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Ping An: This chapter appears in Volume 11, Chapter 39 "Ju Tong Lun" (Discourse on the Causes of Pain) of the *Su Wen* (Basic Questions), and also in Volume 1, Chapter 1 of the *Jia Yi Jing* (Classified Classic of Acupuncture and Moxibustion).

The Yellow Emperor said: I have heard that all diseases arise from Qi abnormalities. Anger causes Qi to ascend; joy causes Qi to slacken; grief causes Qi to dissipate; fear causes Qi to sink; cold causes Qi to contract and gather; heat causes the Cou Li (skin pores) to open and Qi to leak out; worry causes Qi to become disordered; exertion causes Qi to be depleted; and contemplation causes Qi to knot. These nine types of Qi changes differ from one another; what diseases do they generate? (Jiong sounds like "gui," meaning heat. The reason people become ill is invariably due to internal imbalances of the Five Emotions—anger, joy, worry, pensiveness, and fear—and external invasions by Yin-Yang, cold, and heat, which disturb Qi and give rise to myriad diseases. Therefore, those who are skilled in preserving health eliminate internal emotional excesses and avoid external climatic evils, thus avoiding premature death and achieving longevity. If one indulges in emotions, anger causes Qi to ascend and damage Hun (Ethereal Soul); damage to Hun results in Liver injury. Joy causes Qi to slacken and damage Shen (Spirit); damage to Shen results in Heart injury. Worry and grief cause Qi to dissipate and also damage Hun; damage to Hun results in Liver injury. Fear causes Qi to sink and damage Zhi (Willpower); damage to Zhi results in Kidney injury. Excessive cold causes Qi to contract and gather, internally injuring the Lung. Excessive heat causes Cou Li to open and leak, internally injuring the Heart. Worry causes Qi to become disordered and damage Po (Corporeal Soul); damage to Po results in Lung injury. Excessive exertion causes Qi to deplete, injuring the Kidney. Contemplation causes Qi to knot and damage Yi (Intellect); damage to Yi results in Spleen injury. Once the Five Zang Organs are injured, death occurs when the time comes when each organ is overcome by its controlling element. All these illnesses arise from the Nine Evils generated by the Nine Qi changes. (Ping An: In the *Su Wen*, "I have heard" is written as "I know"; under "Qi contracts," the character "gather" is absent; above "Qi leaks," the three characters "Cou Li open" are absent; "worry" is written as "fright." Xin Zheng Xiao Yun: According to the *Tai Su*, "fright" is written as "worry." This aligns perfectly with this text. Furthermore, in the annotations, the two instances of "Po" in "injure Po" and "Po injured" were originally copied as "Hun" and corrected by the original annotator to "Po." As the classic states: "The Lung stores Qi, and Qi houses Po." It also states: "In the emotions, the Lung corresponds to worry." Writing "injure Po" is also consistent.)

Qi Bo said: Anger causes Qi to rebel; in severe cases, it leads to vomiting blood and regurgitation of food with rebellious Qi ascending. (Because it draws Qi upward, Qi rebels. Severe anger causes Qi rebellion, leading to vomiting blood and the upward reversal of food and Qi. (Ping An: "Food and Qi reversing" in the *Su Wen* is written as "undigested stool diarrhea." According to Xin Zheng Xiao Yun: According to the *Jia Yi Jing* and *Tai Su*, it is written as "food and Qi reversing." This aligns perfectly with this text.)

Joy causes Qi to harmonize and the will to be unobstructed, allowing Ying and Wei Qi to flow freely and smoothly, thus causing Qi to slacken. (Joy harmonizes Qi and opens the will, making Ying and Wei Qi flow smoothly, thus causing Qi slackness as a pathology. (Ping An: Above the character "flow," both the *Su Wen* and *Jia Yi Jing* lack the character "xing" (walk/run).)

Grief causes the Heart vessels to contract, the Lung lobes to expand and elevate, blocking communication between the Upper and Middle Jiao, preventing the dispersion of Ying and Wei Qi, trapping heat in the center, thus causing Qi to dissipate. (The Liver channel ascends into the pharynx and connects to the eye system; a branch diverges from the Liver, pierces the diaphragm, and ascends to inject into the Lung. The Lung governs grief. The Upper and Middle Jiao are located in the Heart and Lung. Grief Qi gathers in the Lung, causing the lung lobes to elevate and the Heart vessels to contract. Ying and Wei Qi gather in the Heart and Lung without dispersing, and Shen returns and does not move, resulting in heat and Qi deficiency/dissipation. (Ping An: In the *Su Wen*, "blockage of two Jiaos" is written as "and Upper Jiao blockage." Xin Zheng Xiao Yun: According to the *Jia Yi Jing* and *Tai Su*, it is written as "blockage of two Jiaos." This aligns perfectly with this text. Additionally, Wang Zhu interprets "bu ye" (spreading leaves) as large leaves like a cover. Xin Zheng Xiao Yun doubts this interpretation and quotes Quan Yuanqi: "Grief injures the Heart; contraction of the Heart vessels moves the Lung. Lung Qi connects to all channels; due to rebellion, Lung spreads and leaves elevate. How can one say 'Lung bu' refers to large leaves like a cover?" Based on this, Quan's annotation aligns with the intent of this commentary.)

Fear causes Essence to retreat; retreat causes Upper Jiao closure; closure causes Qi to return; return causes Lower Jiao distension, thus causing Qi to fail to circulate. (Although the Ming Men stores Essence, collectively referred to as the Kidney, the channel originates in the Kidney, passes up through the Liver and Diaphragm, enters the Lung; a branch connects from the Lung to the Heart and injects into the chest. When humans experience fright, Essence retreats. The Upper Jiao begins above the stomach opening. Since the Upper Jiao is closed and blocked, Qi cannot ascend but returns to the Lower Jiao, causing Lower Jiao distension and preventing Qi circulation. (Ping An: "Essence retreats" in the *Jia Yi Jing* is written as "Shen retreats." Additionally, Xin Zheng Xiao Yun in the *Su Wen* states: "Qi fails to circulate" should be read as "Qi descends." Examining the original annotation, it still should be read as "Qi fails to circulate.")

Heat causes Cou Li to open and Ying and Wei Qi to circulate, thus causing profuse sweating. (Qi fails to circulate, or due to heat, Cou Li open and Ying and Wei Qi circulate externally, causing profuse sweating. (Ping An: In the *Su Wen* and *Jia Yi Jing*, "heat" is written as "jiong." In the *Su Wen*, "thus causing profuse sweating" is written as "profuse sweating thus Qi leaks.")

Cold causes Cou Li to close and Qi to fail to circulate, thus causing Qi to contract and gather. (Because Ying and Wei Qi do not circulate, encountering cold causes Cou Li to close, leading to Qi gathering as a pathology. (Ping An: The three sentences "Cold causes Cou Li to close" are absent in the *Jia Yi Jing*; in the *Su Wen*, they appear before the three sentences about "Jiong causes Cou Li to open." The character "gather" in the *Su Wen* is written as "yi".)

Worry causes the Heart to have no place to rest, Shen to have no place to return, and thoughts to have no stability, thus causing Qi to become disordered. (The Heart is the function of Shen. In human worry, one forgets various matters; although there is mental state, there is nothing to attend to, hence "no place to rest." Qi is where Ying resides, and Shen must return to it. Now, since worry is complex, Qi gathers and does not move, so Shen has no return. Lu (deliberation) is also a function of Shen. Thus, worry cannot counteract affairs because Qi lacks a master to guard it, so Qi becomes disordered. (Ping An: In the *Su Wen* and *Jia Yi Jing*, "worry" is written as "fright." Xin Zheng Xiao Yun: In the *Tai Su*, "fright" is written as "worry." The character "ji" (rest/place) in the *Su Wen* and *Jia Yi Jing* is written as "yi" (lean on). In the annotation, "xin qing" (mental state) in other versions is written as "xin jing" (heart essence).)

Exertion causes panting, heavy breathing, and sweating, with internal and external Qi both escaping, thus causing Qi depletion. (When humans exert force and become fatigued, Qi converges, causing panting and heavy breathing. Skin, Cou Li, and the Five Internal Organs all sweat. Since sweat is Qi, sweating causes internal and external Qi to deplete. (Ping An: "Chuan he" (panting and drinking/heavy breath) in Gu Ben edition of *Su Wen* is written as "chuan xi" (panting), Zhao Fu edition writes "chuan qie", same as *Jia Yi Jing*. "Internal and external" in the *Su Wen* is written as "external and internal".)

Contemplation causes body and mind to focus, Shen to settle, Qi to remain and not move, thus causing Qi to knot. (Focusing on one matter causes Heart Qi to reside on one object. Thus, Shen focuses within one object, and Heart Qi draws Qi to gather, thus knotting and becoming pathology. (Ping An: The character "shen" (body) is absent in the *Su Wen* and *Jia Yi Jing*. In the *Jia Yi Jing*, "cun" (exist/reside) is written as "shang" (injure). In the *Su Wen*, "zhi" (stop) is written as "gui zheng" (return to correct); Xin Zheng Xiao Yun states: According to the *Jia Yi Jing*, the two characters "gui zheng" are written as the single character "zhi". "Qi liu" (Qi remains) in the *Jia Yi Jing* is written as "Qi liu" (Qi flows).)