张云。按前篇悉言伤寒。此篇名刺热者。盖即所以治伤寒也。但前篇分伤寒之六经。此篇详伤寒之五脏。
正彼此相为发明耳。
小便先黄 志云。先者。谓先有此内因之热。而先见此证也。肝主疏泄。故小便赤黄。倪朱龙曰。
先者。谓先有此内热之证。未与外热交争也。简按据下文四脏之例。先字当在小便上。评热病论云。小便黄者。
小腹中有热也。
腹痛多卧 吴云。肝脉抵小腹。故腹痛。肝主筋。筋痿故多卧。高云。腹。小腹也。木气不达。故多卧。
不得安卧 高云。卧则血归于肝。肝病而血不归也。
大汗 吴云。汗则阴阳和而愈矣。志云。正胜邪而外出也。
气逆 吴云。逆。为邪胜脏。志云。热淫而反内逆也。阴在内。阳在外。热争者。阴阳交争于外内
之间。阴出于外者生。阴阳并逆于内者死。故曰重逆。
员员 甲乙。作贡贡。马云。靡定也。张同。吴云。小痛貌。志云。周转也。通雅云。头痛员员。
正谓作晕。故今人言头悬。简按考文义。志注近是。
冲头也 甲乙。头下。有痛字。
善呕 吴云。心火炎上。故善呕。
颜青 吴云。脾病而肝乘之。故见青色。简按灵五色篇曰。庭者。颜也。王注下文云。颜。额也。
方言云。东齐谓之颡。汝颖淮泗之间。谓之颜。
腰痛 张云。腰者。肾之府。热争于脾。则土邪乘肾。必注于腰。故为腰痛。
淅然 甲乙。作凄凄然。熊音。淅。音昔。寒惊貌。高云。淅然。如水洒身之意。简按淅。广韵。淅
米也。洒水之义。正取于此。
身热 志云。外感曰发热。从内而外。曰身热。简按此说无明证。
走胸膺背 简按王注腹中论云。膺。胸旁也。颈。项前也。胸。膺间也。张亦云。膺。胸之两旁高处
也。而说文云。膺。胸也。考史赵世家云。大膺大胸。修下而冯。知是胸膺有别。说文疏矣。
出血如大豆立已 高。移此七字于下文肾热病云云刺足少阴太阳之下。而云。此七字。旧本在刺手太
阴阳明下。今改正于此。注云。承上文诸刺而言。若出针之时。出血如大豆。则邪热去。而经脉和。其病当立
已。简按余脏热病。不言出血。独于肺热病而言之。实为可疑。高说近是。
苦渴 吴云。肾者水脏。当火炎水干之时。故口渴而数饮。
项痛而强 寒且 高云。邪正相持而热争。争于上。则项痛而强。争于下。则 寒者 。足下热。
不欲言 吴云。肾主吸。入肾病则吸微。故令不欲言也。志云。不欲言者。肾为生气之原也。高云。
热争于中。则不欲言。
澹澹然 简按说文。澹。水摇也。王注不定。义同。马云。无意味。张云。精神短少。非是。甲乙。
无此三字。
诸汗者至其所胜日汗出也 甲乙。汗上。有当字。出。作甚。高云。此衍文也。下文云。诸当汗者。
至其所胜日。汗大出也。误重于此。简按今从高说。而存下文。
颜先赤 高云。心火居上。故心热病者。颜先赤。五色篇云。庭者。颜也。庭。犹额也。
三周 张云。反。谓泻虚补实也。病而反治。其病必甚。其愈反迟。三周者。谓三遇所胜之日而后
已。高云。三周。三日也。简按考王注。凡六刻。盖二刻一周。故为六刻。此甚速。当从张注。
以饮之寒水 甲乙。以。作先。
刺足阳明而汗出止 吴云。不言孔穴。而混言其经者。取穴不泥于一。但在其经。酌之可也。汗出
止者。经气和也。张云。按寒热病篇曰。足阳明可汗出。当是内庭陷谷二穴。
身重骨痛耳聋好瞑 张云。肾主骨。在窍为耳。热邪居之。故为身重骨痛耳聋。热伤真阴。则志气
昏倦。故好瞑。仲景曰。少阴之为病。但欲寐也。（新校正。引灵枢经。见热病篇。）
眩冒 吴云。目前黑谓之眩。目如蒙谓之冒。少阴肾主骨。骨之精为瞳子。少阴热。故令眩冒。简
按海论云。髓海不足。眩冒目无所见。王注玉机真脏论云。眩。谓目眩视如转也。冒。谓冒闷也。○志云。按
以上三节。用十六先字。盖言有先于内者有先于外者。皆当先治之。
胸胁满 缪刺论云。邪客于足少阴之络。胸胁支满。
刺足少阴少阳 高云。眩冒而热。乃少阴肾精不升。热病之起于少阴也。胸胁满。乃少阳经脉不和。
热病之起于少阳也。少阴为阴枢。少阳为阳枢。枢转有乖而病热。故并刺之。
太阳之脉色荣颧骨热病也 张。脉下句。注云。此下言两感之脉色死期也。荣。发见也。太阳之脉。
起于目内 。太阳之筋。下结于 。故太阳热病者。赤色当荣于颧骨。吴
云。荣。华采之称。赤色是也。简按热病篇云。汗不出。大颧发赤。哕者。死。杨氏骨热病连读。恐非。当从王义。
荣未交 吴。荣。作营。注云。营。阴血也。以其营守于中。如军之中营也。张云。与上节之荣不同。
盖指营卫为言。谓邪犹在卫。未交于营。其气不深。故曰。今且得汗。简按荣。即上文荣颧骨之荣。交。甲乙
作夭。下文同。今从之。
与厥阴脉争见 吴云。伤寒例云。尺寸俱微缓者。厥阴受病也。争见者。谓表见阳热之色。里见厥阴
之脉。法曰。阳病见阴脉者死。故死期不过三日。张云。六经热病之序。其始太阳。其终厥阴。今终始争见。
则六经两感俱传遍。故当三日而死。证之下文。义尤明显。简按弦。少阳之脉。王为厥阴之脉。可疑。
其热病 此三字。甲乙。作热气二字。
少阳之脉色也 简按马据新校正。为衍文。今从之。
与少阴脉争见 甲乙。作手少阴。简按热病无言手经者。是误。
死期不过三日 甲乙。作其死不过三日。简按新校正。为王氏所足成。非也。○张云。如上文言太阳
厥阴争见者。太阳为传表之始。厥阴为传里之终。自始而终也。此以少阳少阴争见者。少阳为传表之终。少阴
为传里之始。自终而始也。言始言终。则六经无不遍矣。故不必言阳明太阴之争见也。简按此说恐是傅会。阳
明太阴之争见。无不必言之理。必为阙文。
热病气穴 志云。此言刺未病者。当取之气穴也。气穴者。泻五脏气分之热。高云。热病气穴。犹
言热病刺法。马云。三椎下间名身柱。四椎下间无穴。五椎下间名神道。六
椎下间名灵台。七椎下间名至阳。张云。三椎下者。魄户也。四椎下旁。膏肓也。五椎下旁。神堂也。六椎下
旁。 也。七椎下旁。膈关也。简按张添一旁字。不可从。气穴。即孔穴。义具于气穴论。
膈中热 甲乙。作胃中热。志云。胸中膈上。乃心肺之宫城。主胸中热者。泻肺热也。膈中热者。
泻心热也。不曰心肺。而曰胸中膈中者。意言热在气分。而不干于脏真也。
荣在 也 吴云。脊凡二十一椎。此独刺上之七椎。而不及其下者。盖以上之七惟。阳分也。故主
热病。下之七椎。阴分也。所以主荣血。刺之则虚其阴。故曰荣在 也。有不可伤之意。张云。盖既取阳邪于
上。仍当补阴于下。故曰。荣在 也。高云。荣为阴。主下。若荣血之热病。其穴在脊骨尽处。故曰荣在 也。
简按此一句难通。诸注并不允。
项上三椎陷者中也 张云。此取脊椎之大法也。项上三椎者。乃项骨三节。非脊椎也。三椎之下陷
者中。方是第一节。穴名大椎。吴云。此风府穴也。言有取项上三椎者。则陷中为是。高云。申明三椎也。从
项上数之。而为三椎也。下间者。椎下椎上陷者中也。盖大椎。乃脊骨之第一椎。从项上数之。则大椎为三椎。
如是推之。诸椎皆得矣。志云。此言五脏之热。入于经荣者。当取之骨穴也。脊骨之尽处曰 。谓如取荣穴当
在。而至项上之三椎陷者中而取之。简按此二句。义未太明。张高据王注而释。今姑从之。甲乙。陷上有骨
字。背 篇云。背中大 。在杼骨之端。千金云。大椎。第一椎上陷中。外台同。云。杼骨之端。云第一椎。
皆非项骨之谓。
牙车 刘熙释名云。辅车。或曰牙车。或曰颊车。或曰 车。凡系于车。皆取在下载上物也。
Zhang Yun: According to the previous chapter (Re Lun), the entire text discusses cold damage. This chapter, titled "Stimulating Heat," is essentially for treating cold damage. However, while the previous chapter divides cold damage into the six meridians, this chapter details the manifestations of cold damage in the five zang organs. These two chapters mutually elucidate each other.
Urine becomes yellow first: Zhi Yun: The term "first" refers to the prior existence of an internal heat etiology, leading to the prior appearance of this symptom. The Liver governs dispersion and drainage; therefore, the urine is red and yellow. Ni Zhulong states: "First" means that there are symptoms of internal heat prior to any conflict with external heat. Jian An: Based on the pattern of the four zang organs described later, the character "first" should precede "urine." Ping Re Bing Lun states: Yellow urine indicates heat in the lower abdomen.
Abdominal pain and excessive sleepiness: Wu Yun: The Liver meridian reaches the lower abdomen, causing abdominal pain. The Liver governs the sinews; flaccidity of the sinews leads to excessive sleepiness. Gao Yun: Abdomen refers to the lower abdomen. When Wood energy fails to circulate freely, it results in excessive sleepiness.
Inability to rest comfortably in bed: Gao Yun: When lying down, blood returns to the Liver. In Liver disease, blood does not return properly.
Profuse sweating: Wu Yun: Sweating allows Yin and Yang to harmonize, leading to recovery. Zhi Yun: Correct Qi overcomes pathogenic factors and expels them outward.
Qi rebellion: Wu Yun: Rebellion occurs when pathogens overcome the organ. Zhi Yun: Excessive heat rebels inwardly. Yin resides inside, Yang outside. Heat contention represents a struggle between Yin and Yang within and without. If Yin emerges outwardly, life is preserved; if both Yin and Yang rebel inwardly, death ensues. Hence, it is termed severe rebellion.
Yuan Yuan (Dizziness): Jia Yi Jing writes it as "Gong Gong." Ma Yun: Indeterminate appearance. Zhang Tong: Wu Yun: Appearance of slight pain. Zhi Yun: Rotation. Tong Ya states: Dizziness in headache is precisely what is meant by dizziness; hence, people today speak of a sensation of the head hanging. Jian An: Examining the textual meaning, Zhi's annotation is closer to the truth.
Rushing to the head: Jia Yi Jing: Under "head," the character "pain" exists.
Frequent vomiting: Wu Yun: Heart Fire flares upward, causing frequent vomiting.
Blue complexion on the face: Wu Yun: Spleen disease allows the Liver to overcome it, resulting in a blue color. Jian An: Ling Shu · Wu Se Pian states: Ting refers to the face. Wang's annotation on the following text says: Yan refers to the forehead. Fang Yan states: In eastern Qi, it is called Sang; between Ru, Ying, Huai, and Si rivers, it is called Yan.
Lower back pain: Zhang Yun: The waist is the mansion of the Kidney. Heat contends in the Spleen, allowing Earth pathogens to attack the Kidney, inevitably affecting the waist, thus causing lower back pain.
Xi Ran (Chilly feeling): Jia Yi Jing writes it as "Qi Qi Ran." Xiong pronunciation: Xi sounds like Xi. Appearance of cold and fright. Gao Yun: Xi Ran implies a sensation like water sprinkled on the body. Jian An: Xi, according to Guang Yun, means washing rice. The meaning of sprinkling water is taken from here.
Body heat: Zhi Yun: External contraction is called fever; heat radiating from inside out is called body heat. Jian An: This explanation lacks clear evidence.
Radiating to the chest, pectoral region, and back: Jian An: Wang's annotation on Fu Zhong Lun states: Ying refers to the sides of the chest. Jing refers to the front of the neck. Xiong refers to the space between the chest and ying. Zhang also states: Ying refers to the high points on both sides of the chest. However, Shuo Wen states: Ying means chest. Examining Shi Ji · Zhao Shi Jia, it says: Large ying and large chest, slender below and leaning forward. Thus, xiong and ying are distinct. Shuo Wen is imprecise.
Bleeding like soybeans leads to immediate cessation: Gao: Move these seven characters to the section on Kidney Heat Disease, specifically after stimulating Foot Shaoyin and Taiyang. He states: These seven characters were originally under the stimulation of Hand Taiyin and Yangming in old editions; now corrected here. The annotation explains: Following the various stimulations mentioned above, if upon withdrawing the needle, bleeding resembles soybeans, then pathogenic heat is eliminated, meridians harmonize, and the illness ceases immediately. Jian An: For heat diseases of other organs, bleeding is not mentioned; only for Lung Heat Disease is it mentioned, which is indeed suspicious. Gao's view is close to the truth.
Bitter thirst: Wu Yun: The Kidney is the Water Organ. When Fire flares and dries up Water, thirst and frequent drinking occur.
Neck pain and stiffness accompanied by chills [missing]: Gao Yun: When pathogens and correct Qi contend with heat, contention above causes neck pain and stiffness. Contention below causes [missing] chills and heat in the soles of the feet.
Unwillingness to speak: Wu Yun: The Kidney governs inhalation. In Kidney disease, inhalation becomes weak, causing unwillingness to speak. Zhi Yun: Unwillingness to speak arises because the Kidney is the source of generating Qi. Gao Yun: Heat contention in the middle causes unwillingness to speak.
Dan Dan Ran (Palpitations/Water-like trembling): Jian An: Shuo Wen: Dan means water shaking. Wang's annotation is uncertain but has similar meaning. Ma Yun: Meaningless. Zhang Yun: Shortage of spirit, which is incorrect. Jia Yi Jing: These three characters are absent.
All sweating occurs on the day they overcome their respective elements: Jia Yi Jing: Above "sweat," there is the character "should." "Chu" is written as "Shen." Gao Yun: This is a redundant text. The following text says: All who should sweat, sweat profusely on the day they overcome their respective elements. It was erroneously repeated here. Jian An: Following Gao's view, retaining the following text.
Complexion turns red first: Gao Yun: Heart Fire resides above; thus, in Heart Heat Disease, the complexion turns red first. Wu Se Pian states: Ting refers to the face. Ting is akin to the forehead.
Three cycles: Zhang Yun: Fan means draining deficiency and tonifying excess. Treating the disease contrary to its nature makes the disease worse and recovery slower. Three Zhou refers to encountering the day of overcoming one's element three times before recovery. Gao Yun: Three Zhou means three days. Jian An: Examining Wang's annotation, it totals six ke (time units). Assuming two ke per cycle, it equals six ke. This is very rapid; Zhang's note should be followed.
Drink cold water: Jia Yi Jing: "Yi" is written as "Xian."
Stimulate Foot Yangming until sweating stops: Wu Yun: Not specifying acupoints but referring generally to the meridian implies that point selection is not rigid but must belong to that meridian, adjusted appropriately. Cessation of sweating indicates harmony of meridian Qi. Zhang Yun: According to Han Re Bing Pian: Foot Yangming can induce sweating. It likely refers to the Neiting and Xangu acupoints.
Heavy body, bone pain, deafness, and desire to keep eyes closed: Zhang Yun: The Kidney governs bones and opens into the ears. Pathogenic heat residing there causes heavy body, bone pain, and deafness. Heat damages True Yin, causing mental fatigue and drowsiness, hence the desire to keep eyes closed. Zhongjing states: The hallmark of Shaoyin disease is desire to sleep. (New Correction cites Ling Shu Jing, seen in Re Bing Pian.)
Vertigo and dizziness: Wu Yun: Darkness before the eyes is called vertigo; eyes covered like by a veil is called dizziness. The Shaoyin Kidney governs bones; the essence of bones forms the pupils. Shaoyin heat causes vertigo and dizziness. Jian An: Hai Lun states: Insufficiency of the Sea of Marrow causes vertigo and blindness. Wang's annotation on Yu Ji Zhen Zang Lun states: Xuan means eyes spinning as if rotating. Mao means stifling sensation. ○ Zhi Yun: Regarding the above three sections, sixteen "first" characters are used, indicating some conditions originate internally and others externally, all requiring prior treatment.
Chest and hypochondriac fullness: Miao Ci Lun states: Pathogens invading the collateral of Foot Shaoyin cause distending fullness in the chest and hypochondrium.
Stimulate Foot Shaoyin and Shaoyang: Gao Yun: Vertigo, dizziness, and heat indicate failure of Shaoyin Kidney Essence to ascend, marking heat disease originating in Shaoyin. Chest and hypochondriac fullness indicate disharmony of Shaoyang meridians, marking heat disease originating in Shaoyang. Shaoyin is the pivot of Yin, Shaoyang is the pivot of Yang. Disordered pivoting leads to heat disease; thus, both are stimulated.
The pulse and color of Taiyang manifest on the cheekbones indicate heat disease: Zhang: Pause after "pulse." Annotation: The following text discusses the pulse, color, and prognosis of death in simultaneous cold damage. Rong means manifestation. The Taiyang pulse originates from the inner canthus. The Taiyang tendon connects downwards to the eye system. Therefore, in Taiyang heat disease, red color manifests on the cheekbones. Wu Yun: Rong refers to luster or brilliance, specifically red color. Jian An: Re Bing Pian states: If no sweat occurs, large cheekbones turn red, and hiccups appear, death ensues. Yang Shi connected "Bone Heat Disease," which is likely incorrect. Wang's interpretation should be followed.
Wei Jing (Nutritive Qi has not yet intersected): Wu: Rong is written as Ying. Annotation: Ying refers to Yin Blood. Because Ying guards within, like an army guarding its camp. Zhang Yun: Different from the Rong in the previous section; it refers to Ying and Wei, stating that pathogens remain in Wei and have not yet entered Ying, so the qi is not deep, hence "now sweating may occur." Jian An: Rong here refers to the Rong in "manifesting on cheekbones." Jiao, Jia Yi Jing writes as Yao. Same in subsequent text. Follow this version.
Contending with Jueyin pulse manifestation: Wu Yun: Shang Han Li states: Pulse at Cun and Chi both fine and slow indicates Jueyin involvement. Contending manifestation means exterior shows Yang-heat color, interior shows Jueyin pulse. The method states: Yang disease showing Yin pulse indicates death; thus, death will not exceed three days. Zhang Yun: The sequence of Six Meridian Heat Disease begins with Taiyang and ends with Jueyin. Now, beginning and end contend simultaneously, meaning all six meridians in simultaneous cold damage have transmitted fully, so death occurs within three days. Comparing with the following text, the meaning is even clearer. Jian An: Xian is the Shaoyang pulse; Wang identifies it as Jueyin pulse, which is questionable.
Its heat disease: These three characters, Jia Yi Jing writes as "Heat Qi."
Shaoyang pulse and color: Jian An: Ma, based on New Correction, considers this redundant text. Follow this.
Contending with Shaoyin pulse manifestation: Jia Yi Jing writes "Hand Shaoyin." Jian An: Re Bing does not mention Hand meridians; this is an error.
Death will not exceed three days: Jia Yi Jing writes "Its death will not exceed three days." Jian An: New Correction was completed by Wang Shi, which is incorrect. ○ Zhang Yun: As stated earlier regarding Taiyang and Jueyin contending, Taiyang is the beginning of transmitting to the exterior, Jueyin is the end of transmitting to the interior. From beginning to end. Here, Shaoyang and Shaoyin contend; Shaoyang is the end of transmitting to the exterior, Shaoyin is the beginning of transmitting to the interior. From end to beginning. Mentioning beginning and end covers all six meridians. Thus, there is no need to mention Yangming and Taiyin contending. Jian An: This theory seems forced. There is no reason why Yangming and Taiyin contending would not be mentioned. It must be missing text.
Acupoints for Heat Disease: Zhi Yun: This discusses stimulating those who are not yet ill, taking Qi Acupoints. Qi Acupoints drain heat from the Qi aspect of the five zang organs. Gao Yun: Heat Disease Acupoints refer to stimulation methods for heat disease. Ma Yun: Between the third and fourth vertebrae is Shen Zhu. No acupoint between fourth and fifth. Between fifth and sixth is Shen Dao. Between sixth and seventh is Ling Tai. Between seventh and eighth is Zhi Yang. Zhang Yun: Below the third vertebra is Po Hu. Beside below the fourth is Gao Huang. Beside below the fifth is Shen Tang. Beside below the sixth is [Missing]. Beside below the seventh is Ge Guan. Jian An: Zhang added the character "beside," which should not be followed. Qi Acupoint means hole/acupoint. Meaning is detailed in Qi Ke Lun.
Heat in the diaphragm: Jia Yi Jing writes "Heat in the stomach." Zhi Yun: The upper chest and diaphragm are the palace city of the Heart and Lungs. To treat heat in the upper chest, drain Lung heat. To treat heat in the diaphragm, drain Heart heat. Not saying Heart and Lung, but Upper Chest and Diaphragm, implies heat is in the Qi aspect and does not affect the true organs.
Ying resides in [Missing]: Wu Yun: The spine has twenty-one vertebrae. Only stimulating the upper seven vertebrae, not the lower ones, is because the upper seven belong to the Yang aspect, thus governing heat disease. The lower seven belong to the Yin aspect, governing Ying Blood. Stimulating them would deplete Yin, hence "Ying resides in [Missing]," implying they should not be injured. Zhang Yun: Since Yang pathogens are taken from above, Yin should still be supplemented below, hence "Ying resides in [Missing]." Gao Yun: Ying is Yin, governing below. If Ying Blood suffers heat disease, its acupoints are at the end of the spinal column, hence "Ying resides in [Missing]." Jian An: This sentence is difficult to understand; none of the annotations are satisfactory.
The depression among the three vertebrae above the neck: Zhang Yun: This is the general rule for locating spinal vertebrae. The three vertebrae above the neck are actually three segments of the cervical bone, not the spinal vertebrae. The depression below the third vertebra is the first segment. The acupoint name is Da Zhui. Wu Yun: This is Feng Fu acupoint. Saying to take the three vertebrae above the neck implies the depression is correct. Gao Yun: Clarifying the three vertebrae. Counting from the top of the neck gives the third vertebra. The space below refers to the depression between the lower and upper vertebrae. Da Zhui is the first spinal vertebra. Counting from the top of the neck, Da Zhui is the third vertebra. By this logic, all vertebrae can be determined. Zhi Yun: This discusses heat entering meridians and Ying from the five zang organs, taking bone acupoints. The end of the spinal column is called [Missing]. Like taking Ying acupoints at [Missing], and stimulating the depression among the three vertebrae above the neck. Jian An: The meaning of these two sentences is not entirely clear. Zhang and Gao explain based on Wang's annotation; follow tentatively. Jia Yi Jing: Above "depression," there is the character "bone." Bei [Missing] Pian states: Large [Missing] in the back, at the end of the vertebral bones. Qian Jin states: Da Zhui, depression above the first vertebra. Wai Tai agrees. Saying end of vertebral bones or first vertebra does not refer to the cervical bone.
Jia Che (Jaw joint): Liu Xi's Shi Ming states: Fu Che, or sometimes called Ya Che, or Jia Che, or [Missing] Che. Anything associated with a cart/wheel takes its name from carrying objects on top.