Library

However, for diseases that occur suddenly, treatment is not necessarily required after the pathogenic factor has transmitted; or the transmission and transformation of the disease may not follow the usual sequence. Due to emotional disturbances such as worry, fear, sorrow, joy, and anger, the disease cannot develop in a step-by-step manner, thus causing severe illness. If excessive joy leads to great deficiency of Heart Qi (Heart Energy), Kidney Qi will invade it; anger causes Liver Qi to invade; sorrow causes Lung Qi to be invaded; fear causes Spleen Qi to be invaded; worry causes Heart Qi to be invaded. This is the principle of emotional pathogens causing mutual invasion among the Zang organs. Therefore, there are five basic types of diseases, each with five variations, totaling twenty-five changes, along with the names of disease transmission, transformation, and mutual invasion.

Normally, external pathogens invading the body transmit to the organ they overcome according to the Five Elements' overcoming cycle, which is the regular principle. However, when pathogens strike suddenly, treatment should not wait for transmission. Moreover, people have varying constitutions (strong or weak), and pathogens vary in severity. Disease changes are manifold, and transmission may not follow the order. For example, injuries caused by emotions like worry and fear cause pathogens to penetrate deeply due to deficiency, without waiting for the transmission sequence, already forming severe illness. Because the Qi of the five Zang organs first invades each other, such as excessive joy leading to dispersion of Heart Qi, then Kidney Qi invades; anger injures the Liver; sorrow injures the Lungs, etc. Thus, one Zang organ can suffer from invasions by all five Zang organs. With twenty-five variations and the names of external pathogen transmission and invasion, how can they be counted? The *Nan Jing* discusses pulse diagnoses, naming the five pathological pulses based on mutual invasion among the five Zang organs, with ten variations of slight and severe degrees; these should be consulted. This section aligns conceptually with Qi Bo's statement: "Not responding to the Qi of the four seasons, but the Zang organ alone dominates the disease."

When the large bones are withered and the large muscles are sunken, the chest is full of Qi, breathing is difficult and labored, and the movement of Qi causes the body to tremble, death is expected within six months. If the True Zang Pulse appears, a specific date of death is given. When the large bones are withered and the large muscles are sunken, the chest is full of Qi, internal pain radiates to the shoulders and neck, death is expected within one month. If the True Zang Pulse appears, a specific date of death is given. When the large bones are withered and the large muscles are sunken, the chest is full of Qi, breathing is difficult and labored, internal pain radiates to the shoulders and neck, the body is hot, flesh is wasted and skin breaks, and the True Zang Pulse appears, death occurs within ten months. When the large bones are withered and the large muscles are sunken, the marrow inside is consumed, movements become increasingly weak, although the True Zang Pulse has not yet appeared, death is expected within one year; if the True Zang Pulse appears, a specific date of death is given. When the large bones are withered and the large muscles are sunken, the chest is full of Qi, abdominal pain, heart discomfort, shoulder/neck/body heat, flesh wasting and skin breaking, eye sockets are sunken, the True Zang Pulse appears, the patient cannot see people, and dies immediately. If the patient can still see people, death occurs at the time when the controlling element overcomes them.

This clarifies the fatal signs of chronic illness. Teeth are the surplus of bones; withered teeth indicate withered bones. The Kidneys govern bones, and the Spleen governs muscles. Withered bones and sunken muscles indicate failure of both Spleen and Kidney. Deficient Yang must rise reversely, causing chest fullness, labored breathing, and body trembling due to Qi movement. Since Spleen and Kidney fail to transport and transform, bowel and bladder functions cease. If the pulse is still mild and moderate, survival may extend for half a year; if the True Zang Pulse appears, the date of death can be determined. If internal pain radiates to the shoulders and neck, or if there is body heat, flesh wasting, and skin breaking, death is more rapid. If abdominal pain and sunken eye sockets are added, Spleen Qi is exhausted, the patient cannot see people, Liver and Kidney are both exhausted, so death is immediate. If the patient can still see people, death occurs at the time of the overcoming element.

Ji Xu (Acute Deficiency) refers to a critical deficiency syndrome occurring suddenly, such as stroke or falling. The Qi of the five Zang organs is blocked and closed, the meridians are obstructed, and Qi does not circulate. It is like falling from a height or drowning, where rescue is impossible, and the time of death cannot be predicted. If the pulse stops completely, or if the pulse beats five or six times per breath, although the flesh has not wasted and the True Zang Pulse has not appeared, death will still occur.

Ji Xu refers to a critical deficiency syndrome occurring suddenly, similar to sudden collapse from wind-stroke. The Qi of the five Zang organs is cut off, and the meridians are closed and blocked. It is like falling into water and drowning, unable to be rescued in time, making the time of death unpredictable. The absence of the pulse indicates the non-interaction of Yin and Yang Qi. A pulse rate of five or six beats per breath indicates impending collapse. Even if the flesh has not wasted and the True Zang Pulse has not initially appeared, such a sudden occurrence still leads to death. Thus, the previously mentioned deadlines merely illustrate general principles and should not be rigidly adhered to.

The *Su Wen: Treatise on Root and Branch Disease Transmission* states: Regarding disease transmission, Heart disease first presents with heart pain. After one day, coughing occurs; after three days, rib support and fullness occur; after five days, obstruction and blockage occur, accompanied by body pain and heaviness. If this persists for another three days without improvement, death occurs, in winter at midnight, in summer at noon.

This is because the pathogen transmits to the organ it overcomes, mutually attacking, leading to death. The Heart is first affected, causing heart pain. Coughing after one day indicates transmission to the Lung, where Fire overcomes Metal. Rib fullness after three days indicates transmission to the Liver, where Metal overcomes Wood. Obstruction and body pain/heaviness after five days indicate transmission to the Spleen, where Wood overcomes Earth. After another three days, Earth overcomes Water, transmitting to the Kidney, leading to death. Since the Kidney is the root of Yin and Yang, midnight is when Yin is most abundant, and noon is when Yang is most abundant. Winter midnight is heavy Yin, summer noon is heavy Yang. Encountering these extreme biases of Yin or Yang cuts off the fundamental Yuan Qi of the body.

Lung disease presents with wheezing and coughing. After three days, rib support and pain occur; after one day, body heaviness and pain occur; after five days, distension occurs. If this persists for ten days without improvement, death occurs, in winter at sunset, in summer at sunrise.

This is transmission from Lung to Liver (Metal overcomes Wood), and Liver to Spleen (Wood overcomes Earth). When Spleen Earth fails, body swelling occurs after five days. Death after ten days corresponds to the numbers of generation and completion (Heaven generates 5 for Earth, Earth completes 10). The Qi of Heaven and Earth rises and falls annually; the Qi of the human body rises and falls daily. Rising Qi is vigorous, falling Qi is declining. Each Zang organ has its time of decline and vigor. When a failing organ encounters the peak of Qi decline or vigor, Yin and Yang cannot interact to generate life, leading to death. The logic behind the death times mentioned in previous sections is generally as follows. However, there are also various changes involving the Five Elements' generation and overcoming, such as sudden deaths from acute diseases, which are incalculable. The subtle principles are hard to explain and should not be forced or interpreted rigidly. By carefully examining the pulse and symptoms, the signs of life and death are clearly visible. Determining the exact moment of death requires divine wisdom.

Liver disease presents with dizziness and vertigo of the head and eyes, rib support and fullness. After three days, body heaviness and pain occur; after five days, distension occurs; after three days, lower abdominal and lumbar pain occur, with calf edema. If this persists for three days without improvement, death occurs, in winter at sunset, in summer at breakfast time.

This is transmission from Liver to Spleen, and Spleen to Kidney, leading to death.

Spleen disease presents with body pain and heaviness. After one day, distension occurs; after two days, lower abdominal, lumbar, and spinal pain occur, with calf edema; after three days, back and spine tendon pain occur, with urinary retention. If this persists for ten days without improvement, death occurs, in winter at Ren Ding hour, in summer at dinner time.

This is transmission from Spleen to Kidney, and Kidney to Bladder, causing back/spine tendon pain and urinary retention.

Kidney disease presents with lower abdominal, lumbar, and spinal pain, with calf edema. After three days, back and spine tendon pain occur, with urinary retention; after three days, abdominal distension occurs; after three days, bilateral rib support and fullness occur. If this persists for three days without improvement, death occurs, in winter at early morning, in summer at dusk.

This is transmission from Kidney to Bladder, Bladder to Spleen, and Spleen to Liver, representing reverse transmission to the organ that overcomes it.

Stomach disease presents with distension and fullness. After five days, lower abdominal, lumbar, and spinal pain occur, with calf edema; after three days, back and spine tendon pain occur, with urinary retention; after five days, body heaviness occurs. If this persists for six days without improvement, death occurs, in winter after midnight, in summer [time missing in original text].

This is transmission from Stomach to Kidney, Kidney to Bladder, and Bladder to Spleen, representing mutual transmission between Fu and Zang organs.

Bladder disease presents with urinary retention. After five days, lower abdominal distension, lumbar and spinal pain occur, with calf edema; after one day, abdominal distension occurs; after one day, body pain occurs. If this persists for two days without improvement, death occurs, in winter at Chicken Crowing hour, in summer at afternoon hour.

This is transmission from Bladder to Kidney, and Kidney to Spleen, leading to death. According to the human body, the five Zang and six Fu organs, along with external Ying and Wei, circulate Qi and Blood continuously without interruption. If there is disharmony, pathogens enter due to deficiency and follow the circulation of Qi and Blood. If the original Yuan Qi is strong, pathogens gradually exit; if Yuan Qi is insufficient, pathogens enter the Zang and Fu organs, transmitting mutually, eventually leading to exhaustion of Yuan Qi and death. Therefore, all the above sections discuss death due to pathogen transmission to Zang and Fu organs, not involving exterior diseases of Ying and Wei.