Five Changes

Huangdi asked Shaoyu: I have heard that the beginning of all diseases must be due to wind, rain, cold, and heat, entering through the pores into the interstices. Some then return, some remain, some become wind-edema with sweating, some become wasting-thirst, some become cold-heat, some become lingering bi, and some become accumulations. Strange and perverse evils overflow, beyond counting. I wish to hear the reason for this. When people fall ill, some contract this disease, some that disease. Is it that Heaven generates different winds for people? Why is the difference so great? Shaoyu said: The wind generated by Heaven is not biased toward any person. Its movement is equitable and upright. Those who offend against it get sick; those who avoid it have no danger. It is not that the wind actively seeks people, but that people themselves go to offend it.

Huangdi said: When people encounter the same wind at the same time and fall ill simultaneously, yet their diseases are different, I wish to hear the reason for this. Shaoyu said: Well asked! Allow me to use a carpenter as a metaphor. A carpenter sharpens his axe and whets his blade to cut wood. The yin and yang sides of wood, as well as its hardness and fragility, differ. Hard places cannot be cut into; fragile places have loose skin. At branch nodes and intersections, the axe blade will be damaged. Within the same piece of wood, hardness and fragility differ. Hard parts are firm; fragile parts are easily injured. How much more so with different kinds of wood, where bark thickness and sap quantity vary, each being dissimilar. Trees that bloom early and produce leaves first, when encountering spring frosts and fierce winds, will have flowers fall and leaves wither. After prolonged scorching sun and great drought, fragile, thin-barked trees have branches with little sap and leaves that wither. After prolonged overcast and continuous rain, thin-barked, sap-rich trees have bark that is moist and shallow. When a sudden violent wind arises, firm but brittle trees have branches that snap and twigs that break. With autumn frosts and swift winds, firm but brittle trees have roots that shake and leaves that fall. In total, these five situations each bring damage. How much more so for humans?

Huangdi said: How does one correspond humans to trees? Shaoyu replied: The damage suffered by trees all injures their branches. Branches that are firm but tough do not sustain injury. When humans frequently fall ill, it is also because their bones, joints, skin, and interstices are not firm. These are the places where evil qi lodges, hence they frequently get sick.

Huangdi said: For people prone to wind reversal with drenching sweat, by what are they diagnosed? Shaoyu replied: If the interior is not firm and the interstices are loose, they are prone to wind disease. Huangdi said: By what are muscles not firm diagnosed? Shaoyu replied: If the popliteal flesh is not firm and lacks distinct striations, the striations are coarse. When striations are coarse and the skin is not dense, the interstices are loose. This speaks to the overall condition.

Huangdi said: For people prone to wasting-thirst, by what are they diagnosed? Shaoyu replied: If the five zang are all weak and soft, they are prone to wasting-thirst. Huangdi said: By what are the weakness and softness of the five zang known? Shaoyu replied: Those who are weak and soft must have a certain hardness. Hardness makes them prone to anger; weakness makes them prone to injury. Huangdi said: By what are weakness-softness and hardness diagnosed? Shaoyu replied: Such people have thin skin, firm and deep-set eyes, and long, straight bowels. Their heart and intestines are hard. Hardness makes them prone to anger. Anger causes qi to rebel upward, accumulating in the chest. Blood and qi flow countercurrent and lodge. The hip skin is full and the flesh firm, but the blood vessels are blocked. This transforms into heat. Heat consumes the skin and flesh, hence becoming wasting-thirst. This means such people have a harsh, violent temper but weak, soft flesh.

Huangdi said: For people prone to cold-heat, by what are they diagnosed? Shaoyu replied: Those with small bones and weak, soft flesh are prone to cold-heat. Huangdi said: By what are the size of bones, the hardness or fragility of flesh, and the unevenness of skin color diagnosed? Shaoyu replied: The cheekbone is the root of the bones. If the cheekbone is large, the bones are large; if the cheekbone is small, the bones are small. Skin thin and flesh without prominence, arms weak and without strength, the color of the chin dull and not matching the color of the celestial court, turbid and unique—these are the diagnostic signs. Then, if the arms are thin, their marrow is insufficient, so they are prone to cold-heat.

Huangdi said: By what are people prone to bi disease diagnosed? Shaoyu replied: Those with coarse striations and flesh that is not firm are prone to bi disease. Huangdi said: Does bi disease have high and low locations? Shaoyu replied: To know its height and lowness, observe separately the corresponding body parts.

Huangdi said: For people prone to accumulations in the intestines, by what are they diagnosed? Shaoyu replied: Skin thin and without luster, flesh not firm but moist. In such cases, the stomach and intestines are weak. Weakness allows evil qi to lodge. Accumulations then damage the region between the spleen and stomach. Cold and warmth are not regulated, and evil qi gradually arrives. When it lodges and accumulates, large accumulations form.

Huangdi said: I have heard of the disease patterns and now know them! I wish to hear about their seasonal timing. Shaoyu replied: First, determine the heavenly stem and earthly branch of the current year to know its seasonal timing. If the seasonal timing is elevated, the disease qi breaks out; if the seasonal timing is depressed, the disease is critical. Even if it does not sink into depression, if the year has an offending pathway, this disease will surely break out. This is called becoming sick according to body form—the essential outline of the five transformations.