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Huangdi asked Qibo: The medical classics state that summer injury by heat (Shu) leads to malaria in autumn. Malaria attacks at specific times; what is the reason for this?

Qibo replied: When pathogenic factors invade the Fengfu acupoint, the disease follows the spine downward. The Wei Qi (Defensive Qi) gathers at the Fengfu point once a day and night. The next day, it descends one vertebral segment. Therefore, the onset of the disease occurs later each day. This is because the pathogen first resides in the back along the spine. Whenever Wei Qi reaches the Fengfu point, the Cou Li (skin texture and pores) open. When the Cou Li open, pathogenic factors enter; when they enter, the disease manifests. This is why the daily onset time delays progressively.

Wei Qi moves from the Fengfu point, descending one vertebral segment daily. After twenty-one days, it reaches the coccyx. On the twenty-second day, it enters the interior of the spine and pours into the Fu Chong Mai (Hidden Chong Vessel). It travels within the Fu Chong Mai for nine days, emerging at the Quepen area. Its qi moves upward, so the condition slightly improves.

The main meaning of this chapter discusses how Wei Qi circulates fully in the skin and muscle layers, serving as the external defense of the body. It travels through the Yang aspects during the day and the Yin aspects at night, responding to the opening and closing of heavenly movements. In one day and night, it gathers at the Fengfu point. The next day, it descends one segment. Within twenty-two days, it internally notes into the Fu Chong Mai. Traveling for nine days more, it emerges superiorly at the Quepen. This corresponds to the moon completing one circuit around the sky in a month. When seawater swells in the west, human blood and qi accumulate, and muscles are full. When seawater swells in the east, human blood and qi become deficient, Wei Qi departs, and only the form remains. This corresponds to the waxing and waning of seawater. Generally, in one day and night, the Heavenly Dao circles the earth once; the qi of water and heaven communicates up and down, and the moon corresponds to water. Wei Qi travels between the muscles and Cou Li. In cold, the skin tightens and the Cou Li close; in heat, the skin relaxes and the Cou Li open. Thus, summer injury by heat leads to malaria in autumn, demonstrating the movement of Wei Qi. Malaria occurs when heat pathogens hide in the skin and muscles. In autumn, Yin qi moves outward. When Yin meets Yang, and cold contends with heat, the pathogen and healthy qi stand in stalemate, resulting in malaria.

Fengfu is an acupoint of the Du Meridian, located in the midline of the posterior hairline. Pathogens residing in Fengfu descend along the spine. Wei Qi gathers at Fengfu daily and nightly, descending one segment the next day, causing delayed onset. This indicates the pathogen initially resided in the back. Thus, whenever Wei Qi reaches Fengfu, the Cou Li open. Opening allows pathogens to enter and meet Wei Qi, triggering the disease. As Wei Qi descends one segment daily, the onset delays further. Essentially, as Wei Qi descends one segment daily, it opens the Cou Li of the lower segment. Pathogens enter due to this opening, meet Wei Qi, and the disease arises.

The Fu Chong refers to the Chong Mai (Penetrating Vessel) running deeply within the back, the sea of the meridians. Wei Qi circulates externally downward and internally upward, circling once, corresponding to the Heavenly Dao. Lu Lianghou stated: Wei Qi traveling through Yang and Yin responds to the brightness and darkness of day and night. Following the spine downward into the Chong Mai and upward responds to the Heavenly Dao's operation externally and its connection internally through the earth. Wei Qi internally notes into the Fu Chong Mai and externally notes into the Foot-Yangming Meridian, similar to the Si Tian (Heavenly Sovereign) and Zai Quan (Earthly Foundation) energies rotating up and down. The spring is below heaven, connecting with the waters within the earth.

If pathogens internally contend with the five Zang organs and horizontally connect to the Mu Yuan (Moyuan/Epigastric region), the path is distant, the qi is deep, and the movement is slow, preventing daily attacks. Thus, it accumulates and attacks on the following day.

Internal contention with the five Zang organs means pathogens remain in the Mu Yuan of the five Zang organs. The Mu Yuan horizontally connects to the fatty membranes between the zang-fu organs. When malaria pathogens internally contend between the five Zang organs' Mu Yuan, the path is distant and the qi is deep. They cannot travel outwards with Wei Qi, so they do not attack daily but every other day. This describes Wei Qi traveling through the Yin at night, moving between the Mu Yuan of the five Zang organs.

Huangdi asked: When Wei Qi reaches Fengfu, the Cou Li open, allowing pathogens to enter. If Wei Qi descends one segment daily, it is no longer at Fengfu. What then?

Qibo answered: The Fengfu position is not fixed. Wherever Wei Qi responds, it must open the Cou Li there. The segment where the qi stays becomes its "Fu" (residence).

This elaborates on the previous text, clarifying that Wei Qi emerges from Quepen, moves upward, gathers at Fengfu in one day and night, and descends one segment the next day. A year has 360 days, plus an excess of 5 days and 940 fen. Thus, a month has an excess of 495 fen. On the ninth day after emerging from Quepen, after traveling one day and night, precisely at dawn on the first day of the new year, it gathers at Fengfu. The next day, descending one segment, the pathogen and Wei Qi also meet at the lower segment, gathering at Fengfu. Wherever Wei Qi responds, it opens the Cou Li. Opening allows pathogens to descend along the spine and meet Wei Qi, causing disease. Thus, Fengfu has no fixed location; it refers to the segment where Wei Qi stays daily as its residence. Hence, it constantly gathers at Fengfu. "Constantly" means twelve gatherings at Fengfu throughout the year. "Gathering" means meeting with the spinal meridian. Starting at Fengfu, the segment stayed at daily is its residence.

Huangdi said: Excellent. Wind and malaria seem similar, yet wind is constant while malaria occurs only at specific times. Why?

Qibo answered: Wind pathogens stay in their location (exterior). Malaria pathogens follow the meridians, sinking and internally contending. Thus, they manifest when Wei Qi arrives.

Wind is a Yang pathogen of heaven, so it stays in the exterior Yang divisions. Malaria involves Cold, Wind, Heat, and Dampness pathogens, governing the alternation of Yin/Yang and Cold/Heat. Thus, they follow the entry and exit of meridians, sinking to internally contend, manifesting when corresponding with Wei Qi. Wei Qi travels counter and smooth along the meridians.

Huangdi asked Shaoshi: I have heard that the eight winds of the four seasons injure people, causing cold or heat. Does cold tighten the skin and close the Cou Li, while heat relaxes the skin and opens the Cou Li, allowing thief-wind and pathogens to enter? Or must one encounter the empty evils of the Eight Rectitudes (Ba Zheng) to be injured?

Shaoshi answered: Not so. Injury by thief-wind and pathogens does not necessarily occur at specific times, but it requires the Cou Li to be open. If entering when open, the invasion is deep, internal illness is extreme, and the patient suffers sudden and violent onset. If entering when closed, the invasion is shallow and lingering, and the disease develops slowly.

This states that pathogens must enter deeply when the Cou Li are open. The four seasons bring cold and heat, so the eight winds include cold wind and heat wind. Cold tightens the skin and closes the Cou Li; heat relaxes the skin and opens the Cou Li. However, injury by thief-wind depends on the deficiency or excess and opening/closing of human qi, leading to shallow or deep invasion, not merely determined by cold or heat.

Huangdi asked: If the climate is moderate and the Cou Li are not open, yet sudden illness occurs, why?

Shaoshi answered: Do you not know how pathogens enter? Even in peaceful living, the opening, closing, slackening, and tightening of the Cou Li have their own timing.

Huangdi asked: May I hear about it?

Shaoshi answered: Humans correspond to Heaven and Earth and resonate with the Sun and Moon. When the moon is full, seawater swells in the west; human blood and qi accumulate, muscles are full, skin is dense, hair is firm, the Cou Li close, and smoke-dust adheres. At this time, even if encountering thief-wind, the invasion is shallow and not deep. When the moon is dark (waning/new), seawater swells in the east; human blood and qi are deficient, Wei Qi departs, and only the form remains. Muscles diminish, skin hangs loose, the Cou Li open, hair falls out, the Cou Li become thin, and smoke-dust falls off. At this time, encountering thief-wind leads to deep invasion and sudden, violent illness.

This elaborates on how human qi's deficiency/excess and opening/closing respond to the waxing/waning of heavenly times. Humans correspond to Heaven and Earth and resonate with the Sun and Moon. Wei Qi travels through Yang by day and Yin by night, responding to the opening and closing of the Heavenly Dao. The sun circles the earth; Wei Qi descends from Fengfu to the sacrum, notes into the Chong Mai, and emerges at Quepen, corresponding to one month when the moon meets heaven. The moon is the Yin soul; thus, its waxing and waning corresponds to the ebb and flow of water. Full moon means seawater swells in the west; dark moon means seawater swells in the east. The moon wanes in the west and fills in the east; it is born in the west, so it swells from west to east. Wei Qi warms the flesh, fills the skin, thickens the Cou Li, and governs opening and closing. When Wei Qi is abundant, muscles are full, skin is dense, hair is firm, Cou Li close, and smoke-dust adheres. Even with thief-wind, invasion is shallow. When the moon is dark, seawater swells in the east, human blood/qi are deficient, Wei Qi departs, muscles diminish, skin loosens, Cou Li open, hair falls, Cou Li thin, smoke-dust falls. "Li" refers to muscle texture, the convergence point of the San Jiao, hence called "Jiao Li". Smoke-dust is the residue of Fire and Earth. San Jiao governs Fire; muscles govern Earth. When Jiao Li is thin, smoke-dust falls, meaning muscle loss and Cou Li opening dissipate the qi of the muscle-Cou Li. Encountering thief-wind then causes deep invasion and sudden illness. "Wei Qi departing" means leaving the body and entering the Fu Chong Mai. On the 22nd day, it enters internally, notes into Fu Chong, travels for 9 days, emerges at Quepen, and moves upward. This is when it re-emerges to the body on the first day of the lunar month and reunites at Fengfu. Thus, the *Ba Zheng Shen Ming Lun* states: When the moon begins to grow, blood and qi begin to refine, and Wei Qi begins to move. The day the moon is dark and revives is called "Shuo" (New Moon); Wei Qi begins to travel through Yang on this day and gathers at Fengfu. This is how Wei Qi corresponds to Heaven and Earth and resonates with the Sun and Moon. Wang Zilv said: Seawater tides rise on the 8th, peak on the 15th, and recede on the 23rd. Thus, Wei Qi swells with the full moon and leaves the body on the 23rd.

Huangdi asked: What causes sudden death or acute illness?

Shaoshi answered: Those who encounter the "Three Deficiencies" (San Xu) die rapidly from acute disease. Those who obtain the "Three Excesses" (San Shi) cannot be harmed by pathogens.

Huangdi asked: Tell me about the Three Deficiencies.

Shaoshi answered: Relying on the weakness of the annual luck, encountering the empty moon, and losing the harmony of the seasons, thereby being injured by thief-wind, is called the Three Deficiencies. One who does not understand the Three Deficiencies is a crude physician.

Huangdi asked: Tell me about the Three Excesses.

Shaoshi answered: Encountering the abundance of the year, meeting the full moon, and obtaining the harmony of the seasons, such that even with thief-wind and pathogens, harm cannot occur, is called the Three Excesses.

Huangdi praised: Excellent theory! Clear Dao! Please store it in the Golden Casket. But this is merely a discussion regarding an individual.

The "weakness of the year" refers to the insufficiency of the Six Qi ruling Si Tian and Zai Quan. The "empty moon" refers to the time of the dark moon. "Losing seasonal harmony" refers to abnormal qi of the four seasons. Since Wei Qi corresponds to Heaven and Earth and resonates with the Sun and Moon, the weakness of the year, emptiness of the moon, and disharmony of time all cause Wei Qi dysfunction. Wei Qi protects the exterior and secures the body. When Wei Qi is deficient, the Cou Li are loose, and pathogens enter directly inward, causing sudden death or acute illness. The Three Deficiencies and Excesses are common to the people. Huangdi's comment "discussion of an individual" implies that empty evil and thief-wind affect those who encounter them, unlike the strong winds mentioned later that can harm everyone. Thus, sages avoid wind as they would avoid arrows and stones.

Huangdi asked: Why do people often suffer from the same diseases in a given year? What is the cause?

Shaoshi answered: This is observed through the Eight Rectitudes (Ba Zheng).

Huangdi asked: How to observe?

Shaoshi answered: Usually, on the Winter Solstice day, Tai Yi stands in the Ye Zhe Palace. Upon its arrival, heaven responds with wind and rain. Wind and rain coming from the south are Empty Winds (Xu Feng), which injure people. If they arrive at midnight, people are asleep and not affected, so few fall ill that year. If they arrive during the day, people are lax and struck by Empty Wind, so many fall ill. Empty evil enters the bones but does not immediately manifest externally. By Li Chun (Start of Spring), Yang qi expands greatly, and the Cou Li open. Coinciding with Li Chun, wind comes from the west, and people are again struck by Empty Wind. These two evils contend, causing stagnation in the meridians. Any occurrence of wind accompanied by rain is called "Sui Lu" (Yearly Dew). If the year is harmonious with few thief-winds, people are few in illness and death. If the year has many thief-winds and pathogens, with discordant cold and warmth, people suffer much illness and death.

The Eight Rectitudes refer to Winter Solstice, Summer Solstice, Spring Equinox, Autumn Equinox, Start of Spring, Start of Summer, Start of Autumn, and Start of Winter, determining the eight cardinal directions to observe wind and rain. On Winter Solstice, wind comes from the south; on Li Chun, wind comes from the west. These come from the opposing direction, acting as Empty Wind injuring people. Halfway through the Zi hour on Winter Solstice, the qi is just beginning; thus, empty evil enters the bones without immediate manifestation. At Li Chun, Yang qi expands, Cou Li open, and coinciding with western wind, the two evils contend, causing meridian stagnation. Wind is the qi of heaven; rain is the dew of heaven. Occurrences of wind and rain together are called Sui Lu. If a year receives timely wind and rain with few thief-winds, it is harmonious, leading to good harvests, peace, and little illness. If wind and rain are untimely and fierce winds/pathogens abound, losing seasonal harmony, people suffer much illness and death.

Huangdi asked: Regarding Empty Wind, how severe is the injury, and how is it observed?

Shaoshi answered: On the first day of the first lunar month, Tai Yi resides in the Tian Liu Palace. If there is a northwest wind without rain, many will die. On the first day of the first month, north wind at dawn causes many deaths in spring. If north wind blows at dawn, three out of ten people die. North wind at noon causes many deaths in summer. North wind at dusk causes many deaths in autumn. All-day north wind causes six out of ten to die of serious illness. Wind from the south on the first day is called "Dry Land"; from the west, "White Bones," indicating national disaster and much death. Wind from the east, overturning houses and raising sand, indicates major national calamity. Wind from the southeast causes deaths in spring. If the weather is warm and windless, grain is cheap and people are healthy. If cold and windy, grain is expensive and people are sick. This is how to predict the year's wind and human health. If there is no wind on the Chou day of the second month, people suffer heart and abdominal diseases. If the Xu day of the third month is not warm, people suffer cold and heat disorders. If the Si day of the fourth month is not hot, people suffer jaundice. If the Shen day of the tenth month is not cold, people suffer sudden death. The winds described here are those that overturn houses, break trees, raise sand, raise goosebumps, and open the Cou Li.

Observing the four seasons' annual qi on the first day of the first month uses the Yin month as the start of the year, as humans are born in Yin. The statement "no wind on Chou day of the second month" relates to observing heaven's wind and rain starting from Tai Yi in the Ye Zhe Palace on Winter Solstice, using the Zi month as the start of the year, as heaven opens in Zi. The third month governs Chen; "not warm on Xu day of the third month" is because Chen and Xu combine. In the twelve months, the governance lies in the twelve Earthly Branches; in the Six Qi, it lies in the Three Yin and Three Yang. Hence, "not warm on Xu day of the third month, not hot on Si day of the fourth month." Some follow Six Qi, some follow twelve Branches. Yin-Shen Shaoyang governs the Qi; "not cold on Shen day of the tenth month" refers to the governance of Six Qi. Heavenly Stems start with Jia; Earthly Branches start with Zi. In Zi-Wu years, Yin-Shen Shaoyang governs the fifth qi in the ninth and tenth months. "Not cold on Shen day of the tenth month" means the dominant qi is out of season, causing sudden death. The master and guest qi of the four seasons are governed by the Three Yin and Three Yang. The four seasons of a day correspond to the four seasons of a year, circling the Heavenly Dao daily, and the year meets heaven.

Wind from the east on the first day is the Proper Wind. Because it lifts wood and raises sand, it brings national disaster. Cold weather with wind on the Chou day of February is called Harmonious Wind. The winds described earlier were fierce winds breaking trees and raising sand, lacking moist rain, causing death.

This chapter discusses human deficiency and excess, responding to the waxing and waning of heavenly qi, and the different harmonious or harsh qualities of seasonal wind and dew. Thus, sages say: Avoid empty evil as one avoids arrows and stones, so that miscellaneous evils cannot harm.