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Huangdi said: I received the Nine Needles from my teacher and privately studied various medical prescriptions. Among them, are there methods such as Dao Yin (guided breathing and movement), Qi circulation, massage, moxibustion, hot compresses, acupuncture, or herbal medicine that can be adhered to exclusively? Or should all of them be practiced?

Qibo replied: Various prescriptions are treatments suitable for the masses; they are not methods that a single individual can practice in their entirety.

Huangdi said: This is what is meant by "maintaining the One without losing it," which allows one to encompass all things.

This chapter discusses the human body, noting its layers of depth and superficiality, and the deficiency or excess of blood and Qi. Therefore, treatments such as Bian stone therapy, drugs, and moxibustion each adhere to their specific indications; no single person practices all of them.

The term "disease transmission" refers to pathogenic factors entering from the skin hair and manifesting in the interstices (cou-li, the spaces between skin and muscle), then entering the meridians, and finally transmitting to the Zang organs. This is known as pathogens affecting the meridians and entering the Zang-Fu organs, constituting an internal cause. If pathogens enter the Zang organs, death ensues and cannot be saved. Thus, when pathogens are at the level of the skin hair, Bian stone therapy is appropriate to remove them; when at the level of vessels, flesh, sinews, and bones, acupuncture is appropriate to drain them; when pathogens enter the interior, Dao Yin and Qi circulation are appropriate to expel them; when cold pathogens penetrate deeply, hot compresses are appropriate to unblock them; when pathogens are internal and the constitution is deficient, sweet and mild herbs are used to tonify; when the constitution is excess, harsh drugs are used to attack; when pathogens sink downward, moxibustion is appropriate to raise and open them. Therefore, among drugs, stones, moxibustion, acupuncture, and Dao Yin, treatments are applied according to the specific diseases of individuals, not practiced universally by one person. This chapter teaches that disease transmission has degrees of depth. For treatable conditions, one should maintain the correct method without error, preventing major pathogens from entering the Zang organs and becoming incurable. The merit of benefiting all beings is thus fulfilled.

Now, I have heard of the essentials of Yin and Yang, the principles of deficiency and excess, the errors of pathogenic shifting, and categories of treatable diseases. I wish to hear about the changes of diseases, specifically those where excessive pathogens transmit, leading to exhaustion and failure, making them incurable. Can you explain this?

Qibo said: Indeed, asking about the Way! Clarity is like waking up in the bright day; confusion is like falling asleep in the dark night. If one can accept and apply these principles, the spirit will form with them. If one fully applies them, the spirit will naturally attain them. The principles of generating and nourishing the spirit can be recorded on bamboo slips and silk, but cannot be directly transmitted to descendants.

Huangdi said: What do you mean by "like waking up in the bright day"?

Qibo said: Understanding Yin and Yang is like resolving confusion, like waking from a drunken stupor.

Huangdi said: What do you mean by "falling asleep in the dark night"?

Qibo said: Silent and soundless, indistinct and formless. Hair follicles collapse, pores open, upright Qi collapses horizontally, excessive pathogens spread diffusely, blood vessels transmit pathogens, and major Qi (major pathogens) enters the Zang organs. Symptoms include abdominal pain and dysentery. This leads to death and cannot sustain life.

This section discusses how when both form and spirit are diseased, pathogens cannot enter the interstices, nor cause blood vessel transmission, resulting in an incurable fatal syndrome. The essence of Yin and Yang lies in: skin and interstices belong to Yang, while blood vessels belong to Yin. Interstices are where San Jiao (Triple Burner) Yuan Zhen (Primordial True Qi) converges and communicates; blood vessels are where Shen (Spirit) and Qi reside. Deficiency and excess refer to the states of blood and Qi. If interstices are solid and dense, Yuan Zhen is smooth, blood vessels are harmonious, and Spirit is kept within, how can pathogens enter internally? Upon deficiency, pathogens transmit into the Zang organs, leading to death and inability to survive. Thus, the principles of generating and nourishing the spirit can be recorded on bamboo and silk to educate future generations, but cannot be directly passed to descendants. This implies that cultivating this Spirit and Qi is a personal effort of self-cultivation. "Shifting errors" refer to the collapse of hair follicles, opening of pores, and horizontal collapse of upright Qi. "Treatable categories" refer to pathogens remaining in the skin and interstices, not yet transmitting through blood vessels, and major pathogens not having entered the Zang organs. This indicates that external pathogens are still treatable. Maintaining the correct method prevents pathogens from flowing inward. Hence, skilled healers treat the skin hair first, then muscles, then meridians, then Zang organs. Treating Zang organs results in half survival and half death. Intermittent transmission (Jian Chuan) leads to survival; transmission to the organ it overcomes (Suo Sheng) leads to non-treatment. Regarding disease changes, excessive spreading, exhaustion, and incurability occur when pathogens spread diffusely, transmit through blood vessels, and major Qi enters the Zang organs, leading to death. Understanding Yin and Yang is like resolving confusion and waking from drunkenness. Fully applying these principles allows the spirit to attain them naturally. This is why people of ancient times who understood the Dao followed Yin and Yang, harmonized with techniques, regulated diet and起居 (daily routine), did not labor recklessly, thus maintaining form and spirit together to complete their natural lifespan. "Silent and soundless, indistinct and formless" describes those who do not understand the Dao: their skin and pores are loose, and blood vessels are depleted.

Deficient pathogens and thief winds invade humans subtly; their nature is unknown, their form unseen, gradually leading to excessive pathogens entering the Zang organs, which cannot be sustained. Pathogens invading humans begin at the skin hair, causing hair collapse and pore opening. Once opened, pathogens enter from the hair, penetrating deep into the interstices. Interstices are where San Jiao Yuan Zhen converges; thus, upright Qi collapses horizontally. Excessive pathogens spread in the interstices, then transmit to blood vessels and enter the Zang organs internally. Meridians connect internally to Zang-Fu organs and externally to the body. Therefore, meridian pathogens entering Zang-Fu organs constitute an internal cause. Excessive pathogens spreading in interstices damage Qi; transmitting through blood vessels into Zang organs damages Shen. When both Shen and Qi are damaged, death occurs, and life cannot be sustained. Therefore, the teachings of the Sages are: avoid deficient pathogens and thief winds in due time; remain tranquil and empty, keeping the Spirit within; how can disease arise? Thus, these principles can be recorded on bamboo and silk, intending for all people and future generations to know this way of health preservation.

Huangdi said: How does major Qi (major pathogens) enter the Zang organs?

Qibo said: If disease originates in the Heart, it transmits to the Lung after one day, to the Liver after three days, and to the Spleen after five days. If it persists for three more days without improvement, death ensues. Death occurs at midnight in winter and midday in summer.

This section discusses major pathogens entering the Zang organs and transmitting to the organ they cannot overcome (Suo Bu Sheng), leading to death. The Five Zang organs are born from the Qi of the Five Directions and Five Elements; thus, life arises from mutual generation, and death from mutual overcoming. Disease originating in the Heart transmits to the Lung in one day, to the Liver in three days, and to the Spleen in five days. All are reverse transmissions to the organ they cannot overcome. After another three days without improvement, death occurs. The Heart is a Fire organ; Winter governs Water, Summer governs Fire. Midnight in winter represents Water overcoming and extinguishing Fire; midday in summer represents Fire reaching extreme exuberance and self-immolating. Yang Yuanru stated: According to *Su Wen: Yu Ji Zhen Zang Lun*, when disease enters the Five Zang organs and transmits reversely to the overcoming organ, it can still be treated with bathing, medication, and moxibustion. Thus, "death if not improved in three days" means that even if pathogens enter the Zang organs, there is still a chance for recovery. Hence, the beginning mentions Dao Yin, Qi circulation, massage, moxibustion, acupuncture, and drugs, while the end states that diseases transmitting sequentially all have a death period and cannot be treated with acupuncture. Pathogens in the形体 (form/body surface) are suitable for acupuncture; those entering the Zang organs can only be treated with massage and drugs. The Sages' heart to save people leaves no effort unused.

If disease originates in the Lung, it transmits to the Liver after three days, to the Spleen after one day, and to the Stomach after five days. If it persists for ten days without improvement, death ensues. Death occurs at sunset in winter and sunrise in summer.

Yang Yuanru stated: The Lung governs Qi. Qi begins to flourish at sunrise and contracts at sunset. Sunset in winter means Qi enters and is cut off internally; sunrise in summer means Qi exits and is cut off externally. Note: Only Winter and Summer are mentioned because the four seasons' Qi generally belongs to the alternation of cold and heat. Midnight and midday represent the separation of Yin and Yang at Zi and Wu hours; sunrise and sunset represent the separation of Yin and Yang at Mao and You hours. The days of transmission (1, 3, 5) are heavenly odd numbers. The Five Zang organs are born from the Earth's Five Elements but originate from the transformation of Heavenly Stems.

If disease originates in the Liver, it transmits to the Spleen after three days, to the Stomach after five days, and to the Kidney after three days. If it persists for three more days without improvement, death ensues. Death occurs at sunset in winter and at breakfast time in summer.

Yang Yuanru stated: According to *Su Wen: Ben Biao Bing Zhuan Lun*: Liver disease causes dizziness and vertigo of the head and eyes, fullness and distension in the hypochondrium. After three days, the body feels heavy and painful. After five days, abdominal distension occurs. After three more days, pain in the lower abdomen, lumbar region, and small abdomen, along with swelling of the calves, appears. If not improved in three days, death ensues. Death occurs at sunset in winter and breakfast time in summer. Since disease originates in the Liver, there is dizziness and hypochondriac fullness. Transmission to the Spleen after three days causes heaviness and pain. Transmission to the Stomach after five days causes distension. Transmission to the Kidney after three days causes lower abdominal and lumbar pain with calf swelling. Sunset in winter and breakfast time in summer are times when Wood Qi is exhausted during the Metal-dominant Mao and You hours.

If disease originates in the Spleen, it transmits to the Stomach after one day, to the Kidney after two days, and to the Lumbar Sinews and Bladder after three days. If it persists for ten days without improvement, death ensues. Death occurs at "Ren Ding" (early evening/settling time) in winter and at late meal time in summer.

Yang Yuanru stated: According to *Su Wen: Ben Biao Bing Zhuan Lun*: Spleen disease causes heavy body and pain. After one day, distension occurs. After two days, lower abdominal, lumbar, and spinal pain with calf swelling appears. After three days, pain in the back and lumbar sinews occurs, along with urinary retention. If not improved in ten days, death ensues. Death occurs at Ren Ding in winter and late meal time in summer. Since disease originates in the Spleen, there is body pain and heaviness. Transmission to the Stomach after one day causes distension. Transmission to the Kidney after two days causes lower abdominal, lumbar, and spinal pain with calf swelling. "Lumbar Sinews and Bladder" refers to the Bladder attached to the lumbar sinews on the back. Thus, transmission to the Lumbar Sinews and Bladder after three days causes back and lumbar sinew pain and urinary retention. Ren Ding corresponds to the Yin hour, where Wood is prosperous and Earth is exhausted. Late meal time in summer corresponds to the Hai hour, where Water floods and Earth fails.

If disease originates in the Stomach, it transmits to the Kidney after five days, to the Lumbar Sinews and Bladder after three days, and ascends to the Heart after five days. If it persists for two more days without improvement, death ensues. Death occurs at midnight in winter and at "Ri Ze" (afternoon sun slanting) in summer. (Ze sounds like 'di', meaning the sun is past its zenith).

Note: *Su Wen: Ben Biao Bing Zhuan Lun* states: Stomach disease causes abdominal fullness. After five days, lower abdominal, lumbar, and spinal pain with calf swelling occurs. After three days, back and abdominal sinew pain and urinary retention appear. After five days, the body feels heavy. If not improved in six days, death ensues. Death occurs at midnight in winter and Ri Ze in summer. Since disease originates in the Stomach, there is fullness. Transmission to the Kidney after five days causes lower abdominal, lumbar, and spinal pain with calf swelling. Transmission to the Lumbar Sinews and Bladder after three days causes back and abdominal sinew pain. Ascending to the Heart after five days causes body heaviness. The Heart governs blood vessels, which nourish sinews and bones and lubricate joints. Two is the generative number of Fire; Six is the completed number of Water. Death on the second day signifies the extinction of Fire's generative Qi; death on the sixth day signifies Water overpowering and extinguishing Fire. Thus, midnight in winter signifies Water overpowering and extinguishing Fire. Ri Ze in summer also signifies the extinction of Taiyang's generative Qi. Zhu Jigong stated: Winter governs Water, Summer governs Fire. Ri Ze is the time when prosperity begins to decline.

If disease originates in the Kidney, it transmits to the Lumbar Sinews and Bladder after three days, ascends to the Heart after three days, and transmits to the Small Intestine after three days. If it persists for three more days without improvement, death ensues. Death occurs at "Da Chen" (early morning/dawn) in winter and at "Yan Bu" (late afternoon/evening) in summer.

Note: *Su Wen: Ben Biao Bing Zhuan Lun* states: Kidney disease causes lower abdominal, lumbar, and spinal pain with calf swelling. After three days, back and lumbar sinew pain and urinary retention occur. After three days, abdominal distension appears. After three more days, bilateral hypochondriac fullness and pain occur. If not improved in two days, death ensues. Since disease originates in the Kidney, there is lower abdominal, lumbar, and spinal pain with calf swelling. Transmission to the Lumbar Sinews and Bladder after three days causes back and lumbar sinew pain and urinary retention. Ascending to the Heart after three days causes abdominal distension. The Foot Shaoyin Kidney Meridian descends to connect with the Bladder, ascends from the abdomen to the chest, enters the Lung, and connects with the Heart. This is pathogens entering the Zang organs, also transmitting via blood vessels. In the previous section, disease was in the Heart, causing body heaviness; here, it transmits from the Bladder to the Heart, then descends from the Heart to the Small Intestine, causing abdominal distension. Da Chen in winter is the Yin-Mao hour, when Wood is prosperous, draining Water Qi. Yan Bu in summer is when Earth Qi dominates, as Earth overcomes Water. Three days signify the simultaneous extinction of Water and Fire's generative Qi; two days signify the extinction of Fire's generative Qi. Diseases nearing death may die from the extinction of the initially affected Zang organ's Qi or the transmitted Zang organ's Qi. Thus, slight differences exist between *Ling Shu* and *Su Wen*; students should comprehend this.

If disease originates in the Bladder, it transmits to the Kidney after five days, to the Small Intestine after one day, and to the Heart after one day. If it persists for two more days without improvement, death ensues. Death occurs at "Ji Ming" (cockcrow) in winter and at "Xia Bu" (late afternoon) in summer.

Note: *Biao Ben Bing Zhuan Lun* states: Bladder disease causes urinary retention. After five days, lower abdominal distension, lumbar and spinal pain, and calf swelling occur. After one day, abdominal distension appears. After one day, body pain occurs. If not improved in two days, death ensues. Since disease originates in the Bladder, there is urinary retention. Transmission to the Kidney after five days causes lower abdominal distension, lumbar and spinal pain, and calf swelling. Transmission to the Small Intestine after one day causes abdominal distension. Transmission to the Heart causes body pain. Ji Ming in winter and Xia Bu in summer correspond to Da Chen and Yan Bu mentioned earlier. Regarding the transmission of the Five Zang organs, the involvement of the Bladder and Stomach Fu organs is because the Stomach resides in the center, serves as the Sea of Water and Grain, and is the source of generation for the Five Zang organs; the Taiyang channel governs the Qi of all Yang channels.

When various diseases transmit sequentially as described, all have a death period and cannot be treated with acupuncture. If transmission skips one Zang organ, or two, three, or four Zang organs, acupuncture may be used.

*Yu Ji Zhen Zang Lun* states: The Five Zang organs are interconnected, and shifts follow a sequence. When disease affects the Five Zang organs, it transmits to the organ it overcomes (Suo Sheng). Nearing death, transmission must proceed until it reaches the organ it cannot overcome (Suo Bu Sheng), at which point the patient dies. Therefore, such cases involve reverse transmission to the overcoming organ, all having a death period and being unsuitable for acupuncture. Skipping one Zang organ means Heart transmits to Liver, or Lung to Spleen; this is the Son acting upon the Mother (generation relationship). Skipping two Zang organs means Heart transmits to Spleen, or Lung to Kidney; this is the Mother acting upon the Son, where Mother and Son Qi mutually support each other. Skipping three Zang organs means Heart transmits to Kidney, or Lung to Heart; coming from the organ one cannot overcome is considered minor evil. Regarding inter-transmission of the Five Zang organs, there is skipping three but not skipping four. "Skipping four" refers to transmission from Zang to Fu, and then from Fu to another Zang; thus, Fu organs can also be named Zang. Yang Yuanru stated: According to *Wu Zang Bie Lun*, Huangdi asked: I have heard that some physicians consider brain and marrow as Zang, or intestines and stomach as Zang. Those that store goods are called Fu; therefore, Fu can also be named Zang.