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(Su Wen: Yin Yang Bie Lun)

Qibo stated: Diseases of the Er Yang (Two Yangs) originate in the Heart and Spleen, manifesting as sexual dysfunction ("bu de yin qu") and amenorrhea in women. (Er Yang refers to the Yangming channel, comprising the Stomach and Large Intestine meridians. However, since the Large and Small Intestines are functionally subordinate to the Stomach, this section focuses primarily on the Stomach. The Stomach and Heart share a mother-son relationship; excessive emotional desires first injure the Heart, and injury to the mother organ affects the son. The Stomach and Spleen are exterior-interior partners; physical fatigue first injures the Spleen, and zang disease extends to the fu organs. Thus, internal injury to essence and external injury to form can both lead to stomach pathology, which is why Er Yang diseases originate from the Heart and Spleen. "Bu de yin qu" refers to pathology of the yang pathway (sexual function). The Stomach is the sea of water and grain and the source of qi and blood, responsible for transforming Ying and Wei qi and moistening the Zong Jin (major tendons). As stated in the Jue Lun chapter: "The anterior orifice is where the Zong Jin gather, combining the Taiyin and Yangming channels." The Wei Lun chapter also states: "Yin and Yang converge at the Zong Jin, meeting at the Qichuan acupoint, with the Yangming channel acting as their leader." Since the descending of essence and blood relies on the Yangming channel as its primary source, if this source becomes diseased, the yang pathway weakens externally, leading to sexual dysfunction. In women, this manifests as amenorrhea, which is also a corresponding sign. The concept of the Stomach as the sea of water, grain, blood, and qi is detailed in Class 32 of the Meridians section. According to Wang Bing's commentary: "When the intestines and stomach are diseased, the Heart and Spleen are affected; heart affection leads to stagnant blood, and spleen affection leads to undigested food." However, one must carefully examine why the Heart and Spleen would be affected by gastrointestinal diseases, as this connection may seem forced. The term "yin qu" appears five times in this classic, always referring to the yang pathway; through analogy, its meaning can be understood. See the Huitong Qiheng Class for details.) If the disease transmits and develops into Feng Xiao (wind-induced emaciation) or Xi Ben (labored breathing), it is a fatal condition that cannot be treated. (Feng refers to Wood qi; Xiao means emaciation; Ben means urgency. When the Yangming channel is diseased and transmits over time, Wood pathogen overcomes Earth, causing muscle wasting. Stomach disease deprives the Lung of nourishment, causing rapid breathing. Qi exhaustion above results from essence deficiency below, damaging the Five Zang organs, leading to death.)

It is said: Diseases of the San Yang (Three Yangs) present with chills and fever, abscesses/swellings below, and Wei Jue (flaccidity and cold limbs). (San Yang refers to the Taiyang channel, comprising the Bladder and Small Intestine meridians. As the exterior, San Yang diseases present with chills, fever, and abscesses. The Foot Taiyang meridian descends from the head, passes down the back, enters the buttocks, goes through the popliteal fossa, follows the calf to the foot. Therefore, its diseases manifest as weakness in the feet and knees called Wei, cold limbs called Jue, and soreness/pain in the calf muscles called Luan. Luan sounds like 'zhuan' and 'yuan'.) If the disease transmits and develops into Su Ze (loss of skin luster) or Tui Shan (scrotal/testicular hernia pain). (Yang pathogen in the exterior transforms into heat, dissipating the moisture/luster of the skin, known as Su Ze. Tui Shan involves pain radiating from the lower abdomen to the testicles. According to the Xieqi Zangfu Bingxing Pian chapter: "Bladder disease causes unilateral swelling and pain in urination. Small Intestine disease causes lower abdominal pain and pain radiating from the lumbar spine to the testicles." This indicates the Taiyang transmission to Tui Shan. Tui is synonymous with 'zhui'.)

It is said: Disease of the Yi Yang (One Yang) presents with shortness of breath, frequent coughing, and frequent diarrhea. (Yi Yang refers to the Shaoyang channel, comprising the Gallbladder and Sanjiao meridians. The Gallbladder belongs to Wind-Wood, and the Sanjiao to Ministerial Fire. Their pathology involves Strong Fire consuming Qi and injuring the Lung, causing shortness of breath and cough. Excessive Wood overacts on Earth, causing frequent diarrhea.) If the disease transmits and develops into Xin Che (heart palpitations/tugging sensation) or Ge (obstruction/dysphagia). (The Heart is Sovereign Fire; when Ministerial Fire flares upward, they seek each other via similar qi, and pathogen returns to the Heart. The Heart spirit becomes restless, feeling as if pulled, named Xin Che. Another transmission occurs because Wood attacks Earth, injuring the Spleen and Stomach, forming Ge syndrome. As the Xieqi Zangfu Bingxing Pian states: "Slightly urgent Spleen pulse indicates Ge Zhong." The Feng Lun states: "Stomach Wind symptoms include inability to swallow food and drink, and obstruction." The Shang Ge Pian states: "Food and drink entering and then regurgitating" all refer to Ge. Che has pronunciations 'che' and 'chi'.)

Disease of Er Yang and Yi Yin simultaneously manifests mainly as fright, back pain, frequent belching, and yawning, named Feng Jue. (Er Yang refers to the Stomach and Large Intestine. Yi Yin refers to the Liver and Pericardium. Both Liver and Stomach meridians govern fright. As the Jin Gui Zhen Yan Lun states: "East connects to the Liver, its disease manifests as fright." The Jingmai Pian states: "Foot Yangming disease causes sudden fright upon hearing wood sounds." Back pain occurs because the sinews of Hand and Foot Yangming meridians flank the spine. Yi refers to belching, governed by the Heart. However, the Xieke Pian states: "All pathogens in the Heart are actually in the Pericardium." Additionally, the Maijie Pian states: "Qi moving upward to the Heart causing belching" occurs when Yin excess moves upward to Yangming; the Yangming collateral connects to the Heart, hence the description. Qian refers to yawning. Although governed by the Kidney, the Jingmai Pian notes frequent yawning in Foot Yangming disease, linking belching and yawning to the Pericardium and Stomach meridians. The Liver governs Wind, the Pericardium governs Fire; Wind-Heat pathogen affecting Yangming results in the name Feng Jue. For the meaning of Feng Jue, see Ping Re Bing Lun, later in Chapter 30.)

Disease of Er Yin and Yi Yang simultaneously manifests as distension, chest fullness, and frequent sighing. (Er Yin refers to the Heart and Kidney. Yi Yang refers to the Gallbladder and Sanjiao. Excess pathogen in the Gallbladder channel overacts on the Spleen, causing distension. Excess pathogen in the Kidney channel overacts on the Heart, causing chest fullness. Sanjiao disease blocks upper and lower movement, causing frequent sighing.)

Disease of San Yang and San Yin simultaneously manifests as Pi Ku (hemiplegia), Wei Yi (limb flaccidity/instability), and inability to lift the four limbs. (San Yang refers to the Bladder and Small Intestine. San Yin refers to the Spleen and Lung. The Bladder meridian descends from the head/back to the legs. The Small Intestine meridian ascends from the hands to the scapula. The Spleen governs the four limbs, and the Lung governs all Qi. With these four meridians diseased, Pi Ku, Wei Yi, and inability to move the limbs occur. Wei Yi refers to limb flaccidity unable to support weight, with left and right alternating instability.)

A pulse beating strongly like a hook is called Gou (Hook); beating lightly like a feather is called Mao (Feather); Yang excess beating urgently is called Xian (Bowstring); Yang reaching extremity and sinking is called Shi (Stone); Yin and Yang passing smoothly is called Liu (Slippery). (This lists the five pulse bodies, distinguishing Yin/Yang by slight excess/deficiency, not the meridian sequence mentioned earlier. Gu means strong. Yi Yang Yi Yin refers to slight Yin/Yang. A pulse showing slight Yang with strong beating presents as Gou; its qi comes strong and departs weak, corresponding to the Heart pulse. A pulse showing slight Yin with strong beating presents as Mao; its qi comes light, empty, and floating, corresponding to the Lung pulse. Beating Yang pulse with excess and urgency is Xian; its qi comes straight and long without being too urgent, corresponding to the Liver pulse. Yang reaching extremity and sinking indicates latent Yang, named Shi pulse; its qi comes deep and pounding, corresponding to the Kidney pulse. Yin and Yang passing smoothly implies unimpeded flow, named Liu pulse; its qi comes soft, slow, and harmonious, corresponding to the Spleen pulse.)

Yin contending internally, Yang disturbing externally, Po Han (sweat) fails to store, Si Ni (cold limbs) arises; arising Si Ni steams the Lung, causing wheezing and stridor. (This discusses the harm of Yin/Yang involving both interior and exterior. Exterior-interior disharmony leads either to Zang disease (Yin contending internally) or Jing disease (Yang disturbing externally). Regardless, both interfere with the Lung. The Lung governs Qi, connects externally to skin/hair, and serves as the chief of the Six Fu and Five Zang internally. Failure to store Po Han indicates insecure exterior. Arising Si Ni indicates depletion of internal Yang. Eventually, righteous Qi fails against pathogen, heat steams upward to the Lung, causing wheezing and stridor. This results from depletion of Ying and Wei below and lone Yang floating above, an inevitable state.)

What generates Yin, its root is Harmony. (Yin refers to the true Yin of the Five Zang. Yin is generated because Zang Qi is harmonious; Zang Qi harmony depends on Yin-Yang harmony. Disharmony leads to contention and disturbance, rigidity or dampness, and disease arises.)

Therefore, Rigidity meets Rigidity, Yang Qi breaks and scatters, and Yin Qi perishes. (This describes the harm of Yang bias. Rigidity meeting Rigidity is extreme Yang. Adding fire to fire leads to decline after peak, so Yang Qi scatters. Once Yang scatters, Yin cannot exist alone and also perishes, leading to total Yin-Yang extinction.)

Dampness leads to Rigidity-Disharmony, and Jing Qi perishes. (This describes the harm of Yin bias. Nao refers to rampant Cold-Dampness and Yin excess. If Yang-Rigidity and Yin-Softness lose harmony, Jing Qi perishes.)

Belonging to Death Yin category, death occurs within three days; belonging to Life Yang category, death occurs within four days. (This discusses Zang transmission, noting differences in life and death. The meanings of Death Yin and Life Yang follow. Regarding "death within four days," Quan Yuanqi's version reads "four days only"; since it is Life Yang, it should not die, so "death" is likely an error.)

Regarding Life Yang and Death Yin: Liver transmitting to Heart is called Life Yang, (Liver to Heart is transmission from Liver to Heart. Wood generating Fire obtains Sheng Qi, called Life Yang, recovering within four days.) Heart transmitting to Lung is called Death Yin, (Heart to Lung is transmission from Heart to Lung. Fire overcoming Metal causes Yin Qi to scatter and perish, called Death Yin, dying within three days.) Lung transmitting to Kidney is called Chong Yin, (Lung is Metal, Kidney is Water. Though mother-son, both Metal and Water are diseased, called Chong Yin, a sign of no Yang.) Kidney transmitting to Spleen is called Pi Yin, fatal and untreatable. (Pi means unrestrained. Earth normally controls Water, but Water insults Spleen; Water fears nothing, called Pi Yin, thus fatal and untreatable. Pi sounds like 'pi'.)

Jie Yang (Yang Qi knotting) causes swelling of the four limbs. (Below discusses diseases caused by pathogen gathering in various meridians. Yang refers to the Six Yang meridians. Yang Qi knotting causes limb swelling because limbs are the root of all Yang meridians.)

Jie Yin (Yin Qi knotting) causes hematochezia: first knotting one sheng, second knotting two sheng, third knotting three sheng. (Yin refers to the Six Yin meridians. Yin governs Blood; pathogen knotting in Yin division injures Blood, causing hematochezia. Superficial cases cause one sheng bleeding, implying pathogen should resolve. If unresolved and re-knotting due to excess pathogen, bleeding increases to two sheng. If still unresolved, pathogen is worse, hence three sheng.)

Yin-Yang pathogen knotting obliquely, with much Yin and little Yang, is called Shi Shui (Stone Water), presenting with lower abdominal swelling. (Xie is synonymous with Pathogen. Both Yin and Yang meridians can knot Water pathogen; if mostly in Yin and little in Yang, it is Shi Shui. Shi Shui is heavy and firm below, presenting with lower abdominal swelling.)

Er Yang knotting is called Xiao (Consumption), referring to Stomach and Large Intestine meridians. Yang pathogen lingering and knotting in the intestines/stomach causes thirst and hunger, named Xiao. Meaning of Three Xiaos is in Chapter 60.)

San Yang knotting is called Ge (Obstruction), (referring to Bladder and Small Intestine meridians. Small Intestine is Fire, Bladder is Water. Pathogen knotting in Small Intestine prevents Yang transformation; knotting in Bladder prevents fluid circulation. Lower blockage prevents Upper transport, causing Obstruction syndrome.)

San Yin knotting is called Shui (Water retention), (referring to Spleen and Lung meridians. Spleen Earth controls Water; Earth disease allows Water to insult. Lung Metal generates Water; Qi disease stops Water flow. Thus, Cold knotting in San Yin causes Qi transformation failure turning into Water.)

Yi Yin and Yi Yang knotting is called Hou Bi (Throat Bi). (Yi Yin refers to Liver and Pericardium. Yi Yang refers to Gallbladder and Sanjiao. Liver/Gallbladder are Wood, Pericardium/Sanjiao are Fire. All four meridians transform into Heat; their vessels connect to the throat. Internal knotting of Heat pathogen causes Hou Bi. Bi means obstruction. Bi sounds like 'mi'.)