偏枯。身偏不用而痛。言不变。志不乱。病在分腠之间。巨针取之。益其不足。损其有余。乃
可复也。
此篇论外感风寒之热。内有五脏之热。外内阴阳邪正之为病。而先论其外因焉。经曰。虚邪
偏客于身半。其入深。内居荣卫。荣卫稍衰。故真气去。邪气独留。故为偏枯。是风寒之邪。偏中
于形身。则身偏不用而痛。夫心主言。肾藏志。言不变。志不乱。此病在于分腠之间。而不伤于
内也。以巨针取之。益其正气之不足。损其邪气之有余。而偏伤之正气。乃可复也。按、素问热论。
论热病者。皆伤寒之类。本经论热病。首言偏枯。次言痱之为病。而不曰中风。盖风寒之邪。皆
能为热也。此篇与刺热论大义相同。故刺热论中。亦用五十九刺之法。
痱之为病也。身无痛者。四肢不收。智乱不甚。其言微。知可治。甚则不能言。不可治也。病
先起于阳。后入于阴者。先取其阳。后取其阴。浮而取之。（痱音肥）
痱者。风热之为病也。身无痛者。邪入于里也。风木之邪。贼伤中土。脾藏智而外属四肢。四
肢不收。智乱不甚者。邪虽内入。尚在于表里之间。脏真之气未伤也。其言微者。此伤于气。故知
可治。甚则不能言者。邪入于脏。
不可治也。夫外为阳。内为阴。病先起于分腠之间。而后入于里阴者。先取其阳。后取其阴。浮而
取之者。使外受之邪。仍从表出也。沈亮宸曰。风之为病也。善行而数变。上节论偏客于形身。此
论在于表里之间。入内而干脏则死。浮而取之外出则愈。二节之中。有左右外内出入邪正虚实死生
之别。
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。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。
沈亮宸曰。热病三日。三阳为尽。三阴当受邪。如气口静而人迎躁者。此邪尚在阳。而未传于
阴也。故当取诸阳。为五十九刺。以泻其热。而出其汗。实其阴以补其不足。勿使邪气之入阴也。
如身热甚而阴阳之脉皆静者。此邪热甚而阴阳之正气皆虚。有死征而勿刺也。其可刺者。急取之。
如邪在阳分。即出其汗。在阴分即从下泄。此邪虽甚而正气未脱。故当急泻其邪。张开之曰。夫热
病者。皆伤寒之类也。六经相传。七日来复。在三阳三阴之气分。而不涉于经。故候在人迎气口。
不汗则泄。即素问之所谓未满三日者。可汗而已。其满三日者。可下而已。尚御公曰。内经言其常。
仲景言其变。张隐庵曰。热病三日。气口静而人迎躁者。即常中之变也。
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。
此热病七日八日。而邪仍在表阳者。急从汗解也。表阳之邪。七日来复。八日不解。将作再经。
而有传阴之害矣。如脉口动喘而短者。邪尚在于肤表。急取手太阴之少商使之汗。则邪自共并而出
矣。按素问有喘脉。喘
而短者。谓脉之喘动于寸口。而不及于尺。故知其可汗解也。余伯荣曰。此即伤寒论之太阳病。
脉浮紧无汗。发热身疼痛。八九日不解。表证仍在。麻黄汤主之。夫麻黄汤。即取手大指汗出之剂
也。仲祖伤寒立论。缘本于灵素诸经。学人引伸触类。头头是道。何必守针。
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。
此外热不解。内传少阴而为死证也。六经传遍。七日来复。八日不解。又作再经矣。微细。少阴
之脉也。少阴之上。君火主之。病者溲血。病足少阴之水脏也。口中干。病手少阴之君火也。一日
半死者。死于一二日之间。阴阳水火之气终也。夫脉始于肾而主于心。脉代者已绝于下。故一日
而死。沈亮宸曰。巨阳者。为诸阳主气。故伤寒热病。本于太阳。太阳与少阴为表里。故伤寒论曰。
伤寒一日。太阳受之。脉若静者为不传。颇欲吐。若躁烦。脉数急者为传也。此太阳之邪。传于少
阴。少阴标阴而本热。故阳烦而阴躁也。本经之再经七八日。即伤寒论之初经一二日也。少阴从本
从标。故伤寒论有急下急温之证。本经之溲血口中干。一日半死者。标本皆病也。
热病。已得汗出。而脉尚躁喘。且复热。勿刺肤。喘甚者死。
热病已得汗而脉尚躁者。阳热甚而不从汗解也。喘而且复热者。邪入于里。故勿刺肤。喘甚者。
邪盛在里。而阴气受伤。故死。
热病。七日八日。脉不躁。躁不散数。后三日中有汗。三日不汗。四日死。未曾汗者。勿腠
刺之。（数叶朔）
热病七八日。脉不躁者。外已解也。脉即躁而不散数。此邪热虽未去。而正气不伤。后三日。
乃再经之十一日。此复传于里阴。必得阴液之汗而解。故未曾汗者。勿腠刺之。当取汗于阴也。
如三日不汗。乃阳热盛而阴气已绝。故至四日而死。上节论热病在外。虽得汗而不解。邪复传于里
阴。此论邪入于阴。如有汗而不死。谓阳可入阴。而阴亦可出于阳也。以上论外因风寒之热病。有
表里阴阳邪正虚实之死生。莫云从曰。此篇先论风寒。而后论热病。伤寒论先言中风。而后论伤寒。
热病。先肤痛。窒鼻充面。取之皮。以第一针五十九。苛轸鼻。索皮于肺。不得。索之火。火
者心也。
此以下论内因之热。病在五脏。当取诸外合之皮脉肉筋骨。如不得解。当以五行胜制之法治之。
热病先肤痛鼻窒者。热在肺而病气先应于皮肤鼻窍也。故当以第一之 针取之皮。用五十九刺之法。
以泻五脏之热。若皮苛鼻轸。当索皮于内合之肺。再不得解。索之于火。火者心也。当取心脏之气。
以胜制其金焉。盖五脏内合五行之气。外合皮肉筋骨之形。病气先在于外合之形。故先取之形。次
索之脏气。再以五行胜制之法治之。盖先标而后本也。前章论外因之热。病在六气。此论内因之热。
病在五行。莫云从曰。上章与素问之热论。此与评热论。大同小异。
热病。先身涩。倚而热。烦 。干唇口嗌。取之脉。以第一针五十九。肤胀口干。寒汗出。
索脉于心。不得。索之水。水者肾也。
此热在心主之包络。而病见于脉也。经脉者。所以行血气而营阴阳。病在血脉。故先身涩倚而
热。烦 者。相火盛而心不安也。唇口嗌干者。火炎上也。当取之脉。以第一针为五十九刺之法以泻
其热。若肤胀
者。脉盛而胀于皮肤也。仍口干而寒汗出者。热在内而蒸发其阴液也。当索脉于心。索脉于心者。
刺脉而久留之。以候心气之至也。如不得解。当索之水。水者肾也。取肾气以胜制其火也。按此节
当以第三针取脉。用第一针者。以络脉之在皮肤。故曰肤胀。盖在皮肤间而取诸络。皮肤络脉之
相通也。
热病。嗌干多饮。善惊。卧不能起。取之肤肉。以第六针五十九。目 青。索肉于脾。不得。
索之木。木者肝也。
喉主天气。嗌主地气。嗌干多饮者。脾热上行也。脾热盛则及于胃。故善惊。脾主肌肉四肢。
故卧不能起。当取之肤肉。以第六针为五十九刺之法以泻其热。脾主合同束。若目 青者。脾病未
去也。当索肉于脾。不得。索之木。木者肝也。取肝木之气。以胜制其土。（此当以第四针取肤肉）
热病。面青脑痛。手足躁。取之筋骨。以第四针于四逆。筋 目浸。索筋于肝。不得。索之金。
金者肺也。
色主春。面青者。肝木之病色见于面也。肝脉上额循巅下项中。故脑痛。肝主筋。诸筋皆起于
四肢之指井。并经而循于形身。故手足为之躁扰。当取之筋间。以第四针刺手足之四逆。肝开窍于
目。筋之精为黑眼。若筋 而目浸淫。当索筋于肝。不得。索之金。金者肺也。取肺金之气。以胜
制其肝木。
热病。数惊 而狂。取之脉。以第四针急泻有余者。癫疾毛发去。索血于心。不得。索之水。
水者肾也。（数叶朔）
心病热。故数惊。本经曰。心脉急甚为 。心气实则狂也。当取之脉。以第四针急泻其血
络之有余者。癫疾。脉癫疾也。发者血之余。若癫疾而毛发去。当索血于心。不得。索之水。水者
肾也。取肾水之气。以胜制其心火。
热病。身重骨痛。耳聋而好瞑。取之骨。以第四针五十九刺骨。病不食。啮齿耳青。索骨于肾。不
得。索之土。土者脾肾为生气之原。热伤气。故身重。肾主骨。故骨痛也。肾开窍于耳。肾气逆。故
耳聋。病在少阴。故欲寐也。当取之骨。以第四针。为五十九刺之法以刺骨。若病而不欲食者。肾
气实也。经曰。肾是动病。饥不欲食。啮齿者。热盛而切牙也。齿者骨之余。耳者肾之窍。若啮齿
耳青。当索骨于肾。不得。索之土。土者脾也。取脾土之气。以胜制其水焉。夫五脏者。形脏也。五
行者。五脏之气也。病气出于外。合之皮肉筋骨。故先治其外。不得。故复内索于五脏五行之气焉。
莫云从曰。若重感其外邪。则为外内交争之证。
热病。不知所痛。耳聋不能自收。口干。阳热甚。阴颇有寒者。热在髓。死不可治。
本篇首章论外因之热。上章论内因之热。此以下复论外内之热。合并而交争者也。凡病皆生
于风雨寒暑。阴阳喜怒。饮食居处。故有因外邪而病热者。有因内伤而病热者。有因于外而不因于
内者。有因于内而不因于外者。有外内之兼病者。此章与素问刺热论合参。大义自明矣。热病不知
所痛者。外因之热。入于内也。耳聋不能自收口干者。肾脏之热乘于上也。阳热甚而阴颇有寒者。
在内之热。交争于外也。热在髓者。外因之热。交争于内也。凡病出于外者生。深入于内者死。
热病头痛。颞 目HT 。脉痛善衄。厥热病也。取之以第三针。视有余不足。寒热痔。
此外因之热。与肝热交争也。肝脉上巅顶。热病头痛者。表邪之热。交于肝脉也。颞 目HT 者。
口目振战之貌。
此肝脏之热。逆于上也。脉痛善衄者。表邪之热。迫于经也。此厥阴肝经之热。与外热交逆而
为病也。当以第三针取脉。视其外内之有余不足而治之。经云。风客淫气。精乃亡。邪伤肝也。因
而饱食。筋脉横解。肠 为痔。如外感风淫之热。内因饱食而热。外内不解。则往来寒热而为痔矣。
按外内交争之热。皆在气而不涉于经。
此节论热入于经。故曰厥热。谓外内之热。厥逆于厥阴之经而为病也。盖有热在气而皆出入于
气分者。有病在气而转入于经者。经气外内之相通也。莫云从曰。在经气外内之间。故为寒热。在
筋脉。故为痔。筋在脉外之气分。
热病体重。肠中热。取之以第四针于其 。及下诸指间。索气于胃胳。得气也。（胳当作络）
此外因之热。与脾热交争也。热病体重者。脾热出于外也。热病肠中热者。外热入于内也。取
之于第四针于其 。 主土也。及下诸趾间。乃足太阴之隐白。阳明之历兑也。大肠小肠属胃。索
气于胃络。得手太阳阳明之气。则肠中之外邪。随气而出矣。
热病。挟脐急痛。胸胁满。取之涌泉。与阴陵泉。取以第四针。针嗌里。
此外淫之热。与心热并交也。内经云。环脐而痛者。病名伏梁。此风根也。热病挟脐急痛者。
外淫之风邪。客于心下而为伏梁也。胸胁满者。内因之心热逆于内也。取足少阴之涌泉。索水气以
济心火。取足太阴之阴陵泉。补中土以散心腹之伏梁。嗌里。舌下也。取第四针针嗌里。以泻外内
心下之热邪。
热病。而汗且出。及脉顺可汗者。取之鱼际太渊。大都太白。泻之则热去。补之则汗出。汗出
太甚。取内踝上横脉以止之。
此外因之热。与肺热相交。可俱从汗解也。热病而汗且出。及脉顺者。外内之热。皆在于肤表
也。故取手太阴之鱼际太渊。补足太阴之大都隐白。盖泻肺经则热去。补脾土则津液生而汗出矣。
内踝上横脉。即足太阴之三阴交。盖汗随气而宣发于外。取气下行。则汗止矣。夫外内之热。入深
者死不可治。外出者易散而愈。金匮玉函曰。非谓一病。百病皆然。在外者可治。入里者死。然因
于内者。从内而外。因于外者。从外而内。是以上工治皮毛。其次治肌肉。其次治经脉。其次治六
腑。其次治五脏。治五脏者半死半生。
热病。已得汗而脉尚躁盛。此阴脉之极也。死。其得汗而脉静者生。热病者。脉尚躁而不得汗
者。此阳脉之极也。死。脉盛躁。得汗。静也。生。
此总结上文。而言外内之热。皆宜从汗而外解也。夫外为阳。内为阴。热病已得汗而脉尚躁盛
者。此内因之热。外虽汗出而里热不解。此内热之极也。死。于得汗而脉静者。热已清而脉平和。
故生。热病者。脉尚躁。病外因之热而及于经也。不得汗者。不得从乎外解。此外热之极也。故死。
脉盛躁。得汗而脉静者。外淫之邪。从表汗而散故生。
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
偏枯。身体一侧肢体不能活动且伴有疼痛。言语功能正常。神志清醒。病邪位于分肉与腠理之间。用巨针进行治疗。补益正气之不足。祛除邪气之有余。这样才可以恢复。
这一篇论述外感风寒引起的热病，以及体内五脏的热病，涉及外内、阴阳、邪正之间的致病关系，而首先论述外因。经文说：虚邪（致病的外邪）偏客于身体的一半，侵入较深，内居营卫之中。营卫之气逐渐衰弱，所以真气离去，只有邪气独留。因此形成偏枯。这是风寒之邪，偏中于形体半身，导致身体一侧不能活动且疼痛。心主言语，肾藏志。言语不变，神志不乱，说明病邪在于分肉腠理之间，而没有伤及内脏。用巨针取穴治疗，补益正气的不足，祛除邪气的有余，那么偏侧受损的正气，才可以恢复。按：《素问·热论》论述热病，都属于伤寒一类。本经论述热病，首先讲偏枯，其次讲痱病，而不称为中风。大概因为风寒之邪，都能化为热病。本篇与《刺热论》的大义相同，所以《刺热论》中也使用五十九刺的方法。
痱病这种病症，身体没有疼痛，四肢弛缓不收，智力混乱不严重，说话声音微弱，知道可以治疗；如果严重到不能说话，就无法治疗了。病势先从阳分起，后传入阴分的，先取阳分穴位，后取阴分穴位，浅刺以浮取。（痱音肥）
痱病，是风热邪气造成的疾病。身体没有疼痛，是因为邪气入里。风木之邪，贼害损伤中土（脾胃）。脾藏智而外合四肢。四肢弛缓不收，智力混乱不严重，说明邪气虽然内入，尚处于表里之间，脏真之气尚未受伤。说话声音微弱的，这是伤于气分，所以知道可以治疗；严重到不能说话的，是邪气入脏，无法治疗。外为阳，内为阴。病势先从分肉腠理之间起，而后传入里阴的，先取阳分，后取阴分。所谓“浮而取之”，是使受于外部的邪气，仍然从体表排出。沈亮宸说：风邪致病，善于游走且变化多端。上节论述邪气偏客于形体半身，本节论述邪气在表里之间，入内干扰脏腑则死，通过浅刺使邪气外出则愈。这两节内容中，有左右、内外、出入、邪正、虚实、死生的区别。
热病三天，气口脉象平静，人迎脉象躁动，取诸阳经穴位，用五十九刺法，以泻其热，使其出汗，充实阴液，以补其不足。如果身热很甚，但寸口和人迎脉象都平静，不要针刺。那些可以针刺的，赶快取穴，不出汗就用泄法。所谓“不要针刺”，是有死征的表现。
沈亮宸说：热病三天，三阳经邪气已尽，三阴经应当受邪。如果气口平静而人迎躁动，这说明邪气尚在阳分，而未传入阴分。所以应当取诸阳经穴位，行五十九刺法，以泻其热，使其出汗，充实阴液以补其不足，防止邪气传入阴分。如果身热很甚而阴阳脉象都平静，这是邪热很盛而阴阳正气都已虚弱，有死征，所以不要针刺。那些可以针刺的，赶快取穴。如果邪在阳分，就使其出汗；在阴分就从下泄法。这表示邪气虽盛但正气未脱，所以应当急泻邪气。张开之说：热病，都属于伤寒一类。六经相传，七天为一个周期。在三阳三阴的气分层面，而不涉及经脉，所以观察人迎和气口脉象。不出汗就用泄法，即《素问》所说的“未满三天的，可以通过发汗治愈；已满三天的，可以通过攻下治愈”。尚御公说：《内经》论述常法，张仲景论述变法。张隐庵说：热病三天，气口平静而人迎躁动，这是常法中的变法。
热病，第七天或第八天，脉口跳动，气喘且呼吸短促，赶快针刺，汗将会自然流出，浅刺手大指间（少商穴）。
这是热病第七八天，而邪气仍在表阳，赶快从汗解。表阳之邪，七天一个周期，第八天不解，将要进入再经，而有传入阴分的危害。如果脉口跳动、气喘且呼吸短促，邪气尚在于肤表，赶快取手太阴肺经的少商穴使之出汗，那么邪气自然会随汗而出。按：《素问》中有喘脉，气喘且呼吸短促，是指脉象在寸口处躁动，而不及于尺部，所以知道可以通过发汗解除。余伯荣说：这就是《伤寒论》中的太阳病，脉浮紧无汗，发热身疼痛，八九日不解，表证仍在，用麻黄汤主治。麻黄汤，就是取手大指（少商）出汗的方剂。仲景创立《伤寒论》，源于《灵枢》《素问》等经典，学者引伸触类，头头是道，何必只守针灸？
热病，第七天或第八天，脉象微小，病人尿血，口中干燥，一天半后死亡。脉象代（间歇）的，一天后死亡。
这是外部热邪不解，内部传入少阴而成为死证。六经传遍，七天一个周期，第八天不解，又进入再经。微细，是少阴的脉象。少阴之上，君火主事。病人尿血，是足少阴水脏生病。口中干燥，是手少阴君火生病。一天半死亡的，死在一二日之间，是阴阳水火之气终结。脉始于肾而主于心。脉代者，下部之气已绝，所以一天后死亡。沈亮宸说：巨阳（太阳），是诸阳之主气，所以伤寒热病，本于太阳。太阳与少阴为表里，所以《伤寒论》说：伤寒第一天，太阳受邪，脉若平静是不传经；颇欲吐，若烦躁，脉数急的是传经。这是太阳之邪，传入少阴。少阴标阴而本热，所以阳烦而阴躁。本经的再经七八天，即《伤寒论》之初经一两天。少阴从本从标，所以《伤寒论》有急下急温的证候。本经的尿血口中干燥，一天半死亡，是标本皆病。
热病，已经出汗，但脉象仍然躁动气喘，并且再次发热，不要刺皮肤。气喘严重的会死亡。
热病已经出汗但脉象仍然躁动的，是阳热很盛而不从汗解。气喘并且再次发热的，是邪气入里，所以不要刺皮肤。气喘严重的，是邪气盛在里，而阴气受伤，所以死亡。
热病，第七天或第八天，脉象不躁动，躁动但不散乱且数急，后三天中有汗，三天不出汗，第四天死亡。未曾出汗的，不要刺腠理。（数读朔）
热病七八天，脉象不躁动，说明外部已解。脉象即使躁动但不散乱且数急，这是邪热虽未去除，但正气未伤。后三天，是再经的第十一天，邪气重新传入里阴，必须得到阴液的汗才能解除。所以未曾出汗的，不要刺腠理，应当从阴分取汗。如果三天不出汗，是阳热盛而阴气已绝，所以到第四天死亡。上节论述热病在外，虽然出汗但未解除，邪气重新传入里阴。本节论述邪气入于阴，如果有汗而不死，说明阳可入阴，而阴也可出于阳。以上论述外因风寒的热病，有表里、阴阳、邪正、虚实、死生的区别。莫云从说：本篇先论风寒，而后论热病。《伤寒论》先言中风，而后论伤寒。
热病，先皮肤疼痛，鼻塞面肿，取皮部，用第一针和五十九刺法。鼻部生疮疹，向肺索求皮部之气，不得，向火（心）索求。火者，心也。
此以下论述内因的热病，病在五脏，应当取外合的皮、脉、肉、筋、骨。如果不得解，当用五行胜制之法治疗。热病先皮肤疼痛、鼻塞的，是热在肺，病气先应于皮肤鼻窍。所以应当用第一针取皮部，用五十九刺法，以泻五脏之热。如果皮肤粗糙、鼻生疮疹，应当向内合的肺索求皮部之气，再不得解，向火索求。火者，心也。应当取心脏之气，以胜制其金。大概五脏内合五行之气，外合皮肉筋骨之形。病气先在于外合之形，所以先取形，次索求脏气，再以五行胜制之法治疗。这是先治标而后治本。前章论述外因的热，病在六气。本节论述内因的热，病在五行。莫云从说：上章与《素问·热论》大同小异，本章与《评热论》大同小异。
热病，先身体涩滞，倚靠发热，心烦，口干唇燥咽干，取脉部，用第一针和五十九刺法。皮肤胀满，口干，出冷汗，向心索求脉部之气，不得，向水（肾）索求。水者，肾也。
此热在心主之包络，而病见于脉。经脉，是用来运行气血而营养阴阳的。病在血脉，所以先身体涩滞、倚靠发热。心烦，是相火盛而心不安。唇口咽干，是火炎向上。应当取脉部，用第一针作为五十九刺法以泻其热。如果皮肤胀满，是脉盛而胀于皮肤。仍然口干而出冷汗的，是热在内而蒸发其阴液。应当索求脉部于心，索求脉部于心，是刺脉而久留针，以候心气之至。如不得解，应当索求于水，水者，肾也。取肾气以胜制其火。按：此节应当以第三针取脉，用第一针的，是因为络脉在皮肤，所以叫皮肤胀。大概在皮肤间取诸络，皮肤络脉是相通的。
热病，咽干多饮，容易惊恐，躺下不能起身，取肤肉，用第六针和五十九刺法。目睛青黑，向脾索求肉部之气，不得，向木（肝）索求。木者，肝也。
喉主天气，咽主地气。咽干多饮，是脾热上行。脾热盛则波及胃，所以容易惊恐。脾主肌肉四肢，所以躺下不能起身。应当取肤肉，用第六针作为五十九刺法以泻其热。脾主合同束，如果目睛青黑，是脾病未去。应当向脾索求肉部之气，不得，向木索求。木者，肝也。取肝木之气，以胜制其土。（此处应当以第四针取肤肉）
热病，面色青，脑痛，手足躁动，取筋骨，用第四针在四逆穴。筋脉拘急，目睛浸淫，向肝索求筋部之气，不得，向金（肺）索求。金者，肺也。
色主春，面色青，是肝木的病色见于面。肝脉上额循巅顶下项中，所以脑痛。肝主筋，诸筋都起于四肢之井穴，并经而行于形体，所以手足为之躁扰。应当取筋间，用第四针刺手足的四逆穴。肝开窍于目，筋之精为黑眼。如果筋脉拘急而目睛浸淫，应当向肝索求筋部之气，不得，向金索求。金者，肺也。取肺金之气，以胜制其肝木。
热病，多次惊恐而发狂，取脉部，用第四针急泻有余者。癫疾，毛发脱落，向心索求血气，不得，向水（肾）索求。水者，肾也。（数读朔）
心病热，所以多次惊恐。本经说：心脉急甚为瘛疭，心气实则狂。应当取脉部，用第四针急泻其血络之有余者。癫疾，是脉癫疾。发者，血之余。如果癫疾而毛发脱落，应当向心索求血气，不得，向水索求。水者，肾也。取肾水之气，以胜制其心火。
热病，身体沉重骨痛，耳聋而喜欢闭目，取骨，用第四针和五十九刺骨。病不欲食，咬齿耳廓青，向肾索求骨部之气，不得，向土（脾）索求。土者，脾也。
肾脾为生气之源。热伤气，所以身体沉重。肾主骨，所以骨痛。肾开窍于耳，肾气逆，所以耳聋。病在少阴，所以想睡觉。应当取骨，用第四针，作为五十九刺法以刺骨。如果病而不欲食，是肾气实。经说：肾是动病，饥不欲食。咬齿，是热盛而切牙。齿者，骨之余。耳者，肾之窍。如果咬齿耳廓青，应当向肾索求骨部之气，不得，向土索求。土者，脾也。取脾土之气，以胜制其水。夫五脏，是形脏。五行，是五脏之气。病气出于外，合之皮肉筋骨，所以先治其外。不得，所以复向内索求于五脏五行之气。莫云从说：如果再感受外邪，就成为外内交争的证候。
热病，不知道疼痛，耳聋不能自持收摄，口干，阳热很盛，阴颇有寒，热在髓，死，不可治。
本篇首章论外因之热，上章论内因之热，此以下复论外内之热，合并而交争的。凡病都生于风雨寒暑、阴阳喜怒、饮食居处，所以有因外邪而病热者，有因内伤而病热者，有因于外而不因于内者，有因于内而不因于外者，有外内兼病者。本章与《素问·刺热论》合参，大义自明。热病不知道疼痛的，是外因之热，入于内。耳聋不能自持收摄、口干的，是肾脏之热乘于上。阳热甚而阴颇有寒的，是在内之热，交争于外。热在髓的，是外因之热，交争于内。凡病出于外的生，深入于内的死。
热病头痛，颞颥痛，目眶痛，善衄血，是厥热病。取以第三针，视有余不足。寒热痔。
这是外因之热，与肝热交争。肝脉上巅顶，热病头痛，是表邪之热，交于肝脉。颞颥痛，目眶痛，是口目振战之貌。这是肝脏之热，逆于上。脉痛善衄血，是表邪之热，迫于经。这是厥阴肝经之热，与外热交逆而为病。应当以第三针取脉，视其外内之有余不足而治之。经云：风客淫气，精乃亡，邪伤肝也。因而饱食，筋脉横解，肠澼为痔。如外感风淫之热，内因饱食而热，外内不解，则往来寒热而为痔矣。按：外内交争之热，皆在气而不涉于经。
此节论热入于经，故曰厥热。谓外内之热，厥逆于厥阴之经而为病。盖有热在气而皆出入于气分者，有病在气而转入于经者，经气外内之相通。莫云从说：在经气外内之间，故为寒热。在筋脉，故为痔。筋在脉外之气分。
热病体重，肠中热，取以第四针于其腧，及下诸指间。索气于胃络，得气。（腧当作输，络当作络）
这是外因之热，与脾热交争。热病体重，是脾热出于外。热病肠中热，是外热入于内。取之于第四针于其腧。腧主土。及下诸趾间，是足太阴之隐白，阳明之厉兑。大肠小肠属胃，索气于胃络，得手太阳阳明之气，则肠中之外邪，随气而出。
热病，挟脐急痛，胸胁满，取涌泉与阴陵泉，取以第四针，针嗌里。
这是外淫之热，与心热并交。内经云：环脐而痛者，病名伏梁，此风根也。热病挟脐急痛，是外淫之风邪，客于心下而为伏梁。胸胁满，是内因之心热逆于内。取足少阴之涌泉，索水气以济心火。取足太阴之阴陵泉，补中土以散心腹之伏梁。嗌里，舌下。取第四针针嗌里，以泻外内心下之热邪。
热病，而汗且出，及脉顺可汗者，取鱼际、太渊、大都、太白。泻之则热去，补之则汗出。汗出太甚，取内踝上横脉以止之。
这是外因之热，与肺热相交，可俱从汗解。热病而汗且出，及脉顺者，外内之热，皆在于肤表。故取手太阴之鱼际、太渊，补足太阴之大都、隐白。盖泻肺经则热去，补脾土则津液生而汗出。内踝上横脉，即足太阴之三阴交。盖汗随气而宣发于外，取气下行，则汗止。夫外内之热，入深者死不可治，外出者易散而愈。《金匮玉函》说：非谓一病，百病皆然。在外者可治，入里者死。然因于内者，从内而外；因于外者，从外而内。是以上工治皮毛，其次治肌肉，其次治经脉，其次治六腑，其次治五脏。治五脏者，半死半生。
热病，已得汗而脉尚躁盛，此阴脉之极也，死。其得汗而脉静者生。热病者，脉尚躁而不得汗者，此阳脉之极也，死。脉盛躁，得汗，静也，生。
此总结上文，而言外内之热，皆宜从汗而外解。夫外为阳，内为阴。热病已得汗而脉尚躁盛者，此内因之热，外虽汗出而里热不解，此内热之极也，死。于得汗而脉静者，热已清而脉平和，故生。热病者，脉尚躁，病外因之热而及于经。不得汗者，不得从乎外解，此外热之极也，故死。脉盛躁，得汗而脉静者，外淫之邪，从表汗而散，故生。
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
Pian Ku (Hemiplegia). The body is paralyzed on one side and painful. Speech remains unchanged, and the mind is not confused. The disease lies between the muscle intervals and interstices. Treat with a large needle. Tonify the deficiency and reduce the excess, so that recovery is possible.
This chapter discusses heat diseases caused by external wind-cold, as well as internal heat of the five zang organs, involving pathogenic factors and righteous qi in terms of exterior-interior, yin-yang, and evil-righteous relationships, beginning with the discussion of external causes. The Classic states: Deficient evil (pathogenic external factors) lodges unevenly on half of the body, penetrating deeply, residing within Ying and Wei (Nutritive and Defensive Qi). As Ying and Wei gradually decline, true qi departs, leaving only the evil to remain. Thus, Pian Ku (hemiplegia) occurs. This indicates that wind-cold evil strikes one side of the body, causing paralysis and pain on that side. The Heart governs speech, and the Kidney stores Zhi (Willpower). Since speech is unchanged and the mind is not confused, the disease is located in the muscle intervals and interstices, without damaging the interior. Using a large needle for treatment, tonifying the deficiency of righteous qi and reducing the excess of evil qi allows the damaged righteous qi on the affected side to recover. Note: In *Su Wen: Re Lun*, heat diseases are discussed as belonging to the category of Shang Han (Cold Damage). This Classic begins discussing heat diseases with Pian Ku, followed by Fei (Flaccidity), rather than calling it Zhong Feng (Wind Stroke). Presumably, because both wind and cold evils can transform into heat. The main idea of this chapter is identical to *Ci Re Lun* (Chapter on Needling Heat), which is why the method of fifty-nine acupoints is also used in *Ci Re Lun*.
Fei (Flaccidity) disease presents with no body pain but flaccid paralysis of the four limbs. Mental confusion is mild, and speech is faint; knowing this allows for treatment. If severe, where speech is lost, it is untreatable. When the disease originates in Yang first and then enters Yin, treat the Yang aspect first, then the Yin aspect, using superficial needling (floating extraction). (Fei sounds like 'fei').
Fei disease is caused by wind-heat evil. The absence of body pain indicates the evil has entered the interior. Wind-Liver wood evil damages the Central Earth (Spleen/Stomach). The Spleen stores intelligence and corresponds externally to the four limbs. Flaccid paralysis and mild mental confusion indicate that although the evil has entered internally, it remains between the exterior and interior, and the genuine qi of the zang organs is not yet injured. Faint speech indicates injury to the Qi level, hence it is treatable. Loss of speech indicates the evil has entered the zang organs, making it untreatable. Exterior is Yang, interior is Yin. When the disease starts in the muscle intervals and interstices and then enters the interior Yin, treat Yang first, then Yin. "Floating extraction" means allowing the externally acquired evil to exit from the surface. Shen Liangchen stated: Wind disease tends to move rapidly and change frequently. The previous section discussed evil lodging unevenly on the body; this section discusses evil between the exterior and interior. Entering the interior to disturb the zang leads to death; superficial needling to expel the evil externally leads to recovery. Between these two sections, there are distinctions regarding left/right, exterior/interior, entering/exiting, evil/righteous, deficiency/excess, and life/death.
On the third day of heat disease, if the Qi Kou (radial artery pulse) is calm and the Ren Ying (carotid artery pulse) is restless, select points from the Yang meridians and use the fifty-nine needling method to drain the heat, induce sweating, and fill the Yin to tonify deficiencies. If body heat is very high but both Yin and Yang pulses are calm, do not needle. For those who can be needled, act quickly; if sweat does not occur, use purgation. The instruction "do not needle" refers to signs of impending death.
Shen Liangchen stated: On the third day of heat disease, the Three Yang meridians are exhausted, and the Three Yin meridians should receive the evil. If Qi Kou is calm and Ren Ying is restless, the evil remains in the Yang aspect and has not transmitted to Yin. Therefore, select points from the Yang meridians, apply the fifty-nine needling method to drain heat, induce sweating, and fill Yin to tonify deficiencies, preventing the evil from entering Yin. If body heat is high but both Yin and Yang pulses are calm, this indicates extreme evil heat and deficiency of both Yin and Yang righteous qi, presenting signs of death, so do not needle. For those who can be needled, act quickly. If the evil is in the Yang aspect, induce sweating; if in the Yin aspect, use purgation. This implies that although the evil is severe, the righteous qi has not collapsed, so urgent draining of the evil is required. Zhang Kaizhi stated: Heat diseases belong to the category of Shang Han. Transmission through the Six Meridians completes a cycle in seven days. Observing the Qi Kou and Ren Ying pulses helps determine if the disease is in the Qi level of the Six Meridians without involving the channels. No sweating requires purgation, consistent with *Su Wen*: "If less than three days have passed, it can be cured by inducing sweat; if more than three days have passed, it can be cured by purgation." Shang Yugong stated: *Nei Jing* discusses standard patterns, while Zhang Zhongjing discusses variable patterns. Zhang Yinan stated: Heat disease on the third day with calm Qi Kou and restless Ren Ying represents a variation within the standard pattern.
On the seventh or eighth day of heat disease, if the Mai Kou (radial pulse) moves, accompanied by wheezing and shortness of breath, urgently needle. Sweat will naturally emerge. Superficially needle the space between the thumb and index finger (Shaoshang).
This indicates that on the seventh or eighth day, the evil still resides in the exterior Yang. Urgent resolution via sweating is required. Exterior Yang evil follows a seven-day cycle; if unresolved on the eighth day, it may enter a second cycle and transmit to Yin, causing harm. If the Mai Kou moves with wheezing and shortness of breath, the evil remains at the skin surface. Urgently selecting Shaoshang of the Hand Taiyin Lung Meridian induces sweating, allowing the evil to exit naturally. Note: *Su Wen* mentions "wheezing pulse." Wheezing and shortness of breath here refer to the pulse being restless at the Cun position but not reaching the Chi position, indicating it can be resolved by sweating. Yu Borong stated: This corresponds to the Taiyang Disease in *Shang Han Lun*: floating-tight pulse, no sweat, fever, body pain, unresolved after eight or nine days, with exterior symptoms persisting, treated with Mahuang Tang. Mahuang Tang is essentially equivalent to the method of inducing sweat from the thumb. Zhongjing established the theory of *Shang Han Lun* based on *Ling Shu* and *Su Wen*. Scholars should extend and relate concepts logically; why restrict oneself only to acupuncture?
On the seventh or eighth day of heat disease, if the pulse is minute, the patient passes blood in urine, and the mouth is dry, death occurs within one and a half days. If the pulse is intermittent (Dai), death occurs within one day.
This is unresolved external heat transmitting internally to Shaoyin, becoming a fatal syndrome. After transmission through all six meridians and a seven-day cycle, if unresolved on the eighth day, it enters a second cycle. Minute and fine pulses are characteristic of Shaoyin. Above Shaoyin, Minister Fire prevails. Passing blood in urine indicates disease of the Foot Shaoyin Water Organ (Kidney). Dry mouth indicates disease of the Hand Shaoyin Minister Fire (Heart). Death within one and a half days signifies the exhaustion of Yin-Yang and Water-Fire qi. The pulse originates in the Kidney and is governed by the Heart. An intermittent pulse indicates that the lower qi has severed, leading to death within one day. Shen Liangchen stated: Juyang (Taiyang) is the master of all Yang qi; thus, Shang Han and heat diseases originate in Taiyang. Taiyang and Shaoyin are exterior-interior pairs. *Shang Han Lun* states: On the first day of Shang Han, Taiyang receives the evil; if the pulse is calm, there is no transmission; if there is a desire to vomit, restlessness, and a rapid/impatient pulse, transmission occurs. Here, Taiyang evil transmits to Shaoyin. Shaoyin's marked aspect is Yin, and its root aspect is Heat, causing Yang restlessness and Yin agitation. The "second cycle" of seven or eight days in this Classic corresponds to the first one or two days in *Shang Han Lun*. Shaoyin follows both root and marked aspects, explaining the urgent purgation and warming syndromes in *Shang Han Lun*. The urinary blood and dry mouth leading to death within one and a half days in this Classic indicate simultaneous disease of root and marked aspects.
In heat disease, if sweat has occurred but the pulse remains restless and wheezy, and fever recurs, do not needle the skin. Severe wheezing indicates death.
If sweat occurs in heat disease but the pulse remains restless, Yang heat is excessive and not resolving through sweat. Wheezing combined with recurrent fever indicates the evil has entered the interior; therefore, do not needle the skin. Severe wheezing indicates excessive evil in the interior and injury to Yin qi, leading to death.
On the seventh or eighth day of heat disease, if the pulse is not restless, or is restless but not scattered and rapid, sweat may appear within the next three days. If no sweat appears in three days, death occurs on the fourth day. For those who have never sweated, do not needle the interstices. (Shuo reads as 'shuo').
On the seventh or eighth day of heat disease, a non-restless pulse indicates the exterior has resolved. If the pulse is restless but not scattered and rapid, the evil heat remains, but righteous qi is undamaged. The next three days mark the eleventh day of the second cycle, when the evil re-transmits to interior Yin. Resolution requires sweat derived from Yin fluids. Therefore, for those who have never sweated, do not needle the interstices; instead, seek sweat from the Yin aspect. If no sweat appears in three days, Yang heat is excessive and Yin qi is exhausted, leading to death on the fourth day. The previous section discussed external heat that did not resolve despite sweating, with evil re-transmitting to interior Yin. This section discusses evil entering Yin; if sweat occurs without death, it indicates Yang can enter Yin, and Yin can exit to Yang. The above discusses heat diseases caused by external wind-cold, covering exterior-interior, yin-yang, evil-righteous, deficiency-excess, and life-death dynamics. Mo Congcong stated: This chapter first discusses wind-cold, then heat disease. *Shang Han Lun* first discusses Wind Strike, then Cold Damage.
Heat disease initially presents with skin pain, nasal congestion, and facial swelling. Treat the skin layer using the First Needle and the fifty-nine needling method. If rough skin and nasal sores occur, seek the skin aspect from the Lung. If ineffective, seek from Fire (Heart). Fire corresponds to the Heart.
The following sections discuss internally caused heat diseases affecting the five zang organs, requiring selection of the externally corresponding tissues: skin, vessels, flesh, sinews, and bones. If ineffective, apply the Five Elements overcoming strategy. Initial skin pain and nasal congestion in heat disease indicate heat in the Lung, with pathological qi manifesting first in the skin and nasal orifices. Therefore, use the First Needle to treat the skin layer and the fifty-nine needling method to drain heat from the five zang organs. If rough skin and nasal sores occur, seek the skin aspect from the internally corresponding Lung. If still ineffective, seek from Fire. Fire corresponds to the Heart. Select Heart qi to overcome Metal. The five zang organs internally correspond to Five Elements qi and externally correspond to the forms of skin, flesh, sinews, and bones. Pathological qi manifests first in the external forms, so treat the form first, then seek the zang qi, and finally apply the Five Elements overcoming strategy. This treats the branch first and the root later. The previous chapter discussed external heat affecting the Six Qi; this chapter discusses internal heat affecting the Five Elements. Mo Congcong stated: The previous chapter is similar to *Su Wen: Re Lun*; this chapter is similar to *Ping Re Lun*.
Heat disease initially presents with body stiffness, leaning posture with fever, irritability, dry lips/mouth/throat. Treat the vessels using the First Needle and the fifty-nine needling method. If skin distension, dry mouth, and cold sweat occur, seek the vessel aspect from the Heart. If ineffective, seek from Water (Kidney). Water corresponds to the Kidney.
This heat affects the Pericardium of the Heart Master, manifesting in the vessels. Vessels transport Qi and Blood and nourish Yin and Yang. Disease in the blood vessels causes initial body stiffness, leaning posture, and fever. Irrability indicates excessive Minister Fire and Heart unrest. Dry lips, mouth, and throat indicate Fire flaming upward. Treat the vessels using the First Needle as part of the fifty-nine needling method to drain heat. Skin distension indicates vessel fullness expanding into the skin. Persistent dry mouth and cold sweat indicate internal heat evaporating Yin fluids. Seek the vessel aspect from the Heart; this involves needling the vessel and retaining the needle to await Heart qi arrival. If ineffective, seek from Water. Water corresponds to the Kidney. Select Kidney qi to overcome Fire. Note: This section should ideally use the Third Needle for vessels; using the First Needle is because collateral vessels reside in the skin, causing skin distension. Collaterals in the skin are interconnected.
Heat disease presents with dry throat, excessive thirst, frequent fright, inability to rise from bed. Treat the flesh using the Sixth Needle and the fifty-nine needling method. If eyes appear blue/black, seek the flesh aspect from the Spleen. If ineffective, seek from Wood (Liver). Wood corresponds to the Liver.
The throat governs Heavenly Qi, and the pharynx governs Earthly Qi. Dry throat and excessive thirst indicate Spleen heat ascending. Excessive Spleen heat spreads to the Stomach, causing frequent fright. The Spleen governs muscles and four limbs, causing inability to rise. Treat the flesh using the Sixth Needle as part of the fifty-nine needling method to drain heat. The Spleen governs contraction and binding. If eyes appear blue/black, Spleen disease persists. Seek the flesh aspect from the Spleen. If ineffective, seek from Wood. Wood corresponds to the Liver. Select Liver Wood qi to overcome Earth. (Note: The Fourth Needle should be used for flesh here.)
Heat disease presents with blue complexion, brain pain, and restless hands and feet. Treat sinews and bones using the Fourth Needle at Si Ni points. If sinews contract and eyes become cloudy, seek the sinew aspect from the Liver. If ineffective, seek from Metal (Lung). Metal corresponds to the Lung.
Complexion relates to Spring; blue complexion indicates Liver Wood disease color appearing on the face. The Liver channel ascends to the forehead, circles the vertex, and descends the nape, causing brain pain. The Liver governs sinews; all sinews originate at the Jing-Well points of the four limbs and traverse the body, causing restlessness in hands and feet. Treat the sinews using the Fourth Needle at the Si Ni points of the hands and feet. The Liver opens into the eyes; the essence of sinews forms the black pupil. If sinews contract and eyes become cloudy, seek the sinew aspect from the Liver. If ineffective, seek from Metal. Metal corresponds to the Lung. Select Lung Metal qi to overcome Liver Wood.
Heat disease presents with frequent fright and mania. Treat the vessels using the Fourth Needle to urgently drain excess. If epilepsy occurs with hair loss, seek blood from the Heart. If ineffective, seek from Water (Kidney). Water corresponds to the Kidney. (Shuo reads as 'shuo').
Heart heat causes frequent fright. This Classic states: Extremely tense Heart pulse indicates spasms; excess Heart Qi causes mania. Treat the vessels using the Fourth Needle to urgently drain excess from the blood collaterals. Epilepsy refers to pulse-related epilepsy. Hair is the surplus of blood. If epilepsy accompanies hair loss, seek blood from the Heart. If ineffective, seek from Water. Water corresponds to the Kidney. Select Kidney Water qi to overcome Heart Fire.
Heat disease presents with heavy body, bone pain, deafness, and desire to close eyes. Treat bones using the Fourth Needle and the fifty-nine needling method for bones. If the patient refuses food, grinds teeth, and ears turn blue, seek the bone aspect from the Kidney. If ineffective, seek from Earth (Spleen). Earth corresponds to the Spleen.
Kidney and Spleen are the sources of generating Qi. Heat injures Qi, causing heaviness. The Kidney governs bones, causing bone pain. The Kidney opens into the ears; reversed Kidney Qi causes deafness. Disease in Shaoyin causes drowsiness. Treat bones using the Fourth Needle as part of the fifty-nine needling method for bones. Refusal to eat indicates Kidney Qi excess. The Classic states: Shi Jing disease includes hunger without desire to eat. Teeth grinding indicates excessive heat clenching jaws. Teeth are the surplus of bones; ears are the orifice of the Kidney. If teeth grinding and blue ears occur, seek the bone aspect from the Kidney. If ineffective, seek from Earth. Earth corresponds to the Spleen. Select Spleen Earth qi to overcome Water. The five zang organs are Form Zang organs; the Five Elements are the Qi of the five zang organs. Pathological qi emerges externally, corresponding to skin, flesh, sinews, and bones, so treat the exterior first. If ineffective, seek internally from the five zang organs and Five Elements qi. Mo Congcong stated: If additionally affected by external evil, it becomes a syndrome of exterior-interior conflict.
Heat disease presents with unawareness of pain, deafness, inability to control movements, dry mouth, extreme Yang heat with slight Yin cold. Heat is in the Marrow. This is fatal and untreatable.
The first chapter of this section discussed external heat; the previous chapter discussed internal heat. The following sections revisit external and internal heat merging and conflicting. All diseases arise from wind, rain, cold, heat, yin-yang emotions, diet, and lifestyle. Thus, there are heat diseases caused by external evil, internal injury, external only, internal only, or both. Comparing this chapter with *Su Wen: Ci Re Lun* clarifies the main ideas. Unawareness of pain in heat disease indicates external heat entering the interior. Deafness, inability to control movements, and dry mouth indicate Kidney heat rising. Extreme Yang heat with slight Yin cold indicates internal heat conflicting externally. Heat in the Marrow indicates external heat conflicting internally. Diseases emerging from the exterior survive; those penetrating deeply die.
Heat disease presents with headache, temporal pain, orbital pain, and frequent epistaxis. This is Jue Yin Heat Disease. Treat using the Third Needle, assessing excess and deficiency. Chills, fever, and hemorrhoids.
This is external heat conflicting with Liver heat. The Liver channel ascends to the vertex. Headache in heat disease indicates exterior evil heat interacting with the Liver channel. Temporal and orbital pain indicate trembling of the mouth and eyes. This is Liver heat reversing upward. Pulse pain and frequent epistaxis indicate exterior evil heat pressing on the channels. This is Jueyin Liver channel heat conflicting with external heat. Treat using the Third Needle for vessels, addressing exterior-interior excess/deficiency. The Classic states: Wind guest and excessive Qi cause essence depletion, injuring the Liver. Combined with overeating, sinews and vessels relax, leading to intestinal dysentery and hemorrhoids. External wind-heat combined with internal heat from overeating, unresolved externally and internally, leads to alternating chills/fever and hemorrhoids. Note: Heat from exterior-interior conflict resides in Qi without involving channels.
This section discusses heat entering the channels, hence called Jue Heat. It refers to external and internal heat reversing in the Jueyin channel. Some heat resides in Qi and moves within the Qi level; some heat in Qi transitions into channels due to the connection between exterior and interior channel qi. Mo Congcong stated: Being between exterior-interior channel qi causes chills/fever. Being in sinews/vessels causes hemorrhoids. Sinews reside in the Qi level outside the vessels.
Heat disease presents with heavy body and intestinal heat. Treat using the Fourth Needle at the Shu points and between the toes. Seek Qi from the Stomach Luo. Obtain Qi. (Luo should be read as Luo).
This is external heat conflicting with Spleen heat. Heavy body in heat disease indicates Spleen heat emerging externally. Intestinal heat indicates external heat entering internally. Use the Fourth Needle at the Shu points. Shu points govern Earth. Between the toes are Yinbai of Foot Taiyin and Lidui of Yangming. Large and Small Intestines belong to the Stomach. Seeking Qi from the Stomach Luo obtains Hand Taiyang and Yangming Qi, allowing external evil in the intestines to exit with Qi.
Heat disease presents with urgent pain around the umbilicus and chest/hypochondriac fullness. Treat Yongquan and Yinlingquan using the Fourth Needle, and needle the interior of the pharynx.
This is external invading heat conflicting with Heart heat. *Nei Jing* states: Pain circling the umbilicus is named Fuliang (Hidden Beam), rooted in wind. Urgent periumbilical pain in heat disease indicates external wind evil lodging below the heart as Fuliang. Chest/hypochondriac fullness indicates internal Heart heat reversing inward. Select Yongquan of Foot Shaoyin to seek Water Qi to balance Heart Fire. Select Yinlingquan of Foot Taiyin to tonify Central Earth to dissipate Fuliang in the heart/abdomen. Interior of the pharynx refers to under the tongue. Use the Fourth Needle at the interior of the pharynx to drain external/internal heat below the heart.
Heat disease presents with impending sweat and a smooth pulse suitable for sweating. Treat Yuji, Taiyuan, Dadu, and Taibai. Draining removes heat; tonifying induces sweat. If sweat is excessive, treat the horizontal vessel above the medial malleolus to stop it.
This is external heat interacting with Lung heat, both resolvable via sweat. Impending sweat and smooth pulse indicate external and internal heat residing in the skin surface. Select Yuji and Taiyuan of Hand Taiyin, and tonify Dadu and Yinbai of Foot Taiyin. Draining Lung meridian removes heat; tonifying Spleen Earth generates fluids and induces sweat. The horizontal vessel above the medial malleolus is Sanyinjiao of Foot Taiyin. Sweat is disseminated externally with Qi; directing Qi downward stops sweat. Deeply entering external/internal heat is fatal and untreatable; exiting external heat disperses easily and heals. *Jin Gui Yu Han* states: Not just one disease, but all hundred diseases follow this rule. Exterior cases are treatable; interior cases are fatal. However, internally caused diseases progress from inside out; externally caused diseases progress from outside in. Hence, expert physicians treat the skin/hair first, then muscles, then vessels/channels, then Six Fu organs, then five Zang organs. Treating the five Zang organs results in half death, half survival.
Heat disease: If sweat occurs but the pulse remains rapid and vigorous, this is the extreme of Yin pulses; fatal. If sweat occurs and the pulse becomes calm, survival. Heat disease: If the pulse remains rapid and no sweat occurs, this is the extreme of Yang pulses; fatal. Rapid/vigorous pulse becoming calm after sweat indicates survival.
This summarizes the above, stating that both external and internal heat should resolve externally via sweat. Exterior is Yang, interior is Yin. If sweat occurs but the pulse remains rapid/vigorous, this is internal heat; although sweat occurs externally, interior heat is unresolved, representing the extreme of internal heat; fatal. If sweat occurs and the pulse calms, heat clears and pulse normalizes, indicating survival. If the pulse remains rapid in heat disease, external evil heat has reached the channels. Lack of sweat means it cannot resolve externally, representing the extreme of external heat; fatal. Rapid/vigorous pulse calming after sweat indicates external invading evil dispersing via surface sweat; survival.
There are nine types of heat disease unsuitable for needling. 1. No sweat, red cheeks, and hiccups indicate death. 2. Diarrhea with severe abdominal fullness indicates death. 3. Blurred vision with persistent heat indicates death. 4. Elderly and infants with heat and abdominal fullness indicate death. 5. No sweat, vomiting, and bloody stool indicate death. 6. Ulcerated tongue base with persistent heat...