素问·至真要大论 Comprehensive Discourse on the Essentials of Truth
黄帝问曰：五气交合，盈虚更作，余知之矣。六气分治，司天地者，其至何如。歧伯再拜对曰：明乎哉问也。天地之大纪，人神之通应也。帝曰：愿闻上合昭昭，下合冥冥，柰何。歧伯曰：此道之所主，工之所疑也。帝曰：愿闻其道也。歧伯曰：厥阴司天，其化以风，少阴司天，其化以热，太阴司天，其化以湿，少阳司天，其化以火，阳明司天，其化以燥，太阳司天，其化以寒，以所临藏位，命其病者也。帝曰：地化柰何。歧伯曰：司天同候，间气皆然。帝曰：间气何谓。歧伯曰：司左右者，是谓间气也。帝曰：何以异之。歧伯曰：主岁者纪岁，间气者纪步也。帝曰：善。岁主奈何。歧伯曰：厥阴司天为风化，在泉为酸化，司气为苍化，闲气为动化。少阴司天为热化，在泉为苦化，不司气化，居气为灼化。太阴司天为湿化，在泉为甘化，司气为黅化，闲气为柔化。少阳司天为火化，在泉为苦化，司气为丹化，间气为明化。阳明司天为燥化，在泉为辛化，司气为素化，间气为清化。太阳司天为寒化，在泉为咸化，司气为玄化，间气为藏化。故治病者，必明六化分治，五味五色所生，五藏所宜，乃可以言盈虚病生之绪也。
帝曰：厥阴在泉而酸化，先余知之矣。风化之行也何如。歧伯曰：风行于地，所谓本也，馀气同法。本乎天者，天之气也，本乎地者，地之气也，天地合气，六节分而万物化生矣。故曰：谨候气宜，无失病机，此之谓也。帝曰：其主病何如。歧伯曰：司岁备物，则无遗主矣。帝曰：先岁物何也。歧伯曰：天地之专精也。帝曰：司气者何如。歧伯曰：司气者主岁同，然有馀不足也。帝曰：非司岁物何谓也。歧伯曰：散也，故质同而异等也，气味有薄厚，性用有躁静，治保有多少，力化有浅深，此之谓也。帝曰：岁主藏害何谓。歧伯曰：以所不胜命之则其要也。帝曰：治之柰何。歧伯曰：上淫于下，所胜平之，外淫于内，所胜治之。帝曰：善。平气何如。歧伯曰：谨察阴阳所在而调之，以平为期，正者正治，反者反治。
帝曰：夫子言察阴阳所在而调之，论言人迎与寸口相应，若引绳小大齐等，命曰平，阴之所在寸口何如。歧伯曰：视岁南北，可知之矣。帝曰：愿卒闻之。歧伯曰：北政之岁，少阴在泉，则寸口不应，厥阴在泉，则右不应，太阴在泉，则左不应。南政之岁，少阴司天，则寸口不应，厥阴司天，则右不应，太阴司天，则左不应。诸不应者，反其诊则见矣。帝曰：尺候何如。歧伯曰：北政之岁，三阴在下，则寸不应，三阴在上，则尺不应。南政之岁，三阴在天，则寸不应，三阴在泉，则尺不应，左右同。故曰：知其要者，一言而终，不知其要，流散无穷，此之谓也。
帝曰：善。天地之气，内淫而病何如。歧伯曰：岁厥阴在泉，风淫所胜，则地气不明，平野昧，草乃早秀，民病洒洒振寒，善伸数欠，心痛支满，两脇里急，饮食不下，鬲咽不通，食则呕，腹胀善噫，得后与气，则快然如衰，身体皆重。岁少阴在泉，热淫所胜，则焰浮川泽，阴处反明，民病腹中常鸣，气上冲胸，喘不能久立，寒热皮肤痛，目瞑齿痛䪼肿，恶寒发热如疟，少腹中痛腹大，蛰虫不藏。岁太阴在泉，草乃早荣，湿淫所胜，则埃昏岩谷黄反见黑，至阴之交民病饮积心痛耳聋，浑浑焞焞，嗌肿喉痹，阴病血见，少腹痛肿，不得小便，病冲头痛，目似脱，项似拔，腰似折，髀不可以回，膕如结，腨如别。岁少阳在泉，火淫所胜，则焰明郊野，寒热更至，民病注泄赤白，少腹痛溺赤，甚则血便，少阴同候。岁阳明在泉，燥淫所胜，则霿雾清暝，民病喜呕，呕有苦善大息，心胁痛不能反侧，甚则嗌乾面尘，身无膏泽，足外反热。岁太阳在泉，寒淫所胜则凝肃惨栗，民病少腹控睾，引腰脊上冲心痛，血见，嗌痛颔肿。帝曰：善。治之柰何。歧伯曰：诸气在泉，风淫于内，治以辛凉，佐以苦，以甘缓之，以辛散之。热淫于内，治以咸寒，佐以甘苦，以酸收之，以苦发之。湿淫于内，治以苦热，佐以酸淡，以苦燥之，以淡泄之。火淫于内，治以咸冷，佐以苦辛，以酸收之，以苦发之。燥淫于内，治以苦温，佐以甘辛，以苦下之。寒淫于内，治以甘热，佐以苦辛，以咸写之，以辛润之，以苦坚之。
帝曰：善。天气之变何如。歧伯曰：厥阴司天，风淫所胜，则太虚埃昏，云物以扰，寒生春气，流水不冰，民病胃脘当心而痛，上支两胁，鬲咽不通，饮食不下，舌本强，食则呕，冷泄腹胀溏泄瘕水闭，蛰虫不去，病本于脾。冲阳绝，死不治。少阴司天，热淫所胜，怫热至火行其政，民病胸中烦热嗌乾，右胠满，皮肤痛，寒热咳喘，大雨且至，唾血血泄，鼽衂嚏呕，溺色变，甚则疮疡胕肿，肩背臂臑及缺盆中痛，心痛肺䐜，腹大满膨，膨而喘咳，病本于肺，尺泽绝，死不治。太阴司天，湿淫所胜，则沈阴且布，雨变枯槁，胕肿骨痛阴痹，阴痹者按之不得，腰脊头项痛时眩，大便难，阴气不用，饥不欲食，咳唾则有血，心如悬，病本于肾。太溪绝，死不治。少阳司天，火淫所胜，则温气流行，金政不平，民病头痛发热恶寒而疟，热上皮肤痛，色变黄赤，传而为水，身面胕肿，腹满仰息，泄注赤白，疮疡咳唾血，烦心胸中热，甚则鼽衂，病本于肺，天府绝，死不治。阳明司天，燥淫所胜，则木乃晚荣，草乃晚生，筋骨内变，民病左胠脇痛，寒清于中感而疟，大凉革候，咳，腹中鸣注泄鹜溏，名木敛生菀于下，草焦上首，心胁暴痛，不可反侧，嗌乾面尘腰痛，丈夫㿉疝，妇人少腹痛，目昧眦，疡疮痤痈，蛰虫来见，病本于肝。太冲绝，死不治。太阳司天，寒淫所胜，则寒气反至，水且冰，血变于中，发为痈疡，民病厥心痛，呕血血泄鼽衂，善悲时眩仆，运火炎烈，雨暴乃雹，胸腹满，手热肘挛，掖冲，心澹澹大动，胸脇胃脘不安，面赤目黄，善噫嗌乾，甚则色炱，渴而欲饮，病本于心。神门绝，死不治。所谓动气知其藏也。帝曰：善。治之柰何。歧伯曰：司天之气，风淫所胜，平以辛凉，佐以苦甘，以甘缓之，以酸写之。热淫所胜，平以咸寒，佐以苦甘，以酸收之。湿淫所胜，平以苦热，佐以酸辛，以苦燥之，以淡泄之。湿上甚而热，治以苦温，佐以甘辛，以汗为故而止。火淫所胜，平以酸冷，佐以苦甘，以酸收之，以苦发之，以酸复之，热淫同。燥淫所胜，平以苦湿，佐以酸辛，以苦下之。寒淫所胜，平以辛热，佐以甘苦，以咸写之。
帝曰：善。邪气反胜，治之柰何。歧伯曰：风司于地，清反胜之，治以酸温，佐以苦甘，以辛平之。热司于地，寒反胜之，治以甘热，佐以苦辛，以咸平之。湿司于地，热反胜之，治以苦冷，佐以咸甘，以苦平之。火司于地，寒反胜之，治以甘热，佐以苦辛，以咸平之。燥司于地，热反胜之，治以平寒，佐以苦甘，以酸平之，以和为利。寒司于地，热反胜之，治以咸冷，佐以甘辛，以苦平之。帝曰：其司天邪胜何如。歧伯曰：风化于天，清反胜之，治以酸温，佐以甘苦。热化于天，寒反胜之，治以甘温，佐以苦酸辛。湿化于天，热反胜之，治以苦寒，佐以苦酸。火化于天，寒反胜之，治以甘热，佐以苦辛。燥化于天，热反胜之，治以辛寒，佐以苦甘。寒化于天，热反胜之，治以咸冷，佐以苦辛。
帝曰：六气相胜柰何。歧伯曰：厥阴之胜，耳鸣头眩，愦愦欲吐，胃鬲如寒，大风数举，倮虫不滋，胠脇气并，化而为热，小便黄赤，胃脘当心而痛，上支两脇，肠鸣飱泄，少腹痛，注下赤白，甚则呕吐，鬲咽不通。少阴之胜，心下热善饥，齐下反动，气游三焦，炎暑至，木乃津，草乃萎，呕逆躁烦，腹满痛溏泄，传为赤沃。太阴之胜，火气内郁，疮疡于中，流散于外，病在胠脇，甚则心痛热格，头痛喉痹项强，独胜则湿气内郁，寒迫下焦，痛留顶，互引眉闲，胃满，雨数至，燥化乃见，少腹满腰脽重强，内不便善注泄，足下温，头重足胫胕肿，饮发于中，胕肿于上。少阳之胜，热客于胃，烦心心痛，目赤欲呕，呕酸善饥，耳痛溺赤，善惊谵妄，暴热消烁，草萎水涸，介虫乃屈，少腹痛下沃赤白。阳明之胜，清发于中，左胠脇痛溏泄，内为嗌塞，外发㿉疝，大凉肃杀，华英改容，毛虫乃殃，胸中不便，嗌塞而咳。太阳之胜，凝凓且至，非时水冰，羽乃后化，痔疟发，寒厥入胃，则内生心痛，阴中乃疡，隐曲不利，互引阴股，筋肉拘苛，血脉凝泣，络满色变，或为血泄，皮肤否肿，腹满食减，热反上行，头项囟顶脑户中痛，目如脱寒入下焦，传为濡写。帝曰：治之柰何。歧伯曰：厥阴之胜，治以甘清，佐以苦辛，以酸写之。少阴之胜，治以辛寒，佐以苦咸，以甘写之。太阴之胜，治以咸热，佐以辛甘，以苦写之。少阳之胜，治以辛寒，佐以甘咸，以甘写之。阳明之胜，治以酸温，佐以辛甘，以苦泄之。太阳之胜，治以甘热，佐以辛酸，以咸写之。
帝曰：六气之复何如。歧伯曰：悉乎哉问也。厥阴之复，少腹坚满，里急暴痛，偃木飞沙，倮虫不荣，厥心痛，汗发呕吐，饮食不入，入而复出，筋骨掉眩，清厥，甚则入脾，食痹而吐。冲阳绝，死不治。少阴之复，燠热内作，烦躁鼽嚏，少腹绞痛，火见燔焫嗌燥，分注时止，气动于左，上行于右，咳，皮肤痛，暴喑心痛郁冒不知人，乃洒淅恶寒振栗谵妄，寒已而热，渴而欲饮，少气骨痿隔肠不便，外为浮肿哕噫，赤气后化，流水不冰，热气大行，介虫不复，病痱胗疮疡痈疽痤痔，甚则入肺，咳而鼻渊。天府绝，死不治。太阴之复，湿变乃举，体重中满，食饮不化，阴气上厥，胸中不便，饮发于中，咳喘有声，大雨时行，鳞见于陆，头顶痛重，而掉瘛尤甚，呕而密默唾吐清液，甚则入肾，窍写无度。太溪绝，死不治。少阳之复，大热将至，枯燥燔爇，介虫乃耗，惊瘛咳衄，心热烦躁，便数憎风，厥气上行，面如浮埃，目乃瞤瘛，火气内发，上为口糜呕逆，血溢血泄，发而为疟，恶寒鼓栗，寒极反热，嗌络焦槁，渴引水浆，色变黄赤，少气脉萎，化而为水，传为胕肿，甚则入肺，咳而血泄。尺泽绝，死不治。阳明之复，清气大举，森木苍乾，毛虫乃厉，病生胠脇，气归于左，善太息，甚则心痛否满，腹胀而泄，呕苦咳哕烦心，病在鬲中头痛，甚则入肝，惊骇筋挛。太冲绝，死不治。太阳之复，厥气上行，水凝雨冰，羽虫乃死，心胃生寒，胸膈不利，心痛否满，头痛善悲，时眩仆，食减腰脽反痛，屈伸不便，地裂冰坚，阳光不治，少腹控睾，引腰脊上冲心，唾出清水及为哕噫，甚则入心，善忘善悲。神门绝，死不治。帝曰：善。治之柰何。歧伯曰：厥阴之复，治以酸寒，佐以甘辛，以酸写之，以甘缓之。少阴之复，治以咸寒，佐以苦辛，以甘写之，以酸收之，辛苦发之，以咸耎之。太阴之复，治以苦热，佐以酸辛，以苦写之，燥之泄之。少阳之复，治以咸冷，佐以苦辛，以咸耎之，以酸收之，辛苦发之，发不远热，无犯温凉，少阴同法。阳明之复，治以辛温，佐以苦甘，以苦泄之，以苦下之，以酸补之。太阳之复，治以咸热，佐以甘辛，以苦坚之。治诸胜复，寒者热之，热者寒之，温者清之，清者温之，散者收之，抑者散之，燥者润之，急者缓之，坚者耎之，脆者坚之，衰者补之，强者写之，各安其气，必清必静，则病气衰去，归其所宗，此治之大体也。
帝曰；善。气之上下，何谓也。歧伯曰：身半以上，其气三矣，天之分也，天气主之。身半以下，其气三矣，地之分也，地气主之。以名命气，以气命处，而言其病，半所谓天枢也。故上胜而下俱病者，以地名之，下胜而上俱病者，以天名之。所谓胜至报气，屈伏而未发也，复至则不以天地异名，皆如复气为法也。
帝曰：胜复之动，时有常乎，气有必乎。歧伯曰：时有常位，而气无必也。帝曰：愿闻其道也。歧伯曰：初气终三气，天气主之，胜之常也。四气尽终气，地气主之，复之常也。有胜则复，无胜则否。帝曰：善。复已而胜何如。歧伯曰：胜至则复，无常数也，衰乃止耳。复已而胜，不复则害，此伤生也。帝曰：复而反病何也。歧伯曰：居非其位，不相得也，大复其胜则主胜之，故反病也，所谓火燥热也。帝曰：治之何如。歧伯曰：夫气之胜也，微者随之，甚者制之，气之复也，和者平之，暴者夺之，皆随胜气，安其屈伏，无问其数，以平为期，此其道也。
帝曰：善。客主之胜复柰何。歧伯曰：客主之气，胜而无复也。帝曰：其逆从何如。歧伯曰：主胜逆，客胜从，天之道也。帝曰：其生病何如。歧伯曰：厥阴司天，客胜则耳鸣掉眩，甚则咳，主胜则胸脇痛，舌难以言。少阴司天，客胜则鼽嚏颈项强，肩背瞀热，头痛少气发热耳聋目瞑，甚则胕肿血溢，疮疡咳喘，主胜则心热烦躁，甚则脇痛支满。太阴司天，客胜则首面胕肿，呼吸气喘，主胜则胸腹满，食已而瞀。少阳司天，客胜则丹胗外发，及为丹熛疮疡，呕逆喉痹，头痛嗌肿，耳聋血溢，内为瘛瘲，主胜则胸满咳仰息，甚而有血，手热。阳明司天，清复内馀，则咳衂嗌塞，心鬲中热，咳不止而白血出者死。太阳司天，客胜则胸中不利，出清涕感寒则咳，主胜则喉嗌中鸣。厥阴在泉，客胜则大关节不利，内为痉强拘瘛，外为不便，主胜则筋骨繇并，腰腹时痛。少阴在泉，客胜则腰痛尻股膝髀腨䯒足病，瞀热以酸，胕肿不能久立，溲便变，主胜则厥气上行，心痛发热，鬲中众痹皆作，发于胠脇魄汗不藏，四逆而起。太阴在泉，客胜则足痿下重，便溲不时，湿客下焦，发而濡写，及为肿隐曲之疾，主胜则寒气逆满，食饮不下，甚则为疝。少阳在泉，客胜则腰腹痛而反恶寒，甚则下白溺白，主胜则热反上行而客于心，心痛发热，格中而呕，少阴同候。阳明在泉，客胜则清气动下，少腹坚满而数便写，主胜则腰重腹痛，少腹生寒下为鹜溏，则寒厥于肠，上冲胸中，甚则喘不能久立。太阳在泉，寒复内馀，则腰尻痛屈伸不利，股胫足膝中痛。帝曰：善。治之柰何。歧伯曰：高者抑之，下者举之，有馀折之，不足补之，佐以所利，和以所宜，必安其主客，适其寒温，同者逆之，异者从之。帝曰：治寒以热，治热以寒，气相得者逆之，不相得者从之，余以知之矣。其于正味何如。歧伯曰：木位之主，其写以酸，其补以辛。火位之主，其写以甘，其补以咸。土位之主，其写以苦，其补以甘。金位之主，其写以辛，其补以酸。水位之主，其写以咸，其补以苦。厥阴之客，以辛补之，以酸写之，以甘缓之。少阴之客，以咸补之，以甘写之，以咸收之。太阴之客，以甘补之，以苦写之，以甘缓之。少阳之客，以咸补之，以甘写之，以咸耎之。阳明之客，以酸补之，以辛写之，以苦泄之。太阳之客，以苦补之，以咸写之，以苦坚之，以辛润之，开发腠理，致津液通气也。
帝曰：善。愿闻阴阳之三也何谓。歧伯曰：气有多少，异用也。帝曰：阳明何谓也。歧伯曰：两阳合明也。帝曰：厥阴何也。歧伯曰：两阴交尽也。帝曰：气有多少，病有盛衰，治有缓急，方有大小，愿闻其约柰何。歧伯曰：气有高下，病有远近，证有中外，治有轻重，适其至所为故也。《大要》曰：君一臣二，奇之制也，君二臣四，偶之制也，君二臣三，奇之制也，君二臣六，偶之制也。故曰：近者奇之，远者偶之，汗者不以奇，下者不以偶，补上治上，制以缓，补下治下，制以急，急则气味厚，缓则气味薄，适其至所，此之谓也。病所远，而中道气味之者食而过之，无越其制度也。是故平气之道，近而奇偶，制小其服也。远而奇偶，制大其服也。大则数少，小则数多。多则九之，少则二之。奇之不去则偶之，是谓重方。偶之不去，则反佐以取之，所谓寒热温凉反从其病也。帝曰：善。病生于本，余知之矣。生于标者，治之柰何。歧伯曰：病反其本，得标之病，治反其本，得标之方。
帝曰：善。六气之胜，何以候之。歧伯曰：乘其至也，清气大来，燥之胜也，风木受邪，肝病生焉。热气大来，火之胜也，金燥受邪，肺病生焉。寒气大来，水之胜也，火热受邪，心病生焉。湿气大来，土之胜也，寒水受邪，肾病生焉。风气大来，木之胜也，土湿受邪，脾病生焉。所谓感邪而生病也。乘年之虚，则邪甚也。失时之和，亦邪甚也。遇月之空，亦邪甚也。重感于邪，则病危矣。有胜之气，其必来复也。帝曰：其脉至何如。歧伯曰：厥阴之至其脉弦，少阴之至其脉钩，太阴之至其脉沈，少阳之至大而浮，阳明之至短而涩，太阳之至大而长。至而和则平，至而甚则病，至而反者病，至而不至者病，未至而至者病，阴阳易者危。
帝曰：六气标本，所从不同，柰何。歧伯曰：气有从本者，有从标本者，有不从标本者也。帝曰：愿卒闻之。歧伯曰：少阳太阴从本，少阴太阳从本从标，阳明厥阴不从标本从乎中也。故从本者，化生于本，从标本者，有标本之化，从中者，以中气为化也。帝曰：脉从而病反者，其诊何如。歧伯曰：脉至而从，按之不鼓，诸阳皆然。帝曰：诸阴之反，其脉何如。歧伯曰：脉至而从，按之鼓甚而盛也。是故百病之起，有生于本者，有生于摽者，有生于中气者，有取本而得者，有取摽而得者，有取中气而得者，有取摽本而得者，有逆取而得者，有从取而得者。逆，正顺也。若顺，逆也。故曰：知摽与本，用之不殆，明知逆顺，正行无问。此之谓也。不知是者，不足以言诊，足以乱经。故《大要》曰：粗工嘻嘻，以为可知，言热未已，寒病复始，同气异形，迷诊乱经，此之谓也。夫标本之道，要而博，小而大，可以言一而知百病之害，言摽与本，易而勿损，察本与摽，气可令调，明知胜复，为万民式，天之道毕矣。
帝曰：胜复之变，早晏何如。歧伯曰：夫所胜者，胜至已病，病已愠愠，而复已萌也。夫所复者，胜尽而起，得位而甚，胜有微甚，复有少多，胜和而和，胜虚而虚，天之常也。帝曰：胜复之作，动不当位，或后时而至，其故何也。歧伯曰：夫气之生，与其化衰盛异也。寒暑温凉盛衰之用，其在四维。故阳之动，始于温，盛于暑，阴之动，始于清，盛于寒。春夏秋冬，各差其分。故《大要》曰：彼春之暖，为夏之暑，彼秋之忿，为冬之怒，谨按四维，斥候皆归，其终可见，其始可知。此之谓也。帝曰：差有数乎。歧伯曰：又凡三十度也。帝曰：其脉应皆何如。歧伯曰：差同正法，待时而去也。脉要曰：春不沈，夏不弦，冬不涩，秋不数，是谓四塞。沈甚曰病，弦甚曰病，涩甚曰病，数甚曰病，参见曰病，复见曰病，未去而去曰病，去而不去曰病，反者死。故曰：气之相守司也，如权衡之不得相失也。夫阴阳之气，清静则生化治，动则苛疾起，此之谓也。帝曰：幽明何如。歧伯曰：两阴交尽故曰幽，两阳合明故曰明，幽明之配，寒暑之异也。帝曰：分至何如。歧伯曰：气至之谓至，气分之谓分，至则气同，分则气异，所谓天地之正纪也。帝曰：夫子言春秋气始于前，冬夏气始于后，余已知之矣。然六气往复，主岁不常也，其补写柰何。歧伯曰：上下所主，随其攸利，正其味，则其要也，左右同法。《大要》曰：少阳之主，先甘后咸，阳明之主，先辛后酸，太阳之主，先咸后苦，厥阴之主，先酸后辛，少阴之主，先甘后咸，太阴之主，先苦后甘，佐以所利，资以所生，是谓得气。
帝曰：善。夫百病之生也，皆生于风寒暑湿燥火，以之化之变也。经言盛者写之，虚者补之，余锡以方士，而方士用之尚未能十全，余欲令要道必行，桴鼓相应，犹拔刺雪污，工巧神圣，可得闻乎。歧伯曰：审察病机无失气宜，此之谓也。帝曰：愿闻病机何如。歧伯曰：诸风掉胘1，皆属于肝。诸寒收引，皆属于肾。诸气膹郁，皆属于肺。诸湿肿满，皆属于脾。诸热瞀瘛，皆属于火。诸病痒疮，皆属于心。诸厥固泄，皆属于下。诸痿喘呕，皆属于上。诸禁鼓栗，如丧神守，皆属于火。诸痉项强，皆属于湿。诸逆冲上，皆属于火。诸胀腹大，皆属于热。诸躁狂越，皆属于火。诸暴强直，皆属于风。诸病有声鼓之如鼓，皆属于热。诸病胕肿疼酸惊骇，皆属于火。诸转反戾水液浑浊，皆属于热。诸病水液澄澈清冷，皆属于寒。诸呕吐酸暴注下迫，皆属于热。故《大要》曰：谨守病机，各司其属，有者求之，无者求之，盛者责之，虚者责之，必先五胜，踈其血气，令其调达，而致和平，此之谓也。1. 胘 : 或作“眩”。《乾隆御览四库全书荟要》本作“眩”。
帝曰：善。五味阴阳之用何如。歧伯曰：辛甘发散为阳，酸苦涌泄为阴，咸味涌泄为阴，淡味渗泄为阳。六者，或收，或散，或缓，或急，或燥，或润，或耎，或坚，以所利而行之，调其气，使其平也。帝曰：非调气而得者，治之柰何。有毒无毒，何先何后，愿闻其道。歧伯曰：有毒无毒，所治为主，适大小为制也。帝曰：请言其制。歧伯曰：君一臣二，制之小也，君一臣三佐五，制之中也，君一臣三佐九，制之大也。寒者热之，热者寒之，微者逆之，甚者从之，坚者削之，客者除之，劳者温之，结者散之，留者攻之，燥者濡之，急者缓之，散者收之，损者温之，逸者行之，惊者平之，上之下之，摩之浴之，薄之劫之，开之发之，适事为故。
帝曰：何谓逆从。歧伯曰：逆者正治，从者反治，从少从多，观其事也。帝曰：反治何谓。歧伯曰：热因寒用，寒因热用，塞因塞用，通因通用，必伏其所主，而先其所因，其始则同，其终则异，可使破积，可使溃坚，可使气和，可使必已。
帝曰：善。气调而得者何如。歧伯曰：逆之，从之，逆而从之，从而逆之，踈气令调则其道也。帝曰：善。病之中外何如。歧伯曰：从内之外者调其内，从外之内者治其外，从内之外而盛于外者，先调其内而后治其外，从外之内而盛于内者，先治其外而后调其内，中外不相及，则治主病。
帝曰：善。火热复恶寒，发热有如疟状，或一日发，或闲数日发，其故何也。歧伯曰：胜复之气，会遇之时，有多少也。阴气多而阳气少，则其发日远，阳气多而阴气少，则其发日近。此胜复相薄盛衰之节，疟亦同法。帝曰：论言治寒以热，治热以寒，而方士不能废绳墨而更其道也。有病热者，寒之而热，有病寒者，热之而寒，二者皆在新病复起，柰何治。歧伯曰：诸寒之而热者取之阴，热之而寒者取之阳，所谓求其属也。帝曰：善。服寒而反热，服热而反寒，其故何也。歧伯曰：治其王气，是以反也。帝曰：不治王而然者，何也。歧伯曰：悉乎哉问也。不治五味属也。夫五味入胃，各归所喜，攻酸先入肝，苦先入心，甘先入脾，辛先入肺，咸先入肾，久而增气，物化之常也。气增而久，夭之由也。
帝曰：善。方制君臣何谓也。歧伯曰：主病之谓君，佐君之谓臣，应臣之谓使，非上下三品之谓也。帝曰：三品何谓。歧伯曰：所以明善恶之殊贯也。帝曰：善。病之中外何如。歧伯曰：调气之方，必别阴阳，定其中外，各守其乡。内者内治，外者外治，微者调之，其次平之，盛者夺之，汗者下之，寒热温凉，衰之以属，随其攸利，谨道如法，万举万全，气血正平，长有天命。帝曰：善。
Huangdi asked: 'I already understand how the five qi intermingle and how fullness and depletion alternately arise. But as for the six qi governing in their respective divisions, presiding over heaven and earth, how do they arrive?' Qibo bowed twice and replied: 'How penetrating this question is! This is the great regulating principle of heaven and earth, and it corresponds throughout to the human spirit.' The Emperor said: 'I wish to hear how above it accords with the bright and manifest, and below it accords with the dark and hidden.' Qibo said: 'This is what the Way governs, yet it is what practitioners find perplexing.' The Emperor said: 'I wish to hear this Way.' Qibo said: 'When reverting yin governs heaven, its transformation is by wind; when lesser yin governs heaven, its transformation is by heat; when greater yin governs heaven, its transformation is by dampness; when lesser yang governs heaven, its transformation is by fire; when yang brightness governs heaven, its transformation is by dryness; when greater yang governs heaven, its transformation is by cold. According to the visceral position over which each presides, one names the disease that arises.' The Emperor said: 'What of the transformations of the earth?' Qibo said: 'They correspond in the same manner as those governing heaven; the intervening qi are likewise so.' The Emperor said: 'What is meant by the intervening qi?' Qibo said: 'Those that govern the left and right positions are called the intervening qi.' The Emperor said: 'How do they differ?' Qibo said: 'That which governs the year regulates the year as a whole; the intervening qi regulate the successive steps within it.' The Emperor said: 'Good. What of the governance of the year?' Qibo said: 'When reverting yin governs heaven, its transformation is wind; when it is at the spring, its transformation is sour; when it governs the qi of the year, its transformation is verdant; as an intervening qi, its transformation is movement. When lesser yin governs heaven, its transformation is heat; when it is at the spring, its transformation is bitter; it does not govern the transformation of the year as a whole; when it resides as an intervening qi, its transformation is scorching. When greater yin governs heaven, its transformation is dampness; when it is at the spring, its transformation is sweet; when it governs the qi, its transformation is yellow; as an intervening qi, its transformation is softening. When lesser yang governs heaven, its transformation is fire; when it is at the spring, its transformation is bitter; when it governs the qi, its transformation is scarlet; as an intervening qi, its transformation is brightness. When yang brightness governs heaven, its transformation is dryness; when it is at the spring, its transformation is acrid; when it governs the qi, its transformation is white; as an intervening qi, its transformation is clearing. When greater yang governs heaven, its transformation is cold; when it is at the spring, its transformation is salty; when it governs the qi, its transformation is black; as an intervening qi, its transformation is storing. Therefore, one who treats disease must clearly understand how the six transformations govern their respective divisions, what is generated by the five flavors and five colors, and what is suitable for the five viscera; only then can one speak of the threads by which fullness, depletion, and the generation of disease arise.'
The Emperor said: 'That reverting yin at the spring transforms into sourness, this I already know. But how does the transformation of wind proceed?' Qibo said: 'Wind circulates over the earth; this is what is called the root. The remaining qi follow the same pattern. That which is rooted in heaven is the qi of heaven; that which is rooted in earth is the qi of earth. When the qi of heaven and earth combine, the six divisions are apportioned and the myriad things are transformed and generated. Hence it is said: carefully observe what is appropriate to the qi, and do not lose the pivotal mechanism of disease, this is what is meant.' The Emperor said: 'How does it govern disease?' Qibo said: 'If one prepares materia medica according to what governs the year, then nothing essential to its governance will be lost.' The Emperor said: 'What are the substances proper to the year?' Qibo said: 'They are the concentrated essence of heaven and earth.' The Emperor said: 'What of those that govern the intervening qi?' Qibo said: 'Those that govern the qi are the same as those governing the year, yet there is surplus and insufficiency in their potency.' The Emperor said: 'What is meant by substances that do not govern the year?' Qibo said: 'They are dispersed in potency. Hence though their substance is the same, their grade differs: their qi and flavor may be thin or thick, their nature and function may be hasty or calm, their curative and preservative power may be greater or lesser, and the depth of their transformative force may be shallow or deep, this is what is meant.' The Emperor said: 'What is meant by the year's governance bringing harm to a viscus?' Qibo said: 'One names it according to that which it cannot overcome, this is the essential point.' The Emperor said: 'How does one treat it?' Qibo said: 'When excess above overflows below, one levels it with that which overcomes it; when excess outside overflows within, one treats it with that which overcomes it.' The Emperor said: 'Good. What of leveling the qi?' Qibo said: 'Carefully examine where yin and yang reside and regulate accordingly, taking balance as the goal. What is straightforward is treated by direct treatment; what is contrary is treated by contrary treatment.'
The Emperor said: 'You, Master, have said that one examines where yin and yang reside in order to regulate it. The classic text states that when the Man Ying and Cun Kou pulses correspond to one another, as though a cord were drawn taut, equal in size at both ends, this is called balance. What then of where yin resides at the Cun Kou?' Qibo said: 'Observe whether the year is of southern or northern governance, and it can be known.' The Emperor said: 'I wish to hear the whole of it.' Qibo said: 'In years of northern governance, if lesser yin is at the spring, then the Cun Kou does not respond; if reverting yin is at the spring, the right does not respond; if greater yin is at the spring, the left does not respond. In years of southern governance, if lesser yin governs heaven, then the Cun Kou does not respond; if reverting yin governs heaven, the right does not respond; if greater yin governs heaven, the left does not respond. In all cases of non-response, if one reverses the side of examination, the pulse will appear.' The Emperor said: 'What of the sign at the Chi position?' Qibo said: 'In years of northern governance, if the three yin are below, the Cun does not respond; if the three yin are above, the Chi does not respond. In years of southern governance, if the three yin are in heaven, the Cun does not respond; if the three yin are at the spring, the Chi does not respond, and this holds the same for the left and right sides. Hence it is said: he who knows the essential can finish it in a single phrase; he who does not know the essential is scattered and lost without end, this is what is meant.'
The Emperor said: 'Good. When the qi of heaven and earth overflow within and cause disease, how is it?' Qibo said: 'In a year when reverting yin is at the spring, wind excess prevails: the qi of the earth is obscured, the level plains grow dim, and the grasses flourish prematurely. People suffer from shivering chills, frequent stretching and yawning, heart pain with distension to the sides, urgent tightness in both flanks, inability to take in food and drink, blockage of the diaphragm and throat, vomiting after eating, abdominal distension with frequent belching; when they obtain a bowel movement or pass qi, they feel eased as though the affliction had abated, though the whole body remains heavy. In a year when lesser yin is at the spring, heat excess prevails: flames seem to float over rivers and marshes, and shaded places appear bright. People suffer from constant rumbling in the abdomen, qi surging up to the chest, panting such that they cannot stand for long, alternating cold and heat with pain in the skin, dimness of vision, toothache, swelling of the cheeks, aversion to cold and fever resembling malaria, pain and distension in the lower abdomen; hibernating creatures fail to go into hiding. In a year when greater yin is at the spring, the grasses flourish prematurely, and dampness excess prevails: dust and haze obscure the crags and valleys, and yellow tones appear black instead. At the confluence of utmost yin, people suffer from fluid accumulation with heart pain, deafness, a dull and muddled sensation, swelling of the throat with throat-block, bleeding disorders of the lower yin regions, painful swelling of the lower abdomen with inability to urinate, disease with surging headache such that the eyes feel as if bulging out, the nape as if being pulled, the lower back as if broken, the thighs unable to turn, the popliteal fossa as if knotted, and the calves as if split apart. In a year when lesser yang is at the spring, fire excess prevails: flames blaze brightly over the outlying fields, and cold and heat arrive in alternation. People suffer from pouring diarrhea with red and white discharge, pain in the lower abdomen with reddish urine, and in severe cases blood in the stool, corresponding in the same manner as lesser yin. In a year when yang brightness is at the spring, dryness excess prevails: fog and mist bring clear darkness. People are prone to retching, vomiting with a bitter taste, frequent sighing, pain in the heart and flanks such that they cannot turn from side to side, and in severe cases dryness of the throat, a dusty complexion, a body lacking luster, with the outer aspect of the feet turning hot instead. In a year when greater yang is at the spring, cold excess prevails: there is a congealing, stern, bleak severity. People suffer from lower abdominal pain drawing upon the testicles, pulling on the lumbar spine and surging up to cause heart pain, with bleeding, sore throat, and swelling of the jaw.' The Emperor said: 'Good. How does one treat these?' Qibo said: 'For all the qi at the spring: when wind is in excess within, treat with acrid and cool substances, assisted by bitter ones; moderate it with sweetness and disperse it with acridity. When heat is in excess within, treat with salty and cold substances, assisted by sweet and bitter ones; astringe it with sourness and vent it with bitterness. When dampness is in excess within, treat with bitter and hot substances, assisted by sour and bland ones; dry it with bitterness and drain it with blandness. When fire is in excess within, treat with salty and cold substances, assisted by bitter and acrid ones; astringe it with sourness and vent it with bitterness. When dryness is in excess within, treat with bitter and warm substances, assisted by sweet and acrid ones; purge it with bitterness. When cold is in excess within, treat with sweet and hot substances, assisted by bitter and acrid ones; drain it with saltiness, moisten it with acridity, and firm it with bitterness.'
The Emperor said: 'Good. What of the changes wrought by the qi of heaven?' Qibo said: 'When reverting yin governs heaven, wind excess prevails: the great void is dusty and dim, clouds and vapors are disturbed, cold arises within the spring qi, and flowing water fails to freeze. People suffer from pain in the stomach duct opposite the heart, extending upward to the two flanks, blockage of the diaphragm and throat, inability to take in food and drink, stiffness at the root of the tongue, vomiting after eating, diarrhea with cold, abdominal distension, loose stools, abdominal concretions, and retention of water; hibernating creatures fail to depart their burrows. The disease is rooted in the spleen. If the Chongyang pulse is cut off, death, and it cannot be treated. When lesser yin governs heaven, heat excess prevails: oppressive heat arrives and fire carries out its governance. People suffer from vexing heat in the chest, dryness of the throat, fullness of the right side, pain in the skin, alternating cold and heat with cough and panting; heavy rains are about to arrive; there is spitting of blood and bleeding from below, nosebleed, sneezing, and retching, and change in the color of the urine; in severe cases, sores and swelling, pain in the shoulders, back, upper arms, and supraclavicular fossa, heart pain and lung distension, great abdominal fullness and bloating, bloating with panting and cough. The disease is rooted in the lung. If the Chize pulse is cut off, death, and it cannot be treated. When greater yin governs heaven, dampness excess prevails: heavy overcast clouds spread across the sky, and rain transforms what is withered. There is swelling, bone pain, and yin blockage, in yin blockage, pressing on the affected area yields nothing; pain in the lower back, spine, head, and nape with intermittent dizziness; difficulty with bowel movement; the yin qi fails to function; hunger without desire to eat; coughing up blood-streaked sputum; a sensation as though the heart were suspended. The disease is rooted in the kidney. If the Taixi pulse is cut off, death, and it cannot be treated. When lesser yang governs heaven, fire excess prevails: warm qi circulates freely, and the governance of metal is disrupted. People suffer from headache, fever, and aversion to cold resembling malaria; heat rising with pain in the skin; the complexion turning yellow and red; the condition transmitting to become edema, with swelling of the body and face; abdominal fullness with labored breathing requiring the head tilted back; pouring diarrhea with red and white discharge; sores and coughing up of blood; vexation of the heart with heat in the chest; and in severe cases, nosebleed. The disease is rooted in the lung. If the Tianfu pulse is cut off, death, and it cannot be treated. When yang brightness governs heaven, dryness excess prevails: trees flourish late, grasses grow late, and there are internal changes in the sinews and bones. People suffer from pain in the left flank, cold settling within the body giving rise to malaria-like conditions, great coolness that transforms the season's normal signs, coughing, rumbling in the abdomen with pouring diarrhea and duck-slop stools. Renowned trees contract and their growth withers below, while the tips of grasses scorch above. There is sudden severe pain in the heart and flanks such that one cannot turn from side to side, dryness of the throat, a dusty complexion, lower back pain, hernial swelling in men, lower abdominal pain in women, dimness at the corners of the eyes, sores, papules, and carbuncles; hibernating creatures come out of hiding prematurely. The disease is rooted in the liver. If the Taichong pulse is cut off, death, and it cannot be treated. When greater yang governs heaven, cold excess prevails: cold qi arrives contrary to season, water freezes, and blood is altered within, breaking out as sores and abscesses. People suffer from reversal heart pain, vomiting of blood, bleeding from below, nosebleed, frequent sorrow, intermittent dizziness and collapse; when the fire movement blazes fiercely, sudden rain turns to hail. There is fullness of chest and abdomen, heat in the hands, spasm of the elbows, and a surging sensation in the axilla; the heart pounds and races violently; the chest, flanks, and stomach duct feel unsettled; the face is red and the eyes yellow; frequent belching and dry throat; in severe cases the complexion turns sooty black, with thirst and desire to drink. The disease is rooted in the heart. If the Shenmen pulse is cut off, death, and it cannot be treated. This is what is meant by knowing the affected viscus through the pulsation of its qi.' The Emperor said: 'Good. How does one treat these?' Qibo said: 'For the qi governing heaven: when wind excess prevails, level it with acrid and cool substances, assisted by bitter and sweet ones; moderate it with sweetness and drain it with sourness. When heat excess prevails, level it with salty and cold substances, assisted by bitter and sweet ones; astringe it with sourness. When dampness excess prevails, level it with bitter and hot substances, assisted by sour and acrid ones; dry it with bitterness and drain it with blandness. If dampness above is severe and accompanied by heat, treat with bitter and warm substances, assisted by sweet and acrid ones, and stop once sweating has been induced. When fire excess prevails, level it with sour and cold substances, assisted by bitter and sweet ones; astringe it with sourness, vent it with bitterness, and restore it with sourness, the same applies to heat excess. When dryness excess prevails, level it with bitter and moistening substances, assisted by sour and acrid ones; purge it with bitterness. When cold excess prevails, level it with acrid and hot substances, assisted by sweet and bitter ones; drain it with saltiness.'
The Emperor said: 'Good. When the pathogenic qi is instead overcome by that which should not naturally prevail over it, how does one treat this?' Qibo said: 'When wind governs at the earth but clearness instead prevails over it, treat with sour and warm substances, assisted by bitter and sweet ones, and level it with acridity. When heat governs at the earth but cold instead prevails over it, treat with sweet and hot substances, assisted by bitter and acrid ones, and level it with saltiness. When dampness governs at the earth but heat instead prevails over it, treat with bitter and cold substances, assisted by salty and sweet ones, and level it with bitterness. When fire governs at the earth but cold instead prevails over it, treat with sweet and hot substances, assisted by bitter and acrid ones, and level it with saltiness. When dryness governs at the earth but heat instead prevails over it, treat with mild and cold substances, assisted by bitter and sweet ones, level it with sourness, and take harmony as the beneficial course. When cold governs at the earth but heat instead prevails over it, treat with salty and cold substances, assisted by sweet and acrid ones, and level it with bitterness.' The Emperor said: 'What of when the pathogenic qi prevails over what governs heaven?' Qibo said: 'When wind transforms at heaven but clearness instead prevails over it, treat with sour and warm substances, assisted by sweet and bitter ones. When heat transforms at heaven but cold instead prevails over it, treat with sweet and warm substances, assisted by bitter, sour, and acrid ones. When dampness transforms at heaven but heat instead prevails over it, treat with bitter and cold substances, assisted by bitter and sour ones. When fire transforms at heaven but cold instead prevails over it, treat with sweet and hot substances, assisted by bitter and acrid ones. When dryness transforms at heaven but heat instead prevails over it, treat with acrid and cold substances, assisted by bitter and sweet ones. When cold transforms at heaven but heat instead prevails over it, treat with salty and cold substances, assisted by bitter and acrid ones.'
The Emperor said: 'How do the six qi mutually dominate one another?' Qibo said: 'When reverting yin dominates: ringing in the ears, dizziness of the head, a muddled sensation with desire to vomit, a chilled feeling in the stomach and diaphragm; great winds rise repeatedly, and bare-skinned creatures fail to reproduce; qi gathers in the sides and flanks and transforms into heat; the urine turns yellow-red; pain in the stomach duct opposite the heart extending up to both flanks; intestinal rumbling with undigested-food diarrhea; pain in the lower abdomen; pouring discharge of red and white; in severe cases, vomiting, with blockage of the diaphragm and throat. When lesser yin dominates: heat below the heart with frequent hunger; throbbing below the navel; qi roams through the triple burner; blazing summer heat arrives; trees exude sap and grasses wilt; retching and vomiting with agitation and vexation; abdominal fullness and pain with loose stools, transmitting to become a reddish discharge. When greater yin dominates: fire qi is stifled within, sores erupt within and spread scattered without; the disease lies in the flanks; in severe cases, heart pain with heat blockage, headache, throat-block, and stiffness of the nape. When dampness dominates alone, damp qi is stifled within, cold presses upon the lower burner, pain lodges in the vertex and pulls mutually between the eyebrows; fullness of the stomach; rain falls repeatedly and, paradoxically, signs of dryness appear; fullness and heavy stiffness of the lower abdomen and buttocks; internal discomfort with frequent pouring diarrhea; warmth beneath the feet; heaviness of the head, swelling of the lower legs and feet; fluid accumulation arises within, and swelling appears above. When lesser yang dominates: heat lodges in the stomach; vexation of the heart with heart pain; redness of the eyes with desire to retch; vomiting of sour fluid with frequent hunger; ear pain, reddish urine; frequent fright, delirious speech; sudden heat that wastes and scorches; grasses wilt and waters dry up; shelled creatures shrink back; pain in the lower abdomen with discharge of red and white below. When yang brightness dominates: clearness arises within; pain in the left flank with loose stools; within, blockage of the throat; without, hernial swelling breaks out; great coolness brings a stern, killing severity; flowers and blossoms change their appearance; furred creatures suffer calamity; discomfort in the chest; throat blockage with cough. When greater yang dominates: a congealing chill arrives, and waters freeze out of season; feathered creatures delay their breeding; hemorrhoids and malarial disorders break out; cold reversal enters the stomach, generating heart pain within; sores form in the yin region, and the private functions become inhibited, pulling mutually into the inner thighs; the sinews and flesh become cramped and stiff; the blood vessels congeal and stagnate; the network vessels become full and the complexion changes; there may be bleeding from below; the skin becomes blocked and swollen; abdominal fullness with reduced appetite; heat instead rises upward, causing pain in the head, nape, fontanelle, vertex, and occiput, with the eyes feeling as if bulging out; cold enters the lower burner and transmits to become watery diarrhea.' The Emperor said: 'How does one treat these?' Qibo said: 'For dominance of reverting yin, treat with sweet and clearing substances, assisted by bitter and acrid ones, and drain it with sourness. For dominance of lesser yin, treat with acrid and cold substances, assisted by bitter and salty ones, and drain it with sweetness. For dominance of greater yin, treat with salty and hot substances, assisted by acrid and sweet ones, and drain it with bitterness. For dominance of lesser yang, treat with acrid and cold substances, assisted by sweet and salty ones, and drain it with sweetness. For dominance of yang brightness, treat with sour and warm substances, assisted by acrid and sweet ones, and drain it with bitterness. For dominance of greater yang, treat with sweet and hot substances, assisted by acrid and sour ones, and drain it with saltiness.'
The Emperor said: 'What of the return of the six qi?' Qibo said: 'How thorough is this question! In the return of reverting yin: hardness and fullness of the lower abdomen, urgent tension with sudden pain; trees are flattened and sand flies; bare-skinned creatures fail to flourish; reversal heart pain; sweating with retching and vomiting; food and drink cannot be taken in, or if taken in are brought back up again; trembling and dizziness of sinews and bones; cold reversal; in severe cases it enters the spleen, causing food blockage with vomiting. If the Chongyang pulse is cut off, death, and it cannot be treated. In the return of lesser yin: warm heat arises within; vexation and agitation with sneezing and nasal congestion; griping pain of the lower abdomen; fire appears, scorching and burning, with dryness of the throat; discharges that alternate between occurring and stopping; qi stirs on the left and moves up to the right; cough, pain of the skin; sudden loss of voice, heart pain, clouding of the head with loss of consciousness, then shivering aversion to cold, trembling, and delirious speech; cold subsides and heat follows; thirst with desire to drink; shortness of breath, wasting and weakness of the bones, obstruction of the intestines with discomfort; externally, floating edema, hiccup, and belching; the fire qi transforms afterward; flowing water fails to freeze; heat qi runs rampant; shelled creatures fail to reproduce; there arise skin eruptions, papules, sores, carbuncles, deep-rooted abscesses, boils and hemorrhoids; in severe cases it enters the lung, causing cough with a foul nasal discharge. If the Tianfu pulse is cut off, death, and it cannot be treated. In the return of greater yin: transformations of dampness arise; heaviness of the body with fullness at the center; food and drink fail to be digested; yin qi reverses upward; discomfort in the chest; fluid accumulation arises within; cough and panting with audible sound; heavy rains fall repeatedly, and scaled creatures appear on dry land; pain and heaviness of the vertex, with trembling and convulsion especially severe; retching with a silent, withdrawn manner, spitting up clear fluid; in severe cases it enters the kidney, causing unrestrained discharge from the orifices. If the Taixi pulse is cut off, death, and it cannot be treated. In the return of lesser yang: great heat is about to arrive; withering dryness and scorching burning; shelled creatures waste away; fright and convulsion with cough and nosebleed; heat in the heart with vexation and agitation; frequent bowel movements with aversion to wind; reversal qi moves upward; the face appears as though covered with floating dust; the eyes twitch and convulse; fire qi erupts within, rising above to cause erosive sores of the mouth and retching; overflow bleeding and bleeding from below; breaking out as malarial disorder, with aversion to cold, chattering teeth and trembling; when the cold reaches its extreme it turns instead to heat; the throat and its network vessels become scorched and parched; thirst with craving for fluids; the complexion turns yellow-red; shortness of breath with a wilted pulse; transforming into edema, transmitting to become swelling; in severe cases it enters the lung, causing cough with bleeding from below. If the Chize pulse is cut off, death, and it cannot be treated. In the return of yang brightness: clear qi rises in force; dense forests turn ashen and parched; furred creatures suffer pestilence; disease arises in the flank; qi gathers on the left; frequent sighing; in severe cases, heart pain with glomus and fullness; abdominal distension with diarrhea; vomiting of bitter fluid, cough, hiccup, and vexation of the heart; disease located in the diaphragm with headache; in severe cases it enters the liver, causing fright and convulsion of the sinews. If the Taichong pulse is cut off, death, and it cannot be treated. In the return of greater yang: reversal qi moves upward; water congeals and rain turns to ice; feathered creatures perish; cold is generated in the heart and stomach; discomfort in the chest and diaphragm; heart pain with glomus and fullness; headache with frequent sorrow; intermittent dizziness and collapse; reduced appetite with pain instead in the lower back and buttocks; difficulty bending and stretching; the earth cracks and ice hardens; the light of the sun fails to prevail; the lower abdomen draws upon the testicles, pulling on the lumbar spine and surging up toward the heart; spitting up of clear fluid, and hiccup and belching; in severe cases it enters the heart, causing frequent forgetfulness and frequent sorrow. If the Shenmen pulse is cut off, death, and it cannot be treated.' The Emperor said: 'Good. How does one treat these?' Qibo said: 'For the return of reverting yin, treat with sour and cold substances, assisted by sweet and acrid ones; drain it with sourness and moderate it with sweetness. For the return of lesser yin, treat with salty and cold substances, assisted by bitter and acrid ones; drain it with sweetness, astringe it with sourness, vent it with acridity and bitterness, and soften it with saltiness. For the return of greater yin, treat with bitter and hot substances, assisted by sour and acrid ones; drain it with bitterness, dry it, and drain it further. For the return of lesser yang, treat with salty and cold substances, assisted by bitter and acrid ones; soften it with saltiness, astringe it with sourness, and vent it with acridity and bitterness. In venting, do not shy from heat, yet do not transgress against warmth or coolness, the same method applies as for lesser yin. For the return of yang brightness, treat with acrid and warm substances, assisted by bitter and sweet ones; drain it with bitterness, purge it with bitterness, and supplement it with sourness. For the return of greater yang, treat with salty and hot substances, assisted by sweet and acrid ones, and firm it with bitterness. In treating all cases of dominance and return: what is cold, heat it; what is hot, cool it; what is warm, clear it; what is cool, warm it; what is dispersed, gather it; what is repressed, disperse it; what is dry, moisten it; what is urgent, moderate it; what is hard, soften it; what is brittle, firm it; what is weakened, supplement it; what is strong, drain it, settling each in its proper qi. One must achieve clarity and stillness, and then the pathogenic qi will decline and depart, returning to its proper source. This is the general framework of treatment.'
The Emperor said: 'Good. What is meant by the upper and lower divisions of qi?' Qibo said: 'Above the midpoint of the body, there are three qi, this is the division of heaven, governed by the qi of heaven. Below the midpoint of the body, there are three qi, this is the division of earth, governed by the qi of earth. One names the qi according to its position, and names the location according to the qi, in order to speak of the disease, the midpoint is what is called the Celestial Pivot. Hence, when the upper qi dominates and both above and below fall ill, one names it after the earth division; when the lower qi dominates and both above and below fall ill, one names it after the heaven division. What is called the arrival of the dominant qi is when the answering qi is bent and suppressed, not yet issued forth; once the return arrives, one no longer distinguishes it by the names of heaven and earth, all are treated according to the pattern of the returning qi.'
The Emperor said: 'In the movement of dominance and return, is there a constant timing? Is there a certainty to the qi?' Qibo said: 'The timing has a constant position, but the qi has no certainty.' The Emperor said: 'I wish to hear this principle.' Qibo said: 'From the first qi through the third qi, the qi of heaven governs, this is the constant period of dominance. From the fourth qi through the final qi, the qi of earth governs, this is the constant period of return. Where there is dominance, there is return; where there is no dominance, there is none.' The Emperor said: 'Good. What of when, after the return has ended, dominance occurs again?' Qibo said: 'When dominance arrives, return follows, there is no fixed number of occurrences; it ceases only when it has waned. If, after the return has ended, dominance occurs again and is not met with a further return, harm results, this injures life.' The Emperor said: 'Why does the return itself sometimes cause disease?' Qibo said: 'It resides in a position not its own, and the two fail to accord with each other. When the return greatly overcomes the dominant qi, the governing qi that ought to prevail seasonally instead is overcome by it, hence disease results contrarily. This is what is meant by fire, dryness, and heat arising out of due season.' The Emperor said: 'How does one treat this?' Qibo said: 'As for the dominance of qi: when slight, follow along with it; when severe, control it. As for the return of qi: when mild, level it; when violent, seize control of it. In all cases, follow the dominant qi and settle what is bent and suppressed, without concern for its number of occurrences, taking balance as the goal, this is the principle.'
The Emperor said: 'Good. What of the dominance and return between guest and host qi?' Qibo said: 'Between the guest and host qi, there is dominance but no return.' The Emperor said: 'What of their contrariety and compliance?' Qibo said: 'When the host dominates, it is contrary; when the guest dominates, it is compliant, this is the Way of heaven.' The Emperor said: 'How do they generate disease?' Qibo said: 'When reverting yin governs heaven: if the guest dominates, there is ringing in the ears with trembling dizziness, and in severe cases cough; if the host dominates, there is pain in the chest and flanks, and difficulty speaking. When lesser yin governs heaven: if the guest dominates, there is nasal congestion and sneezing, stiffness of the neck and nape, dizzying heat in the shoulders and back, headache, shortness of breath, fever, deafness, and dim vision, and in severe cases swelling with overflow bleeding, sores, cough and panting; if the host dominates, there is heat in the heart with vexation and agitation, and in severe cases pain in the flanks with distension. When greater yin governs heaven: if the guest dominates, there is swelling of the head and face with panting breath; if the host dominates, there is fullness of chest and abdomen with dizziness after eating. When lesser yang governs heaven: if the guest dominates, there break out red papules externally, and also erysipelas-like sores, retching, throat-block, headache, and swollen throat, deafness and overflow bleeding, and internally convulsions; if the host dominates, there is fullness of the chest with cough requiring the head tilted back, and in severe cases bleeding, with heat in the hands. When yang brightness governs heaven, if clearness returns and there is a surplus within, there is cough with nosebleed and blocked throat, heat in the heart and diaphragm; if the cough does not cease and pale blood is coughed up, death results. When greater yang governs heaven: if the guest dominates, there is discomfort in the chest with clear nasal discharge, and cough upon exposure to cold; if the host dominates, there is a rattling sound in the throat. When reverting yin is at the spring: if the guest dominates, the major joints are impaired, with internal spasm, stiffness, and convulsion, and external difficulty of movement; if the host dominates, the sinews and bones shake together, with intermittent pain in the lower back and abdomen. When lesser yin is at the spring: if the guest dominates, there is pain in the lower back, buttocks, thighs, knees, calves, shins, and feet, with dizzying heat and soreness, swelling such that one cannot stand for long, and change in urination and defecation; if the host dominates, reversal qi moves upward, with heart pain and fever, and all manner of blockage arise in the diaphragm, breaking out in the flanks with unrestrained sweating, and cold reversal of the four limbs sets in. When greater yin is at the spring: if the guest dominates, there is wilting weakness of the feet with heaviness below, irregular urination and defecation, dampness lodging in the lower burner, breaking out as watery diarrhea, and swelling with disorders of the private parts; if the host dominates, cold qi reverses and causes fullness, food and drink cannot descend, and in severe cases hernial disorders occur. When lesser yang is at the spring: if the guest dominates, there is pain in the lower back and abdomen with, paradoxically, aversion to cold, and in severe cases white discharge below and turbid urine; if the host dominates, heat instead rises upward and lodges in the heart, causing heart pain and fever, blockage within with vomiting, corresponding in the same manner as lesser yin. When yang brightness is at the spring: if the guest dominates, clear qi stirs below, with hardness and fullness of the lower abdomen and frequent watery bowel movements; if the host dominates, there is heaviness of the lower back with abdominal pain, cold arising in the lower abdomen giving rise to duck-slop stools below, cold reversal in the intestines surging up into the chest, and in severe cases panting such that one cannot stand for long. When greater yang is at the spring, if cold returns and there is a surplus within, there is pain in the lower back and buttocks with difficulty bending and stretching, and pain in the thighs, shins, feet, and knees.' The Emperor said: 'Good. How does one treat these?' Qibo said: 'What is high, suppress it; what is low, raise it; what is in excess, break it down; what is insufficient, supplement it; assist it with what benefits it, and harmonize it with what suits it. One must settle the host and guest qi, and adapt to the cold or warmth appropriate, where they are alike, treat by contrary means; where they differ, treat by compliant means.' The Emperor said: 'Treating cold with heat and heat with cold, treating by contrary means when the qi accord with each other and by compliant means when they do not, this I already understand. But what of the proper flavors involved?' Qibo said: 'For the host of the wood position, one drains with sourness and supplements with acridity. For the host of the fire position, one drains with sweetness and supplements with saltiness. For the host of the earth position, one drains with bitterness and supplements with sweetness. For the host of the metal position, one drains with acridity and supplements with sourness. For the host of the water position, one drains with saltiness and supplements with bitterness. For the guest qi of reverting yin, supplement with acridity, drain with sourness, and moderate with sweetness. For the guest qi of lesser yin, supplement with saltiness, drain with sweetness, and astringe with saltiness. For the guest qi of greater yin, supplement with sweetness, drain with bitterness, and moderate with sweetness. For the guest qi of lesser yang, supplement with saltiness, drain with sweetness, and soften with saltiness. For the guest qi of yang brightness, supplement with sourness, drain with acridity, and drain further with bitterness. For the guest qi of greater yang, supplement with bitterness, drain with saltiness, firm with bitterness, and moisten with acridity, thereby opening the interstices and pores, bringing about the circulation of fluids and the free flow of qi.'
The Emperor said: 'Good. I wish to hear what is meant by the three divisions of yin and yang.' Qibo said: 'The qi has greater and lesser quantities, hence differing functions.' The Emperor said: 'What is meant by yang brightness?' Qibo said: 'It is where the two yang combine into brightness.' The Emperor said: 'What is reverting yin?' Qibo said: 'It is where the two yin meet and are exhausted.' The Emperor said: 'The qi has greater and lesser quantities, disease has flourishing and waning, treatment has the gradual and the urgent, and formulas have the large and the small, I wish to hear the essential rule governing these.' Qibo said: 'The qi has high and low positions, disease has near and far locations, symptoms have internal and external aspects, and treatment has light and heavy degrees, the aim is to have the treatment reach precisely the site of disease. The Da Yao states: one sovereign ingredient and two ministers constitute an odd-numbered formula; two sovereigns and four ministers constitute an even-numbered formula; two sovereigns and three ministers constitute an odd-numbered formula; two sovereigns and six ministers constitute an even-numbered formula. Hence it is said: for disease nearby, use odd-numbered formulas; for disease far off, use even-numbered formulas. For inducing sweating, do not use odd-numbered formulas; for purgation, do not use even-numbered formulas. To supplement the upper and treat the upper, formulate with gradual action; to supplement the lower and treat the lower, formulate with urgent action. What is urgent has thick qi and flavor; what is gradual has thin qi and flavor, the aim being to have it reach precisely the site. This is what is meant. When the site of disease is distant, and the qi and flavor of the medicine would be absorbed along the way, one should take the medicine with food so that it passes beyond the intervening region, one must not exceed the proper regulation. Therefore, in the way of leveling the qi: for disease nearby, whether odd or even, formulate a small dose; for disease far off, whether odd or even, formulate a large dose. Large doses are taken in fewer administrations; small doses are taken in more administrations, at most, nine times; at least, twice. If an odd-numbered formula fails to resolve the disease, follow with an even-numbered one, this is called a doubled formula. If the even-numbered formula still fails to resolve it, then employ a paradoxical adjuvant to achieve the effect, this is what is meant by cold, heat, warm, and cool agents being used contrary to, yet in accordance with, the nature of the disease.' The Emperor said: 'Good. That disease arises from the root, this I already understand. But when it arises from the branch, how does one treat it?' Qibo said: 'When the disease runs contrary to its root, one obtains a disease of the branch; the treatment then runs contrary to the root, and one obtains a formula that addresses the branch.'
The Emperor said: 'Good. By what signs does one observe the dominance of the six qi?' Qibo said: 'One observes their arrival: when clear qi comes strongly, this is the dominance of dryness; wind-wood receives the pathogenic influence, and disease of the liver is generated. When heat qi comes strongly, this is the dominance of fire; metal-dryness receives the pathogenic influence, and disease of the lung is generated. When cold qi comes strongly, this is the dominance of water; fire-heat receives the pathogenic influence, and disease of the heart is generated. When damp qi comes strongly, this is the dominance of earth; cold-water receives the pathogenic influence, and disease of the kidney is generated. When wind qi comes strongly, this is the dominance of wood; earth-dampness receives the pathogenic influence, and disease of the spleen is generated. This is what is meant by contracting a pathogenic influence and thereby generating disease. If one is exposed at a time when the year's qi is deficient, the pathogenic influence will be severe. If the harmony proper to the season is lost, the pathogenic influence will also be severe. If one encounters the moon's waning emptiness, the pathogenic influence will also be severe. If one is doubly exposed to pathogenic influence, the disease becomes critical. Wherever there is a dominant qi, a return is bound to follow.' The Emperor said: 'How does the pulse arrive in each case?' Qibo said: 'At the arrival of reverting yin, the pulse is wiry; at the arrival of lesser yin, the pulse is hook-like; at the arrival of greater yin, the pulse is deep; at the arrival of lesser yang, the pulse is large and floating; at the arrival of yang brightness, the pulse is short and choppy; at the arrival of greater yang, the pulse is large and long. If it arrives in a balanced manner, this is normal; if it arrives excessively, this is disease; if it arrives in a contrary manner, this is disease; if it fails to arrive when it should, this is disease; if it arrives before it should, this is disease; and if yin and yang are reversed in their expected arrival, the condition is critical.'
The Emperor said: 'The root and branch of the six qi are followed differently, how is this?' Qibo said: 'Among the qi, some follow the root, some follow both root and branch, and some follow neither root nor branch.' The Emperor said: 'I wish to hear the whole of it.' Qibo said: 'Lesser yang and greater yin follow the root; lesser yin and greater yang follow both the root and the branch; yang brightness and reverting yin follow neither root nor branch, but follow the intermediate paired qi instead. Hence, for those that follow the root, transformation is generated from the root; for those that follow both root and branch, there is transformation of both root and branch; for those that follow the intermediate qi, transformation occurs by means of the intermediate qi.' The Emperor said: 'When the pulse is compliant yet the disease is contrary, how does one diagnose this?' Qibo said: 'The pulse arrives in a seemingly compliant manner, yet upon pressing it does not beat vigorously, this holds true for all the yang conditions.' The Emperor said: 'What of the pulse in the contrariety of the yin conditions?' Qibo said: 'The pulse arrives in a seemingly compliant manner, yet upon pressing it beats vigorously and is full. Hence, in the arising of the hundred diseases, some are generated from the root, some from the branch, some from the intermediate qi; some are resolved by treating the root, some by treating the branch, some by treating the intermediate qi, some by treating both branch and root; some are resolved by contrary treatment, some by compliant treatment. What appears contrary may in truth be compliant; what appears compliant may in truth be contrary. Hence it is said: he who knows branch and root can apply treatment without peril; he who clearly knows contrariety and compliance can act correctly without hesitation. This is what is meant. He who does not know this is unfit to speak of diagnosis, and is apt to throw the classics into confusion. Hence the Da Yao states: the crude practitioner chatters glibly, believing he knows it all; he says the heat has not yet ceased, when in fact a cold disease has already begun anew. Though the qi is the same, its manifestation differs, and he becomes confused in diagnosis and throws the classics into disorder. This is what is meant. Now, the way of branch and root is at once concise and broad, small yet vast, one may speak of a single principle and thereby know the harm of the hundred diseases. To speak of branch and root is easy, provided nothing is lost; to examine root and branch enables the qi to be brought into balance. He who clearly understands dominance and return becomes a model for the myriad people, and the Way of heaven is thereby fulfilled.'
The Emperor said: 'In the changes of dominance and return, how do early and late timing come about?' Qibo said: 'As for the dominant qi: once dominance arrives, disease has already set in; and once the disease has become sullenly established, the return has already begun to sprout. As for the return: it arises once the dominance has run its course, and becomes severe once it attains its proper seasonal position. Dominance may be slight or severe, and return may be little or great; where the dominance is mild, the return is mild; where the dominance is depleted, the return is depleted, this is the constancy of heaven.' The Emperor said: 'When dominance and return occur, their movement sometimes fails to match the proper seasonal position, or arrives later than the expected time, what is the reason for this?' Qibo said: 'The generation of qi differs from the waxing and waning of its transformation. The functioning of the waxing and waning of cold, heat, warmth, and coolness lies in the four intercalary corners. Hence the movement of yang begins with warmth and reaches its height in summer heat; the movement of yin begins with clearness and reaches its height in cold. Spring, summer, autumn, and winter each vary somewhat in their divisions. Hence the Da Yao states: the mildness of spring becomes the heat of summer; the harshness of autumn becomes the fury of winter. Carefully examine the four intercalary corners, and all the signs of observation converge there, their culmination can be seen, and their inception can be known. This is what is meant.' The Emperor said: 'Does this variance have a fixed measure?' Qibo said: 'It amounts in all to about thirty degrees.' The Emperor said: 'How does the pulse respond in each case?' Qibo said: 'The variance follows the same regular pattern, awaiting its proper time before departing. The Mai Yao states: in spring the pulse should not be deep; in summer it should not be wiry; in winter it should not be choppy; in autumn it should not be rapid, this is called the four blockages. If deepness is excessive, this is disease; if wiriness is excessive, this is disease; if choppiness is excessive, this is disease; if rapidity is excessive, this is disease. If these signs appear intermingled, this is disease; if they reappear out of season, this is disease; if a sign departs before it should, this is disease; if a sign fails to depart when it should, this is disease; and if the reverse of the seasonal norm occurs, death results. Hence it is said: the mutual custody of the qi between seasons and pulses is like a balance scale that must not lose its equilibrium. As for the qi of yin and yang: when clear and still, generation and transformation proceed in order; when disturbed, grave illness arises. This is what is meant.' The Emperor said: 'What of the obscure and the bright?' Qibo said: 'Where the two yin meet and are exhausted, it is called obscure; where the two yang combine into brightness, it is called bright. The pairing of the obscure and the bright corresponds to the distinction between cold and heat.' The Emperor said: 'What of the equinoxes and solstices?' Qibo said: 'The point where the qi culminates is called a solstice; the point where the qi divides is called an equinox. At a solstice, the qi is the same; at an equinox, the qi is differentiated, this is what is called the proper regulation of heaven and earth.' The Emperor said: 'You, Master, have said that the qi of spring and autumn begins beforehand, while the qi of winter and summer begins afterward, this I already understand. Yet the coming and going of the six qi and their governance of the year are not constant, how, then, does one supplement and drain?' Qibo said: 'What is governed above and below, follow what is beneficial to each; rectifying the flavor used is the essential point, the same method applies to left and right. The Da Yao states: for the governance of lesser yang, use sweetness first and saltiness afterward; for yang brightness, use acridity first and sourness afterward; for greater yang, use saltiness first and bitterness afterward; for reverting yin, use sourness first and acridity afterward; for lesser yin, use sweetness first and saltiness afterward; for greater yin, use bitterness first and sweetness afterward. Assist with what is beneficial and nourish with what generates the needed qi, this is called attaining the qi.'
The Emperor said: 'Good. Now, the hundred diseases that arise are all generated from wind, cold, summer-heat, dampness, dryness, and fire, through their transformations and changes. The classics say: what is in excess, drain it; what is deficient, supplement it. I have granted this to the practitioners, yet the practitioners' application of it has still not achieved complete success. I wish to make the essential Way infallible in practice, responding like drumstick to drum, as swift and sure as pulling out a thorn or washing away a stain, the skill of the crafty, the subtle, the spiritlike, and the sagely. May I hear of it?' Qibo said: 'To carefully examine the pivotal mechanism of disease without losing what is proper to the qi, this is what is meant.' The Emperor said: 'I wish to hear what the pivotal mechanisms of disease are.' Qibo said: 'All conditions of wind with trembling and dizziness belong to the liver. All conditions of cold with contraction and tension belong to the kidney. All conditions of qi with oppression and stifling belong to the lung. All conditions of dampness with swelling and fullness belong to the spleen. All conditions of heat with clouded vision and convulsion belong to fire. All diseases of itching and sores belong to the heart. All conditions of reversal, retention, and discharge belong to the lower region. All conditions of wilting, panting, and vomiting belong to the upper region. All conditions of chattering teeth and trembling, as though the spirit had lost its guard, belong to fire. All conditions of spasm and stiffness of the nape belong to dampness. All conditions of contrary surging upward belong to fire. All conditions of distension with enlarged abdomen belong to heat. All conditions of agitation, mania, and reckless behavior belong to fire. All conditions of sudden rigidity and stiffness belong to wind. All conditions with sound, such that percussion of the abdomen resounds like a drum, belong to heat. All diseases of swelling, aching pain and soreness, fright and alarm belong to fire. All conditions of twisting, contortion, and turbid bodily fluids belong to heat. All diseases with clear, cold, and limpid bodily fluids belong to cold. All conditions of vomiting of sour fluid and sudden pouring diarrhea with urgent tenesmus belong to heat. Hence the Da Yao states: carefully hold to the pivotal mechanisms of disease, and attend to each according to its category. Where a sign is present, seek its cause; where it is absent, still seek its cause. Where there is excess, hold it accountable; where there is deficiency, hold it accountable. One must first determine the dominance among the five phases, unblock the blood and qi, bring about their smooth flow, and achieve harmony and balance. This is what is meant.'
The Emperor said: 'Good. What of the yin-yang functions of the five flavors?' Qibo said: 'Acrid and sweet flavors, which effuse and disperse, are yang; sour and bitter flavors, which surge upward and drain downward, are yin; the salty flavor, which surges upward and drains downward, is yin; the bland flavor, which percolates and drains, is yang. Of these six flavors, some astringe, some disperse, some moderate, some quicken, some dry, some moisten, some soften, some firm, one applies them according to what is beneficial, regulating the qi so as to bring it into balance.' The Emperor said: 'For conditions not resolved by regulating the qi alone, how does one treat them? Among substances toxic and non-toxic, which comes first and which comes after? I wish to hear this principle.' Qibo said: 'Whether toxic or non-toxic, what is treated takes precedence, and the formula is regulated according to the disease's magnitude.' The Emperor said: 'Please tell me of this regulation.' Qibo said: 'One sovereign and two ministers constitute a small formula; one sovereign, three ministers, and five assistants constitute a medium formula; one sovereign, three ministers, and nine assistants constitute a large formula. What is cold, heat it; what is hot, cool it; what is mild, oppose it directly; what is severe, follow it with paradoxical treatment; what is hardened, whittle it away; what is a lodged pathogen, expel it; what is fatigued from taxation, warm it; what is bound, disperse it; what is retained, attack it; what is dry, moisten it; what is urgent, moderate it; what is dispersed, gather it; what is damaged, warm it; what is sluggish, move it; what is startled, calm it. Treat by raising or by lowering, by rubbing or by bathing, by pressing or by forceful seizure, by opening or by venting, in each case, fit the treatment to the matter at hand.'
The Emperor said: 'What is meant by contrary and compliant treatment?' Qibo said: 'Contrary treatment is direct treatment; compliant treatment is paradoxical treatment. Whether one follows it a little or a great deal depends on observing the particular case.' The Emperor said: 'What is meant by paradoxical treatment?' Qibo said: 'Heat medicine is used by means of cold symptoms, cold medicine is used by means of heat symptoms, blocking agents are used for conditions of blockage, and freely flowing agents are used for conditions of free flow. One must subdue the governing pathology, while first addressing its underlying cause. At the outset the treatment and symptom appear alike, but in the end they differ. In this way one may cause accumulations to be broken up, hardness to be dissolved, the qi to be harmonized, and the disease to be surely resolved.'
The Emperor said: 'Good. What of cases resolved simply by regulating the qi?' Qibo said: 'Treat by contrariety, or treat by compliance; treat contrarily yet in a compliant manner, or treat compliantly yet in a contrary manner. Unblocking the qi so as to bring it into regulation is the principle.' The Emperor said: 'Good. What of disease located internally and externally?' Qibo said: 'When disease proceeds from within to without, regulate the interior; when it proceeds from without to within, treat the exterior. When it proceeds from within to without and becomes predominant in the exterior, first regulate the interior and afterward treat the exterior; when it proceeds from without to within and becomes predominant in the interior, first treat the exterior and afterward regulate the interior. When the interior and exterior are unrelated to each other, treat the governing disease directly.'
The Emperor said: 'Good. When fire-heat is followed by aversion to cold, with fever resembling malaria, occurring sometimes once daily and sometimes once every several days, what is the reason for this?' Qibo said: 'This is because, at the time when the dominant and returning qi meet, there is a difference in their relative abundance. If yin qi is abundant and yang qi scant, the onset occurs at longer intervals; if yang qi is abundant and yin qi scant, the onset occurs at shorter intervals. This is the rhythm of the mutual clash and waxing-waning of dominance and return, malaria follows the same pattern.' The Emperor said: 'The classic texts say to treat cold with heat and heat with cold, and practitioners cannot abandon this rule and alter this Way. Yet there are cases of heat disease that, when treated with cold, remain hot, and cases of cold disease that, when treated with heat, remain cold, in both cases a new disease arises anew. How should these be treated?' Qibo said: 'In all cases where cooling treatment fails to relieve heat, seek the root in yin; where warming treatment fails to relieve cold, seek the root in yang. This is what is meant by seeking its category.' The Emperor said: 'Good. Why is it that taking a cold medicine instead produces heat, and taking a hot medicine instead produces cold?' Qibo said: 'This is because one has treated the already dominant qi, and hence the result is contrary.' The Emperor said: 'What of when this occurs even without treating the dominant qi?' Qibo said: 'How thorough is this question! This is due not to treating the dominant qi, but to the affinities of the five flavors. Now, when the five flavors enter the stomach, each returns to what it favors: sourness enters the liver first, bitterness the heart first, sweetness the spleen first, acridity the lung first, and saltiness the kidney first. Over time, this augments the corresponding qi, this is the constant pattern by which substances transform the body. Yet if the augmentation of qi persists too long, this becomes the cause of premature death.'
The Emperor said: 'Good. What is meant by sovereign and minister in the composition of a formula?' Qibo said: 'That which governs the disease is called the sovereign; that which assists the sovereign is called the minister; that which corresponds to the minister is called the envoy, this is not the same as the three grades of superior, middle, and inferior in classifying materia medica.' The Emperor said: 'What are the three grades?' Qibo said: 'They serve to clarify the distinct categories of the beneficial and the harmful.' The Emperor said: 'Good. What of disease internal and external?' Qibo said: 'In the method of regulating the qi, one must distinguish yin and yang, determine what is internal and external, and let each keep to its own domain. What is internal, treat internally; what is external, treat externally. What is mild, regulate it; what is more than mild, level it; what is exuberant, seize it. For excess that would be treated by sweating, instead purge it when appropriate. Cold, heat, warmth, and coolness are each diminished according to their category. Follow what is beneficial, adhere carefully to the Way as prescribed, and every action will attain complete success; the qi and blood will be rightly balanced, and one will long preserve the mandate of heaven.' The Emperor said: 'Good.'