马云。末有故得之气厥也。则凡寒热相移。皆气逆使然。故名篇。吴同。
肾移寒于肝 肝字。诸家据新校正。改作脾。今从之。
痈肿少气 吴云。寒毒移于骨肉之间。壅塞营卫。或先肿后痛。或先痛后肿。皆曰痈肿。少气者。
肾以阴气吸纳。
今肾之阴气移。而并于脾。则肾之阴气微矣。无以吸纳。故少气。张云。肾中寒气。移于脾者。乃为痈肿。凡
痈毒之病。寒热皆能为之。热者为阳毒。寒者为阴毒。盖脾主肌肉。得寒则气聚而坚。坚而不散。则为肿为痈
也。一曰。痈者。壅也。肾以寒水之气。反传所胜。侵侮脾土。故壅为浮肿。其义尤通。少气者。寒盛则阳虚
于下。阳虚则无以化气也。简按张注后说。义为明晰。悬壅。作悬痈。（甲乙）及孟子痈疽（韩非作雍 。）
之类。古假借通用颇多。马志及高。并仍王注。为痈疽之义。不可从。
隔中 灵邪气脏腑病形篇云。隔中。食饮入而还出。后沃沫。
肺消 张云。心火不足。则不能温养肺金。肺气不温。则不能行化津液。故饮虽一。而溲则倍之。夫
肺者。水之母也。水去多。则肺气从而索矣。故曰肺消。门户失守。本元日竭。故死不能治。王氏注云云。愚
谓火烁于内者。又安得饮一而溲二。此注似为未妥。简按方出于圣济总录五十八卷。
涌水 张云。涌。 同。涌水者。水自下而上。如泉之涌也。水者。阴气也。其本在肾。其末在肺。
肺移寒于肾。则阳气不化于下。阳气不化。则水泛为邪。而客于大肠。以大肠为肺之合也。汪昂云。痈肿狂膈
肺消之症。多属火热。而经文俱云移寒。若作热解。则下文又有移热一段。诸注随证训释。或言热。或言寒。
语虽不一。义实难移。窃谓移寒。寒字。当作受病之始。言如隔塞。多属热结。若云膈症。间有寒膈痈肿。间
有寒疡。而属热者。多与狂颠肺消。均当作寒久变热解。于义始通。若下文移肾涌水。则始终均属阴寒也。简
按汪昂盖不见张注。故有此等说。恐未免附会。涌水方。具圣济总录七十九卷。
濯濯 灵邪气脏腑病形篇云。大肠病者。肠中切痛。而鸣濯濯。
膈消 马云。一说。膈证肺消。当为二病。张云。膈上焦烦。饮水多而善消也。上文言肺消者因于
寒。此言膈消者因于热。可见消有阴阳二证。不可不辨。李氏兰室秘藏云。上消者。舌上赤裂。大渴引饮。经
云。心移热于肺。传为膈消。是也。简按李以为上消渴。是。膈消方。具于圣济总录四十九卷。
柔 简按柔者。阴之义。伤寒论。太阳病。发热无汗。反恶寒者。名曰刚 。太阳病。发热汗出。
不恶寒者。名曰柔 。成无己注。 字。乃痉之误。盖肺属太阴。肾属少阴。肺移热于肾而发痉。故曰柔痉。
活人书云。柔痉。又云阴痉。是也。马张根据王注云。柔谓筋纵而无力也。说文。痉。劲急也。筋纵无力。何得
云痉。于理太乖。吴云。柔。多汗也。亦误。
肠 死 张云。肾移热于脾者。阴火上炎也。邪热在下。真阴必亏。故传为虚损。肾本水脏。而挟
热侮脾。故名肠 。下利脓血。阴虚反克。则水土俱败。故死。
胞移热于膀胱 楼云。胞。谓女子之胞也。吴云。胞。阴胞也。在男则为精室。在女则为血室。张
同。简按精室无所考。当从楼说。王履溯洄集云。膀胱固为津液之腑。又有胞居膀胱之中。程序医彀云。胞。
本胞胎之胞。履错认为尿脬之脬。却乃牵合而傅会。以膀胱联而为一。若有热何待于移。移者。由他脏移至之
谓。是语相矛盾矣。张五味篇注。亦辨履之误。当考。（胞义。详于五脏别论。）
口麇 麇。诸本作麋。简按古通用。（盐铁论。麇鬲。论衡。麇烂。并麋同。）然宋本以下。并作
麋。当改。志云。小肠之下。名曰
阑门。济泌别汁。渗入膀胱。膀胱反移热于小肠。是以鬲肠不能下渗。湿热之气。反随经上逆。而口为之麋烂
矣。圣济总录云。热气厥逆。膀胱移热于小肠。胃之水谷。不得传输于下。故鬲塞不便。上则令口生疮而糜烂
也。大抵心胃壅热。则必熏蒸于上。不可概用傅药。当求其本而治之。方具于一百十七卷。
瘕 张云。小肠之热下行。则移于大肠。热结不散。则或气或血。留聚于曲折之处。是为 瘕。
简按颜氏家训曰。宓。伏。 。古来通字。方具于圣济总录第五十卷。（瘕。详于大奇论注。）
为沉 马云。伏瘕。则沉其中也。吴云。为隐伏秘匿之瘕。极其痛苦奔注。如火之灼。痛止则如不
病之平人。为患深沉。不易求也。张同。志云。沉痔也。邪气脏腑篇曰。肾脉微涩为沉痔。曰沉者。抑上古之
省文。或简脱耶。诸家注释。皆以沉为伏瘕沉滞。按经文用二为字。是系二证。不可并作一证论。高本。沉下
有痔字。注云。痔字简脱。今补。火热下行。而为沉痔。简按据二为字。志高似是。汪昂云。沉。疝字之误。
非也。儒门事亲云。夫妇人月事沉滞。数月不行。肌肉不减。内经曰。是名为瘕为沉也。沉者。月事沉滞不行
也。急宜服桃仁承气汤加当归。大作剂料服。不过三服立愈。
善食而瘦 甲乙。瘦。作溲。非也。
食亦 甲乙。作食 。入。作又。在 字下。简按亦。易也。即跛易痿易狂易之易。虽善食而不肥。
与平常变易。故曰食易。张云。虽食亦病而瘦。所以谓之食亦。高同。此训为助字之亦。乃非名病之义。千金
方云。食多身瘦。名曰食晦。先取脾俞。后取季胁。盖晦。不见之义。即食 也。（ 字义详见于平人气象论。）
楼氏纲目云。食 者。谓食移易而过。不
生肌肤。亦易饥也。东垣云。善食而瘦者。胃伏火邪于气分则能食。脾虚则肌肉削也。方具于圣济总录四十七卷。
辛 鼻渊 吴良。脑受其热。故令 中辛辣。鼻液如渊之流。无止息也。简按玉篇。 。鼻茎也。
释名。 。鞍也。偃折如鞍也。图翼云。 。音遏。鼻梁亦名下极。即山根也。沈子禄云。俗呼为鼻根 。或
作。（蹙 。见史蔡泽传。）高云。两 辛 。鼻两旁曰 。非也。千金方云。夫鼻洞者。浊下不止。传为
鼽瞢瞑目。故得之气厥。盖鼻洞者。鼻液洞下不止之义。即鼻渊也。张氏医通云。鼻渊鼻鼽。当分寒热。若涕
脓而臭者为渊。属热。清凉之药散之。若涕清而不臭者为鼽。属虚寒。辛温之剂调之。
衄 甲乙。 。作 。（广韵。 。目赤也。）释音。 。莫结切。简按王注汗血。见说文。吴
云。鼻中出血。谓之衄 。盛者为衄。微者为 。未详所据。圣济总录云。在鼻为衄。在汗空为 。此误读王
注。以污为汗也。太疏。
故得之气厥也 简按王以降诸家。以为结总一篇之义。然涌水癃溺血 瘕食亦。恐不得之气厥。乃
谓辛 鼻渊衄 瞑目而已。全本并此篇于厥论。其名篇以气厥者。王所改定。知此非总结之文也。
Ma Yun: Finally, there is the syndrome of "Qi Jue" (Qi Reversal) caused by contracting pathogenic factors. Therefore, all diseases involving the mutual transition of cold and heat are caused by the reversal of Qi mechanism, which is why this chapter is named accordingly. Wu Kun: The Kidney transmits cold to the Liver (Note: Various scholars, following the *Xin Zheng* [New Corrections], changed the character "Liver" in the original text to "Spleen"; here we follow that correction).
Symptoms include carbuncles and swelling, and shortness of breath. Wu Kun stated: Cold-toxin migrates into the space between bone and flesh, obstructing Ying (Nutritive) and Wei (Defensive) Qi. Sometimes swelling precedes pain, sometimes pain precedes swelling; both are termed carbuncles and swelling. "Shortness of breath" occurs because the Kidney relies on Yin Qi for its grasping function. Now, when the Kidney's Yin Qi migrates and merges with the Spleen, the Kidney's Yin Qi becomes weak and lacks the power to grasp, resulting in shortness of breath. Zhang Jingyue stated: When cold qi from the Kidney migrates to the Spleen, it forms carbuncles. Generally, carbuncle diseases can be caused by either cold or heat pathogens. Heat belongs to Yang toxin, while cold belongs to Yin toxin. Since the Spleen governs muscles, upon receiving cold, Qi aggregates and hardens; if it remains hard and does not dissipate, it forms swelling and abscesses. Another view states: "Carbuncle" (Yong) means "obstruction." The Kidney, using its cold-water Qi, reversely transmits to overcome what it normally controls, invading and insulting the Earth element of the Spleen, thus causing obstruction and edema. This interpretation is particularly coherent. Regarding "shortness of breath," severe cold leads to deficiency of Yang Qi in the lower jiao; when Yang Qi is deficient, it cannot transform into Yuan Qi. Jian An: Zhang Jingyue's latter explanation is clear and logical. "Xuan Yong" should be written as "Xuan Yong" (see *Jia Yi Jing*) and similar to Mencius' mention of "carbuncles and ulcers" (written as "Yong" in *Han Feizi*). Ancient texts frequently used phonetic loans. Ma Shi and Gao Shishi followed Wang Bing's commentary, interpreting it as carbuncles and ulcers, which is incorrect.
"Gé Zhong" (Diaphragmatic Obstruction): *Ling Shu · Xie Qi Zang Fu Bing Xing Pian* states: In Gé Zhong syndrome, food and drink enter but are regurgitated, followed by the expulsion of saliva.
"Fei Xiao" (Lung Wasting-Thirst): Zhang Jingyue stated: If Heart Fire is insufficient, it cannot warm and nourish Lung Metal. If Lung Qi is not warm, it cannot transport and transform body fluids. Thus, although one cup of water is drunk, two cups of urine are excreted. The Lung is the mother of water; excessive loss of water causes Lung Qi to wither. Hence, it is called Fei Xiao. When the gates fail to hold and the root essence depletes daily, death ensues and treatment is impossible. Wang Bing's commentary is as follows. I believe that if internal fire were scorching, how could one drink one and urinate two? This commentary seems inappropriate. Jian An: This prescription appears in *Sheng Ji Zong Lu*, Volume 58.
"Yong Shui" (Surging Water): Zhang Jingyue stated: "Yong" is synonymous with "surge." Yong Shui refers to water surging upward like a spring. Water represents Yin Qi; its root is in the Kidney, and its branch is in the Lung. When the Lung transmits cold to the Kidney, Yang Qi fails to transform in the lower jiao. Without transformation, water overflows and becomes pathogenic, lodging in the Large Intestine, as the Large Intestine is the interior-exterior partner of the Lung. Wang Ang stated: Carbuncles, mania, Gé Zhong, and Fei Xiao are mostly due to heat-fire, yet the classic text mentions "transmitting cold." If interpreted as heat, then the subsequent section on "transmitting heat" would be redundant. Commentators explain symptoms variably as hot or cold; although words differ, the meaning is hard to change. I privately suggest that the character "cold" in "transmitting cold" should denote the initial stage of disease acquisition. Conditions like obstruction often involve heat accumulation; however, some cases of diaphragm syndrome may be cold-type, and some carbuncles may be cold-type wounds. Those classified as heat, such as mania, epilepsy, and Fei Xiao, should generally be understood as cold transforming into heat after a long duration, which makes logical sense. Conversely, regarding Yong Shui caused by heat transmission from the Kidney, it remains purely Yin-cold throughout. Jian An: Wang Ang likely did not see Zhang Jingyue's commentary, leading to these remarks, which seem forced. The prescription for Yong Shui is found in *Sheng Ji Zong Lu*, Volume 79.
"Zhuo Zhuo": *Ling Shu · Xie Qi Zang Fu Bing Xing Pian* states: When the Large Intestine is diseased, there is cutting pain in the intestines accompanied by gurgling sounds (Zhuo Zhuo).
"Ge Xiao" (Diaphragm Wasting-Thirst): Ma Yun stated: One theory suggests that Diaphragm Syndrome and Fei Xiao should be treated as two distinct diseases. Zhang Jingyue stated: Ge Xiao presents with upper jiao irritability, excessive drinking, and rapid consumption. The previous text stated that Fei Xiao is caused by cold; this text states that Ge Xiao is caused by heat. This shows that Wasting-Thirst has Yin and Yang syndromes that must be distinguished. Li Dongyuan in *Lan Shi Mi Cang* stated: Upper Xiao presents with red cracks on the tongue and extreme thirst prompting drinking. The classic text says: When Heart transmits heat to the Lung, it transforms into Ge Xiao. This is correct. Jian An: Li's identification as Upper Xiao is correct. The prescription for Ge Xiao is in *Sheng Ji Zong Lu*, Volume 49.
"Rou Jing" (Soft Spasm): Jian An: "Rou" implies Yin. *Shang Han Lun* states: Taiyang disease with fever, no sweat, and aversion to cold is named Gang Jing (Hard Spasm); Taiyang disease with fever, sweating, and no aversion to cold is named Rou Jing (Soft Spasm). Cheng Wuji commented that the character "Jing" was a typo for "Spasm" (Note: Context implies discussing the nature of spasm). Since the Lung belongs to Taiyin and the Kidney to Shaoyin, when Lung transmits heat to the Kidney triggering spasms, it is called Rou Jing. *Huo Ren Shu* also calls it Yin Spasm. Ma Shi and Zhang Jingyue, following Wang Bing, stated: Rou means flaccid tendons lacking strength. *Shuo Wen* defines Jing as stiff and urgent. How can flaccid tendons be called Jing? This contradicts logic. Wu Kun stated: Rou means profuse sweating, which is also wrong.
"Chang Pi Death": Zhang Jingyue stated: When the Kidney transmits heat to the Spleen, it is Yin fire flaming upward. Pathogenic heat in the lower jiao inevitably depletes True Yin, transforming into deficiency damage. The Kidney is a Water organ but insults the Spleen with heat, hence called Chang Pi. Dysentery with pus and blood indicates Yin deficiency counter-attacking, leading to the failure of both Water and Earth elements, resulting in death.
"Bao Transmits Heat to Bladder": Lou Quanshan stated: Bao refers to the uterus in women. Wu Kun stated: Bao is the Yin Bao. In men, it is the Essence Chamber; in women, it is the Blood Chamber. Zhang Jingyue agreed. Jian An: The Essence Chamber lacks verification; Lou's view should be followed. Wang Lu in *Su Hui Ji* stated: Although the Bladder is the腑 of fluids, the Bao resides within the Bladder. Cheng Guopeng in *Yi Xue Xin Wu* stated: Bao originally referred to the womb; Wang Lu mistakenly identified it as the urinary bladder, forcing a connection. If heat exists, why wait for transmission? "Transmission" implies movement from another organ. This statement is contradictory. Zhang Jingyue also refuted Wang Lu's error in his commentary on the Five Flavors chapter. (See *Wu Zang Bie Lun* commentary for details on Bao.)
"Mouth Melt" (Kou Mi): The character Jun is written as Mi in most editions. Jian An: They were interchangeable in ancient times (*Salt and Iron Discourse*: Jun Ge; *Lun Heng*: Jun Lan, both same as Mi). However, Song editions and later use Mi, so it should be corrected. Ma Shi stated: Below the Small Intestine is the Lan Men, filtering juices into the Bladder. When the Bladder transmits heat to the Small Intestine, the intestine becomes obstructed and cannot descend. Damp-heat rises along the meridians, causing mouth erosion. *Sheng Ji Zong Lu* states: Qi reversal with heat, Bladder transmitting heat to Small Intestine, prevents stomach contents from descending. This causes oral sores and erosion above. Generally, heat congestion in Heart and Stomach steams upward; topical applications alone are insufficient. One must treat the root. Prescription in Volume 117.
"Fu Jia" (Hidden Mass): Zhang Jingyue stated: Heat from the Small Intestine descends and transmits to the Large Intestine. If heat knots and does not dissipate, Qi or Blood stagnates in tortuous areas, forming Fu Jia. Jian An: *Yan Shi Jia Xun* states: Mi, Fu, and Yin were interchangeable characters. Prescription in *Sheng Ji Zong Lu*, Volume 50. (See *Da Qi Lun* commentary for details on Jia.)
"Chen": Ma Yun stated: Fu Jia sinks within. Wu Kun stated: It refers to hidden masses causing extreme, rushing pain like burning; when pain stops, the person appears normal. The harm is deep and hard to diagnose. Zhang Jingyue agreed. Ma Shi stated: Chen Hemorrhoids. *Xie Qi Pian* states: Fine and choppy Kidney pulse indicates Chen Hemorrhoids. "Chen" might be an abbreviation or omission in ancient texts. Most commentators interpret Chen as stagnant Fu Jia. However, the text uses "Wei" (is/called) twice, indicating two separate conditions, not one. Gao Shishi's edition adds "Hemorrhoid" after "Chen," noting it was omitted and now supplemented. Heat descending causes Chen Hemorrhoids. Jian An: Based on the double "Wei," Ma and Gao seem correct. Wang Ang claimed "Chen" is a typo for "Shan" (Hernia), which is incorrect. *Ru Men Shi Qin* stated: Women with stagnant menstruation lasting months without muscle loss, *Nei Jing* calls this Jia and Chen. Chen means stagnant menstruation. Immediate treatment with Tao Ren Cheng Qi Tang plus Dang Gui, taken as a large dose, cures within three doses.
"Eats Well but Emaciates": *Jia Yi Jing* writes "Sou" (urinate) instead of "Shou" (emaciate), which is incorrect.
"Shi Yi": *Jia Yi Jing* writes "Shi Hui," changing "Ru" to "You," placed under "Yi." Jian An: "Yi" is interchangeable with "Yi" (change), as in Bo Yi, Wei Yi, Kuang Yi. Though eating well, one does not gain weight, differing from normal changes, hence Shi Yi. Zhang Jingyue stated: Eating yet becoming sick and thin is called Shi Yi. Gao Shishi agreed. Interpreting "Yi" as a particle misses the disease name meaning. *Qian Jin Fang* stated: Eating much but losing weight is called Shi Hui. Treat first with Pi Shu, then Ji Xie. "Hui" means invisible, equivalent to Shi Yi. (See *Ping Ren Qi Xiang Lun* for character meaning). Lou Quan Shan's *Gang Mu* stated: Shi Yi means food passes through quickly without nourishing flesh, and hunger comes easily. Li Dongyuan stated: Eating well but emaciating occurs when Stomach harbors fire in Qi level allowing eating, while Spleen deficiency causes muscle wasting. Prescription in *Sheng Ji Zong Lu*, Volume 47.
"Stinging Nose Pool" (Xin Bi Yuan): Wu Kun stated: Brain受热 (receives heat), causing stinging in nasal passages, with nasal discharge flowing like a pool without cessation. Jian An: *Yu Pian* defines as nasal bridge. *Shi Ming* compares it to a saddle. *Tu Yi* says pronunciation is 'E', also called Lower Peak or Shan Gen. Shen Zilu said: Commonly called nose root, or written as (frowning, see *Shi Ji · Cai Ze Zhuan*). Gao Shishi stated: Stinging on both sides of nose, lateral nose is called Bi, which is incorrect. *Qian Jin Fang* stated: Nasal cavity discharge unceasing transforms into Qiu Meng Ming Mu. Thus, it results from Qi Jue. Nasal cavity discharge unceasing is Bi Yuan. Zhang Lu's *Zhang Shi Yi Tong* stated: Differentiate Bi Yuan and Bi Qiu by cold/heat. Purulent smelly discharge is Yuan (Heat), treat with cooling dispersants. Clear non-smelly discharge is Qiu (Deficiency-Cold), treat with acrid-warm regulators.
"Nu": *Jia Yi Jing* writes character differently (*Guang Yun*: Red eyes). Pronunciation: Mo Jie Qie. Jian An: Wang Bing's note "Sweat Blood" appears in *Shuo Wen*. Wu Kun stated: Bleeding from nose is Nu. Heavy bleeding is Nu, light bleeding is , with unclear basis. *Sheng Ji Zong Lu* stated: In nose it is Nu, in sweat pores it is . This misreads Wang Bing, confusing filth with sweat, which is too negligent.
"Therefore, obtained via Qi Jue": Jian An: Wang Bing and subsequent commentators considered this the summary of the chapter. However, Yong Shui, Long Ni Xue, Fu Jia, Shi Yi, etc., are unlikely to be solely due to Qi Jue. It likely refers only to Stinging, Bi Yuan, Nu, and Ming Mu. The whole book includes this chapter in *Jue Lun*; the title "Qi Jue" was revised by Wang Bing. Knowing this is not a summary text.