黄帝问曰。五脏六腑。寒热相移者何。（帝突问脏腑寒热相移。则为何如之病。盖承上章而复论疟气之厥逆也。寒热
者。邪正阴阳之气也。如邪舍于脏腑募原之间。阴阳外内相乘。则为往来之寒热。如脏邪传移于脏。腑邪传移于腑。则
为气逆之变病矣。是以此篇单论五脏六腑。寒热相移。杨元如曰。疟邪不解。多生变病者。当知气厥之所致。倪冲
之曰。疟不死人。病疟而有死者。传脏故也。）岐伯曰。肾移寒于肝。痈肿少气。（按下文肾移热于脾。此移寒于肝。
亦当作脾。脾主肌肉。寒气化热。则腐肉而为痈脓。脾统摄元真之气。脾脏受邪。故少气也。）脾移寒于肝。痈肿筋挛。
（肝主血。寒则血凝泣。经曰荣气不行。乃发为痈。肝主筋。故筋挛也。）肝移寒于心。狂。隔中。（肝为阳脏。而木火
主气。阳并于阳故狂。心居膈上。肝处膈下。母子之气。上下相通。肝邪上移于心。留于心下。故为隔中。盖言脏不受
邪。五脏之寒热相移。留薄于脏外而干脏气。不伤脏真者也。倪冲之曰。治五脏者半死半生。盖病脏气者生。伤脏真
者死。）心移寒于肺。肺消。肺消者。饮一溲二。死不治。（肺受心邪。则不能通调水液而惟下泄矣。肺为金水之原。寒
随心火。消烁肺精。是以饮一溲二者。肺液并消。故为不治之死证。）肺移寒于肾为涌水。涌水者。按腹不坚。水气客
于大肠。疾行则鸣濯濯。如囊裹浆。水之病也。（夫在地为水。在天为寒。肾为水脏。肺主生原。是以肺之寒邪。下移
于肾。而肾之水气。反上涌于肺矣。大肠乃肺之府。肺居膈上。故水气客于大肠。疾行则鸣濯濯有声。如以囊裹浆者。
水不沾流。走于肠间也。倪冲之曰。肺移于肾。肝移于心。传其我所生也。肾移于脾。脾移于肝。侮其所不胜也。心
移于肺。乘其己所胜也。）脾移热于肝。则为惊衄。（东方肝木。其病发惊骇。肝主血。故热甚则衄。）肝移热于心则死。
（心主君火而不受邪。邪热乘之。故死。）心移热于肺。传为膈消。（心肺居于膈上。火热淫于肺金。则金水之液涸矣。
膈消者。膈上之津液耗竭。而为消渴也。）肺移热于肾。传为柔 。（肾者水也。而生骨。肾脏燥热则髓精不生。是以筋
骨痿弱。而为柔 。）肾移热于脾。传为虚肠 。死不可治。（太阴湿土主气。不能制水。而反受湿热相乘。脾气虚伤。
则不能磨运水谷。而为肠 下利。谷气已绝。故为不治之死证。）胞移热于膀胱。则癃溺血。（膀胱者。胞之室也。冲
任起于胞中。为经血之海。胞移热于膀胱。是经血之邪移于膀胱。故溺血。热则水道燥涸。故癃闭也。张兆璜曰。脏
为阴。腑为阳。故脏邪相传。有寒有热。腑邪相传。但热不寒。盖寒邪在腑。亦化热矣。）膀胱移热于小肠。膈肠不便。
上为口麋。（小肠之脉。络心循咽。下膈属小肠。小肠之下。名曰阑门。济泌别汁。渗入膀胱。膀胱反移热于小肠。是以
膈肠不能下渗。湿热之气。反随经上逆。而口为之糜烂矣。）小肠移热于大肠。为 瘕。为沉。（ 音伏与伏同。瘕者
假也。假津血而为聚汁也。盖小肠主液。大肠主津。小肠移热于大肠。则津液留聚。而为伏瘕矣。沉、痔也。小肠主火。
大肠主金。火热淫金。则为肠痔。邪气脏腑篇曰。肾脉微涩为不月沉痔。曰沉者。抑上古之省文。或简脱耶。朱圣公
曰。诸家注释。皆以沉为伏瘕沉滞。按经文用二为字。是系二证。不可并作一证论。当以师注为是。）大肠移热于胃。善
食而瘦。又谓之食亦。（胃主受纳水谷。大肠为传导之官。大肠热邪。反逆乘于胃。是以胃热则消谷善食。阳明燥热。则
荣卫津液不生。故虽能食而瘦。亦、解 也。谓虽能食而身体懈惰。故又谓之食 。）胃移热于胆。亦曰食亦。（五脏六
腑之生气。皆取决于胆。胆气燥热则生阳不升。故身体懈惰。胃气热则消谷善饥。故亦曰食 。张兆璜曰。足少阳之疟。
令人身体解 。今胃移热于少阳。故亦名曰食 。）胆移热于脑。则辛 鼻渊。鼻渊者。浊涕下不止也。（ 音遏。胆气
上升。则热随入脑。挟鼻两旁曰 。辛 者。鼻 辛酸也。鼻渊者。浊涕下不止也。盖脑为精髓之海。髓者骨之充也。
脑者阴也。故脑渗则为涕。愚按胞胆脑髓。奇恒之府也。肠胃膀胱。四形脏也。论奇恒之府相传者。谓胆与脑。胞与膀
胱。无经络之相通。乃热邪在气而气相乘也。至于肠胃之逆传。亦邪热在气而不在腑。故为伏瘕食 之证。而不得从下
解。杨元如曰。肾主藏精而居下。脑为精髓之海而居上。胆者中精之府也。三者并主藏精。精气相通。故胆邪移入于
脑。倪冲之曰。少阳属肾。胆气通于脑。脑髓通于肾。是精气之上下循环。）传为衄蔑瞑目。故得之气厥也。（此总释脏
腑寒热相移。皆在气而不在经。故曰得之气厥也。夫热气上升。迫于络脉则为衄。淡渗皮毛之血。不能化液为汗则为蔑。
邪热伤气而阳气虚则目瞑。言邪出于脑。则传于气分。而为衄蔑瞑目之证。并释经脉内连脏腑。如脏邪在经。入脏则死。
腑邪在经。则溜于肠胃而从下解。此邪在脏腑气分。故外内相乘。则为寒热之往来。脏腑相移。则为寒热之气厥。此在
气而不在经。故篇名气厥论。而末结曰。得之气厥也。）
黄帝问道：五脏六腑之间，寒热邪气相互传移，是怎么回事？（黄帝突然询问脏腑寒热相移的病症表现。这是承接上一章，进一步讨论疟疾之气厥逆的机理。所谓寒热，是指邪正、阴阳之气。如果邪气停留在脏腑募原之间，阴阳内外相互乘袭，就会产生往来交替的寒热症状；如果脏的邪气传移到另一脏，腑的邪气传移到另一腑，就会形成气机逆乱的病变。因此本篇专门论述五脏六腑寒热相移的情况。杨元如说：疟邪不解，往往产生变证，应当知道这是由气厥引起的。倪冲之说：疟疾本身不致死，患疟疾而死的，是因为病邪传入内脏的缘故。）
岐伯回答说：肾将寒邪移于肝，会导致痈肿和少气。（根据下文“肾移热于脾”，此处“移寒于肝”可能应为“移寒于脾”。脾主肌肉，寒气化为热邪，则腐蚀肌肉而成痈脓。脾统摄元气，脾脏受邪，所以出现少气的症状。）脾将寒邪移于肝，会导致痈肿和筋脉拘挛。（肝主血，寒邪导致血液凝滞不畅，经书说营气运行受阻，就会发生痈肿。肝主筋，所以出现筋脉拘挛。）肝将寒邪移于心，会导致发狂和膈中阻塞。（肝为阳脏，木火主气，阳气并入阳位故发狂。心位于膈上，肝位于膈下，母子之气上下相通。肝之邪气上移于心，停留于心下，所以造成膈中阻塞。意思是说脏不受邪，五脏之间的寒热相移，是邪气留滞于脏外而干扰脏气，并不损伤脏的真气。倪冲之说：治疗五脏的病，一半能活一半会死。这是因为病在脏气尚能生还，若伤及脏真则会死亡。）心将寒邪移于肺，会导致肺消。肺消的症状是喝水一分，排尿二分，属于死症，无法治愈。（肺受到心的邪气影响，就不能通调水液，只能向下泄出。肺是金水之源，寒邪随着心火，消烁肺的精气，因此出现饮水一分、排尿二分的症状，肺液全部消耗，所以是不治的死证。）肺将寒邪移于肾，称为涌水。涌水的症状是按压腹部并不坚硬，水气客居在大肠，快速行走时腹部发出濯濯的水声，像囊袋包裹着浆液一样，这是水病的表现。（大地之水对应天之寒，肾为水脏，肺主生水之源，因此肺的寒邪下移于肾，肾的水气反而上涌于肺。大肠是肺的腑，肺位于膈上，所以水气客居在大肠，快速行走时发出濯濯有声，如同囊裹浆液，这是因为水液不沾流，走窜于肠间所致。倪冲之说：肺移邪于肾，肝移邪于心，是传其所生的脏器；肾移邪于脾，脾移邪于肝，是侮其所不胜的脏器；心移邪于肺，是乘其所胜的脏器。）脾将热邪移于肝，会导致惊骇和鼻衄。（东方属肝木，其病发作时常有惊骇。肝主血，所以热盛则导致鼻出血。）肝将热邪移于心则会死亡。（心主君火而不受邪，邪热乘袭心脏，所以死亡。）心将热邪移于肺，传变为膈消。（心肺位于膈上，火热淫滥于肺金，则金水之液枯竭。膈消是指膈上的津液耗竭，从而形成消渴病。）肺将热邪移于肾，传变为柔疳（筋骨痿弱）。（肾属水，主生骨，肾脏燥热则髓精不生，因此筋骨痿弱，形成柔疳。）肾将热邪移于脾，传变为虚损导致的肠澼（痢疾），属于死症，不可治愈。（太阴湿土主气，不能制水，反而受湿热乘袭，脾气虚伤，就不能磨运水谷，导致肠澼下利。谷气已绝，所以是不治的死证。）胞宫将热邪移于膀胱，会导致小便不通和尿血。（膀胱是胞宫的室舍。冲任二脉起于胞中，是经血的海源。胞宫的热邪移于膀胱，是经血之邪移入膀胱，所以尿血。热则水道干燥枯竭，所以小便不通。）膀胱将热邪移于小肠，会导致膈部和小肠气机阻滞不通，向上发展为口腔糜烂。（小肠的经脉，络心循咽，下膈属小肠。小肠之下名为阑门，过滤分别汁液，渗入膀胱。膀胱反移热于小肠，因此膈和小肠不能向下渗透，湿热之气反而随经脉上逆，导致口腔糜烂。）小肠将热邪移于大肠，会导致伏瘕和沉痔。（“沉”音同“伏”。瘕是指假性的积聚，借津血而形成聚汁。小肠主液，大肠主津，小肠移热于大肠，则津液留聚，形成伏瘕。沉即痔。小肠主火，大肠主金，火热淫滥于金，则形成肠痔。《邪气脏腑病形篇》说：肾脉微涩表现为闭经和沉痔。“沉”字或许是上古文献的省文或简脱。朱圣公说：各家注释都将“沉”解释为伏瘕沉滞。按经文用了两个“为”字，说明是两种病症，不可合并为一证论，应以师注为准。）大肠将热邪移于胃，表现为食欲旺盛但身体消瘦，又叫做食亦。（胃主受纳水谷，大肠是传导之官。大肠的热邪反逆乘于胃，因此胃热则消化食物快、食欲好。阳明燥热，则荣卫津液不生，所以虽然能吃却身体消瘦。“亦”通“懈”，指虽然能吃但身体懈怠懒惰，所以又叫食亦。）胃将热邪移于胆，也叫食亦。（五脏六腑的生气，都取决于胆。胆气燥热则生阳不升，所以身体懈怠。胃气热则消化食物快、容易饥饿，所以也叫食亦。张兆璜说：足少阳疟疾，使人身体懈怠。现在胃移热于少阳，所以也名叫食亦。）胆将热邪移于脑，会导致鼻辛、鼻渊。鼻渊的症状是浊涕不断流出。（“辛”音同“遏”。胆气上升，则热邪随之进入脑部。挟持鼻两旁称为“辛”。“鼻辛”指鼻子辛酸。“鼻渊”指浊涕不断流出。脑是精髓的海源，髓是充实骨骼的物质。脑属阴，所以脑渗液则为鼻涕。我认为胞、胆、脑、髓属于奇恒之府；肠胃、膀胱属于四形脏。论述奇恒之府相传，是指胆与脑、胞与膀胱，没有经络直接相通，而是热邪在气分而气相乘。至于肠胃的逆传，也是邪热在气而不在腑，所以形成伏瘕、食亦的病症，而不能从下面解决。杨元如说：肾主藏精而居于下，脑为精髓之海而居于上，胆是中精之府。三者都主藏精，精气相通，所以胆的邪气移入于脑。倪冲之说：少阳隶属于肾，胆气通于脑，脑髓通于肾，这是精气的上下循环。）这种病传变会导致鼻衄、目盲和视物不清。所以说是由于气厥引起的。（这里总括解释脏腑寒热相移，都是在气分而不在经脉，所以说得之于气厥。热气上升，迫于络脉则导致鼻衄；淡渗皮毛之血，不能化液为汗则导致蔑（微小出血）；邪热伤气而阳气虚则导致目瞑（眼睛闭合或失明）。意思是邪气出于脑，则传于气分，形成衄、蔑、瞑目的病症。并解释经脉内连脏腑，如果脏邪在经脉，入脏则死；腑邪在经脉，则流入肠胃而从下面解决。此处的邪气在脏腑气分，所以内外相乘，产生寒热的往来；脏腑相移，产生寒热的气厥。这是在气而不在经，所以篇名叫做《气厥论》，结尾总结说：得之于气厥。）
Huangdi asked, "What is the mechanism behind the mutual transmission of cold and heat pathogens among the Zang and Fu organs?" (Huangdi suddenly inquired about the pathological manifestations of cold and heat transmission between Zang and Fu organs. This follows the previous chapter to further discuss the pathogenesis of Qi Jue [Qi Reversal] associated with Malaria qi. The terms 'cold and heat' refer to the pathogens and righteous Qi, or Yin and Yang energies. If pathogens reside between the Zang and Fu organs at the Mu Yuan [Gates of Origin], causing mutual assault between internal and external Yin and Yang, alternating chills and fever will occur. If Zang pathogens transmit to another Zang, or Fu pathogens to another Fu, it results in pathological changes of Qi reversal. Therefore, this chapter specifically discusses the mutual transmission of cold and heat among the Five Zang and Six Fu organs. Yang Yuanru stated: When malaria pathogens remain unresolved, they often cause complicated diseases; one must understand this is caused by Qi Jue. Ni Chongzhi said: Malaria itself does not kill people; those who die from malaria do so because the disease has transmitted into the Zang organs.)
Qibo replied, "When Kidney transmits cold to Liver, it causes abscesses and shortness of breath." (According to the following text 'Kidney transmits heat to Spleen', 'transmitting cold to Liver' here might be a textual error for 'transmitting cold to Spleen'. Spleen governs muscles; when cold transforms into heat, it corrupts muscle tissue forming abscesses and pus. Spleen controls the Yuan True Qi; when the Spleen organ is affected by pathogens, shortness of breath occurs.) "When Spleen transmits cold to Liver, it causes abscesses and tendon spasms." (Liver governs Blood; cold causes blood stagnation. The Classics state that if Ying [Nutrient] Qi fails to circulate, abscesses develop. Liver governs tendons, hence tendon spasms occur.) "When Liver transmits cold to Heart, it causes mania and obstruction in the epigastrium/chest." (Liver is a Yang organ, governed by Wood and Fire Qi. When Yang merges with Yang, mania ensues. Heart resides above the diaphragm, while Liver is below. The Mother-Child Qi connects them vertically. Liver pathogens moving upward to Heart and lingering below the heart cause chest/epigastric obstruction. This implies that Zang organs do not directly accept pathogens; rather, cold and heat transmission among Zang organs involves pathogens lingering outside the Zang to interfere with Zang Qi without damaging the True Qi of the Zang. Ni Chongzhi said: Treating Zang diseases results in half survival and half mortality. Disease affecting Zang Qi allows for survival, but damage to Zang True Qi leads to death.) "When Heart transmits cold to Lung, it causes Lung Xiao [Lung Wasting-Thirst]. Lung Xiao is characterized by drinking one part urine outputting two parts; it is incurable and fatal." (When Lung is affected by Heart pathogens, it loses its ability to regulate water passages, leading only to downward leakage. Lung is the source of Metal and Water; cold follows Heart Fire, consuming Lung Essence. Thus, drinking one part resulting in two parts urination indicates complete consumption of Lung fluids, making it an incurable fatal syndrome.) "When Lung transmits cold to Kidney, it is called Yong Shui [Surging Water]. In Yong Shui, abdominal palpation reveals no hardness; water Qi lodges in the Large Intestine, producing gurgling sounds upon rapid movement, resembling a bag wrapped around liquid. This is a water pathology." (Water on earth corresponds to Cold in heaven. Kidney is the Water Organ, and Lung governs the origin of generation. Thus, Lung cold pathogens move downward to Kidney, causing Kidney water Qi to surge upward to Lung. Large Intestine is the Fu of Lung. Since Lung is above the diaphragm, water Qi lodges in the Large Intestine, producing gurgling sounds upon movement, like a bag containing liquid, because water flows freely through the intestines. Ni Chongzhi said: Lung transmitting to Kidney and Liver transmitting to Heart represent transmission to the organs they generate; Kidney transmitting to Spleen and Spleen transmitting to Liver represent insulting the organs they cannot overcome; Heart transmitting to Lung represents overpowering the organ it overcomes.) "When Spleen transmits heat to Liver, it causes fright and epistaxis." (East belongs to Liver Wood; its diseases often manifest as fright. Liver governs Blood, so excessive heat causes nosebleeds.) "When Liver transmits heat to Heart, it is fatal." (Heart governs Jun Fire [Monarch Fire] and does not accept pathogens; when evil heat attacks it, death occurs.) "When Heart transmits heat to Lung, it transmits as Ge Xiao [Diaphragmatic Thirst]." (Heart and Lung reside above the diaphragm. Excessive fire invading Lung Metal dries up the fluids of Metal and Water. Ge Xiao refers to the exhaustion of fluids above the diaphragm, leading to Xiao Ke [Wasting-Thirst Syndrome].) "When Lung transmits heat to Kidney, it transmits as Rou Gou [Soft Atrophy/Withering]." (Kidney belongs to Water and generates bone. Dry-heat in Kidney prevents the production of Marrow Essence, leading to weak tendons and bones, forming Rou Gou.) "When Kidney transmits heat to Spleen, it transmits as Xu Chang Pi [Deficiency Dysentery], which is fatal and incurable." (Taiyin Damp Earth governs Qi and should control Water; instead, it suffers damp-heat assault. Spleen Qi deficiency impairs digestion and transportation of food and fluids, causing dysenteric diarrhea. With the extinction of Gu Qi [Grain Qi], it becomes an incurable fatal syndrome.) "When Bao Gong [Uterus/Microcosm] transmits heat to Bladder, it causes Long [Dysuria] and hematuria." (Bladder is the chamber of Bao Gong. Chong and Ren meridians originate from Bao Gong and serve as the sea of menstrual blood. Heat from Bao Gong transmitting to Bladder means blood-pathogen transfers to Bladder, causing hematuria. Heat dries the water passages, causing urinary retention.) "When Bladder transmits heat to Small Intestine, it causes obstruction in the diaphragm and intestines, ascending to cause oral ulceration." (The Small Intestine meridian connects to Heart, follows the pharynx, descends through the diaphragm, and enters the Small Intestine. Below the Small Intestine is the Lan Men [Gate of Separation], which filters juices into the Bladder. If Bladder heat transmits back to Small Intestine, the diaphragm and intestines cannot descend properly. Damp-heat Qi reverses along the meridians upward, causing oral erosion.) "When Small Intestine transmits heat to Large Intestine, it causes Fu Xia [Hidden Masses] and Chen Zhi [Hemorrhoids]." ('Chen' sounds like 'Fu'. Xia refers to假 [false] masses formed by accumulated fluids and blood. Small Intestine governs Ye [Turbid Fluids], Large Intestine governs Jin [Clear Fluids]. Heat from Small Intestine to Large Intestine causes fluid stagnation, forming Fu Xia. Chen refers to hemorrhoids. Small Intestine governs Fire, Large Intestine governs Metal. Fire invading Metal causes intestinal hemorrhoids. The *Xieqi Zangfu Bingxing Pian* states: 'A faint and choppy Kidney pulse indicates amenorrhea and Chen Hemorrhoids.' 'Chen' may be an abbreviation or omission in ancient texts. Zhu Shenggong said: Commentators interpret 'Chen' as stagnant Fu Xia. However, the text uses two 'wei' [is/called] characters, indicating two distinct conditions, not one. The Master's annotation is correct.) "When Large Intestine transmits heat to Stomach, it causes polyphagia with emaciation, also called Shi Yi [Food Also]." (Stomach receives and decomposes food; Large Intestine is the official of conduction. Heat from Large Intestine counter-attacks Stomach. Stomach heat accelerates digestion and increases appetite. Yangming dry-heat prevents the generation of Ying, Wei, and Jin fluids. Thus, despite eating well, the body wastes away. 'Yi' is synonymous with 'Xie' [slack/lazy], meaning although capable of eating, the body feels lethargic. Hence, it is called Shi Yi.) "When Stomach transmits heat to Gallbladder, it is also called Shi Yi." (The vital Qi of all Zang and Fu organs depends on Gallbladder. Dry-heat in Gallbladder prevents the ascent of Sheng Yang [Vital Yang], causing bodily lethargy. Heat in Stomach accelerates digestion and hunger, hence also called Shi Yi. Zhang Zhaohuang said: Shaoyang Malaria causes bodily lethargy. Now, Stomach heat transmitting to Shaoyang is therefore also named Shi Yi.) "When Gallbladder transmits heat to Brain, it causes Xin Bi [Bitter Nasal Sensation] and Bi Yuan [Nasal Fount]. Bi Yuan is characterized by continuous discharge of turbid nasal mucus." ('Xin' sounds like 'E'. Gallbladder Qi ascends, carrying heat into the Brain. The area flanking the nose is called 'Xin'. 'Bi Xin' refers to nasal bitterness/astringency. 'Bi Yuan' refers to continuous turbid nasal discharge. The Brain is the sea of Essence and Marrow, filling the bones. Brain is Yin; thus, brain exudate becomes nasal mucus. I believe Bao, Gallbladder, Brain, and Marrow belong to the Qi Heng Zhi Fu [Extraordinary Fu Organs]; Gastrointestinal tract and Bladder belong to the Si Xing Zang [Four Form Organs]. Discussing transmission among Extraordinary Fu Organs implies that Gallbladder and Brain, Bao and Bladder, lack direct meridian connections; rather, heat pathogens interact via Qi. As for gastrointestinal reverse transmission, it is also heat in Qi rather than in the Fu, resulting in Fu Xia and Shi Yi, which cannot be resolved from below. Yang Yuanru said: Kidney stores Essence and resides inferiorly; Brain is the sea of Essence and Marrow residing superiorly; Gallbladder is the house of Middle Essence. All three store Essence, and their Essence Qi connects, allowing Gallbladder pathogens to transmit to Brain. Ni Chongzhi said: Shaoyang attaches to Kidney, Gallbladder Qi connects to Brain, and Brain Marrow connects to Kidney, representing the cyclical circulation of Essence Qi from top to bottom.) "This transmission leads to epistaxis, blindness, and dim vision. Therefore, it is attributed to Qi Jue." (This summarizes that cold and heat transmission among Zang and Fu organs occurs in the Qi level, not the Meridians, hence 'obtained from Qi Jue'. Rising heat forces blood into collateral vessels causing epistaxis; failure of skin/hair blood to transform into sweat causes minor bleeding (Mie); Qi injury and Yang deficiency cause eye closure/blindness (Ming). This means pathogens emerging from the Brain transmit to the Qi level, causing epistaxis, Mie, and Ming symptoms. It also explains that meridians connect internally to Zang and Fu. If Zang pathogens are in the meridians and enter the Zang, death occurs; if Fu pathogens are in the meridians, they flow into the intestines/stomach and resolve from below. Here, pathogens are in the Zang/Fu Qi level, causing internal-external assault and alternating cold/heat. Zang-Fu transmission causes cold/heat Qi Jue. Since this is in Qi and not Meridians, the chapter is named *Qi Jue Lun*, concluding with 'obtained from Qi Jue'.)