The Impact of Labor and Leisure on Qi and Blood in Traditional Chinese Medicine

In the “Suwen: On Pain” it is proposed that “all diseases arise from Qi.” Qi is responsible for the movement of essence, blood, and body fluids, as well as maintaining the normal function of the organs. Conversely, if the essence, blood, body fluids, and organ functions are abnormal, Qi diseases often occur. Qi is the driving force of life activities in the human body; therefore, both labor and leisure can lead to illness, primarily attributed to Qi. 1. Labor leads to the depletion of essence and Qi, while leisure leads to Qi stagnation and blood stasis Labor results in “shortness of breath and sweating, both internally and externally,” which can be further categorized into five labors, six extremes, and seven injuries. According to the “Treatise on the Origins and Symptoms of Diseases: On Deficiency Labor,” the five labors are: first, will labor; second, thought labor; third, heart labor; fourth, worry labor; fifth, thin labor. Additionally, lung labor manifests as shortness of breath and facial swelling, an inability to smell scents; liver labor presents as a dry, dark face, bitter mouth, lack of spirit, fear, inability to sleep alone, and unclear vision; heart labor results in forgetfulness, difficulty with bowel movements, or sometimes loose stools, and mouth sores; spleen labor shows a bitter tongue base and difficulty swallowing saliva; kidney labor presents as difficulty bending and straightening the back, poor urination, red-yellow color with residual dribbling, pain in the genitals, dampness, sores in the bladder, and fullness and urgency in the lower abdomen. The five labors can be seen as emotional injuries or specific deficiencies of the five organs. The six extremes are: first, Qi extreme, leading to internal deficiency, insufficient organ function, excessive pathogenic Qi, and insufficient righteous Qi, resulting in reluctance to speak; second, blood extreme, leading to pallor, hair loss, and forgetfulness; third, sinew extreme, causing muscle cramps and pain in the fingers and nails, fatigue, and inability to stand for long; fourth, bone extreme, resulting in soreness, tooth pain, and inability to stand or move; fifth, muscle extreme, leading to emaciation and lack of moisture, with food not nourishing the skin; sixth, essence extreme, causing fatigue and internal deficiency, insufficient Qi in the five organs, hair loss, and forgetfulness. The six extremes represent a type of deficiency syndrome caused by extreme fatigue, with symptoms manifesting in Qi, blood, sinews, bones, and muscles, while essence extreme indicates a failure in nourishment or further labor injury, leading to severe deficiency and significant kidney essence damage. The seven injuries are: first, cold and dampness; second, yin deficiency; third, internal urgency; fourth, essence connection; fifth, essence deficiency, dampness below; sixth, essence clarity; seventh, frequent painful urination. Additionally, one injury is excessive eating harming the spleen, leading to a desire to lie down and a pale face; another is excessive anger harming the liver, resulting in blood deficiency and dark vision; third, excessive lifting or sitting on damp ground harming the kidneys, leading to essence deficiency, back pain, and coldness below; fourth, cold drinks harming the lungs, resulting in shortness of breath and cough; fifth, worry and overthinking harming the heart, leading to anxiety, forgetfulness, and irritability; sixth, wind, rain, cold, and heat harming the body, leading to dryness and skin issues; seventh, excessive fear harming the will, leading to confusion and unhappiness. The descriptions of the seven injuries in ancient medical texts vary slightly. In the “Treatise on the Origins and Symptoms of Diseases,” the seven injuries are understood in two ways: one is the seven symptoms of kidney deficiency, such as loss of essence and internal cold; the other is the seven conditions caused by external pathogens, emotional distress, and internal injuries. In the “Emergency Essentials of the Golden Chamber: Kidney Formulas: Nourishing the Kidneys,” the seven injuries are also understood in two ways: one refers to “exterior and interior diseases,” specifically, “first, liver injury leads to vivid dreams; second, heart injury leads to forgetfulness; third, spleen injury leads to excessive drinking; fourth, lung injury leads to phlegm; fifth, kidney injury leads to excessive salivation; sixth, bone injury leads to hunger; seventh, pulse injury leads to cough,” indicating the damage to the essence and Qi of the five organs, plus the bones and pulse; the other refers to “excessive thinking and worrying harming the body, excessive joy harming the body, excessive anger harming the body, excessive desire harming the body, excessive concern harming the body, excessive coldness harming the body,” indicating emotional extremes causing harm, but exceeding the seven emotions makes it difficult to attribute to specific organs. In summary, the five labors and seven emotions involve both physical and mental labor, while the six extremes are relatively fixed clinical manifestations of extreme organ Qi deficiency. The five labors, six extremes, and seven injuries comprehensively explain the symptoms of labor-related illnesses from different perspectives, including physical, emotional, external, and internal injuries. The mechanism of leisure-related illnesses is Qi stagnation. According to Qing Dynasty scholar Zhou Xuehai in “Medical Notes: On the Differences in Treatment for the Rich and Poor,” “Wealthy individuals, living in comfort, have their organs and meridians filled with phlegm and stagnation, causing Qi to stagnate and unable to flow, thus the pathogenic Qi cannot be expelled, which is not due to insufficient righteous Qi, but rather the failure of righteous Qi to circulate.” Individuals who indulge in leisure for long periods experience stagnation of defensive and nutritive Qi, leading to poor circulation of Qi and blood, and body fluids. This not only makes them susceptible to external pathogens but also causes Qi, blood, and body fluids to accumulate and form internal phlegm, dampness, and blood stasis, all due to Qi stagnation. Furthermore, due to the obstruction of Qi, the nutritive and defensive Qi struggles to circulate internally and externally, causing pathogenic Qi to linger on the skin or in the organs, making it difficult to eliminate, such as in cases of prolonged febrile diseases or external pathogens entering the interior, leading to phlegm, dampness, and heat accumulating internally, making recovery difficult. This appears to be a “deficiency of righteous Qi,” but the fundamental mechanism is the “failure of righteous Qi to circulate.” Many ancient and modern physicians have made similar statements, all agreeing that the mechanism of leisure-related illnesses is Qi stagnation, which will not be elaborated further here. 2. Labor leads to emaciation, while leisure leads to obesity The human body requires the nourishment of Qi, blood, and body fluids to maintain strength and health. Individuals with deficiency labor often lack Qi, blood, and body fluids. According to the “Treatise on the Origins and Symptoms of Diseases: On Deficiency Labor,” “Blood and Qi are what nourish the body. Those with deficiency labor have depleted essence and marrow, weak blood and Qi, unable to nourish the skin, hence they become emaciated.” Excessive labor depletes Qi, blood, and body fluids, preventing nourishment of the limbs and organs, leading to emaciation over time. In contrast, individuals who indulge in leisure may appear physically robust, but this does not indicate health; they are often strong on the outside but weak internally. According to the “Classified Treatise: On Treatment Differences in Suffering and Joy,” “Those who are physically comfortable are idle, while those who are mentally comfortable are lazy. Overeating without exercise harms the spleen, which governs the muscles, leading to illness.” Leisurely individuals live comfortably, overindulging, resulting in internal phlegm and dampness accumulating, which is transported through the blood and accumulates in the muscles and skin, leading to a protruding abdomen, oily skin, and poor bowel movements. Additionally, due to lack of physical activity, they may also become weak and frail over time, similar to those who are labor injured. In summary, labor often leads to emaciation, while leisure often leads to obesity. Labor and leisure present opposite physical manifestations. Furthermore, labor injuries lead to weakness due to lack of nourishment, while excessive leisure leads to weakness due to lack of activity, indicating a certain similarity between the two. 3. Labor leads to fatigue and forgetfulness, while leisure leads to laziness of the spirit Individuals who are labor injured often experience Qi and essence deficiency, leading to fatigue and forgetfulness. In the “Suwen: On the Five Excesses,” it states: “Excessive joy and excessive suffering, initial joy followed by suffering, all harm the essence and Qi. When essence and Qi are exhausted, the body deteriorates… Therefore, it is important to release pressure; even without external pathogens, internal injuries to the spirit will lead to bodily decline.” Joy and sorrow are emotional extremes, thus excessive pressure often leads to worry and depression, which can harm the essence and Qi of the five organs and deplete the body. Among the seven injuries, “worry and overthinking harm the heart, leading to anxiety, forgetfulness, and irritability,” describes the internal injury of the spirit, where insufficient spirit leads to easy fright or erratic emotions, resulting in forgetfulness. Therefore, insufficient spirit often leads to fatigue and exhaustion. In contrast, individuals who indulge in leisure experience Qi and blood stagnation, leading to laziness of the spirit. According to the “Lingshu: On the Spirit,” “The heart is what governs things; when the heart remembers, it is called intention; when intention is stored, it is called will; when will changes, it is called thought; when thought yearns, it is called worry; when worry interacts with things, it is called wisdom.” The seven emotions and five intentions correspond to the five organs, with the heart being the ruler. If the spirit is scattered and busy with a predetermined life plan and goals, or if one is lazy and negative towards work and study, it reflects a lack of control over the heart, leading to ineffective mental activities such as intention, will, thought, worry, and wisdom. The mental activities of a person are actually completed under the guidance of the “heart spirit,” with the cooperation of the five organs, thus a lack of control over the heart can also lead to stagnation of Qi and weakened organ functions. Excessive mental labor or excessive leisure can also harm the essence and Qi of the five organs, manifesting not only as abnormal mental states but also affecting the functions of the organs and body. 4. Labor leads to deficiency causing excess, while leisure leads to excess causing deficiency Individuals who are labor injured experience Qi and blood depletion, leading to insufficient righteous Qi, which can internally generate phlegm and blood stasis, resulting in deficiency causing excess. According to the “Golden Chamber Essentials: Blood Stasis and Deficiency Labor Pulse Diagnosis and Treatment”: “Excessive labor leads to extreme deficiency and emaciation, fullness in the abdomen preventing eating, injuries from food, worry, drinking, sexual activity, hunger, and labor injuries, damaging the Qi of the meridians and the nutritive and defensive Qi, leading to internal stagnation of blood, skin issues, and darkening of the eyes. Gradual supplementation of deficiency is the treatment, with Dahuang Zhechong Wan as the main remedy.” Blood and body fluids are tangible substances; thus, excessive labor can lead to deficiency causing stagnation of blood and body fluids. In contrast, individuals with leisure-related illnesses experience Qi and blood stagnation, leading to a common presentation of excess causing deficiency. According to Qing Dynasty scholar Feng Zhaozhang in “Feng’s Secret Record: On the Different Illnesses of the Rich and Poor”: “Wealthy individuals often labor mentally and become internally deficient, with soft muscles and brittle bones… Living in comfort, their organs are delicate… Spacious rooms and excessive indulgence lead to easy invasion of the six evils.” Those who indulge excessively often have favorable living conditions, overindulging in food and lacking exercise, leading to stagnation of Qi in the organs, which can cause the skin and pores to become weak, and muscles and bones to become weak. Even slight exertion or exposure to wind, cold, heat, or dampness can lead to illness. 5. Labor and leisure injure the five organs, causing imbalance of Yin, Yang, Qi, and blood Labor depletes Qi and blood, leading to insufficient nourishment of the five organs, while leisure causes Qi stagnation, leading to dysfunction of the five organs, both of which can affect the physiological functions of the five organs, resulting in disharmony of Yin and Yang, and abnormal Qi and blood, leading to dysfunction of the body and spirit. 5.1 Labor leads to liver Yin deficiency, while leisure leads to liver dysfunction, both causing weakness of the sinews The liver is Yin in nature and Yang in function, governing blood storage and housing the fire of the heart. Therefore, labor that injures the liver often harms the liver Yin and blood, leading to symptoms of deficiency heat, and in severe cases, can cause the heart fire to rise. According to the “Treatise on the Origins and Symptoms of Diseases: On Deficiency Labor”: “Liver labor presents as a dry, dark face, bitter mouth, lack of spirit, fear, inability to sleep alone, and unclear vision.” Blood nourishes the head and face; if the liver fails to store blood, the head and face will lack nourishment, leading to dryness and darkness, and the spirit will be unsettled, causing fear; if blood is deficient, the heart fire will rise, leading to a bitter mouth and dizziness. Labor exhausts the sinews, or excessive anger can damage the liver Yin and blood, leading to internal heat; mild cases present with a bitter mouth and red, dry eyes, while severe cases can lead to fainting and other critical conditions. As stated in the “Suwen: On the Flow of Yang Qi”: “Yang Qi, when overworked, expands, leading to exhaustion, causing accumulation in summer, resulting in fainting; the eyes cannot see, the ears cannot hear, and the body feels as if it is breaking down,” which is a detailed explanation of the liver labor mechanism and clinical manifestations. In contrast, individuals who indulge in leisure experience a lack of physical activity, leading to poor liver function and difficulty in the circulation of stored blood, which is essential for nourishing the organs and orifices. According to the “Suwen: On the Generation of the Five Organs”: “The liver receives blood to enable vision, the feet receive blood to enable walking, the hands receive blood to enable grasping, and the fingers receive blood to enable fine movements.” The eyes are the orifices of the liver and require nourishment to distinguish colors. The palms, feet, and fingers also require nourishment to perform fine activities. Due to the failure of Qi to circulate, blood flow becomes obstructed, leading to a lack of nourishment in the limbs and joints, resulting in true and false deficiency symptoms. If there is also excessive indulgence, it can lead to internal damp-heat, which can invade the liver and gallbladder, scorching the liver meridian and damaging liver blood. According to Qing Dynasty scholar Xue Xue in “The Original Intent of Medical Classics: On Dampness (dàn, referring to heat or damp-heat in TCM)”: “The kidney pulse and liver pulse are both weak, indicating consumption of dampness, and the liver and kidney are in the lower body, indicating lower consumption.” Those who indulge excessively and live in comfort, due to their sedentary lifestyle and excessive consumption of rich foods, can ultimately generate heat or damp-heat, leading to symptoms such as red, dry eyes, excessive tears, a bitter mouth, irritability, or urinary issues such as cloudy or painful urination, and constipation. Prolonged heat in the liver meridian can scorch body fluids, injuring liver Yin, leading to Yang Qi becoming uncontrolled, resulting in harm, or damaging liver blood, leading to insufficient liver blood, causing the spirit to become unsettled, easily angered, or excessively excited with minimal stimulation. The liver governs all sinews; excessive labor can injure the liver, leading to sinew weakness. According to the “Suwen: On Sinew Disorders”: “Liver Qi heat leads to bile leakage, causing a bitter mouth, dry sinews, and tight sinews, resulting in sinew weakness.” Excessive labor can lead to liver Yin deficiency, causing internal heat, which scorches the sinews, leading to weakness. The description in the “Treatise on the Origins and Symptoms of Diseases: On Deficiency Labor” that “sinew extremes cause muscle cramps and pain in the fingers and nails, fatigue, and inability to stand for long” is a typical clinical manifestation of sinew weakness. If the individual only injures the sinews of the joints, they may experience dryness and tightness of the sinews, pain after activity or exposure to cold, without the heat pain symptoms caused by excessive Yang. However, liver Qi heat can be caused by labor leading to deficiency heat or by leisure leading to excess heat. According to the “Suwen: On the Flow of Yang Qi”: “If damp-heat is not eliminated, large sinews become soft and short, while small sinews become long and weak. Soft and short indicates stiffness, while long and weak indicates weakness.” Excessive indulgence can lead to internal damp-heat, scorching the sinews and damaging liver Yin, which can also lead to sinew weakness. If the limbs lack movement, the flexibility of the sinews decreases, and due to Qi and blood stagnation, the sinews can become weak and powerless. In summary, both labor and leisure can injure the liver, though they differ in deficiency and excess, but both can lead to heat damaging the liver meridian, resulting in weakness of the sinews. 5.2 Labor injures the heart, leading to blood deficiency, while leisure scatters the spirit and causes blood stasis, both leading to insufficient nourishment of the spirit The heart is the sovereign organ, governing the spirit and blood vessels, and its manifestation is in the face. According to the “Lingshu: On the Nourishment of the Spirit”: “Blood is the essence of the spirit,” indicating that the fullness and normal circulation of heart blood is the material basis for normal cognitive and emotional activities. Excessive mental labor can damage heart blood, leading to labor injuries. According to the “Treatise on the Origins and Symptoms of Diseases: On Deficiency Labor”: “Blood extremes lead to pallor, hair loss, and forgetfulness.” Excessive mental labor can deplete heart Yin and blood, manifesting as fatigue and forgetfulness, hair loss, and other symptoms. Blood deficiency can also be reflected on the tongue, leading to an inability to taste flavors or difficulty speaking. In contrast, individuals who indulge in leisure experience Qi stagnation, leading to a scattered spirit and loss of control over heart Qi, resulting in weak blood circulation and stasis. If such individuals indulge in rich foods, excess water and food can generate phlegm and dampness, which can enter the blood vessels and combine with blood stasis, obstructing blood circulation. This can be reflected on the tongue as a dark purple color, thick and greasy coating, and if the blood vessels of the tongue are obstructed, it can also lead to difficulty in tongue movement and speech. The heart is the sovereign organ, governing cognitive, conscious, emotional, and other mental activities. “Yang Qi, when overworked, expands”; if the five intentions are excessive and the seven emotions are out of balance, such as excessive thinking and worrying, or excessive joy and anger, heart Qi can become overused, transforming into heat; or blood stasis can obstruct heart Qi, transforming into fire that disturbs the heart, damaging heart Yin and blood, and conversely consuming heart Yang and Qi. Labor leads to heart Qi transforming into deficiency heat, while leisure leads to heart Qi transforming into excess heat, and prolonged excess heat can damage Yin, transforming into deficiency heat. Heat disturbances can lead to symptoms such as mouth sores and irritability, which is a commonality in the injuries caused by labor and leisure. Furthermore, the heart is connected to the blood vessels. If blood vessels are empty, the heart will lack nourishment, leading to palpitations, anxiety, and in severe cases, a feeling of great movement in the heart, as if the heart Qi is about to escape. If blood vessels are obstructed, blood circulation becomes sluggish, and heart Qi must strengthen its pushing force; heart Yin assists heart Yang, promoting the heart to enlarge its structure to aid blood circulation. If phlegm and dampness stagnate for a long time, or continue to worsen, heart Qi will become excessively strong and weak, and blood cannot circulate throughout the body, leading to fatigue, shortness of breath upon exertion, and in severe cases, important organs such as the heart, brain, and kidneys, or the extremities, may lack nourishment, endangering life. The heart’s manifestation is in the face; when heart Qi is sufficient and blood is clear, the complexion is rosy and radiant. If heart blood is insufficient, the complexion appears pale and lacks luster; if blood is turbid, the face appears dirty and dull; when heart Qi is abundant, the face may appear oily, while when heart Qi is deficient, the face appears oily and dark. The tongue is the sprout of the heart; labor and leisure injuries to the heart can lead to heart Qi transforming into fire, which can inflame the tongue, leading to mouth sores. Over time, excess heat can transform into deficiency, and pathogenic Qi can linger, causing recurrent mouth sores that are difficult to heal. Additionally, heat disturbances can also disturb the spirit, leading to difficulty concentrating when awake or restlessness, and during sleep, the spirit may be disturbed, leading to vivid dreams and easy awakening, often resulting in fatigue and weakness upon waking. In summary, both labor and leisure can injure the heart, though they differ in deficiency and excess, but both can lead to changes in heart blood, resulting in insufficient nourishment of the spirit. 5.3 Labor leads to spleen and stomach deficiency, while leisure leads to spleen dysfunction, both causing obstruction of the pivot The spleen’s manifestation is in the lips, and the spleen and stomach govern the muscles, serving as the source of Qi and blood transformation. Injuries to the spleen and stomach often manifest as changes in the lips and muscle atrophy. According to the “Treatise on the Origins and Symptoms of Diseases: On Deficiency Labor”: “Spleen labor presents as a bitter tongue base and difficulty swallowing saliva… Muscle extremes lead to emaciation and lack of moisture, with food not nourishing the skin.” Excessive labor can harm the spleen and stomach, leading to spleen labor, and excessive labor can lead to muscle atrophy, termed muscle extremes. Qi and blood are transformed by the spleen and stomach; prolonged labor and insufficient nourishment can lead to Qi and blood deficiency, resulting in the spleen and stomach failing to nourish the body, leading to a strong tongue and difficulty in movement; additionally, prolonged overuse of the spleen and stomach can lead to decline, resulting in insufficient generation of Qi and blood, leading to muscle extremes, with individuals appearing pale and emaciated, with lips lacking color. If spleen Qi deficiency persists, it can damage spleen Yang, leading to undigested food and persistent diarrhea. According to the “Shibu Zhai Medical Book: On Leisure Illnesses”: “Leisure illnesses are spleen illnesses.” The spleen and stomach govern the transformation and transportation of food and fluids, serving as the pivot for the rise and fall of Qi. Leisure illnesses often arise from a lack of exercise, leading to Qi stagnation, and excessive indulgence in food is a significant contributing factor, thus spleen and stomach Qi stagnation is the most important pathophysiological mechanism of leisure illnesses. “Excessive eating harms the spleen and stomach,” leading to overuse of the spleen and stomach Qi; according to the “Neijing: Key Points on Treatment”: “Excessive leisure leads to Qi stagnation,” and insufficient physical activity reduces the body’s demand for food and fluids, leading to slow transformation and distribution of Qi, blood, and body fluids. Both conditions can lead to weakened spleen and stomach function, causing Qi and blood stagnation. Additionally, food and fluids can accumulate in the middle burner due to poor transformation, leading to “loss of proper transformation,” generating phlegm and dampness that obstruct Qi circulation. Such individuals often present with a protruding abdomen, fullness in the brain and intestines, and poor bowel movements, with oily lips and excessive secretion. The spleen governs the upward movement of clear Qi, while the stomach governs the downward movement of turbid Qi; the spleen and stomach rise and fall in relation to each other, serving as the pivot for the rise and fall of Qi. The normal functioning of lung Qi and liver Qi, as well as the physiological functions of the lungs, depend on the normal operation of spleen and stomach Qi. Therefore, appropriate labor and leisure, along with moderation in diet, are necessary conditions to ensure the normal operation of spleen and stomach Qi. The spleen Qi distributes food and fluids to nourish the organs and body, ensuring their normal function. Thus, moderation in diet leads to a strong spleen and stomach, aiding the normal function of the body and organs; appropriate exercise can promote the spleen and stomach’s ability to rise and fall, preventing food and fluids from stagnating in the spleen and stomach. According to Qing Dynasty scholar Ye Gui in “Ye’s Selected Medical Balance: On Illnesses Caused by Deficiency and Excess”: “Hunger and overindulgence harm the spleen; the poor often experience this… Excessive rich and sour foods harm the stomach; the wealthy often experience this.” Injury to the spleen refers to the injury to the upward movement of Qi, while injury to the stomach refers to the injury to the downward movement of turbid Qi. The upward movement of the spleen and the downward movement of the stomach complement each other; thus, in summary, both hunger and overindulgence can harm the spleen and stomach, leading to insufficient rise and fall of Qi. When analyzed in detail, insufficient food and excessive labor lead to insufficient spleen and stomach Qi, with clear Qi failing to rise and turbid Qi failing to descend, often resulting in emaciation, fatigue, poor appetite, and difficult bowel movements; conversely, excessive eating and leisure lead to stagnation of spleen and stomach Qi, with stomach Qi failing to descend and spleen Qi failing to rise, often resulting in obesity, fatigue, abdominal distension, and difficulty with bowel movements. In summary, both labor and leisure can injure the spleen and stomach, though they differ in deficiency and excess, but both can lead to impaired transportation and transformation, resulting in obstruction of the pivot. 5.4 Labor leads to lung Qi deficiency, while leisure leads to lung Qi stagnation, both causing abnormal diffusion and descent The lungs govern the body’s Qi and can distribute defensive Qi to warm the skin and protect against external pathogens. According to the “Treatise on the Origins and Symptoms of Diseases: On Deficiency Labor”: “Lung labor presents as shortness of breath and facial swelling, with an inability to distinguish scents.” This indicates some clinical manifestations of lung Qi deficiency and suggests the pathophysiological mechanisms involved. The lungs govern Qi; thus, lung labor depletes Qi, leading to shortness of breath; “when cold is excessive, it floats”; the lungs govern the diffusion of defensive Qi, which can warm and protect the skin; if lung Qi is deficient, the defense against external cold is compromised, leading to facial swelling; the nose is the orifice of the lungs, and if lung Qi is deficient, it cannot nourish the nasal orifice, leading to an inability to distinguish scents. The “Treatise on the Origins and Symptoms of Diseases” lists the characteristics of lung Qi deficiency affecting the lung’s governing function, its manifestation, and its orifices, all of which are due to lung Qi labor injury. In contrast, individuals who indulge in leisure experience Qi stagnation, leading to lung Qi often being obstructed. According to the “Huangdi Neijing: Taisu: On Nourishing the Body”: “Prolonged lying harms Qi; when lying down, lung Qi is difficult to emerge, thus prolonged lying harms the lungs, and lung injury leads to Qi injury.” Lung Qi being difficult to emerge indicates lung Qi stagnation; excessive leisure and lack of labor, prolonged sitting or lying down, or excessive indulgence can generate phlegm and dampness that rises to the lungs, leading to lung Qi stagnation, making it difficult to diffuse, resulting in fullness in the chest and rough breathing. Additionally, due to insufficient exercise, lung Qi is not sufficiently stimulated, leading to reduced generation of gathering Qi, which cannot assist the heart in circulating blood or regulate breathing, and cannot nourish the vital Qi, leading to shortness of breath and rapid heartbeat with slight exertion. Lung Qi can distribute food and fluids. According to the “Suwen: On the Differentiation of Meridians”: “Food Qi enters the stomach… the lungs connect to the hundred vessels, distributing essence to the skin and hair. The meridians connect with essence, circulating Qi in the organs, and the organs are spiritually clear, retaining the essence… Food enters the stomach… and ascends to the lungs, distributing water and fluids downward to the bladder.” This indicates that the water and food essence transformed by the spleen and stomach must be diffused by the lungs to nourish the skin and internal organs. Labor injuries the lungs, leading to insufficient lung Qi to promote diffusion, resulting in both the body and spirit lacking nourishment from food and fluids, leading to internal deficiency of the five organs, weak defenses, fatigue, and lack of speech. Conversely, excessive leisure leads to Qi stagnation, causing lung Qi to be obstructed, resulting in abnormal diffusion and descent, leading to stagnation of food and fluids in the lungs, generating phlegm and dampness that obstruct the lung meridians, or defensive Qi failing to reach the skin, leading to weak defenses. In summary, both labor and leisure can injure the lungs, though they differ in deficiency and excess, but both can lead to the lungs failing to perform their functions, resulting in abnormal diffusion and descent. 5.5 Labor leads to kidney essence depletion, while leisure leads to kidney Qi deficiency, both causing insufficient marrow and brittle bones The kidneys are the source of storage, governing the essence and Qi of the body, and controlling the balance of Yin and Yang. When labor and leisure are appropriate, kidney essence is released in moderation, Qi and blood are generated regularly, and Yin and Yang operate according to their laws, allowing the organs and meridians to function smoothly, and the limbs and body to remain active. However, if labor and leisure are imbalanced, it can affect the kidney’s storage function. Excessive labor injures the kidneys, leading to damage to kidney Yin, kidney Yang, and kidney essence. According to the “Treatise on the Origins and Symptoms of Diseases: On Deficiency Labor”: “Kidney labor presents as difficulty bending and straightening the back, poor urination, red-yellow color with residual dribbling, pain in the genitals, dampness, sores in the bladder, and fullness and urgency in the lower abdomen… Essence extremes lead to fatigue and internal deficiency, insufficient Qi in the five organs, hair loss, and forgetfulness.” The lower back is the residence of the kidneys; if kidney labor occurs, bending and straightening the back becomes difficult; kidney Yin deficiency leads to heat, often presenting with red, painful urination, internal heat, or five hearts feeling hot; kidney Yang deficiency leads to cold, presenting with dampness in the scrotum and sores, lower abdominal pain, or coldness in the lower limbs. Prolonged deficiency of Yin and Yang can damage kidney essence. Kidney essence nourishes the entire body; when essence is deficient, it can lead to symptoms of Qi and blood deficiency in the whole body, such as fatigue, dry skin, hair loss, excessive dreaming, and various deficiencies in the five organs. The kidneys govern the release of essence; individuals who indulge in leisure experience weakened kidney function, leading to insufficient generation of reproductive essence, resulting in poor sperm quality in men and insufficient Qi and blood in the uterus in women, leading to poor fetal health. Additionally, during pregnancy, excessive indulgence can lead to Qi and blood stagnation, resulting in fetal overgrowth and often leading to difficult labor. As stated by Qing Dynasty scholar Ye Gui in “The Complete Book of Jingyue: On Delivery”: “In wealthy families, excessive leisure often leads to Qi and blood stagnation, preventing the fetus from moving.” Although modern cesarean sections can avoid the risks of difficult labor, the resulting infants often appear robust externally but are weak internally. If excessive indulgence leads to phlegm and dampness, and Qi stagnation occurs, it can also affect the kidneys. Kidney Yang governs the transformation of fluids; individuals who indulge excessively experience weakened organ functions, leading to insufficient kidney Yang to transform fluids, resulting in dampness accumulating in the skin and mixing with urine, leading to cloudy urine. If damp-heat accumulates, or if dampness obstructs Qi and generates heat, it can lead to symptoms such as burning and painful urination. The kidneys govern the generation of marrow; both pre-natal and post-natal essence are stored in the kidneys, transforming into marrow to nourish the bones. Labor injuries kidney essence, leading to insufficient marrow, resulting in brittle bones that cannot withstand exertion and are prone to fractures. The tibia and femur can bear the body’s weight, while the humerus and radius can lift objects; thus, individuals with labor injuries often experience pain and fractures in the large bones of the hands and feet, dry and painful teeth, and emaciation. Therefore, appropriate exercise can strengthen bone quality, making large bones robust and solid, reducing the risk of fractures from external impacts. Conversely, individuals who indulge in leisure and lack movement experience insufficient stimulation to the bones, leading to reduced kidney essence release, decreased marrow generation, and brittle bones that are prone to fractures. Even slight pressure or external impact can lead to fractures, and standing or walking for extended periods can cause foot pain and weakness in the knees, leading to fatigue and inability to endure prolonged exertion. In summary, both labor and leisure can injure the kidneys, though they differ in deficiency and excess, but both can lead to insufficient marrow and brittle bones that are prone to fractures. 6. Conclusion From the perspective of basic pathophysiology, both labor and leisure can lead to illness, primarily due to Qi. Labor depletes Qi, while leisure causes Qi stagnation; other pathophysiological mechanisms develop from these two foundations. From the perspective of physical and mental states, physical labor leads to emaciation, while leisure leads to obesity; mental labor leads to fatigue, while mental leisure leads to sluggishness. This is a difference. However, both labor and leisure can lead to weakness and fatigue, with ineffective mental activity and weakened organ functions, which is a commonality. From the perspective of deficiency and excess, labor leads to internal Qi deficiency, causing blood and body fluids to stagnate throughout the body, resulting in deficiency causing excess; leisure leads to internal Qi stagnation, causing blood and body fluids to stagnate and fail to nourish the body, resulting in excess causing deficiency. From the perspective of the organs, labor leads to deficiency of the five organs, while leisure leads to Qi stagnation in the organs, with differences in deficiency and excess; however, both labor and leisure can lead to clinical manifestations of physiological function decline in the five organs. In summary, both labor and leisure can lead to illness, with different pathophysiological mechanisms, but certain clinical manifestations show similarities.

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