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[Ping An]: This section, from the beginning of the chapter to "is called the highest treatment," is found in *Ling Shu* (Spiritual Pivot), Volume 10, Chapter 66, "The Origin of Hundred Diseases," and also in *Jia Yi Jing* (Classified Classic of Acupuncture and Moxibustion), Volume 8, Section 2. From "Five Evils Enter" to the end, it is found in *Su Wen* (Basic Questions), Volume 7, Chapter 23, "The Manifestation of Five Qi."

Yellow Emperor asked Qibo: The onset of various diseases all arises from wind, rain, cold, heat, clear dampness, and emotions of joy and anger. (Dampness arises from the earth, rain falls from above; although their nature is similar, the diseases they cause differ. Cold originates externally, clear qi emerges internally; though essentially one thing, their origins are internal or external, leading to different diseases. Joy belongs to Yang, anger belongs to Yin. These are the causes of disease.) Unregulated joy and anger will damage the Zang organs. (The Heart governs joy, the Liver governs anger. If these two emotions arise excessively, they damage Shen (Spirit). Damaging Shen constitutes internal injury to the five Zang organs, which is the internal sector of disease.) Wind and rain damage the upper part, while clear dampness damages the lower part. The three types of pathogenic factors damage different areas; I wish to hear how they converge. (Wind and rain descend from the head and back, thus constituting upper pathogenic factors. Clear dampness ascends from the sacrum and feet, thus constituting lower pathogenic factors. Since the types of damage differ, I hope you will explain them comprehensively.) Qibo replied: The three types of pathogenic factors are different; some originate in the Yin, and some in the Yang. Please allow me to explain their principles. (Some originate in Yin, referring to the arms and sacrum. Some originate in Yang, referring to the face, neck, chest, back, and flanks. I will elaborate fully.) Unregulated joy and anger damage the Zang organs; when Zang organs are damaged, disease originates in Yin. (Yin refers to the interior.) Clear dampness attacks deficiency, so disease originates in the lower part; wind and rain attack deficiency, so disease originates in the upper part. (When Foot Yang meridians merge with Yin, Yin deficiency allows clear dampness to attack, hence disease originates in the lower part. When facial and neck Yin meridians merge with Yang, Qi deficiency allows wind and rain to attack, hence disease resides in the upper part.) This is called the Three Parts. As for the rampant dispersion of pathogens, changes are countless. (This means that the three parts of pathogenic factors cause different diseases, varying with the cause, spreading extensively beyond measure. Ping An: Yi in *Ling Shu* and *Jia Yi Jing* is written as Yi [overflow], same below.) Yellow Emperor asked: I cannot enumerate them all, so I ask the Heavenly Master; please tell me this principle completely. (Various evils transmit and transform into disease; I know they cannot be counted. What the Heavenly Master knows should reach the ultimate numbers; I request to hear your complete explanation. Heavenly Master is a title of respect. Ping An: In *Ling Shu*, Heavenly Master is written as Former Master.) Qibo replied: Wind, rain, cold, and heat, if not empty evil (Xu Xie), cannot harm people alone. Those who suddenly encounter fierce winds and heavy rains without getting sick do so because, without empty evil, they cannot be harmed alone. It must be due to the wind of empty evil combined with the body's own deficiency; when two deficiencies meet, the pathogen can reside in the form. (Empty evil refers to wind coming from an empty direction, hence called empty evil. Wind, rain, cold, and heat are the correct Qi of the four seasons. Correct Qi of the four seasons, without the Qi of empty evil, cannot harm people. Sudden fierce winds and heavy rains, though not correct Qi, cannot harm people without the Qi of empty evil. Only the Qi of empty evil cannot harm people either. It requires the wind of empty evil and the body's deficiency to resonate, allowing the pathogen to reside in the form. Ping An: "Also no empty evil" in *Jia Yi Jing* is written as Gai; *Ling Shu* is the same, only with the character Gu before Xi. "Xiang De" in *Jia Yi Jing* is written as Xiang Bo.) When two realities meet, the masses have firm flesh. (Being attacked by empty evil depends on heavenly timing and one's own body, combining emptiness and fullness, leading to major illness. (Wind, rain, cold, and heat are the four seasons' correct Qi, constituting Real Wind. Firm flesh of the masses constitutes Real Form. When two realities meet, no pathogen resides to cause disease. Thus, when empty evil enters humans, it must be due to heavenly timing's empty wind and bodily deficiency, combining emptiness and fullness. Can means combine. Emptiness refers to bodily deficiency. Fullness refers to abundant pathogenic Qi. The combination of the two leads to major illness. Ping An: "Zhong Ren Rou Jian" in *Jia Yi Jing* is written as Zhong Ren Rou Jian; "Yin Yu Tian Shi" as Yin Yu Tian Shi. Gong Shen in *Ling Shu* is written as Shen Xing.) Qi has fixed abodes, named according to location. (The fixed place where pathogenic Qi resides determines the disease name based on that location. For example, if pathogenic Qi resides in the head, it causes head diseases like dizziness; if in the abdomen, abdominal pain and diarrhea; if in the feet, numbness in the feet.) Upper, lower, middle, and exterior are divided into three Zheng. (Upper refers to the face and head. Lower refers to the sacrum and feet. Middle refers to the abdomen. Each of the three parts has its exterior. Zhen means correct. Each of the three parts has distinctions, hence called Three Zheng. Ping An: Zhen in *Ling Shu* is written as Yuan; in *Jia Yi Jing* as Zhen.) Therefore, when empty evil enters humans, it starts at the skin. If the skin is lax, pores open, entering through hair follicles. Once entered, it goes deeper; once deep, hair stands erect causing chills, and the skin hurts. (Skin laxity occurs because the skin is struck by pathogenic Qi, losing tension, hence lax. Human hair follicles are hollow, so pathogenic Qi enters through this void. Jiu means long. When pathogenic Qi reverses and penetrates deeply into the interstices over time, chills occur. Ping An: "Cong Mao Fa Ru" in *Ling Shu* is written as Kai Ze Xie Cong Mao Fa Ru. Jiu in *Ling Shu* is written as Di; in *Jia Yi Jing* as Shao.) If it stays and does not leave, it transits to the Luo vessels. At this stage, there is muscle pain, and when painful, the large meridians are affected. (Qu means dissipating pathogenic Qi. Sun Luo and Da Luo are both called Luo vessels. The twelve main meridians circulate alternately; since the large meridians are in the muscles, current muscle pain affects the large meridians' circulation. Ping An: "Ze Chuan She Yu Luo Mai" in *Jia Yi Jing* is written as Ze She Yu Luo; "Tong Yu Ji Rou" as Tong Yu Ji Rou; "Qi Bing Shi" as Qi Bing Shi Tong Shi Xi; *Ling Shu* has Xi character after Xia.)
If it stays and does not leave, it transits to the Jing meridians. At this stage, there is frequent fright. (Meridians connect to the five Zang organs; when Zang organs are moved by pathogenic Qi, fright occurs. Fright is synonymous with Sa Xi chills. Su sound. Ping An: Xu , in *Ling Shu* is written as Sa Xi; same in *Jia Yi Jing*. Shan in *Ling Shu* is written as Xi.)
If it stays and does not leave, it transits to the Shu points. At this stage, the six meridians are blocked, limbs and joints ache, and the waist and spine become stiff. (Shu refers to the twenty-five Shu points of the five Zang organs and thirty-six Shu points of the six Fu organs. Large meridians refer to the Three Yin and Three Yang. Shu points are in the limbs, hence limb pain. Foot Taiyang and Du Meridian are in the waist and spine; pathogenic Qi follows them, causing stiffness. Ping An: Shu in *Su Wen* and *Jia Yi Jing* is written as Yu. "Si Zhi Jie Tong" in *Ling Shu* is written as Si Zhi Ze Zhi Jie Tong; in *Jia Yi Jing* as Si Jie Ji Tong.)
If it stays and does not leave, it transits to the Fu Chong vessel. At this stage, the body feels heavy and painful. (Chong Meridian is the sea of meridians; thus, pathogenic residence causes heaviness. Ping An: "Chuan She" in *Jia Yi Jing* is written as Fu She. After Fu Chong, *Ling Shu* and *Jia Yi Jing* have Zhi Mai two characters. "Ti Zhong Shen Tong" in *Jia Yi Jing* is written as Shen Ti Zhong Tong.)
If it stays and does not leave, it transits to the stomach and intestines. Residing in the stomach and intestines, there is distension and fullness. With much cold, there is borborygmus and undigested stool diarrhea; with much heat, there is loose, mushy stool. (Ben Xiang describes a vacuous rising appearance. Much cold leads to pathogenic undigested stool diarrhea; much heat leads to pathogenic loose mush. Mi means yellow like porridge. Ping An: Xiang in *Ling Shu* is written as Xiang; in *Jia Yi Jing* as Xiang; Yuan edition writes Xiang. *Jia Yi Jing* lacks Shi character before Bu Hua. Note: Mao in Yuan edition is mistakenly written as Ye.)
If it stays and does not leave, it transits outside the stomach and intestines, between the Mu Yuan. (Outside the stomach and intestines fu organs, there is Mu Yuan; pathogenic Qi transmits outside the stomach and intestines, overflowing to the space between Mu Yuan.) If it lingers in the vessels, detaining and not leaving, breathing accumulates into a mass. (Mai refers to Jing meridians and Luo vessels. Pathogenic Qi adheres to the meridians and vessels, transmitting into the stomach and intestines, accumulating into a mass disease over time; this sentence is a summary. Ping An: *Ling Shu* and *Jia Yi Jing* have Liu character after Qi.) It may adhere to Sun Luo, or to Luo vessels, or to Jing meridians, or to Shu vessels, or to Fu Chong vessels, or to Lv Jin, or to Mu Yuan of the stomach and intestines, connecting upwards to Huan Jin. The rampant dispersion of pathogenic Qi is indescribable. (Below discusses pathogenic adherence forming masses, briefly mentioning seven locations; changes are complex and cannot be fully discussed. Shu vessel refers to Foot Taiyang meridian, managing Shu points of five Zang and six Fu organs, hence called Shu vessel. Lv Jin refers to the tendons behind the spine. Huan Jin refers to Foot Yangming tendons, as Yangming Qi governs relaxation. Ping An: Sun Luo in *Ling Shu* is written as Sun Mai. Note: Zi Zhang in Yuan edition is written as Zi Man.) Yellow Emperor said: I wish to hear completely how it happens. (Wishing to hear completely means wishing to hear completely how masses form.) Qibo said: For those adhering to Sun Luo vessels forming masses, the mass moves up and down. Located in the arm and hand Sun Luo, which are floating and lax, unable to detain the mass Qi, it moves back and forth. Water in the intestines gathers and seeps, making a Zhuo Zhuo sound. (Ju means adhering. Pathogenic Qi adheres to arm and hand Sun Luo, moving up and down with the vessels. The Sun Luo is floating and lax, unable to detain mass Qi. Arm and hand vessels run through the intestinal area, so pathogenic Qi follows the vessels, causing water in the intestines to gather and make sound. Zhuo Zhuo is the sound of water. Ping An: *Jia Yi Jing* writes Bi Shou as Bo Hu; note: Bo sounds like Pai, meaning broken completely. Gou is written as ; Chang Jian Zhi Shui is written as Chang Wei Zhi Wai; *Ling Shu* writes Chang Jian Zhi Jian Shui.) With cold, the vessels fill and thunder pulls, causing occasional sharp pain. (Pathogenic Qi follows the vessels; when in the intestinal area, with cold, Sun Luo fills, pulling the intestines to make thunderous sounds, causing occasional sharp pain. Ping An: *Ling Shu* lacks Mai character; *Jia Yi Jing* writes Mai as Fu.) For those adhering to the Yangming Meridian, the mass resides beside the navel. After a full meal, it becomes larger; when hungry, it becomes smaller. (Stomach meridian, Foot Yangming Meridian, straight branch descends along the inner breast, beside the navel, entering Qi Street. Thus, when pathogenic Qi adheres, after a full meal the vessel is coarse and large; when hungry with less grain Qi, the vessel is fine and small. People today call this disease Liang . Ping An: Xia in *Ling Shu* is written as Jia.) For those adhering to Huan Jin, it resembles Yangming mass. After a full meal, it hurts; when hungry, it is comfortable. (Huan Jin is Foot Yangming tendon. Pathogenic Qi residing in Huan Jin means Foot Yangming tendon runs from upper and lower abdomen, beside the navel, resembling Foot Yangming Meridian mass. Full makes it large and painful; hungry makes it small and comfortable, also reflecting the size change of pathogenic Qi in the meridian. Ping An: Si in Yuan edition is written as Yi, note same; *Ling Shu* also writes Si.) For those adhering to Mu Yuan of the stomach and intestines, it hurts and connects externally to Huan Jin. After a full meal, it is comfortable; when hungry, it hurts. (Mu refers to the Mu of stomach and intestines fu organs. Yuan refers to the Yuan of stomach and intestines fu organs. Mu Yuan Qi connects externally to Foot Yangming tendon, so pathogenic Qi causes comfort when full and pain when hungry. Ping An: Note Foot Yangming Jin, Yuan edition mistakenly writes Jing.) For those adhering to Fu Chong vessel, it throbs and responds to touch. Upon releasing hand, hot air descends to both thighs, like boiling water pouring. (Lower Chong Meridian injects into large Luo of Shaoyin, exits Qi Street, follows inner thigh, enters Zhong, lies hidden inside bone, descends to ankle junction then branches; former lies hidden exiting dorsum descending, follows dorsum entering big toe gap. Because it lies hidden, it is called Fu Chong. Chuai means move. Pressing with hand, it moves responding to touch; releasing hand, hot air descends to both thighs like boiling water, indicating severe pathogenic Qi. Ping An: Chuai Chuai in *Ling Shu* and *Jia Yi Jing* is written as Chuai Zhi.) For those adhering to Lv Jin behind the intestines, the mass appears when hungry, disappears when full, and cannot be felt upon pressing. (Lv Jin is Foot Shaoyin tendon, following spine internally clamping Lv, attaching to spine behind small intestine. Appears when hungry, palpable when pressed; disappears when full, hard to feel when pressed. Ping An: *Jia Yi Jing* writes Fu De as Fu De.) For those adhering to Shu vessels, blockage occurs, fluids do not descend, orifices become dry and obstructed. (Shu vessel is Foot Taiyang meridian. Managing all Shu points, connecting to Kidney and belonging to Bladder, thus when pathogenic Qi adheres, fluids do not flow, stool becomes dry and obstructed, unable to exit via urination and defecation orifices. Ping An: Kong in *Ling Shu* is written as Kong; in *Jia Yi Jing* as Er Kong Qian Gan.) This is pathogenic Qi entering from exterior to interior, from upper to lower. (Location where pathogenic Qi knots and travels.) Yellow Emperor said: How does the initial formation of a mass proceed until it is fully formed? Qibo said: Masses initially form, arising from cold, and ascending Jue Qi forms the mass. (Ju is Yang pathogenic Qi, Ji is Yin pathogenic Qi; this speaks of disease completion; if speaking of generation, it involves Yin-Yang generation. Thus, mass initial formation, pathogen obtains cold Qi, enters and resides in foot, marking mass start, hence arising from cold. Cold Jue pathogenic Qi ascends, enters stomach and intestines, forming mass. Ping An: Under Jue in *Ling Shu* lacks Shang character; *Jia Yi Jing* writes Shang as Zhi.) Yellow Emperor said: How is the mass formed? Qibo said: Jue Qi generates foot overflow, foot overflow generates calf cold, calf cold causes blood vessels to coagulate and stagnate. Cold Qi ascends into stomach and intestines; entering stomach and intestines causes distension; distension forces extraintestinal fluid droplets to gather and not disperse, gradually forming a mass. (Above explains three origins of mass formation. External pathogenic Jue rebellious Qi attacks, causing Yang meridians to be deficient, hence calf cold. Calf vessels have thin skin, hence blood cold and coagulation/stagnation. Coagulation means solidifying. Cold blood follows Luo vessels upward, entering stomach and intestines. Cold blood entering stomach and intestines causes internal distension; cold fluid droplets outside intestines gather and cannot disperse, thus gradually forming mass. This is origin one of mass generation. Ping An: Zu in *Jia Yi Jing* is written as Zu Yi; note: *Ling Shu* writes Zu . Qi in *Ling Shu* is written as Ning Se; in *Jia Yi Jing* as Ning Qi. Han Qi Shang in *Jia Yi Jing* is written as Han Re Shang Xia.) Sudden excessive eating and drinking causes vessel fullness. Irregular living habits and excessive effort injure Luo vessels. Injury to Yang Luo causes blood to overflow externally, resulting in epistaxis. Injury to Yin Luo causes blood to overflow internally, resulting in hematochezia. Injury to extraintestinal Luo causes blood to overflow outside intestines. If there is cold outside intestines, fluid droplets and blood clash, combining and aggregating without dispersing, forming a mass. (Excessive drinking and eating without restraint causes vessel fullness. Irregular living and excessive effort injure internal Luo vessels. If internal Yang Luo of intestines is injured, epistaxis results; if internal Yin Luo of intestines is injured, hematochezia results; if extraintestinal Luo is injured, blood and cold fluid coagulate into mass. This is origin two of mass generation. Ping An: Sheng Shi Duo Yin in *Ling Shu* is written as Duo Shi Yin; Mai Man as Chang Man. Ju in *Ling Shu* and *Jia Yi Jing* is written as Ning Ju; San has Er character after it.) Sudden external strike by cold, or internal injury by sorrow and anger, causes Qi to rebel upward. Upward rebelling Qi blocks the six Shu points, preventing warm Qi from circulating. Coagulated blood is wrapped and does not disperse; fluids coagulate and stagnate, adhering and not leaving, thus masses form. (Sudden external cold entering internally, internal injury by sorrow and anger responding externally, internal and external clash, Jue Qi rebels upward. With abundant Yin Qi, six Fu organ Yang meridians and six Shu points cannot communicate, Wei Qi does not circulate, cold blood coagulates and stagnates, wraps and does not disperse, adhering to form mass, this is origin three. Ping An: You Nu in *Jia Yi Jing* is written as You Kong; Liu Shu as Xue Yu; Xue Yun Guo as Ning Xue Yun Guo; Qi Zao as Ning Se; *Ling Shu* writes Se Shen.) Yellow Emperor said: How about those originating in Yin? Qibo said: Worry and thought damage Heart. (Previously spoke of mass forming in Yang; below speaks of mass forming in Yin. Worry and thought labor Shen, thus damaging Heart.) Double cold damages Lung. (Dietary external cold, physical internal cold, hence double cold. Lung dislikes cold, thus double cold damages Lung.) Anger damages Liver. (Liver governs anger, thus excessive anger damages Liver.) Intercourse while drunk, sweating facing wind, damages Spleen. (Intercourse while drunk, sweating facing wind, Spleen sweat receives wind, thus damaging Spleen. Ping An: Zui Yi in *Jia Yi Jing* is written as Zui Bao.) Excessive effort or intercourse, sweating bathing in water, damages Kidney. (Kidney and Ming Men govern intercourse, thus effort and intercourse, sweating bathing in water, damages Kidney. Ping An: *Ling Shu* lacks Shui character.) These are the diseases generated by external, internal, and three parts. Yellow Emperor said: Good. (Worry and thought are internal, double cold is external, intercourse and facing wind constitute external/internal, thus combining the previous three parts' diseases. Ping An: *Ling Shu* and *Jia Yi Jing* write Wai Nei as Nei Wai.) How to treat? Qibo said: Observe the pain to know the response. With excess or deficiency, tonify if needed, drain if needed. Do not go against heavenly timing; this is called the highest treatment. (All mass diseases have pain; thus observe pain to await mass. Having obtained the disease, follow four seasons to apply tonification and drainage, achieving subtlety.)

Five Evils Enter: Evil entering Yang causes mania; evil entering Yin causes Blood Bi. Evil entering Yang, clashing causes epilepsy; evil entering Yin, clashing causes aphonia. Yang entering Yin, disease is quiet; Yin exiting to Yang, disease manifests as irritability. (Hot Qi entering Yang meridians, double Yang causes mania. Cold evil entering Yin meridians, double Yin causes Blood Bi. Yang evil entering Yang meridians, gathering causes epilepsy. Yang evil entering Yin meridians, gathering causes aphonia unable to speak. Yang evil entering Yin causes disease favoring quietness. Yin evil exiting to Yang, Yang movement causes frequent anger. Ping An: *Su Wen* Wu Xie Ru is written as Wu Xie Suo Luan; Ze Wei Xue Bi ze is written as Bi; Xie Ru Yu Yang Bo is written as Bo Yang two characters; Xie Ru Yu Yin Bo is written as Bo Yin two characters; Shang Wu Shan character before Nu. Xin Zheng Xiao says: "Nan Jing says: Double Yang is mania, double Yin is epilepsy. Chao Yuan Fang says: Evil entering Yin is epilepsy. Mai Jing says: Yin attaching to Yang is mania, Yang attaching to Yin is epilepsy. Sun Simiao says: Evil entering Yang is mania, evil entering Yin is Blood Bi. Evil entering Yang, transmitting causes epilepsy/spasm; evil entering Yin, transmitting causes pain/aphonia. Quan Yuanqi says: Evil already entered Yin, re-transmits to Yang, pathogenic Qi abundant, Zang-Fu receive evil, causing Qi not to arrive, Ying Qi not to circulate whole body, evil clashes with correct Qi, activating epilepsy. Evil already entered Yang, Yang now re-transmits to Yin, Zang-Fu receive evil, thus unable to speak, this is overcoming correct Qi. Various schools differ, thus all recorded." Also quotes Quan Yuanqi: Yang entering Yin is quiet, exiting is fear. Qian Jin Fang says: Yang entering Yin disease is quiet, Yin exiting to Yang disease is anger.) Five Manifestations: Yin disease manifests in bones, Yang disease manifests in blood, flavor disease manifests in Qi, Yang disease manifests in winter, Yin disease manifests in summer. (Yin disease manifests as bone pain etc. Yang disease manifests as Blood Bi etc. Five flavors disease manifests as Qi imbalance etc. Winter Yang is inside, thus disease manifests in winter. Summer Yang is outside, thus disease manifests in summer. Ping An: *Su Wen* Wu Fa is written as Wu Bing Suo Fa; Yi Wei Bing Fa Yu Qi is written as Yin Bing Fa Yu Rou.)