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The chapter consists of four sections: the first discusses Yin-Jiao (Yin-Yang Intermingling), the second discusses Feng-Jue (Wind-Jue), the third discusses Lao-Feng (Labor-Wind), and the fourth discusses Shen-Feng (Kidney-Wind). The term "Ping Re" (Evaluating Heat) refers to the fact that these four diseases are all rooted in heat, and this text evaluates them.

Each section contains profound principles that should be carefully contemplated.

The Yellow Emperor asked: There is a condition where a patient suffers from warm disease; after sweating, fever returns immediately, the pulse remains rapid and restless without slowing down due to sweating, there is delirious speech, and an inability to eat. What is the name of this disease? Qibo replied: This disease is named Yin-Jiao (Yin-Yang Intermingling).
Jiao (Intermingling) indicates death. (Jiao means the intermingling of Yin and Yang Qi, where they no longer remain distinct.) The Emperor said: I wish to hear the explanation. Qibo said: The reason humans sweat is that it originates from grain (dietary nutrients), and grain essence derives from Jing (Essence). (This means Gu Qi [Grain Qi] transforms into Essence; when Essence is abundant, it becomes sweat.) Now, when pathogenic factors contend with healthy Qi in the muscles and bones, if sweating occurs, it indicates that the pathogen has retreated and Essence has prevailed. When Essence prevails, one should be able to eat and not have recurrent fever. Recurrent fever is caused by pathogenic factors; sweat is produced by Essence. Now, sweating followed immediately by recurrent fever indicates that the pathogen has prevailed. The inability to eat means that Essence receives no assistance (Bi: aid/supply). If the disease lingers, life expectancy will collapse immediately. (Wu Bi means there is no means to generate sweat. If grains are not digested, Essence is not generated; if Essence does not transform and circulate, there is no source for sweat. Note: The *Jia Yi Jing* reads "Re Liu" [Heat Linger], which is also acceptable. Generally, pathogenic heat resolves with sweating. Now, heat returning after sweating indicates internal exhaustion of Essence, which cannot expel the pathogen outward, so the heat lingers and does not depart. Neither inducing sweat nor tonifying can help at this stage, leading inevitably to death.)

Furthermore, the *Lun Re* (Treatise on Heat) states: If the pulse remains rapid and vigorous after sweating, death ensues. (*Lun Re* refers to the ancient *Shang Gu Lun Re*). Now, the pulse does not correspond with the sweating, indicating that healthy Qi cannot overcome the disease; death is evident. Delirious speech indicates loss of Zhi (Will/Shen), and loss of Zhi leads to death. Since three signs of death are present and no sign of life is seen, even if there is temporary recovery, death is inevitable. (Note: Here, an ancient treatise is cited to repeatedly detail why recurrent fever after sweating is invariably fatal.)

The Emperor asked: There is a condition where the body is hot, sweating occurs accompanied by vexation and fullness, and vexation/fullness does not resolve with sweating. What disease is this? Qibo said: Body heat with sweating is Wind. Vexation and fullness that do not resolve with sweating are Jue (Reversal/Cold Extremities). This disease is named Feng-Jue (Wind-Jue). The Emperor said: I wish to hear the details. Qibo said: The Taiyang (Greater Yang) channel governs Qi and thus is the first to be invaded by pathogens. Shaoyin (Lesser Yin) is interiorly-exteriorly related to Taiyang; when affected by heat, Shaoyin Qi follows upward, leading to Jue. The Emperor asked: How should it be treated? Qibo said: Acupuncture both the exterior and interior channels, and administer herbal decoctions. (Note: The sweating here is spontaneous sweating. Taiyang is the exterior, Shaoyin is the interior. Exterior deficiency allows Wind invasion, causing spontaneous sweating and body heat. Wind transforms into heat; excessive heat causes Kidney Water to attempt to cool it. Shaoyin is Kidney Water, but Water fails to overcome Fire, resulting in vexation, fullness, and Jue due to rebellious Qi moving upward from below. Although Qibo did not explicitly state the rationale, the treatment principle is implied. The key is to clear heat and release the exterior while simultaneously nourishing Yin.)

The Emperor asked: What is the nature of Lao-Feng (Labor-Wind)? Qibo said: Lao-Feng typically resides below the Lung. (It is called Lao-Feng because it arises from labor-induced wind invasion. Note: "Below the Lung" likely refers to the pathological process originating lower in the lung region and moving upward.) This disease causes stiffness of the neck and upper back, and blurred vision. (Note: Since the pathology is in the Lung, Qi must be asthmatic. "Qiang Shang" means forcing the head upward; bending forward exacerbates asthma. "Ming Shi" means impaired vision due to internal rushing of Qi. "Qiang" is pronounced as a rising tone.) The patient expectorates sputum resembling mucus, feels aversion to wind, and experiences chills. This constitutes Lao-Feng. The Emperor asked: How should it be treated? Qibo said: The primary goal is to restore normal breathing movements.
Those with robust Jing recover in three days, middle-aged individuals in five days, and those with deficient Jing in seven days. They cough up green-yellow phlegm resembling pus, sized like a bullet, expelled from the mouth or nose. If not expelled, the Lung is damaged, and damage to the Lung leads to death. (Note: Qibo's response, from "restore breathing" to "seven days," consists of twenty-one characters that seem meaningless; there is likely an error here, so we preserve the doubt. Strictly speaking, the Lao-Feng section states the pathology is below the Lung, mentions expectoration of mucus-like fluid, aversion to wind and chills, and coughing up green-yellow phlegm resembling pus, ending with "damage to Lung leads to death." Detailed analysis shows this is entirely a Lung disease. The Lung governs the skin and hair; upon labor, pores open, allowing Wind to invade and lodge in the Lung, condensing into turbid fluids like mucus or pus. Thus, expulsion leads to survival, while retention damages the Lung and causes death. Wang Bing’s commentary interpreting this as Kidney Labor and forcibly explaining terms like "drawing Jing" is highly disjointed. Even interpretations in the *Jia Yi Jing* and *Qian Jin Fang* lack clarity.)

The Emperor asked: A patient suffering from Shen-Feng (Kidney-Wind) presents with facial edema and difficulty speaking. Can acupuncture be used? (Ran describes swelling. Yong refers to the swollen appearance under the eyes resembling a sleeping silkworm. The Kidney meridian ascends from the Kidney, passes through the Liver and Diaphragm, enters the Lung, follows the throat, and attaches to the root of the tongue, hence interfering with speech.) Qibo said: Deficiency patterns should not be needled. If needled inappropriately, pathogenic Qi will arrive in five days. (Zhi means the arrival of pathogenic Qi.) The Emperor asked: What will happen when it arrives? Qibo said: Upon arrival, there will be shortness of breath, intermittent fever, and sweating starting from the chest and back moving to the head, hot palms, dry mouth with bitter taste and thirst, yellow urine, edema under the eyes, borborygmus, heaviness of the body making movement difficult, amenorrhea, vexation with inability to eat, inability to lie flat, and coughing when lying flat. This disease is named Feng Shui (Wind-Water). The Emperor said: I wish to hear the explanation. Qibo said: Wherever pathogenic factors gather, Healthy Qi is necessarily deficient. When Yin is deficient, Yang pathogenic factors inevitably gather, causing shortness of breath, intermittent fever, and sweating. Yellow urine indicates heat in the lower abdomen. Inability to lie flat indicates disharmony in the Stomach. Coughing worsens when lying flat because Qi presses upward against the Lung. All conditions involving water retention show slight edema first under the eyes. (Note: Abundant Qi suffices to defend the exterior, preventing pathogen entry. Only when Qi is deficient can pathogens gather. Qi deficiency is Yang deficiency; Yang deficiency certainly invites pathogens. Regarding Yin deficiency: Yin is Water, Yang is Fire. Abundant Water controls Fire, maintaining balance; depleted Water allows Fire to prevail. The more Yin is deficient, the more Yang excels, creating blazing fire throughout the body. One must realize this stems from Yin deficiency, understanding that bitter-cold herbs should not be administered recklessly. Cou (Gather) means the convergence of fire. Inability to lie flat occurs because stomach disharmony leads to restlessness. If the Stomach is disharmonious, it fails to nourish the Lung and instead harasses it.) The Emperor asked: Why say this? Qibo said: Water is Yin, and the area under the eyes is also Yin. The abdomen is the residence of Supreme Yin. Therefore, when water accumulates in the abdomen, edema under the eyes necessarily occurs. True Qi rebels upward (here interpreted as Fire Qi to match the context of bitter taste and dry mouth), causing bitter taste, dry tongue, inability to lie flat, and coughing up clear fluid when lying flat. All water diseases prevent lying down; lying down causes fright, and fright exacerbates coughing. Borborygmus originates in the Stomach. Pathogens pressing on the Spleen cause vexation and anorexia. Inability to swallow food is due to obstruction in the epigastrium. Heaviness and difficulty walking relate to the Stomach Meridian running along the feet. Amenorrhea results from closure of the Bao Mai (Uterine Vessels). Bao Mai belongs to the Heart and connects to the Uterus. Now, Qi presses upward against the Lung, preventing Heart Qi from descending, thus causing amenorrhea. (Note: Qibo’s answer appears inconsistent before and after; commentators suggest missing bamboo slips, which is plausible. Alternatively, he may have expanded on the Emperor’s question, being brief initially and detailed later, explaining the discrepancy. "True Qi" should be interpreted as "Fire Qi" to align with bitter taste and dry mouth. Water diseases prevent lying down, and lying down causes fright, because water properties descend; lying down causes rebellious Qi and unrest. Heart Qi failing to descend causes amenorrhea because the Heart governs Blood.) The Emperor said: Excellent!