黄帝曰。夫自古通天者。生之本。本于阴阳。天地之间。六合之内。其气九州九窍五脏十二节。皆通乎天气。（凡人
有生。受气于天。故通乎天者。乃所生之本。天以阴阳五行。化生万物。故生之本。本乎阴阳也。是以天地之间。六合
之内。其地气之九州。人气之九窍五脏十二节。皆通乎天气。十二节者。骨节也。两手两足各三大节。合小节之交。共
三百六十五会。灵枢邪客曰。地有九州。人有九窍。天有五音。人有五脏。岁有十二月。人有十二节。岁有三百六十五
日。人有三百六十节。地有十二经水。人有十二经脉。盖节乃神气之所游行。故应天之岁月。脉乃血液之所流注。故应
地之经水。九窍乃藏气之所出入。五脏乃阴阳二气之所舍藏。故皆通乎天气。此篇论阴阳二气。与天气相通。故曰地之
九州。人之五脏。天为阳。是以先论阳。而后论阴也。朱济公曰。天乙生水。气乃坎中之满也。曰自古者。言自上古
天真所生之气也。本乎阴阳者。天真之有阴有阳也。）其生五。其气三。数犯此者。则邪气伤人。此寿命之本也。（天之
十干。化生地之五行。故曰其生五。地之五行。上应三阴三阳之气。故曰其气三。三阴者。寒燥湿也。三阳者。风火暑
也。如不能调养。而数犯此三阴三阳之气者。则邪气伤人而为病矣。夫人禀五行之气而生。犯此五行之气而死。有如水
之所以载舟。而亦能覆舟。故曰此寿命之本也。）苍天之气清净。则志意治。顺之则阳气固。虽有贼邪。弗能害也。此因
时之序。故圣人传精神。服天气。而通神明。（生气通乎天。是以苍天之气清净。则人之志意亦治。人能顺此清净之气。
而吾身之阳气外固。虽有贼邪。勿能为害。此因四时之序。而能调养者也。故圣人传运其精神。餐服苍天之清气。以通
吾之神明。）失之则内闭九窍。外壅肌肉。卫气散解。此谓自伤。气之削也。（逆苍天清净之气。则九窍内闭。肌肉外壅。
卫外之阳气散解。此不能顺天之气而自伤。以致气之消削。盖人气通乎天。逆天气。则人气亦逆矣。）阳气者。若天与日。
失其所则折寿而不彰。故天运当以日光明。是故阳因而上。卫外者也。（上节言顺苍天之气。以养吾身之阳。此复言人之
阳气。又当如天与日焉。若失其所居之位。所运之机。则短折其寿而不能彰着矣。夫天气。清净光明者也。然明德惟藏。
而健运不息。故天运当以日光明。天之藏德不下。故人之阳气亦因而居上。天之交通。表彰于六合九州之外。故人之阳
气。所以卫外者也。）因于寒。欲如运枢。起居如惊。神气乃浮。（夫阳气生于至阴。由枢转而外出。风寒之邪。皆始伤
皮毛气分。是故因于寒。而吾身之阳气。当如运枢以外应。阳气司表。邪客在门。故起居如惊。而神气乃浮出以应之。
神气、神藏之阳气也。莫仲超曰。此节运枢照应后之开阖。太阳主表主开。而本于下焦之寒水。故欲从枢而后出。又曰。
按伤寒始伤皮毛气分。得阳气以化热。热虽盛不死。此能运枢而外应者也。如太阳病。发热头疼。脉反沉。当救其里。
此神气不能运浮于外。故急用干姜附子。以救在里之阳气而外出焉。夫在天阴寒之邪。藉吾身之阳气以对待。故因于寒
者。欲其阳气如此而出。所谓阳因于上。卫外者也。）因于暑。汗烦则喘喝。静则多言。体若燔炭。汗出而散。（天之阳
邪。伤人阳气。气伤外弛。故汗出也。气分之邪热盛。则迫及所生。心主脉。故心烦。肺乃心之盖。故烦则喘喝也。如
不烦而静。此邪仍在气分而气伤。神气虚。故多言也。脉要精微论曰。言而微。终日乃复言者。此夺气也。天之阳邪。
伤人阳气。两阳相搏。故体若燔炭。阳热之邪。得吾身之阴液而解。故汗出乃散也。按伤寒论曰。病常自汗出者。此卫
气不和也。复发其汗。荣卫和则愈。故因于暑而汗出者。暑伤阳而卫气不和也。汗出而散者。得荣卫和而汗出乃解也。）
因于湿。首如裹。湿热不攘。大筋 短。小筋弛长。 短为拘。弛长为痿。（ 音软此言湿伤阳气。而见证之如此也。
阳气者。若天与日。因而上者也。伤于湿者。下先受之。除病者。下行极而上。阴湿之邪。上干阳气而冒明。故首如裹
也。湿伤阳气。则因阳而化热矣。阳气者。柔则养筋。阳气伤而不能荣养于筋。故大筋 短。小筋弛长。盖大筋连于骨
节之内。故郁热而 短。小筋络于骨肉之外。故因湿而弛长。短则缩急而为拘挛。长则放纵而为痿弃。此言寒暑湿邪。
伤人阳气者如此。）因于气为肿。四维相代。阳气乃竭。（此总结上文而言。因外淫之邪。有伤于气。则为肿矣。阴阳别
论曰。结阳者肿四肢。盖阳气伤而不能营运。则荣血泣而为肿矣。四维、四肢也。四肢为诸阳之本。气为邪伤。是以四
肢之阳。交相代谢。而阳气乃竭也。朱济公曰。四维、四时也。至真要大论曰。谨按四维。斥候皆归。其终可见。其始
可知。盖手足三阳之气。旺于四时。有盛有衰。如四时之代谢。故曰四维相代也。又问曰。六淫之邪。止言三气者何也。
曰。六气生于五行。暑热总属于火。阳气与卫气各有分别。风伤卫而兼伤阳。故另提曰风客淫气。经曰。燥胜则干。燥
淫之邪。伤人血液而不伤气。）阳气者。烦劳则张。精绝。辟积于夏。使人煎厥。目盲不可以视。耳闭不可以听。溃溃乎
若坏都。 乎不可止。 音骨此言烦劳而伤其阳气也。按金匮要略云。劳之为病。其脉大。手足烦。春夏剧。秋冬
瘥。阴寒精自出。酸削不能行。盖阴阳之要。阳密乃固。烦劳则阳气外张。阴不得阳之温固。则精自出而绝于内矣。秋
冬之阳气。内而收藏。夏则阳气张浮于外。故益虚而煎厥也。精气虚故目盲不可以视。耳闭不可以听也。（膀胱者。州都
之官。精液藏焉。而又属太阳之腑。太阳为诸阳主气。阳气伤。则坏其腑矣。溃、漏也。言其州都之坏。而不能藏精。
、流貌。言其阴寒精出。而不可止也。）阳气者。大怒则形气绝。而血菀于上。使人薄厥。有伤于筋纵。其若不容。（菀
于远切此因怒而伤其阳气也。阳气者。通会于皮肤腠理之间。大怒则气上逆。而形中之气。绝其旋转之机矣。菀、茂
貌。血随气行而茂于上矣。薄、迫也。气血并逆。而使人迫厥也。阳气者。柔主养筋。血脉者。所以濡筋骨。利关节者
也。阳气伤而血逆于上。则有伤于筋矣。筋伤而弛纵。则四体有若不容我所用也。前节论外因而伤其阳气。此因劳伤大
怒。而亦伤其阳气焉。）汗出偏沮。使人偏枯。汗出见湿。乃生痤 。高粱之变。足生大丁。受如持虚。劳汗当风。寒
薄为 。郁乃痤。（沮音疽痤才何切。坐平声 音费 织加切音柞丁即疔沮、湿也。痤、小疖也。 、如疹之类。 、
面鼻赤瘰也。此言阳气者。外卫于皮肤。充塞于四体。若天气之运用于六合九州之外。而为阴之固也。如汗出而止半身
沮湿者。是阳气虚而不能充身遍泽。必有偏枯之患矣。如汗出见湿。湿热郁于皮肤之间。则生痤 矣。高粱、浓味也。
味浓伤形。气伤于味。形气伤则肌腠虚矣。高粱所变之热毒。逆于肉理而多生大疔。盖肤腠虚而热毒乘之。有如持虚之
器而受之也。劳汗当风。寒湿薄于皮肤之间。则为 为痤矣。夫 与痤 。乃血滞于肤表之轻证。盖言阳气外卫于皮肤
之间。为邪所薄。则淡渗于皮毛之血而为病矣。故曰。汗出偏沮。使人偏枯者。言阳气之若天与日。宜普遍于九州也。
乃生痤 。寒薄为 者。言阳气之外卫。而在于皮毛之间也。高粱之变。足生大疔者。言阳气之通会于腠理也。朱济公
曰。经云。微者冲气疏。疏则其肤空。又曰。腠理者。三焦通会元真之处。夫形食味。形气虚。则高粱之味毒乘之。故
曰受如持虚。）阳气者。精则养神。柔则养筋。（承上文而言阳气者。内养五脏之神。出而荣养筋骨。非只通会于肌腠。
外卫于皮毛。盖有开有阖。有出有入者也。本经曰。五味入口。藏于肠胃。味有所藏。以养五气。气和而生。津液相成。
神乃自生。阳气者。水谷之精也。故先养于五脏之神。柔者。少阳初生之气也。初出之微阳。而荣养于筋。是以少阳之
生筋也。莫子晋问曰。首论神气本于天真。奚又属五味之所生养。曰。精气神。皆有先天。有后天。先天之神气。又藉
后天水谷之所资生而资养。故曰。两精相搏谓之神。两精者。天乙之精。水谷之精也。）开阖不得。寒气从之。乃生大偻。
陷脉为 。留连肉腠。俞气化薄。传为善畏。及为惊骇。荣气不从。逆于肉理。乃生痈肿。（开者。一日而主外。阖者。
暮而收引也。如失其开阖之机。则寒气从而内薄矣。背为阳。阳虚则寒邪痹闭于背。而形体为之俯偻。金匮所谓痹侠背
行是也。如阳虚不能为荣血之卫。邪陷于脉中而为 。留连于肉腠之间。金匮所谓马刀侠瘿是也。如经俞之气化虚薄。
则传入于内。而干及藏神矣。心主脉。神伤则恐惧自失。肝主血。故其病发惊骇也。金匮要略云。经络受邪。入脏腑为
内所因。邪入于经俞。故内干脏气也。如邪逆于肉理气分。而阴阳不和。则生痈肿。经曰。阳气有余。荣气不行。乃发
为痈。阴阳不通。两热相搏。乃化为脓。此言阳气不固。致邪薄于所养之筋而为偻。内及于所养之神而为惊为畏。重阳
气之外卫也。济公曰。外卫者。首重皮毛。皮毛不固。则入于肉理脉络矣。莫子晋曰。高粱之变。逆于肉理。乃生大疔。
外淫之邪。逆于肉理。乃生痈肿。皮毛肉理。皆阳气之所主。故曰。清净则肉腠闭拒。邪弗能害。如肌腠固密。即邪伤
皮毛。止不过痤 之轻疾耳。）魄汗未尽。形弱而气烁。穴俞以闭。发为风疟。（上二俞字并音输此言表气与邪气。并
陷于肌腠之间而为疟也。肺主皮毛。魄汗未尽。表邪未去也。形弱、肌腠虚也。腠理空疏。则表阳邪气。同陷于其间。
寒邪在表。则随阳而化热。故气烁也。邪虽陷于肌腠。而表气不入于经。是以穴俞以闭。风疟。但热不寒之疟也。表阳
之邪。与卫气相遇。则发热也。夫表气者。太阳之气也。肌腠之气者。五脏元真之气也。金匮要略曰。腠者。三焦通会
元真之处。又曰。五脏元真通畅。人即安和。灵枢经曰。三焦膀胱者。腠理毫毛其应。盖三焦之气。通腠理。太阳之气
主皮毛。是以表气邪气。陷入于肌腠。则伤元真之气。而太阳之气仍在外也。如肌腠之邪留而不去。则转入于经俞。盖
五脏经气之相合也。此节论表气实而肌气虚。是以表气同邪并陷于肌腠之间。太阳之气与五脏之经不相合。故穴俞以闭
也。此注当与伤寒论注疏合看。）故风者。百病之始也。清静则肉腠闭拒。虽有大风苛毒。弗之能害。此因时之序也。（此
重调养元真之气。而肌腠之宜闭密也。夫寒暑始伤于皮毛。风邪直透于肌腠。风者善行而数变。入于肌腠。则及经脉。
或为热中。或为寒中。或为偏枯。或成积聚。或入腑而生。或干脏而死。邪气淫佚。不可胜论。故曰。风者。百病之始
也。人能顺苍天清净之气。而调摄其元神。则肉腠固密。虽有大风苛毒。勿之能害。此因四时之序。而能顺养者也。夫
肌腠之气。乃五脏之元真。故宜顺四时五行之气而调养。要略云。若使五脏元真通畅。人即安和。不使形体有衰。病即
无由入其腠理。前节论寒暑湿邪伤其表阳。故毋烦劳而伤其阳。此论风邪直伤于肌腠。又当固密其元真也。）故病久则传
化。上下不并。良医勿为。故阳蓄积病死。而阳气当隔。隔者当泻。不亟正治。粗乃败之。（病久者。邪留而不去也。传
者。始伤皮毛。留而不去。则入于肌腠。留而不去。则入于经脉波俞。留而不去。则入于募原脏腑。化者。或化而为寒。
或化而为热。或化而为燥结。或化而为湿泻。盖天有六淫之邪。而吾身有六气之化也。久而传化。则上下阴阳。不相交
并。虽有良工。勿能为已。故病在阳分。而蓄积至死者。以其病久而传化也。故病在阳分。而良工当亟助阳气。以隔拒
其邪。勿使其传化。隔者当泻却其邪。更勿使其留而不去也。若不急用此正治之法。皆粗工之败乃事也。）故阳气者。一
日而主外。平旦人气生。日中而阳气隆。日西而阳气已虚。气门乃闭。是故暮而收拒。无扰筋骨。无见雾露。反此三时。
形乃困薄。（总结上文而言阳气之有开有阖。然又重其卫外而为固也。灵枢经云。春生夏长。秋收冬藏。是气之常也。人
亦应之。以一日分为四时。朝则为春。日中为夏。日入为秋。夜半为冬。朝则人气始生。故旦慧。日中人气长。长则胜
邪。夕则人气始衰。夜半人气入脏。是故暮而收敛其气。隔拒其邪。无扰筋骨。无烦劳也。无见雾露。宜清净也。若反
此。而欲如三时之动作。则形体乃为邪所困薄矣。气门、玄府也。三时、平旦日中日西也。）岐伯曰。阴者。藏精而起
亟也。阳者。卫外而为固也。（生之本本于阴阳。阳生于阴也。故帝先论阳而伯复论其阴焉。亟、数也。阴者主藏精。而
Huangdi said: Since ancient times, the connection between humans and Heaven is the root of life, and this root lies in Yin and Yang. Within the space between Heaven and Earth, and within the Six Directions, the Earth corresponds to the Nine Provinces, and humans correspond to the Nine Orifices, Five Zang Organs, and Twelve Joints (bone joints), all of which are connected with the Qi of Heaven. (All living beings receive their Qi from Heaven, thus connecting with Heaven is the root of their existence. Heaven generates all things through Yin, Yang, and the Five Phases, so the root of life lies in Yin and Yang. Therefore, within the space between Heaven and Earth and the Six Directions, the Earth's Qi corresponds to the Nine Provinces, while human Qi corresponds to the Nine Orifices, Five Zang Organs, and Twelve Joints, all connecting with the Qi of Heaven. The "Twelve Joints" refer to bone joints. Each hand and foot has three major joints, plus the connections of minor joints, totaling 365 meeting points. *Ling Shu: Xie Ke* states: The Earth has Nine Provinces, humans have Nine Orifices; Heaven has Five Tones, humans have Five Zang Organs; a year has twelve months, humans have twelve joints; a year has 365 days, humans have 360 joints; the Earth has twelve great rivers, humans have twelve primary meridians. Generally, joints are where Shen Qi (Spiritual Qi) travels, corresponding to Heaven's years and months; meridians are where blood flows, corresponding to the Earth's rivers; the nine orifices are the gates for Zang Qi to enter and exit, and the five Zang organs are the storage places for Yin and Yang Qi, thus all connecting with the Qi of Heaven. This chapter discusses how Yin and Yang Qi connect with the Qi of Heaven. Since Heaven belongs to Yang, Yang is discussed first, followed by Yin. Zhu Jigong stated: Tian Yi generates Water, and Qi is the fullness within Kan (Water trigram). "Since ancient times" refers to the True Qi generated since ancient times. "Rooted in Yin and Yang" means that True Qi possesses both Yin and Yang aspects.) Life is generated by the Five Phases, and human Qi is divided into Three Yin and Three Yang. If these patterns are frequently violated, pathogenic Qi will harm the person, which is the foundation of lifespan. (The Ten Heavenly Stems generate the Five Earthly Phases, hence it is said "its generation is five." The Five Earthly Phases correspond upwards to the Qi of Three Yin and Three Yang, hence it is said "its Qi is three." The Three Yin refer to Cold, Dryness, and Dampness; the Three Yang refer to Wind, Fire, and Summer-heat. If one fails to regulate oneself and frequently violates these Three Yin and Three Yang Qi, pathogenic Qi will harm the body and cause disease. Humans are born receiving the Qi of the Five Phases and die by violating them, just as water can carry a boat but also capsize it. Thus, it is said that this is the foundation of lifespan.) When the Qi of the Blue Heaven is pure and clear, human will and intention remain orderly; complying with it makes Yang Qi secure, so even if harmful pathogens exist, they cannot cause harm. This is because one follows the sequence of the seasons. Therefore, the sages preserve their spirit, ingest the Qi of Heaven, and communicate with divine illumination. (Sheng Qi connects with Heaven; thus, when the Qi of the Blue Heaven is pure and clear, human will and intention are orderly. If humans comply with this pure and clear Qi, their bodily Yang Qi becomes secure on the exterior, and even if harmful pathogens exist, they cannot cause harm. This results from following the seasonal sequence and regulating oneself. Thus, sages circulate their spirit and ingest the clear Qi of the Blue Heaven to communicate with their own divine illumination.) Failure to comply leads to internal blockage of the nine orifices, external stagnation of muscles, and dispersion of Wei Qi (Defensive Qi). This is called self-injury, leading to the depletion of Qi. (Violating the pure and clear Qi of Heaven causes the nine orifices to close internally and muscles to stagnate externally, causing the defensive Yang Qi to disperse. This is failing to comply with Heaven's Qi and injuring oneself, resulting in Qi depletion. Human Qi connects with Heaven; violating Heaven's Qi causes human Qi to become inverted.) Human Yang Qi is like the sky and the sun; if it loses its proper position and function, lifespan is shortened and brilliance is obscured. Therefore, the movement of Heaven relies on the brightness of the Sun. Thus, Yang Qi resides above and protects the exterior. (The previous section discussed complying with Heaven's Qi to nourish bodily Yang; here it reiterates that human Yang Qi should be like Heaven and the Sun. If it loses its proper position and operational mechanism, lifespan is shortened and not manifested. Heaven's Qi is pure, clear, and bright, yet its virtue is hidden and its operation is ceaseless, so Heaven's movement relies on the Sun's brightness. Heaven's hidden virtue does not descend, so human Yang Qi resides above. Heaven's communication is manifest beyond the Six Directions and Nine Provinces, so human Yang Qi serves to protect the exterior.)
When affected by Cold, Yang Qi should operate flexibly like a turning door pivot; if daily activities involve panic or disturbance, Shen Qi (Spiritual Qi) will float outward. (Yang Qi is generated from Extreme Yin and moves outward through the Pivot mechanism. Wind-Cold pathogens initially damage the skin-hair layer and Qi level. Therefore, when affected by Cold, bodily Yang Qi should respond outwardly like a turning pivot. Yang Qi governs the exterior, and pathogens lodge at the gate; thus, if daily activities are disturbed, Shen Qi floats out to respond. Shen Qi refers to the Yang Qi of the Spirit-storage organs. Mo Zhongchao noted: The "turning pivot" in this section corresponds to the subsequent "opening and closing." Taiyang governs the exterior and opening, rooted in the Cold Water of the Lower Jiao, so it seeks to emerge via the Pivot. Also, according to *Shang Han Lun*, initial damage to the skin-hair Qi level transforms into heat upon receiving Yang Qi; even if heat is severe, death does not ensue, representing the ability to turn the pivot and respond outwardly. For example, in Taiyang disease with fever, headache, and a deep pulse, the interior must be rescued, indicating Shen Qi cannot float outward, requiring urgent use of Gan Jiang (Dried Ginger) and Fu Zi (Prepared Aconite) to rescue interior Yang Qi and facilitate its outward movement. In Heaven, Yin-Cold pathogens are countered by bodily Yang Qi; thus, when affected by Cold, Yang Qi should emerge as described, fulfilling the principle of "Yang residing above and protecting the exterior.")
When affected by Summer-heat, sweating occurs; if vexed, there is panting and shouting; if quiet, there is excessive talking. The body feels hot like burning charcoal, and symptoms dissipate after sweating. (Heaven's Yang pathogens damage bodily Yang Qi, causing Qi deficiency and external flaccidity, leading to sweating. Excessive heat in the Qi level forces the Heart (which governs vessels), causing mental vexation. The Lung is the canopy of the Heart, so vexation leads to panting and shouting. If there is no vexation but quietness, the pathogen remains in the Qi level, damaging Qi and causing Shen Qi deficiency, leading to excessive talking. *Mai Yao Jing Wei Lun* states: Speaking faintly and only speaking occasionally throughout the day indicates Qi depletion. Heaven's Yang pathogens damage Yang Qi; the interaction of two Yangs causes the body to feel hot like burning charcoal. Yang-Heat pathogens are resolved by bodily Yin fluids, so symptoms dissipate after sweating. According to *Shang Han Lun*: Frequent spontaneous sweating indicates Disharmony of Wei Qi; inducing sweat again resolves it when Ying and Wei harmonize. Thus, sweating due to Summer-heat indicates Summer-heat damages Yang and causes Wei Qi disharmony. Dissipation after sweating indicates resolution upon Ying-Wei harmony.)
When affected by Dampness, the head feels heavy as if wrapped. If Damp-Heat is not cleared, large tendons shorten and small tendons elongate. Shortening causes spasms/contracture, while elongation causes flaccidity/paralysis. (This section describes Dampness damaging Yang Qi and presenting such symptoms. Yang Qi, like Heaven and the Sun, tends upward. Dampness injures the lower part first. Removing disease involves progression from bottom to top. Yin-Damp pathogens ascend to harass Yang Qi and obscure clarity, causing the head to feel wrapped. Dampness damages Yang Qi, transforming into Heat due to Yang. Yang Qi, when soft, nourishes tendons. Damage to Yang Qi prevents it from nourishing tendons, causing large tendons to shorten and small tendons to elongate. Large tendons connect within bone joints, so郁热 (stagnant heat) causes shortening; small tendons lie outside bone and flesh, so Dampness causes elongation. Shortening leads to contraction and spasms; elongation leads to laxity and flaccidity. This illustrates how Cold, Summer-heat, and Dampness damage Yang Qi.)
When affected by Qi pathogens, swelling occurs. If the Four Limbs alternate in affliction, Yang Qi is exhausted. (This summarizes the preceding text: external pathogenic factors damaging Qi cause swelling. *Yin Yang Bie Lun* states: Accumulation in Yang causes swelling of the four limbs. Damage to Yang Qi prevents circulation, causing Ying Blood to stagnate and swell. "Four Dimensions" refers to the four limbs. The limbs are the root of all Yang Qi. When Qi is damaged by pathogens, the Yang Qi of the limbs alternates in failure, leading to exhaustion of Yang Qi. Zhu Jigong stated: "Four Dimensions" refers to the four seasons. *Zhi Zhen Yao Da Lun* states: Carefully observe the four dimensions; prognosis returns, endings are visible, beginnings are known. The Qi of Hand and Foot Yang meridians peaks in the four seasons, waxing and waning like seasonal changes, hence "Four Dimensions alternate." Another question: Why mention only three Qi (Cold, Summer-heat, Dampness) among the Six Pathogens? Answer: Six Qi arise from the Five Phases; Summer-heat and Heat belong to Fire. Yang Qi and Wei Qi are distinct. Wind damages Wei and simultaneously Yang, hence separately mentioned as "Wind lodging in excess Qi." The Classic states: Dryness overcomes and causes dryness. Dryness pathogens damage Blood but not Qi.)
Yang Qi, when subjected to excessive mental or physical labor, expands excessively, leading to Essence exhaustion. Accumulating into Summer, this causes Jian Jue (Frying Collapse). Eyes become blind unable to see, ears closed unable to hear, chaotic like a collapsing dam, and unceasing like a bursting dike. (This section discusses labor damaging Yang Qi. *Jin Gui Yao Lue* states: Labor diseases present with large pulses, irritability in hands and feet, worsening in Spring/Summer, improving in Autumn/Winter, spontaneous emission of cold essence, soreness preventing walking. The key to Yin and Yang is that Yang density ensures stability. Excessive labor causes Yang Qi to expand outward; without Yang's warmth and stability, Yin Essence leaks and depletes internally. In Autumn/Winter, Yang Qi stores inward; in Summer, Yang Qi floats outward, becoming increasingly deficient and leading to Jian Jue. Deficient Essence causes blindness and deafness. The Bladder is the Officer of the Metropolis, storing fluids, and belongs to the Taiyang Fu organ. Taiyang governs all Yang Qi; damage to Yang Qi damages the Fu organ. "Kui" means leaking, describing the failure of the Metropolis to store Essence; "Nuan" describes flowing, indicating unceasing emission of cold essence.)
Yang Qi, during extreme anger, causes Form and Qi to sever, with Blood pooling above, leading to Bo Jue (Thrusting Collapse). Injury to tendons causes flaccidity, making limbs seem unusable. (Anger damages Yang Qi. Yang Qi converges in the skin and interstices. Extreme anger causes Qi to rebel upward, severing the rotational mechanism of Qi in the form. "Wan" means lush/proliferating; Blood follows Qi and proliferates upward. "Bo" means pressing/thrusting; simultaneous rebellion of Qi and Blood causes Thrusting Collapse. Yang Qi softens and nourishes tendons. Vessels moisten bones/tendons and benefit joints. Damage to Yang Qi and upward reversal of Blood injures tendons. Flaccid tendons make limbs seem uncontrollable. The previous section discussed external causes damaging Yang Qi; this section discusses how labor and extreme anger also damage Yang Qi.)
Sweating limited to one side (Pian Ju) leads to hemiplegia (Pian Ku). Sweating exposed to dampness generates acne-like boils (Cuo Fei). Changes from rich food and alcohol lead to carbuncles (Ding). Receiving pathogens is like holding an empty vessel. Labor sweat exposed to wind, cold thinning causes zha (pimples), stagnation causes cuo (acne). (Ju means dampness; Cuo means small boil; Zha resembles rash; Fei refers to red lesions on face/nose. This section states Yang Qi guards the skin externally and fills the limbs, similar to Heaven's Qi operating beyond the Six Directions and Nine Provinces, solidifying Yin. If sweating is limited to half the body (dampness/stagnation), it indicates Yang Qi deficiency failing to permeate the body, predisposing to hemiplegia. Sweating exposed to dampness causes Damp-Heat to stagnate in the skin, generating Cuo and Fei. "Gao Liang" refers to rich flavors. Rich flavors damage Form, and Qi is damaged by flavor; when Form and Qi are damaged, muscle interstices become deficient. Heat-toxins from rich foods reverse in the flesh理 (texture) and often generate large carbuncles. Because skin-interstices are deficient, heat-toxins exploit them, like holding an empty vessel. Labor sweat exposed to wind allows Cold-Damp to thin the skin, causing Zha and Cuo. Zha and Cuo/Fei are mild conditions of Blood stagnation in the superficial skin, indicating Yang Qi guarding the skin is attacked by pathogens, causing pale seepage of blood in hair follicles. Thus: "Sweating limited to one side leads to hemiplegia" indicates Yang Qi, like Heaven and Sun, should pervade the Nine Provinces. "Generating Cuo/Fei, cold thinning causes Zha" indicates Yang Qi's external guard lies in the hair follicles. "Changes from rich food lead to carbuncles" indicates Yang Qi's convergence in the interstices. Zhu Jigong stated: The Classic says, slight imbalance disperses Qi, dispersal leaves skin empty. Also: Interstices are where the San Jiao converges Yuan Zhen (Original Truth). Form consumes flavor; if Form-Qi is deficient, rich flavor toxins exploit it, hence "receiving like an empty vessel.")
Yang Qi, when refined, nourishes the Spirit; when soft, nourishes the tendons. (Continuing from above, Yang Qi internally nourishes the Spirit of the Five Zang Organs and externally nourishes sinews/bones, not merely converging in muscle interstices and guarding the skin-hair. It has opening/closing and exiting/entering functions. The Classic states: Flavors enter the mouth, store in stomach/intestines, nourish Five Qi; when Qi harmonizes, fluids form, and Spirit arises. Yang Qi is the essence of grain/water, thus first nourishing the Spirit of the Five Zang Organs. "Soft" refers to the nascent Qi of Shaoyang. Initial subtle Yang nourishes tendons, hence Shaoyang generates tendons. Mo Zijin asked: The beginning discusses Spirit/Qi rooted in True Nature, why is it also nourished by the Five Flavors? Answer: Essence, Qi, and Spirit have both Pre-Heaven and Post-Heaven aspects. Pre-Heaven Spirit/Qi relies on Post-Heaven grain/water for generation and nourishment. Hence: "Two Essences interacting creates Spirit." The two Essences are Tian Yi Essence and Grain/Water Essence.)
If opening and closing mechanisms fail, Cold Qi enters, causing severe stooping (Da Lou). Cold sinking into vessels causes goiters (Ying); lingering in muscle interstices, acupoint Qi transformation weakens, transmitting to cause fear and惊骇 (fright). Ying Qi does not follow, reverses in flesh texture, causing abscesses/swellings (Yong Zhong). (Opening governs exterior during the day; Closing gathers inward at dusk. Losing opening/closing mechanism allows Cold Qi to invade internally. Back is Yang; Yang deficiency allows Cold pathogens to bi-block the back, causing stooping, as described in *Jin Gui* as Bi pain along the spine. If Yang deficiency fails to guard Ying Blood, pathogens sink into vessels causing goiters, lingering in muscle interstices, as *Jin Gui* describes as Horse Knife Goiter. If acupoint Qi transformation is deficient, pathogens transmit internally, harassing Spirit-storage organs. Heart governs vessels; Spirit damage causes fear and loss of self. Liver governs Blood; thus disease manifests as fright. *Jin Gui Yao Lue* states: Pathogens entering meridians/organs constitute internal causes. Pathogens entering acupoints/internal organs harass Zang Qi. If pathogens reverse in flesh texture/Qi level causing Yin-Yang disharmony, abscesses form. The Classic states: Excess Yang Qi and stagnant Ying Qi cause abscesses. Yin-Yang blockage and clashing heat transform into pus. This explains Yang insecurity allowing pathogens to attack nourished tendons (causing stooping) and internal Spirit (causing fear/fright), emphasizing Yang's external protection. Jigong stated: External protection prioritizes skin-hair; if insecure, pathogens enter flesh/meridians. Mo Zijin stated: Rich food changes reverse in flesh texture causing carbuncles; external pathogens reverse in flesh texture causing abscesses. Skin-hair and flesh texture are governed by Yang Qi. Thus: "Purity closes/rejects muscle interstices, pathogens cannot harm." If muscle interstices are dense, even if pathogens attack skin-hair, it remains only mild Cuo/Fei.)
Unfinished魄汗 (Poh Sweat/Sweat associated with Lung), form weakens and Qi scorches, acupoints close, developing Feng Nue (Wind Malaria). (Note: Yu characters pronounced Shu. This section discusses Surface Qi and Pathogenic Qi sinking together into muscle interstices causing Malaria. Lung governs skin-hair; unfinished Poh Sweat indicates Surface Pathogen remains. "Form weak" means deficient muscle interstices. Sparse interstices allow Surface Yang Pathogen to sink together. Cold Pathogen on surface transforms into Heat following Yang, hence Qi scorches. Although pathogens sink into muscle interstices, Surface Qi does not enter meridians, so acupoints close. Feng Nue is malaria with heat but no chills. Surface Yang Pathogen meets Wei Qi, causing fever. Surface Qi is Taiyang Qi. Muscle interstitial Qi is Yuan Zhen Qi of Five Zang Organs. *Jin Gui Yao Lue* states: Interstices are where San Jiao converges Yuan Zhen. Also: Unobstructed Yuan Zhen of Five Zang Organs ensures health. *Ling Shu* states: San Jiao and Bladder correspond to interstices and hair. San Jiao Qi connects interstices; Taiyang Qi governs skin-hair. Thus, Surface Pathogen sinking into muscle interstices damages Yuan Zhen Qi, while Taiyang Qi remains external. If interstitial pathogens linger, they transfer to acupoints, combining Five Zang Meridian Qi. This section discusses robust Surface Qi but deficient Muscle Qi, causing Surface Qi and Pathogen to sink together into muscle interstices. Taiyang Qi does not combine with Five Zang Meridian Qi, so acupoints close. This annotation should be read with *Shang Han Lun* commentary.)
Therefore, Wind is the beginning of all diseases. Purity and stillness close/reject muscle interstices; even with great Wind and severe toxins, harm is avoided, because one follows the seasonal sequence. (This reiterates nurturing Yuan Zhen Qi and the necessity of dense muscle interstices. Cold/Heat initially damage skin-hair; Wind penetrates directly into muscle interstices. Wind moves swiftly and changes frequently; entering muscle interstices affects meridians, causing Heat in Middle, Cold in Middle, hemiplegia, accumulations/masses, Fu organ diseases, or Zang organ death. Pathogenic excesses are countless, hence "Wind is the beginning of all diseases." Complying with Heaven's pure Qi and regulating Primordial Spirit ensures dense muscle interstices, avoiding harm from great Wind/severe toxins. This follows seasonal sequence and nurturing. Muscle interstitial Qi is Yuan Zhen of Five Zang Organs, thus should be regulated according to seasonal/Five Phase Qi. *Yao Lue* states: Unobstructed Yuan Zhen of Five Zang Organs ensures health; without physical decline, pathogens cannot enter interstices. Previous sections discussed Cold/Summer-heat/Dampness damaging Surface Yang, advising against labor damaging Yang; this section discusses Wind directly damaging muscle interstices, advising densification of Yuan Zhen.)
If disease persists, it transmits and transforms; if Upper and Lower do not connect, even good doctors cannot help. Death from Yang accumulation occurs because Yang Qi is blocked; blocked conditions require purging. Without urgent correct treatment, incompetent physicians ruin the case. (Persistent disease means pathogens remain. Transmission: starting in skin-hair, remaining in muscle interstices, then meridians/acupoints, then Mu Yuan/Zang-Fu. Transformation: changing to Cold, Heat, Dryness/Stagnation, or Dampness/Diarrhea. Heaven has Six Excess Pathogens; the body has Six Qi transformations. Long-term transmission/transformation causes Yin-Yang of Upper and Lower to disconnect; even skilled doctors cannot cure. Disease in Yang branch accumulating to death results from long-term transmission. Skilled doctors should urgently assist Yang Qi to block pathogens and prevent transmission. Blocked conditions require purging pathogens to prevent retention. Failure to use correct treatment urgently leads to failure by incompetent physicians.)
Yang Qi governs the exterior daily. At dawn, Human Qi generates; at noon, Yang Qi peaks; at sunset, Yang Qi declines, and Gate Qi (pores) close. Therefore, evening requires gathering and rejecting; do not disturb sinews/bones, do not expose to fog/dew. Reversing these three times leads to physical exhaustion. (Summarizing opening/closing of Yang Qi, emphasizing external protection. *Ling Shu* states: Spring generates, Summer grows, Autumn harvests, Winter stores; this is Qi's norm, and humans comply. Dividing a day into four seasons: Morning is Spring, Noon is Summer, Sunset is Autumn, Midnight is Winter. Morning sees initial Human Qi generation, hence clarity at dawn. Noon sees growth of Human Qi, overcoming pathogens. Evening sees decline. Midnight sees entry into Zang Organs. Thus, evening gathers Qi, rejects pathogens, avoids disturbing sinews/bones/labor, and avoids fog/dew (requiring purity). Reversing this leads to physical exhaustion by pathogens. "Gate Qi" refers to Xuan Fu (mysterious portals). "Three Times" refer to dawn, noon, sunset.)
Qibo said: Yin stores Essence and acts frequently (Qi Ji); Yang protects the exterior and secures it. (Life's root lies in Yin and Yang; Yang is born from Yin. Thus, the Emperor discussed Yang first, and Bo returned to discuss Yin. "Ji" means frequent/numerous. Yin governs storing Essence...)