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Chapter 77 of 78
黄帝内经·素问
Overall Paraphrase
This chapter discusses the flourishing and decline of qi dynamics, adherence and deviation, and diagnostic methods. Lei Gong asks: The human qi has surplus and deficit—what is considered contrary, and what is compliant? The Yellow Emperor answers: Yang qi ascends from the left, yin qi descends from the right; the qi dynamics of the elderly tend toward the upper body, while those of the young tend toward the lower body. Therefore, in spring and summer, when qi returns to yang, it governs life; if it instead returns to the yin of autumn and winter, it governs death. In autumn and winter, the reverse holds: when qi returns to yin, it governs life; when it returns to the yang of spring and summer, it governs death. Thus, whether qi is abundant or deficient, any chaotic deviation in its movement may give rise to syncopal disorders (jue).
Lei Gong further asks: Can surplus of qi also cause syncope? The Yellow Emperor replies: If qi only rises without descending, it may cause cold syncope extending to the knees; if this occurs in a young person during autumn or winter, death is likely, but in an elderly person during the same seasons, survival is possible. When qi surges upward without descending, it may trigger headache and disorders of the vertex. At such times, seeking from the yang aspect yields nothing, examining from the yin aspect fails to distinguish clearly—the five viscera appear blocked with no evident signs. The patient seems to stand in a deserted field, or lie hidden in an empty room—breath faint and lingering, unlikely to last even one day.
Therefore, syncope due to qi deficiency causes chaotic dreams, and in severe cases, mental confusion. Exhaustion of the three yang channels with faintness of the three yin channels constitutes qi deficiency.
Hence, when lung qi is deficient, one dreams of white objects, sees killings and blood flowing across the ground; if this coincides with the time when lung metal is in command, one dreams of warfare. When kidney qi is deficient, one dreams of boats capsizing and people drowning; if this coincides with the time when kidney water is in command, one dreams of being submerged in water, attended by fear. When liver qi is deficient, one dreams of fungi, fragrant herbs, and growing vegetation; if this coincides with the time when liver wood is in command, one dreams of hiding beneath a tree, not daring to rise. When heart qi is deficient, one dreams of firefighting; if this coincides with the time when heart fire is in command, one dreams of great conflagration. When spleen qi is deficient, one dreams of insufficient food and drink; if this coincides with the time when spleen earth is in command, one dreams of building walls and constructing houses. These all result from deficiency of qi in the five viscera, where yang qi is relatively excessive and yin qi insufficient. One should synthesize the five diagnostic methods, regulate yin and yang, and apply them in accordance with the channels and collaterals.
🩺 Diagnosis encompasses ten measurement methods: pulse measurement, viscera measurement, flesh measurement, sinew measurement, and shu-point measurement. When the transformation of yin and yang reaches its extreme, disease naturally manifests in the person. When the pulse beat follows no fixed pattern, yin qi is scattered, yang qi is predominant, and the pulse signs are detached and incomplete—there is no fixed procedure for diagnosis. Examination must account for both upper and lower aspects, and must also consider whether the patient is a commoner, a sovereign, or a high official, along with their differing constitutions and lifestyles.
If one studies medicine without completing the full scope of learning, if medical skill is unclear, and if one does not examine adherence and deviation, this constitutes reckless practice. Grasping one aspect while losing another, abandoning yin to cling only to yang, failing to synthesize—these make diagnosis unclear. Passing such theories to later generations only serves to propagate error.
When extreme yin is weakened, heavenly qi loses its support and becomes severed; when extreme yang is excessive, earthly qi becomes insufficient. The convergence and parallel movement of yin and yang constitute the guiding principle of the highest sages. At the convergence of yin and yang, yang qi arrives first, and yin qi follows after. Therefore, the sage in mastering diagnosis first distinguishes the precedence and subsequence of yin and yang. The Qicheng zhi shi (The Momentum of the Extraordinary) comprises sixty chapters, synthesizing subtle signs, tracing the transformations of yin and yang, and revealing the inner conditions of the five viscera. By grasping the essentials of deficiency and excess, and establishing the content of the five measurements, one who knows these is sufficient to diagnose disease.
Therefore, if examination reaches yin but fails to understand yang, the diagnostic information will be incomplete. If one understands yang but not yin, learning remains shallow. Knowing only the left but not the right, knowing the right but not the left, knowing the upper but not the lower, knowing what comes before but not what follows—treatment will be difficult to sustain. Knowing the bad and likewise the good, knowing disease and also the pre-disease state, knowing the high and also the low, knowing sitting and also rising, knowing moving and also stillness—when application follows a governing framework, the way of diagnosis is complete and can endure for ten thousand generations. From surplus, infer deficiency; measure upper and lower—only then can the pulse be fully explored. Therefore, when both the body and qi are weak, the prognosis is poor. When bodily qi is excessive but pulse qi is insufficient, the prognosis is poor. When pulse qi is excessive but bodily qi is slightly deficient, the prognosis is relatively good.
Thus, diagnosis has its great principles: sitting, standing, rising, and moving follow regular patterns; activity and rest have measure. Harmonize the spirit and maintain clarity and stillness of the mind. Observe heaven above and earth below, watch for the eight righteous-path pathogens (external evils such as the eight winds of the four seasons), and distinguish the internal conditions of the five viscera. Examine the movement and stillness of the pulse, follow the slipperiness or roughness, cold or warmth of the forearm skin. Observe whether the pulse and physical signs are large or small, strong or weak, and integrate them with the manifestations of illness. Thus, adherence and deviation can be determined, the name of the disease ascertained, and diagnosis will not miss one in ten, nor violate human circumstances. During examination, one must also observe respiration, mental expression, and volitional state—only then may one maintain proper order in practice. When medical skill is precise and clarity is achieved, one can endure for long. Failing to know this path, transgressing the classics, and speaking recklessly with presumptuous judgment is what is called "losing the way."
The central theme of this chapter lies in the "adherence and deviation of qi." Under normal conditions, the body's qi dynamics correspond to yin-yang, the four seasons, upper-lower disposition, and age: yang ascends from the left, and yin descends from the right. In spring and summer, yang-qi governs the exterior; in autumn and winter, yin-qi governs the interior. Once this order is disrupted, whether qi is excessive or deficient, "syncope" (jue) may arise—a manifestation of chaotic qi dynamics and the disconnection between yin and yang.
The text specifically connects "syncope due to qi deficiency" with dreams, holding that qi deficiency in the five viscera disturbs the spirit, producing distinctive dream imagery. This embodies the consistent "visceral manifestation–spirit" thinking of the Inner Canon: the five viscera store essence and house spirit; when visceral qi is weak, the spirit loses its abode, and dreams become abnormal. These dream images are not arbitrary but follow the five-element system of categorical correspondences: the lung belongs to metal, metal governs whiteness and killing, hence dreams of white objects, executions, and warfare; the kidney belongs to water, hence dreams of water, boats, drowning, and fear; the liver belongs to wood, hence dreams of plants and hiding beneath trees; the heart belongs to fire, hence dreams of fire and scorching; the spleen belongs to earth, hence dreams of food and building walls. Such interpretations emphasize the principle that "what is within necessarily manifests without"—dreams can serve as a reflection of visceral qi imbalance.
The diagnostic section emphasizes the "ten measurements" and "comprehensive synthesis." The ten measurements require assessing a person from multiple dimensions—pulse, viscera, flesh, sinew, and shu-points—rather than examining only one aspect. The text repeatedly criticizes one-sided diagnosis: "knowing the left but not the right, knowing the upper but not the lower, grasping the female but losing the male, abandoning yin and clinging to yang," insisting that yin and yang, precedence and subsequence, upper and lower, left and right, and both bodily and pulse qi must be examined together. In particular, "weak body with deficient qi leads to death," "excessive bodily qi with insufficient pulse qi leads to death," and "excessive pulse qi with slightly deficient bodily qi leads to survival" propose a prognostic principle comparing "body" and "pulse"—the core being whether true qi of the viscera is sufficient and whether pulse qi remains rooted.
The correspondences between dreams and the five viscera in this chapter belong to ancient "categorical analogical" thinking. Modern sleep medicine acknowledges that physical discomfort, emotional stress, fever, and hypoglycemia can influence dream content. However, directly inferring deficiency of a specific visceral qi based on five-element dream categorizations lacks reproducible objective evidence and should not be used as a clinical diagnostic standard. This should be regarded as an early observation and theoretical construction by ancient physicians regarding the "mind-body connection."
"Ten measurements in diagnosis" reflects a highly valuable systems-based assessment approach. Modern medicine equally emphasizes multi-dimensional integration—history-taking, inspection, palpation, auscultation, and laboratory investigations—to reduce diagnostic error. The ancients' proposal to "examine both upper and lower" and "consider whether the patient is a commoner, sovereign, or official" demonstrates awareness that age, social role, and lifestyle habits influence disease manifestation—sharing conceptual resonance with modern "personalized medicine" and the "biopsychosocial" model.
The prognostic judgment regarding "bodily qi" and "pulse qi" can be understood as the ancients' comprehensive assessment of overall status. Modern critical care medicine likewise attends to overall indicators such as muscle wasting, nutritional status, and circulatory function. However, the ancient conclusions of "death" and "survival" represent empirical generalizations that cannot be directly applied by modern standards, nor should they replace medical examination.
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 guidance, or therapeutic advice. If you experience discomfort, please seek timely medical attention.