然其卒发者，不必治于传，或其传化有不以次，不以次入者，忧恐悲喜怒，令不得以其次，故令人有大病
矣。因而喜，大虚，则肾气乘矣；怒，则肝气乘矣；悲，则肺气乘矣；恐，则脾气乘矣；忧，则心气乘矣，
此其道也。故病有五，五五二十五变，及其传化传乘之名也。
上衣冠文物邪传其所胜之脏，是常理也；而邪之伤人卒发者，原不必待其传而治之，且人有强弱，邪有重轻，
病之变化多端，其传有不以次序者，假如忧恐等情志所伤，其邪必乘虚深入，不待传次，已成大病矣。因其五
脏之气，先自相乘犯，如过喜而心气虚散，则肾气乘之，怒则伤肝，悲则伤肺之类，故一脏而有五脏乘犯之病，
五五二十五变，及外邪传化传乘之病名，何可数计乎！《难经》论脉，以五脏相乘犯名五邪，有微甚之十变，
宜参观之。此条与前岐伯所云∶不应四时之气，而脏独主其病者，义理可以会通也。
大骨枯槁，大肉陷下，胸中气满，喘息不便，其气动形，期六月死，真脏脉见，乃予之期日，大骨枯槁；
大肉陷下，胸中气满，内痛引肩项，期一月死，真脏见，乃予之期日；大骨枯槁，大肉陷下，胸中气满，喘
息不便，内痛引肩项，身热，脱肉破 ，真脏见，十
月之内死，大骨枯槁，大肉陷下，骨髓内消，动作益衰，真脏未见，期一岁死，见其真脏，乃予之期日；大骨
枯槁，大肉陷下，胸中气满，腹内痛，心中不便，肩项身热，破 脱肉，目眶陷，真脏见，目不见人，立死，
其见人者，至其所不胜之时则死。
此即明久病之死证也。齿为骨之余，齿枯则知其骨枯矣。肾主骨，脾主肉，骨枯肉陷，则脾肾两败，其虚
阳必然上逆而胸中气满，喘息而气振动形，脾肾皆不输化，则不便矣。如脉尚和缓者，可延半年，若真脏脉现，
可定期日而死也；其内痛引肩项，或又身热，脱肉破 ，则死更速矣；或又加腹痛，目眶陷，脾气已绝，目不
见人，肝肾俱绝，故立死，其见人者，至相克之日时则死。
急虚，身中卒至，五脏绝闭，脉道不通，气不往来，譬于堕溺，不可为期。其脉绝不来，若人一息。五六
至，其形肉不脱，真脏虽不见，犹死也。
急虚者，危急之虚证，卒然而至，如中风暴仆之类。五脏之气阻绝，经脉闭而不通，譬如堕溺水中，不及
救援，其死不可定期。其脉绝不来，此阴阳之气不往来也，或一呼五六至，将脱之脉矣。其形肉虽未脱，真脏脉
初亦不现，而卒然如此者，犹死也。可知上节所云死期，亦不过明其常理，非可拘执也。
《素问·标本病传论》曰∶夫病传者，心病先心痛，一日而咳，三日胁支满，五日闭塞不通，身痛体重，
三日不已，死，冬夜半，夏日中。
此邪传其所胜之脏，互相克贼，故死也。心先受邪而心痛，
一日而咳，则传于肺，火克金也；三日胁支满，则传于肝，金克木也；五日闭塞不通，身痛体重，则传于脾，
木克土也；又三日，则土克水，传肾而死。以肾为阴阳之根，夜半阴盛，日中阳盛，冬令夜半则重阴，夏令
日中则重阳，遇重阴重阳之偏气，而身中之根元绝也。
肺病喘咳，三日而胁支满痛，一日身重体痛，五日而胀，十日不已，死，冬日入，夏日出。
此由肺传肝，金克木也，肝传脾，木克土也，脾土败，则五日而身胀，十日死者，以天五生土，地十成之，
其败其绝，以应生成之数也。天地之气，以一岁而升降，人身之气，应一日之升降，升者气旺，降者气衰，五
脏之气，各有衰旺之时，其脏败者，遇气衰旺极时，其阴阳不能交接而生化，则死矣。前后各条所言死期，
义理大抵如是。然又有五行生克者，暴病卒死者，种种变化，莫可数计，其中妙理，固难言喻，自不可拘泥而
穿凿者。但细审其脉证，而生死之象，灼然可见，若确定其时刻，则非神圣不能也。
肝病头目眩，胁支满，三日体重身痛，五日而胀，三日腰脊少腹痛，胫 ，三日不已，死，冬日入，夏早食。
此由肝传脾，脾传肾而死。
脾病身痛体重，一日而胀，二日少腹腰脊痛，胫 ，三日背膂筋痛，小便闭，十日不已，死，冬人定，夏
晏食。
此由脾传肾，肾传膀胱，故背膂筋痛，小便闭也。
肾病少腹腰脊痛， ，三日背膂筋痛，小便闭，三日腹胀，三日两胁支满，三日不已，死，冬大晨，夏
晏晡。
此由肾传膀胱，膀胱传脾，脾传肝，是逆传其所不胜也。
胃病胀满，五日少腹腰脊痛， ，三日背膂筋痛，小便闭，五日身体重，六日不已，死，冬夜半后，
夏日 。
此由胃传肾，肾传膀胱，膀胱传脾，是腑脏互传也。
膀胱病，小便闭，五日少腹胀，腰脊痛， ，一日腹胀，一日身体痛，二日不已，死，冬鸡鸣，夏下晡。
此由膀胱传肾，肾传脾而死也。按人身五内腑，外营卫，气血周流，循环无间，其有失调，则邪乘虚而入，
以随气血流行，如本元气胜，其邪渐从外出，若元气不胜，而邪入脏腑，互相传变，久则元气败绝而死。是故
以上各条，皆言邪传脏腑而死，未有营卫之表病也。
然而那些突然发作的疾病，不一定需要等到病邪传变后再治疗；或者病邪的传化不按常规次序进行。由于忧、恐、悲、喜、怒等情志刺激，使得病情不能按部就班地发展，从而导致人患上重病。如果因过喜导致心气大虚，肾气就会乘虚侵犯心脏；发怒则肝气亢盛侵犯他脏；悲伤则肺气受损被乘；恐惧则脾气受损被乘；忧愁则心气受损被乘，这就是情志致病导致五脏相乘的道理。所以疾病有五种基本类型，每类又有五种变化，共二十五种变证，以及病邪传化、相乘的名称。
通常，外邪侵入人体后，会按照五行相克的顺序传变到其所胜之脏，这是常理；但外邪伤人突然发病时，原本就不必等待其传变再治疗。况且人的体质有强弱之分，邪气有轻重之别，病的变化多端，其传变可能不按次序。例如忧、恐等情志所伤，邪气必然乘虚深入，不待传次，就已经形成大病了。因为五脏之气先自相乘犯，如过喜导致心气虚散，则肾气乘之；发怒则伤肝，悲伤则伤肺等等，所以一脏就有五脏乘犯的病证，五五二十五变，加上外邪传化传乘的病名，哪里能计算得尽呢！《难经》论述脉象时，以五脏相乘犯命名为五邪，有微甚之十变，应当参考阅读。这一条与前文岐伯所说的“不应四时之气，而脏独主其病者”，义理是可以融会贯通的。
大骨枯槁，大肉陷下，胸中气满，喘息不便，呼吸时身体随之震动，预期六个月死亡；若出现真脏脉，则给予具体的死期日期。大骨枯槁，大肉陷下，胸中气满，内部疼痛牵引肩项，预期一个月死亡；若出现真脏脉，则给予具体的死期日期。大骨枯槁，大肉陷下，胸中气满，喘息不便，内部疼痛牵引肩项，身体发热，肌肉脱失且皮肤破裂，出现真脏脉，预期十个月之内死亡。大骨枯槁，大肉陷下，骨髓内消，动作日益衰弱，虽未出现真脏脉，预期一年死亡；若出现真脏脉，则给予具体的死期日期。大骨枯槁，大肉陷下，胸中气满，腹内疼痛，心中痞闷不适，肩项身热，肌肉脱失且皮肤破裂，眼眶凹陷，出现真脏脉，眼睛看不见人，立即死亡；若还能看见人，则至其所不胜之时（即克我之时）死亡。
这里明确说明了久病的死证。齿为骨之余，牙齿枯槁就知道骨骼枯槁了。肾主骨，脾主肉，骨枯肉陷，说明脾肾两败，其虚阳必然上逆而导致胸中气满，喘息且气振动形体，脾肾都不能输布运化，所以二便不通。如果脉象尚且和缓，可以延续半年；若真脏脉显现，就可以确定死期；若内部疼痛牵引肩项，或者又身体发热，肌肉脱失且皮肤破裂，则死得更迅速；或者又加上腹痛，眼眶凹陷，脾气已绝，眼睛看不见人，肝肾俱绝，所以立即死亡；若还能看见人，则至相克之日时死亡。
急虚证，身体突然遭受重创，五脏气机闭绝，脉道不通，气机无法往来，如同从高处坠落或溺水一样，无法预测死期。如果脉搏断绝不来，或者人一呼一吸之间脉跳五六次，虽然形肉没有脱失，真脏脉也未见，仍然会死亡。
急虚，是指危急的虚证，突然发生，如中风跌倒之类。五脏之气阻绝，经脉闭塞不通，譬如堕入水中溺水，来不及救援，其死亡无法定期预测。其脉绝不来，这是阴阳之气不往来的表现；或者一呼一吸脉跳五六次，这是将脱之脉。虽然形肉尚未脱失，真脏脉起初也未显现，但突然如此，仍然会死亡。可知上文所说的死期，也不过是阐明常理，不可拘泥执着。
《素问·标本病传论》说：所谓病邪传变，心病先发心痛，一天后咳嗽，三天后胁肋支撑胀满，五天后大小便闭塞不通，身体疼痛沉重，再过三天病不愈，就会死亡，死于冬季夜半，夏季日中。
这是邪气传变到其所胜之脏，互相克贼，所以死亡。心脏先受邪而心痛，一天后咳嗽，则是传于肺，火克金；三天后胁肋支撑胀满，则是传于肝，金克木；五天后闭塞不通，身体疼痛沉重，则是传于脾，木克土；再过三天，则是土克水，传于肾而死。因为肾为阴阳之根，夜半阴气最盛，日中阳气最盛，冬季夜半则是重阴，夏季日中则是重阳，遇到重阴重阳的偏盛之气，人身中的根本元气就断绝了。
肺病喘咳，三天后胁肋支撑胀满疼痛，一天后身体沉重疼痛，五天后腹胀，十天病不愈，就会死亡，死于冬季日落时分，夏季日出时分。
这是由肺传肝，金克木；肝传脾，木克土；脾土败坏，则五天后身体肿胀，十天死亡的，是因为天五生土，地十成之，其败绝应验了生成之数。天地之气，以一年为周期升降，人身之气，应一日之升降，升者气旺，降者气衰，五脏之气，各有衰旺之时，其脏败者，遇到气衰旺极之时，其阴阳不能交接而生化，就会死亡。前后各条所言的死期，义理大致如此。然而又有五行生克的关系，暴病卒死者，种种变化，不可计数，其中的妙理，难以言喻，自然不可拘泥穿凿。只要仔细审察其脉证，生死的征象，显然可见，若要确定具体时刻，除非是神圣之人才能做到。
肝病头目眩晕，胁肋支撑胀满，三天后身体沉重疼痛，五天后腹胀，三天后腰脊少腹痛，小腿浮肿，三天病不愈，就会死亡，死于冬季日落时分，夏季早饭时分。
脾病身体疼痛沉重，一天后腹胀，两天后少腹腰脊痛，小腿浮肿，三天后背膂筋痛，小便闭塞，十天病不愈，就会死亡，死于冬季人定时分，夏季晚饭时分。
肾病少腹腰脊痛，小腿浮肿，三天后背膂筋痛，小便闭塞，三天后腹胀，三天后两胁支撑胀满，三天病不愈，就会死亡，死于冬季大晨时分，夏季傍晚时分。
胃病胀满，五天后少腹腰脊痛，小腿浮肿，三天后背膂筋痛，小便闭塞，五天后身体沉重，六天病不愈，就会死亡，死于冬季夜半之后，夏季……（原文此处似有缺字，依上下文推测为特定时辰）。
膀胱病小便闭塞，五天后少腹胀，腰脊痛，小腿浮肿，一天后腹胀，一天后身体疼痛，二天病不愈，就会死亡，死于冬季鸡鸣时分，夏季下午时分。
这是由膀胱传肾，肾传脾而死。按人体五脏六腑，外营卫，气血周流，循环无间，若有失调，则邪气乘虚而入，随着气血流行，如果本元之气胜，邪气逐渐从外出；若元气不胜，邪气进入脏腑，互相传变，日久则元气败绝而死。因此以上各条，都是讲邪气传脏腑而死，没有涉及营卫表证的。
However, for diseases that occur suddenly, treatment is not necessarily required after the pathogenic factor has transmitted; or the transmission and transformation of the disease may not follow the usual sequence. Due to emotional disturbances such as worry, fear, sorrow, joy, and anger, the disease cannot develop in a step-by-step manner, thus causing severe illness. If excessive joy leads to great deficiency of Heart Qi (Heart Energy), Kidney Qi will invade it; anger causes Liver Qi to invade; sorrow causes Lung Qi to be invaded; fear causes Spleen Qi to be invaded; worry causes Heart Qi to be invaded. This is the principle of emotional pathogens causing mutual invasion among the Zang organs. Therefore, there are five basic types of diseases, each with five variations, totaling twenty-five changes, along with the names of disease transmission, transformation, and mutual invasion.
Normally, external pathogens invading the body transmit to the organ they overcome according to the Five Elements' overcoming cycle, which is the regular principle. However, when pathogens strike suddenly, treatment should not wait for transmission. Moreover, people have varying constitutions (strong or weak), and pathogens vary in severity. Disease changes are manifold, and transmission may not follow the order. For example, injuries caused by emotions like worry and fear cause pathogens to penetrate deeply due to deficiency, without waiting for the transmission sequence, already forming severe illness. Because the Qi of the five Zang organs first invades each other, such as excessive joy leading to dispersion of Heart Qi, then Kidney Qi invades; anger injures the Liver; sorrow injures the Lungs, etc. Thus, one Zang organ can suffer from invasions by all five Zang organs. With twenty-five variations and the names of external pathogen transmission and invasion, how can they be counted? The *Nan Jing* discusses pulse diagnoses, naming the five pathological pulses based on mutual invasion among the five Zang organs, with ten variations of slight and severe degrees; these should be consulted. This section aligns conceptually with Qi Bo's statement: "Not responding to the Qi of the four seasons, but the Zang organ alone dominates the disease."
When the large bones are withered and the large muscles are sunken, the chest is full of Qi, breathing is difficult and labored, and the movement of Qi causes the body to tremble, death is expected within six months. If the True Zang Pulse appears, a specific date of death is given. When the large bones are withered and the large muscles are sunken, the chest is full of Qi, internal pain radiates to the shoulders and neck, death is expected within one month. If the True Zang Pulse appears, a specific date of death is given. When the large bones are withered and the large muscles are sunken, the chest is full of Qi, breathing is difficult and labored, internal pain radiates to the shoulders and neck, the body is hot, flesh is wasted and skin breaks, and the True Zang Pulse appears, death occurs within ten months. When the large bones are withered and the large muscles are sunken, the marrow inside is consumed, movements become increasingly weak, although the True Zang Pulse has not yet appeared, death is expected within one year; if the True Zang Pulse appears, a specific date of death is given. When the large bones are withered and the large muscles are sunken, the chest is full of Qi, abdominal pain, heart discomfort, shoulder/neck/body heat, flesh wasting and skin breaking, eye sockets are sunken, the True Zang Pulse appears, the patient cannot see people, and dies immediately. If the patient can still see people, death occurs at the time when the controlling element overcomes them.
This clarifies the fatal signs of chronic illness. Teeth are the surplus of bones; withered teeth indicate withered bones. The Kidneys govern bones, and the Spleen governs muscles. Withered bones and sunken muscles indicate failure of both Spleen and Kidney. Deficient Yang must rise reversely, causing chest fullness, labored breathing, and body trembling due to Qi movement. Since Spleen and Kidney fail to transport and transform, bowel and bladder functions cease. If the pulse is still mild and moderate, survival may extend for half a year; if the True Zang Pulse appears, the date of death can be determined. If internal pain radiates to the shoulders and neck, or if there is body heat, flesh wasting, and skin breaking, death is more rapid. If abdominal pain and sunken eye sockets are added, Spleen Qi is exhausted, the patient cannot see people, Liver and Kidney are both exhausted, so death is immediate. If the patient can still see people, death occurs at the time of the overcoming element.
Ji Xu (Acute Deficiency) refers to a critical deficiency syndrome occurring suddenly, such as stroke or falling. The Qi of the five Zang organs is blocked and closed, the meridians are obstructed, and Qi does not circulate. It is like falling from a height or drowning, where rescue is impossible, and the time of death cannot be predicted. If the pulse stops completely, or if the pulse beats five or six times per breath, although the flesh has not wasted and the True Zang Pulse has not appeared, death will still occur.
Ji Xu refers to a critical deficiency syndrome occurring suddenly, similar to sudden collapse from wind-stroke. The Qi of the five Zang organs is cut off, and the meridians are closed and blocked. It is like falling into water and drowning, unable to be rescued in time, making the time of death unpredictable. The absence of the pulse indicates the non-interaction of Yin and Yang Qi. A pulse rate of five or six beats per breath indicates impending collapse. Even if the flesh has not wasted and the True Zang Pulse has not initially appeared, such a sudden occurrence still leads to death. Thus, the previously mentioned deadlines merely illustrate general principles and should not be rigidly adhered to.
The *Su Wen: Treatise on Root and Branch Disease Transmission* states: Regarding disease transmission, Heart disease first presents with heart pain. After one day, coughing occurs; after three days, rib support and fullness occur; after five days, obstruction and blockage occur, accompanied by body pain and heaviness. If this persists for another three days without improvement, death occurs, in winter at midnight, in summer at noon.
This is because the pathogen transmits to the organ it overcomes, mutually attacking, leading to death. The Heart is first affected, causing heart pain. Coughing after one day indicates transmission to the Lung, where Fire overcomes Metal. Rib fullness after three days indicates transmission to the Liver, where Metal overcomes Wood. Obstruction and body pain/heaviness after five days indicate transmission to the Spleen, where Wood overcomes Earth. After another three days, Earth overcomes Water, transmitting to the Kidney, leading to death. Since the Kidney is the root of Yin and Yang, midnight is when Yin is most abundant, and noon is when Yang is most abundant. Winter midnight is heavy Yin, summer noon is heavy Yang. Encountering these extreme biases of Yin or Yang cuts off the fundamental Yuan Qi of the body.
Lung disease presents with wheezing and coughing. After three days, rib support and pain occur; after one day, body heaviness and pain occur; after five days, distension occurs. If this persists for ten days without improvement, death occurs, in winter at sunset, in summer at sunrise.
This is transmission from Lung to Liver (Metal overcomes Wood), and Liver to Spleen (Wood overcomes Earth). When Spleen Earth fails, body swelling occurs after five days. Death after ten days corresponds to the numbers of generation and completion (Heaven generates 5 for Earth, Earth completes 10). The Qi of Heaven and Earth rises and falls annually; the Qi of the human body rises and falls daily. Rising Qi is vigorous, falling Qi is declining. Each Zang organ has its time of decline and vigor. When a failing organ encounters the peak of Qi decline or vigor, Yin and Yang cannot interact to generate life, leading to death. The logic behind the death times mentioned in previous sections is generally as follows. However, there are also various changes involving the Five Elements' generation and overcoming, such as sudden deaths from acute diseases, which are incalculable. The subtle principles are hard to explain and should not be forced or interpreted rigidly. By carefully examining the pulse and symptoms, the signs of life and death are clearly visible. Determining the exact moment of death requires divine wisdom.
Liver disease presents with dizziness and vertigo of the head and eyes, rib support and fullness. After three days, body heaviness and pain occur; after five days, distension occurs; after three days, lower abdominal and lumbar pain occur, with calf edema. If this persists for three days without improvement, death occurs, in winter at sunset, in summer at breakfast time.
This is transmission from Liver to Spleen, and Spleen to Kidney, leading to death.
Spleen disease presents with body pain and heaviness. After one day, distension occurs; after two days, lower abdominal, lumbar, and spinal pain occur, with calf edema; after three days, back and spine tendon pain occur, with urinary retention. If this persists for ten days without improvement, death occurs, in winter at Ren Ding hour, in summer at dinner time.
This is transmission from Spleen to Kidney, and Kidney to Bladder, causing back/spine tendon pain and urinary retention.
Kidney disease presents with lower abdominal, lumbar, and spinal pain, with calf edema. After three days, back and spine tendon pain occur, with urinary retention; after three days, abdominal distension occurs; after three days, bilateral rib support and fullness occur. If this persists for three days without improvement, death occurs, in winter at early morning, in summer at dusk.
This is transmission from Kidney to Bladder, Bladder to Spleen, and Spleen to Liver, representing reverse transmission to the organ that overcomes it.
Stomach disease presents with distension and fullness. After five days, lower abdominal, lumbar, and spinal pain occur, with calf edema; after three days, back and spine tendon pain occur, with urinary retention; after five days, body heaviness occurs. If this persists for six days without improvement, death occurs, in winter after midnight, in summer [time missing in original text].
This is transmission from Stomach to Kidney, Kidney to Bladder, and Bladder to Spleen, representing mutual transmission between Fu and Zang organs.
Bladder disease presents with urinary retention. After five days, lower abdominal distension, lumbar and spinal pain occur, with calf edema; after one day, abdominal distension occurs; after one day, body pain occurs. If this persists for two days without improvement, death occurs, in winter at Chicken Crowing hour, in summer at afternoon hour.
This is transmission from Bladder to Kidney, and Kidney to Spleen, leading to death. According to the human body, the five Zang and six Fu organs, along with external Ying and Wei, circulate Qi and Blood continuously without interruption. If there is disharmony, pathogens enter due to deficiency and follow the circulation of Qi and Blood. If the original Yuan Qi is strong, pathogens gradually exit; if Yuan Qi is insufficient, pathogens enter the Zang and Fu organs, transmitting mutually, eventually leading to exhaustion of Yuan Qi and death. Therefore, all the above sections discuss death due to pathogen transmission to Zang and Fu organs, not involving exterior diseases of Ying and Wei.