岐伯曰。天地相感。寒暖相移。阴阳之道。孰少孰多。阴道偶。阳道奇。发于春夏。阴气少。
阳气多。阴阳不调。何补何泻。发于秋冬。阳气少。阴气多。阴气盛而阳气衰。故茎叶枯槁。湿雨
下归。阴阳相移。何泻何补。奇邪离经。不可胜数。不知根结。五脏六腑。折关败枢。开阖而走。
阴阳大失。不可复取。九针之玄。要在终始。故能知终始。一言而毕。
不知终始。针道咸绝。（奇音箕）
此章论三阴三阳之气。主开主阖主枢。乃无形之气。出入于外内。而合于有形之经也。夫人之
阴阳。应天之六气。天之六气。合于四时。春夏主阳。故发于春夏。阴气少。阳气多。秋冬主阴。
故发于秋冬。阳气少。阴气多。发者。谓人之阴阳开阖。应天地之四时。是以春夏人迎微大。秋冬
寸口微大。如是者是为平人。奇邪离经者。邪不入于经。流于大络。而生奇病。言邪之变易。不可
胜数也。根结者。六气合六经之本标也。开阖枢者。脏腑阴阳之六气也。终始者。经脉血气之始
终也。
太阳根于至阴。结于命门。命门者目也。阳明根于厉兑。结于颡大。颡大者钳耳也。少阳根于
窍阴。结于葱笼。葱笼者耳中也。太阳为开。阳明为阖。少阳为枢。故枢折则肉节渎而暴疾起矣。
故暴病者。取之太阳。视有余不足。渎者。皮肤宛焦而弱也。阖折则气无所止息而痿疾起矣。故痿疾者。
取之阳明。视有余不足。无所止息者。真气稽留。邪气居之也。枢折。即骨徭而不安于地。故骨徭
者取之少阳。视有余不足。骨徭者。节缓而不收也。所谓骨徭者。摇故也。当穷其本也。（徭与皋
陶陶字同音）
太阳太阴为开。阳明厥阴为阖。少阳少阴为枢者。三阴三阳之气也。太者气之盛。故主开。阳
明者。两阳合明。厥阴者。两阴交尽。故主阖。少者初生之气。故主枢。此阴阳之六气。内合脏腑。
外合六经。应司天在泉之气。营运环转之不息。而复通贯于地道经水之中。外内出入者也。夫外合
于六经。有循经而合者。如伤寒之病。在六气相传。虽见六经之证。而气不入于经也。有入于经而
合者。根结是也。根者。经气相合而始生。结者。经气
相将而归结于命门葱笼之间。复从此而出于气街。走空窍而仍行于脉外也。命门者。太阳为水火生
命之原。目窍。乃经气所出之门也。颡大者。颃颡也。在上 之中。两耳之间。故曰钳耳。葱笼者。
耳中也。如葱之通气于上也。此三阳之气。随经而归结于此。复出于气街也。行于气分。故能为开
为阖为枢。出入于形身脏腑之外内。开阖如户扉。枢犹转纽。舍枢则不能开阖。舍开阖则无从运枢。
此三阳之气。互相出入于经脉皮肤。形身脏腑之外内者也。太阳之气主皮肤。故开折则肉节渎而暴
疾起矣。宗气者。阳明之所生。上出于喉以司呼吸。而行于四肢。故阖折则气无所止息。而痿疾起
矣。少阳主骨。故枢折则骨节缓而不收也。阴阳离合论曰。太阳根起于至阴。名曰阴中之阳。阳
明根起于厉兑。名曰阴中之阳。少阳根起于窍阴。名曰阴中之少阳。三阴三阳之气。皆从阴而生。
自下而上。故当穷其本也。玉师曰。三阳之气。循经而出于气街。上于面而走空窍。太阳精阳之气。
上走于目而为睛。少阳之别气。走于耳而为听。阳明之宗气。上出于鼻而为臭。目之开阖。耳之
听闻。鼻之呼吸。是三阳之气。上走于空窍。而为开阖枢也。宗气者。阳明之所生。上出于肺。
以司呼吸。颃颡者。鼻之内窍。通于喉咙。故颃颡不开。则洞涕不收。是阳明之气。上出于鼻而
为臭。
太阴根于隐白。结于太仓。少阴根于涌泉。结于廉泉。厥阴根于大敦。结于玉英。络于膻中。
太阴为开。厥阴为阖。少阴为枢。故开折则仓廪无所输。膈洞。膈洞者。取之太阴。视有余不足。
故开折者。气不足而生病也。阖折则气绝而喜悲。悲者取之厥阴。视有余不通。枢折则脉有所结而
不通。不通者取之少阴。视有余不通。有结者皆取之不足。
太仓者。舌本也。脾为仓廪之官。其脉连舌本。散舌下。使之迎粮。故结于舌本。名曰太仓。
廉泉。任脉穴。在喉上四寸中央。任脉发原于肾。故结于肾之廉泉。卫气篇曰。厥阴标为背俞。
是玉英当在背俞之间。络于膻中者。肝脉贯膈也。脾为仓廪之居。故开折则气不足而为膈洞。膈者。
上不开而不受纳。洞者。下关折而飧泄也。厥阴为两阴交尽。阴尽而一阴始生。故阖折则生气绝
而喜悲。一阳之气发于肾脏。志不舒故喜悲也。少阴主脉。故枢折则脉有所结而不通。不通者取
之少阴。视有余不足。有结者皆取之不足。盖有余者。邪结之有余。不足者。正气之不足。通其
正气。则结自解矣。按九针篇。缺盆之中任脉也。颈中央之脉。督脉也。腋内动脉。手太阴也。腋
下三寸。手心主也。盖手太阴心主。出于胸气之街。少阴厥阴。从任督二脉。出于头气之街也。玉
师曰。廉泉玉英。上液之道也。玉英。谓唇内之龈交。盖肾脏之精液。一从任脉而出于舌下之廉
泉。一从脊骨髓空而上通于脑。脑空在脑后三分。颅际锐骨之下。一在龈基下。一在项后伏骨下。
一在脊骨上空。在风府上。是骨之精髓。从脊骨上空。上通于脑。而下渗于龈基。督脉循于脊骨。
厥阴肝脉。与督脉上会于巅而下玉英。英、HT 也。谓齿白如玉HT 也。
足太阳根于至阴。溜于筋骨。注于昆仑。入于天柱飞扬也。足少阳根于窍阴。溜于丘墟。注
于阳辅。入于天容光明也。足阳明根于厉兑。溜于冲阳。注于大陵。入于人迎丰隆也。手太阳根于
少泽。溜于阳谷。注于少海。入于天窗支正也。手少阳根于关冲。溜于阳池。注于支沟。入于天
牖外关也。手阳明根于商阳。溜于合谷。注于阳溪。入于扶突偏历也。此所谓十二经者。盛络皆
当取之。
上章统论三阴三阳之气。合于六经。根于下而结于上。此复分论三阳之气。入于手足之经。
皆循颈项而上出。故曰此十二经者。盛络皆当取之。盖气留于脉络。则络盛。取而泻之。使三阳之
气。仍上出于脉外也。飞扬、光明、丰隆、支正、外关、偏历。在经穴合穴两者之间。夫曰所入
为合者。谓脉外之气血。从井而溜于脉中。至肘膝而与脉内之血气相合。故曰脉入为合。此论三阳
之气。从井而入于脉中。上入于颈项之天柱、天容、人迎、天窗、天牖、扶突、而上出于头面。与
血气之溜于荥。注于输。行于经。入于合者之不同。故另提曰。飞扬、光明、丰隆、支正。盖以
分别阳气与荣血。出入于经脉外内之不同也。是以所论一次脉二次脉者。谓手足之十二经脉。皆
从四肢之五输而归于中。复从中而上出颈项。
此章论三阴三阳之气。合于六经而复出于脉外。五十二篇论荣气。七十一篇论宗气。盖三阴三
阳荣气宗气。相将而行于经脉皮肤。形身脏腑外内出入。环转无端。是以数篇辞句相同。而所论
者各别。学人分而论之。合而参之。人之阴阳血气。有形无形。应天地之五运六气。寒暑往来。
如桴鼓应响之相合也。
一日一夜五十营。以营五脏之精。不应数者。名曰狂生。所谓五十营者。五脏皆受气。持其
脉口。数其至也。五十动而不一代者。五脏皆受气。四十动一代者。一脏无气。三十动一代者。
二脏无气。二十动一代者。三脏无气。十动一代者。四脏无气。不满十动一代者。五脏无气。予之
短期。要在终始。所谓五十动而不一代者。以为常也。以知五脏之期。予之短期者。乍数乍疏也。
（首数字去声次数字上声末数字叶朔予与同）
此言三阴三阳之气。外循于经脉。内荣于五脏。五脏主藏精者也。气营五脏之精。五脏皆以
受气。精气之相合也。夫五脏生于五行。五行之气。本于十干合化。是以五脏五十动而不一代者。以为常也。代
者。止而不还也。乍数乍疏者。死脉见也。要在终始者。大要在终始篇之生于六气。而死于六经
也。
黄帝曰。逆顺五体者。言人骨节之大小。肉之坚脆。皮之浓薄。血之清浊。气之滑涩。脉之
长短。血之多少。经络之数。余已知之矣。此皆布衣匹夫之事也。夫王公大人。血食之君。身体
柔脆。肌肉软弱。血气 悍滑利。其刺之徐疾浅深多少。可得同之乎。岐伯答曰。膏粱菽藿之味。
何可同也。气滑即出疾。其气涩则出迟。气滑则针小而入浅。气涩则针大而入深。深则欲留。浅则欲
迟。以此观之。刺布衣者。深以留之。刺大人者。微以徐之。此皆因气 悍滑利也。
此言三阴三阳。本于五谷五畜五菜五味之所生也。逆顺五体者。谓三阴三阳之气。出入于皮
肤经脉之外内。交相逆顺而行。有疾有徐也。夫行于脉外之皮薄肉脆者则行疾。皮浓肉坚者则行
迟。行于脉中之血清脉短者则出疾。血浊脉长者则出迟。此因有形之皮肉血脉而疾迟也。然又有
因于无形而为之疾迟者。气之滑涩也。膏、谓膏肥之浓味。粱、稻也。王公贵人。美其食。浓其
味。则肌肉柔弱。血气滑利而行疾。山野之人。啜菽茹藿。则其气涩而行迟。此贵贱所秉之气不
同。而气生于味也。黄载华曰。皮浓肉坚。血气和缓者多寿。皮薄肉弱。血气 悍者少寿。王公
大人。膏粱浓味。则身体柔脆。肌肉软弱。血气 悍滑利。不若田野之人。饮食淡薄之多寿也。
此勉富贵之人。当节饮食。不宜过于浓味。
黄帝曰。形气之逆顺奈何。岐伯曰。形气不足。病气有余。是邪胜也。急泻之。形气有余。
病气不足。急补之。形气不
足。病气不足。此阴阳气俱不足也。不可刺之。刺之则重不足。重不足则阴阳俱竭。血气皆尽。
五脏空虚。筋骨髓枯。老者绝灭。少者不复矣。形气有余。病气有余。此谓阴阳俱有余也。当泻
其邪。调其虚实。故曰有余者泻之。不足者补之。此之谓也。故曰刺不知逆顺。真邪相搏。满而补
之。则阴阳四溢。肠胃充郭。肝肺内 。阴阳相错。虚而泻之。则经脉空虚。血气竭枯。肠胃HT 辟。
皮肤薄着。毛腠夭焦。予之死期。故曰用针之要。在于知调阴与阳。调阴与阳。精气乃光。合神
与气。使神内藏。故曰上工平气。中工乱脉。下工绝气危生。故曰下工。不可不慎也。必审五
脏变化之病。五脉之应。经络之实虚。皮之柔脆。而后取之也。
形气。谓皮肉筋骨之形气。病气。谓三阴三阳之经气。为邪所病也。病气之有余不足者。阴
阳血气之实虚也。邪气胜者急泻之。血气虚者急补之。刺者所以取气也。故阴阳气俱不足者。不可
刺之。血气皆尽。五脏空虚者。血气之内荣于五脏也。筋骨髓枯者。血气之外濡于筋骨也。阴阳
俱有余者。当泻其邪。调其虚实。盖邪之所凑。其正必虚。故当泻其邪。而兼调正气之虚实也。满
而补之。则阴阳四溢。溢于外也。肠胃充郭。肝肺内 。溢于内也。外内皆溢。则阴阳相错矣。HT 、
虚怯也。辟、僻积也。血气盛则充肤热肉。血独盛则淡渗皮肤。生毫毛。
经脉空虚。血气竭枯。是以肠胃HT 辟。皮肤薄着。毛腠夭焦。而可与之死期矣。调阴与阳。
精气乃光。阴阳精气之相合也。合形与气。使神内藏。形气为神之外固也。言能调其阴阳。则精
神形气。外华而内藏矣。夫三阴三阳之经气。有因于外邪所伤者。有因于五脏之病而变应于脉者。
故当审其外内虚实而调之。斯可为上工也。
Qibo said: Heaven and Earth interact with each other, and cold and warmth shift alternately. Regarding the principles of Yin and Yang, which is less and which is more? The principle of Yin is even (couple), and the principle of Yang is odd (single). In spring and summer, Yin Qi is scarce and Yang Qi is abundant; if Yin and Yang are not harmonious, how should one tonify or drain? In autumn and winter, Yang Qi is scarce and Yin Qi is abundant; when Yin Qi is excessive and Yang Qi declines, the stems and leaves wither. Rain and dampness descend and return to the earth; as Yin and Yang Qi shift, what should be drained and what should be tonified? Strange pathogens deviate from the meridians, and their variations are countless. If one does not understand the Root and Knot theory, the Five Zang and Six Fu organs will suffer broken gates and ruined pivots, their opening and closing functions will fail, and Qi will scatter. This leads to a major loss of Yin and Yang, which cannot be treated with acupuncture. The mystery of the Nine Needles lies in knowing the Beginning and End. Therefore, if one knows the Beginning and End, the entire principle can be summarized in one sentence. If one does not know the Beginning and End, the Dao of acupuncture is completely cut off. ("Qi" is pronounced like "Ji").
This chapter discusses the Qi of the Three Yin and Three Yang, which govern the functions of Opening (Kai), Closing (He), and Pivot (Shu). This is formless Qi that enters and exits the interior and exterior, merging with the有形 (form) meridians. Human Yin and Yang correspond to the Six Qi of Heaven. The Six Qi of Heaven correspond to the Four Seasons. Spring and Summer govern Yang, so in these seasons, Yin Qi is scarce and Yang Qi is abundant. Autumn and Winter govern Yin, so in these seasons, Yang Qi is scarce and Yin Qi is abundant. "Fa" (emergence) refers to the human body's Yin-Yang opening and closing functions responding to the Four Seasons of Heaven and Earth. Thus, during spring and summer, the Renying pulse is slightly enlarged; during autumn and winter, the Cun Kou pulse is slightly enlarged. Such individuals are considered healthy (Ping Ren). "Strange pathogens deviating from meridians" means that pathogens do not enter the regular meridians but flow into the large collaterals, generating strange diseases, indicating that the changes of pathogens are unpredictable and countless. "Root and Knot" refers to the relationship between the Six Qi and the roots and markers of the Six Meridians. "Opening, Closing, and Pivot" refer to the Six Qi functions of the Zang-Fu organs and Yin-Yang. "Beginning and End" refer to the start and finish of meridian Qi and Blood.
The Foot-Taiyang Bladder Meridian originates at Zhiyin (BL67) and knots at Mingmen (the eyes). The Foot-Yangming Stomach Meridian originates at Lidui (ST45) and knots at Sangda (the nasopharynx, located between the ears like pincers). The Foot-Shaoyang Gallbladder Meridian originates at Qiaoyin (GB28) and knots at Conglong (inside the ear). Taiyang governs Opening, Yangming governs Closing, and Shaoyang governs the Pivot. Therefore, if the Pivot breaks, the joints become loose and sudden acute diseases arise. Thus, for sudden diseases, one should select points on the Taiyang meridian and observe whether there is excess or deficiency. "Du" refers to skin that is dry, scorched, and weak. If the Closing mechanism breaks, Qi has no place to rest, leading to flaccidity syndromes. Thus, for flaccidity syndromes, one should select points on the Yangming meridian and observe excess or deficiency. "Qi having no place to rest" means that True Qi stagnates and pathogenic Qi occupies the space. If the Pivot breaks, the bones shake and cannot stand steadily. Thus, for bone shaking, one should select points on the Shaoyang meridian and observe excess or deficiency. "Gu Yao" refers to joints that are lax and cannot contract. "Yao" has the same pronunciation as "Yao" in Gaoyao.
Foot-Taiyang and Foot-Taiyin govern Opening; Foot-Yangming and Foot-Jueyin govern Closing; Foot-Shaoyang and Foot-Shaoyin govern the Pivot. These are the functions of the Three Yin and Three Yang Qi. "Tai" indicates the most abundant Qi, thus governing Opening. "Yangming" means the convergence of two Yangs, and "Jueyin" means the exhaustion of two Yins, thus governing Closing. "Shao" indicates newly generated Qi, thus governing the Pivot. These Six Qi of Yin and Yang internally combine with the Zang-Fu organs and externally with the Six Meridians, responding to the Si Tian and Zai Quan Qi, circulating endlessly, and penetrating through the earthly channels and waters, facilitating internal and external exchange. Externally combining with the Six Meridians, some follow the meridians to combine, such as in Cold Damage diseases where Qi transmits among the Six Qi; although symptoms of the Six Meridians appear, the Qi does not truly enter the meridians. Others enter the meridians to combine, which is the Root and Knot. "Gen" (Root) is where meridian Qi begins to generate through combination. "Jie" (Knot) is where meridian Qi follows and gathers at Mingmen and Conglong, then exits via the Qi Street, moves to the orifices, and still travels outside the vessels. Mingmen is the origin of life for Fire and Water of Taiyang, and the eye orifice is the gate where meridian Qi emerges. Sangda is the Hangsang (nasopharynx), located in the upper court between the ears, hence described as clamping the ears. Conglong is inside the ear, ventilating upwards like a scallion. These Three Yang Qi follow the meridians to gather here, then exit via the Qi Street, travel in the Qi level, and thus function as Opening, Closing, and Pivot, entering and exiting the interior and exterior of the body and Zang-Fu organs. Opening and closing are like doors; the pivot is like a hinge. Without the pivot, there can be no opening or closing; without opening and closing, the pivot cannot turn. These Three Yang Qi mutually enter and exit within the meridians, skin, body, and Zang-Fu organs. Taiyang Qi governs the skin; thus, if the Opening breaks, the joints become loose and sudden acute diseases arise. Zong Qi (Gathering Qi) is generated by Yangming, emerges upward from the throat to govern respiration, and travels to the four limbs; thus, if the Closing breaks, Qi has no place to rest, leading to flaccidity syndromes. Shaoyang governs the bones; thus, if the Pivot breaks, the bone joints become lax and cannot contract. The *Lun Yu Yi He* states: Taiyang originates at Zhiyin, named Yang within Yin; Yangming originates at Lidui, named Yang within Yin; Shaoyang originates at Qiaoyin, named Lesser Yang within Yin. The Qi of the Three Yin and Three Yang all arise from Yin, moving from below to above, so one must investigate their root. Master Yu said: The Qi of the Three Yang follows the meridians to exit the Qi Street, ascends to the face, and moves to the orifices. The Jing Yang Qi of Taiyang ascends to the eyes for vision; the branch Qi of Shaoyang ascends to the ears for hearing; the Zong Qi of Yangming ascends out of the nose for smell. The opening/closing of the eyes, hearing of the ears, and breathing of the nose are the functions of the Three Yang Qi ascending to the orifices, manifesting as Opening, Closing, and Pivot. Zong Qi is generated by Yangming, ascends out of the lungs to govern respiration. Hangsang is the inner orifice of the nose, connecting to the throat; thus, if Hangsang does not open, clear rhinorrhea cannot be controlled, showing that Yangming Qi ascends out of the nose to govern smell.
The Foot-Taiyin Spleen Meridian originates at Yinbai (SP1) and knots at Tai Cang (the stomach/tongue root). The Foot-Shaoyin Kidney Meridian originates at Yongquan (KI1) and knots at Lianquan (CV23). The Foot-Jueyin Liver Meridian originates at Dacun (LR1) and knots at Yuying, connecting to Danzhong (CV17). Taiyin governs Opening, Jueyin governs Closing, and Shaoyin governs the Pivot. Thus, if the Opening breaks, the granaries cannot transport nutrients, leading to Ge Dong syndrome. To treat Ge Dong, select points on the Taiyin meridian and observe excess or deficiency. Opening breakage is caused by Qi deficiency leading to disease. If the Closing breaks, Qi perishes and sadness arises; to treat sadness, select points on the Jueyin meridian and observe excess or obstruction. If the Pivot breaks, pulse Qi becomes knotted and obstructed; to treat obstruction, select points on the Shaoyin meridian and observe excess or obstruction. For all knotting, select deficient points.
Tai Cang refers to the tongue root. The Spleen is the official of the granaries; its meridian connects to the tongue root and spreads under the tongue, enabling it to receive food, hence knotting at the tongue root, named Tai Cang. Lianquan is an acupoint of the Ren Mai, located 4 cun above the larynx in the center. The Ren Mai originates from the Kidneys, hence knotting at the Kidney's Lianquan. The *Wei Qi Pian* states: The marker of Jueyin is the Back-Shu point, so Yuying should be between the Back-Shu points. Connecting to Danzhong occurs because the Liver meridian penetrates the diaphragm. The Spleen is the residence of the granaries; thus, if the Opening breaks, Qi deficiency leads to Ge Dong. "Ge" means the upper part does not open and cannot accept; "Dong" means the lower gate breaks and causes undigested stool expulsion. Jueyin is the exhaustion of two Yins; when Yin exhausts, one Yin begins to generate. Thus, if the Closing breaks, the generating Qi perishes, leading to sadness. One Yang Qi originates from the Kidneys; unsmoothed Will (Zhi) leads to sadness. Shaoyin governs the pulses; thus, if the Pivot breaks, pulse Qi knots and obstructs. Obstruction is treated by selecting Shaoyin points and observing excess or deficiency. Knotting is treated by selecting deficient points. Excess refers to pathogenic knotting; deficiency refers to Zheng Qi (Upright Qi) deficiency. Unblocking Zheng Qi resolves the knotting. According to the *Jiu Zhen Pian*: The middle of Quepen is the Ren Mai; the central vessel of the neck is the Du Mai; the arterial pulse in the axilla is the Hand-Taiyin Lung Meridian; three cun below the axilla is the Hand-Jueyin Pericardium Meridian. Hand-Taiyin and Hand-Jueyin emerge from the Chest Qi Street; Shaoyin and Jueyin emerge from the Head Qi Street via the Ren and Du Mai. Master Yu said: Lianquan and Yuying are the pathways for upper fluids. Yuying refers to the Gingiao acupoint inside the lips. Kidney essence/fluid travels one way from the Ren Mai to Lianquan under the tongue, and another way from the spinal marrow cavity up to the brain. Naokong is three fen behind the head, below the sharp bone of the skull; one is below the gingival base, one is below the hidden bone at the back of the neck, and one is in the empty space of the spine, above Fengfu. This is the essence of the bones, traveling from the empty space of the spine up to the brain and down to the gingival base. The Du Mai runs along the spine; the Jueyin Liver Meridian meets the Du Mai at the vertex and descends to Yuying. "Ying" implies whiteness like jade.
The Foot-Taiyang Bladder Meridian originates at Zhiyin, flows through the sinews and bones, injects into Kunlun (BL60), and enters Tianzhu (BL10) and Feiyang (BL58). The Foot-Shaoyang Gallbladder Meridian originates at Qiaoyin, flows through Qiuxu (GB40), injects into Yangfu (GB38), and enters Tianrong (SI17) and Guangming (GB37). The Foot-Yangming Stomach Meridian originates at Lidui, flows through Chongyang (ST42), injects into Daling (PC7 - *Note: Text says Daling, usually PC7, but context suggests ST area or error in source text interpretation, sticking to text*), and enters Yingchang (ST9) and Fenglong (ST40). The Hand-Taiyang Small Intestine Meridian originates at Shaoze (SI1), flows through Yanggu (SI04), injects into Shaohai (SI08), and enters Tianchuang (SI16) and Zhizheng (SI07). The Hand-Shaoyang Sanjiao Meridian originates at Guanchong (SJ1), flows through Yangchi (SJ04), injects into Zhigou (SJ06), and enters Tianyou (SJ16) and Waiguan (SJ05). The Hand-Yangming Large Intestine Meridian originates at Shangyang (LI1), flows through Hegu (LI4), injects into Yangxi (LI5), and enters Futu (LI18) and Pianli (LI06). These are the Twelve Meridians; their full collaterals should all be selected.
The previous chapter generally discussed the Qi of the Three Yin and Three Yang combining with the Six Meridians, rooting below and knotting above. This chapter further discusses the Qi of the Three Yang entering the hand and foot meridians, all ascending along the neck and head. Hence, it says the full collaterals of these twelve meridians should be selected. Generally, if Qi stays in the collaterals, they become full; draining them allows the Qi of the Three Yang to ascend outside the vessels again. Feiyang, Guangming, Fenglong, Zhizheng, Waiguan, and Pianli are located between the Jing-River points and He-Sea points. "What enters is the He-Sea" means that Qi and Blood outside the vessels flow from the Jing-Well points into the vessels, reaching the elbows and knees to merge with the Qi and Blood inside the vessels. Thus, it is called "meridian entry is He-Sea." This discusses the Qi of the Three Yang entering the vessels from the Jing-Well points, ascending to Tianzhu, Tianrong, Yingchang, Tianchuang, Tianyou, Futu in the neck, and emerging from the head and face. This differs from Blood and Qi flowing through Ying-Spring, Shu-Stream, Jing-River, and He-Sea points. Hence, it specifically mentions Feiyang, Guangming, Fenglong, and Zhizheng to distinguish the different entry and exit of Yang Qi and Ying-Blood inside and outside the meridians. Therefore, the discussion of primary and secondary pulses refers to the twelve hand and foot meridians, all returning to the center from the Five Shu points of the limbs, then ascending from the center to the neck.
This chapter discusses the Qi of the Three Yin and Three Yang combining with the Six Meridians and then emerging outside the vessels. Chapter 52 discusses Ying-Qi, and Chapter 71 discusses Zong-Qi. Generally, the Ying-Qi and Zong-Qi of the Three Yin and Three Yang travel together inside and outside the meridians, skin, body, and Zang-Fu organs, circulating endlessly. Thus, although the wording is similar across chapters, the topics differ. Learners should analyze them separately and synthesize them. Human Yin-Yang and Qi-Blood, form and formlessness, correspond to the Five Movements and Six Qi of Heaven, with cold and heat alternating, just as a drumstick strikes a drum and sound responds immediately.
In one day and night, Qi circulates fifty times, nourishing the essence of the Five Zang organs. If it does not conform to this number, it is called "Kuang Sheng" (abnormal growth or premature death). The term "Fifty Camps" means that all Five Zang organs receive Qi. Holding the pulse at the Cun Kou and counting the beats: if there are fifty beats without a single Dai pulse (intermittent beat), all Five Zang organs receive Qi. If there is one Dai pulse in forty beats, one Zang lacks Qi. If there is one Dai pulse in thirty beats, two Zang lack Qi. If there is one Dai pulse in twenty beats, three Zang lack Qi. If there is one Dai pulse in ten beats, four Zang lack Qi. If there is a Dai pulse in fewer than ten beats, all Five Zang lack Qi. This gives a short-term prognosis of death. The key lies in the Beginning and End. Fifty beats without a Dai pulse is considered normal. This allows one to know the lifespan of the Five Zang. A short-term prognosis is indicated by irregular pulse rates (fast and slow). ("Shu" as a verb is read with the departing tone; as an adjective, with the rising tone; "Mo" rhymes with "Shuo"; "Yu" is the same as "Yu").
This explains that the Qi of the Three Yin and Three Yang circulates externally along the meridians and internally nourishes the Five Zang organs. The Five Zang organs store essence. Qi nourishes the essence of the Five Zang, and all Five Zang receive Qi, which is the combination of Essence and Qi. The Five Zang are born from the Five Elements; the Qi of the Five Elements originates from the Ten Heavenly Stems' combination and transformation. Thus, fifty beats without a Dai pulse is considered normal. "Dai" means stopping and not returning. Irregular fast and slow rates indicate a dying pulse. The key to the Beginning and End lies in the *Zhong Shi Pian*, which states that life comes from the Six Qi and death comes from the Six Meridians.
Huangdi said: Regarding the reversals and順 (compliance) of the five bodies, I have already learned about the size of bone joints, the firmness or fragility of muscles, the thickness of skin, the clarity or turbidity of blood, the slipperiness or roughness of Qi, the length of pulses, the quantity of blood, and the number of meridians. These are matters for commoners. However, for kings and nobles, rulers who eat meat and enjoy luxury, whose bodies are soft and fragile, muscles are weak, and Qi and Blood are fierce, slippery, and rapid, can their acupuncture treatment regarding speed, depth, and quantity be the same? Qibo replied: How can those who eat rich foods and coarse grains be treated the same? If Qi is slippery, the needle is withdrawn quickly; if Qi is rough, it is withdrawn slowly. If Qi is slippery, use small needles and shallow insertion; if Qi is rough, use large needles and deep insertion. Deep insertion requires retention; shallow insertion requires quick withdrawal. From this, we see that treating commoners involves deep insertion and retention, while treating nobles involves light insertion and slow withdrawal. This is due to their fierce, slippery, and rapid Qi.
This explains that the Three Yin and Three Yang originate from the generation of five grains, five animals, five vegetables, and five flavors. "Reversal and compliance of the five bodies" refers to the Qi of the Three Yin and Three Yang entering and exiting the skin and meridians, moving in alternating reversal and compliance, with varying speeds. For those with thin skin and fragile muscles where Qi travels outside the vessels, Qi moves fast; for those with thick skin and firm muscles, Qi moves slow. For those with clear blood and short pulses where Qi travels inside the vessels, needle withdrawal is fast; for those with turbid blood and long pulses, withdrawal is slow. This is determined by the form of skin, muscle, and vessels. However, there are also determinants of speed based on the formless, namely the slipperiness or roughness of Qi. "Gao" refers to rich, fatty flavors; "Liang" refers to rice. Nobles and dignitaries eat exquisite food with strong flavors, resulting in soft muscles and slippery, rapid Qi. People in the mountains and fields eat beans and vegetable soup, resulting in rough, slow Qi. This difference in Qi held by high and low status arises from flavor. Huang Zaihua said: Those with thick skin, firm muscles, and harmonious, moderate Qi live long; those with thin skin, weak muscles, and fierce Qi live short lives. Nobles eating rich foods have soft bodies and weak muscles with fierce, slippery Qi, unlike field people who eat bland food and live longer. This encourages the wealthy to regulate their diet and avoid overly rich flavors.
Huangdi asked: What is the reversal and compliance of Xing Qi (Form Qi) and Bing Qi (Pathological Qi)? Qibo answered: If Xing Qi is insufficient and Bing Qi is excessive, this is pathogenic excess; urgently drain it. If Xing Qi is excessive and Bing Qi is insufficient, urgently tonify it. If both Xing Qi and Bing Qi are insufficient, this is a deficiency of both Yin and Yang Qi; do not use acupuncture. Acupuncture would cause double deficiency. Double deficiency leads to the exhaustion of both Yin and Yang, the depletion of Qi and Blood, emptiness of the Five Zang, and desiccation of sinews, bones, and marrow. The elderly will die, and the young will not recover. If both Xing Qi and Bing Qi are excessive, this is excess of both Yin and Yang; drain the pathogen and regulate deficiency and excess. Thus, it is said, "Tonify deficiency, drain excess." This is what is meant. Therefore, if acupuncture ignores reversal and compliance, True Qi and Pathogenic Qi clash. Tonifying excess causes Yin and Yang to overflow outward, filling the intestines and stomach, causing internal congestion of the liver and lungs, and disorder of Yin and Yang. Draining deficiency causes emptiness of the meridians, depletion of Qi and Blood, contraction of the intestines and stomach, thinning of the skin, and withering of hair and pores, giving a death date. Thus, the essence of acupuncture lies in knowing how to regulate Yin and Yang. Regulating Yin and Yang makes Jing and Qi bright. Combining Spirit and Qi keeps the Spirit stored internally. Thus, it is said: Superior doctors balance Qi; intermediate doctors disrupt pulses; inferior doctors sever Qi and endanger life. Therefore, inferior doctors must be cautious. One must examine the diseases of change in the Five Zang, the responses of the five pulses, the excess and deficiency of meridians, and the softness or fragility of the skin before selecting points.
Xing Qi refers to the Qi of the form (skin, flesh, sinews, bones); Bing Qi refers to the meridian Qi of the Three Yin and Three Yang, diseased by pathogens. The excess or deficiency of Bing Qi reflects the excess or deficiency of Yin-Yang Qi and Blood. Pathogenic excess requires urgent draining; Blood and Qi deficiency requires urgent tonification. Acupuncture is used to obtain Qi. Therefore, if both Yin and Yang Qi are deficient, acupuncture should not be used. Depletion of Qi and Blood and emptiness of the Five Zang mean that Qi and Blood cannot internally nourish the Zang organs. Desiccation of sinews, bones, and marrow means that Qi and Blood cannot externally moisten the sinews and bones. For excess of Yin and Yang, one should drain the pathogen and regulate deficiency and excess. Generally, where pathogens gather, Zheng Qi is necessarily deficient; thus, one should drain the pathogen and simultaneously regulate the deficiency and excess of Zheng Qi. Tonifying excess causes Yin and Yang to overflow outward. Filling the intestines and stomach and internal congestion of the liver and lungs represent overflow inward. Overflow in both interior and exterior causes disorder of Yin and Yang. "HT" (likely a typo for 'qie' or similar) means weakness/fear; "Pi" means痞 accumulation. Abundant Qi and Blood fill the skin and warm the muscles; exclusive abundance of Blood seeps into the skin and generates hair. Emptiness of meridians and depletion of Qi and Blood lead to weakness and痞 accumulation in the intestines and stomach, thinning of the skin, and withering of hair and pores, allowing one to give a death date. Regulating Yin and Yang makes Jing and Qi bright, representing the combination of Yin-Yang Jing and Qi. Combining Form and Qi keeps the Spirit stored internally. Form and Qi are the external protection of the Spirit. By regulating Yin and Yang, Spirit, Form, and Qi can shine externally and be stored securely internally. The meridian Qi of the Three Yin and Three Yang may be damaged by external pathogens or changed by internal Zang organ diseases reflected in the pulses. Therefore, one must examine internal and external excess and deficiency to regulate them, thereby becoming a superior doctor.