素问·本病论 Discourse on the Root of Disease

Huangdi asked: I already understand the nine obstructions of the celestial origin; I wish now to hear about the interchange of qi — what is meant by "losing its hold"? Qi Bo replied: It refers to the ascending and descending of qi above and below, its shifting into correct position and its retreating from position, each governed by its own canonical principles; when above and below each fails to advance, this is called "losing its hold." Thus when the interchange of qi loses its proper place, the interchange itself is altered, and this alteration is not ordinary — the four seasons lose their sequence, the transformations of the myriad things become unsettled, and this is transformed into disease among the people.

The Emperor said: I wish to hear the reason why ascent and descent fail to advance. When the interchange of qi undergoes alteration, how can this be clearly known?

Qi Bo said: How illuminating is this question! You have grasped the Dao. When the interchange of qi undergoes alteration, this is what is called the pivot of heaven and earth. When a qi wishes to descend but cannot descend, it is that the obstruction of earth restrains it. Again, when one of the five movements is in excess and arrives before its due season, the interchange fails to advance: when a qi wishes to ascend but cannot ascend, the central movement suppresses it; when it wishes to descend but cannot descend, the central movement likewise suppresses it. Thus there are cases where ascent fails to advance, where descent fails to go down, where ascent reaches heaven [but no further], and where both ascent and descent fail to advance — such are the distinctions to be made. The alterations of the qi interchange thus differ from one another, never quite the same, and the resulting calamities vary in severity.

The Emperor said: I wish to hear of the reasons why, in the encounters and meetings of the qi interchange, one qi overcomes and suppresses another, and this is transformed into disease among the people — how do the degrees of severity compare? Qi Bo said: When the prevailing [qi] meet one another, suppression and latency result. Thus in the years of chen and xu, wood qi ascends to heaven; the governing [palace] it encounters is Tianzhu (Celestial Pillar), and being overcome, it fails to advance. If one further encounters a gengxu year in which the metal movement arrives ahead of its season, the central movement suddenly overcomes it, so that it fails to advance. As wood's movement ascends to heaven, metal then suppresses it; ascent fails to advance, and thus clearing qi arises while wind is scant, autumnal severity descends upon the spring, dew and frost fall again, and plants and trees wither. People suffer from warm pestilence arising early, dryness of the throat, fullness of the four limbs, and pain throughout the joints. When this persists and turns to stagnation, great winds break and tear at things, snapping and felling them amid a discordant howling. People suffer from sudden stroke with widespread numbness and paralysis, the hands and feet losing sensation.

Thus in the years of ji and hai, the sovereign fire ascends to heaven; the governing [palace] it encounters is Tianpeng (Celestial Canopy), and being overcome, it fails to advance. Further, when reverting-yin wood shifts into correct position while lesser yin has not yet been able to ascend to heaven, and the water movement arrives in the interim — the sovereign fire wishes to ascend, but the central water movement suppresses it, so that its ascent fails to advance; clear cold then reappears, and cold arises at dawn and dusk. People suffer from latent yang, which generates vexing heat internally, so that the heart-spirit is startled and palpitates, and cold and heat alternate. When this persists and turns into stagnation, sudden intense heat then arrives: red wind, swelling, and clouding of vision appear, turning into epidemic disease; warm pestilence and fervent disorders arise, red qi becomes miasmic and turns into a fire epidemic — in all cases there is vexation together with agitation and thirst; when the thirst is severe, treatment by draining can bring it to a halt.

Thus in the years of zi and wu, greater yin ascends to heaven; the governing obstruction is Tianchong (Celestial Thoroughfare), and it is overcome and fails to advance. Further, should one encounter a renzi year in which the wood movement arrives ahead of its season, the central [earth qi's] ascent is obstructed by wood. When ascent to heaven fails to advance, wind-borne dust rises on all sides, at times lifting into a murky haze, and rain and dampness fail to transform. People suffer from wind reversal with excessive salivation, generalized numbness and paralysis with loss of movement, and distension and fullness. When this persists and becomes latent stagnation, yellow dust turns into epidemic disease; people die prematurely, the face and limbs and organs become swollen and jaundiced and blocked, the governance of dampness fails to spread, and the transformation of rain becomes scant.

Thus in the years of chou and wei, lesser yang ascends to heaven; the governing obstruction is Tianpeng (Celestial Canopy), and it is overcome and fails to advance. Further, should one encounter a case in which greater yin has not yet shifted into correct position, so that lesser yin has not yet ascended to heaven, and the water movement arrives [in its place] — when ascent to heaven fails to advance, cold vapors spread contrarily, bitter and biting as in winter; waters that had thawed dry up again, ice reforms, warmth flares up briefly and then cold spreads once more, so that cold and warmth come at irregular times. People suffer from latent yang lodged within, generating vexing heat internally, so that the heart-spirit is startled and alarmed, and cold and heat contend by turns. When this persists and turns into stagnation, sudden intense heat then arises: red wind qi causes clouding of the pupils, turning into stagnant pestilence, producing latent heat and internal vexation, numbness that gives rise to reversal, and in severe cases, overflow of blood.

Thus in the years of yin and shen, yang brightness ascends to heaven; the governing obstruction is Tianying (Celestial Blossom), and it is overcome and fails to advance. Further, should one encounter a wuyin year in which the fire movement arrives ahead of its season — metal wishes to ascend to heaven, but the fire movement suppresses it, so that its ascent fails to advance; seasonal rains fail to fall, west winds repeatedly rise, and salinity and dryness are generated. People suffer from heat above with panting, coughing, and overflow of blood. When this persists and turns into stagnation, white dust obscures the mist, clear qi generates a killing autumnal qi; people suffer from fullness of the rib-sides and sorrowfulness, cold with nasal congestion and sneezing, dryness of the throat, and cracking of the hands with dry skin.

Thus in the years of mao and you, greater yang ascends to heaven; the governing obstruction is Tiannei (Celestial Inner Palace), and it is overcome and fails to advance. Further, should one encounter a case in which yang brightness has not yet shifted into correct position, so that greater yang has not yet ascended to heaven, and the earth movement arrives [in its place] — water wishes to ascend to heaven, but the earth movement suppresses it, so that its ascent fails to advance; dampness then steams together with heat, and cold arises amid the rains. People suffer from pouring diarrhea, and food fails to be digested. When this persists and turns into stagnation, cold arrives as a guest upon heat, and hail suddenly descends. People suffer from reversal counterflow with retching, heat generated within and qi obstructed without, aching and soreness of the shins and lower legs, and conversely, palpitations with oppressive heat, sudden vexation followed again by reversal.

Huangdi said: Regarding ascent that fails to advance, I have now fully grasped its meaning. I wish to hear about descent that fails to go down — may this be made clear? Qi Bo said: How thorough is this question! This is what is called the subtle purport of heaven and earth, and I may set forth this Dao in full: what has ascended must in due course descend. Having reached heaven, after three years the following year it must descend; descending, it enters the earth, and thereupon becomes the left intercalary position. Such is the coming and going of ascent and descent, and this is called the six chronograms. Thus in the years of chou and wei, reverting yin descends to earth; the governing obstruction is Dixiao (Terrestrial Brightness), and it is overcome and fails to advance. Further, should one encounter a case in which lesser yin has not yet retreated from position, so that reverting yin has not yet descended, and the metal movement arrives in the interim — the metal movement receives it from above, and its descent fails to go down; suppressed, it turns to stagnation. Wood wishes to descend, but metal receives and opposes it from above, so that descent fails to go down: blue-green dust is seen in the distance, white qi bears down upon it, wind lifts dust into a haze, clear dryness carries out its killing work, dew and frost fall again, and the governance of autumnal severity spreads. When this persists without descending, the suppression turns to stagnation, and wind and dryness lie latent together, contending with each other; warmth then turns contrarily to clearness, plants and trees sprout and stir, the killing frost fails to come on schedule, hibernating creatures fail to appear, and there is dread that the clear qi will injure the viscera stored within.

Thus in the years of yin and shen, lesser yin descends to earth; the governing obstruction is Dixuan (Terrestrial Mystery), and it is overcome and does not enter. Further, should one encounter a bingshen or bingyin year in which the water movement is in excess and arrives ahead of its season — the sovereign fire wishes to descend, but the water movement receives and opposes it from above, so that descent fails to go down: crimson clouds are barely glimpsed before black qi arises contrarily; warmth seems about to unfold, yet cold repeatedly spreads snow, biting cold recurs, and the sky and clouds turn bleak and mournful. When this persists without descending, the latent qi turns to stagnation; cold, having prevailed, turns again to heat, and red wind transforms into epidemic disease. People suffer redness of the face and vexation of the heart, headache and dizziness of vision; when red qi becomes manifest, warm-disease is about to arise.

Thus in the years of mao and you, greater yin descends to earth; the governing obstruction is Dicang (Terrestrial Blue-green), and it is overcome and does not enter. Further, should lesser yang not yet have retreated from position, so that greater yin cannot yet descend, and the wood movement arrives [in its place] — the wood movement receives and opposes it from above, so that descent fails to go down: yellow clouds appear together with blue-green rosy vapors made manifest, stagnant steaming arises together with great winds, fog and dust-haze prevail, and breaking and destruction then occur. When this persists without descending, the latent qi turns to stagnation; the sky is filled with yellow dust-qi, and the earth spreads damp steam. People suffer from inability to raise the four limbs, dizziness and pain of the joints, and fullness of the abdomen pressing upon the chest.

Thus in the years of chen and xu, lesser yang descends to earth; the governing obstruction is Dixuan (Terrestrial Mystery), and it is overcome and does not enter. Further, should one encounter a year in which the water movement is in excess and arrives ahead of its season — the water movement receives and opposes it, so that water's descent fails to go down: crimson clouds are barely glimpsed before black qi arises contrarily; warmth is about to arise when cold qi suddenly descends, and in severe cases there is hail. When this persists without descending, the latent qi turns to stagnation; cold qi turns again to heat, and red wind transforms into epidemic disease. People suffer redness of the face and vexation of the heart, headache and dizziness of vision; when red qi becomes manifest, heat-disease is about to arise.

Thus in the years of ji and hai, yang brightness descends to earth; the governing obstruction is Ditong (Terrestrial Vermilion), and it is overcome and does not enter. Further, should one encounter a year in which greater yin has not yet retreated from position, so that lesser yang cannot yet descend, and the fire movement arrives [in its place] — the fire movement receives and opposes it, so that descent fails to go down: the sky turns clear and stern, red qi becomes manifest, and warm heat arises contrarily. People all feel languor and fatigue, unrest at night when lying down, dryness of the throat with craving for drink, oppressive heat and internal vexation; the sky turns markedly clear at dawn and dusk, yet warmth returns again. When this persists without descending, the latent qi turns to stagnation; the sky turns clear with a thin chill, and white qi is generated in the distance. People suffer from shaking and dizziness, stiffness and numbness of the hands and feet, pain in both rib-sides, and eyes filled with a hurried, unsettled blur.

Thus in the years of zi and wu, greater yang descends to earth; the governing obstruction is Difu (Terrestrial Abundance), and it is overcome, its descent failing to enter. Further, should one encounter a year in which the earth movement is in excess and arrives ahead of its season — the earth movement receives and opposes it, so that descent fails to enter: the sky is filled with black qi, dim and desolate; scarcely has yellow dust been dispersed than dampness spreads, the transformation of cold governs the qi, and steaming dampness governs once more. When this persists without descending, the latent qi turns to stagnation; people suffer from great reversal, heaviness and lassitude of the four limbs, impotence and lack of strength, the sky spreads a sunken overcast, and steaming dampness arises intermittently.

The Emperor said: Regarding the failure of ascent and descent to advance, I have understood this clearly to its root. I wish now to hear of shifting into correct position — may this be made clear? Qi Bo said: When the proper qi governs the central position, this is called shifting into correct position. When the governor of heaven fails to attain its shift into correct position, it is because the preceding governor of heaven has overstepped the time of the handover of governance. That is, one encounters a case in which the governor of heaven is in excess and has surplus days remaining, so that it continues to govern the heavenly count as before, and the new governor of heaven has not yet been able to shift into correct position. When reverting yin fails to shift into correct position, wind and warmth come at irregular times, flowers and plants wither and become sickly. People suffer from painful urinary dripping, twisting of the eye-connecting vessels, cramping of the sinews together with irritability and anger, and reddened urine. Wind wishes to exercise its governance, yet cold does not depart on its account; warmth fails to be proper, and the correct timing of spring is lost. When lesser yin fails to shift into correct position, cold qi does not retreat: spring turns cold, followed by further chill, and warmth comes at irregular times. People suffer from cold and heat, vexing pain of the four limbs, and rigidity of the lower back and spine. Although wood qi is in excess, its position does not surpass that of the sovereign fire. When greater yin fails to shift into correct position, the governance of clouds and rain is lost, the myriad things wither and scorch, and what should sprout fails to put forth growth. People suffer from swelling and fullness of the joints of hands and feet, watery swelling of the great abdomen, fullness pressing on the chest with inability to eat, undigested diarrhea and fullness of the rib-sides, and inability to raise the four limbs. The transformation of rain wishes to exercise its governance, yet heat still governs in its stead; the warming of qi becomes excessive without bringing moisture. When lesser yang fails to shift into correct position, scorching heat fails to exercise its governance, sprouts and weeds do not flourish, harsh heat persists into autumn, the arrival of autumnal severity is delayed, and frost and dew come at irregular times. People suffer from malarial disorders with bone-deep heat, palpitations and startling fright, and in severe cases, overflow of blood. When yang brightness fails to shift into correct position, the transformation of summer heat governs what precedes, and severity governs what follows, so that plants and trees flourish contrary to season. People suffer from cold and heat with nasal congestion and sneezing, damage to the skin and body hair, withering and scorching of the nails, and in severe cases, panting and coughing with rapid, raised breath, sorrow and unhappiness. The transformation of heat then spreads, while the transformation of dryness fails to exercise its governance; clear, forceful autumn qi fails to proceed, and the lung metal falls ill in turn. When greater yang fails to shift into correct position, the clearness of winter turns contrarily to cold, and this governance shifts over into spring: killing frost comes first, and cold ice follows after; sunlight governs again, biting cold fails to arise, and clouded vapors await their proper time. People suffer from the arrival of warm pestilence, closure of the throat and dryness overflowing, vexation and agitation with thirst, and panting breath accompanied by wheezing sound. The transformation of cold awaits dryness, each still governing heaven in the other's stead; when qi oversteps and loses its proper sequence, it becomes a calamity for the people.

The Emperor said: Having named the purport of early and late shifting into correct position, I wish now to hear of retreating from position — may this be made clear? Qi Bo said: What is called "not retreating" means that the heavenly count has not yet ended, that the heavenly count still has surplus; this is called "renewing the spread of governance," and hence also called "governing heaven a second time" — that is, the heavenly mandate continues as before and does not retreat from position. When reverting yin fails to retreat from position, great winds rise early, seasonal rains fail to fall, and the governance of dampness fails to transform. People suffer from warm pestilence, blemishing debility, and wind-generated disorders; people all suffer joint pain, headache and eye pain, latent heat with internal vexation, and dryness of the throat with craving for drink. When lesser yin fails to retreat from position, warmth is generated in spring and winter, hibernating creatures emerge early, and plants and trees sprout and grow. People suffer from diaphragmatic heat and dryness of the throat, overflow of blood with startling fright, reddened and hesitant urination, and cinnabar-tumors, rashes, sores, and ulcers that retain toxin. When greater yin fails to retreat from position, cold and heat come at irregular times, dusty haze spreads, and the governance of warmth does not depart. People suffer from lack of strength in the four limbs, inability to take in food and drink, pouring diarrhea and dripping fullness, cold of the shins and lower legs, impotence and blockage, and incontinence with frequent urination. When lesser yang fails to retreat from position, heat is generated in spring, and summer heat transforms only later; winter turns warm without freezing, flowing water does not ice over, and hibernating creatures emerge and appear. People suffer from shortage of qi, cold and heat alternating, blood in the stool with heat rising above, hardness and fullness of the lower abdomen, reddened and turbid urine, and in severe cases, overflow of blood. When yang brightness fails to retreat from position, spring generates clear cold, plants and trees flourish late, and cold and heat come intermittently. People suffer from vomiting and sudden pouring diarrhea, inability to take in food and drink, dryness of the stool, inability to raise the four limbs, and dimness of vision with dizziness.

The Emperor said: Regarding the early and late shifting of the heavenly year, I now understand it. I wish to hear of the earthly count — may I gain leisure to understand it? Qi Bo said: The pattern by which the qi below on earth shifts into correct position, ascends, or retreats from position without advancing, is precisely the pattern by which the earth's production and transformation, and the myriad things, lose their proper timing of transformation.

The Emperor said: I have heard of the two sexagenary cycles of heaven and earth, the ten heavenly stems and twelve earthly branches, which serve as the warp and weft above and below for heaven and earth, their numbers shifting in succession, at times losing their hold on position — may this be made clear? Qi Bo said: "Losing position through succession" means that although a year attains its correct stem-branch designation, it has not attained the governance proper to its correct position, so that the four seasons lose their regulation and great epidemics are generated. A note to the Xuanzhu miyu (Secret Sayings of the Mysterious Pearl) states: of the thirty yang years, six are removed as years of Heaven's constraint (tianxing), leaving twenty-four reckoned as years of excess; apart from these six, all are treated as functioning in excess — this is the purport of when it is not so. What is now spoken of as "succession of branches, succession of position" may in every case be treated as a case of insufficiency.

Suppose in a jiazi yang year, the earth movement is greatly obstructed, as when the preceding guihai year still has surplus in its heavenly count: although the year has turned to jiazi, reverting yin still governs heaven, while below, the earth-governing qi has already shifted into correct position, yang brightness being at the spring below. The lesser yang of the past year serves as the right intercalary position; thus it is reverting yin above paired with yang brightness below, and the two do not harmonize with and uphold one another. Gui and si meet in correspondence: the earth movement, though nominally in excess, is instead depleted and overcome by wood, and is therefore not truly in excess. How, then, can the earth movement be called excessive? Moreover, the pitch pipe Huangzhong (Yellow Bell) fails to respond with its full obstructive note. Once wood has prevailed, metal returns to restore balance; once metal has been restored, lesser yin then arrives as though on schedule; yet since wood's dominance resembles that of fire, metal's restoration is in turn feeble. In this way jia and ji lose their hold, and in the third year thereafter an earth epidemic takes form — arriving late in a mao year, or early in a bingyin year, the earth epidemic then arrives. Its magnitude and severity, whether benign or malign, are to be reckoned from the numbers of heaven and earth, examined in detail through the Great One (Taiyi). Again, take simply the jiazi year: jia reaches the branch zi and the two correspond, so that the handover of governance ought to take place and heaven ought to be governed accordingly. Yet if, below, the jiwei earth-governing qi has not shifted into correct position, and the wuyin lesser yang has not yet retreated from position, this too is a case where jia and ji fail to correspond below: the earth movement is then not truly in excess, and wood takes advantage of this void to overcome earth; metal, in its turn, again moves to overcome wood in restoration — this is the transformation into a contrary, pathogenic pattern. Yin and yang, heaven and earth, differ from one case to the next; hence the magnitude and severity, whether benign or malign, all follow uniformly the statutes and purport of heaven and earth.

Suppose in a bingyin yang year of excess, as when the preceding yichou year still has surplus in its heavenly count: although the year has turned to bingyin, greater yin still governs heaven, while below, the earth-governing qi has already shifted into correct position, reverting yin governing the earth. The greater yang of the past year serves as the right intercalary position; thus heaven is greater yin while earth is reverting yin, and so the earth fails to uphold the transformation of heaven. Yi and xin meet in correspondence: the water movement, greatly depleted, is instead overcome by earth, and is therefore not truly in excess — that is, the pitch pipe of Taicu (Great Budding) fails to respond in its Taiyu note; earth prevails and brings about the transformation of rain, while water, in restoring balance, instead produces wind. This is a case in which bing and xin lose their mutual correspondence, and in the third year thereafter a water epidemic takes form — arriving late in a jisi year, or early in a wuchen year; when severe it arrives swiftly, when mild it arrives slowly, and the water epidemic then comes. Its magnitude and severity, whether benign or malign, are to be reckoned from the numbers of heaven and earth, following the wandering palaces of the Great One (Taiyi). Again, take simply the bingyin year: bing reaches the branch yin and the two correspond, so that the handover of governance ought to take place and heaven ought to be governed accordingly. Yet if xinsi has not attained its shift into correct position, and the gengchen greater yang has not yet retreated from position, this too is a case where bing and xin fail to unite in virtue: the water movement is then only slightly depleted and only slightly overcome, and there may or may not be a restorative reaction. In the third year thereafter it transforms into a pestilence called water pestilence, whose manifestations resemble the water epidemic; the method of treatment is as given above.

Suppose in a gengchen yang year of excess, as when the preceding jimao year still has surplus in its heavenly count: although the year has turned to gengchen, yang brightness still governs heaven, while below, the earth-governing qi has already shifted into correct position, greater yin governing the earth. The lesser yin of the past year serves as the right intercalary position; thus heaven is yang brightness while earth is greater yin, and so the earth below does uphold heaven. Yi and geng meet in correspondence: the metal movement, greatly depleted, is instead overcome by fire, and is therefore not truly in excess — that is, the pitch pipe of Guxian (Old Purification) fails to respond in its Taishang note; fire prevails and brings about the transformation of heat, while water, in restoring balance, inflicts cold. This is a case in which yi and geng lose their hold, and in the third year thereafter a metal epidemic takes form; arriving swiftly in a renwu year, or slowly in a guiwei year, the metal epidemic then comes. Its magnitude and severity, whether benign or malign, are to be reckoned from the heavenly count of the base year together with the Great One (Taiyi). Again, take simply the gengchen year: geng reaches the branch chen and the two correspond, so that the handover of governance ought to take place and heaven ought to be governed accordingly. Yet if, below, yiwei has not attained its shift into correct position, and the jiawu lesser yin below has not yet retreated from position, this too is a case where yi and geng fail to unite in virtue: below, yiwei's stem loses its firmness, and this too is a slight depletion of the metal movement, with a slight prevailing that may or may not have a further restoration. In the third year thereafter it transforms into a pestilence called metal pestilence, whose manifestations resemble the metal epidemic; the method of treatment is as given above.

Suppose in a renwu yang year of excess, as when the preceding xinsi year still has surplus in its heavenly count: although the year has turned to renwu, reverting yin still governs heaven, while below, the earth-governing qi has already shifted into correct position, yang brightness being at the spring. The lesser yang of the past bingshen year serves as the right intercalary position; thus heaven is reverting yin while earth is yang brightness, and so the earth fails to uphold heaven. Ding and xin meet in correspondence: the wood movement, greatly depleted, is instead overcome by metal, and is therefore not truly in excess — that is, the pitch pipe of Ruibin (Luxuriant Guest) fails to respond in its Taijiao note; metal's course brings about the prevailing of dryness, and fire's transformation restores heat; when severe it arrives swiftly, when mild it arrives slowly, and when the pestilence arrives, its magnitude and severity, whether benign or malign, are to be reckoned from the heavenly count of the year in which the pestilence arrives, together with the Great One (Taiyi). Again, take simply the case where ren reaches the branch wu and the two correspond, so that the handover of governance ought to take place accordingly. Yet if, below, dingyou has not attained its shift into correct position, and the bingshen lesser yang below has not yet attained its retreat from position, we see that ding and ren fail to unite in virtue: ding, the yielding stem, loses its firmness, and this too is a slight depletion of the wood movement, with a slight prevailing and a slight restoration. In the third year thereafter it transforms into a pestilence called wood pestilence, whose manifestations resemble a wind epidemic; the method of treatment is as given above.

Suppose in a wushen yang year of excess, as when the preceding dingwei year still has surplus in its heavenly count: although the year has turned into shen, greater yin still governs heaven, while below, the earth-governing qi has already shifted into correct position, reverting yin being at the spring. The greater yang of the past renxu year retreated from position to serve as the right intercalary position; thus heaven is dingwei and earth is guihai, and so the earth fails to uphold the transformation of heaven. Ding and gui meet in correspondence: the fire movement, greatly depleted, is instead overcome by water, and is therefore not truly in excess — that is, the pitch pipe of Yize (Barbarian Constancy) fails to respond in its upper Taizhi note. This is a case in which wu and gui lose their mutual correspondence, and in the third year thereafter an epidemic takes form, arriving swiftly in a gengxu year. Its magnitude and severity, whether benign or malign, are to be reckoned from the heavenly count of the year in which the pestilence arrives, together with the Great One (Taiyi). Again, take simply the wushen year: wu reaches the branch shen and the two correspond, so that the handover of governance ought to take place and heaven ought to be governed accordingly. Yet if, below, guihai has not attained its shift into correct position, and the renxu greater yang below has not yet retreated from position, we see that wu and gui fail to unite in virtue: below, gui, the yielding stem, loses its firmness, and we see this as a slight depletion of the fire movement, with a slight prevailing that may or may not have a further restoration. In the third year thereafter it transforms into a pestilence called fire pestilence; the method of treatment is as given above — treatment may proceed by cooling and by draining.

Huangdi said: When a person's qi is insufficient and heaven's qi is likewise vacuous, the person's spirit loses its hold, the spirit-light fails to gather, and pathogenic ghosts assail the person, bringing about premature death — may this be explained to me? Qi Bo said: When one of a person's five viscera is insufficient, and this coincides with a vacuity of heaven's qi, the arrival of pathogenic influence follows. When a person is beset by worry, grief, and excessive contemplation, the heart is thereby injured. If this further coincides with a year in which lesser yin governs heaven but its heavenly count is insufficient, so that greater yin arrives to fill the intervening gap — this is called a vacuity of heaven, and it is a case in which the person's qi and heaven's qi are simultaneously vacuous. If one further encounters fright that plunders the essence, causing sweat to issue from the heart, then a threefold vacuity results, and the spirit-brilliance loses its hold. The heart is the office of the sovereign ruler, whence spirit-brilliance issues; when the spirit loses its hold on its position, it wanders up to the upper cinnabar field, beneath the Palace of the Muddy Pellet (niwan) where the Sovereign Lord Great One resides. Once the spirit has lost its hold, the spirit-light fails to gather; should this then coincide with a year in which fire is insufficient, a black corpse-demon will appear, causing the person to die suddenly. When a person is beset by excess in eating and drinking, or by fatigue from overexertion, the spleen is thereby injured. If this further coincides with a year in which greater yin governs heaven but its heavenly count is insufficient, so that lesser yang arrives to fill the intervening gap — this too is called a vacuity, a case in which the person's qi and heaven's qi are both vacuous. If one further encounters overeating to satiety, causing sweat to issue from the stomach, or engaging in intercourse while drunk and replete, causing sweat to issue from the spleen, then a threefold vacuity results, and the spleen-spirit loses its hold. The spleen is the office of remonstrance and counsel, whence comprehensive wisdom issues; once the spirit has lost its hold, the spirit-light loses its position and fails to gather; should this then coincide with a year in which earth is insufficient — whether a ji year or a jia year that has lost its hold, or a vacuity of greater yin governing heaven — a blue-green corpse-demon will appear, causing the person to die suddenly. When a person sits long upon damp ground, or exerts great force entering water, the kidney is thereby injured. The kidney is the office of vigor and strength, whence skill and dexterity issue; a threefold vacuity thereby results, and the kidney-spirit loses its hold, the will and spirit lose their position, and the spirit-light fails to gather; should this then coincide with a year in which water is insufficient — whether xin fails to meet its tally, or a bing year loses its hold, or a vacuity of greater yang governing heaven — a yellow corpse-demon will arrive, and its appearance causes the person to die suddenly. When a person is beset by resentment and anger, so that qi surges upward and fails to descend, the liver is thereby injured. If this further coincides with a year in which reverting yin governs heaven but its heavenly count is insufficient, so that lesser yin arrives to fill the intervening gap — this is called a vacuity of heaven, a case of both heaven's vacuity and the person's vacuity. If one further encounters running in haste combined with fear, causing sweat to issue from the liver — the liver being the office of the general, whence planning and deliberation issue — the spirit's position loses its hold, and the spirit-light fails to gather; should this then coincide with a year in which wood is insufficient — whether a ding year fails to correspond, or a ren year loses its hold, or a vacuity of reverting yin governing heaven — a white corpse-demon will appear, causing the person to die suddenly. In all five of these cases of losing one's hold, heaven is vacuous and the person is vacuous; when the spirit wanders and loses its hold on position, the five corpse-demons assail the person and cause sudden death — this is called corpse-collapse (shijue). When a person transgresses so that the five spirits exchange their proper places, the spirit-light is no longer whole and round; and it is not corpse-demons alone — every kind of pathogenic invasion arises from the spirit's loss of its hold on position. Hence it is said: those who maintain their hold live, those who lose their hold perish; those who retain their spirit flourish, those who lose their spirit die.