黄帝问曰。何谓虚实。（此亦承上章而复问也。）岐伯对曰。邪气盛则实。精气夺则虚。（邪气者。风寒暑湿之邪。精
气者。荣卫之气也。盖邪气有微盛。故邪盛则实。正气有强弱。故精夺则虚。夺、失也。或为邪所夺也。）帝曰。虚实
何如。岐伯曰。气虚者。肺虚也。气逆者。足寒也。非其时则生。当其时则死。（伯言虚实者。皆从物类始。如肺主气。
其类金。五行之气。先虚于外。而后内伤五脏。盖邪从表入里。在外之气血骨肉。先为邪病所虚。是以骨肉滑利。则邪
不内侵。而里亦实。表气虚则内伤五脏。而里亦虚。此表里之虚实也。如气逆于上。则下虚而足寒。此上下之虚实也。
如值其生旺之时。则生。当其胜克之时则死。此四时之虚实也。）余脏皆如此。（夫肝主筋。其类木。心主血。其类火。
脾主肉。其类土。肺主气。其类金。肾主骨。其类水。盖五脏之气。外合于五行。五行之气。岁应于四时。故皆有生旺
克胜之气。而各有死生之分。）帝曰。何谓重实。岐伯曰。所谓重实者。言大热病。气热脉满。是谓重实。重平声。
大热者。邪气盛也。气为阳。血脉为阴。邪盛而气血皆伤。故为重实。此论血气之阴阳虚实也。徐公遐曰。重实则其中
有重虚。故上文曰。虚实何如。下文曰。夫虚实者。帝曰。经络俱实何如。何以治之。（此论经络之阴阳虚实也。夫肤腠
气分为阳。经络血分为阴。然经络又有深浅阴阳之别。所谓阳中有阴。阴中有阳也。）岐伯曰。经络皆实。是寸脉急而尺
缓也。皆当治之。（邪盛于经。则寸口脉急。缓为内热。热在于络。则尺脉缓也。皆当以针取之。此以寸尺而候血脉之阴
阳也。）故曰。滑则从。涩则逆也。（滑主气血皆盛。故为从。涩主血气皆少。故为逆。朱圣公曰。故曰者。为阴阳血气
邪正而言也。）夫虚实者。皆从其物类始。故五脏骨肉滑利。可以长久也。（五行者。天地之阴阳也。五脏者。人之阴阳
也。易曰。方以类聚。物以群分。皮肉筋骨。五脏之外合也。金木水火土。五脏之外类也。夫邪之中人。始于皮肤。次
于肌肉。留而不去。则入于经脉。以及于筋骨。故邪之中人。先从其物类始。是以壮者之血气盛。其肌肉滑。气道通。
荣卫之行。不失其常。可以长久其天命。如五脏不坚。使道不长。空外以张。数中风寒。血气虚。脉不通。真邪相攻。
乱而相引。故不寿而尽也。徐公遐曰。邪气实则正气虚。故曰。夫虚实者。朱圣公曰。此复结首章之义。张兆璜曰。此
篇论邪实者。先从外而内。正虚者。亦先外而内。如木败者先叶落而后枝枯。故用诊尺之法。诊尺之法。先从外而内也。）
帝曰。络气不足。经气有余。何如。（不足者。精气夺。有余者。邪气盛。此邪去络而入于经也。）岐伯曰。络气不足。
经气有余者。脉口热而尺寒也。（此论经络之气虚实也。寒热者。尺寸之肤寒热。而应于经络也。络脉外连皮肤为阳主外。
经脉内连脏腑为阴主内。经云。荣出中焦。卫出下焦。卫气先行皮肤。先充络脉。络脉先盛。卫气已平。营气乃满。而
经脉大盛。经脉之虚实也。以气口知之。故以尺肤候络。而以寸候经。）秋冬为逆。春夏为从。治主病者。（夫邪气之从
外而内。犹藉正气之从内而外以 御。使邪仍从肤表而出。秋冬之气降沉。不能使邪外散。故为逆。春夏之气生浮。故
为从也。邪病在经。当从其经而取之。此论外因之虚实也。）帝曰。经虚络满何如。（此论内因之虚实也。）岐伯曰。经
虚络满者。尺脉满。脉口寒涩也。（尺脉热满。故主络满。脉口寒涩。故主经虚。）此春夏死。秋冬生也。（春夏之气。
生长于外。气惟外弛。而根本虚脱。故死。秋冬之气。收藏于内。故生。盖外因之病。宜神机外运。内因之病。宜根本
实坚。）帝曰。治此者奈何。岐伯曰。络满经虚。灸阴刺阳。经满络虚。刺阴灸阳。（络为阳。经为阴。刺者泻其盛满之
气。灸者启其陷下之阳。盖不足者病。而太过者亦为病也。）帝曰。何谓重虚。（此论脉气皆虚也。上节论经络之实。
即可类推于虚。此篇论气分之虚。亦可类推于实。）岐伯曰。脉气上虚。尺虚。是谓重虚。（血者。神气也。荣气宗气。
行于脉中。卫气行于脉外。故曰脉气。盖以气口之脉。可以候血。而可以候气也。上虚者。寸口之脉气虚也。尺虚者。
脉气虚于下也。上下皆虚。故曰重虚。朱永年曰。气逆于上而足寒者。上实下虚也。此上下皆虚。故谓重虚。）帝曰。何
以治之。（谓何以补其虚也。）岐伯曰。所谓气虚者。言无常也。尺虚者。行步 然。（ 音匡。气者。谓阳明所生之荣卫
宗气也。经曰。谷始入于胃。其精微者。先出于胃之两焦。以溉五脏。别出两行荣卫之道。其大气之搏而不行者。积于
胸中。命曰气海。出于肺。循喉咙以司呼吸。是阳气者。阳明之所生也。言无常者。宗气虚而语言无接续也。针经曰。
尽泻三阳之气。令病患 然。 、虚怯也。谓阳明之气虚于上。则言语无常。阳明之气虚于下。则令人行步 然。盖气
从太阴。出注手阳明。上行注足阳明。下行至跗上。故曰。身半以上。手太阴阳明皆主之。身半以下。足太阴阳明皆主
之。按帝问何以治之。而伯答以所病之因。盖知阳气生始之原。则知所以治矣。此论后天之主气也。针经曰。用针之
类。在于调气。气积于胃。以通荣卫。各经其道。宗气流于海。其下者注于气街。其上者走于息道。故厥在手足。宗气
不下。脉中之血凝而留止。徐公遐曰。此注当与九候论之地以候胸中之气注合参。）脉虚者。不象阴也。（气为阳。血
脉为阴。阳明之生气为阳。少阴之精气为阴。盖言以寸尺之脉。以候阳明之生气。而不效象其阴之虚也。朱圣公问曰。
上节以尺肤而候络脉之阴。此以寸尺之脉而候气分之阳。岂以皮肤候血脉。而反以脉候气耶。曰。经言善调尺者。不待
于寸。脉急者。尺之皮肤亦急。脉缓者。尺之皮肤亦缓。盖阴阳虚实之气。由脏腑而达于经脉。由经脉而出于肤表。以
尺肤之缓急滑涩而候脏腑血气之虚实者。是犹以色诊也。上节以络脉在皮之部。故以尺肤审之。此候脉气之虚实。故以
寸尺之脉诊也。论疾诊尺篇曰。尺肤寒。其脉小者。泄少气。是尺肤尺诊。皆可以候气候血也。诊候之道。通变无穷。
不可执一而论。惟会心者明之。张兆璜曰。此节论荣卫宗气之生于阳明。言气虚之脉。不象阴虚之少精血。）如此者。滑
则生。涩则死也。（夫气生于阳明。而发原在肾。少阴之气。上与阳明相合。阴阳相搏。其脉则滑。搏则化水谷之精微而
气生矣。故主生。涩主少气。生原已绝。故死。）帝曰。寒气暴上。脉满而实。何如。岐伯曰。实而滑则生。实而逆则
死。（此承上文之意而复问也。盖脉气生于胃腑。而发原在于少阴。是以上节论生气之原。此以下复论发原之始。夫肾脏
主水。在气为寒。寒气暴上者。水寒之气暴上。而满于脉也。实而滑者。得阳明之气相和。故生。逆者。少阴之生气已
绝。故死。盖寒气上乘。则真气反下逆矣。平脉篇曰。少阴脉弱而涩。弱者微烦。涩者厥逆。谓少阴之气不生。而手足
逆冷也。王子方曰。水寒之气暴上。曰脉满而实。少阴之气暴上。而曰脉实满。阴寒之气。皆实满于脉。而各有意存焉。
朱圣公曰。水寒之气暴上。则少阴之真气不升。故先论其寒气。而后论其真气。后又复论其水气也。）帝曰。脉实满。
手足寒头热。何如。岐伯曰。春秋则生。冬夏则死。（肾主生气之原。膀胱为太阳之府。脉实满者。少阴之寒气充于外也。
手足寒者。少阴之生气虚于内也。头热者。太阳之气。发越于上也。肾与膀胱。阴阳并交。咸主生气。若盛于外。则反
虚于内矣。春时阳气微上。阴气微下。秋时阴气微上。阳气微下。阴阳二气。交相资生。故主生。冬时阴气尽出于外。
夏时阳气尽虚于内。故主死。言阴阳之根气。不可虚脱者也。徐公遐曰。是以圣人春夏养阳。秋冬养阴。以从其根。
王芳侯曰。少阴之气。上与阳明相合。化生荣卫。行于脉中。若真阴之气。直溢于脉。则反虚其根矣。）脉浮而涩。涩而
身有热者死。（脉浮而涩。阴越于外而虚于内也。涩而身热。阳脱于内而弛于外也。此复言阴阳之根气脱者。皆为死证。
非但冬夏死而春秋可生。上节论无形之水气溢于脉中。故脉满而实。下节论有形之水邪溢于脉外。故形尽满。水气溢
者少精血。故宜脉滑。水邪溢者生气衰。故宜手足温。此论下焦之生气外脱。）帝曰。其形尽满何如。（肾为水脏。在气
为寒。上节论寒气暴上。此复论其水体泛溢故其形尽满也。形谓皮肤肌腠。盖经脉之内。有有形之血。是以无形之气乘
之。肌腠之间。主无形之气。是以有形之水乘之。而为肿胀也。）岐伯曰。其形尽满者。脉急大坚。尺涩而不应也。（诸
急为寒。寒水充溢于形身。故脉急而坚大。水邪外溢。则少阴之正气不升。故尺涩而不应也。灵枢经曰。脉坚大以涩者
胀也。）如是者。故从则生。逆则死。（夫少阴之气。从下而上。合于阳明。戊癸合而化火。火土之气。故有如是之证者。
得少阴之气。仍从下而上者生。逆而下者死。）帝曰。何谓从则生。逆则死。岐伯曰。所谓从者。手足温也。所谓逆者。
手足寒也。（手足温者。少阴之生气复也。生气复则火土之气渐旺。水寒之邪渐消。手足寒者。少阴之生气已绝。故死。
以上论生阳之气。发原于下焦。如寒水之邪实。则真阴之气虚。）帝曰。乳子而病热。脉悬小者。何如。（夫病热者。
皆伤寒之类也。凡伤于寒。藉阳气以化热。热虽盛不死。然阳气生于精水之中。男子八岁。女子七岁。肾气始实。乳子
天癸未至。肾气未盛。故帝复有此问焉。夫心主脉而资生于肾。心肾水火之气。上下时交。肾气不能上资于心。则心悬
如病饥。而寸口之脉悬绝小者。肾气未盛也。）岐伯曰。手足温则生。寒则死。（伯答乳子之生阳。藉后天之气也。四肢
皆禀气于胃。故阳受气于四末。是以手足温者。胃气尚盛。故生。寒则胃气已绝。故死。夫水谷入于胃。津液各走其道。
肾为水脏。受五脏之精而藏之。是先天之精。犹藉后天之所资益者也。又别出两行荣卫之道。其大气之搏而不行者。名
曰宗气。积于胸中。上出于肺。以司呼吸。是四肢之原俞。又受资于胃腑所生之荣卫宗气。是以手足温者生。寒者死。
朱
永年曰。当知少阴阳明之气。皆主手足之寒温。医者不可不审。）帝曰。乳子中风热。喘鸣肩息者。脉何如。岐伯曰。
喘鸣肩息者。脉实大也。缓则生。急则死。（此复论后天所生之宗气。而亦不可伤也。宗气者。五脏六腑。十二经脉之宗
始。故曰宗气。肩息者。呼吸摇肩也。风热之邪。始伤皮毛。喘鸣肩息。是风热盛而内干肺气宗气。故脉实大也。夫脉
之所以和缓者。得阳明之胃气也。急则胃气已绝。故死。徐公遐曰。水谷之精。虽藉先天之气以生化。然先天之气。又
藉水谷之精以相资。是以天癸至。肾气盛。齿发长。筋骨坚。皆受后天之养。非但于乳子也。故复设此问焉。上节论下
焦之根气。此论上焦之生气。皆由中焦之所生。）帝曰。肠 便血何如。岐伯曰。身热则死。寒则生。（上节言气之虚
实。此复论其血焉。肠 者。邪僻积于肠间。而为便利也。经言阳络伤则血外溢。血外溢则衄血。阴络伤则血内溢。血
内溢则便血。肠胃之络伤。则血溢于肠外。肠外有寒汁沫。与血相搏。则合并凝聚。而积成矣。是以肠 便血者。阴络
之血溢也。肠 下白沫者。肠外之寒汁沫也。肠 下脓血者。汁沫与血相搏。并合而下者也。夫便血。阴泄于内也。发
热。阳脱于外也。本经曰。阴阳虚。肠 死。此阴阳血气之相离也。朱圣公问曰。灵枢经论。恐为积聚而言也。曰。
百病之生也。皆起于内伤外感。不外乎气血阴阳。如留蓄于肠外。则为五积。便痢则为下积矣。）帝曰。肠 下白沫何如。
岐伯曰。脉沉则生。脉浮则死。（下白沫者。阴液下注。故脉沉者为顺。如脉浮是经气下泄。脉气上浮。此经脉相离。故
为死证。）帝曰。肠 下脓血何如。岐伯曰。脉悬绝则死。滑大则生。（夫血脉始于足少阴肾。生于足阳明胃。主于手少
阴心。输于足太阴脾。悬绝者。足少阴之阴液绝也。滑大者。足少阴之生气盛也。）帝曰。肠 之属。身不热。脉不悬
绝。何如。岐伯曰。滑大者曰生。悬涩者曰死。（此复申明血气之生原。又重在阳明之胃气也。身不热者。阳不外脱也。
脉不悬绝。阴不下绝也。悬涩者。阳明之生气已脱。故死。辨脉篇曰。趺阳脉浮而涩。故知脾气不足。胃气虚也。悬则
胃气绝矣。）以脏期之。（胃气已绝。则真脏之脉见矣。故当以脏期之。肝至悬绝十八日死。心至悬绝九日死。肺至悬绝
Huangdi asked, saying: What are deficiency and excess? (This question follows up on the previous chapter.) Qibo replied, saying: When pathogenic factors are flourishing, it is excess; when essence and qi are depleted, it is deficiency. (Pathogenic factors refer to wind, cold, summerheat, and dampness. Essence and qi refer to Ying-Wei Qi. Since pathogenic factors vary in degree, their flourishing constitutes excess; since healthy qi varies in strength, the depletion of essence constitutes deficiency. "Depletion" means loss, or being deprived by pathogens.) Huangdi said: How are deficiency and excess manifested? Qibo said: Deficiency of Qi refers to Lung deficiency. Qi rebellion manifests as cold feet. If occurring out of season, there is survival; if occurring in season, there is death. (Qibo meant that discussions of deficiency and excess begin with the classification of things. For example, the Lung governs Qi and corresponds to Metal. The Qi of the Five Elements first becomes deficient externally, then internally injures the Zang organs. Pathogens enter from the exterior to the interior; the blood, Qi, bones, and flesh at the exterior are first made deficient by pathogenic diseases. Therefore, if bones and flesh are smooth and supple, pathogens cannot invade internally, and the interior remains full; if exterior Qi is deficient, it internally injures the Zang organs, and the interior becomes deficient. This is the deficiency and excess between interior and exterior. If Qi rebels upward, the lower part becomes empty and feet become cold; this is the deficiency and excess between upper and lower. If encountering a time of growth and prosperity, there is survival; if encountering a time of overcoming and suppression, there is death. This is the deficiency and excess among the Four Seasons.) The other Zang organs follow this pattern. (The Liver governs sinews and corresponds to Wood; the Heart governs Blood and corresponds to Fire; the Spleen governs flesh and corresponds to Earth; the Lung governs Qi and corresponds to Metal; the Kidney governs bones and corresponds to Water. The Qi of the Five Zang organs corresponds externally to the Five Elements. The Qi of the Five Elements responds to the Four Seasons annually. Thus, each has phases of growth/prosperity and overcoming/suppression, leading to different outcomes of life and death.) Huangdi asked: What is called "Chong Shi" (Double Excess)? Qibo said: By "Chong Shi," we mean severe heat disease, where Qi is hot and the pulse is full and solid; this is called Chong Shi. "Chong" is pronounced with the level tone. Severe heat indicates flourishing pathogens. Qi belongs to Yang, and blood vessels belong to Yin. Flourishing pathogens injure both Qi and Blood, hence it is called Double Excess. This discusses the Yin-Yang deficiency and excess of Blood and Qi. Xu Gongxia said: Within Double Excess lies Double Deficiency, which is why the text previously asked "How are deficiency and excess?" and later states "As for deficiency and excess..." Huangdi asked: What if both the Collaterals and Meridians are in an excess state? How should they be treated? (This discusses the Yin-Yang deficiency and excess of the Meridians. Skin pores and Qi division belong to Yang; Meridians and Blood division belong to Yin. However, meridians also have differences in depth and Yin-Yang, meaning Yang contains Yin, and Yin contains Yang.) Qibo said: When both Collaterals and Meridians are in excess, the Cun pulse is rapid/tight while the Chi pulse is slow/relaxed. Both should be treated. (When pathogens flourish in the meridians, the Cun-kou pulse is rapid/tight; slowness/relaxation indicates internal heat. Heat in the collaterals makes the Chi pulse relaxed. Both should be treated with acupuncture. This uses the Cun and Chi positions to inspect the Yin-Yang of blood vessels.) Therefore it is said: Smooth pulses indicate favorable prognosis; choppy pulses indicate unfavorable prognosis. (Smooth pulses indicate abundant Qi and Blood, hence favorable; choppy pulses indicate scarce Qi and Blood, hence unfavorable. Zhu Shenggong said: The phrase "Therefore it is said" refers to Yin-Yang, Blood-Qi, pathogens, and healthy Qi.) All cases of deficiency and excess begin with their respective elemental categories. Therefore, if the Five Zang organs and bones/flesh are smooth and supple, one can live long. (The Five Elements are the Yin-Yang of Heaven and Earth. The Five Zang organs are the Yin-Yang of humans. The I Ching says: "Categories gather together, things group by kind." Skin, flesh, sinews, and bones are external correspondences of the Zang organs. Metal, Wood, Water, Fire, and Earth are external categories of the Zang organs. Pathogens attacking humans start at the skin, then move to muscles; if lingering, they enter the meridians and reach sinews and bones. Thus, pathogen attack begins with their elemental category. Therefore, robust individuals have abundant Qi and Blood, smooth muscles, unobstructed Qi pathways, and normal Ying-Wei circulation, allowing them to fulfill their lifespan. If the Five Zang organs are not firm, nasal passages are short, nostrils flare open, frequent exposure to wind-cold occurs, Qi and Blood are deficient, pulses are obstructed, true Qi and pathogens clash chaotically, leading to premature death. Xu Gongxia said: When pathogens are excessive, healthy Qi is deficient, hence "As for deficiency and excess..." Zhu Shenggong said: This reiterates the meaning of the opening chapter. Zhang Zhaohuang said: This chapter discusses how excess pathogens enter from exterior to interior, and how healthy deficiency also starts from exterior to interior, like trees losing leaves before branches wither. Hence the method of inspecting the Chi skin, which proceeds from exterior to interior.) Huangdi asked: What if Collateral Qi is deficient and Meridian Qi is excessive? (Deficiency means depletion of essence; excess means flourishing pathogens. This indicates pathogens leaving the collaterals and entering the meridians.) Qibo said: In cases of deficient Collateral Qi and excessive Meridian Qi, the Mai-kou (Cun-kou) is hot while the Chi skin is cold. (This discusses the deficiency and excess of Qi in meridians and collaterals. Cold and heat refer to the temperature of the skin at Cun and Chi positions, corresponding to meridians and collaterals. Collaterals connect externally to skin, belonging to Yang and governing the exterior; meridians connect internally to Zang-fu, belonging to Yin and governing the interior. The Classics state: Ying Qi emerges from the Middle Jiao, Wei Qi emerges from the Lower Jiao. Wei Qi moves first through the skin, filling the collaterals; once collaterals are full and Wei Qi stabilizes, Ying Qi fills, and meridians become highly prosperous. The deficiency/excess of meridians is known via the Qi-kou. Hence, Chi skin inspects collaterals, while Cun inspects meridians.) Occurrence in Autumn/Winter is unfavorable; occurrence in Spring/Summer is favorable. Treat the primary diseased area. (Pathogens entering from exterior to interior rely on healthy Qi moving from interior to exterior to resist, allowing pathogens to exit via the skin surface. Autumn/Winter Qi descends and sinks, unable to disperse pathogens outward, hence unfavorable; Spring/Summer Qi rises and floats, hence favorable. If disease is in the meridians, treat according to the affected meridian. This discusses exogenous deficiency and excess.) Huangdi asked: What if Meridians are deficient and Collaterals are excessive? (This discusses endogenous deficiency and excess.) Qibo said: In cases of deficient Meridians and excessive Collaterals, the Chi pulse is full/solid, while the Mai-kou is cold and choppy. (Chi pulse heat/fullness indicates excessive collaterals; Mai-kou cold/choppy indicates deficient meridians.) Death in Spring/Summer; survival in Autumn/Winter. (Spring/Summer Qi grows outward; Qi only relaxes outward, causing root depletion, hence death. Autumn/Winter Qi stores inward, hence survival. Generally, exogenous diseases benefit from Shen-Ji (Spirit Mechanism) moving outward; endogenous diseases benefit from a solid root.) Huangdi asked: How to treat this? Qibo said: For excessive collaterals and deficient meridians, moxa Yin meridians and needle Yang meridians; for excessive meridians and deficient collaterals, needle Yin meridians and moxa Yang meridians. (Collaterals are Yang, Meridians are Yin. Needling drains excessive Qi; moxibustion raises sunken Yang. Deficiency is disease, but excess is also disease.) Huangdi asked: What is called "Chong Xu" (Double Deficiency)? (This discusses universal pulse Qi deficiency. The previous section discussed Meridian/Collateral excess, inferable to deficiency. This section discusses Qi-level deficiency, inferable to excess.) Qibo said: Upper pulse Qi deficiency and Chi pulse Qi deficiency is called Double Deficiency. (Blood is the basis of Shen-Qi. Ying Qi and Zong Qi flow within vessels; Wei Qi flows outside vessels, hence "Pulse Qi." The Qi-kou pulse can inspect both Blood and Qi. "Upper deficiency" refers to Cun-kou pulse Qi deficiency; "Chi deficiency" refers to pulse Qi deficiency in the lower part. Both upper and lower are deficient, hence Double Deficiency. Zhu Yongnian said: Qi rebelling upward with cold feet is Upper Excess/Lower Deficiency. Here, both upper and lower are deficient, hence Double Deficiency.) Huangdi asked: How to treat it? (Meaning how to tonify the deficiency.) Qibo said: Regarding Qi deficiency, speech is irregular. Chi deficiency manifests as unsteady gait. ("Kuang" sound. Qi refers to Ying-Wei Zong Qi generated by Stomach-Meridian of Foot-Yangming. The Classics say: Food enters the Stomach; its refined essences emerge from the two Jiaos of the Stomach to nourish the Zang organs, separating into two paths of Ying and Wei. The great Qi that gathers without flowing accumulates in the Chest Sea, named Qi Hai, emerging from the Lung, traveling along the throat to govern respiration. This Yang Qi is generated by Yangming. Irregular speech indicates Zong Qi deficiency failing to sustain continuity. The Needle Classic says: Draining all Three-Yang Qi causes patients to stand unsteadily. "Pi" means weak/cowardly. It means Yangming Qi deficiency above causes irregular speech; Yangming Qi deficiency below causes unsteady gait. Qi flows from Taiyin to Hand-Yangming, ascending to Foot-Yangming, descending to the dorsum of the foot. Thus: Above the waist, Hand-Taiyin and Hand-Yangming govern; below the waist, Foot-Taiyin and Foot-Yangming govern. Huangdi asked how to treat, and Qibo answered with the cause, implying that knowing the origin of Yang Qi generation reveals the treatment. This discusses Post-Heaven Main Qi. The Needle Classic says: The principle of needling lies in regulating Qi. Qi accumulates in the Stomach to connect Ying and Wei, following their respective channels. Zong Qi flows to the Sea; downward it pours into Qichong; upward it travels to the respiratory tract. Thus, Jue-Ni in hands and feet occurs because Zong Qi does not descend, causing blood in vessels to stagnate. Xu Gongxia said: This annotation should be cross-referenced with "Di Yi Hou Xiong Zhong Zhi Qi" in the Nine Inspections Chapter.) Pulse deficiency does not resemble Yin pulses. (Qi is Yang, Blood vessels are Yin. Yangming's generating Qi is Yang; Shaoyin's essence Qi is Yin. Using Cun-Chi pulses to inspect Yangming's generating Qi does not reflect its Yin deficiency. Zhu Shenggong asked: The previous section used Chi skin to inspect Collateral Yin; this section uses Cun-Chi pulses to inspect Qi-level Yang. Does skin inspect blood vessels while pulse inspects Qi? Answer: The Classics say those skilled at adjusting Chi do not rely on Cun. Rapid pulse means Chi skin is also tight; slow pulse means Chi skin is also relaxed. Yin-Yang deficiency/excess Qi reaches meridians from Zang-fu, and exits skin from meridians. Inspecting Zang-fu/Blood-Qi deficiency/excess via Chi skin relaxation/tightness/smoothness/choppiness is like color diagnosis. Previous section inspected Collaterals in skin layer via Chi skin; this section inspects Pulse Qi deficiency/excess via Cun-Chi pulses. "Lun Ji Zhen Chi Pian" says: Cold Chi skin with small pulse indicates diarrhea and Qi deficiency. Thus Chi skin and Chi pulse inspection can both inspect climate and blood. Diagnostic methods are infinite and variable; do not adhere to one view. Only those who understand intuitively will see clearly. Zhang Zhaohuang said: This section discusses Ying-Wei Zong Qi generated by Yangming; Qi deficiency pulses do not resemble Yin deficiency with scanty essence/blood.) In such cases, smooth pulses indicate survival; choppy pulses indicate death. (Qi generates in Yangming but originates in Kidney. Shaoyin Qi combines with Yangming; Yin-Yang struggle makes the pulse smooth. Struggle transforms grain essences into Qi, hence survival. Choppy indicates Qi deficiency; origin of life is exhausted, hence death.) Huangdi asked: Cold Qi suddenly ascends, pulse is full and solid. How is this? Qibo said: Solid and smooth indicates survival; solid and reversed indicates death. (This continues the previous inquiry. Pulse Qi generates in Stomach Fu but originates in Shaoyin. Previous section discussed origin of generating Qi; this section discusses the beginning of origin. Kidney governs Water, associated with Cold in Qi. Sudden ascent of Cold Qi is sudden ascent of Water-Cold Qi filling the vessels. Solid and smooth indicates harmony with Yangming Qi, hence survival. Reversed indicates Shaoyin generating Qi is exhausted, hence death. Cold Qi surging upward causes True Qi to reverse downward. "Ping Mai Pian" says: Weak and choppy Shaoyin pulse—weak indicates slight vexation, choppy indicates Jue-Ni. Shaoyin Qi failing to generate leads to cold extremities. Wang Zifang said: Sudden ascent of Water-Cold Qi is described as "pulse full and solid"; sudden ascent of Shaoyin Qi is described as "pulse solid and full." Yin-Cold Qi fills vessels, each carrying specific implications. Zhu Shenggong said: Sudden ascent of Water-Cold Qi prevents Shaoyin True Qi from rising, so Cold Qi is discussed first, then True Qi, then Water Qi again.) Huangdi asked: Pulse full and solid, cold hands and feet, hot head. How is this? Qibo said: Survival in Spring/Autumn; death in Winter/Summer. (Kidney is origin of generating Qi; Bladder is Fu organ of Taiyang. Pulse full and solid indicates Shaoyin Cold Qi filling the exterior. Cold hands/feet indicate Shaoyin Generating Qi deficient internally. Hot head indicates Taiyang Qi venting upward. Kidney and Bladder interact Yin-Yang, both governing generating Qi. If excessive externally, it becomes deficient internally. Spring: Yang Qi slightly ascends, Yin Qi slightly descends. Autumn: Yin Qi slightly ascends, Yang Qi slightly descends. Yin-Yang Qi mutually support, hence survival. Winter: Yin Qi entirely exits outward; Summer: Yang Qi entirely deficient internally, hence death. This emphasizes that root Qi of Yin-Yang must not be depleted. Xu Gongxia said: Thus Sages nourish Yang in Spring/Summer and Yin in Autumn/Winter, following the root. Wang Fanghou said: Shaoyin Qi combines with Yangming to generate Ying-Wei, flowing in vessels. If True Yin Qi directly overflows into vessels, it depletes the root.) Floating and choppy pulse, choppy with body heat: Death. (Floating and choppy pulse: Yin escapes outward, deficient internally. Choppy with body heat: Yang escapes internally, relaxes outward. This reiterates that exhaustion of Yin-Yang root Qi is a death sign, not just death in Winter/Summer but survival in Spring/Autumn. Previous section discussed formless Water Qi overflowing into vessels (pulse full/solid); next section discusses formless Water Evil overflowing outside vessels (full swelling). Water Qi overflow implies scanty essence/blood, favoring smooth pulse; Water Evil overflow implies declining generating Qi, favoring warm extremities. This discusses Lower Jiao generating Qi escaping outward.) Huangdi asked: What if the body is fully swollen? (Kidney is Water Zang, associated with Cold. Previous section discussed sudden Cold Qi ascent; here discusses water body flooding causing full body swelling. "Body" refers to skin and muscle clefts. Inside meridians is form-blood; formless Qi acts upon it. Between muscle clefts governs formless Qi; formless Water acts upon it, causing distension/swelling.) Qibo said: Full body swelling presents with rapid, large, firm pulse; Chi position is choppy and unresponsive. (All rapid pulses indicate Cold. Cold Water flooding the body makes pulse rapid and firm/large. Water evil overflowing externally prevents Shaoyin True Qi from rising, making Chi choppy and unresponsive. "Ling Shu Jing" says: Firm, large, and choppy pulse indicates distension.) In such cases, favorable indicates survival; unfavorable indicates death. (Shaoyin Qi moves upward from below, combining with Yangming. Wu-Gui combine to transform Fire; Fire-Earth Qi produces such symptoms. Getting Shaoyin Qi still moving upward from below indicates survival; reversing downward indicates death.) Huangdi asked: What defines favorable survival and unfavorable death? Qibo said: Favorable means warm hands and feet. Unfavorable means cold hands and feet. (Warm hands/feet indicate recovery of Shaoyin Generating Qi. Recovery of generating Qi makes Fire-Earth Qi gradually prosperous and Water-Cold evil gradually dissipate. Cold hands/feet indicate Shaoyin Generating Qi is exhausted, hence death. Above discusses Sheng-Yang Qi originating in Lower Jiao. If Cold-Water evil is excessive, True Yin Qi is deficient.) Huangdi asked: Infant suffering from heat disease, pulse is suspended and small. How is this? (Heat diseases are similar to Cold Damage. Injury by Cold relies on Yang Qi to transform into heat; even if heat is severe, death does not ensue. However, Yang Qi is born within Jing-Water. Boys at age eight, girls at age seven, Kidney Qi begins to solidify. Infants have not yet reached Tian Gui, Kidney Qi is not vigorous, hence Huangdi asks again. Heart governs pulse and is nourished by Kidney; Heart-Kidney Water-Fire Qi interacts上下. If Kidney Qi cannot nourish Heart upward, Heart hangs like hunger, and Cun-kou pulse is suspended/extreme/small, indicating Kidney Qi is not yet vigorous.) Qibo said: Warm hands and feet indicate survival; cold indicates death. (Qibo answers that infant Sheng-Yang relies on Post-Heaven Qi. Limbs receive Qi from Stomach; Yang receives Qi at the four ends. Thus, warm hands/feet indicate Stomach Qi is still vigorous, hence survival. Cold indicates Stomach Qi is exhausted, hence death. Food/water enters Stomach, fluids go their ways. Kidney is Water Zang, storing essence of Five Zang; this Pre-Heaven essence still relies on Post-Heaven supplementation. Two paths of Ying-Wei separate; great Qi gathering without flowing is named Zong Qi, accumulating in Chest, emerging from Lung to govern respiration. These limb Yuan-Shu points are also nourished by Ying-Wei Zong Qi generated by Stomach Fu. Thus warm hands/feet survive, cold die. Zhu Yongnian said: Know that Shaoyin and Yangming Qi govern warmth/cold of hands/feet; physicians must examine carefully.) Huangdi asked: Infant suffering from Wind-Heat, panting, wheezing, shoulder breathing. How is the pulse? Qibo said: Panting, wheezing, shoulder breathing present with solid-large pulse. Slow indicates survival; rapid indicates death. (This re-discusses Post-Heaven generated Zong Qi, which must not be injured. Zong Qi is the ancestor of Five Zang, Six Fu, and Twelve Meridians, hence named Zong Qi. Shoulder breathing means breathing involves shoulder movement. Wind-Heat initially injures skin/hair; panting/wheezing/shoulder breathing indicates Wind-Heat is flourishing and internally interfering with Lung Qi and Zong Qi, hence solid-large pulse. Pulse smoothness comes from Yangming Stomach Qi. Rapid means Stomach Qi is exhausted, hence death. Xu Gongxia said: Grain essences rely on Pre-Heaven Qi for transformation, but Pre-Heaven Qi relies on grain essences for support. Thus when Tian Gui arrives, Kidney Qi is vigorous, teeth/hair grow, sinews/bones strengthen, all nourished by Post-Heaven, not just in infants. Hence this question is posed. Previous section discussed Lower Jiao root Qi; this section discusses Upper Jiao generating Qi, both produced by Middle Jiao.) Huangdi asked: Chang Pi with bloody stool. How is this? Qibo said: Body heat indicates death; cold indicates survival. (Previous section discussed Qi deficiency/excess; here discusses Blood. Chang Pi means pathogenic accumulation in intestines causing loose stools. Classics say: Injury to Yang Luo causes external blood overflow (epistaxis); injury to Yin Luo causes internal blood overflow (hematochezia). Injury to Gut/Stomach Luo causes blood overflow outside intestines. Cold fluid foam outside intestines clashes with blood, coagulating into masses. Thus Chang Pi with bloody stool is Yin Luo blood overflow. Chang Pi with white mucus is cold fluid foam outside intestines. Chang Pi with pus/blood is foam clashing with blood, exiting together. Bloody stool is Yin leaking internally. Fever is Yang escaping externally. The Classic says: Yin-Yang deficiency, Chang Pi dies. This is separation of Yin-Yang Blood-Qi. Zhu Shenggong asked: "Ling Shu Jing" discussion seems to refer to accumulations. Answer: Diseases arise from internal injury and external invasion, never outside Yin-Yang Blood-Qi. Accumulation outside intestines forms Five Accumulations; dysentery forms Lower Accumulation.) Huangdi asked: Chang Pi with white mucus. How is this? Qibo said: Deep pulse indicates survival; floating pulse indicates death. (White mucus indicates Yin fluids draining downward; deep pulse is favorable. Floating pulse indicates Meridian Qi draining downward and Pulse Qi floating upward, separation of meridians, hence death.) Huangdi asked: Chang Pi with pus and blood. How is this? Qibo said: Suspended-extreme pulse indicates death; smooth-large pulse indicates survival. (Blood vessels begin in Foot-Shaoyin Kidney, generate in Foot-Yangming Stomach, governed by Hand-Shaoyin Heart, transported by Foot-Taiyin Spleen. Suspended-extreme indicates Foot-Shaoyin Yin fluid exhaustion. Smooth-large indicates Foot-Shaoyin generating Qi prosperity.) Huangdi asked: Chang Pi type, no body heat, no suspended-extreme pulse. How is this? Qibo said: Smooth-large indicates survival; suspended-choppy indicates death. (This reiterates origin of Blood-Qi, emphasizing Yangming Stomach Qi. No body heat means Yang does not escape externally. No suspended-extreme means Yin does not exhaust downward. Suspended-choppy means Yangming generating Qi is exhausted, hence death. "Bian Mai Pian" says: Fu-Yang pulse floating and choppy indicates Spleen Qi deficiency and Stomach Qi deficiency. Suspended means Stomach Qi exhaustion.) Expect death according to Zang organ timing. (Stomach Qi exhausted, True Zang pulse appears. Thus expect death by Zang timing. Liver suspended-extreme dies in 18 days; Heart suspended-extreme dies in 9 days; Lung suspended-extreme...)