黄帝问曰。余闻刺法言。有余泻之。不足补之。何谓有余。何谓不足。岐伯对曰。有余有五。不足亦有五。帝欲何
问。帝曰。愿尽闻之。岐伯曰。神有余有不足。气有余有不足。血有余有不足。形有余有不足。志有余有不足。凡此十
者。其气不等也。（其气。谓五者之气。皆有虚实之不等。此篇论五脏所生之气血神志。而归重于血气。故篇名调经论。）
帝曰。人有精气。津液。四肢。九窍。五脏。十六部。三百六十五节。乃生百病。百病之生。皆有虚实。今夫子乃言有
余有五。不足亦有五。何以生之乎。（灵枢经云。两神相搏。合而成形。常先身生。是谓精。上焦开发。宣五谷味。充肤
熏身泽毛。若雾露之溉。是谓气。腠理开发。汗出溱溱。是谓津。谷入气满。淖泽注于骨。骨肉屈伸。泄泽补益脑髓。
皮肤润泽。是谓液。中焦受气取汁。变化而赤。是谓血。壅遏营气。令无所避。是谓脉。四肢为诸阳之本。九窍为水注
之气。五脏者。所以藏精神血气魂魄者也。十六部者。十六部之经脉也。手足经脉十二。跷脉二。督脉一。任脉一。共
十六部。脉亦计十六丈二尺。而一周于身。节之交。三百六十五会。神气之所游行出入。乃百病之所从而生。皆有虚有
实。）岐伯曰。皆生于五脏也。夫心藏神。肺藏气。肝藏血。脾藏肉。肾藏志。而此成形。（此言五者之气。皆生于五脏。
而五脏所藏之血气神志。以成此形。）志意通。内连骨髓而成身形五脏。（志意者。所以御精神。收魂魄。适寒温。和喜
怒者也。志意通。内连骨髓而成身形五脏。上节言有形之五脏。以生无形之五志。此言无形之五志。以成有形之身形。
五志者。心藏神。肝藏魂。肺藏魄。脾藏意。肾藏志也。张兆璜曰。阴阳者。血气之男女也。神志者。水火之精也。
人秉阴阳水火而成此形。）五脏之道。皆出于经隧。以行血气。血气不和。百病乃变化而生。是故守经隧焉。（此言五脏
之道。又皆归于经隧。经隧者。五脏之大络。以行血气者也。血气不和。百病乃变化而生。是故调治之道。亦守其经隧
焉。）帝曰。神有余不足何如。岐伯曰。神有余则笑不休。神不足则悲。（神者心之所藏也。心藏脉。脉舍神。心在志
为喜。在声为笑。故有余则笑不休。不足则金气反胜而为悲。阴阳应象论曰。悲胜怒。宣明五气篇曰。并于肺则悲。是
悲属肺志。）血气未并。五脏安定。邪客于形。洒淅起于毫毛。未入于经络也。故命曰神之微。（血气未并。则阴阳匀平。
五脏之道。皆入于经隧以行血气。故血气和。则五脏安定矣。邪客于形。尚在于皮肤之间。洒淅动形。而未入于经络。
此神气为病之微者也。张兆璜曰。血气相并。则有虚有实。邪入深而客于肌肉经脉。亦有虚有实。此血气平而邪客之
浅者也。）帝曰。补泻奈何。岐伯曰。神有余。则泻其小络之血出血。勿之深斥。无中其大经。神气乃平。（血者。神气
也。泻其小络之血出其血。则有余之神气自平。斥、推也。若深推而中其大经。则反伤其血气矣。）神不足者。视其虚络。
按而致之。刺而利之。无出其血。无泄其气。以通其经。神气乃平。（心主血脉。视其心之皮部有虚络者。按其穴而致其
气。刺其络而利其血。无泄其血气。以通其经脉。而神气乃平矣。愚按针刺之道。通利经脉。无泄其气血。即所以补虚
也。盖血气流通。而形神自生矣。人之为病。因郁滞而成虚者。十居其半医者但知补虚。不知通利之中。更有补虚之妙
用。）帝曰。刺微奈何。岐伯曰。按摩勿释。着针勿斥。移气于不足。神气乃得复。（言刺神之微者。当按摩其处。勿令
释手。着针者。如以布 着之乃从单布上刺。谓当刺之极浅。而勿推内其针。移其邪气于不足。而神气乃自复矣。）帝
曰。善。气有余不足奈何。岐伯曰。气有余。则喘咳上气。不足则息利少气。（肺主气而司呼吸。故有余则喘咳上逆。不
足则呼吸不利而少气也。）血气未并。五脏安定。皮肤微病。命曰白气微泄。（肺合皮。其色白。微邪客于皮肤。命曰白
气微泄。谓微伤其肺气也。）帝曰。补泻奈何。岐伯曰。气有余则泻其经隧。无伤其经。无出其血。无泄其气。不足则补
其经隧。无出其气。（经隧、大络也。五脏之所以出血气者也。故有余则泻其经隧之血气。而勿再伤其经脉之血气也。不
足则补其经隧之血气。而无泄其经隧之气焉。）帝曰。刺微奈何。岐伯曰。按摩勿释。出针视之。曰。我将深之。适人必
革。精气自伏。邪气散乱。无所休息。气泄腠理。真气乃相得。（出针。出而浅之也。视之。视其浅深之义也。曰我将深
之。适人之邪。浅客于皮。必与正气相格。庶邪散而正气不泄。故曰我将深之。谓将持内之。而使精气自伏。复放而出
之。令邪无散乱。迎之随之。以意和之。无所休息。使邪气泄于皮毛腠理。而真气乃相得复于肌表。此用针浅深之妙法
也。）帝曰。善。血有余不足奈何。岐伯曰。血有余则怒。不足则恐。（肝志怒。肾志恐。故血有余。则肝气盛而主怒。
不足。则母气衰而并于脾。故恐。莫仲超曰。木气不足则土气盛。土气盛。则并于所不胜之肾脏而为恐。）血气未并。
五脏安定。孙络水溢。则经有留血。（下文之所谓病在脉。调之血者。心包络所主之血也。此所谓血者。肝脏之所主也。
肝藏之血。本于冲脉。冲脉起于胞中。其浮而外者。循腹上行。散于皮肤肌肉之间。充肤热肉生毫毛。卧则归于肝脏。
寤则随卫气而行于脉外。孙络水溢者。胞中之津水也。水谷之津。流溢于中。奉心神化赤而为血。故曰水入于经。而血
乃成。夫经脉之血。从经而脉。脉而络。络而孙。脉外之血。从皮肤而转注于孙脉。从孙络而入于经俞。此脉内脉外之
血气。互相交通者也。故曰孙络水溢。则经有留血。此肝有微病。致经水之溢于经也。）帝曰。补泻奈何。岐伯曰。血有
余。则泻其盛经出其血。不足则视其虚经。内针其脉中。久留而视。脉大。疾出其针。无令血泄。（盛经、冲脉也。冲脉
为经络之海。故曰盛经。虚经。虚而不盛也。久留、候气至也。脉大气至而血复也。张兆璜曰。凡病虚中有实。实中
有虚。出针视之。曰。我将深之。适人必革。此泻邪而兼补其正气也。久留而视。脉大。疾出其针。此补虚而兼出其微
邪也。迎之随之。浅深在意。斯尽调经之妙用。二视字宜玩。）帝曰。刺留血奈何。岐伯曰。视其血络。刺出其血。无令
恶血得入于经。以成其疾。（经云。经脉为里。支而横者为络。络之别者为孙。盛而血者疾诛之。盛者泻之。盖血在于络。
是孙络之水溢。留于络中而成败恶之血矣。此将入于经。故当疾刺以泻出之。）帝曰。善。形有余不足奈何。岐伯曰。
形有余则腹胀。泾溲不利。不足则四肢不用。（腹乃脾土之郛郭。故有余则胀。灵枢经云。脾气实则经溲不利。盖土气盛
实。则克制其水而不流。脾主四肢。故虚则不用。）血气未并。五脏安定。肌肉蠕动。命曰微风。（蠕叶软。虫行动貌。
盖风伤卫。卫气行于肌肉之间。故蠕动也。）帝曰。补泻奈何。岐伯曰。形有余则泻其阳经。不足则补其阳络。（阳、谓
阳明也。阳明与太阴为表里。盖皮肤气分为阳。脾所主在肌肉。故当从阳以补泻。泻刺其经者。从内而出于外也。补刺
其络者。从外而内于内也。）帝曰。刺微奈何。岐伯曰。取分肉间。无中其经。无伤其络。卫气得复。邪气乃索。（微风
伤卫。卫气行于脉外。故当取之分肉。而无伤其经络。所谓病在肉。调之分肉也。索、散也。尽也。）帝曰。善。志有
余不足奈何。岐伯曰。志有余则腹胀飧泄。不足则厥。（肾者。胃之关也。关门不利。则聚水而为腹胀飧泄矣。肾为生气
之原。故不足则厥逆而冷。）血气未并。五脏安定。骨节有动。（骨节有动者。亦为微风所伤也。故下文曰。邪所以能立
虚。）帝曰。补泻奈何。岐伯曰。志有余则泻然筋血者。不足则补其血溜。（然、谓然谷穴。在足踝下之两经间。故曰然
筋。足少阴之荥穴也。荥为火。故有余则当泻其坎中之满。复溜足少阴之经穴也。经属金。虚则补其母也。）帝曰。刺未
并奈何。岐伯曰。即取之。无中其经。邪所乃能立虚。（即取之者。即于骨节有动之处而取之也。邪所。谓邪客而有动之
所也。此病在骨者调之骨。故无中其经。）帝曰。善。余已闻虚实之形。不知其何以生。岐伯曰。气血以并。阴阳相倾。
气乱于卫。血逆于经。血气离居。一实一虚。（此言五者之有余不足。生于血气之相并也。血气者。阴阳也。阴阳者。皮
肤气分为阳。经脉血分为阴。表为阳。里为阴。身半以上为阳。身半以下为阴。气乱于卫者。血并于气也。血逆于经者。
气并于血也。血并于气。则血离其居。气并于血。则气离其居矣。血离其居。则血虚而气实。气离其居。则气虚而血实。
故曰一实一虚。盖有者为实。无者为虚也。此节论血气相并之总纲。再按卫者。水谷之悍气也。肺主之气。乃三阳之表
气。肌腠之元真。故曰气乱于卫。谓乱于卫之部署也。下文曰。取气于卫。病在气。调之卫。皆属此意。盖皮肤肌肉之
腠理处。皆卫气游行出入之所。谓当取之于皮肤肌腠。而无动其经脉也。当知卫气出于阳明。日行于阳。夜行于阴。大
会于风府。游行于外内者也。太阳三焦之气。生于下焦水中。从下而上。自内而外。主司于肤表。通会于肌腠。故曰三
焦膀胱者。腠理毫毛其应。分别血气生始出入之原。乃上乘之学问。学人当于针经。乃本经针刺诸篇。用心参究。）血并
于阴。气并于阳。故为惊狂。（此言血分气分之为阴阳也。脉外气分为阳。脉内血分为阴。阴血满之于外。阳气注于脉中。
是为阴阳匀平。如血并居于阴。则阴盛而血实。心主血脉。故阴盛则惊。气并于阳。则阳盛而气实。阳盛则发狂也。）血
并于阳。气并于阴。乃为炅中。（此言外内之为阴阳也。炅、热也。血并于阳。则阴虚而生内热矣。气并于阴。则阳气内
盛而为热中矣。故阴阳外内相并。而总属炅中。）血并于上。气并于下。心烦惋善怒。血并于下。气并于上。乱而喜忘。
（此分上下之为阴阳也。血并上。则脉气实而心烦惋。气并于下。则气不舒而多怒也。血并于下。则血蓄于下而喜忘。
气并于上。则气逆于上而为 乱。灵枢经曰。清浊之气相干。乱于胸中。是为大 。伤寒论曰。其人喜忘者。必有蓄血。
宜抵当汤下之。按抵当汤证。乃血蓄于气分。当知气并于上。非则并于脉外。而兼并于脉中。故曰清浊之气相干。血并
于下。非则并于脉中。而兼并于脉外。故其人喜忘。经云上气不足。下气有余。肠胃实而心气虚。虚则营卫留之于下。
久之不以时上。故喜忘也。）帝曰。血并于阴。气并于阳。如是血气离居。何者为实。何者为虚。岐伯曰。血气者。喜
温而恶寒。寒则泣不能留。温则消而去之。是故气之所并为血虚。血之所并为气虚。（此复申明血气。各自并居而成虚也。
离、分也。泣、涩也。夫血满于外。气注于阴。是阴阳相合而为和平。如血并于阴。气并于阳。是血气各自分其居矣。
故血气喜其温和相合。而恶其寒涩独居。如血并于阴。则寒泣而不能流行。血不流行。则气不得以和之矣。气并于阳。
则气温而血消去。气热消铄。则血不得以和之矣。是故气之所并为血虚。血之所并为气虚也。张兆璜问曰。血并于阴。
则气亦并于阳矣。故谓血气离居。似血气皆当为实。而以血并为气虚。气并为血虚。两者皆虚。何也。曰。血并于阴者。
血并而气不并也。血并于阴。则阴盛而寒。寒则血中之气。亦涩而不能流行矣。气并于阳者。气并而血不并也。气并于
阳则阳盛而热。热则气分之血。亦消烁而去矣。故曰。气并则无血。血并则无气。）帝曰。人之所有者。血与气耳。今夫
子乃言血并为虚。气并为虚。是无实乎。岐伯曰。有者为实。无者为虚。故气并则无血。血并则无气。今血与气相失。
故为虚焉。（此再申明血气并而成虚者。因无而为虚也。如血并于阴。则阴寒盛而血中之气亦无矣。如气并于阳。则阳热
盛而气分之血亦消去矣。故气并则无血。血并则无气。今血与气相失。而不能相和。故皆为虚焉。）络之与孙脉。俱输于
经。血与气并。则为实焉。血之与气。并走于上。则为大厥。厥则暴死。气复反则生。不反则死。（此申明血气共并之为
实也。络者。经脉之支别也。孙脉者。乃孙络之脉别经者。亦三百六十五脉。内通于十二大络。外通于肤腠皮毛。五脏
之血气。从大络而出于孙脉。从孙脉而出于肤表。表阳之气。从孙络而入于大络。从大络而注于经俞。此外内交通血气
之径路也。是络脉之血气。孙络之气血。俱输于经。是血与气。共并于血分。则为实也。血之与气。并走于上。则为大
Yellow Emperor asked, saying: I have heard the teachings on needling methods, stating that excess conditions are treated by draining (reducing) and deficiency conditions by tonifying. What constitutes an excess condition? What constitutes a deficiency condition?
Qibo replied: There are five types of excess and five types of deficiency. Which aspect do you wish to inquire about?
The Yellow Emperor said: I wish to hear them all.
Qibo said: There is excess and deficiency in Shen (Spirit), Qi (Vital Energy), Blood, Xing (Form/Body), and Zhi (Will). These ten states all involve an imbalance of Qi. ("Qi" here refers to the Qi of these five aspects, all of which possess inequalities of excess and deficiency. This chapter discusses the Qi, Blood, Shen, and Zhi generated by the Five Zang Organs, emphasizing Blood and Qi, hence the title "Treatise on Regulating the Channels".)
The Yellow Emperor said: Humans possess Jing Essence, Jin Ye (Body Fluids), four limbs, nine orifices, five Zang organs, sixteen channel systems, and three hundred and sixty-five acupoints, from which arise a hundred diseases. The generation of these diseases involves both excess and deficiency. Now, Master, you speak of five excesses and five deficiencies; how do they arise? (As stated in the *Ling Shu*: When two spirits interact, they combine to form a shape, existing prior to the body's formation; this is called Jing Essence. The Upper Jiao opens and develops, disseminating the flavors of grains and beans to fill the skin, warm the body, and moisten the hair, like mist and dew; this is called Qi. When the interstices open and sweat flows profusely, this is called Jin. When grain enters and Qi fills, the thick and moist substances pour into the bones, enabling flexion and extension of bone and flesh, seeping to nourish the brain marrow, and moistening the skin; this is called Ye. The Middle Jiao receives Qi and extracts juices, transforming them into red; this is called Blood. Confining Ying Nutrient Qi so it has nowhere to evade; this is called Mai (Vessels). The four limbs are the root of all Yang. The nine orifices are where water Qi pours. The five Zang organs store Spirit, Qi, Blood, Hun, Po, Yi, and Zhi. The sixteen systems refer to the sixteen channel systems: twelve channels of the hands and feet, two Chong (Flying Vessels), one Du (Governing Vessel), and one Ren (Conception Vessel), totaling sixteen. The total length of vessels is sixteen zhang and two chi, circling the body once. At the intersections of joints, there are three hundred and sixty-five meeting points, the pathways for the travel and entry/exit of Shen Qi, where all diseases originate, possessing both deficiency and excess.)
Qibo said: All these arise from the Five Zang Organs. The Heart stores Shen, the Lungs store Qi, the Liver stores Blood, the Spleen governs flesh (muscles), and the Kidneys store Zhi, thereby forming the physical body. (This states that the Qi of these five originates from the Five Zang Organs, and the Blood, Qi, Shen, and Zhi stored within them constitute this form.) When Zhi Yi (Will and Intention) are smooth, they connect internally with the bone marrow to form the body shape and Five Zang Organs. (Zhi Yi serves to control Spirit, gather Hun and Po, adapt to cold and heat, and harmonize joy and anger. When Zhi Yi is smooth, it connects internally with bone marrow to form the body and Zang organs. The previous section discussed how tangible Zang organs generate intangible Five Wills; this section discusses how intangible Five Wills form tangible body shapes. The Five Wills are: Heart stores Shen, Liver stores Hun, Lungs store Po, Spleen stores Yi, Kidneys store Zhi. Zhang Zhaohuang stated: Yin and Yang are the male and female aspects of Blood and Qi; Shen and Zhi are the essence of Water and Fire. Humans inherit Yin, Yang, Water, and Fire to form this body.)
The pathways of the Five Zang Organs all emerge from the Jing Sui (Channel Tunnels/Vessels) to circulate Blood and Qi. If Blood and Qi are not harmonious, a hundred diseases will change and arise. Therefore, one must guard the Jing Sui. (This states that the pathways of the Five Zang Organs return to the Jing Sui. Jing Sui refers to the great collaterals of the Five Zang Organs, used to circulate Blood and Qi. Since disharmony of Blood and Qi gives rise to myriad diseases, the method of regulation also lies in guarding these Jing Sui.)
The Yellow Emperor asked: How do excess and deficiency in Shen manifest?
Qibo said: Excess in Shen leads to incessant laughter; deficiency in Shen leads to sorrow. (Shen is stored in the Heart. The Heart stores vessels, and vessels house Shen. The Heart's emotion is Joy, and its sound is laughter. Thus, excess leads to incessant laughter. Deficiency allows Metal Qi to counter-attack, resulting in sorrow. The *Yin Yang Ying Xiang Da Lun* states: Sorrow overcomes Anger. The *Xuan Ming Wu Qi Pian* states: When Qi gathers in the Lung, there is sorrow; thus, sorrow belongs to the Lung's will.)
When Blood and Qi have not yet merged, and the Five Zang Organs are stable, pathogenic factors invade the form, causing shivering and aversion starting from the fine hairs, but not yet entering the meridians. This is termed the subtle level of Shen pathology. (When Blood and Qi have not merged, Yin and Yang are balanced, and the pathways of the Five Zang Organs enter the Jing Sui to circulate Blood and Qi; thus, harmonious Blood and Qi ensure stable Zang organs. Pathogens invading the form remain in the skin and muscles, causing shivering without entering the meridians; this is the subtle stage of Shen Qi disease. Zhang Zhaohuang noted: When Blood and Qi merge, there is excess and deficiency; deep invasion into muscles and meridians also presents excess and deficiency. Here, Blood and Qi are peaceful, and pathogens are shallowly invaded.)
The Yellow Emperor asked: How should tonification and reduction be applied?
Qibo said: For excess in Shen, drain the blood from small collaterals until bleeding occurs. Do not push deeply, and avoid injuring major meridians, so that Shen Qi becomes balanced. (Blood is the substance of Shen Qi. Draining blood from small collaterals balances excess Shen Qi. "Chi" means to push. Deep pushing that injures major meridians would damage Blood and Qi.) For deficiency in Shen, observe the deficient collaterals, press to guide Qi, needle to facilitate flow, do not cause bleeding, do not dissipate Qi, and unblock the meridians so that Shen Qi becomes balanced. (The Heart governs Blood and Vessels. Observe the skin regions of the Heart for deficient collaterals, press acupoints to guide Qi, needle collaterals to facilitate Blood flow, without leaking Blood and Qi, thereby unblocking meridians and balancing Shen Qi. Note: The way of needling is to unblock meridians without leaking Blood and Qi; this is itself tonifying deficiency. When Blood and Qi flow freely, Form and Spirit naturally arise. Half of diseases caused by stagnation become deficiency. Physicians only know tonification, unaware of the subtle tonifying effect within unblocking and facilitating flow.)
The Yellow Emperor asked: How to treat the subtle level?
Qibo said: Massage continuously without releasing; apply needles without deep thrusting. Transfer Qi to the deficient area, and Shen Qi will recover. (To treat subtle Shen pathology, massage the area without letting go. Applying needles implies placing cloth on the skin and needling through it, meaning very superficial needling without internal thrusting. Transferring pathogenic Qi to the deficient area allows Shen Qi to recover.)
The Yellow Emperor said: Excellent. How do excess and deficiency in Qi manifest?
Qibo said: Excess in Qi leads to panting, coughing, and rebellious Qi; deficiency in Qi leads to free breathing but shortness of breath. (The Lungs govern Qi and respiration. Excess causes panting, coughing, and upward rebellion; deficiency causes difficult respiration and shortness of breath.)
When Blood and Qi have not yet merged, and the Five Zang Organs are stable, there is a slight pathological change in the skin, termed "White Qi Micro-Dissipation." (The Lungs govern the skin, and their color is white. Slight pathogens invading the skin are termed White Qi Micro-Dissipation, indicating slight injury to Lung Qi.)
The Yellow Emperor asked: How should tonification and reduction be applied?
Qibo said: For excess in Qi, drain the Jing Sui (major collaterals), but do not injure the meridians, do not cause bleeding, and do not dissipate Qi. For deficiency, tonify the Jing Sui, without dissipating Qi. (Jing Sui refers to major collaterals, the source from which Five Zang Organs output Blood and Qi. For excess, drain Blood and Qi from Jing Sui without further injuring meridian Blood and Qi. For deficiency, tonify Jing Sui Blood and Qi without dissipating Jing Sui Qi.)
The Yellow Emperor asked: How to treat the subtle level?
Qibo said: Massage continuously without releasing. Upon withdrawing the needle, look at it and say, "I will insert it deeply." Adapt to the patient's reaction; Jing Qi will settle, pathogenic Qi will scatter, having no place to rest. Qi leaks through the cilia, and True Qi is restored. (Withdrawing the needle initially involves superficial insertion. Looking at it refers to observing depth. Saying "I will insert deeply" addresses pathogens shallowly lodged in the skin, ensuring they conflict with Zheng Qi so pathogens scatter while Zheng Qi remains secure. It means holding the needle to settle Jing Qi, then withdrawing to prevent pathogenic scattering, following and welcoming Qi, harmonizing with intention, allowing no rest for pathogens, expelling them through skin and cilia, so True Qi returns to the muscle surface. This is the profound method of shallow and deep needling.)
The Yellow Emperor said: Excellent. How do excess and deficiency in Blood manifest?
Qibo said: Excess in Blood leads to anger; deficiency in Blood leads to fear. (The Liver's emotion is Anger; the Kidney's emotion is Fear. Excess Blood makes Liver Qi vigorous, leading to anger. Deficiency makes the Mother Qi weak, merging with the Spleen, leading to fear. Mo Zhongchao stated: When Wood Qi is deficient, Earth Qi becomes excessive; excessive Earth Qi merges with the conquering Kidney, causing fear.)
When Blood and Qi have not yet merged, and the Five Zang Organs are stable, Sun Collaterals overflow with water, leading to stagnant Blood in the main vessels. (The subsequent text mentions treating blood diseases in vessels, governed by the Pericardium Luo. Here, Blood is governed by the Liver. Liver-stored Blood originates from the Chong Mai, which starts in the uterus. Its superficial external branch ascends along the abdomen, dispersing into skin and muscles, filling skin, warming flesh, generating hair. During sleep, it returns to the Liver; during wakefulness, it travels outside vessels with Wei Qi. Overflowing Sun Collateral water refers to fluids in the uterus. Grain-fluids overflow internally, assisting Heart Spirit to transform red, hence "Water enters vessels, and Blood forms." Blood moves from vessels to mai, mai to luo, luo to sun. External blood turns from skin to sun vessels, entering Jing Shu from Sun Collaterals. This mutual communication of internal and external Blood and Qi explains why overflowing Sun Collateral water leads to stagnant Blood in vessels. This slight Liver pathology causes vessel water to overflow.)
The Yellow Emperor asked: How should tonification and reduction be applied?
Qibo said: For excess Blood, drain the Sheng Jing (Full Vessels, i.e., Chong Mai) and cause bleeding. For deficiency, observe the Xu Jing (Deficient Vessels), insert the needle into the pulse, retain it for a long time while observing. When the pulse becomes large, quickly withdraw the needle without causing bleeding. (Sheng Jing refers to the Chong Mai, the Sea of Vessels. Xu Jing refers to vessels that are deficient and not full. Long retention waits for Qi arrival. Large pulse indicates Qi arrival and Blood restoration. Zhang Zhaohuang noted: Diseases often contain deficiency within excess and vice versa. "Withdraw needle, look, say I will insert deeply, adapt to patient" drains pathogen while tonifying Zheng Qi. "Long retention, observe large pulse, quickly withdraw" tonifies deficiency while draining slight pathogen. Welcoming and following, shallow and deep depend on intent; this exhausts the wonders of regulating channels. The two "look" characters deserve careful study.)
The Yellow Emperor asked: How to treat stagnant Blood?
Qibo said: Observe the blood collaterals, needle to extract blood, preventing evil blood from entering the meridians to form disease. (Classics state: Meridians are interior; branching horizontally are collaterals; branches of collaterals are sun vessels. Where vessels are full of blood, purge quickly. Fullness requires draining. Blood in collaterals results from Sun Collateral water overflowing and stagnating as foul blood. As it is about to enter meridians, quick needling is required to drain it.)
The Yellow Emperor said: Excellent. How do excess and deficiency in Xing (Form) manifest?
Qibo said: Excess in Xing leads to abdominal distension and difficulty in urination and defecation; deficiency leads to inability to use the four limbs. (The abdomen is the enclosure of Spleen Earth. Excess causes distension. *Ling Shu* states: Spleen Qi excess leads to difficult urination and defecation. Excessive Earth Qi controls Water, stopping flow. Spleen governs four limbs; deficiency leads to immobility.)
When Blood and Qi have not yet merged, and the Five Zang Organs are stable, muscles twitch, termed "Micro Wind." (Twitching resembles insect movement. Wind injures Wei Qi, which travels between muscles, causing twitching.)
The Yellow Emperor asked: How should tonification and reduction be applied?
Qibo said: For excess in Xing, drain Yang meridians; for deficiency, tonify Yang collaterals. (Yang refers to Yangming. Yangming and Taiyin are exterior-interior pairs. Skin and Qi division are Yang; Spleen governs muscles, so regulation should proceed via Yang. Draining meridians moves from interior to exterior; tonifying collaterals moves from exterior to interior.)
The Yellow Emperor asked: How to treat the subtle level?
Qibo said: Select areas between muscle bundles, do not injure meridians or collaterals. When Wei Qi recovers, pathogenic Qi scatters. (Micro wind injures Wei Qi, which travels outside vessels; thus, select between muscles without injuring meridians/collaterals. This is treating flesh diseases by regulating muscle bundles. Suo means scatter or exhaust.)
The Yellow Emperor said: Excellent. How do excess and deficiency in Zhi manifest?
Qibo said: Excess in Zhi leads to abdominal distension and undigested stool diarrhea; deficiency leads to cold extremities (Jue). (The Kidney is the gate of the Stomach. If the gate is obstructed, water accumulates causing distension and undigested diarrhea. The Kidney is the origin of generating Qi; deficiency leads to Jue and cold.)
When Blood and Qi have not yet merged, and the Five Zang Organs are stable, bone joints move. (Movement in bone joints is also caused by micro wind, hence the later statement: pathogens can instantly create deficiency.)
The Yellow Emperor asked: How should tonification and reduction be applied?
Qibo said: For excess in Zhi, drain the blood at Ranjin (Rangu acupoint); for deficiency, tonify Xueliu (Fuliu acupoint). (Ran refers to Rangu, located between two meridians below the ankle, hence Ranjin. It is the Ying-Spring point of Foot Shaoyin. Ying is Fire; excess requires draining the fullness in Kan (Water). Fuliu is the Jing-River point of Foot Shaoyin. Jing is Metal; deficiency requires tonifying the Mother.)
The Yellow Emperor asked: How to treat before merging (when pathogens have not yet merged with Blood/Qi)?
Qibo said: Treat immediately, do not injure meridians, and the pathogenic site will instantly become empty. (Treating immediately means selecting the site of joint movement. "Pathogenic site" refers to where pathogens lodge and cause movement. Treating bone diseases by regulating bone avoids injuring meridians.)
The Yellow Emperor said: Excellent. I have heard of the forms of excess and deficiency, but not how they arise.
Qibo said: When Qi and Blood merge, Yin and Yang tilt. Qi disorders in Wei, Blood rebels in Jing. Blood and Qi separate from their dwellings, resulting in one excess and one deficiency. (This states that the five excesses/deficiencies arise from the merging of Blood and Qi. Blood and Qi are Yin and Yang. Skin/Qi division is Yang; Vessel/Blood division is Yin; Exterior is Yang; Interior is Yin; Upper half is Yang; Lower half is Yin. Qi disorder in Wei is Blood merging with Qi. Blood rebellion in Jing is Qi merging with Blood. Blood merging with Qi separates Blood from its dwelling; Qi merging with Blood separates Qi from its dwelling. Blood separation causes Blood deficiency and Qi excess; Qi separation causes Qi deficiency and Blood excess. Hence, one excess, one deficiency. That which exists is excess; that which is absent is deficiency. This section outlines the general principle of Blood-Qi merging. Note: Wei is the fierce Qi of grain and water. Lung-governed Qi is the exterior Qi of Three Yang, the primal truth of muscle-cilia. "Qi disorder in Wei" means disorder in Wei's deployment. Later texts mention taking Qi from Wei, treating Qi diseases by regulating Wei. Muscle-cilia are pathways for Wei Qi travel. One should take from skin/muscle-cilia without disturbing meridians. Know that Wei Qi originates from Yangming, travels Yang by day, Yin by night, meets at Fengfu, and travels内外. Taiyang and Sanjiao Qi originate from Lower Jiao water, ascending from lower to upper, inside to outside, governing skin surface and connecting muscle-cilia. Thus, Sanjiao and Bladder correspond to cilia and hair. Distinguishing the origins of Blood/Qi generation and entry/exit is advanced learning; students should study the *Zhen Jing* (Needling Classic) chapters carefully.)
When Blood merges in Yin and Qi merges in Yang,惊狂 (startle and mania) occur. (This distinguishes Yin/Yang in Blood/Qi divisions. External Qi is Yang; Internal Blood is Yin. If Yin Blood fills externally and Yang Qi injects internally, Yin/Yang are balanced. If Blood resides in Yin, Yin is excess and Blood is solid. Heart governs vessels; Yin excess causes startle. If Qi merges in Yang, Yang is excess and Qi is solid. Yang excess causes mania.)
When Blood merges in Yang and Qi merges in Yin, Jiong Zhong (internal heat) occurs. (This distinguishes Yin/Yang in External/Internal. Jiong means heat. Blood merging in Yang causes Yin deficiency and internal heat. Qi merging in Yin causes internal Yang excess and heat middle. Thus, external/internal Yin-Yang merging totals Jiong Zhong.)
When Blood merges above and Qi merges below, there is heart vexation, resentment, and frequent anger. When Blood merges below and Qi merges above, there is confusion and forgetfulness. (This distinguishes Yin/Yang in Above/Below. Blood merging above makes vessel Qi solid, causing heart vexation. Qi merging below makes Qi stagnant, causing anger. Blood merging below causes blood stasis below, leading to forgetfulness. Qi merging above causes Qi rebellion above, leading to confusion. *Ling Shu* states: Turbid and Clear Qi interfere, chaos in chest is severe闷. *Shang Han Lun* states: Forgetfulness indicates blood stasis, treat with Didang Tang. Didang Tang treats blood stasis in Qi division. Note: Qi merging above is not just external but also internal to vessels, causing turbid/clear interference. Blood merging below is not just internal but also external, causing forgetfulness. Classics state: Upper Qi deficiency, Lower Qi excess, intestines/stomach full, Heart Qi deficient. Deficiency causes Ying/Wei to stay below, failing to ascend, causing forgetfulness.)
The Yellow Emperor asked: When Blood merges in Yin and Qi merges in Yang, and Blood/Qi separate, what is excess and what is deficiency?
Qibo said: Blood and Qi prefer warmth and dislike cold. Cold causes stagnation and inability to remain; warmth causes dissolution and departure. Thus, where Qi merges, Blood is deficient; where Blood merges, Qi is deficient. (This reiterates that Blood/Qi merging creates deficiency by separation. Li means separation. Qi means stagnation. When Blood fills externally and Qi enters Yin, Yin/Yang combine for peace. If Blood merges in Yin and Qi in Yang, they separate dwellings. Blood/Qi prefer warm harmony and dislike cold isolation. Blood in Yin causes cold stagnation, preventing flow, so Qi cannot harmonize. Qi in Yang causes warmth, dissolving Blood, so Blood cannot harmonize. Thus, Qi merger causes Blood deficiency; Blood merger causes Qi deficiency. Zhang Zhaohuang asked: If Blood merges in Yin, Qi merges in Yang, implying separation, shouldn't both be excess? Why are they both deficiency? Answer: Blood merging in Yin means Blood merges but Qi does not. Yin excess brings cold, making Qi in Blood stagnant and unable to flow. Qi merging in Yang means Qi merges but Blood does not. Yang excess brings heat, burning Blood in Qi division. Thus, Qi merger means no Blood; Blood merger means no Qi.)
The Yellow Emperor asked: Humans possess only Blood and Qi. You say Blood merger is deficiency and Qi merger is deficiency; is there no excess?
Qibo said: That which exists is excess; that which is absent is deficiency. Qi merger means no Blood; Blood merger means no Qi. Now Blood and Qi are lost to each other, hence deficiency. (Reiterating that merging creates deficiency due to absence. Blood in Yin makes Yin cold, eliminating Qi in Blood. Qi in Yang makes Yang hot, eliminating Blood in Qi. Qi merger means no Blood; Blood merger means no Qi. Lost and unable to harmonize, both are deficiency.)
Collaterals and Sun Vessels all transport to the Main Meridians. When Blood and Qi merge, it is excess. If Blood and Qi rush together upward, it is Great Jue (Syncope). Jue leads to sudden death; if Qi returns, life is saved; if not, death ensues. (This clarifies common merging of Blood/Qi as excess. Collaterals are branches of meridians. Sun vessels are distinct from Sun collaterals, numbering 365, connecting internally to twelve great collaterals and externally to skin/cilia. Zang Blood/Qi exits great collaterals to Sun vessels, then to skin. Exterior Yang Qi enters great collaterals from Sun collaterals, then to Jing Shu. This is the pathway of external/internal Blood/Qi traffic. Collateral and Sun Blood/Qi transport to meridians; common merging in Blood division is excess. Rushing upward causes Great Jue, sudden death. Return of Qi saves life; failure to return causes death.)