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(The original text states: The Spleen dislikes dampness and should urgently consume bitter flavors to dry it. As for the dietary preferences of the Liver, Heart, Lungs, and Kidneys, they should all align with the preceding text. However, for the Spleen, salty flavors are not used with bitter ones; therefore, Wang Bing specifically annotated the underlying meaning.) Pungent flavor can disperse and also moisten; Sour flavor can astringe; Sweet flavor can relax; Bitter flavor can firm and dry; Salty flavor can soften. (These are all natural properties of Qi. However, pungent flavor is not only dispersing but also moistening, hence it is said: "When the Spleen suffers from dampness, urgently eat bitter to dry it." Bitter flavor is not only firming but also drying and draining, hence it is said: "When the Lungs suffer from rebellious Qi, urgently eat bitter to drain it.") Toxic substances attack pathogens; Five Grains provide nourishment; Five Fruits assist; Five Livestock benefit; Five Vegetables clear and unblock. (Continued annotation: "Toxic substances" refer to metals, jade, stones, earth, herbs, trees, vegetables, fruits, insects, fish, birds, and beasts. However, only toxicity can remove pathogens and stabilize righteousness, so they are collectively called toxic substances. Five Grains include glutinous rice, adzuki beans, soybeans, wheat, and broomcorn millet. Five Fruits include peaches, plums, apricots, chestnuts, and jujubes. Five Vegetables include malva, vetches, wild leeks, green onions, and Chinese chives. I believe this is to ensure sufficient nutrition, using five vegetables to unblock the intestines and stomach, allowing the qi of food to circulate.) By consuming them in accordance with their flavors and properties, one can tonify essence and replenish Qi. (Continued annotation: Qi belongs to Yang and transforms; Flavor belongs to Yin and applies. When flavors and properties harmonize, they tonify essence and Qi. The Classic says: "For deficiencies of form, warm with Qi; for deficiencies of essence, tonify with flavor." Sun Simiao said: "Essence is generated by the Qi of food; Qi nourishes essence to luster the complexion; Form is constituted by food flavors; Flavors nourish the complexion to generate strength. Essence follows the Five Qi to become spiritual. If the Qi of foods repels each other, Essence is damaged; Form receives flavors to be formed; if food flavors are unharmonized, Form is harmed. Therefore, sages first use dietary taboos to preserve nature and prevent excessive warming/tonifying flavors from damaging Qi and Essence. This is called consuming flavors and properties in combination to tonify essence and replenish Qi.") These five flavors (Sour, Pungent, Sweet, Bitter, Salty) each have specific benefits: some disperse, some astringe, some relax, some urgent/firm, some dry/firm, some soften. Diseases of the Four Seasons and Five Zang Organs should be selected according to the suitability of the five flavors (from *Zang Qi Fa Shi Lun*).

There are prohibitions for the five flavors: Pungent moves Qi; those with Qi disorders should not eat much pungent. Salty moves Blood; those with Blood disorders should not eat much salty (Blood belongs to Water, so salty moves to it). Bitter moves to Bones; those with Bone disorders should not eat much bitter. (Continued annotation: Huangfu Mi said salty moves to the Kidney first; here it says it moves to Blood because the Kidney combines with the San Jiao, and although blood vessels belong to the Liver and Heart, they are located in the Middle Jiao pathway, so salty and Fire move to Blood. Bitter moves to the Heart; here it says it moves to Bones because Water and Fire interact, and Bone Qi connects to the Heart.) Sweet moves to Flesh; those with Flesh disorders should not eat much sweet. Sour moves to Sinews; those with Sinew disorders should not eat much sour. (Continued annotation: This is because they move Qi rapidly, so one does not wish to eat much. If not eaten, the disease may worsen.) This is called the Five Prohibitions; do not let patients eat too much (from *Xuan Ming Wu Qi Lun*).

Eating too much salty causes blood vessels to coagulate and stagnate, changing the complexion. (Continued annotation: The Heart governs vessels, its luster is in the face. Salty benefits the Kidney and overcomes the Heart, causing vessel coagulation and color change.) Eating too much bitter causes skin to wither and hair to fall out. (Continued annotation: The Lungs govern skin, their luster is in hair. Bitter benefits the Heart and overcomes the Lungs, causing skin withering and hair loss.) Eating too much pungent causes sinews to contract and nails to wither. (Continued annotation: The Liver governs sinews, its luster is in nails. Pungent benefits the Lungs and overcomes the Liver, causing sinew contraction and nail withering.) Eating too much sour causes flesh to become calloused and lips to peel/retract. (Continued annotation: The Spleen governs flesh, its luster is in the lips. Sour benefits the Liver and overcomes the Spleen, causing calloused flesh and peeling lips.) Eating too much sweet causes bone pain and hair loss. (Continued annotation: The Kidneys govern bones, their luster is in hair. Sweet benefits the Spleen and overcomes the Kidneys, causing bone pain and hair falling.) These are the injuries caused by the five flavors. (The five flavors enter the mouth, travel to the intestines and stomach, and internally nourish the five Zang organs. Each has what it nourishes and what it desires; desire leads to mutual injury, hence the following text says:) Thus, the Heart desires bitter, the Lungs desire pungent, the Liver desires sour, the Spleen desires sweet, and the Kidneys desire salty. This is the correspondence between the five flavors and the Qi of the five Zang organs. (Continued annotation: Each returns to where it is desired. Quan Yuanqi stated that the five flavors combine with the Qi of the five Zang organs; these two sentences are connected.)

Colors and flavors correspond to the five Zang organs: White corresponds to the Lungs and Pungent flavor; Red corresponds to the Heart and Bitter flavor; Green/Cyan corresponds to the Liver and Sour flavor; Yellow corresponds to the Spleen and Sweet flavor; Black corresponds to the Kidneys and Salty flavor. (Continued annotation: Each corresponds to its appropriate color and flavor.) Thus, white corresponds to skin, red to vessels, green/cyan to sinews, yellow to flesh, and black to bones. (Continued annotation: Each corresponds to the Qi of the organ it nourishes. From *Wu Zang Sheng Cheng Pian*.)

The Emperor asked: I wish to hear about the essentials of Deficiency and Excess. Qibo replied: Qi Excess with Form Excess, Qi Deficiency with Form Deficiency—this is the norm. Opposite to this is disease. (Continued annotation: Qi refers to pulse Qi, Form refers to physical body. Opposite means non-correspondence, losing the normal equilibrium. When Form and Qi are opposite, disease arises.) Grain abundance leads to Qi abundance; Grain deficiency leads to Qi deficiency—this is the norm. Opposite to this is disease. (Continued annotation: *Ling Shu Jing* states: The way of Ying Qi relies on internal grain for fullness. Grain enters the Stomach, Qi transmits to the Lungs, the refined part ascends through the meridians. Thus, the fullness or emptiness of Grain Qi must correspond. If the signs do not match, it is disease.) Pulse Excess with Blood Excess, Pulse Deficiency with Blood Deficiency—this is the norm. Opposite to this is disease. (Continued annotation: The Pulse is the residence of Blood, so fullness and emptiness are the same. Opposition and non-correspondence indicate disease.)

What constitutes opposition? Qi Deficiency with Body Heat—this is called opposition. (Continued annotation: Qi Deficiency means insufficient Yang Qi. Insufficient Yang Qi should result in cold body; instead, there is heat. The pulse should be full but is not, and symptoms do not match, hence called opposition. According to *Jia Yi Jing*: Qi Excess with Cold Body, Qi Deficiency with Heat Body—this is called opposition. These four characters should be added.) Abundant grain intake but little Qi—this is called opposition. (The Stomach produces Grain Qi which spreads to the meridians. Grain enters the Stomach, and the pulse channels scatter. Now, abundant grain intake but little Qi means the Stomach Qi cannot scatter, hence called opposition.) No grain intake but abundant Qi—this is called opposition. (Continued annotation: Stomach Qi scatters externally, and Lung Qi joins it.) Pulse Excess with Blood Scarcity—this is called opposition; Pulse Scarcity with Blood Excess—this is called opposition. (Continued annotation: Jing Meridians move Qi, Luo Meridians receive Blood. Jing Qi enters Luo, Luo receives Jing Qi. Climate and Qi do not match, so both are abnormal.)

Qi Excess with Cold Body results from Cold Injury; Qi Deficiency with Heat Body results from Summerheat Injury. (Continued annotation: Cold injures Form, hence Qi Excess and Cold Body; Heat injures Qi, hence Qi Deficiency and Heat Body.) Abundant grain intake but little Qi results from Blood Loss, with Dampness residing below. (Continued annotation: Blood loss leads to Blood Deficiency; Blood Deficiency leads to Qi Excess. Internally stagnant, it transforms into fluids flowing to the Lower Jiao, hence called Dampness residing below.) Scarce grain intake but abundant Qi indicates Pathogen in the Stomach and Lungs. (Continued annotation: Stomach Qi is insufficient, Lung Qi flows down into the Stomach, hence Pathogen in the Stomach. Since Lung Qi enters the Stomach, Lung Qi cannot guard itself, and Pathogen Qi follows, hence Pathogen in the Stomach and Lungs.) Small Pulse with Abundant Blood indicates Heat within Fluid Retention. (Continued annotation: Fluid Retention refers to retained fluids. Fluids retained in the Spleen and Stomach cause Spleen Heat; overflowing Spleen Heat generates heat in the middle.) Large Pulse with Scarce Blood indicates Wind Qi in the Pulse and inability to ingest water/gruel. This is called... (Continued annotation: Wind Qi is abundant and full, preventing water/gruel from entering the pulse. From *Ci Zhi Lun*.)

Heavenly pathogenic Qi, when contracted, harms the Five Zang Organs. (Continued annotation: Qi of the four seasons and wind of the eight directions are all Heavenly pathogens. Entering wind generates pathogenic Qi, meridians receive it, then it follows the meridians to touch the five Zang organs.) Cold and heat of water and grain, when contracted, harm the Six Fu Organs. (Continued annotation: Heat harms the Stomach and Bladder; Cold harms the Intestines and Gallbladder.) Earthly dampness, when contracted, harms the skin, flesh, sinews, and vessels. (When dampness is abundant, Ying and Wei Qi and vessels do not flow, so contraction harms skin, flesh, sinews, and vessels. From *Yin Yang Ying Xiang Da Lun*.)

Qibo said: Yang is Heavenly Qi, governing the Exterior; Yin is Earthly Qi, governing the Interior. Therefore, the Way of Yang is Full/Excess, and the Way of Yin is Empty/Deficient. Thus, those who suffer from treacherous wind and empty pathogens are affected in the Yang (meridians); those with irregular diet and improper daily routine are affected in the Yin (meridians). Affected in Yang, it enters the Six Fu Organs; affected in Yin, it enters the Five Zang Organs. Entering the Six Fu Organs causes fever, restlessness, and upper manifestations like wheezing; entering the Five Zang Organs causes abdominal fullness and obstruction, lower manifestations like undigested diarrhea, and long-term development into intestinal dysentery. (Commentary: *Yin Yang Ying Xiang Da Lun* states: Heavenly pathogenic Qi harms the Five Zang; cold/heat of water/grain harms the Six Fu. *Tai Yang Yang Ming Lun* states: Treacherous wind/empty pathogens affect Yang; diet/lifestyle affects Yin. Yang affects enters Six Fu; Yin affects enters Five Zang. Why do these two statements seem contradictory? They appear contrary but are not. Heavenly pathogenic Qi and treacherous wind are external excess diseases; cold/heat of water/grain and diet/lifestyle are internal deficiency diseases. Both can harm the Zang and Fu, depending on where they enter and manifest. One should not doubt due to apparent differences, as they run parallel without contradiction. Heavenly pathogenic Qi certainly harms the Zang but may also harm the Fu; cold/heat of water/grain certainly harms the Fu but may also harm the Zang. As for earthly dampness, it may not exclusively harm skin/flesh/sinews/vessels nor fail to harm Zang/Fu. Pathogenic Qi is formless, and Zang stores essence/Qi, so similar things attract, harming Zang more. Water/grain have form, and Fu transmit/digest, so they follow their path and harm Fu more. Dampness infiltrates slowly, entering gradually starting from the feet, moving upward from shallow to deep, thus mostly harming skin/flesh/sinews/vessels. Who would say dampness never reaches the Zang/Fu?)

Therefore, the Throat governs Heavenly Qi, and the Pharynx governs Earthly Qi; thus, Yang receives Wind Qi, and Yin receives Damp Qi. (Continued annotation: Like attracts like.) Yin Qi travels upward from the feet to the head, then descends along the arms to the fingertips. Yang Qi travels from the hands to the head, then descends to the feet. (Continued annotation: *Ling Shu Jing* states: Hand Three Yin move from Zang to Hands; Hand Three Yang move from Hands to Head; Foot Three Yang move from Head to Feet; Foot Three Yin move from Feet to Abdomen. Their paths differ, so they alternate in reversal and following.) Thus, it is said: Yang diseases ascend to the extreme and then descend; Yin diseases descend to the extreme and then ascend. (Continued annotation: This speaks generally. However, Foot Shaoyin descends differently from other Yin Qi.) Thus, those injured by Wind are first affected above; those injured by Dampness are first affected below. (Continued annotation: Yang Qi flares upward, so it receives Wind; Yin Qi moistens downward, so it receives Dampness. Because like attracts like. From *Tai Yang Yang Ming Pian*.)

The Five Zang receive Qi from what they generate, transmit it to what they overcome, store Qi in what generates them, and die from what overcomes them. When death is imminent, the disease must first transmit to what overcomes it before death occurs. (Continued annotation: Receiving Qi from what is generated means receiving pathological Qi from what one generates. Transmitting to what is overcome means transmitting to what one controls. Storing Qi in what generates means resting in what generates oneself. Dying from what overcomes means dying at the position of what controls oneself. Transmission is not smooth, hence death is inevitable.) This describes the reverse movement of Qi, hence death. (Continued annotation: The reasons for reversal are described below.) The Liver receives Qi from the Heart (Wood generates Fire), transmits to the Spleen, stores in the Kidney, and dies at the Lung. The Heart receives Qi from the Spleen, transmits to the Lung, stores in the Liver, and dies at the Kidney. The Spleen receives Qi from the Lung, transmits to the Kidney, stores in the Heart, and dies at the Liver. The Lung receives Qi from the Kidney, transmits to the Liver, stores in the Spleen, and dies at the Heart. The Kidney receives Qi from the Liver, transmits to the Heart, stores in the Lung, and dies at the Spleen. All these are deaths by reverse transmission. Dividing day and night into five parts allows one to predict the timing of death. (Continued annotation: Liver dies at Lung's position in Autumn, Geng/Xin days; the others follow similarly. Morning governs Jia/Yi, Day governs Bing/Ding, Four Seasons/Earth governs Wu/Ji, Afternoon governs Geng/Xin, Night governs Ren/Gui. From this, the early or late timing of death can be known. Correction: "Predict life and death" should be "Predict death". From *Yu Ji Zhen Cang Lun*.)

Heaven has the Four Seasons and Five Elements (*Tian Yuan Ji Da Lun* reads "Heaven has Five Elements to control Five Positions"), which promote growth, flourishing, harvesting, and storage, generating Cold, Heat, Dryness, Dampness, and Wind. (Continued annotation: Spring Growth, Summer Flourishing, Autumn Harvest, Winter Storage are the growth/storage of the four seasons. Winter Water Cold, Summer Fire Heat, Autumn Metal Dryness, Wood Spring/Summer Wind, Earth Dampness are the Cold/Heat/Dryness/Dampness/Wind of the Five Elements. Although Earth Qi寄旺 (is parasitically prosperous) in the four seasons, its primary governance is central, hence it is said Five Elements generate the five Qi: Cold, Heat, Dryness, Dampness, Wind.) Humans have Five Zang Organs that transform Five Qi, generating Joy, Anger, Sorrow, Thought, and Fear. (Continued annotation: Five Qi refers to Joy, Anger, Sorrow, Thought, Fear. However, these five Qi can damage the harmonious Qi of the five Zang. ○ Correction: In *Tian Yuan Ji Da Lun*, "Sorrow" is written as "Thought". Perhaps saying Sorrow wins Fear takes the perspective of five emotions mutually overcoming each other; Thought is the emotion of the Spleen. Naming one leaves meaning incomplete; seeing both complements the meaning.)

Joy and Anger damage Qi; Cold and Heat damage Form. (Continued annotation: Joy and Anger arise from Qi, hence Joy/Anger damage Qi. Cold and Heat prevail over Form, hence Cold/Heat damage Form. Taking examples from the body, this is how it is. Finely speaking, Heat damages Qi, Cold damages Form.) Violent anger damages Yin; violent joy damages Yang. (Continued annotation: Anger causes Qi to rise, Joy causes Qi to descend. Sudden rising of Qi damages Yin; sudden descending of Qi damages Yang.) Rebellious Qi moves upward, filling the vessels and separating spirit from form. (Continued annotation: Rebellious Qi is inverted. Inverted Qi moves upward, filling the collaterals, causing floating Qi and wandering Spirit to separate from Form and Marrow.) Unregulated Joy and Anger, excessive Cold and Heat, lead to unstable vitality. (*Ling Shu Jing* states: The wise nurture themselves by following the four seasons and adapting to cold/heat, harmonizing joy/anger and living securely. But if joy/anger are irregular and cold/heat excessive, how can primal Qi last long?)

Thus, Extreme Yin becomes Yang; Extreme Yang becomes Yin. (Continued annotation: Speaking of Cold and Summerheat injuries being the same. From *Yin Yang Ying Xiang Da Lun*). Wind Excess causes Tremor/Movement. (Continued annotation: Restlessness. Wind excess causes all things to shake, hence movement. *Zuo Zhuan* says: Wind shakes the tips, illness is severe. Correction details on "Wind excess causes movement" to "Dampness excess causes loose stool" five sentences differ from *Yin Yang Ying Xiang Da Lun* text and notes.) Heat Excess causes Swelling. (Continued annotation: Heat excess causes internal stagnation of Yang Qi, leading to sudden red swelling. Severe cases, Ying Qi reverses in muscle tissue, gathering into abscesses. Also: Heat excess Qi causes Erysipelas; excess Blood causes Pus/Abscess; excess Bone/Flesh causes Edema, pressing leaves no dent.) Dryness Excess causes Dryness. (Continued annotation: Dry externally causes skin cracking; dry internally causes essence/blood depletion; dry Qi/fluids causes flesh dryness and skin adhering to bone.) Cold Excess causes Floating/Edema. (Continued annotation: Floating means rising, visible upon pressing. Also: Cold excess causes Yin Qi to knot at the pores; pores close tightly, Yang Qi attacks internally, hence floating.) Dampness Excess causes Loose Stool; severe cases cause Urinary Obstruction and Edema. (Continued annotation: Dampness excess attacks internally the Spleen/Stomach; Spleen/Stomach receiving dampness fails to separate water/grain, hence Large Intestine conducts and pours out loose stool. Because dampness is internally abundant, it is called loose stool. *Zuo Zhuan* says: Rain indulgence causes abdominal illness. Loose stool is watery diarrhea. Edema is soft flesh, pressing sinks and does not rise. Urinary obstruction means overflow into subcutaneous tissue. From *Liu Yuan Zheng Ji Da Lun*.)

The Emperor asked: Why does Spleen disease cause immobility of the four limbs? Qibo said: The four limbs all receive Qi from the Stomach but cannot reach the meridians directly. (Continued annotation: *Tai Su* reads "reach the meridian path". Yang Shangshan said: The Stomass provides water/grain to nourish the four limbs but cannot reach them directly; it must rely on the Spleen to distribute transformed water/grain fluids, so the four limbs receive endowment.) It must rely on the Spleen to receive endowment. Now, Spleen disease cannot transport fluids for the Stomach; the four limbs cannot receive water/grain Qi; day by day they decline, pulse channels become obstructed, sinews/muscles lack Qi to generate, hence immobility.

Asked: Why does the Spleen not govern a specific season? Answered: The Spleen is Earth, governing the Center, constantly nurturing the Four Zang throughout the four seasons, ruling for 18 days each in succession, not solely governing a time. The Spleen organ constantly attaches to the essence of Stomach Earth. Earth generates all things and models Heaven and Earth, hence from top to bottom including head and feet, it cannot solely govern a time. (Continued annotation: Govern means rule. Attach means constantly bound to the Stomach. Earth Qi in the four seasons rules for 18 days at the end of each season, so Five Element Qi rules 72 days each to complete the year. Externally governing four seasons, internally corresponding to hands and feet.)

Asked: The Spleen and Stomach are connected by membranes, yet how can it transport fluids? Answered: Foot Taiyin is the Three Yin; its pulse penetrates the Stomach, belongs to the Spleen, and connects to the pharynx, thus Taiyin transports Qi to the Three Yin. Yangming is the Exterior. (Continued annotation: Stomach is the exterior of the Spleen.) It is the Sea of the Five Zang and Six Fu Organs, and also transports Qi to the Three Yang. The Zang and Fu each receive Qi from Yangming via their meridians. (From *Tai Yang Yang Ming Lun*.)

Weak Form and Deficient Qi lead to Death. (Continued annotation: Internal and external both deficient.) Form and Qi Excess but Pulse Qi Deficiency lead to Death. (Continued annotation: Zang decline causes pulse deficiency.) Pulse Qi Excess but Form and Qi Deficiency lead to Survival. (Continued annotation: Zang prosperity causes pulse Qi excess. From *Fang Sheng Shuai Lun*.)

Qibo said: Salt tastes salty; its vapor causes moisture in vessels to leak. Strings breaking produce hoarse sounds. Trees spreading (decaying) cause leaves to fall. Deep disease produces hiccups. A person having these three conditions is called having a Ruined Mansion (organ failure). Toxic drugs cannot treat it; short needles cannot take it. These are all severing skin, injuring flesh, and blood/Qi struggling turning black. (This section has errors. "Tree spreading leaves fall," *Tai Su* reads "Old trees shed leaves." "Struggle black" should be "Struggle different." Ruined Mansion refers to the disease of the three, like a collapsing place. Detailed meaning: Breaking strings mean hoarse sound; old trees shedding leaves; salty salt vapor leaks fluid; deep disease produces hiccups. Severing skin, injuring flesh, blood/Qi struggle differently. Having these three is Ruined Mansion. Drugs cannot treat, needles cannot take. Comparing string breaking to hiccups, tree falling to injury, fluid leaking to blood struggle. ○ Yang Shangshan said: To know scattered disease, know the signs. Salt in tears leaks fluid externally; seeing fluid knows salt is salty; hiccups know strings will break; leaf fall knows old tree is dead. Using these three decay signs to compare hiccups identifies deep disease. Having hiccups matching three metaphors is sign of Mansion ruin. Inner Mansion ruin is deep disease. Disease is deep, so medicine cannot take, because skin/flesh/blood/Qi do not get along. ○ Commentary: Yang's note connects well but Hua Shou's note is denser.)

Qibo said: Wood is felled by Metal; Fire is extinguished by Water; Earth is penetrated by Wood; Metal is lacking by Fire; Water is cut off by Earth. All things are thus, too numerous to list. (Continued annotation: Penetrate means通达 (penetrative/unimpeded). Though species are inexhaustible, summarily, they all have Five Element Qi with winning/losing natures. From *Bao Ming Quan Xing Lun*.)

Yin Excess dreams of wading in water and fear. (Continued annotation: Yin is Water, hence dreaming of wading and fear.) Yang Excess dreams of great fire burning. (Continued annotation: Yang is Fire, hence dreaming of fire burning.) Yin and Yang both Excess dream of killing and injuring. (Continued annotation: Also resembles images of conflict.) Upper Excess dreams of flying. (Continued annotation: Qi rises, hence dreaming of flying.) Lower Excess dreams of falling. (Continued annotation: Qi descends, hence dreaming of falling.) Very full dreams of giving. (Continued annotation: Internal surplus.) Very hungry dreams of taking. (Continued annotation: Internal deficit.) Liver Qi Excess dreams of anger. (Continued annotation: Liver emotion is Anger.) Lung Qi Excess dreams of crying. (Continued annotation: Lung voice is mournful, hence dreaming of crying. Still lacks Heart/Spleen/Kidney Qi dreams, now included in *Jia Yi Jing*.) Many short parasites dream of gathering crowds; many long parasites dream of fighting and injuring. (Continued annotation: Long parasites moving causes internal unrest; internal unrest causes spirit agitation, hence dreaming this. From *Jin Yao Jing Wei Lun*.)