【素】五气更立。（五行之气。）各有所胜。盛虚之变。此其常也。春胜长夏。（季夏十八日为长夏。木克土。）长夏
胜冬。（土克水。）冬胜夏。（水克火。）夏胜秋。（火克金。）秋胜春。（金克木。）所谓得五行时之胜。（五行皆以生时为胜。）
各以气命其脏。（如春气属肝之类。）求其至也。皆归始春。（至。气至也。吴注。春为四时之长。其气不合于时。则五脏
更相克胜。邪僻多矣。玉机真脏论。春脉者。肝也。东方木也。万物之所以始生也。）未至而至。此谓太过。则薄所不胜。
而乘所胜也。命曰气淫。（气有余。则侮所不胜。而乘其所胜。如木气有余。则反侮金。而乘脾土之类是也。）至而不至。
此谓不及。则所胜妄行。而所生受病。所不胜薄之也。命曰气迫。（气不足。则己所胜者无所畏而妄行。生己者遇妄行之
克而受病。己所不胜者乘之而贼薄我。如木不足不能制土。土无所畏而妄行。生我之水。被土凌而生病。己所不胜之金
乘之而薄我也。）（六节脏象论）
【素】夫邪气之客于身也。以胜相加。（邪气感人。皆以胜相凌。如木病由金胜。土病由木胜之类。）至其所生而愈。
（己所生者。如肝病愈于夏。心病愈于长夏之类。）至其所不胜而甚。（克己者。如肝病甚于秋。心病甚于冬之类。）至其
所生而持。（生己者。如肝病持于冬。心病持于春之类。）自得其位而起。（逢己之旺。如肝病起于春。心病起于夏之类。）
必先定五脏之脉。（如弦钩 毛石之类。）乃可言间甚之时。死生之期也。（皆以生克为断。）（脏气法时论）
【素】阴阳者。天地之道也。万物之纲纪。变化之父母。生杀之本始。神明之府也。治病必求其本。（必先明于阴阳。
凡人之脏腑气血。气之风寒暑湿。病之表里上下。脉之迟数浮沉。药之温平寒热。皆不外阴阳二义。）故积阳为天。积阴
为地。阴静阳躁。阳生阴长。阳杀阴脏。（天元纪大论曰。天以阳生阴长。地以阳杀阴脏。新校正云。干阳也。位戌亥。
九月十月。万物之所收杀也。孰谓无阳杀之理哉。）阳化气。阴成形。寒极生热。热极生寒。（阴阳之理。极则变生。即
大易老变而少不变之义。）寒气生浊。热气生清。清气在下。则生飧泄。浊气在上。则生 （音真。）胀。此阴阳反作。
病之逆从也。（阴阳相反。清浊易位。则为逆。顺则为从矣。）故清阳为天。浊阴为地。地气上为云。天气下为雨。雨出
地气。云出天气。（天地相交。云行雨施。而后能化生万物。以人言之。饮食入胃。游溢精气。上输于脾。脾气散精。上
归于肺。是地气上为云也。肺行下降之令。通调水道。下输膀胱。水精四布。是天气下为雨也。六微旨大论云。升而已
降。降者谓天。是云出天气也。降已而升。升者谓地。是雨出地气也。此皆上下相输应也。故互言之。）故清阳出上窍。
（耳目口鼻。）浊阴出下窍。（前后二阴。）清阳发腠理。（阳主外。）浊阴走五脏。（阴主内。）清阳实四肢。（四肢为诸阳
之本。）浊阴归六腑。（传化五谷。）水为阴。火为阳。（人身之水火。）阳为气。阴为味。味归形。形归气。气归精。精归
化。（王注。形食味。故味归形。气生形。故形归气。精食气。故气归精。化生精。故精归化。）精食气。形食味。（气和
精生。味和形长。）化生精。气生形。（神能生精。气能生形。）味伤形。气伤精。（味太过。则偏胜。故伤形。气有余。
便是火。故伤精。）精化为气。气伤于味。（食伤则气怠。）阴味出下窍。（便溺。）阳气出上窍。（精神。）味浓者为阴。薄
为阴之阳。气浓者为阳。薄为阳之阴。味浓则泄。（纯阴下降。故能泻火。）薄则通。（薄但通利。不至大泄。）气薄则发
泄。（能发汗升散。）浓则发热。（气浓纯阳。能补阳。）壮火之气衰。少火之气壮。壮已必衰。少已则壮。壮火食气。气
食少火。壮火散气。少火生气。（火。即气也。火壮则能耗散元气。故曰壮火食气。少火则能生长元气。故曰气食少火。
盖人身赖此火以有生。亦因此火而致病。但可使之和平。而不可使之亢盛。以亢则必致害耳。马注乃以此段解作药味。
反訾王注为不明。引东垣用药法象以实之。而曰用气味太浓之药。壮火之品。则吾人之气。不能当之。而反衰矣。是桂
附永无可用之期也。有是理乎。叛经背道。贻误后学。不可不辨也。）气味辛甘发散为阳。酸苦涌泄为阴。（此处加气味
二字别之。则上文专言气而不言味可知矣。安得以壮火属之药味乎。辛散甘缓。故发散为阳。酸收苦泄。故涌泄为阴。）
阴胜则阳病。阳胜则阴病。阳胜则热。阴胜则寒。重寒则热。重热则寒。（物极则反。）寒伤形。（寒由形感。）热伤气。（热
则气泄。亦犹壮火食气之义。）气伤痛。形伤肿。故先痛而后肿者。气伤形也。先肿而后痛者。形伤气也。风胜则动。（眩
运搐搦。热胜则肿。（痈疡痤 。）燥胜则干。（津液枯涸。皮肤皴揭。）寒胜则浮。（寒变为热。神气乃浮。）湿胜则濡泻。
（土不能防水。而水反侮土。）天有四时五行。以生长收藏。以生寒暑燥湿风。（外感五邪。水寒。火暑。金燥。土湿。
木风。）人有五脏。化五气以生喜怒悲忧恐。（内伤五邪。心喜。肝怒。肺悲。脾忧。肾恐。）故喜怒伤气。寒暑伤形。暴
怒伤阴。暴喜伤阳。厥气上行。满脉去形。（逆气上行。能满溢于经络。而令神气离形。）喜怒不节。（内伤。）寒暑过度。
（外感。）生乃不固。故重阴必阳。重阳必阴。（阴症反似阳。阳症反似阴。）故曰冬伤于寒。春必病温。（寒毒最为杀厉。
伏藏肉裹。至春变为温病。至夏变为热病。）春伤于风。夏生飧泄。（风木克土。）夏伤于暑。秋必 疟。（暑热伏藏。复
感秋风。必为寒热之疟。）秋伤于湿。冬生咳嗽。（王注。秋湿既多。冬水复旺。寒湿相搏。故嗽。喻嘉言改作秋伤于燥。
多事。）故曰。天地者。万物之上下也。阴阳者。血气之男女也。左右者。阴阳之道路也。水火者。阴阳之征兆也。阴阳
者。万物之能始也。（资始成能。）故曰。阴在内。阳之守也。（为阳营守。）阳在外。阴之使也。（为阴捍卫。）阳胜则身
热。腠理闭。喘粗。（腠理不开。而气并于鼻。故喘粗。）为之俯仰。（不安之貌。）汗不出。（阳胜而腠理闭。故无汗。）
而热。齿干（阳明热盛。）以烦冤。腹满死。（热胀。内外合邪。故死。）能（作耐。）冬不能夏。（夏为火令。冬尚可耐。）
阴胜则身寒汗出。（阴胜多汗。阳虚不能卫外。）身常清。（冷。）数栗而寒。寒则厥。（四肢逆冷。）厥则腹满死。（寒胀。）
能夏不能冬。（冬为水令。）（阴阳应象大论）
【素】阴阳异位。更实更虚。更逆更从。或从内。或从外。所从不同。故病异名也。阳者天气也。主外。阴者地气
也。主内。（阴阳异位。）故阳道实。阴道虚。（更实更虚。吴鹤皋加阴道实。阳道虚句。）故犯贼风虚邪者。阳受之。食
饮不节。起居不时者。阴受之。（外感阳受。内伤阴受。所谓从内从外。）阳受之则入六腑。阴受之则入五脏。（腑属。阳
脏属阴。）入六腑。则身热不时卧。上为喘呼。入五脏则 满闭塞。下为飧泄。久为肠 。（便血下痢。）故喉主天气。咽
主地气。（肺系属喉。司呼吸。受气于鼻。胃系属咽。纳水谷。受气于口。）故阳受风气。（风为阳邪。）阴受湿气。（湿为
阴邪。）故阴气从足上行至头。而下行从臂至指端。阳气从手上行至头。而下行至足。（灵枢曰。手三阴从脏走手。手三
阳从手走头。足三阳从头走足。足三阴从足走腹。所谓更逆更从也。）故曰。阳病者上行极而下。阴病者下行极而上。故
伤于风者。上先受之。（风为天气。极则下行。）伤于湿者。下先受之。（湿为地气。极则上行。）（太阴阳明论）
【素】阳虚则外寒。阳受气于上焦。以温皮肤分肉之间。今寒气在外。则上焦不通。上焦不通。则寒气独留于外。
故寒栗。（阳虚之人。无以卫外。虽不感邪。亦必畏寒。）阴虚生内热。有所劳倦。形气衰少。谷气不盛。（形劳气虚食少。
此内伤之症。）上焦不行。下脘不通。胃气热。（虚而生热。）热气熏胸中。故内热。（阴虚之人。水不能制火。则内热自
生。）阳盛生外热。上焦不通利。则皮肤致密。腠理闭塞。玄府。（汗孔也。）不通。卫气不得泄越。故外热。（此即今人
外感伤寒之症。）阴盛生内寒。厥气上逆。寒气积于胸中而不泻。不泻则温气去。寒独留。则血凝泣。（涩。）凝则脉不通。
其脉盛大以涩。故中寒。（昂按。阴盛中寒血涩之人。何以反得盛大之脉。）（调经论篇）
【素】阳气者。若天与日。失其所则折寿而不彰。故天运当以日光明。（人之有阳。犹天有日。）是故阳因而上。卫
外者也。因于寒。欲如运枢。（如枢运动。则寒气散。）起居如惊。神气乃浮。（经曰。寒胜则浮。盖寒变为热。令人起居
惊扰。而神气浮越。）因于暑汗。（暑多挟湿挟虚。故多汗。）烦则喘喝。静则多言。（暑先入心。而热熏肺。故烦喘多言。）
体若燔炭。汗出而散。（暑症无甚热。不宜汗。若热如燔炭。必汗以散之。）因于湿。首如裹。（头目昏重。如物裹之。）
湿热不攘。大筋 （音软。）短。小筋弛长。 。短为拘。弛长为痿。（筋受热则缩而短。故拘急。受湿则弛而长。故痿
。）因于气为肿。（气伤形而为肿。）四维相代。阳气乃坏。（王注。筋骨血肉。更代而坏。马注。四维。四肢也。按至
真要大论。彼春之暖。为夏之暑。彼秋之忿。为冬之怒。谨按四维斥候皆归。则四维乃四时也。二句总结上文四段。言
感此邪者。更历寒暑之代谢。则阳气尽坏矣。非单指因气而言也。）阳气者。烦劳则张。精绝。（气张于外。精绝于中。）
辟积于夏。（如衣襞积。）使人煎厥。（煎烦厥逆。）目盲不可以视。耳闭不可以听。（精绝所致。）溃溃乎若坏都。 乎
不可止。阳气者。大怒则形气绝。（常行之经气阻绝。不周于形体。）而血菀。（郁同。）于上。使人薄厥。（有升无降而厥
逆。）有伤于筋。纵其若不容。（纵缓不能为容止。）汗出偏沮。使人偏枯。（沮。止也。偏。不遍也。阳气不能周于一身。
无汗之处。必有半身不遂之患。）汗出见湿。乃生痤 。（痤，疖也。 。风瘾也。）高（膏同。）粱之变。足（能也。）生
大丁。受如持虚。（王注。如持虚器。以受邪毒。吴注。初起之时。不觉其重。）劳汗当风。寒薄为 。（粉刺。）郁乃痤。
（久则为痤。）阳气者。精则养神。柔则养筋。开阖不得。寒气从之。乃生大偻。（身形拘急俯偻。吴注。此阳气受伤。
不能养筋也。）陷脉为 。（漏也。音闾。亦音漏。寒气陷入血中。而生疡漏。）留连肉腠。俞气化薄。传为善畏。及为惊
骇。（寒气留连于肉腠之间。由俞穴传化。而薄于脏腑。则为恐畏惊骇。此阳气被伤。不能养神也。）营气不从。（顺。）
逆于肉理。乃生痈肿。（营血逆于肉之条理。热聚为痈。）魄汗未尽。形弱而气烁。穴俞以闭。发为风疟。（汗未止。而为
风暑之气所烁。闭于穴俞。则发为风疟。故下文接言风。）故风者百病之始也。清静则肉腠闭拒。虽有大风苛毒。莫之能
害。此因时之序也。故阳气者。一日而主外。（卫气昼行于阳二十五度。）平旦人气生。日中而阳气隆。日西而阳气已虚。
气门乃闭。（气门。谓玄府。即汗孔。）是故暮而收拒。（阳气藏宜收敛。）无扰筋骨。无见雾露。反此三时。（旦中暮。）
形乃困薄。风客淫气。（风之客邪。淫乱于气。）精乃亡。邪伤肝也。（风气通于肝。风能生热。故伤精。）因而饱食。筋
脉横解。肠 为痔。（风木克制脾土。而为肠风血痔之症。）因而大饮。则气逆。（饮多则肺布叶举。故气逆。）因而强力。
（用力过度。或入房太甚。）肾气乃伤。高骨乃坏。（腰间命门穴上。有骨高起。）凡阴阳之要。阳密乃固。两者不和。若
春无秋。若冬无夏。因而和之。是谓圣度。故阳强不能密。阴气乃绝。（无阳则阴无以生。）阴平阳秘。精神乃治。阴阳
离决。精气乃绝。（生气通天论）
【素】五气所病。心为噫。（嗳同。脉解篇云。上走心为噫者。阴盛而上走于阳明。阳明络属心也。）肺为咳。（肺属
金。邪中之则有声。）肝为语。（肝属木。木欲舒。故为语。）脾为吞。（坤土翕受。为吞。）肾为欠为嚏。（阴阳相引。故
呵欠。人之阳气和利。满于心出于鼻而为嚏。盖肾络上通于肺也。）胃为气逆为哕为恐。（哕。气牾也。俗作呃忒。寒盛
气逆故哕。肾志为恐。土下克水。故恐。）大肠小肠为泄。（二经虚则泄利。）下焦溢为水。（不能蓄泄。溢而为水。）膀胱
[Suwen] The Qi of the Five Elements takes turns to govern, each having objects it overcomes. The variations of excess and deficiency are the normal pattern. In Spring, Wood Qi overcomes Changxia (Late Summer) Earth Qi (the eighteen days of Ji Xia constitute Changxia; Wood overcomes Earth). Changxia Earth Qi overcomes Winter Water Qi (Earth overcomes Water). Winter Water Qi overcomes Summer Fire Qi (Water overcomes Fire). Summer Fire Qi overcomes Autumn Metal Qi (Fire overcomes Metal). Autumn Metal Qi overcomes Spring Wood Qi (Metal overcomes Wood). This is what is meant by conforming to the overcoming relationships of the Five Elements according to their seasons (The Five Elements are strongest in their generating/waxing times). Organs are named according to their corresponding Qi characteristics (e.g., Spring Qi corresponds to the Liver). Observing the arrival of Qi, all return to early Spring (Zhi refers to the arrival of Qi. Wu's commentary: Spring is the head of the four seasons; if its Qi does not accord with the season, the Five Zang organs will mutually overcome and counteract, leading to many pathological deviations. *Yu Ji Zhen Zang Lun* states: The Spring pulse belongs to the Liver, which is Eastern Wood, the cause of the beginning of generation for all things). If Qi arrives before its time, this is called "Excess" (Tai Guo), which will bully the element it cannot overcome (the one that overcomes it) and exploit the element it overcomes (the one it controls), termed "Qi Yin" (When Qi is in excess, it insults the element it cannot overcome and exploits the element it overcomes; e.g., if Wood Qi is in excess, it insults Metal and exploits Spleen Earth). If Qi arrives but lacks expected strength, this is called "Deficiency" (Bu Ji), causing the element it overcomes to act recklessly, the element that generates it to suffer disease, and the element that overcomes it to bully it, termed "Qi Po" (When Qi is insufficient, the element it overcomes acts recklessly without fear; the element that generates it suffers from the reckless control; the element that overcomes it takes advantage to harm it; e.g., if Wood is insufficient and cannot control Earth, Earth acts recklessly without fear; the Water that generates Wood suffers from Earth's oppression; the Metal that overcomes Wood takes advantage to harm it.) (From *Liu Jie Zang Xiang Lun*)
[Suwen] When pathogenic factors invade the body, they interact based on overcoming relationships (Pathogens affect humans through mutual overcoming; e.g., Liver disease caused by Metal overcoming, or Spleen disease caused by Wood overcoming). Recovery occurs when reaching the element it generates (e.g., Liver disease improves in Summer, Heart disease improves in Changxia). Worsening occurs when reaching the element that overcomes it (e.g., Liver disease worsens in Autumn, Heart disease worsens in Winter). Stability/maintenance occurs when reaching the element that generates it (e.g., Liver disease persists in Winter, Heart disease persists in Spring). Onset/exacerbation occurs when reaching its own prosperous phase (e.g., Liver disease arises in Spring, Heart disease arises in Summer). One must first determine the pulses of the Five Zang organs (such as Xian [Wiry], Gou [Hook], Mao [Feather], Shi [Stone]) before discussing the timing of aggravation/remission and periods of life and death (All judgments are based on the Five Elements' generating and overcoming cycles.) (From *Zang Qi Fa Shi Lun*)
[Suwen] Yin and Yang are the Way of Heaven and Earth, the general principles of all things, the parents of change, the origin of life and death, and the residence of spiritual clarity. Treating diseases requires seeking the root (One must first understand Yin and Yang. All aspects of human Zang-Fu organs, Qi and Blood, external pathogens like Wind, Cold, Summer-heat, Dampness, the interior/exterior and upper/lower locations of disease, pulse characteristics like slow/rapid and floating/sinking, and drug properties like warm/neutral/cold/hot, do not exceed the two principles of Yin and Yang). Thus, accumulated Yang becomes Heaven, accumulated Yin becomes Earth. Yin is still, Yang is active; Yang generates, Yin grows; Yang kills, Yin stores ( *Tian Yuan Ji Da Lun* says: Heaven generates through Yang and grows through Yin; Earth kills/stores through Yang and Yin. New Correction notes: Qian belongs to Yang, positioned at Xu and Hai, the ninth and tenth months, when all things are harvested and killed. Who says there is no principle of Yang killing?). Yang transforms into Qi, Yin forms into structure. Extreme cold generates heat, extreme heat generates cold (The principle of Yin and Yang dictates that upon reaching extremes, transformation occurs, consistent with the meaning in the *I Ching* where old lines change while young lines remain static). Cold Qi generates turbidity, Hot Qi generates clarity. If clear Qi stays below, it produces undigested diarrhea (Sun Xie); if turbid Qi stays above, it produces distension (Zhen). This is a reversal of Yin and Yang, representing the adverse and favorable states of disease (If Yin and Yang are reversed and clarity/turbidity exchange positions, it is adverse; if orderly, it is favorable). Thus, clear Yang is Heaven, turbid Yin is Earth. Earth Qi rises to become clouds, Heaven Qi descends to become rain. Rain comes from Earth Qi, clouds come from Heaven Qi (Heaven and Earth interact; cloud movement and rain distribution allow for the generation of all things. Speaking of humans: food enters the Stomach, its essence floats up, is transported to the Spleen, the Spleen disperses essence, and returns it upward to the Lung; this is Earth Qi rising to become clouds. The Lung issues descending commands, regulates water passages, transports downward to the Bladder, and distributes water essence everywhere; this is Heaven Qi descending to become rain. *Liu Wei Zhi Da Lun* states: After ascending, it descends; the descending is called Heaven, meaning clouds come from Heaven Qi. After descending, it ascends; the ascending is called Earth, meaning rain comes from Earth Qi. These are mutual correspondences between upper and lower, hence stated interchangeably). Thus, clear Yang exits through the upper orifices (eyes, ears, mouth, nose), turbid Yin exits through the lower orifices (anus, urethra). Clear Yang disperses into the Cou Li (interstitial spaces), turbid Yin travels to the Five Zang organs (Yin governs the interior). Clear Yang fills the four limbs (the limbs are the root of all Yang), turbid Yin returns to the Six Fu organs (transmitting and transforming grains). Water is Yin, Fire is Yang (Human Water and Fire). Yang is Qi, Yin is Flavor. Flavor returns to form, form returns to Qi, Qi returns to Essence, Essence returns to Transformation (Wang's commentary: Form consumes flavor, so flavor returns to form. Qi generates form, so form returns to Qi. Essence consumes Qi, so Qi returns to essence. Transformation generates essence, so essence returns to transformation). Essence consumes Qi, form consumes flavor (Harmonious Qi generates essence, harmonious flavor grows form). Transformation generates essence, Qi generates form (Spirit can generate essence, Qi can generate form). Excessive flavor damages form, excessive Qi damages essence (If flavor is excessive, it leads to imbalance and thus damages form. If Qi is in excess, it becomes Fire, thus damaging essence). Essence transforms into Qi, Qi is damaged by flavor (Food injury leads to Qi lethargy). Yin flavors exit through the lower orifices (urine/feces), Yang Qi exits through the upper orifices (spiritual consciousness). Strong flavors are Yin, thin flavors are Yang within Yin. Strong Qi is Yang, thin Qi is Yin within Yang. Strong flavors cause purging (Pure Yin descends, thus can purge fire). Thin flavors promote circulation (Thin flavors merely promote circulation, not causing severe purging). Thin Qi causes dispersion (Can induce sweating and ascending/dispersing). Strong flavors cause fever (Strong Qi is pure Yang, can tonify Yang). Strong Fire diminishes Qi, Mild Fire strengthens Qi. Once strong, it must decline; once mild, it strengthens. Strong Fire consumes Qi, Qi feeds on Mild Fire. Strong Fire scatters Qi, Mild Fire generates Qi (Fire is essentially Qi. Strong Fire can consume and dissipate Original Qi, hence "Strong Fire consumes Qi." Mild Fire can grow Original Qi, hence "Qi feeds on Mild Fire." The human body relies on this Fire for life, but also becomes diseased because of it. It should be kept in harmony, not allowed to become hyperactive, as hyperactivity inevitably causes harm. Ma's commentary interprets this passage as referring to medicinal flavors, criticizing Wang's commentary as unclear, citing Dong Yuan's *Xiang Fa* to support his view, stating that using drugs with too strong flavors, items of Strong Fire, would overwhelm our Qi, causing it to weaken. Is this logical? This betrays the classics and misleads future students; it must be辨析 (distinguished)). Aromatic and sweet flavors that disperse and diffuse are Yang; sour and bitter flavors that induce vomiting and purging are Yin (Adding "flavor and aroma" here distinguishes them, showing the previous text spoke only of Qi, not flavor. How can Strong Fire be attributed to drug flavors? Acrid disperses, Sweet moderates, hence dispersing is Yang. Sour astringes, Bitter purges, hence inducing vomiting/purging is Yin). Yin excess causes Yang pathology, Yang excess causes Yin pathology. Yang excess causes Heat, Yin excess causes Cold. Extreme Cold generates Heat, extreme Heat generates Cold (Things reverse at extremes). Cold damages Form (Cold affects via physical sensation). Heat damages Qi (Heat causes Qi leakage, similar to the meaning of Strong Fire consuming Qi). Qi damage causes pain, Form damage causes swelling. Therefore, pain preceding swelling indicates Qi damaging Form. Swelling preceding pain indicates Form damaging Qi. Wind excess causes movement (vertigo, convulsions). Heat excess causes swelling (abscesses, acne). Dryness excess causes dryness (dehydration of fluids, skin cracking). Cold excess causes edema/floatiness (Cold transforms to Heat, Spirit Qi floats). Dampness excess causes loose stools (Earth cannot control Water, and Water insults Earth). Heaven has Four Seasons and Five Elements, used for growth, flourishing, harvesting, and storing, producing Cold, Summer-heat, Dryness, Dampness, and Wind (External Five Pathogens: Water-Cold, Fire-Summer-heat, Metal-Dryness, Earth-Dampness, Wood-Wind). Humans have Five Zang organs, transforming Five Qi to produce Joy, Anger, Sorrow, Worry, and Fear (Internal Five Pathogens: Heart-Joy, Liver-Anger, Lung-Sorrow, Spleen-Worry, Kidney-Fear). Thus, Joy and Anger damage Qi, Cold and Summer-heat damage Form. Violent Anger damages Yin, violent Joy damages Yang. Jue Qi ascends, filling vessels and separating from Form (Rebellious Qi ascends, overflowing meridians, causing Spirit Qi to separate from Form). Unregulated Joy and Anger (Internal injury). Excessive Cold and Summer-heat (External contraction). Life becomes unstable. Thus, Heavy Yin must transform to Yang, Heavy Yang must transform to Yin (Yin syndromes may resemble Yang, Yang syndromes may resemble Yin). It is said: Injury by Cold in Winter leads to Warm Disease in Spring (Cold toxin is most lethal, hiding in muscle layers, transforming into Warm Disease in Spring, Heat Disease in Summer). Injury by Wind in Spring leads to Sun Xie (undigested diarrhea) in Summer (Wood insults Earth). Injury by Summer-heat in Summer leads to Nue (Malaria) in Autumn (Summer-heat hides, combined with Autumn Wind, causing alternating chills and fever Malaria). Injury by Dampness in Autumn leads to Cough in Winter (Wang's commentary: Autumn Dampness is abundant, Winter Water is prosperous; Cold and Damp combine, causing cough. Yu Jiayan changed this to "Injury by Dryness in Autumn," which is controversial). It is said: Heaven and Earth are the upper and lower of all things. Yin and Yang are the male and female of Blood and Qi. Left and Right are the pathways of Yin and Yang. Water and Fire are the signs of Yin and Yang. Yin and Yang are the capable beginnings of all things (Providing origin and capability). It is said: Yin inside is the guardian of Yang (Guarding Yang internally). Yang outside is the servant of Yin (Protecting Yin externally). Yang excess causes body heat, closed Cou Li, rapid breathing (Cou Li not open, Qi merges into nose, causing rapid breathing). Restlessness (sign of discomfort). No sweat (Yang excess closes Cou Li, hence no sweat). Heat, dry teeth (Yangming Heat excess), irritability, abdominal fullness leading to death (Heat distension, internal and external pathogens combining, hence death). Can endure Winter but not Summer (Summer is Fire command, Winter is bearable). Yin excess causes body coldness and sweating (Yin excess causes sweating, Yang deficiency fails to guard exterior). Constant feeling of cold. Frequent shivering and cold, cold leads to Jue (cold extremities). Jue leads to abdominal fullness and death (Cold distension). Can endure Summer but not Winter (Winter is Water command.) (From *Yin Yang Ying Xiang Da Lun*)
[Suwen] Yin and Yang occupy different positions, alternating excess and deficiency, reversal and compliance, sometimes originating internally, sometimes externally. Since origins differ, disease names vary. Yang is Heaven's Qi, governing the exterior. Yin is Earth's Qi, governing the interior (Different positions of Yin and Yang). Thus, the Path of Yang is solid, the Path of Yin is hollow (Alternating excess and deficiency. Wu Hegao added "Yin Path is solid, Yang Path is hollow"). Those afflicted by thief-wind and empty-pathogens receive them in Yang channels; those with irregular diet and lifestyle receive them in Yin channels (External contractions affect Yang, internal injuries affect Yin, known as originating from outside or inside). Yang reception transmits to the Six Fu organs, Yin reception transmits to the Five Zang organs (Fu belong to Yang, Zang belong to Yin). Transmission to Six Fu causes body heat, inability to lie down regularly, upward progression to wheezing. Transmission to Five Zang causes chest fullness and obstruction, downward progression to Sun Xie (undigested diarrhea), long-term becoming Chang Pi (bloody dysentery). Thus, the Throat governs Heaven's Qi, the Pharynx governs Earth's Qi (Lung system belongs to Throat, governs respiration, receives Qi from nose; Stomach system belongs to Pharynx, receives food/water, receives Qi from mouth). Thus, Yang receives Wind (Wind is Yang pathogen). Yin receives Dampness (Dampness is Yin pathogen). Thus, Yin Qi ascends from feet to head, then descends from arms to fingertips. Yang Qi ascends from hands to head, then descends to feet (*Ling Shu* states: Hand Three Yin travel from Zang to hand, Hand Three Yang from hand to head, Foot Three Yang from head to foot, Foot Three Yin from foot to abdomen. This is alternating reversal and compliance). It is said: Yang diseases ascend to the extreme then descend; Yin diseases descend to the extreme then ascend. Thus, wind injury affects the upper part first (Wind is Heaven's Qi, at extreme it descends). Dampness injury affects the lower part first (Dampness is Earth's Qi, at extreme it ascends.) (From *Tai Yang Yang Ming Lun*)
[Suwen] Yang deficiency causes external cold. Yang receives Qi from the Upper Jiao to warm the skin and intermuscular spaces. Now, Cold Qi is outside, causing Upper Jiao blockage. Upper Jiao blockage causes Cold Qi to remain alone outside, resulting in chills (Those with Yang deficiency lack exterior defense; even without pathogens, they fear cold). Yin deficiency generates internal heat. Due to fatigue, form and Qi decline, Grain Qi is insufficient (Physical labor, Qi deficiency, poor appetite—this is an internal injury syndrome). Upper Jiao fails to function, Lower Wan (stomach outlet) is blocked, Stomach Qi becomes hot (deficiency generates heat). Hot Qi steams the chest, causing internal heat (Those with Yin deficiency, Water cannot control Fire, so internal heat arises spontaneously). Yang excess generates external heat. Upper Jiao is not smooth, skin becomes dense, Cou Li closes, Xuan Fu (sweat pores) block, Wei Qi cannot vent, causing external heat (This is modern external contraction Cold Damage syndrome). Yin excess generates internal cold. Jue Qi rebels upward, Cold Qi accumulates in the chest without discharge. Without discharge, Warm Qi departs, Cold remains alone, causing blood coagulation and stasis (Stagnant). Stasis blocks vessels, pulse is large and choppy, causing middle cold (Ang's note: Why does a person with Yin excess, middle cold, and blood stasis present with a large pulse?) (From *Tiao Jing Lun*)
[Suwen] Yang Qi is like Heaven and the Sun. Losing its proper place shortens life and obscures vitality. Thus, Heaven's motion depends on the Sun's brightness (Humans' Yang is like Heaven's Sun). Therefore, Yang moves upward and guards the exterior. Affected by Cold, one should move like a pivot (Pivot movement disperses Cold). Disturbed lifestyle causes Spirit Qi to float (Classic says: Cold excess causes floatiness. Cold transforms to Heat, disturbing lifestyle and causing Spirit Qi to float). Affected by Summer-heat, sweating occurs (Summer-heat often carries Dampness and Deficiency, hence frequent sweating). Irritability causes panting/drinking, quietness causes verbosity (Summer-heat enters Heart first, Heat steams Lung, causing irritability, panting, verbosity). Body like burning charcoal, sweat disperses it (Summer-heat syndromes rarely have extreme heat; sweating is generally inappropriate. If heat is like burning charcoal, sweating is necessary to disperse it). Affected by Dampness, head feels wrapped (Head/eyes heavy, as if wrapped). If Damp-Heat is not removed, large tendons become soft and short, small tendons become lax and long. Soft/short causes spasm, lax/long causes flaccidity (Tendons heated shrink and shorten, causing spasm. Tendons affected by Dampness relax and lengthen, causing flaccidity). Affected by Qi, swelling occurs (Qi damages form, causing swelling). Four dimensions replace each other, Yang Qi is ruined (Wang's commentary: Tendons, bones, flesh, blood deteriorate alternately. Ma's commentary: Si Wei refers to four limbs. According to *Zhi Yao Da Lun*, Spring warmth becomes Summer heat, Autumn anger becomes Winter rage. Observing Si Wei indicators returns to all, Si Wei refers to the four seasons. These two sentences summarize the previous four paragraphs: contracting these pathogens through seasonal changes ruins Yang Qi entirely, not just referring to Qi injury). Yang Qi, when subjected to mental exertion, expands, Essence is exhausted (Qi expands outward, Essence exhausts inward). Accumulating into Summer (like folded clothes), causing Jian Jue (burning vexation and syncope). Blindness prevents sight, deafness prevents hearing (Caused by Essence exhaustion). Ruinous like a collapsing dam, unstoppable. Yang Qi, in great anger, cuts off Form and Qi (Normal meridian Qi is blocked, failing to circulate the body), and Blood stagnates above, causing Bo Jue (rebellious syncope due to ascent without descent). Injury to tendons causes flaccidity and inability to maintain posture. Sweating on one side only causes hemiplegia (Ju means stop. Pian means not universal. Yang Qi fails to circulate the whole body; areas without sweat will develop hemiplegia). Sweating exposed to dampness produces acne (Cuo, boils; , wind hives). Changes from rich/greasy food lead to large Ding (carbuncles) on the feet. Reception is like holding a void vessel (Wang's commentary: Like holding an empty vessel to receive pathogenic toxins. Wu's commentary: Initially, severity is not felt). Labor sweat meeting wind, cold pressing causes (acne comedones). Stagnation causes Cuo (long-term becomes acne). Yang Qi, refined, nourishes Spirit; flexible, nourishes tendons. If opening/closing fails, Cold Qi enters, causing severe kyphosis (Body stiff and bent. Wu's commentary: Yang Qi is injured, unable to nourish tendons). Penetrating vessels causes Leaks (Leakage. Sound Lu/Lou. Cold Qi sinks into blood, causing ulcerative leaks). Lingering in flesh/Cou Li, Shu Qi transforms and presses, transmitting as fear and fright (Cold Qi lingers in flesh/Cou Li, transmits via Shu points, presses on Zang-Fu, causing fear/fright. This is Yang Qi injured, unable to nourish Spirit). Ying Qi does not comply (flow smoothly), rebels in flesh texture, causing abscesses/swellings (Ying Blood rebels in flesh textures, heat gathers into abscesses). Soul sweat not finished, form weak and Qi scorched, acupoints closed, developing Feng Nue (Sweat not stopped, scorched by Wind/Summer-heat, closed in acupoints, developing Wind Malaria. Hence the following text mentions Wind). Thus, Wind is the beginning of all diseases. Clarity and stillness close and reject Cou Li; even with great wind/toxin, nothing can harm. This follows seasonal order. Thus, Yang Qi governs the exterior daily (Wei Qi circulates in Yang twenty-five degrees during the day). At dawn, Human Qi generates; at noon, Yang Qi peaks; at dusk, Yang Qi declines, Gate Qi closes (Gate Qi refers to Xuan Fu, sweat pores). Thus, evening brings gathering and rejection (Yang Qi storage requires convergence). Do not disturb sinews/bones, do not expose to fog/dew. Violating these three times (dawn, noon, dusk), Form becomes exhausted and thin. Wind guest contaminates Qi (Wind pathogen contaminates Qi), Essence perishes, pathogen damages Liver (Wind Qi connects to Liver, Wind generates Heat, thus damaging Essence). Eating until full causes tendons/vessels to relax horizontally, intestinal pi becomes hemorrhoids (Wood insults Earth, causing intestinal wind/blood hemorrhoids). Drinking heavily causes Qi rebellion (Too much drinking lifts Lung leaves, causing Qi rebellion). Forceful exertion (Overuse of force or excessive intercourse) injures Kidney Qi, high bones deteriorate (High bone above Mingmen point in waist). The key of Yin and Yang is that Yang being dense ensures stability. If the two do not harmonize, it is like Spring without Autumn, Winter without Summer. Harmonizing them is the sage standard. Thus, if Yang is strong but not dense, Yin Qi is exhausted (Without Yang, Yin cannot generate). If Yin is peaceful and Yang is secreted, Spirit is governed. If Yin and Yang separate and decide, Essence and Qi perish. (From *Sheng Qi Tong Tian Lun*)
[Suwen] Diseases caused by the Five Qi. Heart manifests as Yi (belching/snoring. *Mai Jie Lun* says: Ascending to Heart as Yi occurs when Yin excess ascends to Yangming, and Yangming connects to Heart). Lung manifests as Ke (cough. Lung belongs to Metal; pathogen affecting it causes sound). Liver manifests as Yu (speaking. Liver belongs to Wood; Wood desires expansion, hence speaking). Spleen manifests as Tun (swallowing. Kun Earth accepts, hence swallowing). Kidney manifests as Qian (yawning) and Ti (sneezing. Yin and Yang attract, hence yawning. Human Yang Qi is harmonious, fills Heart, exits Nose as sneeze. Kidney meridian connects upward to Lung). Stomach manifests as Qi rebellion, Yue (hiccups), and Kong (fear). Yue is Qi opposition (commonly written as E Te). Cold excess and Qi rebellion cause Yue. Kidney emotion is Fear; Earth overcomes Water below, hence fear). Large Intestine and Small Intestine manifest as Xie (diarrhea. Two meridians deficient cause diarrhea). Lower Jiao overflows as Water (Cannot store/drain, overflows as water). Bladder...