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(From *Lingshu: Xieke Pian* and *Da Huo Lun*)

Huangdi asked Bogao: When pathogenic factors invade the human body, some cause people to keep their eyes open and be unable to sleep. What qi causes this? (From *Lingshu: Xieke Pian*)

When pathogenic factors invade the human body, they prevent the generation of sleep, hence it is called "unable to sleep." Ming (close eyes), pronounced míng, also read with the departing tone. Bogao replied: When five grains enter the stomach, their dregs, body fluids, and Zong Qi (Gathering Qi) are divided into three channels for transport. Therefore, Zong Qi accumulates in the chest, emerges from the throat, penetrates the Heart vessels, and governs respiration. (Zong Qi is also known as Da Qi [Great Qi]. Sui refers to a channel or pathway. The channel for dregs emerges from the Lower Jiao; the channel for body fluids emerges from the Middle Jiao; the channel for Zong Qi emerges from the Upper Jiao, thus forming three channels. The throat is the connection of the Lung, extending downward to connect with the Heart, allowing the passage of Zong Qi to govern respiration. Po is pronounced pò. Sui is pronounced suì.) Ying Qi (Nutritive Qi) secretes body fluids, injects them into the vessels, transforms them into blood, nourishes the four extremities, and internally irrigates the Five Zang and Six Fu organs, its circulation rhythm corresponding to the water clock. (Ying Qi originates from the Middle Jiao. The Middle Jiao receives the essence of food and drink, secretes body fluids, and transforms them into blood vessels. Externally reaching the limbs and internally reaching the viscera, it permeates everywhere; thus, its number of circulations corresponds to the water clock. For detailed principles, see Meridians Category 24 and 26. Mi is pronounced bì, describing the appearance of spring water flowing.) Wei Qi (Defensive Qi) emits its fierce and slippery nature, proceeding first among the four extremities, interstices of muscles, and skin without rest. During the day, it travels in the Yang aspects; at night, it travels in the Yin aspects, usually starting from the interspaces of Foot Shaoyin Kidney Channel, traveling through the Five Zang and Six Fu organs. (Wei Qi is the fierce qi derived from food and drink. Its nature is swift and slippery, unable to enter the vessels, so it proceeds first among the extremities, muscle interstices, and skin without rest. For detailed principles, see this category item 67 and Meridians Category 6. Traveling in Yang during the day usually begins with Foot Taiyang Bladder Channel; traveling in Yin at night usually begins with Foot Shaoyin Kidney Channel, see Meridians Category 25 for details.)

Now, if Jue Qi (Rebellious Qi) lodges in the Five Zang and Six Fu organs, Wei Qi can only guard the exterior, traveling in the Yang aspects and failing to enter the Yin aspects. Traveling in Yang leads to an excess of Yang qi; when Yang qi is excessive, the Yang Qiao vessel becomes deficient/injured. Failing to enter Yin leads to deficiency of Yin qi, resulting in inability to close the eyes. (Pathogenic factors rebelling in the viscera prevent Wei Qi from entering the Yin aspect, causing it to prevail in Yang. Prevailing in Yang causes injury to the Yang Qiao vessel; "Xian" implies injury. Yang excess and Yin deficiency result in inability to close the eyes. Furthermore, the principle in *Da Huo Lun* is identical to this, detailed below. Qiao has five pronunciations: qiāo, jiǎo, qiáo, jiǎo, and jí nüè qiē.) Huangdi said: Excellent. How should it be treated? Bogao said: Tonify what is insufficient, sedate what is excessive. (This refers to tonification and sedation in acupuncture. Tonifying insufficiency involves the Zhaohai point of Foot Shaoyin Kidney Channel, where the Yin Qiao vessel originates. Sedating excess involves the Shenmai point of Foot Taiyang Bladder Channel, where the Yang Qiao vessel originates. If one suffers from excessive Yin and deficient Yang leading to hypersomnia, one should naturally tonify Yang and sedate Yin.) Harmonize deficiency and excess, unblock the pathways, and eliminate pathogenic factors. Administer one dose of Banxia Tang (Pinellia Decoction); once Yin and Yang are unblocked, sleep will resume immediately. (This means that after acupuncture, medication should still be used for treatment. Generally, insomnia due to pathogenic excess belongs to external causes, while insomnia due to Ying deficiency belongs to internal causes. This method of Banxia Tang is specifically designed to eliminate pathogens.) Huangdi said: Excellent. This is what is meant by dredging obstructions, unblocking the meridians extensively, and harmonizing Yin and Yang. I wish to hear the prescription. Bogao said: The formula is as follows: Use eight sheng of running water from a distance of a thousand li, stir and splash it ten thousand times, take five sheng of the clear water for decoction, and use reed firewood as fuel. (Ancient and modern measurements differ. Approximately, one dou of millet in ancient times equals about 3.2 sheng in modern iron hu measures. Thus, eight sheng equals about 2.56 sheng today; five sheng equals about 1.6 sheng today. Once the water boils, add one sheng of Shumi (Glutinous Millet) and half a sheng of prepared Banxia (Pinellia Rhizome), simmer slowly until the volume reduces to one and a half sheng. "Boiling" here means boiling the water first before adding the herbs. Shumi is glutinous millet, similar to Setaria italica but with smaller grains, usable for brewing wine, commonly called small yellow millet in the North. Its nature is sweet, sticky, and slightly cool, capable of nourishing Ying Qi and tonifying Yin. Banxia is acrid and warm, capable of harmonizing the Stomach, dispersing pathogens, relieving abdominal distension, and treating insomnia. Hence, both are used together. One sheng of Shumi is approximately 3.2 chi today; half a sheng of Banxia is approximately 1.6 chi today. Simmering to one and a half sheng is approximately 4.8 chi today. Shu is pronounced shú.) Remove the dregs, drink one small cup, three times a day, gradually increasing the dose until therapeutic effects are observed. For newly onset cases, sleep occurs immediately after drinking, and sweating indicates recovery; for chronic cases, three doses suffice. (Zi is pronounced zǐ, referring to dregs.)

Huangdi asked: What qi causes illness-related insomnia? (From *Lingshu: Da Huo Lun*.)

This discusses insomnia caused by illness. Qibo said: When Wei Qi fails to enter Yin and remains in Yang, Yang qi becomes full. Fullness of Yang qi leads to abundance of Yang Qiao vessel. Failure to enter Yin results in deficiency of Yin qi, causing inability to close the eyes. (Wei Qi travels in Yang during the day and in Yin at night; traveling in Yang leads to wakefulness, traveling in Yin leads to sleep—this is the norm. If illness disrupts this pattern, Qi may remain in Yin or Yang. Retention leads to Yin-Yang imbalance and deficiency, causing abnormal sleep-wake cycles.)

Huangdi asked: What qi causes illness-related inability to open the eyes and see? Qibo said: When Wei Qi remains in Yin and fails to travel in Yang, Yin qi becomes abundant. Abundance of Yin qi leads to fullness of Yin Qiao vessel. Failure to enter Yang results in deficiency of Yang qi, causing the eyes to remain closed. (This discusses illness-related inability to open the eyes and hypersomnia, caused by Wei Qi remaining in Yin, leading to fullness of Yin Qiao and deficiency of Yang. As stated in *Hanre Bing Pian*: Yin Qiao and Yang Qiao intersect; Yang enters Yin, Yin exits Yang, meeting at the inner canthus. Abundant Yang qi leads to opening the eyes; abundant Yin qi leads to closing the eyes for sleep. This aligns with the previous two sections. See Acupuncture Category 44 for details.)

Huangdi asked: What qi causes natural hypersomnia? Qibo said: In such individuals, the intestines and stomach are large, the skin is damp, and the muscle interstices are not loose/efficient. Large intestines and stomach cause Wei Qi to remain longer; damp skin and inefficient muscle interstices cause slow movement. Wei Qi normally travels in Yang during the day and in Yin at night; thus, when Yang qi exhausts, one sleeps, and when Yin qi exhausts, one wakes. Therefore, large intestines and stomach prolong Wei Qi's stay in Yin; damp skin and inefficient muscle interstices slow its movement, prolonging its stay in Yin. Lack of refined Yang qi induces sleepiness, hence hypersomnia. (The following two sections explain differences in hypersomnia and hypsomnolence not caused by disease. "Jie" means efficient/unobstructed. Viscera are internal (Yin); skin and muscles are external (Yang). Large intestines and stomach mean the Yin pathway is circuitous; damp and obstructed muscle texture means the Yang pathway is slow. Thus, Wei Qi stays longer in Yin and less in Yang, lacking refined Yang, leading to frequent sleep. Modern people often feel sleepy after eating because the fierce qi of food suddenly fills the interior, making Wei Qi abundant in Yin, overpowering the refined Yang qi. Laypeople call this "Spleen fatigue," unaware of the underlying mechanism.) Conversely, if the intestines and stomach are small, the skin is smooth and relaxed, and the muscle interstices are efficient, Wei Qi stays longer in Yang, hence less sleep. (Small intestines and stomach mean shorter stay of Wei Qi in Yin; smooth skin and efficient muscles mean longer stay of Wei Qi in Yang, hence less sleep.)

Huangdi asked: What qi causes sudden hypersomnia deviating from normal meridian patterns? (Deviating from normal patterns implies pathology, indicating causation by pathogenic factors.) Qibo said: When pathogenic factors lodge in the Upper Jiao, causing obstruction and blockage, especially after eating or drinking soup, Wei Qi remains long in Yin and cannot exit, causing sudden hypersomnia. (Pathogens in the Upper Jiao combined with food/drink cause Wei Qi to be blocked in the Middle Jiao, unable to reach Yang, leading to sudden hypersomnia. However, there are cases of inability to sleep due to illness, where pathogens lodge in the Zang, repelling Wei Qi and preventing it from returning to Yin. , same as Jiao.) Huangdi said: Excellent. How should these pathogenic conditions be treated? Qibo said: First examine the Zang-Fu organs, correct minor deviations, then regulate Qi. Excess conditions require sedation, deficiency conditions require tonification. One must first clearly understand the patient's physical and mental state of hardship or comfort before determining the treatment. (Treating these pathogens covers the eight syndromes discussed in this chapter. This section classifies five; the other three involving spirit disorder are detailed in Chapter 81. Examining Zang-Fu aims to distinguish the depth of Yin-Yang pathology. Correcting minor deviations means even non-severe conditions must be addressed. Etiologies vary, so observing physical toil and mental comfort is crucial. Generally, hardship/worry damages Heart-Lung Yang; indulgence/comfort damages Spleen-Kidney Yin. Only with clear judgment can treatment proceed.)