二十四难曰∶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，则骨枯。少阴者，冬脉也，伏行而温于骨髓。故骨髓不温，则肉不着骨，骨肉不相亲，则肉濡
而却，肉濡而却，故齿长而枯，发无润泽，无润泽者，骨先死。戊日笃，己日死。
此承上文手足三阴三阳气绝必有其候，引《灵枢·经脉篇》错杂言之也。足少阴，肾脉也，肾主
冬，故云冬脉也。肾主内营骨髓，故云伏行而温于骨髓也。濡，软也。却，退缩也。肾气已绝，骨肉不
相亲，则齿龈之肉结缩，故齿渐长而枯燥也。肾主藏精而化血，发者血之余，肾之精气绝，故发不润泽
也。戊己，土也。肾，水也。土克水，故云戊日笃，己日死也。
足太阴气绝，则脉不荣其口唇。口唇者，肌肉之本也。脉不荣，则肌肉不滑泽；肌肉不滑泽则肉
满；肉满则唇反；唇反则肉先死。甲日笃，乙日死。
足太阴，脾脉也。脾主肌肉，脾开窍于口，其华在唇四白，脉不荣，则太阴之气绝，故肌肉不滑泽，
肉满唇反也。甲乙，木也。脾，土也。木克土，故云甲日笃，乙日死也。
足厥阴气绝，则筋缩引卵与舌。厥阴者，肝脉也。肝者，筋之合也。筋者，聚于阴器而络于舌本，
故脉不荣则筋缩急，筋缩急则引卵与舌。故舌卷卵缩，则筋
先死。庚日笃，辛日死。
足厥阴，肝脉也。其华在爪，其充在筋，其脉循阴器而络于舌本，脉不营则厥阴之气绝，故筋急
舌卷而卵缩也。庚辛，金也。肝，木也。金克木，故云庚日笃，辛日死也。
手太阴气绝，则皮毛焦。太阴者，肺也，行气温于皮毛者也。气弗荣则皮毛焦；皮毛焦，则津液
去；津液去，则皮节伤；皮节伤，则皮枯毛折。毛折者，则毛先死。丙日笃，丁日死。
手太阴，肺脉也。其华在毛，其充在皮，脉不营，则皮毛焦。肺主气，气主薰肤泽毛，太阴气绝，
故津液去，则皮枯毛折而节伤也。丙丁，火也。肺，金也。火克金，故云丙日笃，丁日死也。
手少阴气绝，则脉不通。少阴者，心脉也，心者，脉之合也。脉不通则血不流，血不流则色泽去，
故面黑如黧，此血先死。壬日笃，癸日死。
手少阴，心脉也。心主血脉，其荣色也，其华在面。心气绝，则脉不通，血不流而色泽去矣。
面黑如黧，黧，黑黄色而无润泽也，言心血不能营于面，则黄黑而无光华也。壬癸，水也。心，
火也。水克火，故云壬日笃，癸日死也。
按∶手三阴，今释太阴，少阴，而独遗手厥阴者，何也？盖包络与心同候，言心气绝，则包络
之气亦绝，其诊既同，不必别解。故《灵枢·经脉篇》亦无手厥阴之候也。
三阴气俱绝者，则目眩转，目瞑；目瞑者为失志；失志者则志先死。死即目瞑也。
三阴者，手足三阴脉，此五脏之脉也。五脏者，人之根本也。目眩者，眩乱而见之不真也。转者，目
或反背，或朝上，或左右侧也。目瞑者，盲而无所见也。此三阴气绝，精神俱去之候。失志者，人之五志，
各属一脏，肝志怒，心志喜，脾志思，肺志忧，肾志恐。今三阴已绝，五脏皆失其志，故无喜怒忧思恐，
五志俱亡，故曰失志即死也。
六阳气俱绝者，则阴与阳相离，阴阳相离，则腠理泄，绝汗乃出，大如贯珠，转出不流，则气先死。
旦占夕死，夕占旦死。
六阳者，手足三阳也。阴与阳相离者，阴阳隔绝不相附也。夫阳气卫外，则腠理密；阳气绝，
则腠理不固，阴不可独留，故毛孔皆开，阴气亦从腠理而泄矣。甚则绝汗出，大如贯珠者，言身体汗出着
肉，如缀珠而不流散。故曰贯珠也。气属于阳，阳绝，故气先死也。
按∶《灵枢·经脉篇》无三阳分候之法，止有总论六阳气绝一节，若终始篇及《素问·诊要经终论》，
俱载三阳绝候法。今既以三阴三阳为问，当引经文以证明之，补其未备。太阳之脉，其终也，戴眼反折，
螈，其色白，绝汗乃出，出则死矣。少阳终者，耳聋，百节皆纵，目HT 绝系，绝系一日半死。其死也，
色先青白，乃死矣。阳明终者，口目动作，善惊妄言，色黄，其上下经盛而不仁，则终矣。此三阳脉绝之状
也。夫太阳之气主皮毛。气绝于皮，故色白，而
绝汗出也。少阳主骨，百节尽纵，则少阳之气绝，少阳属肾，肾藏志，目系绝者，志先死矣。阳明之脉，
挟口承目，故口目动作，乃其经气欲绝也。善惊妄言，阳明之神气外出也，色黄，阳明之土气外脱也。
上下经盛，胃气绝而无柔和之象也。肌肤不仁，则营卫之气绝矣。
Chapter 24 states: When the Qi of the three Yin and three Yang meridians of the hands and feet is exhausted, what are the signs? Can their prognosis be determined?
The response is: When the Qi of the Foot Shaoyin (Kidney Meridian) meridian is exhausted, the bones become withered. Shaoyin corresponds to the winter pulse; it runs deep within and warms the bone marrow. Therefore, if the bone marrow is not warmed, the flesh cannot adhere to the bones. If the flesh and bones do not adhere closely, the flesh becomes soft and retracts. Due to this retraction of the flesh, the teeth appear elongated and dry, and the hair loses its luster. The loss of luster in the hair indicates that the Qi of the bones has died first. The condition will worsen on Wu days and death will occur on Ji days.
This passage follows up on the previous discussion that the exhaustion of Qi in the three Yin and three Yang meridians must have specific signs, citing the interleaved text from *Ling Shu: Jing Mai* (Spiritual Pivot: Meridians). The Foot Shaoyin is the Kidney meridian; the Kidney governs winter, hence it is called the winter pulse. The Kidney governs internal nourishment of the bone marrow, hence it is said to run deep and warm the bone marrow. "Ru" means soft. "Que" means retracting. When Kidney Qi is exhausted, the flesh and bones lose their connection, causing the gingival flesh to contract. Thus, the teeth gradually appear longer and dry. The Kidney stores Essence and transforms Blood; hair is considered the surplus of Blood. When the Kidney's Essence and Qi are exhausted, the hair loses its luster. Wu and Ji belong to Earth. The Kidney belongs to Water. Since Earth overcomes Water, it is stated that the condition worsens on Wu days and death occurs on Ji days.
When the Qi of the Foot Taiyin (Spleen Meridian) meridian is exhausted, the vessels fail to nourish the lips. The lips are the root of the muscles. If the vessels are not nourished, the muscles will not be smooth and lustrous. If the muscles are not smooth and lustrous, they become full and swollen. If the muscles become full and swollen, the lips will evert. If the lips evert, the Qi of the flesh dies first. The condition will worsen on Jia days and death will occur on Yi days.
The Foot Taiyin is the Spleen meridian. The Spleen governs the muscles, opens into the mouth, and its brilliance manifests in the white area around the lips. If the vessels are not nourished, it signifies the exhaustion of Taiyin Qi, resulting in muscles that are not smooth and lustrous, muscle swelling, and lip eversion. Jia and Yi belong to Wood. The Spleen belongs to Earth. Since Wood overcomes Earth, it is stated that the condition worsens on Jia days and death occurs on Yi days.
When the Qi of the Foot Jueyin (Liver Meridian) meridian is exhausted, there will be tendon contraction pulling on the scrotum and tongue. Jueyin is the Liver meridian. The Liver is the convergence of tendons. Tendons converge at the genitalia and connect to the base of the tongue. Therefore, if the vessels are not nourished, the tendons will become tight and contracted. If the tendons are tight and contracted, they will pull on the scrotum and tongue. Thus, when the tongue curls and the testicles retract, the Qi of the tendons dies first. The condition will worsen on Geng days and death will occur on Xin days.
The Foot Jueyin is the Liver meridian. Its brilliance manifests in the nails, and it nourishes the tendons. Its vessel circulates through the genitalia and connects to the base of the tongue. If the vessels do not nourish, it signifies the exhaustion of Jueyin Qi, resulting in tight tendons, a curled tongue, and retracted testicles. Geng and Xin belong to Metal. The Liver belongs to Wood. Since Metal overcomes Wood, it is stated that the condition worsens on Geng days and death occurs on Xin days.
When the Qi of the Hand Taiyin (Lung Meridian) meridian is exhausted, the skin and hair become scorched and dry. Taiyin corresponds to the Lung, which circulates Qi and warms the skin and hair. If Qi fails to nourish, the skin and hair become scorched. If the skin and hair become scorched, body fluids are lost. If body fluids are lost, the joints of the skin are damaged. If the skin joints are damaged, the skin becomes dry and hair breaks. Hair breaking indicates that the Qi of the hair dies first. The condition will worsen on Bing days and death will occur on Ding days.
The Hand Taiyin is the Lung meridian. Its brilliance manifests in the hair, and it nourishes the skin. If the vessels are not nourished, the skin and hair become scorched. The Lung governs Qi; Qi primarily steams the skin and moistens the hair. When Taiyin Lung Qi is exhausted, body fluids are lost, leading to dry skin, broken hair, and damaged joints. Bing and Ding belong to Fire. The Lung belongs to Metal. Since Fire overcomes Metal, it is stated that the condition worsens on Bing days and death occurs on Ding days.
When the Qi of the Hand Shaoyin (Heart Meridian) meridian is exhausted, the vessels become obstructed. Shaoyin is the Heart meridian; the Heart is the convergence of vessels. If the vessels are obstructed, blood does not flow. If blood does not flow, the complexion loses its luster. Consequently, the face appears black like charcoal; this indicates that the Qi of blood dies first. The condition will worsen on Ren days and death will occur on Gui days.
The Hand Shaoyin is the Heart meridian. The Heart governs blood and vessels, its brilliance is in the color, and its manifestation is on the face. When Heart Qi is exhausted, the vessels become obstructed, blood does not flow, and the complexion loses its luster. "Black like Li" refers to a dark yellow-black color without luster, meaning that Heart Blood fails to nourish the face, resulting in a dull yellow-black hue. Ren and Gui belong to Water. The Heart belongs to Fire. Since Water overcomes Fire, it is stated that the condition worsens on Ren days and death occurs on Gui days.
Note: Regarding the three Yin meridians of the hand, the Taiyin and Shaoyin are explained here, but the Hand Jueyin is omitted. Why? Because the Pericardium (Bao Luo) shares the same signs as the Heart. Stating that Heart Qi is exhausted implies that Pericardium Qi is also exhausted. Since their diagnostic methods are identical, no separate explanation is needed. Therefore, *Ling Shu: Jing Mai* also does not record signs for the Hand Jueyin meridian.
If the Qi of the three Yin meridians is completely exhausted, there will be dizziness, vertigo, and closed eyes. Closed eyes indicate the loss of Zhi (Will/Spirit); loss of Zhi indicates that the Zhi Qi dies first. Death is manifested by closed eyes.
The three Yin meridians refer to the three Yin meridians of the hand and foot, which correspond to the five Zang organs. The five Zang organs are the root of human life. Dizziness (Xuan) refers to confusion and unclear vision. "Zhuan" refers to the eyeballs turning backward, upward, or to the sides. "Ming" refers to blindness where nothing can be seen. These are signs that the Qi of the three Yin meridians is exhausted and the Spirit has departed. Loss of Zhi refers to the five emotional dispositions, each belonging to one organ: Liver governs Anger, Heart governs Joy, Spleen governs Pensiveness, Lung governs Worry, and Kidney governs Fear. Now that the three Yin meridians are exhausted, the five Zang organs have lost their respective dispositions, so there is no anger, joy, worry, pensiveness, or fear. With all five dispositions perished, it is said that loss of Zhi leads to death.
If the Qi of the six Yang meridians is completely exhausted, Yin and Yang will separate. When Yin and Yang separate, the interstices (Cou Li) will leak, and "Jue Han" (desperate sweat) will emerge. The sweat drops will be large like beads strung together, rolling out but not flowing away. This indicates that Yang Qi dies first. Predicted in the morning, death occurs in the evening; predicted in the evening, death occurs in the morning.
The six Yang meridians refer to the three Yang meridians of the hand and foot. Separation of Yin and Yang means they are isolated and do not attach to each other. Yang Qi guards the exterior, keeping the interstices dense. When Yang Qi is exhausted, the interstices are not secure, and Yin cannot remain alone. Thus, all pores open, and Yin Qi also leaks out through the interstices. In severe cases, desperate sweat emerges, large like beads, meaning the sweat adheres to the skin like attached beads without scattering. Hence, it is called "Guan Zhu" (strung beads). Qi belongs to Yang; when Yang Qi is exhausted, Yang Qi dies first.
Note: *Ling Shu: Jing Mai* does not contain methods for distinguishing the signs of the three Yang meridians separately, only a general discussion on the exhaustion of the six Yang Qi. However, *Zhong Shi* and *Su Wen: Zhen Yao Jing Zhong Lun* both record the signs of exhaustion for the three Yang meridians. Since the question concerns the three Yin and three Yang, scriptural citations should be used to prove this and supplement the incomplete sections. When the Taiyang meridian reaches its end, there is retroversion of the eyes, opisthotonos, convulsions, pale complexion, and emergence of desperate sweat; once the sweat emerges, death ensues. When the Shaoyang meridian reaches its end, there is deafness, flaccidity of all joints, and severance of the visual system; severance of the visual system leads to death in one and a half days. At death, the complexion turns blue-white before death. When the Yangming meridian reaches its end, there are movements of the mouth and eyes, frequent fright, delirious speech, yellow complexion, and fullness in the upper and lower channels with insensitivity of the skin; this marks the end. These are the states of exhaustion of the three Yang meridians. Taiyang Qi governs the skin and hair. Exhaustion of Qi in the skin results in a pale complexion and desperate sweat. Shaoyang governs the bones; complete flaccidity of all joints indicates exhaustion of Shaoyang Qi. Shaoyang is affiliated with the Kidney, which stores Zhi; severance of the visual system indicates that Zhi Qi dies first. The Yangming meridian flanks the mouth and supports the eyes; thus, movements of the mouth and eyes indicate the impending exhaustion of its channel Qi. Frequent fright and delirious speech represent the outward escape of Yangming Shen (Spirit); a yellow complexion represents the outward escape of Yangming Earth Qi. Fullness in the upper and lower channels indicates exhaustion of Stomach Qi without any sign of gentleness. Insensitivity of the skin and flesh indicates exhaustion of Ying and Wei Qi.