马云。篇内大气入脏。先发于何脏。何日传何脏。即素问病传论之所谓病传也。故以病传名篇。然素问
以论标本病传为一篇。本经以病本论标本。以病传论病之所传。分为二篇。
导引行气 简案、巢源有虾蟆行气。
乔摩 甲乙作按摩。马云。乔、跷同。
饮药之一者可独守耶 甲乙无之字。简案、据甲乙药下句。义尤明显。
诸方者（止）万物毕者也 张云。谓当因人所宜以施治。是众人各有其方也。人得其一。则万变之道
可毕矣。移精变气论曰。治之极于一。即此谓也。
HT 移之过 马云。大抵内经谓病为有过。
其如且醒 诸本且、作日。此字误。当改。下同。甲乙作旦亦通。
彼而服之 马云。果能佩而服之。则神自生。而与道俱成。
可着于竹帛 不可传于子孙 马云。可着于竹帛。传之天下后世。盖上达必由心悟。可以待其人而
后行也。虽子孙亦不可传之。犹梓匠轮舆。能使人规矩。不能使人巧。故父不得以私诸子也。张云。昭乎如醒。
道之明也。窘乎如瞑。察之难也。着之竹帛。则泽及于人。传之子孙。则道私于己。故不可也。
乎 诸本作喑乎。此字误。当改。
折毛发理 志云。毛发折而腠理开。开则邪从毛发入。入则抵深而入于腠理。是以正气横倾。
血脉传溜 甲乙。溜、作留。志云。传流于血脉而入脏。则伤神。
大气入脏 腹痛下淫 马云。大邪入脏。而腹痛下传。诚有易死难生者。张云。大气、大邪之气也。
凡邪之中人。喑乎其无声。不可得而闻也。漠乎其无形。不可得而见也。至其绝则为折毛发理。正气横倾等证。
故有死无生也。
病先发于心（止）夏日中 张云。病发于心而得于肺。火
乘金也。三日而金复乘木。故传之肝也。五日而木复乘土。故传之脾也。再三日而邪气不退。其甚则死冬月夜
半。水王之极也。夏月日中。火王之极也。心火畏水。故冬则死于夜半。阳邪亢极。故夏则死于日中。盖衰极
亦死。盛极亦死。有所偏胜。则有所偏绝也。五行之气。无不皆然。下文之义。皆仿此。马云。素问标本病传
论言病。本篇言脏。其实病即脏之病也。
病先发于肺（止）夏日出 张云。自肺而肝。自肝而脾。皆传所胜也。自脾而胃。表里相传也。肺邪
王于申酉。故冬则死于日入。金气绝于寅卯。故夏则死于日出。杨元如云。按止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。简案、病传日数。未详本于何义。杨说难通。
病先发于肝（止）夏早食 张云。此肝木传土。而土邪复传水脏也。水受伤者金胜则危。故冬畏日。
入肝发病者。木衰则剧。故夏畏早食时也。马云。冬之日入在申。以金旺木衰。故冬死于日入。夏之早食在卯。
以木旺亦不能扶。故夏死于早食也。
病先发于脾（止）夏晏食 张云。此土邪乘水而表里俱相传也。人定在亥。而土病于冬者畏之。寒水
反能侮土也。晏食在巳。而脾病于夏者畏之。以戊己王乡。而合邪为患也。杨元如云。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。（见标本病传篇）小便闭。人定在寅。水旺而土绝也。夏之
晏食在亥。水泛而土败也。马云。冬之人定在亥。以土不胜水。故冬死于人定。夏之晏食在寅。以木来
克土。故夏死于晏食也。简案、晏、玉篇晚也。淮南天文训。日至于桑野。是谓晏食。盖以理推之。人定在亥。
晏食在戌。（见标本病传高注）
病先发于胃（止）夏日 张云。此土邪传水。而水复传火。故自膀胱以及于心也。标本病传论曰。冬
夜半后丑也。夏日 未也。皆土王之时。故胃病逢之。气极则败。志云。 、音笛。日昃也。
病先发于肾（止）夏早晡 早、马张志作晏。他本并作早。简案、据标本病传论作晏为是。张云。此水
病乘火。则表里皆相传也。大晨、辰刻也。为水之库。晏晡、戌时也。土能伐水。故病发于肾者。不能出乎此
也。马云。冬之大明在寅末。夏之晏晡以向昏。土能克水。故冬死于大晨。而夏死于晏晡也。
病先发于膀胱（止）夏下晡 张云。此亦水火二脏。自表而里之相传也。冬之鸡鸣在丑。阴之极也。夏
之下晡在未。水所长也。膀胱为水府。故其盛极衰极。皆能死。志云。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。简案、甲乙
合本篇。及标本病传论。成篇当参考。
诸病以次相传（止）乃可刺也 志云。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。心先传行。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。止有间三而无间
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。马云。难经五十三难。七传者死。
间脏者生。与此篇大义同。
Ma Yun states: The "large qi entering the zang organs" mentioned in this chapter, which zang organ is first affected? After how many days does it transmit to which zang organ? This refers to what is called "disease transmission" in the *Su Wen* (Basic Questions) chapter on Disease Transmission. Therefore, this chapter is named "Disease Transmission". However, the *Su Wen* combines the discussion of root and branch with disease transmission into one chapter; whereas this classic (*Ling Shu*) separates the discussion of the root and branch of disease from the discussion of disease transmission into two chapters.
Daoyin Xingqi (Guiding and Pulling Qi): Jian An notes that Chao Yuanfang's *Zhu Bing Yuan Hou Lun* (General Treatise on the Origins and Manifestations of All Diseases) contains "Toad Qi Circulation".
Qiao Mo (Qiao Massage): The *Jia Yi Jing* writes it as "An Mo" (Massage). Ma Yun says: "Qiao" is synonymous with "Qiao".
"Can drinking medicine be guarded by one alone?": The *Jia Yi Jing* lacks the character "zhi" (of). Jian An notes: According to the sentence following "medicine" in the *Jia Yi Jing*, the meaning is even clearer.
"The various methods... all things are completed": Zhang Jingyue says, this means treatment should be applied according to each individual's suitability; thus, everyone has their own method. If a person grasps one point, then the way of ten thousand changes can be fully understood. The *Yi Jing Bian Qi Lun* (Chapter on Shifting Essence and Changing Qi) states: "The ultimate limit of treatment lies in 'One'", which refers to this concept.
HT Yi Zhi Guo (Shifting the Excess): Ma Yun says, generally speaking, the *Nei Jing* considers disease as an excess (pathogenic invasion).
Qi Ru Qie Xing (As if just waking up): In various editions, "qie" (and/just) is written as "ri" (sun/day). This character is erroneous and should be corrected. The same applies below. The *Jia Yi Jing* writes "dan" (morning), which is also acceptable.
Bi Er Fu Zhi (Wearing and Taking It): Ma Yun says, if one can wear and take it, then divine spirit will naturally arise, achieving unity with the Dao.
Ke Zhuo Yu Zhu Bo, Bu Ke Chuan Yu Zi Sun (Can be inscribed on bamboo and silk, cannot be passed to descendants): Ma Yun says, it can be inscribed on bamboo slips and silk and transmitted to the world and future generations. Because profound truths must be realized through mental comprehension, they can be taught only when the right person appears. Even descendants should not receive private transmission. Just as carpenters and wheelwrights can teach others to use compasses and squares, but cannot make them skillful. Thus, a father cannot privately pass it to his son. Zhang Jingyue says: Clarity is like awakening, revealing the brightness of the Dao; confusion is like sleeping, showing the difficulty of observation. Inscribing on bamboo and silk benefits others; passing to descendants makes the Dao private. Therefore, it should not be done.
Yin Hu (Silently): Various editions write "yin hu". This character is erroneous and should be corrected. [Note: Context implies describing pathogenic factors as silent and formless].
Zhe Mao Fa Li (Breaking Hair Follicles and Opening Pores): Ma Shi says, hair follicles break and pores open; once opened, pathogens enter through the hair follicles, penetrating deeply into the interstices. Consequently, righteous qi overflows and collapses.
Xue Mai Chuan Liu (Blood Vessels Transmitting Flow): The *Jia Yi Jing* writes "liu" (flow) as "liu" (stay). Ma Shi says, transmitting flow into blood vessels and entering zang organs damages the Shen (Spirit).
Da Qi Ru Zang, Fu Tong Xia Yin (Large Qi Entering Zang, Abdominal Pain and Downward Discharge): Ma Yun says, large pathogenic qi entering the zang organs causes abdominal pain and downward transmission; indeed, there are cases that are easy to die from and difficult to survive. Zhang Jingyue says, "Da Qi" refers to large pathogenic qi. Whenever pathogens invade humans, they are silent and inaudible; formless and invisible. When they reach extremity, symptoms such as broken hair follicles, opened pores, and overflowing righteous qi appear, leading to death without survival.
Bing Xian Fa Yu Xin... Xia Ri Zhong (Disease First Arises in the Heart... Summer at Noon): Zhang Jingyue says, disease arises in the Heart and is acquired from the Lung; Fire overwhelms Metal (Fire controls Metal). After three days, Metal overwhelms Wood (Metal controls Wood), so it transmits to the Liver. After five days, Wood overwhelms Earth (Wood controls Earth), so it transmits to the Spleen. If after another three days the pathogenic qi does not retreat and the condition worsens, death occurs at midnight in winter, which is the extreme peak of Water prosperity. Death occurs at noon in summer, which is the extreme peak of Fire prosperity. Heart Fire fears Water, hence death at midnight in winter; Yang pathogenic qi reaches extreme exuberance, hence death at noon in summer. Generally, extreme decline leads to death, and extreme exuberance leads to death; where there is partial dominance, there is partial extinction. This applies to all Five Elements qi. The meaning of the following text follows this pattern. Ma Yun says, the *Su Wen* chapter on Root/Branch and Disease Transmission discusses diseases, while this chapter discusses zang organs; in essence, disease is the disease of the zang organs.
Bing Xian Fa Yu Fei... Xia Ri Chu (Disease First Arises in the Lung... Summer at Sunrise): Zhang Jingyue says, from Lung to Liver, and from Liver to Spleen, these are transmissions to what they overcome (control). From Spleen to Stomach, this is interior-exterior transmission. Lung pathogenic qi prospers at Shen and You hours, hence death at sunset in winter; Metal qi ends at Yin and Mao hours, hence death at sunrise in summer. Yang Yuanru says, regarding why only Winter and Summer are mentioned and not Spring and Autumn: the qi of the four seasons belongs generally to the coming and going of cold and heat. Midnight and noon represent the division of Yin and Yang at Zi and Wu; sunrise and sunset represent the separation of Yin and Yang at Mao and You. The days of disease transmission (1, 3, 5) are heavenly odd numbers. Roughly, the five zang organs are born from the five elements of earth, rooted in the transformation of heavenly stems. Jian An notes: The basis for the number of days in disease transmission is unclear; Yang's explanation is difficult to accept.
Bing Xian Fa Yu Gan... Xia Zao Shi (Disease First Arises in the Liver... Summer at Early Meal): Zhang Jingyue says, this is Liver Wood transmitting to Earth, and Earth pathogenic qi transmitting back to the Water zang organ. If Water is injured and Metal becomes excessive, it is dangerous; hence, winter fears sunset. When Liver disease arises, Wood decline makes it severe; hence, summer fears early meal time. Ma Yun says, winter sunset is at Shen hour; because Metal is prosperous and Wood is weak, death occurs at sunset in winter. Summer early meal is at Mao hour; although Wood is prosperous, it cannot support [the body against the disease], hence death at early meal in summer.
Bing Xian Fa Yu Pi... Xia Yan Shi (Disease First Arises in the Spleen... Summer at Late Meal): Zhang Jingyue says, this is Earth pathogenic qi overwhelming Water, with both interior and exterior transmitting together. Ren Ding (Human Rest/Settling) is at Hai hour; Spleen Earth disease in winter fears this because Cold Water insults Earth. Yan Shi (Late Meal) is at Si hour; Spleen disease in summer fears this because Wu and Ji [Earth stems] are prosperous, combining with pathogens to cause harm. Yang Yuanru says, "Lu Bladder" refers to the bladder attached to the Lu tendons on the spine. Thus, after three days it reaches the Lu Bladder, causing back tendon pain (see *Root/Branch and Disease Transmission Chapter*). Urine closure. Ren Ding is at Yin hour [Note: Textual discrepancy noted in original commentary]; Water is prosperous and Earth is extinct. Summer Yan Shi is at Hai hour [Note: Textual discrepancy noted]; Water floods and Earth fails. Ma Yun says, winter Ren Ding is at Hai hour; because Earth cannot overcome Water, death occurs at Ren Ding in winter. Summer Yan Shi is at Yin hour; because Wood overcomes Earth, death occurs at Yan Shi in summer. Jian An notes: "Yan" means late in the *Yu Pian*. *Huainanzi·Tianwen Xun* states: "When the sun reaches Sang Ye, it is called Yan Shi." Reasoning logically, Ren Ding is at Hai, Yan Shi is at Xu (see *Gao's Commentary on Root/Branch and Disease Transmission*).
Bing Xian Fa Yu Wei... Xia Ri Die (Disease First Arises in the Stomach... Summer at Sun Declining): Zhang Jingyue says, this is Earth pathogenic qi transmitting to Water, and Water transmitting back to Fire, thus from Bladder to Heart. The *Root/Branch and Disease Transmission Lun* states: Winter midnight after Chou hour, Summer Ri Die (Sun Declining) at Wei hour; these are times when Earth is prosperous. Thus, Stomach disease encountering these times leads to qi exhaustion and failure. Ma Shi says: "Die", pronounced Di, means sun declining (afternoon).
Bing Xian Fa Yu Shen... Xia Zao Bu (Disease First Arises in the Kidney... Summer at Early Evening): "Zao" (Early), Ma Yun and Ma Shi write "Yan" (Late); other editions write "Zao". Jian An notes: Based on the *Root/Branch and Disease Transmission Lun*, writing "Yan" is correct. Zhang Jingyue says, this is Water disease overwhelming Fire, with both interior and exterior transmitting. Da Chen (Great Morning) is the Chen hour, the storehouse of Water. Yan Bu (Late Evening) is the Xu hour; Earth can subdue Water. Thus, for disease arising in the Kidney, one cannot escape this time. Ma Yun says, winter Da Ming (Bright Sun) is at the end of Yin; summer Yan Bu approaches dusk; Earth can overcome Water. Hence, death occurs at Da Chen in winter and at Yan Bu in summer.
Bing Xian Fa Yu Pang Guang... Xia Xia Bu (Disease First Arises in the Bladder... Summer at Lower Evening): Zhang Jingyue says, this is also the transmission between Water and Fire zang organs, from exterior to interior. Winter Ji Ming (Rooster Crowing) is at Chou hour, the extreme of Yin. Summer Xia Bu (Lower Evening) is at Wei hour, when Water is long/prosperous. The Bladder is the mansion of Water, so both its extreme prosperity and extreme decline can lead to death. Ma Shi says, Winter Ji Ming and Summer Xia Bu correspond to the times of Da Chen and Yan Bu mentioned in the previous section. Regarding the transmission of the five zang organs involving the Bladder and Stomach fu organs: The Stomach resides in the center, is the sea of water and grain, and is the source of life for the five zang organs; Tai Yang governs the qi of all yang. Jian An notes: The *Jia Yi Jing* combines this chapter with the *Root/Branch and Disease Transmission Lun*; the formation of chapters should be referenced.
Zhu Bing Yi Ci Xiang Chuan... Nai Ke Ci Ye (All Diseases Transmit in Order... Then Acupuncture Can Be Used): Ma Shi says, the *Yu Ji Zhen Zang Lun* states: The five zang organs are connected, and shifts have order. When the five zang organs have disease, they transmit to what they overcome. When disease is about to cause death, the Heart transmits first, reaching what it cannot overcome, and then death occurs. Thus, in such cases, it is reverse transmission to what it overcomes, having a fixed death date, and acupuncture is contraindicated. If skipping one zang organ, e.g., Heart transmitting to Liver, or Lung to Spleen, this is Son overcoming Mother. Skipping two zang organs, e.g., Heart to Spleen, or Lung to Kidney, this is Mother overcoming Son; the qi of Son and Mother mutually nourish each other. Skipping three zang organs, e.g., Heart to Kidney, or Lung to Heart, this comes from what overcomes [it], called minor pathogenic factor. Note: In five zang skipping transmission, there is skipping three but no skipping four. What is called skipping four zang organs involves transmission from zang to fu, and then fu transmitting to another zang; roughly, fu organs can also be named zang. Ma Yun says, *Nan Jing* Difficulty 53 states: Seven-step transmission leads to death, skipping zang transmission leads to survival; this shares the same major principle as this chapter.