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Question: Why does a skilled physician treat disease before it arises?
The Master replied: To treat disease before it arises means that when one sees liver disease, one knows that the liver transmits to the spleen, and thus should first strengthen the spleen. If the spleen is prosperous in any of the four seasons and not susceptible to pathogenic factors, then no supplementation is needed. An average physician, unaware of this transmission, seeing liver disease, fails to strengthen the spleen and merely treats the liver. In treating liver disease, sour flavors are used for tonification, scorched bitter flavors for assistance, and sweet flavors for harmonization. Sour enters the liver, scorched bitter enters the heart, and sweet enters the spleen. A strong spleen can restrain the kidney; if kidney qi is weak, water metabolism is controlled. If water metabolism is controlled, heart fire does not become excessive. If heart fire is not excessive, it does not injure the lung. If the lung is not injured, metal qi (lung qi) functions normally. Normal metal qi restrains wood, preventing liver qi from becoming excessive, thus allowing the liver disease to heal. This is the subtlety of "treating the liver by supplementing the spleen." This method applies to liver deficiency; it is not used for liver excess. The Classics state: "Do not make deficiency more deficient or excess more excess"; tonify what is insufficient and reduce what is excessive. This is the principle. The same applies to other organs.

Note: The *Suwen* states that when pathogenic factors invade the body, they act according to the cycle of overcoming (Wu Xing). The liver corresponds to Wood and overcomes Spleen Earth; thus, liver disease should transmit to the spleen. "Strengthening the spleen" means assisting the spleen's qi to prosper so it is not susceptible to pathogens, which is the essence of "treating disease before it arises." If one ignores this and only treats the liver, the liver disease may not resolve, and spleen disease may arise. Is this the conduct of a skilled physician? Using sour flavors to tonify the liver is because liver insufficiency is supplemented with its native flavor. This differs from the *Neijing* statement that pungent flavors tonify the liver. However, the liver is a Yin organ containing Sheng Qi (vital generating energy); using pungent flavors assists its function (Yong), while using sour flavors nourishes its substance (Ti). Although the statements differ, both principles are appropriate. Assisting with scorched bitter flavors aligns with the *Qianjin Fang*, which states that when Heart Qi prospers, it influences the Liver. Supplementing with sweet flavors to harmonize aligns with the *Nanjing*, which says that to damage the liver, one must soothe its center (Huan Qi Zhong). The fifteen sentences starting from "Sour enters the liver" are suspected not to be Zhang Zhongjing's original text but rather erroneous annotations added by later authors and mistakenly included by compilers. Zhang Zhongjing's key point in "treating the liver by supplementing the spleen" lies in making the spleen solid so it does not receive liver pathogens, not in harming the kidney via spleen tonification or allowing heart fire to punish the lung. If that were the case, the benefit would be small and the harm great. Moreover, if the spleen is tonified, the lung will naturally prosper; if the kidney is injured, it will weaken and affect its child organ (Liver). Where is the logic of restraining metal to strengthen wood? Carefully analyzing the meaning, the nine sentences from "Seeing liver disease..." answer the question on "skilled physicians treating disease before it arises," while the three sentences "Tonify with sour..." present the standard treatment for liver deficiency. As stated later, "Use this method for liver deficiency, not for excess," this is clear. Generally, Zang diseases accept tonification only when deficient, not when excess; Zang pathogens transmit only when excess, not when deficient. Therefore, in treating liver excess, one first strengthens Spleen Earth to prevent spread; in treating liver deficiency, one directly tonifies the Liver Zang to prevent external invasion. This is Zhang Zhongjing's essential principle of addressing both deficiency and excess. Later scholars, failing to understand the principle of soothing the liver's center, erroneously clung to the saying that "sweet enters the spleen first," omitting sour and scorched bitter, and excessively interpreting the use of sweet flavors as the essence of "treating the liver by supplementing the spleen." As the ancients said, "Words reveal one's obscurations," which applies here.

Humans inherit the Five Constants and grow due to Wind and Qi. While Wind and Qi can generate all things, they can also harm them, just as water can float a boat or capsize it. If the Yuan Zhen (Original True Qi) of the Five Zang Organs flows smoothly, the person remains peaceful and harmonious. If Ke Qi (Guest Pathogens) and Xie Feng (Evil Winds) invade, death often follows. The myriad calamitous diseases do not exceed three categories: 1. Pathogens entering the meridians and transmitting to the Zang Organs, constituting an internal cause. 2. Pathogens affecting the limbs and nine orifices, spreading through blood vessels causing blockage, constituting an external skin invasion. 3. Injuries from sexual indiscretion, metal/blades, insects, or beasts. Analyzing these comprehensively, the origins of disease are exhausted. If one cultivates caution, preventing evil winds from violating the meridians, and treats them immediately upon meridian invasion but before reaching the Zang Organs; if one uses Daoyin (guiding and pulling), Tunai (breathing exercises), acupuncture, moxibustion, and massage at the first sign of limb heaviness, preventing the closure of the nine orifices; if one avoids legal punishments, animal disasters, and sexual exhaustion; and regulates diet regarding temperature and the five flavors (bitter, sour, pungent, sweet) without letting the physical form decline, then pathogens cannot enter the Cou Li (interstices). Cou Li are the places where the San Jiao (Triple Burner) meets and circulates Yuan Zhen. Li refers to the structural patterns of the skin and Zang Organs.

Humans inherit the norms of Yin-Yang and the Five Elements, and their growth depends on Wind and Qi. Without the Eight Winds, there is no movement and harmony; without the Six Qi, there is no transformation and nourishment. However, where there is Zheng Qi (Upright Qi), there is Ke Qi (Guest Qi); where there is He Feng (Harmonious Wind), there is Xie Feng (Evil Wind). Their ability to generate or harm stems from the same mechanism, like water floating or capsizing boats. When in harmony, it is Zheng Qi; out of harmony, it is Ke Qi. When correct, it is He Feng; incorrect, it is Xie Feng. The greater their power to generate, the greater their power to harm. Thus, invasion by pathogens often leads to death. Wind varies in severity, and disease in depth. Summarizing, there are three causes: 1. Pathogens entering deeply from meridians to Zang Organs (Internal Cause). 2. Pathogens remaining shallowly in limbs, orifices, skin, and blood vessels (External Cause). 3. Diseases arising from legal troubles, sexual excess, metal/blades, or insect/beast bites (Neither Internal nor External Cause). One must cultivate caution here, preventing evil winds from violating the meridians. If pathogens enter meridians but not Zang Organs, they can be cured by sweating, vomiting, or harmonizing methods. This corresponds to the internal cause section mentioned earlier. If wind invades the limbs and approaches the orifices, use breathing exercises to move Qi and acupuncture/massage to expel pathogens, clearing heaviness and preventing closure. This corresponds to the external cause section. Avoiding legal/animal dangers preserves the body; avoiding sexual excess preserves spirit. This corresponds to the sexual excess section. "Cou Li" implies that diseases entangling the body extend beyond meridians and vessels into the interstices, so one must guard against their entry. "Cou" is where the San Jiao connects with bone joints, the place of Shen Qi (Spirit Qi) circulation, hence "Yuan Zhen Hui Tong." "Li" refers to the intricate structures of skin and Zang Organs, hence "Wen Li." Zhang Zhongjing's discussion focuses on wind invading humans; thus, entry from meridians to Zang is deep/internal, while flow from skin to vessels is shallow/external. Injuries from sex, blades, or beasts are distinct from guest pathogens and have no direct interference with meridians/Zang, hence "Neither Internal nor External." (Excerpt from Xu's commentary)

Note: Chen Wuyue in *San Yin Fang* classifies Six Excesses as External Causes, Five Zang Emotions as Internal Causes, and diet/sex/falls/blades as Neither Internal nor External. Zhang Zhongjing's theory focuses on guest pathogens, distinguishing internal/external based on meridians/Zang, as Xu noted. Chen Wuyue distinguishes based on origin (outside vs. inside), which is also clear and can coexist with Zhang's theory.

Question: Patients show facial complexion changes. I wish to hear the explanation.
The Master said: A blue color on the nose tip indicates abdominal pain; if accompanied by cold intolerance, it indicates death. A slightly black nose tip indicates Water Qi (fluid retention). A yellow color indicates Cold in the Chest. A white color indicates Blood Loss. If slightly red and not during the summer season, it indicates death. Fixed, staring eyes indicate Spasm (Jing), which is incurable. Additionally, blue indicates Pain, black indicates Consumption (Lao), red indicates Wind, yellow indicates difficult defecation, and a bright/shiny complexion indicates Retained Fluid (Liu Yin).

This differentiation of Qi and Color is known as "Diagnosis by Observation." The nose tip is the area of the Spleen; blue is the color of the Liver. Abdominal pain indicates Earth being attacked by Wood. Cold indicates Yang depletion and Cold Water aiding the pathogen, hence death. The Kidney governs Water; black is the color of Water. If Spleen Earth is weak and Kidney Water dominates, Water Qi arises. Yellow face indicates Spleen disease; Spleen disease generates Phlegm-Fluid, leading to Cold-Fluid in the chest. White face indicates Blood Loss; loss of blood results in lack of luster. If slightly red outside the fire season, it is Deficient Yang floating upward, hence death. Fixed eyes indicate Yin exhaustion. Spasm is a Wind-Excess disease; Yin exhaustion and Yang excess make it incurable. Pain causes blood stasis, hence blue. Consumption damages the Kidney, hence black. The Classics say: "Kidney deficiency makes the face look like lacquered charcoal." Wind is a Yang pathogen, hence red. Spleen dysfunction causes difficult defecation. Bright/shiny complexion indicates Retained Fluid. The Classics say: "Water patients have puffiness under the eyes and a shiny face."

The Master said: A patient whose voice is quiet but who suddenly cries out in fear has disease in the joints. A patient whose voice is hoarse and indistinct has disease in the Heart and Diaphragm. A patient whose voice is fine and long has disease in the Head.

Quiet voice with sudden cries indicates Kidney/Liver disease, caused by cold in sinews/marrow triggering intermittent pain. Hoarse voice indicates Heart/Lung disease, where airways are blocked. Fine, long voice indicates head pain; the patient dares not raise their voice, but the chest/diaphragm airway is free, so the voice sounds long despite being fine. This is "Diagnosis by Listening." It is incomplete; students should infer the rest.

The Master said: Breathing with shoulder shrugging indicates fullness in the Heart. Breathing drawing Qi upward from the chest indicates Cough. Breathing with open mouth and shortness of breath indicates Lung萎 (Fei Wei) with frothy saliva.

Fullness in the Heart obstructs Qi entry/exit, causing shoulder shrugging during respiration. Cough involves rebellious Qi and Lung failure to descend. Lung Wei involves Qi injury and difficult respiration, causing open-mouthed shortness. This is disease damaging Qi.

The Master said: Slight rapidity in inhalation indicates Excess in the Middle Jiao; purgation cures it. Deficiency is incurable. Inhalation is rapid (Cu) in Upper Jiao disease; inhalation is distant/long (Yuan) in Lower Jiao disease. Both are difficult to treat. Trembling during respiration is incurable.

"Inhalation" refers specifically to incoming Qi. Middle Jiao Excess blocks downward movement, causing slight rapidity. Purgation removes excess and restores flow. If deficiency, the rootless Qi dissipates, hence incurable. Some say Middle Jiao Excess with Yuan Qi Deficiency cannot tolerate purgation nor self-regulate, hence incurable. Upper Jiao Excess prevents Qi entry, causing rapid inhalation. Lower Jiao Excess delays Qi return, causing long inhalation. These involve Zang Qi and are harder to treat than Middle Jiao Excess. Trembling indicates Excess Qi and Deficient Form, unable to sustain itself, hence incurable.

The Master said: Cun Kou pulse movements follow the prosperous season. For example, Liver prosperity brings Blue color. Each season has its corresponding color. If Liver prosperity (Spring) shows White instead of Blue, or colors/pulses appear out of season, disease is present. When the season arrives, Qi prospers, pulse moves, and color responds. Spring Liver: String-like pulse, Blue color—this is normal. If Blue should be present but White appears, it violates the ruling Qi. Thus, both Liver and Lung are diseased. Hence, "Color and Pulse both indicate disease."

Question: What are "Arriving before time," "Arriving late," "Not departing," and "Excessive arrival"?
The Master said: After Winter Solstice, on the Jia-Zi day at midnight, Shao Yang Qi begins. Shao Yang marks the beginning of Yang generation and mild weather. If weather is mild before Jia-Zi, it is "Arriving before time." If weather is not mild after Jia-Zi, it is "Arriving late." If severe cold persists after Jia-Zi, it is "Not departing." If weather is hot like midsummer after Jia-Zi, it is "Excessive arrival." "Arriving" refers to seasonal timing; "Qi arriving" refers to climatic change. Seasons are fixed; climate shifts. Ancient calendars set Winter Solstice on a Jia-Zi day. Sixty days later is another Jia-Zi, coinciding with Rain Water (Yu Shui), when ice melts and warmth begins. "Shao Yang rises" means Yang emerges from the earth. This is not the initial Yang at Winter Solstice. I argue: Summer Solstice generates Yin, followed by Heat; Winter Solstice generates Yang, followed by Cold. Yin/Yang generation follows extreme depletion. Summer Solstice: Yin generates underground when Yang peaks above. Winter Solstice: Yang generates underground when Yin peaks above. Extreme Yang brings heat; extreme Yin brings cold. Thus, "Yang generating brings warmth" differs from Winter Solstice Yang generation. Deviations in climate cause disease; only sages adapt perfectly.

The Master said: Floating pulse at Cun (Front) indicates Exterior disease. Floating pulse at Chi (Back) indicates Interior disease, accompanied by lower back pain, stiffness, inability to walk, shortness of breath, and exhaustion.
Cun is Front (Yang); Chi is Back (Yin). Floating at Cun (Yang in Yang position) indicates Exterior. Floating at Chi (Yang in Yin position) indicates Interior. However, since it is a Yang pulse in the Interior, it is "Exterior within Interior," not true Interior disease (Intestines/Kidneys). Thus, pathology affects waist/back/knees/calves. Eventually, it causes shortness of breath and exhaustion because chronic physical injury affects Qi, and lingering Exterior disease penetrates Interior.

Question: What is "Jue Yang moving alone"?
The Master said: This is Yang without Yin, called Jue Yang.
Jue Yang moving alone is solitary Yang Qi reversing upward. Yang without Yin wanders, like a man without a wife. *Qianjin Fang* states: "Yin pulses relax, blood scatters, True Yang reverses, Yin does not follow." This is the essence of Jue Yang.

Question: Cun pulse is Deep, Large, and Slippery. Deep indicates Excess (Blood); Slippery indicates Qi. Excess and Qi struggle. If Blood/Qi enters Zang, death; if enters Fu, recovery. This is Cu Jue (Sudden Syncope). Explain.
The Master said: Blue lips and cold body indicate entry into Zang (Death). Warm body and spontaneous sweat indicate entry into Fu (Recovery).
"Excess" is Blood Excess; "Qi" is Qi Excess. Struggle means Blood and Qi congregate. Zang store and do not drain; if invaded, Spirit leaves, Machine stops, leading to death. Fu transmit and do not store; if invaded, Qi returns, Blood flows, leading to recovery. The Classics say: "Blood and Qi rushing upward causes Great Jue... if Qi returns, life; if not, death."

Question: Pulse Tuō (Loss/Vanishing) entering Zang means death; entering Fu means recovery. Why?
The Master said: This applies to all diseases. Like Eczema (Jin Yin Chuang): flowing from mouth to limbs is curable (Inside to Outside); flowing from limbs to mouth is incurable (Outside to Inside). Disease outside is curable; entering Inside is fatal.
"Pulse Tuō" means pathogens suddenly oppress Zheng Qi, blocking meridians, making pulse seem absent. It is akin to暴厥 (Bao Jue). If Jue enters Zang (deep), Qi exhausts and dies. If enters Fu (shallow), Qi moves and recovers. Eczema flowing outward is Inside-to-Outside (curable); flowing inward is Outside-to-Inside (incurable). "Disease outside... entering inside" applies generally. Examples include Bi Qi entering abdomen or Gout attacking the Heart.

Question: What are the 18 Yang Diseases?
The Master said: Headache, Neck stiffness, Low back pain, Spine stiffness, Arm pain, Leg cramping pain.
What are the 18 Yin Diseases?
The Master said: Cough, Rebellious Qi, Wheezing, Hiccups, Throat obstruction, Bowel sounds, Distension, Heart pain, Cramping/Tension.
Each of the Five Zang has 18 diseases, totaling 90. Humans also have Six Minor (Wei) conditions, each with 18 diseases, totaling 108. Five Labors, Seven Injuries, Six Extremes, and Women's 36 Diseases are excluded. Clear Pathogens reside above, Turbid below. Major Pathogens strike the Exterior, Minor Pathogens strike the Interior. Grain/Food pathogens enter via the mouth (Retention of Food). The Five Pathogens attack humans with specific patterns: Wind strikes the front (morning), Cold strikes at dusk, Dampness injures the lower body, Fog injures the upper body. Wind makes pulse Floating, Cold makes pulse Tight. Fog injures skin/Cou Li, Dampness flows to joints. Food injures Spleen/Stomach. Extreme Cold injures Meridians, Extreme Heat injures Collaterals.

Head, neck, back, spine, arms, legs are external (Yang). Cough, etc., are internal (Yin). External diseases vary by Ying/Wei involvement (3 types x 6 locations = 18). Internal diseases vary by Deficiency/Excess (2 types x 9 symptoms = 18). Zang diseases (18 each) and Wei diseases (18 each) stem from Six Excesses (Wind, Cold, Summer-Heat, Damp, Dryness, Fire) affecting Qi/Blood combinations (3 types x 6 pathogens = 18). Total: 5 Zang x 18 = 90; 6 Wei x 18 = 108. Five Labors/Seven Injuries arise from lifestyle/emotions. Women's 36 Diseases relate to menstruation/birth/leukorrhea. These are not caused by external Six Qi, hence excluded. Clear Pathogens (Wind/Dew) are above; Turbid (Water/Earth) are below. Major Pathogens (General Wind) are diffuse, striking Exterior. Minor Pathogens (Gap Wind) are sharp, striking Interior. Grain/Food enters mouth and injures Stomach. Thus, pathogens vary in clarity/turbidity and size...