Plain Questions: Yuban Treatise, Chapter 15
Overall Paraphrased Meaning
🩺 The Yellow Emperor asked: I have heard that "Kuidu" (assessing the depth of illness) and "Qiheng" (identifying abnormal pathological patterns) refer to different things. How should they be grasped in actual practice?
Qi Bo replied: Kuidu is used to measure the shallowness or depth of the disease location; Qiheng is a discussion of unusual pathological patterns. Allow me to explain the most essential principle in medicine: through the changes in the five colors and pulse signs, one can assess Kuidu and Qiheng, and the core reasoning reduces to "the One." Shenji 💨 (the body's internal mechanism of vital activity) functioning normally never flows backward; once it reverses, it cannot function properly, and vitality is lost. This is the crux of the most subtle principle—so subtle as to approach the invisible—hence it should be inscribed on a jade tablet and named "He Yu Ji" (Combined Jade Mechanism).
The complexion manifests in the upper, lower, left, and right regions, each with its own diagnostic essentials. If the complexion is light, the illness is still shallow; the ancients treated it with Tangye 🌿 (an ancient decoction form), with recovery in about ten days. If the complexion is deeper, the illness has penetrated further, requiring "Biqi" (ancient commentaries differ on its exact meaning; it may be understood as a treatment method deeper than Tangye), with recovery in about twenty-one days. If the complexion is even more pronounced, treatment with Laojiu 🍶 (fermented wine preparation) is used, with recovery in about one hundred days. If the complexion is withered and lusterless, with facial muscles sunken and collapsed, this is a critical sign difficult to treat, and the essence may be exhausted within one hundred days. A short pulse with qi exhaustion indicates death; febrile disease with severely deficient vital qi also indicates death.
The coloration appears in the upper, lower, left, and right regions, each with its own rules of adverse or favorable: manifestation in the upper region is adverse (unfavorable), in the lower region is favorable; for women, the right side is adverse and the left side is favorable; for men, the left side is adverse and the right side is favorable. If this yin-yang favorable/adverse relationship becomes inverted, forming Chongyang (redundant yang excess) or Chongyin (redundant yin excess), death may ensue.
When yin and yang are abnormally deranged, the key to treatment lies in weighing the excess and deficiency of yin and yang, bringing them into mutual harmony. This is a matter of both "Qiheng" and "Kuidu." When the pulse pounds forcefully with bi syndrome (obstruction) and bi (inability to walk), it is caused by the conflict of cold and heat pathogenic qi 🔥. Mai gu (a pulse devoid of stomach qi, showing isolation and exhaustion) indicates the consumption of vital qi; pulse deficiency with diarrhea indicates the loss of blood and essence. Gu is adverse; deficiency is favorable.
In applying the method of Qiheng, examination begins with the Taiyin cun-kou pulse on the hand. According to the five-element generation and control relationships, if the pulse qi travels in the direction of the "suo busheng" (the direction it is controlled by), it is adverse, and the prognosis is dire; if it travels in the direction of the "suo sheng" (the direction it controls), it is favorable, and the prognosis is better. Eight winds (seasonal external pathogens from eight directions) and the prevailing qi of the four seasons alternately overcome each other, cycling endlessly; if one episode of derangement occurs out of order, the pattern can no longer be calculated by routine rules. The essentials of this treatise conclude here.
🧠 Deep Understanding
Core Principles 💡
This chapter unifies "Kuidu" and "Qiheng" within the framework of "the Dao resides in the One," emphasizing the use of external signs—complexion, pulse, and spirit—to judge the depth, favorability, and prognosis of illness. The core ideas include:
- The Favorable or Adverse Flow of Shenji Determines Vitality: When the Shenji functions normally, the illness has a chance of recovery; when the Shenji reverses, vitality declines. Therefore, observing whether "spirit" is scattered is key to prognosis.
- The Depth of Complexion Reflects the Depth of Illness: The complexion progressing from light to deep corresponds to pathogenic factors advancing from the exterior to the interior, with treatment formulations progressing from Tangye to Laojiu step by step, embodying the principle of "treating according to depth and guiding the situation."
- Favorable and Adverse Are Dynamic Judgments: Upper/lower, left/right, male/female, and five-element generation-control relationships can all be used to judge favorability or adversity. Essentially, one observes whether the body's yin-yang and qi-blood are flowing in their appropriate directions. Adverse means loss of normality; favorable means conformity to normality.
- The Pulse Values the Presence of Stomach Qi: Gu pulse (isolated pulse) and deficient pulse with diarrhea indicate the decline of vital qi or the loss of essence and blood. The ancients used these to judge favorable or adverse outcomes, embodying the pulse principle that "with stomach qi there is life; without stomach qi there is death."
Modern Perspectives 🌟
- "Kuidu Qiheng" resembles modern disease severity assessment and differential diagnosis: using clues from complexion, mental state, and pulse to judge the severity and prognosis of illness, which has a reasonable basis in clinical observation.
- "Shen rotates without turning back" can be understood as the body's homeostatic regulatory capacity. When the body's compensatory ability remains intact, the illness tends toward recovery; once decompensation or internal environmental disturbance occurs, the condition can deteriorate rapidly. This shares conceptual ground with the modern medical notion of "homeostasis," though the ancients expressed it as "Shenji" within their theoretical language.
- The specific time frames in the text—"ten days," "twenty-one days," "one hundred days"—are empirical summaries from ancient observation and should not be directly applied as modern treatment timelines. Modern diagnosis and treatment have far more precise examination, diagnostic, and therapeutic methods.
- Concepts such as "male left, female right," "upper adverse, lower favorable," and "the five-element concepts of what controls and what is controlled" belong to the ancient yin-yang five-element model. They hold certain dialectical value but lack modern anatomical and physiological evidence; they should be understood as historical theory rather than mechanically applied.
- The mention of Tangye, Biqi, and Laojiu serves only to explain ancient treatment rationales and does not constitute any medication or treatment recommendation.
Health Insights ⚡
- Pay daily attention to complexion and spirit: A sudden deterioration of complexion, prolonged mental fatigue, or significant weight loss are signals from the body. One should promptly adjust rest patterns and seek medical care, rather than making prognoses based on ancient texts.
- Maintain stability of "Shenji": Avoid prolonged emotional extremes and mental exhaustion; maintain a calm mind to support overall physical and mental stability.
- Follow the four seasons and avoid external pathogens: Adjust daily routines according to seasonal changes, avoid excesses of cold and heat, and reduce external triggers that disturb the body.
- Eat moderately with balanced temperatures: Avoid overindulgence in rich, fatty foods or cold items; protect the qi of the spleen and stomach so that qi and blood have a source of production.
📚 Related Knowledge
- Related Concepts: Kuidu, Qiheng, Shenji, five-color diagnosis, pulse diagnosis, stomach qi, favorable/adverse, five-element generation and control, eight winds and four seasons, Tangye and Laojiu.
- Further Reading: Plain Questions · Yuji Zhenzang Lun (related to "He Yu Ji," discussing the four-season pulse and true organ pulses), Miraculous Pivot · Wuse (facial color regional diagnosis), Plain Questions · Pingren Qixiang Lun (the pulse taking stomach qi as its root), Plain Questions · Yin-Yang Yingxiang Dalun (foundations of yin-yang and five elements).
BuGua Reminder: This content is based on classic 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 timely medical attention if you feel unwell.
