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(From *Ling Shu: Wei Qi Shi Chang* Chapter)

Huang Di asked: When Wei Qi (Defensive Qi, 卫气) remains in the abdomen, accumulates and fails to circulate, becoming stagnant and unable to flow normally, causing fullness in the limbs, hypochondrium, and epigastrium, as well as wheezing and dyspnea (喘呼逆息), how should this be treated? (Wei Qi is the vigorous and rapid aspect of the essence derived from food and water. Normally, it circulates within the skin, between the muscle layers, steams into the Hui membrane (肓膜), and disperses throughout the chest and abdomen; this is the normal state of Wei Qi. When it loses its normal course, it sinks inward with pathogenic factors, remaining in the abdomen, accumulating without moving, and stagnating to cause disease. Thus, the *Jin Fu* chapter states that "Wei Qi is the mother of a hundred diseases." Yuan (苑) is synonymous with Yu (郁), meaning stagnation.)

Bo Gao replied: If the Qi accumulates in the chest, treat it by selecting points above; if it accumulates in the abdomen, treat it by selecting points below; if both upper and lower regions are full, treat it by selecting points on the sides.

Huang Di asked: How exactly should one select these points?

Bo Gao answered: For accumulation in the upper region, reduce Renying (ST9, Human Well), Tiantu (CV22, Heavenly Tower), and Houzhong (CV23, Throat Middle); (Accumulation in the upper region manifests as wheezing and dyspnea, so reduction should be applied at the upper points. Renying belongs to the Foot-Yangming Stomach Meridian. Tiantu and Houzhong belong to the Ren Mai (Conception Vessel). Houzhong is identical to Lianquan (CV23, Spring under the Chin).) For accumulation in the lower region, reduce Zusanli (ST36, Three Mile) and Qijie (ST30, Street of the Hip); (Accumulation in the abdomen requires reducing the lower points. Zusanli and Qijie both belong to the Foot-Yangming Stomach Meridian.) For fullness in both upper and lower regions, treat both upper and lower areas, plus the point one cun below the costal margin; for severe cases, use the "Chicken-Foot" needling technique. (When both upper and lower regions are diseased, points in both areas should be selected, such as the five points mentioned above. The point one cun below the costal margin corresponds to Zhangmen (LR13, Gate of the Rib), belonging to the Foot-Jueyin Liver Meridian. For severe diseases, the Chicken-Foot technique should still be used, which means clustering needles like chicken claws, also known as Hegu Ci (合谷刺, Valley-Needle) described in the *Guan Zhen* chapter, detailed in item six previously. Another version states one cun deep below the costal margin.) If pulse diagnosis reveals a large and wiry-taut pulse, or an absent pulse, or severe tension of the abdominal skin, acupuncture is contraindicated. (A large and wiry-taut pulse indicates Yin deficiency and the manifestation of the True Organ pulse. An absent pulse indicates the depletion of Ying Qi (Nutritive Qi). Severe abdominal skin tension indicates the severance of Zhonghe Qi (Central Harmonizing Qi) and the failure of Spleen Yuan (Spleen Primordial Qi). Acupuncture is not suitable.)

Huang Di said: Excellent.

Huang Di asked Bo Gao: How can one identify diseases of the Skin, Flesh, Qi, Blood, Tendons, and Bones?

Bo Gao said: When the complexion shows thin luster at the glabella (two eyebrows), the disease is in the Skin. (The area between the two eyebrows is called Guazhong; it corresponds to the Lung, which governs the skin, hence the disease is in the skin.) When the lips display colors of green, yellow, red, white, or black abnormally, the disease is in the Flesh/Muscle. (The Spleen's Qi connects to the lips, hence the disease is in the flesh.) When Ying Qi presents with dampness/moisture signs, the disease is in the Qi and Blood. (Ru implies wetness. Ying Qi is originally formless; manifestations such as sweating at the skin pores, swelling of muscles, and diarrhea/dysuria are all considered Ru signs. Disease in the Ying level involves Qi and Blood.) When the eyes show abnormal colors of green, yellow, red, white, or black, the disease is in the Tendons. (The eyes are the orifices of the Liver, and the Liver governs the tendons, hence the disease is in the tendons.) When the ears appear dry, withered, scorched, and covered in dust, the disease is in the Bones. (The ears are the orifices of the Kidney, and the Kidney governs the bones, hence the disease is in the bones.)

Huang Di asked: What are the clinical manifestations? How should they be treated?

Bo Gao said: The changes of myriad diseases are countless, but the Skin has its sectors, the Muscle has its pillars, Qi and Blood have their transport points, and the Bone has its attachments.

Huang Di said: I wish to hear the rationale.

Bo Gao said: The sector of the Skin transports to the four extremities. (Disease in the skin belongs to the Yang level. Yang Qi receives energy from the four extremities because the skin is superficial and Qi is floating; thus, the skin sector transports to the four extremities.) The pillars of the Muscle are located in the intermuscular spaces of the Yang meridians of the arms and legs, and in the intermuscular spaces of the Foot-Shaoyin meridian. (For disease in the muscle, one should treat its pillars. Pillars refer to thick, firm muscle masses. Firm and dense muscles are mostly found in the intermuscular spaces of the Hand and Foot Three-Yang meridians because flesh is governed by the Spleen, which governs the four limbs. The Foot-Shaoyin Kidney Meridian originates from the sole of the foot, follows behind the medial malleolus, enters the heel, ascends along the medial aspect of the popliteal fossa, emerges from the medial edge of the popliteal fossa, ascends along the posterior-medial aspect of the thigh, meets at the sacrum and buttocks, penetrates the spine; the muscles here are dense, so they also serve as muscle pillars.) The transport of Qi and Blood distributes through the collateral vessels; when Qi and Blood stagnate, they become abundant and raised. (For disease in Qi and Blood, one should treat the transport points. Transporting to various collaterals refers to the Luo-Connecting points of the various meridians. When Qi and Blood stagnate, the meridians become congested and prominent, so these points should be selected.) The sector of the Tendons has no Yin/Yang distinction and no Left/Right distinction; one should observe and treat according to the location of the disease. (For disease in the tendons, there is no need to distinguish Yin/Yang or Left/Right; treatment should follow the site of the pathology.) The attachment of the Bone refers to the bone cavities (joint spaces), which benefit the brain and marrow. (For disease in the bone attachments, one should treat the bone cavities to nourish the marrow. Marrow fills the bones, so nourishing marrow is equivalent to treating the bone. The meaning of bone cavities is detailed in the Meridians category, item nineteen.)

Huang Di asked: How exactly should one select the points?

Bo Gao said: The changes of disease vary in floating/sinking and shallow/deep levels, which are inexhaustible and located in different places. For mild diseases, needle shallowly; for severe diseases, needle deeply. For mild diseases, use few points; for severe diseases, use many points. By adjusting Qi according to the variations of the disease, one is called a Shang Gong (Superior Physician). (Mild disease implies light severity, so needling should be shallow and sparse. Severe disease implies heavy severity, so needling should be deep and extensive. Pathological changes are infinite; those who can adjust treatment appropriately according to these changes are called Superior Physicians.)