五十一难曰∶病有欲得温者，有欲得寒者，有欲得见人者，有不欲得见人者，而各不同，病在
何脏腑也？
然∶病欲得寒，而欲得见人者，病在腑也；病欲得温，而不欲见人者，病在脏也。何以
言之？腑者阳也，阳病欲得寒，又欲见人；脏者阴也，阴病欲得温，又欲闭户独处，恶闻人声。故
以别知脏腑之病也。
《素问·金匮真言论》曰∶腑者，阳也，脏者，阴也。腑为阳，阳病则热胜，故饮食衣服居
处，皆欲就寒而远热也。阳主动而散，以应乎外，故欲得见人也。脏为阴，阴病则寒胜，故饮
食衣服居处，皆欲就温而远寒也，阴主静而藏，以应乎内，故闭户独处，恶闻人声也。此统论
脏腑阴阳大义，故与阳明脉解篇阳明病恶人与火，指一经热甚而烦惋者，有间也。
五十二难曰∶腑脏发病，根本等不？
然∶不等也。其不等奈何？
然∶脏病者，止而不移，其病
不离其处；腑病者，仿佛贲响，上下行流，居处无常。故以此知脏腑根本不同也。
脏为阴，阴主静，故止而不移也。腑为阳，阳主动，故上下流行也。仿佛，无形质也。贲响，
动而有声也。居无常处者，忽上忽下，即流行之谓也。脏病腑病，其根本不同者如此。
五十三难曰∶经言七传者死，间脏者生，何谓也？
然∶七传者，传其所胜也。间脏者，传其子
也。何以言之？假令心病传肺、肺传肝、肝传脾、脾传肾、肾传心，一脏不再伤，故言七传者死也。
七传者，根据序传其所胜所克之脏也。如心病传肺，是火克金也。肺又传肝，是金克木也。肝
又传脾，是木克土也。脾又传肾，是土克水也。肾复传心，是水克火也。心又欲传肺，是七传
矣。一脏不能再受邪伤，则死矣。吕广以（七）当作（次）字之误，与下间字方相合，其说亦
通。盖心病六传，由肾至心，心脏不能复传至肺也。其一脏不再伤者，是指心之不任再伤于第
七传而死也。此即《素问·标本病传论》诸病以次相传者，皆有死期，不可刺之义。
间脏者，传其所生也。假令心病传脾、脾传肺、肺传肾、肾传肝、肝传心，是子母相传，竟
而复始，如环之无端，故曰生也。
间脏者，间一脏传其所生也。如心欲传肺，而脾者肺之母，心之子，中间间此一脏，不传所
克也。假令心病传脾，是间肺所胜之脏，为火生土也。脾病传肺，是间肾所胜之脏，为土生金
也。肺病传肾，是间肝所胜之脏，为金生水也。肾病传肝，是间心所胜之脏，为水生木也。肝
病传心，是间脾所胜之脏，为木生火也。心病又复传脾，则病自已，此子母相传而生也。
第五十一难说：疾病中，有的患者希望得到温暖，有的希望得到清凉；有的希望见到人，有的不希望见到人，表现各不相同。这是哪个脏腑发生的病变呢？
回答说：患病者希望得到清凉，并且希望见到人的，病在腑；患病者希望得到温暖，并且不希望见到人的，病在脏。为什么这样说呢？腑属于阳，阳病（阳经受邪所致的病证）患者希望得到清凉，又希望见到人；脏属于阴，阴病（阴经受邪所致的病证）患者希望得到温暖，又喜欢关上门独自居住，厌恶听到别人的声音。所以根据这些表现来辨别是脏病还是腑病。
《素问·金匮真言论》说：腑属于阳，脏属于阴。腑为阳，阳病则热邪偏盛，所以在饮食、衣着和居住方面，都倾向于靠近寒凉而远离温热。阳主运动而发散，以顺应外在，所以希望见到人。脏为阴，阴病则寒邪偏盛，所以在饮食、衣着和居住方面，都倾向于靠近温暖而远离寒冷。阴主静止而闭藏，以顺应内在，所以关上门独自居住，厌恶听到别人的声音。这是统论脏腑阴阳的大义，所以与《灵枢·阳明脉解篇》中提到的阳明病厌恶人和火光，是指某一经热邪极盛而导致烦闷的情况，是有区别的。
第五十二难说：腑和脏发病，根本情况相同吗？
回答说：不相同。它们的不同在哪里呢？
回答说：脏病的特点是静止而不移动，病痛不离开其所在的部位；腑病的特点是隐隐作响，上下流动运行，位置没有定处。所以根据这些特点可以知道脏和腑的根本不同。
脏属阴，阴主静，所以静止而不移动。腑属阳，阳主动，所以上下流行运行。“仿佛”是指无形质，“贲响”是指动而有声。位置不固定，忽上忽下，这就是流行的意思。脏病和腑病的根本不同就是这样。
第五十三难说：医经中说“七传者死，间脏者生”，这是什么意思呢？
回答说：“七传”是指传给它所克制的脏腑。“间脏”是指传给它的子脏。为什么这样说呢？假设心病传肺、肺传肝、肝传脾、脾传肾、肾传心，一个脏不再受第二次伤害，所以说“七传者死”。
所谓“七传”，是按照次序传给它所克制的脏腑。比如心病传肺，这是火克金。肺又传肝，这是金克木。肝又传脾，这是木克土。脾又传肾，这是土克水。肾再传心，这是水克火。心又想传肺，这就构成了“七传”。如果一个脏不能再承受邪气的伤害，就会死亡。吕广认为这里的“七”字是“次”字的误写，与下面的“间”字才相符合，这种说法也讲得通。大概心病经过六次传变，由肾传到心，心脏就不能再传回给肺了。那个“一脏不再伤”，是指心脏不能承受第七次传变而死亡。这也就是《素问·标本病传论》中说的各种疾病按次序相传的，都有死亡的期限，不可针刺的道理。
所谓“间脏”，是指传给它所生的脏腑。假设心病传脾、脾传肺、肺传肾、肾传肝、肝传心，这是子母相传，循环往复，像圆环一样没有尽头，所以说“生”。
所谓“间脏”，是间隔一个脏，传给它所生的脏腑。比如心想要传肺，但脾是肺的母亲，也是心的儿子，中间间隔了这个脏，就不传给它所克的脏了。假设心病传脾，这是间隔了肺这个被克的脏，因为火生土。脾病传肺，这是间隔了肾这个被克的脏，因为土生金。肺病传肾，这是间隔了肝这个被克的脏，因为金生水。肾病传肝，这是间隔了心这个被克的脏，因为水生木。肝病传心，这是间隔了脾这个被克的脏，因为木生火。心病再传脾，那么病就会自愈，这就是子母相传而能生的道理。
Difficulty 51 states: In diseases, some patients desire warmth, others desire cold; some wish to see people, others do not wish to see people. These manifestations differ. Which Zang or Fu organs are affected?
The answer is: If the patient desires cold and wishes to see people, the disease is in the Fu organs. If the patient desires warmth and does not wish to see people, the disease is in the Zang organs. Why is this so? The Fu organs belong to Yang. In Yang diseases (diseases caused by pathogenic factors affecting the Yang meridians), patients desire cold and wish to see people. The Zang organs belong to Yin. In Yin diseases (diseases caused by pathogenic factors affecting the Yin meridians), patients desire warmth and prefer to stay alone behind closed doors, disliking the sound of other people's voices. Thus, these signs are used to distinguish between Zang and Fu organ diseases.
The *Suwen* (Plain Questions) chapter "Jingui Zhenyan Lun" states: The Fu organs are Yang, and the Zang organs are Yin. Since the Fu organs are Yang, Yang diseases involve excess heat; therefore, regarding diet, clothing, and residence, patients seek cold and avoid heat. Yang governs movement and dispersion, corresponding to the exterior, hence the desire to see people. Since the Zang organs are Yin, Yin diseases involve excess cold; therefore, regarding diet, clothing, and residence, patients seek warmth and avoid cold. Yin governs stillness and storage, corresponding to the interior, hence closing doors and staying alone, disliking the sound of voices. This discusses the general principles of Yin and Yang in Zang and Fu organs. Therefore, it differs from the discussion in the *Ling Shu* chapter "Yangming Maijie Pian," where Yangming disease involves aversion to people and fire, referring to a condition where heat is extreme in one meridian causing irritability.
Difficulty 52 asks: Are the fundamental characteristics of diseases originating in the Fu and Zang organs the same?
The answer is: They are not the same. How do they differ?
The answer is: Diseases of the Zang organs are stationary and do not migrate; the pathology remains in its specific location. Diseases of the Fu organs present with vague sensations and rumbling noises, moving up and down, without a fixed location. Thus, we know that the fundamentals of Zang and Fu diseases are different.
Zang belongs to Yin, and Yin governs stillness, hence the pathology is stationary and does not move. Fu belongs to Yang, and Yang governs movement, hence the pathology flows up and down. "Fufu" refers to formless conditions. "Benxiang" refers to movement accompanied by sound. Having no fixed location means moving up and down, which is what "flowing" implies. This is how the fundamentals of Zang and Fu diseases differ.
Difficulty 53 states: The classics say, "Seven-step transmission leads to death; intervening Zang transmission leads to survival." What does this mean?
The answer is: "Seven-step transmission" refers to transmission to the organ it overcomes (controls). "Intervening Zang transmission" refers to transmission to its offspring organ (the organ it generates). Why is this so? For example, if Heart disease transmits to the Lung, then to the Liver, then to the Spleen, then to the Kidney, and finally back to the Heart, an organ is injured only once. Hence, it is said that "seven-step transmission leads to death."
"Seven-step transmission" follows the sequence of overcoming/controlling relationships. For instance, Heart disease transmitting to the Lung represents Fire overcoming Metal. The Lung transmitting to the Liver represents Metal overcoming Wood. The Liver transmitting to the Spleen represents Wood overcoming Earth. The Spleen transmitting to the Kidney represents Earth overcoming Water. The Kidney transmitting to the Heart represents Water overcoming Fire. If the Heart then attempts to transmit to the Lung again, this constitutes the seventh step. If an organ cannot withstand further injury, death ensues. Lv Guang suggested that the character "qi" (seven) was a typo for "ci" (sequence/order), which aligns better with the term "jian" (intervene); his interpretation is also plausible. Essentially, after six transmissions from the Heart to the Lung, through to the Kidney and back to the Heart, the Heart cannot transmit further to the Lung. The phrase "an organ is injured only once" refers specifically to the Heart failing to withstand the seventh transmission, leading to death. This corresponds to the meaning in the *Suwen* chapter "Biaoben Bingchuan Lun": when various diseases transmit sequentially, there is a time limit for death, and acupuncture should not be used.
"Intervening Zang transmission" refers to transmission to the organ it generates. For example, if Heart disease transmits to the Spleen, then to the Lung, then to the Kidney, then to the Liver, and back to the Heart, this is mother-son transmission, cycling endlessly like a circle, hence it is said to lead to survival.
"Intervening Zang transmission" means skipping one organ to transmit to the one it generates. For instance, if the Heart intends to transmit to the Lung, but the Spleen is the mother of the Lung and the son of the Heart, intervening this organ prevents transmission to the overcome organ. Specifically, Heart disease transmitting to the Spleen skips the Lung (the overcome organ), representing Fire generating Earth. Spleen disease transmitting to the Lung skips the Kidney (the overcome organ), representing Earth generating Metal. Lung disease transmitting to the Kidney skips the Liver (the overcome organ), representing Metal generating Water. Kidney disease transmitting to the Liver skips the Heart (the overcome organ), representing Water generating Wood. Liver disease transmitting to the Heart skips the Spleen (the overcome organ), representing Wood generating Fire. If Heart disease then transmits to the Spleen again, the illness will resolve itself. This is the principle of mother-son transmission leading to recovery.