Library

The Five Qi refer to the pathogenic qi generated by the dysfunction of the Five Zang organs. "Xuanming" (Making Manifest) means elucidating their principles to make them clear and understandable. This section contains thirteen propositions, which are the fundamental tenets of medicine and the essential guide for syndrome differentiation and treatment; they must be carefully comprehended and recognized in clinical practice.

The Five Flavors enter [specific organs]: Sour flavor enters the Liver (the Liver corresponds to Wood and its flavor is sour), Pungent flavor enters the Lung (the Lung corresponds to Metal and its flavor is pungent), Bitter flavor enters the Heart (the Heart corresponds to Fire and its flavor is bitter). Salty flavor enters the Kidney (the Kidney corresponds to Water and its flavor is salty), Sweet flavor enters the Spleen (the Spleen corresponds to Earth and its flavor is sweet. Note: The New Corrected Text states: "The *Tai Su* also records that sweet flavor enters the Stomach."). This is called the "Five Entrances."

Diseases caused by the Five Qi: Heart disease manifests as belching (symbolizing fire flaming upward, with smoke following the flame; the Heart does not accept turbid qi, so it expels it via belching. Note: Belching here refers to eructation without sound. The Heart is the organ of Fire; when Fire is depressed internally and desires to ascend but cannot, one closes the mouth, inhales inwardly, and draws up the depressed qi from below to expel it through the mouth. *Yi* is pronounced jie). Lung disease manifests as coughing (symbolizing the firmness and stiffness of Metal, which makes a sound when struck; when pathogens strike the Lung, coughing results). Liver disease manifests as excessive talking (symbolizing the branches of Wood, which have many offshoots; speech expresses complex thoughts, thus originating from the Liver. Note: Excessive talking serves to vent internal depression. The Liver likes smooth flow and dislikes stagnation, so it uses talking to disperse the depression of qi). Spleen disease manifests as frequent swallowing (symbolizing the包容 nature of Earth, where things return inward and are all accepted, thus manifesting as swallowing). Kidney disease manifests as yawning and sneezing (Note: Yawning is caused by the lethargy of Shen-Qi. The Kidney stores Essence; when Essence is deficient, Shen-Qi becomes lethargic, leading to yawning. Sneezing is caused by the external expression of Lung qi. The Kidney is Cold Water, whose qi easily freezes; as the Child of the Lung, its qi ascends to the Mother, triggering sneezing; this is not limited to sneezing caused by external Wind-Cold). Stomach disease manifests as rebellious qi, hiccups, and fear (Note: Rebellious qi is typically a Lung pathology; why does the Stomach exhibit it? The Stomach is the Sea of Water and Grain; overeating causes upward reflux leading to burping with a rotten smell. Alternatively, if food stagnates and fails to descend, it may reverse and cause vomiting. Although different from Lung wheezing, both involve upward rushing of qi. *Yue* refers to hiccups. The Stomach likes warmth and dislikes cold; when cold enters the Stomach, qi stagnates causing hiccups, indicating that cold in the Stomach leads to hiccups. Alternatively, if Stomach Fire blazes intensely, the mouth craves cold, or if pears and persimmons are consumed excessively, or bitter-cold herbs are overused, suppressing Fire with Cold disrupts qi and causes hiccups, indicating that extreme heat followed by excessive cold leads to hiccups. Deficiency of the Kidney leads to fear; fear is not a Stomach disease per se. However, the Stomach is rich in Qi and Blood, and its Fire is most vigorous; vigorous Fire scorches Water, leading to Water deficiency and Kidney weakness, where the Kidney cannot withstand the Stomach, thus generating fear. One must know that Stomach diseases can also present with fear). Large Intestine and Small Intestine diseases manifest as diarrhea; overflow in the Lower Jiao manifests as edema (The Large Intestine is the Fu organ of transmission; the Small Intestine is the Fu organ of reception and transformation. When the qi of reception and transformation is deficient, the control of transmission is lost, leading to diarrhea. The Lower Jiao is the site of distribution; when qi is obstructed and cannot drain, it overflows to form water). Bladder dysfunction manifests as stranguria (difficulty urinating); lack of constraint manifests as enuresis (involuntary urination) (Note: The *Ling Shu* states: "The Foot Sanjiao is the collateral branch of the Taiyang channel; it runs alongside the main Taiyang channel, enters and connects with the Bladder, and regulates the Lower Jiao. In excess conditions, there is stranguria; in deficiency conditions, there is enuresis."). Gallbladder disease manifests as irritability (Note: Anger is the emotion of the Liver, and the Gallbladder is its paired organ. The Gallbladder is the official of integrity and justice, from whom decision-making emerges. When the Gallbladder is diseased, it becomes biased and unable to decide, and qi follows its pairing to manifest as anger). This is called the "Five Diseases."

The Five Essences merging: When Jing-Essence merges into the Heart, there is joy; into the Lung, sorrow; into the Liver, worry; into the Spleen, timidity; into the Kidney, fear. This is called the "Five Mergings," which occurs due to deficiency and mutual encroachment (Note: Each Zang organ has its Essence; having Essence implies having Qi. The commentary restricts this to the essence of Fire, which is biased. The classic text generally speaks of deficiency leading to mutual merging, where "merging" implies annexation or吞併. When the Qi of the Five Zang is weak, it is encroached upon by the element that overcomes it; for example, Metal is weak and fears Fire, so Jing-Essence merges into the Heart, making the Heart prosperous. The Heart governs Joy; when the Heart is prosperous, its Qi becomes excessive, leading to inappropriate joy, which constitutes a disease of excess. The treatment method is to use Fear to overcome it. Although the text for the other four Zang organs appears similar, the underlying meaning differs. For instance, the Heart's emotion is Joy, and the Kidney's is Fear; when Jing-Essence merges, the emotion becomes excessive. The Lung's emotion is Worry, but here it says Sorrow; however, Sorrow arises from Worry, so the meaning is consistent. As for the Liver, whose emotion is Anger, here it says Worry; and the Spleen, whose emotion is Pensiveness, here says Timidity. Worry is the emotion of the Lung, which overcomes the Liver; Timidity is a form of Fear, the emotion of the Kidney, which overcomes the Spleen. These differences within the Five Mergings require explanation. The answer lies in the phrase "deficiency and mutual merging." It implies that if one is not deficient, nothing happens; but once deficient, not only is one encroached upon by the overcoming element, but even the conquered element may encroach upon oneself, and one's own emotional state is overridden. Thus, the Liver encroaches on the Lung resulting in Worry, and the Spleen encroaches on the Kidney resulting directly in Timidity, all caused by a single deficiency. Generally speaking, those whose Jing-Essence merges and retains its proper emotion are the Heart, Lung, and Kidney. The Spleen is where Jing-Essence becomes strong in the overcoming element and encroaches upon the conquered element. The Liver is where Jing-Essence becomes strong in the conquered element but reversely encroaches upon the overcoming element. The cause of merging is fundamentally deficiency. The specific addition of this phrase in the text suggests Yao Zhinan was providing his own annotation. If interpreted as the commentary suggests, it would merely describe merging rather than mutual merging.)

The Five Dislikes of the Zang Organs: The Heart dislikes Heat (Note: Although the Heart is the organ of Fire, extreme heat leads to self-incineration). The Lung dislikes Cold (Note: The Lung governs the skin and hair, making it susceptible to Cold invasion; hence, "cold of the body and cold drinks injure the Lung"). The Liver dislikes Wind (Note: Although the Liver belongs to Wood and governs Wind, excessive Wind causes Wood to break). The Spleen dislikes Dampness (Note: The Spleen is inherently Damp Earth but prefers dryness; excessive Dampness causes Qi stagnation and impairs transformation). The Kidney dislikes Dryness (Dryness leads to exhaustion of Essence. Note: The Kidney is Water and deals with Moisture; if Water is deficient, it cannot control Fire, leading to Dryness, resulting in the risk of dried-up Essence and Blood). This is called the "Five Dislikes."

The Five Fluids transformed by the Zang Organs: The Heart transforms into Sweat (excreted through the skin and pores). The Lung transforms into Nasal Mucus (moistening the nasal orifices). The Liver transforms into Tears (flowing into the eyes). The Spleen transforms into Saliva (overflowing at the lips and mouth). The Kidney transforms into Thick Saliva (generated in the teeth). This is called the "Five Fluids."

Prohibitions regarding the Five Flavors: Pungent flavors move Qi; those with Qi disorders should not eat much Pungent (Disorder here refers to weakness where one cannot sustain effort. Note: Pungent enters the Lung, which governs Qi. If Qi is already diseased, while small amounts of Pungent can open stagnation, excessive consumption will likely dissipate True Qi). Salty flavors move Blood; those with Blood disorders should not eat much Salty; Bitter flavors move to the Bones; those with Bone disorders should not eat much Bitter (Note: Salty originally enters the Kidney but has a Yin nature moving toward Blood, which is generated by the Heart. The *Zang Wu Sheng Cheng Pian* states: "Excessive salty intake causes pulse stagnation and color changes." Since the pulse also pairs with the Heart, Salty should not be consumed excessively, reflecting the principle that Heart Fire fears Water. Bitter originally enters the Heart but also has a Yin nature; its Qi is firm and moves toward the Bones. Bones belong to Yin and are solid. However, bones are governed by the Kidney. The *Zang Wu Sheng Cheng Pian* states: "Excessive bitter intake causes withered skin and fallen hair." Skin and hair belong to the Lung; this indicates that Bitter enters the Heart to supplement Fire, and excessive Fire attacks Metal. Now, stating that Bone disorders prohibit excessive Bitter intake reflects the idea that Bitter benefits the Heart, intensifying Fire, which Water cannot overcome. The Heart and Kidney are the sources of Water and Fire; Salty and Bitter are heavy flavors among tastes, causing different harms; can they be eaten in excess? Their prohibitions differ, so they should be distinguished). Sweet flavors move to Flesh; those with Flesh disorders should not eat much Sweet; Sour flavors move to Tendons; those with Tendon disorders should not eat much Sour (Note: Flesh belongs to the Spleen, and Sweet is its flavor. Tendons belong to the Liver, and Sour is its flavor. Sweet and Sour are the correct flavors for the Spleen and Liver; if consumed appropriately, they sufficiently nourish flesh and tendons. However, if flesh and tendons are already diseased, indulging in their preferred flavors means that what nourishes flesh may consume it, and what nourishes tendons may harm them; can they be eaten in excess?). This is called the "Five Prohibitions"; do not allow excessive consumption (Note: This proposition uniquely adds this sentence, emphasizing that improper diet or medication will worsen the disease, hence the earnest warning, repeated at the beginning and end.).

Onset of the Five Diseases: Yin diseases manifest in the Bones, Yang diseases manifest in the Blood, Yin diseases manifest in the Flesh (Bone and flesh are Yin and static, so Yang Qi follows them; blood vessels are Yang and dynamic, so Yin Qi takes advantage of them). Yang diseases manifest in Winter, Yin diseases manifest in Summer (Summer is abundant in Yang Qi, so Yin diseases manifest in Summer; Winter is abundant in Yin Qi, so Yang diseases manifest in Winter, each following the minority. Note: Why do Yang diseases manifest in Winter? In Winter, Yin Qi condenses, Yang cannot settle, and Yang pathogens become depressed. Why do Yin diseases manifest in Summer? In Summer, Yang Qi leaks out, Yin reaches the exterior, and Yin pathogens follow Yang to exit). This is called the "Five Onsets."

Disorder caused by the Five Pathogens: When pathogens enter Yang, there is mania; when pathogens enter Yin, there is bi-syndrome (When pathogens reside in Yang meridians, limbs become hot, leading to mania; when pathogens enter Yin meridians, the six channels become stagnant and blocked, leading to bi-syndrome. Note: The commentary's focus on "meridian" is too rigid; referring simply to Yin and Yang divisions is sufficient). When pathogens contend with Yang, there is headache/disease of the vertex (When pathogens internally contend with Yang, pulse flow becomes rapid, leading to diseases of the vertex). When pathogens contend with Yin, there is aphonia (When pathogens internally contend with Yin, pulse flow stops, leading to aphonia and inability to speak. Note: The *Nan Jing* states: "Extreme Yang leads to mania, extreme Yin leads to epilepsy." Chao Yuanfang considers pathogens entering Yin as epilepsy. The *Mai Jing* states: "Yin attaching to Yang causes mania, Yang attaching to Yin causes epilepsy." Sun Simiao states: "Pathogens entering Yang cause mania; entering Yin causes blood bi. If Yang pathogens transmit, they cause epilepsy and spasms; if Yin pathogens transmit, they cause pain and aphonia." Quan Yuanqi states: "If pathogens have entered Yin and transmit back to Yang, the pathogenic qi is vigorous, affecting zang-fu, preventing Qi from ascending, and Ying Qi from circulating the body. Pathogens clash with healthy Qi, triggering epilepsy. If pathogens have entered Yang and now transmit to Yin, zang-fu are affected, causing inability to speak, representing victory over healthy Qi." Various schools differ; all are recorded here). When Yang enters Yin, there is quietness; when Yin exits to Yang, there is anger (Note: The *Qian Jin Fang* states: "Yang entering Yin causes quiet illness, Yin exiting to Yang causes angry illness." Both quietness and anger are pathological. Generally, quietness often indicates bad prognosis, while anger often indicates good prognosis. This is because diseases generally favor Yang and dislike Yin). This is called the "Five Disorders."

Manifestations of the Five Pathological Pulses: Spring presents with Autumn pulse, Summer presents with Winter pulse, Late Summer presents with Spring pulse, Autumn presents with Summer pulse, Winter presents with Late Summer pulse... This is called the "Five Pathologies"... fatal and untreatable (Note: This is the fixed rule of mutual overcoming, known as being controlled by the overcoming element, where ghost thieves punish each other; none survive.).

What the Five Zang Organs Store: The Heart stores Shen-Spirit (Note: The *Ling Shu* states: "The interaction of two essences is called Shen." Shen is that which governs the whole body and directs changes). The Lung stores Po-Physical Soul (Note: The *Ling Shu* states: "That which exits and enters with Essence is called Po."). The Liver stores Hun-Ethereal Soul (Note: The *Ling Shu* states: "That which accompanies Shen and comes and goes is called Hun."). The Spleen stores Yi-Mental Imagery (Memory that is not forgotten. Note: The *Ling Shu* states: "Recollection by the Heart is called Yi."). The Kidney stores Zhi-Will (Focused intent that does not shift. Note: The *Ling Shu* states: "What is stored by Yi is called Zhi." The Kidney receives the Essence of the Five Zang and Six Fu organs and stores it; it is the root of generation and the gate of the Stomach, thus when Will is regulated, Life Force flows. Additionally, Yang Shangshan stated: "There are two Kidneys: the left is the Kidney, storing Will; the right is the Mingmen, storing Essence.") This is called "What the Five Zang Organs Store."

What the Five Zang Organs Govern: The Heart governs the Vessels (restricting Ying Qi, moving with the breath). The Lung governs the Skin (wrapping muscles and tendons, resisting various pathogens). The Liver governs the Tendons (binding joints and mechanisms, moving with Shen). The Spleen governs the Flesh (encasing and supporting bones and tendons, circulating Wei Qi). The Kidney governs the Bones (stretching tendons to transform marrow, serving as the pillar of the body). This is called the "Five Governing Roles."

Injuries Caused by the Five Labors: Prolonged viewing injures Blood (Note: The eyes see due to Blood; prolonged viewing exhausts eye power and injures Blood). Prolonged lying down injures Qi (Note: Qi moves with activity; prolonged lying down causes Qi to become slack and cease flowing). Prolonged sitting injures Flesh (Note: Flesh encases zang-fu, supports bones and tendons, and fills the body. Flesh is externally static but internally dynamic, with Qi and Blood flowing and the Spleen-Stomach responding. Prolonged sitting causes Qi and Blood stagnation and flesh disease). Prolonged standing injures Bones (Note: Bones are the pillars of the body, keeping one upright; reliance is solely on bones. Prolonged standing risks flaccidity and weakness). Prolonged walking injures Tendons (Note: Tendons connect joints and enable flexion, extension, bending, and stretching. Movement is their function, stillness is their nourishment; they can walk but not for long. Prolonged walking risks laxity and strain). This is called "Injuries Caused by the Five Labors" (The functions of these five are indispensable. Overuse leads to labor injury. The *Jing Mai Bie Lun Pian* states: "Illnesses of Yin and Yang in the four seasons arise from overuse." This is what is meant.).

Pulse Images Corresponding to the Five Zang Organs: Liver pulse is Xian/String-like (empty and slippery, straight and long). Heart pulse is Gou/Hook-like (like an inverted hook, vigorous arrival and declining departure). Spleen pulse is Dai/Intermittent (weak). Lung pulse is Mao/Hair-like (light, floating, and empty, like feathers). Kidney pulse is Shi/Stone-like (deep, firm, and forceful, like a thrown stone). This is called the "Pulses of the Five Zang Organs."