六微旨论曰∶出入废则神机化灭，升降息则气立孤危。故非出入则无以生长壮老已，非
升降则
无以生长化收藏。升降出入，无器不有，器散则分之，生化息矣。王氏释之曰∶凡窍横者，
皆有出入去来之气；窍竖者，皆有阴阳升降之气往复于中。即如壁窗户牖，两面伺之，皆承
来气冲击于人，是则出入气也。(西医谓∶人居室中，不可两面开窗，则人之中气，为往来
之气所冲击不能支，即头空痛矣。)又如阳升则井寒，阴升则水暖，以物投井，及叶坠空中
，翩翩不疾，皆升气所碍也。虚管溉满，捻上悬之，水固不泄，为无升气而不能降也。空瓶
小口，顿溉不入，为气不出而不能入也。可谓
发挥尽致矣。刘河间曰∶皮肤之汗孔者，谓泄汗之孔窍也。一名气门，谓泄气之门户也。一
名腠理，谓气液之隧道纹理也。一名鬼门，谓幽冥之门也。一名玄府，谓玄微之府也。然玄
府者，无物不有，人之脏腑、皮毛、肌肉、筋膜、骨髓、爪牙，至于万物，悉皆有之，乃出
入升降道路门户也。经曰∶升降出入，无器不有。故知人之眼、耳、鼻、舌、身、意、神、
识，能为用者，皆由升降出入之通利也。有所闭塞，则不能用也。故目无所见，耳无所闻，
鼻不闻香，舌不知味，筋痿、骨痹、爪退、齿腐、毛发堕落、皮肤不仁、肠胃不能渗泄者，
悉由热气怫郁，玄府闭塞，而致津液、血脉、荣卫、清浊之气不能升降出入故也。各随怫郁
微甚，而为病之大小焉。李东垣曰∶圣人治病，必本四时升降浮沉之理，权变之宜，必先岁
气
，无伐天和。经谓∶升降浮沉则顺之，寒热温凉则逆之。仲景谓阳盛阴虚，下之则愈，汗之
则死；阴盛阳虚，汗之则愈，下之则死。大抵圣人立法，且如升阳或散发之剂，是助春夏之
阳气令其上升，乃泻秋冬收藏殒杀寒凉之气。此升降浮沉之至理也。天地之气，以升降浮沉
，乃生四时。如治病，不可逆之。故顺天者昌，逆天者亡。夫人之身，亦有四时天地之气，
不可只认在外，人亦体同天地也。《吴医汇讲》引蒋星墀说曰∶《伤寒论》所谓传经，即是
出入精义。盖正气出入，由厥阴而少阴、太阴，而少阳、阳明、太阳，循环往复。六淫之邪
，则从太阳，入一步，反归一步，至厥阴而极。此邪气进而正气退行，不复与外气相通，故
开、阖、枢三者，最为要旨。(见《素问·阴阳离合论》、《灵枢·根结篇》中。)分言之，
为出入，为升降；合言之，总不外乎一气而已矣。观东垣《脾胃论》浮沉补泻图，以卯酉为
道路，而归重于苍天之气。考其所订诸方，用升、柴、苓、泽等法，实即发源于长沙论中葛
根、柴胡、五苓之意，引而伸之，所谓升之九天之上，降之九地之下。虽内伤、外感殊科，
而于气之升降出入，则无以异耳!吴鞠通《温病条辨》有曰∶风之体不一，而风之用亦殊。
春
风自下而上，夏风横行空中，秋风自上而下，冬风刮地而行。其方位也，则有四正、四隅，
此方位之合于四时八节也。诸家之论，阐发无余蕴矣。
升降出入者，天地之体用，万物之橐 ，百病之纲领，生死之枢机也。兹更举天地之气
、人身之气，与夫脉象、病机、治宜，一一而条析之。
四时之气，春生、夏长、秋收、冬藏。其行也。如轮之转旋，至圆者也。如春气自下而
上，
直行者，是冬气横敛已极，坚不可解，若径从横散，则与冬气骤逆矣。气不可逆也，故先从
直行以活其机，而后继以夏之横散也。夏气疏散已极，若径从横敛，又与夏气骤逆矣。转
旋之机不可骤也，故先以秋之直降，而后继以冬之横敛也。所以然者，各以其横行、直行之
极也。直行极，则不可以径从直升、直降，而必先有横行开阖之气以疏之；横行极，则不可
以径从横散、横敛，而必先有直行浮沉之气以达之。若直行未极，则升者未尝不可以直降，
降者未尝不可以直升；横行未极，则散者未尝不可以横敛，敛者未尝不可以横散。即如春日
未尝无秋风，而春之后，决不可继以秋也；夏日未尝无冬风，而夏之后，决不可继以冬也。
此天地四时斡旋之机妙也。
人身肌肉筋骨，各有横直腠理，为气所出入升降之道。升降者，里气与里气相回旋之道
也；
出入者，里气与外气相交接之道也。里气者，身气也；外气者，空气也。鼻息一呼，而周身
八万四千毛孔，皆为之一张；一吸，而周身八万四千毛孔，皆为之一翕。出入如此，升降亦
然，无一瞬或停者也。《内经》曰∶阳在外，阴之使也；阴在内，阳之守也。又曰∶阳气者
，卫外而为固也；阴气者，藏精而起亟也。此出入之机也。又曰∶天地之精气，其大数常出
三而入一，故谷不入，半日则气衰，一日则气少矣。此出入之数也。《推求师意》曰∶在肝
则温化，其气升；在心则热化，其气浮；在脾则冲和之化，其气备；
在肺则凉化，其气降；在肾则寒化，其气藏。《内经》曰∶浊气在上
，则生 胀；清气在下，则生飧泄。又曰∶夏暑汗不出，秋成风疟。冬不藏精，春必病温。
此升降出入之常变也。内而脏腑，外而肌肉，纵横往来，并行不悖，如水之流，逝者自逝，
而波浪之起伏自起伏也。
其合四时也，春则上升者强，而下镇者微矣；夏则外舒者盛，而内守者微矣；秋则下抑
，而
上鼓者微矣；冬则内敛，而外发者微矣。此其常也。逆冬气，则奉生者少矣；逆春气，则奉
长者少矣；逆夏气，则奉收者少矣；逆秋气，则奉藏者少矣。太过不及，皆为逆也，此其变
也。故圣人必顺四时，以调其神气也。
其在脉象，则有三部九候。三部者，寸关尺也，以候形段之上下，以直言之也。九候者
，浮
中沉也，以候形层之表里，以横言之也。病在上则见于寸，在下则见于尺；病在里则见于沉
，在表则见于浮；里寒外热，则沉紧浮缓；里热外寒，则沉缓浮紧。上虚下实，则寸小尺大
；上实下虚，则寸强尺弱。此脉象之大略也。
其在病机，则内伤之病，多病于升降，以升降主里也；外感之病，多病于出入，以出入
主外
也。伤寒分六经，以表里言；温病分三焦，以高下言，温病从里发故也。升降之病极，则亦
累及出入矣；出入之病极，则亦累及升降矣。故饮食之伤，亦发寒热；风寒之感，亦形喘喝
。此病机之大略也。
至于治法，则必明于天地四时之气，旋转之机，至圆之用，而后可应于无穷。气之亢于
上者
，抑而降之；陷于下者，升而举之；散于外者，敛而固之；结于内者，疏而散之。对证施治
，岂不显然而易见者乎?然此以治病之轻且浅者可耳!若深重者，则不可以径行，而必有待于
致曲。夫所谓曲者，何也?气亢于上，不可径抑也，审其有余不足∶有余耶，先疏而散之，
后清而降之；不足耶，行敛而固之，后重而镇之。气陷于下，不可径举也，审其有余不足∶
有余耶，先疏而散之，后开而提之；不足耶，先敛而固之，后兜而托之。气郁于内，不可径
散也，审其有余不足∶有余者，攻其实而汗自通，故承气可先于桂枝；不足者，升其阳而表
自退，故益气有借于升、柴。气散于外，不可径敛也，审其有余不足∶有余者，自汗由于肠
胃之实，下其实而阳气内收；不足者，表虚由于脾肺之亏，宣其阳而卫气外固。此皆治法
之要妙也。苟不达此，而直升、直降、直敛、直散，鲜不偾事矣!尝忆先哲有言∶胸腹痞胀
，昧者以槟榔、枳、朴攻之，及其气下陷，泄利不止，复以参、 、升、柴举之，于是气上
下脱而死矣。此直升、直降之祸也。况升降出入，交相为用者也，用之不可太过。当升而过
于升，不但下气虚，而里气亦不固，气喘者将有汗脱之虞矣；当降而过于降，不但上气陷，
而表气亦不充，下利者每有恶寒之证矣；当敛而过于敛，不但里气郁，而下气亦不能上朝；
当散而过于散，不但表气疏，而上气亦不能下济矣。故医者之于天人之气也，必明于体，尤
必明于用；必明于常，尤必明于变。物性亦然。寒热燥湿，其体性也；升降敛散，其功用也
。
升、柴、参、 ，气之直升者也；硝、黄、枳、朴，气之直降者也；五味、山萸、金樱、覆
盆，气之内敛者也；麻黄、桂枝、荆芥、防风，气之外散者也。此其体也。而用之在人，此
其常也。而善用之，则变化可应于不穷；不善用之，则变患每生于不测。王汉皋论温病大便
秘，右寸洪实，而胸滞闷者，宜枳、朴、菔子横解之，苏子、桔梗、半夏、槟榔竖解之。
其言横解、竖解是矣，其所指诸药，则未是也
。即东垣诸方，惯用升、柴、枳、朴，亦未免直撞之弊。若洁古枳术丸，以荷叶烧饭为丸，
则有欲直先横之妙矣。吁!医岂易言者乎?
又尝论之，气之开阖，必有其枢。无升降则无以为出入，无出入则无以为升降，升降出
入，
互为其枢者也。故人之病风寒喘咳者，以毛窍束于风寒，出入之经隧不利，而升降亦迫矣。
病尸厥卒死者，以升降之大气不转，而出入亦微矣。生气通天曰∶大怒则血菀于上，使人薄
厥。调经曰∶血气并走于上，则为大厥。扁鹊曰∶阳脉下坠，阴脉上争，会气闭而不通，阴
上而阳内行，下内鼓而不起，上外绝而不为使；上有绝阳之络，下有破阴之纽，破阴、绝阳
之色已废，脉乱，故形静如死状。凡人出入之气，本微于升降，升降既息，出入更微矣。故
扁鹊谓∶当闻其耳鸣而鼻张，循其两股以至于阴，当尚温也。此所谓出入更微者也。
又尝着《左右阴阳论》、《劳痹证治论》，文义浅陋，而与此相发。
其《论左右阴阳》曰∶朱丹溪谓脾具坤静之体，而有干健之运，故能使心、肺之阳降，
肝、
肾之阴升，而成地天交之泰矣。近世黄元御着书，专主左升右降立说，以为心、肺阳也，随
胃气而右降，降则化为阴；肝、肾阴也，随脾气而左升，升则化为阳。故戊己二土中气，四
气之枢纽，百病之权衡，生死之门户，养生之道，治病之法，俱不可不谨于此。其书八种，
直将《素问》、《灵枢》、《伤寒》、《金匮》、《本草》五大部圣经，俱笼入左升右降四
字之中。盖自以为独开生面，得《内经》左右阴阳道路之奥旨矣。窃思《内经》之论阴阳也
，不只言升降，而必言出入。升降直而出入横，气不能有升降而无出入，出入废则升降亦必
息矣。只论升降，不论出入，是已得一而遗一，况必以升降分属左右，则尤难通之义也。左
右俱有阴阳，俱有升降。尝推求西医所论人身脉络功用，与夫气血之流行，合之《内经》大
旨，荣行脉中，卫行脉外。荣气是随六阴、六阳之经循环往来，终而复始，即以经脉之升降
为升降也。卫气不拘于经，行于手足六阳之部分则上升，行于手足六阴之部分则下降，是表
升而里降也。《内经》以左右为阴阳之道路，未尝以左即升、右即降也。其义如寸口候阴，
主中；人迎候阳，主外。举其大概而已。脉法又以左尺主膀胱、前阴；右尺主大肠、后阴。
其于《内经》背阳腹阴，将何以合之?故确求升降之道路，只当分表里，而无分于左右也。
或曰∶人之患半身不遂者，何也?曰∶半身不遂，是横病，不是直病。何以言之?人身腠理毛
窍，在左边者，俱左外向；在右边者。俱右外向，前自鼻柱，后自脊骨，截然中分。故人侧
卧，汗出显有界畔者，因侧卧，则向上半边毛窍热气上蒸，向下半边毛窍热气不能下蒸也。
《内经》曰∶汗出偏沮，使人偏枯。故偏枯者，横气不能左右相通也；下痿者，直气不能上
下相济也。左有左之升降，右有右之升降；上有上之升降，下有下之升降；上下左右，又合
为一大升降者也。是故先天八卦，坎离分东西。此左阳右阴之义也；后天八卦，坎离分南北
，此表升里降之义也。即如人身，热气蒸腾，只是向上，其表升可知也；水谷入胃，糟粕下
传，此必有气以行之，其里降可知也。经必以左右分阴阳者，日月升于东，降于西，人为日
月所照，气亦随之而转旋。表之升也，动于左而右随之；里之降也，动于右而左随之。左则
表升之力强，右则里降之力强耳!经谓∶人左手足不及右强，右耳目不及左聪明者，亦此意
也。
其《论劳痹证治》曰∶痹者，闭也。其病有二∶有虚劳之痹；有积聚、痈疽、麻木、疼
痛之
痹。其积聚、痈疽、麻木、疼痛之痹，有在经络者，有在脏腑者，前人论之详矣。《内经》
、《中藏经》诸篇，可熟读也。至于虚劳之痹，即俗所谓干血劳者。人身外而经络，内而脏
腑，其气不外五行。自上而下直分之，有直五行，即直五层，一肺、二心、三脾、四肝、五
肾也；自外而内横分之，有横五行，即横五层，亦一肺、二心、三脾、四肝、五肾也。《内
经》升降息则气立孤危，言直也；出入废则神机化灭，言横也。脉法∶左寸心、关肝、尺肾
《素问·六微旨大论》说：如果出入的功能废弛，那么生命活动的内在机制就会消亡；如果升降的作用停止，那么依赖自然界气候而生存的生命就会陷入孤立危险的境地。因此，没有出入就没有生长、壮盛、衰老和死亡的过程；没有升降就没有生、长、化、收、藏的变化。升降出入，任何有形的器官（指人体脏腑组织）都具备，一旦器官解散，这些功能也就停止了。王冰对此解释为：凡是横向的孔窍，都有进出往复的气流；凡是竖向的孔窍，都有阴阳升降之气在内部往复运动。就像墙壁上的窗户，从两面观察，都是承接外来气流冲击人体，这就是出入之气。（西医认为：人在室内，如果两面都开窗，人体内气会受到往来气流的冲击而无法承受，就会导致头部空痛。）又如阳气上升则井水变寒，阴气上升则水温变暖，把物体投入井中，或者树叶从空中飘落，翩翩而下并不急促，都是因为受到上升之气的阻碍。用空心管子灌满水，捏住上端悬挂起来，水确实不会流出，是因为没有上升之气导致无法下降。空瓶口小，倒水进不去，是因为里面的气出不来导致外面的气进不去。这可以说是发挥得淋漓尽致了。刘河间说：皮肤上的汗孔，是排泄汗液的孔窍。又称作“气门”，是排泄气的门户。又称作“腠理”，是气液通行的隧道纹理。又称作“鬼门”，是幽冥之门。又称作“玄府”，是玄妙微细的府库。然而“玄府”无处不在，人的脏腑、皮毛、肌肉、筋膜、骨髓、爪牙，以至于万物，全都具备，它们是升降出入道路的门户。经典说：升降出入，任何器官都具备。所以知道人的眼、耳、鼻、舌、身、意、神、识之所以能发挥作用，都是因为升降出入通畅有利。如果有闭塞不通，就不能发挥作用。所以眼睛看不见，耳朵听不到，鼻子闻不到香味，舌头尝不出味道，筋脉痿软、骨骼痹痛、指甲退化、牙齿腐烂、毛发脱落、皮肤麻木不仁、肠胃不能渗透排泄，全都是由于热气郁结，玄府闭塞，导致津液、血脉、营卫、清浊之气不能升降出入的缘故。根据郁结的轻重不同，从而产生大小不同的疾病。李东垣说：圣人治病，必须依据四季升降浮沉的道理，权衡变化的适宜性，必须先了解当年的岁气，不要破坏自然的和谐。经典说：对于升降浮沉要顺应它，对于寒热温凉要逆治它。张仲景说：阳盛阴虚，用下法则愈，用汗法则死；阴盛阳虚，用汗法则愈，用下法则死。大抵圣人的立法，比如升阳或发散的方剂，是助长春夏的阳气使其上升，这是泻除秋冬收藏殒杀的寒凉之气。这是升降浮沉的最高道理。天地之气，通过升降浮沉，产生了四季。比如治病，不可违背它。所以顺应天道者昌，违背天道者亡。人的身体，也有四季天地之气，不能只认为在外，人也体同天地。《吴医汇讲》引用蒋星墀的说法说：《伤寒论》所说的传经，就是出入的精义。大概正气出入，由厥阴经到少阴经、太阴经，再到少阳经、阳明经、太阳经，循环往复。六淫邪气，则从太阳经进入一步，反而退归一步，直到厥阴经达到极点。这是邪气前进而正气后退，不再与外气相通，所以开、阖、枢三者，是最为重要的宗旨。（见《素问·阴阳离合论》、《灵枢·根结篇》中。）分开来说，是出入，是升降；合起来说，总不外乎一气罢了。看李东垣《脾胃论》中的浮沉补泻图，以卯酉（东西方向）为道路，而归重于苍天之气。考察他所制定的各方，使用升麻、柴胡、茯苓、泽泻等方法，实际上即发源于长沙论中葛根、柴胡、五苓散的意思，引申开来，所谓升到九天之上，降到九地之下。虽然内伤、外感属于不同的类别，但在气的升降出入方面，却没有不同！吴鞠通《温病条辨》中有说：风的体性不一，风的作用也不同。春风自下而上，夏风横行空中，秋风自上而下，冬风刮地而行。其方位，则有四正、四隅，这是方位符合四时八节。各家论述，阐发了其中没有剩余的深意。
升降出入，是天地的体用，万物的橐龠（风箱），百病的纲领，生死的枢纽。这里再列举天地之气、人身之气，以及脉象、病机、治宜，一一进行条理分析。
四季之气，春生、夏长、秋收、冬藏。它们的运行，像轮子旋转一样，至为圆满。比如春气自下而上，如果是直行，那是冬气横敛到了极点，坚硬不可解，如果直接从横向散开，就与冬气骤然相逆了。气不可逆，所以先从直行以激活其机能，然后继之以夏季的横散。夏气疏散到了极点，如果直接从横向收敛，又与夏气骤然相逆了。旋转的机理不可骤变，所以先以秋季的直降，然后继之以冬季的横敛。之所以这样，是因为各自达到了横行、直行的极点。直行到了极点，就不能直接从直升、直降，而必须先有横行开阖之气来疏泄它；横行到了极点，就不能直接从横散、横敛，而必须先有直行浮沉之气来通达它。如果直行未到极点，那么升者未尝不可以直降，降者未尝不可以直升；横行未到极点，那么散者未尝不可以横敛，敛者未尝不可以横散。就像春日未尝没有秋风，但春天之后，决不可接着是秋天；夏日未尝没有冬风，但夏天之后，决不可接着是冬天。这是天地四季运转的机理精妙之处。
人身肌肉筋骨，各有纵横的腠理，是气出入升降的道路。升降，是里气与里气相互回旋的道路；出入，是里气与外气相互交接的道路。里气，是身体之气；外气，是空气。鼻息一呼，周身八万四千毛孔，都为之一张；一吸，周身八万四千毛孔，都为之一合。出入如此，升降亦然，没有一瞬间停止的。《内经》说：阳在外，是阴的使役；阴在内，是阳的守持。又说：阳气者，护卫体表而固密；阴气者，藏精而起急应需。这是出入的机理。又说：天地精气，其大数常出三而入一，所以谷物不吃，半天则气衰，一天则气少了。这是出入的数量。《推求师意》说：在肝则温化，其气升；在心则热化，其气浮；在脾则冲和之化，其气备；在肺则凉化，其气降；在肾则寒化，其气藏。《内经》说：浊气在上，则生胀满；清气在下，则生飧泄。又说：夏暑汗不出，秋天成风疟。冬天不藏精，春天必病温。这是升降出入的常与变。内而脏腑，外而肌肉，纵横往来，并行不悖，像水流一样，逝去的自然逝去，而波浪的起伏自然起伏。
其对应四季时，春季则上升者强，而下镇者微弱；夏季则外舒者盛，而内守者微弱；秋季则下抑，而上鼓者微弱；冬季则内敛，而外发者微弱。这是常态。违背冬气，则奉养生的力量就少；违背春气，则奉养长的力量就少；违背夏气，则奉养收的力量就少；违背秋气，则奉养藏的力量就少。太过和不足，都是违背，这是变异。所以圣人一定顺应四季，来调摄神气。
其在脉象上，则有三部九候。三部，是寸、关、尺，用来候形体部位的上下，是直言而言。九候，是浮、中、沉，用来候形体层次的表里，是横言而言。病在上则见于寸脉，在下则见于尺脉；病在里则见于沉脉，在表则见于浮脉；里寒外热，则沉紧浮缓；里热外寒，则沉缓浮紧。上虚下实，则寸小尺大；上实下虚，则寸强尺弱。这是脉象的大略。
其在病机上，内伤的疾病，多病于升降，因为升降主里；外感的疾病，多病于出入，因为出入主外。伤寒分六经，是从表里来说；温病分三焦，是从高下来讲，因为温病从里发故也。升降的病到了极点，也会累及出入；出入的病到了极点，也会累及升降。所以饮食之伤，也会引发寒热；风寒之感，也会形成喘喝。这是病机的大略。
至于治法，必须明白天地四季之气旋转的机理，至圆的作用，然后才可以应对无穷。气亢于上的，抑制并降低它；陷于下的，提升并举起它；散于外的，收敛并固护它；结于内的，疏泄并消散它。对证施治，难道不是显然易见的吗？然而这只能用于治疗轻浅的疾病！如果病情深重，则不可以直接施行，而必须有待于“致曲”（曲折迂回的方法）。所谓的“曲”，是什么呢？气亢于上，不可以直接抑制，要审视其有余还是不足：如果是有余，先疏泄并消散它，后清热并降低它；如果是不足，先行收敛并固护它，后沉重地镇压它。气陷于下，不可以直接举提，要审视其有余还是不足：如果是有余，先疏泄并消散它，后开启并提举它；如果是不足，先收敛并固护它，后兜托并举起它。气郁于内，不可以直接消散，要审视其有余还是不足：有余者，攻其实邪而汗自然通，所以承气汤可以先于桂枝汤使用；不足者，升其阳气而表证自然退，所以益气需要借助升麻、柴胡。气散于外，不可以直接收敛，要审视其有余还是不足：有余者，自汗是由于肠胃之实，下其实邪而阳气内收；不足者，表虚是由于脾肺之亏，宣发其阳气而卫气外固。这些都是治法的精妙之处。如果不明白这些，而直接升、直接降、直接敛、直接散，很少有不败事的！曾经记得先哲有话说：胸腹痞胀，庸医以为用槟榔、枳实、厚朴攻下，等到气下陷，泄利不止，再用人参、白术、升麻、柴胡举提，于是气上下脱而死。这是直接升、直接降的祸患。何况升降出入，是互相为用的，使用不可太过。当升而过于升，不但下气虚，而且里气也不固，气喘的人将有汗脱的危险；当降而过于降，不但上气陷，而且表气也不充，下利的人常有恶寒的症状；当敛而过于敛，不但里气郁，而且下气也不能上朝；当散而过于散，不但表气疏，而且上气也不能下济。所以医生对于天人之气，必须明白其体，尤其必须明白其用；必须明白其常，尤其必须明白其变。物性也是如此。寒热燥湿，是其体性；升降敛散，是其功用。
升麻、柴胡、人参、白术，是气之直升的；硝石、大黄、枳实、厚朴，是气之直降的；五味子、山茱萸、金樱子、覆盆子，是气之内敛的；麻黄、桂枝、荆芥、防风，是气之外散的。这是其体。而用在于人，这是其常。而善于使用它，则变化可以应对无穷；不善于使用它，则变患常常生于不测。王汉皋论述温病大便秘结，右寸脉洪实，而胸中滞闷的，适宜用枳实、厚朴、莱菔子横向解除，苏子、桔梗、半夏、槟榔纵向解除。他说横解、竖解是对的，但他所指的那些药，则不对。即使李东垣各方，惯用升麻、柴胡、枳实、厚朴，也难免有直撞的弊病。如果洁古的枳术丸，用荷叶烧饭为丸，则有欲直先横的妙处。唉！医学岂是容易说的呢？
又曾论述，气的开阖，必有其枢。没有升降就没有出入的基础，没有出入就没有升降的基础，升降出入，互为其枢机。所以人患风寒喘咳的，是因为毛窍被风寒束缚，出入的经络不利，而升降也受逼迫了。患尸厥卒死的，是因为升降的大气不转，而出入也微弱了。《生气通天论》说：大怒则血郁积于上，使人薄厥。《调经论》说：血气并走于上，则为大厥。扁鹊说：阳脉下坠，阴脉上争，会气闭而不通，阴上而阳内行，下内鼓而不起，上外绝而不为使；上有绝阳之络，下有破阴之纽，破阴、绝阳之色已废，脉乱，所以形体静如死状。凡人的出入之气，本比升降微弱，升降既停，出入更微弱了。所以扁鹊说：应当听到他耳鸣而鼻孔张开，顺着他的两腿一直到阴部，应当还温热。这就是所谓出入更微弱的情况。
又曾著《左右阴阳论》、《劳痹证治论》，文义浅陋，而与此相互发明。
其《论左右阴阳》说：朱丹溪说脾具有坤静之体，而有乾健之运，所以能使心肺之阳降，肝肾之阴升，而成地天交泰之局。近世黄元御著书，专主左升右降立说，认为心、肺属阳，随胃气而右降，降则化为阴；肝、肾属阴，随脾气而左升，升则化为阳。所以戊己二土的中气，是四气的枢纽，百病的权衡，生死的门户，养生之道，治病之法，都不可不谨慎于此。他的书八种，直接将《素问》、《灵枢》、《伤寒》、《金匮》、《本草》五大部圣经，都笼入左升右降四字之中。大概自以为独开生面，得到《内经》左右阴阳道路的奥旨了。我私下思考，《内经》论阴阳，不只说升降，而必说出入。升降是直而出入是横，气不能有升降而无出入，出入废弛则升降也必然停止。只论升降，不论出入，是已得一而遗一，何况一定要以升降分属左右，则是更难通晓的道理。左右俱有阴阳，俱有升降。曾推求西医所论人身脉络功用，以及气血的流行，结合《内经》大意，营气行于脉中，卫气行于脉外。营气是随六阴、六阳之经循环往来，终而复始，即以经脉之升降为升降。卫气不拘泥于经脉，行于手足六阳的部分则上升，行于手足六阴的部分则下降，这是表升而里降。《内经》以左右为阴阳的道路，未曾说左即升、右即降。其义如寸口候阴，主中；人迎候阳，主外。举其大概而已。脉法又以左尺主膀胱、前阴；右尺主大肠、后阴。这与《内经》背阳腹阴，将如何契合？所以确切寻求升降的道路，只应当分表里，而无须分左右。
有人说：人的半身不遂，为什么呢？回答说：半身不遂，是横病，不是直病。为什么这么说？人身腠理毛窍，在左边的，都向左外向；在右边的，都向右外向，前自鼻柱，后自脊骨，截然中分。所以人侧卧，汗出显有界限，是因为侧卧，则向上半边毛窍热气上蒸，向下半边毛窍热气不能下蒸。《内经》说：汗出偏沮，使人偏枯。所以偏枯，是横气不能左右相通；下痿，是直气不能上下相济。左有左的升降，右有右的升降；上有上的升降，下有下的升降；上下左右，又合为一大升降。所以先天八卦，坎离分东西，这是左阳右阴的意义；后天八卦，坎离分南北，这是表升里降的意义。就像人身，热气蒸腾，只是向上，其表升可知；水谷入胃，糟粕下传，这必须有气以行之，其里降可知。经典必以左右分阴阳，是因为日月升于东，降于西，人受日月照耀，气也随之而转旋。表的升，动于左而右随之；里的降，动于右而左随之。左则表升之力强，右则里降之力强！经典说：人左手足不及右强，右耳目不及左聪明，也是这个意思。
其《论劳痹证治》说：痹，是闭的意思。其病有二：有虚劳之痹；有积聚、痈疽、麻木、疼痛之痹。其积聚、痈疽、麻木、疼痛之痹，有的在经络，有的在脏腑，前人论述得很详细。《内经》、《中藏经》诸篇，可熟读。至于虚劳之痹，即俗所谓干血劳。人身外而经络，内而脏腑，其气不外五行。自上而下直分之，有直五行，即直五层，一肺、二心、三脾、四肝、五肾；自外而内横分之，有横五行，即横五层，亦一肺、二心、三脾、四肝、五肾。《内经》说升降息则气立孤危，说的是直；出入废则神机化灭，说的是横。脉法：左寸心、关肝、尺肾
The *Suwen* (Basic Questions) chapter "Liu Wei Zhi Da Lun" states: If the functions of exit and entry are abolished, the spiritual mechanism of life will perish; if the movements of ascending and descending cease, the qi that establishes life through interaction with nature will become isolated and precarious. Therefore, without exit and entry, there can be no process of growth, flourishing, aging, and death; without ascending and descending, there can be no transformation of generation, growth, transformation, harvest, and storage. Ascending, descending, exit, and entry are present in all vessels (referring to human organs and tissues); once a vessel disintegrates, these functions cease. Wang Bing explained this as follows: For any orifice that is horizontal, there is qi flowing in and out; for any orifice that is vertical, there is yin and yang qi rising and falling within. Just like windows on a wall, observing from both sides, one sees incoming air impacting the person; this is the qi of exit and entry. (Western medicine posits: When a person is indoors, if windows are open on both sides, the internal qi of the person will be impacted by the incoming and outgoing air currents, becoming unable to withstand it, resulting in empty pain in the head.) Furthermore, when yang qi ascends, well water becomes cold; when yin qi ascends, water becomes warm. Throwing an object into a well, or leaves falling from the sky, drifting slowly without haste, are all due to obstruction by ascending qi. Filling a hollow tube with water, pinching the top end and suspending it, the water indeed does not leak, because there is no ascending qi to cause descent. An empty bottle with a small mouth cannot be filled with water poured in, because the internal qi cannot exit, preventing external qi from entering. This can be said to have been elaborated to perfection. Liu Wansu stated: The sweat pores on the skin are the orifices for excreting sweat. They are also called "Qi Men" (Gate of Qi), meaning the portal for expelling qi. Also called "Cou Li" (Interstices), meaning the tunnel textures for the passage of qi and fluids. Also called "Gui Men" (Ghost Gate), meaning the gate of the netherworld. Also called "Xuan Fu" (Mysterious Mansion), meaning the mansion of profound subtleties. However, "Xuan Fu" exists everywhere; in humans, the zang-fu organs, skin, hair, muscles, fascia, bone marrow, nails, and teeth, and even in all things, all possess them. They are the portals for the pathways of ascending, descending, exit, and entry. The classics state: Ascending, descending, exit, and entry are present in all vessels. Thus, we know that the eyes, ears, nose, tongue, body, mind, spirit, and consciousness of humans function only because the ascending, descending, exit, and entry are smooth and unobstructed. If there is any blockage, they cannot function. Therefore, blindness, deafness, anosmia, ageusia, tendon flaccidity, bone bi-syndrome, nail degeneration, tooth decay, hair loss, skin numbness, and intestinal inability to permeate and excrete are all caused by heat qi stagnation, closure of Xuan Fu, leading to the inability of body fluids, blood vessels, Ying-Wei, and clear and turbid qi to ascend, descend, exit, and enter. Depending on the severity of the stagnation, various diseases arise. Li Dongyuan stated: The sages treating disease must base their actions on the principles of seasonal ascending, descending, floating, and sinking, exercising appropriate flexibility. One must first understand the annual climate qi and not disrupt natural harmony. The classics say: For ascending, descending, floating, and sinking, follow them; for cold, heat, warmth, and coolness, counteract them. Zhang Zhongjing stated: In cases of excess yang and deficiency yin, purgation leads to recovery, while sweating leads to death; in cases of excess yin and deficiency yang, sweating leads to recovery, while purgation leads to death. Generally, the legislation of the sages, such as formulas for raising yang or dispersing exterior, aids the yang qi of spring and summer to rise, thereby draining the cold and cooling qi of autumn and winter storage and destruction. This is the ultimate principle of ascending, descending, floating, and sinking. The qi of heaven and earth generates the four seasons through ascending, descending, floating, and sinking. Similarly, in treating disease, one must not go against it. Thus, those who follow heaven prosper, and those who defy heaven perish. The human body also possesses the qi of the four seasons and heaven and earth; one cannot assume it exists only externally, as humans mirror heaven and earth. *Wu Yi Hui Jiang* quotes Jiang Xingchi saying: The "transmission of lines" mentioned in *Shanghan Lun* is the essence of exit and entry. Generally, the righteous qi exits and enters, moving from Jueyin to Shaoyin and Taiyin, then to Shaoyang, Yangming, and Taiyang, cycling repeatedly. The six pathogenic factors enter from Taiyang, advancing one step and retreating one step, reaching the extreme at Jueyin. This represents pathogenic qi advancing while righteous qi retreats, no longer communicating with external qi. Therefore, Kai (Opening), He (Closing), and Shu (Pivot) are the most crucial principles. (See *Suwen: Yin Yang Li He Lun* and *Lingshu: Gen Jie Pian*.) Separately discussed, they are exit/entry and ascending/descending; collectively, they are nothing but one qi. Observing Li Dongyuan’s *Pi Wei Lun* diagram of floating/sinking tonification and drainage, using Mao and You (east/west directions) as pathways and emphasizing the qi of the blue sky, his prescribed formulas using Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Ling (Poria), Ze (Alismatis Rhizoma), etc., actually originate from the ideas of Gegen (Puerariae Lobatae Radix), Chaihu, and Wuling San in Changsha's discussions, extended to mean "ascending to the highest heavens, descending to the deepest earth." Although internal injury and external contraction belong to different categories, regarding the ascending, descending, exit, and entry of qi, there is no difference! Wu Jutong stated in *Wenbing Tiaobian*: The nature of wind varies, and its effects differ. Spring wind rises from below; summer wind sweeps across the sky; autumn wind descends from above; winter wind scrapes along the ground. Its directions include the four cardinal points and four intercardinal points, aligning with the eight solar terms of the four seasons. Various theories have exhaustively elucidated these profound meanings.
Ascending, descending, exit, and entry are the substance and function of heaven and earth, the bellows of all things, the general outline of hundred diseases, and the pivot of life and death. Here, I further enumerate the qi of heaven and earth, the qi of the human body, as well as pulse manifestations, disease mechanisms, and treatment indications, analyzing them item by item.
The qi of the four seasons involves spring generation, summer growth, autumn harvest, and winter storage. Their movement is like a rotating wheel, perfectly round. For instance, spring qi rises from below; if it moves directly upward, it is because winter qi has reached the extreme of lateral condensation, becoming hard and inseparable. If it were to scatter directly laterally, it would abruptly oppose winter qi. Qi cannot oppose abruptly, so it first moves directly to activate its mechanism, followed by the lateral scattering of summer. Summer qi scatters to the extreme; if it were to condense directly laterally, it would abruptly oppose summer qi. The mechanism of rotation cannot change suddenly, so it first undergoes the direct descent of autumn, followed by the lateral condensation of winter. The reason is that each reaches the extreme of lateral or direct movement. When direct movement reaches the extreme, it cannot proceed directly to higher ascent or lower descent; it must first have lateral opening and closing qi to dredge it. When lateral movement reaches the extreme, it cannot proceed directly to lateral scattering or condensation; it must first have direct floating and sinking qi to penetrate it. If direct movement has not reached the extreme, what ascends can still descend directly, and what descends can still ascend directly; if lateral movement has not reached the extreme, what scatters can still condense laterally, and what condenses can still scatter laterally. Just as spring days may have autumn winds, yet after spring, autumn certainly does not follow; just as summer days may have winter winds, yet after summer, winter certainly does not follow. This is the subtle mechanism of the rotation of the four seasons of heaven and earth.
In the human body, muscles, tendons, and bones have their own lateral and direct Cou Li (interstices), which serve as the pathways for the exit, entry, ascending, and descending of qi. Ascending and descending refer to the pathway where interior qi rotates with interior qi; exit and entry refer to the pathway where interior qi interfaces with exterior qi. Interior qi is the body's qi; exterior qi is the atmospheric air. With one exhalation through the nose, all 84,000 pores throughout the body expand; with one inhalation, all 84,000 pores contract. Exit and entry are thus, and ascending and descending are the same, never pausing for an instant. The *Neijing* states: Yang outside is the servant of Yin; Yin inside is the guardian of Yang. It also says: Yang qi guards the exterior and secures it; Yin qi stores essence and arises urgently to respond. This is the mechanism of exit and entry. It also says: The essence and qi of heaven and earth generally exit three times for every one time they enter. Therefore, if no grain is consumed, qi declines after half a day and diminishes after one day. This is the quantity of exit and entry. *Tui Qiu Shi Yi* states: In the Liver, transformation is warm, and its qi ascends; in the Heart, transformation is hot, and its qi floats; in the Spleen, transformation is harmonious, and its qi is complete; in the Lung, transformation is cool, and its qi descends; in the Kidney, transformation is cold, and its qi stores. The *Neijing* states: If turbid qi is above, distension occurs; if clear qi is below, undigested stool diarrhea occurs. It also says: If sweat is not produced during summer heat, wind-malaria develops in autumn. If essence is not stored in winter, warm diseases will surely occur in spring. These are the normal and abnormal variations of ascending, descending, exit, and entry. Internally within the zang-fu organs, externally within muscles, they move longitudinally and transversely, proceeding together without conflict, like flowing water, where the passing flows away and waves rise and fall naturally.
Corresponding to the four seasons: In spring, ascending is strong, and downward anchoring is weak; in summer, outward expansion is vigorous, and inward guarding is weak; in autumn, downward suppression is dominant, and upward鼓 (drumming/rising) is weak; in winter, inward condensation is dominant, and outward emission is weak. This is the norm. Violating winter qi reduces the support for generation; violating spring qi reduces the support for growth; violating summer qi reduces the support for harvest; violating autumn qi reduces the support for storage. Excess and deficiency are both violations; this is the variation. Therefore, the sages always follow the four seasons to regulate their spirit and qi.
Regarding pulse manifestations, there are Three Regions and Nine Palpations. The Three Regions are Cun, Guan, and Chi, used to palpate the upper and lower segments of the body form, spoken directly. The Nine Palpations are Floating, Middle, and Deep, used to palpate the superficial and deep layers of the body form, spoken transversely. Disease in the upper presents in Cun; disease in the lower presents in Chi. Disease in the interior presents in Deep pulses; disease in the exterior presents in Floating pulses. Interior cold and exterior heat present as Deep-Tight and Floating-Slow; interior heat and exterior cold present as Deep-Slow and Floating-Tight. Upper deficiency and lower excess present as Small Cun and Large Chi; upper excess and lower deficiency present as Strong Cun and Weak Chi. This is the general overview of pulse manifestations.
Regarding disease mechanisms, internal injuries mostly involve disorders of ascending and descending, as ascending and descending govern the interior; external contractions mostly involve disorders of exit and entry, as exit and entry govern the exterior. Shanghan (Cold Damage) is divided into Six Channels based on exterior-interior relationships; Wenbing (Warm Diseases) is divided into Three Burners based on high-low positions, because warm diseases originate from the interior. When ascending-descending disorders reach the extreme, they affect exit-entry; when exit-entry disorders reach the extreme, they affect ascending-descending. Therefore, dietary injuries can induce chills and fever; wind-cold contractions can manifest as wheezing and coughing. This is the general overview of disease mechanisms.
As for treatment methods, one must understand the rotational mechanism and perfect circular function of the qi of heaven and earth in the four seasons before being able to respond infinitely. For qi that is hyperactive upwards, suppress and descend it; for qi that sinks downwards, raise and lift it; for qi that scatters outwards, condense and secure it; for qi that knots internally, dredge and dissipate it. Treating according to symptoms is obviously straightforward. However, this applies only to mild and superficial diseases! For severe cases, direct action is not possible; one must resort to "Zhi Qu" (indirect/curved approaches). What is meant by "Qu"? If qi is hyperactive upwards, it cannot be directly suppressed; one must examine if there is excess or deficiency. If excess, first dredge and dissipate it, then clear and descend it; if deficiency, first condense and secure it, then heavily sedate it. If qi sinks downwards, it cannot be directly lifted; examine excess or deficiency. If excess, first dredge and dissipate it, then open and lift it; if deficiency, first condense and secure it, then scoop and support it. If qi is stagnant internally, it cannot be directly dissipated; examine excess or deficiency. If excess, attack the excess, and sweating will naturally occur, so Chengqi Tang can precede Guizhi Tang; if deficiency, raise the yang, and the exterior syndrome will recede, so Yiqi (Tonifying Qi) relies on Shengma and Chaihu. If qi scatters externally, it cannot be directly condensed; examine excess or deficiency. If excess, spontaneous sweating is due to gastrointestinal excess; purge the excess, and yang qi will return inward; if deficiency, exterior deficiency is due to Spleen-Lung insufficiency; diffuse yang, and defensive qi will secure the exterior. These are the essential subtleties of treatment. If one does not understand this, and directly raises, descends, condenses, or dissipates, failure is almost inevitable. I recall the words of former sages: For chest and abdominal fullness, ignorant physicians use Binglang (Arecae Semen), Zhishi (Aurantii Fructus), and Zhusu (Magnoliae Officinalis Cortex) to attack. When qi sinks and diarrhea persists, they use Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Shengma, and Chaihu to lift. Consequently, qi escapes up and down, leading to death. This is the disaster of direct lifting and direct descending. Moreover, ascending-descending and exit-entry mutually support each other; their use must not be excessive. Lifting too much when lifting is indicated not only depletes lower qi but also fails to secure interior qi, causing asthmatic patients to risk sweating collapse. Descending too much when descending is indicated not only causes upper qi to sink but also fails to充盈 (fill) exterior qi, causing diarrheal patients to often experience aversion to cold. Condensing too much when condensing is indicated not only stagnates interior qi but prevents lower qi from ascending to the upper; dissipating too much when dissipating is indicated not only loosens exterior qi but prevents upper qi from descending to nourish the lower. Therefore, physicians must understand the substance and especially the function of heavenly and human qi; they must understand the norm and especially the variation. The nature of substances is the same. Cold, heat, dryness, dampness are their substances; ascending, descending, condensing, dissipating are their functions.
Shengma, Chaihu, Renshen, Baizhu are qi that directly ascend; Xiaoshuang (Natrii Sulfas), Dahuang (Rhei Radix et Rhizoma), Zhishi, Zhusu are qi that directly descend. Wuweizi (Schisandrae Fructus), Shanzhuyu (Corni Fructus), Jinyingzi (Chrysanthemi Fructus), Fupenzi (Rubiae Fructus) are qi that internally condense; Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix) are qi that externally dissipate. This is their substance. Use depends on the practitioner; this is the norm. Skillful use allows infinite adaptation; unskillful use breeds unpredictable disasters. Wang Hangao discussed constipation in warm diseases with a surging and solid Right Cun pulse and chest stagnation, recommending Zhishi, Zhusu, and Lapsacus (Radish Seed) for lateral resolution, and Suszi (Perillae Fructus), Jiegeng (Platycodonis Radix), Banxia (Pinelliae Rhizoma), and Binglang for vertical resolution. His concepts of lateral and vertical resolution were correct, but the specific herbs he pointed to were incorrect. Even Li Dongyuan’s formulas, habitually using Shengma, Chaihu, Zhishi, and Zhusu, inevitably suffer from the flaw of direct collision. However, Jiegu’s Zhizhu Wan, made into pills with lotus leaf and roasted rice, possesses the subtlety of "seeking directness through lateral movement." Alas! Medicine is not easy to discuss!
I have also argued that the opening and closing of qi must have a pivot. Without ascending and descending, there is no basis for exit and entry; without exit and entry, there is no basis for ascending and descending. Ascending-descending and exit-entry are mutual pivots. Therefore, in humans suffering from wind-cold wheezing and coughing, the hair follicles are bound by wind-cold, making the meridians of exit and entry unfavorable, and forcing ascending and descending. In cases of尸厥 (corpse-like coma) or sudden death, the great qi of ascending and descending does not rotate, and exit and entry become minute. *Shengqi Tongtian Lun* states: Great anger causes blood to pool upwards, leading to Bo Jue (abrupt fainting). *Tiao Jing Lun* states: If blood and qi rush upwards together, it results in Da Jue (great fainting). Bian Que stated: Yang pulses sink, Yin pulses contend upwards; meeting qi closes and becomes obstructed. Yin rises while Yang moves internally; internally below it drums but does not rise; externally above it cuts off and does not act as a messenger. There are severed Yang collaterals above and broken Yin ties below. The colors of broken Yin and severed Yang disappear, pulses become chaotic, so the body appears static as if dead. The exit and entry qi of humans is inherently weaker than ascending and descending; once ascending and descending cease, exit and entry become even more minute. Thus, Bian Que said: One should hear tinnitus and see nostrils flare, and tracing down the thighs to the genitals, warmth should remain. This is what is meant by exit and entry becoming even more minute.
I have also written *Lun Zuo You Yin Yang* (Discussion on Left-Right Yin-Yang) and *Laobi Zhengzhi Lun* (Discussion on Treatment of Asthenia-Bi Syndromes), which are shallow in text but complement this discussion.
In *Lun Zuo You Yin Yang*, Zhu Danxi stated that the Spleen possesses the quiet nature of Kun (Earth) but the active operation of Qian (Heaven), thus enabling the Yang of Heart and Lung to descend and the Yin of Liver and Kidney to ascend, achieving the harmony of Heaven and Earth (Tai). Recently, Huang Yuanyu wrote books specifically advocating left-ascending and right-descending, arguing that Heart and Lung are Yang, following Stomach qi to descend on the right, transforming into Yin; Liver and Kidney are Yin, following Spleen qi to ascend on the left, transforming into Yang. Thus, the central qi of Wu and Ji (Earth) is the pivot of the four qi, the balance of hundred diseases, the gateway of life and death. Health preservation and disease treatment must be cautious here. His eight volumes encompass the five canonical texts (*Suwen*, *Lingshu*, *Shanghan*, *Jingui*, *Bencao*) entirely within the four characters "Left Ascending, Right Descending," claiming to have uniquely opened a new path and grasped the profound secrets of left-right yin-yang pathways in the *Neijing*. I privately ponder: The *Neijing* discusses yin-yang not only in terms of ascending-descending but necessarily includes exit-entry. Ascending-descending is vertical, while exit-entry is horizontal. Qi cannot have ascending-descending without exit-entry; if exit-entry ceases, ascending-descending must also stop. Discussing only ascending-descending and ignoring exit-entry is obtaining one part while losing another. Moreover, assigning ascending-descending strictly to left-right is an even harder-to-understand doctrine. Both left and right possess yin-yang and ascending-descending. Having studied Western medical discussions on human vascular functions and blood-qii circulation, combined with the main gist of the *Neijing*: Ying Qi circulates within the vessels, following the Six Yin and Six Yang meridians in a continuous loop, using meridian ascending-descending as its own. Wei Qi is not confined to meridians; it ascends when circulating in the Six Yang limbs and descends when circulating in the Six Yin limbs, representing Exterior Ascending and Interior Descending. The *Neijing* uses left and right as pathways for yin-yang but never states that Left is Ascending and Right is Descending. The general idea is that Cun Kou palpates Yin (Interior/Middle), and Ren Ying palpates Yang (Exterior). Pulse diagnosis also assigns Left Chi to Bladder and anterior orifice, and Right Chi to Large Intestine and posterior orifice. How does this align with the *Neijing*'s "Back is Yang, Abdomen is Yin"? Therefore, to accurately seek the pathways of ascending-descending, one should distinguish between Exterior and Interior, not Left and Right.
Someone asks: Why do people suffer from hemiplegia? I reply: Hemiplegia is a horizontal disease, not a vertical one. Why? The Cou Li and hair follicles on the left side face left-outward; those on the right side face right-outward. From the nasal bridge in front to the spine behind, they are distinctly divided in the middle. Thus, when lying on one side, sweat appears with a clear boundary because the upper half's pores steam heat upward, while the lower half's pores cannot steam heat downward. The *Neijing* states: Sweating on one side leads to hemiplegia. Therefore, hemiplegia is due to horizontal qi failing to communicate left and right; lower flaccidity is due to vertical qi failing to connect up and down. The left has its own ascending-descending; the right has its own. The upper has its own; the lower has its own. Up-down and left-right combine into one great ascending-descending system. Hence, in the Prior Heaven Bagua, Kan and Li divide East and West, representing the meaning of Left-Yang and Right-Yin. In the Posterior Heaven Bagua, Kan and Li divide North and South, representing the meaning of Exterior-Ascending and Interior-Descending. Just as in the human body, heat steams upward, indicating Exterior Ascending; food and water enter the Stomach, and dregs pass downward, requiring qi to move them, indicating Interior Descending. The classics divide yin-yang by left and right because the sun and moon rise in the East and set in the West. Humans are illuminated by them, and qi rotates accordingly. Exterior ascending moves from the left, followed by the right; Interior descending moves from the right, followed by the left. Thus, the power of Exterior Ascending is stronger on the left, and the power of Interior Descending is stronger on the right. The classics state: Human left limbs and feet are not as strong as the right; right ears and eyes are not as acute as the left. This is the same meaning.
In *Lun Laobi Zhengzhi*, Bi (Obstruction) means closure. There are two types of Bi: Asthenia-Bi and Bi caused by accumulations, carbuncles, numbness, and pain. The latter, whether in meridians or zang-fu, has been detailed by predecessors. *Neijing* and *Zhongzang Jing* chapters should be studied thoroughly. As for Asthenia-Bi, commonly known as Dry Blood Asthenia. Externally in meridians, internally in zang-fu, the qi does not exceed the Five Phases. Divided vertically from top to bottom, there are Vertical Five Phases (Five Layers): 1. Lung, 2. Heart, 3. Spleen, 4. Liver, 5. Kidney. Divided horizontally from outside to inside, there are Horizontal Five Phases (Five Layers): 1. Lung, 2. Heart, 3. Spleen, 4. Liver, 5. Kidney. *Neijing* states "Ascending-descending cease, qi stands isolated and precarious," referring to the vertical; "Exit-entry abolish, spiritual mechanism perishes," refers to the horizontal. Pulse diagnosis: Left Cun Heart, Guan Liver, Chi Kidney.