The Six Qi Revisited: TCM Insights for Modern Health

Emperor Huang inquired, “I am already aware that the Five Transports interact and alternate, with excess and deficiency replacing each other. However, how do the changes occur when the governing Qi of heaven and the Qi of the springs arrive?”

Qi Bo bowed and replied, “What a clear and insightful question! These are the fundamental principles of the changes in heaven and earth, and also the rules by which the human body corresponds to these changes.”

Emperor Huang said, “I would like to hear how these principles can be integrated with the bright and clear heavenly Dao above and the profound and distant earthly Qi below.”

Qi Bo responded, “This is the core of medical theory, which is not well understood by many physicians.”

Emperor Huang said, “I am eager to learn more about this aspect.” Qi Bo explained, “When Jue Yin governs heaven, the Qi transforms into wind; when Shao Yin governs heaven, the Qi transforms into heat; when Tai Yin governs heaven, the Qi transforms into dampness; when Shao Yang governs heaven, the Qi transforms into fire; when Yang Ming governs heaven, the Qi transforms into dryness; when Tai Yang governs heaven, the Qi transforms into cold. The names of the diseases are determined by the organs affected by the guest Qi.”

Emperor Huang asked, “What about the transformations of the Qi in the springs?” Qi Bo said, “They are the same as the governing Qi, and the intercalary Qi follows suit.” Emperor Huang inquired, “What is meant by intercalary Qi?” Qi Bo answered, “The Qi that governs the left and right of the heaven and spring Qi is called intercalary Qi.” Emperor Huang further asked, “How does it differ from the heaven and spring Qi?” Qi Bo clarified, “The heaven and spring Qi govern the annual Qi, the main Qi of the year. The intercalary Qi governs the Qi for sixty days.”

Emperor Huang said, “What is the main Qi of the year?” Qi Bo explained, “When Jue Yin governs heaven, it is the transformation of wind; in the spring, it is the transformation of sourness; in the annual transport, it is the transformation of green; in the intercalary Qi, it is the transformation of movement. When Shao Yin governs heaven, it is the transformation of heat; in the spring, it is the transformation of bitterness; it does not govern the annual transport, but in the residing Qi, it is the transformation of burning. When Tai Yin governs heaven, it is the transformation of dampness; in the spring, it is the transformation of sweetness; in the annual transport, it is the transformation of yellow; in the intercalary Qi, it is the transformation of softness. When Shao Yang governs heaven, it is the transformation of fire; in the spring, it is the transformation of bitterness; in the annual transport, it is the transformation of red; in the intercalary Qi, it is the transformation of brightness. When Yang Ming governs heaven, it is the transformation of dryness; in the spring, it is the transformation of pungency; in the annual transport, it is the transformation of white; in the intercalary Qi, it is the transformation of clarity. When Tai Yang governs heaven, it is the transformation of cold; in the spring, it is the transformation of saltiness; in the annual transport, it is the transformation of black; in the intercalary Qi, it is the transformation of storage. Therefore, a physician must understand the different transformations of the Six Qi and the effects of the five flavors and colors on the five viscera, as well as their likes and dislikes, in order to have a clear understanding of the abundance and deficiency of Qi transformations and the occurrence of diseases.”

Emperor Huang said, “I already understand that Jue Yin in the spring follows the transformation of sourness, but what about the transformation of wind?” Qi Bo replied, “The wind Qi travels on the earth, originating from the earth’s Qi as wind transformation. The other five Qi are similar. That which belongs to heaven is the Qi of heaven, and that which belongs to earth is the Qi of earth. When the Qi of heaven and earth combine, the six climatic divisions are formed, and thus all things can be transformed and born. Therefore, it is said: Pay special attention to observing the changes in climate and do not miss the changes in the病情 (病情 – illness condition).”

Emperor Huang asked, “What about the medicinal herbs used to treat diseases?” Qi Bo said, “By preparing medicinal herbs according to the annual Qi, there will be no omissions.” Emperor Huang inquired, “Why prepare medicinal herbs according to the annual Qi?” Qi Bo explained, “Because they can obtain the specialized and refined Qi of heaven and earth, resulting in better therapeutic effects.” Emperor Huang asked, “What about the medicinal herbs that govern the transport of Qi?” Qi Bo said, “The medicinal herbs that govern the transport of Qi are the same as those that govern the main year, but there is a distinction between excess and deficiency.” Emperor Huang further asked, “What about medicinal herbs that are not for the main year?” Qi Bo said, “Their Qi is scattered and not pure. Although the essence is the same, the ranks are different, such as the thickness and thinness of the aroma and taste, the quietness and restlessness of the properties, the more or less of the therapeutic effects, and the depth and shallowness of the medicinal power. This is the explanation for medicinal herbs that are not for the main year.”

Emperor Huang said, “Why does the main Qi of the year harm the five viscera?” Qi Bo answered, “The key is to explain it from the perspective of the Qi that it cannot overcome.” Emperor Huang asked, “How to treat it?” Qi Bo said, “If the Qi governing heaven is excessive and indulges below, then use the Qi that one can overcome to regulate it; if the Qi in the spring is excessive and indulges outside, then use the Qi that one can overcome to treat it.”

Emperor Huang said, “Well said! But there are also cases where diseases occur when the annual Qi is balanced. How to treat them?” Qi Bo replied, “This requires careful observation of the locations of the Three Yin and Three Yang governing heaven and spring, and to regulate them to achieve normalcy. Use the correct treatment method for the correct disease, and the reverse treatment method for the reverse disease.”

Emperor Huang said, “You mentioned observing the locations of Yin and Yang for treatment, but some books say that the pulses of Renying and Cunkou should correspond, like a drawn rope, with equal size called balance. So, how should Yin be in Cunkou?” Qi Bo said, “By observing whether the main year is the Southern or Northern governance, one can understand.” Emperor Huang said, “I hope to understand thoroughly.” Qi Bo explained, “When the Northern governance is the main year, if Shao Yin is in the spring, the Cunkou pulse is deep, fine, and hidden, not responding to the finger; if Jue Yin is in the spring, the right Cunkou is deep, fine, and hidden, not responding to the finger; if Tai Yin is in the spring, the left Cunkou is deep, fine, and hidden, not responding to the finger. When the Southern governance is the main year, if Shao Yin governs heaven, the Cunkou pulse is deep, fine, and hidden, not responding to the finger; if Jue Yin governs heaven, the right Cunkou is deep, fine, and hidden, not responding to the finger; if Tai Yin governs heaven, the left Cunkou is deep, fine, and hidden, not responding to the finger. Whenever the Cunkou pulse does not respond, ‘reversing the diagnosis’ will reveal it. Emperor Huang asked, “What about the pulse in the Chi (尺 – inch) part?” Qi Bo said, “When the Northern governance is the main year, if the Three Yin are in the spring, the Cunkou does not respond; if the Three Yin govern heaven, the Chi part does not respond. When the Southern governance is the main year, if the Three Yin govern heaven, the Cunkou does not respond; if the Three Yin are in the spring, the Chi part does not respond. The non-response of the left and right pulses is the same as the above. Therefore, it is said that understanding the key point can be explained in one sentence, but without understanding, it is boundless, which is what is meant here.”

Emperor Huang said, “Very well, then what about the diseases named after the Qi of heaven and earth invading the human body?” Qi Bo said, “In the year when Jue Yin is in the spring, if the wind Qi is excessive, the earth Qi will be unclear, the plains will be dark, and the grass and grains will sprout prematurely. People are prone to chills, constant groaning, incessant yawning, heart pain with a feeling of fullness, tightness and discomfort in the hypochondria, inability to eat, obstruction in the throat, vomiting after eating, abdominal bloating, frequent belching, but feeling relieved and lazy after defecation or flatulence, and general weakness.

In the year when Shao Yin is in the spring, if the heat Qi is excessive, the Qi will rise and float in the rivers and lakes, and the shady places will appear bright. People are prone to abdominal rumbling, rebellious Qi rushing to the chest and diaphragm, shortness of breath preventing long standing, chills and fever, skin pain, blurred vision, toothache, neck swelling, alternating chills and fever like malaria, pain in the lower abdomen, and abdominal distension. Hibernating insects will not hide.

In the year when Tai Yin is in the spring, if the damp Qi is excessive, the herbs will bloom early, and the valleys will be dark and turbid, with a yellow earthy color. When dampness is excessive, black color will appear, which is the phenomenon of damp earth Qi intermingling. People are prone to drink evil accumulation, heart pain, deafness, no perception of hearing, throat swelling, throat pain, and blood in the urine or stool, such as blood dysentery, hematuria, lower abdominal pain and swelling, inability to urinate, feeling of upward rushing headache, eyes feeling like they will pop out, neck feeling like it will be pulled out, waist feeling like it will break, thigh bone unable to rotate, popliteal fossa feeling like it is solidified, and calf feeling like it is stiff.

In the year when Shao Yang is in the spring, if the fire Qi is excessive, the heaven and earth will present a condensed heat and fiery radiance. The weather will be alternately cold and hot. People are prone to diarrhea, dysentery with red and white discharge, lower abdominal pain, and red urine, with severe cases showing blood, and other symptoms similar to those when Shao Yin is in the spring.

In the year when Yang Ming is in the spring, if the dry Qi is excessive, there will be foggy and unclear vision, and the weather will be cold and thin. People are prone to vomiting, vomiting of bitter fluids, frequent sighing, pain in the heart and hypochondria, inability to turn over; in severe cases, dry throat, face like dust, and dry and unmoistened skin, with the external part of the foot feeling hot.

In the year when Tai Yang is in the spring, if the cold Qi is excessive, the heaven and earth will present a condensed and severe atmosphere. People are prone to lower abdominal pain, pulling the testicles and waist spine, upward rushing to the chest and diaphragm causing pain, bleeding, sore throat, and chin swelling.

Emperor Huang said, “Well said! So how to treat them?” Qi Bo said, “For any Qi in the spring that is excessive and harms the body, the main medicine should be pungent and cool, with bitter medicine as an auxiliary, sweet medicine to alleviate, and pungent medicine to disperse wind evil; for heat Qi that is excessive and harms the body, the main medicine should be salty and cold, with sweet and bitter medicine as an auxiliary, sour medicine to收敛阴气 (converge Yin Qi), and bitter medicine to disperse heat evil; for damp Qi that is excessive and harms the body, the main medicine should be bitter and hot, with sour and bland medicine as an auxiliary, bitter medicine to dry dampness, and bland medicine to drain damp evil; for fire Qi that is excessive and harms the body, the main medicine should be salty and cold, with bitter and pungent medicine as an auxiliary, sour medicine to converge Yin Qi, and bitter medicine to disperse fire evil; for dry Qi that is excessive and harms the body, the main medicine should be bitter and warm, with sweet and pungent medicine as an auxiliary, and bitter medicine to drain heat; for cold Qi that is excessive and harms the body, the main medicine should be sweet and hot, with bitter and pungent medicine as an auxiliary, salty medicine to purge, pungent medicine to warm and moisten, and bitter medicine to solidify.”

Emperor Huang said, “Well said! What about when the weather changes?” Qi Bo said, “When Jue Yin governs heaven and the wind Qi is excessive, the sky will be dusty and unclear, with clouds and objects being tossed about by the wind, cold days with spring orders, and flowing water not freezing. People are prone to pain in the epigastrium, upward support of the hypochondria, obstruction of the diaphragm and throat, inability to eat, stiff tongue root, vomiting after eating, cold diarrhea, abdominal bloating, and qi congealing into masses, with difficulty in urination. Hibernating insects will stay in the soil and not leave. The root of these diseases is in the spleen. If the Chongyang pulse is cut off, it means the stomach Qi has failed, and death will occur without cure.

When Shao Yin governs heaven and the heat Qi is excessive, it will be sultry, with heavy rain approaching, and the sovereign fire will be in command. People are prone to restlessness and heat in the chest, dry throat, fullness in the right hypochondrium, skin pain, chills and fever, cough and asthma, due to excessive heat and heavy rain, hemoptysis, hematuria, epistaxis, sneezing, vomiting, discolored urine, and even carbuncles and edema, with pain in the shoulders, back, arms, upper arms, and缺盆 (缺盆 – clavicular fossa), heart pain, lung distension, abdominal distension and fullness, shortness of breath and cough, these diseases root in the lungs. If the Tianfu pulse is cut off, it means the lung Qi has failed, and death will occur without treatment.

When Tai Yin governs heaven and the damp Qi is excessive, it will be overcast with too much rain, causing the herbs and trees to wither. People are prone to edema, bone pain and Yin bi, Yin bi this disease when pressed, there is no pain. Waist, spine, head and neck pain, frequent dizziness, difficulty in defecation, Yin Qi unable to transform, hunger but unwilling to eat, coughing up blood, restless heart like hanging in the air, these diseases root in the kidneys. If the Taixi pulse is cut off, it means the kidney Qi has failed, and death will occur without cure.

When Shao Yang governs heaven and the fire Qi is excessive, it will be warm and hot, with the metal losing its clear and astringent Qi, so it cannot be in command. People are prone to headache, fever and chills with malaria, heat in the upper body, skin pain, color changing to yellow and red, heat transmitted to the interior, governance not functioning, turning into water disease, facial and bodily edema, abdominal distension, gasping for breath, diarrhea, dysentery with red and white discharge, carbuncles, hemoptysis, restlessness, heat in the chest, and even nosebleeds, these diseases root in the lungs. If the Tianfu pulse is cut off, it means the lung Qi has failed, and death will occur without cure.

When Yang Ming governs heaven and the dry Qi is excessive, the herbs and trees will sprout late in spring. In people, there will be changes in the muscles and bones. People are prone to pain in the left hypochondrium, if the cold Qi in the viscera is affected by external blockage, it will develop into malaria, with the extremely cold Qi causing abnormal weather, prone to cough, abdominal rumbling, sudden diarrhea, and loose stools. The branches of large trees wither and converge, with the vital energy suppressed below, the grass tips also become dry, prone to sudden severe pain in the heart and hypochondria, inability to turn over, dry throat, face like dust, waist pain, men with hernia, women with lower abdominal pain, blurred vision in the corners of the eyes, carbuncles and boils, hibernating insects reappear. These diseases root in the liver. If the Taichong pulse is cut off, it means the liver Qi has failed, and death will occur without cure.

When Tai Yang governs heaven and the cold Qi is excessive, the cold Qi will come unexpectedly, and the water will freeze. Changes in the blood and Qi in the body will lead to carbuncles and sores, reversal and heart pain, vomiting of blood, hematuria, epistaxis, sadness, and frequent dizziness and falling. When the transportation Qi meets the year of Wu and Gui with fiery inflammation, there will be heavy rain and hail, prone to chest and abdominal fullness, hand heat, elbow spasm, axillary swelling, palpitations and restlessness, discomfort in the chest, hypochondria, epigastrium, red face, yellow eyes, frequent belching, dry mouth and tongue, and even the face becomes black like soot, thirsty and wanting to drink, these diseases root in the heart. If the Shenmen pulse is cut off, it means the heart Qi has failed, and death will occur without treatment. Therefore, it can be known that the existence of the organ Qi can be judged by the pulsation of the pulse.

Emperor Huang said, “How to treat them?” Qi Bo said, “For diseases caused by the excessive Qi governed by heaven, if it is wind excess, use pungent and cool medicine to level the excessive Qi, with bitter and sweet medicine as an auxiliary, sweet medicine to alleviate urgency, and sour medicine to drain the evil; if it is heat excess, use salty and cold medicine to level the excessive Qi, with salty and sweet medicine as an auxiliary, sour medicine to converge Yin Qi; if it is damp excess, use bitter and hot medicine to level the excessive Qi, with sour and pungent medicine as an auxiliary, bitter medicine to dry dampness, and bland medicine to drain damp evil; if damp evil is excessive in the upper part and there is heat, treat with bitter and warm medicine, with sweet and pungent medicine as an auxiliary, and use sweating method to restore normalcy and stop; if it is fire excess, use sour and cold medicine to level the excessive Qi, with bitter and sweet medicine as an auxiliary, sour medicine to converge Yin Qi, bitter medicine to drain fire evil, and salty medicine to restore Yin fluid, heat excess is the same; if it is dry excess, use bitter and warm medicine to level the excessive Qi, with sour and pungent medicine as an auxiliary, and bitter medicine to purge dryness; if it is cold excess, use pungent and hot medicine to level the excessive Qi, with sweet and bitter medicine as an auxiliary, and salty medicine to purge cold evil.”

Emperor Huang asked, “How should we treat diseases caused by the excessive victory of pathogenic factors?”

Qi Bo replied, “When wind prevails on earth and the clear, purifying metal energy counteracts it, we should use sour and warm medicines as the main treatment, supplemented by bitter and sweet medicines, and employ pungent flavors to balance the vital energy. When heat prevails on earth and cold counteracts it, we should use sweet and warm medicines, supplemented by bitter and pungent medicines, and employ salty flavors to balance the vital energy. When dampness prevails on earth and heat counteracts it, we should use bitter and cool medicines, supplemented by salty and sweet medicines, and employ bitter flavors to balance the vital energy. When fire prevails on earth and cold counteracts it, we should use sweet and warm medicines, supplemented by bitter and pungent medicines, and employ salty flavors to balance the vital energy. When dryness prevails on earth and heat counteracts it, we should use neutral and cool medicines, supplemented by bitter and sweet medicines, and employ sour flavors to balance the vital energy. In all cases, the use of medicine should aim for harmony. When cold prevails on earth and heat counteracts it, we should use salty and cool medicines, supplemented by sweet and pungent medicines, and employ bitter flavors to balance the vital energy.”

Emperor Huang inquired, “How should we treat conditions where the governing energy of heaven is insufficient and pathogenic factors prevail?”

Qi Bo answered, “When wind governs heaven and cool energy counteracts it, we should use sour and warm medicines, supplemented by sweet and bitter medicines. When heat governs heaven and cold counteracts it, we should use sweet and warm medicines, supplemented by bitter, sour, and pungent medicines. When dampness governs heaven and heat counteracts it, we should use bitter and cold medicines, supplemented by bitter and sour medicines. When fire governs heaven and cold counteracts it, we should use sweet and warm medicines, supplemented by bitter and pungent medicines. When dryness governs heaven and heat counteracts it, we should use pungent and cold medicines, supplemented by bitter and sweet medicines. When cold governs heaven and heat counteracts it, we should use salty and cold medicines, supplemented by bitter and pungent medicines.”

Emperor Huang asked, “What are the manifestations when the Six Qi overpower each other?”

Qi Bo explained, “When Jue Yin (wind) energy is excessive, there will be tinnitus, dizziness, restlessness, and nausea. There will be a sensation of cold above the stomach and below the diaphragm. Strong winds will arise, and creatures with bare skin will fail to thrive. People will be prone to pain in the hypochondrium on one side, which may turn into heat, resulting in yellow or red urine, pain in the epigastric region, fullness in the upper limbs and hypochondria, intestinal rumbling, diarrhea, and lower abdominal pain. In severe cases, there will be vomiting and obstruction in the throat.”

“When Shao Yin (heat) energy is excessive, there will be heat in the chest, constant hunger, and pain below the navel. Heat energy will affect the Triple Burner, and with the arrival of intense heat, trees and flowing water will lose their moisture, causing grass to wither. People will experience vomiting, restlessness, abdominal distension and pain, and loose stools, which may lead to blood in the urine.”

“When Tai Yin (dampness) energy is excessive, and fire energy is suppressed within the body, it may lead to the formation of sores and ulcers. If the dampness is excessive and affects the exterior, it will cause pain in the hypochondrium, and in severe cases, heart pain. If heat is obstructed in the upper part of the body, it will cause headaches, sore throat, and stiffness in the neck. If dampness alone is excessive and suppressed internally, the cold and damp energy will affect the lower burner, causing pain in the top of the head and between the eyebrows, and a feeling of fullness in the stomach. With frequent rain, the signs of dryness will appear, leading to lower abdominal distension, heavy and rigid waist, and difficulty in movement, with frequent diarrhea and swelling in the lower limbs.”

“When Shao Yang (fire) energy is excessive, the pathogenic heat will linger in the stomach, causing symptoms such as restlessness, heart pain, red eyes, nausea, sour vomiting, constant hunger, ear pain, and red urine. The intense heat will scorch all things, causing grass to wither and water to dry up, and creatures with shells will become inactive. In the human body, this will manifest as lower abdominal pain and dysentery with red and white discharge.”

“When Yang Ming (dryness) energy is excessive, cool energy will arise from within, causing pain in the left hypochondrium, diarrhea, and obstruction in the throat. The intense cool energy will cause plants to wither and yellow, and creatures with hair will die. In the human body, this will cause discomfort in the chest, obstruction in the throat, and coughing.”

“When Tai Yang (cold) energy is excessive, the cold and severe energy will arrive, causing water to freeze even before the time for freezing. Creatures with feathers will delay their development. This will lead to hemorrhoids and malaria. When cold energy enters the stomach and causes qi to reverse upwards, it will cause heart pain, sores in the genital area, difficulty in urination, pain radiating to the inner thighs, muscle spasms, and blood stasis, resulting in fullness of the collateral vessels and color changes, or blood in the stool. The skin will swell due to the accumulation of water, and there will be fullness in the abdomen, reduced appetite, and heat rising to cause pain in the head, neck, and top of the head, with eyes feeling as if they will pop out. When cold energy enters the lower burner, it will turn into watery diarrhea.”

Emperor Huang asked, “How should these conditions be treated?”

Qi Bo replied, “For diseases caused by the excessive victory of Jue Yin (wind) energy, use sweet and cool medicines as the main treatment, supplemented by bitter and pungent medicines, and employ sour flavors to drain the excessive energy. For diseases caused by the excessive victory of Shao Yin (heat) energy, use pungent and cold medicines as the main treatment, supplemented by bitter and salty medicines, and employ sweet flavors to drain the excessive energy. For diseases caused by the excessive victory of Tai Yin (dampness) energy, use salty and hot medicines as the main treatment, supplemented by pungent and sweet medicines, and employ bitter flavors to drain the excessive energy. For diseases caused by the excessive victory of Shao Yang (fire) energy, use pungent and cold medicines as the main treatment, supplemented by sweet and salty medicines, and employ sweet flavors to drain the excessive energy. For diseases caused by the excessive victory of Yang Ming (dryness) energy, use sour and warm medicines as the main treatment, supplemented by pungent and sweet medicines, and employ bitter flavors to drain the excessive energy. For diseases caused by the excessive victory of Tai Sun (cold) energy, use sweet and hot medicines as the main treatment, supplemented by pungent and sour medicines, and employ salty flavors to drain the excessive energy.”

Emperor Huang asked, “What are the manifestations of diseases caused by the retaliatory actions of the Six Qi?”

Qi Bo said, “Your question is truly detailed! When Jue Yin retaliates, it will cause lower abdominal distension and hardness, spasms and pain in the abdomen and hypochondria, and sudden pain. In nature, there will be phenomena such as trees bending, sand and soil flying, and creatures with bare skin failing to develop. In terms of diseases, there will be qi syncope and heart pain, sweating, vomiting, inability to eat, and vomiting after eating, tremors in the muscles and bones, dizziness, and coldness in the hands and feet. In severe cases, wind energy will enter the spleen, causing food to be vomited after eating, known as food obstruction. If the Chongyang pulse is cut off, it is a death sentence and cannot be cured.”

When the Shao Yin energy retaliates, restlessness and heat emanate from the heart, leading to irritability, nosebleeds, sneezing, and colicky pain in the lower abdomen. The body feels as if it is on fire, with dryness in the throat and intermittent bowel movements. Qi surges on the left side and reverses to the right, causing coughing, skin pain, sudden loss of voice, heart pain, and confusion. Subsequently, one may experience chills, shivering, delirious speech, and after the cold passes, fever returns. Thirst and a desire for water, shortness of breath, weak bones, intestinal obstruction, and swelling may occur, along with hiccups and belching. If the Tianfu pulse ceases, it is a death sentence, beyond cure.

When Tai Yin retaliates, dampness takes hold, causing heaviness in the body, chest fullness, indigestion, and reversal of Yin energy. The chest feels uncomfortable, and coughing persists. If heavy rains fall frequently and fish swim onto land, people may experience headaches and heaviness. Fear or shock can exacerbate these symptoms, leading to vomiting, reluctance to move, and spitting of clear water. In severe cases, dampness invades the kidneys, causing uncontrolled diarrhea. If the Taixi pulse ceases, it is a death sentence, beyond cure.

When Shao Yang retaliates, intense heat is imminent, with dryness and scorching affecting creatures with shells. People may suffer from fright, convulsions, coughing, nosebleeds, heart heat, restlessness, frequent urination, and aversion to wind. Rebellious Qi rises, giving the face a dusty appearance and causing eye movements. Internal fire leads to dry mouth, vomiting, or bleeding, while downward it causes bloody stools. Malaria may develop, with chills and shivering. Extreme cold turning to heat dries the throat, causing thirst and a yellowish complexion. The Shao Yang pulse becomes weak. If the Qi steams and transforms into water, edema occurs, and in severe cases, evil Qi enters the lungs, causing coughing with blood. If the Chi Ze pulse ceases, it is a death sentence, beyond cure.

When Yang Ming retaliates, the purifying Qi prevails, causing many trees to wither and animals to succumb to epidemics. Human diseases arise in the hypochondrium, with discomfort on the left side, sighing, and in severe cases, heart pain, fullness, abdominal bloating, diarrhea, vomiting, coughing, hiccups, and restlessness. Headaches may occur, and if evil Qi enters the liver, fear and convulsions develop. If the Tai Chong pulse ceases, it is a death sentence, beyond cure.

When Tai Sun retaliates, cold Qi rises, water freezes, and snow falls, causing birds to die. People may experience coldness in the heart and stomach, discomfort in the chest, heart pain, fullness, headaches, fear, dizziness, reduced appetite, and back pain. If the ground cracks and ice is thick and hard, with the sun lacking warmth, people may have lower abdominal pain, testicular pain, and back pain. Rebellious Qi surges to the heart, causing spitting of clear water, hiccups, and belching. In severe cases, evil Qi enters the heart, causing forgetfulness and sadness. If the Shen Men pulse ceases, it is a death sentence, beyond cure.

Emperor Huang said, “Well said! How should these conditions be treated?” Qi Bo replied, “For diseases caused by the retaliatory Qi of Jue Yin, use sour and cold medicines as the main treatment, supplemented by sweet and pungent medicines. Use sour medicines to drain the evil Qi and sweet medicines to alleviate urgency. For Shao Yin retaliatory Qi, use salty and cold medicines, supplemented by bitter and pungent medicines. Use sweet medicines to drain the evil Qi, sour medicines to收敛 (converge), pungent and bitter medicines to disperse, and salty medicines to soften hardness. For Tai Yin retaliatory Qi, use bitter and hot medicines, supplemented by sour and pungent medicines. Use bitter medicines to drain the evil Qi and dry dampness, or to drain damp evil. For Shao Yang retaliatory Qi, use salty and cold medicines, supplemented by bitter and pungent medicines. Use salty medicines to soften hardness, sour medicines to收敛, and pungent and bitter medicines to induce sweating. Sweating medicines should not be avoided in hot weather; use warm and cool medicines instead. For Shao Yin retaliatory Qi, the sweating method is the same. For Yang Ming retaliatory Qi, use pungent and warm medicines, supplemented by bitter and sweet medicines. Use bitter medicines to seep and disperse, and sour medicines to tonify deficiency. For Tai Sun retaliatory Qi, use salty and hot medicines, supplemented by sweet and pungent medicines, and use bitter medicines to strengthen the Qi. In treating diseases caused by the retaliatory Qi of the Six Qi, use hot medicines for cold, cold medicines for heat, cooling medicines for warmth, and warm medicines for coolness. Use astringent medicines for depleted vital energy, dispersing medicines for depressed Qi, moisturizing medicines for dryness, and soothing medicines for urgency. Use softening medicines for solid evil Qi, tonifying medicines for weakness, and purgative medicines for excess. Ensure that the Qi of the five viscera each find their proper place, quiet and undisturbed, and the disease Qi will naturally subside. Then the rest will return to their categories, with no excessive dominance, and normalcy will be restored. This is the general method of treatment.”

Emperor Huang asked, “How is the Qi of the human body divided into upper and lower parts?” Qi Bo replied, “Above the midpoint of the body, there are three types of Qi, corresponding to the heavenly part of the human body, governed by the Qi of heaven. Below the midpoint, there are three types of Qi, corresponding to the earthly part of the human body, governed by the Qi of the springs. Use the upper and lower parts to indicate their dominant and retaliatory Qi, and use the Six Qi to indicate the parts of the body and explain the diseases. The term ‘midpoint’ refers to the Tian Shu point. When the upper three Qi dominate and the lower three Qi are all affected, the diseases are named after the earthly Qi. When the lower three Qi dominate and the upper three Qi are all affected, the diseases are named after the heavenly Qi. This refers to the situation where the dominant Qi arrives and the retaliatory Qi is still latent. When the retaliatory Qi arrives, it is not distinguished by the Qi of heaven and springs, but the disease names are determined according to the changes of the retaliatory Qi.” Emperor Huang asked, “Do the changes of dominant and retaliatory Qi have a fixed time? Is there a certain pattern to their arrival or non-arrival?” Qi Bo said, “The four seasons have fixed positions, but the arrival or non-arrival of dominant and retaliatory Qi is not certain.”

Emperor Huang said, “I would like to hear the principle behind this.” Qi Bo explained, “From the first Qi to the third Qi, it is governed by the heavenly Qi, which is the common position of the dominant Qi. From the fourth Qi to the final Qi, it is governed by the earthly Qi, which is the common position of the retaliatory Qi. There is retaliatory Qi only when there is dominant Qi; without dominant Qi, there is no retaliatory Qi.” Emperor Huang asked, “Sometimes the retaliatory Qi has subsided, but the dominant Qi arises again. Why is that?” Qi Bo said, “When the dominant Qi arrives, the retaliatory Qi follows, with no fixed pattern, until the Qi declines and stops. If the retaliatory Qi is followed by the dominant Qi again, and there is no corresponding retaliatory Qi after the dominant Qi, it will cause harm and can injure life.” Emperor Huang asked, “What is the reason when the retaliatory Qi arrives but the retaliatory Qi itself becomes ill?” Qi Bo said, “This is because the time of the retaliatory Qi’s arrival is not its proper position, and its Qi does not match its position. If the retaliatory Qi greatly retaliates against the dominant Qi, the retaliatory Qi itself becomes deficient, and the governing Qi of the time overcomes it, so the retaliatory Qi becomes ill. This applies to the three Qi of fire, dryness, and heat.”

Emperor Huang inquired, “What are the treatment methods?” Qi Bo replied, “For diseases caused by the excessive Qi, mild cases can be gently guided, while severe cases should be firmly restrained. For diseases caused by the retaliatory Qi, mild cases can be gently adjusted, while violent cases should be weakened. In short, we should follow the excessive Qi and stabilize the suppressed Qi. There is no need to worry about the frequency of medication, and peace should be the endpoint. This is the principle of treatment.”

Emperor Huang asked, “How about the excessive and retaliatory Qi of the guest and host Qi?” Qi Bo said, “Between the guest and host Qi, there is only excessive Qi, but no retaliatory Qi.” Emperor Huang asked, “How to distinguish the reverse and smooth?” Qi Bo said, “The excessive host Qi is reverse, and the excessive guest Qi is smooth. This is the law of heaven and earth.”

Emperor Huang asked, “What are the symptoms of the diseases?” Qi Bo said, “When Jue Yin governs heaven, excessive guest Qi can cause tinnitus and dizziness, and in severe cases, coughing. Excessive host Qi can cause pain in the chest and hypochondria, and difficulty in speaking due to tongue stiffness. When Shao Yin governs heaven, excessive guest Qi can cause rhinorrhea, sneezing, stiffness in the neck and shoulders, fever in the back, headache, shortness of breath, fever, deafness, and blurred vision. In severe cases, it can lead to edema, bleeding, sores, and coughing with asthma. Excessive host Qi can cause restlessness and heat in the heart, and even pain and fullness in the hypochondria. When Tai Yin governs heaven, excessive guest Qi can cause edema in the head and face, and difficulty in breathing. Excessive host Qi can cause fullness in the chest and abdomen, and mental confusion after eating. When Shao Yang governs heaven, excessive guest Qi can cause erysipelas on the skin, which may develop into poisonous sores, vomiting, sore throat, headache, swollen pharynx, deafness, bleeding, and convulsions in the hands and feet. Excessive host Qi can cause fullness in the chest, coughing, and shortness of breath, and even coughing up blood and hot hands. When Yang Ming governs heaven, if the purifying Qi is excessive internally, it can cause coughing, nosebleeds, obstruction in the throat, heat in the heart and diaphragm, and persistent coughing. If the face is pale and bleeding does not stop, it is a death sentence. When Tai Sun governs heaven, excessive guest Qi can cause discomfort in the chest, runny nose, and coughing when exposed to cold. Excessive host Qi can cause rumbling in the throat.”

“When Jue Yin is in the spring, excessive guest Qi can cause discomfort in the large joints, spasms and rigidity internally, and inconvenience in movement externally. Excessive host Qi can cause shaking and rigidity in the muscles and bones, and frequent pain in the waist and abdomen. When Shao Yin is in the spring, excessive guest Qi can cause waist pain, discomfort in the buttocks, thighs, knees, calves, and feet, irregular burning and sourness, edema, and inability to stand for a long time, and changes in the color of urine and stool. Excessive host Qi can cause rebellious Qi rushing upwards, heart pain with heat, various bi syndromes in the diaphragm, diseases occurring in the hypochondria, excessive sweating, and coldness in the limbs. When Tai Yin is in the spring, excessive guest Qi can cause foot atrophy, heavy lower limbs, and abnormal urine and stool. Dampness lingering in the lower burner can cause diarrhea and edema. Excessive host Qi can cause cold Qi rushing upwards, fullness and discomfort, reduced appetite, and even hernia pain. When Shao Yang is in the spring, excessive guest Qi can cause pain in the waist and abdomen, aversion to cold, and even white urine and stool. Excessive host Qi can cause heat rushing upwards and invading the heart, heart pain with heat, vomiting, and other symptoms similar to those caused by Shao Yin in the spring. When Yang Ming is in the spring, excessive guest Qi can cause cool Qi disturbing the lower body, fullness in the lower abdomen, and frequent diarrhea. Excessive host Qi can cause heavy waist and abdominal pain, coldness in the lower abdomen, diarrhea, cold Qi reversing in the intestines and stomach, and rushing upwards to the chest. In severe cases, it can cause shortness of breath and inability to stand for a long time. When Tai Sun is in the spring, excessive cold Qi internally can cause pain in the waist and buttocks, inconvenience in bending and stretching, and pain in the thighs, calves, and knees.”

Emperor Huang asked, “How should these conditions be treated?” Qi Bo said, “For those with Qi rushing upwards, suppress it to make it go down; for those with Qi sinking, lift it to make it rise. For those with excess, drain the excess; for those with deficiency, tonify the deficiency. Use beneficial medicines as an auxiliary, adjust with appropriate diet, and make the guest and host Qi harmonious, and moderate the cold and heat. For the same Qi of guest and host, if the excessive Qi is too strong, it can be reversed and broken. If the Qi of guest and host is different, adjust according to the stronger or weaker Qi.”

Emperor Huang said, “I understand that for cold, use heat; for heat, use cold. For the same guest and host Qi, use reverse treatment; for opposite Qi, use follow treatment. But what about the correct flavors for the Five Elements’ tonification and drainage?” Qi Bo said, “For diseases caused by Jue Yin wind and wood, use sour flavor to drain and pungent flavor to tonify. For diseases caused by Shao Yin sovereign fire and Shao Yang ministerial fire, use sweet flavor to drain and salty flavor to tonify. For diseases caused by Tai Yin damp earth, use bitter flavor to drain and sweet flavor to tonify. For diseases caused by Yang Ming dry metal, use pungent flavor to drain and sour flavor to tonify. For diseases caused by Tai Sun cold water, use salty flavor to drain and bitter flavor to tonify. For Jue Yin guest Qi diseases, tonify with pungent flavor, drain with sour flavor, and moderate with sweet flavor. For Shao Yin guest Qi diseases, tonify with salty flavor, drain with sweet flavor, and astringe with salty flavor. For Tai Yin guest Qi diseases, tonify with sweet flavor, drain with bitter flavor, and moderate with sweet flavor. For Shao Yang guest Qi diseases, tonify with salty flavor, drain with sweet flavor, and soften hardness with salty flavor. For Yang Ming guest Qi diseases, tonify with sour flavor, drain with pungent flavor, and purge downwards with bitter flavor. For Tai Sun guest Qi diseases, tonify with bitter flavor, drain with salty flavor, and solidify with bitter flavor. All these are to unblock the interstitial spaces, promote body fluids, and announce Yang Qi.”

Emperor Huang asked, “I have heard that Yin and Yang each have three aspects. What is the reason for this?” Qi Bo said, “This is because the Qi of Yin and Yang has more or less, and their functions are also different.” Emperor Huang asked, “What does Yang Ming mean?” Qi Bo said, “The combination of Tai Yang and Shao Yang forms the brightness, so it is called Yang Ming.” Emperor Huang asked, “What does Jue Yin mean?” Qi Bo said, “The Qi of Tai Yin and Shao Yin is exhausted, so it is called Jue Yin.”

Emperor Huang asked, “There are differences in the amount of Qi, the strength of diseases, the urgency of treatment methods, and the size of prescriptions. I hope to hear the basis for dividing them.” Qi Bo said, “Evil Qi has high and low distinctions, diseases have near and far differences, and symptoms have internal and external differences. Therefore, treatment methods need to be light or heavy. In short, the criterion is to reach the disease with the medicinal power. The ‘Great Essentials’ say: one sovereign medicine and two ministerial medicines are the methods of odd prescriptions; two sovereign medicines and four ministerial medicines are the methods of even prescriptions; two sovereign medicines and three ministerial medicines are the methods of odd prescriptions; two sovereign medicines and six ministerial medicines are the methods of even prescriptions. For diseases in the near, use odd prescriptions; for diseases in the far, use even prescriptions. Sweating agents do not use odd prescriptions, and purgatives do not use even prescriptions. Prescriptions for tonifying the upper part and treating the upper part should be slow, while those for tonifying the lower part and treating the lower part should be urgent. Medicines with rapid Qi and flavor have strong flavors, while those with slow nature have light flavors. The prescription and medication should be just right for the disease. If the disease is far and the Qi and flavor of the medicine are lacking halfway, consider taking it before or after meals to ensure the medicinal power reaches the disease. Do not violate this rule. Therefore, the law of harmonizing the disease Qi is: if the disease is near, regardless of odd or even prescriptions, the prescription and dosage should be small; if the disease is far, regardless of odd or even prescriptions, the prescription and dosage should be large. Large prescriptions have fewer flavors but heavier quantities; small prescriptions have more flavors but lighter quantities. The number of flavors can be up to nine, and the fewest can be two. If the disease does not improve with an odd prescription, use an even prescription, which is called a heavy prescription. If the disease still does not improve with an even prescription, use counter-adjunct medicines to treat according to the disease, which belongs to the reverse use of cold, hot, warm, and cool medicines.”

Emperor Huang said, “I understand that diseases originate from the root. But how about diseases that originate from the branch (symptoms)?”

Qi Bo replied, “If it’s the opposite of the root disease, you can tell it’s a branch disease. When treating, focus not on the root but on the branch, and that clarifies the method for treating symptoms.”

Emperor Huang asked, “How do we diagnose the excessive Qi of the Six Qi?”

Qi Bo said, “Observe when the Six Qi arrive. A strong, purifying Qi indicates the dominance of dryness. When dryness prevails, the wind and wood elements are affected, leading to liver diseases. A surge of heat means the fire Qi is dominant. When fire is excessive, the metal and dryness elements are affected, causing lung diseases. A rush of cold signifies the dominance of water Qi. When water is excessive, the fire and heat elements are affected, resulting in heart diseases. A strong dampness indicates the dominance of earth Qi. When earth is excessive, the cold and water elements are affected, leading to kidney diseases. A surge of wind means the wood Qi is dominant. When wood is excessive, the upper dampness is affected, causing spleen diseases. These are all illnesses resulting from exposure to pathogenic factors. If it’s a year when the annual Qi is insufficient, the pathogenic Qi becomes even stronger. If the governing Qi is disharmonious, it also intensifies the pathogenic Qi. During the time of the lunar void, the pathogenic Qi is also exacerbated. In these three situations, if one is further exposed to pathogenic factors, the disease becomes critical. Whenever there is excessive Qi, a retaliatory Qi will surely follow.”

Emperor Huang asked, “What are the pulse characteristics when the Six Qi arrive?”

Qi Bo said, “When Jue Yin Qi arrives, the pulse should be taut. When Shao Yin Qi arrives, the pulse should be hook-like. When Tai Yin Qi arrives, the pulse should be deep. When Shao Yang Qi arrives, the pulse should be large and floating. When Yang Ming Qi arrives, the pulse should be short and rough. When Tai Yang Qi arrives, the pulse should be large and long. It’s normal if the Qi arrives and the pulse is harmonious. But if the Qi arrives and the pulse is too strong, it’s a disease. If the Qi arrives and the pulse is contrary, it’s a disease. If the Qi arrives but the pulse doesn’t, it’s a disease. If the Qi hasn’t arrived but the pulse has, it’s a disease. If the Yin and Yang Qi change and the pulse is disordered, it’s critical.”

Emperor Huang asked, “Why do the Six Qi have different transformations in terms of root and branch?”

Qi Bo said, “The Six Qi can transform according to the root, according to both root and branch, or not according to either.”

Emperor Huang said, “I want to fully understand this principle.”

Qi Bo said, “Shao Yang and Tai Yin transform according to the root. Shao Yin and Tai Yang transform according to both root and branch. Yang Ming and Jue Yin do not transform according to root or branch but according to the middle Qi. Those that transform according to the root do so because the pathogenic factors originate from the root Qi. Those that transform according to both root and branch do so because diseases can arise from both root and branch. Those that transform according to the middle Qi do so because diseases originate from the middle Qi.”

Emperor Huang asked, “How to diagnose when the pulse matches but the disease is contrary?”

Qi Bo said, “If the pulse arrives and matches the symptoms but feels weak upon pressure, it’s not a true Yang disease. All Yang symptoms and pulses are like this.”

Emperor Huang asked, “What about the pulse in cases of Yin symptoms with contrary manifestations?”

Qi Bo said, “If the pulse arrives and matches the disease but feels full and strong upon pressure, it’s not a true Yin disease.”

Thus, the onset of all diseases can be due to the root Qi, the branch Qi, or the middle Qi. In treatment, some are cured by addressing the root Qi, some by addressing the branch Qi, some by addressing the middle Qi, and some by treating both root and branch Qi. Some are cured by reversing the disease trend, and some by following the disease’s nature. Reversing means going against the disease’s nature, which in treatment is the correct method. If you follow the disease’s nature, it may seem compliant on the surface, but in reality, it’s reversing. Therefore, understanding the root and branch allows for harmless treatment in clinical practice. Knowing the principles of reversing and following enables one to treat without asking questions. This is the meaning. Not understanding these principles prevents accurate diagnosis and disrupts the meridian Qi. The ‘Great Essentials’ say: mediocre doctors are complacent, thinking they know all diseases, but when faced with clinical cases, they discuss heat symptoms without end, and then signs of cold diseases appear. They don’t understand that the same Qi can cause different diseases, leading to confusion, unclear diagnosis, and disruption of meridian Qi. This is what is meant. The principle of root and branch is concise but widely applicable, from small to large, and understanding one example clarifies all disease changes. Therefore, understanding root and branch makes treatment easy without harm; observing whether it belongs to root or branch can harmonize the disease Qi. Clearly understanding the principles of the Six Qi’s dominance and retaliation can serve as a model for physicians and fully comprehend the changes of heaven and earth.

Emperor Huang asked, “The changes of dominant and retaliatory Qi occur at different times. How does this happen?”

Qi Bo said, “When the dominant Qi arrives, people are already ill, and when the disease Qi accumulates, the retaliatory Qi begins to sprout. The retaliatory Qi takes advantage when the dominant Qi ends, and if it gets the right timing, it intensifies. The dominant Qi can be light or heavy, and the retaliatory Qi can be little or much. If the dominant Qi is moderate, the retaliatory Qi is also moderate. If the dominant Qi is weak, the retaliatory Qi is also weak. This is the norm of weather changes.”

Emperor Huang asked, “Sometimes the onset of dominance and retaliation does not coincide with their timing, or it comes later than expected. Why is that?”

Qi Bo said, “This is because the occurrence and change of the Six Qi have different degrees of decline and prosperity. The effects of cold, heat, warmth, and coolness are manifested in the four seasons. The rise of Yang Qi begins with warmth and peaks in summer heat, while the rise of Yin Qi begins with coolness and peaks in winter cold. The climates of spring, summer, autumn, and winter each have their differences. Therefore, the ‘Great Essentials’ say: the warmth of spring develops into the heat of summer, and the purity of autumn develops into the severity of winter. Carefully follow the changes of the four seasons and observe the return of the climate. In this way, you can see the end of the Qi and know the beginning of the Qi. This is the meaning.”

The Seasons: Do the Changes Follow a Set Pattern?

The Yellow Emperor once asked Qi Bo: “Is there a constant in the transitions of the four seasons?” Qi Bo responded: “Approximately every thirty days, there is a shift.” The seasons are inherently cyclical, yet their changes are not random; they follow a rhythm, like a clockwork system, where each part plays its role, just like the components of a scale: indispensable, each balancing the other.

The classic text “Maoyao” describes the pulse patterns corresponding to each season:

• Spring pulses are never too deep.
• Summer pulses avoid tension.
• Winter pulses should not be excessively stagnant.
• Autumn pulses are never rapid. In excess, these pulse patterns signal illness. When the pulse becomes too deep, tense, stagnant, or rapid, it indicates a diseased state.

There’s also a fascinating insight: if the pulse and Qi become misaligned—such as when Qi leaves before the pulse or lingers when it should have gone—it signals grave illness or even death. In this way, the interplay of the seasonal Qi within the body mirrors the interaction of Yin and Yang in the universe: balanced during stillness, chaotic during motion, and illness during imbalance.

What Are “Yin” and “Yang” in This Context?

The Yellow Emperor inquires: “What is meant by ‘Yin and Yang’?” Qi Bo explains that the complete cessation of Yin Qi is referred to as “Yin” or ‘obscurity,’ while the complete union of Yang Qi is termed “Yang” or ‘brightness.’ This union creates the diverse temperature fluctuations we associate with winter’s chill and summer’s warmth. It’s a constant, natural cycle that governs both health and disease.

The Concept of “Zhi” and “Fen” (Arrival and Departure of Qi)

The Yellow Emperor asks further: “What causes the Qi to arrive and depart?” Qi Bo explains that when Qi arrives, it is called “Zhi,” and when it departs, it is called “Fen.” During its arrival, Qi is unified and consistent; upon its departure, however, it begins to diverge. This, Qi Bo asserts, is a universal law in nature: the shifting balance of energies.

The Six Qi and Their Treatment Principles

The Yellow Emperor continues with practical concerns: “How can one treat the ever-changing nature of the Six Qi and the fluctuating energies that govern health?” Qi Bo advises that a physician should adjust treatment based on the favorable conditions of Qi, tailoring remedies accordingly. “For example, in the case of Shaoyang Qi, one should begin with sweet herbs and follow with salty ones; for Yangming, start with pungent herbs, then use sour ones.” The essential idea is that medicinal choices must align with the specific qualities of the Qi involved to harmonize the body’s energetic landscape.

The Role of Six Qi in Disease Development

The Yellow Emperor presses further: “How do diseases emerge from the Six Qi?” Qi Bo offers a systematic approach:

• Wind-induced conditions often lead to dizziness or tremors (related to the liver).
• Cold can manifest as stiff muscles and joint pains (relating to the kidneys).
• Qi imbalances often cause irritability and heaviness (linked to the lungs).
• Dampness may cause swelling and bloating (pertaining to the spleen).
• Heat typically leads to blurry vision or muscle spasms (connected to fire elements).
• Pain, itching, or sores often relate to the heart.
• For other conditions such as swelling, constipation, and breathing difficulties, they are often traced back to the lower or upper body’s Qi disturbances.

Qi Bo emphasizes that understanding the “mechanism of disease” involves analyzing the interplay of the Five Elements (Wood, Fire, Earth, Metal, Water) and determining which Qi is in excess or deficiency.

The Influence of Tastes and Energies in Herbal Medicine

Finally, Qi Bo explains the nuances of herbs and their flavors:

• Spicy and sweet herbs tend to disperse energy and are Yang in nature.
• Sour and bitter herbs work by constricting and cooling, making them Yin.
• Salty herbs also work by purging and cooling, thus belonging to the Yin category.
• Bland herbs, which promote fluid retention, are more Yang.

Every herb and its taste carries its own unique energy, and the selection of herbs should aim to correct imbalances in the body’s energetic system, guiding it back to harmony.

The Yellow Emperor said: “Illness cannot be cured by regulating qi alone. How should we proceed with treatment? Should we use toxic or non-toxic medicine first? Let’s hear your insights.”

Qibo responded: “The choice between toxic and non-toxic medicine should be based on what is needed to cure the illness. The dosage should be determined according to the severity of the disease.”

The Yellow Emperor continued: “Please explain the formulation of prescriptions.”

Qibo elaborated: “In small prescriptions, there is one main drug (the Monarch) and two secondary drugs (the Ministers). In medium prescriptions, there is one main drug, three secondary drugs, and five assisting drugs (the Assistants). In large prescriptions, there is one main drug, three secondary drugs, and nine assisting drugs. For a cold-related disease, use hot medicine. For a heat-related disease, use cold medicine. For mild diseases, treat against the symptoms; for severe diseases, treat according to the symptoms. If the disease pathogen is strong, reduce it; if it lingers in the body, expel it. For diseases caused by fatigue, nourish it; for those caused by qi and blood stagnation, disperse it. Attack stubborn pathogens, moisten dry conditions, relieve acute illnesses, consolidate for dispersing conditions, and strengthen for weak conditions. Use methods such as lifting, lowering, massage, baths, expelling pathogens, or stimulating outward pathogens, all depending on the condition of the disease.”

The Yellow Emperor asked: “What is the concept of ‘reverse’ and ‘conform’ treatments?”

Qibo replied: “Reverse treatment means treating by opposites, conform treatment means treating by similarity. The dosage of conform treatment should be adjusted according to the severity of the disease.”

The Yellow Emperor queried further: “What is reverse treatment?”

Qibo explained: “Using heat to treat heat with cooling medicine, using cold to treat cold with warming medicine, using tonics for fullness, and using purgatives for diarrhea. It starts with seeming alignment of the medicine’s nature to the disease, but the outcome differs, breaking stagnations, dissolving hard masses, harmonizing qi and blood, and curing the disease.”

The Yellow Emperor asked: “How should diseases caused by the imbalance of six qi be treated?”

Qibo answered: “Either use reverse treatment or conform treatment, or combine them appropriately to harmonize the body’s functions.”

The Yellow Emperor praised: “Well said! How should diseases that influence both inside and outside be treated?”

Qibo said: “For diseases that originate internally and then manifest externally, treat internally first. For those originating externally and then affecting the internal, treat externally first. If the disease is internal but impacts the exterior more, treat internally first, then externally. If the disease starts externally but impacts the interior more, treat externally first, then internally. If there is no clear internal or external origin, treat the primary symptoms.”

The Yellow Emperor commented: “Well spoken! When heat and cold alternate causing chills and fevers similar to malaria, why do some occur daily and others every few days?”

Qibo replied: “This is due to the varying encounters of prevailing and returning qi. More yin and less yang results in longer intervals; more yang and less yin results in shorter intervals. The dynamics of excess and deficiency govern the symptoms.”

The Yellow Emperor remarked: “It’s said that cold diseases should be treated with hot medicines and hot diseases with cold medicines. Some hot diseases worsen with cold medicines and vice versa. How should these be treated?”

Qibo concluded: “When cold medicines worsen hot diseases, nourish the yin. When hot medicines worsen cold diseases, replenish the yang. This is the principle of treating by similarity. The essence lies in addressing the primary disorder while identifying the root cause. Initial treatment may seem aligned with the disease’s nature but yields contrasting results, dissolving stasis, harmonizing qi and blood, and curing the illness.”

The Yellow Emperor inquired: “What’s the principle of a three-tier prescription system?”

Qibo explained: “The primary drug targeting the disease is the Monarch; the assisting drugs are the Ministers and Assistants, not implying a hierarchical class. The three-tier system refers to the properties of the medicine—whether toxic or non-toxic.”

The Yellow Emperor asked: “How should diseases be treated internally and externally?”

Qibo responded: “The treatment of disease must distinguish between yin and yang, and whether it’s internal or external. Treat internal diseases internally, external diseases externally, adjust mild diseases, neutralize severe ones, and attack when the disease is strong. Use methods like sweating, purging, differentiating the nature of the pathogen as cold, hot, warm, or cool, guiding its retreat based on what benefits the condition. Adhering to these principles ensures comprehensive treatment, balancing qi and blood, and promoting longevity.”

The Yellow Emperor commended: “Well articulated.”