《黃帝內經素問補註釋文》Vol. 50

The Yellow Emperor was in the Bright Hall, the place where ancient rulers held discussions and taught. Thunder Duke sat beside him. The Yellow Emperor said, “You have read many books and studied many methods of medicine. Please speak about successes and failures in diagnosis and treatment: why is it that sometimes they are carried out properly, while at other times mistakes occur?”

Thunder Duke replied, “When I studied under my teacher according to the medical classics, he always said that this could be done perfectly, without the slightest error. Yet when I put it into practice, mistakes still occur. I would like to hear why.”

In other words, those who study under a teacher by following the classics often assume they can achieve perfection. But when they actually practice medicine and put the right path into effect, successes and failures may still arise in the world. Thunder Duke therefore asks the Yellow Emperor to explain the reason.

The Yellow Emperor said, “Is it because you are still young and lack sufficient wisdom? Or because you have mixed together different teachings and used them indiscriminately?”

The Yellow Emperor seems to be asking: Can you not achieve perfection because you are young and have yet to understand the principles of medicine, or because you have blended together the different methods of various people?

“The twelve channels and three hundred and sixty-five network vessels are familiar to everyone, and physicians all rely on them when diagnosing and treating patients.”

This means that physicians should examine and treat patients according to the theory of the channels and vessels.

“The reason you cannot achieve perfection is that your spirit is not focused and your thoughts lack order. The signs on the body’s surface do not correspond to the pulse within, so at times you become uncertain and find it difficult to judge.”

Here, “the exterior” refers to signs on the body’s surface, such as complexion, while “the interior” refers to the pulse. If the physician’s mind is unfocused and their thinking lacks order during examination, their judgment will be careless and inaccurate. The complexion and pulse may then appear inconsistent, making the physician hesitate.

“When you take the pulse, you do not understand the waxing and waning of Yin-Yang or the principles of change and their accordance or opposition. This is the first kind of error in diagnosis and treatment.”

The “Discourse on the Essentials of the Pulse” says that forty-five days after the winter solstice, Yang Qi begins to rise slightly and Yin Qi begins to decline slightly; forty-five days after the summer solstice, Yin Qi begins to rise slightly and Yang Qi begins to decline slightly. Yin-Yang changes according to a set sequence, and these changes also appear in the pulse. The classic further says that the subtleties of the pulse must be examined carefully, and that diagnosis requires a standard, which begins with the changes of Yin-Yang. Thus, failing to understand the changes of Yin-Yang in the pulse, and whether those changes accord with or oppose their proper course, is the first kind of error.

“You did not finish studying under your teacher, yet you took it upon yourself to establish another method. You explain things recklessly, calling error the right path; you change the names of things and count clever techniques as achievements…” The original text breaks off here.

Using a stone lancet (a stone needle used in ancient times to puncture or cut an affected area) indiscriminately and thereby bringing calamity upon oneself is the second error in treating illness.

If one does not follow the medical teachings passed down by one’s teachers, but acts only on unfounded notions; if one carelessly changes established methods from antiquity and treats patients according to one’s own ideas, is it not only natural that calamity should follow? This is why it is called the second error. Laozi said, “Not bringing calamity upon oneself is called keeping to the constant.” These words are directed precisely at careless, reckless conduct.

When treating illness, if one does not consider whether the patient is poor or wealthy, lowly or high-ranking; the conditions of the patient’s home and surroundings for sitting or lying down; the cold or heat to which the body has been exposed; or whether the patient’s diet has been appropriate—and if one cannot distinguish the robust from the timid or reason by analogy—one may be thrown into confusion and unable to explain the principles clearly. This is the third error in treating illness.

The poor and lowly tend to do more labor, while the wealthy and high-ranking tend to live in greater ease. Those who live at ease are less likely to be harmed by pathogenic Qi, but more likely to be injured by overexertion. Those who labor are more likely to be harmed by pathogenic Qi, but less likely to be injured by overexertion. As for overexertion, the wealthy suffer about half as much as the high-ranking; as for pathogenic Qi, the poor suffer about half as much as the lowly. This is generally the case, though families that have enjoyed official stipends for generations may sometimes be an exception. The robust are less likely to be attacked by pathogenic influences, while the timid are more easily harmed. The difference between these two groups probably lies in the relative strength of their Shen Qi (spirit and vital energy). From the circumstances of the poor and lowly, and the wealthy and high-ranking, one can also infer the effects of better or worse conditions for sitting and lying down, exposure to cold or heat, and the suitability of the diet. Without the ability to reason by analogy, one’s use of medicine will stray from the proper course. If one’s mind is confused, how can one expect diagnosis and treatment to be clear and thorough? This is why it is called the third error.

When diagnosing a patient, if one does not ask about earlier fears and anxieties, hardships, irregular eating and drinking, excessive activity and rest, or possible exposure to poisons, but instead abruptly examines the cun-kou (the pulse at the wrist) and asks, “What illness do you have?”, then claims to judge the condition accurately while inventing a diagnosis at will, this is crude medicine and the fourth error in treating illness.

Here, “anxiety” refers to fear and apprehension, while “hardship” refers to adversity encountered. “Irregular eating and drinking” means eating to excess; “excessive activity and rest” means overdoing one’s daily activities and exhausting the body. “Exposure to poisons” means that the condition cannot be treated by rigidly applying ordinary rules, such as the mutual subjugation of the Zang-Fu organs. “Abruptly examining the cun-kou” means proceeding without first using the pulse to determine whether it is calm and even or abnormal. Even those with refined medical skill who are versed in the four methods of diagnosis may still have doubts when examining a patient. Therefore, if one has not determined the form and name of an illness, and one’s words do not accord with the medical classics, yet one invents an account without warrant, that is crude and shallow practice. Even ordinary physicians can recognize how such baseless claims violate the truth; how much more readily, then, would someone deeply versed in medical principles see the errors? This is why it is called the fourth error.

Thus, popular opinions may spread a thousand miles, yet fail to understand the principles of diagnosis by the cun-kou pulse. They also disregard the patient’s actual circumstances when making a diagnosis.

Whether a physician’s skill is accomplished or crude, and whether his reputation is praised or condemned, all depend on what people say. Even if his fame spreads a thousand miles, if he does not understand the principles of examining the pulse at the cun and chi positions, how can anyone know what his medical skill is worth?

The principles of diagnosis and treatment require calmly observing the pulse. The phrase “the qi of the ruling pulse” refers to examining the strength and weakness, and the relative height and depth, of the pulse qi, and using these qualities as a basis for comparison and classification.

A physician may sit and feel someone’s pulse yet fail to distinguish the pulse signs of the five viscera or the causes of the many illnesses. To blame the teacher and complain about him is wrong. It is one’s own failure to study the medical Way deeply that leads to errors in diagnosis. Blaming the teacher for every complaint and mistake has never been proper.

Thus, to abandon the principles of medicine and discard what one has learned, then practice carelessly among the people in the marketplace, is not the way of a physician. If one happens to cure an illness and then thinks oneself highly skilled, that is foolish. If one has not studied the principles of medicine seriously but boasts of and hawks one’s medical skill in the marketplace, people will naturally disbelieve it and consider it empty and absurd. This is why it is called “casting medicine aside in the marketplace.” Even if a foolish person happens to guess correctly once in a thousand attempts, what merit can there be in that? The Xinzhizhu edition has “skill” here; the Taisu edition has “self-merit.”

Alas, who can truly understand the mysterious and profound Dao?

The Great Dao may be likened to Heaven and Earth: its height, depth, and vastness cannot be measured. It also corresponds to the Four Seas, whose depth and breadth cannot be fathomed. If one cannot grasp its principles and explain them clearly, then even upon encountering the luminous Great Dao, one will mistake it for darkness. “Hui” means dark.

Treatise on the Categories of Yin and Yang

At the beginning of Mengchun, the first month of spring, the Yellow Emperor sat at ease, observing the distant scenes in the eight directions and discerning the weather carried by the winds from those directions. He then asked Leigong, “Among the categories of Yin and Yang, the movement of the meridians, and the matters governed individually by the five viscera, which is most important?”

“Mengchun has just begun” refers to the day of the Beginning of Spring. “Yan” means to sit at ease. “Observing the eight extremities” means surveying the distant scenes in the eight directions; “discerning the eight winds” means observing the direction and weather of winds coming from all eight directions. The ancients believed that the winds from the eight directions converged before the Great One, Taiyi. Here, “the five centers” refers to the five viscera. The textual commentators note that the account of the eight winds converging before Taiyi appears in the Tianyuan Yuce.

Heaven and Earth each have Yin and Yang. The human role is to bring them into harmony. If there is Yin without Yang, all things will decline without end; if there is Yang without Yin, all things will grow in excess. Either condition harms the other: when Yin is harmed, calamities associated with Yin arise; when Yang is harmed, afflictions associated with Yang appear. Therefore, a sage must harmonize the Qi of Yin and Yang between Heaven and Earth, so that all things can grow.

The way to bring them into harmony is first to cultivate oneself and build up De. When one’s own De is upright, the Qi of Yin and Yang can be harmonized. When Yin and Yang are in harmony, the winds of the eight seasonal junctures—the beginnings and transitions of the four seasons—will be gentle, and the abnormal winds from the eight directions, which assail the body, will subside. Then illness and unusual calamities will not occur, and auspicious events will gather. This transformation has its underlying principles, though not everyone can explain why it happens.

Thus the Yellow Emperor asked about the relative importance of the body’s meridians. He hoped to use this knowledge to nurture the body and cultivate De, thereby setting the winds from the eight directions in order.

Lei Gong replied, “Spring corresponds to the days of Jia and Yi and to the color green in the east, and governs the liver. The liver meridian governs the seasonal cycle for seventy-two days, so I consider the liver the most important of the five viscera.”

Jia and Yi in the east belong to the Qi of spring, and their corresponding color is naturally green; inwardly, they connect with the liver. The Treatise on the True Words of the Golden Coffer says, “The eastern color is green, and it enters to connect with the liver.” Thus green corresponds to the liver. Each of the Five Phases governs seventy-two days; five periods of seventy-two days make the three hundred and sixty days of a year. Hence it is said that the liver governs seventy-two days. Spring begins the four seasons, and among the five viscera, the liver corresponds to spring. For this reason, Lei Gong considered the liver the most important. Some versions write “Way” where they should have “viscus”; this is incorrect.

The Yellow Emperor said, “I recall that the Upper and Lower Jing compare Yin and Yang and discuss how they relate. The ‘most important’ organ you mention seems, by comparison, to rank lower.”

“Calmly” here means to compare and reason by analogy in an unhurried way. The Yellow Emperor recalled that the upper and lower chapters of the Pulse Classic compare the relationships between form and Qi through Yin and Yang, without calling the liver the most important. He therefore pointed out that although Lei Gong considered the liver most important, in the order discussed in the text it actually ranks lower.

Lei Gong observed a purification fast for seven days, then came again at dawn to sit and talk with the Yellow Emperor.

The commentators explain that Lei Gong fasted to purify his mind. Realizing that his earlier statement was mistaken, he came again to ask for instruction.

The Yellow Emperor said, “The three Yang are the channels; the three Yang are the supports; the one Yang is the circulating region.”

“Channel” carries the sense of organizing and bringing things to completion, while “support” means sustaining and maintaining the original Qi of Heaven. “Circulate” means to move through; “region” refers to the different parts of the body. The original text continues: “Thus, the Qi of life can bring things to completion; the Qi that transforms grain can sustain what is original; the Qi that governs color can disperse essence…” The final sentence is incomplete in the text provided.

The three Yang channels circulate among the different parts of the body. Yang Shangshan says: The “three Yang” refers to the Foot Taiyang channel. It begins at the inner corner of the eye, rises to the head, and divides into four pathways. It descends along the nape; together with its other branches, there are six pathways in all. They run up and down along the back and sustain the whole body. The “two Yang” refers to the Foot Yangming channel. It begins at the nose, descends through the throat, and divides into four pathways. Together with the main channel and its diverging branches, there are six pathways in all. They run up and down through the abdomen and sustain the whole body. The “one Yang” refers to the Foot Shaoyang channel. It begins at the outer corner of the eye and connects with the head, dividing into four pathways. It descends to Quepen, the hollow above the collarbone; together with the main channel and its diverging branches, there are six pathways in all. They run up and down, govern the joints throughout the body, and distribute Qi and blood. Since the three groups of channels each circulate through the body, they are called the “circulating regions.”

In this way, one can understand the beginning and end of the Five Zang’s activity. By observing how the channels crisscross, sustain the whole body, and circulate through its different regions, one can be said to understand the beginning and end of the Five Zang’s activity.

The three Yang are the exterior, and the two Yin are the interior. Here, “three Yang” refers to Taiyang, and “two Yin” to Shaoyin. Shaoyin and Taiyang are paired as interior and exterior, so the text says that the three Yang are on the exterior and the two Yin on the interior.

When one Yin reaches its limit, darkness forms; when Yin Qi begins to arise, the new moon forms. Here, “one Yin” refers to Jueyin; jue means “to reach an end.” The Ling Shu Jing says that Hai corresponds to Jueyin of the left foot, and Xu to Jueyin of the right foot. Both Yin have reached their limit, which is why it is called Jueyin. When Yin Qi is exhausted, there is darkness; when Yin Qi arises, there is the new moon. Jueyin is named for Yin Qi nearing its end. In terms of Qi’s flourishing, it coincides with the new moon; in terms of Qi’s exhaustion, it coincides with darkness. Thus, “one Yin reaches its limit” carries the sense of both the new moon and darkness. If we also relate the condition in which Yin Qi is completely exhausted to the arising of Wood Qi, this can explain how the Five Phases correspond in their movements and cycle without end.

The collator adds: In the commentary’s explanation that “when Yin is exhausted, there is darkness; when Yin arises, there is the new moon,” the phrase “when Yin arises, there is the new moon” should probably read “when Yang arises, there is the new moon.”

Lei Gong said, “Even after receiving your instruction, I still do not understand.”

This means that he still does not understand the signs revealed by changes in the climate.

The Yellow Emperor said, “The so-called three Yang refers to the Taiyang channel.”

The Taiyang channel has abundant Yang Qi, which is why it is called Taiyang.

The pulse Qi of all three Yang channels reaches the Hand Taiyin channel—that is, the site of the cun-kou pulse. The pulse feels wiry and floating, not deep. It should be examined carefully according to the proper method, and judged in light of one’s understanding of Yin and Yang.

The Hand Taiyin channel corresponds to the cun-kou. The cun-kou is where the pulse Qi of the Hand Taiyin channel arrives and circulates, so the pulse Qi of the various channels can all be examined there. The pulse of the Taiyang channel is large…

This passage explains the relationship between human meridians and Yin-Yang balance. When the pulse appears long, wiry, and floating without sinking, one must assess it according to seasonal changes while observing different reactions of the five organs, using Yin-Yang theory to diagnose whether visceral functions are normal.

The text mentions "Two Yang" (二阳), referring to the Yangming meridian (one of the Yang meridians in the human meridian system). According to the Ling Shu Jing (Spiritual Pivot), the Chen hour (7-9 AM) corresponds to the left foot's Yangming meridian, while the Si hour (9-11 AM) corresponds to the right foot's Yangming meridian—these two Yang meridians combine, hence called "Two Yang." If the hand Taiyin lung meridian exhibits a deep, wiry, rapid pulse without pulsation, accompanied by fever, this indicates critical illness. Normally, the Yangming meridian's pulse should be floating, large, and short; if it becomes wiry, tense, deep, and non-pulsating, it signifies excessive Yin Qi and weakened Yang Qi—like a lamp burning brighter before extinguishing, these are dangerous signs.

"One Yang" (一阳) refers to the Shaoyang meridian (a meridian where Yang Qi is nascent but not yet flourishing). When the hand Taiyin lung meridian's pulse connects upward to the Renying point (where the pulse can be felt about 1.5 inches beside the Adam's apple) and shows a wiry, tense, and suspended pulse that doesn't break, this indicates Shaoyang meridian disorder. "Suspended" describes a pulse resembling a hanging object swaying unsteadily.

If "sole Yin" (专阴, only Yin without Yang) occurs, it leads to death. "Three Yin" (三阴) refers to the Taiyin meridian, which governs the six meridians (three Yin and three Yang). All meridians converge at the hand Taiyin lung meridian because the lungs command the Qi of the entire body's meridians, and this Qi gathers at the Qikou (wrist pulse point). As stated in the Discourse on the Distinctive Meridians (经脉别论), "the lungs receive the hundred meridians."

When the pulse is deep, hidden, and pulsating but doesn't rise, it affects the function of "Zhi Xin" (志心, the heart's willpower). This pulse indicates insufficient heart Qi, which pulls upward to sicken the heart. "Zhi Xin" refers to the "small heart" (小心), as mentioned in the Discourse on Needling Prohibitions (刺禁论): "Beside the seventh vertebra lies the small heart" (possibly indicating the heart or pericardium region).

Yang Shangshan considers a floating and rough Lung pulse to be a normal pulse pattern.

Now the pulse is seen to be deep and forceful. This is the Kidney pulse. The Foot Shaoyin Kidney channel runs through the spine and belongs to the Kidneys. It ascends into the Lungs, then emerges from them and connects with the Heart. Lung Qi descends into the Kidneys; what ascends into the Heart is associated with the spirit of the Heart. Wang Bing takes “intention of the Heart” to mean “careful attention,” but this interpretation does not make the passage sufficiently coherent.

The Foot Shaoyin Kidney channel ascends to the Lungs, and Lung Qi returns to the Bladder; externally, the Bladder connects with the Spleen and Stomach. The “two Yin” mentioned here refers to the Foot Shaoyin Kidney channel. A branch of the Shaoyin channel enters the heel, ascends along the inner rear edge of the thigh, runs through the spine, belongs to the Kidneys, and connects with the Bladder. Its direct course ascends from the Kidneys through the Liver and diaphragm and enters the Lungs. Thus the Foot Shaoyin channel ascends to the Lungs, while Lung Qi returns to the Bladder, which connects externally with the Spleen and Stomach.

If the pulse of only one Yin channel appears on its own, while the Qi of the Lung channel is cut off within the body, the pulse Qi will float at the surface without a forceful beat. If the channel Qi is not cut off, the pulse will be hooked in shape and smooth. The New Collation notes that Yang Shangshan takes “one Yin” here to refer to the Foot Jueyin Liver channel.

These six pulse patterns may at times show Yin and at other times Yang. They meet and connect with one another, reach the Five Zang organs, and correspond with Yin and Yang. A pulse may show Yang within Yin or Yin within Yang because Qi meets and interacts. In examining the pulse, one should carefully compare its different types in order to distinguish Yin from Yang.

The pulse that arrives first is the principal pulse; the one that arrives later is the guest pulse. At times the pulse Qi shows Yin while the pulse is Yang, and at times it shows Yang while the pulse is Yin. How should these be distinguished? The pulse that arrives first is taken as the principal one, and the later pulse as the guest. “Arrive” here means that the pulse Qi reaches the cun opening, the pulse-taking site at the wrist.

Lei Gong said, “I have done my utmost to understand and receive this teaching. I have memorized the essentials of the channels and learned the method of calmly discerning the pulse. I wished to use it to compare and classify pulse patterns, yet I still do not understand Yin and Yang, nor female and male.”

Here, “recite” means to memorize. Lei Gong says that he has memorized and studied the subtle method of calmly discerning the pulse, and wished to follow the methods of the ancients to compare and classify pulse patterns, but still does not understand the order of rank between Yin and Yang, or the distinct meanings of “female” and “male.” He therefore asks the Yellow Emperor to explain the underlying principles, so that the correspondences and interplay between Yin and Yang, and between female and male, may become clear.

The Yellow Emperor said, “The three Yang are the father.” A father guides and supports others; here this means that the three Yang hold a high and honored position.

“The two Yang are the guard.” The guard repels external evils and protects the body; here this means that the two Yang support life.

“The one Yang is the framework.” The framework governs and sustains the body and Qi; here this means that the one Yang keeps the body in balance.

“The three Yin are the mother.”

The idea that the mother body nurtures its children means that it can nourish and give rise to them.

“Two Yin” is called the female.

“Female” is a term for Yin.

“One Yin” is called the “sole messenger.”

The organ associated with “One Yin” corresponds externally with the Triple Burner. The Triple Burner conducts and circulates the various forms of Qi, so it is called a “messenger”; hence the name “sole messenger.”

“With Two Yang and One Yin”: Yangming governs the illness, and the illness overwhelms One Yin. The pulse is soft yet forceful, and all nine orifices are sluggish and blocked.

“One Yin” refers to the Qi of Liver Wood in Jueyin, while “Two Yang” refers to the Qi of Stomach Earth in Yangming. Wood and Earth press against each other, making Yangming susceptible to illness. Wood restrains Earth, and Earth cannot overcome Wood; hence the statement that “Yangming governs the illness and cannot overcome One Yin.” The pulse is soft yet forceful because softness represents Stomach Qi, while forcefulness points to Wood Qi. As Wood restrains Earth and the two contend, Stomach Qi cannot circulate normally, so the nine orifices become sluggish and blocked.

“With Three Yang and One Yin”: the pulse force of Taiyang is strong, and One Yin cannot restrain it. This disturbs the Five Zang organs internally and manifests outwardly as terror.

“Three Yang” refers to Taiyang Qi, hence the statement that Taiyang is strong. Wood can generate Fire, but now blazing Yang scorches Wood Qi, which is itself affected in turn. When Yang Qi is excessive, an inner feverish agitation arises and disturbs the Five Zang organs. The Liver governs fear, so the disturbance appears outwardly as terror.

“With Two Yin and Two Yang”: the illness is in the Lungs. The Shaoyin pulse is deep, hidden, and forceful; the Lungs are damaged, affecting the Spleen, while the limbs are harmed outwardly.

“Two Yin” refers to the pulse of the Hand Shaoyin Heart channel, while “Two Yang” also refers to the Stomach pulse. When the Heart and Stomach are both ill, pathogenic Qi moves upward and downward, injuring the Spleen internally and the Lungs externally. This is because the Stomach is the Spleen’s Fu organ, while Heart Fire restrains Lung Metal. The Spleen governs the limbs, so when the Spleen is damaged, the limbs are affected as well. The Shaoyin pulse referred to here is the Shenmen pulse, about five fen behind the palm, on the side near the little finger.

The newly collated edition holds that “Two Yang” should refer to the Hand Yangming Large Intestine channel; the Large Intestine is the Lungs’ Fu organ. Heart Fire of Shaoyin restrains Metal Qi, hence the statement that the illness is in the Lungs. Wang Bing’s interpretation of “Two Yang” as the Stomach pulse is not very coherent, especially since it also involves the claim that “Stomach illness affects the Kidneys.” The passage should instead be describing how Heart illness affects the Lungs. Moreover, the versions in Quan Yuanqi, the Zhenjiu Jiayi Jing, the Taisu, and other texts all read “Two Yin and One Yang.”

“When Two Yin and Two Yang converge and arrive, the illness is in the Kidneys,” producing symptoms such as insults, abnormal behavior, and madness.

“Two Yin” refers to the Kidneys, which belong to Water; “Two Yang” refers to the Stomach, which belongs to Earth.

Earth qi restrains Water qi, so illnesses arise alternately from the qi of Earth and Water, with the disease located in the kidneys. When Kidney Water cannot restrain Stomach Earth, Stomach qi becomes excessive, giving rise to disordered awareness and manic behavior.

In illnesses described as “two Yin and one Yang,” the disease arises in the kidneys. Kidney Yin qi rises and invades the space between the heart and the Stomach region, leaving the orifices below the Stomach region empty. The movement of qi becomes obstructed, like water behind a blocked embankment, and the limbs lose their coordination, as though separated from one another.

“One Yang” here refers to the Hand Shaoyang Sanjiao channel. The Sanjiao belongs to Fire; Kidney Water rises to attack Fire, so the illness begins in the kidneys, with Kidney Yin qi ascending to invade the heart. Why does this happen? The Kidney channel rises from the kidneys, passes through the diaphragm and liver, and enters the lungs. A branch of the channel emerges from the lungs, connects with the heart, and converges in the chest. This is why the symptoms described above occur. Kidney Yin qi travels upward, but the Stomach cannot restrain it, showing that Stomach Earth qi is weak. As a result, the orifices below the Stomach region are all obstructed. “Embankment” means that, like a dam, it prevents qi from flowing out normally. The Stomach channel runs through the feet, while the Heart channel connects with the hands; thus the limbs seem separated from one another and cannot move normally.

A note in Xin Zhi Zheng states: Wang Bing’s commentary says that “the Stomach channel runs through the feet,” but in the phrase “illnesses of two Yin and one Yang arise in the kidneys,” “Stomach” should read “Kidney.”

When the pulse of “one Yin and one Yang” alternately stops, Yin qi reaches the heart. The movement of qi up and down has no regular pattern, and its coming and going cannot be discerned. The throat becomes dry, and the disease affects the upper part of the body and the Spleen.

“One Yin” refers to the Foot Jueyin Liver channel, and “one Yang” to the Foot Shaoyang Gallbladder channel; both belong to Wood qi. “Alternately stopping” means that the pulse pauses partway through its beating. This alternating interruption in the pulse gives rise to the illness. Wood qi can generate Fire, so after the illness begins, Yin qi rises to the heart. The qi of the Liver and Gallbladder can reach the head above, the waist and feet below, and the abdomen and flanks in between; symptoms may therefore occur in different parts of the body. If the patient cannot taste food, has irregular bowel movements, and suffers from a dry throat, this is because the pharynx behind the throat is associated with the function of the Gallbladder. Although the illness manifests in the Spleen, which belongs to Earth, its root lies in the Liver and Gallbladder.

In illnesses described as “two Yang and three Yin,” the qi of Utmost Yin remains entirely within the Yin domain and cannot cross into the Yang domain. Yang qi cannot restrain Yin qi, and the qi of Yin and Yang is cut off altogether. When the pulse is floating, blood concretions appear; when it is deep, pus adheres.

“Two Yang” refers to the Yangming channel, “three Yin” to the Hand Taiyin channel, and “Utmost Yin” to the Spleen; all are therefore situated in the Yin domain. Yet Yin qi cannot cross over into the Yang domain, and Yang qi cannot restrain Yin qi. The qi of Yin and Yang bind against each other, and the pulse is interrupted and no longer continuous. A floating pulse means that Yang qi presses against the Yin domain, causing blood concretions to form. The original text breaks off after the word “deep”; on the basis of the surviving text, it can only be translated as: when the pulse is deep, pus adheres.

This is because yin qi (vital energy) presses upon yang qi, causing pus to gather, and the lungs consequently rot.

When yin and yang are both strong and continually press against each other, the illness gradually penetrates to where Yin-Yang meet, becoming a grave disease. The "yin and yang" referred to here mean, in men, the yang passage and, in women, the yin organs. These parts are able to hold jing (essence) and qi, which is why they are so named.

Upward they join the place of brightness, and downward they join the place of obscurity. "Brightness" (zhaozhao) refers to the upper part of the Yangming (the region where yang qi shines most brightly). "Obscurity" (mingming) refers to the dark interior of the Zhiyin (the place where yin qi is most abundant).

In diagnosing illness and determining the limits of life and death, one must ultimately compare the suishou (the beginning of the year, the season when each year begins). This passage describes methods for estimating how much time remains to the patient.

Lei Gong asked: "How can one determine the timing of a short-term death?" The Yellow Emperor did not answer, wishing Lei Gong to press the question again so that it could be asked more specifically.

Lei Gong asked again, and the Yellow Emperor said: "This is recorded in the classic treatises," referring to the scriptures of high antiquity. The Xin Jiao Zheng (New Collation) states that, according to the Quan Yuanqi edition, the passage beginning with "Lei Gong" forms a separate chapter, whose title is "Illnesses by the Four Seasons."

Lei Gong asked: "How can one determine the timing of a short-term death?" The Yellow Emperor said: "If illness arises in the three winter months and joins with yang, and by the first month of spring the pulse shows signs of death, the patient will die by the end of spring." The phrase "illness joins with yang" means that yin in front joins with yang to produce disease. Even if the pulse already shows signs of death in the first month, because yang qi is beginning to sprout, the patient may still survive until the end of spring, that is, the end of the third month, at the beginning of summer.

"When illness arises in the three winter months, by pathological reasoning the course of the disease is exhausted by this time, and the grasses and willow leaves have withered." Here, li refers to the yin qi of the kidneys, that is, the yin qi of the two yins. If a kidney patient's pulse shows signs of death in the first month, then when the dry grasses are spent and the pine needles turn green, he too will die. The word li, "reason," is interchangeable with li, "interior," and yi, "already," is interchangeable with yi, "to use," in ancient texts.

When yin and yang qi are both cut off in spring, the limit of life lies in mengchun (the first month of spring). After the beginning of spring, if yin and yang qi are both suspended in the pulse, the patient is expected not to survive the first month. The Xin Jiao Zheng states that the Taisu edition lacks the character for "spring."

Illness arising in the three spring months is called "yang killing." The "yang illness" here does not mean cold damage, warm disease, or heat disease. It refers instead to fever out of season, with a pulse that is large, surging, and rapid. Spring yang qi has not yet fully flourished, so if fever arises and the pulse takes on summer characteristics, then, as the classic says, "the pulse no longer appears." That is, the vital signs corresponding to the present season no longer appear in the pulse. With no yang qi outside to respond to it, the patient is certain to die by the summer solstice. At the solstice, yang qi reaches its peak and begins to harm the myriad things, which is why it is called "yang killing."

When yin and yang qi are both cut off, the limit of life lies at the time when the grasses and trees wither.

If the illness is not a simple yang illness, but both the yang and yin pulses are extremely weak, barely perceptible, the patient will die, and the time of death will be during the Frost's Descent solar period, when the grasses and trees wither.

A febrile disease contracted during the three summer months, if it belongs to the Most Yin (referring to the spleen, which belongs to Earth and occupies the most yin position within the yin), will not last beyond ten days. This passage refers to heat disease. When the spleen is heated, the spleen is in danger. The completion number of Earth is ten, so the patient will not survive beyond ten days.

The time of death in "yin-yang intersection" is the period of Lian water. The Discussion of Febrile Diseases says: when a patient with warm disease sweats and then immediately develops fever again, with a agitated and rapid pulse that does not subside after sweating, and the patient speaks incoherently and cannot eat, this is called "yin-yang intersection." In the sixth month, a patient who contracts summer heat disease has yin and yang qi contending again and reaching a standstill, so death will come by the Beginning of Autumn. Editorial note by Xin Jiaozheng: the Quan Yuanqi edition says that Lian water refers to the seventh month, which belongs to the Shen (monkey) position of the calendar, where water is born at the Shen position and yin and yang oppose each other. Yang Shanshan says that "Lian" means the calm of water, referring to the time in the seventh month when water begins to stir.

A disease contracted during the three autumn months, if the three yang qi arise simultaneously, will heal on its own without treatment. This is because yang qi declines in autumn and yin qi gradually emerges. Since yang qi cannot overcome yin qi, the disease ceases of its own accord.

In the disease of yin-yang intersection, the patient cannot sit down while standing and cannot rise while sitting. This is because the qi of the body does not circulate along its normal pathways.

When the three yang qi arrive alone in excess, the time of death is during the period of Stone water. This is a case of yang without yin, and so it is called "arriving alone." The Treatise on Arriving at Teaching says that when the three yang arrive alone, it means the three yang arrive together, from which we know there is only yang and no yin. Stone water refers to the time in winter when water freezes into stone. The tomb-storehouse of Fire is at Xu, and since yang qi is weak in winter, death occurs during Stone water. Editorial note by Xin Jiaozheng: the explanation of Stone water originates with Quan Yuanqi, and Wang Bing adopted his view.

When the two yin arrive alone in excess, the time of death is during the period of Full water. This is also the so-called situation of arriving together without yang. Full water refers to the time when rain and snow have melted into water, which is the central qi of the first month (Rain Water). Editorial note by Xin Jiaozheng: in the Quan Yuanqi edition, "two yin" is written as "three yin."

The following is the chapter On the Rise and Decline of Qi. Lei Gong asked: regarding the abundance and deficiency of qi, what is reversal and what is compliance? The Yellow Emperor replied: yang qi travels along the left side, and yin qi travels along the right side. To observe the abundance or deficiency of yang qi, follow the left side; to observe the abundance or deficiency of yin qi, follow the right side. Whatever accords with this direction is compliance, and whatever contradicts it is reversal. The Great Treatise on the Correspondence of Yin-Yang and Phenomena says that left and right are the pathways along which yin and yang move.

Those who are old should adjust their health from the upper body, and those who are young should adjust it from the lower body. The elderly gradually lose the ability to digest and absorb grains, so adjusting from the upper part of the body suits them better. The young have stronger desires, so adjusting from the lower part suits them better.

Therefore, in spring and summer, when one accords with yang and returns to yang, there is vitality. If one returns to the yin of autumn and winter, one moves toward death. Here, "returning to autumn and winter" means turning to return to yin. To return to yin is to accord with the austere, withering qi, and so one proceeds toward decline. If the situation is reversed, returning to autumn and winter instead brings vitality. Here "reversed" means that returning to yin in autumn and winter is what sustains life.

When the amount of qi deviates from its normal course, a reversal (jue) forms. Jue is a disorder of qi-movement. If changes in yang qi are abnormal, they appear on the right side. If changes in yin qi are abnormal, they appear on the left side. In all such cases the pattern departs from the normal course, which is why it is said that whether qi is deficient or excessive and moves in disorder, a reversal forms. Here, if the changes described as occurring on the left or right are abnormal, they likewise belong to jue. Jue means qi moving counter to its proper direction.

Question: Does an excess of qi also produce jue?

Answer: Earlier it was said that a deficiency of qi, when it does not flow smoothly, leads to counterflow. Does an excess of qi also produce the reversal disease?

Answer: If yang qi only rises and does not descend, cold reversal (hanjue) arises, with cold reaching as far as the knees. The young die when they meet autumn and winter. The old, on meeting autumn and winter, instead survive.

When the qi of a single channel rises in counterflow and yang cannot descend, how is this recognized? One need only observe whether the cold reversal reaches the knees. The four limbs are the root where the yang channels converge and exert their function. They should be warm, yet they are cold, and so it is called "cold reversal." Autumn and winter here refer to a return to yin. Once one returns to yin, the disease arises on the right side. The young rely chiefly on the activity of yang, so they tend to die in autumn and winter. The old rely chiefly on the activity of yin, so in autumn and winter they instead have vitality. The New Collation (Xinjiaozheng) quotes Yang Shangshan as saying that weakness can also produce reversal. Once yang qi rises only to the head and does not descend to the feet, the lower legs become weak, and so cold reversal reaches the knees.

When qi rises and does not descend, it causes headache and disease of the vertex. "Vertex" refers to the uppermost part of the body, so "vertex disease" means illness of the head.

Seeking yang and not obtaining its manifestation, and seeking yin without being able to judge it accurately; the pulse positions of the five viscera are distant from one another and offer no reliable signs. It is like being in the open wilderness or hiding in an empty house. Qi continues without end, yet it is hard to sustain it for a whole day. Here, the "yang" sought shows a pulse that resembles excess yin, and the "yin" sought shows a pulse that resembles excess yang. Hence the phrase "seeking yang without obtaining it, seeking yin without discerning it." The "five parts" are the pulse positions corresponding to the five viscera. "Distant" (ge) means far apart, and "no signs" means no credible evidence. Seeking yang without finding its heat signs, and seeking yin without being able to determine its cold signs, while the five positions are separated and no reliable signs can be found over time, is why it is said: "seeking yang without obtaining it, seeking yin without discerning it, the five parts distant and without signs." In such a case, one should begin from the long-term movement of qi...

These unusual manifestations are not caused by the cold or heat of Yin-Yang (yin yang) qi (qi). For instance, a patient may at times feel as though they are standing in an open, empty place, with their shen (shen) scattered and unable to settle. At other times they may feel as though they are hiding in an empty room, with their mind quiet and deeply concealed. In the first state, qi rises against its course and the pain grows worse, lasting a long time without ceasing. In the second state, although the pain has subsided, the patient worries that it will return.

"Mianmian" (mianmian) describes breath that is faint and moves little. Although the patient is still alive, and their breath continues without interruption, they feel in their heart that they may not survive to the end of the day. Therefore the text says "mianmian hu shu, bu man ri ye" (mianmian hu shu, bu man ri ye), meaning that although the breath has not been cut off, it seems unable to last a single day.

○ The Xinjiao Zheng (Newly Collated Edition) states: According to the Taisu (Taisu), the phrase "ruo fu kong shi" (ruo fu kong shi, "as if lying in an empty room") is preceded by the five characters "wei yin yang zhi yi" (wei yin yang zhi yi, "is one of Yin and Yang"). It is suspected that these five characters have been omitted here.

Thus, when the qi of the Shaoyin (Shaoyin) channel rises in reverse, it causes absurd dreams. When the reversal is mild, the dreams appear strange. When the reversal reaches its extreme, the dreams cause confusion.

When the qi of the three Yang channels is cut off, and the pulses of the three Yin channels are weak, this is a sign of insufficient qi. ○ The Xinjiao Zheng states: According to the Taisu, the original text reads "san yang jue qi, shi wei shao qi" (san yang jue qi, shi wei shao qi, "cutting off of the three Yang qi is shao qi, or deficient qi").

When lung qi is weak, a person dreams of white things, or dreams of people being cut down, with much blood flowing. White corresponds to Metal among the Five Phases (wu xing), and cutting down is the function of Metal. "Jiji" (jiji) describes dreamed scenes of blood spreading across the ground and the appearance of death.

When the season governed by lung qi arrives, dreams will show scenes of armed battle. "De qi shi" (de qi shi) here refers to the three months of autumn. Metal corresponds to weapons and warfare, so one dreams of fighting.

When kidney qi is weak, a person dreams of boats and of people drowning. Boats and drowning both relate to water, and the kidney corresponds to Water, so such scenes appear in dreams.

When the season governed by kidney qi arrives, one dreams of lying submerged in water, with the heart seemingly fearful. This refers to the three months of winter.

When liver qi is weak, a person dreams of fungi, fragrant herbs, and newly sprouting plants. "Jun xiang" (jun xiang) and "sheng cao" (sheng cao, "newly grown grasses") are all things of the grass-and-tree kind. The liver corresponds to plants and trees, so such scenes appear in dreams. ○ The Xinjiao Zheng states: According to the Quan Yuanqi (Quan Yuanqi) edition, "jun xiang" is written as "gui jun" (gui jun, "cinnamon fungus"). The character qu is read as "lun qie" (lun qie).

When the season governed by liver qi arrives, one dreams of hiding beneath trees and not daring to rise. This refers to the three months of spring.

When heart qi is weak, a person dreams of rescuing someone from fire, or dreams of things that correspond to fire. The heart corresponds to Fire, so such dreams arise. "Yang wu" (yang wu, "yang things") also belongs to the category of fire.

When the season governed by heart qi arrives, dreams show scenes of being burned by fire. This refers to the three months of summer.

When spleen qi is weak, a person dreams of having insufficient food and drink. The spleen governs the transformation and transport of food and water, so one dreams of not having enough to eat and drink.

When this coincides with the corresponding season, one dreams of building walls and erecting houses.

Here, "attaining its season" (de qi shi) means that the months chen, xu, chou, and wei correspond with the related qi movements. "Building walls and roofing houses" refers to constructing walls and erecting houses, activities associated with the Earth phase (tu).

These dream images are all related to weakness of the qi of the five zang organs (wu zang) and to an excess of yang alongside a deficiency of yin. The six fu organs (liu fu) belong to yang, and the five zang organs belong to yin. When the conditions of the five zang and six fu are considered together, yin and yang are regulated according to the five methods of examination, with reference to the meridians (jingmai). The Lingshu Jing (Spiritual Pivot) says that yin and yang must be fully harmonized and the five methods of examination integrated, so the phrase "relying on the meridians" is cited here. Jingmai is also the title of a chapter in the Lingshu Jing.

There are ten standards of examination. They include measuring the pulse, the five zang organs, the muscles, the sinews, and the shu points (the sites where meridian qi flows in and out). Each category has two standards, so "five categories, two each" totals ten, which are used to measure and judge the condition of an illness.

When the changes of yin and yang qi have been examined completely, the patient's illness can be distinguished. If the examination thoroughly grasps the principles of yin and yang vacuity, repletion, decline, and flourishing, the illness can be identified accordingly.

Pulse changes have no fixed constant. Yin qi may disperse while yang qi is excessive. If the pulse omits signs or the examination is incomplete, the illness cannot be diagnosed by the usual method. In such cases the examination must weigh the situation above and below, and separately consider the common people (baixing), the ruler, and the ministers and great officials (qing dafu).

Pulse changes are unfixed, and yin qi may disperse while yang qi is excessive. If the examination has omissions and is incomplete, the illness cannot be observed by routine methods. Then one should weigh the circumstances of the three groups (common people, ruler, and ministers) and treat each according to their condition. Their methods of nourishment differ, because worry, joy, toil, and similar conditions differ, and their status and living conditions differ as well.

If one studies under a teacher without finishing the course, and then applies medical techniques not yet understood, and also fails to discern whether the disease is moving in an adverse or favorable direction, this is reckless action (wang xing). Guarding yin while losing yang, or abandoning yin and leaning only toward yang, without understanding how to examine yin and yang together, means one cannot truly grasp the pathology. These cases all show that what one has learned is incomplete.

If this learning is passed on to later generations, mistaken statements will eventually become visible. Zhang means "to make manifest." When one teaches others what one has not understood, the places where one departs from the original intent of the ancients will inevitably be exposed.

When yin qi is extremely deficient, heavenly qi cannot descend. When yang qi is excessively strong, earthly qi is insufficient to ascend. Here zhi means "the utmost." This situation arises when yin and yang cannot communicate above and below.

That yin and yang interact and move together is something only sages can accomplish. Jiao means mutual communication. Only the sage can regulate yin and yang so that they move in their proper order.

When yin and yang interact, yang arrives first and yin follows afterward. When yin and yang qi travel in parallel and meet in the same place, yang should arrive first and yin follow, because yang moves quickly and yin moves slowly. The Lingshu Jing says that what is called "communication" is yin and yang proceeding together and returning to the same place.

Two kinds of qi (Qi) also converge at the same point.

Therefore, the sage who masters the way of diagnosis first distinguishes the sequence of Yin-Yang, and then examines the pulse according to the "qiheng" (unusual and regular pulse patterns, the variations between abnormal and normal pulses). They master the regularities of the sixty pulse variations, observe subtle signs closely, trace the transformations of Yin and Yang, distinguish the internal conditions of the five zang organs, analyze the principles involved, and grasp the key to judging deficiency and excess. Only with this understanding is one sufficiently capable of practicing diagnosis.

The diagnostic system known as the "sixty qiheng shi" has now been lost.

Thus, if one examines the Yin pulse without distinguishing the Yang pulse, the diagnosis will be inaccurate. If one obtains only the Yang pulse without distinguishing the Yin pulse, one will cling to a single aspect and fail to achieve true comprehension. Knowing only the left and not the right, or only the right and not the left, knowing only the upper body and not the lower, or only the earlier condition and not the later changes, will make treatment difficult to sustain. One must distinguish what is normal from what is abnormal, what is favorable from what is unfavorable, what is illness from what is not, what is high from what is low, what is seated from what is standing, and what is moving from what is still, and apply these distinctions to diagnosis. Only then is the way of diagnosis complete, and it can be practiced over the long term without error.

This is the sage's essential admonition concerning the clear examination of diagnostic method: one must know what is in excess and what is deficient.

The Treatise on the Preservation of Life and the Form Complete states: "When the inner and outer correspond, do not let the form come first." (In diagnosis, one must attend to both the internal and the external, and not judge solely by external appearance.) Knowing where one's own body has excess should lead one to know where the patient is deficient.

To weigh an illness, one must examine both upper and lower conditions; to examine the pulse, one must follow its changes and investigate in depth. The "ge" here means to reach, to penetrate deeply.

When the body is weak and the qi is also insufficient, there is danger to life, because both interior and exterior are deficient. When the body appears strong but the pulse qi is insufficient, there is also danger to life, because the zang-fu organs are weakened. When the pulse qi is abundant but the bodily qi is insufficient, there remains hope of life, because the qi of the zang-fu organs is still vigorous, which is why the pulse qi is in excess.

There is a basic method of diagnosis: one should have a standard manner in sitting and rising. When sitting and rising follow a regular pattern, breathing and exertion can be harmonized appropriately, and so this must be achieved first in diagnosis. Going out and coming in, and all movements, must also proceed in an orderly manner, so that one can perceive the movement of shen qi (spirit qi) as the body changes.

During diagnosis, one must be clear-minded and calm: observe the complexion above, examine the physical form and breath below; discern the eight joints (the transitions of the seasons, when the upright qi changes), distinguish the positions of each of the five zang organs, and then palpate the pulse for its stillness and movement. The "looking above" here refers to observing the complexion; the "examining below" refers to examining the physical form and breath. The "eight upright" refers to the normal signs that should appear at the eight seasonal transitions, and the "five middle" refers to the respective positions of the five zang organs. Afterward, one palpates the movement of the pulse at the cun-kou (inch opening) and the chi portion and other sites, to judge the severity of the illness.

Following the chi portion, one examines whether the pulse is smooth or choppy, and attends to the signs of cold and heat. Observing the magnitude of the pulse and combining this with the course of the illness to judge favorable and unfavorable developments, one can further distinguish the name of the disease. Only through such examination can one hope to achieve perfection in every respect without contradicting the patient's actual condition.

Chapter on Explaining the Refined and Subtle (Jiejingwei Lun Pian)

Those who understand the principles observe the length of the breath and also count the beats of the pulse, which is why diagnosis sometimes involves looking at the breath. Once one grasps the regular correspondence between breath and pulse, one can determine where the disease lies. These are all the orderly methods that the sages followed in observing illness, and they agree with one another.

The principle is very clear and can be fully discerned, so it can be followed for a long time. Without understanding it, one loses the constant pattern of the jingluo (channels), severs the connections among affairs and principles, and the words one speaks lose their grounding, so the results one hopes for naturally fail to appear. This is called losing the Dao (the Way), that is, losing the refined and subtle principle.

The New Collation states that, according to the Quan Yuqi edition, this chapter is titled "Explanation of the Essentials."

The Yellow Emperor (Huangdi) was in the Hall of Light (Mingtang). Lei Gong asked for instruction, saying: "I have received the teachings of my masters and have transmitted and practiced this learning. Drawing on the scriptural treatises, I lecture on the methods of treatment, including the regulation of emotions, the patterns of the body, Yin-Yang, acupuncture, moxibustion, and decoctions. However, among those who receive these teachings, some are capable and some are not, and they may not all be able to avoid every error."

This means that what one has received and applies may be complete, but once it is passed on to others, they may not fully master it. Here, "capable" refers to those whose minds are clear and whose aspirations are broad, while "unworthy" refers to those who are rigid, narrow, and do not act according to standards.

Lei Gong continued: "Concerning sorrow, joy and anger, dryness and dampness, cold and heat, Yin-Yang, and questions about women, I wish to ask about their underlying causes. Whether one's station is low or high, human bodies and endowments differ. As a subordinate who must often carry out orders, I must apply the medical art appropriately when the occasion arises. I humbly listen for your instruction."

These were teachings of the sages that he had heard before, but he had not yet grasped their essential points.

Lei Gong further said: "Permit me, a dull person, to raise some questions beyond what the scriptures have addressed, and to ask about their circumstances."

Here, "omitted" refers to places in the scripture that have not yet been clearly explained. "Dull" is self-deprecation, indicating that one's own understanding is not clear. "Servant" conveys a sense of asking hastily. The New Collation notes that, according to the Quan Yuqi edition, "dull" is written as "simple."

The Yellow Emperor said: "This question is very important."

That is, this is the essential point that people should most value.

Lei Gong asked: "When a person weeps, the tears well up but do not flow out; and even when they do flow, there are very few. Why is this?"

He is asking: which zang-fu organ is failing to function normally, such that this condition arises?

The Yellow Emperor said: "The scriptures have already discussed this."

The Lingshu Jing contains an account of sorrow and the flow of tears.

Lei Gong further asked: "I still do not understand where the jinye (body fluids) and tears are generated and from where they flow out."

Here, "asked again" means pressing the question once more, because he wishes to understand the source of the body fluids and tears.

The Yellow Emperor said: "To ask this question is of no help in treating illness. A physician should understand the principle of it, namely, from what they are born."

The Yellow Emperor's meaning is that tears and body fluids are both transformed from the qi of the body. To inquire where they come from, when this does not aid diagnosis and treatment, has no practical use.

"The heart is the lord, formed by the gathering of the essential qi of the five zang organs."

Zhuanren (exclusive governance) means that the jing (essence) of the five zang organs obeys the direction of the heart, so that the heart becomes the mansion that governs the shen (spirit). For this reason the eyes are the orifice through which the shen manifests. When the shen dwells within, its brightness can look outward, which is why the eyes are said to be its orifice.

Facial complexion and color are the radiance of the shen revealed outwardly. When a person has de (here meaning the function of conforming to the Dao), the qi (vital energy) manifests smoothly in the eyes, and states such as sorrow or discernment also appear in the complexion. De is the function of the Dao. Human life is born from the Dao and nourished by de. Qi is the root of life, and shen is the dwelling place of qi. Heaven disperses de-moisture, earth transforms and generates primordial qi, and humans live by means of these. When qi is harmonious, the shen is settled, and when the shen is settled, outward observation is clear. When qi is not harmonious, the shen cannot remain within the body, and when the shen cannot hold within, its outward radiance diminishes. Therefore it is said that when a person has de, qi manifests smoothly in the eyes, and sorrow and discernment also appear in the complexion. (Editorial note by Xinzhi Zheng: the Taisu edition writes de as the homophone meaning "to obtain" rather than "virtue.")

Therefore, when a person grieves, tears fall. Tears are produced by water. The so-called "water source" (shuizong) is accumulated water. (Editorial note by Xinzhi Zheng: the Jiayi Jing writes shuizong as zhongjing, "the multitude of essences.")

Accumulated water belongs to extreme yin, and extreme yin is the jing qi of the kidneys. The jing water that serves as the source does not flow outward because the jing qi holds it in and also assists and wraps it, so the water cannot escape on its own. The jing qi of water transforms into zhi (will), and the jing qi of fire transforms into shen. When water and fire respond to each other, the shen and zhi grieve together, and the watery fluid in the eyes is thereby produced.

The eyes are the channel through which the upper watery fluids flow out. Therefore, when water and fire respond and the shen and zhi grieve together, the fluid rises upward and reaches the eyes.

Thus the common saying "the heart grieves" is also called "the will grieves," because zhi gathers together with the jing qi of the heart at the eyes. (Here the variant form of cou, meaning "to gather," is read as the standard cou.)

Because water and fire sense each other, this is called "heart grief" or "will grief." When the shen and zhi rise together, zhi and the heart's shen rush together toward the eyes. Therefore, in grief, the shen qi passes into the jing of the heart but not into zhi. Zhi grieves alone, and tears flow out. Tear fluid and nasal mucus are both related to the brain, and the brain belongs to yin. (The Wuzang Bielun states that the brain is born from earth qi and belongs to the yin category, like the earth, which is why it is said here that "the brain belongs to yin." The character shuo means to melt or dissolve. Editorial note by Xinzhi Zheng: the Quan Yuanqi edition, the Jiayi Jing, and the Taisu all write "yin" as "yang.")

Marrow is the substance that nourishes the bones.

Essence and qi are abundant and fill the marrow, so it is called "full" (chong).

Fluid from the brain seeps out and becomes nasal mucus. The nasal orifices connect with the brain, so the fluid in the brain seeps out and flows into the nose.

Zhi (volition, the mind's intention) is governed by the marrow. When fluids flow, nasal mucus flows out with them because they move in the same way. "Same kind" means their natures are similar.

Nasal mucus and tears are like brothers: when in crisis they are harmed together, and when they grow they arise together. Sharing one origin, their rising and falling always follow each other. (The Xinzhi edition reads "when they grow, both arise"; the Taisu reads "when they emerge, both perish.")

When a person's zhi is stirred by grief, nasal mucus and tears well up and flow together. "Horizontal movement" (hengxing) may be a mistake for "flowing movement" (liuxing).

Nasal mucus and tears flow out together and follow each other because they belong to the same category. Here "belonging together" means that both are related to the brain. Why say so? As stated above, both nasal mucus and tears are connected to the brain.

Lei Gong asked: "The principle is profound. May I ask, when a person weeps, why do tears sometimes well up but not flow out, or flow out while the nasal mucus does not follow?"

Lei Gong reasoned that since tears and nasal mucus come from the same category, why should they differ in how they flow out?

The Yellow Emperor replied: "Tears that do not flow out come from weeping without grief. Not weeping means the shen has no feeling of pity. When the shen is not grieved, the zhi will not be sorrowful. When Yin and Yang are held in mutual tension, how could tears flow out alone?"

"Weeping without tears" (qi bu chu) means that tears well up but cannot flow out, while "not weeping" means that there are no tears while crying. The essential qi of water becomes zhi, and the essential qi of fire becomes shen. Water is Yin and fire is Yang, so when Yin and Yang are held in tension, tears cannot flow out alone.

When zhi is stirred by grief, the heart feels agony. The agitated qi of this agony surges against the Yin qi, and the zhi then leaves the eyes. When zhi leaves, the shen can no longer hold the jing (essence). When the jing and the shen leave the eyes, nasal mucus and tears flow out.

"Wan" (agony) refers to inner torment, and "chong" (surging) carries the sense of rising. Shen and zhi respond to each other, and tears arise from this. Thus, when the heart is in agony, Yang qi rises toward the brain, which belongs to Yin. "Leaving the eyes" means that Yin qi cannot remain in the eyes. When zhi leaves the eyes, the shen also drifts and wanders. Once zhi is gone, the eyes lose their inner perception, and once the shen loses its hold, the jing cannot manifest outwardly. Hence it is said that when the shen leaves the eyes, nasal mucus and tears flow out.

Have you not read what the classics say? When qi reverses (jueni), the eyes cannot see. When a person experiences reversal, Yang qi gathers in the upper body and Yin qi gathers in the lower body. Here, "gathering" means that the Yin and Yang qi each collect in their proper places.

When Yang qi gathers above, fire qi alone becomes excessive. When Yin qi gathers below, the feet turn cold, and cold feet lead to distension. When water qi is insufficient and cannot restrain the fire qi of the five zang organs, the corners of the eyes grow dim and blurred.

The eyes are one of the water orifices (shui qiao) of the human body, and the yang qi of the five zang organs, here called the "five fires" (wu huo), belongs to fire.

Note from the New Collation (xin jiaozheng shuo): Checking the Jiayi Jing (Canon of Acupuncture and Moxibustion), there is no character read zi, meaning "eye corner," in this passage.

Therefore, when wind blows into the eyes, tears flow without ceasing. Wind invades the eyes, and the yang qi remains fixed on the jing (essence) qi within them. Fire qi scorches the eyes, so whenever wind arrives, one weeps. Wind forces the yang qi under pressure and keeps it hidden and unable to emerge, so fire burns within the eyes.

This is like a sudden gust rising, which then brings rain. When yang qi is excessive, fire flourishes alone in the upper body while the eyes cannot become bright. The eyes are therefore born from yang qi and connected to the five zang organs. When yin and yang are harmonized and the jing qi in the eyes is abundant, vision becomes clear. When yang qi reverses (rebels, becomes disordered), the light qi cannot ascend. When yin qi reverses, the two feet become cold and swollen.

The saying "one water cannot overcome the five fires" (yi shui bu neng sheng wu huo) means that the yang qi of the hands and feet is like the five fires, while the yin qi below refers to liver qi. Wind blows into the eyes and tears flow without end because, once wind invades the eyes, yang qi stays within the jing qi, and when yang is abundant, fire scorches the eyes. Wind and heat combine, so one weeps. A fierce fire stirs up the force of wind, and that wind in turn brings rain. This serves as a fitting analogy for blazing yang fire stirring up wind, and wind provoking tears.

New Collation note: Checking the Jiayi Jing, the character for "fire" is absent. The Taisu (Plain Questions compilation) reads "the heavenly swift wind can then bring rain," omitting the character sheng (generate).