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The way of heaven and earth is nothing but Yin and Yang. Humans wear heaven on their heads and tread upon the earth, embracing Yin and bearing Yang; their form corresponds to heaven and earth, hence this chapter is named "Yin Yang Ying Xiang" (Yin and Yang Responding to Images). Only when Yin and Yang become inverted and disordered do diseases arise.

It is not only humans who are affected; heaven experiences changes such as solar and lunar eclipses, and earth undergoes shifts in rivers and valleys. The Qi of heaven and earth changes unpredictably; if humans are influenced by these abnormal energies, it will also cause chaos in Blood and Qi, leading to various strange symptoms. Therefore, the ways in which humans violate the laws of Yin and Yang to become ill differ between internal and external causes.

Huang Di said: Yin and Yang are the Way of heaven and earth. (*I Ching* states: "One Yin and one Yang is called the Dao.") They are the general principles of all things, (Yang provides righteous Qi for growth, while Yin provides support for establishment.) They are the parents of change, (Note: Below heaven and above earth, changes occur endlessly, none of which does not originate from Yin and Yang, thus they are called the parents of change. Old注释 focusing only on different species is biased. Moreover, since "all things" was mentioned earlier, different species are naturally included within them.) They are the beginning of life and death. (All things rely on Yang Qi for warmth and life, and perish due to Yin Qi's coldness; thus, the origin of life and death lies in the operation of Yin and Yang.) They are the residence of divine spirit. ("Fu" refers to a palace or residence. It means that the reason for life, death, and change is that the Divine Spirit resides within. *I Ching* says: "Unpredictable Yin and Yang is called Shen [Spirit].") In treating disease, one must seek the root. (Note: From this perspective, the Way of Yin and Yang is indeed great. As a principle, it encompasses everything large and small; as a parent, it relies on generation and formation; as a root, it governs prosperity and decline. *I Ching* says it regulates the transformation of heaven and earth without error and completes all things without omission. Its divine unpredictability is surely the great root of humanity. Since humans originate from Yin and Yang, whether violating Yin and Yang causes disease or doctors treat disease by distinguishing Yin and Yang and regulating compliance and rebellion, the major principles can be illustrated by example. Generally, humans are born wearing heaven and treading earth, embracing Yin and bearing Yang. Daytime Yang moves and is active; nighttime Yin is still and quiet. Spring and summer are suitable for nourishing Yang; autumn and winter are suitable for nourishing Yin. Yin is Blood, storing Essence; Yang is Qi, defending the exterior. If defense is not solid, pathogens enter; the fault lies not solely with the Six Excesses (Six Pathogenic Factors). If storage is not dense, Qi scatters; the fault lies not solely with the Five Fires. Knowing why people get sick allows one to know how to treat disease. If the disease originates in Yang, treat Yang; if it originates in Yin, treat Yin; this is the constant method. If the disease appears Yin but actually originates in Yang, abandon Yin and treat Yang; if it appears Yang but actually originates in Yin, slow down Yang treatment and treat Yin; this is the variable method. The manifestations of disease are countless, but essentially, there is always a root within. If treatment does not seek the root, how can the disease be cured?)

Thus, accumulated Yang becomes Heaven, and accumulated Yin becomes Earth. (Note: Qi is not pure unless accumulated; the Yin and Yang of heaven and earth become pure through accumulation.) Yin is still, Yang is restless. (Note: Yin reaches stillness at its extreme, Yang reaches restlessness at its extreme; this is the variation of Yin and Yang.) Yang generates, Yin grows; Yang kills, Yin stores. (Note: Regarding these two sentences, old注释 were unclear, and even the New Correction's explanation of "Yin grows, Yang kills" caused doubt. I believe the meaning is easy to understand, and those who doubt are mistaken. "Yin grows" refers to the cultivation of Kun Earth and the gestation of women, which is the meaning of "forming shape" below. "Yang kills" refers to the intense heat of midsummer, melting stones and flowing metal, scorching all things; this is Yang reaching hyperactivity. In human disease, pathogenic fire is blazing, purely Yang without Yin, such as the transmission of Yang pathogens internally in Cold Damage, or wind blazing like flames in miscellaneous diseases, or people consuming spicy and hot foods causing fire stagnation and phlegm knotting, with hard and dry stool and urine, all belonging to hyperactive Yang. If not treated urgently, death comes quickly; bitter-cold herbs are needed. The New Correction's definition of "grow" and "kill" based on directions and months is far-fetched.) Yang transforms into Qi, Yin forms shape. (Note: Shape is formed by flesh and blood; Yin governs blood, hence "forms shape.") Extreme cold generates heat; extreme heat generates cold. (Note: When Yin excess reaches its extreme, it repels Yang to the exterior, causing floating deficiency fire, restlessness like madness; this is Yin syndrome resembling Yang, not true heat, but extreme cold. When Yang excess is internal, fire is blocked and unvented, causing cold limbs and even trembling; this is Yang syndrome resembling Yin, not true cold, but extreme heat. Why? Things reverse at their extreme. Diseases may seem different, but the principle remains unchanged; this is the origin of the "following treatment" method.) Cold Qi generates turbidity; Hot Qi generates clarity. Clear Qi descending below causes undigested diarrhea; Turbid Qi ascending above causes distension. (Note: Heaven floats up with light clarity; Earth descends with heavy turbidity; thus clarity and turbidity are the physical qualities of Yin and Yang, fixed distinctions of the two Qi. However, in human disease, the generation of clarity and turbidity has specific causes. What causes turbidity? Generated by cold. Why does cold generate turbidity? Human Qi flows when hot and stagnates when cold; excessive cold causes Qi congestion, self-obstruction, and turbid chaos. What causes clarity? Generated by heat. Why does heat generate clarity? The function of Qi is still when cold and active when hot. Clarity becoming a disease is due to endless movement. If Clear Qi is transformed by heat, it should ascend; if suppressed below, its rapid nature causes violent diarrhea with undigested food. If Turbid Qi is transformed by cold, it should descend; if congested above, Yin coagulation fails to resolve, leading to blockage, fullness, and obstruction. Note: The character "Qing" (Clear) here should not be interpreted positively. Since clarity and turbidity arise from cold and heat, both are diseases. Another note says heat below causes undigested food, but heat aids digestion; why say undigested? He Jian said "Fire's rapid nature causes violent diarrhea," which is correct.) This is the inversion of Yin and Yang, the reversal and compliance of disease. (Note: Summarizing the above eight sentences. For normal diseases, use direct treatment; for reversed ones, use following treatment. Symptoms contrary to normal are called "reversed." The eight sentences from "extreme cold generates heat" describe reversed symptoms requiring following treatment. Old注释 is inaccurate.)

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. (Yin condenses upward to form clouds; Yang disperses downward to flow as rain. Rain applies transformation from clouds, so it is said rain comes from Earth; Clouds rely on Qi interaction, so it is said clouds come from Heaven. Even heaven and earth follow this logic; human body clarity and turbidity are similar. Note: Although heaven and earth have clarity and turbidity distinctions, their Qi actually interacts. The four sentences about Earth Qi precisely state that heaven and earth Qi interact to form clouds and rain.) Thus, Clear Yang exits through the upper orifices, Turbid Yin exits through the lower orifices; (Qi originating from heaven tends upward; Qi originating from earth tends downward, each following its kind. Upper orifices refer to ears, eyes, mouth, nose; lower orifices refer to the two yin openings.) Clear Yang disseminates to the interstices, Turbid Yin travels to the Zang organs; (Interstices are pores for excretion, so Clear Yang can disseminate; Zang organs are repositories, so Turbid Yin can enter.) Clear Yang fills the four limbs, Turbid Yin returns to the Fu organs. Limbs move externally, so Clear Yang fills them; Fu organs digest internally, so Turbid Yin returns to them. Note: The first section of this paragraph uses heaven and earth's clarity and turbidity as an introduction, then discusses human body clarity and turbidity, which have fixed principles and positions. If upside down and confused, it is called Yin-Yang inversion, and disease arises.

Water is Yin, Fire is Yang. (Note: Distinguished by cold/hot and still/moving.) Yang manifests as Qi, Yin manifests as Flavor. (Note: Yang is formless and Qi moves silently; Yin has form and Flavor nourishes shape.) Flavor returns to shape, shape returns to Qi, Qi returns to Essence, Essence returns to Transformation. (Shape eats Flavor, so Flavor returns to shape; Qi generates shape, so shape returns to Qi; Essence eats Qi, so Qi returns to Essence; Transformation generates Essence, so Essence returns to Transformation, hence the following text. Note: "Return" means turning from outside to inside. Flavor nourishes shape, shape is moved by Qi, Qi is stored in Essence, Essence originates from Transformation; all imply tracing back from the branch to the root.) Essence feeds on Qi, shape feeds on Flavor. (Qi transformation generates Essence, harmonious Flavor makes shape grow, hence "feeding." Note: Qi is stored in Essence, but Essence cannot be held without Qi; thus Qi nourishes Essence. Just as five flavors nourish shape, both are called "feeding".) Transformation generates Essence, Qi generates shape. (Note: Transformation is from non-being to being, the motive force of the Supreme Ultimate. Movement stores True Essence. After Essence exists, Qi exists; Essence is substance, Qi is function. After Qi exists, shape exists; where Qi reaches, shape is complete. Endless generation starts from Transformation. Old注释 saying fine fluids come from blood transformation trivializes "Transformation generates Essence" and misunderstands it; reading the four sentences "Flavor returns to shape..." reveals this.) Flavor injures shape, Qi injures Essence. (Exceeding moderation. Note: These two sentences contrast with "Essence feeds on Qi, shape feeds on Flavor" above. Above speaks of normalcy, here speaks of deviation.) Essence transforms into Qi, Qi is injured by Flavor. (Note: Essence borrows Qi for nourishment, i.e., feeding on Qi. Having been nourished, transformation is endless; only by feeding on Qi can one transform Qi. Earlier it said Flavor injures shape; why say Qi is injured by Flavor? Mencius said: "Qi fills the body." If diet is not moderate, intestines and stomach become turbid and Qi chaotic; chaotic Qi damages shape; thus shape injury is actually due to Qi injury.) Yin Flavor exits through lower orifices, Yang Qi exits through upper orifices. (Flavor has substance, so it flows down to excretory orifices; Qi is formless, so it exits up through respiratory gates. Note: Same as "Clear Yang exits upper, Turbid Yin exits lower"; this follows the discussion of Qi and Flavor.)

Strong Flavor is Yin, thin Flavor is Yang within Yin; Strong Qi is Yang, thin Qi is Yin within Yang. (Yang is Qi, strong Qi is Pure Yang; Yin is Flavor, strong Flavor is Pure Yin. Thus thin Flavor is Yang within Yin, thin Qi is Yin within Yang. Note: This refers specifically to medicinal properties/flavors, differing from the general discussion of diet earlier.) Strong Flavor causes purging, thin Flavor promotes circulation; Thin Qi causes sweating, Strong Flavor causes fever. (Yin Qi moistens downward, so strong Flavor causes diarrhea; Yang Qi flares upward, so strong Qi causes fever. Thin Flavor is less Yin, so it promotes circulation/purging; thin Qi is less Yang, so it causes sweating. Note: This describes the therapeutic effects of medicinal Qi and Flavor, which physicians should experience and use cautiously.) Pungent and Sweet flavors/directions that dissipate and spread are Yang; Sour and Bitter flavors/directions that induce vomiting and purging are Yin. (Note: This also discusses medicinal utility, varying in effect. Dissipation and induction must be appropriate. However, these two sentences were originally placed under "Lesser Fire generates Qi," which contradicts context, likely a textual error. Moved here for coherence. "Induce vomiting and purging" refers to emesis.)

Strong Fire diminishes Qi, Lesser Fire strengthens Qi; (Note: Diminish means peak/exhaustion, Strengthen means growing.) Strong Fire consumes Qi, Qi feeds on Lesser Fire; Strong Fire scatters Qi, Lesser Fire generates Qi. (Note: Qi is consumed by Strong Fire and nourished by Lesser Fire. Strong Fire's consumption is depletion; Lesser Fire's presence in Qi is nourishment. Nourishment leads to life, depletion leads to scattering; this is natural law.)

Yin excess injures Yang, Yang excess injures Yin. (Note: Extreme cold weakens Fire; extreme heat dries Water.) Yang excess causes Heat, Yin excess causes Cold. (Note: Explains pathology due to excess. Yang excess leans toward Heat, treatment favors Bitter-Cold; Yin excess leans toward Cold, medicine favors Pungent-Hot; this is Direct Treatment.) Extreme Cold produces Heat, Extreme Heat produces Cold. (Things reverse at extremes, similar to Strong Fire diminishing Qi and Lesser Fire strengthening it. Note: Heat from extreme Cold is not true Heat; Gui Zhi and Fu Zi can guide Fire back to its source. Cold from extreme Heat is not true Cold; dispersing Fire removes Cold; this is Following Treatment. Same meaning as "Extreme cold generates heat, extreme heat generates cold".) Cold injures Shape, Heat injures Qi. Cold impedes Defensive Qi, thus injuring Shape; Heat consumes Nutritive Qi internally, thus injuring Qi. Note: Old注释 is wrong. Wei is Qi, Ying is Blood. Scripture says Cold injures Shape, but注释 says Wei is impeded, which is Qi injury; Scripture says Heat injures Qi, but注释 says Ying is consumed, which is Blood injury. Clearly referring to Shape and Qi, how can Blood and Qi be swapped arbitrarily? It is illogical. "Cold injures Shape" refers to shivering aversion to cold, cold limbs; Cold enters skin and interstices, Shape cannot withstand it. "Heat injures Qi" refers to summerheat with profuse sweating, pungent-hot exhaustion; Heat is fierce, Qi is scorched. Ancient sages' words have precise meanings; careful contemplation is needed, lest minor errors lead to major deviations. Qi injury causes Pain, Shape injury causes Swelling. (Qi injury causes heat knotting in muscle spaces, hence pain; Shape injury causes cold pressing on skin and interstices, hence swelling. Note: This注释 roots in Cold/Heat explanation, which is correct. This further proves the previous注释 was wrong.) Thus, pain before swelling indicates Qi injuring Shape; swelling before pain indicates Shape injuring Qi. (First Qi symptom then Shape disease is Qi injuring Shape; first Shape symptom then Qi disease is Shape injuring Qi. Note: From "Cold injures Shape" to here, three paragraphs discuss Shape and Qi oppositely, seemingly continuous, but layers differ. First section discusses Cold/Heat injury; second discusses Shape/Qi injury causing pain/swelling; third discusses interaction to exhaust disease variations. Wang注释's initial explanation of Shape/Qi is imprecise; later explanation of sequence is unclear. Human diseases have single and combined syndromes. Pain without swelling, swelling without pain are single syndromes; pain with swelling is combined. Within combined syndromes, sequence matters, affecting treatment. Pain then swelling: swelling caused by pain, treat Qi to spare Shape. Swelling then pain: pain caused by swelling, treat Shape to spare Qi. Rectify the root, and the branch corrects itself.) Wind excess causes Tremoring/Movement. (Note: Wind is inherently mobile; Commentary says "Wind excess causes limb ailments.") Heat excess causes Swelling. (Heat excess causes internal stagnation of Yang Qi, hence swelling; severe cases see Nutritive Qi reversing in muscle tissue, gathering into abscess swelling. Note: Earlier said Cold injures Shape, Shape injures Swelling, implying swelling is Cold-related, yet here Heat excess causes swelling, suggesting two types of swelling. Looking at "Cold excess causes Floating," perhaps scripture conflates edema and shape? Or perhaps "Qi injury pain, Shape injury swelling" lacked Cold/Heat qualifiers originally? Could "Shape injury swelling" refer to Heat? Is there no difference between Swelling and Floating? Answer: Solid and internal is Swelling, caused by stagnant Fire; Vast and external is Floating, caused by stagnant Cold/Water. Thus, swelling belongs to Heat, not Cold, which is clear. Why didn't注释 distinguish?) Dryness excess causes Dryness. (Dryness excess depletes Essence and Fluids, hence dry skin. Note: Dryness is Fire transformation, existing internally and externally; mentioning only skin is biased.) Cold excess causes Floating. (Note: Cold excess means Yin excess and Yang deficiency, pore closure prevents Qi escape, causing limbs to swell outwardly.注释 saying Yang Qi attacks internally is indistinguishable from Yang Qi stagnation explaining Heat swelling, thus wrong.) Dampness excess causes Loose Stool/Diarrhea. (Note: Spleen is Wet Earth, likes Dryness, fears Dampness. Dampness excess stagnates Spleen, preventing transport, so water and grain separate, causing loose diarrhea.)

Heaven has Four Seasons and Five Elements, used for growth, flourishing, harvesting, and storing, generating Cold, Heat, Dryness, Dampness, and Wind; Humans have Five Zang organs, transforming Five Qi, generating Joy, Anger, Worry, Grief, and Fear. (Note: Heaven and Earth share one principle, naturally corresponding. Five Qi are Five Element Qi. Joy, Anger, Worry, Grief, Fear are Five Emotions.注释 confusing Five Emotions with Five Qi is wrong. *Tian Yuan Ji Da Lun* writes Grief as Thought, Spleen governs Thought, which is correct. Later text also says Spleen's emotion is Thought. Here listing Grief and Worry (both Lung emotions) loses Spleen's emotion, likely an error; should be Joy, Anger, Thought, Grief, Fear.) Thus, Joy and Anger injure Qi, Cold and Heat injure Shape. (Note: Joy relaxes Qi, Anger raises Qi. Relaxed Qi scatters if unchecked; raised Qi rebels if unchecked; disease is in formless realm. Cold/Heat are external pathogens; entering humans causes multiple symptoms; disease is in formless realm.) Violent Anger injures Yin, Violent Joy injures Yang. (Note: Yin is Blood, stored in Liver, Liver governs Anger. Anger causes Liver Qi to rush and rebel, stirring Blood internally, possibly causing hematemesis. Yang is Qi. Sudden Joy causes Heart Spirit to fly and Qi to scatter.) Rebellious Qi ascends, filling vessels and separating from Shape. (Rebellion means Qi counterflow. Counterflow Qi ascends, filling meridians, causing Spirit Qi to float away from the body.) Unregulated Joy and Anger, excessive Cold and Heat, make life unstable... Thus it is said: Winter injury by Cold leads to Warm Disease in Spring; (Injury by Four Seasons Qi causes disease. Cold Damage is the most lethal. Immediate illness is Cold Damage. Delayed illness: Cold toxin hides in skin/flesh, becoming Warm Disease in Spring, Summerheat Disease in Summer. Health preservers must guard against pathogens.) Spring injury by Wind leads to Undigested Diarrhea in Summer; (Wind enters exterior, correlates internally with Liver. Liver Qi invades Spleen, causing undigested diarrhea.) Summer injury by Summerheat leads to Malaria in Autumn; (Note: Summerheat should dissipate; if retained until Harvest season, heat cannot vent, lingering to become Malaria. Malaria here refers to chronic malaria.) Autumn injury by Dampness leads to Cough in Winter. (Note: Cold shape and cold drinks injure Lungs. Autumn dampness, unable to disperse due to Harvest energy; hiding until Winter, combining with cold water, cold congeals in Lungs causing cough.)

Emperor said: I heard ancient sages discussed human form, distinguished Zang organs, traced meridians, connected the Six Combinations, following each meridian. Acupoints have names and locations. Muscle grooves attach to bones, all having origins. Distribution of reversal and compliance has order. Four Seasons Yin and Yang have regulations. External and internal responses have interior-exterior correspondence. Is this true? (Note: Six Combinations refer to human meridians. *Ling Shu* says Taiyin-Yangming is one combination, Shaoyin-Taiyang is one, Jueyin-Shaoyang is one. Hand and foot meridians each have three, making six combinations. Attaching to bones means bone connections. Interior-Exterior: Yang meridians are Exterior, Yin meridians are Interior.) Qibo answered: East generates Wind, (Wind is beginning of teaching, so generated in East.) Wind generates Wood, (Wind鼓rates Wood flourishing.) Wood generates Sour, (Note: *Hong Fan* says "Curved and straight makes Sour." Sour flavor is emitted by Wood Qi.) Sour generates Liver, (Generate means growth.) Liver generates Tendons, (Liver's essence nourishes tendons.) Tendons generate Heart, (Note: Meaning Wood generates Fire.) Liver governs Eyes. (Note: Essence of all Five Zang pours into eyes, but Liver is the master.) In Heaven it is Profound, (Profound means Xuan Ming, sky is high and not yet bright.) In Humans it is Dao, (Note: Dao is root of all transformations, like Wood flourishing in Spring with endless growth.) On Earth it is Transformation. (Note: Nothing changes better than Wood.) Transformation generates Five Flavors, (Note: Five Flavors