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(From "Ling Shu: Pathogenic Factors and Zang-Fu Diseases")

Huangdi asked Qibo, "How do pathogenic factors invade the human body?" Qibo replied, "Pathogenic factors invade from the upper part." (Wind-cold pathogens invade the upper part first.) Huangdi asked, "Is there a measure or pattern to this high-low distinction?" Qibo said, "For the upper half of the body, wind pathogens invade; for the lower half of the body, dampness pathogens invade." (Yang meridians receive wind Qi, Yin meridians receive dampness Qi.) Therefore it is said: "Pathogenic factors invading the body have no fixed pattern. If they invade the Yin, they flow into the Fu organs; if they invade the Yang, they flow into the Jing meridians." (Detailed below.) Huangdi said, "Yin and Yang are different in name but similar in category. They meet above and below, and the Jing-Luo meridians interconnect like a circle without beginning or end. When pathogenic factors invade, sometimes they invade Yin, sometimes Yang, up and down, left and right, with no constancy. What is the reason for this?" (The meridians interconnect as one, originally belonging to the same category; however, since each location above, below, left, and right has its specific domain, the names of Yin and Yang differ.) Qibo said, "All Yang meridians converge at the face. When invaded, it is often when the body is deficient, or after new exertion, or after eating/drinking with sweating and opening of the Couli (skin pores and interstitial spaces), allowing pathogens to strike. If the pathogen strikes the face, it descends to the Yangming Meridian; if it strikes the nape, it descends to the Taiyang Meridian; if it strikes the cheek, it descends to the Shaoyang Meridian." (This refers to pathogens invading Yang meridians. The six Yang meridians of the hand and foot all converge on the head and face, hence called 'convergence of all Yang'. All three Foot-Yang meridians run from head to foot; thus, invasion of the face leads downward to the Yangming Meridian via the chest and abdomen; invasion of the nape leads downward to the Taiyang Meridian via the back; invasion of the cheek leads downward to the Shaoyang Meridian via the flanks. The meridians circulating throughout the body are primarily the six Foot meridians, so only these are mentioned here.) If pathogens strike the chest, back, and flanks, they also invade their respective meridians. (The chest is anterior, belonging to Yangming; the back is posterior, belonging to Taiyang; the flanks are lateral, belonging to Shaoyang. Invasion of these three Yang meridians is the same as described above.)

Huangdi asked, "How does invasion of the Yin occur?" Qibo answered, "Invasion of the Yin usually begins at the arms and legs. The skin of the arms and inner calves is thin, and the flesh is soft and moist, so both are susceptible to wind pathogens, uniquely injuring the Yin." (This refers to pathogens invading Yin meridians. 'Fu' refers to the calf muscle. 'Naoze' means soft and moist. The inner aspect of the arm and leg is called Yin, where the three Yin meridians of the hand and foot travel. Since the skin is thin and the flesh soft, pathogens striking here injure the Yin meridians. 'Fu' is pronounced 'hang', also 'xingjing qie'. 'Nao' is pronounced 'nao'.) Huangdi asked, "Does this necessarily damage the Zang organs?" Qibo said, "When the body is invaded by wind pathogens, it does not necessarily disturb the Zang organs. Thus, when pathogens enter the Yin meridians, if the Zang Qi is solid, the pathogens cannot lodge, and they return to the Fu organs. Therefore, invasion of Yang flows into the meridians, and invasion of Yin flows into the Fu organs." (Pathogens invading Yin meridians should theoretically connect internally to the five Zang organs, hence the question of whether the Zang is damaged. However, if pathogens enter Yin meridians and the Zang Qi is firm, the pathogens cannot lodge, nor will they necessarily disturb the Zang; instead, they return to the Fu organs, remaining at the exterior level. Thus, pathogens invading Yang flow into the three Yang meridians, while those invading Yin flow into the three Yin Fu organs. For example, the Heart connects to the Small Intestine, Spleen to Stomach, Liver to Gallbladder, Pericardium to Sanjiao, and Kidney to Bladder. Because pathogens invading the three Yin meridians can present with exterior symptoms, discerning individuals must observe this. 'Liu' is pronounced 'lijiu qie'.)

Huangdi asked, "How do pathogens invade the Zang organs?" Qibo said, "Sorrow, worry, and fear damage the Heart. Physical cold exposure and cold drinks damage the Lungs, because the two types of cold interact, damaging both interior and exterior, causing Qi to rebel and move upward." (Below discusses pathogens invading the five Zang organs. However, internal injury must exist first before external pathogens can enter. The Heart houses the Shen (Spirit); sorrow and fear weaken the Shen, thus damaging the Heart. The Lungs combine with the skin and hair, and the organ fears cold; physical cold and cold drinks damage the Lungs. If there is internal injury and subsequent external contraction, both interior and exterior are damaged, causing Qi to rebel upward. At the exterior, this manifests as chills, fever, and pain; at the interior, as wheezing, coughing, vomiting, and hiccuping. The *Ben Bing Lun* states: Sorrow and overthinking damage the Heart; dietary irregularities and fatigue damage the Spleen; sitting on wet ground or forcing entry into water damages the Kidneys; anger with rebellious Qi that fails to descend damages the Liver. See Yunqi Category 44 for details.) Falling injuries with retained evil blood, or extreme anger causing Qi to rush upward without descending and accumulating under the flanks, damage the Liver. (The Liver stores Blood, its emotion is Anger, and its meridian travels through the flanks.) Blows, falls, sexual intercourse after drunkenness, sweating followed by wind exposure, damage the Spleen. (The Spleen governs muscles; blows and falls injure the muscles. Sexual activity after drunkenness with sweating and wind exposure, due to alcohol and food, results in injury to the Spleen.) Excessive lifting, excessive sexual activity, sweating followed by bathing in water, damage the Kidneys. (The Kidneys govern Essence and bones; heavy lifting injures bones, excessive sex injures Essence, and bathing in water while sweating allows Water pathogens to attack the root organ, thus damaging the Kidneys.) Huangdi asked, "How do pathogens invade the five Zang organs?" Qibo said, "Only when both Yin and Yang are affected can the pathogen advance." Huangdi said, "Well said!" (This continues the previous discussion regarding wind invasion of the five Zang organs: only through simultaneous internal and external contraction can the pathogen advance. 'Wang' means to enter/advance.)

Huangdi asked, "What are the clinical manifestations of pathogenic invasion?" (Same as the previous chapter.) Qibo said, "When Xu Xie (deficiency pathogens) invade the body, they cause shivering and trembling of the form. Zheng Xie (correct/pathogenic factors) invading the body is subtle; it first appears in the complexion, is not felt in the body, seeming to be there and not there, existing and yet perishing, having form and yet formless, such that no one knows its true nature." Huangdi said, "Well said!" (This section is largely identical to the *Guan Neng* chapter, see Acupuncture Category 10. Additionally, the *Ba Zheng Shen Ming Lun* details the meanings of Xu Xie and Zheng Xie, see Acupuncture 13.)