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Huangdi said: I have heard that humans possess Jing (Essence), Qi, Jin (Thin Fluids), Ye (Thick Fluids), Blood, and Mai (Vessels). In my mind, I considered them to be one Qi. Now they are distinguished into six names; I do not understand the reason behind this. Qibo said: When the spirits of two parents interact and combine to form a shape, it is often generated before the physical body exists; this is called Jing (Essence). What is called Qi? Qibo said: The Upper Jiao (Upper Burner) opens and develops, distributing the flavors of the five grains. It steams the skin, fills the body, and moistens the hair, resembling the irrigation of fog and dew; this is called Qi. What is called Jin (Thin Fluids)? Qibo said: When the Cou Li (interstices and pores) open and sweat profusely, this is called Jin (Thin Fluids). What is called Ye (Thick Fluids)? Qibo said: When food enters and Qi is full, the rich and moist essence flows into the bones, allowing the bone joints to flex and extend. It leaks moisture to nourish and replenish the brain marrow, and moistens the skin; this is called Ye (Thick Fluids). What is called Blood? Qibo said: The Middle Jiao (Middle Burner) receives Qi, extracts the juice, transforms it, and turns it red; this is called Blood. What is called Mai (Vessels)? Qibo said: Vessels contain and restrain Ying Qi (Nutritive Qi), preventing it from escaping or deviating; this is called Mai (Vessels).

Huangdi said: Regarding these six Qi, how can we know about their excess and deficiency, the quantity of Qi, the emptiness and fullness of the brain marrow, and the clarity and turbidity of the blood vessels? Qibo said: When Jing (Essence) is depleted, there is deafness; when Qi is depleted, vision is unclear; when Jin (Thin Fluids) is depleted, the Cou Li (interstices) open, and there is profuse sweating; when Ye (Thick Fluids) is depleted, the bone joints are stiff and difficult to flex or extend, the complexion is dull, the brain marrow diminishes, the shins ache, and the ears ring frequently. When Blood is depleted, the complexion is white, dry, and lusterless, and the pulse is empty. These are the signs. Huangdi said: How important are these six Qi? Qibo said: Each of the six Qi has its own governing region. Their relative importance and quality can serve as standard rulers, yet the five grains and the Stomach act as the great sea (the fundamental source).

Huangdi said: When Qi causes distension in the body, is it within the blood vessels or inside the Zang-Fu organs? Qibo said: Both exist, but neither is the abode of distension. Huangdi said: I wish to hear where the abode of distension lies. Qibo said: Distension occurs outside the Zang-Fu organs, pushing against them, expanding the chest and hypochondrium, and filling the skin; hence it is named Distension. Huangdi said: The Zang-Fu organs reside within the chest, hypochondrium, and abdomen, like precious artifacts stored in boxes and cabinets. They each have their specific locations, sharing the same domain but possessing different Qi. I wish to understand the reason? Qibo said: The chest and abdomen are the outer walls of the Zang-Fu organs. Danzhong (Conception Vessel 17, Pericardium area) is the palace city of the Heart Master. The Stomach is the Grand Granary. The pharynx and Small Intestine are responsible for transmission and delivery. The five orifices of the Stomach are the gates and doors of the neighborhoods. Lianquan (Renmai 23) and Yuying (an extra point near Lianquan) are the pathways for fluids. Therefore, the Five Zang and Six Fu organs each have boundaries, and their diseases present with distinct shapes. Ying Qi (Nutritive Qi) circulates within the vessels and guards; if Wei Qi (Defensive Qi) rebels, it causes Mai Distension (Distension of the Vessels). If Wei Qi (Defensive Qi) merges with the vessels and circulates through the muscle intervals, it causes Fu Distension (Distension of the Skin). Treatment involves reducing the acupoint Zusanli (Stomach 36). For conditions close to the surface, reduce once; for those far away, reduce three times. Regardless of excess or deficiency, the key for the practitioner is rapid reduction.

Huangdi said: I wish to hear the specific forms of distension. Qibo said: In Heart Distension, there is mental restlessness, shortness of breath, and restless sleep. In Lung Distension, there is a feeling of emptiness and fullness accompanied by wheezing and coughing. In Liver Distension, there is fullness under the hypochondrium, with pain radiating to the lower abdomen. In Spleen Distension, there is frequent hiccups, heaviness and irritability in the four limbs, such that the body feels too heavy to bear clothes, and restless sleep. In Kidney Distension, there is abdominal fullness radiating to the back, a sense of oppression, and pain in the waist and thighs. In Stomach Distension, there is abdominal fullness, epigastric pain, an olfactory sensation of burnt odor, difficulty eating, and hard stools. In Large Intestine Distension, there is borborygmus and gurgling pain; if exposed to cold again in winter, it leads to undigested diarrhea (Sun Xie). In Small Intestine Distension, there is lower abdominal fullness radiating to the waist with pain. In Bladder Distension, there is lower abdominal fullness and urinary retention. In Sanjiao (Triple Burner) Distension, Qi fills the skin, causing a light, puffy swelling that is not firm. In Gallbladder Distension, there is pain and fullness under the hypochondrium, a bitter taste in the mouth, and frequent sighing.

Huangdi said: How does distension arise? What is the cause? Qibo said: Wei Qi (Defensive Qi) normally runs alongside the vessels, circulating through the muscle intervals. Its movement has directionality, with Yin and Yang following each other, thereby achieving harmony in the body. The Five Zang organs renew their functions, the four seasons follow their order, and the five grains are digested. However, if Jue Qi (Rebellious Qi) arises below, Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi) stagnate, Cold Qi rebels upward, and True Qi attacks Evil Qi. The two Qi types contend and combine, resulting in distension. Huangdi said: The Treatise on Distension states that regardless of excess or deficiency, the key is rapid reduction: once for close conditions, three times for distant ones. Yet, some patients undergo three treatments without relief. Where lies the fault? Qibo said: This occurs because Wei Qi (Defensive Qi) is chaotic, and Yin and Yang chase each other in conflict. In cases of distension, if reduction should be applied but is not, the Qi will not descend. If three reductions fail to lower the Qi, the method must be changed. Only when the Qi descends should treatment stop. If it does not descend, restart the process correctly. This ensures complete safety; how could there be danger? In treating distension, one must carefully examine the pulse. Reduce when appropriate, tonify when appropriate. The effect should be as immediate as a drum responding to a beat. How could distension fail to resolve?