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(Su Wen: Yin Yang Ying Xiang Da Lun)

Therefore, when pathogenic wind arrives, it is as swift as wind and rain. (When pathogenic wind invades the human body, it is rapid to this extent.) Thus, a skilled healer treats at the level of the skin and hair, (The skin and hair are superficial; less effort is required and success is easily achieved.) next at the level of muscles and skin, (Deeper than the skin and hair.) next at the level of sinews and vessels, (Deeper than the muscles and skin.) next treating the Six Fu Organs, (Deeper than the sinews and vessels.) and finally treating the Five Zang Organs. To treat diseases of the the Five Zang Organs means that half will die and half will survive. (Because the pathogen has penetrated deeper into the Six Fu Organs. The deeper the pathogen, the harder it is to cure; if treatment begins only after the pathogen has reached the Five Zang Organs, it will inevitably be difficult to exert force, hence it is said that superior physicians intervene at the sprouting stage, while inferior physicians intervene when the disease is established. Intervening when the disease is established requires much effort but yields little success, with good and bad outcomes being equal. The Miao Ci Lun states: When pathogenic factors lodge in the form, they must first stay in the skin and hair; if they remain and do not depart, they enter the meridians, connect internally with the Five Zang Organs, and scatter into the intestines and stomach. Yin and Yang interact, causing injury to the Five Zang Organs. This also states that pathogens travel from the skin and hair to the fu and zang organs, which shares the same meaning as here.)

Thus, pathogenic qi from Heaven, upon invasion, harms the Five Zang Organs; cold and heat from water and grain, upon invasion, harm the Six Fu Organs; (Pathogenic qi from Heaven refers to the six external pathogenic factors: Wind, Cold, Summer-heat, Dampness, Fire, and Dryness, which are received formlessly. The throat governs Heavenly Qi and connects with the Zang Organs, so invading Heavenly Qi harms the Five Zang Organs. The cold and heat of water and grain refer to the flavors and odors of food, which are received materially. The pharynx governs Earthly Qi and connects with the Fu Organs, so invading water and grain pathogens harms the Six Fu Organs.) Dampness from Earth, upon invasion, harms the skin, flesh, sinews, and vessels. (The part of humans corresponding to Earth is flesh; when Dampness prevails, Ying and Wei Qi fail to circulate, so invading Earthly Dampness harms the skin, flesh, sinews, and vessels.)

Therefore, those skilled in acupuncture can draw from Yin to guide Yang, from Yang to guide Yin, treat the right side using the left, treat the left side using the right, know the other through oneself, know the interior through the exterior, observe the principles of excess and deficiency, perceive subtle signs to identify errors, and thus apply these methods without danger. (Those skilled in acupuncture must examine Yin and Yang. The meaning of Yin and Yang is not limited to one aspect; for example, there are distinctions in exterior-interior, Qi-Blood, meridians, Zang-Fu organs, upper-lower, and left-right, as well as in the waxing and waning of time. "Drawing from Yin to guide Yang" means treating the Yin aspect when the disease is in the Yang aspect. "Drawing from Yang to guide Yin" means treating the Yang aspect when the disease is in the Yin aspect. "Treating the right side using the left, and the left side using the right" refers to the method of Miao Ci (Mirror Needling). "Knowing the other through oneself" means inferring others' conditions from one's own. "Knowing the interior through the exterior" means seeking internal evidence through external manifestations. By observing the principles of excess and deficiency in this way, subtle signs become visible, errors can be measured, and application will be free from peril. Measure refers to judgment.)

Those skilled in diagnosis observe complexion and palpate pulses, first distinguishing Yin and Yang; (The following all discuss diagnostic methods. The term "diagnosis" covers a wide range, including examining the clarity and turbidity of complexion, knowing the location of the disease, observing breathing, listening to voice sounds, and observing the balance of pulse qualities. These are all diagnostic methods, not merely referring to pulse diagnosis, but all aim to distinguish Yin and Yang. The previous section discussed Yin and Yang in acupuncture treatment, while this section discusses Yin and Yang in pulse and complexion, both being the most critical aspects for physicians. Hence, it is said to first distinguish Yin and Yang, emphasizing its urgency. For detailed meanings, see chapters on Pulse and Complexion.) Examine the clarity and turbidity of complexion to know the disease location; (Complexion is the brilliance of Shen Qi, so by observing facial complexion and examining clarity and turbidity, one can know the disease location, as stated in the Wu Se Pian. Additionally, Zhang Zhongjing's Jin Gui Yao Lue states: Pathological colors appear on the face. If the tip of the nose is green, abdominal pain and cold indicate death; if slightly black, there is fluid retention; if yellow, there is cold above the chest; if white, there is loss of blood. If slightly red out of season, it indicates death. Green indicates pain, black indicates exhaustion, red indicates wind, yellow indicates difficulty in defecation, and bright colors indicate retained fluids. This is also what is meant here.) Observe breathing and listen to voice sounds to know the patient's suffering; (Suffering is internal, but sound emanates externally, so one can know the suffering by observing breathing and listening to voice sounds. As stated in the Yin Yang Ying Xiang Da Lun: The Liver corresponds to the Jue note and calling sound; the Heart to the Zhi note and laughing sound; the Spleen to the Gong note and singing sound; the Lung to the Shang note and crying sound; the Kidney to the Yu note and groaning sound. These are the sounds of the Five Zang Organs. Disordered sounds indicate disease. Zhang Zhongjing says: Patients whose speech is silent but who startle easily have disease in the joints. Those whose speech is hoarse and obstructed have disease in the heart and diaphragm. Those whose speech is fine and long have disease in the head. He also says: Shoulder movement during breathing indicates fullness in the heart; drawing breath upward from the chest indicates cough; open-mouthed shortness of breath indicates Fei Wei (Lung Withering) with salivation. He also says: Slight rapidity in inhalation indicates excess in the Middle Jiao, which should be purged to heal; deficiency cases are difficult to treat. Involuntary rapid inhalation indicates Upper Jiao disease; distant inhalation indicates Lower Jiao disease; all are difficult to treat. Trembling during respiration indicates incurable disease. He also says: If a patient lies facing the wall, does not rise or look up upon the doctor's arrival, speaks intermittently, and swallows saliva when the pulse is taken, this is feigned illness. If the pulse is harmonious, the patient claims severe illness requiring emetics, purgatives, and extensive acupuncture, but will heal spontaneously. Yawning during pulse taking indicates health. Groaning during pulse taking indicates pain. Slow speech indicates Wind. Shaking the head while speaking indicates internal pain. Slow walking indicates exterior stiffness. Sitting and bending forward indicates shortness of breath. Sitting with one leg extended indicates lower back pain. Protecting the abdomen as if holding an egg indicates Heart pain. He also asks: What is the pulse shape in fear? The doctor replies: The pulse feels like threads, and the face is pale. He also asks: What is the pulse shape in shame? The doctor replies: The pulse is floating, and the face alternates between white and red. All these are the sounds and colors of disease. Sound originates from Qi; abundant Qi makes sound strong, deficient Qi makes sound weak. Hua Yuanhua said: Yang syndromes involve much talking, Yin syndromes involve silence; those who talk easily are easier to save, those who are silent are harder to sustain. Thus, sounds reveal not only suffering but also life and death.) Observe the balance of weights and measures (Quan Heng Gui Ju) to know the main focus of the disease; (The meaning of Quan Heng Gui Ju is detailed in Chapter 9 of Pulse and Complexion, where it refers to pulses. However, these four concepts encompass much more than just pulses. "Quan" refers to weight/heaviness, "Heng" to lightness/balance, "Gui" to roundness/circle, and "Ju" to square/right angle. Understanding the principles of round/square and heavy/light allows one to grasp the way of adaptation.) Palpate the Cun and Chi positions, observe floating, sinking, slippery, and choppy qualities, to know the origin of the disease and treat accordingly; (Meanings detailed in chapters on Pulse and Complexion.) Without deviation in diagnosis, there will be no error. (The term "diagnosis" here corresponds to the earlier "skilled diagnosis." Deviation means error. It means that if one does not deviate from the aforementioned diagnostic methods, treatment will also be free from error.)

It is said: At the beginning of a disease, acupuncture alone may suffice; when the pathogen is vigorous, wait for it to decline before stopping treatment. (The following discusses treatment methods. For newly onset diseases, pathogens are in the meridians, so acupuncture suffices. Once the pathogen is vigorous, one must wait for the vigorous phase to subside before ceasing treatment. "Cease" refers to stopping needles or medicine, implying the concept from the Wu Chang Zheng Da Lun of removing eight-tenths or nine-tenths of the pathogen.)

Therefore, for mild pathogens, use dispersing methods; for heavy pathogens, use reducing methods; for declining pathogens, use reinforcing methods. (Mild pathogens float on the exterior, so dispersing is appropriate. "Disperse" means to scatter. Heavy pathogens are solid in the interior, so reducing is appropriate. "Reduce" means to purge. Declining pathogens indicate Qi and Blood deficiency, so reinforcing is appropriate. "Reinforce" means to nourish and restore Qi and Blood. Through these three, the treatments for exterior-interior and deficiency-excess are fully covered.)

For insufficiency of Form, warm with Qi; for insufficiency of Essence, tonify with Flavor. (This precisely explains the method of "reinforcing," relying on the flavors and odors of medicines and foods. Regarding Form and Essence, Form is Yang, Essence is Yin. Regarding Odor and Flavor, Odor is Yang, Flavor is Yin. Yang protects the exterior and secures it; Yin stores Essence and responds urgently. Insufficiency of Form is a decline of Yang; without Odor, it cannot reach the exterior to warm. Insufficiency of Essence is a decline of Yin; without Flavor, it cannot fill the interior to tonify. Yang is warm, hence "warm"; Yin is quiet, hence "tonify." Note: The original text states "Flavor returns to Form, Form eats Flavor, Odor returns to Essence, Essence eats Odor," yet here it says "Form insufficiency warmed by Odor, Essence insufficiency tonified by Flavor," which seems contradictory. However, Form is formed by Essence, Essence is transformed by Odor, Odor is generated by Flavor, and Flavor moves with Odor. From the perspective of Yin-Yang, Form and Odor are both Yang, so they can be warmed; Flavor and Essence are both Yin, so they can be tonified. From the perspective of Clear-Turbid, Flavor and Form are both Turbid, so Flavor returns to Form; Odor and Essence are both Clear, so Odor returns to Essence. Nevertheless, Odor cannot exist without Flavor, nor Flavor without Odor; although Odor and Flavor have Yin-Yang and Clear-Turbid distinctions, they are actually mutually dependent.)

For pathogens high in the body, induce vomiting; (Vomit means to raise and disperse. Inducing vomiting can treat exterior-interior diseases in the upper body.) For pathogens low in the body, guide and drain them; (Drain means to eliminate. Purging and promoting drainage can treat anterior-posterior diseases in the lower body.) For fullness in the center, purge internally; (The term "Zhong Man" [Central Fullness] requires careful examination; it refers to stagnation, fullness, excess, and hardness, so internal purging is indicated. If edema appears externally but fullness is not internal, it is not Zhong Man; reckless purging will cause harm. The key to this section lies in the character "Zhong" [Center].) For pathogens present, soak the form to induce sweating; (Pathogens are in the muscle-skin layer, so soaking the body to induce sweat is appropriate. "Soak" means immersion, causing sweat as if immersed. For example, Xu Yinzong placed large amounts of Huang Qi Fang Feng Tang under the bed to steam sweat, Zhang Miao heated the floor and added peach leaves to steam sweat, or used herbal decoctions for bathing; all are methods of soaking the form. Soak, pronounced 'zi', fourth tone.) For pathogens in the skin, release via sweating; (The previous mention of "pathogens present" included meridians, indicating depth. This mention of "in the skin" indicates shallowness. Both are exterior syndromes, so sweating is appropriate.) For fierce and urgent pathogens, press and restrain them; (Urgent means rapid. Fierce means aggressive. Press means examine. This applies to both exterior and interior; for aggressive pathogens, pressing reveals their latent nature, allowing them to be restrained. Urgent, pronounced 'piao' or 'piao'. Fierce, pronounced 'han'.) For excess conditions, disperse and purge. (Yang excess should be dispersed. Yin excess should be purged.) Examine Yin and Yang to distinguish soft and hard, (Syndromes have soft and hard characteristics; pulses and complexions have soft and hard characteristics; flavors and odors especially have soft and hard characteristics. Soft belongs to Yin, Hard belongs to Yang. Knowing the transformation of soft and hard means understanding the subtle functions of Yin and Yang, so one must examine and distinguish them.) Treat Yin diseases by addressing Yang, and Yang diseases by addressing Yin, (If Yang prevails, Yin must suffer; if Yin prevails, Yang must suffer. As stated in the Zhen Yao Yao Da Lun: For heat unrelieved by cold treatments, seek the Yin; for cold unrelieved by hot treatments, seek the Yang. Qixuanzi said: Strengthen the master of Water to control the sunlight; benefit the source of Fire to dissipate the yin shadows. These are the principles of treating Yin diseases by addressing Yang, and Yang diseases by addressing Yin. They also reflect the meaning of drawing from Yin to guide Yang, and from Yang to guide Yin mentioned earlier.) Stabilize Qi and Blood, keeping each in its proper place, (Diseases may be in the Blood aspect or the Qi aspect; one must observe their respective locations and avoid confusion.) For Blood excess, decant it; (Decant means to drain the blood, like draining water.) For Qi deficiency, lift and guide it. ("Lift and guide," written as 'Che' in the Jia Yi Jing, means to pull back. Qi deficiency is a gradual loss of Qi; without Qi, death ensues, so one must retrieve and guide Qi back to recovery. For example, rising Qi deficiency is lifted and raised; falling Qi deficiency is gathered and returned; central Qi deficiency is warmed and tonified. All these embody the meaning of lifting and guiding.")