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The term "Bu" (Distribution) refers to Qi spreading throughout the body; the term "Zhong" (End) refers to the dissipation of Qi transformation. When Qi exists, life continues; when Qi is exhausted, death occurs. Between Heaven and Earth, there is only one Qi.) However, the nourishment derived from the Five Flavors varies in thickness and density during generation and transformation, and maturity differs in quantity. The beginning and end are not the same; what is the reason for this? Qibo said: This is controlled by Earthly Qi. It is not that Heaven does not generate, but that Earth does not grow. (Commentary: The generation of humans and all things indeed takes Heavenly Qi as its beginning and end, but the physical body of living beings actually relies on Earthly Qi for growth and nourishment. Therefore, generation and transformation belong to Heaven. Where Heavenly Qi reaches, it should theoretically be uniform, yet differences in thickness, density, and quantity exist. This is not because Heaven's generation of things differs, but likely due to differences in Earth's conditions for growth and nourishment. The following text explains the principle of Earth not growing.) The Emperor said: I wish to hear the principle behind this. Qibo said: The transformations of Cold, Heat, Dryness, and Moisture are different. (By citing the differences among the Four Qi, the transformations of Warmth and Coolness can be inferred.) Thus, when Shaoyang (Ministerial Fire) is in the Lower Heaven (governing the latter half of the year), cold toxins do not grow; the flavor is Pungent; treatment utilizes Bitter and Sour flavors; the corresponding grains are Green and Red. (This pertains to the Qi transformation of Si-Hai years. "Toxin" refers to the excessive and violent Qi of any of the Five Elements. Now, Fire resides in the Earth, its Qi being intensely hot. Cold toxin substances have a nature distinct from the Earthly Qi, leading to different outcomes in life and death, hence they grow rarely. Fire controls Metal Qi, so Pungent-flavored substances do not transform easily. Shaoyang Qi offers itself to Jueyin (Wind-Wood), so the annual transformation manifests as Bitter and Sour flavors. Among the Six Qi governing the year, only this year is harmonious, with Wood and Fire supporting each other, thus there is no Inter-qi. Bitter and Red are transformed by Earthly Qi; Sour and Green are generated by Heavenly Qi. For other years, generation and transformation involve mutual overcoming and restriction between Upper and Lower, hence there are always Inter-qi.) When Yangming (Dryness-Metal) is in the Lower Heaven, damp toxins do not grow; the flavor is Sour; the Qi is Damp; (Commentary: Xin Zhengjiao states, "Upon detailed examination of the Lower Heaven, only in Yangming and Taiyin years is it stated 'its Qi is Damp' or 'its Qi is Hot,' presumably because the characteristics of Dryness/Dampness obscure the signs of Cold/Warmth, hence the Qi is reiterated."; treatment utilizes Pungent, Bitter, and Sweet flavors; the corresponding grains are Red and White. (This pertains to the Qi transformation of Zi-Wu years. Dryness resides in the Earth, its Qi being cool and clear, hence damp-warm toxins undergo little generation and transformation. Metal and Wood mutually restrain each other, so Sour-flavored substances transform less. Yangming Qi offers itself to Shaoyin (Dominant Fire), so the annual transformation manifests as Pungent and Bitter flavors. Pungent and White belong to Earthly Qi; Bitter and Red belong to Heavenly Qi. Sweet is the Inter-qi, used to mediate the overcoming between Metal and Fire, hence Sweet is also treated.) When Taiyang (Cold-Water) is in the Lower Heaven, heat toxins do not grow; the flavor is Bitter; treatment utilizes Bland and Salty flavors; the corresponding grains are Black and Yellow. (This pertains to the Qi transformation of Chou-Wei years. Cold resides in the Earth, distinct from Heat, hence heat toxins do not grow in the products of this year. Water overcomes Fire, so Bitter-flavored substances do not transform. Taiyang Qi offers itself to Taiyin (Damp-Earth), so the annual transformation manifests as Bland and Salty flavors. Taiyin Earth Qi rises to Heaven, being distant and high, so the transformation of Sweet becomes thin and manifests as Bland. Thus, Bland also belongs to Sweet, being a category of Sweet. Bland and Black represent Heavenly transformation; Salty and Yellow represent Earthly transformation. Yellow refers to yellow color. Commentary: Ju sounds like "Ju," referring to black millet.) When Jueyin (Wind-Wood) is in the Lower Heaven, cool toxins do not grow; the flavor is Sweet; treatment utilizes Sour and Bitter flavors; the corresponding grains are Green and Red. (This pertains to the Qi transformation of Yin-Shen years. Warmth resides in the Earth, distinct from Coolness, hence cool toxins do not grow in the products of this year. Wood overcomes Earth, so Sweet-flavored substances transform less. Jueyin Qi combines with Shaoyang (Ministerial Fire); since the combined Qi has no conflict, its treatment and transformation manifest as Sour and Bitter flavors. Sour and Green are Earthly transformations; Bitter and Red are Heavenly transformations. With no mutual overcoming, there is no Inter-qi, relying instead on Sweet transformation.) The Qi is specialized, and the flavor is pure. (In years where Jueyin or Shaoyang is in the Lower Heaven, the Qi transformation is unified and the flavor is pure. However, in other years, there are overcoming and restricting Qi between Upper and Lower, hence there are Inter-qi and Inter-flavors.) When Shaoyin (Dominant Fire) is in the Lower Heaven, cold toxins do not grow; the flavor is Pungent; treatment utilizes Pungent, Bitter, and Sweet flavors; the corresponding grains are White and Red. (This pertains to the Qi transformation of Mao-You years. Heat resides in the Earth, distinct from Cold, hence cold toxins are minimal in the medicines of this year. Fire Qi melts Metal, so Pungent-flavored substances transform less. Shaoyin and Yangming govern Heaven and Earth respectively, so their treatment involves Bitter and Pungent flavors. Bitter and Red are nurtured by Earthly Qi; Pungent and White are generated by Heavenly Qi. Sweet is the Inter-qi, used to inhibit and suppress.) When Taiyin (Damp-Earth) is in the Lower Heaven, dry toxins do not grow; the flavor is Salty; the Qi is Hot; treatment utilizes Sweet and Salty flavors; the corresponding grains are Black and Yellow. (This pertains to the Qi transformation of Chen-Xu years. There is Dampness in the Earth, distinct from Dryness, hence dry toxins do not undergo generation and transformation. Earth is controlled by Wood, so Salty-flavored substances transform less. Taiyin Qi receives support from Taiyang (Cold-Water), so the annual transformation manifests as Sweet and Salty flavors. Sweet and Black are Earthly transformations; Salty and Yellow are Heavenly transformations. Cold and Damp do not cause major conflict, hence the Inter-qi is the same and responds to the Hot Qi.)

When transformation is mellow, Salty flavor remains stable; when Qi is specialized, Pungent flavor transforms and both are governed together. (Mellow means harmonious. "Transformation is mellow" refers to the year of Shaoyang in the Lower Heaven, where Fire resides in the position of Water but still promotes nurturing; thus, the Salty nature of Water guards itself without competing with Fire for transformation. "Qi is specialized" refers to the year of Jueyin in the Lower Heaven, where Wood resides in the position of Water and further transforms downward; Metal is not harmed, so Pungent flavor regenerates and flourishes alongside Salty. Only in these two years is there no suspicion of mutual overcoming between Upper and Lower Qi, allowing Pungent to respond with Salty and flourish together. In other years, changes of overcoming and restriction occur between Upper and Lower, hence Sweet flavor mediates to缓 (slow down/relax) the suppression. The other three flavors—Bitter, Salty, and Sour—do not share the same generation and transformation. Therefore, among drugs between Heaven and Earth, those with Pungent and Sweet flavors are numerous.)

Therefore it is said: To tonify disorders of the Upper and Lower, follow (conform to) the Qi; to treat disorders of the Upper and Lower, oppose (counteract) the Qi; regulate based on the excess or deficiency of Cold and Heat in the respective locations. (Upper refers to Si Tian [Heavenly Qi governing the first half of the year], Lower refers to Zai Quan [Earthly Qi governing the second half of the year]. If Si Tian or Zai Quan Qi is in excess, treat by opposing the flavor; if deficient, treat by conforming to the flavor. "Follow" means conformity.) Treat by taking from above or below, internally or externally, to seek the source of the excess. Those who can tolerate toxicity use strong/concentrated medicine; those who cannot tolerate toxicity use weak/thin medicine. This is the principle. (Taking from above means using medicine to control excessive Qi; if control fails and causes rebellion, induce vomiting. Taking from below means using rapid medicine to remove diseases in the lower part; if attack fails, purge downwards. Internal taking refers to oral administration of food and medicine, regulating based on Cold and Heat. External taking refers to applying medicinal heat packs to the affected area to adjust Qi. For Cold turning into Heat, regulate with cold; for Heat turning into Cold, regulate with warm. If Upper excess persists, vomit to expel; if Lower excess persists, purge to reduce. This is seeking the method to address Qi excess. Concentrated vs. thin medicine refers to the strength of flavor and Qi. Commentary: Xin Zhengjiao states, "Jia Yi Jing says: Those with thick stomach, dark complexion, large bones, and fleshy bodies can tolerate toxicity; those who are thin with weak stomachs cannot. Also, Yi Fa Fang Yi Lun says: People in the West live in hilly areas, exposed to much wind, with hard water and soil, wearing coarse cloth, eating rich foods, and becoming fatty; thus pathogens cannot harm their form, their diseases arise internally, and treatment should utilize toxic medicines." Although the preceding paragraphs start with "Therefore it is said," seemingly connecting to the previous text, they discuss methods of treating disease and prescribing medicine, which is completely different in meaning from the preceding text. Hence, one record is kept while the other is discarded. "Neng" (can) implies endurance.)

For reversed Qi patterns: If the disease is in the Upper, take from the Lower; if in the Lower, take from the Upper; if in the Middle, take from the sides. (Commentary: This decomposes the method of seeking the disease. "Reversed Qi" refers to cases where Cold appears as Heat, Heat appears as Cold, Excess appears as Deficiency, and Deficiency appears as Excess. For example, if Yang floats upward, causing Qi surging and Fire rising, the disease seems to be in the Upper; but if one does not realize this is caused by Yin Deficiency failing to anchor Yang, then methods of Tonifying Yin to match Yang or gathering Fire to return to its source should be used. Similarly, if diarrhea and dysentery flow downward incessantly, the disease seems to be in the Lower; but if one does not realize this is caused by Qi Deficiency sinking, then formulas like Sheng Yang Yi Wei (Raise Yang and Benefit Stomach) or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi) should be applied. Moreover, the Spleen and Stomach reside in the center of the Five Viscera. Distension, acid regurgitation, vomiting, or diarrhea are all diseases of the Center. The Center corresponds to Earth. When Earth is controlled by Wood, disease occurs. Distension is Wood stagnation closing Qi; acid regurgitation is Wood strength causing Fire blazing; vomiting and diarrhea are Wood excess overwhelming Spleen and Stomach. All are diseases of the Spleen and Stomach, caused by Wood. Wood corresponds to Liver and Gallbladder; treatments for Liver and Gallbladder focus on the hypochondrium. Therefore, to treat diseases of the Center, one should target the sides. Wang Bing's commentary is plausible-sounding but incorrect; it is corrected here.)

Treat Heat with Cold, but administer warm; treat Cold with Heat, but administer cool; treat Warmth with Clearing, but administer cold; treat Coolness with Warming, but administer hot. (Commentary: This details the principles of medication. Disease conditions most fear mutual irritation. One must guide using properties similar to the Qi to avoid harsh rejection and non-penetration. Treating Heat with Cold is correct. However, administering cold medicine coldly to a heat patient causes irritation. Therefore, using warmth (similar to Heat) to guide the cold medicine allows it to penetrate, and the heat disease recedes gradually without irritation. The rest follows similarly. The first four sentences describe disease Qi and drug nature; the last four describe the appropriate temperature for ingestion. Wang Bing's commentary is incomprehensible.)

Thus, methods of dispersing, restraining, inducing vomiting, purging, tonifying, and draining are the same for both chronic and acute diseases. (Apply methods according to the excess or deficiency of Qi; the newness or chronicity of the disease does not change the approach.)

The Emperor said: What if the disease is in the Middle Jiao, neither solid nor firm, and gathers and scatters intermittently? How should it be treated? Qibo said: You ask very thoroughly! For conditions without accumulation, investigate the Zang organs. If deficient, tonify them. Use medicine to dispel pathogens, and food to follow up. Perform diuresis/water-moving techniques. Harmonize the interior and exterior, and the condition can be resolved. (Commentary: The Emperor asks about the middle chest and abdomen, appearing有形 (having form) but lacking definite structure. Qibo states that pathological accumulations are usually solid and unscattered. Since this case is otherwise, it is not an accumulation. Accumulations are Zang diseases; Zang deficiency with Qi stagnation mimics excess but is actually empty. The method should be tonification. However, using only tonification without accompanying promoting and unblocking agents will make intermittent gathering/scattering slow to resolve. Thus, after tonifying, one must also dispel (e.g., moving Qi and Blood). "Following" means food should also combine tonification and promotion, avoiding overly rich/greasy foods, hence "following the medicine." Water-moving techniques were mentioned previously.)

The Emperor said: Regarding toxic and non-toxic medicines, is there a fixed dosage rule? (Commentary: "Yue" refers to number/limit.) Qibo said: Diseases vary in duration (new vs. old), prescriptions vary in size, and whether medicines are toxic or non-toxic, there are established standard protocols. (Commentary: Meaning there are indeed standard protocols.) When using highly toxic medicines to treat disease, stop when 60% of the disease is removed; (Lower-grade medicines, highest toxicity.) when using moderately toxic medicines, stop at 70%; (Middle-grade medicines, secondary toxicity.) when using slightly toxic medicines, stop at 80%; (Upper-grade medicines, lowest toxicity.) when using non-toxic medicines, stop at 90%. (Non-toxic medicines across Upper, Middle, and Lower grades are all considered "Neutral/Ping". Commentary: Extraordinary diseases require extraordinary medicines; thus, toxic medicines are used only as a last resort. The more toxic the medicine, the fewer diseases it treats. This is because common diseases are frequent while specific syndromes are rare. Using them appropriately leads to the differences of 60%, 70%, 80%, and 90%. If used improperly, even non-toxic medicines become toxic.) Use grains, meats, fruits, and vegetables to complete the dietary therapy and eliminate residual pathogenic factors. Do not exceed this limit, lest you damage Healthy Qi. (...Commentary: This states that although food is non-toxic, exceeding moderation can still damage Healthy Qi. Zang Qi Fa Shi Lun states: "Toxic medicines attack pathogens; five grains nourish; five fruits assist; five meats benefit; five vegetables fill." This means food should merely nourish Qi and Blood sufficiently; one must never overindulge and harm Healthy Qi.) First consider the Annual Qi, do not violate the Harmony of Heaven. (Commentary: Years differ in North/South; Qi divides into six steps. Each year, one must seek the dominant Qi and respect it. Those treating disease should prioritize Annual Qi. Violating seasonal and chaotic Qi and treating arbitrarily is called violating the Harmony of Heaven, inevitably leading to reinforcing Excess and weakening Deficiency, causing Pathogen to prevail and Healthy Qi to fail. Physicians should deeply beware of this.) Do not reinforce Excess, do not weaken Deficiency, thereby sparing people from premature death. Do not cause Pathogen to prevail, do not let Healthy Qi fail, cutting off people's long life. (Commentary: "Excess" refers to Pathogen Excess; "Deficiency" refers to Healthy Qi Deficiency. If Pathogen is excessive and one suddenly applies tonification, Excess becomes more excessive. If Healthy Qi is deficient and one continues attacking, Deficiency becomes more deficient. Causing Pathogen to prevail and Healthy Qi to fail leads to premature death; who is to blame? The commentary suggests: Not examining Excess/Deficiency, but only thinking of attacking, makes Excess more excessive and Deficiency more deficient, worsening myriad diseases. This is another interpretation.)

The Emperor said: For those with chronic diseases, whose Qi has returned to peace and illness has passed, yet they remain emaciated and weak, how should this be managed? (Commentary: The Emperor asks about chronic patients whose illness has passed and Qi has stabilized, yet they remain frail and weak. How to treat?) Qibo said: Indeed, your question reveals sagacity! Transformation (of nature) cannot be substituted, and the timing of seasons cannot be violated. (Transformation refers to Creation/Nature. Attempting to substitute for a master carpenter may injure one's hands; how much more so for the Qi of Creation, can human effort substitute for it? Growth, flourishing, harvesting, and storage each correspond to the transformations of the Four Seasons. Even the wise and clever cannot bring them forward in time; clearly, this is beyond human power. From this, we see that the growth and storage of things depend on their time; the success/failure and order/chaos of things also depend on time. Since things operate this way, humans should too. Those who claim force can achieve substitution for Creation or violation of seasons are deluded. Commentary: Human life originates from Heavenly Qi and is nourished by Earthly Form. Following Heavenly Time and utilizing Earthly Benefits, what disease could invade? Only by failing to follow the Qi of Heaven and Earth does one fall ill, and eventually chronically. Fortunately, once the illness passes and Qi returns to harmony, the body naturally becomes emaciated and spirit depleted. Impulsive people often seek quick recovery, indulging their appetites until strength briefly returns, or engaging in sexual activity, only to relapse and die frequently. Do they not know that Creation has periods of waxing and waning, and seasons have sequences of decline and prosperity? Without peaceful quietude, how can one recover overnight? Nourishing and harmonizing, waiting quietly for the time, is truly the best advice for post-illness recovery.) When meridians are unblocked and Qi and Blood flow smoothly, restoring insufficiency to match the general population, through nourishment and harmony, waiting quietly for the time, guarding the Qi carefully so it does not collapse or shift, the physical form will become robust, and Vital Qi will grow. This is called the Sage King. Therefore, the Great Summary states: Do not substitute for Transformation, do not violate the Seasons; must nourish and harmonize, wait for recovery. This is what is meant. The Emperor said: Excellent! (Da Yao refers to ancient canonical laws. Citing ancient essential principles to clarify that seasonal transformations cannot be violated nor substituted by force.)