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Diseases, having their causes, have effective prescriptions for treatment. However, if one discusses diseases without discussing their causes, it is altogether fabricated and shall not be recorded.

Yin and Yang are the way of Heaven and Earth, the general principles of all things, the parents of change, the origin of life and death, and the residence of spiritual illumination. Therefore, in treating diseases, one must seek the root. Thus, the accumulation of Yang forms Heaven, and the accumulation of Yin forms Earth; Yin is quiet, Yang is active; Yang generates, Yin nourishes; Yang kills (subdues), Yin stores; Yang transforms into Qi (functional activity), Yin forms into shape. Extreme cold generates heat, and extreme heat generates cold. Cold air generates turbid Yin, and hot air generates clear Yang. If clear Yang is below, it produces diarrhea with undigested food; if turbid Yin is above, it produces distension. This is the reversal of Yin and Yang, leading to the deviation of disease. Thus, clear Yang rises to form Heaven, and turbid Yin descends to form Earth. Earth's Qi rises to form clouds, and Heaven's Qi descends to form rain. Rain comes from Earth's Qi, and clouds come from Heaven's Qi. Therefore, clear Yang exits through the upper orifices (eyes, ears, mouth, nose), and turbid Yin exits through the lower orifices (urethra and anus); clear Yang disperses through the interstices (skin pores), and turbid Yin travels to the Zang organs; clear Yang fills the four limbs, and turbid Yin returns to the Fu organs. Water belongs to Yin, Fire belongs to Yang; Yang manifests as Qi, and Yin manifests as flavor. Flavors enter the stomach to nourish the form; the form relies on Qi transformation; Qi transformation produces Essence; Essence transforms into spiritual processes. Essence is generated by Qi, and the form is nourished by flavors. Excessive flavor damages the form, and excessive Qi transformation damages Essence. Essence can transform into Qi, but improper Qi and flavor damage Essence. Yin flavors exit through the lower orifices, and Yang Qi emerges from the upper orifices. Thick flavors belong to Yin, thin flavors belong to Yin within Yang; thick aromas belong to Yang, thin aromas belong to Yang within Yin. Thick flavors cause diarrhea, while thin ones promote Qi movement; thin aromas cause sweating, while thick ones generate fever. Vigorous Fire (excessive Yang) consumes Qi, while mild Fire (normal Yang) strengthens Qi. Vigorous Fire consumes Qi, while mild Fire generates Qi. Pungent and sweet flavors/actions that disperse belong to Yang; sour and bitter flavors/actions that induce vomiting and purging belong to Yin. Excess Yin damages Yang, and excess Yang damages Yin. Excess Yang leads to Heat syndromes, and excess Yin leads to Cold syndromes. Severe Cold damages the form, and severe Heat damages Qi. Damage to Qi causes pain, and damage to the form causes swelling. Excess Wind causes movement, excess Heat causes swelling, excess Dryness causes dryness, excess Cold causes edema, and excess Dampness causes loose stools.

Heaven has the Four Seasons, and Earth has the Five Elements, which govern growth, flourishing, harvesting, and storage, thereby generating Cold, Heat, Dryness, Dampness, and Wind. Humans have five Zang organs that transform into five Qi, thereby generating Joy, Anger, Sorrow, Worry, and Fear. Thus, excessive Joy and Anger damage Qi, while external Cold and Heat damage the form. Violent Anger damages Yin, and violent Joy damages Yang. Rebellious Qi moving upward causes fullness in the vessels and detachment from the form. Unregulated Joy and Anger, and excessive Cold and Heat, lead to an unstable foundation of life. Thus, extreme Yin transforms into Yang, and extreme Yang transforms into Yin. It is said: Injury by Cold in Winter leads to Warm diseases in Spring; injury by Wind in Spring leads to diarrhea with undigested food in Summer; injury by Summer-Heat in Summer leads to Malaria in Autumn; injury by Dampness in Autumn leads to Cough in Winter.

The East generates Wind, Wind generates Wood, Wood generates Sour, Sour enters the Liver, the Liver generates sinews, sinews generate the Heart, and the Liver opens into the eyes. In Heaven it is Wind, in humans it is Dao (Way), in Earth it is transformation, transformation generates the five flavors, flavors generate wisdom, Wind generates Spirit. Spirit in Heaven is Wind, in Earth is Wood, in the body is sinews, in the Zang is the Liver, in color is green, in tone is Jue, in sound is呼 (shouting), in variation is grasping (convulsions), in orifice is the eye, in flavor is Sour, in emotion is Anger. Anger damages the Liver, Sorrow overcomes Anger. Wind damages sinews, Dryness overcomes Wind. Sour damages sinews, Pungent overcomes Sour.

The South generates Heat, Heat generates Fire, Fire generates Bitter, Bitter enters the Heart, the Heart generates Blood, Blood generates the Spleen, and the Heart opens into the tongue. In Heaven it is Heat, in Earth is Fire, in the body is vessels, in the Zang is the Heart, in color is red, in tone is Zhi, in sound is laughter, in variation is sorrow (note: text says sorrow, though traditionally associated with Lung/Worry, here following source text), in orifice is the tongue, in flavor is Bitter, in emotion is Joy. Joy damages the Heart, Fear overcomes Joy. Heat damages Qi, Cold overcomes Heat. Bitter damages Qi, Salty overcomes Bitter.

The Center generates Dampness, Dampness generates Earth, Earth generates Sweet, Sweet enters the Spleen, the Spleen generates flesh, flesh generates the Lungs, and the Spleen opens into the mouth. In Heaven it is Dampness, in Earth is Earth, in the body is flesh, in the Zang is the Spleen, in color is yellow, in tone is Gong, in sound is singing, in variation is hiccup, in orifice is the mouth, in flavor is Sweet, in emotion is Pensiveness. Pensiveness damages the Spleen, Anger overcomes Pensiveness. Dampness damages flesh, Wind overcomes Dampness. Sweet damages flesh, Sour overcomes Sweet.

The West generates Dryness, Dryness generates Metal, Metal generates Pungent, Pungent enters the Lungs, the Lungs generate skin and hair, skin and hair generate the Kidneys, and the Lungs open into the nose. In Heaven it is Dryness, in Earth is Metal, in the body is skin and hair, in the Zang is the Lungs, in color is white, in tone is Shang, in sound is crying, in variation is cough, in orifice is the nose, in flavor is Pungent, in emotion is Worry. Worry damages the Lungs, Joy overcomes Worry. Heat damages skin and hair, Cold overcomes Heat. Pungent damages skin and hair, Bitter overcomes Pungent.

The North generates Cold, Cold generates Water, Water generates Salty, Salty enters the Kidneys, the Kidneys generate marrow, marrow generates the Liver, and the Kidneys open into the ears. In Heaven it is Cold, in Earth is Water, in the body is bones, in the Zang is the Kidneys, in color is black, in tone is Yu, in sound is groaning, in variation is shivering, in orifice is the ear, in flavor is Salty, in emotion is Fear. Fear damages the Kidneys, Pensiveness overcomes Fear. Cold damages Blood, Dryness overcomes Cold. Salty damages Blood, Sweet overcomes Salty.

Thus, Heaven and Earth are the upper and lower of all things; Yin and Yang are the male and female of Blood and Qi; Left and Right are the pathways of Yin and Yang; Water and Fire are the signs of Yin and Yang; Yin and Yang are the beginning of all things. Thus, Yin inside is the guardian of Yang; Yang outside is the servant of Yin. Heaven is deficient in the Northwest, so the Northwest belongs to Yin, and human right ear and eye are less acute than the left; Earth is incomplete in the Southeast, so the Southeast belongs to Yang, and human left hand and foot are less strong than the right. Heavenly Qi connects with the Lungs, Earthly Qi connects with the throat, Wind Qi connects with the Liver, Thunder Qi connects with the Heart, Grain Qi connects with the Spleen, Rain Qi connects with the Kidneys. Yang sweat is named after Heaven's rain; Yang Qi movement is named after Heaven's swift wind. Violent phenomena resemble Thunder, rebellious Qi resembles Yang. For deficiency of form, warm with Qi; for deficiency of Essence, tonify with flavor. For high pathogenic factors, induce vomiting; for low pathogenic factors, drain downwards; for middle jiao fullness, purge internally; for exterior pathogens, soak the body to sweat; for pathogens in the skin, release via sweating; for fierce pathogens, press and collect; for excess pathogens, dissipate and purge. Examine Yin and Yang to distinguish rigid and soft; treat Yin diseases by regulating Yang, and Yang diseases by regulating Yin. Determine the state of Blood and Qi, keeping them in their proper places. For Blood excess, resolve stasis; for Qi deficiency, lift and guide. (From *Treatise on Yin and Yang*)

Shen Youpeng notes: Vigorous Fire refers to hyperactive Yang, while mild Fire refers to slight Yang. Old interpretations explaining this as Ministerial Fire and Sovereign Fire are unstable. Furthermore, Zhang Zhongjing stated in the preface of *Shanghan Lun*: "I compiled using *Suwen*, *Jiujuan*, *Bayishiyi Nan*, *Treatise on Yin and Yang*, and *Tailu Yaolu*," omitting *Lingshu*. Now *Tailu Yaolu* is largely lost, and *Treatise on Yin and Yang* is incorporated into *Suwen*. Later scholars, following names, naturally considered *Suwen* authentic and *Lingshu* fake. However, upon close reading, *Suwen* contains shallow passages, while *Lingshu* contains profound transformations. Ultimately, *Lingshu* was undoubtedly derived from *Suwen*.

Heaven transforms all things through Yin, Yang, and the Five Elements; Qi forms the shape, and Principle is endowed within. Thus, Heaven nourishes humans with Five Qi; excess of Five Qi causes disease. Earth nourishes humans with Five Flavors; excess of Five Flavors causes disease. Humans possess Five Emotions; excessive use of Five Emotions causes disease. Disease manifestations are myriad, but cannot exceed these categories. Treatment methods merely balance using the overcoming relationship. This is truly concise and deeply insightful. This was originally a standalone book, not merely a chapter in *Suwen*, but truth derived from daily contemplation.

Taiyin and Yangming are interior-exterior pairs, referring to the Spleen and Stomach. Why do they manifest different diseases? Because Yin and Yang occupy different positions, alternating between deficiency and excess, rebellion and compliance, originating either internally or externally. Different origins lead to different disease names. Yang represents Heavenly Qi, governing the exterior; Yin represents Earthly Qi, governing the interior. The pathway of Yang is solid, the pathway of Yin is hollow. Thus, thieves' winds and empty evils affect Yang channels; irregular diet and起居 (daily routine) affect Yin channels. Pathogens entering Yang channels enter the Six Fu organs; those entering Yin channels enter the Five Zang organs. Entering Fu organs causes fever, restlessness, and upper respiratory distress; entering Zang organs causes chest/abdominal fullness, blockage, and lower diarrhea, eventually becoming intestinal dysentery. The throat governs Heavenly Qi, the pharynx governs Earthly Qi. Yang channels receive Wind, Yin channels receive Dampness. Yin Qi ascends from the feet to the head, then descends along the arms to the fingertips; Yang Qi ascends from the hands to the head, then descends to the feet. Thus, Yang diseases progress upward then downward; Yin diseases progress downward then upward. Wind injuries affect the upper body first; Dampness injuries affect the lower body first.

Why does Spleen disease cause inability to use the four limbs? The four limbs receive Qi from the Stomach but cannot reach the meridians directly; they rely on the Spleen to transmit this Qi. Now, Spleen disease fails to transport fluids for the Stomach, so the limbs do not receive water-grain Qi. Qi declines daily, meridians become obstructed, sinews, bones, muscles, and flesh lack Qi generation, hence they cannot function. Why does the Spleen not govern a specific season? The Spleen belongs to Earth, governs the Center, and supports the other four Zang organs during the last 18 days of each season, thus not governing a single season alone. The Spleen and Stomach are connected by membranes, yet the Spleen transports fluids for the Stomach. Why? The Foot-Taiyin Spleen meridian is one of the Three Yin meridians; its vessel penetrates the Stomach, belongs to the Spleen, and connects to the pharynx, thus Taiyin transmits Qi to the Three Yin. Yangming is the exterior meridian, the sea of the Five Zang and Six Fu organs, transmitting Qi to the Three Yang. Organs and Fu receive Qi from Yangming via their respective meridians, thus (the Spleen) transports fluids for the Stomach. (From *Suwen: Treatise on Taiyin and Yangming*)

In Zhang Zhongjing's discussion, "Yangming disease intending to form a mass" indicates Yangming transforming into Taiyin; "transforming into Yangming" indicates Taiyin transforming into Yangming. This aligns with the concept of "alternating excess and deficiency" in this chapter, confirming it as the true classic read by Zhang Zhongjing.

Li Dongyuan's lifelong expertise relied entirely on this chapter.

The Three Yin and Three Yang clearly refer to the twelve meridians. Meridians connect Hand-Taiyin to Hand-Yangming, Hand-Yangming to Foot-Yangming, and Foot-Yangming to Foot-Taiyin, forming a cycle without end. There is no logic in skipping Yin to act solely on Three Yang or skipping Yang to act solely on Three Yin. The Q&A at the end is suspected to be a later addition.

Additionally, *Shennong Bencao Jing* mentions "strengthening the Spleen," whereas *Suwen*, *Lingshu*, and *Nanjing* lack detailed discussion on this. (Shen Youpeng) Once observed bees making honey: during the day, they place flowers in the hive; at night, they spread wings and fan, making buzzing sounds, until flowers become honey. I thought that the Spleen is outside the Stomach, located centrally, connected by membrane, with sides hanging like wings, constantly fanning to assist the true Yang at the bottom of the Stomach in steaming and digesting grain. This "strengthening" implies continuous motion. This is merely my speculative talk, and I am unsure if it is correct.

Current febrile diseases are all types of Cold Damage. Some recover, some die; deaths occur within six to seven days, recoveries after ten days. Why? Juyang (Taiyang) is the affiliation of all Yang meridians, connecting to Fengfu, thus governing Yang Qi. When humans are injured by Cold, they develop febrile disease. Even with high fever, they will not die unless they suffer from "Double Injury by Cold" (simultaneous involvement of exterior and interior meridians), which is fatal. On the first day of Cold Damage, Juyang is affected: headache, stiff neck, and sore back. On the second day, Yangming is affected: Yangming governs flesh, its vessels run alongside the nose and connect to the eyes, causing fever, eye pain, dry nose, and inability to sleep. On the third day, Shaoyang is affected: Shaoyang governs the Gallbladder, its vessels follow the flanks and connect to the ears, causing hypochondriac pain and deafness. If the three Yang meridians are diseased but have not entered the Zang, they can be cured by sweating. On the fourth day, Taiyin is affected: Taiyin vessels distribute in the Stomach and connect to the pharynx, causing abdominal fullness and dry throat. On the fifth day, Shaoyin is affected: Shaoyin vessels penetrate the Kidneys, connect to the Lungs, and attach to the base of the tongue, causing dry mouth, dry tongue, and thirst. On the sixth day, Jueyin is affected: Jueyin vessels circulate around the genitalia and connect to the Liver, causing irritability, fullness, and retraction of the scrotum. When all Yin and Yang, Zang and Fu organs are diseased, Ying and Wei circulation stops, and the Five Zang are blocked, death ensues. For those not suffering from Double Injury, on the seventh day, Juyang disease wanes: headache decreases. On the eighth day, Yangming disease wanes: fever decreases. On the ninth day, Shaoyang disease wanes: hearing slightly improves. On the tenth day, Taiyin disease wanes: abdomen softens, appetite returns. On the eleventh day, Shaoyin disease wanes: thirst stops, fullness resolves, tongue dries, and sneezing occurs. On the twelfth day, Jueyin disease wanes: scrotum relaxes, lower abdomen softens, pathogenic Qi departs, and the disease ends. Treatment requires unblocking the meridian-palace of each organ; as the disease wanes, recovery follows. For febrile diseases under three days, use sweating; for those over three days, use purgation. After slight improvement of fever, eating meat causes relapse, and overeating causes lingering pathogens; these are contraindications.

For Double Injury by Cold: On the first day, Juyang and Shaoyin are both diseased: headache, dry mouth, irritability. On the second day, Yangming and Taiyin are both diseased: abdominal fullness, fever, anorexia, delirium. On the third day, Shaoyang and Jueyin are both diseased: deafness, scrotal retraction, cold limbs, inability to swallow fluids, unconsciousness. Death occurs on the sixth day. When the Five Zang are damaged, Six Fu are blocked, and Ying and Wei do not circulate, death occurs three days later. Why? Yangming is the leader of the twelve meridians, with abundant Blood and Qi. Unconsciousness lasts three days until its Qi is exhausted. For Cold Damage turning into Warm diseases: before Summer Solstice, it is Warm disease; after Summer Solstice, it is Summer-Heat disease. Summer-Heat and sweat should be expelled, not stopped. (From *Suwen: Treatise on Febrile Diseases*)

This chapter discusses febrile diseases. Cold Damage has five types, and febrile disease is only one of them; the others are lost. (Shen Youpeng) I will supplement with *Nanjing*, as detailed in the Diagnosis Collection.

Malaria is caused by Wind. Why does it have regular intervals? Malaria begins with goosebumps, yawning, followed by chills, shaking of the jaw, and pain in the waist and spine. After chills subside, internal and external heat arise, causing severe headache and thirst for cold drinks. This is due to the struggle between Yin and Yang, shifting between deficiency and excess. When Yang merges into Yin, Yin becomes excess and Yang becomes deficient. Deficiency of Yangming causes chills and jaw shaking; deficiency of Juyang causes pain in the waist, back, head, and neck. Deficiency of all three Yang leads to Yin excess, causing bone cold and pain, resulting in internal and external cold. Excess Yang causes external heat, deficiency Yin causes internal heat; combined internal and external heat causes panting and thirst, leading to the desire for cold drinks. This results from Summer-Heat injury, where heat hides in the skin and intestines, the residence of Ying Qi. Sweat opens the pores; autumn wind and bathwater enter, residing with Wei Qi. Wei Qi moves through Yang during the day and Yin at night. Interaction between external Yang and internal Yin causes daily attacks. Deeply seated pathogens affecting Yin and Yang cause every-other-day attacks. Delayed onset is due to pathogens descending from Fengfu; early onset is due to ascending Qi. Every-other-day attacks occur because pathogens are deep, connecting to the membrane source. Chills preceding heat is Cold Malaria; heat preceding chills is Warm Malaria. Heat only without chills is Dan Malaria. When pathogens are strong, healthy Qi is damaged; when weak, healthy Qi recovers. During the asymptomatic phase, regulate the body to allow Healthy Qi to settle and Pathogenic Qi to vanish. (From *Suwen: Treatise on Malaria*)

Wind moves swiftly and changes frequently, hiding in the skin. Open pores cause chills; closed pores cause heat and oppression. Chills reduce appetite; heat wastes muscle, causing shivering and anorexia, known as Cold-Heat. Wind entering the Stomach via Yangming ascends to the inner canthus. Fat people retain wind, causing internal Heat and yellow eyes; thin people expel wind, causing internal Cold and tearing. Wind entering Taiyang spreads to muscles, interfering with Wei Qi, causing swelling and ulcers; stagnant Wei Qi causes numbness. Wind in vessels heats Ying Qi, causing skin ulcers, nasal collapse, and discoloration, known as Leprosy. Wind entering various gates causes Bi-feng, Brain Wind, Eye Wind, Leak Wind, Internal Wind, Head Wind, Intestinal Wind, and Leakage Wind. Wind is the chief of hundred diseases, changing unpredictably. (From *Suwen: Treatise on Wind*)

Cold, Wind, and Dampness combine to cause Bi syndrome. Wind dominance causes Moving Bi; Cold dominance causes Painful Bi; Dampness dominance causes Fixed Bi. Wind dominance heals easily; invasion of Zang organs is fatal. (From *Suwen: Treatise on Bi*)

Dryness and Heat in the Lungs wither leaves, weakening skin and hair, leading to Wei syndrome. Heart Heat causes vessel reversal and deficiency, leading to Vessel Wei. Liver Heat causes bitter taste and dry sinews, leading to Sinew Wei. Spleen Heat causes dry stomach and numb flesh, leading to Flesh Wei. Kidney Heat causes stiff waist and depleted marrow, leading to Bone Wei. The Lungs are the canopy of the Heart. Unfulfilled desires cause Lung鸣 (sound), leading to Lung Heat and withered leaves. All Zang Wei stem from Lung Heat. Excessive grief severs the Pericardium, causing Heart bleeding and frequent bloody urine, leading to Muscle and Vessel Wei. Unfulfilled thoughts and excessive sexual activity cause Sinew Wei and White Turbidity. Dampness leads to Flesh Wei. Extreme heat and fatigue deplete Kidney Water, leading to Bone Wei. Lung Heat shows pale color and hair loss; Heart Heat shows red color and overflowing collaterals; Liver Heat shows green color and brittle nails; Spleen Heat shows yellow color and twitching flesh; Kidney Heat shows black color and rotten teeth. Treating Wei focuses on Yangming. Yangming is the sea of Zang and Fu, moistening Zong Jin (major tendons), which bind bones and facilitate joints. The Chong Mai irrigates valleys, combining with Yangming at Zong Jin. All converge at Qichong, led by Yangming, connected to Dai and Du meridians. Yangming deficiency leads to relaxed Zong Jin and weak legs. (From *Suwen: Treatise on Wei*)

Bending without extension indicates Sinew disease; extending without bending indicates Bone disease. (From *Lingshu*)

Deficiency of Ying Qi causes numbness; deficiency of Wei Qi causes immobility. (From *Suwen*)

Pathogens in the Lungs and Heart remain in the elbows; Liver pathogens in the axillae; Spleen pathogens in the thighs; Kidney pathogens in the popliteal fossa. (From *Lingshu*)

Blood and Qi rushing upward causes Great Jue (syncope), appearing as sudden death. If Qi returns, life is saved; if not, death occurs. (From *Suwen*)

Loss of voice due to internal obstruction indicates Yang excess and Yin deficiency. Internal depletion and Jue cause aphasia and paralysis, indicating Kidney deficiency. (From *Suwen*)

Violent anger causes Qi and form to sever, blood stagnating upward, leading to sudden syncope. (From *Suwen*)

These three sections discuss Jue disease. Jue means rebellion, with lower Qi rebelling upward, causing sudden death. Based on the classics, this stems from the Liver or Kidney, not Wind. Modern practitioners mistake this for Stroke and use Wind-dispelling herbs, which are ascending and worsen the rebellion. Note that *Shanghan Lun* defines Jue as cold extremities due to failure of Yin and Yang Qi to connect, which is different. (From *Suwen*)

Irregular living and overexertion damage collaterals. Damage to Yang collaterals causes external bleeding (epistaxis); damage to Yin collaterals causes internal bleeding (hematochezia). Bleeding from intestinal collaterals outside the gut combines with cold fluids to form masses. (From *Suwen*)

Prolonged viewing damages Blood; prolonged lying damages Qi; prolonged sitting damages flesh; prolonged standing damages bones; prolonged walking damages sinews. These are the Five Labors. (From *Suwen*)

Heaven has stars, Earth has rivers, Humans have meridians. Gentle weather calms river water; cold freezes it; heat boils it; storms swell it. Pathogens entering vessels behave similarly: Cold coagulates Blood, Heat makes Qi fluid. Empty evils (Wind) enter like wind on water. Pulse waves rise and fall; large pulse indicates pathogen, small indicates peace. Pulse position varies between Yin and Yang. (From *Suwen*)

Anger causes Qi to ascend; Joy causes Qi to slow; Grief causes Qi to dissipate; Fear causes Qi to descend; Cold causes Qi to contract; Heat causes Qi to leak; Shock causes Qi to scatter; Labor causes Qi to consume; Pensiveness causes Qi to knot. Anger leads to Qi rebellion and vomiting/blood; Joy leads to harmonious Qi; Grief constricts the Heart/Lungs, blocking upper Jiao; Fear retreats Essence, closing upper Jiao and bloating lower Jiao; Cold closes pores, contracting Qi; Heat opens pores, leaking Qi; Shock confuses the mind, scattering Qi; Labor exhausts Qi through panting/sweating; Pensiveness retains Qi, causing knots. (From *Suwen*)

Rebellious Qi preventing sleep with noisy breathing indicates Yangming rebellion. Yangming normally descends; rebellion upward causes noise. "Stomach disharmony leads to restless sleep." Quiet breathing with noise indicates Lung collateral rebellion. Inability to lie down with panting indicates Water Qi invading. The Kidney governs fluids and sleep.