黄帝问于岐伯曰。经言夏日伤暑。秋病疟。疟之发以时。其故何也。岐伯对曰。邪客于风府。病
循膂而下。卫气一日一夜。常大会于风府。其明日日下一节。故其日作晏。此其先客于脊背也。故每至于
风府。则腠理开。腠理开则邪气入。邪气入则病作。此所以日作尚晏也。卫气之行风府。日下一节。二十
一日。下至尾 。二十二日。入脊内。注于伏冲之脉。其行九日。出于缺盆之中。其气上行。故其病稍益。
全章大义。论卫气充行于皮肤肌腠。为形身之外卫。昼行于阳。夜行于阴。应天运之开阖。一日一夜。
大会于风府。其明日日下一节。二十二日。内注于伏冲之脉。其行九日。上出于缺盆。应月行一月而一周
天。海水西盛。人血气积。肌肉充。海水东盛。人血气虚。卫气去。形独居。应海水之消长。盖一日一夜。
天道绕地一周。水天之气。上下相通。而月以应水也。卫气行于肌腠之间。寒则皮肤急而腠理闭。暑则皮
肤缓而腠理开。故以夏伤于暑。秋成 疟。以证卫气之行焉。疟者。暑邪藏于肌肤。秋时阴气外出。阴与阳
遇。寒与热争。邪正相持。而
发为疟也。风府。督脉穴。在脑后发际中。邪气客于风府。循脊膂而下。卫气一日一夜。大会于风府。
其明日日下一节。故其日作晏。此邪先客于脊背也。故卫气每至于风府。则腠理开。开则邪气入。而
与卫气相遇。则病作。卫气日下一节。故作日晏也。盖卫气日下一节。则开其下节之腠理。邪气因开而
入。与卫气相遇。而病乃作也。伏冲者。冲脉伏行背里。为经络之海。卫气循外而下。从内而上。环
转一周。应天道也。卢良侯曰。卫气行阳行阴。应天与日之晦冥。循脊膂而下注冲脉而上。应天道之
营运于外。而复通贯于地中。卫气内注于伏冲之脉。外注于足阳明之脉。犹司天在泉。上下环转。泉在
天之下。而与地中之经水相通。
至其内搏于五脏。横连募原。其道远。其气深。其行迟。不能日作。故次日乃蓄积而作焉。
内搏五脏者。邪留于五脏之募原。募原者。横连于脏腑之脂膜。疟邪内搏于五脏募原之间。则其
道远。其气深。不能与卫气俱行而外出。故不能日作而间日乃发也。此言卫气夜行于阴者。行于五脏募
原之间也。
黄帝曰。卫气每至于风府。腠理乃发。发则邪入焉。其卫气日下一节。则不当风府奈何。岐伯曰。
风府无常。卫气之所应。必开其腠理。气之所舍节。则其府也。
此承上文申明卫气出于缺盆之中。其气上行。一日一夜。大会于风府。明日日下一节矣。盖岁有
三百六十日。而气盈五日九百四十分。则一月该盈四百九十五分。是出于缺盆之第九日。行一日一夜。
正朔日之平旦。而大会于风府也。其明日日下一节。则邪与卫气亦会于下节。而大会于风府矣。盖卫气
之所应。必开其腠理。开则邪循脊膂而下入。与卫气相遇。则病乃作。故风无常府。谓卫气日下所舍之
节。则其府也。故曰常
大会于风府。常者。谓一岁之中。常十二大会于风府也。大会者。与膂脉相会。盖始于风府。其日下
所舍之节即其府也。
黄帝曰善。夫风之与疟也。相与同类。而风常在。而疟特以时根据何也。岐伯曰。风气留其处。疟气
随经络。沉以内搏。故卫气应乃作也。帝曰善。
风乃天之阳邪。故留于表阳之分。疟乃风寒暑湿之邪。
主阴阳寒热之往来。故随经络之出入。沉以内搏。与卫气相应乃作。盖卫气随经络交相逆顺而行者也。
黄帝问于少师曰。余闻四时八风之中人也。故有寒暑。寒则皮肤急而腠理闭。暑则皮肤缓而腠理开。
贼风邪气。因得以入乎。将必须八正虚邪。乃能伤人乎。少师答曰。不然。贼风邪气之中人也。不得
以时。然必因其开也。其入深。其内极病。其病患也卒暴。因其闭也。其入浅以留。其病也徐以迟。
此言邪气必因其开而入深也。四时有寒暑之往来。故八风之中人也。有寒风而有暑风。寒则皮肤
急而腠理闭。暑则皮肤缓而腠理开。然贼风邪气之中人也。盖因人气之虚实开阖。而入有浅深。不因
寒暑之开闭也。
黄帝曰。有寒温和适。腠理不开。然有卒病者。其故何也。少师答曰。帝弗知邪入乎。虽平居其腠
理开闭缓急。其故常有时也。黄帝曰。可得闻乎。少师曰。人与天地相参也。与日月相应也。故月满
则海水西盛。人血气积。肌肉充。皮肤致。毛发坚。腠理 。烟垢着。当是之时。虽遇贼风。其入浅不
深。至月郭空。则海水东盛。人气血虚。其卫气
去。形独居。肌肉减。皮肤纵。腠理开。毛发残。腠理薄。烟垢落。当是之时。遇贼风则其入深。其
病患也卒暴。
此承上文申明人气之虚实开阖。应天时之盛衰。人与天地相参。与日月相应也。卫气日行于阳。
夜行于阴。应天道之开阖。日丽天而绕地一周。卫气从风府而下至 骨。注冲脉而上出缺盆。应一
月而月与天会。月乃阴魄。故月之盈亏。应水之消长。月郭满则海水西盛。月郭空则海水东盛。盖月
有盈亏。亏于西则满于东。月生于西。故从西而盛于东也。卫气者。所以温分肉。充皮肤。肥腠理。司
开阖者也。故卫气盛则肌肉充。皮肤致。毛发坚。腠理 。烟垢着。当是之时。虽遇贼风。其入浅不
深。至月郭空。则海水东盛。人气血虚。其卫气去而形独居。肌肉减。皮肤纵。腠理开。毛发残。理
者。肌肉之纹理。乃三焦通会之处。故曰焦理。烟垢者。火土之余也。三焦主火。肌肉主土。故焦理
薄则烟垢落。谓肌肉减。腠理开。则肌腠之气。亦消散也。当是之时。遇贼风则其入深。其病患也卒
暴。夫卫气去者。去形身而内入于伏冲之脉也。二十二日。入于内。注于伏冲。其行九日。复出于缺盆。
其气上行。是每月朔旦复出于形身。复会于风府也。故八正神明论曰。月始生则血气始精。卫气始行。
夫月晦初苏曰朔。谓卫气至朔日始行于阳。而大会于风府也。此卫气之与天地相参。与日月相应者
也。王子律曰。海水初八起汐。十五大潮。念三落汐。是以卫气应月满而盛。至念三而去形也。
黄帝曰。其有卒然暴死暴病者何也。少师答曰。三虚者。其死暴疾也。得三实者。邪不能伤人也。
黄帝曰。愿闻三虚。少师曰。乘年之衰。逢月之空。失时之和。因为贼风所伤。是谓三虚。故论不知
三虚。工反为粗。帝曰。愿闻三实。少师曰。逢年之盛。遇月之满。得时之和。虽有贼风邪气。不能危
之也。命曰三实。黄帝曰。善乎哉论。明乎哉道。请藏之金匮。然此一夫之论也。
逢年之虚者。六气司天在泉之不及也。逢月之空者。月郭空之时也。失时之和者。四时不正之
气也。夫卫气与天地相参。与日月相应。是年之虚。月之空。时之违和。皆主卫气失常。盖卫气者
。卫外而为固也。卫气虚。则腠理疏而邪气直入于内。故为暴病卒死。夫三虚三实。民所共由。帝曰此
一夫之论者。谓虚邪贼风。人逢之则中。非比下文之冲风。能伤天下人者也。故圣人避风。如避矢
石焉。
黄帝曰。愿闻岁之所以皆同病者。何因而然。少师曰。此八正之候也。黄帝曰。候之奈何。少师
曰。常以冬至之日。太一立于吐蛰之宫。其至也。天必应之以风雨者矣。风雨从南方来者为虚风。贼伤
人者也。其以夜半至者。万民皆卧而弗犯也。故其岁民少病。其以昼至者。万民懈怠。而皆中于虚
风。故万民多病。虚邪入客于骨。而不发于外。至其立春。阳气大发。腠理开。因立春之日。风从西
方来。万民又皆中于虚风。此两邪相搏。经气结代者矣。故诸逢其风而遇其雨者。命曰遇岁露焉。因
岁之和而少贼风者。民少病而少死。岁多贼风邪气。寒温不和。则民多病而死矣。
八正者。冬至夏至。春分秋分。立春立夏。立秋立冬。定八方之正位。以候八方之风雨也。冬至
之日。风从南方来。立春之日。风从西方来。此从其冲后来。为虚风伤人者也。冬至子之半。其气始
蒙。故虚邪入客于骨而不即发。立春时阳气大发。腠理开。而立春之日。又逢西方来之冲风。两邪相
搏。则经络结代矣。风者天之气。雨者天之露。故诸逢其风而遇其雨者。命曰遇岁露焉。一岁之中。得
及时之风雨。而少贼风者。是因岁之和。则
岁美民安少病。如风雨不时。又多烈风邪气。而失时之和。则民多病而死矣。
黄帝曰。虚邪之风。其所伤贵贱何如。候之奈何。少师答曰。正月朔日。太一居天留之宫。其日
西北风不雨。人多死矣。正月朔日。平旦北风。春民多死。正月朔日。平旦北风行。民病死者十有
三也。正月朔日。日中北风。夏民多死。正月朔日。夕时北风。秋民多死。终日北风。大病死者十
有六。正月朔日。风从南方来。命曰旱乡。从西方来。命曰白骨。将国有殃。人多死亡。正月朔日。
风从东方来。发屋扬沙石。国有大灾也。正月朔日。风从东南方行。春有死亡。正月朔日。天和温
不风。籴贱民不病。天寒而风。籴贵民多病。此所以候岁之风HT 人者也。二月丑不风。民多心腹病。
三月戌不温。民多寒热。四月巳不暑。民多瘅病。十月申不寒。民多暴死。诸所谓风者。皆发屋折
树木。扬沙石。起毫毛。发腠理者也。
正月朔日。候四时之岁气者。以建寅之月为岁首。人生于寅也。二月丑不风者。又常以冬至之
日。太一始居叶蛰之宫。以候天之风雨。以建子之月为岁首。天开于子也。三月主辰。三月戌不温
者。辰与戌合也。在十二月所主在十二辰。在六气所主在三阴三阳。故曰三月戌不温四月巳不暑。盖
或从六气。或从十二辰也。寅申少阳主气。十月申不寒者。以六气之主时也。天干始于甲。地支始
于子。如子午之岁。寅申少阳主五气之九月十月。十月申不寒者。主气失时。民多暴死。盖四时主客
之气。三阴三阳之所主也。以一日之四时。而应一岁之四时者。日日随天道环转一周。而岁与天会也。
正月朔日。风从东方来者。正风也。因发木扬沙。故国有灾也。天寒而风。二月丑风。谓和风也。
诸所谓风者。皆折木扬沙之烈风。又无和润之雨露。故民有死亡也。
此章论人之虚实。因天气之盛衰。而四时之风露。又有和厉之异气。故圣人曰。避虚邪之道。
如避矢石然。庶邪勿能害也。
黄帝向岐伯问道：医经上说，夏天感受暑邪，秋天会患疟疾。疟疾的发作有固定的时间，这是什么缘故呢？
岐伯回答说：邪气侵犯风府穴，病气沿着脊柱向下传导。卫气在一天一夜之间，常在风府穴大会。第二天，卫气下行一节脊椎。所以发病的时间比前一天推迟。这是因为邪气先客居在脊背。每当卫气运行到风府时，腠理（皮肤纹理及汗孔）就会开泄。腠理开泄则邪气得以侵入，邪气侵入则疾病发作。这就是为什么每天发病时间逐渐推迟的原因。
卫气在风府处运行，每日下行一节，二十一日下至尾骶骨。第二十二日，进入脊柱内部，注入伏冲脉。卫气在伏冲脉中运行九日，出于缺盆穴部位。其气向上行，所以病情稍微减轻。
本章的大义，在于论述卫气充盈流行于皮肤肌腠之间，作为形体身体的外部护卫。白天行于阳分，夜晚行于阴分，顺应天体运行的开阖规律。一天一夜，卫气在风府大会。第二天每日下行一节，二十二日内注于伏冲脉。再运行九日，上出于缺盆。这对应月亮运行一个月绕天一周，海水在西边旺盛，人的血气积聚，肌肉充实；海水在东边旺盛，人的血气虚弱，卫气内去，形体独存。这对应海水的消长。大概一天一夜，天道环绕大地一周，水天之气上下相通，而月亮对应着水。卫气运行在肌腠之间，寒冷时皮肤紧缩而腠理闭合，暑热时皮肤松弛而腠理开泄。所以因为夏天伤于暑邪，秋天形成疟疾，以此证明卫气的运行规律。所谓疟疾，是暑邪潜伏在肌肤，到了秋天阴气外出，阴与阳相遇，寒与热相争，邪正双方相持不下，从而发为疟疾。
风府是督脉的穴位，位于脑后发际正中。邪气客居在风府，沿着脊膂向下。卫气一天一夜在风府大会，第二天每日下行一节，所以发病时间推迟。这是邪气先客居在脊背。所以当卫气每到达风府时，腠理就开泄。腠理开泄则邪气侵入，与卫气相遇，疾病就发作。卫气每日下行一节，所以发病时间日益推迟。大概卫气每日下行一节，就开启下一节脊椎的腠理，邪气趁着腠理开泄而侵入，与卫气相遇，疾病才发作。
伏冲脉，即冲脉伏行于背部深处，是经络之海。卫气循行于外表向下，从内部向上，环转一周，顺应天道。卢良侯说：卫气行于阳分、行于阴分，顺应白天黑夜的光明与昏暗；循着脊膂向下注入冲脉再向上，顺应天道在外面的营运，又贯通于地中。卫气内注于伏冲脉，外注于足阳明脉，就像司天在泉之气，上下环转。泉在天之下，与地中的经水相通。
如果邪气向内搏结于五脏，横连募原（脏腑间的脂膜），路径遥远，气机深隐，运行迟缓，不能每天发作，所以要等到第二天蓄积力量后才发作。
邪气留滞于五脏的募原。募原，横连于脏腑之间的脂膜。疟邪内搏于五脏募原之间，因为路径遥远，气机深隐，不能与卫气一起运行而出于体表，所以不能每天发作，而是隔日才发作。这是在说卫气夜间行于阴分时，是行于五脏募原之间的。
黄帝问：卫气每次到达风府，腠理就开泄，开泄后邪气就侵入。如果卫气每日下行一节，就不在风府了，那该怎么办呢？
岐伯回答：风府的位置不是固定不变的。卫气所应合的地方，必定会开泄那里的腠理，气所停留的节段，就是它的“府”。
这里承接上文，申明卫气出于缺盆之中，其气上行，一天一夜在风府大会，第二天每日下行一节。大概一年有三百六十日，加上气盈五日九百四十分，那么一个月该有盈余四百九十五分。这是出于缺盆后的第九日，运行一天一夜，正值正月初一平旦之时，而在风府大会。第二天每日下行一节，那么邪气与卫气也会在下节相会，而在风府大会。大概卫气所应合的地方，必定开泄腠理，腠理开泄则邪气顺着脊膂向下侵入，与卫气相遇，疾病才发作。所以说风府没有固定位置，是指卫气每日下行所停留的节段，就是它的府。所以说常在风府大会。“常”，是指一年之中，常有十二次在风府大会。“大会”，是与脊膂脉相会。起始于风府，每日下行所停留的节段即是其府。
黄帝说：好。风和疟疾，看似同类，但风邪常在，而疟疾却只在特定时间发作，为什么呢？
岐伯回答：风邪停留在体表，疟邪随经络深入，沉潜向内搏结，所以卫气应期而至时才发作。
风是天地的阳邪，所以停留在表阳之分。疟疾是风寒暑湿之邪，主司阴阳寒热的往来，所以随经络的出入，沉潜向内搏结，与卫气相应时才发作。大概卫气是随着经络交错逆顺运行的。
黄帝问少师：我听说四时八风伤人，所以有寒暑之分。寒冷时皮肤紧缩而腠理闭合，暑热时皮肤松弛而腠理开泄，贼风邪气因此得以侵入吗？还是必须遇到八正时的虚邪，才能伤人呢？
少师回答：不是这样。贼风邪气伤人，不一定在特定的时间，但必须趁着腠理开泄的时候。如果趁腠理开泄而入，邪气深入，内部极度生病，患者发病突然猛烈。如果趁着腠理闭合而入，邪气浅留，发病缓慢而迟滞。
这是在说邪气必须趁着腠理开泄才能深入。四时有寒暑的往来，所以八风伤人，有寒风也有暑风。寒冷时皮肤紧缩而腠理闭合，暑热时皮肤松弛而腠理开泄。然而贼风邪气伤人，是因为人气虚实开阖的不同，而入侵有浅深之分，并不单纯取决于寒暑的开闭。
黄帝问：如果寒温适宜，腠理没有开泄，然而却有突然患病的情况，这是什么缘故呢？
少师回答：您不知道邪气是如何进入的吗？即使平时安居，腠理的开闭缓急，也常常有时机变化。
黄帝说：可以说给我听吗？
少师说：人与天地相参，与日月相应。所以月亮圆满时，海水在西边旺盛，人的血气积聚，肌肉充实，皮肤致密，毛发坚挺，腠理闭合，烟垢附着。在这个时候，虽然遇到贼风，邪气侵入浅而不深。到了月亮亏空时，海水在东边旺盛，人的血气虚弱，卫气内去，形体独存，肌肉减损，皮肤纵缓，腠理开泄，毛发残落，腠理变薄，烟垢脱落。在这个时候，遇到贼风，邪气侵入深，发病突然猛烈。
这里承接上文，申明人气的虚实开阖，顺应天时盛衰。人与天地相参，与日月相应。卫气白天行于阳，夜晚行于阴，顺应天道的开阖。太阳照耀天空环绕大地一周，卫气从风府下行至骶骨，注入冲脉而上出缺盆，对应一个月，月亮与天会合。月亮是阴魄，所以月亮的盈亏，对应海水的消长。月郭满则海水西盛，月郭空则海水东盛。大概月亮有盈亏，亏于西则满于东，月亮生于西，所以从西而盛于东。卫气，是用来温煦分肉，充实皮肤，肥厚腠理，主管开阖的。所以卫气盛则肌肉充实，皮肤致密，毛发坚挺，腠理闭合，烟垢附着。在这个时候，虽然遇到贼风，邪气侵入浅而不深。到了月郭空，海水东盛，人气血虚，卫气内去而形体独存，肌肉减损，皮肤纵缓，腠理开泄，毛发残落。理，是肌肉的纹理，是三焦通会之处，所以叫焦理。烟垢，是火土之余。三焦主火，肌肉主土，所以焦理薄则烟垢脱落，意思是肌肉减损，腠理开泄，肌腠之气也消散了。在这个时候，遇到贼风则邪气侵入深，发病突然猛烈。所谓卫气去，是离开形身而内入于伏冲脉。第二十二日，进入内部，注入伏冲，运行九日，再出于缺盆，其气上行。这是每月初一重新出于形身，重新会合于风府。所以《八正神明论》说：月亮始生则血气始精，卫气始行。月亮晦暗初苏叫朔，指卫气到朔日才开始行于阳，而大会于风府。这是卫气与天地相参，与日月相应的表现。王子律说：海水初八起潮汐，十五大潮，二十三退潮。所以卫气对应月满而盛，到二十三离开形身。
少师回答：遇到“三虚”的人，死亡迅速且病势急迫。得到“三实”的人，邪气就不能伤害他。
黄帝说：我想听听什么是三虚。
少师说：乘当年运气之衰弱，逢月亮亏空之时，失四时调和之气，因而被贼风所伤，这叫三虚。所以不懂三虚的道理，医生反而显得粗疏。
黄帝说：我想听听什么是三实。
少师说：逢当年运气之旺盛，遇月亮圆满之时，得四时调和之气，虽然有贼风邪气，也不能危害他，这叫三实。
黄帝说：好啊，这个理论！明白啊，这个道！请把它藏在金匮里。但这只是针对个人的论述罢了。
逢年之虚，是指六气司天在泉不及。逢月之空，是指月郭空的时候。失时之和，是指四时不正之气。卫气与天地相参，与日月相应。年的虚、月的空、时的违和，都导致卫气失常。大概卫气，是保卫外部而固密的。卫气虚，则腠理疏松而邪气直入内部，所以发生暴病卒死。所谓三虚三实，是百姓共同经历的。黄帝说这是“一夫之论”，是指虚邪贼风，人如果遇到就会中邪，不像下文所说的冲风，能伤害天下所有人。所以圣人避风，就像躲避箭石一样。
黄帝问：我想了解为什么每年人们得的病都相同，是什么原因造成的？
黄帝问：如何观察呢？
少师说：通常在冬至日，太一星立于叶蛰宫。当它到来时，天必然以风雨响应。风雨从南方来的是虚风，是伤害人的邪气。如果在夜半到达，万民都在睡觉而不触犯它，所以这一年百姓少病。如果在白天到达，万民懈怠，都中了虚风，所以百姓多病。虚邪侵入骨骼，但不立即在体表发作。到了立春，阳气大发，腠理开泄，恰逢立春之日，风从西方来，万民又都中了虚风。这两种邪气相互搏结，导致经气结代。所以凡是遇到这种风又遇上雨的，叫做遇到岁露。如果年份调和而少贼风，百姓少病少死。如果年份多贼风邪气，寒温不和，百姓就多病而死。
八正，是指冬至、夏至、春分、秋分、立春、立夏、立秋、立冬，确定八方正位，以候八方风雨。冬至日，风从南方来；立春日，风从西方来。这是从其对冲方向后来，为虚风伤人。冬至子时过半，其气始蒙，所以虚邪侵入骨骼而不立即发作。立春时阳气大发，腠理开泄，而立春之日，又逢西方来的冲风，两邪相搏，则经络结代。风是天之气，雨是天之露，所以凡是遇到风又遇上雨的，叫做遇到岁露。一年之中，得到及时的风雨而少贼风的，是因为年份调和，则年景美好百姓安康少病。如果风雨不按时令，又多烈风邪气，失去时令的和气，则百姓多病而死。
黄帝问：虚邪之风，所伤害的轻重程度如何？怎样观察呢？
少师回答：正月初一，太一居于天留宫。如果那天西北风无雨，人多死亡。正月初一，平旦北风，春天百姓多死。正月初一，平旦北风刮，百姓病死十之三。正月初一，日中北风，夏天百姓多死。正月初一，傍晚北风，秋天百姓多死。整天北风，大病死者十之六。正月初一，风从南方来，名叫旱乡；从西方来，名叫白骨，将国有灾殃，人多死亡。正月初一，风从东方来，掀翻房屋扬起沙石，国家有大灾难。正月初一，风从东南方行，春天有死亡。正月初一，天和暖不风，粮价贱百姓不病。天气寒冷而有风，粮价贵百姓多病。这就是用来候测一年风气以预测人群健康的方法。二月丑日不风，百姓多心腹病。三月戌日不温暖，百姓多寒热病。四月巳日不暑热，百姓多疸病。十月申日不寒冷，百姓多暴死。所谓的风，都是掀翻房屋、折断树木、扬起沙石、竖起毫毛、开泄腠理的烈风。
正月初一，候测四时岁气，是以建寅之月为岁首，因为人生于寅。二月丑日不风，又是通常以冬至日，太一开始居于叶蛰宫，以候测天的风雨，以建子之月为岁首，天开于子。三月主辰，三月戌日不温暖，是因为辰与戌相合。在十二月所主在十二辰，在六气所主在三阴三阳，所以说三月戌不温、四月巳不暑。大概有的从六气，有的从十二辰。寅申少阳主气，十月申日不寒冷，是以六气之主时而言。天干始于甲，地支始于子，如子午之年，寅申少阳主五气的九月十月，十月申日不寒冷，是主气失时，百姓多暴死。大概四时主客之气，是三阴三阳所主的。以一日之四时，对应一岁之四时，日日随天道环转一周，而岁与天会合。
正月初一，风从东方来者，是正风。因为掀起木头扬起沙石，所以国家有灾。天气寒冷而有风，二月丑风，称为和风。所谓的风，都是折木扬沙的烈风，又没有和润的雨露，所以百姓有死亡。
本章论述人的虚实，因天气的盛衰，而四时的风露，又有和厉的不同气运。所以圣人说：避开虚邪之道，就像躲避箭石一样，庶几邪气不能伤害人。
Huangdi asked Qibo: The medical classics state that summer injury by heat (Shu) leads to malaria in autumn. Malaria attacks at specific times; what is the reason for this?
Qibo replied: When pathogenic factors invade the Fengfu acupoint, the disease follows the spine downward. The Wei Qi (Defensive Qi) gathers at the Fengfu point once a day and night. The next day, it descends one vertebral segment. Therefore, the onset of the disease occurs later each day. This is because the pathogen first resides in the back along the spine. Whenever Wei Qi reaches the Fengfu point, the Cou Li (skin texture and pores) open. When the Cou Li open, pathogenic factors enter; when they enter, the disease manifests. This is why the daily onset time delays progressively.
Wei Qi moves from the Fengfu point, descending one vertebral segment daily. After twenty-one days, it reaches the coccyx. On the twenty-second day, it enters the interior of the spine and pours into the Fu Chong Mai (Hidden Chong Vessel). It travels within the Fu Chong Mai for nine days, emerging at the Quepen area. Its qi moves upward, so the condition slightly improves.
The main meaning of this chapter discusses how Wei Qi circulates fully in the skin and muscle layers, serving as the external defense of the body. It travels through the Yang aspects during the day and the Yin aspects at night, responding to the opening and closing of heavenly movements. In one day and night, it gathers at the Fengfu point. The next day, it descends one segment. Within twenty-two days, it internally notes into the Fu Chong Mai. Traveling for nine days more, it emerges superiorly at the Quepen. This corresponds to the moon completing one circuit around the sky in a month. When seawater swells in the west, human blood and qi accumulate, and muscles are full. When seawater swells in the east, human blood and qi become deficient, Wei Qi departs, and only the form remains. This corresponds to the waxing and waning of seawater. Generally, in one day and night, the Heavenly Dao circles the earth once; the qi of water and heaven communicates up and down, and the moon corresponds to water. Wei Qi travels between the muscles and Cou Li. In cold, the skin tightens and the Cou Li close; in heat, the skin relaxes and the Cou Li open. Thus, summer injury by heat leads to malaria in autumn, demonstrating the movement of Wei Qi. Malaria occurs when heat pathogens hide in the skin and muscles. In autumn, Yin qi moves outward. When Yin meets Yang, and cold contends with heat, the pathogen and healthy qi stand in stalemate, resulting in malaria.
Fengfu is an acupoint of the Du Meridian, located in the midline of the posterior hairline. Pathogens residing in Fengfu descend along the spine. Wei Qi gathers at Fengfu daily and nightly, descending one segment the next day, causing delayed onset. This indicates the pathogen initially resided in the back. Thus, whenever Wei Qi reaches Fengfu, the Cou Li open. Opening allows pathogens to enter and meet Wei Qi, triggering the disease. As Wei Qi descends one segment daily, the onset delays further. Essentially, as Wei Qi descends one segment daily, it opens the Cou Li of the lower segment. Pathogens enter due to this opening, meet Wei Qi, and the disease arises.
The Fu Chong refers to the Chong Mai (Penetrating Vessel) running deeply within the back, the sea of the meridians. Wei Qi circulates externally downward and internally upward, circling once, corresponding to the Heavenly Dao. Lu Lianghou stated: Wei Qi traveling through Yang and Yin responds to the brightness and darkness of day and night. Following the spine downward into the Chong Mai and upward responds to the Heavenly Dao's operation externally and its connection internally through the earth. Wei Qi internally notes into the Fu Chong Mai and externally notes into the Foot-Yangming Meridian, similar to the Si Tian (Heavenly Sovereign) and Zai Quan (Earthly Foundation) energies rotating up and down. The spring is below heaven, connecting with the waters within the earth.
If pathogens internally contend with the five Zang organs and horizontally connect to the Mu Yuan (Moyuan/Epigastric region), the path is distant, the qi is deep, and the movement is slow, preventing daily attacks. Thus, it accumulates and attacks on the following day.
Internal contention with the five Zang organs means pathogens remain in the Mu Yuan of the five Zang organs. The Mu Yuan horizontally connects to the fatty membranes between the zang-fu organs. When malaria pathogens internally contend between the five Zang organs' Mu Yuan, the path is distant and the qi is deep. They cannot travel outwards with Wei Qi, so they do not attack daily but every other day. This describes Wei Qi traveling through the Yin at night, moving between the Mu Yuan of the five Zang organs.
Huangdi asked: When Wei Qi reaches Fengfu, the Cou Li open, allowing pathogens to enter. If Wei Qi descends one segment daily, it is no longer at Fengfu. What then?
Qibo answered: The Fengfu position is not fixed. Wherever Wei Qi responds, it must open the Cou Li there. The segment where the qi stays becomes its "Fu" (residence).
This elaborates on the previous text, clarifying that Wei Qi emerges from Quepen, moves upward, gathers at Fengfu in one day and night, and descends one segment the next day. A year has 360 days, plus an excess of 5 days and 940 fen. Thus, a month has an excess of 495 fen. On the ninth day after emerging from Quepen, after traveling one day and night, precisely at dawn on the first day of the new year, it gathers at Fengfu. The next day, descending one segment, the pathogen and Wei Qi also meet at the lower segment, gathering at Fengfu. Wherever Wei Qi responds, it opens the Cou Li. Opening allows pathogens to descend along the spine and meet Wei Qi, causing disease. Thus, Fengfu has no fixed location; it refers to the segment where Wei Qi stays daily as its residence. Hence, it constantly gathers at Fengfu. "Constantly" means twelve gatherings at Fengfu throughout the year. "Gathering" means meeting with the spinal meridian. Starting at Fengfu, the segment stayed at daily is its residence.
Huangdi said: Excellent. Wind and malaria seem similar, yet wind is constant while malaria occurs only at specific times. Why?
Qibo answered: Wind pathogens stay in their location (exterior). Malaria pathogens follow the meridians, sinking and internally contending. Thus, they manifest when Wei Qi arrives.
Wind is a Yang pathogen of heaven, so it stays in the exterior Yang divisions. Malaria involves Cold, Wind, Heat, and Dampness pathogens, governing the alternation of Yin/Yang and Cold/Heat. Thus, they follow the entry and exit of meridians, sinking to internally contend, manifesting when corresponding with Wei Qi. Wei Qi travels counter and smooth along the meridians.
Huangdi asked Shaoshi: I have heard that the eight winds of the four seasons injure people, causing cold or heat. Does cold tighten the skin and close the Cou Li, while heat relaxes the skin and opens the Cou Li, allowing thief-wind and pathogens to enter? Or must one encounter the empty evils of the Eight Rectitudes (Ba Zheng) to be injured?
Shaoshi answered: Not so. Injury by thief-wind and pathogens does not necessarily occur at specific times, but it requires the Cou Li to be open. If entering when open, the invasion is deep, internal illness is extreme, and the patient suffers sudden and violent onset. If entering when closed, the invasion is shallow and lingering, and the disease develops slowly.
This states that pathogens must enter deeply when the Cou Li are open. The four seasons bring cold and heat, so the eight winds include cold wind and heat wind. Cold tightens the skin and closes the Cou Li; heat relaxes the skin and opens the Cou Li. However, injury by thief-wind depends on the deficiency or excess and opening/closing of human qi, leading to shallow or deep invasion, not merely determined by cold or heat.
Huangdi asked: If the climate is moderate and the Cou Li are not open, yet sudden illness occurs, why?
Shaoshi answered: Do you not know how pathogens enter? Even in peaceful living, the opening, closing, slackening, and tightening of the Cou Li have their own timing.
Huangdi asked: May I hear about it?
Shaoshi answered: Humans correspond to Heaven and Earth and resonate with the Sun and Moon. When the moon is full, seawater swells in the west; human blood and qi accumulate, muscles are full, skin is dense, hair is firm, the Cou Li close, and smoke-dust adheres. At this time, even if encountering thief-wind, the invasion is shallow and not deep. When the moon is dark (waning/new), seawater swells in the east; human blood and qi are deficient, Wei Qi departs, and only the form remains. Muscles diminish, skin hangs loose, the Cou Li open, hair falls out, the Cou Li become thin, and smoke-dust falls off. At this time, encountering thief-wind leads to deep invasion and sudden, violent illness.
This elaborates on how human qi's deficiency/excess and opening/closing respond to the waxing/waning of heavenly times. Humans correspond to Heaven and Earth and resonate with the Sun and Moon. Wei Qi travels through Yang by day and Yin by night, responding to the opening and closing of the Heavenly Dao. The sun circles the earth; Wei Qi descends from Fengfu to the sacrum, notes into the Chong Mai, and emerges at Quepen, corresponding to one month when the moon meets heaven. The moon is the Yin soul; thus, its waxing and waning corresponds to the ebb and flow of water. Full moon means seawater swells in the west; dark moon means seawater swells in the east. The moon wanes in the west and fills in the east; it is born in the west, so it swells from west to east. Wei Qi warms the flesh, fills the skin, thickens the Cou Li, and governs opening and closing. When Wei Qi is abundant, muscles are full, skin is dense, hair is firm, Cou Li close, and smoke-dust adheres. Even with thief-wind, invasion is shallow. When the moon is dark, seawater swells in the east, human blood/qi are deficient, Wei Qi departs, muscles diminish, skin loosens, Cou Li open, hair falls, Cou Li thin, smoke-dust falls. "Li" refers to muscle texture, the convergence point of the San Jiao, hence called "Jiao Li". Smoke-dust is the residue of Fire and Earth. San Jiao governs Fire; muscles govern Earth. When Jiao Li is thin, smoke-dust falls, meaning muscle loss and Cou Li opening dissipate the qi of the muscle-Cou Li. Encountering thief-wind then causes deep invasion and sudden illness. "Wei Qi departing" means leaving the body and entering the Fu Chong Mai. On the 22nd day, it enters internally, notes into Fu Chong, travels for 9 days, emerges at Quepen, and moves upward. This is when it re-emerges to the body on the first day of the lunar month and reunites at Fengfu. Thus, the *Ba Zheng Shen Ming Lun* states: When the moon begins to grow, blood and qi begin to refine, and Wei Qi begins to move. The day the moon is dark and revives is called "Shuo" (New Moon); Wei Qi begins to travel through Yang on this day and gathers at Fengfu. This is how Wei Qi corresponds to Heaven and Earth and resonates with the Sun and Moon. Wang Zilv said: Seawater tides rise on the 8th, peak on the 15th, and recede on the 23rd. Thus, Wei Qi swells with the full moon and leaves the body on the 23rd.
Huangdi asked: What causes sudden death or acute illness?
Shaoshi answered: Those who encounter the "Three Deficiencies" (San Xu) die rapidly from acute disease. Those who obtain the "Three Excesses" (San Shi) cannot be harmed by pathogens.
Huangdi asked: Tell me about the Three Deficiencies.
Shaoshi answered: Relying on the weakness of the annual luck, encountering the empty moon, and losing the harmony of the seasons, thereby being injured by thief-wind, is called the Three Deficiencies. One who does not understand the Three Deficiencies is a crude physician.
Huangdi asked: Tell me about the Three Excesses.
Shaoshi answered: Encountering the abundance of the year, meeting the full moon, and obtaining the harmony of the seasons, such that even with thief-wind and pathogens, harm cannot occur, is called the Three Excesses.
Huangdi praised: Excellent theory! Clear Dao! Please store it in the Golden Casket. But this is merely a discussion regarding an individual.
The "weakness of the year" refers to the insufficiency of the Six Qi ruling Si Tian and Zai Quan. The "empty moon" refers to the time of the dark moon. "Losing seasonal harmony" refers to abnormal qi of the four seasons. Since Wei Qi corresponds to Heaven and Earth and resonates with the Sun and Moon, the weakness of the year, emptiness of the moon, and disharmony of time all cause Wei Qi dysfunction. Wei Qi protects the exterior and secures the body. When Wei Qi is deficient, the Cou Li are loose, and pathogens enter directly inward, causing sudden death or acute illness. The Three Deficiencies and Excesses are common to the people. Huangdi's comment "discussion of an individual" implies that empty evil and thief-wind affect those who encounter them, unlike the strong winds mentioned later that can harm everyone. Thus, sages avoid wind as they would avoid arrows and stones.
Huangdi asked: Why do people often suffer from the same diseases in a given year? What is the cause?
Shaoshi answered: This is observed through the Eight Rectitudes (Ba Zheng).
Huangdi asked: How to observe?
Shaoshi answered: Usually, on the Winter Solstice day, Tai Yi stands in the Ye Zhe Palace. Upon its arrival, heaven responds with wind and rain. Wind and rain coming from the south are Empty Winds (Xu Feng), which injure people. If they arrive at midnight, people are asleep and not affected, so few fall ill that year. If they arrive during the day, people are lax and struck by Empty Wind, so many fall ill. Empty evil enters the bones but does not immediately manifest externally. By Li Chun (Start of Spring), Yang qi expands greatly, and the Cou Li open. Coinciding with Li Chun, wind comes from the west, and people are again struck by Empty Wind. These two evils contend, causing stagnation in the meridians. Any occurrence of wind accompanied by rain is called "Sui Lu" (Yearly Dew). If the year is harmonious with few thief-winds, people are few in illness and death. If the year has many thief-winds and pathogens, with discordant cold and warmth, people suffer much illness and death.
The Eight Rectitudes refer to Winter Solstice, Summer Solstice, Spring Equinox, Autumn Equinox, Start of Spring, Start of Summer, Start of Autumn, and Start of Winter, determining the eight cardinal directions to observe wind and rain. On Winter Solstice, wind comes from the south; on Li Chun, wind comes from the west. These come from the opposing direction, acting as Empty Wind injuring people. Halfway through the Zi hour on Winter Solstice, the qi is just beginning; thus, empty evil enters the bones without immediate manifestation. At Li Chun, Yang qi expands, Cou Li open, and coinciding with western wind, the two evils contend, causing meridian stagnation. Wind is the qi of heaven; rain is the dew of heaven. Occurrences of wind and rain together are called Sui Lu. If a year receives timely wind and rain with few thief-winds, it is harmonious, leading to good harvests, peace, and little illness. If wind and rain are untimely and fierce winds/pathogens abound, losing seasonal harmony, people suffer much illness and death.
Huangdi asked: Regarding Empty Wind, how severe is the injury, and how is it observed?
Shaoshi answered: On the first day of the first lunar month, Tai Yi resides in the Tian Liu Palace. If there is a northwest wind without rain, many will die. On the first day of the first month, north wind at dawn causes many deaths in spring. If north wind blows at dawn, three out of ten people die. North wind at noon causes many deaths in summer. North wind at dusk causes many deaths in autumn. All-day north wind causes six out of ten to die of serious illness. Wind from the south on the first day is called "Dry Land"; from the west, "White Bones," indicating national disaster and much death. Wind from the east, overturning houses and raising sand, indicates major national calamity. Wind from the southeast causes deaths in spring. If the weather is warm and windless, grain is cheap and people are healthy. If cold and windy, grain is expensive and people are sick. This is how to predict the year's wind and human health. If there is no wind on the Chou day of the second month, people suffer heart and abdominal diseases. If the Xu day of the third month is not warm, people suffer cold and heat disorders. If the Si day of the fourth month is not hot, people suffer jaundice. If the Shen day of the tenth month is not cold, people suffer sudden death. The winds described here are those that overturn houses, break trees, raise sand, raise goosebumps, and open the Cou Li.
Observing the four seasons' annual qi on the first day of the first month uses the Yin month as the start of the year, as humans are born in Yin. The statement "no wind on Chou day of the second month" relates to observing heaven's wind and rain starting from Tai Yi in the Ye Zhe Palace on Winter Solstice, using the Zi month as the start of the year, as heaven opens in Zi. The third month governs Chen; "not warm on Xu day of the third month" is because Chen and Xu combine. In the twelve months, the governance lies in the twelve Earthly Branches; in the Six Qi, it lies in the Three Yin and Three Yang. Hence, "not warm on Xu day of the third month, not hot on Si day of the fourth month." Some follow Six Qi, some follow twelve Branches. Yin-Shen Shaoyang governs the Qi; "not cold on Shen day of the tenth month" refers to the governance of Six Qi. Heavenly Stems start with Jia; Earthly Branches start with Zi. In Zi-Wu years, Yin-Shen Shaoyang governs the fifth qi in the ninth and tenth months. "Not cold on Shen day of the tenth month" means the dominant qi is out of season, causing sudden death. The master and guest qi of the four seasons are governed by the Three Yin and Three Yang. The four seasons of a day correspond to the four seasons of a year, circling the Heavenly Dao daily, and the year meets heaven.
Wind from the east on the first day is the Proper Wind. Because it lifts wood and raises sand, it brings national disaster. Cold weather with wind on the Chou day of February is called Harmonious Wind. The winds described earlier were fierce winds breaking trees and raising sand, lacking moist rain, causing death.
This chapter discusses human deficiency and excess, responding to the waxing and waning of heavenly qi, and the different harmonious or harsh qualities of seasonal wind and dew. Thus, sages say: Avoid empty evil as one avoids arrows and stones, so that miscellaneous evils cannot harm.