黄帝问曰。今夫热病者。皆伤寒之类也。（此论热病。故篇曰热论。盖论外因之热病也。太阳之气主表。阳明之气主
肌。凡外淫之邪。始伤表阳。皆得阳气以化热。故曰凡病热者。皆伤寒之类也。）或愈或死。其死皆以六七日之间。其愈
皆以十日以上者。何也。不知其解。愿闻其故。（六日气周。七日来复。死于六七日之间者。六经之气已终。而不能复也。
愈于十日以上者。七日不作再经。十三日六气已复。故愈。）岐伯对曰。巨阳者。诸阳之属也。（巨、大也。属、会也。
谓太阳为诸阳之会。）其脉连于风府。故为诸阳主气也。（风府、穴名。在脑后发际内一寸。乃督脉阳维之会。督脉者。
总督一身之阳。与太阳之脉。挟背下行。言太阳之气。生于膀胱。出于胸胁。升于头项。主于肤表。太阳之脉。起于睛
明。会于风府。挟督脉循行于背。经气皆阳。故为诸阳主气。）人之伤于寒也。则为病热。热虽甚不死。（为者。谓太阳
之气为之也。太阳标阳而本寒。天之寒邪。始病太阳之气者。同气相感也。得太阳标阳之化。是以则为病热。所谓病反
其本。中标之病。治反其本。中标之方。言本寒邪而反为热病。反以凉药治之。是病太阳之标热。而不病天之阴寒。是
以热虽甚不死也。）其两感于寒而病者。必不免于死。（伤寒一日。太阳受之。二日阳明。三日少阳。是阴寒之邪。得阳
气以化热。虽传入于三阴。而亦为热病。七日来复于太阳。不作再经。而其病自愈。若两感于寒者。阴阳交逆。荣卫不
通。故不免于死。）帝曰。愿闻其状。（状、形象也。伤寒之邪。病三阴三阳之气。而兼涉于皮肤肌络之形层。故曰状者。
谓无形之气象。有形之形层。）岐伯曰。伤寒一日。巨阳受之。故头项痛。腰脊强。（太阳之气主皮毛。故伤寒一日。太
阳受之。阳气在上。故头项痛。背为阳。故腰脊强。此言始病。太阳之气也。伤寒一日太阳。二日阳明。三日少阳。四
日太阴。五日少阴。六日厥阴。七日来复于太阳者。此六气之相传。不涉有形之经络。故首论太阳而不言太阳之经也。
然伤寒为病。变幻无常。有病在六气。而不涉六经者。有经气之兼病者。有气分之邪。转入于经者。为病多有不同。是
以太阳只言气而不言经。阳明少阳。兼经气而言也。倪冲之曰。有云素问言其常。而常中有变在焉。）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。（阳明之气主肌肉。身热者。病阳明之气也。病虽在气。而阳
明之脉。挟鼻络目而属胃。故有目疼鼻干之形证。胃不和。故不得卧也。杨君立问曰。六经伤寒。既病在气。奚复见有
形之证。曰太阳曰阳明者。谓无形之气也。以有形之病。证无形之气。非实病于经也。若邪在经则溜于腑。不复再传少
阳及三阴矣。）三日少阳受之。少阳主胆。其脉循胁络于耳。故胸胁痛而耳聋。（少阳之气。主枢主胆。胆气升则诸阳
之气皆升。所谓因于寒。欲如运枢也。诸阳之气。从枢胁而出于肤表。太阳主表。阳明主肌。少阳主胸胁。胸胁痛而耳
聋者。病在气而见有形之经证也。）三阳经络。皆受其病。而未入于脏者。故可汗而已。（脏者。里也。阴也。言三阳之
经络。皆受三阳邪热之病。然在形身之外。而未入于里阴。可发汗而解也。）四日太阴受之。太阴脉布胃中。络于嗌。故
腹满而嗌干。（六经之脉。皆外络形身。内连脏腑。三阴之脉。言内而不言外者。谓伤寒之邪。随阴气而循于内也。杨君
立曰。即此可见病在气而见于经证也。）五日少阴受之。少阴脉贯肾络于肺。系舌本。故口燥舌干而渴。（六气相传。虽
入于里阴。而皆为热证。故燥渴也。）六日厥阴受之。厥阴脉循阴器而络于肝。故烦满而囊缩。（厥阴木火主气。故烦满。
脉循阴器。故囊缩也。）三阴三阳。五脏六腑皆受病。荣卫不行。五脏不通。则死矣。（夫经络受邪。则内干脏腑。此言
六气相传。而经脉亦病。是以荣卫不行。脏腑皆伤。而为死证也。）其不两感于寒者。七日巨阳病衰。头痛少愈。（此所
谓两感者。承上文而言。荣卫血气皆伤。以致脏腑俱病。故不免于死。若止于气分相传。六日已周。七日来复于表阳。
则太阳之病气渐衰。而头痛少愈矣。）八日阳明病衰。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。大气皆去。病日已矣。（伤寒
之邪。为毒最厉。故曰大气。邪气渐衰。则正气渐复矣。）帝曰。治之奈何。岐伯曰。治之各通其脏脉。病日衰已矣。（脏
脉、谓手足三阴三阳之经脉。病传六气。故当调其六经。经气相调。则荣卫营运。而不内干脏腑矣。）其未满三日者。可
汗而已。其满三日者。可泄而已。（前三日在阳分。故当从汗解。后三日在阴分。故当从下解。此言六气相传。表里阴阳
之大概耳。然伤寒有病传者。有不传者。有八九日仍在表阳而当汗者。有二三日邪中于里阴而当急下者。此又不在阴阳
六气之常法也。）帝曰。热病已愈。时有所遗者。何也。岐伯曰。诸遗者。热甚而强食之。故有所遗也。（伤寒论曰。
大病瘥后劳复者。枳实栀子汤主之。若有宿食者。加大黄如博棋子五六枚。盖因伤寒热甚之时。而强食其食。故有宿食
之所遗也。）若此者。皆病已衰。而热有所藏。因其谷气相薄。两热相合。故有所遗也。（伤寒论曰。病患脉已解。而日
暮微烦。以病新瘥。人强与谷。脾胃气尚弱。不能消谷。故令微烦。损谷则愈。谓其余热未尽。而强增谷食也。此即复
释上文之意。）帝曰善。治遗奈何。岐伯曰。视其虚实。调其逆从。可使必已矣。（夫邪之所凑。其正必虚。正气虚者。
补其正气。余热未尽者。清其余邪。伤寒论曰。伤寒瘥已。后更发热者。小柴胡汤主之。脉浮者以汗解之。脉沉者以下
解之。此之谓调其逆从也。）帝曰。病热当何禁之。岐伯曰。病热少愈。食肉则复。多食则遗。此其禁也。（少愈者。邪
热未尽也。肉、谓豕肉。豕乃水畜。其性躁善奔。盖天之寒邪。即太阳寒水之气。邪未尽而食以豕肉。是动吾身之寒。
以应病之余热。似犹寒伤太阳而复病也。此言天之六淫。与人之六气相合者也。水畜之肉。其性寒冷。是以多食则遗。）
帝曰。其病两感于寒者。其脉应与其病形。何如。岐伯曰。两感于寒者。病一日则巨阳与少阴俱病。则头痛口干而烦满。
（此复论阴阳两感之为病也。太阳与少阴相为表里。一日而阴阳俱受其邪。是以见太阳之头痛。少阴之烦满咽干。）二日
则阳明与太阴俱病。则腹满身热。不欲食。谵言。（阳明与太阴为表里。故见太阴之腹满。阳明之身热。不欲食。谵语。）
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。（少阳与厥阴为表里。故见少阳之耳聋。厥阴之
囊缩而厥。水浆不入。谷气绝也。不知人者。神气伤也。此脏腑皆病。荣卫不行。故尽气终而死也。倪冲之曰。伤寒重
在胃气神气。胃气已绝。则水浆不入。邪伤神脏。则昏不知人。即病在三阳。亦系危证。如两感于寒。而胃气尚存。神
气清爽者。即不致于死也。）帝曰。五脏已伤。六腑不通。荣卫不行。如是之后。三日乃死。何也。岐伯曰。阳明者。
十二经脉之长也。其血气盛。故不知人三日。其气乃尽。故死矣。（此言荣卫血气。脏腑精神。皆阳明之所资生。如胃气
先绝者。不待六气之终。三日乃即死矣。）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。（此复论邪气留连之热病也。凡伤于寒则为病热者。此即病之伤寒也。如邪气留连而不即病者。至春时阳气外出。
邪随正出而发为温病。盖春温夏暑。随气而化。亦随时而命名也。伏匿之邪。与汗共并而出。故不可止之。）
（诸弟子问曰。本篇论三阴三阳之脉。皆属足经。是以有传足不传手之说。盖本诸此乎。曰。伤寒相传。病在三阴
三阳之六气。盖以六经配合六气。经之所循。即气之所至。故兼论其脉。非病在有形之经。而可以计日相传者也。夫天
为阳。地为阴。风寒暑湿燥火。天之阴阳也。木火土金水火。地之阴阳也。天之十干。化生地之五行。地之五行。上呈
天之六气。故在地为水。在天为寒。在地为火。在天为暑。在地为木。在天为风。在地为金。在天为燥。在地为土。在
天为湿。故在天为气。在地成形。形气相感。而化生万物。是以东方生风。风生木。木生酸。酸生肝。肝生筋。南方生
热。热生火。火生苦。苦生心。心生血。中央生湿。湿生土。土生甘。甘生脾。脾生肉。西方生燥。燥生金。金生辛。
辛生肺。肺生皮毛。北方生寒。寒生水。水生咸。咸生肾。肾生骨。是人之形骸脏腑。感在天无形之六气。在地有形之
五行。而生长成形者也。是以人身有无形之六气。以配三阴三阳之经脉。有有形之脏腑骨肉。经脉皮毛。以应在地之五
行。而三阴三阳之经气。又由五脏五行之所生。此亦阴阳形气之相合也。是以有病在无形之气。而涉于有形之经者。有
病在有形之皮毛肌脉。筋骨脏腑。而涉于无形之气者。此形气之相感也。若夫伤寒之邪。系感天之六气。故当于吾身之
六气承之。病在六气。而六经之经脉应之。此人与天地之气。相参合者也。按六微旨大论曰。上下有位。左右有纪。少
阳之右。阳明治之。阳明之右。太阳治之。太阳之右。厥阴治之。厥阴之右。少阴治之。少阴之右。太阴治之。太阴之
右。少阳治之。太阳为诸阳主气。故先受邪。是以一日太阳。二日阳明。三日少阳。四日太阴。五日少阴。六日厥阴。
六日经尽。七日来复。而病气即衰。如七日不愈。又从太阳而当作再经。此病在无形之六气。故能六经传遍。而来复于
太阳。若病在有形之经脉。此系转属一经之病。而不相传于别经者也。再按同篇曰。太阳之上。寒气治之。中见少阴。
阳明之上。燥气治之。中见太阴。少阳之上。火气治之。中见厥阴。太阴之上。湿气治之。中见阳明。少阴之上。君火
治之。中见太阳。厥阴之上。风气治之。中见少阳。又曰。太阳少阴。从本从标。少阳太阴从本。阳明厥阴不从标本。
从乎中也。故从本者。化生于本。从标本者。有标本之化。从中者。以中气为化也。盖太阳标阳而本寒。少阴标阴而本
热。此皆有寒热之化。故曰从本从标。如天之寒邪。即太阳之本气。而病在太阳之标阳。得太阳阳热之气。而反化为热
病。是反天之本寒。而反病标阳之热。所谓病反其本。中标之病。既病太阳标阳之热。而反以凉药治之。所谓治反其病。
中标之方。此太阳之从标也。如病在太阳。而不中标阳之热化。则太阳经中。有四逆汤及诸附子汤。以救太阳之本寒。
此太阳之从本也。如少阴经中。有急下之大热证。此少阴之从本也。有急温之大寒证。此少阴之从标也。故曰。太阳少
阴。从本从标。如阳明感阳热之悍气。则为大下之热病。如得中见阴湿之化。则为汗出和平之缓证。如厥阴得中见少阳
之火化。则为便利脓血之热证。如病本气之阴寒。则为手足厥逆之危证。此皆寒热阴阳之气化者也。本篇论太阳为诸阳
主气。先受天之寒邪。得太阳标阳以化热。即六经传遍。热虽甚而不死。故篇名曰热病论。盖专论病热之伤寒。而不论
伤寒之变证。以其得太阳阳热之气化故也。至如其脉连于风府。循胁络嗌。皆病在无形之六气。而见有形之经证。非太
阳之脉可传于阳明。阳明之脉可传于少阳。少阳之脉可传于三阴者也。能明乎天地阴阳。五行六气之化。庶可与论伤寒
之为病。诸生复问曰。是伤寒之邪。只病在足经而不病手经耶。曰。六脏六腑。配合十二经脉。十二经脉。以应三阴三
阳之气。然阴阳之气。皆从下而生。自内而外。故灵枢经云。六腑皆出于足之三阳。上合于手者也。是以本经以三阴三
阳之气。始应足之六经。足之六经。复上与手经相合。）
黄帝问道：如今所说的热病，都属于伤寒这一类。（这是论述热病，所以篇名叫做《热论》。大概是论述外感引起的热病。太阳经气主管体表，阳明经气主管肌肉。凡是外来的邪气，最初伤害体表的阳气，都会借助阳气而化生为热，所以说凡是发热的病，都是伤寒的一类。）有的痊愈，有的死亡，死亡的都在发病后六七天之间，痊愈的都在十天以上，为什么呢？我不明白其中的道理，希望听听原因。（六天为一个气运周期，第七天开始恢复。在六七天之间死亡的，是因为六经之气已经耗尽，而不能恢复。在十天以上痊愈的，是因为第七天没有再次传经，到了十三天六经之气已经恢复，所以痊愈。）岐伯回答说：巨阳（即太阳经），是诸阳经的统领。（巨，就是大；属，就是会合。意思是说太阳经是诸阳经的会合之处。）它的经脉连接风府穴，所以它是诸阳经的主气。（风府，穴位名。位于脑后发际内一寸，是督脉和阳维脉的会合处。督脉，总督一身之阳气，与太阳经的经脉，沿着背部下行。意思是太阳经的气，产生于膀胱，出于胸胁，升到头项，主宰肤表。太阳经的经脉，起于睛明穴，会合于风府穴，夹着督脉在背部循行，经气都是阳性的，所以成为诸阳经的主气。）人受到寒邪侵袭，就会发生热病，即使热势很严重也不会死。（所谓“为”，是指太阳经的气造成的。太阳经标为阳而本为寒，天的寒邪，首先侵犯太阳经的气，是因为同气相感应。得到太阳经标阳的化育，所以就会发生热病。这就是所谓的病反其本，中标之病，治反其本，中标之方。意思是感受的是本源的寒邪，却反而表现为热病，反过来用凉药治疗，是针对太阳经的标热，而不是针对天的阴寒，所以即使热势很严重也不会死。）如果是两感于寒而发病的，一定不免于死。（伤寒第一天，太阳经受邪；第二天阳明经；第三天少阳经。这是阴寒之邪，得到阳气而化热，虽然传入三阴经，但也属于热病。七天后重新回到太阳经，如果不发生再经传变，病就会自愈。如果是两感于寒，阴阳交逆，营卫不通，所以不免于死。）黄帝说：希望听听它的症状表现。（状，指形象。伤寒的邪气，侵犯三阴三阳的气，同时涉及皮肤肌络的形层，所以说“状”，指的是无形的气象和有形的形层。）岐伯说：伤寒第一天，巨阳受邪，所以头痛、项强、腰脊僵硬。（太阳经气主管皮毛，所以伤寒第一天，太阳经受邪。阳气在上，所以头痛。背为阳，所以腰脊僵硬。这是说刚开始病在太阳经气。伤寒第一天太阳，第二天阳明，第三天少阳，第四天太阴，第五天少阴，第六天厥阴。七天后重新回到太阳经，这是六气的相传，不涉及有形的经络，所以首先论述太阳而不提太阳的经脉。然而伤寒作为疾病，变幻无常，有病在六气而不涉及六经的，有经气兼病的，有气分的邪气转入经脉的，病情多有不同，所以太阳只讲气不讲经，阳明、少阳则兼讲经和气。倪冲之说：有人说《素问》讲的是常理，但常理中包含了变化。）第二天阳明经受邪，阳明经主管肌肉，它的经脉夹鼻络于目，所以身体发热、眼睛疼痛、鼻子干燥、不能安卧。（阳明经气主管肌肉，身体发热是病在阳明经气。病虽然在气分，但阳明经的经脉，夹鼻络目并属于胃，所以有眼睛疼痛、鼻子干燥的症状。胃不和，所以不能安卧。杨君立问道：六经伤寒，既然病在气分，为什么又出现有形的症状？回答说：说太阳、阳明，是指无形的气。用有形的病证来验证无形的气，并不是实病在经脉上。如果邪气在经脉，就会流入腑，不再传变到少阳及三阴了。）第三天少阳经受邪，少阳经主管胆，它的经脉循行胁肋络于耳，所以胸胁疼痛、耳聋。（少阳经气，主枢机、主胆。胆气升发则诸阳之气都升发，所谓因于寒，想要像门轴一样运转。诸阳之气，从枢胁而出达于肤表。太阳主管表，阳明主管肌肉，少阳主管胸胁。胸胁疼痛和耳聋，是病在气分而表现出有形的经脉症状。）三阳经的经络都受了病，但没有进入脏的，所以可以通过发汗治愈。（脏，指里，指阴。意思是三阳经的经络，都受了三阳邪热的病，但在形体之外，没有进入里的阴分，可以发汗而解。）第四天太阴经受邪，太阴经的经脉散布在胃中，络于咽喉，所以腹部胀满、咽喉干燥。（六经的经脉，都外络形体，内连脏腑。三阴经的经脉，只讲内不讲外，是说伤寒的邪气，随着阴气而循行向内。杨君立说：从这里可以看出病在气分而表现在经脉症状上。）第五天少阴经受邪，少阴经的经脉贯穿肾络于肺，系于舌根，所以口燥、舌干而渴。（六气相传，虽然进入里的阴分，但都表现为热证，所以出现燥渴。）第六天厥阴经受邪，厥阴经的经脉循行阴器络于肝，所以心烦、腹满、睾丸收缩。（厥阴木火主气，所以心烦腹满。经脉循行阴器，所以睾丸收缩。）三阴三阳，五脏六腑都受了病，营卫运行停止，五脏不通，就会死亡。（经络受邪，就会内伤脏腑。这里说的是六气相传，而经脉也病了，所以营卫不行，脏腑皆伤，成为死证。）那些不是两感于寒的，第七天太阳经的病势衰退，头痛稍微减轻。（这里所说的两感，是承接上文而言，营卫血气都受伤，导致脏腑俱病，所以不免于死。如果只是气分相传，六天已周遍，七天后重新回到表阳，那么太阳经的病气逐渐衰退，头痛稍微减轻。）第八天阳明经的病势衰退，身体发热稍微减轻。第九天少阳经的病势衰退，耳聋稍微能听到声音。第十天太阴经的病势衰退，腹部胀满消退如常，就想吃东西。第十一天少阴经的病势衰退，口渴停止，腹不满，舌干已缓解并且打喷嚏。第十二天厥阴经的病势衰退，睾丸松弛，小腹微软，大气（邪气）都已去除，病一天天好了。（伤寒的邪气，毒性最猛烈，所以叫大气。邪气逐渐衰退，正气就逐渐恢复。）黄帝说：怎么治疗呢？岐伯说：治疗要分别疏通各脏的经脉，病势就会一天天衰退。（脏脉，指手足三阴三阳的经脉。病传六气，所以应当调理六经。经气相互调和，那么营卫营运正常，就不会内伤脏腑。）病程未满三天的，可以通过发汗治愈。病程已满三天的，可以通过泄下治愈。（前三天在阳分，所以应当从汗解。后三天在阴分，所以应当从下解。这是说六气相传，表里阴阳的大概规律。然而伤寒有病传变的，有不传变的，有八九日仍在表阳而应当发汗的，有二三日邪气中于里阴而应当急下的，这又不在阴阳六气的常规法则之内。）黄帝说：热病已经痊愈，但时常有遗留症状的，是什么原因呢？岐伯说：各种遗留症状，是因为热势很盛时勉强进食，所以有遗留。（《伤寒论》说：大病初愈后因劳累复发的，用枳实栀子汤主治。如果有宿食的，加大黄如博棋子五六枚。这是因为在伤寒热势很盛的时候，强行进食，所以有宿食遗留。）像这种情况，都是病势已衰，但热邪有所潜藏，因为谷气与余热相搏结，两热相合，所以有遗留症状。（《伤寒论》说：病人脉象已平和，但傍晚轻微烦躁，因为病刚痊愈，人强行进食，脾胃之气尚弱，不能消化食物，所以令轻微烦躁。减少饮食就会好。说的是余热未尽，而强行增加谷食。这是对上文意思的再次解释。）黄帝说：好。遗留症状怎么治疗？岐伯说：观察虚实，调理逆从，可以使病必愈。（邪气聚集的地方，正气必然虚弱。正气虚的，补益正气；余热未尽的，清解余邪。《伤寒论》说：伤寒痊愈后，后来又发热的，用小柴胡汤主治。脉浮的用汗法解，脉沉的用下法解。这就叫调理逆从。）黄帝说：患热病应当禁忌什么？岐伯说：热病稍有好转，吃肉就会复发，多吃就会遗留，这是禁忌。（稍好，说明邪热未尽。肉，指猪肉。猪是水畜，性躁善奔。天的寒邪，就是太阳寒水之气。邪气未尽而吃猪肉，是动我们身上的寒，来应和病后的余热，好像寒伤太阳后又生病一样。这是说天的六淫与人体的六气相合。水畜的肉，性质寒冷，所以多吃就会遗留。）黄帝说：两感于寒的病人，其脉象应与病症表现如何？岐伯说：两感于寒的，第一天太阳与少阴同时发病，就会头痛、口干、心烦腹满。（这是再次论述阴阳两感的病症。太阳与少阴互为表里。一天而阴阳都受邪，所以见到太阳的头痛，少阴的心烦腹满咽干。）第二天阳明与太阴同时发病，就会腹部胀满、身体发热、不想吃饭、说胡话。（阳明与太阴互为表里，所以见到太阴的腹部胀满，阳明的身体发热、不想吃饭、谵语。）第三天少阳与厥阴同时发病，就会耳聋、睾丸收缩、四肢厥冷、水浆不进、神志昏迷、六天死亡。（少阳与厥阴互为表里，所以见到少阳的耳聋，厥阴的睾丸收缩和四肢厥冷。水浆不进，说明谷气绝断。神志昏迷，说明神气受伤。这是脏腑都病了，营卫不行，所以耗尽气数而死。倪冲之说：伤寒重在胃气和神气。胃气已绝，则水浆不进；邪伤神脏，则昏不知人。即使病在三阳，也是危证。如两感于寒，而胃气尚存，神气清爽的，就不会死。）黄帝说：五脏已伤，六腑不通，营卫不行，在这之后三天才死亡，是什么原因？岐伯说：阳明经，是十二经脉之长，它的血气旺盛。所以神志昏迷三天，它的气才耗尽，所以死亡。（这是说营卫血气、脏腑精神，都依赖阳明所资生。如果胃气先绝，不等到六气终尽，三天就会立即死亡。）凡是患伤寒而变成温病的，在夏至日之前发病的叫温病，在夏至日之后发病的叫暑病。暑病应当随汗一起排出，不要止住汗。（这是再次论述邪气留连的热病。凡是伤于寒就发生热病的，这就是病之伤寒。如邪气留连而不立即发病，到了春天阳气外出，邪气随正气外出而发为温病。春温夏暑，随气而化，也随时令命名。伏匿的邪气，与汗共同并出，所以不可止汗。）
弟子们问道：本篇论述三阴三阳的经脉，都属于足经，所以有“传足不传手”的说法，大概是根据这个吗？回答说：伤寒相传，病在三阴三阳的六气，大概是以六经配合六气，经脉所循行的地方，就是气所到达的地方，所以兼论其脉，并不是病在有形的经脉上，而是可以按日相传的。天为阳，地为阴。风寒暑湿燥火，是天的阴阳；木火土金水火，是地的阴阳。天的十干，化生地之五行；地之五行，上呈天之六气。所以在地下为水，在天为寒；在地为火，在天为暑；在地为木，在天为风；在地为金，在天为燥；在地为土，在天为湿。所以在天为气，在地成形，形气相感，而化生万物。所以东方生风，风生木，木生酸，酸生肝，肝生筋；南方生热，热生火，火生苦，苦生心，心生血；中央生湿，湿生土，土生甘，甘生脾，脾生肉；西方生燥，燥生金，金生辛，辛生肺，肺生皮毛；北方生寒，寒生水，水生咸，咸生肾，肾生骨。这是人的形体脏腑，感受在天无形的六气，在地有形的五行，而生长成形的。所以人身有无形之六气，以配三阴三阳的经脉；有有形之脏腑骨肉、经脉皮毛，以应在地之五行。而三阴三阳的经气，又由五脏五行所生。这也是阴阳形气相合。所以有病在无形之气而涉及有形之经的，有病在有形之皮毛肌脉筋骨脏腑而涉及无形之气的，这是形气相感。至于伤寒的邪气，是感受天的六气，所以应当由我们身上的六气承受。病在六气，而六经的经脉应之。这是人与天地之气相参合。按《六微旨大论》说：上下有位，左右有纪。少阳之右，阳明治之；阳明之右，太阳治之；太阳之右，厥阴治之；厥阴之右，少阴治之；少阴之右，太阴治之；太阴之右，少阳治之。太阳为诸阳主气，所以先受邪。因此第一天太阳，第二天阳明，第三天少阳，第四天太阴，第五天少阴，第六天厥阴。六天经气走完，七天后恢复，病气就衰退。如果七天不愈，又从太阳当作再经。这是病在无形之六气，所以能六经传遍，而来复于太阳。如果病在有形之经脉，这是转属一经的病，而不相传于别经的。再按同篇说：太阳之上，寒气治之，中见少阴；阳明之上，燥气治之，中见太阴；少阳之上，火气治之，中见厥阴；太阴之上，湿气治之，中见阳明；少阴之上，君火治之，中见太阳；厥阴之上，风气治之，中见少阳。又说：太阳少阴，从本从标；少阳太阴从本；阳明厥阴不从标本，从乎中也。所以从本的，化生于本；从标本的，有标本之化；从中者，以中气为化。盖太阳标阳而本寒，少阴标阴而本热，这些都有寒热之化，所以说从本从标。如天的寒邪，就是太阳的本气，而病在太阳的标阳，得到太阳阳热之气，而反化为热病，是反天的本寒，而反病标阳之热，所谓病反其本，中标之病。既病太阳标阳之热，而反以凉药治之，所谓治反其病，中标之方。这是太阳之从标。如病在太阳，而不中标阳之热化，则太阳经中有四逆汤及诸附子汤，以救太阳之本寒，这是太阳之从本。如少阴经中有急下之大热证，这是少阴之从本；有急温之大寒证，这是少阴之从标。所以说太阳少阴，从本从标。如阳明感阳热之悍气，则为大下之热病；如得中见阴湿之化，则为汗出和平之缓证。如厥阴得中见少阳之火化，则为便利脓血之热证；如病本气之阴寒，则为手足厥逆之危证。这些都是寒热阴阳之气化。本篇论太阳为诸阳主气，先受天之寒邪，得太阳标阳以化热，即六经传遍，热虽甚而不死，故篇名曰《热病论》，盖专论病热之伤寒，而不论伤寒之变证，以其得太阳阳热之气化故也。至如其脉连于风府，循胁络嗌，皆病在无形之六气，而见有形之经证，非太阳之脉可传于阳明，阳明之脉可传于少阳，少阳之脉可传于三阴者也。能明乎天地阴阳、五行六气之化，庶可与论伤寒之为病。诸生又问：是伤寒之邪，只病在足经而不病手经吗？回答说：六脏六腑，配合十二经脉，十二经脉，以应三阴三阳之气。然阴阳之气，皆从下而生，自内而外，所以《灵枢经》说：六腑皆出于足之三阳，上合于手。是以本经以三阴三阳之气，始应足之六经，足之六经，复上与手经相合。
Yellow Emperor asked, saying: Now, all febrile diseases are of the category of Cold Damage (Shanghan). (This discusses febrile diseases, hence the chapter is named "Treatise on Febrile Diseases". It generally discusses exogenous febrile diseases. The Qi of the Taiyang (Greater Yang) channel governs the exterior; the Qi of the Yangming (Two Yang) channel governs the muscles. Whenever external pathogenic factors initially damage the exterior Yang, they transform into heat by relying on Yang Qi. Therefore, it is said that all febrile diseases belong to the category of Cold Damage.) Some recover, some die; those who die do so within six or seven days, while those who recover take more than ten days. Why is this? I do not understand the explanation and wish to hear the reason. (Six days constitute a cycle of Qi; on the seventh day, recovery begins. Death occurring between the sixth and seventh days indicates that the Qi of the Six Channels has exhausted and cannot recover. Recovery after ten days occurs because there is no transmission to a subsequent stage starting from the seventh day; by the thirteenth day, the Qi of the Six Channels has restored, hence recovery.) Qibo replied: Juyang (i.e., Taiyang/Greater Yang) is the commander of all Yang channels. ("Ju" means great; "Shu" means convergence. This means Taiyang is the convergence point of all Yang channels.) Its vessels connect to the Fengfu (GV16) acupoint, thus it is the master Qi of all Yang channels. (Fengfu [GV16] is an acupoint located one cun inside the posterior hairline at the nape, where the Du Mai (Governing Vessel) and Yangwei Mai (Yang Linking Vessel) converge. The Du Mai supervises the Yang Qi of the whole body. Along with the Taiyang vessels, it descends along the back. This implies that Taiyang Qi originates in the Bladder, emerges from the chest and hypochondrium, ascends to the head and neck, and governs the skin surface. The Taiyang vessels originate at Jingming (BL1), converge at Fengfu (GV16), and run along the back alongside the Du Mai. Their meridian Qi is entirely Yang, thus becoming the master Qi of all Yang channels.) When humans are injured by Cold pathogens, they develop febrile diseases. Even if the fever is severe, death does not ensue. (The term "wei" [becomes/caused by] refers to the action of Taiyang Qi. Taiyang is marked as Yang but rooted in Cold. Heavenly Cold pathogens first invade Taiyang Qi due to resonance of similar Qi. Receiving the transformation of Taiyang's marked Yang, heat disease arises. This is what is meant by "the disease reverses its root, manifesting the marked pathology"; consequently, treatment should reverse the root, employing formulas for the marked condition. Although the original pathogen was Cold (root), it manifests as Heat (marked). Treating it with cooling herbs addresses the marked Heat of Taiyang rather than the Yin-Cold of Heaven; thus, even severe fever does not lead to death.) However, in cases of "Lianggan" (Dual Infection) with Cold, death is inevitable. (On the first day of Cold Damage, Taiyang is affected; on the second day, Yangming; on the third day, Shaoyang. This indicates that Yin-Cold pathogens transform into heat upon encountering Yang Qi. Even if transmitted to the Three Yin channels, it remains a febrile disease. After seven days, it returns to Taiyang; if no further transmission occurs, the disease heals spontaneously. In Lianggan, Yin and Yang intersect inversely, and Ying and Wei circulation is blocked, leading inevitably to death.) The Yellow Emperor said: I wish to hear about its clinical manifestations. ("Zhuang" refers to form/appearance. The Cold Damage pathogen affects the Qi of the Three Yin and Three Yang, simultaneously involving the structural layers of skin, muscle, and collaterals. Thus, "Zhuang" refers to both the formless Qi phenomena and the tangible structural layers.) Qibo said: On the first day of Cold Damage, Juyang (Taiyang) is affected, resulting in headache, stiff neck, and rigidity of the lower back and spine. (Taiyang Qi governs the skin and hair; thus, on the first day, Taiyang is affected. Yang Qi ascends, causing headache. The back belongs to Yang, causing stiffness in the waist and spine. This describes the initial involvement of Taiyang Qi. Day 1: Taiyang; Day 2: Yangming; Day 3: Shaoyang; Day 4: Taiyin; Day 5: Shaoyin; Day 6: Jueyin. Return to Taiyang on day 7 represents the transmission of Six Qi, not involving tangible meridians; hence, Taiyang is discussed first without specifying its meridian. However, Cold Damage is variable: some cases involve Six Qi without affecting Six Meridians; some involve concurrent meridian and Qi pathology; some involve Qi-level pathogens entering meridians. Hence, Taiyang is discussed only in terms of Qi, while Yangming and Shaoyang discuss both. Ni Chongzhi stated: *Suwen* describes normal patterns, but variations exist within them.) On the second day, Yangming is affected. Yangming governs flesh; its vessels loop around the nose and connect to the eyes. Thus, there is body heat, eye pain, dry nose, and inability to sleep. (Yangming Qi governs muscles; body heat indicates pathology in Yangming Qi. Although the pathology is in Qi, the Yangming vessels loop around the nose, connect to the eyes, and belong to the Stomach, producing symptoms of eye pain and dry nose. Stomach disharmony causes insomnia. Yang Junli asked: If Six Channel Cold Damage involves Qi, why are tangible symptoms observed? The answer is: Referring to Taiyang and Yangming denotes formless Qi. Using tangible symptoms to verify formless Qi does not mean the disease is solidly in the meridians. If pathogens were in the meridians, they would flow into the Fu organs and cease transmitting to Shaoyang and the Three Yin.) On the third day, Shaoyang is affected. Shaoyang governs the Gallbladder; its vessels course through the hypochondrium and connect to the ears. Thus, there is hypochondriac pain and deafness. (Shaoyang Qi governs the pivot and the Gallbladder. When Gallbladder Qi ascends, all Yang Qi ascends, described as "due to Cold, desiring to move like a pivot." All Yang Qi exits from the pivot/hypochondrium to the skin surface. Taiyang governs the exterior, Yangming governs muscles, Shaoyang governs the hypochondrium. Hypochondriac pain and deafness indicate Qi-level pathology manifesting as tangible meridian symptoms.) When the meridians of the Three Yang are all affected but have not entered the Zang organs, sweating therapy can resolve it. ("Zang" refers to the interior and Yin. This means the meridians of the Three Yang have received Yang-heat pathogens but remain outside the body, not having entered the interior Yin. Sweating can resolve it.) On the fourth day, Taiyin is affected. Taiyin vessels distribute in the Stomach and connect to the throat. Thus, there is abdominal fullness and dry throat. (The vessels of the Six Channels externally connect to the body and internally link to the Zang-Fu. For the Three Yin vessels, discussing only the interior implies that Cold pathogens follow Yin Qi inward. Yang Junli noted: This shows Qi-level pathology manifesting as meridian symptoms.) On the fifth day, Shaoyin is affected. Shaoyin vessels pass through the Kidney, connect to the Lungs, and attach to the root of the tongue. Thus, there is dry mouth, dry tongue, and thirst. (As Six Qi transmit, even when entering the interior Yin, they present as heat syndromes, causing dryness and thirst.) On the sixth day, Jueyin is affected. Jueyin vessels course around the genitalia and connect to the Liver. Thus, there is irritability, abdominal fullness, and retraction of the testicles. (Jueyin Wood-Fire governs Qi, causing irritability and fullness. Vessels course around the genitalia, causing testicular retraction.) When the Three Yin and Three Yang, Five Zang, and Six Fu organs are all affected, and Ying and Wei circulation stops, and the Five Zang become obstructed, death ensues. (Meridian invasion leads to internal Zang-Fu injury. This describes Six Qi transmission affecting meridians, stopping Ying and Wei circulation and injuring Zang-Fu, resulting in fatal conditions.) In cases not involving Lianggan (Dual Infection): On the seventh day, Taiyang pathology declines, and headache slightly improves. (Referring to Lianggan from the previous context: Ying, Wei, Blood, and Qi are all injured, leading to Zang-Fu dysfunction and inevitable death. If transmission is limited to Qi, completing the cycle in six days and returning to Exterior Yang on the seventh, Taiyang pathogenic Qi gradually declines, and headache slightly improves.) On the eighth day, Yangming pathology declines, and body heat slightly subsides. On the ninth day, Shaoyang pathology declines, and hearing slightly recovers. On the tenth day, Taiyin pathology declines, abdominal fullness resolves, appetite returns. On the eleventh day, Shaoyin pathology declines, thirst ceases, abdominal distension resolves, tongue dryness alleviates, and sneezing occurs. On the twelfth day, Jueyin pathology declines, testicles relax, lower abdomen softens, and the "Great Qi" (pathogen) is expelled; the disease resolves daily. (Cold Damage pathogens are highly toxic, termed "Great Qi." As pathogenic Qi declines, Healthy Qi restores.) The Yellow Emperor asked: How should it be treated? Qibo replied: Treatment requires unblocking the meridians of each respective organ; the disease will decline daily. ("Zang Mai" refers to the meridians of the Hand and Foot Three Yin and Three Yang. Since disease transmits via Six Qi, regulating the Six Channels is necessary. Harmonized meridian Qi ensures proper Ying and Wei circulation, preventing internal Zang-Fu injury.) For cases less than three days old, sweating therapy suffices. For cases three days or older, purgative therapy suffices. (First three days: Exterior/Yang level; treat via sweating. Latter three days: Interior/Yin level; treat via purgation. This outlines the general pattern of Six Qi transmission and Yin-Yang/Exterior-Interior dynamics. However, exceptions exist: some transmit, some do not; some remain at Exterior/Yang after eight-nine days requiring sweating; some penetrate Interior/Yin within two-three days requiring urgent purgation. These fall outside standard Six Qi rules.) The Yellow Emperor asked: After febrile disease resolves, why do residual symptoms sometimes persist? Qibo replied: Residual symptoms arise from forcing food intake during high fever. (*Shanghan Lun* states: For recurrence after major illness due to overexertion, use Zhishi Zhizi Tang. If food stagnation exists, add Rhubarb (Dahuang). This results from forcing food during intense fever, leaving food stagnation.) In such cases, pathology has declined, but heat is concealed. Grain Qi conflicts with residual heat; the two heats combine, causing residuals. (*Shanghan Lun* states: If pulse is resolved but evening mild烦 [restlessness] occurs, it is because the patient forced food post-recovery. Spleen-Stomach Qi is weak and cannot digest, causing mild restlessness. Reducing food intake cures it. This explains residual heat combined with forced grain intake, reiterating the previous point.) The Yellow Emperor said: Excellent. How to treat residuals? Qibo replied: Assess deficiency and excess, regulate reversal and compliance; cure is assured. (Where pathogen gathers, Healthy Qi is deficient. Tonify Healthy Qi if deficient; clear residual heat if present. *Shanghan Lun* states: For fever recurring after Cold Damage resolution, use Xiaochaihu Tang. If pulse is floating, use sweating; if sinking, use purgation. This is regulating reversal and compliance.) The Yellow Emperor asked: What dietary prohibitions apply to febrile disease? Qibo replied: When fever slightly improves, eating meat causes recurrence; overeating causes residuals. These are prohibitions. ("Slightly improved" means pathogenic heat is not fully cleared. "Meat" refers to pork. Pigs are water animals, restless and active. Heavenly Cold is Taiyang Cold-Water Qi. Eating pork before pathogen clearance agitates internal Cold to match residual heat, akin to re-injuring Taiyang with Cold. This illustrates the interaction of Heavenly Six Excesses and Human Six Qi. Pork is cold-natured; overeating causes residuals.) The Yellow Emperor asked: Regarding Lianggan with Cold, how do pulses and symptoms correspond? Qibo replied: In Lianggan, on day one, Taiyang and Shaoyin are both affected, causing headache, dry mouth, and irritability/fullness. (Discussing Yin-Yang dual infection again. Taiyang and Shaoyin are exterior-interior pairs. Both receiving pathogens on day one manifests Taiyang headache and Shaoyin irritability/fullness/dry throat.) On day two, Yangming and Taiyin are both affected, causing abdominal fullness, body heat, anorexia, and delirious speech. (Yangming and Taiyin are exterior-interior pairs. Manifesting Taiyin abdominal fullness and Yangming body heat, anorexia, and delirium.) On day three, Shaoyang and Jueyin are both affected, causing deafness, testicular retraction, cold limbs, inability to drink fluids, unconsciousness, and death on the sixth day. (Shaoyang and Jueyin are exterior-interior pairs. Manifesting Shaoyang deafness and Jueyin testicular retraction/cold limbs. Inability to drink indicates exhaustion of Grain Qi. Unconsciousness indicates injury to Spirit Qi. With Zang-Fu injured and Ying-Wei stopped, exhaustion of vital energy leads to death. Ni Chongzhi stated: Cold Damage prioritizes Stomach Qi and Spirit Qi. Exhausted Stomach Qi prevents fluid intake; pathogen injuring Spirit Zang causes unconsciousness. Even Three Yang involvement is critical. If Stomach Qi and Spirit Qi remain intact in Lianggan, death may be avoided.) The Yellow Emperor asked: If Five Zang are injured, Six Fu are obstructed, and Ying-Wei stop, why does death occur three days later? Qibo replied: Yangming is the leader of the Twelve Meridians; its Blood and Qi are abundant. Thus, after three days of unconsciousness, its Qi exhausts, leading to death. (Ying-Wei, Blood-Qi, Zang-Fu, and Spirit all depend on Yangming. If Stomach Qi fails first, death occurs in three days, without waiting for the Six Qi cycle to complete.) Generally, Cold Damage transforming into Warm Disease: onset before Summer Solstice is called Warm Disease (Wen); onset after Summer Solstice is called Summerheat Disease (Shu). Summerheat must exit with sweat; do not stop sweating. (Re-discussing lingering heat pathogens. Cold Damage causing heat is the primary mechanism. If pathogens linger without immediate onset, Spring Yang outward movement carries pathogens out as Warm Disease. Spring Warmth and Summer Heat transform with Qi and are named by season. Latent pathogens exit with sweat; thus, sweating should not be suppressed.) Disciples asked: This chapter discusses Three Yin and Three Yang meridians, all belonging to the Foot channels, implying "transmission to Foot only, not Hand." Is this based on this text? Answered: Cold Damage transmission involves the Six Qi of Three Yin and Three Yang. Six Channels correspond to Six Qi; where meridians run, Qi arrives. Thus, meridians are discussed, but pathology is not in tangible meridians nor strictly time-bound in transmission. Heaven is Yang, Earth is Yin. Wind, Cold, Summerheat, Dampness, Dryness, Fire are Heavenly Yin-Yang; Wood, Fire, Earth, Metal, Water (and Fire) are Earthly Yin-Yang. Heavenly Ten Stems generate Earthly Five Elements; Earthly Five Elements present Heavenly Six Qi. Earthly Water corresponds to Heavenly Cold; Earthly Fire to Heavenly Summerheat; Earthly Wood to Heavenly Wind; Earthly Metal to Heavenly Dryness; Earthly Earth to Heavenly Dampness. Heaven is Qi, Earth is Form. Form and Qi interact to generate all things. East generates Wind, Wind generates Wood, Wood generates Sour, Sour generates Liver, Liver generates Tendons. South generates Heat, Heat generates Fire, Fire generates Bitter, Bitter generates Heart, Heart generates Blood. Center generates Dampness, Dampness generates Earth, Earth generates Sweet, Sweet generates Spleen, Spleen generates Flesh. West generates Dryness, Dryness generates Metal, Metal generates Pungent, Pungent generates Lungs, Lungs generate Skin/Hair. North generates Cold, Cold generates Water, Water generates Salty, Salty generates Kidneys, Kidneys generate Bones. Human form and Zang-Fu grow by sensing Heavenly formless Six Qi and Earthly tangible Five Elements. Thus, the body has formless Six Qi matching Three Yin/Three Yang meridians, and tangible Zang-Fu/bones/skin matching Earthly Five Elements. Three Yin/Three Yang meridian Qi is generated by Five Zang/Five Elements. This is the union of Yin-Yang, Form, and Qi. Pathology may involve formless Qi affecting tangible meridians, or tangible structures affecting formless Qi—this is Form-Qi interaction. Cold Damage pathogens sense Heavenly Six Qi, borne by human Six Qi. Pathology in Six Qi corresponds to Six Channel meridians. This is human-heaven-earth Qi integration. *Liuzhi Da Lun* states: Upper and lower have positions, left and right have records. Right of Shaoyang is governed by Yangming; right of Yangming by Taiyang; right of Taiyang by Jueyin; right of Jueyin by Shaoyin; right of Shaoyin by Taiyin; right of Taiyin by Shaoyang. Taiyang, master of Yang, is first invaded. Day 1 Taiyang, Day 2 Yangming, Day 3 Shaoyang, Day 4 Taiyin, Day 5 Shaoyin, Day 6 Jueyin. Six days complete the cycle; Day 7 recovery brings pathogen decline. If unresolved by Day 7, it restarts from Taiyang ("re-transmission"). This applies to formless Six Qi, allowing full cycle and return to Taiyang. Tangible meridian pathology involves transfer to one channel, not sequential transmission. *Same Chapter* states: Above Taiyang, Cold Qi governs, middle sees Shaoyin; Above Yangming, Dryness Qi governs, middle sees Taiyin; Above Shaoyang, Fire Qi governs, middle sees Jueyin; Above Taiyin, Dampness Qi governs, middle sees Yangming; Above Shaoyin, Minister Fire governs, middle sees Taiyang; Above Jueyin, Wind Qi governs, middle sees Shaoyang. Also: Taiyang-Shaoyin follow Root and Mark; Shaoyang-Taiyin follow Root; Yangming-Jueyin do not follow Root/Mark but follow Middle Qi. Following Root means transformation from Root; following Root/Mark means transformation from both; following Middle means transformation from Middle Qi. Taiyang is Marked Yang, Rooted Cold; Shaoyin is Marked Yin, Rooted Heat. Both have Cold-Heat transformations, hence "follow Root and Mark." Heavenly Cold is Taiyang Root; pathology in Taiyang Marked Yang transforms into Heat via Taiyang Yang-Heat, reversing Heavenly Root Cold to manifest Marked Yang Heat ("disease reverses root, marks pathology"). Treating with cooling herbs addresses Marked Heat ("treatment reverses disease, marks formula"). This is Taiyang following Mark. If Taiyang pathology does not manifest Marked Yang Heat, SiNi Tang and Aconite formulas rescue Taiyang Root Cold. This is Taiyang following Root. Shaoyin has urgent purgation for extreme Heat (following Root) and urgent warming for extreme Cold (following Mark). Hence, Taiyang-Shaoyin follow Root and Mark. Yangming sensing fierce Yang-Heat causes severe purgative heat syndrome; receiving Middle Taiyin Dampness causes mild sweating/peaceful syndrome. Jueyin receiving Middle Shaoyang Fire causes dysentery/pus-blood heat syndrome; Jueyin Root Yin-Cold causes cold limbs/critical syndrome. These are Cold-Heat-Yin-Yang Qi transformations. This chapter states Taiyang, master of Yang, first receives Heavenly Cold, transforms to Heat via Marked Yang. Even after full Six Channel transmission, severe heat does not kill. Hence named "Treatise on Febrile Diseases," focusing on Cold Damage causing heat, not variable syndromes, due to Taiyang Yang-Heat transformation. Vessels connecting to Fengfu, coursing hypochondrium/throat, show formless Six Qi pathology manifesting tangible meridian symptoms; this is not Taiyang vessel transmitting to Yangming, etc. Understanding Heaven-Earth Yin-Yang, Five Elements, and Six Qi transformations allows discussion of Cold Damage pathology. Disciples asked: Does Cold Damage only affect Foot meridians, not Hand meridians? Answered: Six Zang-Six Fu pair with Twelve Meridians; Twelve Meridians correspond to Three Yin-Three Yang Qi. Yin-Yang Qi generate from below, inside-out. *Ling Shu* states: Six Fu organs originate from Foot Three Yang, ascending to merge with Hand. Thus, this text uses Three Yin-Three Yang Qi to correspond to Foot Six Channels, which then merge upward with Hand meridians.