按此难形病脉病。审考其所答之辞。所谓息数不应脉数者。则其形病者。气息短促。形体颤摇。而虽脉有邪势。稍
有胃气存焉。此形病虽甚。应不至死。如脉病而形不病。则形息共稳。而脉见虚豁。无胃气之和。是形病虽无已甚。然
与脉反。不死何俟。盖此难所言。凡内伤之病。则其所发以渐。故所苦亦缓。而脉乃日恶一日。此脉病而人不病也。外
邪之为病。息气动形。屈伸颠沛。然脉动实强。犹有胃气。此形病而脉不病也。滑注所引周氏之说。不可从矣。唯若仲
景之说。乃为稳当。
（第二十一旧二十二）难曰。经言脉有是动。（卫病浅）有所生病。（荣病深）一（经）脉变为二病（是动所生）者。
何
也。然经言是动（病）者（属）气也。所生病者（属）血也。邪在气。（卫外）气（阳）为是动。邪在血。（荣中）血（阴）
为所生病。气主 之。血主濡之。气留而不行者。为（卫）气先病也。血壅而不濡者。为（荣）血后病也。故先为是动。
后所生病也。
按灵枢第十篇。载每经是动所生二病。然或未知二病有何等之别。故此难因设问答。以明各病有阴阳中外之异焉。
所谓是动者气也。所生病者血也。又云。气先病。血后病。此云气血。盖指荣卫为言。所谓是动者。卫病也。邪在脉外。
所生病者。荣病也。邪在脉中。譬如伤风是太阳之卫病。而主桂枝。伤寒是太阳之荣病。而主麻黄之类。大意以此推之。
则知是动所生。俱皆为外邪冒经之病。而其谓先后者。亦有浅深之差。或以分外邪内伤二病等说。似不免牵合。但为荣
卫二分。平易看过时为稳当。
（第二十二旧八）难曰。寸口（三部）脉平（无偏倚）而死者。何谓也。然。诸十二经脉者。皆系于生气之原。（本）
所谓生气之原者。谓十二经之根本也。谓肾（两）间（命门）动气也。此（指动气）五脏六腑之本。十二经脉之根。呼
吸之门。三焦之原。（玄之又玄众妙之门）一名守邪之神。（此一句疑后人所加）故气（即动气）者。人之根本也。根（命
门）绝则茎叶（经脉）枯矣。寸口脉平而死者。（肾间）生气独（暗）绝于内（指玄玄处）也。
按前此诸论。皆承第一二难等义。取手太阴鱼际。却行一寸九分之脉位。以决病之死生。内经所谓饮食入胃。其精
微气变。见于气口。是也。然则前诸篇皆主胃气言。而此所问难。殊异乎彼。盖胚胎之始。天真之气。自然寓于肾间命
门之宫。是谓生气之原。即资始资生之妙。由是而兆。亦不期然而然者。岂唯人耳。万类皆然。方其生来待乳哺水谷之
养。以成脏腑经络四肢百骸之全者。皆以此气之为基故尔。所谓呼吸之门。三焦之原是也。夫寸口脉既谓决脏腑之死生。
则此外复何求。然今其脉平而死者何。辟诸草木之在水瓶中。花叶虽青。其根既断。则宁有一时之荣。遂乃萎尔失其本
色。可刮目待已。或曰。实如此篇。则与前数者。其论相反。扁鹊之言。无乃矛盾邪。且内经云。得谷则昌。失谷则亡。
而今谷入于胃。脉道以通。然其人即死者何。曰。寸口决死生。固其所也。然又有不关寸口者。若夫暴疾卒倒无论已。
虽其长病久患。先脉而可前知者。此一诊已。扁鹊特论诊脉之外。别有命门动气之候。此乃望而知之之最者。而其候诸
家纷纭。无有底止。或以为尺中脉。或以为踝后少阴。又或以为脐下丹田。果其言之是乎。则尺既属寸口中。少阴即是
十二经之一。至于寸口脉平而死。及十二经之根等语穷矣。且肾病齐下有动气。按之牢若痛。所谓邪与生气之动。于彼
丹田。何以择之。可谓皆取其臆者。予尝以其所闻。考诸内经。并取其说。别记藏之。顾其命门。灵枢唯谓目也。他无
所议。而难经数言之。以予考之。内经中所谓耗散其真。真气从之等语。即此是物。何以言之。则以精神之外。别有指
真者。故尔具载外记。并不复赘。本篇旧在第八难。然介诸寸口脉论中。失其序次。故移置此。
（第二十三旧同）难曰。手足三阴三阳。脉之度数。可晓以（有乎字意下同）不。然。手三阳之脉。从手至头。长
五尺。（一经之度下同）五六合三丈。（总）手三阴之脉。从手至胸中。长三尺五寸。三六一丈八尺。五六三尺。合二丈
一尺。（左右六经之度下同）足三阳之脉。从足至头。长八尺。六八四丈八尺。足三阴之脉。从足至胸。长六尺五寸。六
六三丈六尺。五六三尺。合三丈九尺。人两足跷脉。从足至目。长七尺五寸。二七一丈四尺。二五一尺。合一丈五尺。
督脉任脉。各长四尺五寸。二四八尺。二五一尺。合九尺。凡脉长一十六丈二尺。此所谓十二经脉长短之数也。
按十二经脉尺度。总计十三丈八尺。任督跷三脉。总二丈四尺。合十六丈二尺。即一难所谓昼夜五十周身。血气运
行之度也。然又视二十七难奇经八脉。不拘十二经云云者。与此互相反。所以不免于后人之疑焉。滑注无明解。予因考
之。凡诸经络流行。本自一元气。虽有阴阳之分。多少之差。何有隔离阻绝。各异其流之理乎。且所谓十六丈二尺者。
特举手足一体之大经脉而言之。且奇经之中。任督跷在内经而有定尺。其余阴阳维冲带。四奇长短之度。于经亦无所见。
则知其绸缪大经。而余流所及。随省文耳。故知在尺度。则举任督跷以为定数。在流行。即阴阳维冲带。亦寓其中焉。
滑注跷脉为阴跷。予谓不然。经云。男数其阳。女数其阴。当数者为经。不可数者为络。是其证也。然则跷脉在男女各
有阴阳取舍之异可知已。
经脉十二。络脉十五何始何穷也。然。经脉者。行血气。通阴阳。以荣于身者也。其始从中焦注手太阴阳明。阳明
注足阳明太阴。太阴注手少阴太阳。太阳注足太阳少阴。少阴注手心主少阳。少阳注足少阳厥阴。厥阴复还注手太阴。
别络十五。皆因其原。如环无端。转相灌溉。朝于寸口人迎。以处百病。而决死生也。经（终始篇）曰。明知终始。阴
阳定矣。何谓也。然。终始者。脉之纪也。寸口（候阴）人迎。（候阳）阴（脏）阳（腑）之气。通于朝使。如环无端。
故曰始（生）也。终者三阴三阳之脉绝。绝则死。死各有形。故曰终（死）也。
此所引经文二句。出灵枢。终始字。在难经寓死生意耳。
（第二十四旧同）难曰。手足三阴三阳气已绝。何以为候。可知其吉凶不。然。足少阴气绝。即骨枯。少阴者。冬
脉也。伏行而温于骨髓。故骨髓不温。即肉不着骨。骨肉不相亲。即肉濡而却。肉濡而却。故齿（骨余此外候）长而枯。
发（外候）无润泽。无润泽者。骨先死。戊日（阳土）笃。己日（阴土）死。（土克水）足太阴气绝。则脉不营其口唇。
口唇者。肌肉之本也。脉不营。则肌肉不滑泽。肌肉不滑泽。则肉（人中肉此外候）满。肉满则唇反。（脾之所主外候）
唇反则肉先死。甲日（阳木）笃。乙日（阴木）死。（木克土）足厥阴气绝。即筋缩。引卵与舌卷。厥阴者。肝脉也。肝
者。筋之合也。筋者。聚于阴器。而络于舌本。故脉不营。则筋缩急。筋缩急。即引卵（众筋所结）与舌。（肝经贯颃颡）
故舌（外候）卷卵（外候）缩。此筋先死。庚日（阳金）笃。辛日（阴金）死。（金克木）手太阴气绝。即皮毛焦。太阴
者。肺也。行气温于皮毛者也。气弗营。则皮毛焦。皮毛焦。则津液去。津液去。即皮节伤。皮节伤。则皮（外候）枯
毛（外候）折。毛折者。则毛先死。丙日（阳火）笃。丁日（阴火）死。（火克金）手少阴气绝。则脉不通。脉不通。则
血不流。血不流。则色泽去。故面（外候）色黑如黧。此血先死。壬日（阳水）笃。癸日（阴水）死。（水克火）
此篇大意。凡诸经气血。因病经气将绝之候。而诸经脉。皆在肌肉中。其流深潜。何缘能得从外而候之邪。虽然。
既已有斯理。则医者亦不可不知焉。唯其所主在肾。则以齿发为候。于脾乃以唇反为候。于肝乃舌卷卵缩是候。肺与心。
则皮毛焦枯。面色黧黑。是外候之尤着明者。故字旁加圈。以示初学人尔。
二阴（灵枢作六阴）气俱绝者。则目眩转。目瞑。（神志将乱夺精之兆）目瞑者为失志。失志者则志先死。死即目瞑
也。六阳气俱绝者。则阴与阳相离。阴阳相离。则腠理泄。绝汗（津液已绝亡阳之候）乃出。大如贯珠。转出不流。即
气先死。旦占夕死。夕占旦死。
目瞑与绝汗出。此其外候也。此二绝与前每经之绝。其后大异者何。盖彼病以渐而终之候。此则暴病急死。诸经俱
亡之兆。
（第二十五旧同）难曰。有十二经。五脏六腑十一耳。其一经者。何等经也。然。一经者。手少阴与（犹言属与）
心主别脉（手厥阴）也。心主与三焦为表里。俱有名而无形。故言经有十二也。
按此篇所发。示心包络亦为无形之脏。盖以十二经配五脏六腑。则一经无所系属。所以发问焉。心包者何。包络心
脏如内郭。所以温养真心之阳也。三焦者。包罗熏陶诸脏之气。历络上下。如外郭然。故取俱无形者。以为脏腑表里。
花溪虞氏之说。殊有理致。宜以参看。予别有说。今略于此。
（第二十六旧同）难曰。经有十二。络有十五。余三络者。是何等络也。然有阳络。有阴络。有脾之大络。阳络者。
阳跷之络也。（申脉）阴络者。阴跷之络也。（照海）故络有十五焉。
按灵枢以任督配十二经之络。为十五络也。此难以阳跷阴跷代之者。何也。盖奇经比诸十二经。皆络也。故知任督
外二跷所属穴。亦与诸络穴同治。灵枢十五络。有任督二脉。而无阴络阳络。盖任督者。诸经周流之所属而有专穴。故
此难易之以阴阳二跷。充其数者。凡奇经八脉中。任督跷三者。既已系血气。营运五十周身之度。故易任督以跷脉者。
实扩经之余义耳。
（第二十七旧同）难曰。脉有奇经八脉者。不拘于十二经何也。然有阳维。有阴维。有阳跷。有阴跷。有冲。有督。
有任。有带之脉。凡此八脉者。皆不拘于（正）经。故曰奇经八脉也。经有十二。络有十五。凡二十七气。相随上下。
何独不拘于经也。然圣人图设沟渠。通利水道。以备不然。（犹言不虞）天雨降下。沟渠溢满。 霈妄行。（此一句旧本
误在当此之时句下今据脉经移此）当此之时。圣人不能复图也。此络脉（指诸经之络）满溢诸经。（十二正经）不能复拘
也。
按此八脉者。十二经之奇零。而有专穴者。唯任督二脉耳。余六脉。皆因正经属会穴为之主治。详见后篇。络脉满
溢者。则上所谓十五络脉也。滑氏直以为奇经。非是。
（第二十八旧同）难曰。其奇经八脉者。既不拘于十二经。皆何起何继（系同）也。然。督脉者。起于下极之俞。（长
强穴）并于脊里。上至风府。（在脑后）入属于脑。任脉者。起于中极之下。（会阴穴）以上毛际。循腹里。上关元。至
喉咽。冲脉者。起于气冲。（足阳明经穴）并足阳明之经。夹脐上行。至胸中而散也。带脉者。起于季胁。（足少阳带脉
穴）回身一周。阳跷脉者。起于跟中。（足太阳申脉穴）循外踝。上行入风池。阴跷脉者。亦起于跟中。（足少阴照海穴）
循内踝。上行至咽喉。交贯冲脉。（其上者出于颃颡）阳维阴维者。维络于身。故阳维起于诸阳会也。阴维起于诸阴交也。
溢蓄不能环流灌溉诸经者也。（十二字旧本误出故阳维云云前今移于此）比于圣人图设沟渠。（比诸络脉）沟渠满溢。流
于深湖。（比诸奇经）故圣人不能拘通也。而人脉隆盛。入于八脉。而不环周。故十二经亦不能拘之。其（指奇经）受邪
气蓄（积）则肿热砭射之也。
此言八脉流行。滑氏以曲骨穴为任脉所起者。非。所谓中极之下者。直指会阴言。若以曲骨为所起穴。则会阴不属
任脉。而属何经乎。会阴为任脉所起。滑氏既于十四经而言。与此相反者何。冲脉据内经。则并足少阴经。滑氏根据违不
决。予谓冲脉属足少阴。固其所也。然观其所发。乃在足阳明气冲穴。则此难所言。盖似发内经未发之旨。且冲脉之流
行于少阴阳明二经之间。亦可以征矣。李濒湖既得二经之意。予亦从之，溢蓄云云十二字。滑氏移不能拘之之下。文理
不正。故予改移于此。
（第二十九旧同）难曰。奇经之为病。何如。然。阳维维于阳。（手足三阳）阴维维于阴。（手足三阴）阴（维）阳
（维）不能自明维。则怅然失志。（阴维病）溶溶不能自收持。（阳维病）阳维为病。苦寒热。（病属腑）阴维为病。苦心
痛（病属脏）阴跷为病。阳缓（虚）而阴急。（实下同）阳跷为病。阴缓而阳急。冲之为病。逆气而（腹）里（引）急。
督之为病。脊强而厥。任之为病。其（腹）内苦结。男子为七疝。（主气）女子为瘕（血）聚（气）带之为病。腹满腰溶
溶。（失其束缚）若坐水中。（阴中阳虚）此奇经八脉之为病也。
此篇具言八脉主病。二维失其维持。在阴则失志心痛。在阳则不能收持。及寒热两跷为病。其急者受邪而实。缓者
Note: This Jin (difficulty) involves Xing Bing (disease of form/body) and Mai Bing (disease of pulse). Examining the words of the answer, the situation where "the rate of respiration does not correspond to the rate of pulse," if it is Xing Bing, the breath is short and rapid, and the body trembles. Although the pulse shows signs of pathogenic excess, there is still a slight presence of Wei Qi (Stomach Qi, indicating digestive vitality). Even if this Xing Bing is severe, death is unlikely. If it is Mai Bing but Xing is not diseased, then the form and respiration are stable, but the pulse appears empty and hollow, lacking the harmony of Wei Qi. Although the Xing Bing is not severe, it contradicts the pulse; if not dead, what else is there to wait for? Generally, regarding the diseases mentioned in this Jin, those caused by internal injury develop gradually, so the suffering is also slow, while the pulse worsens day by day. This is Mai Bing while the person (form) is not diseased. Diseases caused by external pathogens disturb the Qi and affect the form, causing difficulty in flexion and extension, yet the pulse movement is solid and strong, retaining Wei Qi. This is Xing Bing while the pulse is not diseased. The theory cited by Hua Shou from Mr. Zhou cannot be followed. Only the theory of Zhang Zhongjing is considered steady and appropriate.
(Difficulty 21, Old Edition Difficulty 22) Question: The Classic states that pulses have "Shi Dong" (Moving) diseases and "Suo Sheng" (Generated) diseases. How does one meridian transform into two types of diseases (Shi Dong and Suo Sheng)? Answer: The Classic states that "Shi Dong" diseases belong to Qi, and "Suo Sheng" diseases belong to Blood. When pathogen is in the Qi level, the Wei Yang Qi being affected is called Shi Dong; when pathogen is in the Blood level, the Ying Yin Blood being affected is called Suo Sheng. Qi primarily provides propulsion and warming, while Blood primarily provides nourishment and moistening. When Qi stagnates and fails to circulate, it is a prior disease of Wei Qi; when Blood becomes obstructed and fails to nourish, it is a subsequent disease of Ying Blood. Therefore, Shi Dong diseases appear first, followed by Suo Sheng diseases.
Note: Chapter 10 of *Ling Shu* records the "Shi Dong" and "Suo Sheng" diseases for each meridian, but people do not know the distinction between these two types of diseases. Thus, this Jin sets up questions and answers to clarify that various diseases have differences in Yin/Yang and Interior/Exterior. What is called "Shi Dong" is Qi disease, and "Suo Sheng" is Blood disease. It is also said that Qi diseases occur first, and Blood diseases occur later. The Qi and Blood here actually refer to Ying and Wei. "Shi Dong" refers to Wei Qi disease, where pathogen is outside the vessels; "Suo Sheng" refers to Ying Qi disease, where pathogen is inside the vessels. For example, wind strike is a Wei Qi disease of the Taiyang meridian, treated with Guizhi Tang (Cinnamon Twig Decoction); cold damage is a Ying Blood disease of the Taiyang meridian, treated with Mahuang Tang (Ephedra Decoction) and similar formulas. By extrapolating from this general idea, it can be known that both "Shi Dong" and "Suo Sheng" are diseases caused by external pathogens invading the meridians. The so-called sequence of prior and posterior also implies differences in depth. Classifying them into external pathogen and internal injury diseases seems forced. It is more appropriate to view them simply as a division between Ying and Wei.
(Difficulty 22, Old Edition Difficulty 8) Question: Why does death occur when the Cun Kou (Radial artery at the wrist) pulse is peaceful? Answer: All twelve primary meridians are connected to the Source of Life Qi (Genetic Vitality). The so-called Source of Life Qi is the root of the twelve primary meridians, which is the Moving Qi (Dong Qi) in the space between the kidneys (Mingmen/Gate of Life). This is the root of the five zang and six fu organs, the source of the twelve primary meridians, the gate of respiration, and the original Qi of the San Jiao (Triple Burner). It is also called the God who guards against pathogens (this sentence is suspected to be added by later generations). Therefore, Qi (i.e., Moving Qi) is the root of human life. If the root (Mingmen) is severed, the stems and leaves (meridians) will wither. Death occurs with a peaceful Cun Kou pulse because the Sheng Qi (Vital Qi) of the kidney space alone is internally severed (in the profound mystery).
Note: The previous discussions inherited the principles of Difficulties 1 and 2, taking the pulse position one inch and nine fen backward from the Yuji point of the Hand-Taiyin Lung Meridian to determine life and death. This corresponds to the statement in *Nei Jing* that after food enters the stomach, its refined essence transforms and manifests at the Qi Kou (Cun Kou). However, the previous chapters focused on Stomach Qi, whereas this question differs significantly. At the beginning of embryonic formation, the Heavenly True Qi naturally resides in the palace of the kidney space and Mingmen, called the Source of Life Qi, which is the wonder of initiating and generating life. This sprouts naturally, not just in humans but in all things. After birth, relying on milk and water/grain for nourishment to complete the organs, meridians, limbs, and bones, all rely on this Qi as the foundation, which is the gate of respiration and the source of the San Jiao. Since the Cun Kou pulse can determine the life and death of the zang and fu organs, what else is there to seek? Yet why does death occur when the pulse is peaceful? It is like grass and trees placed in a water vase; although the flowers and leaves are green, if the roots are broken, how can there be temporary prosperity? They will wither and lose their true color, no longer worthy of a second look. Some say: If this chapter is true, it contradicts the previous ones. Is Bian Que's words contradictory? Furthermore, *Nei Jing* says, "Obtaining grain leads to prosperity, losing grain leads to death." Now grain enters the stomach, and the pulse channels are open, yet the person dies. I reply: Determining life and death by Cun Kou is indeed its function. However, there are cases unrelated to Cun Kou. In sudden acute collapse, it goes without saying. Even in chronic long-term illness, if one can predict beforehand through the pulse, this is merely one diagnostic method. Bian Que specifically discusses that besides pulse diagnosis, there is the sign of Moving Qi at the Mingmen, which is the most significant aspect of knowing through observation. However, explanations by various schools are numerous and endless. Some consider it the Chi (Cheel) pulse, some the Shaoyin pulse behind the ankle, and others the Dantian below the navel. If their words were correct, since the Chi pulse belongs within the scope of Cun Kou, and Shaoyin is one of the twelve meridians, the statements about peaceful Cun Kou pulse leading to death and the root of the twelve meridians would be exhausted. Moreover, Kidney disease presents with moving Qi below the navel, firm and painful upon pressure. How to select the interaction between pathogen and the moving Qi of Sheng Qi at the Dantian? These can be considered conjectures. I once examined what I heard against *Nei Jing*, adopted its theories, recorded them separately, and stored them. Regarding Mingmen, *Ling Shu* only refers to the eyes, with no other discussion, whereas *Nan Jing* mentions it frequently. Upon my examination, the phrases in *Nei Jing* such as "scattering its truth, true Qi follows" refer to this entity. Why? Because beyond spirit and mind, there is another reference to "True." Thus, it is detailed in external records, and I will not repeat it here. This chapter was originally in Difficulty 8, but was misplaced among the Cun Kou pulse discussions, losing its order, so it has been moved here.
(Difficulty 23, Old Edition Same) Question: Can the length and measure of the three Yin and three Yang meridians of the hands and feet be explained? Answer: The three Yang meridians of the hands run from hand to head, each five chi long. Six meridians combined make three zhang. The three Yin meridians of the hands run from hand to chest, each three chi and five cun long. Three meridians make one zhang and eight chi, plus five-six three chi, totaling two zhang and one chi. The three Yang meridians of the feet run from foot to head, each eight chi long. Six meridians make four zhang and eight chi. The three Yin meridians of the feet run from foot to chest, each six chi and five cun long. Three meridians make three zhang and six chi, plus five-six three chi, totaling three zhang and nine chi. The two Qiao meridians of the feet run from foot to eye, each seven chi and five cun long. Two meridians make one zhang and four chi, plus two-five one chi, totaling one zhang and five chi. The Du Mai (Governing Vessel) and Ren Mai (Conception Vessel) are each four chi and five cun long. Two vessels make eight chi, plus two-five one chi, totaling nine chi. The total length of all meridians is sixteen zhang and two chi. This is the number of lengths of the twelve primary meridians.
Note: The scale of the twelve primary meridians totals thirteen zhang and eight chi. The Ren, Du, and Qiao meridians total two zhang and four chi, combining to sixteen zhang and two chi. This is the degree of blood and Qi circulation fifty times around the body in a day and night, as stated in Difficulty 1. However, looking at Difficulty 27 regarding the Eight Extraordinary Vessels, which are not restricted to the twelve meridians, it contradicts this, causing doubt among later generations. Hua Shou's commentary lacks clear explanation. I therefore examine that the circulation of all collaterals originates from one primal Qi. Although divided into Yin and Yang with differences in quantity, how could there be isolation or blockage with separate flows? Moreover, the so-called sixteen zhang and two chi specifically refers to the major meridians of the hands and feet as a whole. Among the extraordinary vessels, Ren, Du, and Qiao have fixed measures in *Nei Jing*, while the remaining Yin-Yang Wei, Chong, and Dai meridians have no recorded lengths in the classics. Thus, it is known that they entwine the major meridians, and their remaining branches follow abbreviated texts. Therefore, in terms of measurement, Ren, Du, and Qiao are taken as fixed numbers; in terms of circulation, Yin-Yang Wei, Chong, and Dai are also included. Hua Shou interprets Qiao Mai as only Yin Qiao, which I disagree with. The Classic says, "For men, count the Yang; for women, count the Yin. Those counted are Jing (Meridians), those not counted are Luo (Collaterals)." This is the evidence. Thus, it is known that Qiao Mai has different Yin-Yang selections for men and women.
There are twelve Jing meridians and fifteen Luo collaterals. Where do they start and where do they end? Answer: Jing meridians transport blood and Qi, communicate Yin and Yang, and nourish the body. They begin at the Middle Jiao, flowing into the Hand-Taiyin Lung and Hand-Yangming Large Intestine meridians; Yangming flows into Foot-Yangming Stomach and Foot-Taiyin Spleen; Taiyin flows into Hand-Shaoyin Heart and Hand-Taiyang Small Intestine; Taiyang flows into Foot-Taiyang Bladder and Foot-Shaoyin Kidney; Shaoyin flows into Hand-Jueyin Pericardium and Hand-Shaoyang San Jiao; Shaoyang flows into Foot-Shaoyang Gallbladder and Foot-Jueyin Liver; Jueyin returns to flow into Hand-Taiyin Lung. The fifteen collateral branches all follow their origins, forming a circle without end, irrigating each other, and converging at Cun Kou and Ren Ying to treat hundred diseases and determine life and death. *Ling Shu · Zhong Shi Pian* states: "Knowing the beginning and end, Yin and Yang are determined." What does this mean? Answer: Beginning and End are the discipline of pulses. Cun Kou observes Yin, Ren Ying observes Yang. Yin (Zang) and Yang (Fu) Qi communicate through these points, forming a circle without end, hence called Start (Birth). End refers to the severance of the three Yin and three Yang meridians; severance means death, and death has specific forms, hence called End (Death).
The two quoted sentences come from *Ling Shu*. The characters "Zhong Shi" (End and Beginning) in *Nan Jing* imply life and death.
(Difficulty 24, Old Edition Same) Question: When the Qi of the three Yin and three Yang meridians of the hands and feet is exhausted, what are the signs? Can auspiciousness or misfortune be known? Answer: When Foot-Shaoyin Qi is exhausted, bones become withered. Shaoyin is the Winter pulse, hidden and warming the bone marrow. Thus, if bone marrow is not warm, muscles do not adhere to bones, and bone and flesh are not close. Muscles relax and recede; thus teeth appear long and withered (teeth are surplus of bone, an external sign), and hair lacks luster (hair is an external sign). Lack of luster indicates bone death first. Condition worsens on Wu Day (Yang Earth) and dies on Ji Day (Yin Earth) (Earth overcomes Water). When Foot-Taiyin Qi is exhausted, pulses fail to nourish the lips. Lips are the root of muscles. Pulses failing to nourish means muscles are not smooth. Muscles not smooth means the area above the lip swells. Swelling causes lip retraction (an external sign governed by Spleen). Lip retraction means muscle death first. Condition worsens on Jia Day (Yang Wood) and dies on Yi Day (Yin Wood) (Wood overcomes Earth). When Foot-Jueyin Qi is exhausted, sinews contract, pulling the testicles and tongue inward. Jueyin is the Liver pulse. Liver is the convergence of sinews. Sinews gather at the genitalia and connect to the base of the tongue. Thus, pulses failing to nourish cause sinew contraction and urgency. Contraction pulls the testicles (convergence of many sinews) and tongue (Liver meridian passes through the pharynx). Thus, tongue curls and testicles retract. This indicates sinew death first. Condition worsens on Geng Day (Yang Metal) and dies on Xin Day (Yin Metal) (Metal overcomes Wood). When Hand-Taiyin Qi is exhausted, skin and hair become scorched. Taiyin is the Lung, which transports Qi to warm the skin and hair. Qi failing to nourish causes skin and hair to scorch. Scorched skin and hair lead to loss of body fluids. Loss of fluids injures skin joints. Injury to skin joints causes skin withering and hair breaking (external signs). Hair breaking indicates hair death first. Condition worsens on Bing Day (Yang Fire) and dies on Ding Day (Yin Fire) (Fire overcomes Metal). When Hand-Shaoyin Qi is exhausted, pulses are blocked. Blocked pulses mean blood does not flow. Unflowing blood causes loss of luster. Thus, the face turns black like charcoal. This indicates blood death first. Condition worsens on Ren Day (Yang Water) and dies on Gui Day (Yin Water) (Water overcomes Fire).
The main idea of this chapter is that for all meridians' blood and Qi, these are signs of impending exhaustion due to disease. Since meridians flow deeply within muscles, how can they be observed externally? Nevertheless, since this principle exists, doctors must know it. The Kidney governs teeth and hair as signs; Spleen governs lip retraction; Liver governs tongue curling and testicular retraction; Lung and Heart manifest as scorched skin/hair and dark complexion, which are the most prominent external signs. Circles are added next to characters to indicate this for beginners.
When the two Yin (Six Yin in *Ling Shu*) Qi are exhausted, dizziness and spinning vision occur, leading to eye closure (signs of mental confusion and essence depletion). Eye closure indicates loss of Zhi (Will/Shen). Loss of Zhi means Will dies first; death is accompanied by eye closure. When the six Yang Qi are exhausted, Yin and Yang separate. Separation of Yin and Yang causes pores to open, leading to Absolute Sweat (sign of exhausted fluids and collapsing Yang), which flows out like beads strung together, turning but not flowing. This indicates Qi death first. Predicted in the morning, dies in the evening; predicted in the evening, dies in the morning.
Eye closure and absolute sweat are external signs. Why are these two exhaustions vastly different from the exhaustion of each meridian previously described? Because the former are signs of gradual termination of disease, while the latter are signs of sudden acute death and the demise of all meridians.
(Difficulty 25, Old Edition Same) Question: There are twelve meridians, but only five Zang and six Fu organs, totaling eleven. Which meridian is the extra one? Answer: The extra one is the separation of the Hand-Shaoyin Heart Meridian and the Heart Master's separate pulse (Hand-Jueyin Pericardium Meridian). The Heart Master and San Jiao are exterior-interior pairs, both having names but no form. Hence, it is said there are twelve meridians.
Note: This question demonstrates that the Pericardium (Xin Bao Luo) is also a formless organ. Matching twelve meridians to five Zang and six Fu leaves one meridian unassigned, prompting the question. What is the Pericardium? It envelopes the heart like an inner shell, warming the True Heart Yang. The San Jiao envelops and steams the Qi of all organs, connecting upper and lower like an outer shell. Thus, taking both as formless establishes their exterior-interior relationship. Mr. Yu of Huaxi's theory is very reasonable and should be consulted. I have a different theory, omitted here.
(Difficulty 26, Old Edition Same) Question: There are twelve Jing meridians and fifteen Luo collaterals. What are the remaining three collaterals? Answer: There are Yang Luo, Yin Luo, and the Great Luo of the Spleen. Yang Luo is the collateral of Yang Qiao (Shenmai point). Yin Luo is the collateral of Yin Qiao (Zhaohai point). Thus, there are fifteen collaterals.
Note: *Ling Shu* pairs Ren and Du with the twelve meridians' collaterals to make fifteen. Why does this Jin replace them with Yang Qiao and Yin Qiao? Because extraordinary vessels are collaterals relative to the twelve primary meridians. Thus, the acupoints belonging to Ren, Du, and the two Qiao are treated similarly to other Luo points. *Ling Shu*'s fifteen collaterals include Ren and Du but lack Yin and Yang Luo. Ren and Du have specific points for the circulation of all meridians. Therefore, this Jin replaces them with Yin and Yang Qiao to fill the number. Among the Eight Extraordinary Vessels, Ren, Du, and Qiao are already accounted for in the fifty-circulation blood and Qi cycle. Replacing Ren and Du with Qiao actually expands the residual meaning of the classics.
(Difficulty 27, Old Edition Same) Question: There are Eight Extraordinary Vessels in the pulse. Why are they not restricted to the twelve meridians? Answer: There are Yang Wei, Yin Wei, Yang Qiao, Yin Qiao, Chong, Du, Ren, and Dai meridians. These eight vessels are not restricted to the regular meridians, hence called the Eight Extraordinary Vessels. There are twelve Jing and fifteen Luo, totaling twenty-seven Qi, moving up and down together. Why are they uniquely unrestricted by the meridians? Answer: Sages designed ditches to facilitate waterways, prepared for contingencies. When rain falls heavily and ditches overflow, water floods wildly. At this time, even sages cannot plan further. Similarly, when Luo collaterals (referring to the collaterals of the meridians) are full and overflow, the Jing meridians (twelve regular meridians) cannot restrain them.
Note: These eight vessels are the odd remnants of the twelve meridians. Only Ren and Du have specific points; the other six are treated via meeting points of regular meridians, detailed in later chapters. "Luo collaterals overflowing" refers to the fifteen collaterals mentioned above. Hua Shou directly identifies them as extraordinary vessels, which is incorrect.
(Difficulty 28, Old Edition Same) Question: Since the Eight Extraordinary Vessels are not restricted to the twelve meridians, where do they originate and where do they connect? Answer: The Du Mai originates at Xiaji Shu (Changqiang point), runs parallel in the spine, ascends to Fengfu (at the back of the head), and enters the brain. The Ren Mai originates below Zhongji (Huiyin point), passes above the pubic hair, follows the interior of the abdomen, ascends to Guanyuan, and reaches the throat and pharynx. The Chong Mai originates at Qichong (Foot-Yangming acupoint), runs alongside the Foot-Yangming meridian, flanks the navel upward, and disperses in the chest. The Dai Mai originates at Jixie (Foot-Shaoyang Daibao point), encircles the body once. The Yang Qiao Mai originates in the heel (Foot-Taiyang Shenmai point), follows the lateral malleolus, ascends, and enters Fengchi. The Yin Qiao Mai also originates in the heel (Foot-Shaoyin Zhaohai point), follows the medial malleolus, ascends to the throat, and intersects the Chong Mai (its upper branch emerges from the nasopharynx). Yang Wei and Yin Wei weave and network the body; thus Yang Wei originates from the meeting of all Yang meridians, and Yin Wei from the intersection of all Yin meridians. They store overflow and cannot circulate and irrigate the various meridians (these twelve characters were erroneously placed before "Thus Yang Wei..." in old editions, now moved here). Comparing to sages designing ditches (comparing to Luo collaterals), when ditches overflow, they flow into deep lakes (comparing to extraordinary vessels), so sages cannot restrict their flow. When human pulses are vigorous, they enter the eight vessels and do not circulate continuously, so the twelve meridians cannot restrain them. When they receive pathogenic Qi and accumulate, swelling and heat occur, treatable by bi-shi (stone acupuncture).
Regarding the circulation of the eight vessels, Hua Shou states Ren Mai originates at Qugu point, which is incorrect. "Below Zhongji" directly refers to Huiyin. If Qugu were the origin, Huiyin would not belong to Ren Mai, but to which meridian? Huiyin is the origin of Ren Mai. Why does Hua Shou contradict this in his discussion of the fourteen meridians? According to *Nei Jing*, Chong Mai runs alongside Foot-Shaoyin. Hua Shou is undecided. I believe Chong Mai belongs to Foot-Shaoyin. However, observing its origin at Qichong (Foot-Yangming), this Jin seems to elucidate unstated principles of *Nei Jing*. The circulation of Chong Mai between Shaoyin and Yangming confirms this. Li Binhu understood the intent of both meridians, and I follow him. The twelve characters "Overflow and storage..." were moved by Hua Shou below "cannot restrain," disrupting the logic, so I moved them here.
(Difficulty 29, Old Edition Same) Question: What are the diseases of the extraordinary vessels? Answer: Yang Wei weaves Yang (Three Yang of Hands and Feet); Yin Wei weaves Yin (Three Yin of Hands and Feet). If Yin and Yang cannot maintain themselves, there is melancholy and loss of will (Yin Wei disease), and inability to hold oneself together (Yang Wei disease). Yang Wei disease suffers from chills and fever (disease of Fu); Yin Wei disease suffers from heart pain (disease of Zang). Yin Qiao disease presents with Yang laxity and Yin tension; Yang Qiao disease presents with Yin laxity and Yang tension. Chong disease presents with rebellious Qi and abdominal cramping. Du disease presents with stiff spine and syncope. Ren disease presents with internal knotting in the abdomen. In men, it manifests as Seven Hernias (governs Qi); in women, as Masses/Accumulations (Blood/Qi). Dai disease presents with abdominal fullness and limp waist (loss of binding), feeling as if sitting in water (Yang deficiency in Yin). These are the diseases of the Eight Extraordinary Vessels.
This chapter details the diseases governed by the eight vessels. When Wei loses its maintenance, in Yin it causes loss of will and heart pain; in Yang, inability to hold oneself. For Qiao diseases, the tense side is affected by pathogen and excess, while the lax side...