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Huangdi Neijing · The Yellow Emperor’s Inner Canon
Suwen 20 · Three Regions and Nine Examinations
Read in English. Switch to Original for word notes, or select text to ask a question.
The Yellow Emperor asked: “I have heard from you of the nine needles. Their scope is vast beyond reckoning. I wish to hear the essential Way, entrust it to descendants, transmit it to later ages, inscribe it in marrow and store it in Liver and Lung. I would receive it with a blood oath and dare not disclose it carelessly. To accord with heaven’s Way it must have ending and beginning, answer above to heavenly lights, stars and calendrical order, and below to seasons and phases, ranks alternating, winter yin and summer yang. How do people correspond? I wish to hear the method.”
Qi Bo replied: “How subtle the question! This is heaven and earth’s utmost reckoning.”
The Emperor said: “How is that reckoning joined to human form, the communication of blood and qi, and decisions of life and death?”
Qi Bo said: “The utmost reckoning begins at one and ends at nine. One is heaven, two earth, three humanity. Triple these: three times three is nine, corresponding to the nine fields. People therefore have three regions, each with three observations, to decide life and death, address a hundred illnesses, regulate deficiency and excess, and remove harmful disorders.”
The Emperor asked: “What are the three regions?”
Qi Bo said: “There are lower, middle and upper regions, each with three observations: heaven, earth and humanity. They must be pointed out and demonstrated before true understanding is obtained.
Upper heaven is the moving vessels at both sides of the forehead; upper earth those at both cheeks; upper humanity those before the ears. Middle heaven is Hand Taiyin; middle earth Hand Yangming; middle humanity Hand Shaoyin. Lower heaven is Foot Jueyin; lower earth Foot Shaoyin; lower humanity Foot Taiyin. Lower heaven therefore assesses Liver, earth Kidney, and humanity the qi of Spleen and Stomach.”
The Emperor asked: “What do the middle observations assess?”
Qi Bo said: “There too are heaven, earth and humanity. Heaven assesses Lung, earth the chest’s qi, and humanity Heart.”
The Emperor asked: “What do the upper observations assess?”
Qi Bo said: “There too are heaven, earth and humanity. Heaven assesses the qi at the head’s corners, earth the mouth and teeth, and humanity ears and eyes. Each region has heaven, earth and humanity. Three form heaven, three earth and three humanity; three times three combines as nine. Nine divides into nine fields and the fields correspond to nine storehouses. Five storehouses of spirit and four of form make nine. If the five organs fail, their color must wither; withered color means death.”
The Emperor asked: “How are they used?”
Qi Bo said: “First assess whether the form is plump or thin to regulate deficiency or excess of qi. Drain excess and supplement deficiency. First remove what is obstructing the blood vessels, then regulate them. Whatever the illness, balance is the goal.”
The Emperor asked: “How are life and death decided?”
Qi Bo said: “A full bodily form with a fine pulse and too little qi to breathe is dangerous. A thin form with a large pulse and much qi in the chest means death. Agreement of form and qi means life. Comparison revealing disharmony means illness. All three regions and nine observations disagreeing means death. Pulses above, below, left and right answering like pounding pestles mean severe illness; disagreement beyond counting means death. Even an orderly middle region that disagrees with the other organs means death. Diminishing observations in the middle mean death. Eyes sinking inward mean death.”
The Emperor asked: “How is the illness’s location known?”
Qi Bo said: “Examine the nine observations. One alone small, large, rapid, slow, hot, cold or sunken indicates illness. Press with the left hand five cun above the ankle and tap at the ankle with the right. A gently wriggling response traveling beyond five cun indicates no illness. A rapid, turbulent response under the hand indicates illness, as does a very slow response. Failure to reach five cun upward, or no response to tapping, means death.
Loss of flesh without relief of the bodily condition means death. Alternating sparse and rapid movement in the middle region means death. An intermittent, hooklike pulse places illness in the network vessels. The nine observations must answer above and below as one. One lagging means illness, two severe illness, three danger. Lagging means not answering together. Examine the fu and zang organs to know the time of life or death. Know the channel vessels before abnormal pulses. A true organ pulse appears and death follows through the overcoming influence. Exhausted Foot Taiyang qi prevents bending and extending the feet, with upturned eyes at death.
The Emperor asked: “What of winter yin and summer yang?”
Qi Bo said: “The nine pulses all sinking, fine, suspended and severed are yin, governing winter, so death occurs at midnight. Abundant, agitated, panting and rapid are yang, governing summer, so death occurs at midday. Cold-and-heat illness ends in death at dawn; internal heat and hot illness at midday; Wind illness at dusk; Water illness at midnight. Pulses alternating sparse, rapid, slow and fast indicate death at the day’s four seasonal divisions.
If bodily flesh has fallen away, even orderly nine observations still mean death. If the seven diagnostic abnormalities appear but the nine observations all follow their order, death need not follow. These apparent exceptions are Wind-qi illness and illness of the monthly course, resembling the seven abnormalities without being them. If the seven abnormalities are present and the pulse observations also fail, death follows, necessarily with retching and belching.
Ask carefully how illness began and what illness is present now. Then palpate and trace each pulse, observe floating and sinking of channels and networks, and follow above and below through contrary or following courses. A responsive rapid pulse here does not indicate illness; a slow pulse does. No coming and going means death; skin fixed tightly to the underlying form means death.
Reading note: The day’s four seasonal divisions retains the historical timing scheme. The compressed monthly-course phrase is not expanded into an unrecorded disease name.
The Emperor asked: “How are treatable conditions addressed?”
Qi Bo said: “Channel illness is treated at its channel; fine-network illness at the blood of its fine networks. Blood illness with bodily pain is treated in channels and networks. An anomalous harmful vessel is treated by crossing needling. For fixed retention that does not move, needle by its divisions. Where above is excessive and below deficient, palpate and follow it; seek bound network vessels and needle to release their blood and restore passage. Raised pupils indicate insufficient Taiyang; fully upturned eyes indicate exhausted Taiyang. This essential distinction of life and death must be examined. Retain the needle at the fingers and five fingerbreadths above the outer wrist.”
Reading note: The supplied 留瘦 phrase is compressed and obscure; no precise modern lesion or additional needling depth is invented.
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