阳虚则外寒，阴虚则内热，阳盛则外热，阴盛则内寒。阳受气于上焦，以温皮肤分肉之间。寒气在外。
则上焦不通，上焦不通，则寒气独留于外，故寒栗；（寒气在外，阴遏卫气，不温于表，而寒气独留，为
寒栗，此“阳虚则外寒”也。）有所劳倦，形气衰少，谷气不盛，上焦不行，下脘不通，胃气热，热气熏胸
中，故内热。（形气，阴气也。劳倦不慎而形气衰少，伤脾阴也，以致郁热熏于胸中，此“阴虚生内热”也。
劳倦伤形，指脾胃也。若情欲不节。则五脏失守而伤精，精伤则水亏，故邪火易生，阴虚内热，此为尤甚。）
上焦不通利，则皮肤致密，腠理闭塞，玄府不通，卫气不得泄越，故外热；（外伤寒邪则上焦不通，肌表闭
塞，卫气郁聚无所流行而为外热，所谓“人伤于寒，则病为热”，此外感证也。）厥气上逆，寒气
积于胸中而不泻，不泻则温气去，寒独留则血凝涩，凝则脉不通，其脉盛大以涩，故中寒。（厥气，寒厥之
气也。或寒气伤脏，或食饮寒凉，寒留中焦，阳气乃去，经脉凝滞，故盛大而涩。盖阳脉流利
多滑，不滑则无阳可知，此内伤证也。）
气实形实，气虚形虚，谷盛气盛，谷虚气虚，脉实血实，脉虚血虚，此其常也，反此者病。（形立于外，
气充于内，形气相合，是谓和平。故气实者形实，气虚者形虚，此禀赋之常也。若形气相反，则偏虚
偏实之病生矣。人受气于谷，谷入于胃，以传于肺，五脏六腑，皆以受气。此气生于谷也，是谓“谷气”。
故谷气盛衰，候当相应，不应则为病矣。脉之盛衰者，所以候血气之虚实也，故脉之与血，相应者为常，不
相应者反而病也。）如何而反？气虚身热，气盛身寒，（此以下皆所以释上文也。气虚者，阳虚也，当为身寒，
而反病热者，阴气虚于内，阳气盛于外也，此形气相逆之反也。）谷入多而气少，（谷入多，二阳有余；气少，
三阴不足也。）谷不入而气多，（谷不入，胃腑受邪；气多，及于肺也。脉盛血少，脉少血多，此谓反也。
（脉盛血少者，阳实阴虚也；脉少血多者，阳虚阴实也，皆谓之“反”也。）气盛身寒，得之伤寒；气
虚身热，得之伤暑。（气盛身寒，得之伤寒者，寒伤形也；气虚身热，得之伤暑者，暑伤气也。人之伤于
寒也，则病热。何以身寒者为伤寒，身热者为伤暑？不知四时皆有伤寒，而伤暑惟在夏月。至于夏至之后，
有感寒暑而同时为病者，则不可不察其阴阳也。盖阴邪中人则寒集于表，气聚于里，故邪气盛实而身本
因寒也；暑邪中人则热触于外，气伤于中，故正气疲困而因热无寒也。此夏月寒暑之辨，故以二者并言，非
谓凡患伤寒者皆身寒无热也。）谷入多而气少者，得之有所脱血，湿居下也。（谷入多者。胃热善于消谷也。
脱血者，亡其阴也；湿居下者，脾肾之不足，亦阴虚也。阴虚则无气，故谷虽入多而气则少也。）谷入少
而气多者，邪在胃及与肺也。（邪在胃则不能食，故谷入少，邪在肺则息喘满，故气多。）脉小血多者，饮
中热也。（脉小者，血应少而反见其多，必或酒或饮，中于热而动之也。）脉大血少者，厥有风气，水浆
不入，此之谓也。（风为阳邪，居于脉中，故脉大；水浆不入则中焦无以生化，故血少。）
夫实者，气入也；虚者，气出也。（此下言虚实寒热之因，以用补泻法也，气入者充满于内，所以为实；
气出者漏泄于中，所以为虚。）气实者，热也；气虚者，寒也。（气为阳气，实则阳实，故热气虚则阳虚，
故寒。）又有五实死，五虚死。（五实者，五脏之实也；五虚者，五脏之虚也。五实五虚，具者皆死。然气
虚至尽，尽而死者，理当然也，若五实者，何以亦死？盖邪之所凑，其气必虚，不脱不死，仍归于气尽耳。
然虚实俱有真假，所当辨耳。）脉盛、皮热、腹胀、前后不通、闷瞀，此谓“五实”；（实者，邪气
盛实也。脉盛者，心所主也；皮热者，肺所主也；腹胀者，脾所主也；前后不通，肾开窍于二阴也；闷瞀者，
肝脉贯膈，气逆于中。瞀，目不明也。）脉细、皮寒、气少、泄利前后、饮食
不入，此谓五“虚”（虚者，正气虚也。脉细，心虚也，皮寒，肺虚也；气少，肝虚也；泄利前后，
肾虚也；饮食不入，脾虚也。）其时有生者，浆粥入胃，泄注止，则虚者活；（治之者，能使浆粥入胃，则
脾渐苏；泄渐止，则肾渐固。根本气回，故虚者活也。）身汗，得后利，则实者活。此其候也。（得身汗，
则表邪解；得后利，则里邪除。内外通和，故实者活也，当今之人，实者无几；而虚者七八。病实者其来
速，其去亦速，故其治易；病虚者损伤有渐，不易复元，故其治难。实者少壮新邪，则可攻可拔；虚者根
本有亏，则倏忽变幻，可无虑乎？夫人之虚损，有先天不足者，有后天不足者，先天者由于禀受，宜倍加
谨慎，急以后天人事培补之，庶可延年，使觉之不早而慢不为意，则未有不夭折者矣；后天者由于劳伤，宜
速知警省，即以情性药食调摄之，使治之不早而迁延讳疾，则未有不噬脐者矣。凡劳、伤之辨，劳者劳其神
气，伤者伤其形体，如喜怒思虑则伤心，忧愁悲哀则伤肺，是皆劳其神气也；饮食失度则伤脾，起居不慎则
伤肝，色欲纵肆则伤肾，是皆劳其形体也。损其肺者伤其气，为皮焦而毛槁；损其心者伤其神，为血脉少而
不营于脏腑，此自上而伤者也。损其肝者伤其筋，为筋缓不能自收持；损其肾者伤其精，为骨髓消灭，痿弱
不能起，此自下而伤者也。损其脾者伤其仓廪之本，为饮食不为肌肤，此自中而伤者也。心肺损而神色败，
肝肾损而形体痿，脾胃损而饮食不化，感此病者，皆损之类也。然所损虽分五脏，而五脏所藏，
则无非精与气耳。精为阴，人之水也；气为阳，人之火也，水火得其正则为精为气，水火失其和则为热为寒，
此因偏损，所以致有偏胜。故水中不可无火，无火则阴胜而病寒；故火中不可无水，无水则阳胜而病热。当详
辨阴阳，则虚损之治；无余义矣。水亏者大补真阴，切不可再伐阳气；火虚者大补元阳，切不可再伤阴气。
盖阳既不足，而复伐其阴，阴亦损矣；阴已不足，而再伐其阳，阳亦亡矣。实者阴阳因有余，但去所余，则
得其平；虚者阴阳有不足，再去所有。则两者俱败，其能生乎？故治虚之要，凡阴
虚多热者最嫌辛燥，恐助阳邪也，尤忌苦寒，恐伐生阳也，惟喜纯甘壮水之剂，补阴以配阳，则刚为柔制，
虚火自降而阳归乎阴矣；阳虚多寒者最嫌凉润，恐助阴邪也，尤忌辛散，恐伤阴气也，只宜甘温益火之品，
补阳以配阴，则柔得其主，沉寒自敛而阴从乎阳矣。是以气虚者宜补其上，精虚者宜补其下，阳虚者宜补而兼
暖，阴虚者宜补而兼清，此固阴阳之治辨也。其有气因精而虚者，自当补精以化气；精因气而虚者，自当
补气以生精。又如阳失阴而离者，非补阴何以收散亡之气？水失火而败者，非补火何以补随寂之阴？此又阴阳
相济之妙用也。故善补阳者，必于阴中求阳，则阳得阴助而生化无穷；善补阴者，必于阳中求阴，则阴得阳升
而泉源不竭。故以精气分阴阳，则阴阳不可离；以寒热分阴阳，则阴阳不可混。此又阴阳邪正之离合也。知
阴阳邪正之治，则阴阳和而生道得矣。）
阳虚则体表寒冷，阴虚则体内发热，阳盛则体表发热，阴盛则体内寒冷。阳气从上焦受气，以温煦皮肤和肌肉之间的间隙。若寒气在体外，（则导致）上焦气机不通畅；上焦不通畅，寒气便独自滞留于体表，所以出现寒战发抖的症状。（这是指：寒气在体外，阴寒遏制卫气，不能温煦体表，而寒气独自停留，表现为寒战发抖，这就是“阳虚则外寒”的道理。）如果因过度劳累，形体之气衰弱，水谷精气不充足，上焦气机运行不畅，下脘部位堵塞不通，胃中产生热气，热气熏蒸于胸中，所以出现体内发热。（这里所说的形气，指的是阴气。因劳累不慎导致形气衰弱，是损伤了脾阴，致使郁热熏蒸于胸中，这就是“阴虚生内热”的道理。劳倦伤及形体，主要指脾胃。如果是情欲不节制，则会损伤五脏精气，精伤则肾水亏虚，所以邪火容易滋生，阴虚内热，这种情况更为严重。）上焦气机不通利，则皮肤致密，腠理闭塞，汗孔不通，卫气不能向外发散，所以出现体表发热；（这是指：外伤寒邪导致上焦不通，肌表闭塞，卫气郁结无法流通而产生体表发热，所谓“人感受寒邪，就会生病表现为发热”，这属于外感病证。）厥逆之气向上冲逆，寒气积聚在胸中而不能消散，不能消散则温煦之气离去，寒气独自停留则血液凝滞涩阻，血脉凝滞则脉道不通，脉象盛大而兼涩，所以出现胸中寒冷。（这里的厥气，是指寒厥之气。或者是寒气损伤脏腑，或者是饮食过食寒凉，寒气留滞在 mid-jiao 中焦，阳气于是离去，经脉凝滞，所以脉象盛大而涩。因为阳脉通常流利多滑，如果不滑就说明没有阳气，这属于内伤病证。）
气实则形体充实，气虚则形体虚弱，水谷精气盛则气盛，水谷精气虚则气虚，脉象实则血实，脉象虚则血虚，这是正常的规律，与此相反的就是病态。（形体表现于外，气充养于内，形与气相合，称为平和。所以气实的形体就充实，气虚的形体就虚弱，这是禀赋的正常情况。如果形与气相反，就会产生偏虚或偏实的疾病。人从谷物中获取气，谷物进入胃中，传送给肺，五脏六腑都从中获得气。这种气生于谷物，称为“谷气”。所以谷气的盛衰应当与气相应，如果不相应就是病了。脉象的盛衰是用来候察气血虚实的方法，所以脉与血相应是正常的，不相应反而是病态。）什么是相反呢？气虚却身体发热，气盛却身体寒冷，（以下都是解释上文的内容。气虚，即阳虚，本应身体寒冷，反而生病发热的，是因为阴气在内虚损，阳气在外亢盛，这是形气相逆的反常现象。）进食多但气少，（进食多，说明阳明胃经有余；气少，说明三阴不足。）进食少但气多，（进食少，是胃腑受邪；气多，是邪气波及肺脏。脉象盛大但血少，脉象微弱但血多，这叫做反常。（脉盛血少，是阳实阴虚；脉少血多，是阳虚阴实，都称为“反常”。）气盛身寒，是由于感受伤寒所致；气虚身热，是由于感受暑邪所致。（气盛身寒，得自伤寒，是寒邪损伤形体；气虚身热，得自伤暑，是暑邪损伤气机。人感受寒邪会生病发热。为什么身寒的是伤寒，身热的是伤暑？不知道四季都有伤寒，而伤暑只在夏季发生。至于夏至之后，有人同时感受寒邪和暑邪而发病，就不能不仔细辨别其阴阳属性。大概阴邪中人，则寒邪聚集于体表，气聚于体内，所以邪气盛实而身体本来因寒而冷；暑邪中人，则热邪触于体表，气伤于体内，所以正气疲困而因热无寒。这是夏季寒暑的辨别，所以将两者并提，并不是说凡是患伤寒的人都身寒无热。）进食多但气少，是由于失血或湿气居下所致。（进食多，是胃热善于消化食物。失血，是亡失阴液；湿气居下，是脾肾不足，也属于阴虚。阴虚则无气，所以虽然进食多但气却少。）进食少且气多，是邪气在胃和肺。（邪气在胃则不能进食，所以进食少；邪气在肺则呼吸喘满，所以气多。）脉小但血多，是饮酒或饮水中热所致。（脉小，血应该少却反而见多，必定是酒或饮中热邪扰动所致。）脉大但血少，是厥逆伴有风邪，且水浆不入所致。（风为阳邪，居于脉中，所以脉大；水浆不入则中焦无法生化气血，所以血少。）
所谓的实，是气向内入；所谓的虚，是气向外出。（以下论述虚实寒热的原因，以便使用补泻法。气入充满于内，所以为实；气出漏泄于中，所以为虚。）气实则是热，气虚则是寒。（气即阳气，实则阳实，所以有热气；虚则阳虚，所以有寒气。）又有五实死、五虚死的说法。（五实，是指五脏的实证；五虚，是指五脏的虚证。五实和五虚如果全部具备，都会死亡。然而气虚至极而死，道理上是必然的，那么五实为什么会死呢？大概邪气聚集的地方，正气必然虚弱，如果不通过脱症而死，最终也是归于气尽罢了。但是虚实都有真假，应当仔细辨别。）脉象盛大、皮肤发热、腹部胀满、大小便不通、心中烦闷视物不清，这叫做“五实”；（实，是指邪气盛实。脉盛，由心所主；皮热，由肺所主；腹胀，由脾所主；前后不通，肾开窍于二阴；闷瞀，肝脉贯膈，气逆于中。瞀，指眼睛看不清。）脉象细弱、皮肤寒冷、气短、大小便泄利不止、饮食不进，这叫做“五虚”。（虚，是指正气虚。脉细，心虚；皮寒，肺虚；气少，肝虚；泄利前后，肾虚；饮食不入，脾虚。）其中有时能活的，如果浆粥能进入胃中，泄泻停止，那么虚证患者就能活；（治疗者，能使浆粥入胃，则脾气逐渐苏醒；泄泻渐止，则肾气逐渐固摄。根本之气回复，所以虚证患者能活。）身体出汗，大小便通畅，那么实证患者就能活。这是它们的征候。（得到身体出汗，则表邪解除；得到大小便通畅，则里邪去除。内外通和，所以实证患者能活。当今之人，实证很少；而虚证占七八成。实证病情来得快，去得也快，所以治疗容易；虚证损伤是渐进的，不容易恢复元气，所以治疗困难。实证多是壮年人的新邪，可以攻伐拔除；虚证根本有亏损，变化迅速，能不担忧吗？人的虚损，有先天不足的，有后天不足的。先天不足由于禀受，应倍加谨慎，急于用后天的调养来培补，才可能延年益寿；如果觉察不早而漫不经心，则无不早夭的。后天不足由于劳伤，应速知警省，即以性情和药食调摄；如果治疗不早而拖延讳疾，则无不后悔莫及的。凡劳、伤的辨别：劳者是劳损其神气，伤者是损伤其形体。如喜怒思虑则伤心，忧愁悲哀则伤肺，这些都是劳损神气；饮食失度则伤脾，起居不慎则伤肝，色欲纵肆则伤肾，这些都是劳损形体。损伤肺者伤其气，表现为皮毛枯焦；损伤心者伤其神，表现为血脉减少而不能营养脏腑，这是自上而下损伤。损伤肝者伤其筋，表现为筋缓弛不能自主收持；损伤肾者伤其精，表现为骨髓消灭，痿弱不能起身，这是自下而上损伤。损伤脾者伤其仓廪之本，表现为饮食不能化为肌肤，这是自中而损伤。心肺受损则神色败坏，肝肾受损则形体痿废，脾胃受损则饮食不化，感染这些病的，都属于损类。然而所损虽分五脏，而五脏所藏，无非精与气罢了。精为阴，是人的水；气为阳，是人的火，水火得其正则为精为气，水火失其和则为热为寒，这是因为偏损，所以导致偏胜。所以水中不可无火，无火则阴胜而病寒；火中不可无水，无水则阳胜而病热。应当详细辨别阴阳，那么虚损的治疗就没有遗漏的了。水亏者大补真阴，切不可再伐阳气；火虚者大补元阳，切不可再伤阴气。因为阳既不足，如果再伐其阴，阴也会受损；阴已不足，如果再伐其阳，阳也会亡失。实证是阴阳因有余，只要去掉所余，就能得其平衡；虚证是阴阳有不足，再去掉所有的，则两者俱败，怎么能生存呢？所以治疗虚证的关键，凡是阴虚多热的，最忌讳辛燥，恐怕助长阳邪；尤其忌讳苦寒，恐怕伐伤生阳之气；只喜欢纯甘壮水的药剂，补阴以配阳，则刚强被柔和制约，虚火自然下降而阳回归于阴；阳虚多寒的，最忌讳凉润，恐怕助长阴邪；尤其忌讳辛散，恐怕伤阴气；只宜用甘温益火的药物，补阳以配阴，则柔弱得到主宰，沉寒自然收敛而阴顺从于阳。因此气虚者宜补其上，精虚者宜补其下，阳虚者宜补而兼暖，阴虚者宜补而兼清，这确实是阴阳治疗的辨别。其中有气因精而虚的，自然应当补精以化气；精因气而虚的，自然应当补气以生精。又如阳失去阴而离散者，不补阴怎么能收摄散亡之气？水失去火而败坏者，不补火怎么能补救随寂之阴？这又是阴阳相济的妙用。所以善于补阳的人，必于阴中求阳，则阳得到阴的帮助而生化无穷；善于补阴的人，必于阳中求阴，则阴得到阳的升发而泉源不竭。所以以精气分阴阳，则阴阳不可分离；以寒热分阴阳，则阴阳不可混淆。这又是阴阳邪正的离合关系。懂得阴阳邪正的治疗，则阴阳调和而生道可得矣。）
Yang deficiency leads to external cold, yin deficiency leads to internal heat, yang excess leads to external heat, and yin excess leads to internal cold. Yang receives Qi from the Upper Jiao (Upper Burner) to warm the skin and muscles. If cold pathogen is outside, (it causes) the Upper Jiao to be obstructed; if the Upper Jiao is obstructed, cold pathogen remains alone on the exterior, thus causing chills and shivering. (This refers to: cold pathogen outside, yin-cold restraining Wei Qi (Defensive Qi), failing to warm the surface, while cold pathogen remains alone, manifesting as chills and shivering; this is the principle of "Yang deficiency leads to external cold".) If due to overexertion, the form and Qi decline, Gu Qi (Grain Qi) is insufficient, the Upper Jiao fails to circulate, and the Lower Wan (Lower Stomach) is blocked, stomach heat arises and steams the chest, thus causing internal heat. (Here, Xing Qi (Form Qi) refers to Yin Qi. Overexertion leading to Xing Qi decline damages Spleen Yin, causing stagnant heat to steam the chest; this is the principle of "Yin deficiency generates internal heat". Exertion damaging form mainly refers to the Spleen and Stomach. If emotional desires are unregulated, it damages the Essence of the Five Zang organs; essence damage leads to Kidney Water deficiency, so evil fire easily arises, making yin deficiency with internal heat even more severe.) If the Upper Jiao is not smooth, the skin becomes dense, Cou Li (interstices) close, Xuan Fu (pores) block, and Wei Qi cannot diffuse outward, thus causing external heat; (This refers to: external cold pathogen obstructing the Upper Jiao, muscle surface closing, Wei Qi stagnating without circulation generating external heat; as stated in "when people suffer from cold, they develop heat disease", this belongs to exogenous syndromes.) Jue Qi (Rebellious Qi) moves upward, cold pathogen accumulates in the chest without dissipating; without dissipation, warming Qi departs, cold remains alone, blood coagulates and becomes stagnant, vessels become blocked, the pulse is large and choppy, thus causing internal cold. (Here, Jue Qi refers to Cold-Jue Qi. Either cold pathogen damages Zang organs, or diet involves excessive cold food, cold stays in the Middle Jiao, Yang Qi departs, meridians stagnate, thus the pulse is large and choppy. Because Yang pulses are usually smooth, lack of smoothness indicates absence of Yang; this belongs to endogenous syndromes.)
When Qi is excess, the form is solid; when Qi is deficient, the form is weak; when Grain Qi is abundant, Qi is abundant; when Grain Qi is deficient, Qi is deficient; when the pulse is excess, Blood is excess; when the pulse is deficient, Blood is deficient. This is the normal state; deviation from this constitutes disease. (Form manifests externally, Qi nourishes internally; when form and Qi harmonize, it is called Peace. Thus, excess Qi results in a solid form, deficient Qi results in a weak form; this is the normal constitution. If form and Qi contradict each other, diseases of partial deficiency or excess arise. Humans obtain Qi from grain; grain enters the Stomach, transmits to the Lung, and all Five Zang and Six Fu organs receive Qi. This Qi born from grain is called "Gu Qi" (Grain Qi). Therefore, the abundance or scarcity of Gu Qi should correspond with Qi; non-correspondence indicates disease. The fullness or emptiness of the pulse is used to observe the deficiency or excess of Qi and Blood; thus, correspondence between pulse and Blood is normal, while non-correspondence is pathological.) What constitutes contradiction? Qi deficiency but body heat, Qi excess but body cold. (The following explains the above text. Qi deficiency implies Yang deficiency, which should present with body cold; presenting instead with fever indicates Yin Qi is deficient internally and Yang Qi is excessive externally, a contradictory phenomenon of form and Qi.) Eating much but having little Qi. (Eating much indicates excess in the Two Yang [Stomach/Intestines]; little Qi indicates insufficiency in the Three Yin.) Eating little but having much Qi. (Eating little indicates pathogen in the Stomach Fu; much Qi indicates involvement of the Lung. Pulse large but Blood deficient, pulse small but Blood abundant—this is called contradiction. (Pulse large/Blood deficient indicates Yang excess/Yin deficiency; pulse small/Blood abundant indicates Yang deficiency/Yin excess; both are termed "contradiction".) Qi excess with body cold results from contracting Cold Damage (Shang Han); Qi deficiency with body heat results from contracting Summerheat Damage (Shang Shu). (Qi excess/body cold from Shang Han means cold damages form; Qi deficiency/body heat from Shang Shu means summerheat damages Qi. People suffering from cold develop heat disease. Why is body cold associated with Shang Han and body heat with Shang Shu? One must know that Shang Han occurs in all four seasons, whereas Shang Shu occurs only in summer. After the Summer Solstice, some may contract both cold and summerheat simultaneously; one must carefully distinguish their Yin and Yang attributes. Generally, Yin pathogens entering the body cause cold to gather at the exterior and Qi to accumulate internally, so evil Qi is excess and the body feels cold due to cold; Summerheat pathogens entering the body cause heat to touch the exterior and Qi to be damaged internally, so healthy Qi is fatigued and the body feels hot without cold. This distinguishes summer cold and summerheat, hence mentioned together, not implying all Shang Han patients have cold without heat.) Eating much but having little Qi results from blood loss or dampness residing below. (Eating much indicates Stomach heat digesting food well. Blood loss means loss of Yin; dampness below indicates Spleen/Kidney insufficiency, also Yin deficiency. Yin deficiency leads to lack of Qi, so although eating is abundant, Qi is scarce.) Eating little and having much Qi indicates pathogen in the Stomach and Lung. (Pathogen in Stomach prevents eating, so intake is low; pathogen in Lung causes panting and fullness, so Qi is excessive.) Pulse small but Blood abundant indicates drinking alcohol or fluids with heat. (Pulse small suggests Blood should be deficient yet appears abundant; this must be due to heat in alcohol or drinks stirring it.) Pulse large but Blood deficient indicates Jue with Wind pathogen, and inability to take water or gruel. (Wind is a Yang pathogen residing in vessels, causing large pulse; inability to take fluids means Middle Jiao cannot generate, resulting in deficient Blood.)
Excess refers to Qi entering; deficiency refers to Qi exiting. (The following discusses causes of deficiency/excess/cold/heat to apply tonification/reduction methods. Qi entering fills the interior, constituting excess; Qi exiting leaks from the middle, constituting deficiency.) Qi excess is Heat; Qi deficiency is Cold. (Qi is Yang Qi; excess means Yang excess, thus Heat; deficiency means Yang deficiency, thus Cold.) There is also the saying that Five Excesses and Five Deficiencies lead to death. (Five Excesses refer to excess in the Five Zang; Five Deficiencies refer to deficiency in the Five Zang. If all Five Excesses or all Five Deficiencies are present, death ensues. However, death from extreme Qi deficiency is logically inevitable; why do Five Excesses also cause death? Wherever evil gathers, healthy Qi must be deficient; unless dying through evacuation, it ultimately returns to exhaustion of Qi. Yet deficiency and excess have true and false aspects, requiring careful differentiation.) Pulse surging, skin hot, abdominal distension, obstruction of urination and defecation, mental confusion and blurred vision—this is called "Five Excesses"; (Excess means evil Qi is surging. Surging pulse is governed by Heart; hot skin by Lung; abdominal distension by Spleen; obstruction of front and back relates to Kidney opening at two yin; confusion/blurred vision relates to Liver meridian piercing diaphragm with rebellious Qi in the middle. 'Mao' means unclear vision.) Pulse fine, skin cold, shortness of breath, diarrhea/incontinence of urine and stool, inability to eat—this is called "Five Deficiencies". (Deficiency means healthy Qi is deficient. Fine pulse indicates Heart deficiency; cold skin indicates Lung deficiency; shortness of breath indicates Liver deficiency; diarrhea/incontinence indicates Kidney deficiency; inability to eat indicates Spleen deficiency.) Among these, some survive: if gruel enters the Stomach and diarrhea stops, the deficient patient lives; (Treatment enabling gruel entry revives Spleen Qi gradually; stopping diarrhea consolidates Kidney Qi gradually. Root Qi returns, so deficient patients live.) Sweating occurs, and bowels/bladder open, then the excess patient lives. These are their signs. (Sweating resolves exterior pathogen; bowel/bladder opening eliminates interior pathogen. Interior and exterior harmonize, so excess patients live. Nowadays, few cases are excess; seven or eight out of ten are deficiency. Excess diseases come fast and go fast, so treatment is easy; deficiency injuries are gradual and hard to recover, so treatment is difficult. Excess affects robust individuals with new pathogens, allowing attack and removal; deficiency involves root depletion with sudden changes, warranting caution. Human deficiency stems from congenital insufficiency or acquired insufficiency. Congenital insufficiency arises from endowment, requiring extra caution and urgent postnatal nurturing to prolong life; ignoring it leads to premature death. Acquired insufficiency arises from labor and injury, requiring prompt awareness and regulation via emotion, medicine, and diet; delaying treatment leads to regret. Distinguishing Labor (Lao) and Injury (Shang): Lao damages Shen Qi (Spirit/Qi), such as joy, anger, worry affecting Heart, or sorrow/grief affecting Lung—all damaging Spirit/Qi. Shang damages Form, such as improper diet injuring Spleen, careless living injuring Liver, or sexual excess injuring Kidney—all damaging Form. Damaging Lung injures Qi, causing dry skin and brittle hair; damaging Heart injures Shen, causing scanty Blood failing to nourish Zang organs—this is top-down damage. Damaging Liver injures sinews, causing flaccidity and inability to control; damaging Kidney injures Essence, causing bone marrow depletion and weakness unable to rise—this is bottom-up damage. Damaging Spleen injures the foundation of granaries, causing food not transforming into flesh—this is mid-level damage. Heart/Lung damage ruins spirit and complexion; Liver/Kidney damage ruins form and causes wasting; Spleen/Stomach damage ruins digestion. Diseases of this type belong to the category of "Damage". Although damage divides among Five Zang, what they store is nothing but Essence and Qi. Essence is Yin, human Water; Qi is Yang, human Fire. When Water and Fire are correct, they become Essence and Qi; when imbalanced, they become Heat and Cold. Partial damage leads to partial excess. Thus, Water must contain Fire; without Fire, Yin prevails causing Cold. Fire must contain Water; without Water, Yang prevails causing Heat. Carefully distinguishing Yin and Yang leaves no gaps in treating deficiency-damage. For Water deficiency, greatly tonify True Yin, never again attack Yang Qi; for Fire deficiency, greatly tonify Original Yang, never again injure Yin Qi. Since Yang is already insufficient, attacking Yin further harms Yin; since Yin is already insufficient, attacking Yang further destroys Yang. Excess involves surplus Yin/Yang; removing the surplus restores balance. Deficiency involves lacking Yin/Yang; removing what remains leads to mutual failure, how can life be sustained? Therefore, the key to treating deficiency: for Yin deficiency with much heat, avoid pungent-dry herbs fearing aid to Yang evil; especially avoid bitter-cold fearing destruction of generating Yang Qi; prefer pure-sweet waters-nourishing formulas, tonifying Yin to match Yang, so Yang is controlled by Yin, deficient fire descends, and Yang returns to Yin. For Yang deficiency with much cold, avoid cool-moistening herbs fearing aid to Yin evil; especially avoid pungent-dispersing fearing injury to Yin Qi; use only sweet-warm fire-benefiting substances, tonifying Yang to match Yin, so Yin finds its master, deep cold敛 (conceals), and Yin follows Yang. Thus, Qi deficiency should be treated by tonifying the upper; Essence deficiency by tonifying the lower; Yang deficiency by tonifying with warmth; Yin deficiency by tonifying with clearing. This is the distinction in Yin-Yang treatment. If Qi is deficient due to Essence, naturally tonify Essence to transform Qi; if Essence is deficient due to Qi, naturally tonify Qi to generate Essence. Furthermore, if Yang separates from Yin, how else than tonifying Yin to gather scattered Qi? If Water fails due to Fire, how else than tonifying Fire to rescue sinking Yin? This is the subtle application of Yin-Yang mutual assistance. Therefore, those skilled in tonifying Yang must seek Yang within Yin, so Yang gains Yin's aid and generation is endless; those skilled in tonifying Yin must seek Yin within Yang, so Yin gains Yang's ascent and sources are inexhaustible. Thus, dividing Yin/Yang by Essence/Qi means Yin and Yang cannot separate; dividing by Cold/Heat means Yin and Yang cannot mix. This is the separation and union of Yin/Yang and Evil/Righteous. Knowing the treatment of Yin/Yang and Evil/Righteous leads to harmony of Yin/Yang and attainment of the Dao.)