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When the Shen (Spirit) has no abode and thoughts have no stability, Qi becomes chaotic. (Continuation: When Qi rushes and scatters, it cannot be regulated.) Labor leads to panting (another version reads "qie") and sweating. The Qi inside and outside both scatter outward, thus causing Qi depletion. (Continuation: Physical labor makes Qi move rapidly, leading to panting; rapid Qi movement causes Yang to emit outward, leading to sweating. However, panting and sweating cause the internal and external Qi to exceed normal limits, resulting in Qi depletion.) Excessive thinking causes the mind to focus on one thing and the Shen to have a specific destination, causing Zheng Qi (Upright Qi) to remain stagnant and not flow freely, thus leading to Qi stagnation. (Continuation: If Heart Qi does not disperse, Qi also remains stagnant. From *Ju Tong Lun*.)

Generally, before diagnosing an illness, one must ask if the patient was formerly of high status but later became lowly. Although not afflicted by external pathogens, the disease arises from within, named "Tuo Ying" (Depletion of Ying). (Continuation: This is due to spiritual humiliation. Formerly honored with glory, now humiliated in lowliness, harboring longing and envy, with ambitions bound by worry and fear, diseases arise internally, blood vessels become deficient and reduced, hence called "Tuo Ying".) Those who were formerly rich but later poor are named "Shi Jing" (Loss of Jing), where the Five Qi linger and pathogenic factors combine. (Continuation: In wealth, desires are indulged; in poverty, wealth is lost, leading to internal knotting of worry and external sorrow exceeding norms. Thus, the mind follows past attachments, closing off the pathways of Ying and Wei, slowing blood and Qi circulation, accumulating and combining to cause disease.) When physicians examine, finding the disease not in the Zang-Fu organs and no change in body shape, they feel doubtful and do not know the disease name. (Continuation: At the onset, the disease is caused by longing and attachment, so it has not yet affected the Zang-Fu; arising from emotional thoughts, the body shape remains unchanged. Physicians unaware of this feel doubtful and examine.) The body wastes away day by day, Qi is deficient without essence. (Continuation: This describes the secondary stage of deficiency. Blood and Qi press against each other, flesh slightly emaciates, so the body wastes daily. The Classic says: "Qi returns to Essence, Essence nourishes Qi." Now, deficient Qi cannot transform into Essence, and Essence lacks nourishment.) The disease is deep, lacking Qi, with a shivering sensation and frequent fright. (Continuation: This describes deep disease. Pathogenic Qi is deep, Gu Qi (Grain Qi) is exhausted, Yang Qi presses inward, causing aversion to cold and fright; "shasha" describes the appearance of cold.) Deep disease occurs because Wei Qi is consumed externally and Ying Blood is robbed internally. (Continuation: Blood is consumed by worry, Qi decreases with sorrow, thus Wei Qi is consumed externally and Ying Blood robbed internally. Why is the disease deep? Because of this consumption and robbing.) A skilled physician's error lies in not understanding the condition; this is the first fault in treatment. (Error refers to failing to ask about the origin.)

To diagnose, one must ask about diet and living conditions. (Continuation: Diet and living vary by region, hence the inquiry. See *Yi Fa Fang Yi Lun*. My note: Danxi said treating requires asking about diet and起居 first, focusing on the individual, differing here; reference both.) Sudden joy or sudden anger, starting with joy and ending in suffering, all damage Jing Qi. (Jing Qi exhaustion.) The physical form is ruined and depressed. (Continuation: Joy relaxes Qi, sorrow dissipates Qi. But excessive sorrow moves the center, exhausting life, so Jing Qi exhausts, the form is shallowly destroyed, and Shen scatters.) Violent anger damages Yin; violent joy damages Yang. (Continuation: Anger causes Qi to reverse, damaging Yin; joy causes Qi to relax, damaging Yang. My note: These two sentences and the next repeat *Yin Yang Ying Xiang Da Lun* text but differ in notes; included here.) Jue Qi rises upward, filling the vessels, separating Shen from the form. (Continuation: Qi reversal. Reversal causes Qi to rise, filling meridians, so Shen scatters and leaves the body.) I treat them without knowing tonification or sedation, without understanding the condition; Hua Ri (name/typo) expels evil Qi, which then combines; this is the second fault. (Continuation: Not distinguishing different states of joy/anger, applying tonification/sedation uniformly, causing Zang essence to deplete daily, allowing evil Qi to erode and combine with true Qi.) Good pulse readers use such methods, combining extraordinary and ordinary signs, analyzing calmly to become skilled; without understanding principles, diagnosis is worthless; this is the third fault. (Continuation: Extraordinary refers to abnormal climate signs; calm analysis refers to distinguishing Zang deficiency/excess and similar pulses. *Shi Cong Rong Lun* says: Spleen deficiency floats like Lung, Kidney small float like Spleen, Liver urgent sink/scattered like Kidney; these confuse doctors, but calm analysis resolves them.)

Diagnosis has three constants: ask about nobility/commonness, loss of fiefdom, and desire for lordship. (Continuation: Loss of fiefdom means demotion from duke/minister; desiring lordship means craving high status endlessly.) Thus, nobles losing power, though not struck by evil, suffer internal spiritual injury, leading to bodily ruin. (Continuation: Due to worry, fear, torment, and knotting.) Once rich, now poor, though not struck by evil, skin dries, sinews contract, atrophy and spasms occur. (Continuation: Due to lingering Zang Qi and combined pathogens.) If the physician cannot be strict, cannot move the Shen, appears weak and compliant externally, disrupting the Dao, the disease cannot shift, and medical practice fails; this is the fourth fault. (Continuation: Strictness forbids misconduct to ensure obedience; external weakness implies compliance. Without prohibition or influence, complying with things disrupts heavenly norms; if disease doesn't shift, what use is the doctor?)

Diagnostician must know beginning and end, understand residual clues, palpate pulse, ask names, and consider gender differences. (Continuation: Beginning/end refers to complexion. Classic: Know exterior by tracing end to start, observing five colors cyclically. Residual clues refer to post-onset details. Palpate means finger pressure. Ask clearly means asking disease name. Men have more Yang, left pulse large is favorable; Women have more Yin, right pulse large is favorable; thus combine first.) Separation, severance, depression, knotting, worry, fear, anger, joy cause Zang emptiness and blood/Qi separation. If doctors don't know, what medicine can they speak of? (Continuation: Separation severs love; severance cuts hopes; depression accumulates thought; knotting holds grudges. Loving ones lose soul; severed ones lose intent; accumulated thoughts tire Shen; grudge-holders suffer will. Worry blocks flow; fear loses guard; anger confuses; joy scatters. These eight cause Zang emptiness and Qi/Bi separation. Doctors ignoring this speak nothing.) Once rich, greatly injured, sinews severed, body moves again, but fluids cease. (Continuation: Severed sinews mean excessive damage. Body recovers movement, but fluids don't nourish. Why? Essence depleted. Fluids refer to Jin Ye.)

Thus, Yang failure knots and stays, pressing on Yang, forming pus accumulation with cold/heat. (Continuation: Yang refers to Yang meridians and Fu organs. Jiong means heat. Non-standard damage to sinews/blood causes Qi to knot internally, pressing on Yang meridians, turning to pus, accumulating in abdomen, manifesting as external cold/heat.) Crude physicians treat urgently by needling Yin/Yang meridians, causing body dissolution, limb tetany, death has a date. (Continuation: Not knowing cold/heat stems from pus, mistaking for common heat, needling repeatedly drains Qi, worsening disease, dissolving body, paralyzing limbs. Death date is doctor's fault.) Doctors unclear, not asking causes, only stating death date, are crude; this is the fifth fault. (Continuation: Incomplete diagnosis, careless treatment, ignoring clues, poor conduct make one a crude doctor.)

These five cases stem from unmastered techniques and ignorance of human affairs. (Continuation: Practitioners not grasping subtle principles or human matters.) Thus, sages treating disease know Heaven/Earth, Yin/Yang, Four Seasons, Zang-Fu, Yin/Yang, Exterior/Interior, acupuncture, moxibustion, stones, drugs, handle human affairs calmly to clarify classics. Nobility/poverty/rich/poor have different traits; ask age, courage/fear; examine parts, know root, eight signs, nine pulses match. (Continuation: Sages explain this; doctors should strive. See *Wu Guo Lun*.)

Emperor said: Twelve meridians, 365 collaterals are known and used by doctors. (Continuation: Following and using.) Failure to be perfect comes from unfocused spirit, unruly will, internal/external mismatch, causing doubt/danger. (Continuation: Exterior is color, interior is pulse. Crude estimation fails, color/pulse mismatch, causing self-doubt.) Not knowing Yin/Yang reversal/submission in diagnosis is the first loss. (Continuation: *Mai Yao Jing Wei Lun*: Winter solstice +45 days, Yang rises slightly, Yin falls slightly; Summer solstice +45 days, Yin rises slightly, Yang falls slightly. Yin/Yang have timing matching pulses; not knowing this is one loss.) Incomplete apprenticeship, wild theories, false doctrines, changing names for credit, abusing stone needles, leaving harm, is the second loss. (Continuation: Not finishing study, acting wildly, changing ancient norms, following self, leaving harm, rightly a loss.) Ignoring poverty/nobility housing, seat thickness, body temperature, diet suitability, courage/fear, lacking analogy, confusing oneself, is the third loss. (Continuation: Brave hard to hurt, timid easy to hurt, due to Shen/Qi strength. Understanding poverty/nobility reveals seat/body/diet norms. Lacking analogy causes confusion, not clarity; third loss.) Diagnosing without asking origin, worry, diet irregularity,起居 excess, toxicity, not asking first, suddenly pulsing cunkou, guessing names, becoming crude, is the fourth loss. (Worry/fear/hardship. Not asking these, then pulsing cunkou, guessing disease, acting famous, becoming crude. Must ask then diagnose for perfection, not rely solely on pulse. See *Zheng Si Shi Lun*.)

East wind in Spring, disease in Liver, Shu points in neck/occiput. (Spring wind promotes growth, Shu in neck. Avoid treating neck on Jia/Yi days.) South wind in Summer, disease in Heart, Shu points in chest/hypochondrium. (Heart Shaoyin meridian passes chest/hypochondrium.) West wind in Autumn, disease in Lung, Shu points in shoulder/back. (Lung in upper Jiao, back corresponds to chest, shoulder/back adjacent.) North wind in Winter, disease in Kidney, Shu points in waist/thigh. (Waist is Kidney mansion, thigh connected by Qi.) Center is Earth, disease in Spleen, Shu points in spine. (Spine corresponds to Earth, central.)

Spring disease in head (Liver Qi responds). Summer disease in Zang (Heart response). Autumn disease in shoulder/back (Lung response). Winter disease in four limbs (Limbs lack Qi, cold easily harms, location depends on pathogen). Spring prone to rhinorrhea/epistaxis. (In Qi, in head. Qiu is nasal discharge, Nu is nosebleed.) Mid-summer prone to chest/hypochondrium disease. (Heart meridian passes there.) Late summer prone to severe diarrhea/cold middle. (Earth governs middle, grain processing, hence severe diarrhea/cold.) Autumn prone to wind-malaria. (Cool offsets heat, causing malaria. Monthly Ordinance: Early Autumn doing Summer rites causes malaria.) Winter prone to Bi/Jue. (Blood abundant in water, cold freezes, Qi flows thinly, causing Bi/Jue.)

Winter without massage/guiding prevents Spring rhinorrhea/epistaxis. (An is massage; Qiao is agile movement/guiding. Disturbing sinews/bones hides Yang; Spring Yang rises, heat steams Lung, Lung opens to nose, disease forms. Hence winter no massage, spring no rhinorrhea/epistaxis. Qiu is clear nasal discharge, Nu is blood.) Spring no neck disease, mid-summer no chest disease, late summer no diarrhea, autumn no malaria, winter no Bi/Jue. (All due to winter no massage.)

Essence is body root; storing essence prevents Spring warmth. (Due to winter no massage.) Summer heat without sweat leads to Autumn wind-malaria. (Wind-cool offsets heat sweat. Note: Seems disconnected from previous, similar to *Po Han Wei Jin*. Wang注: Winter hibernation; winter massage disturbs heat, causing seasonal changes. Essence is root, must store. See *Jin Gui Zhen Yan Lun*.)

All vessels belong to eyes. (Vessels are blood house. Long viewing hurts blood, hence vessels belong to eyes. Correction: Heart stores vessels, vessels house Shen, Shen permeates body, hence belongs to eyes.) All marrow belongs to brain. (Brain is sea of marrow.) All sinews belong to joints. (Sinews are firm Qi connecting bones/joints. Long walking hurts sinews.) All blood belongs to Heart. (Blood in vessels, belongs to Heart. Blood/Qi is Shen, Shen is Heart master.) All Qi belongs to Lung. (Lung stores Po...) Blood returns to Liver. (Liver stores blood, Heart moves it. Movement distributes blood to vessels; rest returns blood to Liver. Liver governs blood...) Eyes see when receiving blood. (Function. Eye is Liver palace, receives blood to see.) Feet walk receiving blood, palms... fingers grasp receiving blood. (Blood/Qi is Shen, receiving blood enables use. See *Zang Wu Sheng Cheng Lun*.)

Five flavors enter: Sour to Liver, Pungent to Lung, Bitter to Heart, Salty to Kidney, Sweet to Spleen. (Liver/Wood/Sour, Lung/Metal/Pungent, Heart/Fire/Bitter, Kidney/Water/Salty, Spleen/Earth/Sweet. *Zhi Yao Yao Lun*: Flavors enter stomach, return to preferred organ. Sour to Liver, Bitter to Heart, Sweet to Spleen, Pungent to Lung, Salty to Kidney.)

Five Qi diseases: Heart is belching. (Fire flares up, smoke follows; Heart rejects filth, belches it out.) Lung is cough. (Metal is hard, sounds when struck; pathogen hits Lung, causes cough.) Liver is speech. (Wood branches, speech expresses complexity, originates in Liver.) Spleen is swallowing. (Earth contains, accepts all, hence swallowing.) Kidney is yawning and sneezing. (Water flows down, clouds rise, Qi knots in Stomach, Fire generates. Fire Qi harmonizes, presses Heart, exits nose as sneeze.) Stomach is reflux, hiccup, fear. (Stomach is sea of grain/water, Kidney gate controls flow; blockage causes reflux. Grain likes cold, cold clashes, causes hiccup. Cold excess causes hiccup, heat excess causes fear. Heat weakens Kidney Qi, causing fear. Later: Essence combining in Kidney causes fear.) Large/Small Intestines are diarrhea; Lower Jiao overflow is water. (Large intestine conducts, Small intestine receives. Weak reception, uncontrolled conduction, causes diarrhea. Lower Jiao distributes; blockage causes water overflow.) Bladder dysfunction/incontinence is strangury/enuresis. (Bladder stores fluids. Foot Sanjiao vessel solid, constrains Lower Jiao, blockage causes strangury; vessel deficient, unconstrained, causes enuresis. *Ling Shu*: Foot Sanjiao is Taiyang branch, enters Bladder, constrains Lower Jiao. Solid = strangury, Deficient = enuresis.) Gallbladder is anger. (Decisive, impartial, rigid nature, hence anger. Classic: Eleven Zang depend on Gallbladder.) These are Five Diseases.

Five Essences Combine: Combining in Heart causes joy. (Lung deficient, Heart essence combines, joy. *Ling Shu*: Endless joy hurts Po, Po is Lung Shen. Heart Fire combines Lung Metal.) Combining in Lung causes sorrow. (Liver deficient, Lung essence combines, sorrow. *Ling Shu*: Sorrow hurts Hun, Hun is Liver Shen. Lung Metal combines Liver Wood.) Combining in Liver causes worry. (Liver deficient, Liver Qi combines, worry. *Ling Shu*: Unresolved worry hurts Yi, Yi is combined Shen. Liver Wood combines Spleen Earth.) Combining in Spleen causes fear. (Kidney deficient, Spleen Qi combines, fear. *Ling Shu*: Unresolved fear hurts Jing, Jing is Kidney Shen. Spleen Earth combines Kidney Water.) Combining in Kidney causes terror. (Heart deficient, Kidney Qi combines, terror. *Ling Shu*: Fear/worry hurts Shen, Shen is Heart Ming. Kidney Water combines Heart Fire. All due to righteous Qi deficiency allowing winning Qi to combine. Hence:) These are Five Combinations, combining due to deficiency.

Five Dislikes: Heart dislikes Heat. (Heat causes vessel turbidity.) Lung dislikes Cold. (Cold causes Qi stagnation.) Liver dislikes Wind. (Wind causes sinew dryness/tension.) Spleen dislikes Dampness. (Dampness causes muscle atrophy/swelling.) Kidney dislikes Dryness. (Dryness causes essence depletion.) These are Five Dislikes.

Five Transformations: Heart is sweat. (Exudes through skin.) Lung is mucus. (Moistens nose.) Liver is tears. (Nourishes eyes.) Spleen is saliva. (Overflows lips.) Kidney is thick saliva. (Generates teeth.) These are Five Fluids.

Five Disease Origins: Yin disease starts in bones, Yang disease starts in blood; Yin disease starts in flesh. (Bone/flesh are Yin essence, Yang Qi follows; blood vessels are Yang motion, Yang Qi attacks.) Yang disease starts in Winter, Yin disease starts in Summer. (Summer Yang strong, Yin disease starts; Winter Yin strong, Yang disease starts. Follows scarcity.) These are Five Origins.

Five Chaotic Evils: Entering Yang causes madness; entering Yin causes Bi. (Evil in Yin vessels, limbs hot, madness; evil in Yin meridians, six channels stagnant, Bi.) Clashing Yang causes mania; clashing Yin causes aphasia. (Wang注: Evil clashing Yang, vessels rush, mania; evil clashing Yin, vessels stop, aphasia. Correction: *Nan Jing*: Heavy Yang = madness, Heavy Yin = mania. Chao Yuansfang: Evil in Yin = mania. *Mai Jing*: Yin attaching Yang = madness, Yang attaching Yin = mania. Sun Simiao: Evil in Yang = madness, Evil in Yin = blood Bi; Yang transmitting = mania/spasm, Yin transmitting = pain/aphasia. Quan Yuanqi: Evil in Yin transmits to Yang, Qi doesn't circulate, clashes with righteous Qi, causes mania; Evil in Yang transmits to Yin, Zang/Fu affected, causes aphasia. Different views recorded.) Yang entering Yin causes essence issues; Yin exiting Yang causes anger. (Disease follows direction.) These are Five Chaos.

Five Evil Pulses: Spring getting Autumn pulse, Summer getting Winter pulse, Late Summer getting Spring pulse, Autumn getting Summer pulse, Winter getting Late Summer pulse. These are Five Evils, incurable death.

Five Zang Storage: Heart stores Shen. (Spiritual essence formation. *Ling Shu*: Two essences interacting is Shen.) Lung stores Po. (Essence assistant. *Ling Shu*: Exiting/entering with essence is Po.) Liver stores Hun. (Spirit assistant. *Ling Shu*: Coming/going with Shen is Hun.) Spleen stores Yi. (Memory without forgetting. *Ling Shu*: Heart recalling is Yi.) Kidney stores Zhi. (Focused will unmoving. *Ling Shu*: What Yi stores is Zhi. Kidney receives essence of all Zang/Fu, root of Yuan Qi, root of generation, gate of Stomach, thus Zhi connects to life.) These are Five Storages.

Five Zang Governing: Heart governs vessels. (Restricts Ying Qi, moves with breath.) Lung governs skin. (Wraps muscles, closes evils.) Liver governs sinews. (Binds joints, moves with Shen.) Spleen governs flesh. (Covers sinews/bones, circulates Wei.) Kidney governs bones. (Extends sinews, supports body.) These are Five Governances.

Five Labors: Long viewing hurts blood (Heart labor). Long lying hurts Qi (Lung labor). Long sitting hurts flesh (Spleen labor). Long standing hurts bones (Kidney labor). Long walking hurts sinews (Liver labor). These are Five Labors.

Five Pulse Images: Liver pulse Xian (String-like). (Soft, void, smooth, straight, long.) Heart pulse Gou (Hook). (Like hook, incoming strong, outgoing weak.) Spleen pulse Dai (Alternating). (Soft, weak.) Lung pulse Mao (Feather). (Light, floating, void, like feather.) Kidney pulse Shi (Stone). (Deep, firm, beating, like stone.) These are Five Zang Pulses (*Xuan Shu Wu Qi Lun*).

Liver color Green, eat Sweet: Millet, beef, dates, okra. (Sweet softens Liver urgency.) Red color, eat Sour: Mung bean, dog meat, plum, leek. (Sour astringes Heart relaxation.) Lung color White, eat Bitter: Wheat, mutton, apricot, leek. (Bitter disperses Lung Qi reversal.) Spleen color Yellow, eat Salty: Soybean, pork, chestnut, broad bean leaves. (Salty softens Kidney/Stomach gate. Spleen/Stomach combine, salty aids gate opening, Stomach Qi moves, Spleen transforms.) Kidney color Black, eat Pungent: Yellow millet, chicken, peach, green onion. (Pungent moistens Kidney dryness. Studying these flavors regulates mechanisms. Kidney is Stomach gate, Spleen combines with Stomach, salty softens gate, gate opens, Stomach Qi moves, Spleen transforms, hence Spleen flavor differs. Correction: See above...)