三逆也（咳而溲者，气血俱损。形肉脱者，脾已绝。脉搏者，真脏见矣），呕血，胸满引背，脉小而疾，是四
逆也（呕血而至胸满背曲。病已极矣。脉小属气败，脉疾属血败），咳呕腹胀且飧泄，其脉绝，是五逆也（上
为咳呕，中为胀满，下为飧泄；三焦俱病，六脉已绝）。如是者，不及一时而死（不及一时者，不能周一日之
时也）。
《标本病传论》曰∶夫病传者，心病先心痛（病在心者先心痛），一日而咳（心病传肺，火克金也），
三日胁支痛（肺复传肝，金克木也，故胁支痛），五日闭塞不通，身痛体重（肝传脾，木克土也，脾病则闭塞不通。
脾主肌肉，故身体重痛），
三日不已，死（再三日不已，则脾又传肾，土克水也，五脏俱伤故死），冬夜半，夏日中（冬月夜半，水旺之
极也。夏月日中，火旺之极也。火畏水，故冬则死于夜半。阳邪亢极，故夏则死于日中。盖衰极亦死，盛极亦
死也）。
肺病喘咳（肺主息，故病喘咳）。三日而胁支满痛（三日而之肝，金克木也）。一日身重体痛（一日之脾，
木克土也）。五日而胀（五日而之胃，脏传腑也），十日不已，死（十日不已，胃复传肾，五行之数已极，故
死）。冬日入，夏日出（此卯、酉二时，属燥金之化）。
肝病头目眩，胁支满（肝开窍于目，而经脉布于胁肋），三日体重身痛（三日传脾），五日而胀（脾传胃
也），三日腰脊少腹痛，胫 （三日传肾也），三日不已，死（三日不已，肾复传心，故死），冬日入。夏早食（
亦卯、酉时也，燥金主之，木所畏也）。
脾病身痛体重（脾主肌肉），一日而胀（脾传胃也），二日少腹腰脊痛，胫 （胃传肾也），三日背KT 筋痛，
小便闭（三日而胃传膂膀胱也），十日不已，死（十日不已，复传于心，故死）。冬人定，夏晏食（此巳、亥
时也，司风木之化，脾病畏之）。
肾病少腹腰脊痛， （肾主下部，经脉行于少腹，腰脊， 骨之间），三日背KT 筋痛，小便闭（三
日而传膂膀胱也），三日腹胀（三日而传小肠），三日两胁支痛（三日而上传心，手心主之正，别下渊腋三寸
入胸中，故两胁支痛），三日不已，死（夏伤肺金也），冬大晨，夏晏脯（此辰、戌时也。土旺四季，为水所
畏，故肾病绝焉）。
胃病胀满，五日少腹腰脊痛， （五日之肾也），三日背KT 筋痛，小便闭（三日之膂膀胱也），五日身
体重（《病传论》曰五日而上之心。此云体重疑误），六日不
已、死（心复传肺），冬夜半后，夏日 （丑、未司湿土之化，气通于胃，失守则死）。
膀胱病，小便闭，五日少腹胀，腰脊痛， （五日而之肾也），一日腹胀（一日而之小肠），一日身
体痛（一日而之心，腑传脏也。心主血脉，故为身体痛），二日不已，死（心病不已，必复传金，故死），冬
鸡鸣，夏下晡（丑、未时也，土能制水，故膀胱畏之，相传死期各有远近，脏有要害不同也，以次相传者必死，
间一二脏或三四脏者，可以治矣）。
《灵枢·经脉》篇曰∶手太阴气绝则皮毛焦，太阴者行气温于皮毛者也、故气不荣则皮毛焦、皮毛焦则
津液去皮节，津液去皮节者则爪枯毛折，毛折者毛先死，丙笃丁死，火胜金也（肺属金主气，为水之母，故其气
绝则津液去，而爪枯毛折也）。手少阴气绝则脉不通，脉不通则血不流，血不流则髦色不泽，故其面黑如漆柴
者，血先死，壬笃癸死，水胜火也（心主血脉，故心绝则血先死，其症在髦色不泽，面黑如漆，水化见也）。
足太阴气绝则脉不荣肌肉，唇舌者，肌肉之本也，脉不荣则肌肉软，肌肉软则舌萎人中满，人中满则唇反，唇
反者肉先死，、甲笃乙死，木胜土也（脾主肌肉，故脾绝则肉先死，其症在舌萎、人中满，唇反也）。足少阴
气绝则骨枯，少阴者冬脉也，伏行而濡骨髓者也，故骨不濡则肉不能着也，骨肉不相亲则肉软却，肉软却故齿长而
垢发无泽，发无泽者骨先死，戊笃已死，
土胜水也（肾属水，故为冬脉。肾主骨，故肾绝则骨先死。其症在骨肉不相亲附，则齿长而垢，精枯发无泽
也）。足厥阴气绝则筋绝，厥阴者肝脉也，肝者筋之合也，筋者聚于阴气（当作器）。而脉络于舌本也，故
脉弗荣则筋急，筋急则引舌与卵，故唇青舌卷卵缩，则筋先死，庚笃辛死，金胜木也（肝绝者筋先死。其症
在唇青舌卷而卵缩囊蜷也）。五阴气俱绝则目系转，转则目晕，目晕者为志先死，志先死则远一日半死矣（五
脏之精上注于目，故五阴气绝则目转而晕，志先死矣。志藏于肾，真阴已竭，死在周日间耳）。六阳气绝则阴与
阳相离，离则腠理发泄，绝汗乃出，故旦占夕死，夕占旦死（阳气不能卫外而为固，则汗泄，绝汗者，其形如
珠，凝而不流，或气喘不休，汗出如洗者是也）。
《阴阳类论》曰∶冬三月之病，病合于阳者，至春正月脉有死征，皆归出春（冬三月阴盛之时，而见阳病
者，至春初阳气发动之令，脉必有死征矣。出春者，交夏也，阳病当阳盛，则亢极而不可免矣）。冬三月之病，
在理已尽，草与柳叶皆杀（在理已尽，谓色脉形症皆无生理，则交春草色青、柳叶见，皆其死期也）。春阴阳
皆绝，期在孟春（冬月之病，甫交春而阴阳皆绝，则不待仲季，即于孟春是其死期矣。阴绝者，脉形不至，阳
绝者，脉形微细，或上不至关为阳绝，下不至关为阴绝）。春三月之病，曰阳杀（杀音赛，阳气衰也，阳气方
生之令，而阳气衰败，不能应令也），阴阳皆绝，期在草干（春令木旺之症，而阴阳俱绝，至秋令草干之时，金胜
木而死矣）。夏三月之病，至阴不过十日（《金匮真言论》曰脾为阴中之至阴，五脏六腑之本也。
以至阴之脏而当阳极之时，苟犯死症，期在十日），阴阳交，期在 （音廉）水（阴阳交者。阴脉见于阳，则
阳气失守，阳脉见于阴，则阴气失守。夏月而见此逆象，则仲秋 水之期，不能保其生矣），秋三月之病，三
阳俱起，不治自已（秋时阳气渐衰。阴气渐长，虽三阳之病俱起，而阳不胜阴，故自已）。阴阳交合者，立
不能坐，坐不能起（阴阳交合者，阴阳合病也。起坐不能者，屈伸不利也）。三阳（阳当作阴）独至，期在石
水（阴病而当阴盛，则孤阴不生矣。冰坚如石之候，不能再生，即上文三阳俱起，不治自愈。下文二阴；期在
盛水，则此为三阴无疑）。二阴独至，期在盛水（二阴病比之三阴病者差缓焉、故期在盛水。盛水者，正月雨水
也）。
《诊要经终论》曰∶太阳之脉，其终也戴眼反折螈 ，其色白，绝汗乃出，出则死矣（戴眼者，目睛仰视
而不能转也。反折者，腰脊反张也，筋急曰螈，筋缓曰 。绝汗者，汗出如油也，足太阳之脉起于目内 ，上
额交巅入络脑，下项夹脊抵腰中，下至足之小指。手太阳之脉起于小指之端，循臂上肩，其支者循颈上颊，至
目之外 ，故其病如此。又太阳为三阳之表，故主色白汗出）。少阳终者，耳聋，百节皆纵，目 绝系，绝系
一日半死，其死也色先青白，乃死矣（手足少阳之脉皆入于耳中，亦皆至于目锐 ，故为耳聋目 也， 者，直
视如惊也，因少阳之系绝，不能旋转也，胆应筋，故百节纵也。木之色青，金之色白，金木相贼，则青白先见
矣）。阳明终者，口目动作，善惊妄言，色黄，其上下经盛，不仁则终矣（手足阳明之脉皆挟口入目，故口目动
作也。闻木音则惕然而惊，是阳明善惊也。骂詈不辨亲疏，是阳明妄言也。黄者，土色外见也。上下经盛、谓头、颈、
手、足，阳明之脉皆躁动而盛，是胃之败也。不知痛痒，谓之不仁，是肌肉之败
也）。少阴终者，面黑齿长而垢，腹胀闭，上下不通而终矣（手少阴气绝则血败，足少阴气绝则色如 ，故
面黑也。肾主骨，齿者骨之余，故齿不固而垢也。手少阴之脉下膈络小肠，足少阴之脉络膀胱贯肝膈，故为腹
胀闭、上下不通，是心肾不交也）。太阴终者，腹胀闭不得息，善噫善呕，呕则逆，逆则面赤，不逆则上下不
通，不通则面黑皮毛焦而终矣（足太阴脉入腹属脾，故为腹胀闭。手太阴脉上膈属肺而主呼吸，故不得息、惟
胀闭不得息，故为噫为呕。气逆于上，故面赤。不逆则脾之地气不上升，肺之天气不下降。上下不通者，天地
不交也。脾败无以制水，故面黑。肺败不能主气，故皮毛焦也）。厥阴终者，中热嗌干，善溺心烦，甚则舌卷
卵上缩而终矣（手厥阴心主之脉起于胸中，出属心包络，下膈，历络三焦。足厥阴肝脉循喉咙之后。上入颃颡，
其下者循股阴，入毛中过阴器，故为中热嗌干、善溺心烦等症。舌者心之官也，肝者筋之合也，筋者聚于阴器，
而脉络于舌本，故甚则舌卷卵缩也）。
愚按∶人之有病，犹树之有蠹也。病之有能，犹蠹之所在也。不知蠹之所在，遍树而斫之，蠹未必除而树
先槁矣。不知病之所在，广络而治之，病未必去而命先尽矣。故病能至赜即较若列眉，犹惧或失之，病能未彰
而试之药饵，吾不忍言也。世医矜家传之秘，时医夸历症之多，悻悻卖俗而不知其非。叩之三因之自与其所变，
翻以力赘，是不欲知蠹之所在，而弟思斫树以为功者，嘻！亦惨矣。
三逆（三种危重征象）：咳嗽且小便失禁，说明气血都已亏损；形体肌肉消瘦脱陷，说明脾气已经断绝；脉搏躁动疾数，说明真脏脉已显现。
呕血，胸部胀满并牵引背部疼痛，脉搏细小而快速，这是四逆（四种危重征象）。呕血发展到胸部胀满、背部弯曲的程度，病情已经到了极点。脉搏细小属于气机败坏，脉搏快速属于血液败坏。
咳嗽、呕吐、腹部胀满并且伴有完谷不化的泄泻，脉搏摸不到，这是五逆（五种危重征象）。上部表现为咳嗽呕吐，中部表现为腹胀满，下部表现为完谷不化的泄泻；三焦全部患病，六脉都已经断绝。像这样的病症，不到一个时辰就会死亡（“不及一时”指不能撑满一整天）。
《标本病传论》说：疾病传变的情况是，心病首先表现为心痛（患心病的先出现心痛），一天后传至肺而出现咳嗽（心病传肺，火克金），三天后胁肋部支撑胀痛（肺再传肝，金克木，所以胁肋支撑痛），五天后二便闭塞不通，身体疼痛沉重（肝传脾，木克土，脾病则二便闭塞不通。脾主肌肉，所以身体沉重疼痛），再过三天如果病不愈就会死亡（再过三天不愈，则脾又传肾，土克水，五脏都受伤了所以死亡），在冬季的夜半时分或夏季的日中时分死亡（冬季夜半是水气极旺的时候，夏季日中是火气极旺的时候。火畏水，所以在冬季死于夜半。阳邪亢盛到了极点，所以在夏季死于日中。大概是因为衰极也会死，盛极也会死）。
肺病表现为气喘咳嗽（肺主呼吸，所以生病时气喘咳嗽）。三天后胁肋部支撑满痛（三天后传至肝，金克木）。一天后身体沉重疼痛（一天后传至脾，木克土）。五天后出现腹胀（五天后传至胃，由脏传腑），十天如果病不愈就会死亡（十天不愈，胃再传肾，五行之数已到极限，所以死亡），在冬季日落时分或夏季日出时分死亡（这是卯、酉两个时辰，属于燥金的化气）。
肝病表现为头晕目眩，胁肋部支撑满痛（肝开窍于目，经脉分布于胁肋），三天后身体沉重疼痛（三天后传脾），五天后出现腹胀（脾传胃），三天后腰脊和小腹疼痛，小腿酸痛（三天后传肾），三天如果病不愈就会死亡（三天不愈，肾再传心，所以死亡），在冬季日落时分或夏季早饭时分死亡（也是卯、酉时辰，燥金主事，是木所畏惧的）。
脾病表现为身体疼痛沉重（脾主肌肉），一天后出现腹胀（脾传胃），两天后小腹和腰脊疼痛，小腿酸痛（胃传肾），三天后背部筋脉疼痛，小便闭塞（三天后传至膂膀胱），十天如果病不愈就会死亡（十天不愈，再传于心，所以死亡）。在冬季人定时分或夏季晚食时分死亡（这是巳、亥时辰，司风木之化，脾病畏惧它）。
肾病表现为小腹、腰脊疼痛，小腿酸痛（肾主下部，经脉行于小腹、腰脊、胫骨之间），三天后背部筋脉疼痛，小便闭塞（三天后传膂膀胱），三天后腹胀（三天后传小肠），三天后两侧胁肋支撑疼痛（三天后上传于心，手厥阴心包经的正脉，别出下行渊腋三寸进入胸中，所以两侧胁肋支撑痛），三天如果病不愈就会死亡（夏季伤肺金所致），在冬季大晨时分或夏季晚脯时分死亡（这是辰、戌时辰。土旺于四季，为水所畏惧，所以肾病在此绝灭）。
胃病表现为腹胀满，五天后小腹、腰脊疼痛，小腿酸痛（五天传肾），三天后背部筋脉疼痛，小便闭塞（三天传膂膀胱），五天身体沉重疼痛（《病传论》说五天上传于心。这里说体重可能是误写），六天如果病不愈就会死亡（心再传肺），在冬季夜半之后或夏季未时死亡（丑、未时司湿土之化，气通于胃，失去守御就会死亡）。
膀胱病表现为小便闭塞，五天后小腹胀，腰脊疼痛，小腿酸痛（五天传肾），一天后腹胀（一天传小肠），一天后身体疼痛（一天传心，由腑传脏。心主血脉，所以导致身体疼痛），两天如果病不愈就会死亡（心病不愈，必再传肺金，所以死亡），在冬季鸡鸣时分或夏季下午时分死亡（丑、未时辰，土能制水，所以膀胱畏惧它。疾病相传的死期各有远近，脏腑有要害不同。依次相传的必然死亡，间隔一两个脏腑或三四个脏腑的，还可以治疗）。
《灵枢·经脉》篇说：手太阴肺经之气断绝，则皮毛枯焦。太阴经是运行气以温养皮毛的，所以气不能荣养则皮毛枯焦，皮毛枯焦则津液从皮节流失，津液流失则指甲干枯、毫毛折断，毫毛折断说明毛先死，丙日加重丁日死亡，因为火胜金（肺属金主气，为水之母，所以气绝则津液流失，指甲干枯毫毛折断）。手少阴心经之气断绝，则血脉不通，血脉不通则血液不流动，血液不流动则毛发色泽不润泽，所以面色黑得像漆柴一样，说明血先死，壬日加重癸日死亡，因为水胜火（心主血脉，所以心绝则血先死，症状在毛发色泽不润泽，面色黑如漆，这是水化现出的征兆）。足太阴脾经之气断绝，则脉不能荣养肌肉，唇舌是肌肉的根本，脉不能荣养则肌肉软弱，肌肉软弱则舌萎缩、人中满平，人中满平则嘴唇翻卷，嘴唇翻卷说明肉先死，甲日加重乙日死亡，因为木胜土（脾主肌肉，所以脾绝则肉先死，症状在舌萎、人中满、唇反）。足少阴肾经之气断绝，则骨骼枯槁，少阴经是冬脉，潜行而濡润骨髓，所以骨不濡润则肉不能附着，骨肉不相亲附则肌肉松软退缩，肌肉松软退缩所以牙齿显得长且有污垢、头发无光泽，头发无光泽说明骨先死，戊日加重己日死亡，因为土胜水（肾属水，所以为冬脉。肾主骨，所以肾绝则骨先死。症状在骨肉不相亲附，则牙齿长而有垢，精枯头发无光泽）。足厥阴肝经之气断绝，则筋脉断绝，厥阴经是肝脉，肝是筋的汇聚处，筋聚于阴器（原文当作“器”，指生殖器），脉络连于舌根，所以脉不能荣养则筋脉拘急，筋脉拘急则牵引舌头和睾丸，所以嘴唇青紫、舌头卷曲、睾丸上缩，说明筋先死，庚日加重辛日死亡，因为金胜木（肝绝者筋先死。症状在嘴唇青紫、舌头卷曲、睾丸上缩囊蜷）。五脏阴气都断绝，则目系转动，转动则眼睛昏花，眼睛昏花说明神志先死，神志先死则过一天半死亡（五脏的精气上注于目，所以五脏阴气绝则眼球转动而昏花，神志先死。神志藏于肾，真阴已竭，死期在周日间）。六阳经之气断绝，则阴与阳分离，分离则腠理开泄，绝汗流出，所以早上占测晚上死，晚上占测早上死（阳气不能卫护体表而固摄，则汗液外泄。绝汗，形状如珠，凝结而不流动，或者气喘不停，汗出如洗的样子）。
《阴阳类论》说：冬季三个月的疾病，如果病性合于阳（阳证），到第二年正月脉象出现死征，都会拖到春季以后才死（冬季三个月是阴气盛行的时候，如果出现阳病，到初春阳气发动之时，脉象必有死征。“出春”指进入夏季，阳病应当逢阳盛，则亢盛至极而无法避免死亡）。冬季三个月的疾病，如果道理上讲生机已尽，草木发芽（草色青、柳叶见）的时候就是死期（“在理已尽”指神色、脉象、形态、症状都没有生理迹象，那么交春时草木发芽，就是其死期）。春季阴阳脉象都断绝，死期在孟春（冬季的病，刚交春而阴阳脉象都断绝，则不用等到仲春、季春，就在孟春是其死期了。阴绝，指脉形不至；阳绝，指脉形微细，或者上不至关为阳绝，下不至关为阴绝）。春季三个月的疾病，称为“阳杀”（杀音赛，指阳气衰败。阳气刚刚生发的时令，而阳气衰败，不能顺应时令），如果阴阳都断绝，死期在草木干枯之时（春令木旺的病症，而阴阳俱绝，到秋令草木干枯之时，金胜木而死）。夏季三个月的疾病，至阴（脾）不过十日（《金匮真言论》说脾为阴中之至阴，是五脏六腑的根本。以至阴之脏而当阳极之时，如果犯死症，死期在十日）。阴阳交争，死期在秋水泛滥之时（阴阳交，指阴脉见于阳位，则阳气失守；阳脉见于阴位，则阴气失守。夏季出现这种逆象，则到仲秋秋水泛滥之期，不能保全生命）。秋季三个月的疾病，三阳经气同时发起，不治也能自愈（秋时阳气渐衰，阴气渐长，虽然三阳的病都发起，但阳不胜阴，所以能自愈）。阴阳交合（此处指阴阳错杂之病），站立不能坐下，坐下不能站起（阴阳交合指阴阳合病。起坐不能，指屈伸不利）。三阴经气独盛（原文“三阳”当作“三阴”），死期在石水结冰之时（阴病当逢阴盛，则孤阴不生。冰坚如石的景象，不能再有生机，即上文“三阳俱起，不治自愈”。下文“二阴期在盛水”，则此为三阴无疑）。二阴经气独盛，死期在盛水之时（二阴病比之三阴病稍缓，所以死期在盛水。盛水指正月雨水时节）。
《诊要经终论》说：太阳经气终结，表现为两眼上视不能转动，角弓反张，抽搐，面色苍白，绝汗流出，汗出则死亡（戴眼，指眼球仰视不能转动。反折，指腰脊反张。筋急叫螈，筋缓叫 。绝汗，指出汗如油。足太阳经脉起于目内眦，上额交巅入络脑，下项夹脊抵腰中，下至足小趾。手太阳经脉起于小指端，循臂上肩，支脉循颈上颊，至目外眦，所以病成这样。又太阳为三阳之表，所以主面色白、汗出）。少阳经气终结，表现为耳聋，全身关节松弛无力，眼球直视如惊状而目系断绝，目系断绝一天半死亡，死前颜色先青白，然后死亡（手足少阳经脉都入耳中，也都到达目锐眦，所以耳聋、目直视。 者，指直视如惊，因少阳之系绝，不能旋转。胆应筋，所以全身关节纵弛。木之色青，金之色白，金木相克，则青白色先出现）。阳明经气终结，表现为口眼歪斜抽动，容易惊恐，胡言乱语，面色黄，上下经脉躁盛，不知痛痒则终结（手足阳明经脉都挟口入目，所以口眼动作。听到木声就惕然而惊，是阳明善惊。骂詈不辨亲疏，是阳明妄言。黄是土色外现。上下经盛，指头、颈、手、足，阳明经脉都躁动而盛，是胃气败坏。不知痛痒叫不仁，是肌肉败坏）。少阴经气终结，表现为面色黑，牙齿显得长且有污垢，腹胀闭塞，上下不通而终结（手少阴气绝则血败，足少阴气绝则色如煤，所以面黑。肾主骨，齿是骨之余，所以牙齿不固而有垢。手少阴经脉下膈络小肠，足少阴经脉络膀胱贯肝膈，所以腹胀闭、上下不通，这是心肾不交）。太阴经气终结，表现为腹胀闭塞不得呼吸，喜欢嗳气喜欢呕吐，呕吐则气逆，气逆则面赤，不逆则上下不通，不通则面黑皮毛焦而终结（足太阴脉入腹属脾，所以腹胀闭。手太阴脉上膈属肺主呼吸，所以不得息。只有胀闭不得息，所以为噫为呕。气逆于上，所以面赤。不逆则脾之地气不上升，肺之天气不下降。上下不通，是天地不交。脾败无以制水，所以面黑。肺败不能主气，所以皮毛焦）。厥阴经气终结，表现为心中烦热，咽喉干燥，多尿，心烦，严重时舌头卷曲、睾丸上缩而终结（手厥阴心主经脉起于胸中，出属心包络，下膈，历络三焦。足厥阴肝脉循喉咙之后，上入颃颡，其下者循股阴，入毛中过阴器，所以出现心中烦热、咽喉干燥、多尿、心烦等症状。舌是心的官窍，肝是筋的汇聚处，筋聚于阴器，脉络连于舌根，所以严重时舌头卷曲、睾丸上缩）。
我按语：人得病，就像树上有蛀虫。病的表现（病能），就像蛀虫所在的位置。不知道蛀虫在哪里，遍树砍伐，蛀虫未必除去而树先枯死了。不知道病在哪里，广泛地治疗，病未必去除而性命先耗尽了。所以病的表现即使深奥难懂，也应当像排列眉毛一样清晰明了，还怕有所失误；如果病的表现还不明显就尝试用药饵，我不忍心说这种做法。世间的医生夸耀家传的秘方，当时的医生夸耀经历病症的多，傲慢地迎合世俗而不知道错误。问到三因（内因、外因、不内外因）的来源及其变化，反而认为是多余的赘述，这是不想知道蛀虫在哪里，却只想通过砍树来显示功劳的人，唉！也太悲惨了。
Three Reversals (three critical signs): Coughing accompanied by urinary incontinence indicates that both Qi and Blood are depleted. Emaciation of the body and flesh indicates that Spleen Qi has been severed. A rapid and agitated pulse indicates the appearance of the Zang-organ Pulse (Zhen Zang Mai, a sign of organ failure).
Hematemesis (vomiting blood), chest fullness radiating to the back, with a small and rapid pulse, constitutes the Four Reversals. Hematemesis progressing to chest fullness and a curved back indicates the disease has reached its extreme. A small pulse belongs to Qi failure, and a rapid pulse belongs to Blood failure.
Coughing, vomiting, abdominal distension, and diarrhea with undigested food (Sun Xie), with an imperceptible pulse, constitutes the Five Reversals. The upper manifestation is coughing and vomiting; the middle manifestation is abdominal fullness; the lower manifestation is Sun Xie. When the San Jiao (Triple Burner) is diseased throughout and all six pulses are absent, death occurs within less than one shichen (two-hour period). "Less than one shichen" means unable to last a full day.
The *Biao Ben Bing Zhuan Lun* (Treatise on Root and Branch Disease Transmission) states: In the transmission of disease, Heart disease first presents as heart pain. After one day, it transmits to the Lung, causing coughing (Heart fire overacts on Lung metal). After three days, there is distending pain in the hypochondrium (Lung metal transmits to Liver wood, where metal overacts on wood, causing hypochondriac distending pain). After five days, there is obstruction and inability to pass stool or urine, along with body pain and heaviness (Liver wood transmits to Spleen earth, where wood overacts on earth; Spleen disease causes obstruction. As the Spleen governs muscles, the body feels heavy and painful). If after another three days the disease does not resolve, death ensues (if unresolved after three more days, the Spleen transmits to the Kidney, where earth overacts on water; damage to all five Zang organs leads to death). Death occurs at midnight in winter or midday in summer. Midnight in winter is when Water Qi is at its peak; midday in summer is when Fire Qi is at its peak. Since Fire fears Water, death in winter occurs at midnight. Yang pathogenic factors reaching extreme excess lead to death at midday in summer. Generally, both extreme deficiency and extreme excess lead to death.
Lung disease manifests as wheezing and coughing (the Lung governs respiration, hence wheezing and coughing). After three days, there is distending pain in the hypochondrium (transmission to the Liver after three days, metal overacting on wood). After one day, the body feels heavy and painful (transmission to the Spleen after one day, wood overacting on earth). After five days, abdominal distension occurs (transmission to the Stomach after five days, from Zang to Fu). If unresolved after ten days, death ensues (if unresolved after ten days, the Stomach transmits to the Kidney; the number of the Five Elements reaches its limit, leading to death). Death occurs at sunset in winter or sunrise in summer (these are the Mao and You hours, associated with the transformation of Dry Metal).
Liver disease manifests as dizziness and vertigo, and distending fullness in the hypochondrium (the Liver opens into the eyes, and its meridians distribute through the hypochondrium and ribs). After three days, the body feels heavy and painful (transmission to the Spleen). After five days, abdominal distension occurs (Spleen transmits to Stomach). After three days, there is pain in the lower abdomen, lumbar spine, and calves (transmission to the Kidney). If unresolved after three days, death ensues (if unresolved after three days, the Kidney transmits to the Heart, leading to death). Death occurs at sunset in winter or during breakfast time in summer (also the Mao and You hours, governed by Dry Metal, which is feared by Wood).
Spleen disease manifests as body pain and heaviness (the Spleen governs muscles). After one day, abdominal distension occurs (Spleen transmits to Stomach). After two days, there is pain in the lower abdomen, lumbar spine, and calves (Stomach transmits to Kidney). After three days, there is pain in the back muscles and closed urination (transmission to the Lumbar Bladder after three days). If unresolved after ten days, death ensues (if unresolved after ten days, it transmits to the Heart, leading to death). Death occurs at the Ding Hai hour in winter or at dinner time in summer (these are the Si and Hai hours, governing the transformation of Wind Wood, which the Spleen fears).
Kidney disease manifests as pain in the lower abdomen, lumbar spine, and calves (the Kidney governs the lower part, and its meridians run through the lower abdomen, lumbar spine, and between the tibiae). After three days, there is pain in the back muscles and closed urination (transmission to the Lumbar Bladder). After three days, abdominal distension occurs (transmission to the Small Intestine). After three days, there is distending pain in both hypochondria (transmission upward to the Heart after three days; the regular channel of the Pericardium emerges from the chest, enters the thorax via the Yuan Ye point three cun below the armpit, causing hypochondriac distending pain). If unresolved after three days, death ensues (due to injury by Lung Metal in summer). Death occurs at early morning in winter or late afternoon in summer (these are the Chen and Xu hours. Earth is prosperous in the four seasons and is feared by Water, so Kidney disease perishes here).
Stomach disease manifests as abdominal distension and fullness. After five days, there is pain in the lower abdomen, lumbar spine, and calves (transmission to the Kidney). After three days, there is pain in the back muscles and closed urination (transmission to the Lumbar Bladder). After five days, the body feels heavy and painful (The *Bing Zhuan Lun* states transmission to the Heart after five days; the mention of body heaviness here may be an error). If unresolved after six days, death ensues (the Heart transmits to the Lung). Death occurs after midnight in winter or during the Wei hour in summer (the Chou and Wei hours govern the transformation of Damp Earth; Qi connects to the Stomach, and loss of regulation leads to death).
Bladder disease manifests as closed urination. After five days, there is lower abdominal distension, lumbar spine pain, and calf pain (transmission to the Kidney). After one day, abdominal distension occurs (transmission to the Small Intestine). After one day, body pain occurs (transmission to the Heart, from Fu to Zang. The Heart governs blood vessels, thus causing body pain). If unresolved after two days, death ensues (if Heart disease does not resolve, it must transmit to Metal, leading to death). Death occurs at cockcrow in winter or in the late afternoon in summer (Chou and Wei hours; Earth controls Water, so the Bladder fears this. The timing of death varies depending on the depth of transmission and the critical nature of the organs. Sequential transmission guarantees death; skipping one or two, or three or four organs, allows for treatment).
The *Ling Shu · Jing Mai* chapter states: When the Qi of the Hand-Taiyin (Lung) meridian ceases, the skin and hair become dry and brittle. The Taiyin meridian circulates Qi to nourish the skin and hair; thus, if Qi fails to nourish, the skin and hair become dry. When skin and hair are dry, body fluids leave the joints; when body fluids leave the joints, the nails become withered and fine hairs break. Breaking of fine hairs indicates that hair dies first; the condition worsens on Bing days and death occurs on Ding days, because Fire overacts on Metal (the Lung belongs to Metal, governs Qi, and is the mother of Water; thus, when its Qi ceases, fluids are lost, nails wither, and hairs break). When the Qi of the Hand-Shaoyin (Heart) meridian ceases, the vessels become blocked. When vessels are blocked, blood does not flow. When blood does not flow, the hair loses luster. Thus, when the face becomes black like lacquered charcoal, it indicates that blood dies first; the condition worsens on Ren days and death occurs on Gui days, because Water overacts on Fire (the Heart governs blood vessels; thus, when Heart Qi ceases, blood dies first. Symptoms include lack of luster in hair and a black face, indicating the manifestation of Water transformation). When the Qi of the Foot-Taiyin (Spleen) meridian ceases, the vessels fail to nourish the muscles. The lips and tongue are the root of the muscles; when vessels fail to nourish, the muscles become soft. When muscles are soft, the tongue atrophies and the philtrum becomes full. When the philtrum is full, the lips invert. Lip inversion indicates that flesh dies first; the condition worsens on Jia days and death occurs on Yi days, because Wood overacts on Earth (the Spleen governs muscles; thus, when Spleen Qi ceases, flesh dies first. Symptoms include tongue atrophy, full philtrum, and inverted lips). When the Qi of the Foot-Shaoyin (Kidney) meridian ceases, the bones become withered. The Shaoyin meridian is the Winter pulse, hidden and moistening the bone marrow. Thus, when bones are not moistened, flesh cannot adhere. When flesh and bone do not adhere, the flesh becomes soft and recedes. Consequently, the teeth appear long and dirty, and the hair lacks luster. Lack of luster in hair indicates that bone dies first; the condition worsens on Wu days and death occurs on Ji days, because Earth overacts on Water (the Kidney belongs to Water, hence the Winter pulse. The Kidney governs bones; thus, when Kidney Qi ceases, bone dies first. Symptoms include non-adherence of flesh and bone, long and dirty teeth, withered essence, and lusterless hair). When the Qi of the Foot-Jueyin (Liver) meridian ceases, the sinews cease. The Jueyin meridian is the Liver meridian; the Liver is the convergence of sinews. Sinews gather at the genitalia and connect to the base of the tongue. Thus, when vessels fail to nourish, sinews become tense. Tense sinews pull the tongue and testicles, causing cyanosis of the lips, curling of the tongue, and retraction of the testicles. This indicates that sinews die first; the condition worsens on Geng days and death occurs on Xin days, because Metal overacts on Wood (when the Liver ceases, sinews die first. Symptoms include cyanotic lips, curled tongue, and retracted testicles/scrotum). When the Yin Qi of all five Zang organs ceases, the eye connections rotate, causing dizziness. Dizziness indicates that the Shen (Spirit/Mind) dies first. If the Shen dies first, death occurs in one and a half days (the essence of the five Zang organs ascends to the eyes; thus, when Yin Qi of the five Zang organs ceases, the eyes rotate and dizzy. The Shen resides in the Kidney; when true Yin is exhausted, death occurs within a day and a half). When the Yang Qi of the six Yang meridians ceases, Yin and Yang separate. Separation causes the pores to open and sweat to leak out, resulting in "Jue Han" (desperate sweat). Thus, if observed in the morning, death comes in the evening; if observed in the evening, death comes in the morning (Yang Qi cannot defend the exterior and secure the interior, leading to sweat leakage. Jue Han appears as beads of sweat that coagulate and do not flow, or as continuous panting with sweat pouring like a wash).
The *Yin Yang Lei Lun* states: For diseases occurring in the three winter months, if the disease combines with Yang (manifests as Yang syndrome), by the first month of spring, the pulse will show signs of death, and death will occur after spring passes. During the three winter months, Yin is abundant. If Yang disease appears, when Yang Qi begins to stir in early spring, the pulse will inevitably show death signs. "After spring passes" refers to entering summer; Yang disease should coincide with abundant Yang, leading to extreme hyperactivity and inevitable death. For diseases in the three winter months, if the principles indicate that life is already exhausted (color, pulse, form, and symptoms show no sign of vitality), death will occur when grass turns green and willow leaves appear (signifying the arrival of spring). If both Yin and Yang pulses are absent in spring, death will occur in Meng Chun (early spring). For diseases starting in winter, if both Yin and Yang pulses are absent upon entering spring, death will occur in Meng Chun, without waiting for Zhong or Ji Chun. Absent Yin pulse means the pulse form is not felt; absent Yang pulse means the pulse form is minute, or stops above the Guan position (Yang absence), or stops below the Guan position (Yin absence). For diseases in the three spring months, termed "Yang Sha" (Sha sounds like 'sai', meaning Yang Qi decline), if both Yin and Yang are absent, death will occur when grass dries up. In spring, Wood is prosperous; if both Yin and Yang are absent, death occurs in autumn when grass dries, as Metal overacts on Wood. For diseases in the three summer months, the Zhi Yin (extreme Yin, referring to the Spleen) will not survive more than ten days. The *Jin Gui Zhen Yan Lun* states the Spleen is the Zhi Yin within Yin, the root of the five Zang and six Fu organs. When the Zhi Yin organ faces the time of extreme Yang, if a fatal syndrome occurs, death occurs within ten days. If Yin and Yang intersect (Yin pulse appearing in Yang positions, causing Yang Qi to lose control; Yang pulse appearing in Yin positions, causing Yin Qi to lose control), death will occur during the period of flowing water in mid-autumn. In summer, seeing this reversal means life cannot be preserved during the mid-autumn water phase. For diseases in the three autumn months, if the Qi of the Three Yang meridians arises simultaneously, the disease may heal spontaneously without treatment. In autumn, Yang Qi gradually declines and Yin Qi gradually grows. Although the Three Yang diseases arise, Yang cannot overcome Yin, so it heals itself. If Yin and Yang are mixed (Yin-Yang Jiao He), the patient cannot sit while standing nor stand while sitting (indicating Yin-Yang combined disease and difficulty in flexion/extension). If the Three Yin meridians alone are excessive (text says "Three Yang" but should be "Three Yin"), death will occur during the time of stone water (freezing). If Yin disease coincides with Yin abundance, solitary Yin cannot generate life. Just as ice hardens like stone and cannot revive, this corresponds to the previous statement about Three Yang healing spontaneously. The following text mentions "Two Yin," confirming this refers to Three Yin. If the Two Yin meridians alone are excessive, death will occur during the time of abundant water (spring rain). Two Yin disease is slower than Three Yin disease, so death occurs in Zheng Yue (first lunar month) during the rain.
The *Zhen Yao Jing Zhong Lun* states: When the Taiyang meridian ends, the eyes stare upward without rotation, the body arches backward (opisthotonos), there are spasms, the complexion is white, and desperate sweat appears; once the sweat appears, death follows. "Dai Yan" means the eyeballs look upward and cannot turn. "Fan Zhe" means the waist and spine arch backward. Spasm of tight sinews is called "Yuan"; flaccidity is called "Xian." Desperate sweat resembles oil. The Foot-Taiyang meridian originates at the inner canthus, crosses the forehead, meets at the vertex, enters the brain, descends the neck, runs alongside the spine to the loins, and reaches the little toe. The Hand-Taiyang meridian originates at the tip of the little finger, runs up the arm to the shoulder, and its branch runs up the neck to the cheek, ending at the outer canthus. Hence the symptoms. Taiyang is the exterior of the Three Yang, thus governing white complexion and sweating. When the Shaoyang meridian ends, there is deafness, flaccidity of all joints, and staring eyes with severed connections. Death occurs in one and a half days. The complexion turns blue-white before death. Both Hand and Foot Shaoyang meridians enter the ear and reach the outer canthus, causing deafness and staring. "Shi" means staring straight like fear. Due to the severance of Shaoyang connections, rotation is impossible. The Gallbladder corresponds to sinews, hence joint flaccidity. Wood color is blue, Metal color is white; Metal and Wood attacking each other cause blue-white colors to appear first. When the Yangming meridian ends, there is twitching of the mouth and eyes, frequent fright, delirious speech, yellow complexion, and excessive pulsation in the upper and lower channels. Numbness marks the end. Both Hand and Foot Yangming meridians flank the mouth and enter the eyes, causing twitching. Fright at the sound of wood indicates Yangming's tendency toward fright. Scolding without recognizing relatives indicates delirious speech. Yellow is the external manifestation of Earth color. Excessive pulsation in head, neck, hands, and feet indicates agitation of Yangming meridians and failure of the Stomach. Numbness (lack of pain/itch sensation) indicates muscle failure. When the Shaoyin meridian ends, the face is black, teeth appear long and dirty, abdominal distension and closure occur, and upper/lower blockage leads to death. Shaoyin Qi cessation causes blood failure; Foot-Shaoyin cessation causes coal-black complexion. The Kidney governs bones; teeth are the surplus of bones, hence loose and dirty. Hand-Shaoyin meridians descend through the diaphragm to connect with the Small Intestine; Foot-Shaoyin meridians connect with the Bladder, pierce the Liver and Diaphragm, causing abdominal distension/closure and upper/lower blockage, indicating Heart-Kidney non-interaction. When the Taiyin meridian ends, there is abdominal distension/closure preventing breathing, frequent belching and vomiting. Vomiting causes Qi rebellion, turning the face red. If Qi does not rebel, upper/lower blockage persists, turning the face black and drying the skin/hair, leading to death. Foot-Taiyin meridians enter the abdomen and belong to the Spleen, causing distension. Hand-Taiyin meridians ascend through the diaphragm to belong to the Lung, governing respiration, causing breathlessness. Distension prevents breathing, leading to belching/vomiting. Qi rebelling upward causes red face. If not rebelling, Spleen Earth Qi does not ascend, and Lung Heaven Qi does not descend. Upper/lower blockage signifies non-interaction of Heaven and Earth. Spleen failure fails to control Water, causing black face. Lung failure fails to govern Qi, causing dry skin/hair. When the Jueyin meridian ends, there is internal heat, dry throat, frequent urination, and irritability. Severe cases involve tongue curling and testicular retraction, leading to death. Hand-Jueyin Pericardium meridian originates in the chest, belongs to the Pericardium, descends through the diaphragm, and connects with the San Jiao. Foot-Jueyin Liver meridian follows the throat, enters the nasopharynx, and descends through the groin to the genitalia. Hence the symptoms. The tongue is the organ of the Heart; the Liver is the convergence of sinews; sinews gather at the genitalia and connect to the tongue base. Hence severe cases involve tongue curling and testicular retraction.
My Commentary: Human illness is like a tree infested with borers. The manifestations of disease (Bing Neng) are like the location of the borer. Not knowing where the borer is, one chops the entire tree; the borer may not be removed, but the tree withers first. Not knowing where the disease lies, one treats broadly; the disease may not go away, but life is exhausted first. Therefore, even if the manifestations of disease are profound and complex, they should be as clear as rows of eyebrows. I still fear making mistakes. To attempt medication before the disease manifestations are evident—I cannot bear to speak of such practices. Physicians of the world boast of family secrets; contemporary physicians boast of their experience with many cases. Arrogantly catering to vulgarity, they do not realize their error. When asked about the origins of the Three Causes (Internal, External, Non-internal/External) and their transformations, they dismiss it as superfluous. This is like wanting to know the location of the borer but only thinking of chopping the tree to claim credit. Alas! How tragic.