Mastering Qi Dynamics: Conforming and Reverse Treatments Explained

Leigong asked: “Regarding the rise and fall of qi, which is reverse and which is conform?”

The Yellow Emperor replied: “Yang qi naturally ascends, flowing from left to right; Yin qi naturally descends, flowing from right to left. In old age, qi weakens from below and moves downward; in youth, qi flourishes from below and moves upward.”

The Yellow Emperor continued: “Thus, if a disease appears in spring and summer with yang symptoms and pulses, harmonizing yang with yang is conforming and promotes life. Conversely, if yin symptoms and pulses appear as in autumn and winter, this is reverse and leads to death. On the flip side, if an autumn or winter disease manifests with yin symptoms and pulses, harmonizing yin with yin is conforming and promotes life. Therefore, regardless of whether qi is flourishing or declining, reverse situations lead to collapse.”

Leigong asked again: “Can excess qi also lead to collapse?”

The Yellow Emperor answered: “When yang qi ascends without descending, and yin and yang fail to connect, the feet become cold up to the knees. Young people with this condition in autumn and winter may die, while the elderly may survive. When yang qi ascends without descending, the upper body becomes replete while the lower body becomes empty, leading to headaches and disorders at the crown of the head. This type of collapse, although related to yang, is not due to excess yang; nor is it due to excess yin. The qi of the five organs becomes disconnected, with no obvious signs, resembling being in a vast wilderness or an empty room, seeing and hearing nothing, and the condition drags on with life hanging by a thread, barely surviving a day.”

The Yellow Emperor explained further: “So, qi deficiency causes bizarre dreams; extreme collapse leads to strange and chaotic dreams. The pulses of the three yang channels become suspended, and the three yin pulses become subtle, indicating the signs of deficient qi. Deficient lung qi leads to dreams of white and sorrowful things, or dreams of people being killed and bloodshed, and chaotic corpses. During the time of metal’s dominance, one dreams of war. Deficient kidney qi leads to dreams of drowning and fearful events. During the time of water’s dominance, one dreams of being submerged in water. Deficient liver qi leads to dreams of mushrooms and fragrant plants. During the time of wood’s dominance, one dreams of lying under a tree, unable to rise. Deficient heart qi leads to dreams of fire and thunderstorms. During the time of fire’s dominance, one dreams of raging flames. Deficient spleen qi leads to dreams of insufficient food. During the time of earth’s dominance, one dreams of building walls and covering houses. These are all due to qi deficiency in the five organs, excess yang qi, and insufficient yin qi. By integrating the signs of the five organs and adjusting yin and yang, the details are discussed in the ‘Meridians’ chapter.”

Diagnostic methods have ten measures, which involve assessing the pulse, organs, flesh, tendons, acupoints, and evaluating yin and yang deficiencies to gain a comprehensive understanding of the condition. The movement of the pulse is inherently variable, sometimes showing scattered or biased yin and yang, or having indistinct pulse patterns, resulting in no fixed diagnostic rules. Diagnosing a patient requires knowing their status, whether they are commoners or nobles. If the teachings of one’s master are not fully absorbed and medical skills are not advanced, one cannot distinguish between reverse and conform, leading to blind and partial treatment, seeing one side and missing the other, grasping one point and ignoring another, failing to analyze the overall situation, thus diagnosis becomes unclear. If such diagnostic methods are passed on to future generations, their errors will be evident in practice.

When yin deficiency reaches its extreme, the yang qi of heaven departs; when yang excess reaches its extreme, the yin qi of the earth is insufficient. Enabling mutual support and communication between yin and yang is the skill of a cultivated physician. The mutual support and communication of yin and yang qi begin with yang qi arriving first, followed by yin qi.

Thus, a wise physician diagnosing an illness masters the sequence of yin and yang, identifies normal and abnormal conditions based on sixty fundamental points of odd and regular patterns, integrates minute clinical data gathered through various diagnostic methods, tracks the changes in yin and yang, understands the conditions of the five organs, and makes accurate conclusions. By following the principles of deficiency and excess and the ten measures, a correct diagnosis can be made.

Therefore, if one can only assess yin without understanding yang, such diagnostic methods are not viable; if one can only assess yang without understanding yin, their skills are not advanced. Knowing the left without the right, the right without the left, the upper without the lower, the earlier without the later, their medical practice will not endure. One must understand both the unfavorable and favorable conditions; recognize both disease and health; comprehend both heights and depths; know both sitting and rising; and understand both movement and stillness. Achieving this level of orderly and thorough inquiry ensures that diagnostic procedures are complete and accurate without error.

In the early stages of disease, seeing excess evil qi indicates a deficiency of righteous qi, leading to vulnerability to evil influences; examining the patient’s various parts, integrating pulse signs to thoroughly investigate the pathology. For example, weak qi in the body suggests death; excess physical strength but deficient pulse qi also suggests death; surplus pulse qi but deficient physical strength indicates survival. Therefore, there are fundamental laws in diagnosing diseases. Physicians should maintain a disciplined lifestyle, keeping good conduct in every action; being quick-witted, clear-headed, observing from top to bottom, identifying seasonal pathogenic influences, distinguishing which part of the five organs is affected; feeling the pulse’s movement and exploring the condition of the skin around the wrist, examining changes in urine and feces, and correlating them with symptoms to determine whether the condition is reverse or conform, thus identifying the disease name. By adhering to these diagnostic principles, one can achieve a high accuracy rate, not deviating from common sense. Diagnosing by observing breath or expressions with consistent rationale ensures high medical proficiency and long-lasting accuracy. Ignoring these principles, making arbitrary assumptions about the condition without solid reasoning contradicts the principles of medical practice.”