厥阴有余病阴痹。不足病生热痹。滑则病狐疝风。涩则病少腹积气。（此论六气之内合于五脏也。曰厥阴、少阴、太
阳、少阳。论六气之为病也。曰皮肉筋骨脉者。因六气而及于五脏之外合也。曰心肝脾肺肾者。因六气而及于五脏之次
也。有余者。多气少血。不足者。血气皆少。滑者阳气盛。微有热。涩者多血少气。微有寒。痹者。闭也。血气留着于
皮肉筋骨之间而为痛也。气病之谓疝。血病之谓积。盖气盛而生热。则为疝痛。血多而凝泣。故成积也。厥阴者。阴之
极也。阴极而阳生。得中见少阳之火化。故有寒有热也。厥阴主春生风木之气。故首论厥阴焉。张兆璜问曰。厥阴止
曰寒热。而以少阳病筋病肝者何也。曰此论病在六气。而及于五脏者也。厥阴不从标本。从乎中也。从中者。以中气为
化也。）少阴有余病皮痹隐轸。不足病肺痹。滑则病肺风疝。涩则病积溲血。太阴有余病肉痹寒中。不足病脾痹。滑则
病痹风疝。涩则病积。心腹时满。阳明有余病脉痹。身时热。不足病心痹。滑则病心风疝。涩则病积时善惊。太阳有余
病骨痹身重。不足病肾痹。滑则病肾风疝。涩则病积。善时巅疾。少阳有余病筋痹胁满。不足病肝痹。滑则病肝风疝。
涩则病积。时筋急目痛。（三阴三阳。有多血少气者。有多气少血者。惟阳明血气皆多。盖血气之生于阳明也。荣血行于
脉中。乃阳明水谷之精。上归于心。淫精于脉。脉气归于肺。肺朝百脉。输精于皮毛。毛脉合精。行气于腑。腑者。在
外之皮肉筋骨也。腑精与神明相合。而通于五脏。气复归于权衡。此脉气之生始出入也。是以阳明之有余不足。则为脉
痹心痹。心主脉而上归于肺。肺主皮毛。毛脉合精于皮肤之间。是以少阴之为皮痹肺痹也。脉气散于皮毛。复从太阴所
主之肉。少阳所主之筋。太阳所主之骨。而内通于五脏。是以有余而在外。则为肉痹筋痹骨痹。不足而陷于内。则为脾
痹肝痹肾痹矣。至气有余于内而为热。则为疝。血有余于内而为寒。则为积矣。故所谓风者。热所生也。所谓身重者。
病在气也。所谓溲血腹满。善惊目痛者。病在血也。此三阴三阳所主之血气。生始出入。各有太过不及之为病也。愚按
此章无问答之起句。乃伯承上章而言。）是故春气在经脉。夏气在孙络。长夏气在肌肉。秋气在皮肤。冬气在骨髓中。（此
承上文而言脉气之随四时生长收藏。外出于皮肤。内通于五脏。环转之无端也。）帝曰。余愿闻其故。岐伯曰。春者天气
始开。地气始泄。冻解冰释。水行经通。故人气在脉。夏者经满气溢。入孙络受血。皮肤充实。长夏者。经络皆盛。内
溢肌中。秋者天气始收。腠理闭守塞。皮肤引急。冬者盖藏。血气在中。内着骨髓。通于五脏。（夫经脉为里。支而横者
为络。络之别者为孙。是血气之从经脉而外溢于孙络。从孙络而充于皮肤。从皮肤而复内溢于肌中。从肌肉而着于骨髓。
通于五脏。是脉气之散于脉外。而复内通于五脏也。夫天为阳。地为阴。阴阳合而血气始生。肾主冬令之水而为生气之
原。阳明乃血气所生之府。故曰谷入于胃。脉道乃行。水入于经。而血乃成。然藉肾中之生气。戊癸合化。而后生此水
谷之精微。故天气开。地气泄。冻解冰释。水行经通。肾脏之冬令。已得春生之气。而人气始在脉。是人气之通于天也。
故曰春生夏长。秋收冬藏。是气之常也。人亦应之。以一日分为四时。朝则为春。日中为夏。日入为秋。夜半为冬。朝
则人气始生。日中人气长。夕则人气收。夜半人气在脏。人与天地参也。愚按缪刺篇。论卫气先行皮肤。先充络脉。络
脉先盛。故卫气已平。荣气乃满。而经脉大盛。是卫气之通于脉内也。此篇言血气之从经而络。从络而皮。复从皮肤肌
肉而内着骨髓。通于五脏。是荣血之行于脉外也。当知荣行脉中。卫行脉外者。论通体之经脉也。至于血气之生始出入。
营于脉中。渗于脉外。充肤热肉。生毫毛。内入于募原而通于脏腑。表里上下。无处不周。医者能洞悉血气之原流。而
后能导邪病之 却。故帝曰。经脉者。人之所以生。病之所以成。人之所以治。病之所以起。学之所始。工之所止也。
粗之所易。上之所难也。习上乘者。可不于针刺诸篇。用心求之。）是故邪气者。常随四时之气血而入客也。至其变化。
不可为度。然必从其经气。辟除其邪。除其邪。则乱气不生。（邪气者。在天六淫之邪也。四时之血气者。春气在经脉。
夏气在孙络。长夏气在肌肉。秋气在皮肤。冬气在骨髓中也。至其变化。不可为度者。谓天有六淫之邪。而人有形层六
气之化也。如邪留于外。则为皮肉筋骨之痹。合于内。则为心肝脾肺之痹矣。如留于气分则为疝。留于血分则为积矣。
如身中之阳盛则为热。虚寒则为寒矣。此皆吾身中阴阳虚实之变化也。然必从其四时之经气。辟除其邪。则变乱之气不
生矣。）帝曰。逆四时而生乱气奈何。岐伯曰。春刺络脉。血气外溢。令人少气。春刺肌肉。血气环逆。令人上气。春刺
筋骨。血气内着。令人腹胀。（此言血气之随时环转。自有出入之度。不可使之妄行也。夫刺者。所以取气也。春气在经
脉。而取之于络脉。则血气外溢。而令人少气矣。至于肌肉。则血气环逆。而令人上气矣。环逆者。逆其环转也。言血
气之从经而络。从络而皮。从皮肤而复环转于肌中也。至于筋骨。则血气内着。而令人腹胀矣。王芳侯曰。此后添出
筋字。盖以四时六气而言。则春主筋。而少阳主筋。以形层而言。则皮而肉。肉而筋。筋而骨也。）夏刺经脉。血气乃竭。
令人解 。夏刺肌肉。血气内却。令人善恐。夏刺筋骨。血气上逆。令人善怒。（夏气盛长。而血气已外出于孙络矣。若
再取之于经脉。则血气内竭。而令人懈惰也。血脉出于阳明。外溢于肌腠。夏气在孙络。而使之溢于肌中。则血气虚却
于内矣。阳明脉虚。则恐如人将捕之。夏气浮长于上。而反逆之使下。则气郁不疏。而使人善怒也。上逆当作下逆。）秋
刺经脉。血气上逆。令人善忘。秋刺络脉。气不外行。令人卧不欲动。秋刺筋骨。血气内散。令人寒栗。（秋令降收。而
反令其生长。故使血气上逆。而令人善忘也。血气从络脉而充于皮肤。从皮肤而内溢于肌肉。秋刺络脉。则血气不外行
于皮肤肌肉之间。故令人卧不欲动。盖肌肉者。脾所主也。脾病者。嗜卧不欲动。夫秋令始降。而反取之筋骨。使血气
散于内。而令人寒栗矣。按秋气在皮肤。长夏之气在肌肉。长夏者。夏秋之交也。此篇论经脉之气。从经脉而外出于
孙络。从孙络而充于皮肤。从皮肤而内溢于肌中。从肌中而着于筋骨。是皮肤尚属出机。至肌肉始属回转之降令。故此
章以肌肉主秋令者。从脉气之环转故也。）冬刺经脉。血气皆脱。令人目不明。冬刺络脉。内气外泄。留为大痹。冬刺肌
肉。阳气竭绝。令人善忘。（冬主闭藏。以奉春生之气。应藏而反泄之。故使血气皆脱于内。而令人目不明。盖五脏之精。
皆注于目而为之睛。冬者血气在中。内着骨髓。通于五脏。血气内脱。则五脏皆虚。故令人目不明也。冬刺络脉。则内
气外泄。而留为大痹。大痹者。脏气虚而邪气痹于五脏也。阳气生于阴中。出于肌腠。至冬令之时。复归于阴藏。冬刺
肌肉。是取所藏之气于肌腠之外。故使阳气竭绝于内。而令人善忘也。）凡此四时刺者。大逆之病。不可不从也。反之则
生乱气相淫病焉。（凡逆刺其四时之经气。则变生大病。故不可不从也。乱气、变乱之气也。相淫者。血气淫 也。此言
不从四时之气。则正气变乱而为病也。）故刺不知四时之经。病之所生。以从为逆。正气内乱。与精相薄。（此言邪气者。
常随四时之气血而入客也。故不知四时之经。病之所生。以从为逆。使正气内乱。而邪与精相薄矣。此篇重在六经之气
血。还转出入。宜顺而不宜逆。故上节先论正气为病。此始论其邪。下节复论其正气。）必审九候。正气不乱。精气不转。
（此言知四时之逆从者。必审察其九候也。九候者。有天有地有人。在天主气。在地主血。在人主脉。知血气经脉出入
之源流。则正气不致内乱。而精气不逆回矣。）帝曰。善。刺五脏。中心一日死。其动为噫。中肝五日死。其动为语。
中肺三日死。其动为咳。中肾六日死。其动为嚏欠。中脾十日死。其动为吞。刺伤人五脏必死。其动则根据其脏之所变候。
知其死也。（刺五脏者。谓刺伤其五脏之气也。盖三阴三阳之六气。名合于皮肉筋骨脉。脉肉筋骨。内合于五脏。如病肺
痹肺风。脾痹脾疝。则当取气于皮。取气于肉。不可逆刺以伤其脏真。故曰。刺伤人五脏必死。各根据其藏之所变候。而
知其死期。盖刺五脏。则动其脏气。动脏气。则变候见于外矣。按五脏外合五时。六经上应六气。诊要经终篇。以六
气应五脏而终于六经。此篇以六经应四时而终于五脏。诊要篇以经脉之生于五脏。而外合于六经。此篇以经脉之本于六
气。而内连于五脏。盖脉气之循于皮肉筋骨。内合五行。外合六气。外内之交。相生始出入者也。是以一篇之章句虽同。
而旨意各别。学人宜分析体会。不可以其重而忽之。张兆璜曰。诊要篇论逆刺其脏气之所出。而中伤五脏。故曰。凡刺
胸腹者。必避五脏。此篇论刺六经之内入而中伤五脏。故曰内通五脏。刺五脏中心一日死。谓刺外合之皮肉筋骨脉。而
不可中伤其脏也。）
When the Jueyin (Liver/Pericardium) qi is in excess, it causes Yin Bi (painful obstruction syndrome of the yin aspect); when deficient, it causes Heat Bi. A slippery pulse indicates Hu Shen Feng (fox hernia and wind disease); a choppy pulse indicates accumulation of qi in the lower abdomen. (This discusses the internal correspondence of the Six Qi with the Five Zang organs. Mentioning Jueyin, Shaoyin, Taiyang, and Shaoyang refers to the diseases caused by the Six Qi. Mentioning skin, flesh, sinews, bones, and vessels refers to their external correspondences with the Five Zang organs due to the Six Qi. Mentioning Heart, Liver, Spleen, Lung, and Kidney refers to the sequence of the Five Zang organs due to the Six Qi. "Excess" means abundant qi and scarce blood; "deficiency" means both blood and qi are scarce. A slippery pulse indicates abundant yang qi and slight heat; a choppy pulse indicates abundant blood and scarce qi, with slight cold. "Bi" means obstruction; pain arises when blood and qi stagnate between the skin, flesh, sinews, and bones. Disease of qi is termed "Shan" (hernia), and disease of blood is termed "Ji" (accumulation). Generally, excessive qi generates heat, leading to Shan pain; excessive blood coagulates, forming Ji masses. Jueyin represents the extreme of yin. When yin reaches its extreme, yang is born, receiving the fire transformation of the intermediate Shaoyang, thus presenting both cold and heat syndromes. Jueyin governs the spring generating wind-wood qi, so it is discussed first. Zhang Zhaohuang asked: Jueyin only mentions cold and heat; why are the diseases of Shaoyang, sinews, and Liver included? The answer is: This discusses disease in the Six Qi extending to the Five Zang organs. Jueyin does not follow the root or branch but follows the intermediate qi. Following the intermediate means transforming via the intermediate qi.)
When the Shaoyin (Heart/Kidney) qi is in excess, it causes Pi Bi (skin obstruction) and Yin Zhen (hidden rashes/urticaria); when deficient, it causes Lung Bi. A slippery pulse indicates Lung Wind Shan; a choppy pulse indicates accumulation and hematuria. When the Taiyin (Spleen) qi is in excess, it causes Rou Bi (flesh obstruction) and Han Zhong (internal cold); when deficient, it causes Spleen Bi. A slippery pulse indicates Bi Wind and Shan; a choppy pulse indicates accumulation with occasional fullness of the heart and abdomen. When the Yangming (Large Intestine/Stomach) qi is in excess, it causes Mai Bi (vessel obstruction) and frequent body heat; when deficient, it causes Heart Bi. A slippery pulse indicates Heart Wind Shan; a choppy pulse indicates accumulation with frequent fright. When the Taiyang (Small Intestine/Bladder) qi is in excess, it causes Gu Bi (bone obstruction) and heavy body; when deficient, it causes Kidney Bi. A slippery pulse indicates Kidney Wind Shan; a choppy pulse indicates accumulation with frequent disorders of the vertex (top of the head). When the Shaoyang (Gallbladder/Triple Burner) qi is in excess, it causes Jin Bi (sinew obstruction) and hypochondriac fullness; when deficient, it causes Liver Bi. A slippery pulse indicates Liver Wind Shan; a choppy pulse indicates accumulation with frequent sinew stiffness and eye pain. (The Three Yin and Three Yang meridians have varying ratios of blood and qi; some have abundant blood and scarce qi, others abundant qi and scarce blood. Only the Yangming meridian has abundant blood and qi. Blood and qi are generated from Yangming. Ying blood circulates within the vessels, derived from the essence of water and grain from Yangming, ascending to the Heart, nourishing the vessels. Vessel qi returns to the Lung, which directs all vessels, distributing essence to the skin and hair. Hair and vessel essence combine, circulating qi through the Fu organs. Fu organs refer to the external skin, flesh, sinews, and bones. Fu essence combines with Shen Ming (spiritual brightness) and connects to the Five Zang organs. Qi returns to balance. This describes the origin, entry, and exit of vessel qi. Thus, Yangming excess or deficiency leads to Mai Bi and Heart Bi. The Heart governs vessels and ascends to the Lung; the Lung governs skin and hair. Hair and vessel essence combine at the skin level, hence Shaoyin causes Pi Bi and Lung Bi. Vessel qi disperses into skin and hair, then passes through Taiyin-governed flesh, Shaoyang-governed sinews, and Taiyang-governed bones, internally connecting to the Five Zang organs. Therefore, excess externally causes Rou Bi, Jin Bi, and Gu Bi; deficiency internally sinking causes Spleen Bi, Liver Bi, and Kidney Bi. Qi excess internally generates heat, causing Shan; blood excess internally generates cold, causing Ji. Thus, "Wind" is generated by heat; "Heavy body" indicates disease in qi; "Hematuria, abdominal fullness, fright, and eye pain" indicate disease in blood. These are the diseases caused by excess or deficiency in the generation, origin, entry, and exit of blood and qi governed by the Three Yin and Three Yang. Note: This chapter lacks an introductory question-answer format, continuing from the previous chapter.)
Therefore, Spring qi resides in the Jing-Main vessels; Summer qi resides in the Sun-Luo (collateral) vessels; Late Summer qi resides in the muscles; Autumn qi resides in the skin; Winter qi resides in the bone marrow. (This continues the discussion on how vessel qi follows the growth, flourishing, harvesting, and storage of the four seasons, emerging externally to the skin and internally connecting to the Five Zang organs, cycling endlessly.)
The Yellow Emperor said: I wish to hear the reason. Qibo said: In Spring, heavenly qi begins to open, earthly qi begins to disperse, ice melts, water flows, and meridians become unobstructed. Thus, human qi resides in the vessels. In Summer, vessel qi fills and overflows, entering Sun-Luo vessels to receive blood, making the skin robust. In Late Summer, both vessel and collateral qi are vigorous, overflowing internally into the muscles. In Autumn, heavenly qi begins to gather, pores close and seal, and the skin becomes tight. In Winter, things are hidden; blood and qi remain in the interior, anchoring in the bone marrow and connecting to the Five Zang organs. (Meridians are the interior; branches crossing horizontally are Luo vessels; distinct branches of Luo are Sun vessels. This is the process of blood and qi overflowing from Jing-Mains to Sun-Luos, filling the skin, returning internally to muscles, anchoring in bone marrow, and connecting to the Five Zang organs. This is vessel qi dispersing outside vessels and re-entering the Five Zang organs. Heaven is Yang, Earth is Yin; blood and qi arise from their union. The Kidneys govern winter water as the source of vital qi. Yangming is the repository where blood and qi are generated. Thus, when food enters the stomach, the vessel pathways flow; when water enters the vessels, blood forms. Relying on the vital qi in the Kidneys, Wu-Gui combination transforms, producing the essence of water and grain. Thus, heavenly opening and earthly dispersal lead to melting ice and flowing water, unblocking meridians. The Kidney's winter phase already receives spring-generating qi, so human qi begins in the vessels. This is human qi communicating with Heaven. Hence, "Spring generates, Summer flourishes, Autumn harvests, Winter stores" is the constant pattern of qi. Humans also respond to it. Dividing one day into four phases: morning is Spring, noon is Summer, sunset is Autumn, midnight is Winter. Morning qi begins to generate; noon qi grows; evening qi gathers; midnight qi resides in the Zang organs. Humans participate with Heaven and Earth. Note: The *Miao Ci* chapter discusses Wei qi moving first in the skin, filling Luo vessels first. When Luo vessels are full, Wei qi is balanced, Ying qi fills, and Jing-Mains become vigorous. This is Wei qi communicating inside the vessels. This chapter discusses blood and qi moving from Jing to Luo, from Luo to skin, from skin/muscles internally to bone marrow, connecting to the Five Zang organs. This is Ying blood moving outside the vessels. One must understand that "Ying moves in vessels, Wei moves outside vessels" refers to the whole-body meridians. Regarding the generation, origin, entry, and exit of blood and qi: Ying circulates in vessels, seeps outside vessels, fills the skin, warms the flesh, grows hair, enters internally to the Mu-Yuan (source) and connects to the Zang-Fu organs. It permeates everywhere inside and outside, above and below. If a physician thoroughly understands the source and flow of blood and qi, they can guide away pathogenic diseases. Thus, the Yellow Emperor said: Meridians are the basis of life, the cause of disease, the method of treatment, and the recovery from disease. They are the beginning of learning and the limit of skill. Crude physicians find them easy; superior physicians find them difficult. Those pursuing supreme skills must study the acupuncture chapters diligently.)
Therefore, pathogenic qi often enters and lodges in the body following the changes of blood and qi in the four seasons. Its variations cannot be measured by fixed standards, but one must follow the Jing-Main qi to dispel the pathogen. Once the pathogen is removed, chaotic qi will not arise. (Pathogenic qi refers to the Six Excesses of Heaven. Four-season blood and qi refer to Spring qi in vessels, Summer qi in Sun-Luos, Late Summer qi in muscles, Autumn qi in skin, and Winter qi in bone marrow. "Variations cannot be measured" means Heaven has Six Excess pathogens, and humans have transformations of the six qi in their form layers. If pathogen remains externally, it causes Bi of skin, flesh, sinews, and bones; if it combines internally, it causes Bi of the Heart, Liver, Spleen, Lung, and Kidney. If it stays in the qi level, it causes Shan; if it stays in the blood level, it causes Ji. If yang is excessive in the body, it causes heat; if deficient and cold, it causes cold. These are all variations of yin-yang and deficiency-excess within oneself. However, one must follow the four-season Jing-Main qi to dispel the pathogen, so that chaotic qi does not arise.)
The Yellow Emperor said: How does violating the four seasons generate chaotic qi? Qibo said: Puncturing Luo vessels in Spring causes blood and qi to overflow externally, leading to shortness of breath. Puncturing muscles in Spring causes blood and qi to reverse cyclically, leading to upward rushing of qi. Puncturing sinews and bones in Spring causes blood and qi to anchor internally, leading to abdominal distension. (This states that blood and qi cycle with time, having limits of entry and exit, and should not move recklessly. Puncture aims to extract qi. Spring qi is in the Jing-Mains; puncturing Luo vessels causes blood and qi to overflow externally, leading to shortness of breath. Puncturing muscles causes cyclic reversal of blood and qi, leading to upward qi rush. Cyclic reversal means opposing the cycle. It means blood and qi move from Jing to Luo, from Luo to skin, and cycle back to muscles. Puncturing sinews and bones causes blood and qi to anchor internally, leading to abdominal distension. Wang Fanghou noted: The character "sinew" was added later. Discussing four seasons and six qi, Spring governs sinews, and Shaoyang governs sinews. Discussing physical layers, it is skin, then flesh, then sinew, then bone.)
Puncturing Jing-Mains in Summer depletes blood and qi, leading to lethargy. Puncturing muscles in Summer causes blood and qi to retreat internally, leading to fearfulness. Puncturing sinews and bones in Summer causes blood and qi to reverse upward, leading to irritability. (Summer qi flourishes, and blood and qi have already emerged externally to Sun-Luos. Puncturing Jing-Mains further depletes blood and qi internally, causing lethargy. Vessels originate from Yangming and overflow externally to muscle clefts. Summer qi is in Sun-Luos; forcing it to overflow into muscles causes blood and qi to vacate internally. Vacant Yangming vessels cause fear as if being chased. Summer qi floats and grows upward; reversing it downward causes qi stagnation, leading to irritability. "Upward reversal" in the text should likely be "downward reversal".)
Puncturing Jing-Mains in Autumn causes blood and qi to reverse upward, leading to forgetfulness. Puncturing Luo vessels in Autumn prevents qi from moving externally, leading to drowsiness and lack of desire to move. Puncturing sinews and bones in Autumn causes blood and qi to scatter internally, leading to chills. (Autumn governs descending and gathering; reversing this promotes growth, causing blood and qi to reverse upward, leading to forgetfulness. Blood and qi fill the skin from Luo vessels and overflow internally to muscles. Puncturing Luo vessels in Autumn prevents blood and qi from moving externally to skin and muscles, causing drowsiness. Muscles are governed by the Spleen. Spleen disease causes drowsiness and reluctance to move. Autumn begins to descend; puncturing sinews and bones scatters blood and qi internally, causing chills. Note: Autumn qi is in the skin; Late Summer qi is in the muscles. Late Summer is the transition between Summer and Autumn. This chapter discusses vessel qi moving from Jing-Mains to Sun-Luos, filling the skin, overflowing internally to muscles, and anchoring in sinews and bones. Skin belongs to the exiting mechanism; muscles belong to the turning and descending command. Thus, this chapter assigns muscles to Autumn based on the cyclical nature of vessel qi.)
Puncturing Jing-Mains in Winter causes depletion of both blood and qi, leading to blurred vision. Puncturing Luo vessels in Winter causes internal qi to leak externally, remaining as major Bi. Puncturing muscles in Winter exhausts yang qi, leading to forgetfulness. (Winter governs closure and storage, supporting Spring generation. Storing but instead leaking causes blood and qi to deplete internally, leading to blurred vision. Essence of the Five Zang organs pours into the eyes to form the pupils. In Winter, blood and qi are in the interior, anchoring in bone marrow and connecting to the Five Zang organs. Internal depletion of blood and qi makes the Five Zang deficient, causing blurred vision. Puncturing Luo vessels in Winter leaks internal qi externally, remaining as major Bi. Major Bi is deficiency of Zang qi with pathogen obstructing the Five Zang organs. Yang qi is born in yin and emerges from muscle clefts. In Winter, it returns to yin storage. Puncturing muscles in Winter extracts stored qi from outside the muscle clefts, exhausting internal yang qi and causing forgetfulness.)
These four-season punctures are major violations. One must not deviate from the correct approach. Deviating results in chaotic qi mutually contaminating and causing disease. (Violating the four-season Jing-Main qi generates severe diseases; thus, one must follow the norm. Chaotic qi refers to disordered qi. Mutual contamination refers to the turbidity of blood and qi. This states that failing to follow the four-season qi causes righteous qi to become disordered and diseased.)
Therefore, if one does not know the Jing-Mains of the four seasons and the origin of disease, treating compliance as violation, righteous qi becomes internally chaotic, clashing with essence. (This reiterates that pathogenic qi enters following the four-season blood and qi. Not knowing the four-season Jing-Mains and disease origins, treating compliance as violation, causes righteous qi to become chaotic, with pathogens clashing with essence. This chapter emphasizes the circulation, entry, and exit of qi and blood in the Six Meridians, favoring compliance over violation. The previous section discussed righteous qi pathology; this section discusses pathogens; the next section discusses righteous qi again.)
One must carefully examine the Nine Palpations. Righteous qi will not be chaotic, and essence will not reverse. (This states that those who understand the compliance and violation of the four seasons must examine the Nine Palpations. The Nine Palpations include Heaven, Earth, and Man. Heaven governs qi, Earth governs blood, and Man governs vessels. Knowing the source and flow of blood, qi, and vessel entry/exit ensures righteous qi does not become chaotic and essence does not reverse.)
The Yellow Emperor said: Excellent. Puncturing the Five Zang organs: Hitting the Heart causes death in one day, with symptoms of belching. Hitting the Liver causes death in five days, with symptoms of excessive talking. Hitting the Lung causes death in three days, with symptoms of coughing. Hitting the Kidney causes death in six days, with symptoms of sneezing and yawning. Hitting the Spleen causes death in ten days, with symptoms of swallowing. Puncturing and injuring the Five Zang organs of humans inevitably leads to death. The symptoms manifest according to the transformations of the injured Zang, allowing one to predict the time of death. (Puncturing the Five Zang organs means injuring the qi of the Five Zang organs. The Six Qi of the Three Yin and Three Yang correspond to skin, flesh, sinews, bones, and vessels. Vessels, flesh, sinews, and bones internally correspond to the Five Zang organs. For example, Lung Bi and Lung Wind, Spleen Bi and Spleen Shan, require taking qi from the skin and flesh. One must not puncture inversely to injure the true Zang qi. Thus, it is said: Puncturing and injuring the Five Zang organs inevitably leads to death. Predicting death time relies on the transformation signs of each Zang. Puncturing the Five Zang organs agitates Zang qi; agitated Zang qi manifests externally as transformation signs. Note: The Five Zang externally correspond to the Five Seasons; the Six Meridians internally correspond to the Six Qi. The *Zhen Yao Jing Zhong* chapter aligns Six Qi with Five Zang ending in Six Meridians; this chapter aligns Six Meridians with Four Seasons ending in Five Zang. The *Zhen Yao* chapter derives vessels from Five Zang externally combining with Six Meridians; this chapter derives vessels from Six Qi internally connecting to Five Zang. Vessel qi circulates through skin, flesh, sinews, and bones, internally combining with Five Elements and externally combining with Six Qi. External and internal interactions drive generation and movement. Although the phrasing in this chapter may resemble others, the intent differs. Students should analyze and comprehend carefully, not neglect it due to repetition. Zhang Zhaohuang said: The *Zhen Yao* chapter discusses inverse puncture of Zang qi exit points injuring the Five Zang, stating: When puncturing the chest and abdomen, one must avoid the Five Zang. This chapter discusses internal penetration of Six Meridians injuring the Five Zang, stating: Internally connecting to the Five Zang. Hitting the Heart causes death in one day refers to puncturing the externally corresponding skin, flesh, sinews, bones, and vessels without injuring the Zang.)