帝曰∶法阴阳奈何？岐伯曰∶阳胜则身热，腠理闭，喘粗为之俯仰，汗不出而热，齿干，以烦冤腹满死，
能冬不能夏；阴胜则身寒，汗出，身常清，数 而寒，寒则厥，厥则腹满死，能夏不能冬。此阴阳更胜之变，
病之形能也。
此明阴阳偏胜之病状也。其阳邪胜而身热，腠理闭，喘粗为之俯仰，汗不出者，营卫不通而气上逆也。齿
干、烦冤、腹满者，邪入脏腑，内外皆闭，不得发泄，故死。能冬不能夏者，冬令阴旺，而阳邪胜者，或可耐
时以调治，若夏令阳旺以助邪，则不能治矣。其阴邪胜而阳虚，则身寒，汗出，身常清冷，数 而寒者，表阳
已虚，寒甚则厥，厥则腹满者，内阳又败，故死。能夏不能冬者，义与阳胜者同。此阴阳更相胜负之变，而病形之能
愈不能愈可验也。
清浊气乱
《灵枢·五乱篇》帝曰∶经脉十二者，别为五行，分为四时，何失而乱？何得而治？岐伯曰∶五行有序，
四时有分，相顺则治，相逆则乱。经脉十二者，以应十二月。十二月分为四时，四时者，春夏秋冬，其气各
异，营卫相随，阴阳已和，清浊不相干，如是则顺之而治。清气在阴，浊气在阳，营气顺脉，卫气逆行，清
浊相干，乱于胸中，是谓大闷。故气乱于心，则烦心密嘿，俯首静伏，乱于肺，则俯仰喘喝，接手以呼；乱于
肠胃，则为霍乱；乱于臂胫，则为四厥；乱于头，则为厥逆，头重眩仆。
经脉为枝叶，五脏为根本。五脏具五行之性，故经脉亦有五行之别，而五行之生化有序也。手足三阴三阳
十二经，以应十二月，乃分春夏秋冬四时之气候。是故营卫经络，阴阳气血，生化
流行，皆合乎四时升降之气，五行相生之序，则阴阳和平，清浊
不相干，而各循其道，如是则为顺而治也。夫身半以上为阳，身半以下为阴。清气为阳而上升，浊气为阴而下
降。如清气在阴而不升，浊气在阳而不降，则使营气顺脉而行，不与卫和，卫气逆行，则升降失序，而清浊相
干，故曰∶清气在下，则为飧泄；浊气在上，则为 胀，随其逆乱之处而现病也。如乱于胸中，是谓大 ，
者，郁闷也；乱于心，则烦心密嘿，俯首静伏者，以心烦不欲言动也；乱于肺，则气壅塞，故俯仰喘喝，接手
以呼者，两手交接抵胸，始能呼气以出也；乱于肠胃，则为霍乱，吐泻交
作矣；乱于臂胫，则阴阳经脉，交接之气不通，故四肢厥冷也；乱于头，则气厥上逆，头重下轻，故目眩而跌
仆也。此虽止举数端，而余处皆可概见矣。然其所以致之者，必有外感内伤之因，要必求其所因而调之也。
邪流八虚
《灵枢·邪客篇》帝曰∶人有八虚，各何以候？岐伯曰∶以候五脏。肺心有邪，其气流于两肘；肝有邪，
其气流于两腋；脾有邪，其气流于两髀；肾有邪，其气流于两 。凡此八虚者，皆机关之室，真气之所过，血
络之所游，邪气恶血，固不得住留，住留则伤经络骨节，机关不得屈伸，故病挛也。
两肘、两腋、两髀、两 者，五脏真气之所过，经络血脉之所游，为一身之机枢关要也。故邪气恶血，不
得留住于此。若五脏有邪，其气外走，必由八处流行，而与恶血住留于此者，则伤经络筋骨，机关窒塞，不得
屈伸，而成拘挛之病。故其称八虚者，此八节机关，必要虚通，而气血流行调畅，则无诸病也。
营卫肠胃邪痹
《灵枢·寿夭刚柔篇》帝问营卫寒痹之为病。伯高曰∶营之生病也，寒热少气，血上下行；卫之生病也，
气痛时来时去，怫忾贲响，风寒客于肠胃之中。寒痹之为病也，留而不去，时痛而皮不仁。
营为阴而行脉中，主血；卫为阳而行脉外，主气。经在营分，络在卫分。营卫气血，由经络而周流表里
者也。病在营，则经络不得通和，故发寒热而少气，气郁则血不能四布，而但上下行走，故有因外邪而动血吐
衄者，即营病之征也。盖血得寒则凝
涩，得热则妄溢也；卫行脉外，其气 悍而浮漫，其为病也，逆其气势，则郁结而痛，时来时去者，流走不定
也，怫忾音费欷，郁闷而太息也，以其风寒客于肠胃，清浊相混，故又贲响也，贲同奔。如寒邪痹而不去，则
内时痛而皮不仁，不仁者，顽木不知痛痒，以大肠之气外应于皮，而邪本由皮毛而入也。
风寒伤形 情欲伤气
帝曰∶形气病之先后，外内之应奈何？伯高曰∶风寒伤形，忧恐忿怒伤气。气伤脏，乃病脏；寒伤形，乃
应形；风伤筋脉，筋脉乃应。此形气内外之相应也。
风寒由皮毛而入，故伤形，忧恐忿怒以动神志，故伤元气，元气根于脏，乃致脏病也。若以风寒分之，寒为
阴邪伤形，形者，统营卫、经络、肌肉、筋骨而言也；若风为阳邪，独言伤筋脉者，兼内风而言也。盖筋脉肝
心所主，肝血少，则生风，心劳动，则生火，故有外邪内邪之分，若外邪，则风伤卫，脉缓而有汗，寒伤营，
脉紧而无汗，如仲景所论者，故先统言风寒伤形也。又如《素问·调经论》所云阴盛生内寒者，由内伤阳气
也。如其伤阴血，则生肝风，而心火亦炽，风火交烁，必伤筋脉。此形气与内邪外邪之必相应，而有证状可验
也。
外邪自浅入深
《素问·缪刺论》岐伯曰∶夫邪之客于形也，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，阴阳俱感，五脏乃伤。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。夫邪客大络者，左注右，右注左，上下左右，与经相干，而布于四末，其气无常处，不入于经俞，
命曰缪刺。帝曰∶愿闻缪刺，以左取右，以右取左奈何？其与巨刺，何以别之？岐伯曰∶邪客于经，左盛则右
病，右盛则左病，亦有移易者，左痛未已，而右脉先病，如此者，必巨刺之，必中其经，非络脉也。故络病者，
其痛与经脉缪处，故命曰缪刺。
此节当与痹病篇众痹、周痹各条合观。盖凡外邪之由皮毛入者，必自浅而深，从络入经，则内连五脏，散
于肠胃，以阴阳十二经内通脏腑者也。故阴阳俱感，五脏乃伤，然邪虽深入，其未离于经者，必当从经而治，以
其由表而入，必使仍从表出，不可轻攻其里，反使外邪内陷，则危矣。故如仲景之治少阴病发热者，邪不离经，
乃用麻黄、细辛通经，以附子助里达表，此邪之浅深，治法先后，不可不知也。如邪先舍孙络，留而不去，络
脉闭塞，不与经通，则邪流溢于大络，而生奇病，谓其病状奇异也。因大络散布周身内外，交互错综，与经脉
之径直而有隧道者不同，故邪客大络，则随络气散漫游走，左注右，右注左，上下左右，皆与十二经相干涉，
而分布于四肢之末，其邪游走，不入经俞，故为奇病，如俗名流火游风之类也。治之当用缪刺，以左取右，以右
取左，不同治经之法也。若邪客于经，亦有偏左偏右，互相移易者，必用巨刺以治经，非同刺络之法。缪刺浅，
巨刺深，以络浅经深也。邪在大络，其痛游走无常，与经病之痛有定处者不同。络病之痛，言与经脉缪处者，与
经环回而不在经中。盖十二经交接之处，皆由络脉通贯，而络与经之首尾缪处，故命曰缪刺也。此下皆言络病，
方脉家必须明之。刺法另有专科，而药治亦同一理也。
邪客手足三阴三阳之络
邪客于足少阴之络，令人卒心痛，暴胀，胸胁支满。
邪客于手少阳之络，令人喉痹舌卷，口干心烦，臂外廉痛，手不及头。
邪客于足厥阴之络，令人卒疝暴病。
邪客于足太阳之络，令人头项肩痛。
邪客于手阳明之络，令人气满胸中，喘息支 ，胸中热。
邪客于臂掌之间，不可得屈。
邪客于阳跷之脉，令人目痛，从内 始。
人有所坠堕，恶血留内，腹中满胀，不得前后，先饮利药，此上伤厥阴之脉，下伤少阴之络。
邪客于手阳明之络，令人耳聋，时不闻音。
凡痹往来行无常处者，在分肉间痛而刺之。
邪客于足阳明之络，令人鼽衄，上齿寒。
邪客于足少阳之络，令人胁痛不得息，咳而汗出。咳者，温衣暖食。
邪客于足少阴之络，令人嗌痛，不可内食。无故善怒，气上走贲上，嗌中肿，不能内唾，时不能出唾者。
邪客于足太阴之络，令人腰痛，引少腹控 ，不可以仰息。
邪客于足太阳之络，令人拘挛背急，引胁而痛。
邪客于足少阳之络，令人留于枢中痛，髀不可举。
邪客于五脏之间，其病也，脉引而痛，时来时止。
邪客于手足少阴、太阴、足阳明之络，此五络皆会于耳中，上络左角，五络俱竭，令人身脉皆动，而形无
知也，其状若尸，或曰尸厥。以竹管吹其两耳，剃其左角之发方一寸，燔治，饮以美酒数杯，不能饮者灌之，立已。
手足阴阳十二经交接之处，皆由络脉通贯。经如粗枝而直，络如细枝而横，由络分枝而更细者名孙络，故
经有阴阳浅深，而络亦如之，其部位皆随经而缪处者也。以上所列病证，皆络气行到之处邪客之，其气或闭或
逆，故现诸病。其同一经而有重迭病证不同者，因经之首尾皆有络，而部位又有浅深高下，故其现病各异也。若
其流行次序，及十二经所现病证，已详经络门中经脉篇，当合观之，义理更明也。惟络脉既通经之首尾，而又
散布周身，其孙络浅在皮腠之间而脉愈细，故受邪则气闭不通，凡麻木、痹痛及游走不定者，皆为络病。而阳
络在表，故伤则血外
溢而为吐为衄；阴络在里，故伤则血内溢而为便血溺血也。外邪从络入经，气血自经注络，而血随气行，自内出
外，邪则由表入里，故逆之而成病。若气血旺，邪不能入，故曰∶邪之所凑，其气必虚。但六气之邪，有阴阳
清浊之异，故亦随类相感，或由皮毛而入于经者，或由口鼻而入从中道，而分走表里者，其现证皆各不同，则必
辨明而治之，故当洞明经络部位之浅深也。
邪随时令气候入客
《素问·四时刺逆从论》岐伯曰∶春气在经脉，夏气在孙络，长夏气在肌肉，秋气在皮肤，冬气在骨髓
中。帝曰∶愿闻其故。岐伯曰∶春者，天气始开，地气始泄，冻解冰释，水行经通，故人气在脉；夏者，经满
气溢，入孙络受血，皮肤充实；长夏者，经络皆盛，内溢肌中；秋者，天气始收，腠理闭塞，皮肤引急；冬
者盖，藏血气在中，内着骨髓，通于五脏。是故邪气者，常随四时之气血而入客也。至其变化，不可为度，
然必从其经气，辟除其邪，除其邪，则乱气不生。
此言天地阴阳五行之气，升降流行，以春、夏、季夏、秋、冬五时，应木、火、土、金、水之五气，而主
生、长、化、收、藏，以滋养万物。人生气交之中，故身中元气，应天地之气而浮沉。浮则旺于表而衰于里，
沉则旺于里而衰于表。邪必乘衰而袭之，故亦随时令气候而入客于身，则有浅深部位不同也，每见秋冬风寒之
邪，多从皮毛而入经络，夏令暑湿之邪，多由口鼻而入脾胃。其表里元气之衰旺，亦可征矣。然此言其常理耳，
至其变化为病，不可为一定之度。良以人禀有强弱，感邪有重轻，要必审其受邪之处，从其经气辟除其邪。
盖经者，通表里之道路，表里之邪，皆可由之而辟除，除其邪，则乱气不生而病自愈。故仲景
分六经以辨脉证而立治法，为传轩岐之道脉也。其不究心于仲景而流于浅陋邪僻者，岂不为轩岐之罪人哉。
又按《素问·金匮真言论》曰∶春气者，病在头；夏气者，病在脏；秋气者，病在肩背；冬气者，病在四肢。
与此篇相类，而各有义理不同，录后虚风贼邪篇内，宜合观之。
筋骨不得屈伸
《灵枢·终始篇》曰∶手屈而不伸者，其病在筋；伸而不屈者，其病在骨。在骨守骨，在筋守筋。
筋挛，故屈而不能伸；骨强，故伸而不能屈。肝主筋，肾主骨，各守其主病者而治之也。
《素问·平人气象论》曰∶膝者，筋之府，屈伸不能，行则偻俯，筋将惫矣；骨者，髓之府，不能久立，
行则振掉，骨将惫矣。
此观其行立之状，知其筋骨之将惫。惫者，败也。
疹筋
《素问·奇病论》帝曰∶人有尺脉数甚，筋急而现，此为何病？岐伯曰∶此所谓疹筋，是人腹必急，白
色黑色现，则病甚。
疹者，结气为病之义，故风热之邪郁结血络，发为疹子。此名疹筋者，肝主筋，肾水亏，不能养肝，其阳
郁结于下，不得上达，故尺脉数甚，而肝枯筋燥，故筋急外现，其腹中亦必拘急不舒，白色黑色现，则金水不
能相生，肺肾皆不调，则肝病更甚也。
黄帝问道：如何运用阴阳法则来诊治疾病？岐伯回答说：阳气偏胜则身体发热，腠理闭塞，呼吸急促粗重，甚至因呼吸困难而不得不俯仰起伏，汗不出而身热，牙齿干燥，若出现心烦意乱、腹部胀满的症状就会死亡，这种病能耐受冬季而不能耐受夏季；阴气偏胜则身体发冷，出汗，身体经常感到清冷，频繁战栗发冷，寒冷至极则发生四肢厥逆，厥逆若导致腹部胀满就会死亡，这种病能耐受夏季而不能耐受冬季。这是阴阳相互偏胜的变化，也是疾病表现出的形态和预后特征。
这段文字阐明了阴阳偏胜的病症表现。如果是阳邪偏胜而导致身体发热、腠理闭塞、呼吸急促粗重、俯仰起伏、无汗者，是因为营卫之气不通畅，导致气机上逆。牙齿干燥、心烦意乱、腹部胀满，是因为邪气侵入脏腑，内外闭塞，邪气无法发泄，所以会导致死亡。所谓“能冬不能夏”，是指冬季阴气旺盛，阳邪偏胜的患者或许还能暂时忍受并等待时机进行调治；但如果到了夏季，阳气旺盛会助长邪气，那就无法治愈了。如果是阴邪偏胜而阳气虚弱，就会导致身体发冷、出汗、身体常感清冷，频繁战栗发冷，这是因为表阳已经虚弱，寒邪极盛则发生厥逆，厥逆导致腹部胀满，是因为内阳也败坏了，所以会导致死亡。所谓“能夏不能冬”，其道理与阳胜的情况相同。这就是阴阳相互胜负的变化，通过观察病形的能否痊愈可以验证。
【清浊气乱】
《灵枢·五乱篇》记载：黄帝问道：十二经脉分别对应五行，分为四时，是什么因素导致它们紊乱？又是什么因素使它们得到治疗？岐伯回答说：五行运行有序，四时各有分界，顺应则治理正常，违背则发生紊乱。十二经脉对应一年中的十二个月。十二月分为春夏秋冬四时，四时的气候各不相同，营气和卫气相随而行，阴阳调和，清气和浊气互不干扰，像这样就是顺应的状态从而得到治理。如果清气在阴分，浊气在阳分，营气顺着经脉运行，卫气却逆行，清气和浊气相互干扰，扰乱在胸中，这就称为大闷。因此，气乱在心，就会出现心烦、沉默不语、低头静伏的症状；气乱在肺，就会出现俯仰喘喝，双手交叉抵住胸部以辅助呼吸；气乱在肠胃，就会发生霍乱；气乱在手臂和小腿，就会发生四肢厥冷；气乱在头部，就会发生厥逆，头重脚轻而跌倒。
经脉如同枝叶，五脏则是根本。五脏具备五行的属性，所以经脉也有五行的区别，而五行的生化是有次序的。手足三阴三阳共十二条经脉，对应十二个月，进而分为春夏秋冬四时的气候变化。因此，营卫经络、阴阳气血的生化流行，都符合四时升降的气机规律和五行相生的次序，这样阴阳平和，清浊互不干扰，各自遵循其道，这就是顺应的状态从而得到治理。人体上半身为阳，下半身为阴。清气属阳而上升，浊气属阴而下降。如果清气在下而不升，浊气在上而不降，就会导致营气虽然顺着经脉运行，但不能与卫气和谐，卫气逆行，使得升降失去秩序，清浊相互干扰，所以说：清气在下，就会发生完谷不化的泄泻；浊气在上，就会发生胀满，随着气机逆乱的地方而出现相应的病症。比如气乱在胸中，称为大闷，“闷”的意思是郁闷；气乱在心，出现心烦、沉默不语、低头静伏，是因为心烦不想说话和活动；气乱在肺，气机壅塞，所以俯仰喘喝，双手交叉抵住胸部才能呼气；气乱在肠胃，就发生霍乱，呕吐和腹泻交替发作；气乱在手臂和小腿，阴阳经脉交接的气血不通，所以四肢厥冷；气乱在头部，气机厥逆向上，头重脚轻，所以眼睛眩晕而跌倒。这里虽然只列举了几种情况，但其他地方的病变都可以以此类推。然而导致这些病变的原因，一定有外感或内伤的病因，必须探究其病因并进行调理。
【邪流八虚】
《灵枢·邪客篇》记载：黄帝问道：人有八个虚处（指肘、腋、髀、腘），各用来诊察什么？岐伯回答说：用来诊察五脏。肺和心如果有邪气，其气流注于两肘；肝有邪气，其气流注于两腋；脾有邪气，其气流注于两大腿根部（髀）；肾有邪气，其气流注于两腘窝（膝盖后方）。这八个虚处，都是关节活动的枢纽所在，是真气经过的地方，也是血络游行的地方，邪气和恶血本来不得在此停留，如果停留就会损伤经络骨节，导致关节不能屈伸，从而发生痉挛的病症。
两肘、两腋、两大腿根、两腘窝，是五脏真气经过、经络血脉游行的部位，是一身的机关枢纽关键所在。所以邪气和恶血不得在此停留。如果五脏有邪气，其气向外走散，必然经过这八个部位流行，并与在此停留的恶血相结合，就会损伤经络筋骨，导致关节窒塞，不能屈伸，形成拘挛的病证。所以称这八个部位为“八虚”，意思是这八个关节枢纽必须保持虚空通畅，气血流行调畅，就不会产生各种疾病。
【营卫肠胃邪痹】
《灵枢·寿夭刚柔篇》记载：黄帝询问营气、卫气和寒痹引起的病症。伯高回答说：营气生病，会出现寒热、少气，血液上下妄行；卫气生病，会出现气痛，时来时去，胸膈郁闷、肠鸣有声，这是因为风寒客居于肠胃之中。寒痹引起的病症，邪气留滞不去，时常疼痛且皮肤麻木不知痛痒。
营气属阴，行于脉中，主司血液；卫气属阳，行于脉外，主司气机。经气在营分，络气在卫分。营卫气血通过经络周流于表里之间。病在营分，则经络不通和，所以发寒热而少气，气郁结则血液不能四布，只能上下行走，所以有因外邪扰动血液而发生吐血、衄血的，这就是营病的征象。大概血液遇寒则凝涩，遇热则妄溢；卫气行于脉外，其气剽悍滑利而浮漫，它致病时，如果气势逆乱，就会郁结而痛，时来时去是因为气机流走不定；怫忾（音费欷），指郁闷而叹息，因为风寒客居肠胃，清浊之气相混，所以又出现肠鸣奔响，“贲”通“奔”。如果寒邪痹阻不去，就会内部时常疼痛且皮肤麻木，所谓“不仁”，就是顽木不知痛痒，因为大肠之气外应于皮肤，而邪气本由皮毛而入。
【风寒伤形 情欲伤气】
黄帝问道：形体和气机的病变先后，以及内外相应的关系是怎样的？伯高回答说：风寒伤害形体，忧恐忿怒伤害气机。气机受伤则病及内脏，成为脏病；寒邪伤害形体，则应验于形体；风邪伤害筋脉，筋脉就会相应发病。这就是形体和气机内外相应的关系。
风寒从皮毛而入，所以伤害形体；忧恐忿怒动摇神志，所以伤害元气，元气根源于脏，从而导致脏病。如果区分风寒，寒为阴邪伤害形体，这里的“形”，统指营卫、经络、肌肉、筋骨而言；如果说风为阳邪独言伤害筋脉，是兼指内风而言。因为筋脉由肝心所主，肝血不足则生风，心劳过度则生火，所以有外邪和内邪的区别。如果是外邪，风伤卫气，脉缓而有汗；寒伤营气，脉紧而无汗，如张仲景所论述的那样，所以先统称风寒伤形。又如《素问·调经论》所说阴盛生内寒，是由于内伤阳气所致。如果损伤阴血，则生肝风，心火也会炽盛，风火交灼，必然伤害筋脉。这就是形气与内邪外邪必然相应，并有症状可验证的道理。
【外邪自浅入深】
《素问·缪刺论》记载：岐伯说：邪气侵犯人体，必定先停留在皮毛，停留不去，就进入孙脉；停留不去，就进入络脉；停留不去，就进入经脉，内连五脏，散布于肠胃，阴阳都受到感应，五脏才会受伤。这就是邪气从皮毛进入，直至五脏的顺序。像这样，就要治疗其经脉。现在邪气客于皮毛，进入孙络，停留不去，闭塞不通，不能进入经脉，而是流溢于大络，而产生奇异的病症。邪气客于大络，左边的注入右边，右边的注入左边，上下左右，与经脉相互干涉，而分布于四肢末端，其气没有固定的位置，不入于经穴，命名为缪刺。黄帝问道：希望听听缪刺，为什么左病取右，右病取左？它与巨刺有什么区别？岐伯回答说：邪气客于经脉，左侧盛则右侧发病，右侧盛则左侧发病，也有转移变化的，左侧疼痛未止，而右侧脉象先病，像这样的情况，必须用巨刺法，一定要刺中经脉，而不是络脉。所以络病，其疼痛的位置与经脉交错不同，所以命名为缪刺。
这一节应当与《痹病篇》中的众痹、周痹各条合起来观看。凡是外邪从皮毛进入的，必定由浅入深，从络入经，则内连五脏，散布于肠胃，因为阴阳十二经内通脏腑。所以阴阳都受到感应，五脏才会受伤。然而邪气虽然深入，但只要还没有离开经脉，就必须从经脉治疗，因为它由表而入，必须使其仍从表出，不可轻易攻伐其里，反而使外邪内陷，那就危险了。所以如张仲景治疗少阴病发热者，邪气不离经脉，就用麻黄、细辛通经，用附子助里达表，这是关于邪气的深浅和治疗方法的先后顺序，不可不知道。如果邪气先客于孙络，停留不去，络脉闭塞，不与经脉相通，则邪气流溢于大络，而产生奇异病症，说是病状奇异。因为大络散布于周身内外，交互错综，与经脉径直而有隧道不同，所以邪气客于大络，就随络气散漫游走，左注右，右注左，上下左右，都与十二经相干涉，而分布于四肢之末，其邪游走，不入经俞，所以为奇病，如俗名流火游风之类。治疗当用缪刺，左病取右，右病取左，不同于治疗经脉的方法。如果邪气客于经脉，也有偏左偏右，互相移易的，必须用巨刺来治疗经脉，不同于刺络的方法。缪刺浅，巨刺深，因为络浅经深。邪在大络，其疼痛游走无常，与经病疼痛有定处不同。络病的疼痛，所说的与经脉交错不同，是指与经脉环回而不在经中。因为十二经交接之处，都由络脉通贯，而络与经的首尾交错不同，所以命名为缪刺。以下都讲络病，方脉家必须明白。刺法另有专科，而药物治疗也是同样的道理。
【邪客手足三阴三阳之络】
邪气客于足少阴之络，使人突然心痛，暴胀，胸胁支撑满闷。
邪气客于手少阳之络，使人喉痹舌卷，口干心烦，手臂外侧疼痛，手不能举过头顶。
邪气客于足厥阴之络，使人突然疝气暴病。
邪气客于足太阳之络，使人头项肩痛。
邪气客于手阳明之络，使人气满胸中，喘息支满，胸中热。
邪气客于臂掌之间，不可得屈。
邪气客于阳跷之脉，使人目痛，从内眦开始。
人有所坠堕，恶血留于体内，腹中满胀，大小便不通，先服用通利药物，这是上伤厥阴之脉，下伤少阴之络。
邪气客于手阳明之络，使人耳聋，时常听不见声音。
凡是痹症往来行无常处的，在分肉间疼痛就针刺那里。
邪气客于足阳明之络，使人鼻渊衄血，上齿寒冷。
邪气客于足少阳之络，使人胁痛不得呼吸，咳嗽而汗出。咳嗽的，用温衣暖食治疗。
邪气客于足少阴之络，使人咽痛，不能进食。无故容易发怒，气向上走到贲门之上，咽喉肿，不能吞咽唾液，时常想吐唾沫却吐不出来。
邪气客于足太阴之络，使人腰痛，牵引少腹控引睾丸，不可以仰卧呼吸。
邪气客于足太阳之络，使人拘挛背急，牵引胁部而痛。
邪气客于足少阳之络，使人留在枢中痛，大腿不能举起。
邪气客于五脏之间，其病症是，经脉牵引疼痛，时来时止。
邪气客于手足少阴、太阴、足阳明之络，这五条络脉都交会于耳中，上行联络左角，五条络脉都竭绝，使人全身脉搏跳动，而形体无知觉，其状若尸体，有的称为尸厥。用竹管吹其两耳，剃去左角头发方一寸，烧治，用美酒数杯饮用，不能饮用的灌下去，立刻就好。
手足阴阳十二经交接之处，都由络脉通贯。经脉如粗枝而直，络脉如细枝而横，由络分出更细的分支名为孙络，所以经脉有阴阳浅深，络脉也是如此，其部位都随经脉而交错不同。以上所列病证，都是络气行到之处邪气客之，其气或闭或逆，所以出现各种病症。同一经脉而有重叠病证不同的，是因为经的首尾都有络，而部位又有浅深高下，所以出现的病症各异。至于其流行次序，及十二经所现病证，已在经络门中的经脉篇详述，应当合起来观看，义理更明白。只有络脉既通经的首尾，而又散布周身，其孙络浅在皮腠之间而脉愈细，所以受邪则气闭不通，凡麻木、痹痛及游走不定的，都是络病。而阳络在表，所以受伤则血外溢而为吐血、衄血；阴络在里，所以受伤则血内溢而为便血、溺血。外邪从络入经，气血自经注络，而血随气行，自内出外，邪则由表入里，所以逆之而成病。如果气血旺盛，邪气不能进入，所以说：邪之所凑，其气必虚。但六气之邪，有阴阳清浊的不同，所以也随类相感，或由皮毛而入于经者，或由口鼻而入从中道，而分走表里者，其现证皆各不相同，则必须辨明而治疗，所以应当洞明经络部位的浅深。
【邪随时令气候入客】
《素问·四时刺逆从论》记载：岐伯说：春气在经脉，夏气在孙络，长夏气在肌肉，秋气在皮肤，冬气在骨髓中。黄帝问道：希望听听其中的缘故。岐伯回答说：春季，天气始开，地气始泄，冻解冰释，水行经通，所以人气在脉；夏季，经气满溢，进入孙络受血，皮肤充实；长夏，经络皆盛，内溢肌中；秋季，天气始收，腠理闭塞，皮肤紧缩；冬季，盖藏，血气在中，内着骨髓，通于五脏。所以邪气，常随着四时气血的变化而入客于人体。至于其变化，不可作为固定的尺度，然而必须顺从其经气，辟除其邪气，除去邪气，那么乱气就不会产生。
这段话讲的是天地阴阳五行之气，升降流行，以春、夏、季夏、秋、冬五时，对应木、火、土、金、水之五气，而主生、长、化、收、藏，以滋养万物。人生于气交之中，所以身中元气，应天地之气而浮沉。浮则旺于表而衰于里，沉则旺于里而衰于表。邪气必定乘虚而袭之，所以也随着时令气候而入客于身体，则有浅深部位的不同，每见秋冬风寒之邪，多从皮毛而入经络，夏令暑湿之邪，多由口鼻而入脾胃。其表里元气的衰旺，也可以由此推知。然而这是讲常理，至于其变化为病，不可作为一定的尺度。良以人的禀赋有强弱，感受邪气有轻重，必须审察其受邪之处，顺从其经气辟除其邪气。因为经，是通表里的道路，表里之邪，都可由之而辟除，除去邪气，那么乱气不生而病自愈。所以张仲景分六经以辨脉证而立治法，为传承轩辕岐伯之道脉。那些不研究张仲景而流于浅陋邪僻的人，岂不是轩辕岐伯的罪人吗？
另外按《素问·金匮真言论》说：春气者，病在头；夏气者，病在脏；秋气者，病在肩背；冬气者，病在四肢。与此篇类似，而各有义理不同，录在后文虚风贼邪篇内，宜合观之。
【筋骨不得屈伸】
《灵枢·终始篇》说：手能屈而不能伸的，其病在筋；能伸而不能屈的，其病在骨。病在骨守骨治疗，病在筋守筋治疗。
筋挛缩，所以屈而不能伸；骨强硬，所以伸而不能屈。肝主筋，肾主骨，各守其主治的病位而治疗。
《素问·平人气象论》说：膝，是筋的府库，屈伸不能，行走则弯腰驼背，说明筋将要衰竭了；骨，是髓的府库，不能久立，行走则颤抖摇晃，说明骨将要衰竭了。
这是观察其行立的姿态，就知道筋骨将要衰竭。惫，就是败坏的意思。
【疹筋】
《素问·奇病论》记载：黄帝问道：有人尺脉数甚，筋急而显现，这是什么病？岐伯回答说：这叫做疹筋，这人腹部必定拘急，如果出现白色或黑色，则病情严重。
疹，是结气为病的含义，所以风热之邪郁结血络，发为疹子。这个名称叫疹筋，是因为肝主筋，肾水亏虚，不能养肝，其阳郁结于下，不得上达，所以尺脉数甚，而肝枯筋燥，所以筋急外现，其腹中也必定拘急不舒，出现白色或黑色，则金水不能相生，肺肾都不调和，则肝病更加严重。
Yellow Emperor asked: How should the principles of Yin and Yang be applied in diagnosis and treatment? Qibo replied: When Yang is excessive, the body becomes hot, the interstices (pores) close, breathing becomes rapid and coarse, causing the patient to bend forward and backward due to respiratory distress. There is no sweat but the body remains hot, the teeth become dry, and if symptoms such as vexation, oppression, and abdominal fullness occur, death will ensue. Such patients can tolerate winter but not summer. When Yin is excessive, the body becomes cold, there is sweating, the body often feels chilly, there are frequent chills, extreme cold leads to cold extremities (Jue), and if Jue results in abdominal fullness, death will ensue. Such patients can tolerate summer but not winter. This represents the changes of alternating excess of Yin and Yang, and the manifestations and prognoses of diseases.
This passage elucidates the pathological conditions of Yin-Yang excess. If Yang pathogenic factors are excessive leading to body heat, closed interstices, rapid and coarse breathing, bending movements, and anhidrosis, it is because the Ying (Nutrient) and Wei (Defensive) Qi fail to circulate smoothly, causing Qi to rebel upwards. Dry teeth, vexation, and abdominal fullness indicate that pathogens have invaded the Zang-Fu organs, causing internal and external blockage with no outlet for expulsion, hence leading to death. "Tolerating winter but not summer" means that in winter, when Yin Qi is vigorous, patients with Yang excess might temporarily endure it while awaiting appropriate treatment; however, in summer, when Yang Qi is vigorous, it aids the pathogen, making cure impossible. If Yin pathogens are excessive and Yang Qi is deficient, the body becomes cold with sweating and a constant feeling of chilliness. Frequent chills indicate that Exterior Yang is already deficient; extreme cold leads to Jue (cold extremities), and if Jue causes abdominal fullness, it signifies the collapse of Interior Yang, leading to death. "Tolerating summer but not winter" follows the same logic as Yang excess. These are the variations of Yin-Yang mutual victory/defeat, and the possibility of recovery or non-recovery can be verified by observing the disease's form.
[Disorder of Clear and Turbid Qi]
*Ling Shu · Wu Luan Pian* records: The Yellow Emperor asked: The twelve meridians correspond to the Five Elements and are divided into the Four Seasons. What causes their disorder? And what brings about their regulation? Qibo replied: The Five Elements move in an orderly sequence, and the Four Seasons have distinct divisions. Following these leads to proper regulation, while violating them leads to disorder. The twelve meridians correspond to the twelve months of the year. The twelve months are divided into the Four Seasons: Spring, Summer, Late Summer, and Winter, each with different climatic characteristics. Ying and Wei Qi follow each other, Yin and Yang are harmonized, and Clear and Turbid Qi do not interfere with each other. In such a state, following this order leads to regulation. However, if Clear Qi resides in the Yin aspect and Turbid Qi in the Yang aspect, if Ying Qi flows smoothly along the meridians but Wei Qi rebels against its normal course, Clear and Turbid Qi will interfere with each other and disrupt the chest, termed "Great Oppression" (Da Men). Therefore, if Qi is disrupted in the Heart, there will be mental restlessness, silence, and a tendency to bow the head and sit quietly; if disrupted in the Lung, there will be dyspnea with gasping, requiring the hands to cross over the chest to assist exhalation; if disrupted in the Stomach and Intestines, Huoluan (cholera-like syndrome) occurs; if disrupted in the arms and legs, Si Jue (four-fold cold extremities) occurs; if disrupted in the head, Ni Jue (rebellious Qi reversal) occurs, leading to heavy head, dizziness, and falling.
The meridians are like branches and leaves, while the Five Zang Organs are the root. The Five Zang possess the nature of the Five Elements, so the meridians also have Five Element distinctions, and the generation and transformation of the Five Elements follow an order. The twelve Hand and Foot Yin and Yang meridians correspond to the twelve months, which are further divided into the climatic changes of the Four Seasons. Thus, the generation, transformation, and circulation of Ying, Wei, meridians, Yin, Yang, Qi, and Blood all conform to the ascending and descending Qi of the Four Seasons and the sequence of Mutual Generation of the Five Elements. In this way, Yin and Yang remain peaceful, Clear and Turbid Qi do not interfere, and each follows its own path, resulting in regulation through compliance. The upper half of the body is Yang, and the lower half is Yin. Clear Qi belongs to Yang and ascends, while Turbid Qi belongs to Yin and descends. If Clear Qi remains below without ascending, or Turbid Qi remains above without descending, although Ying Qi may flow along the meridians, it cannot harmonize with Wei Qi, causing Wei Qi to rebel. This disrupts the ascending-descending order, leading to interference between Clear and Turbid Qi. Hence it is said: If Clear Qi is below, it causes undigested diarrhea (Sun Xie); if Turbid Qi is above, it causes distension. Symptoms appear according to the site of Qi rebellion. For instance, Qi disruption in the chest is called Great Oppression ("Men" means depression); Qi disruption in the Heart causes restlessness and silence because the heart-mind is disturbed and the patient lacks the desire to speak or move; Qi disruption in the Lung causes Qi stagnation, leading to dyspnea and gasping, with hands crossing the chest to facilitate exhalation; Qi disruption in the Stomach and Intestines causes Huoluan with alternating vomiting and diarrhea; Qi disruption in the arms and legs blocks the connecting Qi of Yin and Yang meridians, causing cold extremities; Qi disruption in the head causes Qi to rebel upward, leading to a heavy head, light feet, dizziness, and falling. Although only a few examples are listed here, other disorders can be inferred similarly. However, the causes of these disorders must stem from either Exogenous or Endogenous factors, and one must identify the cause to regulate it.
[Pathogens Flowing to the Eight Empties]
*Ling Shu · Xie Ke Pian* records: The Yellow Emperor asked: Humans have eight "empties" (hollow areas: elbows, axillae, groins, popliteal fossae). How are they used for diagnosis? Qibo replied: They are used to diagnose the Five Zang Organs. If the Lung and Heart have pathogens, the Qi flows into the two elbows; if the Liver has pathogens, the Qi flows into the two axillae; if the Spleen has pathogens, the Qi flows into the two thighs (Bi); if the Kidney has pathogens, the Qi flows into the two popliteal fossae (Guo). These eight empties are sites of joint movement, passages of True Qi, and routes of blood collaterals. Pathogenic factors and evil blood should not stay here; if they do, they damage the meridians and joints, preventing flexion and extension, leading to spasms.
The two elbows, two axillae, two thighs, and two popliteal fossae are where the True Qi of the Five Zang passes and where meridians and blood vessels circulate. They are the pivotal points of the body. Therefore, pathogens and evil blood should not accumulate here. If the Five Zang have pathogens, their Qi moves outward and must pass through these eight locations. If combined with stagnant evil blood, they damage meridians, sinews, bones, and joints, causing obstruction and inability to flex/extend, resulting in contracture diseases. Thus, these eight sites are called "Eight Empties," implying that these joint hubs must remain open and unobstructed for smooth Qi and Blood circulation to prevent disease.
[Pathogenic Obstruction of Ying, Wei, Stomach, and Intestines]
*Ling Shu · Shou Tian Gang Rou Pian* records: The Yellow Emperor asked about diseases caused by Ying Qi, Wei Qi, and Cold Bi. Bogao replied: Diseases of Ying Qi present with aversion to cold and fever, shortness of breath, and blood moving up and down abnormally; diseases of Wei Qi present with wandering pain, chest diaphragm oppression, and borborygmus, caused by Wind-Cold lodging in the Stomach and Intestines. Cold Bi disease involves pathogens lingering without departing, causing intermittent pain and skin anesthesia (numbness).
Ying Qi is Yin, flowing within the vessels, governing Blood; Wei Qi is Yang, flowing outside the vessels, governing Qi. Jing Qi resides in the Ying level, and Luo Qi resides in the Wei level. Ying, Wei, Qi, and Blood circulate throughout the interior and exterior via the meridians. Disease in the Ying level causes meridian blockage, leading to aversion to cold, fever, and shortness of breath. Qi stagnation prevents Blood from distributing evenly, causing it to move only up and down, potentially leading to hematemesis or epistaxis triggered by exogenous pathogens—this is a sign of Ying disease. Generally, Blood congeals with Cold and overflows recklessly with Heat. Wei Qi flows outside the vessels; its Qi is fierce, slippery, and floating. When diseased, if its momentum rebels, it causes stagnation and pain. Wandering pain indicates unstable movement. "Fu Kai" refers to sighing due to depression; because Wind-Cold lodges in the Stomach and Intestines, mixing Clear and Turbid Qi, borborygmus occurs ("Ben" implies rushing). If Cold Bi lingers, internal pain and skin numbness occur. "Numbness" means insensitivity to pain and itch. Since the Large Intestine Qi externally corresponds to the skin, and pathogens enter via the skin/hair follicles...
[Wind-Cold Damages Form; Emotional Disturbances Damage Qi]
The Yellow Emperor asked: What is the sequence of form and Qi pathology, and how do internal and external factors correspond? Bogao replied: Wind-Cold damages the Form; worry, fear, anger, and resentment damage Qi. Damage to Qi affects the Zang, becoming Zang disease; Cold damaging the Form manifests on the Form; Wind damaging sinews and vessels manifests on sinews and vessels. This is the correspondence between Form and Qi internally and externally.
Wind-Cold enters via the skin and hair, thus damaging the Form. Worry, fear, and anger disturb the Shen (Spirit), thus damaging Yuan Qi (Original Qi). Since Yuan Qi roots in the Zang, it leads to Zang disease. Differentiating Wind and Cold: Cold is a Yin pathogen damaging the Form (where "Form" collectively refers to Ying, Wei, meridians, muscles, sinews, and bones). Saying Wind is a Yang pathogen damaging sinews specifically includes Internal Wind. Sinews and vessels are governed by the Liver and Heart. Liver Blood deficiency generates Wind; Heart labor generates Fire. Thus, there is a distinction between Exogenous and Endogenous pathogens. For exogenous pathogens: Wind damages Wei Qi, presenting with slow pulse and sweating; Cold damages Ying Qi, presenting with tight pulse and no sweating, as discussed by Zhang Zhongjing. Hence, initially, Wind-Cold is generally stated to damage the Form. As stated in *Su Wen · Tiao Jing Lun*, Yin excess generating Internal Cold is due to endogenous damage to Yang Qi. If Yin Blood is damaged, Liver Wind arises, and Heart Fire flares. Wind and Fire scorch each other, inevitably damaging sinews and vessels. This demonstrates the necessary correspondence between Form/Qi and Endogenous/Exogenous pathogens, verifiable by symptoms.
[Exogenous Pathogens Enter from Shallow to Deep]
*Suo Wen · Miu Ci Lun* records: Qibo said: When pathogens invade the body, they first lodge in the skin and hair. If they linger, they enter the Sun Collaterals; if they linger, they enter the Luo Collaterals; if they linger, they enter the Jing Meridians, connecting internally to the Five Zang and spreading to the Stomach and Intestines. When both Yin and Yang are affected, the Five Zang are injured. This is the sequence of pathogens entering from the skin/hair to the Five Zang. In such cases, treat the Jing Meridians. Now, if pathogens lodge in the skin/hair, enter the Sun Collaterals, and linger without departing, causing blockage and preventing entry into the Jing Meridians, they overflow into the Da Luo (Large Collaterals), producing strange diseases. When pathogens lodge in the Da Luo, they flow from left to right and right to left, interacting with meridians above and below, left and right, and distributing to the four limbs. Their Qi has no fixed location and does not enter the Jing Acupoints; this is named Miu Ci (Counter Puncture). The Yellow Emperor asked: I wish to hear about Miu Ci, why take the left to treat the right and vice versa? How does it differ from Ju Ci? Qibo replied: When pathogens lodge in the Jing Meridians, excess on the left causes disease on the right, and excess on the right causes disease on the left. There may also be migration; if pain persists on the left but the right pulse shows disease first, one must use Ju Ci, targeting the Jing Meridian, not the Luo Collateral. Since Luo disease pain is located counter to the Jing Meridian, it is named Miu Ci.
This section should be read together with the sections on Zhong Bi and Zhou Bi in the *Bi Disease Chapter*. Generally, exogenous pathogens entering from the skin/hair go from shallow to deep, from Luo to Jing, connecting internally to the Five Zang and spreading to the Stomach and Intestines, as the Twelve Yin-Yang Meridians connect internally to the Zang-Fu. Thus, when Yin and Yang are affected, the Five Zang are injured. Although the pathogen has penetrated deeply, if it has not left the Jing Meridian, it must be treated via the Jing Meridian. Since it entered from the exterior, it must be expelled from the exterior. One must not lightly attack the interior, lest exogenous pathogens sink inward, which would be dangerous. For example, Zhang Zhongjing treats Shaoyin disease with fever by using Mahuang and Xixin to unblock the meridian, and Fuzi to assist the interior in reaching the exterior. Understanding the depth of pathogens and the sequence of treatment is crucial. If pathogens first lodge in the Sun Collaterals and linger, blocking the Luo and preventing connection to the Jing, they overflow into the Da Luo, causing strange diseases (so named for their unusual presentation). Because Da Luo distribute throughout the body, intersecting intricately unlike the direct tunnels of Jing Meridians, pathogens in the Da Luo wander with the Luo Qi, flowing left to right and right to left, interfering with the Twelve Meridians and distributing to the limbs. Since the pathogen wanders and does not enter Jing Acupoints, it is considered a strange disease, similar to common terms like "flowing fire" or "wandering wind." Treatment requires Miu Ci, taking left to treat right and vice versa, differing from Jing Meridian treatment. If pathogens lodge in the Jing Meridian, showing lateral preference or migration, Ju Ci must be used to treat the Jing, distinct from Luo treatment. Miu Ci is shallow; Ju Ci is deep, because Luo are superficial and Jing are deep. Pain in Da Luo is wandering and variable, unlike the fixed pain of Jing disease. Luo pain is described as "counter" to the Jing because it intersects rather than running within the Jing. The junctions of the Twelve Meridians are connected by Luo Collaterals, and the heads and tails of Luo and Jing intersect differently, hence "Miu Ci." The following text discusses Luo disease; physicians must understand this. Acupuncture has its own specialty, but herbal treatment follows the same principles.
[Pathogens Lodging in the Collaterals of the Hand and Foot Three Yin and Three Yang]
Pathogens lodging in the collateral of Foot Shaoyin cause sudden heart pain, acute distension, and fullness/supportiveness in the chest and hypochondrium.
Pathogens lodging in the collateral of Hand Shaoyang cause throat obstruction, tongue rolling, dry mouth, mental restlessness, pain on the lateral aspect of the arm, and inability to raise the hand to the head.
Pathogens lodging in the collateral of Foot Jueyin cause sudden hernia and acute illness.
Pathogens lodging in the collateral of Foot Taiyang cause pain in the head, neck, and shoulder.
Pathogens lodging in the collateral of Hand Yangming cause Qi fullness in the chest, wheezing with chest fullness, and heat in the chest.
Pathogens lodging between the arm and palm cause inability to flex.
Pathogens lodging in the Yang Qiao Mai cause eye pain starting from the inner canthus.
Trauma from falling leaves evil blood inside, causing abdominal fullness and constipation/inability to urinate. First administer purgatives. This injures the Jueyin vessel above and the Shaoyin collateral below.
Pathogens lodging in the collateral of Hand Yangming cause deafness and intermittent loss of hearing.
For Bi syndromes with wandering pain without fixed location, needle the area of pain between the muscle bundles.
Pathogens lodging in the collateral of Foot Yangming cause rhinitis/epistaxis and coldness in the upper teeth.
Pathogens lodging in the collateral of Foot Shaoyang cause flank pain, difficulty breathing, coughing with sweating. Coughing is treated with warm clothing and food.
Pathogens lodging in the collateral of Foot Shaoyin cause sore throat, inability to swallow food. Spontaneous irritability, Qi rushing upward to the贲 (cardia), swelling in the throat, inability to swallow saliva, or inability to expectorate saliva.
Pathogens lodging in the collateral of Foot Taiyin cause lower back pain radiating to the lower abdomen and testicles, with inability to lie flat and breathe.
Pathogens lodging in the collateral of Foot Taiyang cause stiffness and back tension, radiating to the flank with pain.
Pathogens lodging in the collateral of Foot Shaoyang cause pain at the pivot point, with inability to lift the thigh.
Pathogens lodging between the Five Zang cause meridian-pulling pain, coming and going intermittently.
Pathogens lodging in the collaterals of Hand/Foot Shaoyin, Hand/Foot Taiyin, and Foot Yangming. These five collaterals converge in the ear and ascend to connect with the left corner of the head. If all five collaterals are exhausted, the body's pulses move, but the form loses consciousness, resembling a corpse, termed Shi Jue (Corpse Syncope). Blow air into both ears with a bamboo tube, shave a square inch of hair from the left corner of the head, burn it, and drink several cups of fine wine. If unable to drink, force-feed. Recovery is immediate.
The junctions of the Twelve Hand and Foot Yin-Yang Meridians are connected by Luo Collaterals. Meridians are like thick, straight branches; collaterals are like thin, horizontal branches. Branches splitting from collaterals are finer and named Sun Collaterals. Thus, meridians have Yin-Yang depth, and collaterals are similar, with locations intersecting according to the meridians. The diseases listed above occur where Luo Qi travels and pathogens lodge, causing Qi blockage or rebellion. The same meridian may present with overlapping but different symptoms because the head and tail of each meridian have collaterals at varying depths and heights. For the sequence of circulation and diseases presented by the Twelve Meridians, refer to the *Meridian Chapter* in the *Meridians Section* for clearer understanding. Since Luo Collaterals connect the heads and tails of meridians and distribute throughout the body, their Sun Collaterals are superficial in the skin and subcutaneous tissue and are finer. Thus, when attacked by pathogens, Qi becomes blocked. Numbness, Bi pain, and wandering pain are all Luo diseases. Yang Luo are exterior; injury causes external bleeding (hematemesis, epistaxis). Yin Luo are interior; injury causes internal bleeding (hematochezia, hematuria). Exogenous pathogens enter from Luo to Jing; Qi and Blood flow from Jing to Luo. Blood follows Qi, moving from interior to exterior. Pathogens move from exterior to interior. Reversal leads to disease. If Qi and Blood are robust, pathogens cannot enter. Hence: "Where pathogens gather, Qi must be deficient." However, the Six Qi pathogens have differences in Yin-Yang and Clear-Turbid qualities, so they resonate by category. Some enter meridians via skin/hair; others enter via mouth/nose, traveling the middle pathway, and dividing to affect interior/exterior. Presentations vary, requiring differentiation and treatment. Thus, one must thoroughly understand the depth of meridian and collateral locations.
[Pathogens Entering According to Seasonal Climate]
*Suo Wen · Si Shi Ni Cong Lun* records: Qibo said: Spring Qi is in the Jing Meridians; Summer Qi is in the Sun Collaterals; Late Summer Qi is in the muscles; Autumn Qi is in the skin; Winter Qi is in the bone marrow. The Yellow Emperor asked: Why? Qibo replied: In Spring, Heaven's Qi opens, Earth's Qi泄 (vents), ice melts, water flows, and meridians clear, so Human Qi is in the vessels. In Summer, vessel Qi is full and overflows into Sun Collaterals for blood reception, filling the skin. In Late Summer, both meridians and collaterals are abundant, overflowing into muscles. In Autumn, Heaven's Qi gathers, interstices close, and skin tightens. In Winter, storage prevails; Qi and Blood reside within, anchoring in bone marrow and connecting to the Five Zang. Therefore, pathogens usually enter the body following the seasonal changes of Qi and Blood. Their variations cannot be measured by fixed standards, but one must follow the Meridian Qi to dispel pathogens. Once pathogens are removed, chaotic Qi will not arise.
This passage explains the rising and falling circulation of Heaven and Earth's Yin-Yang and Five Element Qi. The Five Seasons (Spring, Summer, Late Summer, Autumn, Winter) correspond to the Five Qi (Wood, Fire, Earth, Metal, Water), governing Growth, Flourishing, Transformation, Harvest, and Storage to nourish all things. Humans live within the Qi intersection, so their Yuan Qi floats and sinks in response to Heaven and Earth's Qi. Floating makes it vigorous in the exterior and weak in the interior; sinking makes it vigorous in the interior and weak in the exterior. Pathogens attack where Qi is weak, thus entering the body according to seasonal climates, resulting in different depths and locations. It is often seen that Wind-Cold in Autumn/Winter enters meridians via skin/hair, while Summer-Heat-Dampness in Summer enters the Spleen and Stomach via mouth/nose. The weakness/vigor of interior/exterior Yuan Qi can be deduced from this. However, this describes general principles. Variations in disease cannot be rigidly defined. People have varying constitutions and degrees of pathogenic invasion. One must examine the site of invasion and follow Meridian Qi to dispel pathogens. The Meridian is the pathway connecting interior and exterior; pathogens from both can be expelled through it. Removing pathogens stops chaotic Qi and heals the disease. Thus, Zhang Zhongjing differentiated Six Meridians to distinguish pulse/symptoms and establish treatments, inheriting the Dao of Xuanyuan and Qibo. Those who ignore Zhongjing and fall into shallow/heretical views are sinners against Xuanyuan and Qibo.
Additionally, *Suo Wen · Jin Gui Zhen Yan Lun* states: Spring Qi diseases are in the head; Summer Qi diseases are in the Zang; Autumn Qi diseases are in the shoulders and back; Winter Qi diseases are in the four limbs. This is similar to the current chapter but with different meanings. Record it in the *Xu Feng Zei Xie (Empty Wind and Robber Evil)* section for combined reading.
[Inability of Sinews and Bones to Flex and Extend]
*Ling Shu · Zhong Shi Pian* says: Inability to extend after flexion indicates disease in the sinews; inability to flex after extension indicates disease in the bones. Treat the bone if the disease is in the bone; treat the sinew if the disease is in the sinew.
Sinew contraction causes inability to extend; Bone rigidity causes inability to flex. The Liver governs sinews; the Kidney governs bones. Treat according to the governing organ of the diseased part.
*Suo Wen · Ping Ren Qi Xiang Lun* says: The knee is the mansion of sinews. Inability to flex/extend and stooping while walking indicates sinews are failing. The bone is the mansion of marrow. Inability to stand for long periods and trembling while walking indicates bones are failing.
Observing gait and posture reveals impending failure of sinews and bones. "Bai" means decay/failure.
[Zhen Jin (Rash Sinews)]
*Suo Wen · Qi Bing Lun* records: The Yellow Emperor asked: Someone has a very rapid Chi (Cun Cun) pulse, with tense sinews visible. What disease is this? Qibo replied: This is called Zhen Jin. The abdomen will necessarily be tight. If white or black colors appear on the face, the disease is severe.
"Zhen" implies disease caused by constrained Qi. Thus, Wind-Heat pathogens constrained in blood collaterals manifest as rashes. Named "Zhen Jin" because the Liver governs sinews. Kidney Water deficiency fails to nourish the Liver. Yang becomes constrained below and cannot ascend. Thus, the Chi pulse is very rapid, Liver dries, sinews become brittle, and tension manifests externally. The abdomen will be tight and uncomfortable. Appearance of white (Metal/Lung) or black (Water/Kidney) colors indicates Metal and Water fail to generate each other, Lung and Kidney are disharmonious, exacerbating Liver disease.