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Capítulo 14 de 78
黄帝内经·素问
Overall Paraphrase
The Yellow Emperor asked: What is the method for making Tangye (decocted medicinal fluids) and Liaoli (fermented sweet wines) from the five grains?
Qi Bo replied: One must use rice, and use rice straw as fuel for cooking. The nature of rice is complete (whole and full, having obtained the qi of Heaven and Earth), and the nature of straw is firm (solid and dense, burning steadily and evenly).
The Yellow Emperor asked: Why is this?
Qi Bo said: Rice grows having obtained the harmonious qi of Heaven and Earth, and it grows in terrain of appropriate elevation, so it can grow whole and full; it is harvested at the proper season, so the straw is firm.
The Yellow Emperor asked: The sages of high antiquity made Tangye and Liaoli, but having made them, they did not use them. Why was this?
Qi Bo said: The sages of antiquity made Tangye and Liaoli merely as reserves. People of high antiquity made Tangye, and therefore made it but did not drink it. By the time of the middle ages, people's virtue had declined somewhat, and evil qi (pathogenic abnormal qi) would from time to time invade the body; at this time, taking Tangye and Liaoli was sufficient to preserve health and well-being.
The Yellow Emperor asked: In the present age, even after taking them, recovery is not guaranteed. Why?
Qi Bo said: In the present age, one must combine du yao (drugs with aggressive properties) to attack internally, and use chan shi (sharp stone needles) and zhen ai (acupuncture and moxibustion) to treat externally.
The Yellow Emperor asked: If the body is failing and the blood is exhausted, and yet treatment still shows no effect, what is the reason for this?
Qi Bo said: It is because the spirit does not actuate — the spiritual will no longer fulfills its unifying role.
The Yellow Emperor asked: What does "the spirit does not actuate" mean?
Qi Bo said: The treatment of needle and stone is a "Way." If the spirit cannot gather and guard within, and the will cannot become harmonious and settled, then disease naturally cannot be cured. Now when the essential qi has already been ruined and the spirit qi has already scattered, the rong wei (the refined substances operating within the body and the defensive qi, namely nutritive qi and defensive qi) can no longer be restored or gathered. Why is this? Because desires are without limit, and worries and distress never cease, the essential qi loosens and decays, nutritive qi becomes sluggish, and defensive qi dissipates. Thus the spirit departs, and the disease cannot be cured.
The Yellow Emperor said: When disease first arises, it is extremely subtle and extremely fine; it must first invade and gather in the skin. Now eminent physicians all say: The disease has already formed, and they call it "contrary" (difficult to reverse); needle and stone cannot treat it, and good medicines cannot reach it. But these eminent physicians have mastered the method and hold to the standards; news from relatives and brothers, near and far, is heard daily in their ears, and changes in complexion are observed daily with their eyes — yet the disease still does not heal. Is this not a failure to treat early enough?
Qi Bo said: The disease is the root, the physician is the branch — the patient's own state is fundamental, and the physician's treatment is auxiliary. If root and branch do not align, evil qi will not be subdued. This is exactly what is being spoken of here.
The Yellow Emperor asked: Sometimes disease does not begin at the fine body hair, but rather the yang qi of the five organs is already exhausted, fluids fill the body cavities, the po (the aspect of spirit activity associated with the physical body) dwells alone within, essential qi is left solitary within, qi is consumed externally, and the body swells so that clothing cannot be worn — this is extreme distension of the four limbs with internal agitation; this is qi bound within and the body transformed without. How should this be treated?
Qi Bo said: Use the method of quan heng (balancing and weighing) to treat and regulate: qu yu chen cuo (dispel the stale and accumulated products within the body), gently move the four limbs, wear warm clothing, use miu ci (crosswise acupuncture — needling left for right and right for left) at the corresponding sites, in order to restore the body. Kai gui men (open the sweat pores, i.e., promote sweating method), and jing jing fu (purify the bladder, i.e., promote diuresis method), so that essential qi is distributed at the proper times, the yang qi of the five organs is spread forth, and the five organs are dredged through and washed clean. Thus essential qi is naturally generated, the body naturally becomes full, bones and flesh protect each other, and the great qi (the major qi of the body, upright qi) can be restored to calm. The Yellow Emperor said: Well said.
① "Prepared but not used" and the view of change across eras
The opening of this chapter, through the "made but not consumed" nature of Tangye and Liaoli, sketches a historical picture of human constitution and disease patterns evolving through the ages: people of high antiquity had balanced qi and blood, requiring no medicine; people of the middle ages were attacked by evil qi from time to time, and Tangye was enough to handle it; people of the present age require toxic medicines, needles, and moxibustion treating both internally and externally. This is not a simple lament that "the present is inferior to the past," but rather a dynamic view of prevention and treatment — the intensity of therapeutic measures should correspond to the body's current capacity for tolerance and the depth of the pathogenic evil. Tangye and Liaoli here serve as a concrete expression of the idea of "nourishing health with preparedness": they are stored in peacetime and used when illness arises.
② "The spirit does not actuate" — the fundamental bottleneck in treatment failure
Qi Bo here sets forth an extremely profound proposition: medicines, needles, and stones are only vessels of the Way; if the patient's spiritual will cannot participate, treatment cannot take effect. The text explains "the departure of the spirit" through "unlimited desires and unceasing worries and distress" — prolonged emotional depletion leading to the relaxation of essential qi and the failure of rong and wei to be gathered. This discussion reveals a core medical principle: the integration of essence, qi, and spirit is the precondition for recovery from disease. The body (xing) and the spirit (shen) must be a unified object of treatment; the physician treats the "body," but the participation of the "spirit" lies with the patient themselves.
③ "The disease is the root, the physician is the branch" — the medical philosophy of root-branch relations
"The disease is the root, the physician is the branch" is another famous statement of many generations in this chapter. Here "the disease" refers to the patient's own state (including upright qi, emotions, and lifestyle habits), while "the physician" refers to the physician's technical interventions. Qi Bo's response directly addresses the Yellow Emperor's question: even if the physician has mastered the method and held to the standards, observed daily and cared always, if the fundamental state of the patient has not changed, the evil qi will still not be subdued. Treatment is a collaboration between physician and patient, not a one-sided application by the physician alone.
④ "Open the ghost gate, purify the nether house" — the ancestral source of the great methods for edema
The description at the end of the chapter of "fluid abundant and filling the cavities" and "the four extremities extremely distended, moving the interior" is highly consistent with what is today called severe edema/fluid retention. Qi Bo's treatment method of "opening the ghost gate" and "purifying the nether house," namely promoting sweating together with promoting diuresis, became the two foundational approaches for treating water-related diseases in later generations of Chinese medicine (for example, Zhang Zhongjing's statement in the Jingui Yaolue "swelling above the waist responds to sweating; swelling below the waist responds to promoting urination" directly inherits this framework). The integration of "wearing warm clothing" and "gently moving the four limbs" additionally embodies the overall approach of warming yang and moving qi and blood, rather than simply draining water.
Concerning rice and brewing: The ancients selected rice for the production of Tangye and Liaoli, emphasizing "the harmony of Heaven and Earth" and "appropriateness of elevation," which is fundamentally a naive recognition of the relationship between raw material quality and the growing environment. Modern science confirms that the nutritional components of rice (such as starch, protein, and B vitamins) are indeed influenced by strain, water, soil, climate, and harvest timing. The fermented wine Liaoli, whose trace alcohol helps extract certain active ingredients, shares common principles with solvent extraction in modern pharmacology.
Concerning "the spirit does not actuate": This discussion highly echoes the discoveries of modern psychoneuroimmunology (PNI) . Extensive research shows that long-term stress, anxiety, depression, and other emotional states inhibit immune function and reduce the body's capacity for repair through the hypothalamic-pituitary-adrenal (HPA) axis. The patient's belief in treatment and positive mental state (what modern medicine calls "treatment engagement") do indeed affect prognosis. Of course, the ancients using "the departure of the spirit" to explain all treatment failure has its historical limitations — today we know that many diseases, even with proper mental adjustment, still require surgery, medication, and other precise interventions.
Concerning "the disease is the root, the physician is the branch": This aligns closely with modern medicine's emphasis on patient-centeredness and shared decision making. Treatment outcomes depend not only on the physician's skill, but also on the patient's adherence, lifestyle changes, and self-management abilities.
Concerning the treatment of edema: In modern medicine, "opening the ghost gate" (sweating) and "purifying the nether house" (promoting diuresis) correspond to eliminating excess fluid through the skin and kidneys, the two excretory routes. Diuretics are among the core tools for clinically managing edema in modern medicine, and moderate sweating promotion (such as heat therapy or sauna) does have a modest auxiliary effect in certain mild fluid retention cases. However, it must be made clear: the causes of severe edema (cardiogenic, renal, hepatic, and others) must be definitively diagnosed through modern medicine. The ancient framework of "fluid abundant and filling the cavities" cannot replace modern etiological analysis.
Associated Concepts
Extended Reading
This content is based on the classical texts of traditional Chinese medicine and is provided solely for the study of traditional culture and classical text research; it does not constitute any medical diagnosis, medication recommendation, or treatment advice; if you are unwell, please seek medical attention promptly.