病夏至后变为热病然皆原于伤寒所致故曰热病者皆伤寒之类也○校正按伤寒论变温变暑与王注异王注本素问为说仲景本
阴阳大论为说）岐伯曰人之伤于寒也则为病热热虽甚不死（续寒毒薄于肌肤阳气不得散发而内怫结故伤寒反病热）其两
感于寒而病者必不免于死曰愿闻其状曰伤寒一日巨阳受之巨阳者诸阳之属也（巨大也太阳之气经络气血营卫于身故诸阳
气皆所宗属）其脉连于风府（穴名）故为诸阳主气也（足太阳脉浮气在于头凡五行故统主诸阳之气）故头项痛腰脊强二
日阳明受之阳明主肉其脉挟鼻络于目故身热目疼而鼻干不得卧也（续身热者以肉受邪胃中烦热故不得卧也）三日少阳受
之少阳主胆其脉循胁络于耳故胸胁痛而耳聋三阳经络皆受其病而未入于脏者故可汗而已四日太阴受之太阴脉布胃中络于
嗌故腹满而嗌干五日少阴受之少阴脉贯肾络于肺系舌本故口燥舌干而渴六日厥阴受之厥阴脉循阴器而络于肝故烦满而囊
缩曰治之奈何曰治之各通其脏脉病日衰已矣其未满三日可汗而已其满三日可泄而已其病两感于寒一日则巨阳与少阴俱病
则头痛口干而烦满二日则阳明与太阴俱病则腹满身热不欲食谵言（续谓妄谬不饮一云多言）三日则少阳与厥阴俱病则耳
聋囊缩而厥水浆不入不知人六日死（六日当作三日下文可见）三阴三阳五脏六腑皆受病营卫不行五脏不通则死矣曰五脏
已伤六腑不通营卫不行如是之后三日乃死何也曰阳明者十二经脉之长也（续为十二经血气之海）其血气盛故不知人三日
其气乃尽故死矣其不两感于寒者七日巨阳病衰头痛少愈八日阳明病衰（此以下就再经而言）身热少愈九日少阳病衰耳聋
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十二日厥阴病衰囊纵少腹微下大气（大邪之
气）皆去病日已矣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（此病暑与病渴不同病暑即
热病也宜发汗病渴则不宜汗矣）帝曰热病已愈时有所遗者何也（续邪气衰去不尽）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薄两热相合故有此遗也曰治遗奈何曰视其虚实调其逆从可使必已（续审其虚实而补
泻之则必已）曰病热当何禁之曰病热少愈食肉则复（复复旧病也）多食则遗此其禁也（续此谓戒食劳也热虽少愈犹未尽
除脾胃气虚故未能消化肉坚食驻故热复生热论）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（交谓交错也交合阴阳之气不分别也）人所以汗出者皆生于谷（续言谷气化为精精气胜乃为汗）谷
生于精今邪气交争于骨肉而得汗者是邪却而精胜也（续言初汗也）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（续谷不化则精不生故无可使为汗○愚谓谷气化为精今不能食则精无所俾益）
病而留者其寿可立而倾也（续甲乙经作而热留者王注病当作疾言汗出疾速留着而不去则必立致倾危）且夫热论曰（上古
篇名）汗出而脉尚躁盛者死（续凡汗后脉当迟静而反躁急盛满者是真气竭而邪胜故知必死）今汗不与脉相应此不胜其病
也（愚谓正气不胜其邪气）其死明矣狂言者是失志失志者死（续志合于精今精无俾益是志无所居故谓失志）今见三死不
见一生虽愈必死也（续汗出脉躁盛一死不胜其病二死狂言失志三死评热论）帝曰夫 疟皆生于风其蓄作有时者何也（续
犹老也亦瘦也）岐伯曰疟之始发也先起于毫毛伸欠乃作寒栗鼓颔（续栗战 鼓振动○愚谓此节论疟之形状）腰脊俱痛
寒去则内外皆热头痛如破渴欲冷冻饮料曰何气使然曰阴阳上下交争虚实更作阴阳相移也（续阳气者下行极而上阴气者上行极
而下故曰阴阳上下交争也阳虚则外寒阴虚则内热阳盛则外热阴盛则内寒由此寒去热生则虚实更作阴阳之气相移易也○愚
谓此节论疟之所以发寒热也又为一章之大旨下皆发明此节也）阳并于阴（阳兼疟邪而言谓疟邪随阳气而入于阴分）则阴
实而阳虚（盖营气所在为实不在为虚是也）阳明虚则寒栗鼓颔也（阳明胃脉循颐后下廉出大迎故气不足则恶寒战 而
颔振动也）巨阳虚则腰背头项痛（此下当有少阳虚一节）三阳俱虚则阴气（阴邪）胜阴气胜则骨寒而痛寒生于内故中外
皆寒阳盛则外热阴虚则内热（阳盛亦兼指疟邪而言谓疟邪随阳气而出于外则外之阴虚而阳盛故外热也此应阳气下极而上
也随阴气而入于内则内之阴虚而阳盛故内热此应阴气上行极而下也）外内皆热则喘而渴故欲冷冻饮料也（续热伤气则喘而渴
故欲冷冻饮料也）此皆得之夏伤于暑热气盛藏于皮肤之内肠胃之外此营气之所舍也（续舍犹居也肠胃之外营气所主故曰舍也）
此令人汗空疏腠理开因得秋气汗出遇风及得之以浴水气舍于皮肤之内与卫气并居（言卫气与营气相并合也○愚谓此营中
之卫气也从夏伤于暑至此原所以致疟之故也）卫气者（此乃 悍之卫气不与风寒暑湿合与营中之卫不同）昼日行于阳夜
行于阴此气（指疟）得阳而外出（愚谓指营中之阳盖疟气舍于皮肤之内与卫气并居故随此卫气而出于外与 悍之卫遇故
发之早也）得阴而内薄（愚谓指营言盖疟气藏于皮肤内与营气并居故随此荣而薄于内则内悍与利之卫遇故发之晚）内外
相薄是以日作曰其间日而作者何也其气（指疟）之舍深内薄于阴阳气独发（指 悍之阳也独发言其不与疟气遇也）阴邪
（疟邪）内着阴与（指疟邪）阳争（指悍卫）不得出是以间日而作也（续不与卫气相逢会故隔日发也○愚谓邪之盛衰随
人之气血消长气血旺则邪因之而旺气血衰则邪亦因之而衰久则脏气虚疟气亦虚不能与悍卫争故曰阳气独发必须积养二三
日待气血旺则疟邪亦旺故悍卫内入又复与之相抗而疟又作也）夫疟气者并于阳（乃营中之阳）则阳胜（兼疟言）并于阴
（指营言）则阴胜（兼疟言）阴胜则寒阳胜则热疟者风寒之气不常也病极则复（复谓复旧也言其气发至极还复如旧○愚
谓从卫气者昼行阳起至此言疟之所发早晏也）曰疟先寒而后热者何也曰夏伤于大暑其汗大出腠理开发因遇夏气凄沧之水
（一作小）寒藏于腠理皮肤之中秋伤于风则病成矣（续暑为阳气中风者阳气受之故秋伤于风则病成矣）夫寒者阴气也风
者阳气也先伤于寒而后伤于风故先寒而后热也病以时作名曰寒疟曰先热而后寒者何也曰此先伤于风而后伤于寒故先热而
后寒也亦以时作名曰温疟（续以其先热故谓之温）其但热而不寒者阴气先绝阳气独发（愚谓疟气更盛更虚或寒水之阴邪
先以消绝惟风暑之阳邪独在故曰阳气独发与前阳气独发不同前阳气指 悍卫气也）则少气烦冤手足热而欲呕名曰瘅疟（续
瘅者热者极热为之也○愚谓从疟先寒而后热者何也至此乃言疟有数种也）曰夫疟之寒汤火不能温也及其热冰水不能寒也
此皆有余不足之类当此之时良工不能止必须其自衰乃刺之其故何也曰经言无刺 之热（续盛热也）无刺浑浑之脉（续
无端绪也）无刺漉漉之汗（续汗大出）故为其病逆未可治也故经曰方其盛时必毁（续太素云勿敢必毁）因其衰也事必太
昌此之谓也夫疟之始发也阳气（兼邪）并于阴当是之时阳虚而阴盛（兼邪）外无气故先寒栗也阴气逆极则复出之阳阳与
阴复并于外则阴虚而阳实故先热而渴（续阴盛则胃寒故此寒战栗阳盛则胃热故先热欲饮也）夫疟之未发也阴未并阳阳未
并阴因而调之真气得安邪气乃亡故工不能治其已发为其气逆也（续真气寝息邪气大行真气不胜邪是为逆也）曰攻之奈何
曰
疟之且发也阴阳之且移也必从四末始也阳已伤阴从之故先其时坚束其处令邪气不得入阴气不得出审候见之在孙络盛坚而
血者皆取之此真（太素作真）往而未得并者（续言牢缚四肢令气各在其处则邪所居处必自见之既见之则出出其血尔往犹
去也）曰疟不发其应何如曰疟气者必更盛更虚当气之所在也病在阳（愚谓犹言病属阳阳乃风暑邪也）则热而脉躁在阴则
寒而脉静极则阴阳俱衰（续相薄至极物极则反故极则阴阳俱衰）卫气相离故病得休（愚谓阴阳相离盖言疟乃阴阳之邪阴
阳既已俱衰无能抵 悍之卫故疟之阴阳之邪与卫气相离不相争故疟得休也）卫气集则复病也（集谓与邪会）疟者阴阳更
胜也或甚或不甚故或渴或不渴（续阳胜阴甚则渴阳胜阴不盛甚则不渴也胜谓强于彼之气）曰说言夏伤于暑秋必病疟今疟
不必应者何也（续不必皆言然）曰此应四时者也其病异形者反四时也其以秋病者寒甚（续秋气清凉阳气下降热藏肌肉故
寒甚也）以冬病者寒不甚（续冬气冽严阳气伏藏不与寒争故寒不甚）以春病者恶风（续春气外和阳气外泄内腠开发故恶
于风）以夏病者多汗（续夏气暑热津液充溢外泄皮肤故多汗也）曰夫病温疟而皆安舍舍于何脏曰温疟得之冬中于风寒气
藏于骨髓之中至春则阳气大发邪气不能自出因遇大暑脑髓烁肌肉消腠理发泄或有所用力邪气与汗皆出此病藏于肾其气先
从内出之于外也（续肾主冬冬主骨髓脑为髓海上下相应厥热上熏故脑髓消烁则热气外薄故肌肉减削而病藏于肾也○愚谓
春虽阳气大发尚未尽至于表至夏大暑则阳气尽出于表腠理开泄故肾脏之疟如得从出而出之于外也）阴虚而阳盛阳盛则热
矣（续阴虚谓肾脏气虚阳盛谓巨阳气盛）衰则气复反入入则阳虚阳虚则寒矣（愚谓阳盛极则阴必虚疟则乘虚复入于里而
里之阳已被疟害而虚阳虚则阴实矣故复寒也此可见疟气更盛更虚之验也此条阴阳指经气言也续衰谓病衰退也复反入谓入
肾阴脉中）故先热而后寒名曰温疟曰瘅疟何如曰瘅疟者瘅疟者肺素有热气盛于身厥逆上冲中气实而不外泄（愚谓言肺中
之气实故腠理密而肺热不能外泄）因有所用力腠理开风寒舍于皮肤之内分肉之间而发发则阳气独盛（兼疟言）而不衰则
病矣其气不及于阴故但热而不寒气内藏于心而外舍于分肉之间令人消烁肌肉故命曰瘅疟（疟论）帝曰火热复恶寒发热有
如疟状或一日发或间数日发其故何也曰胜复之气会遇之时有多少也阴气多而阳气少则其发日远阳气多而阴气少则其发日
近此胜复相薄盛衰之节疟亦同法（续阴阳齐等则一日之中寒热相半阳多阴少则一日之发但热不寒阳少阴多则隔日发先寒
后热虽胜复之气若气微则一发后六七日乃发故云愈而复发或频三日发而六七日或止隔十日发而四五日止者皆由气之多少
会遇与不会遇也俗语鬼神暴疾而从祈祷避匿者病势已过旋至于毙自谓其分宁不伤楚习俗既久卒难厘革悲哉奈何至真要
论）○帝曰肺之令人咳何也岐伯曰五脏六腑皆令人咳非独肺也曰愿闻其状曰皮毛者肺之合也皮毛先受邪气邪气以从其合
也（续邪寒邪）其寒饮食入胃从肺脉上至于肺则肺寒肺寒则外内合邪因而客之则为肺咳五脏各以其时受病非其时各传以
与之（续时谓王月也非王月不受邪故各传以与之之）人与天地相参故五脏各以治时感于寒则受病微则为咳甚者为泄为痛
（续寒气微则外应皮毛内通肺故咳寒气甚则入于内内裂则痛入于肠胃则泄利）乘秋则肺先受邪乘春则肝先受之乘夏则心
先受之乘至阴则脾先受之乘冬则肾先受之（续以当用事之时故先受邪气）曰何以异之（异分别也）曰肺咳之状咳而喘息
有音甚则唾血（续肺藏气而应息故咳则喘息而喉中有声甚则肺络逆故唾血也）心咳之状咳则心痛喉仲介介如梗状甚则咽
肿喉痹（续少阴脉从心系上挟咽喉故病如是）肝咳之状咳则两胁下痛甚则不可以转转则两 下满（ 亦胁也）脾咳之状
咳则右 下痛阴阴引肩背甚则不可以动动则咳剧（续脾气连肺故痛引肩背也脾气主右故右 下阴阴然深慢痛也）肾咳之
状咳则腰背相引而痛甚则咳涎曰六腑之咳奈何曰五脏之久咳乃移于六腑脾咳不已则胃受之胃咳之状咳而呕呕甚则长虫出
（续脾与胃合故脾咳不已胃受之也胃寒则呕呕甚则肠气逆上故长虫出）肝咳不已则胆受之胆咳之状咳呕胆汁（续胆气好
逆故呕温苦汁也）肺咳不已则大肠受之大肠咳状咳而遗失（失当作矢如一饭三遗矢大肠为传送之府故寒入则气不禁）心
咳不已则小肠受之小肠咳状咳而失气气与咳俱失（续小肠脉络心故病如是又小肠寒盛气入大肠咳则小肠气下奔故失气
也）肾咳不已则膀胱受之膀胱咳状咳而遗溺（续膀胱为津液之府故遗溺）久咳不已则三焦受之三焦咳状咳而腹满不欲食
饮此皆聚于胃关于肺使人多涕唾而面浮肿气逆也（通结上文○三焦非谓手少阳也谓上焦中焦尔上焦出胃上口并咽以上贯
膈布胸中走腋中焦亦至于胃口出上焦之后此所受气者泌糟粕蒸津液化其精微上注于肺脉乃化而为血故言皆聚于胃关于肺
也两焦受病则邪气熏肺而肺气满故使人多涕唾面浮肿气逆也腹满不欲食者胃寒故也不谓下焦者下焦别于回肠注于膀胱故
水谷者常并居于胃中盛糟粕而俱下于大肠泌别汁循下焦而渗入膀胱寻此行化乃与胃口悬远故不谓此也）曰治之奈何曰治
岐伯说：人受寒邪侵袭，就会发为热病。虽然热势很盛，但不会致死。（补充：寒毒侵薄肌肤，阳气不能发散而郁结在内，所以伤寒反而表现为热病。）如果是表里两经同时感受寒邪而发病的，就一定难免于死。
黄帝说：我希望了解这种病的症状表现。
岐伯说：伤寒第一天，太阳经（足太阳膀胱经，诸阳之属）受邪。太阳经是诸阳经的统领，因为它的经络气血营卫遍布全身，所以诸阳之气都归它宗主。其经脉连接风府穴，所以它是诸阳经的主气。因此出现头痛、项强、腰脊疼痛的症状。
第二天，阳明经（足阳明胃经）受邪。阳明经主肌肉，其经脉挟行鼻旁，联络眼睛，所以出现身体发热、目痛、鼻干、不能安卧的症状。（补充：身热是因为肌肉受邪，胃中烦热，所以不能安卧。）
第三天，少阳经（足少阳胆经）受邪。少阳经主胆，其经脉循行胁肋，联络耳朵，所以出现胸胁疼痛和耳聋的症状。这三条阳经的经络都受了病邪，但病邪还没有传入五脏，所以可以通过发汗的方法治愈。
第四天，太阴经（足太阴脾经）受邪。太阴经散布在胃中，联络咽喉，所以出现腹部胀满、咽喉干燥的症状。
第五天，少阴经（足少阴肾经）受邪。少阴经贯穿肾脏，联络肺系和舌根，所以出现口燥、舌干、口渴的症状。
第六天，厥阴经（足厥阴肝经）受邪。厥阴经循行生殖器，联络肝脏，所以出现心烦、腹满、睾丸收缩的症状。
黄帝说：治疗上该怎么办？
岐伯说：治疗应当分别疏通各脏的经脉，病邪日渐衰退，病就好了。病程未满三天的，可以通过发汗治愈；病程已满三天的，可以通过泄下法治愈。
如果是表里两经同时感受寒邪，第一天就是太阳经与少阴经同时发病，出现头痛、口干、心烦腹满；第二天就是阳明经与太阴经同时发病，出现腹部胀满、身体发热、不想吃东西、胡言乱语（补充：指言语妄谬不饮一物，一说多言）；第三天就是少阳经与厥阴经同时发病，出现耳聋、睾丸收缩、四肢厥冷、水浆不进、神志昏迷。到了第六天就会死亡（注：此处“六日”应为“三日”，从下文可以印证）。如果三阴三阳、五脏六腑都受到病邪，营卫之气运行停滞，五脏气机不通，就会死亡。
黄帝说：如果五脏已经受伤，六腑不通，营卫不行，在此之后三天才死亡，这是为什么呢？
岐伯说：阳明经是十二经脉之长（补充：为十二经血气之海），它的血气最旺盛，所以人神志昏迷三天，等到它的血气耗尽，才会死亡。
那些没有表里两经同病的，第七天太阳经的病势衰退，头痛减轻；第八天阳明经的病势衰退，身体发热减轻（以下就再经而言）；第九天少阳经的病势衰退，耳聋稍有好转，能微微听到声音；第十天太阴经的病势衰退，腹部胀满消退，恢复如常，开始想吃饭；第十一天少阴经的病势衰退，口渴停止，腹胀消失，舌干已愈，并且打喷嚏；第十二天厥阴经的病势衰退，睾丸松弛，小腹轻微舒适，大邪之气全部去除，病就好了。
凡是患伤寒而转化为温病的，在夏至之前发病的叫温病，在夏至之后发病的叫暑病。暑病应当随汗而出，不要强行止汗（此病暑与病渴不同，病暑即热病，宜发汗；病渴则不宜发汗）。
岐伯说：凡是余热遗留，是因为热势很盛时勉强进食，所以有遗留。像这种情况，都是病邪已经衰退，但热邪有所潜藏，因为谷气与残存的热邪相互搏结，两热相合，所以产生余热遗留。
岐伯说：观察病人的虚实，调理气机的逆顺，就可以使病必愈。（补充：审察其虚实而进行补泻，则必愈。）
岐伯说：患热病时，如果稍微好转就吃肉，病就会复发（复：复发旧病）；吃得太多，就会产生余热遗留。这就是需要禁忌的。（补充：这是告诫避免饮食劳倦。热虽稍好但未完全清除，脾胃气虚，所以不能消化肉类，食物停驻，导致热邪再生。）
黄帝说：有一种温病，出汗后随即又发热，脉象躁急，不因出汗而减缓，狂言乱语，不能进食，这叫什么病？
岐伯说：这病名叫阴阳交，阴阳交属于死证。（交：指交错，阴阳之气交合而不分离。）
人之所以出汗，都是因为谷气化生精微（补充：言谷气化为精，精气胜乃为汗）。谷气生于精气。现在邪气与精气在骨肉之间交争，能够出汗，说明邪气退却而精气胜利（补充：言初汗也）。精气胜利，就应当能吃东西且不重新发热。如果重新发热，那是邪气在作祟。汗是由精气化生的，现在出汗后随即又发热，这是邪气胜过正气。如果不能吃东西，精气就没有来源补充（补充：谷不化则精不生，故无可使为汗。愚按：谷气化为精，今不能食则精无所俾益）。
病邪留恋不去，寿命很快就会终结（补充：甲乙经作“而热留者”，王注认为“病”当作“疾”，言汗出疾速留着不去，则必立即导致倾危）。况且《热论》篇中说：出汗后脉象仍然躁盛的一定要死（补充：凡汗后脉当迟静，而反躁急盛满者，是真气竭而邪胜，故知必死）。现在汗出与脉象不相适应，这是正气不胜邪气（愚按：正气不胜其邪气）。死亡是明显的了。狂言乱语是失志的表现，失志的要死（补充：志合于精，今精无俾益，是志无所居，故谓失志）。现在见到三种死征而不见一种生机，虽然暂时看似好转，最终一定会死（补充：1. 汗出脉躁盛；2. 不胜其病；3. 狂言失志，见评热论）。
黄帝说：疟疾都是由风邪引起的，但它发作和休止都有定时，这是为什么呢？（补充：犹老也，亦瘦也。）
岐伯说：疟疾刚开始发作时，先起于毫毛竖立，伸欠哈欠，然后开始恶寒战栗，下巴抖动（补充：栗战鼓振动。愚按：此节论疟之形状），腰脊俱痛。寒战过去后，内外都发热，头痛剧烈如破裂感，口渴想要喝冷饮。
黄帝说：是什么气使得这样呢？
岐伯说：这是阴阳上下交争，虚实更替变化的结果，阴阳之气相互移易（补充：阳气者下行极而上，阴气者上行极而下，故曰阴阳上下交争也。阳虚则外寒，阴虚则内热，阳盛则外热，阴盛则内寒。由此寒去热生，则虚实更作，阴阳之气相移易也。○愚按：此节论疟之所以发寒热也，又为一章之大旨，下皆发明此节也）。
阳气并入阴分（阳兼指疟邪而言，谓疟邪随阳气而入于阴分），则阴实而阳虚（盖营气所在为实，不在为虚是也）。阳明经气虚则恶寒战栗、下巴抖动（阳明胃脉循颐后下廉出大迎，故气不足则恶寒战栗而颔振动也）。太阳经气虚则腰背头项疼痛（此下当有少阳虚一节）。三阳经气都虚，则阴邪胜。阴邪胜则骨寒而痛，寒生于内，所以内外皆寒。
阳气盛则外热，阴虚则内热（阳盛亦兼指疟邪而言，谓疟邪随阳气而出于外，则外之阴虚而阳盛，故外热也。此应阳气下极而上也。随阴气而入于内，则内之阴虚而阳盛，故内热，此应阴气上行极而下也）。外内皆热，则气喘且口渴，所以想要喝冷饮（补充：热伤气则喘而渴，故欲冷冻饮料也）。
这都是因为夏天伤了暑气，热气盛大，藏在皮肤之内、肠胃之外，这里是营气所居之处（补充：舍犹居也，肠胃之外，营气所主，故曰舍也）。这使得毛孔疏松，腠理开泄，因而遇到秋天的凉气，或者出汗时遇风，或者洗澡时水气侵入，这些邪气藏在皮肤之内，与卫气并居（言卫气与营气相并合也。○愚按：此营中之卫气。从夏伤于暑至此，原所以致疟之故也）。
卫气（此为悍疾之卫气，不与风寒暑湿合，与营中之卫不同）白天行于阳分，夜晚行于阴分。这种疟气（指疟邪）遇到卫气外出到阳分就随之外出（愚按：指营中之阳，盖疟气舍于皮肤之内，与卫气并居，故随此卫气而出于外，与悍之卫遇，故发之早也）；遇到卫气进入阴分就随之深入（愚按：指营言，盖疟气藏于皮肤内，与营气并居，故随此荣而薄于内，则内悍与利之卫遇，故发之晚）。内外相薄，所以每天发作。
岐伯说：这种疟气潜伏较深，向内迫近于阴分，只有卫气单独发动（指悍之阳也，独发言其不与疟气遇也）。阴邪（疟邪）内着，阴与阳（指疟邪与悍卫）争，不得外出，所以隔一天发作一次（补充：不与卫气相逢会，故隔日发也。○愚按：邪之盛衰随人之气血消长，气血旺则邪因之而旺，气血衰则邪亦因之而衰。久则脏气虚，疟气亦虚，不能与悍卫争，故曰阳气独发。必须积养二三日，待气血旺，则疟邪亦旺，故悍卫内入，又复与之相抗，而疟又作也）。
夫疟气，并入阳分则阳胜（兼疟言），并入阴分则阴胜（兼疟言）。阴胜则寒，阳胜则热。疟疾的风寒之气不是常态，病情极盛时会反复（复谓复旧也，言其气发至极还复如旧。○愚按：从卫气者昼行阳起，至此言疟之所发早晏也）。
岐伯说：这是因为夏天受了大暑，汗大出，腠理开发，因而遇到夏天的凄沧水寒（一作小寒），寒气藏在腠理皮肤之中。秋天伤了风邪，病就形成了（补充：暑为阳气，中风者阳气受之，故秋伤于风则病成矣）。寒是阴气，风是阳气。先伤于寒，后伤于风，所以先寒而后热。病按时发作，名叫寒疟。
岐伯说：这是因为先伤于风，后伤于寒，所以先热而后寒。也是按时发作，名叫温疟（补充：以其先热，故谓之温）。
那种只发热不恶寒的，是因为阴气先绝，阳气独发（愚按：疟气更盛更虚，或寒水之阴邪先以消绝，惟风暑之阳邪独在，故曰阳气独发。与前阳气独发不同，前阳气指悍卫气也），所以少气、烦闷、手足发热、想呕吐，名叫瘅疟（补充：瘅者热也，极热为之也。○愚按：从疟先寒而后热者何也至此，乃言疟有数种也）。
黄帝说：疟疾发作时，用汤火不能使其温暖，等到发热时，用冰水也不能使其寒冷。这都是有余和不足的情况。在这个时候，即使是良医也不能制止，必须等病势自然衰退才能针刺。这是什么缘故？
岐伯说：经文说：不要在热势炽盛时针刺（续：盛热也），不要在脉象混乱无序时针刺（续：无端绪也），不要在大汗淋漓时针刺（续：汗大出）。因为这些时候病气逆乱，不可治疗。所以经文说：当其邪气盛时，必然损伤正气（续：太素云勿敢必毁）；因其邪气衰退时，治疗必然昌盛。说的就是这个道理。
疟疾刚开始发作时，阳气（兼指邪气）并入阴分，这个时候阳虚而阴盛（兼指邪气），体表没有阳气，所以先出现寒战。阴气逆乱到极点， then 复出到阳分。阳与阴再次并集于外，则阴虚而阳实，所以先出现发热和口渴（补充：阴盛则胃寒，故此寒战栗；阳盛则胃热，故先热欲饮也）。
疟疾在未发作时，阴未并阳，阳未并阴，此时调治，真气得以安宁，邪气乃亡。所以医生不能在发作时治疗，因为那时气机逆乱（补充：真气寝息，邪气大行，真气不胜邪，是为逆也）。
黄帝说：如何攻治？
岐伯说：疟疾将要发作时，阴阳之气即将移易，一定从四肢末端开始。阳气已伤，阴气随之。所以在发作之前，牢固地束缚患处，使邪气不得入，阴气不得出。仔细诊察，看到孙络盛坚且有瘀血的，都予以刺破放血。这是在真气前往而未与邪气相并的时候（续：言牢缚四肢，令气各在其处，则邪所居处必自见之。既见之，则出出其血尔。往犹去也）。
岐伯说：疟气必定更盛更虚，当气在某个部位时，病在阳分（愚按：犹言病属阳，阳乃风暑邪也），则发热而脉躁动；病在阴分，则发冷而脉静止。极盛时阴阳俱衰（续：相薄至极，物极则反，故极则阴阳俱衰）。卫气与邪气分离，所以病得休止（愚按：阴阳相离，盖言疟乃阴阳之邪，阴阳既已俱衰，无能抵悍之卫，故疟之阴阳之邪与卫气相离，不相争，故疟得休也）。卫气集合，则又发病（集谓与邪会）。疟疾是阴阳更替胜负，有的重有的轻，所以有的口渴，有的不渴（续：阳胜阴甚则渴，阳胜阴不盛甚则不渴也。胜谓强于彼之气）。
黄帝说：您说夏天伤于暑，秋天必定病疟。现在疟疾不一定都应验，这是为什么？
岐伯说：这是顺应四时的。但病情形态不同的，反而违背四时规律。在秋天发病的，寒甚（续：秋气清凉，阳气下降，热藏肌肉，故寒甚也）；在冬天发病的，寒不甚（续：冬气冽严，阳气伏藏，不与寒争，故寒不甚）；在春天发病的，怕风（续：春气外和，阳气外泄，内腠开发，故恶于风）；在夏天发病的，多汗（续：夏气暑热，津液充溢，外泄皮肤，故多汗也）。
岐伯说：温疟是由于冬天中了风寒，气藏在骨髓之中。到了春天，阳气大发，邪气不能自己排出，因而遇到大暑，脑髓被灼烧，肌肉消瘦，腠理发泄，或者有所用力，邪气随汗而出。此病藏在肾，其气先从内出于外（续：肾主冬，冬主骨髓，脑为髓海，上下相应，厥热上熏，故脑髓消烁，则热气外薄，故肌肉减削，而病藏于肾也。○愚按：春虽阳气大发，尚未尽至于表，至夏大暑，则阳气尽出于表，腠理开泄，故肾脏之疟如得从出，而出之于外也）。阴虚而阳盛，阳盛则热（续：阴虚谓肾脏气虚，阳盛谓巨阳气盛）。衰退时，气又复返入内，入内则阳虚，阳虚则寒（愚按：阳盛极则阴必虚，疟则乘虚复入于里，而里之阳已被疟害而虚，阳虚则阴实矣，故复寒也。此可见疟气更盛更虚之验也。此条阴阳指经气言也。续：衰谓病衰退也，复反入谓入肾阴脉中）。所以先热而后寒，名叫温疟。
岐伯说：瘅疟患者，肺素有热，热气盛于身，气逆上冲，中气实而不能外泄（愚按：言肺中之气实，故腠理密，而肺热不能外泄）。因而有所用力，腠理开，风寒舍于皮肤之内、分肉之间而发作。发作时阳气独盛（兼疟言）而不衰，就病了。其气不及于阴，所以只发热不恶寒。寒气内藏于心，外舍于分肉之间，使人肌肉消烁，所以名叫瘅疟（引自《疟论》）。
黄帝说：火热交替，恶寒发热，有如疟疾的样子，有时一天发作，有时隔几天发作，这是什么缘故？
岐伯说：胜复之气相遇的时间有多有少。阴气多而阳气少，则发作间隔远；阳气多而阴气少，则发作间隔近。这种胜复相薄、盛衰的节律，疟疾也遵循同样的法则（续：阴阳齐等，则一日之中寒热相半；阳多阴少，则一日之发但热不寒；阳少阴多，则隔日发，先寒后热。虽胜复之气，若气微，则一发后六七日乃发，故云愈而复发；或频三日发而六七日，或止隔十日发而四五日止者，皆由气之多少会遇与不会遇也。俗语鬼神暴疾而从祈祷避匿者，病势已过，旋至于毙，自谓其分宁不伤楚。习俗既久，卒难厘革，悲哉奈何！至真要论）。
黄帝说：我想听听具体情况。
岐伯说：皮毛是肺的外合。皮毛先受邪气，邪气就顺着肺的外合而入（续：邪寒邪）。寒冷的饮食入胃，顺着肺脉上行至于肺，则肺寒。肺寒则外内合邪，因而客居于肺，就成为肺咳。
五脏各自在其所主的时令受病，如果不是其所主的时令，则传给其他脏与之相应（续：时谓王月也，非王月不受邪，故各传以与之之）。人与天地相参，所以五脏各自在其当令之时感受寒邪则受病。轻微的则为咳嗽，严重的则为泄泻或疼痛（续：寒气微则外应皮毛，内通肺，故咳；寒气甚则入于内，内裂则痛，入于肠胃则泄利）。
乘秋令则肺先受邪，乘春令则肝先受之，乘夏令则心先受之，乘长夏（至阴）则脾先受之，乘冬令则肾先受之（续：以当用事之时，故先受邪气）。
黄帝说：如何区分它们？
岐伯说：肺咳的症状是咳嗽伴有喘息，有声音，严重时唾血（续：肺藏气而应息，故咳则喘息而喉中有声，甚则肺络逆，故唾血也）。
心咳的症状是咳嗽时心痛，喉咙中间感觉像有异物梗塞，严重时咽喉肿痛、喉痹（续：少阴脉从心系上挟咽喉，故病如是）。
肝咳的症状是咳嗽时两侧胁下疼痛，严重时不能转身，转身则两胁下胀满（胁亦称胁）。
脾咳的症状是咳嗽时右胁下疼痛，隐隐牵引肩背，严重时不能活动，一动则咳嗽加剧（续：脾气连肺，故痛引肩背也。脾气主右，故右胁下阴阴然深慢痛也）。
岐伯说：五脏久咳不愈，就会转移影响六腑。脾咳不愈，则胃受之。胃咳的症状是咳嗽伴呕吐，呕吐严重时蛔虫吐出（续：脾与胃合，故脾咳不已，胃受之也。胃寒则呕，呕甚则肠气逆上，故长虫出）。
肝咳不愈，则胆受之。胆咳的症状是咳嗽伴呕吐胆汁（续：胆气好逆，故呕温苦汁也）。
肺咳不愈，则大肠受之。大肠咳的症状是咳嗽伴大便失禁（失当作矢，如一饭三遗矢，大肠为传送之府，故寒入则气不禁）。
心咳不愈，则小肠受之。小肠咳的症状是咳嗽伴失气，气与咳嗽一同排出（续：小肠脉络心，故病如是。又小肠寒盛，气入大肠，咳则小肠气下奔，故失气也）。
肾咳不愈，则膀胱受之。膀胱咳的症状是咳嗽伴遗尿（续：膀胱为津液之府，故遗溺）。
久咳不愈，则三焦受之。三焦咳的症状是咳嗽伴腹部胀满，不想饮食。
这些都是邪气聚集于胃，关联于肺，使人多涕唾，面部浮肿，气机上逆所致（通结上文。○三焦非谓手少阳也，谓上焦中焦尔。上焦出胃上口，并咽以上贯膈，布胸中，走腋。中焦亦至于胃口，出上焦之后，此所受气者，泌糟粕，蒸津液，化其精微，上注于肺脉，乃化而为血，故言皆聚于胃，关于肺也。两焦受病，则邪气熏肺，而肺气满，故使人多涕唾，面浮肿，气逆也。腹满不欲食者，胃寒故也。不谓下焦者，下焦别于回肠，注于膀胱，故水谷者常并居于胃中，盛糟粕而俱下于大肠，泌别汁循下焦而渗入膀胱，寻此行化，乃与胃口悬远，故不谓此也）。
黄帝说：治疗上该怎么办？
Qibo said: When humans are injured by cold pathogens, they develop febrile diseases. Although the heat may be severe, it is not fatal. (Supplement: Cold toxins invade the skin and muscles, preventing the dispersal of yang qi, which becomes internally constrained; thus, cold injuries manifest as heat.) However, if both exterior and interior meridians are simultaneously affected by cold, death is inevitable.
Huangdi said: I wish to understand the manifestations of this condition.
Qibo said: On the first day of a cold injury, the Taiyang meridian (Foot-Taiyang Bladder Meridian, the commander of all yang meridians) is affected. The Taiyang meridian governs the qi of all yang meridians because its collaterals, blood, qi, ying, and wei circulate throughout the body. Its vessels connect to the Fengfu acupoint, making it the master of yang qi. Consequently, symptoms include headache, stiffness of the neck and back, and pain in the waist and spine.
On the second day, the Yangming meridian (Foot-Yangming Stomach Meridian) is affected. Yangming governs the flesh; its vessels run along the nose and connect to the eyes. Symptoms include fever, eye pain, dryness of the nose, and inability to sleep. (Supplement: Fever arises because the flesh is invaded by pathogens, causing irritability and heat in the stomach.)
On the third day, the Shaoyang meridian (Foot-Shaoyang Gallbladder Meridian) is affected. Shaoyang governs the gallbladder; its vessels traverse the hypochondrium and connect to the ears. Symptoms include pain in the chest and hypochondrium, and deafness. If the disease affects these three yang meridians but has not yet entered the zang organs, it can be cured by inducing sweating.
On the fourth day, the Taiyin meridian (Foot-Taiyin Spleen Meridian) is affected. Taiyin spreads through the stomach and connects to the throat. Symptoms include abdominal fullness and dryness of the throat.
On the fifth day, the Shaoyin meridian (Foot-Shaoyin Kidney Meridian) is affected. Shaoyin passes through the kidneys, connects to the lung system, and reaches the root of the tongue. Symptoms include dry mouth, dry tongue, and thirst.
On the sixth day, the Jueyin meridian (Foot-Jueyin Liver Meridian) is affected. Jueyin traverses the genitalia and connects to the liver. Symptoms include vexation, abdominal fullness, and contraction of the scrotum.
Huangdi asked: How should this be treated?
Qibo replied: Treatment should focus on unblocking the meridians of the respective organs. As the pathogenic factors decline, the illness will resolve. If the duration is less than three days, induce sweating. If it exceeds three days, use purgation.
In cases where exterior and interior meridians are simultaneously affected: On the first day, Taiyang and Shaoyin are both diseased, presenting with headache, dry mouth, and vexation/fullness. On the second day, Yangming and Taiyin are both diseased, presenting with abdominal fullness, fever, anorexia, and delirium (supplement: referring to incoherent speech or excessive talking). On the third day, Shaoyang and Jueyin are both diseased, presenting with deafness, scrotal contraction, cold limbs, inability to swallow fluids, and unconsciousness. Death occurs by the sixth day (Note: "Sixth day" likely refers to the third day based on subsequent text). If all three yin and yang meridians and the five zang and six fu organs are affected, and the circulation of ying and wei qi ceases while the five zang organs become blocked, death ensues.
Huangdi asked: If the five zang organs are damaged, the six fu organs are blocked, and ying and wei qi do not circulate, why does death occur three days later?
Qibo explained: The Yangming meridian is the leader of the twelve meridians (the sea of blood and qi of the twelve meridians). Its blood and qi are most abundant. Therefore, after a person loses consciousness for three days, when their qi is exhausted, they die.
For those not suffering from simultaneous exterior-interior infection: On the seventh day, the Taiyang disease declines, and headache improves slightly. On the eighth day, Yangming disease declines, and body heat subsides slightly. On the ninth day, Shaoyang disease declines, and hearing improves slightly. On the tenth day, Taiyin disease declines, abdominal fullness resolves, appetite returns. On the eleventh day, Shaoyin disease declines, thirst stops, bloating ceases, tongue dryness resolves, and sneezing occurs. On the twelfth day, Jueyin disease declines, the scrotum relaxes, lower abdominal discomfort subsides, and major pathogenic factors are expelled, leading to recovery.
Regarding cold injuries transforming into warm diseases: Those occurring before the Summer Solstice are called Warm Diseases (Wen Bing); those occurring after are called Summerheat Diseases (Shu Bing). Summerheat diseases should be treated by allowing sweat to escape; do not forcibly stop sweating. (Summerheat differs from thirst-related conditions; summerheat requires sweating, whereas thirst does not.)
Huangdi asked: Why do residual heat persist after a febrile disease has seemingly resolved?
Qibo answered: Residual heat occurs when food is consumed forcefully while heat is still intense. Even if the pathogen has declined, heat remains latent. The qi from food interacts with residual heat, combining to create lingering heat.
Huangdi asked: How should residual heat be treated?
Qibo replied: Assess deficiency and excess, and regulate the reversal and normal flow of qi. This ensures recovery. (Supplement: By examining deficiency/excess and applying tonification or drainage, recovery is guaranteed.)
Huangdi asked: What dietary restrictions apply to febrile diseases?
Qibo stated: If meat is eaten when the fever begins to subside, the disease will relapse. Overeating causes residual heat. These are the prohibitions. (Supplement: This warns against dietary indiscretion. Although heat subsides slightly, spleen and stomach qi are weak and cannot digest tough meat, leading to stagnation and regeneration of heat.)
Huangdi asked: There is a condition called Warm Disease where sweating is followed immediately by renewed fever, rapid and restless pulse that does not slow with sweat, delirium, and an inability to eat. What is this disease named?
Qibo replied: This is called Yin-Jiao (Yin-Yang Intersection), which is a fatal condition. (Jiao means intersection, where yin and yang qi mix without separation.)
Sweat is generated from grain qi transforming into essence. Now, if pathogens contend with essence in the muscles and bones, and sweat is produced, it indicates that pathogens are retreating and essence is victorious. If essence is victorious, the patient should be able to eat and not have recurrent fever. Recurrent fever indicates pathogenic victory. Sweat is derived from essence; if fever recurs after sweating, it shows pathogen victory. Inability to eat means essence has no source for replenishment (Supplement: Grain transforms into essence; inability to eat means essence lacks support). If the disease lingers, life will soon end. Furthermore, the *Heat Treatise* states: If pulse remains rapid and full after sweating, death is certain. Here, sweat and pulse are discordant, indicating righteous qi cannot overcome pathogenic qi. Death is evident. Delirium indicates loss of Zhi (will/mind), which is fatal. Seeing three signs of death and no sign of life means death is inevitable despite temporary improvement.
Huangdi asked: Malaria is caused by wind, yet it has periodic attacks and remissions. Why?
Qibo explained: Malaria initially presents with piloerection, yawning, followed by chills and shaking of the jaw, pain in the waist and spine. After chills cease, internal and external heat arise, causing severe headache, thirst, and desire for cold drinks.
Huangdi asked: What qi causes this?
Qibo replied: It is due to the contention between yin and yang, shifting between deficiency and excess, and the migration of yin and yang qi. When yang qi merges into yin, yin becomes full and yang deficient. Yangming deficiency causes chills and jaw shaking. Taiyang deficiency causes pain in the waist, back, head, and neck. If all three yang meridians are deficient, yin pathogens prevail, causing bone cold and pain. Internal cold leads to external cold. Yang excess causes external heat; yin deficiency causes internal heat. External and internal heat cause panting, thirst, and desire for cold drinks.
This results from summer heat injuring the body during summer. Heat resides inside the skin and outside the intestines/stomach, where ying qi dwells. This makes pores loose and interstices open. Autumn coolness, wind encountered during sweating, or water from bathing enters the skin and resides with wei qi.
Wei qi travels through yang during the day and yin at night. This malaria qi follows wei qi outward to yang (early onset) or inward to yin (late onset). Their interaction causes daily attacks.
Huangdi asked: Why do some cases attack every other day?
Qibo replied: The malaria qi hides deeply, pressing against yin. Only wei qi moves independently. Yin pathogens reside internally, contending with yang (wei qi), unable to exit, causing every-other-day attacks. (Supplement: Pathogen strength varies with righteous qi. When righteous qi is strong, pathogens thrive; when weak, they recede. Eventually, organ qi weakens, malaria qi also weakens, unable to contend with wei qi. It takes two to three days for qi to accumulate, allowing pathogens to thrive again, leading to recurrence.)
When malaria qi merges with yang, yang prevails; when it merges with yin, yin prevails. Yin prevalence causes cold; yang prevalence causes heat.
Huangdi asked: Why does some malaria start with cold then heat?
Qibo replied: Summer heat causes profuse sweating and open pores. Winter cold hides in the interstices. Autumn wind completes the pathology. Cold is yin, wind is yang. Injury by cold first, then wind, results in cold preceding heat. This is called Cold Malaria.
Why does some malaria start with heat then cold?
Qibo replied: Injury by wind first, then cold, results in heat preceding cold. This is called Warm Malaria.
What about malaria with only heat and no cold?
Qibo replied: This is Dan Malaria. Yin qi is exhausted, and yang qi acts alone. Symptoms include shortness of breath, vexation, hot hands and feet, and nausea.
Huangdi asked: Why can neither fire nor ice control the temperature fluctuations in malaria? Why must treatment wait for natural decline?
Qibo replied: Classics state: Do not needle when heat is extreme, pulse is chaotic, or sweating is profuse. At these times, pathogenic qi is rebellious. Needle when qi is盛 (excessive/strong) damages righteous qi; needle when qi is declining ensures success.
At the onset of malaria, yang merges into yin, causing external cold. When yin reverses and merges with yang externally, yin becomes deficient and yang excess, causing heat and thirst. Treatment should occur before onset when yin and yang are not yet merged, allowing righteous qi to rest and pathogens to vanish. Treating during发作 (attack) fails because qi is rebellious.
To treat: Bind the extremities firmly before onset to prevent pathogen entry and righteous qi exit. Observe for full and hard sun-collaterals with blood stasis, and puncture them. This targets the pathogen before it merges with righteous qi.
When malaria is not attacking, what is the pulse like?
Qibo replied: Malaria qi fluctuates between excess and deficiency. When in yang, heat and rapid pulse occur; when in yin, cold and quiet pulse occur. At extremes, both yin and yang decline. Wei qi separates from pathogens, and the disease rests. When wei qi gathers, the disease recurs. Malaria involves alternating yin-yang victory. Thirst depends on whether yang overcomes yin significantly.
Huangdi asked: You said summer heat leads to autumn malaria. Why don't all cases follow this?
Qibo replied: Most follow the four seasons. Deviations occur due to different pathological forms. Autumn cases have severe cold; winter cases have mild cold; spring cases involve aversion to wind; summer cases involve profuse sweating.
Huangdi asked: Where does the pathogen of Warm Malaria reside? Which zang organ?
Qibo replied: Warm Malaria originates from winter wind-cold hiding in the bone marrow. In spring, rising yang qi cannot expel the pathogen. Summer heat burns brain marrow, consumes muscle, opens pores, or physical exertion forces pathogen out with sweat. The pathogen resides in the Kidney, moving from interior to exterior. Yin deficiency and yang excess cause heat. Decline allows qi to re-enter, causing yang deficiency and cold. Thus, heat precedes cold: Warm Malaria.
What about Dan Malaria?
Qibo replied: Dan Malaria patients have prior lung heat. Qi rushes upward, middle jiao is full but cannot vent externally. Physical exertion opens pores, allowing wind-cold to lodge in skin and muscle layers. Attack causes isolated yang excess without decline, leading to disease. Qi does not reach yin, so only heat occurs without cold. Cold resides in the Heart, exteriorly in muscles, consuming flesh. Hence, Dan Malaria.
Huangdi asked: Why do some heat/cold patterns resemble malaria but vary in frequency?
Qibo replied: It depends on the meeting of winning and retaliatory qi. More yin/fewer yang means distant intervals; more yang/fewer yin means close intervals. Malaria follows similar laws of盛衰 (excess/decline).
Huangdi asked: Why does the Lung cause cough?
Qibo replied: All five zang and six fu organs can cause cough, not just the Lung.
Huangdi asked: Explain the details.
Qibo replied: Skin and hair are the exterior of the Lung. Pathogens enter via skin/hair. Cold food entering the stomach travels up the Lung meridian, cooling the Lung. Internal and external cold combine, lodging in the Lung, causing Lung Cough. Each zang is susceptible in its ruling season. If not the ruling season, transmission occurs. Humans resonate with heaven and earth. Mild cold causes cough; severe cold causes diarrhea or pain.
Autumn: Lung affected first. Spring: Liver. Summer: Heart. Late Summer (Earth): Spleen. Winter: Kidney.
How to distinguish?
Lung Cough: Cough with wheezing, sounds in throat, hemoptysis in severe cases.
Heart Cough: Cough with heart pain, sensation of obstruction in throat, severe sore throat/pharyngitis.
Liver Cough: Cough with hypochondriac pain, inability to turn, severe distension.
Spleen Cough: Cough with right hypochondriac pain radiating to shoulder/back, worsened by movement.
Kidney Cough: Cough with pulling pain in waist and back, severe salivation.
What about Six Fu Coughs?
Prolonged Spleen Cough transmits to Stomach. Stomach Cough: Cough with vomiting, severe expulsion of parasites.
Prolonged Liver Cough transmits to Gallbladder. Gallbladder Cough: Cough with bitter bile vomiting.
Prolonged Lung Cough transmits to Large Intestine. Large Intestine Cough: Cough with fecal incontinence.
Prolonged Heart Cough transmits to Small Intestine. Small Intestine Cough: Cough with flatus.
Prolonged Kidney Cough transmits to Bladder. Bladder Cough: Cough with urinary incontinence.
Prolonged cough transmits to Sanjiao (Triple Burner). Sanjiao Cough: Cough with abdominal fullness and anorexia.
These conditions gather in the Stomach and relate to the Lung, causing excessive phlegm/saliva, facial edema, and rebellious qi.
Huangdi asked: How to treat?