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Yang Qi is like the sun in the sky. If it loses its proper function, it will shorten life and prevent it from flourishing (If the sun is not bright, all things cannot be manifest; if a person lacks Yang Qi, they will suffer premature death and short life). Therefore, the movement of heaven relies on the brightness of the sun (The sun is Yang, and Yang is brightness). Thus, Yang Qi resides in the upper part of the body and serves to defend the exterior (Humans rely on Yang Qi as a defensive barrier). Yang Qi should operate freely like a door pivot (circulating fifty times throughout the body day and night); if daily activities are disturbed or startled, Shen Qi (Spiritual Energy) will float and become unconsolidated. (In older editions, the three characters "Yin Yu Han" [Due to Cold] appeared above "Yu Ru Yun Shu"; this is now moved below according to Wu Kun's commentary.)

If affected by Cold, the body becomes hot like burning charcoal, and sweating will disperse the pathogen. (When injured by Cold, illness manifests as heat; for pathogens at the exterior, sweating is used to disperse them.) (In older editions, the two lines "Ti Ruo Fan Tan" [Body like burning charcoal] were placed under "Jing Ze Duo Yan" [Quiet but talkative]; this is now moved here according to Wu Kun's commentary.)

If affected by Summerheat with excessive sweating, mental restlessness leads to panting and loud breathing, while quietness leads to excessive, incoherent speech (Summerheat first enters the Heart, and heat steams the Lung, causing excessive sweating; restlessness causes panting and loud exhalations; quietness results in talking without order).

If affected by Dampness, the head feels heavy as if wrapped (heavy and dull). If Damp-Heat is not cleared (removed), the large tendons contract and shorten, while the small tendons relax and lengthen. Shortening of large tendons causes spasms (Ju Luan), and lengthening of small tendons causes flaccidity (Wei Ruo) (Dampness stagnates and generates Heat; large tendons connect bone and flesh, contracting when heated, thus causing spasms; small tendons network outside bones, stretching when wet, thus causing flaccidity).

If affected by Qi disorder, edema occurs (Qi mechanism is obstructed, leading to swelling). When the four limbs alternate in suffering, Yang Qi will be exhausted (Si Wei refers to the four limbs; Xiang Dai means alternating illness; Jie Jin means exhaustion. These two sentences summarize the preceding text).

In persons with Yang Qi, excessive mental labor causes Yang Qi to expand and flare outward, leading to the depletion of Essence (Jing). This accumulation of pathological Qi into summer, when Fire is prosperous, causes Yin Essence to further decline, resulting in solitary Yang reversing upward, known as Jian Jue (Frying Reversal) (Disturbing Yang causes Qi to expand and Fire to blaze, thus depleting Essence. The pathological Qi accumulated during spring reaches its peak in summer when Fire is strong, causing Yin Essence to亏 (decline) further, leading to solitary Yang reversal, hence called Jian Jue.) (The previous text discussed Yang Qi being insecure and injured by external pathogens; the following text discusses how irregular lifestyle injures Yang Qi.)

The eyes cannot see, and the ears cannot hear (The Essence of the Kidney forms the pupils, and the ears are the orifices of the Kidney. With Essence depleted internally, these symptoms appear). The condition deteriorates like a breached dam, irrecoverable (Du refers to a flood embankment).

In persons with Yang Qi, extreme anger causes the separation of Form and Qi, with Blood stagnating in the upper part, leading to Bo Jue (Thin Reversal) (Yang Qi values fullness and harmony; extreme anger damages Form and Qi, driving Qi to the Liver, causing Blood to flow recklessly and stagnate in the Upper Jiao. Mutual pressure is called Bo, Qi reversal is called Jue. With both Qi and Blood chaotic, it is termed Bo Jue).

If tendons are injured, they become flaccid and uncontrolled, as if unable to maintain posture (Flaccid and unretracted, as if difficult to control movements).

Sweating occurs only on one side (Ju implies obstruction/blockage). This leads to hemiplegia (Pian Ku) (If half the body sweats constantly, it indicates biased obstruction of Qi and Blood; over time, Ying Qi (Nutritive Energy) becomes insecure and lost, resulting in Pian Ku, i.e., hemiplegia).

Sweating followed by exposure to Dampness generates Acne (Cuo) and Prickly Heat (Fei) (When sweating, pores open; if Dampness remains in the skin and interstices, severe cases develop Cuo [small boils], mild cases develop Fei [urticaria-like rash]).

Excessive consumption of rich food and wine (Gao Liang) can lead to severe Ding Sores (High Liang is synonymous with Gao Liang; Zu Neng means sufficient/able to cause. Rich foods create internal stagnant heat; their transformation easily generates large Ding sores, triggering easily, like holding an empty vessel to receive objects).

Sweating from exertion exposed to wind, where Cold forces the fluid to congeal into comedones (Zha), which, if stagnated severely, become acne (Physical labor causes sweating; cold wind attacks it, condensing fluids in the skin and interstices into Zha [comedones]. If stagnation worsens, it becomes Cuo [acne]).

Yang Qi, in its refined aspect, nourishes Shen (Spirit); in its soft aspect, it nourishes the tendons (Internally transforming fine essences to nourish Spirit; externally becoming fluids to soften tendons).

If opening and closing functions fail, Cold Qi follows and invades, leading to severe kyphosis (Kai refers to skin excretion; He refers to closure of Xuan Fu [pores]. If attacked by Cold, Yang Qi is injured and cannot soften tendons, resulting in a hunched posture).

Cold Qi sinking into vessels lingers in muscle interstices, causing ulcers (Lou) (Cold Qi sinks from tendons into vessels, causing ulcers, lingering in the interstices).

Qi transformation at Shu points invading organs transmits as fear and fright (Cold Qi flows through meridian Shu points and invades organs via Qi transformation, causing fear and fright; this is because injured Yang Qi cannot nourish Shen).

Ying Qi (Nutritive Qi) does not follow its course, reversing in muscle tissue, leading to carbuncles and swellings (Ying Qi moves within vessels; when pathogens sink into vessels, it becomes irregular and reverses in muscle tissue, causing blood stagnation and heat accumulation, thus forming carbuncles).

Unfinished Po Sweat (sweat derived from Yin fluids, hence Po Sweat), with weak form and dissipating Qi, closed Shu points, develops into Wind Malaria (Po is Yin; sweat comes from Yin fluids, thus Po Sweat. If sweat has not stopped, form is weak and Qi is consumed; Cold and Wind attack, Shu points close, pathogen stays causing Malaria; since the pathology involves Wind, it is named Wind Malaria).

Therefore, Wind is the beginning of all diseases. Clarity and stillness allow muscle interstices to close and resist; even with great wind and harsh toxins, harm cannot occur, due to following the sequence of seasons (The way of clarity and stillness lies in following the sequence of Four Seasons' Qi for regulation).

Thus, injury by Wind in Spring, with pathogen lingering, leads to Profuse Diarrhea (Dong Xie) (Wind shakes Wood and prevails; acute illness is external contraction, but if pathogen lingers long, it suppresses Spleen Earth, causing Dong Xie).

Injury by Summerheat in Summer leads to Nu Malaria in Autumn (Summerheat pathogen lies dormant; extending to autumn coolness which binds externally, Cold and Heat contend, causing Nu Malaria).

Injury by Dampness in Autumn leads to rebellious cough and Wei Jue (Flaccidity and Reversal) (Damp Earth governs late Chang Xia, so Autumn injury is by Dampness. However, Autumn Qi connects to Lung; Damp stagnates into Heat, causing Qi rebellion and cough. Damp injures tendons, relaxation causes Flaccidity; Yang cannot overcome Damp, causing Reversal/Jue).

Injury by Cold in Winter leads to Warm Disease in Spring (Winter Cold pathogen does not immediately manifest; Cold toxin hides in Yin divisions. When Spring arrives and Yang Qi rises, it transforms into Warm Disease).

The Qi of the Four Seasons alternately injures the Five Zang Organs (Wind, Summerheat, Cold, and Damp alternate in victory and defeat, so the Qi of the Four Seasons alternately injures the harmony of the Five Zang. However, the Five Zang hide Yin Qi internally; only when internal defense fails can external pathogens invade.)