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(Full text of *Ling Shu: Kou Wen* Chapter)

When Huangdi was at leisure, he dismissed his attendants and asked Qibo: "I have already studied the classic theories of the Nine Needles, and the discussions on Yin-Yang, reversals, and the Six Meridians are complete. I now wish to learn about 'Kou Wen' (Questions from the Mouth)." Qibo rose from his seat, bowed twice, and said: "Excellent is your question! This is knowledge orally transmitted by our former masters." Huangdi said: "I wish to hear this oral transmission." Qibo replied: "The onset of all diseases arises from wind, rain, cold, and heat; imbalances in Yin-Yang and emotions such as joy and anger; improper diet and living habits; as well as sudden fright and terror. These factors cause the separation of blood and Qi, the disintegration of Yin and Yang, the blockage of collaterals, the obstruction of pulse pathways, the reversal of Yin and Yang Qi, the stagnation of Wei Qi (Defensive Qi), the emptiness of meridians, and the disorderly flow of blood and Qi, thereby losing their normal state. Regarding those matters not recorded in the classics, please allow me to explain their principles. (The following questions concern neither external pathogens like wind-cold nor internal injuries from emotions. Since they are not recorded in the classics, they should be taught orally, hence the name 'Kou Wen'.)"

Huangdi asked: "Why do people yawn? What Qi causes this?" Qibo answered: "Wei Qi (Defensive Qi) travels through the Yang aspects during the day and through the Yin aspects at midnight. Yin governs the night, and the night governs sleep. Yang governs the upper part, and Yin governs the lower part. Therefore, when Yin Qi accumulates in the lower part while Yang Qi has not yet fully entered Yin, Yang pulls upward and Yin pulls downward. The mutual attraction of Yin and Yang results in frequent yawning. (Yawning involves opening the mouth to breathe or stretching arms and waist, caused by the mutual attraction of Yin and Yang. Yang governs the day and ascending; Yin governs the night and descending. A person's wakefulness and sleep depend on Wei Qi. When Wei Qi travels through Yang during the day, the person is active and awake; when it travels through Yin at night, the person is quiet and asleep. Thus, just before falling asleep, one must yawn because Yang Qi is about to enter Yin, Yin accumulates below, and Yang is still unsettled. Yang desires to ascend, Yin desires to descend, and their mutual attraction generates yawning. Now, some people yawn due to mental fatigue and weariness, which is a sign that Yang cannot overcome Yin.) When Yang Qi is exhausted and Yin Qi is abundant, the eyes close; when Yin Qi is exhausted and Yang Qi is abundant, the person awakens. (*Da Huo Lun* states: If Wei Qi cannot enter Yin and remains in Yang, Yang becomes full and Yang Qiao Mai becomes strong. Unable to enter Yin, Yin becomes deficient, so the eyes cannot close. If Wei Qi remains in Yin and cannot travel to Yang, Yin becomes full and Yin Qiao Mai becomes strong. Unable to enter Yang, Yang becomes deficient, so the eyes remain closed. Wu Xuangang said: Awakening combines with Yang, sleep merges with Yin. Those who awaken often have strong Hun (Ethereal Soul); those who sleep long have strong Po (Corporeal Soul). Strong Hun leads to life; strong Po leads to death. These illustrate the principles of Yin-Yang abundance and deficiency. Ming sounds like 'ming', also pronounced with the rising tone.) Treatment should involve reducing Foot Shaoyin (Kidney Meridian) and tonifying Foot Taiyang (Bladder Meridian). (Wei Qi begins its journey through Yang from Foot Taiyang and through Yin from Foot Shaoyin. Yin excess and Yang deficiency cause yawning. Therefore, one should reduce Zhaohai (KI6) of Foot Shaoyin, where Yin Qiao Mai originates, and tonify Shenmai (BL62) of Foot Taiyang, where Yang Qiao Mai originates. The rationale for selecting Yin and Yang Qiao Mai is explained in the previous note.)"

Huangdi asked: "Why do people hiccup? What Qi causes this?" Qibo said: "Food enters the stomach, and Stomach Qi flows upward into the Lungs. However, if old cold pathogen and new food Qi both return to the stomach, the new and old mix chaotically, Zheng Qi (Upright Qi) and Xie Qi (Pathogenic Qi) attack each other, Qi gathers and rebels, and re-emerges from the stomach, causing hiccups. (Hiccup refers to eructation or diaphragmatic spasm. See Acupuncture Category 53 for details. When water and food enter the stomach, their refined Qi must flow upward to the Lungs before circulating to the Zang-Fu organs and Ying-Wei. If there is pre-existing cold in the Middle Jiao, the newly ingested food Qi condenses and fails to move. Lack of movement causes old and new pathogenic Qi to remain in the stomach. Stagnation leads to rebellion and upward exit, causing hiccups. Yue sounds like 'yue', also 'hui'.) Treatment should involve tonifying Hand Taiyin (Lung Meridian) and reducing Foot Shaoyin (Kidney Meridian). (Hand Taiyin is the Lung Meridian. Foot Shaoyin is the Kidney Meridian. Cold pathogen rises from below and rebels, causing hiccups. Therefore, one should tonify the Lung above to strengthen Qi and reduce the Kidney below to guide cold downward. Generally, cold transforms from Water. The branch of hiccups is in the Stomach, but the root is in the Kidney.)"

Huangdi asked: "Why do people sigh and sob? What Qi causes this?" Qibo said: "This occurs when Yin Qi is excessive and Yang Qi is deficient, Yin moves rapidly while Yang moves slowly, and Yin is extremely abundant while Yang is depleted, resulting in sighing and sobbing. (Xi is synonymous with Xi, referring to the gasping sound during crying. Definitions describe it as gasping and drawing breath while weeping bitterly. Some say it is the lingering sound after crying. Others say it is grief without tears. Grief and sorrow arise from Yin and gloom, making it a sign of Yin excess and Yang deficiency. Xi sounds like 'xi', also 'xi'.) Treatment should involve tonifying Foot Taiyang (Bladder Meridian) and reducing Foot Shaoyin (Kidney Meridian). (It should also refer to Shenmai (BL62) of Yang Qiao Mai and Zhaohai (KI6) of Yin Qiao Mai. Rationale seen previously.)"

Huangdi asked: "Why do people shiver with cold? What Qi causes this?" Qibo said: "Cold pathogen lodges in the skin, Yin Qi is excessive, and Yang Qi is deficient, causing shivering and chills. Treatment should involve tonifying all Yang meridians. (Shivering with cold means feeling fearful of cold and trembling. Tonifying all Yang meridians refers to selecting appropriate points from the Yuan and He points of the three Yang meridities of the hands and feet, as well as Yang Qiao Mai, etc.)"

Huangdi asked: "Why do people belch? What Qi causes this?" Qibo said: "Cold pathogen lodges in the stomach, Jue Ni (Rebellious Qi) scatters upward from below and re-emerges from the stomach, causing belching. (Belching refers to expelling air after eating. Definition: breathing after a full meal. Rationale seen in Category 25 earlier. Note that this section and the previous mention of hiccups are both caused by cold in the stomach. However, 'old cold' implies deep-seated chronic cold, whereas 'cold lodging' implies superficial, transient cold. Thus, rebellious Qi scatters upward and emerges from the stomach as belching. Yi sounds like 'yi', also 'ai'.) Treatment should involve tonifying Foot Taiyin (Spleen Meridian) and Foot Yangming (Stomach Meridian), or alternatively tonifying Cuanzhu (BL2). (Tonifying Taiyin and Yangming warms the Spleen and Stomach, dispersing lodged cold and eliminating belching. Meiben refers to Cuanzhu (BL2) of Foot Taiyang, which also tonifies Yang Qi.)"

Huangdi asked: "Why do people sneeze? What Qi causes this?" Qibo said: "When Yang Qi is peaceful and smooth, filling the Heart and emerging from the nose, sneezing occurs. (Peaceful and smooth Yang Qi overflows from the Heart, reaches the Lungs, and emerges from the nose as a sneeze. However, sneezing triggered by wind-cold occurs because cold pathogen binds the skin and hair, trapping Yang Qi which then erupts upward. This confirms that sneezing originates from Yang Qi. Zhang Zhongjing said: 'If one wants to sneeze but cannot, there is cold in the abdomen,' indicating Yang deficiency. Thus, for patients with Yang deficiency who suddenly sneeze after a long period, it is a good omen of returning Yang Qi. Ti sounds like 'ti'.) Treatment should involve tonifying the Ying point of Foot Taiyang at Meiben, or alternatively above the eyebrows. (When Yang is deficient below, it cannot reach above to cause sneezing. Tonifying the Ying point of Foot Taiyang at Meiben, named Cuanzhu or located above the eyebrow, tonifies Yang within Yin. As stated in *Xuan Ming Wu Qi Pian*: 'The Kidney manifests as yawning and sneezing.' This aligns with the current explanation. See Category 25 earlier.)"

Huangdi asked: "Why does the body tremble and sag? What Qi causes this?" Qibo said: "If Stomach Qi is insufficient, all pulses become weak. Weak pulses lead to laxity of sinews and vessels. Laxity causes weakness when exerting force during walking, and Qi cannot recover, resulting in trembling and sagging. ( , defined as a drooping appearance. Also interpreted as avoiding. Previous commentators used these definitions, but they seem inconsistent with the classic meaning. I recall the colloquial term 'Zhan ', likely an ancient remnant, suggesting is related to trembling. Trembling due to cold is called 'Han Zhan'; trembling not due to cold is caused by Qi deficiency. The Stomach is the Sea of the Five Zang and Six Fu organs. If Stomach Qi is insufficient, pulses weaken and laxity arises. Exertion further depletes Yang Qi, causing trembling. Although this symptom is common, its name is rarely heard. I believe it refers to this condition, awaiting clarification by experts. Duo sounds like 'duo'.) Treatment depends on the location, tonifying the space between muscles and flesh. (Trembling in the four limbs has specific locations. The Stomach corresponds to muscle. Therefore, treat based on the location, tonifying the intermuscular spaces to strengthen Stomach Qi.)"

Huangdi asked: "Why do people cry and shed tears and mucus when grieving? What Qi causes this?" Qibo said: "The Heart is the master of the Five Zang and Six Fu organs. The eyes are the gathering place of Zong Mai (Major Vessels) and the pathway for upper fluids. The mouth and nose are the gates of Qi. Therefore, grief and sorrow move the Heart, causing all Zang-Fu to tremble. Trembling stimulates Zong Mai, opening the fluid pathways, leading to the discharge of tears and mucus. (Zong means total/gathering. Essence-Qi of all Zang-Fu ascends to the eyes, making them the gathering place of Zong Mai and the pathway for upper fluids. Qi enters and exits via mouth and nose, serving as the gate. Where Qi goes, fluids follow: saliva from the mouth, nasal mucus from the nose, tears from the eyes. All are upper fluids. Discharge originates from the Heart. As master of Zang-Fu, if grief moves the Heart, Zang-Fu respond and tremble, stimulating Zong Mai, opening fluid pathways, and causing tears/mucus. Fluids nourish essence and moisten orifices. If upper fluid pathways open, tears flow. Unceasing tearing depletes fluids. Depleted fluids fail to nourish essence. Without essence nourishment, vision is lost, termed 'Duojing' (Deprivation of Essence). Essence transforms from fluids; orifices are filled by fluids. Loss of fluids injures essence, causing dimness and eventual blindness. Many lose sight due to excessive crying. Compare this with *Jie Jing Wei Lun*, see lower volume. Kong is synonymous with Kong.) Treatment should involve tonifying Tianzhu (BL10) along the neck. (Tianzhu is a point on Foot Taiyang Bladder Meridian, located alongside the posterior neck.)"

Huangdi asked: "Why do people sigh deeply? What Qi causes this?" Qibo said: "Worry and thought cause tension in the Xin Mai (Heart Vessel). Tension restricts the Qi pathway, causing obstruction. Deep sighing expands the chest to relieve this. (Tai Xi is a long, deep breath, i.e., sighing. Yue means binding. Worry and thought suppress Qi, causing Heart Vessel tension and Qi pathway restriction, leading to chest fullness. Sighing is involuntary.) Treatment should involve tonifying Hand Shaoyin (Heart Meridian) and Hand Jueyin (Pericardium Meridian), and retaining needle in Foot Shaoyang (Gallbladder Meridian). (Hand Shaoyin is Heart. Xin Zhu is Pericardium. Foot Shaoyang is Gallbladder. Supporting Wood and Fire organs soothes Yang Qi and resolves depression, warranting needle retention for tonification.)"

Huangdi asked: "Why does saliva flow excessively? What Qi causes this?" Qibo said: "Food enters the stomach. Heat in the stomach causes worms to move. Worm movement relaxes the stomach. Relaxation opens Lianquan, causing saliva to flow. (Foot Yangming meridian emerges from the mouth. Heat causes worm movement and stomach relaxation, opening Lianquan. Excessive tearing and rhinorrhea also result from heat opening upper fluid pathways. Some say severe Lung heat causes rhinorrhea, similar principle.) Treatment should involve tonifying Foot Shaoyin (Kidney Meridian). (The Kidney is the gate of the Stomach and its meridian connects to the tongue. Tonifying strengthens Water to control Fire, governing fluids and stopping salivation.)"

Huangdi asked: "Why does the ear ring? What Qi causes this?" Qibo said: "The ear is the gathering place of Zong Mai. Emptiness of the Stomach leads to weakness of Zong Mai. Weakness causes Qi to sink, exhausting the pulses, resulting in tinnitus. (All hand and foot Yin and Yang meridians enter the ear, making it a gathering place of Zong Mai. Yangming is the sea of pulses. Stomach emptiness weakens Zong Mai, preventing Yang Qi from ascending and causing it to sink. Sinking exhausts the upper part, causing mild tinnitus or severe deafness. Shaoyang excess can also cause tinnitus due to blockage, but deficiency is gradual while excess is sudden. Differentiation lies in the presence of pathogen. Liu sounds like 'liu'.) Treatment should involve tonifying Keyuren (ST7) and the point where the nail meets flesh on the thumb. (Keyuren is Foot Shaoyang, meeting point of Shaoyang and Yangming. Thumb point is Shaoshang (LU11), Jing-well point of Lung. Tonifying both aids Yang Qi.)"

Huangdi asked: "Why does one bite one's own tongue? What Qi causes this?" (Qibo's answer is missing.) "This is due to Jue Ni (Rebellious Qi) rising, with pulse Qi arriving in clusters. Arrival of Shaoyin Qi bites the tongue; Shaoyang Qi bites the cheek; Yangming Qi bites the lip. (Bei means category/class. Rising rebellious Qi causes surging blood and Qi, creating strange disorders. Each location has specific sites: Shaoyin runs to the tongue base, Shaoyang to the jaw, Yangming around the lips. Swelling or itching occurs depending on the site, leading to biting. Bei is vulgarly written as HT. Nie sounds like 'nie'.) Observe the primary diseased meridian and tonify it. (Tonify the meridian identified as the main pathology.)"

"These twelve evils are all odd pathogens affecting the orifices. (Unlike common diseases, hence 'odd pathogens'.) Wherever the pathogen resides, it is due to deficiency. (Only when Zheng Qi is deficient can Xie Qi invade. *Nan Jing 75* states: 'If you cannot treat the deficiency, how can you ask about the rest?' implying this deep meaning.) If Upper Qi is insufficient, the head feels empty, ears ring painfully, the head feels heavy and inclined, and the eyes dizzy. (Qing means heavy/unable to support. Xuan sounds like 'xuan', also departing tone.) If Middle Qi is insufficient, urination and defecation become abnormal, and the intestines rumble painfully. Water transformation relies on Qi. (Thus, Middle Qi insufficiency alters urine/stool color and volume, often due to desire, fatigue, or essence depletion. Ignorant practitioners mistake this for Fire, leading to errors. Middle Qi insufficiency allows turbid Qi to occupy, causing intestinal rumbling. Sou sounds like 'sou'.) If Lower Qi is insufficient, Wei (atrophy) and Jue (cold extremities) occur, along with heart . (Wei is leg weakness. Jue is cold limbs. refers to stifling sensation. Lower Qi insufficiency disrupts ascent/descent, causing Heart Qi stagnation and stifling. Mu sounds like 'mu'.) Treatment should involve tonifying the point below the lateral malleolus and retaining the needle. (This is Kunlun (BL60), a Jing-river point of Foot Taiyang. It treats Qi deficiency in upper, middle, and lower Jiao. Huai sounds like 'huai'.)"

Huangdi asked: "How to treat them?" (Asking again to supplement previous omissions.) Qibo said: "Kidney governs yawning; take Foot Shaoyin. Lung governs hiccups; take Hand Taiyin and Foot Shaoyin. (Previous text didn't link yawning to Kidney, clarified here. Hiccups originate in Stomach but are governed by Lung due to cold rebelling upward, affecting Qi in Stomach but rooted in Lung.) For Xi (sighing/sobbing), Yin and Yang are severed; tonify Foot Taiyang, reduce Foot Shaoyin. (Severance means Yang doesn't attach to Yin. Tonifying Yang and reducing Yin harmonizes rigidity and flexibility.) For Zhen Han (shivering), tonify all Yang. For Yi (belching), tonify Foot Taiyin and Yangming. For Ti (sneezing), tonify Foot Taiyang Meiben. For (trembling), tonify intermuscular spaces at the affected site. For crying, tonify Tianzhu along the neck (neck midline). For Tai Xi (sighing), tonify Hand Shaoyin, Pericardium, and retain needle in Foot Shaoyang. For saliva flow, tonify Foot Shaoyin. For tinnitus, tonify Keyuren and thumb nail junction. For self-biting, tonify the primary diseased meridian. For dizziness and head heaviness, tonify below lateral malleolus and retain needle. (Treatments match previous text. For Wei/Jue/heart stifling, prick two cun above the big toe joint and retain, or below ankle. Two cun above big toe is Taichong (LR3) of Liver, or Taibai (SP3) of Spleen, differing slightly from above. Below ankle refers to previous explanation.)"