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(Phlegmon and swelling with shortness of breath; phlegmon and swelling with tendon contraction; mania; chest diaphragm fullness; lung xiao (wasting-thirst); yong shui (gurgling water))

In the *Suwen: Qi Jue Lun* chapter, the Yellow Emperor asked: What is the mechanism by which cold and heat pathogens transfer among the five zang organs and six fu organs? Qibo replied: When kidney cold transfers to the spleen, it results in phlegmon and swelling with shortness of breath; when spleen cold transfers to the liver, it results in phlegmon and swelling with tendon contraction; when liver cold transfers to the heart, it leads to mania and chest diaphragm fullness; when heart cold transfers to the lungs, it forms lung xiao (wasting-thirst). Lung xiao is characterized by drinking one unit of fluid but excreting two units of urine; this is a fatal condition that cannot be treated. When lung cold transfers to the kidneys, it forms yong shui (gurgling water). Yong shui is characterized by a soft abdomen upon palpation, where water qi resides in the large intestine, producing gurgling sounds during rapid movement, resembling a disease where water is contained within a bag.

This passage clarifies how external cold and heat pathogens circulate among the zang and fu organs, causing various pathological changes. For instance, when the kidney receives cold pathogens and transfers them to the spleen, since the spleen is located in the abdomen, the cold prevents yang qi from transforming, leading to abdominal distension, bloating, swelling, shortness of breath, and weakness. When spleen cold transfers to the liver, accompanied by tendon contraction, it occurs because the liver governs the tendons, and cold causes them to become tense and contracted. These two conditions arise from transmission to the organ I overcome (so sheng), indicating insufficiency of the original qi of the liver and spleen. If liver cold transfers to the heart, although heart fire is generated by wood, the introduction of cold excites the fire, causing mania, similar to thunder exploding when yang is suppressed by yin; the heart yang fails to flow smoothly, resulting in obstruction and blockage in the epigastrium and diaphragm. When heart cold transfers to the lungs, it transmits to the organ I overcome (so sheng). The lung metal becomes cold, lacking yang qi to transform and ascend body fluids, leading to wasting-thirst. With no fire in the lower origin, body fluids instead flow downward, resulting in drinking one unit and excreting two units. This represents the failure of both fire and earth, with cold water and cold metal, hence it is fatal. If lung qi has not yet failed, and since metal generates water, cold may transfer to the kidneys. As the kidney is the organ of water, combined with cold pathogens, the lower jiao yang qi lacks the strength to diffuse and transform. Water accumulates in the large intestine without moving; thus, the abdomen feels soft upon pressure, and rapid movement creates gurgling sounds, like water in a bag, named yong shui, where "yong" means obstruction.

(Astartus and epistaxis; fatal signs; ge xiao (diaphragmatic wasting-thirst); rou jing (flexible tetanus); chang pi (dysentery))

When spleen heat transfers to the liver, it causes astartus and epistaxis; when liver heat transfers to the heart, it leads to death; when heart heat transfers to the lungs, it transforms into ge xiao (diaphragmatic wasting-thirst); when lung heat transfers to the kidneys, it transforms into rou jing (flexible tetanus); when kidney heat transfers to the spleen, it transforms into deficiency and chang pi (dysentery), which is a fatal condition that cannot be treated.

Spleen heat transferring to the organ that overcomes me (suo bu sheng) indicates liver deficiency. Evil heat damages the liver, causing blood and qi to boil and become chaotic, leading to astartus and epistaxis. Alternatively, if it sequentially transmits to the heart, which inherently belongs to fire, the addition of evil fire causes mental confusion and death. If the heart does not accept the pathogen and transfers heat to the lungs, transmitting to the organ I overcome (suo sheng), the diaphragmatic heat efficiently consumes fluids, as the lungs are located at the diaphragm. This contrasts sharply with the previously mentioned lung xiao (drinking one, urinating two, belonging to deficiency-cold). Zhang Zhongjing’s discussion of "drinking one, urinating one" also pertains to deficiency-cold, treated with Shenqi Wan (Kidney Qi Pill) for warming and tonification. In contrast, "drinking one, urinating two" is a fatal sign. If lung heat transfers to the kidneys, as the kidney is the water organ, evil heat causes water to boil and overflow as sweat, while tendons and vessels become dry and rigid, forming rou jing (flexible tetanus), which is similar to jing syndrome. Zhang Zhongjing stated that tetanus with sweating is called rou jing (flexible tetanus), and without sweating is gang jing (stiff tetanus), distinguishing them by deficiency/excess, cold/heat, and external/internal origins. If kidney heat transfers to the spleen, transmitting to the organ that overcomes me (suo bu sheng), spleen deficiency is evident. Spleen deficiency generates dampness, leading to diarrhea mixed with heat, forming chang pi (dysentery), akin to modern "resting dysentery." At this stage, evil pathogens are entrenched and righteous qi is exhausted, making it a fatal condition that cannot be treated.