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(Continuing from the previous text) If this condition occurs, death ensues. Reversal of Yangming [Stomach/Large Intestine] channel qi leads to panting and coughing, fever, frequent fright, epistaxis, or hematemesis. Reversal of Hand-Taiyin [Lung] channel qi presents with empty fullness and coughing, and frequent vomiting of frothy saliva; treatment should target the primary diseased channel. Reversal of Hand-Jueyin [Pericardium] and Hand-Shaoyin [Heart] channel qi involves heart pain radiating to the throat and fever; this is a fatal condition that cannot be treated. Reversal of Hand-Taiyang [Small Intestine] channel qi manifests as deafness, tearing, stiffness of the neck preventing turning the head, and inability to bend or extend the waist; treatment should target the primary diseased channel. Reversal of Hand-Yangming [Large Intestine] and Hand-Shaoyang [Sanjiao] channel qi results in throat obstruction (Hou Bi), swelling of the pharynx, [text missing here], and treatment should target the primary diseased channel.

The *Treatise on the Generation of the Five Zang Organs* states: "When one wakes from sleep and is exposed to wind, blood coagulates in the skin forming Bi syndrome (obstruction), coagulates in the vessels forming Se syndrome (stagnation), and coagulates in the feet causing Jue syndrome (cold extremities/reversal). In these three cases, blood circulation fails to return to its voids (referring to major meridians), thus resulting in Bi and Jue syndromes."

In the *Treatise on Evaluating Feverish Diseases*, the Yellow Emperor asked: "There is a disease characterized by fever, sweating, and vexatious fullness, where the vexatious fullness does not resolve with sweating. What is this disease?" Qibo replied: "Fever accompanied by sweating indicates Wind pathogen; vexatious fullness persisting after sweating indicates Jue (reversal). This disease is named Feng Jue (Wind Jue)." The Yellow Emperor said: "I wish to hear more about it." Qibo said: "The Foot-Taiyang [Bladder] channel governs the exterior Qi and is therefore the first to receive the pathogen. The Foot-Shaoyin [Kidney] channel is interior-exterior related to it; when heat enters, Shaoyin follows Taiyang upward. Following upward leads to Jue." The Yellow Emperor asked: "How should it be treated?" Qibo said: "Puncture the interior-exterior channels and administer decoctions."

"Following upward" refers to Shaoyin Qi following Taiyang upward. Administering decoctions aims to stop the rebellious Kidney Qi ascending.

In the *Treatise on Heat Diseases*, the Yellow Emperor asked: "Currently, all heat diseases belong to the category of Shanghan (Cold Damage). Some recover, some die; those who die do so within six or seven days, while those who recover take ten days or more. Why is this?"

Injury by the Qi of the four seasons can all cause disease. Among them, Shanghan is the most toxic because it takes advantage of the killing and fierce Qi. If illness occurs immediately upon injury, it is called Shanghan; if it does not occur immediately, it is called Cold Toxicity, hiding in the skin and muscles. By the time of Summer Solstice, the Qi transforms into Wenbing (Warm Disease); after Summer Solstice, it transforms into Rebeng (Hot Disease). All originate from Shanghan, hence it is said that heat diseases all belong to the category of Shanghan. [Correction]: According to *Shanghan Lun*, the transformation into Warm and Shu differs from Wang Bing's commentary. Wang's commentary is based on *Suwen*, while Zhang Zhongjing's work is based on *Yin Yang Da Lun*.

Qibo said: "When humans are injured by Cold, they develop heat diseases. Even if the heat is severe, they will not die. (This is because Cold toxicity presses on the skin and muscles, closing and sealing Yang Qi so it cannot diffuse outward, leading to internal stagnation; thus, Shanghan paradoxically causes heat.) However, those who suffer from 'Liang Gan' (simultaneous contraction of two channels by Cold) will inevitably die." The Yellow Emperor said: "I wish to hear the symptoms." Qibo said: "On the first day of Shanghan, Foot-Taiyang [Bladder] receives it. Foot-Taiyang belongs to all Yang channels; its vessels connect to Fengfu [Acupoint]. Thus, it governs the Qi of all Yang channels, causing headache, stiff neck, and sore back/spine. On the second day, Foot-Yangming [Stomach] receives it. Yangming governs flesh; its vessels run along the nose and connect to the eyes, causing fever, eye pain, dry nose, and inability to lie down. On the third day, Foot-Shaoyang [Gallbladder] receives it. Shaoyang governs the Gallbladder; its vessels follow the costal region and connect to the ears, causing hypochondriac pain and deafness. When the meridians of the Three Yang channels are all diseased but have not entered the Zang organs, it can be cured by inducing sweating. On the fourth day, Foot-Taiyin [Spleen] receives it. Taiyin vessels distribute in the stomach and connect to the pharynx, causing abdominal fullness and dry throat. On the fifth day, Foot-Shaoyin [Kidney] receives it. Shaoyin vessels pass through the Kidney, connect to the Lung, and attach to the root of the tongue, causing dry mouth, dry tongue, and thirst. On the sixth day, Foot-Jueyin [Liver] receives it. Jueyin vessels circulate around the genitalia and connect to the Liver, causing vexatious fullness and retraction of the testicles." The Yellow Emperor asked: "How to treat?" Qibo said: "Treat by unblocking the meridians of each respective Zang organ, and the disease will decline daily. If the course is less than three days, cure by sweating; if three days or more, cure by purging. For Liang Gan cases: On day one, Foot-Taiyang and Foot-Shaoyin both suffer, causing headache, dry mouth, and vexatious fullness; on day two, Foot-Yangming and Foot-Taiyin both suffer, causing abdominal fullness, fever, anorexia, and delirious speech; on day three, Foot-Shaoyang and Foot-Jueyin both suffer, causing deafness, testicular retraction, cold limbs, inability to swallow fluids, and unconsciousness. Death occurs on the sixth day. (Note: 'Sixth day' should likely be 'third day', as evidenced by the following text.) If all Three Yin and Three Yang channels, and all Five Zang and Six Fu organs are diseased, Ying and Wei Qi cease to function, and the Five Zang become blocked, death ensues." The Yellow Emperor asked: "If the Five Zang are already damaged, the Six Fu are blocked, Ying and Wei Qi do not flow, and death occurs three days later, why?" Qibo said: "Yangming is the leader of the Twelve Meridians; its Blood and Qi are abundant. Therefore, unconsciousness persists for three days until its Qi is exhausted, leading to death."

This passage discusses how those with Liang Gan die because the pathogenic Qi is extremely fierce and violent.

For those without Liang Gan: On the seventh day, Taiyang disease declines, and headache slightly improves. On the eighth day, Yangming disease declines, and body heat slightly improves. On the ninth day, Shaoyang disease declines, and deafness slightly improves (hearing returns). On the tenth day, Taiyin disease declines, abdominal fullness subsides to normal, and appetite returns. On the eleventh day, Shaoyin disease declines, thirst stops, fullness resolves, dry tongue heals, and sneezing occurs. On the twelfth day, Jueyin disease declines, testicles relax, lower abdomen softens, and the Great Evil Qi (major pathogen) has departed; the disease heals daily.

This passage explains that for non-Liang Gan cases, after six days, the pathogen recedes sequentially from the beginning, and the disease heals daily.

The Yellow Emperor asked: "Heat diseases have healed, yet sometimes residual symptoms remain. Why?" (Residual symptoms mean the pathogen has not completely left.) Qibo said: "All residual conditions arise because food was forced during high fever. In such cases, the disease has declined but heat remains hidden. The Qi of food struggles with the residual heat; the two heats combine, causing residuals." The Yellow Emperor asked: "How to treat residuals?" Qibo said: "Assess deficiency and excess, regulate rebellion and compliance, and the disease will certainly heal." The Yellow Emperor asked: "What should be forbidden during heat disease?" Qibo said: "When heat disease slightly improves, eating meat causes recurrence (Fu), and overeating causes residuals. These are the prohibitions."

This section discusses residuals and prohibitions: ignorance of caution after recovery leads to recurrent heat, hence termed 'residual'.

Generally, Shanghan evolving into epidemic diseases: those occurring before Summer Solstice are Wenbing (Plague/Warm Epidemic); those after are Shubing (Summerheat Disease). Shubing should exit with sweat; do not forcibly stop sweating.

In the *Treatise on Evaluating Feverish Diseases*, the Yellow Emperor asked: "A patient with Wenbing sweats, then immediately fevers again; the pulse is rapid and restless and does not slow with sweating; there is delirium and anorexia. What is this disease?" Qibo said: "This is named Yin-Yang Jiao (Intertwining of Yin and Yang). Jiao implies death. Humans sweat because of Grain; Grain produces Essence. Now, when pathogens struggle in flesh and bone and sweat is produced, it means the pathogen is retreating and Essence is victorious. If Essence wins, the patient should eat and not fever again. Recurrent fever indicates the pathogen prevails. Sweat is Essence. Now, sweat is out but fever returns, indicating pathogen victory. Anorexia means Essence receives no benefit. With disease lingering, life ends swiftly. Furthermore, the *Treatise on Heat* says: 'Sweating with still-rapid and vigorous pulse indicates death.' Now, the pulse does not correspond with sweat, meaning the body cannot overcome the disease; death is evident. Delirium indicates loss of Zhi (Will/Shen). Loss of Zhi leads to death. Seeing three signs of death and no sign of life, even if temporary improvement occurs, death is certain."

Sweating with rapid pulse, unable to overcome disease; delirium and loss of Will—these are three signs of death. How can life be possible?

In the *Treatise on Malaria*, the Yellow Emperor asked: "Malaria all originates from Wind. Why does its accumulation and发作 (attack) have a fixed time?" Qibo said: "Malaria begins with sensation in the fine hairs, followed by yawning/stretching. Then comes chills, shivering of the chin, and pain in the waist and spine. After the cold passes, both interior and exterior become hot, with splitting headache and thirst for cold drinks."

This describes the shape of malaria; the following text elaborates on this point.

The Yellow Emperor asked: "What Qi causes this?" Qibo said: "Yin and Yang struggle above and below, alternating between deficiency and excess, shifting Yin and Yang. When Yang merges into Yin (Yang here refers to the Malaria pathogen entering the Yin aspect with Yang Qi), Yin becomes full and Yang deficient. Yangming deficiency causes chills and chin shivering; Taiyang deficiency causes back, head, and neck pain; if all Three Yang are deficient, Yin Qi prevails. Yin dominance causes bone cold and pain, cold generated internally, hence external and internal cold. Yang excess causes external heat; Yin deficiency causes internal heat. Internal and external heat together cause panting and thirst, hence desire for cold drinks."

This explains the earlier point about Yin-Yang struggle causing alternating cold and heat along the meridians.

These conditions result from Summer injury by Summerheat. The intense heat hides inside the skin and outside the intestines/stomach, which is where Ying Qi resides. (She means dwelling.) This makes sweat pores loose and cou li (interstitial spaces) open. Consequently, Autumn Qi is encountered. When sweating and exposed to wind, or during bathing, water Qi settles inside the skin and dwells with Wei Qi. Wei Qi travels in Yang during the day and Yin at night. This Qi moves outward when encountering Yang and inward when encountering Yin. The struggle between interior and exterior causes daily attacks. The Yellow Emperor asked: "Why do some attack every other day?" Qibo said: "The Qi resides deeply, pressing inward on Yin. Yang Qi alone flares up, while Yin pathogen (Malaria) attaches internally. Yin and Yang struggle but cannot exit, hence every-other-day attacks. Malaria Qi, merging with Yang makes Yang prevail; merging with Yin makes Yin prevail. Yin prevailing causes cold; Yang prevailing causes heat. Malaria involves irregular Wind-Cold Qi; extreme illness recurs." The Yellow Emperor asked: "Why does malaria start with cold then heat?" Qibo said: "Summer injury by great heat causes profuse sweating and open cou li. Encountering chilly winter-like cold water in summer, the cold hides in cou li and skin. Autumn injury by Wind completes the disease. Cold is Yin Qi; Wind is Yang Qi. Injury by Cold first, then Wind, causes cold first, then heat. Attacking at fixed times, it is named Han Malaria (Cold Malaria)." The Yellow Emperor asked: "Why heat first then cold?" Qibo said: "This is injury by Wind first, then Cold, causing heat first, then cold. Attacking at fixed times, it is named Wen Malaria (Warm Malaria)." Those with only heat and no cold have exhausted Yin Qi first, with Yang Qi flaring alone. This causes shortness of breath, vexation, hot hands/feet, and nausea, named Dan Malaria (Crimson Malaria).

This discusses the causes of cold/heat in malaria, stating there are several types.

The Yellow Emperor asked: "Malaria cold cannot be warmed by soup or fire; its heat cannot be cooled by ice or water. These belong to excess and deficiency. At this time, even skilled doctors cannot stop it; one must wait for natural decline before puncturing. Why?" Qibo said: "The classics say: Do not puncture when malaria heat is raging, do not puncture when the pulse is chaotic, do not puncture when sweat is pouring (Lu Lu means heavy sweating). Thus, because the pathogenic Qi is rebellious, it cannot be treated. The classics say: Puncturing during peak strength destroys Qi; treating during decline ensures great success. This is what is meant. When malaria starts, Yang merges into Yin. At this time, Yang is deficient and Yin is excessive, with no Qi on the exterior, hence initial chills. When Yin Qi rebels to the extreme, it exits to Yang. Yang and Yin merge externally again, making Yin deficient and Yang excessive, hence initial heat and thirst. Before malaria attacks, Yin has not merged with Yang, nor Yang with Yin. Regulating at this time allows True Qi to rest and Pathogen to perish. Hence, doctors cannot treat after onset because Qi is rebellious." The Yellow Emperor asked: "How to attack it?" Qibo said: "When malaria is about to attack, Yin and Yang are about to shift. It always starts from the Four Extremities. Yang is already injured, Yin follows. Therefore, bind the area firmly before onset to prevent pathogen entry and Yin Qi exit. Carefully observe; if Sun Luo (collateral vessels) are full, hard, and bloody, puncture them. This targets the pathogen before it merges."

Four Extremities refer to the four limbs. This means binding the limbs firmly keeps Qi in place, revealing where the pathogen resides, allowing puncture to bleed.

The Yellow Emperor asked: "What is the response when malaria is not attacking?" Qibo said: "Malaria Qi alternates between excess and deficiency, depending on where the Qi is located. Disease in Yang causes heat and rapid pulse; in Yin causes cold and quiet pulse. At the extreme, both Yin and Yang decline, Wei Qi separates, so the disease rests. When Wei Qi gathers, the disease recurs. (Li means not struggling; Ji means pathogens meeting.) Malaria is alternating Yin-Yang victory. Sometimes severe, sometimes not, hence sometimes thirsty, sometimes not. The Treatise says: Summer injury by Summerheat leads to Autumn malaria. Why doesn't malaria always correspond now?" Qibo said: "This corresponds to the Four Seasons. Diseases with different shapes reverse the seasons. Autumn attacks have severe cold; Winter attacks have mild cold; Spring attacks have aversion to wind; Summer attacks have profuse sweating." The Yellow Emperor asked: "Where do Wen Malaria and Han Malaria reside? Which Zang organ?" Qibo said: "Wen Malaria results from Winter Wind injury. Cold Qi hides in Marrow. By Spring, Yang Qi expands greatly, but pathogen cannot exit. Encountering great Summerheat, brain marrow melts, muscles waste, cou li opens, or due to exertion, pathogen exits with sweat. This disease hides in the Kidney. Its Qi emerges from interior to exterior. Thus, Yin deficient and Yang excessive causes heat; when declining, Qi returns inward. Inward return causes Yang deficiency and cold. Hence heat first, then cold, named Wen Malaria." The Yellow Emperor asked: "What about Dan Malaria?" Qibo said: "Dan Malaria patients have pre-existing Lung Heat, excessive throughout the body. Qi rebels upward, Middle Qi is full but does not leak outward. Due to exertion, cou li opens, Wind-Cold hides inside skin and between muscle layers. Upon attack, Yang Qi becomes excessive. If Yang remains excessive without decline, disease persists. Its Qi does not reach Yin, hence only heat, no cold. Qi hides internally in the Heart and externally in muscle layers, causing wasting and emaciation, hence named Dan Malaria."

In the *Treatise on the Most Essential and Greatest Truth*, the Yellow Emperor asked: "Fire-Heat resurgence causes aversion to cold and fever, resembling malaria, sometimes daily, sometimes every few days. Why?" Qibo said: "Sheng (Victorious) and Fu (Rebounding) Qi meet in varying amounts. More Yin and less Yang means distant intervals; more Yang and less Yin means close intervals. This Sheng-Fu struggle follows the rhythm of excess and decline, same as malaria."

When Yin and Yang are equal, cold and heat are half-and-half in a day; Yang more than Yin means daily attack, heat only, no cold; Yang less than Yin means every-other-day attack, cold first, heat second. Although Sheng-Fu Qi, if weak, may recur after six or seven days, hence 'recurrence after healing'. Sometimes frequent every three days then stopping for six or seven days, or every ten days then stopping for four or five days, all depend on the amount of Qi and whether they meet. Folk custom attributes sudden plague to ghosts, seeking prayer and hiding. But if the disease trend has passed, death follows quickly, blaming fate. Is this not sad? Customs are long-standing, hard to change. Alas!

In the *Treatise on Cough*, the Yellow Emperor asked: "Why does Lung cause cough?" Qibo said: "All Five Zang and Six Fu organs can cause cough, not just Lung." The Yellow Emperor asked: "Describe the symptoms." Qibo said: "Skin and hair are the exterior of Lung. Skin/hair receive pathogen first, which enters via the exterior connection. (Pathogen refers to Cold.) Cold food entering the Stomach travels up the Lung meridian to the Lung, cooling it. Lung cold combines with external pathogen, lodging there causes Lung Cough. Each Zang receives disease in its prosperous month; in non-prosperous months, they transmit to each other."

This explains the origin of Zang disease. 'Each in its time' refers to the prosperous month. If not prosperous, it does not receive pathogen directly, hence transmission occurs.

Humans correspond to Heaven and Earth. Each Zang receives Cold in its governing season and gets sick. Mildly causes cough; severely causes diarrhea or pain. Autumn: Lung receives first. Spring: Liver receives first. Summer: Heart receives first. Late Summer (Zhi Yin): Spleen receives first. Winter: Kidney receives first. The Yellow Emperor asked: "How to distinguish?" (Yi means differentiate.) Qibo said: "Lung Cough: cough with wheezing/noise, severe cases spit blood. Heart Cough: cough with heart pain, throat feels obstructed like a stalk, severe cases have swollen throat and obstruction. Liver Cough: cough with hypochondriac pain, severe cases cannot turn, turning causes fullness in both flanks. ( , also means flank.) Spleen Cough: cough with right flank pain radiating to shoulder/back, severe cases cannot move, moving worsens cough. Kidney Cough: cough with waist/back pulling pain, severe cases spit phlegm/saliva." The Yellow Emperor asked: "What about Six Fu Cough?" Qibo said: "Long-term Zang cough transfers to Six Fu. Unchecked Spleen Cough affects Stomach: Stomach Cough presents with cough and vomiting, severe cases expel roundworms. Unchecked Liver Cough affects Gallbladder: Gallbladder Cough vomits bile. Unchecked Lung Cough affects Large Intestine: Large Intestine Cough presents with cough and fecal incontinence. Unchecked Heart Cough affects Small Intestine: Small Intestine Cough presents with cough and passing gas, gas lost with cough. Unchecked Kidney Cough affects Bladder: Bladder Cough presents with cough and urinary incontinence. Long-term unchecked cough affects Sanjiao: Sanjiao Cough presents with cough, abdominal fullness, and anorexia. All gather in Stomach, relate to Lung, causing excessive phlegm/saliva, facial edema, and rebellious Qi. (Summarizes previous text.) The Yellow Emperor asked: "How to treat?" Qibo said: "Treat Zang by puncturing Shu points; treat Fu by puncturing He points; treat edema by puncturing Jing points."

This summarizes the meaning of the entire chapter.

In the *Treatise on Examining Pain*, the Yellow Emperor asked: "I heard that those good at discussing Heaven verify in humans; those good at discussing antiquity verify in the present; those good at discussing humans verify in themselves. Thus, the Dao is clear, numbers are complete, called Ming. Now I ask you, Master, to make words knowable, visible, and palpable, verified in myself, like clearing fog and resolving confusion. May I hear?" Qibo bowed twice and replied: "What Dao do you ask about?" (The question is vast, yet this only covers sudden Zang pain, which is confusing.) The Yellow Emperor asked: "I wish to hear what Qi causes sudden pain in the Five Zang organs." Qibo said: "Meridian Qi flows endlessly, circling continuously. Cold Qi enters meridians, slowing and stagnating. Lodged outside vessels, Blood is scarce; lodged inside vessels, Qi is blocked. Hence sudden pain." The Yellow Emperor asked: "Pain varies: some stop suddenly, some persist severely, some cannot be pressed, some relieve with pressure, some unaffected by pressure, some pulse beats against hand, some heart-back pulling pain, some hypochondriac-lower abdomen pulling pain, some abdominal pain radiating to inner thigh, some chronic pain forming masses, some sudden pain causing unconsciousness recovering later, some pain with vomiting, some pain with diarrhea, some pain with constipation. All these pains differ in form. How to distinguish?" Qibo said: "Cold lodged outside vessels causes vessel cold, contraction, curling, cramping, pulling small collaterals, hence sudden pain. Getting warmth stops pain immediately. Repeated Cold injury makes pain last. Cold lodged inside vessels combats Warm Qi, causing vessel fullness, fullness causes severe pain unpressable. (Should read 'pain persists severely'.) Cold lingers, Warm Qi follows, vessels swell, Blood/Qi chaotic, hence severe unpressable pain. Cold lodged between intestines/stomach and membrane origins prevents Blood dispersion, small collateral tension causes pain; pressure disperses Blood/Qi, relieving pain. Cold lodged beside spine vessels requires deep pressure to reach, hence pressure ineffective. Cold lodged in Chong Mai, originating at Guanyuan, rising straight up abdomen, blocks vessels; blockage causes Qi rebellion, hence pulsation against hand. Cold lodged in Back-Shu vessels causes Blood stagnation, stagnation causes Blood deficiency, deficiency causes pain. Shu points connect to Heart, hence pulling pain; pressure brings warmth, relieving pain. Cold lodged in Jueyin vessels (connecting genitals to Liver) causes Blood stagnation and vessel cramping, hence hypochondriac-lower abdomen pulling pain. Jue Qi lodged in inner thighs, Cold Qi reaching lower abdomen, Blood stagnation below pulls, hence abdominal pain radiating to inner thigh. Cold lodged in Small Intestine membrane/collateral Blood causes Blood stagnation unable to enter major vessels, Blood/Qi stasis forms masses over time. Cold lodged in Five Zang causes Jue reversal upward discharge, Yin Qi exhausted, Yang Qi not yet entered, hence sudden pain causing death..."