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This further elucidates the previously mentioned condition where cold qi suddenly ascends, causing both form and qi to reverse and become full. The pulse must be rapid, large, and firm, while the skin of the forearm (Chifu) is rough and dry, inconsistent with the pulse. Why? The rapidity and largeness of this pulse are not originally due to an excess of Qi and Blood; rather, because Essence and Qi have been depleted internally, the pulse lacks a soft and harmonious appearance. With the depletion of Essence and Qi, the Chifu becomes rough and dry without moisture. In such cases, if the hands and feet are warm, it indicates that the Middle Jiao still has Yang Qi distributing to the four limbs, representing a favorable prognosis for survival; if the hands and feet are cold, it indicates the failure and reversal of Yang Qi, leading to death.

Five Excesses and Five Deficiencies
The *Suwen: Yuji Zhenzang Lun* states: The Yellow Emperor said, "I have heard that life and death can be determined by Excess and Deficiency; I wish to hear the details." Qibo replied, "Death occurs with Five Excesses and death occurs with Five Deficiencies. A surging pulse, hot skin, abdominal distension, obstruction of urination and defecation, and dizziness with oppression constitute the Five Excesses; a fine pulse, cold skin, shortness of breath, incontinence of urine and stool, and inability to ingest food constitute the Five Deficiencies." The Yellow Emperor asked, "Under what circumstances might there be survival?" Qibo answered, "If gruel and porridge enter the Stomach and diarrhea stops, the deficient patient will live; if the body sweats and bowel movements become unobstructed, the excess patient will live. These are the signs of survival."

This passage generally discusses the syndromes of Excess and Deficiency arising from external contraction and internal injury. A surging pulse, hot skin, and abdominal distension indicate pathogenic factors prevailing in the exterior and interior. Obstruction of urination and defecation means pathogens have no outlet, and dizziness with restlessness and oppression indicates the exhaustion of Yuan Qi, leading to death; this is named Five Excesses. A fine pulse, cold skin, and shortness of breath indicate the depletion of Jing-Qi in both the exterior and interior. Incontinence of urine and stool combined with inability to eat leads to the exhaustion of the root Yuan Qi, resulting in death; this is named Five Deficiencies. For excess conditions, sweating and unobstructed urination/defecation allow the resolution of exterior-interior pathogens and the gradual recovery of healthy Qi. For deficiency conditions, the cessation of diarrhea and the intake of gruel/porridge allow the gradual continuation of generating Qi. Thus, both can survive.

Qi Deficiency of the Triple Burner
The *Lingshu: Kouwen Pian* states: When Qi at the Upper Jiao is insufficient, the brain feels empty and unsatisfied, the ears suffer from tinnitus, the head feels heavy and difficult to hold upright, and the eyes experience vertigo. When Qi at the Middle Jiao is insufficient, urination and defecation undergo abnormal changes, and the intestines suffer from borborygmus. When Qi at the Lower Jiao is insufficient, it leads to flaccidity and cold extremities, along with mental restlessness and oppression (*Xin Xian*).

"Upper Jiao is like mist" refers to clear Yang Qi swirling and rotating, ascending like clouds to nourish the brain and head. Therefore, when Qi is insufficient, the brain feels empty, and symptoms such as tinnitus, head heaviness, and vertigo occur because clear Yang fails to extend, allowing turbid Yin to ascend improperly. When turbid Yin ascends improperly, the head becomes heavy and tilts; when Yang is depressed below, tinnitus and vertigo arise. "Middle Jiao is like a fermenting vat" refers to the Spleen and Stomach brewing food and drink, transporting and transforming fluids via the Middle Jiao. Thus, when Qi is insufficient, transport and transformation lose their measure, causing abnormalities in urination and defecation. Weak intestinal conduction leads to stagnation and borborygmus. "Lower Jiao is like a ditch" refers to waste and fluids exiting through it, relying on the Yuan Yang of the Kidney for steaming and transformation. Therefore, when Lower Jiao Yuan Qi is deficient, one may experience leg flaccidity and weakness or cold extremities. If waste stagnates and cannot exit, it reverses upward, causing mental restlessness and oppression (*Xin Xian*), where "Xian" denotes a sensation of fullness and oppression.