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Shen Mingzong stated: When pathogenic factors invade the Zang organs, causing confusion of the Shen (Spirit), sudden collapse, and loss of consciousness, it is called "Cu Jue" (Sudden Collapse). If the lips and mouth turn cyan, the body becomes cold, the Shen mechanism cannot enter or exit, and the Qi of the Zang organs is on the verge of exhaustion, death is the outcome. The Classics state: "When Blood and Qi rush upwards simultaneously, it results in Da Jue (Great Collapse) or Bao Jue (Violent Collapse)." However, if the body is warm and sweating occurs, this indicates that the pathogenic factor has entered the Fu organs. The temporary blockage of Qi mechanism causes sudden collapse, which is not comparable to the exhaustion of Zang organ Qi. After a short while, the Yang mechanism reaches the exterior, and the pathogenic factor is expelled outward with it; thus, we know that invasion of the Fu organs leads to recovery.

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Question: Why does pulse disappearance indicating invasion of Zang organs lead to death, while invasion of Fu organs leads to recovery? The Master said: This principle applies not to a single disease but to all diseases. For example, in Jin Yin Chuang (Erosive Sores), if the lesion starts at the mouth and spreads to the limbs, it is treatable; if it starts from the limbs and flows back into the mouth, it is untreatable. Diseases remaining in the exterior are treatable, whereas those penetrating inward are difficult to cure.

[Annotation]
This section elaborates on the meaning that invasion of Zang organs leads to death, while invasion of Fu organs leads to recovery. In Cu Jue, the pulse often disappears. Death associated with an absent pulse indicates that the Zheng Qi (Upright Qi) cannot return; survival with an absent pulse indicates that the pathogenic obstruction has reopened. This applies to all diseases involving Zang and Fu invasion, not just Jue diseases. Similarly, for erosive sores or Leprosy-like conditions, lesions spreading from the mouth to the limbs are treatable, while those flowing from limbs to the mouth are not. Generally, diseases moving outward are treatable, while those moving inward are hard to treat, reflecting the same principle.

[Collected Annotations]
Zhao Liang stated: "Tuo" (Disappearance/Departure) means leaving. The Jing Mai (Meridians) are the tunnels connecting the Zang and Fu organs. Forced by pathogenic factors, the Qi cuts off, the pulse disappears, and the pathogen sinks inward. The Five Zang are Yin, and the Six Fu are Yang. Yin governs death, and Yang governs life; hence, invasion of Zang leads to death, while invasion of Fu leads to recovery and is treatable. This is not limited to Zang and Fu; it applies to any pathogenic toxin entering or exiting the interior or exterior based on Yin-Yang principles.

Xu Bin stated: Pathogens that can exit to the Yang aspect are superficial and thus survivable; those blocked within the Yin aspect are deep and thus fatal. This applies to all diseases, not just one. Using Jin Yin Chuang as a metaphor: starting at the mouth and spreading to limbs means the pathogen emerges from the interior to the exterior, excreting without advancing further, making it treatable. Starting from limbs and flowing into the mouth means the pathogen enters from the exterior to the interior, advancing without excretion, damaging and ruining Zang Qi, making it untreatable.

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Question: What are the Eighteen Yang Diseases? The Master said: Headache, stiffness/pain in the neck, waist, spine, arms, and pulling pain in the legs. Question: What are the Eighteen Yin Diseases? The Master said: Cough, Sheng Qi (Rebellious Qi), wheezing, Hui (Hiccup/Belching), throat discomfort, intestinal borborygmus, abdominal distension, heart pain, and spasm/tightness. Each of the Five Zang has eighteen types of diseases, totaling ninety diseases. Humans also have six minor diseases, each with eighteen types, totaling one hundred eight diseases. The Wu Lao (Five Exhaustions), Qi Shang (Seven Injuries), Liu Ji (Six Extremes), and Thirty-Six Diseases of Women are not included in these counts. Qing Xie (Clear Pathogens) reside in the upper part, Zhuo Xie (Turbid Pathogens) in the lower part, Da Xie (Major Pathogens) strike the exterior, Xiao Xie (Minor Pathogens) strike the interior, and Qi Qi (Dietary Pathogens) entering through the mouth constitute Su Shi (Retained Food). The Five Pathogens affecting humans follow specific patterns: Wind affects the morning, Cold affects the evening, Dampness injures the lower body, Fog injures the upper body, Wind causes a floating pulse, Cold causes a tight pulse, Fog injures the skin and Cou Li (Pores), Dampness flows into the joints, Diet injures the Spleen and Stomach, Extreme Cold injures the Jing Mai (Channels), and Extreme Heat injures the Luo Mai (Collaterals).

[Note]
The character '□' is not in the dictionary; it should be 'Qi' (漀), pronounced 'Qing', meaning water pouring sideways. The character 'Qi' in the Accumulation and Mass chapter is also written incorrectly.

[Annotation]
The references to "eighteen," "ninety," etc., in this chapter are from ancient medical texts and cannot be verified today, so forced explanations are avoided. The concepts of Wu Lao and Qi Shang are detailed in *Qian Jin Fang* (*Essential Prescriptions Worth a Thousand Gold*), so they are not annotated here. Headache, neck/waist/spine/arm/leg pain are external diseases, hence Yang diseases. Cough, rebellious Qi, wheezing, hiccup, throat issues, borborygmus, distension, heart pain, and spasms are internal diseases, hence Yin diseases. Qing Xie refers to Fog pathogens originating from Heaven; Zhuo Xie refers to Dampness pathogens originating from Earth. The Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire) are Heavenly Pathogens, hence "Major Pathogens," injuring the exterior ("striking the surface"). The Seven Emotions are Human Pathogens, hence "Minor Pathogens," injuring the interior ("striking the inside"). "Qi Qi" refers to diet; dietary pathogens enter via the mouth, and undigested food from previous days is called Su Shi (Retained Food). The Five Pathogens are Wind, Cold, Dampness, Fog, and Diet. These five pathogens affect humans according to their nature. "Former" refers to morning; 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. Dietary irregularities injure the Spleen and Stomach. Extremely cold food injures the Jing Mai because Channels belong to Yin; extremely hot food injures the Luo Mai because Collaterals belong to Yang.

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Question: In some cases, one must urgently treat the Interior or the Exterior first. What does this mean? The Master said: If a patient undergoes inappropriate purgation and subsequently develops persistent diarrhea with undigested food, accompanied by body pain, one must urgently treat the Interior. Later, if the body pain persists but bowel movements normalize, one must urgently treat the Exterior.

[Annotation]
See *Shang Han Lun* (Treatise on Cold Damage), Ta Yin Chapter, for details. No further explanation is provided here.

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When a chronic, entrenched disease (Gu Ji) is complicated by an acute, sudden disease (Cu Bing), the acute disease should be treated first, followed by the chronic disease.

[Annotation]
Gu Ji refers to old/chronic diseases. Cu 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 disease first, then the chronic disease.

[Collected Annotations]
Zhao Liang stated: Gu Ji diseases are deep-seated and stubborn, not curable in a day or two. Cu Bing refers to sudden onset, newly contracted diseases, which can be resolved quickly. One should seize the opportunity while the pathogen has not penetrated deeply, urgently expelling it to prevent stagnation and complications. Patients with chronic diseases have inherently deficient Zheng Qi, making them susceptible to rapid pathogen transmission. Over-caution may cause old and new pathogens to combine, creating severe harm. Zhang Zhongjing established this rule to teach students the correct order of treatment.

Shen Mingzong stated: When a patient with a pre-existing condition contracts a new pathogen, treatment must be sequenced. Gu implies stubborn pathogens hard to remove; Cu implies sudden pathogens easy to remove. If a chronic patient suddenly acquires an acute illness, one must prioritize treating the acute illness to prevent pathogen combination and exacerbation of the chronic condition. Chronic diseases cannot be cured overnight and require gradual management; hence, treat the chronic disease last.

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The Master said: Diseases of the Five Zang resolve when they encounter favorable conditions; however, each Zang has aversions. Illness arises following what the Zang dislikes. If a patient craves foods they normally avoid, fever will likely ensue.

[Annotation]
This explains that Zang diseases heal under favorable conditions, referring to the mutual overcoming of emotions (e.g., anger injures the Liver, but grief cures it because Grief overcomes Anger). Some diseases heal due to timing. The Classics state: Liver diseases heal in Summer because they benefit from the Zi (Water) element controlling the Sheng (Fire) element that dominates them. If they do not heal in Summer, they worsen in Autumn because they fear the element that controls them, yet gain strength from the Wang (Prosperous) Qi. If they survive Autumn, they persist in Winter because they benefit from the Mu (Mother) element generating them. If they arise in Spring, it is because they regain their own position and prosper. Other Zangs follow this pattern. Regarding cravings: if a person desires foods they usually dislike during illness, it indicates a change in pathogenic influence and Zang Qi. Even if they crave it, eating it will likely cause fever.

[Collected Annotations]
Cheng Lin stated: The *Nei Jing* says: Liver color is green, suitable for sweet taste; Heart color is red, suitable for sour taste; Lung color is white, suitable for bitter taste; Spleen color is yellow, suitable for sour taste; Kidney color is black, suitable for pungent taste. This describes healing through diet. Liver diseases heal on Bing/Ding days, arising on Jia/Yi days; Heart diseases heal on Wu/Ji days, arising on Bing/Ding days; Spleen diseases heal on Geng/Xin days, arising on Wu/Ji days; Lung diseases heal on Ren/Gui days, arising on Geng/Xin days; Kidney diseases heal on Jia/Yi days, arising on Ren/Gui days. This describes healing when the Zang regains its proper position. The aversions of the Five Zang are: Heart fears Heat, Lung fears Cold, Liver fears Wind, Spleen fears Dampness, Kidney fears Dryness. Illness follows what they dislike. If a patient who usually abstains from certain foods eats them excessively, it enters the Yin and augments Yang heat, inevitably causing fever.

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For diseases located in the Zang organs, if attack is necessary, one should follow the location where the pathogen has gathered. For example, for thirst, administer Zhu Ling Tang (Polyporus Decoction); apply this principle to other cases.

[Note]
After "for thirst," the phrase "with difficulty in urination" (Xiao Bian Bu Li) is missing, likely due to copying errors.

[Annotation]
Zang refers to the Interior. For diseases in the Interior with indications for attack, one must attack according to the severity and location of the pathogen's accumulation, not arbitrarily. For instance, in cases of thirst with urinary difficulty, first use Zhu Ling Tang to promote urination. Once urination normalizes, proceed with the appropriate attack. This principle applies to other conditions where immediate attack is not advisable.