六节脏象者,谓天以六节成岁,而人之脏腑与之相应也。然细阅之,通篇约分七段∶首三段,俱言节气。
第四段,言五气更立,各有所胜,所胜则微,所不胜则甚,所谓病因时变,为本篇之要旨,医家之纲领也。第
五段,言天生五味以养人,而人得之以化精液。第六段,言五脏之象,而并解六腑之妙用,与五脏相应,总
取决于胆。末段言脉太盛则为关格,启玄云“物不可以久盛,极则衰败”,是矣。
黄帝问曰∶余闻天以六六之节以成一岁,人以九九制会,计人亦有三百六十五节以为天地,久矣。不知其
所谓也?(按∶六六之节以成一岁,其义易明,不必更赘。九九制会,注言“九周于九野之数,以制人形之
会通”,误矣。按本篇后又言地以九九制会,方是九州九野之义。然人所谓九九制会者,以数而言也。夫天地
之数,起于一,终于十,数之成也。执其成而不能变,则数穷矣。是故虚其一而九焉,则数变;又复从而九其
九焉,则数愈变。是六六之节,虽为天地一定之数。然而气盈六日,朔虚六日,一岁之中,人则因其盈虚之数,
通其变而会于原,于是五岁再闰焉。由是言之,一定不易者天地也,变化无穷者人也。易曰∶“参天两地而倚
数。”又曰∶“财成天地之化而不过,曲成万物而不遗。”非人无由矣。节谓骨节,惟人与天地合德,故其骨
节亦与天地之数相符也。然止应三百六十
而余其五者,此以盈而变,亦犹九九之数以其虚而能变也。按此节之下,注言“九九制会,气之数也”,是
启玄亦知其为数矣,何自相背谬乃尔乎。)岐伯对曰∶昭乎哉问也!请遂言之。夫六六之节、九九制会者,
所以正天之度,气之数也。(六六之节,天之度也。九九制会,气之数也。所谓气数者,生成之气也。周天之
分,凡三百六十五度四分度之一,以十二节气均之,则岁有三百六十日而终,兼以小月日,又不足其数矣,是
以六十四气而常置闰焉。何者?以其积差分故也。天地之生育,本址于阴阳,人神之运为,始终于九气,九
之为用,岂不大哉!律书曰∶“黄钟之律,管长九寸,冬至之日,气应灰飞。”由此则万物之生,咸因于九气
矣。古之九寸,即今之七寸二分,大小不同,以其先 黍之制而有异也。)天度者,所以制日月之行也;气数
者,所以纪化生之用也。(制谓准度,纪谓纲纪。准日月之行度者,所以明日月之行迟速也;纪化生之为用者,
所以彰气至而斯应也。气应无差,则生成之理不替;迟速以度,而大小之月生焉。按∶天虽至广不可度矣,然
而盈虚消息之理,弦望晦朔之期,行有躔次,蚀有分钞,总不离乎数。数之所至,气即至焉,故曰气数。气
数分明,天度虽玄,燎若指掌矣。)天为阳,地为阴;日为阳,月为阴;行有分纪,周有道理。日行一度,
月行十三度而有奇焉。故大小月三百六十五日而成岁,积气余而盈闰矣。(日行迟,故昼夜行天之一度,而三
百六十五日一周天而犹有度之奇分矣。月行速,故昼夜行天之十三度余,而二十九日一周天也。言有奇者,
谓十三度外,复行十九分度之七,故云月行十三度而有奇也。礼义及汉律历志云,二十八宿及诸星皆从东而循
天西行,日月及五星皆从西而循天东行。今太史说云,并循天而东行,从东而西转也。诸历家说,月一日至四日,
月行最疾,日夜行十四度余;自五日至八日,行次疾,日夜行十三度余;自九日至十九日,其行迟,日夜行十
二度余;二十日至二十三日,行又小疾,日夜行十三度余;二十四日至晦日,行又大疾,日夜行十四度余。今
太史说月行之率;不如此矣,月
行有十五日前疾,有十五日后迟者;有十五日前迟,有十五日后疾者。大率一月四分之,而皆有迟疾。迟速之
度,固无常准矣。虽尔,终以二十七日,月行一周天,凡行三百六十一度。二十九日,日行二十九度,月行三百
八十七度,少七度而不及日也。至三十日,日复迁,计率至十三分之八,月方及日矣,此大尽之月也。大率其
计率至十三分日之半者,亦大尽法也。其计率至十三分日之五、之六而及日者,小尽之月也。故云大小月三百
六十五日而成岁也。正言之者,三百六十五日四分日之一,乃一岁法。以奇不成日,故举大以言之。若通以六小
为法,则岁止三百五十四日,岁少十一日余矣。取月所少之辰,加岁外余之日,故从闰后三十二日而盈闰焉。
尚书曰∶“期三百有六旬有六日,以闰月定四时成岁”,则其义也。积余盈闰者,盖以月之大小,不尽天度故
也。)立端于始,表正于中,推余于终,而天度毕矣。(端,首也。始,初也。表,彰示也。正,斗建也。
中,月半也。推,退位也。言立首气于初节之日,示斗建于月半之辰,退余闰于相望之后。是以闰之前,则气
不及月;闰之后,则月不及气。故常月之制,建初立中,闰月之纪,无初无中,纵历有之,皆他节气也。按∶
此天官家言,是正所谓人以九九制会也。)帝曰∶余已闻天度矣,愿闻气数何以合之?岐伯曰∶天以六六为节,
地以九九制会。(按∶首节言天以六六之节以成一岁,人以九九制会,指成岁盈闰言。言天虽有六六之节,必
赖人以九九之数推之,而后岁功成也。此则并言天地,言天有六六之节为一岁,地有九州九野而与天相应也。
王注竟无分别。)天有十日,日六竟而周甲,甲六复而终岁,三百六十日法也。(按∶此言每一岁之常数也。
若以盈虚言,则前言大小月三百六十五日而成岁,积气余而盈闰,与此不同矣。盈谓气盈,虚谓朔虚也。)夫
自古通天者,生之本,本于阴阳。其气九州九窍,皆通乎天气。(按∶此节无甚深义,注解殊觉支离。盖言天
以六六之节成于上,地以九州九野列于下,人则戴天履地而其气常与之相通也。)故其生五,其气三。(按∶
五,五脏,谓人具五
脏以生也。三,生气通天论注作天气、地气、运气,谓人在天地之中,必本其气以为气也。)三而成天,三而
成地,三而成人。(非唯人由三气以生,天地之道亦如是矣,故易乾坤诸卦皆必三矣。)三而三之,合则为九,
九分为九野,九野为九脏。(按∶九,九州,九野。尔雅云∶“邑外谓之郊,郊外谓之牧,牧外谓之野,野外
谓之林,林外谓之 。”王注所引多“郊外谓甸”,然亦止七野而缺其二焉。九野为九脏,犹言九脏应九野,
盖互文也。)故形脏四,神脏五,合为九脏以应之也。(按∶神脏五∶一肝,二心,三脾,四肺,五肾。五脏
藏神,如宣明五气篇及九针论所言是也。形脏四,三部九候论言“一头角,二耳目,三口齿,四胸中”,
是也。)
帝曰∶余已闻六六九九之会也,夫子言积气盈闰,愿闻何谓气?……岐伯曰∶五日谓之候,三候谓之气,
六气谓之时,四时谓之岁,而各从其主治焉。(按∶此言主治,盖谓一岁则以司天为主,一节则以主令为主,
而后为之施治也。)五运相袭而皆治之,终期之日,周而复始,时立气布,如环无端。候亦同法,故曰不知年
之所加,气之盛衰,虚实之所起,不可以为工矣。(按∶春木生夏火,火生长夏土,土生秋金,金生冬水,水
又生春木,是相袭也。皆治之,谓各主时行令也。时立气布,谓时当春则木气旺而生发之令行,时当夏则火气旺
而长养之令行之类是也。候亦同法,指治病者言,人与四时之气相应,亦当随时施治也。故曰以下,正言不能
候时以施治,则不得谓之医也。注与校正俱不明确。)帝曰∶五运之始,如环无端,其太过不及何如?岐伯曰∶
五气更立,各有所胜,盛虚之交,此其常也。……帝曰∶何谓所胜?岐伯曰∶春胜长夏,长夏胜冬,冬胜夏,
夏胜秋,秋胜春,所谓得五行时之胜,各以气命其脏,(长夏者,六月也。土生
于火,长在夏中,既长而旺,故云长夏也。以气命脏者,春之木内合肝,长夏土内合脾之类,故曰以气命其脏。
命,名也。)帝曰∶何以知其胜?岐伯曰∶求其至也,皆归始春。(始春谓立春之日也,春为四时之长,故
候气皆归于立春前之日也。)未至而至,此谓太过,则薄所不胜而乘所胜也,命曰气淫。……至而不至,此谓
不及,则所胜妄行,而所生受病,所不胜薄之也,命曰气迫。(凡气之至,皆谓立春前十五日,乃候之初也。
未至而至,谓所直之气,未应至而先期至也。先期而至,是气有余,故曰太过。至而不至,谓所直之气,应至
不至而后期至。后期而至,是气不足,故曰不及。凡五行之气,我克者为所胜,克我者为所不胜,生我者为所
生。假令肝木有余,是肺金不足,金不制木,故木太过。木气既余,则反薄肺金,而乘于脾土矣,故曰太过则
薄所不胜而乘所胜也。此皆五脏之气内相淫并为疾,故命曰气淫也。余太过例同。又如木气少不能制土,土气
无畏而遂妄行,水被土凌,故云所胜妄行而所生受病也。肝木之气不平,肺金之气自薄,故曰所不胜薄之。
然木气不平,土金交薄,相迫为疾,故曰气迫也。余不及例同。)所谓求其至者,气至之时也。(按∶气因时
而变,一岁有一岁之气,故占一岁之气于始春。一时有一时之气,又必随时而验其气。气有至有不至,则知太过
与不及,可因时而治病矣。此二句虽是申解皆归始春句意,却亦是言四时各有应至之气,不独始春为然也。)
谨候其时,气可与期,失时反候,五治不分,邪僻内生,工不能禁也。(按∶人之五脏,配合五行,外应四时,
病时不同,治法亦异,故云五治。)帝曰∶有不袭乎?(言五行之气,有不相承袭者乎?)岐伯曰∶苍天之气,
不得无常也。气之不袭,是谓非常,非常则变矣。(按∶天气清净,高远难名,洵非形迹之可求。然而春温
夏暑,秋凉冬寒,历今古而不易,谓之无常不得也。有如春应温而反寒,夏应暑而反凉,冬应寒而反温,秋应
凉而反热,四时之气,不相
承袭,则已非天之常道,灾害必由是而起,故下文即云变至则病也。)帝曰∶非常而变奈何?岐伯曰∶变至
则病,所胜则微,所不胜则甚,因而重感于邪则死矣。故非其时则微,当其时则甚也。(言苍天布气,尚不越
于五行;人在气中,岂不应于天道。按∶注此四语是矣,继云“假命木直之年,有火气至,后二岁病矣”等语,
恐未确。按变至则病,是根上文,言四时之气,既反其常,是天气变而人受病也。然病则病矣,其中又有微甚
之分焉。譬如木直之年,所能胜木者,金也。若人感不正之气,病在于肺,肺金也,金能平木,本不为害,虽
病亦微。所不能胜木而为木所克者,土也。若人感不正之气,病在脾胃,脾胃土也,土本畏木,木旺土虚,其
病必甚。病既甚矣,而或更感外邪,邪根据于肝,肝木愈盛,脾胃愈虚,虚不任邪,故不但病甚,而且必死也。
然此特就生克之常而论,若木直之岁,而人病于秋冬之时则病微,病于春夏之日则病甚者,秋非木旺之时故微,
春当木旺之时故甚也。变至则病一句是头;所胜所不胜三句,是说病之微甚,分于五行之相制;非其时二句,
则又以邪之衰旺本于时,而分病之微甚也。意各不同,注俱浑沦无别,且以后二三岁病为微,四五岁病为甚,
殊属荒唐。)帝曰∶善!余闻气合而有形,因变以正名。(按∶气不合则形不成,是故形生于气也;气不变
则病不生,是故病始于变也。正名者,病名于是正也。闵芝庆作正名论,论伤寒与类证。伤寒之名宜正,凡病
之名亦不可不正,可类推矣。)天地之运,阴阳之化,其于万物,孰少孰多,可得闻乎?岐伯曰∶悉哉问也!天
至广,不可度,地至大,不可量,大神灵问,请陈其方。草生五色,五色之变,不可胜视,草生五味,五味之美,
不可胜极。(言物生之众,禀化各殊,目视口味,尚无能尽之,况于人心,乃能包括耶。)嗜欲不同,各有所
通。(按∶人性多偏,故嗜欲亦异。)天食人以五气,地食人以五味。天以五气食人者,臊气凑肝,焦气凑心,
香气凑脾,
腥气凑肺,腐气凑肾也。地以五味食人者,酸味入肝,苦味入心,甘味入脾,辛味入肺,咸味入肾也。阴阳应
象论曰∶“阳为气,阴为味。”五气入鼻,藏于心肺,上使五色修明,音声能彰。五味入口,藏于肠胃,味有
所藏,以养五气。(心荣面色,肺主音声,故气藏于心肺,上使五色修洁分明,音声彰着。气为水母,故味
藏于肠胃,内养五气。按∶五气入鼻,无所不到,何独藏于心肺耶?盖心者血脏也,气由鼻入,先行本脏,而
后会于心而生血,惟生血,故能使五色修明也。肺者气龠也,鼻为肺窍,气由鼻入,会于肺而后颁布于各脏,
清浊于是乎分焉,惟能厘清浊,故使音声彰着也。谓之藏于心肺,宜矣。至于五味入口,藏于肠胃,而五脏之气
即借之以养者,盖人必具五脏以生,而五脏又必须五气而运。然非饮之食之,则五脏之气亦干槁而闭塞矣。是
“六节脏象”,是指天以六个节气阶段构成一年,而人的脏腑与之相应。然而仔细研读全文,大致可分为七段:前三段,都在讲述节气。
第四段,讲述五气(风、热、火、湿、燥、寒中的五行之气)轮流主事,各有其所克制的对象,被克制者则病轻,克制者则病重,这就是所谓的病因随时间变化,是本篇的要旨,也是医家的纲领。
第五段,讲述天生成五味来滋养人,人依靠五味化生精液。
第六段,讲述五脏的征象,并解释六腑的妙用,六腑与五脏相应,总取决于胆。
末段讲述脉象过于盛大则为关格(阴阳离决之危候),启玄子说:“事物不可能长久处于极盛状态,到了极点就会衰败”,这是正确的。
黄帝问道:我听说天以六六之数(三十六)为节律以构成一年,人以九九之数(八十一)来制定会通之法,计算人体也有三百六十五个骨节以对应天地,这已经很久了。不知道其中的含义是什么?(按语:六六之节构成一年,其意义容易明白,不必再赘述。关于“九九制会”,注释说“九周于九野之数,以制人形之会通”,这是错误的。按本篇后文又说地以九九制会,这才是九州九野的含义。然而人所说的九九制会,是从数理而言的。天地的数,起于一,终于十,这是数的完成。执着于完成的数而不能变化,那么数就穷尽了。所以虚去其一而为九,那么数就能变化;又进而将九乘以九,那么数就更善于变化。因此,六六之节,虽然是天地固定的数。然而气有余六日,朔月亏缺六日,一年之中,人便依据这些盈虚之数,通晓变化而归原,于是五年中设置两次闰月。由此说来,固定不变的是天地,变化无穷的是人。《易经》说:“参天两地而倚数。”又说:“裁成天地之道而不逾越,曲成万物而不遗漏。”如果不是人,是无法做到的。节指骨节,只有人与天地合德,所以他的骨节也与天地的数相符。然而只对应三百六十,而余下五个,这是以盈余而变化,也就像九九之数因其虚空而能变化一样。按此节之下,注释说“九九制会,气之数也”,这说明启玄子也知道这是数,为何自相矛盾如此呢?)岐伯回答说:问得真高明啊!请让我详细说说。所谓六六之节、九九制会,是用来端正天的度数和气的数量的。(六六之节,是天的度数。九九制会,是气的数量。所谓气数,是指生成之气。周天之分,共三百六十五度四分度之一,以十二节气平均分配,则岁有三百六十日结束,加上小月的天数,又不足这个数了,所以以六十四气常设闰月。为什么呢?因为积累差分的原因。天地生育,本基于阴阳,人神运作,始终在于九气,九的作用,难道不大吗!《律书》说:“黄钟之律,管长九寸,冬至之日,气应灰飞。”由此可知万物之生,都因于九气。古时的九寸,即现在的七寸二分,大小不同,是因为先以黍米为标准制作而有差异。)天的度数,是用来规范日月运行的;气的数量,是用来记录化生作用的。(制指准度,纪指纲纪。准度日月之行度,是为了明确日月运行的快慢;记录化生的作用,是为了彰显气至而相应的道理。气应无差错,则生成的原理不废;快慢以度数衡量,而生月的盈亏就产生了。按:天虽然极其广阔不可度量,然而盈虚消长的道理,弦望晦朔的日期,运行有躔次,蚀有分秒,总离不开数。数所到之处,气也就到了,所以说气数。气数分明,天的度数虽然玄妙,却像指掌一样清晰了。)天为阳,地为阴;日为阳,月为阴;运行有分界和纪限,周旋有道理。太阳每天运行一度,月亮每天运行十三度多一点。所以大月小月累计三百六十五日构成一年,积累气的余数而设置闰月。(太阳运行慢,所以昼夜运行天空的一度,而三百六十五天一周天还有度的零头。月亮运行快,所以昼夜运行天空的十三度多,而二十九天一周天。说有零头,是指在十三度之外,又运行十九分之七,所以说月亮运行十三度有余。《礼义》及《汉律历志》说,二十八宿及诸星都从东向西循天而行,日月及五星都从西向东循天而行。现在太史的说法是,都循天向东行,从东向西转。各历法家的说法,月亮一日至四日,运行最快,日夜运行十四度多;自五日至八日,运行次快,日夜运行十三度多;自九日至十九日,运行慢,日夜运行十二度多;二十日至二十三日,运行又稍快,日夜运行十三度多;二十四日至月末,运行又快,日夜运行十四度多。现在太史说的月亮运行规律,不像这样了,月亮运行有十五日前快,十五日后慢的;有十五日前慢,十五日后快的。大概一个月分为四部分,都有迟疾。迟速的度数,本来没有固定的标准。即使这样,最终以二十七天,月亮运行一周天,共运行三百六十一度。二十九天,太阳运行二十九度,月亮运行三百八十七度,少七度而不及太阳。到三十天,太阳又迁移,计算速率到十三分之八,月亮才赶上太阳,这是大尽之月。大概计算速率到十三分之半的,也是大尽的方法。计算速率到十三分之五、六而赶上太阳的,是小尽之月。所以说大小月三百六十五日构成一年。正言之,三百六十五天四分之一,乃一年的法则。因为零头不成日,所以举大的来说。如果通以六个月为法,则岁止三百五十四天,岁少十一天多了。取月亮所少的时辰,加在岁外余下的日子,所以从闰后三十二天而满闰。《尚书》说:“期三百有六旬有六日,以闰月定四时成岁”,就是这个意思。积累余数满闰,是因为月亮的大小,不能尽合天度。)在开始确立开端,在中间表正,在末尾推算余数,而天的度数就完备了。(端,首也。始,初也。表,彰示也。正,斗建也。中,月半也。推,退位也。意思是立春之初节之日确立首气,示斗建于月半之辰,退余闰于相望之后。因此闰之前,则气不及月;闰之后,则月不及气。所以常月的制度,建立初一和月中,闰月的纪年,没有初一和月中,纵历法中有,都是其他节气。按:这是天官家的说法,正是所谓人以九九制会。)皇帝说:我已经知道了天的度数,希望知道气的数量如何与之结合?岐伯说:天以六六为节,地以九九制会。(按:首节说天以六六之节以成一岁,人以九九制会,指成岁盈闰而言。说天虽有六六之节,必赖人以九九之数推之,而后岁功成。这里则是并言天地,说天有六六之节为一岁,地有九州九野而与天相应。王注竟然没有分别。)天有十日,日六竟而周甲,甲六复而终岁,三百六十日法也。(按:这是说每一岁的常数。如果以盈虚而言,则前文说大小月三百六十五日而成岁,积气余而盈闰,与此不同了。盈谓气盈,虚谓朔虚也。)自古通天者,生命的根本,根本在于阴阳。其气贯通九州九窍,都与天气相通。(按:此节无甚深义,注解殊觉支离。大概是说天以六六之节成于上,地以九州九野列于下,人则戴天履地而其气常与之相通。)所以人生成于五(五行/五脏),其气分为三。(按:五,指五脏,谓人具五脏以生。三,生气通天论注作天气、地气、运气,谓人在天地之中,必本其气以为气也。)三而成天,三而成地,三而成人。(不仅人由三气以生,天地之道也是如此,所以《易》乾坤诸卦皆必三。)三而三之,合则为九,九分为九野,九野为九脏。(按:九,九州,九野。《尔雅》云:“邑外谓之郊,郊外谓之牧,牧外谓之野,野外谓之林,林外谓之 。”王注所引多“郊外谓甸”,但也只止七野而缺其二。九野为九脏,犹言九脏应九野,盖互文也。)所以形脏四,神脏五,合为九脏以应之。(按:神脏五:一肝,二心,三脾,四肺,五肾。五脏藏神,如宣明五气篇及九针论所言是也。形脏四,《三部九候论》言“一头角,二耳目,三口齿,四胸中”,是也。)
皇帝说:我已经知道了六六九九之会,先生讲积气盈闰,希望知道什么叫气?……岐伯说:五日谓之候,三候谓之气,六气谓之时,四时谓之岁,而各从其主治焉。(按:此言主治,大概谓一岁则以司天为主,一节则以主令为主,而后为之施治。)五运相袭而皆治之,终期之日,周而复始,时立气布,如环无端。候亦同法,所以说不知道年之所加,气之盛衰,虚实之所起,不可以为医生。(按:春木生夏火,火生长夏土,土生秋金,金生冬水,水又生春木,是相袭也。皆治之,谓各主时行令也。时立气布,谓时当春则木气旺而生发之令行,时当夏则火气旺而长养之令行之类是也。候亦同法,指治病者言,人与四时之气相应,亦当随时施治也。故曰以下,正言不能候时以施治,则不得谓之医也。注与校正俱不明确。)皇帝说:五运之始,如环无端,其太过不及如何?岐伯说:五气更立,各有所胜,盛虚之交,此其常也。……皇帝说:什么叫所胜?岐伯说:春胜长夏,长夏胜冬,冬胜夏,夏胜秋,秋胜春,所谓得五行时之胜,各以气命其脏,(长夏者,六月也。土生于火,长在夏中,既长而旺,故云长夏也。以气命脏者,春之木内合肝,长夏土内合脾之类,故曰以气命其脏。命,名也。)皇帝说:怎么知道其胜?岐伯说:求其至也,皆归始春。(始春谓立春之日也,春为四时之长,故候气皆归于立春前之日也。)未至而至,此谓太过,则薄所不胜而乘所胜也,命曰气淫。……至而不至,此谓不及,则所胜妄行,而所生受病,所不胜薄之也,命曰气迫。(凡气之至,皆谓立春前十五日,乃候之初也。未至而至,谓所直之气,未应至而先期至也。先期而至,是气有余,故曰太过。至而不至,谓所直之气,应至不至而后期至。后期而至,是气不足,故曰不及。凡五行之气,我克者为所胜,克我者为所不胜,生我者为所生。假令肝木有余,是肺金不足,金不制木,故木太过。木气既余,则反薄肺金,而乘于脾土矣,故曰太过则薄所不胜而乘所胜也。此皆五脏之气内相淫并为疾,故命曰气淫也。余太过例同。又如木气少不能制土,土气无畏而遂妄行,水被土凌,故云所胜妄行而所生受病也。肝木之气不平,肺金之气自薄,故曰所不胜薄之。然木气不平,土金交薄,相迫为疾,故曰气迫也。余不及例同。)所谓求其至者,气至之时也。(按:气因时而变,一岁有一岁之气,故占一岁之气于始春。一时有一时之气,又必随时而验其气。气有至有不至,则知太过与不及,可因时而治病矣。此二句虽是申解皆归始春句意,却亦是言四时各有应至之气,不独始春为然也。)谨慎等候其时,气可以与预期相符,失时反候,五治不分,邪僻内生,医生不能禁止。(按:人之五脏,配合五行,外应四时,病时不同,治法亦异,故云五治。)皇帝说:有不相承袭的吗?(言五行之气,有不相承袭者乎?)岐伯说:苍天之气,不得无常也。气之不袭,是谓非常,非常则变矣。(按:天气清净,高远难名,洵非形迹之可求。然而春温夏暑,秋凉冬寒,历今古而不易,谓之无常不得也。有如春应温而反寒,夏应暑而反凉,冬应寒而反温,秋应凉而反热,四时之气,不相承袭,则已非天之常道,灾害必由是而起,故下文即云变至则病也。)皇帝说:非常而变如何?岐伯说:变至则病,所胜则微,所不胜则甚,因而重感于邪则死矣。故非其时则微,当其时则甚也。(言苍天布气,尚不越于五行;人在气中,岂不应于天道。按:注此四语是矣,继云“假命木直之年,有火气至,后二岁病矣”等语,恐未确。按变至则病,是根上文,言四时之气,既反其常,是天气变而人受病也。然病则病矣,其中又有微甚之分焉。譬如木直之年,所能胜木者,金也。若人感不正之气,病在于肺,肺金也,金能平木,本不为害,虽病亦微。所不能胜木而为木所克者,土也。若人感不正之气,病在脾胃,脾胃土也,土本畏木,木旺土虚,其病必甚。病既甚矣,而或更感外邪,邪根据于肝,肝木愈盛,脾胃愈虚,虚不任邪,故不但病甚,而且必死也。然此特就生克之常而论,若木直之岁,而人病于秋冬之时则病微,病于春夏之日则病甚者,秋非木旺之时故微,春当木旺之时故甚也。变至则病一句是头;所胜所不胜三句,是说病之微甚,分于五行之相制;非其时二句,则又以邪之衰旺本于时,而分病之微甚也。意各不同,注俱浑沦无别,且以后二三岁病为微,四五岁病为甚,殊属荒唐。)皇帝说:好!我听说气合而有形,因变以正名。(按:气不合则形不成,是故形生于气也;气不变则病不生,是故病始于变也。正名者,病名于是正也。闵芝庆作正名论,论伤寒与类证。伤寒之名宜正,凡病之名亦不可不正,可类推矣。)天地之运,阴阳之化,其于万物,孰少孰多,可得闻乎?岐伯说:问得详尽啊!天至广,不可度,地至大,不可量,大神灵问,请陈其方。草生五色,五色之变,不可胜视,草生五味,五味之美,不可胜极。(言物生之众,禀化各殊,目视口味,尚无能尽之,况于人心,乃能包括耶。)嗜欲不同,各有所通。(按:人性多偏,故嗜欲亦异。)天食人以五气,地食人以五味。天以五气食人者,臊气凑肝,焦气凑心,香气凑脾,腥气凑肺,腐气凑肾也。地以五味食人者,酸味入肝,苦味入心,甘味入脾,辛味入肺,咸味入肾也。《阴阳应象论》曰:“阳为气,阴为味。”五气入鼻,藏于心肺,上使五色修明,音声能彰。五味入口,藏于肠胃,味有所藏,以养五气。(心荣面色,肺主音声,故气藏于心肺,上使五色修洁分明,音声彰着。气为水母,故味藏于肠胃,内养五气。按:五气入鼻,无所不到,何独藏于心肺耶?盖心者血脏也,气由鼻入,先行本脏,而后会于心而生血,惟生血,故能使五色修明也。肺者气龠也,鼻为肺窍,气由鼻入,会于肺而后颁布于各脏,清浊于是乎分焉,惟能厘清浊,故使音声彰着也。谓之藏于心肺,宜矣。至于五味入口,藏于肠胃,而五脏之气即借之以养者,盖人必具五脏以生,而五脏又必须五气而运。然非饮之食之,则五脏之气亦干槁而闭塞矣。是)
"Liu Jie Zang Xiang" (Six Solar Terms and Visceral Manifestations) refers to the heaven forming a year through six solar term stages, while the human viscera correspond to it. However, upon careful reading of the entire passage, it can be roughly divided into seven sections: the first three sections all discuss solar terms.
The fourth section discusses the five Qi (Wu Qi, the energies of the Five Phases) taking turns in authority, each having what it overcomes; what is overcome becomes mild, what overcomes becomes severe. This is what is meant by etiology changing with time, which is the main purport of this chapter and the guideline for physicians.
The fifth section discusses how Heaven generates the Five Flavors (Wu Wei) to nourish humans, and humans rely on them to transform into Essence and Fluids (Jing Ye).
The sixth section discusses the manifestations of the Five Zang Organs (Wu Zang), and explains the subtle functions of the Six Fu Organs (Liu Fu), which correspond to the Five Zang Organs, ultimately depending on the Gallbladder (Dan).
The final section discusses that when the pulse is excessively vigorous, it leads to Guan Ge (Guan-Ge syndrome, a critical condition of Yin-Yang separation); Qixuanzi said, "Things cannot remain in extreme prosperity for long; when they reach the limit, they decline." This is correct.
The Yellow Emperor asked: I have heard that Heaven uses the cycle of six-six (36) as a rhythm to form a year, and humans use the cycle of nine-nine (81) to establish correspondence. It has been calculated that the human body also has 365 bone joints to correspond to Heaven and Earth. I have known this for a long time but do not understand its meaning. [Commentary: The meaning of six-six forming a year is easy to understand and needs no further elaboration. Regarding "nine-nine establishing correspondence," the annotation states "Nine cycles through the number of the Nine Fields to regulate the convergence of human form," which is incorrect. According to the latter part of this chapter, it says Earth uses nine-nine to establish correspondence, which refers to the Nine Provinces and Nine Fields. However, what humans mean by nine-nine establishing correspondence is from the perspective of numbers. The numbers of Heaven and Earth start from one and end at ten, representing the completion of numbers. If one clings to the completed number without change, the number reaches its limit. Therefore, by leaving one empty to make nine, the number changes; furthermore, multiplying nine by nine makes the number even more variable. Thus, although six-six is a fixed number of Heaven and Earth, there are six surplus days of Qi and six deficient days of the new moon. Within a year, humans follow these surplus and deficient numbers, understanding change to return to the origin, thus setting two leap months every five years. From this we see: what is fixed and unchanging is Heaven and Earth, while what changes infinitely is humanity. The *I Ching* says: "Relying on the numbers of Heaven and Earth." It also says: "Completing the transformations of Heaven and Earth without excess, shaping all things without omission." Without humanity, this would not be possible. 'Jie' refers to bone joints. Only when humans possess virtue in harmony with Heaven and Earth do their bone joints correspond to the numbers of Heaven and Earth. However, they only correspond to 360, leaving five remaining. This is change through surplus, just as the number nine can change due to its emptiness. Below this section, the annotation says "Nine-nine establishing correspondence is the number of Qi," indicating that Qixuanzi knew it was a number. Why is he so self-contradictory?]
Boqi replied: What an insightful question! Let me explain. The concepts of six-six as rhythm and nine-nine as correspondence are used to rectify the degrees of Heaven and the count of Qi. [Six-six as rhythm is the degree of Heaven. Nine-nine as correspondence is the count of Qi. What is meant by the count of Qi is the generating Qi. The division of the celestial sphere is 365 and 1/4 degrees. Divided equally by twelve solar terms, a year ends at 360 days. Adding the days of small months, it falls short of this number. Therefore, leap months are often set based on sixty-four Qi. Why? Because of accumulated differences. The generation and nurturing of Heaven and Earth are fundamentally based on Yin and Yang. The movement of human spirit begins and ends with the Nine Qi. Is not the function of Nine great! The *Book of Rhythms* says: "The pitch pipe of Huangzhong is nine cun long. On the day of Winter Solstice, the Qi responds with ash flying." From this, we see that the birth of all things depends on the Nine Qi. Ancient nine cun is equivalent to modern 7.2 cun; the difference in size arises from the ancient standard using millet grains.] The degree of Heaven is used to regulate the movement of the Sun and Moon; the count of Qi is used to record the function of transformation and generation. [Regulate means to measure accurately; Record means to govern. Measuring the movement of the Sun and Moon clarifies their speed; Recording the function of transformation and generation manifests the arrival of Qi and its response. If Qi response has no error, the principle of generation does not cease; measuring speed and slowness allows the waxing and waning of months to arise. Commentary: Although Heaven is extremely vast and immeasurable, the principles of waxing/waning and increasing/decreasing, the dates of quarters/full moons/new moons, the movements have specific paths, eclipses have specific degrees, all inseparable from numbers. Where numbers reach, Qi arrives, hence called the count of Qi. When the count of Qi is clear, even if the degree of Heaven is profound, it is as clear as looking at one's palm.] Heaven is Yang, Earth is Yin; Sun is Yang, Moon is Yin; movements have divisions and limits, rotations have principles. The Sun moves one degree per day, while the Moon moves thirteen degrees and a fraction. Thus, large and small months accumulate to 365 days to form a year, accumulating Qi surplus to create leap months. [The Sun moves slowly, traversing one degree of the sky daily, completing a circle in 365 days plus a fraction. The Moon moves fast, traversing over thirteen degrees daily, completing a circle in 29 days. "Fraction" means beyond thirteen degrees, it travels another 7/19ths of a degree. *Li Yi* and *Han Lü Li Zhi* state that the Twenty-Eight Mansions and stars move westward along the sky from east to west, while the Sun, Moon, and five planets move eastward along the sky from west to east. The current Grand Historian's theory states they all move eastward along the sky, turning from east to west. Various calendar experts say: From day 1 to 4, the Moon moves fastest, over 14 degrees daily; from day 5 to 8, next fastest, over 13 degrees daily; from day 9 to 19, slowest, over 12 degrees daily; from day 20 to 23, slightly faster, over 13 degrees daily; from day 24 to month-end, fastest again, over 14 degrees daily. The current Grand Historian's theory differs: the Moon's motion has acceleration 15 days before full moon and deceleration 15 days after; or deceleration 15 days before and acceleration 15 days after. Generally, the month is divided into four parts, all having varying speeds. The degrees of speed are not constant. Nevertheless, finally, in 27 days, the Moon completes a circle, traveling 361 degrees. In 29 days, the Sun travels 29 degrees, the Moon travels 387 degrees, falling short of the Sun by 7 degrees. By day 30, the Sun shifts again; calculating the rate to 8/13ths, the Moon catches up to the Sun, which is a "Great Full" month. Generally, calculating to half of 13/13 is also Great Full method. Calculating to 5/13 or 6/13 to catch the Sun is a "Small Full" month. Hence, large and small months of 365 days form a year. Strictly speaking, 365 and 1/4 days is the annual law. Since fractions do not make a full day, the larger number is cited. If calculated by six small months, the year is only 354 days, short by over 11 days. Taking the missing time of the Moon and adding the surplus days outside the year, leap months fill up after 32 days. The *Book of Documents* says: "A period of 366 days, determining the four seasons with leap months to complete the year," which is the meaning. Accumulating surplus to fill leaps is because the size of the Moon does not fully match the Heavenly degrees.] Establish the beginning at the start, show correctness in the middle, deduce surplus at the end, and the degrees of Heaven are complete. [Duan means head/start. Shi means beginning. Biao means manifest/show. Zheng means Dipper construction (position of Big Dipper). Zhong means mid-month. Tui means retreat/position. It means establishing the first Qi on the day of the initial solar term, showing the Dipper position at mid-month, retreating surplus leap months after the full moon. Thus, before the leap month, Qi does not reach the Moon; after the leap month, the Moon does not reach Qi. Therefore, the system of normal months establishes the beginning and middle; the record of leap months has no beginning or middle. Even if calendars mention them, they refer to other solar terms. Commentary: This is the language of astronomers, precisely what is meant by humans using nine-nine to establish correspondence.]
The Emperor said: I have heard of the degrees of Heaven. I wish to hear how the count of Qi combines with it.
Boqi said: Heaven uses six-six as rhythm, Earth uses nine-nine to establish correspondence. [Commentary: The first section said Heaven uses six-six to form a year, humans use nine-nine to establish correspondence, referring to the accumulation of surplus and leap months. It means although Heaven has six-six rhythm, it relies on humans using nine-nine numbers to deduce it, so the work of the year is completed. Here, Heaven and Earth are discussed together: Heaven has six-six rhythm for a year, Earth has Nine Provinces/Nine Fields corresponding to Heaven. Wang Bing's annotation fails to distinguish this.] Heaven has Ten Heavenly Stems. Six cycles complete a Jia (60-year cycle), and six repetitions complete a year, following the 360-day method. [Commentary: This refers to the constant number of each year. If discussing surplus and deficiency, it differs from the previous statement about 365 days and leap months. Surplus refers to Qi surplus, deficiency refers to New Moon deficiency.] Since antiquity, those who connect with Heaven regard life as fundamental, rooted in Yin and Yang. Their Qi connects through the Nine Provinces and Nine Orifices, all communicating with Heavenly Qi. [Commentary: This section has little deep meaning; annotations seem fragmented. It likely means Heaven forms above with six-six rhythm, Earth arranges below with Nine Provinces/Nine Fields, and humans, wearing Heaven and treading Earth, have Qi constantly communicating with it.] Thus, life generates from Five (Five Elements/Five Zang), and its Qi divides into Three. [Commentary: Five refers to Five Zang Organs, meaning humans are born with Five Zang. Three refers to Heavenly Qi, Earthly Qi, and Transporting Qi, as noted in *Sheng Qi Tong Tian Lun*, meaning humans within Heaven and Earth must base their Qi on these.] Three combine to form Heaven, three combine to form Earth, three combine to form Humanity. [Not only does humanity arise from three Qi, but the Way of Heaven and Earth is also like this; thus, the hexagrams Qian and Kun in the *I Ching* must involve three.] Three multiplied by three equals nine. Nine divides into Nine Fields, and Nine Fields correspond to Nine Zang. [Commentary: Nine refers to Nine Provinces, Nine Fields. *Erya* says: "Outside the city is Jiao, outside Jiao is Mu, outside Mu is Ye, outside Ye is Lin, outside Lin is ..." Wang Bing's citation mostly mentions "outside Jiao is Dian," but stops at seven fields, missing two. Nine Fields corresponding to Nine Zang means Nine Zang correspond to Nine Fields, an intertextual reference.] Thus, there are Four Form Zang and Five Spirit Zang, combining to form Nine Zang to correspond. [Commentary: Five Spirit Zang: 1 Liver, 2 Heart, 3 Spleen, 4 Lung, 5 Kidney. Five Zang store Spirit, as stated in *Xuan Ming Wu Qi Pian* and *Jiu Zhen Lun*. Four Form Zang: *San Bu Jiu Hou Lun* mentions "1 Head/Horns, 2 Eyes/Ears, 3 Mouth/Teeth, 4 Chest/Middle," which is correct.]
The Emperor said: I have heard of the meeting of six-six and nine-nine. You mentioned accumulating Qi to fill leaps. I wish to know what is meant by Qi? ...
Boqi said: Five days are called a Hou (Climate/Term), three Hou constitute a Qi (Solar Term), six Qi constitute a Shi (Season), and four Shi constitute a Year, each following its governing authority. [Commentary: Governing authority here likely means the Sovereign Qi (Si Tian) governs the year, and the Dominant Qi (Zhu Ling) governs the solar term, guiding treatment thereafter.] The Five Movements (Wu Yun) succeed each other and all govern, reaching the end of the period, cycling endlessly. Seasons are established, Qi is distributed, like a ring without end. Hou follows the same law. Therefore, it is said: One cannot be a physician without knowing the addition of the year, the flourishing and declining of Qi, and the origin of deficiency and excess. [Commentary: Spring Wood generates Summer Fire, Summer Fire generates Late Summer Earth, Earth generates Autumn Metal, Metal generates Winter Water, Water generates Spring Wood again; this is succession. "All govern" means each rules its season. "Seasons established, Qi distributed" means when it is Spring, Wood Qi is prosperous and the command of growth acts; when Summer, Fire Qi is prosperous and the command of nurturing acts. "Hou follows the same law" refers to healers: humans correspond to the Qi of four seasons and should treat according to time. Thus, below this, it correctly states that failing to wait for the appropriate time to treat disqualifies one as a physician. Annotations and corrections are unclear.]
The Emperor said: The beginning of the Five Movements is like a ring without end. How are excess and deficiency?
Boqi said: The Five Qi take turns standing, each having what it overcomes. The intersection of prosperity and deficiency is the norm. ...
The Emperor said: What is meant by "what it overcomes"?
Boqi said: Spring overcomes Late Summer, Late Summer overcomes Winter, Winter overcomes Summer, Summer overcomes Autumn, Autumn overcomes Spring. This is obtaining the victory of the Five Phases in time, naming each Zang according to Qi. [Late Summer is the sixth month. Earth is born from Fire, grows in mid-Summer, and becomes prosperous after growing, hence Late Summer. Naming Zang by Qi means Spring Wood internally corresponds to Liver, Late Summer Earth internally corresponds to Spleen, etc., hence "naming Zang by Qi." Ming means name.]
The Emperor said: How do we know the victory?
Boqi said: Seek its arrival; all return to Early Spring. [Early Spring refers to the day of Start of Spring. Spring is the leader of the four seasons, so awaiting Qi all returns to the days before Start of Spring.]
If it arrives before its time, this is called Excess (Tai Guo). It will encroach upon what it cannot overcome and ride upon what it overcomes, named Qi Yin (Qi Indulgence). ...
If it arrives late, this is called Deficiency (Bu Ji). Then what it overacts runs wild, what it generates suffers disease, and what overcomes it encroaches upon it, named Qi Po (Qi Oppression). [All arrivals of Qi refer to 15 days before Start of Spring, the beginning of Hou. "Arriving before time" means the direct Qi arrives early when it should not. Arriving early means Qi is surplus, hence Excess. "Arriving late" means the direct Qi arrives late when it should. Arriving late means Qi is insufficient, hence Deficiency. Of the Five Phases Qi: what I overcome is what I overcome (Suo Sheng); what overcomes me is what overcomes me (Suo Bu Sheng); what generates me is what generates me. Suppose Liver Wood is excessive, then Lung Metal is deficient. Metal does not control Wood, so Wood is excessive. Since Wood Qi is surplus, it encroaches upon Lung Metal and rides upon Spleen Earth. Hence, "Excess encroaches upon what it cannot overcome and rides upon what it overcomes." These are diseases caused by internal mutual indulgence of Five Zang Qi, hence named Qi Yin. Other cases of Excess are similar. Again, if Wood Qi is weak and cannot control Earth, Earth Qi, fearing nothing, runs wild. Water is oppressed by Earth, hence "what it overacts runs wild and what it generates suffers." Liver Wood Qi is uneven, Lung Metal Qi naturally encroaches, hence "what overcomes me encroaches." However, since Wood Qi is uneven, Earth and Metal mutually encroach, oppressing each other causing disease, hence Qi Po. Other cases of Deficiency are similar.]
What is meant by seeking its arrival is the time of Qi arrival. [Commentary: Qi changes with time. A year has a year's Qi, so one predicts a year's Qi at Early Spring. A season has a season's Qi, so one must verify Qi at any time. If Qi arrives or does not arrive, one knows Excess and Deficiency and can treat according to time. These two sentences explain "all return to Early Spring" but also state that each of the four seasons has its proper Qi, not just Early Spring.]
Closely await its time, and Qi can be expected. Losing time and reversing Hou, failing to distinguish the Five Treatments, evil deviations arise internally, and physicians cannot prevent them. [Commentary: Human Five Zang correspond to Five Phases and externally respond to four seasons. Diseases differ by time, treatments differ, hence "Five Treatments."]
The Emperor said: Is there non-succession? (Meaning: Is there Five Phase Qi that does not succeed each other?)
Boqi said: The Qi of Blue Heaven cannot be without constancy. Non-succession of Qi is called Abnormality. Abnormality leads to Change. [Commentary: Heavenly Qi is pure, high, distant, and hard to name, truly not seekable by traces. However, Spring Warmth, Summer Heat, Autumn Coolness, Winter Cold have not changed throughout history; calling it non-constant is impossible. If Spring should be warm but is cold, Summer should be hot but is cool, Winter should be cold but is warm, Autumn should be cool but is hot, the Qi of four seasons does not succeed each other, violating the constant Way of Heaven, disasters must arise from this, hence the following text says "Change arriving causes disease."]
The Emperor said: How does Abnormality and Change occur?
Boqi said: When Change arrives, disease occurs. What is overcome is mild, what overcomes is severe. If additionally heavily affected by Evil, death ensues. Hence, if not at its time, it is mild; if at its time, it is severe. [Commentary: Blue Heaven distributes Qi, not exceeding Five Phases; humans in Qi, should they not respond to Heavenly Way? Commentary: These four words are correct. Subsequent statements like "Suppose in a Mu Zhi year, Fire Qi arrives, disease occurs two years later" are likely inaccurate. "Change arriving causes disease" roots from above: Qi of four seasons reverses normalcy, Heavenly Qi changes and humans suffer disease. But although disease occurs, there is distinction between mild and severe. For example, in a Mu Zhi year, what can overcome Wood is Metal. If humans contract abnormal Qi, disease is in Lung (Metal). Metal can level Wood, originally harmless, though diseased, it is mild. What cannot overcome Wood and is overcome by Wood is Earth. If humans contract abnormal Qi, disease is in Spleen/Stomach (Earth). Earth fears Wood; Wood prosperous, Earth deficient, disease must be severe. If disease is severe, and external Evil is contracted again, Evil bases on Liver, Liver Wood becomes stronger, Spleen/Stomach weaker. Deficiency cannot bear Evil, hence not only severe disease, but certain death. However, this specifically argues from the constant of generation/overcoming. If in a Mu Zhi year, humans fall ill in Autumn/Winter, disease is mild; in Spring/Summer, disease is severe. Autumn is not Wood-prosperous time, hence mild; Spring is Wood-prosperous time, hence severe. "Change arriving causes disease" is the header; "What is overcome/mild, what overcomes/severe" three sentences explain severity based on Five Phase restriction; "Not at its time/mild, at its time/severe" two sentences explain severity based on Evil's waxing/waning originating from time. Meanings differ, annotations are confused, and claiming disease in 2nd-3rd year is mild, 4th-5th year severe, is absurd.]
The Emperor said: Excellent! I have heard Qi combines to form Form, and names are corrected due to Change. [Commentary: If Qi does not combine, Form does not form; thus Form is born from Qi. If Qi does not change, Disease does not arise; thus Disease starts from Change. Correcting names means disease names are thereby rectified. Min Ziqing wrote *Zheng Ming Lun*, discussing Shang Han and related syndromes. The name Shang Han should be rectified; names of all diseases should not be unrectified, which can be inferred.]
The movement of Heaven and Earth, the transformation of Yin and Yang, regarding all things, which is less and which is more, may I hear?
Boqi said: Your question is thorough! Heaven is extremely vast, immeasurable; Earth is extremely large, unmeasurable. Great Divine Spirit asks, please let me state the method. Grasses grow in five colors; changes of five colors cannot be fully seen. Grasses grow with five flavors; beauty of five flavors cannot be fully exhausted. [Commentary: Things born are numerous, endowed transformations differ. Eyes seeing and taste testing still cannot exhaust them, let alone the human mind encompassing them.] Desires and preferences differ, each having its connection. [Commentary: Human nature is mostly biased, so desires differ too.] Heaven feeds humans with Five Qi, Earth feeds humans with Five Flavors. Heaven feeding humans with Five Qi: Sour smell gathers in Liver, Scorched smell gathers in Heart, Fragrant smell gathers in Spleen, Fishy smell gathers in Lung, Putrid smell gathers in Kidney. Earth feeding humans with Five Flavors: Sour flavor enters Liver, Bitter flavor enters Heart, Sweet flavor enters Spleen, Pungent flavor enters Lung, Salty flavor enters Kidney. *Yin Yang Ying Xiang Lun* says: "Yang is Qi, Yin is Flavor." Five Qi enter the nose, store in Heart and Lung, above making five colors bright and voice distinct. Five Flavors enter the mouth, store in intestines and stomach, flavors stored to nourish Five Qi. [Heart nourishes facial color, Lung governs voice, so Qi storing in Heart/Lung above makes five colors bright/clear and voice distinct. Qi is mother of Water, so Flavor stores in intestines/stomach, internally nourishing Five Qi. Commentary: Five Qi entering nose go everywhere, why only store in Heart/Lung? Heart is Blood organ. Qi enters nose, first goes to its own organ, then meets Heart to generate Blood. Only by generating Blood can it make five colors bright. Lung is Qi bellows, Nose is Lung orifice. Qi enters nose, meets Lung then distributes to all organs, Clear and Turbid are separated here. Only by separating Clear/Turbid can it make voice distinct. Calling it storing in Heart/Lung is appropriate. As for Five Flavors entering mouth, storing in intestines/stomach, and Five Zang Qi borrowing it to nourish themselves: Humans must have Five Zang to live, and Five Zang must have Five Qi to operate. However, without drinking and eating, Five Zang Qi would wither and close. This is...]