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Wu Yun: "Xuan" (宣) means to disperse. The "Five Qi" (五气) refer to the five phases of Wood, Fire, Earth, Metal, and Water. This text expounds on the relationships of the Five Qi regarding invasion, disease causation, aggregation, aversion, fluid transformation, contraindications, induction, disorder, pathogenic invasion, internal storage, governance, injury, and correspondence. This chapter elucidates all these aspects.

This is referred to as the "Five Entries" (五入). Ma Yun: This is identical to the *Ling Shu: Nine Needles Treatise*, except that the latter includes an additional phrase "Salty taste enters the Stomach." Danbo Jian'an: The *Rites of Zhou: Office of Disease Physicians* states: "In general harmonization, spring favors sour, summer favors bitter, autumn favors pungent, winter favors salty, adjusted with slippery and sweet tastes." This shares the same meaning.

The Heart corresponds to Yi (噫, belching). Ma Yun: The *Ling Shu: Mouth Inquiry Chapter* states: "Yi originates from the Stomach." Both the *San Bu Jiu Hou Treatise* and this chapter state: "The Heart governs Yi." Examining the *Mai Jie Chapter*, what is meant by "ascending to the Heart manifests as Yi" is that when Yin is excessive and ascends to the Yangming channel, and since the Yangming channels connect to the Heart, it is said to ascend to the Heart manifesting as Yi. Is not the purport of the classics essentially one and the same? Zhang Jingyue: Yi refers to belching. Scanning the entire classic, there is no separate syndrome listed solely as "belching," but only "Yi," which presumably refers to this. Danbo Jian'an: The *Shuo Wen Jie Zi* defines Yi as a sigh after a full meal. The *Book of Rites: Inner Rules* says: "Do not belch or retch," which refers to this. (Yi, pronounced 'ai' in the Wu jie rhyme; if pronounced 'yi' in the Yu Xi rhyme, it denotes a cry of pain, which differs in meaning.) Ai (嗳), according to the *Zi Hui*, is pronounced 'ai' and means belching. Essentially, "Ai" is the colloquial character for "Yi." Gao Shi: Yi is slight belching. Incorrect.

The Liver corresponds to Yu (语, excessive speech). Zhi: When Liver Qi desires to flow freely, it manifests as excessive speech. The *Zhen Yao Jing Zhong Chapter* states: "If needling is performed in the winter areas during spring, pathogenic factors adhere to the Zang organs, the illness does not resolve, and the patient desires to speak." This indicates that the Liver Qi of spring fails to unblock. Gao Shi: When pathogenic Qi is in the Liver, it manifests as excessive speech; Yu means talking much. Danbo Jian'an: Since the heading is "Diseases Caused by the Five Qi," the interpretations of Wang Bing, Ma Yun, Wu Kun, and Zhang Jingyue are all incorrect. The explanation for "Tun" below follows the same logic.

The Spleen corresponds to Tun (吞, swallowing/swallowing acid). Zhi: The Spleen is responsible for transporting fluids for the Stomach. If Spleen Qi is diseased and cannot irrigate the four Zang organs, fluids overflow into the opening of the Spleen, the mouth, resulting in symptoms of swallowing (or swallowing acid). Danbo Jian'an: According to Zhi's annotation, "Tun" refers to swallowing acid/vinegar. The *Ping Mai Fa* states: "Belching accompanied by swallowing acid, food suddenly cannot go down." It also states: "If the Upper Jiao does not return, belching accompanies acidic swallowing." Gong Tingxian stated: Swallowing acid differs from vomiting acid. Swallowing acid is water piercing the Heart; vomiting acid is spitting out acidic water. This is correct. Gao Shi: Tun refers to disharmony of the tongue root. Unknown basis.

The Kidney corresponds to Qian (欠, yawning) and Ti (嚏, sneezing). Zhi: The *Ling Shu* states: "Yang governs ascending, Yin governs descending. Yang draws upward, Yin draws downward; mutual attraction causes frequent yawning." One should drain the Foot Shaoyin and tonify the Foot Taiyang. (See *Kou Wen Chapter*). Generally, Shaoyin Qi resides below; when diseased, it rebels upward and seeks to draw downward. Seeking to draw downward causes yawning; rebelling upward causes sneezing. Generally, Kidney collaterals connect upwards to the Lung. Danbo Jian'an: The *Jiu Zhen Lun* lacks the word "Ti"; this is suspected to be a later addition.

(It also corresponds to Yue 哕, hiccup, and Kong 恐, fear.) Danbo Jian'an: The phrase "manifests as fear" is unclear in various annotations. The *Jiu Zhen Lun* lacks these two words; suspected to be a later addition.

Excess fluid in the Lower Jiao transforms into edema. Gao Shi: When the Lower Jiao is diseased and cannot dredge, fluid overflows causing edema. Danbo Jian'an: The *Ling Lan Mi Dian Lun* states: "The San Jiao is the official of dredging, through which water passages exit." Here, the Lower Jiao is listed alongside the Stomach, Large Intestine, Small Intestine, Bladder, and Gallbladder. Thus, the Lower Jiao refers to the San Jiao mentioned in the *Ling Lan Mi Dian Lun*. (For detailed meaning, see *Liu Jie Zang Xiang Lun*.) As one of the Six Fu organs, cross-referencing reveals that the San Jiao among the Six Fu organs specifically refers to the Lower Jiao.

Bladder dysfunction leads to Long (癃, urinary retention). Ma Yun: The *Ling Lan Mi Dian Lun* states: "The Bladder is the official of the city depot, storing fluids; upon Qi transformation, they can exit." Now it says dysfunction leads to Long; Long is a disease of blocked water passages. Zhang Jingyue: The *Ben Shu Chapter* states: "The San Jiao is a branch of the Taiyang, merging with the main Taiyang, entering and connecting to the Bladder, regulating the Lower Jiao. Excess leads to closure and Long; deficiency leads to enuresis." Generally, the San Jiao is the central dredging organ, the source of water passages, so the San Jiao is also attributed to the Bladder. Danbo Jian'an: The *San Yin Fang* states: "Lin (strangury) was called Long in ancient times; names differ." Long implies exhaustion/blockage; Lin implies dripping. Although the modern name is common, it fits the meaning better. Danbo Jian'an: Lin as a urination disease first appears in the *Liu Yuan Zheng Ji Da Lun*. Long is the general term for urinary obstruction. Ma's annotation is correct.

The Gallbladder corresponds to Nu (怒, anger). Zhang Jingyue: Anger is the emotion of the Liver, but the Gallbladder is the same, as the Liver and Gallbladder are exterior-interior pairs, both possessing rigid Qi, and Liver function depends on the Gallbladder. Gao Shi: When Gallbladder disease stagnates and fails to soothe, it manifests as anger.

This is referred to as the "Five Diseases" (五病). Zhi: Refers to diseases of the Five Zang Five Phase Qi, while the Six Fu organs also correspond to the Five Phases. Danbo Jian'an: The *Jiu Zhen Lun* states: "Qi of the Five Zang: Heart governs Yi, Lung governs cough, Liver governs speech, Spleen governs swallowing, Kidney governs yawning. Qi of the Six Fu: Gallbladder manifests as anger, Stomach as rebellious Qi and hiccup, Large and Small Intestines as diarrhea, Bladder lack of control as enuresis, Lower Jiao excess fluid as edema." Here, Six Fu diseases are listed, yet it speaks of Five Jing (Essence). Perhaps because both Large and Small Intestines manifest as diarrhea.

Aggregation of the Five Jing (Essences). Wu Yun: The Five Jing refer to the essential Qi of the Five Zang. Aggregation implies entering. If the essential Qi of the Five Zang remains in its own organ, there is no disease. If it aggregates into one organ, pathogenic factors fill it, manifesting respective emotions. Zhang Jingyue: Bing (并) means gathering. Gao Shi: Organ deficiency allows essence and Qi to aggregate. Jing refers to Yin Essence, Qi refers to Yang Qi. Danbo Jian'an: Essence and Qi are the essential Qi from grain and water; there is no need to divide them into Yin and Yang.

Aggregation into the Liver manifests as You (忧, sorrow/worry). Ma Yun: The *Yin Yang Ying Xiang Da Lun* states the Liver governs anger, but here it says sorrow, because Lung Qi can overcome it. Gao Shi: The Liver governs anger; here it says sorrow because the previous section stated the Gallbladder governs anger, so the Liver governs sorrow. Anger indicates excess; sorrow indicates deficiency. Lou: You should be Nu (anger). Danbo Jian'an: The *Jiu Zhen Lun* also writes You.

Aggregation into the Spleen manifests as Wei (畏, fear). Ma Yun: The *Yin Yang Ying Xiang Da Lun* states the Spleen governs Si (thought), but here it says fear, perhaps excessive thought turns into fear. Gao Shi: Thought is the essence of the Spleen; here it says fear, indicating extreme deliberation. Lou: Wei should be Si (thought). Danbo Jian'an: The *Jiu Zhen Lun* also writes Wei; *Jia Yi Jing* writes Ji (hunger). (Consistent with Wang Bing's note.)

Transformation of Fluids by the Five Zang. Gao Shi: Transformation of fluids refers to food and drink entering, where fluids follow their respective paths. The Five Zang receive the essence of grain and water,渗注 (seeping) to external orifices, transforming into Five Fluids.

The Heart corresponds to Sweat. Wu Yun: The Heart governs Blood; sweat is the surplus of blood, thus sweat is the fluid of the Heart. Danbo Jian'an: The *Ying Wei Sheng Hui Chapter* states: "Those who lose blood have no sweat; those who lose sweat have no blood." The *San Yin Fang* considers nasal bleeding in cold damage as "red sweat," sharing the same intent.

The Lung corresponds to Nasal Discharge (Ti 涕). Danbo Jian'an: Various dictionaries define Ti as eye tears, but medical texts specifically refer to nasal discharge. Examining the *Shuo Wen Jie Zi*, Ti is nasal discharge. Generally, Ti and Ti are interchangeable. The *Yu Pian* notes: Ti, pronounced 'ji', is nasal fluid. The *Book of Rites: Inner Rules* states: "Do not spit or blow nose." The commentary states: Originally written as Ti.

The Spleen corresponds to Saliva (Xian 涎). Wu Kun and Zhang Jingyue both state: Saliva exits from the mouth, which is the orifice of the Spleen. Danbo Jian'an: The *Zheng Zhi Zhun Sheng: Injury Section* states: "There are salivary sacs in both cheeks," confirming saliva exits from the mouth.

The Kidney corresponds to Spittle (Tuo 唾). Wu Yun: Spittle exits from the Lianquan orifices, which flank the root of the tongue. The Foot Shaoyin Kidney meridian follows the throat and flanks the tongue root, thus spittle is the fluid of the Kidney. Gao Shi: The *Ling Shu: Gen Jie Chapter* states: "Shaoyin roots at Yongquan and knots at Lianquan," the sublingual orifice. The Kidney is the Water organ, rising from below. Although there are five fluids, the Kidney governs them all; hence all five fluids are salty, and salt is the taste of water.

Patients with Blood diseases should not consume excessive salty taste. Zhang Jingyue: Blood coagulates and stops flowing when it encounters salt. The *Wu Wei Lun* states: "When blood meets salt, it coagulates."

Patients with Bone diseases should not consume excessive bitter taste. Zhi: The Kidney governs bones. Fire flares up making things bitter; bitter travels to bones, representing Fire Qi interacting downward with the Kidney. In bone disease, consuming excessive bitter taste causes Fire Qi to overpower. This is consistent with the meaning of "aggregation into the Heart manifests as joy, aggregation into the Kidney manifests as fear." Generally, the Water-Fire Qi of Heart and Kidney constantly interact and balance, so the tastes they govern interchange. For the other three Zang organs, it is the taste of the organ itself, traveling to the sinews/muscles governed by that organ. Danbo Jian'an: The *Ling Shu: Wu Wei Lun* states: "Sour travels to sinews, excessive consumption causes strangury; Salt travels to blood, excessive consumption causes thirst; Pungent travels to Qi, excessive consumption causes hollow heart pain; Bitter travels to bones, excessive consumption causes vomiting; Sweet travels to flesh, excessive consumption causes muggy heart." This aligns perfectly with this section. The *Jiu Zhen Lun* states: "Bitter travels to blood, do not eat bitter if disease is in blood; Salt travels to bones, do not eat salt if disease is in bones." This discusses from the perspective of the taste of the specific organ.

This is referred to as the "Five Contraindications" (五禁). The *Jiu Zhen Lun* writes "Five Cuts" (五裁); the *Wu Xing Da Yi* citing the *Huang Di Yang Sheng Jing* writes "Five Thieves" (五贼).

Yin diseases originate in the bones. Zhang Jingyue: Bones belong to the Kidney; the Kidney is Yin within Yin. Wu Kun and Ma Yun agree.

Yang diseases originate in the blood. Zhang Jingyue: Blood belongs to the Heart; the Heart is Yang within Yang.

Yin diseases originate in the flesh/muscles. Zhang Jingyue: Flesh belongs to the Spleen; the Spleen is Yin within Supreme Yin.

Pathogenic factors entering Yang cause mania (Kuang 狂). Ma Yun: The *Sheng Qi Tong Tian Lun* states: "If Yin cannot overcome Yang, pulses flow rapidly and forcefully, leading to mania."

Pathogenic factors entering Yin cause Bi syndrome (Bi 痹). Wu Yun: Pathogen refers to Yin pathogen. Bi refers to the Five Zang Bi described in the *Bi Lun*. Yin pathogen entering Yin is double Yin, resulting in Five Zang Bi. Ma Yun: Becomes Bi syndrome. Zhang Jingyue: The *Shou Yao Gang Rou Chapter* states: "Disease in Yin is named Bi." The *Jiu Zhen Lun* states: "Pathogen entering Yin becomes Blood Bi."

Pathogenic factors clashing with Yang cause Dian disease (巅疾, epilepsy/manic disorder). Zhang Jingyue: Bo (搏) means strike. Dian (巅) is synonymous with Dian (癫, epilepsy). Pathogen clashing with Yang injures Yang Qi, thus causing epileptic/manic disorders. The previous text stated pathogen entering Yang causes Kuang (mania), which is pathogen assisting Yang, an excess condition of Yang. Here, clashing with Yang causes Dian disease, which is pathogen attacking Yang, a deficiency condition of Yang. Hence the difference between Kuang and Dian. The *Jiu Zhen Lun* states: "Pathogen entering Yang, turning leads to Dian disease." Meaning it turns into the Yin aspect, thus becoming Dian. Danbo Jian'an: Bo is synonymous with Bo (薄), meaning pressure. Ma and Wu interpret Dian disease as disease of the vertex, which is incorrect. Xu's *Jing Luo Quan Shu* states: Bo should be Chuan (transmit), do not follow. (Same for "Bo Yin" below.) Dian and Kuang are distinctly different diseases, but later generations confused them. Therefore, several explanations are cited to clarify. The *Nan Jing: Fifty-Ninth Difficulty* asks: How to distinguish Kuang and Dian? Answer: Kuang begins with little sleep, no hunger, considering oneself wise and noble, speaking arrogantly, laughing excessively, singing, walking aimlessly without rest. Dian begins with unhappiness, sudden collapse, staring straight. Yang Xuancuo states: Symptoms of Kuang include unwillingness to sleep or eat, claiming wisdom, singing and walking; this is caused by excessive Yang Qi, hence the classic says "Double Yang is Kuang." Modern people call this Dian disease, which is wrong. Dian means toppling; onset involves collapsing to the ground, hence "Dian Jue." Excessive Yin Qi prevents standing/walking, causing collapse. Modern people call this Epilepsy (Xian), which is also wrong. Chen's *Xue Tan Ju Yi Yue* states: Kuang refers to nonsense and running; Dian refers to collapse and unconsciousness. They are separate syndromes. However, the classics mention "Kuang Dian Ji" (see *Jue Lun*: Yangming Jue leads to Dian disease wanting to run and shout, where Dian seems to imply Kuang); mentions "Kuang interweaves with Dian"; and mentions "Dian disease is Kuang" (see *Yin Yang Lei Lun*). These refer to combined Kuang-Dian diseases. Current diseases include cases of Kuang speech/walking followed by collapse; or collapse followed by hallucinations resolving after half a day. These are combined Kuang-Dian. Those who wish to stay alone behind closed doors, where Yin cannot overcome Yang, pulses flow rapidly and forcefully, represent isolated Kuang syndrome. Presenting these theories, verifying against the classics and patients, provides clarity.

Pathogenic factors clashing with Yin cause Aphonia (Yin 喑). Zhang Jingyue: Pathogen clashing with Yin injures Yin Qi, thus voice becomes aphonic. Yin refers to the Yin of the Five Zang. Generally, the Heart governs the tongue; the Hand Shaoyin Heart meridian ascends to the throat and ties to the tongue root; the Hand Taiyin Lung meridian follows the throat; the Foot Taiyin Spleen meridian ascends to knot at the pharynx, connects to the tongue root, and spreads under the tongue; the Foot Jueyin Liver meridian follows the throat posteriorly, enters the epiglottis, and sinew collaterals tie to the tongue root; the Foot Shaoyin Kidney meridian follows the throat and ties to the tongue root. Thus, all these govern aphonia. The *Jiu Zhen Lun* states: "Pathogen entering Yin, turning leads to aphonia." Meaning turning to the Yang aspect causes Qi disease, thus aphonia. Lou's *Gang Mu* states: Yin is pathogen entering the Yin region. The classic states: "Pathogen clashing with Yin leads to aphonia," and "Pathogen entering Yin, clashing leads to aphonia." There are two types: one is She Yin (tongue aphonia), such as stroke where the tongue cannot move for speech; the other is Hou Yin (throat aphonia), such as loss of voice from chronic cough. Generally, She Yin means the tongue root cannot move for speech, but throat sounds remain normal; Hou Yin means hoarseness in the throat, but the tongue root can still move for speech. Tang Huilin's *Cang Jing Yi Yi* states: Yin is silent and soundless; Ya (mute) has sound but no speech due to immovable tongue. Danbo Jian'an: Wu Yun states: Yin means mute. Zhang Jingyue states: Manifests as aphonia. This indicates Lou's She Yin and Lin Yin's Ya.

Yang entering Yin leads to tranquility. Danbo Jian'an: Sun Yi's *Shi Er Bian* states: The character "Zhi" (之) means change. The *Zuo Zhuan* "Encountering Guan changing to Pi" means Guan changes to Pi. Generally, Yang disease outside causes agitation; if it enters and changes to Yin, it becomes tranquil. The following text "Exiting to Yang" has the same meaning. Wang Bing interprets "Zhi" as going, which seems inappropriate.

This is referred to as the "Five Disorders" (五乱). Zhi: Refers to pathogenic factors disrupting the Yin-Yang of the Five Zang. Danbo Jian'an: Mentioning Kuang, Bi, Dian, Yin, Jing (tranquility), and Nu (anger) are all caused by disordered Qi; it should be called Six Disorders. However, this chapter focuses on the Five Zang, hence it is called Five Disorders.

(All five pathogens) share the same name: death untreatable. The Wu edition lacks the character "Ming" (命). Ma Yun: This is called the Five Pathogens, all similarly termed death untreatable. Gao edition agrees. Note below states: This is called the Five Pathogens, all similarly stating the Five Zang receive pathogens, similar to Wood receiving Metal punishment. Ming death untreatable, Zhi edition also agrees. Note states: Ming means calculating the remaining lifespan and time of death; the period is determined by monthly/seasonal overcoming; death does not occur immediately. Danbo Jian'an: Following Ma's annotation is correct.

The Kidney stores Zhi (Will). The *Jiu Zhen Lun* writes Jing (Essence) instead of Zhi; the *Nan Jing* agrees.

Prolonged viewing injures Blood. Danbo Jian'an: The *Wu Zang Sheng Cheng Chapter* states: "All vessels belong to the eyes." Prolonged viewing injuring Blood means injuring the blood vessels.

Prolonged lying down injures Qi. Zhang Jingyue: Prolonged lying down prevents Yang Qi from extending, thus injuring Qi.

Prolonged sitting injures Flesh/Muscles. Zhang Jingyue: Prolonged sitting causes blood vessels to stagnate in the four limbs, thus injuring flesh.

Prolonged standing injures Bones. Zhi: Prolonged standing injures the waist, kidneys, knees, and shins, thus injuring bones.

Prolonged walking injures Sinews. Zhi: Walking to exhaustion injures sinews.

The Five Labors Cause Injury. Zhi: Lao (Labor/Exertion) means excess. Ancients were physically active but not exhausted. Danbo Jian'an: Lao, according to *Shuo Wen*, means severe/intense. From Li (power) with省略 (provisional) Ying (fire burning)... exerting force is Lao, pronounced 'lu dao'. The *Er Ya: Shi Gu* states: Lao means diligence/toil.