than five cun and is wriggling, wriggling, there is no illness. If the answering is hurried, and in the hand it is rushing, rushing, there is illness; if in the hand it is slow, slow, there is illness. If the answering cannot reach five cun above, and flicking brings no answer, there is death. Therefore those whose flesh has deserted and whose body does not leave — death. Those whose middle region is suddenly sparse, suddenly rapid — death. A pulse that is intermittent and hooked: the illness is in the collateral vessels. The answering of the nine assessments should be as one above and below, and must not lose one another. If one assessment lags, there is illness; if two lag, the illness is severe; if three lag, the illness is in danger. What is called lagging is that they do not answer together. Examine the fu and the zang, to know the date of death and life. One must first know the channel-pulses, and only then know an ill pulse. When a true-zang pulse appears, what prevails, dies. When the qi of foot-taiyang is cut off, the foot cannot bend and stretch; in death the eyes must stare upward. The Emperor said: Winter yin and summer yang — how is this? Qi Bo said: Among the pulses of the nine assessments, those that are all sunken, fine, hanging, and cut off are yin, and govern winter; therefore death comes at midnight. Those that are abundant, restless, panting, and rapid are yang, and govern summer; therefore death comes at midday. Thus illnesses of cold and heat die at the calm dawn. Heat in the center and heat illness die at midday. Illness of wind dies at sundown. Illness of water dies at midnight. Those whose pulse is suddenly sparse, suddenly rapid, suddenly slow, suddenly hurried, die when the day rides the four seasons. When form and flesh have already deserted, even if the nine assessments are attuned, still there is death. If the seven examinations appear, yet the nine assessments all follow, there is no death. What is called no death: illnesses of wind-qi, and illnesses of the monthly channels, may resemble the illnesses of the seven examinations and yet are not; therefore one says there is no death. If there is an illness of the seven examinations, and the pulse assessments also fail, there is death — there must be hiccup and belching. One must ask carefully where the illness first began, and what is now just becoming illness; then in each case feel and follow the pulses, look at whether the channels and collaterals are floating or sunken, and follow them above and below, against and with. A pulse that is hurried is without illness; a pulse that is slow is illness; a pulse that does not come and go is death; skin that sticks is death. The Emperor said: Those that can be treated — how is it? Qi Bo said: If the illness is in a channel, treat the channel. If the illness is in the minute collaterals, treat the blood of the minute collaterals. If the illness is in the blood and the body has pain, treat the channels and collaterals. If the illness is in an extraordinary pathogen, needle the opposite side on the vessel of the extraordinary pathogen. If it lingers, wasted, and does not move, needle it at the joints. If the upper is replete and the lower vacuous, feel and follow it; seek the knotted collateral vessels, needle and let out the blood, so that communication is seen. Pupils sitting high: taiyang is insufficient. Eyes staring upward: taiyang is already cut off. These are the essentials of deciding death and life; they must be examined. At the fingers, and above the outer ankle of the hand toward the five fingers, leave the needle.

The line

Qi Bo said: The utmost number of heaven and earth begins in one and ends in nine.

The note

The three regions and nine assessments put the person back into the number of heaven and earth. It begins in one and ends in nine. First set this number, and examination is no longer pieces.