《黃帝內經素問補註釋文》Vol. 43

This is Chapter 43 of The Plain Questions of the Yellow Emperor’s Inner Classic: Supplementary Annotations and Commentary. It was arranged and annotated by Wang Bing, the Tang dynasty Director of the Court of the Imperial Stud, who used the style name Qixuanzi. Lin Yi and others, officials of the Song dynasty, collated the text, and Sun Zhao, a Song dynasty official in the Bureau of Agriculture of the Department of State Affairs, later corrected further errors. This chapter is titled “Treatise on the Five Constant Administrations, Part Two.”

The Yellow Emperor asked: “The northwest of Heaven is deficient, so in the northwest the left side is cold and the right side cool. The southeast of Earth is incomplete, so in the southeast the right side is hot and the left side warm. What is the reason for this?” (Commentary: The Yellow Emperor was facing southeast when he asked this.)

Qibo replied: “This is the principle of the Yin-Yang Qi having higher and lower positions, and also of its differing abundance.” (Commentary: “Higher and lower” refers to the elevation of the terrain; “abundance” refers to differences in the strength or weakness of Yin-Yang Qi.) “The terrain of the Central Plains is higher in the northwest and lower in the southeast. Thus the west is cool, the north cold, the east warm, and the south hot. The changes in climate follow this same pattern.

“The southeast belongs to Yang. Its vital essence descends, so the right side is hot and the left side warm.” (Commentary: As Yang essence descends, the Earth Qi becomes warm and harmonizes below. Yang Qi arises in the east and is at its strongest in the south, so the east is warm and the south hot; the relative abundance of Yang Qi is evident.)

“The northwest belongs to Yin. Its vital essence rises to the heavens, so the left side is cold and the right side cool.” (Commentary: As Yin essence rises, the Earth Qi becomes cold and harmonizes above. Yin Qi arises in the west and is at its strongest in the north, so the west is cool and the north cold. The Yellow Emperor faced southeast when he asked, while Qibo faced northwest when he replied. The editors of the new collation note that this account of the Yin and Yang deficiencies of Heaven and Earth also appears in the “Treatise on the Correspondence of Yin and Yang.”)

“Thus the terrain has high and low places, and the climate has warm and cool places: the Qi is cold at higher elevations and hot at lower ones.” (The editors of the new collation note: The “Treatise on the Six Climatic Changes and Their Cyclical Periods” says that winter cold is constantly present at the highest elevations, while spring warmth is constantly present at the lowest.)

“For this reason, people who go to cold and cool places are prone to abdominal distension, while those who go to warm and hot places are prone to sores. Abdominal distension is cured by purging, and sores by inducing sweating. This follows the usual pattern of the opening and closing of the couli—the skin and muscle texture where the pores open and close—though it varies according to the size of the region. ‘Northwest’ and ‘southeast’ refer to broad regional divisions. We can verify this by looking at the climate and terrain of the Central Plains: wherever the land is high, it is cold; wherever it is low, it is hot. Consider this: mountains receive more snow, while plains receive more rain; mountains are colder, while plains are hotter. The relation between elevation and cold or heat can be seen from this. The same principle can be used to understand conditions throughout China.”

Differences caused by variations in elevation can broadly be divided into three sections in each of the east–west and north–south directions.

The three north–south sections are as follows: the first extends from the Han River, Shu, and the Jiangnan region down to the coast; the second extends from north of the Han River to Pingyao County; and the third extends from the mountains north of Pingyao to the northern frontier and the North Sea. The southern section is therefore extremely hot, the middle section has roughly equal warmth and cold, and the northern section is extremely cold. Beyond the north–south boundary, cold and heat become even more extreme: in very hot regions the cold is milder, while in very cold regions the warmth is milder. Yet on the summit of an exceptionally high mountain, the climates on its southern and northern sides differ greatly, as do the flourishing and withering of plants and trees.

Differences in elevation from east to west also divide into three sections: the first extends west from Qianyuan County, in present-day Shaanxi, as far as Shazhou; the second extends west from Kaifeng County to Qianyuan County; and the third extends east from Kaifeng County to the Eastern Sea. The eastern section is therefore extremely warm, the middle section has roughly equal warmth and coolness, and the western section is extremely cool. In very warm regions, cold accounts for about two-fifths; in very cool regions, warmth also accounts for about two-fifths. Beyond the boundary between warmth and coolness, the contrast is especially pronounced, and conditions may become very hot or bitterly cold.

Broadly speaking, among the nine regions, the northeast is coldest and the southwest hottest. Elevation also varies within each of the nine regions: higher places are damper, while lower places are drier. These are smaller differences within a single region. On a broad scale, variations in elevation have two main causes: differences in the height of the terrain, and differences in the abundance of Yin and Yang energies. The western and northern parts of the Central Plain are higher, while its eastern and southern parts are lower. Today, the rivers converge and ultimately flow into the Eastern Sea, which also reveals the differences in elevation from east to west and north to south.

Differences in terrain elevation cause variations in cold and warmth; differences in the abundance of Yin and Yang energies cause variations in warmth and coolness. This can be verified by observing changes in the climate: spring Qi moves westward, autumn Qi eastward, winter Qi southward, and summer Qi northward. Taking the central region as a point of comparison, climate changes from Kaifeng to Qianyuan County broadly correspond to what the calendar records. Comparing areas to the east, from Kaifeng to the Eastern Sea, for every hundred li farther east, the arrival of autumn is about one day later, while the emergence of spring is about one day earlier. Comparing areas to the west, from west of Qianyuan County to the sandy and stony lands along the frontier, in places lying southward, northwestward, or southeastward, spring arrives about one day later and autumn about one day earlier for every forty li. In places lying northward, northeastward, or southwestward, spring…

When adjusting for the early or late arrival of seasonal conditions as one travels south, account for the shape of the rivers. If a river flows northward, northeastward, or southwestward, then for every five hundred li …. The Newly Revised Edition says that other versions give “fifteen li” here.

When Yang Qi runs late by one day, Yin Qi runs early by one day. If a river flows southward, southeastward, or northwestward, then for every fifteen li, warm conditions arrive one day earlier and cold conditions one day later. In broad, level terrain, for every fifty li, Yang Qi begins one day earlier and cold conditions arrive one day later.

When traveling north, adjust for the shape of the rivers. If a river flows southward, southeastward, or northwestward, then for every twenty-five li, Yang Qi runs late by one day and Yin Qi runs early by one day. If a river flows northward, northeastward, or southwestward, then for every fifteen li, cold conditions arrive one day earlier and warm conditions one day later. In broad, level terrain, for every twenty li, warm conditions run late by one day and cold conditions arrive one day earlier. This is the general pattern.

In high, steep places, however, winter conditions often linger; in flat, low-lying places, summer conditions often linger. This can be seen by observing the snow and the growth of plants.

Terrain naturally takes different forms, such as bow-shaped, snake-shaped, and crescent-shaped rivers. The landforms vary, and so do the growth, decline, flourishing, and withering of all things. Even within the same area, climate may differ according to the terrain and its orientation. In places facing the directions Li, Bing, Xun, Yi, and Zhen, spring conditions arrive early and autumn conditions arrive late, with a difference of fifteen days. In places facing Ding, Kun, Geng, Dui, Xin, Qian, Kan, and Gen, autumn conditions arrive early and spring conditions arrive late, with a difference of twenty days. This is what is meant by “mountain-facing terrain,” where the land beside a mountain has different orientations.

By carefully observing the terrain’s orientation and whether it faces the sun or lies in shade, one can understand the local climate. In cold, shaded places, the skin’s pores open less and close more. When they remain more closed, Yang Qi is less readily dispersed, so people exposed to cold in such places are prone to abdominal distension. In damp, hot places, the pores open more and close less. When they remain more open, Yang Qi readily disperses outward, so people in warm places are prone to skin sores. Treatment with purgation clears the stagnation of Qi within the body, and the abdominal distension subsides; treatment by inducing perspiration vents Yang Qi outward, and the sores subside.

The Yellow Emperor asked, “What do these conditions have to do with the length of people’s lives?”

This refers to people living in different places, whose lifespans may be longer or shorter.

Qi Bo replied, “People live longer in places nourished by Yin essence; they live shorter lives where Yang essence is abundant and gathers below.” Abundant nourishment by Yin essence refers to higher terrain; Yang essence gathering below refers to lower terrain.

In lands of yin, Yang Qi does not readily dissipate outward, and the cold can protect the body from outside. As a result, harmful influences rarely invade, and the body’s vital Qi can remain firmly guarded; people therefore tend to live longer. In lands of yang, Yang Qi readily dissipates and is discharged without restraint. Wind-dampness evils often invade, and true Qi gradually declines, so people are more likely to die young.

This can be confirmed by present-day conditions. In the Central Plains, people in the northwest tend to live longer, while those in the southeast tend to live shorter lives. There are also differences from place to place within each region, but in general this is an important cause of differences in lifespan. The word “region” here refers to geographical direction, and such conditions should be examined carefully.

The Yellow Emperor said, “Well said. When people in different regions suffer from the same illness, how should it be treated?”

Qibo said, “For people in the northwest, treatment should disperse the flow of Qi and use cooling methods. For people in the southeast, it should gather the flow of Qi and use warming methods. Thus the same illness calls for different treatments.”

People in the west and north have tighter skin and denser couli—the skin’s texture and pores—and they tend to eat warming foods, so treatment should disperse and cool. People in the east and south have looser skin and more open couli, and they tend to eat cooling foods, so treatment should gather and warm. Here, “disperse” means using warm bathing to open the flow of Qi inside and outside the body; “gather” means warming the interior without dispersing the body’s exterior. Some local customs today are precisely the opposite. If these differences are ignored and illness is treated according to local custom, the condition may worsen.

Therefore, for illness in cold regions, cooling treatment may be combined with immersion in water. For illness in warm regions, warming treatment should be used to strengthen the body’s internal defenses. Treatment must accord with the Qi of the place where the illness arose in order to bring the body into balance.

In unusual circumstances, treatment should be reversed. If someone from a cold region develops a heat illness, a warming method commonly used in warm regions may be applied. If someone from a warm region develops a heat condition, cooling methods commonly used in cold regions may be applied. In other words, treatment should ordinarily follow the local climate and constitution, but when the pattern of illness is contrary to these, the choice of treatment should be reversed.

The Yellow Emperor said, “Well said. Within a single province, why do growth, change, and lifespan differ from place to place?”

Qibo said, “This is due to differences in elevation. In high, steep places, yin predominates; in low-lying places, yang predominates. Where yang is dominant, living things grow earlier; where yin is dominant, they grow later.”

“Earlier” means earlier than the seasons set by Heaven and Earth; “later” means later than those seasons. This refers to the order in which all things between Heaven and Earth flourish and then decline and wither. Since this is true of all things, it is true of people as well. This is the natural principle by which geographical conditions affect growth and change.

The Yellow Emperor then asked, “Do people in these places also differ in the length of their lives?”

Qibo said: “In places where the terrain is high, people receive clear, enduring Qi, so they live longer. In places where the terrain is low, people receive Qi that is brief and constrained, so they live shorter lives. The distances between regions vary, as do the scale and nature of their effects. When regions are far apart—about ten thousand li—this is called a ‘great difference.’ When settlements are closer, perhaps twenty or thirty li apart, or about a hundred li, this is called a ‘small difference.’ If the terrain in two places differs greatly in elevation, they may count as a ‘small difference’ even when close together. If the terrain is gently sloped and the airs flow into one another, places two or three hundred li apart may also count as a ‘small difference.’ Differences in the Qi of the land lead to differences in people’s growth and innate endowment.

“So anyone who treats illness must understand the seasons, geography, the waxing and waning of Yin-Yang, and the sequence of climatic changes. Only by knowing the patterns of human longevity and growth can one judge a person’s form and Qi. If one does not understand the Qi of Heaven and Earth or recognize the signs of Yin-Yang change, one will mistake the long-lived for the short-lived, and the short-lived for the long-lived. Even with all the methods devised by the sages of antiquity to preserve life, and a thorough command of the subtleties of the channels, medicines, and needles and stones, one will still be misunderstood and blamed by the people.”

The Yellow Emperor said: “Good. Why is it that in some years people do not fall ill, yet the Qi of their organs and bowels does not respond or function?”

Qibo said: “This is because the Qi of Heaven constrains people, and their Qi follows it.” Here, “follows” means that people’s Qi submits to the influence of the external climate without regard for the needs of its own internal harmony.

The Yellow Emperor said: “Please explain these principles to me in detail.”

Qibo said: “When Shaoyang governs Heaven—that is, when Shaoyang Qi presides over the weather in the first half of the year—Fire Qi descends and acts upon the Lung Qi above. White Qi appears, and the activity of Metal is affected; plants and trees suffer, Fire becomes manifest, and metal implements are damaged. Heat prevails, bringing symptoms such as coughing, sneezing, a runny nose or nosebleed, nasal congestion, sores, alternating chills and fever, and swelling.”

This refers to the Yin and Shen years. “Descends” means that Fire Qi is above and exerts its influence below; “follows” means that Lung Qi responds to the climate above; “arises” refers to prices rising; and “function” refers to the administration of punishments. “Ge” means leather, and also carries the sense of change; “Metal” means metal implements; “diminished” means depleted. The burning heat of Fire Qi can cause sores on the body: sores on the body are called chuang, while sores on the head are called yang. “Chills and fever” means first feeling cold and then hot, like an attack of malaria. When the Lungs are injured by pathogenic heat, Water Qi comes to protect them and lodges in the Lungs, producing swelling. When pressed, this swelling does not quickly return to its former shape. These are all symptoms that may be caused by changes in the weather.

Textual note: The commentary says that sores on the body are called chuang and sores on the head are called yang, but the passage in the classic here gives only “called yang”; the word chuang may have been omitted. Some editions also write “kou” instead of “yue.”

Wind Qi moves across the ground, whipping up dust. People may experience heart pain, pain in the upper abdomen, Qi surging upward in reverse, and obstruction in the chest and diaphragm. The illness comes on abruptly and develops rapidly.

When Jueyin, the Qi of Wind-Wood, is in control below—governing the climate beneath the ground—Wind Qi moves across the ground. Illnesses caused by an excess of Wind Qi arise from this condition. The changes in Shaoyang and Jueyin Qi are both abrupt and rapid, so illness develops quickly. Hence the description of an illness that comes on abruptly and develops rapidly. This is caused by an irregular course of terrestrial Qi.

The New Collation says: On close examination, when Jueyin or Shaoyang is in control below, the text says “its activity is sudden and rapid,” referring to how quickly these forces arise. It therefore does not go on to say that a particular illness appears when the Qi reaches its extreme.

When Yangming governs above, presiding over the seasons of the first half of the year, Dryness descends and Liver Qi responds upward. The color green appears, and Wood Qi comes into operation; Earth Qi is consequently harmed. Chilling, cold weather occurs repeatedly. Wood Qi is damaged, and plants wither. People may suffer pain along the ribs, red eyes, swaying and trembling, shivering, and weakened sinews that make it difficult to stand for long.

These are the climatic effects of Mao and You years. “Wood comes into operation” means that Wood Qi is active; “chilling and cold” refers to cool weather. The illnesses described above are caused by heavenly Qi.

When fierce Heat arrives, Earth Qi turns to summer heat. Yang Qi gathers and breaks forth. People may have abnormal urination, alternate between chills and fever, and suffer symptoms like malaria. In severe cases, there may be heart pain. Fire Qi moves, drying out all things; flowing water does not freeze, and hibernating insects emerge.

When Shaoyin, the Qi of Sovereign Fire, is in control below, Heat Qi is strong at the surface of the earth, giving rise to these illnesses. They are caused by terrestrial Qi.

When Taiyang governs above, presiding over the seasons of the first half of the year, Cold descends and Heart Qi responds upward. Fire Qi then becomes pronounced.

The New Collation says: The three characters “Fire is bright” should, according to the meaning of the passage, be corrected to the two characters “Fire comes into operation.”

The color red appears, and Metal Qi is harmed. Cool, cold weather occurs frequently; when Cold prevails, water freezes. Fire Qi blazes upward. People may feel heat and agitation in the heart, have a dry throat and become thirsty easily, develop a runny nose and sneeze, feel sorrow readily, and yawn repeatedly. When Heat Qi moves irregularly, Cold Qi then strikes back, and frost falls out of season. People may become forgetful; in severe cases, there may be heart pain.

These are the climatic effects of Chen and Xu years. “Cold and clear weather often occurs” means that the Cold-Water Qi of Taiyang is in command. “Fire Qi is high and bright” means that Fire Qi is fierce and scorches all things. “Out of season” means that frost falls too early or too late, or harms certain things selectively, moving out of step with the seasons and failing to affect all things uniformly. The illnesses described above are caused by heavenly Qi.

Earth Qi is moist, and Water is abundant. Cold invades, Yin Qi grows deep, and moisture is generated; changes in the climate affect all things. People may develop abdominal distension and lose their appetite because fluids and pathogenic water accumulate in the body. Their skin may become numb, their muscles uncomfortable, and the movement of their sinews and vessels impeded. In severe cases, they may develop swelling and sores on the back of the body.

When Taiyin, the Qi of Damp-Earth, is in control below, Dampness is strong at the surface of the earth, giving rise to these illnesses. They are caused by terrestrial Qi.

The New Collation says: According to the meaning of the passage, “sores on the back of the body” should be corrected to “difficulty behind the body.”

When Jueyin rules heaven, Wind Qi descends to affect the earth, and Spleen Qi responds by rising, so Earth Qi flourishes. Water Qi begins to suffer damage, and the action of Earth Qi changes. People may feel heaviness in the body, weakness in the muscles, reduced appetite, and a dulled sense of taste. When the wind is fierce, clouds and landscapes shift; people may feel that everything before their eyes is spinning and hear ringing in their ears.

These are the climatic patterns of the Si and Hai years. “Earth flourishing” and “the action of Earth changing” mean that Earth Qi is strong, active, and undergoing change; it can also be said that Earth Qi is in command. The shifting clouds and landscapes indicate that the wind is very strong. These illnesses are caused by the Qi of heaven.

When Fire runs unchecked and grows fierce, the earth becomes hot. Great heat consumes and scorches all things; red pools of water flow downward, hibernating creatures emerge repeatedly, and running water does not freeze.

Shaoyang is in charge below, governing the Qi of the earth. Fire Qi takes shape on the earth, giving rise to these phenomena. The onset and signs of illness are caused by the Qi of the earth.

The changes in Shaoyang and Jueyin Qi are sudden and rapid, and the illnesses they cause come on just as quickly, like a mechanism abruptly triggered. Hence the phrase “its onset is swift as a trigger.”

When Shaoyin rules heaven, Heat Qi descends to affect the earth, and Lung Qi responds by rising. White Qi appears, Metal Qi is affected, and plants are harmed. People may experience panting, vomiting, alternating chills and fever, sneezing, clear nasal discharge or nosebleeds, and nasal congestion; the Qi of great summer heat also prevails.

These are the climatic patterns of the Zi and Wu years. Heat governs the Qi of heaven, so these illnesses are caused by the Qi of heaven.

When the heat is severe, sores and ulcers may form, burning like fire, and even metal and stone may melt. This occurs when the Qi of heaven and earth converge.

The earth becomes dry and bleakly cold, and cold arrives repeatedly. People may experience pain in the ribs and flanks and sigh often. The Qi of desolation and killing prevails, and plants change as well. Here, “change” means that plants alter their original forms; pain in the flanks and sighing are caused by the Qi of the earth.

When Taiyin rules heaven, Dampness Qi descends to affect the earth, and Kidney Qi responds by rising. Black Qi appears, and Water Qi undergoes change. (The New Collation says that the three characters “lesser Fire brings calamity” are doubtful in light of the surrounding text.) Dust fills the air and clouds and rain form; people feel discomfort in the chest. The genitals become weak, vitality declines sharply, erection becomes impossible, and sexual intercourse cannot be performed. (The New Collation says the two characters “cannot be used” should read “Water is in use.”)

Under these seasonal conditions, people may also have pain in the lower back and buttocks, and find it difficult to turn or move.

These are the climatic patterns of the Chou and Wei years. “Water changing” means that sweet spring water turns salty. “Ai” means dust, “mao” means obscured so that distant things cannot be seen, and “clouds and rain” belong to changes in Earth Qi. “Wei” refers to the muscles of the buttocks. These illnesses are caused by the Qi of heaven.

“Counterflow reversal” (the New Collation suggests that these two characters may belong at the end of the preceding passage).

The earth then gathers in Yin Qi, and severe cold is on its way. Hibernating creatures hide early. There may be fullness and pain below the heart, cracks in the earth, hard frost and ice, pain in the lower abdomen, and sometimes difficulty eating. If Metal Qi restrains Water Qi, the abnormality of Water Qi will cease. If Water Qi grows stronger, the water will taste salty and its flow will diminish.

Still water refers to water in wells and springs; flowing water refers to water moving through rivers and channels. Even after remaining still for a long time, water can change its original nature: water that was once sweet may become salty. Illness sometimes arises from the qi of the earth.

The Newly Collated Edition says: “Look closely at the changes when Taiyin governs the heavens. This passage does not say, ‘When the qi is excessive, what illness will result?’ Instead, it says, ‘at that time,’ and also ‘when it is acted upon by Metal.’ These expressions complement and explain one another, just as in the preceding passage.”

The Yellow Emperor asked: “Pregnancy occurs every year, yet some living things cannot reproduce, or reproduce only incompletely. Which qi influences this?”

Qibo replied: “The Six Qi and the five classes of living things have a relationship of mutual dominance and restraint. Those whose qi is of the same nature flourish; those whose qi is of a different nature decline. This is the constant principle by which Heaven and Earth move, grow, and transform.

“When Jueyin governs the heavens, hairy creatures reproduce quietly, feathered creatures can reproduce, and shelled creatures cannot develop fully.

“This refers to the years of Yi-Si, Ding-Si, Ji-Si, Xin-Si, and Gui-Si, as well as Yi-Hai, Ding-Hai, Ji-Hai, Xin-Hai, and Gui-Hai. ‘Quietly’ means without sound; it also means temporarily receding and not acting first. Feathered creatures belong to Fire, which shares the nature of the earthly qi. Fire can restrain Metal qi, so shelled creatures cannot develop fully. Shelled creatures are white animals with shells; ‘cannot develop fully’ means that few are born, not that none are born.

“When Jueyin is in the spring, hairy creatures reproduce, naked creatures—animals without feathers, scales, or shells, such as humans—are harmed, and feathered creatures cannot reproduce.

“This is because the earthly qi restrains Earth qi, thereby harming yellow, unshelled naked creatures. If Wood’s annual movement is also dominant that year, the effect is more severe. Feathered creatures cannot reproduce because Shaoyang qi restrains itself. This refers to the five Yin years and the five Shen years. ‘Cannot reproduce’ and ‘cannot develop’ both mean that reproduction is reduced, not that it ceases entirely.

“When Shaoyin governs the heavens, feathered creatures reproduce quietly, shelled creatures can reproduce, and hairy creatures cannot develop fully.

“This refers to the years of Jia-Zi, Bing-Zi, Wu-Zi, Geng-Zi, and Ren-Zi, as well as Jia-Wu, Bing-Wu, Wu-Wu, Geng-Wu, and Ren-Wu. ‘Quietly’ refers to feathered creatures such as the Chinese babbler found in the regions of Hu, Yue, and Yan. At this time, few black-haired creatures are conceived and survive.

“When Shaoyin is in the spring, feathered creatures reproduce, while shelled creatures are harmed and cannot reproduce.

“This is because the earthly qi restrains Metal qi, so white shelled creatures cannot reproduce. If Fire’s annual movement is also dominant that year, the effect is more severe. This refers to the five Mao years and the five You years.”

The Newly Collated Edition says: “Shelled creatures are harmed because Shaoyin is in the spring, where Fire overcomes Metal. They cannot reproduce because the qi of Yangming in the heavens restrains itself.”

“When Taiyin governs the heavens, naked creatures reproduce quietly, scaled creatures can reproduce, and feathered creatures cannot develop fully.

“This refers to the years of Yi-Chou, Ding-Chou, Ji-Chou, Xin-Chou, and Gui-Chou, as well as Yi-Wei, Ding-Wei, Ji-Wei, Xin-Wei, and Gui-Wei. Naked creatures include humans and shrimp …”

Among scale-bearing animals, greenish birds such as parrots, woodpeckers, kingfishers, and blue-green birds are all affected in years of Metal movement, and the effects are especially severe.

When the Qi Below Governs (zaiquan, the force governing the climate of the latter half of the year), naked animals—those without feathers, scales, or shells—breed, while scale-bearing animals cannot breed. The New Collation says: “On careful checking, the character ‘decline’ is missing here.” Earth Qi restrains Water Qi, preventing black scale-bearing animals from breeding. If the year also has Earth movement, the effects are even more severe. These are the five Chen years and the five Xu years.

When Lesser Yang Governs Above (shaoyang sitian, the Qi of Lesser Yang governing the first half of the year), feathered animals are inactive, furry animals breed, and naked animals cannot breed. This refers to the years Jia Yin, Bing Yin, Wu Yin, Geng Yin, and Ren Yin, as well as Jia Shen, Bing Shen, Wu Shen, Geng Shen, and Ren Shen. Naked animals here refers to greenish animals; feathered animals refers to black winged creatures such as the yueyan swallow and the black-naped oriole.

When Lesser Yang Governs Below, feathered animals breed, shelled animals decline, and furry animals cannot breed. Earth Qi restrains Metal Qi, harming white shelled animals; if the year also has Fire movement, the damage is more severe. Furry animals cannot breed because they are restrained by the Qi Above. These are the five Si years and the five Hai years.

When Yang Brightness Governs Above (yangming sitian, the Qi of Yang Brightness governing the first half of the year), shelled animals are inactive, feathered animals breed, and red shelled animals cannot breed. This refers to the years Yi Mao, Ding Mao, Ji Mao, Xin Mao, and Gui Mao, as well as Yi You, Ding You, Ji You, Xin You, and Gui You. Feathered animals belong to Fire, so they flourish; among shelled animals, those with red shells cannot breed because they are restrained by the Qi Above.

When Yang Brightness Governs Below, shelled animals breed, furry animals decline, and feathered animals cannot breed. Earth Qi restrains Wood Qi, causing black furry animals to decline; if the year also has Metal movement, the damage is even more severe. The inability of feathered animals to breed was explained above, in the section on Lesser Yin.

When Greater Yang Governs Above (taiyang sitian, the Qi of Greater Yang governing the first half of the year), scale-bearing animals are inactive and naked animals breed. This refers to the years Jia Chen, Bing Chen, Wu Chen, Geng Chen, and Ren Chen, as well as Jia Xu, Bing Xu, Wu Xu, Geng Xu, and Ren Xu. Naked animals breed because the Qi Below is in harmony with them; scale-bearing animals are inactive, meaning that yellow scale-bearing animals do not move. There is less thunder and lightning in these years because they are suppressed by the Qi Above. The New Collation says: “On careful checking, this should read ‘scale-bearing animals fail to develop.’”

When Greater Yang Governs Below, scale-bearing animals decline and naked animals cannot breed. The Qi Above restrains them and gains the upper hand, causing yellow and black scale-bearing animals to decline. These are the five Chou years and the five Wei years. The New Collation says: “On careful checking, this should read ‘scale-bearing animals breed, feathered animals decline, and naked animals cannot breed’; the character ‘scale’ in the commentary should also be changed to ‘feather.’”

In years that do not accord with the regular pattern of the Five Phases (Wood, Fire, Earth, Metal, Water), the effects are greater. When Wood governs the year, shelled creatures have difficulty reproducing; when Fire governs, scaled creatures; when Earth governs, hairy creatures; when Metal governs, naked creatures; and when Water governs, feathered creatures. The circumstances in these years are as described above: few living things are able to conceive and reproduce. In years when the cycles of movement and Qi are in harmony, if they also coincide with a cycle that overcomes or is overcome, a returning Qi, the Celestial Tally, or the Year Meeting, one or two out of every ten pregnancies often fail to survive.

Thus, within the cycles of movement and Qi, there are forces that govern and restrain. The annual movement gives rise to something; Earth Qi restrains what it overcomes, while Heaven Qi restrains what overcomes it. Heaven Qi restrains by following the side that it cannot overcome; this is called “restraining its color.” Earth Qi restrains by following the side that it overcomes; this is called “restraining its form.” Hence it is also said that Heaven Qi restrains color, while Earth Qi restrains form. Among the five kinds of living things between Heaven and Earth, there are relations of overcoming, transformation, generation, and restraint. The rise and decline of these five kinds change according to the Qi suited to each; when the climate is favorable, they flourish and multiply.

Thus, pregnancies that fail to come to term, and the inability of governance and care to make them all survive, are common features of change in the cycles of Qi.

Living things between Heaven and Earth can broadly be divided into five kinds: hairy creatures, feathered creatures, naked creatures, scaled creatures, and shelled creatures. Tradition says there are 360 kinds of hairy creatures, led by the qilin; 360 kinds of feathered creatures, led by the phoenix; 360 kinds of naked creatures, led by humans; 360 kinds of scaled creatures, led by the dragon; and 360 kinds of shelled creatures, led by the turtle. Any living thing with a body that crawls, flies, runs, or breathes—whatever its size, height, or color—may be called a “creature” if its body is covered with hair, feathers, scales, or shell. Those without any of these four coverings are classed as naked creatures. The five kinds discussed here include different modes of reproduction: live birth, laying eggs, generation in moisture, and transformation. They are discussed because someone asked about them.

“Inner root” means that the root of vital energy arises from within the body. The vital energy of each of the five kinds of creatures depends on something external in order to exist; once that external thing is gone, their vital energy is cut off as well. There are also five kinds of external roots, referring to the Five Flavors and Five Colors, among other things. The forms associated with Wood, Fire, Earth, Metal, and Water all rely on the colors of external things and the Qi stored within them for their generation and transformation. Once the external things are removed, their vital energy also…

Once Qi is cut off, transformation and generation cease. These processes therefore all depend fundamentally on Qi from outside.

The Newly Revised Text says: “Judging from the context, the two characters ‘stored form’ in the commentary should read ‘already formed.’”

There are five kinds of distinction in transformation and generation: the five Qi, the five flavors, the five colors, the five categories, and the five appropriate relations. These twenty-five manifestations are all present within living beings and are also connected with the external world.

The five Qi are rank, scorched, fragrant, fishy, and rotten. The five flavors are sour, bitter, sweet, pungent, and salty. The five colors are blue-green, yellow, red, white, and black. The five categories have two interpretations. One refers to furry animals, feathered animals, naked animals (those without fur or feathers), scaled animals, and shelled animals. The other refers to dryness, dampness, fluidity, firmness, and softness. Among all things, each of these attributes has its own appropriate relation to the others.

The Yellow Emperor asked, “What does it mean for each to have its own appropriate relation?” Qibo replied, “What has its source within is called the ‘spirit mechanism.’ When the spirit mechanism departs, the pivot of life’s activity comes to a halt. What has its source outside is called ‘Qi establishment.’ When the action of Qi ceases, transformation and generation are cut off.”

All living beings with physical form have their source within, and their origin of life is connected to Heaven. Their activities and changes take Shen and Qi as their pivot and guiding force. Thus, beings themselves do not know how their life activities come about. Once the spirit mechanism departs, the pivot and action of life cease.

Living beings whose source is outside are connected to Earth in their origin. Their growth, transformation, maturation, contraction, and storage are brought about by the Qi of creation and transformation. Thus, beings themselves do not know how they come into being. Once Qi ceases, the processes of transformation, condensation, and taking form are cut off.

Wood, Fire, Earth, Metal, and Water, as well as dryness, dampness, fluidity, firmness, and flexibility, each have their constant properties. But when external conditions change, life-giving Qi leaves its source and transformation and generation cease; their original forms, properties, and colors also change to some degree.

The Newly Revised Text quotes the Treatise on the Six Subtle Influences: “When coming and going are abolished, the spirit mechanism is extinguished; when rising and descending cease, Qi establishment is left isolated and imperiled.” In other words, without coming and going, there can be no passage through growth, maturity, decline, and ending; without rising and descending, growth, transformation, contraction, and storage cannot be completed.

All things have their own patterns of regulation, overcoming, generation, and accomplishment, whether their source is within or outside.

Therefore, without understanding the influence of the seasons each year, and the similarities and differences in climatic Qi, one cannot speak of transformation and generation. This is what is meant here.

The Newly Revised Text also quotes the Treatise on the Six Cycles and the Images of the Viscera: “One who does not understand the seasonal influence on Qi, or how Qi waxes and wanes, becomes full or deficient, cannot be called a qualified physician.”

The Yellow Emperor asked, “When Qi begins to move, transformation and generation arise; when Qi spreads out, physical forms take shape; when Qi is distributed everywhere, all things flourish and grow…”

When the movement of Qi reaches its ultimate stage, the forms of the myriad things change. The principle is the same in every case.

“Beginning” means that Qi starts to stir. “Dispersal” means that Qi flows and spreads among the myriad things. “Distribution” means that Qi brings about change and gives the myriad things form. “Congealing” means that their forms solidify. “Completion” means that Qi’s activity reaches its endpoint and returns to storage. Thus, when Qi starts to stir, the myriad things begin to change; when it spreads, they take on form; when it brings about change, they congeal into form; and when its movement reaches its endpoint, their forms change. We can confirm this by observing things in Heaven and Earth: formed things are soft and yielding while alive, but become hard after death. Cases like these show how forms change as life passes into death. This is what happens when the movement of Qi reaches its ultimate stage.

○ The Newly Collated Commentary says: According to the Treatise on the Heavenly Origin and Chronological Cycles, the beginning of the myriad things’ growth is called “transformation,” while their development to its utmost point is called “change.” The Treatise on the Six Subtle Indicators also says that the growth of the myriad things begins with “transformation,” and, when it reaches its utmost point, turns into “change.” Transformation and change act upon one another; they are the cause of the rise and decline, success and failure of the myriad things.

Yet the growth and transformation on which the Five Flavors—sour, bitter, sweet, pungent, and salty—depend may be slight or substantial. The amount that matures may be great or small, and growth and completion take different forms. Why is this? Qibo replied: “This is governed by Earth Qi. It is not that Heaven fails to bring the myriad things to life, nor that Earth fails to bring them to maturity.”

Although Heaven and Earth have no conscious will, they still bring about change, and the Qi that drives these changes differs in its qualities. Why is this so? Because within the body of Earth, the Six Qi interact. Since Qi differs, some things can grow and transform while others cannot; some grow and transform only to a small degree, while others do so extensively. Thus, between Heaven and Earth, there is no fixed rule that the myriad things must grow or transform, must not grow or transform, or must grow and transform either slightly or extensively. Each thing changes according to the Qi it has received, in keeping with what suits or does not suit it, and with what it shares or does not share with other things.

The Yellow Emperor said, “I would like to hear the principle behind this.” Qibo replied, “When cold, heat, dryness, and dampness differ, the changes that occur in the myriad things differ as well.”

By citing these four kinds of Qi—cold, heat, dryness, and dampness—we can infer that climatic conditions such as warmth and coolness also bring about different changes.

Thus, when Shaoyang is in charge below, things whose nature is toxic in the cold are difficult to grow. The Five Flavor associated with it is pungent; the flavors used to regulate it are bitter and sour, and the corresponding grains are blue-green and red.

This describes the Qi transformations in the years of Si and Hai. What is called “toxic” is caused by the excessive, fierce, and violent predominance of Qi from one of the Five Phases. Here Fire Qi occupies the interior of Earth, and the climate is hot. Things whose nature is toxic in the cold have a Qi that differs from the local climate, so the conditions are unsuitable for their growth and survival, making them difficult to grow. Fire Qi constrains Metal Qi, so things with a pungent flavor are difficult to transform and grow. Shaoyang Qi receives and follows Jueyin Qi above, so the Qi transformation of this year is associated with the bitter and sour flavors. Among the years governed by the Six Qi, only this year…

The climate is harmonious, with Wood Qi followed by Fire Qi, so there is no intermediate Qi. Things that are bitter in flavor and cinnabar in color are transformed by Earth Qi; things that are sour in flavor and blue-green in color are generated by Heaven Qi. The transformations I have described all involve the Qi above and below restraining one another and overcoming one another, so they all have intermediate Qi.

When Yangming is in charge below, things with damp toxins do not grow. The flavors of things tend toward sourness, and the climate tends toward dampness.

The “Newly Collated Notes” says: A close examination of the six kinds of years when a Qi is in charge below shows that only in years ruled below by Yangming or Taiyin do the notes say, “Its Qi is damp” or “Its Qi is hot.” This is because dampness and dryness have not yet manifested as cold or warmth, so “its Qi” is stated again.

When Yangming is in charge below, treatment should use the three flavors pungent, bitter, and sweet. The corresponding grain colors are cinnabar and white.

Years of the Zi and Wu branches are years in which Qi transformation proceeds. Dryness is below the earth, and the Qi it transforms is cool and clear, so things with damp or warm toxins are less likely to form. Metal Qi restrains Wood Qi, so fewer sour-flavored things are transformed. Yangming Qi rises to meet Shaoyin Qi, and thus the year’s Qi transformation produces the pungent and bitter flavors. Pungent belongs to white and is transformed by Earth Qi; bitter belongs to cinnabar and is transformed by Heaven Qi; sweet belongs to intermediate Qi. Because intermediate Qi can harmonize the contest and mutual restraint between Metal and Fire, sweet is also included in treatment.

When Taiyang is in charge below, things with heat toxins do not grow, and the flavors of things tend toward bitterness. Treatment should use bland and salty flavors, with dark yellow and black grains as the corresponding colors.

Years of the Chou and Wei branches are years in which Qi transformation proceeds. Cold is below the earth, and its nature differs from that of heat; therefore, things with heat toxins do not grow among the year’s produce. Wood Qi restrains Fire Qi, and Fire corresponds to bitterness. The “Newly Collated Notes” points out that the note “therefore it should be bitter” should read “therefore bitter-flavored things do not transform”; the former wording is a copying error. Taiyang Qi rises to meet Taiyin Qi, and thus Qi transformation produces bland and salty flavors. Taiyin belongs to Earth, and Earth Qi rises and is generated by Heaven Qi. Since Heaven Qi is remote and high, the transformation of sweet flavor is faint, becoming bland. Bland flavor also belongs to sweet; it is a kind of sweet flavor. Bland belongs to dark yellow and is transformed by Heaven Qi; salty belongs to black and is transformed by Earth Qi. Dark yellow means yellow.

When Jueyin is in charge below, things with clear toxins do not grow, and the flavors of things tend toward sweetness. Treatment should use the two flavors sour and bitter, with blue-green and red grains as the corresponding colors.

Years of the Yin and Shen branches are years in which Qi transformation proceeds. Warmth is below the earth, and its nature differs from that of clarity; therefore, things with clear toxins do not grow among the year’s produce. Wood Qi restrains Earth Qi, so fewer sweet-flavored things are transformed. Jueyin Qi rises and joins with Shaoyang; the Qi they join with is neither contrary nor conflicting, so treatment uses sour and bitter flavors. Sour belongs to blue-green and is transformed by Earth Qi; bitter belongs to red and is transformed by Heaven Qi. Since the climate involves no contest or mutual restraint, there is no intermediate Qi, and the produce is transformed with a sweet flavor.

The statement here, “its Qi is focused and its flavor is pure,” refers to years when Jueyin or Shaoyang is in charge below: Qi transformation is focused, and the flavors of things are pure.

Therefore, in the years governed by the other annual Qi, changes of mutual dominance and restraint occur between Heaven above and Earth below. In all these years, an intervening Qi is needed to bring them into balance.

The role of intervening Qi is reflected in the flavors and properties of medicines.

In years when Lesser Yin governs below, cold and toxic substances do not grow. At such times, pungent flavor predominates. Treatment uses pungent, bitter, and sweet flavors, and the grains are white and red.

The Mao and You years are marked by this pattern of annual Qi. The heat within the Earth differs in nature from cold Qi, so cold and toxic substances do not grow in these years. Fire Qi melts Metal Qi, so pungent medicines are produced in small quantities. Lesser Yin governs the Qi of Heaven, while Yangming governs the Qi of Earth; treatment therefore uses bitter and pungent flavors. Bitter-flavored, cinnabar-colored medicines are produced by the Qi of Earth; pungent-flavored, white medicines are produced by the Qi of Heaven. Sweet flavor is produced by the intervening Qi. The intervening Qi changes to balance the Qi of Heaven and Earth and ease their mutual restraint.

In years when Great Yin governs below, dry and toxic substances do not grow. Salty flavor predominates, and the medicinal Qi is hot. Treatment uses sweet and salty flavors, and the grains are yellow-black and black.

The Chen and Xu years are marked by this pattern of annual Qi. Dampness within the Earth differs in nature from dryness, so it cannot produce dry and toxic substances. Earth Qi is restrained by Water Qi, so salty medicines are produced in smaller quantities. The Qi of Great Yin rises to receive the Qi of Greater Yang, so the annual Qi in these years manifests through sweet and salty flavors: sweet-flavored, yellow medicines are produced by the Qi of Earth; salty-flavored, black grains are produced by the Qi of Heaven. Cold dampness and dryness do not clash violently, so the intervening Qi is the same as the governing Qi. If the medicinal Qi of the year is hot, it is matched with hot Qi.

When the annual Qi is rich and balanced, salty flavor can maintain its own Qi. When the Qi is concentrated, pungent flavor can also be produced. Both can be used in treatment.

“Rich and balanced” means harmonious. “Pure transformation” refers to years when Lesser Yang governs below: Fire Qi enters the position of Water, yet can still promote transformation and growth; Water’s salty flavor maintains its own nature and does not contend with Fire in transformation. “Concentrated Qi” refers to years when Conjunct Yin governs below: Wood Qi occupies the position of Water and can also transform downward to produce Metal Qi without being harmed. Pungent flavor is therefore produced again, flourishing alongside salty flavor. Only in these two years is there no mutual restraint between the Qi of Heaven above and Earth below, so pungent flavor can flourish in season together with salty flavor. In the other years, the Qi of Heaven above and Earth below undergoes mutual dominance and restraint. Sweet flavor must therefore also be produced by the intervening Qi to ease the governing Qi’s restraint. The production of bitter, salty, and sour flavors differs. For this reason, pungent- and sweet-flavored medicines are plentiful between Heaven and Earth.

Thus it is said: to tonify the upper or lower part, follow the corresponding Qi; to treat the upper or lower part, oppose the corresponding Qi. Treatment must also be adjusted according to the location of the illness and the relative strength of cold and heat.

“Above” refers to the Qi governing Heaven, and “below” refers to the Qi governing Earth. If the Qi governing Heaven or Earth is excessive, treat it with a medicinal flavor that opposes it; if the Qi is deficient, regulate it by following its nature. “Following” means complying with it.

Thus, in treatment, examine excess and deficiency above, below, within, and without. As for medicines that are toxic…

When medicines that are too strong still cannot curb the course of the illness, switch to milder, lighter medicines. This is what is meant by “medicines have degrees of strength and gentleness.”

“Treating from above” means using medicines to regulate Qi that is excessive in the upper body; if it remains disordered after treatment, use emetics to induce vomiting. “Treating from below” means using fast-acting medicines to clear pathogenic factors from the lower body; if they persist despite treatment, use purgatives. “Treating internally” means taking food or medicine by mouth and, after determining whether the condition is cold or hot, using it to restore balance. “Treating externally” means applying heated medicines as a compress (medicinal ironing) to restore harmony to the Qi dynamic at the affected site. If the body should be cold but is instead hot, treat it with cooling methods; if it should be hot but is instead cold, regulate it with warming methods. If pathogenic Qi in the upper body remains congested and does not recede, induce vomiting to disperse it; if pathogenic Qi in the lower body remains congested, use purgation to expel it. These methods all aim to identify and correct the root of excess in the Qi dynamic. The “strength and gentleness” of medicines refers to the relative strength or mildness of their flavors and effects.

The New Collation states: The Jia Yi Jing says that people with robust Stomach Qi, dark complexions, large bones, and thick muscles can generally tolerate medicines with strong effects, whereas thin people with weak Stomach Qi cannot. The Suwen: Treatise on the Different Methods Suited to Different Regions also says that people in the west live on high ground, where there is much wind and sand and the terrain and waters are harsh. They wear coarse cloth and sleep on grass mats, and their diet is rich and oily. For this reason, external pathogens do not easily harm their bodies, and their illnesses mostly arise internally; treatment with strongly acting medicines is appropriate.

When the Qi dynamic becomes abnormal, an illness in the upper body can be treated from below, an illness in the lower body from above, and an illness in the middle from the side.

“Treating from below” refers to cold lodged in the lower body while heat assails the upper body. If the lower body is obstructed, warm it; if Qi in the upper body is abundant and congested, warming the lower body can also bring it into balance. “Treating from above” refers to cold accumulating in the lower body and failing to disperse after warming treatment; in that case, replenish Yang Qi because it is insufficient. “Treating from the side” means that if the Qi dynamic gathers excessively on the left, apply a warm medicinal compress to the right; if it gathers on the right, warm the left to restore balance. During treatment, the degree of warmth or coolness must be adjusted to the condition. All these methods target pathogenic factors. To apply them flexibly and in a way that accords with the underlying pattern is to treat with precision.

To treat a hot condition, use cooling medicines, but administer or apply them warm. To treat a cold condition, use warming medicines, but administer or apply them cool. Treat a warm or hot condition with cooling methods; treat a cool or cold condition with warming methods.

Medicines’ effects may be forceful or gentle, illnesses may be mild or severe, prescriptions may use larger or smaller doses, and methods of regulation may be cooling or warming. When the illness is severe, treat in accordance with the medicine’s nature; when it is mild and weak, counteract that nature to suppress it. Different kinds of pathogenic factors must not be treated with interchangeable principal medicines; when the illness is strong, treatment to expel it must be intensified. Preparing decoctions and drinks according to these principles is how prescriptions and medicines are used to regulate the Qi dynamic.

The New Collation states: The Suwen: Treatise on the Essential Truth of the Great Treatise says, “For heat, use cold in its administration; for cold, use heat in its administration…”

In treatment, warming medicines must address the conditions they are intended to treat, and the causes of illness should be dealt with first. The methods of treatment may be the same at the onset of a disease, but can differ in its later stages. Medicines can be used to disperse accumulations, break up hard masses, and harmonize the movement of Qi, until the condition is cured. Thus, regardless of how long the illness has lasted, treatment should be adapted to the condition and may involve dispersing, restraining, inducing vomiting, purging, tonifying, or draining. In treating a specific case, the strength or weakness of the body’s vital Qi must be assessed. New and chronic illnesses do not require two entirely different sets of treatment principles.

The Yellow Emperor asked: “The illness is inside the body, but there are no firm masses; it merely gathers and disperses from time to time. How should it be treated?”

Qibo replied: “That is a comprehensive question. When there are no masses, treatment should begin with the related internal organs. If the Qi of an organ is weak, it should be tonified. Judge which organ is involved according to the location of the illness, then nourish it.

“Medicines are used to dispel pathogenic influences, while food is used to nourish the body. Non-toxic medicines can be combined with decoctions or pills, allowing their effects to develop gradually until the pathogenic influences are fully eliminated. The body can then be regulated through methods such as soaking in water, bringing inner and outer conditions into harmony so that the illness gradually resolves.

“When the body’s interior and exterior are unobstructed and in harmony, and the movement of Qi is free of blockage, the pathogenic influences will dissipate and vital Qi will return to balance.”

The Yellow Emperor asked: “Is there a proper limit to how much toxic and non-toxic medicine one should take?”

Qibo replied: “Illnesses differ in how recent or longstanding they are, prescriptions differ in size, and medicines differ in toxicity. In every case, there should be an appropriate limit to how much is taken. When a highly toxic medicine is used, stop once six tenths of the illness has been eliminated. With a moderately toxic medicine, stop when seven tenths has been eliminated; with a mildly toxic medicine, stop when eight tenths has been eliminated; and with a non-toxic medicine, stop when nine tenths has been eliminated. The medicines classified as superior, middle, and inferior grades are all included in the categories of toxic or non-toxic medicines.

“Once the appropriate limit has been reached, nourish the body with grains, meat, fruit, and vegetables to resolve what remains of the illness. Do not overuse medicines, lest they damage vital Qi.

“Highly toxic medicines have strong effects and can readily cause considerable harm. Mildly toxic medicines act more gently and cause less harm. The strength of moderately toxic medicines falls between the two, and the harm they can cause may be inferred accordingly. Therefore, when the illness has reached the appropriate degree of resolution, stop taking medicine and observe how it develops.

“Even non-toxic medicines, though gentle in nature, may cause Qi within the body to become excessive if taken in large quantities for a long time, and may even damage the Qi of the internal organs. Prolonged, aggressive treatment weakens and exhausts the Qi of the organs, so medicines should not be taken for too long. Once nine tenths of the illness has been eliminated, stop medicinal treatment. Afterward, nourish the body with grains, meat, fruit, and vegetables suited to the Five Zang organs. If illness remains, treatment may continue through a combination of medicines and food.”

The passage concludes by referring to the “Treatise on the Zang Qi and the Correspondence of the Seasons,” a chapter in the Basic Questions of the Yellow Emperor’s Inner Canon.

Use toxic medicines to attack and treat pathogenic influences; use the five grains to nourish the body, the five fruits to assist it, the five domestic animals to supplement it, and the five vegetables to enrich it. If the pathogenic influence has not been fully eliminated, treat it again by the methods described earlier. “Methods” here refers to the four principles mentioned above. If the pathogenic influence still remains, attack it again with medicine. The strength of the medicine must be exactly appropriate: stop once it has achieved its purpose, and never use too much.

First, one must understand the year’s changes in climate and avoid going against the qi of nature. Each year, the six qi take charge in turn, and the climates in the south and north also differ. One should first know where the six qi are positioned, then observe the person’s cun-kou pulse at the wrist. When Taiyin is in charge, the pulse is deep; when Shaoyin is in charge, it is hook-shaped; when Jueyin is in charge, it is taut like a string; when Taiyang is in charge, it is large and long; when Yangming is in charge, it is short and rough; and when Shaoyang is in charge, it is large and floating. When these six pulse qualities correspond to the climate at the time, this is called “Heavenly Harmony”—a state in which people and nature are in accord.

If one does not understand these patterns, one may treat a cold condition as though it were a hot one, trying to make it turn hot with cooling medicine. Yet the pulse does not change, and a heat illness has already arisen. Or one may treat a hot condition as though it were cold, trying to make it turn cold with warming medicine. The pulse remains as it was, and a cold illness breaks out again. How could one find the right treatment this way? Illnesses worsen and may even threaten life largely for this reason.

Do not further strengthen a pathogenic influence that is already strong, or further deplete the body’s righteous qi when it is already weak, lest this bring a person to an untimely death. If one fails to distinguish excess from deficiency and thinks only of attacking, the strong pathogenic influence will grow stronger, while the weak righteous qi will grow weaker. Illnesses worsen as a result, true qi is gradually consumed, and the disease deepens. When calamity arrives, it is like a disaster sent down by Heaven, difficult to escape. How tragic.

Do not invite pathogenic influences or damage righteous qi, or a person’s longevity will be cut short. To go against “Heavenly Harmony” means mistaking a deficient condition for an excess condition and attacking it; this invites pathogenic influences. Failing to recognize the weakness of the internal organs damages righteous qi. Once righteous qi is exhausted, the person dies.

The Yellow Emperor asked: “When someone has been ill for a long time, even though treatment follows the course of the illness, the body still does not recover. After the illness is cured, the person is emaciated. What should be done?”

Here, “following” means adapting to the course of the illness.

Qibo replied: “How wise of you to ask! The transformations of all things cannot be carried out by people in their place, and the seasons cannot be defied.

“Transformation” means the natural workings of creation. Even when cutting wood on behalf of a master carpenter, one may injure one’s own hand. How much less can human strength take the place of the qi of natural creation? The growth, flourishing, gathering, and storing of all things each follow the changes of the four seasons. Even people of great intelligence and ability cannot make these processes occur ahead of time. Such changes are beyond human control. From this we can see that the growth and storing of all things must await the proper season; success and failure, order and disorder, each have their time as well. This is true of all things, and it is true of people. It is wrong to claim that human effort can accomplish anything for certain, even taking the place of nature and defying the four seasons.”

The channels and collaterals must be kept clear so that blood and Qi flow smoothly and return to a full state, like those of an ordinary person.

The body should be nourished and brought into harmony, while one quietly waits for the right moment. The Qi within must be guarded carefully, so that it neither weakens nor strays. Only then can vitality appear in the body’s form and the Qi of life grow. This is called the Way of the sage ruler. Thus, the Essentials says: “Do not interfere with natural change, and do not go against the seasons. You must nourish and harmonize, then wait for recovery to occur on its own.” This is what it means. The Yellow Emperor said, “Good.”

The Essentials mentioned here is a set of classical principles handed down from ancient times. Citing the central teachings of the ancients serves to explain that seasonal changes must not be opposed, nor can they be forcibly replaced by human action.

Supplementary Annotations and Commentary on the Plain Questions of the Yellow Emperor’s Inner Classic, juan 43