通评虚实，犹言统论虚实也，大义邪气盛，则实；精气夺，则虚，二语尽之。然有气热脉满，而
为重实者，有脉虚气虚，而为重虚者，有寒满热喘，肠 ，癫疾，消瘅，痈疽，腹满霍乱，五脏痫惊，内
外上下，阴阳脏腑诸病，而或死或生，或实或虚者，故曰通评虚实
也。
黄帝问曰∶何谓虚实？
人身经脉贵得其平，故为虚实之问。
岐伯对曰∶邪气盛则实，精气夺则虚。
虚实者，非但经脉血气之虚实，乃邪气盛于人身则实，精气夺于五内则虚，是邪实而正虚也。
帝曰∶虚实何如？
既虚既实，人之脏腑血气当何如？
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，余脏皆如此。
气主于肺，行于内外，故气虚者乃肺虚也。气机营运，从下而上，故气逆者，乃足寒也。邪逆正虚，
伤其五内，故非其克制之时则生，当其克制之时则死。不特肺受火克，诸脏皆有所克，故余脏皆如此。
帝曰∶何谓重实？
重，平声。余同。因上文虚实而问重实。
岐伯曰∶所谓重实者，言大热病，气热脉满，谓是重实。
重实者，言人身大热之病，气盛而热，脉盛而满，阴阳血气皆实，是谓重实。
帝曰∶经络俱实何如，何以治之？
气热脉满，则经络俱实，故为此问，而探其治。
岐伯曰∶经络皆实，是寸脉急而尺缓也，皆当治之。
经络皆实，气血盛于阳分，是寸脉当急，而尺则缓也。经实者治其经，络实者治其络，经络皆实，皆当治之。
故曰∶滑则从，涩则逆也。
经络内通血脉，外通皮肤，经络盛则皮肤滑泽，经络衰则皮肤涩滞，故曰滑则从，涩则逆也。
夫虚实者，皆从其物类始，故五脏骨肉滑利，可以长久也。
物，犹形也。类，犹合也。物类者，五脏在内，皮肉筋脉骨，
有形在外，而合于五脏者也。始，先见也。皮涩而虚，则肺脏亦虚，皮滑而实，则肺脏亦实，故夫虚实者，
皆从其有形之外合，以先见也。皮和肺，肉合脾，脉合心，筋合肝，骨合肾，故五脏调合
于内，骨肉滑利于外，可以长久而永天命也。
帝曰∶络气不足，经气有余何如？
承上文经络皆实，言更有络满经虚，经满络虚之不同，故有络气不足，经气有余，并下经虚络满之间。
岐伯曰∶络气不足，经气有余者，脉口热而尺寒也，秋冬为逆，春夏为从。治主病者。
脉口，寸口也。经气有余，则脉口肤热，络气不足，而尺肤寒也。《荣卫生会》论云∶荣出于中焦，卫
出于下焦，故以寸肤候经，荣为经也，尺肤候络，卫为络也。秋冬之气降而沉，故寸热尺寒为
逆，春夏之气升而浮，故寸热尺寒为从。经络外通皮肉，内通筋骨，肤之寒热，其病有皮肉脉筋骨，浅
深不同，贵得其主病之所在而治之，故曰治主病者。
帝曰∶经虚络满何如？
经虚则经气不足，络满则络气有余。
岐伯曰∶经虚络满者，尺热满，脉口寒涩也，此春夏死，秋冬生也。
虚，不足也。满，有余也。上文以尺候络，故络满者，尺肤热而满，以寸候经，故经虚者，脉口寒
而涩也。寸为阳，主春夏，脉口寒涩，故春夏死，尺为阴，主秋冬，尺热满，故秋冬生。承上文
从逆而言，故曰此也。
帝曰∶治此者奈何？
上文言治主病者，此不言治，帝故问之。
岐伯曰∶络满经虚，灸阴刺阳，经满络虚，刺阴灸阳。
此络满经虚，当灸阴刺阳，灸阴所以补经虚，刺阳所以泻络满。上文经满络虚，当刺阴灸阳，刺
阴所以泻经满，灸阳所以补络虚。此以灸刺通于上文，则上文治主病者，亦当通如此矣。
帝曰∶何谓重虚？
因上文重实而问重虚。
岐伯曰∶脉气上虚，尺虚，是为重虚。
人身阴阳，不外脉气，故提脉气二字。上虚者，脉气虚于上之寸部。尺虚者，脉气虚于下之尺部。脉主
阴血，气主阳气，脉虚气虚，则阴阳血气皆虚，是谓重虚。
帝曰∶何以治之？岐伯曰∶所谓气虚者，言无常也；尺虚者，行
步 然；脉虚者，不象阴也。如此者，滑则生，涩则死也。
知其气脉死生，则知施治之法，故复言气脉，不言治也。所谓气虚者，虚于寸部之阳，则言语无常，而
心主之神明不聪也；虚于尺部之阴，而为尺虚者，则足骨屈伸不利，故行步 然， 然，虚
怯貌。此言气之虚也。脉之大体，有阴有阳，若脉虚者，浮泛于上，有阳无阴，不能效象于阴也。此言脉
之虚也。如此者，指气虚脉虚也。气虚脉虚，诊得皮肤滑泽则生，涩滞则死也。盖气脉既虚
于内，皮肤不可荣于外，明气脉之虚而知其死生，则知治之法矣。
帝曰∶寒气暴上，脉满而实何如？
承上文气热脉满之意，言气热脉满，是谓重实，有寒气暴止，脉满而实何如。暴，卒暴也。
岐伯曰∶实而滑则生，实而逆则死。
上文云滑则从，涩则逆，下文云从则生，逆则死，故曰实而滑则生，实而逆则死，是知逆者因涩而逆也。
帝曰∶脉实满，手足寒，头热何如？
脉实满，手足寒是实而逆则死∶今寒不尽寒，而头复热如何？
岐伯曰∶春秋则生，冬夏则死，脉浮而涩，涩而身有热者，死。
手足寒而头热，乃寒中有热，热中有寒，春时则寒中有热，秋时则热中有寒，故春秋则生，冬气全寒，
夏气全热，今寒中有热，热中有寒，不合天时，故冬夏则死。若脉浮而涩，乃越于外而虚于
内，涩而身有热，乃虚于内而越于外，此根气不足，故皆死。
帝曰∶其形尽满如何？
承经络皆实之意而言，经脉络脉，统于周身，不但经络皆实，
而其形且尽满，何如？形，形身也。满，犹实也。
岐伯曰∶其形尽满者，脉急大坚，尺涩而不应也。
其形尽满者，阳气浮越于外，故脉急大坚，而余于外，尺涩不应，而虚于内也。
如是者，故从则生，逆则死。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。
上文云∶滑则从，涩则逆，今脉急大坚，尺涩不应，如是者，故滑从则生，涩逆则死，帝复问之。而
所谓从者，手足温和，温和则滑也，所谓逆者，手足寒冷，寒冷则涩也，反复辨论，仍明滑则从，涩则逆也。
帝曰∶乳子而病热，脉悬小者何如？
承上文寒气暴上，脉满而实之意，复问乳子病热，脉悬小者何如？
岐伯曰∶手足温则生，寒则死。
乳子秉质未充，借后天乳食以生，故胃气行于四肢，而手足温则生，胃气不行于四肢，而手足寒则死。
帝曰∶乳子中风热，喘鸣肩息者，脉何如？
中，去声，下同。上文乳子病热而脉悬小，此言乳子中风热而脉实大，但举喘鸣肩息，借岐伯以申明之。
岐伯曰∶喘鸣肩息者，脉实大也，缓则生，急则死。
乳子既中风热，复喘鸣肩息，其脉当实大也。脉实大而缓，脉有胃气则生，脉实大而急，脉无胃气则死。
帝曰∶肠 便血何如？
因上文喘鸣病肺，而问大肠之肠 也。肠 者，寒热之邪，伤其阴络，泄泻下利也。热气盛而血溢
肠外，则便血，寒气盛而津溢肠外，则下白沫，寒热相持，血与白沫相兼而下，则下脓血，帝故各举以问。
岐伯曰∶身热则死，寒则生。
肠 便血，则阴虚于内，身热则阳虚于外。《阴阳别论》云∶阴阳虚，肠 死。故身热则死。寒者，
身不热也，不热则阴虚而阳不虚，故生。
帝曰∶肠 下白沫，何如？岐伯曰∶脉沉则生，脉浮则死。
肠 下白沫，乃寒汁下泄。脉沉则血气内守，故生；脉浮则血气外驰，故死。
帝曰∶肠 下脓血，何如？岐伯曰∶脉悬绝则死，滑大则生。
肠 下脓血，乃血与白沫相兼而下。其脉悬绝，则津血内脱，
生阳不生，故死；脉滑大，则阴阳和合，血气充盛，故生。
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，以脏期之。
泄泻下利，属于肠 ，非便血白沫脓血之肠 ，故曰肠 之属。上文言身热则死，又言脉悬绝则死，
帝承上文之意而言，身不热，脉不悬绝何如？帝承上文之意以问，伯亦承上文之意以对。夫
滑大者，既曰生，则悬涩者曰死。悬涩，悬绝之渐也。须知肠 之脉，不宜悬涩矣。悬涩将绝，当以五
脏之死日期之。《阴阳别论》云∶肝至悬绝，十八日死；心至悬绝，九日死；肺至悬绝，十二日
死；肾至悬绝，七日死，脾至悬绝，四日死。
帝曰∶癫疾何如？
承上文肺病之喘鸣，大肠之肠 ，而问心病之癫疾消瘅。心者，君主之官，神明出焉，癫疾则
心不神明，病当何如？
岐伯曰∶脉搏大滑久自已；脉小坚急死不治。
心不受邪，脉搏大滑，则正气内持，邪不干脏，故病久当自已；脉小坚急，乃正气不足，邪必干脏，故死不治。
帝曰∶癫疾之脉，虚实何如？
心不受邪，则癫疾之脉，宜虚乎，抑宜实乎？
岐伯曰∶虚则可治，实则死。
心不受邪，其脉宜虚，故虚则可治；实则邪气内入，故实则
死。
帝曰∶消瘅虚实何如？
癫疾则心气寒，消瘅则心气热，故问消瘅之脉，虚实当何如？
岐伯曰∶脉实大，病久可治；脉悬小坚，病久不可治。
火热而渴，消瘅病也，其脉实大，脉病皆为有余，虽久可治；
脉悬小坚，则病有余，脉不足，久则正气益虚，故不可治。
帝曰∶形度、骨度、脉度、筋度，何以知其度也？
皮与肉为形度；骨度者，肾之合；脉度者，心之合；筋度者，肝之合。承上文诸病，而问形
骨脉筋之度，必知内外相合之度，始知致病之由，故复问之。
岐伯曰∶春亟治经络，夏亟治经俞，秋亟治六腑，冬则闭塞，闭塞者，用药而少针石也。
岐伯二字，旧本讹帝，今改正。度有浅深，合于四时，故春亟治经络，经络无病，筋度和矣；夏
亟治经俞，经俞无病，脉度和矣；秋亟治六腑，六腑无病，通体之形度和矣；冬则闭塞，闭塞
者，宜用药调之，而少针石也，闭塞内藏，骨度和矣。
所谓少针石者，非痈疽之谓也，痈疽不得顷时回。
申明所谓少针石者，乃骨度无病，勿针石以泄之，非痈疽发于骨度之谓也。若痈疽发于骨度，乃
少阴神机所主，当亟刺以泄其毒，不得顷时之缓，而使神机之回也，此言痈疽发于骨度也。
痈不知所，按之不应手，乍来乍已，刺手太阴旁三 ，与缨脉各二。
，音季，余篇同。骨度为阴，故言痈疽，形度脉度筋度为阳，故言痈，不言疽。痈发于通
体之形度，或上或下或左或右，故不知其所，将成未成，故按之不应手，时肿时消，故乍来乍已。肺
主周身之气，故刺手太阴旁三 。手太阴旁，膺胸之旁也。 ，针眼如小疮也。三 ，针疮凡三也。
缨脉，结缨两旁之脉也。各二，左右各刺其二也。此言痈发于形度也。
腋痈大热，刺足少阳五，刺而热不止，刺手心主三，刺手太阴
经络者，大骨之会各三。
胁上曰腋，少阳行身之侧部，合于腋，故腋痈大热，当刺足少阳五，以泄其热，刺之而热不止，则刺手
心主三。心主包络之脉上抵腋下也。更刺手太阴经络者，大骨之会各三。大骨之会，臂骨与
手交会之处也，此言痈发于脉度也。
暴痈筋 ，随分而痛，魄汗不尽，胞气不足，治在经俞。
暴，凶暴也。毒瓦斯深入，内伤其筋，则为暴痈。筋 ，随大筋之分理而痛，谓不掀痛于外，而隐痛于内
也。皮毛之魄汗，不尽出于外，由胞中血海之气，不足于内也。筋 ，胞虚不可以刺，故治在经俞。治，调
治也。使胞中血气，由内达外，则 者强，雍者通，此言痈发于筋度也。
腹暴满，按之不下，取手太阳经络者，胃之募也。少阴俞，去脊椎三寸，旁五，用员利针。
腹中卒暴而满，太阴脾土病也。按之不下，既满且硬，不应指而下也。取手太阳经络者，以小肠居胃下，
化物而出，乃胃之募也。取而刺之，以泻腹满。又取少阴俞所以行泄其水也。少阴俞，即肾俞也，两旁去脊
椎各开三寸。各刺其五，用员利针者，《九针十二原》论曰∶针大如厘，且员且锐，中身微大，以取暴气。
盖肾俞两旁，不可深刺，故用厘针泄肾脏之水气，以治腹满，上文形度骨度脉度筋度，未及于脾，此举脾病，
以足形度之义。
霍乱，刺俞旁五，足阳明及上旁三。
霍乱，胃病也。霍乱之病，脾胃不和，故亦刺少阴俞旁五。病在阳明，故刺足阳明，及上旁三，阳
明胃俞，在肾俞之上，故曰及上旁。三者，两旁各三刺也。本经论五脏，必兼言胃，故举胃病以足五脏之义。
刺痫惊脉五，针手太阴各五，刺足太阳五，刺手少阴经络旁者
一，足阳明一，上踝五寸，刺三针。
足太阳，旧本讹经太阳，今改。痫，癫痫也。惊，震惊也。痫
惊之病，病在于脉，故刺痫惊脉有五，其一针手太阴各五。肺手太
阴之脉起于中焦，出腋上，循 内，各五者，左右各为五刺，刺之所以和金气也。其一刺足太阳五，膀胱足
太阳之脉，起于目内 ，上额交巅，循足太阳之脉，而五刺之，所以和水气也。其一刺手少阴经络旁者一，
To comprehensively evaluate deficiency and excess is to discuss them in general. The main principle is: when pathogenic factors are abundant, it is excess; when vital essence is depleted, it is deficiency. These two phrases summarize the essence. However, there are cases of "double excess" (Chong Shi) characterized by Qi heat and full pulse, and cases of "double deficiency" (Chong Xu) characterized by deficient pulse and deficient Qi. There are also various diseases involving cold fullness, hot panting, Changpi (dysentery), Dianji (epilepsy), Xiaodan (wasting-thirst syndrome), Yongju (carbuncles and sores), abdominal fullness, Huoluan (cholera-like disorder), Zangfu epilepsy and fright, affecting internal and external, upper and lower, Yin and Yang, and Zang and Fu organs. Some result in death, some in survival, some in excess, some in deficiency. Therefore, it is said to comprehensively evaluate deficiency and excess.
Huangdi asked: What are deficiency and excess?
The meridians of the human body value balance, hence the inquiry regarding deficiency and excess.
Qibo replied: When pathogenic factors are abundant, it is excess; when vital essence is depleted, it is deficiency.
Deficiency and excess refer not only to the deficiency or excess of blood and Qi in the meridians, but specifically to pathogenic factors becoming abundant in the body constituting excess, and vital essence being depleted within the five Zang organs constituting deficiency. This means pathogenic excess and righteous deficiency.
Huangdi asked: How are deficiency and excess manifested?
If there is both deficiency and excess, what should be the state of the Zang organs and blood/Qi in the human body?
Qibo said: Qi deficiency corresponds to Lung deficiency. Qi rebellion manifests as cold feet. If it occurs during a season that does not overcome the affected organ, the patient survives; if it occurs during a season that overcomes the affected organ, the patient dies. The same applies to other Zang organs.
Qi is governed by the Lung and circulates internally and externally; thus, Qi deficiency implies Lung deficiency. The movement of Qi mechanism operates from below upwards; therefore, Qi rebellion leads to cold feet. Pathogenic rebellion and righteous deficiency damage the five Zang organs. Thus, survival occurs when not overcome, and death occurs when overcome. It is not only the Lung that is overcome by Fire; all Zang organs have their respective overcoming relationships, so the situation is similar for the others.
Huangdi asked: What is double excess (Chong Shi)?
"Chong" is pronounced with the level tone. The rest follows the previous context. This question arises from the preceding discussion on deficiency and excess.
Qibo said: Double excess refers to severe heat diseases where Qi is hot and the pulse is full. This is called double excess.
Double excess means the body suffers from a severe heat disease, with abundant Qi causing heat and a full pulse indicating abundance. Both Yin and Yang, blood and Qi are in a state of excess, which is termed double excess.
Huangdi asked: What if both the Jing (Regular) and Luo (Collateral) meridians are in a state of excess, and how should they be treated?
Qi heat and a full pulse indicate excess in both Jing and Luo meridians, hence this inquiry to explore treatment methods.
Qibo said: Excess in both Jing and Luo meridians presents as an urgent pulse at the Cun position (radial artery proximal crease) and a relaxed/slow sensation at the Chi position (distal wrist). Both require treatment.
Excess in both Jing and Luo meridians indicates abundant Qi and Blood in the Yang aspects. Thus, the Cun pulse should be urgent, while the Chi skin feels relaxed/slow. Treat excess in the Jing meridians by treating the Jing meridians; treat excess in the Luo meridians by treating the Luo meridians. Since both are in excess, both must be treated.
Therefore, it is said: A slippery pulse indicates compliance (favorable prognosis); a choppy pulse indicates resistance (unfavorable prognosis).
The meridians connect internally with the blood vessels and externally with the skin. Abundant meridians result in smooth and lustrous skin; declining meridians result in rough and stagnant skin. Hence, slippery indicates compliance, and choppy indicates resistance.
Deficiency and excess manifest first through their corresponding physical forms. Therefore, if the five Zang organs and the bones/flesh are smooth and supple, longevity can be achieved.
"Wu" (things) refers to form. "Lei" (category) refers to correspondence. The correspondence between internal and external forms means the five Zang organs reside internally, while skin, flesh, sinews, vessels, and bones have visible forms externally and correspond to the five Zang organs. "Shi" (beginning/first) refers to the initial manifestation. Rough and deficient skin indicates Lung deficiency; smooth and substantial skin indicates Lung excess. Thus, deficiency and excess are initially revealed through these external form correspondences. Skin corresponds to the Lung, flesh to the Spleen, vessels to the Heart, sinews to the Liver, and bones to the Kidney. Therefore, when the five Zang organs are harmonized internally, and the bones and flesh are smooth and supple externally, one can achieve longevity and fulfill their natural lifespan.
Huangdi asked: What if the Luo Qi is insufficient and the Jing Qi is abundant?
Continuing from the previous point about excess in both Jing and Luo, this addresses the differences between full Luo/deficient Jing and full Jing/deficient Luo, leading to questions about insufficient Luo Qi, abundant Jing Qi, and subsequently, deficient Jing/full Luo.
Qibo said: In cases of insufficient Luo Qi and abundant Jing Qi, the pulse at the Maikou (Cun position) is hot, while the Chi skin is cold. This is contrary (Ni) in Autumn and Winter, but compliant (Cong) in Spring and Summer. Treat the primary site of the disease.
Maikou refers to the Cun position. Abundant Jing Qi causes heat at the Cun skin; insufficient Luo Qi causes cold at the Chi skin. The *Yingwei Hui* chapter states: Ying Qi originates from the Middle Jiao, Wei Qi from the Lower Jiao. Therefore, the Cun skin observes the Jing (Ying is Jing), and the Chi skin observes the Luo (Wei is Luo). The Qi of Autumn and Winter descends and sinks; thus, Cun heat and Chi cold are contrary. The Qi of Spring and Summer ascends and floats; thus, Cun heat and Chi cold are compliant. The meridians connect externally with skin/flesh and internally with sinews/bones. The temperature of the skin reflects diseases at different depths (skin, flesh, vessels, sinews, bones). One must identify the primary site of the disease to treat it effectively, hence "treat the primary site."
Huangdi asked: What if the Jing is deficient and the Luo is full?
Jing deficiency means insufficient Jing Qi; Luo fullness means abundant Luo Qi.
Qibo said: In cases of Jing deficiency and Luo fullness, the Chi skin is hot and full, while the Maikou pulse is cold and choppy. Death occurs in Spring and Summer; survival occurs in Autumn and Winter.
Deficiency means insufficiency; fullness means abundance. Previously, the Chi position observed the Luo; thus, Luo fullness manifests as hot and full Chi skin. The Cun position observed the Jing; thus, Jing deficiency manifests as cold and choply Maikou pulse. Cun is Yang, governing Spring and Summer; cold and choply pulse here leads to death in these seasons. Chi is Yin, governing Autumn and Winter; hot and full Chi here leads to survival in these seasons. This follows the logic of compliance and resistance mentioned earlier.
Huangdi asked: How to treat this?
The previous text mentioned treating the primary site, but did not specify the method, prompting Huangdi's inquiry.
Qibo said: For full Luo and deficient Jing, moxibustion on Yin points and needling on Yang points. For full Jing and deficient Luo, needling on Yin points and moxibustion on Yang points.
For full Luo and deficient Jing, one should apply moxibustion to Yin (to tonify Jing deficiency) and needle Yang (to drain Luo fullness). For full Jing and deficient Luo, one should needle Yin (to drain Jing fullness) and apply moxibustion to Yang (to tonify Luo deficiency). Connecting this with the previous discussion, the instruction to "treat the primary site" should be understood in this integrated manner.
Huangdi asked: What is double deficiency (Chong Xu)?
This question follows the discussion on double excess.
Qibo said: Deficiency of Qi pulse in the upper part and deficiency in the Chi part constitute double deficiency.
Human Yin and Yang are reflected in the Qi pulse. "Upper deficiency" refers to Qi pulse deficiency in the upper Cun section. "Chi deficiency" refers to Qi pulse deficiency in the lower Chi section. The Pulse governs Yin Blood, and Qi governs Yang Qi. If both Pulse and Qi are deficient, then both Yin/Yang and Blood/Qi are deficient, which is termed double deficiency.
Huangdi asked: How to treat it? Qibo said: Regarding Qi deficiency, speech becomes erratic; regarding Chi deficiency, walking is unsteady; regarding Pulse deficiency, it lacks the characteristics of Yin. In such cases, a slippery pulse indicates survival, while a choppy pulse indicates death.
Understanding the life-and-death patterns of Qi and Pulse allows one to determine treatment methods. Thus, we discuss Qi and Pulse again without detailing specific treatments. Qi deficiency in the upper (Yang/Cun) section leads to erratic speech and lack of clarity in the Spirit governed by the Heart. Deficiency in the lower (Yin/Chi) section leads to difficulty in flexing and extending the foot bones, resulting in an unsteady gait ("Pan Shan," meaning weak and timid). This describes Qi deficiency. The general nature of the Pulse includes both Yin and Yang. If the Pulse is deficient, it floats superficially, having Yang but lacking Yin, failing to reflect Yin qualities. This describes Pulse deficiency. "Such cases" refer to both Qi and Pulse deficiency. If Qi and Pulse are deficient internally, the skin cannot be nourished externally. A slippery skin texture indicates survival, while roughness indicates death. Knowing the deficiency of Qi and Pulse allows one to predict survival or death and determine treatment.
Huangdi asked: What if Cold Qi suddenly rises, and the pulse is full and excess?
Continuing from the concept of Qi heat and full pulse (double excess), this asks about sudden Cold Qi rising with a full and excess pulse. "Bao" means sudden.
Qibo said: If excess and slippery, survival; if excess and resistant/choppy, death.
As stated before, slippery indicates compliance and choppy indicates resistance. Compliance leads to survival, resistance to death. Thus, excess with slippery pulse leads to survival, and excess with resistant (choppy) pulse leads to death. Resistance arises from choppy quality.
Huangdi asked: What if the pulse is full and excess, hands and feet are cold, and the head is hot?
Full/excess pulse with cold hands and feet indicates excess and resistance, leading to death. But here, the coldness is not complete, and the head is hot. How is this?
Qibo said: Survival in Spring and Autumn; death in Winter and Summer. If the pulse is floating and choppy, and the body has heat, death ensues.
Cold hands/feet with a hot head indicates cold containing heat and heat containing cold. In Spring, cold contains heat; in Autumn, heat contains cold. Thus, survival in Spring/Autumn. Winter is purely cold, Summer is purely hot. The current condition (cold containing heat, heat containing cold) contradicts the seasonal climate, leading to death in Winter/Summer. If the pulse is floating and choppy, it indicates vacuity inside and overflow outside. Choppy pulse with body heat indicates internal vacuity overflowing externally. This signifies insufficiency of Root Qi, leading to death.
Huangdi asked: What if the entire body form is fully distended?
Continuing from the idea of excess in both Jing and Luo, the meridians and collaterals pervade the whole body. Not only are the Jing and Luo in excess, but the entire body form is fully distended. How is this? "Xing" refers to body form. "Man" means full/excess.
Qibo said: In cases of full body distension, the pulse is urgent, large, and firm, while the Chi skin is choppy and unresponsive.
Full body distension indicates Yang Qi floating outward, resulting in an urgent, large, and firm pulse externally, while the Chi skin is choppy and unresponsive, indicating internal vacuity.
In such cases, compliance leads to survival, resistance leads to death. Huangdi asked: What defines compliance leading to survival and resistance leading to death? Qibo said: Compliance means warm hands and feet; resistance means cold hands and feet.
Previously, slippery was defined as compliance and choppy as resistance. Now, with an urgent, large, firm pulse and choppy/unresponsive Chi skin, slippery/compliance leads to survival, and choppy/resistance leads to death. Huangdi asks for clarification. Compliance (warm hands/feet) corresponds to slipperiness; resistance (cold hands/feet) corresponds to choppy texture. This reiterates that slippery is compliance and choppy is resistance.
Huangdi asked: What if an infant suffers from heat disease, and the pulse is suspended and small?
Continuing from the previous discussion on sudden Cold Qi and full/excess pulse, this asks about infants with heat disease and a suspended/small pulse.
Qibo said: Warm hands and feet indicate survival; cold hands and feet indicate death.
Infants have incomplete constitution and rely on postnatal milk/nourishment for growth. Stomach Qi circulates to the four limbs. Warm hands and feet indicate Stomach Qi reaching the limbs (survival); cold hands and feet indicate Stomach Qi failing to reach the limbs (death).
Huangdi asked: What if an infant contracts Wind-Heat, experiences panting with wheezing and shoulder breathing, and what is the pulse like?
"Zhong" is pronounced with the departing tone. Previously, infant heat disease had a suspended/small pulse. Here, infant Wind-Heat with panting/wheezing/shoulder breathing presents with a substantial/large pulse. Qibo clarifies this.
Qibo said: Panting with wheezing and shoulder breathing presents with a substantial and large pulse. If slow, survival; if rapid/tight, death.
After contracting Wind-Heat and experiencing panting/wheezing/shoulder breathing, the pulse should be substantial and large. A substantial/large pulse that is slow indicates the presence of Stomach Qi (survival). A substantial/large pulse that is rapid/tight indicates the absence of Stomach Qi (death).
Huangdi asked: What about Changpi (dysentery) with bloody stool?
Following the discussion on Lung disease (panting), this asks about Large Intestine Changpi. Changpi involves Cold/Heat pathogens damaging Yin collaterals, causing diarrhea/dysentery. Abundant Heat causes blood to溢出 (overflow) outside the intestines, leading to bloody stool. Abundant Cold causes fluids to overflow, leading to white mucus. Cold and Heat contend, mixing blood and white mucus, leading to pus and blood in stool. Huangdi asks about each scenario.
Qibo said: Body heat indicates death; absence of heat indicates survival.
Changpi with bloody stool indicates internal Yin deficiency. Body heat indicates external Yang deficiency. The *Yin Yang Bie Lun* states: "Yin and Yang deficiency in Changpi leads to death." Thus, body heat indicates death. Absence of heat means Yin is deficient but Yang is not, hence survival.
Huangdi asked: What about Changpi with white mucus discharge? Qibo said: Deep pulse indicates survival; floating pulse indicates death.
Changpi with white mucus indicates downward leakage of Cold fluids. A deep pulse indicates Qi and Blood remaining internal (survival). A floating pulse indicates Qi and Blood rushing outward (death).
Huangdi asked: What about Changpi with pus and blood discharge? Qibo said: Suspended/extreme pulse indicates death; slippery and large pulse indicates survival.
Changpi with pus and blood involves mixed discharge. A suspended/extreme pulse indicates internal depletion of Jin-Ye and Blood, loss of Sheng Yang (Life-giving Yang), leading to death. A slippery and large pulse indicates harmony of Yin and Yang, abundance of Qi and Blood, leading to survival.
Huangdi asked: Regarding Changpi-type diseases, if there is no body heat and no suspended/extreme pulse, what happens? Qibo said: Slippery and large pulse indicates survival; suspended and choppy pulse indicates death. Predict based on the Five Zang death cycles.
Diarrhea/dysentery belongs to Changpi, distinct from bloody/mucous/purulent stools. Previously, body heat and suspended/extreme pulse were linked to death. Huangdi asks about cases without these signs. Slippery/large indicates survival; suspended/choppy indicates death. Suspended/choppy is a precursor to suspension/extinction. The pulse in Changpi should not be suspended/choppy. As suspension approaches extinction, predict death based on the Five Zang cycles. The *Yin Yang Bie Lun* states: Liver suspension/extinction – 18 days to death; Heart – 9 days; Lung – 12 days; Kidney – 7 days; Spleen – 4 days.
Huangdi asked: What about Dianji (epilepsy)?
Following Lung disease (panting) and Large Intestine disease (Changpi), this asks about Heart disease (Dianji and Xiaodan). The Heart is the Sovereign Official, from which Shen (Spirit) emerges. Dianji implies loss of Shen clarity. How is this?
Qibo said: If the pulse is large, slippery, and prolonged, the disease will resolve spontaneously. If the pulse is small, firm, and tight, death is inevitable and untreatable.
The Heart does not easily accept pathogenic factors. A large, slippery pulse indicates strong internal Righteous Qi, preventing pathogens from invading the Zang. Thus, the disease resolves over time. A small, firm, tight pulse indicates insufficient Righteous Qi, allowing pathogens to invade the Zang, leading to inevitable death.
Huangdi asked: Regarding Dianji, is the pulse deficiency or excess?
Since the Heart resists pathogens, should the Dianji pulse be deficient or excess?
Qibo said: Deficiency is treatable; excess indicates death.
The Heart resisting pathogens implies the pulse should be deficient. Thus, deficiency is treatable. Excess indicates internal invasion of pathogens, leading to death.
Huangdi asked: What about the deficiency/excess of Xiaodan (wasting-thirst)?
Dianji involves Cold Qi in the Heart; Xiaodan involves Heat Qi in the Heart. Thus, asking about the pulse nature of Xiaodan.
Qibo said: Substantial and large pulse, even if chronic, is treatable. Suspended, small, and firm pulse, if chronic, is untreatable.
Xiaodan is characterized by Fire-Heat and thirst. A substantial/large pulse indicates excess in both disease and pulse. Even if chronic, it is treatable. A suspended/small/firm pulse indicates excess in disease but deficiency in pulse. Over time, Righteous Qi further depletes, making it untreatable.
Huangdi asked: Xing Du (Form Measure), Gu Du (Bone Measure), Mai Du (Pulse Measure), Jin Du (Sinew Measure). How do we know these measures?
Skin and flesh constitute Xing Du. Bone Du corresponds to the Kidney. Pulse Du corresponds to the Heart. Sinew Du corresponds to the Liver. Following the discussion on various diseases, Huangdi asks about the measures of Form, Bone, Pulse, and Sinew. Understanding internal-external correspondence is key to identifying the cause of disease.
Qibo said: In Spring, urgently treat the Jing and Luo meridians. In Summer, urgently treat the Jing and Shu points. In Autumn, urgently treat the Six Fu organs. In Winter, closure prevails; use medication and minimize acupuncture/stone therapy.
"Qibo" was erroneously printed as "Di" in old editions; corrected here. Measures vary in depth and correspond to the Four Seasons. Spring: Urgently treat Jing/Luo meridians; if free of disease, Sinew measure is harmonized. Summer: Urgently treat Jing/Shu points; if free of disease, Pulse measure is harmonized. Autumn: Urgently treat Six Fu organs; if free of disease, Body Form measure is harmonized. Winter: Closure prevails. Use medication to regulate, minimizing acupuncture/stone therapy. Internal organs are closed; Bone measure is harmonized.
"Minimizing acupuncture/stone" does not refer to Yongju (carbuncles/sores). Yongju requires immediate intervention.
Clarification: Minimizing acupuncture/stone applies when Bone measure is healthy, avoiding draining via needles/stones. It does not apply to Yongju arising in the Bone measure region. If Yongju arises there, it is governed by the Shaoyin Shen Ji (Divine Mechanism). Urgent needling is required to drain toxicity, allowing no delay, to restore the Shen Ji. This refers to Yongju in the Bone measure.
For Yongju of unknown location, non-palpable, appearing and disappearing suddenly, needle three points beside the Hand Taiyin Meridian and two points each on the Ying Mai (Collar Veins).
"Ji" is pronounced similarly to previous chapters. Bone measure is Yin; thus, Yongju (Carbuncle/Sore) is discussed. Xing/Pulse/Sinew measures are Yang; thus, only Yong (Carbuncle) is mentioned, not Ju (Sore). Yong arising in the general body form (Xing Du) can occur anywhere (up/down/left/right), hence unknown location. As it forms, it is non-palpable; fluctuating swelling makes it appear/disappear suddenly. The Lung governs Qi throughout the body; thus, needle three points beside the Hand Taiyin Meridian. "Beside Hand Taiyin" refers to the side of the chest. "Ji" refers to needle wounds resembling small sores. "Three Ji" means three needle wounds. "Ying Mai" refers to veins on both sides of the collar tie. "Two each" means two points on left and right. This discusses Yong arising in the Xing Du.
For axillary Yong with high heat, needle five points on the Foot Shaoyang Meridian. If heat persists after needling, needle three points on the Hand Jueyin (Pericardium) Meridian. Also needle the Hand Taiyin Jing/Luo meridians at the intersection of large bones, three points each.
Axilla is above the rib. Shaoyang runs along the lateral body and converges in the axilla. Axillary Yong with high heat requires needling five Foot Shaoyang points to drain heat. If heat persists, needle three Hand Jueyin points, as the Pericardium meridian reaches the axilla. Additionally, needle the Hand Taiyin Jing/Luo at the "Large Bone Intersection" (junction of arm and hand bones), three points each. This discusses Yong arising in the Pulse Du.
For acute Yong affecting sinews, pain follows the sinew divisions. Unrestrained魄汗 (Pore Sweat) indicates insufficient Qi in the Bao (Uterus/Blood Sea). Treatment focuses on Jing Shu points.
"Bao" means fierce. Deep penetration of toxins damages sinews internally, causing acute Yong. Pain in sinews follows the major sinew divisions, manifesting as deep, hidden pain rather than superficial inflammation. Unrestrained pore sweat indicates insufficient Qi in the Bao (Blood Sea) internally. Due to sinew involvement and Bao deficiency, direct needling of sinews is contraindicated; thus, treat via Jing Shu points. "Zhi" means regulation. Regulating Qi and Blood from Bao to exterior strengthens sinews and clears obstruction. This discusses Yong arising in the Sinew Du.
For sudden abdominal fullness that is hard and unyielding to pressure, select the Mu-Alarm point of the Stomach, located on the Hand Taiyang Meridian (Small Intestine). Also select the Shaoyin Shu points, three cun lateral to the spine, five points on each side, using Yuanli needles.
Sudden abdominal fullness is a Spleen Earth disorder. Hardness indicates fullness and rigidity. Select the Hand Taiyang (Small Intestine) Mu point, as the Small Intestine resides below the Stomach, transforms substances, and acts as the Stomach's Mu point. Needling drains abdominal fullness. Select Shaoyin Shu (Kidney Shu) to drain water. Kidney Shu is three cun lateral to the spine. Five points on each side using Yuanli needles. The *Nine Needles and Twelve Sources* states: Yuanli needles are thick as a hair, round yet sharp, slightly thicker in the middle, used to remove acute Qi. Kidney Shu should not be needled deeply; thus, fine needles drain Kidney Water Qi to treat abdominal fullness. This example of Spleen disease complements the Form Measure discussion.
For Huoluan (cholera-like disorder), needle five points beside the Shu points, plus Foot Yangming and three points above laterally.
Huoluan is a Stomach disorder involving Disharmony of Spleen and Stomach. Thus, needle five points beside Shaoyin Shu. Since the disease involves Yangming, needle Foot Yangming and three points above laterally. Yangming Stomach Shu is above Kidney Shu. "Three" means three points on each side. The Classic always mentions the Stomach alongside the Five Zang; this illustrates the Stomach's role in fulfilling the Five Zang functions.
To treat epilepsy and fright, needle five points on the pulse, five points on Hand Taiyin, five points on Foot Taiyang, one point beside Hand Shaoyin Jing/Luo, one point on Foot Yangming, and three needles five cun above the ankle.
"Foot Taiyang" was erroneously "Jing Taiyang" in old texts; corrected. Epilepsy and fright involve the pulses. Needle five points for epilepsy/fright. First, five points on Hand Taiyin. Lung Taiyin meridian originates in Middle Jiao, exits axilla, runs along... Five points mean five on each side, tonifying Metal Qi. Second, five points on Foot Taiyang. Bladder Taiyin meridian originates in inner canthus, crosses vertex... Five points harmonize Water Qi. Third, one point beside Hand Shaoyin Jing/Luo,