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Yellow Emperor asked: How should the principles of Yin and Yang be applied in diagnosis and treatment? Qibo replied: When Yang is excessive, the body becomes hot, the interstices (pores) close, breathing becomes rapid and coarse, causing the patient to bend forward and backward due to respiratory distress. There is no sweat but the body remains hot, the teeth become dry, and if symptoms such as vexation, oppression, and abdominal fullness occur, death will ensue. Such patients can tolerate winter but not summer. When Yin is excessive, the body becomes cold, there is sweating, the body often feels chilly, there are frequent chills, extreme cold leads to cold extremities (Jue), and if Jue results in abdominal fullness, death will ensue. Such patients can tolerate summer but not winter. This represents the changes of alternating excess of Yin and Yang, and the manifestations and prognoses of diseases.

This passage elucidates the pathological conditions of Yin-Yang excess. If Yang pathogenic factors are excessive leading to body heat, closed interstices, rapid and coarse breathing, bending movements, and anhidrosis, it is because the Ying (Nutrient) and Wei (Defensive) Qi fail to circulate smoothly, causing Qi to rebel upwards. Dry teeth, vexation, and abdominal fullness indicate that pathogens have invaded the Zang-Fu organs, causing internal and external blockage with no outlet for expulsion, hence leading to death. "Tolerating winter but not summer" means that in winter, when Yin Qi is vigorous, patients with Yang excess might temporarily endure it while awaiting appropriate treatment; however, in summer, when Yang Qi is vigorous, it aids the pathogen, making cure impossible. If Yin pathogens are excessive and Yang Qi is deficient, the body becomes cold with sweating and a constant feeling of chilliness. Frequent chills indicate that Exterior Yang is already deficient; extreme cold leads to Jue (cold extremities), and if Jue causes abdominal fullness, it signifies the collapse of Interior Yang, leading to death. "Tolerating summer but not winter" follows the same logic as Yang excess. These are the variations of Yin-Yang mutual victory/defeat, and the possibility of recovery or non-recovery can be verified by observing the disease's form.

[Disorder of Clear and Turbid Qi]
*Ling Shu · Wu Luan Pian* records: The Yellow Emperor asked: The twelve meridians correspond to the Five Elements and are divided into the Four Seasons. What causes their disorder? And what brings about their regulation? Qibo replied: The Five Elements move in an orderly sequence, and the Four Seasons have distinct divisions. Following these leads to proper regulation, while violating them leads to disorder. The twelve meridians correspond to the twelve months of the year. The twelve months are divided into the Four Seasons: Spring, Summer, Late Summer, and Winter, each with different climatic characteristics. Ying and Wei Qi follow each other, Yin and Yang are harmonized, and Clear and Turbid Qi do not interfere with each other. In such a state, following this order leads to regulation. However, if Clear Qi resides in the Yin aspect and Turbid Qi in the Yang aspect, if Ying Qi flows smoothly along the meridians but Wei Qi rebels against its normal course, Clear and Turbid Qi will interfere with each other and disrupt the chest, termed "Great Oppression" (Da Men). Therefore, if Qi is disrupted in the Heart, there will be mental restlessness, silence, and a tendency to bow the head and sit quietly; if disrupted in the Lung, there will be dyspnea with gasping, requiring the hands to cross over the chest to assist exhalation; if disrupted in the Stomach and Intestines, Huoluan (cholera-like syndrome) occurs; if disrupted in the arms and legs, Si Jue (four-fold cold extremities) occurs; if disrupted in the head, Ni Jue (rebellious Qi reversal) occurs, leading to heavy head, dizziness, and falling.

The meridians are like branches and leaves, while the Five Zang Organs are the root. The Five Zang possess the nature of the Five Elements, so the meridians also have Five Element distinctions, and the generation and transformation of the Five Elements follow an order. The twelve Hand and Foot Yin and Yang meridians correspond to the twelve months, which are further divided into the climatic changes of the Four Seasons. Thus, the generation, transformation, and circulation of Ying, Wei, meridians, Yin, Yang, Qi, and Blood all conform to the ascending and descending Qi of the Four Seasons and the sequence of Mutual Generation of the Five Elements. In this way, Yin and Yang remain peaceful, Clear and Turbid Qi do not interfere, and each follows its own path, resulting in regulation through compliance. The upper half of the body is Yang, and the lower half is Yin. Clear Qi belongs to Yang and ascends, while Turbid Qi belongs to Yin and descends. If Clear Qi remains below without ascending, or Turbid Qi remains above without descending, although Ying Qi may flow along the meridians, it cannot harmonize with Wei Qi, causing Wei Qi to rebel. This disrupts the ascending-descending order, leading to interference between Clear and Turbid Qi. Hence it is said: If Clear Qi is below, it causes undigested diarrhea (Sun Xie); if Turbid Qi is above, it causes distension. Symptoms appear according to the site of Qi rebellion. For instance, Qi disruption in the chest is called Great Oppression ("Men" means depression); Qi disruption in the Heart causes restlessness and silence because the heart-mind is disturbed and the patient lacks the desire to speak or move; Qi disruption in the Lung causes Qi stagnation, leading to dyspnea and gasping, with hands crossing the chest to facilitate exhalation; Qi disruption in the Stomach and Intestines causes Huoluan with alternating vomiting and diarrhea; Qi disruption in the arms and legs blocks the connecting Qi of Yin and Yang meridians, causing cold extremities; Qi disruption in the head causes Qi to rebel upward, leading to a heavy head, light feet, dizziness, and falling. Although only a few examples are listed here, other disorders can be inferred similarly. However, the causes of these disorders must stem from either Exogenous or Endogenous factors, and one must identify the cause to regulate it.

[Pathogens Flowing to the Eight Empties]
*Ling Shu · Xie Ke Pian* records: The Yellow Emperor asked: Humans have eight "empties" (hollow areas: elbows, axillae, groins, popliteal fossae). How are they used for diagnosis? Qibo replied: They are used to diagnose the Five Zang Organs. If the Lung and Heart have pathogens, the Qi flows into the two elbows; if the Liver has pathogens, the Qi flows into the two axillae; if the Spleen has pathogens, the Qi flows into the two thighs (Bi); if the Kidney has pathogens, the Qi flows into the two popliteal fossae (Guo). These eight empties are sites of joint movement, passages of True Qi, and routes of blood collaterals. Pathogenic factors and evil blood should not stay here; if they do, they damage the meridians and joints, preventing flexion and extension, leading to spasms.

The two elbows, two axillae, two thighs, and two popliteal fossae are where the True Qi of the Five Zang passes and where meridians and blood vessels circulate. They are the pivotal points of the body. Therefore, pathogens and evil blood should not accumulate here. If the Five Zang have pathogens, their Qi moves outward and must pass through these eight locations. If combined with stagnant evil blood, they damage meridians, sinews, bones, and joints, causing obstruction and inability to flex/extend, resulting in contracture diseases. Thus, these eight sites are called "Eight Empties," implying that these joint hubs must remain open and unobstructed for smooth Qi and Blood circulation to prevent disease.

[Pathogenic Obstruction of Ying, Wei, Stomach, and Intestines]
*Ling Shu · Shou Tian Gang Rou Pian* records: The Yellow Emperor asked about diseases caused by Ying Qi, Wei Qi, and Cold Bi. Bogao replied: Diseases of Ying Qi present with aversion to cold and fever, shortness of breath, and blood moving up and down abnormally; diseases of Wei Qi present with wandering pain, chest diaphragm oppression, and borborygmus, caused by Wind-Cold lodging in the Stomach and Intestines. Cold Bi disease involves pathogens lingering without departing, causing intermittent pain and skin anesthesia (numbness).

Ying Qi is Yin, flowing within the vessels, governing Blood; Wei Qi is Yang, flowing outside the vessels, governing Qi. Jing Qi resides in the Ying level, and Luo Qi resides in the Wei level. Ying, Wei, Qi, and Blood circulate throughout the interior and exterior via the meridians. Disease in the Ying level causes meridian blockage, leading to aversion to cold, fever, and shortness of breath. Qi stagnation prevents Blood from distributing evenly, causing it to move only up and down, potentially leading to hematemesis or epistaxis triggered by exogenous pathogens—this is a sign of Ying disease. Generally, Blood congeals with Cold and overflows recklessly with Heat. Wei Qi flows outside the vessels; its Qi is fierce, slippery, and floating. When diseased, if its momentum rebels, it causes stagnation and pain. Wandering pain indicates unstable movement. "Fu Kai" refers to sighing due to depression; because Wind-Cold lodges in the Stomach and Intestines, mixing Clear and Turbid Qi, borborygmus occurs ("Ben" implies rushing). If Cold Bi lingers, internal pain and skin numbness occur. "Numbness" means insensitivity to pain and itch. Since the Large Intestine Qi externally corresponds to the skin, and pathogens enter via the skin/hair follicles...

[Wind-Cold Damages Form; Emotional Disturbances Damage Qi]
The Yellow Emperor asked: What is the sequence of form and Qi pathology, and how do internal and external factors correspond? Bogao replied: Wind-Cold damages the Form; worry, fear, anger, and resentment damage Qi. Damage to Qi affects the Zang, becoming Zang disease; Cold damaging the Form manifests on the Form; Wind damaging sinews and vessels manifests on sinews and vessels. This is the correspondence between Form and Qi internally and externally.

Wind-Cold enters via the skin and hair, thus damaging the Form. Worry, fear, and anger disturb the Shen (Spirit), thus damaging Yuan Qi (Original Qi). Since Yuan Qi roots in the Zang, it leads to Zang disease. Differentiating Wind and Cold: Cold is a Yin pathogen damaging the Form (where "Form" collectively refers to Ying, Wei, meridians, muscles, sinews, and bones). Saying Wind is a Yang pathogen damaging sinews specifically includes Internal Wind. Sinews and vessels are governed by the Liver and Heart. Liver Blood deficiency generates Wind; Heart labor generates Fire. Thus, there is a distinction between Exogenous and Endogenous pathogens. For exogenous pathogens: Wind damages Wei Qi, presenting with slow pulse and sweating; Cold damages Ying Qi, presenting with tight pulse and no sweating, as discussed by Zhang Zhongjing. Hence, initially, Wind-Cold is generally stated to damage the Form. As stated in *Su Wen · Tiao Jing Lun*, Yin excess generating Internal Cold is due to endogenous damage to Yang Qi. If Yin Blood is damaged, Liver Wind arises, and Heart Fire flares. Wind and Fire scorch each other, inevitably damaging sinews and vessels. This demonstrates the necessary correspondence between Form/Qi and Endogenous/Exogenous pathogens, verifiable by symptoms.

[Exogenous Pathogens Enter from Shallow to Deep]
*Suo Wen · Miu Ci Lun* records: Qibo said: When pathogens invade the body, they first lodge in the skin and hair. If they linger, they enter the Sun Collaterals; if they linger, they enter the Luo Collaterals; if they linger, they enter the Jing Meridians, connecting internally to the Five Zang and spreading to the Stomach and Intestines. When both Yin and Yang are affected, the Five Zang are injured. This is the sequence of pathogens entering from the skin/hair to the Five Zang. In such cases, treat the Jing Meridians. Now, if pathogens lodge in the skin/hair, enter the Sun Collaterals, and linger without departing, causing blockage and preventing entry into the Jing Meridians, they overflow into the Da Luo (Large Collaterals), producing strange diseases. When pathogens lodge in the Da Luo, they flow from left to right and right to left, interacting with meridians above and below, left and right, and distributing to the four limbs. Their Qi has no fixed location and does not enter the Jing Acupoints; this is named Miu Ci (Counter Puncture). The Yellow Emperor asked: I wish to hear about Miu Ci, why take the left to treat the right and vice versa? How does it differ from Ju Ci? Qibo replied: When pathogens lodge in the Jing Meridians, excess on the left causes disease on the right, and excess on the right causes disease on the left. There may also be migration; if pain persists on the left but the right pulse shows disease first, one must use Ju Ci, targeting the Jing Meridian, not the Luo Collateral. Since Luo disease pain is located counter to the Jing Meridian, it is named Miu Ci.

This section should be read together with the sections on Zhong Bi and Zhou Bi in the *Bi Disease Chapter*. Generally, exogenous pathogens entering from the skin/hair go from shallow to deep, from Luo to Jing, connecting internally to the Five Zang and spreading to the Stomach and Intestines, as the Twelve Yin-Yang Meridians connect internally to the Zang-Fu. Thus, when Yin and Yang are affected, the Five Zang are injured. Although the pathogen has penetrated deeply, if it has not left the Jing Meridian, it must be treated via the Jing Meridian. Since it entered from the exterior, it must be expelled from the exterior. One must not lightly attack the interior, lest exogenous pathogens sink inward, which would be dangerous. For example, Zhang Zhongjing treats Shaoyin disease with fever by using Mahuang and Xixin to unblock the meridian, and Fuzi to assist the interior in reaching the exterior. Understanding the depth of pathogens and the sequence of treatment is crucial. If pathogens first lodge in the Sun Collaterals and linger, blocking the Luo and preventing connection to the Jing, they overflow into the Da Luo, causing strange diseases (so named for their unusual presentation). Because Da Luo distribute throughout the body, intersecting intricately unlike the direct tunnels of Jing Meridians, pathogens in the Da Luo wander with the Luo Qi, flowing left to right and right to left, interfering with the Twelve Meridians and distributing to the limbs. Since the pathogen wanders and does not enter Jing Acupoints, it is considered a strange disease, similar to common terms like "flowing fire" or "wandering wind." Treatment requires Miu Ci, taking left to treat right and vice versa, differing from Jing Meridian treatment. If pathogens lodge in the Jing Meridian, showing lateral preference or migration, Ju Ci must be used to treat the Jing, distinct from Luo treatment. Miu Ci is shallow; Ju Ci is deep, because Luo are superficial and Jing are deep. Pain in Da Luo is wandering and variable, unlike the fixed pain of Jing disease. Luo pain is described as "counter" to the Jing because it intersects rather than running within the Jing. The junctions of the Twelve Meridians are connected by Luo Collaterals, and the heads and tails of Luo and Jing intersect differently, hence "Miu Ci." The following text discusses Luo disease; physicians must understand this. Acupuncture has its own specialty, but herbal treatment follows the same principles.

[Pathogens Lodging in the Collaterals of the Hand and Foot Three Yin and Three Yang]
Pathogens lodging in the collateral of Foot Shaoyin cause sudden heart pain, acute distension, and fullness/supportiveness in the chest and hypochondrium.
Pathogens lodging in the collateral of Hand Shaoyang cause throat obstruction, tongue rolling, dry mouth, mental restlessness, pain on the lateral aspect of the arm, and inability to raise the hand to the head.
Pathogens lodging in the collateral of Foot Jueyin cause sudden hernia and acute illness.
Pathogens lodging in the collateral of Foot Taiyang cause pain in the head, neck, and shoulder.
Pathogens lodging in the collateral of Hand Yangming cause Qi fullness in the chest, wheezing with chest fullness, and heat in the chest.
Pathogens lodging between the arm and palm cause inability to flex.
Pathogens lodging in the Yang Qiao Mai cause eye pain starting from the inner canthus.
Trauma from falling leaves evil blood inside, causing abdominal fullness and constipation/inability to urinate. First administer purgatives. This injures the Jueyin vessel above and the Shaoyin collateral below.
Pathogens lodging in the collateral of Hand Yangming cause deafness and intermittent loss of hearing.
For Bi syndromes with wandering pain without fixed location, needle the area of pain between the muscle bundles.
Pathogens lodging in the collateral of Foot Yangming cause rhinitis/epistaxis and coldness in the upper teeth.
Pathogens lodging in the collateral of Foot Shaoyang cause flank pain, difficulty breathing, coughing with sweating. Coughing is treated with warm clothing and food.
Pathogens lodging in the collateral of Foot Shaoyin cause sore throat, inability to swallow food. Spontaneous irritability, Qi rushing upward to the贲 (cardia), swelling in the throat, inability to swallow saliva, or inability to expectorate saliva.
Pathogens lodging in the collateral of Foot Taiyin cause lower back pain radiating to the lower abdomen and testicles, with inability to lie flat and breathe.
Pathogens lodging in the collateral of Foot Taiyang cause stiffness and back tension, radiating to the flank with pain.
Pathogens lodging in the collateral of Foot Shaoyang cause pain at the pivot point, with inability to lift the thigh.
Pathogens lodging between the Five Zang cause meridian-pulling pain, coming and going intermittently.
Pathogens lodging in the collaterals of Hand/Foot Shaoyin, Hand/Foot Taiyin, and Foot Yangming. These five collaterals converge in the ear and ascend to connect with the left corner of the head. If all five collaterals are exhausted, the body's pulses move, but the form loses consciousness, resembling a corpse, termed Shi Jue (Corpse Syncope). Blow air into both ears with a bamboo tube, shave a square inch of hair from the left corner of the head, burn it, and drink several cups of fine wine. If unable to drink, force-feed. Recovery is immediate.

The junctions of the Twelve Hand and Foot Yin-Yang Meridians are connected by Luo Collaterals. Meridians are like thick, straight branches; collaterals are like thin, horizontal branches. Branches splitting from collaterals are finer and named Sun Collaterals. Thus, meridians have Yin-Yang depth, and collaterals are similar, with locations intersecting according to the meridians. The diseases listed above occur where Luo Qi travels and pathogens lodge, causing Qi blockage or rebellion. The same meridian may present with overlapping but different symptoms because the head and tail of each meridian have collaterals at varying depths and heights. For the sequence of circulation and diseases presented by the Twelve Meridians, refer to the *Meridian Chapter* in the *Meridians Section* for clearer understanding. Since Luo Collaterals connect the heads and tails of meridians and distribute throughout the body, their Sun Collaterals are superficial in the skin and subcutaneous tissue and are finer. Thus, when attacked by pathogens, Qi becomes blocked. Numbness, Bi pain, and wandering pain are all Luo diseases. Yang Luo are exterior; injury causes external bleeding (hematemesis, epistaxis). Yin Luo are interior; injury causes internal bleeding (hematochezia, hematuria). Exogenous pathogens enter from Luo to Jing; Qi and Blood flow from Jing to Luo. Blood follows Qi, moving from interior to exterior. Pathogens move from exterior to interior. Reversal leads to disease. If Qi and Blood are robust, pathogens cannot enter. Hence: "Where pathogens gather, Qi must be deficient." However, the Six Qi pathogens have differences in Yin-Yang and Clear-Turbid qualities, so they resonate by category. Some enter meridians via skin/hair; others enter via mouth/nose, traveling the middle pathway, and dividing to affect interior/exterior. Presentations vary, requiring differentiation and treatment. Thus, one must thoroughly understand the depth of meridian and collateral locations.

[Pathogens Entering According to Seasonal Climate]
*Suo Wen · Si Shi Ni Cong Lun* records: Qibo said: Spring Qi is in the Jing Meridians; Summer Qi is in the Sun Collaterals; Late Summer Qi is in the muscles; Autumn Qi is in the skin; Winter Qi is in the bone marrow. The Yellow Emperor asked: Why? Qibo replied: In Spring, Heaven's Qi opens, Earth's Qi泄 (vents), ice melts, water flows, and meridians clear, so Human Qi is in the vessels. In Summer, vessel Qi is full and overflows into Sun Collaterals for blood reception, filling the skin. In Late Summer, both meridians and collaterals are abundant, overflowing into muscles. In Autumn, Heaven's Qi gathers, interstices close, and skin tightens. In Winter, storage prevails; Qi and Blood reside within, anchoring in bone marrow and connecting to the Five Zang. Therefore, pathogens usually enter the body following the seasonal changes of Qi and Blood. Their variations cannot be measured by fixed standards, but one must follow the Meridian Qi to dispel pathogens. Once pathogens are removed, chaotic Qi will not arise.

This passage explains the rising and falling circulation of Heaven and Earth's Yin-Yang and Five Element Qi. The Five Seasons (Spring, Summer, Late Summer, Autumn, Winter) correspond to the Five Qi (Wood, Fire, Earth, Metal, Water), governing Growth, Flourishing, Transformation, Harvest, and Storage to nourish all things. Humans live within the Qi intersection, so their Yuan Qi floats and sinks in response to Heaven and Earth's Qi. Floating makes it vigorous in the exterior and weak in the interior; sinking makes it vigorous in the interior and weak in the exterior. Pathogens attack where Qi is weak, thus entering the body according to seasonal climates, resulting in different depths and locations. It is often seen that Wind-Cold in Autumn/Winter enters meridians via skin/hair, while Summer-Heat-Dampness in Summer enters the Spleen and Stomach via mouth/nose. The weakness/vigor of interior/exterior Yuan Qi can be deduced from this. However, this describes general principles. Variations in disease cannot be rigidly defined. People have varying constitutions and degrees of pathogenic invasion. One must examine the site of invasion and follow Meridian Qi to dispel pathogens. The Meridian is the pathway connecting interior and exterior; pathogens from both can be expelled through it. Removing pathogens stops chaotic Qi and heals the disease. Thus, Zhang Zhongjing differentiated Six Meridians to distinguish pulse/symptoms and establish treatments, inheriting the Dao of Xuanyuan and Qibo. Those who ignore Zhongjing and fall into shallow/heretical views are sinners against Xuanyuan and Qibo.
Additionally, *Suo Wen · Jin Gui Zhen Yan Lun* states: Spring Qi diseases are in the head; Summer Qi diseases are in the Zang; Autumn Qi diseases are in the shoulders and back; Winter Qi diseases are in the four limbs. This is similar to the current chapter but with different meanings. Record it in the *Xu Feng Zei Xie (Empty Wind and Robber Evil)* section for combined reading.

[Inability of Sinews and Bones to Flex and Extend]
*Ling Shu · Zhong Shi Pian* says: Inability to extend after flexion indicates disease in the sinews; inability to flex after extension indicates disease in the bones. Treat the bone if the disease is in the bone; treat the sinew if the disease is in the sinew.
Sinew contraction causes inability to extend; Bone rigidity causes inability to flex. The Liver governs sinews; the Kidney governs bones. Treat according to the governing organ of the diseased part.

*Suo Wen · Ping Ren Qi Xiang Lun* says: The knee is the mansion of sinews. Inability to flex/extend and stooping while walking indicates sinews are failing. The bone is the mansion of marrow. Inability to stand for long periods and trembling while walking indicates bones are failing.
Observing gait and posture reveals impending failure of sinews and bones. "Bai" means decay/failure.

[Zhen Jin (Rash Sinews)]
*Suo Wen · Qi Bing Lun* records: The Yellow Emperor asked: Someone has a very rapid Chi (Cun Cun) pulse, with tense sinews visible. What disease is this? Qibo replied: This is called Zhen Jin. The abdomen will necessarily be tight. If white or black colors appear on the face, the disease is severe.
"Zhen" implies disease caused by constrained Qi. Thus, Wind-Heat pathogens constrained in blood collaterals manifest as rashes. Named "Zhen Jin" because the Liver governs sinews. Kidney Water deficiency fails to nourish the Liver. Yang becomes constrained below and cannot ascend. Thus, the Chi pulse is very rapid, Liver dries, sinews become brittle, and tension manifests externally. The abdomen will be tight and uncomfortable. Appearance of white (Metal/Lung) or black (Water/Kidney) colors indicates Metal and Water fail to generate each other, Lung and Kidney are disharmonious, exacerbating Liver disease.