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Huangdi asked, "Diseases arise from various causes, and the pathogenic factors affecting different parts of the body cause damage to different organs. I wish to hear the principles behind this." Qibo replied, "Unregulated emotions such as joy and anger injure the Zang organs; injury to the Zang organs leads to disease originating from the Yin level. Clear dampness attacks deficiency, leading to disease originating from the lower part; wind and rain attack deficiency, leading to disease originating from the upper part. This is referred to as the three regions. As for the proliferation of pathogenic factors, it is countless. Wind, rain, cold, and heat cannot harm a person alone unless there is internal deficiency. Those who suddenly encounter fierce winds and heavy rains without falling ill do so because they lack internal deficiency, preventing external pathogens from harming them alone. It must be that the external empty pathogenic wind combines with the body's internal deficiency; when two deficiencies collide, the pathogen enters the form. When two realities meet (i.e., sufficient healthy Qi and normal climate), the pathogen remains between the muscles. For those struck by empty pathogenic wind, due to abnormal weather and their own bodily deficiency, combined with the assessment of excess and deficiency, major diseases are formed. Pathogenic Qi has specific abodes, named according to location, divided into upper, lower, internal, and external regions. Thus, when empty pathogenic factors invade the human body, they begin at the skin. If the skin is loose, the Couli (pores) open; if the Couli open, pathogens enter through the hair; entering through the hair, they go slightly deeper; going slightly deeper, the hair stands erect, causing chills and skin pain. If they remain and do not depart, they transmit to the Luo vessels. At the stage of the Luo vessels, the Six Meridians are blocked, causing pain in the four joints and stiffness in the waist and spine. If they remain and do not depart, they transmit to the Fu Chong Mai (Chong Mai deep within the spine). At the stage of the Fu Chong Mai, the body feels heavy and painful. If they remain and do not depart, they transmit to the Stomach and Intestines. At the stage of the Stomach and Intestines, there is epigastric distension and abdominal fullness; with much cold, there is borborygmus and diarrhea with undigested food; with much heat, there is loose, mushy stool. If they remain and do not depart, they transmit to outside the Stomach and Intestines, between the Mu Yuan (membranous origin). Lingerling in the vessels, staying and not departing, they form accumulations. Or they attach to the Sun Luo (fine collateral vessels), or to the Luo vessels, or to the Jing Mai (main meridians), or to the 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 (superficial abdominal muscles). The proliferation of pathogenic factors is endless and cannot be fully discussed. Accumulations attaching to the Sun Luo move up and down, feeling like the Sun Luo area being tapped; they are floating and loose, unable to confine the accumulation and stop it. Thus, they reside where the Stomach and Intestines are; after a full meal, they enlarge; when hungry, they shrink. Accumulations attaching to the Huan Jin resemble accumulations of the Yangming channel; they hurt when full and are comfortable when hungry. Accumulations attaching to the Mu Yuan of the Stomach and Intestines hurt and extend outward to the Huan Jin; they are comfortable when full and hurt when hungry. Accumulations attaching to the Fu Chong Mai respond to touch with pulsation; upon releasing pressure, heat arises; Qi descends to the inner thighs, resembling the sensation of hot water pouring. Accumulations attaching to the Lv Jin behind the intestines are visible when hungry, invisible when full, and unpalpable. Accumulations attaching to the Shu vessels cause blockage, preventing fluids from descending and drying out the orifices. This is how pathogenic factors enter internally and descend from above. Someone asked, "How do accumulations begin, and how are they formed?" He answered, "Accumulations begin with cold, generating Jue Qi (rebellious Qi); when Jue Qi stops, the accumulation forms." Asked again, "How is it formed?" He answered, "Jue Qi generates foot swelling (Zu Fu in Ling Shu); foot swelling generates cold in the shins; cold in the shins causes blood congealing and stagnation; cold and heat move up and down, entering the Stomach and Intestines; entering the Stomach and Intestines causes bloating; external fluid droplets are forced to gather and cannot disperse, forming an accumulation day by day. Sudden overeating and drinking fill the vessels. Irregular living habits and excessive effort injure the Luo vessels. Injury to Yang Luo causes external bleeding, resulting in epistaxis or hematemesis; injury to Yin Luo causes internal bleeding, resulting in hematochezia. External Luo vessel injury causes blood to overflow outside the intestines; if there is cold and fluid droplets, they contend with the blood, coagulate together, and cannot disperse, forming an accumulation. Sudden exposure to cold, or internal injury from worry and fear, causes Qi to rebel upward; rebellious Qi blocks the acupoints and Shu points, preventing Warm Qi from circulating; congealed blood gathers inside and does not disperse, fluids become sticky, adhere and do not depart, thus formations of accumulation occur." Asked, "How do accumulations originate from the Yin?" He answered, "Worry and thought injure the Heart; severe cold injures the Lung; anger injures the Liver; drunkenness and fullness followed by intercourse, sweating and exposure to wind, injure the Spleen; excessive effort, intercourse with sweating followed by bathing, injure the Kidney. These are the diseases arising from the three internal and external regions. Observe the site of pain to know the corresponding organ; if there is excess, tonify; if deficient, sedate; do not go against the timing of Heaven. This is called supreme treatment."

Asked, "How can one predict who is prone to intestinal accumulations?" He answered, "Thin skin lacking luster, and flesh that is not firm but soft; such people have poor gastrointestinal function. Poor function allows pathogenic factors to linger, and accumulations arise."

Accumulations in the Stomach and Intestines arise from irregular cold and warmth, allowing pathogenic factors to linger. As they accumulate and stay, major aggregations arise.

Asked, "What disease is characterized by swelling of the body, waist, thighs, and back, and pain around the navel?" He answered, "It is called Fu Liang (Volute Beam). This is the root of wind pathogen. It should not be manipulated, as manipulation leads to edema and dysuria. Another condition presents with fullness and hardness in the lower abdomen, with roots extending left, right, up, and down, also called Fu Liang. It contains large amounts of pus and blood, located outside the Stomach and Intestines. It is untreatable; palpation may lead to death. Downward progression involves Yin injury,必然 leading to purulent bloody stools; upward progression compresses the epigastrium and diaphragm, causing internal abscesses near the stomach. This is a chronic disease, difficult to treat. Located above the navel is adverse; below the navel is favorable. Do not rush to deplete. Qi overflows into the Large Intestine and attaches to the Huang (Sanjiao membrane). The source of Huang is below the navel, hence the periumbilical pain."

The Nan Jing states: "The accumulation of the Heart is called Fu Liang, starting above the navel, extending up to below the Heart, size like an arm. If unresolved for a long time, it causes heart vexation and pain. It is contracted on Geng/Xin days in Autumn. Kidney disease transmits to the Heart; the Heart should transmit to the Lung, but the Lung, being prosperous in Autumn, does not accept the pathogen, so it stays and knots to form an accumulation."

The Nan Jing states: "The accumulation of the Lung is called Xi Ben (Gathering Breath), located under the right hypochondrium, covering an area as large as a cup. If unresolved for a long time, it causes aversion to cold, rebellious Qi, asthma, cough, and lung abscess. It is contracted on Jia/Yi days in Spring. Heart disease transmits to the Lung; the Lung should transmit to the Liver, but the Liver, being prosperous in Spring, does not accept the pathogen, so it stays and knots to form an accumulation."

Asked, "What disease presents with fullness under the hypochondrium and rebellious Qi, lasting two or three years?" He answered, "The disease is named Xi Ben. It does not affect eating. Moxibustion and acupuncture are contraindicated. Accumulations require Daoyin (guiding and pulling exercises) and herbal medicine; herbs alone cannot cure it."

The Nan Jing states: "The accumulation of the Liver is called Fei Qi (Fat Qi), located under the left hypochondrium, like an inverted cup, with head and feet resembling a turtle or tortoise. If unresolved for a long time, it causes cough, rebellious Qi, and malaria, persisting for years. It is contracted on Wu/Ji days in Late Summer. Lung disease transmits to the Liver; the Liver should transmit to the Spleen, but the Spleen, being prosperous in Late Summer, does not accept the pathogen, so it stays and knots to form an accumulation. This is similar to Xi Ben."

The Nan Jing states: "The accumulation of the Spleen is called Pi Qi (Stagnant Qi), located in the epigastrium, covering an area as large as a plate. If unresolved for a long time, it causes flaccidity of the four limbs, jaundice, and failure of food to nourish the flesh. It is contracted on Ren/Gui days in Winter. Liver disease transmits to the Spleen; the Spleen should transmit to the Kidney, but the Kidney, being prosperous in Winter, does not accept the pathogen, so it stays and knots to form an accumulation."

The Nan Jing states: "The accumulation of the Kidney is called Ben Tun (Rushing Pig), originating in the lower abdomen, rising to the epigastrium like a running pig, moving up and down without fixed times. If unresolved for a long time, it causes asthma, rebellious Qi, bone flaccidity, and shortness of breath. It is contracted on Bing/Ding days in Summer. Lung disease transmits to the Kidney; the Kidney should transmit to the Heart, but the Heart, being prosperous in Summer, does not accept the pathogen, so it stays and knots to form an accumulation."

Xi Ben with frequent spitting of blood is treated by Ju Que (CV14). Accumulations moving up and down in the abdomen are treated by Xuan Shu (GV9). Hernia accumulation with chest pain and inability to bend is treated by Tian Rong (SI17). Sudden heart and abdominal pain, hernia striking upward to the heart, is treated by Yun Men (LU2). Hardness below the heart is treated by Huang Shu (KI16), Qi Men (LR14), and Zhong Wan (CV12). Hernia below the navel with periumbilical pain, rushing to the chest causing dyspnea, is treated by Zhong Ji (CV3). Ben Tun ascending with abdominal hardness, pain radiating to the genitals, inability to urinate, and retracted testicles, is treated by Yin Jiao (CV7). Hernia below the navel with periumbilical pain is treated by Shi Men (CV5). Ben Tun Qi ascending with abdominal pain, rigidity preventing speech, penile swelling radiating to the lower back and abdomen, lumbar stiffness, radiation to genitals, inability to urinate, and retracted testicles, is treated by Shi Men (CV5). Ben Tun cold Qi entering the lower abdomen, frequent nausea, middle-jiao injury, hematuria, frequent urination, back-nape pain radiating to genitals, abdominal urgency with diarrhea, is treated by Guan Yuan (CV4). Ben Tun Qi rushing to the heart, severe dyspnea, mental confusion, shortness of breath, Chi pulse reversal, heart vexation and pain, hunger but inability to eat, frequent interior cold, abdominal distension radiating to the hypochondrium and pain, sudden pain controlled by the lower back and abdomen, frequent urgency to defecate, is treated by Zhong Ji (CV3). Sharp pain from abdominal accumulations is treated by Shang Qu (ST18). Hernia and mass below the navel with blood in the uterus is treated by Si Man (SP14). Hernia around the navel with pain radiating upward to the heart is treated by Tian Shu (ST25). Qi hernia with hiccups and vomiting, facial swelling, and Ben Tun is treated by Tian Shu (ST25). Ben Tun with testicular ascent, pain radiating to the penis, is treated by Gui Lai (ST29). Ben Tun moving up and down is treated by Qi Men (LR14). Hernia and mass with acute pain in the thigh, radiating along the hypochondrium, striking the heart, abdominal pain and accumulation, is treated by Fu She (LR28). Ben Tun with abdominal distension and swelling is treated by Zhang Men (LR13). Lower abdominal accumulation is treated by Lao Gong (PC8). Periumbilical pain, genital retraction, testicular retraction, hard pain preventing sleep, is treated by Tai Chong (LR3). Cold hernia extending to the abdomen, popliteal fossa, knees, and waist, pain like flowing water, major abdominal hernias palpable up to the knees, is treated by Fu Tu (ST32). Cold hernia with abdominal distension, flaccidity and reversal, shortness of breath, is treated by Yin Shi (ST33). Major hernia with abdominal hardness is treated by Qiu Xu (GB40).