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The root of human life lies in the Qi transformation of Heaven and Earth.

In *Suwen: Treatise on the Connection between Life and the Nourishing Heaven*, the Yellow Emperor asked: Since ancient times, those who can connect with Heaven—the root of life—lie in Yin and Yang. Within the space between Heaven and Earth, within the Six Directions, the Qi connects with the Nine Provinces (referring to the earth), the nine orifices, the five Zang organs, and the twelve joints, all communicating with the Heavenly Qi. Life is based on the Five Phases (Metal, Wood, Water, Fire, Earth), and the Qi is divided into Three Yin and Three Yang. If one frequently violates these principles, pathogenic Qi will harm the body; this is the root of longevity. If the Qi of the Blue Heaven remains pure and clear, one’s will and intent will be regulated; by complying with it, the Defensive Qi (Wei Qi) becomes solid, and even if there are thieving pathogens (pathogenic factors), they cannot cause harm. This is following the sequence of the seasons. Therefore, the sages conserve their spirit, ingest the Heavenly Qi, and thereby communicate with the Divine Spirit. If one deviates from this, the nine orifices internally become blocked, the muscles externally become congested, and the Defensive Qi scatters and dissolves. This is called self-injury, leading to the depletion of Yuan Qi (Original Qi).

This section summarizes the origins of external contraction and internal injury. Humans and Heaven and Earth share the same root; thus, the form and Qi within Heaven and Earth and the Six Directions correspond to the Nine Provinces of the earth. In the human body, there are nine orifices, five Zang organs, and twelve joints, all of which communicate with Heavenly Qi. What humans receive for life is the Qi of the Five Phases; what sustains them is the mechanism of the Three Yin and Three Yang that generates and nourishes all things. The circulation of Yin-Yang and the Five Phases involves Qi transformation, which inevitably has periods of prosperity, decline, and deviation. Deviation constitutes pathogenic Qi. If one does not regulate properly and frequently encounters pathogenic Qi, the body is harmed. Thus, the Qi transformation of Heaven and Earth is the root of human life and longevity. If the Qi of the human body can be as pure and clear as the Qi of the Blue Heaven, then the Heart-Mind will be harmonious and the will orderly, the internal Yang Qi will be solid and dense, and although thieving pathogens exist, they cannot cause harm. This is complying with the order of Heavenly Qi transformation. Therefore, the sages teach people to nourish the spirit and ingest Heavenly Qi to communicate with the Divine Spirit. If one fails to regulate and suffers from pathogens, the nine orifices internally block, the muscles externally congest, and the Defensive Qi scatters. This is self-injury, resulting in the depletion of Original Qi. The key lies in maintaining purity to regulate the will, which is the way to dispel disease and nurture life.

Yang Qi is like the sky and the sun. If it loses its proper position and function, it shortens life and fails to manifest. Therefore, the movement of Heaven relies on the brightness of the sun. Thus, Yang Qi is located superiorly and serves to defend the exterior. It should rotate freely like a door pivot; if daily activities involve sudden惊扰 (startle/disturbance), the Shen Qi (Spiritual Qi) will float upward.

Continuing from the above, it states that the Yang Qi of the human body should be as pure and clear as the Blue Heaven and as bright as the sun. In this state, the Heart-Mind is harmonious and the will is orderly. If it loses its proper position, life is shortened, and the Divine Spirit fails to manifest. Heaven moves vigorously without ceasing because the Heavenly body is pure and the sunlight shines brightly. If humans have a pure heart and clear Qi, the light of the Spirit naturally manifests. This is because Human Yang Qi is rooted in Yin, rises from below, and moves outward to serve as defense. Rising must be followed by descending, circulating internally and externally. To rotate continuously like a pivot, if daily activities involve disturbance, the Shen becomes labored and Qi agitated, causing Yang Qi to lose its solidity, allowing external pathogens to harm it. If injured by Summer-Heat, Summer-Heat should exit with sweat and should not be suppressed, as Summer-Heat is formed by the combination of Fire and Dampness; sweating eliminates Dampness and allows Fire to vent. If Fire flares upward, it causes mental restlessness and lung wheezing/panting; if the Qi is calm but Heart-Fire is unsettled, there will be excessive talking. If injured by Cold Pathogen, the Exterior Yang is constrained, causing body heat like burning charcoal. As Zhang Zhongjing stated, pulse tight, body hot, no sweat indicates Cold Damage (Shang Han), treated with Mahuang Decoction (Ephedra Decoction) to induce sweating; once sweat occurs, the pathogen disperses. This refers to Cold Damage affecting the Yang meridians. If Cold damages the Yin meridians, there is no body heat or headache, and sweating should not be induced. If injured by Dampness, Earthly Dampness affects the lower part first, while misty/dewy Dampness affects the upper part first. Dampness obscures the Clear Yang, causing heaviness in the head and eyes as if wrapped. Dampness invades the sinews, Yang stagnates and transforms into Heat. If not cleared promptly, the sinews are damaged: large sinews become soft and short (causing spasms/contracture), small sinews become lax and long (causing flaccidity/paralysis). Swelling caused by Qi (here referring to Dampness injuring Yang) occurs because Dampness injures Yang rather than sinews. Spleen is Taiyin Damp-Earth, governing the muscles. Dampness injures Yang and burdens the Spleen, causing muscle swelling. Spleen Earth prospers during the Chen, Xu, Chou, and Wei months (the four seasons/transition periods), serving as the framework of the year. If Spleen damage causes swelling and does not heal during these prosperous periods, when the prosperous Qi passes and seasons change, Yang Qi will exhaust and death will occur. Hence, "When the Four Dimensions succeed each other, Yang Qi exhausts." Old commentaries interpreted "Four Dimensions" as sinews, flesh, blood, and bone, or as the four limbs. However, how can sinews/flesh/blood/bone or four limbs succeed each other? This makes no logical sense. Furthermore, in *Suwen: Treatise on the Most Essential and Greatest Principles*, Qibo said: The generation and transformation of Qi differ in prosperity and decline. The effects of Cold, Heat, Warmth, and Coolness depend on their prosperity and decline, manifested in the Four Dimensions. This means the circulation of Cold, Heat, Warmth, and Coolness undergoes changes after prosperity and decline. At the time of change, during the four seasons of Chen, Xu, Chou, and Wei, the four seasons of Spring, Summer, Autumn, and Winter are established. Thus, Earth prospers in the four seasons, serving as the annual framework. This is because Spring, Summer, Autumn, and Winter correspond to the Qi of Wood, Fire, Metal, and Water. Metal, Wood, Water, and Fire mutually overcome each other; they rely on the Earth of the four seasons in the middle to regulate and maintain, thereby achieving the work of creation. Hence, "The use of prosperity and decline lies in the Four Dimensions." Does not this logic prove the point conclusively?

When Yang Qi is subjected to excessive fatigue and labor, it hyperactivates, leading to exhaustion of Essence. If this accumulation persists into Summer, it causes Jian Jue (Frying Syncope), characterized by blindness preventing vision, deafness preventing hearing, a crumbling state like a breached dam, and uncontrollable leakage. When Yang Qi is subjected to extreme anger, the form and Qi become severed, and Blood stagnates in the upper body, causing Bo Jue (Thin Syncope). Injury to the sinews leads to flaccidity and inability to control movement. Sweating on only one side (hemihidrosis) leads to hemiplegia. Sweating while exposed to Dampness generates acne (Cuo Chu). Long-term consumption of rich, fatty foods is sufficient to generate large carbuncles (Ding); accepting pathogens is as easy as holding an empty vessel. Labor-induced sweating exposed to wind, where Cold compresses the surface Yang, results in prickly heat (Fei); stagnation leads to acne.

The previous section discussed injuries from external pathogens; this section clarifies injuries from fatigue and desire. The beginning of the chapter states that purity regulates the will and consolidates Yang Qi. If fatigue is unceasing, Yang Qi hyperactivates, transforming into pathogenic Fire. Intense Fire consumes Water (Jing/Blood source). As Water gradually depletes until Essence is exhausted, pathogenic Qi accumulates. By Summer, when Fire is prosperous, the body feels scorched, meridians are obstructed, and Yang Qi cannot circulate to the limbs, resulting in cold extremities (Jue). This is called Jian Jue, commonly known as Bone Steaming Dry Blood Consumption. Eyes see due to Blood; with exhausted Essence and Blood, blindness occurs. Essence loss causes deafness; thus, Qi blockage prevents hearing. At such severe damage, the body is like a ruined city, with Qi and Blood scattering uncontrollably. Even with medicine, it cannot be cured. The Liver is a rigid organ, storing Blood and belonging to Wood, governing the ascending Qi of Spring. Extreme anger causes Liver Qi to rebel, blocking the Qi mechanism that fills the form. Blood follows Qi and stagnates in the Upper Jiao, blocking Ying and Wei Qi and meridians, causing Bo Jue (sudden syncope from angry rage). The Liver governs sinews; injury causes sinew flaccidity, inability to bind bones, trembling while walking/standing, and loss of posture. Qi warms, Blood moistens. Yang Qi rebellion disrupts Ying and Wei harmony, causing hemihidrosis. "Ju" means leakage. As stated in *Yueling*: Earthly Qi leaks, meaning Jin Ye (Body Fluids) do not circulate uniformly but leak from either left or right, forming hemiplegia. The above describes injuries from emotions and desires. If pores are open during sweating and Dampness invades, obstructing Ying Qi, acne and boils arise. Those accustomed to rich, fatty foods may develop large carbuncles, not just acne, because accumulated pathogenic Heat is deep, like filling an empty vessel. Labor-induced sweating exposed to Cold/Wind compresses Surface Yang, causing prickly heat or acne (commonly called freckles/moles), which are superficial and harmless.

Yang Qi, in its refined state, nourishes the Shen (Spirit); in its soft state, it nourishes the sinews. If opening and closing fail, Cold Qi enters, causing severe kyphosis (Da Lou). Pathogens sinking into vessels cause scrofula (Luo Li); lingering in flesh and skin causes issues. When Shu points' Qi transformation is forced, it transmits to fear and惊骇 (fright). If Ying Qi does not follow the course and rebels in the flesh, abscesses/swellings arise. If Po Sweat (Pore Sweat) is not fully expelled, the form weakens and Qi burns, acupoints close, and Wind Malaria develops. Therefore, Wind is the beginning of all diseases. Purity closes and rejects pathogens at the flesh and skin; even strong winds and severe toxins cannot harm, by following the seasonal order. If disease persists, transmission and transformation occur. If Upper and Lower do not connect, even good doctors cannot help. If Yang Qi accumulates to death, and Yang Qi is blocked at the diaphragm, it must be drained. Failure to treat urgently leads to failure by incompetent physicians.

All above discuss Yang Qi, referring to the balanced, neutral Qi of Yin and Yang. Its refined neutrality nourishes the Heart-Mind; its soft neutrality nourishes sinews and bones. It spreads and circulates, internally from Zang organs, externally to collaterals, cycling through interior/exterior and Yin/Yang without interruption. Taiyang is Opening, Yangming is Closing, Shaoyang is Pivot; Taiyin is Opening, Jueyin is Closing, Shaoyin is Pivot. If Qi rebels, disrupting rising/falling and opening/closing, external Cold enters, causing sinew stiffness and severe kyphosis. If pathogens sink into blood vessels, Ying Qi stagnates, forming scrofula or rat sores. If pathogens linger in flesh/skin, forcing Shu point Qi, invading internal organs over time, transmitting to fear/fright, it injures Liver/Gallbladder. If Ying Qi rebels in flesh, abscesses form. Lung stores Po; skin/hair pores are the exterior of Lung. Sweat from pores is Po Sweat. Incomplete sweating due to internal weakness of form/Qi and external Wind pathogens closes acupoints, causing Wind Malaria. All six climatic pathogens attacking humans involve Wind, as Wind is sharp and penetrates easily; thus, Wind is the beginning of all diseases. If internal Yang Qi is pure and solid, flesh/skin closes and rejects; even strong winds/toxins cannot harm, by following seasonal Qi transformation. Strong winds/toxins refer to Empty Winds/Thieving Pathogens mentioned in *Ling Shu: Chapter on Nine Palaces and Eight Winds*. Hence, "Where pathogens gather, Qi must be deficient." If disease persists and pathogens transform, ascending/descending Yin/Yang repel each other and do not connect. At this stage, even good doctors cannot help. If Yang Qi transforms into pathogenic Qi, accumulating to death, and pathogenic Yang is blocked at the diaphragm, it must be drained early. Failure to treat urgently leads to failure by incompetent physicians.

Therefore, Yang Qi governs the exterior throughout the day: At dawn, Human Qi arises; at noon, Yang Qi is robust; at sunset, Yang Qi is deficient, and the Qi Gates close. Thus, in the evening, Yang Qi retracts and rejects the exterior; do not disturb sinews and bones, nor expose oneself to mist and dew. Violating these three times leads to physical exhaustion and thinning.

This summarizes the previous text. Above, it stated Yang moves upward and defends the exterior; here, it specifically discusses Wei Yang Qi, which travels through the Yang aspects of the body during the day, thus governing the exterior daily. At dawn, emerging from Yin to Yang, Qi begins to arise. At noon, Yang Qi is abundant. At sunset, it returns to Yin, so Exterior Defending Yang Qi is deficient, and Qi Gates close. Thus, in the evening, Yang Qi retracts internally to reject the exterior; do not disturb sinews/bones to injure internal Qi. With deficient Surface Yang, avoid mist/dew Yin-Dampness to injure the exterior. If one does not know the sequence of Yang Qi entry/exit at morning, noon, and evening, and acts against it, Form and Qi become exhausted and listless. This clarifies that external pathogen injury is due to internal deficiency of Yang Qi, responding to the earlier principle that solid Yang Qi prevents external pathogens from harming.

Qibo said: Yin stores Essence and responds frequently (Qi Ji); Yang defends the exterior and provides solidity. If Yin cannot overcome Yang, pulses flow rapidly and violently, leading to mania. If Yang cannot overcome Yin, the Qi of the five Zang organs contends, and the nine orifices become blocked. Therefore, the sages arrange Yin and Yang, harmonizing sinews and pulses, solidifying marrow, and ensuring smooth Qi and Blood flow. In this way, interior and exterior are harmonized, pathogens cannot harm, ears and eyes are acute, and Qi stands firm as before.

This further explains the mutual root of Yin and Yang, showing that balance is essential and neither should dominate. The classics elaborate repeatedly on this principle. Since Zhu Danxi proposed "Yang is often in excess, Yin is often deficient," and Zhang Jingze countered with "Yang is often deficient, Yin is often in excess," both, despite their insights, obscure the classic teachings and confuse students. This section specifically highlights diseases of Yin-Yang imbalance. Yin and Yang Qi originate from the Life Root (Ming Di), flowing as Ying and Wei. The Life Root resembles the Taiji (Supreme Ultimate). Yin and Yang are rooted in Taiji; thus, hyperactivity leads to extinction. Essence is Yang within Yin; Yang is rooted in Yin, so Yin stores Essence. "Qi" (Rise) refers to Kun trigram rising from below, and Yin is rooted in Yang, so Qian trigram changes. "Ji" means rising again and again, without interruption or end, representing continuous mutual generation of Yin and Yang. Flowing as Ying and Wei, Ying flows in vessels (Yin), Wei flows outside vessels (Yang). Thus, Yang defends the exterior and provides bodily solidity. If imbalanced and Yin cannot overcome Yang, Ying in vessels is insufficient, so pulses flow weakly and rapidly due to Yang dominance. When extreme, Qi merges entirely into Yang, causing mania. If Yang cannot overcome Yin, and Yin belongs to Zang organs, its Qi stagnates, failing to circulate smoothly and contending. Clear Yang cannot rotate between interior/exterior, causing nine orifices to block. Therefore, the sages detail the generation/transformation of Yin and Yang, ensuring smooth Qi/Blood flow, harmonizing sinews/pulses, solidifying marrow, harmonizing interior/exterior, preventing pathogen harm, and naturally restoring acute senses and Original Qi.

Wind pathogens invade and disorder Qi, causing Essence to perish, damaging the Liver. If followed by overeating, sinews and pulses relax, leading to dysentery and hemorrhoids. If followed by heavy drinking, Qi rebels. If followed by excessive force, Kidney Qi is injured, and high bones (vertebrae) are damaged. The key to Yin and Yang is that Yang must be dense to provide solidity. If the two do not harmonize, it is like Spring without Autumn, or Winter without Summer. Harmonizing them is the Sage's standard. Thus, if Yang is hyperactive and not dense, Yin Qi perishes. If Yin is peaceful and Yang is secret/dense, Spirit and Essence are regulated. If Yin and Yang separate and sever, Essence and Qi perish.

This explains diseases caused by Yin-Yang disharmony. Wind Qi connects with the Liver. If Wind pathogens invade and linger, they transform into Heat and injure Yin Essence, causing Essence to perish, due to Liver injury. The Liver governs sinews. After pathogen injury, overeating burdens the Spleen, causing sinew/pulse relaxation (flaccidity). Spleen burden generates Dampness, which sinks downward causing dysentery/hemorrhoids. Heavy drinking causes Qi rebellion. Excessive force injures Kidney Qi and Du Mai, damaging the high bones (neck vertebrae). The key to Yin and Yang is Yang density for solidity. Disharmony is like seasonal disorder, cutting off generation/transformation. Harmonizing them is the Sage's method. Without following this, harmony is impossible. Hyperactive Yang without density leads to Yin depletion. Peaceful Yin and dense Yang allow mutual generation, regulating Spirit/Essence. Separation/severance of Yin/Yang leads to death.

Exposure to wind/dew causes chills and fever. Spring Wind injury lingers, causing profuse diarrhea. Summer Summer-Heat injury manifests as malaria in Autumn. Autumn Dampness injury (note: text suggests 'Damp' is likely a typo for 'Dry' in some contexts, but here retains Damp context or corrects to Dry/Lung issue) causes rebellious Qi and cough, developing into flaccidity/Jue. Winter Cold injury manifests as Warm Disease in Spring. The Qi of the four seasons alternately injure the five Zang organs.

Wind/Dew pathogens injure Ying and Wei, causing chills/fever. Pathogen depth and transformation vary. Spring is governed by Wind-Wood; Wind injury lingers, entering intestines/stomach causing profuse diarrhea due to Wind's dispersing nature. Summer Summer-Heat lodges in Membrane Source; Summer Qi floats outward without immediate illness. Autumn cool wind binds exterior, trapping pathogens, causing Malaria (Jie Nuè), where pathogens are trapped internally and closed externally, lasting long. Autumn "Dampness" is noted as a likely error for "Dryness" in previous works; Lung is Dry-Metal, Autumn is Dry season. Dryness injures Lung fluids, causing rebellious Qi and cough. *Treatise on Flaccidity* states Lung Heat scorches leaves, causing flaccidity; meridian Qi fails to circulate, causing Jue. If Dampness belonged to Spleen, it would cause swelling, not cough/rebellion, proving the error. Winter Cold injures Kidney (Cold-Water organ, governing Winter). Similar Qi attracts, pathogens hide in meridians. Spring Yang rises, pathogens transform into Heat, causing Warm Disease. The four seasons alternately injuring five Zang organs confirms human Qi connects with Heavenly Qi. Impure Qi is harmed, leading to various diseases of hyperactivity, hiding, and transmission, comprehensively summarizing the previous text.

*Suwen: Treatise on Yin-Yang Correspondence in Image* states: Heaven has four seasons and five phases, generating growth, flourishing, harvesting, and storage, producing Cold, Heat, Dryness, Dampness, and Wind. Humans have five Zang organs, transforming five Qi, producing Joy, Anger, Sorrow, Worry, and Fear. Thus, Joy/Anger injure Qi; Cold/Heat injure Form. Extreme Anger injures Yin; extreme Joy injures Yang. Rebellion upward fills pulses and separates from form. Unregulated Joy/Anger and excessive Cold/Heat make life unstable. Heavy Yin becomes Yang; Heavy Yang becomes Yin. Thus: Winter Cold injury leads to Spring Warm Disease; Spring Wind injury leads to Summer incomplete digestion diarrhea; Summer Summer-Heat injury leads to Autumn Malaria; Autumn Dampness injury leads to Winter Cough.

This explains Heaven-Human Qi agreement, indicating origins of external/internal injury. Heaven has Qi, Earth has Form, both generated/stored by four seasons/five phases. Cold/Heat/Dryness/Dampness/Wind are generated by Water/Fire/Metal/Wood/Earth Qi. Humans receive this Qi, having five Zang organs transform Five Phase Qi to produce five emotions. Indulging in emotions injures Qi; external Cold/Heat injures Form. Extreme Anger causes Qi rebellion transforming into Fire, injuring Yin. Extreme Joy causes Spirit agitation and Qi relaxation, injuring Yang. Yin/Yang partial injury causes Qi rebellion upward, emptying Zang organs, filling pulses, rushing Qi/Blood, separating from form. Will commands Qi; Qi fills form. Emotions move Will and暴 (violently release) Qi, separating it from form. Qi injury precedes Form injury; Form injury precedes Qi injury. Unregulated emotions/excessive climate exposure destabilizes life. Mentioning Joy/Anger implies Sorrow/Worry/Fear similarly; mentioning Cold/Heat implies Dryness/Dampness/Wind similarly. These are causes of internal/external injury. Heavy Yin becomes Yang, Heavy Yang becomes Yin, following Taiji's movement/stillness cycle, the natural way of change/generation. "Winter Cold...Spring Warm" proves the previous text on four seasons injuring five Zang organs. Winter Yin command + Cold Yin pathogen = Heavy Yin; transforms to Spring Warm Disease = Heavy Yin becomes Yang. Spring Yang command + Wind Yang pathogen = Heavy Yang; transforms to Summer Diarrhea = Yang pathogen transmits to Yin = Heavy Yang becomes Yin. The way of change can be extrapolated.