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[Yuan] Smallpox originates internally from the Zang-Fu organs and corresponds externally to the Yunqi (Yunqi refers to the laws of climate change in nature, specifically the Five Movements and Six Qi). The movement of heaven responds with the human body without the slightest error. Therefore, for those treating smallpox, understanding Yunqi is urgent. Examining past records, major outbreaks generally occur every three years. Although sporadic cases may appear in any given year, the cycle for large-scale epidemics is standardized at three years. The so-called "three years" mostly refer to the years of Zi, Wu, Mao, and You. In the years of Zi and Wu, Shaoyin Junhuo (the qi transformation characteristics of the Heart and Small Intestine meridians) governs the Sky (Si Tian, controlling the climate of the first half of the year), while Yangming Zaojin (the qi transformation characteristics of the Lung and Large Intestine meridians) governs the Spring (Zai Quan, controlling the climate of the second half of the year). In the years of Mao and You, Yangming Zaojin governs the Sky, and Shaoyin Junhuo governs the Spring. Various sores and ulcers are not ignited by Fire, nor collected by Metal. The reason why smallpox primarily involves the Shaoyin and Yangming meridians is due to this mechanism. However, profound transformations shift subtly; the Principal Qi (Zhu Qi) and Guest Qi (Ke Qi) interact mutually. The Five Movements (Wu Yun: Wood, Fire, Earth, Metal, Water) differ in being Normal (Ping Qi), Excessive (Tai Guo), or Deficient (Bu Ji). The Six Qi (Liu Qi: Wind, Cold, Summer Heat, Dampness, Dryness, Fire) differ in being Constant Transformation (Chang Hua), Overwhelming Victory (Yin Sheng), Counter Victory (Fan Sheng), or Mutual Restriction (Xiang Sheng). Even slight differences lead to entirely different overall conditions. There are years when smallpox should prevail but does not, and years when it should not prevail yet spreads widely. Thus, one cannot adhere to a single fixed theory.

[Wan] The onset of sores and rashes may occur after an interval of several years, or it may persist continuously for years. Why? The Classic says: "If one does not know the addition of the year, the prosperity and decline of Qi, and the origin of deficiency and excess, one cannot be a skilled physician." Generally, Si Tian (Sky Governance) executes the orders of Heaven, occupying the Upper position. Sui Yun (Annual Movement) governs the Qi of transformation and generation for all things between Heaven and Earth, occupying the Middle position. Zai Quan (Spring Governance) governs the transformation and execution on Earth, occupying the Middle-Lower position. Within a year, these three Qi—Upper, Middle, and Lower—each exercise their transformative commands. If these Qi coincidentally align and harmonize, they penetrate their transformative influence; when this acts upon humans, disease occurs. Hence, sores and rashes must wait for specific years to erupt. Within a sixty-year Jiazi cycle, there are twelve Tian Fu (Heavenly符/Agreement) years: (Wu Zi, Wu Wu, Ji Chou, Ji Wei, Wu Yin, Wu Shen, Yi Mao, Yi You, Bing Chen, Bing Xu, Ding Si, Ding Hai). Among these, four years are Taiyi Tianfu (Great Heavenly Agreement): (Wu Wu, Ji Chou, Ji Wei, Yi You). It is called "Tian Fu" when the Si Tian Qi is identical to the Sui Yun Qi. It is called "Taiyi Tianfu" when the Si Tian Qi, Sui Yun Qi, and the Earthly Branch's elemental attribute are all identical. There are eight Sui Hui (Year Meeting) years: (Bing Zi, Ji Chou, Ding Mao, Jia Chen, Jia Xu, Wu Wu, Ji Wei, Yi You). It is called "Sui Hui" when the Sui Yun Qi is identical to the Earthly Branch's elemental attribute. There are six Tong Tian Fu (Same Heaven Agreement) years: (Jia Chen, Jia Xu, Geng Zi, Geng Wu, Ren Yin, Ren Shen), and six Tong Sui Hui (Same Year Meeting) years: (Gui Mao, Gui You, Gui Si, Gui Hai, Xin Chou, Xin Wei). "Tong" refers to the Sui Yun Qi combining its transformational nature with the Zai Quan Qi. Yang years are called Tong Tian Fu; Yin years are called Tong Sui Hui. Speaking杂乱ly, these five categories total thirty-six years; speaking collectively, there are only twenty-six unique years. The Classic states: "Tian Fu is the Law Enforcer, Sui Wei is the Order Executor, Taiyi Tianfu is the Noble Person." When pathogenic Qi attacks humans: encountering the Law Enforcer causes rapid and critical illness; encountering the Order Executor causes slow and lingering illness; encountering the Noble Person causes sudden and fatal illness. Furthermore, in Zi and Wu years, Shaoyin Junhuo presides; in Yin and Shen years, Shaoyang Xianghuo (the qi transformation characteristics of the Sanjiao and Gallbladder meridians) presides. The Classic says: "What Shaoyin reaches manifests as ulcers and rashes. What Shaoyang reaches manifests as sneezing, vomiting, sores, ulcers, malignant diseases, and sudden death." In these years, if Gang-Rou (Yin-Yang) loses control, ascending and descending are obstructed, old pathogens do not recede, and new pathogens do not migrate, then continuous outbreaks will occur without cessation.

Commentary: Discussions on Yunqi occupy nearly half of the *Nei Jing* (Inner Canon), yet few in the world apply it. This is likely because people stick to the constant without understanding the variable, leading them to deem it unverified. My friend Miao Zhongchun (Miao Xi Yong) was highly intelligent and skilled in medicine, yet he constantly rejected the fallacies of the Five Movements and Six Qi. I refuted him using the arguments of Wang Yan and Shen Gua, but he remained unconvinced, probably because he did not examine it with an open mind and careful inquiry. Suppose Jueyin Fengmu (Wind-Wood) is in charge; its Qi is windy, and the people suffer from damp diarrhea. Does this mean the whole world is windy and everyone suffers from damp diarrhea? Even within a single county, rainfall varies. How can such Yunqi be absolutely uniform? It is impossible to claim it has no errors. Generally, physical principles have constants and variables. What Yunqi dominates is the constant; what abnormal Qi dominates is the variable. The constant resembles the original Qi, stable and predictable. The variable is ubiquitous but has specific correspondences. Thus, manifestations include following (Cong), opposing (Ni), overflowing/stagnating (Yin Yu), victory/reversal (Sheng Fu), excess (Tai Guo), and deficiency (Bu Zu). Their eruptions differ. If Jueyin Fengmu is in charge, causing much wind and lush vegetation, this is called "Following"; clear, dry weather without wind is called "Opposing"; sky filled with dust, flowing water not freezing is called "Overflowing"; strong winds breaking trees, turbid clouds disturbing objects is called "Stagnation"; scorched mountains and marshes, withered grass and trees is called "Victory"; intense summer heat burning like fire, locust disasters is called "Reversal"; earthquakes, landslides, frequent dust storms is called "Excess"; perpetual gloom, heavy clouds darkening the day is called "Deficiency". Diseases and plagues respond to these changes. One must observe the local climate signs; even within a few miles, if the climate differs, the resulting diseases differ completely. How can one rigidly adhere to a fixed pattern? During the Xining era of Emperor Shenzong of Song, the capital suffered prolonged drought despite extensive prayers. For several days, it was overcast, and people believed rain was imminent. Suddenly, one day cleared up with blazing sun. Shen Kuo and Shi Yan entered the court for an audience. The Emperor asked about the rain forecast. Shen Kuo replied that the signs of rain were already visible, and it would rain tomorrow. The crowd argued that despite previous humid overcast days, it hadn't rained; under such dry conditions, how could rain be expected? The next day, indeed, heavy rain fell. At that time, Wet Earth was in charge. The previous overcast days showed the effect of the "Following Qi," but it was suppressed by Jueyin Wind, preventing rain. The subsequent sudden clearing indicated Dry Metal entering the phase, suppressing Jueyin Wind, allowing Taiyin Wet Earth to expand. With favorable Yunqi the following day, he knew rain was certain. Alas! Where can we find someone like Shen Cunzhong (Shen Kuo) today to discuss Yunqi with?