此论经脉之热病也。厥阴之上，风气主之；少阴之上，热气主之；太阴之上，湿气主之；少阳之上，火
气主之；阳明之上，燥气主之；太阳之上，寒气主之。风热湿火燥寒，六气之本也。厥阴、少阴、太阴、
少阳、阳明、太阳，六气之标也。凡人之生，主气之次，始于厥阴，终于太阳，从阴而阳，循环无已，所
谓神转不回。若病伤寒，则始于太阳，终于厥阴，从阳而阴，所谓回则不转，乃失其机。此云巨阳、阳明、
少阳等，乃人身三阳三阴之经脉也。巨阳受之、阳明受之、少阳受之等，乃三阳三阴，各受寒邪而病热
也。一日巨阳、二日阳明、三日少阳等，乃以六日而明六经也。三阳三阴，各受为病，一日受者，七日愈；
二日受者，八日愈；三日受者，九日愈；四日受者，十日愈；五日受者，十一日愈∶六日受
者，十二日愈，究而言之，皆一日受而七日愈，期虽有次，非一定也。两感于寒，则阴阳俱病，腑脏皆伤，
不免于死。气化无形，经脉有形，故下即有刺热之篇，复有评热之论。此篇只论人身经脉受
病，不论标本气化，后仲景《伤寒论》，论标本气化者，与此热论不同也。
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。
人身经脉调和，则无寒无热；经脉不和，则或寒或热，故热病者，皆伤寒之类。其病或愈或死，期日不同，故以为
问。
岐伯对曰∶巨阳者，诸阳之属也，其脉连于风府，故为诸阳主气也。
巨阳，太阳也。阳热之气，病于通体，故曰巨阳。诸阳之气，皆巨阳通体所主，故巨阳者，诸阳之
属也。若论其脉，则上连督脉之风府，督脉督于阳，故为诸阳主气也。
人之伤于寒也，则为病热，热虽甚不死，其两感于寒而病者，必不免于死。
热病者，伤寒之类，故人之伤于寒也，则为病热。热者人身阳热之气，阳常有余，故热虽甚不死。其两
感于寒而病者，阳脉受寒，阴脉亦受寒，阴阳皆受，腑脏俱伤，故必不免于死。所以或愈或死也。
帝曰，愿闻其状。
病经脉之有形，则有诸脉受病之状，故愿闻之。
岐伯曰∶伤寒一日，巨阳受之，故头项痛、腰脊强。
强，去声。试以六经受病言之，如伤寒一日，通体之巨阳受之，上文云其脉连于风府，风府，项也，从
项而上，故头项痛，从项而下，故腰脊强，此巨阳之脉受病为然。今以一日受之而明其状。
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。
阳明之脉，则以二日受之，而明其状，阳明者，土也，故阳明主肉，其脉起于鼻交 中，旁约太阳之脉，
故挟鼻络于目。主肉，故身热；络于目，故目疼；挟鼻，故鼻干；阳明胃不和，故不得卧也。
三日少阳受之，少阳主胆，其脉循胁，络于耳，故胸胁痛而耳聋。
少阳之脉，则以三日受之，而明其状。少阳者木也，故少阳主胆。其脉下胸中，循胁里，其支从耳后，
入耳中，出走耳前，故循胁络于耳。循胁，故胸胁痛，络耳，故耳聋。
三阳经络，皆受其病，而未入于脏者，故可汗而已。
结上文三阳受病，非比一日太阳，二日阳明，三日少阳，故三阳经络，一日皆受其病，三阳主六
腑，而未入于三阴之五脏，故可汗而已，此热虽甚不死也。
四日太阴受之，太阴脉布胃中，络于嗌，故腹满而嗌干。
太阴之脉，则以四日受之而明其状。其脉属脾络胃，挟咽，连
舌本，故太阴脉布胃中、络于嗌。布胃中，故腹满，络于嗌，故嗌干。
五日少阴受之，少阴脉贯肾，络于肺，系舌本，故口燥舌干而渴。
少阴之脉，则以五日受之，而明其状，其脉从肾，上贯肝膈入
肺中，循喉咙、挟舌本，故少阴脉贯肾、络于肺、系舌本。少阴水火不相交济，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。
厥阴之脉，则以六日受之，而明其状。厥阴肝脉过阴器，抵小
腹，故厥阴脉循阴器而络于肝。厥阴木气逆、火气盛，故烦满。循阴器，故囊缩。
三阴三阳，五脏六腑皆受病，荣卫不行，五脏不通、则死矣。
则，犹即也。结上文三阴受病，非必四日太阴、五日少阴、六日厥阴，故内之三阴，外之三阳，内
之五脏，外之六腑，一日皆受其病，致荣卫不行，五脏不通，即死矣。较之两感于寒不免于死者更甚也。
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。
其不两感于寒，属经脉之热病，皆以七日环复，病衰而愈，由
此观之，则上文所云，一日受二日受者，乃循次言之，非一定不移之期日也。会悟圣经，当勿以辞害意。
帝曰∶治之奈何？
治得其宜，不必七日始愈，故以为问。
岐伯曰∶治之各通其脏脉，病日衰已矣。
脏脉者，如上文太阴脾脏之脉、少阴肾脏之脉、厥阴肝脏之脉
也。治之而各通其脏脉，则病日渐衰而可已，如是则免于死矣。
其未满三日者，可汗而已；其满三日者，可泄而已。
若病在三阳，其未满三日而在外者，可汗而已；其满三日而在内者，可泄而已，如是，不必七日环复而始愈矣。
帝曰∶热病已愈，时有所遗者，何也？
承汗已泄已之意，而问时有所遗，未全愈者何也？
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，因其谷气相薄，两热相合，故有所遗也。
强，上声。食，音饲。藏，如字。诸遗者，乃热甚之时，而强食之，故有所遗也。又言若此者，皆外
热之病已衰，而内热有所藏，因其谷气与所藏之热相薄，相薄则阳明胃热，与所藏之热，两热相合，故有所遗也。
帝曰∶善。治遗奈何？
病遗未愈，何以治之。
岐伯曰∶视其虚实，调其逆从，可使必已矣。
视其经脉之虚实，调其阴阳之逆从，如是以治，可使病之必已，而无遗矣
帝曰∶病热当何禁之？
病有所遗，而复治之，不若当其病时而禁忌之，故问病热何禁。
岐伯曰∶病热少愈，食肉则复，多食则遗，此其禁也。
病热少愈，未全愈时，毋食肉，毋多食。食肉则重浊难消，热病当复；多食则谷气相薄，病有所遗。
食肉、多食，此其禁也。
帝曰∶其病两感于寒者，其脉应与其病形何如？
应，平声。形，犹状也。诸脉受病之状，上文详言之，此复问两感于寒之脉状。
岐伯曰∶两感于寒者，病一日，则巨阳与少阴俱病，则头痛、口干而烦满；二日则阳明与太阴
俱病，则腹满、身热、不欲食、谵言；三日则少阳与厥阴俱病，则耳聋、囊缩而厥、水浆不入、不知
人，六日死。
所谓两感于寒者，巨阳与少阴、阳明与太阴、少阳与厥阴，皆
表里雌雄相应。故病一日，则巨阳与少阴俱病。病巨阳之脉状，则头痛，病少阴之脉状，则口干而烦满。二
日则阳明与太阴俱病，病太阴之脉状，则腹满身热，病阳明之脉状，则不欲食、谵言。三日
则少阳与厥阴俱病，病少阳之脉状，则耳聋，病厥阴之脉状，则囊缩而厥。夫三阳以胃气为本，三阴以神
气为先，水浆不入，胃气绝矣∶不知人，神气亡矣。至六日，则不能环复而死，言巨阳少阴、
阳明太阴、少阳厥阴皆以六日为期而死，则一日二日三日，有次序而非一定，亦当意会者也。
帝曰∶五脏已伤，六腑不通，荣卫不行，如是之后，三日乃死何也？
承上文三阴三阳、五脏六腑皆受病，荣卫不行、五脏不通，则死之意，而问三日乃死，非即死矣。
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。
长，上声。五脏六腑，神气营运，皆禀气于胃，故阳明者，乃十二经脉之长也。阳明多气多血，故其血
气盛，不知人，则神气已绝。而阳明之气未绝，故不知人三日，其阳明之气乃尽，故死矣。虽不即死，犹之死也。
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。
冬伤于寒，春必病温，故凡病伤寒而成温者，先夏至日而发者为病温，后夏至日而发者为病暑。温，犹
热也。暑，热之极也。暑热之病，汗出而散，温热之病，亦当汗出，故暑当与汗而皆出勿
止，汗虽多不可止之也。上文热病随感随发，与寒气留连伏匿而发者不同，故举温暑以别上文热病之意。
这是论述经脉热病的篇章。厥阴经之上，由风气所主；少阴经之上，由热气所主；太阴经之上，由湿气所主；少阳经之上，由火气所主；阳明经之上，由燥气所主；太阳经之上，由寒气所主。风、热、湿、火、燥、寒，是六气（自然界六种气候因素）的根本。厥阴、少阴、太阴、少阳、阳明、太阳，是六气的标象（外在表现）。大凡人的生机，主气的次序，始于厥阴，终于太阳，从阴向阳转化，循环往复没有止境，这就是所说的“神转不回”（生机流转而不逆转）。如果患伤寒病，则始于太阳经，终于厥阴经，从阳向阴传变，这就是所说的“回则不转”（逆转则生机停滞），于是失去了正常的生理机制。这里所说的巨阳（即太阳经）、阳明、少阳等，是指人身三阳和三阴的经脉。巨阳受邪、阳明受邪、少阳受邪等，是指三阳和三阴各自感受寒邪而发为热病。第一天巨阳受病、第二天阳明受病、第三天少阳受病等，是用六天来阐明六经的传变规律。三阳三阴，各自受邪发病，第一天受邪的，第七日痊愈；第二天受邪的，第八日痊愈；第三天受邪的，第九日痊愈；第四天受邪的，第十日痊愈；第五天受邪的，第十一日痊愈；第六天受邪的，第十二日痊愈。究其根本而言，都是第一天受邪而第七日痊愈，日期虽有先后次序，但并非绝对固定。如果两感于寒（表里两经同时受邪），则阴阳经脉都发病，脏腑都受伤，不免于死亡。气化是无形的，经脉是有形的，所以下面紧接着有刺热篇，又有评热论。这一篇只论述人身经脉受邪发病，不论标本和气化，后来张仲景的《伤寒论》，论述标本气化的，与这篇热论不同。
黄帝问道：如今的热病，都属于伤寒一类，有的痊愈，有的死亡，死亡的都在六七天之间，痊愈的都在十日以上，为什么呢？我不明白其中的道理，希望听听原因。
人身经脉调和，就没有寒热之病；经脉不和，就会或寒或热，所以热病，都属于伤寒一类。病情有的痊愈有的死亡，病程日期不同，所以提出疑问。
岐伯回答说：巨阳经，是诸阳经的统领，它的脉连于风府穴，所以是诸阳经的主气所在。
巨阳，就是太阳经。阳热之气，遍布全身，所以叫巨阳。诸阳之气，都由巨阳经全身所统主，所以巨阳经是诸阳经的统领。如果论及其经脉，则向上连属督脉的风府穴，督脉总督诸阳，所以是诸阳经的主气所在。
人受了寒邪，就会发为热病，热势虽然严重也不会死，那些两感于寒而发病的，必定不免于死亡。
热病，属于伤寒一类，所以人受了寒邪，就会发为热病。热是人体内的阳热之气，阳气通常有余，所以热势虽然严重也不会死。那些两感于寒而发病的，阳脉受寒，阴脉也受寒，阴阳都受邪，脏腑都受伤，所以必定不免于死亡。因此有的痊愈有的死亡。
皇帝说：希望听听它的症状表现。
病在经脉这种有形之物上，就有各条经脉受病的症状，所以希望听听。
强，读去声。试以六经受病来说明，比如伤寒第一天，全身的巨阳经受邪，上文说它的脉连于风府，风府在项部，脉从项部向上，所以头痛，从项部向下，所以腰脊强直，这是巨阳经脉受病的缘故。现在用第一天受邪来说明其症状。
第二天阳明经受邪，阳明经主管肌肉，它的脉挟持鼻旁联络眼睛，所以身体发热、目痛、鼻干，不能安卧。
阳明经的脉，在第二天受邪，从而说明其症状。阳明经属土，所以阳明经主管肌肉，它的脉起于鼻旁交于目中，旁边约束太阳经的脉，所以挟持鼻旁联络眼睛。主管肌肉，所以身体发热；联络眼睛，所以目痛；挟持鼻旁，所以鼻干；阳明胃气不和，所以不能安卧。
第三天少阳经受邪，少阳经主管胆，它的脉循行于胁肋，联络耳朵，所以胸胁疼痛且耳聋。
少阳经的脉，在第三天受邪，从而说明其症状。少阳经属木，所以少阳经主管胆。它的脉下行经过胸中，循行于胁肋内部，其分支从耳后进入耳中，走出耳前，所以循行于胁肋联络耳朵。循行于胁肋，所以胸胁痛；联络耳朵，所以耳聋。
三阳经的经络都受了病邪，但病邪未传入五脏，所以可以通过发汗的方法治愈。
总结上文三阳经受病，不像第一天太阳、第二天阳明、第三天少阳那样依次单独受病，而是三阳经络一天之内都受病。三阳经主六腑，病邪未传入三阴经的五脏，所以可以通过发汗治愈，这就是前面说的热势虽重也不致死的原因。
第四天太阴经受邪，太阴经的脉散布在胃中，联络咽喉，所以腹部胀满且咽喉干燥。
太阴经的脉，在第四天受邪，从而说明其症状。它的脉属脾络胃，挟持咽喉，连系舌根，所以太阴经的脉散布在胃中、联络咽喉。散布在胃中，所以腹部胀满；联络咽喉，所以咽喉干燥。
第五天少阴经受邪，少阴经的脉贯穿肾脏，联络肺脏，系连舌根，所以口燥舌干且口渴。
少阴经的脉，在第五天受邪，从而说明其症状，它的脉从肾脏上行，贯穿肝膈进入肺中，循行喉咙、挟持舌根，所以少阴经的脉贯穿肾脏、联络肺脏、系连舌根。少阴经水火不能相交济，所以口燥舌干且口渴。
第六天厥阴经受邪，厥阴经的脉循行于阴器，联络肝脏，所以心烦腹满且阴囊收缩。
厥阴经的脉，在第六天受邪，从而说明其症状。厥阴肝脉经过阴器，抵达小腹，所以厥阴经的脉循行于阴器而联络肝脏。厥阴木气逆乱、火气旺盛，所以心烦腹满。循行于阴器，所以阴囊收缩。
三阴三阳，五脏六腑都受了病邪，营卫之气运行停止，五脏气机不通，就会死亡。
则，就是即的意思。总结上文三阴经受病，不一定是第四天太阴、第五天少阴、第六天厥阴依次受病，所以内部的三阴，外部的三阳，内部的五脏，外部的六腑，一天之内都受病，导致营卫之气运行停止，五脏气机不通，就会立即死亡。这比两感于寒不免于死亡的情况更严重。
那些没有两感于寒的，第七天巨阳经病势衰退，头痛稍有好转；第八天阳明经病势衰退，身体发热稍有好转；第九天少阳经病势衰退，耳聋稍微能听到声音；第十天太阴经病势衰退，腹部胀满消退如常，开始想吃东西；第十一天少阴经病势衰退，口渴停止，腹不满，舌干已愈，并且打喷嚏；第十二天厥阴经病势衰退，阴囊松弛，小腹胀满轻微减轻，大气（邪气）都已去除，病一天天好了。
那些没有两感于寒的，属于经脉的热病，都以七日为一个循环周期，病势衰退而痊愈，由此看来，上文所说的一天受邪、两天受邪等，是顺着次序讲的，不是绝对固定的日期。领会经典圣意，应当不要因拘泥文字而损害原意。
皇帝说：怎么治疗呢？
治疗得当，不必等到七日才痊愈，所以提出疑问。
岐伯说：治疗时要分别疏通各经的脏脉，病势就会日渐衰退而痊愈。
脏脉，就像上文提到的太阴脾脏之脉、少阴肾脏之脉、厥阴肝脏之脉等。治疗时分别疏通各经的脏脉，病势就会日渐衰退而可以痊愈，像这样就能免于死亡了。
病程未满三天的，可以通过发汗治愈；病程已满三天的，可以通过泄热治愈。
如果病在三阳经，病程未满三天且病邪在外的，可以通过发汗治愈；病程已满三天且病邪在内的，可以通过泄热治愈，像这样，不必等到七日循环周期结束才能痊愈。
皇帝说：热病已经痊愈，但时常还有余热遗留，为什么呢？
承接上文发汗和泄热的意思，询问为何有时还有余热遗留，未能完全痊愈。
岐伯说：各种余热遗留的情况，是因为热势严重时强行进食，所以有遗留；像这种情况，都是病邪已衰退，但热邪有所潜藏，因为谷气（食物之气）与潜藏的热邪相互搏结，两热相合，所以有遗留。
强，读上声。食，音饲。藏，按字面读音。各种余热遗留，是在热势严重时强行进食，所以有遗留。又说像这种情况，都是体表的病邪已衰退，但体内的热邪有所潜藏，因为谷气与潜藏的热邪相互搏结，相互搏结则导致阳明胃热与潜藏的热邪，两热相合，所以有遗留。
皇帝说：好。治疗余热遗留怎么办？
病邪遗留未愈，如何治疗。
岐伯说：观察虚实，调理逆从，可以使病必愈。
观察经脉的虚实，调理阴阳的逆从，像这样治疗，可以使病必愈，而没有遗留。
皇帝说：热病应当禁忌什么？
有了余热遗留，再进行治疗，不如在患病当时就加以禁忌，所以问热病应当禁忌什么。
岐伯说：热病稍见好转时，吃肉就会复发，多吃就会遗留余热，这是需要禁忌的。
热病稍见好转，尚未完全痊愈时，不要吃肉，不要多吃。吃肉则油腻难消化，热病就会复发；多吃则谷气与热邪相搏结，病会有遗留。
吃肉、多吃，这是需要禁忌的。
皇帝说：那些两感于寒的病人，他们的脉象和病症表现是怎样的？
应，读平声。形，就是状的意思。各条经脉受病的状况，上文已详细讲述，这里又问两感于寒的脉状。
岐伯说：两感于寒的病人，第一天，巨阳经与少阴经同时发病，就会出现头痛、口干且心烦腹满；第二天，阳明经与太阴经同时发病，就会出现腹部胀满、身体发热、不想吃东西、说胡话；第三天，少阳经与厥阴经同时发病，就会出现耳聋、阴囊收缩且四肢厥冷、水浆不进、神志昏迷，到第六天死亡。
所谓两感于寒，是指巨阳与少阴、阳明与太阴、少阳与厥阴，都是表里、雌雄相应的经脉。所以第一天，巨阳经与少阴经同时发病。病在巨阳经的症状，是头痛；病在少阴经的症状，是口干且心烦腹满。第二天，阳明经与太阴经同时发病，病在太阴经的症状，是腹部胀满身体发热；病在阳明经的症状，是不想吃东西、说胡话。第三天，少阳经与厥阴经同时发病，病在少阳经的症状，是耳聋；病在厥阴经的症状，是阴囊收缩且四肢厥冷。三阳经以胃气为本，三阴经以神气为先，水浆不进，说明胃气绝了；神志昏迷，说明神气亡了。到了第六天，就不能完成循环而死亡，意思是巨阳少阴、阳明太阴、少阳厥阴都以第六天为期而死亡，那么第一天、第二天、第三天，虽然有次序但不是绝对固定的，也应当通过意会来理解。
皇帝说：五脏已经受伤，六腑不通，营卫不行，像这样的情况之后，还要过三天才死亡，为什么呢？
承接上文三阴三阳、五脏六腑都受病，营卫不行、五脏不通就会死亡的意思，而问为何还要过三天才死，而不是立即死亡。
岐伯说：阳明经，是十二经脉之长，它的血气旺盛，所以神志昏迷三天，它的元气耗尽才死亡。
长，读上声。五脏六腑的神气营运，都禀受于胃气，所以阳明经是十二经脉之长。阳明经多气多血，所以血气旺盛，神志昏迷，说明神气已绝。但阳明经的元气尚未绝尽，所以神志昏迷三天，阳明经的元气才耗尽，所以死亡。虽然不是立即死亡，但也等同于死亡。
凡是患伤寒而转化为温病的，在夏至日之前发病的叫温病，在夏至日之后发病的叫暑病。暑病应当随着汗液一起排出，不要止汗。
冬天伤了寒邪，春天必然发生温病，所以凡是患伤寒而转化为温病的，在夏至日之前发作的叫温病，在夏至日之后发作的叫暑病。温，就是热。暑，是热的极致。暑热之病，随汗出而消散，温热之病，也应当随汗出，所以暑病应当随汗而出，不要止住，即使汗出很多也不可止住。上文的热病是随感随发，与寒气留连伏匿而后发的情况不同，所以举出温病和暑病来区别上文热病的含义。
This section discusses heat diseases of the meridians. Above Jueyin (Liver/Pericardium), Wind Qi governs; above Shaoyin (Heart/Kidney), Heat Qi governs; above Taiyin (Spleen/Lung), Dampness Qi governs; above Shaoyang (Gallbladder/Triple Burner), Fire Qi governs; above Yangming (Stomach/Large Intestine), Dryness Qi governs; above Taiyang (Bladder/Small Intestine), Cold Qi governs. Wind, Heat, Dampness, Fire, Dryness, and Cold are the root of the Six Qi (Six Climatic Factors). Jueyin, Shaoyin, Taiyin, Shaoyang, Yangming, and Taiyang are the markers (external manifestations) of the Six Qi. In human life, the sequence of governing Qi begins with Jueyin and ends with Taiyang, transforming from Yin to Yang in an endless cycle, which is called "Shen Zhuan Bu Hui" (the spirit turns without reversing). If one contracts Shanghan (Cold Damage), it begins at Taiyang and ends at Jueyin, transforming from Yang to Yin, which is called "Hui Ze Bu Zhuan" (reversal leads to stagnation), thus losing its mechanism. The mention here of Jutai (Taiyang), Yangming, Shaoyang, etc., refers to the three Yang and three Yin meridians of the body. When Jutai receives [pathogen], Yangming receives, Shaoyang receives, etc., it means the three Yang and three Yin meridians each receive Cold pathogen and develop heat disease. One day Jutai, two days Yangming, three days Shaoyang, etc., use six days to illustrate the transmission of the Six Meridians. When the three Yang and three Yin meridians each receive pathogen and become diseased: those receiving on the first day recover on the seventh; those on the second day recover on the eighth; on the third day, the ninth; fourth day, the tenth; fifth day, the eleventh; sixth day, the twelfth. Ultimately speaking, all receive on the first day and recover on the seventh; although there is a sequence, it is not absolute. If suffering from Lianggan Yu Han (Double Exposure to Cold, where exterior and interior meridians are simultaneously affected), both Yin and Yang meridians become diseased, and zang-fu organs are injured, death is inevitable. Qi transformation is formless, while meridians have form; hence, the following chapter on acupuncture for heat exists, along with discussions on evaluating heat. This chapter only discusses meridian diseases, not the root/markers or qi transformation. Later, Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage) discusses root/markers and qi transformation, differing from this *Re Lun*.
Yellow Emperor asked: "Now, heat diseases all belong to the category of Shanghan. Some recover, some die; those who die do so within six to seven days, and those who recover do so after ten days. Why is this? I do not understand the explanation and wish to hear the reason."
When the meridians of the body are harmonious, there is no cold or heat; when meridians are disharmonious, there may be cold or heat. Thus, heat diseases all belong to the category of Shanghan. Since the outcome varies between recovery and death with different durations, a question is raised.
Qibo replied: "Jutai is the leader of all Yang meridians; its vessel connects to Fengfu (GV16), thus it is the master of Qi for all Yang meridians."
Jutai is Taiyang. Yang-Heat Qi affects the entire body, hence called Jutai. The Qi of all Yang meridians is governed by the entire body of Jutai, hence Jutai is the leader of all Yang meridians. Regarding its vessel, it connects superiorly to Fengfu of the Du Mai (Governor Vessel); since Du Mai supervises Yang, it is the master of Qi for all Yang meridians.
When humans are injured by Cold, they develop heat disease. Even if the heat is severe, death does not occur; however, those who suffer from Lianggan Yu Han will inevitably die.
Heat disease belongs to Shanghan; thus, injury by Cold leads to heat disease. Heat is the Yang-Heat Qi of the body. Yang is usually in excess, so even severe heat does not cause death. In cases of Lianggan Yu Han, Yang vessels receive Cold, and Yin vessels also receive Cold; both Yin and Yang are affected, and zang-fu organs are injured, hence death is inevitable. This explains why some recover and some die.
The Emperor said: "I wish to hear the symptoms."
Since the disease is in the tangible meridians, there are specific symptoms for each affected meridian, hence the request to hear them.
Qibo said: "On the first day of Shanghan, Jutai receives [the pathogen], resulting in headache, pain in the neck and spine, and stiffness."
'Qiang' is pronounced with the departing tone. To explain via the six meridians: on the first day, the whole-body Jutai receives [the pathogen]. As mentioned earlier, its vessel connects to Fengfu, located at the nape. The vessel goes up from the nape, causing headache; it goes down from the nape, causing stiffness in the waist and spine. This is how Jutai meridian disease presents. Now, using the first day of infection to illustrate the symptoms.
On the second day, Yangming receives [the pathogen]. Yangming governs the flesh; its vessel runs alongside the nose and connects to the eyes. Thus, there is fever, eye pain, dry nose, and inability to sleep.
Yangming vessel receives [the pathogen] on the second day, illustrating its symptoms. Yangming corresponds to Earth, hence it governs the flesh. Its vessel originates beside the nose, crossing at Yingxiang (LI20), and binds alongside Taiyang’s vessel, running alongside the nose and connecting to the eyes. Governing the flesh causes fever; connecting to the eyes causes eye pain; running alongside the nose causes dry nose; disharmony of Yangming Stomach causes inability to sleep.
On the third day, Shaoyang receives [the pathogen]. Shaoyang governs the Gallbladder; its vessel follows the hypochondrium and connects to the ears. Thus, there is pain in the chest and hypochondrium, and deafness.
Shaoyang vessel receives [the pathogen] on the third day, illustrating its symptoms. Shaoyang corresponds to Wood, hence it governs the Gallbladder. Its vessel descends through the chest, follows the interior of the hypochondrium; its branch enters the ear from behind, exits anterior to the ear. Following the hypochondrium causes chest/hypochondriac pain; connecting to the ear causes deafness.
When the sinews and vessels of the Three Yang meridians are all diseased, but the pathogen has not entered the Zang organs, it can be cured by sweating.
Summarizing the previous text regarding Three Yang meridian disease: unlike the sequential single-meridian involvement (Day 1 Taiyang, Day 2 Yangming, Day 3 Shaoyang), the Three Yang sinews and vessels are all affected on the first day. Three Yang govern the Six Fu organs, and the pathogen has not entered the Five Zang organs of the Three Yin. Therefore, it can be cured by inducing sweat. This is why severe heat does not lead to death.
On the fourth day, Taiyin receives [the pathogen]. Taiyin vessel spreads in the stomach and connects to the throat. Thus, there is abdominal fullness and dry throat.
Taiyin vessel receives [the pathogen] on the fourth day, illustrating its symptoms. Its vessel belongs to Spleen, connects to Stomach, flanks the pharynx, and connects to the root of the tongue. Hence, Taiyin vessel spreads in the stomach and connects to the throat. Spreading in the stomach causes abdominal fullness; connecting to the throat causes dry throat.
On the fifth day, Shaoyin receives [the pathogen]. Shaoyin vessel penetrates the Kidney, connects to the Lung, and ties to the root of the tongue. Thus, there is dry mouth, dry tongue, and thirst.
Shaoyin vessel receives [the pathogen] on the fifth day, illustrating its symptoms. Its vessel ascends from the Kidney, passes through the Liver and Diaphragm into the Lung, follows the throat, and flanks the root of the tongue. Hence, Shaoyin vessel penetrates the Kidney, connects to the Lung, and ties to the root of the tongue. Shaoyin Water and Fire fail to interact and nourish each other, causing dry mouth, dry tongue, and thirst.
On the sixth day, Jueyin receives [the pathogen]. Jueyin vessel follows the genitalia and connects to the Liver. Thus, there is vexation, fullness, and retraction of the scrotum.
Jueyin vessel receives [the pathogen] on the sixth day, illustrating its symptoms. Jueyin Liver vessel passes over the genitalia and reaches the lower abdomen. Hence, Jueyin vessel follows the genitalia and connects to the Liver. Jueyin Wood Qi rebels and Fire Qi is excessive, causing vexation and fullness. Following the genitalia causes scrotal retraction.
When the Three Yin and Three Yang, Five Zang and Six Fu organs are all diseased, Ying and Wei circulation stops, and Five Zang obstruction occurs, death ensues.
'Ze' implies 'ji' (immediately). Summarizing the previous text on Three Yin meridian disease: it is not necessarily that Taiyin is affected on Day 4, Shaoyin on Day 5, and Jueyin on Day 6 sequentially. Rather, the internal Three Yin, external Three Yang, internal Five Zang, and external Six Fu are all affected on the first day, leading to cessation of Ying and Wei circulation and obstruction of Five Zang, resulting in immediate death. This is more severe than Lianggan Yu Han, which inevitably leads to death.
For those not suffering from Lianggan Yu Han, on the seventh day, Jutai disease wanes, and headache slightly improves; on the eighth day, Yangming disease wanes, and body heat slightly improves; on the ninth day, Shaoyang disease wanes, and deafness slightly allows hearing; on the tenth day, Taiyin disease wanes, abdominal fullness decreases as before, and appetite returns; on the eleventh day, Shaoyin disease wanes, thirst stops, fullness ceases, tongue dryness resolves, and sneezing occurs; on the twelfth day, Jueyin disease wanes, scrotum relaxes, lower abdominal distension slightly subsides, and the great Qi (pathogen) is expelled, with the illness resolving day by day.
Those not suffering from Lianggan Yu Han, belonging to meridian heat diseases, all complete a seven-day cycle, with disease waning and recovery occurring. From this, we see that the previously mentioned one-day or two-day infections were described in sequence, not as fixed, unchangeable dates. Understanding the Sacred Classics requires not letting literal words obscure the meaning.
The Emperor said: "How should it be treated?"
If treatment is appropriate, recovery need not wait until the seventh day, hence the question.
Qibo said: "Treat by unblocking the pulse of each respective Zang organ; the disease will wane day by day and resolve."
Zang pulses refer to, as mentioned earlier, the Taiyin Spleen pulse, Shaoyin Kidney pulse, and Jueyin Liver pulse. By treating and unblocking the pulse of each respective Zang organ, the disease will wane day by day and resolve, thereby avoiding death.
For cases less than three days duration, sweating can cure; for cases three days or more, purging/draining can cure.
If the disease is in the Three Yang meridians and less than three days old (exterior), sweating can cure; if three days or more (interior), draining/purging can cure. Thus, recovery need not wait for the seven-day cycle.
The Emperor said: "After heat disease has resolved, sometimes residual symptoms remain. Why?"
Following the intent of sweating and draining, asking why residual symptoms sometimes remain and full recovery is delayed.
Qibo said: "All residual conditions arise because food was forced during severe heat, leaving remnants; in such cases, the disease has waned, but heat is hidden. Because grain Qi interacts with the hidden heat, the two heats combine, causing residuals."
'Qiang' is pronounced with the rising tone. 'Shi' sounds like 'si'. 'Cang' is read literally. All residual conditions occur because food was forced during severe heat, leaving remnants. Furthermore, in such cases, external heat has waned, but internal heat is hidden. Grain Qi interacts with the hidden heat; this interaction causes Yangming Stomach heat to combine with the hidden heat, resulting in residuals.
The Emperor said: "Excellent. How to treat residuals?"
Disease residuals persist; how to treat.
Qibo said: "Observe deficiency and excess, regulate reversal and compliance; this ensures certain recovery."
Observe the deficiency and excess of the meridians, regulate the reversal and compliance of Yin and Yang. Treating in this manner ensures certain recovery without residuals.
The Emperor said: "What should be prohibited during heat disease?"
Having residuals and then treating is inferior to prohibiting things during the active disease phase; hence the question on prohibitions.
Qibo said: "When heat disease slightly improves, eating meat causes recurrence; overeating causes residuals. These are the prohibitions."
When heat disease slightly improves but has not fully resolved, avoid meat and avoid overeating. Meat is heavy and greasy, difficult to digest, causing heat disease to recur; overeating causes grain Qi to interact with heat, leading to residuals. Eating meat and overeating are these prohibitions.
The Emperor said: "For those suffering from Lianggan Yu Han, what are their pulses and clinical manifestations?"
'Ying' is pronounced with the level tone. 'Xing' means condition/symptom. The conditions of various meridians receiving disease were detailed earlier; here, the pulse and condition of Lianggan Yu Han are asked again.
Qibo said: "In Lianggan Yu Han, on the first day, Jutai 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, anorexia, and delirious speech; on the third day, Shaoyang and Jueyin are both diseased, causing deafness, scrotal retraction, cold limbs, inability to drink fluids, and unconsciousness. Death occurs on the sixth day."
Lianggan Yu Han refers to Jutai-Shaoyin, Yangming-Taiyin, and Shaoyang-Jueyin, which are exterior-interior and yin-yang pairs. Thus, on the first day, Jutai and Shaoyin are both diseased. Symptoms of Jutai disease include headache; symptoms of Shaoyin disease include dry mouth and vexation/fullness. On the second day, Yangming and Taiyin are both diseased. Symptoms of Taiyin disease include abdominal fullness and fever; symptoms of Yangming disease include anorexia and delirious speech. On the third day, Shaoyang and Jueyin are both diseased. Symptoms of Shaoyang disease include deafness; symptoms of Jueyin disease include scrotal retraction and cold limbs. The Three Yang meridians rely on Stomach Qi as their root; the Three Yin meridians prioritize Shen Qi. Inability to drink fluids indicates exhaustion of Stomach Qi; unconsciousness indicates loss of Shen Qi. By the sixth day, the cycle cannot complete, leading to death. This means Jutai-Shaoyin, Yangming-Taiyin, and Shaoyang-Jueyin all reach death by the sixth day. Although Days 1, 2, and 3 have a sequence, they are not absolute; understanding requires intuitive comprehension.
The Emperor said: "When Five Zang are injured, Six Fu are obstructed, and Ying-Wei circulation stops, why does death occur three days later, rather than immediately?"
Continuing from the previous point that when Three Yin/Yang, Five Zang/Six Fu are diseased, and Ying-Wei/Zang obstruction occurs, death ensues; asking why death takes three days instead of being immediate.
Qibo said: "Yangming is the head of the twelve meridians; its Blood and Qi are abundant. Thus, after unconsciousness for three days, when its Qi is exhausted, death occurs."
'Zhang' is pronounced with the rising tone. The Shen Qi operation of Five Zang and Six Fu all relies on Stomach Qi; thus, Yangming is the head of the twelve meridians. Yangming has abundant Qi and Blood, hence its Blood and Qi are vigorous. Unconsciousness indicates Shen Qi is severed. However, Yangming Qi has not yet exhausted; thus, after three days of unconsciousness, when Yangming Qi is exhausted, death occurs. Though not immediate, it is tantamount to death.
Any Shanghan transforming into Wen (Warm Disease): those appearing before the Summer Solstice are classified as Wenbing (Warm Disease); those appearing after the Summer Solstice are classified as Shubing (Summerheat Disease). Shubing should exit with sweat; do not stop sweating.
Winter injury by Cold leads to Spring Wenbing. Thus, any Shanghan transforming into Wen: those manifesting before the Summer Solstice are Wenbing; those after are Shubing. Wen is equivalent to Heat. Shu is extreme Heat. Shu-Heat diseases dissipate with sweat; Warm-Heat diseases should also dissipate with sweat. Therefore, Shu should exit with sweat; do not stop it, even if sweating is profuse. The heat diseases discussed earlier appear immediately upon contraction, differing from Cold pathogens that linger and lie dormant before manifesting. Thus, Wen and Shu are cited to distinguish the intent of the preceding heat disease discussion.