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The meridian of Foot-Shaoyang (Lesser Yang of the Foot) originates at the outer canthus, ascends to the corner of the head, and descends behind the ear; the meridian of Foot-Jueyin (Terminal Yin of the Foot) connects with the eye system, emerges above the forehead, and meets the Du Meridian (Governing Vessel) at the vertex. Therefore, this disease arises. In severe cases, the pathogen transfers from one Zang organ to another and merges into the Liver. The following three sections do not explicitly state "severe cases enter the Zang organs," but although the text is incomplete, the meaning is the same.) Abdominal fullness and distension, obstruction in the chest and hypochondrium, cold extremities below and turbidity above, the fault lies in the Foot-Taiyin (Greater Yin of the Foot) and Foot-Yangming (Yang Brightness of the Foot). ("Obstruction in the chest" means blockage. [Missing character], above the hypochondrium. The Foot-Taiyin meridian enters the abdomen, belongs to the Spleen, and connects with the Stomach. Ascending through the diaphragm, the Foot-Yangming meridian belongs to the Stomach and connects with the Spleen; its branch runs along the interior of the abdomen. Since both the Spleen and Stomach govern the four limbs, the obstruction in the chest and hypochondrium, along with cold extremities below and turbid oppression in the chest and abdomen above, are all due to faults in the Foot-Taiyin and Foot-Yangming meridians.) Coughing and rebellious Qi, coldness in the chest, the fault lies in the Hand-Yangming (Yang Brightness of the Hand) and Hand-Taiyin (Greater Yin of the Hand). ("Rebellious Qi" refers to wheezing and urgency. The Lung resides in the chest and belongs to the Hand-Taiyin. Its meridian originates in the middle Jiao, ascends through the diaphragm, and belongs to the Lung. The Hand-Yangming is the Large Intestine, which is the exterior counterpart to the Taiyin; its meridian descends into the Clavicular Fossa and connects with the Lung. The Qi of these two meridians can both rebel in the chest, thus causing diseases of coughing and rebellious Qi.) Heart vexation and headache, the disease is in the middle of the diaphragm, the fault lies in the Hand-Ju-Yang (Great Yang of the Hand, i.e., Hand-Taiyang) and Hand-Shaoyin (Lesser Yin of the Hand). ("Middle of the diaphragm" refers to above the diaphragm. The meridian of the Hand-Taiyang Small Intestine enters the Clavicular Fossa and connects with the Heart; its branch runs along the neck up to the cheek, reaching the outer canthus. The meridian of the Hand-Shaoyin Heart originates in the heart, emerges to belong to the Heart System, and its branch ascends alongside the pharynx, connecting with the eye system. Therefore, when the disease is in the middle of the diaphragm causing heart vexation and headache, the fault lies in the Hand-Taiyang and Hand-Shaoyin meridians.

Humans have eight Xu (Deficient) points, (The Eight Xu refer to the Eight Valleys/Creeks. These are all gaps between sinews and bones, where Qi and Blood flow and pour.) to observe the five Zang organs. (By observing the Eight Xu, one can inspect diseases of the five Zang organs.) When the Lung and Heart have pathogens, their Qi remains in the two elbows; (The Lung and Heart reside above the diaphragm, and their meridians belong to the Hand; the Spleen, Liver, and Kidney are all below the diaphragm, and their meridians belong to the Foot. Therefore, when the Lung and Heart have pathogens, taking advantage of deficiency, their Qi must remain in the two elbows: in the Lung, it is near Chize (LU5); in the Heart, it is near Shaohai (HT3).) When the Liver has a pathogen, its Qi remains in the two axillae; (The Liver and Gallbladder are paired, and their meridians ascend from the foot, all running between the costal region and axilla. Therefore, when Liver pathogens take advantage of deficiency to gather, their Qi should remain in the two axillae, near points such as Qimen (LR14) and Yuanye (GB22).) When the Spleen has a pathogen, its Qi remains in the two thighs; (The Spleen and Stomach are paired, and their meridians all emerge from between Chongmen (SP12) and Qichong (ST30) on the shins and thighs. Therefore, if pathogenic Qi remains in the inguinal region, it is known as a disease of the Spleen meridian.) When the Kidney has a pathogen, its Qi remains in the two popliteal fossae. (The Kidney and Bladder are exterior-interior pairs, and their meridians all emerge between Yinggu (BL39) and Weizhong (BL40) behind the knees. Therefore, if pathogenic Qi remains in the two popliteal fossae, it is known as a disease of the Kidney meridian.) All these eight Xu points are chambers of joints, passages of True Qi, and遊 paths of blood collaterals. Pathogenic Qi and foul blood cannot naturally stay here; if they stay, they damage the meridians and collaterals, and the joints and mechanisms cannot flex or extend, leading to spasms and contracture. (Joints are important assemblies. Chamber is like a room. All these eight are pathways of Qi and Blood. When Healthy Qi resides there, it functions; when Pathogenic Qi resides there, it damages meridians, collaterals, and joints, making flexion and extension difficult. These eight Xu points can be used to observe the five Zang organs.)

Regarding the deficiency and excess of diseases: Excess occurs when pathogenic Qi is strong; deficiency occurs when Essence and Qi are depleted. (Pathogenic Qi has varying degrees of strength, so strong pathogens cause excess; Healthy Qi has varying degrees of strength, so depletion of Essence causes deficiency. "Depletion" means loss. These two sentences are the general outline for treating diseases. Their words seem obvious, but their meaning is subtle. They require detailed discrimination, yet are the most difficult to distinguish. "Excess" refers to pathogenic Qi, and excess should be drained; "deficiency" refers to Healthy Qi, and deficiency should be tonified. Whenever pathogenic and healthy Qi interact to cause disease, both pathogenic excess and healthy deficiency can be discussed. Those advocating draining say "when pathogens are strong, drain them"; those advocating tonifying say "when Essence is depleted, tonify them." Each holds one view, using rhetorical embellishments, turning profound teachings into great harm. One must not know that there are immutable principles: observing the urgency and presence/absence of deficiency and excess. If there is no deficiency, the urgency lies in the pathogen; if not removed quickly, changes will arise. If there is much deficiency, the urgency lies in Healthy Qi; if not nourished early, it will be useless when needed. If there is slight deficiency and slight excess, treat the excess, and it can be swept away. If there is severe deficiency and severe excess, fear the deficiency; only by consolidating the root can you make yourself invincible, and then pathogens will retreat. If there are two deficiencies and one excess, address the excess while opening a way; if there are two excesses and one deficiency, address the deficiency to prevent unpredictable outcomes. In short, mistakenly tonifying an excess condition will inevitably increase pathogens. Although it may still be salvageable, the disaster is small; mistakenly attacking a deficiency condition causes sudden loss of True Qi, which cannot be recovered, and the disaster is great. The urgency of deficiency and excess must not be ignored. What is meant by "presence and absence" is observing the presence or absence of pathogenic Qi. Wind, Cold, Summerheat, Dampness, Dryness, and Fire can all become pathogens. Whether pathogens are in the exterior or interior, Fu or Zang organs, they must have a residence. Find the root, and attack directly. This is what is meant by "presence"; presence means pathogenic excess. If there are no six-Qi pathogens, but the disease arises from the Three Yin, it is only emotional desires injuring the interior and labor/fatigue injuring the exterior. It is not truly a pathogen but resembles one; it is not truly excess but resembles excess. This is what is meant by "absence"; absence means the disease lies in Yuan Qi (Primal Qi). Failing to understand the meaning of deficiency/excess and presence/absence will lead to treating reversal as compliance and symptoms as the root, cutting people's long life and damaging virtue greatly. How can one not be cautious and extremely cautious!) The general principle of deficiency and excess of the five Zang organs: Qi deficiency is Lung deficiency; rebellious Qi results in cold feet. (The Lung governs Qi, so Qi deficiency is Lung deficiency. If Qi rebels and does not move, it cannot reach the four limbs. Yang deficiency below results in cold feet.) If it is not the corresponding season, the patient lives; if it is the corresponding season, the patient dies. (With Lung deficiency passing through autumn and winter, it is not a time of mutual destruction, so the patient lives. If it is spring, Metal and Wood are disharmonious, and the disease will be severe; if it is summer, Metal is weak and subjected to control, and the patient will die.) The other organs are similar. (Heart, Spleen, Liver, and Kidney each have periods of decline and dominance. Using the Lung as an example, others can be inferred.) Severe excess presents with high fever, where the disease Qi is hot and the pulse is full. When both meridians and collaterals are in excess, the Cun pulse is rapid/tight and the Chi pulse is slow/relaxed; all should be treated. (Meridians refer to the Twelve Meridians. Collaterals refer to the Fifteen Luo vessels. Here, using the Cun and Chi positions of the pulse gate, we generally observe the deficiency and excess of meridians and collaterals. The straight line of the Cun pulse is the Taiyin Meridian; Lieque (LU7) at the Chi position branches to the Yangming, representing the Taiyin Collateral. Speaking of upper and lower, Cun is Yang and Chi is Yin; speaking of interior and exterior, Collaterals are Yang and Meridians are Yin. Therefore, a rapid Cun pulse indicates pathogens residing in the Meridian; a relaxed Chi pulse indicates heat prevailing in the Collaterals. Thus, both meridians and collaterals are in excess, and all should be treated. "Treat" here means to drain. Slow and slippery indicates Heat in the Middle; slow often indicates heat, so a relaxed Chi pulse is considered excess.) Therefore, it is said, "Slippery indicates compliance, Choppy indicates reversal." (Slippery is a Yang pulse. Choppy is a Yin pulse. Excess accompanied by slippery indicates Yang Qi predominance, hence compliance; if Choppy is seen, Yin pathogens predominate and Yang Qi departs, hence reversal.) Deficiency and excess all begin according to their categories. Therefore, if the five Zang organs and bones/flesh are smooth and free, longevity can be achieved. (Living things are smooth and free; dead things are withered and choppy, all due to the existence or extinction of Yang Qi. The compliance or reversal of pulses is also like this.) When Collateral Qi is insufficient and Meridian Qi is excessive, the pulse gate is hot and the Chi position is cold. Autumn and Winter indicate reversal; Spring and Summer indicate compliance. Treat the governing disease. (Collateral vessels are on the exterior and govern Yang; Meridian vessels connect to the interior and govern Yin. Excessive Meridian Qi makes the pulse gate hot, indicating盛 (excess) of Yin-part pathogens; insufficient Collateral Qi makes the Chi position cold, indicating deficiency of Yang-part Qi. Yang deficiency fears times of Yin predominance, so Autumn and Winter are reversal, Spring and Summer are compliance. "Treat the governing disease" means treating what it governs. Wang Shi interpreted Cun and Chi as Yin and Yang, annotating "Yin part governs Collaterals, Yang part governs Meridians," which is opposite to this. Cun and Chi merely divide Yin and Yang positions, while Yin and Yang Qi are everywhere above and below the five Zang organs. For example, Cun has Lung Metal; is Yin not above? Chi has Mingmen; is Yang not below? Therefore, reversing Cun and Chi is acceptable, but reversing Meridians and Collaterals is not.) When Meridians are deficient and Collaterals are full, the Chi position is hot and full, and the pulse gate is cold and choppy. Death in Spring and Summer, Life in Autumn and Winter. (When Meridians are deficient and Collaterals are full, Yin Qi is insufficient and Yang pathogens are excessive. Yin deficiency fears times of Yang predominance, so death in Spring and Summer, life in Autumn and Winter.) When Pulse Qi is deficient above and Chi is deficient, this is called "Double Deficiency." (Both Yin and Yang are deficient, which is double deficiency.) What is meant by Qi deficiency is irregular speech. When Chi is deficient, walking is hesitant/weak. (Qi deficiency is Upper deficiency. Qi deficiency above causes irregular speech; e.g., speaking faintly and repeating throughout the day indicates Qi depletion. Chi deficiency is Lower deficiency, hence hesitant and weak walking.) When the pulse is deficient, it does not resemble Yin. (The five Zang organs are Yin; Zang deficiency leads to pulse deficiency. A deficient pulse is a sign of Yin depletion, hence "does not resemble Yin.") In such cases, Slippery indicates life, Choppy indicates death. Sudden upward invasion of Cold Qi, pulse is full and excess. Excess with Slippery indicates life; Excess with Reversal indicates death. (This refers to conditions belonging to Shanghan. When pathogens are strong, the pulse should be excess. Excess accompanied by Slippery obtains a Yang pulse, hence life; if a Yin pulse is seen, it is reversal, hence death. Weak and slippery pulse indicates Stomach Qi, named easy to treat. Pulse contrary to the four seasons is untreatable.) Pulse is full and excess, hands and feet are cold, head is hot. Life in Spring and Autumn, Death in Winter and Summer. (Full and excess pulse indicates excess pathogens. Cold hands and feet indicate Yin rebellion below. Hot head indicates Yang pathogens above. Yin and Yang have separated, thus this is a disease of Upper Excess and Lower Deficiency. Spring and Autumn are times of Yin-Yang peace, obtaining harmonious Qi, hence life; Winter and Summer are times of Yin-Yang bias. Yang is extreme in Summer, Yin is extreme in Winter, hence death.) Pulse is Floating and Choppy, Choppy with body heat indicates death. (Floating with body heat indicates盛 Yang pathogens; Choppy indicates Qi and Blood deficiency, Yin insufficiency. Exterior excess and Interior deficiency mean solitary Yang cannot be maintained, hence death.) When the form is completely full, the pulse is rapid, large, and firm, and the Chi position is Choppy and unresponsive. (This correctly describes the pattern of Yang Excess and Yin Deficiency. Yang is excessive, hence the form is completely full, and the pulse should be rapid, large, and firm; Yin is insufficient, hence the Chi position should be Choppy and unresponsive.) In such cases, Compliance indicates life, Reversal indicates death. By "Compliance" is meant warm hands and feet; by "Reversal" is meant cold hands and feet. (The four limbs are the root of all Yang. Therefore, when Yang pathogens are strong, warm hands and feet are compliant; if hands and feet are cold, it is because pathogens are strong on the exterior and Qi is deficient on the interior, Healthy Qi cannot overcome pathogens, hence reversal.) Liver disease Excess: pain under both hypochondria radiating to the lower abdomen, making one prone to anger. (This speaks of Excess as Pathogenic Excess; the following speaks of Deficiency as Healthy Deficiency. The five Zang organs follow this principle.) Deficiency: eyes see nothing, ears hear nothing, prone to fear, as if being hunted. Rebellious Qi causes headache, deafness and poor hearing, swollen cheeks. Heart disease Excess: pain in the chest, fullness and pain under the hypochondria, pain in the chest, back, and between the shoulder blades, pain in the inner arms. Deficiency: large chest and abdomen, pain drawing from under the hypochondria to the waist. Spleen disease Excess: heavy body, frequent hunger, muscle atrophy, inability to hold the feet, frequent convulsions while walking, pain under the feet. Deficiency: abdominal fullness, borborygmus, undigested stool diarrhea, food not transforming. Lung disease Excess: wheezing, coughing, rebellious Qi, shoulder and back pain, sweating, pain in the buttocks, groin, knees, thighs, calves, ankles, and feet. Deficiency: shortness of breath, inability to complete inhalation, deafness, dry throat. Kidney disease Excess: large abdomen, swollen shins, wheezing and coughing, heavy body, night sweats, aversion to wind. Deficiency: pain in the chest, large and lower abdominal pain, clear cold extremities, unhappiness. All should be tonified or drained according to the deficiency and excess of their meridians.

There are five types of Excess and five types of Insufficiency. These ten differ in their Qi. Shen (Spirit) Excess leads to incessant laughter; Shen Insufficiency leads to sorrow. (The Heart stores the Pulse, and the Pulse houses the Shen. Heart Qi deficiency leads to sorrow; Excess leads to incessant laughter.) When Blood and Qi have not merged, the five Zang organs are stable. Pathogens invade the形体 (form), causing chills starting from the hair follicles, not yet entering the meridians. This is named "Minor Shen Disease." (This is external pathogens affecting the Heart meridian. "Merge" means gathering to one side. When pathogens strike humans and do not dissipate for a long time, they either merge with Qi or merge with Blood, and the disease becomes severe. Now, since Blood and Qi have not merged and pathogens are not deep, the five Zang organs are stable. Only chills start from the hair follicles, not reaching the meridians. This is a superficial minor pathogen on the exterior of the pulse, a minor disease of Shen, hence named "Minor Shen Disease".) Qi Excess leads to wheezing, coughing, and rebellious Qi; Qi Insufficiency leads to difficult breathing and shortness of breath. (This is the deficiency and excess of the Lung Zang. Lung Qi deficiency leads to nasal congestion, difficulty breathing, and shortness of breath; Excess leads to wheezing and coughing, chest fullness requiring仰息 (breathing with mouth open/upward posture).) When Blood and Qi have not merged, the five Zang organs are stable, and the skin has minor diseases. This is named "Minor Leakage of White Qi." (This is exterior pathogens of Lung Metal. The Lung governs the skin and belongs to Metal. Minor pathogens invade it, hence named "Minor Leakage of White Qi".) Blood Excess leads to anger; Blood Insufficiency leads to fear. (This is the deficiency and excess of the Liver Zang. Liver Qi deficiency leads to fear; Excess leads to anger.) When Blood and Qi have not merged, the five Zang organs are stable, and Sun-collaterals overflow, leaving blood in the main meridians. (This is exterior pathogens of the Liver meridian. Pathogens are not in the Zang but in the meridian. Observing that the Sun-collateral pulses overflow indicates that stagnant blood exists within the major meridians.) Form Excess leads to abdominal distension and difficult urination/stool; Form Insufficiency leads to inability to use the four limbs. (This is the deficiency and excess of the Spleen Zang. Jing is a water name; Sou is urine. Spleen Dampness predominance causes Qi stagnation, hence abdominal distension and difficult urination/stool. The Spleen governs the four limbs, hence Insufficiency leads to inability to use the four limbs.) When Blood and Qi have not merged, the five Zang organs are stable, and muscles twitch. This is named "Minor Wind." (This is exterior pathogens of the Spleen meridian. The Spleen governs muscles. When minor pathogens are not deep, only twitching occurs in the muscles, as if insects are moving slightly. Spleen Earth fears Wind Wood; Wind moves, hence named "Minor Wind".) Zhi (Will) Excess leads to abdominal distension and undigested stool diarrhea; Zhi Insufficiency leads to cold extremities/reversal. This is the deficiency and excess of the Kidney Zang. The Kidney stores Zhi and is the essence of Water. Water transforms into Cold. Therefore, Kidney pathogen Excess means Cold Qi is in the abdomen, causing abdominal distension and undigested stool diarrhea; Kidney Qi Insufficiency means Yin deficiency and Yang predominance, causing Reversal and upward rushing. The Kidney stores Jing, and Jing houses Zhi. Kidney Qi deficiency leads to Reversal; Excess leads to distension. Reversal means Yang Qi merges above and Yin Qi merges below. Yang merging above means Fire shines alone; Yin merging below means cold feet, and cold feet lead to distension.) When Blood and Qi have not merged, the five Zang organs are stable, and bone joints move. All should be tonified or drained according to their Excess or Insufficiency. (This is minor pathogens of the Kidney meridian. The Kidney governs bones. Pathogens have not entered the Zang but press on the bones, hence only trembling occurs between the bone joints.) When Blood and Qi merge, Yin and Yang incline against each other. Qi is chaotic in the Wei (Defensive) level; Blood rebels in the Jing (Main) meridians. Blood and Qi dwell apart, resulting in one Excess and one Deficiency. ("Merge" means predominance. "Incline" means collapse. Qi is Yang, hence chaotic in Wei; Blood is Yin, hence rebelling in Jing. Yin and Yang disharmony causes Blood and Qi to dwell apart, so the Excess part is excessively Excess, and the Deficient part is excessively Deficient, leaning against each other.) Blood merging in Yin, Qi merging in Yang, thus causing惊狂 (Fright and Mania). (Blood merging in Yin is Heavy Yin; Qi merging in Yang is Heavy Yang. Heavy Yin leads to Dian (Depression/Epilepsy), Heavy Yang leads to Kuang (Mania), hence Fright and Mania.) Blood merging in Yang, Qi merging in Yin, thus causing Jiong Zhong (Heat in the Center). (Blood merging in Yang means Yin is on the exterior; Qi merging in Yin means Yang is in the interior, hence "Jiong Zhong". Jiong means Heat.) Blood merging above, Qi merging below, causing heart vexation and resentment, prone to anger. (Above is above the diaphragm. Below is below the diaphragm. Blood merging above means Yin pathogens suppress the Heart, hence vexation and resentment; Qi merging below means Fire stirs in the Liver, hence prone to anger. "Wan" is pronounced Wu Guan Qie.) Blood merging below, Qi merging above, causing confusion and forgetfulness. (Blood merging below means Yin Qi does not ascend; Qi merging above means Yang Qi does not descend. Yin and Yang separate, hence Shen is confused and prone to forgetfulness. Blood merging in Yin, Qi merging in Yang, thus Blood and Qi dwell apart. Which is Excess? Which is Deficiency? Blood merging in Yin means there is no Yin in Yang; Qi merging in Yang means there is no Yang in Yin. Yin and Yang disharmony, hence Blood and Qi dwell apart.) Blood and Qi prefer Warmth and dislike Cold. Cold causes stagnation and inability to flow; Warmth causes dissipation and removal. (Blood and Qi, though different in form, are the same in nature, hence both prefer Warmth and dislike Cold. Cold causes coagulation, stagnation, and retention; Warmth causes dissipation and circulation. Pathogens merging with either Blood or Qi stem from this.) Therefore, where Qi merges, Blood is deficient; where Blood merges, Qi is deficient. (Qi merging in Yang means no Blood, hence Blood deficiency; Blood merging in Yin means no Qi, hence Qi deficiency.) However, what humans possess is only Blood and Qi. If one says Blood merging is deficiency and Qi merging is deficiency, is there no Excess? No. That which is present is Excess; that which is absent is Deficiency. (Having Blood but no Qi is Blood Excess and Qi Deficiency; Having Qi but no Blood is Qi Excess and Blood Deficiency.) Qi merging means no Blood; Blood merging means no Qi. Blood and Qi lose each other, hence becoming Deficient. (Losing each other means not assisting each other; losing leads to Deficiency.) Collaterals and Sun-collaterals all transport to the Main Meridians. When Blood and Qi merge, it becomes Excess. When Blood and Qi merge and rush upwards, it becomes Da Jue (Great Reversal). Jue leads to sudden death. If Qi returns, the patient lives; if it does not return, the patient dies. (The previous text spoke of Blood merging with Blood and Qi merging with Qi, resulting in partial deficiency and partial excess. This text speaks of Blood and Qi merging. Merged parts are Excess; unmixed parts are Deficient. Blood and Qi merging and rushing upwards leads to Upper Excess and Lower Deficiency. Lower Deficiency leads to Yin collapse. Yin collapse means the root is severed, leading to Lower Jue and Upper Exhaustion, which is Great Jue, hence sudden death. If Qi returns after cessation, Yin will gradually return, hence recovery is possible; if it goes and does not return, life is impossible.) Where does Excess come from? Where does Deficiency go? Yin and Yang both have Shu and Hui points. Yang pours into Yin; Yin fills the exterior. Yin and Yang are balanced, filling the form. The nine palpations are uniform, named "Ping Ren" (Healthy Person). (Shu and Hui refer to Shu and Hui acupoints. Yang pouring into Yin means returning from Meridians to Zang organs; Yin filling the exterior means going from Zang organs to Meridians. If the nine palpations are uniform, Yin and Yang are harmonious, Blood and Qi are even, and the body is safe and disease-free, hence "Healthy Person".) And pathogens arise, either from Yin or from Yang: Those arising from Yang result from Wind, Rain, Cold, and Summerheat; those arising from Yin result from Diet, Dwelling, Yin-Yang (sexual activity), and Joy/Anger. (Wind, Rain, Cold, Summerheat arise externally, hence External Contraction, named "Yang"; Diet, Dwelling, Yin-Yang, Joy/Anger arise internally, hence Internal Injury, named "Yin". External contractions mostly have Excess; internal injuries mostly have Insufficiency. This is why Excess comes and Deficiency goes.) Wind and Rain injuring humans first lodge in the skin, transmit to Sun-collaterals. When Sun-collaterals are full, they transmit to Luo-collaterals. When Luo-collaterals are full, they transport to Major Meridians. Blood, Qi, and pathogens all lodge between the Fen-Cou (interspaces). The pulse is firm and large, hence named Excess. Excess is firm and full on the exterior, cannot be pressed, and pressing causes pain. (This is how External Contractions generate Excess. Excess pain must be firm and full, with lingering pathogens inside. Pressing causes Excess pathogens to resist, hence pain worsens; Deficiency pain must be soft, empty inside. Pressing brings Qi and warmth, hence pain stops. Therefore, pressable pain is Deficiency, resisting pain is...)