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Although this chapter is titled "Decoctions and Malt Liquors," its essential meaning lies in the latter half. Among them, the syndrome of distension (Zhang Zheng) is most critical. "Removing accumulated stagnation" (Qu Wan Chen Cuo) refers to eliminating solid accumulations; "Opening the ghost gate" (Kai Gui Men) refers to dispersing pathogenic factors from the exterior; "Purifying the clean mansion" (Jie Jing Fu) refers to promoting urination to drain water downward. These three methods roughly cover the treatment for distension.

The Yellow Emperor asked: How should one prepare decoctions and malt liquors from the five grains? (Note: Zhang Jingyue said: "Decoctions and malt liquors both belong to the category of wine." Yunyi states: "Turbid wine is called Lao." Shihua states: "Sweet, turbid, but not clear wine is called Li." Thus, decoctions are likely similar to clear wine. Lao sounds like 'lao'. Li sounds like 'li'. Cuo sounds like 'ji'.) Qibo replied: One must use rice as the grain and rice straw as the fuel. Rice is complete/perfect, and rice straw is firm/strong. The Emperor asked: Why is this so? Qibo said: This is because they obtain the harmony of heaven and earth and the suitability of high and low places, thus achieving perfection; they are harvested at the appropriate time, thus achieving firmness. (Note: Complete means fully equipped. Firm means tough and vigorous. Rice obtains the harmonious qi of the four seasons, its nature is neutral, its taste is bland, nourishing people daily, because its power is complete and efficacy is ready. Rice straw is harvested in late autumn and early winter, hence its color is dark and texture is strong.) The Emperor asked: Why did the sages of ancient times make decoctions and malt liquors but not use them? Qibo said: Since ancient times, sages made decoctions and malt liquors merely for preparation/reserve. In ancient times, decoctions were made but not taken. (Note: Sages treat disease before it occurs, hence they only prepare for reserve and do not take them. In the middle antiquity, virtue and morality slightly declined, and pathogenic qi frequently arrived; taking them ensured complete cure.) (Although virtue declined slightly and pathogenic qi arrived, the heart was still close to the Dao, so taking them yielded perfect results.) The Emperor asked: Why is it that in today's world, recovery is not guaranteed as in middle antiquity? (Meaning: Why is it not as easy to recover as in middle antiquity?) Qibo said: In today's world, one must definitely use medicinal drugs to attack internally, and bi-shi (stone needles), acupuncture, and moxibustion to treat externally. (Note: The more advanced the era, the more complete the methods. Qi is synonymous with Ji/Dose.) The Emperor asked: If the form is exhausted and blood depleted, yet therapeutic effect is not established, why is this? Qibo said: It is because the Shen (Spirit) does not respond/be used. (Note: Zhang Jingyue said: "In treating disease, attacking pathogens relies on needles and drugs, while executing drug effects relies on Shen-Qi. Thus, treatment is applied externally, and Shen responds internally; making it ascend causes ascent, making it descend causes descent; this shows Shen can be directed. If internal treatment with drugs fails to elicit Zang-Qi response, or external treatment with needles/moxa fails to elist Jing-Qi response, it indicates Shen-Qi has departed and cannot be directed. Even with utmost effort, treatment ultimately becomes futile.") The Emperor asked: What is meant by "Shen does not respond"? Qibo said: This refers to the Way of needles and stones. If Spirit is advanced and Will is regulated, then the disease can be cured. (Note: Treatment methods require needles and stones; these are tools, but the Way resides within them. Wang Bing's edition reads "If Spirit does not advance and Will is not regulated, then disease cannot be cured." Analyzing the context tone, this seems erroneous. Xin Zhengjiao notes: "Quan Yuanqi's edition reads 'If Spirit advances and Will is regulated, then disease can be cured.' The textual logic is smoother; we now correct and follow it." Now, if Essence is ruined and Spirit departs, Ying (Nutritive) and Wei (Defensive) Qi cannot be recovered. Why? Because desires are endless, and worries/sorrow are unceasing, causing Jing-Essence to relax and ruin, Ying-Blood to become stagnant/astringent, and Wei-Defensive Qi to dissipate; thus Spirit departs and disease does not heal. (Note: Zhang Jingyue said: "Kidney stores Essence, Essence is Yin; Heart stores Spirit, Spirit is Yang. Essence ruin and Spirit departure mean both Yin and Yang fail, interior and exterior are injured, and Ying-Wei cannot be restored. The reason is that modern people indulge in desires and sorrows without restraint, losing their nourishment, leading to Jing-Essence ruin, Ying-Stagnation, and Wei-Dissipation, rendering them powerless. Ying is same as Rong. Qi (stagnant) is same as Se.") The Emperor asked: When a disease first arises, it is extremely subtle and refined, necessarily entering and knotting in the skin. Now, excellent physicians all call this disease "formed" (Cheng) and name it "adverse" (Ni), stating that needles and stones cannot treat it, and good medicines cannot reach it. Excellent physicians today all possess the method and guard the numbers/patterns. Relatives and brothers, near and far, hear voices daily and see colors daily, yet the disease does not heal. Is this not because treatment was too late? (Note: Zhang Jingyue said: "'Extremely subtle' means light and shallow, not deep; 'extremely refined' means focused and not chaotic. At this time, treatment is still easy. Once the disease forms, excellent physicians call it 'adverse'. However, if excellent physicians have mastered the method and lost no precision, and relatives' observations are familiar, with no error in sound or color, one would expect rapid healing. But allowing the patient to reach the point of essence ruin and spirit departure where disease cannot heal, is this not due to treatment being too late? Xia implies negligence/delay.) Qibo said: Disease is the root (Ben), physician is the branch (Biao). If root and branch do not match, pathogenic Qi will not be subdued; this is what is meant. (Note: Ben implies prior, Biao implies posterior, meaning disease exists first, then medical treatment follows. Disease must be treated to heal; a physician who can胜任 is called excellent. If a true excellent physician cannot handle it, or those who can handle it are not excellent, then pathogenic Qi remains rampant, and how can the disease heal? This is called root and branch mismatch. Alas, later generations often fall into this fault! *Wu Zang Bie Lun* says: "One constrained by ghosts and spirits cannot be spoken to regarding supreme virtue; one who dislikes needles and stones cannot be spoken to regarding supreme skill; if the patient does not permit treatment, the disease will certainly not heal, and treatment will be ineffective." This is exactly what is meant.)

The Emperor asked: There is a condition that does not arise from the hair and skin (exterior), but rather the Yang Qi of the Five Zang organs has already exhausted. Fluids fill the chest and abdomen (Guo), only Po (Corporeal Soul/Yin) remains alone. Solitary Essence is inside,耗散ed Qi is outside. The form is so swollen it cannot fit into clothes. The four extremities are urgent/tense and affect the interior. This is Qi rejecting inside, and Form manifesting outside. How to treat? (Note: Zhang Jingyue said: "Not arising from hair/skin means disease originates internally. Exhaustion of Five Zang Yang means there is Yin but no Yang. Fluids refer to water. Guo refers to the body/chest and abdomen. *Zhang Lun* says: 'Chest and abdomen are the Guo of the Zang-Fu.' The key to Yin-Yang is that Yin cannot move without Yang, and water cannot transform without Qi. Thus *Ling Lan Mi Dian Lun* says: 'Only after Qi transformation can it exit.' Now that Yang Qi is exhausted, it cannot regulate water passages, so fluids wander and fill the Guo. Po belongs to Yin; although form is full, Qi departs, so Po remains alone. Essence without Qi means Essence is solitary inside. Yin inside without Yang means Qi dissipates outside. San Jiao is blocked, water passages do not flow, skin is distended, body is emaciated, so form cannot be maintained by clothes. Four extremities are the root of all Yang; Yang Qi does not move, so four extremities have much Yin and become tense/distended. Distension is caused by Yin stagnation; because Stomach Yang cannot control water, Lung and Kidney are diseased, followed by wheezing/coughing, thus affecting the interior. This is Yin Qi rejecting inside, so water distension manifests outside as this disease." Guo sounds like 'kuo'.) Qibo said: Treat it by balancing the scales (Ping Zhi Yu Quan Heng). (Note: Zhang Jingyue said: "The method of balancing treatment should be like a scale, seeking equilibrium. For example, in water distension, the root is Kidney, the branch is Lung. If Five Zang Yang is exhausted and Po remains alone, the master is Lung; Lung governs Qi, what method transforms Qi? Fluids fill Guo, solitary Essence inside, the master is Kidney; Kidney governs Water, what method levels Water? However, Lung Metal is born from Spleen, Kidney Water is controlled by Earth. Therefore, treating swelling requires focusing on Spleen, Lung, and Kidney, treating according to excess or deficiency to achieve balance. This is the Way of the Scale.") Remove accumulated stagnation, slightly move the four extremities, wear warm clothing, apply Miu Ci (twisted needle) therapy at the sites, to restore the form. Open the Ghost Gate (sweat pores), purify the Clean Mansion (bladder). Essence will function timely. Five Yang will be distributed. Dredge and cleanse the Five Zang. Thus Essence generates spontaneously, Form prospers spontaneously, bone and flesh protect each other, and Great Qi becomes peaceful. The Emperor said: Excellent! (Note: Zhang Jingyue said: "Wan means accumulation. Chen means old/long-standing. Cuo means cutting grass. It means removing the old accumulation of water Qi, desiring to remove it gradually like cutting grass. Si Ji refers to four extremities. Slightly moving them desires circulation so Qi moves easily. Warm clothing desires to assist Muscular-Surface Yang so Yin coagulation disperses easily. Then apply Miu Ci, left treating right, right treating left, to remove stagnation in large collaterals. Ghost Gate refers to sweat pores; Lung governs skin/hair, stores Po, belongs to Yin, hence called Ghost Gate. Clean Mansion refers to Bladder; upper end has no entry hole, lower end has exit, impurities cannot enter, hence called Clean Mansion. Pathogens in exterior are scattered, in interior are transformed, hence Open Ghost Gate, Purify Clean Mansion. When water Qi leaves, True Essence functions. Fu means movement. When Yin pathogens are removed, Five Yang distribute. Five Yang refers to Stomach Qi of the Five Zang. From this, Essence generates, Form prospers, bone/flesh protect each other, and Great Qi can be pacified. Wan is same as Yu. Cuo sounds like 'cuo'.)"