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Huangdi Neijing · The Yellow Emperor’s Inner Canon
Lingshu 59 · Disordered Defensive Qi
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The Yellow Emperor said: “When defensive qi remains in the abdomen, accumulates without moving and is pent up away from its usual place, bringing fullness in limbs, rib-sides and Stomach, with panting cries and counterflow breathing, how can it be removed?”
Bo Gao said: “For qi accumulated in the chest, address above. For qi accumulated in the abdomen, address below. For fullness both above and below, address beside.”
The Yellow Emperor said: “How is it addressed?”
Bo Gao replied: “For accumulation above, drain Daying, Tiantu and within the throat. For accumulation below, drain Sanli and Qijie. For fullness both above and below, address both above and below and one cun below the lowest ribs. For severe cases, use the chicken-foot method. Inspect the pulse: if large, wiry and urgent, or cut off so it does not arrive, or if abdominal skin is extremely tense, do not needle.”
The chicken-foot method is retained by name; no additional construction, depth or needle placement is supplied here.
The Yellow Emperor said: “Good.”
The Yellow Emperor asked Bo Gao: “How can one know illness of skin, flesh, qi and blood, sinews or bones?”
Bo Gao said: “Color arising at both brows, thin and lustrous, indicates illness in the skin. Blue-green, yellow, red, white or black lips indicate illness in flesh. A soft, moist condition of nutritive qi indicates illness in blood and qi. Blue-green, yellow, red, white or black eyes indicate illness in sinews. Scorched, withered ears that gather dust and dirt indicate illness in bone.”
The Yellow Emperor said: “What forms do these illnesses take, and how are they addressed?”
Bo Gao said: “The transformations of the many illnesses cannot be counted. Yet skin has divisions, flesh has pillars, blood and qi have transporting sites, and bones have connections.”
The Yellow Emperor said: “I wish to hear why.”
Bo Gao said: “The skin divisions transport to the four extremities. The pillars of flesh lie between the divisions of flesh of the yang channels in arms and shins, and in the divisions of Foot Shaoyin. Blood and qi transport into the networks; where they remain, the networks become abundant and rise. The sinew divisions have no fixed yin or yang, left or right: observe where illness lies. Bone connections are the hollows through which bones receive benefit and in turn benefit brain and marrow.”
The Yellow Emperor said: “How are they addressed?”
Bo Gao said: “Illness changes in superficiality and sinking, depth and shallowness, without end, each in its place. For milder illness act shallowly; for severe illness deeply. For milder illness use fewer interventions; for severe illness more. Regulate qi according to its changes: this is why one is called a highest practitioner.”
The Yellow Emperor asked Bo Gao: “People differ in stoutness and thinness, size, cold and warmth, old age, maturity, youth and childhood. How are they distinguished?”
Bo Gao replied: “Fifty and above is old; twenty and above mature; eighteen and above young; six and above a child.”
The Yellow Emperor said: “How can stoutness and thinness be measured and known?”
Bo Gao said: “There are the stout, the rich-fat and the fleshy.”
The first form is written fei here and described with zhi, firm fat, later in this passage. Gao denotes the softer rich-fat form, and rou the fleshy form. The wording difference is retained.
The Yellow Emperor said: “How are these distinguished?”
Bo Gao said: “Firm flesh behind the knee with full skin is the stout form. Unfirm flesh behind the knee with relaxed skin is the rich-fat form. Skin and flesh that do not separate are the fleshy form.”
The Yellow Emperor said: “What of bodily cold and warmth?”
Bo Gao said: “In the rich-fat form, soft flesh and coarse texture mean a cold body; fine texture a hot body. In the firm-fat form, flesh is firm: fine texture means heat and coarse texture cold.”
The Yellow Emperor said: “How do stoutness, thinness and size differ?”
Bo Gao said: “The rich-fat form has much qi and loose, relaxed skin, allowing a slack belly and hanging fat. The fleshy form has a capacious, large body. The firm-fat form is compact and small.”
The Yellow Emperor said: “How much qi and blood do these three have?”
Bo Gao said: “The rich-fat form has much qi; much qi brings heat, and heat bears cold. In the fleshy form, much blood fills the body, and a filled body is balanced. In the firm-fat form, blood is clear and qi slippery but scant, so it cannot become large. These distinguish them from ordinary people.”
The Yellow Emperor said: “What are ordinary people like?”
Bo Gao said: “In ordinary people, skin, flesh and the two forms of fat do not outstrip one another; neither blood nor qi greatly exceeds the other. Their form is neither small nor large, each proportioned to its own body. They are called ordinary people.”
The Yellow Emperor said: “Good. How are they treated?”
Bo Gao said: “First distinguish the three forms, the amount of blood and the clarity or turbidity of qi, then regulate. Treatment must not depart from the ordinary channels. Thus the rich-fat person has a slack belly and hanging fat; the fleshy person is capacious above and below; the firm-fat person, though possessing fat, cannot become large.”
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