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Chapter 44 of 81
黄帝内经·灵枢
The Yellow Emperor asked: The occurrence of all diseases is certainly caused by external pathogens such as dryness, dampness, cold, summer heat, wind, and rain, as well as internal factors including yin-yang disharmony, emotional disturbances of joy and anger, irregular diet, and inappropriate living conditions. When pathogenic qi combines with healthy qi, the pattern of disease is formed; when pathogenic qi invades specific organs, the disease acquires its name. These I already understand. However, in most diseases, patients generally feel refreshed in the morning, stable during the day, aggravated in the evening, and most severe at night. Why is this?
Qibo replied: This is the influence of the qi of the four seasons.
The Yellow Emperor said: I would like to hear your explanation of the principles of the four seasons' qi.
Qibo said: Spring brings birth, summer brings growth, autumn brings harvest, and winter brings storage—these are the constant patterns of the four seasons' qi movement, and the human body corresponds to them. Divide a single day into four seasons: morning is spring, noon is summer, sunset is autumn, and midnight is winter. In the morning, yang qi of the human body begins to rise, and pathogenic qi declines, so the patient feels refreshed in the morning (旦慧 / morning clarity); at noon, yang qi is flourishing, and when yang qi prevails, it can overcome pathogenic qi, so the patient is stable (昼安 / daytime stability); in the evening, yang qi begins to wane and retract, pathogenic qi begins to proliferate, so the condition worsens (夕加 / evening aggravation); at midnight, yang qi is hidden deep within, and pathogenic qi alone fills the body, so the condition is most severe (夜甚 / nocturnal severity).
The Yellow Emperor asked: Sometimes the disease pattern does not follow this pattern. Why?
Qibo replied: This is because the disease does not correspond to the four seasons' qi but is instead predominantly governed by a single organ. If the disease is not influenced by the four seasons and is dominated solely by organ qi, then the condition will worsen during the time period that the organ cannot overcome, and improve during the time period that the organ can overcome.
The Yellow Emperor asked: How should it be treated?
Qibo replied: By regulating in accordance with the patterns of heaven's times, the cure can be anticipated. A physician who can conform to heaven's timing is a superior physician (工 / gong); a physician who violates heaven's timing is a coarse physician (粗 / cu).
The Yellow Emperor said: Excellent. I have heard that acupuncture techniques include five transformations (five corresponding changes of the five viscera), which correspond to the five Shu points (the Jing, Ying, Shu, Jing, and He points). I would like to hear the principles behind this.
Qibo replied: Humans have five viscera, each viscera has five transformations, and each transformation has its corresponding five Shu points. Thus, five times five makes twenty-five Shu points, corresponding to the five flavors.
The Yellow Emperor said: I would like to hear about the five transformations.
Qibo said: The liver is a Mu viscus (yang viscus); its color is green, its season is spring, its days are jia-yi, its tone is jue, and its flavor is sour. The heart is a Mu viscus; its color is red, its season is summer, its days are bing-ding, its tone is zhi, and its flavor is bitter. The spleen is a Pin viscus (yin viscus); its color is yellow, its season is late summer, its days are wu-ji, its tone is gong, and its flavor is sweet. The lung is a Pin viscus; its color is white, its season is autumn, its days are geng-xin, its tone is shang, and its flavor is pungent. The kidney is a Pin viscus; its color is black, its season is winter, its days are ren-gui, its tone is yu, and its flavor is salty. These are the five transformations.
The Yellow Emperor asked: How do the five transformations correspond to the five Shu points?
Qibo replied: The five viscera govern winter, therefore diseases residing in the viscera are treated at the Jing-well point; the five colors govern spring, therefore diseases manifesting as changes in color are treated at the Ying-spring point; the five seasons govern summer, therefore conditions that alternate between severity and relief are treated at the Shu-stream point; the five tones govern late summer, therefore diseases manifesting as changes in voice are treated at the Jing-river point; the five flavors govern autumn, therefore diseases of the stomach or those caused by irregular diet are treated at the He-sea point. This is the pattern of the five transformations corresponding to the five Shu points.
The Yellow Emperor asked: How does the Source point coordinate with these to form six Shu points?
Qibo replied: The Source point does not independently correspond to the five seasons but is incorporated into the Jing-river points for coordination, thereby matching the count; thus, six times six makes thirty-six Shu points.
The Yellow Emperor asked: Why is it said that the viscera govern winter, the seasons govern summer, the tones govern late summer, the flavors govern autumn, and the colors govern spring? I would like to hear the reasons.
Qibo replied: For diseases residing in the five viscera, select the Jing-well point; for diseases manifesting as changes in color, select the Ying-spring point; for conditions alternating between severity and relief, select the Shu-stream point; for diseases manifesting as changes in voice, select the Jing-river point—if the meridian is congested with blood stasis, the Jing-river point may be needled to let blood; for diseases of the stomach or those contracted through irregular diet, select the He-sea point. Thus, it is said that flavors govern the He-sea point. This is the principle of the five transformations.
(Note: In the original text, "其音激" should be "其音徵," "音都" should be "音商," "藏主冬，各制并" should be "藏主冬，冬刺井," "春利荣" should be "春刺荥," "夏刺输" should be "长夏刺经," "秋刺合," etc., all corrected according to contextual consistency. The original "故命回味主合" should be "故命曰味主合." The original "其旧壬癸" should be "其日壬癸.")
The Four Seasons in a Day and the Rise and Fall of Yang Qi: The most central idea of this chapter is dividing a single day into four periods corresponding to the qi transformations of the four seasons—morning as spring (birth), noon as summer (growth), sunset as autumn (harvest), and midnight as winter (storage). The yang qi of the human body follows the pattern of "rise → flourish → decline → storage." The manifestations of morning clarity, daytime stability, evening aggravation, and nocturnal severity essentially reflect changes in the balance of power between healthy qi and pathogenic qi as yang qi waxes and wanes: in the morning, yang qi is just arising, suppressing pathogenic qi; at noon, yang qi is at its peak, allowing correct qi to overcome pathogens; in the evening, yang qi begins to retract, and pathogenic qi counterattacks; at midnight, yang qi is hidden within, and pathogenic qi dominates alone. This theory refines the concept of "correspondence between heaven and humanity" from the seasonal level to the day-and-night level, establishing a framework connecting "daily rhythms" with pathological changes.
Organ-Dominant Disease and the Five-Phase Generating/Overcoming Cycles: When a disease does not follow the diurnal rhythm, Qibo indicates that this is because "the organ alone dominates the disease," meaning pathology of a specific organ takes precedence. In such cases, the condition worsens during the time period that the organ cannot overcome (e.g., liver disease aggravated during the Metal period because Metal overcomes Wood) and improves during the period the organ can overcome (e.g., liver disease alleviated during the Earth period because Wood overcomes Earth). This reflects the application of Five-Phase generational and overcoming cycles in the temporal dimension.
The Acupoint Selection Principle of Five Transformations Corresponding to Five Shu Points: The latter half constructs an expansive correspondence system: five viscera → five colors → five seasons → five days → five tones → five flavors, with each layer interconnected, ultimately resolving into the acupoint selection principles of the five Shu points (Jing, Ying, Shu, Jing, He)—disease in the viscera selects Jing-well; color changes select Ying-spring; alternating severity selects Shu-stream; voice changes select Jing-river; diet-related stomach disease selects He-sea. This embodies the acupuncture philosophy of "like qi responds to like" and "selecting points according to transformation."
Scientific Validation of Circadian Rhythms: Modern chronomedicine has confirmed that body temperature, hormone secretion (e.g., cortisol, melatonin), immune cell activity, blood pressure, and heart rate all exhibit clear circadian rhythms, regulated by the "biological clock" of the suprachiasmatic nucleus in the hypothalamus. Many diseases indeed show diurnal fluctuations: asthma worsens at night related to increased vagal tone; morning stiffness in arthritis is associated with nighttime accumulation of inflammatory cytokines; cardiovascular events peak in the early morning due to the morning blood pressure surge and enhanced platelet aggregation. The observation of "morning clarity, daytime stability, evening aggravation, and nocturnal severity" made by ancients over two millennia ago aligns in direction with modern chronopathology findings, demonstrating keen empirical observation.
Bridging Yin-Yang Language with Modern Explanation: The ancients used "rise, flourish, decline, and storage of yang qi" to summarize the human body's daily rhythm—essentially an ancient model representing the daily fluctuations of the neuro-endocrine-immune system. Although this expression does not use modern terminologies, its core logic of "the balance of power between healthy and pathogenic qi changing over time" resonates with the modern understanding that "a time lag exists between host immune responses and pathogen activity."
Limitations of Five Transformations and Five Shu Points Correspondence: The strict correspondence between five colors, five tones, five flavors, and five Shu points represents a systematic extrapolation through Five-Phase categorization, bearing noticeable philosophical and pattern-based characteristics. Its clinical guidance lacks sufficient experimental validation in modern acupuncture. This content is best studied as intellectual history and theoretical framework rather than as directly operable clinical protocol.
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This content is based on classical Chinese medicine texts and is provided solely for traditional cultural study purposes. It does not constitute any medical diagnosis, prescription, or treatment advice. Please consult a qualified healthcare professional if unwell.