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This section discusses heat diseases of the meridians. Above Jueyin (Liver/Pericardium), Wind Qi governs; above Shaoyin (Heart/Kidney), Heat Qi governs; above Taiyin (Spleen/Lung), Dampness Qi governs; above Shaoyang (Gallbladder/Triple Burner), Fire Qi governs; above Yangming (Stomach/Large Intestine), Dryness Qi governs; above Taiyang (Bladder/Small Intestine), Cold Qi governs. Wind, Heat, Dampness, Fire, Dryness, and Cold are the root of the Six Qi (Six Climatic Factors). Jueyin, Shaoyin, Taiyin, Shaoyang, Yangming, and Taiyang are the markers (external manifestations) of the Six Qi. In human life, the sequence of governing Qi begins with Jueyin and ends with Taiyang, transforming from Yin to Yang in an endless cycle, which is called "Shen Zhuan Bu Hui" (the spirit turns without reversing). If one contracts Shanghan (Cold Damage), it begins at Taiyang and ends at Jueyin, transforming from Yang to Yin, which is called "Hui Ze Bu Zhuan" (reversal leads to stagnation), thus losing its mechanism. The mention here of Jutai (Taiyang), Yangming, Shaoyang, etc., refers to the three Yang and three Yin meridians of the body. When Jutai receives [pathogen], Yangming receives, Shaoyang receives, etc., it means the three Yang and three Yin meridians each receive Cold pathogen and develop heat disease. One day Jutai, two days Yangming, three days Shaoyang, etc., use six days to illustrate the transmission of the Six Meridians. When the three Yang and three Yin meridians each receive pathogen and become diseased: those receiving on the first day recover on the seventh; those on the second day recover on the eighth; on the third day, the ninth; fourth day, the tenth; fifth day, the eleventh; sixth day, the twelfth. Ultimately speaking, all receive on the first day and recover on the seventh; although there is a sequence, it is not absolute. If suffering from Lianggan Yu Han (Double Exposure to Cold, where exterior and interior meridians are simultaneously affected), both Yin and Yang meridians become diseased, and zang-fu organs are injured, death is inevitable. Qi transformation is formless, while meridians have form; hence, the following chapter on acupuncture for heat exists, along with discussions on evaluating heat. This chapter only discusses meridian diseases, not the root/markers or qi transformation. Later, Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage) discusses root/markers and qi transformation, differing from this *Re Lun*.

Yellow Emperor asked: "Now, heat diseases all belong to the category of Shanghan. Some recover, some die; those who die do so within six to seven days, and those who recover do so after ten days. Why is this? I do not understand the explanation and wish to hear the reason."

When the meridians of the body are harmonious, there is no cold or heat; when meridians are disharmonious, there may be cold or heat. Thus, heat diseases all belong to the category of Shanghan. Since the outcome varies between recovery and death with different durations, a question is raised.

Qibo replied: "Jutai is the leader of all Yang meridians; its vessel connects to Fengfu (GV16), thus it is the master of Qi for all Yang meridians."

Jutai is Taiyang. Yang-Heat Qi affects the entire body, hence called Jutai. The Qi of all Yang meridians is governed by the entire body of Jutai, hence Jutai is the leader of all Yang meridians. Regarding its vessel, it connects superiorly to Fengfu of the Du Mai (Governor Vessel); since Du Mai supervises Yang, it is the master of Qi for all Yang meridians.

When humans are injured by Cold, they develop heat disease. Even if the heat is severe, death does not occur; however, those who suffer from Lianggan Yu Han will inevitably die.

Heat disease belongs to Shanghan; thus, injury by Cold leads to heat disease. Heat is the Yang-Heat Qi of the body. Yang is usually in excess, so even severe heat does not cause death. In cases of Lianggan Yu Han, Yang vessels receive Cold, and Yin vessels also receive Cold; both Yin and Yang are affected, and zang-fu organs are injured, hence death is inevitable. This explains why some recover and some die.

The Emperor said: "I wish to hear the symptoms."

Since the disease is in the tangible meridians, there are specific symptoms for each affected meridian, hence the request to hear them.

Qibo said: "On the first day of Shanghan, Jutai receives [the pathogen], resulting in headache, pain in the neck and spine, and stiffness."

'Qiang' is pronounced with the departing tone. To explain via the six meridians: on the first day, the whole-body Jutai receives [the pathogen]. As mentioned earlier, its vessel connects to Fengfu, located at the nape. The vessel goes up from the nape, causing headache; it goes down from the nape, causing stiffness in the waist and spine. This is how Jutai meridian disease presents. Now, using the first day of infection to illustrate the symptoms.

On the second day, Yangming receives [the pathogen]. Yangming governs the flesh; its vessel runs alongside the nose and connects to the eyes. Thus, there is fever, eye pain, dry nose, and inability to sleep.

Yangming vessel receives [the pathogen] on the second day, illustrating its symptoms. Yangming corresponds to Earth, hence it governs the flesh. Its vessel originates beside the nose, crossing at Yingxiang (LI20), and binds alongside Taiyang’s vessel, running alongside the nose and connecting to the eyes. Governing the flesh causes fever; connecting to the eyes causes eye pain; running alongside the nose causes dry nose; disharmony of Yangming Stomach causes inability to sleep.

On the third day, Shaoyang receives [the pathogen]. Shaoyang governs the Gallbladder; its vessel follows the hypochondrium and connects to the ears. Thus, there is pain in the chest and hypochondrium, and deafness.

Shaoyang vessel receives [the pathogen] on the third day, illustrating its symptoms. Shaoyang corresponds to Wood, hence it governs the Gallbladder. Its vessel descends through the chest, follows the interior of the hypochondrium; its branch enters the ear from behind, exits anterior to the ear. Following the hypochondrium causes chest/hypochondriac pain; connecting to the ear causes deafness.

When the sinews and vessels of the Three Yang meridians are all diseased, but the pathogen has not entered the Zang organs, it can be cured by sweating.

Summarizing the previous text regarding Three Yang meridian disease: unlike the sequential single-meridian involvement (Day 1 Taiyang, Day 2 Yangming, Day 3 Shaoyang), the Three Yang sinews and vessels are all affected on the first day. Three Yang govern the Six Fu organs, and the pathogen has not entered the Five Zang organs of the Three Yin. Therefore, it can be cured by inducing sweat. This is why severe heat does not lead to death.

On the fourth day, Taiyin receives [the pathogen]. Taiyin vessel spreads in the stomach and connects to the throat. Thus, there is abdominal fullness and dry throat.

Taiyin vessel receives [the pathogen] on the fourth day, illustrating its symptoms. Its vessel belongs to Spleen, connects to Stomach, flanks the pharynx, and connects to the root of the tongue. Hence, Taiyin vessel spreads in the stomach and connects to the throat. Spreading in the stomach causes abdominal fullness; connecting to the throat causes dry throat.

On the fifth day, Shaoyin receives [the pathogen]. Shaoyin vessel penetrates the Kidney, connects to the Lung, and ties to the root of the tongue. Thus, there is dry mouth, dry tongue, and thirst.

Shaoyin vessel receives [the pathogen] on the fifth day, illustrating its symptoms. Its vessel ascends from the Kidney, passes through the Liver and Diaphragm into the Lung, follows the throat, and flanks the root of the tongue. Hence, Shaoyin vessel penetrates the Kidney, connects to the Lung, and ties to the root of the tongue. Shaoyin Water and Fire fail to interact and nourish each other, causing dry mouth, dry tongue, and thirst.

On the sixth day, Jueyin receives [the pathogen]. Jueyin vessel follows the genitalia and connects to the Liver. Thus, there is vexation, fullness, and retraction of the scrotum.

Jueyin vessel receives [the pathogen] on the sixth day, illustrating its symptoms. Jueyin Liver vessel passes over the genitalia and reaches the lower abdomen. Hence, Jueyin vessel follows the genitalia and connects to the Liver. Jueyin Wood Qi rebels and Fire Qi is excessive, causing vexation and fullness. Following the genitalia causes scrotal retraction.

When the Three Yin and Three Yang, Five Zang and Six Fu organs are all diseased, Ying and Wei circulation stops, and Five Zang obstruction occurs, death ensues.

'Ze' implies 'ji' (immediately). Summarizing the previous text on Three Yin meridian disease: it is not necessarily that Taiyin is affected on Day 4, Shaoyin on Day 5, and Jueyin on Day 6 sequentially. Rather, the internal Three Yin, external Three Yang, internal Five Zang, and external Six Fu are all affected on the first day, leading to cessation of Ying and Wei circulation and obstruction of Five Zang, resulting in immediate death. This is more severe than Lianggan Yu Han, which inevitably leads to death.

For those not suffering from Lianggan Yu Han, on the seventh day, Jutai disease wanes, and headache slightly improves; on the eighth day, Yangming disease wanes, and body heat slightly improves; on the ninth day, Shaoyang disease wanes, and deafness slightly allows hearing; on the tenth day, Taiyin disease wanes, abdominal fullness decreases as before, and appetite returns; on the eleventh day, Shaoyin disease wanes, thirst stops, fullness ceases, tongue dryness resolves, and sneezing occurs; on the twelfth day, Jueyin disease wanes, scrotum relaxes, lower abdominal distension slightly subsides, and the great Qi (pathogen) is expelled, with the illness resolving day by day.

Those not suffering from Lianggan Yu Han, belonging to meridian heat diseases, all complete a seven-day cycle, with disease waning and recovery occurring. From this, we see that the previously mentioned one-day or two-day infections were described in sequence, not as fixed, unchangeable dates. Understanding the Sacred Classics requires not letting literal words obscure the meaning.

The Emperor said: "How should it be treated?"

If treatment is appropriate, recovery need not wait until the seventh day, hence the question.

Qibo said: "Treat by unblocking the pulse of each respective Zang organ; the disease will wane day by day and resolve."

Zang pulses refer to, as mentioned earlier, the Taiyin Spleen pulse, Shaoyin Kidney pulse, and Jueyin Liver pulse. By treating and unblocking the pulse of each respective Zang organ, the disease will wane day by day and resolve, thereby avoiding death.

For cases less than three days duration, sweating can cure; for cases three days or more, purging/draining can cure.

If the disease is in the Three Yang meridians and less than three days old (exterior), sweating can cure; if three days or more (interior), draining/purging can cure. Thus, recovery need not wait for the seven-day cycle.

The Emperor said: "After heat disease has resolved, sometimes residual symptoms remain. Why?"

Following the intent of sweating and draining, asking why residual symptoms sometimes remain and full recovery is delayed.

Qibo said: "All residual conditions arise because food was forced during severe heat, leaving remnants; in such cases, the disease has waned, but heat is hidden. Because grain Qi interacts with the hidden heat, the two heats combine, causing residuals."

'Qiang' is pronounced with the rising tone. 'Shi' sounds like 'si'. 'Cang' is read literally. All residual conditions occur because food was forced during severe heat, leaving remnants. Furthermore, in such cases, external heat has waned, but internal heat is hidden. Grain Qi interacts with the hidden heat; this interaction causes Yangming Stomach heat to combine with the hidden heat, resulting in residuals.

The Emperor said: "Excellent. How to treat residuals?"

Disease residuals persist; how to treat.

Qibo said: "Observe deficiency and excess, regulate reversal and compliance; this ensures certain recovery."

Observe the deficiency and excess of the meridians, regulate the reversal and compliance of Yin and Yang. Treating in this manner ensures certain recovery without residuals.

The Emperor said: "What should be prohibited during heat disease?"

Having residuals and then treating is inferior to prohibiting things during the active disease phase; hence the question on prohibitions.

Qibo said: "When heat disease slightly improves, eating meat causes recurrence; overeating causes residuals. These are the prohibitions."

When heat disease slightly improves but has not fully resolved, avoid meat and avoid overeating. Meat is heavy and greasy, difficult to digest, causing heat disease to recur; overeating causes grain Qi to interact with heat, leading to residuals. Eating meat and overeating are these prohibitions.

The Emperor said: "For those suffering from Lianggan Yu Han, what are their pulses and clinical manifestations?"

'Ying' is pronounced with the level tone. 'Xing' means condition/symptom. The conditions of various meridians receiving disease were detailed earlier; here, the pulse and condition of Lianggan Yu Han are asked again.

Qibo said: "In Lianggan Yu Han, on the first day, Jutai and Shaoyin are both diseased, causing headache, dry mouth, and vexation/fullness; on the second day, Yangming and Taiyin are both diseased, causing abdominal fullness, fever, anorexia, and delirious speech; on the third day, Shaoyang and Jueyin are both diseased, causing deafness, scrotal retraction, cold limbs, inability to drink fluids, and unconsciousness. Death occurs on the sixth day."

Lianggan Yu Han refers to Jutai-Shaoyin, Yangming-Taiyin, and Shaoyang-Jueyin, which are exterior-interior and yin-yang pairs. Thus, on the first day, Jutai and Shaoyin are both diseased. Symptoms of Jutai disease include headache; symptoms of Shaoyin disease include dry mouth and vexation/fullness. On the second day, Yangming and Taiyin are both diseased. Symptoms of Taiyin disease include abdominal fullness and fever; symptoms of Yangming disease include anorexia and delirious speech. On the third day, Shaoyang and Jueyin are both diseased. Symptoms of Shaoyang disease include deafness; symptoms of Jueyin disease include scrotal retraction and cold limbs. The Three Yang meridians rely on Stomach Qi as their root; the Three Yin meridians prioritize Shen Qi. Inability to drink fluids indicates exhaustion of Stomach Qi; unconsciousness indicates loss of Shen Qi. By the sixth day, the cycle cannot complete, leading to death. This means Jutai-Shaoyin, Yangming-Taiyin, and Shaoyang-Jueyin all reach death by the sixth day. Although Days 1, 2, and 3 have a sequence, they are not absolute; understanding requires intuitive comprehension.

The Emperor said: "When Five Zang are injured, Six Fu are obstructed, and Ying-Wei circulation stops, why does death occur three days later, rather than immediately?"

Continuing from the previous point that when Three Yin/Yang, Five Zang/Six Fu are diseased, and Ying-Wei/Zang obstruction occurs, death ensues; asking why death takes three days instead of being immediate.

Qibo said: "Yangming is the head of the twelve meridians; its Blood and Qi are abundant. Thus, after unconsciousness for three days, when its Qi is exhausted, death occurs."

'Zhang' is pronounced with the rising tone. The Shen Qi operation of Five Zang and Six Fu all relies on Stomach Qi; thus, Yangming is the head of the twelve meridians. Yangming has abundant Qi and Blood, hence its Blood and Qi are vigorous. Unconsciousness indicates Shen Qi is severed. However, Yangming Qi has not yet exhausted; thus, after three days of unconsciousness, when Yangming Qi is exhausted, death occurs. Though not immediate, it is tantamount to death.

Any Shanghan transforming into Wen (Warm Disease): those appearing before the Summer Solstice are classified as Wenbing (Warm Disease); those appearing after the Summer Solstice are classified as Shubing (Summerheat Disease). Shubing should exit with sweat; do not stop sweating.

Winter injury by Cold leads to Spring Wenbing. Thus, any Shanghan transforming into Wen: those manifesting before the Summer Solstice are Wenbing; those after are Shubing. Wen is equivalent to Heat. Shu is extreme Heat. Shu-Heat diseases dissipate with sweat; Warm-Heat diseases should also dissipate with sweat. Therefore, Shu should exit with sweat; do not stop it, even if sweating is profuse. The heat diseases discussed earlier appear immediately upon contraction, differing from Cold pathogens that linger and lie dormant before manifesting. Thus, Wen and Shu are cited to distinguish the intent of the preceding heat disease discussion.