黄帝问于岐伯曰。余闻虚实。以决死生。愿闻其情。岐伯曰。五实死。五虚死。（人之所病。五实具有者。不
泄当死。所病五虚具有者。不下食当死也。）黄帝曰。何谓五实、五虚。岐伯曰。脉盛其皮热。腹胀前后不通HT
瞀。此谓五实。（人迎脉口脉大洪盛一实也。皮肤温热。阳盛二实也。心腹胀满。三实也。大小便不通。四实也。
闷瞀不醒。五实也。HT 音闷瞀木。候反HT 目也。）脉细。皮寒。气少。泄注利。前后饮食不入。此谓五虚。（人
迎脉口脉少细一虚也。皮肤寒冷。阳虚。二虚也。心腹少气。三虚也。大小便利。四虚也。饮食不下。五虚也。）
黄帝曰。其时有生者。何也。岐伯曰。浆粥入胃。泄注止。则虚者活。（浆是谷液。为粥止利具。有五虚。粥得入
胃。即虚者可生也。）身汗得后利。则实可活。此其候也。（服药发汗。或利得通。则实者可活也。）黄帝问岐伯曰。
愿闻虚实之要。（虚实是死生之本。故为要也。）岐伯对曰。气实形实。气虚形虚。此其常也。反此者病。（气谓卫
气也。形身也。）谷盛气盛。谷虚气虚。此其常也。反此者病。（食多入胃。曰谷盛也。胃气多。曰气盛也。）脉实
血实。脉虚血虚。此其常也。反此者病。（脉谓。人迎寸口脉也。血谓。经络血也。）黄帝曰。如何而反。岐伯曰。
气虚身热。此谓反。（卫气虚者。阴乘必身冷。今气虚。其身更热。故为逆也。）谷入气少。此谓反谷。不入气多。
此谓反。（食多入胃者。胃气还多。食不入胃。胃气还少。此为顺也。食多入胃。胃气反少。食不入胃。胃气反多。
此为逆也。）脉盛血少。此谓反脉。少血多。此谓反。（寸口人迎脉盛。经络血盛。寸口人迎脉少。经络血少此为顺
也。寸口人迎脉盛。而血反少。寸口人迎脉少。而经络血多此为逆也。）气盛身寒者。病得之。伤寒气虚。身热者。
得之伤暑。（卫气盛者。其身当热。今反身冷。此以伤寒所致也。卫气虚者。其身当冷今反热者。此以伤热所致也。）
谷多而气少者。得之有所脱血。居湿下也。（多食。当噫胃气多也。而反少者。此为脱血。虚劣安卧处湿。湿伤脾
气。故少气也）谷入少气多者。邪在胃及与肺也。（食少当胃气少也。而反多者。因胃及肺受于邪气。以为呼吸故
气多也。）脉小血多者。饮中热也。（寸口人迎脉小。络络之血当少。今反多者。因伤热饮。故经络血盛也。）脉大
血少者。脉有风气。水浆不入。此之谓也。（寸口人迎脉大。经脉之血应多。今反少者。因脉有邪气。浆水之液。
不得入脉。故血少也。）夫实者。气入也。夫虚者。气出也。（以下方刺之法。邪气入中。为实也。正气出中为虚也。）
地实者。热也。地虚者。寒也。（地者行于补泻。病之处者也。以手扪循其地。热者所病。即实可行泻也。其地冷
者。所病即虚。宜行补也。）入实者。左手开针空。（左手以针刺入。于实行其泻已可。徐出针用左手开其针空。令
气得出。以为泻也。）入虚者。左手闭也。（右手刺入。于虚行其补已。可疾出针用。左手闭其针空。使气不出。以
为补也。）黄帝问曰。何谓虚实。岐伯答曰。邪气盛。则实。精气夺。则虚。（风寒暑湿。客身盛满为实。五脏精气
夺。失为虚也。）何谓重实曰。所谓重实者。言大热。病气热脉满。是谓重实。（伤寒热病。大热曰实。经络盛。满
故曰重实也。）问曰。经络俱实。如何。何以治之。答曰。经络皆实。是络急而尺缓也。皆当俱治之。故曰滑。则
顺涩则逆。（脉寸口阳也。尺脉阴也。脉急寒多也。尺缓热多也。寸口是阳。今反急寒尺地。是阴冷反为热。是为
经络皆实可俱。泻之经络虽实。脉滑气盛为顺。易已脉涩气少为逆。难已也。）夫虚实者。皆从其物类。终始五脏
骨肉滑利。可以长久。（万物之类。虚实终始。皆滑利和调。物得久生也。是以五脏六腑筋脉骨肉柔弱滑利。可以
长生。故曰。柔弱者生之徒者也。）问曰。寒气暴上脉满。实如何。答曰。实如滑。则生实。如逆。则死矣。（虽实
柔滑可生也。实而寒。温涩死之徒也。）问曰。其形尽满何如。答曰。举形尽满者。脉急大坚。尺满而不应也。如
是者。顺则生。逆则死。（举身满闷曰。形尽满也。寸口之脉。寒气盛。坚然尺脉。不应其满闷。然手足温者。顺
疗之易已。故生手足寒者。逆故死也。）问曰。何谓顺则生。逆则死。答曰。所谓顺者。手之温也。所谓逆者。手
足寒也。（寒气满身。手足冷者。阳气尽。故死。手足温者。阳气在四体渐来。通阳气和。则生。）问曰。乳子而病。
热脉悬小者。何如。答曰。足温则生。寒则死。（乳子病。热脉应浮滑而反悬。小者足温气下。故生足寒气不下。
逆者而致死也。）问曰。乳子中风。病热者喘鸣。肩息者何如。答曰。喘鸣肩息者。脉实大也。缓则生。急则死。（乳
子中风。病热气多。血少得脉。缓热宣泄。故生得急。为寒不泄。故死也。）问曰。何谓重虚。答曰。脉气虚。尺
虚是谓重虚也。（寸口脉虚。尺地及脉不虚。故曰重虚也。）问曰。何以知之。答曰。所谓气虚者。言无常也。尺虚
者。行步 然也。脉虚者。不象阴也。（ HT 方。反怯也。谓行步虚。怯然也。重虚者。何以知其候也。膻中气
虚。不足令人无言志。定诊得尺脉虚者。阴气不足。腰脚有病。故行步不正也。诊得寸口之脉虚。则手太阴肺虚。
阴气不足。故曰不象也。）问曰。如此者。何如答曰。滑则生。涩则死。（寸口虽不得太阴。和脉而得温滑者。生寒
涩者。死也。）问曰。肠 便血何如。答曰。身热则死。寒则生。（血虚阳乘故死。血未甚虚。其身犹寒。所以得生
也。）问曰。肠 下白沫何如。答曰。脉沉则生。脉浮则死。（脉沉阴气犹在。故生脉浮阴尽。阳乘故死也。）问曰。
肠下脓血何如。答曰。脉悬绝则死。滑大则生。（脉悬绝阳气尽绝也。故死。滑大气盛。犹温也。故生也。）问曰。
肠之病。身不热。何如。答曰。身不热。脉不悬绝。滑大皆曰生。悬涩皆曰死。以藏期之。（脉不悬绝。阴气犹
在。滑大是阳气盛好。故生。其脉悬绝涩为寒。是为阳绝。以其脏之病。次传为死期也。）问曰。癫疾何如。答曰。
脉搏大。滑久自已。脉小坚急。死不治。（大者气多。血少滑者。气盛微热。以其气盛微热故久。自瘥脉小气血俱
少。坚急为寒。是则阳虚阴乘故死之。）问曰。癫疾之脉虚实何如。答曰。虚则可治。实则死。（癫疾阳盛病也。故
阳脉盛。而实者不离于死。阳虚阴和故可疗也。）问曰。消瘅虚实何如。答曰。脉实大病久可治。脉悬小坚病久不
可治死。（脉实又气多血少病。虽久可疗其脉悬绝。血气俱少。又脉坚病。久不可疗当死。）问曰。虚实何如。答曰。
气虚者肺虚也。气逆足寒。非其时则生。当其时则死。余藏皆如是也。（气虚者肺气虚也。脉虚故足寒。寒为气逆
也。秋时肺王肺气虚者为死。余时肺气虚不死。如有肝气虚肝。气逆者足逆冷。当春时肝气王时虚者。为死非其时
为生。如此余脏以为例也。）问曰。脉实满手足寒头热何如。答曰。春秋则生。冬夏则死。（下则阳虚阴盛。故手足
冷也。上则阴虚阳盛。故头热也。春之时阳气未大秋时。阴气未盛。各处其和。故病者。遇之得生夏日阳盛阴格则
头热加病也。冬时阴盛阳闭手足冷者。益甚也。故病遇此时。即死也。）
Huangdi asked Qibo: I have heard that by determining deficiency and excess, one can decide life and death. I wish to hear the details. Qibo replied: If five signs of excess are present, death ensues; if five signs of deficiency are present, death also ensues. (If a patient presents with all five signs of excess and does not evacuate, they will die. If a patient presents with all five signs of deficiency and cannot take food, they will die.) Huangdi asked: What are the five excesses and five deficiencies? Qibo said: A surging pulse, hot skin, abdominal distension, obstruction of both bowels and bladder, and dizziness/blurred vision. This is called the five excesses. (A surging and full Renying and Cun Kou pulse is the first excess; warm skin indicates Yang excess, the second excess; abdominal distension is the third excess; obstruction of stool and urine is the fourth excess; dizziness and unconsciousness is the fifth excess. HT "Mao" refers to blurred vision.) A fine pulse, cold skin, shortness of breath, diarrhea like water, and inability to eat or drink despite patent bowels and bladder. This is called the five deficiencies. (A fine and weak Renying and Cun Kou pulse is the first deficiency; cold skin indicates Yang deficiency, the second deficiency; shortness of breath in the heart and abdomen is the third deficiency; patent stool and urine is the fourth deficiency; inability to ingest food is the fifth deficiency.) Huangdi asked: Sometimes there are cases of survival among these. Why is this? Qibo said: If gruel enters the stomach and diarrhea stops, the deficient patient will live. (Gruel refers to grain liquid; making it into porridge helps stop diarrhea. If the five signs of deficiency are present but porridge can enter the stomach, the deficient patient can survive.) If the body sweats and bowels and bladder become unobstructed, the excess patient will live. These are the signs of survival. (After taking medicine to induce sweating, or if bowel and bladder functions become unobstructed, the excess patient can survive.) Huangdi asked Qibo: I wish to hear the essentials of distinguishing deficiency and excess. (Deficiency and excess are the root of life and death, hence they are termed essential.) Qibo answered: When Qi is excess, the form is solid; when Qi is deficient, the form is weak. This is the normal state. The opposite indicates disease. (Qi refers to Wei Qi; Form refers to the body.) Abundant food intake leads to abundant Qi; scant food intake leads to scant Qi. This is the normal state. The opposite indicates disease. (Food entering the stomach abundantly is called abundant Grain; abundant Stomach Qi is called abundant Qi.) A surging pulse indicates abundant Blood; a fine pulse indicates scant Blood. This is the normal state. The opposite indicates disease. (Pulse refers to Renying and Cun Kou pulses; Blood refers to Blood in the collaterals and vessels.) Huangdi asked: How does one identify the opposite? Qibo said: Scant Qi with body heat is called contrary. (When Wei Qi is deficient, Yin encroaching causes coldness; now, with Qi deficiency, the body is hot, thus it is contrary.) Eating much but having scant Qi is called contrary regarding Grain; eating little but having abundant Qi is also called contrary. (Much food entering the stomach should result in abundant Stomach Qi; no food entering should result in scant Stomach Qi. This is compliant. Much food entering but Stomach Qi being scant, or no food entering but Stomach Qi being abundant, is non-compliant/contrary.) A surging pulse with scant Blood is called contrary regarding Pulse; scant Blood with a surging pulse is also called contrary. (Surging Renying and Cun Kou pulses should correspond to abundant collateral Blood; fine Renying and Cun Kou pulses should correspond to scant collateral Blood. This is compliant. Surging pulses with scant Blood, or fine pulses with abundant Blood, are non-compliant/contrary.) Excess Qi with cold body indicates contraction from Cold; Deficient Qi with body heat indicates contraction from Heat. (Abundant Wei Qi should cause heat; now coldness indicates it is caused by Cold Injury. Deficient Wei Qi should cause cold; now heat indicates it is caused by Heat Injury.) Eating much but having scant Qi results from blood loss or dwelling in damp, low places. (Eating much should mean abundant Stomach Qi; scarcity here implies blood loss. Weakness lying in dampness damages Spleen Qi, causing scant Qi.) Eating little but having abundant Qi occurs when pathogenic factors are in the Stomach and Lung. (Eating little should mean scant Stomach Qi; abundance here is due to pathogens in Stomach and Lung causing rapid breathing.) A small pulse with abundant Blood results from drinking hot substances. (Small Renying and Cun Kou pulses should indicate scant collateral Blood; abundance here is due to injury from hot drinks causing abundant vessel Blood.) A large pulse with scant Blood occurs when Wind pathogen is in the pulse and fluids cannot enter. This is described as such. (Large Renying and Cun Kou pulses should indicate abundant vessel Blood; scarcity here is due to pathogens in the pulse preventing fluids from entering, resulting in scant Blood.) Excess is Qi entering; deficiency is Qi exiting. (Regarding acupuncture methods below: Pathogen entering interior is Excess; Healthy Qi exiting interior is Deficiency.) Local sensation of Excess (Heat) indicates Heat syndrome; local sensation of Deficiency (Cold) indicates Cold syndrome. ("Earth" refers to the site for tonification or sedation, i.e., the diseased area. Palpating this area: if hot, the disease is Excess and sedation may be applied; if cold, the disease is Deficient and tonification is suitable.) For treating Excess, open the needle hole with the left hand. (Insert needle with left hand, apply sedation for Excess, withdraw slowly, and use left hand to open the needle hole to allow Qi/Evil to exit, constituting sedation.) For treating Deficiency, close the needle hole with the left hand. (Insert needle with right hand, apply tonification for Deficiency, withdraw quickly, and use left hand to close the needle hole to prevent Qi from escaping, constituting tonification.) Huangdi asked: What are deficiency and excess? Qibo answered: When pathogenic Qi is flourishing, it is Excess; when Essence and Qi are depleted, it is Deficiency. (Wind, Cold, Summer-heat, Dampness invading and filling the body constitute Excess; depletion of Five Zang Essence constitutes Deficiency.) What is called Heavy Excess? It is said that Heavy Excess refers to high fever, intense pathological heat, and a full pulse. This is Heavy Excess. (In Cold Damage febrile diseases, high fever is Excess; full collaterals and vessels make it Heavy Excess.) Question: What if both collaterals and vessels are Excess? How to treat? Answer: Both collaterals and vessels being Excess manifests as tight collaterals and a slow Chi pulse. Both should be treated. Thus, slippery pulse is compliant, choppy pulse is non-compliant. (Cun Kou pulse is Yang, Chi pulse is Yin. Tight pulse indicates more Cold; slow Chi indicates more Heat. Cun Kou is Yang, but now tight (Cold); Chi (Yin) is cold but shows Heat. This is Excess in both collaterals and vessels, which can be sedated. Although vessels are Excess, a slippery pulse with abundant Qi is compliant and easy to cure; a choppy pulse with scant Qi is non-compliant and difficult to cure.) Deficiency and excess follow the categories of things. If the Five Zang and bones/flesh remain slippery and smooth, longevity is possible. (The beginning and end of deficiency and excess in all things are slippery and harmonious, allowing long life. Thus, if Five Zang, Six Fu, sinews, vessels, bones, and flesh are soft and slippery, one can live long. Hence, "softness belongs to the living.") Question: What if Cold Qi suddenly ascends and the pulse is full and Excess? Answer: If the pulse is slippery, life; if the pulse is non-compliant/choppy, death. (Although Excess, if soft and slippery, life can be preserved; if Excess with Cold and choppy, it is a death case.) Question: What if the entire form is full/distended? Answer: Full distension of the whole body presents with a tight, large, and firm pulse, where the Chi pulse is full but does not respond appropriately. In such cases, compliance brings life, non-compliance brings death. (Full body distension is called "Form Fully Full". Cun Kou pulse is firm due to abundant Cold Qi; Chi pulse does not match the distension. If hands and feet are warm, it is compliant, easy to cure, thus life; if hands and feet are cold, it is non-compliant, thus death.) Question: What is meant by compliance bringing life and non-compliance bringing death? Answer: Compliance means warm hands; non-compliance means cold hands and feet. (Cold Qi pervading the body with cold hands and feet means exhaustion of Yang Qi, thus death. Warm hands and feet mean Yang Qi is returning to the four limbs, harmonizing Yang Qi, thus life.) Question: An infant has a disease with fever and a suspended-small pulse. What happens? Answer: Warm feet bring life; cold feet bring death. (Infant with fever should have a floating-slippery pulse but instead has a suspended-small one. If feet are warm, Qi descends, thus life; if feet are cold, Qi does not descend, non-compliant, thus death.) Question: An infant contracts Wind, has fever, wheezing with sound, and shoulder-lifting respiration. What happens? Answer: Wheezing with sound and shoulder-lifting respiration present with an Excess-large pulse. Slow pulse brings life; rapid/tight pulse brings death. (Infant contracting Wind with abundant Heat and scant Blood gets a slow pulse, Heat vents, thus life; getting a tight pulse means Cold does not vent, thus death.) Question: What is Heavy Deficiency? Answer: Deficient Qi pulse and deficient Chi pulse is called Heavy Deficiency. (Cun Kou pulse is deficient, but Chi and pulse are not, hence Heavy Deficiency.) Question: How to know this? Answer: Qi deficiency manifests as speechlessness; Chi deficiency manifests as unsteady gait; pulse deficiency manifests as not resembling Yin characteristics. (HT Fang, meaning timid. Gait is timid. How to identify Heavy Deficiency signs? Chest Qi deficiency causes inability to speak clearly. Diagnosing deficient Chi pulse indicates insufficient Yin Qi, leading to waist/leg issues and unsteady gait. Diagnosing deficient Cun Kou pulse indicates Hand Taiyin Lung deficiency and insufficient Yin Qi, hence "not resembling".) Question: What happens in such cases? Answer: Slippery pulse brings life; choppy pulse brings death. (Even if Cun Kou lacks Taiyin harmony, a warm-slippery pulse indicates life; Cold-choppy indicates death.) Question: Intestinal discharge with blood, what happens? Answer: Body heat brings death; body cold brings life. (Blood deficiency with Yang encroachment leads to death; Blood not severely deficient, body still cold, thus life.) Question: Intestinal discharge with white foam, what happens? Answer: Deep pulse brings life; superficial pulse brings death. (Deep pulse means Yin Qi remains, thus life; superficial pulse means Yin exhausted, Yang encroaches, thus death.) Question: Intestinal discharge with pus and blood, what happens? Answer: Suspended-extinct pulse brings death; slippery-large pulse brings life. (Suspended-extinct pulse means Yang Qi exhausted, thus death; slippery-large means Qi abundant and still warm, thus life.) Question: Intestinal disease, body not hot, what happens? Answer: Body not hot, pulse not suspended-extinct, slippery-large indicates life; suspended-choppy indicates death. Predict based on Zang timing. (Pulse not suspended-extinct means Yin Qi remains; slippery-large means Yang Qi is good, thus life. Suspended-choppy is Cold, indicating Yang extinction. Based on the Zang disease transmission, predict the time of death.) Question: Epilepsy, what happens? Answer: Large, slippery pulse, self-heals after a long time; small, firm-tight pulse, death, untreatable. (Large means abundant Qi, scant Blood; slippery means Qi abundant with slight Heat. Due to abundant Qi and slight Heat, it heals itself over time. Small pulse means both Qi and Blood are scant; firm-tight indicates Cold, Yang deficiency with Yin encroachment, thus death.) Question: What about Excess/Deficiency of epilepsy pulse? Answer: Deficient is treatable; Excess is fatal. (Epilepsy is a Yang-excess disease. Thus, abundant Yang pulse and Excess condition leads inevitably to death; Yang deficiency and Yin harmony allows treatment.) Question: What about Excess/Deficiency of Xiao Dan (Wasting-Thirst)? Answer: Excess pulse with long-standing disease is treatable; suspended-small-firm pulse with long-standing disease is untreatable and fatal. (Excess pulse with abundant Qi and scant Blood, though long-standing, is treatable; suspended-extinct pulse with scant Qi and Blood, plus firm pulse in long-standing disease, is untreatable and fatal.) Question: What about Excess/Deficiency? Answer: Qi deficiency is Lung deficiency. Qi rebellion with cold feet: life if not in its season, death if in its season. Other Zangs are similar. (Qi deficiency is Lung Qi deficiency. Pulse deficiency causes cold feet. Cold indicates Qi rebellion. In Autumn, when Lung is Wang, Lung Qi deficiency leads to death; in other seasons, Lung Qi deficiency does not lead to death. Similarly, Liver Qi deficiency with rebellious Qi and cold feet: in Spring, when Liver is Wang, deficiency leads to death; in other seasons, life. Other Zangs follow this example.) Question: Pulse Excess-full, cold hands and feet, hot head, what happens? Answer: Life in Spring/Autumn, death in Winter/Summer. (Lower part Yang deficient and Yin excess causes cold hands/feet. Upper part Yin deficient and Yang excess causes hot head. In Spring, Yang Qi not yet great; in Autumn, Yin Qi not yet abundant. Each is in harmony, so the patient survives. In Summer, Yang is abundant and Yin repelled, adding to head heat. In Winter, Yin is abundant and Yang closed, worsening cold hands/feet. Thus, encountering illness at these times leads to death.)