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(When the pulse changes first, this indicates that the congenital Qi has arrived, thus disease occurs.) When Yin and Yang exchange positions, the condition is critical. (This does not conform to the normal pattern of Heaven; Qi appears in a disordered manner, losing its fixed position and exchanging places. When Yin positions show Yang pulses, and Yang positions show Yin pulses, this is called exchanging positions. Due to the chaos of Yin and Yang Qi, it is dangerous.)

The Yellow Emperor said: Why do the Ben (Root) and Biao (Branch) of the Six Qi differ? Qibo said: Some Qi follow the Ben, some follow both Ben and Biao, and some do not follow either but follow the Zhong Qi (Middle Qi). The Yellow Emperor said: I wish to hear this in detail. Qibo said: Shaoyang (Lesser Yang) and Taiyin (Greater Yin) follow the Ben; Shaoyin (Lesser Yin) and Taiyang (Greater Yang) follow both the Ben and the Biao; Yangming (Bright Yang) and Jueyin (Terminal Yin) do not follow the Ben or Biao but follow the Zhong Qi. (The Ben of Shaoyang is Fire, and the Ben of Taiyin is Dampness; since the Ben and End are the same, they follow the Ben. The Ben of Shaoyin is Heat, and its Biao is Yin; the Ben of Taiyang is Cold, and its Biao is Yang; since the Ben and End differ, they follow both the Ben and the Biao. The Zhong Qi of Yangming is Taiyin, and the Zhong Qi of Jueyin is Shaoyang; since the Ben, End, and Middle Qi are all different, they do not follow the Ben or Biao but follow the Zhong Qi. Whether following the Ben, Biao, or Zhong Qi, it is all due to the function of the master of transformation.) Therefore, those following the Ben have transformation born from the Ben; those following the Ben and Biao have transformations of both Ben and Biao; those following the Zhong Qi have transformation governed by the Middle Qi. ("Transformation" refers to the primary master of Qi transformation. In disease treatment, one treats according to the primary Qi, using Cold or Hot medicines. Note: *Liu Wei Zhi Da Lun* states: "What is called the Ben. Below the Ben is the manifestation of the Middle Qi. Below the Middle Qi is the Biao of the Qi. When Ben and Biao differ, the Qi responds with different phenomena." This is what is meant.)

The Yellow Emperor said: What is the diagnosis when the pulse conforms to the disease but the symptoms are contrary? Qibo said: The pulse may appear to conform, but upon deep pressure, it does not throb; this applies to all Yang conditions. (This means that although the disease presents as Heat with a rapid pulse, the pulse does not move upon deep pressure. This is caused by severe Cold repelling Yang, not true Heat.) The Yellow Emperor said: What about the contrary pulses in all Yin conditions? Qibo said: The pulse may appear to conform, but upon deep pressure, it throbs strongly and vigorously. (Although the physical signs indicate Cold, if the pulse qi beats strongly under the fingers upon deep pressure, this is caused by severe Heat repelling Yin, not true Cold. Note: "Contrary" refers to Yang diseases having pulses that should be Floating and Rapid but are instead Deep and Slow, or Yin diseases having pulses that should be Deep and Slow but are instead Floating and Rapid, such as Yang syndromes resembling Yin, or Yin syndromes resembling Yang. If the syndrome is Yang but the pulse is Yin, and this occurs in chronic illness, it indicates Yang deficiency and Qi weakness, with severe depletion of True Yuan; the method should be warming and tonifying. If this occurs in acute illness, it indicates Qi deficiency with pathogen sinking, Yin excess and Yang decline, often leading to critical danger. If the syndrome is Yin but the pulse is Yang, and this occurs in early illness, it may be due to sudden anger, vomiting blood, or floating deficient Fire; it can still be treated with nourishment. If this occurs in chronic illness, it indicates exhaustion of Yin with floating Yang, and dryness of essence and blood, resulting in consumptive disease. In all such cases, the syndrome is the Ben, and the contrary pulse is the Biao; the diagnostician must distinguish them clearly. The commentary notes that this is ambiguous and not yet clear.)

Therefore, the onset of all diseases arises from the Ben, from the Biao, or from the Zhong Qi. Treatment may cure by targeting the Ben, by targeting the Biao, by targeting the Zhong Qi, by treating both Ben and Biao, by counter-treatment (Ni), or by compliance treatment (Cong). Counter-treatment is actually correct compliance with the nature; compliance with the appearance is actually counter-treatment. (Note: Treating Heat symptoms with Hot medicine for a condition with Cold Ben and Heat Biao, or treating Cold symptoms with Cold medicine for a condition with Heat Ben and Cold Biao, is indeed counter-treatment for the Biao but correct compliance for the Ben; this is the subtle method of compliance treatment. Unskilled physicians do not understand this principle and stick only to external appearances. If they treat Heat with Cold for Cold-Ben/Heat-Biao, or Heat with Hot for Heat-Ben/Cold-Biao, it seems compliant for the Biao but counter for the Ben. Can one not be cautious?) Thus it is said: Knowing the Ben and Biao, one uses them without peril; clearly understanding Ni and Cong, one acts without error. This is what is meant. ... *Da Yao* says: The crude physician laughs, thinking he knows everything; before discussing Heat, Cold diseases reappear. Same Qi, different forms, confusing diagnosis and disordering the meridians. This refers to such people. (...Note: This repeatedly sighs that the Ben and Biao must be understood. If Ben and Biao are unclear, Cold and Heat will be misapplied.)

The Yellow Emperor said: How early or late are the changes of Sheng (Overcoming) and Fu (Rebounding)? Qibo said: Regarding Sheng, once the Sheng Qi arrives, disease occurs; as the disease brews, the Fu Qi begins to sprout. Regarding Fu, it rises after the Sheng Qi is exhausted and becomes severe when it attains its position. (Note: The way of Heaven and Earth involves waxing and waning, fullness and emptiness, cycling endlessly. Where there is Sheng, there must be Fu; this is natural law. When Sheng arrives, disease occurs, and the mechanism for Fu is already brewing. Thus, Fu rebounds at the peak of Sheng. When Sheng exhausts, Fu rises; when Fu Qi takes command, it develops to severity, and Fu again resembles Sheng. Sheng then Fu, Fu then Sheng, like a circle without end.) Sheng has slight and severe degrees; Fu has few and many degrees. If Sheng is mild, Fu is mild; if Sheng is weak, Fu is weak; this is the constant way of Heaven. (Note: Fu usually corresponds to Sheng.) The Yellow Emperor said: Why do Sheng and Fu sometimes act out of position or arrive late? (Note: This asks why the expected periods of Sheng and Fu in the four seasons sometimes do not occur.) Qibo said: The generation and transformation of Qi differ in decline and abundance. The use of Cold, Heat, Warmth, and Coolness in their abundance lies in the Four Corners (Si Wei). Thus, the movement of Yang begins with Warmth and peaks in Summer Heat; the movement of Yin begins with Coolness and peaks in Winter Cold. Spring, Summer, Autumn, and Winter each have their differences. (Referring to the four regular Qi of Spring, Summer, Autumn, and Winter, located in the divisions of the Four Corners. Note: The sequence shifts, time comes, and Qi changes. Within a year, this is roughly natural Sheng and Fu. The Four Corners are the moments of transition. Abundance comes early, decline comes late; seen at the transition, hence "in the Four Corners." This discusses the norm of Sheng and Fu by seasonal order; the previous discussion discussed the variation of Sheng and Fu by pathogenic Qi. Are there two types of Sheng and Fu? Answer: Only the seasonal Sheng and Fu have differences in decline and abundance, so the pathological Sheng and Fu have distinctions of slight and severe; the two are one. "Cha" is pronounced "qi".) Thus *Da Yao* says: The warmth of that spring becomes the heat of summer; the severity of that autumn becomes the anger of winter. Carefully observe the Four Corners; all observations return here. The end is visible, the beginning is known. This is what is meant. (Note: Extreme warmth leads to heat; extreme severity leads to anger. The beginning and end can certainly be recognized.) The Yellow Emperor said: Is there a specific number for these differences? Qibo said: It is thirty du. (Du refers to days. Note: Xin Zheng Jiao says: "*Liu Yuan Zheng Ji Da Lun* states: 'Is there a specific number for the difference? Answer: Afterward, there are always thirty du plus fractions.' Here it says thirty du; this text is abbreviated.") The Yellow Emperor said: How do the pulse responses correspond? Qibo said: The differences follow the standard method, waiting for the time to pass and then subsiding. (Note: "Waiting for the time to pass" is unclear. *Mai Yao* says: In Spring, no Deep pulse; in Summer, no Wiry pulse; in Winter, no Choppy pulse; in Autumn, no Rapid pulse. This is called Si Sai (Four Obstructions). (Note: Sai means closed and blocked. Human meridians respond externally to the four seasons, showing Wiry in Spring, Rapid in Summer, Choppy in Autumn, and Deep in Winter. However, their Qi constantly flows through upper/lower and front/back. For example, Spring pulse should be Wiry, but its Qi connects upward to Winter and flows downward to Summer, so the Spring pulse is Wiry and slightly Deep; Summer pulse is Rapid and contains Wiry qualities, indicating connection between upper and lower Qi. If transitioning from Winter to Spring, the pulse shows only Wiry, it means upper and lower Qi are separated and blocked. Thus, Spring should be Wiry and Deep, Summer Rapid and Wiry, Autumn Choppy and Rapid, Winter Deep and Choppy; otherwise, it is called Si Sai. Wang Bing's commentary only explains the meaning of Sai but fails to explain the non-Deep/non-Wiry etc. meanings. I believe this section should be cross-referenced with *Si Qi Tiao Shen Da Lun*.) Excessive Deep is disease; excessive Wiry is disease; excessive Choppy is disease; excessive Rapid is disease. (Note: The previous section discussed harm from discontinuous seasonal Qi; this section discusses harm from excessive seasonal pulses, where Qi extremity causes disease.) Concurrent appearance is disease; repeated appearance is disease; absent yet gone is disease; gone yet remaining is disease. (Concurrent appearance refers to mixed Qi appearing together; repeated appearance refers to seeing again the Qi of decay and death. "Gone" refers to the ruling Qi having passed. If the sun's degree has not exceeded the difference, it is called Heaven's Qi not yet emerged; if the sun's degree exceeds the difference, it is called Heaven's Qi already gone, yet the pulse remains. Since it does not match the expectation, it is called disease. Note: Commentary on concurrent appearance is too vague. Repeated appearance: commentary says seeing again decaying/dead Qi. If a dead pulse appears once, it is already critical; if seen again, how can it be merely disease? "Can" implies variety, meaning multiple pulses in one region; impure pulse images inevitably cause disease. "Repeated appearance" means previously diseased with a certain pulse, after slight improvement, the old pulse returns, indicating the root of disease is not removed. The meaning of "gone/not gone" is indeed as Wang Bing noted.) Contrary [pulse] indicates death. (...Seeing Deep in Summer, Rapid in Autumn, Moderate in Winter, Choppy in Spring is called Contrary. Violating the mandate of Heaven, how can one last long? Note: Xin Zheng Jiao says: "Examining the above, 'Autumn no Rapid' is Si Sai; this note says 'Autumn sees Rapid' is Contrary. Since pulse difference is only in the second month, if the Rapid pulse does not cease after the difference ends, and in the third month of Autumn the pulse is still Rapid, it is Contrary." This distinction is very clear.) The Qi of Yin and Yang, if quiet and pure, generates and transforms orderly; if agitated, severe diseases arise. This is what is meant. (Note: *Liu Wei Zhi Da Lun* states: "Success and failure lie hidden in movement; continuous movement leads to transformation.")

The Yellow Emperor said: What are You (Dark) and Ming (Bright)? Qibo said: When two Yins intersect and exhaust, it is called You; when two Yangs combine and brighten, it is called Ming. The pairing of You and Ming corresponds to the distinction between Cold and Heat. (Two Yins exhaust at Xu and Hai; Two Yangs combine at Chen and Si. *Ling Shu: Xi Ri Yue Lun* states: "Hai (10th lunar month) Left Foot Jueyin, Xu (9th lunar month) Right Foot Jueyin; these two Yins exhaust, hence Jueyin. Chen (3rd lunar month) Left Foot Yangming, Si (4th lunar month) Right Foot Yangming; these two Yangs combine anteriorly, hence Yangming." Thus Yin intersection is You, Yang combination is Ming; the imagery of You and Ming should be so. Cold and Heat are positioned Southwest and Northeast; You and Ming are positioned Northwest and Southeast. The pairing of You and Ming, and the positions of Cold and Heat, are indeed distinct.) The Yellow Emperor said: What are Fen (Equinox) and Zhi (Solstice)? Qibo said: Qi arriving is called Zhi; Qi dividing is called Fen. At Zhi, Qi is the same; at Fen, Qi differs. This is called the Correct Chronicle of Heaven and Earth. (Arising from the question of You and Ming, this meaning is formed. It says Winter and Summer Solstices are where Heaven and Earth Qi govern the year. Spring and Autumn Equinoxes are intermediate Qi; Chu, Er, Si, Wu, the four Qi each divide governance around the ruling Qi of the year.)

The Yellow Emperor said: The Master spoke of Spring and Autumn Qi starting earlier, and Winter and Summer Qi starting later; I know this now. However, the six Qi cycle back and forth, and the ruling Qi is not constant. How should tonification and sedation be applied? (Using Equinoxes and Solstices to clarify the positions of the six Qi, the first and fourth Qi start 15 days before Lichun and Liqiu respectively as the standard; the third and sixth Qi start 15 days after Lixia and Lidong respectively as the standard. From this, the standards of the first and fourth Qi being ahead and behind mean that within the third and sixth Qi, the Solstices fall exactly. Hence: Spring/Autumn Qi starts earlier, Winter/Summer Qi starts later. However, changing one Qi every 365 days, as one year passes, the Qi changes to new. When new Qi comes, old Qi goes. The suitable flavors differ between Heaven and Earth; the methods of tonification and sedation should know priority and sequence, hence the question.) Qibo said: ... The ruler of Shaoyang: First Sweet, then Salty; The ruler of Yangming: First Pungent, then Sour; The ruler of Taiyang: First Salty, then Bitter; The ruler of Jueyin: First Sour, then Pungent; The ruler of Shaoyin: First Sweet, then Salty; The ruler of Taiyin: First Bitter, then Sweet. Assist with what is beneficial, nourish with what generates; this is called De Qi (Obtaining Qi). (Ruler refers to the ruling Qi of the year; Obtaining means obtaining its nature and function. Obtaining its nature and function allows flexibility; failing to obtain it leads to conflict and deviation. How can one expect to dispel pathogens?)

The Yellow Emperor said: Excellent! The generation of all diseases arises from Wind, Cold, Summer Heat, Dampness, Dryness, and Fire. These are the Six Qi of Heaven. Quiet and compliant is Hua (Transformation); agitated and changing is Bian (Variation). Hence "Zhi Hua Zhi Bian". The Classics say: Sedate the Excess, Tonify the Deficiency. I bestowed formulas on physicians, yet their use is not perfect. I desire that the essential Dao be practiced, responding like a drumstick to a drum, pulling out thorns and washing away filth. Can you tell me how to achieve skill and sacredness? (Acupuncture is Skill; Medicine is Sacred. Note: *Nan Jing* states: "Knowing by observation is Divine; knowing by listening/smelling is Sage; knowing by inquiry is Worker; knowing by palpation is Skilled. Knowing externally is Sage; knowing internally is Divine.") Qibo said: Examine the Bing Ji (Pathogenesis) carefully, do not lose the Qi Yi (Appropriateness of Qi). This is what is meant. (Note: Diseases have their own mechanisms; when the mechanism moves, Qi categories separate. Examining appropriateness prevents error. Zhang Jingyue said: "In *Qi Jiao Bian*, *Wu Chang Zheng*, and *Zhi Yao Yao Lun*, the excess and deficiency of the Five Movements and Six Qi are detailed, and heavenly times and human diseases change accordingly, leading to differences in淫胜 (Excessive Overcoming), Fan Sheng (Reverse Overcoming), Ke Sheng (Guest Overcoming), and Zhu Sheng (Host Overcoming). Excess Qi becomes hyperactive and Excess; Deficient Qi is bullied and Deficient. This is the natural law of Yin/Yang excess/deficiency. This section at the end summarizes Pathogenesis, stating the five Zang and six Qi each have rulers, whether Excess or Deficient, all vary with Qi changes causing different diseases. For example, 'All wind, tremors, and dizziness belong to Liver.' If Wood overcomes, limbs stiffen causing tremor, wind moves upward causing dizziness; Spleen Earth is affected, this is Liver Excess. If Wood declines, blood fails to nourish tendons causing tremor, Qi is deficient upward causing dizziness; Metal evil attacks Wood, this is Liver Deficiency. Similarly, 'All pain, itching, and sores belong to Heart.' If Fire is abundant, intense heat causes abscesses, Heart Excess; if Yang declines, Yin prevails causing gangrene, Heart Deficiency. This applies to all Zang and Qi. Thus the chapter begins with 'Sedate Excess, Tonify Deficiency' and ends with 'Seek the Present, Seek the Absent, Blame the Excess, Blame the Deficiency.' Having discussed Pathogenesis via Qi Appropriateness, it specifically uses the four characters Excess, Deficiency, Present, Absent to connect the beginning and end, exhausting the meaning. This is the heart transmission of the Sages, the essence, and the most crucial guideline. Alas, Liu Hejian did not examine this carefully, omitting the beginning and end, taking only the nineteen clauses to write *Yuan Bing Shi*, focusing only on Excess Qi and Evil, and among the nineteen clauses, seven or eight attribute to Fire, ignoring Deficient/Evil Qi. He also said: 'In treatment, one should only sedate the excessive Qi as the root of disease, not mistakenly treat the accompanying transformations.' Such statements are unbearable for the Deficient. Thus Lou pointed out his bias in treatment, which is not an exaggeration. Pathogenesis is the gateway to the Way and the step-by-step method. If the method is flawed, it confines the mind. Beginners who learn it often cannot transcend it in life; with long practice, the弊端 deepen. So modern physicians act with Hejian's legacy, easily draining false Heat and attacking true Deficiency. Some excuse him: He lived in the Yuan dynasty, customs differed, adapting to times, hence this theory. Even if true, times have changed. To follow it blindly would be like mixing ice and charcoal. I pity this and must clarify." I respectfully note: Hejian's theory is clear, but *Yuan Bing Shi* only explains the text literally, leaning towards Excess-Heat without innovation, inviting criticism. Speakers should be impartial. Jingyue's debate restores Balance, tests truth, and captures both Pathogenesis and Qi Appropriateness. However, his main emphasis seems to lean towards Deficient-Cold. If later doctors follow this rigidly, they will overcorrect. I fear future use of Aconite, Asarum, Cinnamon, and Ginger will be like the past use of Scutellaria, Phellodendron, Gardenia, and Platycodon, wrongly accused. *Yin Yang Ying Xiang Da Lun* states: "Good diagnosticians observe color and pulse, first distinguishing Yin and Yang." If physicians do not carefully recognize, and colors/pulses are confused, Yin/Yang inverted, those following Hejian will further Deficiency, and those following Jingyue will further Excess. How terrible it is for physicians to have preconceptions!) The Yellow Emperor said: I wish to hear about Pathogenesis. Qibo said: All wind, tremors, and dizziness belong to the Liver. (Note: Zhang Jingyue says: "Wind varies, hence 'All Wind'. Tremor is shaking. Dizziness is spinning. Wind moves, transformation of Wood, hence belongs to Liver. Both Deficiency and Excess can cause this. In the Ji of Generation, movement includes tremors/dizziness/head disease; in Jueyin rebound, tendon/bone tremors/dizziness, these are Liver Excess. E.g., Yangming ruling Heaven, tremors/shivering, tendon flaccidity unable to stand long, Dryness Metal is strong, Liver is attacked. In Taieyin rebound, heavy head pain with severe tremors/spasms, Wood fails to control Earth, Dampness overcomes, these are Liver Deficiency. Thus *Wei Qi Lun* says: 'Lower deficiency causes reversal, upper deficiency causes dizziness.' This is what is meant. Excess should be cooled and sedated; Deficiency should be warmed and tonified. Reversing this brings disaster quickly. My treatments follow this.") All cold, contraction, and drawing-in belong to the Kidney. ("Contraction" is gathering. "Drawing-in" is tightening. Kidney belongs to Water, its transformation is Cold. Whenever Yang Qi does not reach, Ying and Wei condense, body contracts; all are called contraction. E.g., Taiyang overcoming causes muscle stiffness, blood vessels stagnating; Year Water Excess causes Yin reversal, cold in upper/lower/middle, Water Excess. Year Water Deficiency causes foot flaccidity/cold reversal, He Liu Ji, disease is stranguria, Water Deficiency. Water Excess/Deficiency both originate in Kidney.) All Qi [asthma] and depression belong to the Lung. ("[Asthma] is panting. Depression is stuffiness. Lung belongs to Metal, its transformation is Dryness. Dryness Metal excess, Clear Evil in Lung, Lung disease is Excess, e.g., Year Metal Excess, severe asthma/cough/reverse Qi. Metal Qi decline, Fire Evil overcomes, Lung disease is Deficient, e.g., Cong Ge Ji, asthma/cough. Lung governs Qi, hence all Qi [asthma] and depression, whether Deficient or Excess, belong to Lung." Note: Jingyue's claim of Dryness transformation is mistaken. Lung and Large Intestine are interior-exterior, both Metal. But Lung governs Pungent, Yin Metal. Yangming Large Intestine belongs to Geng, Yang Metal, its transformation is called Dryness. Among the Six Qi, Dryness Metal is one, referring to Large Intestine, not Lung. Question: Does Lung Metal have no transformation? Answer: Clear and肃 (Solemn) is it. Pronounced "fen".) All dampness, swelling, and fullness belong to the Spleen. ("Spleen belongs to Earth, its transformation is Dampness. Earth Qi Excess, Dampness prevails, e.g., Year Earth Excess, fluid retention, middle fullness, reduced appetite, limbs unable to lift. Earth Qi Deficient, Wind Wood overcomes, Cold Water insults, e.g., Year Wood Excess, Spleen Earth attacked, people have borborygmus, abdominal distension; Bei Jian Ji, disease is lingering fullness/blockage; Year Water Excess, severe abdominal swelling, leg edema. Spleen governs muscles, hence all dampness/swelling/fullness, whether Deficient or Excess, belong to Spleen.") All pain, itching, and sores belong to the Heart. ("Severe Heat causes sore pain; mild Heat causes sore itching. Heart belongs to Fire, its transformation is Heat, hence all pain/itching/sores belong to Heart. However, He Xi Ji, disease is sores/ulcers, Heart Evil Excess. Taiyang ruling Heaven, also causes abscesses, Cold Water overcomes. Fire Excess is Heart Excess; Water Excess is Heart Deficiency, visible here." Note: In ancient texts, this clause was below "All Heat, confusion, and spasms"; now placed here to match the preceding text.) All Heat, confusion, and spasms belong to Fire. ("Confusion" is mental clouding. "Spasms" are convulsions. Evil Heat damages Spirit causing confusion; Hyperactive Yang damages Blood causing spasms, hence all belong to Fire. However, Year Fire Deficiency, people suffer inner arm pain, depression/cloudiness. Year Water Excess, people suffer body heat, vexation, irritability...