布者遍满，终者化去也。气至则生，气尽则死，天地之间，一气而已。）然而五味所资，生化有薄浓，成熟有
少多，终始不同，其故何也？岐伯曰∶地气制之也，非天不生，地不长也。（按∶人物之生，固以天气为始终，
而生物之体，实借地气以长养。故生化成熟者天也，天气所至，宜无不同，而其间有薄浓多少之殊者，则非天
之生物有异，盖由地之长养不同耳。下文正说地不长。）帝曰∶愿闻其道。岐伯曰∶寒热燥湿不同其化也。
（举四气不同，则温清异化可知之矣。）故少阳在泉，寒毒不生，其味辛，其治苦酸，其谷苍丹。（巳亥岁气化
也。夫毒者，皆五行 盛暴烈之气所为也。今火在地中，其气正热，寒毒之物，气与地殊，生死不同，故生少
也。火制金气，故味辛者不化也。少阳之气，上奉厥阴，故其岁化苦与酸也。六气主岁，唯此岁通和，木火相承，
故无间气也。苦丹，地气所化；酸苍，天气所生矣。余所生化，悉有上下胜克，故皆有间气也。）阳明在泉，湿
毒不生，其味酸，其气湿，（按∶新校正云∶“详在泉，唯阳明与太阴之岁，云其气湿，其气热，盖以湿燥未见
寒温之气，故再云其气也。”）其治辛苦甘，其谷丹素。（子午岁气化也。燥在地中，其气凉清，故湿温毒药少
生化也。金木相制，故味酸者少化也。阳明之气，上奉少阴，故其岁化辛与苦也。辛素，地气也。苦丹，天气也。
甘，间气也，所以间金火之胜克，故兼治甘。）太阳在泉，热毒不生，其味苦，其治淡咸，其谷 。（丑未岁气
化也。寒在地中，与热殊化，故其岁物，热毒不生。水胜火，故味苦者不化。太阳之气，上奉太阴，故其岁化生
淡咸也。太阴土气，上生于天，气远而高，故甘之化薄而为淡也。所以淡亦属甘，甘之类也。淡 ，天化也。咸
，地化也。 ，黄也。按∶ 音巨，黑黍。）厥阴在泉，清毒不
生，其味甘，其治酸苦，其谷苍赤，（寅申岁气化也。温在地中，与清殊性，故其岁物，清毒不生。木胜其土，
故味甘少化也。厥阴之气，上合少阳，所合之气既无乖忤，故其治化酸与苦也。酸苍，地化也。苦赤，天化也。
气无胜克，故不间气，以甘化也。）其气专，其味正。（厥阴少阳在泉之岁，皆气化专一，其味纯正。然余岁
悉上下有胜克之气，故皆有间气间味矣。）少阴在泉，寒毒不生，其味辛，其治辛苦甘，其谷白丹。（卯酉岁气化
也。热在地中，与寒殊化，故其岁药，寒毒甚微。火气烁金，故味辛少化也。少阴阳明主天主地，故其所治，
苦与辛也。苦丹为地气所育，辛白为天气所生。甘，间气也，所以间止克伐也。）太阴在泉，燥毒不生，其味
咸，其气热，其治甘咸，其谷 。（辰戌岁气化也。地中有湿，与燥不同，故干毒之物，不生化也。土制于
木，故味咸少化也。太阴之气，上承太阳，故其岁化，甘与咸也。甘 ，地化也。咸 ，天化也。寒湿不为
大忤，故间气同而气热者应之。）
化淳则咸守，气专则辛化而俱治。（淳，和也。化淳谓少阳在泉之岁也，火来居水而反能化育，是水咸自守，
不与火争化也。气专谓厥阴在泉之岁也，木居于水而复下化，金不受害，故辛复生化，与咸俱王也。唯此两岁，
上下之气，无克伐之嫌，故辛得与咸同应王而生化也。余岁皆上下有胜克之变，故其中间甘味兼化以缓其制抑。
余苦咸酸三味，不同其生化也。故天地之间，药物辛甘者多也。）
故曰∶补上下者从之，治上下者逆之，以所在寒热盛衰而调之。（上谓司天，下谓在泉也。司天地气太过，
则逆其味以治之；司天地气不及，则顺其味以和之。从，顺也。）上取下取，内取外取，以求其过。能毒者以浓药，
不胜毒者以薄药。此之谓也。（上取谓以药制有过之气也，制而不顺则吐之。下取谓以迅疾之药除下病，攻之
不去则下之。内取谓食及以药内之，审其寒热而调之。外取谓药熨病所，令气调适也。当寒反热，以冷调之；
当热反寒，以温和之；上盛不已，吐而脱之；下盛不已，下而夺之，谓求得气过之道也。药浓薄谓气味浓薄者
也。按∶新校正云∶“甲乙经云∶胃浓色黑大骨肉肥者皆胜毒，其瘦而薄胃者皆不胜毒。又异法方宜论云∶
西方之民，陵居而多风，水土刚强，不衣而褐荐，华食而脂肥，故邪不能伤其形体，其病生于内，其治宜毒药。”
以上二段，虽有故曰二字，似根上文。然是说治病用药之法，与上文之义绝不相同，故别书其一而去其一。能音
耐。）气反者，病在上取之下，病在下取之上，病在中旁取之。（按∶此分解求病之法也。气反谓本寒似热，
本热似寒，本实似虚，本虚似实之类也。即如阳浮于上者，气涌火腾，病在于上矣；而不知其为阴虚不能维阳
之所致，则补阴配阳与夫敛火归原之法可用也。又如泄利下注者，流滑不已，病在于下矣；而不知其为气虚下
脱之所致，则升阳益胃与夫补中益气之剂宜施也。且夫脾胃者五脏之中也，或满闷，或嘈杂，或呕吐，或泻利，
皆中之病也。中者土也，土见制于木则病。满闷者，木郁而气闭也；嘈杂者，木强而火炽也；呕吐泻利者，木
盛之极，凌脾与胃也。皆脾胃之病，即皆木之为患也。木者肝与胆也，肝胆之治在两胁，故欲治中病，当取两
旁也。王注似是而非，今厘正之。）治热以寒，温而行之；治寒以热，凉而行之；治温以清，冷而行之；治清
以温，热而行之。（按∶此详言用药之理也。凡病之情，最忌相激，必各因其气之相近者以引之，斯无悍格不
相入之患。即如治热以寒，治之正也。然以寒药治热病，而即寒以饮之则激矣。是故与热相近者温也，温以引
寒，寒药必行，热病自退，斯为渐而不激也。余同。上四句是说病气药性，下四句是说饮时各有寒热温凉之宜
也。王注殊不可解。）故消之制之，吐之下之，补之泻之，久新同法。（量气盛虚而行其法，病之新久无异道
也。）
帝曰∶病在中，而不实不坚，且聚且散，奈何？岐伯曰∶悉乎哉问也！无积者求其脏，虚者补之，药以
祛之，食以随之，行水渍之，和其中外，可使毕已。（按∶帝问盖谓胸腹之间，似有形而实无一定者，治当若
何。伯言凡病成
积，多是坚实不散，今既若此，是盖无积者也。积为脏病，脏虚气壅，似有实无，法宜补之。然一于用补，而
苟非兼用通利之品以佐之，则或聚或散者，必且纡徐而难效，故既补之又必祛之，祛谓利气行血之类也。随者，
言食物之类，亦当如药之补利兼施，不可偏于肥浓，故曰随之，谓随药也。行水解已见前。）
帝曰∶有毒无毒，服有约乎？（按∶约谓数目。）岐伯曰∶病有久新，方有大小，有毒无毒，固宜常制矣。
（按∶谓洵有常制也。）大毒治病，十去其六；（下品药毒，毒之大也。）常毒治病，十去其七；（中品药毒，
次于下也。）小毒治病，十去其八；（上品药毒，毒之小也。）无毒治病，十去其九。（上品中品下品无毒药，
悉谓之平。按∶非常之病，非非常之药不能治，是故毒药者，乃不得已而用之也。药愈毒则所治之病愈少，所
以然者，常病多而异证少也。用之各适其宜，乃有六七八九之殊。若用乖其道，则不特毒者毒，而无毒者亦毒
矣。）谷肉果菜，食养尽之，无使过之，伤其正也。（……按∶此言食虽无毒，而用过其节，则亦能伤正气也。
脏气法时论曰∶“毒药攻邪，五谷为养，五果为助，五畜为益，五菜为充。”盖谓人之于食，但使能养气血足
矣，万勿过节以害正气也。）必先岁气，无伐天和，（按∶岁有南北之殊，气有六步之分，每当一岁，必求其
气之所主而谨奉之，欲治病者，当以岁气为先也。若背时乱气，妄为施治，是谓伐天之和，必致盛盛虚虚，致
邪失正，医者所当深戒者也。）无盛盛，无虚虚，而遗人夭殃，无致邪，无失正，绝人长命。（按∶盛者邪气
盛，虚者正气虚。邪盛矣而遽施补益，则盛者愈盛；正虚矣而犹然攻击，则虚者愈虚。致邪失正，人之夭丧，
伊芳谁咎哉。注谓不察虚实，但思攻击，而盛者转盛，虚者转虚，万端之病，从兹而甚，亦一解也。）
帝曰∶其久病者，有气从不康，病去而瘠，奈何？（按；帝问久病之人，病已去而气已平，乃瘠弱无力，
如何治之。）岐伯
曰∶昭乎哉圣人之问也！化不可代，时不可违。（化谓造化也。代大匠斫，犹伤其手，况造化之气，人能以力代
之乎。夫生长收藏，各应四时之化，虽智巧者亦无能先时而致之，明非人力所及。由是观之，则物之生长收藏，
必待其时也；物之成败理乱，亦待其时也。物既有之，人亦宜然。或言力必可致而能代造化、违四时者，妄也。
按∶人之生也，气本乎天，形养于地。顺天之时，因地之利，何病能侵。惟不能顺天地之气，于是乎病，而且病
至于久矣。幸而病去气从，然其形体自必瘠弱，精神自必衰耗。躁妄之人，每求速愈，纵恣口腹，气力稍充，或
近房色，旋至复发而死者，比比然也。岂知造化有消长之期，四时有衰旺之序，苟非安心静守，焉能一旦复元，
养之和之，静以待时，真病后之良箴哉！）夫经络以通，血气以从，复其不足，与众齐同，养之和之，静以待时，
谨守其气，无使倾移，其形乃彰，生气以长，命曰圣王。故大要曰∶无代化，无违时，必养必和，待其来复。
此之谓也。帝曰∶善！（大要，上古经法也。引古之要旨，以明时化之不可违，不可以力代也。）
所谓“布”，是指气遍布周身；所谓“终”，是指气化作用消散。气存在则生命延续，气耗尽则死亡，天地之间，不过是一气罢了。）然而五味所资取的营养，生化有厚薄浓淡之分，成熟有少多之别，开始和结束的情况各不相同，这是什么原因呢？岐伯说：这是地气制约的结果，并非天不生成，而是地不生长。（按语：人和万物的生成，固然以天气为始终，但生物的身体，实际上借助地气来长养。所以生化和成熟是天，天气所到的地方，按理应该没有不同，但其中却有厚薄多少的差异，这并不是天在生物方面有差异，大概是由于地的长养条件不同罢了。下文正是说明地不长养的道理。）黄帝说：我想听听其中的道理。岐伯说：寒、热、燥、湿四种气候的化育作用是不同的。（列举了四气不同，那么温凉异化的情况就可以推知了。）所以，当少阳相火在泉（主管下半年气候）时，寒毒之物不能生长，其味辛，治疗宜用苦、酸味药物，对应的谷物是青色和红色。（这是巳亥年的气化特点。所谓毒，都是五行中某一行盛极暴烈之气造成的。现在火在地中，其气正热，寒毒之物，气性与地气殊异，生死不同，所以生长很少。火克制金气，所以辛味之物不易化生。少阳之气，上奉厥阴风木，所以该年的气化表现为苦味与酸味。六气主岁，只有这一年通体调和，木火相生，所以没有间气。苦味和丹色，是地气所化；酸味和苍色，是天气所生。其余年份的生化和化育，都有上下胜克的关系，所以都有间气。）当阳明燥金在泉时，湿毒之物不能生长，其味酸，其气湿，（按语：新校正说：“详细考察在泉之气，只有阳明和太阴之年，才说‘其气湿’、‘其气热’，大概是因为湿燥之气未见寒温之变，所以再次强调其气。”）治疗宜用辛、苦、甘味药物，对应的谷物是丹色和白色。（这是子午年的气化特点。燥在地中，其气凉清，所以湿温毒药较少生化。金木相互制约，所以酸味之物化生较少。阳明之气，上奉少阴君火，所以该年的气化表现为辛味与苦味。辛味和白色，属地气；苦味和丹色，属天气。甘味是间气，用来调节金火之间的胜克关系，所以兼治甘味。）当太阳寒水在泉时，热毒之物不能生长，其味苦，治疗宜用淡、咸味药物，对应的谷物是黑色和黄色。（这是丑未年的气化特点。寒在地中，与热殊异，所以该年的物产，热毒不生。水胜火，所以苦味之物不化。太阳之气，上奉太阴湿土，所以该年的气化表现为淡味和咸味。太阴土气，上生于天，气远而高，所以甘的化育薄弱而表现为淡味。所以淡也属于甘，是甘的一类。淡味和黑色，是天化；咸味和黄色，是地化。黄，指黄色。按语：巨音同“巨”，指黑黍。）当厥阴风木在泉时，清毒（清凉之毒）不能生长，其味甘，治疗宜用酸、苦味药物，对应的谷物是青色和赤色。（这是寅申年的气化特点。温在地中，与清殊性，所以该年的物产，清毒不生。木胜土，所以甘味之物化生减少。厥阴之气，上合少阳相火，所合之气既无乖违抵触，所以其治疗和化育表现为酸味与苦味。酸味和青色，是地化；苦味和赤色，是天化。气无胜克，所以无间气，以甘味化育为主。）该年气化专一，味道纯正。（厥阴和少阳在泉的年份，都是气化专一，味道纯正。然而其他年份上下都有胜克之气，所以都有间气和间味。）当少阴君火在泉时，寒毒之物不能生长，其味辛，治疗宜用辛、苦、甘味药物，对应的谷物是白色和丹色。（这是卯酉年的气化特点。热在地中，与寒殊异，所以该年的药物，寒毒甚微。火气烁金，所以辛味之物化生较少。少阴和阳明主天属地，所以其所治，是苦味与辛味。苦味和丹色由地气养育，辛味和白色由天气所生。甘味是间气，用来抑制克伐。）当太阴湿土在泉时，燥毒之物不能生长，其味咸，其气热，治疗宜用甘、咸味药物，对应的谷物是黑色和黄色。（这是辰戌年的气化特点。地中有湿，与燥不同，所以干毒之物，不生化。土被木制约，所以咸味之物化生较少。太阴之气，上承太阳寒水，所以该年的气化，是甘味与咸味。甘味和黑色，是地化；咸味和黄色，是天化。寒湿不为大冲突，所以间气相同且气热相应。）
化育淳厚则咸味自守，气化专一则辛味化生并共同主治。（淳，即和。化淳指少阳在泉之年，火居水位却能反能化育，所以水的咸味自然守住，不与火争化。气专指厥阴在泉之年，木居水位又下化，金不受害，所以辛味重新生化，与咸味共同旺盛。只有这两年，上下之气，没有克伐的嫌疑，所以辛能与咸同应王而生化。其他年份上下都有胜克的变故，所以中间甘味兼化以缓和制抑。其余苦、咸、酸三味，生化不同。所以天地之间，辛甘味的药物较多。）
所以说：补益上下的病证要顺从其气，治疗上下的病证要逆从其气，根据所在部位的寒热盛衰来调理。（上指司天，下指在泉。司天或在泉之气太过，则逆其味来治疗；司天或在泉之气不及，则顺其味来调和。从，即顺。）上取或下取，内取或外取，以求得病气的过盛之处。体质强壮能耐受药力的人用浓药，体质虚弱不能耐受药力的人用薄药。说的就是这个道理。（上取指用药制约过盛之气，若制约而不顺则催吐。下取指用迅疾的药物去除下部疾病，若攻之不去则泻下。内取指饮食及药物内服，审察其寒热来调理。外取指药熨患处，使气机调适。应当寒反热的，用冷药调理；应当热反寒的，用温和药调理；上部盛极不止的，用吐法脱泄；下部盛极不止的，用下法夺邪，这就是求得气过的方法。药浓薄指气味浓薄的药物。按语：新校正说：“《甲乙经》说：胃浓色黑大骨肉肥者都胜毒，瘦而胃薄者都不胜毒。又《异法方宜论》说：西方之民，陵居而多风，水土刚强，不穿衣而穿粗布，吃华食而脂肥，所以邪不能伤其形体，其病生于内，其治疗宜用毒药。”以上两段，虽然有“故曰”二字，似乎承接上文。但是这是说治病用药的方法，与上文的意思完全不同，所以单独记录一段而删去另一段。能，通耐。）气机反常的，病在上部取之下部，病在下部取之上部，病在中部取之两旁。（按语：这是分解求病的方法。气反指本寒似热，本热似寒，本实似虚，本虚似实之类。就像阳气浮于上，气涌火腾，病在于上；但不知道这是阴虚不能维系阳气所致，则可以用补阴配阳以及敛火归原的方法。又如泄利下注，流滑不已，病在于下；但不知道这是气虚下脱所致，则应该施用升阳益胃以及补中益气等剂。况且脾胃位于五脏之中，或满闷，或嘈杂，或呕吐，或泻利，都是中的病。中属土，土被木制约则生病。满闷，是木郁而气闭；嘈杂，是木强而火炽；呕吐泻利，是木盛之极，凌犯脾与胃。这些都是脾胃的病，也就是木引起的祸患。木对应肝与胆，肝胆的治疗在两胁，所以想要治疗中的病，应当取两旁。王冰的注释似是而非，现在加以厘正。）治疗热病用寒药，但要温着服用；治疗寒病用热药，但要凉着服用；治疗温病用清药，但要冷着服用；治疗清病用温药，但要热着服用。（按语：这是详细阐述用药的原理。凡是病情，最忌讳相互激惹，必须各因其气的相近者来引导，这样就没有悍戾格拒不相入的祸患。就像治热用寒，是正确的。然而用寒药治热病，如果立即用冷药冷饮，就会激惹。所以与热相近的是温，用温来引导寒，寒药必能行散，热病自然退去，这才是渐进而不激惹。其余同理。上四句是说病气和药性，下四句是说饮用时的寒热温凉各有适宜。王冰的注释实在不可理解。）所以消导、制约、催吐、泻下、补益、泻实等方法，无论久病新病，方法相同。（根据气盛的虚实来施行其法，病的新旧没有不同的道理。）
黄帝说：病在中焦，但不坚实，而且聚散无常，怎么办？岐伯说：问得真详尽啊！没有积滞的，探求其脏腑，虚的则补益，用药祛除病邪，用食物跟随调养，行水利尿，调和内外，可以使病痊愈。（按语：黄帝问的大概是胸腹之间，似有形而实无定形，治疗应当如何。岐伯说凡病成积，多是坚实不散，现在既然这样，这是没有积滞。积是脏病，脏虚气壅，似有实无，法宜补益。然而一味用补，如果不同时兼用通利之品来佐助，那么或聚或散的病，必定缓慢而难见效，所以既补之又必祛之，祛指利气行血之类。随，指食物之类，也应当像药一样补利兼施，不可偏于肥浓，所以说随之，谓随药而行。行水解已见前。）
黄帝说：有毒无毒的药，服用有定数吗？（按语：约指数目。）岐伯说：病有久新，方有大小，有毒无毒，本来就有常规制度。（按语：谓确实有常规制度。）用大毒药物治疗，病去十分之六；（下品药毒，毒之大也。）用常毒药物治疗，病去十分之七；（中品药毒，次于下品。）用小毒药物治疗，病去十分之八；（上品药毒，毒之小也。）用无毒药物治疗，病去十分之九。（上品、中品、下品的无毒药，都称为平药。按语：非常之病，非非常之药不能治，所以毒药，是不得已而用之。药越毒，所治之病越少，之所以这样，是因为常病多而异证少。使用各自适合的程度，才有六七八九的区别。如果用得不合其道，那么不仅有毒的药有毒，无毒的药也有毒了。）用谷肉果菜，食疗来尽除余邪，不要过度，以免损伤正气。（……按语：此言食物虽无毒，但如果超过节制，也能损伤正气。《脏气法时论》说：“毒药攻邪，五谷为养，五果为助，五畜为益，五菜为充。”大概说人对于食物，只要能使气血充足即可，千万不要过节以害正气。）必须首先考虑当年的岁气，不要破坏天和（按语：岁有南北之殊，气有六步之分，每当一岁，必求其气之所主而谨奉之，欲治病者，当以岁气为先也。若背时乱气，妄为施治，是谓伐天之和，必致盛盛虚虚，致邪失正，医者所当深戒者也），不要使实证更实，不要使虚证更虚，从而给人带来夭折的灾殃，不要导致邪气盛，不要使正气失，断绝人的长命。（按语：盛者指邪气盛，虚者指正气虚。邪盛了却遽然施补益，则盛者愈盛；正虚了却仍然攻击，则虚者愈虚。致邪失正，使人夭丧，这怪谁呢？注解说：不察虚实，只想着攻击，而盛者转盛，虚者转虚，万端之病，从此加重，也是一种解释。）
黄帝说：那些久病的人，气机已经平顺不再亢逆，病邪已去却身体消瘦虚弱，怎么办？（按语：帝问久病之人，病已去而气已平，乃瘠弱无力，如何治之。）岐伯说：圣人问得真明白啊！造化之功不可代替，四时之序不可违背。（化指造化。代大匠斫，犹伤其手，何况造化之气，人能以力代之乎。夫生长收藏，各应四时之化，虽智巧者亦无能先时而致之，明非人力所及。由此观之，则物之生长收藏，必待其时也；物之成败理乱，亦待其时也。物既有之，人亦宜然。或言力必可致而能代造化、违四时者，妄也。按语：人之生也，气本乎天，形养于地。顺天之时，因地之利，何病能侵。惟不能顺天地之气，于是乎病，而且病至于久矣。幸而病去气从，然其形体自必瘠弱，精神自必衰耗。躁妄之人，每求速愈，纵恣口腹，气力稍充，或近房色，旋至复发而死者，比比然也。岂知造化有消长之期，四时有衰旺之序，苟非安心静守，焉能一旦复元，养之和之，静以待时，真病后之良箴哉！）经络通畅，血气顺行，恢复其不足，与众人齐同，调养和谐，静待时机，谨守其气，不让它倾覆移易，其形体才能彰显，生气得以增长，这就叫圣王。所以大要说：不要代替造化，不要违背四时，必须调养和谐，等待其恢复。说的就是这个道理。黄帝说：好！（大要，上古经法也。引古之要旨，以明时化之不可违，不可以力代也。）
The term "Bu" (Distribution) refers to Qi spreading throughout the body; the term "Zhong" (End) refers to the dissipation of Qi transformation. When Qi exists, life continues; when Qi is exhausted, death occurs. Between Heaven and Earth, there is only one Qi.) However, the nourishment derived from the Five Flavors varies in thickness and density during generation and transformation, and maturity differs in quantity. The beginning and end are not the same; what is the reason for this? Qibo said: This is controlled by Earthly Qi. It is not that Heaven does not generate, but that Earth does not grow. (Commentary: The generation of humans and all things indeed takes Heavenly Qi as its beginning and end, but the physical body of living beings actually relies on Earthly Qi for growth and nourishment. Therefore, generation and transformation belong to Heaven. Where Heavenly Qi reaches, it should theoretically be uniform, yet differences in thickness, density, and quantity exist. This is not because Heaven's generation of things differs, but likely due to differences in Earth's conditions for growth and nourishment. The following text explains the principle of Earth not growing.) The Emperor said: I wish to hear the principle behind this. Qibo said: The transformations of Cold, Heat, Dryness, and Moisture are different. (By citing the differences among the Four Qi, the transformations of Warmth and Coolness can be inferred.) Thus, when Shaoyang (Ministerial Fire) is in the Lower Heaven (governing the latter half of the year), cold toxins do not grow; the flavor is Pungent; treatment utilizes Bitter and Sour flavors; the corresponding grains are Green and Red. (This pertains to the Qi transformation of Si-Hai years. "Toxin" refers to the excessive and violent Qi of any of the Five Elements. Now, Fire resides in the Earth, its Qi being intensely hot. Cold toxin substances have a nature distinct from the Earthly Qi, leading to different outcomes in life and death, hence they grow rarely. Fire controls Metal Qi, so Pungent-flavored substances do not transform easily. Shaoyang Qi offers itself to Jueyin (Wind-Wood), so the annual transformation manifests as Bitter and Sour flavors. Among the Six Qi governing the year, only this year is harmonious, with Wood and Fire supporting each other, thus there is no Inter-qi. Bitter and Red are transformed by Earthly Qi; Sour and Green are generated by Heavenly Qi. For other years, generation and transformation involve mutual overcoming and restriction between Upper and Lower, hence there are always Inter-qi.) When Yangming (Dryness-Metal) is in the Lower Heaven, damp toxins do not grow; the flavor is Sour; the Qi is Damp; (Commentary: Xin Zhengjiao states, "Upon detailed examination of the Lower Heaven, only in Yangming and Taiyin years is it stated 'its Qi is Damp' or 'its Qi is Hot,' presumably because the characteristics of Dryness/Dampness obscure the signs of Cold/Warmth, hence the Qi is reiterated."; treatment utilizes Pungent, Bitter, and Sweet flavors; the corresponding grains are Red and White. (This pertains to the Qi transformation of Zi-Wu years. Dryness resides in the Earth, its Qi being cool and clear, hence damp-warm toxins undergo little generation and transformation. Metal and Wood mutually restrain each other, so Sour-flavored substances transform less. Yangming Qi offers itself to Shaoyin (Dominant Fire), so the annual transformation manifests as Pungent and Bitter flavors. Pungent and White belong to Earthly Qi; Bitter and Red belong to Heavenly Qi. Sweet is the Inter-qi, used to mediate the overcoming between Metal and Fire, hence Sweet is also treated.) When Taiyang (Cold-Water) is in the Lower Heaven, heat toxins do not grow; the flavor is Bitter; treatment utilizes Bland and Salty flavors; the corresponding grains are Black and Yellow. (This pertains to the Qi transformation of Chou-Wei years. Cold resides in the Earth, distinct from Heat, hence heat toxins do not grow in the products of this year. Water overcomes Fire, so Bitter-flavored substances do not transform. Taiyang Qi offers itself to Taiyin (Damp-Earth), so the annual transformation manifests as Bland and Salty flavors. Taiyin Earth Qi rises to Heaven, being distant and high, so the transformation of Sweet becomes thin and manifests as Bland. Thus, Bland also belongs to Sweet, being a category of Sweet. Bland and Black represent Heavenly transformation; Salty and Yellow represent Earthly transformation. Yellow refers to yellow color. Commentary: Ju sounds like "Ju," referring to black millet.) When Jueyin (Wind-Wood) is in the Lower Heaven, cool toxins do not grow; the flavor is Sweet; treatment utilizes Sour and Bitter flavors; the corresponding grains are Green and Red. (This pertains to the Qi transformation of Yin-Shen years. Warmth resides in the Earth, distinct from Coolness, hence cool toxins do not grow in the products of this year. Wood overcomes Earth, so Sweet-flavored substances transform less. Jueyin Qi combines with Shaoyang (Ministerial Fire); since the combined Qi has no conflict, its treatment and transformation manifest as Sour and Bitter flavors. Sour and Green are Earthly transformations; Bitter and Red are Heavenly transformations. With no mutual overcoming, there is no Inter-qi, relying instead on Sweet transformation.) The Qi is specialized, and the flavor is pure. (In years where Jueyin or Shaoyang is in the Lower Heaven, the Qi transformation is unified and the flavor is pure. However, in other years, there are overcoming and restricting Qi between Upper and Lower, hence there are Inter-qi and Inter-flavors.) When Shaoyin (Dominant Fire) is in the Lower Heaven, cold toxins do not grow; the flavor is Pungent; treatment utilizes Pungent, Bitter, and Sweet flavors; the corresponding grains are White and Red. (This pertains to the Qi transformation of Mao-You years. Heat resides in the Earth, distinct from Cold, hence cold toxins are minimal in the medicines of this year. Fire Qi melts Metal, so Pungent-flavored substances transform less. Shaoyin and Yangming govern Heaven and Earth respectively, so their treatment involves Bitter and Pungent flavors. Bitter and Red are nurtured by Earthly Qi; Pungent and White are generated by Heavenly Qi. Sweet is the Inter-qi, used to inhibit and suppress.) When Taiyin (Damp-Earth) is in the Lower Heaven, dry toxins do not grow; the flavor is Salty; the Qi is Hot; treatment utilizes Sweet and Salty flavors; the corresponding grains are Black and Yellow. (This pertains to the Qi transformation of Chen-Xu years. There is Dampness in the Earth, distinct from Dryness, hence dry toxins do not undergo generation and transformation. Earth is controlled by Wood, so Salty-flavored substances transform less. Taiyin Qi receives support from Taiyang (Cold-Water), so the annual transformation manifests as Sweet and Salty flavors. Sweet and Black are Earthly transformations; Salty and Yellow are Heavenly transformations. Cold and Damp do not cause major conflict, hence the Inter-qi is the same and responds to the Hot Qi.)
When transformation is mellow, Salty flavor remains stable; when Qi is specialized, Pungent flavor transforms and both are governed together. (Mellow means harmonious. "Transformation is mellow" refers to the year of Shaoyang in the Lower Heaven, where Fire resides in the position of Water but still promotes nurturing; thus, the Salty nature of Water guards itself without competing with Fire for transformation. "Qi is specialized" refers to the year of Jueyin in the Lower Heaven, where Wood resides in the position of Water and further transforms downward; Metal is not harmed, so Pungent flavor regenerates and flourishes alongside Salty. Only in these two years is there no suspicion of mutual overcoming between Upper and Lower Qi, allowing Pungent to respond with Salty and flourish together. In other years, changes of overcoming and restriction occur between Upper and Lower, hence Sweet flavor mediates to缓 (slow down/relax) the suppression. The other three flavors—Bitter, Salty, and Sour—do not share the same generation and transformation. Therefore, among drugs between Heaven and Earth, those with Pungent and Sweet flavors are numerous.)
Therefore it is said: To tonify disorders of the Upper and Lower, follow (conform to) the Qi; to treat disorders of the Upper and Lower, oppose (counteract) the Qi; regulate based on the excess or deficiency of Cold and Heat in the respective locations. (Upper refers to Si Tian [Heavenly Qi governing the first half of the year], Lower refers to Zai Quan [Earthly Qi governing the second half of the year]. If Si Tian or Zai Quan Qi is in excess, treat by opposing the flavor; if deficient, treat by conforming to the flavor. "Follow" means conformity.) Treat by taking from above or below, internally or externally, to seek the source of the excess. Those who can tolerate toxicity use strong/concentrated medicine; those who cannot tolerate toxicity use weak/thin medicine. This is the principle. (Taking from above means using medicine to control excessive Qi; if control fails and causes rebellion, induce vomiting. Taking from below means using rapid medicine to remove diseases in the lower part; if attack fails, purge downwards. Internal taking refers to oral administration of food and medicine, regulating based on Cold and Heat. External taking refers to applying medicinal heat packs to the affected area to adjust Qi. For Cold turning into Heat, regulate with cold; for Heat turning into Cold, regulate with warm. If Upper excess persists, vomit to expel; if Lower excess persists, purge to reduce. This is seeking the method to address Qi excess. Concentrated vs. thin medicine refers to the strength of flavor and Qi. Commentary: Xin Zhengjiao states, "Jia Yi Jing says: Those with thick stomach, dark complexion, large bones, and fleshy bodies can tolerate toxicity; those who are thin with weak stomachs cannot. Also, Yi Fa Fang Yi Lun says: People in the West live in hilly areas, exposed to much wind, with hard water and soil, wearing coarse cloth, eating rich foods, and becoming fatty; thus pathogens cannot harm their form, their diseases arise internally, and treatment should utilize toxic medicines." Although the preceding paragraphs start with "Therefore it is said," seemingly connecting to the previous text, they discuss methods of treating disease and prescribing medicine, which is completely different in meaning from the preceding text. Hence, one record is kept while the other is discarded. "Neng" (can) implies endurance.)
For reversed Qi patterns: If the disease is in the Upper, take from the Lower; if in the Lower, take from the Upper; if in the Middle, take from the sides. (Commentary: This decomposes the method of seeking the disease. "Reversed Qi" refers to cases where Cold appears as Heat, Heat appears as Cold, Excess appears as Deficiency, and Deficiency appears as Excess. For example, if Yang floats upward, causing Qi surging and Fire rising, the disease seems to be in the Upper; but if one does not realize this is caused by Yin Deficiency failing to anchor Yang, then methods of Tonifying Yin to match Yang or gathering Fire to return to its source should be used. Similarly, if diarrhea and dysentery flow downward incessantly, the disease seems to be in the Lower; but if one does not realize this is caused by Qi Deficiency sinking, then formulas like Sheng Yang Yi Wei (Raise Yang and Benefit Stomach) or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi) should be applied. Moreover, the Spleen and Stomach reside in the center of the Five Viscera. Distension, acid regurgitation, vomiting, or diarrhea are all diseases of the Center. The Center corresponds to Earth. When Earth is controlled by Wood, disease occurs. Distension is Wood stagnation closing Qi; acid regurgitation is Wood strength causing Fire blazing; vomiting and diarrhea are Wood excess overwhelming Spleen and Stomach. All are diseases of the Spleen and Stomach, caused by Wood. Wood corresponds to Liver and Gallbladder; treatments for Liver and Gallbladder focus on the hypochondrium. Therefore, to treat diseases of the Center, one should target the sides. Wang Bing's commentary is plausible-sounding but incorrect; it is corrected here.)
Treat Heat with Cold, but administer warm; treat Cold with Heat, but administer cool; treat Warmth with Clearing, but administer cold; treat Coolness with Warming, but administer hot. (Commentary: This details the principles of medication. Disease conditions most fear mutual irritation. One must guide using properties similar to the Qi to avoid harsh rejection and non-penetration. Treating Heat with Cold is correct. However, administering cold medicine coldly to a heat patient causes irritation. Therefore, using warmth (similar to Heat) to guide the cold medicine allows it to penetrate, and the heat disease recedes gradually without irritation. The rest follows similarly. The first four sentences describe disease Qi and drug nature; the last four describe the appropriate temperature for ingestion. Wang Bing's commentary is incomprehensible.)
Thus, methods of dispersing, restraining, inducing vomiting, purging, tonifying, and draining are the same for both chronic and acute diseases. (Apply methods according to the excess or deficiency of Qi; the newness or chronicity of the disease does not change the approach.)
The Emperor said: What if the disease is in the Middle Jiao, neither solid nor firm, and gathers and scatters intermittently? How should it be treated? Qibo said: You ask very thoroughly! For conditions without accumulation, investigate the Zang organs. If deficient, tonify them. Use medicine to dispel pathogens, and food to follow up. Perform diuresis/water-moving techniques. Harmonize the interior and exterior, and the condition can be resolved. (Commentary: The Emperor asks about the middle chest and abdomen, appearing有形 (having form) but lacking definite structure. Qibo states that pathological accumulations are usually solid and unscattered. Since this case is otherwise, it is not an accumulation. Accumulations are Zang diseases; Zang deficiency with Qi stagnation mimics excess but is actually empty. The method should be tonification. However, using only tonification without accompanying promoting and unblocking agents will make intermittent gathering/scattering slow to resolve. Thus, after tonifying, one must also dispel (e.g., moving Qi and Blood). "Following" means food should also combine tonification and promotion, avoiding overly rich/greasy foods, hence "following the medicine." Water-moving techniques were mentioned previously.)
The Emperor said: Regarding toxic and non-toxic medicines, is there a fixed dosage rule? (Commentary: "Yue" refers to number/limit.) Qibo said: Diseases vary in duration (new vs. old), prescriptions vary in size, and whether medicines are toxic or non-toxic, there are established standard protocols. (Commentary: Meaning there are indeed standard protocols.) When using highly toxic medicines to treat disease, stop when 60% of the disease is removed; (Lower-grade medicines, highest toxicity.) when using moderately toxic medicines, stop at 70%; (Middle-grade medicines, secondary toxicity.) when using slightly toxic medicines, stop at 80%; (Upper-grade medicines, lowest toxicity.) when using non-toxic medicines, stop at 90%. (Non-toxic medicines across Upper, Middle, and Lower grades are all considered "Neutral/Ping". Commentary: Extraordinary diseases require extraordinary medicines; thus, toxic medicines are used only as a last resort. The more toxic the medicine, the fewer diseases it treats. This is because common diseases are frequent while specific syndromes are rare. Using them appropriately leads to the differences of 60%, 70%, 80%, and 90%. If used improperly, even non-toxic medicines become toxic.) Use grains, meats, fruits, and vegetables to complete the dietary therapy and eliminate residual pathogenic factors. Do not exceed this limit, lest you damage Healthy Qi. (...Commentary: This states that although food is non-toxic, exceeding moderation can still damage Healthy Qi. Zang Qi Fa Shi Lun states: "Toxic medicines attack pathogens; five grains nourish; five fruits assist; five meats benefit; five vegetables fill." This means food should merely nourish Qi and Blood sufficiently; one must never overindulge and harm Healthy Qi.) First consider the Annual Qi, do not violate the Harmony of Heaven. (Commentary: Years differ in North/South; Qi divides into six steps. Each year, one must seek the dominant Qi and respect it. Those treating disease should prioritize Annual Qi. Violating seasonal and chaotic Qi and treating arbitrarily is called violating the Harmony of Heaven, inevitably leading to reinforcing Excess and weakening Deficiency, causing Pathogen to prevail and Healthy Qi to fail. Physicians should deeply beware of this.) Do not reinforce Excess, do not weaken Deficiency, thereby sparing people from premature death. Do not cause Pathogen to prevail, do not let Healthy Qi fail, cutting off people's long life. (Commentary: "Excess" refers to Pathogen Excess; "Deficiency" refers to Healthy Qi Deficiency. If Pathogen is excessive and one suddenly applies tonification, Excess becomes more excessive. If Healthy Qi is deficient and one continues attacking, Deficiency becomes more deficient. Causing Pathogen to prevail and Healthy Qi to fail leads to premature death; who is to blame? The commentary suggests: Not examining Excess/Deficiency, but only thinking of attacking, makes Excess more excessive and Deficiency more deficient, worsening myriad diseases. This is another interpretation.)
The Emperor said: For those with chronic diseases, whose Qi has returned to peace and illness has passed, yet they remain emaciated and weak, how should this be managed? (Commentary: The Emperor asks about chronic patients whose illness has passed and Qi has stabilized, yet they remain frail and weak. How to treat?) Qibo said: Indeed, your question reveals sagacity! Transformation (of nature) cannot be substituted, and the timing of seasons cannot be violated. (Transformation refers to Creation/Nature. Attempting to substitute for a master carpenter may injure one's hands; how much more so for the Qi of Creation, can human effort substitute for it? Growth, flourishing, harvesting, and storage each correspond to the transformations of the Four Seasons. Even the wise and clever cannot bring them forward in time; clearly, this is beyond human power. From this, we see that the growth and storage of things depend on their time; the success/failure and order/chaos of things also depend on time. Since things operate this way, humans should too. Those who claim force can achieve substitution for Creation or violation of seasons are deluded. Commentary: Human life originates from Heavenly Qi and is nourished by Earthly Form. Following Heavenly Time and utilizing Earthly Benefits, what disease could invade? Only by failing to follow the Qi of Heaven and Earth does one fall ill, and eventually chronically. Fortunately, once the illness passes and Qi returns to harmony, the body naturally becomes emaciated and spirit depleted. Impulsive people often seek quick recovery, indulging their appetites until strength briefly returns, or engaging in sexual activity, only to relapse and die frequently. Do they not know that Creation has periods of waxing and waning, and seasons have sequences of decline and prosperity? Without peaceful quietude, how can one recover overnight? Nourishing and harmonizing, waiting quietly for the time, is truly the best advice for post-illness recovery.) When meridians are unblocked and Qi and Blood flow smoothly, restoring insufficiency to match the general population, through nourishment and harmony, waiting quietly for the time, guarding the Qi carefully so it does not collapse or shift, the physical form will become robust, and Vital Qi will grow. This is called the Sage King. Therefore, the Great Summary states: Do not substitute for Transformation, do not violate the Seasons; must nourish and harmonize, wait for recovery. This is what is meant. The Emperor said: Excellent! (Da Yao refers to ancient canonical laws. Citing ancient essential principles to clarify that seasonal transformations cannot be violated nor substituted by force.)