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*Suwen: Yujizhenzang Lun* (Plain Questions: Treatise on the True Visceral Manifestations of the Jade Machine)

The Qi of the Five Zang organs receives from the organ it generates, transmits to the organ it overcomes, stays in the organ that generates it, and dies at the organ that overcomes it. When a disease is about to cause death, it must first transmit to the organ that overcomes it (the organ it cannot control), and only then does the patient die. (Generally speaking, the pathological Qi of the Five Zang organs has a source of reception, a destination of transmission, a place of retention, and a cause of death. "She" (retention) means staying or halting. Receiving Qi from what it generates refers to receiving Qi from the offspring organ generated by itself. Transmitting to what it overcomes refers to transmitting to the organ it controls via the controlling cycle. Qi staying in what generates it refers to staying in the mother organ that generates itself. Dying from what overcomes it refers to dying due to the organ that controls it.) This describes the retrograde movement of Qi, which leads to death. (When one cannot overcome another, Qi moves retrogradely; hence it is called retrograde movement, and retrograde movement implies death.) For example, the Liver receives Qi from the Heart (its offspring), transmits it to the Spleen (the organ it overcomes), retains it in the Kidney (its mother), and dies when it reaches the Lung (the organ that overcomes it). (This elaborates on how the Qi of one Zang organ can pervade all other Zang organs. The Liver receives Qi from the Heart because the Heart is the offspring of the Liver, fulfilling the principle of "receiving Qi from what it generates." The Spleen is the organ overcome by the Liver, fulfilling the principle of "transmitting to what it overcomes." The Kidney is the mother of the Liver, so Qi stays here, fulfilling the principle of "Qi staying in what generates it." The Lung is the feared organ for the Liver (i.e., the one that overcomes it), so death occurs here, fulfilling the principle of "dying from what overcomes it.") The Heart receives Qi from the Spleen, transmits it to the Lung, retains it in the Liver, and dies when it reaches the Kidney. The Spleen receives Qi from the Lung, transmits it to the Kidney, retains it in the Heart, and dies when it reaches the Liver. The Lung receives Qi from the Kidney, transmits it to the Liver, retains it in the Spleen, and dies when it reaches the Heart. The Kidney receives Qi from the Liver, transmits it to the Heart, retains it in the Lung, and dies when it reaches the Spleen. All these are cases of retrograde transmission leading to death. (The meaning of retrograde death is as described above; below is the sequence of forward transmission.) Dividing a day and night into five parts allows one to predict the early or late time of death. (The five parts correspond as follows: morning governs Jia-Yi Wood, daytime governs Bing-Ding Fire, the last days of each season govern Wu-Ji Earth, dusk governs Geng-Xin Metal, and night governs Ren-Gui Water. This is the sequence of the Five Elements within a day. Since the Five Zang organs have overcoming relationships, this pattern determines the timing of life and death.) Huangdi said: The Five Zang organs are interconnected, and changes occur in a specific order. When diseases arise in the Five Zang organs, they transmit to the organs they overcome. (Transmitting to the organ it overcomes means, as stated later in this chapter, wind pathogen enters the Lung causing Fei Bi (Lung Bi), if untreated, the Lung transmits to the Liver causing Gan Bi (Liver Bi); if untreated, the Liver transmits to the Spleen causing Pi Feng (Spleen Wind); if untreated, the Spleen transmits to the Kidney causing Shan Jia (Hernia Mass); if untreated, the Kidney transmits to the Heart causing Chou Yuan (Convulsions/Spasms); if untreated, the Heart transmits back to the Lung, and according to the law, death ensues. See Disease Category 29, originally in the same chapter, for cross-reference.) If untreated, according to the law, death may occur in three months or six months, or in three days or six days, when the disease has transmitted through all Five Zang organs. (If a disease is not treated early, mutual transmission will inevitably occur. In distant cases, it takes three or six months; in near cases, only three or six days. Once all Five Zang organs are involved, death is inevitable according to the law. The numbers "three" and "six" relate to the rhythm of Heaven and Earth Qi, which uses six as a unit. For instance, Three Yin and Three Yang constitute the Six Qi; Six Yin and Six Yang constitute twelve months. Thus, the number of transmissions among the Five Zang organs also culminates in three and six. If transmission completes in three months, it is one Qi per Zang; if in six months, it is one month per Zang. If in three days, it is one Zang per day and night; if in six days, it is one Zang per day. Although there are only five Zang organs, transmission is counted up to six. For example, if the disease starts in the Lung (1st), transmits to the Liver (2nd), then to the Spleen (3rd), then to the Kidney (4th), then to the Heart (5th), and finally back to the Lung (6th), this is called "Six Transmissions." Once six transmissions are exhausted, no further transmission occurs. Hence, *Nanjing Chapter 53* states: "One Zang is not injured twice; the seventh transmission causes death." Furthermore, viewing the numbers three and six through the lens of Three Yin and Three Yang, three represents the combined number of Yin and Yang, while six represents the split number. Combined numbers involve the interaction of odd and even Qi, while split numbers involve different manifestations of male and female principles. Observing *Re Lun* (Treatise on Cold Damage): "Cold damage on the first day affects Taiyang; on the second day, Yangming; on the third day, Shaoyang; on the fourth day, Taiyin; on the fifth day, Shaoyin; on the sixth day, Jueyin." This also reflects the number six. However, if two meridians are affected daily, known as "Lianggan" (Double Contraction), it reflects the number three. Wang Bing (Qixuanzi) commented: Three months refer to the migration of a year. Six months refer to reaching the position of the overcome element. Three days refer to combining the number of Three Yang with days. Six days refer to including Three Yin in the count. These also align with the meaning of three and six. Therefore, some patients recover after seven days because their True Yuan (True Origin) Qi was not severely damaged, allowing the meridians to restore their Qi after the completion of six transmissions, thus enabling survival. The *I Ching* says: "Seven days to return," which is the movement of Heaven. The principle is identical.) This is the sequence of forward transmission to the overcome organs. (The "retrograde" mentioned above refers to the state of Zang Qi. Because the Five Zang organs are overcome, their Qi becomes turbulent, hence called retrograde movement. The "forward" mentioned here refers to disease transmission. Whenever transmission occurs to the overcome organ, it follows a specific order, hence called forward transmission. This forward transmission is actually retrograde Qi movement; therefore, those whose Five Zang organs have fully transmitted should die.) It is said: Differentiating Yang allows one to know the origin of the disease; differentiating Yin allows one to know the period of life and death. (Yang refers to the exterior, i.e., external signs; Yin refers to the interior, i.e., Zang Qi status. When pathogens invade the body, they necessarily manifest externally. By observing external signs, one can determine which meridian is affected; thus, differentiating Yang reveals the disease's origin. When disease damages Zang Qi, it necessarily destroys True Yin. By observing the root, one can determine the day of danger; thus, differentiating Yin reveals the timing of life and death. Here, Yin and Yang are discussed in terms of interior and exterior. As stated in *Yinyang Bie Lun*: "What is called Yin is the True Zang manifestation; its appearance indicates failure, and failure leads to death. What is called Yang is the Stomach Qi." Differentiating Yang locates the disease; differentiating Yin predicts life and death. Here, Yin and Yang are discussed in terms of pulse diagnosis. See Pulse and Color Category 26 for details.) This speaks of knowing that death occurs when the disease reaches the point of being trapped (overcome). (Dying when trapped means dying from the organ that overcomes it. Whether considering years, months, days, or hours, the signs remain the same.)