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Hemiplegia (bi-limb paralysis), occurring when sweat is exposed to dampness, leads to the generation of *cuo fei* (acne miliaris/sweat rash). Changes resulting from a diet rich in rich and sweet foods can cause large *ding* (severe carbuncles) to grow on the feet. Pathogenic invasion in this state is like holding an empty vessel; if wind strikes while laboring and sweating, cold constrains the skin, leading to stagnation and the formation of acne vulgaris (described by Wang Bing as accumulation; resembling rice grains or needles, small pustules) and small boils. The Yang Qi, when refined, nourishes the Shen (Spirit); when soft and flexible, it nourishes the Jin (Tendons/Sinews). If the opening and closing of the pores are dysfunctional, Cold Qi enters with it, resulting in severe kyphosis (*da lou*). If Ying Qi (Nutritive Qi) does not flow smoothly and rebels within the muscle tissue, abscesses and swellings occur. Pathogens sinking into the meridians form fistulas, lingering in the muscle layers; when Qi transformation is constrained, it transmits to cause excessive fear and惊骇 (startle/panic). (Note: The twelve characters "Ying Qi does not flow smoothly, rebels within the muscle tissue, resulting in abscesses and swellings" were erroneously placed after "and startle/panic" in older editions. In reality, Yang Qi loses its defensive function, allowing Cold to enter causing kyphosis; then Ying Qi rebels causing abscesses; untreated abscesses allow pathogens to sink into meridians forming fistulas that linger in the muscle layers. *Lou*, pronounced lǚ, refers to the back being bent forward and unable to straighten.) When Po Han (night sweats or cold sweats) are not fully resolved, the body becomes weak and Qi is scorched by heat; acupoints and Shu points become blocked, triggering Feng Nue (Wind Malaria). Therefore, Wind is the beginning of all diseases. If one maintains purity and stillness, the muscle texture closes and resists pathogens; even strong winds and severe toxins cannot harm the body, which is following the order of the seasons. If a disease persists for a long time, it transforms and spreads; if the upper and lower Jiao do not communicate, even a good physician cannot help. Thus, excessive accumulation of Yang Qi leads to death; Yang Qi should be unblocked, and blockage requires purgation. Without prompt correct treatment, incompetent physicians will worsen the condition. (From *Sheng Qi Tong Tian Lun*)

The Emperor said: I know that all diseases arise from Qi dysfunction. Anger causes Qi to rise upward; Joy causes Qi to relax; Sorrow causes Qi to dissipate; Fear causes Qi to sink downward; Cold causes Qi to contract; Heat causes Qi to leak out; Startle causes Qi to become chaotic; Labor causes Qi to be exhausted; Thought causes Qi to knot. These nine Qi changes differ; what diseases do they produce? Qibo replied: Anger causes Qi to rebel; severely, it leads to vomiting blood and undigested diarrhea, hence Qi rises. Joy makes Qi harmonious and will reached, Ying and Wei (Defensive Qi) flow freely, hence Qi relaxes. Sorrow makes the Heart Meridian tight and Lung leaves elevate, blocking the Upper Jiao, preventing Ying and Wei from dispersing, trapping heat in the center, hence Qi dissipates. Fear causes Essence to retreat; retreat blocks the Upper Jiao; blockage causes Qi to return; returning Qi causes Lower Jiao distension, hence Qi fails to move. Cold closes the pores, obstructing Qi movement, hence Qi contracts. Heat opens the pores, allowing Ying and Wei to flow freely with profuse sweating, hence Qi leaks. Startle leaves the Heart without support, the Shen without refuge, and thoughts without certainty, hence Qi becomes chaotic. Labor causes panting and sweating, with internal and external Qi escaping outward, hence Qi is exhausted. Thought keeps the mind focused and Shen anchored, causing Zheng Qi (Upright Qi) to stagnate and not move, hence Qi knots. (From *Ju Tong Pian*)

At forty years of age, Yin Qi naturally halves, and daily activities decline. (From *Yin Yang Ying Xiang Lun*)

Yin Qi, when quiet, stores the Shen; when restless, the Shen perishes. Doubling food intake injures the stomach and intestines. (From *Bi Lun*)

Yin is generated from the Five Flavors. The five palaces (organs) governing Yin are injured by the Five Flavors. (From *Sheng Qi Tong Tian Lun*)

[Li Dongyuan] In *Lao Juan Suo Shang Lun* and *Tiao Jing Pian*, it is stated: Injury to Yin Qi generates internal heat. Qibo said: With labor and fatigue, the form and Qi decline, Gu Qi (Grain Qi) becomes insufficient, the Upper Jiao fails to circulate, and the Lower Wan (stomach outlet) is blocked. Stomach Qi becomes hot, and heat steams the chest, generating internal heat. *Ju Tong Lun* states: Labor exhausts Qi; labor causes panting and sweating, with internal and external Qi escaping, hence Qi is exhausted. If anger and joy are unregulated, and daily life irregular, combined with labor and fatigue, Qi is damaged. Decline leads to Fire flourishing; flourishing Fire attacks Spleen Earth. Since the Spleen governs the four limbs, the person feels weary and hot, lacks energy to move, is lazy to speak, pants and fatigues with movement, has surface heat and spontaneous sweating, and feels vexed and uneasy. During illness, one should sit quietly to nourish Qi, use Sweet-Cold herbs to clear fire-heat, use Sour flavors to gather scattered Qi, and use Sweet-Warm herbs to regulate Middle Qi. The Classics say "Labor requires warming" and "Deficiency requires warming." Zhang Zhongjing said: A normal person with a large pulse suffers from labor; an extremely deficient pulse also indicates labor. The pulse in labor disease is floating and large, with vexed heat in hands and feet, worsening in Spring/Summer and improving in Autumn/Winter. A large pulse indicates pathogenic heat; extreme deficiency indicates Qi damage. Worsening in Spring/Summer is due to seasonal aid to pathogens; improvement in Autumn/Winter is due to seasonal suppression of pathogens. Use Huangqi Jianzhong Tang to tonify, which is also a method of "warming." The sages of antiquity regulated their diet, maintained regular routines, and did not overexert themselves, thus maintaining unity of form and Shen, living out their natural lifespan to a hundred years, which is treating disease before it arises. Since the middle antiquity, far from the sages, people have had irregular diets, improper routines, and excessive labor, injuring both form and Shen, so they treat disease with medicine only after it arises, which is treating existing disease. Tracing the source of all diseases, they stem from dietary and labor injuries causing Stomach Qi and Yuan Qi (Source Qi) to scatter, failing to nourish the hundred vessels, irrigate the Zang-Fu organs, and protect the body. Therefore, Heaven's Qi values purity, and Yang Qi dislikes vexation and labor. Can one not be cautious regarding diet, emotions, climate, and routine? Above is Li Dongyuan's *Lao Juan Suo Shang Lun*. My other discussions are found in the entry for Buzhong Yiqi Tang under methods for treating deficiency and excess.

*[Su Wen]* Pathogens arise either from Yin or from Yang. Those arising from Yang come from wind, rain, cold, and summer heat; those arising from Yin come from diet, dwelling, and emotional fluctuations (Yin/Yang anger and joy). (From *Tiao Jing Lun*)

Here, Yin and Yang refer to internal and external factors, summarizing injuries to Yin/Yang, form, and Qi. Mr. Dongyuan referred to these as internal and external injuries. Injuries from diet, emotions, etc., belong internally as Yin; injuries from cold, warmth, wind, and dampness belong externally as Yang.

*[Ling Shu]* The onset of all diseases stems from wind, rain, cold, summer heat, emotional fluctuations, diet, dwelling, sudden fright, and abrupt fear. These cause separation of Blood and Qi, disintegration of Yin and Yang, interruption of meridians, blockage of pulse channels, reversal of Yin and Yang, stagnation of Wei Qi, emptiness of meridians, disorder of Blood and Qi, and loss of normal function. (From *Kou Wen Pian*)

*[Su Wen]* Anger and joy injure Qi; cold and summer heat injure Form; violent anger injures Yin; violent joy injures Yang. Jue Qi ascends, filling the vessels and detaching from the form. Unregulated anger and joy, excessive cold and heat, lead to unstable life. (From *Yin Yang Ying Xiang Lun*). Cold injures Form, Heat injures Qi; Qi injury causes pain, Form injury causes swelling. Therefore, pain preceding swelling indicates Qi injuring Form; swelling preceding pain indicates Form injuring Qi. (These two sections seem contradictory: why say Anger/Joy injure Qi but also Violent Anger injures Yin/Violent Joy injures Yang? Why say Cold/Heat injure Form but also Cold injures Form/Heat injures Qi? Although statements vary, the principle converges. Anger and joy affect from within, starting with Qi, hence "Anger/Joy injure Qi." Cold and heat invade from outside, attaching to Form first, hence "Cold/Heat injure Form." Specifically, Anger's Qi rises from below, affecting Yin first, hence "Violent Anger injures Yin"; Joy's Qi descends from above, affecting Yang first, hence "Violent Joy injures Yang." In cold, human Qi stores internally, so Cold attaches to Form first, hence "Cold injures Form." In summer heat, human Qi flows externally, so Heat attaches to Qi first, hence "Heat injures Qi.")