偏枯，汗出见湿，乃生痤痱。膏粱之变，足生大疔。受如持虚，劳汗当风，寒薄为 ，
郁乃痤（王注云∶菀，积也。 曰粉刺，形如米如针也。痤，小疖也）。阳气者，精则养神，
柔则养筋，开阖不得，寒气从之，乃生大偻。荣气不从，逆于肉理，乃生痈肿。陷脉为 ，
留连肉腠， 气化薄，传为善畏，及为惊骇（“荣气不从，逆于肉理，乃生痈肿”十二字，
旧本元误在“及为惊骇”之下。夫阳气因失卫而寒气从之为偻，然后荣气逆而为痈肿，痈肿
失治然后陷脉为 ，而陷留连于肉腠焉。偻，力主切，背俯不能仰也）。魄汗未尽，形弱而
气烁，穴俞以闭，发为风疟。故风者百病之始也，清净则肉腠闭拒，虽有大风苛毒，弗之能
害，此因时之序也。故病久则传化，上下不并，良医弗为。故阳蓄积病死，而阳气当隔，隔
者当泻，不亟正治，粗乃败之。（《生气通天论》）
帝曰∶余知百病生于气也。怒则气上。喜则气缓，悲则气消，恐则气下，寒则气收，炅
则气泄，惊则气乱，劳则气耗，思则气结，九气不同，何病之生？岐伯曰∶怒则气逆，甚则
呕血及飧泄，故气上矣。喜则气和志达，荣卫通利，故气缓矣。悲则心系急，肺布叶举，而
上焦不通，荣卫不散，热气在中，故气消矣。恐则精却，却则上焦闭，闭则气还，还则下焦
胀，故气不行矣。寒则腠理闭，气不行，故气收矣。炅则腠理开，荣卫通，汗大泄，故气泄
矣。惊则心无所倚，神无所归，虑无所定，故气乱矣。劳则喘息汗出，外内皆越，故气耗矣
。思则心有所存，神有所归，正气留而不行，故气结矣。（《举痛篇》）
年四十而阴气自半也，起居衰矣。（《阴阳应象论》）
阴气者，静，则神藏；躁，则消亡，饮食自倍，肠胃乃伤。（《痹论》）
阴之所生，本在五味。阴之五宫，伤在五味。（《生气通天论》）
〔垣〕《劳倦所伤论》《调经篇》云∶阴气生内热。岐伯曰∶有所劳倦，形气衰少，谷
气不盛，上焦不行，下脘不通，而胃气热，热气熏胸中，故内热。《举痛论》云∶劳则气耗
，劳则喘息汗出，外内皆越，故气耗矣。夫喜怒不节，起居不时，有所劳倦，皆损其气，衰
则火旺，火旺则乘脾土，脾主四肢，故困热，无气以动，懒于语言，动作喘乏，表热自汗，
心烦不安。当病之时，宜安心静坐，以养其气，以甘寒泻其热火，以酸味收其散气，以甘温
调其中气，经言劳者，温之；损者，温之是也。仲景云∶平人脉大为劳，脉极虚亦为劳。夫
劳之为病，其脉浮大，手足烦热，春夏剧，秋冬瘥。脉大者，热邪也。极虚者，气损也。春
夏剧，邪助时也。秋冬瘥，时胜邪也。以黄 建中汤补之，此亦温之也。夫上古圣人，饮食
有节，起居有常，不妄作劳，故能形与神俱，而尽终其天年，度百岁乃去，谓治未病也。中
古以下，去圣久远，饮食失节，起居失宜，妄作劳役，形神俱伤，故病而后以药之，是治已
病也。推其百病之源，皆因饮食劳倦，胃气元气散解，不能滋荣百脉，溉灌脏腑，卫护周身
之所致也。故苍天之气贵清净，阳气恶烦劳，则饮食喜怒之间，寒暑起居之际，可不慎欤。
上东垣《劳倦所伤论》。余论见治虚实法补中益气汤方条。
〔《素》〕夫邪之生也，或生于阴，或生于阳。其生于阳者，得之风雨寒暑；其生于阴者
，得之饮食居处，阴阳喜怒。（《调经论》）
此阴阳以内外言之，而总诸阴阳形气之伤，东垣先生谓内外伤者是也。谓男女饮食喜怒
所伤者，皆属内为阴也，诸寒温风湿所伤，皆属外为阳也。
〔《灵》〕夫百病之始生也，皆生于风雨寒暑，阴阳喜怒，饮食居处，大惊卒恐，则血气
分离，阴阳破散，经络厥绝，脉道不通，阴阳相逆，卫气稽留，经脉空虚，血气不次，乃失
其常。（《口问篇》）
〔《素》〕喜怒伤气，寒暑伤形，暴怒伤阴，暴喜伤阳。厥气上行，满脉去形，喜怒不节
，寒暑过度，生乃不固（《阴阳应象论》）。寒伤形，热伤气，气伤痛，形伤肿，故先痛而后
肿者，气伤形也；先肿而后痛者，形伤气也。（此上二节经旨似自相矛盾，既曰喜怒伤气，
又曰暴怒伤阴，暴喜伤阳；既曰寒暑伤形，又曰寒伤形，热伤气者，何也？盖言虽不一，而
理则有归。夫喜怒之伤人从内出而先发于气，故曰喜怒伤气也。寒暑之伤人从外入而先着于
形，故曰寒暑伤形也。分而言之，则怒之气从下上而先发于阴，故曰暴怒伤阴；喜之气从上
下而先发于阳，故曰暴喜伤阳。寒则人气内藏，气内藏则寒之伤人先着于形，故曰寒伤形。
暑则人气外溢，气外益则暑之伤人先着于气，故曰热伤气也）
偏枯（半身不遂），因出汗时受湿邪侵袭，从而产生痤痱（一种皮肤小疹或汗疹）。过食肥甘厚味会导致病变，足部易生大疔（严重的疔疮）。这种病邪入侵如同持虚器以待物，极易发生；若劳作出汗后当风，寒气迫近肌肤，郁结则形成粉刺（形如米粒、针尖的小疹）和小疖。阳气的作用，在于精微时能滋养精神，柔和时能濡养筋脉。若腠理开阖失常，寒气乘虚而入，就会导致身体严重弯曲（大偻）。营气运行不畅，逆乱于肌肉纹理之间，就会发生痈肿。病邪陷入经脉化为瘘管，滞留流连于肌肉腠理，气化功能受阻，传变导致患者容易恐惧，甚至出现惊骇症状。（注：“营气不从，逆于肉理，乃生痈肿”这十二个字，在旧版书中错误地排在“及为惊骇”之后。实际上，阳气因失去卫外功能而寒气侵入导致偻曲，然后营气逆乱形成痈肿，痈肿失治后病邪陷入经脉化为瘘管，并滞留于肌肉腠理。偻，音lǚ，指背部俯曲不能仰起。）魄汗（夜间盗汗或冷汗）未尽，形体虚弱而气被热邪消烁，穴位俞穴闭塞，发作成为风疟。所以风邪是百病的开端，若能保持清净，则肌肉腠理闭合拒邪，即使有大风苛毒，也不能伤害人体，这是顺应四时次序的结果。如果病程长久，病气会传变转化，上下气机不通，即使是良医也难以治疗。所以阳气蓄积到极点会导致死亡，阳气应当被阻隔，阻隔的情况应当用泻法治疗，如果不及时正确治疗，粗疏的医生就会使病情恶化。（出自《生气通天论》）
黄帝说：我知道百病都生于气的失调。愤怒会使气上逆，喜悦会使气舒缓，悲哀会使气消散，恐惧会使气下陷，寒冷会使气收敛，炎热会使气泄越，惊吓会使气紊乱，劳累会使气耗损，思虑会使气结聚。这九种气机变化不同，会产生什么疾病呢？岐伯回答说：愤怒会使气逆乱，严重时会导致呕血和完谷不化的腹泻，这就是气上的表现。喜悦能使气和顺、志意通达，营卫运行通利，所以气机舒缓。悲哀会使心脉拘急，肺叶张举，导致上焦不通畅，营卫之气不能布散，热气郁结在中焦，所以气被消耗。恐惧会使精气退缩，精气退缩则上焦闭塞，上焦闭塞则气还留于下，气还留于下则下焦胀满，所以气机不行。寒冷使腠理闭塞，气机运行受阻，所以气收敛。炎热使腠理开张，营卫通畅，大汗淋漓，所以气泄越。惊吓使心神无所依托，神志无所归依，思虑无所定夺，所以气机紊乱。劳累使人喘息出汗，内外之气皆向外越出，所以气耗损。思虑使心神有所存守，神志有所归依，正气停留而不行，所以气机结聚。（出自《举痛篇》）
人到四十岁，阴气自然减半，起居能力开始衰退。（出自《阴阳应象论》）
阴气的作用，静则神气内藏，躁动则神气消亡。饮食过量一倍，肠胃就会受伤。（出自《痹论》）
阴精的产生，根本在于五味。主管阴精的五脏，损伤也在于五味。（出自《生气通天论》）
〔李东垣〕在《劳倦所伤论》和《调经篇》中说：阴气受损会产生内热。岐伯说：如果有劳倦过度，形体和气都会衰少，谷气不旺盛，上焦不通畅，下脘不通利，导致胃气发热，热气熏蒸胸中，所以产生内热。《举痛论》说：劳累会使气耗损，劳累使人喘息出汗，内外之气皆向外越出，所以气耗损。如果喜怒没有节制，起居没有规律，加上有劳倦过度，都会损伤人气，气衰则火旺，火旺则克制脾土。脾主四肢，所以人会感到困倦发热，没有力气活动，懒于说话，动作时气喘乏力，体表发热自汗，心烦不安。患病之时，应当安心静坐，以养护其气，用甘寒药物清泻火热，用酸味药物收敛散逸之气，用甘温药物调和其中气。经文说“劳者温之”、“损者温之”正是此意。张仲景说：普通人脉象大为劳病，脉象极虚也是劳病。劳病这种病症，其脉象浮大，手足烦热，春夏季节加重，秋冬季节减轻。脉大，代表有热邪。极虚，代表气受损。春夏加重，是因为时令助长邪气。秋冬减轻，是因为时令克制邪气。可以用黄芪建中汤来补益，这也是“温之”的方法。上古的圣人，饮食有节制，起居有规律，不妄加劳累，所以能形体与精神俱备，尽享天然寿命，活到百岁才离世，这叫治未病。中古以后，距离圣人时代久远，饮食失去节制，起居不合适宜，妄加劳役，导致形体和精神都受伤，所以生病后才用药治疗，这叫治已病。推究百病的根源，都是因为饮食劳倦，导致胃气和元气散失解离，不能滋养荣润百脉，灌溉脏腑，卫护周身所致。所以苍天之气贵在清净，阳气厌恶烦劳，那么在饮食、喜怒之间，寒暑、起居之际，能不谨慎吗？以上引用东垣先生的《劳倦所伤论》。我的其他论述见治虚实法中的补中益气汤方条。
〔《素问》〕邪气的产生，有的生于阴分，有的生于阳分。生于阳分的，是由于风雨寒暑等外感因素；生于阴分的，是由于饮食居处不当，以及阴阳喜怒等内伤因素。（出自《调经论》）
这里所说的阴阳是从内外角度而言的，总括了各种阴阳形气的损伤。东垣先生所说的内外伤就是这种情况。认为男女饮食、喜怒所伤的，都属于内部，为阴；各种寒温风湿所伤的，都属于外部，为阳。
〔《灵枢》〕百病的起始，都生于风雨寒暑、阴阳喜怒、饮食居处，以及大惊卒恐。这些情况会导致血气分离，阴阳破散，经络厥绝，脉道不通，阴阳相逆，卫气稽留，经脉空虚，血气运行无序，从而失去常态。（出自《口问篇》）
〔《素问》〕喜怒损伤气，寒暑损伤形，暴怒损伤阴，暴喜损伤阳。厥气上行，充满脉道，脱离形体，喜怒没有节制，寒暑过度，生命就不稳固（出自《阴阳应象论》）。寒邪伤形，热邪伤气，气伤则痛，形伤则肿。所以先痛后肿的，是气伤及形；先肿后痛的，是形伤及气。（这两段经文旨意看似自相矛盾，既然说喜怒伤气，又说暴怒伤阴、暴喜伤阳；既然说寒暑伤形，又说寒伤形、热伤气，为什么呢？大概说法虽不一，但道理有归宿。喜怒伤人从内发出而先发于气，所以说喜怒伤气。寒暑伤人从外侵入而先着于形，所以说寒暑伤形。分开来说，怒的气从下向上发而先发于阴，所以说暴怒伤阴；喜的气从上向下发而先发于阳，所以说暴喜伤阳。寒冷时人气内藏，气内藏则寒邪伤人先着于形，所以说寒伤形。暑热时人气外溢，气外溢则暑邪伤人先着于气，所以说热伤气）
Hemiplegia (bi-limb paralysis), occurring when sweat is exposed to dampness, leads to the generation of *cuo fei* (acne miliaris/sweat rash). Changes resulting from a diet rich in rich and sweet foods can cause large *ding* (severe carbuncles) to grow on the feet. Pathogenic invasion in this state is like holding an empty vessel; if wind strikes while laboring and sweating, cold constrains the skin, leading to stagnation and the formation of acne vulgaris (described by Wang Bing as accumulation; resembling rice grains or needles, small pustules) and small boils. The Yang Qi, when refined, nourishes the Shen (Spirit); when soft and flexible, it nourishes the Jin (Tendons/Sinews). If the opening and closing of the pores are dysfunctional, Cold Qi enters with it, resulting in severe kyphosis (*da lou*). If Ying Qi (Nutritive Qi) does not flow smoothly and rebels within the muscle tissue, abscesses and swellings occur. Pathogens sinking into the meridians form fistulas, lingering in the muscle layers; when Qi transformation is constrained, it transmits to cause excessive fear and惊骇 (startle/panic). (Note: The twelve characters "Ying Qi does not flow smoothly, rebels within the muscle tissue, resulting in abscesses and swellings" were erroneously placed after "and startle/panic" in older editions. In reality, Yang Qi loses its defensive function, allowing Cold to enter causing kyphosis; then Ying Qi rebels causing abscesses; untreated abscesses allow pathogens to sink into meridians forming fistulas that linger in the muscle layers. *Lou*, pronounced lǚ, refers to the back being bent forward and unable to straighten.) When Po Han (night sweats or cold sweats) are not fully resolved, the body becomes weak and Qi is scorched by heat; acupoints and Shu points become blocked, triggering Feng Nue (Wind Malaria). Therefore, Wind is the beginning of all diseases. If one maintains purity and stillness, the muscle texture closes and resists pathogens; even strong winds and severe toxins cannot harm the body, which is following the order of the seasons. If a disease persists for a long time, it transforms and spreads; if the upper and lower Jiao do not communicate, even a good physician cannot help. Thus, excessive accumulation of Yang Qi leads to death; Yang Qi should be unblocked, and blockage requires purgation. Without prompt correct treatment, incompetent physicians will worsen the condition. (From *Sheng Qi Tong Tian Lun*)
The Emperor said: I know that all diseases arise from Qi dysfunction. Anger causes Qi to rise upward; Joy causes Qi to relax; Sorrow causes Qi to dissipate; Fear causes Qi to sink downward; Cold causes Qi to contract; Heat causes Qi to leak out; Startle causes Qi to become chaotic; Labor causes Qi to be exhausted; Thought causes Qi to knot. These nine Qi changes differ; what diseases do they produce? Qibo replied: Anger causes Qi to rebel; severely, it leads to vomiting blood and undigested diarrhea, hence Qi rises. Joy makes Qi harmonious and will reached, Ying and Wei (Defensive Qi) flow freely, hence Qi relaxes. Sorrow makes the Heart Meridian tight and Lung leaves elevate, blocking the Upper Jiao, preventing Ying and Wei from dispersing, trapping heat in the center, hence Qi dissipates. Fear causes Essence to retreat; retreat blocks the Upper Jiao; blockage causes Qi to return; returning Qi causes Lower Jiao distension, hence Qi fails to move. Cold closes the pores, obstructing Qi movement, hence Qi contracts. Heat opens the pores, allowing Ying and Wei to flow freely with profuse sweating, hence Qi leaks. Startle leaves the Heart without support, the Shen without refuge, and thoughts without certainty, hence Qi becomes chaotic. Labor causes panting and sweating, with internal and external Qi escaping outward, hence Qi is exhausted. Thought keeps the mind focused and Shen anchored, causing Zheng Qi (Upright Qi) to stagnate and not move, hence Qi knots. (From *Ju Tong Pian*)
At forty years of age, Yin Qi naturally halves, and daily activities decline. (From *Yin Yang Ying Xiang Lun*)
Yin Qi, when quiet, stores the Shen; when restless, the Shen perishes. Doubling food intake injures the stomach and intestines. (From *Bi Lun*)
Yin is generated from the Five Flavors. The five palaces (organs) governing Yin are injured by the Five Flavors. (From *Sheng Qi Tong Tian Lun*)
[Li Dongyuan] In *Lao Juan Suo Shang Lun* and *Tiao Jing Pian*, it is stated: Injury to Yin Qi generates internal heat. Qibo said: With labor and fatigue, the form and Qi decline, Gu Qi (Grain Qi) becomes insufficient, the Upper Jiao fails to circulate, and the Lower Wan (stomach outlet) is blocked. Stomach Qi becomes hot, and heat steams the chest, generating internal heat. *Ju Tong Lun* states: Labor exhausts Qi; labor causes panting and sweating, with internal and external Qi escaping, hence Qi is exhausted. If anger and joy are unregulated, and daily life irregular, combined with labor and fatigue, Qi is damaged. Decline leads to Fire flourishing; flourishing Fire attacks Spleen Earth. Since the Spleen governs the four limbs, the person feels weary and hot, lacks energy to move, is lazy to speak, pants and fatigues with movement, has surface heat and spontaneous sweating, and feels vexed and uneasy. During illness, one should sit quietly to nourish Qi, use Sweet-Cold herbs to clear fire-heat, use Sour flavors to gather scattered Qi, and use Sweet-Warm herbs to regulate Middle Qi. The Classics say "Labor requires warming" and "Deficiency requires warming." Zhang Zhongjing said: A normal person with a large pulse suffers from labor; an extremely deficient pulse also indicates labor. The pulse in labor disease is floating and large, with vexed heat in hands and feet, worsening in Spring/Summer and improving in Autumn/Winter. A large pulse indicates pathogenic heat; extreme deficiency indicates Qi damage. Worsening in Spring/Summer is due to seasonal aid to pathogens; improvement in Autumn/Winter is due to seasonal suppression of pathogens. Use Huangqi Jianzhong Tang to tonify, which is also a method of "warming." The sages of antiquity regulated their diet, maintained regular routines, and did not overexert themselves, thus maintaining unity of form and Shen, living out their natural lifespan to a hundred years, which is treating disease before it arises. Since the middle antiquity, far from the sages, people have had irregular diets, improper routines, and excessive labor, injuring both form and Shen, so they treat disease with medicine only after it arises, which is treating existing disease. Tracing the source of all diseases, they stem from dietary and labor injuries causing Stomach Qi and Yuan Qi (Source Qi) to scatter, failing to nourish the hundred vessels, irrigate the Zang-Fu organs, and protect the body. Therefore, Heaven's Qi values purity, and Yang Qi dislikes vexation and labor. Can one not be cautious regarding diet, emotions, climate, and routine? Above is Li Dongyuan's *Lao Juan Suo Shang Lun*. My other discussions are found in the entry for Buzhong Yiqi Tang under methods for treating deficiency and excess.
*[Su Wen]* Pathogens arise either from Yin or from Yang. Those arising from Yang come from wind, rain, cold, and summer heat; those arising from Yin come from diet, dwelling, and emotional fluctuations (Yin/Yang anger and joy). (From *Tiao Jing Lun*)
Here, Yin and Yang refer to internal and external factors, summarizing injuries to Yin/Yang, form, and Qi. Mr. Dongyuan referred to these as internal and external injuries. Injuries from diet, emotions, etc., belong internally as Yin; injuries from cold, warmth, wind, and dampness belong externally as Yang.
*[Ling Shu]* The onset of all diseases stems from wind, rain, cold, summer heat, emotional fluctuations, diet, dwelling, sudden fright, and abrupt fear. These cause separation of Blood and Qi, disintegration of Yin and Yang, interruption of meridians, blockage of pulse channels, reversal of Yin and Yang, stagnation of Wei Qi, emptiness of meridians, disorder of Blood and Qi, and loss of normal function. (From *Kou Wen Pian*)
*[Su Wen]* Anger and joy injure Qi; cold and summer heat injure Form; violent anger injures Yin; violent joy injures Yang. Jue Qi ascends, filling the vessels and detaching from the form. Unregulated anger and joy, excessive cold and heat, lead to unstable life. (From *Yin Yang Ying Xiang Lun*). Cold injures Form, Heat injures Qi; Qi injury causes pain, Form injury causes swelling. Therefore, pain preceding swelling indicates Qi injuring Form; swelling preceding pain indicates Form injuring Qi. (These two sections seem contradictory: why say Anger/Joy injure Qi but also Violent Anger injures Yin/Violent Joy injures Yang? Why say Cold/Heat injure Form but also Cold injures Form/Heat injures Qi? Although statements vary, the principle converges. Anger and joy affect from within, starting with Qi, hence "Anger/Joy injure Qi." Cold and heat invade from outside, attaching to Form first, hence "Cold/Heat injure Form." Specifically, Anger's Qi rises from below, affecting Yin first, hence "Violent Anger injures Yin"; Joy's Qi descends from above, affecting Yang first, hence "Violent Joy injures Yang." In cold, human Qi stores internally, so Cold attaches to Form first, hence "Cold injures Form." In summer heat, human Qi flows externally, so Heat attaches to Qi first, hence "Heat injures Qi.")