《黃帝內經素問補註釋文》Vol. 47

The “Discourse on Acupuncture Methods” and the “Discourse on the Origin of Illnesses” have been lost. The New Collation holds that these two chapters were already missing before Wang Bing wrote his annotations. According to Wang Bing’s note at the end of the “Discourse on the Capacities of Illness,” the transmitted text of his time already lacked the seventh and second chapters; these are the two chapters in question. The works later circulated under the names “Lost Chapters of the Suwen” and “Treatise on Hidden Meaning in the Zhaoming Tradition” have been described by some as the lost chapters, but they are forgeries falsely attributed to Wang Bing. Their language and ideas are both shallow, and they are not worth trusting. Older editions placed this chapter after the “Discourse on the Six Qi’s Regular Cycles.” It was only later that someone moved it to its present position. Judging by the example of the lost chapters of the Book of Documents, whose titles are listed at the ends of the chapters to which they relate, the arrangement in the older editions is more reasonable.

Discourse on the Great Truth of the Supreme [Chapter One]

The Yellow Emperor asked: “I already understand how the Qi of the Five Phases interact and combine, and how their abundance and decline change. What are the circumstances of the Six Qi when each governs its season and oversees Heaven and Earth?”

Wang Bing’s note: The Five Phases govern the year, and each Qi waxes and wanes over the course of the year, so there is an alternating pattern of fullness and deficiency. The “Discourse on the Regular Cycles of the Heavenly Origin” says: “What is in excess at first later becomes deficient; what is deficient at first later becomes excessive.” This is what it means. The Qi between Heaven and Earth divides into six kinds, distributed across and governing the vast expanse: the third Qi governs Heaven, and the final Qi oversees Earth. From this arise the great patterns of growth and change in Heaven and Earth. Since the Six Qi that govern Heaven and Earth have been mentioned, the other four Qi can be inferred.

After bowing, Qibo replied: “Your question is clear and discerning! This is the great framework of how Heaven and Earth operate, and the principle by which the human body responds to Heaven and Earth.”

Wang Bing’s note: Although the changes of Heaven and Earth and the workings of the human body differ as outer and inner, the principle of their mutual response is the same.

The Yellow Emperor said: “I would like to know how one can accord above with the bright, visible signs of Heaven, and below with the deep, hidden patterns of Earth.”

Qibo answered: “This is the order governed by the Great Dao, and it is also what often puzzles physicians.”

Wang Bing’s note: Without understanding its essentials, one’s understanding becomes scattered and boundless.

The Yellow Emperor said: “I would like to hear its principles.”

Qibo said: “When Jueyin governs Heaven (the Qi of Jueyin Wind-Wood governs the seasons), the change it governs is wind.”

Wang Bing’s note: Wind Qi surges and blows, stirring forth harmonious Qi. In this way, the myriad things flourish or wither; their changes, successes, and failures are all affected by it.

Qibo said: “When Shaoyin governs Heaven (the Qi of Shaoyin Sovereign Fire governs the seasons), the change it governs is heat.”

Wang Bing’s note: Heat Qi rises in vapor, making the weather hot and humid, so the myriad things grow lush and dense.

Qibo said: “When Taiyin governs Heaven (the Qi of Taiyin Damp-Earth governs the seasons), the change it governs is dampness.”

Clouds and rain moisten all things, enabling bodily fluids—the water-based fluids within the body—to form.

When Lesser Yang governs Heaven, its Qi transformation manifests as Fire. Its heat blazes fiercely and can melt away cold.

When Yangming governs Heaven, its Qi transformation manifests as dryness. Dryness circulates and prevents all things from decaying through dampness.

When Greater Yang governs Heaven, its Qi transformation manifests as cold. This is called “the transformation of opposition to Yang.” The New Collation says: The detailed commentary reads “the transformation of opposition to Yang,” but the character “Yang” may be an error.

The position occupied by the Six Qi is used to determine which organ and location it affects, and what illnesses it causes. The liver belongs to Wood and is in the east; the heart belongs to Fire and is in the south; the spleen belongs to Earth and is in the center; the lungs belong to Metal and are in the west; and the kidneys belong to Water and are in the north. These are the fixed positions of the five organs. However, the Six Qi govern the Five Phases. When the Six Qi arrive, they cause illness if they are out of harmony with the Five Phases, and bring balance if they are in harmony. That is why the discussion first describes where the Six Qi arrive, and then the disorders of the five organs.

The Yellow Emperor asked, “How do the transformations of Earth Qi work?” Qibo replied, “They work just like the Qi that governs Heaven. The intermediate Qi—the Qi positioned to the left and right of the Qi governing Heaven and Earth—works the same way. Each of the Six Qi has its own fixed nature, so even when its position changes, its Qi transformations and governing functions remain the same.”

The Yellow Emperor asked, “What is meant by intermediate Qi?” Qibo replied, “The Qi governing the two sides of the positions of the Qi that governs Heaven and the Qi that governs Earth is called intermediate Qi.”

When the Six Qi are distributed, two of them generally govern Heaven and Earth, occupying the upper and lower positions. From this one can determine the auspicious and inauspicious conditions of the year, the Qi’s predominance and restoration, and the relationship between guest and host Qi, and so understand the changes throughout the year. The remaining four Qi occupy the positions to the left and right. Thus, the Treatise on the Correspondence of Yin and Yang says: “Heaven and Earth are above and below all things; left and right are the pathways along which Yin and Yang move.” This is what it means.

The Yellow Emperor asked, “How are they distinguished?” Qibo replied, “The Qi that governs the year is used to mark the year; intermediate Qi is used to mark the six periods of the year.”

A year has 365 and one-quarter days. Each period lasts 60 days and 87 and one-half ke. Adding together the days in each period makes up a year.

The Yellow Emperor said, “Well said. How does the host Qi of the year work?” Qibo replied, “When Jueyin governs Heaven, it governs the transformation of Wind. In Si and Hai years, Wind rises high and extends far; clouds drift and all things sway. These are manifestations of Wind Qi. When Jueyin governs Earth, it governs the transformation of sourness.

“In Yin and Shen years, Wood Qi governs Earth, so the transformations of all things arise from sourness.

“When the governing Qi is in effect, it governs transformations of the color azure. Ding and Ren years belong to the Wood phase of the Five Phases cycle, whose transformation is the color blue-green.

“Intermediate Qi governs transformations that set things in motion. Each Qi governs a period of 60 days and 87 and one-half ke.

“The New Collation says: On close examination, in Chou and Wei years Jueyin is the first Qi; in Zi and Wu years, the second Qi; in Chen and Xu years, the fourth Qi; in Mao and You years…”

When Lesser Yin governs heaven, it directs the seasonal climate and manifests as heat transformation.

In Zi and Wu years, the sunlight is bright and dazzling, and summer heat prevails. This is the manifestation of heat transformation. The character “yi” is pronounced “yang ru qie.”

When Lesser Yin is at the source, it directs the qi of the earth and manifests as bitter transformation.

In Mao and You years, Fire qi governs the qi of the earth, so all things first manifest a bitter taste.

Lesser Yin does not govern the transformation of the qi of the annual cycle. The New Commentary says: According to the “Great Treatise on the Heavenly Origin,” “Ruler Fire is defined by its name; Minister Fire by its position.” This means that Ruler Fire does not govern the qi of the annual cycle.

The qi in which Lesser Yin resides manifests as scorching transformation. Each qi lasts about sixty days and eighty-seven and a half ke. Ruler Fire, the principal Fire represented by Lesser Yin, occupies its proper position and is not counted among the intervening qi. The New Commentary says: On close examination, Lesser Yin is called “residing qi” rather than “intervening qi” because Ruler Fire is held in special esteem: it is considered to be everywhere and therefore should not be counted among the intervening qi. Wang’s commentary says that only when it occupies its proper position is it called “residing”; when it is elsewhere, it does not count as “residing” and may be classed as intervening qi. In Yin and Shen years, Lesser Yin occurs in the first qi; in Chou and Wei years, in the second; in Si and Hai years, in the fourth; and in Chen and Xu years, in the fifth.

When Greater Yin governs heaven, it manifests as dampness transformation.

In Chou and Wei years, dust gathers, the sky grows dim, and clouds and rain moisten the land. This is the manifestation of dampness transformation.

When Greater Yin is at the source, it manifests as sweet transformation.

In Chen and Xu years, Earth qi governs the qi of the earth, so sweet transformation appears first.

The qi governed by Greater Yin manifests as yellow transformation. “Jin” means yellow and refers to the qi of Earth’s annual movement; Jia and Ji years belong to Earth’s movement and are associated with yellow.

The intervening qi of Greater Yin manifests as softening transformation. When dampness qi prevails, all things become soft. The New Commentary says: On close examination, in Mao and You years, Greater Yin occurs in the first qi; in Yin and Shen years, in the second; in Zi and Wu years, in the fourth; and in Si and Hai years, in the fifth.

When Lesser Yang governs heaven, it manifests as Fire transformation.

In Yin and Shen years, the flames blaze fiercely, burning all things and leaving them scorched and withered. This is the manifestation of Fire transformation.

When Lesser Yang is at the source, it manifests as bitter transformation.

In Si and Hai years, Fire qi governs the qi of the earth, so bitter transformation appears first.

The qi governed by Lesser Yang manifests as red transformation. “Dan” means red; Wu and Gui years belong to Fire’s annual movement.

The intervening qi of Lesser Yang manifests as brightness transformation. “Brightness” means radiance; it is also called “rosy glow and scorching heat.” The New Commentary says: On close examination, in Chen and Xu years, Lesser Yang occurs in the first qi; in Mao and You years, in the second; in Yin and Shen years, in the fourth; and in Chou and Wei years, in the fifth.

When Yangming governs heaven, it manifests as dryness transformation.

In years of Mao and You, the weather is cool, clear, and crisp; fog and dew are scarce, and the climate is bleak. These are changes produced by Dryness Qi.

The Qi governing the Earth transforms into pungency. In years of Zi and Wu, Metal Qi governs the Earth, so pungency appears first.

The Qi governing the year’s fortune transforms into plainness, or the color white. Years of Yi and Geng belong to Metal’s movement.

The Qi that takes turns governing the different periods transforms into clarity. After the wind has passed, plants and trees appear cold and resilient. These are changes produced by Clear Qi.

The Newly Collated Commentary says: For details, see the years when Yangming Dryness Qi is in command. In years of Si and Hai, this occurs in the first period; in years of Chen and Xu, in the second; in years of Yin and Shen, in the fourth; and in years of Chou and Wei, in the fifth.

When Taiyang Cold Qi governs Heaven, it transforms into cold. In years of Chen and Xu, the climate is severe and harsh, bitterly cold and shivering, with things frozen hard. These are changes produced by Cold Qi.

The Qi governing the Earth transforms into saltiness. In years of Chou and Wei, Water Qi governs the Earth, so the transformation is described in terms of salty flavor.

The Qi governing the year’s fortune transforms into darkness, or the color black. Years of Bing and Xin belong to Water’s movement.

The Qi that takes turns governing the different periods transforms into storage, or concealment. Yin Qi gathers and grows cold, and all things draw in and contract. These are changes produced by Storage Qi.

The Newly Collated Commentary says: For details, see the years when Taiyang Cold Qi is in command. In years of Zi and Wu, this occurs in the first period; in years of Si and Hai, in the second; in years of Mao and You, in the fourth; and in years of Yin and Shen, in the fifth.

Therefore, those who treat illness must understand the transformations governed by each of the Six Qi, how the Five Flavors and Five Colors arise, and what is suited to each of the Five Viscera. Only with this knowledge can they discuss the waxing and waning of Qi transformations and trace how illness develops. Learning should never stop at what one has already acquired; one must keep adding to one’s knowledge and studying it repeatedly.

The Yellow Emperor said, “I already understand that when Jueyin governs the Earth, sourness appears first. What happens when Wind Qi moves across the Earth?”

Qibo replied, “Wind moving across the Earth is what is called the ‘root.’ The same principle applies to all the other Qi. When Jueyin governs the Earth, Wind Qi moves across it; when Shaoyin governs the Earth, Heat Qi moves across it; when Taiyin governs the Earth, Dampness Qi moves across it; when Shaoyang governs the Earth, Fire Qi moves across it; when Yangming governs the Earth, Dryness Qi moves across it; and when Taiyang governs the Earth, Cold Qi moves across it. So the same principle applies to all the other Qi.”

Here, “root” refers to the fundamental Qi on which the Six Qi depend. What takes Heaven as its root belongs to the Qi of Heaven; what takes Earth as its root belongs to the Qi of Earth. Changes that occur in Heaven are called Heavenly Qi; changes that occur on Earth are called Earthly Qi. The Newly Collated Commentary cites the Yijing: “What takes Heaven as its root tends upward; what takes Earth as its root tends downward.” This is what the passage means.

When the Qi of Heaven and Earth combine, the year is divided in sequence into six periods, and all things come into being through this process.

All things live between Heaven and Earth. They are generated and transformed by the Six Qi—Wind, Cold, Summer Heat, Dampness, Dryness, and Fire—and governed by the workings of Yin-Yang. Nothing can escape the laws of generation and transformation or the workings of Yin-Yang. Hence the saying: “Observe carefully whether the climate is suitable, and do not overlook the key factors in the onset of illness.” This is the point being made. The mechanisms by which illness arises will be explained in detail later.

The Yellow Emperor asked: “What kinds of illness are medicines chiefly used to treat, and how should we determine this?”

Qibo replied: “When gathering medicines, prepare them according to the qi of the year—that is, the climate patterns that predominate each year. This ensures that the main medicines needed for that year are not overlooked. Carefully observe the qi governing Heaven and the qi governing Earth, which rule respectively over the first and second halves of the year, and you can tell whether the flavors and qi of the medicines generated that year suit its particular character. Medicines gathered specifically according to the qi of the year have relatively pure properties. When used, they accord with that year’s proper qi and flavors, allowing them to fully exert their therapeutic effects. A commentary notes here that the character ze may perhaps be corrected to yong.”

The Yellow Emperor asked: “What is meant by ‘medicines that precede the year’?”

Qibo replied: “These are medicines generated by the refined and concentrated qi of Heaven and Earth. Medicines generated by such refined and concentrated qi have a rich substance and potent medicinal power. When used, they also correspond to the proper qi and flavors of that year.” A later textual note suggests that “precede the year” may perhaps be a correction of “govern the year.”

The Yellow Emperor asked: “What is meant by ‘qi that governs’?”

A commentary explains that this refers to the qi that governs the annual cycle.

Qibo replied: “Medicines associated with the governing qi are the same as those associated with the ruling year, and are likewise affected by whether the annual cycle’s qi is excessive or deficient. When the Five Phases—Wood, Fire, Earth, Metal, and Water—govern a year, the qi may be excessive in some years and deficient in others. The medicines generated in a given year may consequently be less potent. Medicines generated when the qi of the year is concentrated and refined are purer.”

The Yellow Emperor asked: “What is the condition of medicines that do not belong to those associated with the governing year?”

Qibo replied: “Their qi is more dispersed. When the qi is dispersed, the medicines’ properties are impure. Thus, even when their shape and substance are the same, their effects differ. Medicines may be similar in form and substance yet vary in strength, so they cannot be selected by appearance alone. Their qi and flavors may be strong or mild, their properties may be forceful or gentle, the doses needed to regulate them may be large or small, and the depth of their effects may also vary. That is what this refers to.”

The Yellow Emperor asked: “What effects follow when medicines do not accord with the qi of the year?”

The Yellow Emperor then asked again: “When the qi of the year takes the lead, how can we determine the harm it causes?”

Qibo replied: “The key is to name it according to the phase that overcomes it within the Five Phases. For example, Wood is overcome by Metal, and Metal is overcome by Fire; the pattern can be determined according to these relations of overcoming.”

The Yellow Emperor asked: “How should it be treated?”

Qibo replied: “When the qi of Heaven descends and encroaches upon the qi of Earth, use the force that can restrain it to restore balance. When an external qi of Earth enters the body, treat it with the force that can restrain it. ‘Excessive influence’ refers to qi extending into a domain where it cannot prevail. The downward influence of Heaven’s qi is the effect of the heavenly climate; the entry of external qi into the body is the effect of the earthly climate. Treatment should follow the relations of overcoming and restraint to restore balance. Here, ‘overcoming’ means selecting the Five Flavors and medicinal properties such as cold, hot, warm, or cool according to the illness. This will be explained in more detail later.”

When an excess of disruptive Qi is concentrated in one part, it need only be harmonized and balanced. That is why the text says “balance” rather than “treat.”

The Yellow Emperor said, “Good. How can Qi be restored to balance?”

“Balancing” means examining whether Qi is in balance.

Qibo said, “Carefully examine the condition of Yin and Yang in each location, then regulate them accordingly, with the aim of restoring balance. When the pattern of illness agrees with the pulse, use the ordinary method of treatment; when the pattern of illness opposes the pulse, use the contrary method.

“Only by understanding where Yin and Yang are located can you judge whether the pulses at the cun and kou, and at the renying, correspond. Without knowing their locations, you may mistake what is normal for abnormal and what is contrary for favorable. So they must be examined carefully.

“When there is a Yin illness but the Yang pulse is unaffected, or a Yang illness but the Yin pulse is unaffected, this is an ordinary pattern and should be treated by the ordinary method: use cold medicines for heat patterns and warm medicines for cold patterns. When a Yang pulse appears in a Yin location, or a Yin pulse in a Yang location, this is called a contrary pattern and should be treated by the contrary method: use cold to treat cold, and heat to treat heat. The principles for ordinary prescriptions do not always apply in this way. That is why a contrary pattern calls for the contrary method.”

The Yellow Emperor said, “You have said that we should examine where Yin and Yang are located, then regulate them accordingly. The Treatise says that the renying and cun-kou pulses correspond like a taut cord, equal in size on both sides; this is called balance.”

The editorial note to the new edition says, “The passage in the Treatise from ‘the renying and cun-kou pulses correspond’ to ‘this is called balance’ comes from the Spiritual Pivot. The Jia Yi Jing records: the cun-kou pulse governs the interior of the body, while the renying pulse governs the exterior. The two pulses correspond and move in unison, equal in size like a taut cord. In spring and summer, the renying pulse is slightly larger; in autumn and winter, the cun-kou pulse is slightly larger. This is called balance.”

The Yellow Emperor asked, “What should the cun-kou pulse be like when Yin Qi is located there?”

“Where Yin Qi is located, the pulse is deep and hidden, difficult to detect. So judging balance by whether the pulses on both sides are equal in size does not fully apply. The Yellow Emperor asked this question to make the principle clear.”

Qibo said, “By observing whether the current year is governed by the southern or northern administration, you can know.” The Yellow Emperor said, “Please explain in detail.”

Qibo said, “In a year governed by the northern administration, if Shaoyin is in charge at the spring, the cun-kou pulse will fail to respond. In years governed by the Wood, Fire, Metal, or Water phases, Qi receives its command facing north. For any Qi in charge at the spring, its pulse may be difficult to detect; the pulses for the Qi on either side of it can be detected. When the Qi in charge at the spring is normal, its pulse is not apparent; only when it is abnormal may the pulse become apparent. The illness should be judged according to the relationship between the Qi of the season, guest Qi, and host Qi, as well as any excess of Qi. The same applies to Qi in the heavens.

“When Jueyin is in charge at the spring, the pulse on the right fails to respond, because Shaoyin is to its right.

“When Taiyin is in charge at the spring, the pulse on the left fails to respond, because Shaoyin is to its left.

“In a year governed by the southern administration, if Shaoyin is in charge of the heavens, the cun-kou pulse will fail to respond. In a year governed by the Earth phase, commands are issued while facing south. Therefore, when Shaoyin is in charge of the heavens, the cun-kou pulses at both wrists fail to respond.”

When Jueyin governs Heaven, the pulse on the right may seem unresponsive; when Taiyin governs Heaven, the pulse on the left may seem unresponsive. This also explains how the pulse corresponds to the left and right sides.

Whenever a pulse seems unresponsive, it can be clarified by examining it with the hand turned over: the pulse that initially seemed unresponsive will then become apparent. “Unresponsive” always refers to a pulse that is sunken and concealed. When the pulse is sunken, taking it with the palm facing upward makes it feel deep. Turn the hand over and take the pulse again: the deep pulse will appear floating, and a fine pulse will appear large.

The Yellow Emperor asked, “What are the pulse signs at the wrist?” Qibo replied, “In years of Northern Governance, when the Qi of the three Yin is below, the pulse at the inch position is unresponsive; when the Qi of the three Yin is above, the pulse at the cubit position is unresponsive.”

“Governing Heaven” means the Qi above, and “being at the Spring” means the Qi below. In years of Southern Governance, when the Qi of the three Yin is in Heaven, the inch pulse is unresponsive; when the Qi of the three Yin is at the Spring, the cubit pulse is unresponsive. The same applies on both the left and right sides. When the cubit pulse is unresponsive, the method for assessing the pulses on the left and right at the inch position is the same as when the inch pulse is unresponsive.

That is why it is said that someone who understands the essential point can explain it in a single sentence, while someone who does not understand it becomes confused and talks on without end. The essential point here is to determine where the Yin and Yang Qi are located. Once this is understood, it can be applied correctly in pulse diagnosis without causing confusion. Without it, the floating or sunken, large or small qualities of the inch and cubit pulses often change every three years. Trying to understand why is like circling around a tree branch: even after studying until one’s hair turns white, one may still not know which way to go—let alone after only ten days or half a month of study.

The Yellow Emperor said, “Well said. What happens when the Qi of Heaven and Earth enters the human body and causes illness?” Qibo replied, “In years when Jueyin is at the Spring, if wind becomes excessive and dominant, the Qi of the Earth grows dim; the open country turns gloomy, and plants head and flower early. People experience bouts of shivering and often stretch their bodies and yawn. They may have heart pain and a tense, distended feeling in the ribs and flanks; food is difficult to swallow, and the chest, diaphragm, and throat feel obstructed. After eating, they may vomit, feel abdominal distension, and belch repeatedly. After passing stool or gas, they feel somewhat relieved, as though the illness has eased, but their bodies also feel heavy.”

The years when Jueyin is at the Spring include 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. “The Qi of the Earth is dim” means that the sky near the boundary between Heaven and Earth is dark. Wind moves over the ground, so the open country also appears gloomy. “Mei” means dim or dark. “Flanks” refers to the areas below the breasts and to either side of the torso; “stretch” means wanting to extend and loosen the sinews and bones.

The New Corrected Edition notes that, according to the Jiayi Jing, “bouts of shivering, frequent stretching, and repeated yawning” are signs of stomach illness; “vomiting after eating, abdominal distension, belching, relief after passing stool or gas, and bodily heaviness” are signs of spleen illness; and difficulty swallowing, with obstruction in the chest, diaphragm, and throat, indicates that the pathogenic Qi is in the stomach region. The general idea is that in years when Jueyin is at the Spring, Wood Qi is strong and overacts on the Earth of the spleen and stomach, producing these symptoms.

“Vomiting as soon as one eats” occurs because food has accumulated in excess and filled the stomach, so it overflows upward.

“When one passes stool and then releases gas, one feels relieved, as though the illness has eased” occurs because in the twelfth month, Yin Qi declines downward and Yang Qi is about to rise. Thus, after passing stool and releasing gas, one feels relieved, as if the illness has eased.

In years when Lesser Yin Qi (Shaoyin) governs at the spring, if pathogenic heat becomes excessive, it makes fire Qi surge upward, as though flames were burning over rivers and lakes; places shaded from the sun seem bright instead. People may experience frequent rumbling in the abdomen, Qi surging up into the chest, panting and an inability to stand for long, chills and fever, painful skin, blurred vision, toothache, and swelling of the neck. They may also have pain in the lower abdomen and abdominal distension, while hibernating creatures no longer remain concealed.

This refers to the years Yimao, Dingmao, Jimao, Xinmao, and Guimao, as well as Yiyou, Dingyou, Jiyou, Xinyou, and Guiyou. “Shaded places” means the northern regions sheltered from the sun. “Unable to stand for long” means weakness in the feet. “Abdominal distension” means that Heart Qi is deficient. These conditions arise because Metal Qi and Fire Qi press against one another.

The New Collation says: According to the Jia Yi Jing, toothache and swelling of the neck belong to disorders of the Large Intestine. Rumbling in the abdomen, Qi surging into the chest, and panting with an inability to stand for long indicate that pathogenic Qi is in the Large Intestine. This is probably because, in years when Lesser Yin governs at the spring, Fire overcomes Metal, making the Large Intestine prone to illness.

In years when Greater Yin Qi (Taiyin) governs at the spring, plants flourish early.

The New Collation says: On close examination of the four characters “plants flourish early,” they appear to be an interpolation.

When pathogenic Dampness becomes excessive, it makes dust and mist obscure the mountain valleys. Earth Qi, which should appear yellow in the sky, instead appears black in the north. This is a sign that Earth Qi and Water Qi have converged. People may experience accumulations of fluid, Heart pain, deafness, roaring and muffled sounds in the ears, swelling of the throat, and throat obstruction. Disorders of the genitals may also involve bleeding, along with lower abdominal pain and swelling, and inability to urinate. When the illness surges upward, it causes headache, a sensation that the eyes are about to protrude, a feeling that the neck is being pulled upward, and a sensation that the lower back is about to break. The thighs cannot turn; the hollows behind the knees feel bound with a knot, while the calves hurt as if being pulled apart.

This refers to the years Jiachen, Bingchen, Wuchen, Gengchen, and Renchen, as well as Jiaxu, Bingxu, Wuxu, Gengxu, and Renxu. Greater Yin belongs to Earth, whose corresponding color is yellow. It should therefore appear in the center of the sky, but instead appears in the north, the direction associated with black. Water and Earth Qi appear together, so this is called the “convergence of utmost Yin,” meaning that the colors of the two kinds of Qi combine. “Surging headache” means pain from the back of the head to the space between the eyebrows. “Guo” refers to the hollow at the back of the knee, and “tuan” to the soft muscle at the back of the lower leg.

The New Collation says: According to the Jia Yi Jing, deafness, roaring and muffled sounds in the ears, swelling of the throat, and throat obstruction belong to disorders of the Triple Burner. Headache surging upward, a sensation that the eyes are about to protrude, a feeling that the neck is being pulled upward, a sensation that the lower back is about to break, inability to turn the thighs, and a feeling that the hollows behind the knees are bound with a knot…

When the calf muscles cramp and tighten, as if bound by a rope, this is a disorder of the Foot Taiyang Bladder Channel. Other symptoms include swelling and pain in the lower abdomen and inability to urinate. The pathogenic influence is in the Triple Burner—the upper, middle, and lower pathways through which Qi moves, according to Chinese medicine. These disorders occur because, in years when Taiyin governs the heavens and is in the earthly position, Earth Qi is excessive and restrains the Taiyang Channel. The character “guo” is pronounced by combining the sounds “ge” and “mai.”

In years when Shaoyang is in the earthly position, excessive Fire Qi becomes dominant, and flame-like brightness spreads across the countryside. People develop alternating chills and fever. They may also have diarrhea, red and white mucus in the stool, lower abdominal pain, and reddish urine; in severe cases, there is blood in the stool. These symptoms are the same as those that occur when Shaoyin is in the earthly position.

The years referred to here are the Yi-Si, Ding-Si, Ji-Si, Xin-Si, Gui-Si, Yi-Hai, Ding-Hai, Ji-Hai, Xin-Hai, and Gui-Hai years. As the weather turns cold, heat appears in alternation: when the heat passes, the cold follows. This is why it is called “geng zhi,” or “arriving in turn.” The other symptoms are the same as those associated with Shaoyin in the earthly position.

In years when Yangming is in the earthly position, excessive Dryness Qi becomes dominant, bringing hazy skies and a clear, chilly atmosphere. People are prone to vomiting, with bitter-tasting vomit, and often sigh. They experience pain around the heart and in the ribs, and cannot turn over. In severe cases, the throat becomes dry, the face looks as if covered in dust, the skin loses its moisture, and the outer sides of the feet become unusually hot.

The years referred to here are the Jia-Zi, Bing-Zi, Wu-Zi, Geng-Zi, Ren-Zi, Jia-Wu, Bing-Wu, Wu-Wu, Geng-Wu, and Ren-Wu years. “Mengwu” refers to dim skies, as if obscured by fog; “qing” means clear and chilly, or slightly cold. In other words, fog rises and the sky grows so dim that objects are hard to make out, while the weather is slightly cold. “Pain in the heart and ribs” means pain around the heart and in the rib area; “dusty face” means a complexion that looks as though it is coated in dust.

The Xin Jiaozheng commentary says that, according to the Jia Yi Jing, nausea and vomiting with bitter-tasting vomit, frequent sighing, pain in the heart and ribs, inability to turn over, and, in severe cases, a dusty-looking face, loss of moisture in the body, and heat along the outer sides of the feet are signs of Gallbladder disease. A dry throat and a dusty-looking face are signs of Liver disease. These disorders occur because Metal Qi is strong in years when Yangming is in the earthly position and restrains Wood Qi.

The Mai Jie also explains that pain in the heart and ribs in Shaoyang disease arises because Shaoyang Qi is strong. When Shaoyang is strong, Heart Qi is relatively weak. In the ninth month, Yang Qi has vanished and Yin Qi is flourishing, which is why pain occurs in the heart and ribs. The inability to turn over is due to Yin Qi gathering in and enclosing all things. Since things are gathered in and cannot move, a person likewise cannot turn over.

In years when Taiyang is in the earthly position, excessive Cold Qi becomes dominant, bringing freezing cold and a bleak, bitterly harsh atmosphere. People experience pain in the lower abdomen that pulls toward the testicles. The pain extends to the lower back and spine and surges upward, causing heart pain. Other symptoms include bleeding, a sore throat, and swelling of the lower jaw.

The years referred to here include the Yi-Chou, Ding-Chou, Ji-Chou, Xin-Chou, Gui-Chou, Yi-Wei, Ding-Wei, Ji…

In years designated by the earthly branches Wei, Xin, and Gui, when Cold Water governs Heaven and is present below, cold envelops the sky, congeals, and ceases to flow. All things consequently become quiet and still. “Grim and shivering” describes extreme cold. “Drawing pain” means pain that pulls along a pathway; “testicles” refers to the testes; and “jaw” refers to the lower jaw.

The New Corrected Edition cites the Jia Yi Jing: pain in the throat and swelling of the jaw belong to disorders of the small intestine. Pain in the lower abdomen that pulls into the testicles and extends to the lower back, then surges upward to the heart and lungs, indicates that pathogenic Qi has lodged in the small intestine. This is probably because, in years when Taiyang is present below, Water Qi restrains Fire Qi, giving rise to these kinds of symptoms.

The Yellow Emperor asked, “Well said. How should these conditions be treated?” Qibo replied:

When pathogenic influences from the climate are present below and cause illness, if Wind Qi is excessive and invades the body, treat it with pungent, cool medicines, assist them with bitter medicines, moderate them with sweet medicines, and disperse them with pungent medicines. Wind favors warmth and dislikes coolness, so cool medicines restrain it; bitter medicines assist by following what suits its nature. When Wood Qi is tense, sweet medicines moderate it; when it is constrained, pungent medicines disperse it. The Treatise on the Qi of the Organs and the Seasons says, “When the Liver’s Qi suffers from tension, promptly use sweetness to moderate it; when the Liver’s Qi needs to be dispersed, promptly use pungency to disperse it.” This is what the passage means. Here, shi means “to feed”: when one eats oneself, it is called shi; when one gives food to another, it is called si. This is the general principle for using medicines; an actual prescription need not include every measure. One or two assisting medicines are enough, and they should be stopped once the illness is cured. The methods for treating other pathogenic influences are broadly similar.

If Heat is excessive and invades the body, treat it with salty, cold medicines, assist them with sweet and bitter medicines, then use sour medicines to astringe and bitter medicines to disperse. Heat dislikes cold, so cold medicines are used to treat it. If Heat is especially strong, particularly at the body’s surface, use bitter medicines to disperse it; if pathogenic Heat remains, restrain it with cold medicines. If it is still not cleared after being restrained with cold medicines, use bitter medicines to disperse it and sour medicines to astringe. For a severe condition, this method may be repeated once; for a milder one, use it once. If the condition comes and goes, use sour medicines to astringe.

If Dampness is excessive and invades the body, treat it with bitter, warm medicines, assist them with sour and bland medicines, then use bitterness to dry the Dampness and blandness to promote drainage. Dampness and dryness oppose one another, so bitter, warm medicines treat Dampness, with sour and bland medicines to assist them. Drying properties can eliminate Dampness, so bitterness is used to dry it. Blandness can open and facilitate the body’s orifices, so it is used to drain water and Dampness. The Treatise on the Qi of the Organs and the Seasons says, “When the Spleen suffers from Dampness, promptly use bitterness to dry it.” The Ling Shu Jing says that blandness can open and facilitate the body’s orifices. The Treatise on the Vital Qi Reaching Heaven says that when bitterness is excessive, the Spleen Qi can no longer moisten, and the Stomach Qi becomes congested and thickened. This shows that bitterness has a drying effect.

The New Corrected Edition also cites the Treatise on the Six Cycles and the Regularities of the Periods: “When Taiyin is present below, its Qi transformation tends toward sweetness and warmth.”

When Fire qi is excessive within the body, treat it with salty and cooling substances, assist with bitter and pungent flavors, and use sour flavor to astringe. When necessary, bitter flavor may also be used to disperse.

“Fire prevailing within” refers to an excess of fiery heat in the body. The phrase “arising from the heart, the abdomen, and anger in the heart” means that these disorders often arise from hyperactive Heart Fire and inner agitation or anger. Salty flavor has a softening and moderating effect, so it is used for treatment; sour flavor has an astringent effect and can therefore gather and contain. In general, treatment depends on whether the patient needs to sweat. If sweating is needed, pungent flavor may be used as an aid, but bitter flavor need not be relied on to induce sweating. To soften an excessive condition, use salty flavor. The “Treatise on Regulating the Zang by the Seasons” says: “When Heart qi is tense and urgent, quickly use salty flavor to soften it; when Heart qi is scattered, quickly use sour flavor to astringe it.” This is the principle being described.

When Dryness qi is excessive within the body, treat it with bitter-flavored, warm-natured substances, assist with sweet and pungent flavors, and then use bitter flavor to promote free passage, allowing the Dryness pathogen to be expelled. Warm nature promotes the movement of what is cool, so bitter flavor is used in treatment. Here, “downward” means to promote free passage and enable the pathogenic qi to be discharged.

The “New Corrected Edition” says: The “Treatise on Regulating the Zang by the Seasons” records that when Lung qi counterflows upward, bitter flavor should quickly be used to drain it, pungent flavor to disperse and purge it, and sour flavor to supplement it. Also, in the passage below, “When Dryness prevails under the governance of the celestial influence,” the assisting flavors are listed as sour and pungent. The character “sweet” here may therefore have been intended to read “sour.” When the “Great Treatise on the Heavenly Origin and Cycles” discusses this passage, it also says to use sour flavor to astringe and stabilize the lower body; when the condition is severe, use bitter flavor to drain it.

When Cold qi is excessive within the body, treat it with sweet-flavored, hot-natured substances, assist with bitter and pungent flavors, then use salty flavor to purge the Cold pathogen, pungent flavor to moisten, and bitter flavor to firm.

Hot-natured substances are used to treat Cold patterns in order to suppress the Cold pathogen and diminish its force, preventing the Cold from growing and flourishing. Bitter and pungent flavors serve as aids, opening the flow and driving the action of the medicines.

The “New Corrected Edition” says: The “Treatise on Regulating the Zang by the Seasons” records that when Kidney qi is dry, pungent flavor should quickly be used to moisten it. When Kidney qi is weak and needs to be firmed, bitter flavor should quickly be used to firm it, with bitter flavor to supplement and salty flavor to purge. The old commentary placed this quotation after “Dampness prevailing within,” where it did not fit the meaning. It has now been moved here.

The Yellow Emperor said, “Good. What happens when the qi of the seasons changes?”

Qibo said, “When Jueyin governs the heavens—that is, when the wind-Wood qi of Jueyin rules the first half of the year—and the wind qi becomes excessive, dust darkens the sky and clouds churn in disorder. Cold qi arises, and spring qi circulates, yet rivers do not freeze. People may experience pain in the epigastrium and around the heart, with pain drawing upward into the flanks; obstruction in the chest, diaphragm, and throat; and difficulty swallowing food. The root of the tongue becomes stiff, and eating causes vomiting. Other symptoms include cold diarrhea, abdominal distension, loose stools, accumulations, and obstruction of fluids. Hibernating creatures are unable to emerge from the earth. The root of the illness lies in the Spleen.

“The years referred to here are the Yi-si, Ding-si, Ji-si, Xin-si, and Gui-si years, as well as the Yi-hai, Ding-hai, Ji-hai, Xin-hai, and Gui-hai years. In these years, illnesses are mostly concentrated in the middle of the body.”

When the celestial bodies move, dust rises in space and the wind blows with it, making clouds and all kinds of scenery appear confused and drifting.

“Dust” refers to blue-green particles of earth. When dust fills the air, distant objects become hard to see. Illness caused by turbid Earth Qi commonly takes the form of diarrhea. If fluids stagnate, urination becomes blocked. Severe diarrhea may also cause excessive menstrual bleeding, or even make menstruation stop altogether.

The Newly Collated Commentary says that, according to the Jia Yi Jing, a stiff tongue root, vomiting upon eating, abdominal distension, loose stools and diarrhea, masses in the abdomen, and blocked fluids all belong to Spleen disorders. The Jia Yi Jing also says that Stomach disorders may involve abdominal fullness, pain in the epigastrium over the heart, pain drawing upward into both flanks, obstruction of the diaphragm and throat, and difficulty swallowing food. These symptoms occur because in years when Jueyin governs Heaven, Wood Qi is strong and restrains Earth Qi.

If the Chongyang pulse is severed, there is no remedy.

The Chongyang point lies on the top of the foot, where a pulsating vessel can be felt by pressing. The Chongyang pulse represents Stomach Qi: when it is weak, appetite declines; when its Qi is severed, neither medicine nor food can be taken in, and even if treatment is forced, it will be vomited back up. Treatment cannot take effect, and nourishment cannot restore the body. The pathogenic Qi grows stronger day by day while the true Qi within is depleted; death is therefore inevitable, and there is no way to save the patient.

In years when Shaoyin governs Heaven, pathogenic Heat prevails, its force becomes pent up, and Fire rules. People are prone to illness, with symptoms such as vexation and heat in the chest, a dry throat, fullness in the right flank, skin pain, chills and fever, coughing, and labored breathing. When heavy rain is imminent, there may also be vomiting of blood, blood in the stool, nasal congestion and discharge, nosebleeds, sneezing, vomiting, and changes in the color of the urine. In severe cases, sores and swelling may appear, with pain in the shoulders, back, upper arms, forearms, and supraclavicular area, as well as heart pain, distension in the lungs, abdominal swelling and fullness, wheezing, and coughing. The root of this illness lies in the Lung.

The years referred to here are Jiazi, Bingzi, Wuzi, Gengzi, and Renzi, as well as Jiawu, Bingwu, Wuwu, Gengwu, and Renwu. When Shaoyin governs Heaven, Heat becomes pent up and Fire takes charge, so people develop the symptoms described above. The symptoms occur mostly on the right side because the Small Intestine is connected with the Heart. The root of the illness lies in the Lung, hence the statement, “The illness has its root in the Lung.”

The Newly Collated Commentary says that, according to the Jia Yi Jing, changes in the color of the urine, pain in the shoulders, back, upper arms, forearms, and supraclavicular area, abdominal distension and fullness, and wheezing with cough all belong to Lung disorders; nasal congestion and discharge, and nosebleeds, belong to Large Intestine disorders. These symptoms occur because in years when Shaoyin governs Heaven, Fire restrains Metal. Wang Bing’s commentary explains that the symptoms occur mostly on the right side because the Small Intestine is connected with the Heart. But the Jia Yi Jing records that the Large Intestine runs close to the spine and curves around to the left, while the ileum runs close to the spine and curves around to the right, so this explanation seems inconsistent. Perhaps the force of Fire becomes strong and restrains Metal, causing the Large Intestine to become ill.

If the Chize pulse is severed, there is no remedy.

The Chize point lies in the inner crease of the elbow. A pulse can be felt beneath the fingers there; this is where Lung Qi is reflected. The Lungs correspond to Metal. When Metal Qi is scorched by Fire Qi and is also affected by the season, Lung Qi is cut off within the body, so the illness is bound to be critical.

If no pulse can be felt at Chize, Lung Qi has already become depleted. The circulation of nutritive Qi and defensive Qi has also lost its governing force, and the body’s true Qi is exhausted. Life can then scarcely be sustained.

When Taiyin governs the heavens—that is, when the damp Earth Qi of Taiyin, one of the Six Qi, rules the season—dampness becomes excessive. Cold, damp Qi spreads everywhere, rainfall becomes abnormal, and plants wither. People may develop swelling, bone pain, and Yin impediment (painful obstruction caused by cold Yin and damp pathogens, difficult to detect by pressing). They may also have pain in the lower back, back, head, and neck, and sometimes dizziness. Bowel movements become difficult; Yin Qi cannot function normally, and people feel neither hunger nor any desire to eat. Coughing and expectorating may bring up blood, and the heart feels unsettled, as though suspended. The root of the illness lies in the Kidneys.

This refers to the years 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. “Sinking” means that something has become stagnant for a long time. When the Kidneys are invaded by a pathogen, fluids fail to moisten the lower burner—the lower part of the body, including the Kidneys and bladder—and dryness results, making bowel movements difficult.

The “Newly Corrected Edition” quotes the Jia Yi Jing: Kidney disease causes loss of appetite, coughing and expectoration with blood, and a hollow, unsettled feeling in the heart, like hunger. When a pathogen enters the Kidneys, it can also cause bone pain and Yin impediment. The pain of Yin impediment is difficult to detect by pressing, and may be accompanied by abdominal distension, lower back pain, difficult bowel movements, stiffness and pain in the shoulders, back, and neck, as well as dizziness. These symptoms arise because, in a year when Taiyin governs the heavens, Earth Qi restrains Water Qi.

When the pulse at Taixi ceases, there is no treatment that can help.

The Taixi point lies behind the inner ankle, above the heel bone. A pulse can be felt beneath the fingers there; this is where Kidney Qi is reflected. The Earth pathogen overpowers Water Qi, cutting off Kidney Qi within the body. The pathogen is strong and the body’s healthy Qi is weak, so there is no way to save the patient.

When Shaoyang governs the heavens—that is, when the ministerial Fire Qi of Shaoyang, one of the Six Qi, rules the season—Fire Qi becomes excessive, warm and hot Qi prevails, and Metal Qi cannot function normally. People may have headaches and fever, feel cold, or suffer malaria-like bouts of alternating chills and fever. Heat surges to the skin, causing pain and a yellow or red discoloration. As the illness progresses, swelling may develop: the body and face become puffy, the abdomen distends, and breathing becomes difficult when lying on one’s back. Diarrhea may also occur, with red and white discharge. Sores may appear; coughing and expectorating may bring up blood; the heart feels restless, and the chest becomes intensely hot. In severe cases, the nose may become blocked or bleed. The root of the illness lies in the Lungs.

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. When Fire Qi is in command, the Lungs correspond to Metal, and Metal Qi is disturbed by the pathogen; hence it is said that Metal Qi cannot function normally. Fire and heat flare upward and invade the Lungs, while the body’s Water Qi cannot restrain the heat. This gives rise to the symptoms described above. If the excessive Fire pathogen can be subdued, the illness will subside.

The “Newly Corrected Edition” quotes the Jia Yi Jing: A pathogen in the Lungs causes skin pain and alternating chills and fever. This is because, in a year when Shaoyang governs the heavens, Fire Qi restrains…

Therefore, disease manifestations will appear in this way.

When the pulse qi at the Tianfu (Heavenly Storehouse) point is cut off, the person will die and cannot be saved. The Tianfu point lies on the inner side behind the elbow, three cun below the armpit (“cun” are proportional body measures taken on the same person). The pulse here should be palpable and responsive, reflecting lung qi. When fire qi is strong and the lung-metal pulse is severed, death follows.

When Yangming governs heaven (Yangming dry-metal qi presides over the climate of the first half of the year), excessive dryness delays the flourishing of wood qi and delays the sprouting of vegetation. Changes occur within the sinews and bones; people feel pain in the left hypochondriac region and cold inside the body, and after contracting cold evil they develop malaria.

When the weather turns abruptly and severely cold, people cough, the abdomen rumbles, and they have watery diarrhea or loose stools. This is called “the named wood gathers and flourishes below”: trees hold in their vitality, and the generative qi of plants stagnates underground and cannot rise. Above, plants wither and scorch. In humans there may be sudden severe pain in the heart and hypochondrium and inability to turn over, dry throat, dark complexion, and low back pain; men develop yong shan (hernia-like illness), and women have lower abdominal pain. There may also be dim vision, sores at the corners of the eyes, acne, or abscesses and swellings. Hibernating insects may appear ahead of season. The root of these illnesses lies in the liver.

The years in question are 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. Metal qi overcomes wood qi, so vegetation flourishes and grows late. In the body, wood qi corresponds to sinews and bones, so sinews and bones are affected and movement is hindered.

When great cold qi alters the seasonal climate, people feel cold within; if they further contract cold evil, they develop jie malaria (recurrent malaria). The large intestine is on the right side of the body, and lung qi communicates with it; when lung qi invades inward, it affects the liver on the left, so the left hypochondrium feels as if pierced and cut.

If in that year people often have diarrhea, they will instead not suffer the diseases caused by excessive dryness. Great cold qi is close to cold; when cold is excessive, yang qi cannot circulate, wood qi contracts, and plants also sprout late. Generative qi was rising but is blocked because yang qi cannot be expressed, and it stagnates below. In the body, there is pain in the lower abdomen; pathogenic factors accumulate there and break out in midsummer. Sores and ulcers may persist into mid-autumn: the upper body tends to develop acne, the lower body abscesses and swellings. Though the sores are red, the center is white—this is a common pattern in seasonal color and sign.

New correction note: According to the Jia Yi Jing, inability to bend and stretch at the waist, male yong shan, female lower abdominal swelling and pain, and in severe cases dry throat and dark complexion, belong to liver disease; chest fullness and diarrhea also belong to liver disease. Pain in the chest and heart with inability to turn over, detachment or sores at the corners of the eyes, swelling and pain in the quepen (supraclavicular fossa), axillary swelling shaped like a saber (scrofula-like lesions), sweating, chilliness, and malaria belong to gallbladder disease. In years when Yangming governs heaven, metal overcomes wood, so these manifestations appear. The Pulse Explained also records that Jueyin channel syndromes include yong shan and disorders of the female lower abdomen.

Swelling corresponds to Jueyin, which in turn corresponds to the Chen month, or the third lunar month. In the third month, Yang Qi gradually grows stronger, yet Yin Qi remains within it, so pathogenic Qi stays in the body.

This can lead to a scrotal hernia or a similar disorder, with swelling in the lower abdomen.

If the pulse at the Great Rushing point disappears completely, the person will die and cannot be saved.

The Great Rushing point lies about two cun behind the joint at the base of the big toe. Its pulse can be felt there, and it reflects Liver Qi. When Metal Qi overcomes Wood Qi, Liver Qi is cut off within the body. True Qi can no longer overcome pathogenic Qi, and this outcome becomes unavoidable.

When Taiyang governs the heavens—that is, when the cold Water Qi of Taiyang governs the year’s climate—excessive cold brings severe, abnormal chill. Rivers freeze, and the Qi and Blood in the body also undergo changes, giving rise to abscesses and sores in the skin or muscles. People may suffer from Heart reversal pain, vomit blood, pass blood in the stool, have nasal congestion or nosebleeds, and become prone to sadness. At times, they may feel dizzy and fall. If the year also has a strong Fire phase in its cycle, Fire Qi blazes fiercely and may bring torrential rain, with raindrops even freezing into hail. Common symptoms include fullness and distension in the chest and abdomen, heat in the palms, spasms in the elbows, swelling in the armpits, palpitations, discomfort in the chest, flanks, and upper abdomen, a flushed face and yellow eyes, frequent belching, and a dry throat. In severe cases, the face turns dark and the person becomes thirsty. The root of these illnesses lies in the Heart.

This passage refers to the years Jiachen, Bingchen, Wuchen, Gengchen, and Renchen, as well as Jiaxu, Bingxu, Wuxu, Gengxu, and Renxu. Taiyang governs the heavens in these years, and cold Qi dominates the climate, so water freezes and Qi and Blood congeal. When Defensive Qi gathers between the skin layers, abscesses and sores may form. If a strong Fire phase also occurs, Fire and Water contend, bringing torrential rain whose drops freeze into rounded pellets of hail.

When Heart Qi surges upward, it causes belching, so belching may become frequent. In these years, people’s illnesses tend to affect the Heart and flanks. Yang Qi becomes constrained within the body, while Dampness steams upward from below. This can lead to Heart reversal pain, vomiting blood, blood in the stool, nasal congestion or nosebleeds, a flushed face and yellow eyes, frequent belching, hot hands, elbow spasms, swollen armpits, and a dry throat. In severe cases, cold Qi suppresses Yang Qi and Water Qi overcomes Fire Qi. Fire Qi is then constrained within the body, causing thirst. The illness begins in the Heart because Yin cold encroaches upon Heart Yang; hence the saying, “The root of the illness lies in the Heart.”

The New Corrected Edition says: According to the Jia Yi Jing, heat in the hands, spasms in the elbows, and swelling in the armpits—and, in severe cases, fullness and distension in the chest and flanks, palpitations, a flushed face, and yellow eyes—are disorders of the Hand Heart Master channel, the Hand Jueyin Pericardium channel. When pathogenic Qi enters the Heart, it causes Heart pain, a tendency toward sadness, and occasional dizziness and falls. These symptoms arise because, in years when Taiyang governs the heavens, Water Qi overcomes Fire Qi.

If the pulse at the Shenmen point disappears completely, the person will die and cannot be saved.

The Shenmen point lies on the little-finger side of the wrist, at the end of the raised bone behind the palm. Its pulse can be felt there, and it reflects Heart Qi. Water Qi overcomes Fire Qi, cutting off Heart Qi within the body; the Heart’s spirit has also declined, and death becomes unavoidable. A skilled diagnostician can use this sign to determine whether an illness can be treated.

“Moving Qi” means learning about the condition of the internal organs by observing the pulse.

By examining the pulse to observe the flow of Qi and blood through the meridians, one can determine the functional state of the five viscera (heart, liver, spleen, lungs, and kidneys). The Yellow Emperor inquired about treatment methods, and Qibo replied that therapy should be tailored according to the specific pathogenic factors.

When wind pathogens (external pathogenic factors from nature) are excessive, the primary treatment should use pungent-cool herbs, supplemented with bitter-sweet herbs to harmonize. Sweet herbs alleviate symptoms, while sour herbs help expel pathogens. If the Qi in the Jueyin meridian (one of the body's meridian systems) is not excessively hot, cool-natured herbs are suitable for regulation. The properties of herbs—hot, cold, warm, or cool—are crucial: a small amount of hot herbs produces warmth, a small amount of cold herbs produces coolness; excessive warm herbs become hot, and excessive cool herbs become cold. The proportions must be carefully balanced.

For excessive heat pathogens, the primary herbs should be salty-cold, supplemented with bitter-sweet herbs, and sour herbs to astringe. If the fever recurs after subsiding, it indicates weak and unconsolidated heart Qi. In this case, sour herbs should be used to astringe, combined with cold herbs to address the root cause. For severe heat syndromes, bitter herbs are first used to induce sweating and reduce fever. If the fever subsides after sweating, it means the pathogens have been expelled, and cold herbs are no longer needed. If fever persists after sweating, the pathogens remain, and sour astringent methods should continue. Recurrent fever and sweating indicate heart Qi deficiency, requiring tonification. Heat syndrome treatments generally do not exceed three or four courses.

For dampness pathogens, the primary herbs should be bitter-hot, supplemented with sour-pungent herbs. Bitter herbs dry dampness, while bland herbs promote urination to eliminate dampness. Dampness can cause edema, which naturally resolves once dampness is expelled. For dampness in the upper body, bitter herbs induce vomiting; for dampness in the lower body, bitter herbs promote bowel movements, and bland herbs promote urination—all methods achieve the drying effect. The so-called "draining" refers to eliminating dampness through diuresis.

(Note: "Sitian" refers to the influence of celestial Qi changes on the human body, while "Zaiquan" refers to terrestrial Qi changes—part of the "Sitian-Zaiquan" theory in Chinese medicine, which posits that shifts in Heaven and Earth Qi cause different diseases.)

To treat dampness, use sour-flavored medicines. Though sour medicines tend to be warm, here they are chosen for their ability to promote urination and eliminate fluids that have stagnated in the body. If dampness is not discharged through urination, the treatment is not appropriate.

The New Commentary says: According to the preceding passage in the Suwen, “When dampness runs rampant within, assist the treatment with sour and bland flavors.” The text here reads “sour and acrid”; the word “acrid” is probably a mistake for “bland.”

When dampness is strongest in the upper body and has also transformed into heat, treat it with bitter-flavored, warm-natured medicines, assisted by sweet and acrid medicines. Use sweating to dispel the pathogenic influence. Thus, the treatment aims to induce sweating and ends once sweat has been produced.

When the upper body is affected by warm Qi and residual warmth becomes congested and fails to disperse, dampness and heat bind together. Use bitter-flavored, warm-natured medicines along with sweet and acrid medicines to release the exterior and induce sweating, thereby dispelling the pathogenic influence. This is why treatment is based on inducing sweating to drive out the pathogen: stop once that aim has been achieved.

When Fire is predominant, use salty-flavored, cold-natured medicines to restore balance, assisted by sweet and bitter medicines. Use sour medicines to astringe and bitter medicines to disperse. The same method applies when heat is predominant. Treat heat patterns in this way too, using sour medicines to return the pathogenic heat to its normal state. If it is not restored, the body’s healthy Qi will be weakened after the pathogen recedes, leaving it vulnerable to a new pathogenic influence.

When dryness is predominant, use bitter-flavored, warm-natured medicines to restore balance, assisted by sour and acrid medicines. If purging is needed, use bitter medicines. Dryness must be controlled with bitter, warm-natured medicines, drawing on the nature of Fire. Use bitter medicines when purging is needed, sour medicines when tonification is needed, and acrid medicines when the pathogen must be dispersed. If excessive dryness generates cold that lingers and does not depart, use bitter, warm-natured medicines to purge it. When the pathogenic influence is excessive, use acrid medicines to disperse it. The methods for treating other pathogenic influences are broadly similar.

The New Commentary says: In the preceding passage, “When dryness runs rampant within, treat it with bitterness and warmth,” the word “damp” here should read “warm.” The three instances of “damp” in the commentary should also read “warm.” Further, the Treatise on the Six Qi and Their Cycles gives the wording here as “bitter and slightly warm.”

When cold is predominant, use acrid-flavored, hot-natured medicines to restore balance, assisted by bitter and sweet medicines; then use salty medicines to purge the cold. The aim is to disperse the pathogenic influence and bring the illness to an end, but the medicines must not be used excessively.

The New Commentary says: In the preceding passage, “When cold runs rampant within, treat it with sweetness and warmth, assisted by bitterness and acridity,” the wording here, “restore balance with acrid and hot medicines, assisted by sweet and bitter medicines,” is erroneous. Further, the Treatise on the Six Qi and Their Cycles says, “In a year governed by Taiyang, the year calls for bitterness to dry it.”

The Yellow Emperor said, “Well said. If the pathogenic influence instead gains the upper hand, how should it be treated?”

Qibo said, “When one Qi cannot prevail over another but instead becomes the one held in check, that constrained Qi becomes pathogenic and then exploits its advantage to invade.”

Qibo also said, “When Jueyin governs below, wind Qi governs the surface. If clear Qi instead gains the upper hand, treat it with sour-flavored, warm-natured medicines, assisted by bitter and sweet medicines; then use acrid medicines to harmonize and restore balance. Jueyin governing below refers to the Yin and Shen years.”

Because the pathogenic influence is excessively strong, first use sour-tasting medicines to drain it, then support the treatment with bitter- and sweet-tasting medicines. Once the pathogenic influence has receded, the body’s healthy Qi will be weakened, so use pungent-tasting medicines to nourish it and restore balance between Yin and Yang.

When Lesser Yin is in control below, heat governs the earthly Qi but is overcome by cold. Treat with sweet-tasting, warm-natured medicines, supported by bitter- and pungent-tasting medicines, then use salty-tasting medicines to harmonize and balance them. Lesser Yin in control below refers to the fifth year of the Mao and You cycles.

When Great Yin is in control below, dampness governs the earthly Qi but is overcome by heat. Treat with bitter-tasting, cold-natured medicines, supported by salty- and sweet-tasting medicines, then use bitter-tasting medicines to harmonize them. Great Yin in control below refers to the fifth year of the Chen and Xu cycles.

When Lesser Yang is in control below, fire governs the earthly Qi but is overcome by cold. Treat with sweet-tasting, warm-natured medicines, supported by bitter- and pungent-tasting medicines, then use salty-tasting medicines to harmonize them. Lesser Yang in control below refers to the fifth year of the Si and Hai cycles.

When Yangming is in control below, dryness governs the earthly Qi but is overcome by heat. Treat with medicines of balanced nature that tend toward cold, supported by bitter- and sweet-tasting medicines, then use sour-tasting medicines to harmonize them and achieve a gentle balance. Yangming in control below refers to the fifth year of the Zi and Wu cycles. Dryness abhors heat and also fears cold, so treatment should moderate both cold and heat.

When Taiyang is in control below, cold governs the earthly Qi but is overcome by heat. Treat with salty-tasting, cold-natured medicines, supported by sweet- and pungent-tasting medicines, then use bitter-tasting medicines to harmonize them. Taiyang in control below refers to the fifth year of the Chou and Wei cycles.

The same principles of supplementing and draining apply to the other kinds of Qi in control below. The methods for treating the Six Qi described here differ from the “method of overcoming” discussed earlier: “treat” means draining the invading influence that has overcome the governing Qi; “assist” means supporting the treatment with medicines chosen for their benefit and suitability; and “balance” means nourishing the healthy Qi after it has weakened.

The Yellow Emperor asked, “When the Qi governing the heavens is overcome by a pathogenic influence, how should it be treated?” Qibo replied:

When wind governs the heavens and clear Qi overcomes it, treat with sour-tasting, warm-natured medicines, supported by sweet- and bitter-tasting medicines. This refers to the Si and Hai years.

When heat governs the heavens and cold overcomes it, treat with sweet-tasting, warm-natured medicines, supported by bitter-, sour-, and pungent-tasting medicines. This refers to the Zi and Wu years.

When dampness governs the heavens and heat overcomes it, treat with bitter-tasting, cold-natured medicines, supported by bitter- and sour-tasting medicines. This refers to the Chou and Wei years.

When fire governs the heavens and cold overcomes it, treat with sweet-tasting, warm-natured medicines, supported by bitter- and pungent-tasting medicines. This refers to the Yin and Shen years.

When dryness governs the heavens and heat overcomes it, treat with pungent-tasting, cold-natured medicines, supported by sweet- and bitter-tasting medicines. This refers to the Mao and You years.

When cold governs the heavens and heat overcomes it, treat with salty-tasting, cold-natured medicines, supported by bitter- and pungent-tasting medicines. This refers to the Chen and Xu years.

Here, “in control below” refers to the Six Qi governing the earthly Qi, while “governing the heavens” refers to the Six Qi governing the heavens. Terms such as “fifth Mao year” name years formed by matching the Five Phases’ cyclical movements with the Earthly Branches. Sour, bitter, sweet, pungent, and salty refer to the five tastes of medicines; cold, hot, warm, and cool refer to their medicinal properties.

The Yellow Emperor asked, “What happens when the six Qi overcome one another?”

The answer first describes what occurs when each of the six Qi takes effect and gains the upper hand.

Qibo replied:

When Jueyin (Wind-Wood Qi) is in excess, there may be ringing in the ears, dizziness, clouded awareness, nausea, and obstruction in the movement of Qi in the stomach. At times, the condition resembles exposure to cold; strong winds blow frequently, and naked animals have difficulty breeding. When Qi gathers to one side and stagnates, transforming into heat, the urine becomes yellow or reddish, and there is pain in the area between the stomach and the heart, extending upward into both flanks. The intestines rumble, undigested food passes in the stool, the lower abdomen hurts, and discharge containing red and white matter occurs. In severe cases, there is vomiting: food and drink are brought back up after being swallowed, and the passage through the throat is obstructed.

“Five Si and Five Hai” refers to the corresponding Si and Hai years. The area below the heart and above the navel is where the stomach is located; “stomach and diaphragm” refers to the area above the stomach and below the diaphragm. Wind and cold Qi can bring on these symptoms. “Qi gathering” means that Qi concentrates on one side; “obstruction of the diaphragm and throat” means that food and drink are vomited after entering the mouth. The New Collation notes that the Jia Yi Jing describes stomach illness with pain in the area between the stomach and heart, pain extending into both flanks, and obstruction of the diaphragm and throat.

When Shaoyin (Imperial Fire Qi) is in excess, heat develops below the heart and hunger comes easily, yet pain occurs below the navel. Qi moves through the Triple Burner—the pathways through which Qi transforms in the upper, middle, and lower regions—and summer heat follows. Woody plants begin to produce fluid, while grasses and trees wither. There may also be vomiting, agitation, abdominal fullness and pain, and loose stools; the condition may progress to red-colored diarrhea.

“Five Zi and Five Wu” refers to the corresponding Zi and Wu years. “To soak” means to bathe; here it describes watery diarrhea.

When Taiyin (Damp-Earth Qi) is in excess, Fire Qi becomes constrained within the body, causing sores and ulcers. The pathogenic Qi then spreads outward, with the affected area lying along the flanks, from the armpits to the sides of the waist. In severe cases, there is heart pain, and Heat obstructs the movement of Qi, causing headache, throat impediment (swelling or blockage of the throat), and stiffness in the neck. If Dampness alone is in excess, without accompanying constrained Fire, it stagnates within the body. Cold presses on the lower region, and pain settles at the crown of the head, extending between the eyebrows. The stomach also becomes distended; only when rain is frequent does Dryness become apparent. The lower abdomen swells, the waist and buttocks feel heavy and stiff, and movement within the body is impaired, often resulting in diarrhea. The soles of the feet become hot, the head feels heavy, and the ankles and lower legs swell. Retained fluids may arise within the body, and swelling can appear on the head and face.

“Five Chou and Five Wei” refers to the corresponding Chou and Wei years. When Dampness is in excess in the upper region, it causes Fire Qi to become constrained within the body; when it is in excess in the middle region, Cold presses on the lower region. When rivers and channels swell, fish leave the water. “Buttock” refers to the flesh of the buttocks; “impaired movement” means that the waist feels heavy and rigid, making it difficult to bend or straighten. “Dampness alone in excess” means that Dampness is predominant without accompanying constrained Fire. “Swelling above” means swelling of the head and face; swelling of the ankles is caused by constrained Fire.

The New Collation notes that Wang Bing’s commentary says, “When rivers and channels swell, fish leave the water,” but the scripture itself offers no corresponding explanation. It also observes that the “Taiyin’s Return” chapter of the Suwen says, “Heavy rains come, and scaled creatures appear on land.” It therefore suggests that the four characters “lightly, scaled creatures appear on land” may have been omitted after “rain comes frequently” in this passage. Otherwise, Wang Bing’s commentary would have no basis.

When Shaoyang Qi becomes excessive, pathogenic heat invades the stomach, causing irritability and heart pain, a flushed complexion, nausea or vomiting, a sour or bitter taste in the mouth, and easy hunger. Ear pain, reddish urine, and a tendency to startle may also occur, along with incoherent speech and mental confusion. If the heat suddenly intensifies, plants wither and wetlands dry up; shell-bearing creatures curl up and draw in their limbs. There may also be pain in the lower abdomen, diarrhea, and stool mixed with red or white matter.

This refers to the years of the five Yin and five Shen. The heat becomes suddenly intense, withering plants and drying up wetlands; it also consumes Yin Qi. Shell-bearing creatures belong to Metal, so when Fire Qi surges, they are subdued and curl up. “Sour” refers to a taste like vinegar and belongs to Water.

When Yangming Qi becomes excessive, cold and clear Qi arises from within, causing pain in the left ribs and loose stools or diarrhea. Internally, the throat may become obstructed; externally, a tuishan, a type of hernia, may develop. Severe cold and desolation strip plants of the forms they once had, and furry creatures are also harmed. There may be discomfort in the chest, throat obstruction, and coughing.

This refers to the years of the five Mao and five You. The severe cold and desolation result from Metal Qi overcoming Wood Qi. The desolating Qi damages the flowers and leaves of plants, changing their form and color and scorching their upper parts. Furry creatures belong to Wood and cannot withstand Metal Qi; when Metal Qi prevails, they die and waste away. Liver Wood Qi governs Yin in the lower body, and when severe cold prevails, tuishan may develop. “Discomfort in the chest” means that the movement of breath within the chest is obstructed; there may be pain, or the breathing may alternate between slow and rapid. Because the Qi is strong, the throat becomes obstructed and coughing occurs. Here, “yi” refers to the lower part of the throat, where it connects with the lungs in the chest.

When Taiyang Qi becomes excessive, weather with intense, freezing cold arrives. Even outside the cold season, water freezes, and the growth and development of feathered creatures slow down. Hemorrhoids, malaria, and cold reversal—severe cold with icy limbs—may also occur. When cold pathogen enters the stomach, it causes heart pain. Sores may develop in the genital region; movement in the private parts may become difficult, with pain extending along the inner thigh. The muscles and flesh may tighten and ache, the blood vessels congeal, and the smaller channels become congested and full. The complexion changes. There may also be blood in the stool, blocked or swollen skin, abdominal distension, and reduced appetite. Heat Qi may instead surge upward, causing pain in the head, neck, fontanel, crown, and naohu point at the back of the head, while the eyes feel as though they might protrude. When cold pathogen enters the lower burner, the region containing the body’s lower organs, it turns into watery diarrhea.

This refers to the years of the five Chen and five Xu. Cold Qi presses on Yang Qi, which cannot hold it back, so water freezes before the cold season arrives. Water Qi becomes excessive, preventing Yang Fire from circulating; as a result, the growth and development of feathered creatures slow down. “Ju” means stiffness and contraction; “ke” means heaviness. “Luo” refers to the smaller channels. Taiyang Qi travels over the crown, so heat Qi surges upward to the head. The Taiyang channel begins at the inner corner of the eye, travels up to the forehead, meets at the crown, enters and connects with the brain, then branches downward to the neck. This is why the fontanel, crown, and naohu point ache, and why the eyes feel as though they might protrude. “Ru” means watery diarrhea. The original text continues beyond this point.

The hemorrhoids and malaria described in the Yi Jing, along with pain in the center of the head, neck, fontanel, crown, and brain portal (an acupuncture point at the back of the head), and the sensation that the eyes are about to protrude, are disorders of the Taiyang channel.

The Yellow Emperor asked, “How should they be treated?”

Qibo said, “When the Qi of Jueyin is in excess, treat it with medicines that are sweet and cool, supported by bitter and acrid medicines; use sour medicines to drain the excess. When the Qi of Shaoyin is in excess, treat it with medicines that are acrid and cold, supported by bitter and salty medicines; use sweet medicines to drain it. When the Qi of Taiyin is in excess, treat it with medicines that are salty and warm, supported by acrid and sweet medicines; use bitter medicines to disperse and drain it. When the Qi of Shaoyang is in excess, treat it with medicines that are acrid and cold, supported by sweet and salty medicines; use sweet medicines to drain it. When the Qi of Yangming is in excess, treat it with medicines that are sour and warm, supported by acrid and sweet medicines; use bitter medicines to disperse and drain it. When the Qi of Taiyang is in excess, treat it with medicines that are sweet and hot, supported by acrid and sour medicines; use salty medicines to drain it.”

Whenever one of the Six Qi becomes excessive, first address the force it overcomes: drain the excess in the overcome force to restore the flow of Qi, then drain the force that is overcoming it so that it subsides. If excess Qi is treated without being dispersed and drained, it will gradually grow stronger and cause various diseases within the body.

The New Collation says: A close examination of these treatments shows that they all first drain the force being overcome, then drain the force that has become excessive. The one exception is the instruction to treat excess Taiyang Qi with sweet and hot medicines. It is possible that “sweet” is a copying error for “bitter.” If the reading is “bitter and hot medicines,” the methods for treating excess in all Six Qi would be consistent.

The Yellow Emperor asked, “What happens when the Six Qi retaliate?”

“Retaliation” means responding to an earlier excess by acting against it and restraining it in turn. In general, an excess is followed by retaliation.

The New Collation says: According to the Xuan Zhu, each of the Six Qi has a proper transformation and an opposing transformation. Jueyin’s proper transformation occurs in Hai and its opposing transformation in Si; Shaoyin’s proper transformation occurs in Wu and its opposing transformation in Zi; Taiyin’s proper transformation occurs in Wei and its opposing transformation in Chou; Shaoyang’s proper transformation occurs in Yin and its opposing transformation in Shen; Yangming’s proper transformation occurs in You and its opposing transformation in Mao; and Taiyang’s proper transformation occurs in Xu and its opposing transformation in Chen. The Qi governing the proper transformation is full, while the Qi governing the opposing transformation is weak. When the Qi of the opposing transformation becomes excessive, retaliation occurs; when the Qi of the proper transformation becomes excessive, it does not. Therefore, the commentary’s statement that “an excess is always followed by retaliation” does not seem entirely accurate.

Qibo said, “That is a very thorough question. When Jueyin Qi retaliates, the lower abdomen becomes hard and distended, and the abdomen contracts with sudden, severe pain. Trees are blown down, dust and sand fill the air, and the naked creatures (an ancient term for a class of insects without scales or armor) do not thrive. There may also be Jue heart pain (pain caused by rebellious Qi in the chest and heart region), sweating, vomiting, and inability to eat; even if food is swallowed, it is vomited back up. The sinews and bones tremble and shake, the head spins and the vision blurs, and the hands and feet feel cold. In severe cases, the pathogenic influence enters the Spleen, causing food to stagnate, difficulty swallowing, and vomiting.”

Here, “inside” refers to the abdomen and the area beneath the ribs. Fallen trees and blowing dust and sand indicate violent winds. Wind…

When Wood Qi is excessive, Earth Qi cannot grow normally. “Qi reversal” refers to Qi surging upward into the chest and flanks, sometimes even invading the heart. When rebellious Qi affects the stomach and surges up toward the heart, it causes heart pain. If the pain is severe, sweating follows and the body’s fluids are lost. “Movement within the flesh” means twitching inside the muscles; “cold reversal” means that the hands and feet become cold.

“Food obstruction” refers to a dull pain in the pit of the stomach after eating. The pain is hard to describe and difficult to endure, and stops only after vomiting. This happens when stomach Qi rebels and cannot descend. If food cannot be taken in, or is vomited back up after eating, it is because Liver Qi is overriding the Spleen and Stomach.

If the Chongyang pulse is severed, no medicine can cure the condition. Chongyang refers to the pulse Qi of the Stomach meridian.

When the Qi of Lesser Yin relapses, dryness and heat arise within the body, causing agitation along with nasal congestion, sneezing, cramping pain in the lower abdomen, burning heat, and a dry throat. Qi disperses and flows downward, with symptoms coming and going. When Qi stirs on the left side of the body and travels upward to the right, it can cause coughing, skin pain, sudden loss of voice, heart pain, oppressive confusion, and even unconsciousness. This is followed by fear of cold, shivering, and delirious speech. When the chill passes, fever returns, with thirst, a desire to drink, shortness of breath, and weakened bones. The intestines seem blocked, making bowel movements difficult, while the body’s surface becomes swollen. Hiccups and belching may also occur. Red Fire Qi appears in the later stages; fluids continue to flow, but do not freeze. When heat Qi prevails, beetles and other insects cannot live in peace. People develop prickly heat, rashes, sores, carbuncles, boils, acne, and hemorrhoids. In severe cases, pathogenic heat enters the Lungs, causing coughing and a continuous discharge of cloudy nasal mucus.

Fire and heat Qi begins in the Small Intestine, passes along the left side below the navel into the Large Intestine, then rises to the left flank. When the illness is severe, it rises further, turns to the right, and enters the Lungs. Thus, Qi that stirs on the left and travels upward to the right causes skin pain. “Separate discharge” means that both urination and defecation occur. “Bone withering” means weakened bones and loss of strength; “intestinal obstruction” means that the bowels seem blocked and stool cannot pass.

These changes occur when cold and heat are severe. Yangming Qi first gains the upper hand, so the red Fire Qi appears only in the later stages, while fluids continue to flow without freezing. The fundamental action of Lesser Yin Qi is governed by the Earth. In the human body, the pulse Qi in winter should ordinarily draw inward and become still. Water at high elevations, such as in mountain valleys, also freezes, while rivers on the plains flow as usual. Fire Qi steams within the body, while Metal Qi guards its surface. When Yang heat becomes trapped inside, it gives rise to prickly heat, rashes, and sores. Severe rashes may develop into sores. When the heat is mild, the illness appears on the body’s surface as prickly heat and rashes; when it is more severe, carbuncles and boils form inside the body. Heat in the Small Intestine causes hemorrhoids on the lower part of the body’s surface. These disorders caused by a relapse of pathogenic heat mostly occur on the back and outer sides of the body: prickly heat, rashes, and sores appear on the upper body, while carbuncles, boils, acne, and hemorrhoids appear on the lower body. If they occur in the opposite locations, the condition is considered contrary to the normal pattern.

If the Tianfu pulse is severed, no medicine can cure the condition.

Tianfu is the point where the Qi of the Lung channel emerges. The New Collation states: According to the passage above, when Shaoyin governs the heavens and pathogenic Heat is excessive, the Qi of the Chize pulse is cut off, foretelling a critical condition that is difficult to treat. When Shaoyang governs the heavens and pathogenic Fire is excessive, the Qi of the Tianfu pulse is likewise cut off, also foretelling a critical condition. Here, the text says that when Shaoyin Qi flares up again, the Qi of the Tianfu pulse is cut off; below, it says that when Shaoyang Qi flares up again, the Qi of the Chize pulse is cut off. The wording seems contradictory because Chize and Tianfu are both points where the Qi of the Hand Taiyin Lung channel emerges, so the names are used interchangeably here.

When Taiyin Qi flares up again, Dampness transforms and arises. The body feels heavy all over, the chest and abdomen become distended, and food cannot be digested. Yin Qi surges upward, making the chest uncomfortable; fluids accumulate in the body, causing coughing, panting, and noisy breathing in the throat. Heavy rain often falls at this time, and fish seem to appear on dry land. The crown of the head feels painful and heavy, and the person may shake their head and convulse, sometimes severely. They may also vomit, become quiet and speak little, and bring up thin, clear fluid. In severe cases, the pathogenic influence penetrates deep into the Kidneys, leading to loss of control over urination and bowel movements.

Dampness moves counter to its proper course in the body, Cold cannot circulate normally, and the Qi of the Taiyang channel flows upward; these factors give rise to the symptoms. The crown of the head feels painful and heavy, and in severe cases the brain seems to shake and convulsions occur. Cold and Dampness affect the stomach and intestines, preventing Heat from circulating normally; it then steams upward into the chest, causing discomfort and impairing digestion. Vomiting and silence occur because the patient wants to remain still. The throat is affected by Cold, so the person brings up cold fluid. Cold moves upward into the Lungs and throat, obstructing the passage of breath and causing coughing, panting, and noisy breathing. When water gathers in lakes and marshes, fish seem to swim into the marketplace: this image of waters and fish represents Dampness spreading unchecked. When the crown of the head and chest are painful, women may also feel pain between the eyebrows. The New Collation states: According to the passage above, when Taiyin is in control below, it records “headache, as though the neck were being pulled upward”; when Taiyin governs the heavens, it also records pain at the crown of the head. Perhaps “crown of the head” here should read “neck.”

When the Qi of the Taixi pulse is cut off, it foretells a critical condition that is difficult to treat. Taixi is the point where the Qi of the Kidney channel emerges.

When Shaoyang Qi flares up again, intense Heat is imminent. The climate becomes dry, fierce Fire blazes, and beetles and other insects dwindle. People become fearful and convulse, cough, and bleed from the nose; they feel Heat and agitation in the heart, urinate frequently, and fear the wind. Qi surges upward, the complexion looks as though covered with a layer of dust, and the eyes twitch and convulse. Fire and Heat erupt within and steam upward, causing sores in the mouth and vomiting, sometimes with blood in the vomit or stool. Malaria may also arise: first come fear of Cold and shivering, followed by Heat when the Cold reaches its peak. The channels of the throat dry out, thirst develops, the complexion turns yellowish-red, the breath becomes short, and pulse Qi grows weak. When the movement of fluids is disrupted, the illness may progress to edema. In severe cases, the pathogenic influence enters the Lungs, causing coughing and the expectoration of blood, or blood in the stool.

When Fire erupts with great force, it dries out plants and trees, which may even catch fire spontaneously. This is the meaning of “burning and scorching.” Fire and Heat rage within the body, giving rise to fear, convulsions, coughing, nosebleeds, heat and agitation in the heart, frequent urination, and fear of the wind.

When Fire Qi blazes upward, all things seem to lose their luster. The face looks as though covered by a layer of dust, and the eyelids twitch involuntarily. When Fire Qi burns inside the body, the mouth and tongue may become ulcerated, with vomiting, rebellious Qi, vomiting blood, blood in the stool, or profuse bleeding. When Wind and Fire clash and bind together, they can produce warm malaria, a malarial illness marked chiefly by fever. When Qi is steamed and transformed by heat, water illness develops and may then change into edema, in which the flesh and skin swell together; pressing the swelling leaves a muddy-looking indentation that does not immediately spring back. These disorders all arise from Fire Qi.

If the pulse at Chize, a point on the Hand Taiyin Lung channel—here referring to the Qi of the Lung pulse—is severed, the person will die, and the condition cannot be treated.

When the Qi of Yangming Dry Metal returns in force—“return” meaning that a previously suppressed force regains strength and strikes back—the cool, withering Qi becomes dominant. The blue-green branches and leaves of plants dry up, and hairy creatures suffer epidemic disease. The disorder affects the area from beneath the armpit to the ribs, with Qi gathering more on the left. The patient often sighs deeply; in severe cases there is heart pain and a stuffy, distended sensation in the chest and abdomen, abdominal distension and diarrhea, vomiting of bitter fluid, coughing, hiccups, and vexation in the heart. The disorder is located in the diaphragm. When the headache is severe, the pathogenic influence may invade the Liver, causing fright and cramping of the sinews and channels.

The commentary explains: When the withering Qi is strong, Wood Qi cannot overcome it, so the green leaves dry up before they turn yellow. “Li” means a pestilence or epidemic disease that causes death. This happens because cool Qi is excessive inside the body, while heat is trapped at the body’s surface.

If the Taichong pulse, a point on the Foot Jueyin Liver channel—here referring to the Qi of the Liver pulse—is severed, the person will die, and the condition cannot be treated.

When the Qi of Taiyang Cold Water returns in force, Cold and Reversal Qi rises upward, water congeals, and hail falls, causing winged creatures to die. Cold Qi arises in the Heart and Stomach; the chest feels constricted, with heart pain, fullness, and headache. The patient is often sorrowful and at times becomes dizzy and falls. Appetite diminishes, the lower back and buttocks hurt, and bending and straightening become difficult. The earth cracks, the ice grows thick, and even sunlight cannot melt it easily. Other symptoms include pain in the lower abdomen that pulls toward the testicles and extends to the lower back, Qi surging up to the Heart, vomiting clear fluid, hiccups, and belching. In severe cases, Cold invades the Heart, causing forgetfulness and a tendency to sorrow.

The commentary explains: “Rain ice” means hail. When cold weather is accompanied by hail, the resulting deaths among living things are natural. Cold Qi arises in the earth, with Earth Qi covering it above; therefore the ground cracks, standing water freezes, and the ice does not melt for a long time. This is because the Qi of the sun cannot overcome what has congealed through cold. When Taiyang Qi returns in force, there is dampness above and cold below, leaving Fire Qi nowhere to go. Heart Qi becomes congested inside, generating heat; Fire and heat burn within the body, producing these symptoms. The collator adds that the word “not” in the commentary’s phrase “does not hold together” may instead have been intended to read “Earth.”

If the Shenmen pulse, a point on the Hand Shaoyin Heart channel—here referring to the pulse Qi of the true Heart—is severed, the person will die, and the condition cannot be treated.

The Yellow Emperor said, “Good. How, then, should these conditions be treated?” He asked first about treatment because the returning Qi had grown even stronger.

Qibo said, “For disorders caused by the return of Jueyin Wind Wood Qi, treatment should be based on medicines that are sour in flavor and cold in nature, with sweet and pungent medicines as adjuncts. Use sourness to drain its excess, and sweetness to moderate it.”

Because the illness has not yet eased substantially and continues into summer, the pathogenic Qi will gain momentum and worsen it. Treatment should therefore use pungent, cold methods. ○ The Newly Collated Corrections notes that another edition reads “treat with sour, cold methods” here, rather than “pungent, cold methods.”

When lesser Yin Qi recurs, treatment should use salty, cold medicines, supported by bitter and pungent medicines. Sweet medicines make the pathogenic Qi descend and discharge; sour medicines astringe; bitter medicines diffuse; and salty medicines soften hardness.

Do not induce heavy sweating or attack forcefully with cold medicines. If treatment is delayed until mid-autumn, the Heat pathogen will lie dormant inside the body, become constrained, and give rise to Heat in the heart, shortness of breath, and weakness, to the point that the patient cannot rise. If the latent Heat does not disperse, it will penetrate deeper into the bones.

When greater Yin Qi recurs, treatment should use bitter, hot medicines, supported by sour and pungent medicines. Bitter medicines drain the pathogen, dry it, and expel it.

If it is not dried and expelled in time, prolonged illness will bring swelling of the body, abdominal distension, and stiff joints. The calves and the fùtù area—the muscles at the front of the thigh above the knee—will also become constrained and distended. Qi within the body will stagnate, and swelling will develop around the knees, waist, and inner calves.

When lesser Yang Qi recurs, treatment should use salty, cold medicines, supported by bitter and pungent medicines. Salty medicines soften hardness; sour medicines astringe; and pungent and bitter medicines diffuse. Diffusion should not be separated from the use of Heat, but one must not violate the cautions against either warming and Heat or cold and cool methods. The same principle applies to treating lesser Yin disease.

If sweating is not induced to reduce excessive Yang Qi, the Heat pathogen will harass the limbs inside the body, producing a condition that is difficult to name precisely. Here, “jieran” means that the illness shows no clear tendency toward either Heat or cold, and appears neither strong nor weak; it cannot readily be described by a single name. For this reason, inexperienced physicians sometimes call it “ghost Qi” or “evil disease.” If it does not resolve over a long period, Heat develops in the bones, the marrow dries up, and the teeth become dry, ultimately turning into a bone-Heat disease.

Sweating can disperse excessive Yang Qi and prevent the Heat pathogen from remaining lodged in the body. But sweating itself can also deplete Yang Qi and body fluids. Therefore, even if the illness improves in summer, caution is needed if hot medicines are used to induce sweating. In spring and autumn, if Heat pathogen is predominant, hot medicines must especially not be used to induce sweating: sweat will fail to emerge, and the medicines’ hot nature will instead intensify the Heat pathogen within the body, aggravate the illness, and turn it into an adverse condition resembling malaria. This practice is also considered an offense against the spirits, which is why one must not recklessly use warming and Heat or cold and cool methods. The treatment of Heat patterns in lesser Yin disease follows the same principle; hence the text says it is treated in the same way as lesser Yin. Repeated sweating will exhaust the body fluids, so sour medicines should be used to astringe and salty medicines to moisten. ○ The Newly Collated Corrections notes that the Treatise on the Six Configurations and Regularities states: “When dispersing an exterior pathogen, the use of Heat must not be abandoned.”

When Yangming Qi recurs, treatment should use pungent, warm medicines, supported by bitter and sweet medicines. Bitter medicines drain the pathogen, then bitter medicines are used to purge downward, and sour medicines to replenish.

Here, “drain” includes expelling the pathogen through sweat or urination, as well as methods such as bathing in medicinal decoctions. Treatment by dispersal may also be used around the autumn equinox. If a prevailing Qi occurs in spring, treat according to the method for that particular prevailing Qi. If the illness has still not eased, the original text continues its discussion below.

Use medicinal decoctions to moisten and harmonize the body, regulating both its interior and exterior. After an excess Qi and its counteracting Qi alternate, the body’s normal Qi becomes weak. It should therefore be nourished with mild, safe methods so that Qi can regain its stability. Treat other conditions according to the same principle.

When counteracting Qi arises in the Taiyang phase, treat it with salty, hot medicines, supplemented by sweet and pungent medicines. Then use bitter medicines to strengthen it. If it is not properly regulated and stabilized, cold Qi will change within the body. The illness may stop and return, lingering for years and eventually leading to severe cold disease.

To treat the various excess and counteracting Qi, choose methods that oppose the nature of the condition: use heat for cold patterns and cold for heat patterns; clear warm patterns and warm clear patterns; gather what is dispersed and disperse what is constrained; moisten what is dry and ease what is tense; soften what is hard and strengthen what is fragile; replenish what is depleted and reduce what is excessive. Let each Qi settle in its proper state, remain still, and avoid reckless disturbance. Then pathogenic Qi will decline and return to the place to which it originally belongs. This is the fundamental principle of treatment.

Taiyang Qi belongs to cold; Shaoyin and Shaoyang Qi belong to heat; Jueyin Qi belongs to warmth; Yangming Qi belongs to clarity; and Taiyin Qi belongs to dampness. When excess Qi and counteracting Qi arise, strengthen the appropriate treatment according to each one’s nature, bringing them back into balance. “Root” means the place to which something belongs. When treatment follows the governing principles, the remaining Qi will naturally return to its proper place, and Qi that has diminished will settle back where it belongs. Once excess and counteracting Qi have subsided, replenish and balance them as needed so that they become stable. As long as stillness is maintained and there is no reckless disturbance, the Six Qi will circulate and the Five Spirits will be at peace. If changes in the movement of Qi bring about cold or heat, treat and restore balance according to the principles above, so that each Qi returns to the place it governs. This is the pattern by which the Qi of Heaven and Earth move.

The Yellow Emperor said, “Well said.”