五十三难曰。经言七传者死。间脏者生。何谓也。然。七传者、传其所胜也。间脏者、传其子也。何以言之。假令
心病传肺。肺传肝。肝传脾。脾传肾。肾传心。一脏不再伤。故言七传者死也。间脏者、传其所生也。
丁曰。经云前七传者死。后言间脏者生。其言七传者。是五脏为阴。传其所胜。间脏者。是六腑为阳。故传其所生。
亦五脏六腑并应五行。传其所生者生。传其所胜者死。其言传肺。肺死而不传。故一脏不再伤也。吕曰。七当为次字之
误也。此下有间字。即知上当为次。又有五脏。心独再伤。为有六传耳。此盖次传其所胜脏故其病死也。虞曰。七传者
死。七字明也。吕氏以七为次。深为误矣。又声音不相近也。今明之以示后学。谓五行相生而数之。数终于五。又却再
数至二成七。向上之五。来传于七。七之被克。故云死也。今举一例以发明之。假令相生之数。数木火土金水木火。第
五水字。隔第六木字。来克第七火字。火被水克。故曰七传。下文云间脏者。是第五水字。下传与第六木字。见相生。
故曰间脏者生也。吕氏言次者。次正成间脏也。
假令心病传脾。脾传肺。肺传肾。肾传肝。肝传心。是母子相传。竟而复始。如环之无端。故言生也。
丁曰。其言心传脾。脾得生气。再传于肺。是母子相传。故言生也。吕曰。间脏者、间其所胜之脏而相传也。心胜
肺。脾间之。肝胜脾。心间之。脾胜肾。肺间之。肺胜肝。肾间之。肾胜心。肝间之。此谓传其所生也。
五十四难曰。脏病难治。腑病易治。何谓也。然。脏病所以难治者、传其所胜也。腑病易治者、传其子也。与七传
间脏同法也。
丁曰。脏者、阴也。病难治者、谓言传其胜也（按谓言二字。当衍其一。）胜者、谓肝胜脾。脾胜肾。肾胜心。心胜
肺。肺胜肝。故难治也。腑者。阳也。言阳病传其子者。即是木病传火。火病传土。土病传金。金病传水。水木递相生。
即腑病易治也。是故与七传间脏法同也。杨曰。
Difficulty 53 states: The classic texts say, "Transmission in the seventh stage leads to death; transmission intervening between organs leads to survival." What does this mean? It is answered that "transmission in the seventh stage" refers to transmission to the organ it overcomes (Ke), while "intervening transmission" refers to transmission to its offspring organ. Why is this so? For example, if Heart disease transmits to Lung, Lung to Liver, Liver to Spleen, Spleen to Kidney, and Kidney back to Heart, no single organ is injured twice. Therefore, it is said that "transmission in the seventh stage leads to death." "Intervening transmission" refers to transmission to the organ it generates (Sheng).
Ding stated: The classic text first says "transmission in the seventh stage leads to death," and later says "intervening transmission leads to survival." The term "transmission in the seventh stage" applies because the Five Zang Organs are Yin, transmitting to what they overcome. "Intervening transmission" applies because the Six Fu Organs are Yang, thus transmitting to what they generate. This also aligns with the Five Zang and Six Fu corresponding to the Five Elements. Transmission to what one generates leads to life; transmission to what one overcomes leads to death. The text mentions "transmitting to Lung"; once Lung is overcome, it dies and does not continue transmitting, hence an organ is not injured twice. Lü stated: The character "seven" (Qi) is likely a scribal error for "sequence" or "next" (Ci). Given the presence of the character "intervene" (Jian) below, it is known that the upper character should be "Ci." Including the five organs themselves, the Heart alone is injured twice, resulting in only six transmissions. This essentially describes sequential transmission to the organ it overcomes, leading to the patient's death. Yu stated: "Transmision in the seventh stage leads to death"; the character "seven" is clear. Lü’s interpretation of "seven" as "sequence" is deeply erroneous. Furthermore, their pronunciations are not similar. I now clarify this for future students. Counting according to the generation cycle of the Five Elements, the count ends at five, then restarts from two to reach seven. The five above represents Water, which transmits to seven (Fire). Since Seven (Fire) is overcome by Water, it is said to lead to death. Let us illustrate with an example. Assuming the generative sequence numbers Wood, Fire, Earth, Metal, Water, Wood, Fire. The fifth character is Water. Skipping the sixth character Wood, it overcomes the seventh character Fire. Fire is overcome by Water, hence called "transmission in the seventh stage." The following text says "intervening transmission": the fifth character Water transmits down to the sixth character Wood, observing a generative relationship, hence called "intervening transmission leads to survival." Lü’s mention of "sequence" actually constitutes "intervening transmission."
For example, if Heart disease transmits to Spleen, Spleen to Lung, Lung to Kidney, Kidney to Liver, and Liver back to Heart, this is mother-to-son transmission, cycling endlessly like a circle without beginning or end. Therefore, it is said to lead to survival.
Ding stated: When Heart transmits to Spleen, Spleen receives vital Qi and transmits further to Lung. This is mother-to-son transmission, hence it is said to lead to survival. Lü stated: "Intervening transmission" means transmitting while bypassing the organ it overcomes. Heart overcomes Lung, but Spleen intervenes; Liver overcomes Spleen, but Heart intervenes; Spleen overcomes Kidney, but Lung intervenes; Lung overcomes Liver, but Kidney intervenes; Kidney overcomes Heart, but Liver intervenes. This is called transmitting to what one generates.
Difficulty 54 states: Diseases of the Zang organs are difficult to treat, while diseases of the Fu organs are easy to treat. What does this mean? It is answered that diseases of the Zang organs are difficult to treat because they transmit to what they overcome. Diseases of the Fu organs are easy to treat because they transmit to what they generate. This follows the same principle as "transmission in the seventh stage" and "intervening transmission."
Ding stated: The Zang organs are Yin. Diseases are difficult to treat when referring to transmission to what they overcome. "What they overcome" refers to Liver overcoming Spleen, Spleen overcoming Kidney, Kidney overcoming Heart, Heart overcoming Lung, and Lung overcoming Liver; hence, they are difficult to treat. The Fu organs are Yang. Referring to Yang diseases transmitting to what they generate means Wood disease transmits to Fire, Fire to Earth, Earth to Metal, Metal to Water, and Water to Wood in mutual generation. Thus, Fu organ diseases are easy to treat. Therefore, it is consistent with the principles of "transmission in the seventh stage" and "intervening transmission." Yang stated: