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The Qi of Spring moves westward, the Qi of Summer moves northward, the Qi of Autumn moves eastward, and the Qi of Winter moves southward. (Areas near the East are first affected by the Qi of Spring, gradually extending to the West; areas near the South are first affected by the Qi of Summer, gradually extending to the North; areas near the West are first affected by the Qi of Autumn, gradually extending to the East; areas near the North are first affected by the Qi of Winter, gradually extending to the South.) Therefore, the Qi of Spring begins from below (ascending from below), and the Qi of Autumn begins from above (descending from above). Thus, in places of extreme height, the Qi of Winter Cold is always present (snow remains on mountain peaks even in summer); in places of extreme lowness, the Qi of Spring Warmth is always present (grass grows in marshes even in winter).

To release the exterior (using methods to disperse pathogens from the exterior) does not avoid heat environments or herbs; to attack the interior (using methods to purge interior excess) does not avoid cold environments or herbs. (Releasing the exterior utilizes heat; in summer, releasing the exterior does not avoid heat. Attacking the interior utilizes cold; in winter, attacking the interior does not avoid cold. This is because the substances for releasing the exterior and attacking the interior should not remain stagnant in the middle jiao but should be appropriate.) If one neither releases nor attacks, but instead offends with cold and heat, the disease will worsen. (If one does not treat via release or attack but offends with cold and heat, the disease worsens. If one has no disease but offends with cold and heat, cold and heat syndromes will arise.)

For Wood stagnation, promote its free flow (Stagnation refers to constraint. Wood nature favors expansion; the treatment principle is to ascend it to allow smooth growth). For Fire stagnation, disperse it (Fire nature flares upward; the treatment principle is to scatter it to allow dispersion). For Earth stagnation, seize/purge it (Earth nature favors unblocking; thus, purging is suitable). For Metal stagnation, drain it (Metal nature is clear and draining; thus, draining is suitable). For Water stagnation, restrain it (Water nature flows downward; thus, restrain it to prevent rebellious upward movement). However, to regulate Qi, for excessive conditions, use what it fears to restrain it; this is called "draining" (The above details the treatments for the Five Stagnations, then states that after treatment, Qi must be regulated. If there is still excess not regulated, use what it fears to restrain it. The meaning of restraint is what is called "draining." What it "fears" means: Wood fears Sour, Fire fears Sweet, Earth fears Bitter, Metal fears Pungent, Water fears Salty).

How do the Six Qi govern their respective domains of Heaven and Earth? It is said: Jueyin Wind-Wood governs Heaven (in years of Si and Hai), its transformation manifests as Wind (Wood Qi transforms into Wind); Shaoyin Ministerial Fire governs Heaven (in years of Zi and Wu), its transformation manifests as Heat (Shaoyin Sovereign Fire transforms into Heat); Taiyin Damp-Earth governs Heaven (in years of Chou and Wei), its transformation manifests as Dampness (Earth Qi transforms into Dampness); Shaoyang Ministerial Fire governs Heaven (in years of Yin and Shen), its transformation manifests as Fire (Shaoyang Ministerial Fire, its transformation fears Fire); Yangming Dryness-Metal governs Heaven (in years of Mao and You), its transformation manifests as Dryness (Metal Qi transforms into Dryness); Taiyang Cold-Water governs Heaven (in years of Chen and Xu), its transformation manifests as Cold (Water Qi transforms into Cold). Diseases are named according to the Zang-Fu positions influenced (Wang Bing's commentary: Liver Wood is positioned in the East, Heart Fire in the South, Spleen Earth in the Center and four corners, Lung Metal in the West, Kidney Water in the North. This is the positioning of the Five Zang. However, the Five Movements correspond to the arrival of the Six Qi. When Qi is harmonious, there is peace; when discordant, disease arises. Hence, the influence of the Six Qi is discussed first, followed by diseases of the Five Zang). How does the transformation of Earth (Qi of Earthly Substrate) manifest? It is said: It shares the same signs as Heaven-governing Qi (When Heavenly Qi shifts and Earthly Qi takes effect, diseases are named based on Zang-Fu positions, following the same diagnostic rules as Heaven-governing Qi). Intermittent Qi follows the same pattern (Intermittent Qi takes effect, diseases are named based on Zang-Fu positions, following the same diagnostic rules as Heaven-governing Qi). Those governing left and right are called Intermittent Qi (A year has six Qi. One governs Heaven, one governs Earthly Substrate. The remaining four are: one Left Intermittent to Heaven, one Right Intermittent to Heaven, one Left Intermittent to Earthly Substrate, and one Right Intermittent to Earthly Substrate. As stated in the Great Treatise on Five Movements: Regarding left and right, if Jueyin appears above, Shao Yin is left and Tai Yang is right; if Shao Yin appears above, Tai Yin is left and Jue Yin is right; if Tai Yin appears above, Shao Yang is left and Shao Yin is right; if Shao Yang appears above, Yang Ming is left and Tai Yin is right; if Yang Ming appears above, Tai Yang is left and Shao Yang is right; if Tai Yang appears above, Jue Yin is left and Yang Ming is right. This is determining positions facing North: If Jue Yin is above, Shao Yang is below, Yang Ming is left, Tai Yin is right; if Shao Yin is above, Yang Ming is below, Tai Yang is left, Shao Yang is right; if Tai Yin is above, Tai Yang is below, Jue Yin is left, Yang Ming is right; if Shao Yang is above, Jue Yin is below, Shao Yin is left, Tai Yang is right; if Yang Ming is above, Shao Yin is below, Tai Yin is left, Jue Yin is right; if Tai Yang is above, Tai Yin is below, Shao Yang is left, Shao Yin is right. This is determining positions facing South: Heaven-governing Qi is above, positioned in the South, so facing North defines left and right; Left governs West, Right governs East. Earthly-substrate Qi is below, positioned in the North, so facing South defines left and right; Left governs East, Right governs West. Up and Down differ, and Left and Right vary accordingly).

When various Qi are at the Earthly Substrate, Wind overflows internally (meaning invading from outside to inside), treat with Pungent-Cool (Metal overcomes Wood Qi), assist with Bitter-Sweet (Excessive Pungent may damage Qi, so assist with Bitter to overcome Pungent and Sweet to tonify Qi), soothe with Sweet, disperse with Pungent (Wood nature is urgent, so Sweet soothing and Pungent dispersing are suitable). Heat overflows internally, treat with Salty-Cold (Sovereign Fire Qi can be overcome by Water), assist with Sweet-Bitter (Sweet overcomes Salty, Bitter drains Heat), astringe with Sour, disperse with Bitter (Heat abundant in meridians requires Sour astringency; Heat constrained internally requires Bitter dispersion). Dampness overflows internally, treat with Bitter-Hot (Dampness is Earth Qi; Bitter-Hot transforms via Fire, capable of drying Dampness), assist with Sour-Light (Sour controls Earth, Light promotes orifices), dry with Bitter, drain with Light (Damp-Heat suits Bitter drying; Dampness causing edema suits Light draining; draining refers to diuresis and sweating). Fire overflows internally, treat with Salty-Cold, assist with Bitter-Pungent (Wu's commentary: Ministerial Fire fears Fire, so Salty, Bitter, and Pungent are used to drain Heat and nourish Yin-Water), astringe with Sour, disperse with Bitter (Same principle as the Heat overflow section). Dryness overflows internally, treat with Bitter-Warm (Dryness is Metal Qi; Bitter-Warm transforms via Fire, thus overcoming Metal Qi), assist with Sweet-Pungent (Wood injured by Metal suits Sweet soothing and Pungent dispersing), purge with Bitter (Severe Dryness constipation requires Bitter purgation). Cold overflows internally, treat with Sweet-Hot (Cold is Water Qi; Sweet transforms via Earth, Hot transforms via Fire, thus controlling Water and overcoming Cold), assist with Bitter-Pungent (Bitter and Pungent are also hot-natured), drain with Salty (Salty is the true flavor of Water, draining it), moisten with Pungent, firm with Bitter (Kidney dislikes dryness, urgently eat Pungent to moisten it; Kidney desires firmness, urgently eat Bitter to firm it; this is the meaning here).

When Heaven-governing Qi causes Wind to prevail, level it with Pungent-Cool, assist with Bitter-Sweet, soothe with Sweet, drain with Sour (Wood Qi ascends but does not descend, thus...). When Heat prevails, level it with Salty-Cold, assist with Bitter-Sweet, astringe with Sour (To afloat Heat). When Dampness prevails, level it with Bitter-Hot, assist with Sour-Pungent (Sour and Pungent combined mean it is not a drink), dry with Bitter, drain with Light. If Dampness is severe above with Heat, treat with Bitter-Warm (to dry dampness), assist with Sweet (to benefit Earth) and Pungent (to disperse stagnation), stop when sweat occurs (when sweat is achieved, Dampness is expelled externally). When Dryness prevails, level it with Bitter-Damp (Bitter and dampness provide moisture to Dryness), assist with Sour (to generate fluids) and Pungent (to moisten dryness), purge with Bitter (Severe Dryness cannot be removed without purgation). When Cold prevails, level it with Pungent (to disperse Cold) and Hot (to restore Yang), assist with Bitter-Sweet (to harmonize Pungent-Hot), drain with Salty (If Cold injury leads to interior Heat, Salty drainage is suitable. Li Pinhu says: Heaven-governing Qi dominates the first half of the year, governed by Heavenly Qi, hence Six Excesses are called "prevailing," invading from above downwards, thus termed "leveling." Earthly-substrate Qi dominates the second half, governed by Earthly Qi, hence Six Excesses are called "overflowing internally," invading from outside to inside, thus termed "treating." When the season receives the Qi that overcomes it, it is called "counter-prevailing." How to verify the prevalence of Six Qi? e.g., Dryness prevailing dries the earth, Summer Heat prevailing makes the earth windy/hot, Wind prevailing shakes the earth, Dampness prevailing muddies the earth, Cold prevailing cracks the earth, Fire prevailing solidifies the earth).

In Spring, the pulse should not be Deep; in Summer, not Wiry; in Winter, not Choppy; in Autumn, not Rapid. This is called the Four Obstructions (Spring Wiry, Summer Rapid, Autumn Choppy, Winter Deep are normal pulses. If Spring presents Deep, Summer presents Wiry, Winter presents Choppy, Autumn presents Rapid, losing the mother Qi despite the ruling Qi, this is called Four Obstructions, where the Five Zang do not communicate). Simultaneous appearance indicates disease; reappearance indicates disease; disappearance before time indicates disease; retention beyond time indicates disease (Simultaneous appearance of various pulses in one position indicates mutual overcoming and insulting; appearance in another position after appearing in its own indicates excessive pathogenic Qi; disappearance before time indicates deficiency of root Qi and excess of incoming Qi; retention beyond time indicates excess of root Qi and deficiency of incoming Qi). Reversal indicates death (Reversal means Spring pulse is Choppy, Summer is Deep, Autumn is Rapid, Winter is Slow. Seeing the pulse of the overcoming element indicates death).

All wind-related tremors and vertigo belong to the Liver (Wind types vary, hence "all winds." Tremors and vertigo). All cold-related contraction and pulling belong to the Kidney (Contraction and pulling. Kidney governs Cold-Water transformation. When Yang Qi does not reach, Ying and Wei condense, causing body spasms). All Qi-related stifling and depression belong to the Lung (Stifling breathing, depression and lack of smooth flow). All dampness-related swelling and fullness belong to the Spleen (Swelling externally, fullness internally, i.e., distension). All heat-related confusion and convulsions belong to Fire. All pain, itching, and sores belong to the Heart (Severe heat causes sore pain; mild heat causes sore itching. Heart belongs to Fire transforming Heat, hence sores belong to Heart). All reversal, retention, and incontinence belong to the Lower Jiao (Reversal refers to rebellion; retention refers to urinary/fecal obstruction; incontinence refers to urinary/fecal incontinence. Lower refers to Kidney. Kidney resides below the Five Zang, governing both Water and Fire. Deficiency of Yin essence leads to solitary Fire action causing Heat Reversal; decline of Mingmen leads to solitary Water action causing Cold Reversal. Kidney opens into the two yin orifices. Water deficiency and Fire excess lead to dryness and Heat constipation; Yin deficiency leads to lack of Qi, causing turbid/clear separation failure and Cold retention. Kidney Water decline leads to Fire forcing leakage causing Heat incontinence; Mingmen Fire decline leads to Yang deficiency and incontinence causing Cold incontinence). All atrophy, wheezing, and vomiting belong to the Upper Jiao (Lung governs Qi. Lung Heat scorches leaves, preventing hands/feet from receiving Qi, leading to tendon, muscle, vessel, and bone atrophy.急促 breathing is wheezing, disease in Lung; reverse sound is vomiting, disease in stomach opening; thus all are Upper Jiao diseases). All locking, drumming, and shivering, as if losing spiritual control, belong to Fire (Locking refers to clenched teeth. Drumming refers to jaw trembling. Shivering refers to shaking. Spirit controlling form is Spiritual Control. Locking, drumming, and shivering without spiritual support is like losing spiritual control, all Fire diseases. If Heart Fire is extremely hyperactive, it may counteract with Water transformation, causing cold shivering, which is Excess Fire. If Yin prevails, it is Cold; Cold consumes True Qi, leading to deficiency. Deficiency allows Cold to grip the skin, which is Deficient Fire. Malaria onset involves Yang merging into Yin, making Yin excess and Yang deficiency. Yang Ming deficiency causes cold shivering and jaw trembling. Also, during resolution of Cold Damage, if the person is originally deficient, pathogen and righteous Qi struggle causing shivering sweat. Thus, all shivering is a struggle of Yin and Yang). All spasms and neck stiffness belong to Dampness (Spasm is a wind-strong disease. Here, severe Dampness combines with Wind-Wood transformation). All rebellious rushing upward belong to Fire (Fire nature flares upward). All distension and abdominal enlargement belong to Heat (Internal excess Heat causes distension in Lung (upper), Spleen/Stomach (middle), Liver/Kidney (lower). This is caused by Fire pathogen, leading to vexation and fullness). All restlessness, mania, and transgression belong to Fire (Restlessness is vexation; Mania is madness; Transgression is exceeding bounds. Fire entering Lung causes vexation; Fire entering Kidney causes restlessness. As per Great Treatise on Qi Intersection: Excessive Year Water, Cold Qi spreads, harming Heart Fire, causing body heat, vexation, Yin reversal, and delirium, known as Yin Excess causing Fire-like Restlessness. Cheng Wuji says: Even if restless, wanting to sit in a well, desiring water but unable to swallow, this is it). All sudden rigidity belong to Wind (Sudden. Rigidity is a tendon disease, strong and stiff). All diseases with sounds (bowel sounds) and drum-like abdomen belong to Heat (Caused by rebellious Yang Qi, thus Heat). All diseases with edema, pain, soreness, fright, and horror belong to Fire (Edema is Yang excess externally, Fire in meridians. Pain/soreness is Fire severely restricting Metal, failing to calm Wood, causing Wood excess and sourness. Fright/horror is Sovereign Fire excess). All twisting, arching, and turbid fluids belong to Heat (Wood excess assisting Fire causes tendon tension, leading to twisting/arching contrary to normal. Fluids refer to urine). All diseases with clear, cold fluids belong to Cold (Fluids refer to excretions from above and below). All vomiting and acid regurgitation, sudden diarrhea with tenesmus belong to Heat (Intestinal/Stomach Heat causes abnormal transmission, leading to sudden diarrhea. Tenesmus is heavy sensation and urgent pain in the lower rectum).

Cold is treated with Heat, Heat is treated with Cold (This is Direct Treatment). Minor conditions are treated oppositely, Severe conditions are treated similarly. Opposite is Direct Treatment (Treating Heat with Cold, Cold with Heat, opposing the disease, is called Direct Treatment). Similar is Reverse Treatment (Treating Cold with Cold, Heat with Heat, following the disease, is called Reverse Treatment). Follow less or follow more, observe the case (Follow less means one same and two different; Follow more means two same and one different). Heat due to Cold usage (Hot medicine taken cold), Cold due to Heat usage (Cold medicine taken hot), Blockage due to Blockage usage (e.g., Lower Qi deficiency with Middle Jiao congestion. To disperse fullness would further weaken the lower; tonifying lower would worsen middle fullness. First attack the fullness. Medicine intake may reduce temporarily, but returns. Not knowing that small doses nourish stagnation while large doses promote circulation, clearing the middle and strongly tonifying the lower, once lower deficiency is filled, middle fullness naturally resolves), Patency due to Patency usage (e.g., Internal severe Heat causing continuous diarrhea, treat with Cold purgation; Cold accumulation causing chronic diarrhea, treat with Hot purgation). Must subdue the main factor and address the cause first (The above four treatments must conceal the main factor and first seek the cause of disease, which is Reverse Treatment). Discussions say treat Cold with Heat, Heat with Cold, yet physicians cannot abandon standards and change the path. If a patient with Heat is treated with Cold but Heat remains (Using Bitter-Cold to treat Heat, yet Heat persists); if a patient with Cold is treated with Heat but Cold remains (Using Pungent-Hot to treat Cold, yet Cold persists). Both arise from new diseases recurring. How to treat? It is said: For those treated with Cold who become hotter, treat the Yin (Tonify Yin to match Yang, so Yin recovers and Heat retreats); for those treated with Heat who become colder, treat the Yang (Add Fire to Water, so Yang recovers and Cold dissipates). This is seeking the affiliation. Why does taking Cold result in Heat and taking Heat result in Cold? It is said: Treating the Prosperous Qi causes this reversal (e.g., treating Fire prosperity with Bitter-Cold descending, if Yin is damaged, Fire becomes stronger; treating Yin prosperity with Pungent-Warm consuming Qi, Cold becomes stronger. These are specifically treating Prosperous Qi, hence the reversal). Why does it happen if not treating Prosperous Qi? It is said: Not treating the Five Flavors' affiliations. The Five Flavors enter the Stomach and each return to their preferred organ. Sour enters Liver first, Bitter enters Heart first, Sweet enters Spleen first, Pungent enters Lung first, Salty enters Kidney first. Long-term use increases Qi, which is the normal transformation of things. Increasing Qi for too long is the cause of premature death (Each Flavor enters its affiliated organ. Biased long-term use increases Qi, which is normal transformation. If Qi increases indefinitely, organs have excess and others have depletion. As per Treatise on Life Connection: Excessive Sour, Liver Qi floods, Spleen Qi fails; Excessive Salty, large bones labor, muscles shorten, Heart Qi suppressed; Excessive Sweet, Heart Qi panting/full, complexion black, Kidney Qi unbalanced; Excessive Bitter, Spleen Qi not moist, Stomach Qi thick; Excessive Pungent, tendons/vessels relaxed.)