内虚，则惊惑、恶寒、战栗、谵
妄。太阴肺天之气，不能四布其水津则 满。少阳三焦之气不能游行出入则惊躁瞀昧而暴病。阳明大肠
主津液所生病，津液虚寒则为鼻鼽。阳明胃脉下髀关，抵伏兔，下膝膑中，下循胫外廉，下足
跗。故尻阴股膝髀 足皆病。太阳之脉挟脊抵腰，病则腰痛。此亦六气发病之常也。
厥阴所至为 戾，少阴所至为悲妄，衄 。太阴所至为中满、霍乱吐下。
少阳所至为喉痹耳鸣，呕涌。阳明所至为胸痛皴揭。太阳所至为寝汗痉。病之常也。
胸，旧本讹胁今改。皴音逡，痉音劲。戾，了戾小便所注之关戾也。 ，缩也。厥阴之脉入毛中过阴器，
病则癃闭，故厥阴所至为 戾。悲，悲哀，心气虚也。妄，狂妄，心气实也。脉虚而热则
衄，脉虚而寒则 。少阴属心主脉，故少阴所至为悲妄衄 ，中满则上下不交，霍乱吐下则上涌下泄。手
太阴主上，足太阴主下，故太阴所至为中满、霍乱吐下。一阴一阳结，谓之喉痹。一阴，厥阴
也，一阳，少阳也。手足少阳之脉皆从耳后入耳中，出走耳前。经脉虚则耳鸣，少阳枢转不利，则干呕上涌，
故少阳所至为喉痹。耳鸣、呕涌、胸痛者，手足阳明之脉不能入缺盆而下膈也。皮皱曰
皴，掀起曰揭。皴揭者，阳明燥胜，皮皴而掀揭也。故阳明所至为胸痛皴揭。手太阳之脉主液所生病。寝
汗，液虚也。足太阳之脉，主筋所生病，痉，筋挛也。故太阳所至为寝汗、痉。此亦六气发病之常也。
厥阴所至为胁痛。呕泄。少阴所至为语笑。太阴所至为重， 肿。少阳所至为
暴注 螈，暴死。阳明所至为鼽嚏。太阳所至为流泄。禁止。病之常也。
初阳之气，起于厥阴，阴极而初阳不升则胁痛。上呕下泄。故厥阴所至为胁痛呕泄。语言喜笑，心所
主也。心气实则语笑多，故少阴所至为语笑。土虚湿胜则身重 肿，故太阴所至为重的 肿。
注，洞泄也，暴注，卒然洞泄也。暴泄如注，则生阳之气不充于身，故肉 筋螈。表里上下不交则一时暴
死，故少阳所至为暴注
螈暴死，水津不藏则鼽，以木击金则嚏，故阳明所至为鼽衄。流泄者，汗流外泄。禁止者，小便不行。流泄
则津液虚，禁止则小便闭，故太阳所至为流泄禁止。此亦六气发病之常也。凡此亦皆六气应
见，以为六变之纪者有如此。
凡此十二变者，报德以德，报化以化，报政以政，报令以令。气高则高，气下则下，
气后则后，气前则前，气中则中，气外则外，位之常也。故风胜则动，热胜则肿，燥胜则干，
寒胜则浮，湿胜则濡泄，甚则水闭 肿。随气所在，以言其变耳。
总结上文六正六变之意，正变皆六，气之常，故曰凡此十二变者。上文两言德化之常，故曰报德以德，
言报复之德以其先施之德也。一言司化之常，一言气化之常，故曰报化以化，言报复之化以
其先施之化也。一言布政之常，故曰报政以政，言报复之政，以其先布之政也。此结上文六化之正也。上文六
气之变，变而为病。言病之常者四，言气变之常者一，言令行之常者一。故曰报令以令，言报复之令以其
先行之令也。其气变之常，发病之常，乃火水金木土火之六气变而为病。火位居高，故曰气高则高，谓火
变则火病也。水位居下，故曰气下则下，谓水变则水位也。金位居后，故曰气后则后，谓金变则金病也。木
位居前，故曰气前则前，谓木变则木病也。土位居中，故曰气中则中，谓土变则土病也。火
居高而位外，故曰气外则外，亦火变则火病也。火水木金土火六气有高下前后中外之位，乃位之常也。此
结上文六气之变也。阴阳应象大论云，风胜则动，热胜则肿，燥胜则干，寒胜则浮，湿胜则濡
泄，引之以明风热燥寒湿之气胜于上，则人身经脉为动为肿为干为浮为濡泄，而病于下甚则土气不行，水闭
浮肿。此随六气之所在以言其变而为病耳。
帝曰∶愿闻其用也。
上文岐伯云有化有变有胜有复有用有病，不同其候，今六气之
化、六气之变、六气之胜六气之复，六气之病皆明言之，而六气之用未悉其旨，帝故问之。
岐伯曰∶夫六气之用，各归不胜而为化。故太阴雨化，施于太
阳。太阳寒化，施于少阴。少阴热化，施于阳明。阳明燥化，施于
厥阴。厥阴风化，施于太阴。名命其所在，以征之也。
不胜，受其制也。不胜而为化，犹言制则生化也。夫六气之用，制化为先。是以各归不胜而为化，故太阴
雨化，土也施于太阳则土制其水，而土之金德生其水，是不胜而为化也。太阳寒化，水也，施于少阴，则
水制其火，而水之子木复生其火。少阴热化，火也，施于阳明则火制其金，而火之子土复生其金。阳明燥化，
金也，施于厥阴，则金制其木，而金之子水，复生其木。厥阴风化，木也，施于太阴，则木制其土，而
木之子火复生其土。是皆不胜而为化也。六气合五行，不言少阳者，同于少阴也。此不胜为化，乃六气
之用。欲征其用，名命其所在之气以征之也。如太阴之气在长夏，太阳之气在于冬，少阴之气在于夏，阳
明之气在于秋。厥阴之气在于春者是也。
帝曰∶自得其位何如？
命其所在，乃自得其位，故问自得其位，何如？
岐伯曰∶自得其位，常化也。
自得其位者，得其四时六气之常化也。
帝曰∶愿闻其所在也。
帝欲详明所在之位，故复问之。
岐伯曰∶命其位，而方月可知也。
命其位者，命其六气之位也。方月者，厥阴之位，东北方也。正月二月，少阴之位，东南方也。三
月四月，太阴之位，西南方也。五月六月，少阳之位，正南方也。七月八月，阳明之位，西北方
也。九月十月，太阳之位，正北方也。十一月十二月。命其位而知其方月，则六气之用，益可知矣。
帝曰∶六位之气，盈虚何如？
六位之气有盛衰，故问盈虚何如。
岐伯曰，太少异也，太者之至徐而常，少者暴而亡。
岁运阳年为太，太则六位之气盈，阴年为少，少则六位之气虚，此太少之异，而有盈虚也。太
主气盈，故太者之至，其气徐而常。言气舒徐而有常度也。少主气虚，故少者之至，其气暴而亡。言气
促疾而无常度也。此明位气之盈虚也。
帝曰∶天地之气盈虚何如？
六位之气主十二月，而天地一岁之气，盈虚何如。
岐伯曰∶天气不足，地气随之；地气不足天气从之，运居其中
而常先也。恶所不胜，归所同和，随运归从而生其病也。故上胜则
天气降而下，下胜则地气迁而上。多少而差其分，微者小差，甚者
大差。甚则位易气交，易则大变生而病作矣。大要曰甚纪五分，微纪七分，其差可见，此之谓也。
分，去声。天干乙丁己辛癸主不足，地支丑卯巳未酉亥，主不足。干支配合，有余则皆有余。不足
则皆不足。故天干之气不足，则地支之地气亦随之。地支之地气不足，则天干之天气亦从之。地
支主六气，天干化五运。五运在中，故运居其中。而常为六气之先也。不足之岁先郁后复。先郁则恶所不
胜，后复则归所同和。五运在中，随运归从而生其民病也。此言天气地气之不足而为虚也。岁
半之前，司天之气主之，上胜者，司天之气有余也。故上胜则有余之天气降而大。降而下者，流于岁半
之复也。岁半之后，在泉之气主之，下胜者，在泉之气有余也。故下胜则有余之地气迁而上，迁
而上者，移于岁半之前也。其上下所胜之气有多少而差其分，胜之微者小差，胜之甚者大差。甚则位易气
交。如上胜则易四之气而归于上，下胜则易三之气而归于下，易则大变生，而民病作矣。揆其
微甚之大要，则曰甚纪五分，谓五分在于本位，而五分降迁也。微纪七分，谓七分在于本位，而三分降迁也。
五分七分则其差可见。即此多少而差其分之谓也。此言上胜下胜，有余而为盈也。如此推之，则
天地之盈虚从可知矣。
帝曰∶善。论言，热无犯热，寒无犯寒，余欲不远寒，不远热，奈何？
天地盈虚之理既明，帝故善之，上文岐伯之用热远热，用寒远
寒者，无犯之谓。帝引其言而言余欲用寒用热，实用其力而不远，奈何？
岐伯曰∶悉乎哉问也，发表不远热，攻里不远寒。
时令当热，寒邪在表，用辛热之药以发之，是发表而不远热也。
时令当寒，热邪在里，用寒泄之药以攻之，是攻里而不远寒也。
帝曰∶不发不攻而犯寒犯热，何如？
发表犯热，攻里犯寒，不发不攻，而犯寒犯热何如？
岐伯曰∶寒热内贼其病益甚。
不当攻发，而用寒热，是为内贼。贼、害也。害则其病益甚。
帝曰∶愿闻无病者，何如？
其人有病，故病益甚，愿闻无病而用寒热何如？
岐伯曰∶无者生之，有者甚之。
无病而犯寒热则病生，故无者生之。有病而犯寒热则病甚，故有者甚之。
帝曰∶生者何如？
所生之病何如？
岐伯曰∶不远热则热至，不远寒则寒至。
热至寒至，病所以生也。
寒至则坚痞，腹满痛急，下利之病生矣。
凡此皆不远寒，而生寒病也。
热至则生热，吐下霍乱，痈疽疮疡，瞀郁注下、 螈肿胀呕，
鼽衄，头痛，骨节变、肉痛血溢血泄、淋 之病生矣。
凡此皆不远热而生热病也。
帝曰治之奈何？岐伯曰∶时必顺之，犯者治以胜也。
治病之法，时必顺之，若违时而犯寒犯热者，仍治以胜也。胜者，犯寒以热治，犯热以寒治也。
帝曰∶妇人重身，毒之何如？
妇人怀孕重身，当犯寒热以毒之，则何如？
岐伯曰∶有故无殒亦无殒也。
有寒热之病，用寒热之毒，谓之有故，有故而用，则无殒减之患。然亦无过用而致殒灭也。
帝曰∶愿闻其故，何谓也？
有故无殒，何谓故也？
岐伯曰∶大积大聚，其可犯也，衰其大半而止，过者死。
有故，内有积聚也。大积大聚，其毒药之可犯也。不过衰其大半而止，若攻之过者，则死矣。
帝曰∶善。郁之甚者，治之奈何？
承无过用之意，谓病之过者，或可过用，故谓郁之甚者，治之奈何。
岐伯曰∶木郁达之，火郁发之，土郁夺之，金郁泄之，水郁折之。然调其气，过者折
之，以其畏也。所谓泻之。
水郁折之，旧本误析今改。五行之气贵得其平，故木郁则达之，达，通达也。火郁则发之，发，开
发也。土郁则夺之，夺，裁夺也。金郁则泄之，泄，疏泄也。水郁则析之，析，分析也。虽曰
达之发之夺之泄之析之，然必调其正气，若郁之过者则逆其气而析之，析，析抑也。析之以其有所畏也。
析之而畏，所谓实则泻之也。
帝曰∶假者何如？
真实则泻，若假者何如？
岐伯曰∶有假其气，则无禁也。所谓主气不足，客气胜也。
实者邪气实，原非正气之实也，有假其气即当泻之则无禁也。所谓主气不足，客气胜也。
客气胜，泻之可也。
帝曰∶至哉圣人之道，天地大化，营运之节，临御之纪，阴阳之政，寒暑之令，非
夫子孰能通之。请藏之灵兰之室，署曰《六元正纪》。非斋戒不敢示，慎传也。
圣人之道，惟圣人能通之，故当藏密其旨，不敢轻示，此天地之营运，阴阳之临御，寒暑之往
来，千百世而无传人也。运气之理，不綦至微而难测欤。
如果体内正气虚弱，就会出现惊恐疑惑、怕冷、颤抖、胡言乱语等症状。太阴肺脏的天之气，不能将水津布散到全身，就会导致胸腹满闷。少阳三焦之气不能正常游行出入，就会引发惊躁、神志昏蒙以及突发的疾病。阳明大肠主管津液所生的疾病，如果津液虚寒，就会发生鼻流清涕（鼻鼽）。阳明胃经的脉道向下经过髀关穴，抵达伏兔穴，下行至膝盖髌骨中，再沿小腿外侧下行，到达足背。因此，尻部、阴部、大腿、膝盖、小腿和足部都会发病。太阳经脉夹行于脊柱两侧并抵达腰部，发病时会出现腰痛。这也是六气致病的常规情况。
厥阴风木之气到来时，会导致小便不利且短涩；少阴君火之气到来时，会导致悲伤妄乱及鼻出血。太阴湿土之气到来时，会导致胸腹胀满、霍乱吐泻。少阳相火之气到来时，会导致喉痹、耳鸣、呕吐涌逆。阳明燥金之气到来时，会导致胸痛、皮肤皱裂。太阳寒水之气到来时，会导致睡中出汗（寝汗）和痉挛。这是疾病的常规表现。（注：原文“胸”字，旧本误作“胁”，今改正。“皴”音逡，“痉”音劲。“戾”，指小便排泄不畅的关口。）“缩”，即收缩之意。厥阴肝经进入阴毛中，经过生殖器，发病时会导致小便癃闭，所以厥阴之气到来时表现为小便不利短涩。悲，是悲哀，属于心气虚；妄，是狂妄，属于心气实。脉象虚而兼热则导致鼻衄，脉象虚而兼寒则导致身体收缩。少阴心主血脉，所以少阴之气到来时表现为悲伤妄乱、鼻衄和身体收缩。胸腹胀满是因为上下气机不交，霍乱吐泻是因为上涌下泄。手太阴肺经主上部，足太阴脾经主下部，所以太阴之气到来时表现为胸腹胀满、霍乱吐泻。一阴（厥阴）和一阳（少阳）气结，称为喉痹。手足少阳经脉都从耳后进入耳中，走出耳前。经脉虚弱则耳鸣，少阳枢转不利，则干呕上涌，所以少阳之气到来时表现为喉痹、耳鸣、呕吐涌逆。胸痛，是因为手足阳明经脉不能进入缺盆而下膈。皮肤起皱纹叫“皴”，掀起叫“揭”。皴揭，是指阳明燥气偏胜，皮肤皱裂而掀起。所以阳明之气到来时表现为胸痛、皮肤皴揭。手太阳小肠经主管津液所生的疾病。睡中出汗，是津液虚的表现。足太阳膀胱经主管筋所生的疾病，痉，是筋脉挛急。所以太阳之气到来时表现为睡中出汗、痉挛。这也是六气致病的常规情况。
厥阴之气到来时，表现为胁痛、呕吐泄泻。少阴之气到来时，表现为多言喜笑。太阴之气到来时，表现为身体沉重、浮肿。少阳之气到来时，表现为急性腹泻、抽搐、突然死亡。阳明之气到来时，表现为鼻流清涕、打喷嚏。太阳之气到来时，表现为汗出外泄、小便不通。这是疾病的常规情况。
初生之阳气，起始于厥阴。如果阴极而初阳不能上升，就会导致胁痛、上呕下泄。所以厥阴之气到来时表现为胁痛、呕吐泄泻。语言喜笑，由心所主。心气实则多言喜笑，所以少阴之气到来时表现为多言喜笑。脾气虚湿气盛则身体沉重浮肿，所以太阴之气到来时表现为身体沉重浮肿。注，指洞泄；暴注，指突然发生的洞泄。暴泄如注，则体内的生阳之气不能充盈全身，所以肌肉筋脉抽搐。表里上下气机不交，则会一时性突然死亡，所以少阳之气到来时表现为急性腹泻、抽搐、突然死亡。水津不能固藏则流清涕，以木击金则打喷嚏，所以阳明之气到来时表现为流清涕、打喷嚏。流泄，指汗液外泄；禁止，指小便不行。流泄则津液虚，禁止则小便闭，所以太阳之气到来时表现为汗出外泄、小便不通。这也是六气致病的常规情况。凡此种种，都是六气应时而现，作为六变纪纲的情况就是这样。
凡是这十二种变化，是以德报德，以化报化，以政报政，以令报令。气位高则病在上，气位低则病在下，气在后则病在后，气在前则病在前，气在中则病在中，气在外则病在外，这是位置的常规规律。所以风气偏胜则肢体动摇，热气偏胜则红肿，燥气偏胜则干燥，寒气偏胜则浮肿，湿气偏胜则濡泄，严重时则小便闭塞、浮肿。随着气所在部位的不同，来论述其病变而已。
总结上文六正六变的含义，正变皆属六气之常，所以说“凡此十二变者”。上文两次提到德化之常，所以说“报德以德”，意思是报复的德基于先前施加的德。一次提到司化之常，一次提到气化之常，所以说“报化以化”，意思是报复的化基于先前施加的化。一次提到布政之常，所以说“报政以政”，意思是报复的政基于先前颁布的政。这是总结上文六化之正。上文六气的变化，变而为病。讲疾病常规的有四处，讲气变常规的有一处，讲令行常规的有一处。所以说“报令以令”，意思是报复的令基于先前施行的令。其气变之常、发病之常，乃是火、水、金、木、土、火这六气变而为病。火位居高，所以说“气高则高”，意思是火变则导致火病。水位居下，所以说“气下则下”，意思是水变则导致水病。金位居后，所以说“气后则后”，意思是金变则导致金病。木位居前，所以说“气前则前”，意思是木变则导致木病。土位居中，所以说“气中则中”，意思是土变则导致土病。火居高且位外，所以说“气外则外”，也是火变则导致火病。火、水、木、金、土、火六气有高、下、前、后、中、外的位置，这是位置的常规。这是总结上文六气之变。《阴阳应象大论》说：“风胜则动，热胜则肿，燥胜则干，寒胜则浮，湿胜则濡泄。”引用这段话是为了说明风、热、燥、寒、湿之气偏胜于上，则人身经脉出现动摇、红肿、干燥、浮肿、濡泄等病变，甚至土气不行，导致水液闭塞、浮肿。这是随着六气所在部位来论述其变而为病的情况。
上文岐伯说有化、有变、有胜、有复、有用、有病，征候各不相同。现在六气的化、六气的变、六气的胜、六气的复、六气的病都已明确说明，但六气的作用尚未完全明白其旨意，所以黄帝发问。
岐伯说：六气的作用，各自归于其所不胜之气而产生生化作用。所以太阴的雨化，作用于太阳。太阳的寒化，作用于少阴。少阴的热化，作用于阳明。阳明的燥化，作用于厥阴。厥阴的风化，作用于太阴。命名并指定其所在的气，以此来验证它。
“不胜”，指受其制约。“不胜而为化”，犹如说“制则生化”。六气的作用，以制约化为先。所以各自归于其所不胜之气而产生生化作用。例如太阴雨化，属土，作用于太阳（水），则是土制约水，而土的金德生水，这就是“不胜而为化”。太阳寒化，属水，作用于少阴（火），则是水制约火，而水之子木又复生火。少阴热化，属火，作用于阳明（金），则是火制约金，而火之子土又复生金。阳明燥化，属金，作用于厥阴（木），则是金制约木，而金之子水又复生木。厥阴风化，属木，作用于太阴（土），则是木制约土，而木之子火又复生土。这些都是“不胜而为化”。六气合五行，这里不言少阳，是因为少阳同于少阴。这种“不胜为化”，就是六气的作用。想要验证其作用，就命名并指定其所在的气来验证。例如太阴之气在长夏，太阳之气在冬季，少阴之气在夏季，阳明之气在秋季，厥阴之气在春季，就是这样。
黄帝说：如果各得其本位，会怎样？
指定其所在，就是自得其位，所以问自得其位会怎样？
岐伯说：自得其位，是正常的生化。
自得其位，就是得到四时六气的正常生化。
黄帝说：希望了解它们的具体位置。
黄帝想详细明了所在的位置，所以再次发问。
岐伯说：确定其位置，就可以知道对应的方位和月份了。
确定其位置，就是确定六气的位置。方位和月份方面：厥阴之位，在东北方，对应正月、二月；少阴之位，在东南方，对应三月、四月；太阴之位，在西南方，对应五月、六月；少阳之位，在正南方，对应七月、八月；阳明之位，在西北方，对应九月、十月；太阳之位，在正北方，对应十一月、十二月。确定其位置而知道其方位月份，那么六气的作用就更加可知了。
黄帝说：六位的运气，盈虚情况如何？
六位之气有盛衰，所以问盈虚情况如何。
岐伯说：太少不同。太过之气到来缓慢而持久，不及之气到来急促而短暂。
岁运阳年为太（太过），太则六位之气盈（盛）；阴年为少（不及），少则六位之气虚（衰）。这是太少的差异，而有盈虚之分。太主气盈，所以太过之气到来，其气舒缓而有常度。少主气虚，所以不及之气到来，其气急促而无常度。这是阐明位气的盈虚情况。
黄帝说：天地之气的盈虚情况如何？
六位之气主管十二月，而天地一年的运气，盈虚情况如何？
岐伯说：天气不足，地气随之；地气不足，天气从之。五运居于其中，且常常领先。厌恶其所不胜之气，归附与其相同和谐之气，随着五运的归从而产生疾病。所以上方胜则天气下降，下方胜则地气迁升。多少而有差数，轻微的差数小，严重的差数大。严重到极点则位置改变、气机相交，位置改变则大变发生而疾病发作。大要说：甚纪五分，微纪七分，其差数可见，说的就是这个道理。
“分”，读去声。天干乙、丁、己、辛、癸主不足，地支丑、卯、巳、未、酉、亥主不足。干支配合，有余则皆有余，不足则皆不足。所以天干之气不足，则地支之地气也随之下沉。地支之地气不足，则天干之天气也从之。地支主六气，天干化五运。五运居中，所以运居于中，且常常为六气之先导。不足之年，先郁结后复气。先郁结则厌恶其所不胜，后复气则归附与其同和之气。五运居中，随着五运的归从而产生民众的疾病。这是讲天气地气因不足而导致的虚。岁半之前，司天之气主事，上方胜，是司天之气有余。所以上方胜则有余的天气下降而盛大。下降下沉的，流于岁半之后的复气。岁半之后，在泉之气主事，下方胜，是在泉之气有余。所以下方胜则有余的地气迁升而上行。迁升上行的，移于岁半之前的时段。其上下所胜之气有多少而差其分，胜之轻微者差数小，胜之严重者差数大。严重到极点则位置改变、气机相交。如上胜则易四之气而归于上，下胜则易三之气而归于下，位置改变则大变发生，而民众疾病发作。揆度其微甚的大要，就说甚纪五分，谓五分在于本位，而五分降迁。微纪七分，谓七分在于本位，而三分降迁。五分七分则其差数可见。即此所谓多少而差其分。这是讲上胜下胜，因有余而导致的盈。如此推演，则天地之盈虚就可以知道了。
黄帝说：好。医论说，热无犯热，寒无犯寒。我想要不用远避寒热的方法，该怎么办？
天地盈虚的道理既然明白了，黄帝对此表示赞许。上文岐伯说用热远热、用寒远寒，意思是不触犯。黄帝引用其话并说我想用寒用热，实际用力而不远避，该怎么办？
岐伯说：问得很详尽啊！发表（解表）不远离热药，攻里（泻下）不远离寒药。
时令当热，寒邪在表，用辛热之药以发散，这是发表而不远离热药。
时令当寒，热邪在里，用寒凉泄下之药以攻逐，这是攻里而不远离寒药。
不当攻发，而用寒热，是为内贼。贼，害也。害则病情更加严重。
黄帝说：希望了解没有病的人，会怎样？
人有病，所以病情加重，希望了解没有病而用寒热药会怎样？
无病而触犯寒热则生病，所以无者生之。有病而触犯寒热则病重，所以有者甚之。
黄帝说：生了什么病？
所生的病是什么样？
岐伯说：不远热则热邪至，不远寒则寒邪至。
热至寒至，是生病的原因。
凡此皆是不远寒而生寒病。
热邪至则生热病，出现呕吐、下利、霍乱、痈疽疮疡、神志昏蒙郁滞、泄泻不止、抽搐、肿胀、呕吐、鼻流清涕、鼻衄、头痛、骨节变形、肌肉疼痛、血溢、血泄、淋证等疾病。
凡此皆是不远热而生热病。
黄帝说：怎么治疗？岐伯说：治病必须顺应时令，触犯寒热的，用克制之法治疗。胜者，犯寒用热治，犯热用寒治。
黄帝说：孕妇怀孕，用毒药治疗会怎样？
妇人怀孕，当触犯寒热而用毒药治疗，会怎样？
岐伯说：有故无殒，亦无殒也。
有寒热之病，用寒热之毒，叫做“有故”。有故而用药，则母体无损伤之患。然而也不能过用而导致胎儿殒灭。
黄帝说：希望了解其中的缘故，什么叫“有故”？
有故无殒，什么叫故？
岐伯说：大积大聚，可以触犯，但病势衰减大半就要停止，过度攻伐会导致死亡。
有故，指内有积聚。大积大聚，可以用毒药攻伐。但不超过病势衰减大半就停止，如果攻伐过度，则会导致死亡。
承接不过用的意思，谓病之过者，或许可以过用，所以问郁结严重的怎么治疗。
岐伯说：木郁达之，火郁发之，土郁夺之，金郁泄之，水郁折之。然而要调顺其气，过者折之，因其有所畏惧。这就是所谓的泻法。
“水郁折之”，旧本误作“析”，今改正。五行之气贵在平衡，所以木郁则达之，达，通达也。火郁则发之，发，开发也。土郁则夺之，夺，裁夺也。金郁则泄之，泄，疏泄也。水郁则折之，折，抑制也。虽然说是达之、发之、夺之、泄之、折之，但必须调顺正气，如果郁结过甚者，则逆其气而折之，折，抑止也。折之是因为其有所畏。折之而畏，就是所谓的“实则泻之”。
黄帝说：假证怎么样？
真实证则泻，如果是假证怎么样？
实者是邪气实，原本不是正气实。有假其气就当泻之，没有禁忌。所谓主气不足，客气胜也。客气胜，泻之是可以的。
黄帝说：真是伟大啊，圣人的道！天地的大化，营运的节律，临御的纲纪，阴阳的政令，寒暑的命令，如果不是先生谁能通晓？请将其藏在灵兰之室，署名为《六元正纪》。非斋戒不敢示人，慎重传承。
圣人的道，只有圣人能通晓，所以应当保密其旨意，不敢轻易示人。这是天地之营运，阴阳之临御，寒暑之往来，千百世而无传人。运气之理，不是很精微难测吗？
If the interior is deficient, there will be fright and confusion, aversion to cold, tremors, and delirious speech. The Heavenly Qi of Taiyin Lung cannot distribute its water fluids throughout the body, resulting in fullness. The Qi of Shaoyang Sanjiao cannot circulate freely in and out, leading to restlessness, mental clouding, and sudden illness. Yangming Large Intestine governs diseases arising from body fluids; when body fluids are deficient and cold, it results in rhinorrhea (runny nose). The Yangming Stomach meridian descends through Bituan (ST31), reaches Futu (ST32), goes down to the middle of the knee patella, follows the lateral aspect of the lower leg, and descends to the dorsum of the foot. Therefore, the sacrum, yin region, thigh, knee, leg, and foot all become diseased. The Taiyang meridian runs alongside the spine and reaches the waist; when diseased, it causes lower back pain. This is also the normal pattern of disease caused by the Six Qi.
When Jueyin arrives, it manifests as strangury with incomplete emptying; when Shaoyin arrives, it manifests as sorrow and madness, along with epistaxis. When Taiyin arrives, it manifests as central fullness, cholera-like vomiting and diarrhea. When Shaoyang arrives, it manifests as throat obstruction, tinnitus, and retching/vomiting. When Yangming arrives, it manifests as chest pain and skin cracking/peeling. When Taiyang arrives, it manifests as nocturnal sweating and spasms. These are the normal manifestations of disease. (Note: "Chest" in the original text was erroneously recorded as "hypochondrium" in old editions and has been corrected here. "Cun" [cracking] is pronounced qūn; "Jing" [spasm] is pronounced jìng. "Li" refers to the gate where urine flows.) "Suo" means contraction/shrinking. The Jueyin Liver meridian enters the pubic region and passes through the genitalia; when diseased, it causes urinary retention, hence Jueyin arrival manifests as strangury. Sorrow indicates sadness due to Heart Qi deficiency; madness indicates unruliness due to Heart Qi excess. A deficient pulse with heat leads to epistaxis; a deficient pulse with cold leads to contraction. Shaoyin Heart governs the vessels, so Shaoyin arrival manifests as sorrow, madness, epistaxis, and contraction. Central fullness occurs because upper and lower Qi do not interact; cholera vomiting and diarrhea occur because Qi surges upward and downward. Hand Taiyin Lung governs the upper, Foot Taiyin Spleen governs the lower, so Taiyin arrival manifests as central fullness and cholera vomiting/diarrhea. One Yin (Jueyin) and One Yang (Shaoyang) knotting together is called throat obstruction. The Hand and Foot Shaoyang meridians both enter the ear from behind, exit before the ear. Deficiency of the meridians causes tinnitus; unfavorable pivot function of Shaoyang causes dry retching and surging vomit, so Shaoyang arrival manifests as throat obstruction, tinnitus, and retching. Chest pain occurs because the Hand and Foot Yangming meridians cannot enter the Clavicular fossa (Quepen) and descend through the diaphragm. Skin wrinkling is called "cun"; lifting/peeling is called "jie". Cun-jie refers to Yangming Dryness prevailing, causing skin to wrinkle and peel. Thus, Yangming arrival manifests as chest pain and skin cracking. Hand Taiyang Small Intestine governs diseases arising from fluids. Nocturnal sweating indicates fluid deficiency. Foot Taiyang Bladder governs diseases arising from sinews; Jing refers to sinew spasm. Thus, Taiyang arrival manifests as nocturnal sweating and spasms. This is also the normal pattern of disease caused by the Six Qi.
When Jueyin arrives, it manifests as hypochondriac pain, vomiting, and diarrhea. When Shaoyin arrives, it manifests as talking and laughing. When Taiyin arrives, it manifests in heaviness and edema. When Shaoyang arrives, it manifests as acute diarrhea, convulsions, and sudden death. When Yangming arrives, it manifests as rhinorrhea and sneezing. When Taiyang arrives, it manifests as profuse sweating and urinary retention. These are the normal manifestations of disease.
The initial Yang Qi originates from Jueyin. If Yin reaches its extreme and initial Yang fails to ascend, it causes hypochondriac pain, upper vomiting, and lower diarrhea. Hence, Jueyin arrival manifests as hypochondriac pain, vomiting, and diarrhea. Speech and laughter are governed by the Heart. Excess Heart Qi leads to excessive talking and laughing, so Shaoyin arrival manifests as talking and laughing. Spleen Qi deficiency with dampness excess causes bodily heaviness and edema, so Taiyin arrival manifests in heavy limbs and edema. Zhu refers to clear diarrhea; Bao-zhu refers to sudden clear diarrhea. Sudden diarrhea like a torrent means the generating Yang Qi cannot fill the body, causing muscle and sinew convulsions. Lack of interaction between interior/exterior and upper/lower leads to sudden death at one time, so Shaoyang arrival manifests as acute diarrhea, convulsions, and sudden death. Failure to store water fluids leads to rhinorrhea; striking metal with wood causes sneezing, so Yangming arrival manifests as rhinorrhea and sneezing. Liu-xie refers to sweat leaking externally; Jin-zhi refers to urinary blockage. Leakage leads to fluid deficiency; blockage leads to urinary closure, so Taiyang arrival manifests as sweating and urinary retention. This is also the normal pattern of disease caused by the Six Qi. All these cases illustrate how the Six Qi appear according to their season, serving as the chronicle of the Six Changes.
Regarding these twelve changes, virtue is repaid with virtue, transformation with transformation, administration with administration, and decree with decree. High Qi results in high pathology; low Qi results in low pathology; posterior Qi results in posterior pathology; anterior Qi results in anterior pathology; central Qi results in central pathology; external Qi results in external pathology. This is the normal order of positions. Therefore, Wind excess causes movement; Heat excess causes swelling; Dryness excess causes dryness; Cold excess causes floating/edema; Dampness excess causes loose stools; severe cases lead to urinary retention and edema. Depending on where the Qi resides, one describes its variations.
Summarizing the meaning of the Six Regularities and Six Changes above: both regularity and change belong to the Six Qi, which is constant, hence "these twelve changes." The text mentioned the constancy of Virtue and Transformation twice, hence "repaying virtue with virtue," meaning the retribution of virtue is based on the virtue previously exerted. It mentioned the constancy of governing transformation and qi transformation once each, hence "repaying transformation with transformation," meaning the retribution of transformation is based on the transformation previously exerted. It mentioned the constancy of administering policy once, hence "repaying administration with administration," meaning the retribution of administration is based on the policy previously administered. This concludes the six regular transformations. The changes of the Six Qi above transform into disease. Four instances describe the constancy of disease, one instance describes the constancy of qi change, and one instance describes the constancy of decree execution. Hence "repaying decree with decree," meaning the retribution of decree is based on the decree previously executed. The constancy of qi change and disease manifestation involves Fire, Water, Metal, Wood, Earth, and Fire transforming into disease. Fire occupies the high position, hence "High Qi results in high pathology," meaning Fire change leads to Fire disease. Water occupies the low position, hence "Low Qi results in low pathology," meaning Water change leads to Water disease. Metal occupies the rear position, hence "Posterior Qi results in posterior pathology," meaning Metal change leads to Metal disease. Wood occupies the front position, hence "Anterior Qi results in anterior pathology," meaning Wood change leads to Wood disease. Earth occupies the center, hence "Central Qi results in central pathology," meaning Earth change leads to Earth disease. Fire is high and external, hence "External Qi results in external pathology," also meaning Fire change leads to Fire disease. The Six Qi (Fire, Water, Wood, Metal, Earth, Fire) have positions of high, low, front, rear, center, and external, which is the normal order. This concludes the discussion on the changes of the Six Qi. *Yin Yang Ying Xiang Da Lun* states: "Wind excess causes movement, Heat excess causes swelling, Dryness excess causes dryness, Cold excess causes floating, Dampness excess causes loose stools." This citation clarifies that when Wind, Heat, Dryness, Cold, and Dampness prevail superiorly, the human meridians exhibit movement, swelling, dryness, floating, and loose stools, potentially leading to Earth Qi stagnation, water retention, and edema. This describes disease variation based on the location of the Six Qi.
The Yellow Emperor said: I wish to hear about their application.
Earlier, Qibo stated there are transformation, change, excess, counteraction, application, and disease, with different signs. Now, the transformation, change, excess, counteraction, and disease of the Six Qi are clearly explained, but the application of the Six Qi remains unclear in principle, so the Emperor asks.
Qibo said: The application of the Six Qi returns to what they cannot overcome to generate transformation. Thus, the Rain Transformation of Taiyin acts upon Taiyang. The Cold Transformation of Taiyang acts upon Shaoyin. The Heat Transformation of Shaoyin acts upon Yangming. The Dryness Transformation of Yangming acts upon Jueyin. The Wind Transformation of Jueyin acts upon Taiyin. Naming and assigning their locations serves to verify them.
"Cannot overcome" means being controlled. "Transformation through inability to overcome" is akin to saying "control generates transformation." The application of the Six Qi prioritizes control and transformation. Thus, each returns to what it cannot overcome to generate transformation. For example, Taiyin Rain Transformation belongs to Earth; acting upon Taiyang (Water) means Earth controls Water, and the Metal virtue of Earth generates Water; this is transformation through inability to overcome. Taiyang Cold Transformation belongs to Water; acting upon Shaoyin (Fire) means Water controls Fire, and the Wood child of Water regenerates Fire. Shaoyin Heat Transformation belongs to Fire; acting upon Yangming (Metal) means Fire controls Metal, and the Earth child of Fire regenerates Metal. Yangming Dryness Transformation belongs to Metal; acting upon Jueyin (Wood) means Metal controls Wood, and the Water child of Metal regenerates Wood. Jueyin Wind Transformation belongs to Wood; acting upon Taiyin (Earth) means Wood controls Earth, and the Fire child of Wood regenerates Earth. All these are transformations through inability to overcome. The Six Qi combine with the Five Elements; Shaoyang is not mentioned separately because it is identical to Shaoyin. This "transformation through inability to overcome" is the application of the Six Qi. To verify this application, one names and assigns the residing Qi for verification. For instance, Taiyin Qi is in late summer, Taiyang Qi in winter, Shaoyin Qi in summer, Yangming Qi in autumn, and Jueyin Qi in spring.
The Yellow Emperor said: What if they obtain their own positions?
Assigning their location is obtaining one's own position, so he asks what happens when they obtain their own positions.
Qibo said: Obtaining one's own position is the normal transformation.
Obtaining one's own position means obtaining the normal transformation of the four seasons and Six Qi.
The Yellow Emperor said: I wish to know their specific locations.
The Emperor wishes to clarify the specific locations, so he asks again.
Qibo said: Assigning their positions allows one to know the directions and months.
Assigning positions means assigning the positions of the Six Qi. Regarding directions and months: Jueyin is in the Northeast, corresponding to the 1st and 2nd months; Shaoyin is in the Southeast, corresponding to the 3rd and 4th months; Taiyin is in the Southwest, corresponding to the 5th and 6th months; Shaoyang is in the South, corresponding to the 7th and 8th months; Yangming is in the Northwest, corresponding to the 9th and 10th months; Taiyang is in the North, corresponding to the 11th and 12th months. By assigning positions and knowing directions and months, the application of the Six Qi becomes even more understandable.
The Yellow Emperor said: How are the fullness and emptiness of the Qi in the six positions?
The Qi in the six positions has prosperity and decline, so he asks about fullness and emptiness.
Qibo said: Tai and Shao differ. The arrival of Tai (Excess) is slow and constant; the arrival of Shao (Deficiency) is sudden and fleeting.
Yearly movements of Yang years are Tai (Excess); Tai means the Qi of the six positions is full/prosperous. Yin years are Shao (Deficiency); Shao means the Qi of the six positions is empty/declining. This difference between Tai and Shao results in fullness and emptiness. Tai governs Qi fullness, so the arrival of Tai is slow and constant, meaning the Qi is leisurely and regulated. Shao governs Qi deficiency, so the arrival of Shao is sudden and fleeting, meaning the Qi is hurried and unregulated. This clarifies the fullness and emptiness of positional Qi.
The Yellow Emperor said: How is the fullness and emptiness of Heaven and Earth Qi?
The Qi of the six positions governs twelve months, but what is the fullness and emptiness of Heaven and Earth Qi over a year?
Qibo said: When Heaven Qi is insufficient, Earth Qi follows; when Earth Qi is insufficient, Heaven Qi complies. Yun (Movement) resides in the middle and often precedes. It dislikes what it cannot overcome and returns to what is harmonious with it, generating disease following the Yun's return. Thus, Superior Excess causes Heaven Qi to descend; Inferior Excess causes Earth Qi to migrate upward. There are differences in degree; minor differences are small, major differences are large. Severe cases involve position exchange and Qi intersection; when positions change, great changes arise and disease occurs. The general rule states: Severe cases show a five-part difference, minor cases show a seven-part difference; the difference is visible. This is what is meant.
"Fen" is pronounced with the departing tone. Heavenly Stems Yi, Ding, Ji, Xin, Gui indicate insufficiency; Earthly Branches Chou, Mao, Si, Wei, You, Hai indicate insufficiency. Stem-branch combinations: if surplus, all are surplus; if insufficient, all are insufficient. Thus, if Heavenly Stem Qi is insufficient, Earthly Branch Earth Qi follows suit. If Earthly Branch Earth Qi is insufficient, Heavenly Stem Heaven Qi complies. Earthly Branches govern Six Qi; Heavenly Stems transform Five Yun. Five Yun are in the middle, so Yun resides in the middle and often precedes the Six Qi. In years of insufficiency, there is first stagnation then counteraction. First stagnation dislikes what it cannot overcome; later counteraction returns to what is harmonious. Five Yun reside in the middle, generating public disease following the Yun's return. This discusses insufficiency of Heaven and Earth Qi leading to emptiness. Before mid-year, Si Tian (Guest Heaven) Qi governs; Superior Excess means Si Tian Qi is surplus. Thus, Superior Excess causes surplus Heaven Qi to descend greatly. Descending sinks into the counteraction after mid-year. After mid-year, Zai Quan (Guest Earth) Qi governs; Inferior Excess means Zai Quan Qi is surplus. Thus, Inferior Excess causes surplus Earth Qi to migrate upward. Migrating upward shifts to the period before mid-year. The amount of Superior/Inferior excess varies; minor excess has small difference, major excess has large difference. Severe cases involve position exchange and Qi intersection. E.g., Superior Excess exchanges the 4th Qi to return to the top; Inferior Excess exchanges the 3rd Qi to return to the bottom. Position change brings great changes, and public disease arises. Estimating the major/minor difference: Severe case implies five parts remain in original position, five parts descend/migrate. Minor case implies seven parts remain, three parts descend/migrate. The five or seven parts make the difference visible. This discusses Superior/Inferior Excess leading to fullness due to surplus. Deduced thus, the fullness and emptiness of Heaven and Earth can be known.
The Yellow Emperor said: Excellent. The treatise says, "Do not violate Heat with Heat, do not violate Cold with Cold." I wish to use Cold and Heat without avoiding them. How should I proceed?
Having clarified the principles of Heaven and Earth fullness/emptiness, the Emperor approves. Earlier, Qibo said "Use Heat far from Heat, Use Cold far from Cold," meaning do not violate. The Emperor cites this and asks how to use Cold and Heat effectively without avoidance.
Qibo said: Your question is thorough! For releasing the exterior, do not avoid Heat; for attacking the interior, do not avoid Cold.
When the season is hot but Cold pathogen is in the exterior, using acrid-hot herbs to release is "releasing the exterior without avoiding Heat."
When the season is cold but Heat pathogen is in the interior, using cold-purgative herbs to attack is "attacking the interior without avoiding Cold."
The Yellow Emperor said: What if one neither releases nor attacks, but violates Cold and Heat?
Violating Heat in release, violating Cold in attack—what if one does neither release nor attack, but violates Cold and Heat?
Qibo said: Cold and Heat becoming internal thieves will worsen the disease.
Using Cold/Heat when attack/release is inappropriate constitutes an internal thief. Thief means harm. Harm leads to worsening disease.
The Yellow Emperor said: What about those without disease?
Those with disease worsen; I wish to know what happens to those without disease who use Cold/Heat.
Qibo said: For those without disease, it generates disease; for those with disease, it exacerbates it.
Using Cold/Heat without disease generates illness, hence "generates for the healthy." Using Cold/Heat with disease worsens illness, hence "exacerbates for the sick."
The Yellow Emperor said: What kind of disease is generated?
What is the nature of the generated disease?
Qibo said: Not avoiding Heat leads to Heat arrival; not avoiding Cold leads to Cold arrival.
Heat/Cold arrival is the cause of disease generation.
Cold arrival leads to hardness, masses, abdominal fullness, pain, urgency, and diarrhea. All these are Cold diseases generated by not avoiding Cold.
Heat arrival leads to Heat diseases: vomiting, diarrhea, cholera, carbuncles, ulcers, mental clouding/depression, continuous diarrhea, convulsions, swelling, vomiting, rhinorrhea, epistaxis, headache, bone/joint deformation, muscle pain, hemorrhage, bloody stool, strangury. All these are Heat diseases generated by not avoiding Heat.
The Yellow Emperor said: How to treat? Qibo said: Treatment must conform to the season. Those who violate Cold/Heat should be treated with the conquering method. Conquering means treating Cold violation with Heat, and Heat violation with Cold.
The Yellow Emperor said: What about pregnant women using toxic drugs?
For pregnant women, what happens if one uses toxic drugs to violate Cold/Heat?
Qibo said: "You Gu Wu Yun, Yi Wu Yun Ye."
"You Gu" means having a specific pathology (e.g., Cold/Heat disease). Using toxic Cold/Heat drugs for this pathology is "You Gu." With a cause, there is no miscarriage/harm to the mother. However, one must not overuse to the point of fetal death.
The Yellow Emperor said: Explain the reason. What is "Gu"?
What is "Gu" in "You Gu Wu Yun"?
Qibo said: Major accumulations and masses can be attacked, but stop when the pathogen is reduced by more than half. Over-treatment leads to death.
"You Gu" refers to internal accumulation. Major accumulations/masses can be treated with toxic drugs. Stop when the pathogen is reduced by more than half; over-treatment leads to death.
The Yellow Emperor said: Excellent. How to treat severe stagnation?
Continuing the idea of non-overuse, implying that for severe cases, overuse might be considered, he asks how to treat severe stagnation.
Qibo said: For Wood stagnation, promote it; for Fire stagnation, vent it; for Earth stagnation, drain it; for Metal stagnation, disperse it; for Water stagnation, restrain it. However, regulate the Qi. For excess, restrain it because it fears something. This is called purging.
"Shui Yu Zhe Zhi" was erroneously written as "Xi" in old editions; corrected here. The Qi of the Five Elements values balance. Wood stagnation is promoted (Da, meaning unblocked); Fire stagnation is vented (Fa, meaning opened); Earth stagnation is drained (Duo, meaning cut off/reduced); Metal stagnation is dispersed (Xie, meaning cleared); Water stagnation is restrained (Zhe, meaning suppressed). Although termed Da, Fa, Duo, Xie, Zhe, one must regulate Zheng Qi. For severe stagnation, reverse the Qi and suppress it (Zhe, meaning suppression). Suppression works because the pathogen fears certain treatments. Suppression inducing fear is "Purging Excess."
The Yellow Emperor said: What about false conditions?
True excess is purged; what about false conditions?
Qibo said: If there is false Qi, there are no prohibitions. This refers to Host Qi deficiency and Guest Qi excess.
True excess is Pathogenic Qi excess, not Healthy Qi excess. If there is false Qi, purging is permissible without prohibition. This refers to Host Qi deficiency and Guest Qi excess. Guest Qi excess can be purged.
The Yellow Emperor said: Great indeed is the Way of the Sage! The great transformation of Heaven and Earth, the rhythm of operation, the discipline of governance, the politics of Yin and Yang, the commands of Cold and Heat—if not for you, Master, who could understand them? Please hide this in the Linglan Chamber, titled "Liu Yuan Zheng Ji." I dare not show it unless fasting and purified. Pray transmit it cautiously.
The Way of the Sage is understood only by sages; thus, its essence must be kept secret and not lightly shown. This concerns the operation of Heaven and Earth, governance of Yin and Yang, and cycle of Cold and Heat, which may lack successors for thousands of generations. Is the theory of Yun Qi not extremely subtle and hard to fathom?