夫百病之始生也（止）不可胜数 张云。百病始生。无非外感内伤。而复有上中下之分也。喜怒不节。五
志病也。内伤于脏。故起于阴。清湿袭虚。阴邪之在表也。故起于下。风雨袭虚。阳邪之在表也。故起于上。
受病之始。只此三部。至其浸淫流 。则变有不可胜数矣。
先师 张云。先进之称也。
风雨寒热（止）分为三员 甲乙。相得、作相搏。肉坚、作肉间。员、作真。马云。上文言风雨寒暑清
湿。而此曰风雨寒热。又曰疾风豪雨。辞不同而均之为外感也。然此诸外感者。不得天之虚邪。则不能伤人也。
（虚邪见本经九宫八风等篇）又不得之人之本虚。亦不能伤人也。此以天之虚。人身形之虚。两虚相得。所以
诸邪得以客其形耳。若天有实风。（九宫八风篇以从其所居之乡来为实风主生长养万物）人有实气。则两实相
逢。众人肉坚。必不客其形矣。三员、犹言三部也。盖人身大体。自纵而言之。则以上中下为三部。自横而言
之。则以在表在里半表半里为三部。故谓之上下中外之三员也。张云。三员如下文虚邪之中人。病因表也。积
聚之已成。病因内也。情欲之伤脏。病在阴也。即内外三部之谓。志云。此论风雨伤上。下节论情湿伤下。末
节论喜怒伤中。而分为三员也。简案、据有一外字。张注为是。员数也。故马注为部。
是故（止）故皮肤痛 甲乙。抵、作稍。张云。此下言阳邪传舍之次也。邪之中人。必由表入里。始于
皮肤。表虚则皮肤缓。故邪得乘之。邪在表则毛发竖立。因而淅然。寒邪伤卫。则血气凝滞。故皮肤为痛。凡
寒邪所袭之处。必多酸痛。察系何经。则在阴在阳。或深或浅。从可知矣。诊表证
者。当先乎此也。此下百病始生之义。与皮部论大同。
留而不去（止）大经乃代 甲乙。其痛之时息。作其病时痛时息。张云。邪在皮毛。当治于外。留
而不去。其入渐深。则传舍于络脉。络浅于经。故痛于肌肉之间。若肌肉之痛。时渐止息。是邪将去络而深。
大经代受之矣。简案、马以代为脉代中止之义。非也。志云。大经者。经隧也。经隧者。五脏六腑之大络也。
盖大经即经脉对络。而谓之大经。志注恐误。
留而不去（止）喜惊 张云。络浮而浅。经隐而深。邪气自络入经。犹为在表。故洒淅恶寒。然经气
连藏。故又喜惊也。
留而不去（止）乃强 甲乙。四肢则肢节痛、作四节即痛四字。张云。凡诸输穴。皆经气聚会之处。
其所留止。必在关节溪谷之间。故邪气自经传舍于输。则六经为之不通。而肢节腰脊。为痛为强也。
留而不去（止）身痛 张云。伏冲之脉。即衡脉之在脊者。以其最深。故曰伏冲。岁露篇曰。入脊内
注于伏冲之脉是也。邪自经输。留而不去。深入于此。故为体重身痛等病。简案、伏冲之脉。即疟论伏膂之脉。
马以伏膂之脉。为下文所谓膂筋。误。
留而不去（止）溏出麋 张云。邪气自经入脏。则传舍于肠胃。而为奔向腹胀之病。寒则澄澈清冷。
水谷不分。故为肠鸣飧泄。食不化热。则溺垢下注。故为溏为麋。以麋秽如泥也。简案、麋、糜古通用。及麋
烂也。溏出麋。盖谓肠垢赤白滞下之属。张注似为麋鹿之屎。恐非也。马则云。麋者谷之不化也。志同。则与
上文飧泄何别。误尤甚。
留而不去（止）息而成积 马云。募原之间者。即皮里膜
外也。张云。肠胃之外。募原之间。谓皮里膜外也。是皆隐蔽曲折之所。气血不易流通。若邪气留着于中。则
止息成积。如疟 之属也。志云。募原者。肠胃外之膏膜。楼氏纲目。从是。故虚邪之中人也。至舍于肠胃之
外。募原之间为一节。注云。以上数端。皆邪气袭虚。留而不解去。以次相传。未曾留着。无有定所。若留着
而有定所。则不能传矣。所谓留着者。当如下文法云。
或着孙脉（止）不可胜论 甲乙。孙脉、作孙络。志云。伏冲者。伏行于腹之冲脉。募原者。肠胃之脂
膜也。膂筋者。附于脊膂之筋。缓筋者。循于腹内之筋也。此数者。在于肠胃之前后左右。邪随着而为积。邪
之淫溢。不可胜数也。简案、张云。募原如手太阴中腑为募。太渊为原之类也。缓筋、支别之柔筋也。此说不
可从。志注为是。盖缓筋即宗筋也。王氏痿论注云。横骨上下齐两旁竖筋。正宗筋也。此可以证下文云。其着
于缓筋也。似阳明之积。乃与痿论冲脉者。经脉之海也。主渗灌溪谷。与阳明合于宗筋相符。
臂手（止）故时切痛 甲乙。臂手、作擘乎。（注云擘音拍破尽也）句、作拘。肠胃之间。之间作外。
无水字。 上有腹字。无张字。张云。凡络脉之细小者。皆孙络也。句、拘也。邪着孙络成积者。其积能往来
上下。盖积在大肠小肠之络。皆属手经。其络浮而浅。缓而不急。不能句积而留止之。故移行于肠胃之间。若
有水则凑渗注灌。濯濯有声。若有寒。则为胀满及雷鸣。相引时为切痛。简案、臂手、作擘。于义易通。
其着于阳明之经（止）益小 张云。足阳明经。挟脐下行。故其为积则挟脐而居也。阳明属胃。受水谷
之气。故饱则大。饥则小。
其着于缓筋也（止）饥则安 张云。缓筋在肌肉之间。故
似阳明之积。饱则肉壅故痛。肌则气退故安。志云。缓筋者。经于腹内之筋。故有似乎阳明之积。饱则胀故痛。
肌则止而安也。
其着于肠胃之募原也（止）饥则痛 张云。肠胃募原。痛连缓筋。饱则内充外舒故安。饥则反是故痛。
志云。募原者。肠胃之膏膜。饱则津液渗润于外。故安。饥则干躁故痛也。
其着于伏冲之脉者（止）如汤沃之状 张云。伏冲义如前。其上行者循背里。络于督脉。其下行者。
注少阴之大络。出于气街。循阴股内廉。入 中。故揣按于腹。（旧作股今改）则应手而动。若起其手。则热
气上行于两股间。此邪着伏冲之验也。马云。以手揣摸其积。应手而动。举手则热气下于两股间。简案、举痛
论曰。寒气客于冲脉。则脉不通。则气因之。故喘动应手矣。乃此之义也。
其着于膂筋（止）按之不得 张云。膂吕同。脊骨也。脊内之筋曰膂筋。故在肠胃之后。饥则肠空。
故积可见。饱则肠满蔽之。故积不可见。按之亦不可得也。
其着于输之脉者（止）孔窍干壅 张云。输脉者。所以通血气。若闭塞不通。则津液干壅如此。志云。
输之脉者。转输津液之脉。脏腑之大络也。胃腑水谷之精。从胃之大络。而注于脏腑之大络。从脏腑之大络。
而出于皮肤。故积着于输之脉。则脉道闭塞不通。津液不下。而皮毛之化窍干塞也。此邪气之从外而内。从上
而下。以成其积也。
此邪气之从外入内 从上下也 张云。此总结上文邪气之起于阳者。必自外而内。从上而下也。楼
云。此谓风雨袭阴之虚。病起于上而积生也。
厥乃成积也 甲乙厥下有止字。张云。此下言积之所以成也。
厥气生足 （止）日以成积 甲乙二 字作溢。张云。此言寒气下逆之成积者。厥气、逆气也。寒逆于
下。故生足 。谓肢节痛滞。不便利也。由胫寒而血气凝涩。则寒气自下而上。渐入肠胃。肠胃寒则阳气不化。
故为 胀。而肠外汁沫迫聚不散。则日以成积矣。
卒然多食饮（止）而积成矣 张云。此言食饮起居。失节之成积者也。卒然多食饮。谓食不从缓。多而
暴也。肠胃运化不及。则汁溢膜外。与血相传。乃成食积。如婴童痞疾之类是也。又或起居用力过度。致伤阴
阳之络。以动其血瘀。血得寒汁沫相聚于肠外。乃成血积。此必纵肆口腹。及举动不慎者。多有之。马云。如
阳经之络脉受伤。则血当外溢而为衄。如阴经之络脉受伤。则血当内溢而去后有血。志云。阳络者上行之络脉。
阴络者下行之脉络。
卒然外中于寒（止）积皆成矣 甲乙。忧怒、作忧恐。六输、作穴输。蕴里、作蕴裹。涩渗、作凝涩。
张云。此言情志内伤。而挟寒成积者也。寒邪既中于外。忧怒复伤其内。气因寒逆。则六经之输不通。暖气不
行。则阴血凝聚。血因气逆而成积。此必情性乖戾者。多有之也。楼云。此谓清湿袭阴之虚。病起于下而成积
也。简案、甲乙六字里字。并误。
忧思伤心（止）伤肾 甲乙浴下有水字。张云。伤心者病在阳。伤肺者病在气。伤肝者病在血。伤脾者
病在营卫。伤肾者病在真阴。凡伤脏者。皆病生于阴也。此节与下编邪气脏腑病形论者大同。楼云。此谓喜怒
伤脏。病起于阴也。风雨袭阴之虚。则病起于上而生积。清湿袭阴之虚。则病起于下而成积。此内外三部皆受
病。其积方成矣。
毋逆天时 马云。如春气在肝。及月郭空满之类。皆是也。
凡是各种疾病的发生，其起始原因多得无法计算。张云：百病的发生，无非是外感或内伤，并且又有上、中、下的区别。喜怒没有节制，这是五志致病，内伤于五脏，所以起于阴（内部）。清湿侵袭虚弱之处，这是阴邪在体表，所以起于下（下部）。风雨侵袭虚弱之处，这是阳邪在体表，所以起于上（上部）。受病的初始，只有这三个部位，至于病情逐渐蔓延扩散，那么变化就多得不可胜数了。
先师：是对前辈的尊称。
风雨寒热……分为三部：甲乙经注：“相得”作“相搏”，“肉坚”作“肉间”，“员”作“真”。马云：上文讲风雨寒暑清湿，这里讲风雨寒热，又讲疾风豪雨，言辞不同但都属于外感。然而这些外感邪气，如果不是遇到天时的虚邪，就不能伤害人。（虚邪见本经《九宫八风》等篇）如果不是遇到人体本身的正气虚弱，也不能伤害人。这是因为天的虚邪与人身形体的虚弱，两虚相遇，所以各种邪气得以客居在人体形体之中。如果天有实风（《九宫八风》篇说从居住地的方向吹来的是实风，主生长养育万物），人有实气的正气，那么两实相逢，众人肌肉坚实，邪气一定不能客居在人体形体上了。“三员”犹言“三部”。大概人体大体，从纵向来说，以上中下为三部；从横向来说，以在表、在里、半表半里为三部。所以称为上下中外的三部。张云：“三员”如下文所述，虚邪中人，病因在于表；积聚已成，病因在于内；情欲损伤脏腑，病在阴。这就是内外三部所说的意思。志云：此论风雨伤上，下一节论清湿伤下，末节论喜怒伤中，而分为三部。简案：根据有一个“外”字，张注是正确的。“员”即数量之意，所以马注解释为“部”。
因此……所以皮肤疼痛：甲乙经注：“抵”作“稍”。张云：这下面讲的是阳邪传舍的次序。邪气侵入人体，必然由表入里，始于皮肤。表虚则皮肤松弛，所以邪气得以乘虚而入。邪气在表则毛发竖立，因而感到淅沥恶寒。寒邪损伤卫气，则血气凝滞，所以皮肤疼痛。凡是寒邪所侵袭的地方，必定多有酸痛。观察属于哪一经，则在阴或在阳，或深或浅，从此就可以知道了。诊断表证的人，应当先从这方面着手。这下面关于百病始生的意义，与《皮部论》大致相同。
停留而不消除……大经才替代受邪：甲乙经注：“其痛之时息”作“其病时痛时息”。张云：邪气在皮毛，应当在外部治疗。如果停留而不消除，它进入的层次逐渐加深，就会传舍于络脉。络脉比经脉浅，所以疼痛在肌肉之间。如果肌肉的疼痛渐渐停止，这是邪气将要离开络脉而深入，大经便替代受邪了。简案：马注把“代”解释为脉代中止的意思，是不对的。志云：大经，就是经隧。经隧，就是五脏六腑的大络。大概大经就是相对于络而言的经脉，称之为大经。志注恐怕有误。
停留而不消除……容易受惊：张云：络脉浮浅，经脉隐深。邪气从络脉传入经脉，仍然算是在表，所以洒淅恶寒。然而经气连接脏腑，所以又容易受惊。
停留而不消除……肢体僵硬：甲乙经注：“四肢则肢节痛”作“四节即痛”四字。张云：凡各输穴，都是经气聚会的地方。邪气停留止息，必定在关节溪谷之间。所以邪气从经脉传舍于输穴，则六经为之不通，而肢节腰脊，出现疼痛和僵硬。
停留而不消除……身体疼痛：张云：伏冲之脉，就是行于脊柱中的衡脉。因为它最深，所以叫伏冲。《岁露》篇说：“入脊内注入伏冲之脉”就是指的这个。邪气从经输停留而不消除，深入到这里，所以出现体重身痛等疾病。简案：伏冲之脉，就是《疟论》中的伏膂之脉。马注把伏膂之脉解释为下文所说的膂筋，是错误的。
停留而不消除……大便溏泄如糜：张云：邪气从经脉传入脏腑，就会传舍于肠胃，而出现奔向腹部、腹胀的疾病。如果是寒邪，则排泄物澄澈清冷，水谷不分，所以出现肠鸣飧泄，食物不化。如果不产生热邪，则尿垢向下灌注，所以出现溏泄和如糜样的秽物。因为秽物像泥一样。简案：“麋”、“糜”古字通用，指糜烂。溏出麋，大概是指肠垢赤白滞下之类的病症。张注似乎认为是麋鹿的粪便，恐怕不对。马注说：“麋”是谷物不消化的意思，志注也同此意，那就与上文的飧泄有什么区别呢？错误尤其严重。
停留而不消除……停滞而成积聚：马云：募原之间，就是皮里膜外。张云：肠胃之外，募原之间，说的就是皮里膜外。这些都是隐蔽曲折的地方，气血不容易流通。如果邪气留着在中焦，则停滞而成积聚，像疟疾之类。志云：募原是肠胃外面的膏膜。楼氏《纲目》采纳这种说法。所以虚邪侵入人体，到了舍于肠胃之外、募原之间作为一个段落。注解说：以上几种情况，都是邪气侵袭虚弱之处，停留而不能解除离去，依次相传，未曾留着，没有固定所在。如果留着而有固定所在，就不能传变了。所谓留着，应当像下文所说的那样。
或者附着于孙脉……不可胜数论述：甲乙经注：“孙脉”作“孙络”。志云：伏冲，是伏行于腹部的冲脉。募原，是肠胃的脂膜。膂筋，是附着于脊背的筋。缓筋，是循行于腹内的筋。这几个部位，位于肠胃的前后左右，邪气随着停留而形成积聚。邪气的淫溢，多得不可胜数。简案：张云：募原像手太阴肺经的中腑为募，太渊为原之类。缓筋，是分支的柔筋。这种说法不可取。志注是正确的。大概缓筋就是宗筋。王氏《痿论》注说：横骨上下齐两旁竖筋，是正宗筋。这可以证明下文所说：其附着于缓筋的，像是阳明经的积聚，乃与《痿论》中“冲脉者，经脉之海也，主渗灌溪谷，与阳明合于宗筋”相符。
手臂手部……所以时常剧烈疼痛：甲乙经注：“臂手”作“擘乎”（注云擘音拍，意为破尽），“句”作“拘”。肠胃之间，“之间”作“外”，无“水”字。上有“腹”字，无“张”字。张云：凡细小的络脉，都是孙络。“句”即“拘”。邪气附着于孙络形成积聚，这个积聚能够往来上下。大概积在大肠小肠的络脉，都属手经。其络脉浮浅，弛缓而不紧急，不能拘束积聚而使其留止，所以移行于肠胃之间。如果有水液，则凑集渗透灌注，发出濯濯的声音。如果有寒气，则出现胀满及雷鸣声，相互牵引时出现剧烈疼痛。简案：“臂手”作“擘”，在义理上更容易通顺。
其附着于阳明经……反而变小：张云：足阳明经，挟脐下行，所以它形成的积聚则挟脐而居。阳明属胃，接受水谷之气，所以饱食时积聚变大，饥饿时积聚变小。
其附着于缓筋……饥饿时舒适：张云：缓筋在肌肉之间，所以看起来像阳明经的积聚。饱食时肌肉壅塞所以疼痛，饥饿时气退所以舒适。志云：缓筋是经行于腹内的筋，所以有类似阳明经积聚的表现。饱食时胀所以疼痛，饥饿时静止所以舒适。
其附着于肠胃的募原……饥饿时疼痛：张云：肠胃募原，疼痛牵连缓筋。饱食时内部充实外部舒展所以舒适，饥饿时相反所以疼痛。志云：募原是肠胃的膏膜。饱食时津液渗透滋润于外部，所以舒适。饥饿时干燥所以疼痛。
其附着于伏冲之脉……像热水浇灌的样子：张云：伏冲的意义如前所述。其上行者循行于背部里面，联络于督脉。其下行者，注入少阴的大络，出于气街，循行于大腿内侧，进入腘中。所以用手揣摸按压腹部（旧本作股，今改为腹），则应手而动。如果抬起手，则热气上行于两腿之间。这是邪气附着于伏冲之脉的验证。马云：用手揣摸它的积聚，应手而动，举手则热气下于两腿之间。简案：《举痛论》说：“寒气客于冲脉，则脉不通，则气因之，故喘动应手矣。”就是这个意思。
其附着于膂筋……按压也摸不到：张云：膂吕同字，指脊骨。脊骨里面的筋叫膂筋。所以在肠胃之后。饥饿时肠空，所以积聚可见；饱食时肠满遮蔽它，所以积聚不可见。按压也摸不到。
其附着于输之脉……孔窍干燥壅塞：张云：输脉，是用来通行血气的。如果闭塞不通，津液就会像这样干燥壅塞。志云：输之脉，是转输津液的脉，是脏腑的大络。胃腑水谷的精微，从胃的大络，注入脏腑的大络，从脏腑的大络，而出于皮肤。所以积聚附着于输之脉，则脉道闭塞不通，津液不下，而皮毛的化生孔窍干燥堵塞。这是邪气从外而入，从上而下，从而形成积聚。
这些邪气从外入内，从上到下：张云：这是总结上文邪气起于阳者，必然自外而内，自上而下。楼云：这是说风雨侵袭阴分的虚弱，病起于上而积聚生成。
厥气于是形成积聚：甲乙经在“厥”下有“止”字。张云：这下面讲积聚之所以形成的原因。
厥气产生于足部……日益形成积聚：甲乙经两个“ ”字作“溢”。张云：这讲寒气下逆形成积聚的情况。厥气，就是逆气。寒气逆于下部，所以产生足部 痹，指肢节疼痛滞涩，不便利。由于小腿寒冷导致血气凝涩，则寒气自下而上，逐渐进入肠胃。肠胃寒冷则阳气不能运化，所以出现 胀气。而肠外的汁沫逼迫聚集不散，则日益形成积聚。
突然多食饮……而积聚形成：张云：这讲饮食起居失节形成积聚的情况。突然多食饮，指进食不缓慢，多且暴急。肠胃运化不及，则汁液溢出膜外，与血液相互传变，于是形成食积，像婴幼儿痞疾之类就是。又或者起居用力过度，导致损伤阴阳的络脉，引起血瘀。血液得到寒气和汁沫相聚于肠外，于是形成血积。这一定是放纵口腹之欲，以及举动不慎的人，大多会有这种情况。马云：如果阳经的络脉受伤，则血液应当外溢而为衄血；如果阴经的络脉受伤，则血液应当内溢而去后有瘀血。志云：阳络是上行的络脉，阴络是下行的脉络。
突然外部受寒……积聚都形成了：甲乙经：“忧怒”作“忧恐”，“六输”作“穴输”，“蕴里”作“蕴裹”，“涩渗”作“凝涩”。张云：这讲情志内伤，夹杂寒气形成积聚的情况。寒邪既然中于外部，忧怒又损伤内部。气因寒而逆乱，则六经的输穴不通。暖气不行，则阴血凝聚。血因气逆而形成积聚。这一定是性情乖戾的人，大多会有这种情况。楼云：这是说清湿侵袭阴分的虚弱，病起于下而形成积聚。简案：甲乙经的“六”、“字”、“里”三字并误。
忧思伤心……伤肾：甲乙经“浴下”有“水”字。张云：伤心，病在阳；伤肺，病在气；伤肝，病在血；伤脾，病在营卫；伤肾，病在真阴。凡是损伤脏腑的，都是病生于阴。这一节与下编《邪气脏腑病形论》大致相同。楼云：这是说喜怒损伤脏腑，病起于阴。风雨侵袭阴分的虚弱，则病起于上而生积聚；清湿侵袭阴分的虚弱，则病起于下而成积聚。这内外三部都受到病邪，其积聚才形成。
The origins of all diseases are countless. Zhang Yun: The onset of various diseases stems either from external pathogens or internal injuries, and can be categorized into upper, middle, and lower regions. Unregulated emotions (anger, joy, worry, pensiveness, fear) constitute disorders of the Five Zang emotions, causing internal injury to the Zang organs; thus, they originate from the Yin (interior). Clear dampness invading deficiency constitutes Yin pathogens on the exterior; thus, they originate from below. Wind and rain invading deficiency constitute Yang pathogens on the exterior; thus, they originate from above. The initial sites of disease are limited to these three areas. However, as the pathogen infiltrates and spreads, the variations become incalculable.
"Former Master": A respectful term for a senior teacher.
Wind, rain, cold, and heat... divided into three sections: Jia Yi text notes: "Xiang de" (mutual meeting) is read as "Xiang bo" (mutual combat); "Rou jian" (firm flesh) is read as "Rou jian" (between muscles); "Yuan" is read as "Zhen" (true). Ma Yun: The previous section discusses wind, rain, cold, heat, clear air, and dampness, while this section mentions wind, rain, cold, heat, and violent storms. Although the terminology differs, they all belong to external infections. However, these external pathogens cannot harm the human body unless they coincide with the "deficient evil" (Xu Xie, pathological factors arising from abnormal seasonal climates) of heaven. (See *Jiu Gong Ba Feng* chapter in this classic). Nor can they harm the body without the inherent deficiency of human Qi. It is the convergence of heavenly deficiency and bodily deficiency that allows various pathogens to lodge within the physical form. If there is a "real wind" (Shi Feng, winds coming from the direction of residence, which promote growth and nourishment, as described in *Jiu Gong Ba Feng*), and the person possesses robust Qi, then two realities meet. With firm flesh and robust constitution, pathogens cannot lodge in the body. "San Yuan" (Three Rounds/Sections) refers to the "Three Parts." Generally speaking, longitudinally, the human body is divided into upper, middle, and lower parts; transversely, it is divided into exterior, interior, and half-exterior/half-interior. Hence, they are called the three sections of upper/lower and middle/exterior. Zhang Yun: As mentioned later, when deficient evil invades, the cause is exterior; when accumulation forms, the cause is interior; when desires injure the Zang organs, the disease is in Yin. This refers to the three sections of interior/exterior. Zhi Yun: This passage discusses wind/rain injuring the upper part; the next section discusses clear/damp injuring the lower part; the final section discusses emotions injuring the middle part, thereby dividing them into three sections. Brief note: Based on the character "Wai" (external), Zhang's annotation is correct. "Yuan" means number/count, so Ma's interpretation as "part/section" is appropriate.
Therefore... leading to skin pain: Jia Yi text notes: "Di" is read as "Shao" (slightly). Zhang Yun: The following describes the sequence of transmission and lodging of Yang pathogens. Pathogens entering the body must move from the exterior to the interior, starting at the skin. When the exterior is deficient, the skin becomes lax, allowing pathogens to exploit this weakness. When pathogens are at the exterior, hair stands erect, causing shivering and aversion to cold. Cold pathogens damaging Wei Qi leads to stagnation of Blood and Qi, resulting in skin pain. Wherever cold pathogens invade, soreness and pain are common. By observing which meridian is involved, one can determine if it is Yin or Yang, and whether the depth is shallow or deep. In diagnosing exterior syndromes, one should start here. The meaning of the onset of diseases below aligns largely with the *Pi Bu Lun* (Treatise on Skin Regions).
Lodging and not dispersing... the Large Meridians take over: Jia Yi text notes: "Qi tong zhi shi xi" is read as "Qi bing shi tong shi xi" (pain comes and goes intermittently). Zhang Yun: When pathogens are in the hair and skin, treatment should focus on the exterior. If they remain undispersed, they penetrate deeper and lodge in the Luo Collaterals. Since Luo Collaterals are shallower than the Jing Meridians, pain occurs between the muscles. If muscle pain gradually subsides, it indicates the pathogen is leaving the Luo Collaterals to deepen further, and the Large Meridians (Da Jing) subsequently bear the burden. Brief note: Ma interprets "Dai" as intermittent pulse arrest, which is incorrect. Zhi Yun: Da Jing refers to Jing Sui (Meridian Passages). Jing Sui refers to the large collaterals of the Five Zang and Six Fu organs. Essentially, Da Jing is the term used for the main meridians in contrast to Luo Collaterals. Zhi's annotation may be erroneous.
Lodging and not dispersing... prone to fright: Zhang Yun: Luo Collaterals are superficial and floating; Jing Meridials are hidden and deep. When pathogens move from Luo Collaterals to Jing Meridians, they are still considered at the exterior, hence the shivering and aversion to cold. However, since Jing Qi connects to the Zang organs, the patient also becomes prone to fright.
Lodging and not dispersing... stiffness: Jia Yi text notes: "Si zhi ze zhi jie tong" is read as "Si jie ji tong" (four joints immediately painful). Zhang Yun: All Shu points are locations where Jing Qi gathers. Pathogens lodging here reside between the joints and valleys. Thus, when pathogens transmit from Jing Meridians to Shu points, the Six Meridians become obstructed, causing pain and stiffness in the limbs, joints, waist, and spine.
Lodging and not dispersing... body pain: Zhang Yun: The Fu Chong Mai (Hidden Chong Vessel) is the Heng Mai running along the spine. Due to its depth, it is called "Fu" (Hidden). The *Sui Lu* chapter states: "Entering the spine and injecting into the Fu Chong Mai." When pathogens lodge in the Shu points and do not disperse, penetrating deeply here, symptoms such as heavy body and body pain arise. Brief note: The Fu Chong Mai is the Fu Lv Mai (Hidden Spine Vessel) mentioned in the *Nu Lun*. Ma incorrectly identifies Fu Lv Mai as the Lv Jin (Spine Tendons) mentioned later.
Lodging and not dispersing... loose stool like paste: Zhang Yun: When pathogens enter the Zang organs from the Meridians, they lodge in the Stomach and Intestines, causing urgency, abdominal distension, and diarrhea. If Cold, the excrement is clear and cold, with undigested food and water mixing, leading to borborygmus and incomplete digestion (Sun Xie). If Heat does not dominate, turbid urine flows downward, resulting in loose stools and pasty discharge. "Mi" (paste/millet-like) refers to the muddy consistency. Brief note: "Mi" and "Mi" (millet/paste) are interchangeable in ancient texts, referring to decay/paste. "Tang chu mi" likely refers to dysentery with red and white turbid discharge. Zhang's interpretation of "Mi" as deer feces is likely incorrect. Ma defines "Mi" as undigested grain, consistent with Zhi's view, but this fails to distinguish it from the previously mentioned Sun Xie, making the error more severe.
Lodging and not dispersing... stagnation forming accumulation: Ma Yun: The Mo Yuan (Moyuan) is located between the skin and the membranes. Zhang Yun: Outside the intestines and stomach, in the Moyuan, refers to the space between the skin and the inner membranes. These are concealed and tortuous areas where Qi and Blood do not flow easily. If pathogens linger in the center, they stagnate and form accumulations, similar to Malaria. Zhi Yun: Moyuan refers to the fatty membranes outside the intestines and stomach. Lou's *Gang Mu* adopts this view. Thus, when deficient evil invades, reaching the area outside the intestines and stomach, in the Moyuan, constitutes a specific stage. The commentary notes: The aforementioned scenarios all involve pathogens attacking deficiency, lingering without resolving, and transmitting sequentially without fixed lodging. If they lodge firmly with a fixed location, transmission ceases. The concept of "lodging" is explained in the subsequent text.
Or attaching to Sun Collaterals... incalculable: Jia Yi text notes: "Sun Mai" is read as "Sun Luo". Zhi Yun: Fu Chong refers to the Chong Mai running hidden in the abdomen. Moyuan refers to the fatty membranes of the intestines and stomach. Lv Jin refers to the tendons attached to the spine. Huan Jin refers to the tendons circulating within the abdomen. These structures are located anterior, posterior, lateral, and medial to the intestines and stomach. Pathogens follow and lodge to form accumulations. The proliferation of pathogens is incalculable. Brief note: Zhang Yun suggests Moyuan is analogous to Zhong Fu (Front-Mu point of Lung) and Tai Yuan (Source point of Lung). He defines Huan Jin as soft branch tendons. This view is untenable. Zhi's annotation is correct. Huan Jin is essentially Zong Jin (Master Tendon). Wang Shi's commentary on *Wei Lun* states: Vertical tendons flanking the horizontal bone are the true Zong Jin. This corroborates the later text stating that accumulation in Huan Jin resembles Yangming accumulation, aligning with *Wei Lun*: "Chong Mai is the Sea of Meridians, governing seepage and irrigation of valleys, combining with Yangming at the Zong Jin."
Arms and hands... causing frequent sharp pain: Jia Yi text notes: "Bi Shou" is read as "Bo Hu" (note: Bo sounds like 'pai', meaning to break apart); "Ju" is read as "Ju" (to constrain/twist). Between the intestines and stomach, "zhi jian" is read as "wai" (outside), omitting "shui" (water). Above is "fu" (abdomen), omitting "Zhang". Zhang Yun: All fine collaterals are Sun Collaterals. "Ju" means constraint. When pathogens attach to Sun Collaterals to form an accumulation, the mass can migrate up and down. Accumulations in the collaterals of the Large and Small Intestines belong to the Hand Meridians. These collaterals are superficial and lax, unable to constrain the accumulation, causing it to shift between the intestines and stomach. If fluid is present, it gathers and permeates, producing gurgling sounds ("Zhuo Zhuo"). If Cold is present, it causes distension and borborygmus ("Lei Ming"), and mutual traction results in sharp pain. Brief note: Reading "Bi Shou" as "Bo" makes the meaning clearer.
Attaching to the Yangming Meridian... becoming smaller: Zhang Yun: The Foot Yangming Meridian descends alongside the navel. Therefore, its accumulation resides beside the navel. Yangming belongs to the Stomach, which receives Qi from food and drink. Thus, after eating, the accumulation enlarges; when hungry, it shrinks.
Attaching to the Huan Jin... comfort when hungry: Zhang Yun: Huan Jin lies within the muscles, resembling Yangming accumulation. After eating, muscle congestion causes pain; when hungry, Qi recedes, bringing relief. Zhi Yun: Huan Jin are tendons circulating within the abdomen, resembling Yangming accumulation. Distension after eating causes pain; stillness when hunger brings comfort.
Attaching to the Moyuan of the intestines and stomach... pain when hungry: Zhang Yun: Pain in the intestinal Moyuan radiates to the Huan Jin. Fullness after eating expands internally and externally, bringing comfort; emptiness when hungry causes pain. Zhi Yun: Moyuan are the fatty membranes of the intestines and stomach. After eating, fluids seep and moisten externally, bringing comfort; dryness when hungry causes pain.
Attaching to the Fu Chong Mai... feeling like hot water pouring: Zhang Yun: The nature of Fu Chong is as described earlier. Its ascending branch runs along the interior of the back, connecting to the Du Mai. Its descending branch injects into the large collateral of Shaoyin, emerges at Qichuang (Gas Street), follows the medial aspect of the thigh, and enters the popliteal fossa. Pressing the abdomen (old text: thigh, corrected to abdomen) elicits movement under the hand. Lifting the hand causes warm Qi to rise between the thighs. This confirms pathogen attachment to the Fu Chong Mai. Ma Yun: Palpating the accumulation yields pulsation under the hand; lifting the hand causes warm Qi to descend between the thighs. Brief note: *Ju Tong Lun* states: "When Cold Qi lodges in the Chong Mai, the vessels become obstructed, Qi follows, causing panting and pulsation palpable under the hand." This explains the phenomenon.
Attaching to the Lv Jin... unpalpable: Zhang Yun: "Lv" and "Lu" are identical, referring to the vertebral column. The tendons inside the spine are called Lv Jin. Located behind the intestines and stomach, when hungry, the intestines are empty, making the accumulation visible; when full, the intestines are distended and obscure it, making the accumulation invisible. It cannot be felt upon palpation.
Attaching to the Shu Meridians... dry and obstructed orifices: Zhang Yun: Shu Meridians transport Blood and Qi. Obstruction leads to dryness and stagnation of Body Fluids as described. Zhi Yun: Shu Meridians transport Body Fluids and are the large collaterals of the Zang-Fu. Essence from food and drink in the Stomach passes through the Stomach's large collateral to the Zang-Fu's large collaterals, and finally emerges in the skin. When accumulation attaches to the Shu Meridians, the vessel pathway becomes blocked, Body Fluids fail to descend, and the pores of the skin and hair become dry and clogged. This illustrates how pathogens enter from the exterior and descend from above to form accumulations.
These pathogens enter from the exterior and descend from above: Zhang Yun: This summarizes the preceding discussion: pathogens originating from Yang inevitably move from exterior to interior and from top to bottom. Lou Yun: This refers to wind and rain invading the deficiency of Yin, causing disease to start from above and generate accumulation.
Jue Qi then forms accumulation: Jia Yi text adds "Zhi" after "Jue". Zhang Yun: The following explains the formation of accumulation.
Jue Qi arises in the feet... gradually forming accumulation: Jia Yi text reads two " " characters as "Yi". Zhang Yun: This describes accumulation formed by rebellious Cold Qi. Jue Qi is rebellious Qi. Cold rebels in the lower body, causing foot Bi (obstruction), characterized by joint pain, stiffness, and inconvenience. Cold calves lead to stagnant Qi and Blood. Cold Qi moves upward from below into the intestines and stomach. Cold in the intestines and stomach prevents Yang Qi transformation, causing distension. Juice and phlegm outside the intestines are forced together and do not disperse, gradually forming accumulation.
Sudden excessive eating and drinking... accumulation forms: Zhang Yun: This describes accumulation caused by irregular diet and lifestyle. Sudden excessive intake implies rapid,暴饮暴食 (bingyinbao shi - binge eating/drinking). The intestines and stomach cannot digest it promptly, causing juices to overflow into the membranes and mix with Blood, forming Food Accumulation (e.g., pediatric痞疾 pi ji). Alternatively, excessive physical exertion damages the collaterals of Yin and Yang, causing Blood stasis. Blood combines with Cold and juices outside the intestines, forming Blood Accumulation. This is common in those who indulge their appetites and act recklessly. Ma Yun: Injury to Yang meridian collaterals causes external bleeding (nu); injury to Yin meridian collaterals causes internal bleeding and residual blood stasis. Zhi Yun: Yang collaterals ascend; Yin collaterals descend.
Sudden external Cold invasion... accumulation forms: Jia Yi text: "You Nu" is read as "You Kong"; "Liu Shu" as "Xue Shu"; "Yun Li" as "Yun Guo"; "Se Shen" as "Ning Se". Zhang Yun: This describes accumulation caused by emotional internal injury combined with Cold. External Cold attacks, while sorrow and anger injure the interior. Qi rebels due to Cold, blocking the Shu points of the Six Meridians. Warm Qi fails to circulate, causing Yin Blood to coagulate. Blood forms accumulation due to Qi rebellion. This is common in individuals with volatile temperaments. Lou Yun: This refers to clear dampness invading the deficiency of Yin, causing disease to start from below and form accumulation. Brief note: The characters "Liu", "Zi", and "Li" in Jia Yi are errors.
Sorrow and thought injure the Heart... Kidney injured: Jia Yi text adds "Shui" after "Yu Xia". Zhang Yun: Injury to the Heart affects Yang; injury to the Lung affects Qi; injury to the Liver affects Blood; injury to the Spleen affects Ying and Wei; injury to the Kidney affects True Yin. Any injury to the Zang organs results in disease originating from Yin. This section aligns with *Xie Qi Zang Fu Bing Xing Lun*. Lou Yun: This describes emotions injuring the Zang, with disease originating from Yin. Wind/rain invading Yin deficiency starts disease from above; clear/damp invading Yin deficiency starts disease from below. Only when all three sections (exterior/interior) are affected does accumulation fully form.
Do not violate the timing of Heaven: Ma Yun: For example, Spring Qi resides in the Liver, and the phases of the moon (waxing/waning) are relevant. These are examples.