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The so-called "rebellious Qi" refers to Qi rushing upward from the Dantian. However, there is a distinction between deficiency and excess, truth and falsehood: if it is due to external contraction of Wind-Cold, or true Phlegm-Dampness and Excess Fire, these are syndromes of surplus, representing True Yang (Excess Syndrome);
if there is Yin deficiency in the lower body causing Yang to float upward, resulting in panting, urgency, and oppression, although the appearance suggests Yang excess, it is actually a deficiency of True Yin (Kidney Yin). The commentary stating that "rebellious Qi invades the upper part, and Yang is also like this," implying that all Yang is rebellious, is erroneous.) Therefore, when pathogenic Wind strikes the human body, it does so swiftly as wind and rain; thus, a skilled practitioner treats at the level of the skin and hair, then next at the level of the muscles and skin, then next at the level of the sinews and vessels, then next at the level of the Six Fu Organs, and finally at the level of the Five Zang Organs. If treatment begins only after the disease has entered the Five Zang Organs, half will die and half will survive. (A skilled practitioner intervenes before the disease forms or just as it is forming; this is the concept of "treating disease before it arises" employed by superior physicians. Once the pathogen enters the Five Zang Organs, treatment becomes perilous. Thus, treatment must not be delayed.)

Therefore, pathogenic Qi from Heaven (external pathogens), when contracted, harms the Five Zang Organs; (Note: Pathogenic Qi from Heaven refers to the abnormal Qi of the four seasons, i.e., the Six Excesses. When pathogenic Qi invades the human body, it moves from shallow to deep, stopping only when it reaches the extreme depth of the Five Zang Organs; it does not bypass the meridians and Six Fu Organs to reach the Zang Organs directly, as seen in stroke affecting the Zang or cold damage transmitting through the lines.) Cold and heat from food and drink, when contracted, harm the Six Fu Organs; (Note: The flavors of diet should be balanced, but their nature indeed differs in cold and heat. Bias toward cold causes stagnation and obstruction; bias toward heat causes blazing and scorching dryness. One might ask: Since Zang and Fu organs reside in the same body, why does the harm of cold and heat only affect the Fu organs and not the Zang? The answer is: Food and drink first enter the Stomach. The Stomach resides with the other Fu organs below the diaphragm; its position is Yang and its location is superficial. In contrast, the Zang organs are Yin and deep; food and drink cannot enter them directly, so they are not harmed.) Dampness from Earth, when contracted, harms the skin, flesh, sinews, and vessels. (When dampness prevails, Ying and Wei Qi fail to circulate, so contraction harms the skin, flesh, sinews, and vessels. Note: The above discusses the causes of human illness, which generally fall into these three categories. The following sections contain the profound essence of treatment methods and the mysterious principles of Xuanyuan and Qibo; the main gist of the entire book is summarized here.)

Therefore, those skilled in acupuncture guide Yang from Yin, guide Yin from Yang, treat the left side using the right, and treat the right side using the left; infer the patient's condition from one's own, understand interior pathology from exterior symptoms, observe the principles of excess and deficiency, detect minor anomalies to identify errors, and thus avoid danger without failure. (This is because they deeply understand the underlying principles.) Those skilled in diagnosis examine complexion and palpate pulses, first distinguishing Yin and Yang; (Note: The way of Heaven and Earth is nothing but Yin and Yang. Human diseases may lean toward Yin, toward Yang, involve Yang excess, Yin excess, Yang deficiency, Yin deficiency, Yin excess with Yang deficiency, or Yang excess with Yin deficiency. The variations of disease are countless, so the key lies in first distinguishing Yin and Yang.) Assess the clarity or turbidity of the complexion to know the location of the disease; (Note: The Heart is superior, Kidney inferior, Liver on the left, Lung on the right, Spleen in the center. By assessing the clarity or turbidity of Qi, one can determine the site of the disease.) Observe breathing and listen to voice sounds to know where the patient suffers; (Note: Rebellious and rapid Qi is called panting; one exhalation and one inhalation is called respiration. Sound produced from the mouth is voice; distinct sounds are tones. However, panting varies in speed, and voices vary in clarity or turbidity. Internal suffering naturally manifests externally. Since panting involves sound, why speak of "observing"? Generally, when panting occurs, the body necessarily moves. Mild cases involve more exhalation than inhalation; severe cases involve staring eyes, flaring nostrils, shrugging ribs, and lifting shoulders. Thus, one must not only hear the sound of breathing but also carefully observe the state of breathing; this is the essential method of inspection and auscultation.) Observe the balance, weights, rules, and compasses (referring to pulse qualities of weight and shape) to know the root of the disease; (Note: Weights measure heaviness and lightness; compasses and squares determine roundness and squareness; these are the standards of human conduct. Only in disease do speech become aberrant and movements lose measure; the manifestations in countenance indicate the primary cause of illness. Thus, observing countenance reveals the Heart, just as holding jade reveals its height or lowliness, observing postures such as bowing or rising.) Palpate the Cun and Chi positions, observe the floating, sinking, slippery, and choppy qualities to know the origin of the disease for treatment. (Floating pulse is felt lightly. Sinking pulse is felt only with heavy pressure. Slippery pulse flows smoothly. Choppy pulse flows with difficulty. Thus, by examining the image of the pulse, one knows the cause of the disease and treats accordingly. If one does not err in diagnosis, one will not fail. (...Note: "No error in diagnosis" means if pulse diagnosis is truly accurate, then treatment will naturally be free of mistakes. The commentary saying "whether there is error or not, it is known by diagnosis" confuses the concepts.) ) Therefore, according to the lightness of the pathogen, use dispersing methods (Yang); (Note: Pathogen in superficial layers is called light; disperse it outward to prevent deeper invasion.) According to the heaviness of the pathogen, use reducing methods (Jian); (Note: Heavy indicates deep-seated pathogen; the momentum is hard to remove instantly. Address the urgent aspects first, allowing gradual reduction without causing agitation or injury. According to the decline of Zheng Qi, use reinforcing methods (Zhang). Note: Decline means the pathogen is nearly exhausted but Zheng Qi has not yet recovered; urgently reinforce to make Zheng Qi vigorous and force the pathogen outward.) For insufficiency of form, warm with Qi-tonifying herbs; for insufficiency of essence, tonify with flavor-rich herbs. (Note: Insufficiency of form refers to emaciated muscles. Flavor returns to form; form consumes flavor, as stated earlier in this chapter. Emaciation is suitable for nourishment via flavor, yet here it says warm with Qi. Why? Flavor nourishes humans, but excess harms. Insufficiency of form may result from overeating. Adding more flavor would further burden the Spleen and exacerbate muscle wasting. The treatment for this avoids Yin-cold substances and urgently warms and nourishes Qi. When Qi harmonizes, Blood circulates naturally, and flesh fills; this is the principle of Yang generating Yin. Insufficiency of essence refers to depletion of marrow and essence. Qi returns to essence; essence consumes Qi, also stated earlier. Essence deficiency should ideally be treated by tonifying Qi, yet here it says tonify with flavor. Can coarse diet truly benefit true essence? Qi归属于 essence, originating from essence; essence relies on Qi, nourished by Qi. Now that essence is depleted, it cannot transform Qi, leading to Qi extinction; if Qi is extinct, how can it nourish essence? Thus, formless Jing-Qi must borrow有形 dietary substances to replenish itself. The Chapter on Distinctions of the Five Zang states: "Five flavors enter the mouth, store in the Stomach to nourish the Qi of the Five Zang." The Chapter on Organ Qi and Seasons states: "Grains for nourishment, fruits for assistance, meats for benefit, vegetables for filling; consume combined flavors and aromas to benefit essence and Qi." The Chapter on Meridian Distinctions states: "Food and drink enter the Stomach, overflow with Jing-Qi, ascend to the Spleen; Spleen Qi scatters essence, transports upward to the Lung, regulates water passages, transports downward to the Bladder; water essence distributes everywhere, five meridians run together." From this, the ability of flavor to tonify essence is evident.) For pathology located high, induce vomiting (Yue); (Note: Yue means to discharge upward. For pathology in the upper region, vomiting is appropriate; emetic methods are suitable not only for cold damage.) For pathology located low, guide to exhaust it (Jie); (Note: Since pathology is in the lower region, follow the trend to guide it out completely without retention.) For fullness in the middle, drain internally (Xie zhi yu nei); (Note: Qi congestion in the chest and abdomen causing fullness and obstruction is called middle fullness. There is a distinction between excess and deficiency: Excess often involves Phlegm-Fire, cleared by purging and draining; Deficiency presents with panting and distension, much saliva, little phlegm, apparent heat without fire; regulating Qi removes fullness naturally, eliminating it subtly, which is called draining internally. Zhang Jingyue erred in associating middle fullness with great excess and hardness. As mentioned later, true excess involves hardness. Middle fullness only affects the Upper and Middle Jiao; "draining" here merely means regulating and promoting flow, unlike treating gastrointestinal excess-hardness by purgation.) For those with pathogenic factors, soak the body to induce sweating (Ze xing yi wei han); for those with pathogen in the skin, release via sweating (Han er fa zhi); (Note: Why are there only two clauses for sweating methods? Pathogen in skin and hair certainly warrants sweating. However, whenever abnormal Qi flows into meridians, harboring internal pathogen, it is especially suitable for acrid-sweet formulas to permeate the whole body, allowing pathogen resolution via sweat. This shows that even slightly deeper pathogen benefits from sweating, not just that in the skin. Tao Shangwen said: "For cold damage lasting seven to eight days, if exterior signs remain unresolved, sweating should still be induced." This truly understands the profound principles of Xuanyuan and Qibo.) For fierce pathogenic Qi, press and gather it (An er shou zhi); (Note: Fierce refers to excessive dispersion, such as floating deficient Yang or insufficient True Yin. Pressing means suppressing and descending, causing convergence and return to the source.) For excess conditions, disperse and purge (San er xie zhi). (Yang excess is dispersed; Yin excess is ventilated and purged.) Examine Yin and Yang to distinguish rigid and flexible; treat Yin diseases by addressing Yang, and Yang diseases by addressing Yin. (Note: Yin and Yang are the principles of Heaven and Earth; rigid and flexible are the natures of Yin and Yang. Yin disease syndromes are necessarily flexible; Yang disease syndromes are necessarily rigid. This describes the normal state of disease, requiring direct treatment. However, if internal Yin exhaustion leads to external Yang floating, or Yang failing to protect the exterior leads to Yin depletion, one should not treat Yang simply because it appears Yang, nor Yin because it appears Yin. For variable diseases, one must employ contrary treatment. The precise essence of the sages' treatment methods is fully contained here; the commentary's casual citation of superficial phrases severely distorts the original intent.) For blood excess, lacerate/drained it (Jue zhi); (Jue means to lacerate the blood. Note: Jue applies to both exterior and interior. For blood deficiency, supplementation is required. For exterior excess-heat such as carbuncles and ulcers, needle-lancing is needed to break the toxicity. For interior Yang excess with blood heat, or stasis causing pain, urgent purgation is needed to remove excess; all these constitute Jue.) For Qi deficiency, guide/pull it (Che yin zhi). (Note: HT [textual error, likely Che], the commentary is wrong. The *Jia Yi Jing* writes "Che" (pull/draw), which is correct. Che means pulling an object with hand. When Qi is excess, it lodges in the Dantian; when deficient, it floats and rebels upward. Secular use of Qi-moving drugs further depletes Qi. The terms "Che" and "Yin" are exquisite: e.g., gathering and descending to protect the Lung, or warming and nourishing the Middle Palace to support the mother, or nourishing Kidney Yin to return to the source; gentle regulation makes floating Qi smooth and non-rebellious; this is the meaning of Che-Yin. Interpreting it as Daoyin/massage belongs to the massage school and likely misses the intent of Xuanyuan and Qibo.)