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Chapter 14 of 78
黄帝内经·素问
Overall Paraphrase
The Yellow Emperor asked: What is the method for making decoctions (medicinal liquids extracted through boiling) and fermented beverages (sweet wines produced by fermentation) from the five grains?
Qibo replied: One must use rice, with rice straw as fuel for cooking. The nature of rice is complete (whole and full, obtaining the qi of Heaven and Earth), and the nature of rice straw is firm (solid and dense, burning persistently and evenly).
The Yellow Emperor asked: Why is this?
Qibo said: Rice growth obtains the harmonious qi of Heaven and Earth, and it is situated on terrain of appropriate elevation, so it can grow whole and full; harvested at the proper season, so the stalks are firm.
The Yellow Emperor asked: The sages of high antiquity made decoctions and fermented beverages, but after making them, they did not use them—why?
Qibo said: The sages of antiquity made decoctions and fermented beverages merely as reserves. People of high antiquity made decoctions, so they prepared them but did not consume them. By the era of middle antiquity, people's virtue had slightly declined, and pathogenic qi (abnormal qi that causes disease) would frequently invade the body; at that time, consuming decoctions and fermented beverages could preserve health and well-being.
The Yellow Emperor asked: In the present era, even after taking them, recovery is not guaranteed—why?
Qibo said: In this present age, one must combine potent medicines (drugs with strong, fierce properties) to attack internally, and use sharp stone needles and acupuncture and moxibustion to treat externally.
The Yellow Emperor asked: If the body has declined and blood has been exhausted, yet treatment still shows no effect—what is the reason?
Qibo said: It is because the spirit does not activate—the mental will no longer exercises its governing function.
The Yellow Emperor asked: What is meant by "the spirit does not activate"?
Qibo said: Treatment with acupuncture and stones is a "Way." If the spirit cannot gather and be preserved within, and the will cannot be harmonized and settled, the disease naturally cannot be cured. Now when essential qi has already been ruined and spirit qi has already dispersed, the nutritive and defensive qi (the refined substances operating within the body and the defensive qi protecting it, namely ying qi and wei qi) can no longer be restored and gathered. Why? Because desires and appetites are without limit, and worries and misfortunes do not cease. Essential qi becomes lax and ruined, nutritive qi becomes sluggish, and defensive qi disperses—therefore the spirit departs, and the disease cannot be cured.
The Yellow Emperor said: When disease first arises, it is extremely subtle and extremely fine, inevitably first invading and accumulating in the skin. Now skilled physicians all say: once the disease has formed, it is called "counterflow" (the condition is severe and difficult to reverse); acupuncture and stones cannot treat it, and good medicines cannot reach it. Yet skilled physicians all grasp the methods and observe the standards; news of relatives and brothers near and far is heard daily, changes in complexion are seen daily—yet the disease still does not heal. Is it not that treatment was begun too late?
Qibo said: The patient is the root; the physician is the branch—the patient's own state is fundamental, and the physician's treatment is supplementary. If root and branch cannot correspond, pathogenic qi will not be subdued. This is what is being spoken of.
The Yellow Emperor asked: Some diseases do not begin from the body surface, but rather the yang qi of the five viscera is already exhausted, fluids fill the body cavities, the corporeal soul (that part of mental activity associated with the physical body) dwells alone within, essential qi is stranded within, qi is depleted without, and the body swells so that clothing cannot be worn—this is extreme distension of the four limbs with internal agitation, qi being obstructed within while the body is deformed without. How should this be treated?
Qibo said: Use the method of balancing and weighing (regulating equilibrium) to treat it: remove stagnant and decayed accumulations, gently move the four limbs, wear warm clothing, and apply contralateral needling (crosswise needling—needling the right for left-side disorders and the left for right-side disorders) to the corresponding areas, in order to restore the body. Open the sweat pores (induce sweating), and cleanse the bladder (promote diuresis), thereby allowing essential qi to be distributed in due course, and the yang qi of the five viscera to be spread forth, dredging and washing the five viscera. Thus essential qi is naturally generated, the body naturally becomes robust, bones and flesh mutually preserve each other, and the great qi (the body's major qi, its righteous qi) is then restored to equilibrium. The Yellow Emperor said: Excellently spoken.
① "Prepared but unused" and the view of change across eras
The opening of this chapter, through the "made but not consumed" nature of decoctions and fermented beverages, sketches a historical landscape of human constitution and disease patterns evolving through the ages: people of high antiquity had balanced qi and blood, requiring no medication; people of middle antiquity experienced pathogenic qi arriving from time to time, and decoctions sufficed; people of the present age require potent medicines and acupuncture/stones for both internal and external treatment. This is not merely a lament of "the present is inferior to the past," but rather a dynamic view of prevention and treatment—the intensity of therapeutic measures should match the current body's capacity and the depth of the pathogenic evil. Here, decoctions and fermented beverages represent the concretization of the concept of "preparedness for nurturing life": stored in ordinary times, employed during illness.
② "The spirit does not activate"—the fundamental bottleneck of ineffective treatment
Qibo here proposes an extremely profound proposition: medicines and acupuncture/stones are merely vessels of the "Way"; if the patient's mental will cannot participate, treatment cannot take effect. The text uses "desires and appetites without limit, worries and misfortunes without end" to explain the cause of "spirit departure"—long-term emotional depletion leading to laxity and ruin of essential qi, with nutritive and defensive qi failing to be gathered. This discussion reveals a core medical principle: the integration of essence, qi, and spirit is the precondition for recovery from disease. Both the physical body and the spirit must be unified objects of treatment; the physician treats the "body," but the participation of the "spirit" lies with the patient themselves.
③ "The patient is the root; the physician is the branch"—the medical philosophy of root-branch relationships
"The patient is the root; the physician is the branch" is another timeless saying from this chapter. Here "disease" refers to the patient's own state (including righteous qi, emotional state, and lifestyle habits), while "physician" refers to the physician's technical intervention. Qibo's response directly answers the Yellow Emperor's question: even if the physician "obtains the methods and observes the standards," observing daily and caring constantly, if the patient's own fundamental state does not change, pathogenic qi will still not be subdued. Treatment is a collaboration between physician and patient, not a one-sided administration by the physician.
④ "Open the sweat pores, cleanse the bladder"—the source of the great method for treating edema
The description at the chapter's end of "fluids filling the body cavities" and "four limbs rapidly distending with internal agitation" closely resembles what we today call severe edema/fluid retention. The treatment principle Qibo provides—"open the sweat pores, cleanse the bladder"—that is, inducing sweating and promoting diuresis in parallel, became the two fundamental methods for treating water-related diseases in later Chinese medicine (for example, Zhang Zhongjing's Jingui Yaolue statement that "swelling above the waist should be treated by inducing sweating; swelling below the waist should be treated by promoting urination" directly inherits this thought). At the same time, the incorporation of "wearing warm clothing" and "gently moving the four limbs" reflects a holistic approach of warming yang, transforming qi, and promoting the circulation of qi and blood, rather than merely draining water.
On rice and brewing: The ancients' choice of rice for making decoctions and fermented beverages, emphasizing "the harmony of Heaven and Earth" and "appropriateness of terrain," essentially reflects a rudimentary understanding of the relationship between raw material quality and growing environment. Modern science confirms that the nutritional components of rice (such as starch, protein, and B vitamins) are indeed influenced by variety, soil, climate, and harvest timing. The trace alcohol in fermented beverages can aid in extracting certain active ingredients, which shares some principles with solvent extraction in modern pharmacology.
On "the spirit does not activate": This discourse resonates highly with modern discoveries in psychoneuroimmunology (PNI) . A large body of research demonstrates that chronic stress, anxiety, depression, and other emotional states can suppress immune function through the hypothalamic-pituitary-adrenal (HPA) axis, reducing the body's capacity for repair. Patients' belief in treatment and positive mental states (what modern medicine calls "treatment engagement") do influence prognosis. Of course, the ancients' explanation of all poor treatment outcomes through "spirit departure" has its era's limitations—today we know that many diseases require surgical, pharmacological, and other precise interventions even when mental adjustment is appropriate.
On "the patient is the root; the physician is the branch": This aligns with modern medicine's emphasis on patient-centered care and shared decision making. Treatment outcomes depend not only on the physician's skill but also on the patient's adherence, lifestyle modification, and self-management capacity.
On edema treatment: "Opening the sweat pores" (inducing sweating) and "cleansing the bladder" (promoting diuresis) in modern medicine correspond to eliminating excess body fluid through two routes: the skin and the kidneys. Diuretics are core tools in modern clinical management of edema, and moderate sweating (such as heat therapy or sauna) does have some auxiliary benefit for mild fluid retention. However, it must be made clear: the causes of severe edema (cardiac, renal, hepatic, etc.) must be definitively diagnosed by modern medicine; the ancients' conceptual framework of "fluids filling the body cavities" cannot replace modern etiological analysis.
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This content is based on classical texts of traditional Chinese medicine and is provided solely for the study and appreciation of traditional culture. It does not constitute any medical diagnosis, medication recommendation, or treatment advice. If you feel unwell, please seek medical attention promptly.