（《素问·诊要经终论》《四时刺逆从论》）
黄帝问曰∶诊要何如？
（《素问·诊要经终篇》）岐伯对曰∶正月二月，天气始方，地气始发，人气在肝。（方，谓气方升也，岁方首也，人事方
与也。发，万物发生也。肝属木，气应春，故人气在肝。）三月四月，天气正方，地气定发，人气在脾。（正方，谓时气
正升，岁事正新也。定发，专于发生也。此时天地之气，自下而升，土居升降之中而脾应之，故人气在脾。）五月六月，
天气盛，地气高，人气在头。（盛夏阳升之极，故人气应之在头。）七月八月，阴气始杀，人气在肺。（气升则物生，气降
则物死。此时天气渐降，清秋当令，阴气始杀，万物人气自头而降，肺金应之，故人气在肺。）九月十月，阴气始冰，地
气始闭，人气在心。（自秋入冬，阴气始凝，心气始闭，阳气在中，故人气在心。）十一月十二月，冰复，地气合，人气
在肾。（复言其重，寒凝之甚也。斯时阳气深伏于下，故人气在肾。）
故春刺散俞，及与分理，血出而止，甚者传气，间者环也。（按∶《四时刺逆从论》曰∶春气在经脉。此散俞者，即
诸经之散穴也，义如下文。分理，肌肉分理也。春宜疏达，故欲血出而止。传，布散也。环，周也。病甚者针宜久留，
故必待其传气。病稍间者，但候其气行一周于身，约二刻许，可止针也。）夏刺络俞，见血而止，尽气闭环，痛病必下。
（络俞，谓诸经浮络之穴，以夏气在孙络也。夏宜宣泄，故必见血而止。尽气，尽去其邪血邪气也。闭环，谓去针闭穴，
须气行一周之顷也。凡有痛病，必退下矣。）秋刺皮肤循理，上下同法，神变而止。（循理，循分肉之理也。上言手经，
下言足经，刺皆同法。秋气在皮肤，邪犹未深，故但察其神气变易，异于未刺之前，可止针矣。）冬刺俞窍于分理，甚者
直下，间在散下。（孔穴之深者曰窍。冬气在骨髓中，故当深取俞窍于分理间也。甚者直下，察邪所在而直取其深处也。
间者散下，或左右上下，散布其针而稍宜缓也。）春夏秋冬，各有所刺，法其所在。（上文十二月言气之升降，此四季言
气之深浅，故各有所刺，法其所在。）
春刺夏分，脉乱气微，入淫骨髓，病不能愈，令人不嗜食，又且少气；（此下言四时之误刺也。春刺孙络，是春刺夏
分也。夏应心，心主脉，故脉乱气微。肾水受气于夏，肾主骨，故入淫于骨髓。心火微则胃土失其所养，故不嗜食。不
嗜食，故少气也。）春刺秋分，筋挛逆气，环为咳嗽，病不愈，令人时惊，又且哭；（春刺皮肤，是刺秋分也。肝木受气
于秋，肝主筋，故筋挛也。逆气者，肝气上逆也。环，周也。秋应肺，故气周及肺，为咳嗽也。肝主惊，故时惊。肺主
悲忧，故又且哭。）春刺冬分，邪气着藏，令人胀病不愈，又且欲言语。（春刺骨髓，是春刺冬分也。冬应肾，肾伤则邪
气内侵而着藏，故令人胀。火受气于冬，心属火而主言，故且欲言语也。）夏刺春分，病不愈，令人解惰；（夏刺经俞，
是夏刺春分也。肝应春，其主筋，伤其肝气，故令人筋力解惰。）夏刺秋分，病不愈，令人心中欲无言，惕惕如人将捕之；
（夏刺秋分，伤其肺也，肺气不足，故令人欲无言。惕惕如人将捕之者，恐也，恐为肾之志，肺金受伤，病及其子，故
亦虚而恐也。）夏刺冬分，病不愈，令人少气，时欲怒。（夏伤其肾，则精虚不能化气，故令人少气。水亏则木失所养而
肝气强急，故时欲怒也。）秋刺春分，病不已，令人惕然欲有所为，起而忘之；（秋刺春分，伤肝气也。心失其母则神有
不足，故令人惕然，且善忘也。）秋刺夏分，病不已，令人益嗜卧，又且善寐；（秋刺夏分，则心气少而脾气孤。脾虚则
倦而嗜卧，心虚则神不安而善梦。）秋刺冬分，病不已，令人洒洒时寒。（秋刺冬分，误伤肾阴，则精气耗散，故令人洒
洒寒栗也。）冬刺春分，病不已，令人欲卧不能眠，眠而有见；（肝藏魂，肝气受伤则神魂散乱，故令人欲卧不能眠，或
眠而有见，谓怪异等物也。）冬刺夏分，病不愈，气上，发为诸痹；（心应夏，其主血脉，脉伤则邪气乘虚客之，故发为
诸痹。）冬刺秋分，病不已，令人善渴。（刺伤肺金，必亏肾水，故令人善渴。）
凡刺胸腹者，必避五脏。（此下言刺害也。五脏伤则五神去，神去则死矣，故凡刺胸腹者必避五脏。）中心者环死，
中脾者五日死，中肾者七日死，中肺者五日死。（环，周一日也。此节止言四脏，独不及肝，必脱简耳。按∶刺禁论所言
五脏死期，尤为详悉，但与本节稍有不同，见本类后六十四。）中膈者皆为伤中，其病虽愈，不过一岁必死。（膈膜，前
齐鸠尾，后齐十一椎。心肺居于膈上，肝肾居于膈下，脾居在下，近于膈间。膈者，所以隔清浊、分上下而限五脏也。
五脏之气，分主四季，若伤其膈，则脏气阴阳相乱，是为伤中，故不出一年死。）刺避五脏者，知逆从也。所谓从者，膈
与脾肾之处，不知者反之。（膈连胸胁四周，脾居于中，肾着于脊，知而避之者为从，不知者为逆，是谓反也。）
刺胸腹者，必以布HT 着之，乃从单布上刺，（此下言刺法也。胸腹虚浅近脏，故必以布HT 着之而后刺，所以护
心腹，慎风寒也。HT 音皎，布也。着音灼，被服也。）刺之不愈复刺。（以平为期也。）刺针必肃，（敬谨毋忽也。）刺肿
摇针，（摇大其窍，泻之速也。）经刺勿摇，（恐泄其气也。）此刺之道也。
是故春气在经脉，夏气在孙络，长夏气在肌肉，秋气在皮肤，冬气在骨髓中
（《素问·四时刺逆从论》）。）帝曰∶余愿闻其故。岐伯曰∶春者，天气始开，地气始泄，冻解冰释，水行经通，故
人气在脉。（春时天地气动，水泉流行，故人气亦在经脉。）夏者经满气溢，入孙络受血，皮肤充实。（夏时气盛，故溢入
孙络而充皮肤，所以人气在孙络。）长夏者，经络皆盛，内溢肌中。（六月建未，是为长夏土胜之时，经络皆盛，所以人
气在肌肉中。）秋者，天气始收，腠理闭塞，皮肤引急。（秋气始收，腠理始闭，所以人气在皮肤。）冬者盖藏，血气在中，
内着骨髓，通于五脏。（冬气伏藏，内通五脏，所以人气在骨髓中。）是故邪气者，常随四时之气血而入客也，至其变化，
不可为度，然必从其经气，辟除其邪，除其邪则乱气不生。（时气迁变，病必随之。察病气，从经气，以辟除其邪，邪去
气调，故不致生乱矣。）
帝曰∶逆四时而生乱气奈何？（此下言刺逆四时也。）岐伯曰∶春刺络脉，血气外溢，令人少气；（此春刺夏分也。
夏气未至，先夺于外，故令血气外溢而少气血。）春刺肌肉，血气环逆，令人上气；（此春刺长夏也。春时木王，土气本
虚，复刺肌肉，重伤脾元，血气环周皆逆，不相营运，故为喘满上气。按∶本篇与前诊要经终论者义同文异，但彼分四
时，此分五时，故有刺肌肉之谓。然本篇春夏冬三时，皆关刺秋分皮肤等义。意者以长夏近秋，故取肌肉，即所以刺秋
分也。后仿此。）春刺筋骨，血气内着，令人腹胀。（此春刺冬分也。春气发越，而复深取筋骨以伤其阴，故血气内着，
令人腹胀。）夏刺经脉，血气乃竭，令人解 ；（误刺经脉，所以血气内竭。解 者，形迹困倦，莫可名之之谓。 音迹。）
夏刺肌肉，血气内却，令人善恐；（长夏未至而先夺其气，所以血气却弱，故令人善恐。）夏刺筋骨，血气上逆，令人善
怒。（夏刺冬分，则阴虚于内，阳胜于外，故令人血气逆而善怒。）秋刺经脉，血气上逆，令人善忘；（心主脉，误刺经脉
则心气虚，故令人善忘。）秋刺络脉，气不卫外，令人卧不欲动；（秋时收敛，气已去络而复刺之，则气虚不能卫外。气
属阳，阳虚故卧不欲动。）秋刺筋骨，血气内散，令人寒栗。（秋气未至筋骨而深刺之，则血气内散而中气虚，所以寒栗。）
冬刺经脉，血气皆脱，令人目不明；（诸脉者皆属于目，冬刺经脉，预夺之也，故令人血气脱而目不明。）冬刺络脉，内
气外泄，留为大痹；（当阳气伏藏之时，而刺其阳分，则阳气外泄。阳虚阴胜，故留为大痹。）冬刺肌肉，阳气竭绝，令
人善忘。（冬时刺其夏之气，故阳气竭绝。阳气者精则养神，阳虚则神衰，所以善忘。）凡此四时刺者，大逆之病，不可
不从也，反之则生乱气，相淫病焉。（刺失四时，是为大逆，此时气之不可不从也。若反而为之，必生乱气，故相淫为病。）
凡刺不知四时之经，病之所生，以从为逆，正气内乱，与精相搏，必审九候，正气不乱，精气不转。（薄，邪正相迫也。
九候各有其部，必审明病之所在，从而刺之，庶正气不乱，精气不致转变矣。）
帝曰∶善。刺五脏，中心一日死，其动为噫；中肝五日死，其动为语；中肺三日死，其动为咳；中肾六日死，其动
为嚏欠；中脾十日死，其动为吞。（此节义与刺禁论同，但多一欠字，详见本类后六十四。）刺伤人五脏必死，其动则根据
其脏之所变候，知其死也。（动，变动也。见其变动之候，则识其伤在某脏，故可知其死期。）
(Su Wen · Zhen Yao Jing Zhong Lun, Si Shi Ci Ni Cong Lun)
The Yellow Emperor asked: What are the essentials of diagnosis and treatment?
Qibo replied: In the first and second months, the Qi of Heaven begins to rise, the Qi of Earth begins to emerge, and the human Qi is in the Liver. ("Fang" refers to the Qi just beginning to ascend, the year just starting, and human activities just commencing. "Fa" refers to the generation of all things. The Liver belongs to Wood and corresponds to Spring, so the human Qi is in the Liver.) In the third and fourth months, the Qi of Heaven is fully ascending, the Qi of Earth is firmly emerging, and the human Qi is in the Spleen. ("Zheng Fang" means the seasonal Qi is properly ascending, and the affairs of the year are newly renewed. "Ding Fa" refers specifically to generation. At this time, the Qi of Heaven and Earth ascends from below; Earth resides in the middle of ascent and descent, and the Spleen corresponds to it, so the human Qi is in the Spleen.) In the fifth and sixth months, the Qi of Heaven is abundant, the Qi of Earth is high, and the human Qi is in the Head. (In midsummer, Yang Qi reaches its peak, so the human Qi responds by being in the Head.) In the seventh and eighth months, Yin Qi begins to kill (wither), and the human Qi is in the Lungs. (When Qi ascends, things grow; when Qi descends, things die. At this time, the Qi of Heaven gradually descends, Clear Autumn takes command, Yin Qi begins to wither, and the human Qi of all things descends from the head. Metal of the Lung corresponds to this, so the human Qi is in the Lungs.) In the ninth and tenth months, Yin Qi begins to freeze, the Qi of Earth begins to close, and the human Qi is in the Heart. (From Autumn to Winter, Yin Qi begins to condense, Heart Qi begins to close, and Yang Qi remains in the center, so the human Qi is in the Heart.) In the eleventh and twelfth months, ice thickens, the Qi of Earth closes, and the human Qi is in the Kidneys. ("Fu" implies repetition/heaviness, indicating severe cold coagulation. At this time, Yang Qi is deeply hidden below, so the human Qi is in the Kidneys.)
Therefore, in Spring, one punctures scattered acupoints (San Shu) and muscle fissures (Fen Li); stop when blood appears. For severe cases, wait for Qi transmission; for mild cases, wait for one cycle of Qi circulation. (Note: *Si Shi Ci Ni Cong Lun* states: "Spring Qi is in the Meridians." Here, "San Shu" refers to the scattered acupoints of various meridians, as explained below. "Fen Li" refers to muscle fissures. Spring favors dispersion and unblocking, so stopping upon bleeding is desired. "Chuan" means dissemination. "Huan" means circle. For severe illness, the needle should remain longer, waiting for Qi transmission. For milder illness, waiting for Qi to circulate once around the body, approximately two *ke* (approx. 30 mins), is sufficient before withdrawing the needle.) In Summer, one punctures collateral acupoints (Luo Shu); stop when blood appears. Remove evil Qi and blood completely, and close the acupoint after withdrawing the needle; pain will definitely subside. ("Luo Shu" refers to acupoints on floating collaterals of various meridians, as Summer Qi is in Sun Luo (branchial collaterals). Summer favors discharge, so stopping upon bleeding is necessary. "Jin Qi" means exhausting evil Qi and blood. "Bi Huan" means closing the acupoint after withdrawing the needle, requiring the time for one Qi cycle. Any pain disease will surely recede.) In Autumn, one punctures the skin following the grain/fissures; the method is the same for upper and lower parts. Stop when the Shen (Spirit) changes. ("Xun Li" means following muscle fissures. The text mentions Hand Meridians above and Foot Meridians below; the puncture method is the same. Autumn Qi is in the skin, and pathogens are not deep, so one only observes if the Shen Qi has changed compared to before puncturing, then stops.) In Winter, one punctures deep acupoints (Shu Qiao) within the fissures. For severe cases, insert straight down; for mild cases, scatter the insertion. ("Qiao" refers to deep acupoints. Winter Qi is in the Marrow, so one should deeply puncture Shu Qiao between the fissures. "Shen Zhe Zhi Xia" means observing where the pathogen is and directly targeting the deep area. "Jian Zhe San Xia" means scattering needles left, right, up, or down, slightly slowing the process.) Spring, Summer, Autumn, and Winter each have their specific puncture methods, following the location of the Qi. (The previous section discussed the rising and falling of Qi over twelve months; this section discusses the depth of Qi across four seasons, hence each has specific puncture methods following the Qi's location.)
Puncturing the Summer division during Spring causes chaotic pulses and weak Qi, pathogens invade the marrow, the disease cannot be cured, leading to loss of appetite and shortness of breath. (This section discusses errors in puncturing according to the four seasons. Puncturing Sun Luo in Spring is puncturing the Summer division. Summer corresponds to the Heart, which governs pulses, so pulses become chaotic and Qi weak. Kidney Water receives Qi from Summer; Kidneys govern bones, so pathogens invade the marrow. Weak Heart Fire causes Stomach Earth to lose nourishment, leading to loss of appetite. Loss of appetite leads to shortness of breath.) Puncturing the Autumn division during Spring causes tendon spasms and rebellious Qi, circling to cause coughing, the disease cannot be cured, leading to frequent fright and crying. (Puncturing the skin in Spring is puncturing the Autumn division. Liver Wood receives Qi from Autumn; Liver governs tendons, so tendons spasm. Rebellious Qi refers to Liver Qi rebelling upward. "Huan" means circle. Autumn corresponds to the Lungs, so Qi circles to the Lungs, causing coughing. Liver governs fright, so there is frequent fright. Lungs govern sorrow/grief, so there is crying.) Puncturing the Winter division during Spring causes pathogens to adhere to the Zang organs, leading to abdominal distension that cannot be cured, and a desire to speak. (Puncturing the marrow in Spring is puncturing the Winter division. Winter corresponds to the Kidneys; if Kidneys are injured, pathogens invade internally and adhere to the Zang, causing distension. Fire receives Qi from Winter; the Heart belongs to Fire and governs speech, so there is a desire to speak.) Puncturing the Spring division during Summer causes the disease not to heal, leading to lethargy and weakness. (Puncturing Jing Shu in Summer is puncturing the Spring division. Liver corresponds to Spring and governs tendons; injuring Liver Qi causes tendons and muscles to become weak and lethargic.) Puncturing the Autumn division during Summer causes the disease not to heal, leading to a reluctance to speak and a feeling of terror as if someone were about to capture them. (Puncturing the Autumn division in Summer injures the Lungs; insufficient Lung Qi leads to a reluctance to speak. Feeling terrified as if captured is fear; fear is the emotion of the Kidneys. When Lung Metal is injured, the disease affects its child organ [Kidney], causing deficiency and fear.) Puncturing the Winter division during Summer causes the disease not to heal, leading to shortness of breath and occasional anger. (Injuring the Kidneys in Summer causes essence deficiency unable to transform Qi, leading to shortness of breath. Water deficiency causes Wood to lose nourishment, making Liver Qi strong and irritable, leading to occasional anger.) Puncturing the Spring division during Autumn causes the disease not to heal, leading to a startled feeling, wanting to do something, but forgetting it upon standing. (Puncturing the Spring division in Autumn injures Liver Qi. If the Heart loses its mother [Wood generates Fire], Shen becomes deficient, causing startlement and forgetfulness.) Puncturing the Summer division during Autumn causes the disease not to heal, leading to increased drowsiness and propensity to sleep. (Puncturing the Summer division in Autumn reduces Heart Qi and isolates Spleen Qi. Spleen deficiency causes fatigue and drowsiness; Heart deficiency causes unsettled Shen and vivid dreams.) Puncturing the Winter division during Autumn causes the disease not to heal, leading to shivering and chills. (Puncturing the Winter division in Autumn mistakenly injures Kidney Yin, dissipating essence and Qi, causing shivering and chills.) Puncturing the Spring division during Winter causes the disease not to heal, leading to an inability to sleep despite wanting to lie down, or seeing hallucinations while sleeping. (Liver stores Hun; if Liver Qi is injured, Hun and Shen scatter, causing an inability to sleep or seeing strange objects while sleeping.) Puncturing the Summer division during Winter causes the disease not to heal, leading to ascending Qi and development of various Bi syndromes. (Heart corresponds to Summer and governs blood vessels; if vessels are injured, pathogens enter via deficiency, causing various Bi syndromes.) Puncturing the Autumn division during Winter causes the disease not to heal, leading to excessive thirst. (Injuring Lung Metal inevitably depletes Kidney Water, causing excessive thirst.)
Whenever puncturing the chest and abdomen, one must avoid the Five Zang Organs. (This section discusses puncture injuries. If the Five Zang are injured, the Five Shen depart; if Shen departs, death occurs. Therefore, when puncturing the chest and abdomen, one must avoid the Five Zang.) Puncturing the Heart leads to death within one day; puncturing the Spleen leads to death within five days; puncturing the Kidneys leads to death within seven days; puncturing the Lungs leads to death within five days. ("Huan" means one day. This section mentions only four Zang, omitting the Liver, likely due to lost text. Note: *Ci Jin Lun* details the death periods for all five Zang more thoroughly, though slightly different from this section, see item 64 in this category.) Puncturing the Diaphragm constitutes injury to the Middle Jiao; even if the disease seems to heal, death will occur within a year. (The diaphragm aligns anteriorly with Jiutail and posteriorly with the 11th thoracic vertebra. Heart and Lungs reside above the diaphragm; Liver and Kidneys reside below; Spleen resides below, near the diaphragm. The diaphragm separates clear from turbid, divides upper from lower, and limits the Five Zang. The Qi of the Five Zang governs the four seasons respectively. If the diaphragm is injured, Zang Qi and Yin-Yang become chaotic, constituting injury to the Middle, hence death within a year.) Avoiding the Five Zang in puncture demonstrates knowledge of following and opposing. What is called "following" is knowing the locations of the Diaphragm, Spleen, and Kidneys; those who do not know act oppositely. (The diaphragm connects around the chest and hypochondrium; the Spleen resides in the center; the Kidneys attach to the spine. Knowing to avoid them is "following"; not knowing is "opposing," which is considered reversal.)
When puncturing the chest and abdomen, one must cover the area with cloth, then puncture through the single layer of cloth. (This section discusses puncture technique. The chest and abdomen are hollow, shallow, and close to the Zang, so covering with cloth before puncturing protects the Heart and Abdomen and guards against Wind-Cold. "HT" sounds like "jiao," meaning cloth. "Zhuo" sounds like "zhuo," meaning clothing/covering.) If puncturing does not cure, repeat. (Aim for balance.) Be solemn/respectful with the needle. (Be diligent and not negligent.) When puncturing swelling, shake the needle. (Widen the aperture to rapidly drain.) When puncturing meridians, do not shake the needle. (To prevent leaking Qi.) This is the way of puncture.
Therefore, Spring Qi is in the Meridians, Summer Qi is in the Sun Luo (branchial collaterals), Late Summer Qi is in the Muscles, Autumn Qi is in the Skin, and Winter Qi is in the Bone Marrow (*Su Wen · Si Shi Ci Ni Cong Lun*). The Emperor said: I wish to hear the reason. Qibo said: In Spring, Heaven's Qi opens, Earth's Qi exudes, ice melts, water flows, and meridians connect, so Human Qi is in the vessels. (In Spring, Heaven and Earth Qi move, springs flow, so Human Qi is also in the meridians.) In Summer, meridians are full and Qi overflows, entering Sun Luo to receive blood, filling the skin. (In Summer, Qi is abundant, overflowing into Sun Luo and filling the skin, so Human Qi is in the Sun Luo.) In Late Summer, both meridians and collaterals are abundant, overflowing internally into the muscles. (The sixth month is Wei, representing Late Summer when Earth prevails; meridians and collaterals are abundant, so Human Qi is in the muscles.) In Autumn, Heaven's Qi begins to gather, pores close, and skin tightens. (Autumn Qi gathers, pores close, so Human Qi is in the skin.) In Winter, storage prevails, Blood and Qi remain inside, adhering to the marrow and connecting to the Five Zang. (Winter Qi hides, connecting internally to the Five Zang, so Human Qi is in the bone marrow.) Therefore, pathogenic Qi often enters and lodges following the Blood and Qi of the four seasons. Its changes are immeasurable, but one must follow the Jing Qi to dispel the pathogen. Once the pathogen is removed, chaotic Qi will not arise. (Seasonal Qi changes, and diseases follow. Observing disease Qi and following Jing Qi to dispel pathogens ensures Qi regulation and prevents chaos.)
The Emperor said: How does opposing the four seasons generate chaotic Qi? (This section discusses opposing the four seasons in puncture.) Qibo said: Puncturing collaterals in Spring causes Blood and Qi to overflow externally, leading to shortness of breath. (This is puncturing the Summer division in Spring. Summer Qi has not arrived, but is seized externally, causing Blood and Qi to overflow and become deficient.) Puncturing muscles in Spring causes Blood and Qi to reverse in a cycle, leading to rebellious Qi (asthma/fullness). (This is puncturing Late Summer in Spring. In Spring, Wood prevails, and Earth Qi is inherently weak. Puncturing muscles further injures Spleen Yuan. Blood and Qi reverse cyclically, failing to circulate, causing asthma and fullness. Note: This chapter and *Zhen Yao Jing Zhong Lun* have similar meanings but different texts; the latter divides four seasons, this one divides five, hence "puncturing muscles." However, this chapter's Spring, Summer, and Winter sections relate to puncturing Autumn skin etc. Perhaps because Late Summer is close to Autumn, taking muscles is equivalent to puncturing the Autumn division. Subsequent cases follow this logic.) Puncturing sinews/bones in Spring causes Blood and Qi to adhere internally, leading to abdominal distension. (This is puncturing the Winter division in Spring. Spring Qi expands, but deeply puncturing sinews/bones injures Yin, causing Blood and Qi to adhere internally and leading to distension.) Puncturing meridians in Summer causes Blood and Qi to exhaust, leading to lethargy. (Mistakenly puncturing meridians exhausts Blood and Qi internally. "Xie Ji" refers to physical exhaustion and weariness, indescribable. "Ji" sounds like "ji".) Puncturing muscles in Summer causes Blood and Qi to retreat internally, leading to timidity/fear. (Late Summer has not arrived, but Qi is seized first, causing Blood and Qi to weaken, leading to fear.) Puncturing sinews/bones in Summer causes Blood and Qi to rebel upward, leading to irritability/anger. (Puncturing the Winter division in Summer causes internal Yin deficiency and external Yang excess, leading to rebellious Blood/Qi and anger.) Puncturing meridians in Autumn causes Blood and Qi to rebel upward, leading to forgetfulness. (The Heart governs pulses; mistakenly puncturing meridians causes Heart Qi deficiency, leading to forgetfulness.) Puncturing collaterals in Autumn causes Qi to fail to defend the exterior, leading to lying down without desire to move. (In Autumn, Qi converges; if Qi has left the collaterals and they are punctured again, Qi becomes deficient and fails to defend the exterior. Qi belongs to Yang; Yang deficiency causes lying down without desire to move.) Puncturing sinews/bones in Autumn causes Blood and Qi to scatter internally, leading to chills. (Deeply puncturing sinews/bones before Autumn Qi arrives causes Blood and Qi to scatter internally and Middle Qi to become deficient, leading to chills.) Puncturing meridians in Winter causes Blood and Qi to both escape, leading to blurred vision. (All vessels connect to the eyes; puncturing meridians in Winter prematurely seizes them, causing Blood/Qi escape and blurred vision.) Puncturing collaterals in Winter causes internal Qi to leak externally, remaining as major Bi syndrome. (When Yang Qi is hidden, puncturing the Yang aspect causes Yang Qi to leak externally. Yang deficiency and Yin excess result in major Bi syndrome.) Puncturing muscles in Winter causes Yang Qi to exhaust, leading to forgetfulness. (Puncturing Summer Qi in Winter exhausts Yang Qi. Yang Qi nourishes Shen when refined; Yang deficiency causes Shen decline, leading to forgetfulness.) All these punctures contrary to the four seasons are major reversals; one must not oppose them. Opposing them generates chaotic Qi and mutual contamination of diseases. (Puncturing contrary to the four seasons is a major reversal; seasonal Qi must not be opposed. Doing so generates chaotic Qi, leading to contaminating diseases.)
If one does not know the meridians of the four seasons and the origin of diseases, treating "following" as "opposing," internal Zheng Qi becomes chaotic, contending with Jing Essence. One must examine the Nine Pulses. If Zheng Qi is not chaotic, Jing Essence will not shift. ("Bo" means pathogens and Zheng Qi pressing against each other. The Nine Pulses have their respective regions; one must clearly identify the location of the disease and puncture accordingly, so Zheng Qi remains unchaotic and Jing Essence does not shift.)
The Emperor said: Excellent. Puncturing the Five Zang: Puncturing the Heart leads to death in one day, with movement manifesting as belching; puncturing the Liver leads to death in five days, with movement manifesting as talking/sleep-talking; puncturing the Lungs leads to death in three days, with movement manifesting as coughing; puncturing the Kidneys leads to death in six days, with movement manifesting as sneezing and yawning; puncturing the Spleen leads to death in ten days, with movement manifesting as swallowing. (This section's meaning is the same as *Ci Jin Lun*, but adds "yawning," detailed in item 64 of this category.) Puncturing and injuring the Five Zang必定 leads to death; the movements correspond to the transformations of the injured Zang, allowing one to know the time of death. ("Dong" means transformation. Observing the transformed signs identifies which Zang is injured, thus predicting the time of death.)