灵枢经·五变 Discourse on the Five Variations

Huangdi asked Shaoyu, saying: 'I have heard that when the hundred diseases first begin, they must arise from wind, rain, cold, and heat, following the fine body hair and entering the interstices of the skin. Sometimes the pathogen turns back and departs; sometimes it lingers and lodges; sometimes it becomes wind-swelling with sweating; sometimes it becomes wasting-thirst; sometimes it becomes cold and heat; sometimes it becomes lingering impediment; sometimes it becomes accumulations and gatherings. Strange evils overflow in countless variety, and I wish to hear the reason for this. Now when people fall ill at the same time, some contract this disease and others that — is it perhaps that Heaven generates wind differently for different people? Why should there be such difference?' Shaoyu said: 'Now when Heaven generates wind, it is not out of partiality toward the common people. Its movement is fair, level, and upright: those who transgress against it are struck by it, and those who avoid it escape harm. It is not that Heaven seeks out a person, but that the person transgresses against it of their own accord.'

Huangdi said: 'When people meet with wind at one and the same time and fall ill together, why do their illnesses differ? I wish to hear the reason.' Shaoyu said: 'An excellent question! Let me explain it by comparison with a craftsman. When a craftsman sharpens his axe and hones his blade to cut and fell timber, the wood itself — being of yin and yang — still has its hard and its brittle portions. Where the wood is hard, the blade will not bite; where it is brittle, the bark gives way easily; and where the grain crosses at a knot, the axe itself may be nicked. Now within a single tree, the hard and the brittle portions differ: the hard is unyielding, the brittle is easily damaged — how much more so, then, when the timbers themselves differ, in the thickness of their bark and the abundance of their sap, so that each is distinct from the others! Consider trees that flower early and put forth leaves before others: if they meet with spring frost and fierce wind, their blossoms fall and their leaves wither. In prolonged exposure and great drought, those trees that are brittle-wooded and thin-barked have branches and twigs with little sap, and their leaves wither. In prolonged overcast and excessive rain, those that are thin-barked and rich in sap have their bark soaked through and shallowly rotted. When sudden violent wind arises, trees that are hard yet brittle have their branches snapped and broken. When autumn frost comes with swift wind, trees that are hard yet brittle have their roots shaken and their leaves shed. In each of these five cases, the harm done differs according to the tree — how much more must this be so for human beings!'

Huangdi said: 'How does this correspond in human beings, as with trees?' Shaoyu answered: 'Where a tree is harmed, it is always the branches that suffer the harm; a branch that is hard, brittle yet firm does not yet come to harm. In human beings, when a person has a recurring illness, it is likewise because of some place — in the bones and joints, the skin, or the interstices — that is not firm and solid; it is there that the pathogen lodges, and so illness recurs there constantly.'

Huangdi said: 'In people who are prone to wind reversal with dripping sweat, how may this be known in advance?' Shaoyu answered: 'When the interior is not firm and the interstices are loose, one is prone to wind disease.' Huangdi said: 'How may one know that the flesh is not firm?' Shaoyu answered: 'When the flesh of the hollow of the knee is not firm and lacks distinct texture — that is, when its texture is coarse, and where the texture is coarse the skin is not close-knit — the interstices are loose. This describes the condition taken as a whole.'

Huangdi said: 'In people who are prone to wasting-thirst, how may this be known in advance?' Shaoyu answered: 'Those in whom all five viscera are soft and weak are prone to wasting-thirst.' Huangdi said: 'How does one recognize that the five viscera are soft and weak?' Shaoyu answered: 'Now where there is softness and weakness, there must also be hardness and strength present together with it; hardness and strength incline toward frequent anger, while the soft is easily injured.' Huangdi said: 'How does one distinguish the soft and weak from the hard and strong?' Shaoyu answered: 'Such a person has thin skin, and eyes that are firm, fixed, and deep-set; the passage from throat to intestine is long and straight. Their heart is hard, and hardness inclines toward frequent anger; anger causes the qi to rebel upward, accumulating and gathering within the chest, so that blood and qi flow backward and lodge there. The flesh beneath the flank becomes engorged, the blood vessels fail to circulate, and this turns into heat; heat then consumes the flesh and skin, and so wasting-thirst results. This describes a person who is fierce and hard by temperament but whose flesh and muscles are weak.'

Huangdi said: 'In people who are prone to cold-heat disorders, how may this be known in advance?' Shaoyu answered: 'Those with small bones and weak flesh are prone to cold-heat disorders.' Huangdi said: 'How does one determine whether the bones are large or small, the flesh hard or brittle, and the complexion uneven?' Shaoyu answered: 'The cheekbone is the root of the bony structure: when the cheekbone is large, the bones are large; when the cheekbone is small, the bones are small. When the skin is thin and the flesh lacks firm bulk, when the arms are soft and feeble, and when the complexion at the lower portion of the face appears dull and lifeless, not matching the color of the upper portion, but sullied and distinctly different — this is the sign. Moreover, in one whose arms are thin, the marrow is not full, and so such a person is prone to cold-heat disorders.'

Huangdi said: 'How may one recognize a person prone to impediment disorders?' Shaoyu answered: 'One whose skin texture is coarse and whose flesh is not firm is prone to impediment.' Huangdi said: 'Does impediment have fixed locations, whether high or low in the body?' Shaoyu answered: 'To know whether it will occur high or low, one need only observe the region affected in each case.'

Huangdi said: 'In people prone to accumulations and gatherings within the intestines, how may this be known in advance?' Shaoyu answered: 'When the skin is thin and lacks luster, and the flesh is not firm but moist and soft, then the intestines and stomach are in poor condition. Being in poor condition, evil qi lingers and lodges there; accumulations and gatherings then injure the region between the spleen and stomach. When cold and warmth are not properly regulated, evil qi gradually arrives, accumulating and lingering until it lodges there, and a great gathering then arises.'

Huangdi said: 'I have now heard of the forms these illnesses take, and I understand them. I wish now to hear of their timing.' Shaoyu answered: 'One must first establish the person's age, so as to know the proper season. If the season is in its ascendant phase, the illness will arise; if the season is in its declining phase, the danger is greater still. Even where there is no marked decline, if in that year there is a pathway of clash and encounter, the illness will certainly arise. This is what is meant by disease arising according to the body's constitution — this is the guiding thread of the five variations.'