《黃帝內經素問補註釋文》Vol. 17

A person’s living environment, daily activities, calmness or agitation, and courage or timidity can all cause the pulse to change.

Qibo replied: A person’s fright, anger, fatigue, activity, or rest can all alter the pulse. The “change” referred to here means that the pulse departs from its normal state.

When someone walks at night, panting arises from the kidneys. Kidney Qi is vigorous at night, and the night corresponds to darkness. Thus, when walking at night causes fatigue, panting is brought on by the kidneys. When the movement of Qi becomes disordered, it can in turn injure the lungs.

After being startled and frightened by a fall, panting arises from the liver. Fear is associated with the liver, while a fall can injure the sinews, vessels, and Qi and Blood. The breath therefore becomes hurried, and panting is brought on by the liver. Disordered movement of Qi can damage the spleen, because excessive liver Qi can impair Spleen Earth.

When someone is startled and afraid, panting arises from the lungs. Startlement leaves the mind-spirit without support and the spirit without a place to settle; the breath in the chest becomes disordered, and panting is therefore brought on by the lungs. Startlement can also cause the spirit to float upward and the Qi mechanism to become disordered, which in turn injures the heart.

When someone falls while wading through water, panting is associated with the kidneys and bones. Dampness connects with the kidneys, and the kidneys govern the bones. Thus, after a fall while wading, panting is related to the kidneys and bones. “Stumbling” refers to losing one’s footing; “falling” refers to the body hitting the ground.

In such circumstances, a courageous person’s Qi and Blood flow smoothly, and the symptoms subside. A timid person is more easily affected, and the condition can develop into an illness. This is because people’s Qi varies in strength, and their spirits in firmness or timidity; naturally, their responses differ.

One way to examine illness, then, is to observe a person’s courage or timidity, bones, muscles, and skin, and use these to understand the condition of the body. Only by understanding a person’s temperament and grasping the specific circumstances can one gain a thorough understanding of the illness and apply diagnostic methods appropriately.

After eating too much, sweat emerges from the stomach, because the stomach is full of food. When someone is startled and the spirit is harmed, sweat emerges from the heart. Startlement disturbs the heart-mind, causes the breath to float upward, and presses Yang Qi inward, so sweating occurs. When someone carries a heavy object over a long distance, sweat emerges from the kidneys. This happens because the bones are overworked and the breath is depleted, leaving Kidney Qi excessively fatigued as well.

Sweat produced by intense running or fear comes from the liver.

Sudden exertion and excessive strain on the sinews and bones tire the Liver Qi. That is why intense running or fear causes sweating, and why this sweat is associated with the liver.

Sweat produced by moving the body and laboring strenuously comes from the spleen.

“Moving the body and laboring strenuously” here means physical activity and exerting oneself at work, not running fast or traveling long distances. When one exerts oneself in activity, the vital essence derived from grain is dispersed throughout the body. The spleen governs the transformation and transportation of food and drink, so the sweat produced at such times is associated with the spleen.

Thus, in spring, summer, autumn, and winter, amid the Yin-Yang changes of the four seasons, illness often arises because the body is overused. This is a general rule.

Failing to heed one’s own condition and forcing oneself to do more than one can bear leads to illness. This is common sense. The Qi that each of the five organs can bear and use has a definite limit; depleting it excessively leads to illness. Hence the following passage says:

After the Qi of food and drink enters the stomach, its vital essence spreads to the liver, where it nourishes the sinews.

The liver governs the nourishment of the sinews. The stomach transforms and disperses the vital essence of grain; some of it enters the liver and gradually nourishes the sinews and channels.

After the Qi of food and drink enters the stomach, the coarser grain Qi goes to the heart, while the refined Qi fills the vessels.

“Coarse Qi” here refers to the Qi of grain. The heart lies above the stomach, so grain Qi rises to the heart, while refined Qi fills the vessels. This is because the heart governs the vessels.

Qi in the vessels flows through the channels, and the Qi of the channels converges in the lungs. The lungs gather the Qi of all the vessels and send vital essence to the skin and body hair.

This passage says that as Qi in the vessels moves, it becomes the Qi of the major channels. The Qi of the channels converges above in the lungs. The lungs sit high like a canopy and regulate the movement of Qi, so the Qi of all the vessels gathers there. The “Treatise on the Pulse of the Normal Person” says, “The true Qi of the organs is above in the lungs.” This means that the vital essence of the five organs gathers in the lungs, which then circulate nutritive Qi and defensive Qi, bringing Yin and Yang into balance. The lungs thereby disperse vital essence to the skin and body hair.

The Qi of the skin and body hair joins with the vital essence in the vessels, and Qi then flows to the Qi Mansion.

“Mansion” means a place where Qi gathers—in other words, the Sea of Qi. It lies between the breasts and is called Shanzhong.

The vital essence and spirit Qi in the Qi Mansion remain there and harmonize the four organs, while Qi returns to the balance point.

The Qi dispersed from Shanzhong divides into three pathways: the downward pathway leads to Qijie, and the upward pathway leads to the breath passage. Ancestral Qi gathers in the Sea of Qi, accumulating in the chest; this place is also called the Sea of Qi. Through this distribution of Qi, each organ is stabilized, the Triple Burner is balanced, and everything within and outside the body, above and below, finds its proper place.

Once balance is achieved, the pulse at the Qi Mouth can be divided into the Cun, Guan, and Chi sections, which are used to judge life and death.

Pulse methods throughout the ages have divided the three inches into the Cun, Guan, and Chi sections. Therefore, in…

Only when the outer breath is balanced in strength and the movement of Qi is even and calm can the pulse at the wrist be felt at the cun position. The “Qi mouth” is an important site for examining the pulse. The Qi of all the vessels converges there, so it can be used to judge life and death.

After food enters the stomach, its refined Qi circulates through the body and is transported upward to the spleen. When fluids reach the middle burner—the area between the chest and abdomen where the spleen and stomach are located—they are transformed into subtle substances that rise like clouds and mist. As the clouds and mist disperse and change, they flow into the spleen. The Ling Shu Jing says, “The upper burner is like mist; the middle burner is like a pivot.” This describes that process.

The spleen’s Qi transports the subtle substances upward to the lungs. The lungs then disperse and regulate the movement of fluids, sending them downward to the bladder. Water combines with the refined Qi of grain and rises to nourish the lungs. Lung Qi also reaches the kidneys, enabling it to regulate the waterways and direct fluids into the lower burner, the lower abdomen. When fluids reach the bladder, the bladder’s Qi transformation turns them into urine. The Ling Shu Jing says, “The lower burner is like a drainage channel.” This describes the principle.

The subtle essence of water spreads throughout the body and circulates through the five channels. Its movement corresponds to the Yin-Yang changes of the four seasons and the five organs. This movement must follow certain rules in order to become the normal pattern.

In accordance with this pattern, the subtle essence of water spreads through the channels, while Qi moves through the sinews and bones, generating blood and Qi. These processes adapt to the cold and heat of the four seasons and accord with the changes and waxing and waning of Yin and Yang in the five organs. They are the regular measures governing the movement of Qi and blood in the body. Here, “measure” means a rule or standard. ○ The New Collation notes: According to one edition, the original phrase “measuring Yin and Yang” reads “the movement and stillness of Yin and Yang.”

When the pulse of the Greater Yang channel alone is exuberant, with counterflow, panting, Qi deficiency, or rebellious Qi, this indicates that Yin Qi is insufficient and Yang Qi is excessive.

Here, Yin refers to the kidneys and Yang to the bladder. Therefore, the text goes on to say: “Both the exterior and interior should be drained together; select the transport points on the feet.” (Transport points are the points through which channel Qi enters, exits, and is conveyed.)

“Yang alone arrives” means that Yang Qi is exuberant on its own. When Yang Qi is excessive and Yin Qi is insufficient, pathogenic Yang takes advantage of the deficiency and invades. Both the exterior and interior should therefore be drained together, using the corresponding points on the feet. The original text says “lower transport points,” meaning the transport points on the feet. ○ The New Collation notes: On close examination, “six” should be a corruption of “points.” The six bowels each have six transport points, while the five organs each have five. Since both organs and bowels are to be drained here, it cannot mean that only the “six transport points” are selected. The phrase “points and transport points” includes both organs and bowels.

When the pulse of the Yangming channel alone is exuberant, this indicates an excessive concentration of Yang Qi. Treatment should drain Yang and supplement Yin, selecting the transport points on the feet.

When the pulse of the Shaoyang channel alone is exuberant, this is caused by counterflow Qi. If the pulse at the front of the Heel Vessel suddenly becomes very large, select the transport points on the feet. Here, “Heel Vessel” refers to the Yang Heel Vessel. The Yang Heel Vessel passes beneath the outer ankle. The Foot Shaoyang channel reaches the end of the fibula, descends to the front of the outer ankle, and then runs along the top of the foot.

When the pulse suddenly becomes large and forceful, Shaoyang Qi is excessive. Treatment should therefore target the Shu point on the foot Shaoyang channel, where channel Qi gathers.

When only the Shaoyang pulse is prominent, the Qi of one Yang is excessive. One Yang refers to Shaoyang, and “excess” means an overabundance. Because Shaoyang Qi is excessive, the pulse suddenly becomes large.

When the pulse of the Taiyin channel is abnormal, observe it carefully to determine whether it is a true organ pulse, an abnormal pulse that appears when the Qi of the Five Viscera is failing. If the Taiyin pulse is hidden yet throbbing, examine it closely. If it is indeed a true organ pulse, treatment should be avoided.

The pulse Qi of all Five Viscera appears deficient, and Stomach Qi is also out of harmony. This is a problem of the Three Yin. Among the Three Yin, Taiyin is the Spleen channel. Deficiency in the pulse Qi of the Five Viscera and disharmony in Stomach Qi may also result from excessive Taiyin Qi. Treatment should target the lower Shu points, supplement Yang, and drain Yin, because Yin Qi is excessive.

A ringing sound like a whistle in just one part of the ear is caused by rebellious Qi in Shaoyang. “Whistling” refers to a sound in the ear like a blown whistle. The Gallbladder and Triple Burner channels both pass through the ear; when Qi rebels upward, the ear rings.

The Corrected Edition notes: The preceding passage mentions the Three Yang, while this one mentions the Three Yin. Here it speaks of Shaoyang but does not mention Shaoyin, so “one Yang” may be a copying error for “two Yin.” On checking the Quan Yuanqi edition, this passage reads “Shaoyin counterflow,” which shows that it must refer to the second Yin.

Yang Qi gathers together in the upper body, and the four pulses strain against one another; the Qi then returns to the Kidneys. “Four pulses” refers to the pulses of the Heart, Spleen, Liver, and Lungs. Yang Qi gathers in the upper body because Kidney Qi is deficient, so the Qi returns to the Kidneys. Treatment should address the channels and collaterals, drain Yang, and supplement Yin. Once Yin Qi is sufficient, Yang Qi will no longer gather in the upper body.

The arrival of the Qi of one Yin falls within the scope of treatment for the Jueyin channel. If genuine Qi is weak and there is pain in the Heart region, counterflow Qi may lodge within and press inward, causing white sweat to appear. Regulate the diet, use medicines, and treat the lower Shu points. Some editions read “two Yin” instead of “one Yin,” perhaps because of a copying error: the preceding passage says that when two Yin arrive, Shaoyin should be treated, while the following passage says to treat Jueyin, which would correspond to the arrival of one Yin. However, the ancient books known as the Three Mounds have circulated for a long time and have rarely been studied in later periods, so their texts contain many copying errors. The term “yuan” is read as “yuan” and refers to pain in the joints.

The Yellow Emperor asked, “What is the pulse of Taiyang like?” Qibo replied, “It resembles the Three Yang; the pulse is floating.” The Yellow Emperor then asked, “What is the pulse of Shaoyang like?” Qibo replied, “It resembles one Yang. The pulse of one Yang is slippery but not full.” The Yellow Emperor asked again, “What is the pulse of Yangming like?” Qibo replied, “The pulse is large and floating.”

The Corrected Edition notes that both the Taisu and Quan Yuanqi editions read, “It is large and floating, like the pulse of the Heart.”

The Taiyin zang pulse beats forcefully; when pressed it feels like a hidden drum. The “er yin” pulse beats deeply and does not float on the surface.

This is the pulse condition referred to earlier as “ming qian du zhi.” The Xin Jiaozheng says, “On careful examination of the preceding text, it seems that some words have been omitted.”

Here it writes “er yin” but not “yi yin,” so one can know that the original text has a lacuna.

Chapter on the Method of Zang Qi According to the Seasons (Zangqi Fashi Lun)

The Yellow Emperor asked: “How should one combine the human form with the four seasons and the Five Phases and treat accordingly? What counts as compliance and what as violation? I wish to understand the principles of gain and loss in this.”

Qibo replied: “The Five Phases are metal, wood, water, fire, and earth. The qi of the Five Phases sometimes flourishes and sometimes declines. By understanding these changes, one can judge life and death, decide success and failure, and determine the seasons when the qi of the five zang becomes aggravated or remits, as well as the time limits of life and death.”

The Yellow Emperor said: “I wish to hear this in detail.”

Qibo said: “The liver governs spring and corresponds to wood.

The foot Jueyin liver channel and the foot Shaoyang gallbladder channel jointly govern treatment. Jueyin is the liver vessel; Shaoyang is the gallbladder vessel. The liver and gallbladder are paired, so the treatment principles of the two channels are the same.

The day stems corresponding to the liver are jia and yi. Jia and yi belong to wood and are the heavenly stems of the east.

When liver qi is not free, urgently use sweet-flavored medicinals to harmonize and relax it. The sweet flavor is mild and moderating. The Xin Jiaozheng says: according to Quan Yuanqi’s edition, the original text reads “gan ku ji” (the liver suffers from urgency); this means liver qi is in excess.

The heart governs summer and corresponds to fire.

The hand Shaoyin heart channel and the hand Taiyang small intestine channel jointly govern treatment. Shaoyin is the heart vessel; Taiyang is the small intestine vessel. The heart and small intestine are paired, so the treatment principles of the two channels are the same.

The day stems corresponding to the heart are bing and ding. Bing and ding belong to fire and are the heavenly stems of the south.

When heart qi scatters, urgently use sour-flavored medicinals to astringe it. The sour flavor has an astringent action. The Xin Jiaozheng says: according to Quan Yuanqi’s edition, the original text reads “xin ku huan” (the heart suffers from slackness); this means heart qi is insufficient.

The spleen governs long summer (changxia). Long summer refers to the sixth month. Summer belongs to fire; earth is engendered by fire. Earth qi grows in the middle and at this time presides over transformation and transport, so it is called “long summer.” The Xin Jiaozheng says: according to Quan Yuanqi’s edition, the spleen flourishes in the four seasons and in the sixth month. The sixth month is within the time of fire’s flourishing; it can also be said that the spleen governs the center, the sixth month is the middle of the twelve months and also half of the year, and therefore it is said that the spleen flourishes in the sixth month.

The foot Taiyin spleen channel and the foot Yangming stomach channel jointly govern treatment. Taiyin is the spleen vessel; Yangming is the stomach vessel. The spleen and stomach are paired, so the treatment principles of the two channels are the same.

The day stems corresponding to the spleen are wu and ji. Wu and ji belong to earth and are the heavenly stems of the center.

When the spleen is encumbered by dampness, urgently use bitter-flavored medicinals to dry it. The bitter flavor has a drying action.

The lungs govern autumn and correspond to metal.

The hand Taiyin lung channel and the hand Yangming large intestine channel jointly govern treatment…”

Greater Yin is the system associated with the Lung and Large Intestine channels. The Lung and Large Intestine are paired, so the two channels govern treatment together. Their corresponding Heavenly Stems are Geng and Xin; Geng and Xin belong to Metal and are the Heavenly Stems of the west.

The Lung is most vulnerable to Qi rising counter to its natural direction, so bitter flavors should be used in time to drain and direct it downward. Bitter flavors promote discharge, so they can be used to regulate the Lung. The New Collation quotes Quan Yuanqi as saying that when Lung Qi rises counter to its natural direction, it indicates that Lung Qi is excessive.

The Kidney governs winter and corresponds to Water. The Foot Shaoyin Kidney channel and the Foot Taiyang Bladder channel govern treatment; the Kidney and Bladder are paired, so the two channels govern treatment together. Their corresponding Heavenly Stems are Ren and Gui; Ren and Gui belong to Water and are the Heavenly Stems of the north.

The Kidney is vulnerable to dryness, so pungent flavors should be used in time to moisten and nourish it. This opens the skin’s interstices—the skin’s texture and sweat pores—so fluids can circulate and the movement of Qi can flow freely. Pungent flavors help fluids moisten the body. Once the interstices are open and fluids can circulate, Lung Qi can move downward. The Kidney and Lung communicate with one another, so this is said to allow the movement of Qi to flow freely.

Liver disease improves in summer because, within the relationships of generation and control among the Five Phases, summer Fire restrains the “ghost Qi” of Liver Wood—that is, the force that overcomes Liver Wood. The improvement of disorders in other organs can be understood in the same way. If the condition does not improve in summer, it worsens in autumn, when Metal Qi is dominant and can overcome Liver Wood. If it does not worsen in autumn and remains stable into winter, this is because Metal Qi declines in autumn, while Water Qi in winter can nourish Liver Wood. Thus the disease Qi is sustained during the season associated with the organ’s parent. The same reasoning applies to the other organs. If the disease breaks out in spring, it is because Liver Wood has returned to its season of dominance. Disorders of the other organs can likewise be understood in terms of the seasons they govern.

Liver disease calls for avoiding wind, because wind Qi is connected with the Liver; the body should therefore not be exposed to pathogenic wind.

Liver disease improves on Bing and Ding days, since Bing and Ding correspond to summer. If it has not improved by those days, it worsens on Geng and Xin days, which correspond to autumn. If it does not worsen on Geng and Xin days and remains stable through Ren and Gui days, these correspond to winter. It may then break out again on Jia and Yi days, when the Wood Qi of spring is dominant.

People with Liver disease feel clearheaded and less ill in the early morning, grow worse in the evening, and are more settled around midnight. Wood Qi is strong in the early morning, so the mind feels clear. Metal Qi is strong in the evening; Metal overcomes Wood, so the condition worsens. Water Qi is strong around midnight, and Water generates Wood, so the illness settles and eases. Other organs also have times when their disorders are milder or worse, though the times when they settle differ somewhat.

Liver Qi needs to spread and unfold, so pungent flavors should be used in time to help it disperse. Liver Qi is naturally meant to unfold, so pungent flavors are used to disperse the movement of Qi. The Treatise on the Correspondence of Yin and Yang says, “Pungent and sweet flavors disperse and belong to Yang.” The Treatise on the Appearance of the Normal Person’s Qi says, “The true Qi of the organs disperses in the Liver,” likewise describing the Liver’s true Qi as naturally having a tendency to spread and unfold.

Use pungent flavors to tonify the Liver and sour flavors to drain it. Pungent flavors disperse, so they are used to tonify the Liver; sour flavors astringe, so they are used to drain it.

The Quán Yuánqǐ recension records, “Use sour to supplement and benefit; use pungent to disperse and drain.” This is another formulation.

When the heart is diseased, the condition tends to improve in late summer. If it has not improved by then, it will worsen in winter, though this will not cause death. In spring, the illness will stabilize; in summer, it will flare up. This follows the same pattern as liver disease.

When suffering from heart disease, one should avoid warm and hot foods in one’s diet and daily routine, and should not dress too warmly. Excessive heat in the body can make the heart spirit restless, so it should be avoided.

Heart disease tends to improve on days of Wu and Ji, because Wu and Ji correspond to late summer. If it has not improved by then, the condition will worsen on days of Ren and Gui, because Ren and Gui correspond to winter. If the patient has not died by those days, the illness will stabilize on days of Jia and Yi, because Jia and Yi correspond to spring; on days of Bing and Ding, it will flare up, because Bing and Ding correspond to the fiery Qi of summer.

People with heart disease tend to feel better at noon, worsen at midnight, and be relatively calm at dawn. This, too, explains changes in the illness through the waxing and waning of the Five Phases’ Qi.

The heart prefers softness. In the diet, salty flavor may be used promptly to soften it, because the Qi stored in the heart favors softness, and salty flavor has a softening effect. The Treatise on the Appearance of a Healthy Person’s Qi says, “The true Qi of the organs communicates with the heart.” This means that the heart’s normal state often requires gentleness and ease. Use salty flavor to supplement and benefit; use sweet flavor to disperse and drain: salty flavor is valued for its softening quality, and sweet flavor for its soothing quality.

When the spleen is diseased, the condition tends to improve in autumn. If it has not improved by then, it will worsen in spring, though this will not cause death. In summer, the illness will stabilize; in late summer, it will flare up. Avoid warm and hot foods, overeating, living in damp places, and wearing wet clothes. Warmth, dampness, and overeating all damage the spleen’s Qi, so they should be avoided.

Spleen disease tends to improve on days of Geng and Xin, because Geng and Xin correspond to the Qi of autumn. If it has not improved by then, the condition will worsen on days of Jia and Yi, because Jia and Yi correspond to the Qi of spring. If the patient has not died by those days, the illness will stabilize on days of Bing and Ding, because Bing and Ding correspond to the Qi of summer; on days of Wu and Ji, it will flare up, because Wu and Ji correspond to late summer.

People with spleen disease tend to feel better around the time the sun has passed its zenith and begun to move westward, roughly in the afternoon, and worsen at sunrise. The revisers of the new edition point out that the Jiayi Jing gives “dawn” where the text has “sunrise.” In the account above, the time when Wood Qi is vigorous is consistently called “dawn,” not “sunrise.” Since sunrise varies with the seasons, occurring earlier or later in winter and summer, “dawn” may be more appropriate. In the later afternoon, the illness tends to be relatively calm.

When Earth Qi is vigorous, the patient feels clear and refreshed; when Wood Qi overcomes Earth, the condition worsens; when Metal Qi supports Earth, the illness becomes calmer and recedes. This, too, explains changes in the illness through the waxing and waning of the Five Phases. Some versions say that the illness stabilizes at noon in people with spleen disease; this is incorrect.

Changes in the course of diseases of the five zang organs all follow the patterns of the Five Phases: overcoming, generating, and the vigor of each organ’s own Qi. When the season overcomes the affected organ, the condition worsens; when it is the season generated by that organ, the illness improves; when it is the season that generates and supports that organ, the condition stabilizes; and when it is the season governed by that organ, the illness flares up. Thus, every organ disease has times when its symptoms ease or worsen, as well as moments when life and death may change.

When the Spleen is to remain relaxed and its transforming and transporting functions balanced, foods with a sweet flavor may be eaten in moderation to bring it into harmony. Sweetness is gentle in nature and helps accord with the Spleen’s quiet, balanced character. Bitter flavors drain the Spleen because of their firming and drying nature; sweet flavors tonify it because of their calming, gentle nature.

Lung diseases usually improve in winter. If they have not resolved by then, they worsen in summer. If summer does not bring a life-threatening crisis, the illness tends to stabilize in Long Summer, the transition between summer and autumn; in autumn, it may flare up or change. This pattern of illness is similar to that of Liver disease.

People with Lung disease should avoid exposure to cold, as well as cold foods and lightly worn clothing that leaves them chilled. The Lung is vulnerable to cold, so care should be taken to avoid it in both diet and clothing. The Ling Shu Jing (Spiritual Pivot) says that exposure to cold combined with drinking cold beverages damages the Lung. If cold beverages can harm it, cold foods have an even stronger effect. The Lung is vulnerable to heat as well as cold.

Lung disease tends to improve on Ren and Gui days, associated with Water and winter in the Five Phases (Wuxing). If it has not improved by those days, it worsens on Bing and Ding days, associated with Fire and summer. If the illness has not become critical by Bing and Ding days, it tends to stabilize on Wu and Ji days, associated with Earth and Long Summer. On Geng and Xin days, associated with Metal and autumn, the illness begins to change.

People with Lung disease often feel better around Shen time in the afternoon, known as the late afternoon period; their condition worsens at midday and is relatively calm around midnight. This is explained through the waxing and waning of the Five Phases: the illness improves when Metal is strong, is calm when Water is strong, and worsens when Fire is strong.

Sour flavors tonify the Lung, while pungent flavors drain it. Sourness is astringent, so it can tonify; pungency disperses, so it can drain.

Kidney diseases usually improve in spring. If they have not resolved by then, they worsen in Long Summer. If Long Summer does not bring a life-threatening crisis, the illness tends to stabilize in autumn; in winter, it may flare up or change. This pattern of illness is similar to that of Liver disease.

People with Kidney disease should avoid exposure to hot fumes such as cui and ai, as well as warm, hot, or grilled foods and excessively warm clothing. Here, cui and ai refer to oppressive heat. A note in the revised edition says that another version has cui instead. The Kidney is vulnerable to dryness, which is why these restrictions apply.

Kidney disease tends to improve on Jia and Yi days, associated with Wood and spring. If it has not improved by those days, it worsens on Wu and Ji days, associated with Earth and Long Summer. If the illness has not become critical by Wu and Ji days, it tends to stabilize on Geng and Xin days, associated with Metal and autumn. On Ren and Gui days, associated with Water and winter, the illness begins to change.

People with Kidney disease usually improve around midnight, worsen on days at the end of the four seasons, when Earth is strong, and are relatively calm around Shen time in the afternoon. This is explained through the waxing and waning of the Five Phases: the illness improves when Water is strong, worsens when Earth is strong, and is calm when Metal is strong.

Bitter flavors tonify the Kidney, while salty flavors drain it. Bitter flavors can firm, so they are used to tonify; salty flavors can soften, so they are used to drain. “Softening” here refers to damp Earth restraining Kidney Water, which is why salty flavors are used to drain it.

When pathogenic Qi enters the body, it affects the organs in accordance with the Five Phases’ cycle of mutual overcoming.

Demonic Qi refers to abnormal factors that cause illness. Wind, cold, summer heat, dampness, eating too little or too much, and excessive exertion or idleness can all become demonic Qi. It does not refer only to ghosts, poisons, epidemics, and the like.

When the illness reaches the season or stage associated with what generates the Liver, it will improve. When it reaches the season or stage that restrains the Liver, it will worsen. When it reaches the season or stage that supports the Liver, its course will stabilize. When it is in the season or stage governed by the Liver, the illness may flare up.

The pulse signs of the Five Zang organs must first be distinguished before one can determine when an illness will ease or worsen, and its likely outcome. The pulse signs are: the Liver pulse is wiry, the Heart pulse is hooked, the Lung pulse is floating, the Kidney pulse is nutritive, and the Spleen pulse is intermittent. Only by distinguishing the pulses in this way can one judge changes in the severity of an illness and whether it will be fatal. The Treatise on the Three Regions and Nine Indicators says, “One must first understand the channels before one can understand the pulses of illness.” This is the principle it describes.

A person with Liver disease has pain below both sides of the ribs, with pain extending into the lower abdomen, and is prone to anger. The Liver’s Jueyin channel ascends from the foot, encircles the genitals, reaches the lower abdomen, then passes upward through the Liver and diaphragm and spreads between the ribs. This is why pain occurs below both sides of the ribs and extends into the lower abdomen. When Liver Qi is excessive, a person is prone to anger. The Huangdi’s Inner Classic: Spiritual Pivot says, “When Liver Qi is excessive, one becomes angry.”

When Liver Qi is weak, the vision grows dim and objects become difficult to see; hearing also fails, and the person is prone to fear, as though someone were coming to seize them. The Liver’s Jueyin channel ascends from the ribs along the throat, enters the nasopharynx, and connects with the ocular network, the channels linked to the eyes. A branch of the Gallbladder’s Shaoyang channel enters the ear from behind, emerges, travels toward the front of the ear, and reaches the outer corner of the eye. Thus, disharmony in the Liver and Gallbladder channels can produce these symptoms. Here, “fear” means unease of the spirit and apprehension.

For treatment, select the channels of the Foot Jueyin Liver and Foot Shaoyang Gallbladder. Here, “channel” refers to the main channel: the illness is not in the connecting vessels, so the main channels are selected. The Jueyin channel is selected to regulate Liver Qi, and the Shaoyang channel to restore the flow of Qi when it counterflows upward. Therefore, the following passage says:

When Qi counterflows upward, it causes headache, deafness or impaired hearing, and swelling of the cheeks. The Liver’s Jueyin channel ascends from the ocular network, emerges at the forehead, and meets the Governing Vessel at the crown of the head; this is why headache occurs. A branch of the Gallbladder’s Shaoyang channel emerges from the ear and travels toward its front; another branch passes through the cheek and jaw. A branch of the Jueyin channel also descends from the ocular network and passes along the inside of the cheek. This is why deafness, impaired hearing, and swelling of the cheeks occur, and why the Shaoyang channel was also selected for treatment earlier.

When treating by bloodletting, if the blood in a channel is visibly abundant and the pulse differs from its usual state, this provides a basis for diagnosing counterflow of Qi. Compare the two sides, and needle to release blood on the side where the abnormality appears.

When the heart is diseased, there may be pain in the chest, fullness and distension in both sides of the rib cage, pain below the ribs, and pain in the chest, back, and between the shoulder blades. The inner sides of both arms may also hurt.

A branch of the Hand Shaoyin Heart Meridian runs outward along the chest and passes through the sides of the rib cage. The Hand Jueyin Pericardium Meridian begins in the chest, and one of its branches also runs outward along the chest through the sides of the rib cage. It descends to a point three inches below the armpit, then rises to the armpit. From there it travels down the inner upper arm, enters the elbow between the Hand Taiyin Lung Meridian and the Hand Shaoyin Heart Meridian, and continues down the forearm between the two tendons.

The direct pathway of the Hand Shaoyin Heart Meridian turns upward from the heart network—the vessels connecting to the heart—passes through the lungs, and emerges below the armpit. It then descends along the back edge of the inner upper arm, passes behind the Hand Taiyin Lung Meridian and the Hand Jueyin Pericardium Meridian at the inner elbow, and runs along the back edge of the inner forearm to the tip of the prominent bone on the little-finger side of the wrist. The Hand Taiyang Small Intestine Meridian passes around the shoulder blade and meets the meridian at the top of the shoulder. This is why disorders of these meridians produce the symptoms described above.

In deficiency, the chest and abdomen become distended, there is pain below the ribs, and the pain extends to the lower back.

The Hand Jueyin Pericardium Meridian emerges from the chest, connects with the pericardium, descends through the diaphragm, and links with the Triple Burner. One of its branches runs outward along the chest through the sides of the rib cage. The Hand Shaoyin Heart Meridian descends from the heart network through the diaphragm and links with the small intestine. These pathways account for the symptoms.

For treatment, select points on the Hand Shaoyin and Hand Taiyang Meridians. If there is bleeding beneath the tongue, the vessels beneath the tongue may also be punctured to let blood. The Hand Shaoyin Heart Meridian rises from the heart network and runs upward alongside the throat, so blood may be let from below the base of the tongue and from points along the meridian.

If the condition changes and vomiting occurs, bleed the Xi-Cleft point of the Hand Shaoyin Meridian, especially when the blood vessels at that point are engorged. The Xi-Cleft point of the Hand Shaoyin Heart Meridian lies in the pulse at the back of the palm, half an inch from the wrist, on the little-finger side.

When the spleen is diseased, the body feels heavy, hunger comes easily, the muscles become weak and withered, the feet cannot be drawn upward, walking may cause spasms, and the soles of the feet hurt.

The spleen corresponds to Earth and governs the muscles, so spleen disease makes the body feel heavy and the muscles weak and withered. “Withering” means weakness and loss of strength. The Foot Taiyin Spleen Meridian begins at the tip of the big toe, runs along its inner side, passes in front of the inner ankle, and then ascends along the inner side of the lower leg. The Foot Shaoyin Kidney Meridian begins beneath the little toe, runs obliquely toward the center of the sole, and ascends along the inner side of the lower leg, passing the inner side of the popliteal fossa. This explains why spleen disease may make it difficult to draw up the feet, cause spasms while walking, and bring pain in the soles. For treatment, points on the Foot Shaoyin Meridian may be selected.

The New Collation says that, according to the Jia Yi Jing, the original text should read, “hunger comes easily, and the muscles become weak and withered.” The Qian Jin Fang instead reads, “hunger comes easily, the feet become weak and withered, and cannot be drawn upward.” The original text of the following passage, “When Qi interacts and changes greatly…,” is incomplete.

The treatise says: The muscles and feet become weak and withered, making it impossible to contract them or walk; spasms may also occur. (“Chì” refers to symptoms involving spasms.)

When the Spleen is deficient, the abdomen becomes distended, the intestines rumble, and food is passed before it has been digested. The Foot Taiyin Spleen Channel, the Spleen’s channel, ascends along the front edge of the inner thigh, enters the abdomen, connects with the Spleen, and links to the Stomach. That is why illness of the Spleen Channel can produce these symptoms. The Ling Shu Jing says: “When the qi within the center is insufficient, the abdomen tends to become distended, and the intestines rumble.”

For treatment, select points on the Foot Taiyin Spleen Channel, Foot Yangming Stomach Channel, and Foot Shaoyin Kidney Channel, and bleed the corresponding areas. The Foot Shaoyin Kidney Channel is included because the spasms and pain in the soles mentioned earlier are also related to it. When Qi and blood are congested and abundant, bleeding can release and disperse them.

Lung illness may cause labored breathing, coughing, qi counterflow, and pain in the shoulders and back. A note by the New Textual Collation points out that the Qian Jin Fang reads “shoulder breathing and back pain.” There may also be sweating, along with pain in the buttocks, perineum, thighs, knees, groin, calves, lower legs, and feet. A note by the New Textual Collation points out that the Jia Yi Jing and Mai Jing have “spasms” after “knees,” meaning that the knees become cramped and contracted.

The Lung stores Qi and governs breathing. Its disorders often manifest as coughing, so Lung illness can cause labored breathing, coughing, and qi counterflow. The back corresponds externally to the chest, and the shoulders lie close to the chest, which is why they may hurt along with the back. The Lung nourishes the skin and body hair. When pathogenic qi is strong, the Heart’s fluids leak outward, causing sweating. The Foot Shaoyin Kidney Channel begins at the sole, ascends through the inner calf, the inner side of the hollow behind the knee, and the rear edge of the inner thigh, then passes through the spine, connects with the Kidney, and links to the Bladder. When the Lung is ill, the Kidney Channel may also be affected by pathogenic qi; this can cause pain in the buttocks, perineum, thighs, knees, groin, calves, lower legs, and feet. Treatment should therefore select points on the Foot Shaoyin Kidney Channel.

When the Lung is deficient, breathing becomes short and it is difficult to take the next breath smoothly; deafness and a dry throat may also occur. Because qi is deficient, inhalation cannot follow smoothly. The collateral of the Foot Taiyin Lung Channel converges in the ear, so illness of the Lung Channel may cause deafness. The Foot Shaoyin Kidney Channel ascends from the Kidney, passes through the Liver and diaphragm, enters the Lung, then travels up along the throat and runs beside the root of the tongue. When the Lung is deficient, Kidney qi is also insufficient and cannot moisten the throat above, so the throat becomes dry. For this reason, the Foot Shaoyin Kidney Channel is also included in the treatment below.

For treatment, select the blood vessels associated with the Foot Taiyin Lung Channel, the outer side of the Foot Taiyang Bladder Channel, and the inner side of the Foot Jueyin Liver Channel. “Outside the Foot Taiyang and inside the Jueyin” refers to the area that runs upward in a straight line along the inner calf, behind the inner ankle—in other words, the course of the Foot Shaoyin Kidney Channel. Examine the Foot Shaoyin channel areas on both feet. If any blood vessels appear engorged or differ in color or condition from the surrounding area, promptly needle them to release blood.

People with kidney disease develop abdominal distension and swelling in the lower legs. The Jia Yi Jing says that swelling in the lower legs may also be painful.

The Shaoyin channel of the kidney rises from the foot, travels along the back of the lower leg, passes near the pubic bone, then ascends through the abdomen and enters the lung. This is why kidney disease can cause abdominal distension, swelling in the lower legs, and panting with coughing. When the kidneys are diseased, the bones cannot properly support the body, so the person feels heavy. Kidney pathogenic influence affects the lung, weakening Qi in the heart; the heart’s fluids then become sweat, which is why sweating occurs during sleep. As the lower legs are already swollen and sweat continues to be lost, Yin Qi stagnates in the interstices of the skin while Yang Qi scorches the upper burner. Heat therefore builds up inside, while the body surface feels cold, making the person especially afraid of wind. Here, “loathing wind” means deeply disliking and fearing it.

When the kidneys are deficient, there may be pain in the chest, upper and lower abdomen, cold limbs, and Qi counterflow, along with a troubled mood. The Shaoyin channel emerges from the lung, connects with the heart, and then reaches the chest. When kidney Qi is deficient, the heart loses its restraint, and heart Qi disturbs the lung, causing pain to gather in the chest. The Foot Taiyang channel runs down from the neck to the feet. When the kidneys are deficient, Taiyang Qi cannot circulate fully to the feet, so the feet become cold and the breath moves upward in counterflow. “Clear” refers to breath that is cold; “counterflow” means that the breath moves upward against its normal course. Because the breath is cold and rises in counterflow, the upper and lower abdomen may hurt. When the kidney’s will is deficient, the spirit becomes easily restless and unsettled, so the person feels unhappy. The Jia Yi Jing gives “large intestine and small intestine” where the text has “upper and lower abdomen.”

For treatment, needle and bleed places of blood stasis along the Shaoyin and Taiyang channels. The principle of needling is to tonify deficiency and drain excess. When neither excess nor deficiency predominates, treat according to the condition of the channels; this is called following the way of needling. If there is stagnant blood in the channels and it is released by needling, this is called following the rules of treatment. One should also first examine the body and assess the state of Qi, removing the stagnant blood before regulating any excess or deficiency of Qi. The Treatise on the Three Regions and Nine Indicators likewise says to first assess whether the body is stout or thin in order to judge whether Qi is deficient or excessive: drain excess and tonify deficiency, first clearing stagnant blood from the vessels and then regulating the condition. This is the principle being described.

The liver corresponds to the color green and should be nourished with sweet-tasting foods, such as polished rice, beef, dates, and mallow. The liver’s nature tends toward tension, so sweet foods are used for their relaxing effect. The New Critical Edition notes that the passage beginning “The liver’s color is green” and continuing to the end of this section originally appeared in the sixth fascicle of the Quan Yuanqi edition; Wang later moved it here.

The heart corresponds to the color red and should be nourished with sour-tasting foods, such as beans. The Jia Yi Jing and the Taisu record “hemp” instead of “beans.” Dog meat, plums, and chives are also sour in flavor.

The heart is associated with Wood, and its nature tends toward ease and relaxation. Sour foods are therefore appropriate, for their astringent effect.

The lung is associated with the color white, and bitter foods are appropriate, such as bitter wheat, mutton, apricots, and xie, a vegetable similar to scallion bulbs. All of these are classified as bitter. Lung Qi tends to rise in rebellion, so bitter foods are suitable for their ability to disperse and promote free flow.

The spleen is associated with the color yellow, and salty foods are appropriate, such as soybeans, pork, chestnuts, and huo, a vegetable of the bean-leaf type. All of these are classified as salty. A close look at these dietary recommendations and prohibitions reveals the principles behind regulating the organs and joints and keeping the movement of Qi unobstructed. The kidneys serve as the stomach’s gateway, and the spleen is paired with the stomach. Salty flavors are therefore used to soften the gateway and allow it to open freely. Once the gateway is unobstructed, stomach Qi can move; when stomach Qi moves, spleen Qi can transform and transport. This is why the flavor suited to the spleen differs from those suited to the other organs.

The Xin Jiao Zheng says: “The preceding passage explains that when Liver Qi is tense, one should promptly eat sweet foods to relax it; when Heart Qi is slack, one should promptly eat sour foods to astringe it; when the spleen is constrained by dampness, one should promptly eat bitter foods to dry the dampness; when Lung Qi rises in rebellion, one should promptly eat bitter foods to promote free flow; and when the kidneys are affected by dryness, one should promptly eat pungent foods to moisten them. The flavors suited to the liver, heart, lungs, and kidneys all accord with the preceding passage. Only the spleen is said to benefit from salty rather than bitter flavors, so Wang Bing added a special note to explain the reasoning.”

The kidneys are associated with the color black, and pungent foods are appropriate, such as yellow millet, chicken, peaches, and scallions. All of these are classified as pungent. The kidneys tend toward dryness, so pungent foods are suitable for their ability to moisten and generate fluids.

Pungent flavors disperse, sour flavors astringe, sweet flavors relax, bitter flavors strengthen and dry, and salty flavors soften. These are all effects of the natural Qi. Yet the effects of pungent and bitter flavors are not limited to dispersing or strengthening and drying: pungent flavors can also moisten, while bitter flavors can dry dampness and promote free flow. The preceding passage says to eat bitter foods when the spleen is constrained by dampness, in order to dry the dampness, and when Lung Qi rises in rebellion, in order to promote free flow; these statements refer to bitter flavors’ ability to dry dampness and promote free flow. It also says to eat pungent foods when the kidneys are affected by dryness, in order to moisten them; this refers to the moistening effect of pungent flavors. Here, “ruan” is read as “soft.”

“Medicines with toxic properties attack pathogenic influences”: Medicines include minerals and metals, earth and stone, plants and trees, vegetables and fruits, insects and fish, birds and animals, and other categories. All can be used to dispel pathogenic influences and support healthy Qi. Because medicines can drive out pathogenic influences and restore order, ancient books collectively called them “medicines with toxic properties.” The Xin Jiao Zheng quotes the Ben Cao, which says that lower-grade medicines serve as adjuncts in treating illness. Many of these substances are toxic and should not be taken for long periods. They are chiefly used to expel pathogenic influences of cold and heat, disperse accumulations, and treat disease; hence the phrase “medicines with toxic properties attack pathogenic influences.”

“Five grains nourish” refers to non-glutinous rice, small beans, wheat, soybeans, and yellow millet.

“Five fruits assist” refers to peaches, plums, apricots, chestnuts, and dates.

The five domestic animals—oxen, sheep, pigs, dogs, and chickens—can strengthen the body; the five vegetables—mallow, bean leaves, Chinese chives, scallions, and garlic chives—can nourish it.

According to the “Treatise on the Five Regularities of Governance,” when treating illness with highly toxic medicines, stop once six-tenths of the illness has been removed; with ordinarily toxic medicines, stop at seven-tenths; with mildly toxic medicines, at eight-tenths; and with non-toxic medicines, at nine-tenths. The remainder should be cleared through dietary nourishment with grains, meat, fruit, and vegetables. Do not eat to excess, lest the body’s righteous Qi be harmed.

When the Qi and flavors of foods are brought into balance before eating, they can replenish and nourish Jing and Qi. Here, “Qi” refers to qualities such as warmth and dispersing action in food; “flavor” belongs to Yin and refers to a food’s taste and nourishing effects. When Qi and flavor are balanced, they can replenish Jing and Qi. The “Treatise on the Manifestations of Yin and Yang” says that Yang is expressed as Qi, while Yin is expressed as flavor; flavor returns to the body, the body depends on Qi, Qi returns to Jing, and Jing in turn gives rise to transformation. Jing must be nourished by Qi, while the body must be nourished by flavor. It also says that when the body is deficient, it should be warmed and nourished with Qi; when Jing is deficient, it should be replenished with flavor. This is the principle behind “replenishing Jing and benefiting Qi.”

The “Newly Collated Commentary” quotes Sun Simiao as saying: Jing is nourished by the Qi of food, and Qi in turn nourishes Jing, bringing radiance to the complexion and body. The body is nourished by the flavor of food; flavor nourishes the body and gives a person strength. Jing responds to the Five Qi and gives rise to awareness. If the qualities of the foods one eats conflict, they will harm Jing. The body is formed through nourishment from food, and if the flavors of one’s diet are not balanced, they will harm the body as well. Therefore, the sages first set out dietary prohibitions to preserve the root of life, then used medicines to protect life. To warm and nourish the body with Qi and flavor, and to preserve Jing and Qi, means to consume foods whose Qi and flavors have been balanced, thereby replenishing Jing and benefiting Qi.

The five categories of food each have the five flavors—pungent, sour, sweet, bitter, and salty—and each flavor suits different needs. Some can disperse, others astringe; some can harmonize, others drain; some can firm, while others soften. The appropriate flavor should be chosen according to the changes of the four seasons, the condition of the five zang organs, and the illness.

When using the five flavors to regulate the five zang organs, sweet flavor is paired with the liver, sour with the heart, salty with the spleen, bitter with the lungs, and pungent with the kidneys. These pairings are chosen according to the needs of regulation: to harmonize, astringe, soften, drain, disperse, or firm, one selects the corresponding flavor. This describes the regulatory effects of the five flavors individually; the pairings are not based on the relationships of mutual generation and nourishment among the Five Phases.