虚实者。百病之定体。所谓邪气盛则实。精气夺则虚。二者而已。然而标本逆从之治。皆起于此。不可无缓急有无
之辨。以进求其详也。缓急者。察虚实之缓急也。无虚则急在邪气。多虚则急在正气。微实则虽治实而当固守根本。微
虚则虽治虚而当兼防不测。有无者。察邪气之有无也。表里脏腑。邪有所居。永得其本。而直取之。是有为。邪之实也。
情欲伤内。劳倦伤外。非邪似邪。病在元气。而明辨之。是无为。真之虚也。苟不审此。以逆为从。以标作本。倾人命
矣。
虚有脉象。岐伯曰。气虚。肺虚也。气逆者。足寒也。人之元本。主在元气。而元气之主在肺。故气虚则肺虚。肺
虚而一身之元气。无不皆虚矣。虚则必见气逆。其气逆者。足寒也。人之阴阳。其气皆起于足。若足寒则阳不足而阴乘
之可知矣。凡虚宜以此为断也。
有重虚者。经曰、脉虚上虚尺虚。是谓重虚。脉虚者。不象阴也。气虚者。言无常也。尺虚者。行步 然。重虚盖
谓阴阳两虚。故引此条为两虚之榜样。其一在脉。而云不象阴者。脉出于阴分之营。营衰则神脱。神脱则不能如五脏应
四时之象。其不应时而响应病。甚至不应病而又不应时。则全失其阴象矣。故曰。不象阴也。其一在上。即谓肺虚。肺
虚则气逆。恒见之上而脉气不定。故言无常。其一在尺。尺肾脉也。肾主骨与精。所以固肌肤之会。筋骸之束。今行步
然。将根本倾拨。不能立矣。占虚者以此三事。所谓虚者尽此矣。
内经言百病之生。皆有虚实。皆生于五脏。而必皆见于神气血肉志凡五者。至于邪之入。亦即此五者而诊其先后次
第焉。凡根本虚实。与邪入虚实。莫不从此辨治。故心藏神者也。若有余则笑不休。不足则悲肺藏气者也。有余则喘咳
上气。不足则息利少气。肝藏血者也。有余则怒。不足则恐。脾主内以为形也。有余则腹胀泾溲不利。不足则四肢不用。
肾藏志者也。有余则腹胀飧泄。不足则厥。此其有余。所谓邪气盛则实。此其不足。所谓正气夺则虚也。至若风邪之猝
入。亦必先犯此五者。而自其形层次第以入之。仲景分六经以治伤寒。禀此法也。是以经于邪入之。又每曰血气未并。
五脏安定。见邪必自外而入。不遽内并也。故曰。邪客于形。则洒淅起于毫毛。以未入经络也。故命曰神之微。夫心部
于表。肾部于里。自神至肾。所部有表里之分。方邪客之洒淅起毫毛。则神先觉。是故命曰神微。次则入皮肤。皮肤微
病。犯肺之气矣。命曰气微泄。又次则邪入孙络。孙络外溢。犯肝之血矣。所谓动其营也。故曰维有留血。又次则邪犯
肌肉。肌肉蠕动。此犯在分肉之间。脾之所主矣。命曰微风。又次骨节有动。则邪入经而动骨节。惟志觉之。所谓动志
也。邪入乃深矣。然所谓神先觉者。怆然凄然。不快不乐之谓。所谓气者。畏寒畏风之类。所谓血者。翕翕发热之类。
所谓形者。转辗疼痛之类。所谓志者。烦而不安之类。皆邪之次也。内经按次五层以针法。循次五治。岂非后世所谓表
法解法耶。观其虚实。则五脏之有余不足如彼。循其治法。则形层之浅深次第如此。后之治邪。思过半矣。
有相并之虚实。阴阳相倾。气血以并。气乱于卫。血逆于经。气血离居。一实一虚。所以然者。血气喜温而恶寒。
寒则留滞。温则消散。此相倾以并之因也。故气之所并为血虚。血之所并为气虚。是以有者为实。无者为虚。如血并于
阴。气并于阳。为惊狂者。血并阴。是重阴也。气并阳。是重阳也。重阴者颠。重阳者狂。故为狂惊。血并于阳。气并
于阴。为炅中者。阴在表则阴内虚。阳在里则阳内热。故为炅中。炅。热也。血并于上。气并于下。心烦惋善怒者。血
并上则阴邪抑心。故烦惋。气并下则火动于肝。故善怒。血并于下。气并于上。神乱而喜忘者。血并下则阴气不升。气
并上则阳气不降。阴阳离散。故神乱而喜忘。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。盖血
与气相失则为血虚。与气相并则为实。至夫气血并走于上则上实下虚。下虚则阴脱。阴脱则根本离绝。下厥上竭。是为
大厥。所以暴死。若气极而反。阴可渐回。一去不反。不能生矣。此相并之大概也。
有外感内伤之为虚实者。邪生于阳。得之风雨寒暑。此生于外也。为外感。邪生于阴。得之饮食居处阴阳喜怒。此
生于内也。为内伤。外感多有余。内伤多不足。然有内伤而致外感者。则虚中微实。外感而仍内伤者。则实处多虚。此
中之虚实。固当细辨。而要即外感内伤。亦各自有虚实。如风雨伤人。客毛满络。极于分腠。其脉坚大。此则为实。而
寒湿之伤人。必伤卫气。致皮肤不收而纵缓。肌肉坚紧而削瘦。营涩脉中。卫去脉外。此则为虚。又如内伤之喜怒不节。
则阴气上逆。上逆则阴虚于下。而阳邪凑之。此则为实。然实因于虚。则实为假实也。若夫喜则气下。悲则气消。下与
消则脉空虚。或因饮食寒气薰满。则血涩气去。此则为虚。此外感内伤之大概也。
有主乎虚实之大要者。其一在气。人之元气。所以充形而统血。故气实则形实。气虚则形虚。若形气相反。则偏实
偏虚之病生矣。其一在谷气。谷盛气盛。谷虚气虚。所谓食入于阴。长气于阳者也。五脏六腑。皆已受气。谷之谓矣。
其一在脉。脉为血之府。脉实血实。脉虚血虚。常相应也。而时有反者。岐伯曰。气盛身寒。此谓反也。气虚身热。此
谓反也。夫气盛为热。虚为寒。今反寒反热。此阳内郁而阴外袭。阴内虚而邪外盛。皆形气之相逆。故谓之反也。又其
反者。谷入多而气少。谷不入而气多。一则二阳有余。三阴不足。一则邪并肺胃也。又其反者。脉盛血少。脉小血多。
一为阳实阴虚。一为阳虚阴实也。
有诊虚实之大概者。气充满于内。所为气入。实也。气满泄于外。所谓气出。虚也。气为阳气。实则阳实。必热也。
虚则阳虚。必寒也。此虚实寒热之见于气者。可诊矣。
五实五虚。以决死生。何谓五实。脉盛皮热腹胀及前后不通闷瞀。是也。何谓五虚。脉细皮寒气少及前后泄利饮食
不入。是也。备此者皆死。而有不死者。粥浆入胃泄注止。则虚者活。身汗得后利。则实者活。此其候也。
虚实，是各种疾病确定的本质。所谓邪气亢盛就表现为实证，精气耗损就表现为虚证，仅此二者罢了。然而，治疗中的标本逆从原则，都由此产生，不能没有对缓急、有无的辨别，以此来进一步探求其详细情况。
所谓“缓急”，是指察辨虚实病情的缓急程度。如果没有明显的虚象，那么紧急之处就在邪气；如果正气多虚，那么紧急之处就在正气。如果是轻微的实证，虽然要治疗实证，但也应当固守根本；如果是轻微的虚证，虽然要治疗虚证，但也应当兼防意外变故。
所谓“有无”，是指察辨邪气的有无。如果表里脏腑中有邪气停留，永远抓住根本，直接祛除它，这就是“有为”，属于邪气的实证。如果是情欲损伤内脏，劳倦损伤体表，这些非邪似邪的情况，病在元气，需要明辨之，这就是“无为”，属于真元的虚证。如果不审慎辨别这一点，把逆当作从，把标当作本，就会危及人的生命。
虚证有相应的脉象。岐伯说：气虚，就是肺虚。气逆的人，脚底发冷。人的元本，主宰在于元气，而元气的主宰在于肺。所以气虚则肺虚，肺虚则一身元气无不皆虚。虚证必然出现气逆，那个气逆的表现，就是脚底发冷。人的阴阳之气，都起于足部。如果脚底发冷，就知道是阳气不足而阴气乘虚而入。凡是虚证，都可以以此作为判断依据。
有“重虚”的情况。经书说：脉虚、上虚、尺虚，称为重虚。脉虚，是指脉搏不像阴脉应有的样子。气虚，是指言语无常。尺虚（尺脉虚弱），是指行走不稳、摇晃的样子。“重虚”大概是指阴阳两虚，所以引用这一条作为两虚的榜样。其中一点在脉，说“不象阴”，是因为脉出于阴分的营气，营气衰败则神气脱失，神气脱失就不能像五脏应合四时的正常脉象。那些不应时而响应病，甚至既不应病又不应时，就完全失去了阴脉的形象。所以说“不象阴”。另一点在上，即指肺虚。肺虚则气逆，常常表现为上部症状且脉气不定，所以言语无常。另一点在尺，尺脉对应肾脏。肾主骨与精，用来巩固肌肤的结合和筋骸的束缚。现在行走摇晃不稳，说明根本动摇，无法站立。占测虚证者以这三件事为依据，所说的虚证大致就是这样了。
《内经》说百病的产生，都有虚实之分，都生于五脏，并且必定表现在神、气、血、肉、志这五个方面。至于邪气的侵入，也是通过这五者来诊察其先后次序。凡是根本的虚实与邪气侵入的虚实，无不从此进行辨治。所以心藏神，如果有余则笑个不停，不足则悲伤。肺藏气，有余则喘咳气逆，不足则呼吸通畅但气短。肝藏血，有余则易怒，不足则恐惧。脾主运化以构成形体，有余则腹胀、大小便不利，不足则四肢不能使用。肾藏志，有余则腹胀、完谷不化的泄泻，不足则厥逆。这些有余的情况，就是所谓的“邪气盛则实”；这些不足的情况，就是所谓的“正气夺则虚”。至于风邪突然侵入，也必定先侵犯这五者，然后按照形体层次依次深入。张仲景分六经来治疗伤寒，就是秉承这种法则。因此经文在论述邪气侵入时，常说“血气未并，五脏安定”，见到邪气必定是从外而入，不会立刻向内并与五脏相并。所以说：“邪气客留于形体，就会使人洒淅恶寒，起于毫毛”，因为邪气尚未进入经络，所以命名为“神之微”。心分布于表，肾分布于里，从神到肾，所分布的部位有表里之分。当邪气客留引起洒淅恶寒、毫毛竖起时，神最先察觉，所以命名为“神微”。其次邪气进入皮肤，皮肤轻微受病，侵犯了肺的气，命名为“气微泄”。再次邪气进入孙络，孙络外溢，侵犯了肝的血，所谓动摇了营气，所以说“维有留血”。再次邪气侵犯肌肉，肌肉蠕动，这是侵犯在分肉之间，由脾所主，命名为“微风”。再次骨节有动静，则邪气进入经脉而动及骨节，只有志能察觉，所谓动摇了志，邪气已经深入了。然而所谓“神先觉”，是指怆然凄然、不快不乐的感觉；所谓“气”，是指畏寒畏风之类；所谓“血”，是指翕翕发热之类；所谓“形”，是指辗转疼痛之类；所谓“志”，是指烦躁不安之类，这些都是邪气侵袭的次第。《内经》按照这五个层次制定针法，遵循这五个阶段进行治疗，难道不是后世所说的解表法吗？观察其虚实，则五脏的有余不足像上面所说的那样；遵循其治法，则形层的浅深次第像这样。后世的医生治疗邪气，如果能思考到这里，也就思过半了。
有“相并”导致的虚实。阴阳相互倾轧，气血相并，气乱于卫分，血逆于经脉，气血分离居住，一实一虚。之所以如此，是因为气血喜温而恶寒，寒则凝滞，温则消散，这是相互倾轧相并的原因。所以气之所并为血虚，血之所并为气虚。因此，有的地方是实，没有的地方就是虚。例如血并于阴，气并于阳，会出现惊狂的症状。血并于阴，是重阴；气并于阳，是重阳。重阴则癫，重阳则狂，所以出现狂惊。血并于阳，气并于阴，会出现体内灼热的症状。阴在表则内部阴虚，阳在里则内部阳热，所以出现体内灼热。“炅”就是热的意思。血并于上，气并于下，会出现心烦闷、容易发怒的症状。血并于上则阴邪抑制心，所以心烦闷；气并于下则火动于肝，所以容易发怒。血并于下，气并于上，会出现神志混乱、喜欢遗忘的症状。血并于下则阴气不升，气并于上则阳气不降，阴阳离散，所以神志混乱且喜欢遗忘。血与气一起向上走，就会发生大厥，厥证会导致暴死，如果气能回复则生，不能回复则死。大概血与气相失则为血虚，与气相并则为实。至于气血一起向上走，则是上实下虚，下虚则阴脱，阴脱则根本离绝，下厥上竭，这就是大厥，所以导致暴死。如果气极而反，阴气可以逐渐恢复，一旦一去不返，就不能生存了。这是相并的大概情况。
有因外感和内伤导致的虚实。邪气生于阳，得之于风雨寒暑，这是生于外部的，称为外感。邪气生于阴，得之于饮食居处、阴阳喜怒，这是生于内部的，称为内伤。外感多为有余（实证），内伤多为不足（虚证）。但是有因内伤而导致外感的，则是虚中夹微实；有因外感而仍然内伤的，则是实中多虚。其中的虚实，固然应当仔细辨别，但主要在于外感和内伤，它们各自也有虚实。例如风雨伤人，客留于毛发满络，极于分腠，其脉坚大，这就属于实证。而寒湿伤人，必定损伤卫气，导致皮肤松弛不收而纵缓，肌肉坚紧而消瘦，营气涩滞于脉中，卫气离开脉外，这就属于虚证。又如内伤中喜怒不节制，则阴气上逆，上逆则下部阴虚，而阳邪凑集于此，这就属于实证。然而这种实是因虚而产生的，所以实为假实。如果是喜则气下，悲则气消，下与消则脉空虚，或者因为饮食寒气熏满，则血涩气去，这就属于虚证。这是外感和内伤的大概情况。
有掌握虚实大要的关键。其一在于气。人的元气，用来充实形体并统帅血液，所以气实则形体实，气虚则形体虚。如果形体与气相反，就会产生偏实或偏虚的疾病。其二在于谷气。谷气盛则人气盛，谷气虚则人气虚，这就是所谓的“食入于阴，长气于阳”。五脏六腑，都已经接受了谷气，这就是“谷”的含义。其三在于脉。脉是血的府库，脉实则血实，脉虚则血虚，通常是相应的。但有时会有相反的情况。岐伯说：气盛身寒，这叫反常。气虚身热，这也叫反常。气盛应该发热，气虚应该发寒，现在反而寒反而热，这是因为阳郁于内而阴袭于外，阴虚于内而邪盛于外，都是形气相逆，所以称为反常。又有其他反常的情况：谷入多而气少，谷不入而气多。前者是二阳有余，三阴不足；后者是邪气并聚于肺胃。又有其他反常的情况：脉盛血少，脉小血多。前者是阳实阴虚，后者是阳虚阴实。
有诊察虚实的大概方法。气充满于内，称为气入，属于实。气满泄于外，称为气出，属于虚。气属于阳气，实则阳实，必定发热；虚则阳虚，必定发寒。这是虚实寒热见于气的表现，可以通过诊察得知。
五实和五虚，用来决断生死。什么是五实？脉盛、皮热、腹胀、前后不通、闷瞀，这就是五实。什么是五虚？脉细、皮寒、气少、前后泄利、饮食不入，这就是五虚。具备这五种症状的都属死证，但有不死的情况。如果是粥浆能够进入胃中，泄注停止，那么虚证患者就能活；如果身体出汗且大小通利，那么实证患者就能活。这就是它们的征候。
Deficiency and Excess are the definitive nature of all diseases. As stated, "When pathogenic factors are flourishing, it is Excess; when essential qi is depleted, it is Deficiency." These are merely the two conditions. However, the treatments regarding root and branch, and contrary and compliant approaches, all originate from this. One cannot lack the distinction between urgency and non-urgency, or presence and absence, to further seek detailed understanding.
"Urgency and non-urgency" refers to observing the urgency of deficiency and excess conditions. If there is no significant deficiency, the urgency lies in the pathogenic factor; if there is much deficiency, the urgency lies in the healthy qi. In cases of slight excess, although treating the excess is necessary, one must also consolidate the root. In cases of slight deficiency, although treating the deficiency is necessary, one must also guard against unforeseen changes.
"Presence and absence" refers to observing whether pathogenic factors are present. If pathogens reside in the exterior, interior, zang-fu organs, they have a specific location; grasping the root and directly eliminating them constitutes "active intervention," which characterizes the excess of pathogens. Conversely, injuries caused by emotions/desires damaging the interior, or fatigue/overwork damaging the exterior, are "non-pathogens resembling pathogens"; the disease lies in the primordial qi, requiring clear differentiation. This constitutes "non-active intervention," representing the true deficiency of the original qi. If one fails to examine this carefully, mistaking contrary for compliant, or branch for root, it will endanger human life.
Deficiency presents with specific pulse manifestations. Qibo stated: "Qi deficiency is Lung deficiency. Qi rebellion manifests as cold feet." The primordial root of humans is governed by Yuan Qi (Primordial Qi), and the master of Yuan Qi is the Lung. Therefore, Qi deficiency leads to Lung deficiency, and Lung deficiency leads to universal deficiency of the body's Yuan Qi. Deficiency inevitably manifests as Qi rebellion, specifically as cold feet. The Yin and Yang Qi of humans all originate from the feet. If the feet are cold, it indicates insufficient Yang allowing Yin to invade. Thus, this serves as a criterion for judging all deficiencies.
There is a condition called "Double Deficiency." The Classics state: "Pulse deficiency, Upper deficiency, and Chi (Cun Cun) deficiency constitute Double Deficiency." Pulse deficiency means the pulse does not resemble the Yin pattern. Qi deficiency manifests as irregular speech. Chi deficiency manifests as unsteady gait. "Double Deficiency" generally refers to the simultaneous deficiency of Yin and Yang, so this passage is cited as an example of dual deficiency. First, regarding the pulse: saying it "does not resemble Yin" implies that the pulse arises from the Ying (Nutrient) Qi of the Yin aspect. When Ying Qi declines, Shen (Spirit) detaches. Once Shen detaches, it cannot reflect the normal images of the Five Zang Organs responding to the Four Seasons. Such pulses fail to correspond to time or disease, completely losing their Yin image; hence, "not resembling Yin." Second, regarding the Upper: this refers to Lung deficiency. Lung deficiency causes Qi rebellion, often manifesting as upper symptoms and unstable pulse Qi, leading to irregular speech. Third, regarding the Chi position: the Chi pulse corresponds to the Kidney. The Kidney governs bones and Essence, consolidating the union of skin/flesh and the binding of sinews/bones. Now, with an unsteady gait indicating a shaking foundation unable to stand, this confirms the diagnosis. Observers judge deficiency based on these three aspects; thus, deficiency is essentially described here.
The *Nei Jing* states that the generation of all diseases involves deficiency and excess, originating from the Five Zang Organs, and invariably manifesting in Shen (Spirit), Qi, Blood, Flesh, and Zhi (Will). Regarding pathogen invasion, diagnosis follows the sequence through these five aspects. Both root deficiency/excess and pathogenic deficiency/excess are differentiated thus. The Heart stores Shen; excess leads to incessant laughter, deficiency to sorrow. The Lung stores Qi; excess leads to wheezing, coughing, and upward Qi rebellion, while deficiency leads to smooth breathing but shortness of breath. The Liver stores Blood; excess leads to anger, deficiency to fear. the Spleen governs transformation to form the body; excess leads to abdominal distension and difficult urination/defecation, while deficiency leads to inability to use the four limbs. The Kidney stores Zhi; excess leads to abdominal distension and undigested stool diarrhea, while deficiency leads to Jue (Cold Reversal). These excesses represent "Pathogenic Flourishing = Excess"; these deficiencies represent "Healthy Qi Depletion = Deficiency." Even sudden wind pathogens first attack these five aspects, entering layer by layer through the physical form. Zhang Zhongjing’s division of Six Channels for treating Cold Damage inherits this method. Thus, the Classics state regarding invasion: "When Blood and Qi have not yet mingled, the Five Zang are stable." Pathogens enter from outside and do not immediately merge internally. Hence, "When pathogens lodge in the form, shivering starts at the hair follicles" because they have not entered the meridians; this is named "Shen Wei" (Subtle Spirit involvement). The Heart distributes to the Exterior, the Kidney to the Interior. From Shen to Kidney, there is an Exterior-Interior distinction. When pathogens cause shivering and hair erection, Shen perceives it first, hence "Shen Wei." Next, pathogens enter the skin, causing minor skin pathology affecting Lung Qi, named "Qi Wei Xie" (Minor Leakage of Qi). Next, pathogens enter Sun Luo (Sun Collaterals), overflowing externally and affecting Liver Blood, disturbing Ying Qi, hence "Wei You Liu Xue" (Collateral Stasis of Blood). Next, pathogens affect muscles, causing muscle twitching in the Fen Rou (intermuscular spaces) governed by the Spleen, named "Xiao Feng" (Minor Wind). Next, joint movement indicates pathogens entering Jing (Main) Meridians and affecting bones, perceived only by Zhi, meaning Zhi is disturbed and pathogens are deep. However, "Shen perception first" refers to a desolate, unhappy feeling. "Qi" refers to aversion to cold/wind. "Blood" refers to mild fever. "Form" refers to turning pain. "Zhi" refers to restlessness. These are the stages of pathogen invasion. The *Nei Jing* prescribes acupuncture methods according to these five layers and treatments accordingly—is this not what later generations call Exterior-Releasing Methods? Observing deficiency/excess reveals the excess/deficiency of the Five Zang as above; following treatment methods reveals the depth/sequence of physical layers as such. Later physicians treating pathogens need only ponder half as much to understand this.
There is deficiency/excess caused by "Merging." Yin and Yang clash; Qi and Blood merge. Qi becomes chaotic in the Wei (Defensive) level; Blood rebels in the meridians. Qi and Blood separate, resulting in one Excess and one Deficiency. This occurs because Qi and Blood prefer warmth and dislike cold; cold causes stagnation, warmth causes dispersion. Thus, where Qi merges, Blood becomes deficient; where Blood merges, Qi becomes deficient. Therefore, presence indicates Excess, absence indicates Deficiency. For example, if Blood merges into Yin and Qi merges into Yang, it causes惊狂 (Fright and Mania). Blood merging into Yin is Heavy Yin; Qi merging into Yang is Heavy Yang. Heavy Yin leads to Dian (Manic Depression/Epilepsy); Heavy Yang leads to Kuang (Mania). Hence, Fright and Mania occur. If Blood merges into Yang and Qi merges into Yin, it causes Jiong Zhong (Internal Heat/Burning Sensation). Yin at the Exterior implies internal Yin deficiency; Yang at the Interior implies internal Yang heat. Hence, Internal Heat. "Jiong" means heat. If Blood merges upward and Qi merges downward, it causes heart vexation and irritability. Blood merging upward suppresses the Heart with Yin pathogens, causing vexation; Qi merging downward stirs Fire in the Liver, causing irritability. If Blood merges downward and Qi merges upward, it causes mental confusion and forgetfulness. Blood merging downward prevents Yin Qi from ascending; Qi merging upward prevents Yang Qi from descending. Yin and Yang scatter, causing mental confusion and forgetfulness. If Blood and Qi both rush upward, it results in Da Jue (Great Jue Syndrome), leading to sudden death. If Qi returns, life is preserved; if not, death ensues. Generally, loss of connection between Blood and Qi causes Blood Deficiency; merging causes Excess. When Blood and Qi rush upward, there is Upper Excess and Lower Deficiency. Lower Deficiency leads to Yin Collapse. Yin Collapse severs the root, causing Lower Jue and Upper Exhaustion, i.e., Great Jue, leading to sudden death. If Qi reverses at its extreme, Yin can gradually return; once gone without return, survival is impossible. This is the general principle of Merging.
There is deficiency/excess due to External Invasion and Internal Injury. Pathogens arising from Yang come from Wind, Rain, Cold, Summer-heat; these arise externally, termed External Invasion. Pathogens arising from Yin come from Diet, Dwelling, Yin-Yang imbalance, Joy/Anger; these arise internally, termed Internal Injury. External invasions are mostly Excess; Internal injuries are mostly Deficiency. However, Internal injury leading to External invasion results in Deficiency with slight Excess; External invasion still involving Internal injury results in Excess with much Deficiency. The nuances of deficiency/excess here must be carefully distinguished, but primarily, External and Internal categories each have their own deficiency/excess patterns. For instance, Wind/Rain attacking lodges in hair/full collaterals, reaching Fen Cou (skin/muscle intervals), presenting with firm/large pulses—this is Excess. Cold/Dampness attacking damages Wei Qi, causing loose/redundant skin, tight/thin muscles, stagnant Ying in vessels, and Wei leaving vessels—this is Deficiency. Similarly, unregulated Joy/Anger in Internal Injury causes Yin Qi to rebel upward, creating Lower Yin Deficiency attracting Yang pathogens—this is Excess. However, if this Excess stems from Deficiency, it is False Excess. Joy causes Qi to sink; Sorrow causes Qi to dissipate; sinking/dissipating leads to empty pulses. Dietary cold filling the interior causes stagnant Blood and departing Qi—this is Deficiency. This covers the generalities of External and Internal causes.
Key principles governing deficiency/excess include: First, Qi. Human Yuan Qi fills the form and commands Blood. Thus, Excess Qi means Excess Form; Deficient Qi means Deficient Form. If Form and Qi contradict, pathological Excess or Deficiency arises. Second, Grain Qi (Gu Qi). Abundant Grain leads to abundant Qi; scarce Grain leads to scarce Qi. This is "Food enters Yin, nourishes Yang." The Five Zang and Six Fu organs receive Qi from Grain. Third, Pulse. Pulse is the mansion of Blood. Excess Pulse means Excess Blood; Deficient Pulse means Deficient Blood. Usually, they correspond. Sometimes they reverse. Qibo said: "Qi Excess with Cold Body" is a reversal. "Qi Deficiency with Hot Body" is a reversal. Qi Excess should bring Heat; Qi Deficiency should bring Cold. Reversals occur due to Yang depression inside/Yin attacking outside, or Yin deficiency inside/Pathogen excess outside, constituting Form-Qi contradiction. Other reversals: Eating much but having little Qi (Excess Er Yang, Deficiency San Yin); eating nothing but having much Qi (Pathogen merging in Lung/Stomach). Pulse full with little Blood (Yang Excess, Yin Deficiency); Pulse small with much Blood (Yang Deficiency, Yin Excess).
General methods for diagnosing deficiency/excess: Qi filling internally is "Qi Entering," indicating Excess. Qi leaking externally is "Qi Exiting," indicating Deficiency. Qi belongs to Yang Qi. Excess means Yang Excess, necessarily Heat. Deficiency means Yang Deficiency, necessarily Cold. These manifestations of deficiency/excess and cold/heat in Qi can be diagnosed.
Wu Shi (Five Excesses) and Wu Xu (Five Deficiencies) determine life and death. What are the Five Excesses? Full pulse, hot skin, abdominal distension, obstruction of front/back (urination/defecation), and stifling/dizziness. These are the Five Excesses. What are the Five Deficiencies? Thin pulse, cold skin, shortness of breath, diarrhea/incontinence of front/back, and inability to eat/drink. These are the Five Deficiencies. Those exhibiting all five are destined to die, but some survive. If gruel enters the stomach and diarrhea stops, the Deficient patient lives. If sweat appears and bowels/bladder open, the Excess patient lives. These are the prognostic signs.