病之体以阴阳。病之势以寒热。而寒热必有由。然阳虚则外寒。阴虚则内热。阳盛则外热。阴盛则内寒。原夫阳受
气于上焦以温分肉皮肤。寒威卒袭之。使上焦不通。斯内阳无所出而寒独留于外。此阳虚外寒也。劳倦形衰则伤肝气。
木郁而乘脾。致谷气不盛。谷气不盛。而上焦不行。下脘不通。则胃气热而留于胸中。是脾不行而内热也。此阴虚生内
热也。又情欲不节。五脏失守而伤精。精伤则水亏。此亦阴虚之内热也。阳盛外热者。寒邪既壅上焦。则肌表固闭。卫
气郁聚而为外热。以其能盛格寒而为外热也。阴盛内寒者。厥气上逆。寒留中焦。阳气乃去。其脉盛大以涩。寒邪壅中。
故脉盛大滞。而不行故涩。皆阴盛所致。故阴盛生内寒也。
寒伤形。热伤气。气伤痛。形伤肿。寒阴能伤血。故伤形。热阳能伤气。故伤气。气无形。故伤之而病痛。血有形。
故伤之而病肿。
寒极生热。热极生寒。寒气生浊。热气生清。寒气生浊阴。热气生清阳。此其正也。乃清阳在下。则生飧泄者。邪
热不杀谷。完谷而出。是为飧泄。浊气在上。则生 胀者。浊邪实于膻中。膻中不能化气。是谓腹胀。所谓阴阳反作者
也。
阴胜则寒。阳胜则热。重寒则热。重热则寒。阴阳以不相胜为和平。阴胜是水袭而火灭。阳胜是火灼而水干。寒极
则热。热极则寒。阴极则阳生。冬至是也。阳极则阴生。夏至是也。此可知其旨矣。
寒热相倾。有所以感之不同。有所以受之不同。则亦其所感所受之多少而分焉。有热而烦满者。以其人阴气少。阳
气胜。故阳邪实于阴分也。有寒从中生者。以其人正气素不行而多痹。是以阳气少。阴气多。营卫不能充达。故寒从中
生。所谓寒痹也。有四肢逢风寒而如炙如火者。其人阴气虚。阳气盛。四肢之阳与外相得。而少水不能灭盛火。故阳独
胜而止耳。是其如炙如火当肉烁也。更有奇者。前寒中为痹病矣。乃更有身寒。而汤火不能热。浓衣不能温。然不冻
者。以其人之素恃以水为事。使太阳气衰。肾脂枯涸不长骨髓。不充气。外内皆涸。故令寒。甚至骨。然肾家一水既竭。
肝心两火独存。是阴气已虚于内外。而浮阳独持于中。故虽寒而不冻 。是名骨痹。骨痹。当挛节也。生于病热而有所
痛者。则以阳明入阴也。病热者。阳脉人迎一盛少阳。二盛太阳。至三盛极于阳明矣。阳明盛极。必入于阴。夫阳入于
阴。则阴与阳俱盛。是以病在头与腹。乃腹胀而头痛也。
有气厥而脏腑寒热皆能相移者。人气和则阴阳和。阴阳和则气血不至淖与刚。至淖与刚。则阴阳不相入而相胜矣。
所谓回则不转而气皆厥也。故淖与淖。刚与刚遇必致相移。相移者相倾也。止一气厥而诸病生焉。故篇名气厥。其移者
如下文所云也。
肾移寒于脾。壅肿少气者。所谓淖与淖也。肾中内蕴真火。不惟能温寒水。而亦能为土母以使之化物。所谓命门真
火也。今止存寒水之气。反传所胜。侵汨脾土。是脾土亦久失温燥之气矣。故壅肿少气。盖寒盛则阳微无以化气也。
脾移寒于肝。壅肿筋挛。肝之木。温达而疏脾也。然木食米于土。亦赖中州之养。今中土寒胜。是土既失其震发。
而木乃无气以升。势必移寒于肝。土寒故壅肿。木废则筋寒。故为拘挛。
肝移寒于心。狂。隔中。心藏神。而其火受生于肝。是肝之藏荣。正心之为荣也。今乃受其寒逆。则荣与神俱失。
是以乱而为狂。且心主血脉为阴。抑而不行。则将壅于膻中。是为屯膏。故又隔中也。
心移寒于肺。肺消。肺消者。饮一溲二。死不治。肺主气。而通调水道。其能调之有制者。赖温气以行不也。故内
经曰。肺之合皮也。其主心也。岂非赖心时与以温气。而为之主以润燥金者耶。今心火不足。不惟不能温养肺金。而移
之以寒。寒与金化则金冷矣。金冷则气沉而不得升。下有沟渎而上无雨露。故饮一溲二也。肺气以下而枯索。是肺消。
死不治。夫心肺主膻中为君相之尊。神明之辅。今两寒失志。此岂特本原日竭。门户失守而已哉。肺移寒于肾。谓之涌
水。涌水者。水气客于大肠。如囊盛浆也。夫形寒饮冷。肺气不足则肺寒。母病传子。则寒可移于肾。肾为寒水。以寒
济寒。故水气不升而为涌。涌不于肾而客于大肠者大肠为肺之下流。归于腑也。如囊者裹而不能散也。
寒可移。热亦可移。所谓以刚乘刚。阳气散破也。故脾移热于肝。则为惊衄。脾移热于肝。为反传所胜。此土燥木
枯。热之甚也。肝不足。病主惊骇。今土燥移木。伤其藏血。故主惊又主衄也。
肝移热于心则死。肝藏血而以热。是肝枯不能贡荣于心也。今乃以风热相移。则心荣亦枯。而木火相燔。是肾水之
所不能救。而唯君火自焚而已。故死也。
心移热于肺。传为鬲消。肺本燥金。心复以热移之。是火燥相即也。因而鬲上焦烦。饮水多而善消也。上文肺消因
于寒。此言鬲消因于热。可见消有阴阳。不可不辨。
肺移热于肾。传为柔痉。肾主骨。为作强之官。肺以热移之。则必精铄而骨 。是精无裨也。故为柔 。
肾移热于脾。传为虚。肠 。死不可治。肾移热于脾者。阴火上炎也。邪热在下。真阴亏损。而上挟势热以扶脾。
是阴虚反克。水土俱败。故为肠 。若是者。其始传已虚。而又淫热伤脾。何不败之有。
胞移热于膀胱。则癃溺血。胞。子宫也。男为精海。女为血室。命门火盛。则胞宫移热于膀胱。故小便不利为癃。
甚则溺血。盖相火妄动。逆而不通。多患此也。
膀胱移热于小肠。鬲肠不便。上为口糜。膀胱之热不解。则移于小肠。小肠之经。循咽下鬲。故受热为鬲肠不便。
如是则否塞不通。壅遏于经。上侵咽颊。为口糜也。
小肠移热于大肠。为 瘕。为沉。小肠之热下行。则移于大肠。将下焦之滞热不散。必留郁于曲折之处。是为 瘕。
沉者。沉而在下也。
大肠移热于胃。喜食而瘦。又谓之食 。大肠移热于胃。燥热上行也。故善消谷。阳明主肌肉。今阳明燥热故瘦。
是谓食 。
胃移热于胆。亦曰食 。胆以少阳和气游行三焦。为胃腐熟水谷。乃阳明本经热甚。反移热于胆。此为木火合邪。
岂能生脾。故亦当食多而瘦。为食 也。
胆移热于脑。则辛额鼻渊。鼻渊者。浊涕下不止也。辛额者。下时额 。乃下也传为衄蔑瞑目。胆以其经上抵头角。
脑者。玄珠之府。肾之精也。少阳连肾。故其热随冲督。并其经以入脑。脑不胜。则辛额辣气先在额户。乃有浊涕注下。
或浊黄水者。皆鼻渊也。热而不止。则传为蔑衄瞑目矣。凡此以上寒热数条。皆得之气厥也。
凡阴阳之胜有见证。阳胜身热。腠理闭。喘粗。为之俯仰。汗不出而热。齿干以烦冤腹满死。阴胜身寒。汗出常清。
淅然厥。厥至腹满死。阳邪作实。内外皆邪。是为阴绝。故死。阴寒用事而至腹满。又为阴邪作实。内外皆阴。是为阳
绝。故死。盖诸证而至腹满。则阳明亦绝。无复能支矣。故皆死也。
诸病皆有顺逆。察病必先于此。不可不知也。岐伯曰。腹胀身热脉大。是一逆也。身热脉大。邪盛于外也。而加以
腹胀。是表里之邪充塞也矣。即上章所谓腹满死也。
腹鸣而满。四肢满泄。其脉大。是二逆也。腹鸣且满。四肢清兼泄。阴证备矣。脉不宜大而大者。格阳也。为二逆。
衄而不止。脉大。是三逆也。鼻衄在阴脉大为阳。阳实阴虚。是为三逆。
咳且溲血脱形。其脉小劲是四逆也。咳溲血脱形。正气已衰。脉劲急。邪气仍在。邪正不相当。是谓四逆。
咳脱形身热。脉小以疾。是五逆也。脱形身热。真阴已亏而火犹不清。其脉细小疾数。邪盛正衰之候也。为五逆。
其腹大胀。四末清脱泄甚。一逆也。腹大胀者。最忌中虚。见四肢清脱又泄甚。是脾元已败。阳气去也。此一逆。
腹胀便血。其脉大时绝。二逆也。胀与便血。阴病也。脉大时绝。孤阳将脱也。此二逆。
咳溲血形肉脱。脉搏。三逆也。咳而溲血。气血俱病。形肉脱败在脾。搏为真藏见。败在胃。此三逆。
呕血胸满引背。脉大而疾。四逆也。呕血胸满引背。藏气连于背也。脉见细小。尚留阴在。今大而疾。真元已亏矣。
咳呕腹胀且飧泄。其脉绝。是五逆也。如是者不及一时而死矣。上为呕逆。中为腹胀。下为飧泄。三焦俱病。而脉
至于绝者。有邪无正也。工不察此。是为逆治。
疾病的本质在于阴阳。疾病的表现趋势在于寒热。而寒热的产生必有其缘由。然而，阳气虚弱则体表发冷，阴液亏虚则体内发热，阳气亢盛则体表发热，阴气过盛则体内发冷。
起初，阳气从上焦受气以温煦肌肉和皮肤。如果寒邪突然侵袭，导致上焦不通畅，那么体内的阳气就无法向外发散，只有寒气独自停留在体表。这就是阳气虚弱导致的体表寒冷。
过度劳累和形体衰弱会损伤肝气。肝气郁结进而克制脾土，导致水谷精微之气不旺盛。水谷精微之气不旺盛，就会导致上焦之气不能下行，下脘（胃的下口）不通畅，于是胃气郁积化热而停留于胸中。这是脾气运行不畅导致的体内发热。这就是阴液亏虚产生的内热。
另外，如果情欲没有节制，导致五脏精气失守而损伤肾精。肾精受损则肾水亏虚，这也属于阴液亏虚导致的内热。
所谓阳气亢盛导致的体表发热，是因为寒邪壅滞在上焦，导致肌表毛孔闭塞，卫气郁结聚集从而产生体表发热。这是因为阳气被寒邪格拒于外而产生的发热。
所谓阴气过盛导致的体内寒冷，是因为厥逆之气向上冲逆，寒气留滞在中焦，阳气随之离去。此时脉象盛大而涩滞。寒气壅滞在中焦，所以脉象盛大且滞涩不行。这些都是由阴气过盛引起的，所以说阴气过盛会产生内寒。
寒邪伤害形体，热邪伤害气机。气受伤会导致疼痛，形受伤会导致肿胀。寒属阴，能伤害血分，所以伤害形体；热属阳，能伤害气分，所以伤害气机。气是无形的，所以受伤后表现为病痛；血是有形的，所以受伤后表现为肿胀。
寒极则生热，热极则生寒。寒气产生浊阴，热气产生清阳。寒气产生浊阴，热气产生清阳，这是正常的规律。但如果清阳之气在下焦，就会发生完谷不化的泄泻（飧泄），这是因为邪热不能腐熟水谷，食物原样排出，称为飧泄。如果浊气在上焦，就会发生腹胀，这是因为浊邪实于膻中，膻中不能化气，称为腹胀。这叫做阴阳反作。
阴气胜则寒，阳气胜则热。重寒则转化为热，重热则转化为寒。阴阳以互不相胜为和平状态。阴胜是水气侵袭而火气熄灭，阳胜是火气灼烧而水气干枯。寒极则热，热极则寒。阴极则阳生，冬至就是这种情况。阳极则阴生，夏至就是这种情况。由此可以明白其中的旨意。
寒热相争，感邪的原因不同，受邪的部位也不同，因此根据所感所受邪气的多少而有所区分。有的出现发热且烦闷，是因为其人阴气少，阳气胜，所以阳邪实于阴分。有的从体内产生寒冷，是因为其人正气素来运行不畅且多痹证，所以阳气少，阴气多，营卫之气不能充达周身，所以寒冷从内生，这叫做寒痹。有的四肢遇到风寒却感觉像被烧烤一样火热，是因为其人阴气虚，阳气盛，四肢的阳气与外邪相合，而少量的阴水不能扑灭旺盛的阳火，所以阳气独盛，这就导致肌肉消烁的感觉。
更奇特的是，前面已经因为寒邪中阻成为痹病，现在身体更加寒冷，用汤火不能温暖，穿厚衣也不能保暖，但并不觉得冻僵，是因为其人平素从事与水有关的工作，使太阳经气衰败，肾脂枯竭不长骨髓，不能充气，内外都干枯，所以感到寒冷，甚至深入骨骼。然而肾家的一水既已枯竭，肝心两火独存，这是阴气在内外都已亏虚，而浮越的阳气独持于中，所以虽然寒冷但不冻僵，这名叫骨痹。骨痹应当伴有关节拘挛。
生于病热且有疼痛的，是因为阳明经入于阴分。患热病时，阳脉人迎脉一盛对应少阳，二盛对应太阳，至三盛则极于阳明。阳明盛极，必然入于阴分。阳入于阴，则阴与阳俱盛，所以病在头部和腹部，出现腹胀和头痛。
有气机厥逆而导致脏腑寒热相互转移的情况。人气调和则阴阳调和，阴阳调和则气血不会过于柔润或刚强。一旦气血变得过于柔润或刚强，阴阳就不能相互交融而互相克胜了。所谓“回则不转”而气皆厥逆。所以柔润之气与柔润之气相遇，刚强之气与刚强之气相遇，必定导致相互转移。相互转移就是相互倾轧。只要一气厥逆，各种病症就产生了，所以篇章名为《气厥》。其转移情况如下文所述：
肾将寒邪移于脾，出现壅肿、少气，这叫“淖与淖”。肾中蕴藏真火，不仅能温煦寒水，也能作为脾土的母脏使其运化水谷，这叫命门真火。现在只剩下寒水之气，反而传其所胜之脏，侵扰脾土，这样脾土也长久失去了温燥之气。所以出现壅肿和少气，大概是因为寒盛则阳微，无法化生气机。
脾将寒邪移于肝，出现壅肿、筋脉拘挛。肝属木，性温达而疏泄脾土。但木食米于土，也依赖中焦脾胃的滋养。现在中焦土气寒盛，土既失去了震动生发之气，木也就没有气机上升，势必寒邪移于肝。土寒故壅肿，木废则筋寒，所以出现拘挛。
肝将寒邪移于心，出现狂乱、膈中阻塞。心藏神，其火受生于肝，肝所藏的荣血正是心所主的荣血。现在受到肝的寒逆，则荣血与心神都失去濡养，所以紊乱而为狂乱。而且心主血脉属阴，被抑制而不行，则将壅滞于膻中，这叫屯膏（油脂积聚），所以又出现膈中阻塞。
心将寒邪移于肺，出现肺消。肺消的症状是喝一斤水，小便二斤，死不治。肺主气，通调水道，能调节水液有节制，依赖于温气的运行。所以《内经》说：“肺之合皮也，其主心也。”难道不是依赖心时常给予温气，来主宰并滋润燥金吗？现在心火不足，不仅不能温养肺金，反而将寒邪移之于肺。寒与金化则金冷，金冷则气沉而不能升，下有沟渎而上无雨露，所以出现喝一溲二的症状。肺气以下行而枯索，这就是肺消，死不治。心肺主宰膻中，为君相之尊，神明之辅。现在两脏皆寒失志，这岂止是本源日渐枯竭，门户失守而已呢？
肺将寒邪移于肾，叫涌水。涌水的症状是水气客居于大肠，像囊袋盛浆一样。形体受寒、饮食生冷，肺气不足则肺寒，母病传子，寒可移于肾。肾为寒水，以寒济寒，所以水气不升而为涌。水气不在肾而在大肠停留，是因为大肠为肺之下流，归于腑。像囊袋一样包裹而不能散开。
寒邪可以转移，热邪也可以转移，这叫“以刚乘刚”，阳气散破。所以脾将热邪移于肝，则出现惊骇、鼻衄。脾移热于肝，为反传所胜，这是土燥木枯，热势很甚。肝不足，病主惊骇。现在土燥移热于木，损伤其藏血功能，所以主惊骇又主鼻衄。
肝将热邪移于心则死。肝藏血而受热，则肝枯不能贡奉荣血于心。现在风热相移，则心之荣血也枯，木火相燔，这是肾水所不能救，而唯有心火自焚罢了，所以死。
心将热邪移于肺，传变为膈消。肺本为燥金，心复以热邪移之，是火燥相即。因而膈上焦烦，饮水多而善消。上文肺消因于寒，此言膈消因于热，可见消渴有阴阳之分，不可不辨。
肺将热邪移于肾，传变为柔痉。肾主骨，为作强之官。肺以热邪移之，则必精液销铄而骨枯，是精无裨益。所以为柔痉。
肾将热邪移于脾，传变为虚劳、肠澼，死不可治。肾移热于脾者，是阴火上炎。邪热在下，真阴亏损，而上挟势热以扶脾，是阴虚反克，水土俱败，所以为肠澼。若是这样，其始传已虚，而又淫热伤脾，何有不败的道理。
胞宫将热邪移于膀胱，则出现癃闭、溺血。胞，指子宫。男为精海，女为血室。命门火盛，则胞宫移热于膀胱，所以小便不利为癃，甚则溺血。大概是因为相火妄动，逆而不通，多患此病。
膀胱将热邪移于小肠，出现膈肠不便，上行则为口糜。膀胱之热不解，则移于小肠。小肠之经脉，循咽下膈，所以受热为膈肠不便。如是则否塞不通，壅遏于经，上侵咽颊，形成口糜。
小肠将热邪移于大肠，形成瘕积、沉疝。小肠之热下行，则移于大肠，将下焦之滞热不散，必留郁于曲折之处，是为瘕积。沉者，沉而在下也。
大肠将热邪移于胃，出现食欲旺盛但身体消瘦，又叫食痃。大肠移热于胃，是燥热上行。所以善消谷。阳明主肌肉，现在阳明燥热，所以消瘦，这叫食痃。
胃将热邪移于胆，也叫食痃。胆以少阳和气游行三焦，协助胃腐熟水谷。现在是阳明本经热甚，反移热于胆，此为木火合邪，岂能生脾？所以也应当吃得多而瘦，为食痃。
胆将热邪移于脑，出现额痛、鼻渊。鼻渊是指浊涕下不止。辛额是指额头刺痛，乃向下传导为衄血、目盲。胆以其经脉上抵头角。脑者，玄珠之府，肾之精也。少阳连肾，所以其热随冲督二脉，并入其经以入脑。脑不胜热，则额部刺痛，辣气先在额户，于是有浊涕注下，或浊黄水者，都是鼻渊。热而不止，则传为衄血、目盲。凡此以上寒热数条，皆得之于气厥。
凡是阴阳偏胜都有见证。阳胜则身热，腠理闭塞，喘促粗气，为之俯仰困难，汗不出而热，牙齿干燥且烦冤腹满而死。阴胜则身寒，汗出常清，淅然恶寒厥逆，厥逆至腹满而死。阳邪作实，内外皆邪，这叫阴绝，所以死。阴寒用事而至腹满，又为阴邪作实，内外皆阴，这叫阳绝，所以死。大概诸证而至腹满，则阳明亦绝，无复能支矣，所以皆死。
各种病症都有顺逆，察病必先于此，不可不知。岐伯说：腹胀、身热、脉大，是一逆。身热脉大，是邪盛于外。而加以腹胀，是表里之邪充塞，即上章所谓腹满死。
腹鸣而满，四肢满且泄，其脉大，是二逆。腹鸣且满，四肢清冷兼泄，阴证备矣。脉不宜大而大者，是格阳，为二逆。
鼻衄不止，脉大，是三逆。鼻衄在阴脉大为阳，阳实阴虚，是为三逆。
咳嗽且尿血，形体脱失，其脉小劲，是四逆。咳溲血脱形，正气已衰，脉劲急，邪气仍在，邪正不相当，是谓四逆。
咳嗽、形体脱失、身热，脉小以疾，是五逆。脱形身热，真阴已亏而火犹不清，其脉细小疾数，是邪盛正衰之候，为五逆。
其腹大胀，四肢清冷，脱泄严重，是一逆。腹大胀者，最忌中虚，见四肢清冷脱泄又泄甚，是脾元已败，阳气去也，此一逆。
腹胀便血，其脉大时绝，二逆。胀与便血，阴病也。脉大时绝，孤阳将脱也，此二逆。
咳嗽、尿血、形肉脱，脉搏坚搏，三逆。咳而溲血，气血俱病，形肉脱败在脾，搏为真脏见，败在胃，此三逆。
呕血、胸满引背，脉大而疾，四逆。呕血胸满引背，藏气连于背也。脉见细小，尚留阴在，今大而疾，真元已亏矣。
咳嗽、呕吐、腹胀且飧泄，其脉绝，是五逆。如是者不及一时而死矣。上为呕逆，中为腹胀，下为飧泄，三焦俱病，而脉至于绝者，有邪无正也。工不察此，是为逆治。
The essence of disease lies in Yin and Yang. The trend of disease manifestation lies in Cold and Heat. However, the generation of Cold and Heat must have its causes. When Yang is deficient, there is external Cold; when Yin is deficient, there is internal Heat; when Yang is excessive, there is external Heat; when Yin is excessive, there is internal Cold.
Initially, Qi receives Qi from the Upper Jiao (Upper Burner) to warm the muscles and skin. If pathogenic Cold suddenly attacks, causing the Upper Jiao to be obstructed, then the internal Yang cannot exit, leaving only Cold stagnating externally. This is External Cold due to Yang deficiency.
Excessive labor and physical decline damage Liver Qi. Liver Qi stagnation overacts on Spleen Earth, leading to insufficient Qi from grain and water (Gu Qi). Insufficient Gu Qi causes the Qi of the Upper Jiao to fail to descend, and the Lower Wan (lower opening of the stomach) becomes obstructed. Consequently, Stomach Qi stagnates and transforms into Heat, remaining in the chest. This is Internal Heat caused by impaired Spleen function. This is Internal Heat generated by Yin deficiency.
Furthermore, if desires are not regulated, the Five Zang organs lose their retention, damaging Jing (Essence). Damage to Jing leads to a deficiency of Water (Kidney Yin), which also constitutes Internal Heat due to Yin deficiency.
Regarding External Heat due to Yang excess: when pathogenic Cold obstructs the Upper Jiao, the muscle surface and pores become tightly closed. Wei Qi (Defensive Qi) stagnates and accumulates, generating external Heat. This occurs because Yang is blocked by Cold and forced outward, creating external Heat.
Regarding Internal Cold due to Yin excess: Jue Qi (Rebellious Qi) moves upward, and Cold remains in the Middle Jiao, causing Yang to depart. The pulse is large and choppy. Cold obstructs the Middle Jiao, hence the pulse is large and sluggish/choppy due to lack of flow. All these are caused by Yin excess; thus, Yin excess generates Internal Cold.
Cold damages the Form (Xing), while Heat damages Qi. Damage to Qi causes pain; damage to Form causes swelling. Cold, being Yin, can damage Blood; thus, it damages the Form. Heat, being Yang, can damage Qi; thus, it damages Qi. Qi is formless; therefore, when damaged, it manifests as pain. Blood has form; therefore, when damaged, it manifests as swelling.
Extreme Cold generates Heat; extreme Heat generates Cold. Cold Qi generates Turbid Yin; Hot Qi generates Clear Yang. Cold generates Turbid Yin, and Heat generates Clear Yang; this is the normal state. However, if Clear Yang is located below, it causes Sundun Diarrhea (incomplete digestion diarrhea), because pathogenic Heat fails to digest food, resulting in undigested stool exiting whole. If Turbid Qi is located above, it causes abdominal distension, because Turbid Pathogen fills the Danzhong (Chest/Middle), and Danzhong fails to transform Qi, termed abdominal distension. This is called "Yin and Yang acting in reverse."
When Yin prevails, there is Cold; when Yang prevails, there is Heat. Extreme Cold transforms into Heat; extreme Heat transforms into Cold. Peace exists when Yin and Yang do not overpower each other. Yin prevailing is like Water invading and extinguishing Fire; Yang prevailing is like Fire scorching and drying up Water. Extreme Cold leads to Heat; extreme Heat leads to Cold. At the extreme of Yin, Yang is born (Winter Solstice); at the extreme of Yang, Yin is born (Summer Solstice). From this, one can understand the principle.
Cold and Heat contend, with different causes of contraction and different sites of reception. Thus, they are distinguished by the quantity of pathogen contracted and received. Some present with Heat and vexation/fullness because their Yin Qi is scant and Yang Qi is abundant, so Yang Pathogen fills the Yin aspect. Some generate Cold from within because their Zheng Qi (Upright Qi) has always been stagnant with many Bi syndromes, meaning Yang Qi is scarce and Yin Qi is abundant, preventing Ying (Nutritive) and Wei Qi from reaching the periphery, so Cold generates internally, known as Cold Bi. Some experience limbs feeling like roasting or burning upon exposure to Wind-Cold because their Yin Qi is deficient and Yang Qi is abundant. The Yang of the limbs combines with external factors, but little Water cannot extinguish the blazing Fire, so Yang alone prevails, causing the flesh to seem scorched.
More remarkably, although Cold obstruction previously caused Bi disease, now the body feels even colder, unable to be warmed by hot water or fire or thick clothing, yet without freezing stiff. This is because the person historically engaged in work involving water, causing Taiyang Qi to decline, Kidney Marrow Essence to dry up and fail to nourish bone marrow, failing to fill Qi. Both interior and exterior are dried out, causing cold penetrating to the bones. However, since the single Water of the Kidney is exhausted, the Fire of Liver and Heart stands alone. Yin is deficient inside and out, while floating Yang holds sway internally. Thus, although cold, it does not freeze stiff; this is named Bone Bi. Bone Bi should involve joint contracture.
Those suffering from Heat diseases with pain occur because the Yangming channel enters Yin. In Heat diseases, if the Renying pulse (Yangming artery) is one-fold stronger, it corresponds to Shaoyang; two-fold stronger, to Taiyang; three-fold stronger, it reaches extremity in Yangming. When Yangming is extremely excessive, it must enter Yin. When Yang enters Yin, both Yin and Yang become excessive, resulting in disease in the head and abdomen, manifesting as abdominal distension and headache.
There are cases where Qi rebellion causes Cold and Heat among Zang-Fu organs to shift into one another. When human Qi is harmonious, Yin and Yang are harmonious; when Yin and Yang are harmonious, Qi and Blood do not become overly fluid or rigid. Once Qi and Blood become overly fluid or rigid, Yin and Yang cannot interpenetrate and instead overcome each other. This is referred to as "returning without turning," where all Qi rebels. Thus, fluid meets fluid, and rigid meets rigid, inevitably causing mutual shifting. Shifting implies overcoming. A single Qi rebellion gives rise to various diseases; hence the chapter is titled "Qi Rebellion." The shifts are described below:
Kidney transfers Cold to Spleen, causing edema and shortness of breath. This is "Fluid meeting Fluid." The Kidney harbors True Fire, which not only warms Cold Water but also acts as the Mother of Earth to facilitate transformation. This is the True Fire of the Mingmen (Gate of Life). Now, only Cold Water Qi remains, which counter-transfers to overcome the next element, invading Spleen Earth. Thus, Spleen Earth loses its warming and drying Qi for a long time. Hence, edema and shortness of breath occur, likely because extreme Cold makes Yang微弱 (weak), unable to transform Qi.
Spleen transfers Cold to Liver, causing edema and tendon cramping. Liver Wood is warm and spreading, aiding Spleen dispersal. However, Wood feeds on Grain from Earth and relies on the Middle Jiao's nourishment. Now, Middle Earth is dominated by Cold. Since Earth loses its vibratory generation, Wood lacks Qi to ascend, inevitably transferring Cold to the Liver. Earth Cold causes edema; Wood failure causes Tendon Cold, leading to contracture.
Liver transfers Cold to Heart, causing mania and chest obstruction. The Heart houses the Shen (Spirit), and its Fire is born from the Liver. The Ying Blood stored in the Liver is precisely the Ying Blood governed by the Heart. Now receiving Liver's Cold rebellion, both Ying and Shen lose support, becoming disordered and manic. Moreover, the Heart governs Blood vessels (Yin); suppressed and stagnant, it blocks in the Danzhong, termed Tun Gao (accumulated fat/oil), causing chest obstruction.
Heart transfers Cold to Lung, causing Lung Xiao (Wasting-Thirst). Lung Xiao involves drinking one unit and urinating two units, a fatal untreatable condition. The Lung governs Qi and regulates water passages. Its ability to regulate water with restraint depends on Warm Qi for movement. Thus, *Neijing* states: "The Lung's association is with the skin; its master is the Heart." Does this not rely on the Heart constantly providing Warm Qi to dominate and moisten the Dry Metal? Now, Heart Fire is insufficient, failing not only to warm/nourish Lung Metal but transferring Cold to it. Cold combining with Metal makes Metal cold. Cold Metal causes Qi to sink and fail to rise. With ditches below but no rain above, drinking one results in urinating two. Lung Qi descends and withers; this is Lung Xiao, fatal and untreatable. The Heart and Lung dominate the Danzhong, serving as the dignitaries of Sovereign and Minister, assisting spirit and enlightenment. Now both are cold and lose their will. Is this merely the daily exhaustion of the root and loss of gatekeeping?
Lung transfers Cold to Kidney, called Yong Shui (Surging Water). Yong Shui means Water Qi lodges in the Large Intestine, like a bag holding liquid. Physical cold and cold drinks cause Lung Qi insufficiency and Lung Cold. Mother disease transmitting to Child allows Cold to transfer to the Kidney. The Kidney is Cold Water; Cold supplementing Cold causes Water Qi to fail to rise, becoming Surging. Water surges not in the Kidney but lodges in the Large Intestine because the Large Intestine is the lower stream of the Lung, returning to the Fu organs. Like a bag, it wraps but cannot disperse.
Cold can transfer; Heat can also transfer, termed "Rigid overcoming Rigid," causing Yang Qi to scatter and break. Thus, Spleen transfers Heat to Liver, causing fright and epistaxis. Spleen transferring Heat to Liver is counter-transferring to overcome, representing Dry Earth and Withered Wood, extreme Heat. Liver deficiency primarily causes fright/terror. Now Dry Earth transfers Heat to Wood, damaging its blood-storing function, causing fright and epistaxis.
Liver transferring Heat to Heart is fatal. The Liver stores Blood; heated, the Liver withers and cannot offer Ying to the Heart. Now Wind-Heat transfers, causing Heart Ying to wither. Wood and Fire burn together; Kidney Water cannot save it, and only the Sovereign Fire burns itself. Hence, death.
Heart transferring Heat to Lung transmits to Ge Xiao (Diaphragm Thirst). The Lung is originally Dry Metal; Heart transfers Heat to it, creating Fire-Dryness combination. This causes vexation in the upper diaphragm/jiao, excessive thirst, and rapid consumption. The previous Lung Xiao was due to Cold; this Ge Xiao is due to Heat. Thus, Xiao (Thirst/Wasting) has Yin and Yang aspects and must be distinguished.
Lung transferring Heat to Kidney transmits to Rou Jing (Soft Spasm). The Kidney governs bones and is the official of strength. Lung transferring Heat causes Essence to evaporate and bones to wither; Essence provides no benefit. Hence, Rou Jing.
Kidney transferring Heat to Spleen transmits to Xu Lao (Deficiency Consumption) and Chang Pi (Dysentery/Bloody Stool), fatal and untreatable. Kidney transferring Heat to Spleen is Yin Fire flaming upward. Pathogenic Heat is below, True Yin is depleted, and it carries Heat upward to assist Spleen. This is Yin deficiency counter-overacting, causing both Water and Earth to fail. Hence, Chang Pi. If such, initially transferred deficiency is compounded by excessive Heat injuring Spleen; how could it not fail?
Bao Gong (Uterus/Bladder area) transferring Heat to Bladder causes Long (Strangury/Difficult Urination) and Hematuria. Bao refers to the Uterus. In men, it is the Sea of Essence; in women, the Chamber of Blood. Mingmen Fire excess causes Bao Gong to transfer Heat to the Bladder, causing difficult urination (Long), and severely, hematuria. Generally,妄动 (reckless movement) of Minister Fire, rebellious and obstructed, often suffers this.
Bladder transferring Heat to Small Intestine causes Ge Chang (Diaphragmatic Intestinal Obstruction) and oral ulcers (Kou Mi). Unresolved Bladder Heat transfers to the Small Intestine. The Small Intestine meridian follows the throat down through the diaphragm. Receiving Heat causes Ge Chang obstruction. Thus, blockage prevents flow, stagnating in the meridian, invading the throat and cheeks, forming oral ulcers.
Small Intestine transferring Heat to Large Intestine forms Jia Masses and Chen Hernias. Small Intestine Heat moving downward transfers to the Large Intestine. Lower Jiao stagnant Heat fails to dissipate, lingering in convoluted areas, forming Jia masses. Chen refers to sinking below.
Large Intestine transferring Heat to Stomach causes increased appetite but emaciation, also called Shi Xuan. Large Intestine transferring Heat to Stomach is Dry-Heat moving upward. Hence, efficient digestion of grains. Yangming governs muscles; now Yangming Dry-Heat causes emaciation, termed Shi Xuan.
Stomach transferring Heat to Gallbladder is also called Shi Xuan. The Gallbladder uses Shaoyang Harmonious Qi to circulate through the San Jiao, assisting the Stomach in rotting and ripening food. Now Yangming Meridian Heat is severe, transferring Heat to the Gallbladder. This is Wood-Fire combined Pathogen, unable to generate Spleen. Hence, eating much but losing weight, termed Shi Xuan.
Gallbladder transferring Heat to Brain causes Xin E (numb/painful forehead) and Bi Yuan (Nasal Sinusitis/Oozing Nose). Bi Yuan is continuous discharge of turbid mucus. Xin E is stabbing pain in the forehead, transmitting downward to Ni Mie (epistaxis/blindness). The Gallbladder meridian ascends to the head corners. The Brain is the Mansion of the Mysterious Pearl, the Essence of the Kidney. Shaoyling connects to the Kidney; thus, its Heat follows the Chong and Du meridians, entering the Brain along its channels. The Brain cannot withstand Heat, causing numb/stabbing forehead pain.辣气 (pungent Qi) first appears at the forehead gate, leading to turbid mucus discharge or yellow turbid water, all Bi Yuan. If Heat persists, it transmits to epistaxis and blindness. All the aforementioned Cold and Heat items result from Qi Rebellion.
Whenever Yin or Yang prevails, there are manifestations. Yang prevalence causes body heat, closed pores, coarse breathing, difficulty bending/straightening, anhidrosis with heat, dry teeth, vexation, abdominal fullness leading to death. Yin prevalence causes body cold, sweating clear fluid, shivering chills and cold limbs, cold limbs extending to abdominal fullness leading to death. Yang Pathogen becoming Excess, with pathogens inside and out, is Yin Absolute (Yin Jue), hence death. Yin Cold taking charge leading to abdominal fullness, with Yin Pathogen becoming Excess, Yin inside and out, is Yang Absolute (Yang Jue), hence death. Generally, when symptoms reach abdominal fullness, Yangming also fails, unable to sustain, hence death.
All diseases have Shun (Smooth/Favorable) and Ni (Reverse/Unfavorable) patterns. Examining disease must start here; one must know this. Qibo said: Abdominal distension, body heat, and large pulse constitute the First Reverse. Body heat and large pulse indicate Pathogen excess externally. Adding abdominal fullness means Pathogen fills interior and exterior, i.e., the abdominal fullness death mentioned earlier.
Abdominal borborygmus and fullness, limb fullness and diarrhea, with a large pulse constitute the Second Reverse. Borborygmus and fullness, cold limbs with diarrhea, complete Yin syndrome. A large pulse is inappropriate; a large pulse indicates Ge Yang (Repelling Yang), constituting the Second Reverse.
Epistaxis unceasing with a large pulse constitutes the Third Reverse. Epistaxis with a large pulse in Yin vessels indicates Yang. Yang Excess and Yin Deficiency constitute the Third Reverse.
Cough with hematuria, emaciation, and small/tense pulse constitute the Fourth Reverse. Cough, hematuria, and emaciation indicate declining Zheng Qi. Tense pulse indicates Pathogen remains. Pathogen and Zheng Qi are mismatched, termed Fourth Reverse.
Cough, emaciation, body heat, and small/fast pulse constitute the Fifth Reverse. Emaciation and body heat indicate True Yin depletion and lingering Fire. Small, fine, fast pulse indicates Pathogen Excess and Zheng Qi Decline, constituting the Fifth Reverse.
Abdominal distension, cold extremities, severe diarrhea constitute the First Reverse. Abdominal distension fears Middle Deficiency most. Seeing cold extremities and severe diarrhea indicates Spleen Yuan failure and Yang departure, constituting the First Reverse.
Abdominal distension with bloody stool, pulse large and intermittent constitutes the Second Reverse. Distension and bloody stool are Yin diseases. Large, intermittent pulse indicates solitary Yang about to detach, constituting the Second Reverse.
Cough, hematuria, emaciation, and pounding pulse constitute the Third Reverse. Cough and hematuria indicate Qi and Blood disease. Emaciation indicates Spleen failure. Pounding pulse indicates True Zang appearance, indicating Stomach failure, constituting the Third Reverse.
Hematemesis, chest fullness radiating to back, large/fast pulse constitute the Fourth Reverse. Hematemesis and chest fullness radiating to back indicate Zang Qi connecting to the back. Fine/small pulse retains Yin; large/fast pulse indicates True Yuan depletion.
Cough, vomiting, abdominal distension, and Sundun Diarrhea with absent pulse constitute the Fifth Reverse. Such patients die within an hour. Upper: vomiting/reversal; Middle: abdominal distension; Lower: Sundun Diarrhea. San Jiao is diseased, and pulse is absent, indicating Pathogen without Zheng Qi. Physicians failing to observe this practice Reverse Treatment.