阴阳应象论云喜怒伤气寒暑伤形暴怒伤阴暴喜伤阳厥气上行满脉去形喜怒不节寒暑过度
生乃不固故重阴必阳重阳必阴
玉机真藏论云忧喜悲恐怒令不得以其次故令人有大病矣因而喜大虚则肾气乘矣忧则心气
乘矣怒则肝气乘矣悲则肺气乘矣恐则脾气乘矣
举痛论云百病生于气也怒则气上喜则气缓悲则气消恐则气下寒则气收炅则气泄惊则气乱
劳则气耗思则气结九气不同为病(详见本文)
经曰脉滑者多血少气 涩者少血多气 大者血气俱多 脉来大而坚者血气俱实 小者血
气俱
少脉来细而缓者血气俱虚 代者气衰 细者气少 浮而绝者气辟 大而滑中有短气 尺脉涩
而坚为血实气虚 尺脉细而微者血气俱不足(云云见本文)刘立之脉理玄要曰下手脉沉便知是
气沉极则伏涩弱难治其或沉滑气兼痰饮
子和云夫天地之气常则安变则病而况人禀天地之气五运迭侵于外七情交战于中是以圣人
啬气
如持至宝庸人投物而反伤大和此轩岐所以论诸痛皆因于气百病皆生于气遂有九气不同之说气
本一也因所触而为九怒喜悲恐寒暑惊思劳也其言曰怒则气逆甚则呕血及飧泄故气逆上矣王太
仆曰怒则阳气逆上而肝木乘脾故甚则呕血及飧泄也喜则气和志达荣卫通利故气缓矣悲则心系
急肺布叶举而上焦不通荣卫不散热气在中故气消矣恐则精却却则上焦闭闭则气还还则下焦胀
故
气不行矣太仆云恐则伤精却上而不下流下焦阴气亦回还而不散故聚而胀也然上焦固禁下焦气
还故气下行也寒则腠理闭气不行故气收矣太仆云身凉则卫气沉故皮肤文理及渗泄之处皆闭密
而气不流行卫气收敛于中而不散也炅则腠理开荣卫通汗大出故气泄矣太仆云人在阳则舒在阴
则惨故热则肤腠开发荣卫大通津液而汗大出也惊则心无所根据神无所归虑无所定故气乱矣劳则
喘息汗出内外皆越故气耗矣太仆云疲劳役则气奔速故喘息气奔速则阳外发故汗出内外皆逾越
于常纪故气耗损也思则心有所存神有所归正气留而不行故气结矣太仆云系心不散故气亦停留
此素问之论九气其变甚详其理甚明然论九气所感之疾则略惟论呕血及飧泄余皆不言惟灵枢论
思虑悲哀喜乐愁忧盛怒恐惧而言其病曰思虑而伤神神伤则恐惧自失破 脱肉毛瘁色夭死于冬
脾忧愁而不解则伤意意务则恍乱四肢不举毛瘁色夭死于春肝悲哀动中则伤魂魂伤则狂忘不精
不正当人阴而挛筋两胁不举毛瘁色夭死于秋肺喜乐无极则伤魄魄伤则狂狂者意不存人毛革焦
毛瘁色夭死于夏肾盛怒而不止则伤志志伤则喜忘其前腰脊不可俯仰屈伸毛瘁色夭死于季夏恐
惧不解则伤精精伤则骨痿厥精时自下是故五脏主藏精者也不可伤伤则失守而阴虚虚则无气无
气则死矣灵枢论神意魂魄志精所主之病然无寒暑惊劳四证余以是推而广之怒气所至为呕血为
飧泄为煎厥为薄厥为阳厥为胸满胁痛食则气逆而不下为喘渴烦心为 瘅为肥气为日暴盲耳暴
闭筋纵发于外为疽痈喜气所至为笈不休为毛革焦为肉病为阳气不收甚则为狂悲气所至为阴缩
为筋挛为肌脾为脉痿男为数溲血女为血崩为酸鼻辛 为目昏为少气不能报息为泣则臂麻恐
气所
至为破 脱肉为骨酸痿厥为暴下添水为面热肤急为阴痿为惧而脱颐惊气所至为潮涎为目HT 为
口为痴痫为不省人为僵仆久则为 痹劳气所至为咽噎病为喘促为嗽血为腰痛骨痿为肺鸣为
高骨坏为阴痿为唾血为冥视为耳闭男为少精女为不月衰甚则溃溃乎若坏都汨汨乎不可止思气
所至为不眠为嗜卧为昏瞀为中痞三焦闭塞为咽嗌不利为胆痹呕苦为筋痿为白淫为得后与气快
然
如衰为不嗜食寒气所至为上下所出水液(云云见寒门)炅气所至为喘呕吐酸暴注下迫(云云见
火门)凡此九者内经有治法但以五行相胜之理治之夫怒伤肝肝属木怒则气并于肝而脾土受邪
木太过则肝亦自病喜伤心心属火喜则气并于心而肺金受邪火太过则心亦自病悲伤肺肺属金悲
则气并于肺而肝木受邪金太过则肺亦自病恐伤肾肾属水恐则气并于肾而心火受邪水太过则肾
亦自病思伤脾脾属土思则气并于脾而肾水受邪土太过则脾亦自病寒伤形形属阴寒胜热则阳受
病寒太过则阴亦自病炅伤气气属阳热胜寒则阴受病热太过则阳亦自病凡此七者更相为治故悲
可以治怒以怆恻苦楚之言感之喜可以治悲以谑浪亵狎之言娱之恐可以治喜以迫遽死亡之言怖
之怒可以治思以污辱欺罔之言触之思可以治恐以虑彼忘此之言夺之凡此五者必诡诈谲怪无所
不至然后可以动人耳目易人视听若胸中无材器之人亦不能以此五法也炅可以治寒寒可以治炅
逸可以治劳习可以治惊经曰惊者平之平谓平常也夫惊以其忽然而遇之也使习见习闻则不惊矣
此九者内经自有是理庸工废而不行今代刘河间治五志独得言外之意(云云见后)昔余治一书生
劳苦太过大便结燥咳逆上气时喝喝然有音唾呕鲜血以苦剂解毒汤加木香汉防己煎服时时啜之
复以木香槟榔丸泄其逆气不月余而痊余又尝以巫跃妓抵以治人之悲结者又尝以针下之时使杂
舞忽鼓笛应之以治人之忧而心痛者余尝击拍门窗使其声不绝以治因惊而畏响魂气飞扬者尝治
一妇人久思而不眠余日醉而不问妇果呵怒是夜困睡又尝以酸枣仁丸治人多忧者然惟劳而气耗
恐而气夺者为难治喜者少病百脉舒和故也又闻庄先生者治喜乐之极而病者庄切其脉为之失声
佯曰吾取药去数日更不来病者悲泣辞其亲友曰吾不久矣庄知其将愈慰之诘其故庄引素问曰惧
胜喜可谓得玄关者也
按此论九气所动病机至为详悉然七情诸证局方多用气药论治固然但不分其夹热兼痰虚实
之例
而于寒热二证亦似谓备于九气兼用气药而治之其弊甚矣且夫七情诸证有乘逆厥中之殊人有苦
乐安扰之异是以先哲就用五志相胜之理治之药之于伤寒温暑自有其例也后世俗不能本此恃之
于药而相胜之理不行况其药不热即峻虚虚实实不无差误故河间戴人者出论以上病机究所至之
因以平火为主兼五志相胜之理或音乐抵戏甚至诡诈谲怪诸法为治应变亦已至矣我东垣丹溪先
生更论诸气为病有郁痞逆滞不同随证用药有寒热温凉之异如劳气者宜补中益气滋阴助阳或兼
所挟之邪论治深备先哲旨趣惜乎其道皆不能大行于世者由局方障之也
《阴阳应象大论》说:喜怒会损伤气,寒暑会损伤形体。暴怒会损伤阴,暴喜会损伤阳。厥逆之气向上冲逆,导致脉道充满而形体脱离(指精气耗散),这是因为喜怒没有节制,寒暑过度侵袭,所以生命根基不稳固。因此,重阴必转化为阳,重阳必转化为阴。
《玉机真脏论》说:忧、喜、悲、恐、怒这些情绪如果不能按照正常的次序调节,就会使人患上严重的疾病。如果因为喜乐过度而导致心气大虚,肾气就会乘虚侵犯;忧愁会导致心气被侵犯;愤怒会导致肝气被侵犯;悲伤会导致肺气被侵犯;恐惧会导致脾气被侵犯。
《举痛论》说:百病都产生于气的变化。愤怒会使气上逆,喜乐会使气舒缓,悲伤会使气消减,恐惧会使气下陷,寒冷会使气收敛,炎热会使气外泄,惊吓会使气紊乱,劳倦会使气耗散,思虑会使气结聚。这九种气机变化不同,导致的病症也不同(详见本文)。
经文说:脉象滑利的,是多血少气;脉象涩滞的,是少血多气;脉象大的,是气血俱多;脉来大而坚硬的,是气血俱实;脉象小的,是气血俱少;脉来细而缓的,是气血俱虚;脉象代(间歇)的,是气衰;脉象细的,是气少;脉浮而按之断绝的,是气散;脉大而滑但中间有短促感的,是伴有短气;尺部脉涩而坚硬的,是血实气虚;尺部脉细而微弱的,是气血俱不足(等等,详见本文)。刘立之在《脉理玄要》中说:切脉时若感觉沉,就知道是气病;沉极则伏,涩弱难治。如果是沉滑脉,则是气兼痰饮。
张子和说:天地之气,常态则安,变异则病,何况人禀受天地之气,五运在外交替侵袭,七情在内交战。所以圣人爱惜气如同持有至宝,庸人却随意投掷反而伤害了太和之气。这就是轩辕、岐伯论述各种疼痛皆因于气,百病皆生于气,于是有了九气不同的说法。气本是一体,因所触发的因素不同而分为九种:怒、喜、悲、恐、寒、暑、惊、思、劳。他们说:愤怒会使气逆乱,严重时呕血及完谷不化的腹泻,所以气逆上了。王太仆(王冰)说:愤怒使阳气逆上,肝木乘犯脾土,所以严重时呕血及完谷不化的腹泻。喜乐使气和顺、志意通达、营卫通利,所以气舒缓。悲伤使心系紧急,肺叶布展举起,上焦不通畅,营卫不畅,热气郁结在中,所以气消减。恐惧使精气退却,退却则上焦闭塞,闭塞则气还留,气还留则下焦胀满,所以气不行。太仆说:恐惧伤精,精气退却不上行也不下流,下焦阴气回还而不散,所以聚而胀。然而上焦固禁,下焦气还,所以气下行。寒冷使腠理闭塞,气不行,所以气收敛。太仆说:身体凉则卫气下沉,所以皮肤纹理及汗孔皆闭密,气不流行,卫气收敛于中而不散。炎热使腠理开泄,营卫通利,大汗出,所以气外泄。太仆说:人在阳热环境则舒展,在阴冷环境则凄惨,所以热则皮肤腠理开发,营卫大通,津液随汗大出。惊吓使心无所依凭,神无所归,虑无所定,所以气紊乱。劳倦使喘息汗出,内外皆越,所以气耗散。太仆说:疲劳役作则气奔速,气奔速则阳气外发,所以汗出,内外都逾越常度,所以气耗损。思虑使心有所存,神有所归,正气停留而不行,所以气结聚。太仆说:心系不散,所以气也停留。这是《素问》关于九气的论述,其变化非常详细,其道理非常明确。然而论述九气所感之疾则较简略,只论述了呕血及完谷不化的腹泻,其余都不言及。只有《灵枢》论述思虑、悲哀、喜乐、愁忧、盛怒、恐惧而言及其病症:思虑伤神,神伤则恐惧自失,肌肉破脱,毛发憔悴,面色夭折,死于冬季,属脾;忧愁不解则伤意,意乱则恍惚,四肢不举,毛发憔悴,面色夭折,死于春季,属肝;悲哀动中则伤魂,魂伤则狂妄不精,不正当行为,阴缩而筋挛,两胁不举,毛发憔悴,面色夭折,死于秋季,属肺;喜乐无极则伤魄,魄伤则狂,狂者意不存,毛发焦枯,毛发憔悴,面色夭折,死于夏季,属肾;盛怒不止则伤志,志伤则喜忘其前言,腰脊不可俯仰屈伸,毛发憔悴,面色夭折,死于长夏;恐惧不解则伤精,精伤则骨痿厥,精气时常自下。所以五脏主藏精,不可受伤,受伤则失守而阴虚,虚则无气,无气则死。《灵枢》论述神、意、魂、魄、志、精所主的病症,但没有寒、暑、惊、劳四证。我据此推演并扩充它:怒气所致,为呕血,为完谷不化的腹泻,为煎厥,为薄厥,为阳厥,为胸满胁痛,食后气逆不下,为喘渴烦心,为疸,为肥气,为突然失明,为突然耳聋,筋纵,发于外为疽痈。喜气所致,为气上冲不止,为毛发焦枯,为肉病,为阳气不收,甚则为狂。悲气所致,为阴缩,为筋挛,为肌痹,为脉痿,男子为数次尿血,女子为血崩,为酸鼻辛,为目昏,为少气不能报息,为哭泣则手臂麻木。恐气所致,为肌肉破脱,为骨酸痿厥,为暴泻如水,为面热肤急,为阳痿,为惧而脱颐。惊气所致,为潮涎,为目斜视,为口歪,为痴痫,为不省人事,为僵仆,久则成痹。劳气所致,为咽噎病,为喘促,为嗽血,为腰痛骨痿,为肺鸣,为高骨坏,为阳痿,为唾血,为冥视,为耳闭,男子为少精,女子为闭经,衰甚则溃烂,像堤坝崩溃,水流滚滚不可止。思气所致,为不眠,为嗜卧,为昏瞀,为中痞,三焦闭塞,为咽嗌不利,为胆痹呕苦,为筋痿,为白淫,为得大便与排气后感觉轻松如衰弱状,为不嗜食。寒气所致,为上下出水液(详见寒门)。热气所致,为喘呕吐酸,为暴注下迫(详见火门)。凡此九者,《内经》有治法,只是用五行相胜的道理来治疗。比如怒伤肝,肝属木,怒则气并于肝而脾土受邪,木太过则肝亦自病;喜伤心,心属火,喜则气并于心而肺金受邪,火太过则心亦自病;悲伤肺,肺属金,悲则气并于肺而肝木受邪,金太过则肺亦自病;恐伤肾,肾属水,恐则气并于肾而心火受邪,水太过则肾亦自病;思伤脾,脾属土,思则气并于脾而肾水受邪,土太过则脾亦自病;寒伤形,形属阴,寒胜热则阳受病,寒太过则阴亦自病;热伤气,气属阳,热胜寒则阴受病,热太过则阳亦自病。凡此七者,互相制约以治疗。所以悲伤可以治疗愤怒,用凄惨苦楚的话感动他;喜悦可以治疗悲伤,用戏谑轻慢的话娱乐他;恐惧可以治疗喜悦,用紧迫死亡的话吓唬他;愤怒可以治疗思虑,用污辱欺骗的话触动他;思虑可以治疗恐惧,用考虑别的事情的话转移他的注意力。凡此五种方法,必须诡诈怪异,无所不用其极,然后才能打动人的耳目,改变人的视听。如果胸中没有才器的人,也不能用这五种方法。热气可以治疗寒,寒可以治疗热,安逸可以治疗劳倦,习惯可以治疗惊吓。经文说:惊者平之。“平”谓平常。惊吓是因为忽然遇到,如果习惯于见惯闻熟,就不会惊吓了。这九者的道理,《内经》自有,庸医废弃而不施行。当今刘河间治疗五志独得言外之意(详见后)。过去我治疗一个书生,劳苦太过,大便结燥,咳逆上气,时时发出声音,呕吐鲜血,用苦剂解毒汤加木香、汉防己煎服,时时啜饮,又用木香槟榔丸泄其逆气,不到一个月痊愈。我又曾用让巫女跳舞妓女抵偿的方法,治疗人的悲结;又曾用针灸时让乐师杂舞,忽鼓笛应和,治疗人的忧而心痛;我曾敲击门窗使其声音不绝,治疗因惊吓而畏响、魂气飞扬者;曾治疗一个妇人久思而不眠,我每天喝醉而不问事,妇人果然呵斥愤怒,当晚困睡;又曾用酸枣仁丸治疗人多忧者。然而只有劳而气耗、恐而气夺者难治。喜乐者少病,因为百脉舒和的缘故。又听说庄先生治疗喜乐之极而病者,庄切其脉,为之失声,假装说我去取药,数日不再来,病者悲泣辞别亲友说我不久矣,庄知道他将愈,安慰他。问他原因,庄引用《素问》说:惧胜喜。可谓得玄关者也。
按:此论九气所动病机非常详细。然而七情诸证,《局方》多用气药论治,固然不错,但不分其夹热、兼痰、虚实之例,而对于寒热二证,似乎也完备于九气,兼用气药治疗,其弊病很大。况且七情诸证有乘逆、厥中之不同,人有苦、乐、安、扰之异,所以先哲就用五志相胜的道理治疗。药物对于伤寒、温暑自有其例。后世俗人不能本着此理,依赖药物,而相胜之理不行。况且其药不是热就是峻,虚虚实实,不无差误。所以河间、戴人出来,论述以上病机,究其所至之因,以平火为主,兼五志相胜之理,或音乐抵戏,甚至诡诈怪异诸法为治,应变也已至极。我东垣、丹溪先生更论诸气为病有郁、痞、逆、滞不同,随证用药有寒、热、温、凉之异。如劳气者宜补中益气、滋阴助阳,或兼所挟之邪论治,深备先哲旨趣。可惜其道皆不能大行于世者,是由《局方》障之也。
The *Yin Yang Ying Xiang Da Lun* (Great Treatise on Yin and Yang Corresponding to Images) states: Joy and anger injure Qi, while cold and heat injure the Form. Violent anger injures Yin, and violent joy injures Yang. The rebellious Qi ascends, filling the vessels and causing the Form to detach (referring to the dissipation of essence), because joy and anger are unregulated, and cold and heat invade excessively, thus the root of life becomes unstable. Therefore, extreme Yin transforms into Yang, and extreme Yang transforms into Yin.
The *Yu Ji Zhen Zang Lun* (Treatise on Jade Machine and True Viscera) states: If emotions such as worry, joy, grief, fear, and anger cannot be regulated in their proper order, they will cause severe illness in humans. If excessive joy leads to a great deficiency of Heart Qi, Kidney Qi will invade due to emptiness; worry causes Heart Qi to be invaded; anger causes Liver Qi to be invaded; grief causes Lung Qi to be invaded; and fear causes Spleen Qi to be invaded.
The *Ju Tong Lun* (Treatise on Pain) states: All diseases arise from Qi dynamics. Anger causes Qi to ascend; joy causes Qi to relax; grief causes Qi to dissipate; fear causes Qi to sink; cold causes Qi to contract; heat causes Qi to leak; shock causes Qi to become chaotic; fatigue causes Qi to be consumed; and contemplation causes Qi to knot. These nine types of Qi dynamics differ in the diseases they produce (see detailed text below).
The Classics state: A slippery pulse indicates abundant Blood and deficient Qi; a choppy pulse indicates deficient Blood and abundant Qi; a large pulse indicates abundant Qi and Blood; a pulse that is large and firm indicates excess in both Qi and Blood; a small pulse indicates deficiency in both Qi and Blood; a fine and slow pulse indicates deficiency in both Qi and Blood; an intermittent pulse (Dai Mai) indicates declining Qi; a fine pulse indicates deficient Qi; a floating pulse that cuts off upon pressure indicates scattered Qi; a large and slippery pulse with a short sensation in the middle indicates accompanying shortness of breath; a choppy and firm pulse at the Chi position indicates excess Blood and deficient Qi; a fine and weak pulse at the Chi position indicates deficiency in both Qi and Blood (etc., see detailed text below). Liu Lizhi, in his *Mai Li Xuan Yao* (Mysterious Essentials of Pulse Diagnosis), states: If the pulse feels deep upon palpation, one knows it is a Qi disorder; if extremely deep, it is hidden (Fu Mai); choppy and weak pulses are difficult to treat. If the pulse is deep and slippery, it indicates Qi disorder accompanied by phlegm-fluids.
Zhang Hezi states: The Qi of Heaven and Earth, in its normal state, brings peace; in its altered state, it brings disease. How much more so for humans who inherit the Qi of Heaven and Earth, subject to the alternating invasion of the Five Movements externally and the internal conflict of the Seven Emotions? Thus, sages cherish Qi as if holding a supreme treasure, while fools throw it away and harm the Great Harmony. This is why Xuanyuan and Qibo discussed that all pain arises from Qi, and all diseases are born from Qi, leading to the theory of the Nine Qi differences. Qi is originally one, but divided into nine due to different triggers: anger, joy, grief, fear, cold, heat, shock, contemplation, and fatigue. They said: Anger causes Qi to rebel; severely, it leads to vomiting blood and undigested stool diarrhea, so Qi rebels upward. Wang Taipu (Wang Bing) stated: Anger causes Yang Qi to rebel upward, and Liver Wood invades Spleen Earth, hence severe cases involve vomiting blood and undigested stool diarrhea. Joy causes Qi to harmonize, will to reach, and Ying-Wei to flow freely, so Qi relaxes. Grief causes the Heart Tie to tighten, Lung leaves to spread and rise, Upper Jiao to become blocked, Ying-Wei to stagnate, and heat to remain in the center, so Qi dissipates. Fear causes Essence to retreat; retreat leads to Upper Jiao closure; closure causes Qi to return; returning Qi causes Lower Jiao distension, so Qi does not move. Taipu said: Fear injures Essence; Essence retreats without flowing up or down; Lower Jiao Yin Qi returns and does not disperse, gathering to cause distension. However, since the Upper Jiao is sealed and Lower Jiao Qi returns, Qi moves downward. Cold closes the Couli (pores), blocking Qi flow, so Qi contracts. Taipu said: When the body is cool, Wei Qi sinks; thus skin texture and sweat pores close tightly, Qi does not circulate, and Wei Qi converges internally without dispersing. Heat opens the Couli, allowing Ying-Wei to flow freely and sweat profusely, so Qi leaks. Taipu said: Humans feel comfortable in Yang/heat and miserable in Yin/cold; thus heat opens skin and Couli, allowing Ying-Wei to flow widely and fluids to sweat out. Shock leaves the Heart without support, Shen (Spirit) without refuge, and thoughts without focus, so Qi becomes chaotic. Fatigue causes panting and sweating, with internal and external Qi escaping, so Qi is consumed. Taipu said: Labor and exertion make Qi rush; rushing Qi causes Yang to emit externally, leading to sweating; internal and external Qi exceed normal limits, so Qi is depleted. Contemplation keeps the Heart focused and Shen returned, causing Zheng Qi to stay and not move, so Qi knots. Taipu said: Since the Heart tie does not scatter, Qi also stays. This is the discussion of Nine Qi in the *Su Wen*; its variations are detailed, and its principles are clear. However, the diseases caused by the Nine Qi are discussed briefly, mentioning only vomiting blood and undigested stool diarrhea, ignoring others. Only the *Ling Shu* discusses diseases from contemplation, grief, joy, sorrow, excessive anger, and fear: Contemplation injures Shen; Shen injury leads to self-fear, muscle wasting, hair deterioration, premature death in winter, associated with Spleen; unresolved worry injries Yi (Intellect); Yi confusion leads to dizziness and immobility of limbs, hair deterioration, premature death in spring, associated with Liver; grief moving internally injures Hun (Ethereal Soul); Hun injury leads to madness and lack of precision, improper behavior, Yin retraction and tendon cramping, immobility of two hypochondria, hair deterioration, premature death in autumn, associated with Lung; endless joy injures Po (Corporeal Soul); Po injury leads to madness and loss of intent, hair scorching, hair deterioration, premature death in summer, associated with Kidney; unceasing excessive anger injures Zhi (Will); Zhi injury leads to forgetfulness, inability to flex/extend waist and spine, hair deterioration, premature death in late summer; unresolved fear injures Jing (Essence); Jing injury leads to bone萎 (atrophy/withering) and jue (cold extremities), spontaneous leakage of essence. Thus, the Five Zang store Essence and must not be injured; injury leads to loss of control and Yin deficiency; deficiency leads to lack of Qi; lack of Qi leads to death. The *Ling Shu* discusses diseases governed by Shen, Yi, Hun, Po, Zhi, and Jing, but omits cold, heat, shock, and fatigue. I deduce and expand upon this: Anger can lead to vomiting blood, undigested stool diarrhea, Jian Jue (boiling collapse), Bo Jue (thin collapse), Yang Jue, chest fullness and hypochondriac pain, postprandial Qi rebellion, panting/thirst/irritability, Dan jaundice, Fei Qi (mass), sudden blindness, sudden deafness, tendon flaccidity, and external carbuncles. Joy can lead to continuous Qi rising, hair scorching, flesh disease, failure of Yang Qi to secure, and severe madness. Grief can lead to Yin retraction, tendon cramping, Muscle Bi, Mai痿 (vessel atrophy), frequent hematuria in men, metrorrhagia in women, sour nose/sinus issues, blurred vision, shortness of breath, arm numbness when crying. Fear can lead to muscle wasting, bone soreness/atrophy/jue, acute watery diarrhea, facial heat/tight skin, impotence, jaw dropping from fright. Shock can lead to salivary overflow, strabismus, mouth deviation, dementia/epilepsy, unconsciousness, stiff falling, and chronic Bi syndrome. Fatigue can lead to dysphagia, panting, coughing blood, lower back pain/bone atrophy, lung sounds, high bone destruction, impotence, spitting blood, dark vision, ear blockage, oligospermia in men, amenorrhea in women, and severe ulceration like a breached dam. Contemplation can lead to insomnia, hypersomnia, dizziness, epigastric fullness, Three Jiao blockage, throat obstruction, Gallbladder Bi with bitter regurgitation, tendon atrophy, Bai Yin (white discharge), relief after defecation/gas passage, and loss of appetite. Cold can lead to fluid accumulation above and below (see Cold section). Heat can lead to panting/vomiting acid, acute diarrhea with tenesmus (see Fire section). For these nine, the *Nei Jing* provides treatment methods based on the principle of Five Elements overcoming each other. For example, anger injures Liver (Wood); Qi gathers in Liver, injuring Spleen Earth; excess Wood injures Liver itself. Joy injures Heart (Fire); Qi gathers in Heart, injuring Lung Metal; excess Fire injures Heart itself. Grief injures Lung (Metal); Qi gathers in Lung, injuring Liver Wood; excess Metal injures Lung itself. Fear injures Kidney (Water); Qi gathers in Kidney, injuring Heart Fire; excess Water injures Kidney itself. Contemplation injures Spleen (Earth); Qi gathers in Spleen, injuring Kidney Water; excess Earth injures Spleen itself. Cold injures Form (Yin); Cold overcomes Heat, injuring Yang; excess Cold injures Yin itself. Heat injures Qi (Yang); Heat overcomes Cold, injuring Yin; excess Heat injures Yang itself. These seven mutually treat each other. Thus, grief can treat anger by evoking pity; joy can treat grief by providing amusement; fear can treat joy by threatening death; anger can treat contemplation by provoking insult; contemplation can treat fear by distracting attention. These five methods require cunning and strangeness to affect the senses. One without talent cannot use them. Heat treats cold; cold treats heat; rest treats fatigue; habituation treats shock. The Classics say: "Shock is treated by making it ordinary." Ordinary means familiar. Shock arises from the unexpected; familiarity removes the shock. The *Nei Jing* contains these principles, but mediocre doctors ignore them. Liu Hejian of the present era uniquely grasps the meaning beyond words regarding the Five Zhi (see later). Once, I treated a scholar who was overly fatigued, suffering from dry stool, reverse Qi coughing with sound, and vomiting fresh blood. I prescribed Bitter Detoxification Decoction with Mugwort and Han Fangji, taken frequently, followed by Mu Xiang Bing Lang Wan to drain rebellious Qi, resulting in recovery within a month. I once used a dancing witch/prostitute to treat emotional constriction from grief; I used acupuncture combined with music/dance to treat忧 (worry) causing heart pain; I made noise by knocking doors/windows to treat shock-induced fear and flying soul; I treated a woman with long-term contemplation insomnia by getting drunk and ignoring her, causing her to scold me in anger, which led to sleep that night; I used Suan Zao Ren Pill for those with excessive worry. However, fatigue consuming Qi and fear stealing Qi are difficult to treat. Joyful people rarely get sick because their vessels are relaxed. I heard Mr. Zhuang treat someone ill from excessive joy: he felt the pulse, feigned shock, said he needed to fetch medicine, and stayed away for days. The patient, grieving and saying goodbye to friends, thought he would die soon. Zhuang knew he would recover and comforted him. When asked why, Zhuang cited the *Su Wen*: "Fear overcomes Joy." This is truly understanding the secret gate.
Note: This discussion of Nine Qi pathogenesis is very detailed. However, the *Ju Fang* (Standard Formulary) often uses Qi-regulating herbs for Seven Emotion disorders. While correct, it fails to distinguish between accompanying heat, phlegm, deficiency, or excess. It also seems to cover cold/heat disorders comprehensively via Nine Qi and Qi herbs, which is flawed. Seven Emotion disorders vary by rebellion/collapse and individual circumstances. Thus, ancient sages used the Five Zhi overcoming principle. Drugs have their place for Wind-Cold/Warmth, but laypeople rely solely on drugs, neglecting the overcoming principle. Moreover, drugs are either hot or harsh, risking deficiency/excess errors. Hence, Liu Hejian and Dai Ren emerged, analyzing pathogenesis, focusing on calming Fire, combining Five Zhi overcoming, music, play, and even cunning methods, achieving great adaptability. My predecessors Dongyuan and Danxi further discussed Qi disorders as stagnation, fullness, rebellion, or blockage, using cold/hot/warm/cool herbs accordingly. For fatigue, they recommended Bu Zhong Yi Qi Tang or nourishing Yin/supporting Yang, addressing concurrent pathogens, deeply preserving ancient wisdom. Alas, these paths failed to prevail due to the obstruction of the *Ju Fang*.