汗出，乃邪气入腑，不得出入，一时卒倒，非脏绝之比，顷时阳机外达，邪气随之外泄，故
知入腑即愈。
问曰∶脉脱入脏即死，入腑即愈，何谓也？师曰∶非为一病，百病皆然。譬如浸淫
疮，从口起流向四肢者，可治；从四肢流来入口者，不可治。病在外者，可治；入里者，
即死。
【注】此详申入脏即死、入腑即愈之义也。
卒厥之病，多脉脱而不见，脉脱不见而死者，是正气不反也；脉脱不见而生者，是邪气闭
而复通也。非为厥气一病，百病入脏入腑皆然也。譬如浸淫、疠风等疮，从口起流向四
肢，可治；从四肢流来入口者，不可治也。盖以病向外者，可治；病入里者，难医，亦此
义也。
【集注】赵良曰∶脱者去也，经脉乃脏腑之隧道。为邪气所逼，故绝气脱去其脉而入
于内。五脏阴也，六腑阳也，阴主死而阳主生，所以入脏即死，入腑即愈，而可治。非
惟脏腑之阴阳然也，凡内外阴阳之邪毒出入表里者，皆然也。
徐彬曰∶凡病邪能出阳为浅，故生；闭阴不出为深，故死。非止一病，百病皆然。复
以浸淫疮喻之∶若从口起而流向四肢者，是邪从内发于外，泄而不进，故可治；若从四
肢起，流入口者，是邪由外入于内，进而不泄，此脏气伤败，故不可治。
问曰∶阳病十八，何谓也？师曰∶头痛，项，腰、脊、臂、脚掣痛。阴病十八，何谓
也？师曰∶咳、上气、喘、哕、咽、肠鸣、胀满、心痛、拘急。五脏病各有十八，合为九
十病；人又有六微，微有十八病，合为一百八病。五劳、七伤、六极、妇人三十六病，不
在其中。清邪居上，浊邪居下。大邪中表，小邪中里。 之邪，从口入者，宿食也。五
邪中人，各有法度∶风中于前，寒中于暮，湿伤于下，雾伤于上；风令脉浮，寒令脉急，雾
伤皮腠，湿流关节，食伤脾胃。极寒伤经，极热伤络。
【按】字典无“ ”字，当是“ ”字。 音倾，侧水也。后之积聚门， 气之“ ”字亦误。
【注】此章曰十八、曰九十等文，乃古医书之文，今不可考，难以强释。五劳七伤等
说，亦详在《千金》，故不复注也。头痛，项、腰、脊、臂、脚掣痛，病皆在外，故为阳病
也；咳、上气、喘、哕、咽、肠鸣、胀满、心痛、拘急，病皆在内，故为阴病也。清邪居
上，谓雾邪本乎天也；浊邪居下，谓湿邪本乎地也。六淫天邪，故名大邪，六淫伤外，故
曰中表也；七情人邪，故名小邪，七情伤内，故曰中里也。 者，饮食也。饮食之邪，从
口而入，食伤隔夜不化，故名曰宿食也。五邪，谓风、寒、湿、雾、饮食也。夫五邪之
中人，莫不各以类而相从。前者早也，风中于早，从阳类也。寒中于暮，从阴类也。雾
邪清轻，故伤皮肤。湿邪浊重，故流关节。饮食失节，故伤脾胃。极寒之食伤经，以经属
阴也；极热之食伤络，以络属阳也。
问曰∶病有急当救里救表者，何谓也？师曰∶病，医下之，续得下利清谷不止，身体
疼痛者，急当救里；后身体疼痛，清便自调者，急当救表也。
【注】详见《伤寒论·太阴篇》内，不复释。
夫病痼疾，加以卒病，当先治其卒病，后乃治其痼疾也。
【注】痼疾，旧病也。卒病，新疾也。当以旧病为本、为缓，新疾为标、为急，急则
治标，缓则治本，故先治卒病，后治痼疾也。
【集注】赵良曰∶痼疾病已沉痼，非旦夕可取效者；卒病谓卒然而来，新感之病，可
取效于旦夕者，乘其所入未深，急去其邪，不使稽留而为患也。且痼疾之人，正气素虚，邪
尤易传，设多瞻顾，致令两邪相合，为患不浅，故仲景立言于此，使后学人知所先后也。
沈明宗曰∶此有旧疾，复感新邪，当分先后治也。痼者，邪气坚固难拔；卒者，邪
气骤来而易去也。若病者素有痼疾，而忽加卒病，务当先治卒病，不使邪气相并，转增
旧疾。但久病乃非朝夕可除，须当缓图，所以后乃治其痼疾也。
师曰∶五脏病各有得者愈；五脏病各有所恶，各随其所不喜者为病。病者素不应食，
而反暴思之，必发热也。
【注】此明五脏各有所得而愈，言以情志相胜也，即如怒伤肝，得悲而愈，此悲胜怒
也。亦有得之时日而愈者，经曰∶病在肝，愈于夏，是喜得子气，制其胜我者也；夏不愈，
胜于秋，是恶其胜我者，得旺气也；秋不死，持于冬，是我喜得母气以生我也；起于春，是
喜自得其位而气旺也，余脏仿此。病者云云，谓平素不爱食之物，及当病之时，而反暴思
食，是病邪脏气之变，故虽思食，而食之必发热也。
【集注】程林曰∶《内经》云∶肝色青，宜食甘；心色赤，宜食酸；肺色白，宜食苦；脾
色黄，宜食酸；肾色黑，宜食辛。此五脏得饮食而愈者。肝病愈于丙丁，起于甲乙；心
病愈于戊己，起于丙丁；脾病愈于庚辛，起于戊己；肺病愈于壬癸，起于庚辛；肾病愈
于甲乙，起于壬癸。此五脏自得其位而愈者。五脏所恶，心恶热，肺恶寒，肝恶风，脾恶
湿，肾恶燥，各随其所恶而不喜者为病也。若病患素不食而暴食之，则入于阴，长气于阳，
必发热也。
夫诸病在脏，欲攻之，当随其所得而攻之，如渴者，与猪苓汤。余皆仿此。
【按】如渴者之下，当有“小便不利”四字，必传写之遗也。
【注】脏者里也。凡诸病在里有可攻之证，虽欲攻之，当随其所得之轻重而攻之，不可
卒意而攻之也。如渴者、小便不利，先与猪苓汤利其小便，俟小便利乃可攻也。余皆仿
此，谓他证或有未可遽攻者，皆仿此也。
汗出，是邪气侵入腑，导致气机出入受阻，突然昏倒，这并非脏气衰竭的情况。片刻之后，阳气机能向外通达，邪气随之从体表泄出，因此知道邪气入腑即可痊愈。
问：脉象脱失（指脉搏暂时摸不到），邪气入脏就会死亡，入腑就会痊愈，这是什么意思？老师说：这不单是一种病的情况，各种疾病都是这样。比如浸淫疮（一种流脓流水的皮肤病），从口部开始流向四肢的，可以治愈；从四肢流回口部的，无法治愈。病在体表的，可治；病入体内的，就会死亡。
【注】这里详细阐述了“入脏即死、入腑即愈”的道理。卒厥（突然昏倒）这种病，多表现为脉象脱失而看不见。脉象脱失而看不见的如果死亡，是因为正气不能回复；脉象脱失而看不见的如果存活，是因为邪气闭塞后重新通畅。不仅仅是厥气这一种病，各种疾病邪气入脏或入腑都是这个道理。比如浸淫疮、疠风（麻风病）等疮疡，从口部开始流向四肢的，可治；从四肢流回口部的，不可治。这是因为病势向外的，可治；病势入里的，难医，也是这个道理。
【集注】赵良说：脱，就是离去的意思，经脉是脏腑之间的通道。因为被邪气逼迫，所以真气断绝，脉气脱离进入体内。五脏属阴，六腑属阳，阴主死而阳主生，所以邪气入脏就死，入腑就愈，是可以治疗的。不只是脏腑的阴阳如此，凡是内外阴阳邪毒出入表里的情况，都是这样。
徐彬说：凡是病邪能出于阳分，说明病位浅，所以生；闭阻于阴分不出，说明病位深，所以死。不只是一种病，各种病都是这样。再用浸淫疮来比喻：如果从口部开始流向四肢，这是邪气从内发于外，发泄而不深入，所以可治；如果从四肢开始，流入口部，这是邪气由外入于内，深入而不发泄，此时脏气受伤败坏，所以不可治。
问：阳病有十八种，是什么？老师说：头痛、项强、腰痛、脊痛、手臂牵掣痛、脚部牵掣痛。阴病有十八种，是什么？老师说：咳嗽、上气、气喘、呃逆、咽部不适、肠鸣、胀满、心痛、拘急。五脏的病各有十八种，合起来是九十种病；人又有六种微病，每种微病有十八种，合起来是一百零八种病。五劳、七伤、六极、妇人三十六病，不在这个数目之中。清邪居上位，浊邪居下位。大邪中伤体表，小邪中伤体内。饮食之邪，从口进入的，是宿食。五种邪气中人，各有规律：风邪早晨伤人，寒邪傍晚伤人，湿邪损伤下部，雾邪损伤上部；风邪使脉象浮，寒邪使脉象紧急，雾邪损伤皮肤腠理，湿邪流注关节，饮食损伤脾胃。极寒损伤经脉，极热损伤络脉。
【按】字典中没有“ ”字，应该是“ ”字。 音倾，指侧流的雨水。后来的积聚门中， 气的“ ”字也写错了。
【注】本章提到的十八、九十等文字，是古医书中的内容，现在已不可考证，难以强行解释。五劳七伤等说法，也在《千金方》中有详细说明，所以不再注释。头痛、项强、腰痛、脊痛、手臂牵掣痛、脚部牵掣痛，病都在体表，所以称为阳病；咳嗽、上气、气喘、呃逆、咽部不适、肠鸣、胀满、心痛、拘急，病都在体内，所以称为阴病。清邪居上，是指雾邪本乎天；浊邪居下，是指湿邪本乎地。六淫天邪，所以叫大邪，六淫伤外，所以叫中表；七情人邪，所以叫小邪，七情伤内，所以叫中里。 者，指饮食。饮食之邪，从口而入，食物隔夜不化，所以叫宿食。五邪，指风、寒、湿、雾、饮食。这五种邪气中人，没有不是各以同类相从的。前者指早晨，风邪在早晨伤人，属于阳类。寒邪在傍晚伤人，属于阴类。雾邪清轻，所以损伤皮肤。湿邪浊重，所以流注关节。饮食失节，所以损伤脾胃。极寒的食物损伤经脉，因为经脉属阴；极热的食物损伤络脉，因为络脉属阳。
问：有病应当先救里或先救表的，是什么意思？老师说：患病后，医生误用泻下法，接着出现下利清谷（拉出未消化的食物）不止，身体疼痛的，应当急当救里；后来身体疼痛，大小便正常的，应当急当救表。
【注】详见《伤寒论·太阴篇》，不再解释。
如果有久治不愈的痼疾，又加上突发的卒病，应当先治疗卒病，然后再治疗痼疾。
【注】痼疾，是旧病。卒病，是新病。应当以旧病为本、为缓，新病为标、为急，急则治标，缓则治本，所以先治卒病，后治痼疾。
【集注】赵良说：痼疾病程已深，不是早晚就能见效的；卒病是突然发生的，新感受的病，可以早晚见效。趁着邪气入侵未深，急忙去除邪气，不让它稽留成为祸患。而且患有痼疾的人，正气素来虚弱，邪气更容易传变，如果过多顾虑，致使新旧邪气结合，造成的祸患不浅，所以张仲景在这里立言，让后学者知道治疗的先后顺序。
沈明宗说：这里有旧疾，又感受新邪，应当分清先后治疗。痼疾，邪气坚固难拔除；卒病，邪气骤来而易去除。如果病人素有痼疾，忽然加上卒病，务必先治卒病，不让邪气相并，转而加重旧疾。但久病不是朝夕能除去的，必须慢慢图谋，所以后治痼疾。
老师说：五脏的病各有适宜的条件就能痊愈；五脏的病各有厌恶的因素，随着它们所不喜欢的事物就会生病。病人平时不应该吃的东西，却突然想吃，一定会发热。
【注】这里阐明五脏各有适宜的条件而痊愈，说的是以情志相胜的道理，就像怒伤肝，得到悲伤的情绪就能痊愈，这是悲胜怒。也有因时日适宜而痊愈的，经书说：肝病，在夏季痊愈，是因为喜欢得到子气（水生木），制约了克制我的因素；夏季不愈，在秋季受克，是因为厌恶克制我的因素，得到了旺气（金克木）；秋季不死，在冬季维持，是因为我喜欢得到母气（水生木）来生养我；在春季起病，是因为我喜欢自得其位而气旺，其他脏腑仿照此理。病人所说的，是指平素不爱吃的东西，以及在患病之时，却突然想吃，这是病邪和脏气变化的表现，所以虽然想吃，吃了之后必定发热。
【集注】程林说：《内经》说：肝色青，宜食甘味；心色赤，宜食酸味；肺色白，宜食苦味；脾色黄，宜食酸味；肾色黑，宜食辛味。这是五脏通过饮食而痊愈的情况。肝病在丙丁日痊愈，在甲乙日起病；心病在戊己日痊愈，在丙丁日起病；脾病在庚辛日痊愈，在戊己日起病；肺病在壬癸日痊愈，在庚辛日起病；肾病在甲乙日痊愈，在壬癸日起病。这是五脏自得其位而痊愈的情况。五脏所厌恶的，心恶热，肺恶寒，肝恶风，脾恶湿，肾恶燥，各自随着他们所厌恶且不喜欢的因素就会生病。如果病人平时不吃却暴食，那么邪气进入阴分，助长阳分之气，必定发热。
凡是诸病在脏，想要攻逐邪气，应当随着邪气所得到的条件而攻逐，比如口渴的，给予猪苓汤。其余都仿照这个例子。
【按】在“如渴者”之下，应该有“小便不利”四个字，一定是传抄遗漏了。
【注】脏就是里。凡是诸病在里有可攻逐的证候，虽然想要攻逐，应当根据邪气所得程度的轻重而攻逐，不可以鲁莽地攻逐。比如口渴、小便不利，先用猪苓汤通利小便，等到小便通利后才可以攻逐。其余都仿照这个例子，意思是其他证候或有不可立即攻逐的，都仿照这个原则。
Sweating indicates that pathogenic factors have entered the Fu organs (Yang organs), causing obstruction to the entrance and exit of Qi, resulting in sudden collapse. This is not comparable to the exhaustion of Zang organ (Yin organs) function. After a short while, Yang Qi mechanisms reach the exterior, and pathogenic factors are expelled along with it; therefore, we know that entry into the Fu organs leads to recovery.
Question: What is meant by "pulse disappearance indicating death if entering Zang organs, but recovery if entering Fu organs"? The Master said: This applies not to just one disease, but to all diseases. For example, in impetigo (a skin condition characterized by oozing sores), if it starts from the mouth and flows towards the limbs, it is treatable; if it flows from the limbs back to the mouth, it is untreatable. Diseases remaining on the exterior are treatable; those penetrating inward lead to death.
[Annotation] This section elaborates on the meaning of "death upon entering Zang organs, recovery upon entering Fu organs." In cases of sudden collapse (Cu Jue), the pulse often disappears. If death occurs with a disappeared pulse, it is because the healthy Qi cannot return; if survival occurs with a disappeared pulse, it is because the blocked pathogenic factors have reopened. This principle applies not only to collapse but to all diseases where pathogens enter Zang or Fu organs. Similarly, for conditions like impetigo or leprosy, lesions starting from the mouth and flowing to the limbs are treatable, whereas those flowing from limbs to the mouth are untreatable. This is because outward-moving diseases are treatable, while inward-penetrating diseases are difficult to cure.
[Collected Commentaries] Zhao Liang stated: "Tu" (disappearance/loss) means departure. Meridians are the tunnels connecting Zang and Fu organs. Forced by pathogenic factors, the vital energy breaks off, and the pulse vanishes as pathogens enter internally. Zang organs belong to Yin, and Fu organs to Yang; Yin governs death, and Yang governs life. Thus, entry into Zang organs leads to death, while entry into Fu organs leads to recovery and treatability. This logic extends beyond Zang and Fu organs; any situation involving the movement of internal/external or Yin/Yang pathogenic toxins between interior/exterior follows this pattern.
Xu Bin stated: Pathogens that can exit to the Yang aspect indicate a shallow location, leading to survival; those closed within the Yin aspect indicate a deep location, leading to death. This applies to all diseases, not just one. Using impetigo as an analogy: if it starts at the mouth and flows to the limbs, the pathogen emerges from the interior to the exterior, venting without advancing further, making it treatable. If it starts at the limbs and flows to the mouth, the pathogen enters from the exterior to the interior, advancing without venting, damaging the Zang Qi, making it untreatable.
Question: What are the eighteen Yang diseases? The Master said: Headache, stiff neck, low back pain, spinal pain, pulling pain in the arms, and pulling pain in the legs. What are the eighteen Yin diseases? The Master said: Cough, rebellious Qi, wheezing, hiccups, throat discomfort, borborygmus (intestinal rumbling), distension and fullness, heart pain, and spasm/tightness. Each of the five Zang organs has eighteen types of diseases, totaling ninety diseases. Humans also have six minor categories, each with eighteen diseases, totaling one hundred eight diseases. The five labors, seven injuries, six extremes, and thirty-six diseases of women are not included in these numbers. Clear pathogens reside in the upper part, turbid pathogens reside in the lower part. Major pathogens strike the exterior, minor pathogens strike the interior. Dietary pathogens entering through the mouth constitute retained food (Su Shi). The five types of pathogens affecting humans follow specific patterns: Wind strikes in the morning, Cold strikes in the evening, Dampness injures the lower body, Fog injures the upper body; Wind causes floating pulses, Cold causes tight pulses, Fog injures the skin and interstices, Dampness flows into the joints, Diet injures the Spleen and Stomach. Extreme Cold injures the meridians, Extreme Heat injures the collaterals.
[Note] The character " " is not found in dictionaries and should likely be " ". It sounds like "qing," referring to slanting rain. The character " " in the Accumulation and Mass chapter regarding "Qi" is also erroneously written.
[Annotation] The references to "eighteen," "ninety," etc., in this chapter are from ancient medical texts and are no longer verifiable, making forced interpretation difficult. The concepts of five labors and seven injuries are detailed in *Qian Jin Fang*, so they are not annotated here. Headache, stiff neck, low back pain, spinal pain, arm and leg pulling pains are diseases on the exterior, hence called Yang diseases. Cough, rebellious Qi, wheezing, hiccups, throat issues, borborygmus, distension, heart pain, and spasm are diseases within, hence called Yin diseases. "Clear pathogens reside above" refers to fog pathogens originating from Heaven; "turbid pathogens reside below" refers to damp pathogens originating from Earth. Six Evils (Liu Yin) are heavenly pathogens, hence called Major Pathogens striking the exterior; Seven Emotions are human pathogens, hence called Minor Pathogens striking the interior. " " refers to diet. Dietary pathogens enter via the mouth; food that remains undigested overnight is called retained food. The Five Pathogens refer to Wind, Cold, Dampness, Fog, and Diet. These five pathogens affect humans according to their nature. "Morning" refers to early day; Wind strikes in the morning, aligning with Yang. Cold strikes in the evening, aligning with Yin. Fog is clear and light, thus injuring the skin. Dampness is turbid and heavy, thus flowing into joints. Irregular diet injures the Spleen and Stomach. Extremely cold food injures the meridians (which belong to Yin); extremely hot food injures the collaterals (which belong to Yang).
Question: When should acute treatment focus on the Interior versus the Exterior? The Master said: If a patient undergoes inappropriate purgation and subsequently suffers from persistent diarrhea with undigested food, accompanied by body pain, urgent treatment must focus on the Interior. Later, if the body pain persists but bowel movements normalize, urgent treatment must focus on the Exterior.
[Annotation] See *Shang Han Lun · Tai Yin Chapter* for details; no further explanation provided.
When a chronic, entrenched disease (Gu Ji) is complicated by an acute, sudden illness (Zu Bing), the acute illness should be treated first, followed by the chronic disease.
[Annotation] Gu Ji refers to old/chronic diseases; Zu Bing refers to new/acute diseases. The old disease is the root and slow; the new disease is the branch and urgent. In urgent cases, treat the branch; in slow cases, treat the root. Therefore, treat the acute illness first, then the chronic illness.
[Collected Commentaries] Zhao Liang stated: Chronic diseases are entrenched and cannot be cured quickly; acute illnesses arise suddenly and can be resolved quickly. One should seize the opportunity while the pathogen has not penetrated deeply, urgently expelling it to prevent stagnation and harm. Moreover, patients with chronic diseases have deficient healthy Qi, making them susceptible to pathogen transmission. Excessive hesitation may cause both pathogens to combine, creating significant harm. Zhang Zhongjing established this rule to teach students the correct order of treatment.
Shen Mingzong stated: When old diseases coexist with new infections, treatment must prioritize sequence. Chronic diseases involve stubborn pathogens hard to remove; acute diseases involve pathogens that arrive suddenly and are easy to remove. If a patient with a chronic condition suddenly acquires an acute illness, one must treat the acute illness first to prevent pathogen combination and exacerbation of the old disease. However, chronic diseases cannot be eliminated overnight and require gradual management; thus, the chronic disease is treated later.
The Master said: Diseases of the five Zang organs recover when they obtain favorable conditions; they worsen when exposed to factors they dislike. If a patient craves foods they normally avoid, fever will likely ensue.
[Annotation] This explains that Zang organ diseases recover under specific conditions, illustrating the principle of emotional counteraction (e.g., anger injures the Liver, but grief cures it because grief overcomes anger). Recovery can also depend on timing. The Classics state: Liver diseases recover in Summer because they benefit from Water (the generating element) controlling Metal (the controlling element). If they do not recover in Summer, they are controlled in Autumn by Metal (the controlling element) gaining strength. If they survive Autumn, they persist in Winter due to Water (the mother element) nourishing Wood. They rise in Spring because they regain their dominant position. Other organs follow this pattern. The statement about craving implies that if a person desires foods they usually dislike during illness, it indicates a pathological change in the pathogen and Zang Qi. Eating such foods will likely cause fever.
[Collected Commentaries] Cheng Lin stated: According to the *Nei Jing*: Green corresponds to the Liver, favoring Sweet taste; Red corresponds to the Heart, favoring Sour taste; White corresponds to the Lungs, favoring Bitter taste; Yellow corresponds to the Spleen, favoring Sour taste; Black corresponds to the Kidneys, favoring Pungent taste. This describes recovery through dietary adjustment. Liver diseases recover on Bing/Ding days and begin on Jia/Yi days; Heart diseases recover on Wu/Ji days and begin on Bing/Ding days; Spleen diseases recover on Geng/Xin days and begin on Wu/Ji days; Lung diseases recover on Ren/Gui days and begin on Geng/Xin days; Kidney diseases recover on Jia/Yi days and begin on Ren/Gui days. This describes recovery when organs regain their natural dominance. The dislikes of the Zang organs are: Heart fears Heat, Lungs fear Cold, Liver fears Wind, Spleen fears Dampness, Kidneys fear Dryness. Exposure to these disliked factors causes disease. If a patient who usually abstains from certain foods eats them excessively, the pathogen enters the Yin, boosting Yang Qi, leading to fever.
For diseases located in the Zang organs, if attack therapy is required, one should follow the conditions the pathogen has acquired. For example, for thirst, administer Zhu Ling Tang (Polyporus Decoction). Other cases follow this principle.
[Note] The phrase "urinary difficulty" (Xiao Bian Bu Li) is likely missing after "thirst"; this is probably a transcription error.
[Annotation] Zang organs represent the Interior. For interior diseases requiring attack therapy, one must assess the severity of the pathogen's acquisition before attacking, avoiding rash intervention. For instance, in cases of thirst and urinary difficulty, use Zhu Ling Tang to promote urination first. Once urination normalizes, attack therapy can proceed. Other cases follow this principle, meaning that for other conditions where immediate attack is unsuitable, this cautious approach applies.