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Difficulty 51 states: In diseases, some patients desire warmth, others desire cold; some wish to see people, others do not wish to see people. These manifestations differ. Which Zang or Fu organs are affected?

The answer is: If the patient desires cold and wishes to see people, the disease is in the Fu organs. If the patient desires warmth and does not wish to see people, the disease is in the Zang organs. Why is this so? The Fu organs belong to Yang. In Yang diseases (diseases caused by pathogenic factors affecting the Yang meridians), patients desire cold and wish to see people. The Zang organs belong to Yin. In Yin diseases (diseases caused by pathogenic factors affecting the Yin meridians), patients desire warmth and prefer to stay alone behind closed doors, disliking the sound of other people's voices. Thus, these signs are used to distinguish between Zang and Fu organ diseases.

The *Suwen* (Plain Questions) chapter "Jingui Zhenyan Lun" states: The Fu organs are Yang, and the Zang organs are Yin. Since the Fu organs are Yang, Yang diseases involve excess heat; therefore, regarding diet, clothing, and residence, patients seek cold and avoid heat. Yang governs movement and dispersion, corresponding to the exterior, hence the desire to see people. Since the Zang organs are Yin, Yin diseases involve excess cold; therefore, regarding diet, clothing, and residence, patients seek warmth and avoid cold. Yin governs stillness and storage, corresponding to the interior, hence closing doors and staying alone, disliking the sound of voices. This discusses the general principles of Yin and Yang in Zang and Fu organs. Therefore, it differs from the discussion in the *Ling Shu* chapter "Yangming Maijie Pian," where Yangming disease involves aversion to people and fire, referring to a condition where heat is extreme in one meridian causing irritability.

Difficulty 52 asks: Are the fundamental characteristics of diseases originating in the Fu and Zang organs the same?

The answer is: They are not the same. How do they differ?

The answer is: Diseases of the Zang organs are stationary and do not migrate; the pathology remains in its specific location. Diseases of the Fu organs present with vague sensations and rumbling noises, moving up and down, without a fixed location. Thus, we know that the fundamentals of Zang and Fu diseases are different.

Zang belongs to Yin, and Yin governs stillness, hence the pathology is stationary and does not move. Fu belongs to Yang, and Yang governs movement, hence the pathology flows up and down. "Fufu" refers to formless conditions. "Benxiang" refers to movement accompanied by sound. Having no fixed location means moving up and down, which is what "flowing" implies. This is how the fundamentals of Zang and Fu diseases differ.

Difficulty 53 states: The classics say, "Seven-step transmission leads to death; intervening Zang transmission leads to survival." What does this mean?

The answer is: "Seven-step transmission" refers to transmission to the organ it overcomes (controls). "Intervening Zang transmission" refers to transmission to its offspring organ (the organ it generates). Why is this so? For example, if Heart disease transmits to the Lung, then to the Liver, then to the Spleen, then to the Kidney, and finally back to the Heart, an organ is injured only once. Hence, it is said that "seven-step transmission leads to death."

"Seven-step transmission" follows the sequence of overcoming/controlling relationships. For instance, Heart disease transmitting to the Lung represents Fire overcoming Metal. The Lung transmitting to the Liver represents Metal overcoming Wood. The Liver transmitting to the Spleen represents Wood overcoming Earth. The Spleen transmitting to the Kidney represents Earth overcoming Water. The Kidney transmitting to the Heart represents Water overcoming Fire. If the Heart then attempts to transmit to the Lung again, this constitutes the seventh step. If an organ cannot withstand further injury, death ensues. Lv Guang suggested that the character "qi" (seven) was a typo for "ci" (sequence/order), which aligns better with the term "jian" (intervene); his interpretation is also plausible. Essentially, after six transmissions from the Heart to the Lung, through to the Kidney and back to the Heart, the Heart cannot transmit further to the Lung. The phrase "an organ is injured only once" refers specifically to the Heart failing to withstand the seventh transmission, leading to death. This corresponds to the meaning in the *Suwen* chapter "Biaoben Bingchuan Lun": when various diseases transmit sequentially, there is a time limit for death, and acupuncture should not be used.

"Intervening Zang transmission" refers to transmission to the organ it generates. For example, if Heart disease transmits to the Spleen, then to the Lung, then to the Kidney, then to the Liver, and back to the Heart, this is mother-son transmission, cycling endlessly like a circle, hence it is said to lead to survival.

"Intervening Zang transmission" means skipping one organ to transmit to the one it generates. For instance, if the Heart intends to transmit to the Lung, but the Spleen is the mother of the Lung and the son of the Heart, intervening this organ prevents transmission to the overcome organ. Specifically, Heart disease transmitting to the Spleen skips the Lung (the overcome organ), representing Fire generating Earth. Spleen disease transmitting to the Lung skips the Kidney (the overcome organ), representing Earth generating Metal. Lung disease transmitting to the Kidney skips the Liver (the overcome organ), representing Metal generating Water. Kidney disease transmitting to the Liver skips the Heart (the overcome organ), representing Water generating Wood. Liver disease transmitting to the Heart skips the Spleen (the overcome organ), representing Wood generating Fire. If Heart disease then transmits to the Spleen again, the illness will resolve itself. This is the principle of mother-son transmission leading to recovery.