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Suwen 5 Translation of Section 1 plus notes

黃帝內經素問陰陽應象大論篇第五》

Suwen 5: Great Discourse on the Responsive Manifestations of Yin and Yang

 

(一)黃帝曰︰陰陽者,天地之道也,萬物之綱紀,變化之父母,生殺之本始,神明之府也

1) The Yellow Emperor said: “As for yin and yang, they are the Dao of heaven and earth, the lead rope and netting of the myriad things, the father and mother of alterations and metamorphoses, the root and beginning of giving and taking life, and the palace of the shenming.

          The importance of this chapter is underscored by the fact that the title describes it as a “Great Discourse”! Besides the seven Suwen chapters that Wang Bing added later, only two chapters in the Suwen are titled 大論 “great discourse,” namely the present one and chapter 2 (四氣調神大論 Great Discourse on Attuning the Shen in Accordance with the Four Qi).

          神明: I have left this term untranslated because it is too complex of a concept to convey in a single combination of English words. To offer just one possible approach, note these two definitions: 陰陽不測謂之神 "what is immeasurable / intangible in yin and yang is called shen"; 事物照章謂之明 "what is clearly apparent from the outside in affairs and things is called ming."

          綱紀: These are two technical terms referring to the two types of rope that make up a fishing net, one the stronger guide rope on the top to encircle and enclose the net and the other the smaller strands that form the actual net. The expression here refers to the general principles for understanding the universeand the detailed standards to measure specific manifestations thereof, respectively.

 

(二)治病必求于本。

2) To treat disease, we must seek out its root.

          治病必求于本。The meaning of the term “root” here is not completely clear but depends on context. To give just two examples how this line has been interpreted throughout history, "root" can refer to the six qi 六氣 (the six climatic factors), or to chronic, old conditions as opposed to newly emerging “tip” (biǎo ) manifestations.

 

(三)故積陽為天,積陰為地。陰靜陽躁,陽生陰長,陽殺陰藏。

3) Therefore, yang accumulated becomes heaven, and yin accumulated becomes earth. Yin stills and Yang agitates; yang gives life and yin promotes growth; yang takes life and yin withdraws into storage.

          變化 "Alterations and metamorphoses”: A reference to two types of change, namely hua-type sudden irreversible substantial change (such as from the pupa to the butterfly) and bian-style gradual, slow alteration (such as between yin and yang, day or night, water or ice, or seasonal changes). In Chinese commentaries, these two types are explained like this: 物之漸,謂之變;物之極,謂之化  (Gradual [change] of things is called bian, the extreme poles of things is called hua.) Another way to think of these two types of change in English may be as permutations and transmutations. It might also help to associate with yang-type change, such as in the creation of the cosmos, and with yin-type change, such as the innumerable and never-ending changes that are the characteristic of the material realm in the cycle of the Five Phases and Yin and Yang. The most commonly cited examples of hua-type change are perhaps found in the Zhuangzi: the metamorphosis from the fish Kun to the bird Peng, or from the dreaming Zhuangzi himself to the butterfly.

          陰靜陽躁: This expression, and its longer extrapolation 動則生陽;靜則生陰 (“agitation results in generating yang; stillness results in generating yin”), is important for treatment and such practices as qigong, but also for diagnosis, in the sense that agitated patients tend to suffer from yang diseases and still patients from yin conditions.

 

(四)陽化氣,陰成形。

4) Yang transmutes qi; yin completes the physical form.

          Yang disperses wei qi and hence acts on qi. Yin completes the physical form, such as essence, blood, flesh, and other yin materials. In clinic, we use warming medicinals to tonify yang. Cases of yin deficiency mean that the physical body () is incomplete, as in congenital deficiencies in newborn babies, which should be treated with Liuwei Dihuang Wan 六味地黃丸.

 

(五)寒極生熱,熱極生寒。寒氣生濁,熱氣生清。清氣在下,則生飧泄;濁氣在上,則生脹。

5) Extremes of cold engender heat; extremes of heat engender cold. Cold qi engenders turbidity; heat qi engenders clarity. When clear qi is located below, it engenders diarrhea with undigested food particles; when turbid qi is located above, it engenders swelling and distention.

          寒極生熱…: This phrase does not refer to the medical phenomenon of false heat or false warmth, where yang that is getting pushed up and out can temporarily cause superficial heat as the result of deep internal cold, leading to a hot head, flushed cheeks etc. Another example of this would be a yangming fu pattern where heat is locked inside but cannot effuse to the outside, causing false cold symptoms in the exterior. Instead, the present line refers to diseases in their critical stage, which in contemporary Western practices are generally sent to the emergency room rather than the acupuncturist’s office. In malaria, for example, we see lots of chills and cold symptoms at first, but when these develop into the extreme, they turn into fever and other heat symptoms. Similarly, in babies with severe high temperatures, we see the body turning cold.

          When we apply the same phrase to the natural world, the alternating changes of yin and yang are easily measurable and observable. During the three 15-day seasonal nodes that follow the summer and winter solstices, namely 夏至,小暑,大暑 (summer solstice, small heat, and great heat) and 冬至,小寒,大寒 (winter solstice, small cold, and great cold), the foundations are laid for the reversal of weather and the return of cold or heat thereafter. As this example shows, it is important that we read yin and yang first as laws of nature and only secondly as a philosophy. As a third step, we can then interpret them as medical concepts that demonstrate the concrete applications of the Dao of nature at the site of the human body, to be experienced concretely and personally.

          清氣在下,則生飧泄;濁氣在上,則生䐜脹: Heat from the spleen and stomach causes clear qi to ascend to the lung and facilitate the sprinkler function of the lung there, while turbid qi is supposed to descend. When this direction is reversed and clear qi descends instead, this indicates pathology, manifesting in diarrhea.

          飧泄 sūn xiè: The character can mean “supper,” but originally means to soak rice in water to prepare it for cooking. The term here refers to a type of diarrhea that looks like that, an outpouring of only partially digested food. This indicates a weakening and dropping of center qi, manifesting in inadequate functioning of the spleen/stomach. As the result, they fail to extract the subtle essences (jingwei 精微) from food and drink and transport them to the upper body, instead eliminating them in the stool.

          䐜脹 chēn zhàng: Both of these characters refer to an inflated, bloated appearance, usually explained as an indication of impaired lung function and resulting accumulation of fluids. Here, it is explained as turbid qi rising, due to the inability of the intestines to push food down to the rectum, so that it ascends to the middle jiao and causes congestion in the rib-sides and chest. For these kinds of conditions, Li Dongyuans 李東垣 focus on promoting the raising of clear yang qi by regulating the spleen and stomach and thereby causing turbid yin qi to descend naturally may be an ideal choice. Buzhong Yiqi Tang 補中益氣湯 represents this treatment approach. An option for babies or seniors with digestive issues may be Shen Ling Baizhu San 參苓白朮散, while qi-moving prescriptions may aggravate such conditions instead of strengthening the spleen and stomach.

 

(六)此陰陽反作,病之逆從也。

6) These are the contrary actions of yin and yang, and the manifestations of disease that go against the proper course of things.

          According to most commentators, here should be read as , to turn something upside down, the opposite of what it is supposed to be like. 逆從 has been interpreted in different ways by commentators, either as a pair of verbs that describe movement in opposite directions, or specifically as welcoming and sending off (see Lingshu 1 for this usage, there referring to the movement of the blood and qi in the vessels and the physician's response), or thirdly as going against what is proper or healthy, with being parallel to in the previous phrase.


Note: This blog post is based on a class that I am currently team-teaching with Dr. Long Rihui at the School of Classical Chinese Medicine, National College of Natural Medicine in Portland (OR). My notes are a combination of my knowledge, several historical Chinese and Japanese commentaries, and Dr. Long' teachings.

Sabine Wilms1 Comment