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Huangdi asked: The five zang organs are mutually connected, and the transmission of pathogenic qi does not follow a fixed sequence. When disease occurs in the five zang organs, it transmits to the organ it overcomes (Wood overcomes Earth, Earth overcomes Water, etc.). If left untreated, death may occur after three months, six months, three days, or six days; when transmitted to the respective organ according to this sequence, death ensues (Suwen adds that this is the order of sequential transmission to the overcome organ). Therefore it is said: One who distinguishes Yang-level disorders knows the origin of the disease; one who distinguishes Yin-level disorders knows the timing of life and death, referring to death occurring when the disease reaches its point of exhaustion. Thus, Wind is the leader of all diseases. When Wind-Cold invades the human body, it causes the hair follicles to stand erect and the skin pores to close, resulting in fever. At this stage, treatment by sweating (Diaphoresis) is appropriate. If Bi syndrome (Obstruction Syndrome), numbness, swelling, or pain occur, treatment with hot compresses, moxibustion, or acupuncture is appropriate at this stage. If untreated, the pathogen enters the Lung, named Lung Bi (Lung Obstruction), manifesting as cough and Qi rebellion. If untreated, the Lung disease transmits to the Liver, named Liver Bi (Liver Obstruction), also called Jue syndrome, manifesting as hypochondriac pain and vomiting food. At this stage, massage or acupuncture is appropriate. If untreated, the Liver disease transmits to the Spleen, named Spleen Wind, manifesting as jaundice, heat in the abdomen, vexation, and sweating (Suwen omits "sweating"). At this stage, sweating, herbal medicine, or cauterization (or bathing, per another version) is appropriate. If untreated, the Spleen disease transmits to the Kidney, named Shan Jia (Hernia Mass), manifesting as irritability and pain in the lower abdomen (Suwen reads "discharge of white fluid"), also known as Gu disease. At this stage, massage or herbal medicine is appropriate. If untreated, the Kidney disease transmits to the Heart, manifesting as pulling and acute spasms of sinews and vessels, named Xi (Seizure/Spasm). At this stage, moxibustion or herbal medicine is appropriate. If untreated, death should occur within ten days. After Kidney transmits to Heart, the Heart reversely transmits to the Lung, manifesting as chills and fever, with death expected within three years according to the pattern. This is the sequence of disease transmission. However, sudden onset diseases need not be treated according to this rule. If transmission does not follow the sequence, it is due to emotional disturbances—worry, fear, sorrow, joy, anger—that disrupt the orderly transmission, leading to severe illness. For instance, excessive joy causes Heart Qi deficiency, allowing Kidney Qi to invade; anger causes Liver Qi to invade; sorrow causes Lung Qi to invade; fear causes Spleen Qi to invade; worry causes Heart Qi to invade. This is the principle. Thus, there are five types of diseases, yielding twenty-five variations and their transmissions. "Transmission" is synonymous with "Overcoming" (Cheng).

If the large bones are emaciated, the large muscles are sunken, the chest is full of Qi, breathing is labored and difficult, and the rebellious Qi exceeds the physical form, death is expected in six months; if the Zang-True Pulse appears, the exact date of death can be predicted. If the large bones are emaciated, the large muscles are sunken, the chest is full of Qi, breathing is labored and difficult, internal pain radiates to the shoulders and neck, death is expected in one month; if the Zang-True Pulse appears, the exact date of death can be predicted. If the large bones are emaciated, the large muscles are sunken, the chest is full of Qi, breathing is labored and difficult, internal pain radiates to the shoulders and neck, accompanied by heat, muscle wasting, and bone exposure, and the Zang-True Pulse appears, death is expected within ten months. If the large bones are emaciated, the large muscles are sunken, the chest is full of Qi, abdominal pain, heart vexation, shoulder/neck/body heat, muscle wasting, and sunken eye sockets appear, and the Zang-True Pulse appears, if the patient cannot see people, death is immediate; if they can see people, death occurs during the time element they cannot overcome. In cases of acute deficiency where the body suddenly collapses, the five Zang organs close and seal off, the pulse channels become blocked, and Qi ceases to circulate, resembling falling from a height or drowning, the time of death cannot be predicted. If the pulse is absent, or if there are five to six beats per respiration, even if the flesh has not wasted away and the Zang-True Pulse is not yet visible, death will still occur.

The True Liver Pulse arrives tight and urgent inside and out, like touching the edge of a knife, sharp and rasping, or like pressing a lute string; the complexion is blue-white without luster, hair breaks, and then death occurs.
The True Heart Pulse arrives tight and hard with strong beating, like touching clusters of Job's tears seeds; the complexion is red-black without luster, hair breaks, and then death occurs.
The True Lung Pulse arrives large and empty, like a feather penetrating the skin; the complexion is red-white without luster, hair breaks, and then death occurs.
The True Spleen Pulse arrives weak and intermittently slow and rapid; the complexion is green-yellow without luster, hair breaks, and then death occurs.
The True Kidney Pulse arrives forceful but interrupted, like fingers striking stone, crisp and distinct; the complexion is black-yellow without luster, hair breaks, and then death occurs. All appearances of Zang-True Pulses indicate terminal conditions that are untreatable.

It was asked: What generates scrofula (Luoli, lymph node tuberculosis) characterized by chills and fever located in the neck and axilla? It is answered: These are all Shu Lu (Mouse Scrofula), caused by toxic factors of cold and heat stagnating in the meridians and not dispersing. The root of Shu Lu lies in the Zang organs, while its branches emerge between the neck and axilla. If the pathogen floats in the chest, has not adhered to the muscles, and externally manifests as pus and blood, it is easy to remove. It was asked: How to remove it? It is answered: Follow the root and guide the branch, so that the pathogenic Qi declines and the cold-heat is cut off. Carefully examine the meridian pathways to treat it; insert the needle slowly and withdraw it slowly to dispel the pathogen. If the nodule is small like a wheat grain, one insertion brings improvement, three insertions cure it. To determine life and death, observe the eyes: if red vessels run vertically through the pupil, one vessel indicates death in one year, half a vessel in one and a half years, two vessels in two years, two and a half vessels in two and a half years, three vessels in three years. Red vessels that do not penetrate the pupil downward are treatable.

It was asked: Some people are prone to chills and fever; how to diagnose them? It is answered: Those with small bones and weak flesh are prone to chills and fever. The cheekbones are the root of the bones; large cheekbones indicate large bones, small cheekbones indicate small bones. Thin skin and weak flesh without substance, arms that are flaccid, and a dark, muddy complexion different from the normal colors of heaven and earth are signs of this predisposition. Arms that are thin indicate insufficient marrow, hence prone to chills and fever. Contracting Wind leads to chills and fever. Skin Chills-Fever presents as inability to lie on the mat, scorched hair, dry and shriveled nose, and anhidrosis; treat by taking the collateral of the Three Yang meridians and supplementing Hand Taiyang. Muscle Chills-Fever presents as muscle pain, scorched hair, dry and shriveled lips, and anhidrosis; treat by taking the lower Three Yang meridians to remove blood stasis and supplementing Taiyin to induce sweating. Bone Chills-Fever presents as pain with no comfortable position, profuse sweating, and dry, painful tooth roots; take the collateral of Foot Shaoyin in the inner thigh. If teeth are dry and withered, it is untreatable death. Bone Jue follows the same pattern. Men suffer like Gu disease, women suffer like obstruction; the body and spine feel as if dislocated, appetite is lost. First, puncture Yongquan (KI1) until bleeding; observe the dorsum of the foot for full pulses and bleed them completely. Methods for moxibustion in chills and fever: First, moxa Dazhui (GV14) in the neck, using one moxa cone per year of age; second, moxa the tip of the coccyx (Jugu), using one moxa cone per year of age; moxa any depressed Back-Shu points on the back; moxa the depression above the shoulder when the arm is raised; moxa the space between the two costal margins; moxa the end of Juegu (GB39) above the lateral malleolus; moxa between the first and second toes of the foot; moxa the pulse in the depression above the popliteal fossa; moxa behind the lateral malleolus; moxa the area above the clavicle that feels hard and tendon-like upon pressure; moxa the depression between the bones in the chest; moxa below the metacarpals in the palm; moxa Guan Yuan (CV4), three cun below the umbilicus; moxa the arterial pulse at the pubic hairline; moxa the space two cun below the umbilicus; moxa the arterial pulse on the dorsum of the foot (Foot Yangming); moxa one point on the vertex; moxa the site bitten by a dog, treating it with three cones as per dog-bite injury protocols. Total of twenty-nine sites for moxibustion.

For chills, fever, headache, wheezing, and inability to see, Shenting (GV24) is indicated; for tearing but without headache, Tinghui (GB2) is indicated. For severe chills, fever, headache feeling like splitting, eye pain feeling like protrusion, wheezing with vexation and fullness, vomiting, difficulty speaking due to sweating, Touwei (ST8) is indicated; for chills and fever, needle Naohu (GV16).