娄全善曰∶“天以阴阳五行化生万物，人得其气以有生。故血气也，上下也，虚实也，寒热也，皆一阴阳
也，五脏也，六腑也，十二经也，五运六气也，皆一五行也。病态千万，皆不出此。故诊病者，必先分别血气、
表里、上下、脏腑之分野，以知受病之所在，次察所病虚实寒热之邪以治之。务在阴阳不偏倾，脏腑不胜负，
补泻随宜，适其病所，使之安痊。而已尔。”
《灵枢》曰∶夫百病之始生也，皆生于风雨、寒暑、清湿、喜怒。风雨袭虚，则病起于上。清湿袭虚，则
病起于下。喜怒不节，则伤脏，脏伤则病起于阴。盖风雨寒热，无虚则不能独伤人。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。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。留而不去，传舍于经；在经之时，洒淅喜惊。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。留而不去，传舍于伏冲之脉；在伏冲之
时，体重身痛。留而不去，传舍于肠胃；在肠胃之时，贲响腹胀，多寒则肠鸣飧泄，食不化；多热则溏出糜。
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。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。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，水溱渗注灌，濯濯有音，有寒则 满雷引，故时切痛。其着于阳明之经，则挟脐而居。饱食则益大，
饥则益小。其着于输之脉者，闭塞不通，津液不下，孔窍干壅。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。其着于膂筋，在肠后者，饥则积见，饱则积不见，按之不得。其着于肠胃之募原也，
痛而外连于缓筋，饱食则安，饥则痛。其着于缓筋也，似阳明之积，饱食则痛，饥则安，邪气淫 不可胜论。
积之始生也，得寒乃生，厥乃成积。盖厥气生足 ， 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。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，与血相搏，则并合凝聚，不得散，而积成矣，此病之起于阳者也。其伤脏而起于阴者，忧思
伤心；重寒伤肺；愤怒伤肝；醉以入房，汗出当风，伤脾；用力过度，若入房汗出浴，伤肾。此内外三部之所
生病者也（稍次《百病始生》篇文）。
《难经》曰∶病从后来者为虚邪（谓生我者），从前来者为实邪（谓我生者），从所不胜来者为贼邪（谓
克我者），从所胜来者为微邪（谓我克者）。自病，为正邪（本经自病，无他邪相干也）。假令心病（心经有
病），中风，得之为虚邪（中风者，肝木先病，木生火，是从后来也。火中有木，木克土，无土则水至矣，故为
虚邪）。饮食劳倦，得之为实邪（饮食劳倦者，脾土先病，土生于火，是从后来也，火中
有土，水不能至，则子能制鬼矣，故为实邪）。中湿。得之为贼邪（中湿者，肾水先病，水克火，是从所不胜
来也。既不能胜，故为贼邪）。伤寒，得之为微邪（伤寒者，肺金先病，火克金，是从所胜来也，胜则不能为
害，故为微邪）。伤暑得之为正邪（伤暑者，心火自病）。余仿此（稍次《五十难》文，末增一句）。
《素问》曰∶诸风掉眩，皆属于肝。诸寒收引，皆属于肾（收敛也，引急也）。诸气 郁，皆属于肺（ ，
满也。郁，奔迫也）诸湿肿满，皆属于脾。诸热瞀 ，皆属于火（瞀，目不明也。 ，筋跳掣也）。诸痛痒
疮，皆属于心。固泄，皆属于下（厥，气逆也。固，禁固也。泄，不诸厥禁也。下，谓下焦肝肾气也）。诸痿
喘呕，皆属于上（上，谓上焦心肺气也，肺热叶焦，发为痿 ）。诸禁鼓栗，如丧神守，皆属于火。诸痉项强，
皆属于湿（痉，强急也，太阳伤热）。诸逆冲上，皆属于火。诸胀腹大，皆属于热。诸躁狂越，皆属于火。诸
暴强直，皆属于风。（阳内郁而阴行于外）。诸病有声，鼓之如鼓，皆属于热（上鼓，击也。下鼓，如鼓声也）。
诸病 肿，疼酸惊骇，皆属于火。诸转反戾，水液混浊，皆属于热（反戾，筋转也。水液，小便也，）诸病
水液，澄彻清冷，皆属于寒（上下所出，及吐出溺出也）。诸呕吐酸，暴注下迫，皆属于热。故《大要》曰∶
谨守病机，各司其属。〔有〕〔者〕〔求〕〔之〕，〔无〕〔者〕〔求〕〔之〕，〔盛〕〔者〕〔责〕〔之〕，
〔虚〕〔者〕〔责〕〔之〕。必先五胜，疏其血气，令其调达，而致和平，此之谓也（《至真要大论篇》。此
言运气病机也。娄全善曰∶病机十九条，乃察病之要旨也。而有者求之四句，又要旨中之要旨。刘河间《原病
式》，但以十九条立论，而遗此四句，譬之有舟无操舟之工；有兵无将兵之
帅，不免临病误施，至人夭折。今僭引经传而正之。夫诸风属肝，为阳 、急惊等病，治以凉剂固矣。然燥金
胜则肝为邪攻，而病亦化风，如阳明司天，燥气下临，病掉振之类，是为阴 、慢惊等病。不以温剂治之，
而亦与凉剂可乎？诸火属心，为阳躁 语等病，治以攻剂固矣。然寒水胜，则心为邪攻，而病亦化火热，如岁
水太过，病躁、悸、烦心、 语之类，是为阴躁郑声等病，不以补剂治之，而亦与攻剂可乎？诸湿属脾，为濡
泄等病，仲景用五苓等剂去湿固矣。然风木胜，则脾为邪攻，而病亦化湿，如岁木太过，病飧泄之类，则当用
钱氏宣风等剂，以去风可也，乃亦去湿可乎？诸气属肺，为 郁寒喘等病，治以热剂固矣。然火热胜，则肺为
邪攻，而病亦化 郁。如岁火太过，病咳喘之类，则当如东垣以凉剂治热喘可也，乃亦用热剂可乎？诸寒属肾，
为屈伸不利等病，仲景用乌头汤等剂固矣。然湿土胜，则肾为邪攻。而病亦化寒。如湿气变病，筋脉不利之类，
则当用东垣复煎散、健步丸等剂治之可也，乃亦用去寒之剂可乎？盖其在太过，而化之病为盛，盛者真气也。
其在受攻，而化之病为虚，虚者假气也。是故有其病化者必求之，恐其气之假也。无其病化者，亦必求之，恐
其邪隐于中，如寒胜化火之类也。其病之化似盛者，必责之，恐其盛之未的也；其病之化似虚者，亦必责之，
恐其虚之未真也。病机皆用此四句为法。庶几补泻不差。今河间但以病化有者为盛，无者为虚，不复究其假者
虚者，殊为未备。此则智者之一失也）。
又曰∶气实形实，气虚形虚，此其常也。反此者病（气，脉气也。形，身形也。反，谓失其常也）。气盛
身寒，气虚身热，此谓反也。谷盛气盛，谷虚气虚，此其常也。反此者病（营气之道，纳谷为实）。谷入多而
气少（胃病不散），
谷不入而气多（肾气外散，肺并之也）此谓反也。脉实血实，脉虚血虚，此其常也。反此者病（脉者血之府）。
脉盛血少，脉少血多，此谓反也（经脉行气，络脉受血，经气入络，络受经气，候不相合，皆为反常）。（增
损《刺志论》篇文）
又曰∶五病所发∶阴病发于骨，阳病发于血，阴病发于肉。（骨肉阴静，故阴气从之。血脉阳动，故阳
气乘之），阳病发于冬，阴病发于夏（冬阴气盛，故阳病发于冬。夏阳气盛，故阴病发于夏，各随其少也），
是谓五发。五邪所乱∶邪入于阳则狂，入于阴则痹（邪居阳脉之中，则四肢热盛而为狂邪。入阴脉之中，则六
经凝涩不通而为痹），搏阳则为巅疾（巅，谓巅顶。邪内搏于阳，则脉流，故为上巅之疾。一云∶诸家解巅作
癫，阳附阴则癫。又云∶搏当作传，邪已入阴，复传于阳、则为癫。其说不同，今并存之。《难经》曰∶狂癫
之病，何以别之？夫狂之始发，少卧而不饥。自高贤也，自辨智也，自贵居也，妄笑，好歌乐，妄行不休者是
也。癫之始发，意不乐，直视僵仆，其脉三部，阴阳俱盛者是也），搏阴则为 （邪内搏于阴则脉不流，故令
不能言。一云∶搏亦当作传），阳入之阴则静，阴出之阳则怒（之，往也。一云∶怒者当作恐），是为五乱。
（《宣明五气篇》）
又曰∶年长则求之于腑（年之长者，甚于味，味恣则伤腑），年少则求之于经（年之少者，劳于使；劳于
使，则经中风邪），年壮则求之于脏（年之壮者，过于内；过于内，则耗散精气）。（《示从容论篇》）
娄全善说：“天通过阴阳和五行化生万物，人禀受天地之气而生存。因此，血气、上下、虚实、寒热，都统一于阴阳；五脏、六腑、十二经脉、五运六气，都统一于五行。疾病的形态成千上万，都不超出这个范围。所以诊治疾病的人，必须先分辨血气、表里、上下、脏腑的分布区域，以了解病变所在的部位，其次观察所患疾病的虚实寒热的性质来进行治疗。务必使阴阳不偏颇，脏腑之间不相克胜，补泻手法根据病情适宜选用，适应病位，使患者痊愈康复，仅此而已。”
《灵枢》说：“各种疾病的产生，都源于风雨、寒暑、清湿、喜怒。风雨侵袭人体虚弱之处，则疾病起于上部；清湿侵袭人体虚弱之处，则疾病起于下部；喜怒没有节制，则会损伤内脏，内脏受损则疾病起于阴分。大概风雨寒热，如果没有人体虚弱的内在条件，就不能单独伤害人。因此，虚邪贼风侵入人体，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，进入后到达深处，到达深处则毫毛竖立，毫毛竖立则感到寒冷战栗，所以皮肤疼痛。邪气停留不去，则传舍于络脉；在络脉的时候，肌肉疼痛，疼痛有时停止，大的经脉随即受累。邪气停留不去，传舍于经脉；在经脉的时候，出现洒淅恶寒、容易惊恐的症状。邪气停留不去，传舍于输穴；在输穴的时候，六经气血不通达四肢，则肢节疼痛，腰脊僵硬。邪气停留不去，传舍于伏冲之脉（冲脉深行部分）；在伏冲之脉的时候，身体沉重、全身疼痛。邪气停留不去，传舍于肠胃；在肠胃的时候，腹部鸣响胀满，寒气多则肠鸣飧泄（完谷不化的腹泻），食物不消化；热气多则大便稀溏如糜。邪气停留不去，传舍于肠胃之外、募原（胸腹腔内筋膜间隙）之间。邪气留着于脉中，稽留不去，逐渐形成积块。或者附着于孙脉（细小的脉络），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（脊柱两侧的筋肉），或者附着于肠胃的募原，向上连接于缓筋。那些附着在孙络并形成积块的，其积块往来上下移动，因为手臂手部的孙络位置浅表且松弛，不能拘束积块使其停止。所以积块在肠胃之间移行，水液渗注灌注，发出濯濯的声音，如果有寒气，则腹满雷鸣牵引，所以时常剧烈疼痛。那些附着在阳明经的，则挟持脐部居住。饱食时积块增大，饥饿时积块缩小。那些附着在输脉的，闭塞不通，津液不下行，孔窍干燥壅滞。那些附着在伏冲之脉的，按压时感觉应手跳动，抬手后热气下行至两大腿，像热水浇淋的样子。那些附着在膂筋，且在肠后的，饥饿时积块显现，饱食时积块隐没，按压摸不到。那些附着在肠胃的募原的，疼痛并向外连及缓筋，饱食时安宁，饥饿时疼痛。那些附着在缓筋的，类似阳明经的积块，饱食时疼痛，饥饿时安宁。邪气淫溢变化，不可胜数地论述。
积块开始生成，得寒邪乃生，厥逆之气乃成积。大概厥逆之气生于足部，导致小腿寒冷，小腿寒冷则血脉凝涩，血脉凝涩，则寒气上入于肠胃，进入肠胃则腹胀，腹胀则肠外的汁沫被迫聚集不得消散，日积月累形成积块。突然饮食过多，则肠道充满。起居没有节制，用力过度，则络脉受伤。阳络受伤则血液外溢，血液外溢则发生鼻衄（鼻出血）；阴络受伤则血液内溢，血液内溢则发生便血（后血）。肠胃的络脉受伤，则血液溢于肠外，肠外有寒气和汁沫，与血液相互搏结，则并合凝聚，不得消散，从而形成积块，这是疾病起于阳分的。那些损伤内脏而起于阴分的，忧愁思虑伤心；重寒伤肺；愤怒伤肝；醉酒后行房事，汗出当风，伤脾；用力过度，或者行房事后出汗洗澡，伤肾。这就是内外三部所生的疾病。（此处文字次序稍次于《百病始生》篇原文）。
《难经》说：“病从后来者为虚邪（指生我者，即母病及子），从前来者为实邪（指我生者，即子病犯母），从所不胜来者为贼邪（指克我者），从所胜来者为微邪（指我克者）。自病，为正邪（本经自病，无他邪相干也）。假设心病（心经有病），中风，得之为虚邪（中风者，肝木先病，木生火，是从后来也。火中有木，木克土，无土则水至矣，故为虚邪）。饮食劳倦，得之为实邪（饮食劳倦者，脾土先病，土生于火，是从后来也，火中有土，水不能至，则子能制鬼矣，故为实邪）。中湿，得之为贼邪（中湿者，肾水先病，水克火，是从所不胜来也。既不能胜，故为贼邪）。伤寒，得之为微邪（伤寒者，肺金先病，火克金，是从所胜来也，胜则不能为害，故为微邪）。伤暑得之为正邪（伤暑者，心火自病）。其余仿此（此处文字次序稍次于《五十难》，末尾增加了一句）。
《素问》说：“诸风掉眩，皆属于肝。诸寒收引，皆属于肾（收敛也，引急也）。诸气膹郁，皆属于肺（膹，满也。郁，奔迫也）。诸湿肿满，皆属于脾。诸热瞀瘛，皆属于火（瞀，目不明也。瘛，筋跳掣也）。诸痛痒疮，皆属于心。固泄，皆属于下（厥，气逆也。固，禁固也。泄，不诸厥禁也。下，谓下焦肝肾气也）。诸痿喘呕，皆属于上（上，谓上焦心肺气也，肺热叶焦，发为痿躄）。诸禁鼓栗，如丧神守，皆属于火。诸痉项强，皆属于湿（痉，强急也，太阳伤热）。诸逆冲上，皆属于火。诸胀腹大，皆属于热。诸躁狂越，皆属于火。诸暴强直，皆属于风。（阳内郁而阴行于外）。诸病有声，鼓之如鼓，皆属于热（上鼓，击也。下鼓，如鼓声也）。诸病胕肿，疼酸惊骇，皆属于火。诸转反戾，水液混浊，皆属于热（反戾，筋转也。水液，小便也，）。诸病水液，澄彻清冷，皆属于寒（上下所出，及吐出溺出也）。诸呕吐酸，暴注下迫，皆属于热。所以《大要》说：‘谨守病机，各司其属。有者求之，无者求之，盛者责之，虚者责之。必先五胜，疏其血气，令其调达，而致和平，此之谓也’（出自《至真要大论篇》。这里讲的是运气病机。娄全善说：病机十九条，是察病的要旨。而有者求之四句，又是这要旨中的要旨。刘河间《原病式》，只以十九条立论，而遗漏了这四句，好比有船没有划船工人；有兵没有带兵的元帅，难免临证误施，导致人死亡。现在僭越引用经典来纠正它。凡是风属于肝，为阳风、急惊等病，用凉剂治疗固然正确。然而燥金胜则肝被邪气攻击，病也化为风，如阳明司天，燥气下临，病见掉振之类，这是阴风、慢惊等病。不用温剂治疗，而也用凉剂可以吗？凡是火属于心，为阳躁、谵语等病，用攻剂治疗固然正确。然而寒水胜，则心被邪气攻击，病也化为火热，如岁水太过，病见躁、悸、烦心、谵语之类，这是阴躁、郑声等病。不用补剂治疗，而也用攻剂可以吗？凡是湿属于脾，为濡泄等病，张仲景用五苓散等剂去湿固然正确。然而风木胜，则脾被邪气攻击，病也化为湿，如岁木太过，病见飧泄之类，则应当用钱氏宣风散等剂，以去风即可，难道也可以只用去湿的方法吗？凡是气属于肺，为膹郁、寒喘等病，用热剂治疗固然正确。然而火热胜，则肺被邪气攻击，病也化为膹郁。如岁火太过，病见咳喘之类，则应当像李东垣那样用凉剂治热喘即可，难道也可以用热剂吗？凡是寒属于肾，为屈伸不利等病，张仲景用乌头汤等剂固然正确。然而湿土胜，则肾被邪气攻击，病也化为寒。如湿气变病，筋脉不利之类，则应当用李东垣复煎散、健步丸等剂治疗即可，难道也可以用去寒的药剂吗？大概在其太过，而化生的病为盛，盛者是真气。在其受攻，而化生的病为虚，虚者是假气。所以有其病化者必求之，恐怕其气是假的。无其病化者，亦必求之，恐怕邪气隐藏在中，如寒胜化火之类也。其病之化似盛者，必责之，恐怕其盛的未确切也；其病之化似虚者，亦责之，恐怕其虚的不真实也。病机都用这四句作为法则。这样补泻就不会出错。现在河间只以病化有者为盛，无者为虚，不再追究假者和虚者，非常不完备。这是智者的一个失误啊）。
又说：“气实形实，气虚形虚，这是常态。与此相反的就是病（气，脉气也。形，身形也。反，谓失其常也）。气盛身寒，气虚身热，这叫反常。谷盛气盛，谷虚气虚，这是常态。与此相反的就是病（营气之道，纳谷为实）。谷入多而气少（胃病不散），谷不入而气多（肾气外散，肺并之也）这叫反常。脉实血实，脉虚血虚，这是常态。与此相反的就是病（脉者血之府）。脉盛血少，脉少血多，这叫反常（经脉行气，络脉受血，经气入络，络受经气，候不相合，皆为反常）。（此处文字增损自《刺志论》篇原文）。
又说：“五病所发：阴病发于骨，阳病发于血，阴病发于肉。（骨肉阴静，故阴气从之。血脉阳动，故阳气乘之），阳病发于冬，阴病发于夏（冬阴气盛，故阳病发于冬。夏阳气盛，故阴病发于夏，各随其少也），这叫五发。五邪所乱：邪入于阳则狂，入于阴则痹（邪居阳脉之中，则四肢热盛而为狂邪。入阴脉之中，则六经凝涩不通而为痹），搏阳则为巅疾（巅，谓巅顶。邪内搏于阳，则脉流，故为上巅之疾。一说：各家解释巅作癫，阳附阴则癫。又一说：搏当作传，邪已入阴，复传于阳、则为癫。说法不同，现在并存。《难经》说：狂癫之病，如何区别？狂病刚开始发作，睡眠少且不饿，自认为贤能，自认为聪明，自认为尊贵，妄笑，喜欢唱歌快乐，妄行不休的就是。癫病刚开始发作，心情不乐，直视僵仆，其脉三部，阴阳俱盛的就是），搏阴则为喑（邪内搏于阴则脉不流，故令不能言。一说：搏亦当作传），阳入之阴则静，阴出之阳则怒（之，往也。一说：怒者当作恐），这叫五乱。（出自《宣明五气篇》）。
又说：“年长则求之于腑（年长者，甚于味，味恣则伤腑），年少则求之于经（年少者，劳于使；劳于使，则经中风邪），年壮则求之于脏（年壮者，过于内；过于内，则耗散精气）。（出自《示从容论篇》）”
Lou Quanshan said: "Heaven generates all things through Yin and Yang and the Five Elements, and humans acquire Qi to exist. Therefore, Blood and Qi, Upper and Lower, Deficiency and Excess, Cold and Heat are all unified under Yin and Yang; the Zang Organs, Fu Organs, Twelve Meridians, and the Five Movements and Six Qi are all unified under the Five Elements. The manifestations of disease number in the thousands, yet none fall outside this scope. Thus, those who diagnose diseases must first distinguish the domains of Blood and Qi, Exterior and Interior, Upper and Lower, and Zang and Fu organs to know where the disease resides. Secondly, they must observe the nature of the pathogenic factors—Deficiency, Excess, Cold, and Heat—to treat them. One must ensure that Yin and Yang do not deviate, and that the Zang and Fu organs do not overcome each other excessively. Tonification and Purging should be applied appropriately according to the condition and location, so that the patient may recover fully. That is all."
The *Ling Shu* (Spiritual Pivot) states: "The onset of all diseases arises from Wind and Rain, Cold and Heat, Clearness and Dampness, and Joy and Anger. When Wind and Rain attack deficiency, the disease originates in the Upper part. When Clearness and Dampness attack deficiency, the disease originates in the Lower part. When Joy and Anger are unregulated, the Zang Organs are injured, and the disease originates in the Yin aspect. Generally speaking, Wind, Rain, Cold, and Heat cannot harm people alone without internal deficiency. Therefore, when Empty Pathogens (Xu Xie) invade the human body, they begin at the Skin. If the skin is lax, the Cou Li (pores/cutaneous spaces) open; once open, pathogens enter via the hair follicles. Upon entering, they reach depth; upon reaching depth, the fine hairs stand erect. When the fine hairs stand erect, one feels chilly and shivering, hence skin pain. If the pathogen remains and does not depart, it transmits to the Luo Vessels (Collaterals). At this stage, there is pain in the muscles, which comes and goes, while the larger meridians subsequently become involved. If it remains and does not depart, it transmits to the Jing Meridians (Main Channels). At this stage, there is aversion to cold with shivering and a tendency toward fright. If it remains and does not depart, it transmits to the Shu Points (Transport points). At this stage, the Qi and Blood of the Six Meridians fail to flow to the limbs, resulting in joint pain and stiffness in the waist and spine. If it remains and does not depart, it transmits to the Fu Chong Mai (Deep-running portion of the Chong Mai/Conception Vessel branch). At this stage, there is heaviness of the body and generalized pain. If it remains and does not depart, it transmits to the Stomach and Intestines. At this stage, there is borborygmus and abdominal distension; if Cold predominates, there is borborygmus and loose stools with undigested food; if Heat predominates, there is watery diarrhea resembling gruel. If it remains and does not depart, it transmits to the area outside the Stomach and Intestines, between the Mu Yuan (pleural/diaphragmatic spaces). Lingered within the vessels, staying put and not departing, it gradually forms an Accumulation (Ji). It may attach to Sun Vessels (Branchial vessels), or to Luo Vessels, or to Jing Meridians, or to Shu Vessels, or to the Fu Chong Mai, or to the Lv Jin (muscles along the spine), or to the Mu Yuan of the Stomach and Intestines, connecting upward to the Huan Jin (relaxed muscles). Those accumulations forming in the Sun Luo vessels move up and down because these vessels are superficial and lax, unable to confine the accumulation. Thus, the accumulation migrates between the Stomach and Intestines, with fluids infiltrating and gurgling audibly. With Cold, there is fullness, thunderous sounds, and traction pain, causing sharp pain. Those attaching to the Yangming Meridian reside flanking the umbilicus; they enlarge after eating and shrink when hungry. Those attaching to the Shu Vessels cause obstruction, preventing the descent of Body Fluids, leading to dryness and congestion of the orifices. Those attaching to the Fu Chong Mai feel pulsatile upon palpation; upon releasing pressure, heat flows down into both thighs, feeling like hot water poured on them. Those attaching to the Lv Jin behind the intestines appear when hungry, disappear when full, and are impalpable. Those attaching to the Mu Yuan of the Stomach and Intestines cause pain radiating outward to the Huan Jin; they are comfortable after eating but painful when hungry. Those attaching to the Huan Jin resemble accumulations in the Yangming Meridian; they hurt after eating but are comfortable when hungry. The proliferation and transformation of pathogenic Qi are too numerous to describe exhaustively.
Accumulations begin to form due to Cold, and are completed by the reversal of Qi (Jue Qi). Generally, Jue Qi originates in the feet, causing cold in the calves. Cold in the calves causes the blood vessels to coagulate and stagnate. This stagnation allows Cold Qi to ascend into the Stomach and Intestines. Once in the Stomach and Intestines, it causes distension. Distension forces the juices and foam outside the intestines to gather and prevents them from dispersing, eventually forming an accumulation. Sudden overeating causes intestinal fullness. Irregular lifestyle and excessive exertion injure the Luo Vessels. Injury to Yang Luo vessels causes external bleeding (e.g., epistaxis); injury to Yin Luo vessels causes internal bleeding (e.g., hematochezia). Injury to the Luo vessels of the Stomach and Intestines causes blood to spill outside the intestines. If there is Cold and juice-foam outside the intestines, it combines with the spilled blood, coagulates, and fails to disperse, thus forming an accumulation. This is disease originating from the Yang aspect. Disease originating from the Yin aspect involves injury to the Zang Organs: worry and thought injure the Heart; severe Cold injures the Lungs; anger injures the Liver; intercourse while drunk with sweat exposed to wind injures the Spleen; excessive exertion or intercourse followed by sweating and bathing injures the Kidneys. These are the diseases arising from the three internal and external sectors (text slightly reordered from *Bai Bing Shi Sheng*).
The *Nan Jing* (Classic of Difficult Issues) states: "Disease coming from the later stage is Empty Pathogen (Xu Xie) (meaning the element that generates me, i.e., Mother affecting Child). Disease coming from the earlier stage is Excess Pathogen (Shi Xie) (meaning the element I generate, i.e., Child affecting Mother). Disease coming from what I cannot overcome is Thief Pathogen (Zei Xie) (meaning the element that controls me). Disease coming from what I can overcome is Minor Pathogen (Wei Xie) (meaning the element I control). Self-disease is Correct Pathogen (Zheng Xie) (disease of the own meridian without interference from other pathogens). For example, Heart disease: Contracting Wind results in Empty Pathogen (Wind disease implies Liver Wood is diseased first; Wood generates Fire, so it comes from later. Fire contains Wood; Wood controls Earth, without Earth Water arrives, hence Empty Pathogen). Diet and fatigue result in Excess Pathogen (Diet/fatigue implies Spleen Earth is diseased first; Earth is generated by Fire, so it comes from later. Fire contains Earth; Water cannot arrive, so the child can control the 'ghost', hence Excess Pathogen). Contracting Dampness results in Thief Pathogen (Dampness implies Kidney Water is diseased first; Water controls Fire, coming from what I cannot overcome; since it cannot be overcome, it is Thief Pathogen). Contracting Cold results in Minor Pathogen (Cold implies Lung Metal is diseased first; Fire controls Metal, coming from what I can overcome; since it is overcome, it causes no harm, hence Minor Pathogen). Contracting Summerheat results in Correct Pathogen (Summerheat implies Heart Fire self-disease). The rest follow this pattern (text slightly reordered from *Fifty Nan*, with an added sentence at the end).
The *Su Wen* (Basic Questions) states: "All wind-related tremors and vertigo belong to the Liver. All cold-related contraction and pulling belong to the Kidney (contraction means gathering; pulling means tightening). All Qi-related fullness and depression belong to the Lungs (Fullness means bloating; Depression means rushing and oppression). All dampness-related swelling and fullness belong to the Spleen. All heat-related confusion and spasms belong to Fire (Confusion means unclear vision; Spasms mean muscle twitching). All pain, itching, and sores belong to the Heart. Retention and incontinence belong to the Lower (Reversal means Qi counterflow; Retention means inhibition; Incontinence means failure of inhibition; Lower refers to the Qi of the Lower Jiao, Liver and Kidneys). All wasting-thirst, panting, and vomiting belong to the Upper (Upper refers to the Qi of the Upper Jiao, Heart and Lungs; Lung Heat scorches the leaves, leading to wasting-thirst). All suppression, drumming, and shivering, as if losing spiritual control, belong to Fire. All spasms and neck stiffness belong to Dampness (Spasm means rigidity; caused by Heat injuring the Taiyang). All rebellious Qi rushing upward belongs to Fire. All distension and abdominal enlargement belong to Heat. All restlessness, mania, and unruliness belong to Fire. All sudden rigidity and straightening belong to Wind (Yang is depressed internally, Yin moves externally). All diseases with sounds, where percussion yields a drum-like sound, belong to Heat (First 'drum' means to strike; second 'drum' means the sound of a drum). All diseases with edema, soreness, acidity, fright, and alarm belong to Fire. All twisting, arching back, turbid fluids belong to Heat (Arching back means tendon rotation; turbid fluids refer to urine). All diseases involving clear and cold fluids belong to Cold (Fluids discharged from above or below, including vomit and urine). All vomiting of sour fluid, sudden diarrhea, and tenesmus belong to Heat. Therefore, the *Da Yao* states: 'Carefully observe the Pathogenesis (Bing Ji), and assign each to its category. Seek those that are present, seek those that are absent; hold accountable those that are Excess, hold accountable those that are Deficient. First determine the dominance of the Five Elements, then unblock their Blood and Qi, allowing them to flow smoothly and achieve harmony. This is called it.' (From *Zhi Zhen Yao Da Lun*. This discusses the pathogenesis of Movement and Qi. Lou Quanshan said: The Nineteen Pathogeneses are the essence of disease observation. The four sentences 'Seek those present...' are the essence of that essence. Liu Hejian's *Yuan Bing Shi* relies only on the Nineteen Pathogeneses and omits these four sentences, like having a boat without a rower, or soldiers without a general, inevitably leading to misdiagnosis and death. Now I presumptuously cite classics to correct this. For Wind belonging to Liver, treating Yang Wind and acute convulsions with cooling agents is correct. However, if Dryness Metal dominates, attacking the Liver, the disease transforms into Wind, such as in Yangming ruling heaven with descending Dryness causing tremors; this is Yin Wind and slow convulsions. Is it appropriate to use cooling agents instead of warming ones? For Fire belonging to Heart, treating Yang agitation and delirium with purgatives is correct. However, if Cold Water dominates, attacking the Heart, the disease transforms into Fire/Heat, such as in years of excessive Water causing agitation, palpitations, vexation, and delirium; this is Yin agitation and monotonous speech. Is it appropriate to use purgatives instead of tonics? For Dampness belonging to Spleen, treating moist diarrhea with Wu Ling San to drain dampness is correct. However, if Wind Wood dominates, attacking the Spleen, the disease transforms into Dampness, such as in years of excessive Wood causing loose stools; one should use Qian Yi's Xuan Feng San to dispel Wind, not just drain Dampness. For Qi belonging to Lung, treating fullness/depression and cold asthma with warming agents is correct. However, if Fire/Heat dominates, attacking the Lung, the disease transforms into fullness/depression, such as in years of excessive Fire causing cough and asthma; one should use Li Dongyuan's method of cooling agents for heat-induced asthma, not warming agents. For Cold belonging to Kidney, treating limited flexion/extension with Wu Tou Tang is correct. However, if Wet Earth dominates, attacking the Kidney, the disease transforms into Cold, such as in dampness diseases causing tendon/muscle dysfunction; one should use Li Dongyuan's Fu Jian San or Jian Bu Wan, not just cold-dispelling agents. Generally, when excess leads to transformation, the resulting disease is Excess (True Qi). When attacked leads to transformation, the resulting disease is Deficiency (False Qi). Therefore, if transformation exists, one must investigate, fearing false Qi. If transformation does not exist, one must still investigate, fearing hidden pathogens, e.g., Cold transforming into Fire. If the transformed disease appears Excess, one must scrutinize, fearing the Excess is not genuine. If it appears Deficient, one must scrutinize, fearing the Deficiency is not true. These four sentences are the method for all Pathogeneses, ensuring accurate tonification and purging. Now Hejian only considers presence as Excess and absence as Deficiency, failing to investigate false and deficient aspects, which is incomplete. This is a lapse of wisdom)."
It also states: "Qi Excess corresponds to Form Excess, Qi Deficiency corresponds to Form Deficiency; this is normal. Reversal indicates disease (Qi refers to Pulse Qi; Form refers to Body Shape. Reversal means deviation from normal). Qi Excess with Body Cold, or Qi Deficiency with Body Heat, is called reversal. Grain abundance corresponds to Qi abundance, Grain scarcity corresponds to Qi scarcity; this is normal. Reversal indicates disease (The way of Ying Qi incorporates Grain to become substantial). Eating much but having little Qi (Stomach disease fails to disseminate), or eating nothing but having much Qi (Kidney Qi scatters externally, Lung Qi joins it); this is called reversal. Pulse Excess corresponds to Blood Excess, Pulse Deficiency corresponds to Blood Deficiency; this is normal. Reversal indicates disease (Pulse is the mansion of Blood). Pulse Excess with Blood Scarcity, or Pulse Scarcity with Blood Excess, is called reversal (Jing Meridians circulate Qi, Luo Vessels receive Blood; Jing Qi enters Luo, Luo receives Jing Qi; mismatched signs are all abnormal) (Text modified from *Ci Zhi Lun*)."
It also states: "The five origins of disease: Yin diseases originate in Bone, Yang diseases originate in Blood, Yin diseases originate in Flesh. (Bone and flesh are Yin and static, so Yin Qi follows them. Blood vessels are Yang and active, so Yang Qi exploits them). Yang diseases manifest in Winter, Yin diseases manifest in Summer. (Winter has abundant Yin Qi, so Yang diseases manifest in Winter. Summer has abundant Yang Qi, so Yin diseases manifest in Summer, following the principle of 'following the lesser'). This is called the Five Origins. The five disturbances of Evil: Evil entering Yang causes Mania (Kuang); entering Yin causes Bi Syndrome (Obstruction). (Evil residing in Yang meridians causes extreme heat in the four limbs leading to Mania. Entering Yin meridians causes stagnation of the Six Meridians leading to Bi). Striking Yang causes Dian Disease (Cranial disease). (Dian refers to the vertex. Evil striking internally to Yang causes vessel flow issues, leading to cranial disease. Some interpret Dian as Dian epilepsy; Yang attaching to Yin causes epilepsy. Others say 'Striking' should be 'Transmitting'; if Evil enters Yin and transmits to Yang, it becomes epilepsy. Different theories exist, preserved here. *Nan Jing* asks: How to distinguish Kuang and Dian? Kuang begins with little sleep and no hunger, arrogance, self-perceived wisdom, self-perceived nobility, irrational laughter, singing, joy, and continuous erratic behavior. Dian begins with unhappiness, staring straight, and collapsing stiffly; pulse is Excess in all three positions, Yin and Yang alike). Striking Yin causes Aphonia (Yin). (Evil striking internally to Yin stops vessel flow, causing inability to speak. Some say 'Striking' should be 'Transmitting'). Yang entering Yin causes Quietness; Yin exiting to Yang causes Anger (Entering means going. Some say 'Anger' should be 'Fear'). This is called the Five Disturbances. (From *Xuan Ming Wu Qi Pian*)."
It also states: "For the elderly, seek pathology in the Fu Organs (Elderly are prone to dietary excess; indulgence injures Fu Organs). For the young, seek pathology in the Meridians (Youth are prone to physical labor; labor exposes meridians to Wind-Evil). For the prime-aged, seek pathology in the Zang Organs (Prime-aged are prone to internal excess; internal excess consumes Essence and Qi). (From *Shi Cong Rong Lun*)."