〔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（自然界气候变化的规律），天体运动与人体随之响应，分毫不差。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，痘疮大流行大致每三年一次，虽然各年零星散发、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”，多指子年、午年、卯年、酉年。在子年和午年，少阴君火（心与小肠经的气化特性）司天（主管上半年的气候），阳明燥金（肺与大肠经的气化特性）在泉（主管下半年的气候）；在卯年和酉年，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，痘疮之所以以少阴、阳明二经为主要病变经络，正是因为这个原因。然而，玄妙的气化微妙转移，主气与客气相互运用，五运（木火土金水五种气候运行）有平气（正常）、太过（过盛）、不及（不足）的区别，六气（风寒暑湿燥火六种气候）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）的不同。细微的差异，会导致整体情况截然不同。痘疮有的年份应当盛行却不盛行，有的年份不应当盛行却传染遍及各地，这是不可拘泥于固定模式来论断的。
【万】疮疹的发作，有的间隔数年才发，有的发作则连年不停，为什么呢？《内经》说：不知道每年岁运的变化，气的盛衰，虚实产生的原因，就不能成为好医生。大概司天之气，主管执行天的命令，属于上位；岁运之气，主管天地之间人物化生所依赖的气，属于中位；在泉之气，主管地面上的气化运行，属于中下位。一年之中，有上、中、下这三种气，各自行使化育的命令。如果这些气偶然相符会合而相同，就会贯通其气化作用，这种气化作用于人，人就会生病，所以疮疹一定要等到特定的年份才会发作。在六十年甲子周期中，天符年有十二年（戊子、戊午、己丑、己未、戊寅、戊申、乙卯、乙酉、丙辰、丙戌、丁巳、丁亥）。其中又有四年是太乙天符年（戊午、己丑、己未、乙酉）。称为“天符”的，是指司天之气与岁运之气相同。称为“太乙天符”的，是指司天之气、岁运之气与地支五行属性三者相同。岁会年有八年（丙子、己丑、丁卯、甲辰、甲戌、戊午、己未、乙酉）。称为“岁会”的，是指岁运之气与地支五行属性相同。同天符年有六年（甲辰、甲戌、庚子、庚午、壬寅、壬申），同岁会年有六年（癸卯、癸酉、癸巳、癸亥、辛丑、辛未）。称为“同”的，是指岁运之气与在泉之气相合其气化性质，阳年称为同天符，阴年称为同岁会。这五种情况，杂乱地说起来共有三十六年，合并计算起来，实际上只有二十六年。《内经》说：天符年是执法者，岁会年是行令者，太乙天符年是贵人。邪气伤人时，遇到执法者，发病迅速且危险；遇到行令者，发病缓慢且病程长；遇到贵人，发病暴烈且致死。另外，子年和午年，由少阴君火主事；寅年和申年，由少阳相火（三焦与胆经的气化特性）主事。《内经》说：少阴之气所致病症为疡疹。少阳之气所致病症为喷嚏、呕吐、疮疡，以及恶病暴死。凡是这几年，如果刚柔失守（阴阳失调），升降窒塞压抑，旧有的病气不退，新的病气不迁，就会连年发作不停。
按语：关于运气学说的论述，《内经》中几乎占了一半，但世间很少有人应用它。大概是人们拘泥于常规，不通晓其变化，就认为没有验证效果。我的朋友缪仲淳（缪希雍）高明且善于医术，以至于口中不停地排斥五运六气学说是谬误的。我用王炎、沈栝的观点来反驳他，他也不信服，大概是因为他没有虚心细致地探求吧。假如厥阴风木主事，其气多风，百姓容易患湿泄之症，难道普天之下都多风，普天之下的百姓都患湿泄吗？甚至在一个县城范围内，降雨情况都有不同，这种气运怎么可能是绝对统一的呢？想要它没有谬误，是不可能的。大凡事物的物理有常规和变化，运气所主导的是常规，异气所主导的是变化。常规就像本气一样稳定，变化则无所不至，但各有对应的征象。所以其候应有从顺、逆乱、淫溢郁结、胜复、太过、不足等变化，其发作都不相同。如果厥阴风木主事，多风且草木茂盛，这叫“从”；天气明洁干燥而无风，这叫“逆”；天空尘埃昏暗，流水不结冰，这叫“淫”；大风折断树木，云物浑浊扰乱，这叫“郁”；山泽焦枯，草木凋落，这叫“胜”；大暑燃烧燎原，螟蝗成灾，这叫“复”；山崩地震，尘土飞扬时常出现，这叫“太过”；阴沉森冷无时不在，厚重云层白天也昏暗，这叫“不足”。随着气候的变化，瘟疫疾病随之响应，都要看当时当地的气候候象，即使几里之间，只要气候不同，所引发的疾病就完全不同，怎么能固执于一定的模式呢？宋神宗熙宁年间，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、时彦因事入宫应对，皇帝问下雨的时间，沈括回答说雨候已经显现，日期就在明天。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。那时是湿土主事，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，未能形成降雨。后来突然放晴，是燥金之气进入候期，厥阴风木应当受挫，那么太阴湿土得以伸展，第二天的运气都顺遂，因此知道必定会下雨。唉！如今哪里还能找到像沈存中（沈括）这样的人，和他谈论运气学说呢！
[Yuan] Smallpox originates internally from the Zang-Fu organs and corresponds externally to the Yunqi (Yunqi refers to the laws of climate change in nature, specifically the Five Movements and Six Qi). The movement of heaven responds with the human body without the slightest error. Therefore, for those treating smallpox, understanding Yunqi is urgent. Examining past records, major outbreaks generally occur every three years. Although sporadic cases may appear in any given year, the cycle for large-scale epidemics is standardized at three years. The so-called "three years" mostly refer to the years of Zi, Wu, Mao, and You. In the years of Zi and Wu, Shaoyin Junhuo (the qi transformation characteristics of the Heart and Small Intestine meridians) governs the Sky (Si Tian, controlling the climate of the first half of the year), while Yangming Zaojin (the qi transformation characteristics of the Lung and Large Intestine meridians) governs the Spring (Zai Quan, controlling the climate of the second half of the year). In the years of Mao and You, Yangming Zaojin governs the Sky, and Shaoyin Junhuo governs the Spring. Various sores and ulcers are not ignited by Fire, nor collected by Metal. The reason why smallpox primarily involves the Shaoyin and Yangming meridians is due to this mechanism. However, profound transformations shift subtly; the Principal Qi (Zhu Qi) and Guest Qi (Ke Qi) interact mutually. The Five Movements (Wu Yun: Wood, Fire, Earth, Metal, Water) differ in being Normal (Ping Qi), Excessive (Tai Guo), or Deficient (Bu Ji). The Six Qi (Liu Qi: Wind, Cold, Summer Heat, Dampness, Dryness, Fire) differ in being Constant Transformation (Chang Hua), Overwhelming Victory (Yin Sheng), Counter Victory (Fan Sheng), or Mutual Restriction (Xiang Sheng). Even slight differences lead to entirely different overall conditions. There are years when smallpox should prevail but does not, and years when it should not prevail yet spreads widely. Thus, one cannot adhere to a single fixed theory.
[Wan] The onset of sores and rashes may occur after an interval of several years, or it may persist continuously for years. Why? The Classic says: "If one does not know the addition of the year, the prosperity and decline of Qi, and the origin of deficiency and excess, one cannot be a skilled physician." Generally, Si Tian (Sky Governance) executes the orders of Heaven, occupying the Upper position. Sui Yun (Annual Movement) governs the Qi of transformation and generation for all things between Heaven and Earth, occupying the Middle position. Zai Quan (Spring Governance) governs the transformation and execution on Earth, occupying the Middle-Lower position. Within a year, these three Qi—Upper, Middle, and Lower—each exercise their transformative commands. If these Qi coincidentally align and harmonize, they penetrate their transformative influence; when this acts upon humans, disease occurs. Hence, sores and rashes must wait for specific years to erupt. Within a sixty-year Jiazi cycle, there are twelve Tian Fu (Heavenly符/Agreement) years: (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 Taiyi Tianfu (Great Heavenly Agreement): (Wu Wu, Ji Chou, Ji Wei, Yi You). It is called "Tian Fu" when the Si Tian Qi is identical to the Sui Yun Qi. It is called "Taiyi Tianfu" when the Si Tian Qi, Sui Yun Qi, and the Earthly Branch's elemental attribute are all identical. There are eight Sui Hui (Year Meeting) years: (Bing Zi, Ji Chou, Ding Mao, Jia Chen, Jia Xu, Wu Wu, Ji Wei, Yi You). It is called "Sui Hui" when the Sui Yun Qi is identical to the Earthly Branch's elemental attribute. There are six Tong Tian Fu (Same Heaven Agreement) years: (Jia Chen, Jia Xu, Geng Zi, Geng Wu, Ren Yin, Ren Shen), and six Tong Sui Hui (Same Year Meeting) years: (Gui Mao, Gui You, Gui Si, Gui Hai, Xin Chou, Xin Wei). "Tong" refers to the Sui Yun Qi combining its transformational nature with the Zai Quan Qi. Yang years are called Tong Tian Fu; Yin years are called Tong Sui Hui. Speaking杂乱ly, these five categories total thirty-six years; speaking collectively, there are only twenty-six unique years. The Classic states: "Tian Fu is the Law Enforcer, Sui Wei is the Order Executor, Taiyi Tianfu is the Noble Person." When pathogenic Qi attacks humans: encountering the Law Enforcer causes rapid and critical illness; encountering the Order Executor causes slow and lingering illness; encountering the Noble Person causes sudden and fatal illness. Furthermore, in Zi and Wu years, Shaoyin Junhuo presides; in Yin and Shen years, Shaoyang Xianghuo (the qi transformation characteristics of the Sanjiao and Gallbladder meridians) presides. The Classic says: "What Shaoyin reaches manifests as ulcers and rashes. What Shaoyang reaches manifests as sneezing, vomiting, sores, ulcers, malignant diseases, and sudden death." In these years, if Gang-Rou (Yin-Yang) loses control, ascending and descending are obstructed, old pathogens do not recede, and new pathogens do not migrate, then continuous outbreaks will occur without cessation.
Commentary: Discussions on Yunqi occupy nearly half of the *Nei Jing* (Inner Canon), yet few in the world apply it. This is likely because people stick to the constant without understanding the variable, leading them to deem it unverified. My friend Miao Zhongchun (Miao Xi Yong) was highly intelligent and skilled in medicine, yet he constantly rejected the fallacies of the Five Movements and Six Qi. I refuted him using the arguments of Wang Yan and Shen Gua, but he remained unconvinced, probably because he did not examine it with an open mind and careful inquiry. Suppose Jueyin Fengmu (Wind-Wood) is in charge; its Qi is windy, and the people suffer from damp diarrhea. Does this mean the whole world is windy and everyone suffers from damp diarrhea? Even within a single county, rainfall varies. How can such Yunqi be absolutely uniform? It is impossible to claim it has no errors. Generally, physical principles have constants and variables. What Yunqi dominates is the constant; what abnormal Qi dominates is the variable. The constant resembles the original Qi, stable and predictable. The variable is ubiquitous but has specific correspondences. Thus, manifestations include following (Cong), opposing (Ni), overflowing/stagnating (Yin Yu), victory/reversal (Sheng Fu), excess (Tai Guo), and deficiency (Bu Zu). Their eruptions differ. If Jueyin Fengmu is in charge, causing much wind and lush vegetation, this is called "Following"; clear, dry weather without wind is called "Opposing"; sky filled with dust, flowing water not freezing is called "Overflowing"; strong winds breaking trees, turbid clouds disturbing objects is called "Stagnation"; scorched mountains and marshes, withered grass and trees is called "Victory"; intense summer heat burning like fire, locust disasters is called "Reversal"; earthquakes, landslides, frequent dust storms is called "Excess"; perpetual gloom, heavy clouds darkening the day is called "Deficiency". Diseases and plagues respond to these changes. One must observe the local climate signs; even within a few miles, if the climate differs, the resulting diseases differ completely. How can one rigidly adhere to a fixed pattern? During the Xining era of Emperor Shenzong of Song, the capital suffered prolonged drought despite extensive prayers. For several days, it was overcast, and people believed rain was imminent. Suddenly, one day cleared up with blazing sun. Shen Kuo and Shi Yan entered the court for an audience. The Emperor asked about the rain forecast. Shen Kuo replied that the signs of rain were already visible, and it would rain tomorrow. The crowd argued that despite previous humid overcast days, it hadn't rained; under such dry conditions, how could rain be expected? The next day, indeed, heavy rain fell. At that time, Wet Earth was in charge. The previous overcast days showed the effect of the "Following Qi," but it was suppressed by Jueyin Wind, preventing rain. The subsequent sudden clearing indicated Dry Metal entering the phase, suppressing Jueyin Wind, allowing Taiyin Wet Earth to expand. With favorable Yunqi the following day, he knew rain was certain. Alas! Where can we find someone like Shen Cunzhong (Shen Kuo) today to discuss Yunqi with?