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Huangdi Neijing · The Yellow Emperor’s Inner Canon
Lingshu 4 · Harmful Qi and the Illness Forms of Zang and Fu
Read in English. Switch to Original for word notes, or select text to ask a question.
The Yellow Emperor asked Qi Bo: “How does harmful qi strike a person?”
Qi Bo replied: “Harmful qi strikes a person high up.”
The Yellow Emperor said: “Is there a measure of high and low?”
Qi Bo said: “Above the body’s midpoint, harmful influence strikes; below the midpoint, Damp strikes. Thus harmful influence has no constant manner of striking: when it strikes yin, it flows to the fu; when it strikes yang, it flows to the channels.”
The Yellow Emperor said: “Yin and yang have different names but belong to the same kind. Above and below meet; channels and networks pass through one another like a ring without an end. Harmful influence strikes sometimes yin, sometimes yang, above or below, left or right, with no constancy. Why?”
Qi Bo said: “The meetings of all yang are in the face. Harmful influence takes advantage of a time of emptiness, recent exertion, or sweating after food and drink, when the interstices open. Striking the face, it descends through Yangming; striking the nape, through Taiyang; striking the cheek, through Shaoyang. If it strikes chest, back or both rib-sides, it likewise strikes their channels.”
The Yellow Emperor said: “What of striking yin?”
Qi Bo replied: “An attack on yin begins from arms and shins. Their yin skin is thin and their flesh soft and moist. Thus both receive Wind, which particularly injures their yin.”
The displayed leg graph is anomalous and is read by the limb context.
The Yellow Emperor said: “Does this therefore injure the zang?”
Qi Bo replied: “Wind striking the body need not disturb the zang. When harmful influence enters a yin channel but its zang qi is replete, it cannot lodge there and returns to the fu. Thus an attack on yang flows to the channels; an attack on yin to the fu.”
The Yellow Emperor said: “How does harmful influence strike a person’s zang?”
Qi Bo said: “Grief, worry, fear and dread injure the Heart. A cold body and cold drink injure the Lung: the two colds act together, injuring both within and outside, so qi counterflows upward. A fall with bad blood retained within, or great anger that sends qi upward without descent and accumulates it below the rib-sides, injures the Liver. A blow or fall, or sexual activity while drunk followed by sweating in Wind, injures the Spleen. Exertion in lifting heavy loads, excessive sexual activity, or bathing in water while sweating injures the Kidney.”
The Yellow Emperor said: “How does Wind strike the five zang?”
Qi Bo said: “When yin and yang are both affected, harmful influence can proceed there.”
The Yellow Emperor said: “Good.”
The Yellow Emperor asked Qi Bo: “Head, face and bodily form all belong to bones, connect through sinews and share blood and qi. In cold weather earth cracks and water freezes; sudden cold may leave hands and feet slack. Yet the face is not clothed. Why?”
Qi Bo replied: “The blood and qi of the twelve channel vessels and three hundred sixty-five networks all rise to the face and run to the openings. Their essential yang qi rises to the eyes and makes the pupils; their branching qi runs to the ears and makes hearing. Their gathering qi rises through the nose and makes smell. Turbid qi emerges from the Stomach, runs to lips and tongue and makes taste. Their fluids all steam upward to the face. Its skin is thick and flesh firm, so great heat or severe cold cannot overcome it.”
The Yellow Emperor said: “What forms of illness appear when harmful influence strikes?”
Qi Bo said: “Empty harmful influence striking the body produces shivering that shakes the form. Proper harmful influence strikes subtly, first appearing in complexion without being felt in the body: as if present or absent, gone or remaining, formed or formless. Its circumstances are hard to know.”
Empty and proper harmful influences retain the text’s distinct categories; “proper” does not mean beneficial here.
The Yellow Emperor said: “Good.”
The Yellow Emperor asked Qi Bo: “I have heard that seeing complexion and knowing illness is called clarity; pressing the pulse and knowing illness is called spiritual insight; asking about illness and knowing its place is called skill. I wish to hear how one knows by seeing, obtains by pressing and reaches the full account by asking.”
Qi Bo replied: “The correspondence of complexion, pulse and the chi region is like drumstick and drum, shadow and echo: they must not fail one another. They are outward signs of trunk and tip, root and leaf. If the root dies, the leaves wither. Complexion, pulse, bodily form and flesh must not fail one another. Knowing one makes a skilled practitioner; knowing two gives spiritual insight; knowing three gives both insight and clarity.”
The Yellow Emperor said: “I wish to hear it fully.”
Qi Bo replied: “With blue-green complexion, the pulse is string-like.
“With red, hooked.
“With yellow, intermittent.
“With white, hair-like.
“With black, stony.
“If the complexion is seen but its pulse is absent and an overcoming pulse appears instead, death follows. If the generating pulse appears, illness ceases.”
The Yellow Emperor asked Qi Bo: “What are the illness forms produced by changes in the five zang?”
Qi Bo replied: “First determine the correspondence of the five colors and five pulses. Then their illnesses can be distinguished.”
The Yellow Emperor said: “Once complexion and pulse are determined, how are they distinguished?”
Qi Bo said: “Assess whether the pulse is relaxed or tense, small or large, slippery or rough; then the illness’s changes can be determined.”
The Yellow Emperor said: “How is this assessed?”
Qi Bo replied: “With a tense pulse, the chi-region skin is tense; with a relaxed pulse, relaxed; with a small pulse, diminished and scant of qi; with a large pulse, raised and bulging; with a slippery pulse, slippery; with a rough pulse, rough. These changes may be slight or severe.
“One skilled in assessing chi need not await cun; one skilled in assessing the pulse need not await complexion. One who combines all three may be a superior practitioner. The text assigns the superior nine successes in ten. One using two is intermediate, with seven in ten. One using one is inferior, with six in ten.”
The figures are the source’s stated ranks of diagnostic success, not measured modern outcomes.
The Yellow Emperor said: “May I ask what illness forms correspond to relaxed, tense, small, large, slippery and rough pulses?”
Qi Bo said: “Let me describe the changes of the five zang.
“For the Heart pulse:
“Very tense: spasms. Slightly tense: heart pain drawing to the back, with inability to take down food.
“Very relaxed: frenzied laughter. Slightly relaxed: the hidden-beam disorder, moving up and down below the heart, with occasional spitting of blood.
“Very large: a catching obstruction in the throat. Slightly large: Heart obstruction drawing to the back and frequent tears.
“Very small: frequent hiccups. Slightly small: wasting heat.
“Very slippery: frequent thirst. Slightly slippery: heart-region hernial pain drawing to the navel, with lower abdominal rumbling.
“Very rough: loss of voice. Slightly rough: overflowing blood, wei counterflow, ringing ears and illness of the head.”
Wei retains the source’s connecting-vessel expression without assigning a new diagnosis.
“For the Lung pulse:
“Very tense: convulsive illness. Slightly tense: Lung cold and heat, weariness, coughing and spitting blood, drawing into lower back, back and chest, or nasal flesh blocking passage.
“Very relaxed: much sweating. Slightly relaxed: wilting and fistulous disorder, one-sided Wind, and unceasing sweat below the head.
“Very large: swollen shins. Slightly large: Lung obstruction drawing into chest and back, with aversion to sunlight on rising.
“Very small: diarrhea. Slightly small: wasting heat.
“Very slippery: urgent rising breath. Slightly slippery: bleeding above and below.
“Very rough: vomiting blood. Slightly rough: mouse-like fistulous swellings between neck and armpit, the lower unable to bear the upper, with frequent aching as its response.”
The displayed anomalous graphs in the wilting and mouse-like disorders are read through the parallel fistulous terms, without equating them with a modern disease.
“For the Liver pulse:
“Very tense: hostile speech. Slightly tense: the fat-qi accumulation below the rib-sides, like an overturned cup.
“Very relaxed: frequent vomiting. Slightly relaxed: water masses and obstruction.
“Very large: internal abscess and frequent vomiting or nosebleeds. Slightly large: Liver obstruction, genital contraction and cough drawing into the lower abdomen.
“Very small: much drinking. Slightly small: wasting heat.
“Very slippery: swollen hernial disorder. Slightly slippery: loss of urinary control.
“Very rough: overflowing retained fluids. Slightly rough: spasms, contractures and sinew obstruction.”
The hernial modifier is corrupt in the displayed source; swelling is its contextual reading from parallel texts.
“For the Spleen pulse:
“Very tense: spasms. Slightly tense: blockage at the diaphragm; food and drink enter and return, with frothy discharge afterward.
“Very relaxed: wilting counterflow. Slightly relaxed: Wind wilting, the limbs unusable while the mind is clear as though free of illness.
“Very large: sudden collapse. Slightly large: hernial qi, enlarged abdomen, and pus and blood outside intestines and stomach.
“Very small: cold and heat. Slightly small: wasting heat.
“Very slippery: swollen urinary obstruction. Slightly slippery: worm poison, roundworm-like parasites and abdominal heat.
“Very rough: intestinal tui disorder. Slightly rough: internal tui disorder, with much pus and blood passing below.”
The repeated displayed xiang graph is read as the parallel tui disorder term, associated here with swelling, obstruction and discharge; the parasite graphs are also corrupt. No modern organism or more specific diagnosis is supplied.
“For the Kidney pulse:
“Very tense: bone convulsive illness. Slightly tense: sinking counterflow, running-piglet rushing, feet unable to draw in, and inability to pass urine or stool.
“Very relaxed: a spine as though broken. Slightly relaxed: through-flow, meaning food does not transform and returns after passing the throat.
“Very large: genital wilting. Slightly large: stone-water swelling, rising from below the navel into the lower abdomen and swelling upward to the stomach cavity; the text says death follows and it cannot be treated.
“Very small: through-flow diarrhea. Slightly small: wasting heat.
“Very slippery: urinary obstruction with tui disorder. Slightly slippery: bone wilting, inability to rise from sitting, and inability to see on rising.
“Very rough: great abscess. Slightly rough: absent menses and deep hemorrhoids.”
The anomalous tui graph is read as in the preceding list. The source’s names and prognostic claim are retained without modern diagnostic substitution.
The Yellow Emperor said: “How are the six changes of illness needled?”
Qi Bo replied: “Tense pulses mostly have cold; relaxed pulses mostly heat. Large pulses have much qi and little blood; small pulses have little of both. Slippery pulses have abundant yang qi and slight heat; rough pulses much blood, little qi and slight cold.
“For tense pulses, the text describes deep insertion and long retention. For relaxed pulses, shallow insertion and swift withdrawal to remove heat. For large pulses, slightly drain qi without bringing out blood. For slippery pulses, swiftly withdraw and insert shallowly to drain yang qi and remove heat. For rough pulses, reach the vessel, follow its opposing or following course and retain long. First press and trace it; after withdrawing, promptly press the puncture, allowing no blood to emerge, to harmonize the vessel.
“For all small pulses, yin and yang, form and qi are insufficient. Do not address them with needles; regulate with sweet medicinals.”
The Yellow Emperor said: “I have heard that where the spring and stream qi of the five zang and six fu enter is called the sea. By what route do they enter, and what do they connect with and pass? I wish to hear why.”
Qi Bo replied: “These are branches of yang vessels entering within and belonging to the fu.”
The Yellow Emperor said: “Do springs and streams and seas each have their names?”
Qi Bo replied: “Springs and streams treat the external channels; seas treat the internal fu.”
The Yellow Emperor said: “How are the internal fu treated?”
Qi Bo said: “Address their seas.”
The Yellow Emperor said: “Do the seas each have a name?”
Qi Bo replied: “The Stomach joins at Sanli. The Large Intestine enters and joins at Juxu Shanglian. The Small Intestine joins and enters at Juxu Xialian. The Triple Burner joins and enters at Weiyang. The Bladder joins and enters at the center of the knee hollow, Weizhong. The Gallbladder joins and enters at Yanglingquan.”
The Yellow Emperor said: “How are they addressed?”
Qi Bo replied: “For Sanli, lower the instep; for Juxu, raise the foot. Seek Weiyang through bending and extending; address Weizhong with bending. For Yanglingquan, set the knee upright and take the level downward toward the yang side of Weiyang. For external channels, extend and follow them.”
The Yanglingquan leveling clause is obscure. Its supplied relation is retained without adding an exact angle or modern landmark.
The Yellow Emperor said: “I wish to hear the illnesses of the six fu.”
Qi Bo replied: “Heat in the face indicates Foot Yangming illness. Blood in the networks of the fish-like hand eminence indicates Hand Yangming illness. Upright or sunken vessels on both insteps indicate Foot Yangming illness: this is the Stomach vessel.”
“Large Intestine illness brings cutting intestinal pain and splashing rumbling. In winter, renewed exposure to cold brings diarrhea with pain at the navel and inability to stand long. Its manifestations are shared with the Stomach. Address Juxu Shanglian.”
“Stomach illness brings swollen abdominal distension and pain at the stomach cavity opposite the heart, propping upward against both rib-sides. Diaphragm and throat are blocked and food and drink cannot descend. Address Sanli.”
The swelling and rib-side graphs are anomalous and are read from context.
“Small Intestine illness brings lower abdominal pain and pain drawing between lower back, spine and testicles. There is occasional urgency to pass stool, with heat before the ear, or severe cold, or marked heat over one shoulder and heat between the little finger and its neighboring finger. A sunken vessel is also its sign. This is Hand Taiyang illness. Address Juxu Xialian.”
“Triple Burner illness brings abdominal qi fullness, especially hardness in the lower abdomen, and inability to urinate. With urgent pressure and overflow, water remains and distension forms. Its indicator is the great network outside Foot Taiyang, between Taiyang and Shaoyang, also visible in the vessel. Address Weiyang.”
“Bladder illness brings one-sided painful swelling of the lower abdomen. Pressing with the hand produces the urge to urinate without being able to do so. There is heat over the shoulder, or a sunken vessel; heat also occurs at the little toe’s outer edge and behind shin and ankle, or the vessel is sunken. Address the center of the knee hollow, Weizhong.”
“Gallbladder illness brings frequent sighing, bitter mouth, vomiting of old fluid, fluttering below the heart and fear that someone is about to seize the person. There is a catching sensation in the throat and frequent spitting. Examine root and tip of Foot Shaoyang and any sunken vessel, applying moxibustion there. For its cold and heat, address Yanglingquan.”
The Yellow Emperor said: “Is there a Way of needling?”
Qi Bo replied: “Needling these must reach qi openings, not flesh nodes. Reaching qi openings lets the needle enter the passage; striking flesh nodes causes skin pain. Reversing supplementation and draining makes illness graver. Striking a sinew loosens it while harmful qi fails to emerge. It contends and disorders the true qi without leaving, then returns to lodge within. Inaccurate needling turns following into opposing.”
The needle-and-passage phrase contains an unusual displayed verb; entry into the passage is its contextual sense, without added procedural detail.
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