（出素问第三十一篇）
内经热论一篇。乃伤寒之根本也。张仲景着伤寒论。其六经传变。即从此篇之文而推展之。故凡治伤寒者。必先
究内经热论。后读仲景伤寒。庶几学有源流。心有主宰。因不揣固陋。为之解释。冀有志于斯道者。一展卷而知所宗焉。
黄帝问曰。今夫热病者。皆伤寒之类也。（伤寒本系热病。其余如温暑诸证。亦为热病。观难经云。伤寒有五。可见
推此篇帝问之意。以热病莫大于伤寒。故凡今诸热病者。皆伤寒之类也。王太仆注。竟以温热之病。即由冬时伤寒。至
夏至前后所变。是此热病者。其根先伏于隔年之冬。有是理乎。即伤寒论中云然。要与此段经旨不合。更推帝于当日。
何不曰伤寒所变。或竟曰伤寒所致。而曰伤寒之类。其旨当从愚注可知。马玄台注亦不明。兹不更录。）或愈或死。其死
皆以六七日之间。其愈皆以十日以上者。何也。不知其解。愿闻其故。岐伯对曰。巨阳者。（即太阳）诸阳之属也。其脉
连于风府。（按图经云。风府一穴。在顶上入发际一寸。大筋内宛宛中。乃督脉所行之穴。与太阳经无涉。经文中举之者。
以太阳一经。夹督脉而行故也。）故为诸阳主气也。（马注云。足太阳膀胱之脉。自睛明穴而始。上连于督脉之风府穴。
从头项至背至足。凡一身手足阳经皆属于此。故穴有一百二十六。真为诸阳经主气也。）人之伤于寒也。则为病热。热虽
甚不死。（此句对上其愈。皆以十日以上句。）其两感于寒而病者。必不免于死。（此句对上其死。皆以六七日之间句。）
帝曰。愿闻其状。（此问伤寒传经病热之状。）岐伯曰。伤寒一日巨阳受之。（伤寒之邪。由表传里。太阳为表之表。所以
寒邪伤表。第一日太阳先受。伤寒论云。尺寸俱浮者。太阳受病也。当一二日发。可见伤寒之发。不可拘拘于日数矣。
按伤寒论以下有其脉。上连风府句。）故头项痛。腰脊强。（足太阳之脉。从巅入络脑。还出别下项。循肩 内。挟脊抵
腰中。故见头项痛。腰脊强之证。经文中不言热者。以太阳病。有未发热之时也。）二日阳明受之。阳明主肉。（阳明为
表之中。故太阳之邪不解。第二日当传入阳明也。伤寒论云。阳明受病。当二三日发其后诸经。皆兼二日而言。）其脉挟
鼻。络于目。故身热目疼而鼻干。不得卧也。（身热目疼鼻干。非病热而何。六经经脉之行。详后图中）三日少阳受之。
少阳主胆。（少阳为表之里。故其传又次之。）其脉循胁。络于耳。故胸胁痛而耳聋。（详此亦病热之状。）三阳经络。皆
受其病。而未入于藏者。故可汗而已。（按藏字。伤寒论作府字大妙。后全元起杨上善皆宗之。李东垣云。此非五脏之脏。
乃藏物之藏。不改作府亦通。马注云。此即指后三阴经。以三阴属五脏。故以藏字言。此论欠通。成无己注伤寒论云。
三阳受邪。为病在表。法当汗解。然三阳亦有便入府者。入府则宜下。故云未入于府者。可汗而已。已止也。言病热之
势衰也。）四日太阴受之。（太阴为里之表。其有失于汗。而邪不已者。当自少阳而传入于太阴经也。）太阴脉布胃中。络
于嗌。故腹满而嗌干。（成注云。脾经壅而成热也。）五日少阴受之。（少阴为里之中。）少阴脉贯肾。络于肺。系舌本。
故口燥舌干而渴。（成注云。邪传入里。热气渐深也。）六日厥阴受之。（厥阴为里之里。）厥阴脉循阴器。而络于肝。故
烦满而囊缩。（病愈深而热愈极。谁谓伤寒为寒证乎。按伤寒论以下。有此三经皆受病。已入于府者。可下而已三句。成
注云。三阴在经者。犹宜汗。故云。已入于腑者。可下而已也。）三阴三阳。五脏六腑皆受病。营卫不行。五脏不通。则
死矣。（当其时也。阴阳六经皆病。脏腑受热已深。宜用下药。以泄其热。如初时失于汗者。急宜汗下兼施。方免于死。
有如当汗不汗。当下不下。经络之邪未解。胃府之实未去。则营卫之阴阳不行。五脏之气血不通。必不免于死。所谓其
死。皆以六七日之间者。此也。）其不两感于寒者。（此承上文而言。循经传入之证。初非两感于寒。要其病热已极。其
治稍疏。亦不能免于死。今则以其不两感于寒。而病热轻者言之。）七日巨阳病衰。头痛少愈。（此言初时巨阳所感之邪。
或热不甚。不传入于诸经。即或热甚渐传入于诸经。要其未尽传者。尚在巨阳。至第七日。比之初时之病。其热必衰。
而头痛等证。则少愈焉下诸经病衰注仿此。）八日阳明病衰。身热少愈（愈字伤寒论改作歇字）九日少阳病衰。耳聋微闻。
十日太阴病衰。腹减如故。则思饮食。十一日少阴病衰。渴止。不满。舌干已而嚏。（少阴脉络于肺。嚏者。肺热得泄。
阴阳和畅也。）十二日。厥阴病衰。囊纵。少腹微下。大气皆去。病日已矣。（大气。谓大热之邪气。至十二日以后。则
皆去而病已。所谓其愈皆在十日以上者此。也所谓热虽甚不死者。亦此也。）帝曰。治之奈何。（此因上文。有死于失治
者。故问治之之法也。）岐伯曰。治之。各通其藏脉。病日衰已矣。其未满三日者。可汗而已。其满三日者。可泄而已。
（此言治之之法也。大抵三日以前。邪必在表。故云可汗。三日以后。邪多入里。故云可泄。此正所以各通其脏腑之经
脉。而衰已其病热之势也。愚按伤寒汗下之法。不可拘于日数。王注云。日数虽多。但有表证。脉大浮数。犹宜发汗。
日数虽少。即有里证。脉沉细数。盒饭下之。治伤寒者。须审辩脉证。方得无误。此篇中文。凡言日数。皆不可拘也。）
帝曰。热病已愈。时有所遗者。何也。（谓热未尽去。尚有遗留于脏腑间也。）岐伯曰。诸遗者。热甚而强食之。故有所
遗也。若此者。皆病已衰。而热有所藏。（所藏者。即所遗之热也。）因其谷气相薄。两热相合。故有所遗也。（两热者。
谓所藏之热。与新入谷气之热相侵薄。故相交合也。）帝曰。善。治遗奈何。岐伯曰。视其虚实。调其逆从。（逆者正治。
谓以寒治热也。从者反治。谓以热治热也。）可使必已矣。帝曰。病热当何禁之。岐伯曰。病热少愈。食肉则复。（谓热
病复发如故。）多食则遗。（谓初时热病不能尽去。盖病遗热轻。而病复热重也。）此其禁也。帝曰。其病两感于寒者。其
脉应与其病形何如。（脉应者。谓三阴。三阳经脉之应也。）岐伯曰。两感于寒者。病一日。则巨阳与少阴俱病。则头痛。
（巨阳。）口干而烦满。（少阴 按伤寒论云。口干烦满而渴。）二日。则阳明与太阴俱病。则腹满。（太阴）身热（阳明）
不欲食（太阴）谵言（阳明）。三日则少阳与厥阴俱病。则耳聋。（少阳）囊缩而厥。（厥阴。）水浆不入。不知人。六日
死。（此则其阴阳经脉之相应。表里俱病之互形。有如此。）帝曰。五脏已伤。六腑不通。营卫不行。如是之后。三日乃
死。何也。（此承上文。帝疑两感伤寒。非若单传之病。其死必待六七日之间。而伯言三日之时。病患脏腑营卫。亢热已
极。此时宜即死矣。如是之后。必又三日乃死者。何也。）岐伯曰。阳明者。十二经脉之长也。其气血盛。故不知人。三
日其气乃尽。故死矣。（阳明为十二经之长。以上诸经之气血盛。则诸经之病热亦甚。热甚。故不知人。方其初病三日之
时。诸经之邪热虽甚。而阳明之元气未尽。故不即死。又三日。则阳明之元气尽。不能胜诸经之邪热。故云。必不免于
死耳。）凡病伤寒而成温者。先夏至日者。为病温。后夏至日者。为病暑。暑当与汗皆出。勿止。（凡热病因时变迁。冬
为寒。春为温。夏为暑。秋为疟。各因时气所伤。分立病名。上言病伤寒。而成温者。谓热病发于冬。则为伤寒。如发
于夏至以前。三春之时。时令已温。故成温病。如过夏至以后。时令大热。故成暑病。总之为温为暑。各有时也。暑病
多汗。勿止汗者。谓不可遽用实表之药。以止其汗。亦不可反用发表之药。以泄其汗。乃清暑解肌之法也。治暑法另具
暑门治温法。见后第十三卷论中）
（出自《素问》第三十一篇）
《内经·热论》这一篇，是伤寒病的根本。张仲景撰写《伤寒论》，其中六经的传变规律，就是依据本篇的文字推演扩展而来的。所以凡是治疗伤寒的人，必须先研究《内经·热论》，然后再研读仲景的《伤寒论》，这样学习才有源头和流变，心中才有主见。因此我不顾自己学识浅陋，对此进行解释，希望有志于这门学问的人，一打开书卷就知道效法的宗旨。
黄帝问道：现在所说的热病，都属于伤寒一类。（伤寒本来属于热病，其余如温病、暑病等各种证候，也属于热病。看《难经》说“伤寒有五”，就可以看出这篇中黄帝提问的本意，是以热病中没有比伤寒更大的了，所以现在各种热病，都是伤寒的一类。王冰注解说，温热之病，都是由冬季感受寒邪，到夏至前后所转化而成的，这种热病的根源先潜伏在隔年的冬天，有这样的道理吗？即便《伤寒论》中有类似说法，也与这段经文的主旨不合。再推究黄帝当时的意思，为什么不直接说“伤寒所变”或者干脆说“伤寒所致”，而要说“伤寒之类”，其主旨应当遵从我的注解可知。马莳注也不明确，这里不再收录。）有的痊愈，有的死亡，那些死亡的，都在六七天之间；那些痊愈的，都在十天以上，为什么呢？我不知道其中的道理，希望能听听原因。岐伯回答说：巨阳（即太阳经），是诸阳经的统领。它的经脉连于风府穴。（按《图经》记载，风府这一个穴位，在头顶入发际一寸处，大筋内的凹陷中，是督脉运行的穴位，与太阳经没有直接关系。经文中提到它，是因为太阳一经夹着督脉而行，所以如此。）因此它是诸阳经主气的地方。（马莳注说：足太阳膀胱经的脉气，从睛明穴开始，向上连于督脉的风府穴，从头项到背再到足，全身手足的阳经都归属于此，所以穴位有一百二十六穴，确实是诸阳经主气的地方。）人受到寒邪侵袭，就会得病发热。热势虽然很盛也不会死。（这句话对应上文“痊愈都在十天以上”。）如果是两感于寒而发病的，就一定难免于死亡。（这句话对应上文“死亡都在六七天之间”。）
黄帝说：我想听听它的症状表现。（这是询问伤寒传经导致发热的症状。）岐伯说：伤寒第一天，巨阳经受邪。（伤寒的病邪由表传里，太阳经是表的表层，所以寒邪伤表，第一天太阳经最先受邪。《伤寒论》说：“尺寸脉俱浮者，是太阳经受病，应当在第一二天发作。”可见伤寒的发作，不能拘泥于日数。按《伤寒论》以下有“其脉上连风府”一句。）所以出现头项痛、腰脊僵硬的症状。（足太阳经脉，从头顶入络于脑，复出别下行项部，沿肩内侧，挟脊抵腰部，所以出现头项痛、腰脊强的症状。经文中没有提发热，是因为太阳病有尚未发热的阶段。）第二天，阳明经受邪。阳明经主管肌肉。（阳明经是表的中间层，所以太阳经的病邪不解，第二天应当传入阳明经。《伤寒论》说：“阳明经受病，应当在第二三天发作。”其后各经都兼带“二日”来说。）它的脉气挟行于鼻旁，联络于目，所以身体发热、眼睛疼痛且鼻子干燥，无法安卧。（身体发热、眼睛疼痛、鼻子干燥，不是病热又是什么呢？六经经脉的运行路线，详见后图。）第三天，少阳经受邪。少阳经主管胆腑。（少阳经是表的里层，所以它的传变又次于前两者。）它的脉气循行于胁肋，联络于耳，所以胸胁疼痛且耳聋。（详细看这也是病热的症状。）三阳经的经络都受了病邪，但还没有传入五脏的，所以可以通过发汗的方法治愈。（按“脏”字，《伤寒论》作“腑”字非常妙，后来全元起、杨上善都遵循这个观点。李东垣说：这里的“脏”不是指五脏之脏，而是指藏物的“脏”，不改作“腑”也通顺。马莳注说：这指的是后面的三阴经，因为三阴属五脏，所以用“脏”字来说。这种论述欠通。成无己注《伤寒论》说：三阳经受邪，病在体表，法当用汗法解表。然而三阳经也有直接进入腑的情况，进入腑则应当用下法，所以说“未入于腑者，可汗而已”。已，停止的意思。是说病热的势头衰退了。）第四天，太阴经受邪。（太阴经是里的表层，如果有失于发汗而邪气不止的，应当从少阳经传入太阴经。）太阴经的脉气散布于胃中，联络于咽喉，所以腹部胀满且咽喉干燥。（成无己注说：脾经壅滞而成热。）第五天，少阴经受邪。（少阴经是里的中层。）少阴经的脉气贯穿肾脏，联络于肺，系连舌根，所以口燥、舌干且口渴。（成无己注说：邪气传入里层，热气逐渐加深。）第六天，厥阴经受邪。（厥阴经是里的里层。）厥阴经的脉气循行于阴器，联络于肝脏，所以心烦腹满且睾丸收缩。（病越深热越极，谁说伤寒是寒证呢？按《伤寒论》以下有“此三经皆受病，已入于腑者，可下而已”三句。成无己注说：三阴经在经者，仍然适宜用汗法，所以说“已入于腑者，可下而已”。）如果三阴三阳、五脏六腑都受了病邪，营卫之气运行停滞，五脏气机不通，就会死亡。（在这个时候，阴阳六经都发病，脏腑受热已经很深，应当使用下药来泄热。如果起初失于发汗，急宜汗法和下法并用，才能免于死亡。如果该发汗而不发汗，该攻下而不攻下，经络的邪气未解，胃腑的实邪未去，那么营卫的阴阳就不能运行，五脏的气血就不通畅，必然不免于死亡。这就是所谓“死亡都在六七天之间”的原因。）
那些没有两感于寒的。（这是承接上文而言，按照经络顺序传变的证候，起初并非两感于寒。但要注意的是，即使病热已经极盛，治疗稍有疏忽，也不能免于死亡。现在则是针对那些没有两感于寒，且病热较轻的情况来说的。）第七天，巨阳经的病势衰退，头痛稍微减轻。（这是说起初巨阳经感受的邪气，或者热势不重，不传入其他各经；或者即使热势重逐渐传入其他各经，但只要还有未完全传遍的，还在巨阳经，到了第七天，比起初时的病情，热势必然衰退，而头痛等症状，也就稍微减轻了。下面各经病衰的注解仿照此例。）第八天，阳明经的病势衰退，身体发热稍微减轻（“愈”字在《伤寒论》中改为“歇”字）。第九天，少阳经的病势衰退，耳聋稍微能听到声音。第十天，太阴经的病势衰退，腹部胀满消退恢复原状，就开始想吃东西。第十一天，少阴经的病势衰退，口渴停止，腹不满，舌干已缓解并且打喷嚏。（少阴经脉络于肺，打喷嚏说明肺热得以宣泄，阴阳调和畅达。）第十二天，厥阴经的病势衰退，睾丸松弛，小腹轻微舒缓，大热之邪气都已去除，病快要好了。（“大气”指大热之邪气。到了十二天以后，邪气都去除了，病就好了。这就是所谓“痊愈都在十天以上”的原因。所谓“热虽甚不死”，也是指这种情况。）
黄帝说：怎么治疗呢？（这是因为上文提到有因误治而死的情况，所以询问治疗方法。）岐伯说：治疗时，要分别疏通各脏腑的经脉，病势就会一天天衰退痊愈。病程未满三天的，可以通过发汗治愈；病程已满三天的，可以通过泄热（攻下或清泄）治愈。（这是说治疗的方法。大致三天以前，邪气一定在体表，所以说可汗；三天以后，邪气多入里，所以说可泄。这正是为了分别疏通脏腑的经脉，从而衰退病热的势头。我认为《伤寒论》中的汗法和下法，不可拘泥于日数。王冰注说：日数虽然多，只要有表证，脉象大浮数，仍然适宜发汗；日数虽然少，只要有里证，脉象沉细数，就应当攻下。治疗伤寒的人，必须审辨脉证，才不会出错。这篇文中的日数，都不可以拘泥。）
黄帝说：热病已经痊愈，但时常有遗留症状的，是什么原因呢？（意思是热邪未尽去除，还有遗留于脏腑之间。）岐伯说：所有遗留症状，都是因为热势正盛时强行进食，所以有所遗留。像这种情况，都是病势已经衰退，但热邪有所潜藏。（潜藏的，就是所遗留的热邪。）因为食物谷气与体内余热相互搏结，两种热邪相合，所以产生遗留症状。（两种热，是指潜藏的热邪与新摄入的谷气之热相互侵迫，所以相交合。）
黄帝说：好。遗留症状怎么治疗？岐伯说：观察虚实，调理逆从。（逆，指正治，即用寒药治热病；从，指反治，即用热药治热病——此处语境下主要指根据病情顺逆调整治法，通常理解为辨证施治，顺其病势或逆其病势）。这样就可以使疾病必定痊愈。
黄帝说：患热病时应当禁忌什么？岐伯说：患热病稍有好转时，吃肉就会复发。（意思是热病复发如初。）多吃就会导致遗留。（意思是起初的热病不能完全去除，遗留的热邪较轻，而复发的热邪较重。）这就是禁忌所在。
黄帝说：两感于寒的病，其脉象应与病症表现如何？（脉应，指三阴三阳经脉的反应。）岐伯说：两感于寒的病，第一天，巨阳经与少阴经同时发病，则头痛（巨阳）、口干且烦闷（少阴）。按《伤寒论》说：口干、烦满且渴。第二天，阳明经与太阴经同时发病，则腹满（太阴）、身体发热（阳明）、不想吃东西（太阴）、胡言乱语（阳明）。第三天，少阳经与厥阴经同时发病，则耳聋（少阳）、睾丸收缩且四肢厥冷（厥阴）。水浆喝不进去，神志昏迷不知人，第六天死亡。（这就是阴阳经脉相应，表里同病的互现情况，如此这般。）
黄帝说：五脏已经受伤，六腑不通，营卫不行，在此之后，还要过三天才死，为什么呢？（这是承接上文，黄帝怀疑两感伤寒，不像单传的疾病那样，死亡一定要等到六七天之间。而岐伯说在第三天时，病患的脏腑营卫，亢盛的热邪已经极盛，此时应该立即死亡。如果在此之后，必又过三天才死，为什么呢？）岐伯说：阳明经是十二经脉之长，气血旺盛。所以神志昏迷不知人。经过三天，阳明经的气血耗尽，所以死亡。（阳明为十二经之长，上述各经的气血旺盛，则各经的病热也很严重。热势极盛，所以神志昏迷。在其初病三日之时，各经的邪热虽然严重，但阳明经的元气尚未耗尽，所以不立即死亡。又过三天，阳明经的元气耗尽，不能抵御各经的邪热，所以说“必然不免于死亡”。）
凡是患伤寒而转化为温病的，发生在夏至日之前的，称为温病；发生在夏至日之后的，称为暑病。暑病应当随着汗液一起排出，不要止汗。（凡是热病因季节变迁而变化，冬季为寒，春季为温，夏季为暑，秋季为疟，各自因时令之气所伤，分立病名。上面说患伤寒而转化为温病，是指热病发于冬季，则为伤寒；如发于夏至以前的春季，时令已温暖，故成为温病；如过了夏至以后，时令大热，故成为暑病。总之为温为暑，各有其时。暑病多汗，不要止汗，是指不可急于使用固表药来止汗，也不可反过来使用发表药来发散汗液，这是清暑解肌的方法。治疗暑病的方法另见于暑门，治疗温病的方法见后第十三卷论中。）
(From Chapter 31 of *Suwen*)
The chapter "Re Lun" (Discussion on Heat) in the *Neijing* is the root of Shanghan (Cold Damage). Zhang Zhongjing authored the *Shanghan Lun* (Treatise on Cold Damage), and its theory of Six Meridian transmission was deduced and expanded from the text of this chapter. Therefore, anyone treating Shanghan must first study the *Neijing Re Lun*, and then read Zhongjing's *Shanghan Lun*. In this way, one's learning will have a source and flow, and one's mind will have a master. Thus, disregarding my own limitations, I provide an explanation, hoping that those dedicated to this path will know their allegiance upon opening the scroll.
Huangdi asked: Now, all heat diseases belong to the category of Shanghan. (Shanghan originally belongs to heat diseases; other conditions such as Warmth and Summerheat are also heat diseases. As stated in the *Nanjing*, "Shanghan has five types," which indicates the intent of Huangdi's question here: since no heat disease is greater than Shanghan, all current heat diseases are considered categories of Shanghan. Wang Bing's commentary claims that warm-heat diseases arise from cold damage in winter, transforming around the time of Summer Solstice. Is it true that the root of these heat diseases lies dormant in the previous winter? Even if similar statements exist in the *Shanghan Lun*, they do not align with the purport of this scripture. Furthermore, considering Huangdi's phrasing at the time, why did he not say "transformed by Shanghan" or simply "caused by Shanghan," but rather "categories of Shanghan"? The purport should be understood according to my annotation. Ma Shi's commentary is also unclear, so it is not recorded here.) Some recover, some die. Those who die usually do so within six or seven days, while those who recover usually do so after ten days. Why is this? I do not understand the resolution; I wish to hear the reason.
Qibo replied: Juyang (i.e., Taiyang/Sunshine Meridian) is the leader of all Yang meridians. Its vessels connect to the Fengfu acupoint. (According to the *Tu Jing*, the Fengfu acupoint is located one cun inside the hairline at the vertex, within the depression of the large tendons. It is an acupoint on the Du Meridian and has no direct relation to the Taiyang Meridian. The scripture mentions it because the Taiyang Meridian runs alongside the Du Meridian.) Therefore, it governs the Qi of all Yang meridians. (Ma Shi commented: The Foot-Taiyang Bladder Meridian begins at the Jingming acupoint, connects upward to the Fengfu acupoint of the Du Meridian, and travels from the head and neck to the back and feet. All Yang meridians of the body and limbs belong to it, comprising 126 acupoints, truly governing the Qi of all Yang meridians.) When humans are injured by cold pathogens, they develop febrile diseases. Even if the heat is severe, death does not occur. (This sentence corresponds to "recoveries happen after ten days.") However, those suffering from Lianggan (Simultaneous Invasion) by cold will inevitably die. (This sentence corresponds to "deaths happen within six or seven days.")
Huangdi said: I wish to hear the manifestations. (This asks about the manifestations of heat caused by the transmission of Shanghan along the meridians.) Qibo said: On the first day of Shanghan, the Juyang meridian receives the pathogen. (The Shanghan pathogen transmits from the exterior to the interior. Taiyang is the most exterior layer, so when cold pathogens injure the exterior, Taiyang is affected first on the first day. The *Shanghan Lun* states: "When both Cun and Chi pulses are floating, Taiyang is diseased, manifesting on the first or second day." This shows that the onset of Shanghan cannot be rigidly bound to specific days. Note: Below this in the *Shanghan Lun* is the phrase "its vessels connect to Fengfu".) Therefore, headache, stiff neck, and rigidity of the waist and spine occur. (The Foot-Taiyang meridian enters the brain from the vertex, emerges to descend the nape, runs along the medial shoulder, and reaches the middle of the waist via the spine. Hence, symptoms of headache, stiff neck, and spinal rigidity appear. The scripture does not mention fever here because there is a stage in Taiyang disease before fever manifests.) On the second day, the Yangming meridian receives the pathogen. Yangming governs the flesh. (Yangming is the middle layer of the exterior; thus, if Taiyang pathogens remain unresolved, they transmit to Yangming on the second day. The *Shanghan Lun* states: "Yangming disease manifests on the second or third day." Subsequent meridians are described similarly.) Its vessels run alongside the nose and connect to the eyes. Therefore, body heat, eye pain, dry nose, and inability to lie down occur. (Body heat, eye pain, and dry nose indicate febrile disease. The pathways of the Six Meridians are detailed in the following diagram.) On the third day, the Shaoyang meridian receives the pathogen. Shaoyang governs the Gallbladder. (Shaoyang is the interior layer of the exterior; thus, its transmission follows subsequently.) Its vessels circulate along the flanks and connect to the ears. Therefore, hypochondriac pain and deafness occur. (Clearly, this is also a manifestation of febrile disease.) When the collaterals of the Three Yang meridians are all diseased, but the pathogen has not entered the Zang organs, it can be cured by sweating. (Note: The character "Zang" (Storehouse/Organ) is written as "Fu" (Cavity/Viscera) in the *Shanghan Lun*, which is excellent. Quan Yuanqi and Yang Shangshan later followed this. Li Dongyuan said: This "Zang" does not refer to the Five Zang organs, but to the concept of storing things; leaving it as "Zang" is also acceptable. Ma Shi commented: This refers to the subsequent Three Yin meridians, as Three Yin belong to the Five Zang, hence the term "Zang." This argument is flawed. Cheng Wuji's commentary on the *Shanghan Lun* states: Pathogens in the Three Yang meridians cause disease in the exterior, requiring sweat therapy. However, Three Yang pathogens can also enter the Fu organs; if they enter the Fu organs, purge therapy is indicated. Thus, "those not yet entering the Fu organs can be cured by sweating." 'Yi' means stop/end, indicating the decline of the febrile condition.) On the fourth day, the Taiyin meridian receives the pathogen. (Taiyin is the exterior layer of the interior. If sweat therapy was neglected and pathogens persist, they transmit from Shaoyang to Taiyin.) The Taiyin vessels distribute into the stomach and connect to the throat. Therefore, abdominal fullness and dry throat occur. (Cheng's commentary states: Spleen meridian stagnation generates heat.) On the fifth day, the Shaoyin meridian receives the pathogen. (Shaoyin is the middle layer of the interior.) The Shaoyin vessels penetrate the Kidneys, connect to the Lungs, and tie to the root of the tongue. Therefore, dry mouth, dry tongue, and thirst occur. (Cheng's commentary states: Pathogens transmitting to the interior cause heat to deepen.) On the sixth day, the Jueyin meridian receives the pathogen. (Jueyin is the interior layer of the interior.) The Jueyin vessels circulate along the genitalia and connect to the Liver. Therefore, vexation, fullness, and contraction of the scrotum occur. (The deeper the disease, the more extreme the heat. Who says Shanghan is a cold condition? Note: Below this in the *Shanghan Lun* are the three sentences: "If these three meridians are all diseased and have entered the Fu organs, they can be cured by purging." Cheng's commentary states: For Three Yin pathogens in the meridians, sweat therapy is still appropriate; thus, "those entering the Fu organs can be cured by purging.") If the Three Yin and Three Yang, and the Five Zang and Six Fu organs are all diseased, and Ying and Wei circulation stops, and the Five Zang qi mechanisms are blocked, death occurs. (At this time, Yin and Yang, and the Six Meridians are all diseased, and the Zang and Fu organs are deeply heated. Purge therapy should be used to drain heat. If sweat therapy was initially neglected, urgent combined sweat and purge therapy is needed to avoid death. If sweat is indicated but not given, or purge is indicated but not given, the pathogenic factors in the meridians remain unresolved, and the excess in the Stomach Fu is not removed. Consequently, the Yin and Yang of Ying and Wei cannot circulate, and the Qi and Blood of the Five Zang cannot flow unimpeded, leading inevitably to death. This is what is meant by "death occurs within six or seven days.")
Regarding those who did not suffer from Lianggan (Simultaneous Invasion): (This continues from above, referring to conditions transmitted sequentially along the meridians, which were not initially Lianggan. However, even if heat becomes extreme, slight negligence in treatment can lead to death. Here, we discuss cases without Lianggan and with milder heat.) On the seventh day, the Juyang disease declines, and headache slightly improves. (This refers to the initial pathogen affecting Juyang. If heat was mild, it did not transmit to other meridians; if heat was severe and transmitted, any remaining pathogen was still in Juyang. By the seventh day, compared to the onset, heat must decline, and symptoms like headache improve. Annotations for subsequent meridians follow this pattern.) On the eighth day, Yangming disease declines, and body heat slightly subsides. (The character "yi" (recover) is changed to "xie" (rest/subside) in the *Shanghan Lun*.) On the ninth day, Shaoyang disease declines, and deafness slightly improves (hearing returns slightly). On the tenth day, Taiyin disease declines, abdominal fullness reduces to normal, and appetite returns. On the eleventh day, Shaoyin disease declines, thirst ceases, abdominal fullness resolves, tongue dryness disappears, and sneezing occurs. (Shaoyin vessels connect to the Lungs; sneezing indicates lung heat is vented, and Yin and Yang are harmonious.) On the twelve days, Jueyin disease declines, the scrotum relaxes, lower abdominal tension subsides, and the great pathogenic heat dissipates. The illness is nearly resolved. ("Da Qi" refers to the great heat pathogen. After twelve days, it dissipates, and the illness ends. This explains "recovery happens after ten days." It also illustrates "even if heat is severe, death does not occur.")
Huangdi said: How should it be treated? (Asking for treatment methods due to deaths from mismanagement mentioned earlier.) Qibo said: Treatment requires differentiating and unblocking the vessels of each Zang organ. The disease will decline daily. If the duration is less than three days, it can be cured by sweating. If the duration is three days or more, it can be cured by draining (purging/clearing). (This describes treatment principles. Generally, before three days, pathogens are in the exterior, hence sweating; after three days, pathogens often enter the interior, hence draining. This unblocks the meridian vessels of the Zang and Fu, reducing the febrile condition. I note that sweat and purge therapies in the *Shanghan Lun* should not be rigidly bound to days. Wang Bing commented: Even if many days have passed, if exterior signs exist and the pulse is large, floating, and rapid, sweating is still appropriate. Even if few days have passed, if interior signs exist and the pulse is deep, fine, and rapid, purging is required. Practitioners must examine pulse and signs to avoid errors. The day counts in this chapter should not be rigidly applied.)
Huangdi said: After heat disease has healed, residual symptoms sometimes persist. What is the cause? (Meaning heat has not fully cleared, lingering in the Zang and Fu.) Qibo said: Residual symptoms occur because food is forced during peak heat. In such cases, the disease has declined, but heat remains hidden. (The hidden heat is the residual heat.) Because grain Qi clashes with internal heat, the two heats combine, causing residuals. (The "two heats" refer to the hidden heat and the heat from newly ingested grain Qi interacting.)
Huangdi said: Good. How to treat residuals? Qibo said: Observe deficiency and excess, regulate contrary and compliant approaches. (Contrary refers to standard treatment, using cold to treat heat; Compliant refers to reverse treatment, using heat to treat heat—here implying adjusting therapy based on syndrome differentiation.) This ensures recovery.
Huangdi said: What are the dietary prohibitions for heat disease? Qibo said: When heat disease slightly improves, eating meat causes recurrence (relapse). Eating too much causes residuals (lingering heat is mild, relapse is severe). These are the prohibitions.
Huangdi said: For Lianggan by cold, how do the pulses correspond to the disease manifestations? (Pulse correspondence refers to reactions of the Three Yin and Three Yang meridians.) Qibo said: In Lianggan by cold, on the first day, Juyang and Shaoyin are simultaneously diseased, causing headache (Juyang), dry mouth, and vexation/fullness (Shaoyin). (*Shanghan Lun* adds: thirst). On the second day, Yangming and Taiyin are simultaneously diseased, causing abdominal fullness (Taiyin), body heat (Yangming), anorexia (Taiyin), and delirious speech (Yangming). On the third day, Shaoyang and Jueyin are simultaneously diseased, causing deafness (Shaoyang), scrotal contraction, and cold extremities (Jueyin). Inability to take fluids and loss of consciousness lead to death on the sixth day. (This demonstrates the corresponding nature of Yin-Yang meridians and simultaneous exterior-interior disease.)
Huangdi said: The Five Zang are injured, Six Fu are blocked, Ying and Wei do not circulate. Why does death occur three days after this state? (Huangdi doubts that Lianggan Shanghan differs from single transmission, where death waits until six or seven days. Qibo states that by the third day, Zang, Fu, Ying, and Wei are at extreme hyperthermia, suggesting immediate death. Why wait another three days?) Qibo said: Yangming is the chief of the Twelve Meridians, possessing abundant Qi and Blood. Loss of consciousness occurs due to extreme heat. After three days, Yangming Qi exhausts, leading to death. (As the chief of Twelve Meridians, abundant Qi and Blood in Yangming mean severe heat in other meridians. Extreme heat causes unconsciousness. Initially, although heat is severe, Yangming's primal Qi remains, preventing immediate death. After three more days, Yangming's primal Qi exhausts, unable to withstand the pathogenic heat of other meridians, hence inevitable death.)
Any Shanghan transforming into Warmth: If occurring before Summer Solstice, it is Warm Disease; if after Summer Solstice, it is Summerheat Disease. Summerheat disease involves sweating; do not stop the sweat. (Heat diseases change with seasons: Winter-Cold, Spring-Warmth, Summer-Heat, Autumn-Malaria. Each is named based on seasonal Qi injury. "Shanghan transforming into Warmth" means heat disease originating in winter is Shanghan; if originating in spring before Summer Solstice, it becomes Warm Disease due to warming weather; if after Summer Solstice, it becomes Summerheat Disease due to intense heat. Both have seasonal timing. Summerheat causes profuse sweating; "do not stop sweat" means do not hastily use astringents to stop sweat, nor use diaphoretics to force sweat. This is the method of clearing Summerheat and resolving the muscle layer. Summerheat treatment is detailed in the Summerheat section; Warmth treatment is in Volume 13.)