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(From the chapter "Shun Qi Yi Ri Fen Wei Si Shi" of *Ling Shu*)

Huangdi said: The origin of all diseases must arise from external factors such as dryness, dampness, cold, heat, wind, and rain; internal factors such as yin-yang imbalance and excessive emotions (joy and anger); and lifestyle factors such as improper diet and living conditions. When these pathogenic factors combine with the body's qi, they form tangible pathological changes; when they reside within the zang-fu organs, they acquire specific names. I understand this to be the case.

However, why do many diseases manifest with lucidity in the morning, stability during the day, exacerbation in the evening, and severity at night? (Dryness, dampness, cold, heat, wind, and rain are exogenous pathogens. Yin-yang imbalance, emotional excesses, dietary irregularities, and improper living habits constitute endogenous injuries. The combination of qi and pathogens forms tangible disease, which can be evidenced by pulse and symptoms. Disease attribution to zang-fu organs allows for the observation of interior and exterior relationships. Although diseases vary, the pattern of morning lucidity, daytime stability, evening exacerbation, and nighttime severity is common to many diseases due to similar underlying mechanisms.)

Qibo replied: This is caused by the influence of the seasonal qi.

Huangdi said: I wish to hear about the qi of the four seasons.

Qibo said: Spring generates, Summer grows, Autumn harvests, and Winter stores; this is the normal course of climatic qi. (Spring generation is due to the rising of Yang qi; Summer growth is due to the flourishing of Yang qi; Autumn harvesting is due to the descending of Yang qi; Winter storing is due to the hiding of Yang qi. This regularity of qi is described in terms of Yang qi.) Humans also respond to this, dividing one day into four seasons: morning corresponds to Spring, midday to Summer, sunset to Autumn, and midnight to Winter. (The interaction between Heaven and Earth, and the sequence of the four seasons, are fully expressed through the ascending and descending of Yin and Yang. After Zi hour, Taiyang [Governing Vessel/Solar Qi] rises from the left, rising constitutes Yang; after Wu hour, Taiyang descends from the right, descending constitutes Yin. Whether on a grand scale of a year or a small scale of a day, this principle applies universally; thus, one day can also be divided into four seasons.) In the morning, Ying qi [Nutritive Qi] begins to generate, and pathogenic qi declines, hence lucidity in the morning. At midday, Ying qi grows strong; being strong allows it to overcome pathogenic qi, hence stability during the day. In the evening, Ying qi begins to decline, and pathogenic qi begins to proliferate, hence exacerbation. At midnight, Ying qi enters the zang-fu organs, leaving pathogenic qi to dominate the body alone, hence severity. (In the morning, the sun is in the Yin-Mao positions, rising from below; corresponding to the human body, Yang qi is ascending, so pathogenic qi declines and there is morning lucidity. At midday, the sun is in the Si-Wu positions, moving from east to center; corresponding to the human body, Yang qi is flourishing, so it can overcome pathogenic qi and there is daytime stability. In the evening, the sun is in the Shen-You positions, declining from center to west; corresponding to the human body, Yang qi begins to decline, so pathogenic qi gradually becomes dominant and the condition worsens at dusk. At midnight, the sun is in the Xu-Hai positions, descending from above; corresponding to the human body, Yang qi is hidden, while pathogenic qi is vigorous, so the condition is severe at night. Generally, the severity of pathogenic qi depends on the strength of Zheng qi [Upright Qi]. Zheng qi is Yang qi. Ascending follows the Yang path, leading to life; descending follows the Yin path, leading to death. The qi of Heaven and Humanity is essentially one.)

Huangdi said: Why are there cases that contradict this? ("Contradict" refers to situations not following the aforementioned explanation.)

Qibo said: This occurs because the disease does not follow the general laws of seasonal qi but is dominated exclusively by a specific zang organ. Such diseases will inevitably worsen during the time element that overcomes the zang organ's qi and improve during the time element that the zang organ's qi overcomes. (When not responding to seasonal qi, the zang organ's qi exclusively dominates the disease, involving mutual overcoming relationships. "Overcome by" (the element that controls me), for example, Spleen disease fears Wood qi, Lung disease fears Fire qi, Kidney disease fears Earth qi, Liver disease fears Metal qi, and Heart disease fears Water qi; encountering these times causes the disease to worsen. "Overcomes" (the elements controlled by me), for example, Spleen disease favors Fire and Earth qi, Lung disease favors Earth and Metal qi, Kidney disease favors Metal and Water qi, Liver disease favors Water and Wood qi, and Heart disease favors Wood and Fire qi; encountering these times causes the disease to improve.)

Huangdi said: How should it be treated?

Qibo said: By conforming to the timing of Heaven, the prognosis of the disease can be predicted. Those who conform are skilled physicians; those who oppose are crude physicians.

Huangdi said: Excellent. (Those who conform to Heaven's timing, understanding the deficiency and excess of Yin and Yang based on the rise and fall of seasonal climate, can predict the auspiciousness or inauspiciousness of the disease; this is the act of the wise. Crude physicians invert right and wrong, treating symptoms as root causes, merely opposing the natural order; how could they possibly understand this?)