黄帝问于少俞曰。余闻百疾之始期也。必生于风雨寒暑。循毫毛而入腠理。或复还。或留止。或为
风肿汗出。或为消瘅。或为寒热。或为留痹。或为积聚。奇邪淫溢。不可胜数。愿闻其故。夫同时得
病。或病此。或病彼。意者天之为人生风乎。何其异也。少俞曰。夫天之生风者。非以私百姓也。其行
公平正直。犯者得之。避者得无殆非求人而人自犯之。
马仲化曰。此言人之感邪同。而病否异者。非天之有私。而人有避不避之异也。
黄帝曰。一时遇风。同时得病。其病各异。愿闻其故。少俞曰。善乎哉问。请论以比匠人。匠人磨
斧斤砺刀。削断材木之阴阳。尚有坚脆。坚者不入。脆者皮弛。至其交节而缺斤斧焉。夫一木之中。坚脆
不同。坚者则刚。脆者易伤。况其材木之不同。皮之浓薄。汁之多少。而各异耶。夫木之早花先生叶者。
遇春霜烈风。则花落而叶萎。久曝大旱。则脆木薄皮者。枝条汁少而叶萎。久阴淫雨。则薄皮多汁者。
皮溃而漉。卒风暴起。则刚脆之木。枝折杌伤。秋
霜疾风。则刚脆之木。根摇而叶落。凡此五者。各有所伤。况于人乎。黄帝曰。以人应木奈何。少俞
答曰。木之所伤也。皆伤其枝。枝之刚脆而坚未成伤也。人之有常病也。亦因其骨节皮肤腠理之不坚固者。
邪之所舍也。故常为病也。
此章论因形而生病。乃感六气之化。有五变之纪也。夫形之皮肤肌腠筋骨。有浓薄坚脆之不同。故
邪舍有浅深。而其病各异。即五脏之病消瘅。肠胃之有积聚。亦因形之皮肤肌肉。而病及于内也。故以
木之皮汁坚脆多少方之。阴阳者。木之枝干皮肉也。交节而缺斧斤者。比人之皮弛肉脆。而骨节坚刚
也。是以一木之中。尚有坚脆之不同。坚者则刚。脆者易伤。况其材木之不同耶。木之皮薄枝脆者。比
人之皮不致密。肤腠疏也。木之多汁少汁者。比皮肤之津液多少也。木之早花先叶者。木气外敷。而不
禁风霜也。溃、散也。漉、渗也。皮薄多汁者。遇久阴淫雨。则溃而漉。刚脆之木。遇卒风暴起。则枝折
杌伤。盖汁多者不宜阴雨。刚脆者又忌暴风。以比人之腠理疏者漉汗。刚直多怒者消瘅也。木之所伤。
皆伤其枝。枝之刚脆者易伤。而坚者未成伤也。故人之常病。亦因其骨节皮肤腠理之不坚固者。邪之所
舍。而常为病也。朱永年曰。木枝者。比人之四肢。本经曰。中于阴。常从 臂始。是以上古之人。起
居有常。不妄作劳。养其四体也。
黄帝曰。人之善病风厥漉汗者。何以候之。少俞答曰。肉不坚。腠理疏。则善病风。黄帝曰。何以
候肉之不坚也。少俞答曰。 肉不坚而无分理。理者粗理。粗理而皮不致者腠理疏。此言其浑然者。
朱永年曰。此言皮不致密。肉理粗疏。致风邪厥逆于内。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。委中之下曰 。太阳之部分也。盖太阳之气。主于皮肤。如 肉不坚而无分理。无分理
者。粗理也。理粗而皮不致密。则腠理疏而浑然汗出矣。倪冲之曰。太阳之津气。营运于肤表。如天道
之浑然。水随气行者也。故皮不密则气泄。气泄则津亦泄矣。
黄帝曰。人之善病消瘅者。何以候之。少俞答曰。五脏皆柔弱者。善病消瘅。黄帝曰。何以知五
脏之柔弱也。少俞答曰。夫柔弱者。必有刚强。刚强多怒。柔者易伤也。黄帝曰。何以候柔弱之与刚
强。少俞答曰。此人皮肤薄而目坚固以深者。长冲直扬。其心刚。刚则多怒。怒则气上逆。胸中蓄积。
血气逆留。 皮充肌。血脉不行。转而为热。热则消肌肤。故为消瘅。此言人之暴刚而肌肉弱者也。
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。故此人薄皮肤而目坚固以深者。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。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。朱永年曰。按、本
经有五脏之消瘅。有肌肉之消瘅。五脏之消瘅。津液内消而消渴也。肌肉之消瘅。肌肉外消而消瘦也。
盖因于内者。必及于外。因于外者。必及于内。形体五脏。外内之相合也。高士宗曰。按、平脉篇云。
肾气微。少精血。奔气促迫。上入胸膈。盖精血少则逆气反上奔。故曰柔弱者必有刚强。谓五脏之精质
柔弱。而气反刚强。是柔者愈弱。而刚者愈强。刚柔之不和也。
黄帝曰。人之善病寒热者。何以候之。少俞答曰。小骨弱肉者。善病寒热。黄帝曰。何以候骨之
小大。肉之坚脆。色之不一也。少俞答曰。颧骨者。骨之本也。颧大则骨大。颧小则骨小。皮肤薄而其肉无
。其臂懦懦然。其地色殆然。不与其天同色。汗然独异。此其候也。然后臂薄者。其髓不满。故善病
寒热也。（ 音窘懦音糯）
此言骨小肉弱者。善病寒热也。夫肾主骨。颧者。肾之外候也。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。
倪冲之曰。津液随三焦出气。以温肌肉。充腠理。淖泽注于骨。补益脑髓。润泽皮肤。如臂薄者。通体之
皮肉薄弱矣。皮肉薄弱。则津液竭少。故曰臂薄者其髓不满。高士宗曰。邪在皮肤则发热。深入于骨
则发寒。
黄帝曰。何以候人之善病痹者。少俞答曰。粗理而肉不坚者。善病痹。黄帝曰。痹之高下有处乎。少俞
答曰。欲知其高下者。各视其部。
此言理粗而肉不坚者。善病痹也。理者。肌肉之纹理。如粗疏而不致密。则邪留而为痹。夫皮脉
肉筋骨。五脏之分部也。痹论曰。风寒湿三气杂至。合而为痹。以冬遇此者为骨痹。以春遇此者为筋痹。
以夏遇此者为脉痹。以至阴遇此者为肌痹。以秋遇此者为皮痹。故各视其部。则知痹之高下。盖心肺之痹在
在高。肝肾脾痹在下也。
黄帝曰。人之善病肠中积聚者。何以候之。少俞答曰。皮肤薄而不泽。肉不坚而淖泽。如此则肠
胃恶。恶则邪气留止。积聚乃伤。脾胃之间。寒温不次。邪气稍至。蓄积留止。大聚乃起。
朱永年曰。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。恶则邪气留止而成积聚。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。夫阳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。则毫毛开而腠理疏。疏则邪气留止。渐
溜于肠胃之间而成积聚矣。
黄帝曰。余闻病形。已知之矣。愿闻其时。少俞答曰。先立其年。以知其时。时高则起。时下则
殆。虽不陷下。当年有冲通。其病必起。是谓因形而生病。五变之纪也。
风雨寒暑。营运之六气也。六气在外以病形。故当先立其年。以知其时之六气。如辰戌之岁。太阳
司天二之客气。乃阳明燥金。主气乃少阴君火。此主气胜临御之气。值此时气高而病必起。起者。即帝
所谓或复还也。如三之客气。乃太阳寒水。主气乃少阳相火。四之客气。乃厥阴风木。主气乃太阴湿
土。五之客气。乃少阴君火。主气乃阳明燥金。终之客气。乃太阴湿土。主气乃太阳寒水。值时气下而
为客气所胜。故其病必殆。殆将也。时气下而不能胜。则病将留止。即帝所谓或留止也。盖风雨寒暑。乃
临御之化。六期环转。客于形而为病。
故必因时气以胜之。此论六气之在外也。陷下者。陷于肠胃之间而成积聚也。冲通者。五运之气。通出
于外。而冲散其病气也。如太阳寒水司天。而五运乃太宫土运。此在内之运气胜之。故病亦不能留止也。
盖六气在外。以应天之三阴三阳。五运主中。以应地之五行。人之五脏。此脏气胜岁气。故虽不陷下。
病留止于外者。亦能冲通而散。盖六气主升降于上下。五运主出入于外内者也。是谓因形而生病。五变之
纪也。夫皮肤肌腠曰形。腠者。皮肤肌肉之纹理。乃营卫出入之道路。此病形而不病气者也。如病气则与
营卫俱行淫于内。而与魂魄飞扬矣。如传溜于血脉。则入脏腑。为内所因矣。此病形而不病气。亦不溜
于脉中。故为漉汗消瘅寒热留痹积聚五者之病。即陷于内。乃伤脾胃之间。郛郭之中。而不及于脏腑。此
奇邪淫溢。或病形。或病气。或溜于血脉。或入于脏腑。病之变化。不可胜数也。是以伤寒论六篇。首论
三阴三阳之气。以及六经之证。然亦有病形而不病气者。故太阳篇中曰。形作伤寒。盖在天成气。在地成
形。此天地之生命。所以立形定气。而视寿夭者。必明乎此。临病患以观邪之中人。或病气。或病形。或溜
于血脉。或入于脏腑。以知病之轻重。人之死生者。必明乎此。朱氏曰。素问岁运诸篇。有客气胜主气。
而为民病者。主气胜客气。而为民病者。有六气胜五运而为民病者。五运胜六气而为民病者。此概论岁运之
太过不及也。此篇论人之皮薄理疏。风雨寒暑之气。循毫毛而入腠理。为五变之病。故藉主气以胜之。主
气者。吾身中有此六气。而合于天之四时也。
朱卫公曰。气者。三阴三阳之气。相将出入之营气卫气。三焦通会元真之气。所以充行于皮肤肌
腠之间。此病形而不病气。故藉此形中之阴阳。合四时之六气以胜邪。若病气。则又有气之变证矣。倪冲
之曰。按、阴
阳别论云。气伤痛。形伤肿。先痛而后肿者。气伤形也。先肿而后痛者。形伤气也。盖形舍气。气归形。
故病形必及于气。病气必及于形。此章论病形而不病气。盖阴阳之道。有有形。有无形。有经常。有变易。
上宗曰。理者。皮肤脏腑之纹理也。盖在外乃皮肤肌肉之纹理。在内乃脏腑募原之纹理。故留止而成积
聚者。在脏腑外之募原。故乃伤脾胃之间。而不涉于脏腑。募原者。连于肠胃之膏膜。
黄帝向少俞问道：我听说各种疾病的发生，必定源于风、雨、寒、暑等外邪。这些邪气顺着毫毛进入腠理（皮肤与肌肉之间的间隙），有的又返回体外，有的则停留体内。有的导致风肿并出汗，有的导致消瘅（以多饮、多食、消瘦为特征的病证），有的导致寒热往来，有的导致留痹（经络阻滞不通的病证），有的导致积聚（腹内结块的病证）。奇邪淫溢泛滥，情况多得数不清。我希望了解其中的原因。为什么同时感受邪气生病，有的人患这种病，有的人患那种病？我想是不是上天特意给人制造风邪呢？为什么差异如此之大呢？
少俞回答说：上天产生风邪，并不是为了偏私百姓。风的运行公平正直，触犯它的人就会得病，躲避它的人就能避免危险。这并非风专门寻找人来侵犯，而是人自己触犯了它。
马仲化说：这段话讲的是人们感受邪气相同，但发病与否却不同，这并不是因为天有私心，而是因为人有躲避和未躲避的区别。
黄帝说：在同一时间遇到风邪，同时生病，但病症各异，希望听听其中的原因。少俞说：问得好！请允许我用匠人来作比喻。匠人磨快斧头刀刃，砍削木材的阴阳面，木材中仍有坚硬和脆软的区别。坚硬的部位斧头难以切入，脆软的地方表皮松弛。到了节疤处，连斧头都会缺损。同一棵树中，坚硬和脆软的程度不同。坚硬的就刚强，脆软的就容易受伤。更何况不同的木材，树皮厚薄不同，汁液多少不同，从而各有差异呢？树木早春开花先长叶的，遇到春霜烈风，花朵就凋落，叶子就枯萎；长期暴晒大旱，树皮薄脆的树，枝条汁液少而叶子枯萎；长期阴雨连绵，树皮薄且汁液多的树，皮溃烂渗水；突然刮起暴风，刚硬或脆软的树木，树枝折断树干受损；秋霜疾风，刚硬或脆软的树木，根部动摇叶子脱落。这五种情况，各自受到不同的伤害，何况是人呢？
黄帝说：用人体来对应树木，是怎么回事？少俞回答说：树木受到的伤害，都伤及其枝干。枝干的刚脆和坚固程度决定了是否受伤。人之所以常有疾病，也是因为其骨节、皮肤、腠理不够坚固，邪气得以栖息，所以经常生病。
本章论述因体质形态不同而导致的疾病变化，是感受六气（风、寒、暑、湿、燥、火）化生影响的五种变异规律。人的形体包括皮肤、肌肉、腠理、筋骨，有厚薄、坚脆的不同，所以邪气栖息的深浅不同，引发的疾病也各异。即使是五脏的消瘅、肠胃的积聚，也是因形体的皮肤肌肉病变波及到内脏。所以用树木的皮、汁、坚、脆、多少来类比。阴阳好比树木的枝干、皮肉。节疤处斧头缺损，比喻人的皮弛肉脆，而骨节坚刚。因此在一棵树中，还有坚脆的不同，坚硬者刚强，脆软者易伤，何况是不同的木材呢？树皮薄、枝条脆的树木，比喻人的皮肤不致密，肤腠疏松。树木汁液多或少，比喻皮肤津液的多少。树木早花先叶，比喻木气外敷，不能经受风霜。溃，指散开；漉，指渗漏。树皮薄且多汁的树，遇到久阴淫雨，就会溃烂渗漏；刚脆的树木，遇到突然刮起的暴风，就会枝折干伤。大概汁液多的树不宜阴雨，刚脆的树又忌讳暴风。这比喻人的腠理疏松者容易漉汗，性情刚直易怒者容易患消瘅。树木受到的伤害，都伤及枝干。枝干刚脆者易伤，坚硬者未成重伤。所以人常生病，也是因为骨节、皮肤、腠理不坚固，邪气得以栖息，从而经常发病。朱永年说：树木的枝干，比喻人的四肢。《本经》说：邪中于阴经，常从手臂开始。所以上古之人起居有常度，不妄加劳损，保养四肢。
黄帝说：人容易患风厥（中风伴汗出）漉汗（淋漓出汗）的，如何诊断？少俞回答说：肌肉不坚实，腠理疏松，就容易患风病。黄帝说：如何诊断肌肉不坚实呢？少俞回答说：肌肉不坚实且没有分明的纹理，纹理粗疏，皮肤不致密，说明腠理疏松。这是指浑然一体的表现。朱永年说：这是说皮肤不致密，肌肉纹理粗疏，导致风邪厥逆于内，出现淋漓之汗。津液充塞于皮腠之间，皮溃理疏，津液外泄成为汗。委穴下方称为“”，是太阳经的分区。大概太阳经之气，主管皮肤。如肌肉不坚实且无分理，无分理即粗理。理粗且皮不致密，则腠理疏松，浑然出汗。倪冲之说：太阳经的津气，营运于肤表，如同天道浑然一体，水随气行。所以皮不密则气泄，气泄则津液也泄。
黄帝说：人容易患消瘅的，如何诊断？少俞回答说：五脏都柔弱的人，容易患消瘅。黄帝说：如何知道五脏柔弱呢？少俞回答说：柔弱的人，必然伴有刚强的性格。刚强且多怒，柔弱之体容易受伤。黄帝说：如何诊断柔弱与刚强？少俞回答说：这种人皮肤薄，眼睛坚固深邃，眉毛长而直竖，内心刚强。刚强则多怒，怒则气上逆，胸中蓄积，血气逆行留滞，皮肤充盈肌肉僵硬，血脉不通，转而为热。热则消耗肌肤，所以患消瘅。这是说人外表刚暴而肌肉虚弱。消瘅，是指热盛而消渴消瘦。《邪气脏腑病形篇》说：五脏脉微小为消瘅。大概五脏主藏精。五脏皆柔弱，则津液枯竭而善患消瘅。形体是五脏的外合。皮肤薄而肌肉弱，说明五脏皆柔弱。所谓“柔弱者必有刚强”，是指形体弱而性气刚。所以这种人皮肤薄、眼睛坚固深邃，其气有长冲直扬之势，内心刚强，刚强则多怒，怒则气上逆，血积于胸中，气逆留滞，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。
这是说其人外表刚暴而肌肉虚弱。肌肉弱则五脏皆柔，外表刚暴则多怒而气上逆。朱永年说：按，《本经》中有五脏的消瘅，有肌肉的消瘅。五脏的消瘅，是津液内消而消渴；肌肉的消瘅，是肌肉外消而消瘦。大概因内伤者必及于外，因外伤者必及于内。形体与五脏，是内外相合的关系。高士宗说：按，《平脉篇》说：肾气微弱，精血少，奔气急促迫促，上入胸膈。大概精血少则逆气反向上奔，所以说“柔弱者必有刚强”，是指五脏的精质柔弱，而气反刚强，这是柔者愈弱，刚者愈强，刚柔不和的表现。
黄帝说：人容易患寒热的，如何诊断？少俞回答说：骨骼小、肌肉弱的人，容易患寒热病。黄帝说：如何诊断骨的大小、肉的坚脆、面色不一？少俞回答说：颧骨是骨的根本。颧大则骨大，颧小则骨小。皮肤薄而肌肉软弱无力，手臂柔弱，地阁之色暗淡，不与天庭同色，色泽独异。这就是征象。然后看手臂薄的，其髓不满，所以容易患寒热病。（“”音窘，“懦”音糯）
这是说骨小肉弱者，容易患寒热病。肾主骨，颧是肾之外候，所以颧骨为骨之本。颧大则周身之骨皆大，颧小则知其骨小。“”是肉的指标。“懦懦”意为柔弱。手臂薄，指大腿和大臂的大肌肉不丰满。“地色”指地阁之色暗淡，不与天庭同色，这是土气卑污的表现。“髓”是骨的充实物。骨小则髓不满。在外者，皮肤为阳，筋骨为阴。骨小皮薄，则阴阳两虚。阳虚则生寒，阴虚则发热。所以骨小皮薄的人，容易患寒热病。倪冲之说：津液随三焦出气，以温肌肉，充腠理，淖泽注入骨中，补益脑髓，润泽皮肤。如手臂薄者，通体皮肉薄弱。皮肉薄弱，则津液竭少，所以说手臂薄者髓不满。高士宗说：邪在皮肤则发热，深入于骨则发寒。
黄帝说：如何诊断人容易患痹病的？少俞回答说：纹理粗疏且肌肉不坚实的人，容易患痹病。黄帝说：痹病有高下之分吗？少俞回答说：想知道高下，各观察其所属部位即可。
这是说理粗肉不坚者，容易患痹病。“理”指肌肉的纹理。如粗疏而不致密，则邪气停留而成痹。皮、脉、肉、筋、骨，是五脏的分部。《痹论》说：风寒湿三气杂至，合而为痹。冬季遇此者为骨痹，春季遇此者为筋痹，夏季遇此者为脉痹，长夏遇此者为肌痹，秋季遇此者为皮痹。所以各视其部，就知道痹病的高下。大概心肺之痹在上，肝肾脾之痹在下。
黄帝说：人容易患肠中积聚的，如何诊断？少俞回答说：皮肤薄而无光泽，肌肉不坚实而湿润。像这样，则肠胃功能恶劣。功能恶劣则邪气停留，积聚乃成，损伤脾胃之间。若饮食寒温不调，邪气稍至，蓄积停留，大聚乃起。
朱永年说：这是说善患肠中积聚者，是因为肠胃功能恶劣。皮肤薄则气不充身泽毛，肌肉不坚实则津液不能淖泽。像这样则肠胃功能恶劣。大概津液血气由肠胃所生。功能恶劣则邪气停留而成积聚，乃伤脾胃之间。如果再饮食寒温不节，邪气稍至，即蓄积成大聚。阳是肺的配合，主皮毛主气；胃是脾的配合，主肌肉主津液。所以皮肤薄而肌肉不坚实，则气不充而津液不淖泽。气不充而液不泽，则毫毛开而腠理疏。疏则邪气停留，逐渐流入肠胃之间而成积聚。
黄帝说：我已知道了疾病的形态，希望了解发病的时间。少俞回答说：先确立年份，以知晓当时的气候。时气高亢则病起，时气低下则病危。即使不陷下，当年有冲通之气，病也会起。这叫做因形而生病，是五变的规律。
风雨寒暑，是营运的六气。六气在外致病形，所以应当先立其年，以知晓当时的六气。如辰戌之年，太阳司天，二之客气乃阳明燥金，主气乃少阴君火。此时主气胜临御之气，值此时气高而病必起。起者，即黄帝所说的“或复还”。如三之客气乃太阳寒水，主气乃少阳相火；四之客气乃厥阴风木，主气乃太阴湿土；五之客气乃少阴君火，主气乃阳明燥金；终之气乃太阴湿土，主气乃太阳寒水。值时气下而为客气所胜，故其病必殆。殆，是将要的意思。时气下而不能胜，则病将留止，即黄帝所说的“或留止”。大概风雨寒暑，是临御之化，六期环转，客于形而为病。
所以必须因时气来战胜它。此论六气在外。陷下者，陷于肠胃之间而成积聚。冲通者，五运之气通出于外，而冲散其病气。如太阳寒水司天，而五运乃太宫土运。此在内之运气胜之，故病亦不能留止。大概六气在外，应天之三阴三阳；五运主中，应地之五行；人之五脏，此脏气胜岁气，故虽不陷下，病留止于外者，亦能冲通而散。大概六气主升降于上下，五运主出入于外内。这叫做因形而生病，是五变的规律。夫皮肤肌腠曰形。腠，是皮肤肌肉的纹理，是营卫出入的道路。此病形而不病气。如病气则与营卫俱行淫于内，而与魂魄飞扬。如传溜于血脉，则入脏腑，为内所因。此病形而不病气，亦不溜于脉中，故为漉汗、消瘅、寒热、留痹、积聚五者之病。即陷于内，乃伤脾胃之间，郛郭之中，而不及于脏腑。此奇邪淫溢，或病形，或病气，或溜于血脉，或入于脏腑，病之变化，不可胜数。是以《伤寒论》六篇，首论三阴三阳之气，以及六经之证。然亦有病形而不病气者，故太阳篇中说：“形作伤寒”。盖在天成气，在地成形。此天地之生命，所以立形定气，而视寿夭者，必明乎此。临病患以观邪之中人，或病气，或病形，或溜于血脉，或入于脏腑，以知病之轻重，人之死生者，必明乎此。朱氏说：《素问》岁运诸篇，有客气胜主气而为民病者，主气胜客气而为民病者，有六气胜五运而为民病者，五运胜六气而为民病者。此概论岁运之太过不及。此篇论人之皮薄理疏，风雨寒暑之气，循毫毛而入腠理，为五变之病。故藉主气以胜之。主气者，吾身中有此六气，而合于天之四时也。
朱卫公说：气者，三阴三阳之气，相将出入的营气卫气，三焦通会元真之气，所以充行于皮肤肌腠之间。此病形而不病气，故藉此形中之阴阳，合四时之六气以胜邪。若病气，则又有气之变证矣。倪冲之说：按，《阴阳别论》说：气伤痛，形伤肿。先痛而后肿者，气伤形也；先肿而后痛者，形伤气也。大概形舍气，气归形，故病形必及于气，病气必及于形。此章论病形而不病气。盖阴阳之道，有有形，有无形，有经常，有变易。上宗说：理者，皮肤脏腑之纹理也。盖在外乃皮肤肌肉之纹理，在内乃脏腑募原之纹理。故留止而成积聚者，在脏腑外之募原，故乃伤脾胃之间，而不涉于脏腑。募原者，连于肠胃之膏膜。
Huangdi asked Shaoyu, "I have heard that the onset of various diseases must originate from wind, rain, cold, and summer heat. These pathogens enter the couli (interstices between skin and muscle) via the fine hairs. Some return outward, while some remain inside. They may cause wind swelling with sweating, Xiao Dan (a disease characterized by polydipsia, polyphagia, and emaciation), alternating chills and fever, Li Bi (obstruction in meridians causing pain or numbness), or Ji Ju (accumulations and masses). The overflow of strange pathogens is countless. I wish to know the reason. Why do people who are exposed to pathogens at the same time develop different diseases? Is it that Heaven intentionally creates wind for humans? Why is there such variation?"
Shaoyu replied, "Heaven's generation of wind is not biased towards any individual. Wind moves fairly and uprightly; those who encounter it get sick, while those who avoid it remain safe. It is not that wind seeks out humans to attack, but rather that humans inadvertently encounter it."
Ma Zhonghua commented: "This passage explains that although people are exposed to pathogens equally, whether they fall ill varies. This is not due to Heaven's bias, but due to differences in whether individuals avoid or fail to avoid the pathogens."
Huangdi said, "Encountering wind at the same time and falling ill simultaneously, yet presenting different symptoms, I wish to hear the reason." Shaoyu said, "Excellent question! Let me use a carpenter as an analogy. A carpenter sharpens axes and knives to cut wood. Even within the same piece of wood, there are hard and brittle parts. Axes cannot easily penetrate hard parts, while brittle parts have loose skin. At the knots, even axes may break. Within a single tree, hardness and brittleness differ. Hard parts are strong, while brittle parts are easily damaged. How much more so for different types of wood, varying in bark thickness and sap content?"
"H trees that flower early and leaf first will lose flowers and wither leaves when encountering spring frost and fierce winds. During prolonged droughts, trees with thin and brittle bark will have dry branches and withered leaves due to low sap content. In cases of prolonged damp rain, trees with thin bark and abundant sap will suffer from rotting and leaking bark. When sudden storms arise, both hard and brittle trees may suffer broken branches and damaged trunks. In autumn frost and fierce winds, roots of hard and brittle trees may shake, and leaves fall. All these five scenarios cause specific damages. How much more so for humans?"
Huangdi asked, "How does the human body correspond to trees?" Shaoyu answered, "Tree damage primarily affects its branches. Whether branches are damaged depends on their hardness or brittleness. Humans often suffer from diseases because their bones, joints, skin, and couli are not firm enough, providing a habitat for pathogens. Thus, illness is common."
This chapter discusses how diseases arise due to physical constitution, representing the five variations caused by the transformation of the Six Qi (Wind, Cold, Summer Heat, Dampness, Dryness, Fire). The human form—skin, muscle, couli, sinews, and bone—varies in thickness and firmness. Therefore, the depth of pathogen invasion differs, leading to diverse diseases. Even internal diseases like Xiao Dan in the Zang organs or Ji Ju in the intestines and stomach result from external changes in skin and muscle affecting the interior. Hence, tree characteristics like bark, sap, hardness, and brittleness are used as analogies. Yin and Yang correspond to tree branches, trunk, bark, and flesh. Knots where axes break represent loose skin and weak muscles contrasted with firm bone joints. Thus, even within one tree, hardness and brittleness vary; hard parts are strong, brittle parts are vulnerable. How much more so for different woods? Thin-barked, brittle-branched trees resemble humans with non-tight skin and loose couli. Sap quantity resembles skin fluid levels. Early-flowering trees unable to withstand wind and frost resemble humans whose Wood Qi spreads outward without resistance. 'Kui' means scattering; 'Lu' means seeping. Thin-barked, sap-rich trees rot and leak in damp rains; hard/brittle trees break in storms. Abundant sap makes trees susceptible to dampness; hardness/brittleness makes them vulnerable to storms. Similarly, humans with loose couli sweat profusely, while those with rigid, angry temperaments prone to Xiao Dan. Tree damage affects branches; brittle branches break easily, hard ones resist. Thus, human illness stems from unfirm bones, skin, and couli, allowing pathogens to reside. Zhu Yongnian stated: Tree branches correspond to human limbs. The Classic states: "Pathogens entering Yin meridians often start from the arms." Therefore, ancient people maintained regular routines, avoided excessive labor, and nourished their four limbs.
Huangdi asked, "How can we diagnose those prone to Feng Jue (wind stroke with sweating) and profuse sweating?" Shaoyu answered, "Those with unfirm muscles and loose couli are prone to wind diseases." Huangdi asked, "How to diagnose unfirm muscles?" Shaoyu replied, "Unfirm muscles lack distinct textures. Coarse textures and non-tight skin indicate loose couli. This refers to a generalized state." Zhu Yongnian commented: "Non-tight skin and coarse muscle texture allow wind pathogens to reverse internally, causing profuse sweating. Fluids fill the couli; if skin is loose and textures coarse, fluids leak as sweat. Below the Weizhong acupoint lies the Taiyang region, governing the skin. If muscles are unfirm and lack texture, indicating coarse texture and loose couli, sweating occurs naturally." Ni Chongzhi added: "Taiyang Jing fluids and Qi circulate on the body surface, akin to the natural order, with water following Qi. Loose skin leads to Qi leakage, which causes fluid leakage."
Huangdi asked, "How to diagnose those prone to Xiao Dan?" Shaoyu answered, "Those with weak Zang organs are prone to Xiao Dan." Huangdi asked, "How to know Zang weakness?" Shaoyu replied, "Weakness implies accompanying rigidity. Rigidity involves anger; weak constitutions are easily injured." Huangdi asked, "How to distinguish weak from rigid?" Shaoyu answered, "Such individuals have thin skin, deep/firm eyes, long/straight eyebrows, and a rigid heart. Rigidity leads to anger; anger causes Qi to rebel upward, accumulating in the chest. Blood and Qi stagnate, skin becomes full, muscles stiffen, vessels obstruct, transforming into heat. Heat consumes flesh, causing Xiao Dan. This describes someone externally rigid but internally weak. Xiao Dan involves heat-induced thirst and emaciation. The *Chapter on Pathogens and Zang-Fu* states: 'Small/fine pulses of Zang organs indicate Xiao Dan.' Zang organs store Essence. Weakness leads to fluid depletion and susceptibility to Xiao Dan. Form reflects Zang status. Thin skin and weak muscles indicate Zang weakness. 'Weakness implies rigidity' means weak form but rigid temperament. Such individuals have rising Qi energy, rigid hearts, anger, upward-rebelling Qi, chest blood stasis, muscle blockage, vessel obstruction, heat transformation, and finally Xiao Dan."
This describes external rigidity and internal weakness. Weak muscles imply weak Zang; external rigidity implies anger and rebellious Qi. Zhu Yongnian noted: There are Zang-type Xiao Dan (internal fluid loss causing thirst) and Muscle-type Xiao Dan (external muscle wasting). Internal issues affect external, and vice versa. Form and Zang are interconnected. Gao Shizong cited the *Pulse Chapter*: "Weak Kidney Qi and essence/blood lead to rushing Qi ascending to the chest. Low essence/blood causes rebellious Qi ascent. Thus, 'weakness implies rigidity' means Zang essence is weak, but Qi is overly rigid, creating imbalance."
Huangdi asked, "How to diagnose those prone to alternating chills and fever?" Shaoyu answered, "Those with small bones and weak muscles are prone to chills and fever." Huangdi asked, "How to assess bone size, muscle firmness, and complexion?" Shaoyu replied, "The zygomatic bone is the root of bones. Large zygoma means large bones; small zygoma means small bones. Thin skin, weak arms ('Nuonuo'), dull lower face color differing from the upper face indicates this pattern. Thin arms suggest insufficient marrow, predisposing to chills and fever."
Small bones and weak muscles predispose to chills and fever. Kidneys govern bones; the zygoma reflects Kidney status. Large/small zygomas reflect whole-body bone size. 'Yi' indicates muscle quality. 'Nuonuo' means weak. Thin arms mean lacking substantial thigh/arm muscles. Dull lower face color contrasting with the forehead indicates deficient Earth Qi. Marrow fills bones; small bones imply empty marrow. Skin is Yang, bones/tendons are Yin. Small bones/thin skin mean dual deficiency. Yang deficiency causes cold; Yin deficiency causes fever. Thus, small bones/thin skin lead to chills/fever. Ni Chongzhi explained: Sanjiao Qi transports fluids to warm muscles and fill couli/marrow/skin. Thin arms indicate weak whole-body tissue, leading to fluid depletion and empty marrow. Gao Shizong added: Pathogens in skin cause fever; penetrating bones cause chills.
Huangdi asked, "How to diagnose those prone to Bi syndrome?" Shaoyu answered, "Coarse textures and unfirm muscles are prone to Bi." Huangdi asked, "Does Bi have high/low locations?" Shaoyu replied, "Observe the respective regions."
Coarse textures/unfirm muscles lead to Bi. 'Texture' refers to muscle grain. Coarse/non-tight textures allow pathogen retention causing Bi. Skin, vessels, muscle, tendons, bones correspond to Zang/Fu divisions. The *Bi Syndrome Chapter* states: Wind, Cold, Dampness combine to cause Bi. Winter exposure causes Bone Bi; Spring causes Sinew Bi; Summer causes Vessel Bi; Late Summer causes Muscle Bi; Autumn causes Skin Bi. Observing regions reveals Bi location. Heart/Lung Bi is upper; Liver/Kidney/Spleen Bi is lower.
Huangdi asked, "How to diagnose those prone to intestinal Ji Ju?" Shaoyu answered, "Thin, lusterless skin and unfirm, moist muscles indicate poor gastrointestinal function. Poor function allows pathogen retention, forming accumulations that damage the Spleen/Stomach area. Dietary irregularities exacerbate this, leading to large masses."
Zhu Yongnian commented: Intestinal Ji Ju stems from poor GI function. Thin skin lacks Qi/fluid nourishment; unfirm muscles lack fluid lubrication. Poor GI function impairs fluid/blood production. Retained pathogens form accumulations, damaging Spleen/Stomach. Irregular diet worsens this. Lung governs skin/Qi; Stomach (paired with Spleen) governs muscle/fluids. Thin skin/unfirm muscles mean deficient Qi/fluids. Deficiency opens pores/loosens couli, allowing pathogens to flow into intestines/stomach, forming accumulations.
Huangdi said, "I know the forms; I wish to know the timing." Shaoyu replied, "Establish the year to know the season. High seasonal Qi triggers onset; low seasonal Qi brings danger. Even without sinking, if the year has 'Chong Tong' (pulsating/freeing) Qi, disease arises. This is 'illness arising from form,' the law of Five Variations."
Wind/Rain/Cold/Summer Heat are the Six Qi. External pathogens affect form. One must establish the year to know the Qi. E.g., Chen/Xu years: Taiyang rules heaven, 2nd guest Qi is Yangming Dry Metal, main Qi is Shaoyin Ministerial Fire. Main Qi overcoming Guest Qi means high Qi triggers disease ("return"). 3rd Guest Qi is Taiyang Cold Water, Main Qi is Shaoyang Ministerial Fire. 4th Guest Qi is Jueyin Wind Wood, Main Qi is Taiyin Damp Earth. 5th Guest Qi is Shaoyin Ministerial Fire, Main Qi is Yangming Dry Metal. Final Guest Qi is Taiyin Damp Earth, Main Qi is Taiyang Cold Water. Low Qi overcome by Guest Qi brings danger ("dai"). Low Qi failing to overcome leads to retention ("stay"). Wind/Cold/Summer Heat are ruling transformations cycling through six periods, attacking form. Thus, one must use seasonal Qi to counteract them. This discusses external Six Qi. 'Sinking' refers to accumulation in intestines/stomach. 'Chong Tong' refers to Five Transport Qi bursting outward to scatter pathogens. E.g., Taiyang Cold Water ruling heaven with Tai Gong Earth transport: internal transport overcomes, preventing retention. Six Qi (external/Yin-Yang) vs. Five Transport (internal/Five Elements) vs. Zang Qi. If Zang Qi overcomes Year Qi, even external retention can be cleared. Six Qi govern vertical movement; Five Transport governs horizontal/internal-external movement. This is 'illness from form,' the law of Five Variations. Form includes skin/couli. Couli are textures and pathways for Ying/Wei Qi. This affects form, not Qi. If Qi is affected, it mixes with Ying/Wei, disturbing Hun/Po. If entering vessels/organs, it becomes internal cause. Here, form is affected, not Qi/vessels, causing sweating, Xiao Dan, chills/fever, Bi, Ji Ju. Damage is to Spleen/Stomach pericardium, not organs. Strange pathogens overflow, affecting form/Qi/vessels/organs variably. *Shanghan Lun* discusses Three Yin/Three Yang and Six Meridians. Some cases are form-only (e.g., "Form resembles Shanghan"). Heaven generates Qi, Earth generates Form. Understanding this determines life/death. Observing patients requires distinguishing Qi/Form/Vessel/Organ involvement to judge severity/prognosis. Zhu noted: *Suwen* discusses Guest/Main Qi and Five Transport interactions causing disease. This chapter focuses on thin skin/coarse couli allowing pathogens to enter, causing Five Variations. Main Qi (internal Six Qi matching Four Seasons) counters this.
Zhuweigong stated: Qi includes Three Yin/Three Yang, Ying/Wei Qi, and Yuanzhen Qi in Sanjiao, circulating in skin/couli. This case affects form, not Qi, using internal Yin/Yang and seasonal Qi to defeat pathogens. If Qi is affected, complications arise. Nichongzhi cited *Yin Yang Bie Lun*: "Qi injury causes pain; Form injury causes swelling. Pain then swelling = Qi injuring Form; Swelling then pain = Form injuring Qi." Form houses Qi; Qi returns to Form. Disease in form affects Qi, and vice versa. This chapter discusses form-disease without Qi-disease. Yin/Yang has form/substance, constancy/change. Shangzong defined 'texture' as skin/organ patterns. External: skin/muscle texture; Internal: organ/Muyuan texture. Accumulations form in Muyuan (outside organs), damaging Spleen/Stomach area, not organs directly. Muyuan connects to intestinal fat membranes.