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Jue (Reversal) refers to reversal. The qi that circulates throughout the human body is vital energy. When qi is smooth, health is maintained; when qi is reversed, disease occurs. This chapter discusses diseases caused by the reversal of qi, hence it is called "Qi Jue" (Vital Energy Reversal). The reason why qi becomes reversed and causes disease is due to the influence of cold or heat pathogens. The transfer of cold and heat occurs because the pathogens become excessive and reverse their flow. However, although both cold and heat cause disease, the transfer of cold is limited only to the Five Zang Organs, whereas the transfer of heat extends to all Six Fu Organs. Why is this? Generally, cold originates from water transformation; its nature is Yin, and its movement is quiet, so the pathology remains confined to the Five Zang Organs. Heat originates from fire transformation; its nature is Yang, and its movement is active, so the pathology spreads from the Zang to the Fu Organs.

The Yellow Emperor asked: What is the mechanism behind the mutual transfer of cold and heat between the Five Zang and Six Fu Organs? Qibo replied: When Kidney transfers cold to Spleen, it results in carbuncles/swellings and shortness of breath. (Note: Wang Bing's edition writes "transfers cold to Liver," but based on textual context, it should be "transfers cold to Spleen." Quan Yuanqi's edition states: "Kidney transfers cold to Spleen." The annotation explains: "When Kidney is injured by cold and transmits it to Spleen, since Spleen governs flesh, cold generated in the flesh condenses into hardness, which turns into pus, thus forming a carbuncle. Blood is damaged and Qi is deficient, hence 'shortness of breath.' " The *Jia Yi Jing* also records "transfers cold to Spleen." Wang's version writing "Liver" is likely a copying error. It has been corrected here.) When Spleen transfers cold to Liver, it results in carbuncles/swellings and tendon spasms. (Spleen governs flesh, Liver governs tendons. Warm flesh allows tendons to relax; cold flesh causes tendons to tighten, leading to spasms. Note: Spleen cold causes Qi stagnation, Liver cold causes blood coagulation. Stagnant Qi and congealed blood form carbuncles/swellings. The annotation mentioning "cold flesh" fails to convey the meaning accurately.) When Liver transfers cold to Heart, it results in mania and chest obstruction. (Note: Excessive internal Wood and Fire lead to mania. Mania is a heat condition; how can cold cause mania? The *Su Wen · Liu Yuan Zheng Ji Da Lun* states: "For Wood depression, promote its spread; for Fire depression, vent it." The nature of Wood and Fire prefers expansion and detests depression. When Liver receives cold and transmits it to Heart, the Wood and Fire Qi are depressed and cannot expand freely, causing the Spirit to become chaotic and resulting in mania. Thus, this "mania" is actually caused by Fire Qi being blocked internally.) When Heart transfers cold to Lung, it results in Lung Xiao (Wasting-Thirst of the Lung). Lung Xiao is characterized by drinking one part fluid and urinating two parts; it is a fatal condition and untreatable. (Note: "Xiao" refers to Fire excess scorching Water, which is also a heat disease. How can Heart receiving Cold damage Lung Metal? Heart belongs to Fire and controls Lung Metal; Lung belongs to Metal and fears Fire control. Fire nature disperses outward when hot but closes inward when cold. Having received cold, the Fire in Heart is suppressed by cold, wrapped externally by cold while harboring Fire internally. This Fire attacks the Lung internally. Lung Metal cannot withstand the penalty, leading to dissipation and urine volume exceeding intake. With little intake and excessive output, Essence and Qi are exhausted; who can cure it?) When Lung transfers cold to Kidney, it results in Yong Shui (Surging Water). Yong Shui is characterized by a non-tender abdomen when pressed. Water Qi resides in the Large Intestine, making a gurgling sound when moving quickly, like a bag wrapping paste; this is a water disease. (Note: Qi is the mother of Water. Lung governs all Qi and controls the descending function. Therefore, smooth Qi leads to flowing Water, while closed Qi leads to stagnant Water. Qi flows when hot and closes when cold. Now, Lung cold transfers to Kidney, meaning Qi is closed and cannot descend, causing Water to surge into the Large Intestine and produce gurgling sounds. Large Intestine is the interior-exterior pair of Lung; Qi closure and Water reversal manifest as Lung disease through its paired organ.)

When Spleen transfers heat to Liver, it results in fright and epistaxis. (Liver stores Blood and governs fright. When heat approaches, it causes fright and bleeding from the nose.) When Liver transfers heat to Heart, death ensues. (Note: Heart is inherently a Fire organ. Receiving burning heat from Wood makes it Fire adding to Fire, leading to extreme Yang hyperactivity. How can one not die? Wang Bing's annotation incorrectly cites and forces an explanation, which is extremely presumptuous and erroneous.) When Heart transfers heat to Lung, it transmits to Ge Xiao (Diaphragm Wasting-Thirst). (Note: Heart Fire penalizes Lung Metal. Since Metal cannot withstand heat, Wasting-Thirst results. "Ge" refers to the upper diaphragm. Fire Qi rushes up to the Lung, and the pathology stays above the diaphragm, distinguishing it from middle and lower levels; this is Upper Xiao.) When Lung transfers heat to Kidney, it transmits to Rou Jing (Soft Spasm). (Note: The annotation for "Rou Jing" is unclear. I speculate that "Jing" refers to muscle twitching/spasms, a disorder of Wood. Wood is nourished by Water. Now Kidney receives Lung heat, causing Water depletion and inability to nourish tendons, leading to continuous convulsions. Compared to Gang Jing (Stiff Spasm), it is milder, hence called "Rou" (Soft). Jing sounds like 'chi'.) When Kidney transfers heat to Spleen, it transmits to Xu Sun (Deficiency Damage) and Chang Pi (Intestinal Dysentery), which is fatal and untreatable. (Spleen Earth normally controls Water. If Kidney transfers heat to it, Spleen Earth fails to control Water and becomes diseased, eventually transmitting to deficiency. The reason Chang Pi leads to death is: Kidney governs the Lower Jiao, resembles Water, and is cold. Transferring heat means Essence and Qi are consumed internally, and the Lower Jiao loses its master to guard and hold, causing Chang Pi to occur with uncontrolled Qi. Note: Chang Pi is dysentery. Although dysentery seems related only to Spleen, it is actually caused by receiving transferred heat from Kidney. To remove Kidney heat, Yin-nourishing methods must be used. Treating dysentery solely by addressing Spleen, as done in the world today, is incorrect.) When Bao (Uterus/Essence Chamber) transfers heat to Bladder, it results in Long Bi (Dysuria) and hematuria. (Note: Bladder is the pathway for water metabolism. Bao is where urine is stored, commonly known as the urinary bladder. Bao and Bladder are connected and close. Saying "transfer" follows the previous text. Both are heated; water is scorched by fire, causing urinary retention and hematuria.) When Bladder transfers heat to Small Intestine, it results in obstruction of the diaphragm and intestines, difficulty in defecation, and upward progression to oral ulcers. (Mi means rotting. Note: Small Intestine receives and transforms substances; Bladder stores fluids. Bladder is below Small Intestine. Now receiving heat and transferring to Small Intestine, the pathogen moves upward from below. Fire nature flares upward, causing discomfort in the chest, diaphragm, and intestines, and oral ulcers. "Bu Bian" means unrest/obstruction.) When Small Intestine transfers heat to Large Intestine, it results in Jia Masses and deep pulse. (Note: Small Intestine is the Fu organ of Heart, belonging to Bing Fire. Large Intestine is the Fu organ of Lung, belonging to Geng Metal. Small Intestine belongs to Fire and receives other heat, transferring to Large Intestine. Fire Qi harasses Metal. Metal cannot overcome it, so Qi hides and forms Jia masses. Jia means false; it is the gathering of Qi. In such cases, the pulse is deep. Metal fears Fire penalty, similar to Geng Metal hiding in midsummer. The annotation interpreting Jia as blood overflow and Shen as amenorrhea ignores the meaning of Metal and Fire and is erroneous. Jia is synonymous with Fu.) When Large Intestine transfers heat to Stomach, it manifests as polyphagia with emaciation, called Shi Yi. (Shi Yi means food passes through without nourishing the body. Yi means change. Note: Stomach governs reception; Large Intestine governs transformation. Digestion is their duty. With heat in both Fu organs, Yangming Fire blazes, consuming grain internally and scorching muscles externally. Thus, despite eating much, the person becomes thinner. The interpretation of Shi Yi aligns with the annotation. Wang's edition writes "Shou Ru" instead of "Shou Ren," which is hard to understand. *Jia Yi Jing* writes "Ru" as "You," connecting to the next sentence, which lacks context and logic. I believe "Ru" is a typo for "Ren." Reading it as "Shou Ren" (emaciated person) is smoother. It has been corrected here.) When Stomach transfers heat to Gallbladder, it is also called Shi Yi. (Note: Gallbladder is the Fu organ of Liver, belonging to Yang Wood. Wood inherently contains Fire. Receiving Stomach heat, Wood and Fire burn each other. Thus, the disease is similar to the combination of Two Yangs, hence also called Shi Yi.) When Gallbladder transfers heat to Brain, it results in Xin Bi (Nasal Pain) and Bi Yuan (Nasal Sinusitis). Bi Yuan is characterized by continuous discharge of turbid nasal mucus, which may transmit to Nu Mie (Epistaxis/Hemorrhage) and Ming Mu (Blindness/Closed Eyes). (Brain fluid seeps down to become turbid mucus. Continuous discharge like a spring is called Bi Yuan. Xin refers to the nose and forehead. Heat excess causes Yang collaterals to overflow, leading to epistaxis and sweat-blood. Ming Mu refers to closing eyes/blindness. Severe blood loss weakens Yangming and Taiyang meridians, failing to nourish the eyes, causing them to close or vision to dim. Ming means dark. Note: Gallbladder belongs to Wood and generates Fire. Receiving multiple Fire pathogens and transferring to Brain, Wood-Fire Qi rushes upward, so symptoms are in the upper body. Xin means pungent/spicy, the quality of Fire. Annotation interpreting it as soreness/pain is wrong. Chuan means sequential involvement, implying Bi Yuan precedes epistaxis and blindness. E sounds like 'he', referring to the nasal bridge.)

These conditions all arise from Qi Jue. (Jue means Qi reversal; all result from Qi reversing. Note: This summarizes the main point of the preceding text. The annotation is correct. However, the explanation of "reversal" implies not only upward movement but also disorder and chaos. Smooth Qi brings order; reversed Qi brings chaos. The transfer of cold and heat is indeed due to Qi reversal and disorder.)