（灵枢百病始生篇 全）
黄帝问于岐伯曰∶夫百病之始生也，皆生于风雨寒暑，清湿喜怒。喜怒不节则伤藏，风雨则伤上，清湿则伤下。三
部之气所伤异类，愿闻其会。岐伯曰∶三部之气各不同，或起于阴，或起于阳，请言其方。喜怒不节则伤藏，藏伤则病
起于阴也；清湿袭虚，则病起于下；风雨袭虚，则病起于上，是谓三部。至于其淫 ，不可胜数。（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，内伤于藏，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。 音逸。）黄帝曰∶余固不
能数，故问先师，愿卒闻其道。（先师，先进之称也。）岐伯曰∶风雨寒热，不得虚邪不能独伤人。卒然逢疾风豪雨而不
病者，盖无虚，故邪不能触伤人，此必因虚邪之风，与其身形，两虚相得，乃客其形，两实相逢，众人肉坚。其中于虚
邪也，因于天时，与其身形，参以虚实，大病乃成，气有定舍，因处为名，上下中外，分为三员。（从冲后来者为虚风，
伤人者也。从所居之乡来者为实风，主生长养万物者也。若人气不虚，虽遇虚风，不能伤人。故必以身之虚而逢天之虚，
两虚相得，乃客其形也。若天有实风，人有实气，两实相逢而众人肉坚，邪不能入矣。三员，如下文虚邪之中人，病因
表也；积聚之已成，病因内也；情欲之伤藏，病在阴也，即内外三部之谓。虚风义详运气类三十五、六。）
是故虚邪之中人也，始于皮肤，皮肤缓则腠理开，开则邪从毛发入，入则抵深，深则毛发立，毛发立则淅然，故皮
肤痛。（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，详经络类三十一。）留而不去，则传舍于络脉，在络
之时，痛于肌肉，其痛之时息，大经乃代。（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。）留而不去，传舍于经，在经之时，洒淅喜惊。
（络浮而浅，经隐而深，邪气自络入经，犹为在表，故洒淅恶寒。然经气连脏，故又喜惊也。）留而不去，传舍于输，在
输之时，六经不通，四肢则肢节痛，腰脊乃强。（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，传舍于伏冲之脉，在伏冲之时，体重身痛。（伏冲
之脉，即冲脉之在脊者，以其最深，故曰伏冲，岁露篇曰入脊内注于伏冲之脉是也。详本类后四十九。邪自经输，留而
不去，深入于此，故为体重身痛等病。）留而不去，传舍于肠胃，在肠胃之时，贲向腹胀，多寒则肠鸣飧泄食不化，多热
则溏出麋。（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；热则浊
垢下注，故为溏为麋，以麋秽如泥也。）留而不去，传舍于肠胃之外，募原之间，留着于脉，稽留而不去，息而成积。（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，如疟痞之属也。
募音暮。）
或着孙脉，或着络脉，或着经脉，或着输脉，或着于伏冲之脉，或着于膂筋，或着于肠胃之募原，上连于缓筋，邪
气淫 ，不可胜论。（此下言邪气所着，淫 之变也。膂筋详下文。募原，如手太阴中府为募、太渊为原之类也。缓筋，
支别之柔筋也。邪之所着则留而为病，无处不到，故淫 不可胜数。膂音吕。 音逸。）黄帝曰∶愿尽闻其所由然。岐伯
曰∶其着孙络之脉而成积者，其积往来上下，臂手孙络之居也，浮而缓，不能句积而止之，故往来移行肠胃之间，水凑
渗注灌，濯濯有音，有寒则 胀满雷引，故时切痛。（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。句音垢。 音嗔。）其着于阳明之经，则挟脐而居，
饱食则益大，饥则益小。（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，似阳明之积，饱食则痛，饥则安。（缓筋在肌肉之间，故似阳明之积。饱则肉壅，故痛。饥则气退，故安。）
其着于肠胃之募原也，痛而外连于缓筋，饱食则安，饥则痛。（肠胃募原痛连缓筋，饱则内充外舒，故安。饥则反是，故
痛。）其着于伏冲之脉者，揣之应手而动，发手则热气下于两股，如汤沃之状。（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。故揣按于股，则应手而动；若起其手，则热气下行于
两股间。此邪着伏冲之验也。沃音屋。）其着于膂筋在肠后者，饥则积见，饱则积不见，按之不得。（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，闭塞不通，津液不下，孔窍干壅。（输脉者，所以通血气。若闭塞不通，则津液干壅如此。）此邪气之从外入内，从
上下也。（此总结上文邪气之起于阳者，必自外而内，从上而下也。）
黄帝曰∶积之始生，至其已成奈何？岐伯曰∶积之始生，得寒乃生，厥乃成积也。（此下言积之所以成也。）黄帝曰∶
其成积奈何？岐伯曰∶厥气生足 ， 生胫寒，胫寒则血脉凝涩，血脉凝涩则寒气上入于肠胃，入于肠胃则 胀， 胀
则肠外之汁沫迫聚不得散，日以成积。（此言寒气下逆之成积者也。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。 ，美本切。胫，形景、形敬二切。）卒然多食饮则肠满，起居不节，用力过度，则络脉伤，阳络伤则血外溢，
血外溢则衄血，阴络伤则血内溢，血内溢则后血，肠胃之络伤，则血溢于肠外，肠外有寒汁沫与血相抟，则并合凝聚不
得散而积成矣。（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
血相抟，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。）卒然外中于寒，若内伤于忧怒，则气上逆，气上逆则六输不通，温气不
行，凝血蕴里而不散，津液涩渗，着而不去，而积皆成矣。（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。）
黄帝曰∶其生于阴者奈何？（此言情欲伤藏，病起于阴也。）岐伯曰∶忧思伤心；重寒伤肺；忿怒伤肝；醉以入房，
汗出当风伤脾；用力过度，若入房汗出浴则伤肾。（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。）此内外三部之所生病者也。（总结上文
也。）黄帝曰∶善。治之奈何？岐伯答曰∶察其所痛，以知其应，有余不足，当补则补，当泻则泻，毋逆天时，是谓至治。
（此总言内外三部之治法也。察其所痛之处，则阴阳表里病应可知。虚补实泻，毋逆天时，如春气在肝、及月郭空满之
类皆是也。）
《灵枢·百病始生篇》（全文）
黄帝向岐伯问道：各种疾病的发生，都源于风雨寒暑、清湿以及喜怒情绪。如果喜怒情绪没有节制，就会损伤内脏；风雨之邪会伤害人体上部；清湿之邪会伤害人体下部。这三部之气所导致的病变各不相同，我希望听听它们是如何汇聚关联的。
岐伯回答说：三部之气的致病特点各不相同，有的起于阴分，有的起于阳分，请让我说明其规律。喜怒情绪没有节制就会损伤内脏，内脏受损则疾病起于阴分；清湿之邪侵袭虚弱之处，则疾病起于下部；风雨之邪侵袭虚弱之处，则疾病起于上部，这就称为三部。至于邪气浸淫流布产生的变化，多得数不清。（百病始生，无非外感与内伤，并且又有上、中、下的区别。喜怒不节，属于五志为病，内伤于脏腑，所以起于阴。清湿侵袭虚弱，是阴邪在体表，所以起于下。风雨侵袭虚弱，是阳邪在体表，所以起于上。受病的初始，只有这三部，等到邪气浸淫流布，变化就不可胜数了。淫音逸。）
黄帝说：我本来就不能列举尽数，所以询问先师，希望您能详尽地告诉我其中的道理。（先师，是对前辈医家的尊称。）
岐伯说：风雨寒热等邪气，如果不是虚邪贼风，就不能单独伤人。突然遭遇疾风暴雨却不生病的人，是因为体内正气不虚，所以邪气不能触动伤人。这一定是因为遇到了虚邪之风，又加上身体虚弱，两虚相合，邪气才得以客居形体。如果是实风与人体的实气相遇，众人肌肉坚实，邪气无法侵入。其中于虚邪，是由于天时气候异常，结合人体体质的虚实，大病才形成。邪气有固定的停留部位，根据停留处命名，上下内外分为三员（即三部）。（从冲后来者为虚风，是伤人的邪气。从居住之乡来者为实风，主生长养育万物。如果人气不虚，即使遇到虚风，也不能伤人。所以必须身体虚弱又逢天气虚邪，两虚相得，邪气才能客居形体。如果天有实风，人有实气，两实相逢，众人肌肉坚实，邪气不能进入。三员，如下文所述：虚邪中人，病因在表；积聚已成，病因在内；情欲伤脏，病在阴，这就是内外三部之意。虚风的含义详见运气类第三十五、三十六篇。）
因此，虚邪贼风中人，始于皮肤。皮肤松弛则腠理开泄，腠理开泄则邪气从毛发进入，进入后逐渐深入，深入则毛发竖立，毛发竖立则感到寒冷战栗，所以皮肤疼痛。（这里讲述阳邪传舍的次序。邪气中人，必由表入里，始于皮肤。表虚则皮肤松弛，所以邪气得乘。邪在表则毛发竖立，因而感到寒冷战栗。寒邪伤卫气则血气凝滞，所以皮肤疼痛。凡是寒邪侵袭之处，多有酸痛，察看在哪条经络，则在阴在阳，或深或浅，由此可知。诊察表证者，应当先从这方面入手。以下关于百病始生的意义，与皮部论大体相同，详见经络类第三十一篇。）
邪气停留不去，则传舍于络脉。在络脉之时，疼痛在肌肉之间，这种疼痛有时暂时停止，随后大经（十二正经）开始受邪。（邪在皮毛，应当治于外部。停留不去，进入逐渐加深，则传舍于络脉。络脉比经脉浅，所以痛在肌肉之间。如果肌肉的疼痛逐渐停止，说明邪气将离开络脉而深入，大经代替受邪。）
邪气停留不去，传舍于经脉。在经脉之时，出现洒淅恶寒且容易惊恐。（络脉浮浅，经脉隐深。邪气自络入经，仍属在表，所以洒淅恶寒。但经气连属脏腑，所以又容易惊恐。）
邪气停留不去，传舍于输穴。在输穴之时，六经气血不通，四肢关节疼痛，腰脊僵硬。（各种输穴，都是经气聚会之处，邪气停留，必在关节溪谷之间。所以邪气自经传舍于输，则六经为之不通，肢节腰脊出现疼痛和僵硬。）
邪气停留不去，传舍于伏冲之脉。在伏冲之时，身体沉重，全身疼痛。（伏冲之脉，即冲脉在脊柱内的部分，因为它最深，所以叫伏冲。《岁露篇》说“入脊内注于伏冲之脉”就是指的这个。详见本类第四十九篇。邪气自经输停留不去，深入于此，所以出现身体沉重、全身疼痛等疾病。）
邪气停留不去，传舍于肠胃。在肠胃之时，出现奔豚腹胀。寒气多则肠鸣、完谷不化的腹泻、食物不消化；热气多则排出稀烂污浊的大便。（邪气自经入脏，传舍于肠胃，导致奔豚腹胀的病。寒则水液清澈冷冽，水谷不分，所以肠鸣、完谷不化、食物不消化；热则浊垢下注，所以大便稀烂污浊，像泥一样。）
邪气停留不去，传舍于肠胃之外、募原之间，留着于脉中，稽留不去，逐渐形成积块。（肠胃之外，募原之间，指皮里膜外之处，这些都是隐蔽曲折的地方，气血不易流通。如果邪气留着在中焦，则停止并结成积块，如疟疾、痞块之类。募音暮。）
或者邪气附着于孙脉，或者附着于络脉，或者附着于经脉，或者附着于输脉，或者附着于伏冲之脉，或者附着于膂筋，或者附着于肠胃的募原，向上连接于缓筋。邪气浸淫流布，多得无法论述。（这里讲述邪气所着之处及浸淫的变化。膂筋详见下文。募原，如手太阴肺经的中府为募、太渊为原之类。缓筋，是支别出来的柔筋。邪气所着则停留成为疾病，无处不到，所以浸淫变化不可胜数。膂音吕。淫音逸。）
黄帝说：希望听您详尽说明其产生的原因。
岐伯说：邪气附着于孙络而成积的，其积块往来上下移动，位于手臂孙络所在之处。孙络浮浅而松弛，不能拘束积块使其停止，所以积块在肠胃之间移行。如果有水饮，则凑渗注灌，发出濯濯的声音；如果有寒气，则胀满雷鸣牵引，时常剧烈疼痛。（凡是细小的络脉，都叫孙络。邪着孙络成积，其积能往来上下，大概积在大肠小肠的络脉，都属于手经。这些络脉浮浅，松弛而不紧急，不能拘束积块使其停留，所以移行于肠胃之间。如果有水，则凑渗注灌，发出声音；如果有寒，则胀满，以及雷鸣相引，时常切痛。句音垢。 音嗔。）
邪气附着于阳明经，则积块挟脐而居，饱食时积块变大，饥饿时积块变小。（足阳明胃经挟脐下行，所以其形成的积块挟脐而居。阳明属胃，受纳水谷之气，所以饱食时变大，饥饿时变小。）
邪气附着于缓筋，症状类似阳明经的积块，饱食时疼痛，饥饿时缓解。（缓筋在肌肉之间，所以类似阳明经的积块。饱食时肌肉壅塞，所以疼痛。饥饿时气退，所以缓解。）
邪气附着于肠胃的募原，疼痛并向外牵连缓筋，饱食时缓解，饥饿时疼痛。（肠胃募原疼痛牵连缓筋，饱食时内部充盈外部舒展，所以缓解。饥饿时相反，所以疼痛。）
邪气附着于伏冲之脉的，用手揣按感觉跳动，抬手后热气下行至两大腿，像热水浇灌的样子。（伏冲的含义如前所述。其上行者，沿背里，联络督脉；其下行者，注入少阴的大络，出于气街，沿大腿内侧进入腘中。所以在股部揣按，则应手跳动；如果抬起手，则热气下行于两腿间。这是邪气附着伏冲的征象。沃音屋。）
邪气附着于膂筋且在肠后的，饥饿时积块可见，饱食时积块不可见，按压也摸不到。（膂，同吕，指脊骨。脊内的筋叫膂筋，所以在肠胃之后。饥饿时肠空，所以积块可见。饱食时肠满遮蔽它，所以积块不可见，按压也摸不到。）
邪气附着于输脉的，闭塞不通，津液不下，孔窍干燥壅塞。（输脉是用来通行血气的。如果闭塞不通，津液就会像这样干枯壅塞。）
以上是邪气从外入内、从上往下的情况。（这里总结上文邪气起于阳者，必自外而内，从上而下。）
岐伯说：积块的生成，得到寒气才开始产生，气机逆乱才形成积块。（这里讲述积之所以形成的原因。）
岐伯说：厥逆之气产生足部痿弱，寒气产生小腿寒冷，小腿寒冷则血脉凝涩，血脉凝涩则寒气上入肠胃，进入肠胃则引起胀满，胀满则肠外的汁沫被迫聚集不得消散，日久形成积块。（这里讲述寒气下逆形成积块。厥气，即逆气。寒逆于下，所以产生足部痿弱，指肢节疼痛滞涩不便。由于小腿寒冷导致血气凝涩，寒气自下而上渐入肠胃，肠胃寒则阳气不化，所以发生胀满。肠外汁沫被迫聚集不散，则日久形成积块。 美本切。胫，形景、形敬二切。）
突然暴饮暴食则肠满，起居无节制，用力过度，则络脉受伤。阳络受伤则血液外溢，血液外溢则鼻衄或吐血；阴络受伤则血液内溢，血液内溢则便血。肠胃的络脉受伤，则血液溢出到肠外，肠外有寒气、汁沫与血液相互搏结，并合凝聚不得消散，从而形成积块。（这里讲述饮食起居失节形成积块。突然多食饮，指进食不缓慢，多而急。肠胃运化不及，则汁液溢出膜外，与血液相搏，乃成食积，如婴幼儿痞疾之类。又或者起居用力过度，致使阴阳之络受伤而动血，瘀血得寒，汁沫相聚于肠外，乃成血积，这多见于放纵口腹及举动不慎的人。）
突然外感寒邪，或者内伤于忧怒，则气机上逆。气机上逆则六经输穴不通，温煦之气不行，凝血蕴积在里面不得消散，津液涩滞渗透，附着不去，积块就形成了。（这里讲述情志内伤兼夹寒气形成积块。寒邪既中于外，忧怒又伤其内，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，这多见于性情乖戾的人。）
黄帝说：那些生于阴分的疾病是怎么回事？（这里讲述情欲伤脏，病起于阴。）
岐伯说：忧愁思虑伤心；重寒伤肺；忿怒伤肝；醉酒后行房事，汗出当风伤脾；用力过度，或者房事后汗出洗澡伤肾。（伤心则病在阳，伤肺则病在气，伤肝则病在血，伤脾则病在营卫，伤肾则病在真阴。凡是伤脏的，都是病生于阴。这一节与下编《邪气脏腑病形论》大体相同。）
这就是内外三部所发生的疾病。（总结上文。）
黄帝说：好。怎么治疗呢？
岐伯回答说：观察患者疼痛的部位，以推断病变的反应，辨别有余和不足，应当补的就补，应当泻的就泻，不要违背天时，这就叫做最高明的治疗。（这里总述内外三部的治疗方法。观察疼痛之处，则阴阳表里病应可知。虚则补之，实则泻之，不要违背天时，如春气在肝、以及月郭空满之类的原则皆是如此。）
*Lingshu: Hundred Diseases Originate* (Full Text)
Huangdi asked Qibo: The origin of all diseases arises from wind, rain, cold, and heat; clear dampness; and joy and anger. If joy and anger are not regulated, they damage the Zang organs; wind and rain damage the upper part of the body; clear dampness damages the lower part. The pathogenic factors in these three regions differ in their nature. I wish to hear how they converge.
Qibo replied: The pathogenic factors in the three regions are different; some originate from the Yin, and some from the Yang. Let me explain their principles. If joy and anger are not regulated, they damage the Zang organs; when the Zang organs are damaged, disease originates from the Yin. Clear dampness attacks deficiency, so disease originates from the lower part; wind and rain attack deficiency, so disease originates from the upper part. This is called the Three Regions. As for the overflowing and spreading [of pathogens], it is countless. (The origin of all diseases involves neither external contraction nor internal injury alone, but also has distinctions among the upper, middle, and lower parts. Unregulated joy and anger constitute disorders of the Five Emotions, damaging the Zang internally, thus originating from the Yin. Clear dampness attacking deficiency represents Yin pathogens on the exterior, thus originating from below. Wind and rain attacking deficiency represent Yang pathogens on the exterior, thus originating from above. The initial reception of disease lies only in these three regions; however, once the pathogens overflow and spread, the changes become incalculable. *Yin* sounds like 'yi'.)
Huangdi said: I certainly cannot enumerate them all, which is why I ask my predecessors. I hope you will exhaustively explain this principle. (Predecessors refer to senior masters.)
Qibo said: Wind, rain, cold, and heat cannot harm people independently unless they are *Xu Xie* (Deficient Pathogens/Empty Winds). Those who suddenly encounter fierce winds and heavy rains without falling ill do so because their interior Qi is not deficient, so pathogens cannot touch them. This occurs only when one encounters *Xu Xie* winds while the body is in a state of deficiency; the two deficiencies meeting allows the pathogen to lodge in the form. If real winds meet with robust human Qi, the masses have firm flesh, and pathogens cannot enter. Contracting *Xu Xie* depends on the timing of heaven and the constitution of the body, combined with excess or deficiency, leading to major illness. Qi has fixed abodes, and names are given according to location, divided into upper, lower, and outer/inner as three components (*San Yuan*). (Coming from the direction opposite to the prevailing wind is *Xu Feng* (Empty Wind), which harms people. Coming from the inhabited direction is *Shi Feng* (Real Wind), which governs growth and nourishment. If human Qi is not deficient, even encountering Empty Wind cannot harm. Thus, bodily deficiency must meet heavenly deficiency; the two deficiencies meeting allows the pathogen to lodge. If heaven has Real Wind and humans have Real Qi, the two realities meeting results in firm flesh, and pathogens cannot enter. *San Yuan* refers to: *Xu Xie* entering people, etiology on the exterior; formed accumulations, etiology on the interior; emotional desires damaging Zang, pathology in Yin—this is the meaning of the three internal/external regions. The meaning of Empty Wind is detailed in the Luck Class, chapters 35 and 36.)
Therefore, when *Xu Xie* enters a person, it begins at the skin. If the skin is lax, the pores open; if the pores open, pathogens enter through the hair; upon entering, they reach depth; at depth, the hair stands erect; when hair stands erect, one feels chilly, hence skin pain. (This section below describes the sequence of transmission of Yang pathogens. Pathogens entering a person must go from exterior to interior, starting at the skin. Exterior deficiency causes skin laxity, allowing pathogens to take advantage. When pathogens are at the exterior, hair stands erect, causing chills. Cold pathogens damaging Wei Qi cause blood and Qi stagnation, resulting in skin pain. Wherever cold pathogens strike, there is often soreness and pain; observing which meridian is involved reveals whether it is Yin or Yang, deep or shallow. For diagnosing exterior syndromes, one should start here. The meaning of the origin of all diseases below is largely consistent with the Pi Bu Lun, detailed in the Meridian Class, chapter 31.)
If it remains and does not depart, it transmits to the Luo Collaterals. At this stage, pain is felt in the muscles; the pain may cease intermittently, after which the Large Meridians (Twelve Primary Meridians) take over. (When pathogens are in the skin and hair, treatment should be external. If remaining and not departing, entry becomes deeper, transmitting to the Luo Collaterals. Since collaterals are shallower than meridians, pain is felt between muscles. If muscle pain gradually ceases, it indicates pathogens are leaving the collaterals to deepen, and the Large Meridians assume the burden.)
If it remains and does not depart, it transmits to the Jing Meridians. At this stage, one experiences shivering aversion to cold and frequent fright. (Collaterals are floating and superficial; meridians are hidden and deep. Pathogens entering meridians from collaterals remain at the exterior, hence shivering aversion to cold. However, since meridian Qi connects to the Zang organs, fright also occurs.)
If it remains and does not depart, it transmits to the Shu Points. At this stage, the Six Meridians are blocked, causing pain in the limbs and joints, and stiffness in the waist and spine. (All Shu points are places where meridian Qi gathers. Where it stays, it must be in the joints and valleys. Thus, when pathogens transmit from meridians to Shu points, the Six Meridians become blocked, causing pain and stiffness in the limbs, joints, waist, and spine.)
If it remains and does not depart, it transmits to the Fu Chong Mai (Hidden Chong Vessel). At this stage, there is heaviness of the body and whole-body pain. (The Fu Chong Mai is the portion of the Chong Mai within the spine; because it is deepest, it is called Hidden. The Sui Lu Pian states "enters the spine and pours into the Fu Chong Mai." See Chapter 49 of this class. Pathogens staying from meridians and Shu points deepen here, causing symptoms like body heaviness and pain.)
If it remains and does not depart, it transmits to the Stomach and Intestines. At this stage, there is abdominal distension and rushing sensations. With excessive cold, there is borborygmus, undigested stool diarrhea, and food not transforming; with excessive heat, there is loose, foul-smelling discharge. (Pathogens entering Zang from meridians transmit to the stomach and intestines, causing rushing and abdominal distension. Cold leads to clear and cold fluids, failure to separate water and grain, hence borborygmus, undigested stool, and indigestion; heat leads to turbid filth flowing downward, hence loose and muddy stools.)
If it remains and does not depart, it transmits outside the stomach and intestines, to the Mu Yuan (Muo-Original), lingering in the vessels. If it lingers and does not depart, it slowly forms an accumulation. (Outside the stomach and intestines, in the Mu Yuan, refers to the space between skin and fascia. These are concealed and winding places where Qi and Blood do not flow easily. If pathogens linger inside, they stop and form accumulations, such as malaria or痞块 (masses). *Mu* sounds like 'mu'.)
Or pathogens attach to Sun Collaterals, or Luo Collaterals, or Jing Meridians, or Shu Meridians, or Fu Chong Mai, or Lü Jin (Spinal Muscles/Tendons), or the Mu Yuan of the stomach and intestines, connecting upwards to Huan Jin (Relaxed Tendons). The overflowing and spreading of pathogens is too numerous to discuss. (This section below discusses where pathogens attach and the variations of overflowing. Lü Jin is detailed below. Mu Yuan, for example, Zhongfu is Mu and Taiyuan is Yuan for the Hand Taiyin Lung Meridian. Huan Jin are branched soft tendons. Wherever pathogens attach, they stay and cause disease, reaching everywhere, hence overflowing changes are incalculable. *Lü* sounds like 'lü'. *Yin* sounds like 'yi'.)
Huangdi said: I wish to hear completely why this happens.
Qibo said: When pathogens attach to Sun Collaterals forming an accumulation, the accumulation moves up and down. It resides in the arm Sun Collaterals, which are floating and lax, unable to constrain the accumulation to stop it; thus, it migrates between the stomach and intestines. If water gathers, it seeps and pours, making a gurgling sound; if cold is present, there is distension and thunder-like pulling pain, causing sharp pain occasionally. (All fine collaterals are called Sun Collaterals. Ju means to constrain. When pathogens attach to Sun Collaterals forming accumulation, the accumulation can move up and down, likely residing in the collaterals of the Large and Small Intestines, belonging to the Hand Meridians. These collaterals are floating, shallow, lax, and not urgent, unable to constrain the accumulation, so it migrates between the stomach and intestines. If there is water, it seeps and pours, making sound; if there is cold, there is distension and thunder-like pulling, causing occasional sharp pain. *Ju* sounds like 'gou'. *Chen* sounds like 'chen'.)
When pathogens attach to the Yangming Meridian, the accumulation resides flanking the navel. After full meals, it becomes larger; when hungry, it becomes smaller. (Foot Yangming Meridian descends flanking the navel, so its accumulation resides flanking the navel. Yangming belongs to the Stomach, receiving Qi of water and grain, so it enlarges when full and shrinks when hungry.)
When pathogens attach to Huan Jin, it resembles an accumulation of Yangming. It hurts after full meals and feels comfortable when hungry. (Huan Jin is between muscles, resembling Yangming accumulation. Fullness causes muscle congestion, hence pain. Hunger causes Qi retreat, hence comfort.)
When pathogens attach to the Mu Yuan of the stomach and intestines, pain extends outward to connect with Huan Jin. It feels comfortable after full meals and hurts when hungry. (Pain in stomach/intestine Mu Yuan connecting to Huan Jin: fullness causes internal filling and external relaxation, hence comfort. Hunger reverses this, hence pain.)
When pathogens attach to the Fu Chong Mai, palpation reveals pulsation under the hand; upon lifting the hand, hot Qi flows down to both thighs, resembling the sensation of hot water pouring. (Meaning of Fu Chong as before. The ascending branch follows the back interior, connecting to Du Mai; the descending branch pours into the Large Luo of Shaoyin, emerges at Qichong, follows the inner aspect of the thigh into the popliteal fossa. Thus, palpating the thigh reveals pulsation; lifting the hand causes hot Qi to descend between the thighs. This is the sign of pathogens attaching to Fu Chong. *Wo* sounds like 'wu'.)
When pathogens attach to Lü Jin behind the intestines, the accumulation is visible when hungry, invisible when full, and unpalpable. (Lü is same as Lv, referring to spinal bone. Tendons within the spine are called Lü Jin, thus located behind the stomach and intestines. When hungry, intestines are empty, so accumulation is visible. When full, intestines are filled and cover it, so accumulation is invisible and unpalpable.)
When pathogens attach to Shu Meridians, blockage occurs, fluids fail to descend, and orifices become dry and congested. (Shu Meridians conduct Blood and Qi. If blocked, fluids become dry and congested as described.)
These are pathogens entering from the exterior to the interior, from top to bottom. (This summarizes the above regarding pathogens originating from Yang, necessarily moving from exterior to interior, from top to bottom.)
Huangdi said: How does an accumulation begin, and how does it become established?
Qibo said: Accumulations begin with the acquisition of Cold, and formation requires Qi Rebellion (Jue Qi). (This section below explains why accumulations form.)
Huangdi said: How does the accumulation form?
Qibo said: Jue Qi generates foot weakness; Cold generates calf coldness. Calf coldness causes blood vessels to coagulate and stagnate; coagulated blood vessels allow Cold Qi to enter the stomach and intestines from above. Entering the stomach and intestines causes distension; distension forces the juices and foam outside the intestines to gather and prevents dispersion, forming accumulations day by day. (This describes accumulations formed by downward-reversing Cold Qi. Jue Qi is rebellious Qi. Cold reversing downward generates foot weakness, meaning joint pain and sluggishness. Due to calf coldness, blood and Qi coagulate; Cold Qi ascends from below to enter the stomach and intestines. Stomach/intestine cold prevents Yang Qi transformation, causing distension. Externally gathered juices and foam fail to disperse, forming accumulations over time. *Man* Mei Ben Qie. *Jing* Xing Jing, Xing Jing two readings.)
Sudden overeating and drinking cause intestinal fullness. Irregular living habits and excessive effort injure the collaterals. Injury to Yang Collaterals causes external blood overflow, leading to epistaxis or hematemesis; injury to Yin Collaterals causes internal blood overflow, leading to hematochezia or hematuria. Injury to stomach/intestine collaterals causes blood to overflow outside the intestines. If Cold and juices exist outside the intestines, they mix with blood, coalesce, and fail to disperse, forming accumulations. (This describes accumulations formed by irregular diet and lifestyle. Sudden overeating means eating rapidly and excessively. Digestive capacity is exceeded, juices overflow the membrane, mixing with blood to form food accumulations, similar to infant痞疾 (masses). Alternatively, excessive effort injures Yin/Yang collaterals, disturbing blood. Stasis combined with Cold and juices outside intestines forms blood accumulations, common in those who indulge in food and movement.)
Sudden external contraction of Cold, or internal injury from sorrow and anger, causes Qi to rebel upward. Upward rebellion blocks the Six Shu points, preventing Warm Qi from circulating. Coagulated blood accumulates internally without dispersing; fluids become viscous and渗 (seep/stagnate), adhering and not departing, forming accumulations. (This describes accumulations formed by emotional internal injury combined with Cold. External Cold plus internal sorrow/anger causes Qi reversal due to Cold, blocking Six Meridian Shu points. Lack of Warm Qi causes Yin Blood coagulation. Blood forms accumulation due to Qi rebellion, common in those with perverse temperaments.)
Huangdi said: What about those originating from Yin? (This discusses emotional/desire damage to Zang, disease originating from Yin.)
Qibo said: Worry and thought damage the Heart; severe Cold damages the Lungs; resentment and anger damage the Liver; drunkenness followed by intercourse, sweating, and exposure to wind damage the Spleen; excessive effort, or intercourse followed by sweating and bathing, damage the Kidneys. (Damage to Heart affects Yang; damage to Lungs affects Qi; damage to Liver affects Blood; damage to Spleen affects Ying and Wei; damage to Kidneys affects True Yin. All Zang damage results in disease originating from Yin. This section is largely consistent with the *Xie Qi Zang Fu Bing Xing Lun* in the following scroll.)
These are the diseases generated in the three internal and external regions. (Summarizing the above.)
Huangdi said: Excellent. How should they be treated?
Qibo answered: Observe the site of pain to know the corresponding reaction. Determine excess and deficiency; tonify when deficient, drain when excessive. Do not go against the timing of Heaven. This is called Supreme Treatment. (This generally summarizes treatment methods for the three internal/external regions. Observing pain sites reveals Yin/Yang, exterior/interior, and pathological responses. Tonify deficiency, drain excess, do not defy Heavenly timing, such as Spring Qi relating to Liver, or lunar phase changes, etc.)