黄帝问曰。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。岐伯对曰。病名阴阳交。交者
死也。（温病者。冬伤于寒。先夏至日发者。为病温也。阴阳交者。谓汗乃阴液。外出于阳。阳热不从汗解。复入之阴。
名曰阴阳交。交者。乃正不能胜邪。而邪复伤正气。故为死证。）帝曰。愿闻其说。岐伯曰。人所以汗出者。皆生于谷。
谷生于精。（汗生于水谷之精。水谷之精。由精气之所化。故曰谷生于精。夫汗之发原有二。一出于水谷之精。一出于肾
藏之精。而曰皆生于谷者。言肾藏之精。亦水谷之所生也。）今邪气交争于骨肉而得汗者。是邪却而精胜也。（交争于骨
肉者。邪气伏匿于骨肉之间。至春时与正气交争。而发为温病。得汗是精气胜。而邪当共并而出矣。倪冲之曰。胃主肉。
肾主骨。谷精之汗出于胃。血液之汗原于肾。邪在肉者。得水谷之汗而解。邪在骨者。得肾精之汗而后解。
）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。病而
留者。其寿可立而倾也。（此言水谷之精。由肾藏精气之所化。所谓谷生于精也。夫肾为水脏。受水谷之精而藏之。其精
气上与阳明相合。戊癸合而化火。火土之气。消水谷之精微。而复生此精。是先后二天。互相资生者也。今汗出而邪留
不去。则热邪复伤其阴精矣。精气受伤。则不能复与阳明合化。而使之食。是精气之生原并绝。其寿命可立而倾也。董
帷园曰。互相生长之道。旋转如环。）且夫热论曰。汗出而脉尚躁盛者死。（此复引热论。以释明汗生于谷。谷生于精。
不能食而精无俾者之义。灵枢热论篇曰。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。脉盛躁得汗静者生。夫汗者。精气也。汗出而脉尚躁盛者。是邪气盛而精不胜
也。阴脉、少阴之脉。极、终也。此邪热盛而少阴之气终也。脉尚躁而不得汗者。是阳热盛而胃气绝也。）今脉不与汗相
应。此不胜其病也。其死明矣。狂言者是失志。失志者死。（脉不与汗相应者。胃气虚而不胜其邪。正不胜邪。是胃气将
绝。其死明矣。肾藏志。狂言者。是精气伤而志先死。志先死者。不过一日半而死矣。）今见三死。不见一生。虽愈必死
也。（病而留者。一死也。胃气绝者。一死也。肾气绝者。一死也。夫肾为生气之原。肾之精气。由水谷之所生。水谷之
精。由肾气之所化。如汗不胜邪。而肾藏之精气尚在。一生也。如精气受伤。而阳明之生原未绝。一生也。愈者。谓邪
病去也。邪虽去而生气已绝。必死之道也。以上论邪正阴阳之理。而归重于正气之生原。不可伤也。）帝曰。有病身热。
汗出烦满。烦满不为汗解。此为何病。（按此篇评论阳热之邪。惟藉阴精以制胜。汗者精气也。一出于水谷之精。一出于
肾藏之液。水谷入胃。津液四布。汗出溱溱。水谷之精气也。又肾为水脏。受五脏之精而藏之。所藏之精。奉心化赤而
为血。血之液为汗。此肾藏之精气也。是以上节论汗生于谷。此以下复论风伤肾藏之精焉。盖风行则水涣。水气泛溢。
则精气自虚。此节论风动肾藏之精气。劳风节论风动肾藏之水气。肾风节论风动肾藏之水邪。而总属精气皆虚。）岐伯曰。
汗出而身热者风也。汗出而烦满不解者厥也。病名曰风厥。（风为阳邪。开发肌腠。腠理之汗。水谷之精也。津液外泄。
风热留之。故身热也。风热不去。则伤动其肾气而上逆。逆于上则心烦。乘于脾土则中满。病名曰风厥。谓因风邪而使
肾气之厥逆也。上节论病虽愈而正气绝者死。此以下论邪病虽留。而根本不坏者不死。邪正虚实。大有死生之关系。而
学人不可不审。）帝曰。愿卒闻之。岐伯曰。巨阳主气。故先受邪。少阴与其为表里也。得热则上从之。从之则厥也。
（巨阳、太阳也。太阳之气主表。风为阳邪。伤人阳气。两阳相搏。则为病热。少阴与太阳相为表里。阳热在上。则阴
气从之。从之则为厥逆矣。）帝曰。治之奈何。岐伯曰。表里刺之。饮之服汤。（表里者。阴阳也。刺表以泻风热之阳邪。
刺里以下少阴之逆气。饮之服汤。以助水津之汗。）帝曰。劳风为病何如。（此论劳汗当风。而伤其肾也。烦劳则阳气
外张。精气内绝。阳虚于外。则易于受风。精虚于内。则反动其水气矣。）岐伯曰。劳风法在肺下。（伯言风动寒水之气。
法当在肺下。水热穴论曰。肾者至阴也。至阴者盛水也。肺者太阴也。少阴者冬脉也。故其本在肾。其末在肺。皆积水
也。）其为病也。使人强上冥视。（强上者。头项强也。阳气张而重感于风。则使人强于上。阴精竭而更受其伤。故目肓
不可以视也。）唾出若涕。恶风而振寒。此为劳风之病。（肾之水液。入肺为涕。自入为唾。风动肾水。注在肺下。故唾
出若涕。肺主皮毛。肺受风寒。故恶风而振寒。此为勇而劳甚。则肾汗出。肾汗出而逢于风也。）帝曰。治之奈何。岐伯
曰。以救俯仰。（金匮水气篇曰。气强则为水。难以俯仰。此水寒之气。厥逆于上。则有形之水。将欲随之。故当急救其
水邪。勿使其上溢。以致不能俯仰也。）巨阳引精者三日。中年者五日。不精者七日。（此言救俯仰之法。当从小便而出
也。巨阳引精者。谓太阳膀胱之府。津液藏焉。气化则出。巨阳气盛。能引肾精之邪水。从小便而出者。三日而愈。中
年精气虚者五日。老年精气衰者七日。三五七者。阳之数也。谓得阳气之化。而阴水自出矣。）咳出青黄涕。其状如脓。
大如弹丸。从口中若鼻中出。不出则伤肺。伤肺则死也。（此言水寒之邪。逆于肺下者。又当从上窍以出之。此上下分消
之法也。夫肾为水脏。受五脏之精而藏之。今肾藏之水气。反逆于上。则四脏之津。皆为之凝聚而不下矣。青黄涕者。
肝脾之津也。脓乃赤白之间色。如脓状者。心肺之津也。四脏之津。不下归于肾。反凝聚于肺下。故当咳而出之。肺之
下。脾之上也。或从脾而出之口。或从肺而出之鼻。皆涕唾所出之外窍也。肺主气而至清虚。故邪浊伤之则死。）帝曰。
有病肾风者。面 然。壅害于言。可刺不。（ 音附 音芒不否同。肾风者。因风而动肾藏之水。故又名风水。 。足
也。 然。肿貌。言面足 然而肿也。少阴之脉。贯肾系舌本。水邪上逆。故壅害于言。）岐伯曰。虚不当刺。不当
刺而刺。后五日。其气必至。（肾为风邪所伤。则精气已虚。故不当刺。虚反刺之。后五日。其逆气必至。平脉篇曰。肾
气微。少精血。奔气促迫。上入胸膈。谓精气虚。则水邪之气反上逆矣。五日者。言风邪亦始病太阳。五日则病及少阴
而动其气矣。）帝曰。其至何如。岐伯曰。至必少气时热。时热从胸背上至头。汗出手热。口干苦渴。小便黄。目下肿。
腹中鸣。身重难以行。月事不来。烦而不能食。不能正偃。正偃则咳。病名曰风水。论在刺法中。（病名风水者。因风而
动其水也。在刺法中。谓在本经水热穴论中。）帝曰。愿闻其说。岐伯曰。邪之所凑。其气必虚。阴虚者。阳必凑之。
故少气时热而汗出也。小便黄者。少腹中有热也。（风邪伤肾。精气必虚。阴虚则阳往乘之。故时时发热。肾为生气之原。
故少气也。阳加于阴则汗出。湿热上蒸。故从胸背而直上于头。热在下焦。故小便黄也。倪冲之曰。太阳与少阴标本
相合。风邪伤肾。始病太阳。甚则入肾。今肾热上蒸。亦随太阳之气而上。故从胸背而上至于头。）不能正偃者。胃中不
和也。正偃则咳甚。上迫肺也。（此申明阳邪伤阴。而动肾藏之水也。正偃、仰卧也。水上乘于胃。则胃中不和。故不得
正偃。肺脉下络大肠。还循胃口。故上迫肺也。上节论阳热伤其精气。此复论动其水焉。倪冲之曰。劳风注在肺下。
谓水气迫于肺下。而所出之涕。乃是肺液。非肾藏之水也。盖肺乃水之生原。肾气反逆。则水源凝聚于上矣。今正偃迫
肺。亦系胃气上乘。而非肾藏之水。即目下微肿。亦属水邪在腹。而肿见于目下。当知肾虚水泛。止至于腹耳。）诸有水
气者。微肿。先见于目下也。帝曰。何以言。岐伯曰。水者阴也。目下亦阴也。腹者至阴之所居。故水在腹者。必使目
下肿也。（太阴者至阴也。水邪上乘于腹。始伤胃而渐及于脾。故微肿先见于目下。脾主合同束也。倪冲之曰。水止在腹。
肿见于目下者。水气也。）真气上逆。故口苦舌干。（真气者。脏真之心气也。心属火而恶水邪。水气上乘。则迫其心气
上逆。是以口苦舌干。）卧不能正偃。正偃则咳出清水也。（此言水气上乘。始胃而脾。脾而心。心而肺也。肾为本。肺
为末。金水子母之脏。皆积水也。是以水气上逆于肺。则咳出清水。）诸水病者。故不得卧。卧则惊。惊则咳甚也。（此
言肾邪上乘于胃。则胃气上薄于心。胃气薄于心。则心气迫于肺矣。水邪乘胃。故不得卧。胃络上通于心。阳气入阴。
阴阳相薄。故惊恐也。心气上乘于肺。金畏火热。故咳甚也。上节论水气从下而上。此复论腑脏之气。亦从下而上也。）
腹中鸣者。病本于胃也。薄脾则烦不能食。食不下者。胃脘隔也。身重难以行者。胃脉在足也。（此言水气乘于经脉之中。
随经环转。复从上而下也。水病本于胃。而随经下泄。故腹作雷鸣。薄于脾则烦而不能食。盖脾络上膈注心中。故烦。
上焦主纳。故不能食也。胃脘阻隔。故食不下。水气随经下流。故身重难以行也。倪冲之曰。按经旨水邪止乘于胃。
其薄脾干肺迫心。乃胃气之转乘。非水邪直至于心下。盖肾者胃之关也。水出于关。则邪留在胃。故曰病本于胃。）月事
不来者。胞脉闭也。胞脉者。属心而络于胞中。今气上迫肺。心气不得下通。故月事不来也。帝曰。善。（中焦之汁。流
溢于肾而为精。奉心化赤而为血。血之液为汗。此节首论风伤肾藏之精。末结不能奉心化赤。盖此篇评论阳热之邪。惟
藉阴精汗液以制胜。前章论谷精之汗。不能胜邪者死。此言肾藏之精。为风邪所伤。而又不得心气下通以化赤。是风邪
亦不得从汗解矣。再按荣气之道。纳谷为实。谷入于胃。乃传之肺。流溢于中。布散于外。专精者。荣于经隧。常荣无
已。是血乃中焦水谷之汁。而行于经脉。渗于皮肤。有二道焉。夫中焦受气取汁。变化而赤。此专精而行于经隧之血也。
流溢于中。布散于外者。是流溢于胞中。布散于皮肤之血也。胞脉属心。得心气下通而为血。冲脉任脉。皆起于胞中。
上循背里。为经络之海。其浮而外者。循腹右上行。会于咽喉。别而络唇口。血气盛。则充肤热肉。血独盛则淡渗皮肤。
生毫毛。男子至唇口而长髭须。女子至胸中而下为月事。是血之液为汗者。乃渗于皮肤之血。非经脉之血也。故举女子
之月事以申明之。气上迫肺者。真气上逆。口苦舌干。惊则咳甚。是心气上炎而不下通也。此篇虽曰评热。然皆论精血
汗液之生原。盖知生始之原。则知所以养正而胜邪矣。水谷之精藉肾藏精气之所化。胞肾之精血。由胃腑水谷之所生。
王芳侯曰。出红汗曰蔑。此渗于皮肤之血。而又不能化汗者矣。）
黄帝问道：有一种患温病的人，出汗后随即又发热，脉搏躁动疾速，并不因出汗而减弱，伴有胡言乱语、不能进食的症状。这是什么病？岐伯回答说：这种病名叫“阴阳交”。所谓“交”，是指死亡。（温病，是因为冬季感受寒邪，在夏至之前发作的，称为温病。“阴阳交”，是说汗液属于阴液，向外出于阳分，但阳热之邪没有随着汗液解除，反而再次侵入阴分，这就叫做“阴阳交”。“交”的含义，是正气不能战胜邪气，而邪气反过来伤害正气，所以是死证。）黄帝说：我想听听其中的道理。岐伯说：人之所以出汗，都是源于水谷精微。（汗由水谷的精微化生，水谷的精微又由精气所转化，所以说“谷生于精”。发汗的来源有两个：一是出于水谷之精，一是出于肾脏之精。文中说“皆生于谷”，意思是肾脏之精也是由水谷所生成的。）现在邪气与正气在骨肉之间交争而能够出汗的，这是邪气退却而精气占胜。（邪气伏匿在骨肉之间，到春季时与正气交争，从而发为温病。能出汗说明精气占胜，邪气应当随之排出。倪冲之说：胃主肌肉，肾主骨骼。源于胃的水谷之精产生的汗，和源于肾的血液之精产生的汗不同。邪气在肌肉层面，得到水谷之汗即可解除；邪气在骨骼层面，得到肾精之汗才能解除。）精气占胜则应当能够进食且不再发热。如果再次发热，那是邪气在作祟；出汗的是精气。现在出汗后随即又发热，这是邪气占胜。不能进食，是因为精气得不到补充。病邪滞留不去，寿命就会立刻终结。（这里讲水谷之精由肾脏精气所化，即所谓“谷生于精”。肾是水脏，接受水谷之精并贮藏它，其精气向上与阳明经相合，戊癸相合化为火，火土之气消化水谷精微，进而再生成此精，这是先后天互相资生的关系。现在出汗后邪气留恋不去，热邪就会再次损伤阴精。精气受伤，就不能再与阳明经合化以助消化进食，这意味着精气的生化源头断绝，寿命也就顷刻间终结了。董帷园说：互相生长的道理，旋转如环。）况且《热论》中说：出汗后脉搏仍然躁动旺盛的，会死亡。（这里再次引用《热论》来解释“汗生于谷，谷生于精，不能食而精无俾”的道理。《灵枢·热论篇》说：热病已经出汗，但脉搏仍然躁动旺盛，这是阴脉到了极点，主死。如果出汗后脉搏平静的，主生。患热病的人，脉搏仍然躁动却不出汗的，这是阳脉到了极点，主死。脉搏盛大躁动，出汗后变平静的，主生。汗是精气。出汗后脉搏仍然躁动旺盛，说明邪气盛而精气不胜。阴脉指少阴之脉，“极”意为终尽，这是邪热盛而少阴之气终尽的表现。脉搏仍然躁动却不出汗，说明阳热盛而胃气绝。）现在脉搏不与出汗相应（即汗出脉不静），这是正气不胜病邪。死亡是显而易见的。胡言乱语是神志丧失，神志丧失就会死亡。（脉搏不与出汗相应，说明胃气虚而不能抗邪，正不胜邪，意味着胃气将绝，死亡显而易见。肾藏志，胡言乱语，说明精气受伤而神志先亡。神志先亡的，不过一天半就会死亡。）现在出现了三种死征，看不到一丝生机，即使暂时痊愈，最终也必死无疑。（病邪滞留，是一死；胃气绝，是一死；肾气绝，是一死。肾是生气的根源，肾的精气由水谷生成，水谷之精由肾气化生。如果汗不能胜邪，但肾脏精气尚存，这是一线生机；如果精气受伤，但阳明胃气的生化之源未绝，也是一线生机。“愈”是指病邪去除。如果病邪虽去但生气已绝，必然是死路一条。以上论述了邪正阴阳的道理，归结于重视正气的生化之源，不可损伤。）黄帝说：有一种病，身体发热，出汗后心中烦闷胀满，烦闷胀满不因出汗而缓解，这是什么病？（按：本篇评论阳热之邪，只有依靠阴精才能制胜。汗是精气，一种出于水谷之精，一种出于肾脏之液。水谷进入胃中，津液四布，汗出淋漓，这是水谷之精气。另外肾是水脏，接受五脏之精并贮藏它，所藏的精髓奉心化赤而为血，血的液体部分为汗，这是肾脏之精气。所以上一节论述汗生于谷，这一节以下重新论述风邪伤害肾脏之精。大概风气流行则水涣散，水气泛溢，则精气自然虚弱。这一节论述风动肾脏之精气，劳风节论述风动肾脏之水气，肾风节论述风动肾脏之水邪，总归都属于精气皆虚。）岐伯说：出汗而身体发热的，是风邪；出汗而烦闷不解的，是厥逆。病名叫做“风厥”。（风为阳邪，开发肌腠，腠理的汗液是水谷之精。津液外泄，风热留滞，所以身体发热。风热不去，就会伤动肾气而上逆，逆于上则心烦，乘袭脾土则中焦胀满，病名叫做“风厥”，意指因风邪导致肾气厥逆。上一节论述病虽愈但正气绝者死，这一节以下论述邪病虽留但根本不坏者不死。邪正的虚实，大有生死的关系，学习的人不可不审察。）黄帝说：我想彻底了解它。岐伯说：巨阳（太阳）主司体表之气，所以首先受邪。少阴与太阳互为表里，受到热邪影响就向上从属它，从属它就发生厥逆。（巨阳即太阳。太阳之气主表，风为阳邪，伤害人体阳气，两阳相搏，就发为热病。少阴与太阳相为表里，阳热在上，则阴气随之而上，随之而上就形成厥逆。）黄帝说：怎么治疗？岐伯说：表里两经都进行针刺，并服用汤药。（表里指阴阳。刺表经以泻除风热之阳邪，刺里经以降下少阴之逆气。饮用汤药，以助生水津之汗。）黄帝说：劳风病怎么样？（这里论述劳作出汗当风，从而伤害肾脏。烦劳则阳气外张，精气内绝。阳虚于外，就容易受风；精虚于内，就会反动其水气。）岐伯说：劳风病的部位通常在肺下。（伯说风动寒水之气，应当在肺下。《水热穴论》说：肾是至阴，至阴盛水；肺是太阴；少阴是冬脉。所以病的根本在肾，标末在肺，都是积水所致。）它的症状使人头项强直、视物模糊。（头项强直，是因为阳气张越又重感风邪，使人头部强急；阴精枯竭又受损伤，所以眼睛昏盲不能视物。）咳唾出像鼻涕一样的痰，怕风且战栗发冷，这就是劳风病。（肾的水液，入肺成为涕，自口而出成为唾。风动肾水，注于肺下，所以咳唾出像鼻涕一样的痰。肺主皮毛，肺受风寒，所以怕风且战栗发冷。这是因为勇力过度且劳累甚久，导致肾汗出，肾汗出后又遇到风邪。）黄帝说：怎么治疗？岐伯说：要急救使其能够俯仰自如。（《金匮要略·水气篇》说：气强则为水，难以俯仰。这是水寒之气厥逆于上，有形之水将要随之上溢，所以应当急救其水邪，不要让它上溢导致不能俯仰。）如果是太阳经气能引精气下行从小便排出的，三天可愈；中年人需要五天；精气不充盛的老年人需要七天。（这里讲救俯仰的方法，应当从小便排出。所谓“巨阳引精”，是指太阳膀胱之腑，津液藏焉，气化则出。太阳经气旺盛，能引导肾脏精气中的邪水从小便排出，三天痊愈。中年人气精虚者需五天，老年精气衰者需七天。三、五、七是阳数，说明得到阳气的化育，阴水自然排出。）如果咳出青黄色的痰，状如脓液，大如弹丸，从口中或鼻中排出，如果不排出就会伤肺，伤肺就会死亡。（这里讲水寒之邪逆于肺下，又应当从上窍排出，这是上下分消的方法。肾是水脏，接受五脏之精并贮藏它。现在肾脏的水气反逆于上，那么四脏的津液都会凝聚而不下降。青黄色的痰，是肝脾的津液；脓是红白之间的颜色，如脓状的，是心肺的津液。四脏的津液不向下归于肾，反而凝聚在肺下，所以应当咳出来。肺在下，脾在上，或者从脾而出的口，或者从肺而出的鼻，都是涕唾排出的外窍。肺主气而至清虚，所以邪浊伤害它就会死。）黄帝说：有一种患肾风病的人，面部浮肿，言语受阻，可以针刺吗？（“頄”音附，“瞤”音芒，不否同义。肾风病，是因风邪而动肾脏之水，所以又名风水。“頄”指足部，“瞤然”指肿胀的样子，意思是面足都浮肿。少阴经脉贯穿肾脏联系舌根，水邪上逆，所以言语受阻。）岐伯说：虚证不应当针刺。不应当针刺而误刺，五天后邪气必然到达。（肾脏被风邪所伤，精气已经虚弱，所以不应当针刺。虚证反而针刺，五天后，逆气必然到达。《平脉篇》说：肾气微弱，少精血，奔气促迫，上入胸膈。意思是精气虚，则水邪之气反而上逆。五天，是说风邪起初病在太阳，五天后病及少阴而动其气。）黄帝说：邪气到达后会有什么表现？岐伯说：到达后必定气短、时时发热，发热从胸背直到头部，出汗、手足发热，口干苦渴，小便黄，眼下浮肿，腹中鸣响，身体沉重难以行走，月经不来，心烦不能进食，不能仰卧，仰卧则咳嗽。病名叫做“风水”。相关论述在《刺法》篇中。（病名风水，是因为因风而动其水。在《刺法》中，是指在本经《水热穴论》中。）黄帝说：我想听听其中的道理。岐伯说：邪气聚集的地方，正气必然虚弱。阴虚的地方，阳邪必然凑集。所以会出现气短、时时发热和出汗。（风邪伤害肾脏，精气必然虚弱。阴虚则阳往乘之，所以时时发热。肾是生气的根源，所以气短。阳加于阴则汗出，湿热上蒸，所以从胸背一直上到头。热在下焦，所以小便黄。倪冲之说：太阳与少阴标本相合，风邪伤肾，始病太阳，严重时入肾。现在肾热上蒸，也随太阳之气而上，所以从胸背而上至于头。）不能仰卧的，是因为胃中不和。仰卧则咳嗽加重，是因为气上迫肺。（这里申明阳邪伤阴，而动肾脏之水。正偃即仰卧。水上乘于胃，则胃中不和，所以不能正偃。肺脉下络大肠，还循胃口，所以气上迫肺。上一节论述阳热伤其精气，这一节重新论述动其水。倪冲之说：劳风注在肺下，是说水气迫于肺下，而所出的涕，乃是肺液，不是肾脏之水。盖肺乃水之生原，肾气反逆，则水源凝聚于上。现在正偃迫肺，也是胃气上乘，而不是肾脏之水。即眼下微肿，也属水邪在腹，而肿见于目下。应当知道肾虚水泛，只至于腹部罢了。）所有有水气病的人，轻微浮肿，先出现在眼下。黄帝说：为什么这样说？岐伯说：水是阴，眼下也是阴。腹部是至阴所在之处，所以水在腹部，必然使眼下浮肿。（太阴是至阴。水邪上乘于腹，开始伤害胃而逐渐波及脾。所以轻微浮肿先见于眼下。脾主约束。倪冲之说：水止在腹，肿见于目下，这是水气。）真气上逆，所以口苦舌干。（真气，指脏真之心气。心属火而厌恶水邪，水气上乘，则逼迫心气上逆，所以口苦舌干。）躺下不能仰卧，仰卧则咳出清水。（这里讲水气上乘，始自胃而脾，脾而心，心而肺。肾为本，肺为末，金水子母之脏，都积水。所以水气上逆于肺，则咳出清水。）所有水病患者，所以不能卧，卧则惊恐，惊恐则咳嗽加重。（这里讲肾邪上乘于胃，则胃气上薄于心。胃气薄于心，则心气迫于肺。水邪乘胃，所以不能卧。胃络上通于心，阳气入阴，阴阳相搏，所以惊恐。心气上乘于肺，金畏火热，所以咳嗽加重。上一节论述水气从下而上，这一节重新论述脏腑之气也从下而上。）腹中鸣响，病本在于胃。（这里讲水气乘于经脉之中，随经环转，复从上而下。水病本于胃，而随经下泄，所以腹作雷鸣。薄于脾则烦而不能食。因为脾络上膈注心中，所以烦。上焦主纳，所以不能食。胃脘阻隔，所以食不下。水气随经下流，所以身重难以行走。倪冲之说：按经文旨意，水邪只乘于胃，其薄脾干肺迫心，乃是胃气之转乘，并非水邪直至于心下。盖肾是胃之关，水出于关，则邪留在胃，所以说病本于胃。）月经不来，是因为胞脉闭塞。胞脉，属于心而联络于胞中。现在气上迫肺，心气不得下通，所以月经不来。黄帝说：好。（中焦的汁液，流溢于肾成为精，奉心化赤成为血。血的液体部分为汗。这一节开头论述风伤肾脏之精，结尾归结于不能奉心化赤。大概这一篇评论阳热之邪，只有依靠阴精汗液才能制胜。前章论述谷精之汗不能胜邪者死，这里说肾脏之精被风邪所伤，而又不得心气下通以化赤，这样风邪也无法从汗解了。再按营气之道，纳谷为实，谷入于胃，乃传之肺，流溢于中，布散于外。专精者，荣于经隧，常荣无已，这是血乃中焦水谷之汁，而行于经脉，渗于皮肤，有两条途径。夫中焦受气取汁，变化而赤，这是专精而行于经隧的血。流溢于中，布散于外，是流溢于胞中，布散于皮肤的血液。胞脉属心，得心气下通而为血。冲脉任脉，皆起于胞中，上循背里，为经络之海。其浮而外者，循腹右上行，会于咽喉，别而络唇口。血气盛，则充肤热肉，血独盛则淡渗皮肤，生毫毛。男子至唇口而长髭须，女子至胸中而下为月事。是血之液为汗者，乃渗于皮肤之血，非经脉之血也。所以举女子的月事来申明这一点。气上迫肺者，真气上逆，口苦舌干，惊则咳甚，这是心气上炎而不下通。这一篇虽然叫评热，然而都论述精血汗液的生化源头。大概知道了生始的源头，就知道如何养正而胜邪了。水谷之精藉肾脏精气之所化，胞肾之精血，由胃腑水谷之所生。王芳侯说：出红汗曰蔑，这是渗于皮肤之血，而又不能化汗的情况了。）
Huangdi asked, "There is a patient suffering from a warm disease. After sweating, the fever returns immediately, and the pulse is rapid and restless, not subsiding with the sweat. The patient also exhibits delirium and an inability to eat. What is this disease named?" Qibo replied, "This disease is called 'Yin-Yang Jiao' (Crossing of Yin and Yang). 'Jiao' implies death. (Warm diseases arise from cold injury in winter; those manifesting before the Summer Solstice are termed warm diseases. 'Yin-Yang Jiao' refers to the phenomenon where sweat, being Yin fluid, exits to the exterior (Yang), but the Yang heat pathogen does not resolve with the sweat but instead re-enters the Yin. This crossing signifies that the healthy Qi cannot overcome the pathogenic factor, and the pathogen subsequently damages the healthy Qi, resulting in a fatal condition.)" Huangdi said, "I wish to hear the explanation." Qibo said, "The reason humans sweat is that it all originates from grain (food and drink). Grain essence generates Jing (Essence). (Sweat is generated from the essence of water and grain. The essence of water and grain is transformed by Jing essence, hence it is said that 'grain generates Jing'. There are two origins for sweat: one comes from the essence of water and grain, and the other from the Jing stored in the Kidney. When it is said that 'all originate from grain', it means that the Jing stored in the Kidney is also produced by water and grain.) Now, if pathogens and healthy Qi contend between the bones and muscles and sweat occurs, this indicates that the pathogen is retreating and the Jing has prevailed. (Contending between bones and muscles means the pathogen hides between them. In spring, it contends with healthy Qi, causing warm disease. Sweating indicates that Jing prevails, and the pathogen should exit together. Ni Chongzhi stated: The Stomach governs flesh, and the Kidney governs bones. Sweat from stomachal grain essence differs from sweat originating from kidney blood essence. If the pathogen is in the flesh, it resolves with grain sweat; if in the bones, it requires kidney Jing sweat to resolve.) When Jing prevails, the patient should be able to eat and not have recurrent fever. Recurrent fever indicates the presence of the pathogen; sweat represents Jing essence. Now, sweating followed immediately by fever indicates the pathogen has prevailed. The inability to eat means there is no supplementation for the Jing. If the disease lingers, life will end abruptly. (This explains that the essence of water and grain is transformed by Kidney Jing. The Kidney is the Water Organ, receiving and storing the essence of water and grain. Its Jing ascends to combine with the Yangming channel. Wu and Gui combine to transform into Fire; the Qi of Fire and Earth digest the essence of water and grain to regenerate this Jing, illustrating the mutual nourishment of the Pre-Heaven and Post-Heaven sources. Now, after sweating, if the pathogen lingers, the heat pathogen will damage the Yin Jing again. Damaged Jing cannot combine with Yangming to aid digestion, meaning the source of Jing generation is cut off, and life will end instantly. Dong Weiyuan noted: The way of mutual growth rotates like a ring.) Furthermore, the *Lun* on Heat states: 'If the pulse remains rapid and vigorous after sweating, death ensues.' (This cites the *Lun* on Heat to explain the meaning of 'sweat originates from grain, grain from Jing, inability to eat, and lack of Jing supplementation'. The *Ling Shu: Lun on Heat* states: 'In heat disease, if sweat occurs but the pulse remains rapid and vigorous, this is the extreme of the Yin pulse, indicating death. If the pulse becomes calm after sweating, survival is indicated. If the pulse is rapid and vigorous but no sweat occurs, this is the extreme of the Yang pulse, indicating death. If the pulse is full and rapid but becomes calm after sweating, survival is indicated. Sweat is Jing essence. Rapid and vigorous pulse after sweating means the pathogen is strong and Jing is insufficient. The Yin pulse refers to the Shaoyin pulse; 'extreme' means termination. This indicates Shaoyin Qi is terminated due to intense heat pathogen. Rapid pulse without sweat indicates excessive Yang heat and exhaustion of Stomach Qi.) Now, the pulse does not correspond with the sweat (i.e., the pulse remains rapid despite sweating); this shows the healthy Qi cannot overcome the disease. Death is evident. Delirium indicates loss of Zhi (Will/Shen), and loss of Zhi leads to death. (Pulse not corresponding to sweat indicates deficient Stomach Qi unable to resist the pathogen, implying imminent Stomach Qi exhaustion. The Kidney stores Zhi. Delirium indicates Jing injury and premature death of Zhi. Premature death of Zhi results in death within one and a half days.) Now, three signs of death are present, with no sign of life. Even if temporary recovery occurs, death is inevitable. (Lingering disease is one sign of death; exhausted Stomach Qi is another; exhausted Kidney Qi is the third. The Kidney is the root of living Qi. If sweat fails to overcome the pathogen but Kidney Jing remains, there is a chance for life. If Jing is injured but Yangming's generative source is intact, there is a chance. 'Recovery' here means the pathogen is gone. If the pathogen is gone but the source of living Qi is exhausted, death is certain. The above discusses the principles of pathogen vs. healthy Qi and Yin-Yang, emphasizing the importance of protecting the generative source of healthy Qi.)" Huangdi asked, "There is a disease characterized by body heat, sweating, and vexation/fullness, where vexation/fullness does not resolve with sweating. What is this disease?" (Note: This chapter discusses how Yang heat pathogens are countered only by Yin Jing. Sweat is Jing essence, originating either from water/grain essence or Kidney fluids. Water/grain enters the Stomach, fluids distribute, and sweat flows profusely—this is water/grain essence. The Kidney is the Water Organ, storing essence from the five Zang organs. This essence transforms into blood via the Heart; the fluid of blood is sweat—this is Kidney essence. Thus, the previous section discussed sweat from grain, and this section below discusses wind damaging Kidney Jing. Wind causes water to disperse; overflowing water leads to deficiency of Jing. This section discusses wind moving Kidney Jing; the Lao Feng section discusses wind moving Kidney water Qi; the Shen Feng section discusses wind moving Kidney water pathogen—all ultimately belonging to deficiency of both Jing and Qi.) Qibo said, "Sweating with body heat is due to Wind. Sweating with unresolved vexation/fullness is due to Jue (Reversal). The disease is named 'Feng Jue' (Wind Jue). (Wind is a Yang pathogen that opens the muscle interstices. Sweat from the interstices is water/grain essence. Fluid leakage allows wind-heat to linger, causing body heat. Lingering wind-heat damages Kidney Qi, causing it to rebel upward. Upward rebellion causes heart vexation; attacking Spleen earth causes middle jiao fullness. Named 'Feng Jue' because wind causes Kidney Qi reversal. The previous section discussed death when healthy Qi is exhausted despite apparent recovery; this section discusses survival when the root remains intact despite lingering pathogen. The reality/deficiency of pathogen and healthy Qi determines life and death significantly; students must examine this carefully.)" Huangdi said, "I wish to hear the complete details." Qibo said, "Ju Yang (Taiyang) governs the exterior Qi and thus receives the pathogen first. Shaoyin is its interior-exterior pair.受热 (receiving heat) causes it to follow upwards; following upwards leads to Jue. (Ju Yang is Taiyang. Taiyang Qi governs the exterior. Wind is a Yang pathogen damaging Yang Qi. Two Yangs clashing cause heat disease. Shaoyin and Taiyang are interior-exterior pairs. Yang heat above causes Yin Qi to follow it up; following up results in Jue.)" Huangdi said, "How should it be treated?" Qibo said, "Needle both the exterior and interior channels, and administer decoctions. (Exterior and interior refer to Yin and Yang. Needling the exterior drains the Yang pathogen of wind-heat; needling the interior descends the rebellious Qi of Shaoyin. Administering decoctions assists in generating fluid-Jing sweat.)" Huangdi asked, "What about Lao Feng (Labor-induced Wind) disease?" (This discusses labor-induced sweating exposed to wind, injuring the Kidney. Vexation/labor causes Yang Qi to expand outward and Jing to deplete inward. Exterior Yang deficiency makes one susceptible to wind; interior Jing deficiency agitates water Qi.) Qibo said, "Lao Feng typically manifests below the Lung. (Wind moves cold-water Qi, which should reside below the Lung. *Shui Re Xue Lun* states: The Kidney is Supreme Yin, holding water; the Lung is Taiyin; Shaoyin is the Winter pulse. Thus, the root is in the Kidney, the branch in the Lung, both involving water accumulation.) Its symptoms include stiffness of the head and neck, and blurred vision. (Stiffness arises because Yang expands and wind strikes again, causing upper stiffness. Jing depletion and further injury cause blindness/blurred vision.) The patient spits phlegm resembling mucus, fears wind, and shivers with cold. This is Lao Feng disease. (Kidney fluids enter the Lung to become mucus; exiting the mouth is saliva. Wind moves Kidney water to the Lung base, causing spit resembling mucus. The Lung governs skin/hair; wind-cold invading the Lung causes fear of wind and chills. This occurs when one exerts oneself vigorously and labors heavily, causing Kidney sweat, which then encounters wind.)" Huangdi said, "How should it be treated?" Qibo said, "Rescue the ability to bend and extend. (*Jin Gui Yao Lue: Water Qi Chapter* states: Excessive Qi creates water, making bending and extension difficult. Cold-water Qi rebels upward, carrying有形 (form) water with it. One must urgently rescue the water pathogen to prevent upward overflow causing immobility.) If Taiyang Qi can guide Jing downward for urination, recovery takes three days; middle-aged individuals take five days; those with deficient Jing (elderly) take seven days. (This describes the method for restoring mobility, which should exit via urine. 'Taiyang guiding Jing' refers to the Bladder Fu, which stores fluids and excretes them upon Qi transformation. Strong Taiyang Qi guides Kidney pathogenic water out via urine, curing in three days. Middle-aged people with deficient Jing take five days; elderly with declining Jing take seven days. Three, five, and seven are Yang numbers, indicating that with Yang transformation, Yin water naturally exits.) If the patient coughs up green-yellow phlegm resembling pus, size of a bullet, exiting via mouth or nose, failure to expel it injures the Lung, leading to death. (This describes expelling cold-water pathogen rebelling below the Lung via the upper orifices, a method of draining from top and bottom. The Kidney is the Water Organ, storing essence from the five Zang. Now, Kidney water rebels upward, causing fluids of the four Zang to coagulate rather than descend. Green-yellow phlegm represents Liver/Spleen fluids; pus-like substance represents Heart/Lung fluids. Since these fluids do not descend to the Kidney but accumulate below the Lung, they must be coughed out. The Lung is above the Spleen. Exit via mouth (Spleen connection) or nose (Lung connection) are the external orifices for phlegm/saliva. The Lung is pure and empty; pathogenic turbidity injuring it causes death.)" Huangdi asked, "There is a patient with Shen Feng (Kidney Wind), presenting with facial edema and obstructed speech. Can acupuncture be used?" ('Qiu' refers to the cheekbone/foot swelling; 'Run' means swelling. Facial and foot edema. Shaoyin meridian passes through the Kidney and connects to the tongue root. Water pathogen rebels upward, obstructing speech.) Qibo said, "Deficiency patterns should not be needled. If needled inappropriately, the pathogen will arrive in five days. (Kidney damaged by wind has deficient Jing/Qi, so needling is contraindicated. Needling deficiency causes rebellious Qi to arrive in five days. *Ping Mai Pian* states: Weak Kidney Qi and scant Jing/blood cause rushing Qi entering the chest/diaphragm. Deficient Jing allows water pathogen to rebel upward. Five days refers to the pathogen starting in Taiyang and reaching Shaoyin to move Qi after five days.)" Huangdi asked, "What will happen when it arrives?" Qibo said, "It will definitely present with shortness of breath, intermittent fever, sweating, hot hands/feet, dry mouth with bitter taste and thirst, yellow urine, edema under the eyes, abdominal borborygmi, heavy body with difficulty walking, amenorrhea, vexation with inability to eat, inability to lie flat (supine position causes coughing). The disease is named 'Feng Shui' (Wind-Water). Discussion is in the *Ci Fa* (Acupuncture Methods) chapter. (Named Feng Shui because wind moves water. 'In Ci Fa' refers to the *Shui Re Xue Lun* chapter.)" Huangdi said, "I wish to hear the explanation." Qibo said, "Where the pathogen gathers, the Qi is necessarily deficient. Where Yin is deficient, Yang inevitably gathers. Hence, shortness of breath, intermittent fever, and sweating occur. (Wind damages the Kidney, causing Jing deficiency. Yin deficiency allows Yang to invade, causing intermittent fever. Kidney is the root of living Qi, hence shortness of breath. Yang added to Yin causes sweating. Damp-heat steams upward from chest/back to head. Heat in Lower Jiao causes yellow urine. Ni Chongzhi stated: Taiyang and Shaoyin share root/branch. Wind damages Kidney, starting in Taiyang, progressing to Kidney. Kidney heat steams upward along Taiyang Qi to the head.) Inability to lie flat is due to Stomach disharmony. Supine position worsens coughing because Qi presses on the Lung. (This clarifies Yang pathogen injuring Yin and moving Kidney water. 'Zheng Yan' is supine. Water rising to Stomach causes disharmony, preventing supine posture. Lung meridian connects to Large Intestine and circles the Stomach, so Qi presses on Lung. Previous section discussed Yang heat injuring Jing; this section discusses moving water. Ni Chongzhi stated: Lao Feng accumulates below Lung, producing lung fluid (phlegm), not Kidney water. Lung is the source of water; reversed Kidney Qi condenses water above. Supine pressing on Lung is due to Stomach Qi rising, not Kidney water. Edema under eyes is abdominal water pathogen manifesting below eyes. Note that Kidney deficiency with water flooding only reaches the abdomen.) All patients with water Qi exhibit slight edema, first appearing under the eyes. Huangdi asked, "Why?" Qibo said, "Water is Yin; under the eyes is also Yin. The abdomen is the residence of Supreme Yin. Thus, water in the abdomen causes edema under the eyes. (Taiyin is Supreme Yin. Water pathogen rises to abdomen, injuring Stomach then Spleen. Slight edema appears first under eyes. Spleen binds. Ni Chongzhi stated: Water in abdomen, edema under eyes, is due to water Qi.) True Qi rebels upward, causing bitter taste and dry tongue. (True Qi refers to the Heart Qi of the Zang. Heart is Fire and dislikes water. Water rising forces Heart Qi to rebel, causing bitterness and dryness.) Inability to lie flat; supine position causes coughing up clear water. (This describes water rising from Stomach to Spleen, Heart, and Lung. Kidney is root, Lung is branch; Metal/Water mother-child organs both hold water. Water rebelling to Lung causes coughing clear water.) All water disease patients cannot lie down; lying down causes fright, and fright worsens coughing. (Kidney pathogen rises to Stomach, pressing on Heart. Stomach Qi pressing on Heart forces Heart Qi onto Lung. Water in Stomach prevents lying down. Stomach meridian connects to Heart; Yang entering Yin causes Yin-Yang conflict, leading to fright. Heart Qi pressing on Lung causes Metal to fear Fire, worsening cough. Previous section discussed water rising from below; this section discusses Zang-Fu Qi also rising from below.) Abdominal borborygmi originates in the Stomach. (Water pathogen enters meridians, circulating downwards. Water disease starts in Stomach, draining via meridians, causing rumbling. Pressing Spleen causes vexation/anorexia. Spleen meridian connects to Heart, causing vexation. Upper Jiao governs intake, causing anorexia. Stomach obstruction prevents eating. Water flowing down causes heaviness. Ni Chongzhi stated: Pathogen only attacks Stomach; pressing Spleen/Lung/Heart is secondary Stomach Qi movement, not direct water attack on Heart. Kidney is the gate of Stomach; water exits gate, pathogen stays in Stomach, hence 'originates in Stomach'.) Amenorrhea is due to closure of Bao Mai (Uterine vessels). Bao Mai belongs to the Heart and connects to the Bao (Uterus). Now, Qi presses on the Lung, preventing Heart Qi from descending, hence amenorrhea. Huangdi said, "Excellent." (Fluids of Middle Jiao flow to Kidney as Jing, transform to blood via Heart. Blood fluid is sweat. This section begins with wind damaging Kidney Jing and ends with failure to transform to blood. This chapter evaluates Yang heat pathogens, stating they are countered only by Yin Jing/sweat. Previous chapter stated death if grain-sweat fails to overcome pathogen; here, Kidney Jing damaged by wind and unable to receive Heart Qi to transform to blood means wind cannot exit via sweat. Regarding Ying Qi: Grain enters Stomach, transmits to Lung, flows internally, distributes externally. Refined essence nourishes meridians continuously. Blood is Middle Jiao fluid flowing in meridians and seeping into skin, having two paths. Middle Jiao extracts juice, changes to red—this is refined blood in meridians. Flowing internally/distributing externally is blood in Bao and skin. Bao Mai belongs to Heart, becoming blood via descending Heart Qi. Chong and Ren meridians originate in Bao, ascend back, serving as Sea of Meridians. Floating/exterior branches ascend right abdomen to throat, connect lips/mouth. Abundant Qi/Blood fills skin/flesh; abundant Blood seeps into skin, growing hair. Men grow beard at lips; women menstruate at chest. Blood fluid as sweat is seeped skin blood, not meridian blood. Hence, female menstruation illustrates this. Qi pressing Lung indicates True Qi rebellion, bitter/dry mouth, fright/cough—Heart Qi flaming upward without descending. Though titled 'Evaluating Heat', this chapter discusses the origin of Jing, Blood, and Sweat. Knowing the origin allows one to nurture healthy Qi to overcome pathogen. Water/grain essence relies on Kidney Jing transformation; Bao/Kidney Jing/Blood relies on Stomach grain. Wang Fanghou stated: 'Red sweat' (Mie) is seeped skin blood that fails to transform into sweat.)