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Huangdi asked: The physical form varies in being loose or tense, the vital qi (Zheng Qi) in being abundant or deficient, the bones in size, the muscles in firmness or fragility, and the skin in thickness. How can longevity or premature death be determined based on these features?

Bo Gao replied: Longevity is indicated when the physical form and vital qi are in harmony; premature death occurs when they are disharmonious. Longevity is indicated when the skin and muscles are tightly enveloped together; premature death occurs when they are not closely bound. Longevity is indicated when the blood, qi, and meridians are strong enough to overcome the demands of the physical form; premature death occurs when they cannot.

Huangdi asked: What is meant by the looseness and tension of the physical form?

Bo Gao said: A person with a substantial body but loose and relaxed skin will live long; one with a substantial body but tight and tense skin will die young. If the body is substantial and the pulse is firm and large, it is a favorable sign. If the body is substantial but the pulse is small and weak, it indicates deficient qi, which is dangerous. If the body is substantial but the cheekbones do not protrude, it indicates a small kidney, leading to early death. If the body is tall, and the skin and muscles are firm with clear separations, the muscles are firm, indicating longevity. If the body is tall, but the skin and muscles lack texture and are not firm, the muscles are fragile, indicating early death. These are the natural laws of life, used to establish the physical form and determine the state of qi to assess longevity. One must understand this clearly to evaluate the form and qi before treating patients and determining life and death.

Huangdi asked: How does the mutual overcoming between form and qi determine longevity?

Bo Gao said: In a healthy person, if qi exceeds the form, it indicates longevity. In a sick person, if the flesh and muscles are wasted away yet qi appears excessive (often implying pathogenic excess or floating true qi), it indicates death. If the form exceeds the qi, the condition is critical.

Generally, the five zang organs are the internal repositories. If there is internal fullness and organ distension, accompanied by qi rebellion causing fear, and the voice sounds muffled as if coming from within a room, this indicates dampness in the middle jiao (Middle Burner). If speech is faint and repeated throughout the day, this indicates depletion of qi (Duo Qi). If a person fails to arrange their clothing properly, speaks without discerning good from bad, and ignores distinctions between relatives and strangers, this indicates chaos of the spirit (Shen). If the granaries (Spleen and Stomach) fail to store essence, it is because the gates (sphincters/functions) lack control. If urine flows incessantly, it is because the Bladder fails to store. Retention leads to life; loss leads to death.

The five zang organs are the strength of the body. The head is the residence of clarity and spirit; if the head droops and the eyes are sunken, the spirit is about to be depleted. The back is the residence of the chest (Heart and Lungs); if the back is curved and shoulders collapse, the residence is about to fail. The waist is the residence of the Kidney; if turning and shaking the waist is difficult, the Kidney is about to become exhausted. The knees are the residence of the sinews; if flexion and extension are impossible, and walking requires stooping, the sinews are about to exhaust. The bones are the residence of the marrow; if one cannot stand for long and walks with trembling legs, the bones are about to exhaust. Strength leads to life; loss of strength leads to death.

Qibo said: Those who go against the changes of the four seasons show accumulation of essence (excess) where there should be abundance, and consumption (deficiency) where there should be insufficiency. When excess is expected but deficiency is present, it is essence depletion; when insufficiency is expected but excess is present, it is pathological fluctuation. When Yin and Yang do not correspond, the disease is named Guan Ge (Guan-Ge syndrome, characterized by severe obstruction of yin and yang).

Those with strong bones, tough sinews, relaxed muscles, and thick skin can tolerate pain. They can also tolerate the pain of acupuncture and moxibustion, as well as intense heat. Those with dark complexion and beautiful, solid bones can further tolerate the heat of fire therapy (Moxibustion). Those with firm muscles but thin skin cannot tolerate the pain of needles and stones, nor the heat of fire.

When injured simultaneously, those with more heat in the body recover easily; those with more cold recover with difficulty. Those with strong stomach qi, dark complexion, large bones, and plump flesh can all tolerate toxic drugs; those who are thin and have scant flesh cannot tolerate toxic drugs.