素问·方盛衰论 Discourse on the Waxing and Waning of the Four Directions

Lei Gong asked to inquire about the abundance and paucity of qi — which is counterflow and which is favorable flow. Huangdi answered: Yang follows the left, yin follows the right; the old follow above, the young follow below. Thus, in spring and summer, returning to yang means life, and returning to autumn and winter means death; conversely, returning to autumn and winter means life. Thus, whether qi is abundant or scant, if it is counterflow, it becomes reversal. He asked: Is it that qi in excess becomes reversal? The answer: When qi rises and does not descend, cold reversal reaches the knees; in the young this brings death in autumn and winter, while in the old it brings life in autumn and winter. When qi rises and does not descend, there is headache and disease of the vertex; seeking yang, one cannot find it, seeking yin, one cannot discern it clearly; the five regions are cut off without any sign, as if dwelling in a vast wilderness, as if lying hidden in an empty chamber — faint and continuous, the patient's life does not last out the day. Thus, reversal from scant qi causes people to have disordered dreams, reaching an extreme of confusion. When the three yang are cut off and the three yin are faint, this is called scant qi. Thus, when lung qi is deficient, it causes people to dream of white objects, or of seeing people cut down with blood scattered about; if it occurs in the corresponding season, one dreams of soldiers in battle. When kidney qi is deficient, it causes people to dream of boats and ships and people drowning; if it occurs in the corresponding season, one dreams of lying submerged in water as if in fear and dread. When liver qi is deficient, one dreams of mushrooms, fragrant plants, and growing grass; if it occurs in the corresponding season, one dreams of lying beneath a tree, not daring to rise. When heart qi is deficient, one dreams of putting out fires or of bright, fiery things; if it occurs in the corresponding season, one dreams of burning and scorching. When spleen qi is deficient, one dreams of insufficient food and drink; if it occurs in the corresponding season, one dreams of building walls and roofing houses. All of these are cases where the qi of the five viscera is deficient, yang qi is in excess, and yin qi is insufficient. One must unite this with the five methods of diagnosis, harmonize it with yin and yang, and locate it within the channels and vessels.

In diagnosis there are ten measures: measuring a person's pulse measure, visceral measure, flesh measure, sinew measure, and transport-point measure. When the qi of yin and yang is exhausted, the person's disease manifests of itself. When the pulse moves without constancy, scattering yin and favoring yang unduly, the pulse loses its proper form and is incomplete; diagnosis then has no constant procedure. In diagnosis one must always consider above and below, and gauge whether the person is a commoner, a ruler, or a minister. If one receives instruction from a teacher without completing it, this causes one's art to remain unclear; not examining counterflow and favorable flow, one acts recklessly — holding to the female aspect while losing the male, discarding yin and clinging to yang, not understanding how to combine and unite them. Diagnosis is therefore unclear, yet when it is transmitted to later generations, its contrary conclusions become self-evident. When the utmost yin is deficient, the qi of Heaven is cut off; when the utmost yang is excessive, the qi of Earth is insufficient. The crossing and combining of yin and yang is what the Perfected Person practices. In the crossing and combining of yin and yang, yang qi arrives first and yin qi arrives afterward. Thus the sage, in holding to the Way of diagnosis, attends to the sequence of yin and yang, first and last, in his examination. The configurations of the unusual and the constant number sixty in all. In diagnosis one must unite with subtle matters, trace the transformations of yin and yang, illuminate the true condition of the five centers; within this discourse, one grasps the essentials of deficiency and excess, and fixes the matters of the five measures. Only when one knows all this is one sufficient to diagnose. Thus, if in palpating one grasps yin but not yang, the diagnosis dissolves into nothing; if one grasps yang but not yin, one's learning remains shallow and unrefined. To know the left but not the right, to know the right but not the left, to know above but not below, to know what comes first but not what follows after — for these reasons, treatment cannot endure. To know the bad and know the good, to know disease and know absence of disease, to know high and know low, to know sitting and know rising, to know movement and know stillness — applying this with proper order, the Way of diagnosis is then complete, and it will not fail for ten thousand generations. Rise to what is in excess, and know what is insufficient. Measure the affairs of above and below; the affairs of the pulse follow their proper framework. Thus, when the bodily form is weak and the qi is deficient, this means death. When the form and qi are in excess but the pulse qi is insufficient, this means death. When the pulse qi is in excess but the form and qi are insufficient, this means life.

Thus, in diagnosis there is a great method: sitting and rising have their constant order, going out and coming in have their proper conduct, so as to turn one's spirit toward clarity. One must be pure and clear, observing above and observing below, governing the eight rectitudes and the pathogenic evils, distinguishing the five central regions, examining the movement and stillness of the pulse, following the smoothness or roughness at the chi position, and the sense of cold or warmth; one observes whether it is large or small, unites this with the capacity of the disease, and thereby grasps counterflow and favorable flow, and further knows the name of the disease. Then one's diagnosis can achieve complete success in ten cases out of ten, without losing touch with human circumstances. Therefore, in diagnosing, one observes both the patient's breath and his intent, and thus does not lose the proper order; the Way becomes exceedingly clear and discernible, and thus can endure long. One who does not know this Way loses the classics and severs their principles, speaking recklessly and making baseless predictions of the time of death — this is called losing the Way.