《黃帝內經素問補註釋文》Vol. 4

The Yellow Emperor asked, “Heaven has eight winds, and the meridians have five kinds of illness caused by wind pathogens. What does this mean?”

Qibo replied, “The eight winds—winds coming from the eight directions, also referring to external pathogens that may cause illness—can give rise to pathogenic Qi. When pathogenic Qi enters the meridians, the channels through which protective Qi, nutritive Qi, and blood circulate, it then travels along them and invades the Five Viscera, disturbing the body’s healthy Qi and causing illness.

The phrase ‘the seasons overcome one another’ refers to spring overcoming late summer, late summer overcoming winter, winter overcoming summer, summer overcoming autumn, and autumn overcoming spring. Here, ‘overcome’ means to restrain or regulate. Spring corresponds to Wood, summer to Fire, late summer to Earth, autumn to Metal, and winter to Water. These seasons restrain one another according to the relationships among the Five Phases. This describes how the five seasons overcome one another; it does not mean that after the eight winds invade the body, illness must follow this sequence. Rather, illness is more likely when the body’s Qi is weak during a corresponding season and cannot resist.

Winds from the east arise in spring and are likely to affect the Liver; the corresponding site of illness is the neck. Spring Qi makes all things grow and rise, so the neck corresponds to it. The Records of Seasonal Taboos says, ‘On Jia and Yi days, do not treat the neck,’ referring to this kind of theory.

Winds from the south arise in summer and are likely to affect the Heart; the corresponding site of illness is the chest and flanks. The Heart’s Shaoyin meridian runs through the chest and extends toward the flanks, so the chest and flanks correspond to the Heart.

Winds from the west arise in autumn and are likely to affect the Lungs; the corresponding site of illness is the shoulders and back. The Lungs are located in the upper burner, and the back corresponds to the chest. The shoulders and back are also connected, so they correspond to the Lungs.

Winds from the north arise in winter and are likely to affect the Kidneys; the corresponding sites of illness are the lower back and thighs. The lower back corresponds to the Kidneys, while the thighs join the lower back and share its flow of Qi, so both are mentioned.

The center belongs to Earth and is likely to affect the Spleen; the corresponding site of illness is the spine. The spine corresponds to central Earth; this passage emphasizes that the Spleen resides in the center.

Thus, when the Qi of spring—here referring to Liver Qi—is out of balance, illness is likely to appear in the head. Summer Qi corresponds to the Heart, so illness is likely to appear in the internal organs. Autumn Qi corresponds to the Lungs, so illness is likely to appear in the shoulders and back. Winter Qi corresponds to the Kidneys, so illness is likely to appear in the limbs.

Qi (vital energy) is weaker in the limbs, so they are easily harmed by cold pathogens. Wherever a pathogen enters the body, illness arises in that part.

Thus, nasal congestion, runny nose, nosebleeds, and similar illnesses are common in spring, because the Qi of this season tends to gather in the head. The Book of Rites: Monthly Ordinances says that if the ordinances of summer are carried out in the last month of autumn, people are likely to suffer from nasal congestion and sneezing.

Illnesses of the chest and flanks are common in midsummer, because the Heart channel passes through these areas.

In late summer, people are prone to unremitting diarrhea and internal cold, an illness caused by cold pathogens invading the abdomen. Earth Qi governs the body’s middle, which is like a storehouse for food and drink. The residue left after food and drink are transformed passes through this area, so unremitting diarrhea and internal cold can easily occur.

In autumn, people are prone to wind malaria, a form of malaria caused by wind pathogens. This illness arises when cool Qi damages summer heat. The Treatise on the Qi of Life and Its Connection with Heaven says that if pathogens remain after sweating, weakening the body and damaging its righteous Qi, and the acupoints along the channels become obstructed, wind malaria will occur. This describes the effects of cool Qi damaging summer heat. The Book of Rites: Monthly Ordinances also says that if the ordinances of summer are carried out in the first month of autumn, people are likely to contract malaria.

In winter, people are prone to Bi Jue, numbness, pain, or coldness in the limbs. The flow of Blood is like water: in the cold, it easily congeals and stagnates. When Qi and Blood do not circulate freely, Bi Jue occurs.

Therefore, avoid massage and daoyin exercises in winter, and you will be less likely to suffer from nasal congestion, runny nose, and nosebleeds in spring. An means massage; qiao means moving the hands and feet nimbly, like an agile person, and refers to exercises such as daoyin. Disturbing the sinews and bones prevents Yang Qi from being stored within. When Yang Qi rises in spring, its heat steams the Lungs. The Lungs connect with the nose, so illness in the Lungs manifests as nasal ailments. Thus, avoiding massage and daoyin in winter helps prevent nasal congestion, runny nose, and nosebleeds in spring. Qiu means clear fluid flowing from the nose; nü means bleeding from the nose.

Avoiding illnesses of the neck in spring; illnesses of the chest and flanks in midsummer; unremitting diarrhea and internal cold in late summer; wind malaria in autumn; and Bi Jue, as well as undigested food passing in the stool accompanied by sweating, in winter—all of these are linked to avoiding massage and daoyin in winter. The New Textual Collation considers the six characters meaning “undigested food passing in the stool accompanied by sweating” to be a possible later interpolation.

Jing (essence) is the foundation of life. Therefore, those who know how to preserve Jing Qi will not suffer from warm diseases in spring. This means that when massage and daoyin are avoided in winter, Jing Qi can be stored within. Yang Qi does not rise recklessly, and warm disease does not occur in spring.

If, during the summer heat, sweat cannot flow out normally, wind malaria may develop in autumn. This describes a situation in which cool wind Qi obstructs summer heat and prevents sweat from being released. The New Textual Collation points out that this passage does not connect smoothly with the one above.

This explains the pulse patterns of ordinary people—that is, how to identify illness by examining the pulse of a person in general health.

Thus, Yin contains Yin, and Yang contains Yang. This refers to how Yin-Yang changes in its initial and flourishing stages.

From dawn until noon is the yang within the Heaven’s Yang Qi; from noon until dusk is the yin within the Heaven’s Yang Qi. Yang Qi is at its strongest at noon, so this is called “yang within yang.” As yin Qi gradually grows stronger at dusk, this is called “yin within yang.” Yang Qi governs the daytime, so the period from dawn until dusk belongs to the yang of Heaven, though it contains both yang and yin.

From the middle of the night until the cock crows is the yin within the Heaven’s Yin Qi; from the cock’s crow until dawn is the yang within the Heaven’s Yin Qi. At cockcrow, yang Qi has not yet risen, so this is “yin within yin.” By dawn, yang Qi has risen, so this is “yang within yin.”

The human body also corresponds to these changes in yin and yang. In the human body, the exterior belongs to yang and the interior to yin. As for the front and back, the back belongs to yang and the abdomen to yin. Within the organs, the Five Zang organs belong to yin and the Six Fu organs to yang. “Zang” refers to the five spirit-housing organs, and “fu” to the six transformation organs—that is, the Five Zang and Six Fu.

The liver, heart, spleen, lungs, and kidneys—the Five Zang—belong to yin. The gallbladder, stomach, large intestine, small intestine, urinary bladder, and Triple Burner belong to yang.

The Ling Shu Jing says that the Triple Burner above is paired with the Hand Jueyin Pericardium channel. It also says that the Foot Triple Burner is another name for the Taiyang channel. The Zhengli Lun says that the Triple Burner has a name but no fixed form. Above, it is paired with the Hand Jueyin Pericardium; below, with the right kidney. It governs the pathways through which Qi circulates and serves as a messenger conveying the various kinds of Qi.

Why distinguish “yin within yin” from “yang within yang”? Because illnesses in winter tend to occur in the yin aspect, those in summer in the yang aspect, those in spring in the yin aspect, and those in autumn in the yang aspect. Physicians must determine where an illness is located and treat it with acupuncture or stone needling, an ancient method of stimulating the body with stone needles and similar tools.

The back belongs to yang, and the heart is the yang within yang. The heart is a yang organ and is located in the Upper Burner, the upper part of the chest. As a yang organ situated in a yang region, it is called “yang within yang.” The Ling Shu Jing calls the heart a “male organ”; “male” here means yang.

The back belongs to yang, and the lungs are the yin within yang. The lungs are a yin organ and are located in the Upper Burner. As a yin organ situated in a yang region, they are called “yin within yang.” The Ling Shu Jing calls the lungs a “female organ”; “female” here means yin.

The abdomen belongs to yin, and the kidneys are the yin within yin. The kidneys are yin organs and are located in the Lower Burner, the lower part of the abdomen. As yin organs situated in a yin region, they are called “yin within yin.” The Ling Shu Jing calls the kidneys “female organs,” meaning yin.

The abdomen belongs to yin, and the liver is the yang within yin.

The liver belongs to the Yang organs and is located in the Middle Burner, the area between the chest and abdomen. As a Yang organ situated in a Yin position, it is called “Yang within Yin.” The Jing of the Numinous Pivot (Lingshu Jing) says that the liver is a “male organ” (“male” here refers to Yang).

The abdomen belongs to Yin. Among the Yin organs, the spleen is the most Yin in nature, so it is called “the most Yin within Yin.”

The spleen belongs to the Yin organs and is located in the Middle Burner. As a Great Yin organ situated in a Yin position, it is called “the most Yin within Yin.” The Jing of the Numinous Pivot says that the spleen is a “female organ” (“female” here refers to Yin).

These statements describe how Yin and Yang, exterior and interior, inner and outer, and female and male correspond to and resonate with one another. They are therefore used to relate the body to changes in Yin and Yang in the heavens. The body’s Qi and form correspond and harmonize with Heaven and Earth, enabling them to correspond upward with celestial phenomena.

The Yellow Emperor asked: “Do the Five Viscera correspond to the four seasons, each receiving and responding to particular influences?”

Qibo replied: “Yes. The East corresponds to the color green and is connected with the liver. The liver’s opening is the eyes, and its vital essence is stored in the liver. Here, ‘essence’ means vital essence. The vital essence of Wood is stored in the liver, and its spirit is called the Hun. The East is the direction in which Yang Qi rises, and the liver functions through the eyes, so its opening is the eyes.

“When liver disease arises, it may bring on fear and alarm. This is because the image of Wood bends and extends, and moves unsteadily.”

The Newly Corrected Edition notes that the Eastern entry includes “disease brings on fear and alarm,” while the other directions have no corresponding statement. Since the Treatise on the Five Regular Phases in the Plain Questions says, “In the period of deficient harmony, its manifestation is fear and alarm,” the editors suspect this sentence was added by mistake.

The flavor associated with the liver is sour, and its category is plants and trees. Their nature is pliant and fragile: they can bend and extend.

The animal associated with the liver is the chicken. The chicken is chosen as the corresponding domestic animal based on the symbolic meaning of the Xun trigram in the Book of Changes, which says, “Xun is the chicken.”

The grain associated with the liver is wheat. Wheat is among the Five Grains to ripen earliest, so it is paired with the East. The Materia Medica says, “Wheat is the foremost of the Five Grains.” The Newly Corrected Edition points out that the Treatise on the Five Regular Phases records “its domestic animal is the dog, and its grain is hemp,” which differs from the account here.

The liver corresponds to the seasons and, in the heavens, to the Year Star, Jupiter. The vital essence of Wood rises to become the Year Star, which completes one circuit of the heavens in twelve years.

Thus, Spring Qi is in the head. In spring, all things sprout upward and flourish, so Spring Qi corresponds to the head. The Newly Corrected Edition notes that the Eastern entry says “Spring Qi is in the head” but does not say “therefore disease is in the head.” The other directions state “therefore disease is in” a particular place, but do not say “Qi is in” a particular place. The statements complement one another.

The sound associated with the liver is the Jue tone, one of the Five Tones, corresponding to Wood.

Jue is the tone belonging to Wood. In the first month of spring, the pitch pipe corresponds to Taicu. Taicu is generated by Linzhong; according to the three-part division and subtraction method, its pitch pipe is about eight inches long. In the second month of spring, the pitch pipe corresponds to Jiazhong. Jiazhong is generated by Yize; calculated by the same method, its pitch pipe is about seven inches and five tenths long.

The Newly Corrected Edition quotes Zheng Kangcheng: “Seven inches, two thousand one hundred and eight…” The original text ends here unfinished, and the remainder is missing.

In the last month of spring, the pitch standard Guxi is paired with Nanlü, another of the ancient twelve pitch standards. Nanlü is derived from Guxi by the method of increasing by one third; its pipe is seven and one tenth inches long. The New Correction cites Zheng Xuan as saying that the pipe should be seven and one ninth inches long. All three of these pitch pipes correspond to the Qi of Wood.

The generating number of Wood is three, and its completing number is eight. The Book of Documents, in the “Great Plan” chapter, says, “The third is Wood.” From this we can know that when an illness corresponds to the Qi of Wood, its location is in the sinews. The firm and yielding qualities of Wood resemble the condition of the sinews. The odor corresponding to the Qi of Wood is rank; any odor formed through changes in the Qi of Wood is called rank. The New Correction notes that the Monthly Ordinances writes this as “muttony.”

The south belongs to the color red and is connected with the heart. The heart’s opening is linked to the ears, and its vital essence is stored in the heart. The spirit of Fire’s vital essence is Shen (spirit). The tongue is the organ governed by the heart, so in principle one might say that the heart opens through the tongue. But the tongue’s function is not classified as an “opening,” so the text speaks of the ears. The Treatise on Piercing the Collaterals says that the collateral vessel of the Hand Shaoyin channel converges in the ears; this is the basis for the statement here.

Thus, illness appears in the five viscera because summer Qi corresponds to the viscera. The flavor corresponding to the heart is bitter, and its category is Fire. Fire rises and can burn and scorch. The animal corresponding to Fire is the sheep. The text calls the sheep “livestock” because the sheep is associated with Wei, the earthly branch that belongs to Earth. Since Earth and Fire are both flourishing, the sheep is mentioned as well. The New Correction cites the Treatise on the Five Constant Modes of Governance, which says that the animal corresponding to Fire is the horse and the grain is millet. Millet is red in color.

The Qi of Fire corresponds above to the planet Yinghuo, or Mars. The vital essence of Fire rises and corresponds to Yinghuo, which completes one circuit of the heavens in 740 days. From this we can know that when an illness corresponds to the Qi of Fire, its location is in the vessels. The agitated nature of Fire resembles the Qi of the vessels.

The sound corresponding to Fire is zhi, one of the five notes. In the first month of summer, the pitch standard is Zhonglü. Zhonglü is derived from Wushe by the method of increasing by one third; its pipe is six and one seventh inches long. The New Correction cites Zheng Xuan as saying that the pipe should be six and one twelve-thousand-nine-hundred-seventy-four-thousandths inches long.

In the middle month of summer, the pitch standard is Ruibin. Ruibin is derived from Yingzhong by the method of increasing by one third; its pipe is six and one third inches long. The New Correction cites Zheng Xuan as saying that the pipe should be six and twenty-six eighty-firsts inches long.

In the last month of summer, the pitch standard is Linzhong. Linzhong is derived from Huangzhong by the method of decreasing by one third; its pipe is six inches long. All three of these pitch pipes correspond to the Qi of Fire, whose completing number is seven.

Fire’s generating number is two, and its completing number is seven. The Book of Documents: Great Plan (Shangshu, Hongfan) says, “Second is Fire.” The flavor associated with Fire is scorched: when Qi is transformed by Fire, it becomes scorched in flavor.

The center corresponds to the color yellow and is linked in the human body with the spleen. The spleen opens into the mouth, and its essence and Qi are stored in the spleen. The spirit formed from the essence and Qi of Earth is called Yi (intention). The spleen transforms and transports grain, while the mouth receives food and drink; this is why the spleen is said to open into the mouth.

Accordingly, related illnesses appear at the root of the tongue. The spleen’s channel connects upward to the tongue root, where pathogenic Qi can lodge. The flavor associated with the spleen is sweet, and its category is Earth. Earth is stable by nature and gives rise to the myriad things.

The animal associated with the spleen is the ox. Earth governs the four seasons, so the ox is chosen because it belongs to the earthly branch Chou; oxen are also often yellow. The grain associated with the spleen is millet, because millet is yellow and sweet. In the heavens, the spleen corresponds to Zhenxing (Saturn). The essence and Qi of Earth rise to form Zhenxing, which completes one circuit of the heavens in twenty-eight years.

From this we can understand that the body region associated with Earth is the muscles. Earth is yielding and substantial, like the Qi of the muscles. The musical note associated with the spleen is Gong, which belongs to Earth. The Book of Pitch Standards (Lüshu) identifies Huangzhong as the low Gong tone and Linzhong as the high Gong tone; here, Linzhong corresponds to the pitch for the sixth lunar month. Among the five notes, Gong is primary. The pitch pipes begin with Huangzhong, the low Gong tone, while Linzhong is the high Gong tone. The number associated with Earth is five. The Book of Documents: Great Plan says, “Fifth is Earth.” The flavor associated with Earth is fragrant: when Qi is transformed by Earth, it becomes fragrant.

The west corresponds to the color white and is linked in the human body with the lungs. The lungs open into the nose, and their essence and Qi are stored in the lungs. The spirit formed from the essence and Qi of Metal is called Po (corporeal soul). The lungs store Qi, and the nose is responsible for breathing; this is why the lungs are said to open into the nose.

Accordingly, related illnesses appear in the back. The lungs lie within the chest, and the back is the chest’s outer covering. The flavor associated with the lungs is pungent, and their category is Metal. Metal is hard and resilient by nature, and its sound is clear and bright.

The animal associated with the lungs is the horse, because the horse belongs to Qian. The Book of Changes (Yijing) says, “Qian is the horse.” However, the New Collation (Xinjiaozheng) points out that the Treatise on the Five Constant Processes and Governance (Wuchang Zheng Da Lun) identifies the chicken as the animal associated with the lungs. The grain associated with the lungs is rice, because rice grains are firm and white. In the heavens, the lungs correspond to Taibai (Venus). The essence and Qi of Metal rise to form Taibai, which completes one circuit of the heavens every 365 days.

From this we can understand that the body region associated with Metal is the skin and body hair, because Metal is dense and firm, like the skin and body hair. The musical note associated with the lungs is Shang, which belongs to Metal. In early autumn, the pitch corresponds to Yize. Regarding the pitch for mid-autumn, the text continues: “Produced by Dalu, reduced by one pipe for every two parts, its length is approximately five cun and seven fen…”

(Continued from the previous passage) The pipes corresponding to Zhonglü and Taicou, calculated by the method of “subtracting one third,” have a standard length of five cun.

In the month of late autumn, the pitch standard is Wuyi. The pipe corresponding to Jiazhong, calculated by “subtracting one third,” also has a standard length of five cun. All three pipes correspond to Metal Qi. Metal’s completion number is nine: its generating number is four, and its completion number is nine. The Book of Documents, in the “Great Plan,” says, “Fourth is Metal.”

The flavor corresponding to Metal is rank. Whatever forms through the transformation of Metal Qi becomes a rank or mutton-like odor.

The north corresponds to the color black and connects internally with the kidneys. The kidneys’ openings are the two lower orifices, and Jing is stored in the kidneys. The vital essence of Water corresponds to the kidneys. Since the kidneys store Jing and can discharge and distribute Yin fluids downward, it is said that their openings are the two lower orifices.

Thus, illness manifests in the xi—the small junctions between the muscles. The “Treatise on Acupoints” says, “The larger junctions between the muscles are called gu; the smaller ones are called xi.”

The flavor corresponding to the kidneys is salty, and their category is Water. Water moistens and flows downward, soaking and nourishing.

The animal corresponding to the kidneys is the pig, and the grain is the bean. The pig mentioned here is called zhi. Beans correspond to the kidneys’ Water because they are black.

In the cycle of the seasons, Water Qi transforms in the heavens into Chenxing, the Water Star. The vital essence of Water rises and becomes Chenxing, which completes one circuit of the heavens in about 365 days.

We can therefore understand that illness caused by Water Qi manifests in the bones. Bones govern what is hidden in darkness; their inner structures lie deep within, resembling the nature of Water. For this reason, illness settles in the bones.

The note corresponding to the kidneys is Yu, one of the five notes, and it belongs to Water. Yu is the note of Water. In the month of early winter, the pitch standard is Yingzhong. The pipe corresponding to Guxi, calculated by “subtracting one third,” has a standard length of four cun and seven and a half fen. In the month of midwinter, the pitch standard is Huangzhong. The pipe corresponding to Zhonglü, calculated by “adding one third,” has a standard length of nine cun. In the month of late winter, the pitch standard is Dalu. The pipe corresponding to Ruibin, calculated by “adding one third,” has a standard length of eight cun. All three pipes correspond to Water Qi.

Water’s completion number is six: its generating number is one, and its completion number is six. The Book of Documents, in the “Great Plan,” says, “First is Water.”

The flavor corresponding to Water is putrid. Whatever forms through the transformation of Water Qi becomes a decaying odor.

Therefore, those skilled in pulse diagnosis must carefully examine the five Zang organs and six Fu organs, distinguish whether Qi’s movement is contrary or harmonious, and understand the corresponding relationships between Yin and Yang, the exterior and interior, and the male and female principles. They should keep these teachings in mind and bring them into accord with subtle principles.

Only when the mind is in accord with subtle principles can one deeply understand the transformations of things. Do not teach someone who is unsuited to receive the teaching, and do not transmit what is not true principle. This is called grasping the Dao.

Teach each learner according to their capacity. This is the method of being a good teacher: choosing students and transmitting learning.

The Jing of the Numinous Pivot (Ling Shu Jing) also says: someone with clear, bright eyes can be assigned to distinguish colors; someone with keen ears can be assigned to discern sounds; and someone quick to respond and articulate in speech can be assigned to explain the principles of medicine.

Someone whose movements are composed and temperament calm can be assigned to practice acupuncture and moxibustion. Someone with skillful hands and a careful mind can be assigned to regulate Qi and blood, correct disorders and irregularities in their flow, discern Yin-Yang, and study various methods of treatment.

Someone even-tempered and able to relax body and mind can be assigned to practice daoyin and guide Qi (using bodily movement and regulated breathing to direct the flow of Qi). Someone skilled in speech and able to soothe others with words can be assigned to treat abscesses and other conditions with saliva or incantations. Someone with strong fingers and palms, who knows how to apply force in their work, can be assigned to massage accumulations, push and press, and strike.

Only by arranging things this way can each person make full use of their strengths, medical techniques be put into practice, and a reputation be established. Hence the saying: “Do not teach someone who is not suited to learn; do not transmit what is not a true lineage.”