黄帝问曰。余闻九针于夫子。众多博大。不可胜数。余愿闻要道。以属子孙。传之后世。着之骨髓。藏之肝肺。歃
血而受。不敢妄泄。（离合真邪论曰。余闻九针九篇。夫子乃因而九之。九九八十一篇。余尽通其意矣。此盖言先立针经
八十一篇。论九针之道。然众多博大。不可胜数。故愿闻要道。要道者。以神藏五。合形藏四。以应九候也。故曰着之
骨髓者。藏之深隧也。藏之肝肺者。知血气之诊也。歃血而受者。藏之于心也。不敢妄泄者。藏之于中也。盖必先定五
脏之神。而后知死生之分。察病之所在。以调其虚实。故曰。凡刺之真。必先治神。五脏已定。九候已备。后乃存针。）
令合天道。必有终始。上应天光。星辰历纪。下副四时五行。贵贱更互。冬阴夏阳。以人应之奈何。愿闻其方。岐伯对
曰。妙乎哉问也。此天地之至数。（此篇首论九针九候之道。九针者。天地之大数也。始于一而终于九。故曰。一以法天。
二以法地。三以法人。四以法时。五以法音。六以法律。七以法星。八以法风。九以法野。夫圣人之起天地之数也。一
而九之。故以立九野。九而九之。九九八十一。以起黄钟数焉。以针应数也。一者。天也。天者。阳也。五脏之应天者
肺。肺者。五脏六腑之盖也。皮者。肺之合也。人之阳也。二者。地也。人之所以应土者。肉也。三者。人也。人之所
以成生者。血脉也。四者。时也。时者。四时八风之气也。五者。音也。音者。冬夏之分。分于子午。阴与阳别。寒与
热争。两气相搏也。六者。律也。律者。调阴阳四时。而合于十二经脉也。七者。星也。星者。人之七窍也。八者。风
也。风者。人之股肱八节。八正之虚风。八风之邪。舍于骨节腠理之间也。九者。野也。野者。人之节解皮肤之间也。
此天地之至数。上应天光星辰历纪。下副四时五行。中合人之九脏九窍。三部九候也。贵贱更互者。四时五行之气。以
王者为贵。而相者为贱也。冬阴夏阳者。下文之所谓沉细悬绝。为阴主冬、躁盛喘数。为阳主夏也。帝言九针之道。以
通其意于针经。今愿闻简要之道。是以伯答三部九候之法。三部九候为之原。九针之道。不必存矣。是以针解篇之人皮
应天。人肉应地。人脉应人。人筋应时。人声应音。人阴阳合气应律。人齿面目应星。人出入气应风。人九窍三百六十
五络应野。与灵枢九针论之多有不同。盖灵枢论十二原。本经以三部九候为原也。）帝曰。愿闻天地之至数。合于人形血
气。通决死生。为之奈何。（六节藏象论曰。夫自古通天者生之本。本于阴阳。其气九州九窍。皆通乎天气。）岐伯曰。
天地之至数。始于一。终于九焉。（始于一。终于九者。天之数也。曰天地之至数者。言天包乎地。地气通于天也。故曰
令合天道。）一者天。二者地。三者人。因而三之。三三者九。以应九野。（一者。奇也。阳也。故应天。二者。偶也。
阴也。故应地。三者。参也。故应人。因三才而三之则为九。以应九野。九野者。九州分野。上应天之二十八宿也。朱
永年曰。天以应皮。地以应肉。人以应血脉。一部之中。有皮。有肉。有血脉。有合于四时。五音。六律。七星。八风。
九野。是为九九八十一也。）故人有三部。部有三候。以决死生。以处百病。以调虚实。而除邪疾。（人有三部。部有三
候者。三而成天。三而成地。三而成人也。决死生者。观其形气。别其阴阳。调其血脉。察其腑脏。以知死生之期也。
处百病者。表里阴阳。寒热虚实之为病也。调虚实者。实则泻之。虚则补之也。除邪疾者。去血脉。除邪风也。）帝
曰。何谓三部。岐伯曰。有下部。有中部。有上部。部各有三候。三候者。有天。有地。有人也。必指而导之。乃以为
真。（夫人生于地。悬命于天。天地合气。命之曰人。是以一身之中有三部。一部之中。而各有天地人。不知三部者。阴
阳不别。天地不分。以实为虚。以邪为真。绝人长命。予人夭殃。故必扪循三部九候之盛虚而调之。乃以为刺法之真。）
上部天。两额之动脉。（在额两分。上循于顶。足太阳膀胱脉也。太阳为诸阳主气。故主上部天。）上部地。两颊之动
脉。（在鼻两旁。近于巨 之分。足阳明胃脉也。二阳之气而主土。故为上部地。）上部人。耳前之动脉。（在耳前曲车下
陷中。手太阳小肠脉也。夫心主血而小肠为之使。人之所以生成者。血脉也。故主上部人。此阳气之在上也。朱永年曰。
天主气。足太阳为诸阳主气也。地应肉。足阳明胃土之主肌肉也。人主血脉。手太阳与少阴相为表里也。）中部天。手太
阴也。（两手气口之动脉。手太阴脉也。五脏之应天者肺。然脏为阴。故主中部天。徐公遐曰。中部天。故能主周身之气。）
中部地。手阳明也。（在大指次指歧骨间。合谷之分。动应于手。手阳明大肠脉也。阳明居中土。故主中部地。）中部人
手少阴也。（在锐骨端之动脉。手少阴心脉也。三以应人。人主血脉。心藏血脉之气。故主中部人。）下部天。足厥阴也。
（在毛际外。气冲下。五里之分。动应于手。足厥阴肝脉也。厥阴为阴中之少阳。主春生之气。故主下部天。）下部地。
足少阴也。（在足内踝后。太溪之分。动脉应手。足少阴肾脉也。肾为牝脏而居下。故主下部地。）下部人。足太阴也。
（在鱼腹上越筋间。箕门之分。动脉应手。足太阴脾脉也。脾为阴脏而居中。故主下部人。）故下部之天以候肝。地以候
肾。人以候脾胃之气。（此以下部之三候。以候膈下之三神脏焉。徐公遐问曰。上部地。以候阳明之气。奚复以下部地而
候胃气耶。曰。所谓阳明者。胃之悍气。上冲于头。循咽上走空窍。下客主人。合阳明。并下人迎。此胃气别走于阳明
者也。所谓胃气者。乃水谷柔和之气。与阳热 悍之气有别。故以下部之脾脉候之。细参本经。及灵枢伤寒诸经。其义
自明矣。然荣卫气血。皆由胃气之所资生。故复以脾脉兼候胃气。曰。脾之本脉。亦可候胃气耶。曰。脾与胃以膜相运。
雌雄相应耳。是以仲景以胃脉之趺阳。而候脾气。岐伯以脾脉之箕门。兼候胃气。先圣后圣。其揆一也。）帝曰。中部之
候奈何。岐伯曰。亦有天。亦有地。亦有人。天以候肺。地以候胸中之气。人以候心。（肺属干金而主气。故天以候肺。
心主血脉而居肺之下。故人以候心。胸中。膻中也。宗气之所聚也。宗气者。阳明水谷之所资生。故地以候胸中之气。
此以中部之三候。以候膈上之二神脏。中土之二形脏焉。张二中曰。地以候胸中之气者。言中部之候。亦兼候阳明之胃
气也。今始知三部之中。而皆有阳明之胃气焉。张兆璜曰。太阳之脉下入缺盆。络肺贯膈。故以候胸中。）帝曰。上部以
何候之。岐伯曰。亦有天。亦有地。亦有人。天以候头角之气。地以候口齿之气。人以候耳目之气。（太阳为诸阳主气。
其经脉上额交巅。会于脑。出于项。故天以候头角之气。足阳明之气。胃腑之所生也。其经脉起于鼻交 中。上入齿中。
还出挟口环唇下。故地以候口齿之气。手太阳者。少阴心脏之府也。其经脉上目锐 。入耳中。为听宫。故人以候耳目
之气。此以膺喉头首。以候三形脏焉。盖阳藏之气在上也。朱永年曰。阳明之脉。起于鼻交 中。手太阳之脉。抵鼻。
是上部之三候。以候耳目口鼻之七窍者也。所谓七者星也。星者。人之七窍也。合腰尻下窍。共为九窍。故曰。其气九
州九窍。皆通乎天气。按针解篇曰。人齿面目应星。盖谓人面有七孔。以应七星也。）三部者。各有天。各有地。各有人。
（三部之中。而有九候。）三而成天。三而成地。三而成人。（九候之中。而各有三焉。）三而三之。合则为九。九分为九
野。九野为九藏。（兼三才而三之。合则为九。九分为九野。九野者。言身形之应九野也。左足应立春。左胁应春分。左
手应立夏。膺喉头首应夏至。右手应立秋。右胁应秋分。右足应立冬。腰尻下窍应冬至。六腑膈下三脏应中州。凡此九
者。以候脏腑阴阳之气。故九野为九藏。按星书。立春应天文箕尾分野。禹贡冀州之域。春分应天文心房分野。禹贡徐
州之域。立夏应天文翼轸分野。禹贡荆州之域。夏至应天文井鬼分野。禹贡雍州之域。立秋应天文参井分野。禹贡梁州
之域。秋分应天文奎娄分野。禹贡兖州之域。立冬应天文危室分野。禹贡青州之域。冬至应天文斗牛分野。禹贡扬州之
域。中州应天文张柳分理。禹贡豫州之域。故以身形应九野。九野而合九藏。九藏外通九窍。九野外合九州。而皆通乎
天气。是以兼三才而三之。为九九之数。下经云。人生有形。不离阴阳。天地合气。别为九野。分为四时。即此义也。）
故神脏五。形藏四。合为九藏。（神藏者。心藏神。肝藏魂。肺藏魄。脾藏意。肾藏志也。形藏者。胃与大肠小肠膀胱。
藏有形之物也。夫五味入口。藏于肠胃。味有所藏。以养五气。气和而生。津液相成。神乃自生。是五脏之神。由肠胃
津液之所生也。胃主化水谷之津液。大肠主津。小肠主液。膀胱者。津液之所藏。故以四腑为形脏。而人之阴阳气血。
肌肉经脉。皆由此九藏之所生也。）五脏已败。其色必夭。夭必死矣。（夭、死色也。言五脏之神气。由形藏之资生。五
色之外荣。由五脏之所发。此以九藏九候之气。而复归重于五脏之神气焉。）帝曰。以候奈何。岐伯曰。必先度其形之
肥瘦。以调其气之虚实。实则泻之。虚则补之。必先去其血脉而后调之。无问其病。以平为期。（候者。候三部九候之脉
而刺之也。肥人者。血气充盈。肤革坚固。其气涩以迟。刺此者。宜深而留之。瘦人者。皮薄色少。血清气滑。易脱于
气。易损于血。刺此者。宜浅而疾之。实者。邪气盛也。虚者。精气夺也。宜泻者。迎而夺之。宜补者。追而济之。去
血脉者。除菀陈也。盖凡治病。必先去其血。乃去其所苦。然后泻有余。补不足。无问其病之可否。必候其气至和平。
而后乃出其针也。）帝曰。决死生奈何。岐伯曰。形盛脉细。少气不足以息者危。（夫形充而脉坚大者。顺也。形充而
脉小以弱者。气衰。衰则危矣。）形瘦脉大。胸中多气者死。（针经曰。病而形肉脱。气胜形者死。形胜气者危。盖形瘦
者。正气衰也。脉大者。病气进也。胸中多气者。气胜形也。气胜形者。邪气盛而正气脱也。）形气相得者生。（天之生
命。所以立形定气。形气和平。是为相得。）参伍不调者病。（此即独大独小独疾独徐之意。此总言其不调者病。下节分
言之。以知病之所在。）三部九候。皆相失者死。（皆相失者。非止于参伍不调矣。此脏腑阴阳之气皆病。故死。）上下左
右之脉。相应如参舂者病甚。（夫脉之来去。随气降升。是以九候之相应。上下若一。如参舂者。言脉之上至下去。左至
右去。有如舂者之参差。彼上而此下也。此因邪病甚。而正为邪伤故也。）上下左右。相失不可数者死。（如参舂者。只
言其来去之参差。相失不可数者。并其至数之错乱。此邪病更甚。而正气将脱。故死。）中部之候虽独调。与众脏相失者
死。（中部天主气。中部人主血。中部地主胸中之宗气。夫上下左右之脉。交相应者。血气之循环也。脏腑之脉。得胃气
而至于手太阴者。宗气之所通也。如中部之候虽独调。与众藏相失者。不得中焦之血气以资养。故死。）中部之候。相减
者死。（上节论失其旋转相生之机。此言中焦之生原化薄。）目内陷者死。（目者。五脏六腑之精也。上节言中焦之根本衰
微。此复言脏腑之精气消灭。）帝曰。何以知病之所在。岐伯曰。察九候独小者病。独大者病。独疾者病。独迟者病。
独热者病。独寒者病。独陷下者病。（夫九候之相应也。上下若一。不得相失。如一部独异。即知病之所在。而随证治之。
大小者。脉之体象也。疾迟者。脉之气数也。寒热者。三部皮肤之寒热也。陷下者。沉陷而不起也。针经曰。上下左右。
知其寒温。何经所在。审皮肤之寒温滑涩。知其所苦。）以左手足上。上去踝五寸按之。庶右手足当踝而弹之。（此候生
阳之气。以知病之死生也。诸阳气者。太阳之所主也。根结篇曰。太阳为开。开折则肉节渎而暴病起矣。故暴病者。取
之足太阳。视有余不足。渎者。皮肤宛焦而弱也。是以知病之所在。而又当候太阳之气焉。卫气篇曰。足太阳之本。在
跟上五寸中。而气在胫者。止之于气街。与承山踝上以下。必先按而在久。应于手。乃刺而予之。按承山乃足太阳穴。
在外踝上七寸。故以左手于病者足上。上去踝五寸按之。是在承山之以下矣。庶右手于病者足上当踝而弹之。盖以左手
取脉。庶右手得以在下而弹。其应过五寸以上。蠕蠕然者不病。是更过踝上五寸。而及于承山矣。故曰踝上以下。必先
Huangdi asked, saying: "I have heard from you, Master, about the Nine Needles. The content is numerous and vast, beyond counting. I wish to hear the essential principles, so that I may pass them on to my descendants and transmit them to future generations. I will engrave them in my marrow, store them in my liver and lungs, accept them with a blood oath, and dare not recklessly disclose them. (As stated in 'Li He Zhen Xie Lun': 'I heard that there are nine chapters on the Nine Needles, and the Master expanded them into eighty-one chapters. I have fully understood their meaning.' This likely refers to the establishment of the 'Zhen Jing' [Classic of Acupuncture] with its eighty-one chapters discussing the way of the Nine Needles. However, since the content is numerous and vast, it is hard to count all of them, hence the desire to hear the essential principles. The essential principle lies in aligning the Five Shen Stores with the Four Xing Stores to correspond to the Three Regions and Nine Palpations. Thus, 'engraving in the marrow' implies deep storage; 'storing in the liver and lungs' implies knowing the diagnosis of Qi and Blood; 'accepting with a blood oath' implies storing it in the heart; 'daring not to disclose' implies storing it within. One must first stabilize the Shen of the Five Zang Organs to know the division between life and death, observe the location of diseases, and regulate deficiency and excess. Therefore, it is said: 'The true essence of acupuncture lies first in governing the Shen. Once the Five Zang Organs are stabilized and the Nine Palpations are prepared, then one considers the needle.') May this [method] accord with the Heavenly Dao, having a beginning and an end, corresponding above to the light of heaven, stars, and calendrical cycles, and below to the Four Seasons and Five Elements, with nobility and baseness alternating, winter being Yin and summer being Yang. How should man correspond to this? I wish to hear the method."
Qibo replied, "How profound your question is! This is the ultimate number of Heaven and Earth. (This chapter begins by discussing the way of the Nine Needles and Nine Palpations. The Nine Needles represent the great number of Heaven and Earth, starting from one and ending at nine. Thus, it is said: One corresponds to Heaven, Two to Earth, Three to Man, Four to the Seasons, Five to Musical Tones, Six to Pitch Pipes, Seven to Stars, Eight to Winds, and Nine to the Nine Fields. The sage establishes the numbers of Heaven and Earth from one to nine, thereby setting up the Nine Fields. Nine times nine equals eighty-one, initiating the number of Huangzhong [the fundamental pitch], corresponding the needles to these numbers. One is Heaven. Heaven is Yang. Among the Five Zang Organs, the Lung corresponds to Heaven; the Lung is the canopy of the Five Zang and Six Fu Organs. The skin is the exterior correspondence of the Lung and belongs to the Yang of humans. Two is Earth. What in humans corresponds to Earth is flesh. Three is Man. What enables human life is the blood vessels. Four is Time. Time refers to the Qi of the Four Seasons and the Eight Winds. Five is Tone. Tone marks the division between winter and summer, separated by Zi and Wu hours, where Yin and Yang differ, and cold and heat contend, with the two energies clashing. Six is Pitch Pipe. Pitch pipes harmonize Yin and Yang of the four seasons and correspond to the Twelve Meridians. Seven is Star. Stars correspond to the seven orifices of humans. Eight is Wind. Wind corresponds to the eight joints of the thighs and arms, i.e., the empty winds of the eight directions and the evil winds of the eight directions, which lodge between the bone joints and interstices. Nine is Field. Fields correspond to the joint separations and skin layers of humans. This is the ultimate number of Heaven and Earth, corresponding above to the light of heaven, stars, and calendrical cycles, below to the Four Seasons and Five Elements, and in the middle to the Nine Zang Organs, Nine Orifices, Three Regions, and Nine Palpations of humans. 'Nobility and baseness alternating' means that among the Qi of the Four Seasons and Five Elements, the ruling element is noble, and the assisting element is base. 'Winter Yin and Summer Yang' refers to what is mentioned later: sinking, fine, and suspended-extreme pulses indicate Yin ruling winter; restless, rapid, and panting pulses indicate Yang ruling summer. The Emperor discussed the way of the Nine Needles to clarify its meaning in the Zhen Jing, but now wishes to hear the concise principles. Therefore, Qibo answers with the method of the Three Regions and Nine Palpations. The Three Regions and Nine Palpations are the origin; the way of the Nine Needles need not be emphasized as much. Hence, in the 'Zhen Jie Pian', it says human skin corresponds to Heaven, human flesh to Earth, human vessels to Man, human tendons to Time, human voice to Tone, human Yin-Yang combined Qi to Pitch Pipes, human teeth and face to Stars, human inhalation/exhalation to Wind, and human nine orifices and 365 collaterals to Fields. This differs significantly from the 'Jiu Zhen Lun' in Ling Shu. Perhaps because Ling Shu discusses the Twelve Yuan Points, while this classic takes the Three Regions and Nine Palpations as the origin.)"
Huangdi said, "I wish to hear the ultimate number of Heaven and Earth, how it combines with human form and Qi, and how to determine life and death. What should be done?" (In 'Liu Jie Zang Xiang Lun': "Since ancient times, those who connect with Heaven find the root of life, which lies in Yin and Yang. Their Qi connects through the Nine Provinces and Nine Orifices, all communicating with Heavenly Qi.")
Qibo said, "The ultimate number of Heaven and Earth starts from one and ends at nine. (Starting from one and ending at nine is the number of Heaven. Calling it the ultimate number of Heaven and Earth means that Heaven envelops Earth, and Earth's Qi communicates with Heaven. Thus, it is said to accord with the Heavenly Dao.) One is Heaven, Two is Earth, Three is Man. Multiplying these three by three yields nine, corresponding to the Nine Fields. (One is odd, Yang, thus corresponding to Heaven. Two is even, Yin, thus corresponding to Earth. Three is combination, thus corresponding to Man. Based on the Three Powers [Heaven, Earth, Man] multiplied by three becomes nine, corresponding to the Nine Fields. The Nine Fields refer to the divisions of the Nine Provinces, corresponding above to the Twenty-Eight Mansions of Heaven. Zhu Yongnian said: Heaven corresponds to skin, Earth to flesh, Man to blood vessels. Within one region, there are skin, flesh, blood vessels, and correspondences to the Four Seasons, Five Tones, Six Pitch Pipes, Seven Stars, Eight Winds, and Nine Fields. This constitutes 9x9=81.)
Therefore, humans have Three Regions, each with three palpations, used to determine life and death, treat hundred diseases, regulate deficiency and excess, and eliminate pathogenic diseases. (Humans have Three Regions, each with three palpations; three make Heaven, three make Earth, three make Man. Determining life and death involves observing form and Qi, distinguishing Yin and Yang, regulating blood vessels, and examining Zang and Fu organs to know the timing of death. Treating hundred diseases involves distinguishing illnesses caused by exterior-interior, Yin-Yang, cold-heat, and deficiency-excess. Regulating deficiency and excess means purging excess and tonifying deficiency. Eliminating pathogenic diseases means removing blood stasis and dispelling wind pathogens.)"
Huangdi said, "What are the Three Regions?"
Qibo said, "There is the Lower Region, the Middle Region, and the Upper Region. Each region has three palpations. These three palpations are Heaven, Earth, and Man. One must use fingers to palpate and guide to grasp the truth. (Human life originates from Earth, and destiny hangs from Heaven. Heaven and Earth combine Qi, called Man. Thus, within the whole body there are Three Regions, and within each region, there are Heaven, Earth, and Man. Not knowing the Three Regions leads to confusion of Yin and Yang, Heaven and Earth, mistaking excess for deficiency, and evil for truth, cutting short lives and bringing premature death. Therefore, one must palpate the fullness and emptiness of the Three Regions and Nine Palpations to regulate them, which is the true method of acupuncture.)
Upper Region Heaven: The artery at both temples. (Located on both sides of the forehead, extending upwards to the vertex, belonging to the Foot Taiyang Bladder Meridian. Taiyang is the master Qi of all Yang meridians, thus governing Upper Region Heaven.)
Upper Region Earth: The arteries at both cheeks. (Located beside the nose, near the Juliao point, belonging to the Foot Yangming Stomach Meridian. Er Yang Qi governs Earth, thus governing Upper Region Earth.)
Upper Region Man: The artery in front of the ear. (Located in the depression below the anterior border of the zygomatic arch, belonging to the Hand Taiyang Small Intestine Meridian. The Heart governs Blood, and the Small Intestine serves it. Human generation relies on blood vessels, thus governing Upper Region Man. This represents Yang Qi in the upper part. Zhu Yongnian said: Heaven governs Qi, Foot Taiyang is the master Qi of all Yang; Earth corresponds to flesh, Foot Yangming Stomach Earth governs muscles; Man governs blood vessels, Hand Taiyang and Hand Shaoyin are interior-exterior pairs.)
Middle Region Heaven: Hand Taiyin [Lung Meridian]. (The arterial pulse at the cun kou of both hands, belonging to the Hand Taiyin Meridian. Among the Five Zang Organs, the Lung corresponds to Heaven. However, Zang organs are Yin, thus governing Middle Region Heaven. Xu Gongxia said: Middle Region Heaven therefore governs the Qi of the entire body.)
Middle Region Earth: Hand Yangming [Large Intestine Meridian]. (Between the metacarpals of the thumb and index finger, at the Hegu point, pulsating upon movement, belonging to the Hand Yangming Large Intestine Meridian. Yangming resides in the center and corresponds to Earth, thus governing Middle Region Earth.)
Middle Region Man: Hand Shaoyin [Heart Meridian]. (The arterial pulse at the radial styloid process, belonging to the Hand Shaoyin Heart Meridian. Three corresponds to Man, Man governs blood vessels, and the Heart stores the Qi of blood vessels, thus governing Middle Region Man.)
Lower Region Heaven: Foot Jueyin [Liver Meridian]. (Outside the pubic hairline, below Qichong, at the Wuli point, pulsating upon movement, belonging to the Foot Jueyin Liver Meridian. Jueyin is the Lesser Yang within Yin, governing the Spring generating Qi, thus governing Lower Region Heaven.)
Lower Region Earth: Foot Shaoyin [Kidney Meridian]. (Behind the medial malleolus, at the Taixi point, the arterial pulse is felt, belonging to the Foot Shaoyin Kidney Meridian. The Kidney is a Yin organ residing lower, thus governing Lower Region Earth.)
Lower Region Man: Foot Taiyin [Spleen Meridian]. (Above the fish belly, passing through the tendons, at the Jimen point, the arterial pulse is felt, belonging to the Foot Taiyin Spleen Meridian. The Spleen is a Yin organ residing in the center, thus governing Lower Region Man.)
Thus, Lower Region Heaven observes the Liver, Lower Region Earth observes the Kidney, and Lower Region Man observes the Qi of the Spleen and Stomach. (The following three palpations of the Lower Region observe the three Shen Zang organs below the diaphragm. Xu Gongxia asked: Upper Region Earth observes Yangming Qi, why does Lower Region Earth also observe Stomach Qi? Answer: The so-called Yangming is the fierce Qi of the Stomach, rushing upward to the head, along the throat to the orifices, descending to Zhuren, combining with Yangming, and descending to Renying. This is Stomach Qi taking a separate route to Yangming. The so-called Stomach Qi is the gentle Qi of water and grain, distinct from the fierce Yang-Heat Qi. Therefore, the Spleen pulse in the lower region is used to observe it. Carefully studying this classic and the various meridians in Ling Shu Shang Han clarifies the meaning. However, Ying and Wei Qi and Blood are all generated by Stomach Qi, so the Spleen pulse is also used to observe Stomach Qi. Question: Can the primary pulse of the Spleen observe Stomach Qi? Answer: The Spleen and Stomach are connected by membranes and correspond like male and female. Thus, Zhang Zhongjing uses the Duzi pulse of the Stomach to observe Spleen Qi, and Qibo uses the Jimen pulse of the Spleen to observe Stomach Qi. The former sages and latter sages share the same principle.)"
Huangdi said, "How are the Middle Region palpations conducted?"
Qibo said, "There is Heaven, there is Earth, and there is Man. Heaven observes the Lung, Earth observes the Qi of the Chest, and Man observes the Heart. (The Lung belongs to Metal and governs Qi, thus Heaven observes the Lung. The Heart governs blood vessels and resides below the Lung, thus Man observes the Heart. The chest is Danzhong, where Zong Qi gathers. Zong Qi is generated by Yangming water and grain, thus Earth observes the Qi of the chest. This uses the three palpations of the Middle Region to observe the two Shen Zang organs above the diaphragm and the two Xing Zang organs of Central Earth. Zhang Erzhong said: Earth observing the Qi of the chest means that the Middle Region palpations also observe the Stomach Qi of Yangming. Now we know that Yangming Stomach Qi exists in all three regions. Zhang Zhaohuang said: The Taiyang meridian descends into the supraclavicular fossa, connects to the Lung, and pierces the diaphragm, thus it is used to observe the chest.)"
Huangdi said, "What is observed in the Upper Region?"
Qibo said, "There is Heaven, there is Earth, and there is Man. Heaven observes the Qi of the head and horns [temples], Earth observes the Qi of the mouth and teeth, and Man observes the Qi of the ears and eyes. (Taiyang is the master Qi of all Yang. Its meridian ascends the forehead, crosses the vertex, meets at the brain, and exits at the nape. Thus, Heaven observes the Qi of the head and temples. The Qi of Foot Yangming is produced by the Stomach Fu. Its meridian starts at the nose, crosses the bridge, enters the teeth, emerges beside the mouth, and circles the lips. Thus, Earth observes the Qi of the mouth and teeth. Hand Taiyang is the palace of the Shaoyin Heart. Its meridian ascends to the outer canthus, enters the ear as Tinggong. Thus, Man observes the Qi of the ears and eyes. This uses the chest, throat, head, and neck to observe the three Xing Zang organs. Generally, the Qi of Yang Zang organs is in the upper part. Zhu Yongnian said: The Yangming meridian starts at the nose crossing the bridge; the Hand Taiyang meridian reaches the nose. Thus, the three palpations of the Upper Region observe the seven orifices of the ears, eyes, mouth, and nose. The so-called seven corresponds to Stars, and Stars are the seven orifices of humans. Combined with the lower orifice of the waist and buttocks, there are nine orifices. Thus, it is said: 'Its Qi connects through the Nine Provinces and Nine Orifices, all communicating with Heavenly Qi.' According to the Zhen Jie Pian: 'Human teeth and face correspond to Stars.' This means the human face has seven holes, corresponding to the Seven Stars.)"
The Three Regions each have Heaven, each have Earth, each have Man. (Within the Three Regions, there are Nine Palpations.) Three make Heaven, three make Earth, three make Man. (Within the Nine Palpations, there are three each.) Three multiplied by three makes nine. Nine divided into Nine Fields. Nine Fields correspond to Nine Zang Organs. (Combining the Three Powers and multiplying by three makes nine. Nine divided into Nine Fields. The Nine Fields refer to the body shape corresponding to the Nine Fields. Left foot corresponds to Lichun, left hypochondrium to Chunfen, left hand to Lixia, chest/throat/head to Xiazhi, right hand to Liqiu, right hypochondrium to Qiufen, right foot to Lidong, waist/buttocks/lower orifice to Dongzhi. The Six Fu Organs and three Zang organs below the diaphragm correspond to Central Earth. All these nine are used to observe the Qi of Zang and Fu, Yin and Yang. Thus, Nine Fields correspond to Nine Zang Organs. According to astrological books: Lichun corresponds to the Ji and Wei mansions, Yu Gong territory of Jizhou; Chunfen corresponds to Xin and Fang mansions, Yu Gong territory of Xuzhou; Lixia corresponds to Yi and Zhen mansions, Yu Gong territory of Jingzhou; Xiazhi corresponds to Jing and Gui mansions, Yu Gong territory of Yongzhou; Liqiu corresponds to Shen and Jing mansions, Yu Gong territory of Liangzhou; Qiufen corresponds to Kui and Lou mansions, Yu Gong territory of Yanzhou; Lidong corresponds to Wei and Shi mansions, Yu Gong territory of Qingzhou; Dongzhi corresponds to Dou and Niu mansions, Yu Gong territory of Yangzhou; Central Earth corresponds to Zhang and Liu divisions, Yu Gong territory of Yuzhou. Thus, the body shape corresponds to the Nine Fields, Nine Fields combine with Nine Zang Organs. Nine Zang Organs communicate externally with Nine Orifices, and externally with the Nine Provinces, all communicating with Heavenly Qi. Therefore, combining the Three Powers and multiplying by three results in the number 81. The lower classic says: 'Humans have form, inseparable from Yin and Yang. Heaven and Earth combine Qi, dividing into Nine Fields, separating into Four Seasons.' This is the meaning.)
Thus, the Shen Zang are five, the Xing Zang are four, totaling nine Zang Organs. (Shen Zang refers to the Heart storing Shen, Liver storing Hun, Lung storing Po, Spleen storing Yi, and Kidney storing Zhi. Xing Zang refers to the Stomach, Large Intestine, Small Intestine, and Bladder, which store tangible substances. Flavors enter the mouth and are stored in the intestines and stomach. Flavors are stored to nourish the Five Qi. When Qi is harmonious, life arises; fluids and liquids become complete, and Shen naturally generates. Thus, the Shen of the Five Zang are generated by the fluids of the intestines and stomach. The Stomach transforms fluids of water and grain; the Large Intestine governs Jin; the Small Intestine governs Ye; the Bladder is the storehouse of fluids. Thus, these four Fu organs are called Xing Zang, and human Yin-Yang Qi, blood, muscles, and meridians are all generated by these nine Zang Organs.)
If the Five Zang Organs fail, their complexion will inevitably be dull and lifeless; dull and lifeless indicates death. (Tian refers to the color of death. It means the Shen Qi of the Five Zang Organs is generated by the Xing Zang. The external luster of the five colors emanates from the Five Zang Organs. This emphasizes the Shen Qi of the Five Zang Organs based on the Qi of the Nine Zang Organs and Nine Palpations.)
Huangdi said, "How is the observation conducted?"
Qibo said, "First, measure the fatness and thinness of the body to adjust the deficiency and excess of Qi. Excess is purged, deficiency is tonified. One must first remove blood stasis before regulating, regardless of the disease, aiming for balance. (Observation involves palpating the pulses of the Three Regions and Nine Palpations to perform acupuncture. Fat people have abundant Qi and Blood and firm skin. Their Qi is sluggish and slow. For such patients, deep insertion and retention are appropriate. Thin people have thin skin, little color, clear and slippery Qi/Blood, making them prone to Qi depletion and Blood damage. For such patients, shallow insertion and quick removal are appropriate. Excess means pathogenic Qi is strong. Deficiency means essential Qi is depleted. To purge, attack and seize; to tonify, follow and assist. Removing blood stasis means eliminating accumulated old blood. Generally, treating disease requires first removing blood to alleviate suffering, then purging excess and tonifying deficiency. Regardless of whether the disease is curable, one must wait for the Qi to become balanced before withdrawing the needle.)"
Huangdi said, "How is life and death determined?"
Qibo said, "Robust form but fine pulse, with insufficient Qi to breathe, indicates danger. (Full body but firm and large pulse is favorable. Full body but small and weak pulse indicates Qi decline, which is dangerous.)
Thin form but large pulse, with excessive Qi in the chest, indicates death. (The Zhen Jing says: If the body and flesh are wasted away, and Qi exceeds Form, death occurs; if Form exceeds Qi, danger occurs. Thin form indicates decline of righteous Qi. Large pulse indicates progression of pathogenic Qi. Excessive Qi in the chest means Qi exceeds Form. Qi exceeding Form means pathogenic Qi is strong and righteous Qi is depleted.)
Form and Qi in harmony indicates life. (Heaven creates life to establish form and fix Qi. Harmonious Form and Qi is called harmony.)
Irregular and uncoordinated pulses indicate disease. (This refers to the concepts of exclusively large, exclusively small, exclusively rapid, or exclusively slow. Generally, irregularity indicates disease. The next section details this to locate the disease.)
All Three Regions and Nine Palpations are discordant indicates death. (Discordance here goes beyond mere irregularity. It means the Qi of Zang and Fu and Yin and Yang are all diseased, hence death.)
Pulses in the upper/lower and left/right responding like the uneven beating of a pestle in a mortar indicates severe disease. (The arrival and departure of pulses follow the ascending and descending of Qi. Thus, the Nine Palpations should respond uniformly. Responding like a pestle beating in a mortar means the pulses rise and fall, left and right go out, resembling the uneven rhythm of pounding grain, where one rises while another falls. This is due to severe pathogenic disease injuring the righteous Qi.)
Upper/lower and left/right pulses are discordant and uncountable indicates death. ('Like a pestle' only describes the uneven rhythm of arrival and departure. 'Discordant and uncountable' means even the frequency is chaotic. This indicates more severe pathogenic disease and impending depletion of righteous Qi, hence death.)
If the Middle Region pulse alone is harmonious but discordant with the other Zang organs, death occurs. (Middle Region Heaven governs Qi, Middle Region Man governs Blood, Middle Region Earth governs Zong Qi in the chest. The reciprocal response of upper/lower and left/right pulses represents the circulation of Qi and Blood. The pulses of Zang and Fu, receiving Stomach Qi and reaching the Hand Taiyin, are the passage of Zong Qi. If the Middle Region pulse is harmonious alone but discordant with other Zang organs, it means it lacks the nourishment of Middle Jiao Qi and Blood, hence death.)
If the Middle Region pulse diminishes, death occurs. (The previous section discussed the loss of rotational generation mechanism; this section states that the generative source of the Middle Jiao is weak.)
Sunken eyes indicate death. (The eyes are the essence of the Five Zang and Six Fu Organs. The previous section mentioned the weakness of the Middle Jiao root; this section reiterates the exhaustion of Zang and Fu essence.)
Huangdi said, "How do we know the location of the disease?"
Qibo said, "Examine the Nine Palpations. Exclusively small indicates disease. Exclusively large indicates disease. Exclusively rapid indicates disease. Exclusively slow indicates disease. Exclusively hot indicates disease. Exclusively cold indicates disease. Exclusively sunken/depressed indicates disease. (When the Nine Palpations correspond, they are uniform like Heaven and Earth, not discordant. If one region is different, one knows the location of the disease and treats according to the syndrome. Large/small are the physical characteristics of the pulse. Rapid/slow are the temporal characteristics. Hot/cold refer to the temperature of the skin in the three regions. Sunken/depressed refers to sinking without rising. The Zhen Jing says: Know the cold/warmth and meridian location from the upper/lower and left/right. Examine the cold/warmth and slippery/rough nature of the skin to know the suffering.)
Press with the left hand five cun above the ankle on the foot, and flick the right foot at the ankle. (This observes the Sheng Yang Qi to determine life and death. All Yang Qi is governed by Taiyang. The Gen Jie Pian says: Taiyang is the Opening. If the Opening fails, muscle joints become disordered and acute diseases arise. Therefore, for acute diseases, select the Foot Taiyang meridian and examine excess and deficiency. 'Disordered' means skin is withered and weak. Thus, knowing the disease location requires observing Taiyang Qi. The Wei Qi Pian says: The root of Foot Taiyang is five cun above the heel, and the Qi in the calf stops at Qicheng and Chengshan, below the ankle. One must press and hold for a long time until it responds to the hand, then puncture. Chengshan is a Foot Taiyang point, seven cun above the lateral malleolus. Therefore, press with the left hand five cun above the patient's ankle, which is below Chengshan. Flick with the right hand at the ankle. Using the left hand to take the pulse allows the right hand to flick below. If the response extends more than five cun above the ankle, ripplingly, the person is healthy, reaching Chengshan. Thus, it is said: Below the ankle, one must first...)