《黃帝內經素問補註釋文》Vol. 11

The Yellow Emperor asked: “I have heard that some people skilled in medicine regard the brain and marrow as Zang organs, while others regard the intestines and stomach as Zang organs. Some also classify them as Fu organs. Their accounts contradict one another, yet each side believes itself to be right. I do not understand the reasoning. What is going on?”

“Practitioners of medicine and esoteric arts” refers to people versed in medicine and technical arts. Ancient medical texts do indeed classify the Zang and Fu organs in different ways. The “Treatise on the Secret Canon of the Orchid Chamber” includes the intestines and stomach in the functional system of the twelve Zang; the “Treatise on the Six Qi and the Manifestations of the Zang” says that the functions of the eleven Zang all depend on the gallbladder; and the “Treatise on the Generation of the Five Zang” says that the forms of the five Zang can be inferred by analogy, while their relation to sounds can be understood intuitively. Commentators consider these accounts somewhat at odds with one another. The claim that the brain and marrow are Zang organs, they suggest, may appear in other scriptures.

Qibo replied: “The brain, marrow, bones, vessels, gallbladder, and woman’s womb—the female reproductive organ, chiefly the uterus—are six structures generated by Earth Qi. They are stored within the body and accord in nature with Earth. They only store and do not discharge, so they are called the ‘extraordinary Fu organs,’ special organs distinct from the usual category of Fu.

“Although the brain, marrow, bones, and vessels are called Fu, they do not form the interior-exterior relationships with the spirit-storing Zang—the heart, liver, spleen, lungs, and kidneys—that ordinary Zang and Fu organs do. The gallbladder pairs with the liver, but is not entirely the same as it. Though the woman’s womb receives and releases—it receives Jing and nurtures the formation of the body within it—its processes of entry and exit differ from those of the six Fu. These organs are therefore called the extraordinary Fu that ‘store and do not discharge.’

“The stomach, large intestine, small intestine, Triple Burner—the Fu that governs the movement of fluids and the passage of Qi—and bladder are five structures generated by Heaven Qi. They accord in nature with Heaven and can therefore discharge; unlike the Zang, they do not store. They receive turbid Qi passed on from the five Zang and are called the ‘transforming and transmitting Fu,’ that is, Fu responsible for conveying, transforming, and discharging. They must not allow their contents to remain for long.

“When water and grain—the food and drink we take in—enter the body, the residue is transformed and expelled; it cannot stay inside for a long time. Once transformation is complete, it should be conveyed and discharged. These Fu are therefore called the ‘transforming and transmitting Fu.’

“The gate of the Po, or anus, is also governed by the five Zang, so that water and grain cannot remain stored for long. The gate of the Po is the anus, which communicates with the lungs. Once food has been transformed within the body, it is expelled through this passage.”

The five zang organs allow food and drink to pass through and transform them, so food and drink cannot remain in the body for long.

The five zang organs store Jing and Qi and do not discharge them. They can therefore be filled with Jing and Qi, but cannot be filled in the way that food and drink fill the body. Jing and Qi are said to be “full,” while food and drink are said to be “replete”: because the five zang organs store Jing and Qi, they can be full but not replete. The textual commentators note that in the Quan Yuanqi edition, the Jia Yi Jing, and the Tai Su, “Jing and Qi” appears as “Jing and Shen.”

The six fu organs transport and transform food; they do not store it for long. They can therefore be replete, but cannot remain full. They do not store Jing and Qi, but only temporarily hold food and drink, so they are “replete but not full.”

This is because when food and drink first enter the body, the stomach is replete while the intestines are empty, since the food has not yet descended. Once it descends, the intestines are replete and the stomach is empty. For this reason, the six fu organs are said to be “replete but not full,” and the five zang organs “full but not replete.”

The Yellow Emperor asked, “Why alone can the Qi Mouth reflect the condition of the five zang organs?”

The Qi Mouth is the cun-kou, also called the pulse mouth. It lies about one cun behind the thenar eminence at the wrist and is where the pulse is examined. Because the abundance or decline of Qi can be judged there, and the pulse’s movement or stillness felt, it is called the “Qi Mouth” or “pulse mouth.”

Qibo replied, “The stomach is the sea of food and drink and the source of the Qi transformations and circulation of the six fu organs. The human body has four seas, and the sea of food and drink is one of them. After receiving food and drink, the stomach distributes nourishment throughout the body and is therefore the chief source for the six fu organs.

“The five flavors enter through the mouth and are stored in the stomach to nourish the Qi of the five zang organs. The Qi Mouth also belongs to the Hand Taiyin Lung Channel. It is where the pulse Qi of Hand Taiyin circulates and the pulse becomes apparent, which is why it is said to belong to Taiyin.

“Thus, the flavors and Qi that the five zang and six fu organs receive from the stomach are all reflected in the pulse at the Qi Mouth. When nutritive Qi circulates, it takes food and drink as its basis. The textual commentators note that this annotation appears in the Ling Shu, where the character for ‘replete’ is written as ‘treasure.’ After food and drink enter the stomach, stomach Qi carries their refined essence to the lungs. Lung Qi then circulates through the channels to the Qi Mouth, so the flavors and Qi of the zang and fu organs become apparent there. Another textual note records that in the Quan Yuanqi edition, the character for ‘emerge’ is written as ‘enter.’

“The five Qi enter through the nose and are stored in the heart and lungs. When the heart and lungs are diseased, the nose also becomes obstructed. Whenever treating illness, one must observe whether the patient’s urination and bowel movements are unobstructed, examine the pulse, and observe the patient’s emotions and state of mind.”

When assessing an illness, observe whether the patient’s current signs are normal, and judge the condition of the body from the strength or weakness of the pulse. Also examine whether the patient’s intent is upright, how severe the illness is, and how it may develop; then treat it according to the appropriate method.

The Newly Revised Text says: “In the Taishu, this passage reads: ‘One must examine the upper and lower parts, judge the pulse, and observe the patient’s intent and illness.’”

Someone fixated on ghosts and spirits is not a suitable person with whom to discuss the profound art of medicine.

A person whose intent is deviant likes to pray. If you explain profound medical principles to such a person, they will find them difficult to understand; they are therefore not a suitable person with whom to discuss the profound art of medicine.

Someone who dislikes acupuncture and stone lancets—ancient stone instruments used to puncture and treat illness—is not a suitable person with whom to discuss advanced medical techniques. Since they dislike acupuncture, there is no way to put the art of medicine into practice; they are therefore not a suitable person with whom to discuss advanced needling techniques. The character “wu” is read as “wu,” meaning “to dislike.”

If a patient refuses treatment, the illness cannot be cured. Even if treatment is forced upon them, it will have no effect. When a patient is unwilling to be treated, the illness will inevitably be difficult to save them from; forcing treatment will likewise achieve nothing. That is why it is said that treatment will be ineffective.

Treating by Different Methods According to Local Conditions

The Yellow Emperor asked: “When physicians treat illness, they sometimes use different methods for the same disease, yet all of them succeed in curing it. Why is this?”

Different methods include acupuncture, stone lancets, moxibustion, medicines, and practices such as Daoyin and Anqiao. Daoyin is a health-preserving method involving regulation of the body and breath; Anqiao is a therapy involving massage and pressure on the limbs.

Qibo replied: “This is due to the different terrain and environments of each region.”

In other words, treatment methods should be chosen according to the patterns of birth, growth, gathering, and storage between Heaven and Earth, as well as local conditions such as elevation, dryness, and dampness.

The eastern region is where the myriad things of Heaven and Earth first begin to grow, in accord with the breath of spring. It lies near the sea and waters, and is rich in fish and salt. Fish and salt are resources of the coast; people live by the water and pursue livelihoods suited to the local conditions.

The people there often eat fish and enjoy salty foods. They are settled in their homes and accustomed to the local diet. Fish generates heat within the body, while salt depletes the blood.

Fish can readily bring on sores, a sign of internal heat; salt can readily make people thirsty, a sign that the blood has been depleted. As a result, the people there generally have darker complexions and loose skin texture, and are prone to illnesses such as abscesses and sores. This is because their blood is deficient while heat is present within the body, making them susceptible to abscesses and sores.

Stone lancets are suitable for treating these illnesses.

Stone lancets are needles made from stone. The Classic of Mountains and Seas says that Mount Gaoshi has a stone resembling jade that can be made into needles; these are stone lancets. The Newly Revised Text says that some editions write “fa” instead of “shi.”

Thus, the treatment using stone lancets also originated in the east. People in the east still use it today.

The western region produces abundant gold and jade and has much sand and stone. It is where the myriad things of Heaven and Earth gather in and enter storage……

This passage explains that the climate, terrain, and dietary habits of different regions affect the constitution of their inhabitants and the illnesses they are prone to develop. Treatment methods should therefore vary from place to place.

People should adapt to the climate of autumn. The word “draw” means to draw inward and gather in. People in the western region live at high elevations, where winds are frequent and the soil and water are firm and strong. A commentator explains that “dwelling on heights” means living in elevated places like hills; the Metal Qi of the west is severe and destructive, so the soil and water are strong. Another textual emendation suggests that the western terrain is high and residents live on elevated ridges, making the region windy; the phrase does not necessarily mean that their houses are built to resemble hills.

The people there do not wear silk or padded clothing, but wear garments made of wool and use fine grasses for bedding. They eat rich, savory foods such as butter, cheese, and meat, and are therefore robust. The strong soil and water, together with their rich diet, make their skin and pores dense and their blood and Qi full, so external pathogenic influences do not easily invade their bodies. Their illnesses mostly arise from internal causes. Here, “internal” refers to emotions such as joy, anger, thought, grief, and fear, as well as excess in eating and drinking or in sexual relations. An editor notes that one version reads “grief,” but “thought” is the correct reading here; the relevant explanation appears in the Commentary on “The Treatise on the Correspondences of Yin and Yang.”

Illnesses of this kind are best treated with “poisonous medicines.” Here, the term refers to medicines with strong properties that can attack and treat illness, not exclusively to substances that are toxic. Because the people there have abundant blood and Qi, firm muscles, a rich diet, and strong soil and water, they require medicines with powerful effects. Plants, insects, fish, birds, and animals can all be used as medicines to treat illness. A commentator says that the method of using poisonous medicines also came from the west, where people still practice it today.

The north is where Heaven and Earth close in and store their vitality. The terrain there is high, and people live at elevated places amid biting winds and freezing cold, with ice and snow; these conditions correspond to the climate of winter. The people prefer to live in open country and subsist on dairy products. Cold readily harms the internal organs, causing them to become chilled and bringing on illness. An editor notes that the word “fullness” does not appear in the Jia Yi Jing.

Illnesses of this kind are best treated with moxibustion and cauterization: burning mugwort and similar materials to warm and cauterize the body. A commentator says these methods also came from the north, where people still use them today.

The south is where Heaven and Earth bring forth and nurture life, and where Yang Qi flourishes. The terrain there is low, the soil and water are weak, and mist and dew gather readily; these conditions correspond to the climate of summer. Because the land is low, water collects there, so water is abundant, the soil is weak, and mist and dew accumulate easily. The passage goes on to say that the people there favor sour foods and often eat “fu.” A commentator explains that “fu” refers to food that is not very fragrant; Quan Yuanqi, however, considers it to mean fish.

That is why the people of the south have fine, dense skin and a reddish complexion. They are prone to illnesses such as spasms of the sinews and vessels, numbness, and painful impediment.

Sour flavor has an astringent effect, which is why the people of the south have fine, dense skin. Areas where Yang Qi is abundant appear red. Dampness fills the body, while heat becomes congested at the body’s surface, so spasms of the sinews and vessels, numbness, and painful impediment occur. Treatment is best given with fine needles, used to regulate the relative abundance and deficiency of Qi and blood in the channels.

The Nine Needles, the collective name for ancient forms of acupuncture needle, also originated in the south. The people there place great importance on needling therapy.

The central region is flat and damp. It is where Heaven and Earth bring forth the myriad things, and the great variety of living things reflects the action of Earth’s De. Since the terrain differs from place to place, the illnesses it gives rise to also differ.

The people of the central region eat a wide variety of foods but do not do much physical work. People and goods from all four directions gather there, so their diet is varied while their physical labor is limited.

As a result, they often suffer from weakness and wasting, Qi counterflow, and alternating chills and fever. Dampness accumulates in the lower body, making the limbs weak and wasted and causing Qi to flow upward against its proper course; it can also bring on chills and fever. The “Great Treatise on Yin-Yang Correspondences” says that dampness from the ground can enter the body and damage the flesh, skin, sinews, and vessels. The central region lies near wetlands, so these illnesses are common there.

Treatment is best given through daoyin and anqiao. Daoyin involves moving the sinews and bones and exercising the joints; an means pressing the flesh and skin, while qiao means swiftly lifting the hands and feet. Daoyin and anqiao also originated in the central region and are commonly used there to nourish the spirit and regulate Qi.

Thus, a sage combines different forms of treatment so that each one suits the illness. Adapting treatment to the place and applying it appropriately is possible only by following the methods of the sages.

Although different regions use different methods, all can cure illness because they grasp the actual condition of the disease and understand the general principles of treatment. This is what it means to understand how things work and to follow their natural tendencies.

Treatise on Shifting the Essence and Changing the Qi

The Yellow Emperor asked: “I have heard that in ancient times, to treat illness, people only had to shift a person’s spirit and change their Qi, then use zhuyou—a method of healing through prayers, talismans, and incantations. Today, some illnesses are treated internally with medicines, while others are treated externally with acupuncture or stone lancets. Yet some people recover and others do not. Why is this?”

“Shift” means to move, and “change” means to transform. Both refer to stopping pathogenic Qi from harming healthy Qi, restoring the strength of a person’s spirit, and enabling it to remain within the body. The “Treatise on Qi Communicating with Heaven” says that sages preserve their spirit and follow the Qi of the seasons. The “Treatise on the Heavenly Truth of High Antiquity” says that when the spirit remains within, where could illness come from?

Qi Bo replied: “In the distant past, people lived among birds and beasts, and relied on movement to escape the cold…”

Living in a sheltered room can protect one from the heat. When the mind is free of attachments and longing, one is also free from the rush to seek an official post.

The New Corrected Edition says: According to the Quan Yuanqi recension, “shen” should read “yu.”

This is because when the human mind is calm and detached, pathogenic influences cannot penetrate deeply into the body. Thus, toxic medicines cannot cure such illnesses. When the illness is internal, acupuncture and stone lancets cannot treat its outward signs either. It is enough to shift the spirit and perform Zhuyou, explaining the cause of the illness through prayer and praying for recovery.

In ancient times, people lived in nests or caves, taking shelter at night and going out at dawn, among birds and beasts. From these circumstances, we can gain a rough idea of how they lived. Activity and restlessness, however, cause Yang energy to flourish, making the body warm enough to withstand the cold. Cold Yin energy makes people feel chilled, so living in a sheltered room can protect them from the heat. When a person lets go of scattered thoughts, the mind is free of attachments and longing; when the heart has no desires, one is free from the rush to seek an official post. By quietly preserving one’s innate true Qi, pathogenic influences naturally cannot overcome the body’s healthy Qi. Therefore, as long as the spirit is shifted and the movement of Qi changed, illness can be cured through Zhuyou alone, without toxic medicines, acupuncture, or stone lancets.

The New Corrected Edition says: According to the Quan Yuanqi recension, “Zhuyou” was a kind of spirit in the south.

The world today is no longer like this. People’s feelings, longings, and actions have all strayed from the Dao. Worry and distress arise within, while toil and hardship damage the body. People also fail to follow the changes of the four seasons and cannot adapt to heat and cold. Noxious winds, external winds that cause illness, strike often; deficient pathogenic influences enter the body from dawn to dusk, damaging the Five Zang organs and bone marrow within, and the body’s openings and skin without. As a result, minor illnesses inevitably worsen, serious illnesses inevitably end in death, and Zhuyou can no longer cure them.

The Yellow Emperor said, “Well said. I wish to examine patients myself, judge whether they will live or die, and resolve my doubts. I want to understand the essentials. Can you explain them clearly, like the light of the sun and moon?”

Qibo replied, “Complexion and pulse are diagnostic methods valued by the ancient emperors and passed down by our former masters.” Here, “Supreme Emperor” refers to the ancient emperors, and “former master” refers to Jiu Daiji, the teacher of Qibo’s ancestors.

In ancient times, the emperors ordered Jiu Daiji to examine complexion and pulse, bringing diagnosis to a level of insight into the spirit. He connected these signs with the Five Phases—Metal, Wood, Water, Fire, and Earth—the four seasons, the Eight Winds (winds from the eight directions), and the six directions of space, above and below and the four quarters. He never departed from the normal patterns.

The former master held that a white complexion and a pulse like a hair belong to Metal and correspond to autumn; a green complexion and a pulse like a taut string belong to Wood and correspond to spring; a dark complexion and a pulse like a stone belong to Water and correspond to winter; a red complexion and a forceful, surging pulse belong to Fire and correspond to summer; and a yellow complexion and an intermittent pulse belong to Earth and correspond to late summer and the transitions between the seasons. In this way, complexion and pulse correspond downward to the nature of the Five Phases and upward to the course of the four seasons. Thus, however the Eight Winds stir and change between Heaven and Earth, they do not depart from the normal signs, and their effects can all be anticipated on this basis. How is this possible? By observing change, one comes to understand its patterns. Hence, what follows says…

By observing the subtle ways Yin and Yang shift and transform, one can grasp their key principles. To discern what matters, it is enough to examine the complexion and the pulse.

The point here is that the key to understanding how the Qi of the four seasons and the Five Phases changes and shifts lies in observing the complexion and the pulse. How can these subtle changes be detected? Through the complexion and the pulse.

The complexion corresponds to the sun, and the pulse corresponds to the moon. This means that observing the complexion and the pulse can provide a basis for inferring seasonal changes. In ordinary diagnosis, checking for abnormalities in the complexion and pulse is essential to assessing a person’s health.

Changes in the complexion correspond to the four seasons, and the pulse changes along with them. This is a principle valued by the Supreme Deity of ancient belief because it accords with the spirits. By observing whether the complexion and pulse are strong or weak, one can recognize signs of life and death, and so regularly keep away from death and draw near to vitality.

Living in accordance with the way of nurturing life can extend one’s lifespan. This is called the way of the sage-kings. The Supreme Deity passed down this teaching, and when people diligently put it into practice, the way of life can continue. Only sage-kings were able to do so and to practice it consistently.

In the Middle Antiquity, illness was treated as soon as pathogenic influences arrived. Decoctions—medicinal liquids prepared by boiling herbs—were used to treat it, and within ten days they could dispel diseases caused by the Eight Winds and the Five Bi Syndromes.

The Eight Winds are winds from the eight directions. The Five Bi Syndromes are disorders caused by obstruction in the skin, flesh, sinews, bones, or vessels. According to the Lingshu Jing, the wind that comes from the east is called “Infant Wind”; when it harms a person, it affects the sinews and vessels externally and lodges in the liver internally. The wind that comes from the southeast is called “Weak Wind”; when it harms a person, it affects the flesh externally and lodges in the stomach internally. The wind that comes from the south is called “Great Weak Wind”; when it harms a person, it affects the vessels externally and lodges in the heart internally. The wind that comes from the southwest is called “Strategic Wind”; when it harms a person, it affects the flesh externally and lodges in the spleen internally. The wind that comes from the west is called “Rigid Wind”; when it harms a person, it affects the skin externally and lodges in the lungs internally. The wind that comes from the northwest is called “Breaking Wind”; when it harms a person, it affects the Hand Taiyang meridian externally and lodges in the small intestine internally. The wind that comes from the north is called “Great Rigid Wind”; when it harms a person, it affects the bones externally and lodges in the kidneys internally. The wind that comes from the northeast is called “Baleful Wind”; when it harms a person, it affects the armpits and ribs externally and lodges in the large intestine internally.

The Treatise on Bi Syndromes also says that exposure to pathogenic wind on Jia or Yi days in spring produces sinew Bi; on Bing or Ding days in summer, vessel Bi; and on Geng or Xin days in autumn, skin Bi. The text breaks off here, before completing the passage on winter.

When a person is afflicted on a Ren or Gui day, which corresponds to Water and the kidneys, the resulting illness is bone impediment. When affliction occurs at the time of utmost Yin—Long Summer, roughly the last month of summer—the illness is muscle impediment. This passage refers to illnesses such as the eight winds and the five types of impediment.

The New Collation says: The commentary here cites the Treatise on Impediment, but the text of the extant Treatise on Impediment is not like this. It should instead cite the Treatise on Wind: when a person is afflicted by wind on a Jia or Yi day in spring, liver wind develops; on a Bing or Ding day in summer, heart wind develops; on a Wu or Ji day in late summer, spleen wind develops; on a Geng or Xin day in autumn, lung wind develops; and on a Ren or Gui day in winter, kidney wind develops. The Treatise on Impediment says that when the three pathogenic forces of wind, cold, and dampness attack together, impediment illness develops. If this happens in winter, it becomes bone impediment; in spring, sinew impediment; in summer, vessel impediment; at the time of utmost Yin, muscle impediment; and in autumn, skin impediment.

If the illness has not healed after ten days, treat it with medicines such as cao su and cao gai, using their branches, roots, and other parts in combination. Once both the manifestation and the root cause have been identified, and the pathogenic force has become apparent, administer the medicine.

Cao su refers to a prepared medicinal decoction; cao gai means the roots of herbs; and “branches” means stems. In other words, combine the roots, shoots, and other parts of various medicines, decoct them together, and take them in combination. Some medicines use the root, others the stem or branch, and still others the flower or fruit. Some prescriptions use the root, stem, branch, flower, and fruit together; hence the phrase “the root and tips assist one another.” “Once the manifestation and root cause are determined, the pathogenic force can be treated” means that when the physician’s treatment matches the patient’s condition, the pathogenic force will recede of its own accord. The Treatise on Decoctions and Fermented Liquors says: “The illness is the root; the physician is the manifestation. If manifestation and root do not correspond, the pathogenic force will not yield.” This means that if the condition and the treatment do not match, the pathogenic force will not recede. Some also take “manifestation and root” here to refer to acupuncture treatment.

The New Collation adds: According to the edition by Quan Yuanqi, this passage also reads, “Once the manifestation and root are correctly identified, the pathogenic force will disperse.”

Later generations, however, did not treat illness this way: they did not base treatment on the four seasons, understand the timing of the sun and moon and the seasons, or examine whether the course of the illness was favorable or adverse.

The Qi of each of the four seasons has its own location. To treat without regard to where the pathogenic force is, and instead to attack indiscriminately, violates the ancient method. The Treatise on Following and Opposing the Seasons in Acupuncture says: in spring, Qi is in the channels; in summer, it is in the finer collateral vessels; in Long Summer, it is in the muscles; in autumn, it is in the skin; and in winter, it is in the bones and marrow. Physicians should treat according to where the pathogenic force is, follow the seasons, and find ways to avoid and address the latent pathogenic force.

Do you not know that the sun changes between cold and warmth, brightness and darkness, and that the moon changes through its phases of waning and fullness?

The Treatise on the Eight Measures of the Spirit says: “Whenever acupuncture is performed, one must observe the changes in the sun, moon, and stars, the four seasons, and the vital influences in the eight directions. Wait until the climatic influences have settled before needling.” Thus, when the weather is warm and the sun bright, the body’s blood is moist and flows freely, while Defensive Qi (the Qi that moves along the body’s surface and protects it) circulates externally. Blood then moves easily and Qi passes freely. When the weather is cold and the sky dark, the blood stagnates and flows poorly, while Defensive Qi sinks and lies within.

When the moon first appears, the body’s blood and Qi begin to fill out, and Defensive Qi begins to circulate. When the moon is full, blood and Qi are abundant and the muscles firm. When the moon wanes, the muscles weaken and the channels and collaterals become empty; Defensive Qi leaves the body’s surface, and only the physical form remains. Blood and Qi must therefore be regulated in accord with the seasons and the heavens.

So, do not needle when the weather is cold, and do not let blood and Qi stagnate when it is warm. Do not drain at the beginning of the lunar month, tonify at the full moon, or treat when the moon is waning. This is how to choose the proper time for treatment. Follow the order of the seasons and the changes in fullness and decline; wait until the moon reaches the corresponding phase, then treat with care.

If one drains at the start of the month, when tonification is called for, the Qi of the organs will grow weak. If one tonifies at the full moon, when draining is called for, blood and Qi will become excessive and blood may spill into the channels. This is called “double excess,” when pathogenic excess is compounded by the strength of the body’s normal Qi. Treating when the moon is waning disrupts the channels, throws Yin and Yang into disorder, and makes it difficult to distinguish true Qi from pathogenic Qi. Pathogenic influences then accumulate and linger; the exterior grows weak and the interior becomes disordered, allowing the pathogen to take advantage of the deficiency. This is what the passage describes.

“Failing to examine what runs counter to or accords with the condition” means failing to determine whether the illness can be treated and whether treatment is appropriate. The passage therefore continues:

“When the disease has already taken shape, one then tries to treat the exterior with fine needles and the interior with decoctions.” This means that the physician is careless and has not examined the condition closely.

A careless physician acts in haste, assuming the illness can be attacked. As a result, before the old illness has been cured, a new one appears. “Careless” means lacking due attention; “reckless” means acting without judging whether the treatment is appropriate. Why is this so? Imagine someone who is hungry and weak in body and strength, then suddenly given far too much to eat. Would they not become ill? The food itself is not harmful; the problem is eating at the wrong time and in excessive quantity. If the illness was not caused by a disorder that calls for forceful intervention, then using acupuncture, stone lancets, or decoctions at the wrong time or in excess will only deepen the harm. The New Collation notes: “Huo” is written as “harm” in another edition.

The Yellow Emperor said, “I would like to hear the essentials of treating illness.” Qibo replied, “The most important principle in treating illness is not to overlook the complexion and the pulse. Use them without being misled: this is the great method of treatment.”

Here, “misled” means confused, and “method” means guiding principle. What the complexion and pulse reveal is clear and does not deceive. If one follows these signs without disrupting the principles of diagnosis and treatment, one can examine illness carefully and treat it appropriately.

If diagnosis and treatment go against what is reasonable, reversing the outward signs of illness and its underlying cause, the physician will judge incorrectly and the illness may worsen. “Acting in reverse” means turning what should be done in accordance with reason upside down; “failing to distinguish the signs from the root” means that the physician has not identified the outward manifestations and underlying cause of the illness.

When someone goes against what is reasonable and handles things poorly, how could the harm be limited to the patient? Even when serving as an adviser to a ruler, such a person may prevent the state from enjoying lasting stability.

One must abandon old, mistaken practices and turn to learning new principles in order to become truly discerning. If one cannot distinguish the signs from the root and diagnoses or treats the illness poorly, one should leave those who act against reason and draw close to those who understand it. Only then can one become proficient in the principles of medicine and preserve oneself.

The Yellow Emperor said, “I have already heard the essentials from you, Master. You say diagnosis and treatment cannot be separated from observing the complexion and taking the pulse. I understand this.”

Qibo said, “The highest principle of diagnosis and treatment lies in grasping a single fundamental rule.”

The Yellow Emperor asked, “What does ‘the One’ mean?”

Qibo said, “This rule is to be discovered through questioning the patient.”

The Yellow Emperor asked, “How should this be done?”

Qibo said, “Close the doors and shut the windows. Let the patient be calm, focus your attention, and ask repeatedly about the illness, following the patient’s own wishes to learn what is happening.”

In other words, ask the patient what they desire, then discern what is right or wrong in it and what it reveals about the illness.

The Yellow Emperor said, “Good. Those who preserve their spirit and vital energy will flourish; those whose spirit and vital energy decline will move toward ruin.”