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18. When the Qi arrives in due season, the climate is peaceful and balanced; righteous Qi follows the mandate of Heaven and does not act recklessly. Excessive Qi arrives prematurely, its influence overflowing: it first penalizes that which controls it, then counter-attacks that which it controls. Deficient Qi arrives late; that which it controls acts recklessly, penalizing that which it generates, causing illness in the generated element, while that which controls it also takes advantage to invade.

[Note] "Arriving in due season" refers to the days when the Five Movements and Six Qi transition. When the time is right and the Qi arrives accordingly, this is called "Zheng Hua Ping Qi" (Correct Transformation and Balanced Qi), obeying the mandate of Heaven without reckless action. If the Qi arrives before the season, indicating an excess of incoming Qi, it is termed "Tai Guo" (Excess) or "Qi Yin" (Qi Overflowing), which constitutes pathogenic transformation. "Xing Wo" (Penalizing Me) refers to the element that controls me; "Wo Xing" (I Penalize) refers to the element controlled by me. For instance, if Wood Qi is excessive, the Metal that controls me cannot restrain me; Metal suffers humiliation from Wood, so Wood becomes prosperous and Earth inevitably suffers suppression. In such a year, Liver disease represents "Zheng Xie" (Direct Pathogen), Lung disease represents "Wei Xie" (Minor Pathogen), and Spleen disease represents "Ze Xie" (Tyrannical Pathogen). The same logic applies to other seasons. If the season has arrived but the Qi has not, indicating insufficient incoming Qi, it is termed "Bu Ji" (Deficiency) or "Qi Po" (Qi Pressure), also constituting pathogenic transformation. "Suo Sheng" (What I Control) refers to what I control; "Suo Sheng" (What Is Generated By Me) refers to what I generate; "Suo Bu Sheng" (What Controls Me) refers to what controls me. For example, if Wood Qi is deficient, the Earth that I control, lacking fear, acts recklessly, so the Water that generates me inevitably suffers illness; as Wood declines, Metal takes advantage of the weakness to penalize Wood, causing disease. In such a year, Kidney disease is "Shi Xie" (Excess Pathogen), Heart disease is "Xu Xie" (Deficiency Pathogen), and Lung disease is "Ze Xie" (Tyrannical Pathogen). The same logic applies to other seasons; thus, the principles of concurrent diseases of two or three meridians can be deduced.

19. When Movement and Qi become hyperactive, they all cause harm; fearing the restraint of the offspring element, how dare one not submit? Because there is restraint, transformation and generation occur; hyperactivity without restraint leads to illness. After the victorious Qi, the offspring avenges the mother, restoring balance; suppressed and屈伏 (subdued), depression illness forms. Depression reaches its peak before erupting; because the offspring is weak, it waits for the proper time and position to bring its own disaster and penalty.

[Note] When the Five Movements and Six Qi are excessive to the extreme, it is called "Kang" (Hyperactivity). Hyperactivity inevitably harms that which I control. For instance, if Wood becomes hyperactive, it inevitably harms Earth, which I control. The offspring of Earth is Metal, which rises to restrain Wood. Wood fears and accepts this restraint, daring not to recklessly penalize its mother (Earth). With this principle of mutual restraint among the Five Elements, harmony prevails, allowing transformation and generation without disease. If Wood is hyperactive without restraint, it inevitably produces illness from victory; the victorious organ is the Liver, the afflicted organ is the Spleen, resulting in concurrent disease of two meridians. Where there is victory, there must be retaliation; where there is excess, there must be decline—this is the natural way. After Wood becomes excessive, it must eventually decline. The offspring of Earth, Metal, takes advantage of this decline to avenge the mother's defeat, thereby generating retaliatory illness; the retaliatory illness affects the Lung, while the Liver is afflicted, again involving two meridians. The same applies to other organs. If Wood is deficient, it is suppressed by Metal, becoming subdued and unable to extend, giving rise to Wood Depression illness. However, the reason it erupts only after reaching extreme depression is that deficient Wood Qi cannot make the offspring Fire vigorous, thus unable to retaliate. Therefore, it must wait until its own proper time to erupt. Even when it erupts, it does not harm others but brings disaster upon itself, due to the weakness of its original Qi. Thus, before eruption, it resembles victory illness: victory illness affects the Lung, depression illness affects the Liver. Upon eruption, it no longer afflicts the Lung but only the Liver. The same applies to other organs. The above text uses "excess" to explain "victory" and "deficiency" to explain "depression illness." This does not mean that in a year of excess or deficiency, the governing Qi lacks victory, retaliation, or depression. All cases where excess acts recklessly and harms others, causing disease, are called victory illnesses. Cases where the harmed offspring ultimately fails to retaliate, leading to depression and subsequent illness, are called depression illnesses. Cases where deficiency leads to suppression and illness are also depression illnesses. Cases where depression awaits the offspring to avenge the mother, causing illness, are called retaliatory illnesses. Deduction from these principles allows understanding of all similar cases.