Library

Shao Yu said: The onset of various diseases must originate from wind, rain, cold, and heat. These pathogens enter through the hair follicles into the Couli (the interstices of the skin and muscle where Qi and blood circulate). They may return to the interior, remain stagnant, manifest as wind-induced edema with sweating, develop into Xiao Dan (wasting-thirst disorders similar to diabetes), present as alternating chills and fever, become chronic febrile conditions (Liu Dan), or form accumulations and masses (Ji Ju). Errant pathogens overflow in countless ways. Even when exposed simultaneously, some fall ill with one condition while others with another; this is not because Heaven shows favoritism toward the wind. Those who are exposed fall ill; those who avoid it remain safe. It is not that people actively seek out pathogens, but rather they inadvertently offend them due to negligence. (Danger refers to peril. Heaven does not seek to harm people, but people harm themselves through lack of caution, which explains why some have few illnesses and others many.) Consider a carpenter sharpening axes and knives to chop wood. Based on Yin and Yang properties, wood varies in hardness and brittleness. Hard wood resists cutting, while brittle wood causes the skin to slacken; at the knots, the axe head may chip. Within a single tree, hardness and brittleness differ; hard wood is tough, while brittle wood is easily damaged. How much more so for different types of wood, varying in bark thickness and sap content? (This metaphor of wood quality illustrates human constitutional endowment.) Trees that flower early and leaf out first will lose their flowers and wither leaves when encountering spring frost and fierce winds. Under prolonged sun exposure and drought, brittle trees with thin bark suffer from reduced sap in branches and withered leaves. During prolonged rainy seasons, trees with thin bark and abundant sap suffer from peeling bark and oozing fluids. When sudden storms arise, both hard and brittle trees suffer broken branches and damage. In autumn frost and gales, even hard and brittle trees experience root disturbance and leaf fall. All five scenarios cause specific damages; how much more so for humans! (This illustrates that just as tree decay has specific causes, human diseases also have distinct etiologies. "Wu" refers to a stump without branches.) Tree injuries primarily affect the branches; the hardness, brittleness, or firmness of branches indicates potential vulnerability before actual damage occurs. Humans often suffer from specific diseases because their joints, skin, and Couli are not robust enough, providing a dwelling place for pathogens, thus making these areas prone to disease. (Just as wood has hardness and brittleness leading to varying degrees of injury, humans have constitutionally strong and weak parts leading to varying severity of illness. Therefore, even when exposed to wind simultaneously, susceptibility differs, explaining the variation in diseases.) How can we diagnose those prone to Feng Jue (wind reversal) and profuse sweating? (When wind pathogens disrupt the Couli, causing continuous dripping sweat, the condition is named Feng Jue.) If muscles are not firm and Couli are loose, one is prone to wind diseases. How can we assess if muscles are not firm? Muscles that are not firm and lack clear striations have coarse texture; coarse texture combined with non-tight skin indicates loose Couli. This describes the general state. (The popliteal fossa, specifically the Weizhong acupoint [BL40] of the Foot-Taiyang Bladder Meridian, is the confluence of valleys. Thus, coarse texture and loose skin here indicate loose Couli throughout the body.) How can we diagnose those prone to Xiao Dan? Individuals with weak Zang organs are prone to Xiao Dan. How do we know if the Zang organs are weak? Weakness in the Zang organs is often accompanied by a strong-willed temperament; those who are strong-willed tend to anger easily, and their weak constitutions are susceptible to injury. (Individuals with a harsh temper but weak muscles are prone to injury and thus susceptible to Xiao Dan.) How can we distinguish between weakness and strength? Such individuals have thin skin, deep and firm eyes, straight and upward-gazing gaze, and a rigid heart/mind. (Thin skin implies weak muscles; firm, direct, and upward gaze implies a rigid mind. "Chong" refers to protruding or intense gaze.) Rigidity leads to frequent anger; anger causes Qi to rebel upward, accumulating in the chest, causing Qi and Blood to stagnate and reverse, leading to distended skin and tense muscles. If blood vessels fail to circulate properly, stagnation transforms into heat, which consumes flesh and skin, resulting in Xiao Dan. This characterizes individuals who are outwardly aggressive and rigid but inwardly muscularly weak. (Anger causes Qi rebellion; Qi rebellion causes Blood stagnation, leading to郁 heat formation and eventually Xiao Dan.) How can we diagnose those prone to alternating chills and fever? Individuals with small bones and weak muscles are prone to chills and fever. (Bones belong to the Kidney, and muscles belong to the Spleen, both being locations of extreme Yin. Yin deficiency allows Yang pathogens to invade easily, hence susceptibility to chills and fever.) How can we assess bone size, muscle firmness, and complexion variations? The zygomatic bone is the root of the skeletal structure. Large zygomatic bones indicate large skeletal frames; small zygomatic bones indicate small frames. (The cheekbone below the eye is the zygoma; overall skeletal size can be assessed here.) Thin skin, lack of firm muscle nodules, flaccid arms, and a dull, muddy complexion that differs from the natural sky-like clarity are diagnostic signs. (Refers to firm muscle aggregations. "Nuoruoruan" describes a flaccid appearance. Earthly Qi is turbid and Yin, Heavenly Qi is clear and Yang. A physical color that is excessive yet lacks spiritual luster indicates a mismatch between earthly and heavenly qualities; thus, the dull and muddy appearance signifies differences in muscle firmness and color, allowing assessment of strength and weakness.) Furthermore, individuals with thin arms have insufficient marrow, making them prone to fluctuating chills and fever. (Marrow fills the bones and is the essence of Yin. Insufficient marrow predisposes one to chills and fever.) How can we diagnose susceptibility to Bi syndrome (obstruction)? Individuals with coarse texture and unfirm muscles are prone to Bi syndrome. (Unfirm muscles allow Wind, Cold, and Damp pathogens to invade easily.) To determine the location of the pathology, observe each body region separately. (Upper/lower, left/right, and excess/deficiency vary naturally, so each region must be observed individually.) How can we diagnose those prone to intestinal accumulations? Thin, lusterless skin and unfirm, moist/soggy muscles indicate poor gastrointestinal function. Poor GI function allows pathogens to linger and accumulate, damaging the Spleen and Stomach area. Irregularities in cold and warmth within the gut allow even slight pathogenic invasion to lead to stagnation and mass formation. (Thin skin indicates unfirm muscles. Lack of luster indicates Blood deficiency. Moisture/sogginess indicates Damp stagnation. This reflects weak GI constitution and deficient Qi/Blood endowment, allowing external or internal pathogens to linger, or irregular thermal conditions in the gut to provoke pathogenic accumulation and mass formation.) To predict the timing, establish the annual climate cycle. Favorable cycles (Sheng/Wang) promote recovery ("Qi" means arising/recovery); unfavorable cycles (Shuai/Ke) indicate danger. (Establishing the year reveals the ruling Wu Yun Liu Qi. Encountering generating/prosperous phases favors recovery; encountering weakening/clashing phases indicates peril.) Even without unfavorable phases, if the annual cycle involves clashing or penetrating Qi, the disease will likely emerge. This is called "disease arising from constitution," the principle of the Five Transformations. (Even without clashing/downward phases, annual Qi clashes allow Qi to penetrate, triggering disease. This differs from the previous section's "arising." For example, though Fire fears Water and Wood fears Metal, if Fire prevails, Water suffers; if Wood prevails, Metal suffers. Thus, a Metal-type person may fall ill in Ding-Ren years, and a Wood-type person in Jia-Ji years. This is disease arising from constitution, the core of the Five Transformations.)