黄帝问于岐伯曰。夫百病之始生也。皆生于风雨寒暑。清湿喜怒。喜怒不节则伤脏。风雨则伤上。
清湿则伤下。三部之气。所伤异类。愿闻其会。岐伯曰。三部之气各不同或起于阳。或起于阳。请
言其方。喜怒不节则伤脏。脏伤则病起于阴也。清湿袭虚。则病起于下。风雨袭虚。则病起于上。是
谓三部。至于其淫 。不可胜数。（胜平声数上声）
按本经云。风寒伤形。忧恐忿怒伤气。气伤脏。乃病脏。寒伤形。乃病形。风伤筋脉。筋脉乃应。
此形气外内之相应也。又曰。邪气在上者。言邪气之中人也高。故邪气在上也。清气在下者。言清湿地气
之中人也。必从足始。
故清气在下也。是风雨清湿之邪。病在外而伤于形之上下。喜怒不节。则伤脏而病起于阴。夫形者。
皮脉肉筋骨。五脏之外合也。此盖承上章而言五行之形。不足于上者。则风雨袭虚而病起于上。不
足于下者。则清湿袭虚而病起于下。脏气不足者。则喜怒伤气而病起于阴。故当用五谷五畜五果之五
味。合而服之。以补益精气。使阴阳和调。血气充满。病则无由入其腠理。此贤人之所以养生。良医
之治未病也。徐振公曰。五音之人应五脏。左右太少之人。应身形之上下。五音之人。阴气多而阳
气少。左右太少之人。阴气少而阳气多。是五音之人当病形。左右太少之人当病脏矣。虽然。阴中有
阳。阳中有阴。阳盛者。有血气之不足。阴盛者。亦有血气之不足也。倪仲宣曰。此注照应下章行针论。
黄帝曰。余固不能数。故问先师。愿卒闻其道。岐伯曰。风雨寒热。不得虚邪。不能独伤人。卒
然逢疾风豪雨而不病者。盖无虚故邪不能独伤人。此必因虚邪之风。与其身形两虚相得。乃客其形。
两实相逢。众人肉坚。其中于虚邪也。因于天时。与其身形。参以虚实。大病乃成。气有定舍。因处为
名。上下中外。分为三员。
此言风雨之邪。客于形而不伤气者。传舍于内而成积也。金匮要略云。一者经络受邪。入脏腑为
内所因。此言邪伤六经之气。而内入于脏腑者也。盖三阴三阳之气。主于肤表而合于六经。故邪伤于
气。则折毛发理。使正气横倾。淫邪泮衍于肌腠络脉之间。而传溜于血脉。经脉内连脏腑。是以大邪
入脏。腹痛下淫。可以致死。而不可以致生。盖阴阳六气。生于五行。五脏内合五行。外合六气。故
伤于气者。传溜于血脉。则内干脏腑矣。如病形而不病气者。虽传舍于经脉。只留于肠胃之外而成积也。
夫虚邪之中人也。洒淅动形。正邪之中
人也微。先见于色。不知于其身。若有若无。若亡若存。有形无形。莫知其情。是虚邪伤形。而正邪
伤气也。正邪者。天之正气。风寒暑湿燥火也。盖天有此六气。而人亦此六气。是以正邪中气。同气
相感也。故曰风雨寒热。不得虚邪。不能独伤人。伤人者。谓伤人之形也。虚邪者。虚乡不正之邪风。
形者。皮脉肉筋骨。五脏之外合。应地之五行也。地之五行。应天之五时。地之五方。虚风者。春时之
风。从西方来。夏时之风。从北方来。此五行不正之气。故伤人之形。是天之六气。伤人之六气。地
之五行。伤人之五形。盖人秉天地之形气。而生成此形气也。是以虚邪之风。与其身形。两虚相搏。
乃客于形。传舍于肠胃之外而成积也。众人肉坚者。承上文而言二十五形之人。血气不足。不能充肤热
肉。以致虚邪之客于形。非比众人之肉坚也。因于天时者。因春时之西风。夏时之北风也。大病乃成者。
大邪着于肠胃之间而成积也。气有定舍者。言邪气淫 。不可胜论。或着于孙络。或着于经输。而后有
定名也。此论风雨伤上。下节论清湿伤下。末节论喜怒伤中。而分为三员也。徐振公曰。一篇之中。
并不提一气字。而此节用三形字。反复三转。下节云。内伤于忧怒。则气上逆。正所谓风寒伤形。忧恐
忿怒伤气。阐发圣义。须全经贯通。方能具大手眼。
是故虚邪之中人也。始于皮肤。皮肤缓则腠理开。开则邪从毛发入。入则抵深。深则毛发立。毛发
立则淅然。故皮肤痛。留而不去。则传舍于络脉。在络之时。痛于肌肉。其痛之时息。大经乃代。留而不
去。传舍于经。在经之时。洒淅喜惊。留而不去。传舍于输。在输之时。六气不通。四肢则肢节痛。腰脊
乃强。留而不去。传舍于伏冲之脉。在伏冲之时。体重身痛。留而不去。传舍于肠胃。在肠胃之时。贲响
腹胀。多寒则肠鸣飧泄。食不化。多热则溏出糜。
留而不去。传舍于肠胃之外。募原之间。留着于脉。稽留而不去。息而成积。或着孙脉。或着络脉。
或着经脉。或着输脉。或着于伏冲之脉。或着于膂筋。或着于肠胃之募原。上连于缓筋。邪气淫 。
不可胜论。（飧叶孙胜平声）
此言风雨虚邪。伤于形身之上。从形层传舍于内而成积也。夫邪之中人。必先始于皮毛。人之形虚。
则皮肤缓而腠理开。开则邪从毛发入。入则抵深。深则毛发立。盖气者。所以充肤泽毛。如邪伤气。
则折毛发理。此邪入于皮肤而气不伤。故毛发立。淅然者。洒淅动形也。皮肤痛者。邪留于皮肤也。
络脉者。浮见于皮肤之孙脉络脉。在络之时。痛于肌肉者。邪留于肌肉络脉之间。而不得入于经也。
缪刺篇曰。邪之客于形也。必先舍于皮毛。留而不去。入舍于孙脉。留而不去。入舍于络脉。留而不去。
入舍于经脉。内连五脏。散于肠胃。此邪之从皮毛而入。极于五脏之次也。如此则治其经焉。今邪客
于皮毛。入舍于孙络。留而不去。闭塞不通。不得入于经。流溢于大络而生奇病也。息、止也。大经
乃代者。谓邪止于肌肉络脉之间。不得入于经脉。而流于大经也。大经者。经隧也。经隧者。五脏六腑之
大络也。传舍于经者。传舍于胃腑之经隧。足阳明之脉病。故惕然而喜惊也。输者。转输血气之经脉。
即脏腑之经隧也。脏腑之大络。左右上下。并经而出。布于四末。故邪留于输。则六经不通。四肢之肢
节痛也。腰脊乃强者。脏腑之大络。通于督络之长强也。伏冲者。伏行腹内之冲脉。冲脉者。起于胞中。
挟脐上行至胸中而散于皮肤。充肤热肉。濡养筋骨。邪留于内。则血气不能充溢于形身。故体重身痛也。
留而不去。传舍于肠胃。在肠胃之时。贲响腹胀。多寒则肠鸣飧泄。多热则溏出糜。糜者。谷之不化
者也。募原者。肠胃外之膏膜。留着于脉者。募原间之脉络也。稽留其间而不去。则止于此而成积矣。
孙脉络脉者。募原中之小络。经脉者。胃腑之大经也。输脉者。脏腑之大络。转输水谷之血气者也。伏冲者。
伏行于腹之冲脉。募原者。肠胃之脂膜也。膂筋者。附于脊膂之筋。缓筋者。循于腹内之筋也。此数
者。在于肠胃之前后左右。邪随着而为积。邪之淫溢。不可胜数也。徐振公曰。邪伤气。则邪从
经脉而内干脏腑。盖三阴三阳之气。生于脏腑。从经脉而出于肤表。故邪亦从经脉而内干于脏腑也。
邪伤形。则从别络而入于肠胃之外。盖形中之血气。出于胃腑水谷之精。渗出于胃外之孙脉络脉。溢于
胃之大络。转注于脏腑之经隧。外出于孙络皮肤。所以充肤热肉。渗皮毛濡筋骨者也。是以形中之邪。
亦从外之孙络。传于内之孙络。留于肠胃之外而成积。故下文曰。其着孙络之脉而成积者。其积往来
上下。臂手孙络之居也。浮而缓。不能拘积而止之。盖外内孙络之相通。是以外内之相应也。倪仲
宣曰。古来论完谷不化。有言因于寒者。有言因于热者。今本经以多热则溏出糜。是因于热矣。盖火
能速物而出。故不及化。
黄帝曰。愿尽闻其所由然。岐伯曰。其着孙络之脉而成积者。其积往来上下。臂手孙络之居也。
浮而缓。不能拘积而止之。故往来移行肠胃之间。水凑渗注灌。濯濯有音。有寒则 满雷引。故时切
痛。其着于阳明之经。则挟脐而居。饱食则益大。饥则益小。其着于缓筋也。似阳明之积。饱食则痛。
饥则安。其着于肠胃之募原也。痛而外连于缓筋。饱食则安。饥则痛。其着于伏冲之脉者。揣之应手
而动。发手则热气下于两股。如汤沃之状。其着于膂筋。在肠后者。饥则积见。饱则积不见。按之不
得。其着于输之脉者。闭塞不通。津液不下。孔窍干塞。此邪气之从外入内。从上下也。
此承上文申明留着而成积者。各有形证也。孙络者。肠胃募原间之小络。盖胃腑所出之血气。
渗出于胃外之小络。而转注于大络。从大络而出于孙络皮肤。其着于内之孙络而成积者。其积往
来上下。其臂手孙络之居于外也。浮而缓。不能拘束其积而止之。故往来移行于肠胃之间。胃腑
之水津。渗注于外。则濯濯有声。盖留滞于孙络。而不能注于大络也。阳明之经。乃胃之大络。故
挟脐而居。饱则水谷之津注于外。故大。饥则津血少。故小也。缓筋者。经于腹内之筋。故有似
乎阳明之积。饱则胀。故痛。饥则止而安也。募原者。肠胃之膏膜。饱则津液渗润于外。故安。
饥则干燥。故痛也。伏冲之脉。挟于脐间。故揣之应手而动。发手则热者。冲脉之血气充于外也
。冲脉下循阴股。出于胫气之街。其气下于两股。如汤沃之状者。因积而成热也。膂筋者。附于胁
膂之内。在肠之后。故饥则积见。饱则不见。而按之不得也。输之脉者。转输津液之脉。脏腑之大
络也。胃腑水谷之精。从胃之大络。而注于脏腑之大络。从脏腑之大络。而出于皮肤。故积着于输
之脉。则脉道闭塞不通。津液不下。而皮毛之孔窍干塞也。此邪气之从外而内。从上而下。以成其
积也。徐振公曰。手孙络之居也。浮而缓者。谓无力也。胗孙络之浮缓者。胗尺肤也。盖脉之急者。
尺之皮肤亦急。脉缓者。尺之皮肤亦缓。胃腑所出之气血。从阳明之五里而出于尺肤。是以胗孙络
之浮缓。则知其无力而不能拘积也。倪仲宣曰。寸关尺三部。以候脏腑经脉之气。人迎气口。以
候在外之气。尺肤以候内在之气。
黄帝曰。积之始生。至其已成。奈何。岐伯曰。积之始生。得寒乃生。厥乃成积也。
此承上启下之文。风雨者。在天之邪而伤上。清湿者。在地之邪而伤下。在天曰生。在地曰成。
故积之始生。得寒而生。清湿之邪。厥逆于下而成积也。
黄帝曰。其成积奈何。岐伯曰。厥气生足 。 生胫寒。胫寒则血脉凝涩。血脉凝涩。则寒气
上入于肠胃。入于肠胃则 胀。 胀则肠外之汁沫。迫聚不得散。日以成积。卒然多食饮。则肠满。
起居不节。用力过度。则络脉伤。阳络伤则血外溢。血外溢则衄血。阴络伤则血内溢。血内溢则后
血。肠胃之络伤。则血溢于肠外。肠外有寒汁沫。与血相搏。则并合凝聚不得散。而积成矣。卒然
外中于寒。若内伤于忧怒。则气上逆。气上逆。则六输不通。湿气不行。凝血蕴裹而不散。津液涩
渗。着而不去。而积皆成矣。（ 莫本切也门上声）
此言清湿之邪。伤下之形而成积也。 、闷也。厥逆生足 者。邪气厥逆于下。则足胫 。而
不得疏利矣。 则生寒。寒则血脉凝涩。而寒气上入于肠胃。入于肠胃则 胀。胀则肠外之汁沫。
迫聚不得散。日久而成积矣。若卒然多食饮。则肠满。又或起居不节。用力过度。则络脉伤。络脉者。
即脏腑所出血气之别络也。阳络者。上行之络脉。伤则血外溢于上而为衄。阴络者。下行之络脉。伤
则血内溢而为后血。肠胃之络伤。则血溢于肠外。肠外有寒汁沫。与血相搏。则并合凝聚。不得散而
积成矣。或卒然外中于寒邪。若兼之内伤于忧怒。则气上逆。气上逆则六输不通。输者。转输血气之
脉。六者。手经之输。即阳络也。六输不通。则温肤热肉之气不行。血凝蕴裹而不散。津液涩于络中。
渗于络外。着而不去而积成矣。此言汁沫迫聚。或肠外之寒汁沫。与血相搏。皆为成积也。或外中于
寒。兼之内伤忧怒凝血与津液留着。亦皆成积也。按经脉有手三阴三阳之大络。并经而上循于手。
足三阴三阳之大络。并经而下循于足。主行血气。渗出于脉外以养形。是以阳络伤。则上
出于空窍而为衄血。阴络伤。则内出于肠胃而为便血。六输不得上通于外。则内溢于脉外而成积。
是外内皆主渗出于脉外者也。徐振公曰。因于风雨所生之积。着于有形而生。故曰生。因于清湿
所成之积。乃凝血与津汁。搏聚于空郭之中。如怀子之状。虚悬而成形。盖因于天者。本于无形。
故附于有形而生。因于地者。乃自成其形也。
黄帝曰。其生于阴者奈何。岐伯曰。忧思伤心。重寒伤肺。忿怒伤肝。醉以入房。汗出当风伤
脾。用力过度。若入房汗出则伤肾。此内外三部之所生病者也。
此言喜怒不节。则伤五脏之形。而病起于阴也。忧思伤心。形寒饮冷则伤肺。忿怒不节则伤肝。
醉以入房。汗出当风则伤脾。用力过度。若入房汗出则伤肾。此外因于天之风雨。地之清湿。内因
Huangdi asked Qibo: When various diseases begin to arise, they all originate from wind, rain, cold, and heat, as well as clear dampness and emotions of joy and anger. If joy and anger are not regulated, they will damage the Zang organs; wind and rain will damage the upper part of the body; clear dampness will damage the lower part of the body. The Qi of these three regions causes different types of damage. I wish to hear how they converge.
Qibo replied: The Qi of the three regions is different; some originate from the Yang aspect, and some from the Yin aspect (Note: The original text repeats "originate from Yang," but based on context and medical theory, it should be "originate from Yin"). Let me explain the principle. If joy and anger are not regulated, they will damage the Zang organs. Once the Zang organs are damaged, the disease arises from the Yin aspect. Clear dampness invading a deficient area causes disease to arise from the lower part; wind and rain invading a deficient area cause disease to arise from the upper part. This is called the three regions. As for the rampant diffusion of these pathogenic factors, it is countless.
According to the *Classic of Original Canon* (*Ling Shu*): Wind and cold damage the form; worry, fear, and anger damage the Qi. Damage to Qi leads to damage to the Zang organs, resulting in Zang diseases; cold damaging the form results in Form diseases; wind damaging the sinews and vessels results in corresponding reactions in the sinews and vessels. This is the correspondence between form and Qi, and between exterior and interior. It is also said: Pathogenic factors in the upper part refer to the high position where pathogens invade humans, hence pathogenic factors are in the upper part. Clear Qi in the lower part refers to clear damp earth Qi invading humans, which must start from the feet; hence clear Qi is in the lower part. Thus, the pathogenic factors of wind, rain, clear, and damp affect the exterior and damage the upper and lower parts of the form; unregulated emotions damage the Zang organs, and disease arises from the Yin aspect. The term "form" refers to skin, vessels, flesh, sinews, and bones, which are the external correspondences of the five Zang organs. This likely continues the discussion on the forms of the Five Elements from the previous chapter. Deficiency in the upper part allows wind and rain to invade deficiency, causing disease in the upper part; deficiency in the lower part allows clear dampness to invade deficiency, causing disease in the lower part; deficiency in Zang Qi allows emotions to damage Qi, causing disease in the Yin aspect. Therefore, one should consume the five flavors of the five grains, five animals, and five fruits in combination to tonify Essence and Qi, harmonize Yin and Yang, fill Blood and Qi, so that pathogens cannot enter the Cou Li (interstitial spaces). This is how sages preserve health and good physicians treat disease before it arises. Xu Zhengong said: People with the five musical tones correspond to the five Zang organs; people with Left/Right and Tai/Shao correspond to the upper and lower parts of the form. People with the five musical tones have more Yin Qi and less Yang Qi; people with Left/Right and Tai/Shao have less Yin Qi and more Yang Qi. Therefore, people with the five musical tones are prone to diseases of the form, while those with Left/Right and Tai/Shao are prone to diseases of the Zang organs. Although this is so, Yin contains Yang, and Yang contains Yin. Those with excess Yang may still have insufficiency of Blood and Qi; those with excess Yin may also have insufficiency of Blood and Qi. Ni Zhongxuan said: This commentary echoes the discussion on needle manipulation in the next chapter.
Huangdi said: I could not count them clearly, so I asked my former teacher. I wish to hear the full explanation of this principle.
Qibo said: Wind, rain, cold, and heat, if not acting as Empty Pathogens (pathogenic factors that take advantage of deficiency), cannot harm humans alone. Those who suddenly encounter fierce winds and heavy rains without getting sick do so because there is no internal deficiency, so pathogens cannot harm them alone. This must occur when Empty Pathogen wind meets bodily deficiency; only then can the pathogen reside in the form. If two Excesses meet (robust Qi meeting normal climate), the masses have firm flesh and are not harmed by pathogens. Among those harmed by Empty Pathogens, it is due to the combination of heavenly timing and bodily deficiency. Considering both, major diseases are formed. Qi has fixed abodes, named according to their location, divided into Upper, Lower, Exterior, and Interior regions.
This section discusses how wind and rain pathogens reside in the form without damaging Qi, transmitting internally to form accumulations. The *Jin Gui Yao Lue* states: First, meridians receive pathogens, which enter the Zang-Fu organs, constituting an internal cause. This refers to pathogens damaging the Qi of the Six Meridians and entering the Zang-Fu organs internally. The Qi of the Three Yin and Three Yang governs the skin surface and connects with the Six Meridians. Thus, when pathogens damage Qi, they damage hair follicles and pores, causing righteous Qi to tilt excessively, allowing rampant pathogens to diffuse between muscle layers, Cou Li, and collaterals, eventually flowing into the blood vessels. Since meridians connect internally to Zang-Fu organs, major pathogens entering the Zang organs cause abdominal pain and downward discharge, leading to death rather than survival. Yin-Yang and the Six Qi are born from the Five Elements; the five Zang organs internally correspond to the Five Elements and externally to the Six Qi. Therefore, damage to Qi flows into blood vessels and internally affects the Zang-Fu organs. If only the form is diseased and not Qi, even if transmitted through meridians, it remains outside the intestines and stomach, forming an accumulation.
When Empty Pathogens enter humans, they cause shivering and shaking of the form; when Regular Pathogens enter, the effect is slight, first appearing in the complexion, unnoticed by the body itself, seeming present yet absent, tangible yet intangible, unknown to anyone. This means Empty Pathogens damage the form, while Regular Pathogens damage Qi. Regular Pathogens refer to the regular Qi of Heaven, i.e., Wind, Cold, Summer-Heat, Dampness, Dryness, and Fire. Heaven has these Six Qi, and humans also possess them; thus, Regular Pathogens affecting Qi resonate through similar Qi. Hence, wind, rain, cold, and heat, if not Empty Pathogens, cannot harm humans alone. To say "harm humans" refers to harming the human form. Empty Pathogens refer to irregular winds coming from deficient directions. The form refers to skin, vessels, flesh, sinews, and bones, the external correspondences of the five Zang organs, corresponding to the Earth's Five Elements. The Earth's Five Elements correspond to Heaven's Five Seasons and Earth's Five Directions. Empty winds are west winds in spring and north winds in summer; these are irregular Qi of the Five Elements, thus harming the human form. This is Heaven's Six Qi harming human Six Qi, and Earth's Five Elements harming human Five Forms. Humans inherit the form and Qi of Heaven and Earth to generate this form and Qi. Therefore, Empty Pathogen wind and bodily deficiency interact as two deficiencies, allowing the pathogen to reside in the form, transmitting to outside the intestines and stomach to form accumulations. The masses have firm flesh; this refers back to the twenty-five types of forms mentioned earlier. Those with insufficient Blood and Qi cannot fill the skin or warm the flesh, leading to Empty Pathogens residing in the form, unlike the masses whose flesh is firm. "Due to heavenly timing" refers to west winds in spring and north winds in summer. "Major diseases are formed" means major pathogens attach between the intestines and stomach to form accumulations. "Qi has fixed abodes" means pathogenic Qi diffuses endlessly, attaching to Sun Luo (branch collaterals) or Jing Shu (transport points), thereby gaining specific names. This section discusses wind and rain damaging the upper part; the next section discusses clear dampness damaging the lower part; the final section discusses emotions damaging the middle, dividing into three regions. Xu Zhengong said: In this chapter, the character "Qi" is not mentioned once, but here the character "Form" is used three times, turning repeatedly three times. The next section says: "Internal injury from worry and anger causes Qi to rebel upward," which corresponds to "Wind and cold damage the form, worry, fear, and anger damage Qi." To elucidate the sage's meaning, one must understand the entire classic to possess great insight.
Therefore, when Empty Pathogens enter humans, they start at the skin. If the skin is lax, the Cou Li open; once open, pathogens enter through hair follicles. Upon entering, they reach deep levels; at deep levels, hair stands erect. When hair stands erect, one feels chilly, causing skin pain. If lingering and not expelled, they transmit to the Luo Collaterals. While in the Luo Collaterals, pain occurs in the muscles; the pain comes and goes, and the Major Meridians subsequently take over. If lingering and not expelled, they transmit to the Jing Meridians. While in the Jing Meridians, one experiences chills and fright. If lingering and not expelled, they transmit to the Shu Transport points. While in the Shu points, the Six Qi become blocked, causing joint pain in the four limbs and stiffness in the waist and spine. If lingering and not expelled, they transmit to the Fu Chong Mai (Hidden Chong Vessel). While in the Fu Chong Mai, the body feels heavy and painful. If lingering and not expelled, they transmit to the intestines and stomach. While in the intestines and stomach, there is rumbling and abdominal distension; if excessive cold, there is borborygmus and undigested stool diarrhea; if excessive heat, there is loose, mushy stool.
If lingering and not expelled, they transmit to outside the intestines and stomach, between the Mu Yuan (epigastric membrane), staying in the vessels. If remaining and not expelled, they gradually form accumulations. They may attach to Sun vessels, Luo vessels, Jing vessels, Shu vessels, Fu Chong Mai, Lv Jin (back sinews), or Mu Yuan of the intestines and stomach, connecting upwards to Huan Jin (abdominal sinews). Pathogenic Qi diffuses endlessly, beyond counting.
This section discusses how wind and rain Empty Pathogens damage the upper form, transmitting from the form layer internally to form accumulations. Pathogens entering humans must start at the hair and skin. If the human form is deficient, the skin is lax and Cou Li open; once open, pathogens enter through hair follicles. Upon entering, they reach deep levels; at deep levels, hair stands erect. Qi is what fills the skin and nourishes the hair. If pathogens damage Qi, they damage hair follicles and pores. Here, pathogens enter the skin but do not damage Qi, so hair stands erect. "Xiran" refers to shivering and shaking of the form. Skin pain indicates pathogens remaining in the skin. Luo vessels are the Sun Luo vessels floating on the skin. While in the Luo vessels, pain in the muscles indicates pathogens remaining between muscle Luo vessels, unable to enter the Jing Meridians. The *Miao Ci* chapter states: When pathogens reside in the form, they first lodge in the hair and skin; if lingering, they enter the Sun vessels; if lingering, they enter the Luo vessels; if lingering, they enter the Jing vessels, internally connecting to the five Zang organs and scattering to the intestines and stomach. This is the sequence of pathogens entering from the hair and skin, reaching the extreme of the five Zang organs. In such cases, one treats the Jing Meridians. Now, if pathogens reside in the hair and skin, enter the Sun Luo, linger, blockage occurs, preventing entry into the Jing Meridians, overflowing into the Da Luo (Great Collaterals) to produce strange diseases. "Xi" means stop. "Da Jing Nai Dai" means pathogens stop between muscle Luo vessels, unable to enter the Jing Meridians, and flow into the Da Jing. Da Jing refers to Jing Sui (Meridian Passages). Jing Sui refers to the Great Collaterals of the five Zang and six Fu organs. Transmitting to the Jing refers to transmitting to the Jing Sui of the Stomach Fu. Disease of the Foot Yangming Meridian causes sudden fright and anxiety. "Shu" refers to meridians transporting Blood and Qi, i.e., the Jing Sui of the Zang-Fu organs. The Great Collaterals of the Zang-Fu organs go left and right, up and down, emerging through the meridians and distributing to the four extremities. Thus, pathogens remaining in the Shu cause blockage of the Six Meridians and joint pain in the four limbs. Stiffness in the waist and spine occurs because the Great Collaterals of the Zang-Fu organs connect to Changqiang (DU1) of the Du Meridian. "Fu Chong" refers to the Chong Mai (Penetrating Vessel) running hidden within the abdomen. The Chong Mai originates in the Bao Zhong (uterus/pelvic center), ascends alongside the navel to the chest, and scatters into the skin, filling the skin, warming the flesh, and nourishing the sinews and bones. Pathogens remaining inside prevent Blood and Qi from filling the form, causing heaviness and body pain. Transmitting to the intestines and stomach causes rumbling and distension; excessive cold causes borborygmus and undigested stool diarrhea; excessive heat causes loose, mushy stool. "Mi" refers to undigested grain. "Mu Yuan" refers to the fatty membrane outside the intestines and stomach. "Staying in the vessels" refers to the vessels between the Mu Yuan. Remaining there without expulsion leads to stopping there and forming an accumulation. Sun and Luo vessels are small collaterals within the Mu Yuan. Jing vessels are the great meridians of the Stomach Fu. Shu vessels are the great collaterals of the Zang-Fu organs, transporting Water-Gram and Blood Qi. Fu Chong is the Chong Mai running hidden in the abdomen. Mu Yuan is the fatty membrane of the intestines and stomach. Lv Jin are the sinews attached to the spinal column. Huan Jin are the sinews circulating within the abdomen. These locations are anterior, posterior, lateral, and medial to the intestines and stomach; pathogens follow them to form accumulations. The diffusion of pathogens is endless. Xu Zhengong said: When pathogens damage Qi, they enter the Zang-Fu organs via the Jing Meridians. The Qi of the Three Yin and Three Yang is born in the Zang-Fu organs, emerges from the Jing Meridians to the skin surface, so pathogens also enter the Zang-Fu organs via the Jing Meridians. When pathogens damage the form, they enter the outside of the intestines and stomach via the Bie Luo (Divergent Collaterals). The Blood and Qi in the form come from the essence of Water and Grain in the Stomach Fu, seeping out into the Sun and Luo vessels outside the stomach, overflowing into the Great Collaterals of the stomach, transferring to the Jing Sui of the Zang-Fu organs, emerging from the Sun Luo on the skin, thus filling the skin, warming the flesh, seeping into the hair, and nourishing the sinews and bones. Therefore, pathogens in the form also transmit from the exterior Sun Luo to the interior Sun Luo, remaining outside the intestines and stomach to form accumulations. Hence the following text says: For accumulations formed by attachment to Sun Luo vessels, the accumulation moves up and down, located in the arm and hand Sun Luo. Floating and lax, it cannot restrain the accumulation to stop it. Because interior and exterior Sun Luo are connected, interior and exterior correspond. Ni Zhongxuan said: Ancient discussions on undigested stool attribute it to cold or heat. Now the *Classic* states that excessive heat causes loose, mushy stool, attributing it to heat. Fire accelerates the expulsion of matter, so digestion is incomplete.
Huangdi said: I wish to hear the full explanation of the causes.
Qibo said: For accumulations formed by attachment to Sun Luo vessels, the accumulation moves up and down, located in the arm and hand Sun Luo. Floating and lax, it cannot restrain the accumulation to stop it, so it migrates between the intestines and stomach. Fluids gather, seep, and pour, making a "zhuo zhuo" sound. With cold, there is abdominal fullness like thunder rumbling, causing sharp pain. For accumulations attaching to the Yangming Meridian, they reside beside the navel; after eating, they enlarge; when hungry, they shrink. For accumulations attaching to the Huan Jin, they resemble Yangming accumulations; after eating, there is pain; when hungry, there is relief. For accumulations attaching to the Mu Yuan of the intestines and stomach, there is pain extending externally to the Huan Jin; after eating, there is relief; when hungry, there is pain. For accumulations attaching to the Fu Chong Mai, palpation reveals movement under the fingers; upon releasing pressure, hot air descends to both thighs, resembling water being poured. For accumulations attaching to the Lv Jin behind the intestines, the accumulation is visible when hungry, invisible when full, and impalpable upon pressing. For accumulations attaching to the Shu vessels, there is blockage and non-communication, fluids fail to descend, and orifices become dry and obstructed. This describes pathogens entering from the exterior to the interior, from above to below.
This continues the previous text to clarify that accumulations formed by lingering have specific manifestations. Sun Luo are small collaterals between the intestines, stomach, and Mu Yuan. The Blood and Qi produced by the Stomach Fu seep into the small collaterals outside the stomach and transfer to the Great Collaterals, emerging from the Great Collaterals to the Sun Luo on the skin. For accumulations formed by attachment to the interior Sun Luo, the accumulation moves up and down, corresponding to the exterior arm and hand Sun Luo. Floating and lax, it cannot restrain the accumulation, so it migrates between the intestines and stomach. Stomach fluids seep outward, producing a "zhuo zhuo" sound, because stagnation in the Sun Luo prevents transfer to the Great Collaterals. The Yangming Meridian is the Great Collateral of the Stomach, residing beside the navel. After eating, Water and Grain fluids seep outward, causing enlargement; when hungry, fluid and Blood are scarce, causing shrinking. Huan Jin are sinews circulating within the abdomen, resembling Yangming accumulations. After eating, distension causes pain; when hungry, it stops and brings relief. Mu Yuan is the fatty membrane of the intestines and stomach. After eating, fluids seep and moisten outward, bringing relief; when hungry, dryness causes pain. The Fu Chong Mai runs beside the navel, so palpation reveals movement. Heat upon release indicates Chong Mai Blood and Qi filling the exterior. The Chong Mai descends along the inner thigh, emerging at the Qi Street of the calf; its Qi descends to both thighs, resembling water being poured, due to heat generated by the accumulation. Lv Jin are sinews attached inside the hypochondrium, behind the intestines; thus, the accumulation is visible when hungry, invisible when full, and impalpable. Shu vessels are meridians transporting fluids, i.e., the Great Collaterals of the Zang-Fu organs. The essence of Water and Grain from the Stomach Fu enters the Great Collaterals of the Zang-Fu organs from the Great Collateral of the Stomach, and emerges from the Great Collaterals of the Zang-Fu organs to the skin. Thus, when accumulation attaches to the Shu vessels, the vessel pathway becomes blocked, fluids fail to descend, and skin orifices become dry and obstructed. This describes pathogens entering from the exterior to the interior, from above to below, to form accumulations. Xu Zhengong said: "Arm and hand Sun Luo residence, floating and lax" refers to weakness. Diagnosing the floating and lax nature of Sun Luo involves diagnosing the Chi Skin (skin of the wrist). When the pulse is urgent, the Chi skin is also urgent; when the pulse is lax, the Chi skin is also lax. The Blood and Qi produced by the Stomach Fu emerge from the Chi skin via Wuli (ST41) of the Yangming Meridian; thus, diagnosing the floating and lax nature of Sun Luo indicates weakness and inability to restrain the accumulation. Ni Zhongxuan said: The Cunkou, Guankou, and Chi positions monitor the Qi of the Zang-Fu organs and meridians; Renying and Qikou monitor external Qi; Chi Skin monitors internal Qi.
Huangdi said: How does an accumulation begin to form, and how does it become established?
Qibo said: Accumulations begin to form when they acquire Cold; Jue Qi (rebellious Qi) leads to the formation of accumulations.
This is transitional text. Wind and rain are pathogens in Heaven damaging the upper part; clear dampness is a pathogen in Earth damaging the lower part. In Heaven, it is called "Sheng" (birth/generation); in Earth, it is called "Cheng" (formation). Thus, accumulations begin to form by acquiring Cold. Clear dampness pathogens, reversing in the lower part, form accumulations.
Huangdi said: How is the accumulation formed?
Qibo said: Jue Qi produces coldness in the feet and calves. Coldness in the calves causes blood vessels to coagulate and become stagnant. Stagnant blood vessels allow Cold Qi to ascend into the intestines and stomach. Entering the intestines and stomach causes distension. Distension forces the juices and foam outside the intestines to cluster and prevents dispersion, gradually forming an accumulation. Sudden overeating and drinking cause intestinal fullness. Irregular daily habits and excessive physical effort damage the Luo Collaterals. Damage to Yang Luo causes external bleeding, resulting in epistaxis; damage to Yin Luo causes internal bleeding, resulting in hematochezia. Damage to the Luo vessels of the intestines and stomach causes blood to overflow outside the intestines. If there is Cold juice and foam outside the intestines, it clashes with the blood, combining and coagulating without dispersing, thus forming an accumulation. Sudden external invasion by Cold, combined with internal injury from worry and anger, causes Qi to rebel upward. Upward rebellion of Qi blocks the Six Shu points, preventing the movement of Dampness. Coagulated Blood is wrapped and does not disperse; fluids become viscous and seep, adhering and not leaving, thus all accumulations are formed.
This section discusses how clear dampness pathogens damage the lower form to form accumulations. "Man" means stifling. Jue Ni producing foot and calf man means pathogens reverse in the lower part, causing stifling in the feet and calves without smooth flow. Man produces cold; cold causes blood vessels to coagulate and stagnate, allowing Cold Qi to ascend into the intestines and stomach. Entering the intestines and stomach causes distension. Distension forces juices and foam outside the intestines to cluster and prevents dispersion, gradually forming an accumulation. Sudden overeating causes intestinal fullness. Irregular habits and excessive effort damage the Luo Collaterals. Luo Collaterals are the divergent collaterals from which Zang-Fu organs emit Blood and Qi. Yang Luo are ascending collaterals; damage causes blood to overflow externally upwards, resulting in epistaxis. Yin Luo are descending collaterals; damage causes blood to overflow internally, resulting in hematochezia. Damage to the Luo vessels of the intestines and stomach causes blood to overflow outside the intestines. Cold juice and foam outside the intestines clash with blood, combining and coagulating without dispersing, thus forming an accumulation. Or, sudden external invasion by Cold, combined with internal injury from worry and anger, causes Qi to rebel upward. Upward rebellion of Qi blocks the Six Shu points. Shu refers to meridians transporting Blood and Qi. "Six" refers to the Shu points of the Hand Meridians, i.e., Yang Luo. Blockage of the Six Shu prevents the Qi that warms the skin and flesh from moving; Blood coagulates and wraps without dispersing; fluids become viscous in the collaterals and seep outside, adhering and not leaving, thus forming an accumulation. This discusses how clustered juices or cold juices and foam outside the intestines clashing with blood both form accumulations. Or, external Cold combined with internal injury from worry and anger, with coagulated Blood and lingering fluids, also form accumulations. According to the Meridians, there are Great Collaterals of the Hand Three Yin and Three Yang, ascending to the hands; and Great Collaterals of the Foot Three Yin and Three Yang, descending to the feet. They govern the movement of Blood and Qi, seeping out of the vessels to nourish the form. Thus, damage to Yang Luo causes blood to exit through orifices upwards as epistaxis; damage to Yin Luo causes blood to exit internally from the intestines and stomach as hematochezia. If the Six Shu cannot communicate upwards to the exterior, they overflow internally outside the vessels to form accumulations. Both interior and exterior primarily seep out of the vessels. Xu Zhengong said: Accumulations caused by wind and rain attach to the tangible to be born, hence called "Sheng" (birth). Accumulations caused by clear dampness are coagulated Blood and juices clustering in the hollow cavity, resembling pregnancy, suspended to form shape. Those caused by Heaven originate from the intangible, hence attaching to the tangible to be born; those caused by Earth naturally form their own shape.
Huangdi said: How does it arise from the Yin aspect?
Qibo said: Worry and thought damage the Heart; severe cold damages the Lungs; resentment and anger damage the Liver; intoxication followed by sexual intercourse, with sweating exposed to wind, damages the Spleen; excessive physical effort, or sexual intercourse with sweating, damages the Kidneys. These are diseases arising from the three regions of interior and exterior.
This section discusses how unregulated emotions damage the form of the five Zang organs, causing disease to arise from the Yin aspect. Worry and thought damage the Heart; exposure to cold and consumption of cold drinks damage the Lungs; unregulated anger damages the Liver; intoxication followed by sexual intercourse, with sweating exposed to wind, damages the Spleen; excessive physical effort, or sexual intercourse with sweating, damages the Kidneys. These are external causes from Heaven's wind and rain, Earth's clear dampness, and internal causes...