〔《素》〕邪气盛则实，精气夺则虚。（《通评虚实论》。此二句乃虚实之要领）
邪之所凑，其气必虚（《评热论》《针经》云∶风雨寒热，不得虚邪不能独伤人。许学
士云∶邪之所凑，其气必虚，留而不去，其病则实）。
〔《难》〕人有三虚三实，何谓也？有脉之虚实，有病之虚实，有诊之虚实。脉之虚实者
，濡者，为虚；紧牢者，为实。病之虚实者，出者，为虚；入者，为实。言者，为虚；不言
者，为实。缓者为虚；急者，为实。诊之虚实者，濡者，为虚；牢者，为实。痒者，为虚；
痛者，为实。外痛内快为外实内虚，内痛外快为内实外虚。故曰虚实也。
〔《素》〕所谓重实者，言大热病，气热脉满，是谓重实（《通评虚实论》。下同）。脉气
虚，尺虚（甲乙经作“脉虚气虚尺虚”），是谓重虚。所谓气虚者，言无常也。尺虚者，行步
然。脉虚者，不象阴也。脉盛，皮热，腹胀，前后不通，闷瞀，此谓五实。五实死，
身汗得后利，则实者活（《玉机真藏论》。下同。子和诊一舟子病，乃五实也。作大剂下之
，殊不动摇，计竭智穷，无如之何。忽忆桃花萼丸，频下七八十丸，连泻二百余行，与前药
相兼而下，其昏困数日方已）。脉细，皮寒，气少，泄痢前后，饮食不入，是谓五虚。五虚
死，浆粥入胃，泄注止，则虚可活。（治五虚，黄 建中汤、理中汤之类方见后条伤寒）
〔垣〕胃中元气盛，则能食而不伤，过时而不饥。脾胃俱旺，则能食而肥。脾胃俱虚，则
不能食而瘦，或少食而肥，虽肥而四肢不举，脾实而邪气盛也。（治脾胃虚，补中益气汤。
见发热）。
〔《灵》〕形气不足，病气有余，是邪气也，急泻之。形气有余，病气不足，急补之。形
气不足，病气不足，此阴阳俱不足也，不可刺之，刺之则重不足，重不足则阴阳俱竭，血气
皆尽，五脏空虚，筋骨髓枯，老者绝灭，壮者不复矣。形气有余，病气有余，此谓阴阳俱有
余也，急泻其邪，调其虚实。（《根结篇》。东垣云∶病来潮作之时，病气精神增添者，是
谓病气有余。若病来潮作之时，神气困弱者，是谓病气不足。病气有余，乃邪气胜也，急泻
之以寒凉酸苦之剂。病气不足，急补之以辛甘热之剂。不问形气有余及形气不足，只取病气
有余不足也。夫形气者，气谓口鼻中气息也，形谓皮肉筋骨血脉也。形胜者为有余，消瘦者
为不足。察其气者，审口鼻中气，劳役如鼓为气有余，若喘息气促气短或不足少息者为不足
。其曰形气，谓人形体中之血气也。当补当泻，全不在此。只在病势潮作之时，精神困弱，
语言无力，懒语者急补之。若形气不足，病未潮作之时，亦为不足，此乃阴阳俱不足也，禁
用针，当补之以甘药。不已，灸脐下一寸五分，气海穴也）
〔《素》〕阳道实，阴道虚（《太阴阳明论》）。至阴虚，天气绝；至阳盛，地气不足。（《方盛衰论》）
〔河〕血实气虚则肥，气实血虚则瘦。所以肥能寒而不能热，瘦能热而不能寒者，由寒则
伤血，热则伤气。损其不足，则阴阳愈偏，故不能也。损其有余者，方得平调，故能之矣。
〔《灵》〕肥而泽者，血气有余。肥而不泽者，气有余，血不足。瘦而无泽者，血气俱不
足。审察其形气有余不足而调之，可以知逆顺矣。（《阴阳二十五人篇》）
卫气虚则汗多，荣血虚则无汗。经云∶卫气者，所以肥腠理，司开阖者也。今卫虚则腠
理疏，开阖无司，而汗多矣。又云∶夺血者无汗，夺汗者无血。今血少则无汗矣。
〔《灵》〕美眉者，太阳多血，通髯极须者，少阳多血。美须者，阳明多血。（《五音五
味篇》）
黄帝曰∶夫子之言脉之上下，血气之候，以知形气，奈何？岐伯曰∶足阳明之上，血气
盛则髯美长，血少气多则髯短。故气少血多，则髯少。血气皆少，则无髯，两吻多画。足阳
明之下血气盛，则下毛美长至胸。血多气少，则下毛美短至脐，行则善高举足，足指少肉，
足善寒。血少气多，则肉而善瘃。血气皆少则无毛，有则稀枯瘁，善痿厥，足痹（瘃，少玉
切。乃冻疮也）。足少阳之上，气血盛，则通髯美长。血多气少，则通髯美短。血少气多，
则少髯。血气皆少，则无须。感于寒湿，则善痹骨痛爪枯也。足少阳之下，血气盛则胫毛美
长，外踝肥。血多气少，则胫毛美短，外踝皮坚而浓。血少气多，则 毛少，外踝皮薄
而软。血气皆少则无毛，外踝瘦无肉。足太阳之上，血气盛则美眉，眉有毫毛。血多气少则
恶眉，面多少理，血少气多则面多肉，血气和则美色。足太阴之下，血气盛则跟肉满，踵坚
。气少血多则瘦，跟空。血气皆少则喜转筋，踵下痛。手阳明之上，血气盛则髭美，血少气
多则髭恶，血气皆少则无髭。手阳明之下，血气盛则腋下毛美，手鱼肉以温。血气皆少则手
瘦以寒。手少阳之上，血气盛则眉美以长，耳色美。血气皆少则耳焦恶色。手少阳之下，血
气盛则手卷多肉以温，血气皆少则寒以瘦。气少血多则瘦以多脉。手太阳之上，血气盛则颔
多须。面多肉以平。血气皆少则面瘦恶色。手太阳之下，血气盛则掌肉充满。血气皆少则掌
瘦以寒。（以上见《阴阳二十五人篇》）
〔《灵》〕黄帝曰∶余闻人有精气津液血脉，余意以为一气耳，今乃辨为六名，余不知其
所以然？岐伯曰∶两神相搏，合而成形，常先身生，是为精。何谓气？岐伯曰∶上焦开发，宣
五谷味，熏肤充身泽毛，若雾露之溉，是谓气。何谓津？岐伯曰∶腠理发泄，汗出溱溱，是
为津。何谓液？岐伯曰∶谷入气满，淖泽注于骨，骨属屈伸，泄泽，补益脑髓，皮肤润泽，
是谓液。何谓血？岐伯曰∶中焦受气取汁，变化而赤，是谓血。何谓脉？岐伯曰∶壅遏营气，
令无所避，是谓脉（黄帝曰∶六气者，云云）。精脱者，耳聋。气脱者，目不明。津脱者，腠
理开，汗大泄。液脱者，骨属屈伸不利，色夭，脑髓消，胫酸，耳数鸣。血脱者，色白，夭
然不泽，其脉空虚。（以上《见决气篇》）
上精气津液血脉六者，盖精气即卫气，津液血脉即营血之异名，卫气根于血，营血根于
气，故曰一气也。
〔《素》〕臂多青脉，曰脱血（《平人气象论》。下同）。安卧脉盛，谓之脱血。
〔《灵》〕尺炬然热，人迎大者当夺血。（《论疾诊尺篇》）
气虚则脉弦，血虚则脉大，仲景云∶脉弦则卫气不行。《内经》云∶脉粗大者，阴不足
，阳有余也。
〔《脉》〕脉大而坚者，血气俱实；脉小者，血气俱虚；脉大者，血气俱多；脉细微者，
血气俱虚。
〔《灵》〕脉动而实且疾者，疾泻之，虚而徐者，则补之。（《终始篇》）
〔《难》〕脉有阳虚阴盛，阳盛阴虚，何谓也？然，浮之损小，沉之实大，故曰阴盛阳虚
，沉之损小，浮之实大，故曰阳盛阴虚。是阴阳虚实之意也。（《六难》）
〔仲〕∶脉蔼蔼如车盖者，名曰阳结也；脉累累如循长竿者，名曰阴结也。（如车盖者，浮
大而有力也。如循长竿者，弦而有力也）
〔《脉》〕寸口脉 如羹上肥，阴气微；连连如蜘蛛丝，阴气衰。（如羹上肥
者，浮大而无力也。蜘蛛丝者，细而无力也）
〔仲〕∶脉绵绵如泻漆之绝者，亡其血也。
〔《脉》〕脉滑者，多血少气；脉涩者，少血多气。
〔仲〕∶寸口脉微而涩，微者，卫气衰；涩者，荣气不足。
〔《难》〕脉有损至，何谓也？然，至之脉，一呼再至曰平，三至曰离经，四至曰夺精，
五至曰死，六至曰命绝，此死至之脉也。何谓损？一呼一至曰离经，二呼一至曰夺精，三呼
一至曰死，四呼一至曰命绝，此损之脉也。至脉从下上，损脉从上下也。损脉之为病奈何？
然，一损损于皮毛，皮聚而毛落。二损损于血脉，血脉虚少不能荣于五脏六腑。三损损于肌
肉，肌肉消瘦，饮食不能为肌肤。四损损于筋，筋缓不能自收持。五损损于骨，骨痿不能起
于床。反此者，至脉之病也。从上下者，骨痿不能起于床者死。从下上者，皮聚而毛落者死
。治损之法奈何？然，损其肺者，益其气。损其心者，调其荣卫。损其脾者，调其饮食，适
其寒温。损其肝者，缓其中。损其肾者，益其精。此治损之法也（治损之法，详见虚门）
。脉来一呼再至，一吸再至，不大不小曰平。一呼三至，一吸三至，为适得病。前大后小，
即头痛目眩。前小后大，即胸满短气。一呼四至，一吸四至，病欲甚。脉洪大者，苦烦满；
沉细者，腹中痛；滑者，伤热；涩者，中雾露。一呼五至，一吸五至，其人当困。沉细夜
加，浮大昼加，不大不小，虽困可治，其有大小者，为难治。一呼六至，一吸六至，为死脉
也。沉细夜死，浮大昼死，一呼一至，一吸一至，名曰损。人虽能行，犹当着床，所以然者
，血气皆不足故也。再呼一至，再吸一至，名曰无魂，无魂者，当死也。人虽能行，名曰行
尸。上部有脉，下部无脉，其人当吐，不吐者，死。上部无脉，下部有脉，虽困无能为害也
。所以然者，譬如人之有尺，树之有根，枝叶虽枯槁，根本将自生。脉有根本，人有元气，
故知不死。（以上《十四难》）
〔仲〕寸口诸微亡阳，诸濡亡血。脉来缓时一止复来者，名曰结。脉来数时一止复来者，
名曰促。脉阳盛则促，阴盛则结，此皆病脉。
挟喉两旁人迎脉大为阳盛，两手寸口脉大为阴盛。详见针灸门刺虚实法。（《内经
》以挟喉两旁动脉为人迎，《脉经》以关前为人迎，当以《内经》为正）
〔《素》〕∶阴不胜其阳，则脉流薄疾，并乃狂。阳不胜其阴，则五脏气争，九窍不通。（
《生气通天论》）
洁∶气虚气弱者，陈皮、黄 、人参；气实气结者，青皮、浓朴、木香、沉香。血虚者
，生地黄、当归身；血实恶血积聚者，当归梢、苏木、红花。
〔海〕气血弱者，勿与枳壳，以其损气也；气血盛者，勿与丁香，以其益气也。脉弦而虚
者，勿损气，脉大而实者，勿益气；脉中有少力，浮则似止，胸中真气不及也。
人参 五味子 麦门冬 沉香 川芎 益智 白豆蔻 丁香
气虚，则生脉散；血虚，则三才丸。
四君子汤 治真气虚弱及短气脉弱。
白术 人参 黄 茯苓（等分）
上为粗末。每服五钱，水一盏，煎至七分，食远温服。
〔《千金》〕生脉散
人参 五味 麦门冬
〔（洁）〕益气丸 治语言多，损气懒语。补上益气。
麦门冬（去心） 人参（各三钱） 橘皮（去白） 桔梗 炙甘草（各半两） 五味子（二十一粒）
上为极细末。水浸油饼为丸，如鸡头大。每服一丸，细嚼，津唾咽下（油饼，和油烧饼也）。
虚损。人参黄 汤。
人参（二钱） 黄 白术 陈皮（去白，各一钱） 甘草（半钱，炙） 当归 茯苓（各一钱）
上 咀。水煎，空心热服。胃热不能食者，加姜、枣汤煎。
〔垣〕补中益气汤 治饮食劳倦所伤。（方见《虚热门》）
调中益气汤 治脉弦洪缓而沉，按之中之下，时得一涩，其证心腹满闭，肢节烦疼，难
以屈伸，身体沉重，烦心不安，忽肥忽瘦，四肢懒倦，口失滋味，腹难舒伸，大小便溺清利
而数。或上饮下泄。或大便涩滞不行，一二日一见，夏月飧泄，米谷不化。或便后见血及白
脓，胸满短气，膈咽不通。或痰嗽稠粘，口中沃沫，食入反出，耳鸣耳聋，两目焰火，视物
昏花， 肉红丝，热壅头目，不得安卧，嗜卧无力，不思饮食。
黄氏（一钱） 甘草（五分） 人参（半钱，去芦，嗽者去之） 柴胡（二分，为上气不足，胃气与脾
气下陷，能补上气，从水引火） 橘皮（二分，如腹中气不得运转者，更加一分） 升麻（二分）
苍术（五分） 木香（一分）
上锉如麻豆大。都作一服，水二盏，煎至一盏，去渣，带热服。宿食消尽服之，宁心绝
思，药必神效。盖病在四肢，血脉空虚，宜在旦服。如时显热燥，是下元阴火蒸蒸发也，加
真生地黄（二分）、黄柏（三分）；如大便虚坐不得，或大便了而不了，腹常逼迫，血虚血涩也，加
当归身（三分）；如身体沉重，虽小便数多，亦加茯苓（二分）、苍术（一钱）、泽泻（五分）、黄柏（三分，
时令从权祛湿也，不可常用。兼足太阴已病，其脉络于心中，故显湿热相合而生烦乱也）。
如胃气不和，加汤洗半夏（半钱），生姜三片，以制半夏之毒。有嗽者去之，缘痰厥头痛，非半
夏不能除。此足太阴脾经之邪所作也。如无以上证，只服∶
黄 （一钱） 人参（二钱） 甘草（五分） 橘皮（二分） 柴胡（二分） 升麻（二分） 苍术（五分） 黄柏（
酒洗，一分）
上件锉如麻豆大。根据前煎服。
中气不足随时加减用药法∶如食少不饥，加炒曲；如食已心下痞，别服橘皮枳术丸；如
脉弦四肢满闷，便难而心下痞，加甘草、黄连、柴胡；如腹中气上逆者，是冲脉逆也，加黄
[Suwen] When pathogenic factors are exuberant, it manifests as excess (Shi); when essential qi is depleted, it manifests as deficiency (Xu). (From *Tong Ping Xu Shi Lun*. These two sentences are the essentials for distinguishing deficiency and excess.)
Wherever pathogenic factors gather, the body's qi must be deficient. (From *Ping Re Lun*. The *Zhen Jing* states: Wind, rain, cold, and heat, cannot harm a person alone unless they take advantage of deficiency. Scholar Xu stated: Wherever pathogenic factors gather, the qi must be deficient; if they remain and do not depart, the disease becomes excess.)
[Nan Jing] Humans have three types of deficiency and three types of excess. What does this mean? There is pulse deficiency/excess, disease deficiency/excess, and diagnostic deficiency/excess. Regarding pulse deficiency/excess: a soggy (Ru) pulse indicates deficiency; a tight and firm pulse indicates excess. Regarding disease deficiency/excess: outward manifestations indicate deficiency; inward manifestations indicate excess. Ability to speak indicates deficiency; inability to speak indicates excess. A slow pulse tendency indicates deficiency; a rapid pulse tendency indicates excess. Regarding diagnostic deficiency/excess: a soggy sensation indicates deficiency; a firm sensation indicates excess. Itching indicates deficiency; pain indicates excess. External pain with internal comfort indicates external excess and internal deficiency; internal pain with external comfort indicates internal excess and external deficiency. Thus, these are referred to as deficiency and excess.
[Suwen] The term "heavy excess" (Chong Shi) refers to severe febrile diseases where qi is hot and the pulse is full, which is called heavy excess (from *Tong Ping Xu Shi Lun*, hereinafter same). If the pulse qi is deficient and the cun position is deficient (the *Jia Yi Jing* reads "pulse, qi, and cun are all deficient"), this is called "heavy deficiency" (Chong Xu). The so-called qi deficiency refers to incoherent speech. Cun deficiency refers to unsteady gait. Pulse deficiency refers to the absence of yin pulse characteristics. A surging pulse, hot skin, abdominal distension, obstruction of urination and defecation, and chest oppression with dizziness constitute the "Five Excesses" (Wu Shi). Five Excesses lead to death; however, if sweating occurs and bowels/bladder open, the excess condition can be cured. (From *Yu Ji Zhen Zang Lun*. Li Dongyuan once treated a boatman suffering from Five Excesses. He prescribed large doses of purgatives, but there was no reaction. Exhausted of ideas, he suddenly recalled Taohua E Wan, administering frequent doses of 70-80 pills. The patient had over 200 bowel movements, expelling both the previous medicine and pathogens together. After several days of coma and lethargy, he recovered.) A fine pulse, cold skin, shortness of breath, diarrhea/dysentery with incontinence, and inability to eat constitute the "Five Deficiencies" (Wu Xu). Five Deficiencies lead to death; however, if gruel enters the stomach and diarrhea stops, the deficiency condition can be cured. (To treat Five Deficiencies, formulas such as Huangqi Jianzhong Tang or Lizhong Tang may be used; see later sections on Cold Damage.)
[Li Dongyuan] If yuan qi in the stomach is abundant, one can eat without injury and feel hungry only after the proper time. If spleen and stomach are both robust, one can eat and become plump. If spleen and stomach are both deficient, one cannot eat and becomes thin, or eats little yet remains fat; although fat, the limbs cannot be lifted. This is spleen excess with pathogenic abundance. (To treat spleen/stomach deficiency, use Buzhong Yiqi Tang; see section on Fever.)
[Ling Shu] If form and qi are deficient while disease qi is excessive, this is pathogenic excess; urgently purge it. If form and qi are excessive while disease qi is deficient, urgently tonify it. If both form/qi and disease qi are deficient, this is dual deficiency of yin and yang; acupuncture should not be used. Acupuncture would exacerbate the deficiency, leading to exhaustion of yin and yang, depletion of blood and qi, emptiness of the five zang organs, and withering of sinews, bones, and marrow. The elderly would perish, and the strong would not recover. If form/qi and disease qi are both excessive, this is dual excess of yin and yang; urgently purge the pathogen and regulate deficiency/excess. (From *Gen Jie Pian*. Dongyuan stated: When the disease flares up, if the pathological state and spirit increase, it is called disease qi excess. If during the flare-up, spirit and qi are weak and exhausted, it is called disease qi deficiency. Disease qi excess means pathogenic victory; urgently purge with cold, sour, and bitter agents. Disease qi deficiency requires urgent tonification with acrid, sweet, and hot agents. Regardless of whether form/qi is excess or deficiency, focus solely on whether disease qi is excess or deficiency. 'Form' refers to skin, flesh, sinews, bones, and blood vessels; 'Qi' refers to breath from nose and mouth. Robust form indicates excess; emaciation indicates deficiency. Observing qi involves examining nasal/respiratory breath: labored breathing like drumming indicates qi excess; panting, shortness of breath, or shallow breathing indicates deficiency. The term 'form and qi' here refers to blood and qi within the physical body. Tonification or purgation depends entirely on this. Only when the disease flares up, showing weak spirit and无力 speech, should urgent tonification be applied. If form/qi is deficient even before the disease flares up, it is still deficiency, indicating dual yin-yang deficiency; needles are contraindicated, and sweet herbs should be used for tonification. If ineffective, moxa the Qihai point, located 1.5 cun below the umbilicus.)
[Suwen] The Yang pathway tends toward excess, and the Yin pathway tends toward deficiency (from *Tai Yin Yang Ming Lun*). Extreme yin deficiency leads to the severance of heavenly qi (yang); extreme yang excess leads to the insufficiency of earthly qi (yin) (from *Fang Sheng Shuai Lun*).
[Wang Haogu] Blood excess and qi deficiency lead to obesity; qi excess and blood deficiency lead to emaciation. Therefore, the obese fear cold but not heat, while the emaciated fear heat but not cold. This is because cold injures blood, and heat injures qi. Damaging what is deficient causes further imbalance of yin and yang, hence it fails. Damaging what is excessive achieves balance, hence it succeeds.
[Ling Shu] Those who are plump and lustrous have abundant blood and qi. Those who are plump but lack luster have excess qi and deficient blood. Those who are emaciated and lack luster have deficient blood and qi. By examining their form and qi for excess or deficiency and regulating accordingly, one can understand favorable and unfavorable prognoses. (From *Yin Yang Er Shi Wu Ren Pian*)
When Wei Qi is deficient, there is profuse sweating; when Ying Blood is deficient, there is no sweating. The classics state: Wei Qi fills the cou li (interstices) and controls opening and closing. Now, with deficient Wei Qi, the cou li are loose, control is lost, and sweating is profuse. It also states: Those who lose blood have no sweat; those who lose sweat have no blood. Now, with scant blood, there is no sweat.
[Ling Shu] Beautiful eyebrows indicate abundant blood in the Taiyang channel. Full beard reaching the temples indicates abundant blood in the Shaoyang channel. Beautiful chin hair indicates abundant blood in the Yangming channel. (From *Wu Yin Wu Wei Pian*)
The Yellow Emperor said: Master, regarding your discussion of pulses above and below, and signs of blood and qi to know form and qi, how is this done? Qibo replied: At the upper part of the Foot-Yangming channel, abundant blood and qi result in beautiful, long facial hair; less blood and more qi result in short facial hair. Thus, less qi and more blood result in sparse facial hair. Scant blood and qi result in no facial hair, with many lines at the corners of the mouth. At the lower part of the Foot-Yangming channel, abundant blood and qi result in beautiful, long pubic hair extending to the chest. More blood and less qi result in pubic hair ending at the navel; walking involves high lifting of the feet, toes have little flesh, and feet tend to be cold. Less blood and more qi result in emaciated flesh prone to chilblains. Scant blood and qi result in no hair, or sparse, dry, withered hair, prone to Wei-Jue syndrome and foot numbness (Chilblains are frostbite injuries). At the upper part of the Foot-Shaoyang channel, abundant blood and qi result in beautiful, long sideburns. More blood and less qi result in shorter sideburns. Less blood and more qi result in fewer sideburns. Scant blood and qi result in no beard. Susceptible to bi-syndrome bone pain and withered nails upon cold-damp invasion. At the lower part of the Foot-Shaoyang channel, abundant blood and qi result in beautiful, long leg hair and full lateral malleolus. More blood and less qi result in shorter leg hair and thick, hard skin at the lateral malleolus. Less blood and more qi result in less hair and thin, soft skin at the lateral malleolus. Scant blood and qi result in no hair and a lean, fleshy-less lateral malleolus. At the upper part of the Foot-Taiyang channel, abundant blood and qi result in beautiful eyebrows with terminal hairs. More blood and less qi result in ugly eyebrows and many facial wrinkles. Less blood and more qi result in fleshy faces. Harmonious blood and qi result in beautiful complexion. At the lower part of the Foot-Taiyin channel, abundant blood and qi result in full heel flesh and firm heels. Less qi and more blood result in leanness and hollow heels. Scant blood and qi result in frequent cramps and pain under the heels. At the upper part of the Hand-Yangming channel, abundant blood and qi result in beautiful mustaches; less blood and more qi result in ugly mustaches; scant blood and qi result in no mustaches. At the lower part of the Hand-Yangming channel, abundant blood and qi result in beautiful axillary hair and warm thenar eminences. Scant blood and qi result in thin, cold hands. At the upper part of the Hand-Shaoyang channel, abundant blood and qi result in beautiful, long eyebrows and beautiful ear color. Scant blood and qi result in dry, ugly ears. At the lower part of the Hand-Shaoyang channel, abundant blood and qi result in fleshy, warm hands. Scant blood and qi result in cold, thin hands. Less qi and more blood result in thinness with prominent veins. At the upper part of the Hand-Taiyang channel, abundant blood and qi result in abundant jaw hair and flat, fleshy faces. Scant blood and qi result in thin, ugly faces. At the lower part of the Hand-Taiyang channel, abundant blood and qi result in full palm flesh. Scant blood and qi result in thin, cold palms. (Above from *Yin Yang Er Shi Wu Ren Pian*)
[Ling Shu] The Yellow Emperor said: I have heard that humans possess essence, qi, fluid, liquid, blood, and vessels. I presumed them to be one qi, yet now they are distinguished into six names. I do not understand why? Qibo said: When two spirits interact, they combine to form shape, existing prior to the body; this is Essence (Jing). What is Qi? Qibo said: The Upper Jiao opens and develops, distributing the flavors of grains, steaming the skin, filling the body, and moistening hair, like mist and dew; this is Qi. What is Fluid (Jin)? Qibo said: Pores open, and sweat flows profusely; this is Jin. What is Liquid (Ye)? Qibo said: Grain enters, qi fills, and rich moisture pours into bones, aiding flexion and extension, nourishing brain marrow, and moistening skin; this is Ye. What is Blood? Qibo said: The Middle Jiao receives qi, extracts juice, transforms it red; this is Blood. What is Vessel? Qibo said: It confines Ying Qi, preventing it from escaping; this is Vessel. (Yellow Emperor: The six qi...) Loss of Essence causes deafness. Loss of Qi causes blurred vision. Loss of Jin causes open pores and profuse sweating. Loss of Ye causes stiff joints, sallow complexion, diminished brain marrow, sore shins, and frequent tinnitus. Loss of Blood causes pale, sallow, lusterless complexion and empty pulses. (Above from *Jue Qi Pian*)
These six—Essence, Qi, Fluid, Liquid, Blood, and Vessels—are essentially variations of the same source. Essence/Qi corresponds to Wei Qi; Fluid/Blood/Vessels correspond to Ying Blood. Wei Qi roots in Blood; Ying Blood roots in Qi. Hence, it is said to be one Qi.
[Suwen] Many blue veins on the arms indicate blood loss (from *Ping Ren Qi Xiang Lun*, hereinafter same). Resting quietly with a surging pulse indicates blood loss.
[Ling Shu] Heat in the Chi position and a large Renying pulse indicate blood loss should be drained. (From *Lun Ji Zhen Chi Pian*)
Qi deficiency presents with a string-like (Xian) pulse; Blood deficiency presents with a large (Da) pulse. Zhang Zhongjing stated: A string-like pulse indicates blocked Wei Qi. The *Neijing* states: A coarse/large pulse indicates insufficient Yin and excessive Yang.
[Mai Jing] A large and firm pulse indicates both blood and qi are excess; a small pulse indicates both are deficient; a large pulse indicates abundant blood and qi; a fine and minute pulse indicates both are deficient.
[Ling Shu] Pulses that are active, excess, and rapid require urgent purgation; those that are deficient and slow require tonification. (From *Zhong Shi Pian*)
[Nan Jing] What is meant by pulse patterns of Yang deficiency/Yin excess and Yang excess/Yin deficiency? Answer: If superficial (Fu) palpation reveals a damaged/small pulse and deep (Chen) palpation reveals an excess/large pulse, it is Yin excess and Yang deficiency. If deep palpation reveals a damaged/small pulse and superficial palpation reveals an excess/large pulse, it is Yang excess and Yin deficiency. This is the meaning of yin/yang deficiency/excess. (From *Liu Nan*)
[Zhang Zhongjing] A pulse resembling a chariot canopy (floating, large, and forceful) is named Yang Jie (Yang Knot); a pulse resembling feeling a long bamboo pole (string-like and forceful) is named Yin Jie (Yin Knot).
[Mai Jing] The Cun Kou pulse resembling grease floating on soup indicates slight Yin Qi; a pulse continuous like a spider's thread indicates declining Yin Qi. (Grease on soup: floating, large, and powerless; Spider thread: fine and powerless.)
[Zhang Zhongjing] A pulse continuous like lacquer pouring out just as it breaks indicates loss of blood.
[Mai Jing] A slippery (Hua) pulse indicates much blood and little qi; a choppy (Se) pulse indicates little blood and much qi.
[Zhang Zhongjing] A Cun Kou pulse that is micro (Wei) and choppy (Se): Micro indicates decline of Wei Qi; Se indicates insufficiency of Ying Qi.
[Nan Jing] What are Sun and Zhi pulses? Answer: Zhi pulses: Two beats per breath are normal; three beats deviate from the standard; four beats deplete essence; five beats indicate death; six beats indicate life extinction. These are the dying Zhi pulses. What are Sun pulses? One beat per breath deviates from the standard; one beat per two breaths depletes essence; one beat per three breaths indicates death; one beat per four breaths indicates life extinction. These are Sun pulses. Zhi pulses progress from bottom to top; Sun pulses progress from top to bottom. How do Sun pulses manifest? One Sun damages skin/hair (skin gathers, hair falls). Two Suns damage blood vessels (vessels become deficient, failing to nourish zang-fu). Three Suns damage muscles (muscles emaciate, food fails to nourish flesh). Four Suns damage sinews (sinews relax, unable to hold). Five Suns damage bones (bone萎 prevents rising from bed). The reverse applies to Zhi pulses. Progressing top-to-bottom, bone萎 preventing rising leads to death. Progressing bottom-to-top, skin gathering and hair falling leads to death. How to treat Sun damage? Damage Lung: Benefit Qi. Damage Heart: Regulate Ying/Wei. Damage Spleen: Regulate diet, adapt to cold/warmth. Damage Liver: Soothe the interior. Damage Kidney: Benefit Essence. This is the method for treating Sun damage (See Xu Men for details). A pulse coming twice per inspiration and twice per expiration, neither large nor small, is normal. Three times per inspiration/expiration indicates recent illness. Anterior large/posterior small causes headache/dizziness. Anterior small/posterior large causes chest fullness/shortness of breath. Four times per inspiration/expiration indicates worsening disease. Surging pulse brings vexation/fullness; deep/fine pulse brings abdominal pain; slippery pulse indicates heat injury; choppy pulse indicates fog/damp injury. Five times per inspiration/expiration indicates distress. Deep/fine worsening at night, large/surging worsening at day: if neither large nor small, treatable; if irregular, difficult to treat. Six times per inspiration/expiration is a death pulse. Deep/fine dies at night; large/surging dies at day. One beat per inspiration/expiration is named Sun. Though able to walk, one must lie down due to blood/qi deficiency. One beat per two inspirations/expirations is named No Soul; No Soul leads to death. Though able to walk, called a Walking Corpse. Pulse present above, absent below: expect vomiting; if no vomit, death. Pulse absent above, present below: though distressed, no danger. Why? Like a tree's root; even if branches wither, the root sustains life. Pulses have roots; humans have Yuan Qi; thus, survival is known. (Above from *Shi Si Nan*)
[Zhang Zhongjing] All micro pulses at Cun Kou indicate loss of Yang; all soggy pulses indicate loss of Blood. A pulse that is slow but occasionally pauses and returns is named Jie (Knotted). A pulse that is rapid but occasionally pauses and returns is named Cu (Surging). Yang excess causes Cu; Yin excess causes Jie; these are all pathological pulses.
Enlargement of the Renying pulse beside the throat indicates Yang excess; enlargement of both Cun Kou pulses indicates Yin excess. See Acupuncture section on Needling Excess/Deficiency. (*Neijing* identifies the pulsating artery beside the throat as Renying; *Mai Jing* identifies the anterior Guan position as Renying; *Neijing* is correct.)
[Suwen] If Yin cannot overcome Yang, pulses flow rapidly and violently, leading to mania. If Yang cannot overcome Yin, the five zang qi conflict, and the nine orifices become obstructed. (From *Sheng Qi Tong Tian Lun*)
Luo Tianyi stated: For qi deficiency/weakness, use Chenpi, Huangqi, Renshen; for qi excess/stagnation, use Qingpi, Houpo, Muxiang, Chenxiang. For blood deficiency, use Sheng Dihuang, Danggui Shen; for blood excess/stasis accumulation, use Danggui Shao, Sumu, Honghua.
Zhu Zhenheng stated: For weak blood/qi, do not use Zhike as it damages qi; for abundant blood/qi, do not use Dingxiang as it benefits qi. If the pulse is string-like and deficient, do not damage qi; if large and excess, do not benefit qi. If the pulse shows slight weakness, floating and seeming to stop, it indicates insufficient true qi in the chest.
Renshen, Wuweizi, Maidong, Chenxiang, Chuanxiong, Yizhi, Ba Doukou, Dingxiang.
For qi deficiency, use Shengmai San; for blood deficiency, use Sancai Wan.
Sijunzi Tang treats true qi weakness and shortness of breath with a weak pulse.
Baizhu, Renshen, Huangqi, Fuling (equal parts).
Grind into coarse powder. Take 5 qian per dose, boil in 1 cup of water until 0.7 cups remain, take warm well after meals.
[Qianjin Fang] Shengmai San
Renshen, Wuweizi, Maidong.
[Luo Tianyi] Yiqi Wan treats excessive speech, qi damage causing reluctance to speak. Tonifies upper jiao qi.
Maidong (remove heart), Renshen (3 qian each), Jupi (remove white), Jiegeng, Zhi Gancao (2.5 liang each), Wuweizi (21 seeds).
Grind to fine powder. Make pills using oil-soaked cakes, size of chicken heads. Take one pill per dose, chew finely, swallow with saliva. (Oil cake is baked with oil).
For deficiency consumption, use Renshen Huangqi Tang.
Renshen (2 qian), Huangqi, Baizhu, Jupi (remove white, 1 qian each), Gancao (0.5 qian, roasted), Danggui, Fuling (1 qian each).
Chop. Decoct in water, take hot on an empty stomach. For stomach heat preventing eating, decoct with Ginger and Jujube water.
[Li Dongyuan] Buzhong Yiqi Tang treats injury from diet and overwork. (Formula in *Xu Re Men*).
Tiaozhong Yiqi Tang treats string-surge-slow-deep pulses, felt as slightly choppy at the middle-lower depth. Symptoms: abdominal fullness/closure, limb pain, difficulty bending/stretching, heavy body, vexation, fluctuating weight, lazy limbs, loss of taste, abdominal discomfort, frequent clear urination/defecation. Or drinking above and leaking below. Or constipation, occurring every 1-2 days, summer diarrhea with undigested food. Or blood/white pus after stool, chest fullness/shortness of breath, diaphragm/throat obstruction. Or thick phlegm cough, foamy saliva, regurgitation, tinnitus/deafness, fiery eyes, blurred vision, red filaments in eyelids, heat congestion in head/eyes, inability to sleep, lethargy, loss of appetite.
Huangqi (1 qian), Gancao (0.5 qian), Renshen (0.5 qian, remove rhizome, omit if coughing), Chaihu (0.2 qian, for upper qi deficiency, sinking of stomach/spleen qi, raises upper qi, draws fire from water), Jupi (0.2 qian, add 0.1 qian if abdominal qi stagnation), Shengma (0.2 qian), Cangzhu (0.5 qian), Muxiang (0.1 qian).
Chop like hemp/millet seeds. One dose, boil 2 cups water to 1 cup, strain, take hot. Take after residual food digestion, calm mind, avoid thought, effect will be miraculous. Since disease is in limbs with empty blood vessels, take in morning. If heat/dryness appears, it is yin fire steaming from lower origin; add Sheng Dihuang (0.2 qian), Huangbai (0.3 qian). If tenesmus or incomplete defecation with abdominal pressure, indicating blood deficiency/stasis, add Danggui Shen (0.3 qian). If heavy body with frequent urination, add Fuling (0.2 qian), Cangzhu (1 qian), Zexie (0.5 qian), Huangbai (0.3 qian, dispel dampness according to season, not for long-term use. Since Foot-Taiyin is diseased, connecting to heart, damp-heat causes vexation).
If stomach qi disharmony, add Banxia washed in soup (0.5 qian), Ginger (3 slices) to neutralize Banxia toxicity. Omit if coughing, as phlegm-jue headache requires Banxia. This is evil of Foot-Taiyin Spleen channel. If no above symptoms, take only:
Huangqi (1 qian), Renshen (2 qian), Gancao (0.5 qian), Jupi (0.2 qian), Chaihu (0.2 qian), Shengma (0.2 qian), Cangzhu (0.5 qian), Huangbai (wine-washed, 0.1 qian).
Chop like hemp/millet seeds. Decoct as before.
Modifications for Middle Qi Deficiency:
If poor appetite/no hunger, add fried Qu.
If epigastric fullness after eating, separately take Jupi Zhizhu Wan.
If string-like pulse, limb fullness, difficult defecation, epigastric fullness, add Gancao, Huanglian, Chaihu.
If qi rebels upward in abdomen, Chong Mai rebellion, add Huang...