〔袁〕痘内发于脏腑，外应乎运气，天动人随，毫发不爽，是故治痘者，以明运
气为急也。历稽往者，大率三年一发，虽各年零出，间一有之，而其大发之期，则
三年为准也。所谓三年者，多系子午卯酉之年，子午、少阴君火司天，而阳明燥金
在泉，卯酉、阳明燥金司天，而少阴君火在泉，诸疮非火不发，非金不收，痘以少
阴、阳明二经为正者，为是故也。然玄化密移，主客互用，五运有平气、太过、
不及之殊，六气有常化、淫胜、反胜、相胜之异，几微不同，则全体尽别，痘
有当盛行而不盛行，有不当盛行而传染周遍者，是不可执一论也。〔万〕疮疹之候，
或间数年而发，或发则连年不已，何也？经曰∶不知年之所加，气之盛衰，虚实之
所起，不可以为工矣。盖司天者，主行天之令，上之位也，岁运者，主天地之间人
物化生之气，中之位也，在泉者，主地之化行乎地，中下之位也，一岁之中，有此
上中下三气，各行化令，气偶符会而同者，则通其化，其中于人，则病矣，所以疮
疹必待其年而发也。六十年中，天符十二年，（戊子戊午己丑己未戊寅戊申乙卯乙酉丙辰丙戌丁巳丁亥。）
其中又四年为太乙天符，（戊午己丑己未乙酉。）谓之天符者，司天与运同也。太乙天符者，
司天与运及辰之同也。岁会八年，（丙子己丑丁卯甲辰甲戌戊午己未乙酉。）谓之岁会者，运与支同
也。同天符六年，（甲辰甲戌庚子庚午壬寅壬申。）同岁会六年，（癸卯癸酉癸巳癸亥辛丑辛未。）
谓之同者，谓岁运与在泉合其气化，阳年曰同天符。阴年曰岁会也。此五者，杂而言之，
共三十六年，合而言之，止有二十六年，经曰∶天符为执法，岁位为行令，太乙天
符为贵人，邪之中人，则执法者，其病速而危，行令者，其病徐而待，贵人者，其
病暴而死也。又子午之岁，少阴君火主之，寅申之岁，少阳相火主之，经曰∶少阴
所至为疡疹。少阳所至为嚏呕疮疡，恶病暴死。凡此数年，刚柔失守，升降窒抑，
旧者不退，新者不迁，则连年发而不已也。
按∶运气之说，《内经》几居其半，而世罕行用，盖泥其常，不通其变，则以
为无验。余友缪仲淳高明善医，至排斥五运六气之谬，不容口，余以王炎、沈栝
之说折之，亦不服，盖未尝虚心而细求之也。假令厥阴用事，其气多风，民病
湿泄，岂普天之下皆多风，普天之民皆病湿泄耶，至于一邑之间，而雨 有不
同者，此气运安在，欲其无谬，不可得也。大凡物理有常有变，运气所主者常也，
异气所主者变也，常则如本气，变则无所不至，而各有所占，故其候有从逆、淫
郁、胜复、太过、不足之变，其发皆不同。若厥阴用事，多风而草木荣茂，是
之谓从；天气明洁，燥而无风，此之谓逆；太虚埃昏，流水不冰，此之谓淫；大
风折木，云物浊扰，此之谓郁；山泽焦枯，草木凋落，此之谓胜；大暑燔燎，螟
蝗为灾，此之谓复；山崩地震，埃昏时作，此之谓太过；阴森无时，重云昼昏，
此之谓不足；随其所变，疾疠应之，皆视当时当处之候，虽数里之间，但气候不
同，而所应全异，岂可胶于一定。熙宁中，京师久旱，祈祷备至，连日重阴，人
谓必雨，一日骤晴，炎日赫然，沈、时因事入对，上问雨期，沈对曰雨候已见，期
在明日，众以谓频日晦溽，尚且不雨，如此 燥，岂复有望，次日果大雨，是时湿土用事，
连日阴者，从气已效，但为厥阴所胜，未能成雨，后日骤晴者，燥金入候，厥阴当折，则太
阴得伸，明日运气皆顺，以是知其必雨。呜呼！今安得如存中者，而与之言运气哉。
【袁】痘疮内发于脏腑，外应合于运气（五运六气），天象变动则人体随之响应，丝毫不差。因此，治疗痘疮的人，以通晓运气学说为当务之急。考察过往历史，大率每三年发作一次，虽然各年零星出现，偶尔也有发生，但其大规模爆发的周期，则以三年为标准。所谓三年，多指子、午、卯、酉之年。子年和午年，少阴君火（手少阴心经与足少阴肾经之气）司天（主管上半年气候），阳明燥金（手阳明大肠经与足阳明胃经之气）在泉（主管下半年气候）；卯年和酉年，阳明燥金司天，少阴君火在泉。各种疮疡非火邪不能引发，非金气不能收敛，痘疮以少阴、阳明二经为主要病变经络，正是由于这个原因。然而玄妙的气化微妙转移，主气与客气相互运用，五运有平气（正常）、太过（过盛）、不及（不足）的区别，六气（风、寒、暑、湿、燥、火）有常化（正常变化）、淫胜（过度克制）、反胜（反向克制）、相胜（相互制约）的差异。细微的不同，则整体情况截然不同。痘疮有的应当盛行却不盛行，有的不应当盛行却传染遍及各地，这是不可拘泥于一种定论的。
【万】疮疹的证候，有的间隔数年才发作，有的发作则连年不停止，为什么呢？《内经》说：不知道年份所加临的运气，气的盛衰，虚实的起因，就不能成为好医生。大概司天（主管上半年之气），是主持上天之令，处于上位；岁运（主管全年大运），是主持天地之间人物化生之气，处于中位；在泉（主管下半年之气），是主持大地之化行于地，处于中下位。一年之中，有此上、中、下三气，各自施行化育之令，如果气机偶然相符会合而相同，则贯通其气化作用，其中于人，就会发病，所以疮疹必定等待相应的年份才发作。六十年中，天符（岁运与司天之气相同）十二年，（戊子、戊午、己丑、己未、戊寅、戊申、乙卯、乙酉、丙辰、丙戌、丁巳、丁亥）。其中又有四年为太乙天符（岁运、司天之气与地支五行属性三者相同），（戊午、己丑、己未、乙酉）。称为天符的，是司天与岁运相同。太乙天符的，是司天、岁运及地支五行属性相同。岁会（岁运与地支五行属性相同）八年，（丙子、己丑、丁卯、甲辰、甲戌、戊午、己未、乙酉）。称为岁会的，是岁运与地支相同。同天符（阳干岁运与在泉之气相同）六年，（甲辰、甲戌、庚子、庚午、壬寅、壬申）。同岁会（阴干岁运与在泉之气相同）六年，（癸卯、癸酉、癸巳、癸亥、辛丑、辛未）。称为“同”的，是指岁运与在泉之气合其气化，阳年叫同天符，阴年叫同岁会。这五种情况，杂乱地说来，共三十六年，合并来说，只有二十六年。《内经》说：天符称为执法，岁位称为行令，太乙天符称为贵人。邪气伤人，遇到执法者，病势急骤而危险；遇到行令者，病势缓慢而持久；遇到贵人者，病势暴烈而致死。另外，子年和午年，少阴君火主事；寅年和申年，少阳相火（手少阳三焦经与足少阳胆经之气）主事。《内经》说：少阴所至表现为疡疹。少阳所至表现为喷嚏、呕吐、疮疡，恶病暴死。凡是这几年，刚柔失守（阴阳失调），升降窒塞抑制，旧有的病邪不退去，新的病邪不迁移，就会连年发作而不停止。
按语：运气学说的内容，《黄帝内经》几乎占了一半，但世间很少有人应用它，大概是因为拘泥于常规，不通晓其变化，就认为没有验效。我的朋友缪仲淳（缪希雍）高明且善于医术，以至于口诛笔伐五运六气学说的谬误，但我用王炎、沈栝的说法来反驳他，他也不信服，大概是没有虚心细致探求的缘故。假如厥阴（风木之气）主事，其气多风，百姓易患湿泄（湿气导致的腹泻），难道普天之下都多风，普天之下的百姓都患湿泄吗？至于一个县邑之间，降雨尚且有所不同，这种气运怎么会有错误呢？想要它没有谬误，是不可能的。大凡事物的道理有常规和变通，运气所主导的是常规，异气（异常气候）所主导的是变通。常规就像本气（主气），变通则无所不至，且各有对应占验。所以其征候有从逆（顺从或违背）、淫郁（过度积聚）、胜复（克制与报复）、太过、不足的变化，其发作都不相同。若厥阴主事，多风而草木茂盛，这叫作“从”；天气明洁，干燥而无风，这叫作“逆”；天空尘埃昏暗，流水不结冰，这叫作“淫”；大风折断树木，云物浑浊扰乱，这叫作“郁”；山泽焦枯，草木凋落，这叫作“胜”；大暑猛烈燃烧，螟蝗成灾，这叫作“复”；山崩地震，尘土昏暗时常发生，这叫作“太过”；阴森寒冷无时，厚重云层白天昏暗，这叫作“不足”。随着气候的变化，瘟疫疾病随之响应，都要看当时当地的征候，即使几里之间，只要气候不同，所对应的疾病就完全不同，怎么能拘泥于一定的规则呢？熙宁年间，京城长期干旱，祈祷非常周到，连续几天阴天，人们认为一定会下雨。有一天突然放晴，烈日炎炎，沈括、时公因事入宫对答，皇上问下雨的时间，沈括回答说雨候已经显现，日期在明天。众人认为前几天阴雨潮湿尚且不雨，像这样干燥，哪里还有希望，第二天果然下了大雨。那时湿土之气主事，连续几天的阴天，是从气（顺应之气）已经生效，只是被厥阴风木所克制，未能成雨。后来突然放晴，是燥金之气进入时令，厥阴风木应当受折损，则太阴湿土得以伸展，第二天的运气都顺遂，因此知道必定会下雨。唉！现在哪里能得到像沈存中（沈括）这样的人，和他谈论运气学说呢。
[Yuan] Measles and smallpox (痘疮) originate internally from the Zang-Fu organs (Zang-Fu organs) and externally correspond to the Five Movements and Six Qi (Five Movements and Six Qi, i.e., Wu Yun Liu Qi). When the heavens move, the human body follows, without the slightest error. Therefore, for those treating measles and smallpox, it is urgent to understand the Five Movements and Six Qi. Examining past history, outbreaks generally occur every three years. Although sporadic cases may appear in various years, the period of major epidemics is standardized at three years. The so-called "three years" mostly refers to the years of Zi, Wu, Mao, and You. In the years of Zi and Wu, Shaoyin Junhuo (Ministerial Fire of Hand-Shaoyin Heart and Foot-Shaoyin Kidney meridians) governs the Heaven (Si Tian, controlling the first half of the year), while Yangming Zaojin (Dryness Metal of Hand-Yangming Large Intestine and Foot-Yangming Stomach meridians) governs the Earth (Zai Quan, controlling the second half of the year). In the years of Mao and You, Yangming Zaojin governs the Heaven, and Shaoyin Junhuo governs the Earth. Various sores and ulcers are not ignited without Fire, nor collected without Metal. Measles and smallpox take the Shaoyin and Yangming meridians as their primary channels precisely for this reason. However, the profound transformation of Qi shifts subtly; the Principal Qi (Zhu Qi) and Guest Qi (Ke Qi) use each other mutually. The Five Movements differ into Ping Qi (Normal movement), Tai Guo (Excess), and Bu Ji (Deficiency). The Six Qi (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) differ into Chang Hua (Normal transformation), Yin Sheng (Overacting/Excessive control), Fan Sheng (Counter-control), and Xiang Sheng (Mutual restriction). Even slight differences result in entirely different overall conditions. There are times when measles and smallpox should prevail but do not, and times when they should not prevail but spread everywhere. Thus, one cannot adhere to a single rigid theory.
[Wan] The manifestations of sores and rashes sometimes erupt after an interval of several years, or once erupted, continue year after year. Why? The Classic says: "If one does not know the Qi added to the year, the prosperity and decline of Qi, and the origin of Deficiency and Excess, one cannot be a skilled physician." Generally, Si Tian (governing Heaven) commands the decree of Heaven, occupying the Upper position. Sui Yun (Annual Movement) commands the Qi of generation and transformation of humans and things between Heaven and Earth, occupying the Middle position. Zai Quan (governing Earth) commands the transformation and action on Earth, occupying the Middle-Lower position. Within a year, these Upper, Middle, and Lower Three Qi each execute their transformative decrees. If the Qi occasionally coincides and harmonizes, it penetrates its transformation; if it affects humans, disease occurs. Hence, sores and rashes must wait for the specific year to erupt. Within sixty years, there are twelve Tian Fu (Heavenly符/Agreement) years, where the Annual Movement matches the Si Tian Qi (Wu Zi, Wu Wu, Ji Chou, Ji Wei, Wu Yin, Wu Shen, Yi Mao, Yi You, Bing Chen, Bing Xu, Ding Si, Ding Hai). Among these, four years are Tai Yi Tian Fu (Great Heavenly Agreement), where the Annual Movement, Si Tian, and Earthly Branch attributes all match (Wu Wu, Ji Chou, Ji Wei, Yi You). "Tian Fu" means Si Tian and Sui Yun are identical. "Tai Yi Tian Fu" means Si Tian, Sui Yun, and the Earthly Branch are identical. There are eight Sui Hui (Year Meeting) years, where the Annual Movement matches the Earthly Branch attribute (Bing Zi, Ji Chou, Ding Mao, Jia Chen, Jia Xu, Wu Wu, Ji Wei, Yi You). "Sui Hui" means Sui Yun and the Branch are identical. There are six Tong Tian Fu (Same Heaven Agreement) years, where the Yang-year Sui Yun matches the Zai Quan Qi (Jia Chen, Jia Xu, Geng Zi, Geng Wu, Ren Yin, Ren Shen). There are six Tong Sui Hui (Same Year Meeting) years, where the Yin-year Sui Yun matches the Zai Quan Qi (Gui Mao, Gui You, Gui Si, Gui Hai, Xin Chou, Xin Wei). "Tong" refers to the Sui Yun combining with Zai Quan Qi; Yang years are called Tong Tian Fu, Yin years are called Tong Sui Hui. Speaking of these five categories mixed together, there are thirty-six years; speaking of them combined, there are only twenty-six years. The Classic says: "Tian Fu is called Zhifa (Enforcer), Sui Wei is called Xingling (Order Executor), Tai Yi Tian Fu is called Guiren (Noble Person)." When pathogenic Qi attacks humans, encountering Zhifa results in rapid and critical illness; encountering Xingling results in slow and lingering illness; encountering Guiren results in sudden death. Furthermore, in Zi and Wu years, Shaoyin Junhuo presides; in Yin and Shen years, Shaoyang Xianghuo (Ministerial Fire of Hand-Shaoyang Sanjiao and Foot-Shaoyang Gallbladder meridians) presides. The Classic says: "Where Shaoyin arrives, there are sores and rashes. Where Shaoyang arrives, there are sneezing, vomiting, sores, ulcers, malignant diseases, and sudden death." In these years, if Gang Rou (Yin and Yang) lose their proper positions, and Sheng Jiang (Ascending and Descending) are obstructed, old pathogens do not retreat, and new ones do not migrate, leading to continuous annual outbreaks.
Commentary: The theory of Five Movements and Six Qi occupies nearly half of the *Huangdi Neijing* (Yellow Emperor's Inner Canon), yet few in the world apply it. This is likely because people stick to the constant rules without understanding the variations, thus deeming it ineffective. My friend Miao Zhongchun (Miao Xi Yong) was highly intelligent and skilled in medicine, yet he vehemently rejected the fallacies of Five Movements and Six Qi. I refuted him using the arguments of Wang Yan and Shen Kuo, but he remained unconvinced, probably due to a lack of open-mindedness and detailed inquiry. Suppose Jueyin (Wind-Wood Qi) is in charge; its Qi is predominantly Wind, and the people suffer from Damp-Diarrhea. Does this mean the whole world has much wind and everyone suffers from damp-diarrhea? Even within a single county, rainfall differs. How could such Qi movements be erroneous? It is impossible to claim they are without error. Generally, the principles of things have constants and variables. What the Five Movements and Six Qi dominate are the constants; what abnormal Qi dominates are the variables. Constants resemble the Ben Qi (Principal Qi); variables can reach anywhere and have specific correspondences. Thus, signs vary according to Cong Ni (Following/Opposing), Yin Yu (Excessive Accumulation), Sheng Fu (Overacting/Rebounding), Tai Guo (Excess), and Bu Zu (Deficiency), and their eruptions differ. If Jueyin is in charge, there is much wind and flora flourishes; this is called "Cong" (Following). If the weather is clear and dry without wind, this is called "Ni" (Opposing). If the sky is dusty and murky, and flowing water does not freeze, this is called "Yin" (Excessive). If strong winds break trees and clouds are turbid and chaotic, this is called "Yu" (Stagnation). If mountains and marshes scorch and plants wither, this is called "Sheng" (Overacting). If extreme heat burns and locusts cause disaster, this is called "Fu" (Rebounding). If mountains collapse and earthquakes occur with frequent dust storms, this is called "Tai Guo" (Excess). If it is gloomy and cold at any time, with heavy clouds darkening the day, this is called "Bu Zu" (Deficiency). Diseases and plagues respond to these changes. One must observe the signs of the time and place. Even within a few miles, if the climate differs, the corresponding diseases differ completely. How can one cling to fixed rules? During the Xining era, the capital suffered long droughts despite extensive prayers. For several days, it was overcast, and people believed rain was certain. Then suddenly it cleared, with blazing sun. Shen Kuo and Shi Gong entered court for an audience. The Emperor asked about the rain schedule. Shen replied that the sign for rain had appeared, and it would rain tomorrow. Others argued that despite recent humid overcast days, there was no rain, and how could rain come under such dry conditions? Yet, the next day, heavy rain fell. At that time, Wet Earth Qi was in charge. The previous overcast days showed the effect of the Cong Qi (Following Qi), but it was suppressed by Jueyin Wind Wood, preventing rain. The subsequent sudden clearing indicated Dry Metal Qi entering the season, suppressing Jueyin Wind Wood, allowing Taiyin Wet Earth to expand. The Qi movements became smooth the following day, hence the certainty of rain. Alas! Where can we find someone like Shen Cunzhong (Shen Kuo) today to discuss the Five Movements and Six Qi with?