黄帝曰。余受九针于夫子。而私览于诸方。或有导引行气乔摩灸熨刺 饮药之一者。可独守耶。
将尽行之乎。岐伯曰。诸方者。众人之方也。非一人之所尽行也。黄帝曰。此乃所谓守一勿失。万物毕
者也。
此篇论人之身体。有形层之浅深。有血气之虚实。是以针砭药灸。各守其一。非一人之所尽行也。
病传者。谓邪从皮毛而发于腠理。从腠理而入于经脉。从经脉而传溜于五脏。所谓经络受邪。入脏腑
为内所因也。如邪入于脏不可以致生。故邪在皮毛者。宜砭而去之。在于脉肉筋骨者。宜针而泻之。邪入
于中者。宜导引行气以出之。寒邪之入深者。宜熨而通之。邪在内而虚者。只可饮以甘药。实者可用
毒药以攻之。陷于下者。宜
灸以启之。是以药石灸刺导引诸方。随众人之所病而施之。非一人之所尽行者也。此章教人知病传之
有浅深。如可治之属。即守一勿失。不使大邪入脏而成不救。利济万物之功。毕于此矣。
今余闻阴阳之要。虚实之理。倾移之过。可治之属。愿闻病之变化。淫传绝败而不可治者。可得闻
乎。岐伯曰。要乎哉问道。昭乎其如日醒。窘乎其如夜瞑。能被而服之。神与俱成。毕将服之。神自得
之。生神之理。可着于竹帛。不可传于子孙。黄帝曰。何谓日醒。岐伯曰。明于阴阳。如惑之解。如醉
之醒。黄帝曰。何谓夜暝。岐伯曰。喑乎其无声。漠乎其无形。折毛发理。正气横倾。淫邪泮衍。血脉
传溜。大气入脏。腹痛下淫。可以致死。不可以致生。
此论形与神俱病则无由入其腠理。不致血脉流传。而成不救之死证也。阴阳之要者。皮肤肌腠为阳。
血脉为阴。肌腠者。三焦通会元真之处。血脉者。神气之所藏也。虚实者。血气之虚实也。如腠理固密。
元真通畅。血脉和调。精神内守。邪气何由内入。虚则传溜入脏。而不可以致生。是以生神之理。可着于
竹帛。以教化后世。不可传于子孙。盖言调养此神气者。乃自修之功也。倾移之过者。折毛发理。正气
横倾也。可治之属者。邪尚在于皮肤肌腠之间。未至血脉传流。大邪入脏也。此言邪在于外。犹为可治
之属。守一勿失。不使邪溜于内。故善治者治皮毛。其次治肌肉。其次治经脉。其次治五脏。治五脏者
半死半生。盖间传者生。传之于其所胜者不治也。若夫病之变化。淫传绝败而不可治者。乃淫邪泮衍。
血脉流传。大气入脏。不可以致生也。明于阴阳。如惑之解。如醉之醒。毕将服之。神自得之。所谓上
古之人。其知道者。法于阴阳。和于术数。食饮有节。起居有常。不妄作劳。故能形与神俱。而尽终其
天年。喑乎其无声。漠乎其无形。谓不知道者。肤腠空疏。血脉虚脱。
虚邪之中人也微。莫知其情。莫见其形。渐致淫邪入脏。不可以致生。夫邪之中于人也。始于皮毛。则
毛发折而腠理开。开则邪从毛发入。入则抵深而入于腠理。腠理者。三焦通会元真之处。是以正气横倾。
淫邪泮衍于肌腠之间。则传流于血脉。而内入于脏矣。盖经脉内属于脏腑。外络于形身。是以经脉受邪。
入脏腑为内所因也。淫邪泮衍于肌腠则伤气。传流于血脉而入脏则伤神。神气并伤。故可以致死。而不可
以致生。是以圣人之教下也。虚邪贼风。避之有时。恬淡虚无。精神内守。病从何来。故可着于竹帛。盖
欲使天下后世子孙黎民。咸知此养生之道焉。
黄帝曰。大气入脏奈何。岐伯曰。病先发于心。一日而之肺。三日而之肝。五日而之脾。三日不已死。
冬夜半。夏日中。
此论大邪入脏。传于其所不胜而死。盖五脏秉五方五行之气而生。故生于相生。而死于相胜也。病先发
于心。一日而传之肺。三日而传之肝。五日而传之脾。皆逆传其所不胜。再至三日不已而死。夫心为
火脏。冬主水。夏主火。冬夜半者。水胜而火灭也。夏日中者。亢极而自焚也。杨元如曰。按、素问玉
机真藏论。病入于五脏。逆传于所胜。尚可按可浴可药可灸以救之。故曰三日不已死。谓邪入于脏。犹有可
已之生机。故首言导引行气乔摩灸熨刺 饮药。末言诸病以次相传者。皆有死期。不可刺也。盖邪在于形
层者宜刺。入于脏者。只可按摩饮药以救之。圣人救民之心。无所不用其极。
病先发于肺。三日而之肝。一日而之脾。五日而之胃。十日不已死。冬日入。夏日出。
杨元如曰。肺主气。日出而气始隆。日入而气收引。冬日入者。气入而绝于内也。夏日出者。气出
而绝于外也。按、只言冬夏而不言春秋者。四时之气。总属寒暑之往来。夜半日中。阴阳之分于子午也。
日出日入。阴阳之离于卯酉也。病传之一三五日者。乃天之奇数。盖五脏生于地之五行。而本于天干之
所化。
病先发于肝。三日而之脾。五日而之胃。三日而之肾。三日不已死。冬日入。夏早食。
杨元如曰。按、素问标本病传论云。肝病头目眩。胁支满。三日体重身痛。五日而胀。三日腰脊小
腹痛胫 。三日不已死。冬日入。夏早食。盖病先发于肝。故头目眩而胁支满。三日而之脾。则体重身
痛。五日而之胃。则胀。三日而之肾。则腰脊小腹痛。胫 。冬日入。夏早食。乃木气绝于卯酉金旺之时。
病先发于脾。一日而之胃。二日而之肾。三日而之膂膀胱。十日不已死。冬人定。夏晏食。
杨元如曰。按、素问标本病传论云。脾病身重体痛。一日而胀。二日少腹腰脊痛胫 。三日背膂
筋痛。小便闭。十日不已死。冬人定。夏晏食。盖病发于脾。则身痛体重。一日而之胃则胀。二日而之
肾。则少腹腰脊痛。胫 。膂膀胱者。膀胱附于脊背之膂筋也。是以三日而之膂膀胱。则背膂筋痛。小便
闭。人定在寅。木旺而土绝也。夏之晏食在亥。水泛而土败也。
病先发于胃。五日而之肾。三日而之膂膀胱。五日而上之心。二日不已死。冬夜半。夏日 。（ 音
笛日昃也）
按、素问标本病传论云。胃病胀满。五日少腹腰脊痛 。三日背腹筋痛。小便闭。五日身体重。六日
不已死。冬夜半。夏日 。盖病先发于胃。故胀满。五日而之肾。则少腹腰脊痛 。三日而之膂膀
胱。则背腹筋痛。五
日而上之心。则身体重。盖心主血脉。血脉者。所以濡筋骨而利关节者也。二乃火之生数。六日者。水
之成数也。死于二日者。火之生气绝也。死于六日者。水乘而火灭也。故冬夜半者。即水乘火灭之义。
夏日昃者。亦太阳之生气绝也。朱济公曰。冬主水。夏主火。日昃者。盛而始亏之时。
病先发于肾。三日而之膂膀胱。三日而上之心。三日而之小肠。三日不已死。冬大晨。夏晏晡。
按、素问标本病传论曰。肾病者。少腹腰脊痛 。三日背KT 筋痛。小便闭。三日腹胀。三日两
胁支痛。二日不已死。盖病先发于肾。故少腹腰脊痛 。三日而之膂膀胱。则背膂筋痛。小便闭。三日
而上之心。则腹胀。盖足少阴肾脉。下络膀胱。上从腹注胸中。入肺络心。此邪入于脏。亦从血脉流传
也。上节病在心。故身体重。此从膀胱而上传于心。复从心而下传小肠。故腹胀也。冬大晨者。乃寅卯木
旺之时。木旺则泄其水之气矣。夏晏晡。土气所主之时。土克水也。三日者。水火之生气并绝。二日者。
火之生气绝也。盖病之且死。有死于先发之脏气绝者。有死于所传之脏气绝者。是以灵素经中。少有不同。
学人自当理会。
病先发于膀胱。五日而之肾。一日而之小肠。一日而之心。二日不已死。冬鸡鸣。夏下晡。
按、标本病传论云。膀胱病。小便闭。五日少腹胀。腰脊痛。 。一日腹胀。一日身体痛。二日不
已死。盖病发于膀胱。故小便闭。五日而之肾。则少腹胀。腰脊痛。 。一日而之小肠。则腹胀。一日而之
心。故身体痛也。冬鸡鸣。夏下晡。即上节大晨晏晡之时也。按五脏相传。而有膀胱胃腑者。胃居中
央。为水谷之海。乃五脏之生原。太阳为诸阳主气也。
诸病以次相传。如是者皆有死期。不可刺也。间一脏及二三四脏者。乃可刺也。
玉机真藏论曰。五脏相通。移皆有次。五脏有病。则各传其所胜。病之且死。必先传行。至其所不
胜。病乃死。故如是者。乃逆传其所胜。皆有死期。不可刺也。如间一脏者。乃心传之肝。肺传之脾。
子行乘母也。间二脏者。心传之脾。肺传之肾。乃母行乘子。子母之气。互相资生者也。间三脏者。心传
之肾。肺传之心。从所不胜来者为微邪也。按五脏间传。只有间三而无间四。所谓间四脏者。以脏传之
腑。而腑复传之于他脏。盖腑亦可以名脏也。杨元如曰。按五脏别论。黄帝问曰。余闻方士或以脑髓为
脏。或以肠胃为脏。盖藏货物曰腑。故腑亦可以名脏。
黄帝说：我从老师那里学习了九针，又私下阅览了各种医方。其中有导引、行气、按摩、灸法、熨贴、针刺、服药等其中一种方法，可以单独坚守使用吗？还是应该全部施行呢？
岐伯说：各种医方，是适应众人的治疗方法，并不是某一个人能够全部施行的。
黄帝说：这就是所说的“守一勿失”，就能包罗万象、无所不备了。
这一篇论述人的身体，有层次上的浅深区别，有血气上的虚实不同。因此，砭石、药物、艾灸等方法，各自坚守其适用的一类，并不是某一个人能够全部施行的。
所谓“病传”，是指邪气从皮毛侵入而发于腠理（皮肤纹理及汗孔），从腠理进入经脉，从经脉流传到五脏。这就是所谓的经络受邪，传入脏腑，属于内因致病。如果邪气传入五脏，就会导致死亡而无法救治。所以，邪气在皮毛的，适宜用砭石去除；在脉、肉、筋、骨的，适宜用针刺泻除；邪气入里的，适宜用导引行气的方法将其引出；寒邪深入体内的，适宜用热熨的方法疏通它；邪气在内且体质虚弱的，只可用甘缓的药物调补；体质实盛的，可用峻烈的药物攻伐；邪气下陷的，适宜用艾灸来升提开启。因此，药物、砭石、艾灸、针刺、导引等各种方法，都是根据众人不同的病情而施用的，并不是某一个人能够全部施行的。这一章教导人们知道疾病传播有浅深之分，如果是可治的情况，就坚守一种方法不要失误，不让大邪传入五脏而成不可救治之症，这是救济万物的功德，都包含在这里了。
如今我听闻阴阳的要领，虚实的道理，邪气倾移的过错，以及可治的疾病类别，希望听听疾病的变化，那些淫邪传变、断绝败坏而不可治愈的情况，可以讲给我听吗？
岐伯说：问得好啊！求道之人，明白时如同白日般清醒，困惑时如同黑夜般昏暗。如果能顺应并服用这些道理，精神就会与之俱成。完全奉行这些道理，精神自然自得。产生和养护精神的道理，可以写在竹简丝帛上，但不能直接传授给子孙（因为需要个人体悟）。
黄帝说：什么叫作“如日醒”？
黄帝说：什么叫作“夜暝”？
岐伯说：寂静无声，淡漠无形。毛发折损，腠理开泄，正气横逆倾覆，淫邪蔓延扩散，血脉流传，大气（大邪）侵入五脏，出现腹痛、下利不止，这会导致死亡，而不能维持生命。
这一段论述形体与精神同时受损生病，则邪气无法进入腠理，不会导致血脉流传，从而形成不可救治的死证。阴阳的关键在于：皮肤肌腠属阳，血脉属阴。肌腠是三焦元气通行汇聚的地方，血脉是神气藏居之处。虚实指的是血气的虚实。如果腠理固密，元气通畅，血脉调和，精神内守，邪气从哪里进入呢？一旦虚弱，邪气就会流传进入五脏，从而导致死亡而无法救治。因此，产生和养护精神的道理，可以写在竹简丝帛上，以教化后世，但不能直接传授给子孙。这是因为调养这种神气，是个人的修养功夫。所谓“倾移之过”，是指毛发折损，腠理开泄，正气横逆倾覆。“可治之属”，是指邪气尚且在皮肤肌腠之间，未至于血脉流传，大邪尚未入脏。这说明邪气在外，仍然属于可治的范围，只要坚守一种方法不失误，不让邪气流入体内。所以善于治病的人，先治皮毛，其次治肌肉，其次治经脉，其次治五脏。治疗五脏的病，一半能活一半会死。如果是间隔传变的（间传），还能生存；如果传变到其所克制的脏器（所胜），就无法治愈了。至于疾病的变化，那些淫邪蔓延、断绝败坏而不可治愈的，就是淫邪蔓延，血脉流传，大邪入脏，导致死亡而无法救治。通晓阴阳，就像疑惑解开，像醉酒醒来。完全奉行这些道理，精神自然自得。这就是所谓上古之人，懂得大道的人，效法阴阳，调和术数，饮食有节制，起居有规律，不妄加劳累，所以能形体与精神俱备，从而享尽天然寿命。寂静无声，淡漠无形，说的是不懂大道的人，肤腠空疏，血脉虚脱。
虚邪贼风侵袭人体很轻微，人们不知道它的实情，看不见它的形状，逐渐导致淫邪入脏，无法救治。邪气侵袭人，始于皮毛，则毛发折断而腠理开泄，开泄则邪气从毛发进入，进入则深入到达腠理。腠理是三焦元气通行汇聚的地方，所以正气横逆倾覆，淫邪在肌腠之间蔓延，就流传到血脉，进而内入五脏。经脉内属于脏腑，外联络形体身躯，所以经脉受邪，传入脏腑，属于内因致病。淫邪在肌腠蔓延则伤气，流传到血脉入脏则伤神。神气同时受伤，所以会导致死亡，而不能维持生命。因此圣人的教诲是：对于虚邪贼风，要适时避开；保持恬淡虚无，使精神内守，病从何而来呢？所以这些道理可以写在竹简丝帛上，是想让天下后世的子孙百姓，都知道这种养生的大道。
黄帝说：大气（大邪）入脏是怎么回事？
岐伯说：疾病首先发作于心，一天后传到肺，三天后传到肝，五天后传到脾。如果三天后病情没有好转就会死亡。死于冬天的半夜，夏天的中午。
这一段论述大邪入脏，传变到它所不能克制的脏器而死。五脏禀受五方五行之气而生，所以生于相生关系，死于相克关系。疾病首先发于心，一天后传给肺，三天后传给肝，五天后传给脾，都是逆向传变到它所不胜（克制）的脏器。再过三天如果不好转就会死亡。心为火脏，冬天主水，夏天主火。冬天的半夜，是水胜火灭的时候；夏天的中午，是火气亢极而自焚的时候。杨元如说：按《素问·玉机真藏论》，病入五脏，逆向传变到所胜之脏，还可以用浴法、药法、灸法来救治。所以说“三日不已死”，是说邪气入脏，还有可以痊愈的生机。所以开头说导引、行气、按摩、灸法、针刺、服药，结尾说各种病依次传变的，都有死期，不可针刺。邪气在形体层次的适宜针刺，入于脏的，只能用按摩、服药来救治。圣人救民的心意，无所不用其极。
疾病首先发作于肺，三天后传到肝，一天后传到脾，五天后传到胃。如果十天病情没有好转就会死亡。死于冬天的日落时分，夏天的日出时分。
杨元如说：肺主气，日出时气开始旺盛，日落时气收敛。冬天的日落，是气入而绝于内；夏天的日出，是气出而绝于外。按：只说冬夏而不说春秋，是因为四时的气候，总归是寒暑的往来。半夜和中午，是阴阳在子午时分分开；日出和日落，是阴阳在卯酉时分分离。疾病传变的一、三、五天，是天生的奇数。五脏生于地上的五行，而本源于天干的变化。
疾病首先发作于肝，三天后传到脾，五天后传到胃，三天后传到肾。如果三天病情没有好转就会死亡。死于冬天的日落时分，夏天的早饭时间。
杨元如说：按《素问·标本病传论》说：肝病头目眩晕，胁肋支撑胀满，三天后身体沉重疼痛，五天后腹胀，三天后腰脊和小腹痛，小腿肿胀。三天不好转就会死亡。死于冬天的日落，夏天的早饭时间。盖因疾病首先发于肝，所以头目眩晕而胁肋支撑胀满。三天后传到脾，则身体沉重疼痛。五天后传到胃，则腹胀。三天后传到肾，则腰脊和小腹痛，小腿肿胀。冬天的日落，夏天的早饭时间，是木气在卯酉金旺之时断绝。
疾病首先发作于脾，一天后传到胃，二天后传到肾，三天后传到膂筋和膀胱。如果十天病情没有好转就会死亡。死于冬天的黄昏人定之时，夏天的晚食时间。
杨元如说：按《素问·标本病传论》说：脾病身体沉重疼痛，一天后腹胀，二天后少腹腰脊痛，小腿肿胀，三天后背膂筋痛，小便闭塞。十天不好转就会死亡。死于冬天的黄昏人定之时，夏天的晚食时间。盖因病发于脾，则身体疼痛沉重。一天后传到胃则腹胀。二天后传到肾，则少腹腰脊痛，小腿肿胀。膂膀胱，是指膀胱附着于脊背的膂筋。所以三天后传到膂膀胱，则背膂筋痛，小便闭塞。人定时在寅时，木旺而土绝。夏天的晚食时在亥时，水泛而土败。
疾病首先发作于胃，五天后传到肾，三天后传到膂膀胱，五天后上行传到心。如果两天病情没有好转就会死亡。死于冬天的半夜，夏天的下午太阳偏西时。（昃，音笛，指太阳偏西）
按：《素问·标本病传论》说：胃病胀满，五天后少腹腰脊痛，小腿肿胀，三天后背腹筋痛，小便闭塞，五天后身体沉重，六天不好转死亡。死于冬天的半夜，夏天的下午太阳偏西时。盖因疾病首先发于胃，所以胀满。五天后传到肾，则少腹腰脊痛，小腿肿胀。三天后传到膂膀胱，则背腹筋痛。五天后上行传到心，则身体沉重。盖心主血脉，血脉是用来濡养筋骨而滑利关节的。二是火的生数，六是水的成数。死于两天，是火的生气断绝；死于六天，是水乘势克制而火灭。所以冬天的半夜，即水乘火灭的意思。夏天的太阳偏西，也是太阳的生气断绝。朱济公说：冬天主水，夏天主火。日昃是盛极开始亏损的时候。
疾病首先发作于肾，三天后传到膂膀胱，三天后上行传到心，三天后传到小肠。如果三天病情没有好转就会死亡。死于冬天的天亮时分，夏天的傍晚时分。
按：《素问·标本病传论》说：肾病者，少腹腰脊痛，小腿肿胀，三天后背膂筋痛，小便闭塞，三天后腹胀，三天后两胁支撑疼痛，两天不好转死亡。盖因疾病首先发于肾，所以少腹腰脊痛，小腿肿胀。三天后传到膂膀胱，则背膂筋痛，小便闭塞。三天后上行传到心，则腹胀。盖足少阴肾脉，下行络属膀胱，上行从腹部注入胸中，入肺络心。这是邪气入脏，也从血脉流传。上一节病在心，所以身体沉重；这里从膀胱上传于心，又从心下传小肠，所以腹胀。冬天的天亮时分，是寅卯木旺的时候，木旺则泄其水气。夏天的傍晚，是土气所主的时候，土克水。三天，是水火生气并绝；两天，是火生气绝。盖疾病将死，有死于先发之脏气绝的，有死于所传之脏气绝的。所以《灵枢》和《素问》中少有不同，学习者应当自行领会。
疾病首先发作于膀胱，五天后传到肾，一天后传到小肠，一天后传到心。如果两天病情没有好转就会死亡。死于冬天的鸡鸣时分，夏天的下午时分。
按：《标本病传论》说：膀胱病，小便闭塞，五天后少腹胀，腰脊痛，小腿肿胀，一天后腹胀，一天后身体痛，两天不好转死亡。盖因病发于膀胱，所以小便闭塞。五天后传到肾，则少腹胀，腰脊痛，小腿肿胀。一天后传到小肠，则腹胀。一天后传到心，所以身体痛。冬天的鸡鸣，夏天的下午，即上一节的大晨和晏晡的时候。按五脏相传，而有膀胱、胃腑的参与，是因为胃居中央，为水谷之海，是五脏生成的本源；太阳经为诸阳主气。
各种疾病依次传变，像这样的都有死期，不可针刺。如果是间隔一脏或二、三、四脏传变的，就可以针刺。
《玉机真藏论》说：五脏相通，转移都有次序。五脏有病，则各传其所胜（所克）。病将死时，必先传行，直到其所不胜（被克）之脏，病乃死。所以像这样的，是逆传其所胜，都有死期，不可针刺。如果是间隔一脏的，就是心传肝，肺传脾，是子行乘母（相生关系）。间隔二脏的，心传脾，肺传肾，是母行乘子，子母之气互相资生。间隔三脏的，心传肾，肺传心，是从所不胜来的，称为微邪。按五脏间传，只有间三而无间四。所谓间四脏，是以脏传之腑，而腑又传之于他脏，盖腑也可以名为脏。杨元如说：按《五脏别论》，黄帝问：我听说方士有的把脑髓当作脏，有的把肠胃当作脏。收藏货物的叫做腑，所以腑也可以名为脏。
Huangdi said: I received the Nine Needles from my teacher and privately studied various medical prescriptions. Among them, are there methods such as Dao Yin (guided breathing and movement), Qi circulation, massage, moxibustion, hot compresses, acupuncture, or herbal medicine that can be adhered to exclusively? Or should all of them be practiced?
Qibo replied: Various prescriptions are treatments suitable for the masses; they are not methods that a single individual can practice in their entirety.
Huangdi said: This is what is meant by "maintaining the One without losing it," which allows one to encompass all things.
This chapter discusses the human body, noting its layers of depth and superficiality, and the deficiency or excess of blood and Qi. Therefore, treatments such as Bian stone therapy, drugs, and moxibustion each adhere to their specific indications; no single person practices all of them.
The term "disease transmission" refers to pathogenic factors entering from the skin hair and manifesting in the interstices (cou-li, the spaces between skin and muscle), then entering the meridians, and finally transmitting to the Zang organs. This is known as pathogens affecting the meridians and entering the Zang-Fu organs, constituting an internal cause. If pathogens enter the Zang organs, death ensues and cannot be saved. Thus, when pathogens are at the level of the skin hair, Bian stone therapy is appropriate to remove them; when at the level of vessels, flesh, sinews, and bones, acupuncture is appropriate to drain them; when pathogens enter the interior, Dao Yin and Qi circulation are appropriate to expel them; when cold pathogens penetrate deeply, hot compresses are appropriate to unblock them; when pathogens are internal and the constitution is deficient, sweet and mild herbs are used to tonify; when the constitution is excess, harsh drugs are used to attack; when pathogens sink downward, moxibustion is appropriate to raise and open them. Therefore, among drugs, stones, moxibustion, acupuncture, and Dao Yin, treatments are applied according to the specific diseases of individuals, not practiced universally by one person. This chapter teaches that disease transmission has degrees of depth. For treatable conditions, one should maintain the correct method without error, preventing major pathogens from entering the Zang organs and becoming incurable. The merit of benefiting all beings is thus fulfilled.
Now, I have heard of the essentials of Yin and Yang, the principles of deficiency and excess, the errors of pathogenic shifting, and categories of treatable diseases. I wish to hear about the changes of diseases, specifically those where excessive pathogens transmit, leading to exhaustion and failure, making them incurable. Can you explain this?
Qibo said: Indeed, asking about the Way! Clarity is like waking up in the bright day; confusion is like falling asleep in the dark night. If one can accept and apply these principles, the spirit will form with them. If one fully applies them, the spirit will naturally attain them. The principles of generating and nourishing the spirit can be recorded on bamboo slips and silk, but cannot be directly transmitted to descendants.
Huangdi said: What do you mean by "like waking up in the bright day"?
Qibo said: Understanding Yin and Yang is like resolving confusion, like waking from a drunken stupor.
Huangdi said: What do you mean by "falling asleep in the dark night"?
Qibo said: Silent and soundless, indistinct and formless. Hair follicles collapse, pores open, upright Qi collapses horizontally, excessive pathogens spread diffusely, blood vessels transmit pathogens, and major Qi (major pathogens) enters the Zang organs. Symptoms include abdominal pain and dysentery. This leads to death and cannot sustain life.
This section discusses how when both form and spirit are diseased, pathogens cannot enter the interstices, nor cause blood vessel transmission, resulting in an incurable fatal syndrome. The essence of Yin and Yang lies in: skin and interstices belong to Yang, while blood vessels belong to Yin. Interstices are where San Jiao (Triple Burner) Yuan Zhen (Primordial True Qi) converges and communicates; blood vessels are where Shen (Spirit) and Qi reside. Deficiency and excess refer to the states of blood and Qi. If interstices are solid and dense, Yuan Zhen is smooth, blood vessels are harmonious, and Spirit is kept within, how can pathogens enter internally? Upon deficiency, pathogens transmit into the Zang organs, leading to death and inability to survive. Thus, the principles of generating and nourishing the spirit can be recorded on bamboo and silk to educate future generations, but cannot be directly passed to descendants. This implies that cultivating this Spirit and Qi is a personal effort of self-cultivation. "Shifting errors" refer to the collapse of hair follicles, opening of pores, and horizontal collapse of upright Qi. "Treatable categories" refer to pathogens remaining in the skin and interstices, not yet transmitting through blood vessels, and major pathogens not having entered the Zang organs. This indicates that external pathogens are still treatable. Maintaining the correct method prevents pathogens from flowing inward. Hence, skilled healers treat the skin hair first, then muscles, then meridians, then Zang organs. Treating Zang organs results in half survival and half death. Intermittent transmission (Jian Chuan) leads to survival; transmission to the organ it overcomes (Suo Sheng) leads to non-treatment. Regarding disease changes, excessive spreading, exhaustion, and incurability occur when pathogens spread diffusely, transmit through blood vessels, and major Qi enters the Zang organs, leading to death. Understanding Yin and Yang is like resolving confusion and waking from drunkenness. Fully applying these principles allows the spirit to attain them naturally. This is why people of ancient times who understood the Dao followed Yin and Yang, harmonized with techniques, regulated diet and起居 (daily routine), did not labor recklessly, thus maintaining form and spirit together to complete their natural lifespan. "Silent and soundless, indistinct and formless" describes those who do not understand the Dao: their skin and pores are loose, and blood vessels are depleted.
Deficient pathogens and thief winds invade humans subtly; their nature is unknown, their form unseen, gradually leading to excessive pathogens entering the Zang organs, which cannot be sustained. Pathogens invading humans begin at the skin hair, causing hair collapse and pore opening. Once opened, pathogens enter from the hair, penetrating deep into the interstices. Interstices are where San Jiao Yuan Zhen converges; thus, upright Qi collapses horizontally. Excessive pathogens spread in the interstices, then transmit to blood vessels and enter the Zang organs internally. Meridians connect internally to Zang-Fu organs and externally to the body. Therefore, meridian pathogens entering Zang-Fu organs constitute an internal cause. Excessive pathogens spreading in interstices damage Qi; transmitting through blood vessels into Zang organs damages Shen. When both Shen and Qi are damaged, death occurs, and life cannot be sustained. Therefore, the teachings of the Sages are: avoid deficient pathogens and thief winds in due time; remain tranquil and empty, keeping the Spirit within; how can disease arise? Thus, these principles can be recorded on bamboo and silk, intending for all people and future generations to know this way of health preservation.
Huangdi said: How does major Qi (major pathogens) enter the Zang organs?
Qibo said: If disease originates in the Heart, it transmits to the Lung after one day, to the Liver after three days, and to the Spleen after five days. If it persists for three more days without improvement, death ensues. Death occurs at midnight in winter and midday in summer.
This section discusses major pathogens entering the Zang organs and transmitting to the organ they cannot overcome (Suo Bu Sheng), leading to death. The Five Zang organs are born from the Qi of the Five Directions and Five Elements; thus, life arises from mutual generation, and death from mutual overcoming. Disease originating in the Heart transmits to the Lung in one day, to the Liver in three days, and to the Spleen in five days. All are reverse transmissions to the organ they cannot overcome. After another three days without improvement, death occurs. The Heart is a Fire organ; Winter governs Water, Summer governs Fire. Midnight in winter represents Water overcoming and extinguishing Fire; midday in summer represents Fire reaching extreme exuberance and self-immolating. Yang Yuanru stated: According to *Su Wen: Yu Ji Zhen Zang Lun*, when disease enters the Five Zang organs and transmits reversely to the overcoming organ, it can still be treated with bathing, medication, and moxibustion. Thus, "death if not improved in three days" means that even if pathogens enter the Zang organs, there is still a chance for recovery. Hence, the beginning mentions Dao Yin, Qi circulation, massage, moxibustion, acupuncture, and drugs, while the end states that diseases transmitting sequentially all have a death period and cannot be treated with acupuncture. Pathogens in the形体 (form/body surface) are suitable for acupuncture; those entering the Zang organs can only be treated with massage and drugs. The Sages' heart to save people leaves no effort unused.
If disease originates in the Lung, it transmits to the Liver after three days, to the Spleen after one day, and to the Stomach after five days. If it persists for ten days without improvement, death ensues. Death occurs at sunset in winter and sunrise in summer.
Yang Yuanru stated: The Lung governs Qi. Qi begins to flourish at sunrise and contracts at sunset. Sunset in winter means Qi enters and is cut off internally; sunrise in summer means Qi exits and is cut off externally. Note: Only Winter and Summer are mentioned because the four seasons' Qi generally belongs to the alternation of cold and heat. Midnight and midday represent the separation of Yin and Yang at Zi and Wu hours; sunrise and sunset represent the separation of Yin and Yang at Mao and You hours. The days of transmission (1, 3, 5) are heavenly odd numbers. The Five Zang organs are born from the Earth's Five Elements but originate from the transformation of Heavenly Stems.
If disease originates in the Liver, it transmits to the Spleen after three days, to the Stomach after five days, and to the Kidney after three days. If it persists for three more days without improvement, death ensues. Death occurs at sunset in winter and at breakfast time in summer.
Yang Yuanru stated: According to *Su Wen: Ben Biao Bing Zhuan Lun*: Liver disease causes dizziness and vertigo of the head and eyes, fullness and distension in the hypochondrium. After three days, the body feels heavy and painful. After five days, abdominal distension occurs. After three more days, pain in the lower abdomen, lumbar region, and small abdomen, along with swelling of the calves, appears. If not improved in three days, death ensues. Death occurs at sunset in winter and breakfast time in summer. Since disease originates in the Liver, there is dizziness and hypochondriac fullness. Transmission to the Spleen after three days causes heaviness and pain. Transmission to the Stomach after five days causes distension. Transmission to the Kidney after three days causes lower abdominal and lumbar pain with calf swelling. Sunset in winter and breakfast time in summer are times when Wood Qi is exhausted during the Metal-dominant Mao and You hours.
If disease originates in the Spleen, it transmits to the Stomach after one day, to the Kidney after two days, and to the Lumbar Sinews and Bladder after three days. If it persists for ten days without improvement, death ensues. Death occurs at "Ren Ding" (early evening/settling time) in winter and at late meal time in summer.
Yang Yuanru stated: According to *Su Wen: Ben Biao Bing Zhuan Lun*: Spleen disease causes heavy body and pain. After one day, distension occurs. After two days, lower abdominal, lumbar, and spinal pain with calf swelling appears. After three days, pain in the back and lumbar sinews occurs, along with urinary retention. If not improved in ten days, death ensues. Death occurs at Ren Ding in winter and late meal time in summer. Since disease originates in the Spleen, there is body pain and heaviness. Transmission to the Stomach after one day causes distension. Transmission to the Kidney after two days causes lower abdominal, lumbar, and spinal pain with calf swelling. "Lumbar Sinews and Bladder" refers to the Bladder attached to the lumbar sinews on the back. Thus, transmission to the Lumbar Sinews and Bladder after three days causes back and lumbar sinew pain and urinary retention. Ren Ding corresponds to the Yin hour, where Wood is prosperous and Earth is exhausted. Late meal time in summer corresponds to the Hai hour, where Water floods and Earth fails.
If disease originates in the Stomach, it transmits to the Kidney after five days, to the Lumbar Sinews and Bladder after three days, and ascends to the Heart after five days. If it persists for two more days without improvement, death ensues. Death occurs at midnight in winter and at "Ri Ze" (afternoon sun slanting) in summer. (Ze sounds like 'di', meaning the sun is past its zenith).
Note: *Su Wen: Ben Biao Bing Zhuan Lun* states: Stomach disease causes abdominal fullness. After five days, lower abdominal, lumbar, and spinal pain with calf swelling occurs. After three days, back and abdominal sinew pain and urinary retention appear. After five days, the body feels heavy. If not improved in six days, death ensues. Death occurs at midnight in winter and Ri Ze in summer. Since disease originates in the Stomach, there is fullness. Transmission to the Kidney after five days causes lower abdominal, lumbar, and spinal pain with calf swelling. Transmission to the Lumbar Sinews and Bladder after three days causes back and abdominal sinew pain. Ascending to the Heart after five days causes body heaviness. The Heart governs blood vessels, which nourish sinews and bones and lubricate joints. Two is the generative number of Fire; Six is the completed number of Water. Death on the second day signifies the extinction of Fire's generative Qi; death on the sixth day signifies Water overpowering and extinguishing Fire. Thus, midnight in winter signifies Water overpowering and extinguishing Fire. Ri Ze in summer also signifies the extinction of Taiyang's generative Qi. Zhu Jigong stated: Winter governs Water, Summer governs Fire. Ri Ze is the time when prosperity begins to decline.
If disease originates in the Kidney, it transmits to the Lumbar Sinews and Bladder after three days, ascends to the Heart after three days, and transmits to the Small Intestine after three days. If it persists for three more days without improvement, death ensues. Death occurs at "Da Chen" (early morning/dawn) in winter and at "Yan Bu" (late afternoon/evening) in summer.
Note: *Su Wen: Ben Biao Bing Zhuan Lun* states: Kidney disease causes lower abdominal, lumbar, and spinal pain with calf swelling. After three days, back and lumbar sinew pain and urinary retention occur. After three days, abdominal distension appears. After three more days, bilateral hypochondriac fullness and pain occur. If not improved in two days, death ensues. Since disease originates in the Kidney, there is lower abdominal, lumbar, and spinal pain with calf swelling. Transmission to the Lumbar Sinews and Bladder after three days causes back and lumbar sinew pain and urinary retention. Ascending to the Heart after three days causes abdominal distension. The Foot Shaoyin Kidney Meridian descends to connect with the Bladder, ascends from the abdomen to the chest, enters the Lung, and connects with the Heart. This is pathogens entering the Zang organs, also transmitting via blood vessels. In the previous section, disease was in the Heart, causing body heaviness; here, it transmits from the Bladder to the Heart, then descends from the Heart to the Small Intestine, causing abdominal distension. Da Chen in winter is the Yin-Mao hour, when Wood is prosperous, draining Water Qi. Yan Bu in summer is when Earth Qi dominates, as Earth overcomes Water. Three days signify the simultaneous extinction of Water and Fire's generative Qi; two days signify the extinction of Fire's generative Qi. Diseases nearing death may die from the extinction of the initially affected Zang organ's Qi or the transmitted Zang organ's Qi. Thus, slight differences exist between *Ling Shu* and *Su Wen*; students should comprehend this.
If disease originates in the Bladder, it transmits to the Kidney after five days, to the Small Intestine after one day, and to the Heart after one day. If it persists for two more days without improvement, death ensues. Death occurs at "Ji Ming" (cockcrow) in winter and at "Xia Bu" (late afternoon) in summer.
Note: *Biao Ben Bing Zhuan Lun* states: Bladder disease causes urinary retention. After five days, lower abdominal distension, lumbar and spinal pain, and calf swelling occur. After one day, abdominal distension appears. After one day, body pain occurs. If not improved in two days, death ensues. Since disease originates in the Bladder, there is urinary retention. Transmission to the Kidney after five days causes lower abdominal distension, lumbar and spinal pain, and calf swelling. Transmission to the Small Intestine after one day causes abdominal distension. Transmission to the Heart causes body pain. Ji Ming in winter and Xia Bu in summer correspond to Da Chen and Yan Bu mentioned earlier. Regarding the transmission of the Five Zang organs, the involvement of the Bladder and Stomach Fu organs is because the Stomach resides in the center, serves as the Sea of Water and Grain, and is the source of generation for the Five Zang organs; the Taiyang channel governs the Qi of all Yang channels.
When various diseases transmit sequentially as described, all have a death period and cannot be treated with acupuncture. If transmission skips one Zang organ, or two, three, or four Zang organs, acupuncture may be used.
*Yu Ji Zhen Zang Lun* states: The Five Zang organs are interconnected, and shifts follow a sequence. When disease affects the Five Zang organs, it transmits to the organ it overcomes (Suo Sheng). Nearing death, transmission must proceed until it reaches the organ it cannot overcome (Suo Bu Sheng), at which point the patient dies. Therefore, such cases involve reverse transmission to the overcoming organ, all having a death period and being unsuitable for acupuncture. Skipping one Zang organ means Heart transmits to Liver, or Lung to Spleen; this is the Son acting upon the Mother (generation relationship). Skipping two Zang organs means Heart transmits to Spleen, or Lung to Kidney; this is the Mother acting upon the Son, where Mother and Son Qi mutually support each other. Skipping three Zang organs means Heart transmits to Kidney, or Lung to Heart; coming from the organ one cannot overcome is considered minor evil. Regarding inter-transmission of the Five Zang organs, there is skipping three but not skipping four. "Skipping four" refers to transmission from Zang to Fu, and then from Fu to another Zang; thus, Fu organs can also be named Zang. Yang Yuanru stated: According to *Wu Zang Bie Lun*, Huangdi asked: I have heard that some physicians consider brain and marrow as Zang, or intestines and stomach as Zang. Those that store goods are called Fu; therefore, Fu can also be named Zang.