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Chapter 73 of 78
黄帝内经·素问
The Yellow Emperor, seated in the Bright Hall, summoned Leigong and asked: Do you understand the Way of medicine? Leigong replied: I can recite the medical classics and comprehend them somewhat; I can comprehend, but cannot yet discriminate; I can discriminate, but cannot yet illuminate; I can illuminate, but cannot yet manifest it in clinical practice. At my current level, I am fit only to treat ordinary officials, not sufficient to treat feudal lords and kings. I wish to learn the principles that establish the Way of Heaven, to integrate the Four Seasons and Yin-Yang (the waxing and waning of yin and yang through the seasons), to discern the movements of stars and the radiance of sun and moon, so as to illuminate the classical medical Way and make it clearer for later generations; to continue upward the legacy of Shennong, and to manifest the most true and essential medical Way, comparable to the sages of high antiquity.
The Yellow Emperor said: Good! Do not lose this principle. These are all matters of yin-yang, exterior-interior, upper-lower, male-female mutually transmitting and responding to one another. The medical Way requires knowledge of astronomy above, geography below, and human affairs in between—only then can it be passed down through ages; used to instruct the people, it will not give rise to doubt or danger. The discourses on the medical Way can be transmitted to posterity and treasured as precious.
Leigong said: Please let me receive the medical Way, through recitation and reading to understand and apply it. The Yellow Emperor said: Have you not heard of the Yin-Yang Zhuan (Treatise on Yin and Yang)?
Leigong said: I have not. The Yellow Emperor said: The qi of the Three Yang (here referring to extreme yang-heat qi, or the qi of the Taiyang channel), in the human body presides over the exterior like Heaven; its movement upward and downward has no fixed regularity. Once the qi of the Three Yang combine, pathogens will arrive, injuring yin and yang in a biased manner.
Leigong said: The qi of the Three Yang cannot be withstood—may I ask the principle behind this? The Yellow Emperor said: What is called "Three Yang arriving alone" refers to the qi of the Three Yang combining and arriving together. When they combine and arrive, their momentum is like wind and rain; upward they may cause crown-top disorders, downward they may cause leakage disorders (conditions involving urinary and fecal incontinence). Externally there is no fixed time of onset, internally there is no fixed location, and they do not conform to channel collaterals' regular patterns—at diagnosis it is difficult to judge by upper-lower position, and one can only record and discriminate.
Leigong said: My clinical treatment results are sparse indeed; I merely speak the general idea. The Yellow Emperor said: The Three Yang represent the extreme of yang, and are therefore called Ultimate Yang. When the pathogenic qi of the Three Yang accumulates and combines, fright and palpitations occur; onset is like a swift wind, arriving like thunder and lightning—all nine orifices become blocked and impassable, yang qi overflows like a great flood, the throat dries and becomes obstructed. If it invades the yin aspect, then upper and lower manifestations have no regular pattern; when it presses upon the intestines, it becomes intestinal diarrhea (dysentery, purulent and bloody stools). This is called the pathogenic qi of the Three Yang directly striking the heart and chest—one sits but finds it hard to rise, and only when lying down does the body gain some ease. Since the diseases of the Three Yang are already this complex, if one wishes to know the perfect Way of the world, by what means can one discriminate yin and yang, comply with the four seasons, and accord with the five phases?
Leigong said: When you speak of yang disorders I cannot discriminate them, and when you speak of yin disorders I cannot clarify them either. Please allow me to rise and receive instruction, so as to know the perfect Way. The Yellow Emperor said: If you receive the transmission but do not know how to unite with the perfect Way, you will instead confuse the teacher's instruction. I shall tell you the essential points of the perfect Way: when disease damages the five viscera, the sinews and bones correspondingly wither and decline; if you say you cannot explain or discriminate, then the learning that governs medicine in this world will be severed. Kidney qi (the essential qi of the kidneys) is about to be exhausted—daylong anxiety and disquiet, as the sun sets toward dusk, still unhurriedly confined within, unable to be diligent in human affairs.
The cognitive ladder of the medical Way: recitation, comprehension, discrimination, illumination, manifestation.
Leigong's self-assessment—"I can recite and comprehend, but cannot yet discriminate; I can discriminate, but cannot yet illuminate; I can illuminate, but cannot yet manifest"—reveals that learning medicine cannot stop at recitation and understanding; one must also be able to discriminate similarities and differences, illuminate the underlying mechanisms, and ultimately manifest them in clinical practice. This is the progression from knowledge to capability.
The holistic view of heaven-human correspondence.
The Yellow Emperor emphasizes "yin-yang, exterior-interior, upper-lower, male-female mutually transmitting and responding," and states that the medical Way requires "knowledge of astronomy above, geography below, and human affairs in between." This indicates that classical Chinese medicine views the human body not as isolated, but as connected to heaven, earth, the four seasons, stars, sun, moon, and human affairs. Diagnosis and health preservation must be examined within this larger system.
The pathogenic characteristics of Three Yang combining.
This chapter focuses on "Three Yang arriving alone" and "Three Yang combining," describing it as the sudden excess of ultimate yang qi, arriving with the momentum of wind and rain or thunder and lightning, causing crown-top disorders above, leakage disorders below, blockage of the nine orifices, and overflowing of yang qi—a multi-system, multi-site manifestation. The core idea is: when yang-heat is at its extreme, the disease transmits rapidly, affecting exterior and interior, upper and lower alike, and diagnosis cannot be confined to conventional patterns.
Transmission must "accord with the perfect Way."
The Yellow Emperor warns Leigong that if one merely receives the transmission without uniting with the perfect Way, one will "confuse the teacher's instruction." To accord with the perfect Way means to be able to "discriminate yin and yang, respond to the four seasons, and unite with the five phases," integrating scattered knowledge into the system of yin-yang, five phases, four seasons, and five viscera.
The cognitive ladder parallels modern educational theory.
"Recitation—comprehension—discrimination—illumination—manifestation" resembles the sequence of memory, understanding, analysis, evaluation, and application in modern learning theory, emphasizing that medical education cannot focus solely on memorization but must ultimately arrive at clinical competence and practical judgment.
The holistic view echoes the modern medical model.
"Knowledge of astronomy above, geography below, and human affairs in between" resonates spiritually with today's "biopsychosocial" medical model. Modern chronomedicine and environmental medicine also suggest that climate, circadian rhythms, and geography affect health. However, the ancients' "astronomy, geography, human affairs" is rather general and needs to be specified and validated through modern scientific methods—they cannot be directly equated.
Three Yang combining describes the overall derangement of acute severe illness.
The ancients used phrases like "yang qi overflowing like a flood" and "like wind and rain, thunder and lightning" to describe a state of acute onset, rapid transmission, and multi-system involvement. From a modern perspective, this resembles certain acute infections, high fevers, severe metabolic disturbances, or manifestations of multi-organ dysfunction. It is not a specific disease name, but the observation of "rapid transmission and systemic derangement" carries clinical warning significance. Specific conditions must be diagnosed and managed by modern medicine.
The description of prognosis should be viewed rationally.
"Kidney qi about to be exhausted" and "anxious as the sun sets toward dusk" are ancient descriptions of critical illness and declining vitality—they cannot be simply equated with modern kidney failure. They reflect the ancients' intuitive judgment of poor prognosis in severe cases but lack modern examination-based evidence.
Comply with the four seasons and yin-yang; avoid excess of yang.
This chapter emphasizes the harm of extreme yang hyperactivity. Daily life should avoid behaviors that promote yang-heat excess, such as prolonged heat exposure, chronic sleep deprivation, rage, and excessive consumption of spicy and drying foods; maintain regular sleep and wakefulness and emotional equanimity.
Health knowledge should be acquired progressively.
Do not be satisfied with merely "reciting a few health aphorisms"; learn to discriminate differences among constitutions, seasons, and age groups, gradually building a habit of holistic bodily observation.
Observe the body in holistic interconnection.
The ancients indicated that when Three Yang combine, multiple orifices above and below are simultaneously affected, showing that the body functions as an integrated whole. In daily life, when discomfort arises, do not fixate on a single local area—consider it in connection with sleep, emotions, and diet; if acute or severe conditions occur, seek medical attention promptly.
Bugu Reminder: This content is based on classical Chinese medical texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication, or treatment advice. Please consult a qualified healthcare professional promptly if you feel unwell.