雷公问于黄帝曰。细子得受业。通于九针六十篇。旦暮勤服之。近者编绝。久者简垢。然尚讽诵
弗置。未尽解于意矣。外揣言浑束为一。未知所谓也。夫大则无外。小则无内。大小无极。高下无度。
束之奈何。士之才力。或有浓
薄。智虑褊浅。不能博大深奥。自强于学若细子。细子恐其散于后世。绝于子孙。敢问约之奈何。黄帝
曰。善乎哉问也。此先师之所禁。坐私传之也。割臂歃血之盟也。子若欲得之。何不斋乎。雷公再拜
而起曰。请闻命于是矣。乃斋宿三日而请曰。敢问今日正阳。细子愿以受盟。黄帝乃与俱入斋堂。割臂
歃血。黄帝亲祝曰。今日正阳。歃血传方。敢有背此言者。反受其殃。雷公再拜曰。细子受之。黄帝乃
左握其手。右受之书曰。慎之慎之。吾为子言之。凡刺之理。经脉为始。营其所行。知其度量。内刺五脏。
外刺六腑。审察卫气。为百病母。调其虚实。虚实乃止。泻其血络。血尽不殆矣。
夫气合于天。天合于地。血合于水。外揣篇论九针之道。浑束为一。而合于天道。故篇名外揣。言
天道之营运于外。司外可以揣内也。此篇以气血约而为一。候其人迎气口。外可以知六气。内可以验其
脏腑之病。盖经脉本于脏腑之所生。而合于六气也。故曰凡刺之理。经脉为始。营其所行。知其度量。
内刺五脏。外刺六腑。审察卫气。为百病母。谓邪之中人。必先始于皮毛气分。而入于络脉。从经脉而
入于脏腑。故泻其血络。血尽不殆。盖络脉络于皮肤之间。乃气血之交会。故视其血络。尽泻其血。则
邪病不致传溜于经脉脏腑。而成危殆之证矣。虚实者。血气之虚实也。盖邪在气。则气实而血虚。陷于脉
中。则血实而气虚。故必审察其本末以调之。夫血脉者。上帝之所贵。先师之所禁也。藏之金匮。非其
人勿教。非其真勿授。故帝与歃血立盟。而后乃传方。篇名禁服者。诫其佩服而禁其轻泄也。莫子瑜问
曰。此篇论约束气血为一。奚复引外揣而论。曰天与水相连。而营运于上下。水天之合一也。故曰如水
镜之察。不失其形。外揣篇论九针之道。浑束为一。而合于
天道。远者司外揣内。近者司内揣外。是谓阴阳之极。天地之盖。谓天地之合一也。天地相合。而水在
其中矣。此篇论气血约而为一。应水天之相合。故引外揣而问者。补申明前章之义也。
雷公曰。此皆细子之所以通。未知其所约也。黄帝曰。夫约方者。犹约囊也。囊满而弗约。则输泄。
方成弗约。则神与弗俱。雷公曰。愿为下材者。弗满而约之。黄帝曰。未满而知约之以为工。不可以
为天下师。未满而知约者。知气与血合。候人迎气口。以知三阴三阳之气。而不知阴阳血气。推变无
穷。可浑束为一。而合于天之大数。故通人道于天道者。斯可以为天下师。约方者。约束血气之法。如
约囊者。谓气与血合。犹气在橐龠之中。满而弗约。则输泄矣。故方成而弗约。则神与弗俱。谓血与气
不能共居而合一也。满而弗约者。谓不知经治。脉急弗引也。约而为一者。脉大以弱。此血气已和。则
欲安静也。
雷公曰。愿闻为工。黄帝曰。寸口主中。人迎主外。两者相应。俱往俱来。若引绳大小齐等。春夏
人迎微大。秋冬寸口微大。如是者名曰平人。
愿闻为工者。愿闻血气之相应。而后明合一之大道。是由工而上。上而神。神而明也。寸口主阴。
故主中。人迎主阳。故主外。阴阳中外之气。左右往来。若引绳上下齐等。如脉大者。人迎气口俱大。脉
小者。人迎气口俱小。春夏阳气盛而人迎微大。秋冬阴气盛而寸口微大。如是者阴阳相应。是谓平人。
若不应天之四时。而更偏大于数倍。是为溢阴溢阳之关格矣。此论三阴三阳之气。而应于人迎气口之两
脉也。高子曰。人迎气口。谓左右之两寸口。所以分候阴阳之气。非寸关尺三部也。若以三部论之。
则左有阴阳。而右有阴阳矣。
人迎大一倍于寸口。病在足少阳。一倍而躁。病在手少阳。人迎二倍。病在足太阳。二倍而躁。
病在手太阳。人迎三倍。病在足阳明。三倍而躁。病在手阳明。盛则为热。虚则为寒。紧则为痛痹。
代则乍甚乍间。盛则泻之。虚则补之。紧痛则取之分肉。代则取血络。且饮药。陷下则灸之。不盛不
虚。以经取之。名曰经刺。人迎四倍者。且大且数。名曰溢阳。溢阳为外格。死不治。必审按其本末
。察其寒热。以验其脏腑之病。（间去声数叶朔）
此论阴阳之气偏盛。而脉见于人迎气口。及病之在气在脉。以证明血气之相应相合也。三阳之气
偏盛。则人迎大二倍三倍。此气血之相应也。脉大以弱。则欲安静。此血气之相合也。痛痹者。病在
于皮腠之气分。气伤故痛。气血相抟。其脉则紧。此病在气而见于脉也。代则乍甚乍间。乍痛乍止者。
病在血气之交。或在气。或在脉。有交相更代之义。故脉代也。盛则泻之者。气盛宜泻之也。虚则补
之者。气虚宜补之也。紧痛之在气分。故当取之分肉。代则病在血气之交。故当刺其血络。且饮药者。
助其血脉脏腑。勿使病从络脉而入于经脉。从经脉而入于脏腑也。陷下则灸之者。气之下陷也。不盛
不虚者。气之和平也。以经取之者。病不在气。而已入于经。则当取之于经矣。若人迎大于四倍。且
大且数。名曰溢阳。溢阳者死不治。夫始言人迎大一倍二倍三倍者。此阳气太盛而应于脉也。后言以
经取之。名曰经刺。人迎四倍者。且大且数。名曰溢阳。此阳盛之气。溢于脉中。气血之相合也。此
以阴阳气之偏盛。病之在气在脉。以明气之应于脉而合于脉也。故必审按其本末。察其寒热。以验其
脏腑之病。本者。以三阴三阳之气为本。末者。以左右之人迎气口为标。盖言阴阳血气。浑束为一。外
可以候三阴三阳之六气。内可以候五脏六腑之有形。此阴阳离合之大道。天运常变之大数也。
寸口大于人迎一倍。病在足厥阴。一倍而躁。病在手心主。寸口二倍。病在足少阴。二倍而躁。
病在手少阴。寸口三倍。病在足太阴。三倍而躁。病在手太阴。盛则胀满。寒中。食不化。虚则热中。出
糜。少气。溺变色。紧则痛痹。代则乍痛乍止。盛则泻之。虚则补之。紧则先刺而后灸之。代则取血
络而后调之。陷下则徒灸之。陷下者。脉血络于中。中有着血。血寒故宜灸之。不盛不虚。以经取之。
名曰经刺。寸口四倍者。名曰内关。内关者。且大且数。死不治。必审察其本末之寒温。以验其脏腑
之病。
夫在天苍 丹素玄之气。经于十干之分。化生地之五行。地之五行。上呈天之六气。六气合六经。
五行生五脏。是六气本于五脏之所生。故阴气太盛。则胀满寒中。虚则热中。出糜。溺色变。气从内
而外。由阴而阳也。是以候人迎气口。则知阴阳六气之盛虚。内可以验其脏腑之病。阴阳外内之相通也。
夫痛痹在于分腠之气分。腠者。皮肤脏腑之肉理。故病在阳者。取之分肉。病在阴者。先刺而后灸之。
盖灸者。所以启在内在下之气也。代则气分之邪。交于脉络。故先取血络。而后饮药以调之。陷下则
徒灸之。盖言气陷下者宜灸。今入于脉中。又当取之于经矣。如陷于脉而宜灸者。乃脉受络之留血而
陷于中。中有着血。血寒故宜灸。若气并于血。又非灸之所宜也。此盖因气之盛虚。病之外内。以证
明血气之有分有合。有邪病。有和调。反复辨论。皆所以明约束之道。所谓邪病者。中有着血。犹囊
满而弗约。则输泄矣。和调者。气并于血。神与气俱。浑束为一。阴阳已和。则欲安静。毋用力烦劳。
不可灸也。朱永年曰。本经中论人迎寸口大一二三倍之文。凡四见。其中章
旨不同。学人各宜体会。若仅以三阴三阳论之。去经义远矣。马氏以六气增注脏腑。更为蛇足。
通其荥输。乃可传于大数。大数曰。盛则徒泻之。虚则徒补之。紧则灸刺且饮药。陷下则徒灸之。
不盛不虚。以经取之。所谓经治者。饮药。亦曰灸刺。脉急则引。脉大以弱。则欲安静。用力无劳也。
此总结上文。以申明约束为一之道。通其荥输者。谓血气之相合。从荥输而溜注于脉也。大数者。
谓合一之道。通天道也。故知其大数。则曰盛则徒泻之。虚则徒补之。陷下则徒灸之。盖谓气盛者宜
泻。气虚者宜补。气陷下者宜灸。今气与血合。浑束为一。有病者则当取之于经。气盛于脉中者。又
当引而伸之。血气和平而相合者。则欲安静调养。是以徒泻徒补徒灸也。所谓经治者。饮药。亦曰灸
刺。此病入于经。所当以经治之。脉急则引者。阴阳偏盛之气。并于脉中。故脉数急。又当引而伸之。
盖囊满勿约。则输泄矣。若脉大以弱者。此平和定气。与血相合。而已和调。则欲安静以调养。无用
力以伤其血脉。无烦劳以伤其气也。此章假人迎气口之盛躁。以明气血之合一。故曰脉急则引者。先
言盛躁之气。而合于脉中也。继言脉大以弱者。乃平和之气血。浑束于一也。气并于脉中。故脉大。血
气和调。故柔软也。外揣篇论浑束为一而合于天道。天地有外内上下之气交。故司外可以揣内。司内可
以揣外。此天地之合一也。此篇论阴阳六气。与血脉浑束为一。应司天在上。在泉在下。如水镜之察。
不失其形。此水天之合一也。愚按、此篇大义。谓阴阳六气。外合于手足六经。内合于五脏六腑。可分
可合。可外可内者也。候人迎气口者。候六气之在外。而不涉于经也。陷下则灸之者。谓气陷于内。
而不陷于脉也。故曰审察卫气。为百病母。卫气外行于皮肤分肉。内行于脏腑之募原。六气在外。
同卫气而在肤表之间。陷于内则入于脏腑之募原矣。故曰审察其本末之寒温。以验其脏腑之病。盖以
内为本而外为末。血为本而气为标。审其病之在气在脉。在外在内也。如病在外之六气。有不涉于六
经者。有病在气而转入于经者。有陷于内而不干于脏腑者。有陷于募原之中。而病及于脏腑者。此六
气之于经脉脏腑。可分而可合也。紧则为痛。痹者。病形而伤气也。代则乍甚乍间者。气始入于脉也。
盖六气本于五脏之所生。而外出于肤表。合而为一。则从络而脉。脉而经。经而脏腑也。六气出入于
脏腑经脉之间。有离有合。营运无息者也。春夏人迎微大。秋冬寸口微大。此六气行于脉外也。脉大以
弱。则欲安静。此气与血合。混束而为一矣。即如中风伤寒。六经相传。七日来复。此病在六气。而
不涉于经也。如病一二日。即见呕吐 泄诸证者。此陷于内而入腑也。有病一二日。即见神昏气促烦
躁诸证者。此陷于脏腑之募原而为半死半生之证矣。盖客于脏外者生。干脏者死。干脏而脏真完固。不
为邪伤者生。脏真伤而神昏躁盛者死。故曰治五脏者。半死半生也。如伤寒之黄连阿胶桃花小陷胸证。
此病在气而溜于经也。盖邪入于经。其脏气实。不必动脏。则溜于腑。若血脉传溜。大气入脏。腹痛
下淫。可以致死。而不可以致生矣。夫邪气淫 。不可胜数。有病一二日。或即溜于经。或即陷于内。
或即干脏入腑者。有病多日而渐次溜经陷内。干脏入腑者。有病久而只在气在形。不入于内者。此邪
病之有重轻。正气之有虚实也。此篇论血气之离合出入。审病气之轻重死生。大有关于至道。故帝令
斋宿而始授其书。予亦不厌琐赘而复明之。以勉后学。知正气之出入。则知邪病之浅深。治其始蒙。
其未逆。弗使邪气内入而成不救。此医道中修身善后之大功德也。高子曰。外揣篇论气与
形合。此篇论气与血合。五变章论病在形而不病气。本藏篇论病在脏腑而不病气。本经厥逆诸篇。有
病气者。有病血者。有血气之兼病者。此阴阳离合之道。变化之不测也。
Lei Gong asked Huang Di, saying, "Your humble student has had the honor of receiving instruction and has mastered the sixty chapters of the *Nine Needles* (Jiuzhen). From morning to night, I diligently practice them. For those studied recently, the binding cords have broken; for those studied long ago, the bamboo slips are covered in dust. Yet I still recite them without ceasing. However, I have not yet fully comprehended their meaning. The chapter *Wai Chuai* (Extrapolation from the Exterior) states that all things are unified into one whole, but I do not understand what this means. The Great has no outside, the Small has no inside; size has no limit, height and depth have no measure. How can they be bound and unified? People's talents and abilities vary, some being profound and others shallow; their wisdom and foresight may be narrow and superficial, unable to reach the broad and profound depths. Even forcing myself to study like your humble student, I fear these teachings will scatter in future generations and be cut off among descendants. I dare to ask: how should they be simplified?"
Huang Di said, "Excellent question! This is prohibited by the former masters; it involves private transmission and an oath of cutting arms and drinking blood. If you wish to receive it, why do you not purify yourself?"
Lei Gong bowed twice and rose, saying, "Please allow me to hear your command." He then fasted for three nights before requesting, "Dare I ask: today is the day of pure Yang. Your humble student wishes to accept the oath." Huang Di then entered the purification hall with him, cut his arm, and drank blood as a pledge. Huang Di personally invoked, "Today is the day of pure Yang. We drink blood to transmit the prescriptions. Whoever dares to betray these words shall suffer disaster." Lei Gong bowed twice and said, "Your humble student accepts it."
Huang Di held Lei Gong's hand with his left and received the book with his right, saying, "Be cautious! Be cautious! I will speak to you. The principles of acupuncture begin with the meridians (Jingmai). One must circulate through their pathways and know their measurements. Internally, one punctures the Zang organs; externally, one punctures the Fu organs. Examine the Wei Qi (Defensive Qi), which is the mother of a hundred diseases. Regulate deficiency and excess until they cease. Drain the collateral vessels (Xueluo); when the blood is exhausted, there will be no danger."
"Qi unites with Heaven, and Heaven unites with Earth; Blood unites with Water. The chapter *Wai Chuai* discusses the way of the Nine Needles, unifying them into one and aligning with the Heavenly Dao. Hence the chapter is named *Wai Chuai*, meaning that the operation of Heavenly Dao is external, and observing the exterior allows one to infer the interior. This chapter simplifies Qi and Blood into one. By observing the Renying (Carotid) and Qikou (Radial) pulses, one can know the Six Qi externally and verify internal Zang-Fu diseases. Meridians originate from the generation of Zang-Fu and unite with the Six Qi. Thus it is said: 'The principles of acupuncture begin with the meridians... Internally, one punctures the Zang organs; externally, one punctures the Fu organs. Examine the Wei Qi, which is the mother of a hundred diseases.' This means that when pathogenic factors invade humans, they first start at the skin-hair and Qi level, enter the collaterals, and then move from the meridians into the Zang-Fu. Therefore, draining the collateral vessels until the blood is exhausted prevents the pathogenic disease from spreading to the meridians and Zang-Fu, avoiding critical conditions. Deficiency and excess refer to the deficiency and excess of Blood and Qi. Generally, if the pathogen is in the Qi level, Qi is excess and Blood is deficient; if it sinks into the vessels, Blood is excess and Qi is deficient. Thus, one must examine the root and branch to regulate it. Blood vessels are valued by the Supreme Emperor and prohibited by the former masters. They are stored in the Golden Casket; they are not taught to the unworthy, nor transmitted to the untrue. Thus, the Emperor made an oath of drinking blood before transmitting the prescriptions. The chapter is named *Jin Fu* (Forbidden Service/Wear), warning against wearing [the knowledge] lightly and prohibiting casual disclosure."
Mo Ziyu asked, "This chapter discusses constraining Qi and Blood into one; why does it cite *Wai Chuai* again?" The answer was: "Heaven and Water are connected, operating up and down endlessly; this is the unity of Water and Heaven. Thus it is said: 'Like examining with a water mirror, losing nothing of its form.' The chapter *Wai Chuai* discusses the way of the Nine Needles, unifying them into one and aligning with the Heavenly Dao. Observing the distant exterior allows inference of the interior; observing the near interior allows inference of the exterior. This is called the extreme of Yin and Yang, the cover of Heaven and Earth, referring to the unity of Heaven and Earth. When Heaven and Earth unite, Water is within. This chapter discusses simplifying Qi and Blood into one, corresponding to the union of Water and Heaven. Hence, citing *Wai Chuai* in the question supplements and clarifies the meaning of the previous chapter."
Lei Gong said, "These are all things your humble student understands; he does not know what is meant by 'Yue' (constraint/simplification)."
Huang Di said, "To 'constrain the prescription' (Yue Fang) is like binding a bag. If a full bag is not bound, it leaks. If a prescription is formed but not constrained, the Shen (Spirit) and Qi will not accompany it."
Lei Gong said, "I wish for those of inferior capacity to be constrained even when not full."
Huang Di said, "One who knows how to constrain before being full can be a craftsman but cannot be a teacher for the world. To know how to constrain when not full means knowing that Qi and Blood unite, observing the Renying and Qikou pulses to know the Three Yin and Three Yang Qi, but not knowing that Yin-Yang and Blood-Qi transformations are infinite. One cannot unify them into one and align with the Great Number of Heaven. Only those who connect Human Dao with Heavenly Dao can be teachers for the world. 'Constraining the prescription' is the method of constraining Blood and Qi. Like binding a bag, it means Qi and Blood unite, like Qi in a bellows. If full and not bound, it leaks. Thus, if a prescription is formed but not constrained, Shen and Qi do not coexist, meaning Blood and Qi cannot dwell together as one. 'Full but not bound' refers to not understanding meridian treatment and failing to guide urgent pulses. 'Constrained into one' refers to a pulse that is large yet soft, indicating that Blood and Qi have harmonized, and one desires tranquility."
Lei Gong said, "I wish to hear about becoming a craftsman."
Huang Di said, "The Cun Kou (Radial) pulse governs the interior (Zhong/Yin); the Ren Ying (Carotid) pulse governs the exterior (Wai/Yang). The two correspond, coming and going together, like a drawn rope of equal size. In Spring and Summer, the Ren Ying is slightly larger; in Autumn and Winter, the Cun Kou is slightly larger. Such a person is called a 'Ping Ren' (Normal/Healthy Person)."
"To 'wish to hear about becoming a craftsman' is to wish to hear how Blood and Qi correspond, thereby understanding the Great Way of Unity. This ascends from craftsman to Spirit, and from Spirit to illumination. Cun Kou governs Yin, thus governing the interior; Ren Ying governs Yang, thus governing the exterior. The Qi of Yin-Yang and Interior-Exterior moves left and right, like a drawn rope of equal height. If the pulse is large, both Ren Ying and Qi Kou are large; if small, both are small. In Spring and Summer, Yang Qi is abundant and Ren Ying is slightly large; in Autumn and Winter, Yin Qi is abundant and Cun Kou is slightly large. Such people have corresponding Yin and Yang and are called Ping Ren. If they do not respond to the Four Seasons of Heaven and are instead several times larger, this is 'Overflowing Yin' or 'Overflowing Yang' Guan Ge syndrome, which is incurable death."
"This discusses the Three Yin and Three Yang Qi and their manifestation in the Ren Ying and Qi Kou pulses. Gao Zi said: 'Ren Ying and Qi Kou' refer to the Cun Kou pulses on the left and right hands, used to separately observe Yin and Yang Qi, not the three positions of Cun, Guan, and Chi. If discussed by three positions, then the left hand has Yin and Yang, and the right hand also has Yin and Yang."
"If the Ren Ying pulse is one times larger than the Cun Kou, the disease is in the Foot Shaoyang Gallbladder Meridian; if one times larger and restless, it is in the Hand Shaoyang Sanjiao Meridian. If two times larger, the disease is in the Foot Taiyang Bladder Meridian; if two times larger and restless, it is in the Hand Taiyang Small Intestine Meridian. If three times larger, the disease is in the Foot Yangming Stomach Meridian; if three times larger and restless, it is in the Hand Yangming Large Intestine Meridian. Excess indicates heat; deficiency indicates cold. Tightness indicates painful obstruction (Tong Bi). Intermitting (Dai) pulse indicates symptoms alternating between severe and mild. Excess is drained; deficiency is tonified. For tightness and pain, needle the muscle spaces. For intermitting pulse, drain the collateral vessels and administer medicine. For sinking/depressed Qi, use moxibustion. For neither excess nor deficiency, treat via the meridian itself, called 'Meridian Puncture'. If the Ren Ying is four times larger, both large and rapid, it is called 'Overflowing Yang'. Overflowing Yang is 'External Grid', an incurable death. One must examine the root and branch, observe cold and heat, to verify Zang-Fu diseases."
"This discusses the excessive strength of Yin and Yang Qi, manifested in the Ren Ying and Qi Kou pulses, and whether the disease is in Qi or in the vessels, proving the correspondence and union of Blood and Qi. When the Three Yang Qi are excessively strong, the Ren Ying pulse is two or three times larger; this is the correspondence of Qi and Blood. A pulse that is large yet soft indicates a desire for tranquility; this is the union of Blood and Qi. Painful obstruction occurs when the disease is in the Qi level of the skin and pores; Qi injury causes pain. When Qi and Blood struggle, the pulse becomes tight; this is disease in Qi manifesting in the pulse. An intermitting pulse indicates symptoms alternating between severe and mild, or pain stopping and starting; the disease is at the intersection of Qi and Blood, either in Qi or in the vessel, having the meaning of alternation, hence the intermitting pulse. 'Excess is drained' means Qi excess should be drained; 'deficiency is tonified' means Qi deficiency should be tonified. Tightness and pain in the Qi level require needling the muscle spaces. Intermitting pulse, being at the intersection of Qi and Blood, requires draining the collateral vessels and administering medicine to assist the Blood, vessels, and Zang-Fu, preventing the pathogen from entering the meridians from the collaterals, and from the meridians into the Zang-Fu. 'Sinking/depressed Qi is moxa-ed' refers to Qi sinking. 'Neither excess nor deficiency' refers to peaceful Qi. 'Treating via the meridian' means the disease is not in the Qi level but has entered the meridian, so one should treat the meridian. If the Ren Ying is greater than four times the Cun Kou, both large and rapid, it is called 'Overflowing Yang'. Overflowing Yang is incurable death. Initially, stating that Ren Ying is one, two, or three times larger refers to excessive Yang Qi responding in the pulse. Later, 'treating via the meridian' is called 'Meridian Puncture'. Ren Ying four times larger, both large and rapid, is called 'Overflowing Yang'; this is Yang excess Qi overflowing into the vessels, the union of Qi and Blood. Here, through the excessive strength of Yin-Yang Qi and disease in Qi/vessels, it clarifies that Qi responds to and unites with the vessels. Thus, one must examine the root and branch, observe cold and heat, to verify Zang-Fu diseases. 'Root' refers to the Three Yin and Three Yang Qi; 'branch' refers to the left and right Ren Ying and Qi Kou. It is said that Yin-Yang, Blood, and Qi are unified into one. Externally, one can observe the Six Qi of Three Yin and Three Yang; internally, one can observe the有形 (form) of the Five Zang and Six Fu organs. This is the Great Way of Yin-Yang separation and union, the great number of constant changes in Heavenly movement."
"If the Cun Kou pulse is one times larger than the Ren Ying, the disease is in the Foot Jueyin Liver Meridian; if one times larger and restless, it is in the Hand Jueyin Pericardium Meridian. If two times larger, the disease is in the Foot Shaoyin Kidney Meridian; if two times larger and restless, it is in the Hand Shaoyin Heart Meridian. If three times larger, the disease is in the Foot Taiyin Spleen Meridian; if three times larger and restless, it is in the Hand Taiyin Lung Meridian. Excess leads to distension and fullness, cold in the middle, and indigestion. Deficiency leads to heat in the middle, loose stools like paste, shortness of breath, and discolored urine. Tightness indicates painful obstruction. Intermitting pulse indicates alternating pain and cessation. Excess is drained; deficiency is tonified. For tightness, needle first then moxa. For intermitting pulse, drain the collateral vessels then regulate. For sinking/depressed Qi, only use moxibustion. 'Sinking/depressed' means Blood and vessels in the middle have stagnant blood; due to Cold Blood, moxibustion is suitable. Neither excess nor deficiency: treat via the meridian, called 'Meridian Puncture'. If the Cun Kou is four times larger, it is called 'Internal Obstruction' (Nei Guan). Nei Guan is both large and rapid; it is incurable death. One must examine the cold and warmth of the root and branch to verify Zang-Fu diseases."
"In Heaven, there is Qi of Cang, Dan, Su, and Xuan, passing through the Ten Heavenly Stems, transforming into the Five Elements of Earth. The Five Elements of Earth present upwards the Six Qi of Heaven. The Six Qi combine with the Six Meridians; the Five Elements generate the Five Zang organs. Thus, the Six Qi originate from the generation of the Five Zang. Therefore, if Yin Qi is too excessive, there is distension, cold in the middle; if deficient, there is heat in the middle, loose stools like paste, and changed urine color. Qi moves from inside to outside, from Yin to Yang. Thus, by observing the Ren Ying and Qi Kou pulses, one knows the excess and deficiency of Yin-Yang Six Qi, and internally verifies Zang-Fu diseases; this is the communication of Yin-Yang interior and exterior. Painful obstruction lies in the Qi level of the fen-cou (skin and pores). Cou refers to the texture of skin and flesh between Zang and Fu. Thus, disease in Yang levels is treated by needling the muscle spaces; disease in Yin levels is treated by needling first then moxa. Moxibustion is used to initiate Qi that is internal and lower. Intermitting pulse means pathogenic Qi in the Qi level intersects with the collaterals; thus, one first drains the collateral vessels, then administers medicine to regulate. Sinking/depressed Qi is only moxa-ed, meaning Qi sinking is suitable for moxa. Now that it has entered the vessels, one should take from the meridian. If sinking into the vessels and suitable for moxa, it is because the vessels retain blood from the collaterals sinking into the middle, where there is stagnant blood; due to Cold Blood, moxa is suitable. If Qi merges into Blood, moxa is not suitable. This uses the excess and deficiency of Qi, and the interior/exterior of disease, to prove that Blood and Qi have separation and union, pathogenic disease and harmony. Repeated debate clarifies the way of constraint. 'Pathogenic disease' refers to stagnant blood in the middle, like a full bag not bound leaking. 'Harmony' refers to Qi merging into Blood, Shen and Qi accompanying each other, unified into one, Yin-Yang harmonized, desiring tranquility, without strenuous labor, and no moxa. Zhu Yongnian said: The text discussing Ren Ying and Cun Kou being one, two, or three times larger appears four times in this classic, with different chapter themes. Students should comprehend each. Discussing only by Three Yin and Three Yang departs far from the canonical meaning. Ma's addition of Six Qi linking to Zang-Fu is superfluous. Understanding Ying and Shu points allows transmission to those of the Great Number. The Great Number says: Excess is solely drained; deficiency is solely tonified; tightness is moxa-ed, needled, and medicine given; sinking/depressed is solely moxa-ed; neither excess nor deficiency is treated via the meridian. 'Meridian treatment' includes medicine and also moxa/needling. Urgent pulse requires guiding; large yet weak pulse desires tranquility, no strenuous labor. This summarizes the above to clarify the way of constraint into one. 'Understanding Ying and Shu' means Blood and Qi unite, flowing from Ying and Shu points into the vessels. 'Great Number' means the way of unity, connecting with Heavenly Dao. Knowing the Great Number means: Excess is solely drained, deficiency solely tonified, sinking solely moxa-ed. It means Qi excess should be drained, Qi deficiency tonified, Qi sinking moxa-ed. Now Qi and Blood unite, unified into one. If diseased, treat via the meridian. If Qi is excessive in the vessels, guide and extend it. If Blood and Qi are peaceful and united, desire quiet nourishment. Hence, solely draining, tonifying, or moxa-ing. 'Meridian treatment' means medicine or moxa/needling. This is disease entering the meridian, to be treated via the meridian. 'Urgent pulse requires guiding' means Yin-Yang excessive Qi merges into the vessels, making the pulse rapid and urgent, requiring guidance and extension. Like a full bag not bound leaking. If the pulse is large and weak, this is peaceful Qi uniting with Blood, already harmonized, desiring quiet nourishment, without force injuring Blood vessels, without fatigue injuring Qi. This chapter uses the excess/restlessness of Ren Ying and Qi Kou to clarify the unity of Qi and Blood. Thus, 'urgent pulse requires guiding' first speaks of excess/restless Qi combining with the vessels. Then 'large yet weak pulse' speaks of peaceful Qi and Blood unified. Qi merging into vessels makes the pulse large; Blood and Qi harmonizing makes it soft. The chapter *Wai Chuai* discusses unifying into one and aligning with Heavenly Dao. Heaven and Earth have interior-exterior and upper-lower Qi interaction; thus, observing exterior infers interior, observing interior infers exterior. This is the unity of Heaven and Earth. This chapter discusses Yin-Yang Six Qi and Blood vessels unified into one, corresponding to Si Tian (ruling Heaven) above and Zai Quan (ruling Earth) below, like a water mirror reflecting form without loss. This is the unity of Water and Heaven. I note: The main meaning of this chapter is that Yin-Yang Six Qi externally unite with the Hand and Foot Six Meridians, internally unite with the Five Zang and Six Fu organs; they can be separated or united, exterior or interior. Observing Ren Ying and Qi Kou observes Six Qi externally, not involving the meridians. 'Sinking/depressed Qi is moxa-ed' means Qi sinks internally, not into the vessels. Thus, 'examine Wei Qi, mother of a hundred diseases'. Wei Qi moves externally in skin and muscle spaces, internally in the Mu Yuan (sea of origin) of Zang-Fu. Six Qi externally, same as Wei Qi between skin and surface; sinking internally enters the Mu Yuan of Zang-Fu. Thus, 'examine the cold/warmth of root and branch to verify Zang-Fu diseases'. Generally, interior is root, exterior is branch; Blood is root, Qi is mark. Examine if disease is in Qi or vessels, exterior or interior. If disease is in external Six Qi, not involving Six Meridians; if disease in Qi turns into meridian; if sinking internally not affecting Zang-Fu; if sinking into Mu Yuan affecting Zang-Fu. These Six Qi regarding meridians and Zang-Fu can be separated or united. Tightness causes pain; Bi is disease form injuring Qi. Intermitting pulse indicates alternating severity, Qi beginning to enter vessels. Six Qi originate from Five Zang, exit externally to skin surface, unite into one, flowing from collaterals to vessels, vessels to meridians, meridians to Zang-Fu. Six Qi enter and exit between Zang-Fu and meridians, separating and uniting, operating without rest. Ren Ying slightly large in Spring/Summer, Cun Kou slightly large in Autumn/Winter: this is Six Qi moving outside the vessels. Pulse large yet weak, desiring tranquility: this is Qi and Blood uniting, mixed into one. Just like wind-stroke or cold damage, Six Meridians transmitting, returning after seven days: this is disease in Six Qi, not involving meridians. If disease on day 1-2 shows vomiting and diarrhea: this sinks internally into Fu organs. If disease on day 1-2 shows coma, shortness of breath, irritability: this sinks into Mu Yuan of Zang-Fu, a half-dead half-living condition. Generally, pathogens lodging outside Zang survive; invading Zang die. Invading Zang but Zhen Qi intact, not injured by pathogen survives; Zhen Qi injured with coma and severe irritability dies. Thus, 'treating Zang organs is half-dead half-living'. Examples like Huanglian Ejiao Tang, Taohua Decoction, Xiao Xiexiong Tang in cold damage: this is disease in Qi flowing into meridians. Generally, pathogen entering meridians, Zang Qi is solid, no need to disturb Zang, flows into Fu organs. If Blood vessels transmit, Grand Qi enters Zang, abdominal pain and dysentery can cause death, not life. Pathogenic Qi is countless. Disease on day 1-2 may flow into meridians, sink internally, or invade Zang/Fu. Disease lasting many days may gradually flow into meridians, sink internally, invade Zang/Fu. Disease lasting long may stay only in Qi and Form, not entering internally. This is the heaviness/lightness of pathogenic disease, and deficiency/excess of righteous Qi. This chapter discusses the separation/entry/exit of Blood and Qi, examining the lightness/heaviness and life/death of pathogenic Qi, greatly concerning the Ultimate Dao. Thus, the Emperor ordered fasting before transmitting the book. I do not tire of verbosity but repeat clarification to encourage later learners. Knowing the entry/exit of Righteous Qi, one knows the depth of pathogenic disease. Treat at the onset, before reversal, preventing pathogenic Qi from entering internally to become incurable. This is a great merit in medical cultivation and post-treatment care. Gao Zi said: *Wai Chuai* discusses Qi uniting with Form; this chapter discusses Qi uniting with Blood; *Wu Bian* discusses disease in Form not affecting Qi; *Ben Cang* discusses disease in Zang-Fu not affecting Qi; *Ben Jing* Jue Ni chapters have disease in Qi, disease in Blood, and combined disease in Qi and Blood. This is the way of Yin-Yang separation and union, the unpredictability of change."