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The flavors generally follow the principle of being sweet first and salty later. When Metal is dominant, its draining method uses pungent flavor, and its tonifying method uses sour flavor; therefore, the flavors for treating the Yangming channel generally should be pungent first and sour later. When Water is dominant, its draining method uses salty flavor, and its tonifying method uses bitter flavor; therefore, the flavors for treating the Taiyang channel generally should be salty first and bitter later. When Wood is dominant, its draining method uses sour flavor, and its tonifying method uses pungent flavor; therefore, the flavors for treating the Jueyin channel generally should be sour first and pungent later. The treatment principle for the Shaoyin channel is the same as that for the Shaoyang channel. When Earth is dominant, its draining method uses bitter flavor, and its tonifying method uses sweet flavor; therefore, the flavors for treating the Taiyin channel generally should be bitter first and sweet later. This is the correct flavor profile for the supplementation and draining of the Six Qi (Wind, Heat, Summerheat, Dampness, Dryness, Cold). It is essential to assist with flavors beneficial to the condition and utilize flavors based on the generating cycle; this is called "obtaining the Qi."

The Yellow Emperor said: Excellent. The origin of all diseases lies in the transformations and variations of Wind, Cold, Summerheat, Dampness, Dryness, and Fire. The classics state: drain excess, tonify deficiency. I have bestowed prescriptions upon physicians, yet their application does not always achieve perfect results. I wish to implement this fundamental principle so that therapeutic effects are as immediate as a drumstick striking a drum, as thorough as removing a thorn or washing away dirt, reaching a level of skill that is exquisite and divine. May I hear how this can be achieved?

(Note: "Xue" is synonymous with "Xie," meaning filth.) The origin of all diseases does not exceed the changes of the Six Qi. If supplementation and draining therapies fail to achieve perfection, one must strive for perfection so that the fundamental principle can be implemented. Responding like a drum, just as a thorn can be removed even if long embedded, and dirt can be washed away even if old, medical skill reaches a divine level, distinct from ordinary practitioners; thus, the Yellow Emperor asks.

Qibo said: Examine the disease pathogenesis carefully, and do not deviate from the suitability of the Qi (climatic factors); this is what is meant.

Each of the Six Qi in a year has its own suitability. Changes become diseases, each with its own mechanism. Therefore, one must examine the disease pathogenesis and not miss the climatic suitability; this is referred to as divinity and sageliness.

The Yellow Emperor said: I wish to hear about the disease pathogenesis.

The disease pathogenesis is infinite, and examination is not easy; hence, I wish to hear it.

Qibo said: All cases of wind causing tremors and dizziness belong to the Liver. All cases of cold causing contraction and pulling belong to the Kidney. All cases of Qi stagnation belong to the Lung. All cases of dampness causing swelling and fullness belong to the Spleen. All cases of heat causing mental clouding and convulsions belong to the Heart. (Note: Old editions erroneously wrote "Fire" instead of "Heart"; corrected here.) Diseases involving formless Qi internally belonging to formed organs, or diseases involving formed roots internally belonging to Qi transformation, are all disease pathogenesis. For example, various winds causing head and eye tremors and dizziness belong to the Liver, as Wind Qi connects to the Liver; various colds causing meridian contraction belong to the Kidney, as Cold Qi connects to the Kidney; various Qi issues causing chest and diaphragm oppression belong to the Lung, as Qi connects to the Lung; various dampness causing body swelling and fullness belong to the Spleen, as Dampness connects to the Spleen; various heats causing visual clouding and tendon spasms belong to the Heart, as Heat Qi connects to the Heart. This illustrates formless Six Qi internally belonging to formed viscera.

All cases of pain, itching, and sores belong to Fire. All cases of Jue (reversal) and retention/incontinence belong to the Lower Jiao. All cases of Wei (atrophy), wheezing, and vomiting belong to the Upper Jiao. (Note: Fire, old editions erroneously wrote "Heart"; corrected here.) Various pains, itching, and sores belong to the Fire of the Hand-Shaoyang Sanjiao (Triple Burner). Various cold Jue and retention/incontinence belong to the Lower Jiao. The Lower Jiao refers to the Lower Jiao. Various Wei bi (atrophy and numbness) and wheezing/vomiting belong to the Upper Jiao; the Upper Jiao refers to the Upper Jiao. This indicates that when Sanjiao Fire-Heat Qi is excessive, various sores, pain, and itching occur externally; when Sanjiao Fire-Heat Qi is insufficient, various Jue, retention/incontinence, Wei, and wheezing/vomiting occur internally; thereby clarifying that Sanjiao Qi travels up and down, entering and exiting inside and outside.

All cases of lockjaw, shivering, and loss of spiritual control belong to Fire. (Note: "Jin" is synonymous with "Jin" [lockjaw]. "Sang" is pronounced with the departing tone.) Various cases of lockjaw without speech and body shivering, resembling a loss of spiritual essence and internal control, are diseases of the Hand-Shaoyin Heart Meridian. The Heart belongs to Fire; therefore, they all belong to Fire.

All cases of spasm and neck stiffness belong to Dampness. (Note: "Jing" refers to hand and foot spasms.) Various cases of spasm and neck/back stiffness are diseases of the Foot-Taiyang Bladder Meridian. The Bladder is the mansion of Water and Dampness; therefore, they all belong to Dampness.

All cases of rebellious Qi rushing upward belong to Fire.

Various cases of rebellious Qi rushing above the chest and diaphragm are diseases of the Hand-Jueyin Pericardium. The Pericardium belongs to Fire; therefore, they all belong to Fire.

All cases of abdominal distension and enlargement belong to Heat.

Various cases of distension and large abdomen are diseases of the Foot-Taiyin Spleen Meridian. Heat and Dampness steaming together cause disease in the Spleen Earth; therefore, they all belong to Heat.

All cases of restlessness, mania, and transgression belong to Fire.

Various cases of restless agitation, manic irritability, and behavioral transgression are diseases of the Foot-Yangming Stomach Meridian. the Yangming channel represents Dryness-Heat Qi; therefore, they all belong to Fire.

All cases of sudden rigidity belong to Wind.

Various cases of sudden onset with rigid tendons unable to flex or extend are diseases of the Foot-Jueyin Liver Meridian. Jueyin governs Wind; therefore, they all belong to Wind.

All cases of diseases with sounds, where percussion yields a drum-like sound, belong to Heat.

Various cases with audible nasal breathing, where Qi ascends and causes vibration like a drum, are diseases of the Hand-Taiyin Lung Meridian. The Lung governs Qi, and Qi is Yang; therefore, they all belong to Heat.

All cases of disease presenting with muscle swelling, pain, soreness, and fright belong to Fire. (Note: "Suan" is synonymous with "Suan" [soreness]. "Zhong" refers to muscle swelling.) Muscle swelling causes pain and soreness; irregular Qi mechanism causes fright. These are diseases of the Hand-Yangming Large Intestine Meridian. the Yangming channel represents Dryness-Heat Qi; therefore, they all belong to Fire.

All cases of twisting, retroversion, and turbid urine belong to Heat. (Note: "Li" refers to abnormal curvature.) Various cases of twisting and retroversion lead to difficult urination and defecation; difficult urination leads to turbid fluids. These are diseases of the Hand-Taiyang Small Intestine Meridian. the Taiyang channel represents Yang-Heat Qi; therefore, they all belong to Heat.

All cases of bodily fluids that are clear, transparent, and cold belong to Cold.

Clear, transparent, and cold fluids indicate deficiency-cold in the Lower Jiao. These are diseases of the Foot-Shaoyin Kidney Meridian. the Kidney governs Water and Cold; therefore, they all belong to Cold.

All cases of vomiting acid water, sudden diarrhea with tenesmus belong to Heat.

Vomiting acid water and sudden diarrhea with tenesmus are diseases of the Gallbladder and Foot-Shaoyang Gallbladder Meridian. the Shaoyang channel belongs to Fire; therefore, they all belong to Heat. This illustrates formed viscera internally belonging to formless Six Qi.

Therefore, the general rule states: Carefully observe the disease pathogenesis, assign each to its category. Investigate what is present and what is absent. Address excess by blaming the surplus, and address deficiency by blaming the lack. First, understand the Five Phases' overcoming relationships. Then, unblock the Blood and Qi, allowing them to flow smoothly and harmoniously, thereby achieving peace. This is what is meant.

This summarizes the preceding text, elucidating the method of examination. The diseases mentioned previously belong either to the Zang organs (Liver, Heart, Spleen, Lung, Kidney) or to the Six Qi (Wind, Fire/Heat, Dampness, Cold). Thus, the general rule states: carefully observe the pathogenesis and assign categories. For those belonging to formed viscera, seek the truth; for those belonging to formless Qi transformation, also seek the truth. Excess and abundance disrupt balance, so they must be addressed. Deficiency and insufficiency disrupt balance, so they must also be addressed. One must first know the overcoming relationships of the Five Phases. If overcoming occurs, one must unblock the Blood and Qi, allowing them to flow smoothly to achieve harmony. This is the meaning of investigating presence/absence and addressing excess/deficiency.

The Yellow Emperor said: Excellent. What is the use of the Yin-Yang applications of the Five Flavors?

To unblock the Blood and Qi and allow them to flow smoothly, the use of the Five Flavors and Yin-Yang is necessary; hence, the subsequent question.

Qibo said: Pungent and Sweet flavors that disperse and emit belong to Yang. Sour and Bitter flavors that induce vomiting and drain belong to Yin. Salty flavor that induces vomiting and drains belongs to Yin. Bland flavor that seeps and drains belongs to Yang. These six flavors may astringe or disperse, relax or tense, dry or moisten, soften or harden. They are administered according to what is beneficial, regulating the Qi to bring it to equilibrium.

The Yin-Yang uses of the Five Flavors complement each other. For instance, Pungent disperses outward from within; it must be assisted by Sweet. Thus, Pungent-Sweet flavors disperse and belong to Yang. Bitter induces vomiting and drains downward from the middle; it must be assisted by Sour. Thus, Sour-Bitter flavors induce vomiting/drain and belong to Yin. Salty flavor moistens and descends, primarily draining downward; draining downward implies ascending capability, so Salty flavor inducing vomiting/draining belongs to Yin. Beyond the Five Flavors, there is the Bland flavor. Bland flavor soaks and seeps; soaking and seeping implies draining, so Bland flavor seeping/draining belongs to Yang. These six—Pungent, Sweet, Sour, Bitter, Salty, and Bland—have different aromas and flavors but complementary functions. Some astringe, some disperse; astringing allows dispersion, dispersion allows astringing. Some relax, some tense; relaxing allows tension, tension allows relaxation. Some dry, some moisten; drying allows moistening, moistening allows drying. Some soften, some harden; softening allows hardening, hardening allows softening. This is the complementary function of Yin-Yang among the Five Flavors. Administered according to benefit, they unblock the Blood and Qi. Regulating the Qi ensures smooth flow. Unblocking Blood and Qi achieves harmony, hence "bringing it to peace."

The Yellow Emperor said: For those not cured by Qi regulation, how should they be treated? Regarding toxic and non-toxic herbs, which should be used first or last? I wish to hear the principle.

Continuing from the statement on regulating Qi to achieve peace, another question arises. If not cured by Qi regulation, herbal treatment is required. Regarding the toxicity of herbs and the order of administration, there must be a principle; hence, I wish to hear it.

Qibo said: Whether toxic or non-toxic, the treatment should be primary, adjusted according to the size of the prescription.

Treating diseases has specific targets. Whether herbs are toxic or non-toxic, the treatment target is primary; additionally, the size of the prescription determines the dosage. This is the principle.

The Yellow Emperor said: Please explain the system.

Please explain the system of large and small prescriptions.

Qibo said: One Sovereign herb and two Ministers constitute a small prescription. One Sovereign, three Ministers, and five Assistants constitute a medium prescription. One Sovereign, three Ministers, and nine Assistants constitute a large prescription.

Cold is treated with Heat; Heat is treated with Cold. Minor conditions are treated oppositely (counteracting); severe conditions are treated similarly (following). Hardness is reduced; external pathogens are expelled. Exhaustion is warmed; accumulation is dispersed. Stagnation is attacked; dryness is moistened. Tension is relaxed; scattering is astringed. Damage is tonified; lethargy is activated. Fright is calmed. Ascending disorders are descended; descending disorders are ascended. Massage and bathing are applied. Mild treatments weaken; urgent treatments劫 (rob/seize). Open and disperse. Adapt to the situation as the goal.

The principle of prescribing: One Sovereign and two Ministers, without Assistants or Envoys, constitutes a small preparation. One Sovereign, three Ministers, and five Assistants constitutes a medium preparation. One Sovereign, three Ministers, and nine Assistants constitutes a large preparation. Small, medium, and large preparations generally dictate: Cold diseases treated with Heat; Heat diseases treated with Cold; minor diseases treated counteractively; severe diseases treated conformingly; hardness reduced; external pathogens expelled; exhaustion warmed; accumulation dispersed; stagnation attacked; dryness moistened; tension relaxed; scattering astringed; damage tonified; lethargy activated; fright calmed; things lifted and ascended, pushed and descended; ointments for massage, decoctions for bathing; mild treatment to weaken, urgent treatment to seize; opening and dispersing. All these adapt to the specific situation to restore the original state.

The Yellow Emperor said: What are Counteraction (Ni) and Conformity (Cong)?

Minor conditions are treated counteractively; severe conditions are treated conformingly. What does this mean?

Qibo said: Counteraction is Standard Treatment (Zheng Zhi); Conformity is Reverse Treatment (Fan Zhi). From small to large, observe the circumstances.

Counteraction means treating Heat with Cold and Cold with Heat; this is Standard Treatment. Conformity means treating Heat with Heat and Cold with Cold; this is Reverse Treatment. Prescribing sizes, from small to many, depend on observing the appropriateness of the case.

The Yellow Emperor said: What is Reverse Treatment?

Standard Treatment is normal treatment; Reverse Treatment is contrary treatment. Hence, I ask what Reverse Treatment is.

Qibo said: Treating Heat using Cold administration, treating Cold using Heat administration, treating Obstruction with Obstruction methods, treating Flow with Flow methods. One must subdue the governing factor and address the root cause first. Initially, they appear similar; finally, they differ. This can break accumulations, dissolve hardness, harmonize Qi, and ensure cure.

The principle of Reverse Treatment: To treat Heat with Heat, administer cool medicine; this is "Treating Heat using Cold administration." To treat Cold with Cold, administer warm medicine; this is "Treating Cold using Heat administration." Using tonics to treat fullness is "Treating Obstruction with Obstruction." Using purgatives to treat diarrhea is "Treating Flow with Flow." In these treatments of Cold/Heat and Obstruction/Flow, one must eventually subdue the governing disease and first address the cause. Treating Heat with Heat, Cold with Cold, Obstruction with Obstruction, Flow with Flow—this is the initial similarity. Treating Heat with Cold, Cold with Heat, Obstruction with Flow, Flow with Obstruction—this is the final difference. "Treating Obstruction with Obstruction" strengthens righteous Qi, thus breaking accumulations and dissolving hardness. "Treating Flow with Flow" prevents pathogen retention, thus harmonizing Qi and ensuring cure. This is the principle of Reverse Treatment.

The Yellow Emperor said: Excellent. What about curing through Qi regulation?

The previous section discussed Reverse Treatment; the Yellow Emperor wishes to clarify Standard Treatment, hence asking about curing through Qi regulation.

Qibo said: Counteracting and following, counteracting while following, following while counteracting. Unblocking Qi to make it regulated is the way.

Curing through Qi regulation is the method of Standard Treatment. As stated earlier, Counteraction is Standard Treatment; thus, counteracting is actually following. Counteracting while following, or following while counteracting, aligns with the principle of unblocking Blood and Qi to ensure smooth flow, as mentioned earlier. Hence, "unblocking Qi to regulate it" is the way.

The Yellow Emperor said: Excellent. What about diseases inside and outside?

"Zhong" means inside. Diseases may originate internally and manifest externally, or externally and manifest internally. Hence, I ask about internal and external diseases to fully understand the mechanism.

Qibo said: For diseases originating internally and manifesting externally, regulate the interior. For diseases originating externally and manifesting internally, treat the exterior. For diseases originating internally and manifesting severely externally, first regulate the interior, then treat the exterior. For diseases originating externally and manifesting severely internally, first treat the exterior, then regulate the interior. If interior and exterior are unrelated, treat the primary disease.

Treating disease requires seeking the root. Thus, for diseases originating internally and manifesting externally, regulate the interior; for those originating externally and manifesting internally, treat the exterior. For those originating internally and manifesting severely externally, first regulate the interior, then treat the exterior.

For those originating externally and manifesting severely internally, first treat the exterior, then regulate the interior. Internal disease in Zang-Fu is called "regulation"; external disease in muscles/skin is called "treatment." If internal and exterior are unrelated, only the primary disease is treated.

The Yellow Emperor said: Excellent. When Fire-Heat recurs with aversion to cold and fever, resembling malaria, sometimes occurring daily, sometimes every few days, what is the reason?

Continuing from internal/external diseases, asking about cold/fever resembling malaria, daily or intermittent, whether internal or external.

Qibo said: The time of encounter between Overcoming (Sheng) and Repaying (Fu) Qi varies. When Yin Qi is abundant and Yang Qi is scarce, the interval between attacks is long. When Yang Qi is abundant and Yin Qi is scarce, the interval is short. This is the interplay of Overcoming and Repaying Qi, with rhythms of abundance and scarcity; Malaria follows the same law.

Fire-Heat recurring with aversion to cold, and aversion to cold recurring with fever, constitutes Overcoming and Repaying Qi. Daily or multi-day occurrence constitutes the time of encounter. Variations in cold/fever severity and attack intervals reflect the variation in the encounter time of Overcoming and Repaying Qi. Intermittent attacks imply pathogenic Qi in Yin; abundant Yin and scarce Yang result in longer intervals. Daily attacks imply pathogenic Qi in Yang; abundant Yang and scarce Yin result in shorter intervals. This is the interplay of Overcoming and Repaying Qi with rhythms of abundance and scarcity. Although symptoms resemble malaria, the underlying principle is the same.

The Yellow Emperor said: Classics state treating Cold with Heat and Heat with Cold. Physicians adhere to these rules. However, treating Heat with Cold increases Heat, and treating Cold with Heat increases Cold. Both situations persist, and new diseases arise. How should they be treated?

Re-examining Cold/Heat treatment. Qibo stated: Treat Cold with Heat, Heat with Cold. I ask: Classics say treat Cold with Heat, Heat with Cold, yet physicians cannot abandon these rules. However, with mixed Cold/Heat, treating Heat with Cold exacerbates Heat; treating Cold with Heat exacerbates Cold. Both scenarios exist; treating Heat makes it hotter, treating Cold makes it colder, leading to new diseases. How to treat?

Qibo said: For cases where Cold treatment fails to reduce Heat, seek the Yin. For cases where Heat treatment fails to reduce Cold, seek the Yang. This is called seeking the affiliation/root.

For cases where Cold treatment fails to reduce Heat, the root is Yin deficiency; thus, seek Yin, and treat with Warm/Hot herbs. For cases where Heat treatment fails to reduce Cold, the root is Yang deficiency; thus, seek Yang, and treat with Cold herbs. Treating Heat-induced heat with Heat, and Cold-induced cold with Cold is called seeking the root affiliation to treat.

The Yellow Emperor said: Excellent. Why does taking Cold herbs cause Heat, and taking Hot herbs cause Cold?

Continuing the previous theme: Taking Cold herbs to treat Heat results in more Heat; taking Hot herbs to treat Cold results in more Cold. New diseases arise. What is the reason?

Qibo said: Because you treated the Wang Qi (Dominant Qi).

"Wang" is pronounced with the departing tone. Spring warmth, Summer heat, Autumn clarity, Winter cold are the Wang Qi of the four seasons. Wang Qi should be followed. If one treats Heat with Cold and Cold with Heat, treating the Wang Qi, one causes reverse Heat or Cold.

The Yellow Emperor said: What if one does not treat the Wang Qi, yet still experiences reverse Heat/Cold?

What causes reverse Heat/Cold without treating the Wang Qi?

Qibo said: Your question is very thorough. It is because you did not treat the affiliation of the Five Flavors. When Five Flavors enter the stomach, they return to their preferred organs: Sour enters the Liver first, Bitter enters the Heart first, Sweet enters the Spleen first, Pungent enters the Lung first, Salty enters the Kidney first. Long-term use increases organ Qi; this is the normal transformation of substances. However, prolonged increase in organ Qi leads to imbalance and premature death.

(Gu, old editions erroneously wrote "Gong"; corrected here.) Not treating Wang Qi, but treating via Five Flavor affiliations. When Five Flavors enter the stomach, they go to their preferred organs: Sour to Liver, Bitter to Heart, Sweet to Spleen, Pungent to Lung, Salty to Kidney. Long-term flavor intake increases Zang Qi, which is the normal transformation. However, prolonged increase in Zang Qi leads to one phase overcoming another, causing premature death. Hence, reverse Heat/Cold occurs, and the disease does not heal.

The Yellow Emperor said: Excellent. What is the Sovereign-Minister system in prescriptions?

Since Five Flavors should not dominate excessively, the prescription system establishes Sovereign and Minister roles. The Yellow Emperor asks accordingly.

Qibo said: The herb that treats the main disease is the Sovereign (Jun). The herb that assists the Sovereign is the Minister (Chen). The herb that responds to the Minister is the Envoy (Shi). This is not referring to the Superior, Middle, and Inferior categories of Shennong.

"Shi" is pronounced with the departing tone. Herbs treating the main disease have larger dosages and are called Sovereign. Herbs assisting the Sovereign have smaller dosages and are called Minister. Herbs responding to the Minister have even smaller dosages and are called Envoy. This is not the Superior/Middle/Inferior classification taken by Shennong.

The Yellow Emperor said: What are the Three Categories?

What are the Three Categories of Shennong?

Qibo said: To clarify the distinction between good and bad qualities.

"E" is pronounced as written. Shennong's *Ben Jing* lists 365 species, corresponding to the degrees of the celestial sphere. The Superior Category has 125 species as Sovereign; the Middle Category has 120 species as Minister; the Inferior Category has 120 species as Assistant/Envoy. The Superior Category is non-toxic, mainly nourishing life, extending years, benefiting Qi, and lightening the body. The Middle Category may be toxic or non-toxic, mainly unblocking meridians, dispelling pathogens, and treating disease. The Inferior Category may be toxic or highly toxic, mainly breaking accumulations and eliminating chronic diseases. Among the three, although aromas/flavors and tonifying/draining effects differ, the principles are interconnected, clarifying the distinction between good and bad qualities.

The Yellow Emperor said: Excellent. What about diseases inside and outside?

Using the Three Categories of herbs to treat internal and external diseases, how is it done?

Qibo said: Formulas for regulating Qi must distinguish Yin and Yang, determine internal and external positions, and respect their respective locations. Internal diseases are treated internally; external diseases are treated externally. Minor conditions are regulated; next, balanced; severe conditions are subdued. Use sweating or purging methods. Cold, Heat, Warm, and Cool properties are used according to their affiliation to reduce pathology. Follow what is beneficial. Strictly adhere to the Dao and method, and ten thousand treatments will be successful. With balanced Blood and Qi, one enjoys a long lifespan.

"Bie" is pronounced "bi." Using herbs to treat disease is a formula for regulating Qi; thus, one must distinguish Yin/Yang, determine internal/external positions, and respect their locations. Internal...