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Huangdi asked: What qi causes sudden excessive sleepiness that does not follow the regular meridian patterns? Qibo answered: Pathogenic qi remains in the Upper Jiao (Upper Burner), causing obstruction and blockage. If one has just eaten or drunk soup, the Wei Qi (Defensive Qi) stays for a long time in the Yin aspect and fails to circulate to the Yang aspect, thus causing sudden excessive sleepiness.

This statement refers to cases unrelated to the normal physiological conditions of the size of the intestines and stomach or the slipperiness/roughness of the skin, but rather to instances of sudden excessive sleepiness caused by pathogenic qi stagnating in the Upper Jiao. With the Upper Jiao blocked and obstructed, and further compounded by turbid yin qi from food and drink, the Wei Qi cannot move outward to the Yang aspect but remains stagnant in the Yin aspect, resulting in sudden excessive sleepiness. Generally speaking, although Wei Qi travels through the Yang aspect during the day, it also undergoes floating/sinking and ascending/descending movements. If the Qi mechanism of the Upper Jiao is closed and obstructed by turbid yin qi, the Wei Qi cannot ascend and float; therefore, even during the day, there will be excessive sleepiness. It is crucial to understand that the ascending and descending of Qi relies entirely on the smooth regulation of the Spleen and Stomach. When the Triple Burner (San Jiao) is unobstructed, the Qi of ascending and descending naturally harmonizes. Thus, when the Spleen is fatigued and its transport function is weak, Clear Yang Qi fails to ascend, leading to drowsiness and sleep; when the Stomach's function is disordered, Wei Qi cannot descend into the Yin, leading to insomnia. Therefore, the Spleen and Stomach are the central hub for the ascending, descending, entering, and exiting of Yin and Yang, while the Chong Mai (Penetrating Vessel) and Du Mai (Governing Vessel) — specifically referring here to the Yangqiao and Yinqiao vessels which govern eyelid opening/closing and limb movement — serve as the gateways and pathways for Wei Qi to enter and exit Yin and Yang.

Huangdi asked: How should these various pathogenic conditions be treated? Qibo said: First, determine the location and depth of the Zang-Fu organ involvement, correct minor deviations, and then regulate the Qi. For excess conditions, use draining methods; for deficiency conditions, use tonifying methods. One must first clearly understand the patient's physical labor/rest status and mental state of suffering or joy before deciding on the treatment.

This describes the treatment principle: first distinguish the depth of Zang-Fu pathology to eliminate minor illnesses, then regulate the Qi, applying supplementation or drainage as appropriate. As stated in the "Methods of Treatment" chapter: one must examine whether the patient suffers from "physical comfort but mental distress," "physical distress but mental comfort," "both physical and mental distress," or "both physical and mental comfort." Only by clearly understanding these can one identify the cause of the disease. Once the differentiation between external contraction and internal injury is established, treatment can proceed accordingly.

In the *Ling Shu · Ben Shen* chapter, Qibo stated: Excessive fright and worry injure the Shen (Spirit). When the Shen is injured, fear arises, and essence flows uncontrollably. Sadness that moves internally exhausts life force and leads to loss of vitality. Excessive joy scatters the Shen, preventing it from being stored. Grief and sorrow cause Qi to become blocked and cease to flow. Intense anger causes confusion and loss of rational control. Fear causes the Shen to fluctuate and fail to consolidate.

"Fright and terror" refer to panic. Fright and worry simultaneously injure the Heart and Spleen. Injury to the Heart results in Qi deficiency and constant fear; injury to the Spleen impairs its ability to secure essence and return it to the Kidney, leading to continuous leakage of essence, such as spermatorrhea, nocturnal emission, or turbid leukorrhea. There are also cases where excessive mental exertion causes immediate essence discharge. Sadness consumes Qi, and grief injures the Shen; when Shen and Qi are exhausted, the vitalizing mechanism is lost. Joy disperses Qi, so the Shen becomes scattered and uncontained, manifesting as excessive talking and laughing. Grief and sorrow cause Qi depression and knotting; over time, meridians become blocked and circulation ceases. Intense anger stirs Fire, which disturbs the Shen, causing confusion and inability to manage affairs. Fear causes the Heart-Shen to tremble without mastery, making self-restraint impossible.

Heart: Fright and worry injure the Shen; Shen injury leads to fear and loss of autonomy, muscle wasting, withered hair, and sallow complexion, with death occurring in Winter. Spleen: Unresolved grief injures the Yi (Intellect); Yi injury leads to mental confusion, inability to move the four limbs, withered hair, and sallow complexion, with death occurring in Spring. Liver: Sadness moving internally injures the Hun (Ethereal Soul); Hun injury leads to mania, forgetfulness, and lack of clarity, resulting in improper behavior, retraction of the genitals, tendon spasms, inability to lift the costal bones, withered hair, and sallow complexion, with death occurring in Autumn. Lung: Endless joy injures the Po (Corporeal Soul); Po injury leads to mania, where the manic person ignores others, dry skin, withered hair, and sallow complexion, with death occurring in Summer. Kidney: Unchecked anger injures the Zhi (Will); Zhi injury leads to forgetfulness, inability to flex/extend the waist and spine, withered hair, and sallow complexion, with death occurring in Late Summer. Unresolved fear injures Jing (Essence); Jing injury leads to bone萎 (atrophy/weakness) and cold extremities, with spontaneous leakage of essence. Therefore, the Five Zang organs store Essence and must not be injured. Injury leads to loss of containment and Yin deficiency; Yin deficiency leads to Qi deficiency; Qi deficiency leads to death. Thus, acupuncturists must observe the patient's state to know the presence or absence of Spirit, Soul, Intellect, and Will. If the spirits of the five organs are injured, acupuncture cannot treat them.

This section elaborates on the manifestations of Seven Emotions injuring the Zang organs. The Heart, due to fright and worry, injures the Shen, causing fear and loss of autonomy. Since Heart and Spleen share similar Qi and are interconnected, prolonged injury affects the Spleen, leading to muscle wasting. "Gu" refers to the thick flesh of the buttocks. Spleen Earth injury fails to generate Lung Metal, leading to withered hair and sallow complexion; death in Winter occurs because Water is prosperous and Heart Fire is extinguished. The Spleen, due to unresolved grief, injures the Yi (Intellect), which is the spirit of the Spleen. Yi injury causes mental confusion. Since Spleen and Stomach govern the four limbs, weakness prevents movement. Death in Spring occurs because Wood is prosperous and Earth is extinguished. The Liver, due to sadness moving internally, injures the Hun (Ethereal Soul), which is the spirit of the Liver and belongs to Yang. Injury leads to mania and forgetfulness due to Yang Qi dispersion, resulting in improper speech and action. The genitals are governed by tendons controlled by the Liver; the hypochondrium is the pathway of the Liver Meridian. Thus, genital retraction, tendon spasms, and rib pain occur. Death in Autumn occurs because Metal is prosperous and Wood is extinguished. Joy originates from the Heart; endless joy causes excessive Heart Fire, injuring Lung Metal. Po is the spirit of the Lung and belongs to Yin. Heart Fire attacks Lung Metal, injuring the Po and causing mania where the patient talks and laughs alone, ignoring others. The Lung governs skin and hair; burned by Fire, they become dry. Death in Summer occurs because Fire is prosperous and Metal is extinguished. Anger originates from the Liver; extreme Liver Yang rebellion depletes Kidney Water and injures the Zhi (Will), the spirit of the Kidney, which governs memory. Zhi injury causes forgetfulness. The waist is the mansion of the Kidney; thus, spinal stiffness occurs. Death in Late Summer occurs because Earth is prosperous and Water is extinguished. All injured organs show withered hair and sallow complexion because internal and external vitality is depleted; when the controlling element becomes prosperous, the injured organ's Qi is extinguished, leading to death. Earlier, it was stated that fear causing continuous leakage injures Jing. Jing injury leads to bone atrophy and coldness because Marrow is generated from Essence. This indicates that Heart-Shen injury extends to the Kidney because all spirits (Hun, Po, Yi, Zhi) are derived from the Heart-Shen. All seven emotions originate from the Heart; thus, indulging in emotions injures the organs. Those practicing cultivation must first cut off emotional desires, condensing the Shen in one Heart, so diseases heal and the Dao can be achieved. Each organ stores Essence and Qi for nourishment; injury leads to loss of containment and initial Yin deficiency. Yin deficiency prevents Essence and Qi production, leading to death. Yin and Yang are roots of each other and mutually generate; lacking one means lacking both. Internal injuries to the Zang organs cannot be treated with acupuncture but must be regulated and tonified with sweet herbs.