Chapter 1, Section 1 of the Essentials of the Golden Chamber
Section 1
Question: What does it mean for a skilled physician to treat diseases before they manifest? The Master replied: To treat diseases before they manifest means to recognize liver diseases and understand that the liver transmits to the spleen, thus one must first strengthen the spleen. When the spleen is strong in all four seasons, it is not affected by pathogens, and therefore does not need to be supplemented. A mediocre physician does not understand this transmission; upon seeing liver disease, they only treat the liver. For liver diseases, sour herbs are used to tonify, bitter herbs are used to assist, and sweet herbs are used to harmonize. Sour enters the liver, bitter enters the heart, and sweet enters the spleen. The spleen can harm the kidneys; if kidney qi is weak, water does not flow; if water does not flow, heart fire becomes excessive, which harms the lungs; if the lungs are harmed, metal qi does not flow; if metal qi does not flow, liver qi becomes excessive, and the liver heals itself. This is the essential method of treating the liver by tonifying the spleen. If the liver is deficient, this method is used; if it is excessive, it is not applied. The classics say: Do not confuse deficiency and excess; supplement what is insufficient and reduce what is excessive. This is the principle. The same applies to other organs.
Introduction: The “Essentials of the Golden Chamber” is edited according to the classification method in Liu Duzhou’s commentary on the “Essentials of the Golden Chamber”. Annotations are primarily selected from works of Qing Dynasty and modern physicians, and due to personal understanding, there may be biases. Readers are encouraged to extract the essence and discard the dross, combining it with clinical practice and focusing on self-understanding. Comments and contributions of famous discussions or personal annotations are welcome!
Qing Dynasty, You Yi, “Heart Classics of the Essentials of the Golden Chamber”
According to the “Suwen”, it is said: When evil qi invades the body, it adds to the existing conditions. The liver corresponds to wood and overcomes the spleen’s earth; thus, it is known that liver disease will transmit to the spleen. Strengthening the spleen means assisting the qi to be strong, preventing it from being affected by evil, which is the so-called treatment before disease manifests. If one does not understand this and only treats the liver, then the liver disease will not resolve, and the spleen disease will arise again. Is this the work of a skilled physician? For liver diseases, sour herbs are used to tonify; if the liver is insufficient, it is supplemented with its corresponding flavor, which differs from the “Neijing”‘s view of using pungent herbs for supplementation. However, the liver is a yin organ and contains vital energy; thus, using pungent herbs assists its function, while using sour herbs nourishes its body. Although the words differ, the principles are appropriate.
Assisting with bitter herbs, as mentioned in “Qianjin”, refers to the heart’s qi being affected by the liver. Using sweet herbs to harmonize means that the people of Yue refer to reducing the liver’s burden as alleviating its internal pressure.
The section on sour entering the liver and the following fifteen sentences are suspected to be later additions, mistakenly included by the compiler. The essence of Zhang Zhongjing’s treatment of the liver and tonifying the spleen lies in ensuring the spleen is strong and not affected by liver evil, rather than tonifying the spleen at the expense of the kidneys, or allowing fire to punish metal. If this were the case, what is preserved would be minimal, while what is harmed would be excessive. Moreover, if the spleen is tonified, the lungs will naturally become strong; if the kidneys are harmed, they will be deficient and affect their offspring. How can one control the strong wood over the earth? A careful analysis of the language reveals that the discussion of liver disease in the following nine sentences answers the question of treating diseases before they manifest; the three sentences on using sour herbs are a separate method for treating liver deficiency. The text states: If the liver is deficient, this method is used; if it is excessive, it is not applied. It can be seen that only deficient organs are affected by disease, while excessive organs are not. Therefore, when treating liver excess, one must first strengthen the spleen’s earth to prevent the disaster of excessive growth; when treating liver deficiency, one directly tonifies the root palace to prevent external invasion. This is the essence of Zhang Zhongjing’s approach to addressing both deficiency and excess.
Qing Dynasty, Wu Qian, “Medical Canon of the Golden Mirror”
[Note]
This follows the previous section on the three causes of disease to clarify its treatment. A skilled physician is a good doctor. A mediocre physician is an ordinary doctor. A disease that has already manifested is an existing disease; a disease that has not yet manifested is a potential disease. For example, if there is currently liver disease, this is an existing disease; if liver disease is about to transmit to the spleen, this is a potential disease. A good physician knows that liver disease transmits to the spleen; when seeing a patient with liver disease, they first assess the seasonal strengths and weaknesses, then examine the spleen’s earth for deficiency or excess. If the spleen is strong and not affected by liver evil, they know not to supplement the spleen and directly treat the existing liver disease; if the spleen is weak, they know the liver will definitely transmit to the spleen, so they first tonify the spleen before treating the existing liver disease. The mediocre physician does not understand the seasonal victories and the principles of the five organs transmitting to each other; upon seeing liver disease, they only drain the existing liver without understanding the need to tonify the spleen that has not yet manifested as a disease.
A skilled physician not only knows that liver excess must transmit to spleen deficiency but also understands that liver deficiency does not transmit to spleen deficiency but rather receives lung evil. Therefore, when treating liver deficiency and spleen deficiency, sour herbs are used to enter the liver to tonify the existing liver, bitter herbs are used to enter the heart to assist the healthy heart, and sweet herbs are used to enter the spleen to benefit the deficient spleen. This allows fire to generate earth, and earth to control water; if water is weak, fire is strong; if fire is strong, it controls metal; if metal is controlled, wood does not receive evil, and the liver disease heals itself. This is the principle of excess harming deficiency, and the treatment of alternating conditions, hence it is said: This is the essential method of treating the liver by tonifying the spleen. However, if the liver is deficient, this method is used; if the liver is excessive, this method is not used. The mediocre physician does not understand deficiency and excess; the deficient should be drained, which is called deficiency deficiency; the excessive should be supplemented, which is called excess excess. This is not its meaning. A skilled physician knows deficiency and excess, supplements what is insufficient, and reduces what is excessive. This is its meaning. The same applies to the other four organs. The character for harm should be viewed as control.
[Collected Annotations]
XU Bin said: If there is a disease in the liver meridian, where liver wood overcomes spleen earth, it is known that the evil must transmit to the spleen, and the treatment should prioritize strengthening the spleen, which is the method of treating diseases before they manifest. Do not worry about the deficiency of the root organ, but rather worry about the transmission that does not cease, as the disease deepens, hence the urgent need to strengthen the spleen.
CHENG Lin said: The classics say: Respond to the light by enhancing it, respond to the heavy by reducing it, respond to the weak by highlighting it. The so-called response means to take advantage of the opportunity. Treating diseases before they manifest refers to treating the organs that have not yet manifested disease, not treating the person who has not yet manifested disease. When seeing liver disease, one should first strengthen the spleen, so that the earth is strong enough to overcome water; if water does not flow, fire will be strong, and if fire is strong, it will control metal, allowing the liver to heal itself. This is the method of treating the liver by tonifying the spleen and preventing diseases before they manifest.
GAO Shishan said: Strengthening the spleen specifically controls water, allowing fire to flourish and metal to weaken; if the liver is not controlled, the liver will heal itself. The principle is very subtle, hence it is said: This is the essential method of treating the liver by tonifying the spleen.
Qing Dynasty, Gao Xueshan, “Annotations on the Essentials of the Golden Chamber”
This section discusses the internal and external causes of disease, as well as the causes of disease that are neither internal nor external. All subsequent twenty-four sections of evidence should be treated according to the method of treating diseases before they manifest. Speaking of one liver, the methods of tonifying other organs can be inferred, hence it is said “the other organs follow this method”. Speaking of tonifying the liver, the methods of draining other organs can also be inferred, hence it is said “supplement what is insufficient, reduce what is excessive”. A skilled physician treats diseases before they manifest, as stated in the ancient medical texts, Zhang Zhongjing specifically borrowed this for questions and answers to elaborate on the discussion. When observing liver disease, as the classics say, “In the early morning, it is clear; in the late afternoon, it is severe; at midnight, it is calm,” and also “The eyes are dull and cannot see. The ears cannot hear, and there is great fear,” as if one is about to be captured. This indicates that liver qi is already deficient, and it must carry the qi of the deficient wood to invade the spleen earth, leading to future spleen disease. The method should be to strengthen the spleen to treat the spleen’s potential disease. The earth is the king during the seasonal months; the qi of a person corresponds with the seasonal changes. During the seasonal months, the spleen qi is king and can maintain itself, hence there is no need for this example. The mediocre physician does not understand this, hence those who do understand are the skilled physicians. The answer has been completed; the following nineteen sentences further elaborate on the essence of strengthening the spleen. If the liver is excessive, such as pain under the ribs or fullness, irritability, and headache, or deafness, etc. The two sentences on “liver deficiency” are in agreement with the three sentences on the spleen being king in the four seasons. The previous text states that the king month cannot be supplemented; this statement on liver excess should not be supplemented; otherwise, it contradicts the principles of deficiency and excess. It is not the meaning of supplementing what is insufficient and reducing what is excessive. According to the “Suwen”, the five flavors correspond to the five organs; following them is draining, while opposing them is supplementing. Zhang Zhongjing uses sour to tonify the liver, bitter to assist the heart, and sweet to benefit the spleen, thus following them is considered tonifying, which contradicts the principles of the classics.
Not knowing that the “Neijing” uses opposition for supplementation, supplementing the spirit and will within the organs; Zhang Zhongjing uses following for supplementation, supplementing the qi and blood within the organs. When discussing wood, the wood’s nature prefers warmth and moisture; if one provides what it likes, the qi flows smoothly, and the essence flourishes. However, if the flowers and leaves are abundant, the essence within is scarce. Furthermore, what wood fears is cold, frost, and snow; if one controls what it fears, the branches may temporarily wither, but the roots’ spirit remains intact. This is the subtle use of the great sages and wise men, which learners can distinguish and follow.
Qing Dynasty, Huang Yuanyu, “Suspended Explanations of the Golden Chamber”
The five elements generate and control each other: liver wood overcomes spleen earth, spleen earth overcomes water, kidney water overcomes fire, heart fire overcomes metal, and lung metal overcomes wood. Controlling what it overcomes, hence the disease transmits. When observing liver disease, it is known that spleen earth is invaded, and one must first strengthen the spleen, which is called treating the disease before it manifests. When the spleen is strong in all four seasons, it does not receive evil, and thus does not need to be supplemented. The mediocre physician does not understand the principle of transmission; upon seeing liver disease, they do not understand the need to strengthen the spleen, only treating the liver, which leads to unresolved liver disease and a resurgence of spleen disease. The same applies to other organs.
Qing Dynasty, Cao Yingfu, “Subtle Explanations of the Golden Chamber”
This section uses the transmission of liver disease to clarify the principle of treating diseases before they manifest. If the liver’s blood is deficient, its leaves become dry and press upon the spleen; if the spleen’s qi is stagnant, it causes abdominal pain, leading to symptoms of acute abdominal pain. The “Shanghan Lun” states: Yang pulse is rapid, Yin pulse is wiry, and acute abdominal pain should first be treated with Xiao Jian Zhong Tang. The flavor of Gui Zhi Tang is originally sweet; adding honey enhances its sweetness. The “Neijing” states: “Liver is bitter and urgent; urgently consume sweet to alleviate it,” which is the same as tonifying the spleen. The spleen does not need to be rigidly adhered to the four seasons, but rather during the time when damp earth is abundant.
In the long summer, use Xiao Jian Zhong for bloating, hence it is said not to supplement. The mediocre physician does not understand that the liver’s blood deficiency is the cause and uses sweet flavors to tonify the spleen, mistakenly believing that Xiao Jian Zhong Tang is the only method to treat the liver and tonify the spleen, which is a great error. The liver’s primary flavor is sour, while it contains bile, which is bitter. The liver and stomach reside below the diaphragm, and the stomach is the source of blood production; the liver and gallbladder’s fluids seep into the stomach and can aid digestion. Cold leads to sour vomiting, which is the liver’s fluid; heat leads to bitter vomiting, which is the gallbladder’s fluid. The key is that if the stomach qi is not harmonious, it cannot nourish the blood stored in the liver, and if dampness prevails, the liver and gallbladder will be unregulated, leading to frequent vomiting. Therefore, the so-called tonifying with sour and assisting with bitter refers to the use of Wu Mei Wan. However, the bitter should be understood as warm bitter; using the sour of Wu Mei combined with the warmth of Xi Xin, Gan Jiang, Shu Jiao, Gui Zhi, and Fu Zi, along with the bitter dryness of Huang Lian and Huang Bai, will warm the stomach, transform dampness, and regulate the liver and gallbladder. Furthermore, if there is stomach deficiency and cold, leading to dry heaving and vomiting of saliva, then the use of warm bitter Wu Zhu Yu Tang should be employed, without using sour to tonify, as this indicates the initial onset of cold dampness, and the liver is not yet deficient, thus only the stomach’s yang needs to be assisted to stop the vomiting. If one uses sweet flavors to harmonize, it specifically refers to the use of Jian Zhong Tang. The above three methods are all designed for liver deficiency. In all diseases, deficiency leads to cold, while excess leads to heat; hence there are cases of the liver invading the spleen, the liver invading the lungs, and cases of deep heat leading to downward movement; there are also cases of liver excess and blood heat. Heat leads to heavy downward movement, and Bai Tou Weng Tang is used. If one does not inquire about deficiency and excess, but universally uses Jian Zhong Tang to treat the liver and tonify the spleen, without considering bloating, one may also suffer from irritability. Hence it is said: Do not use it indiscriminately. “No excess excess, no deficiency deficiency; supplement what is insufficient, reduce what is excessive” is an ancient text from the “Neijing”, as seen in Bian Que’s “Nan Jing”. The section from “Sour enters the liver” to “the essential method” discusses the erroneous theories of the mediocre physician, which are not crucial and are specifically omitted, following Huang Kun’s “Suspended Explanations”.
Qing Dynasty, Shen Mingzong, “Zhang Zhongjing’s Essentials of the Golden Chamber”
This question and answer regarding the diseases of the five organs should align with the treatment of deficiency and excess according to the seasons. By observing, listening, questioning, and palpating, one can foresee the transmission of changes and the auspicious or inauspicious outcomes, hence this is the work of a skilled physician. The treatment of diseases before they manifest means that the current disease is treated as if it were already present; the evil qi overcomes the strong, leading to future diseases, such as liver disease transmitting to the spleen, spleen disease transmitting to the kidneys, kidney disease transmitting to the heart, heart disease transmitting to the lungs, and lung disease transmitting to the liver. This chapter highlights liver disease as an existing condition, preventing the potential invasion of wood over the spleen, hence one must first strengthen the spleen, allowing the spleen qi to be strong and the metal to also be king, ensuring that wood is balanced and does not invade the spleen earth. The mediocre physician does not understand the harm of the transmission of spleen earth; they do not understand the need to strengthen the spleen, only treating the liver, which leads to the wood evil invading the earth, causing a sudden onset of spleen disease. The classics state that coarse physicians are dangerous, believing they can attack, hence the disease is not resolved, and new diseases arise.
During the months when the spleen is king in the four seasons, if it does not receive the wood invasion, there is no need to supplement; if one mistakenly supplements, it violates the principle of excess and excess. This statement regarding the reality of the wood during the seasonal months should cultivate the earth’s yin to prevent the wood from invading the potential disease. The following clarifies the deficiency of wood, and one should also cultivate the earth’s yang to nourish the qi and blood, thus assisting the liver deficiency, allowing the liver qi to flourish and the fire to also be king, ensuring that the metal qi is balanced and does not invade the wood, which is also a method of treating diseases before they manifest. Later generations do not understand that Zhang Zhongjing’s teachings clarify the treatment of the five organs based on the liver’s deficiency and excess, and they mistakenly interpret liver excess as a general explanation, hence it is reiterated. The liver’s disease, when tonifying with sour herbs, is because the liver stores blood, and when blood is deficient, it is invaded by evil; thus, sour flavors belong to yin, nourishing the yin blood as the primary method. The classics state that when supplementing the upper and lower, one should follow it. Additionally, using bitter herbs to enter the heart nourishes the righteous, preventing the heart fire from stealing the mother’s qi for assistance. Sweet herbs are used to harmonize, as sweetness can enter the spleen, nourishing the qi and blood, and when the liver receives this nourishment, the metal is also balanced and does not harm the wood. The classics state that the assistant should be the minister, hence due to liver deficiency, sour enters the liver, bitter enters the heart, and sweet enters the spleen to harmonize. Sweet entering the spleen refers to sweet and warm products. It is also said that the spleen can harm the kidneys; if kidney qi is weak, water does not flow; if water does not flow, heart fire becomes excessive, which harms the lungs; if the lungs are harmed, metal qi does not flow; if metal qi does not flow, liver qi becomes excessive, and the liver heals itself. This highlights the interaction of seasonal evils and the principles of mutual control, where auspicious and inauspicious outcomes depend on momentary changes, hence the need to supplement the insufficient and reduce the excessive, which is the common practice of treating diseases. If the liver is excessive, mistakenly tonifying it will assist wood in invading the spleen, leading to potential diseases. This clarifies the liver’s deficiency and the violent harm of metal evil, hence allowing liver qi to flourish will lead to self-healing, reiterating the mutual discussion of previous and subsequent statements, hence it is said: This is the essential method of treating the liver by tonifying the spleen; if the liver is deficient, this method is used; if the liver is excessive, this method is not used. It is also emphasized that one must not confuse deficiency and excess; one should supplement what is insufficient and reduce what is excessive, which is the common practice for treating the deficiency and excess of the five organs, hence it is said: “The other organs follow this method.”
Discussion: The “Discussion on the Law of the Five Organs and Seasons” states: The liver is supplemented with pungent herbs and drained with sour herbs. This discussion states that sour is used for tonification; from this perspective, the ancient sages and wise men had different methods of supplementation and drainage; which is correct? Indeed, the “Neijing” discusses the cold and cool evils that invade and control the liver wood, leading to stagnation of qi and blood, which cannot extend; the liver is associated with wind and wood, its nature is warm and desires to disperse, hence pungent warm yang herbs are used to disperse evil, allowing the evil to depart and the righteous qi to recover, hence it is considered tonifying, which is a method of treating the qi division. The “Golden Chamber” discusses the liver’s storage of blood, with yin blood as the main component; due to yin blood deficiency, qi becomes excessive and transforms into fire, leading to qi dispersing and not gathering, inviting external wind as a disease, hence sour flavors belong to yin, nourishing yin blood and gathering the dispersing qi, allowing the evil to retreat, thus the disease manifests in yang, and is rescued by yin methods, hence it is said to use sour to tonify. Zhang Zhongjing clarifies the treatment from the blood division, which indeed supplements the “Neijing”‘s unmanifested conditions. However, when repeatedly analyzing the “Neijing”, it is evident that the five organs’ qi and blood all have methods of treatment based on their oppositions, hence it is reiterated. The liver stores blood, being the yang within yin, its nature is warm and desires to disperse. If blood is deficient, it should be treated with sour flavors to tonify; if blood is excessive, it should be treated with pungent flavors to disperse evil. If qi is deficient, it should be treated with warm qi to tonify; if qi is excessive, it should be treated with cool qi to disperse evil. The heart governs blood, being the yang within yang, its nature is hot and desires to soften. If blood is deficient, it should be treated with warm bitter herbs to tonify; if blood is excessive, it should be treated with pungent and sweet flavors to disperse evil. If yang is deficient, it should be treated with warm sweet herbs to tonify; if yang is excessive, it should be treated with cool qi to disperse evil. The spleen governs dampness, being the yin within yin, its nature is damp and desires to relax. If blood is deficient, it should be treated with sweet flavors to tonify; if blood is excessive, it should be treated with bitter flavors to disperse evil. If yang is deficient, it should be treated with warm sweet herbs to tonify; if yang is excessive, it should be treated with bitter and cold flavors to disperse evil. The lung governs qi, being the yin within yang, its nature is dry and governs qi, desiring to gather. If blood is deficient, it should be treated with sour flavors to tonify; if blood is excessive, it should be treated with pungent flavors to disperse evil. If qi is deficient, it should be treated with cool qi to tonify; if qi is excessive, it should be treated with warm qi to disperse evil. The kidney governs water, being the yin within yin, its nature is cold and its qi is firm. If yin is deficient, it should be treated with salty and cold flavors to tonify; if yin is excessive, it should be treated with sweet and warm flavors to disperse evil. If yang is deficient, it should be treated with warm qi to tonify; if yang is excessive, it should be treated with cold qi to disperse evil. This outlines the methods of treating the cold, heat, warmth, coolness, and dampness of the five organs, and when encountering the six evils, one should also consider the cold and heat of the evil qi and supplement or drain accordingly, without being rigid in the correct methods. Nowadays, people only discuss the treatment of the qi division’s cold and heat according to the “Neijing”, without exploring the blood division’s treatment methods in the “Golden Chamber”, hence it is reiterated.
Liu Duzhou, “Commentary on the Essentials of the Golden Chamber”
This section discusses the treatment principles of diseases from a holistic perspective.
There exists a relationship of generation and control among the five organs and six bowels; under normal circumstances, there is a mutual nourishing aspect, while in disease, there is a mutual controlling aspect. If one organ is diseased, it does not limit itself but can also affect other organs, and there are certain transmission patterns. Therefore, when treating diseases, one cannot only focus on the diseased organ but must also pay attention to the organs that are not yet diseased. So, how can one discern the organs that are not yet diseased to prevent the transmission of diseases? Zhang Zhongjing proposed the patterns of transmission of organ and meridian diseases, which solves this problem: for example, upon seeing liver disease, one knows that liver disease is most likely to transmit to the spleen. Therefore, when treating diseases, one should first strengthen the spleen, treating the spleen that is not yet diseased to prevent the transmission of disease to the spleen. This way of considering the problem is the level of a skilled physician. However, if during the four seasons the spleen is strong and does not receive liver evil, there is no need to use tonification methods for the spleen. Another perspective is that during the four seasons, if the spleen’s righteous qi is robust and not invaded by evil, then there is no need to rigidly adhere to the treatment of liver excess and spleen tonification. As for the general mediocre physicians, they do not understand the principles of treating liver excess and spleen tonification; upon seeing liver disease, they only know to treat the liver, not understanding the significance of tonifying the spleen, thus failing to eliminate the pathway for disease transmission. Only by understanding the patterns of disease transmission can one grasp the essentials of treating diseases before they manifest, thus achieving satisfactory therapeutic effects.
The above discusses the treatment patterns for liver injury leading to spleen excess, while liver deficiency can be divided into three treatment methods: that is, for liver deficiency, use sour to tonify, bitter to assist, and sweet herbs to harmonize. Sour flavors enter the liver, which can tonify the liver’s body, this is the first method. Bitter flavors enter the heart, making the heart’s qi strong and assisting the liver, this is the second method. Sweet herbs are used to tonify the spleen to control the kidneys, making kidney water weak and heart fire strong; if heart fire is strong, lung qi will also weaken, and the liver wood will not be controlled, thus the liver will flourish and heal itself, this is the third method. This method of treating the liver by tonifying the spleen contains subtle philosophy. In summary: for liver deficiency, use sour to tonify, which is the primary treatment method; assist with bitter to tonify heart qi, “the son can make the mother strong”; this is the secondary treatment method; sweet herbs enter the spleen, benefiting the spleen to overcome the kidneys, allowing fire to flourish and control metal, thus preventing lung metal from harming liver wood, this is the tertiary treatment method. In clinical practice, using these examples, one must clarify the above three treatment methods to improve medical standards.
Finally, the author quotes the text from the “Neijing”, pointing out that if the treatment of deficiency and excess is not conducted in this manner, it is inevitable to mistakenly use draining methods for deficiency and tonifying methods for excess, leading to treatment inversions. The correct approach should be to supplement the deficient and drain the excessive, which is the correct treatment method for deficiency and excess, and this applies to liver diseases, as well as to the heart, lungs, spleen, kidneys, and so forth, hence it is said: “The other organs follow this method.”
Hu Xishu, “Lectures on the Essentials of the Golden Chamber”
“Question: What does it mean for a skilled physician to treat diseases before they manifest?” The teacher replied: “To treat diseases before they manifest means to recognize liver diseases and understand that the liver transmits to the spleen, thus one must first strengthen the spleen.” What does it mean to treat diseases before they manifest? The answer below states that to treat diseases before they manifest, for example, when treating liver disease, if this liver disease is excessive, this is a statement of yin and yang and the five elements; the liver belongs to wood, and wood excess must overcome earth, which is the spleen. Therefore, when treating diseases before they manifest, upon seeing liver excess, one knows that the liver will definitely transmit to the spleen; although the spleen is not yet diseased, a skilled physician knows that the liver must transmit to the spleen because wood excess overcomes earth, hence one must first strengthen the spleen, even if the spleen is not yet diseased; on one hand, treat the liver, and on the other hand, one must first strengthen the spleen. Isn’t this treating diseases before they manifest?
Furthermore, there is another aspect: the seasons have their strengths and weaknesses; one must also understand the seasonal variations. “During the four seasons, the spleen is strong and does not receive evil.” The four seasons refer to spring, summer, autumn, and winter; the last eighteen days of each season are all times of strong earth, and this is based on the twelve earthly branches. You see, Zi, Chou, Yin, Chou belongs to earth, and among the three, there is always one; within three months, there is always one earth, and this earth is during the last eighteen days of each season, totaling seventy-two days. They divide the four seasons into five groups of seventy-two, hence the five elements and the yin-yang theory are organized this way, based on the Jiazi division.
Not dividing according to Jiazi, the ancients also divided it this way: wood is strong in spring, fire is strong in summer, earth is strong in long summer, metal is strong in autumn, and water is strong in winter. This is based on climatic conditions, which is the five movements of heaven; wind, heat, dampness, dryness, and cold. Heaven has five movements, and the earth has five elements; this is all an explanation of the yin-yang theory. Humans are influenced by the qi exchanges, and this is how they view it.
During the four seasons, the spleen is strong and does not receive evil; even if the liver is excessive, during the time when the spleen is strong, there is no need to supplement. To add a note, the original meaning here is that during this period, the spleen is already quite sufficient. A skilled physician treats diseases before they manifest; upon seeing liver disease, they must strengthen the spleen, even if the spleen is not diseased, they must treat it, thus treating diseases before they manifest is complete. However, there is one thing: sometimes there is no need to supplement, depending on the timing; if it coincides with the last eighteen days of the four seasons when the spleen is strong, there is no need to supplement.
“The mediocre physician does not understand the principle of transmission; upon seeing liver disease, they do not understand the need to strengthen the spleen, only treating the liver.” The mediocre physician refers to ordinary doctors, common physicians; they do not understand the principles of the five elements’ overcoming and the transmission of the five organs. “Upon seeing liver disease, they do not understand the need to strengthen the spleen; they only treat the liver.” They do not understand that liver disease can also cause spleen disease; they only look at the liver and treat the liver. This is primarily to say that skilled physicians know how to treat diseases before they manifest, while mediocre physicians do not understand, and the inferior physicians do not need to mention.