调、和也。顺也。言人之阴阳水火。荣卫气血。表里上下。皆当和调。逆调则为病矣。
黄帝问曰。人身非常温也。非常热也。为之热而烦满者。何也。（此论上下阴阳之不和也。非常温者。谓非常有温热
之病在表也。非常热者。谓非常有五脏之热在里也。为之者。乃阳热之气为之也。）岐伯对曰。阴气少而阳气胜。故热而
烦满也。（火为阳而居上。水为阴而居下。阴气少而阳气胜。故热而烦满于上也。）帝曰。人身非衣寒也。中非有寒气也。
寒从中生者何。（身非衣寒。表无寒也。中非有寒气。里无寒也。寒从中生者。谓寒从阴中而生也。）岐伯曰。是人多痹
气也。阳气少。阴气多。故身寒如从水中出。（痹气者。气闭也。阳气少而阴气多者。因是人多痹气故也。病在阴者名曰
痹。寒湿之气。闭于里阴。则火热不得下交于阴而阴气盛。阴气盛则阳气渐衰。阴寒之气过多。故身寒如从水中出。盖
热出于阳火。故烦。寒出于阴水。故如从水中出。此上下水火阴阳之不和也。）帝曰。人有四肢热。逢风寒如灸如火者。
何也。（此论表里阴阳之不和也。四肢为诸阳主气。四肢热者。阳热之气在表也。逢风寒而如灸如火者。邪正相搏。因表
阳之热。而热更盛极也。此节论阳生于阴。阴生于阳。阴阳和调则阳生阴长。逆则孤阴不生。独阳不长耳。）岐伯曰。是
人者。阴气虚。阳气盛。四肢者阳也。两阳相得。而阴气虚少。少水不能灭盛火。而阳独治。独治者。不能生长也。独
胜而止耳。（阴气虚者。里阴之气虚也。阳气盛者。表阳之气盛也。阳受气于四末。阴受气于五脏。四肢者。阳明之所主
也。两阳、阳明也。两阳合明。故曰阳明。相得者。自相得而为热也。阴气少者。少阴之气少也。少水者。津液少也。
津液少而不能还入胃中。则火盛而不能灭矣。夫肾主藏精。阳明之所生也。肾之精气。复上与阳明相合。戊癸合而化火。
火土之气。阴气虚少。则阳独治矣。然独阳不生。谓不能再生长其阳热。惟此独胜而止矣。张兆璜曰。能灭盛火。即
是阴阳和调。）逢风而如灸如火者。是人当肉烁也。（此释明阳明之气。主于四肢。而又所主肌肉也。二阳之气。在于皮
肤肌腠之间。而又逢风热之阳邪。邪正相搏。则火热炽而销铄其肌肉矣。）帝曰。人有身寒。汤火不能热。浓衣不能温。
然不冻栗。是为何病。（身寒而汤火不能热。浓衣不能温者。太阳气衰。而寒在表也。不冻栗者。二阳火热之在里也。）
岐伯曰。是人者。素肾气胜。以水为事。太阳气衰。肾脂枯不长。一水不能胜两火。肾者水也。而生于骨。肾不生则髓
不能满。故寒甚至骨也。（肾气胜者。肾水之气胜也。以水为事者。膀胱之水胜也。谓其人水寒之气偏胜。水寒偏胜则太
阳气衰。太阳气衰则孤阴不长矣。水、精水也。肾藏之精枯不长。而膀胱之一水。不能胜二火矣。夫肾生骨髓。水生肝。
肾脂不生。则髓不能满于骨。是以寒至骨也。以上兼论阴阳水火。互相生长之道。高士宗曰。一水不能胜二火句。似
为衍文。）所以不能冻栗者。肝一阳也。心二阳也。肾孤脏也。一水不能胜二火。故不能冻栗。病名曰骨痹。是人当挛
节也。（肝者。一阳初生之木火也。心者。地二所生之君火也。肾为牝脏。孤脏也。孤脏之阴。藉太阳标本以合化。太阳
气衰。则孤阴不长矣。膀胱之津液。不能胜二火。故其人不能冻栗者。二阳之火热在内也。病名曰骨痹。病在髓枯而骨
痛也。故其人当骨节拘挛。此论表里阴阳之不调也。）帝曰。人之肉苛者。虽近衣絮。犹尚苛也。是谓何疾。（此论荣
卫之气不和也。苛、虐也。谓虽近衣絮。而苛虐如故也。）岐伯曰。荣气虚。卫气实也。（虚实者。不和也。言荣气不得
卫气之和。则荣气虚。卫气不与荣气相和。则卫气实也。盖阳道常实。故曰实。然则过犹不及也。）荣气虚则不仁。卫气
虚则不用。荣卫俱虚则不仁且不用。肉如故也。（不仁者。不知痛痒。不用者。痿而不胜。盖言荣卫不和。则两者皆虚矣。
荣卫两虚者。不仁且不用。不仁不用。而肉苛如故者。不和而致虚也。张兆璜曰。此释明上文之所谓虚实者。乃不和也。）
人身与志不相有。曰死。（人身者。荣卫之所循行也。志者。五脏之神志也。本脏篇曰。经脉者。所以行气血而荣阴阳。
濡筋骨。利关节者也。卫气者。所以温分肉。充皮肤。肥腠理。司开阖者也。志意者。所以御精神。收魂魄。适寒温。
和喜怒者也。是故血和则经脉流行。荣覆阴阳。筋骨劲强。关节清利矣。卫气和则分肉解利。皮肤调柔。腠理致密矣。
志意和则精神专直。魂魄不散。悔怒不起。五脏不受邪矣。寒温和则六腑化谷。经脉通利。肢节得安矣。此人之常平也。
是三者之所当和调者也。如三者皆相失而不相有。则气血不行。魂魄离散而死矣。此言荣气当与卫气和调。荣卫之气。
又当与神志和调者也。）帝曰。人有逆气。不得卧而息有音者。有不得卧而息无音者。有起居如故而息有音者。有得卧。
行而喘者。有不得卧。不能行而喘者。有不得卧。卧而喘者。皆何脏使然。愿闻其故。（此论经气上下之不调也。经气生
于脏腑。故曰何脏使然。）岐伯曰。不得卧而息有音者。是阳明之逆也。足三阳者下行。今逆而上行。故息有音也。（一
呼一吸曰息。息有音者。呼吸有声。气逆之所致也。足之三阳。从头走足。故三阳者下行。今反逆而上。以致呼吸之有
音也。朱圣公曰。是阳明之逆也句。概上下二节而言。）阳明者。胃脉也。胃者六腑之海。其气亦下行。阳明逆。不得
从其道。故不得卧也。下经曰。胃不和则卧不安。此之谓也。（按灵枢动输篇。黄帝曰。经脉十二。而手太阴足少阴阳明
独动不休。何也。岐伯曰。是明胃脉也。胃为五脏六腑之海。其清气上注于肺。肺气从太阴而行之。其行也。以息往来。
故人一呼脉再动。一吸脉亦再动。呼吸不已。故动而不止。黄帝曰。气之过于寸口也。上十焉息。下八焉伏。何道从还。
不知其极。岐伯曰。气之离脏。卒然如弓弩之发。如水之下岸。盖言十二经脉。皆足阳明胃腑之所生。胃气上注于肺。
以司呼吸。下注于肾。以资十二经脉。故曰。阳明者。胃脉也。言胃者。水谷血气之海也。胃之所出血气者。从大络而
上注于肺。从胃脉而下注足少阴也。如阳明逆。不得从其道。则为不得卧而息有音。手太阴逆。则为起居如故而息有音。
足少阴逆。则为不得卧而喘也。此论经脉呼吸之逆调也。下经者。即下文之所谓不得卧。卧则喘者。是水气之客也。盖
阳明之津液。随气而下注于肾。如阳明逆。不得从其道。而肾之水气。反上客于阳明。是以胃不和而卧不安也。再按
上十焉息者。谓阳明所生之荣卫宗气。如弓弩之发。上注于肺。以行呼吸。以荣经脉。居十分之十焉。下八焉伏者。谓
阳明所生之津液。下注于足少阴。如水之下岸。居十分之八焉。盖荣气宗气卫气。皆主上行。是气之十分。皆上行也。
津液二分。行于经隧。八分流溢于肾。故止八分而伏藏于下也。何道从还者。冲脉与少阴之大络。起于肾。下出于气街。
冲脉上循背里。为经络之海。气街者。气之径路也。如络绝则径通。是流溢于肾藏之精液。从冲脉气街之道路。还循于
十二经脉。如环无端。而莫知其极。此血气生始之根原。经脉循行之道路。学人所当用心理会者也。张兆璜曰。灵枢论
经脉顺行之道。此篇论经脉逆调之因。故当复引经语以证明之。）夫起居如故而息有音者。此肺之络脉逆也。络脉不得随
经上下。故留经而不行。络脉之病患也微。故起居如故而息有音也。（此言手太阴之调逆也。肺主呼吸。肺之络脉逆。故
呼吸不利而息有音也。夫脉之循于里曰经。浮而外者为络。外内上下经络相贯。循环无端。络脉逆则气留于经。而不行
于络矣。络脉浮于皮肤之间。其病轻微。故止息有音而起居如故也。）夫不得卧。卧则喘者。是水气之客也。夫水者。循
津液而流也。肾者水脏。主津液。主卧与喘也。帝曰。善。（此言足少阴之逆调也。夫津液者。水谷之所生。肾者胃之关
也。胃之水液。从关而下。入于肾者顺也。如阳明逆。不得从其道而下入于肾。则肾之水气。反循津液之道路。而上乘
于胃矣。是以胃不和而卧不安也。故曰。肾者水脏。主藏津液。又主卧与喘也。夫手太阴足少阴阳明。主血气生始之根
原。经脉呼吸之道路。人之一身。总不外乎水火阴阳。荣卫气血。是以上章论水火阴阳之寒热。后章论呼吸经脉之逆调。
杨君立问曰。帝问有不得卧而息无音者。有得卧行而喘者。有不得卧不能行而喘者。岐伯皆未详答。后人有言简脱者。
有增补其文者。是耶非耶。曰。此节专论气之呼吸。脉之顺逆。盖经脉者。所以行气血而荣阴阳。濡筋骨。利关节者也。
是以三阳之脉上行。则气逆而为息有音。如三阳之脉顺行而下。止阳明不得从其道。是当不得卧而息无音矣。如病在经
脉。则阴阳不和而不得卧。筋骨不利而不能行。今病在络脉。故止息有音而起居如故也。圣人立言。浑然 栝。或言在
意中。或意居言表。奈何后学不细心体认。而妄增臆论耶。）
调和，即和谐、顺遂之意。说的是人体的阴阳、水火、营卫、气血、表里、上下，都应当和调顺遂，如果逆乱不调就会生病。
黄帝问道：人的身体并不是因为穿衣少而感觉冷，也不是体内有寒气，却出现发热且心烦胀满的症状，这是为什么呢？（这是在论述上下阴阳的不和谐。所谓“非常温”，是指体表并没有外感温热之邪；所谓“非常热”，是指体内五脏并没有实热。之所以出现这种症状，是因为阳热之气在体内作祟。）
岐伯回答说：这是因为阴气不足而阳气偏盛，所以会出现发热且心烦胀满的症状。（火属阳而居上，水属阴而居下。阴气少而阳气胜，所以在上部出现发热和心烦胀满。）
黄帝说：人的身体并不是因为衣服穿得少而感到寒冷，体内也没有寒气侵入，但寒气却从体内产生，这是为什么呢？（身体并非因衣薄而寒，体表无寒邪；体内并非有寒气入侵，里无寒邪。所谓“寒从中生”，是指寒气从阴分内部产生。）
岐伯说：这种人多有痹气（气机闭塞不通），阳气少而阴气多，所以身体寒冷，好像刚从水里出来一样。（痹气，就是气机闭塞。阳气少而阴气多的人，因此容易患痹证。病在阴分的称为痹。寒湿之气闭阻于里的阴分，导致火热之气不能下行与阴相交，从而使阴气更盛。阴气盛则阳气逐渐衰退，阴寒之气过多，所以身体寒冷，如同从水中出。大概热出于阳火，所以感到烦闷；寒出于阴水，所以感觉像从水中出来。这是上下水火阴阳不和谐的表现。）
黄帝说：有的人四肢发热，遇到风寒就像被烧烤或火烧一样，这是为什么呢？（这是在论述表里阴阳的不和谐。四肢是诸阳经主气的地方，四肢发热，说明阳热之气在体表。遇到风寒后感觉像被烧烤或火烧，是因为邪气与正气相搏结，由于体表阳热之气旺盛，使得热势更加炽盛。这一节论述的是阳生于阴、阴生于阳的道理，阴阳和调则阳生阴长，逆乱则孤阴不生、独阳不长。）
岐伯说：这种人阴气虚而阳气盛。四肢属于阳，两阳相合（指阳明胃经，为多气多血之经，故称两阳合明），而阴气虚弱稀少。少量的水不能扑灭旺盛的火，导致阳气独自亢盛。所谓“独治”，就是不能与其他脏腑协调生长，只是独自强盛而已。（阴气虚，是指里阴之气虚；阳气盛，是指表阳之气盛。阳受气于四肢末端，阴受气于五脏。四肢是阳明经所主的部位。所谓的“两阳”，就是指阳明经。两阳合明，所以叫阳明。“相得”是指它们相互结合而产生热。阴气少，是指少阴之气少。所谓的“少水”，是指津液少。津液少而不能回流入胃中，那么火就旺盛而不能被熄灭。肾主藏精，是阳明经精气来源的根本。肾的精气复上与阳明相合，戊癸相合化火，火土之气旺盛，阴气虚少，于是阳气独自亢盛。然而独阳不能生长，意思是不能再生长其阳热，只有这种独自强盛的状态罢了。张兆璜说：“能灭盛火”，即是阴阳和调的意思。）遇到风邪就像被烧烤或火烧一样，这种人肌肉将会消烁。（这里解释说明阳明之气主司四肢，同时也主司肌肉。二阳之气存在于皮肤肌腠之间，如果再遇到风热这种阳邪，邪正相搏，则火热炽盛而销铄肌肉。）
黄帝说：有的人身体寒冷，用汤药热敷不能变暖，穿厚衣服也不能温暖，但是却不发抖战栗，这是什么病？（身体寒冷，汤火不能暖，厚衣不能温，是因为太阳经气衰弱，寒邪在表。不战栗，是因为二阳火热之气在里。）
岐伯说：这种人素来肾气偏胜，从事与水有关的工作（或水性体质），导致太阳经气衰弱，肾精枯槁不能滋养骨骼。一水不能胜过两火。肾属水，主骨生髓，肾气不生则骨髓不能充盈，所以寒冷甚至深入骨髓。（肾气胜，是指肾水之气偏胜。以水为事，是指膀胱之水气偏胜。意思是此人水寒之气偏胜。水寒偏胜则太阳经气衰弱，太阳经气衰弱则孤阴不能生长。水，指真水/肾精。肾所藏的精微物质枯槁不能生长，而膀胱中的一水，不能胜过二火。肾生骨髓，水生肝。肾脂不生，则髓不能在骨中充满，所以寒冷至骨。以上兼论了阴阳水火互相生长的道理。高士宗说：“一水不能胜二火”这句话，似乎是衍文。）之所以不战栗，是因为肝为一阳，心为二阳，肾为孤脏。一水不能胜过二火，所以不战栗。这种病名叫骨痹，这种人应当出现关节拘挛。（肝是一阳初生的木火；心是地二所生的君火。肾为牝脏，是孤脏。孤脏的阴气，借助太阳经的标本之气来合化。太阳经气衰弱，则孤阴不能生长。膀胱的津液，不能胜过二火，所以这个人不战栗，是因为二阳的火热在内。病名叫骨痹，病在髓枯而骨痛。所以这个人应当出现骨节拘挛。这是在论述表里阴阳不调。）
黄帝说：有的人肌肉麻木沉重，即使靠近棉絮衣物，仍然觉得麻木沉重，这是什么病？（这是在论述营卫之气的不和谐。苛，意为虐重。意思是即使靠近棉絮，麻木沉重的感觉依然如故。）
岐伯说：这是因为营气虚而卫气实。（虚实在这里指不和。意思是营气得不到卫气的调和，则营气显得虚；卫气不与营气相和，则卫气显得实。大概阳道常实，所以说是实。但这过犹不及。）营气虚则感觉麻木不知痛痒，卫气虚则肢体痿废不能使用。营卫俱虚则既麻木又不能用，肌肉状况依旧如此。（不知痛痒叫不仁，痿废无力叫不用。大概意思是营卫不和，两者都会变虚。营卫两虚，则不仁且不用。在不仁不用的情况下，肌肉麻木沉重依旧，这是不和导致虚损。张兆璜说：这里解释上文所说的虚实，其实是指不和。）人身与神志不相维系，就会死亡。（人身，是营卫循行的地方；志，是五脏的神志。《本脏篇》说：经脉，是用来运行气血而营养阴阳，濡润筋骨，滑利关节的。卫气，是用来温养分肉，充实皮肤，肥厚腠理，主管汗孔开阖的。志意，是用来统御精神，收敛魂魄，适应寒温，调和喜怒的。所以血液调和则经脉流行，营覆阴阳，筋骨强劲，关节滑利。卫气调和则分肉解利，皮肤柔润，腠理致密。志意调和则精神专注，魂魄不散，悔恨愤怒不起，五脏不受邪气侵扰。饮食温和则六腑消化谷物，经脉通利，肢节安适。这是人的常态平衡。这三者应当和调。如果三者都失和而不相维系，则气血不行，魂魄离散而死。这说明营气应当与卫气和调，营卫之气又应当与神志和调。）
黄帝说：有的人气逆，不能平卧且呼吸有声；有的人不能平卧但呼吸无声；有的人起居正常但呼吸有声；有的人能平卧，行走时气喘；有的人不能平卧，不能行走且气喘；有的人不能平卧，躺下就气喘。这些都是哪条经脉或脏腑引起的？我想听听原因。（这是在论述经气上下不调。经气生于脏腑，所以说“何脏使然”。）
岐伯说：不能平卧且呼吸有声的，是阳明经气逆乱。足三阳经的气本应下行，现在逆而上行，所以呼吸有声。（一呼一吸叫做息。呼吸有声，是气逆所致。足部的三阳经从头走足，所以三阳经气本应下行。现在反而逆向上行，导致呼吸有声。朱圣公说：“是阳明之逆也”这句话，概括了上下两节的内容。）阳明经，就是胃脉。胃是六腑之海，其气也下行。阳明经气逆乱，不能顺着其道下行，所以不能平卧。《下经》说：胃不和则卧不安。说的就是这个意思。（按《灵枢·动输篇》，黄帝问：经脉十二，为什么手太阴、足少阴、足阳明唯独跳动不停？岐伯说：这是因为胃脉。胃是五脏六腑之海，其清气上注于肺，肺气从太阴经而行。它的运行，随着呼吸往来。人一呼脉跳两次，一吸脉也跳两次，呼吸不止，所以跳动不停。黄帝问：气经过寸口，上行十分之一处可见其息，下行八分之处潜伏不见，是从什么道路返回的？不知道它的极限。岐伯说：气离开脏腑，突然像弓弩发射，像水从岸上流下。意思是十二经脉，都足阳明胃腑所生。胃气上注于肺，以司呼吸；下注于肾，以资十二经脉。所以说，阳明就是胃脉。说胃，是因为它是水谷血气之海。胃所出的血气，从大络上注于肺，从胃脉下注足少阴。如果阳明经气逆乱，不能顺着其道，就会不得卧而呼吸有声；手太阴经气逆乱，就会起居正常而呼吸有声；足少阴经气逆乱，就会不得卧而气喘。这是在论述经脉呼吸的逆调。《下经》即下文所说的“不得卧，卧则喘者，是水气之客也”。大概阳明经的津液，随气下行注入肾。如果阳明经气逆乱，不能顺着其道，而肾的水气反而上客于阳明，所以胃不和而卧不安。再按，“上十焉息”，是指阳明所生的营卫宗气，像弓弩发射一样，上注于肺，以行呼吸，以荣经脉，占十分的十；“下八焉伏”，是指阳明所生的津液，下注于足少阴，像水从岸上流下，占十分的八。大概营气、宗气、卫气都主上行，这十分之气都上行；津液二分，行于经隧，八分流溢于肾，所以只占八分而伏藏于下。何道从还，是指冲脉与少阴的大络，起于肾，下出于气街。冲脉上循背里，为经络之海。气街，是气运行的径路。如果络绝则径通，即流溢于肾脏的精液，从冲脉气街的道路，还循于十二经脉，如环无端，不知道它的极限。这是血气生成的根本，经脉循行的道路，学人应当用心体会。张兆璜说：《灵枢》论述经脉顺行的道理，本篇论述经脉逆调的原因，所以应当引用经文来证明。）
至于起居正常但呼吸有声的，这是肺的络脉逆乱。络脉不能随经脉上下运行，所以留滞于经而不行于络。络脉的病比较轻微，所以起居正常但呼吸有声。（这是在讲手太阴经的调逆。肺主呼吸，肺的络脉逆乱，所以呼吸不利而呼吸有声。脉行于里的叫经，浮于外的叫络。内外上下经络相连，循环无端。络脉逆则气留于经，而不行于络。络脉浮于皮肤之间，其病轻微，所以只是呼吸有声而起居正常。）
至于不能平卧，躺下就气喘的，这是水气侵犯。水是顺着津液流动的。肾是水脏，主津液，主管睡眠和气喘。（这是在讲足少阴经的逆调。津液是由水谷产生的，肾是胃的关口。胃的水液，从关口下行进入肾，这是顺的。如果阳明经气逆乱，不能顺着其道下行进入肾，那么肾的水气反而顺着津液的道路上乘于胃。所以胃不和而卧不安。所以说，肾是水脏，主藏津液，又主管睡眠和气喘。手太阴、足少阴、阳明，是血气生成的根本，经脉呼吸的道路。人的一身，总不外乎水火阴阳、营卫气血。所以上一章论水火阴阳的寒热，下一章论呼吸经脉的逆调。杨君立问：黄帝问有不得卧而息无音的，有得卧行而喘的，有不得卧不能行而喘的，岐伯都没有详细回答。后人有的说原文简略脱落，有的说增补了文字。是这样吗？我说：这一节专门论述气的呼吸、脉的顺逆。大概经脉，是用来运行气血而营养阴阳，濡润筋骨，滑利关节的。所以三阳经脉上行，则气逆而为呼吸有声；如果三阳经脉顺行而下，只有阳明经不得从其道，应该是不得卧而呼吸无声。如果病在经脉，则阴阳不和而不得卧，筋骨不利而不能行。现在病在络脉，所以只是呼吸有声而起居正常。圣人立言，浑然一体，有时话在意中，有时意在言表，为什么后学不细心体认，而妄加臆测呢？）
Harmony refers to balance and smoothness. It means that the Yin and Yang, Fire and Water, Ying (Nutritive) and Wei (Defensive), Qi and Blood, Exterior and Interior, Upper and Lower in the human body should all be harmonious and balanced. If they are disordered and reversed, disease will occur.
Huangdi asked: The body is not constantly warm, nor constantly hot. Why does one feel feverish with vexation and fullness? (This discusses the disharmony of Yin and Yang between the upper and lower parts. "Not constantly warm" means there is no exterior heat-warmth pathogen. "Not constantly hot" means there is no interior heat from the Five Zang organs. The cause is the action of Yang-heat Qi.)
Qibo replied: This is because Yin Qi is deficient while Yang Qi is excessive, resulting in heat, vexation, and fullness. (Fire belongs to Yang and resides above; Water belongs to Yin and resides below. With deficient Yin and excessive Yang, heat, vexation, and fullness manifest in the upper part.)
Huangdi said: The body is not cold due to lack of clothing, nor is there an invasion of cold Qi internally. Why does cold arise from within? (The body is not cold due to thin clothing, so there is no exterior cold. There is no invasion of cold Qi internally, so there is no interior cold. "Cold arising from within" means cold originates from the Yin aspect internally.)
Qibo said: Such individuals often have Bi Qi (obstruction of Qi flow). Their Yang Qi is scanty, and their Yin Qi is abundant, causing them to feel cold as if emerging from water. (Bi Qi refers to the closure or obstruction of Qi. In individuals with scanty Yang and abundant Yin, Bi syndrome often occurs. Disease located in the Yin is called Bi. When cold-damp Qi closes off the interior Yin, the fire-heat cannot descend to interact with the Yin, causing Yin to become even more abundant. As Yin increases, Yang gradually declines. Excessive Yin-cold Qi causes the body to feel cold as if coming out of water. Heat arises from Yang-fire, hence the vexation; cold arises from Yin-water, hence the sensation of being in water. This illustrates the disharmony of Fire/Water and Yin/Yang between the upper and lower.)
Huangdi asked: Some people have four limbs that are hot, and when exposed to wind and cold, it feels like burning or roasting. Why is this? (This discusses the disharmony of Yin and Yang between the interior and exterior. The four limbs are governed by the Yang meridians. Heat in the four limbs indicates Yang-heat Qi in the exterior. Feeling like burning when encountering wind and cold results from the struggle between pathogenic factors and healthy Qi; due to the strong Yang-heat in the exterior, the heat becomes extreme. This section discusses how Yang is born from Yin and Yin from Yang. When Yin and Yang are harmonious, Yang grows and Yin lengthens; when reversed, solitary Yin cannot grow, and independent Yang cannot thrive.)
Qibo said: In such people, Yin Qi is deficient, and Yang Qi is excessive. The four limbs belong to Yang. When two Yangs combine (referring to the Yangming Stomach meridian, which is rich in Qi and blood, thus called "Two Yangs combining"), but Yin Qi is scarce, a small amount of water cannot extinguish a roaring fire, leading to Yang acting alone. "Acting alone" means failing to generate and grow in coordination with others; it only exists in a state of solitary dominance. (Deficient Yin Qi refers to deficiency of interior Yin. Excessive Yang Qi refers to excess of exterior Yang. Yang receives Qi at the extremities, while Yin receives Qi in the Five Zang organs. The four limbs are governed by the Yangming meridian. "Two Yangs" refers to Yangming. "Combining" means they interact to produce heat. Scanty Yin Qi refers to scarcity of Shaoyin Qi. "Small water" refers to scanty fluids. When fluids are scanty and cannot return to the stomach, fire becomes excessive and unextinguished. The Kidney stores essence and is the root of Yangming's generation. When Kidney essence combines upward with Yangming, Wu-Gui combination transforms into fire. With abundant Fire-Earth Qi and deficient Yin Qi, Yang acts alone. However, independent Yang cannot generate; it means it cannot further generate its own Yang-heat, existing only in this state of solitary dominance. Zhang Zhaohuang stated: "Extinguishing roaring fire" implies harmony between Yin and Yang.) When exposed to wind, it feels like burning or roasting, and such individuals' muscles will waste away. (This explains that Yangming Qi governs the four limbs and also governs the muscles. The Qi of Two Yangs exists between the skin and muscle layers. Encountering wind-heat (a Yang pathogen) causes the pathogen and healthy Qi to struggle, making fire-heat intense and wasting the muscles.)
Huangdi asked: Some people feel cold throughout the body, yet hot baths and thick clothes cannot warm them, but they do not shiver. What disease is this? (Body coldness unresponsive to heat therapy or warm clothing indicates decline of Taiyang Qi and cold in the exterior. Lack of shivering indicates Fire-Heat of Er Yang (Yangming and Shaoyang) residing in the interior.)
Qibo said: Such individuals typically have excessive Kidney Qi and engage in water-related work (or have a water-type constitution), leading to a decline in Taiyang Qi. The Kidney essence dries up and fails to nourish the bones. One water cannot overcome two fires. The Kidney belongs to Water, generates bone marrow, and if Kidney Qi fails to generate, marrow will not fill the bones, causing cold to reach deep into the bones. (Excessive Kidney Qi refers to dominance of Kidney Water Qi. Engaging in water-related work implies dominance of Bladder Water Qi. This means the person has an excess of cold-water Qi. Excess cold-water Qi leads to Taiyang Qi decline. Decline of Taiyang Qi means solitary Yin cannot grow. "Water" here refers to True Water/Kidney Essence. If the essence stored in the Kidney dries up and fails to grow, the single water of the Bladder cannot overcome the two fires. The Kidney generates bone marrow; Water generates Liver. If Kidney fat/essence does not grow, marrow cannot fill the bones, hence cold reaches the bones. The above discusses the mutual generation of Yin/Yang and Fire/Water. Gao Shizong noted: The phrase "One water cannot overcome two fires" might be a later interpolation.) The reason for not shivering is that the Liver is One Yang, the Heart is Two Yang, and the Kidney is a solitary organ. One water cannot overcome two fires, hence no shivering. This disease is named Gu Bi (Bone Bi), and such individuals may experience joint contracture. (The Liver is the initial birth of Wood-Fire as One Yang; the Heart is Ministerial Fire generated by Earth-Two. The Kidney is a Yin organ and a solitary organ. The Yin of the solitary organ relies on the Biao-Biao relationship of Taiyang to transform. Decline of Taiyang Qi means solitary Yin cannot grow. Bladder fluids cannot overcome two fires, so the person does not shiver because Fire-Heat of Two Yangs is internal. Named Bone Bi, the disease involves dry marrow and bone pain. Thus, joint contracture occurs. This discusses the disharmony of Yin/Yang between interior and exterior.)
Huangdi asked: Some people have heavy, numb flesh. Even near cotton wadding, they still feel numb and heavy. What disease is this? (This discusses the disharmony of Ying and Wei Qi. "Ke" means heavy/nagging. It means the feeling of heaviness persists despite proximity to warm materials.)
Qibo said: This is because Ying Qi is deficient and Wei Qi is excessive. (Here, deficiency and excess refer to disharmony. It means Ying Qi lacks the harmonizing influence of Wei Qi, appearing deficient; Wei Qi does not harmonize with Ying Qi, appearing excessive. Generally, the Yang pathway is always substantial/excessive, hence termed "excessive." However, excess is as bad as deficiency.) Deficient Ying Qi leads to anesthesia (loss of sensation); deficient Wei Qi leads to paralysis (loss of function). If both Ying and Wei Qi are deficient, there is both anesthesia and paralysis, and the flesh remains unchanged. (Anesthesia means unawareness of pain or itch; paralysis means weakness and inability to bear weight. Essentially, disharmony of Ying and Wei leads to deficiency in both. With both deficient, there is anesthesia and paralysis. Despite anesthesia and paralysis, the heavy/fleshy sensation persists, caused by disharmony leading to deficiency. Zhang Zhaohuang stated: This clarifies that the "deficiency and excess" mentioned earlier actually refers to disharmony.) If the physical body and the Shen (Spirit/Mind) lose their connection, death ensues. (The physical body is where Ying and Wei circulate; Zhi refers to the spirit/mind of the Five Zang organs. The *Ben Zang* chapter states: Meridians transport Qi and Blood to nourish Yin and Yang, moisten sinews and bones, and lubricate joints. Wei Qi warms the muscles, fills the skin, plumps the interstices, and controls opening/closing. Zhiyi (Will/Intent) controls spirit, gathers soul, adapts to cold/warmth, and harmonizes joy/anger. Therefore, harmonious blood allows meridians to flow, nourishing Yin/Yang, strengthening sinews/bones, and clearing joints. Harmonious Wei Qi makes muscles supple, skin soft, and interstices dense. Harmonious Zhiyi keeps spirit focused, soul intact, and prevents regret/anger, protecting the Zang from pathogens. Moderate diet allows Six Fu organs to digest grain, meridians to flow smoothly, and joints to remain stable. This is the state of normal health. These three aspects must be harmonized. If all three lose harmony and connection, Qi and Blood stagnate, Soul and Spirit scatter, and death occurs. This emphasizes that Ying Qi must harmonize with Wei Qi, and Ying/Wei Qi must harmonize with Shen/Zhi.)
Huangdi asked: Some people have rebellious Qi, cannot lie down, and breathe with sound. Others cannot lie down but breathe silently. Others have normal daily activities but breathe with sound. Some can lie down but pant when walking. Some cannot lie down, cannot walk, and pant. Some cannot lie down and pant immediately upon lying down. Which Zang organs cause these conditions? I wish to hear the explanation. (This discusses the irregularity of Jing Qi movement between upper and lower. Jing Qi originates from the Zang organs, hence asking "Which Zang?")
Qibo said: Those who cannot lie down and breathe with sound have rebellious Yangming Qi. The Foot Three Yang meridians normally descend; now they rebel and ascend, causing breathing sounds. (One exhalation and one inhalation constitute a breath. Breathing with sound is caused by rebellious Qi. The Foot Three Yang meridians run from head to foot, so their Qi naturally descends. Now reversing upward causes respiratory sounds. Zhu Shenggong stated: "Rebellious Yangming Qi" covers the following two sections.) Yangming is the Stomach meridian. The Stomach is the Sea of the Six Fu organs, and its Qi also descends. Rebellious Yangming Qi cannot follow its proper path, causing inability to lie down. The *Xia Jing* (Lower Classic) says: "When the Stomach is not harmonious, sleep is uneasy." This refers to that situation. (According to *Ling Shu: Dong Shu*, Huangdi asked why Hand Taiyin, Foot Shaoyin, and Foot Yangming pulse beats continuously. Qibo answered it is because of the Stomach meridian. The Stomach is the sea of Zang/Fu organs; its clear Qi ascends to the Lung. Lung Qi travels via Taiyin. Its movement follows respiration. Hence, two pulses per breath. Qi leaves the Zang organs suddenly like a bow releasing an arrow or water falling from a cliff. All twelve meridians originate from Foot Yangming/Stomach. Stomach Qi ascends to Lung for respiration and descends to Kidney to nourish the twelve meridians. Thus, Yangming is Stomach meridian; Stomach is the sea of grain-blood-Qi. Blood/Qi from Stomach goes via large collaterals to Lung and via Stomach meridian to Foot Shaoyin. If Yangming rebels, one cannot lie down and breathes with sound; if Hand Taiyin rebels, one breathes with sound but functions normally; if Foot Shaoyin rebels, one cannot lie down and pants. This discusses rebellion in meridian respiration. The *Xia Jing* mentioned later ("cannot lie down, pants when lying down") refers to Water Qi invading. Normally, Yangming fluids descend with Qi to the Kidney. If Yangming rebels, Kidney Water Qi rebels upward to Yangming, causing Stomach disharmony and restless sleep. Also, "ascending ten parts visible" refers to Ying/Wei/Zong Qi generated by Yangming shooting up to Lung for respiration and meridian nourishment, occupying ten-tenths. "Descending eight parts hidden" refers to Yangming fluids descending to Foot Shaoyin like water flowing downhill, occupying eight-tenths. Ying/Zong/Wei Qi all ascend; thus ten-tenths ascend. Fluids: two parts travel in vessels, eight parts overflow to Kidney, hiding below. "Returning path" refers to Chong Mai connecting with large collaterals of Shaoyin, originating in Kidney, exiting at Qichuang. Chong Mai runs along the back, serving as the Sea of Meridians. Qichuang is the pathway of Qi. If collaterals block, pathways open. Fluids/Essence overflowing to Kidney return via Chong Mai/Qichuang to the twelve meridians in a cycle without end, unknown limit. This is the root of blood/Qi generation and the path of meridian circulation, which students must study carefully. Zhang Zhaohuang noted: *Ling Shu* discusses smooth meridian flow; this chapter discusses causes of meridian rebellion, hence citing classics for proof.)
Those with normal activities but breathing with sound have rebellious collateral Qi of the Lung. Collaterals cannot follow meridians up and down, so Qi stays in the main meridians rather than traveling through collaterals. Disease in collaterals is minor, so activities are normal but breathing is noisy. (This discusses Hand Taiyin regulation/rebellion. Lung governs respiration; rebellious Lung collateral Qi causes difficult breathing and noise. Meridians running internally are Jing (Main) meridians; those floating externally are Luo (Collateral) meridians. Internal/external/upper/lower Jing and Luo connect in a cycle. Rebellious Luo Qi stays in Jing meridians, not flowing in Luo. Luo meridians float in skin; disease is mild, hence only noisy breathing and normal activity.)
Those who cannot lie down and pant when lying down suffer from Water Qi invasion. Water flows following fluids. The Kidney is the Water Organ, governs fluids, and controls sleep and panting. (This discusses Foot Shaoyin rebellion. Fluids are produced from grain/water. Kidney is the gate of Stomach. Stomach fluids descending through the gate to Kidney is smooth. If Yangming rebels and cannot descend to Kidney, Kidney Water Qi rebels upward along fluid paths to Stomach. Thus Stomach is unharmonious, sleep is restless. Hence, Kidney is Water Organ, stores fluids, and governs sleep/panting. Hand Taiyin, Foot Shaoyin, and Yangming are roots of blood/Qi generation and paths of meridian/respiration. The whole body is nothing but Fire/Water, Yin/Yang, Ying/Wei, Qi/Blood. Hence, previous chapter discussed Fire/Water/Yin/Yang cold/heat; next chapter discusses rebellion in respiration/meridians. Yang Junli asked: Huangdi asked about those unable to lie down with silent breathing, those able to lie down and pant while walking, and those unable to lie down, unable to walk, and panting. Qibo did not answer these in detail. Later scholars say text is missing or added. Is this true? I say: This section specifically discusses respiration and meridian direction. Meridians transport Qi/Blood, nourish Yin/Yang, moisten sinew/bone, lubricate joints. If Three Yang meridians ascend, Qi rebels causing noisy breathing. If Three Yang meridians descend smoothly, except Yangming failing its path, one would be unable to lie down with silent breathing. If disease is in meridians, Yin/Yang disharmony causes inability to lie down, and sinew/bone dysfunction causes inability to walk. Now disease is in collaterals, hence only noisy breathing and normal activity. Sages speak holistically; meaning may be implicit or explicit. Why do later students speculate rashly instead of careful contemplation?)