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Difficulty 24 states: When the Qi of the three Yin and three Yang meridians of the hands and feet is exhausted, what are the signs? How can one determine their auspiciousness or inauspiciousness (prognosis)? The answer is: When the Qi of the Foot Shaoyin Meridian (Kidney Meridian of Foot-Shaoyin) is exhausted, the bones become withered.

The Shaoyin Meridian corresponds to the winter pulse; it runs deep within and warms the bone marrow. Therefore, if the bone marrow is not warmed, the flesh cannot adhere to the bones; if the flesh and bones are not closely attached, the flesh becomes flaccid and retracts; due to this flaccidity and retraction, the teeth appear elongated and withered, and the hair loses its luster; the lack of luster indicates that the Qi of the bones has died first. The condition will worsen on Wu days and death will occur on Ji days.

When the Qi of the Foot Taiyin Meridian (Spleen Meridian of Foot-Taiyin) is exhausted, the vessels fail to nourish the lips. The lips are the root of the muscles. If the vessels do not nourish them, the muscles lose their smoothness and luster; if the muscles are not smooth and lustrous, they become swollen and full; when swollen and full, the lips evert; lip eversion indicates that the Qi of the flesh has died first. The condition will worsen on Jia days and death will occur on Yi days.

When the Qi of the Foot Jueyin Meridian (Liver Meridian of Foot-Jueyin) is exhausted, there is tendon contraction pulling on the genitals and tongue rolling. The Jueyin Meridian is the Liver Meridian. The Liver governs the tendons, which converge at the genitalia and connect to the base of the tongue. Therefore, if the vessels fail to nourish them, the tendons contract and tighten; tight tendons pull on the genitals and tongue; thus, tongue rolling and testicular retraction occur, indicating that the Qi of the tendons has died first. The condition will worsen on Geng days and death will occur on Xin days.

When the Qi of the Hand Taiyin Meridian (Lung Meridian of Hand-Taiyin) is exhausted, the skin and hair become scorched and withered. The Hand Taiyin belongs to the Lung, which circulates Wei Qi (Defensive Qi) to warm the skin and hair. If Wei Qi fails to nourish, the skin and hair become withered; if the skin and hair are withered, body fluids are lost; if body fluids are lost, the skin and joints are damaged; if the skin and joints are damaged, the skin becomes dry and hair breaks; broken hair indicates that the Qi of the hair (Lung Qi) has died first. The condition will worsen on Bing days and death will occur on Ding days.

When the Qi of the Hand Shaoyin Meridian (Heart Meridian of Hand-Shaoyin) is exhausted, the vessels become obstructed; if the vessels are obstructed, blood does not flow; if blood does not flow, the complexion loses its luster. Therefore, the facial color becomes black like charcoal, indicating that the Qi of blood has died first. The condition will worsen on Ren days and death will occur on Gui days.

When the Qi of all three Yin meridians is exhausted, dizziness, vertigo, and eye closure occur. Eye closure signifies the loss of Zhi (Will/Spirit); loss of Zhi indicates that the Will has died first, manifesting as eye closure upon death.

When the Qi of all six Yang meridians is exhausted, Yin and Yang separate from each other. When Yin and Yang separate, the interstices (Cou Li) become permeable, and absolute sweat (Jue Han) flows out. The sweat beads are large like strings of pearls, rotating but not flowing down, indicating that Yang Qi has died first. If symptoms are observed in the morning, death occurs in the evening; if observed in the evening, death occurs the next morning.