黄帝曰。夫百病之所始生者。必起于燥湿寒暑风雨。阴阳喜怒。饮食居处。气合而有形。得藏而有
名。余知其然也。夫百病者。多以旦慧。昼安。夕加。夜甚何也。岐伯曰。四时之气使然。
此章论阳气昼夜出入。应四时之生长收藏。五脏主五运于中。而外合木火土金水之五气。人之百病。
不出于外内二因。燥湿风雨寒暑。外因于天之六气。气合于有形而为病。藉人气之生长以慧安。盖六淫
之邪。外合于形而病于形也。阴阳喜怒。饮食居处。内因于人之失调。得之于脏而有病名。如伤喜则得
之于心。而有心病矣。伤怒则得之于肝。而有肝病矣。伤悲则得之于肺。而有肺病矣。伤恐则得之于
肾。而有肾病矣。伤于饮食。则得之脾胃。而有脾胃之病矣。是必以脏气之所胜时者起。盖内因之病。
得之于脏而病脏也。此论人之正气。合天地之阴阳五行。人气盛。可以胜天之淫邪。得地之五行。可以
起人之脏病。人与天地参合。而互相资助者也。
黄帝曰。愿闻四时之气。岐伯曰。春生夏长。秋收冬藏。是气之常也。人亦应之。以一日分为四时。
朝则为春。日中为夏。日入为秋。夜半为冬。朝则人气始生。病气衰。故旦慧。日中人气长。长则胜邪。
故安。夕则人气始衰。邪气始生。故加。夜半人气入脏。邪气独居于身。故甚也。
春生夏长。秋收冬藏。一岁之四时。天地之阴阳出入也。朝则为春。日中为夏。日入为秋。夜半为
冬。一日之四
时。人气之阴阳出入也。人气生则病衰。气长则安。气衰则病加。气藏则甚。此邪正之气。交相胜负。
人之正气。可以胜天之淫邪。是以圣人春夏养阳。秋冬养阴。以从其根。养一日之气。以应天之四时。
顺天地之四时。以调养其精气。可以寿敝天地。
黄帝曰。其时有反者何也。岐伯曰。是不应四时之气。独脏主其病者。是必以脏气之所不胜时者
甚。以其所胜时者起也。黄帝曰。治之奈何。岐伯曰。顺天之时。而病可与期。顺者为工。逆者为粗。
此言因于阴阳喜怒。饮食居处者。五脏独主其病。是必以脏气之所不胜时者甚。以其所胜时者起也。
如肝病不能胜申酉时之金气。心病不能胜亥子时之水气。脾病不能胜寅卯时之木气。肺病不能胜巳午
时之火气。肾病不能胜辰戌丑未时之土气。是脏气之所不胜时者甚也。如肝病至辰戌丑未时而起。心
病至申酉时而起。脾病至亥子时而起。肺病至寅丑时而起。肾病至巳午时而起。以其所胜时而起也。故
良工顺天之时。以调养五行之气。则病之起。可与之期。若不知天地阴阳。四时五行之理者。不可以为
工矣。
黄帝曰善。余闻刺有五变。以主五输。愿闻其数。岐伯曰。人有五脏。五脏有五变。五变有五输。
故五五二十五输。以应五时。黄帝曰。愿闻五变。岐伯曰。肝为牡脏。其色青。其时春。其音角。其味
酸。其日甲乙。心为牡脏。其色赤。其时夏。其日丙丁。其音征。其味苦。脾为牝脏。其色黄。其时长
夏。其日戊己。其音宫。其味甘。肺为牝脏。其色白。其音商。其时秋。其日庚辛。其味辛。肾为牝脏。
其色黑。其时冬。其日壬癸。其音羽。其味咸。是为五变。
此言五脏之气。应天之四时五音五色五味也。五脏有五变者。有五时五行五音五色之变异。五变有
五输者。一脏之中。有春刺荥。夏刺输。长夏刺经。秋刺合。冬刺井之五输。故五五有二十五输。以应五时也。
肝属木。心属火。故为牡脏。脾属士。肺属金。肾属水。故为牝脏。
黄帝曰。以主五输奈何。（缺岐伯曰）藏主冬。冬刺井。色主春。春刺荥。时主夏。夏刺输。音主
长夏。长夏刺经。味主秋。秋刺合。是谓五变。以主五输。
此五脏之气。应天之五时。而取之五输。各有所主也。肾者。主封藏之本。藏主冬。此肾合冬藏之
气也。肝主色。色主春。此肝合春生之气也。心者。生之本。神之变也。时主夏。心合夏长之气也。
土数五。五者音也。音主长夏。脾合长夏之气也。五味入口。藏于阳胃。阳明主秋金之气。味主秋。肠胃
合秋收之气也。此五脏之气。应五时之变而取之五输。各有所主也。春刺荥。夏刺输。长夏刺经。秋刺合。
冬刺井。皆从子以透发母气。
黄帝曰。诸原安合。以致六输。岐伯曰。原独不应五时。以经合之以应其数。故六六三十六输。
此六腑之应五时也。春令木。夏令火。长夏主土。秋令金。冬令水。此五时之合于五行也。肝藏木。
心藏火。脾藏土。肺藏金。肾藏水。此五脏之合于五行也。井主木。荥主火。输主土。经主金。合主水。
此五输之合于五行也。六腑有原穴。故不应五时。以经与原合之。则合于五行。以应六六三十六之数矣。
盖木火土金水。地之五行也。以生人之五脏。地之五行。上呈天之六气。以合人之六腑。六气者。木火
土金水火也。君火以明。相火以位。是以六气之中有二火。以六气合六腑。六腑有六输。故应六六三十
六之数。以经火与原火合之。则又合五行之数矣。此阴阳离合之道。五行变化之机。天地生成之妙用也。
黄帝曰。何谓藏主冬。时主夏。音主长夏。味主秋。色主冬。愿闻其故。岐伯曰。病在藏者。取之井。
病变于色者。取之荥。病时间时甚者。取之输。病变于音者。取之经。经满而血者病在胃。及以饮食不
节得病者。取之于合。故命曰味主合。是谓五变也。
前节论五脏之气。应于五时。而取之五输。各有所主。此复论五脏之病。合于五输。而各有所取也。
脏者。阴也。里也。肾治于里。故病在藏者取之井。以泄冬藏之气。肝应春而主色。故病变于色者取之荥。
时间时甚者。火之动象。神之变也。故取之输。脾主土。其数五。其音宫。宫为五音之主音。故变于音者取
之经。肺与阳明。主秋金之令。饮入于胃。上输于肺。食气于胃。淫精于脉。脉气流经。经气归于肺。
肺朝百脉。输精于皮毛。毛脉合精。行气于腑。而通于四脏。是入胃之饮食。由肺气通调输布。而生此营
卫血脉。故经满而血者。病在胃。饮食不节者。肺气不能转输而得病也。按灵素经中。凡论五脏。必兼
论胃腑。以胃为五脏之生原也。肺与阳明。并主秋令。此章以腑合脏。而脏合于四时五行。味主秋。则秋
令所主之脏腑。皆 于中矣。
Huangdi said: The origins of all diseases must arise from external factors such as dryness, dampness, cold, heat, wind, and rain, as well as internal factors such as yin-yang imbalance, excessive joy or anger, irregular diet, and improper living habits. When pathogenic qi combines with the physical form, symptoms manifest; when pathogens enter the zang-fu organs, specific disease names are established. I understand this principle. However, why do many diseases present with clarity in the morning, peace during the day, aggravation in the evening, and severity at night?
Qibo replied: This is caused by the influence of seasonal qi. This chapter discusses the daily circulation of Yang Qi, corresponding to the growth, flourishing, harvest, and storage of the four seasons. The Five Zang Organs govern the Five Movements internally and correspond externally to the Five Qi of Wood, Fire, Earth, Metal, and Water. Diseases in humans stem from either external or internal causes. Dryness, dampness, wind, rain, cold, and heat are the Six Excesses (Six Pathogenic Factors) originating from Heaven. When these pathogens combine with the body's form, illness arises, manifesting as clarity or peace depending on the body's vital qi interacting with seasonal cycles. Generally, the Six Excesses combine externally with the form, causing somatic disease. Yin-yang imbalance, excessive emotions, dietary indiscretion, and lifestyle irregularities are internal causes due to human disharmony. These affect the Zang Organs, giving rise to specific disease names. For instance, excessive joy damages the Heart, leading to Heart disease; excessive anger damages the Liver, leading to Liver disease; excessive grief damages the Lungs, leading to Lung disease; excessive fear damages the Kidneys, leading to Kidney disease; and improper diet damages the Spleen and Stomach, leading to Spleen-Stomach disease. Therefore, such diseases typically worsen during the time periods when the organ's qi is overcome by the season's qi, because internal diseases directly damage the Zang Organs. This section discusses how human Zheng Qi (Upright Qi) harmonizes with the Yin-Yang and Five Elements of Heaven and Earth. When human qi is vigorous, it can overcome pathogenic influences from Heaven; supported by the Five Elements of Earth, it can cure Zang organ diseases. Humans are integrated with Heaven and Earth, mutually supporting each other.
Huangdi said: I wish to hear about the qi of the four seasons.
Qibo said: Spring generates, Summer flourishes, Autumn harvests, and Winter stores. This is the constant rhythm of qi. Humans also respond to it. If we divide a day into four parts corresponding to the seasons, morning is like Spring, noon is like Summer, sunset is like Autumn, and midnight is like Winter. In the morning, Ying Qi (Nutritive Qi) begins to generate, and pathogenic qi declines, so one feels clear-headed. At noon, Ying Qi grows strong; being strong allows it to overcome pathogens, so one feels peaceful. In the evening, Ying Qi begins to decline, and pathogenic qi starts to grow, so symptoms worsen. At midnight, Ying Qi enters the Zang Organs, leaving pathogens to dominate the body alone, so symptoms are most severe.
Spring generation, Summer flourishing, Autumn harvesting, and Winter storing represent the four seasons of a year, reflecting the entry and exit of Yin and Yang in Heaven. Morning like Spring, noon like Summer, sunset like Autumn, and midnight like Winter represent the four phases of a day, reflecting the entry and exit of Yin and Yang in human qi. When human qi generates, disease declines; when it grows, there is peace; when it declines, disease worsens; when it stores, disease becomes severe. This is the mutual struggle between pathogenic and upright qi. Human upright qi can overcome heavenly excesses. Therefore, sages nourish Yang in Spring and Summer, and nourish Yin in Autumn and Winter, following their roots. By nurturing the qi of a single day to align with the four seasons of Heaven, and by adjusting Jing Qi (Essence Qi) according to the four seasons of Heaven and Earth, one can achieve longevity comparable to Heaven and Earth itself.
Huangdi said: Why do some cases contradict this pattern?
Qibo said: This occurs when the condition does not follow the seasonal qi but is dominated by a specific Zang Organ. Such conditions typically worsen during the time period when the organ's qi is overcome by the season's qi, and improve during the time period when the organ's qi overcomes the season's qi.
Huangdi said: How should they be treated?
Qibo said: By conforming to Heavenly timing, the prognosis of the disease can be determined. Those who conform are skilled physicians ("Gong"); those who oppose are crude physicians ("Cu"). Regarding diseases caused by yin-yang imbalance, emotional excesses, and dietary/lifestyle irregularities, which are dominated by the Five Zang Organs, symptoms worsen when the organ's qi is overcome by the season, and improve when the organ's qi overcomes the season. For example, Liver disease cannot overcome the Metal qi of Shen and You hours, so it worsens then; Heart disease cannot overcome the Water qi of Hai and Zi hours, so it worsens then; Spleen disease cannot overcome the Wood qi of Yin and Mao hours, so it worsens then; Lung disease cannot overcome the Fire qi of Si and Wu hours, so it worsens then; Kidney disease cannot overcome the Earth qi of Chen, Xu, Chou, and Wei hours, so it worsens then. This is worsening during the time of overcoming. Conversely, Liver disease improves during Chen, Xu, Chou, and Wei hours; Heart disease improves during Shen and You hours; Spleen disease improves during Hai and Zi hours; Lung disease improves during Yin and Mao hours; Kidney disease improves during Si and Wu hours. This is improvement during the time of overcoming. Thus, skilled physicians conform to Heavenly timing to regulate the Five Elements, allowing them to predict the onset of disease. One who does not understand the principles of Heavenly Yin-Yang and the Four Seasons and Five Elements cannot be a skilled physician.
Huangdi said: Excellent. I have heard that acupuncture involves five changes governing the Five Shu Points. I wish to hear the numerical basis for this.
Qibo said: There are five Zang Organs in humans. Each Zang Organ has five changes. Each change corresponds to a category of Five Shu Points. Thus, there are 5x5=25 points, corresponding to the five seasons.
Huangdi said: I wish to hear what the five changes are.
Qibo said: The Liver is a Yang Organ (Mu Zang), its color is Green, its season is Spring, its note is Jue, its taste is Sour, and its days are Jia and Yi. The Heart is a Yang Organ, its color is Red, its season is Summer, its days are Bing and Ding, its note is Zhi, and its taste is Bitter. The Spleen is a Yin Organ (Pin Zang), its color is Yellow, its season is Late Summer, its days are Wu and Ji, its note is Gong, and its taste is Sweet. The Lungs are a Yin Organ, its color is White, its note is Shang, its season is Autumn, its days are Geng and Xin, and its taste is Pungent. The Kidneys are a Yin Organ, its color is Black, its season is Winter, its days are Ren and Gui, its note is Yu, and its taste is Salty. These constitute the five changes.
This discusses how the qi of the five Zang Organs corresponds to the four seasons, five notes, five colors, and five tastes of Heaven. "Five changes" refers to variations in seasons, elements, notes, and colors. "Five shu points" means that within each organ, there are five types of points: Ying-Spring points needled in Spring, Shu-Stream points in Summer, Jing-River points in Late Summer, He-Sea points in Autumn, and Jing-Well points in Winter. Hence, 5x5=25 points correspond to the five seasons.
The Liver belongs to Wood, and the Heart to Fire, hence they are Yang Organs. The Spleen belongs to Earth, the Lungs to Metal, and the Kidneys to Water, hence they are Yin Organs.
Huangdi said: How are they used to govern the Five Shu Points? (The text omits Qibo's response here).
Zang qi governs Winter; thus, Winter needling uses Jing-Well points. Color governs Spring; thus, Spring needling uses Ying-Spring points. Season governs Summer; thus, Summer needling uses Shu-Stream points. Sound governs Late Summer; thus, Late Summer needling uses Jing-River points. Taste governs Autumn; thus, Autumn needling uses He-Sea points. This is called the five changes, used to govern the five shu points.
This discusses how the qi of the five Zang Organs corresponds to the five seasons of Heaven, with each point having a specific governance. The Kidney is the root of sealing and storing; Zang qi governs Winter, meaning the Kidney corresponds to the storing qi of Winter. The Liver governs color, and color governs Spring, meaning the Liver corresponds to the generating qi of Spring. The Heart is the root of life and the manifestation of Spirit; season governs Summer, meaning the Heart corresponds to the flourishing qi of Summer. Earth has the number five, and five represents sound. Sound governs Late Summer, meaning the Spleen corresponds to the qi of Late Summer. The five tastes enter the mouth and are stored in the Yang Stomach. The Yangming Meridian governs the Metal qi of Autumn. Taste governs Autumn, meaning the Intestines and Stomach correspond to the harvesting qi of Autumn. This discusses how the qi of the five Zang Organs corresponds to the changes of the five seasons, taking the five shu points, each with its own governance. Needling Ying-Spring in Spring, Shu-Stream in Summer, Jing-River in Late Summer, He-Sea in Autumn, and Jing-Well in Winter all involve transmitting the mother qi through the son point.
Huangdi said: How do the Yuan-Source points combine to form six categories of points?
Qibo said: The Yuan-Source points alone do not correspond to the five seasons. They are combined with the Jing-River points to match the numbers, resulting in 6x6=36 points.
This refers to the correspondence of the Six Fu Organs to the five seasons. Spring governs Wood, Summer governs Fire, Late Summer governs Earth, Autumn governs Metal, and Winter governs Water. This is the combination of five seasons with the Five Elements. The Liver stores Wood, the Heart stores Fire, the Spleen stores Earth, the Lungs store Metal, and the Kidneys store Water. This is the combination of the five Zang Organs with the Five Elements. Jing-Well points govern Wood, Ying-Spring points govern Fire, Shu-Stream points govern Earth, Jing-River points govern Metal, and He-Sea points govern Water. This is the combination of the five shu points with the Five Elements. The Six Fu Organs have Yuan-Source points, so they do not individually correspond to the five seasons. Combining the Jing-River points with the Yuan-Source points aligns them with the Five Elements, corresponding to the number thirty-six.
Wood, Fire, Earth, Metal, and Water are the Five Elements of Earth, which generate the five Zang Organs. The Five Elements of Earth ascend to present the Six Qi of Heaven, which correspond to the six Fu Organs. The Six Qi are Wood, Fire, Earth, Metal, Water, and Fire. Ministerial Fire holds its position, while Sovereign Fire illuminates. Thus, among the Six Qi, there are two Fires. Aligning the Six Qi with the Six Fu Organs, the Six Fu Organs have six categories of points, corresponding to the number thirty-six. Combining Jing-Fire with Yuan-Fire aligns them again with the number of the Five Elements. This is the way of Yin-Yang separation and union, the mechanism of Five Elements transformation, and the wonderful application of Heaven and Earth's generation.
Huangdi said: What is meant by Zang governing Winter, Season governing Summer, Sound governing Late Summer, Taste governing Autumn, and Color governing Winter? I wish to hear the reasons.
Qibo said: For diseases located in the Zang Organs, use Jing-Well points. For diseases manifesting in color, use Ying-Spring points. For diseases that fluctuate in severity over time, use Shu-Stream points. For diseases manifesting in voice, use Jing-River points. For fullness in the meridians with blood, indicating disease in the Stomach, or diseases caused by dietary irregularities, use He-Sea points. Thus, it is said that taste governs the He-Sea points. This is called the five changes.
The previous section discussed how the qi of the five Zang Organs corresponds to the five seasons, taking the five shu points, each with its own governance. This section further discusses how diseases of the five Zang Organs correspond to the five shu points, with specific selections. Zang Organs are Yin and interior. The Kidney governs the interior, so for diseases in the Zang, Jing-Well points are used to drain the storing qi of Winter. The Liver corresponds to Spring and governs color, so for diseases manifesting in color, Ying-Spring points are used. Fluctuating severity is a sign of Fire movement and Spirit variation, so Shu-Stream points are used. The Spleen governs Earth, its number is five, and its note is Gong. Gong is the master note of the five tones, so for diseases manifesting in voice, Jing-River points are used. The Lungs and Yangming Meridian govern the Metal command of Autumn. Drink enters the Stomach and is transported upward to the Lungs. Food qi in the Stomach enriches the vessels. Vessel qi flows through the meridians, and meridian qi returns to the Lungs. The Lungs face all vessels, distributing essence to the skin and hair. Skin and vessel essence combine, moving qi through the Fu Organs and connecting to the four Zang Organs. Thus, food entering the Stomach is distributed by the regulating function of Lung qi, generating Ying Qi, Wei Qi, and blood vessels. Therefore, fullness in the meridians with blood indicates disease in the Stomach; dietary irregularities cause disease because Lung qi fails to transport. In the *Lingshu* and *Sujing*, discussions of the five Zang Organs always include the Stomach Fu, because the Stomach is the source of generation for the five Zang Organs. The Lungs and Yangming Meridian jointly govern the Autumn command. This chapter aligns Fu with Zang, and Zang with the four seasons and five elements. Since taste governs Autumn, the Zang and Fu organs governed by Autumn are included herein.