Discourse on the Waxing and Waning of the Visceral Qi

Lei Gong asked: "How is the abundance or scarcity of qi determined, and what constitutes counterflow or compliance?" The Yellow Emperor replied: "Yang qi rises from the left, and yin qi descends from the right; the qi of the elderly moves from above downward, while the qi of the young moves from below upward. Therefore, in spring and summer, if yang qi complies with yang, there is survival; if it complies with autumn and winter, there is death. Conversely, in autumn and winter, if yang qi complies with autumn and winter, there is survival. Thus, regardless of whether qi is abundant or scarce, whenever counterflow disorder occurs, it results in reversal disorder (jue)."

Lei Gong asked further: "Can an excess of qi also cause reversal disorder?" The Yellow Emperor replied: "If yang qi persistently ascends without descending, then the lower limbs become cold, even to the point of cold reaching the knees. In young people encountering this condition, death is likely in autumn and winter; in elderly people encountering this condition, survival is still possible in autumn and winter. When yang qi ascends without descending, it causes headache and disorders at the vertex of the head. This condition cannot be resolved by treatment from the yang aspect, nor can it be clarified by examination from the yin aspect; the five viscera obstruct each other, leaving no discernible signs. The patient feels as if placed in a vast wilderness, or as if crouching in an empty room, with breath weak and faint, barely sustaining through a single day."

Therefore, reversal disorder due to qi deficiency causes people to have extremely bizarre and confused dreams. When the qi of the three yang channels is cut off, and the qi of the three yin channels is faint, this manifests as qi deficiency. Thus, when lung qi is deficient, a person dreams of white objects, or dreams of murder with blood flowing and corpses scattered about; if it coincides with autumn, which corresponds to the lung, they dream of warfare. When kidney qi is deficient, a person dreams of boats sinking and drowning; if it coincides with winter, which corresponds to the kidney, they dream of lying submerged in water, as if in great fear. When liver qi is deficient, a person dreams of mushrooms and fragrant herbs; if it coincides with spring, which corresponds to the liver, they dream of crouching under a tree, not daring to rise. When heart qi is deficient, a person dreams of fire-saving and thunder and lightning, yang-type phenomena; if it coincides with summer, which corresponds to the heart, they dream of great fire burning and scorching. When spleen qi is deficient, a person dreams of insufficient food and not being full; if it coincides with late summer, which corresponds to the spleen, they dream of building walls and houses. These are all manifestations of deficiency of qi in the five viscera, with an excess of yang qi and insufficiency of yin qi. One should integrate the diagnostic signs of the five viscera, harmonize yin and yang, and use this as the basis to examine the channels.

Diagnosis has ten measures: the measure of the vessels, the measure of the viscera, the measure of the flesh, the measure of the sinews, and the measure of the transport points. If both yin and yang qi are exhausted, then the person's disease naturally becomes apparent. When the pulse beats irregularly, without fixed pattern, or when the yin pulses are scattered, or the yang pulses are biased; when the pulse is lost and incomplete, diagnosis has no fixed rule to follow. Diagnosis must clearly distinguish upper and lower, and also consider whether the patient is a commoner or a high official. If one follows a teacher without completing the training, one's medical skill is not refined; if one cannot distinguish compliance from counterflow, it is practicing medicine recklessly. Grasping only yin while discarding yang, or grasping only yang while neglecting yin, without knowing to combine and analyze yin and yang, makes diagnosis unclear. Such medical knowledge passed down to later generations will only expose one's own errors.

If the supreme yin is deficient, then heavenly qi is cut off; if the supreme yang is excessive, then earthly qi is insufficient. The interpenetration and union of yin and yang is what the most enlightened practice. At the moment of yin-yang union, yang qi arrives first, and yin qi arrives later. Therefore, the sage grasps the essentials of diagnosis: distinguishing the sequence of yin and yang and mastering it. The techniques for extraordinary and normal conditions number sixty-one; in diagnosis, one must synthesize subtle principles, trace the changes of yin and yang, and understand the internal conditions of the five viscera. The discussions therein should seize the key points of deficiency and excess, and establish the standards of the five measures (vessels, viscera, flesh, sinews, transport points). Only by knowing these is one qualified to make a diagnosis. Thus, if in pulse-taking one examines only the yin aspect and fails to obtain the yang aspect, diagnosis will be unsuccessful; if one examines only the yang aspect and fails to obtain the yin aspect, the learned medical skill will not be profound. Knowing only the left but not the right, knowing only the right but not the left, knowing only the upper but not the lower, knowing only the before but not the after, then treatment cannot be sustained. Knowing ugliness as well as goodness, knowing disease as well as health, knowing high as well as low, knowing sitting as well as rising, knowing action as well as rest, and applying these with guiding principles, then diagnosis is complete and can endure for ten thousand generations without failure. Use what is in excess to understand what is insufficient. Weigh the upper and lower of the disease, and the principles of the pulse are thereby fully grasped. Therefore, when the physical form is weak and qi is deficient, death occurs. When both physical form and qi are in excess, but pulse qi is insufficient, death occurs. When pulse qi is in excess, but physical form and qi are insufficient, survival is possible.

Thus, diagnosis has great principles: sitting and rising must have regularity, entering and exiting must have standards, so as to circulate the spirit and make it clear and penetrating. One must be tranquil, observe above and examine below, investigate the pathogenic qi of the eight directions and four seasons, differentiate the positions of the five viscera, press and palpate the movement of the pulse, trace the slipperiness, roughness, coldness, and warmth of the skin on the forearm, observe the changes in urine and stool, and integrate these with the manifestations of the disease. When the relationship of compliance and counterflow can be grasped, and the disease name is also known, then diagnosis can achieve ten-out-of-ten accuracy without violating human conditions. Therefore, in diagnosing disease, one observes the patient's breathing and spirit, and thus does not lose the proper order. The principles are very clear, and therefore they remain effective for a long time. If one does not know these principles, one will lose the canonical teachings, sever the principles, speak nonsense, make reckless prognoses, and this is called losing the Way.