诸本无篇字。马云。末节有五变之纪。故名篇。
百疾之始期也 广韵云。期、限也。
避者得无殆 张云。殆、危也。天非求人。而人自犯之。所以有少病病多者。亦在乎人之慎与不慎耳。
斧斤 释名云。斧、甫也。甫、始也。凡将器。始用斧伐木己乃制之也。斤、 同。释名云。所以
平灭斧迹也。
木之阴阳 志云。阴阳者。木之枝干皮肉也。简案、周礼考工记。凡斩毂之道。必矩其阴阳。阳也
者。稹理而坚。阴也者。疏理而柔。
夫木之蚤花（止）况于人乎 张云。此言木之凋残。各有所因。以方人之疾病。亦无不有所致之也。
萎、音威。蔫枯也。（蔫音烟物不鲜而色败也）溃、音会。坏烂也。漉、音鹿。水湿貌。杌音兀。木之无枝者
也。马云。湿腐为漉。
故常为病也 张云。木有坚脆。所以伤有轻重。人有坚脆。所以病有微甚。故虽同时遇风。而
有受有不受。此病之所以异也。
风厥漉汗 甲乙作风洒洒汗出。马云。素问阴阳别论。评热病论。皆有风厥。素问疟论。及本
经逆顺篇。皆言无刺漉漉之汗。则风厥者其汗必漉漉然也。朱长春云。此言皮不致密。肉理粗疏。致风邪厥逆
于肉。而为漉漉之汗。盖津液充于皮腠之间。皮溃理疏。则津泄而为汗矣。
肉不坚（止）此言其浑然者 甲乙。 、作 。肉理粗疏四字。作肉不坚肤粗五字。疏下有也字。
此言以下六字。无无分理者。诸本理下更有理字。马云。理者之理。当作衍。张因删之。此本仍张本。马云。
腓肠之上。膝后曲处为 。
乃委中穴所在也。其肉不坚。而无分理者。其理必粗。粗理而皮不坚致。则一身之腠理必疏。所以善病风厥也。
此乃言其肉之浑然者。则皮必密。理不疏。尚何病风之有。简案、甲乙作 为是。以 肉候通身之肌肉。见本
藏等论。诸家以 释之非也。浑然即无分理之谓。马反为理不疏之义。志亦为浑然汗出。并误。
五脏皆柔弱者（止）肌肉弱者也 甲乙。必下无有字。冲、作衡。注云。太素逆留作留积。又甲乙 皮
充肌。作肤皮充胀。志云。消瘅者。瘅热而消渴消瘦也。邪气脏腑篇曰。五脏之脉微小为消瘅。盖五脏主藏精
者也。五脏皆柔弱。则津液竭而善病消瘅矣。夫形体者。五脏之外合也。薄皮肤而肌肉弱。则五脏皆柔弱矣。
夫柔弱者必有刚强。谓形质弱而性气刚也。故此人皮肤薄而目坚固以深者。其气有长冲直扬之势。其心刚。刚
则多怒。怒则气上逆。而血积于胸中。（马云素问生气通天论曰大怒则形气绝而血菀于上）气逆留则充塞于肌
肉。血蓄积则脉道不行。血气留积。转而为热。热则消肌肤。故为消瘅。此言其人暴刚而肌肉弱者也。盖肌肉
弱则五脏皆柔。暴刚则多怒而气上逆矣。张云。目坚固而视直扬者。其心必刚。冲者目光突露之谓。 、宽同。
简案、冲作衡。似是。论勇篇亦云。勇士者目深。以固长衡直扬是也。前王莽传。肝衡厉色。振扬武怒。注。
眉上曰衡。肝衡、举目扬眉也。又蔡邕释诲。扬衡含笑。 字书体也。又与 同。义难叶。
小骨弱肉者 善病寒热 张云。骨属肾。肉属脾。皆至阴之所在也。阴不足。则阳邪易以入之。故善
病寒热。
颧骨者（止）故善病寒热也 甲乙。殆、作始。志云。夫肾主骨。颧者肾之外侯也。故颧骨为骨之本。
颧大则周身之骨皆大。颧小则知其骨小也。 者肉之指标也。懦懦柔弱也。
臂薄者股肱之大肉不丰也。地色者地阁之色。殆不与天庭同色。此土气之卑污也。髓者骨之充也。骨小则其髓
不满矣。夫在外者皮肤为阳。筋骨为阴。骨小皮薄。则阴阳两虚矣。阳虚则生寒。阴虚则发热。故其人骨小皮
薄者。善病寒热也。张云。懦、儒、糯、软、三音。简案、寒热谓虚劳寒热。内经言寒热者皆然。
粗理（止）各视其部 甲乙无者各二字。部上有三字。张云。肉不坚。则风寒湿邪易以入也。人之上下
左右虚实。自有不同。故当各视其部。
病肠中积聚者（止）大聚乃起 甲乙。乃伤作乃作。稍至作稍止。马云。恶者犹俗云不好也。朱永年云。
此言善病肠中积聚者。以肠胃之恶也。夫皮肤薄而气不充。身泽毛肉不坚。而津液不能淖泽。如此则肠胃恶。
盖津液血气。肠胃之所生也。恶则邪气留止。而或积聚。乃伤脾胃之间。若再饮食之寒温不节。邪气稍至。即
蓄积而大聚乃起。夫肠乃肺之合。而主皮主气。胃乃脾之合。而主肉主津。故皮肤薄而肉不坚。则气不充而津
液不淖泽矣。气不充而液不泽。则皮毛开而腠理疏。疏则邪气留止。渐溜于肠泽之间。而成积聚矣。（马云大
义详见百病始生篇）简案、马云。其肉不坚而反为淖泽。淖泽者推之则移也。此以淖泽为柔脆之义也。张云。
淖泽者湿滞多也。考内经中淖泽多见诸篇。然未见为柔脆之义。若根据张说。而为湿滞多。则与皮肤薄而不泽相反。故朱
带坚上不学而读。更添一不字而释之。义觉分晓。
先立其年（止）五变之纪也 张云。先立其年。则五运六气各有所主。故知其时。凡病遇生王则时之高
也。故可以起。起言愈也。如逢衰克。则时之下也。病当危殆矣。六元正纪大论亦曰。先立其年。以明其气。
虽非衰克陷下之时。而年
有所冲。则气有所通。其病亦因而起。此非上文之所谓起也。如水火相冲。火当畏水。金木相冲。木当畏金。
然火胜则水亦病。木胜则金亦病。故有以金形之人。而反病于丁壬年者。有以木形之人而反病于甲巳年者。是
谓因形生病。五变之纪也。简案、本节诸家并以运气家之言而解之。然运气之说。 于唐以后。乃不可以彼解
此。必别有义之所存。俟考。
各版本中均无“篇”字。马莳说：末节有“五变”的记载，因此以“五变”命名此篇。
百病发生的起始阶段。《广韵》解释说：期，就是期限的意思。
能够避开邪气的人，就能避免危险。张景岳说：殆，就是危险的意思。上天并不专门求祸于人，而是人自己触犯邪气，所以有的人少生病、有的人多生病，也在于人的谨慎与不谨慎罢了。
斧和斤。《释名》解释说：斧，通“甫”，甫即开始的意思。凡是制作器物，开始都要用斧头砍伐木材，然后才制成它。斤，同“斨”。《释名》解释说：它是用来平灭斧痕的工具。
树木的阴阳。张志聪注云：阴阳，指的是树木的枝干、树皮和肉质部分。简案：《周礼·考工记》说：凡制作车轮毂的方法，必须测量其阴阳面。阳面，纹理致密而坚硬；阴面，纹理疏松而柔软。
树木如果过早开花（凋谢），何况是人呢？张景岳说：这是说树木的凋残，各有其原因，以此比喻人的疾病，也无不有所导致的原因。
萎，读音威。指枯萎。（蔫，读音烟，指物体不新鲜而颜色败坏）溃，读音会。指腐烂。漉，读音鹿。指水湿的样子。杌，读音兀。指没有枝条的树。马莳说：湿腐称为漉。
所以经常生病。张景岳说：树木有坚硬和脆弱的区别，所以受到的损伤有轻有重；人有体质坚脆的区别，所以患病的程度有轻有重。因此虽然同时遇到风邪，但有的人受邪发病，有的人不受邪，这就是疾病差异的原因。
风厥且汗出淋漓。《甲乙经》作“风洒洒汗出”。马莳说：《素问·阴阳别论》和《评热病论》中都有“风厥”的说法。《素问·疟论》以及本经《逆顺篇》都说不可针刺“漉漉”之汗，那么风厥导致的汗必然是淋漓不断的。朱长春说：这是说皮肤不致密，肌肉纹理粗疏，导致风邪厥逆于肌肉之间，从而出现淋漓的汗。因为津液充满在皮腠之间，如果皮肤溃散、纹理疏松，津液就会外泄成为汗。
肌肉不坚实（等等），这是说那些浑然一体的情况。《甲乙经》中，“ ”字写作“ ”。“肉理粗疏”四字，写作“肉不坚肤粗”五字。“疏”字下有个“也”字。“此言以下六字”中，没有“无分理者”这几个字。各版本中“理”字下还有“理”字。马莳说：“理”字的“之理”，应当是衍文。张景岳删去了它。这个本子仍沿用张景岳的本子。马莳说：小腿肚之上，膝盖后弯曲的地方叫做 。
这里是委中穴所在的位置。如果那里的肌肉不坚实，而且没有分明的纹理，它的纹理必定粗糙。纹理粗糙且皮肤不坚固致密，那么全身的腠理必定疏松，所以容易患风厥病。这里说的是那些肌肉浑然一体的人，那么皮肤必定致密，纹理不疏松，哪里还会得风病呢？简案：《甲乙经》写作“ ”是正确的，以 来候察全身肌肉，见《本藏》等篇论述。各家解释为“ ”是不对的。“浑然”就是没有分明的意思，马莳反而解释为纹理不疏松，张志聪也解释为浑然汗出，都错了。
五脏都柔弱的人（等等），是指肌肉软弱的人。《甲乙经》中，“必”字下没有“有”字。“冲”写作“衡”。注释说：《太素·逆留》作“留积”。另外，《甲乙经》中“皮充肌”写作“肤皮充胀”。张志聪说：消瘅，是指因热盛而导致的消渴消瘦。《邪气脏腑病形篇》说：五脏的脉象微小，就是消瘅。大概五脏是主藏精气的器官。如果五脏都柔弱，那么津液枯竭就容易患消瘅病。形体是五脏的外应。如果皮肤薄弱而肌肉软弱，那么五脏就都柔弱了。
柔弱的人必然伴有刚强的特性，意思是形体弱而性情刚烈。所以这种人皮肤薄而眼睛坚固深邃，他的气机有长冲直扬的趋势，他的心志刚强。刚强就容易发怒，发怒则气机上逆，血液积聚在胸中。（马莳引《素问·生气通天论》说：大怒则形气隔绝，血液郁积于上部）气逆滞留则充塞于肌肉，血液蓄积则脉道不通。血气留滞，转而化热，热则消耗肌肤，所以形成消瘅。这是说这种人暴戾刚强而肌肉软弱。大概肌肉软弱则五脏皆柔，暴戾刚强则易怒且气机上逆。张景岳说：眼睛坚固且目光直视上扬的人，他的心志必定刚强。“冲”是目光突露的意思。“ ”与“宽”同义。简案：“冲”作“衡”似乎更合理。《论勇篇》也说：勇士的眼睛深陷、坚固、长衡、直视上扬。前汉书《王莽传》中有“肝衡厉色，振扬武怒”，注解说：眉上曰衡。“肝衡”就是举目扬眉。另外蔡邕《释诲》中有“扬衡含笑”，“ ”字是书体。又与“ ”同，意义难以押韵。
小骨头、弱肌肉的人，容易患寒热病。张景岳说：骨属于肾，肉属于脾，都是至阴所在的地方。阴不足，则阳邪容易侵入，所以容易患寒热病。
颧骨是（等等），所以容易患寒热病。《甲乙经》中，“殆”写作“始”。张志聪说：肾主骨，颧部是肾的外候。所以颧骨是骨骼的根本。颧骨大则周身骨骼都大，颧骨小则知道骨骼小。“ ”是肉的指标。“懦懦”形容柔弱。
手臂薄的人，大腿和小腿的大肌肉不丰满。“地色”是指下巴的颜色，大概不与天庭（额头）同色。这是土气卑污的表现。髓是骨的充实物。骨小则髓不满。在外表方面，皮肤属阳，筋骨属阴。骨小皮薄，则阴阳两虚。阳虚则生寒，阴虚则发热。所以那种骨小皮薄的人，容易患寒热病。张景岳说：“懦”、“儒”、“糯”、“软”三个读音。简案：这里的寒热指的是虚劳寒热，《内经》中提到的寒热都是这样。
纹理粗糙（等等），各自观察其部位。《甲乙经》中没有“者各”二字。“部”字上有“三”字。张景岳说：肌肉不坚实，则风寒湿邪容易侵入。人体上下左右的虚实，自然有所不同，所以应当各自观察其部位。
患有肠中积聚病的人（等等），大的聚结才开始形成。《甲乙经》中，“乃伤”写作“乃作”，“稍至”写作“稍止”。马莳说：“恶”就像俗话说的“不好”。朱永年说：这是说容易患肠中积聚病的人，是因为肠胃功能恶劣。如果皮肤薄且气不充盈，身体润泽度差、毛发肌肉不坚实，且津液不能滋润，这样就会导致肠胃功能恶劣。大概津液和血气，是由肠胃生成的。功能恶劣则邪气停留，从而形成积聚，进而损伤脾胃之间。如果再饮食寒温不节制，邪气稍微到达，就会蓄积并形成大的聚结。肠是肺的相合之处，主皮毛主气；胃是脾的相合之处，主肌肉主津液。所以皮肤薄而肌肉不坚实，则气不充盈且津液不滋润。气不充盈且津液不滋润，则毛孔张开且腠理疏松。疏松则邪气停留，逐渐流入肠泽之间，形成积聚。（马莳说大义详见《百病始生篇》）简案：马莳说，他的肌肉不坚实却反而表现为淖泽。“淖泽”是指推之可移动。这里把“淖泽”解释为柔脆的意思。张景岳说：“淖泽”是指湿滞多。考察《内经》中“淖泽”多见诸篇，但未见过解释为柔脆的意思。如果根据张景岳的说法，解释为湿滞多，则与“皮肤薄而不泽”相反。所以朱氏加上“坚上”二字，不学而读，多加一个“不”字来解释，意义觉得清楚。
先确立当年的运气（等等），这是五变的纲领。张景岳说：先确立当年的运气，则五运六气各有所主，所以能知道时令。凡是疾病遇到相生旺盛的年份，就是时机的“高”点，所以可以痊愈。“起”指痊愈。如果遇到相克衰弱的年份，就是时机的“低”点，病情应当危殆了。《六元正纪大论》也说：先确立当年的运气，以明了气机。虽然不是衰弱克制陷下的时候，但如果年份有所冲撞，则气机有所通达，病情也因此而起。这不是上文所说的“起”（痊愈）。比如水火相冲，火当畏水；金木相冲，木当畏金。然而火胜则水也病，木胜则金也病。所以有金形之人，反而在丁壬年生病的；有木形之人，反而在甲巳年生病的。这叫做因形质而生疾病，这就是五变的纲领。简案：本节各家都以运气家的言论来解释。然而运气之说，盛行于唐代以后，不能用后来的理论来解释前面的经文。必定另有其含义存在，等待考证。
The term "Chapter" (Pian) is absent in all versions. Ma Shi states: The final section contains records of the "Five Changes," hence the chapter is named "Five Changes."
This refers to the initial stage of the onset of a hundred diseases. The *Guangyun* dictionary explains: "Qi" means limit or deadline.
Those who can avoid [pathogenic factors] will not face danger. Zhang Jingyue states: "Dai" means danger. Heaven does not specifically seek harm from people, but people themselves violate [natural laws/avoidance], which is why some have few illnesses and others have many; this depends on whether one is cautious or careless.
Fu (axe) and Jin (adze). The *Shiming* explains: "Fu" corresponds to "Pu," and "Pu" means beginning. Generally, when making vessels, one starts by using an axe to fell wood before shaping it. "Jin" is identical to "Qiang." The *Shiming* explains: It is used to level out marks left by the axe.
The Yin and Yang of trees. Zhang Zhicong annotates: Yin and Yang refer to the branches, trunk, bark, and flesh of the tree. Brief note: The *Rites of Zhou · Kaogong Ji* states: In the method of chopping wheel hubs, one must measure their Yin and Yang aspects. The Yang aspect has dense grain and is hard; the Yin aspect has loose grain and is soft.
If trees flower too early [and wither], how much more so for humans? Zhang Jingyue states: This discusses the reasons for tree withering, using it as an analogy for human diseases, which also invariably have specific causes.
Wei (withered), pronounced Wei. Refers to withering. (Nian, pronounced Yan, refers to objects losing freshness and color). Kui (rotten), pronounced Hui. Refers to decay. Lu (dripping/wet), pronounced Lu. Refers to a wet/dripping appearance. Wu (tree without branches), pronounced Wu. Ma Shi states: Wet rot is called Lu.
Therefore, [they] often suffer from disease. Zhang Jingyue states: Trees vary in hardness and brittleness, so injuries range from light to heavy; humans vary in physical constitution, so illness severity ranges from mild to severe. Thus, even when encountering wind pathogen simultaneously, some contract disease while others do not; this is the reason for differences in illness.
Feng Jue (Wind Reversal) with dripping sweat. The *Jia Yi Jing* reads "Feng Sasa Han Chu" (Wind causing shivering sweating). Ma Shi states: Both the *Suwen · Yin Yang Bie Lun* and *Ping Re Bing Lun* mention "Feng Jue." The *Suwen · Nu Lun* and this classic's *Ni Shun Pian* both state that one should not puncture when sweat is dripping ("Lu Lu"), implying that the sweat caused by Feng Jue must be dripping profusely. Zhu Changchun states: This describes skin that is not dense and muscle texture that is coarse, allowing Wind Pathogen to reverse into the muscles, resulting in dripping sweat. Since body fluids fill the interstices between skin and pores, if the skin is loose and texture sparse, fluids leak out as sweat.
Muscle not firm (etc.), this refers to those who are浑然 (indistinct/uniform). The *Jia Yi Jing* writes the character differently. The four characters "rou li cu shu" (muscle texture coarse and sparse) are written as five characters "rou bu jian fu cu" (muscle not firm, skin coarse). There is a "ye" particle after "shu." The six characters starting with "ci yan" lack the phrase "wu fen li zhe" (those without distinct texture). In all versions, there is an extra "li" character after the first "li." Ma Shi states: The "li" in "zhi li" (texture of...) is likely a scribal error (yan wen). Zhang Jingyue deleted it. This edition follows Zhang's version. Ma Shi states: The area above the calf muscle and behind the knee bend is called .
This is where the Weizhong acupoint is located. If the muscle there is not firm and lacks distinct texture, the texture must be coarse. Coarse texture combined with non-firm, non-tight skin means the entire body's couli (pores/interstices) must be sparse, thus prone to Feng Jue. This passage refers to those whose muscles are uniform/homogeneous; such individuals must have tight skin and non-sparse texture, so how could they suffer from wind disease? Brief note: The *Jia Yi Jing*'s reading is correct, using the observation of to assess whole-body muscle, as seen in discussions like *Ben Cang*. Other families' interpretations are incorrect. "Hun ran" means having no distinct boundaries; Ma Shi incorrectly interpreted it as non-sparse texture, and Zhang Zhicong also erred by interpreting it as dripping sweat.
When all five Zang organs are weak and soft (etc.), it refers to those with weak muscles. The *Jia Yi Jing* omits the character "you" after "bi." "Chong" is written as "Heng." The annotation notes: *Taisu · Ni Liu* reads "Liu Ji." Additionally, the *Jia Yi Jing* writes "pi chong ji" as "fu pi chong zhang." Zhang Zhicong states: Xiao Dan refers to wasting-thirst characterized by heat excess leading to thirst and emaciation. The *Xie Qi Zang Fu Pian* states: Micro and small pulses of the five Zang organs indicate Xiao Dan. Since the five Zang organs store essence, if all five are weak and soft, body fluids deplete, predisposing one to Xiao Dan. The physical form is the external correspondence of the five Zang organs. Thin skin and weak muscles indicate that all five Zang organs are weak and soft.
Those who are weak and soft necessarily possess rigidity/stiffness, meaning the physical constitution is weak but the temperament is strong/rigid. Therefore, such individuals have thin skin and firm, deep-set eyes; their Qi has a tendency to surge straight upward. Their heart/mind is rigid. Rigidity leads to frequent anger; anger causes Qi to rebel and ascend, causing blood to accumulate in the chest. (Ma Shi cites *Suwen · Sheng Qi Tong Tian Lun*: Great anger causes form and Qi to disconnect, and blood to stagnate at the upper part.) Stagnant Qi fills the muscles; accumulated blood obstructs the meridians. Stagnant Qi and blood transform into heat; heat consumes muscle and skin, thus forming Xiao Dan. This describes individuals who are violently rigid yet have weak muscles. Weak muscles imply all five Zang organs are soft; violent rigidity implies frequent anger and ascending Qi. Zhang Jingyue states: Individuals with firm eyes and direct, upward-gazing vision must have a rigid mind. "Chong" refers to protruding gaze. is synonymous with "Kuan." Brief note: Reading "Chong" as "Heng" seems more plausible. The *Lun Yong Pian* also states: Warriors have deep, firm eyes, long Heng, and direct upward gaze. The *Han Shu · Wang Mang Zhuan* mentions "Gan Heng Li Se, Zhen Yang Wu Nu," annotated as: Above the eyebrows is Heng. "Gan Heng" means raising eyes and eyebrows. Cai Yong's *Shi Hui* mentions "Yang Heng Han Xiao"; is a calligraphic style. Also identical to , difficult to rhyme semantically.
Individuals with small bones and weak muscles are prone to alternating cold and fever. Zhang Jingyue states: Bones belong to the Kidney, flesh belongs to the Spleen; both are locations of extreme Yin. Insufficiency of Yin allows Yang pathogens to easily enter, hence prone to alternating cold and fever.
The cheekbones are (etc.), therefore prone to alternating cold and fever. The *Jia Yi Jing* writes "Dai" as "Shi." Zhang Zhicong states: The Kidney governs bones; the cheek region is the external indicator of the Kidney. Thus, cheekbones are the root of bones. Large cheekbones indicate large bones throughout the body; small cheekbones indicate small bones. is the indicator of flesh. "Nuonuo" describes weakness.
Thin arms indicate that the large muscles of the thighs and calves are not plump. "Di se" refers to the color of the chin/jaw, which likely differs from the forehead (Tian Ting). This indicates inferior Earth Qi. Marrow is the filling of bones. Small bones mean insufficient marrow. Externally, skin is Yang, and sinews/bones are Yin. Small bones and thin skin indicate deficiency of both Yin and Yang. Yang deficiency generates cold; Yin deficiency generates heat. Thus, individuals with small bones and thin skin are prone to alternating cold and fever. Zhang Jingyue states: "Nuo," "Ru," "Nuo," and "Ruan" share similar pronunciations. Brief note: Here, "alternating cold and fever" refers to deficiency-consumption chills and fevers; this applies to all mentions of alternating cold and fever in the *Neijing*.
Coarse texture (etc.), observe each respective area. The *Jia Yi Jing* lacks the characters "zhe ge." There is a character "san" above "bu." Zhang Jingyue states: Non-firm muscle allows Wind, Cold, and Damp pathogens to easily enter. The deficiency and excess in the upper/lower and left/right parts of the body naturally differ; thus, one must observe each respective area.
For those suffering from intestinal accumulation (etc.), large accumulations begin to form. The *Jia Yi Jing* writes "nai shang" as "nai zuo" and "shao zhi" as "shao zhi." Ma Shi states: "E" is like the colloquial "not good." Zhu Yongnian states: This describes those prone to intestinal accumulation due to poor gastrointestinal function. If skin is thin and Qi is unfulfilled, body luster is poor, hair and muscle are not firm, and body fluids cannot moisten, then gastrointestinal function becomes poor. Body fluids and Blood Qi are generated by the stomach and intestines. Poor function allows pathogenic factors to linger, forming accumulations, thereby injuring the spleen and stomach. If dietary temperature regulation is further neglected, even slight pathogenic arrival leads to accumulation and the formation of large masses. The intestine is the interior-exterior pair of the Lung, governing skin and Qi; the stomach is the interior-exterior pair of the Spleen, governing flesh and fluids. Thus, thin skin and non-firm muscle lead to unfulfilled Qi and unmoistened fluids. Unfulfilled Qi and unmoistened fluids cause pores to open and couli to become sparse. Sparsity allows pathogens to linger, gradually flowing into the intestinal dampness, forming accumulations. (Ma Shi states the main principles are detailed in the *Bai Bing Shi Sheng Pian*). Brief note: Ma Shi argues that non-firm muscle appearing "Nao Ze" (soft/pliable) interprets "Nao Ze" as movable upon pushing, here meaning fragile. Zhang Jingyue states: "Nao Ze" means excessive damp stagnation. Examining the *Neijing*, "Nao Ze" appears frequently but never means fragile. If following Zhang's interpretation of damp stagnation, it contradicts "thin skin and lack of luster." Therefore, Zhu added "jian shang" (firm above) and read it without study, adding a "bu" (not) character to clarify the meaning.
First establish the year (etc.), this is the record of the Five Changes. Zhang Jingyue states: By establishing the year's luck (Yun Qi), the Five Movements and Six Qi have their respective rulers, allowing one to know the timing. When disease encounters a generating/prosperous phase, it is at the "high" point of time, so recovery is possible. "Qi" means recovery. If encountering a weakening/restrictive phase, it is at the "low" point, and the disease becomes critical. The *Liu Yuan Zheng Ji Da Lun* also states: First establish the year to understand the Qi. Even if not in a weakening/restrictive/depressed time, if the year involves clash, Qi may communicate, and disease may arise. This is not the "arise" (recover) mentioned earlier. For example, Water and Fire clash; Fire fears Water. Metal and Wood clash; Wood fears Metal. However, if Fire prevails, Water suffers; if Wood prevails, Metal suffers. Thus, a Metal-type person may fall ill in Ding-Ren years; a Wood-type person may fall ill in Jia-Ji years. This is called illness arising from constitutional type, which is the record of the Five Changes. Brief note: Scholars in this section interpret it using Yun Qi theories. However, Yun Qi theory flourished post-Tang dynasty and should not be used to explain earlier texts. There must be another underlying meaning; awaiting further research.