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Acupuncture treatment. (When the pathogen is in the meridian on the left side, it actually affects the meridian on the right side; therefore, needling the right meridian is called *Juci* (Giant Puncture). Ping An: The original text "Bing zai yu zuo" (Disease lies on the left) is written as "Tong zai yu zuo" (Pain lies on the left) in *Suwen*.) One must carefully examine the nine pulse positions (Jiu Hou), and the principles of acupuncture will be complete. (The reason why examining the nine pulses is prioritized in acupuncture is that once this is done, the methods of acupuncture are fully established.)

Ping An: This section, from the beginning to the end of the chapter, appears in Volume 9, Chapter 31 "Re Lun" (Discourse on Febrile Diseases) of *Suwen*, and also in Volume 7, Chapter 1 of *Jiayi Jing*.

Yellow Emperor asked Qibo: "Currently, all febrile diseases belong to the category of Shanghan (Cold Damage)." (Regarding Shanghan, when people are in winter, due to warm rooms, thick clothing, hot drinks, or hot food, their Couli (skin pores and interstices) open up. If they then expose themselves to cold for pleasure, the Couli close suddenly, trapping the cold qi inside... When the cold becomes extreme, it transforms into heat. When the Three Yin and Three Yang meridians, as well as the Zang and Fu organs, are affected by heat and become diseased, it is called Rebing (Febrile Disease). These febrile diseases originate largely from contracting cold pathogens; they are caused by cold injury. Since these febrile diseases are named after their cause, they are called Rebing and are classified under Shanghan. Thus it is said: 'If one contracts cold in winter, Warm Illness (Wenbing) will develop in spring.' Those that manifest before the Summer Solstice are called Bing Wen (Illness of Warmth); those that manifest after the Summer Solstice are called Bing Shu (Illness of Heat). Ping An: In the commentary, the phrase "Couli kaifa" (Couli opening) misses the character "Kai" (open) in the Yuan edition.) Some recover, while others die, typically within six or seven days of onset. (When both Yin and Yang meridians contract the pathogen simultaneously, the disease spreads through the Zang and Fu organs within three days. Ying and Wei Qi become blocked. After another three days, the condition reaches its extremity; thus, death occurs between the sixth and seventh days. Ping An: In *Suwen*, the characters "Qi Si" (their death) appear above, but the character "Bing" (disease) is missing below.) Why do those who recover take more than ten days? I do not understand the rationale and wish to hear the explanation. (For those who do not suffer from simultaneous contraction of cold by both Zang and Fu, by the seventh day, the Taiyang disease begins to decline; by the ninth day, the Three Yang diseases decline; by the tenth day, the Taiyin disease declines; by the twelfth day, the diseases of the Three Yin and Three Yang all decline. Hence, recovery takes more than ten days. The principle is unclear to me, so I ask for an explanation.)

Qibo replied: Juyang (Foot-Taiyang Bladder Meridian) is the commander of all Yang meridians. (Ju means great. One Yang is Ji, referring to Shaoyang; Two Yang is Wei, referring to Yangming; Three Yang is Fu, referring to Taiyang. Therefore, Foot-Taiyang governs the Three Yang, hence it is called the commander of all Yang. Ping An: In *Jiayi Jing*, "Ju" is written as "Tai", and similarly below.) Its vessel connects to Fengfu (GV16), making it the master of Qi for all Yang meridians. (The straight branch of Foot-Taiyang enters the brain from the vertex, emerges, descends separately along the neck. Fengfu (GV16) is located one cun above the hairline at the nape. Thus, Taiyang Qi connects to Fengfu. All Yang refers to the Du Mai (Governor Vessel) and Yangwei Mai (Yang Linking Vessel). Du Mai is the Sea of Yang Vessels. Yangwei Mai links all Yang vessels, converging at Fengfu and belonging to Taiyang. Therefore, Foot-Taiyang is the master of Qi for all Yang meridians. Consequently, if this vessel is injured by cold, it develops into severe febrile disease. If the disease starts in Yang and later moves to Yin, even with high fever, death is avoided; however, if both Yin and Yang Qi contract cold simultaneously, death is inevitable.)

Yellow Emperor said: "I wish to know the specific manifestations." Qibo said: "On the first day of Shanghan, Juyang receives the pathogen, resulting in pain in the head, neck, lower back, and spine. (When cold injures the body severely and transforms into heat, on the initial day of onset, it is invariably Taiyang receiving heat to cause disease. Hence, it is said that Taiyang receives it on the first day. The reason Yangming and Shaoyang do not receive heat on the first day is that Taiyang governs heat, and with the addition of Shanghan heat, Taiyang is affected first. The head, neck, lower back, and spine are all pathways of the Foot-Taiyang meridian, hence they all hurt. Ping An: *Suwen* reads 'Head and neck pain, stiff lower back and spine'. Xin Zhengjiao states: '*Jiayi Jing* and *Taisu* read 'All parts of head, neck, waist, and spine hurt'.' The current version of *Jiayi Jing* reads 'Stiffness of head, neck, waist, spine, and back', noting: '*Suwen* lacks the character 'back'.' The commentary misses the character 'spine' in 'waist and spine' in the Yuan edition.) On the second day, Yangming receives the pathogen. Yangming governs flesh; its vessel runs alongside the nose and connects to the eyes. Thus, there is body heat, dry nose, and inability to lie down. (Yangming is Two Yang, so it is affected next. Spleen's Taiyin governs muscle; Stomach's Yangming governs flesh. Its vessel connects from the nose to the inner canthus, descends into the abdomen, and reaches the foot; Hand-Yangming belongs to Large Intestine below and runs alongside the nostrils above. Hence, the disease presents with body heat, dry nose, and insomnia. Ping An: *Suwen* and *Jiayi Jing* add 'eye pain' after 'body heat'. Regarding the note 'reaches the foot', the character 'foot' might be a scribal error, omitted in Yuan edition. However, since Stomach is Foot-Yangming, traveling from head to abdomen to foot, this 'foot' likely belongs to the previous sentence, connecting with 'to', and is probably not an error.) On the third day, Shaoyang receives the pathogen. Shaoyang governs bone; its vessel follows the hypochondrium and connects to the ears. Thus, there is chest and hypochondriac pain, and deafness. (Liver's Foot-Jueyin governs tendons. Sanjiao's Hand-Shaoyang combines with Bladder. Bladder and Kidney, being exterior-interior pairs, both govern bone; Foot-Shaoyang originates at the outer canthus, enters the ear, and descends along the chest and hypochondrium to the foot; Hand-Shaoyang pertains to Sanjiao, entering the ear from behind. Hence, the disease presents with deafness and chest/hypochondriac pain. Ping An: 'Governs bone' in *Suwen* is written as 'governs Gallbladder'. Xin Zhengjiao notes: Quan Qiyuan's edition has 'bone' instead of 'Gallbladder'. Qiyuan's commentary says: Shaoyang is the exterior of Liver; Liver controls tendons; tendons converge at bones. Thus, Shaoyang Qi nourishes them, hence it is said to govern bone. *Jiayi Jing* and *Taisu* both write 'bone'.) Since these three meridians are diseased but have not yet entered the Fu organs, they can be cured by inducing sweating. (The three meridians refer to the Three Yang meridians. With heat confined to the Three Yang meridians for less than three days, before reaching the Fu organs, one should use acupuncture and herbs to induce sweating. If the disease of these three meridians persists beyond three days and enters the Fu organs, decoctions can be used to purge and eliminate it. Ping An: *Suwen* adds 'jingluo' (vessels and collaterals) after 'Three Yang', and writes 'wei ru yu zang' (not yet entered the Zang) instead of 'wei ru tong yu fu' (not yet entered the Fu). Xin Zhengjiao states: 'Quan Qiyuan’s edition has 'Fu' instead of 'Zang'. Qiyuan's commentary says: Cold damage disease begins in the skin's Couli, gradually surpasses the Yang meridians but does not enter the Fu, so sweating is required to disperse the cold and heat. *Taisu* also writes 'Fu'.*Jiayi Jing* also writes 'Fu', noting: *Suwen* writes 'Zang'.') On the fourth day, Taiyin receives the pathogen. Taiyin vessel distributes in the stomach and connects to the throat. Thus, there is abdominal fullness and dry throat. (One Yin is Dujue, referring to Jueyin. Two Yin is Ci, referring to Shaoyin. Three Yin is Mu, referring to Taiyin. Taiyin is great, so it receives heat first. Taiyin vessel enters the abdomen from the foot, belongs to Spleen, connects to Stomach, passes through the diaphragm alongside the pharynx, and connects to the root of the tongue; Hand-Taiyin originates in the middle jiao and connects downward to Large Intestine. Hence, abdominal fullness and dry throat occur.) On the fifth day, Shaoyin receives the pathogen. Shaoyin vessel penetrates the Kidney, connects to Lung system and root of tongue. Thus, there is oral heat, dry tongue, and thirst. (Foot-Shaoyin straight branch ascends from Kidney through Liver and Diaphragm into Lung, follows the throat alongside the root of tongue. Hence, oral heat, dry tongue, and thirst occur. Ping An: *Suwen* and *Jiayi Jing* write 'mouth dryness' instead of 'oral heat'.) On the sixth day, Jueyin receives the pathogen. Jueyin vessel circles the genitalia and connects to the Liver. Thus, there is irritability, fullness, and retraction of the scrotum. (Foot-Jueyin vessel circles the genitalia to the lower abdomen, accompanies Stomach, belongs to Liver, and connects to Gallbladder. Hence, irritability, fullness, and scrotal retraction occur. Ping An: 'Shoubing' (receives disease) in *Suwen* and *Jiayi Jing* is written as 'Shouzhi' (receives it).) If the Three Yin and Three Yang, as well as the Five Zang and Six Fu organs, are all diseased, with Ying and Wei Qi stagnant and Zang and Fu communication blocked, death ensues. (Ping An: *Suwen* and *Jiayi Jing* write 'Jie Shoubing' (all receive disease) instead of 'Jie Bing' (all diseased), and 'Wuzang' (Five Zang) instead of 'Fuzang' (Fu and Zang).) For those not suffering from simultaneous contraction (Lianggan), on the seventh day, Juyang disease declines, headache decreases slightly; on the eighth day, Yangming disease declines, body heat decreases slightly; on the ninth day, Shaoyang disease declines, deafness improves slightly allowing faint hearing; (In cases of Lianggan, where Three Yin and Three Yang and Zang and Fu are all diseased with blocked Ying and Wei, death occurs after three more days. In non-Lianggan cases, Taiyang declines on the seventh day, and Shaoyang declines on the ninth day.) On the tenth day, Taiyin disease declines, abdominal distension subsides, appetite returns, and desire to eat arises; (Taiyin Spleen governs grain Qi; thus, upon recovery, abdominal distension reduces and hunger for food/drink increases. Ping An: *Suwen* and *Jiayi Jing* add 'jian' (reduce) after 'abdomen', write 'yinshi' (diet) instead of 'shiyin' (food and drink), and omit 'yushi' (desire to eat).) On the eleventh day, Shaoyin disease declines, thirst stops, fullness resolves, dry tongue heals, and coughing begins; (Foot-Shaoyin vessel enters Lung and accompanies root of tongue; thus, upon recovery, thirst stops and dry tongue heals. Coughing indicates Lung Qi is unblocking. Ping An: *Jiayi Jing* omits 'bu man' (no fullness); 'yi er ke' (then coughs) is written as 'nai yi' (then ceases). *Suwen* writes 'ti' (sneeze) instead of 'ke' (cough).) On the twelfth day, Jueyin disease resolves, scrotum descends slightly from the lower abdomen; (Upon resolution of Jueyin vessel disease, major pathogenic Qi has departed, so the scrotum gradually descends. Ping An: *Suwen* and *Jiayi Jing* write 'shuai' (decline) instead of 'yu' (resolve), and 'zong' (loose/relax) instead of 'cong' (follow/from).) The major pathogenic Qi has all departed, and the illness recovers day by day. (By the twelfth day, major heat Qi has all departed, so the suffering diminishes daily.)

Yellow Emperor said: "How should it be treated?" Qibo said: "Treatment requires unblocking the vessels of each respective Zang organ; the disease will decline day by day. (Assess which Zang vessel the febrile disease affects, identify its location, and apply tonifying or reducing methods to that vessel; the disease will decline.) For those with less than three days of illness, sweating can cure it; for those with three or more days, purging can cure it. (Less than three days: heat is in the Three Yang vessels, between skin and flesh, so sweating is appropriate. More than three days: heat has entered the Zang and Fu organs, so decoctions can be used to purge and eliminate it.)

Yellow Emperor said: "When febrile disease has resolved, why does residual heat sometimes remain?" Qibo said: "In all cases of residual heat, it is because the patient forces themselves to eat while the heat is still intense. Thus, residuals remain. In such cases, although the disease pathogen has declined, heat remains hidden. The Qi of the food clashes with the residual heat, causing the heat to recombine, resulting in residual symptoms. (Qiang means excessive/much. Yi means remainder. Although major heat Qi has gone, residual heat remains inside and outside the Zang and Fu organs. Due to overeating, the heat of the grain Qi clashes with the old heat, re-triggering the febrile disease, known as residual heat disease. Ping An: In *Suwen* and *Jiayi Jing*, 'er re xianghe' (and heat combines) uses 'liang' (two/both) instead of 'er' (and).)

Yellow Emperor said: "Excellent. How should residual heat be treated?" Qibo said: "Observe deficiency and excess, regulate reversal and smoothness, and the disease can certainly be cured. (Reversal makes cure difficult; smoothness makes cure easy. Deficiency of Yin requires tonification; Excess of Yang requires reduction. One must ensure healing, which constitutes the skill of a physician. Ping An: 'Shun' (smooth) in *Suwen* is written as 'Cong' (follow).)

Yellow Emperor said: "What should be prohibited during febrile disease?" Qibo said: "When febrile disease is slightly better, eating meat causes recurrence (Fu); eating too much causes residual heat (Yi). This is the prohibition. (Meat is hotter than grain; thus, eating meat leads to recurrence. Grain is less hot than meat; thus, overeating grain leads to residual heat.)

Yellow Emperor said: "For those with simultaneous contraction (Lianggan), how should their pulse correspond to their clinical presentation?" (Foot-Taiyang and Foot-Shaoyin, being exterior-interior pairs, are jointly injured by cold, hence called Lianggan. In winter, when Lianggan causes disease, what are the pulse findings and clinical forms? Ping An: *Suwen* adds 'Bing' (disease) before 'Lianggan'.) Qibo said: "Those injured by cold in two aspects: On the first day, Juyang and Shaoyin both become diseased, presenting with headache, dry mouth, and irritability/fullness. (Contracting cold in winter involves simultaneous contraction of Yin and Yang. Upon manifestation, they occur simultaneously. Thus, in spring, on the first day, Taiyang and Shaoyin are both diseased. Foot-Taiyang ascends to the head, causing headache. Hand-Shaoyin ascends alongside the pharynx; Foot-Shaoyin accompanies the root of tongue; Hand-Taiyang connects to Heart and follows the pharynx, causing dry mouth. Hand-Shaoyin originates in the Heart; Foot-Shaoyin connects to Heart; Hand-Taiyang connects to Heart, causing irritability and fullness. Ping An: *Suwen* Xin Zhengjiao notes: *Shanghan Lun* reads 'irritability, fullness, and thirst'.) On the second day, Yangming and Taiyin both become diseased, presenting with intestinal fullness, body heat, anorexia, and delirious speech. (Zhan means excessive talking. Hand-Yangming belongs to Large Intestine; Foot-Yangming belongs to Stomach; Foot-Taiyin belongs to Spleen and connects to Stomach; Hand-Taiyin connects to Large Intestine and follows Stomach. Hence, intestinal fullness, body heat, anorexia, and excessive talking occur. Ping An: *Suwen* and *Jiayi Jing* write 'Bu yushi' (no desire to eat) and 'Zhan yan'. Wang Bing's commentary on *Suwen*: 'Speaking wildly and out of order.' Xin Zhengjiao states: 'Yang Shangshan says: excessive talking.' This aligns perfectly with my interpretation.) On the third day, Shaoyang and Jueyin both become diseased, presenting with deafness, scrotal retraction, cold limbs, inability to swallow fluids, and unconsciousness. (Hand and Foot Shaoyang both enter the ears, causing deafness. Foot-Jueyin circles the genitalia; Foot-Shaoyang surrounds the pubic region; Hand-Shaoyang traverses Sanjiao. Hence, scrotal retraction and cold limbs occur. Hand-Shaoyang distributes in Danzhong; Foot-Shaoyang descends in the chest; Foot-Jueyin follows behind the throat; Hand-Jueyin originates in the chest and belongs to Pericardium. Hence, inability to swallow water/gruel and loss of consciousness occur. Ping An: *Suwen* and *Jiayi Jing* add 'Er' (and) before 'Jue' (cold limbs).) Death occurs on the sixth day. (With Three Yin and Three Yang all diseased, Qi reaches extremity after passing through three more days, hence death on the sixth day.)

Yellow Emperor said: "When the Five Zang are damaged, Six Fu are blocked, and Ying and Wei do not circulate, why does death occur three days later?" (When Qi reaches extremity, Zang are injured and Fu are blocked, Ying and Wei stagnate. Why does death occur three days later?) Qibo said: "Yangming is the leader of the Twelve Meridians; its Qi and Blood are abundant. Thus, the patient loses consciousness. After three days, its Qi is exhausted, hence death. (Stomach vessel, Foot-Yangming, governs grain. Qi and Blood are strong. It is the master of the Twelve Meridians. Even if other meridians reach extremity, this Qi is not exhausted. Although unconscious, the Qi remains, allowing survival for three more days before death. Ping An: *Suwen* and *Jiayi Jing* add 'Mai' (vessel) after 'Jing' (meridian).)"