灵枢论疾诊尺篇曰∶冬伤于寒，春生瘅热。
素问生气通天论曰∶冬伤于寒，春必温病。
金匮真言论曰∶藏于精者，春不病温。
诒按∶冬令受寒随时而发者为伤寒，郁久而发者为温病。就温病言，亦有两证∶有随时感受之温邪，如叶
香岩、吴鞠通所论是也；有伏气内发之温邪，即内经所论者是也。是则冬伤于寒，正春月病温之由；而冬不藏
精，又冬时受寒之由也。
又按∶喻西昌尚论后篇，专论伏气发温之病，分为三例∶以冬伤于寒，春必病温为一例，谓寒邪之伏于肌
肤者，以冬不藏精，春必病温为一例，谓寒邪之伏于骨髓者；以冬不藏精，冬伤于寒为一例，谓内外均受邪，
如伤寒两感之证。以此三例，鼎立三纲，分途施治，恰与伤寒论之太阳病之风伤卫、寒伤营、风寒两伤营卫之
三例，前后相符。此喻氏得意之笔也。盖喻氏天才超越，笔力清卓，每有议论，无不力破余地∶而有意为文，
每每虚立门面，创议论以助我波澜。在作文则为高手，而说理则未必皆能精确矣。即如伏气发温之病，惟冬伤
于寒故病温，惟冬不藏精故受寒。其所受之寒，无不伏于少阴，断无伏于肌肤之理。其肾气未至大虚者，倘能
鼓邪外达，则由少阴而达太阳，病势浅而轻。若肾虚不能托邪，则伏于脏而不得外出，病即深而重。同此邪，
同此病，证有轻重，而理原一贯，无三纲之
可分也。喻氏论病，每每骋其才辩，而刻意求高∶抑或借作感慨，而自抒胸臆。逞笔所之，不自觉其言之过当
。学人须分别观之。
又按∶王叔和编次伤寒论略例云∶中而即病者，名伤寒。不即病者，寒毒藏于肌肤，至春变为温病，至夏
变为暑病。暑病者，热极重于温也。按叔和此论，大旨无甚刺谬。喻氏肆意驳之，未免太过。惟寒毒藏于肌肤
一语，于理欠圆。冬寒是时令之邪，与疫疠不同，无所谓毒。于寒下加一毒字，已属骇人。再寒邪之内伏者，
必因肾气之虚而入，故其伏也每在少阴。若皮肤有卫气流行之处，岂容外邪久伏。况果在皮肤，则病发亦轻，
何至深入脏腑，而有险恶之证耶？
素问热论篇曰∶今夫热病者，皆伤寒之类也。又曰∶凡病伤寒而成温者，先夏至日者为病温，后夏至日者
为病暑。暑当与汗皆出，勿止。
诒按∶伏气发温，随时而变。热之轻者曰温，热之重者曰暑。夏至后曰小暑、大暑，冬至后曰小寒、大寒
。寒暑二字，相为对待。内经所称暑与热，本无分别。观篇首云∶热病者，皆伤寒之类也。其义可见。至仲景
始以夏月暴感之热邪名曰 病，正以别于伏气外发之热病也。况伏气随时外发，亦必兼挟时令之邪。如春令兼
风，夏令兼暑，理所必至。是其所以异名者，固不第因乎热之微甚也。
又按经言∶凡病伤寒，是伤寒不必专在于冬时，即三时感寒，亦能郁化为温也。其称夏至后为病暑，则暑
即温之变名，尤不可指为另是一邪。而此独分别言之者，因伏气发于夏至以后，其治法略有不同。盖温病忌汗
，恐其伤阴。若时交长夏，则汗出必多，而邪气亦随汗而出，又未可以汗多而遽止之也。
灵枢邪气脏腑病形篇∶岐伯曰∶虚邪之中身也，洒淅动形。正邪之中人也微，先见于色，不知于身；若有
若无，若亡若存；有形无形，莫知其情。
素问八正神明论∶岐伯曰∶正邪者，身形若用力，汗出腠理开，逢虚风，其中人也微，故莫知其情，莫见
其形。
诒按∶此两节，言冬时寒邪，所以能久伏不觉之故。凡风从时令王方来者为正邪，从冲后来者为虚邪。冬
以寒为正邪，故中于人也令人不觉。近人有疑邪正不并立，不能久伏不发者。曷不取此两节经文，细意绎之。
灵枢论疾诊尺篇∶岐伯曰∶尺肤热甚，脉甚躁者，病温也。其脉盛而滑者，病且出也。
素问平人气象论∶岐伯曰∶人一呼脉三动，一吸脉三动而躁，尺热，曰病温。
诒按∶尺肤发热，热在阴也。尺热而脉数且躁，中有温邪也。更兼盛滑，则热邪已动，有外出之象矣。此
言伏温而发之脉证也。
灵枢热病篇曰∶热病，不知所痛，耳聋不能自收，口干，阳热甚，阴颇有寒者，热在髓，死不可治。又曰
∶热病已得汗，而脉尚躁盛，此阴脉之极也，死。其得汗而脉静者生。热病者脉尚躁盛而不得汗者，此阳脉之
极也，死。脉盛躁，得汗静者生。
诒按∶此节不知所痛二句，形容伏温初发，神情呆钝，其状如绘。阳热甚者，其热邪之浮于外者已甚也。
阴颇有寒者，其寒邪之伏于阴者尚未外透也。若此者，其热深在骨髓，故不可治。
又按∶已得汗而脉尚躁，是热甚而郁于阴也。脉尚躁而不得汗，是热甚而郁于阳也。邪郁不解，阴阳之气
不能主持，故死。
素问热论篇∶黄帝问曰∶今夫热病者，皆伤寒之类也，或愈或死，其死皆以六、七日之间，其愈皆以十日
以上者何也？不知其解，愿闻其故。岐伯对曰∶巨阳者，诸阳之属也。其脉连于风府，故为诸阳主气也。人之
伤于寒也，则为病热，热虽甚不死；其两感于寒而病者，必不免于死。帝曰∶愿闻其状。岐伯曰∶伤寒一日，
巨阳受之，故头项痛，腰脊强；二日阳明受之，阳明主肉，其脉挟鼻络于目，故身热、目痛而鼻干，不得卧也
；三日少阳受之，少阳主胆，其脉循胁络于耳，故胸胁痛而耳聋。三阳经络皆受其病，而未入于脏者，故可汗
而已。四日太阴受之，太阴脉布胃中，络于嗌，故腹痛而嗌干；五日少阴受之，少阴脉贯肾，络于肺，系舌本
，故口燥舌干而渴；六日厥阴受之，厥阴脉循阴器而络于肝，故烦满而囊缩。三阴三阳五脏六腑皆受病，营卫
不行，五脏不通则死矣。其不两感于寒者，七日巨阳病衰，头痛少愈；八日阳明病衰，身热少愈∶九日少
阳病衰，耳聋微闻；十日太阴病衰，腹减如故，则思饮食；十一日少阴病衰，渴止不满，舌干已而嚏；十二日
厥阴病衰，囊纵，少腹微下，大气皆去，病日已矣。帝曰∶治之奈何？岐伯曰∶治之各通其脏脉，病日衰已矣。
其未满三日者，可汗而已；其满三日者，可泄而已。又帝曰∶热病已愈，时有所遗者，何也？岐伯曰∶诸遗者
，热甚而强食之，故有所遗也。若此者，皆病已衰而热有所藏，因其谷气相搏，两热相合，故有所遗也。帝曰
∶善！治遗奈何？岐伯曰∶视其虚实，调其逆从，可使必已矣。帝曰∶病热当何禁之？岐伯曰∶病热少愈，食
肉则复，多食则遗，此其禁也。又帝曰∶其病两感于寒者，其脉应与其病形何如？岐伯曰∶两感于寒者，病一
日则巨阳与少阴俱病，则头痛、口干而烦满；二日则阳明与太阴俱病，则腹满，身热，不欲食，谵言；三日则
少阳与厥阴俱病，则耳聋、囊缩而厥。水浆不入，不知人，六日死。帝曰∶五脏已伤，六腑不通，营卫不行，
如是之后，三日乃死，何也？岐伯曰∶阳明者十二经脉之长也，其血气盛，故不知人；三日，其气乃尽，故死
矣。
又∶凡病伤寒而成温者，先夏至日者为病温；后夏至日者为病暑，暑当与汗皆出，勿止。
诒按∶热论谓人受寒邪，其为病必化热。但随时而发者为
伤寒，其病自外而入内；久伏而发者为温病，其病自内而达外。此论除篇末伤寒成温一节论及温病外，其余所
论，都属伤寒。惟所列六经形证，伤寒与温病，初无二致，故备录之，以为临证时分经认病之则。
又按∶凡伤寒化热，自表入里。初起之日，在三阳经者可汗∶后三日，在三阴经者可泄。故不至于死。其
两感者，乃一脏一腑一阴一阳同时俱病，来势迅速，不及措手，势必阴阳交绝，营卫不通，而不免于死矣。刺
热篇所论，太阳之脉与厥阴脉争见者，死期不过三日一段，即温病中之两感，与此节可以互证。
又按∶食肉则复一节，论病后食复，温病亦与伤寒相同。
又按∶经言冬伤于寒，春必病温，是指冬邪春发者而言。此言凡病伤寒，则无论冬夏，凡有伏邪，均可发
为温病也。故夏至前后，异其时而同其病；曰温曰暑，同其病而异其名也。又温与暑病邪相同，而随时异名。
冬邪春发者，邪郁化热，由里达外，邪随汗去，多汗则伤阴，故汗多者当止之。若至夏令，天时蒸热，先已有
汗，更有伏邪内动，汗泄愈多。但其汗之出也，邪机甫动，而汗即淋漓。若见汗多而遽止之，则邪机亦因之而
窒矣。故特分别言之，而禁其止也。
刺热篇曰∶肝热病者，小便先黄，腹痛多卧，身热。热争则狂言及惊，胁满痛，手足躁，不得安卧。庚辛
甚，甲乙大汗，气逆则庚辛死。刺足厥阴、少阳。其逆则头痛员员，脉引冲头也。
诒按∶肝脉络阴器，肝病不能疏泄，则热郁而小便黄也。腹痛多卧，肝病克脾也。热争者，为热甚而与正
气相争也。狂
言及惊，犯及手径也。胁痛，肝脉所过也。手足躁，不得安卧，热甚生风，风淫四末，故烦搅不安也。庚辛克
木之日，故病甚。甲乙木旺之日，故汗出而愈。气逆者，谓病气甚，而不顺其可愈之期也，更逢克木之日，故
死。厥阴少阳并刺，病在脏，必泻其腑，以求出路也。逆则头痛，病气上升之故。（参吴鞠通意）（庚辛甚以
下之理，各脏仿此）
心热病者，先不乐，数日乃热。热争则卒心痛，烦闷善呕，头痛面赤，无汗。壬癸甚，丙丁大汗，气逆则
壬癸死。刺手少阴、太阳。
诒按∶膻中为喜乐所出，故心病先不乐而发热。与正争则心卒痛，心主火故烦，心气不舒故闷。呕属肝病
，木火同气；且邪在上，多呕也。头痛，火升也。面赤，火越也。汗为心液，热甚则液干，故无汗也。
章虚谷曰∶人身生阳之气，根于肾而发于肝。木生火，火生土，土生金，金生水，水又生木。生气相传，
所以生生不息也。邪伏血气之中，亦随生阳之气而动，动甚则病发，其发也随气所注而无定处。故难经言∶温
病之脉，行在诸经，不知何经之动也。仲景所论∶或发于阴经，或发于阳经，正合难经之旨。今观内经按生气
之序，首列肝，次以心、脾、肺、肾，可见邪随生气而动，不定中是有一定之理，足以印证难经，仲景之言，
而轩岐、越人、仲景之一脉相承，更可见矣。
脾热病者，先头重，颊痛，烦心，颜青，欲呕，身热。热争则腰痛不可用俯仰，腹满泄，两颔痛。甲乙甚
，戊己大汗，气逆则甲乙死。刺足太阴、阳明。
诒按∶湿之中人也，首如裹，故脾病头先重也。颊为少阳
所属，土木互为胜负，土病则木病亦见也。颜青、欲呕、颔痛，皆木病也。脾脉注心下故烦心。腰痛不可用俯
仰，是脾病及胃，不能束筋骨利关节也。腹满泄，脾经本病也。
肺热病者，先淅然厥，起毫毛，恶风寒，舌上黄，身热。热争则喘咳，痛走胸膺背，不得大息，头痛不堪
，汗出而寒。丙丁甚，庚辛大汗，气逆则丙丁死。刺手太阴、阳明，出血如大豆，立已。
诒按∶肺主皮毛，故先恶风寒。肺气不化，则湿热蒸郁，故舌苔黄。喘咳，热邪伤肺也。热郁肺部，胸膺
背走痛而不得太息也。头痛者，天气 郁，而热上冲脑也。热蒸于内，则腠开汗出，热暂泄而生寒也。
肾热病者，先腰痛 酸，苦渴数饮，身热。热争则项痛而强， 寒且酸，足下热，不欲言，其热则项痛员
员澹澹然。戊己甚，壬癸大汗，气逆则戊己死。刺足少阴、太阳。
诒按∶腰为肾之府，又肾脉贯脊，会于督脉之长强穴。又肾脉入跟中以上 内，太阳之脉亦下贯 内。
，即 也。酸者，热烁液也。肾主五液而恶燥，病热则液伤而燥，故苦渴而饮水自救也。又太阳之脉，从巅入
络脑，还出别下项，病甚而移之腑，故项痛而强也。 寒，热极为寒也。肾脉从小指之下斜趋足心，病甚故足
下热也。不欲言，有不能明言之苦也。员员澹澹者，一身不能自主，难以形容之状。
又按∶内经叙列五脏热病，惟肝、肾两节，多其逆一层，他脏无之。可见热病伤阴，惟肝、肾为最要也。
肝热病者，左颊先赤；心热病者，颜先赤；脾热病者，鼻先赤；肺热病者，右颊先赤；肾热病者，颐先赤
。病虽未发，见赤色者刺之、名曰治未病。
章虚谷曰∶此更详五脏热邪未发，而必先见于色之可辨也。左颊、颜、鼻，右颊、颐，是肝、心、脾、肺
、肾五脏之气，应于面之部位也。病虽未发，其色先见，可见邪本伏于气血之中，随气血流行而不觉。良工望
而知其邪动之处，乘其始动，即刺而泄之，使邪势杀而病自轻。即难经所云∶随其经之所在而取之者，是为上
工治未病也。而用药之法，可以类推矣。
治诸热病，以饮之寒水，乃刺之；必寒衣之，居之寒处，身寒而止。
章虚谷曰∶以其久伏之邪，热从内发，故必先饮寒水，从里逐热，然后刺之，从外而泄。再衣以寒，居处
以寒，必身寒热除而后止。
王梦隐曰∶今人不读内经，于温热暑疫诸病，一概治同伤寒，禁其凉饮，浓其衣被，因而致重者不少。然
饮冷亦须有节，过度则有停饮、肿满、呕利等患。更有愈后手指足缝出水，速投米仁三两，白术一两，车前子
《灵枢·论疾诊尺》篇说：冬季感受寒邪，到了春天就会发生瘅热病。
《素问·金匮真言论》说：冬季能固藏精气的人，春天就不会患温病。
柳宝诒按语：冬季受寒随即发病的称为伤寒，寒邪郁积日久才发病的称为温病。就温病而言，也有两种证候：一种是随时感受的温邪，如叶天士、吴鞠通所论述的那样；另一种是伏气内发的温邪，即《内经》所论述的。这样看来，冬季感受寒邪，正是春季患温病的原因；而冬季不能固藏精气，又是冬季容易感受寒邪的原因。
我又按：喻嘉言在《尚论后篇》中专门论述伏气引发温病的病症，分为三种情况：以“冬伤于寒，春必病温”为一种情况，认为这是寒邪潜伏在肌肤；以“冬不藏精，春必病温”为一种情况，认为这是寒邪潜伏在骨髓；以“冬不藏精，冬伤于寒”为一种情况，认为这是内外都受到邪气侵袭，类似于伤寒两感证的证候。用这三种情况，确立三大纲领，分途进行治疗，恰好与《伤寒论》中太阳病的风伤卫、寒伤营、风寒两伤营卫的三种情况前后相符。这是喻氏得意的笔法。大概喻氏才华超越常人，文笔清高卓越，每次发表议论，无不极力打破常规；但如果是为了写文章，往往虚立门户，创立议论来助长自己的气势。在写文章方面他是高手，但在阐述医理方面未必都能精确。就像伏气引发温病的病症，只是因为冬季感受寒邪所以患温病，只是因为冬季不能固藏精气所以感受寒邪。他所感受的寒邪，没有不潜伏在少阴经的，绝对没有潜伏在肌肤的道理。如果肾气没有极度虚弱，如果能鼓动邪气向外透达，那么就从少阴经到达太阳经，病情浅表而轻微。如果肾虚不能托举邪气外出，那么邪气就潜伏在脏腑而不能外出，病情就深重而严重。同样是邪气，同样的病，证候有轻重之分，但医理原本是一贯的，并没有三个纲领可以区分。喻氏论述病症，常常施展他的才华和辩才，并且刻意追求高远；或者借题发挥感慨，抒发自己的胸臆。随着笔势挥洒，不自觉地说得过分了。学习的人必须分别看待。
我又按：王叔和在编次《伤寒论》的略例中说：感受寒邪随即发病的，名叫伤寒。不立即发病的，寒毒潜伏在肌肤，到了春天变为温病，到了夏天变为暑病。暑病，比温病的热更严重。按王叔和的这个论述，大旨没有什么谬误。喻氏肆意驳斥他，未免太过分了。只有“寒毒潜伏在肌肤”这一句话，在医理上不够周全。冬季的寒邪是时令之邪，与疫疠不同，无所谓毒。在“寒”字下面加一个“毒”字，已经让人惊骇。再者，寒邪内伏，一定是因为肾气虚弱才侵入的，所以它的潜伏多在少阴经。如果在皮肤中有卫气流行的地方，怎么容许外邪长久潜伏呢？况且如果真的在皮肤，那么发病也应该轻微，怎么会深入脏腑，而有险恶的证候呢？
《素问·热论》篇说：现在的热病，都属于伤寒一类。又说：凡是患伤寒而变成温病的，在夏至日之前发病的叫病温，在夏至日之后发病的叫病暑。暑病应当随汗一起排出，不要止住。
柳宝诒按语：伏气引发温病，会随时间变化而变化。热轻的叫温，热重的叫暑。夏至后叫小暑、大暑，冬至后叫小寒、大寒。“寒”和“暑”两个字，是相对待的。《内经》所称的暑和热，本来没有分别。看篇首说：“热病者，皆伤寒之类也。”这个意义就可以明白了。直到张仲景才开始把夏季暴感的热邪命名为“暑病”，正是为了区别于伏气外发的热病。何况伏气随时向外发散，也必然兼挟时令的邪气。如春季兼夹风邪，夏季兼夹暑邪，这是理所当然的。它们之所以名称不同，固然不仅仅是因为热的程度轻重不同。
我又按：经文说：“凡病伤寒”，意思是伤寒不一定专指冬季，即使其他三个季节感受寒邪，也能郁结化为温病。它称夏至后为病暑，那么暑就是温的变化名称，尤其不能指认为是另一种邪气。而这里单独分别论述的原因，是因为伏气在夏至以后发作，治疗方法略有不同。大概温病忌用发汗法，担心它损伤阴液。如果时交长夏，那么出汗必然很多，而邪气也随着汗液排出，又不可以因为汗多就立刻止汗。
《灵枢·邪气脏腑病形》篇：岐伯说：虚邪侵犯身体，使人战栗动摇形体。正邪侵犯人很轻微，先表现在面色上，身体感觉不到；若有若无，若存若亡；有形无形，没有人知道其中的情状。
《素问·八正神明论》：岐伯说：正邪，是指人体身形如果用力的时候，汗出腠理开泄，遇到虚风，它侵犯人很轻微，所以不知道它的情状，看不见它的形状。
柳宝诒按语：这两节经文，说的是冬季寒邪所以能长久潜伏而不被察觉的原因。凡是风从当令旺方来的叫正邪，从冲后来（对冲方向）来的叫虚邪。冬季以寒为正邪，所以中人让人不觉察。近代有人怀疑邪正不能并存，不能长久潜伏不发作。为什么不取这两节经文，仔细推究它的意思呢？
《灵枢·论疾诊尺》篇：岐伯说：尺部皮肤发热很厉害，脉象很躁动的，是温病。脉象盛大而滑利的，病将要外出。
《素问·平人气象论》：岐伯说：人一呼脉搏跳动三次，一吸脉搏跳动三次而且躁急，尺部发热，叫做病温。
柳宝诒按语：尺肤发热，热在阴分。尺部热而脉数且躁动，说明体内有温邪。再加上盛大滑利，则热邪已经发动，有外出的征象了。这说的是伏温发作时的脉证。
《灵枢·热病》篇说：热病，不知道疼痛，耳聋不能收持肢体，口干，阳热很盛，阴分却很有寒意，这是热在骨髓，无法治疗，必死。又说：热病已经出汗，但脉象还盛大躁动，这是阴脉的极点，必死。如果出汗后脉象平静的就生。热病患者脉象还盛大躁动而且不出汗的，这是阳脉的极点，必死。脉象盛大躁动，出汗后平静的就生。
柳宝诒按语：这一节中“不知所痛”两句，形容伏温刚发作时，神情呆钝，其状态如同绘画一般逼真。阳热盛的，是说热邪浮越在外的已经很严重了。阴分很有寒意的，是说寒邪潜伏在阴分的还没有向外透发。像这种情况，热邪深在骨髓，所以无法治疗。
我又按：已经出汗但脉象还躁动，是热邪很盛而郁结在阴分。脉象还躁动但不出汗，是热邪很盛而郁结在阳分。邪气郁结不解，阴阳之气不能主持，所以死亡。
《素问·热论》篇：黄帝问道：现在的热病，都属于伤寒一类，有的痊愈有的死亡，死亡的都在六、七天之间，痊愈的都在十天以上，为什么呢？我不明白其中的解释，希望听听原因。岐伯回答说：巨阳经，是诸阳经的统领。它的经脉连于风府，所以是诸阳主气的经络。人感受寒邪，就会发生热病，热虽然严重也不会死；如果两感于寒而发病的，就一定难免于死。黄帝说：希望听听它的症状。岐伯说：伤寒第一天，巨阳经受邪，所以头痛、项强、腰脊僵硬；第二天阳明经受邪，阳明经主管肌肉，它的经脉夹鼻络于目，所以身热、目痛、鼻干、不能安卧；第三天少阳经受邪，少阳经主管胆，它的经脉循行胁肋络于耳，所以胸胁痛、耳聋。三阳经络都受了病，但未入于脏的，所以可以通过发汗治愈。第四天太阴经受邪，太阴经的经脉布散在胃中，络于咽喉，所以腹痛、咽喉干燥；第五天少阴经受邪，少阴经的经脉贯穿肾，络于肺，系舌本，所以口燥、舌干而渴；第六天厥阴经受邪，厥阴经的经脉循行阴器而络于肝，所以烦闷、阴囊收缩。三阴三阳五脏六腑都受了病，营卫运行停滞，五脏不通就会死亡。如果不两感于寒的，第七天巨阳病衰退，头痛稍微减轻；第八天阳明病衰退，身热稍微减轻；第九天少阳病衰退，耳聋稍微能听到声音；第十天太阴病衰退，腹部胀满消退恢复原状，就想吃东西；第十一天少阴病衰退，口渴停止、腹不满、舌干已好并开始打喷嚏；第十二天厥阴病衰退，阴囊松弛，小腹轻微下坠，大气都已去除，病一天天好了。黄帝说：怎么治疗呢？岐伯说：治疗要各通其脏脉，病就会一天天衰退好了。病程未满三天的，可以通过发汗治愈；病程已满三天的，可以通过泄下治愈。又黄帝说：热病已经痊愈，时常还有余热遗留，为什么呢？岐伯说：各种遗留的病，是因为热势很盛而勉强进食，所以有遗留。像这种情况，都是病势已衰而热邪有所潜藏，因为谷气与热邪相搏，两热相合，所以有遗留。黄帝说：好！治疗遗留的病怎么办？岐伯说：观察虚实，调理逆顺，可以使病一定痊愈。黄帝说：患热病应当禁忌什么？岐伯说：患热病稍微好转，吃肉就会复发，多吃就会遗留，这就是禁忌。又黄帝说：两感于寒的病，它的脉象和症状是什么样？岐伯说：两感于寒的，第一天巨阳与少阴同时发病，就会头痛、口干而烦闷；第二天阳明与太阴同时发病，就会腹满、身热、不想吃饭、胡言乱语；第三天少阳与厥阴同时发病，就会耳聋、阴囊收缩而四肢厥冷。水浆喝不进，神志不清，六天死亡。黄帝说：五脏已经受伤，六腑不通，营卫不行，在这之后三天才死亡，为什么呢？岐伯说：阳明经是十二经脉之长，它的血气旺盛，所以神志不清；经过三天，它的气耗尽，所以死亡。
又：凡是患伤寒而变成温病的，在夏至日之前发病的叫病温；在夏至日之后发病的叫病暑，暑病应当随汗一起排出，不要止住。
柳宝诒按语：《热论》说人感受寒邪，它发病一定会化热。但随即发病的叫伤寒，病势自外而入内；久伏而后发病的叫温病，病势自内而达外。这篇论述除了篇末关于伤寒成温的一节论及温病外，其余所论述的，都属于伤寒。只是所列的六经症状，伤寒与温病起初没有两样，所以全部记录下来，作为临证时分经辨病的准则。
我又按：凡是伤寒化热，自表入里。初起的日子，在三阳经的可以发汗；过了三天，在三阴经的可以泄下。所以不至于死。至于两感证，乃是一脏一腑一阴一阳同时俱病，来势迅速，来不及措手，势必导致阴阳交绝，营卫不通，从而不免于死。《刺热》篇所论述的太阳脉与厥阴脉争见的一段，就是温病中的两感证，与此节可以互相印证。
我又按：经文说“冬伤于寒，春必病温”，是指冬季邪气春季发作的情况。这里说“凡病伤寒”，则是无论冬夏，只要有伏邪，都可以发为温病。所以夏至前后，时节不同但病相同；叫温叫暑，病相同但名称不同。另外温病与暑病邪气相同，但随时间不同而名称不同。冬季邪气春季发作的，邪气郁结化热，由里达外，邪随汗去，多汗则会伤阴，所以汗多的应当止汗。如果到了夏季，天时蒸热，本身已有汗出，更有伏邪内动，汗泄更多。但是它的汗出，是邪机刚刚发动，汗就淋漓而出。如果见到汗多就立刻止汗，那么邪机也会因此窒塞。所以特别分别论述，并禁止止汗。
《刺热》篇说：肝热病的人，小便先黄，腹痛，多卧，身热。热邪与正气相争，就会胡言乱语及惊悸，胁肋满痛，手足躁扰，不能安卧。庚辛日加重，甲乙日大汗，气逆则在庚辛日死亡。针刺足厥阴经、足少阳经。如果气逆则头痛晕眩，是脉气牵引冲头所致。
柳宝诒按语：肝脉络阴器，肝病不能疏泄，则热郁而小便黄。腹痛多卧，是肝病克脾。热争，是因为热甚而与正气相争。胡言乱语及惊悸，是犯及手经。胁痛，是肝脉经过的地方。手足躁扰，不能安卧，是热甚生风，风淫于四肢末端，所以烦躁搅动不安。庚辛日是克木之日，所以病重。甲乙日是木旺之日，所以汗出而愈。气逆，是说病气很盛，而不顺其可愈的时期，再逢克木之日，所以死亡。厥阴少阳并刺，病在脏，必须泻其腑，以求出路。气逆则头痛，是病气上升的缘故。（参考吴鞠通的观点）（庚辛日加重以下的道理，各脏仿照此理）
心热病的人，先是不快乐，几天后才发热。热邪与正气相争，就会突然心痛，烦闷，喜欢呕吐，头痛面赤，无汗。壬癸日加重，丙丁日大汗，气逆则在壬癸日死亡。针刺手少阴经、手太阳经。
柳宝诒按语：膻中是喜乐发出的地方，所以心病先不乐而发热。与正气相争则心卒痛，心主火所以烦，心气不舒所以闷。呕吐属于肝病，木火同气；而且邪在上焦，多呕吐。头痛，是火升。面赤，是火越。汗是心液，热甚则液干，所以无汗。
章虚谷说：人身生发阳气，根于肾而发于肝。木生火，火生土，土生金，金生水，水又生木。生气相传，所以生生不息。邪气潜伏在血气之中，也随着生发阳气而动，动得厉害则病发，它的发作随着气所注处而没有固定位置。所以《难经》说：温病的脉，行在诸经，不知道是哪一经在动。张仲景所论述的：或发于阴经，或发于阳经，正符合《难经》的宗旨。现在看《内经》按照生气的顺序，首先列肝，其次心、脾、肺、肾，可见邪气随着生气而动，不定中是有定理的，足以印证《难经》、张仲景的话，而轩辕、岐伯、扁鹊、张仲景一脉相承，更加可见了。
脾热病的人，先头重，颊痛，烦心，颜面青，想呕吐，身热。热邪与正气相争，就会腰痛不可俯仰，腹满泄泻，两颔痛。甲乙日加重，戊己日大汗，气逆则在甲乙日死亡。针刺足太阴经、足阳明经。
柳宝诒按语：湿邪中人，头重如裹，所以脾病头先重。颊部是少阳所属，土木互为胜负，土病则木病也显现。颜面青、想呕吐、颔痛，都是木病。脾脉注入心下所以烦心。腰痛不可俯仰，是脾病波及胃，不能束筋骨利关节。腹满泄，是脾经本病。
肺热病的人，先淅然恶寒，毫毛竖起，恶风寒，舌苔黄，身热。热邪与正气相争，就会喘咳，痛走胸膺背，不能深呼吸，头痛不堪，汗出而寒。丙丁日加重，庚辛日大汗，气逆则在丙丁日死亡。针刺手太阴经、手阳明经，出血如大豆大小，立刻就好。
柳宝诒按语：肺主皮毛，所以先恶风寒。肺气不化，则湿热蒸郁，所以舌苔黄。喘咳，是热邪伤肺。热郁肺部，胸膺背走痛而不能深呼吸。头痛，是天气郁滞，而热上冲脑。热蒸于内，则腠理开汗出，热暂泄而生寒。
肾热病的人，先腰痛酸软，苦渴数饮，身热。热邪与正气相争，就会项痛而强，恶寒且酸，足下热，不想说话，其热则项痛晕眩澹澹然。戊己日加重，壬癸日大汗，气逆则在戊己日死亡。针刺足少阴经、足太阳经。
柳宝诒按语：腰是肾的府邸，又肾脉贯穿脊柱，会于督脉的长强穴。又肾脉入跟中以上内踝，太阳之脉也下贯内踝。酸，是热烁津液。肾主五液而恶燥，病热则液伤而燥，所以苦渴而饮水自救。又太阳之脉，从巅入络脑，还出别下项，病甚而移之腑，所以项痛而强。恶寒，是热极为寒。肾脉从小趾之下斜趋足心，病甚故足下热。不想说话，有不能明言之苦。员员澹澹，是一身不能自主，难以形容的状态。
我又按：《内经》叙列五脏热病，只有肝、肾两节，多了气逆一层，其他脏没有。可见热病伤阴，只有肝、肾最为重要。
肝热病的人，左颊先红；心热病的人，颜面先红；脾热病的人，鼻子先红；肺热病的人，右颊先红；肾热病的人，下巴先红。病虽未发，见到红色就针刺，名叫治未病。
章虚谷说：这里更详细地说明了五脏热邪未发，而必须先见于面色可辨别的情况。左颊、颜、鼻、右颊、颐，是肝、心、脾、肺、肾五脏之气，应于面部的部位。病虽未发，其色先现，可见邪本伏于气血之中，随气血流行而不自觉。良工望而知其邪动之处，乘其始动，就针刺而泄之，使邪势减弱而病自然轻。就是《难经》所说的：随其经之所在而取之，这叫上工治未病。而用药的方法，可以类推了。
治疗各种热病，用喝冷水，然后针刺；一定要穿凉衣服，居住在凉爽的地方，直到身体凉爽为止。
章虚谷说：因为它是久伏的邪气，热从内发，所以必须先喝冷水，从里逐热，然后针刺，从外而泄。再穿凉衣，居处以凉，必须身体凉爽热除才停止。
王梦隐说：现在人不读《内经》，对于温热暑疫诸病，一概按伤寒治疗，禁止凉饮，加厚衣被，因而致重的不少。然而饮冷也必须有个节制，过度则有停饮、肿满、呕利等祸患。更有痊愈后手指足缝出水，速投薏苡仁三两，白术一两，车前子
The *Ling Shu: Lun Ji Zhen Chi* chapter states: If one is injured by cold in winter, chanre heat (a type of febrile disease characterized by intense heat and thirst) will arise in spring.
The *Su Wen: Sheng Qi Tong Tian Lun* states: If one is injured by cold in winter, warm diseases (febrile diseases caused by latent pathogenic factors) will inevitably occur in spring.
The *Su Wen: Jin Gui Zhen Yan Lun* states: Those who store essence well in winter will not suffer from warm diseases in spring.
Yi's commentary: Cold injury acquired in winter that manifests immediately is termed Shanghan (Cold Damage); cold injury that remains latent and manifests after a period of stagnation is termed Wenbing (Warm Disease). Regarding warm diseases, there are two types: one is the warm pathogen contracted at the time of occurrence, as discussed by Ye Tianshi and Wu Jutong; the other is the warm pathogen originating from latent qi within, which is what the *Nei Jing* discusses. Thus, winter cold injury is indeed the cause of warm diseases in spring; and failure to store essence in winter is the reason for contracting cold during winter.
Furthermore, Yu Xichang, in the latter part of *Shanglun*, specifically discusses diseases where latent qi induces warm conditions, categorizing them into three examples: "Winter cold injury leads to warm disease in spring" is one example, referring to cold pathogen latent in the skin and muscles; "Failure to store essence in winter leads to warm disease in spring" is another example, referring to cold pathogen latent in the bone marrow; "Failure to store essence combined with winter cold injury" is the third example, referring to both internal and external pathogen invasion, similar to the condition of simultaneous contraction of Yin and Yang meridians in Shanghan. By establishing these three examples as three main frameworks for separate treatments, it aligns perfectly with the three examples in the *Shanghan Lun*: Wind injuring Wei (Defensive), Cold injuring Ying (Nutritive), and Wind-Cold injuring both Ying and Wei. This is Yu's brilliant stroke. Generally, Yu possessed transcendent talent and clear, outstanding writing skills; his discussions always broke new ground. However, when writing for literary effect, he often created empty facades and invented arguments to enhance his narrative. While he was a master writer, his medical reasoning was not always precise. For instance, regarding latent qi inducing warm disease, it is only because of winter cold injury that warm disease occurs, and only because of failure to store essence that cold injury is contracted. The cold pathogen contracted invariably lies latent in Shaoyin (Lesser Yin), never in the skin and muscles. If Kidney Qi is not severely deficient, and if it can urge the pathogen outward, the pathogen moves from Shaoyin to Taiyang (Greater Yang), resulting in a superficial and mild condition. If Kidney deficiency prevents expelling the pathogen, the pathogen remains latent in the Zang organs and cannot exit, resulting in a deep and severe condition. Although the pathogen and disease are the same, and symptoms vary in severity, the underlying principle is consistent, with no distinct three frameworks to divide. Yu often displayed his eloquence and sought height in his discussions, or used them to express personal sentiments. He wrote freely, unaware of his exaggerations. Students must distinguish their views carefully.
Furthermore, Wang Shuhe, in the Preface to his compilation of the *Shanghan Lun*, stated: Immediate illness upon contraction is named Shanghan. If not immediate, cold toxicity hides in the skin and muscles, transforming into warm disease in spring and summer disease in summer. Summer disease involves heat more intense than warm disease. Wang's argument is largely sound. Yu's arbitrary refutation is excessive. Only the phrase "cold toxicity hides in the skin and muscles" lacks theoretical completeness. Winter cold is a seasonal pathogen, different from epidemic pestilence, and has no concept of "toxicity." Adding "toxicity" to "cold" is startling. Moreover, internally latent cold pathogen enters due to Kidney Qi deficiency, so its latency is usually in Shaoyin. How could external pathogen remain latent long in areas where Wei Qi circulates in the skin? Furthermore, if it were in the skin, onset would be mild, how could it deepen into Zang organs causing dangerous conditions?
The *Su Wen: Re Lun* chapter states: Current febrile diseases all belong to the category of Shanghan. It also states: Of those who contract Shanghan and develop warm disease, those occurring before the Summer Solstice are called Warm Disease; those after are called Summer Heat Disease. Summer Heat should be expelled with sweat; do not stop sweating.
Yi's commentary: Latent qi inducing warm disease changes with time. Mild heat is called Warm; severe heat is called Summer Heat. After Summer Solstice are Minor and Major Heat; after Winter Solstice are Minor and Major Cold. "Cold" and "Heat" are counterparts. In the *Nei Jing*, Summer Heat and Heat are essentially indistinguishable. As stated at the beginning: "Febrile diseases all belong to Shanghan," this meaning is clear. It was Zhang Zhongjing who first named the sudden heat contraction in summer as "Summer Heat Disease," precisely to distinguish it from febrile diseases caused by latent qi emerging externally. Moreover, latent qi emerging externally inevitably combines with seasonal pathogens. For example, combining with Wind in spring and Summer Heat in summer is logical. Thus, their different names are not merely due to the degree of heat.
Furthermore, the scripture says: "All Shanghan diseases," implying Shanghan is not limited to winter; cold contracted in any season can stagnate and transform into warm disease. Calling post-Solstice cases "Summer Heat" means Summer Heat is a variant name of Warm, certainly not a different pathogen. The reason for separate discussion here is that latent qi emerging after the Summer Solstice requires slightly different treatment. Generally, Warm Disease contraindicates sweating, fearing Yin damage. If entering Late Summer, sweating will be profuse, and pathogen exits with sweat; one should not abruptly stop sweating due to volume.
The *Ling Shu: Xieqi Zangfu Bingxing* chapter: Qibo said: When Deficient Pathogens invade the body, they cause shivering and physical agitation. When Correct Pathogens invade, it is subtle; color changes appear first, unnoticed by the body; seeming present yet absent, existing yet lost; tangible yet intangible, no one knows their nature.
The *Su Wen: Ba Zheng Shen Ming Lun*: Qibo said: Correct Pathogens, when the body exerts force, sweat opens pores, encountering Empty Winds, invade subtly, so their nature is unknown and form unseen.
Yi's commentary: These two sections explain why winter cold pathogen can lie latent undetected. Winds coming from the ruling direction of the season are Correct Pathogens; those from the opposing direction are Deficient Pathogens. In winter, Cold is the Correct Pathogen, thus invasion goes unnoticed. Some modern scholars doubt that Correct and Deficient pathogens coexist and remain latent without manifesting. Why not examine these two scriptural passages carefully?
The *Ling Shu: Lun Ji Zhen Chi* chapter: Qibo said: When the skin of the forearm (Chi) is very hot and the pulse is very restless, it is Warm Disease. If the pulse is full and slippery, the disease is about to exit.
The *Su Wen: Ping Ren Qi Xiang Lun*: Qibo said: If in one breath the pulse beats three times, and in one inhalation beats three times with restlessness, and the Chi area is hot, it is called Warm Disease.
Yi's commentary: Chi skin fever indicates heat in Yin. Chi heat with rapid, restless pulse indicates internal Warm pathogen. Combined with fullness and slipperiness, the heat pathogen has moved, showing signs of exiting. This describes the pulse and symptoms of emerging latent warmth.
The *Ling Shu: Re Bing* chapter states: Febrile disease, unaware of pain, deaf, unable to control limbs, dry mouth, extreme Yang heat, yet significant Yin cold, indicates heat in the marrow; this is incurable and fatal. It also states: If febrile disease has sweated but the pulse remains full and restless, this is the extremity of Yin pulse; fatal. If the pulse calms after sweating, survival. If the pulse remains full and restless without sweating, this is the extremity of Yang pulse; fatal. If the pulse is full and restless but calms after sweating, survival.
Yi's commentary: The phrase "unaware of pain" depicts the dull mental state at the initial onset of latent warmth, vividly described. Extreme Yang heat means the heat pathogen floating externally is severe. Significant Yin cold means the cold pathogen latent in Yin has not yet penetrated outward. In such cases, heat is deep in the marrow, hence incurable.
Furthermore: Sweating with remaining restless pulse indicates severe heat stagnant in Yin. Restless pulse without sweating indicates severe heat stagnant in Yang. Pathogen stagnation unresolved, Yin and Yang Qi fail to govern, leading to death.
The *Su Wen: Re Lun* chapter: The Yellow Emperor asked: Febrile diseases all belong to Shanghan. Some recover, some die; deaths occur between the 6th and 7th day, recoveries after the 10th day. Why? I do not understand; please explain. Qibo replied: Taiyang (Greater Yang) is the leader of all Yang meridians. Its vessels connect to Fengfu, making it the master of Yang Qi. When humans contract cold, they develop febrile disease; even severe heat is not fatal. However, simultaneous contraction of Yin and Yang (Lianggan) is inevitably fatal. The Emperor asked for symptoms. Qibo said: On day one of Shanghan, Taiyang is affected, causing headache, stiff neck, and back stiffness. On day two, Yangming is affected; Yangming governs flesh, its vessels run along the nose to the eyes, causing body heat, eye pain, dry nose, and insomnia. On day three, Shaoyang is affected; Shaoyang governs Gallbladder, its vessels follow the costal region to the ears, causing hypochondriac pain and deafness. If the three Yang meridians are diseased but have not entered the Zang, it can be cured by sweating. On day four, Taiyin is affected; Taiyin vessels distribute in the stomach and link to the throat, causing abdominal pain and dry throat. On day five, Shaoyin is affected; Shaoyin vessels pass through the Kidney, link to the Lung, and tie to the root of the tongue, causing dry mouth, dry tongue, and thirst. On day six, Jueyin is affected; Jueyin vessels follow the genitalia and link to the Liver, causing irritability, fullness, and retraction of the scrotum. If all three Yin and three Yang, Five Zang and Six Fu are diseased, Ying and Wei circulation stops, and Five Zang blockage occurs, death results. For those not suffering Lianggan: On day seven, Taiyang disease declines, headache lessens. On day eight, Yangming disease declines, body heat lessens. On day nine, Shaoyang disease declines, hearing slightly returns. On day ten, Taiyin disease declines, abdominal distension resolves, appetite returns. On day eleven, Shaoyin disease declines, thirst stops, fullness resolves, tongue dries, and sneezing occurs. On day twelve, Jueyin disease declines, scrotum relaxes, lower abdomen feels slightly heavy, vital Qi departs, and the disease heals daily. The Emperor asked: How to treat? Qibo said: Treat by unblocking each Zang vessel; the disease will decline daily. For duration under three days, cure by sweating; for over three days, cure by purging. The Emperor asked: Why does residual heat persist after recovery? Qibo said: Residual heat occurs because heat was severe and food was forced, causing retention. The disease had declined, but heat remained hidden; grain Qi fought with heat, two heats merged, causing retention. The Emperor said: Good! How to treat retention? Qibo said: Observe deficiency or excess, regulate reversal or smoothness, and the disease will surely heal. The Emperor asked: What are the dietary prohibitions for febrile disease? Qibo said: When febrile disease slightly improves, eating meat causes relapse; overeating causes retention; these are prohibitions. The Emperor asked: What are the pulse and symptoms for Lianggan? Qibo said: In Lianggan, on day one, Taiyang and Shaoyin both suffer, causing headache, dry mouth, and irritability. On day two, Yangming and Taiyin both suffer, causing abdominal fullness, body heat, anorexia, and delirious speech. On day three, Shaoyang and Jueyin both suffer, causing deafness, scrotal retraction, and cold limbs. Inability to drink water and loss of consciousness lead to death on day six. The Emperor asked: After Five Zang are damaged, Six Fu blocked, Ying and Wei stopped, why death three days later? Qibo said: Yangming is the head of the twelve meridians, rich in Blood and Qi, causing unconsciousness; after three days, its Qi exhausts, leading to death.
Also: Of those contracting Shanghan developing warm disease, pre-Solstice cases are Warm Disease; post-Solstice cases are Summer Heat Disease. Summer Heat should be expelled with sweat; do not stop.
Yi's commentary: *Re Lun* states that cold contraction transforms into heat. Immediate manifestation is Shanghan, moving from exterior to interior; latent manifestation is Warm Disease, moving from interior to exterior. Except for the section on Shanghan becoming Warm at the end, the rest discusses Shanghan. The listed Six Meridian symptoms are identical for Shanghan and Warm Disease initially, so they are recorded fully as guidelines for meridian-based diagnosis.
Furthermore: Shanghan transforming heat moves from exterior to interior. Early stages in Three Yang meridians can be treated by sweating; after three days in Three Yin meridians, by purging. Thus, death is avoided. Lianggan involves simultaneous disease of one Zang, one Fu, one Yin, and one Yang, progressing rapidly, leaving no time for intervention, inevitably leading to Yin-Yang separation and Ying-Wei blockage, causing death. The section in *Ci Re Lun* discussing simultaneous appearance of Taiyang and Jueyin pulses, predicting death within three days, corresponds to Lianggan in Warm Disease and corroborates this section.
Furthermore: The "meat causes relapse" section discusses post-illness dietary relapse; Warm Disease is the same as Shanghan.
Furthermore: "Winter cold injury leads to spring warm disease" refers to winter pathogens emerging in spring. "All Shanghan diseases" implies that regardless of season, any latent pathogen can emerge as warm disease. Thus, pre- and post-Solstice differ in time but share the disease; Warm and Summer Heat share the disease but differ in name. Warm and Summer Heat pathogens are identical but named differently according to time. Winter pathogens emerging in spring involve pathogen stagnation transforming to heat, moving from interior to exterior, exiting with sweat; profuse sweating damages Yin, so excessive sweating should be stopped. In summer, environmental heat causes natural sweating, plus internal latent pathogen movement increases sweating. However, sweating here indicates pathogen mechanism just activating; if stopped abruptly due to volume, the pathogen mechanism becomes obstructed. Hence, separate discussion and prohibition of stopping sweating.
The *Ci Re* chapter states: Liver Heat Disease presents with yellow urine first, abdominal pain, lethargy, and body heat. During heat struggle, delirium and惊悸 (palpitations/fright) occur, hypochondriac fullness and pain, restlessness of hands and feet, and inability to sleep. Symptoms worsen on Geng-Xin days, resolve with profuse sweat on Jia-Yi days, and are fatal with Qi reversal on Geng-Xin days. Needle Foot Jueyin and Foot Shaoyang. Reversal causes dizzy headache due to pulse drawing to the head.
Yi's commentary: Liver vessels connect to genitalia; liver dysfunction fails to diffuse, causing heat stagnation and yellow urine. Abdominal pain and lethargy indicate Liver attacking Spleen. Heat struggle means severe heat fighting healthy Qi. Delirium and fright involve Hand meridians. Hypochondriac pain follows Liver vessel pathway. Restlessness and insomnia result from heat generating wind, affecting extremities, causing agitation. Geng-Xin days metal controls wood, worsening disease. Jia-Yi days wood prospers, allowing sweat resolution. Qi reversal means pathological Qi is strong, resisting the healing period; meeting controlling days causes death. Needling both Jueyin and Shaoyang treats Zang disease by draining the Fu to provide an exit. Headache in reversal is due to rising pathological Qi. (Referencing Wu Jutong) (The logic of worsening on Geng-Xin applies to other Zang).
Heart Heat Disease presents with initial unhappiness, followed by fever after several days. During heat struggle, sudden heart pain, irritability, frequent vomiting, headache, red face, and anhidrosis occur. Symptoms worsen on Ren-Gui days, resolve with profuse sweat on Bing-Ding days, and are fatal with Qi reversal on Ren-Gui days. Needle Hand Shaoyin and Hand Taiyang.
Yi's commentary: Danzhong is the source of joy; Heart disease causes initial unhappiness then fever. Struggle causes sudden heart pain; Heart governs Fire, causing irritability; stagnant Heart Qi causes oppression. Vomiting relates to Liver disease, as Wood and Fire share Qi; upper jiao pathology often causes vomiting. Headache indicates Fire rising. Red face indicates Fire overflowing. Sweat is Heart fluid; severe heat dries fluids, causing anhidrosis.
Zhang Xugu said: The body's generating Yang Qi roots in Kidney and emerges in Liver. Wood generates Fire, Fire generates Earth, Earth generates Metal, Metal generates Water, Water generates Wood. Generating Qi transmits continuously, ensuring endless life. Pathogens latent in Blood and Qi move with generating Qi; vigorous movement triggers disease, appearing where Qi flows. Thus, *Nan Jing* states: Warm disease pulses travel through various meridians, unknown which is active. Zhang Zhongjing's discussion of emergence in Yin or Yang meridians aligns with *Nan Jing*. Observing *Nei Jing* ordering by generating Qi, starting with Liver, then Heart, Spleen, Lung, Kidney, shows pathogens move with generating Qi. Though seemingly random, there is definite logic, confirming *Nan Jing* and Zhang Zhongjing, revealing the lineage from Xuanyuan, Qibo, Bian Que, and Zhang Zhongjing.
Spleen Heat Disease presents with initial heaviness of head, cheek pain, irritability, bluish complexion, desire to vomit, and body heat. During heat struggle, lower back pain preventing bending/straightening, abdominal fullness, diarrhea, and bilateral jaw pain occur. Symptoms worsen on Jia-Yi days, resolve with profuse sweat on Wu-Ji days, and are fatal with Qi reversal on Jia-Yi days. Needle Foot Taiyin and Foot Yangming.
Yi's commentary: Dampness invading causes head heaviness like wrapping; Spleen disease starts with head heaviness. Cheeks belong to Shaoyang; Wood and Earth compete; Spleen disease reveals Liver disease. Bluish complexion, vomiting, jaw pain are Liver signs. Spleen vessels enter below Heart, causing irritability. Lower back pain indicates Spleen disease affecting Stomach, failing to bind sinews and benefit joints. Abdominal fullness and diarrhea are primary Spleen channel diseases.
Lung Heat Disease presents with initial chills, goosebumps, aversion to wind and cold, yellow tongue coating, and body heat. During heat struggle, wheezing and coughing, pain radiating to chest/back, inability to take deep breaths, unbearable headache, sweating with chills occur. Symptoms worsen on Bing-Ding days, resolve with profuse sweat on Geng-Xin days, and are fatal with Qi reversal on Bing-Ding days. Needle Hand Taiyin and Hand Yangming; bleed until bean-sized drops appear for immediate relief.
Yi's commentary: Lung governs skin and hair, hence initial aversion to wind/cold. Lung Qi fails to transform, causing damp-heat steaming, leading to yellow coating. Wheezing/coughing result from heat damaging Lung. Heat stagnating in Lung causes chest/back pain and dyspnea. Headache results from atmospheric stagnation and heat rushing to brain. Internal heat steaming opens pores, sweating temporarily releases heat causing chills.
Kidney Heat Disease presents with initial lower back pain and soreness, bitter thirst with frequent drinking, and body heat. During heat struggle, stiff neck pain, aversion to cold with soreness, hot soles, reluctance to speak, and dizzy, palpitations-like heat sensation occur. Symptoms worsen on Wu-Ji days, resolve with profuse sweat on Ren-Gui days, and are fatal with Qi reversal on Wu-Ji days. Needle Foot Shaoyin and Foot Taiyang.
Yi's commentary: Waist is the house of Kidney; Kidney vessels pass through spine, meeting Du Mai at Changqiang. Kidney vessels enter heel and ascend medial malleolus; Taiyang vessels also descend medial malleolus. Soreness indicates heat consuming fluids. Kidney governs five fluids and dislikes dryness; heat disease damages fluids causing dryness, hence bitter thirst and drinking to self-rescue. Taiyang vessels enter crown, link to brain, emerge to neck; severe disease transferring to Fu causes stiff neck pain. Aversion to cold indicates extreme heat mimicking cold. Kidney vessels slope to sole; severe disease causes hot soles. Reluctance to speak indicates inability to articulate clearly. Dizzy/palpitations describe loss of bodily control, indescribable state.
Furthermore: *Nei Jing* lists Five Zang Heat Diseases; only Liver and Kidney sections mention Qi reversal, others do not. This shows heat disease damaging Yin primarily affects Liver and Kidney.
Liver Heat Disease: Left cheek reddens first. Heart Heat Disease: Forehead reddens first. Spleen Heat Disease: Nose reddens first. Lung Heat Disease: Right cheek reddens first. Kidney Heat Disease: Chin reddens first. Even if disease hasn't erupted, redness indicates needling; this is called treating undiseased.
Zhang Xugu said: This details how undischarged Five Zang heat manifests visibly on facial colors. Left cheek, forehead, nose, right cheek, chin correspond to Liver, Heart, Spleen, Lung, Kidney Qi locations on face. Color appears before disease erupts, showing pathogens latent in Blood/Qi, moving invisibly with circulation. Skilled physicians observe activation points, needle immediately to drain, reducing pathogen strength and lightening disease. This matches *Nan Jing*: "Take points along the affected meridian," known as Superior Physician treating undiseased. Medicinal methods can be inferred similarly.
To treat all heat diseases, drink cold water, then needle; wear cold clothes, reside in cool places, stop when body cools.
Zhang Xugu said: Since latent pathogens generate heat from within, one must first drink cold water to purge heat from inside, then needle to vent from outside. Wear cold, dwell cool, stop only when body cools and heat removes.
Wang Mengyin said: Moderns neglect *Nei Jing*, treating warm, heat, summer heat, and epidemics identically to Shanghan, prohibiting cold drinks and thick clothing, causing many severe cases. However, cold drinking must be moderated; excess causes fluid retention, swelling, vomiting, and diarrhea. Post-recovery, water oozing from fingers/toes requires quick administration of Coix Seed (Yiyiren) 3 liang, Atractylodes (Baizhu) 1 liang, Plantago Seed (Cheqianzi)...