Huangdi Neijing

Kong, Y.C.

Published by The Chinese University of Hong Kong Press

Kong, Y.C.
Huangdi Neijing: A Synopsis with Commentaries.
The Chinese University of Hong Kong Press, 2010.
Project MUSE.muse.jhu.edu/book/24634.

For additional information about this book

https://muse.jhu.edu/book/24634

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 7 Principles of Treatment
(Zhi Ze 治則)

Exegesis

The previous chapters have explained the theoretical basis of body func-
tion and the diagnosis of its aberrations; this chapter now moves on to
expound the principles of the treatment of disease. First of all, it must be
made clear that Chinese medicine does not see a disease as a morbid
manifestation of aberrant body function and/or structure that is caused by
a definite pathogen, as Western medicine does. Western medicine began
as natural medicine, as evidenced by medicine in Ancient Greece, and
Western medical knowledge is based on anatomy and physiology.
Disease is seen as an aberration in the anatomical structure and/or physi-
ological functions of the body. It follows, therefore, that to treat a disease,
a doctor might use surgical intervention (usually to remove the diseased
body part), or seek to redress the aberrant physiological function by either
physical means (e.g. physiotherapy) or with drugs (e.g. cancer chemo-
therapy). Chinese medicine, on the other hand, sees the human body as
part of the cosmic-social system; a healthy body is one which functions
according to the laws of the social, natural and cosmic domain. A diseased
state is perceived as discordance between the body and the universal
laws of society, or nature and the universe. That is why Chinese medicine
has expended much effort over the centuries to explain the maternal/filial
relationship in five elements theory, the administrative hierarchy of the
twelve visceral organs, the six types of evil qi (climatic conditions) that are
out of season, and the wu yun liu qi climatic pattern that determines the
occurrence of disease. This does not mean that Chinese medicine ignores

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 214 Neijing Zhiyao Yigu 內經知要譯詁

the presence of the body. Many passages in Suwen and Lingshu are
devoted to the structure and function of the body, much as was the case
in the early stages of western anatomy and physiology, and there was no
lack of physical, chemical and biological interventions. But the core of
Chinese medical thinking is how to maintain the harmony and synchrony
between the human body and nature (including its social and cosmic
dimensions). Falling out of harmony or synchrony is perceived as a
diseased state (zheng 證), but not a disease (bing 病) per se. The norm in
health is evaluated through its relation to both the internal environment
(harmony among the visceral organs) and the external environment
(harmony with nature). According to this system, a pathogen is not a
tangible substance, foreign or indigenous, that can be identified and
consequently eliminated. A pathogen in Chinese medicine is seen as a
causative factor arising out of an excess of an environmental factor (one
of the six excessive external factors, liu yin 六 淫), or a malfunction of a
certain visceral organ, or a disturbance of the mental state (one of the
seven emotional or internal factors, qi qing 七 情). Between these two
groups, Chinese medicine recognises a large number of “indeterminate”
(neither external nor internal) factors such as traumatic injury, helminthi-
asis, animal bites or stings and so on. No matter which group the causa-
tive factor belongs to, the end result is a disturbance of the yin-yang
balance in the body. Zhang Zhong-jing declared: “For a thousand kinds of
misery, there are only three causes. Either the evil qi hits the conduits and
has reached the visceral organs. Or the conduits and blood vessels are
clogged, the blockage being provoked by external factors. There are also
injuries brought about by sexual indulgence, wounds inflicted by weapons,
animal bites etc.” (Jingui yaolüe 金 匱 要 略). This statement later evolved
into the “Three Causes Theory” elaborated by Chen Yan,1 and it still holds
its ground today among the basic principles of Chinese medicine. It can
be seen from this discussion that to treat a disease in Chinese medicine is
to cause the diseased state (an excess or deficiency of the yin or yang
forces yin yang xu shi 陰 陽 虛 實) to revert to the normal state, which is
judged by the balance of the yin-yang potentials within the body, as a

1
Chen Yan 陳 言, Sanyin fang 三 因 方 (Prescriptions for Diseases due to the Three
Causes), published in 1174.

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 Principles of Treatment 215

reflection of a harmonious relationship of the body with its natural environ-

ment. The “diseased state” (zheng 證), a special concept unique to
Chinese medicine, is often translated as “symptom” or “syndrome”, but
this fails to reflect its medical context. A diseased state refers both to the
ensemble of symptoms, due to single or multiple causative factors, and
also to the actual state of the body while reacting to these factors, and
whether this is overactive or subdued, progressing or regressing. A clini-
cian must first recognise a certain diseased state before he/she can
formulate a treatment plan (bian zheng lun zhi 辨 證 論 治). What is more, a
diseased state may change in the course of its evolution, somewhat like
the different stages of a disease, so that a change in appropriate treat-
ment is essential (zheng bian zhi yi bian 證 變 治 亦 變). A patient should
therefore consult the clinician each day, to allow the latter to monitor the
evolution of the diseased state (sui zheng chu ru jia jian 隨 證 出 入 加 減)
and modify the treatment plan accordingly. This leaves the clinician a
large degree of freedom regarding what to do when presented with a
patient in distress, but this freedom is guided by certain principles of treat-
ment (zhize 治 則), and these are the subject of this chapter. Once a deci-
sion has been made as to the principle of treatment to be employed (if
there is a fever, it needs to be cooled), there are practical methods of
treatment (zhifa 治 法) to follow, which could, for example, be diaphoretic,
sudorific etc. This is symptomatic treatment. Sometimes, Chinese medi-
cine is accused of symptomatic suppression (when there is a headache,
treat the head); such critics presumably are unaware that there is an elab-
orate process of reasoning vis-à-vis the principle of treatment that takes
place first. As Li Zhong-zi commented: “Without knowing the state of yin-
yang balance, the clinician will be hesitant to do this or do that. Therefore,
failing to make a decision when confronted with a forked path will lead to
disastrous results.” (Liezi 列子：qilu wangyang 歧路亡羊). For more discus-
sion on aetiology, pathogenesis and principles of treatment, see ref. 53
(Chapters 5 and 8).
This Chapter draws heavily on Suwen Chapter 74: On Basic
Approaches to Disease Management. This is the last of the seven chap-
ters (not including Chapters 72/73, which are apocryphal) that make up
Volumes 19 to 22, which are devoted to wu yun liu qi. Chapter 74 by itself
makes up the whole of Volume 22, the only example in Suwen, attesting
to its great importance. As a matter of fact, its title “Zhizheng yao dalun”

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 216 Neijing Zhiyao Yigu 內經知要譯詁

至 真 要 大 論 can be translated literally as “The Most Genuine and Impor-

tant (Discourse on Medicine)”. It is the second longest chapter in Suwen
after the previous one (Chapter 71: On Normal Patterns of Atmospheric
Change). The translated title only reflects the last third of its contents. The
chapter begins with a lengthy discussion of the excess of the six qi, when
they are in disagreement with projected climatic patterns, and the morbid
manifestations that follow. Huangdi asks hesitantly: “How shall it be
treated (zhizhi naihe 治 之 奈 何？ )” This opens up a wealth of information
on how to treat each representative symptom, always with respect to the
dominant qi. There are altogether 20 modalities, with minor variations here
and there between different passages. Towards the end of the chapter,
some cardinal rules on prescription format and classification of diseases
are introduced. The latter is the famous 19 principles of pathomechanism
(bingji 病 機). The term bingji seems to stem from an earlier book entitled
Dayao 大要 (The Great Essential), but this work is no longer extant. It may
have been the origin of the title of the present chapter “Zhi zhen yao da
lun.” Dayao is quoted five times in Suwen Chapter 74. One of these quota-
tions concerns the format (zhi 制) of prescriptions in its “odd” and “even”
(according to the number of drugs) variants. But there is another passage
quoting Qibo, on prescription format further down the page on the “size” of
a prescription (large, medium or small, in terms of the different categories
of drugs used). Another quotation again quoting Qibo, on prescription
format defines the different role of each category of drugs (the king, the
minister, the clerks). The last two from Qibo are most relevant to the first
one on “odd” and “even” variants, but they were not quotations from
Dayao. Dayao clearly provided concise guidelines for clinical practice. Its
literary style varies, however, between serious admonition (jin shou bingji
謹 守 病 機) and mockery (cu gong xixi 粗 工 嘻 嘻). It is clear today that
Neijing, both Suwen and Lingshu, quotes from a large amount of contem-
porary medical literature (see ref. 29), and is a pity that only fragments
from these works are quoted; their authors and detailed contents have
been lost in the mists of history. The term bingji is not exactly the equiva-
lent of aetiology or pathogenesis. Huangdi sought an explanation of it from
Qibo, and Qibo’s answer, which here relates only to the first case “wind”,
is that bingji concerns the totality of information about that case—the
causative factor (here, the wind), the morbid symptom (syncope) and the
organ affected (the liver). It sounds more like a consistent profile of a

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 Principles of Treatment 217

disease, but the classification of these 19 “types” is not clear-cut. Qin

Bo-wei tried to clarify this point by preparing a checklist; it is translated
and appended at the end of this chapter.

[Section 7.1] Suwen Chapter 5: On the Phenomena of

Yin-Yang

《素問．陰陽應象大論》曰：陰陽者，天地之道也，萬物之綱紀，變化之父
母，生殺之本始，神明之府也，治病必求於本。
〔故《大要》曰〕
：謹守病機，各司其屬。有者求之，無者求之，盛者責
之，虛者責之。必先五勝，疏其血氣，令其調達，而致和平。

Yin-yang is the law of the universe, the governing principle of myriad things
and the parent [origin] of all changes, the ultimate cause of life and death, the
hall of residence of the mind (shenming). Prior to treating a disease, seek [try
to understand] its origin first [1].
Comply with the pathomechanism [2]. For each case, try to find out
where it belongs. If the symptoms are obvious, find the cause. If the symptoms
are not obvious, find the cause nevertheless. If it is a disease of excess, try to
pin down its cause. If it is a disease of debility, also try to pin down its cause. It
is imperative to find out first which of the five elements [in the climatic cycles]
is dominant, then drain the [congestive] qi and blood; make them flow
smoothly, reaching a peaceful steady state [3].

Explanatory Notes
These two paragraphs define the main theme of this chapter. First, every
disease has a cause. In order to treat a disease, it is imperative to determine the
cause of the disease in the first place (zhi bing bi qiu yu ben 治 病 必 求 於 本).
Second, while seeking the cause of the disease, observe strictly the pathomech-
anism (bingji 病 機). The first paragraph is a recapitulation of Section 2.1 and
is transcribed here verbatim. It is the opening statement in Chapter 2: Yin
Yang. It seems appropriate to use the same statement on both occasions,
because disease is, after all, an imbalance between yin and yang; this is the
root, the origin or the ultimate cause (ben 本) of disease. However, in order to

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 218 Neijing Zhiyao Yigu 內經知要譯詁

treat a disease, which can manifest itself in an infinite number of diseased

states (such as the excess or debility mentioned in this paragraph), it is impor-
tant to understand its causation and course of development at various stages;
this is what is meant by the term “pathomechanism”. The second paragraph is
in fact a quotation from Dayao, in which the term bingji was coined, and from
where it penetrated into Neijing and all subsequent annotations. However,
here it is introduced in the sequence of the original text as if Qibo was
inventing the term. Huangdi acknowledges that he is aware that the causative
factors of diseases must be found among the six evils (viz. wind, cold, summer
heat, wetness, dryness and fire). But he says that when he asked skilled persons
(fangshi 方 士. See Huatuo, Section 8.14) to apply this knowledge in their
practice, it was not always perfect. Thus he wishes for teaching which is reli-
able, and resembles the rapport between the drum-stick and the drum (that
sounds with each beating) (fu gu xiang ying 桴 鼓 相 應). Qibo answers:
“Observe the pathomechanism (bingji 病 機), do not lose sight of the preva-
lent qi. That is it.” This is followed by a concise description of the 19 principles
of pathomechanism, which is the subject of Section 8.1 in the following
chapter.

Footnotes

[1] origin: The origin is an imbalance between yin and yang. The immediate
cause lies in one of the three categories. The exact cause can only be deter-
mined through a complicated process of symptom analysis (bian zheng lun
zhi, see ref. 53, Section 7.1).
[2] pathomechanism: This is actually a paragraph from Suwen Chapter 74. It is a
quotation from Dayao, following an elaborate discussion of the 19 types of
pathomechanism, which is the subject of Section 8.1 that follows.
[3] steady state: The Chinese term is actually heping 和 平 (peace); it is a steady
state of dynamic equilibrium between the ebb and flow of yin and yang. In
such a state, minor deviations from the norm are rapidly and effectively
compensated for.

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 Principles of Treatment 219

[Section 7.2] Suwen Chapter 74: On Basic Approaches to

Disease Management

《素問．至真要大論》曰：君一臣二，奇之制也；君二臣四，偶之制也；君
二臣三，奇之制也；君二臣六，偶之制也。故曰：近者奇之，遠者偶也。
汗者不可以偶，下者不可以奇。補上治上，制以緩；補下治下，制以急。
急則氣味厚，緩則氣味薄。適其所至，此之謂也。病所遠而中道氣味之
〔乏〕者，食而過之，無越其制度也。是故平氣之道，近而奇偶，制小其服
也；遠而奇偶，制大其服也。大則數小，小則數多。多則九之，少則二
之。奇之不去，則偶之，是謂重方。偶之不去，則反佐以取之，所謂寒熱
溫涼反從其病也。
《素問．至真要大論》︰有毒無毒，所治為主，適大小為制也。君一臣
二，制之小也。君二臣三佐五，制之中也。君一臣三佐九，制之大也。
《素問．至真要大論》︰主病之謂君，佐君之謂臣，應臣之謂使，非上
中下三品之謂也。

[It was stated in Dayao that] [1]: “An odd(-numbered) formula consists of one
regal drug [2] and two ministerial drugs [3]. An even(-numbered) formula
consists of two regal drugs and four ministerial drugs. [By the same token], an
odd formula could have two regal drugs and three ministerial drugs. An even
formula could have two regal drugs and six ministerial drugs.” Therefore it
was said [4] that: “When the disease is proximal [running a short course, or a
light disease] [5], use an odd formula. If the disease is distal [running a long
course, or a serious disease], use an even formula. [Furthermore], never use an
even formula to treat a patient with profuse sweating [hidrosis]. [Likewise],
never use an odd formula to treat a patient suffering from diarrhoea [6]. To
treat symptoms of debility, or evil qi lodged in the upper part of the body, use
a mild [slow-acting] [i.e. odd] formula. To treat symptoms of debility, or evil
qi lodged in the lower part of the body, use a fast-acting [i.e. even] formula.
When the [effect of a] formula is fast-acting, drug action is intense; when the
[effect of a] formula is slow-acting, drug action is mild [7]. It is important to
allow the drugs to act appropriately on the target. When the [hearth] of the
disease lies far away [from the centre of the body], such that the effect of the
drug dissipates before reaching the target [8], assist it with a meal. Do not
stray from conventional practice [9]. As a rule, in order to achieve a smooth
flow of qi [recover from a diseased state], use a small number of drugs when

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 220 Neijing Zhiyao Yigu 內經知要譯詁

treating a proximal disease, whether the formula is odd or even [does not
matter]. The reverse is true for distal disease. Use fewer drugs when adminis-
tering a heavy dose. Alternatively, it is permissible to use a greater number of
drugs when administering a small dose. The number of drugs used can vary
between a minimum of two [10] and a maximum of nine. If an odd formula
does not work, change to an even formula. This is called “alternate treatment”
[literally a formula of repetition, but bear in mind it is only from odd to even]
[11]. However, if an even formula does not work, use an “anti-clerical” drug
[12]. This is what it calls a reverse application of the “cold-hot-warm-cool”
principle.
Supplement [13]:
Suwen Chapter 74: [Whether to use a] toxic or non-toxic [14] [drug]
depends on whether it is indicated for the treatment. It is only necessary to
apply a formula of the right size. For a small formula, use one regal drug and
two ministerial drugs. For a medium formula, use two regal drugs, three
ministerial drugs and five “clerical” drugs. For a large formula, use one regal
drug, three ministerial drugs and nine “clerical” drugs.
Suwen Chapter 74: A regal drug, assisted by a ministerial drug, is indi-
cated for the disease. A “clerical” drug depends on the nature of the ministerial
drug. This is not what is known as the superior, medium and inferior catego-
ries [15].

Explanatory Notes
This is an important passage in Suwen Chapter 74 that deals with the “format”
(zhi 制) of a prescription. Huangdi asks Qibo what governs the use of a large
or a small prescription. In an economical 172 characters, Qibo gives an elabo-
rate answer that touches upon all the differential parameters, i.e. the formula
that determines a prescription. This covers the odd and even [number of
drugs], the relative role of each drug in a prescription (for example, regal as
opposed to ministerial drugs), the number and dosage of drugs, contraindica-
tions for treating distal versus proximal diseases, whether a drug should be
taken before or after meals, the minimum and maximum number of drugs to
use, the notion of alternate use of odd- and even-numbered formulae and
finally the notion of reverse-assistance. It is not clear whether all these terms
are being quoted from Dayao 大 要, which was apparently an important guide
to clinical practice at that time, or are largely Qibo’s interpretation of Dayao.

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 Principles of Treatment 221

Later in the chapter, Huangdi asks specifically what [the size] of a formula
refers to. Qibo gives an example of a small, medium and large formula in
terms of the number of drugs used in each category. Here, in addition to the
regal and ministerial drugs mentioned above, he introduces a new category of
drugs, the “clerical” or “assistant” (zuo 佐) drug. Huangdi’s curiosity is then
attracted to the difference between a regal and a ministerial drug. Qibo duly
gives a definition of the regal, ministerial and emissary (shi 使, “despatch” or
“courier”) drugs, the last of which is a form of “clerical” drug. These two
answers (on size and category) were not included in NJZY, but are now added
to the original text in this section to complete the discussion on “format” (zhi).
Li Zhong-zi did quote the passage on reverse versus converse (ni cong 逆 從)
(see ref. 53 Section 8.1.1.1) but not until Section 7.3, below. Concise and
straightforward, these are the basic tenets of the principles of prescribing,
which later evolved into a speciality of Chinese medicine (fangji xue 方 劑 學).
Closely resembling pharmacy, fangji xue in Chinese medicine in fact subsumes
pharmacology, pharmacokinetics and pharmaceutics under a single heading.
Tao Hong-jing 陶 弘 景 (456–536) was no doubt inspired by these early ideas
and expounded them in more detail, in the light of his own experience, in his
preface to Benjing jizhu 本 經 集 注 (Commentaries on Shen-nong bencao jing),
the first comprehensive treatise on pharmaceutical science in Chinese
medicine.

Footnotes

[1] Dayao: In the original text, it is clearly stated that this was a statement from
Dayao, and the respect accorded to the authentic source was quite evident in
Suwen Chapter 74. Another reference, Maiyao 脉 要 (Essentials of Sphyg-
mology) is also quoted, but only once.
[2] regal drug: This is the principal drug indicated for the principal symptom or
complaint. In composing a prescription, it is always the first one to be listed.
It is followed immediately by the ministerial drug, and the two form a drug
pair (yaodui 藥 對). Regal drugs are usually administered in a dose which is
much heavier than that of other items in the prescription, and their actions
are broad spectrum and mild. There is only one regal drug in each prescrip-
tion, although under special circumstances, two regal drugs of similar prop-
erties may be used, and when the prescription is a combination of two
standing prescriptions, like siwu 四物 + sijun 四君 = bazhen 八珍, there will
be two regal drugs, one from each prescription. Zhuangzi recognised the

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 222 Neijing Zhiyao Yigu 內經知要譯詁

importance of regal drugs. He said: “Medicines are a matter of life and death.
Cheap drugs like Aconitum, Euryale, Platycodon, Polyporus can become regal
drugs on the right occasions.” (《莊子．徐無鬼》︰「是時為帝者。」(shishi
wei dizhe, literally, “There are times when they can become the king.”)
[3] ministerial drug: For all intents and purposes, a ministerial drug serves to
complement the regal drug in action, or to expand its range of efficacy.
However, a drug is never designated in bencao as belonging to a certain cate-
gory. Everything depends on their relative roles in a prescription. However,
clerical/emissary drugs are rarely used in the capacity of a regal/ministerial
drug because of their strong and rapid action, which is often accompanied
by undesirable side effects.
[4] From here onwards, the words appear to be those of Qibo, who also gives
further explanations on format later in the chapter. However, the literary
style is consistent with that of Dayao; Qibo may have been reciting passages
from Dayao. Chinese emperors liked to keep a large entourage of learned
scholars around them as their living “data banks”. The scholars had to remain
in a forecourt until summoned, and considered themselves lucky when their
services were required. One particularly talented young scholar, Jia Yi 賈 誼
(200–168 bc), who became famous for his political treatise condemning the
brutality of the Qin empire (Guo Qin lun 過 秦 論), was banished to the
remote southern city of Changsha for a minor offence. While he was
delighted to be recalled to the capital for consultation, Emperor Han Wendi
only asked him about the demons of the nether world. (李 義 山 詩 ︰「不 問
蒼生問鬼神。」)
[5] proximal disease: When the disease is located in the upper part of the body,
use an odd-(numbered) formula. An odd formula has a mild action and is
prescribed in light doses; it is suitable for a disease which runs a short course.
The reverse is true for a distal disease. So proximal/distal has a two-fold
meaning, “near” (upper) and “far” (lower) as well as “short” or “long” in
terms of the course of development of the disease.
[6] diarrhoea: In many other editions of Suwen, the reverse is true, and doctors
are instructed not to use an odd formula to treat symptoms of profuse
sweating. Hidrosis is due to an excess of yangqi, and it presents on the face
and upper part (the yang half) of the body. Under such circumstances, use of
an odd formula (the yang type) is contraindicated. Li Zhong-zi did not give
a reason why his quotation differs here. He may possibly have made a
mistake in transcription, as he did with Section 7.1 above, when he included

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 Principles of Treatment 223

Suwen Chapter 74 under the heading of Chapter 5. In any case, odd or even
depends on the number of drugs, what more important concerns the
potency and range of indications covered.
[7] mild: A strongly acting (thick) prescription acts quickly while a mild acting
(thin) prescription acts slowly. The Chinese terms actually mean “thick—
quick” and “thin—slow”; the potency is coupled to rapidity in the onset of
drug action. In Section 2.1, there is a subtle difference between qi 氣 (drug
action) and wei 味 (drug dose). While the fast action of a drug can be due to
either one or both of these properties, a high dose (wei hou 味 厚) contrib-
utes to the yin and a low dose (wei bo 味薄) to the yang. By the same token, a
strong drug action (qi hou 氣 厚) contributes to the yang and a mild drug
action to the yin. (wei hou zhe wei yin, bo wei yin zhi yang; qi hou zhe wei
yang, bo wei yang zhi yin 味厚者為陰，薄為陰之陽；氣厚者為陽，薄為
陽之陰). Here is a fine example of yin-yang dualism.
[8] reaching the target: According to Qin Bowei (ref. 2), the particle zhi 之 (of)
makes no sense here, and he suggests it should have been fa 乏 (lacking,
worn out).
[9] conventional practice: What is conventional practice is not spelled out in the
text. In clinical practice, drugs are prescribed to be taken after meals when
the disease is light and/or proximal, and before meals when it is more serious
and/or distal. In the former case, the drug stays with the food in the upper
part of the body, whereas if the drug is administered before meals, the food
will carry it to reach more distal parts of the body.
[10] minimum of two: In pre-Qin times, drugs were administered individually to
treat isolated symptoms, but after the introduction of the three categories of
drug in Neijing, prescriptions always contained many items. Basically, a pair
of drugs (yaodui 藥 對) is used, each complementing the other in a regal-
ministerial relationship (for example, the pairing of 豬 苓 Polyporus umbel-
latus with 澤 瀉 Alismata plantago-aquatica as a diuretic). Various assistant
(zuo) drugs are then added for different reasons. Thus a standard prescrip-
tion with four drugs is called a “Four Items Decoction” (Siwu tang 四 物 湯),
or a “Four Gentlemen Decoction” (Si junzi tang 四 君 子 湯). However, today
many single-item prescriptions still survive, most of them folkloric and
regional. The only formal single-item prescription is the “Ginseng Only
Decoction” (Du shen tang 獨參湯).
[11] alternate treatment: The Chinese term is chongfang 重 方 (repeating the
prescription), but it is not a repetition of the same prescription. It is only

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 224 Neijing Zhiyao Yigu 內經知要譯詁

applicable when an odd formula fails to work and use of an even formula is
suggested. However, switching from odd to even breaks all the rules stipu-
lated above. Medication and diagnosis both enjoy a large degree of flexibility
by careful manoeuvring within a set of principles.
[12] anti-clerical: The term fanzuo yao 反佐藥 refers to a drug of the clerical cate-
gory, but which is used in an opposite way against the regal/ministerial
drugs. Fanzuo means “reverse-assistance”. This is allowed in case of “rejection”
(geju 格 拒, “refuse to take in the drug”). It happens when the patient vomits
up the medicine even when forced to take it.
[13] These two short paragraphs were not quoted by Li Zhong-zi but have been
quoted and translated here to complete the discussion on presecription
formulation.
[14] toxic or non-toxic: In Chinese medicine, it is tacitly accepted that all drugs
are toxic to a certain extent (yao you san fen du 藥 有 三 分 毒). It should be
quickly added that “toxic” here means that a drug has undesirable or
unpleasant side-effects. Inasmuch as Chinese herbals are crude drugs, it is
only natural that they contain, besides the principal active compound, many
other compounds that are also active. Furthermore, there are other “neutral”
compounds, such as organic acids, mineral salts, and tannins, which do not
produce harmful side-effects, but do compromise the digestion or appetite.
Thus, drug processing is important to treat these natural products to become
cured drugs, which are further mitigated in their toxic drug action by combi-
nation with other drugs.
[15] category: Shen-nong bencao jing 神 農 本 草 經 (The Divine Ploughman’s
Herbal) classified drugs into three categories, i.e. superior, medium and infe-
rior, with obvious social-ethical overtones. Superior (regal) drugs are mild-
acting, with a broad-range drug action; they are used over a long period to
maintain good health and are not toxic. Medium (ministerial) drugs are
similar to but not as potent as regal drugs. They can complement the drug
effect of the regal drugs. They may be slightly toxic or not toxic at all. Inferior
(clerical) drugs are strong and quick in action. They are used to treat a
specific symptom and must be discontinued as soon as that symptom disap-
pears. They are toxic or even very toxic. Tao Hong-jing gave a detailed
description of this drug profile in Benjing jizhu. The disclaimer as to the
social-ethical implications of the three categories in this section suggests that
the author of Neijing might have seen a draft version of Shen-nong bencao
jing. However, it is generally accepted that Neijing predates this book. Shen-

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 Principles of Treatment 225

nong was an important legendary figure, who ranks third after Huangdi and
Yandi. He was quoted in Zhuangzi: Zhibeiyou 莊子．知北遊 as an imaginary
figure who was keen to learn. Zhong Yong 鍾 嶸, a contemporary of Tao
Hong-jing, used the three categories format to grade poems of his time
(Shipin 詩品).

[Section 7.3] Suwen Chapter 74: On Basic Approaches to

Disease Management

《素問．至真要大論》曰：辛甘發散為陽，酸苦涌泄為陰，咸味涌泄為陰，
淡味滲泄為陽。六者或收或散、或緩或急、或燥或潤、或軟或堅，以所利
而行之。調其氣、使其平也。
寒者熱之，熱者寒之；微者逆之，甚者從之；堅者削之，客者除之，
勞者溫之，結者散之，留者攻之，燥者濡之，急者緩之，散者收之，損者
益 之，逸者行之，驚者平之。上之下之，摩之浴之，薄之刧之，開之發
之，適事為故。
逆者正治，從者反治。從多從少，觀其事也。
熱因寒用，寒因熱用；塞因塞用，通因通用。必伏其所主，而先其所
因。其始則同，其終則異。可使破積，可使潰堅，可使氣和，可使必已。
諸寒之而熱者，取之陰；熱之而寒者，取之陽，所謂求其屬也。
夫五味入胃，各歸所喜攻。酸先入肝，苦先入心，甘先入脾，辛先入
肺，咸先入腎。久而增氣，物化之常也；氣增而久，夭之由也。

Pungent and sweetish drugs are diaphoretic; they belong to the yang category.
Sour and bitter drugs are emetic and laxative; they belong to the yin category.
Salty drugs are [also] emetic and laxative, and hence yin. Bland-tasting [1]
drugs are diuretic [2], and hence yang. These six properties of drugs [3] are
either astringent or diaphoretic. They may be slow-acting or fast-acting. They
can be desiccating or emollient. They can serve to soften or to harden [4]. In a
word, choose a drug that can benefit the situation by promoting a smooth
flow of qi.
Warm what is cold, and cool what is hot. If the disease is not serious, treat
it with a drug of the opposite property [i.e. converse treatment]. If the disease
is serious, treat it with a drug of the same property [i.e. reverse treatment].

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 226 Neijing Zhiyao Yigu 內經知要譯詁

Soften palpable lumps [5] and dispel the exogenous evil qi lodged inside the
body [6]. For an exhausted body, increase thermogenesis. For congestion [of
blood or qi], use a dispersive. Recalcitrant evil qi that refuses to go must be
tackled with strong-acting drugs. A desiccating situation can be improved
with emollients. For cramping [spasmodic] limbs, use spasmolytics [7]. For
lassitude [of muscles or organs], use astringents [8]. An overtaxed body needs
tonics. An inactive body needs physical exercise [to drive the circulation of qi
and blood]. An agitated mind needs calmatives. Whether using an emetic or a
laxative, massage or medicinal baths, a strong dose of drugs to expel the
disease agent or stop [9] its progression, a drug for decongestion or efferves-
cence, the guideline is to achieve optimal effect [10].
To treat against [symptoms of] the disease is the converse mode of treat-
ment [11]. To treat according to [the symptoms of] the disease is the reverse
mode of treatment [12]. As to the number of clerical drugs, they can be many
or few; that depends on the complexity of the presentation of the disease.
When the principal symptom is obvious, use fewer clerical drugs. When there
are many symptoms, [related or unrelated], use more clerical drugs.
[In the reverse mode of treatment], in using a drug with heating proper-
ties [to treat a disease of a cold nature that nevertheless manifests virtual
fever], add a a small amount of cold drugs. [On the contrary], in using a drug
with cold properties [to treat a disease of a hot nature that nevertheless mani-
fests a virtual chill], add a small amount of hot drugs [13]. [It is permissible
to] use a drug with congestive effect for a case of virtual congestion [14]. [It is
also permissible to] use a laxative when there is excessive bowel movement [15].
It is important to direct the drug towards the root of the trouble by first iden-
tifying the hidden cause of the disease. This may seem to aggravate the disease
[by using a drug that conforms with the symptom], but the results are the
other way round. [By adopting this mode of treatment], it can break up the
concretion; it can disintegrate the hard lumps. It can promote a smooth flow
of qi; it will certainly lead to remission.
When treating a hot disease with cold drugs results in [more serious] hot
signs [instead], try to enhance the yin elements [with a drug from the yin
category]. When treating a cold disease with hot drugs results in [more
serious] cold signs [instead], try to enhance the yang elements [with a drug
from the yang category]. This is what is called seeking the [yin or yang] nature
of the disease [16].
When the five tastes [of foods or drugs] enter the stomach, each of them

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 Principles of Treatment 227

homes in on its respective target organ. Sour drugs prefer to act on the liver,
bitter ones on the heart, sweet ones on the spleen, pungent ones on the lung
and salty ones on the kidney. This is natural in drug action. After using these
drugs for some time, the respective organ function will improve. However,
chronic use will lead to premature death.

Explanatory Notes
This section is basically an explanation of clinical pharmacology. “Pharma-
cology” because it discusses drug properties at three levels: yin or yang, hot or
cold, tastes and their zang-organ affinity. This is the field of yaosheng lun 藥 性
論 (discussion of drug properties, i.e. pharmacology). “Clinical” because it
discusses under what clinical conditions a drug of a certain property should
be employed.
Neijing devotes most of its pages to elaborating on theories derived from
acupuncture, which in turn, operates within the theoretical framework of
conduits, so it is rather unusual to read these important passages on drug
properties and how to make use of them. It gives the impression that the
authors of Neijing, at least those of Chapter 74, were as knowledgeable about
herbal drugs as they were experts at acupuncture. The statement about the
three categories attests to this fact. The author(s) of Suwen Chapter 74 must
have had access to contemporary literature on herbal drugs that permitted
him (them) to distil the essence of drug knowledge into this short but vital
passage. The fact that fewer pages in Neijing are devoted to the use of drugs (13
prescriptions, as opposed to a host of practical instructions on acupuncture)
does not necessarily support a preference for acupuncture in the choice of
treatment. Suwen did dedicate one chapter to “Decoctions and Tinctures”
(Suwen Chapter 14: On Aqueous Decoctions and Tinctures). But it cautions that
since ancient times, the sages had prepared decoctions and tinctures just in
case they were needed.2
A discussion of the relative importance of acupuncture and herbal medi-
cine, or which of these two disciplines was first developed into mainstream
therapeutic methods, is academic. For all intents and purposes, clinicians at
the time of Neijing must have needed to be adepts of both disciplines. In

2
《素問．湯液醪醴論》︰「自古聖人之作湯液醪醴者，以為備矣。」

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 228 Neijing Zhiyao Yigu 內經知要譯詁

Suwen Chapter 25, Huangdi, keen to keep his subjects healthy, asks Qibo what
should be done. The answer was: 1) manage the mind; 2) conserve health; 3)
know the toxicity (potency) of drugs; 4) prepare needles of all sizes and 5) be
able to diagnose the plenitude of qi and blood in the visceral organs. The key
to the matter lies in the last sentence. Qibo makes it clear that “all five methods
must be well established, but each may enjoy priority depending on the
circumstances.” (《素問．寶命全形論》︰「五法俱立，各有所先。」)
In Historical Record, Bianque declares: “When the disease is at the couli
(body surface), apply a hot compress; when the disease penetrates the
conduits, apply acupuncture; or, when the disease is lodged in the guts,
administer a herbal decoction or tincture. But when the disease reaches the
[bone] marrow, even the god of Fate can do nothing.” (《史 記．扁 鵲 倉 公 列
傳》) Bianque is explaining to the Lord of Qi why he declined to treat him.
The latter had ignored the advice of Bianque three times to get early treat-
ment, when the disease was still treatable. Hence, it is clear that the choice
between acupuncture and herbal drugs was left to the discretion of the
clinician.
An experienced clinician would not hesitate to use either or both
approaches as the clinical situation might dictate. Suwen Chapter 28 states
that in spring, acupuncture should be used to treat the conduits first; in
summer, the potency acupoints should be used; in autumn, the six fu-organs
and in winter, because all (the channels) are closed, medicines should be used
rather than acupuncture. In case of traumatic injury due to a fall, a herbal
decoction should be administered to relieve the symptoms of internal
bleeding, bloating and anuria/constipation before applying acupuncture,
according to Suwen Chapter 63 (《素 問．繆 刺 論》) . On the other hand, it
says, a dog bite should be treated with moxibustion straight away, according to
standard practice (for dog bites) (《素 問．骨 空 論》). Today, the practice of
acupuncture looks technical and empirical, no more than a surgeon would
tend to ignore the efficacy of internal medicine. This is prompted by the cost-
effectiveness of the medical service market when physical means can produce
quick results. Sun Wai-zhu, in a recent publication, advocated the selection of
acupoints to match the symptoms as if composing a herbal prescription (qu
xue ru xuan fang 取 穴 如 選 方), as both must respect the dictates of the
conduits. According to his experience, a course of acupuncture should be
followed by a dose of a certain standing prescription to reinforce the overall
efficacy. The author had the honour to be invited to write a preface for Sun’s

Neijing.indb 228 2010/2/26 6:58:59 PM

 Principles of Treatment 229

Essential Guide to Clinical Acupuncture3 in which this interesting subject was

discussed.
Of special relevance to clinical pharmacology is the passage on treatment
of “virtual” symptoms. A disease of a cold nature (debility) presents an
apparent symptom of low fever (wu xin fan re 五 心 煩 熱), while a disease of a
hot nature (acute infection) presents an apparent symptom of chills (han chan
寒 顫)—these are construed as “virtual” symptoms. These apparent presenta-
tions do not conform to the underlying cause of the disease. A reverse mode
of treatment is allowed, with the proviso that the underlying cause can be
identified.
This seemingly paradoxical approach was long ago advocated by Wang
Bing when he edited and annotated Neijing (See Section 8.1 below). His
famous dictum reads: “Reinforce the dominance of water to restrain the sun.
Stoke the fire to dissipate the gloomy obscurity.” (zhuang shui zhi zhu, yi zhi
yang guang, yi huo zhi yuan, yi xiao yin yi 壯 水 之 主，以 制 陽 光，益 火 之
源，以 消 陰 翳 ). These days we would speak about nourishing the yin
elements of the kidney (active regulatory molecules produced by the kidney
and adrenal) to combat a surge of yang symptoms (fever) due to a deficiency
of these yin elements, and invigorating the yangqi (hypermetabolic, neurot-
onic) to combat a surge of yin symptoms (chills) due to a deficiency of the
former. In clinical terms, renal products (shenshui 腎 水) can reinforce heart
function (they are cardiotonic). On the contrary, cardiac performance (xinhuo
心 火) can promote renal function (e.g. diuresis). It is evident that “water” and
“fire” are not being perceived in their natural context here. Many critics of
Chinese medicine belittle it as symptomatic treatment, but those who accuse
it of naïve simplification should take note that following “Cool what is hot (re
zhe han zhi 熱者寒之)”, there is a subtext “add a small amount of hot (han yin
re yong 寒因熱用)”.

Footnotes:

[1] bland-tasting: In addition to the five tastes listed in the five elements theory,
in clinical practice there is a sixth taste. The Chinese word 淡 dan means a
weak taste as contrasted to a strong (nong 濃) taste. It does not mean that

3
Sun Wai-zhu 孫 外 主, Zhenjiu linzheng zhinan 針 灸 臨 證 指 南 (Guidebook on the
Practice of Acupucture) (Hong Kong: Commercial Press, 2004).

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 230 Neijing Zhiyao Yigu 內經知要譯詁

something is entirely tasteless. The common saying: “Friendship between

two gentlemen is bland like water”4 does not refer to a rapport devoid of
sympathy and passion, but neither does it refer to a relationship fostered by
feasting and wine (jiurou pengyou 酒 肉 朋 友). In practical terms, a bland
taste is a mildly sweet taste or after-taste. It is due to the hydrolysis of glyco-
sidic compounds, releasing the sugar moiety. A typical example of something
with a bland taste is Poria cocos (fuling 茯 苓, a sclerotium, often enrobing a
segment of pine root).
[2] diuretic: The Chinese term is 滲 泄 shenxie (seeping and leaking). It refers to
sweat seeping out of skin (hanshen 汗 滲) and urine dripping (dili 滴 瀝);
therefore, it is often translated as diuretic, which is the end result. Shenxie is
not straightforward diaphoresis and diuresis, it is actually the removal of
intracellular water into tissue fluid, a process that requires the participation
of cortisol, which eventually drains into circulation, so that water can pass
out of the body through sweating and passing urine. The fuling (Poria) cited
above is a typical example of a bland-tasting drug that promotes the removal
of tissue fluid into circulation, thereby giving it its diuretic property. It is
quite different from standard diuretics that act on the heart or kidney.
[3] six properties of drugs: Neijing always recognises five tastes, for example in
Suwen Chapter 22, which is bound by the strait-jacket of the “five elements”.
Here, it refers to the six properties and blandness has no place in the five
elements framework.
[4] soften or harden: To soften a hard lump is easy to understand, but there
seems to be no structure that requires hardening. It is possible to lift (tisheng
提 升) a prolapse, or contract loosened tissue (shoulian 收 斂, “astringent”).
So hardening (jian 堅) refers to reinforcing the yin elements, to make it
work. This is slightly different from nourishing the yin elements (yangyin 養
陰, ziyin 滋陰), to increase in quantity.
[5] palpable lumps: The original text said: “Chip off what is hard.” Since Neijing
is not advocating surgery, to remove a palpable lump is to soften it. Salty
drugs have this effect. Suwen Chapter 22: “Pungent drugs are dispersive, sour
drugs are astringent, sweet drugs are palliative, bitter drugs are hardening,

4
《莊 子．山 木》︰「君 子 之 交 淡 如 水。」(junzi zhi jiao dan ru shui). There was a
famous Chinese medicine practitioner half a century ago by the name of He Dan-ru
何淡如.

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 Principles of Treatment 231

salty drugs are softening.” (xinsan 辛 散, suanshou 酸 收, ganhuan 甘 緩,

kujian 苦 堅, xianruan 咸 軟). These are the signature properties of the five
tastes.
[6] lodged inside the body: The Chinese word is 客 ke (guest). The evil qi lodged
inside the body is like a guest who is reluctant to leave.
[7] spasmolytic: This can mean relaxing (huanjie 緩解) spasmodic limbs (juji 拘
急), but more often it means relieving a colicky pain. See ganhuan above.
Malt sugar is used in this respect. Alternatively, it can mean stalling a disease
of rapid onset, e.g. to stop a massive haemorrhage or torrential diarrhoea.
Many critics of Chinese medicine believe that it is only useful for the fine-
tuning of chronic disease. But Chinese medicine does cater for emergencies,
e.g. Tao Hong-jing’s Baiyi zhou hou fang 百 一 肘 後 方 (One Hundred
Prescriptions at the Elbow). Today, in China, patients suffering cardiac attack
are treated with acupuncture (acupoint, shenmen 神 門) before any attempt
is made to use nitroglycerin.
[8] astringent: The Chinese word 散 san means “loose, lax, dispersive”. This is
used to describe loose connective tissue or organs. In this case, astringents
are applied. But it also may refer to a dispersion of yangqi, that is a lack of
neural control or sympathetic tone, or a failure of metabolic compensation.
Neurasthenia may be cited as an example of yangqi dispersion (qiji huansan
氣機渙散).
[9] expel and stop short: These are military terms used in a medical sense. Bo (薄
=  ) means “approaching, pressing hard”, as in“a [setting] sun fast
approaching the western hills” (ri bo xi shan 日薄西山). Jie 刧 means “forceful
removal”, or “hijacking”, as in “it is hard to evade a sudden misfortune” (jie
shu nan tao 刧 數 難 逃). So to tackle a disease head on, either expel its inva-
sion or stop short its progression.
[10] optimal effect: The original text said “to achieve optimal effect” (shi shi wei
gu 適 事 為 故). This expression is an echo of Section 7.2: “to act appropri-
ately” (shi qi suo zhi 適 其 所 至). What is optimal or appropriate is a subjec-
tive feeling. To stop where it is appropriate (shi ke er zhi 適 可 而 止) is a
cultural trait that can be traced back to Confucian teaching about the Golden
Mean (zhong yong zhi dao 中 庸 之 道). In clinical terms, Li Zhong-zi advo-
cated that the clinician should navigate between damage to the vital func-
tions and leaving any remnant of morbid disturbance (shang zheng liu xie 傷
正 留 邪). This is valid advice when treating hyperglycaemia or hypertension,
or when undergoing chemotherapy for cancer. Suwen Chapter 68:

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 232 Neijing Zhiyao Yigu 內經知要譯詁

“Exuberance can be damaging, consequently what follows would restrain it

(kang ze hai, cheng nai ji 亢則害，承乃制).” We see here an element of gyro-
scopy in Neijing.
[11] converse mode: The Chinese term 正治 zhengzhi means the correct, conven-
tional, orthodox way of treatment by using a drug with properties contrary
(ni 逆, “against, opposite”) to the symptom of the disease, i.e. “cool what is
hot.” The term is defined by its ethical rather than operational context, and
should never be called nizhi 逆治.
[12] reverse mode: The Chinese term 反 治 fanzhi means the reverse, or opposite
way of treatment by using a drug with properties that conform to (cong 從,
“following, according to”) the symptoms of the disease, i.e. “warm what
(appears) to be hot”. It should more accurately be called congzhi 從治.
[13] It seems that too many words are being put into the mouth of the ancient
author here. It is necessary to explain these two sentences of four words: “re
yin han yong 熱因寒用 and han yin re yong 寒因熱用”. While they are open
to a number of interpretations, the actual meaning is defined by the question
posed by Huangdi, who asks: “What is the meaning of (the) reverse (mode
of) treatment?” However there are certain editions of Neijing which amend
the text to “re yin re yong, han yin han yong”, in conformity with the style of
the two following sentences: “sai yin sai yong, tong yin tong yong 塞因塞用，
通 因 通 用.” In this case, all four sentences can be viewed in the same light. It
would seem paradoxical to use a hot drug to treat a hot disease except in the
context of “reverse treatment”. Then the hot disease carries a virtual hot
symptom.
[14] virtual congestion: Constipation due to debility should not be treated with
laxatives. If a roborant is used, the symptom will go away.
[15] excessive bowel movement: according to Zhang Jie-bin, when there is an
accumulation of hotness (e.g. bacterial enteritis) or coldness (e.g. reverse
osmosis, steatorrhoea) in the bowels causing diarrhoea, it suffices to promote
a complete discharge of the bowel contents by using a laxative with a drug of
the opposite property.
[16] nature of the disease: This seemingly paradoxical statement may be taken out
of context if not referring to previous statements, which are not excerpted. It
states: “A patient suffering from hot disease was treated with cold drugs (han
zhi 寒 之) but the hot signs worsened….” (you bing re zhe han zhi er re 有 病
熱 者 寒 之 而 熱). Here the word han is used as a verb, i.e. to medicate with a
cold drug. With this in mind, it is easy to understand the following sentence

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 Principles of Treatment 233

as translated above: “Treating a hot disease with cold drugs (han zhi 寒 之)
leads to more serious hot signs.” (zhu han zhi er re zhe 諸 寒 之 而 熱 者). It is
also taken to mean that these worsening signs of cold are virtual, i.e. a virtual
fever because of the lack of yin elements. By seeking the nature of the disease
(qiu qi suo shu 求 其 所 屬) is only reiterating a statement at the beginning of
the chapter. It said: “Carefully observe where lie yin and yang and regulate it
with the ultimate purpose of achieving a balance between them.” (jin cha yin
yang suo zai er tiao zhi, yi ping wei qi 謹察陰陽所在而調之，以平為期).

[Section 7.4] Suwen Chapter 5: On the Phenomena of

Yin-Yang

《素問．陰陽應象大論》曰：因其輕而揚之，因其重而減之，因其衰而彰
之。形不足者，溫之以氣；精不足者，補之以味。其高者，因而越之；其
下 者，引 而 竭 之；中 滿 者，瀉 之 於 內；其 有 邪 者，漬 形 以 為 汗；其 在 皮
者，汗而發之；其慓悍者，按而收之；其實者，散而瀉之。審其陰陽，以
別柔剛；陽病治陰，陰病治陽；定其血氣，各守其鄉。血實宜決之，氣虛
宜掣引之。

When it is light, it suffices to winnow it off [1]. When it is serious, try to

reduce it [by laxation]. While it is subsiding, [take advantage of this process of
regression and] restore the brilliance [2]. If the form [3] is in default, warm it
up by enhancing qi [4]; if the essences are lacking, replenish them with [rich]
tastes [5]. For those located high [above the diaphragm], let them get over
from above [6]. For those located below [the diaphragm], drain them [from
the lower end] until exhausted [7]. For those bloating in the middle [i.e.
stomach], discharge them internally [with digestives] [8]. If it is a result of an
evil qi, try to promote hidrosis by soaking the body [in a medicinal bath] [9].
If the evil qi remains at the body’s surface, disperse it with diaphoretics.
Subdue the aggressive [progression of a disease] and restrain it [its damaging
effect]. What is in excess must be dispersed and discharged [10]. [For any
disease], examine its nature so as to decide whether it is yin or yang, supple or
rigid. For treating a disease which is yang in nature, target the yin elements.
For treating a disease which is yin in nature, target the yang elements. Make
sure it is a disease in the blood or the qi domain and try to limit its morbid
development within the proper domain [11]. If there is excess in blood

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 234 Neijing Zhiyao Yigu 內經知要譯詁

[parameters], let blood. If the qi is lacking, get hold of it and conduct it

[towards the norm] [12].

Supplement:
《素問：至真要大論》︰從內之外者，調其內；從外之內者，治其外。
從內之外而盛於外者，先調其內而後治其外。從外之內而盛於內者，先治
其外而後調其內。中外不相及則治主病。
《素問：至真要大論》︰調氣之方，必別陰陽。定其中外，各守其鄉。
內者內治，外者外治。微者調之，其次平之，盛者奪之。汗之下之，寒熱
涼，衰之以屬，隨其攸（所）利。

Suwen Chapter 74: When the disease is moving from the inside of the
body to the outside, attend to [13] the interior symptoms. When the disease is
moving from the outside of the body to the inside, treat [14] the exterior
symptoms. Even for a disease that is moving from inside out and manifesting
blaring symptoms on the outside, attend to the interior symptoms first, and
then treat the exterior ones. For a disease moving from outside in and mani-
festing blaring symptoms in the inside, treat the exterior symptoms first, and
then attend to the interior ones. In case it is hard to determine where the
disease starts and where it ends, treat the principal symptom.
Suwen Chapter 74: The [proper] way to regulate [15] the qi requires
determining first of all whether it is a matter of yin or yang, whether it resides
inside or outside, so as to limit its sphere [of influence]. If the disease resides
in the interior, treat the interior [with herbal decoctions]. If the disease pres-
ents itself outside, treat the exterior [with acupuncture] [16, see Section 7.3,
Explanatory Notes]. Whether to use diaphoretics or laxatives, or drugs of cold,
hot, warm or cool properties, depends on the benefit each brings.

Explanatory Notes
This section comes from the last paragraph of Suwen Chapter 5: On the
Phenomena of Yin-Yang. As the title implies, this chapter is devoted to the
interpretation of yin-yang as the ultimate cause of disease. Huangdi asks: “How
can we adhere to the rules of yin and yang?” Again, “How can we regulate the
yin and yang?” To these questions, Qibo replies with a long and detailed
discussion on the manifestation of yin and yang potentials and their effect on

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 Principles of Treatment 235

the evolution of body functions over a person’s life-span. Failure to strike a

balance between yin and yang is the ultimate cause of disease, he says. To
redress the imbalance between yin and yang, use the needle judiciously. “Those
adroit with the needle can draw the yang from yin, and yin from yang. Treat
the right side [for ailments] on the left side; likewise, treat the left side [for
ailments] on the right side. To understand the other party, start with intro-
spection. To understand the interior, examine the exterior. Thereby one will
appreciate what is excessive and what is inadequate. From the slightest hints,
one would deduce where the trouble is. These rules never fail.” This is a guide-
line for disease management (by acupuncture) at the highest level. But if we
take out the initial phrase “those adroit with the needle”, it can also apply to
the conduct of socio-ethical events in daily life. The cultural trait in Chinese
medical thinking is to view it as a socio-ethical event.
After a short paragraph promoting the same principle for diagnosis, Qibo
comes to the conclusion that a disease is better treated right from its first sign
of indisposition. This paragraph also starts with an initial sentence which
defines its subject matter: “Therefore, it is said that: When a disease begins to
show itself, it is possible to apply the needle. When the disease is in full swing,
[don’t do anything, postpone any treatment] until it wanes.” This is followed
by Section 7.4. Again, without this defining reference to the needle, the larger
part of Section 7.4 might also be moralising on the subtlety of managing
social relationships or handling a management crisis. It is with these thoughts
in mind that Section 7.4 has been translated verbatim, with minimal inclu-
sions, in brackets, to remind us of its subject. Seeing a disease in its social
context might facilitate one’s understanding of it, but it can hardly be called a
scientific approach. However, there is nothing unscientific in such statements
as “While it is subsiding, [continue with the treatment until] the brilliance is
restored”. How often does the modern Western-style doctor insist that a course
of antibiotics must be completed, and that tuberculosis patients must take
drugs under supervision to guarantee full compliance!
The statement about “invigorating the qi and replenishing the essence”
(wen zhi yi qi, bu zhi yi wei 温 之 以 氣，補 之 以 味) has become the ultimate
guideline in the conservation of health through diet therapy. Chinese medi-
cine always advocates diet management as a first step to redress an indisposi-
tion. Sun Si-miao, who might well be called the veritable “drug king” in
Chinese medicine (Shen-nong being the legendary drug god), advised using
diet therapy (shizhi 食 治) prior to any attempt to use drugs and devoted a

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 236 Neijing Zhiyao Yigu 內經知要譯詁

whole chapter (Chapter 22) of his Thousand Gold Prescriptions (Qianjin fang
千 金 方) to diet therapy. In Suwen diet therapy is also mentioned as a supple-
mentary measure to complete recovery (See Section 7.5 below: 食養盡之).

Footnotes

[1] winnow it off: Winnowing involves throwing grains into the air and letting
the debris be blown away by the wind. The Chinese word for this is 揚 yang,
meaning “scattering” or “fluttering in the wind”. In clinical terms, it refers to
the use of diaphoretics, as in the phrase “scattering [the evil qi] by
diaphoresis” (qing yang fa han 清揚發汗).
[2] restore the brilliance: While the disease is in regression, pursue this course
until total recovery, so that brilliance [a radiant countenance] will be
restored. The Chinese term is 彰 zhang, “to make evident”, and it appears in
compounds such as zhaozhang 昭 彰 (to publicise, to highlight), zhangxian
彰 顯 (to stand out), and biaozhang 表 彰 (to laud or praise). There is a
common saying, “Try to cover up, [but instead] blowing up” (yu gai mi zhang
欲蓋彌彰). There is much wisdom in this, for many patients give up medica-
tion as soon as a hint of remission appears. This leads to a deep entrench-
ment of the disease.
[3] form: The Chinese word xing 形 means xingtai 形 態 (morphology or
posture), xingrong 形 容 (countenance), or xinghai 形 骸 (the body structure,
the bones). In the context of this passage, it means “body form, outlook or
physique”. To be totally unbound by social conventions is referred to as fang
lang xing hai 放 浪 形 骸. There is complicated interaction between form and
essence; see Section 2.1 (jing zhi qi, xing zhi wei; jing hua wei qi, qi shang yu
wei).
[4] qi: There are many kinds of qi. To invigorate a dilapidated body form, there
needs to be an increased level of energy metabolism, thermogenesis, anabo-
lism (a building up process) and an alert mind. This is what adepts of aerobic
exercise call an “increase in energy levels”.
[5] essences: This refers to the post-natal essence derived from food. Because
food has taste (shiwei 食味), the character “wei” is often used to mean “food”.
When “wei” is used to refer to the taste of medicinal materials, it means “drug
property” or “potency” (xingwei 性味).
[6] get over: The Chinese word 越 yue means “to surmount, to get over a wall or
hurdle”. In this context, it means “to use an emetic to vomit up the undi-
gested food in the stomach”. It can also mean inducing sweating to treat a

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 Principles of Treatment 237

light fever.
[7] exhaustion: The Chinese word 竭 jie means “to exhaust, drain empty, use up
completely”, as in the common saying: “Empty the pond to get [all the] fish”
(jie ze er yu 竭 澤 而 漁) (《呂 氏 春 秋． 義 賞》). In this context, it means
using a laxative to thoroughly cleanse the bowels. Catharsis, emesis and
hidrosis formed the mainstay of the clinical approach of the “Purgative
School” headed by Zhang Cong-zheng (1156–1228).
[8] discharged internally: Food resting too long in the stomach or small intestine
tends to ferment and form gas. Dyspepsia may be the collateral symptom of
another disease, e.g. some kind of flu. Partially digested food can be effec-
tively removed by digestants that promote digestion as well as gut passage.
An over-the-counter preparation, a mixture of medicinal herbs fermented
with natural yeast to produce shenqu 神  (the miraculous yeast), is indi-
cated for this situation. One of the ingredients, bu zha ye 布 渣 葉 (Microcos
paniculata), can be used alone to brew a tea for the same purpose, especially
for juveniles.
[9] soak the body: The Chinese word 漬 zi means “to soak, to pickle, to
immerse”. In Japanese, “pickle” is ziwu 漬 物. The famous Korean kimchi is
ganzi 甘 漬. In this context, to soak the body, usually in a medicinal bath, is
an early form of medication that persists up to this day. Baths made up with
mugwort (Artemisia vulgaris) or honeysuckle vines (Lonicera japonica) are
effective cures for rheumatism and flu respectively.
[10] dispersed and discharged: This refers to the softening and subsequent disper-
sion of palpable lumps, and the bowel discharge of compact stools.
[11] proper domain: The progression of a disease begins by eliciting the response
of the defence mechanism; this is disease in the domain of qi (qifen 氣 分).
When there is damage done, the pathological products are released into
blood and blood composition changes. This is disease in the domain of xue
(xuefen 血分). Ye Tian-shi (1667–1746) elaborated on this theme and formu-
lated the hypothesis for the advance of warm disease (wenbing 溫 病, usually
a form of seasonal viral infection) in four stages, viz. weiqi → qi → yingqi →
xue. See ref. 53, Section 7.2.3 for more discussion on this subject. Dr. Pau
compares this to the course of pneumonia before the advent of antibiotics.
[12] conduct it [towards the norm]: The Chinese text says simply: “to grasp it and
lead it”. This refers to prolapse of various kinds, which is deemed to be the
result of lack of qi (muscular tone, hence sympathetic tone). But it can also
apply to debility in general, which must be checked and restored to prevent

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 238 Neijing Zhiyao Yigu 內經知要譯詁

total collapse.
[13] attend to: The Chinese word 調 tiao means “to regulate, fine tune, adjust”.
Here it is translated as “to attend to”, implying a milder method of treatment,
usually by acupuncture, as in the context of the original text. The basic
strategy in acupuncture is to regulate the flow of qi (tiao qi 調氣), by turning
the needle clockwise or anticlockwise (zuo bu you xie 左補右瀉) to augment
(zuo ?) or diminish (you ?) respectively.
[14] treat: The Chinese word 治 zhi means “to cure, rule, administer”. Here it is
translated as “to treat”, implying a more serious method of treatment, by
multiple acupoints, and/or other methods like herbal decoction and massage.
[15] regulate: The Chinese term 調 氣 tiao qi has been explained above (see [13]).
Here it is translated as “to regulate”, as regulating the flow of qi by acupunc-
ture was taken as the basic approach in treating a disease.
[16] [with herbal decoction], [with acupuncture]: The original text does not
specify these methods. But it is clear from the Explanatory Notes in Section 7.3
that the preferential methods of treatment for the exterior (acupuncture)
and interior (herbal decoction) were well recognised.

[Section 7.5] Suwen Chapter 70: On Basic Correlations

between the Natural Environment and Body Function

《素問．五常政大論》曰：病有久新，方有大小，有毒無毒，固宜常制矣。
大毒治病，十去其六；常毒治病，十去其七；小毒治病，十去其八；無毒
治病，十去其九。谷肉果菜，食養盡之。無使過之，傷其正也。不盡，行
復如法。必先歲氣，毋伐天和。

[Inasmuch as] there are new and chronic diseases, [they are treated with]
prescriptions of a few or numerous items, with mild or strong drugs [1]; it is
natural that there are conventions regarding each case. When using strongly
acting drugs, stop [using them] when the disease is 60% cured [2]. When
using moderately acting drugs, stop [using them] when the disease is 70%
cured. When using mildly acting drugs, stop [using them] when the disease is
90% cured. [Use] meat, cereal, fruits and vegetables in diet therapy to
complete the treatment [3]. [Under no circumstances], let the drugs overact
so that the vital functions of the body (zhengqi) could be harmed. If the

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 Principles of Treatment 239

disease is not completely cured, one could repeat the above process [4]. It is
imperative to determine the dominant climatic pattern in the first place; never
act against natural harmony [5].

Explanatory Notes
Suwen Chapter 70 is the third longest chapter (after Chapters 71 and 74). It
has been quoted once already, in Section 2.4. This chapter finds itself at the
core of the climatic pattern theory (wu yun liu qi). While the dominant
climatic pattern could be predicted by computation, it might not have agreed
with the natural conditions that actually prevailed. So if it was not normal (ping
qi 平 氣), it could be over-bearing (tai guo 太 過) or inadequate (bu ji 不 及).
These conditions could bring about diseases with different indications,
according to which of the five elements was active or inactive. Towards the end
of the chapter, there are some suggestions for treatment (although these are
better discussed in Chapter 74). Of particular interest is this passage on the
use of drugs. Although it could be equally applicable to the use of acupunc-
ture, this paragraph highlights the “toxicity” of drugs, a property that must be
handled with caution. This implies, succinctly, that herbal drugs vary widely
in potency and side effects, whereas acupuncture is relatively safe to use,
unless the needle is wrongly placed. The complementary relationship between
drug treatment and diet therapy is consistent with the idea of managing the
“form” and the “essences” in Section 7.4.

Footnotes

[1] strong drugs: Strong drugs are “very toxic” (da du) and act strongly for its
indications or side effects. See ibid. 7-2-14 on drug toxicity.
[2] 60% cured: It does not mean that medication should be stopped altogether.
As the symptoms improve, milder drugs should be used, and eventually,
food.
[3] complete the treatment: This was advocated in Neijing times as well as today.
Suwen Chapter 70, one of the seven major discourses on climatic patterns,
has towards the end of the chapter a few passages on pharmacology. Regarding
diet therapy, it says : “Drive away [the symptoms] with drugs, to be followed
by food [diet therapy].” (《素 問．五 常 政 大 論》︰「藥 以 祛 之，食 以 隨
之。」)
[4] above process: To repeat the process of drug treatment followed by diet

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 240 Neijing Zhiyao Yigu 內經知要譯詁

therapy.
[5] natural harmony: This refers to the agreement of body function with the
dominant climatic pattern. It is accepted that the climatic factor can vary
beyond its normal range, but if the body can adjust to it, disease can be
prevented. Preventive measures are as important as treatment.

[Section 7.6] Suwen Chapter 71: On Normal Patterns of

Atmospheric Change

《素問．六元正紀大論》曰︰黃帝問曰︰婦人身重，毒之如何？
岐伯曰︰有故無殞，亦無殞也。
帝曰︰願聞其故何謂也。
岐伯曰︰大積大聚，其可犯也。衰其大半而止。

Huangdi asked: “When a woman is pregnant [1], how can she take strong
drugs?” Qibo said: “If there is a good cause for using strong drugs, there is no
harm [2], as [the fetus] would not be harmed.”
Huangdi asked: “Can you explain?” Qibo said: “Whenever there is serious
accumulation [3] or concretions [4], they can be treated [with strong drugs]
nevertheless. However, stop medication when the ailment is half gone. [Above
this limit, the fetus will die].”

Explanatory Notes
This short paragraph appears towards the end of Chapter 71, the longest in
Suwen. Its main theme is the discussion of atmospheric changes and climatic
patterns that eventually affect body function and health. This paragraph is the
only example of dealing with a clinical situation without reference to climatic
conditions. The reason Wang Bing put it here is not clear, but Li Zhong-zi
discussed “toxicity” in Section 7.5, and by placing this excerpt in Section 7.6,
it reinforces the argument and emphasises prudence in using strong drugs in
spite of their “toxicity”. Li Zhong-zi added cogency in his annotation by
rephrasing “when there is good cause etc.” (you gu wu yun 有 故 無 殞) as “if
there is such a disease, then use the right kind of drug [in spite of its toxicity],
because it is the disease that bears the brunt of the drug’s action.” (you bing ze

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 Principles of Treatment 241

bing dang zhi 有病則病當之). There is a grain of truth in this statement; as we

know today, many carcinostatic drugs are actually mitostatic; because the
cancer cells divide more quickly or frequently, they bear the brunt of the mito-
static action. That is why there is frequently a loss of hair as cancer chemo-
therapy advances. That is also why, when treating pregnant women, the advice
is to stop medication when the disease is more than half cured (shuai qi da
ban 衰其大半).

Footnotes

[1] pregnant: The Chinese term literally means “a heavy body” (zhong shen 重身);
it is a subtle way of describing the added weight and sluggish gait of preg-
nant women.
[2] harm: The Chinese word is 殞 yun, meaning “death”, as in yunming 殞 命,
yunshen 殞身.
[3] concretion: The Chinese word 積 ji (“hoard”) refers to a fixed and palpable
abdominal lump that hurts constantly.
[4] accumulation: the Chinese word 聚 ju (“assemble, accumulate”) refers to an
unidentifiable and movable mass, e.g. ascites, that gives occasional sharp
pain.

Addendum
Qin Bo-wei, in his Neijing zhiyao qianjie (ref. 2), tried to sum up the salient
points in this chapter and arranged them in tabular form. This is a common
practice in teaching Chinese medicine and it helps enormously with memo-
rising, an indispensable skill in the profession. In clinical practice, the clinician
goes through the list mentally till he/she reaches the appropriate item. Qin
acknowledged that the list is not perfect, and some items could arguably be
rearranged or expanded. Nevertheless, this list gives an idea of the way in
which clinical Chinese medicine operates. While translating it, the present
author reformatted this tabulation into a checklist with Chinese key words
added. Suggestions for treatment are those made by Qin. The last block
(Remission) has been added by the author.

Disease Regime (bingzheng 病 症)—­General principle: converse vs reverse

treatment.

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 242 Neijing Zhiyao Yigu 內經知要譯詁

A. Causation (bingyin 病 因)—Identify principal symptom and primary

cause.
A.1 external factors (waigan 外 感)—wind, cold, summer heat, wetness,
aridity, fire, epidemics.
A.2 internal factors (neishuang 內 傷)—emotions, physical exhaustion, diet,
helminthiasis.

B. Presentation (bingxing 病型)

B.1 Debility (xu 虛)—tonics, replenishment, including reverse treatment.
B.1.1 Exhaustion (lao 勞)—roborants, calorigenics.
B.1.2 Aridity (zao 燥)—emollients.
B.1.3 Dispersion/Consumption (san 散)—astringents.
B.1.4 Agitation (jing 驚)—sedatives, calmatives.
B.2 Excess (shi 實)—expel recalcitrant evil qi, including converse treatment
B.2.1 Palpable hard lump (jian 堅)—disintegration.
B.2.2 Concretion/Aggregation (jie 結)—dispersion.
B.2.3 Stasis (liu 留)—expulsion.
B.2.4 Spasm (ji 急)—spasmolytics, relaxants.
B.2.5 Inaction (yi 逸)—kinestherapy.

C. Location (bingsuo 病所)

C.1 Debility (xu 虛)—complete the treatment while progressing.
C.1.1 Exterior (biao 表)
C.1.1.1 Default in form (xing 形)—neurotonics, anabolics.
C.1.1.2 Flaring symptoms (lihan 慄 悍)—suppress the morbid
expressions by using antihidrotics or astringents.
C.1.2 Interior (li 裡)
C.1.2.1 Essence (jing 精)—diet therapy, tonics, rich food.
C.1.2.2 Qi 氣—cardiotonics, neurotonics, increase muscle tone.
C.1.2.3 Yin 陰—nourish/generate yin elements, use sweet/salty
drugs.
C.1.2.4 Yang 陽—restore/raise yang elements, use warm drugs.
C.2 Excess (shi 實)
C.2.1 Exterior (biao 表)
C.2.1.1 On body surface—diaphoretics, effervescents.
C.2.1.2 Entrenched evil qi—diaphoretics, medicinal bath.
C.2.2 Interior (li 裡)
C.2.2.1 Upper burner (shangjiao 上焦)

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 Principles of Treatment 243

C.2.2.1.1—diaphoretics, effervescents, antitussives (winnowing).

C.2.2.1.2—emetics (sour, bitter and salty drugs to induce
vomiting).
C.2.2.2 (zhongjiao 中焦)—digestives, stomachics.
C.2.2.3 Lower burner (xiajiao 下焦)
C.2.2.3.1—digestives, diuretics.
C.2.2.3.2—laxative, purgatives.
C.2.2.4 Blood domain (xuefen 血分)—blood-letting, haemolytics.

D. Remission (bingcheng 病 程 )—Optimal timing for cessation of

medication.
D.1 Complete the course of treatment in spite of remission.
D.2 Very toxic drugs—stop at 60% recovery etc.
D.3 For pregnant women, stop when the disease is more than half cured.
D.4 Complete the course with diet therapy.

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