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Chapter 49 states: There are diseases originating from the meridian itself (Zengjing Zibing) and those caused by injury from the Five Evils (Wuxie). How can they be distinguished?

The response is: Sorrow and excessive thinking damage the Heart; exposure to cold in the body and consumption of cold drinks damage the Lungs; anger with rebellious Qi rising upward without descending damages the Liver; improper diet and overexertion fatigue damage the Spleen; sitting for long periods in damp places or forcing oneself into water while exerting strength damages the Kidneys. These constitute diseases originating from the meridians themselves.

"Zhengjing" refers to the primary meridian. "Wuxie" refers to the pathogenic factors affecting the five Zang organs. The Heart governs thought; if sorrow and labor are excessive, it injures the Heart. The Lungs govern the skin and hair; bodily coldness indicates external contraction of wind-cold on the skin and hair; drinking cold liquids indicates internal intake of cold water. Since the Lung organ inherently possesses a cold nature, excess leads to injury of the Lungs. The Liver governs anger; anger causes stagnation of Wood Qi, injuring the Liver. The Spleen governs the four limbs; excessive labor and fatigue injure the Spleen. The Spleen transforms and transports grain and food; unclean diet also causes injury. The Kidneys govern the bones; forceful exertion, sitting in dampness, or entering water injures the Kidneys, because the Kidney belongs to Water, and similar energies resonate with each other. However, sorrow, thinking, anger, diet, and movement are things humans cannot avoid; one must simply not go to extremes. Extremes will inevitably cause injury.

What are the Five Evils?

The response is: There is Wind Strike (Zhongfeng), Summerheat Injury (Shangshu), Diet and Fatigue Injury (Yinshi Laojuan), Cold Damage (Shanghan), and Dampness Strike (Zhongshi). This is called the Five Evils.

The Liver corresponds to Wind-Wood, so Wind pathogen enters the Liver first. The Heart corresponds to Sovereign Fire; Summerheat-Fire pathogen affects the Heart. Excessive diet and fatigue injure the Spleen, leading to disease. Cold invading the skin and hair injures the Lungs. Moist vapor and misty dampness injure the Kidneys. These five pathogens come from outside, hence termed "external injuries."

Commentary: *Suwen: Benbing Lun* and *Lingshu: Xieqi Zangfu Bingxing Pian* are largely similar to this. For instance, *Suwen: Yin-Yang Yingxiang Dalun* states: Anger injures the Liver, Joy injures the Heart, Thinking injures the Spleen, Sorrow injures the Lungs, Fear injures the Kidneys. These are internal injuries from the Seven Emotions, representing self-disease of the primary organs. *Xuanming Wuqi Pian* states: The Liver dislikes Wind, the Heart dislikes Heat, the Lungs dislike Cold, the Kidneys dislike Dryness, the Spleen dislikes Dampness. These are manifestations of the Six Excesses (Liuyin) as external contractions. All appear similar but differ in essence. Some argue that since Nan Jing mentions primary meridian self-disease arising internally, yet cites bodily cold and cold drinks damaging the Lungs—where bodily cold is external cold affecting the skin and hair, and cold drinks enter the chest and abdomen externally—it seems contradictory, especially since the Five Evils include diet and fatigue. However, the intent is that when the primary meridian is deficient, it cannot withstand cold invasion; such invasion easily causes disease. If the primary meridian is deficient and further injured by diet, it is an internal injury; if disease results merely from dietary indiscretion, it is an external contraction. When *Suwen* says the Kidney dislikes Dryness, it means the Water organ dislikes dryness that depletes fluids. Here, water-dampness injures the Kidney because dampness affects the lower body and thus returns to the Kidney first; the Kidney belongs to Water, and similar energies seek each other. Although the meanings of ancient sages may differ slightly, the principle of distinguishing internal from external injuries remains consistent. Reading requires integration; one should not be rigid. As former scholars said, "reaching the intention to understand the will," this is true acquisition. Truly so.

Suppose there is Heart disease; how do we know it arises from Wind Strike?

The response is: The complexion should be red. Why? The Liver governs colors; Green enters the Liver, Red enters the Heart, Yellow enters the Spleen, White enters the Lungs, Black enters the Kidneys. Since the Liver becomes the evil for the Heart, we know the complexion should be red. Symptoms include fever, fullness and pain in the hypochondrium, and a pulse that is floating, large, and wiry (Xian).

"Suppose Heart disease" uses the Heart as an example. This refers to Heart disease where Liver evil invades, resulting in Wind Strike, as Wind Qi connects with the Liver. The Liver opens into the eyes and thus governs color. When Wind pathogen enters the Liver meridian, the color is green (Cang); when it enters the Heart, the color is red; when it enters the Spleen, yellow; when it enters the Lungs, white; when it enters the Kidneys, black. Therefore, Liver Wind evil entering the Heart results in a red complexion. Fever occurs because external pathogens first injure Ying and Wei (Nutritive and Defensive levels), causing fever; additionally, the Heart belongs to Fire, and heat is the manifestation of Fire evil. Hypochondriac fullness and pain occur because the hypochondrium is the region of the Liver. A floating, large, and wiry pulse: floating and large are the original characteristics of the Heart pulse; the Liver evil invading causes the wiry quality to appear.

How do we know it arises from Summerheat Injury?

The response is: There should be aversion to odors. Why? The Heart governs odors; Scorched odor enters the Heart, Fragrant odor enters the Spleen, Fishy/Sanguine odor enters the Liver, Putrid odor enters the Kidneys, Raw/Fishy odor enters the Lungs. Thus, knowing Heart disease arises from Summerheat, there should be aversion to odors. Symptoms include fever with irritability, heart pain, and a pulse that is floating, large, and scattered (San).

If Heart disease arises from Summerheat, the Summerheat pathogen affects the Heart first, as the Heart governs Summerheat. This is self-disease of the primary meridian, not involving other meridians. However, the Heart belongs to Fire; Summerheat-Heat evil injures it. Fire transforms into substances, producing the five odors. Summerheat entering the primary meridian produces a scorched odor (Qi of Fire). Entering the Spleen produces a fragrant odor (Qi of Earth). Entering the Liver produces a sanguine odor (Qi of Wood). Entering the Kidneys produces a putrid odor (Qi of Water). Entering the Lungs produces a raw/fishy odor (Qi of Metal). Thus, the Heart receiving Summerheat evil emits foul odors. Fever with irritability occurs because Fire stagnation leads to confusion. Heart pain occurs because evil in the Heart causes pain. A floating, large, and scattered pulse: floating and large are the original Heart pulse; scattered means floating, large, empty, and lacking spirit, which is the pathological pulse of the Heart. In self-disease of the primary organ, since the Heart governs odors, diagnosis relies specifically on odors.

How do we know it arises from Diet and Fatigue Injury?

The response is: There should be a preference for bitter taste. Deficiency manifests as lack of appetite; excess manifests as desire to eat. Why? The Spleen governs tastes; Sour enters the Liver, Bitter enters the Heart, Pungent enters the Lungs, Salty enters the Kidneys, Sweet enters the Spleen. Thus, knowing Spleen evil enters the Heart, there is a preference for bitter taste. Symptoms include fever, heavy body, lethargy, inability to control the four limbs, and a pulse that is floating, large, and slow (Huan).

If Heart disease arises from diet and fatigue, the Heart governs Heat, and the Spleen governs fatigue. Now, Heart disease arises from diet and fatigue, indicating Spleen evil enters the Heart. Preference for bitter taste occurs because the Spleen governs taste, the Heart belongs to Fire, and Fire's taste is bitter, conforming to its nature. Deficiency means Spleen Qi cannot transform grain; excess means it can, explaining the difference between ability and inability to eat. If the Liver receives diet/fatigue disease, the taste is sour; if the Heart receives disease, the taste is bitter; if the Lungs receive disease, the taste is pungent; if the Kidneys receive disease, the taste is salty; if the Spleen receives disease itself, the taste is sweet. Fever is a manifestation of the Heart. Heavy body is a manifestation of the Spleen. Floating and large pulse is the original Heart pulse; slow is the Spleen pulse characteristic. This section on diet and fatigue uniquely distinguishes deficiency and excess, clarifying that primary meridian deficiency combined with dietary injury differs from mere dietary indiscretion causing disease.

How do we know it arises from Cold Damage?

The response is: There should be delirious speech. Why? The Lungs govern sounds; Calling out enters the Liver, Speaking enters the Heart, Singing enters the Spleen, Moaning enters the Kidneys, Crying enters the Lungs. Thus, knowing Lung evil enters the Heart, there is delirious speech. Symptoms include fever, shivering aversion to cold, severe panting and coughing, and a pulse that is floating, large, and choppy (Se).

If Heart disease arises from Cold Damage, it is Lung evil entering the Heart. The Lungs govern sounds, hence delirious speech. If Cold evil enters the Liver, there is calling out (Liver sound is call). If it enters the Heart, there is much speaking (Speech is Heart voice; Lung sound is laughter). If it enters the Spleen, there is singing (Spleen sound is song). If it enters the Kidneys, there is moaning (Kidney sound is moan). If it enters the Lung itself, there is crying (Lung sound is cry). Fever and aversion to cold: the Heart is a Fire organ, hence fever; the Lung is originally a Cold organ, hence aversion to cold. Severe panting and coughing occur because the Lungs govern coughing; rebellious Lung Qi causes panting and coughing. Floating and large pulse is the Heart pulse; choppy is the Lung pulse characteristic.

How do we know it arises from Dampness Strike?

The response is: There should be profuse sweating that cannot stop. Why? The Kidneys govern fluids; Tears enter the Liver, Sweat enters the Heart, Saliva enters the Spleen, Nasal mucus enters the Lungs, Spittle enters the Kidneys. Thus, knowing Kidney evil enters the Heart, there is unstoppable sweating. Symptoms include fever, lower abdominal pain, cold and reversed coldness in the calves, and a pulse that is deep (Chen), soggy (Ru), and large. This is the method for the Five Evils.

If Heart disease arises from Dampness Strike, the Heart governs Summerheat, and the Kidneys govern Dampness. Now, Heart disease arises from dampness injury, indicating Kidney evil enters the Heart. The Kidneys transform the five fluids; Kidney becoming Heart evil causes unstoppable sweating. Dampness entering the Liver becomes tears (Liver governs tears). Entering the Heart becomes sweat (Heart governs sweat). Entering the Spleen becomes saliva (Spleen governs saliva). Entering the Lungs becomes nasal mucus (Lungs govern mucus). Entering the Kidneys themselves becomes spittle (Kidneys govern spittle). Fever is a manifestation of the Heart. Lower abdominal pain is the region of the Kidneys. Cold and reversed coldness in the calves occurs because the calves are the pathway of the Kidney meridian, hence fear of cold and reversal coldness; Dampness nature is also near cold. Deep, soggy, and large pulse: deep is the Kidney pulse characteristic; soggy is the sign of Dampness; large is the Heart pulse characteristic. The Heart pulse is floating and large, but only "large" is mentioned here because a deep pulse cannot be floating.

Fa refers to using one case as a representative method. Wuxie refers to the five Zang organs receiving evils corresponding to the Five Elements. To know the symptoms of the Five Evils, one must examine: Liver disease manifests in color, Heart disease in odor, Spleen disease in taste, Lung disease in sound, Kidney disease in fluid. The pulse is primarily based on the primary organ's pulse, combined with the pulse of the invading evil. Here, the Heart meridian is the primary diseased organ, and various symptoms verify the source. This principle is identical to the pulse diagnosis method in Chapter 10. Understanding this makes it clear that not only do the five Zang organs mutually receive the five evils, but also that all hundred diseases' manifestations can be analogously deduced, serving as a standard for pulse diagnosis and syndrome differentiation.