Library

Huangdi asked Qibo: "The onset of all diseases arises from wind, rain, cold, heat, clear dampness, and emotions of joy and anger. Unregulated joy and anger damage the Zang organs; wind and rain damage the upper body; clear dampness damages the lower body. The Qi of these three sectors (wind/rain, clear dampness, emotions) damages different parts. I wish to hear how they converge."

Qibo replied: "The Qi of the three sectors differs in nature. Some originate from the Yin, some from the Yang. Let me explain their directions. Unregulated joy and anger damage the Zang organs; when Zang organs are damaged, disease originates from the Yin. Clear dampness attacks deficiency, so disease originates from below; wind and rain attack deficiency, so disease originates from above. This is called the 'Three Sectors.' As for their spreading and transforming, there are too many to count."

Huangdi said: "I indeed cannot enumerate them all, so I ask my former teachers. I wish you to exhaustively explain this principle."

Qibo said: "Wind, rain, cold, and heat, if they are not 'deficient pathogenic factors' (Xu Xie, pathogenic factors that take advantage of deficiency), cannot harm people alone. Those who suddenly encounter fierce winds and heavy rains without getting sick do so because there is no internal deficiency; thus, pathogens cannot harm people alone. This must be due to the convergence of external deficient pathogenic wind and internal bodily deficiency. When two deficiencies meet, the pathogen enters the body. If two realities (normal climate and strong constitution) meet, with solid flesh and muscles, even deficient pathogenic factors have no effect. Therefore, one must consider both the heavenly timing (climate) and the bodily state, combining reality and deficiency, before major diseases are formed. Qi has fixed abodes; names are given according to location. Upper, lower, interior, and exterior are divided into three sectors. (This is the first section, narrating the general source of disease, covering the whole chapter.)

Therefore, when deficient pathogenic factors enter humans, they start at the skin. If the skin is lax, the Couli (pores and tissue spaces) open. When open, pathogens enter through the hair. Upon entering, they reach depth. At depth, the hair stands erect. When hair stands erect, one feels shivering (Xi Ran), hence skin pain. If it stays and does not leave, it transmits to the Luo vessels. During its stay in the Luo vessels, there is pain in the muscles. The pain comes and goes, and then the main meridians (Da Jing) take over. ('Xi' means long-lasting; 'Dai' means weak and unvigorous Qi. The *Sui Lu Lun* states: 'Meridian Qi becomes knotted and intermittent.') If it stays and does not leave, it transmits to the Jing meridians. During its stay in the Jing meridians, there is shivering aversion to cold and frequent fright. If it stays and does not leave, it transmits to the Shu vessels. During its stay in the Shu vessels, the Qi of the Six Meridians fails to flow to the four limbs, resulting in joint pain and stiffness in the waist and spine. If it stays and does not leave, it transmits to the Fu Chong Mai (Deeply seated Chong vessel). During its stay in the Fu Chong Mai, there is heaviness of the body and pain throughout. If it stays and does not leave, it transmits to the stomach and intestines. During its stay in the stomach and intestines, there is rumbling and abdominal distension. With excess cold, there is borborygmus and undigested stool diarrhea (Sun Xie); food is not transformed. With excess heat, there is loose stool resembling millet gruel. If it stays and does not leave, it transmits outside the stomach and intestines, between the Mu Yuan (epigastric membrane/origin of peritoneum), lingering in the vessels. Staying and not leaving, it gradually forms accumulations (Ji). It may attach to Sun vessels (finest branches), or Luo vessels, or Jing meridians, or Shu vessels, or the Fu Chong Mai, or the Lv Jin (muscles alongside the spine), or the Mu Yuan of the stomach and intestines, connecting upwards to the Huan Jin. (Mu Yuan refers to the hollow spaces within the membranes; Huan Jin refers to the ligaments connecting organs; Western medicine calls this omentum.) The proliferation of pathogenic Qi is indescribable. (This is the second section, narrating the progression of pathogens from shallow to deep, i.e., the abodes of disease.)

Huangdi said: "I wish to hear exhaustively how this happens."

Qibo said: "For those attaching to Sun vessels forming accumulations, the accumulation moves up and down, involving the arms and hands. Because Sun vessels are superficial and lax, they cannot confine the accumulation to stop it; thus, it migrates back and forth. Between the stomach and intestines, water gathers and渗注 (seeps and pours), making a gurgling sound. With cold, there is fullness and thunder-like traction pain, causing sharp pain intermittently. For those attaching to the Yangming Meridian, the accumulation resides flanking the navel. After eating, it enlarges; when hungry, it shrinks. For those attaching to the Huan Jin, it resembles an accumulation of the Yangming Meridian. After eating, there is pain; when hungry, there is relief. For those attaching to the Mu Yuan of the stomach and intestines, there is pain extending externally to the Huan Jin. After eating, there is relief; when hungry, there is pain. For those attaching to the Fu Chong Mai, palpation reveals movement under the hand. Upon releasing pressure, hot qi flows down to both thighs, like boiling water being poured. For those attaching to the Lv Jin, located posterior to the intestines on the right, the accumulation appears when hungry and disappears when full; it cannot be felt by pressing. For those attaching to the Shu vessels, there is blockage and obstruction, fluids fail to descend, and orifices become dry and congested. This is the pathogenic Qi entering internally from externally, descending from above. (This is the third section, narrating disease symptoms; the main meaning is clear. The following text supplements the pathogenesis. Pathogenesis is the intersection of disease origin, abode, and manifestation. The previous section narrated the origin; this section narrates the formation.)

Huangdi said: "How does an accumulation begin and eventually form?"

Qibo said: "Accumulations begin with the acquisition of cold, which generates Jue Qi (rebellious Qi), leading to the formation of accumulation."

Huangdi said: "How is the accumulation formed?"

Qibo said: "Jue Qi originates in the feet, generating cold in the calves. Cold in the calves causes blood vessels to coagulate and become stagnant. Coagulated blood vessels allow cold Qi to ascend into the stomach and intestines. Entering the stomach and intestines causes distension. Distension forces the fluid foam outside the intestines to gather and condense, unable to disperse, forming accumulation day by day. Sudden excessive eating fills the intestines. Irregular living habits and excessive physical effort injure the Luo vessels. Injury to Yang Luo vessels causes blood to overflow externally, manifesting as epistaxis. Injury to Yin Luo vessels causes blood to overflow internally, manifesting as hematochezia. If the Luo vessels of the stomach and intestines are injured, blood overflows outside the intestines. If there is cold outside the intestines, the fluid foam and blood contend and combine, coagulating and unable to disperse, thus forming accumulation. Sudden external invasion by cold, or internal injury by sorrow and anger, causes Qi to rebel upward. Upward rebellion of Qi blocks the Six Shu points, preventing the circulation of warming Qi. Coagulated blood remains trapped inside without dispersing; fluid seeps and adheres without clearing, thus all accumulations are formed. (This is the pathogenesis from external to internal, arising from Yang.)

Huangdi said: "What about those arising from Yin?"

Qibo said: "Worry and thought damage the Heart; double cold damages the Lungs; resentment and anger damage the Liver; sexual intercourse while drunk with sweating exposed to wind damages the Spleen; excessive physical effort, or sexual intercourse followed by sweating and bathing, damages the Kidneys. (This is the pathogenesis formed internally, arising from Yin.) These are the diseases generated by the internal and external three sectors. (Sections 4 and 5 narrate internal and external pathogenesis and should be read as one section.)

Huangdi said: "Excellent. How should they be treated?"

Qibo answered: "Observe the site of pain to know the corresponding reaction. Assess excess and deficiency. Tonify when appropriate, drain when appropriate. Do not go against the timing of Heaven. This is called supreme treatment."

The entire passage discusses accumulations. The cause and effect are orderly. The writing is firm and condensed, the aura vast. The discussion of the three sectors is either separated or combined, manipulated with flexibility and ease, achieving perfect expression. It can be praised for clear reasoning and precise diction.