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Huangdi asked, saying: I have heard that those who are good at discussing the Way of Heaven must have verification in human beings; those who are good at discussing ancient times must correspond to the present; and those who are good at discussing others must find confirmation in themselves. In this way, the Dao is not confused, and its essential principles are grasped, which is what is meant by "clarity." Now I ask you, Master, hoping to hear about things that can be known through words, seen through observation, and obtained through palpation, so that they may be verified on myself, dispelling my ignorance and resolving my doubts. Is this possible? Qibo bowed twice and kowtowed in reply, asking: What aspect of the Dao do you inquire about? The Emperor said: I wish to hear why sudden pain occurs in the five Zang organs, and what Qi causes it. Qibo replied: The flow of Qi and Blood in the meridians never ceases, circulating around without rest. When Cold pathogen enters the meridians, it causes stagnation and slowness, making the blood congeal and fail to flow. If it lodges outside the vessels, there is a deficiency of Blood; if it lodges inside the vessels, the obstruction of Qi occurs. Therefore, sudden pain arises.

The Emperor said: Sometimes the pain stops suddenly; sometimes it is severe and unceasing; sometimes it is so severe that it cannot be pressed; sometimes pressing stops the pain; sometimes pressing yields no benefit; sometimes the pulse moves visibly under the hand; sometimes the heart and back pull each other in pain; sometimes the hypochondrium and lower abdomen pull each other in pain; sometimes abdominal pain radiates to the inner thigh; sometimes pain persists for a long time and forms a mass; sometimes sudden severe pain causes fainting and loss of consciousness, followed by recovery after a short while; sometimes pain is accompanied by vomiting; sometimes abdominal pain is followed by diarrhea; sometimes pain is accompanied by constipation. All these pains differ in form. How should they be distinguished?

Qibo said: When Cold lodges outside the vessels, the vessels become cold. Cold causes contraction and curling, leading to tension and cramping of the vessels. This tension pulls on the small collaterals externally, causing sudden pain. Upon exposure to heat (Jiong), the pain stops immediately. However, if re-exposed to Cold, the pain becomes chronic. When Cold lodges within the vessels and contends with Heat (Jiong) energy, the vessels become full. Fullness leads to severe pain that cannot be pressed. If Cold lingers and Heat rises from above, the vessels swell greatly, and Qi and Blood become chaotic, resulting in severe pain that resists pressure. When Cold lodges between the stomach and intestines, below the membrane origins, Blood cannot disperse, and the small collaterals contract, causing pain. Pressing disperses the Qi and Blood, thus stopping the pain. When Cold lodges in the vessels along the spine, deep palpation cannot reach the affected area, so pressing is ineffective. When Cold lodges in the Chong Mai (Penetrating Vessel), which originates at Guanyuan (CV4) and ascends straight up the abdomen, the blockage of the vessel causes Qi to surge, making the pulse palpable under the hand. When Cold lodges in the Back-Shu vessels, the blood congeals, leading to Blood deficiency and pain. Since the Back-Shu points connect to the Heart, the heart and back pull each other in pain. Pressing brings warmth to the area, and when warmth arrives, the pain stops. When Cold lodges in the Jueyin Liver Meridian, which connects to the genitalia and ties to the Liver, Cold in the vessels causes Blood stasis and vessel tension, leading to pulling pain between the hypochondrium and lower abdomen. When Jueyin Qi lodges in the inner thighs, and Cold reaches the lower abdomen, Blood stasis below causes mutual pulling, resulting in abdominal pain radiating to the inner thighs. When Cold lodges in the membrane origins and collateral blood of the Small Intestine, Blood stagnates and cannot enter the main meridians. Qi and Blood remain stagnant and fail to circulate, eventually forming a mass over time. When Cold lodges in the Five Zang Organs, it causes rebellious Qi to rush upward and leak out, exhausting Yin Qi while Yang Qi fails to enter. This causes sudden severe pain, fainting, and loss of consciousness. If Qi returns, life is preserved. When Cold lodges in the stomach and intestines, rebellious Qi rushes upward, causing pain and vomiting. When Cold lodges in the Small Intestine, it fails to perform its function of gathering and transforming, leading to diarrhea and abdominal pain. When Heat remains in the Small Intestine, it causes intestinal pain. Excessive Heat scorches fluids and causes thirst, leading to dry, hard stool that cannot be expelled, resulting in pain and constipation.

The Emperor said: You mentioned "known through words." What does this mean? And how is it "seen through observation"? Qibo replied: The Five Zang and Six Fu Organs all have specific areas on the body surface. Observing the colors of these areas reveals that yellow and red indicate Heat, white indicates Cold, and blue/black indicates Pain. This is what is meant by "seen through observation." The Emperor asked: How is it "obtained through palpation"? Qibo replied: By observing the pulse of the primary diseased area, one can determine diagnosis through palpation if the pulse is firm, indicates Blood stasis, or appears sunken.

The Emperor said: Excellent. I know that all diseases arise from Qi dysfunction. Anger causes Qi to ascend; Joy causes Qi to relax; Sorrow causes Qi to dissipate; Fear causes Qi to descend; Cold causes Qi to contract; Heat causes Qi to escape; Shock causes Qi to become disordered; Labor causes Qi to be exhausted; Thought causes Qi to knot. These nine types of Qi changes differ. What diseases do they produce? Qibo replied: Anger causes Qi to rebel upward. In severe cases, it leads to hematemesis and undigested food diarrhea, hence "Qi ascending." Joy harmonizes Qi and spreads the will, allowing Ying and Wei Qi to flow freely, hence "Qi relaxing." Sorrow tightens the Heart connection and raises the Lung leaves, obstructing the Upper Jiao. Ying and Wei Qi do not disperse, and Heat accumulates in the middle, hence "Qi dissipating." Fear causes Essence to retreat. Retreat leads to closure of the Upper Jiao, which forces Qi to return downward, causing distension in the Lower Jiao, hence "Qi failing to move." Cold closes the interstices (Cou Li), blocking Qi movement, hence "Qi contracting." Heat opens the interstices, allowing Ying and Wei Qi to flow freely, leading to profuse sweating, hence "Qi escaping." Shock leaves the Heart without support, the Spirit without refuge, and thoughts without focus, hence "Qi becoming disordered." Labor causes panting and sweating, with both internal and external Qi leaking outward, hence "Qi being exhausted." Thought fixes the mind and spirit on a single object, causing Zheng Qi (Upright Qi) to stagnate and fail to move, hence "Qi knotting."