黄帝曰。卫气之留于腹中。蓄积不行。菀蕴不得常所。使人股胁胃中满。喘呼逆息者。何以去
之。伯高曰。其气积于胸中者上取之。积于腹中者下取之。上下皆满者旁取之。黄帝曰。取之奈何。
伯高对曰。积于上。泻大迎天突喉中。积于下者。泻三里与气街。上下皆满者。上下取之。与季胁
之下一寸。重者鸡足取之。诊视其脉大而弦急。及绝不至者。及腹皮急甚者。不可刺也。黄帝曰善。
（菀音郁）
此篇论卫气失常。以明卫气所出所主之常所。有浮沉浅深。及太过不及之别。按第七十六之卫气
行章。论卫气昼行于阳。夜行于阴。外内出入之循度。此篇论卫气始生始出之道路。主于皮肉筋骨之
间。所以温分
肉。充皮肤。肥腠理而司开阖者也。夫卫气者。阳明水谷之悍气也。谷入于胃。其精微者。先出于
胃之两焦。以溉五脏。别出两行营卫之道。营行脉中。卫行脉外。所谓别出者。与谷入于胃。乃传
之肺。流溢于中。布散于外。精专者行于经隧。常营无已。终而复始之营气。所出之道路各别也。卫
气与宗气所出之道路各别也。两行者。谓营气出于气分。而行于脉中。卫气出于脉中。而散于脉外。
此阴阳血气交互之妙道也。夫精专者。行于经隧之营血。始于手太阴肺。终于足厥阴肝。脏腑相通。
外内相贯。环转无端。终而复始。与营行脉中。一呼一吸。脉行六寸。日行二十五度。夜行二十五度
之道路各别也。所谓营行脉中。以应呼吸漏下者。乃中焦所生之津液。随三焦出气。外注于皮肤 谷
之气分。渗入于孙脉络脉。化而为赤者也。五癃篇之所谓三焦出气。以温肌肉。充皮肤。为其津。其
流而不行者为液。决气章之所谓糟粕津液宗气。分为三隧。营气者。泌其津液。注之于脉。化而为血。
以营四末。内注五脏六腑。以应刻数。痈疽章之所谓中焦出气如露。上注 谷。而渗孙脉。津液和
调。变化而赤为血。血和则孙脉先满溢。乃注于络脉皆盈。乃注于经脉。阴阳已张。因息乃行。行有
经纪。周有道理。与天协议。不得休止。是行于脉中。以应呼吸之营气。乃中焦所生之津液。随三焦
之出气。注于皮肤分肉之气分。渗于孙络。变化而赤为血。因息乃行。行有经纪。与营气篇之始于手
太阴肺。终于足厥阴肝之道路各别也。宗气积于胸中。上出于肺。循喉咽。呼则出。吸则入。夫肺主皮
毛。人一呼则气出。而八万四千毛窍皆阖。一吸则气入。而八万四千毛窍皆开。此宗气之应呼吸而司
开阖者也。卫气者。出其悍气之 疾。而先行于四末分肉皮肤之间。昼日行于阳。夜行于阴。司昼夜
之开阖者也。呼吸之开阖。人之开阖也。
昼夜之开阖。应天之开阖也。是以营气卫气之所出所行。各有其道。故曰别出两行营卫之道。此篇论
卫气之始生始出。从阳明之脉络。分行于上下四旁。而布散于形身之外。蓄积菀蕴者。犹草木之生
长茂盛于内也。不得常所者。不得所出所主之常处也。故内积于上者。取之大迎天突。盖卫气之上
出者。从胃之大迎。任之天突。而外出于皮肤也。积于下者。取之三里。盖卫气之下出者。从胃之三
里。而外出于皮肤也。积于中者。取之气街。与季胁之带脉。盖卫气之布于四旁者。从腹之气街。带
脉之章门。而外出于四旁也。夫卫气乃胃腑水谷所生之气。足阳明与任脉会于中脘。上会于承浆。与
带脉会于脐之左右。而出于腹气之街。是阳明所生之气。从阳明之经脉而出。散于皮肤。此卫气始出
之常所也。夫卫为阳。从脉而出。由内而外。自阴而出于阳。营为阴。从 谷气分而入于孙脉经脉。自
外而内。由阳而入于阴。此阴阳血气外内交互之妙道也。鸡足者。以足缓伸缓缩。如鸡足之践地。盖
以疏阳明之经脉。以通卫气之所出也。胗视其脉大而弦急。及绝不至者。及腹皮急甚者。此卫气留
滞于始生之处。非蓄蕴于所以所出之道路。故不可取之外穴也。此论卫气始生始出之常所。与行阳行
阴之度数不同。故反论其失常以证明之。
黄帝问于伯高曰。何以知皮肉气血筋骨之病也。伯高曰。色起两眉薄泽者。病在皮。唇色青黄
赤白黑者。病在肌肉。营气濡然者。病在血气。目色青黄赤白黑者。病在筋。耳焦枯受尘垢。病在骨。
此言卫气从内之脉络。布散于皮肉筋骨之间。而各有所在也。色者。气之章也。两眉间。即关中。
乃肺之部。肺合于皮。故色起两眉薄泽。知卫气之病在皮也。肌肉者。脾土之外合。土灌四脏。故观唇
色青黄赤白黑者。知
卫气之病在肌肉也。营者。血之气也。濡、润也。血之液为汗。汗出而濡然者。知卫气之病在血气也。
肝主筋而开窍在目。视目色之青黄赤白黑者。知卫气之病在筋也。筋合于三阴三阳。十二经脉。故五色
之并见也。耳者肾之窍。耳焦枯受尘垢者。知卫气之病在骨也。夫皮肉筋骨。脉外之气分。卫气出于
形身。而各在其处也。
黄帝曰。病形何如。取之奈何。伯高曰。夫百病变化。不可胜数。然皮有部。肉有柱。血气有输。
骨有属。黄帝曰。愿闻其故。伯高曰。皮之部。输于四末。肉之柱。在臂胫诸阳分肉之间。与足少阴分
间。血气之输。输于诸络。气血留居。则盛而起。筋部无阴无阳。无左无右。候病所在。骨之属者。骨
空之所以受益。而益脑髓者也。黄帝曰。取之奈何。伯高曰。夫病变化。浮沉深浅。不可胜穷。各在其
处。病间者浅之。甚之深之。间者少之。甚之众之。随变而调气。故曰上工。（数上声胜平声间去声）
此承上文而言卫气行于皮肉筋骨之间。各有所主之部属也。卫气行于皮。输于四末。为所主之部。
盖卫气出于阳。从头目而下注于手足之五指。故以四末为部也。行于肌肉。在臂胫诸阳分肉之间。为肉
之柱。柱之为言主也。盖肉之大分为谷。小分为 。分肉之间。 谷之会。以行营卫。以会大气。臂
胫之大肉。肉之大分也。营卫大气。先会于大分之间。故以臂胫之肉为主。犹屋宇之有四柱也。足少阴
分间。乃足少阴出于气街。行于分肉之间。卫气者。后天水谷之所生也。会少阴先天之气于分间。此
气之大会也。诸络者。孙脉络脉也。营气从络而行于经脉。卫气从络而出于皮肤。血气输转于诸络
之间。故气血留居。则络脉盛而起矣。卫气之行于骨者。在骨空之所以受益而益脑髓者也。骨空者。津
液淖泽注于骨。骨属屈伸。补益脑髓。髓空在脑后
三分。颅际锐骨之下。盖髓之所以补益脑者。从尾 而渗于脊骨。从脊骨而上渗于髓空以入脑。卫
气一日一夜。大会于风府。其明日日下一节。二十一日。下至尾 。二十二日。入脊内。其行九日。
出于缺盆。故卫气之行于骨者。以脊骨为所属也。卫气之行于筋者。无分阴阳左右。如留滞于手足某
结之筋。即为病之所在。盖卫气者。应天之气也。筋者。厥阴风气之所生也。风者。大块之噫气。充
满于天地之间。故于卫气相合。阴阳左右。无处不有。若夫皮之部。肉之柱。犹天之四方。骨之属。
犹天之道也。百病变化者。审察卫气。为百病母。行于皮肉筋骨之间。是以浮沉浅深。各在其处。
余伯荣曰。卫气司昼夜之开阖。以应天之气也。一日一夜。大会于风府。明日日下一节。二十一日。
下至尾 。二十二日。入脊内。其行九日。上出缺盆。一月而环转一周。是又应月之一月而一周天也。
是以月郭空则海水东盛。卫气去。形独居。盖水与天气上下相通。日月营运。随天道环转。日日行一
度。故一岁而一周天。月行十三度有奇。故一月而一周天。此阴阳之营运无息者也。人与天地相参。
一息不运。则失其旋转之机。而为奇恒之病。学人玩索而有得焉。非惟临病患以观死生。更可以
通玄门。为养生之秘要。
黄帝问于伯高曰。人之肥瘦大小寒温。有老壮少小。别之奈何。伯高对曰。人年五十以上为老。
二十以上为壮。十八以上为少。六岁以上为小。
此论卫气之有盛衰也。年少小者。卫气始长。年壮者。卫气正盛。五十以上。卫气渐衰。盖应天
之气。而有四时生长收藏之盛衰也。方盛衰论曰。老从上。少从下。老者应秋冬之气。从上而方衰于
下。少者应春夏之气。从
下而方盛于上。王子方曰。数始于一。成于三。三而两之为六。三而三之成九。十八者。二九之数
也。二十者。阴阳之生数始也。五十者。五行之生数终也。马玄台曰。十八以上。六岁以上。俱当作以下。
黄帝曰。何以度知其肥瘦。伯高曰。人有肥有膏有肉。黄帝曰。别此奈何。伯高曰。 肉坚皮
满者肥。 肉不坚皮缓者膏。皮肉不相离者肉。（ 音国）
此以下论卫气之所以温分肉充皮肤肥腠理者也。腠理者。肌肉之纹理。如豕之精肉。条分而有理
路。理中之白膜曰脂。肉外连皮之肥肉曰肥。故曰 肉坚而皮满者肥。盖肥在皮之内。肉之外。故肉坚
而皮满也。膏者。即肥之脂膏。谓如豕肉之红白相间而有数层者为膏。盖肥膏之间于肉内。故肉不坚
而皮缓也。此论卫气之肥腠理。故只论膏而不论肥。然先言人有肥者。以明膏肥之有别也。皮肉不相离
者。谓肉胜而连于皮。内无膏而外无肥。此亦卫气之盛于肉理者也。任谷庵曰。 肉者。俗名腿肚
也。盖肉之柱。在臂胫诸阳分肉之间。故 肉坚。则通体之肉坚矣。又只言胫而不言臂者。气从下而
上也。
黄帝曰。身之寒温何如。伯高曰。膏者。其肉淖而粗理者身寒。细理者身热。脂者其肉坚。细理
者热。粗理者寒。
任谷庵曰。此言卫气之所以温分肉也。膏者肉不坚。故其肉淖。淖、和也。言膏与肉之相间而相
和者也。脂者。腠理固密。故其肉坚。粗理者。卫气外泄。故身寒。细理者。卫气收藏。故身热。
黄帝曰。其肥瘦大小奈何。伯高曰。膏者多气而皮纵缓。故能纵腹垂腴。肉者身体容大。脂者其
身收小。
任氏曰。此复申明卫气之所以肥腠理温分肉也。卫气盛则腠理肥。是以膏者多气而皮纵缓。故能
纵腹垂腴。腴者。脐下之少腹也。肉者身体容大。此卫气盛而满于分肉也。脂者。其身收小。此卫气深沉。
不能充于分肉。以致脂膜相连。而肌肉紧充。故其身收小也。余伯荣曰。卫气之所以温分肉者。充实
于肉之理路。所谓血气盛则充肤热肉。盖非只温肌肉。而能使肌肉盛满。身体容大。故反复以申明之。
黄帝曰。三者之气血多少何如。伯高曰。膏者多气。多气者热。热者耐寒。肉者多血。多血则充
形。充形则平。脂者。其血清。气滑少。故不能大。此别于众人者也。
任谷庵曰。此言卫气与营血相将。充盈于分肉之纹理。其膏肥之内。只有卫气而血不营也。膏者
卫气盛。故热而耐寒。肉者肌肉隆盛。故多血。血气盛则充肤热肉。故充形。血随气行。血气皆盛。
是为营卫和平。脂者。肌肉紧密。是以血清气少。故不能大。此三者。有肥瘦大小之不同。故与平人
之有别也。王子方曰。脂者。卫气不充于分肉。是以血亦清少。血气相将而行者也。
黄帝曰。众人奈何。伯高曰。众人皮肉脂膏。不能相加也。血与气不能相多。故其形不小不大。
各自称其身。命曰众人。
余伯荣曰。此言卫气之浮沉浅深。而各有常所者。其形不大不小也。众人者。平常之大众也。不
能相加者。谓血气和平。则皮肉脂膏。不能相加于肥大也。血气之浮沉浅深。各有常所。不能相多于
肌肉间也。皮肉筋骨。各自称其身。故其形不大不小也。
黄帝曰善。治之奈何。伯高曰。必先别其三形。血之多少。气之清浊。而后调之。治无失常经。
是故膏人纵腹垂腴。肉人者。上下容大。脂人者。虽脂不能大也。
此言人之血气。当使之无过不及也。三者。人之有肥大之太过。瘦小之不及。故当审其血之多少。
气之清浊。而后调之。无失卫气之常经。期为平和之人矣。此因卫气失常。是故膏人纵腹垂腴。肉人
者。上下容大。脂人者虽脂不能大也。盖卫气主于皮肉筋骨之间。浮沉浅深。各在其处。若独充盛
于皮肤分肉之间。而使纵腹垂腴。上下容大。或深沉于筋骨之间。以致脂不能大。皆卫气之失常也。
是以浮沉深浅。不可胜穷。随变而调其气。命曰上工。此篇论卫气失常。以明卫气所出所循之常所。
使后学知阴阳血气之生始出入。为治道之张本也。
Huangdi said: When Wei Qi (Defensive Qi) remains in the abdomen, accumulating and failing to circulate, becoming stagnant and unable to follow its normal course, causing fullness in the thighs, hypochondrium, and stomach, along with panting and rebellious breathing, how can it be removed?
Bo Gao replied: If the Qi accumulates in the chest, treat by selecting points on the upper body. If it accumulates in the abdomen, treat by selecting points on the lower body. If both upper and lower are full, treat by selecting points on the sides.
Huangdi asked: How should these points be selected?
Bo Gao answered: For accumulation in the upper part, apply reducing needling to Daying (ST 9), Tiantu (CV 22), and the throat area. For accumulation in the lower part, apply reducing needling to Zusanli (ST 36) and Qichong (ST 30). If both upper and lower are full, select points on both upper and lower sides, combined with a point one cun below the costal margin. For severe cases, use the "Chicken-Foot" needle technique (inserting one needle and dividing into three branches). If pulse diagnosis reveals a large, wiry, and rapid pulse, or an absent pulse, or severe tension of the abdominal skin, needling is contraindicated.
Huangdi said: Excellent. ("Wen" sounds like "Yu")
This chapter discusses the disorder of Wei Qi (Defensive Qi) to clarify its normal origin, distribution, and governing locations, distinguishing between floating/sinking, superficial/deep, excess, and deficiency patterns. Referencing Chapter 76 of *Ling Shu* ("Wei Qi Circulation"), which discusses Wei Qi (Defensive Qi) circulating in the Yang meridians during the day and Yin meridians at night, detailing its internal and external pathways, this chapter focuses on the initial generation and exit routes of Wei Qi (Defensive Qi). It primarily resides between the skin, muscles, tendons, and bones, warming the muscle spaces, filling the skin, thickening the interstices (Cou Li), and controlling the opening and closing of pores.
Wei Qi (Defensive Qi) is the fierce and agile Qi derived from water and grain in the Stomach (Yangming). After food enters the Stomach, its refined essence first emerges from the upper and lower Jiao (Triple Burner) of the Stomach to irrigate the Five Zang Organs. It then divides into two pathways, forming the channels for Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi). Ying Qi (Nutritive Qi) circulates within the vessels, while Wei Qi (Defensive Qi) circulates outside the vessels. The term "separate emergence" refers to the fact that after food enters the Stomach and transmits to the Lung, flowing internally and spreading externally, the most refined and concentrated part travels through the meridian tunnels, circulating endlessly and restarting cyclically. This path of Ying Qi (Nutritive Qi) differs from the departure paths of other Qi. The departure paths of Wei Qi (Defensive Qi) and Zong Qi (Pectoral Qi) are also distinct. These two pathways refer to Ying Qi (Nutritive Qi) emerging from the Qi aspect and circulating within the vessels, while Wei Qi (Defensive Qi) emerges from within the vessels and disperses outside them. This is the subtle mechanism of interaction between Yin/Yang and Blood/Qi.
The refined and concentrated Ying Blood (Ying Qi and Blood) traveling through the meridian tunnels begins at the Hand Taiyin Lung Meridian and ends at the Foot Jueyin Liver Meridian. The Zang-Fu organs connect, internal and external merge, circling without end, restarting cyclically. This path differs from that of Ying Qi (Nutritive Qi) circulating within the vessels, where Qi moves six cun per breath, traveling twenty-five circuits during the day and twenty-five circuits at night. The phrase "Ying Qi (Nutritive Qi) circulates within the vessels, corresponding to respiration and the clepsydra" refers to the fluids generated in the Middle Jiao (Middle Burner). Following the exiting Qi of the San Jiao (Triple Burner), they flow outward to the skin and the Qi aspect of grain, seeping into the Sun Luo (Branch Collaterals) and Luo Mai (Collateral Vessels), transforming into red blood. As stated in the *Wu Long* chapter, "San Jiao (Triple Burner) exiting Qi warms the muscles and fills the skin." The clear portion is Jin (Fluids), and the non-flowing portion is Ye (Essence Fluids). In the *Jue Qi* chapter, waste products, Jin (Fluids), and Zong Qi (Pectoral Qi) are divided into three tunnels. Ying Qi (Nutritive Qi) secretes Jin (Fluids), injects them into the vessels, and transforms them into blood to nourish the four extremities and internally irrigate the Six Fu Organs and Five Zang Organs, corresponding to the time measured by the clepsydra. In the *Yong Ju* chapter, it is stated that Qi emerging from the Middle Jiao is like dew, flowing upward into the grain pathway, seeping into the Sun Mai (Sun Collaterals). When Jin (Fluids) are harmonized, they transform into red blood. When blood is harmonized, the Sun Mai (Sun Collaterals) fill first, then the Luo Mai (Collateral Vessels) become full, and finally the Jing Mai (Main Meridians) fill. With Yin and Yang expanded, movement occurs with respiration, following regular patterns and principles, aligning with Heaven's Way, never ceasing. This Ying Qi (Nutritive Qi) circulating within the vessels, corresponding to respiration, originates from fluids generated in the Middle Jiao (Middle Burner), follows the exiting Qi of the San Jiao (Triple Burner), notes into the Qi aspect of the skin and muscle spaces, seeps into the Sun Luo (Branch Collaterals), transforms into red blood, moves with respiration, follows regular patterns, and differs from the path described in the *Ying Qi* chapter, which begins at the Hand Taiyin Lung Meridian and ends at the Foot Jueyin Liver Meridian.
Zong Qi (Pectoral Qi) accumulates in the chest, emerges upward from the Lung, follows the throat, exits upon exhalation, and enters upon inhalation. The Lung governs the skin and hair. Upon one exhalation, all eighty-four thousand hair follicles close; upon one inhalation, they open. This is the function of Zong Qi (Pectoral Qi) responding to respiration to control opening and closing. Wei Qi (Defensive Qi), utilizing its fierce and agile nature, moves first in the four extremities, muscle spaces, and skin. It circulates in the Yang aspects during the day and Yin aspects at night, governing the opening and closing of day and night. The opening and closing of respiration is human opening and closing; the opening and closing of day and night corresponds to Heaven's opening and closing. Therefore, the origins and movements of Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi) each have their own paths, hence it is said, "Separately emerging into two pathways for Ying and Wei Qi."
This chapter discusses the initial generation and exit of Wei Qi (Defensive Qi), branching from the Yangming meridians to distribute to the upper, lower, and four sides, spreading over the exterior of the body. Accumulation and stagnation resemble the lush growth of plants internally. "Not reaching the normal place" means failing to reach its proper origin and governing location. Thus, internal accumulation in the upper part is treated by selecting Daying (ST 9) and Tiantu (CV 22). This is because Wei Qi (Defensive Qi) ascending exits via the Stomach's Daying (ST 9) and Ren Mai (Conception Vessel)'s Tiantu (CV 22) to emerge externally into the skin. Accumulation in the lower part is treated by selecting Zusanli (ST 36), as Wei Qi (Defensive Qi) descending exits via the Stomach's Zusanli (ST 36) to emerge externally into the skin. Accumulation in the middle part is treated by selecting Qichong (ST 30) and the Dai Mai (Girdle Vessel) below the costal margin, as Wei Qi (Defensive Qi) distributing to the four sides exits via the abdominal Qichong (ST 30) and the Dai Mai's Zhangmen (LR 13) to emerge externally to the four sides.
Wei Qi (Defensive Qi) is Qi generated from water and grain in the Stomach. The Foot Yangming Stomach Meridian meets the Ren Mai (Conception Vessel) at Zhongwan (CV 12), ascends to meet at Chengjiang (CV 24), and meets the Dai Mai (Girdle Vessel) on the left and right of the umbilicus, emerging from the abdominal Qi Street (Qichong). This Qi generated by Yangming exits via the Yangming meridians and disperses into the skin; this is the normal place of Wei Qi (Defensive Qi) emergence. Wei belongs to Yang, emerging from vessels, moving from interior to exterior, from Yin to Yang. Ying belongs to Yin, entering from the grain Qi aspect into the Sun Mai (Sun Collaterals) and Jing Mai (Main Meridians), moving from exterior to interior, from Yang to Yin. This is the subtle mechanism of internal/external interaction between Yin/Yang and Blood/Qi. The "Chicken-Foot" technique refers to the slow extension and retraction of the foot, resembling a chicken walking. Here, it is used to unblock the Yangming meridians and facilitate the exit of Wei Qi (Defensive Qi). Observing a large, wiry, rapid pulse, an absent pulse, or severe abdominal skin tension indicates Wei Qi (Defensive Qi) stagnating at its site of generation, not accumulated in its exit pathways; thus, external points should not be needled.
This chapter discusses the normal sites of Wei Qi (Defensive Qi) generation and exit, differing from the degrees of circulation in Yang and Yin, so it inversely discusses its disorder to prove the point.
Huangdi asked Bo Gao: How can one know diseases of the skin, flesh, Qi, blood, tendons, and bones?
Bo Gao replied: If the complexion rises with thin luster between the eyebrows, the disease is in the skin. If the lip color shows green, yellow, red, white, or black, the disease is in the muscles. If Ying Qi (Nutritive Qi) appears moist, the disease is in the Qi and blood. If the eye color shows green, yellow, red, white, or black, the disease is in the tendons. If the ears are dry, withered, and covered in dust, the disease is in the bones.
This states that Wei Qi (Defensive Qi) spreads from internal meridians to the skin, muscles, tendons, and bones, each having its specific location. Color is the manifestation of Qi. The area between the eyebrows is the region of Guan Zhong, belonging to the Lung. The Lung combines with the skin; therefore, if color rises between the eyebrows with thin luster, it indicates Wei Qi (Defensive Qi) disease in the skin. Muscles are the external correspondence of Spleen Earth; Earth irrigates the Four Zang Organs. Thus, observing lip colors indicates Wei Qi (Defensive Qi) disease in the muscles. Ying is the Qi of blood; "Ru" means moist. The fluid of blood is sweat; sweating and appearing moist indicates Wei Qi (Defensive Qi) disease in the Qi and blood. The Liver governs tendons and opens into the eyes; observing eye colors indicates Wei Qi (Defensive Qi) disease in the tendons. Tendons combine with the Three Yin and Three Yang Twelve Main Meridians, so five colors may appear together. The ears are the orifice of the Kidney; dry, withered, dusty ears indicate Wei Qi (Defensive Qi) disease in the bones. Skin, muscles, tendons, and bones are the Qi aspect outside the vessels. Wei Qi (Defensive Qi) emerges from the body and resides in its respective places.
Huangdi asked: What are the manifestations of disease? How should points be selected?
Bo Gao replied: The changes of hundred diseases are countless. However, the skin has its regions, muscles have their pillars, Qi and blood have their transport points, and bones have their attachments.
Huangdi said: I wish to hear the reasons.
Bo Gao replied: The regions of the skin transport to the four extremities. The pillars of the muscles are located in the muscle spaces of the various Yang meridians in the arms and legs, and between the muscle spaces of the Foot Shaoyin. The transport of Qi and blood goes to the various collaterals; when Qi and blood stagnate, the collaterals become prominent. The regions of tendons have no Yin/Yang or Left/Right distinction; one must observe the location of the disease. The attachments of bones are found in the bone cavities, which benefit and nourish the brain marrow.
Huangdi asked: How should points be selected?
Bo Gao replied: Disease changes, whether floating/sinking or shallow/deep, are endless and vary by location. For mild conditions, needle shallowly; for severe conditions, needle deeply. For mild conditions, use few needles; for severe conditions, use many needles. Adjust Qi according to the changes; this is called a Superior Physician. ("Shu" is read with rising tone, "Sheng" with level tone, "Jian" with departing tone)
This continues the previous discussion on Wei Qi (Defensive Qi) residing in the skin, muscles, tendons, and bones, each with its specific region. Wei Qi (Defensive Qi) circulates in the skin, transporting to the four extremities as its region. Since Wei Qi (Defensive Qi) emerges from Yang, descending from the head and eyes to the five fingers of the hands and feet, the four extremities are its region. Circulating in muscles, in the muscle spaces of Yang meridians in arms and legs, serves as the pillar of the muscle. "Pillar" means master. Large muscle masses are Gu (valleys), small divisions are Cun (spaces). Between muscle spaces lies the convergence of Gu Qi, regulating Ying and Wei Qi and gathering Great Qi. The large muscles of arms and legs are the major divisions. Ying, Wei, and Great Qi first converge here, making arm and leg muscles the main pillars, like the four pillars of a house. The Foot Shaoyin space is where the Foot Shaoyin emerges from Qichong and travels through muscle spaces. Wei Qi (Defensive Qi) is generated from postnatal water and grain, converging with the congenital Qi of Shaoyin in these spaces, a great convergence of Qi. Various collaterals refer to Sun Luo (Branch Collaterals) and Luo Mai (Collateral Vessels). Ying Qi (Nutritive Qi) travels from collaterals to main meridians, while Wei Qi (Defensive Qi) travels from collaterals to the skin. Qi and blood transport through collaterals; when they stagnate, collaterals become prominent. Wei Qi (Defensive Qi) acting on bones benefits brain marrow through bone cavities. Bone cavities are where Jin (Fluids) permeate bones, allowing flexion and extension, nourishing brain marrow. The Marrow Cavity is three cun behind the head, below the sharp bone of the skull. Marrow nourishes the brain by seeping from the sacrum into the spinal column, then upward into the Marrow Cavity to enter the brain. Wei Qi (Defensive Qi) gathers at Fengfu (GV 16) daily and nightly, descending one segment daily. After twenty-one days, it reaches the sacrum; on the twenty-second day, it enters the spine. After nine days of travel, it emerges from the Clavicle (Quepen). Thus, Wei Qi (Defensive Qi) acting on bones regards the spinal column as its attachment. Wei Qi (Defensive Qi) acting on tendons distinguishes no Yin/Yang or Left/Right; if stagnating at a tendon knot in a limb, that is the disease site. Wei Qi (Defensive Qi) is Qi responding to Heaven; tendons are generated by Jueyin Wind Qi. Wind is the breath of the earth, filling heaven and earth, combining with Wei Qi (Defensive Qi), present everywhere in Yin/Yang and Left/Right. The regions of skin and pillars of muscles are like the four directions of Heaven; the attachments of bones are like the paths of Heaven. Changes of hundred diseases: examining Wei Qi (Defensive Qi), the mother of hundred diseases, circulating in skin, muscles, tendons, and bones, determines floating/sinking and shallow/deep locations.
Yu Borong said: Wei Qi (Defensive Qi) governs day/night opening/closing, responding to Heavenly Qi. Daily and nightly, it gathers at Fengfu (GV 16), descending one segment daily. After twenty-one days, it reaches the sacrum; on the twenty-second day, it enters the spine. Traveling nine days, it emerges upward from Quepen. It completes a cycle in one month, corresponding to the moon's monthly orbit. Thus, when the moon wanes, seawater surges eastward, Wei Qi (Defensive Qi) departs, and the form stands alone. Water and Heavenly Qi communicate above and below; sun and moon operate, circling with Heavenly Way, moving one degree daily, completing a yearly orbit. The moon moves thirteen degrees plus, completing a monthly orbit. This is the ceaseless operation of Yin and Yang. Humans correspond to Heaven and Earth; if one breath does not move, the rotation mechanism is lost, leading to abnormal diseases. Scholars who study and understand this will not only diagnose life and death but also access profound mysteries and essential health preservation methods.
Huangdi asked Bo Gao: How to distinguish people's fat/thin, large/small, cold/warm, old/young, strong/weak?
Bo Gao replied: People over fifty years old are old; over twenty are strong; over eighteen are young; over six are small.
This discusses the prosperity and decline of Wei Qi (Defensive Qi). The young and small have newly growing Wei Qi (Defensive Qi); the strong have flourishing Wei Qi (Defensive Qi); those over fifty have declining Wei Qi (Defensive Qi). This responds to Heavenly Qi and the seasonal cycles of growth, flourishing, harvesting, and storing. *Fang Sheng Shuai Lun* states: The old follow from above, the young follow from below. The old correspond to Autumn/Winter Qi, declining from above downward. The young correspond to Spring/Summer Qi, flourishing from below upward.
Wang Zifang said: Numbers begin with one, complete with three. Three times two is six; three times three is nine. Eighteen is the number of two nines. Twenty is the beginning of Yin/Yang generative numbers. Fifty is the end of Five Elements generative numbers. Ma Xuantai said: "Over eighteen" and "over six" should be read as "under eighteen" and "under six."
Huangdi asked: How to measure and judge fat/thin?
Bo Gao replied: There are three types: Fei (Fat), Gao (Oily/Pasty), and Rou (Muscular).
Huangdi asked: How to distinguish them?
Bo Gao replied: Firm muscles with full skin are Fei (Fat). Non-firm muscles with loose skin are Gao (Oily/Pasty). Skin and flesh tightly adhered without separation are Rou (Muscular). ("Cun" sounds like "Guo")
This section discusses how Wei Qi (Defensive Qi) warms muscle spaces, fills skin, and thickens interstices. Cou Li (Interstices) are muscle textures, like pork lean meat, with distinct lines. The white membrane within textures is Zhi (Adipose); the fatty tissue connecting muscle to skin is Fei (Subcutaneous Fat). Thus, firm muscles and full skin indicate Fei (Fat). Fei (Subcutaneous Fat) lies inside the skin and outside the muscle, hence firm muscles and full skin. Gao (Oily/Pasty) is the adipose of Fei (Fat), like pork with alternating red and white layers. Because fat/oil lies within the muscle, muscles are not firm and skin is loose. This chapter discusses Wei Qi (Defensive Qi) thickening interstices, focusing on Gao (Oily/Pasty) rather than Fei (Subcutaneous Fat) alone, but mentioning Fei (Subcutaneous Fat) first to distinguish it from Gao (Oily/Pasty). "Skin and flesh not separated" means muscle dominates and connects to skin, lacking internal Gao (Oily/Pasty) and external Fei (Subcutaneous Fat), indicating abundant Wei Qi (Defensive Qi) in muscle textures.
Ren Gu'an said: "Cun Rou" is commonly known as the calf. Since the muscle pillars are in the Yang meridian spaces of arms and legs, firm calves indicate firm whole-body muscles. Only the calf is mentioned, not the arm, because Qi moves upward from below.
Huangdi asked: What about body cold/warmth?
Bo Gao replied: In Gao (Oily/Pasty) type, soft flesh with coarse texture indicates cold body; fine texture indicates hot body. In Zhi (Adipose) type, firm flesh with fine texture indicates hot body; coarse texture indicates cold body.
Ren Gu'an said: This explains how Wei Qi (Defensive Qi) warms muscles. Gao (Oily/Pasty) type has non-firm, soft flesh. "Nao" means harmonious, referring to the mixture of Gao (Oily/Pasty) and muscle. Zhi (Adipose) type has dense interstices and firm flesh. Coarse texture allows Wei Qi (Defensive Qi) to leak out, causing coldness; fine texture retains Wei Qi (Defensive Qi), causing heat.
Huangdi asked: What about their fat/thin and large/small differences?
Bo Gao replied: Gao (Oily/Pasty) type has much Qi and loose, hanging skin, resulting in a protruding, sagging abdomen. Rou (Muscular) type has a large body frame. Zhi (Adipose) type has a compact, small body.
Ren Shi said: This reiterates how Wei Qi (Defensive Qi) thickens interstices and warms muscles. Abundant Wei Qi (Defensive Qi) thickens interstices; thus, Gao (Oily/Pasty) type has much Qi and loose skin, causing a sagging abdomen. Yu refers to the lower abdomen below the navel. Rou (Muscular) type is large because Wei Qi (Defensive Qi) is abundant and fills muscle spaces. Zhi (Adipose) type is small because Wei Qi (Defensive Qi) is deep and does not fill muscle spaces, causing tight adhesion of adipose membranes and compact muscles. Yu Borong said: Wei Qi (Defensive Qi) warms muscles by filling muscle textures. When Blood and Qi are abundant, they fill the skin and warm the flesh, making muscles full and body large. Hence the repeated explanation.
Huangdi asked: What are the differences in Blood and Qi amounts among these three?
Bo Gao replied: Gao (Oily/Pasty) type has much Qi; much Qi causes heat, enabling cold tolerance. Rou (Muscular) type has much Blood; much Blood fills the form, resulting in balance. Zhi (Adipose) type has clear Blood and slippery, scarce Qi, thus cannot grow large. This distinguishes them from ordinary people.
Ren Gu'an said: This explains Wei Qi (Defensive Qi) and Ying Blood accompanying each other, filling muscle textures. Inside Gao (Oily/Pasty) fat, there is only Wei Qi (Defensive Qi) without Blood nourishment. Gao (Oily/Pasty) type has abundant Wei Qi (Defensive Qi), hence heat and cold tolerance. Rou (Muscular) type has prominent muscles and much Blood. Abundant Blood and Qi fill skin and warm flesh, filling the form. Blood follows Qi; abundant Blood and Qi constitute balanced Ying and Wei. Zhi (Adipose) type has tight muscles, hence clear Blood and scarce Qi, preventing large size. These three differ in fat/thin and large/small, distinguishing them from normals. Wang Zifang said: In Zhi (Adipose) type, Wei Qi (Defensive Qi) does not fill muscle spaces, so Blood is also clear and scarce. Blood and Qi travel together.
Huangdi asked: What about ordinary people?
Bo Gao replied: In ordinary people, skin, flesh, fat, and oil do not accumulate excessively; Blood and Qi do not exceed normal amounts. Their bodies are neither small nor large, proportionate to themselves. They are called ordinary people.
Yu Borong said: This describes Wei Qi (Defensive Qi) floating/sinking and shallow/deep, each having its normal place, resulting in average size. Ordinary people are the general public. "Do not accumulate excessively" means balanced Blood and Qi prevent excessive fat/thin. Floating/sinking/shallow/deep Blood and Qi have fixed places and do not exceed muscle limits. Skin, flesh, tendons, and bones are proportionate to the body, hence average size.
Huangdi said: Excellent. How to treat?
Bo Gao replied: First distinguish the three body types, the amount of Blood, and the clarity/turbidity of Qi, then regulate. Treatment must not deviate from standard principles.
Therefore, Gao (Oily/Pasty) type has a sagging abdomen; Rou (Muscular) type is large above and below; Zhi (Adipose) type, even with fat, cannot be large.
This states that human Blood and Qi should be neither excessive nor deficient. These three types represent excess fat/large size or deficiency thin/small size. One must examine Blood amount and Qi clarity/turbidity before regulating, preserving the normal course of Wei Qi (Defensive Qi) to achieve balance. Due to Wei Qi (Defensive Qi) disorder, Gao (Oily/Pasty) type sags, Rou (Muscular) type is large, and Zhi (Adipose) type remains small. Wei Qi (Defensive Qi) governs skin, muscles, tendons, and bones, floating/sinking and shallow/deep in specific places. If solely abundant in skin/muscle spaces, causing sagging abdomen and large size, or deep in bones/tendons, preventing Zhi (Adipose) type from growing, these are disorders of Wei Qi (Defensive Qi). Thus, floating/sinking/shallow/deep are endless; adjusting Qi according to changes defines a Superior Physician. This chapter discusses Wei Qi (Defensive Qi) disorder to clarify its normal origin and circulation paths, teaching students the origin, exit, and entry of Yin/Yang, Blood, and Qi, laying the foundation for treatment.