《热论》，论热病之在脉，刺热，论热病之先见，评热，论热病之变证。风厥、劳风、肾风、风水，
皆热病之变。举而评之，故曰《评热病论》。
黄帝问曰∶有病温者，汗出，辄复热，而脉躁疾，不为汗衰，狂言不能食，病名为何？
温，犹热也。温热之病，汗出当愈。今汗出辄复热，而脉更躁疾，不为汗衰；且神志不守，而
狂言，胃气不和而不能食，此热病变证，病名为何？
岐伯对曰∶病名阴阳交，交者死也。
汗乃阴液，外出于阳，阳热不从汗解，复入之阴，名曰阴阳交，交者，正不胜邪，邪复伤正，故死也。
帝曰∶愿闻其说。
愿闻阴阳交而致死之说。
岐伯曰∶人所以汗出者，皆在于谷，谷生于精，今邪气交争于骨肉，而得汗者，是邪却而精胜
也。精胜则当能食而不复热。复热者，邪气也。汗者，精气也。今汗出而辄复热者，是邪胜也。不能
食者，精无俾也。病而留者，其寿可立而倾也。且夫热论曰，汗出
而脉尚躁盛者死。今脉不与汗相应，此不胜其病也。其死明矣。狂
言者是失志。失志者死。今见三死，不见一生，虽愈必死也。
胃腑水谷之精，出而为汗，故人所以汗出者，皆生于谷之精，今邪气交争于骨肉，而得汗者，是
邪却而谷精胜也。精胜则当能食，而不复热。复热者，邪气也。汗者，谷精之气也。今汗出而辄
复热者，是邪胜也。能食则谷之精专，补益经隧，今不能食者，精无俾也。俾，补益也。不能食，精无俾，
致热病留而不去者，其寿可立而倾也。且夫灵枢热病论曰，汗出而脉尚躁盛者死。今脉躁疾
不与汗相应，此正气不胜其病也，其死明矣。狂言者，是失肾脏之志，神志相根据，失志则失神，故失志者死。
夫不能食一死也，汗出而脉躁疾二死也。狂言失志三死也。今见三死，不见一生，始之病
温虽愈，亦必死也。所以详明阴阳交，而致死之说也。
帝曰∶有病身热汗出，烦满。烦满不为汗解，此为何病？
承上文汗出复热之死证，复举汗出烦满之病以问之。
岐伯曰∶汗出而身热者，风也。汗出而烦满不解者，厥也，病名曰风厥。
风为阳邪，性主开发，凡汗出而身发热者，风也。汗乃阴液，外出于阳，今汗出而
心烦胸满不解者，乃阴竭阳虚，不相交济，是为厥也。此因风致汗；因汗致厥，病名曰风厥。
帝曰∶愿卒闻之。
愿尽闻风厥之义。
岐伯曰∶巨阳主气，故先受邪，少阴与其为表里也，得热则上从之，从之则厥也。
通体之气，巨阳主之，故先受邪，巨阳主表，少阴主里，故少阴与其为表里也。巨
阳少阴相为表里，故巨阳得表热之病，则少阴里阴之气，上从之，从之而加于阳，则厥也。
帝曰∶治之奈何？岐伯曰∶表里刺之，饮之服汤。
厥则外阳内阴，不调和矣。治之之法，当表里刺之，和其外内，饮之服汤，调其阴阳，此详
明热病汗出烦满而为风厥之变证也。
帝曰∶劳风为病何如？
劳，烦劳也；劳风，烦劳内虚，生风病也。承上文风厥而问劳风，亦热病之变证也。
岐伯曰∶劳风法在肺下，其为病也，使人强上冥视，唾出若涕，恶风而振寒，此为劳风之病。
强、恶俱去声。肺下，心也。烦劳则伤心，故劳风之病，法在肺下，心脉从心系，上挟咽，系目
系，病则不能挟咽系目，故其为病也，使人强上冥视，火气内炎，故唾出若涕，风淫经脉，故恶风
而振寒。凡此皆为劳风之病。
帝曰∶治之奈何？岐伯曰∶以救俯仰，巨阳引精者，三日；中年者，五日；不精者，七日。
咳出青黄涕，其状如脓，大如弹丸，从口中若鼻中出，不出则伤肺，伤肺则死也。
治之之法，当调和经脉以救俯仰，经脉调和，则俯仰自如，强上可愈。巨阳之脉，起于目内 ，
上额交巅，从巅络脑，救其俯仰，不使强上，斯时巨阳能引精上行者，三日而冥视愈，中年精气
稍虚者，五日而冥视愈。老年不足于精者，七日而冥视愈。始则唾出若涕，至此复咳出青黄涕，其状如脓，
大如弹丸，从口中若鼻中出，则病当愈。若不能出，则火热伤肺。伤肺则死，此言劳风为
病，火气盛而肺全伤，则死也。
帝曰∶有病肾风者，面 庞然，壅害于言，可刺不？
庞，音芒，余篇同。不，否同。皮里肉外曰 ，庞然，肿貌。气道不利，则壅害于言，此肾风之病，
可刺治否？心肾皆属少阴，承上文心病之劳风，而复问肾风也。
岐伯曰∶虚不当刺，不当刺而刺，后五日其气必至。
面 肿而难言，肾气虚也，虚不当刺，不当刺而刺，后五日，
其肾脏之气必至而为病。一日一脏，五日之后，复至其脏而发病也。
帝曰∶其至何如？
其气至之病何如？
岐伯曰∶至必少气，时热。时热从胸背上至头，汗出手热，口干苦渴，小便黄，目下肿，腹中
鸣，身重难以行，月事不来，烦而不能食，不能正偃。正偃则咳，病名曰风水。论在《刺法》中。
偃，犹卧也。肾为生气之原，气至而病必少气，少气则时热，其时热也，从胸背上至于头，经脉虚，
故汗出手热，津液虚，故口干苦渴，气不化，故小便黄，水道不利，故目下肿，肠胃虚寒，故
腹中鸣，足膝不力，故身重难以行。任脉虚，故月事不来，土气虚，故烦不能食，肺肾不交，故不能正偃，
正偃则咳，此肾风之病。肾受风邪，风行水涣，故病名曰风水。论在《刺法》中者，
《水热穴论》云，肾汗出逢于风，传为跗肿，本之于肾，名曰风水。
帝曰∶愿闻其说。
帝欲详明其义，故下文岐伯一一以明之。
岐伯曰∶邪之所凑，其气必虚，阴虚者，阳必凑之，故少气时热，而汗出也。
申明少气时热汗出者，凡邪之所凑，其气必虚，如阴气虚者，阳必凑之，故少气时热而汗出也。
小便黄者，少腹中有热也。
申明小便黄者，膀胱之气，不合太阳而外出，是少腹中有热也。
不能正偃者，胃中不和也。正偃则咳甚，上迫肺也。
申明不能正偃者，乃胃中土气不和也，正偃则咳甚者，肾邪上迫于肺也。
诸有水气者，微肿先见于目下也。
申明目下肿者，凡诸有水气者，微肿先见于目下也。
帝曰∶何以言？
申明未尽故复探之。
岐伯曰∶水者阴也，目下亦阴也。腹者至明之所居，故水在腹者，必使目下肿也。
水者，阴类也。目下，亦阴也。脾为阴中之至阴，而主腹，是
腹者，至阴之所居，故水在腹者，必使目下肿也。此复申明水气之目下肿也。
真气上逆，故口苦舌干。
口干苦渴者，口苦舌干也。津液内竭，真脏之气上逆，故口苦舌干。此申明口干苦渴之义也。
卧不得正偃，正偃则咳出青水也。诸水病者，故不得卧，卧则惊，惊则咳甚也。
卧不能正偃者，乃卧不得正偃，正偃则咳者，乃正偃则咳出青水也。凡诸水病者，水气上逆，故不得
卧，不但胃中不和也，卧则惊，惊则咳甚，不但上迫肺也。此复申明不能偃，乃水气上逆，正
偃则咳甚，乃水气凌心，不但胃不和，上迫肺也。
腹中鸣者，病本于胃也。
肠胃居于腹中，虚寒则鸣，故腹中鸣者，病本于胃也。此申明腹中鸣之义也。
薄脾则烦，不能食，食不下者，胃脘隔也。
脾脉从胃上膈，注心中，邪薄于脾，则烦而不能食。夫胃主纳，脾主运，食不下者，由于胃脘
之阻隔也。此申明烦不能食之义也。
身重难以行者，胃脉在足也。
胃脉循胫下足，身重难以行者，由胃脉在足，而胃之经脉虚也。此申明身重难行之义也。
月事不来者，胞脉闭也。胞脉者，属心而络于胞中，今气上迫肺，心气不得下通，故月事不来也。
胞脉主冲任之血，月事不来者，乃胞脉闭也。中焦取汁，奉心化赤，血归胞中，故胞脉者，属心而
络于胞中，今水气上迫肺，心气不得下通，故月事不来也。此申明月事不来之义也。
帝曰∶善。
冲脉任脉，皆起于胞中，循背里，散胸中，会咽喉，络唇口，淡渗皮肤，行于周身，月事不来，由于
胞脉之闭，则热从胸背上至头手热，亦由胞脉之热。帝故善之，不复问也。
*The Treatise on Heat (Re Lun)* discusses the manifestation of heat diseases in pulse diagnosis; *The Treatise on Acupuncture for Heat (Ci Re)* discusses the initial symptoms appearing first in heat diseases; *The Evaluation of Heat Disease Treatise (Ping Re Bing Lun)* discusses the complicated syndromes of heat diseases. Wind Jue, Labor Wind, Kidney Wind, and Water Wind are all complicated syndromes of heat diseases. By listing and evaluating these, it is named *The Evaluation of Heat Disease Treatise*.
The Yellow Emperor asked: There is a patient suffering from Wen disease (warm-heat disease), who sweats and then immediately fever returns, with a restless and rapid pulse that does not subside with sweating, accompanied by delirious speech and inability to eat. What is this disease called?
Wen implies heat. In warm-heat diseases, sweating should lead to recovery. Now, after sweating, fever returns immediately, and the pulse becomes even more restless and rapid, not subsiding with sweating; furthermore, the spirit is unguarded, leading to delirious speech, and the Stomach Qi is disharmonious, leading to an inability to eat. This is a complicated syndrome of heat disease. What is its name?
Qi Bo replied: The disease is named Yin-Yang Intersection (Yin Yang Jiao). "Intersection" signifies death.
Sweat is Yin fluid, emerging from the exterior Yang. If Yang heat does not resolve through sweating but instead re-enters the Yin, it is called Yin-Yang Intersection. "Intersection" means that the righteous Qi cannot overcome the pathogenic factor, and the pathogen subsequently injures the righteous Qi, thus leading to death.
The Emperor said: I wish to hear the explanation.
I wish to hear the theory regarding how Yin-Yang Intersection leads to death.
Qi Bo said: The reason humans sweat lies in grain (food); grain generates essence (Jing). Now, when pathogenic factors contend with essence in the muscles and bones, if sweating occurs, it indicates that the pathogen has retreated and essence has prevailed. When essence prevails, one should be able to eat and not have recurring fever. Recurring fever indicates the presence of pathogenic factors. Sweat is derived from essence. Now, sweating followed immediately by recurring fever indicates that the pathogen has prevailed over the essence. The inability to eat means that essence receives no assistance. If the disease lingers, life can be lost instantly. Furthermore, *The Treatise on Heat* states: "If there is sweating but the pulse remains restless and vigorous, death ensues." Now, the pulse does not correspond with the sweating, indicating that righteousness cannot overcome the disease. Death is evident. Delirious speech is a sign of loss of Zhi (will/intention). Loss of Zhi leads to death. Now, seeing three signs of death and no sign of life, even if the condition seems to improve initially, death is inevitable.
The refined essence of water and grain in the Stomach Fu transforms into sweat; therefore, human sweating originates from the refined essence of grain. Now, when pathogenic factors contend with essence in the muscles and bones, if sweating occurs, it indicates that the pathogen has retreated and the grain-essence has prevailed. When essence prevails, one should be able to eat and not have recurring fever. Recurring fever is due to pathogenic factors. Sweat is the Qi of grain-essence. Now, sweating followed immediately by recurring fever indicates that the pathogen has prevailed. If one can eat, the grain-essence remains concentrated and nourishes the meridians and collaterals. Now, the inability to eat means that essence receives no assistance ("Bi" means to assist/nourish). The inability to eat and the lack of essence assistance cause the heat disease to linger and not resolve; life can be lost instantly. Furthermore, *Ling Shu: Treatise on Heat Disease* states: "If there is sweating but the pulse remains restless and vigorous, death ensues." Now, the pulse is restless and rapid and does not correspond with sweating, indicating that righteous Qi cannot overcome the disease; death is evident. Delirious speech is the loss of the Zhi stored in the Kidney. Shen (Spirit) and Zhi are interdependent; loss of Zhi leads to loss of Shen, so loss of Zhi leads to death.
Inability to eat is one sign of death; sweating with a restless and rapid pulse is the second sign of death; delirious speech and loss of Zhi is the third sign of death. Now, seeing these three signs of death and no sign of life, although the initial Wen disease may seem to improve, death is inevitable. This details the theory of Yin-Yang Intersection leading to death.
The Emperor asked: There is a patient with body heat and sweating, along with vexation and fullness. Vexation and fullness do not resolve with sweating. What disease is this?
Continuing from the previous discussion on death caused by fever returning after sweating, [the Emperor] raises another question about a disease characterized by sweating with vexation and fullness.
Qi Bo replied: Sweating with body heat is due to Wind. Sweating with unresolved vexation and fullness is due to Jue (reversal/cold extremities). The disease is named Wind Jue.
Wind is a Yang pathogen, whose nature is to disperse. Any case of sweating with body heat is due to Wind. Sweat is Yin fluid, emerging from the exterior Yang. Now, sweating with unresolved heart vexation and chest fullness indicates exhaustion of Yin and deficiency of Yang, failing to mutually support each other, forming Jue. This arises because Wind causes sweating, and sweating causes Jue; the disease is named Wind Jue.
The Emperor said: I wish to hear it completely.
I wish to fully understand the meaning of Wind Jue.
Qi Bo said: Ju Yang (Foot-Taiyang Bladder Meridian) governs the Qi of the whole body, so it is affected first. Shao Yin (Foot-Shaoyin Kidney Meridian) is interior-exterior paired with it. When affected by heat, Shao Yin follows upward, and following upward leads to Jue.
The Qi of the entire body is governed by Ju Yang, so it is affected first. Ju Yang governs the exterior, and Shao Yin governs the interior, so they are interior-exterior paired. Since Ju Yang and Shao Yin are interior-exterior paired, when Ju Yang suffers from exterior heat, the interior Yin Qi of Shao Yin follows upward. Following upward adds to Yang, resulting in Jue.
The Emperor asked: How should it be treated? Qi Bo said: Acupuncture both the exterior and interior meridians, and administer decoctions.
Jue results in exterior Yang and interior Yin being out of harmony. The treatment method is to acupuncture both the exterior and interior meridians to harmonize the inside and outside, and to drink decoctions to regulate Yin and Yang. This details the complicated syndrome of heat disease presenting with sweating, vexation, and fullness, transforming into Wind Jue.
The Emperor asked: What about Labor Wind disease?
"Labor" refers to excessive toil; Labor Wind refers to wind disease arising from internal deficiency due to excessive toil. Continuing from Wind Jue, [the Emperor] asks about Labor Wind, which is also a complicated syndrome of heat disease.
Qi Bo said: Labor Wind typically manifests below the Lung. Its symptoms include stiffness of the neck, blurred vision, expectoration of sputum resembling mucus, aversion to wind, and chills. These constitute Labor Wind disease.
"Qiang" (stiff) and "E" (aversion) are pronounced with the departing tone. "Below the Lung" refers to the Heart. Excessive toil damages the Heart, so Labor Wind disease typically manifests below the Lung (Heart). The Heart meridian ascends along the Heart system, flanking the throat, and connecting to the eye system. When diseased, it fails to flank the throat and connect to the eyes, causing symptoms of neck stiffness and blurred vision. Internal flaming fire causes expectoration of sputum resembling mucus; wind invading the meridions causes aversion to wind and chills. All these are symptoms of Labor Wind.
The Emperor asked: How should it be treated? Qi Bo said: Rescue the ability to bend and extend. For those with abundant Jing (essence), three days; for middle-aged individuals, five days; for those lacking Jing, seven days. Expectorate green or yellow sputum, resembling pus, as large as a pellet, from the mouth or nose. If not expelled, it injures the Lung; injuring the Lung leads to death.
The treatment method is to harmonize the meridians to restore the ability to bend and extend. When meridians are harmonized, bending and extending become free, and neck stiffness resolves. The Ju Yang meridian originates at the inner canthus, crosses the forehead, meets at the vertex, and connects to the brain. Rescuing the difficulty in bending and extending prevents neck stiffness. At this time, if Ju Yang can guide Jing upward, those with abundant Jing will recover from blurred vision in three days; middle-aged individuals with slightly deficient Jing will recover in five days; elderly individuals insufficient in Jing will recover in seven days. Initially, sputum resembling mucus was expectorated; now, green or yellow sputum resembling pus, as large as a pellet, is expectorated from the mouth or nose, indicating the disease should resolve. If it cannot be expelled, fire-heat injures the Lung. Injuring the Lung leads to death. This states that if Labor Wind involves excessive fire-heat completely damaging the Lung, death ensues.
The Emperor asked: There is a patient with Kidney Wind, presenting with facial swelling and obstructed speech. Can it be treated with acupuncture?
"Peng" is pronounced Mang, same as in other chapters. "Bu" is equivalent to "No". Subcutaneous tissue is called Peng; Peng-ran describes swelling. Obstruction of the Qi pathway hinders speech. This is Kidney Wind disease; can it be treated with acupuncture? Both Heart and Kidney belong to Shao Yin. Continuing from the Heart disease Labor Wind discussed above, [the Emperor] asks about Kidney Wind.
Qi Bo said: Deficiency patterns should not be needled. If needled inappropriately, after five days, the Qi will inevitably arrive.
Facial swelling and difficulty speaking indicate Kidney Qi deficiency. Deficiency patterns should not be needled. If needled inappropriately, after five days, the Kidney Qi will inevitably arrive and cause disease. One Zang organ is affected per day; after five days, the pathogen returns to that Zang organ to manifest disease.
The Emperor asked: What will the arrival be like?
What will the disease presentation be when the Qi arrives?
Qi Bo said: Upon arrival, there will definitely be shortness of breath and intermittent fever. The fever rises from the chest and back to the head, with sweating and hot hands, bitter and dry mouth with thirst, yellow urine, edema under the eyes, borborygmus in the abdomen, heaviness of the body making walking difficult, amenorrhea, vexation with inability to eat, and inability to lie flat. Lying flat induces coughing. This disease is named Water Wind. It is discussed in the *Ci Fa* (Acupuncture Methods) chapter.
"Yan" means lying down. The Kidney is the source of generating Qi. When Qi arrives and disease manifests, there will definitely be shortness of breath. Shortness of breath leads to intermittent fever. This fever rises from the chest and back to the head. Due to meridian deficiency, there is sweating and hot hands. Due to fluid deficiency, there is a bitter and dry mouth with thirst. Due to failure of Qi transformation, urine is yellow. Due to obstruction of water pathways, there is edema under the eyes. Due to deficiency-cold in the intestines and stomach, there is borborygmus. Due to weakness in the feet and knees, the body feels heavy and walking is difficult. Due to deficiency of the Ren Mai, menstruation ceases. Due to deficiency of Spleen Earth Qi, there is vexation and inability to eat. Due to lack of communication between Lung and Kidney, one cannot lie flat; lying flat induces coughing. This is Kidney Wind disease. The Kidney is invaded by Wind pathogen; Wind moves and scatters water, hence the disease is named Water Wind. It is discussed in the *Ci Fa* chapter, referring to *Shui Re Xue Lun* (Treatise on Water-Heat Acupoints), which states: "When Kidney sweat encounters wind, it transmits to become edema on the dorsum of the foot, rooted in the Kidney, named Water Wind."
The Emperor said: I wish to hear the explanation.
The Emperor desires to clarify the meaning in detail, so Qi Bo explains it point by point below.
Qi Bo said: Wherever pathogenic factors gather, the Qi must be deficient. When Yin is deficient, Yang inevitably gathers there, resulting in shortness of breath, intermittent fever, and sweating.
Elucidating the causes of shortness of breath, intermittent fever, and sweating: Wherever pathogenic factors gather, the Qi must be deficient. For example, when Yin Qi is deficient, Yang pathogens inevitably gather there, resulting in shortness of breath, intermittent fever, and sweating.
Yellow urine indicates heat in the lower abdomen.
Elucidating the cause of yellow urine: The Qi of the Bladder does not combine with Taiyang but escapes outward, indicating heat in the lower abdomen.
Inability to lie flat is due to disharmony in the Stomach. Cough worsens when lying flat because the pathogen presses upward on the Lung.
Elucidating the inability to lie flat: It is due to disharmony of Earth Qi in the Stomach. Worsening cough when lying flat is due to Kidney pathogen pressing upward on the Lung.
All patients with water qi exhibit slight edema first under the eyes.
Elucidating edema under the eyes: In all cases of water qi disease, slight edema appears first under the eyes.
The Emperor asked: Why do you say so?
Because the previous explanation was incomplete, [the Emperor] probes further.
Qi Bo said: Water belongs to Yin, and the area under the eyes also belongs to Yin. The abdomen is the residence of Zhi Yin (Extreme Yin). Therefore, when water accumulates in the abdomen, it necessarily causes edema under the eyes.
Water belongs to the Yin category. The area under the eyes also belongs to Yin. The Spleen is Extreme Yin within Yin and governs the abdomen; thus, the abdomen is the residence of Extreme Yin. Therefore, when water accumulates in the abdomen, it necessarily causes edema under the eyes. This reiterates the explanation for edema under the eyes in water qi disease.
True Qi rebels upward, causing a bitter taste in the mouth and dry tongue.
Bitter taste, dry tongue, and thirst occur because internal fluids are exhausted and True Zang Qi rebels upward, causing a bitter taste and dry tongue. This elucidates the meaning of bitter taste and dry tongue.
Inability to lie flat; lying flat induces coughing up of blue-green fluid. All water disease patients cannot lie down; lying down causes fright, and fright exacerbates coughing.
Inability to lie flat means one cannot lie straight; lying straight induces coughing, specifically coughing up blue-green fluid. In all water diseases, water qi rebels upward, so one cannot lie down; this is not merely due to Stomach disharmony. Lying down causes fright, and fright exacerbates coughing; this is not merely due to upward pressure on the Lung. This reiterates that the inability to lie flat is due to water qi rebelling upward, and worsening cough when lying flat is due to water qi overwhelming the Heart, not just Stomach disharmony or pressure on the Lung.
Borborygmus in the abdomen stems from the Stomach.
The intestines and stomach reside in the abdomen; deficiency-cold causes rumbling. Thus, borborygmus in the abdomen stems from the Stomach. This elucidates the meaning of borborygmus.
Pathogen pressing on the Spleen causes vexation and inability to eat. Food not going down is due to obstruction in the Stomach epigastrium.
The Spleen meridian ascends from the Stomach, passes through the diaphragm, and enters the Heart. Pathogen pressing on the Spleen causes vexation and inability to eat. The Stomach governs reception, and the Spleen governs transportation; food not going down is due to obstruction in the Stomach epigastrium. This elucidates the meaning of vexation and inability to eat.
Heaviness of the body and difficulty walking are due to the Stomach meridian being in the foot.
The Stomach meridian runs down the shin to the foot. Heaviness of the body and difficulty walking are due to the Stomach meridian being in the foot and the Stomach meridian being deficient. This elucidates the meaning of heaviness and difficulty walking.
Amenorrhea is due to closure of the Bao Mai (Uterine Vessel). Bao Mai belongs to the Heart and connects to the Bao (Uterus). Now, Qi rebels upward pressing on the Lung, and Heart Qi cannot descend and communicate, so menstruation ceases.
Bao Mai governs the blood of Chong and Ren meridians. Amenorrhea is due to closure of Bao Mai. Middle Jiao extracts juice, offers it to the Heart to transform into red blood, and blood returns to the Bao. Thus, Bao Mai belongs to the Heart and connects to the Bao. Now, water qi presses upward on the Lung, and Heart Qi cannot descend and communicate, so menstruation ceases. This elucidates the meaning of amenorrhea.
The Emperor said: Excellent.
Chong and Ren meridians both originate in the Bao, run along the interior of the back, scatter in the chest, meet at the throat, connect to the lips and mouth, diffuse through the skin, and circulate throughout the body. Amenorrhea is due to closure of Bao Mai; thus, heat rising from chest/back to head and hot hands are also due to heat in Bao Mai. The Emperor praised this and did not ask further.