陰陽應象大論篇第五 Su Wen Chapter 5
Updated: Jul 27, 2020
Note: This chapter discusses the meaning and application of the yin yang and five element theories, and of the three levels of heaven, earth and human, especially as it relates to human body's zang-fu, qi and blood, and the theoretical underpinnings of pulse diagnosis in clinical practice.
黃帝 says: "Yin and yang, is the way of heaven and earth, it encompasses all things, is the mother and father of change, is the genesis of life and death, the resting palace for the divine. Treating diseases must seek to treat the the root. The aggregation of yang is the sky, the aggregation of yin is the earth. The yin is quiet and the yang is restless, the yang relates to birth and the yin to growth, the yang kills(i.e. hunts) and the yin stores(gathers). The yang transforms qi, and the yin shapes form.
Extreme cold leads to generating heat, and extreme heat leads to generating cold; cold qi engenders turbidity, and hot qi engenders clearness; when the clear qi is at the bottom there is obstruction and diarrhea, when the turbid qi is at the top, then there is distention and bloating. This is the abnormal functioning of yin and yang, and disease arises from the counterflow.
It is said that the clear yang is of the sky and the turbid yin is of the earth. The earth qi rises as clouds, and the sky qi descends as rain; the rain comes from the earth qi condensing water vapor, and the clouds come from the sky qi evaporating water. It is said that the clear yang leaves from the upper orifices, and the turbid yin from the lower orifices; the clear yang diffuse through the cou-li凑理 (interstitial spaces), the turbid yin permeate the 5 zang(inner organs); the clear yang makes the four limbs sturdy, and the turbid yin recycles through the 6 fu.
The water is yin, the fire is yang. Yang is qi(energy), the yin is flavor(sustenance).
Flavor begets form(blood? or material counterpart to qi), form begets qi,
qi begets jing(essence), jing begets metabolism,
jing consumes qi, form consumes flavor,
metabolism produces jing, qi produces form.
flavors damages form, qi damages essence, jing metabolizes to qi, and qi is damaged by the flavors
(note: the last sentence speaks to improper diet damages the body, excessive exertion damages jing, jing can then be transformed to qi, but then can be damaged by improper diet again)
(note: this section speaks of the complicated yin/yang transformation and interdependence of food, jing, qi, and form)
Yin flavor exits from the lower orifices, the yang qi exits from the upper orifices.
Thick flavors are yin, and thin flavors are the yang of yin.
Thick qi is yang, thin qi is yin of yang.
Thick flavors will be dredged out, thin flavors will course through freely; thin qi will disperse exteriorly, thick qi will percolate heat.
Excessive fire weakens qi, normal fire strengthens qi; excessive fire consumes qi, qi consumes normal fire; excessive fire diffuses qi, normal fire generates qi.
Qi and flavors with the properties of spicy, sweet, disperse and diffuse are yang; sour bitter, surge and dredge is yin.
When the yin overpowers then there is yang disease, when the yang overpowers then there is yin disease. Yang overpowering leads to heat, yin overpowering leads to cold. Excessive cold leads to heat, excessive heat leads to cold. Cold damages form(body, blood), heat damages qi; there is pain in qi damage, there is swelling in form damage. It is said if there is pain first then swelling then this is the qi damaging the form; if there is swelling first then pain then this is form damaging the qi.
When the wind overpowers there is movement(convulsion), when the heat overpowers there is inflammatory swelling, when dryness overpowers there is dehydration, when cold overpowers there is floating (pulse? water swelling or the cold sinks the yin related symptoms), when dampness overpowers there is diarrhea.
Heaven has the four seasons and 5 elements; from which birth, growth, contraction and storage are derived, and from which cold, (summer)heat, dryness, dampness, and wind are derived. Humans have the 5 zang transforming the 5 qi, from which joy, anger, sadness, worry and fear are derived. It is said that joy and anger damages the qi, cold and (summer)heat damages form(and blood?-- material counterpart to qi). Exorbitant anger damages yin, exorbitant joy damages yang. Qi reversal goes upward, fills the pulse and leaves the form/or blood. When joy and anger is erratic, or if cold and heat is not managed, then life is not firm. It is said that excessive yin must lead to yang and excessive yang must lead to yin. It is said: If there is damage by cold in the winter, then this must lead to warm disease in the spring; if there is damage by wind in the spring, then there will be food poisoning/diarrhea in the summer; if there is damage by summerheat in the summer, then there must be malarial diseases in the autumn; if there is damage by dampness in the autumn, then there will be cough in the winter.
黃帝 asks: I heard that the far ancient saintly humans, analyzed theories about the human form, categorized the internal organs(zang fu), laid out the horizontal and lateral collateral channels/meridians, matched the six confluent meetings 会通六合, each from its own channel. (Taiyin, YangMing, ShaoYin, TaiYang, JueYin, ShaoYang, 6 divergent meridian confluences). Where the points emanate qi, they gave them names. They determined the beginnings of where the major and minor meeting points of the muscles to the bones, (毂=major meeting pionts of muscles, 谿=minor meeting points of muscles). They understood reasons for why certain parts counteract or not; and the relationships to the yin and yang and four seasons are recorded. The correspondences of the external and internal reflects on to the exterior surface and the interior core of the body. Are these accurate and believable?
岐伯 answered: "The eastern begets wind (from spring qi), wind begets wood, wood begets sour, sour begets Liver, Liver begets sinews, sinews begets Heart, Liver governs the eyes. This phenomenon in the heavens is a metaphysical mystery, in humans is the dao, on earth is the transformation to life for all things. Transformation of life begets the five flavors, the dao begets knowledge, the metaphysical mystery begets the divine. The divine expression of this in the sky is wind, on the earth is wood, in the body is sinews, in the zang organs is Liver, in the colors is cerulean, in the music is tone mi/E, in the voice is exhale/sighing, in symptoms to change is grasping, in the orifice is eyes, in the flavors is sour, in the emotions is anger. Anger damages the Liver, sadness overpowers anger; wind damages sinews, dryness overpowers wind; sour damages sinews, spicy overpowers sour.
The southern begets heat(from summer qi), heat begets fire, fire begets bitter, bitter begets Heart, Heart begets blood, blood begets Spleen, Heart governs the tongue. This expressed in the sky is heat, on the earth is fire, in the body is pulse, in the organs is Heart, in the colors is red, in the music is Sol/G, in the voice is laughter, in symptoms to change is worry, in the orifices is tongue, in the flavor is bitter, in the emotions is joy. Joy damages heart, fear overpowers joy; heat damages the qi, cold overpowers heat; bitter damages qi, salt overpowers bitter.
The center begets dampness(from long summer qi), dampness begets soil, soil begets sweet, sweet begets Spleen, Spleen begets muscles, muscles begets Lung, the Spleen governs the mouth. This expressed in the sky is dampness, on the earth is soil, in the body is muscles, the organs is Spleen, in the colors is yellow, in the music is Do/C, in the voice is singing, in symptoms to change is nausea/dry heaves, in the orifices is mouth, in the flavors is sweet, in the emotions is thinking. Thinking damages Spleen, anger overpowers pensiveness; dampness damages muscles, wind overpowers dampness; sweet damages muscles, sour overpowers sweet.
The western begets dryness(from autumn qi), dryness begets metal, metal begets spicy, spicy begets Lung, Lung begets body hair, body hair begets Kidneys, Lung governs nose. This expressed in the sky is dryness, on the earth is metal, in the body is body hair, in the organs is Lung, in the colors is white, in the sound is Re/D, in the voice is crying, in the symptoms to change is coughing, in the orifices is nose, in the flavors is spicy, in the emotions is worry. Worry damages the Lung, joy overpowers worry; heat damages body hair, cold overpowers heat; spicy damages body hair, bitter overpowers spicy.
The northern begets cold(from winter qi), cold begets water, water begets salty, salty begets Kidneys, Kidney begets bone marrow, bone marrow begets Liver, Kidney governs the ears. This expressed in the sky is cold, on earth is water, in the body is bones, in the organs is Kidney, in the colors is black, in the sound is La/A, in the voice is groaning, in symptoms to change is trembling, in the orifice is ear, in the flavor is salty, in the emotions is fear. Fear damages the Kidneys, thinking overpowers fear; cold damages blood, dryness overpowers cold; salty damages blood, sweet overpowers salt."
(note: this section lays out the 5 element theory and the generating and control cycles. It also connects the emotions and diet to the physical body, and the symptoms and manifestations of the 5 elements in the environment and its corresponding part in the body.)
"It is said that the sky and earth is the above and below of all things. Yin and yang, is the male and female of the blood and qi. Left and right, are the paths of yin and yang. Water and fire, are the signs of yin and yang. Yin and yang, is the energetic source of all things. It is said: yin in the interior is the guard of the yang; yang in the exterior, is the envoy of yin. 故曰: 阴在内，阳之守也；阳在外，阴之使也" (note: another way to put it, the yin is a safe haven for yang at rest, and the yang protects the yin through action and acts on behalf of the yin as envoy. Remember that a harmonious state of yin and yang is where yang is hugging closely to the yin and is highly interdependent. Another visual might be the way generally we see how a woman hugs to protect the child and how a man fights to protect them.)
黃帝 asks: "How do we apply yin and yang in the body?"
岐伯 answered: "When yang overpowers the body is hot, the cou-li(interstitial spaces) close, the breathing is rough and there is difficulty, the sweat doesn't release so there is heat, the teeth is dry and there are complaints of annoyance, when there is abdominal fullness this means death, can weather through the winter but not the summer. When yin overpowers the body is cold, there is sweating, the body feels cold so there is repeated shivering so there is more cold, cold leads to reversal, and reversal leads to death with abdominal fullness; can weather the summer but not the winter. These are the pathological manifestations in the body of the changes of yin and yang as they overpower each other."
黃帝 asks: "How do we calibrate/adjust the two?"
岐伯 answered: "If you know of the seven injuries and eight benefits 七损八益 of the way to nourishing life, then the yin and yang can be adjusted. If you do not know, then will see premature aging. Such means halving the yin qi by 40 years old, and there is difficulty in waking up and sleeping; by 50 years old the body feels heavy and the hearing and sight is not clear; by 60 years old, there is impotence, major qi deficiency, the 9 orifices are obstructed, there is deficiency below and excess above, and there is often tearing and nasal discharge. It is said that those who know this will be strong, and those that don't will be old; it is said that there would be two different outcomes even if the body starts off at the same place. The knowledgeable can discern the common aspects of health, while the fool can discern only what is superficially different between strength and weakness. The fool is insufficient, while the knowledgeable is abundant. And because of abundance the ears and eyes are sharp and intelligent, the body is light and strong; the body is even strong at an old age, and strong bodies are easy to treat. This is like the saintly humans not doing what is unnecessary, can happily and optimistically approach things, enjoy and abide by simple emptiness and nothingness, and so their life is long, ending along with the sky and earth. These are the ways that the saintly humans treat their body. "
(note: discussions on 七损八益 seven injuries and eight benefits was found in certain texts from the Ma Wan Dui excavation. 《素女经 - 玉房秘诀》It discusses the relationship between proper sexual intercourse to health per the ancient's view. )
The sky is not sufficient in the west and north, as that is of yin, and so human's ear and eyes on the right side are generally not as good as the left side. The earth is not sufficient in the east and south, as that is of yang, and so the human's left limbs are generally not as strong as the right.
黃帝 asks: "Why is that?"
岐伯 answered:"The east is yang, and the yang as it is refined goes up, if it is at the top, then there is clarity above and deficiency below, it is said it makes the ears and eyes sharp and bright, but the limbs clumsy. The west is yin, and yin as it is refined goes down; when it is at the bottom, then there is abundance below and deficiency above, and so the ears and eyes are diminished, and the limbs are agile. If it is attacked by external pathogen, then if attacked above there is heaviness on the right, at the bottom it would be on the left. and this is because there is incompleteness of yin and yang in the body, and those are the places where evil pathogens are likely to reside.
It is said that the sky contains jing(essence), and the earth contains form; the sky has eight seasonal segments, and the earth has the five directions; it is said that is what allows it to be the father and mother of all things. The clear yang ascends to the sky, and the turbid yin returns to the earth, it is said that is the movement of they sky and earth, and the divine encompasses it all, and through birth, growth, contraction and storage, can repeatedly end and begin again. Those virtuous humans that know of this will match the top to the sky to nourish the head, and correspond the bottom to the earth to nourish the feet, and relate to the human affairs to nourish the five zang. The sky qi courses through the Lung, the earth qi courses through the esophagus, the wind qi courses through the Liver, the lightning qi courses through the heart, the food qi/muscle qi courses through the Spleen, the rain qi courses through the Kidneys. The 6 channels are like rivers, the stomach and intestines are like the sea, the 9 orifices are the qi of where the water irrigates. Using the yin and yang of the sky and earth, the sweat of yang, is like the rain of the sky and earth; the qi of yang, is like the wind of the sky and earth. The violent/angry qi manifests like thunder and lightning; the counterflow qi like the errant yang/fire. If treat disorders without the order of sky and the rules of earth, then there will be disaster!
It is said the ultimate evil wind, is a disease like the wind and rain. A good doctor will treat the body hair(superficial layer), then next will treat the skin and muscle layer, then next will treat the sinews and vessels, then next will treat the 6 fu organs, and lastly will treat the 5 zang. Those who treat the 5 zang, have a 50/50 chance of life and death. It is said that the evil qi of the sky, if contracted will injure the 5 zang; the cold and heat of water and food, if contracted will injure the 6 fu; the dampness qi of the earth, if contracted will injure the skin, muscles, sinews and vessels.
It is said that those who are proficient with the needles can guide yang from yin, and guide yin from yang; treat the left with the left, the left with the right; can use self to understand others, use the exterior to know the interior; use their experience and discernment, can see the minor symptoms and catch the disease where it is and treat them before they worsen.
Those who are good at diagnosis, examine complexion, palpate and take pulses to differentiate yin and yang; then inquire about the clear and turbid to know where is the pathology; see the breathing and listen to the voice to know what is the suffering; observe the adherence to the seasons to know what is the main cause; press the wrist(cun-kou) pulse and observe floating, sinking, slippery and choppy qualities to know where the disease originates from. In order to treat without mistakes, the diagnosis must be correct!
It is said that at the onset of disease, needling is sufficient. If it is acute and serious, can wait until it has weakened a bit to treat (for needling could weaken righteous qi). It is said if leads to lightness can disperse, if this leads to heaviness can drain, if leads to weakness can supplement. When the form(blood?) is insufficient, use qi to warm; when the jing is insufficient, use flavors to supplement. If the disease is above, can use vomiting method; if the disease is below, can use directing downward; if the middle is full, then dredge what is within, if there is evil, can take herbal decoctions for inducing sweating; if it is on the skin, can disperse, if the disease is aggressive, can apply pressure to contract?; if excess, dispel and dredge. Determine the yin and yang, to differentiate gentle(yin) or aggressive(yang) pathogens; treat yin for a yang disease and treat yang for a yin disease; assess where the disease lies in the blood or qi in order to compartmentalize and prevent crossover; if blood is excess would be beneficial to bleed out, if the qi is deficient would be beneficial to guide it."