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Harmony refers to the state of balance; "Ni Diao" (Reverse Regulation/Disharmony) refers to the violation of the normal laws governing Cold, Heat, Water, Fire, Ying (Nutrient), and Wei (Defensive) Qi, resulting in a lack of harmony. When Cold and Heat are disharmonious, it manifests as irritability and Bi syndrome (obstruction syndrome). When Water and Fire are disharmonious, it leads to emaciation of muscles (Ruo Shuo) and joint contracture (Luan Jie). When Ying (Nutrient) and Wei (Defensive) Qi are disharmonious, it results in muscle numbness and heaviness (Rou Ke). When Zang-Fu organ Qi is disharmonious, it causes rapid breathing and wheezing (Xi Chuan).

The Yellow Emperor asked: The human body is not constantly warm, nor constantly hot. What is the reason for fever accompanied by irritability and fullness?

This question follows up on the previous discussion. The previous section mentioned that patients with Warm diseases (Wen Bing) experience fever recurring immediately after sweating, hence the inquiry about the body not being constantly warm or hot. It also stated that some patients suffer from body heat, sweating, irritability, and fullness; thus, the question arises regarding the cause of fever accompanied by irritability and fullness.

Qibo replied: This is due to a deficiency of Yin Qi and an excess of Yang Qi, which causes fever and irritability/fullness.

Both Warm diseases and Heat diseases presenting with fever and irritability/fullness are caused by a deficiency of Yin Qi and an excess of Yang Qi. A deficiency of Yin generates internal heat, while an excess of Yang causes fever along with irritability and fullness. Since the mechanism of Warm and Heat diseases is essentially the same, they are answered together.

The Yellow Emperor asked: The body is not cold due to insufficient clothing, nor is there external cold invading the interior. Why does cold arise from within?

Cold is the opposite of Heat; therefore, this inquiry into cold follows the discussion on heat. The body is not cold due to thin clothing, indicating no exterior cold; the interior does not harbor external cold pathogens. "Cold arising from within" means that cold Qi emanates outward from the interior.

Qibo said: Such individuals often have Bi Qi (Obstruction Qi). Because Yang Qi is deficient and Yin Qi is abundant, the body feels cold, as if emerging from water.

Yang governs heat, and Yin governs cold. Diseases affecting the Yin aspect are named Bi syndrome. Cold arising from within occurs because such individuals possess abundant Bi Qi. Abundant Bi Qi results from deficient Yang Qi and abundant Yin Qi. Deficient Yang Qi causes the body to feel cold; abundant Yin Qi makes the body feel as cold as if just emerged from water. This describes how the disharmony of Cold and Heat leads to irritability and Bi syndrome.

The Yellow Emperor asked: Some people have hot limbs, but when exposed to wind and cold, they feel as if being roasted by fire. What is the reason?

Normally, body heat diminishes when encountering the cold of wind. However, in these cases, limb heat intensifies upon exposure to wind cold, feeling like roasting fire, without the heat subsiding. What is the cause?

Qibo said: In such individuals, Yin Qi is deficient and Yang Qi is excessive. The limbs belong to Yang. When two sources of Yang combine, Yin Qi becomes even more deficient. This is akin to a small amount of water failing to extinguish a raging fire, leading to the solitary dominance of Yang. "Solitary dominance" implies that Yang cannot grow or harmonize with other energies; it merely exists in a state of isolated excess. When exposed to wind, feeling as if roasted by fire indicates that such individuals will suffer from muscle emaciation (Ruo Shuo).

"Heat" refers to Yang Qi. The presence of heat in such individuals is due to deficient Yin Qi and excessive Yang Qi. The body interior belongs to Yin, while the limbs, being external, belong to Yang; hence, the limbs are considered Yang. The combination of excessive Yang Qi with the Yang nature of the limbs creates a convergence of two Yangs, further depleting Yin Qi. Yang represents Fire, and Yin represents Water. With deficient Yin Qi, a small amount of water cannot extinguish the intense fire generated by the convergence of two Yangs, resulting in the solitary dominance of Yang. Solitary Yang cannot generate life; thus, "solitary dominance" means an inability to foster growth, existing only in isolated excess. This isolated excess burns the muscles, so upon encountering wind, the sensation of being roasted by fire indicates that such individuals will suffer from muscle emaciation (Ruo Shuo).

The Yellow Emperor asked: Some people feel extremely cold; hot drinks and fires cannot warm them, and thick clothes cannot keep them warm, yet they do not shiver. What disease is this?

Body coldness can usually be cured by warming methods. If someone feels extreme cold that hot drinks, fires, and thick clothes cannot alleviate, it represents extreme cold. However, the absence of shivering raises the question: what disease is this?

This inquiry into extreme cold follows the previous discussion on extreme heat.

Qibo said: Such individuals typically have an excess of Kidney Qi and engage in activities related to water (or have excessive water-dampness internally), leading to the decline of Taiyang (Greater Yang) Qi. Consequently, Kidney essence dries up and fails to nourish the bones. This is described as one water failing to overcome two fires. The Kidney belongs to Water and governs the bones. If Kidney function declines, marrow fails to fill, causing cold to reach the bones.

(Note: The phrase "one water cannot overcome two fires" appears again later in the text and is considered redundant.) Cold belongs to Yin Qi. The sensation of cold in such individuals stems from a typical excess of Kidney Qi. Excess Kidney Qi leads to heavy water-dampness, which causes the decline of Taiyang Yang Qi. The decline of Taiyang Yang Qi results in "Gu Yin" (Lone Yin). Lone Yin cannot grow, leading to dried-up Kidney essence that fails to nourish the bones. As the Kidney belongs to Water and essence is produced in the bones, dried-up essence means the Kidney cannot function properly; improper Kidney function leads to empty marrow, causing cold to penetrate to the bone level. Hence, hot drinks and thick clothes cannot provide warmth.

The reason for not shivering is that the Liver is One Yang, the Heart is Two Yangs, and the Kidney is a Gu Zang (Lone Organ, purely Yin). One water cannot overcome two fires, so despite extreme cold, there is no shivering. This disease is named Gu Bi (Bone Bi). Such individuals will suffer from joint contracture (Luan Jie).

Although cold reaching the bone should theoretically cause shivering, the absence of shivering is because Kidney Water generates Liver Wood. The Liver is Yang within Yin, thus called One Yang. Shaoyin (Lesser Yin) combines with Heart Fire; the Heart is Yang within Yang, thus called Two Yangs. The Kidney is Yin within Yin, thus called the Lone Organ. One Yang and Two Yangs represent Fire, while the Lone Organ represents Water. Currently, one water cannot overcome two fires; therefore, even though cold reaches the bone, there is no freezing shiver. With cold located in the bone, the disease is named Bone Bi. Bone Bi manifests as joint stiffness and contracture; thus, such individuals will suffer from joint contracture.

This section explains that the disharmony of Water and Fire, where solitary Yang cannot generate, leads to muscle emaciation (Ruo Shuo); and where solitary Yin cannot grow, leads to joint contracture (Luan Jie).

The Yellow Emperor asked: Some people suffer from Rou Ke (muscle numbness/heaviness); even near cotton wadding, they still feel numb and heavy. What disease is this?

"Ke" is similar to the sensation in Malaria. Following the theme of Cold and Heat, this refers to individuals who, without external Cold or Heat invasion, experience muscle numbness and heaviness akin to malaria. Even near warming materials, relief is not achieved. What is this disease?

Qibo said: This is due to deficient Ying Qi (Nutrient Qi) and relatively solid/excessive Wei Qi (Defensive Qi). Deficient Ying Qi leads to anesthesia (Bu Ren - loss of sensation); deficient Wei Qi leads to paralysis/immobility (Bu Yong - loss of movement). If both Ying and Wei Qi are deficient, there is both anesthesia and immobility, and the condition of Rou Ke persists. If the physical form and the Shen (Spirit/Mind) are disconnected, death ensues.

Ying and Wei Qi travel together. If Ying Qi is deficient, Wei Qi appears relatively excessive (or unregulated). This clarifies that deficient Ying Qi causes Bu Ren (anesthesia/loss of pain and temperature sensation). Wei Qi deficiency causes Bu Yong (immobility/inability to move freely). If both are deficient, both symptoms occur, and muscle numbness persists. Human Ying and Wei Qi are interconnected with the Shen of the Five Zang organs. If the body and Spirit are disconnected, it signifies a separation of Form and Spirit, leading to death. This explains how the disharmony of Ying and Wei Qi leads to Rou Ke.

The Yellow Emperor asked: Some people have rebellious Qi preventing them from lying flat, accompanied by noisy breathing. Others cannot lie flat but breathe silently. Some have normal daily activities but noisy breathing. Some wheeze only when walking while lying down. Others wheeze when unable to lie flat and unable to walk. Some cannot lie flat and wheeze immediately upon lying down. Which Zang organs are responsible for these conditions? I wish to hear the explanation.

Although all involve rebellious Qi preventing lying flat, the presence or absence of noise differs. Although all have noisy breathing, those with normal activity differ from those who cannot lie flat. Although wheezing is common, the triggers (lying/walking) vary. This is wheezing caused by Zang-Fu Qi disharmony; thus, the question asks which Zang organ is involved.

Qibo said: Inability to lie flat with noisy breathing is due to the rebellion of Yangming Qi. The Qi of the Three Yang meridians normally descends; now, rebelling upward, it causes noisy breathing. Yangming refers to the Stomach meridian. The Stomach is the Sea of the Six Fu organs, and its Qi also descends. If Yangming Qi rebels and cannot follow its descending pathway, it prevents lying flat. The Classic states: "If the Stomach is not harmonious, sleep is restless," which refers to this situation.

(Note: Correction of textual error noted in original commentary.) Inability to lie flat with noisy breathing is due to the rebellion of the Foot-Yangming meridian. The Foot-Three-Yang meridians run from head to foot, so their Qi normally descends. Now rebelling upward, it causes noisy breathing. Yangming is the Stomach meridian. The Stomach is the Sea of the Six Fu organs, and its Qi descends. Rebellious Yangming Qi cannot follow its descending path, preventing lying flat. The *Ping Re Lun* states: "Those who cannot lie flat have disharmony in the Stomach." "Zheng Yan" means lying flat comfortably. Citing the Classic's "Stomach disharmony leads to restless sleep" explains the rebellion of Yangming Qi failing to follow its course. This clarifies the cause of inability to lie flat with noisy breathing.

As for those with normal activity but noisy breathing, this is due to the rebellion of the collateral vessels of the Lung. Collateral vessels cannot ascend and descend with the main meridians, so Qi remains in the main meridians rather than entering the collaterals. Pathology in collateral vessels is minor; thus, daily activities remain normal despite noisy breathing.

Specifically, normal activity with noisy breathing is due to rebellious Qi in the Lung's collateral vessels. Collaterals are external and connect internally to the meridians. Now, Qi cannot flow with the meridians, so Lung Qi stagnates in the meridians instead of flowing into the collaterals. Being external, collateral pathology is mild. Mild illness allows normal activity; stagnation in meridians causes noisy breathing. This clarifies the case of normal activity with noisy breathing.

Regarding inability to lie flat and wheezing upon lying down, this is due to Water Qi invading the Lungs. Water flows along with Jin Ye (Body Fluids). The Kidney is the Water Organ and governs Jin Ye; it also governs sleep and wheezing.

Specifically, inability to lie flat and wheezing upon lying down is due to Cold-Water Qi invading the Lungs. Water flows along the fluids of the intestines and stomach. The Kidney is the Water Organ and master of Jin Ye. Now, with Water Qi invading, it causes inability to lie flat and wheezing. This clarifies the case of inability to lie flat and wheezing upon lying down.

The Yellow Emperor said: Excellent.

Inability to lie flat with noisy breathing is due to Stomach Qi rebellion; inability to lie flat with silent breathing is also due to Stomach Qi rebellion. Normal activity with noisy breathing is due to Lung Collateral rebellion; wheezing while walking (when able to lie down) is also due to Lung Collateral rebellion. Inability to lie flat with wheezing upon lying down is due to Water Qi invasion; inability to lie flat, inability to walk, and wheezing are also due to Water Qi invasion. The Yellow Emperor silently comprehended these principles and praised the answer. This section explains how Zang-Fu Qi disharmony leads to wheezing.