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Ping An: This chapter, from beginning to end, is found in *Ling Shu* (Spiritual Pivot), Volume 10, Chapter 68 "Shang Ge" (Upper Diaphragm), and also in *Jia Yi Jing* (Classified Classic of Jia Yi), Volume 11, Chapter 8.

Huang Di asked Qi Bo: "Qi reversal causes Shang Ge (upper diaphragmatic obstruction/abscess). Regarding Shang Ge, food and drink enter but are immediately regurgitated; I already understand this. Parasites cause Xia Ge (lower diaphragmatic obstruction/abscess). Regarding Xia Ge, food remains for a time before being expelled; I do not yet grasp the meaning behind it. I wish to hear you explain it thoroughly." (Note: 'Ge' is interchangeable with 'Zhi', meaning abscess. When qi pathogen resides in the upper tube causing an abscess and blockage, food enters and is vomited out immediately. When parasite pathogen resides in the lower tube, parasites move upon eating and exit; after they leave, the lower part becomes deficient, leading to accumulation and abscess formation, hence the inquiry. Ping An: In *Ling Shu*, 'Ge' is written as 'Ge' (diaphragm); the characters 'Shang Ge' are not repeated. In *Jia Yi Jing*, there is no character 'Yin' (drink) before 'Ru' (enter).)

Qi Bo replied: "If joy and anger are not regulated, if diet is not moderated, and if cold and warmth are not timed appropriately, then cold fluid will flow into the intestines. Once flowing into the intestines, the parasites become cold. When the parasites become cold, they accumulate and remain in the lower tube. Remaining in the lower tube causes the lower tube to become distended. Wei Qi (Defensive Qi) fails to circulate, and evil qi occupies the space. When a person eats, the parasites move upward to feed. As the parasites move upward, the lower tube becomes deficient. Deficiency allows evil qi to prevail. Accumulated pathogens remain; prolonged retention leads to abscess formation. Once the abscess forms, the lower tube becomes constricted. If the abscess is within the tube, the pulse feels deep and the pain is profound. If the abscess is outside the tube, the abscess is visible externally and the pain is superficial, with heat on the skin overlying the abscess." (The etiology of parasitic abscess involves three factors: first, emotional disturbance injuring the spirit, lacking harmony; second, indulgence in desires and unregulated diet; third, exposure to cold or heat according to mood, disregarding seasonal timing. If any one of these three factors lacks harmony, cold evil fluid flows down into the intestines, chilling the internal parasites, causing them to fill the lower tube, preventing Wei Qi from circulating, and allowing evil qi to occupy the area. Furthermore, due to eating, the parasites move upward, leaving the lower tube deficient. Evil qi accumulates to form an abscess. If the abscess is inside the tube, the pain is deep; if outside, the pain is superficial, accompanied by heat on the skin over the abscess, serving as a sign. Ping An: In *Jia Yi Jing*, 'Liu' (flow) in 'cold fluid flows into the intestines' is written as 'Liu' (remain); 'Liu yu chang zhong ji chong han' is written as 'Liu ze chong han'; 'Guan' (tube) is written as 'Wan' (stomach cavity); 'Ze xia guan chong guo wei qi bu ying' is written as 'Shou xia wan ze chang wei chong guo wei qi bu ying'. In *Ling Shu*, 'Ze xia guan chong guo' has 'ze' followed by 'chang wei chong guo'; 'Xu ze xie qi sheng zhi' is written as 'Xia guan xu ze xie qi sheng zhi'. In *Jia Yi Jing*, there is no 'Zhi' after 'Sheng', but there are 'Sheng Ze'. In *Ling Shu*, 'Ze Chen' is written as 'Ji'.)

Huang Di asked: "How should acupuncture be performed?" Qi Bo said: "Lightly press the abscess to observe the movement of qi." (Press lightly with the hand over the abscess to examine its qi, aiming to know three aspects of the abscess qi's movement: first, to determine the excess or deficiency of the abscess qi; second, to ascertain the depth or shallowness of the abscess; third, to identify the key point for needling. Thus, pressing is used for observation. Ping An: *Jia Yi Jing* omits the character 'Wei' (slightly/lightly).) "First, needle shallowly around the periphery, then gradually deepen the insertion, following the direction of the qi, without exceeding three passes. (Observe where the qi arrives near the abscess; start with shallow needling and gradually deepen it to guide the qi to move. 'Huan' means repetition. Repeat such needling, but do not exceed three passes. Ping An: 'Sui' is written as 'Huan' in *Ling Shu* and *Jia Yi Jing*. According to the commentary note, it should also be 'Huan', likely a transcription error.) Observe the floating or sunken nature [of the abscess] to determine the depth of insertion. (Floating and sunken refer to depth; observe the depth of the abscess to decide the needle depth. Ping An: *Jia Yi Jing* writes 'Qian Shen' [shallow and deep].)" "After needling, apply moxibustion or hot compresses to ensure heat penetrates inward. Daily application of internal heat will cause evil qi to decline further, allowing the large abscess to suppurate and drain." (Cold fluid and evil qi accumulate to form the abscess, causing blockage. Applying heat via needling and warming therapies ensures internal heat generation daily. As cold dissipates, the abscess drains.) "Adhere to the contraindications of the Can Wu diagnostic method to eliminate internal pathogens. (Alternatively, hold pig fat paste in the mouth, avoid cold food, and the disease will resolve in three days. 'Can Wu' refers to comparative assessment and judgment. Ping An: *Jia Yi Jing* writes 'Hu Yi Can Jin'; *Ling Shu* writes 'Wu Yi Can Jin'.)" "Maintain a tranquil and non-action-oriented state of mind to allow qi to circulate. (When emotions are attached, qi becomes congested. Congested qi cannot nourish Wei Qi. Therefore, by forgetting desires and maintaining tranquility and non-action, qi will self-nourish. Ping An: In *Ling Shu* and *Jia Yi Jing*, the character is 'Dan'; Yuan edition writes 'Dan'.)" "Subsequently, administer sour and bitter substances to facilitate the digestion and downward movement of grain." (Sour corresponds to Shaoyang, and bitter corresponds to Taiyang. These two flavors are warm in nature, thus aiding the transformation of food. Ping An: In *Ling Shu*, 'Suan' (sour) is written as 'Xian' (salty). In *Jia Yi Jing*, this sentence reads: 'Subsequently take sour and bitter substances, transforming grain so it descends through the diaphragm.')