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Lou Quanshan said: "Heaven generates all things through Yin and Yang and the Five Elements, and humans acquire Qi to exist. Therefore, Blood and Qi, Upper and Lower, Deficiency and Excess, Cold and Heat are all unified under Yin and Yang; the Zang Organs, Fu Organs, Twelve Meridians, and the Five Movements and Six Qi are all unified under the Five Elements. The manifestations of disease number in the thousands, yet none fall outside this scope. Thus, those who diagnose diseases must first distinguish the domains of Blood and Qi, Exterior and Interior, Upper and Lower, and Zang and Fu organs to know where the disease resides. Secondly, they must observe the nature of the pathogenic factors—Deficiency, Excess, Cold, and Heat—to treat them. One must ensure that Yin and Yang do not deviate, and that the Zang and Fu organs do not overcome each other excessively. Tonification and Purging should be applied appropriately according to the condition and location, so that the patient may recover fully. That is all."

The *Ling Shu* (Spiritual Pivot) states: "The onset of all diseases arises from Wind and Rain, Cold and Heat, Clearness and Dampness, and Joy and Anger. When Wind and Rain attack deficiency, the disease originates in the Upper part. When Clearness and Dampness attack deficiency, the disease originates in the Lower part. When Joy and Anger are unregulated, the Zang Organs are injured, and the disease originates in the Yin aspect. Generally speaking, Wind, Rain, Cold, and Heat cannot harm people alone without internal deficiency. Therefore, when Empty Pathogens (Xu Xie) invade the human body, they begin at the Skin. If the skin is lax, the Cou Li (pores/cutaneous spaces) open; once open, pathogens enter via the hair follicles. Upon entering, they reach depth; upon reaching depth, the fine hairs stand erect. When the fine hairs stand erect, one feels chilly and shivering, hence skin pain. If the pathogen remains and does not depart, it transmits to the Luo Vessels (Collaterals). At this stage, there is pain in the muscles, which comes and goes, while the larger meridians subsequently become involved. If it remains and does not depart, it transmits to the Jing Meridians (Main Channels). At this stage, there is aversion to cold with shivering and a tendency toward fright. If it remains and does not depart, it transmits to the Shu Points (Transport points). At this stage, the Qi and Blood of the Six Meridians fail to flow to the limbs, resulting in joint pain and stiffness in the waist and spine. If it remains and does not depart, it transmits to the Fu Chong Mai (Deep-running portion of the Chong Mai/Conception Vessel branch). At this stage, there is heaviness of the body and generalized pain. If it remains and does not depart, it transmits to the Stomach and Intestines. At this stage, there is borborygmus and abdominal distension; if Cold predominates, there is borborygmus and loose stools with undigested food; if Heat predominates, there is watery diarrhea resembling gruel. If it remains and does not depart, it transmits to the area outside the Stomach and Intestines, between the Mu Yuan (pleural/diaphragmatic spaces). Lingered within the vessels, staying put and not departing, it gradually forms an Accumulation (Ji). It may attach to Sun Vessels (Branchial vessels), or to Luo Vessels, or to Jing Meridians, or to Shu Vessels, or to the Fu Chong Mai, or to the Lv Jin (muscles along the spine), or to the Mu Yuan of the Stomach and Intestines, connecting upward to the Huan Jin (relaxed muscles). Those accumulations forming in the Sun Luo vessels move up and down because these vessels are superficial and lax, unable to confine the accumulation. Thus, the accumulation migrates between the Stomach and Intestines, with fluids infiltrating and gurgling audibly. With Cold, there is fullness, thunderous sounds, and traction pain, causing sharp pain. Those attaching to the Yangming Meridian reside flanking the umbilicus; they enlarge after eating and shrink when hungry. Those attaching to the Shu Vessels cause obstruction, preventing the descent of Body Fluids, leading to dryness and congestion of the orifices. Those attaching to the Fu Chong Mai feel pulsatile upon palpation; upon releasing pressure, heat flows down into both thighs, feeling like hot water poured on them. Those attaching to the Lv Jin behind the intestines appear when hungry, disappear when full, and are impalpable. Those attaching to the Mu Yuan of the Stomach and Intestines cause pain radiating outward to the Huan Jin; they are comfortable after eating but painful when hungry. Those attaching to the Huan Jin resemble accumulations in the Yangming Meridian; they hurt after eating but are comfortable when hungry. The proliferation and transformation of pathogenic Qi are too numerous to describe exhaustively.

Accumulations begin to form due to Cold, and are completed by the reversal of Qi (Jue Qi). Generally, Jue Qi originates in the feet, causing cold in the calves. Cold in the calves causes the blood vessels to coagulate and stagnate. This stagnation allows Cold Qi to ascend into the Stomach and Intestines. Once in the Stomach and Intestines, it causes distension. Distension forces the juices and foam outside the intestines to gather and prevents them from dispersing, eventually forming an accumulation. Sudden overeating causes intestinal fullness. Irregular lifestyle and excessive exertion injure the Luo Vessels. Injury to Yang Luo vessels causes external bleeding (e.g., epistaxis); injury to Yin Luo vessels causes internal bleeding (e.g., hematochezia). Injury to the Luo vessels of the Stomach and Intestines causes blood to spill outside the intestines. If there is Cold and juice-foam outside the intestines, it combines with the spilled blood, coagulates, and fails to disperse, thus forming an accumulation. This is disease originating from the Yang aspect. Disease originating from the Yin aspect involves injury to the Zang Organs: worry and thought injure the Heart; severe Cold injures the Lungs; anger injures the Liver; intercourse while drunk with sweat exposed to wind injures the Spleen; excessive exertion or intercourse followed by sweating and bathing injures the Kidneys. These are the diseases arising from the three internal and external sectors (text slightly reordered from *Bai Bing Shi Sheng*).

The *Nan Jing* (Classic of Difficult Issues) states: "Disease coming from the later stage is Empty Pathogen (Xu Xie) (meaning the element that generates me, i.e., Mother affecting Child). Disease coming from the earlier stage is Excess Pathogen (Shi Xie) (meaning the element I generate, i.e., Child affecting Mother). Disease coming from what I cannot overcome is Thief Pathogen (Zei Xie) (meaning the element that controls me). Disease coming from what I can overcome is Minor Pathogen (Wei Xie) (meaning the element I control). Self-disease is Correct Pathogen (Zheng Xie) (disease of the own meridian without interference from other pathogens). For example, Heart disease: Contracting Wind results in Empty Pathogen (Wind disease implies Liver Wood is diseased first; Wood generates Fire, so it comes from later. Fire contains Wood; Wood controls Earth, without Earth Water arrives, hence Empty Pathogen). Diet and fatigue result in Excess Pathogen (Diet/fatigue implies Spleen Earth is diseased first; Earth is generated by Fire, so it comes from later. Fire contains Earth; Water cannot arrive, so the child can control the 'ghost', hence Excess Pathogen). Contracting Dampness results in Thief Pathogen (Dampness implies Kidney Water is diseased first; Water controls Fire, coming from what I cannot overcome; since it cannot be overcome, it is Thief Pathogen). Contracting Cold results in Minor Pathogen (Cold implies Lung Metal is diseased first; Fire controls Metal, coming from what I can overcome; since it is overcome, it causes no harm, hence Minor Pathogen). Contracting Summerheat results in Correct Pathogen (Summerheat implies Heart Fire self-disease). The rest follow this pattern (text slightly reordered from *Fifty Nan*, with an added sentence at the end).

The *Su Wen* (Basic Questions) states: "All wind-related tremors and vertigo belong to the Liver. All cold-related contraction and pulling belong to the Kidney (contraction means gathering; pulling means tightening). All Qi-related fullness and depression belong to the Lungs (Fullness means bloating; Depression means rushing and oppression). All dampness-related swelling and fullness belong to the Spleen. All heat-related confusion and spasms belong to Fire (Confusion means unclear vision; Spasms mean muscle twitching). All pain, itching, and sores belong to the Heart. Retention and incontinence belong to the Lower (Reversal means Qi counterflow; Retention means inhibition; Incontinence means failure of inhibition; Lower refers to the Qi of the Lower Jiao, Liver and Kidneys). All wasting-thirst, panting, and vomiting belong to the Upper (Upper refers to the Qi of the Upper Jiao, Heart and Lungs; Lung Heat scorches the leaves, leading to wasting-thirst). All suppression, drumming, and shivering, as if losing spiritual control, belong to Fire. All spasms and neck stiffness belong to Dampness (Spasm means rigidity; caused by Heat injuring the Taiyang). All rebellious Qi rushing upward belongs to Fire. All distension and abdominal enlargement belong to Heat. All restlessness, mania, and unruliness belong to Fire. All sudden rigidity and straightening belong to Wind (Yang is depressed internally, Yin moves externally). All diseases with sounds, where percussion yields a drum-like sound, belong to Heat (First 'drum' means to strike; second 'drum' means the sound of a drum). All diseases with edema, soreness, acidity, fright, and alarm belong to Fire. All twisting, arching back, turbid fluids belong to Heat (Arching back means tendon rotation; turbid fluids refer to urine). All diseases involving clear and cold fluids belong to Cold (Fluids discharged from above or below, including vomit and urine). All vomiting of sour fluid, sudden diarrhea, and tenesmus belong to Heat. Therefore, the *Da Yao* states: 'Carefully observe the Pathogenesis (Bing Ji), and assign each to its category. Seek those that are present, seek those that are absent; hold accountable those that are Excess, hold accountable those that are Deficient. First determine the dominance of the Five Elements, then unblock their Blood and Qi, allowing them to flow smoothly and achieve harmony. This is called it.' (From *Zhi Zhen Yao Da Lun*. This discusses the pathogenesis of Movement and Qi. Lou Quanshan said: The Nineteen Pathogeneses are the essence of disease observation. The four sentences 'Seek those present...' are the essence of that essence. Liu Hejian's *Yuan Bing Shi* relies only on the Nineteen Pathogeneses and omits these four sentences, like having a boat without a rower, or soldiers without a general, inevitably leading to misdiagnosis and death. Now I presumptuously cite classics to correct this. For Wind belonging to Liver, treating Yang Wind and acute convulsions with cooling agents is correct. However, if Dryness Metal dominates, attacking the Liver, the disease transforms into Wind, such as in Yangming ruling heaven with descending Dryness causing tremors; this is Yin Wind and slow convulsions. Is it appropriate to use cooling agents instead of warming ones? For Fire belonging to Heart, treating Yang agitation and delirium with purgatives is correct. However, if Cold Water dominates, attacking the Heart, the disease transforms into Fire/Heat, such as in years of excessive Water causing agitation, palpitations, vexation, and delirium; this is Yin agitation and monotonous speech. Is it appropriate to use purgatives instead of tonics? For Dampness belonging to Spleen, treating moist diarrhea with Wu Ling San to drain dampness is correct. However, if Wind Wood dominates, attacking the Spleen, the disease transforms into Dampness, such as in years of excessive Wood causing loose stools; one should use Qian Yi's Xuan Feng San to dispel Wind, not just drain Dampness. For Qi belonging to Lung, treating fullness/depression and cold asthma with warming agents is correct. However, if Fire/Heat dominates, attacking the Lung, the disease transforms into fullness/depression, such as in years of excessive Fire causing cough and asthma; one should use Li Dongyuan's method of cooling agents for heat-induced asthma, not warming agents. For Cold belonging to Kidney, treating limited flexion/extension with Wu Tou Tang is correct. However, if Wet Earth dominates, attacking the Kidney, the disease transforms into Cold, such as in dampness diseases causing tendon/muscle dysfunction; one should use Li Dongyuan's Fu Jian San or Jian Bu Wan, not just cold-dispelling agents. Generally, when excess leads to transformation, the resulting disease is Excess (True Qi). When attacked leads to transformation, the resulting disease is Deficiency (False Qi). Therefore, if transformation exists, one must investigate, fearing false Qi. If transformation does not exist, one must still investigate, fearing hidden pathogens, e.g., Cold transforming into Fire. If the transformed disease appears Excess, one must scrutinize, fearing the Excess is not genuine. If it appears Deficient, one must scrutinize, fearing the Deficiency is not true. These four sentences are the method for all Pathogeneses, ensuring accurate tonification and purging. Now Hejian only considers presence as Excess and absence as Deficiency, failing to investigate false and deficient aspects, which is incomplete. This is a lapse of wisdom)."

It also states: "Qi Excess corresponds to Form Excess, Qi Deficiency corresponds to Form Deficiency; this is normal. Reversal indicates disease (Qi refers to Pulse Qi; Form refers to Body Shape. Reversal means deviation from normal). Qi Excess with Body Cold, or Qi Deficiency with Body Heat, is called reversal. Grain abundance corresponds to Qi abundance, Grain scarcity corresponds to Qi scarcity; this is normal. Reversal indicates disease (The way of Ying Qi incorporates Grain to become substantial). Eating much but having little Qi (Stomach disease fails to disseminate), or eating nothing but having much Qi (Kidney Qi scatters externally, Lung Qi joins it); this is called reversal. Pulse Excess corresponds to Blood Excess, Pulse Deficiency corresponds to Blood Deficiency; this is normal. Reversal indicates disease (Pulse is the mansion of Blood). Pulse Excess with Blood Scarcity, or Pulse Scarcity with Blood Excess, is called reversal (Jing Meridians circulate Qi, Luo Vessels receive Blood; Jing Qi enters Luo, Luo receives Jing Qi; mismatched signs are all abnormal) (Text modified from *Ci Zhi Lun*)."

It also states: "The five origins of disease: Yin diseases originate in Bone, Yang diseases originate in Blood, Yin diseases originate in Flesh. (Bone and flesh are Yin and static, so Yin Qi follows them. Blood vessels are Yang and active, so Yang Qi exploits them). Yang diseases manifest in Winter, Yin diseases manifest in Summer. (Winter has abundant Yin Qi, so Yang diseases manifest in Winter. Summer has abundant Yang Qi, so Yin diseases manifest in Summer, following the principle of 'following the lesser'). This is called the Five Origins. The five disturbances of Evil: Evil entering Yang causes Mania (Kuang); entering Yin causes Bi Syndrome (Obstruction). (Evil residing in Yang meridians causes extreme heat in the four limbs leading to Mania. Entering Yin meridians causes stagnation of the Six Meridians leading to Bi). Striking Yang causes Dian Disease (Cranial disease). (Dian refers to the vertex. Evil striking internally to Yang causes vessel flow issues, leading to cranial disease. Some interpret Dian as Dian epilepsy; Yang attaching to Yin causes epilepsy. Others say 'Striking' should be 'Transmitting'; if Evil enters Yin and transmits to Yang, it becomes epilepsy. Different theories exist, preserved here. *Nan Jing* asks: How to distinguish Kuang and Dian? Kuang begins with little sleep and no hunger, arrogance, self-perceived wisdom, self-perceived nobility, irrational laughter, singing, joy, and continuous erratic behavior. Dian begins with unhappiness, staring straight, and collapsing stiffly; pulse is Excess in all three positions, Yin and Yang alike). Striking Yin causes Aphonia (Yin). (Evil striking internally to Yin stops vessel flow, causing inability to speak. Some say 'Striking' should be 'Transmitting'). Yang entering Yin causes Quietness; Yin exiting to Yang causes Anger (Entering means going. Some say 'Anger' should be 'Fear'). This is called the Five Disturbances. (From *Xuan Ming Wu Qi Pian*)."

It also states: "For the elderly, seek pathology in the Fu Organs (Elderly are prone to dietary excess; indulgence injures Fu Organs). For the young, seek pathology in the Meridians (Youth are prone to physical labor; labor exposes meridians to Wind-Evil). For the prime-aged, seek pathology in the Zang Organs (Prime-aged are prone to internal excess; internal excess consumes Essence and Qi). (From *Shi Cong Rong Lun*)."