Belly So Bloated You Can Eat in the Morning But Not at Night? A Hard Mass in the Lower Belly, Pain Around the Navel? — Doctor Ni Haixia’s Forty-Eighth Lecture on the Huang Di Nei Jing: the Fu Zhong Lun (Abdominal Treatise, Chapter 40) — Finishing the Nine Qi, Drum Distension Treated with Chicken Droppings Wine, Blood Depletion Treated with Cuttlefish Bone and Madder Pills, Fu Liang (Hidden Beam: Peritonitis), Heat in the Middle and Wasting-Thirst as the Disease of the Rich, and the Four Seas of the Body

Patient search words: bloated belly / drum distension / can eat in the morning but not at night / cannot eat / Ji Shi Li / chicken droppings white / blood depletion / menses stopped / spitting blood / blood in the stool / blood in the urine / smelling a fishy stench / epilepsy / hard mass in the lower belly / peritonitis / belly pain that no examination can explain for fifteen years / appendicitis / ruptured gallbladder / pain around the navel / pain around the belly button / aneurysm / wasting-thirst / diabetes / disease of the rich / eating too well / restless heart / heart thumping / afraid of death / fear / thinking overcomes fear / five overwork and seven injuries / too tired / the four seas / sea of marrow / sea of qi / sea of grain and water / sea of the twelve channels / Baihui / Feng Fu / Renying / Zusanli / Chong Mai

Corresponding topics (medical terms): Su Wen · Ju Tong Lun (Comprehensive Pain Treatise, chapter 39) completed — the nine qi (jiu qi): grief makes qi dissipate (bei ze qi xiao: the heart system tightens, the lung spreads its lobes and rises, the upper jiao is blocked, rong-wei cannot disperse, heat lingers in the middle) · fear makes qi sink (kong ze qi xia: fear hurts the kidney, the upper jiao closes, the qi returns to the lower jiao, the lower belly swells, the qi cannot move) · thinking overcomes fear (si sheng kong) · cold contracts qi (han ze qi shou) · heat discharges qi (re ze qi xie) · fright disturbs qi (jing ze qi luan: the heart has nothing to lean on, the spirit has nowhere to return, deliberation has nothing to settle on) · overwork consumes qi (lao ze qi hao: panting and sweating, inside and outside both overflow) · worry knots qi (si ze qi jie: the upright qi stays and cannot move) · Su Wen · Fu Zhong Lun (Abdominal Treatise, chapter 40): drum distension (gu zhang — can eat at dawn but not at dusk; Ji Shi Li, Chicken Droppings Wine: the white of free-range mountain-chicken droppings cooked in rice wine, one dose and you know, two doses and it is gone; the five meats matching the five zang: chicken wood, horse fire, ox earth, dog metal, black pork water; relapse from undisciplined diet; pass it only to those worthy) · blood depletion (xue ku — fullness in chest and flanks, smelling a stench first, spitting blood, cold limbs, dizziness, blood before and behind; from a great hemorrhage in youth or entering the bedroom drunk, zhong qi exhausted and the liver injured, the menses dwindles and stops; cuttlefish bone (hai piao xiao) + madder root (qian cao), formed into pills with bird eggs, taken before meals, drunk with abalone broth; madder root moves blood and dissolves stasis) · fu liang (hidden beam — wrapped pus and blood (guo da nong xue) living outside the stomach and intestines; ruptured gallbladder or ruptured appendix wrapped by the san jiao oil-net = peritonitis; Bo Qi said untreatable, Zhang Zhongjing solved it; the qi jie hot patch from Guanyuan CV4 to Zhongji CV3; the brown ring on the life line of the palm; clearing with da huang and mang xiao — the laxative that is a tonic for the one who needs it; below it follows yin and must discharge pus and blood, above it presses the stomach and creates an internal abscess beside the stomach duct; above the navel is adverse, below the navel is favorable) · the second fu liang, the wind root (feng gen — swelling of the hip bone, pain encircling the navel; qi overflowing the large intestine and lodging in the huang, the origin of the huang below the navel; it must not be moved — moving it causes the disease of blocked urine; ruptured abdominal aneurysm wrapped by the san jiao; Western doctors also dare not move the patient) · heat in the middle and wasting-thirst (re zhong xiao zhong — the disease of the rich; forbidden: fine food (gao liang), fragrant herbs (fang cao), mineral drugs (shi yao); fragrant herbs have beautiful qi, mineral drugs fierce qi, both urgent, hard and strong — only a calm, harmonious person may take them; fearing internal injury to the spleen, earth which hates wood; re-evaluate on the jia-yi wood days) · the four seas (si hai — the brain is the sea of marrow: Baihui GV20 above, Feng Fu GV16 below; the sea of qi is the neck: Tianzhu BL10 above, Renying ST9 below; the sea of grain and water is the stomach: Qi Street above, Zusanli ST36 below; the sea of the twelve channels is the Chong Mai: Dazhu BL11 above, Shangjuxu ST37 and Xiajuxu ST39 below — the four seas for diagnosing chest fullness and abdominal distension)

Opening: the nine qi were not finished — grief, fear, cold, heat, fright, overwork, worry — each one hurts more than the last

The previous lecture opened the nine qi with anger making qi rise and joy making qi slow. In this lecture Doctor Ni races through the remaining seven, then dives straight into a new chapter — the Fu Zhong Lun (Abdominal Treatise).

First, grief. When a person grieves too deeply, the first organ hurt is not the heart — it is the lungs.

💬 Note from Doctor Ni: When grief is excessive it injures the lungs. If you hold an overall picture it is easy to remember: the lungs sit at the top of the chest, the chest is called yang, everything below the diaphragm is called yin — above is yang, below is yin. But that is the view from the outside; inside it is the opposite: inside, yang descends and yin ascends, so our head is cold and our feet are warm — yin and yang support each other. When we speak of the upper jiao we mean the lungs; the cun position on your wrist is yang, the chi position is yin, and the guan position in the middle is the diaphragm — diseases of the diaphragm, the liver, the spleen and the stomach all show at the guan position.

Grief and the heart are connected by a channel.

💬 Note from Doctor Ni: Grief makes the heart system tighten — naturally so, because the heart and the lungs are the fire-metal balance. Your grief injures the lungs; the injured lungs affect the heart, and the heartbeat quickens. The lung spreads its lobes and rises — the lung opens very wide, the upper jiao is blocked, the heart qi is trapped inside, the nutritive and defensive qi (rong-wei) cannot disperse, and the yang heat accumulated in the chest cannot escape. Heat in the lungs, plus the drying heat of heart fire — that is why the qi is consumed. Grief that is severe and long-lasting is dangerous; it can cost a person his life.

Fear: it is not only someone chasing you with a knife

Next comes fear. Doctor Ni first teaches a big principle: keep your mind flexible — do not be a good little obedient student.

💬 Note from Doctor Ni: Fear makes qi sink; fear hurts the kidneys. Normally the kidneys sit below and the lung qi descends; now you are frightened, the kidney is hurt, the lung qi cannot come down — it reverses upward, and the upper jiao closes. Originally the qi was flowing downward; now it reverses, the upper jiao closes, the qi returns to the lungs and back into the lower jiao, and the lower jiao swells. The yin qi should descend, but now the qi cannot come down, the yin qi has no yang qi to push it, so it accumulates — the belly swells, and the qi can no longer move.

So what counts as fear? Doctor Ni says: do not think of fear too narrowly.

💬 Note from Doctor Ni: You ordinary honest people think fear means someone is chasing you with a knife — wrong. Some people are old and terrified of death — that is fear. Some people have broken the law and live in dread — that is fear. Some people marry a wife who is a tigress, a lioness — that is fear. By extension all of these are fear — it is not only a knife-wielding killer that makes fear. Fear lasting a long time injures the kidneys, and the lung qi cannot descend.

How is fear treated? Chinese medicine has a special trick called si sheng kong — thinking overcomes fear.

💬 Note from Doctor Ni: We use thinking-overcomes-fear all the time. Besides counseling the patient, you can observe a person: why is that person so fearful? Inside, that person has no thoughts, no deep feelings. Say you are old and afraid of death — everyone must die, but he is terrified of it. If he thinks back over all the things he did in his life and feels good about them, or fondly remembers how good his wife was to him — when a person has losses, he feels fear. So you should often use this method to help patients dissolve their fear: ask them to dwell on people from the past whom they cherished.

Cold contracts, heat discharges, fright disturbs, overwork consumes, worry knots — the seven qi finished in one breath

Grief and fear done, Doctor Ni races through the remaining five qi, because once you understand the principle, everything connects.

💬 Note from Doctor Ni: Cold closes the interstices (cou li), the qi cannot move, the qi contracts. The interstices on the skin surface are where the human body communicates with the weather. When it turns cold, the pores shrink and the qi is contracted; when it is hot, the interstices open, the nutritive and defensive qi pass through, the sweat pours out, and the qi is discharged outward. So heat discharges qi — sweat that will not stop is qi leaking outward; when there is no sweat, the qi is held in.

Fright strikes straight at the heart.

💬 Note from Doctor Ni: Fright disturbs qi — the fright hits the heart, the mind has nothing to lean on, the spirit has nowhere to return, deliberation has nothing to settle on — that is why the qi is disordered. When fright injures your heart, you feel it — thump, thump, thump, the heart keeps beating and cannot stop.

Overwork and worry are what ordinary people suffer most.

💬 Note from Doctor Ni: Overwork makes you pant and sweat; both inside and outside overflow, so the qi is consumed — people who labor long will deplete their qi. Work is necessary, but labor must be balanced with rest — rest matters. Worry means the mind keeps something, the spirit returns to it, and the upright qi stays and cannot move — so the qi knots. These are the abnormal states that joy, anger, worry, thought, grief, fear, cold and heat produce in a person.

Chapter 40, the Fu Zhong Lun: a kind of drum distension where you can eat in the morning but not at night

With the seven qi finished, Doctor Ni opens the fortieth chapter of the Huang Di Nei Jing — the Fu Zhong Lun (Abdominal Treatise), devoted entirely to diseases of the belly. The very first disease the Yellow Emperor asks about is a strange one.

💬 Note from Doctor Ni: The Yellow Emperor asks: someone is sick with fullness of the heart and belly, and can eat — but he can eat in the morning and cannot eat at night. Bo Qi says this disease is called gu zhang — drum distension. This is the earliest record of drum distension. How is it treated? With Ji Shi Li (Chicken Droppings Wine) — one dose and you know it works, two doses and it is gone. What is Ji Shi Li? It is what we call ji shi bai — the white part of chicken droppings.

Chicken droppings? Doctor Ni knows everyone is about to widen their eyes, so he slowly explains this medicine that looks disgusting but has a real pedigree.

💬 Note from Doctor Ni: In the old days our chickens were free-range — raised outdoors, in the mountains, not locked in cages. When this chicken looks for food, the little insects live inside the soil and between the rocks, so it pecks and swallows the stones and the dirt along with them. A chicken’s beak is pointed and its tongue is long; it cannot separate the dirt and sand out — it just eats the insects; chickens are not that clever. So the droppings of wild chickens, mountain chickens that eat this wild food — in each dropping the center is white. That white part is the useful one. If you go to the airport and collect a big pile of chicken droppings, it is useless — you are already drum-distended and sick; feeding you a pile of chicken droppings is a miserable fate. It is not that the medicine is wrong; it is that you do not know how to find the right material.

Why insist on the white part? Because the chicken’s five-organ nature happens to match the liver.

💬 Note from Doctor Ni: The five meats match the five zang: chicken is wood — that is why we say ‘dumb as a wooden chicken’; horse is fire; ox is earth; dog is metal; black pork is water — matching the liver, heart, spleen, lung and kidney. Chicken belongs to wood and matches the liver. That white part is what comes out after the chicken has eaten plenty of soil and rock fragments and passed them through its digestive tract. Try eating that yourself — you eat it and it will not pass; you get constipated, belly pain, and if you eat too much mud you grow roundworms. The chicken swallows it and plop — it passes right out, a clean white lump, and not only does it do no harm, it cures disease. Collect the white part, dry it, grind it to powder — that powder is actually the material produced from digesting soil and rock — and boil it together with sweet rice wine: that is Ji Shi Li. One dose and the drum distension is gone; the water is expelled.

Speaking of collecting the medicine, Doctor Ni tells a personal story — and it doubles as a lesson in medical ethics for anyone who studies medicine.

💬 Note from Doctor Ni: Ji Shi Li is the first formula in the Huang Di Nei Jing. Later, when I write my Di Ji (Record of the Earth), I will travel to the mainland and collect a great deal of it myself — I will not buy chicken droppings from other people; once it has been dried by someone else, who knows whether it is right. I must collect it myself, only then can I say my methods are clean. People will look at me and think, what a fool, this man from Taiwan — of all things to eat, you collect chicken droppings? Fine, let them call me whatever they like. I go to the southern countryside where there are many free-range chickens, and I tell the farmer: I am here to eat chicken droppings — you do not tell him what they are for. It is not about making money; when people learn how it is used, human nature is terrifying — the price shoots up at once. So you keep collecting, quietly, without a word. What good does it do? You can help people who truly need help. A doctor must have a conscience, a good heart — then helping people is fine. But if the word gets out and profiteers corner the market, you cannot collect it anymore and the patients cannot afford it. That is why the classics say: do not pass it on to those unworthy — if I had not told you about the free-range chicken’s Ji Shi Li, you would never know. Remember, it must always be cooked with wine — why? Because the chicken belongs to wood and matches the liver, so for drum distension of liver disease, one application of this sets it right.

Ji Shi Li works in one dose, two doses and it is gone — but the Yellow Emperor asks again: what if it comes back after eating? Bo Qi’s answer is still a golden sentence of health advice today.

💬 Note from Doctor Ni: Why does it come back? Bo Qi says: undisciplined diet — only then does the disease return. It is the same for every disease, including colds and fevers: the residual heat keeps returning two days after the fever breaks — why? Because you ate meat. We have said it before: keep your daily diet to a standard; eating too full, too much is never good, and after an illness you must be even more careful. Rich or poor, it makes no difference — you can spend money on a fine car and fine clothes, but food must be simple. Disease comes from lack of restraint.

Blood depletion: you smell a fishy stench before the attack — the epilepsy patient’s last sentence

The second disease has symptoms that read like a riddle: fullness in the chest and flanks, cannot eat, smelling a fishy stench before the attack, spitting blood, ice-cold limbs, blurred vision, and blood in both the stool and urine. Bo Qi calls it xue ku — blood depletion.

💬 Note from Doctor Ni: The disease of blood depletion is amusing. I met such a case while treating epilepsy: the patient finished telling me everything about his seizures — I thought to myself, this is simple, I was just about to write the prescription — when he suddenly added one last sentence: strange, you know, before every attack I smell the smell of rotten dead fish. Isn’t dead fish a stench? I said: what you just said — next time, the first sentence out of your mouth when you see me should be this one. Everything you said before was wasted breath. The patient did not understand; he even asked: why do I know my epilepsy is coming every time I smell that fishy smell? The most important sentence always comes last — patients are adorable. This is what we call blood depletion — because the inside has dried up, what you smell is the stench.

Where does blood depletion come from? Doctor Ni says the root is usually laid in youth.

💬 Note from Doctor Ni: It comes from a great hemorrhage in youth: a car accident, or some past massive bleeding; or entering the bedroom drunk after drinking wine — Chinese medicine greatly cautions against sex after drinking. Entering the bedroom drunk, the middle qi (zhong qi) is exhausted, and at that moment your yang qi is also drained — this injures the liver, and it also makes a woman’s menses stop and fail to come, because the blood is depleted.

The treatment is the second main formula of the Huang Di Nei Jing.

💬 Note from Doctor Ni: Use the cuttlefish bone — the white bone you open up inside a cuttlefish; that is hai piao xiao. And madder root, also called ru lü — qian cao (madder root) is a blood-moving, stasis-dissolving herb. Grind the cuttlefish bone and the madder root together, add bird eggs — sparrow eggs or pigeon eggs will do — take out the yolks and mix them in, form pills about the size of mung beans, and take them as hou fan — that is, take the medicine before the meal, then eat afterward. When you take these cuttlefish-bone-and-madder pills, you must drink abalone broth — boil abalone into a soup and drink it: it cleans the intestines (li chang zhong), making the intestines very clean, and at the same time restores the liver’s function. Because the liver stores blood, and this blood depletion does not mean stasis exactly — it means dirty blood is parked inside: after great injury to vitality, when the essence and blood have gone bad, your blood is no longer clean; it sits there too long, and then you smell the stench. Because there is stasis inside, we use madder root — a famous blood-moving, stasis-dissolving herb. In clinical practice we also use it for cancer; we will speak more of it when we teach the Shen Nong Ben Cao (Divine Farmer’s Classic of Materia Medica).

Fu liang: a disease with a root in the lower belly — the gallbladder broke, the intestine broke, the blood vessel broke

The third disease: the Yellow Emperor asks — the lower belly swells, and pressing it up, down, left and right you feel roots, as if something is hidden inside. What disease is this? Bo Qi says: this is called fu liang (hidden beam); it is wrapped pus and blood (guo da nong xue) living outside the stomach and intestines; it cannot be treated — pressing on it kills.

What is fu liang? Doctor Ni brings it alive with clinical experience.

💬 Note from Doctor Ni: Fu liang has two locations. The first: the gallbladder has been blocked for a long time, the bile swells inside; Western medicine removes the gallbladder; if there is no time to treat it, bang — it explodes like a balloon, and the bile leaks out. Outside, the human body has the san jiao (triple burner); the san jiao wraps it up and seals it — wrapped pus and blood; that is one location. Then the appendix (mang chang): the appendix is blocked there for a long time, bang, it bursts, a lump wraps up, the san jiao’s oil-net seals it, and inside is pus and blood — what we now call peritonitis. In Bo Qi’s day he said it cannot be treated — everyone with it died. Can it actually be treated? Yes — Zhang Zhongjing solved this problem. Remarkable!

Doctor Ni also shares his clinical trick for recognizing fu liang at a glance.

💬 Note from Doctor Ni: When you press the belly, this place is always hot: the patient’s lower abdomen — the navel is here, and after the pain, it runs from the navel down toward the pubic bone. This area, coming down from Guanyuan CV4 to Zhongji CV3, we call the qi jie (Qi Street); when it is blocked here, only this patch is hot — the rest of the belly is cold, only this one patch is entirely hot. I had a patient with pain for over ten years, fifteen years — Western medicine could not find the cause; they actually could not find it. This disease is amusing: the hand yang ming large intestine channel runs here, the large intestine and the lung are interior-exterior paired, and the large intestine had a perforation — and on the life line of his palm there was a brown ring, like a written character. I kept clearing him; as I cleared him, the patch kept fading. So when I take a pulse I am also stealing a glance at the palm — a coffee-colored, brown patch sitting on the life line; when you have caught such traces many times, you get fast. Next time we reach the Jin Gui (Essentials from the Golden Cabinet), I will photograph the cases for you — people whose distended bellies nearly drag on the floor; this kind of intestinal inflammation can be cured.

Cleared — with what? Doctor Ni names rhubarb (da huang) and Glauber’s salt (mang xiao).

💬 Note from Doctor Ni: That patient was said to be untouchable; his husband said he told people at home: I keep clearing him — as I clear him, all kinds of colors come out, black, green, even blood comes out; the more I clear him the less there is, and his spirit gets better and better. After clearing him for two months he was almost addicted to da huang and mang xiao — his spirit just kept improving. The Southern school would never dare use mang xiao and da huang like this; I used them continuously, clearing him all the while — when the patient needs it, there is no such thing as tonify or drain; to him this laxative is a tonic, because it matches the pattern, so using it is fine. Bo Qi said everyone with this dies, cannot be treated — why? Because below it follows yin and must discharge pus and blood: this region is yin, yin governs blood, and the intestine has split open. Above it presses the stomach duct and creates an internal abscess beside the stomach duct — an internal abscess of the stomach duct is hard to cure after a long illness. If it is an abscess, blood carried above the stomach, above the navel, is harder to treat; below the navel it is easier. Acupuncture can do it, and formulas can do it too.

A second fu liang: pain circling the navel — this is a wind root, and you must never move it

There is a second kind of fu liang, with completely different symptoms: the thigh bone and the outer hip swell, and pain encircles the navel. Bo Qi says this is also fu liang — and it is a wind root (feng gen).

💬 Note from Doctor Ni: Here the qi overflows the large intestine and lodges in the huang — the huang spoken of here is at the Shimen CV5 and Qihai CV6 points; the origin of the huang lies below, so the pain encircles the navel. At this point it must not be moved — if you move it, it becomes the disease of blocked urine, and the urine can no longer pass. Clinically there is this kind: the abdomen has a great artery; when the artery bursts, the san jiao wraps it up too, the blood wraps it up — Western doctors look and say: aneurysm — that arterial blood-vessel tumor; cut it out, insert a plastic tube. How does Chinese medicine diagnose it? This is diagnosis by pattern — Chinese medicine speaks of patterns. A torn intestine, a torn gallbladder, a torn blood vessel — all produce this symptom, and all are called fu liang.

Why must it absolutely not be moved? Doctor Ni says this is one point where Chinese and Western medicine rarely agree.

💬 Note from Doctor Ni: Bo Qi says do not move it; let him lie quietly. If you move it, sometimes the shaking is violent, the bowels and urine block, the urine will not come out, and the patient dies — so you cannot move him. Western medicine is the same — cannot move him: when the attack comes and you are brought to a small hospital, the small hospital’s doctors would rather have a big-hospital surgeon come over to operate on you than move you — because he cannot be moved; once moved, if the blood clot blocks the urine, the blood spreads and the patient dies.

Heat in the middle and wasting-thirst: the disease of the rich — eating too well is also a disease

The Yellow Emperor asks again: you have spoken several times of re zhong xiao zhong (heat in the middle and wasting-thirst), saying that fine food, fragrant herbs and mineral drugs must not be taken — why exactly? Doctor Ni says this question reaches the very root of the ‘rich man’s disease’.

💬 Note from Doctor Ni: Those with heat in the middle and wasting-thirst are all rich people. The food they eat is of excellent quality. Now you are sick, and you are told these foods cannot be eaten, plain food and simple tea will do — the patient will say your doctor has a problem — it does not suit my taste. Nor can he take fragrant-herb medicines or mineral drugs, or the disease will not heal. The qi of fragrant herbs and fine food is very beautiful; the qi of mineral and metallic drugs is very fierce. When the two meet, both qi are urgent, the nature is hard and strong — so they can only be taken by a calm, harmonious person (fei huan xin he ren bu ke fu). When we use fierce drugs, metal and mineral drugs, the patient must be even-tempered and at peace.

Doctor Ni turns this sentence into the line he says most often in his clinic.

💬 Note from Doctor Ni: I often tell patients: right now you tell me your body is unwell — go home and love your wife, love your children, look after your family; leave the body to me, do not think about it, I will do the worrying for you. That is the sentence I say most often to patients, and it comes from the Huang Di Nei Jing — make the patient forget the disease. If you go home and think about your disease and worry about it, the problem will not solve itself. You paid to see me — let me do the worrying and solve the problem for you; you think of nothing, and above all keep your emotions balanced. So if a person is hugely ambitious — say he wants to run for president of Taiwan — and you give him a lot of fine hot drugs, sulfur and other fierce medicines, his ambition is already huge; taken, they will produce the opposite pattern. You must not harm people.

Why? Bo Qi’s explanation is classic: in heat in the middle and wasting-thirst, the body is already hot inside; adding hot drugs risks internal injury to the spleen.

💬 Note from Doctor Ni: Hot drugs with abundant heat — the medicinal qi is very hot, very fierce; the drug qi is fierce as well. In both kinds of heat-in-the-middle and wasting-thirst the body is already hot inside; at that point, using hot drugs again risks injuring the spleen internally. The spleen is earth and hates wood; take these drugs until the jia-yi days — jia and yi belong to wood, wood conquers earth — and the disease worsens, creating problems in the spleen. So when we are sick we should eat simply; rich or poor, when you are used to eating well, stop it during illness. And when you prescribe, remember: for the richer patient, or the one with huge ambition — when treating a legislator or a vice president, beware of ambition and desire; you cannot prescribe wildly.

Bonus: the four seas of the body — the sea of marrow, the sea of qi, the sea of grain and water, the sea of the twelve channels

At the end of this lecture Doctor Ni gives a big gift package: the four seas (si hai). From now on, when you hear ‘four seas’, you will know it means these four places.

💬 Note from Doctor Ni: First, the brain is the sea of marrow — the sea of water; the brain. Its acupoints: above at Baihui GV20, below at Feng Fu GV16. Second, the sea of qi is at the neck — the whole ring of the neck is the sea of qi: above at Tianzhu BL10, below at the Renying ST9 point. Third, the sea of grain and water is the stomach: above at the Qi Street position, below at the Zusanli ST36 position — from Qi Street to Zusanli is called qi jie; it is below Guanyuan CV4, where the small intestine passes, the official in charge of reception (shou sheng zhi guan). Fourth, the sea of the twelve channels is the Chong Mai (Thoroughfare Vessel): its acupoints above are Dazhu BL11, below are Shangjuxu ST37 and Xiajuxu ST39, at the upper and lower great-emptiness. The seas where the channels gather, the sea of qi, the sea of grain and water, the sea of brain marrow — collectively called the four seas.

Chest fullness and abdominal distension are diagnosed from these four seas — the chest is yang, the neck is the sea of qi, and everything clicks at once.

💬 Note from Doctor Ni: Keep the four seas clear and your pattern differentiation will be easier: the chest is yang, the neck is the sea of qi. Some diseases swell the chest — chest swelling, tight pain, chest fullness and abdominal distension — once you understand the four seas, you know where the qi is stuck and where it needs to open.

Closing: one lecture, a belly full of learning

This lecture carried an enormous amount: the end of the nine qi, drum distension and Ji Shi Li, blood depletion and the cuttlefish-bone-and-madder pills, the two kinds of fu liang, heat in the middle and wasting-thirst, and the four seas. Doctor Ni’s parting words: to study Chinese medicine, keep your mind flexible — do not be a good little obedient student — and keep your heart upright. Medicine can be cheap; a physician’s conscience cannot be discounted.

Based on Doctor Ni Haixia’s Ren Ji (Human Records) Huang Di Nei Jing lecture series (Lecture 48), presented by Doctor Luo Dalun.