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*Ling Shu: Shi Chuan Pian* (The Master's Transmission Chapter of the Spiritual Pivot)

Huang Di said: I have heard from my predecessors that they kept certain knowledge in their hearts, but did not record it in medical formulas. I wish to hear you explain it so that I may treasure it, follow its principles, and put them into practice. By doing so, I can govern the people above and cultivate myself below, ensuring that the common people are free from disease, that there is harmony and closeness between superiors and inferiors, that virtue flows downward, and that descendants live without worry. May this be passed down to future generations without end. Could you please tell me?

Qi Bo replied: Your question is profound indeed. Whether governing the people or oneself, governing others or oneself, managing small matters or great ones, ruling a state or a family, there has never been one who could achieve order by going against the will. It is only through compliance (Shun) that success is achieved. Compliance is not merely about the adherence or deviation of Yin-Yang pulses and Qi; rather, the common people all desire that their wishes be followed. (The utility of compliance is the crux of the physician's art. If words do not comply, the Dao cannot be implemented; if will does not comply, merit cannot be accomplished. Even in cases where absolute compliance is impossible, it is rarely the case that compliance is not used to facilitate the outcome. Alas! Only those who can expand and contract within the realm of compliance and non-compliance are scholars versed in transformation; otherwise, they are insufficient to discuss the Dao.)

Huang Di asked: How should one practice compliance?

Qi Bo answered: When entering a country, inquire about its customs; when entering a home, inquire about its taboos; when ascending the hall, inquire about its etiquette; when facing a patient, inquire about what brings them comfort. (The *Book of Rites* states that upon entering a country, one should inquire about its prohibitions, whereas here we speak of inquiring about customs. This is because the winds and climates of the five directions differ, and preferences vary. The Sage must treat according to what is appropriate, hence we say "customs" rather than "prohibitions." Taboos refer to things to be avoided. Human emotions have biases in likes and dislikes, and speech and expression require avoidance of suspicious topics. Offending these leads to hatred, and hatred prevents harmony; thus, when entering a home, one must ask about taboos. Etiquette refers to ceremonial forms. Interactions have propriety, and movements have measure. Losing these leads to being slighted, and being slighted diminishes the weight of the Dao; thus, when ascending the hall, one must ask about etiquette. "Comfort" (Bian) means appropriateness. There is appropriateness in dwelling, in movement and stillness, in Yin and Yang, in cold and heat, in temperament, and in flavors. If, when attending to a patient, one loses sight of appropriateness, treatment will inevitably clash. Therefore, one must ask what the patient finds comfortable. These are all ways to achieve compliance.)

Huang Di asked: How does one accommodate the patient's needs?

Qi Bo answered: Those with internal heat or Xiao Dan (Wasting-Thirst syndrome) benefit from cold therapies; those with internal cold benefit from warm therapies. (The following sections describe the appropriate treatments for various conditions. "Zhong Re" (Internal Heat) refers to heat residing within the body. "Xiao Dan" refers to excessive internal heat causing Dan syndrome, characterized by hunger, thirst, and daily emaciation. Generally, if heat is internal, treatment should favor cold; if cold is internal, treatment should favor warmth. These are all methods of complying with the disease condition. *Dan* is pronounced Dan, and also read as Shangsheng and Qusheng.)

Heat in the Stomach causes rapid digestion of food, leading to a sensation of emptiness in the heart and frequent hunger. ("Rapid digestion" means food is easily digested. "Empty heart" refers to the upward flaming of Stomach Fire, which scorches Heart Blood, causing a lingering sense of unease. Because Stomach heat digests food rapidly, it causes frequent hunger.)

If the skin above the navel is hot, and there is heat in the Intestines, the stool will be yellow and mushy like porridge. (The area above the navel corresponds to the Stomach and Small Intestine. Thus, heat on the skin above the navel indicates heat in the intestines. Yellow, mushy stool results from damp-heat in the Stomach transmitting to the Small Intestine. *Mi* means rotting/mushy. The previous two sections are examples of heat syndromes benefiting from cold.)

If the skin below the navel is cold, and there is cold in the Stomach, abdominal distension occurs; if there is cold in the Intestines, borborygmus and Sund Xie (undigested food diarrhea) occur. (Cold skin below the navel is due to cold in the Stomach and Intestines. Cold in the Stomach impairs transformation and transportation, leading to abdominal distension. Cold in the Intestines causes Yin Qi to stagnate, preventing the separation of clear and turbid substances, leading to borborygmus and Sund Xie. These are examples of cold syndromes benefiting from warmth. *Sun* is pronounced Sun. Undigested food in stool is called Sund Xie.)

If there is cold in the Stomach and heat in the Intestines, there will be both distension and diarrhea. (The text previously mentioned that cold in the Intestines causes diarrhea, while here it states that heat in the Intestines also causes diarrhea. Thus, there are differences between heat-diarrhea and cold-diarrhea. Heat-diarrhea is called Chang Gou (Intestinal Filth), and cold-diarrhea is called Wu Tang.)

If there is heat in the Stomach and cold in the Intestines, there will be rapid hunger and pain/distension in the lower abdomen. (Heat in the Stomach promotes rapid digestion, causing rapid hunger. Cold in the Intestines causes Yin Qi to cluster and fail to move, resulting in cutting pain and distension in the lower abdomen. The previous two sections indicate that one should regulate based on the specific cold or heat present.)

Huang Di asked: The Stomach desires cold drinks, and the Intestines desire hot drinks. These two desires are contradictory. How should one accommodate them? Furthermore, kings, dukes, and nobles, who consume rich foods and meat, are arrogant and indulge their desires. They look down on others and cannot be restrained. Restraining them goes against their will, but accommodating them worsens their illness. How should one accommodate them? What should be treated first? (Those with heat in the Stomach desire cold drinks, and those with cold in the Intestines desire hot drinks. The urgency of treatment requires a sequence, but conflicting desires are hard to satisfy simultaneously. Moreover, nobles often act willfully, making compliance difficult. Treatment must therefore have a method. *Cong* is synonymous with *Zong*, meaning to indulge.)

Qi Bo answered: Human nature is such that no one dislikes death and loves life. Tell them of the consequences of their actions, speak to them of the benefits, guide them toward what is comfortable for them, and open up avenues to relieve their suffering. Even among the unprincipled, is there anyone who would not listen? (Disliking death and loving life is universal. Thus, moving them with the reality of life and death ensures that their likes and dislikes can be shifted. This aligns with the earlier note regarding handling compliance and non-compliance by leveraging compliance to achieve the goal. The first *E* is pronounced Qusheng, and the second *E* is pronounced Pingsheng.)

Huang Di asked: How specifically should one treat them?

Qi Bo answered: In Spring and Summer, treat the Biao (Branch/Surface) first, then the Ben (Root/Interior); in Autumn and Winter, treat the Ben first, then the Biao. (This states that treatment follows fixed laws and cannot simply accommodate private desires arbitrarily. Thus, the principle of treating Biao and Ben is cited as a general overview. For instance, in Spring and Summer, Qi expands outward, so diseases manifest externally. The exterior is the Biao of the interior, so treat the Biao first, then the Ben. In Autumn and Winter, Qi contracts inward, so diseases reside internally. The interior is the Ben of the exterior, so treat the Ben first, then the Biao. Another interpretation: In Spring and Summer, when growth occurs, it is appropriate to first nourish Qi to treat the Biao. In Autumn and Winter, when storage occurs, it is appropriate to first consolidate Jing to treat the Ben. This is also valid.)

Huang Di asked: How should one accommodate mutually contradictory needs? (Accommodating contradictory needs refers to situations where, amidst circumstances that cannot be fully complied with, one must tactfully accommodate the patient's feelings.)

Qi Bo answered: To accommodate such cases, clothing and diet should adapt to cold and warmth. In cold weather, avoid shivering; in summer heat, avoid profuse sweating. Regarding diet and drink, avoid extremes of scalding heat or freezing cold. Maintain a moderate balance of cold and warmth, so that Yuan Qi (Original Qi) is preserved, and pathogenic deviations do not arise. (*Shi* means appropriate. This explains that when one must accommodate a patient's desires out of necessity, one seeks appropriateness within that accommodation. For example, regarding clothing, if the law dictates against cold but the patient desires it, allow only slight cold, avoiding shivering. If the law dictates against heat but the patient desires it, allow only slight heat, avoiding sweating. Similarly, for food, if they desire heat, do not make it scalding; if they desire cold, do not make it freezing. If cold and heat are balanced, Yuan Qi is maintained, and pathogenic deviations have no entry. This is the application of the Dao of compliance. Otherwise, whether governing the people or oneself, others or self, small or large matters, state or family, there has never been one who could achieve order by opposing the will. Hence, it is said that only compliance matters. *Chuang* is pronounced Chuang. *Qichuang* describes a severe, desolate cold. *Cang* is pronounced Cang, meaning cold. *Pi* is pronounced Pi, meaning improper.)