仲景作伤寒论，为万世汤液之祖，而其源实本于此篇。此篇本论伤寒，而以热论名篇者，寒言其因，热言
其成也。
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。（寒者，冬气也。冬时严寒，万类深藏，君子固密，不伤于寒，触冒之者，乃名伤寒。其
伤于四时之气，皆能为病，以伤寒为毒者最。乘杀厉之气，中而即病，名曰伤寒。不即病者，寒毒藏于肌肤，
至夏至前变为温病，夏至后变为热病。然其发起皆为伤寒致之，故曰热病者，皆伤寒之类也。）岐伯对曰∶巨
阳者，诸阳之属也。（巨，大也。太阳之气，经络血气，荣卫于身，故诸阳气皆所宗属。）其脉达于风府，（风
府，穴名，在项上入发际一寸，宛宛中是。）故为诸阳主气也。人之伤于寒也，则为病热，热虽甚，不死。（寒
毒薄于皮肤，阳气不得发散而内怫结，故伤寒者反为病热。）其两感于寒而病者，必不免于死。（脏腑相应而
俱受寒，谓之两感。按∶伤寒之为病也，感之平日，发于一时，传变不常，真假难辨，为诸病之最，为证治之
纲，医家所当精思而熟计者。以故轩岐特为之立论，仲景更为之阐扬。然其义旨精深，虽以王氏之解，颇称明
确，惜尚有未详尽处。兹特更采闵氏之意而分注之，庶几字句精核，条贯分明，今而后可以读热论，并可读伤
寒论矣。闵氏名芝庆，西吴人也，著作甚富，余恨不尽见，此特其一斑尔。闵氏曰∶“此承帝问而先举其大略以
对也。帝言病热由于伤寒，则凡热病者，皆伤寒
之类也。然其愈其死必有其期者何故？伯言足太阳经，称为巨阳，其脉自睛明而始，上连于督脉之风府穴，由
头项至背至足，凡一身手足阳经，皆属于此，故穴有一百二十六，真为诸阳主气也。人伤于寒，始自巨阳之气，
不得伸越于表，郁而成热，由此渐传入里，皆为热病。热虽甚不死，有大邪衰而自愈者，有可汗可泄者也。唯
两感于寒而一日二经病者，必死。”）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，故身热目疼而鼻干，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，故腹满而嗌干。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。（按∶此详论伤寒传经非两感者，其死其愈之故也。人之一身，三阳为表，三
阴为里。其巨阳为三阳，最在外；阳明为二阳，在太阳之内；少阳为一阳，在阳明之内，此三阳者为表也。其
太阴为三阴，在少阳之内；少阴为二阴，在太阴之内；厥阴为一阴，在少阴之内，此三阴者为里也。皆由内数
至外，故一二三纪其次第如此。伤寒自表入里，以六经言，则始太阳，终厥阴；以一身言，则先入皮肤，次入
肌肉，次入半表半里，次入脏腑，随经之传而日深者也。经之最在外者
先受病，故一日巨阳受之，即太阳膀胱经也。启玄曰∶“太阳脉浮。”伤寒论曰∶“尺寸俱浮者，太阳受病也，
当一二日发。”仲景意谓不可拘夫一日也，故其六经皆兼两日而言。太阳之脉，从巅下项，挟脊抵腰，经为
邪壅而不利，故痛且强也。表邪不解，日渐深入，故二日足阳明受之。三日足少阳受之，故曰主胆。自太阳以
至阳明、少阳，三阳经络皆受其病，而未入于脏腑者，可汗之而已。如可汗不汗，病不得已，及至四日，足太阴
脾经受之。又至五日，足少阴肾经受之。又至六日，足厥阴肝经受之。其病之所苦者，一如其脉络之所到。三
阴继三阳而受病，五脏六腑皆同三阴而受病。如可泄不泄，病亦不已，则终于营卫不行，脏腑不通死矣，所谓死
皆以六七日之间者如此。然日传一经之证，非若两感于寒，必不免于死也。其不两感于寒，亦有自愈焉者，一日
巨阳受之，若病不传别经，不加异气而变为他证，则自一日至七日，当自愈也。伤寒论曰∶“发于阳者七日愈，
以阳数七故也。又自二日至八日，亦是七日而当愈，余经皆以是数计之。如少阴病不传不变而至十一日衰，渴
止、舌干已而发为嚏。原病式曰∶心火邪热干于阳明，发于鼻而痒则嚏也。……伤寒衰而成嚏者，由火热已退，
虚热为痒，痒发则嚏也。”又曰∶“微热则痒。”由太阳以至厥阴，自一日以至十二日，不传变而病衰者，大邪
之气皆去，病日已矣。所谓愈皆在十日以上者如此，所谓热虽甚不死者如此。奈何后世有再传之说也。考之内经
本篇与仲景伤寒论并无此义，乃成氏注释之误耳。夫三阳为表，三阴为里，自太阳以至厥阴，犹人入户升堂以
入于室耳。既至厥阴，乃复出而传之太阳，奈有二阴、三阴、一阳、二阳以隔之，岂有遽出而传之太阳之理。）
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。（按∶此因上文有死于失治者，而言治之大体也。未满三日之前，见三阳病形，如头痛、身热、耳聋之类，
可汗而已其表病。已满三日之后，见三阴病形，如腹满、燥渴、囊缩之类，可泄而已其里病。各能通其脏腑之脉，
病日衰矣。所谓热虽甚不死者又如此。按正理伤寒论曰∶脉大浮数，病为在表，可发其汗。脉细沉数，病为在
里，可下之。）
如或日数过多，尚有表证而脉大浮数，犹宜发汗。日数虽少，已见里证而脉沉细数者，便可下之。汗下之法，
须审脉辨证，不可拘夫日数也。
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。（按∶此言病遗治法，
而禁强食也。热甚之后而强食之，则余邪与谷气相蒸，两热相合，故病有所遗也。视其虚实而补泻之法合其宜，
调其逆从而反正之治得其道，病必已矣。然与其既遗而治之，孰若思患而禁之。病热少愈，胃气尚虚，食肉难化，
郁而助热，热病当复发如故矣。肉固不可多食，凡不可多食者而多食之，则病热有所遗焉，当禁者也。）
帝曰∶其病两感于寒者，其脉应与病形何如？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，谵语。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。（按∶此言两感于寒者，必
不免于六日死也。以经脉之应与病形言之，日传两经，表里之证并见，至三日则六经传尽，水浆不入口，不知人，
延至六日必死矣。当不知人之时，五脏六腑已伤而不通，营卫已不行，宜即死矣，必又三日乃死何也？盖阳明
为十二经脉之长，其气血俱盛，诸经受气于阳明，其气散入
诸经，各随其经而尽，故死必于六日。当三日之时，虽剧不死者，正以气血未尽故也，所谓两感于寒，必不免
于死者如此。）
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。（按∶此结伤寒有
不即病，而过时成温暑者也。中而即病者名曰伤寒。不即病者，寒毒藏于肌肤，先夏至发者为病温，后夏至发者
为病暑，病则热极重于温耳，此以天时病形而为名者也。暑病热邪，自内达表，亦有表证须解，当令其邪与
汗皆出，勿反止之。温病当汗，在不言中矣。）
张仲景撰写《伤寒论》，将其作为后世汤药方剂的始祖，而其源头实际上本于《素问·热论》这一篇。此篇原本论述伤寒，却以“热论”命名，是因为“寒”指致病的原因，“热”指疾病的演变结果。
黄帝问道：如今的热病，都属于伤寒的范畴。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，这是为什么呢？我不明白其中的道理，希望听听其中的原因。（寒，是冬季的气候。冬季时严寒，万物深藏，君子固护严密，不伤于寒，触犯冒犯它的，才叫作伤寒。人体受四时之气侵害，都能导致疾病，其中以伤寒最为毒烈。它乘着肃杀厉烈的邪气，侵入人体随即发病，名叫伤寒。如果不随即发病，寒毒潜伏在肌肤之中，到了夏至前就变为温病，夏至后变为热病。然而它们的发起都是由伤寒引起的，所以说热病，都是伤寒的同类。）岐伯回答说：巨阳（即太阳经），是诸阳经的统领。（巨，就是大的意思。太阳经的气血经络，荣养护卫全身，所以所有的阳气都归它统属。）它的经脉通达风府穴，（风府，穴位名，在项部入发际一寸，凹陷处即是。）所以它是诸阳经的主气所在。人受了寒邪侵袭，就会发生热病，即使热势很盛，也不会死亡。（寒邪侵薄皮肤，阳气不能发散而郁结在内，所以患伤寒反而表现为热病。）如果是两感于寒而发病的，就一定难免于死亡。（脏腑表里相应同时受寒，叫做两感。按语：伤寒这种病，平时感受邪气，一时发作，传变无常，真假难辨，是所有疾病中最严重的，也是证候治疗的纲领，医生应当精心思考并仔细筹划的。因此轩辕和岐伯特意为此立论，张仲景又进一步阐扬发扬。然而其义理精深，虽然王冰的注解颇为明确，可惜还有不够详尽的地方。这里特别采纳闵氏的意见进行分注，希望字句精确，条理分明，这样以后就可以读懂《热论》，也可以读懂《伤寒论》了。闵氏名芝庆，是西吴人，著作很多，我遗憾没能全部见到，这只是他的一斑而已。闵氏说：“这是承接黄帝的问题先举出大概来回答。皇帝说病热由于伤寒，那么凡是热病，都是伤寒的同类。然而它们痊愈或死亡必有固定的期限，这是什么缘故？伯高说足太阳经，称为巨阳，它的经脉从睛明穴开始，向上连于督脉的风府穴，从头项到背到足，凡是一身手足的阳经，都属于这条经，所以穴位有一百二十六个，真正是诸阳经的主气。人受寒邪侵袭，始于巨阳之气，不能伸展越出于体表，郁结而成热，由此逐渐传入体内，都成为热病。热势虽盛不会死亡，有大邪衰退而自愈的，有可以通过发汗、泄下治疗的。只有两感于寒且一天内两条经同时发病的，必然死亡。”）黄帝说：希望听听它的症状表现。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，所以身体发热、眼睛疼痛、鼻子干燥，无法安卧。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，所以胸胁疼痛、耳聋。三阳经的经络都受到病邪侵袭，但尚未传入内脏，所以可以通过发汗治愈。第四天，太阴经受邪。太阴经的经脉散布在胃中，络于咽喉，所以腹部胀满、咽喉干燥。第五天，少阴经受邪。少阴经的经脉贯穿肾脏络于肺，联系舌根，所以口燥、舌干、口渴。第六天，厥阴经受邪。厥阴经的经脉循行生殖器络于肝，所以心烦腹满、睾丸收缩。如果三阴三阳五脏六腑都受到病邪侵袭，营卫运行停滞，五脏气机不通，就会死亡。那些没有两感于寒的患者，第七天，巨阳经的病势衰退，头痛稍微减轻；第八天，阳明经的病势衰退，身体发热稍微减轻；第九天，少阳经的病势衰退，耳聋能微微听到声音；第十天，太阴经的病势衰退，腹部胀满消退恢复如常，开始想吃东西；第十一天，少阴经的病势衰退，口渴停止，腹胀消除，舌干好转并打喷嚏；第十二天，厥阴经的病势衰退，睾丸松弛，小腹轻微舒缓，大邪之气都已去除，病一天天好了。（按语：这里详细论述了伤寒传经而非两感的患者，其死亡或痊愈的原因。人的身体，三阳为表，三阴为里。其中巨阳是三阳，位置最在外；阳明是二阳，在太阳经之内；少阳是一阳，在阳明经之内，这三阳经属于表。其中太阴是三阴，在少阳经之内；少阴是二阴，在太阴经之内；厥阴是一阴，在少阴经之内，这三阴经属于里。都是从内向外数，所以用一二三记录它们的次第如此。伤寒由表入里，从六经来说，始于太阳，终于厥阴；从全身来说，先入皮肤，次入肌肉，次入半表半里，次入脏腑，随着经络的传变而日益深入。经络中最在外的先受病，所以第一天巨阳经受邪，也就是太阳膀胱经。启玄子说：“太阳脉浮。”《伤寒论》说：“尺寸脉俱浮的，是太阳经受病，应当在第一二天发作。”张仲景的意思是不必拘泥于第一天，所以他论述六经都兼论两天而言。太阳经的脉，从头顶下行至项，夹脊抵腰，经脉被邪气壅滞而不通畅，所以疼痛且僵硬。表邪不解，日渐深入，所以第二天足阳明经受邪。第三天足少阳经受邪，所以说主胆。自太阳至阳明、少阳，三阳经络都受病，但未入脏腑的，可以通过发汗治愈。如果该发汗而不发汗，病情不得已，到了第四天，足太阴脾经受邪。又至第五天，足少阴肾经受邪。又至第六天，足厥阴肝经受邪。其所痛苦的症状，完全如同其脉络所到达的部位。三阴继三阳之后受病，五脏六腑都同三阴一起受病。如果该泄下而不泄下，病情也不愈，最终导致营卫不行，脏腑不通而死，所谓死亡都在六七天之间就是这样。然而日传一经的证候，不像两感于寒那样必然死亡。那些没有两感于寒的，也有自愈的情况，第一天巨阳经受邪，如果病不传变到其他经，不加杂其他邪气而变为他证，那么从第一天到第七天，应当自愈。《伤寒论》说：“发于阳的七日愈，因为阳数是七的缘故。又从第二日到第八日，也是七日而当愈，其余各经都以此数计算。如少阴病不传不变而至第十一日衰退，口渴停止、舌干好转并发嚏。《原病式》说：心火邪热干扰阳明，发于鼻而痒则嚏……伤寒衰退而成嚏，是由火热已退，虚热致痒，痒发则嚏也。”又说：“微热则痒。”从太阳至厥阴，自一日至十二日，不传变而病势衰退的，大邪之气都去除了，病一天天好了。所谓痊愈都在十天以上就是这样，所谓热势虽盛不死的也是这样。为什么后世有再传的说法呢？考证《内经》本篇与张仲景《伤寒论》都没有这个意义，乃是成无己注释的错误罢了。夫三阳为表，三阴为里，自太阳至厥阴，就像人入户升堂进入室内一样。既然到了厥阴，又复出传回太阳，奈何有二阴、三阴、一阳、二阳隔着，哪有突然传出而传回太阳的道理。）
黄帝说：如何治疗？岐伯说：治疗要分别疏通各脏的经脉，病势就会一天天衰退痊愈。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。（按语：这是因为上文提到因失治而死的，所以说明治疗的大体原则。未满三天之前，出现三阳病的形症，如头痛、身热、耳聋之类，可以通过发汗解除表病。已满三天之后，出现三阴病的形症，如腹满、燥渴、囊缩之类，可以通过泄下解除里病。各自能通调脏腑之脉，病势就会一天天衰退。所谓热势虽盛不死的又是这样。按正理论《伤寒论》说：脉象大浮数，病在表，可以发汗。脉象细沉数，病在里，可以攻下。）
如果天数过多，仍有表证而脉象大浮数，仍然适宜发汗。天数虽然少，已经见里证而脉象沉细数的，就可以攻下。汗法和下法，必须审察脉象辨证候，不可拘泥于天数。
黄帝说：热病已经痊愈，时常有余邪遗留，是什么原因？岐伯说：所有余邪遗留，是因为热势很盛时勉强进食，所以有余邪遗留。像这种情况，都是病势已衰而热邪有所潜藏，因为食物谷气与余热相搏结，两热相合，所以有余邪遗留。黄帝说：好！如何治疗余邪遗留？岐伯说：观察虚实，调理逆从，可以使病一定痊愈。黄帝说：患热病应当禁忌什么？岐伯说：热病稍有好转，吃肉就会复发，多吃就会遗留余邪，这就是禁忌。（按语：这里讲病遗的治疗方法，以及禁止强行进食。热势很盛之后强行进食，则余邪与谷气相互蒸腾，两热相合，所以病有余邪遗留。观察虚实而补泻之法合乎适宜，调理逆从而反治之道得到要领，病必定痊愈。然而与其既然后遗留再治疗，不如事先考虑祸患加以禁止。热病稍有好转，胃气尚虚弱，肉食难以消化，郁结而助长热邪，热病应当再次发作如故。肉固然不可多吃，凡是不可多吃的而多吃，病热就会有遗留，应当禁止。）
黄帝说：患两感于寒的病，其脉象应与病症表现如何？岐伯说：两感于寒的病，第一天，巨阳与少阴同时发病，则头痛、口干、心烦腹满。第二天，阳明与太阴同时发病，则腹部胀满、身体发热、不想吃东西、胡言乱语。第三天，少阳与厥阴同时发病，则耳聋、睾丸收缩、四肢厥冷。水浆喝不进，神志昏迷不知人，第六天死亡。黄帝说：五脏已伤，六腑不通，营卫不行，在此之后，还要过三天才死，为什么呢？岐伯说：阳明经，是十二经脉之长，它的气血旺盛，所以神志昏迷不知人，经过三天它的正气才耗尽，所以死亡。（按语：这里讲两感于寒的病，必然不免于第六天死亡。从经脉应合病症表现来说，每天传变两条经，表里证候并见，到第三天六经传遍，水浆不入口，不知人，拖延到第六天必然死亡。当不知人的时候，五脏六腑已伤而不通，营卫已不行，理应立即死亡，为何还要过三天才死呢？盖因阳明为十二经脉之长，气血俱盛，各经受气于阳明，其气散入各经，各自随经气耗尽而死，所以死在第六天。当第三天的时候，虽然病情严重但不死，正是因为气血未尽的缘故，所谓两感于寒，必然不免于死亡就是这样。）
凡是患伤寒而变成温病的，先在夏至日前发病的叫温病，后在夏至日后发病的叫暑病，暑病应当让汗液随邪气一同排出，不要止住。（按语：这里总结伤寒有不随即发病，而过时形成温暑病的。侵入随即发病的叫伤寒。不随即发病的，寒毒潜伏在肌肤，先在夏至日发的叫温病，后在夏至日发的叫暑病，发病则热极重于温病，这是以天时病形来命名的。暑病热邪，由内达表，也有表证需要解表，应当令邪气随汗而出，不要反过来止汗。温病应当发汗，是不言而喻的了。）
Zhang Zhongjing authored the *Treatise on Cold Damage* (Shanghan Lun), establishing it as the ancestor of decoctions for all generations, and its source actually originates from this chapter of the *Suwen*. This chapter originally discusses cold damage but is named "Discussion on Heat" because "cold" refers to the etiology, while "heat" refers to the pathogenesis.
The Yellow Emperor asked: "Currently, heat diseases are all of the category of cold damage. Some recover, some die; those who die do so within six or seven days, and those who recover do so after ten days or more. Why is this? I do not understand the explanation and wish to hear the reason." (Cold refers to the Qi of winter. During winter, the cold is severe, and all things hide deeply. The superior person maintains solidity and secrecy, avoiding injury by cold; those who touch or offend it are named as having cold damage. Injury by the Qi of the four seasons can all cause disease, but cold damage is the most toxic. It takes advantage of the killing and fierce Qi, entering and causing immediate illness, named cold damage. If it does not cause immediate illness, the cold toxin hides in the skin and muscles. Before the Summer Solstice, it transforms into warm disease; after the Summer Solstice, it transforms into heat disease. However, their onset is caused by cold damage, hence it is said that heat diseases are all of the category of cold damage.)
Qibo replied: "Giant Yang (Taiyang) belongs to all Yang meridians. (Giant means large. The Qi of the Taiyang meridian, through its channels and blood-Qi, nourishes and guards the body, so all Yang Qi belongs to it.) Its pulse reaches the Fengfu acupoint. (Fengfu is an acupoint name, located one cun above the hairline at the nape, in the depression.) Thus, it is the master Qi of all Yang meridians. When humans are injured by cold, they develop heat disease. Even if the heat is severe, it will not be fatal. (Cold toxin attacks the skin, preventing Yang Qi from dispersing outward, leading to internal stagnation and knotting; thus, cold damage manifests as heat disease.) However, those who suffer from 'two-gan' (simultaneous invasion of exterior and interior) due to cold will inevitably die. (When corresponding Zang and Fu organs are simultaneously invaded by cold, it is called two-gan. Note: Cold damage is a disease where the pathogen is acquired over time but manifests suddenly, with unpredictable transmission, difficult differentiation of true and false symptoms, making it the most severe among diseases and the outline for syndrome treatment. Physicians must ponder carefully. Therefore, Xuanyuan and Qibo specifically established theories on it, and Zhang Zhongjing further elaborated. Although Wang Bing's annotations are quite clear, they are not exhaustive. Here, I adopt Min's views for detailed notes, hoping for precise wording and clear logic, so that one may read the 'Heat Discussion' and also the 'Treatise on Cold Damage'. Min, named Zhiqing, was from Xiwu, and produced many works. I regret not seeing them all; this is just a glimpse. Min said: 'This responds to the Emperor's question by first giving a general overview. The Emperor states that heat disease arises from cold damage, so all heat diseases are of the cold damage category. Yet, recovery or death has a specific timeframe. Why? Bo Gao says the Foot-Taiyang meridian is called Giant Yang. Its channel starts at Jingming, connects upward to the Fengfu acupoint of the Du vessel, running from head and neck to back to foot. All Yang meridians of the body and limbs belong to this, accounting for 126 acupoints, truly the master Qi of all Yang. Human injury by cold begins with the Qi of Giant Yang failing to extend outward, stagnating into heat, gradually transmitting inward, becoming heat disease. Severe heat does not kill; some recover as evil Qi declines, others can be treated with sweating or purging. Only when two-gan occurs, affecting two meridians on the first day, is death inevitable.')
The Yellow Emperor said: "I wish to hear the manifestations." Qibo said: "On the first day of cold damage, Giant Yang receives it. Thus, there is headache, stiff neck, and stiffness in the lower back and spine. On the second day, Yangming receives it. Yangming governs flesh; its vessels run along the nose and connect to the eyes. Thus, there is fever, eye pain, dry nose, and inability to sleep. On the third day, Shaoyang receives it. Shaoyang governs the Gallbladder; its vessels follow the flanks and connect to the ears. Thus, there is hypochondriac pain and deafness. When the meridians of the three Yang are diseased but have not entered the Zang organs, it can be cured by sweating. On the fourth day, Taiyin receives it. Taiyin vessels spread in the stomach and connect to the throat. Thus, there is abdominal fullness and dry throat. On the fifth day, Shaoyin receives it. Shaoyin vessels pass through the Kidney, connect to the Lung, and tie to the root of the tongue. Thus, there is dry mouth, dry tongue, and thirst. On the sixth day, Jueyin receives it. Jueyin vessels follow the genitalia and connect to the Liver. Thus, there is vexation, fullness, and retraction of the scrotum. When the three Yin and three Yang, five Zang and six Fu organs are all diseased, Ying and Wei circulation stops, and the five Zang mechanisms are blocked, death ensues. For those not suffering from two-gan, on the seventh day, the disease in Giant Yang declines, and headache slightly improves; on the eighth day, the disease in Yangming declines, and fever slightly improves; on the ninth day, the disease in Shaoyang declines, and hearing slightly returns; on the tenth day, the disease in Taiyin declines, abdominal fullness subsides returning to normal, and appetite returns; on the eleventh day, the disease in Shaoyin declines, thirst stops, bloating ceases, tongue dryness resolves, and sneezing occurs; on the twelfth day, the disease in Jueyin declines, the scrotum relaxes, the lower abdomen slightly softens, the great evil Qi departs, and the disease heals day by day. (Note: This details the reasons for death or recovery in cold damage transmission without two-gan. In the human body, the three Yang are exterior, and the three Yin are interior. Among them, Giant Yang is the outermost of the three Yang; Yangming is the middle, inside Taiyang; Shaoyang is the innermost of the three Yang, inside Yangming. These three Yang constitute the exterior. Among the three Yin, Taiyin is the outermost, inside Shaoyang; Shaoyin is the middle, inside Taiyin; Jueyin is the innermost, inside Shaoyin. These three Yin constitute the interior. Counting from inside out, the sequence is marked as one, two, three. Cold damage moves from exterior to interior. From the perspective of the Six Meridians, it starts with Taiyang and ends with Jueyin; from the perspective of the body, it enters the skin first, then muscle, then half-exterior half-interior, then Zang-Fu organs, deepening daily with meridian transmission. The most exterior meridians are affected first, hence Giant Yang is affected on the first day, which is the Foot-Taiyang Bladder Meridian. Qixuanzi said: 'Taiyang pulse floats.' The *Treatise on Cold Damage* says: 'If the Cun and Chi pulses are both floating, Taiyang is diseased, manifesting on the first or second day.' Zhang Zhongjing meant not to rigidly adhere to the first day, so he discussed each of the six meridians spanning two days. The Taiyang vessel descends from the vertex to the nape, runs along the spine to the waist. Obstruction by evil Qi causes pain and stiffness. If exterior evil does not resolve, it penetrates deeper daily. Hence, on the second day, the Foot-Yangming is affected. On the third day, the Foot-Shaoyang is affected, hence governing the Gallbladder. From Taiyang to Yangming and Shaoyang, if the three Yang meridians are diseased but not yet in the Zang-Fu, it can be cured by sweating. If sweating is indicated but not performed, and the condition persists, by the fourth day, the Foot-Taiyin Spleen Meridian is affected. By the fifth day, the Foot-Shaoyin Kidney Meridian is affected. By the sixth day, the Foot-Jueyin Liver Meridian is affected. The suffering corresponds exactly to the pathway of the vessels. After the three Yang, the three Yin are affected, and the five Zang and six Fu are affected together with the three Yin. If purging is indicated but not performed, and the condition persists, it ultimately leads to cessation of Ying-Wei circulation and blockage of Zang-Fu, resulting in death. This explains why death occurs within six or seven days. However, the pattern of daily transmission of one meridian is not like two-gan, which inevitably leads to death. Those without two-gan may also heal spontaneously. If on the first day Giant Yang is affected, and the disease does not transmit to other meridians nor transform due to mixed pathogens, it should heal spontaneously from the first to the seventh day. The *Treatise on Cold Damage* says: 'Diseases originating in Yang heal in seven days, because seven is the number of Yang. From the second to the eighth day is also seven days and should heal; other meridians follow this calculation. For example, if Shaoyin disease does not transmit or change and declines by the eleventh day, thirst stops, tongue dryness resolves, and sneezing occurs. The *Yuanbing Shi* says: 'Heart fire and evil heat interfere with Yangming, causing nasal itching and sneezing... Sneezing during cold damage decline occurs because the fire-heat has retreated, leaving deficient heat that causes itching, triggering sneezing.' It also says: 'Slight heat causes itching.' From Taiyang to Jueyin, from day one to twelve, if the disease declines without transmission, the great evil Qi departs, and the disease heals daily. This explains why recovery occurs after ten days or more, and why severe heat does not kill. Why, then, does later medicine speak of 're-transmission'? Examining this chapter of the *Neijing* and Zhang Zhongjing's *Treatise on Cold Damage*, this concept is absent; it is an error in Cheng Wuji's commentary. The three Yang are exterior, the three Yin are interior. Moving from Taiyang to Jueyin is like entering a house, ascending to the hall, and entering the room. Having reached Jueyin, how could it exit and transmit back to Taiyang, given that Er Yin, San Yin, Yi Yang, and Er Yang stand in between? There is no logic for sudden transmission back to Taiyang.')
The Yellow Emperor asked: "How should it be treated?" Qibo said: "Treatment requires unblocking the pulse of each respective organ, and the disease will decline daily. If less than three days have passed, it can be cured by sweating; if three days or more have passed, it can be cured by purging. (Note: This addresses the general principle of treatment following the mention of death due to mismanagement. Before three days, when Yang meridian symptoms appear, such as headache, fever, and deafness, sweating can resolve the exterior disease. After three days, when Yin meridian symptoms appear, such as abdominal fullness, dry thirst, and scrotal retraction, purging can resolve the interior disease. By unblocking the pulses of the Zang-Fu organs, the disease declines daily. This again illustrates why severe heat does not kill. According to Zhengli's *Treatise on Cold Damage*: 'A large, floating, rapid pulse indicates exterior disease, treatable by inducing sweat. A fine, sunken, rapid pulse indicates interior disease, treatable by purging.')
If many days have passed but exterior symptoms persist with a large, floating, rapid pulse, sweating is still appropriate. If few days have passed but interior symptoms appear with a fine, sunken, rapid pulse, purging is indicated. The methods of sweating and purging require careful examination of the pulse and differentiation of syndromes; one must not rigidly adhere to the number of days.
The Yellow Emperor asked: "After heat disease has healed, sometimes residual symptoms remain. Why is this?" Qibo said: "All residual symptoms occur because food is forced upon the patient while the heat is still intense. In such cases, the disease has declined, but heat remains hidden. The Qi of the grain clashes with the residual heat, and the two heats combine, causing residuals. The Yellow Emperor said: 'Excellent! How should residuals be treated?' Qibo said: 'Observe deficiency and excess, regulate reversal and顺 (compliance), and the disease will certainly heal.' The Yellow Emperor asked: "What should be prohibited during heat disease?" Qibo said: "When heat disease slightly improves, eating meat causes recurrence, and overeating causes residuals. These are the prohibitions. (Note: This discusses the treatment of residuals and prohibits forced feeding. After intense heat, forcing food causes residual evil to steam with grain Qi, combining two heats, leading to residuals. Observing deficiency and excess to apply tonification or draining appropriately, and regulating reversal and compliance to restore balance, ensures healing. However, it is better to prevent residuals than to treat them afterward. When heat disease slightly improves, Stomach Qi is still weak; meat is hard to digest, stagnates, and aids heat, causing the heat disease to recur. Meat should not be eaten in excess; any food eaten in excess when prohibited will cause heat residuals and must be forbidden.)
The Yellow Emperor asked: "For those suffering from two-gan due to cold, what should the pulse and symptoms be?" Qibo said: "In two-gan due to cold, on the first day, Giant Yang and Shaoyin are both diseased, causing headache, dry mouth, and vexation/fullness. On the second day, Yangming and Taiyin are both diseased, causing abdominal fullness, fever, aversion to food, and delirious speech. On the third day, Shaoyang and Jueyin are both diseased, causing deafness, scrotal retraction, and cold limbs. Inability to take water or gruel, loss of consciousness, leads to death on the sixth day. The Yellow Emperor asked: "The five Zang are damaged, the six Fu are blocked, Ying and Wei do not circulate. After this, why does death occur three days later?" Qibo said: "Yangming is the leader of the twelve meridians, possessing abundant blood and Qi. Thus, loss of consciousness occurs. Three days later, its Qi is exhausted, leading to death. (Note: This explains why two-gan inevitably leads to death on the sixth day. Regarding meridian correspondence and symptoms, two meridians transmit daily, presenting exterior and interior syndromes simultaneously. By the third day, all six meridians are transmitted. Inability to take fluids and loss of consciousness lead to death by the sixth day. At the point of unconsciousness, the five Zang and six Fu are damaged and blocked, and Ying-Wei has ceased; death should logically occur immediately. Why wait three days? Because Yangming is the leader of the twelve meridians, with abundant Qi and Blood. Other meridians receive Qi from Yangming, which disperses into them. Death occurs as Qi exhausts in each meridian, hence on the sixth day. At the third day, although severe, death does not occur immediately because Qi and Blood are not yet fully exhausted. This explains why two-gan inevitably leads to death.)
Any disease transforming from cold damage into warm disease manifests as warm disease if it occurs before the Summer Solstice, and as summerheat disease if it occurs after the Summer Solstice. Summerheat disease should allow sweat to carry the pathogen out; do not stop it. (Note: This concludes that cold damage may not manifest immediately but becomes warm or summerheat disease over time. Immediate manifestation is cold damage. Non-immediate manifestation involves cold toxin hiding in skin and muscles. Manifesting before the Summer Solstice is warm disease; after is summerheat disease. Summerheat involves extreme heat compared to warm disease, named by seasonal timing and symptomatology. Summerheat evil heat moves from interior to exterior, often presenting exterior signs requiring release. The pathogen should exit with sweat; do not obstruct it. The indication for sweating in warm disease is implicit here.)