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The *Suwen* (Basic Questions) chapter "Liu Wei Zhi Da Lun" states: If the functions of exit and entry are abolished, the spiritual mechanism of life will perish; if the movements of ascending and descending cease, the qi that establishes life through interaction with nature will become isolated and precarious. Therefore, without exit and entry, there can be no process of growth, flourishing, aging, and death; without ascending and descending, there can be no transformation of generation, growth, transformation, harvest, and storage. Ascending, descending, exit, and entry are present in all vessels (referring to human organs and tissues); once a vessel disintegrates, these functions cease. Wang Bing explained this as follows: For any orifice that is horizontal, there is qi flowing in and out; for any orifice that is vertical, there is yin and yang qi rising and falling within. Just like windows on a wall, observing from both sides, one sees incoming air impacting the person; this is the qi of exit and entry. (Western medicine posits: When a person is indoors, if windows are open on both sides, the internal qi of the person will be impacted by the incoming and outgoing air currents, becoming unable to withstand it, resulting in empty pain in the head.) Furthermore, when yang qi ascends, well water becomes cold; when yin qi ascends, water becomes warm. Throwing an object into a well, or leaves falling from the sky, drifting slowly without haste, are all due to obstruction by ascending qi. Filling a hollow tube with water, pinching the top end and suspending it, the water indeed does not leak, because there is no ascending qi to cause descent. An empty bottle with a small mouth cannot be filled with water poured in, because the internal qi cannot exit, preventing external qi from entering. This can be said to have been elaborated to perfection. Liu Wansu stated: The sweat pores on the skin are the orifices for excreting sweat. They are also called "Qi Men" (Gate of Qi), meaning the portal for expelling qi. Also called "Cou Li" (Interstices), meaning the tunnel textures for the passage of qi and fluids. Also called "Gui Men" (Ghost Gate), meaning the gate of the netherworld. Also called "Xuan Fu" (Mysterious Mansion), meaning the mansion of profound subtleties. However, "Xuan Fu" exists everywhere; in humans, the zang-fu organs, skin, hair, muscles, fascia, bone marrow, nails, and teeth, and even in all things, all possess them. They are the portals for the pathways of ascending, descending, exit, and entry. The classics state: Ascending, descending, exit, and entry are present in all vessels. Thus, we know that the eyes, ears, nose, tongue, body, mind, spirit, and consciousness of humans function only because the ascending, descending, exit, and entry are smooth and unobstructed. If there is any blockage, they cannot function. Therefore, blindness, deafness, anosmia, ageusia, tendon flaccidity, bone bi-syndrome, nail degeneration, tooth decay, hair loss, skin numbness, and intestinal inability to permeate and excrete are all caused by heat qi stagnation, closure of Xuan Fu, leading to the inability of body fluids, blood vessels, Ying-Wei, and clear and turbid qi to ascend, descend, exit, and enter. Depending on the severity of the stagnation, various diseases arise. Li Dongyuan stated: The sages treating disease must base their actions on the principles of seasonal ascending, descending, floating, and sinking, exercising appropriate flexibility. One must first understand the annual climate qi and not disrupt natural harmony. The classics say: For ascending, descending, floating, and sinking, follow them; for cold, heat, warmth, and coolness, counteract them. Zhang Zhongjing stated: In cases of excess yang and deficiency yin, purgation leads to recovery, while sweating leads to death; in cases of excess yin and deficiency yang, sweating leads to recovery, while purgation leads to death. Generally, the legislation of the sages, such as formulas for raising yang or dispersing exterior, aids the yang qi of spring and summer to rise, thereby draining the cold and cooling qi of autumn and winter storage and destruction. This is the ultimate principle of ascending, descending, floating, and sinking. The qi of heaven and earth generates the four seasons through ascending, descending, floating, and sinking. Similarly, in treating disease, one must not go against it. Thus, those who follow heaven prosper, and those who defy heaven perish. The human body also possesses the qi of the four seasons and heaven and earth; one cannot assume it exists only externally, as humans mirror heaven and earth. *Wu Yi Hui Jiang* quotes Jiang Xingchi saying: The "transmission of lines" mentioned in *Shanghan Lun* is the essence of exit and entry. Generally, the righteous qi exits and enters, moving from Jueyin to Shaoyin and Taiyin, then to Shaoyang, Yangming, and Taiyang, cycling repeatedly. The six pathogenic factors enter from Taiyang, advancing one step and retreating one step, reaching the extreme at Jueyin. This represents pathogenic qi advancing while righteous qi retreats, no longer communicating with external qi. Therefore, Kai (Opening), He (Closing), and Shu (Pivot) are the most crucial principles. (See *Suwen: Yin Yang Li He Lun* and *Lingshu: Gen Jie Pian*.) Separately discussed, they are exit/entry and ascending/descending; collectively, they are nothing but one qi. Observing Li Dongyuan’s *Pi Wei Lun* diagram of floating/sinking tonification and drainage, using Mao and You (east/west directions) as pathways and emphasizing the qi of the blue sky, his prescribed formulas using Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Ling (Poria), Ze (Alismatis Rhizoma), etc., actually originate from the ideas of Gegen (Puerariae Lobatae Radix), Chaihu, and Wuling San in Changsha's discussions, extended to mean "ascending to the highest heavens, descending to the deepest earth." Although internal injury and external contraction belong to different categories, regarding the ascending, descending, exit, and entry of qi, there is no difference! Wu Jutong stated in *Wenbing Tiaobian*: The nature of wind varies, and its effects differ. Spring wind rises from below; summer wind sweeps across the sky; autumn wind descends from above; winter wind scrapes along the ground. Its directions include the four cardinal points and four intercardinal points, aligning with the eight solar terms of the four seasons. Various theories have exhaustively elucidated these profound meanings.

Ascending, descending, exit, and entry are the substance and function of heaven and earth, the bellows of all things, the general outline of hundred diseases, and the pivot of life and death. Here, I further enumerate the qi of heaven and earth, the qi of the human body, as well as pulse manifestations, disease mechanisms, and treatment indications, analyzing them item by item.

The qi of the four seasons involves spring generation, summer growth, autumn harvest, and winter storage. Their movement is like a rotating wheel, perfectly round. For instance, spring qi rises from below; if it moves directly upward, it is because winter qi has reached the extreme of lateral condensation, becoming hard and inseparable. If it were to scatter directly laterally, it would abruptly oppose winter qi. Qi cannot oppose abruptly, so it first moves directly to activate its mechanism, followed by the lateral scattering of summer. Summer qi scatters to the extreme; if it were to condense directly laterally, it would abruptly oppose summer qi. The mechanism of rotation cannot change suddenly, so it first undergoes the direct descent of autumn, followed by the lateral condensation of winter. The reason is that each reaches the extreme of lateral or direct movement. When direct movement reaches the extreme, it cannot proceed directly to higher ascent or lower descent; it must first have lateral opening and closing qi to dredge it. When lateral movement reaches the extreme, it cannot proceed directly to lateral scattering or condensation; it must first have direct floating and sinking qi to penetrate it. If direct movement has not reached the extreme, what ascends can still descend directly, and what descends can still ascend directly; if lateral movement has not reached the extreme, what scatters can still condense laterally, and what condenses can still scatter laterally. Just as spring days may have autumn winds, yet after spring, autumn certainly does not follow; just as summer days may have winter winds, yet after summer, winter certainly does not follow. This is the subtle mechanism of the rotation of the four seasons of heaven and earth.

In the human body, muscles, tendons, and bones have their own lateral and direct Cou Li (interstices), which serve as the pathways for the exit, entry, ascending, and descending of qi. Ascending and descending refer to the pathway where interior qi rotates with interior qi; exit and entry refer to the pathway where interior qi interfaces with exterior qi. Interior qi is the body's qi; exterior qi is the atmospheric air. With one exhalation through the nose, all 84,000 pores throughout the body expand; with one inhalation, all 84,000 pores contract. Exit and entry are thus, and ascending and descending are the same, never pausing for an instant. The *Neijing* states: Yang outside is the servant of Yin; Yin inside is the guardian of Yang. It also says: Yang qi guards the exterior and secures it; Yin qi stores essence and arises urgently to respond. This is the mechanism of exit and entry. It also says: The essence and qi of heaven and earth generally exit three times for every one time they enter. Therefore, if no grain is consumed, qi declines after half a day and diminishes after one day. This is the quantity of exit and entry. *Tui Qiu Shi Yi* states: In the Liver, transformation is warm, and its qi ascends; in the Heart, transformation is hot, and its qi floats; in the Spleen, transformation is harmonious, and its qi is complete; in the Lung, transformation is cool, and its qi descends; in the Kidney, transformation is cold, and its qi stores. The *Neijing* states: If turbid qi is above, distension occurs; if clear qi is below, undigested stool diarrhea occurs. It also says: If sweat is not produced during summer heat, wind-malaria develops in autumn. If essence is not stored in winter, warm diseases will surely occur in spring. These are the normal and abnormal variations of ascending, descending, exit, and entry. Internally within the zang-fu organs, externally within muscles, they move longitudinally and transversely, proceeding together without conflict, like flowing water, where the passing flows away and waves rise and fall naturally.

Corresponding to the four seasons: In spring, ascending is strong, and downward anchoring is weak; in summer, outward expansion is vigorous, and inward guarding is weak; in autumn, downward suppression is dominant, and upward鼓 (drumming/rising) is weak; in winter, inward condensation is dominant, and outward emission is weak. This is the norm. Violating winter qi reduces the support for generation; violating spring qi reduces the support for growth; violating summer qi reduces the support for harvest; violating autumn qi reduces the support for storage. Excess and deficiency are both violations; this is the variation. Therefore, the sages always follow the four seasons to regulate their spirit and qi.

Regarding pulse manifestations, there are Three Regions and Nine Palpations. The Three Regions are Cun, Guan, and Chi, used to palpate the upper and lower segments of the body form, spoken directly. The Nine Palpations are Floating, Middle, and Deep, used to palpate the superficial and deep layers of the body form, spoken transversely. Disease in the upper presents in Cun; disease in the lower presents in Chi. Disease in the interior presents in Deep pulses; disease in the exterior presents in Floating pulses. Interior cold and exterior heat present as Deep-Tight and Floating-Slow; interior heat and exterior cold present as Deep-Slow and Floating-Tight. Upper deficiency and lower excess present as Small Cun and Large Chi; upper excess and lower deficiency present as Strong Cun and Weak Chi. This is the general overview of pulse manifestations.

Regarding disease mechanisms, internal injuries mostly involve disorders of ascending and descending, as ascending and descending govern the interior; external contractions mostly involve disorders of exit and entry, as exit and entry govern the exterior. Shanghan (Cold Damage) is divided into Six Channels based on exterior-interior relationships; Wenbing (Warm Diseases) is divided into Three Burners based on high-low positions, because warm diseases originate from the interior. When ascending-descending disorders reach the extreme, they affect exit-entry; when exit-entry disorders reach the extreme, they affect ascending-descending. Therefore, dietary injuries can induce chills and fever; wind-cold contractions can manifest as wheezing and coughing. This is the general overview of disease mechanisms.

As for treatment methods, one must understand the rotational mechanism and perfect circular function of the qi of heaven and earth in the four seasons before being able to respond infinitely. For qi that is hyperactive upwards, suppress and descend it; for qi that sinks downwards, raise and lift it; for qi that scatters outwards, condense and secure it; for qi that knots internally, dredge and dissipate it. Treating according to symptoms is obviously straightforward. However, this applies only to mild and superficial diseases! For severe cases, direct action is not possible; one must resort to "Zhi Qu" (indirect/curved approaches). What is meant by "Qu"? If qi is hyperactive upwards, it cannot be directly suppressed; one must examine if there is excess or deficiency. If excess, first dredge and dissipate it, then clear and descend it; if deficiency, first condense and secure it, then heavily sedate it. If qi sinks downwards, it cannot be directly lifted; examine excess or deficiency. If excess, first dredge and dissipate it, then open and lift it; if deficiency, first condense and secure it, then scoop and support it. If qi is stagnant internally, it cannot be directly dissipated; examine excess or deficiency. If excess, attack the excess, and sweating will naturally occur, so Chengqi Tang can precede Guizhi Tang; if deficiency, raise the yang, and the exterior syndrome will recede, so Yiqi (Tonifying Qi) relies on Shengma and Chaihu. If qi scatters externally, it cannot be directly condensed; examine excess or deficiency. If excess, spontaneous sweating is due to gastrointestinal excess; purge the excess, and yang qi will return inward; if deficiency, exterior deficiency is due to Spleen-Lung insufficiency; diffuse yang, and defensive qi will secure the exterior. These are the essential subtleties of treatment. If one does not understand this, and directly raises, descends, condenses, or dissipates, failure is almost inevitable. I recall the words of former sages: For chest and abdominal fullness, ignorant physicians use Binglang (Arecae Semen), Zhishi (Aurantii Fructus), and Zhusu (Magnoliae Officinalis Cortex) to attack. When qi sinks and diarrhea persists, they use Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Shengma, and Chaihu to lift. Consequently, qi escapes up and down, leading to death. This is the disaster of direct lifting and direct descending. Moreover, ascending-descending and exit-entry mutually support each other; their use must not be excessive. Lifting too much when lifting is indicated not only depletes lower qi but also fails to secure interior qi, causing asthmatic patients to risk sweating collapse. Descending too much when descending is indicated not only causes upper qi to sink but also fails to充盈 (fill) exterior qi, causing diarrheal patients to often experience aversion to cold. Condensing too much when condensing is indicated not only stagnates interior qi but prevents lower qi from ascending to the upper; dissipating too much when dissipating is indicated not only loosens exterior qi but prevents upper qi from descending to nourish the lower. Therefore, physicians must understand the substance and especially the function of heavenly and human qi; they must understand the norm and especially the variation. The nature of substances is the same. Cold, heat, dryness, dampness are their substances; ascending, descending, condensing, dissipating are their functions.

Shengma, Chaihu, Renshen, Baizhu are qi that directly ascend; Xiaoshuang (Natrii Sulfas), Dahuang (Rhei Radix et Rhizoma), Zhishi, Zhusu are qi that directly descend. Wuweizi (Schisandrae Fructus), Shanzhuyu (Corni Fructus), Jinyingzi (Chrysanthemi Fructus), Fupenzi (Rubiae Fructus) are qi that internally condense; Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix) are qi that externally dissipate. This is their substance. Use depends on the practitioner; this is the norm. Skillful use allows infinite adaptation; unskillful use breeds unpredictable disasters. Wang Hangao discussed constipation in warm diseases with a surging and solid Right Cun pulse and chest stagnation, recommending Zhishi, Zhusu, and Lapsacus (Radish Seed) for lateral resolution, and Suszi (Perillae Fructus), Jiegeng (Platycodonis Radix), Banxia (Pinelliae Rhizoma), and Binglang for vertical resolution. His concepts of lateral and vertical resolution were correct, but the specific herbs he pointed to were incorrect. Even Li Dongyuan’s formulas, habitually using Shengma, Chaihu, Zhishi, and Zhusu, inevitably suffer from the flaw of direct collision. However, Jiegu’s Zhizhu Wan, made into pills with lotus leaf and roasted rice, possesses the subtlety of "seeking directness through lateral movement." Alas! Medicine is not easy to discuss!

I have also argued that the opening and closing of qi must have a pivot. Without ascending and descending, there is no basis for exit and entry; without exit and entry, there is no basis for ascending and descending. Ascending-descending and exit-entry are mutual pivots. Therefore, in humans suffering from wind-cold wheezing and coughing, the hair follicles are bound by wind-cold, making the meridians of exit and entry unfavorable, and forcing ascending and descending. In cases of尸厥 (corpse-like coma) or sudden death, the great qi of ascending and descending does not rotate, and exit and entry become minute. *Shengqi Tongtian Lun* states: Great anger causes blood to pool upwards, leading to Bo Jue (abrupt fainting). *Tiao Jing Lun* states: If blood and qi rush upwards together, it results in Da Jue (great fainting). Bian Que stated: Yang pulses sink, Yin pulses contend upwards; meeting qi closes and becomes obstructed. Yin rises while Yang moves internally; internally below it drums but does not rise; externally above it cuts off and does not act as a messenger. There are severed Yang collaterals above and broken Yin ties below. The colors of broken Yin and severed Yang disappear, pulses become chaotic, so the body appears static as if dead. The exit and entry qi of humans is inherently weaker than ascending and descending; once ascending and descending cease, exit and entry become even more minute. Thus, Bian Que said: One should hear tinnitus and see nostrils flare, and tracing down the thighs to the genitals, warmth should remain. This is what is meant by exit and entry becoming even more minute.

I have also written *Lun Zuo You Yin Yang* (Discussion on Left-Right Yin-Yang) and *Laobi Zhengzhi Lun* (Discussion on Treatment of Asthenia-Bi Syndromes), which are shallow in text but complement this discussion.

In *Lun Zuo You Yin Yang*, Zhu Danxi stated that the Spleen possesses the quiet nature of Kun (Earth) but the active operation of Qian (Heaven), thus enabling the Yang of Heart and Lung to descend and the Yin of Liver and Kidney to ascend, achieving the harmony of Heaven and Earth (Tai). Recently, Huang Yuanyu wrote books specifically advocating left-ascending and right-descending, arguing that Heart and Lung are Yang, following Stomach qi to descend on the right, transforming into Yin; Liver and Kidney are Yin, following Spleen qi to ascend on the left, transforming into Yang. Thus, the central qi of Wu and Ji (Earth) is the pivot of the four qi, the balance of hundred diseases, the gateway of life and death. Health preservation and disease treatment must be cautious here. His eight volumes encompass the five canonical texts (*Suwen*, *Lingshu*, *Shanghan*, *Jingui*, *Bencao*) entirely within the four characters "Left Ascending, Right Descending," claiming to have uniquely opened a new path and grasped the profound secrets of left-right yin-yang pathways in the *Neijing*. I privately ponder: The *Neijing* discusses yin-yang not only in terms of ascending-descending but necessarily includes exit-entry. Ascending-descending is vertical, while exit-entry is horizontal. Qi cannot have ascending-descending without exit-entry; if exit-entry ceases, ascending-descending must also stop. Discussing only ascending-descending and ignoring exit-entry is obtaining one part while losing another. Moreover, assigning ascending-descending strictly to left-right is an even harder-to-understand doctrine. Both left and right possess yin-yang and ascending-descending. Having studied Western medical discussions on human vascular functions and blood-qii circulation, combined with the main gist of the *Neijing*: Ying Qi circulates within the vessels, following the Six Yin and Six Yang meridians in a continuous loop, using meridian ascending-descending as its own. Wei Qi is not confined to meridians; it ascends when circulating in the Six Yang limbs and descends when circulating in the Six Yin limbs, representing Exterior Ascending and Interior Descending. The *Neijing* uses left and right as pathways for yin-yang but never states that Left is Ascending and Right is Descending. The general idea is that Cun Kou palpates Yin (Interior/Middle), and Ren Ying palpates Yang (Exterior). Pulse diagnosis also assigns Left Chi to Bladder and anterior orifice, and Right Chi to Large Intestine and posterior orifice. How does this align with the *Neijing*'s "Back is Yang, Abdomen is Yin"? Therefore, to accurately seek the pathways of ascending-descending, one should distinguish between Exterior and Interior, not Left and Right.

Someone asks: Why do people suffer from hemiplegia? I reply: Hemiplegia is a horizontal disease, not a vertical one. Why? The Cou Li and hair follicles on the left side face left-outward; those on the right side face right-outward. From the nasal bridge in front to the spine behind, they are distinctly divided in the middle. Thus, when lying on one side, sweat appears with a clear boundary because the upper half's pores steam heat upward, while the lower half's pores cannot steam heat downward. The *Neijing* states: Sweating on one side leads to hemiplegia. Therefore, hemiplegia is due to horizontal qi failing to communicate left and right; lower flaccidity is due to vertical qi failing to connect up and down. The left has its own ascending-descending; the right has its own. The upper has its own; the lower has its own. Up-down and left-right combine into one great ascending-descending system. Hence, in the Prior Heaven Bagua, Kan and Li divide East and West, representing the meaning of Left-Yang and Right-Yin. In the Posterior Heaven Bagua, Kan and Li divide North and South, representing the meaning of Exterior-Ascending and Interior-Descending. Just as in the human body, heat steams upward, indicating Exterior Ascending; food and water enter the Stomach, and dregs pass downward, requiring qi to move them, indicating Interior Descending. The classics divide yin-yang by left and right because the sun and moon rise in the East and set in the West. Humans are illuminated by them, and qi rotates accordingly. Exterior ascending moves from the left, followed by the right; Interior descending moves from the right, followed by the left. Thus, the power of Exterior Ascending is stronger on the left, and the power of Interior Descending is stronger on the right. The classics state: Human left limbs and feet are not as strong as the right; right ears and eyes are not as acute as the left. This is the same meaning.

In *Lun Laobi Zhengzhi*, Bi (Obstruction) means closure. There are two types of Bi: Asthenia-Bi and Bi caused by accumulations, carbuncles, numbness, and pain. The latter, whether in meridians or zang-fu, has been detailed by predecessors. *Neijing* and *Zhongzang Jing* chapters should be studied thoroughly. As for Asthenia-Bi, commonly known as Dry Blood Asthenia. Externally in meridians, internally in zang-fu, the qi does not exceed the Five Phases. Divided vertically from top to bottom, there are Vertical Five Phases (Five Layers): 1. Lung, 2. Heart, 3. Spleen, 4. Liver, 5. Kidney. Divided horizontally from outside to inside, there are Horizontal Five Phases (Five Layers): 1. Lung, 2. Heart, 3. Spleen, 4. Liver, 5. Kidney. *Neijing* states "Ascending-descending cease, qi stands isolated and precarious," referring to the vertical; "Exit-entry abolish, spiritual mechanism perishes," refers to the horizontal. Pulse diagnosis: Left Cun Heart, Guan Liver, Chi Kidney.