刺之。（病在左经，是右经病也，故刺右经为巨刺也。平按∶病在于左《素问》作痛在于左。）必
谨察其九候，针道备矣。（为刺之道，以察九候为先者，针道毕矣。）
平按∶此篇自篇首至末，见《素问》卷九第三十一《热论》篇，又见《甲乙经》卷七第一。
黄帝问于岐伯曰∶今夫热病者，皆伤寒之类也，（夫伤寒者，人于冬时，温室温衣，热饮热
食，腠理开发，快意受寒，腠理因闭，寒居其□□□寒极为热，三阴三阳之脉、五脏六腑受热为
病，名曰热病。斯之热病，本因受寒伤多，亦为寒气所伤，得此热病，以本为名，故称此热病，
伤寒类也。故曰冬伤于寒，春为温病也。其病夏至前发者名为病温，夏至后发者名为病暑也。平
按∶注腠理开发，袁刻脱开字。）或愈或死，皆以病六七日间，（阴阳二经同感，三日而遍脏腑，
营卫不通，复得三日，故极后三日，所以六七日间死也。平按∶《素问》皆以上有其死二字，下
无病字。）其愈皆以十日以上何也？不知其解，愿闻其故。（其不至脏腑两感于寒者，至第七日
即太阳病衰，至九日三阳病衰，至十日太阴病衰，至十二日三阴三阳等病皆衰，故曰其愈皆十日
以上，其理未通，故请闻之也。）岐伯曰∶巨阳者，诸阳之属也，（巨，大也。一阳为纪，少阳
也；二阳为卫，阳明也；三阳为父，太阳也。故足太阳者，三阳属之，故曰诸阳之属也。平按∶
《甲乙》巨作太，下同。）其脉连于风府，故为诸阳主气。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。（足太阳脉直者，从巅入络脑，还
出别下项，其风府在项入发际一寸，则太阳之气连风府也。诸阳者，督脉、阳维脉也。督脉，阳
脉之海。阳维，维诸阳脉，总会风府，属于太阳。故足太阳脉，为诸阳主气。所以人之此脉伤于寒
者，极为热病者也。先发于阳，后发于阴，虽热甚不死；阴阳两气时感者，不免死也。）黄帝曰∶
愿闻其状。岐伯曰∶伤寒一日，巨阳受之，故头项腰脊皆痛。（寒之伤多极为热者，初病发日，
必是太阳受热之为病，故曰一日太阳受之。所以一日阳明少阳不受热者，以其太阳主热，又伤寒
热加，故太阳先病也。头项腰脊，并是足太阳脉所行之处，故皆痛也。平按∶《素问》作头项痛
腰脊强，新校正云∶“《甲乙》及《太素》作头项腰脊皆痛。”今本《甲乙》作头项腰脊背强，注
云∶“《素问》无背字。”注腰脊袁刻脱脊字。）二日阳明受之，阳明主肉，其脉挟鼻络于目，
故身热而鼻干，不得卧。（阳明二阳，故次受病。脾之太阴主肌，胃之阳明主肉。其脉从鼻络目
内，下行入腹至足；手阳明下属大肠，上挟鼻孔，故病身热鼻干不得卧也。平按∶《素问》、
《甲乙》身热下有目疼二字。注至足，足字或疑衍，袁刻脱，按胃为足阳明，从头至腹走足，此
足字当属上句，与至字连读，恐非衍文。）三日少阳受之，少阳主骨，其脉循胁络于耳，故胸胁
痛，耳聋。（肝足厥阴主筋，三焦手少阳与膀胱合，膀胱肾腑，表里皆主骨；足少阳起目锐 ，
入络耳中，下循胸胁下至于足；手少阳偏属三焦，从耳后入耳中，故病耳聋胸胁痛也。平按∶主
骨《素问》作主胆，新校正云∶全元起本胆作骨，元起注云∶少阳者肝之表，肝候筋，筋会于骨，
是少阳之气所荣，故言主于骨。《甲乙》及《太素》并作骨。）三经皆受病而未入通于腑也，故
可汗而已。（三经，三阳经也。热在三阳经中，未满三日，未
至于腑，当以针药发汗而已。三经之病，三日外至腑，可以汤药泄而去。平按∶《素问》三阳下
有经络二字，而未入通于腑作而未入于脏。新校正云∶“全元起本脏作腑，元起注云∶伤寒之病，
始入于皮肤之腠理，渐胜于诸阳而未入腑，故须汗发其寒热而散之。《太素》亦作腑。”《甲乙》
亦作腑，注云∶《素问》作脏。）四日太阴受之，太阴脉布胃中，络于嗌，故腹满而嗌干。（一
阴为独决，厥阴也。二阴为雌，少阴也。三阴为母，太阴也。太阴为大，故先受热。太阴脉从足
入腹，属脾络胃，膈挟咽，连舌本；手太阴起于中焦，下络大肠，故腹满嗌干也。）五日少阴受
之，少阴脉贯肾络肺系舌本，故口热舌干而渴。（足少阴直者，从肾上贯肝膈入肺中，循喉咙挟
舌本，故口热舌干而渴也。平按∶《素问》、《甲乙》口热作口燥。）六日厥阴受病，厥阴脉循阴
器而络于肝，故烦满而囊缩。（足厥阴脉环阴器抵于少腹，挟胃属肝络胆，故烦满囊缩也。平按∶
受病《素问》、《甲乙》作受之。）三阴三阳五脏六腑皆病，营卫不行，腑脏不通，则死矣。（平
按∶《素问》、《甲乙》皆病作皆受病，腑脏作五脏。）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；（如此两感，三阴三阳脏腑皆病，
营卫闭塞，故至后三日则死；不两病者，至第七日太阳病衰，至第九日少阳病衰也。）十日太阴
病衰，腹如故，则思食饮，欲食；（太阴脾主谷气，故病愈腹减思饮食也。平按∶《素问》、《甲
乙》腹下有减字，食饮作饮食，无欲食二字。）十一日少阴病衰，渴止不
满，舌干已而咳；（足少阴脉入肺挟舌本，故病愈渴止舌干已也。咳者，肺气通也。平按∶《甲
乙》无不满二字，已而咳作乃已二字。《素问》咳作嚏。）十二日厥阴病愈，囊从少腹微下，
（厥阴之脉病愈，大气已去，故囊渐下也。平按∶《素问》、《甲乙》愈作衰，从作纵。）大气
皆去，病日已矣。（至十二日大热之气皆去，故所苦日瘳矣。）黄帝曰∶治之奈何？岐伯曰∶治
之各通其脏脉，病日衰已。（量其热病在何脏之脉，知其所在，即于脉以行补泻之法，病衰矣。）
其未满三日者，可汗而已；其满三日者，可泻而已。（未满三日，热在三阳之脉，皮肉之间，故
可汗而已也。三日以外，热入脏腑之中，可服汤药泄而去也。）黄帝曰∶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。若此者，皆病已衰而热有所藏，因其谷气相
薄而热相合，故有所遗。（强，多也。遗，余也。大气虽去，犹有残热在脏腑之内外，因多食，
以谷气热与故热相薄，重发热病，名曰余热病也。平按∶《素问》、《甲乙》而热相合，而作两。）
黄帝曰∶善。治遗奈何？岐伯曰∶视其虚实，调其逆顺，可使必已。（逆者难已，顺者易已，阴
虚补之，阳实泻之，必使其愈，以为工也。平按∶顺《素问》作从。）黄帝曰；病热当何禁？岐
伯曰∶病热少愈，食肉则复，多食则遗，此其禁也。（肉热过谷，故少食则复；谷热少肉，故多
食为遗也。）黄帝曰∶其两感于寒者，其脉应与其病形如何？（足太阳、足少阴，表里共伤于寒，
故曰两感。冬日两感于寒以为病者，脉之应手及病成形，其事何如也。平按∶两感上《素问》有
病字。）岐伯曰∶两伤于寒者，病一日则巨阳与少阴俱病，则头痛口干烦满；（冬感寒时，阴阳
共感，至其发时，还同时发也。故至春发，一日则太阳少阴俱病也。足太阳上
头，故头痛也。手少阴上挟咽，足少阴挟舌本，手太阳络心循咽，故令口干。手少阴起于心中，
足少阴络心，手太阳络心，故令烦满。平按∶《素问》新校正云∶《伤寒论》作烦满而渴四字。）
病二日则阳明与太阴俱病，则肠满身热，不食谵言。（谵，诸阎反，多言也。手阳明属大肠，足
阳明属胃，足太阴属脾络胃，手太阴络大肠循胃，故令肠满身热，不食多言也。平按∶《素问》、
《甲乙》作不欲食谵言，《素问》王注∶“谓妄谬而不次。”新校正云∶“杨上善云∶多言也。”
与此正合。）病三日则少阳与厥阴俱病，则耳聋囊缩厥，水浆不入，则不知人。（手足少阳皆入
耳中，故令耳聋。足厥阴环阴器，足少阳绕毛际，手少阳历三焦，故令囊缩厥也。手少阳布膻中，
足少阳下胸中，足厥阴循喉咙后，手厥阴起胸中属心包，故令浆水不下，不知人也。平按∶《素
问》、《甲乙》厥上有而字。）六日而死。（三阴三阳俱病，气分更经三日皆极，故六日死也。）
黄帝曰∶五脏已伤，六腑不通，营卫不行，如是之后，三日乃死何也？（气分极者，脏伤腑塞，
营卫停壅，后三日死，其故何也？）岐伯曰∶阳明者，十二经之长也，其气血盛，故不知人，三
日其气乃尽，故死。（胃脉足阳明主谷，血气强盛，十二经脉之主，余经虽极，此气未穷，虽不
知人，其气未尽，故更得三日方死也。平按∶《素问》、《甲乙》经下有脉字。）
针刺治疗。（病邪在左侧经脉，实际上是右侧经脉受病，所以针刺右侧经脉称为巨刺法。平按：原文“病在于左”，《素问》作“痛在于左”。）必须谨慎诊察九候脉象，针刺的道理就完备了。（因为针刺之道，以先诊察九候脉象为关键，这样针刺的方法就完备了。）
平按：此篇从篇首到篇末，见于《素问》卷九第三十一《热论》篇，又见于《甲乙经》卷七第一。
黄帝询问岐伯说：现在的热病，都属于伤寒这一类。（所谓伤寒，是指人在冬季，因居室温暖、衣着厚实、饮用热饮或食用热食，导致腠理（皮肤毛孔及纹理）开泄，此时若快意受寒，腠理随即闭塞，寒气滞留体内……寒气极盛则化为热邪，三阴三阳经脉、五脏六腑受热而发病，称为热病。这类热病，大多是因为感受寒邪所致，也是被寒气所伤，得到这种热病，以病因命名，所以称为热病，属于伤寒一类。所以说冬天感受寒邪，春天会发为温病。那些在夏至前发病的称为病温，在夏至后发病的称为病暑。平按：注文中“腠理开发”，袁刻本脱漏了“开”字。）有的痊愈，有的死亡，都发生在患病后的第六七日之间。（阴阳二经同时感受寒邪，三天内病邪传遍脏腑，营卫之气不通畅，再过三天，病情达到极点，所以在第六七日之间死亡。平按：《素问》中上面有“其死”二字，下面没有“病”字。）而那些痊愈的，都要等到十天以上，这是为什么呢？我不明白其中的道理，希望听您讲讲原因。（那些没有发生脏腑两感于寒的情况，到了第七天太阳经的病势开始衰退，到了第九天三阳经的病势衰退，到了第十天太阴经的病势衰退，到了第十二天三阴三阳等经的病势都衰退，所以说痊愈都在十天以上，其中的机理我尚未通晓，所以请教您。）。
岐伯回答说：巨阳（足太阳膀胱经），是诸阳经的统领。（巨，就是大。一阳为纪，指少阳；二阳为卫，指阳明；三阳为父，指太阳。所以足太阳经统领三阳，因此称为诸阳之属。平按：《甲乙经》中“巨”作“太”，以下相同。）它的经脉连接风府穴，所以它是诸阳经的主气。（足太阳脉直行者，从头顶入络于脑，复出别下行于项部，风府穴在项部入发际一寸处，那么太阳之气就连接风府。诸阳，指督脉、阳维脉。督脉是阳脉之海。阳维脉维系诸阳脉，总会于风府，归属于太阳。所以足太阳脉，是诸阳经的主气。因此人如果这条经脉受到寒邪侵袭，就会极重地发展为热病。先发于阳经，后发于阴经，虽然发热严重也不会死亡；如果是阴阳两气同时感受寒邪，那就难免死亡。）
黄帝说：希望了解具体的症状表现。岐伯说：伤寒第一天，巨阳经受邪，所以头项、腰脊都疼痛。（寒邪伤人极重化为热者，初病发作之日，必定是太阳经受热邪而为病，所以说第一天太阳经受邪。之所以第一天阳明、少阳不受热，是因为太阳主热，加上伤寒热邪加重，所以太阳先发病。头项、腰脊，都是足太阳经脉循行的部位，所以都疼痛。平按：《素问》作“头项痛，腰脊强”，新校正说：“《甲乙经》及《太素》作‘头项腰脊皆痛’。”今本《甲乙经》作“头项腰脊背强”，注云：“《素问》无‘背’字。”注文中“腰脊”袁刻本脱漏了“脊”字。）第二天阳明经受邪，阳明经主管肌肉，其经脉挟鼻络于目，所以身体发热且鼻子干燥，不能安卧。（阳明是二阳，所以接着受病。脾之太阴主肌，胃之阳明主肉。其经脉从鼻部络于目内眦，下行入腹至足；手阳明下属大肠，上挟鼻孔，所以生病时出现身热、鼻干、不得卧的症状。平按：《素问》、《甲乙经》在“身热”下有“目疼”二字。注文中“至足”，“足”字或许怀疑是衍文，袁刻本脱漏，按语认为胃为足阳明，从头至腹走足，这个“足”字应当属于上句，与“至”字连读，恐怕不是衍文。）第三天少阳经受邪，少阳经主管骨，其经脉循行胁肋络于耳，所以胸胁疼痛，耳聋。（肝足厥阴主筋，三焦手少阳与膀胱相合，膀胱肾腑，表里都主骨；足少阳起于目锐眦，入络耳中，下循胸胁至于足；手少阳偏属三焦，从耳后入耳中，所以生病时出现耳聋、胸胁痛。平按：“主骨”《素问》作“主胆”，新校正说：全元起本“胆”作“骨”，元起的注解说：少阳是肝之表，肝候筋，筋会于骨，这是少阳之气所荣养，所以说主于骨。《甲乙经》及《太素》都作“骨”。）这三条阳经都受了病邪但尚未传入腑，所以可以通过发汗治愈。（三经，指三条阳经。热邪在三阳经中，未满三日，未至于腑，应当用针药发汗来治疗。三经的病，三天外传入腑，可以用汤药泻下来去除。平按：《素问》在“三阳”下有“经络”二字，“而未入通于腑”作“而未入于脏”。新校正说：“全元起本‘脏’作‘腑’，元起注云：伤寒之病，始入于皮肤之腠理，渐胜于诸阳而未入腑，所以需要发汗散其寒热。《太素》也作‘腑’。”《甲乙经》也作“腑”，注云：《素问》作“脏”。）第四天太阴经受邪，太阴经脉布散于胃中，络于咽喉，所以腹部胀满且咽喉干燥。（一阴为独决，指厥阴。二阴为雌，指少阴。三阴为母，指太阴。太阴为大，所以先受热。太阴经脉从足入腹，属脾络胃，膈部挟咽，连舌本；手太阴起于中焦，下络大肠，所以出现腹满、嗌干的症状。）第五天少阴经受邪，少阴经脉贯穿肾络肺系及舌本，所以口热、舌干且口渴。（足少阴直行者，从肾上贯肝膈入肺中，循喉咙挟舌本，所以出现口热、舌干、口渴。平按：《素问》、《甲乙经》“口热”作“口燥”。）第六天厥阴经受邪，厥阴经脉循行阴器络于肝，所以心烦胀满且睾丸收缩。（足厥阴经脉环绕阴器抵于少腹，挟胃属肝络胆，所以出现烦满、囊缩。平按：“受病”《素问》、《甲乙经》作“受之”。）如果三阴三阳、五脏六腑都病了，营卫之气不行，腑脏之气不通，就会死亡。（平按：《素问》、《甲乙经》“皆病”作“皆受病”，“腑脏”作“五脏”。）那些没有两感于寒的，第七天巨阳经病势衰退，头痛稍减；第八天阳明经病势衰退，身热稍减；第九天少阳经病势衰退，耳聋能微闻声音；（像这种两感的情况，三阴三阳脏腑都病，营卫闭塞，所以到后三天就死亡；不两感的，到第七天太阳病衰，到第九天少阳病衰。）第十天太阴经病势衰退，腹部不再胀满，就想饮食，想吃东西；（太阴脾主谷气，所以病愈后腹减思饮食。平按：《素问》、《甲乙经》“腹”下有“减”字，“食饮”作“饮食”，无“欲食”二字。）第十一天少阴经病势衰退，口渴停止，腹胀消除，舌干已解并开始咳嗽；（足少阴脉入肺挟舌本，所以病愈后渴止舌干已。咳嗽，说明肺气通畅。平按：《甲乙经》无“不满”二字，“已而咳”作“乃已”二字。《素问》“咳”作“嚏”。）第十二天厥阴经病愈，睾丸从少腹微微下降，（厥阴经脉病愈，大气已去，所以睾丸渐渐下垂。平按：《素问》、《甲乙经》“愈”作“衰”，“从”作“纵”。）大热之气都已去除，病一天天好了。（到十二天大热之气都去了，所以痛苦一天天痊愈。）
黄帝说：如何治疗呢？岐伯说：治疗要分别疏通各脏的经脉，病就会一天天衰退痊愈。（衡量热病在哪个脏的经脉，知道病位所在，就在该脉施行补泻之法，病就会衰退。）那些未满三日的，可以通过发汗治愈；那些已满三日的，可以通过泻下治愈。（未满三日，热邪在三阳经脉，皮肉之间，所以可以发汗。三天以外，热邪进入脏腑之中，可以服用汤药泻下来去除。）
黄帝说：热病已经痊愈，但时常还有余热遗留，这是为什么？岐伯说：所有有余热遗留的，是因为热势尚盛时就勉强进食，所以有遗留。像这种情况，都是病势已衰但热邪有所藏伏，因为谷气与残存的热邪相互搏结，热邪重新结合，所以有遗留。（强，是多。遗，是余。大热之气虽去，但脏腑内外仍有残热，因为多吃食物，谷气的热与旧的热邪相互搏结，重新引发热病，称为余热病。平按：《素问》、《甲乙经》“而热相合”中的“而”作“两”。）
黄帝说：好。如何治疗余热遗留呢？岐伯说：观察虚实，调理逆顺，就可以使病必愈。（逆者难愈，顺者易愈，阴虚则补之，阳实则泻之，一定要使其痊愈，这才是高明的医生。平按：“顺”《素问》作“从”。）
黄帝说：患热病时应当禁忌什么？岐伯说：热病刚见好转，吃肉就会复发，多吃就会遗留余热，这就是禁忌。（肉的热性超过谷物，所以少吃肉就会复发；谷的热性少于肉，所以多吃谷物会导致余热遗留。）
黄帝说：那些两感于寒的人，其脉象应与病症表现如何？（足太阳、足少阴，表里共同受伤于寒，所以叫两感。冬天两感于寒而发病，脉象应手及病症成形，情况是怎样的呢？平按：“两感”上《素问》有“病”字。）岐伯说：两伤于寒的人，第一天巨阳与少阴同时发病，就会出现头痛、口干、烦满；（冬天感受寒邪时，阴阳共同感受，到发病时，还同时发作。所以到春天发病，第一天太阳少阴就同时病。足太阳上行头部，所以头痛。手少阴上挟咽喉，足少阴挟舌本，手太阳络心循咽，所以令人口干。手少阴起于心中，足少阴络心，手太阳络心，所以令人烦满。平按：《素问》新校正说：《伤寒论》作“烦满而渴”四字。）第二天阳明与太阴同时发病，就会出现肠满、身热、不吃东西且胡言乱语。（谵，音zhān，多言。手阳明属大肠，足阳明属胃，足太阴属脾络胃，手太阴络大肠循胃，所以令人肠满、身热、不吃东西且多言。平按：《素问》、《甲乙经》作“不欲食谵言”，《素问》王冰注：“谓妄谬而不次。”新校正说：“杨上善云：多言也。”这与我的解释正合。）第三天少阳与厥阴同时发病，就会出现耳聋、睾丸收缩、四肢厥冷、水浆不进、神志昏迷不知人。（手足少阳都入耳中，所以令人耳聋。足厥阴环阴器，足少阳绕毛际，手少阳历三焦，所以令人囊缩、厥冷。手少阳布膻中，足少阳下胸中，足厥阴循喉咙后，手厥阴起胸中属心包，所以令人浆水不下、不知人。平按：《素问》、《甲乙经》“厥”上有“而”字。）第六天死亡。（三阴三阳都病，气分再经过三天都达到极点，所以第六天死亡。）
黄帝说：五脏已经损伤，六腑不通，营卫不行，在此之后，还要过三天才死亡，这是为什么？（气分极盛者，脏伤腑塞，营卫停壅，后三天死亡，其中的缘故是什么？）岐伯说：阳明经是十二经之长，它的气血最旺盛，所以病人不知人事，经过三天它的元气才耗尽，所以死亡。（胃脉足阳明主受纳水谷，血气强盛，是十二经脉之主，其他经脉即使衰竭，此气未尽，虽然不知人事，其气未穷尽，所以还能再活三天才死。平按：《素问》、《甲乙经》“经”下有“脉”字。）
Acupuncture treatment. (When the pathogen is in the meridian on the left side, it actually affects the meridian on the right side; therefore, needling the right meridian is called *Juci* (Giant Puncture). Ping An: The original text "Bing zai yu zuo" (Disease lies on the left) is written as "Tong zai yu zuo" (Pain lies on the left) in *Suwen*.) One must carefully examine the nine pulse positions (Jiu Hou), and the principles of acupuncture will be complete. (The reason why examining the nine pulses is prioritized in acupuncture is that once this is done, the methods of acupuncture are fully established.)
Ping An: This section, from the beginning to the end of the chapter, appears in Volume 9, Chapter 31 "Re Lun" (Discourse on Febrile Diseases) of *Suwen*, and also in Volume 7, Chapter 1 of *Jiayi Jing*.
Yellow Emperor asked Qibo: "Currently, all febrile diseases belong to the category of Shanghan (Cold Damage)." (Regarding Shanghan, when people are in winter, due to warm rooms, thick clothing, hot drinks, or hot food, their Couli (skin pores and interstices) open up. If they then expose themselves to cold for pleasure, the Couli close suddenly, trapping the cold qi inside... When the cold becomes extreme, it transforms into heat. When the Three Yin and Three Yang meridians, as well as the Zang and Fu organs, are affected by heat and become diseased, it is called Rebing (Febrile Disease). These febrile diseases originate largely from contracting cold pathogens; they are caused by cold injury. Since these febrile diseases are named after their cause, they are called Rebing and are classified under Shanghan. Thus it is said: 'If one contracts cold in winter, Warm Illness (Wenbing) will develop in spring.' Those that manifest before the Summer Solstice are called Bing Wen (Illness of Warmth); those that manifest after the Summer Solstice are called Bing Shu (Illness of Heat). Ping An: In the commentary, the phrase "Couli kaifa" (Couli opening) misses the character "Kai" (open) in the Yuan edition.) Some recover, while others die, typically within six or seven days of onset. (When both Yin and Yang meridians contract the pathogen simultaneously, the disease spreads through the Zang and Fu organs within three days. Ying and Wei Qi become blocked. After another three days, the condition reaches its extremity; thus, death occurs between the sixth and seventh days. Ping An: In *Suwen*, the characters "Qi Si" (their death) appear above, but the character "Bing" (disease) is missing below.) Why do those who recover take more than ten days? I do not understand the rationale and wish to hear the explanation. (For those who do not suffer from simultaneous contraction of cold by both Zang and Fu, by the seventh day, the Taiyang disease begins to decline; by the ninth day, the Three Yang diseases decline; by the tenth day, the Taiyin disease declines; by the twelfth day, the diseases of the Three Yin and Three Yang all decline. Hence, recovery takes more than ten days. The principle is unclear to me, so I ask for an explanation.)
Qibo replied: Juyang (Foot-Taiyang Bladder Meridian) is the commander of all Yang meridians. (Ju means great. One Yang is Ji, referring to Shaoyang; Two Yang is Wei, referring to Yangming; Three Yang is Fu, referring to Taiyang. Therefore, Foot-Taiyang governs the Three Yang, hence it is called the commander of all Yang. Ping An: In *Jiayi Jing*, "Ju" is written as "Tai", and similarly below.) Its vessel connects to Fengfu (GV16), making it the master of Qi for all Yang meridians. (The straight branch of Foot-Taiyang enters the brain from the vertex, emerges, descends separately along the neck. Fengfu (GV16) is located one cun above the hairline at the nape. Thus, Taiyang Qi connects to Fengfu. All Yang refers to the Du Mai (Governor Vessel) and Yangwei Mai (Yang Linking Vessel). Du Mai is the Sea of Yang Vessels. Yangwei Mai links all Yang vessels, converging at Fengfu and belonging to Taiyang. Therefore, Foot-Taiyang is the master of Qi for all Yang meridians. Consequently, if this vessel is injured by cold, it develops into severe febrile disease. If the disease starts in Yang and later moves to Yin, even with high fever, death is avoided; however, if both Yin and Yang Qi contract cold simultaneously, death is inevitable.)
Yellow Emperor said: "I wish to know the specific manifestations." Qibo said: "On the first day of Shanghan, Juyang receives the pathogen, resulting in pain in the head, neck, lower back, and spine. (When cold injures the body severely and transforms into heat, on the initial day of onset, it is invariably Taiyang receiving heat to cause disease. Hence, it is said that Taiyang receives it on the first day. The reason Yangming and Shaoyang do not receive heat on the first day is that Taiyang governs heat, and with the addition of Shanghan heat, Taiyang is affected first. The head, neck, lower back, and spine are all pathways of the Foot-Taiyang meridian, hence they all hurt. Ping An: *Suwen* reads 'Head and neck pain, stiff lower back and spine'. Xin Zhengjiao states: '*Jiayi Jing* and *Taisu* read 'All parts of head, neck, waist, and spine hurt'.' The current version of *Jiayi Jing* reads 'Stiffness of head, neck, waist, spine, and back', noting: '*Suwen* lacks the character 'back'.' The commentary misses the character 'spine' in 'waist and spine' in the Yuan edition.) On the second day, Yangming receives the pathogen. Yangming governs flesh; its vessel runs alongside the nose and connects to the eyes. Thus, there is body heat, dry nose, and inability to lie down. (Yangming is Two Yang, so it is affected next. Spleen's Taiyin governs muscle; Stomach's Yangming governs flesh. Its vessel connects from the nose to the inner canthus, descends into the abdomen, and reaches the foot; Hand-Yangming belongs to Large Intestine below and runs alongside the nostrils above. Hence, the disease presents with body heat, dry nose, and insomnia. Ping An: *Suwen* and *Jiayi Jing* add 'eye pain' after 'body heat'. Regarding the note 'reaches the foot', the character 'foot' might be a scribal error, omitted in Yuan edition. However, since Stomach is Foot-Yangming, traveling from head to abdomen to foot, this 'foot' likely belongs to the previous sentence, connecting with 'to', and is probably not an error.) On the third day, Shaoyang receives the pathogen. Shaoyang governs bone; its vessel follows the hypochondrium and connects to the ears. Thus, there is chest and hypochondriac pain, and deafness. (Liver's Foot-Jueyin governs tendons. Sanjiao's Hand-Shaoyang combines with Bladder. Bladder and Kidney, being exterior-interior pairs, both govern bone; Foot-Shaoyang originates at the outer canthus, enters the ear, and descends along the chest and hypochondrium to the foot; Hand-Shaoyang pertains to Sanjiao, entering the ear from behind. Hence, the disease presents with deafness and chest/hypochondriac pain. Ping An: 'Governs bone' in *Suwen* is written as 'governs Gallbladder'. Xin Zhengjiao notes: Quan Qiyuan's edition has 'bone' instead of 'Gallbladder'. Qiyuan's commentary says: Shaoyang is the exterior of Liver; Liver controls tendons; tendons converge at bones. Thus, Shaoyang Qi nourishes them, hence it is said to govern bone. *Jiayi Jing* and *Taisu* both write 'bone'.) Since these three meridians are diseased but have not yet entered the Fu organs, they can be cured by inducing sweating. (The three meridians refer to the Three Yang meridians. With heat confined to the Three Yang meridians for less than three days, before reaching the Fu organs, one should use acupuncture and herbs to induce sweating. If the disease of these three meridians persists beyond three days and enters the Fu organs, decoctions can be used to purge and eliminate it. Ping An: *Suwen* adds 'jingluo' (vessels and collaterals) after 'Three Yang', and writes 'wei ru yu zang' (not yet entered the Zang) instead of 'wei ru tong yu fu' (not yet entered the Fu). Xin Zhengjiao states: 'Quan Qiyuan’s edition has 'Fu' instead of 'Zang'. Qiyuan's commentary says: Cold damage disease begins in the skin's Couli, gradually surpasses the Yang meridians but does not enter the Fu, so sweating is required to disperse the cold and heat. *Taisu* also writes 'Fu'.*Jiayi Jing* also writes 'Fu', noting: *Suwen* writes 'Zang'.') On the fourth day, Taiyin receives the pathogen. Taiyin vessel distributes in the stomach and connects to the throat. Thus, there is abdominal fullness and dry throat. (One Yin is Dujue, referring to Jueyin. Two Yin is Ci, referring to Shaoyin. Three Yin is Mu, referring to Taiyin. Taiyin is great, so it receives heat first. Taiyin vessel enters the abdomen from the foot, belongs to Spleen, connects to Stomach, passes through the diaphragm alongside the pharynx, and connects to the root of the tongue; Hand-Taiyin originates in the middle jiao and connects downward to Large Intestine. Hence, abdominal fullness and dry throat occur.) On the fifth day, Shaoyin receives the pathogen. Shaoyin vessel penetrates the Kidney, connects to Lung system and root of tongue. Thus, there is oral heat, dry tongue, and thirst. (Foot-Shaoyin straight branch ascends from Kidney through Liver and Diaphragm into Lung, follows the throat alongside the root of tongue. Hence, oral heat, dry tongue, and thirst occur. Ping An: *Suwen* and *Jiayi Jing* write 'mouth dryness' instead of 'oral heat'.) On the sixth day, Jueyin receives the pathogen. Jueyin vessel circles the genitalia and connects to the Liver. Thus, there is irritability, fullness, and retraction of the scrotum. (Foot-Jueyin vessel circles the genitalia to the lower abdomen, accompanies Stomach, belongs to Liver, and connects to Gallbladder. Hence, irritability, fullness, and scrotal retraction occur. Ping An: 'Shoubing' (receives disease) in *Suwen* and *Jiayi Jing* is written as 'Shouzhi' (receives it).) If the Three Yin and Three Yang, as well as the Five Zang and Six Fu organs, are all diseased, with Ying and Wei Qi stagnant and Zang and Fu communication blocked, death ensues. (Ping An: *Suwen* and *Jiayi Jing* write 'Jie Shoubing' (all receive disease) instead of 'Jie Bing' (all diseased), and 'Wuzang' (Five Zang) instead of 'Fuzang' (Fu and Zang).) For those not suffering from simultaneous contraction (Lianggan), on the seventh day, Juyang disease declines, headache decreases slightly; on the eighth day, Yangming disease declines, body heat decreases slightly; on the ninth day, Shaoyang disease declines, deafness improves slightly allowing faint hearing; (In cases of Lianggan, where Three Yin and Three Yang and Zang and Fu are all diseased with blocked Ying and Wei, death occurs after three more days. In non-Lianggan cases, Taiyang declines on the seventh day, and Shaoyang declines on the ninth day.) On the tenth day, Taiyin disease declines, abdominal distension subsides, appetite returns, and desire to eat arises; (Taiyin Spleen governs grain Qi; thus, upon recovery, abdominal distension reduces and hunger for food/drink increases. Ping An: *Suwen* and *Jiayi Jing* add 'jian' (reduce) after 'abdomen', write 'yinshi' (diet) instead of 'shiyin' (food and drink), and omit 'yushi' (desire to eat).) On the eleventh day, Shaoyin disease declines, thirst stops, fullness resolves, dry tongue heals, and coughing begins; (Foot-Shaoyin vessel enters Lung and accompanies root of tongue; thus, upon recovery, thirst stops and dry tongue heals. Coughing indicates Lung Qi is unblocking. Ping An: *Jiayi Jing* omits 'bu man' (no fullness); 'yi er ke' (then coughs) is written as 'nai yi' (then ceases). *Suwen* writes 'ti' (sneeze) instead of 'ke' (cough).) On the twelfth day, Jueyin disease resolves, scrotum descends slightly from the lower abdomen; (Upon resolution of Jueyin vessel disease, major pathogenic Qi has departed, so the scrotum gradually descends. Ping An: *Suwen* and *Jiayi Jing* write 'shuai' (decline) instead of 'yu' (resolve), and 'zong' (loose/relax) instead of 'cong' (follow/from).) The major pathogenic Qi has all departed, and the illness recovers day by day. (By the twelfth day, major heat Qi has all departed, so the suffering diminishes daily.)
Yellow Emperor said: "How should it be treated?" Qibo said: "Treatment requires unblocking the vessels of each respective Zang organ; the disease will decline day by day. (Assess which Zang vessel the febrile disease affects, identify its location, and apply tonifying or reducing methods to that vessel; the disease will decline.) For those with less than three days of illness, sweating can cure it; for those with three or more days, purging can cure it. (Less than three days: heat is in the Three Yang vessels, between skin and flesh, so sweating is appropriate. More than three days: heat has entered the Zang and Fu organs, so decoctions can be used to purge and eliminate it.)
Yellow Emperor said: "When febrile disease has resolved, why does residual heat sometimes remain?" Qibo said: "In all cases of residual heat, it is because the patient forces themselves to eat while the heat is still intense. Thus, residuals remain. In such cases, although the disease pathogen has declined, heat remains hidden. The Qi of the food clashes with the residual heat, causing the heat to recombine, resulting in residual symptoms. (Qiang means excessive/much. Yi means remainder. Although major heat Qi has gone, residual heat remains inside and outside the Zang and Fu organs. Due to overeating, the heat of the grain Qi clashes with the old heat, re-triggering the febrile disease, known as residual heat disease. Ping An: In *Suwen* and *Jiayi Jing*, 'er re xianghe' (and heat combines) uses 'liang' (two/both) instead of 'er' (and).)
Yellow Emperor said: "Excellent. How should residual heat be treated?" Qibo said: "Observe deficiency and excess, regulate reversal and smoothness, and the disease can certainly be cured. (Reversal makes cure difficult; smoothness makes cure easy. Deficiency of Yin requires tonification; Excess of Yang requires reduction. One must ensure healing, which constitutes the skill of a physician. Ping An: 'Shun' (smooth) in *Suwen* is written as 'Cong' (follow).)
Yellow Emperor said: "What should be prohibited during febrile disease?" Qibo said: "When febrile disease is slightly better, eating meat causes recurrence (Fu); eating too much causes residual heat (Yi). This is the prohibition. (Meat is hotter than grain; thus, eating meat leads to recurrence. Grain is less hot than meat; thus, overeating grain leads to residual heat.)
Yellow Emperor said: "For those with simultaneous contraction (Lianggan), how should their pulse correspond to their clinical presentation?" (Foot-Taiyang and Foot-Shaoyin, being exterior-interior pairs, are jointly injured by cold, hence called Lianggan. In winter, when Lianggan causes disease, what are the pulse findings and clinical forms? Ping An: *Suwen* adds 'Bing' (disease) before 'Lianggan'.) Qibo said: "Those injured by cold in two aspects: On the first day, Juyang and Shaoyin both become diseased, presenting with headache, dry mouth, and irritability/fullness. (Contracting cold in winter involves simultaneous contraction of Yin and Yang. Upon manifestation, they occur simultaneously. Thus, in spring, on the first day, Taiyang and Shaoyin are both diseased. Foot-Taiyang ascends to the head, causing headache. Hand-Shaoyin ascends alongside the pharynx; Foot-Shaoyin accompanies the root of tongue; Hand-Taiyang connects to Heart and follows the pharynx, causing dry mouth. Hand-Shaoyin originates in the Heart; Foot-Shaoyin connects to Heart; Hand-Taiyang connects to Heart, causing irritability and fullness. Ping An: *Suwen* Xin Zhengjiao notes: *Shanghan Lun* reads 'irritability, fullness, and thirst'.) On the second day, Yangming and Taiyin both become diseased, presenting with intestinal fullness, body heat, anorexia, and delirious speech. (Zhan means excessive talking. Hand-Yangming belongs to Large Intestine; Foot-Yangming belongs to Stomach; Foot-Taiyin belongs to Spleen and connects to Stomach; Hand-Taiyin connects to Large Intestine and follows Stomach. Hence, intestinal fullness, body heat, anorexia, and excessive talking occur. Ping An: *Suwen* and *Jiayi Jing* write 'Bu yushi' (no desire to eat) and 'Zhan yan'. Wang Bing's commentary on *Suwen*: 'Speaking wildly and out of order.' Xin Zhengjiao states: 'Yang Shangshan says: excessive talking.' This aligns perfectly with my interpretation.) On the third day, Shaoyang and Jueyin both become diseased, presenting with deafness, scrotal retraction, cold limbs, inability to swallow fluids, and unconsciousness. (Hand and Foot Shaoyang both enter the ears, causing deafness. Foot-Jueyin circles the genitalia; Foot-Shaoyang surrounds the pubic region; Hand-Shaoyang traverses Sanjiao. Hence, scrotal retraction and cold limbs occur. Hand-Shaoyang distributes in Danzhong; Foot-Shaoyang descends in the chest; Foot-Jueyin follows behind the throat; Hand-Jueyin originates in the chest and belongs to Pericardium. Hence, inability to swallow water/gruel and loss of consciousness occur. Ping An: *Suwen* and *Jiayi Jing* add 'Er' (and) before 'Jue' (cold limbs).) Death occurs on the sixth day. (With Three Yin and Three Yang all diseased, Qi reaches extremity after passing through three more days, hence death on the sixth day.)
Yellow Emperor said: "When the Five Zang are damaged, Six Fu are blocked, and Ying and Wei do not circulate, why does death occur three days later?" (When Qi reaches extremity, Zang are injured and Fu are blocked, Ying and Wei stagnate. Why does death occur three days later?) Qibo said: "Yangming is the leader of the Twelve Meridians; its Qi and Blood are abundant. Thus, the patient loses consciousness. After three days, its Qi is exhausted, hence death. (Stomach vessel, Foot-Yangming, governs grain. Qi and Blood are strong. It is the master of the Twelve Meridians. Even if other meridians reach extremity, this Qi is not exhausted. Although unconscious, the Qi remains, allowing survival for three more days before death. Ping An: *Suwen* and *Jiayi Jing* add 'Mai' (vessel) after 'Jing' (meridian).)"