五钱，桂心一钱，名驱湿保脱汤。连服十剂，可免脚趾脱落。此即谚所谓脱脚伤寒也，亦不可不知。若饮冷虽
多，而汗出亦多，必无后患。
诒按∶治热以寒，一定之理。今人于温病初发，见用凉解，而即言其遏邪者，彼固未明此理也。
太阳之脉，色荣颧骨，热病也。荣未交，曰今且得汗，待时而已。与厥阴脉争见者，死期不过三日，其热
病内连肾。
章虚谷曰∶此言外感与伏邪互病之证也，与热病篇之两感，同中有异。彼则内外同时受邪，内外俱病，故
不免于死。此则外感先发，伏邪后发者可生。若同发，则死期不过三日也。云太阳之脉者，谓邪受于太阳经脉
，即一日巨阳受之，头项痛，腰脊强者是也。色荣颧骨者，谓鲜荣之赤色，见于颧也。盖颧者骨之本，骨者肾
所主，肾脏之伏邪已动，故赤色循荣血而见于颧也。荣未交，今且得汗，待时而已者，太阳与少阴为表里，太
阳经脉外受之邪，与少阴营中伏热之邪，尚未相交，且使得汗，先解外邪，所谓未满三日可汗之是也。其内伏
之邪后发，待脏气旺时可已，如肾热病，待壬癸日得大汗而已也。又如所云见赤色者刺之，名治未病亦可也
。倘与厥阴经脉病证争见，则肾肝皆有邪热内发，其势必与太阳外邪连合而不可解，故比之两感病，死期更速
也。盖两感病起于经，必待胃气尽，六日方死。此则热邪内连肾脏，本元既绝，故死期不过三日也。
少阳之脉，色荣颊前，热病也。荣未交，曰今且得汗，待时而已。与少阴脉争见者，死期不过三日。
章虚谷曰∶上言肝热病者，左颊先赤。肝为厥阴，胆为少阳，相表里者也。外邪受于少阳经脉，而肝脏伏
热之色荣于颊前。若外内之邪尚未相交，今且使其得汗以解外邪。其内发之热，可待脏气旺时而已。若与少阴
经脉病证争见，则肝连肾热，而内外邪势必交合难解；死期不过三日也。大抵外内之邪，发有先后而不交合，
尚可解救，故要紧在荣未交一句。下文病名阴阳交，亦即荣已交之义也。经文只举太阳、少阳两证，不及阳明
太阴合病者，以阳明之腑，可用攻泻之法，不至必死。非同太阳少阴，少阳厥阴，其邪温合而无出路，则必死
也。
评热病篇云∶帝曰∶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？岐伯曰∶病
名阴阳交，交者死也。
章虚谷曰∶阴阳之气，本相交合。今则邪势弥漫，外感阳分之邪，与内发阴分之热，混合不分，而本元正
气绝矣，故曰交者死，非阴阳正气之相交也。下衣冠文物其所以然之理。
人所以出汗者，皆生于谷，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。
章虚谷曰∶汗生于谷，谷生于精者，谓由本元精气，化水谷以生津液，发而为汗。邪随汗泄，则邪却而精
胜也。今汗出复热而不能食，是邪胜而津无所借也。其病仍留连不去，则其寿可立待而倾矣。狂言失志一也，
汗出复热二也，脉与汗不应三也。见三死证，而不见一生证，虽似愈，必死也。
素问阳明脉解篇曰∶足阳明之脉病，恶人与火，闻木音则惕然而惊，钟鼓不为动。闻木音而惊，何也？岐
伯曰∶阳明者胃脉也，胃者土也。故闻木音而惊者。土恶木也。帝曰∶善！其恶火何也？岐伯曰∶阳明主
肉，其脉血气盛，邪客之则热，热甚则恶火。帝曰∶其恶人何也？岐伯曰∶阳明厥则喘而惋，惋则恶人。帝曰
∶或喘而死者，或喘而生者，何也？岐伯曰∶厥逆连脏则死，连经则生。
章虚谷曰∶土畏木克，故闻木音则惊也。热甚则恶火，仲景所谓不恶寒反恶热也。邪结于胃而气厥逆，则
喘而惋，惋者懊 而不欲见人也。邪热内结，则气阻而喘。不能循经外达，则四肢厥逆，盖四肢禀气于脾胃也
。邪内入则连脏故死，外出则连经故生。
帝曰∶病甚则弃衣而走，登高而歌，或至不食数日，逾垣上屋，所上之处，皆非其素所能也，病反能者何
也？岐伯曰∶四肢者，诸阳之本也，阳盛则四肢实，实则能登高也。帝曰∶其弃衣而走者何也？岐伯曰∶热盛
于身，故弃衣欲走也。帝曰∶其妄言骂詈，不避亲疏而歌者，何也？岐伯曰∶阳盛则使人妄言骂詈，不避亲疏
，而不欲食，不欲食，故妄走也。
章虚谷曰∶四肢禀气于脾胃，胃为脏腑之海，而阳明行气于三阳，故四肢为诸阳之本也。邪盛于胃，气实
于四肢，则能登高也。热盛于身，故弃衣欲走也。邪乱神明，故妄言骂詈。胃中邪实，不欲饮食。四肢多力，
则妄走也。此大承气之证。其邪连经，脉必滑大，下之可生。其邪连脏，脉必沉细。仲景云∶阳病见阴脉者死
。则虽有下证，不可用下法矣。
王梦隐曰∶温病误投热药补剂，亦有此候。经证亦有可用白虎汤者。沉细之脉，亦有因热邪闭塞使然，形
证果实，下之
可生，未可概以阴脉而断其必死也。凡热邪壅遏，脉多细 迟涩，按证清解，自形滑数。不比内伤病服凉药而
脉加数者，为虚也。
热论篇曰∶帝曰∶热病已愈，时有所遗者，何也？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，因其谷气相搏、两热相合，故有所遗也。帝曰∶善！治遗奈何？岐伯曰∶视其虚实，
调其逆从，可使必已矣。帝曰∶病热当何禁之？岐伯曰∶病热少愈，食肉则复，多食则遗，此其禁也。
诒按∶此言热邪初愈，余热留而未净，得谷食助气，则两热相合而复炽。观其食肉则复，多食则遗，故病
后必须谨调口腹，只可以清淡稀粥，渐为调养也。
素问玉版论要篇∶岐伯曰∶病温虚甚死。
诒按∶经言藏于精者，春不病温。则凡病温者，其阴气先虚可知。使或虚而未至于甚，则养阴透邪，治之
如法，犹可挽回。若病温者而至虚甚，则热邪内讧，阴精先涸，一发燎原，不可治矣。
灵枢五禁篇∶岐伯曰∶热病脉静，汗已出脉盛躁，是一逆也。
诒按∶热病汗出后而脉转盛躁，此热邪深伏于阴，至汗出而邪机始动而外露，则其伏邪必重，故曰逆也。
灵枢热病篇曰∶热病三日，而气口静、人迎躁者，取之诸阳，五十九刺，以泻其热而出其汗，实其阴以补
其不足者。
吴鞠通曰∶人迎躁，邪在上焦也，故取之诸阳，以泄其邪，阳气通则汗随之。阳盛则阴衰，泻阳则阴得安
其位，故曰实其阴。泻阳之有余，即所以补阴之不足，故曰补其不足也。温热病未有不伤阴者，实其阴以补其
不足，此一句实治温热之吃紧大纲。
身热甚，阴阳皆静者，勿刺也。其可刺者急取之，不汗出则泄。所谓勿刺者，有死征也。热病七日、八日
，脉口动，喘而短者，急刺之，汗且自出，浅刺手大指间。热病七日、八日，脉微小，病者溲血，口中干，一
日半而死，脉代者一日死。热病已得汗出，而脉尚躁，喘且复热，勿刺肤，喘甚者死。
诒按∶热甚而脉浮躁则可刺，当急取之，令其热邪从汗泄而解。若脉阴阳俱静，是阳证见阴脉，已有死征
，故勿刺。脉口动喘而短者，热壅于肺也。刺手大指间肺之少商穴，俾肺之热痹开而汗泄则解矣。热邪灼烁血
分则溲血，阴液被烁则口干，下焦阴伤已甚，而脉又微小，则不惟阴涸，而阳亦伤矣，故主死。已得汗而脉尚
躁，喘且复热，是热不为汗衰，而化源且绝矣，故死。
热病不可刺者有九∶一曰汗不出，大颧发赤，哕者死；二曰泄而腹满甚者死；三曰目不明，热不已者死；
四曰老人婴儿，热而腹满者死；五曰汗不出，呕下血者死；六曰舌本烂，热不已者死；七曰咳而衄，汗不出，
出
而不至足者死；八曰髓热者死；九曰热而痉者死，腰折、螈 、齿噤 也。凡此九者，不可刺也。
诒按∶颧赤而哕，肾阴已竭而虚阳上脱之证，故死。已泄而腹尚满，是阴下脱而邪不减，与热不为汗衰者
相似，故死。目不明，阴脱也；阴脱而仍热；故死。热满当泄，老人幼儿不任攻伐，则热无出路，故死。热蕴
无汗，上逆则呕，下迫则血溢，上下交征，阴液易固，故为死候。舌本烂，乃肾火上结，与胃热炽而口糜者不
同。若既烂而热仍不已，亦为死候。汗不至足，是肺气不下行而化源将绝也。咳衄乃邪闭于上，无汗则邪不外
泄，又兼化源将绝之征，故曰死。髓热如骨蒸之状，邪热深入于肾也。热而痉，致见腰折等证，是邪热深入于
肝也。肾肝为热邪所烁，故死。
吴鞠通曰∶此节历叙热病之死征，以禁人之刺，大抵由于阴竭者为多。然刺固不可，亦有可药而愈者，盖
刺法能泄能通，开热邪之闭结最速；至于益阴以存津，则刺法之所短，汤药之所长也。
五钱，桂心一钱，名为驱湿保脱汤。连续服用十剂，可以避免脚趾脱落。这就是谚语所说的“脱脚伤寒”，也是不可不知的。如果虽然大量饮用冷饮，但汗出也较多，必定不会有后患。
柳宝诒按语：治疗热病用寒凉药，是确定的道理。现在的人对于温病初发，见到使用凉解法，就说是遏制邪气，他们本来就不明白这个道理。
《灵枢》说：太阳经脉的气色反映在颧骨部位，这是热病。如果营气尚未与邪气交争，就说现在可以得到汗解，等待时辰到来即可痊愈。如果与厥阴脉的病证同时出现，死期不超过三天，这是因为热病内连肾脏。
章虚谷说：这里说的是外感与伏邪互相夹杂的病证，与《热病篇》中的两感证，同中有异。两感证是内外同时受邪，内外都生病，所以不免于死。这里是外感先发，伏邪后发，还可以生还。如果同时发作，则死期不超过三天。所谓“太阳之脉”，是指邪气受于太阳经脉，即一日巨阳受邪，出现头项痛、腰脊强直等症状。“色荣颧骨”，是指鲜红润泽的赤色出现在颧部。因为颧部是骨之本，骨由肾所主，肾脏的伏邪已经发动，所以赤色顺着营血而显现于颧部。“荣未交，今且得汗，待时而已”，意思是太阳与少阴互为表里，太阳经脉外受的邪气，与少阴营中伏藏的邪热，尚未相交争，如果能得汗，先解除外邪，这就是所谓“未满三日可汗之”的意思。那内伏的邪气后来发作，等待脏气旺盛时就可以痊愈，比如肾热病，等到壬癸日得到大汗就可以痊愈了。又如同文中所说见赤色者刺之，名为治未病，也可以。倘若与厥阴经脉的病证同时出现，则肝肾都有邪热内发，其势必然与太阳外邪连合而无法解开，所以比两感病死期更快。两感病起于经脉，必须等到胃气耗尽，六天才死。这里是热邪内连肾脏，本元既已断绝，所以死期不超过三天。
少阳经脉的气色反映在颊前部位，这是热病。如果营气尚未与邪气交争，就说现在可以得到汗解，等待时辰到来即可痊愈。如果与少阴脉的病证同时出现，死期不超过三天。
章虚谷说：上文说肝热病，左颊先变红。肝为厥阴，胆为少阳，互为表里。外邪受于少阳经脉，而肝脏伏热的颜色反映在颊前。如果内外邪气尚未相交争，现在使其得汗以解除外邪。那内发的热，可以等待脏气旺盛时痊愈。如果与少阴经脉病证同时出现，则肝连肾热，内外邪气势必交合难解；死期不超过三天。大抵内外邪气，有先后发作而不交合的，还可以解救，所以关键在于“荣未交”这一句。下文提到的病名“阴阳交”，也就是营气已与邪气交争的含义。经文只列举太阳、少阳两证，不及阳明太阴合病，是因为阳明之腑，可以用攻泻的方法，不至于必死。不同于太阳少阴、少阳厥阴，其邪热温合而无出路，则必死。
《评热病篇》说：黄帝问：有患温病的，出汗后立即又发热，脉象躁急快速，不因出汗而减弱，胡言乱语不能进食，这病叫什么名字？岐伯答：病名叫阴阳交，交就是死的征兆。
章虚谷说：阴阳之气，本是相交合的。现在邪气弥漫，外感阳分之邪，与内发阴分之热，混合不分，而本元正气已绝，所以说“交者死”，并非指阴阳正气的相交。下面阐述其所以然的道理。
人之所以出汗，都是源于水谷精微，水谷精微生于精气。现在邪气在骨肉间交争而能出汗的，是邪气退却而精气胜的表现。精气胜，则应当能进食，而不再发热。再次发热的是邪气，出汗的是精气。现在出汗后又立即发热，是邪气胜的表现。不能进食，是因为精气得不到补充。病邪滞留不去，寿命可以立刻倾覆。况且《热论》说：出汗后脉象仍然躁盛的是死证。现在脉象不与汗相应，这是不胜任疾病的表现，死亡是明显的。胡言乱语是失志，失志者死。现在见到三种死证，不见一种生机，即使看似好转，也必死无疑。
章虚谷说：汗生于谷，谷生于精，是说由本元精气，化生水谷以生津液，散发出来成为汗。邪气随汗泄出，则邪气退却而精气胜。现在出汗后又发热而不能进食，是邪气胜而津液无所借助。病邪仍留连不去，则寿命可以立等而尽。胡言乱语失志是一，出汗后又发热是二，脉象与汗不相应是三。见到三种死证，而不见一种生机，虽然看似好转，也必死无疑。
《素问·阳明脉解篇》说：足阳明经脉发病，厌恶人和火，听到木音则惊恐，听到钟鼓声不为动。听到木音而惊恐，为什么呢？岐伯说：阳明是胃脉，胃属土。所以听到木音而惊恐，是因为土恶木。黄帝说：好！为什么厌恶火呢？岐伯说：阳明主肉，其经脉气血旺盛，邪气客居其中则发热，热甚则厌恶火。黄帝说：为什么厌恶人呢？岐伯说：阳明气逆则喘促且心中烦闷，烦闷则厌恶见人。黄帝说：有的喘促而死，有的喘促而生，为什么呢？岐伯说：厥逆连及内脏则死，连及经脉则生。
章虚谷说：土畏惧木克，所以听到木音则惊恐。热甚则厌恶火，就是仲景所说的不恶寒反恶热。邪气结于胃而气机厥逆，则喘促且心中懊恼，懊恼是不想见人的意思。邪热内结，则气机阻滞而喘促。不能循经脉外达，则四肢厥逆，因为四肢禀受气于脾胃。邪气内入则连及内脏故死，外出则连及经脉故生。
黄帝问：病重时抛弃衣服奔跑，登上高处唱歌，或者到了几天不吃饭，翻越墙垣上屋顶，所上的地方，都不是他平时所能做到的，病反而能做到这些，为什么呢？岐伯说：四肢是诸阳之本，阳气盛则四肢充实，充实就能登高。黄帝问：为什么抛弃衣服奔跑呢？岐伯说：热盛于身体，所以抛弃衣服想要奔跑。黄帝问：为什么胡言乱语骂人，不顾亲疏而唱歌呢？岐伯说：阳气盛使人胡言乱语骂人，不顾亲疏，而且不想吃东西，不想吃东西，所以胡乱奔跑。
章虚谷说：四肢禀受气于脾胃，胃是脏腑之海，而阳明经行气于三阳，所以四肢是诸阳之本。邪气盛于胃，气实于四肢，则能登高。热盛于身体，所以抛弃衣服想要奔跑。邪气扰乱神明，所以胡言乱语骂人。胃中邪气实，不想饮食。四肢多力，所以胡乱奔跑。这是大承气汤证的病候。如果邪气连及经脉，脉象必然滑大，用下法可以生还。如果邪气连及内脏，脉象必然沉细。仲景说：阳病见阴脉者死。那么虽然有下法的适应证，也不可用下法了。
王梦隐说：温病误投热药补剂，也有这种征候。经证也有可用白虎汤的情况。沉细的脉象，也有因热邪闭塞使然，如果形证属实，用下法可以生还，不可一概以阴脉来判断必死。凡热邪壅遏，脉象多细迟涩，按照证候清解，自然呈现滑数。不像内伤病服用凉药而脉象加数的，那是虚证。
《热论篇》说：黄帝问：热病已经痊愈，有时还有遗留症状，为什么呢？岐伯说：所有遗留症状，是因为热甚而强行进食，所以有所遗留。像这种情况，都是病邪已衰而热邪有所藏匿，因为谷气与余热相搏，两热相合，所以有所遗留。黄帝说：好！治疗遗留症状怎么办？岐伯说：观察虚实，调理逆从，可以使病必愈。黄帝问：患热病应当禁忌什么？岐伯说：患热病稍有好转，吃肉则复发，多吃则遗留，这是禁忌。
柳宝诒按语：这里说热邪初愈，余热残留未净，得到谷食助长气机，则两热相合而复炽。看其吃肉类则复发，多吃则遗留，所以病后必须谨慎调理饮食，只可以吃清淡稀粥，逐渐调养。
柳宝诒按语：经文说藏精者，春季不患温病。那么凡是患温病的人，其阴气先虚是显而易见的。假如虚而未至于极甚，则养阴透邪，治疗方法得当，还可以挽回。如果患温病而至精气极度虚弱，则热邪内扰，阴精先枯竭，一发如燎原之势，不可治了。
《灵枢·五禁篇》：岐伯说：热病脉象静缓，汗出后脉象盛大躁急，这是一逆。
柳宝诒按语：热病出汗后脉象转为盛大躁急，这是热邪深伏于阴分，至汗出而邪气机始动而外露，则其伏邪必然沉重，所以称为逆。
《灵枢·热病篇》说：热病三天，气口脉静、人迎脉躁动的，取诸阳经穴位，用五十九刺法，以泻其热而出其汗，充实其阴以补其不足。
吴鞠通说：人迎脉躁动，说明邪气在上焦，所以取诸阳经穴位，以泄其邪，阳气通畅则汗随之而出。阳盛则阴衰，泻阳则阴得以安其位，所以叫“实其阴”。泻阳之有余，就是补阴之不足，所以叫“补其不足”。温热病没有不伤阴的，“实其阴以补其不足”这一句，确实是治疗温热的关键大纲。
身体高热，阴阳脉象皆静缓的，不要针刺。可以针刺的，应紧急取穴，不出汗则用泄法。所谓不要针刺的，是有死征。热病七天、八天，脉口跳动，喘促短气的，紧急针刺，汗将会自出，浅刺手大指间（少商穴）。热病七天、八天，脉象微小，病人尿血，口中干燥，一天半而死，脉代的一日死。热病已经出汗，而脉象仍然躁动，喘促且再次发热，不要刺皮肤，喘促严重的会死。
柳宝诒按语：热甚而脉浮躁则可以针刺，应当紧急取穴，令其热邪从汗泄而解。如果脉象阴阳俱静，是阳证见阴脉，已有死征，所以不要针刺。脉口动喘而短气，是热壅于肺。刺手大指间肺之少商穴，使肺之热痹开而汗泄则解了。热邪灼烁血分则尿血，阴液被灼烁则口干，下焦阴伤已甚，而脉又微小，则不仅阴涸，而阳也伤了，所以主死。已经出汗而脉象仍然躁动，喘促且再次发热，是热不为汗衰，而化源将绝了，所以死。
热病不可针刺的有九种情况：一是汗不出，大颧发赤，呃逆的会死；二是腹泻而腹部胀满严重的会死；三是眼睛不明，热不退的会死；四是老人婴儿，发热而腹部胀满的会死；五是汗不出，呕吐下血的会死；六是舌根腐烂，热不退的会死；七是咳嗽而鼻衄，汗不出，汗出不到足的会死；八是髓热的会死；九是发热而痉厥的会死，表现为腰折、抽搐、牙关紧闭。以上九种情况，不可针刺。
柳宝诒按语：颧赤而呃逆，是肾阴已竭而虚阳上脱的证候，所以死。已经腹泻而腹部仍然胀满，是阴气下脱而邪气不减，与热不为汗衰相似，所以死。眼睛不明，是阴脱；阴脱而仍发热，所以死。热满当泄，老人幼儿不耐攻伐，则热无出路，所以死。热蕴无汗，上逆则呕吐，下迫则血溢，上下交征，阴液易固，所以为死候。舌根腐烂，是肾火上结，与胃热炽盛而口糜的不同。如果既烂而热仍不止，也为死候。汗不到足，是肺气不下行而化源将绝。咳衄是邪闭于上，无汗则邪不外泄，又兼化源将绝的征象，所以叫死。髓热如骨蒸之状，是邪热深入于肾。发热而痉厥，导致出现腰折等证，是邪热深入于肝。肾肝被热邪灼烁，所以死。
吴鞠通说：这一节历数热病的死征，以禁止人们针刺，大抵由于阴竭的情况居多。然而针刺固然不可，也有可用药物治愈的，大概针刺法能泄能通，开通热邪闭结最快；至于益阴以存津液，则是针刺法的短处，汤药的长处。
Five qian (3 grams), Guixin (Cinnamomi Cortex, 桂心) one qian (0.6 grams), named Qushi Baotuo Decoction (Decoction to Expel Dampness and Preserve Vitality). Taking it continuously for ten doses can prevent the shedding of toes. This is what the proverb calls "Tuo Jiao Shang Han" (Shedding-Toe Cold Damage), which is also something one must know. If although a large amount of cold drinks are consumed, sweat is also profuse, there will certainly be no subsequent complications.
Liu Baozhi's commentary: Treating heat with cold is a fixed principle. Nowadays, when treating the initial onset of warm diseases, people see the use of cooling and resolving methods and immediately claim it suppresses the pathogen; they simply do not understand this principle.
The *Ling Shu* states: When the color of the Taiyang meridian manifests on the cheekbones, it indicates a heat disease. If Ying Qi has not yet interacted with the pathogen, it is said that if sweat can be obtained now, recovery will await the appropriate time. If symptoms appear simultaneously with the Jueyin meridian, death will occur within three days, as the heat disease internally connects to the Kidney.
Zhang Xugu says: This discusses conditions where external contraction and latent pathogens interact, which shares similarities but also differences with the "Liang Gan" (Double Contraction) in the *Re Bing* chapter. In Liang Gan, both internal and external aspects are affected by pathogens simultaneously, leading inevitably to death. Here, external contraction occurs first, and the latent pathogen emerges later, allowing for survival. If they emerge simultaneously, death will occur within three days. "Taiyang meridian" refers to the pathogen affecting the Taiyang meridian, meaning on the first day, the Great Yang receives the pathogen, causing headache, stiff neck, and back stiffness. "Color manifesting on cheekbones" refers to a fresh, lustrous red color appearing on the cheeks. The cheekbones are the root of bone, and bones are governed by the Kidney. Since the latent pathogen in the Kidney has moved, the red color follows the Ying blood to manifest on the cheekbones. "Ying Qi has not yet interacted, if sweat can be obtained now, await the time" means that Taiyang and Shaoyin are exterior-interior pairs. The pathogen externally contracted on the Taiyang meridian and the latent heat in the Shaoyin Ying have not yet interacted. If sweat can be induced, the external pathogen is resolved first, which is what is meant by "within three days, sweating is indicated." The internally latent pathogen emerges later and resolves when the Zang organ qi is prosperous, such as in Kidney Heat Disease, which resolves with profuse sweat on Ren and Gui days. Similarly, puncturing those who show red color is called "treating before illness," which is also applicable. However, if symptoms appear simultaneously with the Jueyin meridian, both Liver and Kidney have internal pathogenic heat, which will inevitably combine with the external Taiyang pathogen and become intractable, thus dying faster than Liang Gan. Liang Gan originates from meridians and requires six days for Stomach Qi to exhaust before death. Here, heat pathogen internally connects to the Kidney, and since the root vitality is severed, death occurs within three days.
When the color of the Shaoyang meridian manifests on the front of the cheeks, it indicates a heat disease. If Ying Qi has not yet interacted with the pathogen, it is said that if sweat can be obtained now, recovery will await the appropriate time. If symptoms appear simultaneously with the Shaoyin meridian, death will occur within three days.
Zhang Xugu says: Previously, it was stated that Liver Heat Disease causes redness on the left cheek first. The Liver is Jueyin, and the Gallbladder is Shaoyang, which are exterior-interior pairs. External pathogens affect the Shaoyang meridian, while the color of latent heat in the Liver manifests on the front of the cheeks. If external and internal pathogens have not yet interacted, inducing sweat now resolves the external pathogen. The internally emerging heat resolves when the Zang organ qi is prosperous. If symptoms appear simultaneously with the Shaoyin meridian, Liver heat connects to Kidney heat, and the external and internal pathogenic forces inevitably interact and become difficult to resolve; death occurs within three days. Generally, if external and internal pathogens emerge sequentially without interacting, rescue is possible; thus, the key lies in the phrase "Ying Qi has not yet interacted." The disease name "Yin Yang Jiao" (Interaction of Yin and Yang) mentioned below implies that Ying Qi has already interacted with the pathogen. The text only cites Taiyang and Shaoyang cases, omitting Yangming and Taiyin combined diseases, because Yangming Fu organs can be treated with purgative methods, avoiding inevitable death. This differs from Taiyang-Shaoyin and Shaoyang-Jueyin, where heat pathogens merge without an exit route, leading inevitably to death.
The *Ping Re Bing* chapter states: The Yellow Emperor asked: There is a patient with a warm disease whose fever returns immediately after sweating, with a rapid and restless pulse that does not weaken due to sweating, accompanied by delirium and inability to eat. What is this disease named? Qibo answered: The disease is named Yin Yang Jiao (Interaction of Yin and Yang); "Jiao" implies death.
Zhang Xugu says: Yin and Yang Qi naturally interact. Now, pathogenic momentum is pervasive; the external Yang-pathogen mixes indistinguishably with the internally emerging Yin-heat, causing the root vital Qi to cease. Thus, "Jiao implies death" refers to this pathological mixing, not the harmonious interaction of healthy Yin and Yang. Below is the explanation of the rationale.
Human sweat is generated from grain (food), and grain essence is generated from Jing (Essence). When pathogens struggle in the muscles and bones and sweat is produced, it indicates that the pathogen is retreating and Essence is prevailing. If Essence prevails, the patient should be able to eat and not have recurrent fever. Recurrent fever indicates the pathogen; sweat indicates Essence. Now, sweating followed immediately by fever indicates pathogenic victory. Inability to eat means Essence lacks support. If the disease lingers, life can be lost instantly. Furthermore, the *Re Lun* states: "Sweating followed by a still restless and vigorous pulse indicates death." Now, the pulse does not correspond with the sweat, indicating the body cannot overcome the disease; death is evident. Delirium indicates loss of Zhi (Will/Spirit); loss of Zhi leads to death. Seeing three signs of death and no sign of life, even if improvement seems apparent, death is certain.
Zhang Xugu says: "Sweat comes from grain, grain from Essence" means that original Essence transforms food into fluids, which emit as sweat. Pathogens are expelled with sweat, so pathogen retreats and Essence prevails. Now, sweating followed by fever and inability to eat indicates pathogenic victory and lack of fluid support. If the disease lingers, life will end shortly. Delirium and loss of Will is one sign; recurrent fever after sweating is two; pulse not corresponding with sweat is three. Seeing three signs of death and no sign of life, even if seemingly improved, death is certain.
The *Su Wen · Yangming Mai Jie* chapter states: When the Foot-Yangming meridian is diseased, the patient fears people and fire, and is startled by the sound of wood, but not by bells or drums. Why is one startled by the sound of wood? Qibo said: Yangming is the Stomach meridian, and the Stomach belongs to Earth. Thus, fearing the sound of wood is because Earth fears Wood. The Yellow Emperor said: Good! Why fear fire? Qibo said: Yangming governs flesh, and its meridian has abundant Qi and Blood. When pathogens invade, heat arises; excessive heat causes fear of fire. The Yellow Emperor said: Why fear people? Qibo said: Yangming reversal causes panting and distress; distress causes aversion to people. The Yellow Emperor said: Some die from panting, some survive. Why? Qibo said: Reversal connecting to Zang organs leads to death; connecting to meridians leads to survival.
Zhang Xugu says: Earth fears Wood domination, hence the startle at the sound of wood. Excessive heat causes fear of fire, which is Zhongjing's statement of "no aversion to cold but aversion to heat." Pathogens knot in the Stomach causing Qi reversal, leading to panting and mental restlessness (Ao Nan), which is aversion to seeing people. Internal knotting of pathogenic heat blocks Qi flow, causing panting. Failure to reach the exterior via meridians leads to cold limbs, as limbs receive Qi from Spleen and Stomach. Pathogens entering internally connect to Zang organs, causing death; exiting externally connect to meridians, allowing survival.
The Yellow Emperor asked: In severe illness, patients discard clothes and run, climb high places and sing, or go several days without eating, climbing walls and roofs—places they could never reach normally. Why can they do these things contrary to their usual ability? Qibo said: Limbs are the root of all Yang. Excess Yang makes limbs solid and strong, enabling climbing. The Yellow Emperor asked: Why discard clothes and run? Qibo said: Excessive heat in the body causes discarding clothes and running. The Yellow Emperor asked: Why delirious speech, cursing, ignoring kinship, and singing? Qibo said: Excess Yang causes delirious speech, cursing, ignoring kinship, and unwillingness to eat. Unwillingness to eat leads to erratic running.
Zhang Xugu says: Limbs receive Qi from Spleen and Stomach; the Stomach is the sea of Zang-Fu, and Yangming circulates Qi through the Three Yang meridians, making limbs the root of all Yang. Pathogen excess in Stomach and Qi solidity in limbs enable climbing. Body heat excess causes discarding clothes and running. Pathogen disturbing Shen Ming (Spirit) causes delirious cursing. Stomach pathogenic excess causes unwillingness to eat. Strong limbs cause erratic running. This is a Da Cheng Qi Tang syndrome. If pathogens connect to meridians, the pulse will be slippery and large; purgation can save life. If pathogens connect to Zang organs, the pulse will be deep and fine. Zhongjing said: "Yang disease showing Yin pulse indicates death." Thus, even if purgation indications exist, purgation cannot be used.
Wang Mengyin said: Warm diseases mistakenly treated with hot tonics can also present these symptoms. Meridian-stage diseases may also warrant Bai Hu Tang. A deep and fine pulse can also result from heat pathogen obstruction; if physical signs and symptoms are substantial, purgation can save life. One cannot generally judge inevitable death solely based on a Yin pulse. Generally, when heat pathogens are congested, pulses are often fine, slow, and choppy. Clearing and resolving according to symptoms naturally results in a slippery and rapid pulse. This differs from deficiency patterns in internal injuries where taking cold medicines increases pulse rate.
The *Re Lun* chapter states: The Yellow Emperor asked: Heat diseases have healed, yet sometimes residual symptoms remain. Why? Qibo said: All residual symptoms occur because heat is severe and the patient forces food intake. In such cases, the pathogen has declined but heat remains hidden. Grain Qi struggles with residual heat, combining two heats, causing residuals. The Yellow Emperor said: Good! How to treat residuals? Qibo said: Observe deficiency and excess, regulate reversal and compliance, and the disease will surely heal. The Yellow Emperor asked: What should be forbidden during heat disease? Qibo said: When heat disease slightly improves, eating meat causes recurrence; overeating causes residuals. These are the prohibitions.
Liu Baozhi's commentary: This describes how, after initial heat pathogen resolution, residual heat remains uncleaned. Grain food aids Qi, causing the two heats to combine and flare up again. Observing that eating meat causes recurrence and overeating causes residuals, post-illness dietary regulation must be strict. Only light, thin porridge should be consumed for gradual nourishment.
The *Su Wen · Yu Ban Lun Yao* chapter: Qibo said: Patients with warm disease and extreme deficiency will die.
Liu Baozhi's commentary: The classic states, "Those who preserve Essence will not suffer warm diseases in Spring." Thus, anyone suffering warm disease clearly has prior Yin deficiency. If deficiency is not extreme, nourishing Yin and venting pathogens with proper treatment can still reverse the condition. However, if warm disease reaches extreme deficiency, heat pathogens disturb internally, Yin Essence dries up first, and the fire spreads uncontrollably, becoming incurable.
The *Ling Shu · Wu Jin* chapter: Qibo said: Heat disease with a quiet pulse, but a vigorous and restless pulse after sweating, is the first counter-indication (Ni).
Liu Baozhi's commentary: After sweating in heat disease, if the pulse becomes vigorous and restless, it indicates heat pathogens deeply hidden in Yin. Sweating activates the pathogenic mechanism, exposing it externally, implying heavy latent pathogens, hence termed "counter-indication."
The *Ling Shu · Re Bing* chapter states: On the third day of heat disease, if the Qi Kou pulse is quiet and the Ren Ying pulse is restless, puncture the Yang meridians using the Fifty-Nine Acupoints method to drain heat and induce sweat, solidifying Yin to supplement insufficiency.
Wu Juzhong said: Restless Ren Ying pulse indicates pathogen in the Upper Jiao; thus, puncturing Yang meridians drains the pathogen. When Yang Qi flows freely, sweat follows. Yang excess leads to Yin decline; draining Yang allows Yin to settle in its position, hence "solidifying Yin." Draining Yang excess supplements Yin insufficiency, hence "supplementing insufficiency." Warm-heat diseases invariably injure Yin; "solidifying Yin to supplement insufficiency" is the crucial outline for treating warm diseases.
If body heat is severe but both Yin and Yang pulses are quiet, do not puncture. For those suitable for puncture, act urgently; if no sweat occurs, use draining methods. "Do not puncture" applies to those showing signs of death. On the seventh or eighth day of heat disease, if the Mai Kou pulse moves, with panting and shortness of breath, puncture urgently; sweat will likely emerge spontaneously. Puncture shallowly between the big toe (Shaoshang point). On the seventh or eighth day, if the pulse is minute and small, and the patient has hematuria and dry mouth, death occurs in one and a half days; if the pulse is intermittent (Dai), death occurs in one day. If heat disease has sweated, but the pulse remains restless, with panting and recurrent fever, do not puncture the skin; severe panting indicates death.
Liu Baozhi's commentary: Severe heat with restless and floating pulse allows puncture; urgent puncture allows heat pathogens to resolve via sweat. If Yin and Yang pulses are both quiet, it is a Yang disease showing Yin pulse, indicating death signs, so do not puncture. Moving Mai Kou pulse with panting and shortness of breath indicates heat congestion in the Lung. Puncturing Shaoshang, the Lung's Shao-Shang point on the big toe, opens Lung heat obstruction, allowing sweat and resolution. Heat pathogen scorching the Blood level causes hematuria; Yin fluids scorched cause dry mouth. Lower Jiao Yin injury is severe, and with a minute/small pulse, not only is Yin exhausted, but Yang is also damaged, hence fatal. Having sweated but pulse remaining restless, with panting and recurrent fever, indicates heat does not subside with sweat and the source of transformation is failing, hence death.
There are nine types of heat disease unsuitable for puncture: 1. No sweat, red cheekbones, and hiccups indicate death; 2. Diarrhea with severe abdominal fullness indicates death; 3. Unclear vision with persistent heat indicates death; 4. Elderly and infants with heat and abdominal fullness indicate death; 5. No sweat, vomiting, and lower bleeding indicate death; 6. Rotten tongue base with persistent heat indicates death; 7. Coughing with epistaxis, no sweat, or sweat not reaching the feet indicate death; 8. Marrow heat indicates death; 9. Heat with spasms indicates death, presenting as opisthotonos, convulsions, and locked jaw. None of these nine should be punctured.
Liu Baozhi's commentary: Red cheekbones with hiccups indicate Kidney Yin exhaustion and floating Yang escaping upward, hence death. Diarrhea with persistent abdominal fullness indicates downward leakage of Yin and unremoved pathogen, similar to heat not subsiding with sweat, hence death. Unclear vision indicates Yin collapse; Yin collapse with persistent heat leads to death. Heat and fullness require draining, but elderly and children cannot withstand attack, leaving heat with no outlet, hence death. Heat accumulation with no sweat reverses upward causing vomiting, presses downward causing bleeding; upper and lower conflict easily consolidates Yin fluids, a death sign. Rotten tongue base indicates Fire of Kidney knotting, different from Stomach heat causing oral ulcers. If rotten and heat persists, it is a death sign. Sweat not reaching feet indicates Lung Qi failing to descend and source of transformation nearing extinction. Cough and epistaxis indicate pathogen closed above; no sweat means pathogen cannot exit externally, plus signs of failing transformation source, hence death. Marrow heat resembles bone-steaming consumption, indicating pathogen heat deeply entered the Kidney. Heat with spasms causing opisthotonos indicates pathogen heat deeply entered the Liver. Kidney and Liver scorched by heat pathogens lead to death.
Wu Juzhong said: This section lists death signs of heat disease to prohibit puncture, mostly due to Yin exhaustion. Although puncture is contraindicated, some cases can be cured with medicine. Puncture excels at draining and unblocking, rapidly opening pathogenic heat knots; however, benefiting Yin and preserving fluids is the weakness of puncture and the strength of decoctions.