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Huangdi asked: There are people whose qi rebels, preventing them from lying down, accompanied by noisy breathing; there are those who cannot lie down but breathe silently; there are those whose daily activities remain normal yet their breathing is noisy; there are those who can lie down but pant when walking; there are those who cannot lie down, cannot walk, and pant; and there are those who cannot lie down and pant as soon as they lie down. Which organ's pathology causes each of these conditions? I wish to hear the explanation. (From *Suwen: Ni Tiao Lun*.)

Qibo replied: Those who cannot lie down and have noisy breathing suffer from rebellion of Yangming Qi. The Qi of the three Yang meridians of the foot normally descends; now it rebels and ascends, hence the noisy breathing. (The Qi of the three Yang meridians of the foot all descends, while the Qi of the three Yin meridians of the foot all ascends, reflecting the principle that Heaven's Qi descends and Earth's Qi ascends. Therefore, if Yangming Qi ascends, it is rebellion. Rebellion connects the Qi to the Lung, causing noisy breathing, which indicates the failure of Stomach Qi to descend.)

The Yangming meridian is the meridian of the Stomach. The Stomach is the sea of the six Fu organs, and its Qi also should descend. If Yangming Qi rebels and cannot follow its proper pathway, one cannot lie down. (Yangming is the sea of water and grain. If Qi rebels and fails to descend, it rushes upward, thus preventing lying down.) The *Xia Jing* states: "When the Stomach is not harmonious, sleep is uneasy." This refers to such cases. (*Xia Jing* is an ancient classic. "Uneasy" refers to tossing and turning restlessly. Nowadays, people who overeat or suffer from distension often sleep uneasily, all due to disharmony of Stomach Qi. Note: The condition mentioned earlier of "cannot lie down but breathes silently" follows the same logic, so no further answer is given.)

As for those whose daily activities remain normal yet breathing is noisy, this is due to rebellion of the collateral vessels of the Lung. The Qi in the collateral vessels cannot move up and down with the main meridians, so it stagnates in the meridians and fails to circulate smoothly. Since the disease in the collateral vessels is minor, daily activities remain normal, manifesting only as noisy breathing. (The disease is neither in the Stomach nor in the Zang organs, so daily activities are normal. Qi rebelling in the collateral vessels of the Lung indicates a superficial and mild condition, manifesting merely as noisy breathing. The condition mentioned earlier of "can lie down but pants when walking" is similar in logic, so no further answer is given.)

As for those who cannot lie down and pant immediately upon lying down, this is caused by the invasion of Water Qi. Water flows along with body fluids. The Kidney is the Water organ, governing body fluid metabolism, and thus governs both sleep and panting. (In Water diseases, the root lies in the Kidney, and the branch manifests in the Lung. Hence, the inability to lie down and panting upon lying down indicate simultaneous involvement of both root and branch. For detailed principles, see Section 38 on Acupuncture. The condition mentioned earlier of "cannot lie down, cannot walk, and pants" is similar in logic to this section, so no further answer is given. Commentary: The discussion in this chapter regarding panting and inability to lie down distinguishes between the Lung, Stomach, and Kidney. When located in the Lung collaterals, daily activities are normal with only noisy breathing, representing the mildest form. When located in the Stomach, inability to lie down with noisy breathing is more severe than Lung involvement. When located in the Kidney, inability to lie down with immediate panting is the most severe. Noisy breathing is the precursor to panting; if panting originates from the Kidney, the disease is at the root. Thus, the deeper the disease, the more severe it becomes. The logic applies similarly to panting caused by deficiency consumptive disorders, which must be carefully observed.)

Huangdi asked: What causes discomfort in specific areas during sleep? (From *Suwen: Bing Neng Lun*)

Qibo replied: It is because the Zang organs have been injured. (Any injury to the five Zang organs can cause restless sleep, such as those resulting from emotional stress, overwork, improper diet, or exposure to wind and cold.) When the essence finds its proper residence, peace is restored, so one cannot simply ignore the disease. ("Zhi Ji" refers to the return of Qi to its proper state. The five Zang organs store essence. Injury to the Zang leads to loss of essence; loss of essence leads to unrest of the Shen (Spirit). Therefore, one must restore essence and calm the Shen to achieve peaceful sleep. Otherwise, once the disease has taken hold, how can it be disregarded without consequence?)

Huangdi asked: Why can some people not lie on their backs? (Yan means lying on one's back, pronounced "dian".)

Qibo replied: The Lung is the canopy of the Zang organs. (Among the five Zang organs corresponding to Heaven, the Lung is supreme, thus serving as the canopy for the five Zang and six Fu organs.) When Lung Qi is excessive, the pulse becomes large. A large pulse prevents lying on the back. ("Excessive" here refers to excess pathogenic factors, causing a large pulse. When pathogenic factors are abundant in the Lung, lying on the back causes rapid and labored breathing, making it impossible.) Relevant discussions can be found in the chapters *Qi Heng* and *Yin Yang*. (These are titles of ancient classic chapters.)