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Huangdi Neijing · The Yellow Emperor’s Inner Canon
Lingshu 35 · Distension
Read in English. Switch to Original for word notes, or select text to ask a question.
The Yellow Emperor said: “How does distension appear in the pulse at Cunkou?”
Qi Bo said: “A large, firm and rough pulse indicates distension.”
The Yellow Emperor said: “How can one distinguish distension of the zang from that of the fu?”
Qi Bo said: “Yin indicates the zang; yang the fu.”
The Yellow Emperor said: “Does the qi that causes distension lie within blood vessels or within the zang and fu?”
Qi Bo said: “It is present in all three, but they are not the dwelling of distension.”
The Yellow Emperor said: “I wish to hear where distension dwells.”
Qi Bo said: “Distension is outside the zang and fu. It presses against them, expands the chest spaces and stretches the skin; thus it is named distension.”
The Yellow Emperor said: “The zang and fu lie within the chest spaces and abdomen as treasured vessels lie within boxes and chests. Each has its assigned dwelling, with different names yet a common location. Within one enclosure their qi differs. I wish to hear why.”
The Yellow Emperor said: “I have not grasped the meaning.”
Again he asked Qi Bo: “The chest and abdomen are the enclosure of the zang and fu. Danzhong is the palace enclosure of the Heart Ruler. The Stomach is the great granary. The throat and Small Intestine transmit and convey. The Stomach’s five openings are neighborhood gates. Lianquan and Yuying are pathways of jin and ye fluids. Thus the five zang and six fu each have their boundaries and their illnesses distinct forms.
“Nutritive qi follows the vessels; defensive qi moving against them produces vessel distension. Defensive qi joining the vessels and following the divisions produces skin distension. Drain at Sanli: one downward action for a near condition and three for a distant one. Regardless of emptiness or repletion, skill lies in swift draining.”
The supplied speaker sequence presents this passage as a renewed question to Qi Bo; it is retained without silently inserting a different speaker. “One” and “three” downward actions remain the text’s counts, without an invented timing or depth.
The Yellow Emperor said: “I wish to hear the forms of distension.”
Qi Bo said: “Heart distension brings vexation, short qi and restless lying down. Lung distension brings empty fullness, panting and cough.”
Liver distension brings fullness beneath the rib-sides with pain drawing into the lower abdomen. Spleen distension brings frequent retching, distress and oppression of the four limbs, a body too heavy to bear clothing, and restless lying down. Kidney distension brings abdominal fullness pulling into the back, with distressed pain in the waist and thighs.
Of the six fu, Stomach distension brings abdominal fullness, pain in the stomach cavity, a scorched smell perceived in the nose, difficulty eating and difficult stools. Large Intestine distension brings rumbling and pain with splashing sounds; renewed exposure to winter cold brings diarrhea with undigested food. Small Intestine distension brings pouring or expansive lower-abdominal distension and pain drawing into the waist. Bladder distension brings lower-abdominal fullness and qi blockage of urination. Triple Burner distension brings qi fullness within the skin, light and not firm. Gallbladder distension brings painful fullness beneath the rib-sides, bitterness in the mouth and frequent deep sighing.
All these distensions share one principle: clearly understand counterflow and accord and do not lose the proper measure of needling. Draining emptiness and supplementing repletion drive spirit from its chamber, bring in harmful influence, lose the proper condition and leave true qi unsettled. The crude practitioner fails and calls it fate. Supplementing emptiness and draining repletion return spirit to its chamber. Keeping the opening closed for a long time is called the work of a good practitioner.
The Yellow Emperor said: “Where does distension arise, and what brings it about?”
Qi Bo said: “Defensive qi in the body ordinarily runs alongside the vessels and follows the divisions of flesh. Its travel has contrary and favorable courses, with yin and yang following one another. Thus heavenly harmony is obtained, the five zang renew in turn, the four seasons are ordered and the five grains transform. But when reversal qi lies above, nutritive and defensive qi linger and stop, cold qi counterflows upward, and true and harmful qi attack each other. Their striking together combines to produce distension.”
The Yellow Emperor said: “Good. How can the uncertainty be resolved?”
Qi Bo said: “Compare it with the true condition; through three conjunctions it is obtained.”
The brief reference to “three conjunctions” is not expanded into a list that the supplied text does not give.
The Emperor said: “Good.”
The Yellow Emperor asked Qi Bo: “The Discussion of Distension says: regardless of emptiness or repletion, skill lies in swift draining; one downward action for a near condition and three for a distant one. If three have been performed and qi still does not descend, where is the error?”
Qi Bo replied: “This refers to entering the fleshy membranes and striking a qi cavity. If the cavity is not struck, qi remains closed within. If the needle does not enter the membranes, qi does not move. If it passes upward into the flesh, defensive qi is disturbed, yin and yang chase each other, and what should be drained in distension is left undrained. Thus qi does not descend.
“If it has not descended after three actions, the course must be changed. Stop when qi descends; if it does not descend, begin again. This can bring complete success—where need danger arise? In distension one must carefully examine its condition, draining what should be drained and supplementing what should be supplemented. Like a drum answering its stick, how could descent fail?”
The source’s membrane and final examination terms contain anomalous graphs. Their general sense is retained without supplying a modern anatomical layer or additional needling directions. The passage’s certainty of success is its own historical claim.
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