王冰曰言采药之岁也张志聪曰主病谓主治病之药物司岁备物谓从六气五运以备之如少阴少阳二火司岁则当收附子姜
桂之热物如阳明燥金司岁则当收桑皮苍术之燥物如厥阴风气主岁则当收防风羌活之风物如太阳寒水司岁则当收芩连大黄
之寒物如太阴土气司岁则当收山药黄精之类甘平甘温之品及苍丹 素元之谷所谓药食宜也马莳曰此言药备岁物者为天地
之专精而非司气者其气偏非岁物者其气散也上文言候气宜而无失病机则用药以治病不可无所主也伯言每岁各有所司必因
其司岁者以备药物则病无遗主矣
岐伯曰司岁备物则无遗主矣
王冰曰谨候司天地所生化者则其味正当其岁也故彼药工专司岁气所收药物则一岁二岁其所主用无遗略也今详前字当
作则张志聪曰先收岁物谓先备司岁之物即上章之所谓食岁谷以全其真盖食天地之精以养吾身之真也马莳曰每岁各有所司
必因其司岁者以备药物则病无遗主矣张介宾曰如厥阴司岁则备酸物少阳少阴司岁则备苦物太阴司岁则备甘物阳明司岁则
备辛物太阳司岁则备咸物所谓岁物也岁物备则五味之用全矣骥案五常政大论生化之别有五气五味五色五类五宜又五类盛
衰各随其气之所宜如厥阴司天羽虫育在泉毛虫育之类元和纪用经厥阴风火岁主所宜用车前子戎盐之类陈无择三因方厥阴
司天用敷和汤之类他如经言岁谷间谷皆岁物所宜不胜列举义详各条又东垣用药心法司岁备物天地之专精专精之岁药物肥
浓又于使用当其正气味也五运主岁不足则物薄有余则物精非专精则气散气散则物不纯是以形质虽同力用则异
帝曰先岁物何也岐伯曰天地之专精也
王冰曰专精之气药物肥脓又于使用当其正气味也新校正云详先岁疑作司岁张志聪曰司气谓五运之气五运虽与主岁相
同然又有太过不及之分太过之岁则物力浓不及之岁则物力浅薄马莳曰每岁之司天在泉物从其化而天地之专精储焉故不可
不先之张介宾曰岁物者得天地精专之化气全力浓故备所当先此与六元正纪大论食岁物以全其真者同义骥案东垣用药心法
至元庚辰六月治许伯威心悸动吃噫不绝色变青黄精神减少目不欲开倦卧恶人语笑脉动而中止有时自还乃结脉也用炙甘草
汤两剂不效再候之脉证相对曰莫非药有陈腐者乎再市药之气味浓者煎服减半再服而安凡药之昆虫草木产之有地根叶花实
采之有时失其地则性味少异失其时则气味叶不全又况新陈之不同精粗之不等倘不择而用之其不效者医之过也其药贵专精
如此
帝曰司气者何如
王冰曰司运气也张志聪曰若非气运司岁之物则气散而力薄
岐伯曰司岁者主岁同然有余不足也
王冰曰五运主岁者有余不足比之岁物恐有薄有余之岁药专精也张志聪曰形质虽同而气味有浓薄之异马莳曰彼司气者
即司运也如甲己为土运乙庚为金运然太过则有余不及则不足其气偏耳张介宾曰主岁即上文司天在泉之主岁运之与气所主
皆同但五太之运为有余五少之运为不及而物性之禀有浓薄矣骥案五常政大论五气五类有所胜制同者盛之异者衰之又气主
有所制岁立有所生地气制已胜天气制胜己天制色地制形故各有制各有胜各有生各有成故曰不知其年之所加气之同异不足
以言生化此有余不足即此胜制而推之斯无遗主矣
帝曰非司岁物何谓也岐伯曰散也
王冰曰非专精则散气散气则物不纯也张志聪曰治保有多少者谓治病保真之药食或宜多用而宜少用也按中古之世不能
司岁备物用炮制以代天地之助如制附子曰炮制苍术桑皮曰炒盖以火助火而以燥助燥也近有附子以水煮曰自制制桑皮以蜜
拌曰润燥是犹用鹰犬而去其爪牙则驱之抟蹇兔而不能又安望韩卢之技哉马莳曰若非岁物而用之则其气又散张介宾曰非司
岁物谓非主岁之物也散者谓六气之序不司天地则司四间故物生之应亦当随气散见于四方而各有所禀也骥案五常政大论气
始而生化气散而有形气布而蕃育气终而象变非司岁之物正值散气有形之期气衰味薄论语所谓不时不食也况入药治病性味
不全何可用也
故质同而异等也
王冰曰形质虽同力用则异故不尚之马莳曰一物之质同而精有完全偏散之异张介宾曰天地之气变不常故物生之体质虽
同而性用之浓薄则异
气味有薄浓性用有躁静治保有多少力化有浅深此之谓也
王冰曰物与岁不同者何以此尔马莳曰气味有浓薄性用有躁静治保有多少力化有浅深此岁物之不可以不备也张介宾曰
此即质同异等之谓盖司气者与不司气者其有不同如此
帝曰岁主藏害何谓岐伯曰以所不胜命之则其要也
王冰曰木不胜金金不胜火之类是也张志聪曰此论五运之岁受司天在泉之胜制岁主者谓六气之主岁藏五藏也盖言五藏
内属五行而外合五运五运之气受胜制之所伤则病患五藏而为害如少商金运而值二火司天少宫土运而值厥阴在泉此皆运气
之所不胜而受胜气之所胜制故以所不胜命之则岁主藏害之要可知矣命名也马莳曰此言岁之五藏害者以其有所不胜而治之
有法也岁气在天五藏在人而岁主五藏有害者正以木气淫则脾不胜火气淫则肺不胜土气淫则肾不胜金气淫则肝不胜水气淫
则心不胜以所不胜命之则知害藏之要
帝曰治之奈何岐伯曰上淫于下所胜平之外淫于内所胜治之
王冰曰淫谓行所不胜已者也上淫于下天之气也外淫于内地之气也随所制胜而以平治之也制胜谓五味寒热温凉随胜用
之下文备矣新校正云详天气主岁虽有淫胜但当平调之故不曰治而曰平也张志聪曰上淫于下者谓司天之气淫胜其在下之运
气当以所胜平之如少商金运而火热上临宜平以咸寒佐以苦甘外淫于内者在泉之气淫胜其在内之五运当以所胜治之如少宫
土运而风木下淫宜治以辛凉佐以苦甘按司天在泉之气根于外五运之化根于中故曰外淫于内下章平天气曰平治在泉曰治又
诸气在泉曰淫于内马莳曰司天之气淫于下而藏病生则以所胜者平之如木气淫则以金制之者是也至于在泉之气淫于内而藏
病生则亦以所胜者治之即木气淫而以金制之者是也所谓制胜者谓五味寒热温凉随胜而用之耳但上淫于下者淫于三气已前
有胜无复也外淫于内者淫于四气以后有胜无复也张介宾曰淫太过为害也上淫于下谓天以六气而下病六经也外淫于内谓地
以五味而内伤五官也淫邪为害当各以所胜者平治之骥案五常政大论五味所资生化有浓薄成熟有少多寒热燥湿不同其化故
少阳在泉其味辛其治苦酸阳明在泉其味酸其治辛苦甘太阳在泉其味苦其治淡咸厥阴在泉其味甘其治酸苦少阴在泉其味辛
其治辛苦甘太阴在泉其味咸其治甘咸补上下者从之治上下者逆之以所在寒热盛衰而调之
帝曰善平气何如
王冰曰平谓诊平和之气张志聪曰平气谓无上下之胜制运气之和平也马莳曰岁之平而有所病者亦视其正反而善治之上
文言上淫于下外淫于内而为病皆以岁气不平也故问以平气而民病者
岐伯曰谨察阴阳所在而调之以平为期正者正治反者反治
王冰曰知阴阳所在则知尺寸应与不应不知阴阳所在则以得为失以逆为从故谨察之也阴病阳不病阳病阴不病是为正病
则正治之谓以寒治热以热治寒也阴位已见阳脉阳位又见阴脉是为反病则反治之谓以寒治寒以热治热也诸方之制咸悉不然
故曰反者反治也张志聪曰甲丙戊庚壬为阳运乙丁己辛癸为阴运阴阳二运有太过不及之分故谨察阴阳所在而调之以平为期
正者正治谓太过之岁当抑其胜气扶其不胜反者反治谓不及之运为所不胜之气反胜当反佐以取之马莳曰阴阳者尺寸之位曰
阴阳阴脉阳脉阴经阳经皆曰阴阳当谨察而调之以平为期如阴经病而阳经不病阳经病而阴经不病是为正病正则以寒药治热
以热药治寒从而正治之若阴位而见阳脉阳位而见阴脉是为反病反则以寒药治寒以热药治热从而反治之张介宾曰阴阳者脉
有阴阳证有阴阳气味有阴阳经络藏象有阴阳不知阴阳所在则以反为正以逆为从故宜谨察而调之以平为期无令过也骥案五
常政大论养之和之静以待时谨守其气无使倾移其形乃彰生气以长命曰圣王故大要曰无代化无违时必养必和待其来复此之
谓也可为平调之证
王冰说:这是指采集药材的年份。张志聪说:“主病”是指主治疾病的药物。“司岁备物”是指顺应六气和五运来储备药材。例如,少阴和少阳二火主管岁运时,应当采收附子、干姜、肉桂等热性药材;阳明燥金主管岁运时,应当采收桑白皮、苍术等燥性药材;厥阴风气主管岁运时,应当采收防风、羌活等风性药材;太阳寒水主管岁运时,应当采收黄芩、黄连、大黄等寒性药材;太阴土气主管岁运时,应当采收山药、黄精等甘平或甘温的药材,以及丹、素、元之谷,这就是所说的药食相宜的道理。马莳说:这里讲的是储备岁物(当年所产药材)是因为它们是天地精气的专一凝聚,而不是由司天在泉之气所偏胜的;非岁物的药材,其气味是散漫的。上文讲观察气机适宜与否而不违背病机,那么用药治病就不能没有主治方向。每年各有主管之气,必须依据主管岁运之气来储备药物,这样治疗疾病就不会遗漏主治原则。
岐伯说:顺应岁运储备药材,就不会遗漏主治原则。
王冰说:谨慎地观察天地所化生的事物,那么药物的味道就正当于该年。所以那些专门负责按岁气采收药物的药工,在一两年内,他们所主治使用的药物就没有遗漏疏忽了。现在详细考察前文,“作”字应当理解为“择”。张志聪说:先收岁物,意思是预先储备主管岁运的药物,也就是上一章所说的“食用岁谷以保全真元”,即摄取天地的精华来滋养我们身体的真元。马莳说:每年各有主管之气,必须依据主管岁运之气来储备药物,这样治疗疾病就不会遗漏主治原则。张介宾说:例如厥阴主管岁运则储备酸味药物,少阳、少阴主管岁运则储备苦味药物,太阴主管岁运则储备甘味药物,阳明主管岁运则储备辛味药物,太阳主管岁运则储备咸味药物,这就叫岁物。岁物储备齐全,五味的运用就完备了。我(张骥)按语:《五常政大论》中生化各有不同,有五气、五味、五色、五类、五宜,又有五类的盛衰各随其气之所宜,如厥阴司天时羽虫繁育,在泉时毛虫繁育之类。《元和纪用经》记载厥阴风火岁主所宜用车前子、戎盐之类。陈无择《三因方》中厥阴司天用敷和汤之类。其他如经文所言岁谷、间谷,都是岁物所宜,不胜枚举,义理详见各条。另外李东垣《用药心法》提到“司岁备物,天地之专精”,专精之岁的药物肥厚浓郁,使用时正当其正气味。五运主岁,不足则物薄,有余则物精,若非专精则气散,气散则物不纯,因此虽然形质相同,但力用却不同。
黄帝问:为什么要先储备岁物?岐伯说:因为那是天地的精气专一凝聚。
王冰说:专精之气的药物肥厚浓郁,使用时正当其正气味。新校正云:详细考证“先岁”疑为“司岁”。张志聪说:司气是指五运之气。五运虽然与主岁相同,但又有太过和不及的区别。太过之年物力浓厚,不及之年物力浅薄。马莳说:每年的司天在泉之物顺从其气化,而天地的精气便储存其中,所以不可不预先准备。张介宾说:岁物是得到天地精专之化的,气全力浓,所以应当优先储备。这与《六元正纪大论》中“食岁物以全其真”的意义相同。我(张骥)按语:李东垣《用药心法》记载,至元庚辰六月治疗许伯威,心悸动,呃逆不止,面色青黄,精神减少,眼睛不想睁开,疲倦嗜卧,厌恶人说话笑闹,脉跳动而有中止,有时自行恢复,这是结脉。用了两剂炙甘草汤无效,再次诊察,脉证相对,说:“莫非药物有陈旧腐败的吗?”再买气味浓郁的药,煎服减半剂量,再服用后病情安定。凡是药物中的昆虫草木,产地有地域之分,根叶花实采摘有时节之分。失去产地,则性味稍有差异;失去时节,则气味不全。更何况新旧不同,精粗不等,如果不加选择而使用,导致无效,是医生的过错。药物贵在专精,就像这样。
黄帝问:非司岁之物怎么样?
王冰说:那是司运气。张志聪说:如果不是司岁之物,则气味散漫而力薄。
岐伯说:司岁之物与主岁相同,但有有余和不足的区别。
王冰说:五运主岁,有余不足,比起岁物恐怕有薄有余的区别。太过之年的药物是专精的。张志聪说:形质虽然相同,但气味有浓薄的差异。马莳说:所谓“司气者”就是司运。如甲己年为土运,乙庚年为金运,然而太过则有余,不及则不足,其气偏颇。张介宾说:主岁即上文司天在泉的主岁运,与气所主都相同,只是五太过之运为有余,五不及之运为不足,而物性的禀赋就有浓薄之别了。我(张骥)按语:《五常政大论》说五气五类有所胜制,同者盛之,异者衰之。又气主有所制约,岁立有所生,地气制已胜,天气制胜己,天制色,地制形,故各有制,各有胜,各有生,各有成。所以说不知道当年的气之同异,不足以言生化。这里的有余不足,就是由此胜制推演而来,这样就没有遗漏主治原则了。
黄帝问:非司岁之物叫什么?岐伯说:叫散。
王冰说:不专精则气散,气散则物不纯。张志聪说:治病保真有分量多少的区别,谓治病保真的药食,有的宜多用,有的宜少用。按照中古时代不能司岁备物,就用炮制来代替天地的帮助,如制附子说炮制,苍术、桑皮说炒,大概是用火助火,以燥助燥。近来有用附子水煮的叫自制,用蜜拌桑皮叫润燥,这就像用鹰犬却去掉它们的爪牙,驱使它们搏击狡兔而不能成功,又怎能期望韩卢那样的技艺呢?马莳说:如果不是岁物而使用它,那么它的气又是散漫的。张介宾说:非司岁物是指非主岁之物。散者,谓六气之序,不司天地则司四间,所以物生之应也当随气散见于四方而各有所禀。我(张骥)按语:《五常政大论》说气始而生化,气散而有形,气布而蕃育,气终而象变。非司岁之物正值散气有形之期,气衰味薄,《论语》所谓“不时不食”。何况入药治病,性味不全,怎么可以使用呢?
所以质地相同而等级不同。
王冰说:形质虽然相同,力用却不同,所以不推崇它们。马莳说:一物的质地相同,但精粹有完全和偏散的差异。张介宾说:天地之气变化无常,所以物生的体质虽然相同,但性用的浓薄却不同。
气味有薄浓,性用有躁静,治保有分量多少,力化有浅深,说的就是这个道理。
王冰说:物与岁不同的是什么原因呢?马莳说:气味有浓薄,性用有躁静,治保有分量多少,力化有浅深,这就是岁物不可以不储备的原因。张介宾说:这就是质地相同而等级不同的意思。大概司气者与不司气者,其不同之处如此。
黄帝问:岁主藏害是什么意思?岐伯说:以所不胜来命名,就是它的要点。
王冰说:木不胜金,金不胜火之类。张志聪说:这是论述五运之岁受司天在泉之胜制。岁主者,谓六气之主岁;藏,五藏也。大概言五藏内属五行而外合五运,五运之气受胜制之所伤,则病患五藏而为害。如少商金运而值二火司天,少宫土运而值厥阴在泉,这都是运气之所不胜而受胜气之所胜制,所以以所不胜命名,则岁主藏害的要旨可知矣。命名也。马莳说:这是说岁之五藏害者,因为它们有所不胜,而治之有法。岁气在天,五藏在人,而岁主五藏有害者,正是因为木气淫则脾不胜,火气淫则肺不胜,土气淫则肾不胜,金气淫则肝不胜,水气淫则心不胜。以所不胜命名,则知害藏的要旨。
黄帝问:如何治疗?岐伯说:上淫于下,所胜平之;外淫于内,所胜治之。
王冰说:淫谓行所不胜之气。上淫于下是天之气,外淫于内地之气。随所制胜而以平治之。制胜谓五味寒热温凉,下文备矣。新校正云:详细考证天气主岁虽有淫胜,但当平调之,故不曰治而曰平。张志聪说:上淫于下者,谓司天之气淫胜其在下之运气,当以所胜平之。如少商金运而火热上临,宜平以咸寒佐以苦甘。外淫于内者,在泉之气淫胜其在内之五运,当以所胜治之。如少宫土运而风木下淫,宜治以辛凉佐以苦甘。按司天在泉之气根于外,五运之化根于中,故曰外淫于内。下章平天气曰平治,在泉曰治,又诸气在泉曰淫于内。马莳说:司天之气淫于下而藏病生,则以所胜者平之,如木气淫则以金制之。至于在泉之气淫于内而藏病生,则亦以所胜者治之,即木气淫而以金制之。所谓制胜者,谓五味寒热温凉随胜而用之。但上淫于下者,淫于三气以前,有胜无复;外淫于内者,淫于四气以后,有胜无复。张介宾说:淫太过为害。上淫于下,谓天以六气而下病六经;外淫于内,谓地以五味而内伤五官。淫邪为害,当各以所胜者平治之。我(张骥)按语:《五常政大论》说五味所资生化有浓薄,成熟有少多,寒热燥湿不同其化。故少阳在泉其味辛,其治苦酸;阳明在泉其味酸,其治辛苦甘;太阳在泉其味苦,其治淡咸;厥阴在泉其味甘,其治酸苦;少阴在泉其味辛,其治辛苦甘;太阴在泉其味咸,其治甘咸。补上下者从之,治上下者逆之,以所在寒热盛衰而调之。
黄帝问:善平气怎么样?
王冰说:平谓诊平和之气。张志聪说:平气谓无上下之胜制,运气之和平。马莳说:岁之平而有所病者,亦视其正反而善治。上文讲上淫于下、外淫于内而为病,皆以岁气不平。故问以平气而民病者。
岐伯说:谨察阴阳所在而调之,以平为期。正者正治,反者反治。
王冰说:知阴阳所在,则知尺寸应与不应。不知阴阳所在,则以得为失,以逆为从,故谨察之。阴病阳不病,阳病阴不病,是为正病,则正治之,谓以寒治热,以热治寒。阴位已见阳脉,阳位又见阴脉,是为反病,则反治之,谓以寒治寒,以热治热。诸方之制咸悉不然,故曰反者反治。张志聪说:甲丙戊庚壬为阳运,乙丁己辛癸为阴运。阴阳二运有太过不及之分,故谨察阴阳所在而调之,以平为期。正者正治,谓太过之岁当抑其胜气,扶其不胜;反者反治,谓不及之运为所不胜之气反胜,当反佐以取之。马莳说:阴阳者,尺寸之位曰阴阳,阴脉阳脉,阴经阳经皆曰阴阳。当谨察而调之,以平为期。如阴经病而阳经不病,阳经病而阴经不病,是为正病,正则以寒药治热,以热药治寒,从而正治之。若阴位而见阳脉,阳位而见阴脉,是为反病,反则以寒药治寒,以热药治热,从而反治之。张介宾说:阴阳者,脉有阴阳,证有阴阳,气味有阴阳,经络藏象有阴阳。不知阴阳所在,则以反为正,以逆为从,故宜谨察而调之,以平为期,无令过也。我(张骥)按语:《五常政大论》说养之和之,静以待时,谨守其气,无使倾移,其形乃彰,生气以长,命曰圣王。故大要曰:无代化,无违时,必养必和,待其来复,此之谓也。可为平调之证。
Wang Bing stated: This refers to the year of collecting medicinal materials. Zhang Zhicong explained: "Zhu bing" (Main disease treatment) refers to the herbs that primarily treat the disease. "Si sui bei wu" (Preparing yearly substances according to the ruling qi) means preparing medicinal materials in accordance with the Six Qi and Five Movements. For instance, when Shaoyin and Shaoyang (Lesser Yin and Lesser Yang) govern the fire element for the year, one should collect hot-natured substances like Fuzi (Prepared Aconite Root), Ganjiang (Dried Ginger), and Rougui (Cinnamon Bark). When Yangming (Bright Yang) governs dryness and metal, one should collect drying substances like Sangbaipi (Mulberry Root Bark) and Cangzhu (Atractylodes Rhizome). When Jueyin (Terminal Yin) governs wind, one should collect wind-dispelling substances like Fangfeng (Saposhnikovia Root) and Qianghuo (Notopterygium Rhizome). When Taiyang (Greater Yang) governs cold and water, one should collect cold-natured substances like Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), and Dahuang (Rhubarb Root). When Taiyin (Greater Yin) governs earth, one should collect sweet-ping or sweet-warm substances like Shanyao (Dioscorea Rhizome) and Huangjing (Polygonatum Rhizome), as well as Dan, Su, and Yuan grains; this is what is meant by the compatibility of medicine and food. Ma Shi stated: This passage discusses reserving "sui wu" (yearly produced substances) because they are the concentrated essence of heaven and earth, unlike substances governed by Si Tian Zai Quan (Dominant Heaven and Subterranean Qi), whose qi is biased. Non-yearly substances have scattered qi. The preceding text discussed observing the appropriateness of qi without violating the pathogenesis; thus, using medicine to treat disease requires a specific focus. Each year has its governing qi; one must reserve medicines based on the yearly governing qi so that no primary treatment principle is overlooked.
Qibo stated: Preparing yearly substances according to the ruling qi ensures that no primary treatment principle is overlooked.
Wang Bing stated: Carefully observe what heaven and earth generate; then the flavor of the medicine will be appropriate for that year. Therefore, those specialized in collecting medicines according to the yearly qi will not miss any indications over one or two years. Upon detailed examination, the character "zuo" (make/do) should be understood as "ze" (select). Zhang Zhicong stated: Collecting yearly substances first means preparing those governed by the yearly qi, which corresponds to the previous chapter's statement of "eating yearly grains to preserve true yuan," i.e., nourishing one's body's true yuan with the essence of heaven and earth. Ma Shi stated: Each year has its governing qi; one must reserve medicines based on the yearly governing qi so that no primary treatment principle is overlooked. Zhang Jiebin stated: For example, when Jueyin governs the year, prepare sour substances; when Shaoyang and Shaoyin govern, prepare bitter substances; when Taiyin governs, prepare sweet substances; when Yangming governs, prepare pungent substances; when Taiyang governs, prepare salty substances. These are called "sui wu" (yearly substances). When yearly substances are fully prepared, the application of the five flavors is complete. I (Zhang Ji) note: In the *Wu Chang Zheng Da Lun* (Great Treatise on the Normal State of the Five Movements), generation and transformation differ among the Five Qi, Five Flavors, Five Colors, Five Categories, and Five Appropriatenesses. The prosperity and decline of the five categories follow the appropriateness of their qi, such as Yu Chong (feathered creatures) breeding when Jueyin is Si Tian (Dominant Heaven) and Mao Chong (hairy creatures) breeding when it is Zai Quan (Subterranean Qi). The *Yuan He Ji Yong Jing* records that for Jueyin wind-fire years, Cheqianzi (Plantago Seed) and Rongyan (Halite) are suitable. Chen Wuyi's *San Yin Fang* uses Fuhe Tang (Harmonizing Decoction) for Jueyin Si Tian. Other examples include Sui Gu (Yearly Grains) and Jian Gu (Interim Grains) mentioned in the classics, all suitable for yearly substances, too numerous to list; the principles are detailed in respective sections. Furthermore, Li Dongyuan's *Yong Yao Xin Fa* states: "Si sui bei wu, tian di zhi zhuan jing" (Preparing yearly substances is the concentrated essence of heaven and earth). Medicines from a concentrated essence year are plump and rich, possessing their correct aroma and flavor at the time of use. If the Five Movements governing the year are insufficient, substances are thin; if excessive, substances are refined. Without concentrated essence, qi scatters; if qi scatters, substances are impure. Thus, although form and substance may be the same, their efficacy differs.
The Yellow Emperor asked: Why prioritize yearly substances? Qibo answered: Because they are the concentrated essence of heaven and earth.
Wang Bing stated: Medicines with concentrated essence are plump and rich, possessing their correct aroma and flavor at the time of use. The New Correction notes that "xian sui" (prioritize yearly) is likely a typo for "si sui" (govern yearly). Zhang Zhicong stated: Si qi (Governing Qi) refers to the Five Movements. Although the Five Movements correspond to the Main Year, there are distinctions between excess and deficiency. In years of excess, medicinal power is strong; in years of deficiency, medicinal power is weak. Ma Shi stated: The substances of each year's Si Tian and Zai Quan follow their transformation, storing the concentrated essence of heaven and earth; therefore, they must be prepared in advance. Zhang Jiebin stated: Yearly substances obtain the refined and concentrated transformation of heaven and earth, possessing strong qi and potent power, so they should be reserved first. This aligns with the meaning in the *Liu Yuan Zheng Ji Da Lun* regarding "eating yearly substances to preserve true yuan." I (Zhang Ji) note: Li Dongyuan's *Yong Yao Xin Fa* records a case in June of the Gengchen year treating Xu Bowei, who suffered from palpitations, incessant belching, greenish-yellow complexion, reduced spirit, reluctance to open eyes, fatigue, aversion to speech and laughter, and a pulse with intermittent pauses that sometimes recovered spontaneously—a Jie Mai (Knotted Pulse). Two doses of Zhigancao Tang (Licorice Decoction) were ineffective. Upon re-examination, matching pulse and symptoms, he said: "Could the medicine be old or rancid?" He purchased medicine with stronger aroma and flavor, halved the decoction dose, and after another dose, the patient recovered. All herbal and animal medicines have specific origins and harvesting times. Losing the origin alters nature and flavor slightly; losing the time results in incomplete aroma and flavor. Moreover, new and old, fine and coarse, differ greatly. Using them without selection leading to ineffectiveness is the physician's fault. Medicines value concentrated essence, as illustrated here.
The Yellow Emperor asked: What about non-sui wu (non-yearly substances)?
Wang Bing stated: They are governed by Yun Qi (Movement and Qi). Zhang Zhicong stated: If not sui wu substances, their qi is scattered and power is weak.
Qibo stated: Sui wu substances are the same as main year substances, but there are differences in excess and deficiency.
Wang Bing stated: The Five Movements governing the year have excess and deficiency; compared to sui wu, there may be thin or excessive qualities. Medicines from years of excess are concentrated. Zhang Zhicong stated: Although form and substance are the same, aroma and flavor vary in density. Ma Shi stated: Those referred to as "Si Qi" are indeed Si Yun (Governing Movement). For example, Jia and Ji years are Earth Movement, Yi and Geng years are Metal Movement. Excess leads to surplus, deficiency leads to insufficiency, resulting in biased qi. Zhang Jiebin stated: Main year refers to the Si Tian and Zai Quan governing movement mentioned earlier, which is the same as the qi governance. However, the five Excess movements are surplus, and the five Deficient movements are deficit, leading to variations in the density of substance properties. I (Zhang Ji) note: The *Wu Chang Zheng Da Lun* states that the Five Qi and Five Categories have mutual restriction; similar ones prosper, different ones decline. Qi governance has restrictions; yearly establishment has generation. Earth qi controls what it overcomes; Heaven qi controls what overcomes it; Heaven controls color; Earth controls form. Thus, there are restrictions, overcoming, generation, and completion. It is said that without knowing the year's qi similarity and difference, one cannot discuss generation and transformation. This excess and deficiency is deduced from these restrictions, leaving no omission of treatment principles.
The Yellow Emperor asked: What are non-sui wu substances called? Qibo answered: Scattered.
Wang Bing stated: Without concentration, qi scatters; if qi scatters, substances are impure. Zhang Zhicong stated: There are degrees in treating diseases and preserving truth, meaning some medicinal foods should be used in larger amounts and others in smaller amounts. In ancient times, when one could not prepare yearly substances, processing methods substituted for heaven and earth's assistance, such as roasting Fuzi or stir-frying Cangzhu and Sangbaipi, essentially using fire to assist fire and dryness to assist dryness. Recently, boiling Fuzi in water is called "self-made," and mixing Sangbaipi with honey is called "moistening dryness." This is like using hawks and dogs but removing their claws and teeth; driving them to catch cunning rabbits would fail, let alone achieve the skills of Han Lu (a famous hunting dog). Ma Shi stated: If non-yearly substances are used, their qi is scattered. Zhang Jiebin stated: Non-sui wu refers to non-main-year substances. "Scattered" means the sequence of Six Qi does not govern heaven and earth but rather the four interstitial periods; thus, the response of substance generation also scatters to the four directions with distinct endowments. I (Zhang Ji) note: The *Wu Chang Zheng Da Lun* states that qi begins generation, scatters into form, spreads for multiplication, and ends in transformation. Non-sui wu substances fall into the period of scattered qi and formed shape, where qi declines and flavor thins. As the *Analects* say, "Do not eat what is out of season." How can substances with incomplete nature and flavor be used for treating disease?
Thus, substances are identical in quality but differ in grade.
Wang Bing stated: Although form and substance are the same, efficacy differs; therefore, they are not esteemed. Ma Shi stated: One substance has the same quality, but its essence varies between complete and scattered. Zhang Jiebin stated: Heaven and earth's qi changes constantly; thus, although generated substances share the same constitution, their functional density varies.
Flavor has thin and dense qualities; nature and function have restless and quiet qualities; treatment and preservation have varying dosages; efficacy and transformation have shallow and deep levels. This is what is meant.
Wang Bing stated: Why do substances differ from the year? Ma Shi stated: Flavor has density; nature/function has restlessness/quietness; treatment/preservation has dosage variation; efficacy/transformation has depth variation. This is why yearly substances must be prepared. Zhang Jiebin stated: This refers to identical quality but different grades. Essentially, those governed by qi and those not governed by qi differ in this manner.
The Yellow Emperor asked: What is "Sui Zhu Zang Hai" (Yearly Master Organ Harm)? Qibo answered: Naming it by what it cannot overcome is the key.
Wang Bing stated: Wood cannot overcome Metal, Metal cannot overcome Fire, etc. Zhang Zhicong stated: This discusses how the Five Movements of the year are restricted by Si Tian and Zai Quan. "Sui Zhu" refers to the Six Qi governing the year; "Zang" refers to the Five Zang Organs. The Five Zang organs internally belong to the Five Elements and externally correlate with the Five Movements. When the qi of the Five Movements is injured by restriction, it harms the Five Zang organs. For example, Shaoshang Metal Movement encountering Fire ruling Si Tian, or Shaogong Earth Movement encountering Jueyin ruling Zai Quan. These are cases where the movement is overcome by the ruling qi. Thus, naming by what overcomes it reveals the key to yearly organ harm. Ma Shi stated: This explains that the harm to the Five Zang organs in a year occurs because they have something they cannot overcome, and there is a method to treat it. Yearly qi is in Heaven, Five Zang organs are in Man. Harm to the yearly master of the Five Zang organs arises because if Wood qi is excessive, Spleen cannot overcome it; if Fire qi is excessive, Lung cannot overcome it; if Earth qi is excessive, Kidney cannot overcome it; if Metal qi is excessive, Liver cannot overcome it; if Water qi is excessive, Heart cannot overcome it. Naming by what overcomes it reveals the key to harming organs.
The Yellow Emperor asked: How to treat it? Qibo answered: Upper excess affecting the lower, pacify with what overcomes it; external excess affecting the internal, treat with what overcomes it.
Wang Bing stated: "Yin" (Excess/Overflow) refers to moving against what it cannot overcome. Upper excess affecting the lower is Heaven's qi; external excess affecting the internal is Earth's qi. Pacify and treat according to what overcomes it. Overcoming refers to the five flavors, cold, heat, warm, and cool, detailed later. The New Correction notes: Although heavenly qi governing the year has excess and overcoming, it should only be balanced; hence, it says "pacify" not "treat." Zhang Zhicong stated: Upper excess affecting the lower means Si Tian qi excessively influences the underlying Yun Qi; pacify with what overcomes it. For example, Shaoshang Metal Movement with Fire/Heat descending should be pacified with Salty-Cold assisted by Bitter-Sweet. External excess affecting the internal means Zai Quan qi excessively influences the internal Five Movements; treat with what overcomes it. For example, Shaogong Earth Movement with Wind/Wood ascending should be treated with Pungent-Cool assisted by Bitter-Sweet. Si Tian and Zai Quan qi root externally; Five Movements transformation roots internally; hence, external excess affects internal. The next chapter says "pacify and treat" for heavenly qi and "treat" for Zai Quan, while other passages say Zai Quan qi "excesses internally." Ma Shi stated: When Si Tian qi excesses downward causing organ disease, pacify with what overcomes it, e.g., Wood excess controlled by Metal. When Zai Quan qi excesses inward causing organ disease, treat with what overcomes it, e.g., Wood excess controlled by Metal. "Overcoming" means using the five flavors and thermal natures according to what overcomes. Upper excess affects the first three qi phases, having overcoming without return; external excess affects the last four qi phases, having overcoming without return. Zhang Jiebin stated: Excessive Yin causes harm. Upper excess affecting the lower means Heaven's Six Qi descend causing disease in the Six Channels; external excess affecting the internal means Earth's Five Flavors damage the Five Orifices internally. Yin-Evil causing harm should be balanced and treated by what overcomes it. I (Zhang Ji) note: The *Wu Chang Zheng Da Lun* states that the five flavors' generation and transformation have density variations, maturity has quantity variations, and cold/hot/dry/wet have different transformations. Thus, Shaoyang Zai Quan: flavor Pungent, treatment Bitter-Acid; Yangming Zai Quan: flavor Acid, treatment Pungent-Sweet-Bitter; Taiyang Zai Quan: flavor Bitter, treatment Pale-Salty; Jueyin Zai Quan: flavor Sweet, treatment Sour-Bitter; Shaoyin Zai Quan: flavor Pungent, treatment Pungent-Sweet-Bitter; Taiyin Zai Quan: flavor Salty, treatment Sweet-Salty. Tonifying upper/lower follows; treating upper/lower opposes; adjust based on location, cold/heat, and excess/deficiency.
The Yellow Emperor asked: How to skillfully balance qi?
Wang Bing stated: "Ping" (Balance) refers to diagnosing peaceful qi. Zhang Zhicong stated: Ping Qi means no upper/lower overcoming, representing peaceful Yun Qi. Ma Shi stated: Even in peaceful years, disease occurs; one must view normal vs. abnormal and treat skillfully. The preceding text discussed disease from upper/excess downward and external/excess inward due to unbalanced yearly qi. Hence, asking about balancing qi for people's diseases.
Qibo answered: Carefully observe the location of Yin and Yang and regulate it, aiming for balance. Normal cases use standard treatment; reverse cases use reverse treatment.
Wang Bing stated: Knowing the location of Yin and Yang reveals whether the Cun and Chi pulses should respond or not. Not knowing leads to mistaking gain for loss and reversal for compliance; thus, careful observation is needed. Yin disease without Yang disease, or Yang disease without Yin disease, constitutes normal disease; treat normally, e.g., Cold treats Heat, Heat treats Cold. Yin position showing Yang pulse, or Yang position showing Yin pulse, constitutes reverse disease; treat reversely, e.g., Cold treats Cold, Heat treats Heat. Most prescriptions do not follow this reverse pattern; hence, "reverse cases use reverse treatment." Zhang Zhicong stated: Jia, Bing, Wu, Geng, Ren are Yang Movements; Yi, Ding, Ji, Xin, Gui are Yin Movements. Yin and Yang movements have excess and deficiency. Observe Yin/Yang location and regulate for balance. "Normal" means suppressing excess qi and supporting deficient qi in excess years. "Reverse" means assisting the overcoming qi in deficient years where the overcoming qi counter-attacks. Ma Shi stated: Yin and Yang refer to Cun/Chi positions, Yin/Yang pulses, Yin/Yang meridians. Observe and regulate for balance. If Yin Meridian diseased but Yang Meridian healthy, or vice versa, it is normal disease; treat normally (Cold for Heat, Heat for Cold). If Yin position shows Yang pulse or Yang position shows Yin pulse, it is reverse disease; treat reversely (Cold for Cold, Heat for Heat). Zhang Jiebin stated: Yin and Yang exist in pulses, syndromes, flavors, meridians, and organs. Not knowing their location leads to mistaking reverse for normal and inversion for compliance. Observe carefully and regulate for balance, avoiding excess. I (Zhang Ji) note: The *Wu Chang Zheng Da Lun* states: Nourish and harmonize, wait quietly for the time, guard the qi strictly, prevent collapse, manifest form, grow vital qi, called Sage King. Thus, the Great Principle says: Do not replace transformation, do not violate seasons, must nourish and harmonize, await recovery. This applies to balanced regulation cases.