THE HISTORICAL ROOTS AND CLINICAL

APPLICATION OF THE NEI JING

Giovanni Maciocia
Copyright Giovanni Maciocia

馬 萬 里
CHINESE DYNASTIES
XIA 2200-1600 BC (also called “Yin”)
SHANG 1600-1100 BC
ZHOU 1100-771 BC
SPRING AND AUTUMN PERIOD 770-476 BC
WARRING STATE PERIOD 475-221 BC
QIN 221-206 BC Origin of Nei Jing
HAN 206 BC-AD 220
THREE KINGDOMS AD 200-AD 280
JIN 265-420
NORTHERN AND SOUTHERN DYNASTIES 420-581
SUI 581-618
TANG 618-907 Wang Bing, 762 AD
FIVE DYNASTIES 907-960
SONG 960-1279 Revision by Song officials,
triumph of Neo-Confucianism
(LIAO) 906 1125
(JIN) 1115-1234
YUAN 1279-1368
MING 1368-1644
QING 1644-1911
REPUBLIC OF CHINA 1911-1949
PEOPLE’S REPUBLIC OF CHINA 1949-
Zhou Qin Han

475 221 206 220 AD

Socrates 469–399 BC
Democritus 460-370 BC

Plato 429–347 BC
Aristotle 384–322 BC
Epicurus 341-271 BC
Chrysippus 280-207 BC
THE NEI JING 黄 帝 内 经 素 问
The exact date of the Nei Jing is impossible to
determine: the general opinion is that it was
written sometime between 300 and 100 BC.
The best discussion of the date of the Nei Jing
is in Unschuld’s book Huang Di Nei Jing Su
Wen. Modern Chinese historians say that
because the Nei Jing contains the Five
Elements theory it could not be older than Zou
Yan’s times (320 BC), the philosopher who
developed the theory of the Five Elements. My
personal opinion is that the Nei Jing may
indeed be older than that and I think this
because the knowledge of channels found in
the Nei Jing is extremely advanced and one that
could only have been developed over centuries.
I therefore think that the origins of the Nei Jing may be
very old and pre-date Zou Yan’s times. For example,
chapters 10, 11 and 13 of the Ling Shu describe the
pathways of the Main, Divergent and Muscle channels in
great detail and indeed the pathways are the same as we
know them today. In my opinion it must have taken
centuries to develop such a detailed knowledge of the
channels.

Whatever the date of compilation of the original version,

the version we have is the one from Wang Bing from AD
762 and later revised by Song authors in 1026.
Note that in 1026 (Song dynasty) the Nei Jing was edited several times
by imperial committees! Note also that the Song dynasty represented the
triumph of Confucianism as the “orthodox” State philosophy. It was
during the Song dynasty that Neo-Confucianism triumphed with great
thinkers such as Zhou Dun Yi, Cheng Yi, Cheng Hao, Zhang Zai and Zhu
Xi.

Zhang Zai
Cheng Hao
Zhou Dun Yi Cheng Yi

Zhu Xi
“State committees” editing medical texts, “orthodox
philosophy”…sounds familiar? This is the very process that many
people attribute to the modern Marxist regime, i.e. a regime imposing an
orthodox philosophy onto Chinese medicine and “systematization” of
Chinese medicine. In fact, in my opinion, this process was less
pronounced than the one that occurred by Neo-Confucianists during the
Song dynasty.
HUANG DI NEI JING SU WEN 黄 帝 内 经 素 问

LING SHU 灵 枢 靈
HUANG DI 黄 帝 “Yellow Emperor”

HUANG DI 皇 帝 “Emperor” (ex. Qin Shi Huang Di)

The term “Di” has religious overtones and may be translated as “Lord”.
It does not have the meaning of “emperor” as we conceived it in the West
(e.g. as a Roman emperor). The Chinese “Di” had god-like attributes and
he was said to have received the “mandate of Heaven” and conducted
spiritual rituals. Interestingly, Chinese emperors were not military
commanders like Roman emperors or Napoleon. When Christian
missionaries reached China some used the term “Di” to translate “God”
(others used “Shen” 神). Unschuld suggests “thearch” for “Di”.
MEANING OF “DI”
The term “Di” is very ancient and it dates back to the Shang dynasty
(1766 - 1045 BC) during which time it was used in conjunction with
the character “shang”. Shang Di 上 帝 is a concept intimately
associated with ancestor worship. Shang Di was an anthropomorphic
personal deity ruling over the human and natural worlds in a manner
analogous to the earthly ruler. He could and would intervene in
human affairs with regularity and with decisiveness. The fact that
deceased rulers accorded the title of Di would join the realm of
Shang Di reinforced the perception of deity as an intimate and
personal extension of the known world.

帝
The bottom part is “cloth”:
flowing robes and a fine
headgear
MEANING OF “NEI” 内

1) “Nei” could refer to a classification of texts in to “Nei” and

“Wai” i.e. “inner” and “outer”
2) Zhang Jiebin says that “Nei” refers to the Dao, therefore the
“Nei Jing” is the inner classic recording the Dao.
3) A Ming author said that “Nei” means “deep” or
“mysterious”
4) Another said that “Nei” refers to the interior of the body, i.e.
“Nei Jing” would be the classic of internal medicine.
MEANING OF JING 经
The term “Jing” is always referred in Chinese philosophy to ancient
classics. It may be translated as “classic”, “canon”, or “manual”, and
there are many examples of other books called “Jing” such as the Nan
Jing, Mai Jing, Yi Jing, etc. The term “Jing” was used only for books
of fundamental importance, imparting knowledge of extraordinary
significance that was meant to persist through the ages.
Interestingly, the etymology of “Jing” is the “warp”, that is the
threads running lengthwise in a woven fabric. The term “Jing” was
also used to indicate the roads running north-south in China, and later
the meridians in geography. Of course, the term “Jing” is also used to
indicate the channels in acupuncture. Hence, in terms of acupuncture
channels, “jing” implies ‘vertical”.

经
MEANING OF SU WEN 素 问
The term “Su” rather than meaning “simple”, it
probably more correctly means “basic” or
“fundamental” and it refers to the questions asked
by the Yellow Emperor. Another interpretation of
the term “Su” goes back to its etymology which is
undyed silk and according to this view the Yellow
Emperor’s questions were written on undyed silk.

素 问
Modern Chinese doctors list the important contributions of the
Nei Jing as follows:
1) It created a systematic theory of the channels.
2) It deals in depth with the theory of Yin-Yang and the Five
Elements.
3) It discusses the nature and types of Qi in detail.
4) It describes the functions of the Zangfu in detail and their
pathology.
5) It determined the location of 160 acupuncture points and their
names.
6) It describes the nine kinds of needles and their use.
7) It defined the functions of the acupuncture points and their
contraindications.
8) It describes the needling techniques for reinforcing and reducing.
9) It discusses the treatment of many diseases.
10) It establishes the classification of symptoms into Full-Empty,
Hot-Cold, Exterior-Interior and Yin-Yang, thus establishing
the basis for what was later called the Eight Principles 八 纲
Although it is often said that Chinese medicine is
not concerned with anatomy, there are chapters
in the Nei Jing dealing with the measurement of
bone and the size, length and weight of the
internal organs. Also the contraindications to the
use of certain points according to anatomy is
quite correct from the point of view of modern
anatomy.
The Nei Jing is composed of two parts:
- The Su Wen (Simple Questions) in 81 chapters
- The Ling Shu (Spiritual Axis) in 81 chapters
The Nei Jing is primarily an acupuncture classic (especially
the Ling Shu) and it contains very few herbal prescriptions,
although it does elaborate frequently on the five flavors which
are the basis for the classification of herbs.
The Nei Jing contains a detailed knowledge of anatomy,
physiology, pathology and treatment. It also adapted the
sciences of meteorology and calendar to medicine. From
a philosophical point of view, modern Chinese doctors say
that the Nei Jing is based primarily on the philosophy of
Zou Yan’s Yin-Yang school.
This was the name given to the school during the
Warring States period; although it is called the Yin-Yang
school it also encompasses the theory of the Five
Elements. Modern Chinese doctors say that the theory of
Yin-Yang and the Five Elements pervades the whole
book.
However, the Nei Jing is clearly influenced by three
other schools, i.e. Daoism, Confucianism and Legalism.
I disagree with the view that the Nei Jing is based only on the
Yin-Yang School because the book is not based on a single
coherent philosophy but it is a mish-mash of the theories of
most of the schools of the Warring States period, including
the Confucian school, the Legalist school and the Daoist
school. Moreover, the Nei Jing contains also passages related
to a so-called demonic medicine, i.e. medicine based on the
influence of spirits (gui 鬼) on human beings. According to
this medicine diseases were caused by invasion of spirits and
were cured by shamans with incantations.
Although the Nei Jing represented a revolution in the
evolution of medicine from demonic to natural medicine
and from the shaman to the doctor, elements of demonic
medicine remained and the ancient Chinese were
completely comfortable in integrating it with natural
medicine so that the patient could consult both the doctor
and the shaman (see the very beginning of Chapter 1 of the
Su Wen).
Ling Shu chapter 58
“There are situations when there is no apparent
pathogenic factor and yet the patient falls acutely
ill. Is it due to [invasion of] evil spirit? Qi Bo
answers that such a condition is due to the retention
of a pathogenic factor that has not come forth yet
[Latent pathogenic factor]. As the disease starts in a
subtle way and one cannot see or hear anything, it
is attributed to evil spirits.”

LATENT
PATHOGENIC
FACTOR
In the following paragraph in the
same chapter 58, the Ling Shu
does say:
“The ancient shamans knew
the origin of many diseases
and how to overcome them.
They knew how these
diseases arose and their
consequences: therefore, they
could use incantations to
treat them.”

Notice that wu 巫 referred to a woman shaman and the

term for a man shaman was xi 觋
METAPHORS OF CHINESE MEDICINE
It is interesting to note that four of the major Chinese medicine
metaphors originate from the Qin dynasty’s political, economic,
administrative and social structure and therefore both Legalism
and Confucianism. These four metaphors are as follows:

1) War and military metaphor

2) Unitary political and administrative structure of the empire with

the emperor at the top of the pyramid

3) Roads as a metaphor for the channels of acupuncture

4) Channels and canals as a metaphor for the channels of

acupuncture and the Triple Burner.

There is a 5th metaphor influenced by demonic medicine:

5) Gui spirits as causes of disease and shamanism as treatment. This
metaphor is much older, dating back to 1000 BC.
1) Ying 營 = camp, barracks, batallion. Wei
衛 = defend, guard, left and right footprint,
two sentinels back to back.

2) Heart as Ruler and other organs as 11

Ministers

3) Roads. Jing 經 = route, longitudinal,

North-South orientation

4) Canals, irrigation. Triple Burner

official in charge of ditches, water
passages. 8 Extraordinary Vessels
“irrigate” the Cou Li space. Ch 12 Ling
Shu (Water Channels)

5) Gui. Xie 邪 Qi = evil

RU JIA 儒 家 CONFUCIANISM KONG ZI CONFUCIUS
DAO JIA 道 家 DAOISM LAO ZI
FA JIA 法 家 LEGALISM HAN FEI ZI (SHANG YANG)
REN 仁 Benevolence, goodness, compassion, authoritative conduct,
humanity, empathy
YI 義 Rightness, appropriateness 义
LI 礼 (old: 禮) Rituals, rites, ritual propriety. Etiquette, customs,
worship, rules of proper behaviour
ZHI 智 Wisdom, to realize
SHU 恕 Understanding, putting oneself in another’s place
ZHONG 忠 Loyalty, dutifulness, doing one’s utmost
TIAN 天 Heaven
DAO 道 Way
XIN 心 Heart, Mind, Heart-Mind
DE 德 Morality, power, virtue, excellence
SHAN 善 Good, truly adept
XIAO 孝 Filial piety, filial conduct
CONFUCIAN INFLUENCE ON THE NEI JING
Before discussing the Confucian influence on the Nei Jing, we need
to describe briefly the main aspects of Confucianism.

REN 仁 benevolence, kindness, compassion, humanity, human

heartedness, loving others. Made up of the radical for “person” and
“two”, i.e. we are not fully human unless there are at least three
persons. In other words, we can only fully realize ourselves within a
social group. Very different than Buddhist compassion or Christian
“agape”. With Buddhist compassion and Christian love, we give up
part of our self; with “Ren” we become fully human and actually
add to our self. This is because Ren does not start from a
psychological self, centre of our consciousness.
Filial piety and fraternal love were aspects of Ren and the
cornerstone of the social structure.
It is not by chance that the term “ren” 仁 referring to
the Confucian quality of compassion or humanity
(impossible to translate) is homophone with “ren” 人
person. In other words, it is the Confucian quality of
“ren” which makes us a person. There is another
interesting aspect to the Chinese character for the
Confucian “ren” in that it is composed for the radical
for “person” and that for “two”. In other words we are
not fully a person unless there are at least three of them,
i.e. we are not fully a person outside family and society.
Indeed, Mengzi says explicitly, “ren” (Confucian
quality 仁) means “person”.
It should be noted also that the Confucian quality of “ren”
is used in Confucian texts not only as a noun or adjective
but also as a verb. That means that “ren” can be regarded
also as a qualitative transformation of a person which
embraces not only the achieved person but also the process
whereby this quality of humanity is realized. Indeed
Confucius says, “The realization of oneself is called ‘ren’”.

“Ren consists in loving

others”.

仁
Ren is the entire person including one’s cultivated cognitive,
aesthetic, moral and religious sensibilities as they are expressed in
the living of one’s ritualized roles and relationships. This is the
meaning of Zhongyong 20: “Ren means behaving like a human
being [人ren], wherein devotion to one’s kin is most important.” Ren
thus understood is one’s “field of selves” the sum of significant
relationships that constitute one as a social person. Ren is both
mental and physical. It is one’s posture and comportment, gestures
and bodily communication.
Hence, translating ren as “benevolence” is to psychologize the
notion of person in a tradition that does not define the human
experience psychologically. Such a translation is to impoverish ren
by isolating one out of many dispositions at the expense of the
many other aspects that contribute to the complexity of becoming
human.

Ames R and Hall D, Focusing the Familiar, University of Hawai’s Press, Honolulu,
2001
WESTERN CONCEPT OF SELF (You are in striped shirt)
CHINESE CONCEPT OF SELF
SELVES IN THE WEST

SELVES IN CHINA
YI 義 righteousness, the “oughtness” of a situation, categorical
imperative (like Kant). Every one in society and family has to do
certain things for their own sake, because they are morally right;
however, they have to be done out of love; if one does them only out
of duty or for non-moral considerations, then even though one does
what one ought to do, his or her action is no longer a righteous one.
Ren and Yi are related: Ren is the material essence of one’s duties
(out of love), Yi is the formal essence of duties. Example, the father
acts according to the way a father should act (Yi) out of love (Ren).
The practice of Ren leads to the carrying out of one’s
responsibilities and duties in society, in which is comprised the
quality of Yi.

義
LI 禮 rites, rituals. This is the formal, outward aspect of
Yi in social and family relationships. Contrary to what one
might think, Li does not consist in empty rituals but in the
heart-felt practice of family and social relationships. It is
the formal appearance of Yi and Ren in social interaction.

ZHI 智 wisdom.
CARE AND
BENEVOLENCE

OBEDIENCE
ZHONG 忠 indicates the state of mind when one is completely
honest with oneself. It is composed of the radical for “heart” and
“centre”. With one’s heart in the centre, one is true to oneself.
Loyalty.
SHU 恕 indicates the state of mind when one is in complete
understanding and empathy with other people. It has the meaning
“as one’s heart”, i.e. “do unto others as your heart prompts you.” A
passage from the “Doctrine of the Mean” (Zhong Yong), however,
gives away the social meaning of this statement: “Zhong and Shu are
not far from the Dao. What you do not like done to yourself, do not do
to others…Serve your father as you would require your son to serve
you…serve your ruler as you would require your subordinate to serve
you…serve your elder brother as you would require your younger
brother to serve you…set the example in behaving to your friends as
you would require them to behave to you”. This statement clearly
shows that the Confucian concept of “altruism” is very different
than the compassion advocated by the Buddhists or Christians.
Zhong and Shu are the positive and the negative sides
of the same thread. Zhong consists in doing to others as
we would do to ourselves and Shu in not doing to others
as we would not like done to ourselves.
忠 zhong = loyalty
忠诚 zhong cheng = loyalty
CONFUCIAN INFLUENCE ON THE NEI JING
It should be remembered that the Confucian
philosophy became the orthodox State philosophy of
the Chinese Empire already during the Han Dynasty,
(206 BC-AD 220),Wu Di empire. Furthermore, the
edition of the Nei Jing that we have dates back to
AD 762 written by Wang Bing (Tang Dynasty, AD
618-907) by which time the Confucian philosophy
had become even more established as the absolute
State orthodoxy and the arbiter of family and social
relationships.
Of course the Tang Dynasty also marked a revival
of Daoism and this is also obviously reflected in the
Nei Jing. Moreover, the Nei Jing was further edited
during the Song dynasty which marked the
apotheosis of Confucianism. It was actually edited
by imperial committees! This means that it
reflected the official Confucian views.

Passages showing a Confucian influence on the Nei

Jing can be found throughout the text and
practically in every chapter. I will give only a
couple of examples to show such Confucian
examples on the Nei Jing.
For example, Chapter 29 of the Ling Shu has the following
passage:

“To maintain order among the people and to maintain order in ones
body, to maintain order in the State and to maintain order in the
family, it has never been that one acted against the rules and was able
to maintain order. Therefore it is only by following 顺 the rules that
one achieves success. To follow the rules does not apply only to the
acting against or going along with the Qi in the Yin or Yang channels;
even in view of the entire population one should always strive to
follow with their expectations.”
Chapter 29 continues:
“The Yellow Emperor asked, ‘How does one follow the rules?’ Qi Bo
answered, ‘When you enter a State, inquire after its customs. When
you enter a family, inquire after its prohibitions. When you ascend
the hall, inquire after its rites. When you approach a patient, ask
what pleases him.’”
The commentary by Yang Shan Han in the Huang
Di Nei Jing Su Wen Tai Su says: “The ways of
dealing with the State, the family and the body all
have their structures. It has never occurred yet
that someone meant not to follow these structures
but wished to correct them. Customs,
prohibitions, rites and pleasure—these are the
structure of man. Yin, Yang and the Four Seasons
are the structures of Heaven and Earth. In the
Way [Dao 道] of maintaining life 养 生, not one
of these must be left out.
It is very apparent from these passages that
maintaining health was seen as a reflection of order
in the family, society and the State. Thus, disease
was an ethical as much as a medical problem. The
reference to following the rules also reflects a strong
Confucian influence as Confucian ethics is entirely
based on each person assuming a definite role in
family and social relationships and behaves
according to strict ethical rules. Following these
rules was called “shun” while going against them
was called “ni” and interestingly both these
characters are used in Chinese medicine.
Chapter 8 of the Su Wen:
“Hence if the ruler is enlightened, his subjects
are in peace. To nourish one’s life on the basis of
this results in longevity. There will be no peril
till the end of all generations. Thereby there will
be great success under Heaven. If the ruler is
not enlightened, then all 12 officials will be in
danger. This causes the passageways to be
obstructed and impassable. The body will suffer
severe harm. When this is applied to the
nourishment of life, one would suffer health
problems; when it is applied below Heaven it
will cause great disaster.”
This passage is another good example of the
Confucian/Legalist influence on the Nei Jing:
it clearly correlates the harmony of the body
in health with political and administrative
order: as the body depends on the
enlightenment of the Heart, the State depends
on the enlightenment of the Emperor. It also
shows clearly how assigning a primary role
to the Heart is influenced by the political
system in ancient China, based as it was on a
strong, supreme ruler with god-like attributes.
The Heart too has such attributes due to the
numinous nature of Shen.
Chapter 71 of the Ling Shu
“Only the Hand Shao Yin channel has no Shu point, why is that? The
Hand Shao Yin channel pertains to the Heart. The Heart is the ruler of
the 5 Zang and 6 Fu and the residence of Spirit [Jing-Shen]. It is a firm
and solid Zang so that pathogenic factor cannot settle there; if they did,
the Heart would be harmed and if this is harmed the Shen would leave; if
the Shen leaves, it would be death. So pathogenic factors instead of
settling in the Heart, settle in the Pericardium [Xin Bao Luo]. The Xin
Bao Luo is the channel of the ruler of the Heart [Xin Zhu]. For this
reason, [the Heart channel] does not have a Shu point. Since the Heart is
the only one that has no Shu point, does it mean it cannot fall ill? The
channel outside it can but the Zang cannot.”

This is another example of the comparison of the Heart to the

supreme Ruler. Just as the Ruler is protected by his army, the Heart is
protected by the Pericardium.
CONFUCIAN INFLUENCE ON EMOTIONS IN CHINESE
MEDICINE (Anger overemphasized)

逆 Ni: rebellious,
contrary, counter,
disobey, defy, go against

顺 Shun: to conform, in
the same direction as, obey,
yield to, act in submission to
CONFUCIAN METAPHORS IN THE NEI JING
1) The State administration with the Ruler and 11 Ministers
2) The concept that non-following of the rules (ni 逆) brings misfortune
(and ill health) and following the rules (shun 顺) brings fortune (and
health)
3) The idea that the success of a State depends a lot on the
enlightenment of the Ruler, i.e. that the Ruler has the Mandate of
Heaven (Tian Ming 天 命). (Hence importance of Heart)
4) The importance of rituals (Li 禮) in a healthy society (and body)
equivalent to yang sheng 养 生
5) The Nei Jing frequently compares a state of health to the harmony
within the family and obeying parents.

Please note that 1) is also Legalist. 4) and 5) are very much

Confucian.
Some very terms of Chinese medicine are drawn directly from Legalist
or Confucian ideas.

ZHENG QI 正 气. “Zheng” here is the same as the Confucian terms

referring to “correct” behaviour

ZHEN QI 真 气 “Zhen” (“true”) here is the same as the Confucian term

referring to the state achieved by a human being when he or she [and for
the Confucians certainly “he”] realizes ren, yi, li and zhi.
ZHI 治 “to treat” also means “to govern”, “to rule”, “to administer”,
“to put in order”, “seal of local government”, “to control”, “to
harness”, “to wipe out”, “to punish”.
NI 逆 and SHUN 顺 refer to rebellious (counterflow) Qi and Qi flowing
in the correct direction. They also have clear political undertones
meaning “to rebel” and “to conform”, “to obey” respectively. The terms
“ni” and “shun” also appear in the title of three Ling Shu chapters (38, 44
and 55) and one Su Wen (34)
For the Confucians, human beings were the centre of the world and
their whole philosophy was directed at finding ways of optimum
regulation of social relationship to ensure harmonious living. Chapter
25 of the Su Wen reflects this view clearly:

“Covered by Heaven and carried by Earth, all the myriad

beings have come to existence. None has a nobler position
than human beings. Human beings come to life through
the Qi of Heaven and Earth; they mature in accordance
with the laws of the 4 Seasons.”

For the Confucians, human beings were the centre and measure of
the Universe. Human beings possess qualities that set them apart
from other creatures and make them the most valued things on earth.
For the Daoists, by contrast, human beings are but one of the myriad
creatures of nature. It is only by rejecting man-made values in favour
of those of the Dao, that a human being can set himself free of his
limitations.
CONFUCIAN INFLUENCE ON THE “HEART” OF CHINESE
MEDICINE
In my opinion, Confucianism had a huge influence in the development of
the ideas about the Heart and Mind in Chinese medicine.
The first influence derives from the metaphor of the imperial
administrative and political structure with a god-like emperor, ministers
and provincial governors. The Chinese medicine concept of the Heart as
“ruler” [jun zhu 君 主] is very much a Confucian concept. The very
word jun is rich in Confucian meaning. Jun is both “monarch” or “ruler”
but also the “accomplished person” who is endowed with ren, yi, zhi and
li.
There is another connection between the Heart as ruler and the actual
emperor. The emperor was endowed with a god-like nature and had the
Mandate of Heaven (Tian Ming). Not by chance, the Heart is the only
organ that has the same god-like nature. This is evident from the
character for Shen.
神 SHEN. Mind, spirit, consciousness, vitality,
expression, soul, energy, god, God.

=示
SHI “Influx from heaven; auspicious or
inauspicious signs by which the will of Heaven is
known to mankind.” Altar (for sacrifices)

The two lines at the top are the old form of

Shang 上 (superior, above, high, hence
Heaven”)

The three vertical lines represent what is

hanging from Heaven, i.e. the sun, the moon
and the stars, the mutations of which reveal to
people transcendent things.
Confucius Lao Zi
It could be argued that a Confucian human-body
cosmology is based on the Heart being at the top a the
imperial ruler, while a Daoist human-body cosmology is
based more on the Kidneys below, the source of Jing
and the basis for Daoist Qi Gong.
The Confucian view of the Heart as the ruler and the
most important organ derives also from Meng Zi’s (372-
289 BC) views on the Heart-Mind. Please note that the
word Xin for Heart in Confucian philosophy stands also
for “Mind”.
Meng Zi often talked about “losing one’s heart”
(and therefore Mind) and “retaining one’s heart”.
The gentleman [jun zi] retains his heart;
according to Meng Zi “a gentleman differs from
other men in that he retains his heart”. He
thought it necessary to emphasize retention of
the heart because it is something that is easy to
lose. Since the heart is something we posses
originally it is also called the “original heart”.
Meng Zi describes a man who loses his sense of
shame, for example, and comes to do things for
unworthy motives as a man who has lost his
“original heart”.
Meng Zi also calls it the “true heart”. “It is not the case that a man never
possessed the benevolent and righteous heart [according to him we all
have it] but that he has let go of his true heart”.
According to Meng Zi, the main function of the Heart is to think
(hence my translation of Shen as “Mind”). If a man loses his heart, his
senses cause him to be attracted by outside things. “The organs of sight
and hearing are unable to think and can be misled by external things”.
“The heart organ can think, but it will find the answer only if it does
think. Otherwise, it will not find the answer. This is what Heaven has
given me”.
We can see from this passage why Meng Zi attaches the greatest
importance to the Heart. Without the ability to think, a living creature is
completely determined by its desires and the desires are at the mercy of
their objects. It is the gift of the True Heart from Heaven that marks
human being off from animals; but the mere possession of the Heart is
not enough, we must think with it.
What Meng Zi meant by “thinking” is not only cognitive thinking but
also emotional, ethical and volitional, i.e. our thinking about moral
duties, priorities, the purpose and destiny of man. According to Meng
Zi, in the human body, the heart is the highest member and the senses are
lower members. The difference between a gentleman and lesser men is
the relative importance that they give to the highest or lower members.
The “gentleman” [jun zi] gets his priorities right, while the small man
gets them wrong.
According to Meng Zi there are four incipient tendencies in the heart
(“sprouts”). These are the tendencies to:
- Compassion
- Shame
- Modesty and courtesy (or deference)
- Right and wrong (i.e. ability to distinguish right from wrong)
Meng Zi called these incipient tendencies the “four hearts”: they
germinate into the Confucian qualities of benevolence (ren),
righteousness (yi), ritual propriety (li) and wisdom (zhi).

THE FOUR HEARTS OF MENG ZI

1) Heart of compassion is the sprout of benevolence (ren 仁
2) Heart of shame is the sprout of righteousness (yi 義)
3) Heart of deference is the sprout of ritual propriety (li 禮)
4) Heart of right-wrong is the sprout of wisdom (zhi 智)
Both Xun Zi and Meng Zi place the Heart at the top of a hierarchy and
view it as the “ruler”: this is of course, the view of Chinese medicine.
Despite this picture of the Heart as the ruler, for Meng Zi, the Heart is
also linked to emotions and desires. The moral desires of the Heart lead
to the “four sprouts”.

REN YI LI ZHI

Compassion Shame Deference Right/wrong

Xun Zi also discussed the role of the Heart and
Mind. He said:
“Love, hate, delight, anger, sorrow and joy are
stored within. These are called the Heavenly
emotions. The ear, eye, nose, mouth and body can
each sense [objects] but their abilities are not
interchangeable. These are called the Heavenly
faculties. The Heart is called the Heavenly
Lord.”
Thus, this passage illustrated how, also in the
philosophy of Xun Zi, the Heart is the ruler of the
human body and mind, the “emperor” to the
other organs.
Meng Zi places the Heart at the centre of human nature and
also at the “top” of a hierarchy (influence on Chinese
medicine)

Both Xun Zi and Meng Zi place the Heart at the top of a

hierarchy and view it as the “ruler”: this is of course, the
view of Chinese medicine. Despite this picture of the Heart
as the ruler, for Meng Zi, the Heart is also linked to
emotions and desires. The moral desires of the Heart lead
to the “four sprouts”.
It could be argued that a Confucian human-body cosmology is
based on the Heart being at the top as the imperial ruler, while
a Daoist human-body cosmology is based more on the Kidneys
below, the source of Jing and the basis for Daoist Qi Gong.

Zhuang Zi disagreed with the idea of the Heart being the ruler.
He insists that the Heart, being only one of the organs, is no
more “me” than any other organ. We suppose that it could
control the others, but in fact the various members are
interdependent and “take turns as each other’s ruler and
subjects”. According to him, the true ruler is not the Heart but
the Dao.
In conclusion, the Confucian (and especially Meng
Zi’s) discussion of Heart and Mind dating back to the
4th century BC is pivotal in the development of Chinese
philosophy and Chinese medicine. The Confucian did
nothing less than “discover” the Heart and Mind and
made it an essential part of our human nature.
Meng Zi introduced his own version of this
philosophy producing a moral version of the Heart and
Qi. According to Meng Zi, the unique feature of the
make-up of a human being is his Heart and so, when
we speak of human nature, we should have the Heart in
mind primarily. In other words the Heart is our human
nature.
INFLUENCE OF LEGALIST SCHOOL ON THE NEI JING

LEGALIST METHAPHORS IN NEI JING

1) View of human body as State administration with central ruler and
ministers.
2) The placement of the Heart at the top (as emperor)
3) The channels as the highway system developed by the Qin emperor
4) The channels as waterway developed by the Qin emperor
5) The treatment methods of Chinese medicine may be viewed as the
“strict laws’ and “harsh punishments” meted out by the Qin officials.
6) Classification of herbs into “ruler”, “minister”, “assistant” and
“envoy”. The word used for the “rank” [pin 品] of the herbs is the
same as rank of officials.
LEGALISM FA JIA 法 家
QIN DYNASTY AND LEGALISM

Han Fei Zi, the last and most sophisticated of the Warring States' Legalist
thinkers, is credited with synthesizing Shang Yang's and Shen Bu Hai's
achievements. He also borrowed ideas from the Daoist classic Dao De
Jing. It is interesting to note that Han Fei Zi also made reference to the
Dao as an ideal to aspire to. Of course, the Dao to him is different than
the Dao of the Daoists or Confucianists.
To the Legalists, the monistic transcendent power of Dao is
embodied in the ruler, whose authority is limitless and unquestionable.
The principles of Dao are manifested in the Law (hence the “School of
Law” Fa Jia), which thus becomes the constant and unshakable
foundation of human society.
HAN FEI ZI
Unlike the other great Chinese
philosophers of this era (Mo Zi,
Confucius, Mencius, Zhuang Zi, and Xun
Zi) who were impoverished noblemen,
Han Fei Zi was a prince of the royal
family in the state of Han. He was born
around 280 BC and studied under the
Confucian realist Xun Zi at the Ji-Xia
academy along with Li Si, who considered
Han the better student, according to Si Ma
Qian's biography.
Eventually the writings of Han Fei came to the attention of the
young king of Qin, who began ruling in 246 BC and went on
to become the founding Emperor of the Qin dynasty, Shi
Huang Di. His prime minister was Han Fei’s old friend Li Si,
who informed his sovereign these writings were Han Fei’s.

In 234 BC Qin attacked the state of Han, and their king An

sent Han Fei as his envoy to Qin. The king of Qin was
delighted to meet the philosopher, but Li Si warned the king
that Han Fei was of the royal family of Han and likely to
remain loyal to that state and therefore be against Qin.
Charges were brought against Han Fei, who wanted to plead
his case before the king, but he was not allowed an audience.
Book of Lord Shang (Shang Jun Shu)

An important Legalist tract attributed to the fourth-century

chancellor of Qin, Shang Yang, was called the Book of Lord
Shang. In order to strengthen the country Shang Yang
believed that everyone's efforts should be devoted to
agriculture and war. A strict Legalist, Shang Yang's book is
definitely anti-Confucian, as seen by the beginning of the
section on Discussion About the People. “Sophistry and
cleverness are an aid to lawlessness; rites and music are
symptoms of dissipation and licence; kindness and
benevolence (ren) are the foster-mother of transgressions;
employment and promotion are opportunities for the
rapacity of the wicked.”

Note the disparaging reference to “music”, “kindness” and “benevolence”, a clear dig
at Confucianists.
These eight things would make the people stronger than
the government and the state weak. Shang Yang wanted
the government to be stronger than the people so that the
army will be strong, and the state can attain supremacy. If
the officials are virtuous, the people will love their
relatives; but if officials are wicked, people will love the
statutes and spy on others so that crimes will be punished.

Thus this book actually argues against virtue and the

strength of the people but for a strong government and
army. The poor should be urged to work by rewards, and
the rich should be punished so that they will not be
parasites. Private rewards to those below should be
forbidden so that the people will fight forcibly against the
enemy.
The Book of Lord Shang criticizes contemporary states
that are disorderly because of private benefits going to
those in office. Bad ministers let their standards be
influenced by money in order to obtain emoluments. When
the ministers compete with each other in selfishness and
neglect the people, inferiors are estranged from superiors,
dividing the state. States are in disorder, because the law is
not applied. Crimes are committed, because their
perpetrators are not caught.
This book argues that if punishments are too light, crime
cannot be eradicated; but when punishments are heavy,
people will not dare to do wrong. Then everyone will be
virtuous without rewarding the virtuous. Rewarding the
virtuous is not permissible, because it is like giving
rewards for not stealing.

The good may be good toward others but cannot cause

others to be good; they may love others but cannot cause
others to love. Thus goodness is not sufficient for
governing the empire. The wise insist on good faith and
have a method (law) by which the whole empire can be
compelled to have good faith. Thus when law is correctly
administered, the result will be virtue.
These threats are variously described as “lice” or “evils.”
According to him, the six lice are 1) longevity, 2) good
food, 3) beauty, 4) love, 5) ambition, and 6) virtuous
conduct.
The ten evils are 1) rites, 2) music, 3) odes, 4) history, 5)
virtue, 6) moral culture, 7) filial piety, 8) brotherly love, 9)
integrity, and 10) sophistry. Of course, most of these so
called vices were virtues in the philosophy of other schools
such as the Confucians or the Mohists.
The book of Lord Shang even advocated employing
five-man units of mutual surveillance to report on one
another: this is of course the embryo of a police state.
Lord Shang even said that in a well-governed state, the
people are the ruler’s eyes and ears.
One of the most striking ideas in the book of Lord Shang is that of
the negative effect of any economic surplus which, according to him,
would turn people into self-indulgent parasites. The six lice derived
directly from the three constant functions, i.e. farming, trade, and
government office. If farmers have a surplus they become
concerned about living a long life and eating well; if merchants have
a surplus they become concerned about obtaining female beauty and
affection; if officials have time to spare they become concerned
about personal ambition and a reputation for virtue.

Thus, functions outside agriculture and war are to be

discouraged as any surplus available to the people becomes a threat.
War serves not only to conquer enemies and seize their resources,
but also to consume any internal surplus that would otherwise
destroy the state. This is a truly astonishing idea, according to
which, a strong state must know not only how to create energy, but
also how to destroy it.
This accumulation of energy was called “poison”. If a state is
strong and does not engage in war then the poison is
transferred to the interior. Rituals, music, and parasitic
officials arise and the state will inevitably be weakened. But if
a country is strong and carries out war then the poison is
transferred to the enemy: the state will have no rituals, music,
or parasitic officials, and it will inevitably be strong.

Thus the state organized for war as envisaged by the book

of Lord Shang requires not only that all the energies of the
people be devoted to agriculture and war, but that there must
always be another war to fight, another enemy to defeat.
Ultimately, war was fought not for gain but paradoxically for
loss, to expend energies and wealth that would otherwise
accumulate in the hands of those who, by virtue of their
growing prosperity, would come to serve their own interests
rather than those of the state.
The Dao is the beginning of all beings
and the measure of right and wrong.
HAN FEI ZI
Therefore the enlightened ruler holds fast to the beginning
in order to understand the wellspring of all beings,
and minds the measure in order to know the source of good and bad.
He waits, empty and still, letting names define themselves
and affairs reach their own settlement.
Being empty, he can comprehend the true aspect of fullness;
being still, he can correct the mover.
Those whose duty it is to speak Note use of the
will come forward to name themselves; term “Dao”
those whose duty it is to act will produce results.
When names and realities match,
the ruler need do nothing more
and the true aspect of all things will be revealed.
Hence it is said: The ruler must not reveal his desires;
for if he reveals his desires
his ministers will put on the mask that pleases him.
One method Han Fei Zi recommended for making rewards and
punishments more effective was to have people watch each
other and be responsible for reporting crimes in their
community. By rewarding those who denounce criminals and
punishing those who refuse to do so as complicit, he hoped that
all kinds of culprits would be detected. However, this
innovation, which was actually a regression to primitive times,
was implemented by Lord Shang in Qin in the fourth century
BC; it was one of the reasons he was so unpopular and led to
his death.
Han Fei Zi coldly and calculatingly suggested methods of
behavioral modification as political theory under an
authoritarian system of monarchy. He brought these to the
attention of the leaders in the powerful state of Qin, where he
became the first casualty of a policy that allows no one to
challenge the authority of the ruler.
HAN FEI ZI’S CRITICISM OF CONFUCIANS
King Yen practised benevolence (ren) and righteousness
(yi) and the state of Xu was wiped out. Zi-Kong employed
eloquence and wisdom and Lu lost territory. So it is
obvious that benevolence (ren), righteousness (yi),
eloquence and wisdom (zhi) are not the means by which to
maintain the state. Discard the benevolence of King Yen
and put an end to Zi Kong’s wisdom. Build up the might of
Xu and Lun until they can stand to face with a state of
10,000 war chariots.
People will bow naturally to authority but few of them
can be moved by righteousness.
LEGALIST SCHOOL (FA 法 JIA) by Han Fei Zi (280-233 BC)
In persuading the rulers, today’s scholars do not
speak of taking advantage of strong and awe-inspiring
power to subdue bad and disloyal ministers. Instead,
they all speak only of benevolence (ren), righteousness
(yi), kindness and love. Thus, at worst their states are
destroyed and they perish, or at least their territory is
diminished and the ruler is disgraced.
I will thus make clear that benevolence [ren],
righteousness [yi], kindness and love are not worthy of
use, but instead that by means of severe punishments
and heavy penalties one can order the state. Strength
and order come from law; weakness and chaos come
from being soft.
CONFUCIAN “REPLY”
Shame is very ingrained in Confucianist ethics. It is even
something that is considered a beneficial “tool” to keep
people in line. Consider this passage from the Analects of
Confucius:
“The Master said: ‘Lead the people with administrative
injunctions (政 ) and keep them orderly with penal law, and
they will avoid punishments but will be without a sense of
shame. Lead them with morality (de 德) and keep them
orderly through observing ritual propriety (li 禮) and they
will develop a sense of shame; and, moreover, will order
themselves”.
In other words, laws and punishments may keep social
order, but even better is to lead by example so that people
will regulate themselves due to the sense of shame from
not following the social order.
Meng Zi also emphasised the value of shame in
promoting ethical behaviour. “A man must not be
without shame for the shame of being without shame
is shamelessness indeed”. “Great is the use of shame
to man. He who indulges in craftiness has no use for
shame. If a man is not ashamed of being inferior to
other men, how will being their equal have anything
to do with him?” According to Meng Zi, a man’s
aspiration to become a morally better man are
founded on his feelings of shame.
法
The Legalist School was called Fa Jia, i.e. the School of
Law because it placed so much emphasis on the rule of
law to keep people in line (as one cold not rely on ethics
as the Confucians advocated). The term fa pervades the
whole of the Nei Jing and it appears very many times.
Chapter 56 of the Su Wen repeats six times shang xia
tong fa 上 下 同 法. I interpret this to mean that the
same laws that apply to the State apply to the human
body.
ZE 则 is used in the Nei Jing to indicate “principle” as in
“treatment principle”. Ze also means “rule”, “regulation”,
“norm”.
Chapter 77 has a very clear reference to both Legalist
and Confucian political concepts:
“The art of the sages sets an example for all mankind.
Judgment [lun cai 论 裁] and mind [zhi yi 志 意] must
be based on laws [fa 法] and rules [ze 则]. If one follows
the classics and observes the calculations and accordingly
practises medicine with due reverence, this will be
beneficial to all mankind.”
Lun Cai is a typical Legalist concept by Han Fei Zi
while Zhi Yi is a Confucian one by Xun Zi. Note that ze
appears in Chinese medicine a lot as it refers to
[treatment] “principle”.
The above passage shows very clearly the connection
between social and political rules and medicine.
“LEGALIST” TREATMENT METHODS
a) If it is cold, burn it with moxa
b) If it is hot, clear it with bitter herbs
c) If it is Empty, tonify; if it is Full expel pathogenic factors
d) Use vomiting, sweating and purging as treatment methods
e) We use bleeding as treatment method
f) If there is mental-emotional disturbance, use strong acupuncture
treatments to restore normality (Sun Si Miao 12 ghost points) or
bitter medicinals
g) Nowhere in the Nei Jing, does it advocate wu wei in relation to
treatment approach. Nowhere does it say “rely on nature’s
healing power”.
h) The word coined for “to treat” is the same as “to govern” [治]
i) Many references to “law” [fa] and “rules” [ze]
A modern Chinese text reports a quotation from Dou Han Qing
which says:

“To treat a disease is like attacking an enemy. When

military forces are combined and an attack is launched up
and down upon a small group of traitors, they can hardly
escape.”
The expression “up and down” in this passage refers to using a point on the arm
and one on the leg (all pairs of opening and coupled points are located thus).

P-6 .

. SP-4
The herbal medicine tradition from the Han to the Song dynasty
was influenced by Daoism and the theory of Yin-Yang and 5
Elements was not applied to it systematically. By contrast, the Su
Wen tradition was influenced more by Confucianism and
Legalism.
Acupuncture in the Qin and Han times was entirely influenced
by Confucianism and Legalism, not much Daoism. Daoism
influenced more herbal medicine (without the application of Yin-
Yang and 5 Elements to it). Because of the Legalist metaphor of
highways and waterways, acupuncture became an exquisitely
Confucian-Legalist type of therapy, influenced by their ideas.
Some passages from the Su Wen show a remarkable mixture of
Daoist, Legalist and Confucian thinking such as this sentence at
the end of chapter 3:
“If the Dao [Daoist] is carefully observed as the Law [Legalist]
demands, the Mandate of Heaven [Confucian] will last long”
INFLUENCE OF DAOISM ON THE NEI JING
The school of Dao was purportedly started by Lao Zi in the 5th
century BC. However, most serious historians of Daoism agree
that Lao Zi is probably a mythical figure. He was the author of
the Dao De Jing. Another important Daoist classic was that by
Zhuang Zi, but even this author is considered by some to be
mythical. The first Daoist text historically accepted by historians
is the Huai Nan Zi written approximately in 140 BC (although it
is far from entirely Daoist).
The Daoist philosophy is based on two central concepts of Dao
道 and De 德. An analysis of the character for Dao reveals that
its radical indicates walking or movement: this means that the
Dao is not an ontological substance, but a process, a Way. As for
De, it is basically the human quality that we acquire by following
the Dao. Some sinologists translate De as “power”.

道 德
The Daoist school arose more or less at the same time as the
Confucian and Legalist school. The Daoist school’s philosophy
diverged radically from both of these schools. The Confucian school
was all about a system of ethics to ensure harmony in the family,
society and state. The Legalist school was all about ensuring that the
state is governed by a strong ruler with strict laws and harsh
punishments: it specifically looked down on the Confucian stress on
ethics, benevolence, morality, righteousness, etc.
The Daoist school was mostly concerned with natural philosophy,
i.e. it saw human beings as part of nature before seeing them as
members of a society or state. The Daoists were therefore completely
uninterested in state administration and political power; they were
equally scathing of the Confucian’s stress on ethics, in one passage
specifically calling it “hypocritical”.
The Daoist ideal community is a small village that does not need
a state bureaucracy or administration as outlined in Chapter 80 of
the Dao De Jing.
You want a small state with a minimal population.
Have ready to hand weaponry for a sufficient number of military units yet
have no recourse to use them.
Make sure that the common people take dying seriously so that they have
no taste for venturing far from home.
Though you have ships and chariots enough have no reason to man them;
Though you have armor and weapons enough have no reason to parade
them.
Bring the common people back to keeping their records with knotted
string,
To relishing their food,
To finding beauty in their garments,
To enjoying their customs,
And to finding security in their homes.
Although your neighboring states are within eyesight
And the sounds of their dogs and cocks are within earshot,
Your people will grow old and die without having anything to do
with them.
DAO DE JING Chapter 18

Thus when the great Dao falls into disuse

We then have “benevolence” (ren) and “righteousness” (yi)
When “knowledge” (zhi) and “wisdom” (zhi) emerge
The great hypocrisy [da wei 大 偽] then begins;
When family relations are not harmonious
We then have talk of “filiality” (xiao) and “parental
affection”;
When the state is in darkness and chaos
There then appears “upright ministers”
Wei = false, fake, bogus
DAO DE JING Chapter 19
Cut off sageliness, discard wisdom [zhi]
And the people will benefit a hundredfold
Cut off benevolence [ren], discard righteousness [yi]
And the people will return to filiality and parental affection
Cut off cleverness, discard profit
And there will be no thieves or bandits
There three teachings are mere cultural adornments (wen) and are
insufficient
The people must therefore be made to have somewhere they belong
Exhibit the unadorned [su] and embrace the uncarved wood
Reduce selfishness and make few desires
Cut off learning and there will be no worries
DAO DE JING Chapter 38
Chapter 38 of the Dao De Jing is a stinging attack on Confucian
hypocrisy.
“The highest Virtue [De] is not virtuous, and so it possesses Virtue
The lowest Virtue never lets go of Virtue and so is without Virtue
The person of highest Virtue is without action and holds nothing in
regard
The person of highest benevolence (ren) acts, but also holds nothing in
regard
The person of highest righteousness (yi) acts and holds certain things
in regard
The person of highest ritual propriety (li) acts and, when the people do
not respond, rolls up his sleeves and forces them to respond
Hence the Dao was lost when Virtue [De] arose
The rites [li] are the wearing thin of dutifulness and trustworthiness
and the beginning of disorder
Although we in the West tend to identify the Dao De Jing and
Zhuang Zi with Daoism, two more important texts are historically
related to Daoism: the HUAI NAN ZI and the NEI YE 內 葉.
Nei Ye means “inner cultivation” and a text of this name dates
back to 350-300 BC. It is a very short text composed of only 1,607
characters, i.e. about a third of the length of the Dao De Jing. The
Nei Ye was written in the state of Qi and specifically under the
influence of the Ji Xia academy which was set up by the ruler of that
state. The ideas expounded in the Nei Ye had a profound influence
on subsequent philosophers. For example, in this text there is a
discussion of human nature (xing 性) and of destiny (ming 命).
The Nei Ye also discusses the use of Qi, Jing and Shen in
personal cultivation: as can be seen, this ancient text contains
already the famous Three Treasures, i.e. Jing, Qi and Shen. The
cultivations of these forces became common teachings in ancient
Daoist texts and sometimes also in Legalist texts.
The ideas contained in the Nei Ye also
influenced Confucian models of self
cultivation by way of Meng Zi and other
writers who liked his ideas. For example, the
Nei Ye exhorts the reader to engage in
cultivation of the Heart-Mind (xiu xin 修 心),
arguably the central thesis of Meng Zi as well
as of centuries of Neo-Confucians.
Moreover, the Nei Ye describes that practice of cultivation
in terms that not only force us to think of the teachings of
Meng Zi, but even provide a meaningful context for
understanding his otherwise unexplained comment that one
should cultivate the “flood-like Qi” (hao ran zhi Qi 浩 然 之
气). Indeed, Waley thinks that the passages in which Meng Zi
deals with the cultivation of the well-spring of natal breath are
unintelligible unless we relate them to the ideas of the Nei Ye.
The main difference between the Nei Ye and the Dao De Jing is
indicated in the former’s title: Nei means “inner” and this book is
very much about the cultivation of Qi and Jing for physical, mental
and spiritual development, which is not the theme of the Dao De
Jing. The Dao De Jing raises mostly ethical, social and political
issues. The Nei Ye is of particular interest to us because it is all
about Qi. Qi is present both within all things and all around them.
Within each being Qi is centered in Jing.
The vital essence (jing) of all things-
This is what makes life come into being:
Below, it generates the five grains,
Above, it brings about the constellated stars.
When it flows in the interstices of Heaven and Earth,
It is called “spiritual beings”;
When it is stored up inside [a person’s] chest,
It is called “sageliness.”
The term “Shen” is frequently used in the Nei Ye but in a different
sense than the one in which we use it. In the Nei Ye, “Shen” refers
more to perception and comprehension of reality and the basis for
higher forms of awareness. According to the Nei Ye, the practitioner
must attract Shen and take it into his/her quietened Heart-Mind.
The Nei Ye expresses this process in terms of De 德. The
Confucians also often used this term and gave it an ethical
interpretation which it certainly does not have in the Nei Ye. De is
basically the process by which we follow the Dao. Indeed, some
sinologists say that De should be interpreted as a cognate of De 得
which means “to get”. In the Nei Ye, therefore, De could be defined
as the acquisitional agency, for it is not just what we attract and
receive, but that whereby we attract and receive Dao, Qi, Jing and
Shen.
Moreover, the Nei Ye (unlike the Dao De Jing) states that one’s
De is something that one must work on every day; the practitioner
must work to build up his/her De by practice.
Now Dao is what fills one’s form, yet people cannot secure it.
Its going forth cannot be recalled;
Its return cannot be retained.
Silent! None hears its sound.
Sudden! Yet it rests in the mind.
Obscure! None sees its form.
Surging! It comes to life along with me.
None sees its form, none hears its sound,
Yet there is a sequence to its completion.
Call it “Way.” [Dao]
There are many connections between the Daoism of the Nei Ye and
Confucianism, especially that of Meng Zi. As we have seen, the
Meng Zi’s concept of flood-like Qi can only be understood in the
light of the teachings of the Nei Ye. Moreover, we can identify three
basic statements that are common to the teachings of the Nei Ye and
those of Meng Zi:
1) One is born with a Heart-Mind that is
inherently as it should be
2) Our Heart-Mind becomes confused by our
thoughts and emotions
3) By returning our Heart-Mind to its original
state, we allow a natural harmony to take place.
When one reads in the Nei Ye that “the mind’s inner reality is
benefited by rest and quiet” it is strikingly similar to the teachings of
Meng Zi. Either Meng Zi had personal connection with the Nei Ye
community or he encountered a proponent of it at the Ji Xia
academy in the state of Qi.
The main element of Meng Zi’s teachings that is missing
from the Nei Ye text is the Confucian emphasis on saving
society by reviving the principles of proper, moral and
social behavior known as Li (rituals). Those were ideas
common to both Meng Zi and Xun Zi which were
denounced in the Dao De Jing.
By contrast, the Nei Ye is written from a point of view
of philosophers who have no interest at all in that debate.
Its reader is simply taught to align him/herself with the
natural forces in the world because doing so is necessary
for his/her well being. There is no trace of a belief that one
is responsible for changing society, although those who
hold such beliefs are neither faulted nor mocked.

Kirkland R, Taoism, Routledge, New York, 2005.

INFLUENCE OF DAOISM ON THE NEI JING
According to Unschuld, the Daoist philosophy had very
little influence on the Nei Jing.1 His main contention is that
acupuncture diagnosis and treatment was entirely
influenced by the Confucian and Legalist school and the
Nei Jing is mostly about acupuncture. As for herbal
medicine in the Qin-Han dynasty, this was not influenced
by the theory of Yin and Yang and the 5 Elements; the
merging of herbal knowledge with these two theories did
not occur until the Song dynasty.
As we have seen, the metaphor of
acupuncture channels as an image of
highways and waterways is very much
a Legalist metaphor.
1. Unschuld P, Huang Di Nei Jing Su Wen, University of California Press,
Berkeley, 2003.
I would personally not go so far as saying that there is no
Daoist influence on the Nei Jing. For example, the following
topics in the Nei Jing could be seen as expressions of a Daoist
outlook:
1) Internal exercises, breathing and Qi Gong
2) The concept of Dan Tian
3) The nature of the Kidneys and its relation to the Brain.
Indeed, it could be argued that the placement of the Heart as a
ruler reflects a Confucian-Legalist outlook, while a Daoist
outlook would probably place the Kidneys as the ruler.
4) An empirical knowledge of herbs, herbs for longevity.
Indeed some authors think that at least some parts of
Chinese medicine are derived from the practices of Yang Sheng
Again, just as we should not interpret every reference to “Dao”
in the Nei Jing as a reflection of a Daoist influence, the same
goes for reference to “De”. This is because both terms “Dao”
and “De” were used extensively by the Confucians and
occasionally even the Legalists.
Another evidence that Daoism did not have a huge influence
on the Nei Jing is in the differing views of society and state
between Confucianism-Legalism. The Nei Jing is all about
society, state, state administration, laws, rules, following or
rebelling against the rules, government (which is the same as
“treatment’ zhi 治), “correctness” [zheng] of Qi, etc. By
contrast, the Daoist tradition of the Dao De Jing advocates
small communities where government is not needed, laws are
not necessary, rules are not called for and there is no such thing
as “correct” and “incorrect”.
YIN YANG

Contrary to what most of us believe as practitioners of

Chinese medicine, the concept of Yin and Yang has
actually nothing to do with Daoism. As we have seen, the
concept of Yin and Yang originated partly from the school
of Zou Yan and partly from unaffiliated practitioners of
the natural arts as indicated above. Indeed, the terms Yin
and Yang are mentioned only once in Chapter 42 of the
Dao De Jing, and even this reference to Yin and Yang is
rather strange (“everything carries Yin on its shoulders and
Yang in its arms”).
Although we have highlighted the difference
between the Daoist, Confucianist and Legalist
school, such differences refer to the early periods,
i.e. the Warring States period and the Qin-Han
dynasties. In subsequent centuries, and especially
in the Tang and Song dynasties, there was
syncretic movement of integration, especially that
of the Confucian and Daoist school. For example,
Dong Zhong Shu (195-115 BC) integrated Yin-
Yang and the 5 Elements into Confucianism.
THE YIN-YANG SCHOOL
Of course, the Yin-Yang School of Zou Yan had a major influence
on Chinese medicine. Although it is called “Yin-Yang School”, it is
the school that developed the 5 Elements. This is discussed below.

THE HUANG-LAO SCHOOL

Another school that influenced Chinese medicine and that is not
often discussed is the Huang-Lao school that flourished during the
first 6 decades of the Han dynasty. It takes its name from Huang Di
(the Yellow Emperor) and therefore the Nei Jing and from Lao Zi. A
Huang Lao manuscript (the Huang Lao Silk manuscripts) was
found in the Ma Wang Dui tombs.
The influence of the Huang Lao school on the Han court was
eclipsed by that of Confucianism under emperor Wu (141-87 BC).
The Huang Lao School advocated a central government
controlled by a ruler who had achieved profound states of
tranquillity and who governed by taking no intentional action
(weuwei), concepts found in the Dao De Jing.
The Huang Lao School was said to be the product of a Master-
disciple lineage that reached back for more than a century before
the Han dynasty began.
Among the silk scrolls unearthed in the Ma Wang Dui
tomb (closed in 168 BC), were two manuscripts of the Dao De Jing
and four texts that were attached to one of these two manuscripts.
These four texts were by some believed to be the long lost Huang
Di Si Jing (the Four Classics of the Yellow Emperor). They are
also referred to as the Huang Lao Bo Shu (the Huang Lao Silk
Manuscripts). These texts were probably written between 250 and
200 BC.
The philosophy of these texts can be described as a
syncretism between the cosmology of the Dao and an ethos of self-
cultivation and that fully embraces concepts from the Daoist,
Mohist, Legalist and Yin-Yang School. The predominant concern
is how to establish an effective and just government , one that
enables the the mutual flourishing of ruler and subjects.
The Huang Lao School calls for this to be achieved by an
enlightened sage king who has cultivated tranquillity that
enables him to see clearly the fundamental patterns that
underlie the cosmos and human society. Human beings
are not only an integral part of the cosmos, but they also
constitute changing microcosmic homologies to the
macrocosmic whole. Therefore, human behaviour ust be
carefully aligned with the greater standards and patterns
of Heaven and Earth.
OTHER NON-PHILOSOPHICAL TRENDS OF ANCIENT CHINESE
CULTURE (AND MEDICINE)
After having discussed Daoism, Legalism and Confucianism, we should not
forget that these philosophies were very much the preoccupation of the cultural,
educated elite. In ancient Chinese society, there existed a huge substratum of
non-philosophical trends such as soothsayers, horoscope experts, calendar
experts, shamans, healers, ghost exorcists, mediums, etc. All these had a deep
influence on Chinese culture and, to some degree, on Chinese medicine.
For example, shamanism and ghost exorcism had a deep influence on
Chinese medicine in parallel with the sophisticated theories of Yin-Yang, 5
Elements, etc.
THE 5 ELEMENTS IN THE NEI JING
Translation
Although the translation of Wu Xing as “5 Phases” has gained
acceptance, it is not without its problems and many sinologists reject it.
Wu Xing could be translated as “goings”, “conducts”, “movements”,
“forces”, “agents”, “entities’, “activities”, “stages”. John Major argues
for “5 Phases”; M Friedrich and and M Lackner suggest restoring “5
Elements”; Bodde favours “elements” over “phases”; A C Graham uses
“5 processes”.

五 行 CHI CHU
XING (to move,
movement) Left foot Right foot
print print
Indeed, the 5 Elements had different names in Chinese times at various
times and various texts. These are the other names used:

Wu Cai 五 材 Ability, talent, aptitude

Wu De 五 德
Wu Wei 五 位
Place, location, status, condition
The very first rudiments of the theory of the 5 Elements date back
to the Warring States Period (476-221 BC) or even much earlier, some
think even the Shang dynasty (1766-1050) if we take the 4 Directions Si
Fang 四 方 (plus a Centre) as a precursor theory of the 5 Elements.

东 西
Plan of the ritual complex built
by emperor Wang Mang (AD 9)

北 as a reconstruction of the Ming

Tang of antiquity
During the Shang dynasty, the theory of the 4 Directions (plus a Centre)
prevailed: this is obviously very similar to the scheme of the 5 Elements
(with correspondence of seasons and directions). An important feature of
the 5 Elements is that it introduced an important Centre with the Earth
Element. The connection between the 4 Directions and the early 5
Elements confirms that the earliest arrangement of the 5 Elements was in
the cross and not the circular one of the Sheng cycle (in which there is no
Centre).

3 5 4 7
8 10 9
1 6
The theory of the 5 Elements was greatly developed by Zou Yan (305-
240 BC) and his School of philosophy was called the “Yin-Yang
School” (Yin-Yang Jia 阴 阳 家) but it included the 5 Elements.
Needham calls this School the “Naturalist School” and considers it
“proto-science” as opposed to the pseudo-science of the Confucianists.
In ancient times the 5 Elements (Wu Xing) were called Wu Cai 五 材
i.e. the 5 Materials (but could also be “5 abilities” or “5 talents”). It
was Zou Yan who introduced the term Wu Xing and the cycles among
them (Generating, Controlling).

One of the earliest references to the 5 Elements describes them in

terms of movements (note order and therefore numbers):
1. Water: that which soaks and descends
2. Fire: that which blazes and ascends
3. Wood: that which can be bent and straightened
4. Metal: that which can be moulded and changed
5. Earth: that which allows for sowing and to harvesting
The Confucian philosopher Dong Zhong Shu (179-104 BC) elaborated on the 5
Elements and mentions both the Sheng cycle (notice that the numbers would be
different than those of the cross-like arrangement);
“Heaven has 5 Elements: first, Wood; second, Fire; third, Earth; fourth, Metal;
fifth, Water. Wood comes first and Water comes last, Earth being in the middle.
This is the order that Heaven has made. Wood produces Fire, Fire produces
Earth, Earth produces Metal, Metal produces Water, Water produces Wood.
This is their “father and son” relationship. Wood dwells on the left, Metal on
the right, Fire in front and Water behind, with Earth in the centre. As
transmitters, they are fathers; as receivers, sons. There is an unvarying
dependence of the son on the fathers, and a direction from the fathers to the
sons. Such is the Dao of Heaven.”
This is of course a Confucian, ethical interpretation of the 5 Elements (which I
would say is alien to medicine). Notice the reference to the “Dao”.
Both the theory of the 4 Directions and of the 5 Elements were not only cultural
phenomena but also had political overtones. The introduction of a Centre with
both the 4 Direction and even more so with the 5 Elements not by chance
coincides with the political development of a strong central rules called Shang
Di 上 帝.

The theory of 4 Directions prevailed during the Shang and Zhou Dynasty (771-
476 BC) characterized by a Centre: this reflected the political structure of the
Shang and Zhou States characterized by a strong ruler with the Mandate of
Heaven. This central authority collapsed during the fifth century with the rise
of several States fighting each other without a strong, central ruler. So it is not
by chance that the shifting, flowing cycles of the 5 Elements appeared during
the Warring States Period (476-221).
The theory of dynastic transmission based on the 5 Elements was
elaborated by Zou Yan: he envisaged the dynasty transmission as
linked to the reverse Ke (i.e. “Insulting”) cycle of the 5 Elements.
Ruler Power Omen Colour

Huang Di Earth Earthworms, Yellow

crickets
Yu (Xia) Wood Luxuriant Green
vegetation in winter

Tang (Shang) Metal Metal blades in White

water
King Wen Fire Red birds Red
(Zhou)
Qin Water Black
Zhou dynasty

Qin dynasty
QIN TEXT
Calculating the transmission cycle of Wu De 五 德 (5
Powers), the First Emperor (Qin) held that Zhou had the
Power of Fire and Qin was replacing the Power of Zhou
and should follow the Power that Fire could not conquer.
From then on, the Power of Water had begun its dominance.
Let the beginning of the year be changed and all tributes to
the court start at the 11th month, let robes, garments,
feathers, fur, stakes and flags all be in black, let the number
6 be used for regulations…Let the Yellow River be renamed
the “De Water”, symbolizing the beginning of the Power of
Water. Let the policy be harsh, firm, perverse, and occult,
with all affairs determined by law. Be severe and strict
rather than benevolent (ren 仁), kind (en 恩), harmonic (he
和) and righteous (yi 義). [A “dig” at Confucianists] Only
then will it be in accordance with the number of the 5
Powers.
As we have seen, there is a close interaction between the
theoretical cosmology and political power in ancient China and
it is not by chance that the theory of the 5 Elements developed
from the Warring States periods onwards and it consolidated
during the Qin and Han dynasty. The emerging political forces
of this transitional period mobilized correlative cosmologies,
Wuxing in particular, to destroy the centrality of the old
hegemonic state and to construct the new power relations of the
imperial era. Using Wuxing cosmology, they transformed the
static cosmology of Sifang by replacing the notion of an eternal
centre and its surrounding four quarters with five dynamically
interacting cosmic phases, conquering and generating one
another in sequential order.
Besides being used to destroy the old cosmology
and political order, Wuxing cosmology further
functioned as a political discourse of the imperial
era, used by diverse factions of power in contesting
imperial sovereignty, in defining norms for
political behavior, and in constructing emperorship
and the power relations that evolved around it.
The theory of the 5 Elements has many facets which also
depend on the different ways in which they can be arranged,
e.g. cosmological cycle, generating cycle, controlling cycle or
insulting cycle. For example, in one context the theory of the 5
Elements was used to represent a physical order of conquering
forces of nature (controlling cycle). In another context, it was
used to depict a moral order of birth and nurturing (generating
cycle).
For the first Qin emperor, the theory of the 5 Elements was
a cosmology of conquest and violence that replaced the moral
intentionality of Heaven. While for Han Confucian scholars,
the theory of the 5 Elements was a moral cosmology
manifesting the intention of Heaven.

Wang A H, Cosmology and Political Culture in Early China, Cambridge

University Press, Cambridge, 2000.
The Warring States Period marked the disintegration of the
authority of the central ruler, authority which was not only political
but also religious; the ruler was the connection between Heaven and
Earth and he had god-like status. The ruler’s power was taken by
four social groups, not established philosophical Schools but simply
social groups:
1) The religious and natural experts (like our modern scientists)
2) The state bureaucracy
3) The military class
4) The established philosophical Schools (Confucian, Mo Zi, Daoists,
Legalists)
The class of religious and natural experts was an assortment of
diviners, ritualists, astrologers, musicians, physicians, calendar
experts, etc. The theories of Yin-Yang, 5 Elements and Qi were all
developed by this group of people. In their professions, these experts
started to build various correlative classifications between the
natural order and the human world based on numerological sets of
2, 3, 4, 5, etc. By applying these correlative categories to their own
specialities, while serving their patrons, they replaced the king’s
monopoly of communication with the divine with their own
innovation – direct correlation of Heaven, Earth and Person.
The theory of the 5 Elements was used by these experts to curry
favour with various rulers and use the theory to give legitimacy to a
ruler’s reign or dynasty. For example, the first Chinese Emperor
defined himself as pertaining to Water and saying that it was the
time of Water in the cycle of the Five Elements.
SHI JI
“After the First Emperor of Qin had unified all under
Heaven and proclaimed himself Emperor, someone advised
him saying: ‘When Huang Di received the power [de] of
Earth, Yellow Dragon and Earth worm appeared. When the
Xia received the power of Wood, Green Dragon stopped at
the city gates and the grass and trees were luxuriant. When
the Shang received the power of Metal, silver flowed out of
the mountains. When the Zhou received the power of Fire,
red birds appeared as an omen. Now the Qin has replaced
the Zhou, and the time of the power of Water has come’.”

Zou Yan said: “Whenever a sovereign is going to

rise, Heaven will certainly show favourable
omens to the people in advance.”
THE FIVE ELEMENTS IN THE NEI JING

The 5 Elements are mentioned in very many chapters

of the Su Wen and Ling Shu. The most common
correspondences are of the 5 Elements with the
following:
Colours, odors, directions, organs, seasons, flavours,
numbers, orifices. The numerology of 5 is used in
many other instances to classify things such as the 5
stagnations, 5 fullnesses or 5 deficiencies.
CHAPTER 4 SU WEN
The East direction: greenish colour
Having entered it communicates with the Liver
Its orifice opens into the eye
It stores the essence of the Liver
Its flavour: sour
Its class: herbs and trees
Its animal: chicken
Its grain: wheat
its tone: jue
Its number: 8
Its odor: rancid
CHAPTER 5 SU WEN
The East generates wind
Wind generates Wood
Wood generates sour flavour
Sour flavour generates the Liver
The Liver generates the sinews
The sinews generates the Heart
The Liver rules the eyes
Among the Zang it is the Liver
Among the colour, greenish
Among the tone jue
Among the voices: shouting; among the orifices: eyes; among the
flavours: sour; among the emotions: anger
GENERATING AND CONTROLLING CYCLES OF 5
ELEMENTS
The Nei Jing contains many references to the cycles of the 5
Elements which confirms their arrangement away from the cross-
like arrangement of earlier times according to directions. For
example, the Controlling cycle is mentioned frequently in relation to
flavours and their excessive consumption. Example: “If one
consumes large amounts of pungent foods, the sinews will become
tight and the nail wither.” This is because Metal (pungent)
overcomes Wood (sinews and nails). Chapter 25 of the Su Wen
describes the Controlling cycle directly:
When Wood meets Metal it is felled
When Fire meets Water, it is extinguished
When Earth meets Wood, it is penetrated
When Metal meets Fire, it is destroyed
When Water meets Earth, it is interrupted
The Generating and Controlling cycles of the 5 Elements
are also mentioned frequently to describe the progression
of a disease.
Chapter 19 of the Su Wen says:
“The Liver receives its Qi from the Heart
It transmits it to the Spleen
The Qi rests in the Kidneys
Death occurs when it reaches the Lungs”
SU WEN CHAPTER ONE
Shang Gu Tian Zhen Lun 上 古 天 真 论 Discussion on Ancient
Heavenly Truth
The Yellow Emperor asked Qi Bo: “I have heard that people in Ancient
times lived to 100 years without any signs of senility. But people
nowadays become old at the age of 50: Is this due to changes in the
environment or to the deviation from the Way?” Qi Bo answered: “The
Ancients knew the Dao and they followed the rules of Yin and Yang
and they cultivated health. They were moderate in their eating and
drinking, regular in working and resting and avoided over-strain. That
is why they maintained a balance between the Shen and the body,
enjoyed good health and a long life. People nowadays on the contrary
behave just the opposite. They drink wine as if it was rice gruel, regard
wrong as right and seek sexual pleasure after drinking (literally enter
the chamber of love in a drunken condition). As a result, their Jing is
exhausted and their Zhen Qi is scattered. They don’t know how to
preserve their Jing, nor how to regulate the Shen pursuing sensual
pleasures (ni 逆). As they do not follow the Way they age quickly.
People in ancient times taught how to avoid deficiency,
pathogenic factors and perverse wind. In this way their Zhen Qi
was harmonious, their spirit (Jing-Shen 精 神) was preserved
and they were free from disease. Therefore the ancients lived in
peace and contentment without fear. They worked but never
over-strained themselves so that their Qi could flow smoothly
(Shun 顺). They were satisfied with their life and enjoyed the
tasty food, natural clothes and simple customs. They did not
desire high positions and lived simply and naturally. That is why
improper desire and avarice could not distract their eyes and
ears, lewd behavior could not tempt their mind (literally
“Heart”). Neither the ignorant nor the intelligent and neither the
virtuous nor the unworthy feared anything. They followed the
Dao and for this reason they lived to 100 years old without signs
of senility. Because they followed De (德) they were free from
diseases.
Chapter 1 of the Su Wen confirms that old age is
relative and it is possible to preserve a strong body
condition into one’s old age. “Could those who have
mastered the Dao have children when they are over 100?
Those who have mastered the Dao can enjoy good health
and prevent senility. So they still can have children when
they are very old.”
COMMENTS
1) The very first paragraph of Chapter 1 of the Su Wen represents
a revolution in Chinese medicine because it marks the transition
from demonic medicine based on the invasion of evil spirits and
treated by shamans to naturalistic medicine in which diseases are
caused not by evil spirits but by irregular lifestyle. In fact, when
the Yellow Emperor asks Qi Bo why people live a shorter life
compared to the old times, Qi Bo does not say that it is because
they are invaded by evil spirits, but it is because of the wrong
lifestyle characterized by immoderate eating, thinking, working,
desire and sexual behavior.
Indeed it was around the times when the Nei Jing was written
that the Chinese character for “medicine” changed. Before the
Warring States period the character for “medicine” had a shaman
on the bottom part, while after the Warring States period the
shaman was replaced by a herbal wine, indicating the transition
from the shaman to the herbalist.
During the Shang dynasty (1751-1112 BC)
and earlier, the influence of spirits
dominated life and medicine. In medicine,
the main cause of disease was attack by evil
spirits. The vocabulary of acupuncture is a
testimony of this.

YI = Medicine (Shang dynasty)

Wu=Shaman

医 Quiver of arrows
殳 To take out
巫Shaman
醫 Yi = Medicine (after Warring States Period)
酒 Herbal wine
It is interesting to note that, from the Warring States
Period (476-221 BC) onwards, the character for
“medicine” changed by replacing the radical for
“shaman” on the lower part of the character with that
for “herbal wine”: this signified that treatment was no
longer carried out by a shaman but by a herbalist.

醫
Up to Zhou dynasty From about 476 BC
(up to 476 BC) onwards
2) The passages mentioned are heavily influenced by the
Daoist philosophy. The Daoist elements in this passage are
as follows:
- The reference to the knowledge and techniques for
nourishing life.
- The reference to simple lifestyle, curbing of desire and,
crucially, disinterest in high position.
- The constant reference to moderation in eating, drinking,
working and sex.
- The importance attached to longevity.
- The reference to following the Dao (however, the
Confucians also talked about the Dao)
- The reference to the ability of having children in one’s old
age, even after reaching 100 years old, and the attribution of
this to following the Dao.
However, there are also Confucian elements in these
passages:
- The reference to shun (顺) and ni (逆) as code words for
following or not the Way. Following the Way results in
health and going against the Way results in disease.
-The reference to the ancients avoiding lewd behavior
(Confucian sexual repression).
- The interesting mixture of medicine and ethics: disease is
an ethical problem as much as a medical one, i.e. one
deriving from not following the Way.

3) This passage from Chapter 1 of the Su Wen is one of many that

makes reference to ancient sages, often classified into different
categories
“In very ancient times, the True people lived (Zhen Ren
真 人). They followed Yin and Yang, inhaling fresh air,
cultivating their spirit and keeping their muscles
exercised, so their life expectancy was like that of
Heaven and Earth.
Later, the Perfect people lived (Zhi Ren 至 人); they
were of the utmost morality (De 德), followed Yin and
Yang and the four seasons, forsake sexual desire,
avoided distraction. So they could see and hear beyond
the 8 directions. Such self-cultivation enabled them to
keep fit and prolong their life.
The reference to people who could see and hear beyond the 8
directions is interesting because it would seem to point to some
psychic ability. In my opinion, the ancient doctors who described the
channel pathways had such ability.
The third kind of people were the Sages (sheng ren 圣
人): they lived in harmony with the environment and
adapted themselves to the 8 winds. They curbed their
desire and were free from anger and dissatisfaction.
They tried not to exhaust their bodies and, mentally, they
freed themselves from anxiety, taking peace and
happiness as the aim of their life. As a result, their bodies
did not decline and their Shen was never exhausted.
That it why they lived to over 100.
The fourth kind were the Virtuous people (Xian Ren
贤 人): they followed Heaven and Earth and Yin and
Yang, adapted to the four seasons, thus prolonging their
life.”
From the above quotations, we can deduce the
main factors which the ancient Chinese
considered important in order to preserve one’s
constitution. These are:
1) Moderation and balance (diet, exercise,
work, sex, drinking)
2) Avoiding excessive desire and attachment
3) Avoiding “excessive” sexual activity
4) Simplicity of life-style
5) Shunning high social position, i.e. curbing of
ambition
CHAPTER 1 LING SHU
The Yellow Emperor asked: “I hope to hear about the exits
of the 5 Zang and 6 Fu. Qi Po said: The 5 Zang have 5 Shu
points making 25 in total. The 6 Fu have 6 Shu points
making 36 in total. There are 12 Main channels and 15 Luo
channels. The Qi of the 27 channels moves up and down.
Where the Qi exits [出] it is the Jing point; where it glides
(swift current) [溜], the Ying point; where it infuses (pour,
concentrate), [注] the Shu point; where it moves [行], the
Jing point; where it enters [入] the He point. The Qi of the 27
channels flows through the 5 Shu points. There are 365
places (acupuncture points) where joints meet….These are
the places where Shen Qi wanders [you 游]1 and moves in
and out unhindered by skin, muscles, sinews and bones.

1. The term “you” 游 has strong Daoist and Confucian overtones related to a
state of abandonment of the self
CHAPTER 68 NAN JING
Chapter 68 of the Nan Jing says the same things about
the 5 Shu points as the Nei Jing, with the exception that
it uses a different word for the Ying points.
The Nei Jing says that at the Ying points, Qi “glides”
or is a “swift current” [liu 溜] while the Nan Jing says
that it “flows” [liu 流]. But these two characters are
cognate and refers essentially to the same thing. It may
also be an error of transcription.
The 5 Zang have 6 Fu and the 6 Fu have 12
Yuan [points], the 12 Yuan points come out at
the 4 Gates, the 4 Gates treat the 5 Zang, when
the 5 Zang are diseased, treat the Yuan [points].
From [or “through’] the 12 Yuan [points], the 5
Zang receive the Qi and flavour of the 365 joints
[points]. When the 5 Zang are diseased [the
disease] will manifest at the Yuan points,
manifesting at each point. Understand clearly
the Yuan points; examine their correspondences
and know the diseases of the 5 Zang.
Within Yang there is Shao Yin, the Lungs, its Yuan point LU-9:
2points
Within Yang there is Tai Yang, the Heart, its Yuan point P-7: 2
points
Within Yin there is Shao Yang, the Liver, its Yuan point LIV-3:
2 points
Within Yin there is Zhi 至Yin, the Spleen, its Yuan point SP3: 2
points
Within Yin there is Tai Yin, the Kidneys, its Yuan point KI3: 2 pts
The Yuan point of Gao is Jiuwei (Ren-15): 1 point
The Yuan point of Huang is Boyang (Ren-6): 1 point
These are the 12 Yuan points that treat diseases of the 5 Zang
and 6 Fu.
CHAPTER 1 OF THE “SPIRITUAL AXIS” LING SHU
This chapter makes two statements in connection with the Yuan
points, one regarding their use in diagnosis, the other in
treatment.
The first statement says: “Select the Yuan points when the 5
Yin organs are diseased”.1 This clearly indicates that the Yuan
points directly affect the Yin organs.
The other statement says: “When the 5 Zang are diseased [the
disease] will manifest at the Yuan points, manifesting at each
point.”2 This statement clearly indicates that the Yuan points are
in relation with the Yuan Qi (Yuan Qi) and that changes on the
skin over the Yuan points indicate abnormalities in the
functioning of Yin organs and can therefore be used for
diagnosis.
1. 1981 Spiritual Axis (Ling Shu Jing). People’s Health Publishing House,
Beijing, first published c. 100 BC, p.3.
2. Ibid., p. 3.
Abnormalities which can be observed on the Yuan points include
swellings, redness, congested blood vessels (common on KI-3 Taixi),
varicose veins, a deep sunken dip around the point (also commonly
seen on KI-3), whiteness, a bluish colour or very flaccid skin.
When the “Spiritual Axis” proceeds to list the Yuan points,
however, it gives different points from the ones we usually consider.
The “Spiritual Axis” lists the Yuan points as:
- LU-9 Taiyuan for the Lungs 2 points
- P-7 Daling for the Heart 2 points
- SP-3 Taibai for the Spleen 2 points
- LIV-3 Taichong for the Liver 2 points
- KI-3 Taixi for the Kidneys 2 points
Total 10 points
- Ren-15 Jiuwei, Yuan point for
Fat tissue (Gao) 1 point
- Ren-6 Qihai, Yuan point for
Membranes (Huang) 1 point
Grand total 12 points
Regarding these last two points, the “Spiritual Axis” says: “The
Yuan Qi of Fat tissues [Gao] gathers at Jiuwei [Ren-15], the Yuan Qi
of Membranes [Huang] gathers at Qihai [Ren-6]”.3 Although the
book uses a different name, (Boyang), for Ren-6, this is the old
name for Qihai, i.e. Ren-6.
Ren-15 and Ren-6 are also considered the Yuan points for the
chest and the abdomen, and are the Yuan points for all the Yin and
all the Yang organs respectively. “Gao” may also indicate the area
below the heart (controlled by Ren-15) and “Huang” the area
above the diaphragm (controlled by Ren-6). [as in “Gao-Huang”]
Ren-15 is used for mental-emotional problems arising from
disharmonies of the Yin organs (e.g. Heart-Yin deficiency), such as
anxiety, mental restlessness or insomnia, and is an extremely useful
point to calm the Mind.
Ren-6 is used in Deficiency conditions of the Yang organs as it
strongly tonifies Yang Qi.
3. Ibid., p. 4.
The surprising element in this chapter is that the
Ling Shu mentions Yuan points only for the Yin
organs. This is because the Qi of the Yuan points
stems from the Yuan Qi which is related to the Yin
organs; in particular, the Kidneys. The Yuan
points are therefore used mostly to tonify the Yin
organs. However, it should be said that chapter 2
of the Ling Shu itself does mention the Yuan points
of the Yang channels as we know them today.4

4. Ibid., pp. 4-8.

In contrast, the Yuan points of the Yang organs do not
have a similar function and do not tonify the Yang organs
in the same way as the Yin Yuan points tonify the Yin
organs.
The Yang Yuan points are mostly used in Full patterns
to expel pathogenic factors. For example, L.I.-4 Hegu may
be used to release the Exterior and expel Wind; S.I.-4
Yanggu, to move stagnant Liver-Qi and stop pain in the
costal region; BL-64 Jinggu, to expel Damp-Heat from the
Lower Burner; G.B.-40 Qiuxu, for stagnation of Liver-Qi;
ST-42 Chongyang, to expel Wind from the face in facial
paralysis; and T.B.-4 Yangchi, to clear Gall-Bladder Heat
causing deafness or to regulate the Lesser Yang.
Of course, the Yuan points of the Yang channels can also be used to
tonify the relevant Yang organs (as chapter 66 of the Nan Jing says),
but this is not their main use, and they would not be the best points
for this purpose. To tonify the Yang organs, the Lower Sea points
would be the best choice. However, one exception springs to mind:
T.B.-4 Yangchi.

Chapter 66 of the Nan Jing says that the Yuan Qi springs forth
from between the Kidneys through the intermediary of the Triple
Burner. Therefore, the Triple Burner is like the emissary of the
Yuan Qi; as the Yuan points are in direct contact with the Yuan Qi,
T.B.-4 can therefore be used to strengthen the Yuan Qi, and is
particularly used in this way in Japanese acupuncture. It is
interesting to note, however, that none of the indications from old
Chinese texts refer to a tonifying action of this point on the Yuan Qi.
The other surprising statement in this chapter is the mention of
P-7 Daling as the Yuan point of the Heart. This is because in
the times when the Ling Shu was written the Heart and
Pericardium were considered as a single organ, hence the
constant reference to “5 Yin and 6 Yang organs”. It was only
later that the Pericardium and Heart were split into two
separate organs to preserve the symmetry of 12 organs and 12
channels.
In the Yin channels, the Yuan points coincide with the
Stream points, i.e. the third point from the distal end of the
channel; in the Yang channels, the Yuan point follows the
Stream point (Shu) and is therefore the 4th point from the
distal end of the channel (except for the Gall-Bladder channel
in which the Yuan point is the 5th from the distal end).
To summarize, the functions of the Yuan points as from the
Ling Shu are:

1) The Yuan points are in relation with the Yuan Qi.

2) They can be used in diagnosis as they reflect the state of
the Yuan Qi of each Yin organ.
3) They are used in treatment mostly to tonify the Yin
organs.
4) The Yuan points of the Yin organs are more important
than those of the Yang organs.
CHAPTER 66 OF THE NANJING
Chapter 66 of the Nan Jing has the same list of Yuan points
for Yin and Yang channels (with P-7 for the Heart). It also
says that “in the 12 channels” the Shu points (3rd point) are
also Yuan points (actually this is wrong because it only
happens for the Yin channels).
It then says that the Shu points of the 5 Zang are the
places where the Qi of the Triple Burner moves and rests.
Then the emperor asks if it is because the Qi of the Triple
Burner moves in the Shu points that they also function as
Yuan points.
The answer is: below the umbilicus in between the kidneys, there is a
Motive Force [Dong Qi 动 气] which generates human beings Life
[Ming 命]. This Dong Qi is the root of the 12 channels and that is
why it is called Yuan Qi. The Triple Burner is the envoy of the Yuan
Qi [or “it allows the Yuan Qi to differentiate”] and it controls the
flow of the Three Qi [Yuan, Ying, Wei] through the 5 Zang and 6 Fu.
“Yuan” is an honourable [or “honorary”] designation of the Triple
Burner. Hence the places where its Qi comes to a rest are called
Yuan points. When the 5 Zang and 6 Fu are diseases, use the Yuan
point.
12 Channels

5 Zang and 6 Fu

Triple Burner

LEFT KI RIGHT KI
YUAN QI
CHAPTER 2 LING SHU
Chapter 2 of the Ling Shu mentions the Yuan points of the Yang
channels. It does so, listing the Shu points of each channel. For
the 5 Shu points, it uses the same terms used in chapter 1, i.e. the
Jing point is where Qi exits [出], the Ying point where is flows
swiftly [溜], the Shu points where it pours [注], the Jing point
where it moves [行] and the He point where it joins [入]. The Yuan
point is mentioned after the Shu point, where the Qi “crosses” [过].
NAN JING - CHAPTER 65
ON THE JING AND HE POINTS EXITING/ENTERING

Where Qi exits [出], they are the Jing points which are associated
with East and Spring. Where Qi enters [入], they are the He points
which are associated with North and Winter.
COMMENTS
This passage is clinically important. Qi exists at the Well points just
like water springs forth from the ground at the spring. Qi enters at
the He point like a slow-flowing water of a large river joins the sea.
In terms of Qi dynamics, this means that Qi “exits” at the Jing
point and, in my opinion, it has a centrifugal movement, it has a
dynamic quality and, therefore, I use them to expel pathogenic
factors. Qi “enters” at the He point and it has a centripetal
movement and I use those points more to tonify.
Note that the reference to East/Spring and North/Winter should
not be interpreted in terms of the 5 Elements.
出 入
CHAPTER 2 LING SHU
HE-SEA POINTS
After listing all the Shu points of each channel, the Ling Shu has
an interesting statement: “These are the Shu points of the 5 Zang
and 6 Fu, 25 and 36 respectively. The 6 Fu exit at the three Yang of
the leg and connect upward with the arm.”
This statement is saying that all the He-Sea points of the Yang
channels are in the leg (because of the Lower He points ST-37, ST-
39 and BL-39, Lower He points of Large Intestine, Small Intestine
and Triple Burner respectively). These are the “real” He-Sea
points, the ones in the arm being “connections”.

The Arm Yang channels probably have Lower He-Sea points in the
legs because of the anomaly of their channels being in the arm and
their related organs in the lower abdomen (intestines and Triple
Burner).
Lower He-Sea points of
Large Intestine, Triple
Burner and Small
Intestine

... LI-11, TB-10, SI-8

.
..
BL-39

ST-37
ST-39
CHAPTER 2 LING SHU
Chapter 2 of the Ling Shu lists the couples of Yin and Yang organs
(and channels) and has an interesting statement.
“The Lungs are related to the Large Intestine which controls
transportation and passage; the Heart is related to the Small Intestine
which controls receiving; the Liver is related to the Gall-Bladder which
controls pure essence (bile); the Spleen is related to the Stomach which
controls the 5 grains; the Kidneys are related to the Bladder which
controls fluids; the Triple Burner is the Fu of ditches, controls Water
passages and it pertains to the Bladder. It (the Triple Burner) is
unique among the Fu.”

This is an interesting statement as it pairs the Triple Burner with the

Bladder rather than the Pericardium.
LING SHU Chapter 4
The He points are discussed also in chapter 4 of the Ling Shu.
“The Yellow Emperor: I heard that the Qi of the 5 Zang and 6 Fu
enters into the He points from the Ying points. … Qi Bo: The Yang
channels of the Fu organs diverge into the Interior…The Ying points
treat the exterior channels, the He points treat the Fu.
Yellow Emperor: How does one treat the Fu organs? Qi Bo: through
the He points….the Stomach He point is ST-36, the Large Intestine He
point is ST-37, the He point of the Small Intestine is ST-39, the He
point of the Triple Burner is BL-39, the He point of the Bladder is BL-
40, the He point of the Gall-Bladder is G.B.-40.”
When the Large Intestine is affected, there will be acute pain in the
abdomen with borborygmi, if cold invades the body again in winter,
diarrhoea will occur, the patient will have umbilical pain and will be
unable to stand for long; this is treated with ST-37 Shangjuxu.
Therefore chapter 4 is important as it confirms that the
three Yang channels of the arm have what we call a “lower
He point” (the Ling Shu calls them simply “He points”).
These are:
- Large Intestine: ST-37 Shangjuxu
- Small Intestine: ST-39 Xiajuxu
- Triple Burner: BL-39 Weiyang
The Ling Shu also says clearly that these He points are
used to treat diseases of the Fu. This is very important as,
if someone has a Large Intestine pathology, we do not
choose L.I.-11 but ST-37.
Spiritual Axis Chapter 8 on the mental effect of the emotions

“When needling one should first of all concentrate

one’s Mind (Shen). Blood, the blood vessels, the
Nutritive Qi (Ying Qi), Qi, the spirit (Jingshen) are
stored in the 5 Yin Organs. When they are out of
harmony due to the emotions, the Essence (Jing) is
lost, the Hun and Po are scattered, the Will-Power
(Zhi) and Intellect (Yi) are chaotic and the person
lacks wisdom and reflection: why is that? Heaven
bestows us Virtue (De), Earth bestows us Qi. When
De flows and Qi pulsates, there is life.
When the two Essences [of mother and father] unite, the
Mind comes into being. What follows the Mind in its
coming and going is the Hun, what follows the Essence
in its entering and exiting is the Po. The Heart directs
mental activities; it houses memory that is called
Intellect (Yi 意 ); The storing [of data] of the Intellect is
called Will-Power [or Memory, Zhi 志 ]; Memory
generates pensiveness; pensiveness (si) 思 generates
reflection (lu). Thus the wise nourish life (yang sheng
养 生 ) by following (shun 顺 ) the four seasons,
adapting to cold and heat, moderating joy and anger,
regulating Yin and Yang and thus will enjoy long life.
Fear, pensiveness and worry injure the Mind
and Spirit. When the Spirit is injured, fear
may run wild. When sadness agitates inside,
it injures life. Joy scatters the Spirit out of its
residence. Worry obstructs Qi so that it
stagnates. Anger causes loss of self-control.
Fear sweeps the Spirit away. Fright and
pensiveness of the Heart injure the Spirit.
Worry of the Spleen injures the Intellect.
Sadness of the Liver injures the Hun which may cause
manic behaviour and mental confusion; there is
contraction of the sinews, the hypochondrium cannot be
raised, the hair withers. The joy of the Lungs injures the
Po, when the Po is injured there is manic behaviour and
the Yin cannot reside, the skin becomes like heated leather,
the hair withers. Anger of the Kidneys injures the Will-
Power, when the Will-Power is injured it affects the
memory and one does not remember what they said, there
is lower backache and inability to bend or extend the back,
the hair withers. Fear injures the Essence, this injures the
bones.
Thus, the 5 Yin Organs which store the Essence should not be
injured; if they are, Yin deficiency results and from this, Qi
deficiency.
Therefore when needling one should observe the patient in order to
know the condition of the Jing, Shen, Hun, Po, and whether they
have been preserved or not.
The Liver stores Blood and Blood houses the Ethereal Soul:
when Liver-Qi is deficient there is fear; when full, anger. The
Spleen stores nourishment and this houses the Intellect: when
Spleen-Qi is deficient the four limbs are weak and there is an
imbalance in the 5 Yin Organs; when full, abdominal distension
and menstrual and urinary problems. The Heart stores the blood
vessels and these house the Shen: when Heart-Qi is deficient,
there is sadness; when full, incessant laughter. The Lungs store
Qi and this houses the Po: when Lung-Qi is deficient, there is
nasal obstruction; when full, breathlessness and a feeling of
tightness of the chest. The Kidneys store the Jing and this houses
Zhi: when Kidney-Qi is deficient there is collapse; when full,
distension and the 5 Yin Organs are not at peace”.
Several aspects of the above chapter should be noted.
1)The sentence: “Heaven bestows us Virtue (De), Earth
bestows us Qi; when Virtue flows and Qi pulsates,
there is life.” This sentence shows very clearly the
Confucian influence on Chinese medicine, i.e. the
idea that “Heaven bestows Virtue”: the term used
for “Virtue” [de 德 ] is a typical Confucian term
indicating the qualities of the Confucian sage.
2)Note that at the very beginning it does not say the
method of “treatment” (as everyone translates it) but
the method of “needling” should be based on the
Shen (of the practitioner). This is repeated further
down when it says “therefore when needling”.
3) Notice how Shen, Yi and Zhi are closely
interconnected with regard to memory (also
bearing in mind its relevance to consciousness
and self).
4) Note use of the word “shun” to indicate
“following” the right course. But “shun” means
to conform, to yield to, to obey. (Confucian).
5) Note that it says that anger “causes loss of self-
control”, the worse thing that could happen to a
human being in Confucian view.
6) Notice the odd mixture of physical and
emotional symptoms.
凡 刺 之 法 先 必 本 于 神
Fan ci zhi fa xian bi ben yu shen
Every needling’s method first must be based on Shen

“Whenever one needles, one must first

concentrate one’s Shen”

Common translation is “All treatment must be based on the Spirit” [of

the patient]
I propose an alternative translation with two important differences.
Firstly, the text uses the word ci which means “to needle”, not “to
treat”. If the text had meant to use the term “to treat”, it would
have used the word zhi 治which does occur a lot in both the Su Wen
and the Ling Shu. Thus, the first difference is that the first half of
the sentence is “when needling” rather than “when treating”: this is
an extremely important difference.
The second difference is that the “Shen” referred to here may be
interpreted as the Shen of the practitioner, not of the patient.
Therefore, the whole sentence would mean: “When needling, one
must first concentrate one’s mind [Shen]”. If that “Shen” is the Shen
of the practitioner, then “Mind” would be a better translation here.
There are other passages in the Nei Jing that would support this
view. For example, chapter 4 of the Ling Shu uses the word “shen”
to mean the doctor’s skill in palpation and needling. It says: “When
pressing on a channel [the doctor is capable of] understanding the
disease: this is called shen.”
This interpretation is consistent with two factors. Firstly, the Ling Shu is very much an
acupuncture text and therefore the reference to concentrating when needling makes
sense. Secondly, the advice to concentrate and focus when needling is also found in
many places in the Nei Jing. Indeed, the word “shen” is even used occasionally to mean
“needling sensation”. Chapter16 of the Su Wen says: “In Autumn needle the skin and
the space between skin and muscles: stop when the needling sensation [shen] arrives.”

There are many passages in both the Ling Shu and Su Wen that stress the importance of
concentrating one’s mind when needling.

Chapter 25 of the Su Wen contains a sentence that is almost exactly the same as the
opening sentence of the famous chapter 8 of the Ling Shu. Chapter 25 of the Su Wen
contains this sentence: “fan ci zhi zhen, bi xian zhi shen” [凡 刺 之 真， 必 先 治
神]. I would translate this so: “For reliable needling, one must first control one’s mind
[shen].” Note the rhyming of “zhen” with “shen”.

This is confirmed by the note by Wang Bing in Uschuld: “One must concentrate one’s
mind and be calm without motion. This is the central point of piercing.”
The English translation of the Su Wen by Li Zhao Guo simply translates
this sentence as “The key point for acupuncture is to pay full attention.”1
This interpretation is corroborated by the other paragraphs in that chapter
which give advice as to how to practice needling. In fact, it says that the
acupuncturist should not be distracted by people around or by any noise.

Unschuld, in his new translation of the Su Wen, translates this

sentence as “For all piercing to be reliable, one must first regulate the
spirit.”2 This translation would contradict mine but a footnote in the
same book reports the interpretation of Wang Bing (the editor of the Nei
Jing): “One must concentrate one’s mind and be calm without motion.
This is the central point of piercing.”

1. Unschuld P U and Tessenow H, Huang Di Nei Jing Su Wen – An Annotated Translation of the Huang Di’s Inner Classic –
Basic Questions, Vol. I, University of California Press, Berkeley, 2011, p. 428.
2. Li Zhao Guo (translator) Yellow Emperor’s Canon of Medicine, Library of Chinese Classics, World Publishing
Corporation, Xi’an, 2005, p. 335.
The central point that stems from an analysis of the famous opening
sentence of chapter 8 of the Ling Shu is how to translate the word
“Shen”: in my opinion, the word “Shen” can have many different
meanings and only one of them is “Spirit”. Another translation of
“Shen” is that of “Mind” which, in my opinion is appropriate in many
contexts.

I have mentioned above two possible meanings of “shen” in the Nei

Jing, one being the skill of the acupuncturist, the other being the
needling sensation. In other passages, “Shen” is closely identified with
the Vital Essences of the body: this makes sense given the close
integration of body and mind (or spirit) in Chinese medicine. For
example, chapter 26 of the Su Wen says: “Blood and Qi are the shen of
a person.”1 Chapter 32 of the Ling Shu says: “Shen is the refined Qi
of water and grains.”2 Chapter 1 of the Ling Shu says: “Shen is the
Upright Qi [Zheng Qi].”3

1. 1979 The Yellow Emperor’s Classic of Internal Medicine-Simple Questions (Huang Di Nei Jing Su Wen), People’s Health
Publishing House, Beijing, p. 168.
2.Tian Dai Hua 2005 Spiritual Axis (Ling Shu Jing), People’s Health Publishing House, Beijing, p. 77.
3. Ibid., p. 3.
Xu = fear
LIVER Blood HUN
Shi = anger

Blood Xu = sadness
HEART vessels SHEN
Shi = laughter

Xu = weak limbs, 5 Zang disorder

SPLEEN Nourishment YI
Shi = distension, menstrual-
urinary disorders

Xu= nasal obstruction

LUNGS Qi PO
Shi = breathlessness

Xu = collapse
KIDNEYS Jing ZHI
Shi = distension, 5 Zang
disorder
THE FOUR SEAS
Ling Shu Chapter 33. Mentions the Four Seas and twelve
river-like channels. Rivers all flow to the sea.
“There are 4 Seas and 12 channels. The water from the channels
flows into the Seas. There is an East, West, South and North Sea,
which makes 4. There is a Sea of Marrow, Sea of Blood, Sea of Qi and
Sea of Food.
The Stomach is the Sea of Food: its upper “Shu” point is ST-30
Qijie and its lower one ST-36 Zusanli.
The Chong Mai is the Sea of the 12 Channels: its upper “Shu” point
is BL-11 Dashu and its lower ones ST-37 Shangjuxu and ST-39
Xiajuxu.
The Shanzhong is the Sea of Qi and its upper “Shu” is above and
below the vertebra [C-7] [Du-15 Yamen and Du-14Dazhui] and in the
front ST-9 Renying.
The Brain is the Sea of Marrow: its upper “Shu” point is on the
vertex (Du-20 Baihui) and its lower one Du-16 Fengfu.
If the 4 Seas are in a state of order [shun], there is life; if in a
rebellious state [ni], there is disease (literally “loss”).
If the Sea of Qi is in excess there is a feeling of fullness in the chest,
breathlessness and red face; if it is deficient, shortness of breath and
dislike to speak.
If the Sea of Blood is in excess, there is the feeling as if the body is
big and an inability to pinpoint what is wrong; if deficient, a feeling as
of the body is small and an inability to pinpoint what is wrong.
If the Sea of Food is in excess, there is abdominal fullness; if
deficient, hunger but no desire to eat.
If the Sea of Marrow is in excess, there is great physical strength
beyond one’s capability; if deficient, dizziness, tinnitus, blurred vision,
soreness of the legs, poor vision, desire to lie down.

1981 Spiritual Axis (Ling Shu Jing), People’s Health Publishing House,
Beijing. First published c. 100 BC, p. 77
SEA OF FOOD
Excess: Abdominal fullness.
Deficiency: Hunger but no desire to eat.
Points: ST-30 (upper), ST-36 (lower)

The Sea of Food is synonymous with the Stomach and both of

its points are on the Stomach channel. This is also of
relevance in clinical practice as we always need to treat the
Stomach in any disturbance of food absorption or digestion.
However, the Sea of Food is also functionally related to the
Chong Mai as this vessel, besides controlling Blood,
influences the Stomach and Intestines and digestion. The
fact that the Chong Mai corresponds to the Sea of Food
confirms that this vessel is closely linked to the Stomach and
it therefore links the Pre-Heaven (Kidneys) with the Post-
Heaven Qi. Chong Mai emerges at ST-30 Qichong.
气冲 衝
ST-30 Qichong Old form of “chong”

ST-30 was called more

frequently “Qi-Jie” in
ancient times, i.e.
“avenues of Qi”

. .
街
Jie
SEA OF BLOOD
Excess: Feeling of body getting larger, feeling unwell without
being able to pinpoint the trouble.
Deficiency: Feeling of the body getting smaller, unable to
pinpoint trouble.
Points: BL-11 (upper), ST-37 and ST-39 (lower).

The Sea of Blood is synonymous with the

Chong Mai as the text makes clear (although it
calls the Chong Mai the “Sea of the 12
Channels”). This is of great relevance in
clinical practice and especially in gynaecology
as we treat the Chong Mai for disharmonies of
Blood and especially Blood stasis.
SEA OF QI
Excess:Feeling of fullness in the chest, breathlessness,
red face.
Deficiency: Shortness of breath, no desire to speak.
Points: REN-17, DU-15, DU-14, ST-9.

The Sea of Qi is clearly related to the Lungs

and the Gathering Qi (Zong Qi) and its
deficiency symptom (“a dislike of speaking”)
is a Lung-deficiency symptom. The Sea of Qi
is related to the Ren Mai.
SEA OF MARROW
Excess: Full of vigour, great physical strength.
Deficiency: Dizziness, tinnitus, weak legs, blurred vision,
desire to lie down.
Points: DU-20 (upper), DU-16 (lower).

The Sea of Marrow is synonymous with the Brain as it is

Marrow that fills up the Brain. Symptoms of deficiency
are related to obfuscation of the sense orifices due to their
not being nourished by Marrow. As Kidney-Jing is the
origin of Marrow, those symptoms are also symptoms of
Kidney deficiency (dizziness, tinnitus, blurred vision, weak
legs). The Sea of Marrow is related to the Du Mai which
flows in the spine and into the Brain: for this reason, the
points of the Sea of Marrow (Du-20 Baihui and Du-16
Fengfu) are on the Du Mai.
Chapter 8 of the “Su Wen” says: “The Kidneys are the
official in charge of power: skill originates from them.” It
is interesting that the “Simple Questions” mentions
“power” in connection with the Kidneys. This has two
meanings. From a physical point of view, “power”
refers to the fact that the Kidneys are the root of Pre-
Natal Qi and house the Essence: this determines our
innate energy, strength or “power”.
In fact, the symptoms of fullness of the Sea of
Marrow (originating from the Kidneys) are “full of
vigour, great physical strength.”
From a mental point of view, “power” refers to the drive
and steadfastness stemming from the Kidneys. This
corresponds to Zhi, i.e. Will-Power.
The symptoms of fullness and emptiness of the Sea of
Marrow have mental-emotional significance. The
symptoms of fullness of the Sea of Marrow (“full of
vigour, great physical strength”) indicate a
constitutional condition of strength of the individual:
this is not only physical vigour but it also involves
mental “vigour” which means that the person will be
able to stand up to emotional stress keeping the integrity
of his or her Shen. Contrary to what we might think,
many elderly people actually have a constitutional
strength of the Sea of Marrow which makes their Shen
strong and grounded.
The physical symptoms of deficiency of the Sea of Marrow
are dizziness, tinnitus, weak legs, blurred vision, and a desire
to lie down. On a mental-emotional level, a person with a
constitutional deficiency of the Sea of Marrow will be more
prone to emotional stress: his or her Shen is more vulnerable
and the person lacks mental strength and resilience. Under
these conditions, the person is easily prone to depression
when subject to emotional stress.
The points given by chapter 33 of the Ling Shu for the Sea
of Marrow are Du-20 Baihui (described as the “upper”
point) and Du-16 (described as the “lower” point). I
particularly use Du-20 to strengthen the Sea of Marrow,
nourish the Shen and strengthen the Kidney’s Will-Power
(Zhi). For these reasons, Du-20 is a very important point for
depression.
LING SHU Chapter 12: Jing Shui The Water of Channels or
“Water Channels”
Chapter 12 of the Ling Shu is a very good example of the water
metaphor of Chinese medicine. In this chapter, each channel is
compared to a waterway in China. Note also that chapter 12 comes
between chapter 11 on the Divergent Channels and chapter 13 on
the Muscle Channels.
“The 12 channels on the outside are like waterways on the inside,
they connect with the 5 Zang and 6 Fu. The Water Channels receive
Water and they move; the 5 Zang house the Shen, Hun and Po; the 6
Fu receive grain, move and spread Qi. The channels [jing mai]
receive Blood and Ying Qi.”
The next paragraph compares each channel to a waterway in
China, except for the Stomach channel that is compared to the sea.
In this paragraph, there is the important statement that the
channels are ru huan wu duan, i.e. “like a ring with no break”
(repeated in chapter 52).
LING SHU Chapter 52. On Wei Qi.
This chapter lists the “root” [ben 本] and “branch” [biao 标] of each
channel.
BL GB ST KI LIV SP
BL-23 and
BL-1 SI-19 ST-9 Ren-23 BL-18 BL-20
Branch

Root
BL-59 GB-44 ST-45 KI-8 LIV-4 SP-6
LING SHU Chapter 52. On Wei Qi.
This chapter lists the “root” [ben 本] and “branch” [biao 标] of each
channel.
SI TB LI LU P HE

BL-1 TB-20-23 ST-8 LU-3 P-1 BL-15

Branch

Root
SI-6 TB-2 LI-11 LU-9 P-6 HE-7
LING SHU Chapter 52. QI JIE The Streets of Qi

气 街
“In the chest Qi has streets; in the abdomen Qi has streets; in the head
Qi has streets; in the lower legs Qi has streets. Therefore if [there is a
problem with] Qi in the head, stop it at the brain; if [there is a problem
with] Qi in the chest, stop it at the front of the chest and at the Back-
Transporting points; if [there is a problem with] Qi in the abdomen,
stop it at the Back-Transporting points and at the Chong Mai on the
right and left of the umbilicus which is the Moving Qi [or Dong Qi]; if
[there is a problem with] Qi in the lower legs, stop it at ST-30 Qichong
[here called Qijie] and at BL-57 Chengshan.”
The Streets of Qi treat headaches, dizziness, abdominal pain-
fullness-distension, beginning stages of abdominal masses. If there is
pain and the mass in moveable, it is easy to treat; if there is no pain
and the mass in fixed, it is difficult to treat.
Note the points recommended for the Streets of Qi of the chest,
abdomen and legs:
If [there is a problem with] Qi in the chest, stop it at the front of the
chest and at the Back-Shu points; if [there is a problem with] Qi in the
abdomen, stop it at the Back-Shu points and at the Chong Mai on the
right and left of the umbilicus; if [there is a problem with] Qi in the
lower legs, stop it at ST-30 Qichong and at BL-57 Chengshan.
In all cases, it recommends using points on the back and the front
of the body, implying a horizontal movement of Qi in each area.
PATHWAYS OF QI (QI JIE) 气 街
PATHWAYS OF QI (QI JIE)

Under influence of Chong Mai

PATHWAYS OF QI (QI JIE)

LU-1
BL-13
BL-14
BL-15
Ren-17

ST-30
BL-51
Huang
men

ST-37
ST-39
SP-6
Under influence of Chong Mai
LING SHU Chapter 74 Lun Ji Zhen Chi 论 疾 诊 尺 Determining
the Disease from Diagnosis of the Forearm.
FOREARM DIAGNOSIS
Diagnosis by palpating the palmar surface of the forearm between
the elbow and the wrist crease was described in Chapter 74 of the
“Ling Shu” which says: “The rapid or slow, large or small and
slippery or rough condition of the skin of the forearm, as well as the
firmness of the muscles, reflects the location of the disease.”1 This
quotation refers to palpation of the palmar surface of the forearm.

“Rapid or slow” refers to how the hand glides over the patient’s
skin, i.e. “rapid” means that the patient’s skin is smooth and the
practitioner’s hand glides easily and “slow” means that the
patient’s skin is rough and the practitioner’s hand does not glide
easily. “Large or small” refers to the size of the muscles of this part
of the arm and “slippery or rough” refers to the texture of the skin
of the forearm.
1. Spiritual Axis, p. 133.
The same chapter of the “Ling Shu” says: “When the skin of the
forearm is slippery and moist, it indicates invasion of Wind; if it is
rough, it indicates Wind Bi; if it is like fish scales, it indicates Phlegm-
Fluids; if it feels hot and the pulse is Full, it indicates a Heat disease;
if the skin is cold and the pulse is small, it indicates diarrhoea and
deficiency of Qi; if the skin is extremely hot and then becomes cold, it
indicates combined Heat and Cold; if the skin feels cold but becomes
gradually hotter on palpation, it also indicates combined Heat and
Cold.” 2
In other words, the texture of the skin of the inner surface of the
forearm reflects invasions of external Wind if it feels slightly moist,
Blood deficiency if it feels dry, Wind Bi if it feels rough, and severe
Spleen deficiency with Phlegm if it feels rough and coarse like fish
scales. In addition to this, the temperature of the skin of the inner
forearm reflects conditions of Heat (particularly of the Intestines) if
it feels hot or conditions of Cold (particularly of the Intestines) if it
feels cold.
2. Ling Shu, p. 133.
PALPATION OF THE FOREARM (Chapter 74 of the Ling Shu)

• Hot elbow: Heat above the waist

• Hot hand: Heat below the waist
• Hot inner flexure of the elbow: Heat in the chest
• Hot lateral side of the elbow: Heat in the upper back
• Hot inner aspect of the arm: Heat in the abdomen
• Hot 3-4 cun below the lateral side of the elbow: worms in the
Intestines
• Hot palm: Heat in the abdomen
• Cold palm: Cold in the abdomen
• Bluish blood vessels on thenar eminence: Cold in the Stomach
Besides palpation, the skin of the inner aspect of the forearm should
be observed for slackness, tightness, moistness, dryness, protrusion
and shrinking. If the inner aspect of the forearm looks slack and
loose, it indicates Heat; if it is tight, it indicates Cold. If the forearm
is moist it indicates Wind invasion; if it is dry it indicates Blood or
Yin deficiency. If the forearm skin seems to be protruding and
sticking out it indicates a Full condition; if it looks shrinking and
withered, it indicates an Empty condition.
The “Detailed Discussion of the Essence of Pulse Diagnosis” (Mai
Yao Jing Wei Lun) developed the above topography of the forearm
from Chapter 74 of the “Spiritual Axis” into a detailed map of
correspondence between areas of the inner forearm and parts of the
body.3

3. Deng Tie Tao, Practical Chinese Diagnosis (Shi Yong Zhong Yi Zhen Duan Xue),
Shanghai Science Publishing House, Shanghai, 1988, p. 167.
Throat

Throat
Heart Centre of chest Lungs

Liver Diaphragm Spleen Stomach

Kidneys Hypochondrium Hypochondrium Kidneys

Abdomen

Abdomen
Knees Knees
Lumbar Lumbar
Legs Legs
Feet Thigh Feet Thigh