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*Lingshu: Hundred Diseases Originate* (Full Text)

Huangdi asked Qibo: The origin of all diseases arises from wind, rain, cold, and heat; clear dampness; and joy and anger. If joy and anger are not regulated, they damage the Zang organs; wind and rain damage the upper part of the body; clear dampness damages the lower part. The pathogenic factors in these three regions differ in their nature. I wish to hear how they converge.

Qibo replied: The pathogenic factors in the three regions are different; some originate from the Yin, and some from the Yang. Let me explain their principles. If joy and anger are not regulated, they damage the Zang organs; when the Zang organs are damaged, disease originates from the Yin. Clear dampness attacks deficiency, so disease originates from the lower part; wind and rain attack deficiency, so disease originates from the upper part. This is called the Three Regions. As for the overflowing and spreading [of pathogens], it is countless. (The origin of all diseases involves neither external contraction nor internal injury alone, but also has distinctions among the upper, middle, and lower parts. Unregulated joy and anger constitute disorders of the Five Emotions, damaging the Zang internally, thus originating from the Yin. Clear dampness attacking deficiency represents Yin pathogens on the exterior, thus originating from below. Wind and rain attacking deficiency represent Yang pathogens on the exterior, thus originating from above. The initial reception of disease lies only in these three regions; however, once the pathogens overflow and spread, the changes become incalculable. *Yin* sounds like 'yi'.)

Huangdi said: I certainly cannot enumerate them all, which is why I ask my predecessors. I hope you will exhaustively explain this principle. (Predecessors refer to senior masters.)

Qibo said: Wind, rain, cold, and heat cannot harm people independently unless they are *Xu Xie* (Deficient Pathogens/Empty Winds). Those who suddenly encounter fierce winds and heavy rains without falling ill do so because their interior Qi is not deficient, so pathogens cannot touch them. This occurs only when one encounters *Xu Xie* winds while the body is in a state of deficiency; the two deficiencies meeting allows the pathogen to lodge in the form. If real winds meet with robust human Qi, the masses have firm flesh, and pathogens cannot enter. Contracting *Xu Xie* depends on the timing of heaven and the constitution of the body, combined with excess or deficiency, leading to major illness. Qi has fixed abodes, and names are given according to location, divided into upper, lower, and outer/inner as three components (*San Yuan*). (Coming from the direction opposite to the prevailing wind is *Xu Feng* (Empty Wind), which harms people. Coming from the inhabited direction is *Shi Feng* (Real Wind), which governs growth and nourishment. If human Qi is not deficient, even encountering Empty Wind cannot harm. Thus, bodily deficiency must meet heavenly deficiency; the two deficiencies meeting allows the pathogen to lodge. If heaven has Real Wind and humans have Real Qi, the two realities meeting results in firm flesh, and pathogens cannot enter. *San Yuan* refers to: *Xu Xie* entering people, etiology on the exterior; formed accumulations, etiology on the interior; emotional desires damaging Zang, pathology in Yin—this is the meaning of the three internal/external regions. The meaning of Empty Wind is detailed in the Luck Class, chapters 35 and 36.)

Therefore, when *Xu Xie* enters a person, it begins at the skin. If the skin is lax, the pores open; if the pores open, pathogens enter through the hair; upon entering, they reach depth; at depth, the hair stands erect; when hair stands erect, one feels chilly, hence skin pain. (This section below describes the sequence of transmission of Yang pathogens. Pathogens entering a person must go from exterior to interior, starting at the skin. Exterior deficiency causes skin laxity, allowing pathogens to take advantage. When pathogens are at the exterior, hair stands erect, causing chills. Cold pathogens damaging Wei Qi cause blood and Qi stagnation, resulting in skin pain. Wherever cold pathogens strike, there is often soreness and pain; observing which meridian is involved reveals whether it is Yin or Yang, deep or shallow. For diagnosing exterior syndromes, one should start here. The meaning of the origin of all diseases below is largely consistent with the Pi Bu Lun, detailed in the Meridian Class, chapter 31.)

If it remains and does not depart, it transmits to the Luo Collaterals. At this stage, pain is felt in the muscles; the pain may cease intermittently, after which the Large Meridians (Twelve Primary Meridians) take over. (When pathogens are in the skin and hair, treatment should be external. If remaining and not departing, entry becomes deeper, transmitting to the Luo Collaterals. Since collaterals are shallower than meridians, pain is felt between muscles. If muscle pain gradually ceases, it indicates pathogens are leaving the collaterals to deepen, and the Large Meridians assume the burden.)

If it remains and does not depart, it transmits to the Jing Meridians. At this stage, one experiences shivering aversion to cold and frequent fright. (Collaterals are floating and superficial; meridians are hidden and deep. Pathogens entering meridians from collaterals remain at the exterior, hence shivering aversion to cold. However, since meridian Qi connects to the Zang organs, fright also occurs.)

If it remains and does not depart, it transmits to the Shu Points. At this stage, the Six Meridians are blocked, causing pain in the limbs and joints, and stiffness in the waist and spine. (All Shu points are places where meridian Qi gathers. Where it stays, it must be in the joints and valleys. Thus, when pathogens transmit from meridians to Shu points, the Six Meridians become blocked, causing pain and stiffness in the limbs, joints, waist, and spine.)

If it remains and does not depart, it transmits to the Fu Chong Mai (Hidden Chong Vessel). At this stage, there is heaviness of the body and whole-body pain. (The Fu Chong Mai is the portion of the Chong Mai within the spine; because it is deepest, it is called Hidden. The Sui Lu Pian states "enters the spine and pours into the Fu Chong Mai." See Chapter 49 of this class. Pathogens staying from meridians and Shu points deepen here, causing symptoms like body heaviness and pain.)

If it remains and does not depart, it transmits to the Stomach and Intestines. At this stage, there is abdominal distension and rushing sensations. With excessive cold, there is borborygmus, undigested stool diarrhea, and food not transforming; with excessive heat, there is loose, foul-smelling discharge. (Pathogens entering Zang from meridians transmit to the stomach and intestines, causing rushing and abdominal distension. Cold leads to clear and cold fluids, failure to separate water and grain, hence borborygmus, undigested stool, and indigestion; heat leads to turbid filth flowing downward, hence loose and muddy stools.)

If it remains and does not depart, it transmits outside the stomach and intestines, to the Mu Yuan (Muo-Original), lingering in the vessels. If it lingers and does not depart, it slowly forms an accumulation. (Outside the stomach and intestines, in the Mu Yuan, refers to the space between skin and fascia. These are concealed and winding places where Qi and Blood do not flow easily. If pathogens linger inside, they stop and form accumulations, such as malaria or痞块 (masses). *Mu* sounds like 'mu'.)

Or pathogens attach to Sun Collaterals, or Luo Collaterals, or Jing Meridians, or Shu Meridians, or Fu Chong Mai, or Lü Jin (Spinal Muscles/Tendons), or the Mu Yuan of the stomach and intestines, connecting upwards to Huan Jin (Relaxed Tendons). The overflowing and spreading of pathogens is too numerous to discuss. (This section below discusses where pathogens attach and the variations of overflowing. Lü Jin is detailed below. Mu Yuan, for example, Zhongfu is Mu and Taiyuan is Yuan for the Hand Taiyin Lung Meridian. Huan Jin are branched soft tendons. Wherever pathogens attach, they stay and cause disease, reaching everywhere, hence overflowing changes are incalculable. *Lü* sounds like 'lü'. *Yin* sounds like 'yi'.)

Huangdi said: I wish to hear completely why this happens.

Qibo said: When pathogens attach to Sun Collaterals forming an accumulation, the accumulation moves up and down. It resides in the arm Sun Collaterals, which are floating and lax, unable to constrain the accumulation to stop it; thus, it migrates between the stomach and intestines. If water gathers, it seeps and pours, making a gurgling sound; if cold is present, there is distension and thunder-like pulling pain, causing sharp pain occasionally. (All fine collaterals are called Sun Collaterals. Ju means to constrain. When pathogens attach to Sun Collaterals forming accumulation, the accumulation can move up and down, likely residing in the collaterals of the Large and Small Intestines, belonging to the Hand Meridians. These collaterals are floating, shallow, lax, and not urgent, unable to constrain the accumulation, so it migrates between the stomach and intestines. If there is water, it seeps and pours, making sound; if there is cold, there is distension and thunder-like pulling, causing occasional sharp pain. *Ju* sounds like 'gou'. *Chen* sounds like 'chen'.)

When pathogens attach to the Yangming Meridian, the accumulation resides flanking the navel. After full meals, it becomes larger; when hungry, it becomes smaller. (Foot Yangming Meridian descends flanking the navel, so its accumulation resides flanking the navel. Yangming belongs to the Stomach, receiving Qi of water and grain, so it enlarges when full and shrinks when hungry.)

When pathogens attach to Huan Jin, it resembles an accumulation of Yangming. It hurts after full meals and feels comfortable when hungry. (Huan Jin is between muscles, resembling Yangming accumulation. Fullness causes muscle congestion, hence pain. Hunger causes Qi retreat, hence comfort.)

When pathogens attach to the Mu Yuan of the stomach and intestines, pain extends outward to connect with Huan Jin. It feels comfortable after full meals and hurts when hungry. (Pain in stomach/intestine Mu Yuan connecting to Huan Jin: fullness causes internal filling and external relaxation, hence comfort. Hunger reverses this, hence pain.)

When pathogens attach to the Fu Chong Mai, palpation reveals pulsation under the hand; upon lifting the hand, hot Qi flows down to both thighs, resembling the sensation of hot water pouring. (Meaning of Fu Chong as before. The ascending branch follows the back interior, connecting to Du Mai; the descending branch pours into the Large Luo of Shaoyin, emerges at Qichong, follows the inner aspect of the thigh into the popliteal fossa. Thus, palpating the thigh reveals pulsation; lifting the hand causes hot Qi to descend between the thighs. This is the sign of pathogens attaching to Fu Chong. *Wo* sounds like 'wu'.)

When pathogens attach to Lü Jin behind the intestines, the accumulation is visible when hungry, invisible when full, and unpalpable. (Lü is same as Lv, referring to spinal bone. Tendons within the spine are called Lü Jin, thus located behind the stomach and intestines. When hungry, intestines are empty, so accumulation is visible. When full, intestines are filled and cover it, so accumulation is invisible and unpalpable.)

When pathogens attach to Shu Meridians, blockage occurs, fluids fail to descend, and orifices become dry and congested. (Shu Meridians conduct Blood and Qi. If blocked, fluids become dry and congested as described.)

These are pathogens entering from the exterior to the interior, from top to bottom. (This summarizes the above regarding pathogens originating from Yang, necessarily moving from exterior to interior, from top to bottom.)

Huangdi said: How does an accumulation begin, and how does it become established?

Qibo said: Accumulations begin with the acquisition of Cold, and formation requires Qi Rebellion (Jue Qi). (This section below explains why accumulations form.)

Huangdi said: How does the accumulation form?

Qibo said: Jue Qi generates foot weakness; Cold generates calf coldness. Calf coldness causes blood vessels to coagulate and stagnate; coagulated blood vessels allow Cold Qi to enter the stomach and intestines from above. Entering the stomach and intestines causes distension; distension forces the juices and foam outside the intestines to gather and prevents dispersion, forming accumulations day by day. (This describes accumulations formed by downward-reversing Cold Qi. Jue Qi is rebellious Qi. Cold reversing downward generates foot weakness, meaning joint pain and sluggishness. Due to calf coldness, blood and Qi coagulate; Cold Qi ascends from below to enter the stomach and intestines. Stomach/intestine cold prevents Yang Qi transformation, causing distension. Externally gathered juices and foam fail to disperse, forming accumulations over time. *Man* Mei Ben Qie. *Jing* Xing Jing, Xing Jing two readings.)

Sudden overeating and drinking cause intestinal fullness. Irregular living habits and excessive effort injure the collaterals. Injury to Yang Collaterals causes external blood overflow, leading to epistaxis or hematemesis; injury to Yin Collaterals causes internal blood overflow, leading to hematochezia or hematuria. Injury to stomach/intestine collaterals causes blood to overflow outside the intestines. If Cold and juices exist outside the intestines, they mix with blood, coalesce, and fail to disperse, forming accumulations. (This describes accumulations formed by irregular diet and lifestyle. Sudden overeating means eating rapidly and excessively. Digestive capacity is exceeded, juices overflow the membrane, mixing with blood to form food accumulations, similar to infant痞疾 (masses). Alternatively, excessive effort injures Yin/Yang collaterals, disturbing blood. Stasis combined with Cold and juices outside intestines forms blood accumulations, common in those who indulge in food and movement.)

Sudden external contraction of Cold, or internal injury from sorrow and anger, causes Qi to rebel upward. Upward rebellion blocks the Six Shu points, preventing Warm Qi from circulating. Coagulated blood accumulates internally without dispersing; fluids become viscous and渗 (seep/stagnate), adhering and not departing, forming accumulations. (This describes accumulations formed by emotional internal injury combined with Cold. External Cold plus internal sorrow/anger causes Qi reversal due to Cold, blocking Six Meridian Shu points. Lack of Warm Qi causes Yin Blood coagulation. Blood forms accumulation due to Qi rebellion, common in those with perverse temperaments.)

Huangdi said: What about those originating from Yin? (This discusses emotional/desire damage to Zang, disease originating from Yin.)

Qibo said: Worry and thought damage the Heart; severe Cold damages the Lungs; resentment and anger damage the Liver; drunkenness followed by intercourse, sweating, and exposure to wind damage the Spleen; excessive effort, or intercourse followed by sweating and bathing, damage the Kidneys. (Damage to Heart affects Yang; damage to Lungs affects Qi; damage to Liver affects Blood; damage to Spleen affects Ying and Wei; damage to Kidneys affects True Yin. All Zang damage results in disease originating from Yin. This section is largely consistent with the *Xie Qi Zang Fu Bing Xing Lun* in the following scroll.)

These are the diseases generated in the three internal and external regions. (Summarizing the above.)

Huangdi said: Excellent. How should they be treated?

Qibo answered: Observe the site of pain to know the corresponding reaction. Determine excess and deficiency; tonify when deficient, drain when excessive. Do not go against the timing of Heaven. This is called Supreme Treatment. (This generally summarizes treatment methods for the three internal/external regions. Observing pain sites reveals Yin/Yang, exterior/interior, and pathological responses. Tonify deficiency, drain excess, do not defy Heavenly timing, such as Spring Qi relating to Liver, or lunar phase changes, etc.)