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The middle body refers to the central part of the human body. Externally, it includes the chest, hypochondrium, abdomen, back, spine, and umbilicus; internally, it encompasses the Zang organs (solid organs) and Fu organs (hollow organs). Any disease occurring in these areas belongs to the category of the middle body. The origin of such diseases must have a cause: External causes arise from wind in spring, heat and summerheat in summer, dampness in late summer, dryness in autumn, and cold in winter. When these climatic factors arrive in their proper seasons, they are considered normal Qi (vital energy); if they arrive out of season or are excessively strong, they become pathogenic influences (Evil Qi). Diseases caused by these six pathogenic influences (wind, cold, summerheat, dampness, dryness, fire) all belong to external causes. There are also diseases caused by the influence of eight directional winds, such as: Gangfeng (Rigid Wind) from due north on the day of Winter Solstice, Xiongfeng (Auspicious Wind) from northeast on the day of Start of Spring, Ying'erfeng (Infant Wind) from due east on the day of Spring Equinox, Ruofeng (Weak Wind) from southeast on the day of Start of Summer, Daruofeng (Great Weak Wind) from due south on the day of Summer Solstice, Mofeng (Strategizing Wind) from southwest on the day of Start of Autumn, Gangfeng (Rigid Wind) from due west on the day of Autumn Equinox, and Zhefeng (Folding Wind) from northwest on the day of Start of Winter. If these winds arrive in their proper seasons, they nourish all things; if they arrive out of season, they harm all things. If a person contracts these winds, leading to internal severe diseases or external carbuncles and sores, such diseases caused by the eight winds also belong to external causes. Thus, external causes refer to the contraction of the six pathogenic influences and the eight winds.

Internal causes originate from hearing obscene sounds with the ears, viewing lewd sights with the eyes, smelling foul odors with the nose, craving delicious flavors with the tongue, excessive mental activity, and妄生 (wildly generating) thoughts, all of which damage the Shen (Spirit). Diseases caused by these six desires all belong to internal causes. Additionally, excessive joy damages the Heart, excessive anger damages the Liver, excessive thought damages the Spleen, excessive grief damages the Lungs, and excessive fear damages the Kidneys. Prolonged worry leads to Qi stagnation, and sudden fright leads to Qi collapse. Diseases caused by these seven emotions (joy, anger, worry, thought, grief, fear, fright) also belong to internal causes. Thus, internal causes refer to the six desires combined with the seven emotions.

Neither-internal-nor-external causes arise from irregular diet and careless living habits. Excessive consumption of rich wine generates fire, consuming Yin fluids; excessive tea drinking generates dampness and retains fluid; excessive consumption of the "Five Pungents" (garlic, chives, leeks, scallions, and asafoetida) damages Qi and Blood; irregular meals (starvation or overeating) damage the Spleen and Stomach. All these are diseases caused by diet. Daytime overexertion, carrying light loads or heavy burdens, falling, striking, spraining, or dislocating, damages the physical form. Nighttime lack of rest and forced sexual intercourse injure Jing (Essence) and Qi. All these are diseases caused by lifestyle. Those who consume rich and greasy foods often suffer from disharmony of Ying (Nutritive) and Wei (Defensive) Qi, with internal accumulation of Fire-Toxin. Those who consume coarse and meager food often suffer from insufficient Kidney Qi and deficiency of Qi and Blood. These also belong to neither-internal-nor-external causes. Although people's diseases vary in thousands of ways, their origins do not go beyond these three categories. The following case summaries are collected here not to suggest causes outside the Three Categories, but because diseases may present similarly while treatments differ. Therefore, distinctions are made, principles are clarified, names are listed, and symptoms are analyzed one by one, so that practitioners can clearly differentiate syndromes without doubt.

First, the chest is governed by the Lung. The sinews and vessels of the Heart, Spleen, Kidney, Liver, Gallbladder, and Pericardium meridians all ascend to the chest. Chest fullness, shortness of breath, and excess Yang presenting with panting and inability to lie down indicate excess syndrome; chest fullness with epigastric stuffiness but no pain indicates deficiency syndrome. Chest pain mostly belongs to Liver deficiency, with pain radiating to the hypochondrium and back; Liver excess prevents turning and twisting, accompanied by frequent sighing. Other meridians can cause chest fullness and shortness of breath but not pain. Zhang Zhongjing stated: "Chest Bi (obstruction), epigastric stuffiness, trapped Qi knotting in the chest, chest fullness, and rebellious Qi rushing up from the hypochondrium to the heart." This is different from "Zhongman" (central fullness), which presents with external abdominal distension. "Chicken breast" belongs to Lung disease; distension with phlegm indicates Lung Heat, while distension without phlegm indicates Lung deficiency. Both are named "chicken breast" because the chest and diaphragm protrude high.

Second, hypochondriac pain differs between left and right. The left and right are pathways of Yin and Yang. The left belongs to the Liver, which governs Blood; stagnation of Blood causes left-sided pain. The right belongs to the Lung, which governs Qi; when Liver evil invades the Lung, obstructing Qi flow, it causes right-sided pain. However, left pain is not exclusively Blood-related, nor is right pain exclusively Qi-related. Pain that persists even without pressure indicates Blood stasis; distending pain that comes and goes, relieved temporarily by belching but returning later, indicates Qi stagnation. Pain caused by Phlegm-Food retention occurs mainly in the right hypochondrium and must be accompanied by signs of Phlegm-Food, differing from Qi-Blood stagnation, which astute observers can distinguish. In cases of excessive sexual activity and Kidney deficiency with emaciation, there is often dull, slight pain in the chest and hypochondrium. This is because Kidney deficiency fails to grasp Qi, and Qi deficiency fails to generate Blood, causing obstruction in the pathways of Yin-Yang circulation. Failing to seek the root cause and adhering rigidly to one view violates the prohibition against "making deficiency more deficient."

Third, abdominal hardness results from sinking of Spleen Yang, allowing turbid Yin Qi to invade. It feels hard like stone upon pressure and is painless, but painful due to fullness, Qi knotting, and undigested food. This is common in children. Generally, Cold causes contraction, or it results from Food injury. Hard masses with pain indicate Worm pain. Pain encircling the navel caused by Chong Mai (Penetrating Vessel) pathology, where Qi overflows into the Large Intestine, is attributed to Large Intestine disease. Lower abdominal pain radiating upward due to Spleen injury transmitting to the Kidney is also noted. Cold pain below the navel indicates Kidney disease.

Fourth, lower back and back pain: The *Zhenjing* states that deficiency of Juyang (Taiyang/Bladder Meridian) causes head, neck, waist, and back pain. It also states that the three Yang meridities of the foot descend from head to foot, while the three Yin meridities of the foot ascend from foot to abdomen; pain can occur along any meridian pathway. External pathogens (Wind, Cold, Damp, Heat), trauma, Blood stasis, Qi stagnation, and Phlegm accumulation causing internal issues are branch (Biao) diseases. Pain due to sexual exhaustion and Kidney deficiency is a root (Ben) disease. The waist is the mansion of the Kidney; inability to turn indicates impending Kidney failure. The shoulder and back region belongs to the Lung; panting, coughing, and rebellious Qi causing shoulder and back pain indicate Lung Dryness. A band of cold pain across the shoulder and back indicates Phlegm-Fluid and Qi accumulation. Redness, swelling, and pain on the upper back indicate Wind-Heat. Redness belongs to Fire Evil, swelling to Wind excess. The *Neijing* states that excessive Fire in the year causes shoulder and back heat. The upper back is traversed by the Du Mai (Governing Vessel), which connects to the Kidneys. Wind Qi descends from Fengfu (DU16) and accumulates to transform into Heat; thus, Jianding (GB21) and Feishu (BL13) are moxa-ed to dissipate it. Furthermore, when external pathogens clash with circulating Ying and Wei Qi, hundred joints ache, and sinews and bones spasm. Lower body deficiency and cold, with insufficiency of the three Yin meridians, cause soreness and pain in the waist and knees. Whenever True Qi is失调 (disharmonious) or slightly deficient, Five Evils and Six Pathogens can enter through gaps. Therefore, sages earnestly advise nurturing and preserving True Qi as the supreme method for health and disease prevention.

Fifth, Xu Lao (Deficiency Consumption) involves internal depletion of Essence and Blood, leaving all vessels empty. Ancient sages analyzed this in detail. Qin Yueren (Bian Que) discussed deficiency and damage: Deficiency contracting Cold damages Yang; Yang deficiency leads to Yin excess. Damage proceeds top-down: First damage to Lung (skin gathers, hair falls); second to Heart (blood vessels fail to nourish organs); third to Stomach (food fails to nourish flesh); beyond the third stage, it is incurable. Deficiency contracting Heat damages Yin; Yin deficiency leads to Yang excess. Damage proceeds bottom-up: First damage to Kidney (bone atrophy, inability to rise from bed); second to Liver (sinews relax, inability to hold); third to Spleen (food fails to digest); beyond the third stage, it is incurable. Qin Yueren emphasized the Spleen and Stomach as key to treating Xu Lao. Later, Zhang Zhongjing established the Xu Lao chapter, describing five labors leading to extreme deficiency, emaciation, abdominal fullness, anorexia, and internal dried Blood manifesting as rough skin and dark eyes, treated with Dahuang Zhechong Wan. He understood that fever in Xu Lao stems from Blood stasis caused by internal injury, seeking the root cause. Chao Yuanfang's *Zhubing Yuanhou Lun* categorized Xu Lao, Zheng Bing (Steaming Disease), and Zhu Lao (Infectious Consumption) into various subtypes. Modern practitioners were confused by these many paths. Ultimately, these result from alcohol, sex, fatigue, emotions, and diet. Qi injury affects Jing; Jing injury affects Qi. Jing deficiency is Yin deficiency, manifesting as irritability, red face/head, dry lips/tongue, sore throat, mouth ulcers, hematemesis, epistaxis, hematochezia, hematuria, constipation, and dysuria. Qi deficiency is Yang deficiency, manifesting as aversion to cold, emaciation, shortness of breath, fatigue, dizziness, nausea, anorexia, abdominal pain, diarrhea, incontinence, cough, expectoration, nocturnal emission, night sweats, asthma, hoarseness, bone/joint pain, mental confusion, severe muscle wasting, dreams of sexual intercourse, and amenorrhea. Prolonged deficiency becomes Sun (Damage); extreme non-recovery becomes Lao (Consumption). Thus, Lao Zhai arises from Qi and Blood deficiency. Qi fails to generate Blood; Blood stasis leads to Ying deficiency, causing fever. Prolonged fever steams the stagnant Blood, transforming it into worms, leading to Chuanshi (Transmitting Corpse) Lao. Symptoms include alternating chills and fever, night sweats, dreams of sexual intercourse, nocturnal emission, white turbidity, dry erect hair, abdominal masses, small nodules behind the ears, chronic cough with sputum, hemoptysis resembling Fei Wei (Lung Atrophy) or Fei Yong (Lung Abscess), abdominal pain, diarrhea, emaciation, and weakness. Over months and years, it leads to death and transmission to relatives, causing family extinction, unresponsive to charms or medicines. Knowing this, one should apply moxibustion early to Gaohuangshu (BL43) and Sihua acupoints. Delay renders treatment futile. Moxibustion for Xu Lao aids Yang Qi; however, it is contraindicated if the pulse is flooding and Yang is excessive. Clinical judgment is essential.

Sixth, spontaneous sweating and night sweating stem from Heart and Kidney dysfunction. Sweat is the fluid of the Heart; the Kidneys govern the five fluids. Heart Yang deficiency fails to secure the exterior, leading to spontaneous sweating regardless of wakefulness or labor, profusely oozing, caused by Yin steaming Yang. Kidney Yin deficiency fails to nourish internally and store, leading to night sweating (sleep sweat) when Wei Qi enters Yin during sleep, opening pores; sweating stops upon waking, caused by Yang steaming Yin. In Xu Lao fever, flushed cheeks, spontaneous sweating, depleted fluids, and flaring deficient fire leave little Qi and Blood. Spontaneous sweating also occurs in Yangming syndrome approaching excess; night sweating occurs in Shaoyang syndrome at the half-exterior/half-interior level. These require separate discussion.

Seventh, Blood disorders include hemoptysis, hematemesis, spitting blood in saliva, epistaxis, hematochezia, hematuria, Changfeng (Intestinal Wind), Zangdu (Visceral Toxin), and bleeding from ears, eyes, teeth, gums, and pores. Ying Qi, refined from grain and water, harmonizes the Zang organs, spreads to the Fu organs, and enters the vessels. Generated by the Spleen, commanded by the Heart, stored in the Liver, distributed by the Lungs, and excreted by the Kidneys, it irrigates the body. Blood is Shen Qi; possessing it means life, losing it means death. Hemoptysis originates in the Lung; the Lung also governs saliva. Lung governs Qi (rebellion causes cough); Kidney governs Water (transformation creates saliva). Disease in one affects both. Scattered blood in saliva indicates Kidney Fire flaming upward; thread-like blood in sputum indicates Lung collateral heat injury. Coughing up pale, meat-like blood is fatal. Geketsu (spitting blood without coughing) differs from Tuosuo (saliva/spittle); saliva rises freely, while phlegm-bound blood gets stuck in the throat. Both relate to the Kidney. Purple-black clots vomited from upper burner heat originate in the Stomach; Qi deficiency failing to control blood leads to vomiting. Epistaxis results from damaged Yang collaterals; hematochezia from damaged Yin collaterals. Heat in the Bladder causes urinary retention and hematuria; heat penetrating intestines causes Changfeng; heat forcing upward causes bleeding in ears, eyes, mouth, and tongue. Bleeding from pores is called Xuehan (Blood Sweat) or Jinü (Muscle Ecchymosis), indicating extreme deficiency. Treatment requires distinguishing Yin/Yang and excess/deficiency, presence/absence of Fire. If the pulse is floating, flooding, rapid, and full with Fire, moxibustion is contraindicated to avoid adding Fire to Fire.

Eighth, Gu Zhang (Drum Distension): Qibo stated that early edema shows swollen eye sockets, pulsating neck veins, occasional cough, cold inner thighs, swollen calves, and abdominal enlargement. Pressing the abdomen leaves an indentation that rebounds slowly, like a water-filled bag. Fuzhang (Skin Distension) involves Cold invading skin, causing general swelling and abdominal distension, but pressing leaves no indentation. Guzhang involves abdominal distension similar to Fuzhang but with yellowish-green skin and visible abdominal veins. Changtan (Intestinal Tumor) involves Cold invading outside the intestines, interacting with Wei Qi, forming a mass starting size of a chicken egg, growing large like pregnancy, hard to press but movable, with regular menstruation. Shixia (Stone Fibroma) forms in the uterus due to Cold blocking the Zi Men (Cervical Os), trapping bad blood, causing menstrual irregularity; treatable by guiding downward. Zhang Zhongjing described Fengshui (Wind Edema) with floating pulse, joint pain, aversion to wind; Shuishui (Water Edema) with floating pulse, pitting edema, no aversion to wind; Zhengshui (True Water) with deep-slow pulse, wheezing; Shuishui (Stone Water) with deep pulse, abdominal fullness, no wheezing; Huanghan (Yellow Sweat) with deep-slow pulse, fever, chest fullness, swelling of limbs/face, potentially leading to abscesses. The *Neijing* states that Yin Qi ascending causes distension. Yin Qi (Earth Qi) should be below; if it ascends like clouds obscuring sunlight, it creates darkness. Only after thunder, rain, and clearing can light return. Understanding this reveals the *Neijing*'s method for treating distension. Ancient treatments distinguish five Zang organs, Yin/Yang, and causes like Wind-Damp-Cold-Stagnation, Blood-Toxins, Diet, and Fatigue. Clear diagnosis prevents errors of reinforcing excess or draining deficiency.

Ninth, Ji Ju (Accumulation and Gathering) and Pi Kuai (Pi Masses). Formless and deficient is Pi; formed and solid is Kuai. Li Dongyuan stated Pi is epigastric fullness without pain. Taiyin is Dampness, causing obstruction; Earth overacting on the Heart causes Pi Man (Pi Fullness). Ji (Accumulation) is fixed and immovable, located in Zang organs; Ju (Gathering) is movable, located in Fu organs. Liver Ji is Feiqi under left hypochondrium; Lung Ji is Xiben under right hypochondrium; Heart Ji is Fuliang above navel entering heart; Spleen Ji is Piqi in stomach; Kidney Ji is Bentun below navel rushing to heart. Other accumulations involve Cold-Heat, Wine-Food, Water, Qi, Blood, and Toxins, with different treatments based on pathogen location.

Tenth, Xin Tong (Heart Pain) and Abdominal Pain. The "Nine Types of Heart Pain" include five Zang pains, Stomach pain, and Phlegm/Worm/Food accumulation pains. Historically, epigastric pain was confused with heart pain. The Heart, as Sovereign, cannot be invaded; the Pericardium receives evil. Direct invasion causing true heart pain is Zhenxin Tong (True Heart Pain), fatal. Organ meridians carrying evil to the heart cause Jue Xin Tong (Rebellious Heart Pain), corresponding to specific organ symptoms: Kidney pain controls back and stooping; Stomach pain has abdominal/chest fullness; Spleen pain feels like needle刺; Liver pain has cyanotic face and sighing; Lung pain worsens with movement. Stomach pain, originating from the Sea of Grain and Water, can mimic heart pain but always includes stomach symptoms (fullness, bloating, anorexia, vomiting, acid regurgitation, bowel changes, yellow complexion). Li Dongyuan attributed heart/stomach/abdominal pain to excessive labor, irregular diet, Middle Qi deficiency, and Cold invasion. Abdominal pain locations correspond to meridians: Zhongwan (CV12) is Taiyin; Umbilical is Shaoyin; Lower abdomen is Jueyin. Treatment depends on formlessness/form, Zang/Fu, and height, using acupuncture/moxibustion points accordingly.

Eleventh, Ge Ye (Diaphragmatic Dysphagia) is not caused by external pathogens but by emotional depression (worry, thought, fatigue, desire). As Zhang Jifeng noted, if one does not cultivate stillness and clear thoughts, Five Fires arise, Qi rebels, fluids dry, and clear/turbid mix in the chest, preventing swallowing. Obstruction at Xi Men (Admission Gate) is Ge; obstruction at Ben Men (Rebelling Gate) with delayed vomiting is Ye. Both are Upper Burner issues. Li Dongyuan stated: Sai (Obstruction) is Yang Qi failing to ascend (Yin/Blood from Zang); Ye (Dysphagia) is Yin Qi failing to descend (Yang/Qi from Fu). Yang knotting above and Yin deficiency below cause this. The *Neijing* says "Three Yang knotting causes Ge." Three Yang (Large Intestine, Small Intestine, Bladder) heat knots, preventing fluids from nourishing the Lung, closing Xi Men.

Twelfth, Fan Wei (Regurgitation): Food enters but returns later, obstruction at You Men (Pylorus), Middle Burner disease. Morning food evening vomit, evening food morning vomit, undigested food, red urine, hard stools like sheep dung, obstruction at Lan Men (Valve Gate), Lower Burner disease. *Shanghan Lun* notes stomach deficiency failing to digest, with evening Qi clashing with evil causing regurgitation. Wang Bing noted: inability to eat indicates Fire; eating then vomiting indicates No Fire. Chao Yuanfang said cold spleen fails to grind food, causing Qi rebellion. Treat with pungent-hot herbs for Stomach Cold-Qi Deficiency. However, rapid pulse indicates Fire flaming upward; heat failing to digest food or food/drink injury requires differentiation, not just assuming cold-deficiency.

Thirteenth, Huo Luan (Colic Vomiting and Diarrhea): Conflict of Yin/Yang and Clear/Turbid Qi in intestines/stomach causes sudden abdominal pain, vomiting, diarrhea, aversion to cold, high fever, headache, dizziness. Heart pain precedes vomiting; abdominal pain precedes diarrhea. Simultaneous pain causes simultaneous vomiting/diarrhea. Muscle spasms entering abdomen are fatal. Common in late summer/early autumn due to residual summerheat, new coolness, and epidemic Qi invading Stomach Yang. Moxibustion is effective where herbs fail. Gan Huo Luan (Dry Huo Luan) involves inability to vomit or defecate, severe abdominal pain ("Intestinal Twisting"). Immediately administer salt water to induce vomiting for survival. Avoid food/drink until vomiting/diarrhea cease for 2-3 hours, then introduce thin porridge gradually.

Fourteenth, Ou Tu (Vomiting): Li Dongyuan stated all belong to Stomach but differ. Ou (Vomiting with sound and matter) is Yangming (many blood/qi, Qi-Blood disease). Tu (Vomiting with matter only) is Taiyang (many blood, less qi, Blood disease). Gan Ou (Dry Vomiting with sound only) is Shaoyang (many qi, less blood, Qi disease). Root causes include Spleen Qi deficiency, Cold invading Stomach, and dietary injury. Upper Jiao Wind opens pores, disrupting Qi, causing back/arm heat and pain, leading to Lou Qi (Leaking Qi) where food vomits then passes down. Lower Jiao excess causes Zou Bu (Walking Nourishment) with urinary/fecal retention and uncontrollable vomiting. Heat rushing up causes violent vomiting. Chest oppression resembles panting/vomiting/hiccupping. Bitter vomiting indicates Gallbladder evil invading Stomach. Sour vomiting (Tu Suan) is heat from Wood transformation of stagnant fluids. Swallowing sourness (Tun Suan) is stagnant heat in Lung/Stomach aggravated by Cold; treat with warming, avoid cold herbs. Clear water vomiting is Cold-Damp; phlegm vomiting is Fluid retention. Vomiting pus from abscesses resolves spontaneously. Vomiting worms indicates Stomach Cold (Zhang Zhongjing).

Fifteenth, Ke Sou (Cough) must distinguish Six Qi and Five Zang, primarily involving the Lung. *Neijing* and *Jinkui* detailed this. Yu Juyan corrected "Autumn injury by Dampness, Winter produces Cough" to "Summer injury by Summerheat, Late Summer injury by Dampness, Autumn malaria, Autumn injury by Dryness, Winter Cough," aligning Six Qi with Four Seasons. Wind, Fire, Heat, Damp, Dryness, and Cold all invade Lung causing cough. Wind-Lung cough: sweating, headache, difficult phlegm. Fire-Lung cough: panting, obstruction, bloody sputum. Heat-Lung cough: panting, red face, tidal fever, cold extremities if heat is central, diarrhea if heat moves down. Dryness-Lung cough: dry skin, fine eczema, sticky phlegm, constipation. Cold-Lung cough: aversion to cold, no sweat, nasal congestion, body ache, fever, irritability. To...