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The entire text is divided into three sections: the first section discusses the location of vital Qi in each month, the second section discusses the indications and contraindications for acupuncture, and the final section discusses the signs of impending death when the twelve meridians are exhausted. These are matters concerning the end of life. Such content is not recorded in other chapters, so physicians must know them; hence it is called *Zhenyao Jingzhong Lun* (Treatise on the Essentials of Diagnosis and the Exhaustion of Meridians).

Huangdi asked: What are the essentials of diagnosis? Qibo replied: In the first and second months, the Qi of Heaven begins to rise, and the Qi of Earth begins to emerge. The human Qi resides in the Liver (Wood organ, associated with spring and growth). [Commentary: "Fang" means initial movement. Heaven's Qi initiates movement above, and Earth's Qi responds by generating growth. Spring precedes the four seasons; the first and second months are the beginning of the year. At this time, the Qi of Heaven and Earth just sprouts the mechanism of generation, becoming the start of transformation and endless creation. Humans receive the Qi of Heaven and Earth, internally connecting to the Liver. The Liver belongs to Wood, prospers in Spring, and is the beginning of the generating Qi of the five Zang organs.] In the third and fourth months, the Qi of Heaven is fully rising, and the Qi of Earth is firmly activating. The human Qi resides in the Spleen (Earth organ, source of Yuan Qi). [Commentary: Transitioning from Spring to Summer, the rising Qi of Heaven and Earth reaches its peak. The third month corresponds to Chen Earth, and the fourth to Si Fire. Fire and Earth nourish the Spleen. The Spleen is the mother of Yuan Qi; human Qi relies on it to nourish the Zang-Fu organs and generate Blood and Qi.] In the fifth and sixth months, the Qi of Heaven is abundant, and the Qi of Earth is high. The human Qi resides in the Head. [Heavenly Yang is intense, and earthly flames rise high, hence "Qi of Heaven is abundant, Qi of Earth is high." Fire nature flares upward, hence "human Qi resides in the head."] In the seventh and eighth months, Yin Qi begins to kill (wither/contract), and the human Qi resides in the Lungs (Metal organ, associated with autumn and descent). [Commentary: Transitioning from Summer to Autumn, the climate gradually becomes austere and killing. In the Shen and You months, Metal Qi dominates. Metal Qi corresponds to the Lungs, hence "human Qi resides in the Lungs."] In the ninth and tenth months, Yin Qi begins to freeze, and the Qi of Earth begins to close. The human Qi resides in the Heart (Fire organ, associated with winter storage). [Commentary: "Bing" means congeal. At the end of Autumn and beginning of Winter, things converge and store. The Qi of Heaven and Earth returns from Yang to Yin. The fire of the human body is gathered and returns to the Heart, hence "human Qi resides in the Heart."] In the eleventh and twelfth months, ice thickens, and the Qi of Earth closes. The human Qi resides in the Kidneys (Water organ, associated with deep storage). [Commentary: Yang Qi deeply hides, hence Qi is in the Kidney. Changes in Qi originate in Wood, flourish in Earth, become abundant and rise in Fire, become austere in Metal, avoid cold in Water, and hide in Water. This follows the ascending and descending of Yin and Yang. The *Wuzang Shengcheng Lun* states: "The images of the five Zang organs can be inferred by analogy." This refers to such correspondence of Qi categories.] Spring, Summer, Autumn, and Winter each have specific needling methods based on where the Qi resides. [Commentary: See *Shuire Xuelun* and *Sishi Ni Cong Lun*.] If one needles the Summer area during Spring, the pulse becomes chaotic, Qi becomes faint, pathogenic Qi penetrates into the bone marrow, the disease cannot be cured, causing loss of appetite and shortness of Qi. [Heart governs the pulse, hence chaotic pulse and faint Qi. Water receives Qi from Summer; Kidney governs bones, hence pathogenic Qi invades bone marrow. Weak Heart Fire leads to insufficient Stomach Earth, hence loss of appetite and shortness of Qi. Note: *Xin Zhengshuo* says: "*Sishi Ni Cong Lun* states: 'Needling collateral vessels in Spring causes blood and Qi to overflow externally, leading to shortness of Qi.'"] If one needles the Autumn area during Spring, tendons spasm, counterflow Qi causes coughing, the disease cannot be cured, causing frequent fright and weeping. [Wood receives Qi from Autumn; Liver governs tendons, hence needling the Autumn area causes tendon spasms. If Qi circulates inversely, it causes coughing. Liver governs fright, hence frequent fright. Lung governs Qi, hence counterflow Qi and weeping. Note: "*Sishi Ni Cong Lun* states: 'Needling muscle layer in Spring causes blood and Qi to reverse circularly, leading to upper Qi.'" ] If one needles the Winter area during Spring, pathogenic Qi attaches to the Zang organs, causing abdominal distension, the disease cannot be cured, and the patient desires to speak. [Winter governs the hiding of Yang Qi, hence pathogenic Qi attaches to Zang. Fullness in Kidney causes distension, hence needling the Winter area causes distension. Fire receives Qi from Winter; Heart governs speech, hence desire to speak. Note: "*Sishi Ni Cong Lun* states: 'Needling sinews and bones in Spring causes blood and Qi to adhere internally, leading to abdominal distension.'"] If one needles the Spring area during Summer, the disease cannot be cured, causing lethargy and weakness. [Liver nourishes tendons; insufficient Liver Qi causes tendons to relax and weaken. Note: "*Sishi Ni Cong Lun* states: 'Needling meridians in Summer causes blood and Qi to exhaust, leading to lethargy and weakness.'"] If one needles the Autumn area during Summer, the disease cannot be cured, causing a desire for silence in the heart, and a sense of terror as if being pursued. [Commentary: Erroneously needling the Autumn area injures the Lung. Lung governs Qi; Lung injury leads to weak Qi and inability to speak. Weak Qi leads to fear and the sensation of being pursued. The commentary interpreting this as Liver is incorrect.] If one needles the Winter area during Summer, the disease cannot be cured, causing shortness of Qi and frequent anger. [Note: "*Sishi Ni Cong Lun*" also says: "Needling sinews and bones in Summer causes blood and Qi to counterflow upward, leading to irritability." Anger is governed by Liver. Why does Kidney injury cause anger? Kidney is Water, Liver is Wood. Wood is nourished by Water. If Water is empty and lacks Qi, Liver loses nourishment, hence anger.] If one needles the Spring area during Autumn, the disease persists, causing a startled feeling of wanting to act, but forgetting upon standing. [Due to Liver deficiency; improper needling. Note: "*Sishi Ni Cong Lun*" states: "Needling meridians in Autumn causes blood and Qi to counterflow upward, leading to forgetfulness."] If one needles the Summer area during Autumn, the disease persists, causing increased drowsiness and frequent dreaming. [When Heart Qi is deficient, Spleen Qi becomes isolated, causing drowsiness. Heart governs dreams, Spirit creates them, hence frequent dreaming. Note: "*Sishi Ni Cong Lun*" states: "Needling collateral vessels in Autumn causes Qi not to move outward, leading to lying down without desire to move."] If one needles the Winter area during Autumn, the disease persists, causing shivering and frequent aversion to cold. [Commentary: The exterior of the Kidney is the Foot-Taiyang Bladder Meridian. Taiyang governs aversion to cold, hence Kidney injury causes frequent cold sensations. Also, "*Sishi Ni Cong Lun*" states: "Needling sinews and bones in Autumn causes blood and Qi to scatter internally, leading to chills."] If one needles the Spring area during Winter, the disease persists, causing a desire to sleep but inability to do so, and visual hallucinations while sleeping. [Insufficient Liver Qi causes desire to sleep but inability to rest. Liver opens into the eyes, hence seeing shapes while sleeping. Note: "*Sishi Ni Cong Lun*" states: "Needling meridians in Winter causes blood and Qi to both escape, leading to unclear vision."] If one needles the Summer area during Winter, the disease persists, causing various Bi syndromes due to Qi rising. [Due to leaking meridian Qi. Note: "*Sishi Ni Cong Lun*" states: "Needling collateral vessels in Winter causes blood and Qi to leak externally, remaining as major Bi."] If one needles the Autumn area during Winter, the disease persists, causing frequent thirst. [Insufficient Lung Qi causes thirst. Note: "*Sishi Ni Cong Lun*" states: "Needling muscle layer in Winter causes Yang Qi to exhaust, leading to frequent thirst." Thirst is not a Lung disease per se, but Lung injury leads to insufficient Qi and inability to transform fluids, hence thirst.]

Whenever needling the chest and abdomen, one must avoid the Five Zang organs. [Heart and Lung are above the diaphragm; Liver and Kidney are below. Spleen resembles Earth and is central. Thus, needling the chest and abdomen requires avoiding them. The Five Zang store Essence, Spirit, Hun, Po, Yi, and Zhi. Damaging them causes the Five Spirits to depart; when Spirits depart, death arrives. Therefore, caution is essential.] Needling the Heart directly leads to death within one cycle (a cycle refers to the circulation of Qi through the twelve double-hours). [Note: *Xin Zhengshuo* says: "*Cijin Lun* states death occurs in one day, with symptoms of belching, consistent with *Sishi Ni Cong Lun*. This chapter lacks the death day for needling the Liver; *Cijin Lun* states death in five days for Liver, with symptoms of speaking, consistent with *Sishi Ni Cong Lun*.]" Needling the Spleen directly leads to death in five days (Earth number is five). [Note: *Cijin Lun* states death in ten days for Spleen, with symptoms of swallowing, consistent with *Sishi Ni Cong Lun*.] Needling the Kidney directly leads to death in seven days (Water completion number is six; after Water numbers complete, death occurs on the seventh day). [Note: *Cijin Lun* states death in six days for Kidney, with symptoms of sneezing; *Sishi Ni Cong Lun* states death in six days for Kidney, with symptoms of sneezing and yawning.] Needling the Lung directly leads to death in five days. (Metal generation number is four; after Metal numbers complete, death occurs on the fifth day. Some say three days, which is a character error. Note: Both *Cijin Lun* and *Sishi Ni Cong Lun* state three days, which is erroneous; this text should be considered correct.) Needling the Diaphragm constitutes injury to the Middle Jiao. Even if the disease heals, death will occur within one year. [Commentary: The Diaphragm is at the center of the body, where Qi of the Five Zang converges. The Five Zang correspond to one year; thus, Diaphragm injury affects all Five Zang, leading to death within a year.] One must be solemn and respectful when inserting needles (Solemnity ensures waiting for the presence or absence of Qi). When needling swellings/abscesses, shake the needle (to drain large amounts of pus and blood). When needling meridians, do not shake the needle (to prevent leakage of meridian Qi). This is the way of needling.

The Emperor said: I wish to hear about the exhaustion of the twelve meridians. [Exhaustion means termination.] Qibo said: When the Taiyang Meridian exhausts, the eyes stare upward without moving, the body arches backward (opisthotonos), the complexion is white, absolute sweat appears, and death follows immediately. [Daiyan means eyes unable to turn, staring upward. Foot-Taiyang Meridian originates at the inner canthus, crosses the vertex, enters the brain, emerges to descend the neck, runs along the shoulder blades,夹 spine to the waist. Its branch descends the leg to the lateral side of the little toe. Hand-Taiyang Meridian originates at the lateral side of the little finger, runs up the arm to the shoulder, enters the supraclavicular fossa. Its branch ascends the cheek to the inner canthus, connecting to Foot-Taiyang. Note: *Jiayi Jing* reads "obliquely connects to the zygoma." Another branch from the supraclavicular fossa runs up the neck to the cheek, reaching the outer canthus. Hence Daiyan, opisthotonos, white complexion, and absolute sweat. Absolute sweat means sweat suddenly erupts like beads, does not flow, and quickly dries. Taiyang extreme leads to sweating, hence death upon sweating.] When the Shaoyang Meridian exhausts, deafness occurs, all joints become flaccid, the eyes stare fixedly (jingmu) with severed connections, death occurs in one and a half days. The complexion turns green and white before death. [Foot-Shaoyang Meridian originates at the outer canthus, ascends to the corner of the head, descends behind the ear. Its branch enters the ear, exits in front. Hand-Shaoyang branch also enters the ear and exits in front. Hence deafness and fixed eyes with severed connections. Shaoyang governs bones, hence joint flaccidity when Qi exhausts. Green and white complexion indicates Metal and Wood clashing, signifying death. "Jingmu" means staring fixedly like fear. Note: Commentary says Shaoyang governs bones. "Jingmu" old pronunciation is Qiong, commentary says staring like fear. I believe both are wrong. Foot-Shaoyang Gallbladder and Hand-Shaoyang Sanjiao do not govern bones. "All joints flaccid" refers to relaxation of large tendons. "Severed connections" refers to rupture of small tendons. Tendons belong to Liver; Liver combines with Gallbladder; Fu disease affects Zang. "Jingmu" is likely a typo for "Huan" (ring), referring to the eye socket. Eye connections attach to the socket; if one side severs, the eye deviates; if the ring socket severs completely, the eye fixes and cannot move, leading to death in a few days.] When the Yangming Meridian exhausts, the mouth and eyes twitch/spasm, frequent fright, delirious speech, yellow complexion, and excessive pulsation in the upper (Renying) and lower (Fuyang) vessels lead to insensibility and death. [Foot-Yangming Meridian originates at the nose, crosses the glabella, runs down the lateral nose, enters the upper gum, circles the lips, meets at Chengjiang, runs behind the jaw to Daying, along Jiache, up in front of the ear, passes Guanzhu, along the hairline to the forehead. Its branch goes down Renying, along the throat, into the supraclavicular fossa, below the diaphragm. Hand-Yangming Meridian originates at the hand, runs up the arm to the shoulder, emerges at the vertebral junction, enters the supraclavicular fossa, connects to the Lung. Its branch goes up the neck, through the cheek, into the teeth, emerges at the mouth, crosses the philtrum (left to right, right to left), runs alongside the nostrils to meet Foot-Yangming. Hence mouth and eye spasms. Note: Yangming refers to Stomach and Large Intestine. "Movement" means continuous pulling; Stomach meridian circles the mouth. Eyes have no specific function here, but mouth movement pulls the eyes, hence "mouth and eye movement." Yangming disease, hearing wood sounds causes fright, cursing without discrimination. Extreme disease shows external color, hence near death: fright, delirium, yellow color. Upper is Renying (beside larynx); Lower is Fuyang. "Sheng" means pulsating and restless. Ancients diagnosed these to determine death. "Insensibility" means lack of pain and itch sensation. Once these signs appear and muscles become insensible, death is certain.] When the Shaoyin Meridian exhausts, the face is black, teeth appear long and dirty, abdominal distension and closure occur, upper and lower passages are blocked, leading to death. [Hand-Shaoyin Qi exhaustion stops blood flow; Foot-Shaoyin Qi exhaustion fails to moisten bones. Hard bones cause gums to recede, making teeth look long and accumulate dirt; damaged blood causes skin color to die, making the face black like lacquer and lacking redness. Foot-Shaoyin Meridian descends from Kidney, pierces Liver and Diaphragm, enters Lung. Hand-Shaoyin Meridian originates in Heart, belongs to Heart system, descends through Diaphragm, connects to lower abdomen. Hence abdominal distension/closure and blockage of upper/lower passages. Note: Wang Bing commentary says "bones not moist/hard." *Nanjing* and *Jiayi Jing* say "if bones are not moist, flesh cannot adhere." Commentary says Hand-Shaoyin connects to lower abdomen; *Jiayi* says Small Intestine. Both are acceptable.] When the Taiyin Meridian exhausts, abdominal distension and closure occur, breathing difficulty, frequent belching, and frequent vomiting. [Foot-Taiyin Meridian runs along anterior medial thigh, enters abdomen, belongs to Spleen, connects to Stomach, ascends through Diaphragm. Hand-Taiyin Meridian originates at Middle Jiao, connects to Large Intestine, returns along stomach opening, ascends through Diaphragm, belongs to Lung. Hence these symptoms. *Ling Shu* states: "When Foot-Taiyin moves, disease occurs; eating causes vomiting, abdominal distension, frequent belching."] Vomiting causes counterflow Qi, counterflow Qi causes red face. [Vomiting causes Qi counterflow, hence red face.] If there is no vomiting, upper and lower passages are blocked; blockage causes black face and scorched skin/hair, leading to death. [If vomiting occurs, upper passage is open, hence only red face. If no vomiting, lower is closed, upper is also blocked. Heart Qi flares externally, hence scorched skin/hair. Why? Foot-Taiyin branch separates from Stomach, ascends through Diaphragm, pours into Heart. Thus scorched skin/hair results from external flare of Heart Qi.] When the Jueyin Meridian exhausts, internal heat and dry throat occur, frequent urination, vexation, and severely, tongue curling and testicles retracting, leading to death. [Foot-Jueyin Luo runs up the shin to the scrotum, knots at the penis. Main meridian enters pubic region, passes over genitalia, ascends to lower abdomen,夹 Stomach, ascends behind throat, enters Ying Sang. Hand-Jueyin Meridian originates in Chest, belongs to Pericardium. Hence internal heat, dry throat, frequent urination, vexation. *Ling Shu* states: "Liver is the union of tendons. Tendons gather at the genitalia and connect to the root of the tongue." Hence severe cases show tongue curling and testicular retraction. Also because Jueyin meridian circles the genitalia.] This is the exhaustion of the twelve meridians. [Note: The reason the twelve meridians terminate is due to the deterioration of Spirit and Essence.]