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Chapter 13 of 78
黄帝内经·素问
The Yellow Emperor asked: I have heard that in ancient times, when treating illness, one only needed to shift essence and transform qi (regulate the spirit, redirect essence-qi) and use Zhuyou (incantation therapy—explaining the cause of illness, similar to ancient psychological counseling or shamanic healing) and recovery would follow. Now in treating illness, one administers internal medications and applies external acupuncture and bian-stones (stone needles). Some recover, but some do not. Why is this?
Qi Bo replied: People of high antiquity lived among birds and beasts. They moved about to avoid cold and dwelt in shady places to escape heat. Inwardly, they had no burdens of family attachment or longing preoccupations; outwardly, they had no toil of chasing reputation or official position. This was an era of tranquility and detachment—evil qi could not easily penetrate deeply. Therefore, there was no need for internal medications or external needles and stones; only shifting essence and Zhuyou were needed to bring recovery. People of the present age, however, are quite different: inwardly, their minds are entangled with worries; outwardly, their bodies are damaged by toil and hardship. Moreover, they fail to follow the changes of the four seasons and violate the proper adjustments for cold and heat. Abnormal winds frequently attack them, and deficient evil qi invades morning and evening. Internally, it penetrates the five viscera and bone marrow; externally, it harms the orifices, skin, and flesh. Thus, minor illnesses inevitably become severe, and major illnesses often lead to death. Relying on Zhuyou alone can no longer resolve the problem.
The Yellow Emperor said: Well spoken. I wish to face patients, observe life and death, and make judgments on doubtful cases. I want to grasp the essential principle, as clear and bright as the sun and moon. Would you be willing to tell me?
Qi Bo said: Color and pulse (observing facial complexion and palpating the pulse) are the diagnostic methods treasured by the sovereigns of antiquity and transmitted by the venerable teachers. In ancient times, the legendary physician Jiu Daiji was instructed to study complexion and pulse, penetrating the patterns of natural spirit-like transformation, coordinating with the Five Phases, Four Seasons, Eight Winds, and Six Directions—never departing from regular norms—observing the subtle mysteries within change and transformation, thereby grasping the essential principle. The essential principle is color and pulse. Complexion resembles the sun with its alternation of brightness and darkness; pulse resembles the moon with its periodic rhythm. Constantly seeking this essential principle is the key to diagnosis. The correspondence between changes in complexion and the pulse patterns of the four seasons is what the ancient sage-kings treasured, because it aligns with the patterns of natural spirit-like transformation. Therefore, it enables one to distance oneself from death and approach life. One who makes the way of life endure long is called a sage-king.
In middle antiquity, illness was treated after it had already arisen. Tang Ye (decoctions, medicinal liquids of ancient times) was administered for about ten days to dispel conditions such as the Eight Winds and Five Bi (bi syndromes—pattern of wind from eight directions and various obstructive painful disorders). When ten days did not bring a cure, herbal leaves, roots, and stems were additionally combined—the fundamental and the branch supporting each other, the root and manifestation corresponding—only then could evil qi be subdued. The practice in recent times, however, is not like this: treatment is not based on the four seasons; one does not understand the movements of the sun and moon; one does not examine the favorable and unfavorable. Only after the disease pattern has already formed does one hastily attempt to treat the exterior with fine needles and the interior with decoctions. Crude and careless practitioners are recklessly self-assured, believing they can attack evil, yet the old ailment remains uncured while new illness arises on top of it.
The Yellow Emperor said: I wish to hear the fundamental principle.
Qi Bo said: The most essential point in treating illness lies in not losing hold of the color-pulse diagnosis. Using it without confusion is the great method of treatment. When favorable and unfavorable are reversed, and root and manifestation fail to correspond, it will damage the spirit-qi and cause the entire being to decline. Removing the old and moving toward the new is how one reaches the level of a true person.
The Yellow Emperor said: I have heard the essential principle from you, and you say never to depart from color and pulse—this I already understand. Qi Bo said: The root of treating illness returns to "One."
The Yellow Emperor asked: What is meant by "One"? Qi Bo said: "One" means using inquiry to discover the cause of illness and the state of spirit-qi.
The Yellow Emperor asked: How is this done specifically? Qi Bo said: Close the door and block the windows, avoid all disturbances, sit close to the patient, and repeatedly inquire about the illness and emotional state, following the patient's genuine feelings and intentions. Those who grasp the spirit-qi will prosper; those who lose the spirit-qi will perish.
The Yellow Emperor said: Well spoken.
Environment Determines Disease Depth and Treatment Choice
This chapter holds that people of high antiquity lived in tranquility with few desires, so evil qi could not penetrate deeply; hence methods like Zhuyou and shifting essence and transforming qi—spirit-regulating approaches—were sufficient. People of later ages have many worries, heavy toil, and go against the four seasons, allowing evil qi to penetrate deeply into the five viscera and bone marrow; therefore, medications and needles and stones become necessary. This is not a simple rejection of Zhuyou, but rather an emphasis that social environment and lifestyle affect the depth of disease.
Integration of Color and Pulse, Correspondence between Heaven and Humanity
The entire chapter treats color and pulse as the diagnostic framework: complexion corresponds to the sun, pulse corresponds to the moon, and both resonate with the Five Phases, Four Seasons, Eight Winds, and Six Directions. The ancients believed that facial complexion and pulse are not isolated indicators but comprehensive reflections of the correspondence between humanity and the natural environment. By grasping the changes in color and pulse, one can judge favorability, reversals, life, and death.
"The Extreme of Treatment Returns to One" and "Those Who Attain Spirit Flourish; Those Who Lose Spirit Perish"
At the end of the chapter, the root of treatment is ascribed to "One"—that is, through quiet, focused inquiry, repeatedly understanding the patient's emotional state and feelings, one thereby grasps "spirit-qi." The "spirit" here is not superstition but a comprehensive expression of the body's vitality and mental state. Diagnosis and treatment ultimately depend on the flourishing or decline of spirit-qi.
Criticism of "Crude and Careless Practitioners"
Not basing treatment on the four seasons, not understanding the sun and moon, not examining favorable and unfavorable factors, and hastily applying needles and medications only after the disease pattern has already formed—this is a failure of root and manifestation to correspond. The old disease not departing while new illness arises shows that treatment cannot merely attack evil locally; one must assess the situation comprehensively.
The Rational Core and Limitations of Zhuyou
Zhuyou carries the coloring of ancient shamanic medicine and should not be mystified. Its rational aspects resemble psychological suggestion, emotional guidance, and placebo effects; modern psychosomatic medicine also acknowledges that psychological states influence the experience of illness and recovery. However, the ancients' belief that Zhuyou alone could cure the diseases of high antiquity reflects understanding under specific historical conditions and cannot replace standard modern diagnosis and treatment.
Color-Pulse Integration and Biological Rhythms
"Complexion corresponds to the sun; pulse corresponds to the moon" is a philosophical analogy of antiquity, not to be simplistically understood as the complexion being determined by the sun or the pulse by the moon. Yet it contains naive observations of correlations between biological rhythms, seasonal environmental changes, and the state of the human body—ideas that can engage in dialogue with modern chronomedicine and objective research on complexion and pulse.
"Following the Patient's Intentions" and Patient-Centered Care
"Close the door and block the windows, repeatedly inquire about the condition, and follow the patient's intentions" emphasizes quiet, privacy protection, repeated questioning, and respect for the patient's subjective experience. This resonates with modern medicine's emphasis on doctor-patient communication, psychological state assessment, and patient-centered approaches.
Historical Limitations
The decoctions, herbal leaves and roots, and fine needles mentioned in the original text belong to ancient therapeutic concepts and are for scholarly study only, not as medication guidance. Ancient explanations of disease and environment carry the stamp of their era and should be viewed rationally, not blindly applied.
Related Concepts
Zhuyou (incantation therapy), Shifting Essence and Transforming Qi, Color and Pulse, Jiu Daiji, Tang Ye (decoctions), Eight Winds and Five Bi, Root and Manifestation, Spirit-Qi, Tranquility
Further Reading
📖 Bugu Note: This content is based on classical Chinese medicine texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication, or treatment advice. Please seek medical attention promptly if you are unwell.