春气西行夏气北行。秋气东行。冬气南行(近东者先受春气。渐次及西近南者。先受夏
气。
渐次及北。近西者先受秋气。渐次及东。近北者先受冬气渐次及南)故春气始于下(由下而升
)秋气始于上(由上而降)故至高之地冬气常在(高山之巅夏月凝雪)至下之地春气常在(卑下之
泽。冬月草生)
发表不远热。攻里不远寒(发表利用热。夏月发表不远热也。攻里利用寒。冬月攻里不
远寒
也。以发表攻里之品。不留于中而有所宜也)不发不攻寒热内贼。其病益甚(不以发攻而犯
寒犯热。故病益甚。若无病而犯寒犯热。则生寒生热)
木郁达之(郁。怫也。木性发达。治则升之令其条达)火郁发之(火性发越。治则散之令
其发
越)土郁夺之(土性疏通。故宜夺之)金郁泄之(金性清利。故宜泄之)水郁折之(水性就下。故
折之令其无冲逆也)然调其气。过者折之以其畏也。所谓泻之(上文详其。五郁之治。因言既
治之必调其气。而复有过而不调者。则折之以其所畏折之之义。即所谓泻之也。畏者。木畏
酸。火畏甘。土畏苦。金畏辛。水畏咸也。)
六气分治司天地者。其至何如。曰。厥阴司天(巳亥之年)其化以风(木气化风)少阴司天
(子
午之年)其化以热(少阴君火化热)太阴司天(丑未之年)其化以湿(土气化湿)少阳司天(寅申之
年)其化以火(少阳相火也其化畏火)阳明司天(卯酉之年)其化以燥(金气化燥)太阳司天(辰戊
之年)其化以寒(水气化寒)以所临藏位命其病者也(王注肝木位东。心火位南。脾土位中央及
四维。肺金位西。肾水位北。是五脏定位然五运即六气所至。气相得则和不相得则病故先以
六气所临。后言五脏之病也)地化奈何(地化在泉之化也。)曰。司天同候(言天气既迁。地气
用事。因藏位而命其病。皆与司天候法同)间气皆然(间气用事。因藏位而命其病。皆与司天
候法同)司左司右者。是谓间气也(岁有六气。以一气司天。一气在泉。余四气一为司天左间
。一为右间。一为在泉左间。一为右间也。五营运大论。左右者。诸上见厥阴。左少阴右太
阳。见少阴。左太阴。右厥阴。见太阴。左少阳。右少阴。见少阳。左阳明。右太阴。见阳
明。左太阳右少阳。见太阳。左厥阴。右阳明。所谓面北而命其位 厥阴在上。则少阳在下
。左阳明。右太阴。少阴在上。则阳明在下。左太阳。右少阳。太阴在上。则太阳在下。左
厥阴。右阳明。少阳在上。则厥阴在下。左少阴。右太阳。阳明在上。则少阴在下。左太阴
。右厥阴。太阳在上。则太阴在下。左少阳。右少阴。所谓面南而命其位○上主司天。位在
南。故面北而言其左右。左主西言右主东言下主在泉。位在北故面南而言其左右。左主东言
。右主西言。上下异而左右殊也)
诸气在泉。风淫于内(言自外而淫于内也)治以辛凉(金胜木气)佐以苦甘(辛过甚。恐伤
其气
故佐以苦胜辛。甘益气也)以甘缓之。以辛散之(木性急故宜甘缓辛散)热淫于内。治以咸寒(
君火之气。水能胜之)佐以甘苦(甘胜咸苦泻热)以酸收之。以苦发之(热盛于经宜酸收。热结
于内宜苦发)湿淫于内。治以苦热(湿为土气。苦热从火化。能燥湿也)佐以酸淡(酸能制土。
淡能利窍)以苦燥之以淡泄之(湿热宜苦燥。湿濡而肿宜淡泄。泄。渗与汗也)火淫于内。治
以咸冷。佐以苦辛(吴注相火。畏火也。故以咸苦辛泻热而滋阴水)以酸收之。以苦发之(义
与上文热淫条同)燥淫。于内治以苦温(燥为金气。苦温从火化。所以胜金气)佐以甘辛(木受
金伤。宜甘缓辛散)以苦下之(燥结邪实宜以苦下之)寒淫于内。治以甘热(寒为水气。甘从土化
热从火化。所以制水胜寒)佐以苦辛(苦而辛。亦热品也)以咸泻之(水之正味。咸泻之也)以
辛润之。以苦坚之(肾苦燥。急食辛以润之。肾欲坚急食苦以坚之。即此之义)
司天之气风淫所胜。平以辛凉。佐以苦甘。以甘缓之。以酸泻之(木气升而不降。故以
)热淫所胜。平以咸寒。佐以苦甘。以酸收之(收其浮热。)湿淫所胜。平以苦热佐以酸辛(酸
而辛。则非饮矣)以苦燥之。以淡泄之。湿上甚而热。治以苦温(燥湿)佐以甘(益土)辛(散滞
)以汗为故而止(得汗则湿外泄)燥淫所胜。平以苦湿(苦而湿。则燥得其润)佐以酸(生液)辛
。(润燥)以苦下之(燥甚非攻下不除)寒淫所胜平以辛(散寒)热(回阳)佐以苦甘(济和辛热)以
咸泻之(伤寒大胃则为里热者。宜以咸泻之○李频湖曰。司天主上半年。天气司之。故六淫
谓之所胜。上淫于下也。故曰平之在泉主下半年。地气司之。故六淫谓之于内。外淫于内也
。故曰治之。当其时反得胜已之气者。谓之反胜六气之胜。何以征之如燥胜则地干。暑胜则
地热风胜则地动。湿胜则地泥。寒胜则地裂。火胜则地固是也)
春不沉夏不弦。冬不涩秋不数。是为四塞(春弦。夏数秋涩。冬沉。脉之常也。若春至
沉脉
。尽去。夏至弦脉尽去。冬至涩脉尽去秋至数脉尽去。已虽专王。而绝去其母气矣。是谓四
塞五脏不相交通也)参见曰病。复见曰病。未去而去曰病去而不去曰病(一部之中参见诸脉状
。此乘侮交至也既见于本部复见于他部。此淫气太过也。未去而去为本气不足。来气有余。
去而不去为本气有余。来气不足)反者死(反谓春脉涩。夏脉沉。秋脉数。冬脉缓。反见胜已
之脉。故死)
诸风掉眩。皆属于肝(风类不一。故曰诸风掉摇。眩运也)诸寒收引皆属于肾(收敛。引
急也
。肾主寒水之化。凡阳气不达。则营卫凝聚。形体拘挛)诸气 (音愤)郁皆属于肺( 。喘急
。郁不畅也)诸湿肿满。皆属于脾(肿者。肿于外。满者。满于中。痞胀是也)诸热瞀螈(抽掣
)
皆属于火。诸痛痒疮。皆属于心(热甚则疮痛热微则疮痒心属火化热。故疮疡属于心也)诸厥
固泄皆属于下(厥。逆也。固溲便闭也。泄。溲便不禁也。下谓肾也。肾居五脏下。兼水火
之司阴精衰则火独治而有热厥。命门衰。则水独治而有寒厥。肾开窍于二阴。其水亏火盛。
则精液干枯为热结。阴虚则无气。致清浊不化为寒闭。肾家水衰。则火迫注遗为热泄。命门
火衰。则阳虚失禁为寒泄)诸痿(萎同)喘呕皆属于上(肺主气。肺热叶。焦则手足无以受气。
故
有筋痿肉痿脉痿骨痿诸症。息气急曰喘。病在肺。声逆上曰。呕病在胃口故皆上焦之病)诸
禁鼓栗如丧神守。皆属于火(禁作噤切牙也。鼓。鼓颔也栗战也。神能御形谓之神守禁鼓栗
而神不能支持。如丧失神守。皆火之病。若心火亢极。反兼水化制之。故为寒栗者火之实也
若阴胜则为寒。寒则真气去。去则虚。虚则寒搏于皮肤之间者。火之虚也○疟气之发。阳并
于阴。则阴实而阳虚。阳明虚。则寒栗鼓喘。又伤寒将解。其人本虚。邪与正争而为战汗故
凡战栗者。皆阴阳之争也)诸痉项强皆属于湿(痉。风强病也。此湿甚而兼风木之化)诸逆冲
上皆属于火(火性炎上)诸胀腹大。皆属于热(热气内盛者。在肺则胀于上。在脾胃则胀于中
。在肝肾则胀于下。此以火邪所至。乃为烦满也)诸躁狂越皆属于火(躁。烦躁。狂狂乱。越
乘越也。火入于肺则烦。火入于肾则躁。然气交变大论曰。岁水太过寒气流行□害心火。身
热烦心。阴厥谑妄之类。是为阴盛发躁成无已曰。虽躁欲坐井中。但欲水。不得入口是也)
诸暴强直皆属于风(暴猝也。强直筋病强劲也)诸病有声(肠鸣)鼓之如鼓(鼓胀)皆属于热(为
阳气所逆。故属于热)诸病 肿疼酸惊骇皆属于火(浮肿者。阳实于外。火在经也。疼酸者。
火甚制金不能平木。木实作酸也。惊骇者。君火甚也)诸转反戾。水液混浊。皆属于热(木胜
协火。则筋引急。或偏引之。则为转为反而乖戾于常。水液。小便也)诸病水液澄澈清冷。
皆属于寒(水液。上下所出水液也)诸呕吐酸(火炎上也)暴注下迫皆属于热(肠胃热。则传化
失常。故猝暴注泄。下迫。后重里急迫痛也。)
寒者热之。热者寒之(此正治也)微者逆之。甚者从之 逆者正治(以寒治热。以热治寒
逆其
病者。谓之正治)从者反治(以寒治寒。以热治热从其病者。谓之反治)从少从多。观其事也(
从少。谓一同而二异从多。谓二同而一异)热因寒用(热药冷服)寒因热用(寒药热服)塞因塞
用(如下气虚乏。中焦气壅。欲散满则益虚其下。补下则满甚于中。而先攻其满。药入或减
。药过依然乃不知少服则资壅。多服则宣通。疏启其中。峻补其下。下虚既实。中满自除)
通因通用(如大热内蓄。注泄不止。以寒下之寒积久泄以热下之)必伏其所主。而先其所因(
以上四治必隐伏其所主。而先求其病之由。是为反治也)论言治寒以热治热以寒。而方士不
能废绳墨而更其道也。有病热者。寒之而热(言以苦寒治热。而热如故)有病寒者。热之而寒
(言以辛热治寒。而寒如故)二者皆在新病复起。奈何治日。诸寒之而热者。取之阴(补阴以
配其
阳。则阴气复而热自退)热之而寒者。取之阳(补水中之火。则阳气复而寒自消)所谓求其属
也服寒而反热服热而反寒。其故何也。曰。治其旺气。是以反也(如治火旺用苦寒降阴则
火愈盛。如治阴旺。用辛温耗气。则寒愈盛此皆专治旺气。故其病反如此)不治旺而然者何
也。曰。不治五味属也。夫五味入胃。各归所喜攻。酸先入肝。苦先入心。甘先入脾。辛先
入肺。咸先入肾。久而增气。物化之常也。气增而久。夭之由也(五味各入其所属如偏用久
而增气此物化之常。气增。不已。则藏有偏胜而有偏绝矣。如生气通天论曰。味过于酸。肝
气以津。脾气乃绝味过于咸大骨气劳。短肌心气抑。味过于甘。心气喘满色黑。肾气不衡。
味过于苦。脾气不濡胃气乃浓味过于辛筋脉阻。)
春气向西运行，夏气向北运行，秋气向东运行，冬气向南运行。（靠近东方的地区先受到春气的影响，逐渐波及西方；靠近南方的地区先受到夏气的影响，逐渐波及北方；靠近西方的地区先受到秋气的影响，逐渐波及东方；靠近北方的地区先受到冬气的影响，逐渐波及南方。）所以春气从下方开始（由下向上升发），秋气从上方开始（由上向下沉降）。因此，极高之地冬季寒气常在（高山之巅，即使在夏季也有积雪）；极低之地春季暖气常在（低洼沼泽，即使在冬季也有草生长）。
发表（使用解表法发散邪气）不远离热性环境或药物，攻里（使用泻下法清除里实）不远离寒性环境或药物。（发表利用热性，夏季发表不远离热性；攻里利用寒性，冬季攻里不远离寒性。这是因为发表和攻里的药物，如果不留滞于中焦而有所适宜的话……）如果不进行发表或攻里，反而触犯寒热之邪，病情就会加重。（如果不通过发表攻里来治疗，反而犯寒犯热，所以病情加重。如果没有病而犯寒犯热，就会产生寒热病症。）
木郁结者，疏导它（郁，即怫郁。木性喜发达，治疗原则是升发使其条达）。火郁结者，发散它（火性炎上发越，治疗原则是疏散使其发越）。土郁结者，夺去它（土性喜疏通，所以宜用夺法）。金郁结者，泄利它（金性清肃通利，所以宜用泄法）。水郁结者，折抑它（水性就下，所以折抑它使其无冲逆之患）。然而要调畅气机，对于过盛的病气，要用它所畏惧的方法折抑它，这就是所谓的“泻”法。（上文详细论述了五郁的治疗方法，接着说既然治疗了，必须调畅气机，如果还有过盛而未调畅的，就用它所畏惧的方法来折抑，折抑的含义，就是所谓的泻法。所谓“畏”，是指木畏酸，火畏甘，土畏苦，金畏辛，水畏咸。）
六气分治，司天在地的变化是怎样的？回答说：厥阴风木司天（巳亥之年），其气化表现为风（木气化风）；少阴君火司天（子午之年），其气化表现为热（少阴君火化热）；太阴湿土司天（丑未之年），其气化表现为湿（土气化湿）；少阳相火司天（寅申之年），其气化表现为火（少阳相火，其气化畏惧火）；阳明燥金司天（卯酉之年），其气化表现为燥（金气化燥）；太阳寒水司天（辰戌之年），其气化表现为寒（水气化寒）。根据所临脏腑之位来命名疾病。（王冰注：肝木位属东方，心火位属南方，脾土位属中央及四维，肺金位属西方，肾水位属北方。这是五脏的定位。然而五运即六气所至，气相得则和平，不相得则生病，所以先讲六气所临，后讲五脏之病。）地气（在泉之气）的变化如何？回答说：与司天相同候象（言天气既迁，地气用事，因脏腑之位而命名疾病，都与司天的候法相同）。间气也是如此（间气用事，因脏腑之位而命名疾病，都与司天的候法相同）。司左司右的，称为间气（一年有六气，以一气司天，一气在泉，其余四气一为司天左间，一为右间，一为在泉左间，一为右间。《五营运大论》记载：左右者，诸上见厥阴，左少阴右太阳；见少阴，左太阴右厥阴；见太阴，左少阳右少阴；见少阳，左阳明右太阴；见阳明，左太阳右少阳；见太阳，左厥阴右阳明。所谓面北而命其位：厥阴在上，则少阳在下，左阳明，右太阴；少阴在上，则阳明在下，左太阳，右少阳；太阴在上，则太阳在下，左厥阴，右阳明；少阳在上，则厥阴在下，左少阴，右太阳；阳明在上，则少阴在下，左太阴，右厥阴；太阳在上，则太阴在下，左少阳，右少阴。所谓面南而命其位：上主司天，位在南，故面北而言其左右；左主西言右主东；下主在泉，位在北，故面南而言其左右，左主东言，右主西言。上下异而左右殊也）。
诸气在泉，风淫溢于内（言自外而淫于内），治以辛凉（金胜木气），佐以苦甘（辛过甚，恐伤其气，故佐以苦胜辛，甘益气），以甘缓之，以辛散之（木性急，故宜甘缓辛散）。热淫溢于内，治以咸寒（君火之气，水能胜之），佐以甘苦（甘胜咸，苦泻热），以酸收之，以苦发之（热盛于经宜酸收，热结于内宜苦发）。湿淫溢于内，治以苦热（湿为土气，苦热从火化，能燥湿也），佐以酸淡（酸能制土，淡能利窍），以苦燥之，以淡泄之（湿热宜苦燥，湿濡而肿宜淡泄，泄，指渗利与汗出）。火淫溢于内，治以咸冷，佐以苦辛（吴注：相火，畏火也，故以咸苦辛泻热而滋阴水），以酸收之，以苦发之（义与上文热淫条同）。燥淫于内，治以苦温（燥为金气，苦温从火化，所以胜金气），佐以甘辛（木受金伤，宜甘缓辛散），以苦下之（燥结邪实宜以苦下之）。寒淫于内，治以甘热（寒为水气，甘从土化，热从火化，所以制水胜寒），佐以苦辛（苦而辛，亦热品也），以咸泻之（水之正味，咸泻之也），以辛润之，以苦坚之（肾苦燥，急食辛以润之；肾欲坚，急食苦以坚之，即此之义）。
司天之气，风淫所胜，平以辛凉，佐以苦甘，以甘缓之，以酸泻之（木气升而不降，故以……）。热淫所胜，平以咸寒，佐以苦甘，以酸收之（收其浮热）。湿淫所胜，平以苦热，佐以酸辛（酸而辛，则非饮矣），以苦燥之，以淡泄之。湿上甚而热，治以苦温（燥湿），佐以甘（益土）、辛（散滞），以汗为故而止（得汗则湿外泄）。燥淫所胜，平以苦湿（苦而湿，则燥得其润），佐以酸（生液）、辛（润燥），以苦下之（燥甚非攻下不除）。寒淫所胜，平以辛（散寒）、热（回阳），佐以苦甘（济和辛热），以咸泻之（伤寒大胃则为里热者，宜以咸泻之○李频湖曰：司天主上半年，天气司之，故六淫谓之所胜，上淫于下也，故曰平之；在泉主下半年，地气司之，故六淫谓之于内，外淫于内也，故曰治之。当其时反得胜已之气者，谓之反胜。六气之胜，何以征之？如燥胜则地干，暑胜则地热风，风胜则地动，湿胜则地泥，寒胜则地裂，火胜则地固，是也）。
春脉不沉，夏脉不弦，冬脉不涩，秋脉不数，是为四塞（春弦、夏数、秋涩、冬沉，是脉之常象。若春至现沉脉，夏至现弦脉，冬至现涩脉，秋至现数脉，尽去其本气，虽已专旺，而绝去其母气矣，是谓四塞，五脏不相交通也）。参见曰病，复见曰病，未去而去曰病，去而不去曰病（一部之中参见诸脉状，此乘侮交至也；既见于本部复见于他部，此淫气太过也；未去而去为本气不足，来气有余；去而不去为本气有余，来气不足）。反者死（反谓春脉涩，夏脉沉，秋脉数，冬脉缓，反见胜己之脉，故死）。
诸风掉眩，皆属于肝（风类不一，故曰诸风。掉摇，眩运也）。诸寒收引，皆属于肾（收敛，引急也。肾主寒水之化，凡阳气不达，则营卫凝聚，形体拘挛）。诸气𦶟郁，皆属于肺（𦶟，音愤，喘急，郁不畅也）。诸湿肿满，皆属于脾（肿者，肿于外；满者，满于中，痞胀是也）。诸热瞀瘛（抽掣），皆属于火。诸痛痒疮，皆属于心（热甚则疮痛，热微则疮痒。心属火化热，故疮疡属于心也）。诸厥固泄，皆属于下（厥，逆也；固，溲便闭也；泄，溲便不禁也。下谓肾也。肾居五脏下，兼水火之司。阴精衰则火独治而有热厥，命门衰则水独治而有寒厥。肾开窍于二阴，其水亏火盛，则精液干枯为热结；阴虚则无气，致清浊不化为寒闭。肾家水衰，则火迫注遗为热泄；命门火衰，则阳虚失禁为寒泄）。诸痿喘呕，皆属于上（肺主气，肺热叶焦则手足无以受气，故有筋痿、肉痿、脉痿、骨痿诸症。息气急曰喘，病在肺；声逆上曰呕，病在胃口，故皆上焦之病）。诸禁鼓栗，如丧神守，皆属于火（禁作噤切牙也。鼓，鼓颔也；栗，战也。神能御形谓之神守。禁鼓栗而神不能支持，如丧失神守，皆火之病。若心火亢极，反兼水化制之，故为寒栗者，火之实也。若阴胜则为寒，寒则真气去，去则虚，虚则寒搏于皮肤之间者，火之虚也○疟气之发，阳并于阴，则阴实而阳虚，阳明虚，则寒栗鼓颔。又伤寒将解，其人本虚，邪与正争而为战汗，故凡战栗者，皆阴阳之争也）。诸痉项强，皆属于湿（痉，风强病也。此湿甚而兼风木之化）。诸逆冲上，皆属于火（火性炎上）。诸胀腹大，皆属于热（热气内盛者，在肺则胀于上，在脾胃则胀于中，在肝肾则胀于下。此以火邪所至，乃为烦满也）。诸躁狂越，皆属于火（躁，烦躁；狂，狂乱；越，乘越也。火入于肺则烦，火入于肾则躁。然《气交变大论》曰：岁水太过，寒气流行，邪害心火，身热烦心，阴厥谑妄之类，是为阴盛发躁。成无己曰：虽躁欲坐井中，但欲水，不得入口是也）。诸暴强直，皆属于风（暴猝也。强直，筋病强劲也）。诸病有声（肠鸣），鼓之如鼓（鼓胀），皆属于热（为阳气所逆，故属于热）。诸病胕肿疼酸惊骇，皆属于火（浮肿者，阳实于外，火在经也。疼酸者，火甚制金不能平木，木实作酸也。惊骇者，君火甚也）。诸转反戾，水液混浊，皆属于热（木胜协火，则筋引急，或偏引之，则为转为反而乖戾于常。水液，小便也）。诸病水液澄澈清冷，皆属于寒（水液，上下所出水液也）。诸呕吐酸，暴注下迫，皆属于热（肠胃热，则传化失常，故猝暴注泄。下迫，后重里急迫痛也）。
寒者热之，热者寒之（此正治也）。微者逆之，甚者从之。逆者正治（以寒治热，以热治寒，逆其病者，谓之正治）。从者反治（以寒治寒，以热治热，从其病者，谓之反治）。从少从多，观其事也（从少，谓一同而二异；从多，谓二同而一异）。热因寒用（热药冷服），寒因热用（寒药热服），塞因塞用（如下气虚乏，中焦气壅，欲散满则益虚其下，补下则满甚于中，而先攻其满，药入或减，药过依然，乃不知少服则资壅，多服则宣通，疏启其中，峻补其下，下虚既实，中满自除），通因通用（如大热内蓄，注泄不止，以寒下之；寒积久泄，以热下之）。必伏其所主，而先其所因（以上四治，必隐伏其所主，而先求其病之由，是为反治也）。论言治寒以热，治热以寒，而方士不能废绳墨而更其道也。有病热者，寒之而热（言以苦寒治热，而热如故）；有病寒者，热之而寒（言以辛热治寒，而寒如故）。二者皆在新病复起，奈何治曰：诸寒之而热者，取之阴（补阴以配其阳，则阴气复而热自退）；热之而寒者，取之阳（补水中之火，则阳气复而寒自消）。所谓求其属也。服寒而反热，服热而反寒，其故何也？曰：治其旺气，是以反也（如治火旺用苦寒降，阴则火愈盛；如治阴旺用辛温耗气，则寒愈盛。此皆专治旺气，故其病反如此）。不治旺而然者何也？曰：不治五味属也。夫五味入胃，各归所喜攻。酸先入肝，苦先入心，甘先入脾，辛先入肺，咸先入肾。久而增气，物化之常也。气增而久，夭之由也（五味各入其所属，如偏用久而增气，此物化之常。气增不已，则藏有偏胜而有偏绝矣。如《生气通天论》曰：味过于酸，肝气以津，脾气乃绝；味过于咸，大骨气劳，短肌，心气抑；味过于甘，心气喘满，色黑，肾气不衡；味过于苦，脾气不濡，胃气乃浓；味过于辛，筋脉沮弛。）
The Qi of Spring moves westward, the Qi of Summer moves northward, the Qi of Autumn moves eastward, and the Qi of Winter moves southward. (Areas near the East are first affected by the Qi of Spring, gradually extending to the West; areas near the South are first affected by the Qi of Summer, gradually extending to the North; areas near the West are first affected by the Qi of Autumn, gradually extending to the East; areas near the North are first affected by the Qi of Winter, gradually extending to the South.) Therefore, the Qi of Spring begins from below (ascending from below), and the Qi of Autumn begins from above (descending from above). Thus, in places of extreme height, the Qi of Winter Cold is always present (snow remains on mountain peaks even in summer); in places of extreme lowness, the Qi of Spring Warmth is always present (grass grows in marshes even in winter).
To release the exterior (using methods to disperse pathogens from the exterior) does not avoid heat environments or herbs; to attack the interior (using methods to purge interior excess) does not avoid cold environments or herbs. (Releasing the exterior utilizes heat; in summer, releasing the exterior does not avoid heat. Attacking the interior utilizes cold; in winter, attacking the interior does not avoid cold. This is because the substances for releasing the exterior and attacking the interior should not remain stagnant in the middle jiao but should be appropriate.) If one neither releases nor attacks, but instead offends with cold and heat, the disease will worsen. (If one does not treat via release or attack but offends with cold and heat, the disease worsens. If one has no disease but offends with cold and heat, cold and heat syndromes will arise.)
For Wood stagnation, promote its free flow (Stagnation refers to constraint. Wood nature favors expansion; the treatment principle is to ascend it to allow smooth growth). For Fire stagnation, disperse it (Fire nature flares upward; the treatment principle is to scatter it to allow dispersion). For Earth stagnation, seize/purge it (Earth nature favors unblocking; thus, purging is suitable). For Metal stagnation, drain it (Metal nature is clear and draining; thus, draining is suitable). For Water stagnation, restrain it (Water nature flows downward; thus, restrain it to prevent rebellious upward movement). However, to regulate Qi, for excessive conditions, use what it fears to restrain it; this is called "draining" (The above details the treatments for the Five Stagnations, then states that after treatment, Qi must be regulated. If there is still excess not regulated, use what it fears to restrain it. The meaning of restraint is what is called "draining." What it "fears" means: Wood fears Sour, Fire fears Sweet, Earth fears Bitter, Metal fears Pungent, Water fears Salty).
How do the Six Qi govern their respective domains of Heaven and Earth? It is said: Jueyin Wind-Wood governs Heaven (in years of Si and Hai), its transformation manifests as Wind (Wood Qi transforms into Wind); Shaoyin Ministerial Fire governs Heaven (in years of Zi and Wu), its transformation manifests as Heat (Shaoyin Sovereign Fire transforms into Heat); Taiyin Damp-Earth governs Heaven (in years of Chou and Wei), its transformation manifests as Dampness (Earth Qi transforms into Dampness); Shaoyang Ministerial Fire governs Heaven (in years of Yin and Shen), its transformation manifests as Fire (Shaoyang Ministerial Fire, its transformation fears Fire); Yangming Dryness-Metal governs Heaven (in years of Mao and You), its transformation manifests as Dryness (Metal Qi transforms into Dryness); Taiyang Cold-Water governs Heaven (in years of Chen and Xu), its transformation manifests as Cold (Water Qi transforms into Cold). Diseases are named according to the Zang-Fu positions influenced (Wang Bing's commentary: Liver Wood is positioned in the East, Heart Fire in the South, Spleen Earth in the Center and four corners, Lung Metal in the West, Kidney Water in the North. This is the positioning of the Five Zang. However, the Five Movements correspond to the arrival of the Six Qi. When Qi is harmonious, there is peace; when discordant, disease arises. Hence, the influence of the Six Qi is discussed first, followed by diseases of the Five Zang). How does the transformation of Earth (Qi of Earthly Substrate) manifest? It is said: It shares the same signs as Heaven-governing Qi (When Heavenly Qi shifts and Earthly Qi takes effect, diseases are named based on Zang-Fu positions, following the same diagnostic rules as Heaven-governing Qi). Intermittent Qi follows the same pattern (Intermittent Qi takes effect, diseases are named based on Zang-Fu positions, following the same diagnostic rules as Heaven-governing Qi). Those governing left and right are called Intermittent Qi (A year has six Qi. One governs Heaven, one governs Earthly Substrate. The remaining four are: one Left Intermittent to Heaven, one Right Intermittent to Heaven, one Left Intermittent to Earthly Substrate, and one Right Intermittent to Earthly Substrate. As stated in the Great Treatise on Five Movements: Regarding left and right, if Jueyin appears above, Shao Yin is left and Tai Yang is right; if Shao Yin appears above, Tai Yin is left and Jue Yin is right; if Tai Yin appears above, Shao Yang is left and Shao Yin is right; if Shao Yang appears above, Yang Ming is left and Tai Yin is right; if Yang Ming appears above, Tai Yang is left and Shao Yang is right; if Tai Yang appears above, Jue Yin is left and Yang Ming is right. This is determining positions facing North: If Jue Yin is above, Shao Yang is below, Yang Ming is left, Tai Yin is right; if Shao Yin is above, Yang Ming is below, Tai Yang is left, Shao Yang is right; if Tai Yin is above, Tai Yang is below, Jue Yin is left, Yang Ming is right; if Shao Yang is above, Jue Yin is below, Shao Yin is left, Tai Yang is right; if Yang Ming is above, Shao Yin is below, Tai Yin is left, Jue Yin is right; if Tai Yang is above, Tai Yin is below, Shao Yang is left, Shao Yin is right. This is determining positions facing South: Heaven-governing Qi is above, positioned in the South, so facing North defines left and right; Left governs West, Right governs East. Earthly-substrate Qi is below, positioned in the North, so facing South defines left and right; Left governs East, Right governs West. Up and Down differ, and Left and Right vary accordingly).
When various Qi are at the Earthly Substrate, Wind overflows internally (meaning invading from outside to inside), treat with Pungent-Cool (Metal overcomes Wood Qi), assist with Bitter-Sweet (Excessive Pungent may damage Qi, so assist with Bitter to overcome Pungent and Sweet to tonify Qi), soothe with Sweet, disperse with Pungent (Wood nature is urgent, so Sweet soothing and Pungent dispersing are suitable). Heat overflows internally, treat with Salty-Cold (Sovereign Fire Qi can be overcome by Water), assist with Sweet-Bitter (Sweet overcomes Salty, Bitter drains Heat), astringe with Sour, disperse with Bitter (Heat abundant in meridians requires Sour astringency; Heat constrained internally requires Bitter dispersion). Dampness overflows internally, treat with Bitter-Hot (Dampness is Earth Qi; Bitter-Hot transforms via Fire, capable of drying Dampness), assist with Sour-Light (Sour controls Earth, Light promotes orifices), dry with Bitter, drain with Light (Damp-Heat suits Bitter drying; Dampness causing edema suits Light draining; draining refers to diuresis and sweating). Fire overflows internally, treat with Salty-Cold, assist with Bitter-Pungent (Wu's commentary: Ministerial Fire fears Fire, so Salty, Bitter, and Pungent are used to drain Heat and nourish Yin-Water), astringe with Sour, disperse with Bitter (Same principle as the Heat overflow section). Dryness overflows internally, treat with Bitter-Warm (Dryness is Metal Qi; Bitter-Warm transforms via Fire, thus overcoming Metal Qi), assist with Sweet-Pungent (Wood injured by Metal suits Sweet soothing and Pungent dispersing), purge with Bitter (Severe Dryness constipation requires Bitter purgation). Cold overflows internally, treat with Sweet-Hot (Cold is Water Qi; Sweet transforms via Earth, Hot transforms via Fire, thus controlling Water and overcoming Cold), assist with Bitter-Pungent (Bitter and Pungent are also hot-natured), drain with Salty (Salty is the true flavor of Water, draining it), moisten with Pungent, firm with Bitter (Kidney dislikes dryness, urgently eat Pungent to moisten it; Kidney desires firmness, urgently eat Bitter to firm it; this is the meaning here).
When Heaven-governing Qi causes Wind to prevail, level it with Pungent-Cool, assist with Bitter-Sweet, soothe with Sweet, drain with Sour (Wood Qi ascends but does not descend, thus...). When Heat prevails, level it with Salty-Cold, assist with Bitter-Sweet, astringe with Sour (To afloat Heat). When Dampness prevails, level it with Bitter-Hot, assist with Sour-Pungent (Sour and Pungent combined mean it is not a drink), dry with Bitter, drain with Light. If Dampness is severe above with Heat, treat with Bitter-Warm (to dry dampness), assist with Sweet (to benefit Earth) and Pungent (to disperse stagnation), stop when sweat occurs (when sweat is achieved, Dampness is expelled externally). When Dryness prevails, level it with Bitter-Damp (Bitter and dampness provide moisture to Dryness), assist with Sour (to generate fluids) and Pungent (to moisten dryness), purge with Bitter (Severe Dryness cannot be removed without purgation). When Cold prevails, level it with Pungent (to disperse Cold) and Hot (to restore Yang), assist with Bitter-Sweet (to harmonize Pungent-Hot), drain with Salty (If Cold injury leads to interior Heat, Salty drainage is suitable. Li Pinhu says: Heaven-governing Qi dominates the first half of the year, governed by Heavenly Qi, hence Six Excesses are called "prevailing," invading from above downwards, thus termed "leveling." Earthly-substrate Qi dominates the second half, governed by Earthly Qi, hence Six Excesses are called "overflowing internally," invading from outside to inside, thus termed "treating." When the season receives the Qi that overcomes it, it is called "counter-prevailing." How to verify the prevalence of Six Qi? e.g., Dryness prevailing dries the earth, Summer Heat prevailing makes the earth windy/hot, Wind prevailing shakes the earth, Dampness prevailing muddies the earth, Cold prevailing cracks the earth, Fire prevailing solidifies the earth).
In Spring, the pulse should not be Deep; in Summer, not Wiry; in Winter, not Choppy; in Autumn, not Rapid. This is called the Four Obstructions (Spring Wiry, Summer Rapid, Autumn Choppy, Winter Deep are normal pulses. If Spring presents Deep, Summer presents Wiry, Winter presents Choppy, Autumn presents Rapid, losing the mother Qi despite the ruling Qi, this is called Four Obstructions, where the Five Zang do not communicate). Simultaneous appearance indicates disease; reappearance indicates disease; disappearance before time indicates disease; retention beyond time indicates disease (Simultaneous appearance of various pulses in one position indicates mutual overcoming and insulting; appearance in another position after appearing in its own indicates excessive pathogenic Qi; disappearance before time indicates deficiency of root Qi and excess of incoming Qi; retention beyond time indicates excess of root Qi and deficiency of incoming Qi). Reversal indicates death (Reversal means Spring pulse is Choppy, Summer is Deep, Autumn is Rapid, Winter is Slow. Seeing the pulse of the overcoming element indicates death).
All wind-related tremors and vertigo belong to the Liver (Wind types vary, hence "all winds." Tremors and vertigo). All cold-related contraction and pulling belong to the Kidney (Contraction and pulling. Kidney governs Cold-Water transformation. When Yang Qi does not reach, Ying and Wei condense, causing body spasms). All Qi-related stifling and depression belong to the Lung (Stifling breathing, depression and lack of smooth flow). All dampness-related swelling and fullness belong to the Spleen (Swelling externally, fullness internally, i.e., distension). All heat-related confusion and convulsions belong to Fire. All pain, itching, and sores belong to the Heart (Severe heat causes sore pain; mild heat causes sore itching. Heart belongs to Fire transforming Heat, hence sores belong to Heart). All reversal, retention, and incontinence belong to the Lower Jiao (Reversal refers to rebellion; retention refers to urinary/fecal obstruction; incontinence refers to urinary/fecal incontinence. Lower refers to Kidney. Kidney resides below the Five Zang, governing both Water and Fire. Deficiency of Yin essence leads to solitary Fire action causing Heat Reversal; decline of Mingmen leads to solitary Water action causing Cold Reversal. Kidney opens into the two yin orifices. Water deficiency and Fire excess lead to dryness and Heat constipation; Yin deficiency leads to lack of Qi, causing turbid/clear separation failure and Cold retention. Kidney Water decline leads to Fire forcing leakage causing Heat incontinence; Mingmen Fire decline leads to Yang deficiency and incontinence causing Cold incontinence). All atrophy, wheezing, and vomiting belong to the Upper Jiao (Lung governs Qi. Lung Heat scorches leaves, preventing hands/feet from receiving Qi, leading to tendon, muscle, vessel, and bone atrophy.急促 breathing is wheezing, disease in Lung; reverse sound is vomiting, disease in stomach opening; thus all are Upper Jiao diseases). All locking, drumming, and shivering, as if losing spiritual control, belong to Fire (Locking refers to clenched teeth. Drumming refers to jaw trembling. Shivering refers to shaking. Spirit controlling form is Spiritual Control. Locking, drumming, and shivering without spiritual support is like losing spiritual control, all Fire diseases. If Heart Fire is extremely hyperactive, it may counteract with Water transformation, causing cold shivering, which is Excess Fire. If Yin prevails, it is Cold; Cold consumes True Qi, leading to deficiency. Deficiency allows Cold to grip the skin, which is Deficient Fire. Malaria onset involves Yang merging into Yin, making Yin excess and Yang deficiency. Yang Ming deficiency causes cold shivering and jaw trembling. Also, during resolution of Cold Damage, if the person is originally deficient, pathogen and righteous Qi struggle causing shivering sweat. Thus, all shivering is a struggle of Yin and Yang). All spasms and neck stiffness belong to Dampness (Spasm is a wind-strong disease. Here, severe Dampness combines with Wind-Wood transformation). All rebellious rushing upward belong to Fire (Fire nature flares upward). All distension and abdominal enlargement belong to Heat (Internal excess Heat causes distension in Lung (upper), Spleen/Stomach (middle), Liver/Kidney (lower). This is caused by Fire pathogen, leading to vexation and fullness). All restlessness, mania, and transgression belong to Fire (Restlessness is vexation; Mania is madness; Transgression is exceeding bounds. Fire entering Lung causes vexation; Fire entering Kidney causes restlessness. As per Great Treatise on Qi Intersection: Excessive Year Water, Cold Qi spreads, harming Heart Fire, causing body heat, vexation, Yin reversal, and delirium, known as Yin Excess causing Fire-like Restlessness. Cheng Wuji says: Even if restless, wanting to sit in a well, desiring water but unable to swallow, this is it). All sudden rigidity belong to Wind (Sudden. Rigidity is a tendon disease, strong and stiff). All diseases with sounds (bowel sounds) and drum-like abdomen belong to Heat (Caused by rebellious Yang Qi, thus Heat). All diseases with edema, pain, soreness, fright, and horror belong to Fire (Edema is Yang excess externally, Fire in meridians. Pain/soreness is Fire severely restricting Metal, failing to calm Wood, causing Wood excess and sourness. Fright/horror is Sovereign Fire excess). All twisting, arching, and turbid fluids belong to Heat (Wood excess assisting Fire causes tendon tension, leading to twisting/arching contrary to normal. Fluids refer to urine). All diseases with clear, cold fluids belong to Cold (Fluids refer to excretions from above and below). All vomiting and acid regurgitation, sudden diarrhea with tenesmus belong to Heat (Intestinal/Stomach Heat causes abnormal transmission, leading to sudden diarrhea. Tenesmus is heavy sensation and urgent pain in the lower rectum).
Cold is treated with Heat, Heat is treated with Cold (This is Direct Treatment). Minor conditions are treated oppositely, Severe conditions are treated similarly. Opposite is Direct Treatment (Treating Heat with Cold, Cold with Heat, opposing the disease, is called Direct Treatment). Similar is Reverse Treatment (Treating Cold with Cold, Heat with Heat, following the disease, is called Reverse Treatment). Follow less or follow more, observe the case (Follow less means one same and two different; Follow more means two same and one different). Heat due to Cold usage (Hot medicine taken cold), Cold due to Heat usage (Cold medicine taken hot), Blockage due to Blockage usage (e.g., Lower Qi deficiency with Middle Jiao congestion. To disperse fullness would further weaken the lower; tonifying lower would worsen middle fullness. First attack the fullness. Medicine intake may reduce temporarily, but returns. Not knowing that small doses nourish stagnation while large doses promote circulation, clearing the middle and strongly tonifying the lower, once lower deficiency is filled, middle fullness naturally resolves), Patency due to Patency usage (e.g., Internal severe Heat causing continuous diarrhea, treat with Cold purgation; Cold accumulation causing chronic diarrhea, treat with Hot purgation). Must subdue the main factor and address the cause first (The above four treatments must conceal the main factor and first seek the cause of disease, which is Reverse Treatment). Discussions say treat Cold with Heat, Heat with Cold, yet physicians cannot abandon standards and change the path. If a patient with Heat is treated with Cold but Heat remains (Using Bitter-Cold to treat Heat, yet Heat persists); if a patient with Cold is treated with Heat but Cold remains (Using Pungent-Hot to treat Cold, yet Cold persists). Both arise from new diseases recurring. How to treat? It is said: For those treated with Cold who become hotter, treat the Yin (Tonify Yin to match Yang, so Yin recovers and Heat retreats); for those treated with Heat who become colder, treat the Yang (Add Fire to Water, so Yang recovers and Cold dissipates). This is seeking the affiliation. Why does taking Cold result in Heat and taking Heat result in Cold? It is said: Treating the Prosperous Qi causes this reversal (e.g., treating Fire prosperity with Bitter-Cold descending, if Yin is damaged, Fire becomes stronger; treating Yin prosperity with Pungent-Warm consuming Qi, Cold becomes stronger. These are specifically treating Prosperous Qi, hence the reversal). Why does it happen if not treating Prosperous Qi? It is said: Not treating the Five Flavors' affiliations. The Five Flavors enter the Stomach and each return to their preferred organ. Sour enters Liver first, Bitter enters Heart first, Sweet enters Spleen first, Pungent enters Lung first, Salty enters Kidney first. Long-term use increases Qi, which is the normal transformation of things. Increasing Qi for too long is the cause of premature death (Each Flavor enters its affiliated organ. Biased long-term use increases Qi, which is normal transformation. If Qi increases indefinitely, organs have excess and others have depletion. As per Treatise on Life Connection: Excessive Sour, Liver Qi floods, Spleen Qi fails; Excessive Salty, large bones labor, muscles shorten, Heart Qi suppressed; Excessive Sweet, Heart Qi panting/full, complexion black, Kidney Qi unbalanced; Excessive Bitter, Spleen Qi not moist, Stomach Qi thick; Excessive Pungent, tendons/vessels relaxed.)