泾溲不利，水实土虚，则腹胀、飧泄，以肾为寒水之脏，寒水胜土，即谓之肾实，实即有余之谓，是与上编互
明理旨者也。
阴阳气血相倾相并
帝曰∶已闻虚实之形，不知其何以生？岐伯曰∶气血以并，阴阳相倾，气乱于卫，血逆于经，血气离居，
一实一虚。血并于阴，气并于阳，故为惊狂；血并于阳，气并于阴，乃为炅中；血并于上，气并于下，心烦
惋，善怒；血并于下，气并于上，乱而喜忘。
此言阴阳气血相并相倾者也。倾者，偏侧也。偏倾相并，故互有虚实。盖卫主气，营主血，如气乱于卫，
则血不随气循行而逆于营，由是血气各离其本居而相并。气并于血，则血实气虚；血并于气，则血虚气实。血
并于阴经，气并于阳经，则阴阳经络不相通和，发为惊狂之病；血并于阳经，气并于阴经，则阴阳互争，发为
炅中，炅，灼热也；血并走于上焦，气并走于下焦，则心烦惋而善怒，惋，悲恼也；血并于下焦，气并于上焦，
则神乱喜忘，所谓独火乱其神明也。良以阴阳互根互用，以生化气血，故气行则血随，气乱则血逆，气阻则血
瘀，气热则血耗，气寒则血凝，气衰则血少，血少则阴不胜阳而血热，气衰则阳不胜阴而气寒，气旺则血多，
血多则阳不胜阴而血凉，气旺则阴不胜阳而气热。此气血阴阳之衰旺寒热，而又变生诸病者也。
帝曰∶血并于阴，气并于阳，如是血气离居，何者为实？何者为虚？岐伯曰∶血气者，喜温而恶寒，寒则
泣不能流，温则消而去之。是故气之所并为血虚，血之所并为气虚。帝曰∶人之所有者，血与气耳。今言血并
为虚，气并为虚，是无实乎？岐伯曰∶有者为实，无者为虚，故气并则无血，血并则无气，今血气相失，故为
虚焉；络之与孙络，俱输与经，血与气并，则为实焉。
血之与气，并走于上，则为大厥，厥则暴死，气复反则生，不反则死。
寒热者，阴阳之偏气也。阴阳两平，则气血温和，而流行无患。若寒性凝敛，故气血寒则泣而不流，泣者，
涩也，温之则寒消而去，气血方和。如其不和，则必相倾相并，若气并于阳为血虚，血并于阴为气虚，以偏并
一边，即有一实一虚也。盖气血流行于经络，内外相输，循环不已，细者为孙络，络与孙络之气血，俱输于十
二经，以行周身者也。其血与气并走一处，此处即为实焉。故如并走于上则上实，上实则下虚而为大厥，厥则
暴死，气复反则生，不反则死。然其所以相倾相并者，必有外感、内伤之因，要必求其所因而调之。此当与脏
腑门《太阴阳明论》所云更虚更实之理，参合观之。
帝曰∶实者何道从来？虚者何道从去？虚实之要，愿闻其故。岐伯曰∶夫阴与阳，皆有俞会，阳注于阴，
阴满之外，阴阳匀平，以充其形，九候若一，命曰平人。夫邪之生也，或生于阴，或生于阳。其生于阳者，
得之风雨寒暑，其生于阴者，得之饮食居处，阴阳喜怒。
凡病必辨阴阳虚实为纲要。阴阳经络有俞穴交会，气血由之互相贯注，阳经注于阴，阴经满溢，复归于阳，
脉中脉外，营卫脏腑，表里周流，阴阳匀平，以充其形，故其三部九候之脉，若一气所贯而不参差，如是命曰
平人，为无病也。若夫邪之生也，外感风雨寒暑，则必先伤阳分，及久而深入，方伤于阴；若饮食起居，情欲
喜怒，则先伤气血脏腑，为阴分也。此以表里分阴阳，为生病之端也。
外感内伤各分阴阳
帝曰∶风雨之伤人奈何？岐伯曰∶风雨之伤人也，
先客于皮肤，传入于孙络，孙络满，则传入于络脉，络脉满，则输于大经脉，血气与邪，并客于分腠之间，其
脉坚大，故曰实。实者，外坚充满，不可按之，按之则痛。帝曰∶寒湿之伤人奈何？岐伯曰∶寒湿之中人也，
皮肤不收，肌肉坚紧，营血泣，卫气去，故曰虚。虚者，聂辟气不足，按之则气足以温之，故快然而不痛。
此以外邪之阴阳而分虚实也。风为阳邪，故先客皮肤卫分，卫为阳也，入于孙络，而传络脉，然后输于大
经营分血脉之中，则血气与邪并居于分腠之间，其脉坚大，故曰实。实者，以邪结脉中而外坚充满，故不可按，
按之则痛也。若寒湿阴邪所伤者，皮肤弛而不收，以其卫阳不固，阴邪得伤肌肉，而营居肉中，故肌肉坚紧而
营血涩，故曰虚，由阳气虚也。聂辟者，馁乏之状，《灵枢·根结篇》云∶血气枯竭，肠胃聂辟也。此以阴邪
伤阳，按之则阳动，足以温之，故快然而不痛也。
帝曰∶阴之生实奈何？岐伯曰∶喜怒不节，则阴气上逆，上逆则下虚，下虚则阳气走之，故曰实矣。帝
曰∶阴之生虚奈何？岐伯曰∶喜则气下，悲则气消，消则脉空虚，因寒饮食，寒气熏满，则血泣气去，故曰虚矣。
此言内伤之虚实也。喜怒不节，则心志扰动，使阴气上逆而下虚，下虚则阳气走之者，亦从上走也，即前
所云血与气并，故曰实矣。若喜则气下行，悲则气消耗，故脉空虚，因寒饮食之寒气，乘虚熏满于中，则血得
寒而凝涩，阳气因之而去，故曰虚矣。大抵怒则气逆为实，喜与悲则气下消为虚。皆由情志妄动，致阴阳偏倾
而为虚实，下文更详明之。一曰喜则气散，恐则气下，盖气散亦从下泄也。
阳虚外寒 阴虚内热 阳盛外热 阴盛内寒
帝曰∶经言阳虚则外寒，阴虚则内热，阳盛则外热，阴盛则内寒，不知其所由然也。岐伯曰∶阳受气于
上焦，以温皮肤分肉之间，今寒气在外，则上焦不通，上焦不通，则寒气独留于外，故寒 。帝曰∶阴虚生内
热奈何？岐伯曰∶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。帝
曰∶阳盛生外热奈何？岐伯曰∶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。帝
曰∶阴盛生内寒奈何？岐伯曰∶厥气上逆，寒气积于胸中而不泻，不泻则温气去，寒独留，留则血凝涩，凝则
脉不通，其脉盛大以涩，故中寒。
此明阴阳、表里、虚实、寒热之病，统外感、内伤而言也。阳受气于上焦者，言卫阳出于胸中之宗气而行
脉外，以温皮肤分肉之间，今因外感寒气，则上焦阳气不得通行，而寒气独留于外者，是卫阳虚而发寒 ，故
谓之阳虚则外寒也；阴虚生内热者，有所劳倦，致形气衰少，胃中谷气不盛，而清阳不周布于上焦，则浊壅不
降，下脘因之不通，胃气郁而成热，热气熏胸中，是因劳扰耗津液，故谓之阴虚生内热也；阳盛生外热者，以
上焦之气不得通利，致皮肤致密，腠理闭塞，玄府不通，玄府者，毛窍也，以其外邪闭郁，卫阳实而不能泄越，
故谓之阳盛则外热也；阴盛生内寒者，因情志妄动，其气厥逆不顺，而耗伤阳和，其阴寒积于胸中而不泻，
则温气去而寒独留，其血因寒而凝涩，脉者血之府，血凝故脉不通畅而盛大以涩也，此因阳伤而阴浊壅盛，以
成中寒之病，故谓之阴盛则内寒也。盖外寒外热，同是外感之病，如仲景所论，而有阴阳虚实不同也；内热内
寒，同是内伤之
病，如仲景所论，而有伤津液、伤阳和之异也。《内经》举其纲要，而仲景详辨证治，为后学津梁，故仲景云
撰用《素问》者，其所论皆本于《内经》义理也。后学虽悟《内经》义理，而不读仲景之书，必不能善其用，
所以仲景为中古之医圣。近世罕有知仲景之道者，故医风日趋于下矣。
五脏为本
帝曰∶夫子言虚实有十，生于五脏，五脏五脉耳。夫十二经脉，皆生其病，今夫子独言五脏。夫十二经脉
者，皆络三百六十五节，节有病，必被经脉，经脉之病，皆有虚实，何以合之？岐伯曰∶五脏者，故得六腑
与为表里，经络支节，各生虚实，其病所居，随而调之。病在脉，调之血；病在血，调之络；病在气，调之
卫；病在肉，调之分肉；病在筋，调之筋；病在骨，调之骨。
五脏各有虚实，故共有十也。帝即指前所云五有余五不足之言而问，谓五脏止阴经五脉，而阴阳共有十二
经，经皆有络，络有三百六十五节，凡有病必遍被于经络，皆有虚实之分，今独言五脏之虚实，何以合十二经
络、三百六十五节之数乎？岐伯言脏腑经络，本出一源，五脏与六腑为表里，是脏为根，腑为干，经络血脉等
皆枝叶也，则经络支节之病之虚实，总不出五脏之虚实也，故随其病之所居而调之，则一以贯之矣。如病在脉，
调之血者，以脉为血之府，而属于营，血脉，心所主也；病在血，调之络者，以血在络中，故络伤则血溢，
上言脉即经脉，经络血脉，本属一体，以其道路而言，名经络，以其流行而言名血脉也；病在气，调之卫者，
卫气行于脉外而固表，肺所主也，以其昼则行阳二十五度，夜则行阴二十五度，如不循度，为不调也；
病在肉，调之分肉者，肌肉脾所主，统属营卫，故当运脾以通调营卫，其分肉自和矣；病在筋，调之筋者，
筋肝所主也，使肝气血调和，则筋病自愈矣；病在骨，调之骨者，骨肾所主也，使肾脏阴阳充足，精气周流，
则骨病自愈也。是故营卫气血、经络支节、肌肉筋骨之病，总不外乎五脏，审五脏之虚实，而凡病之虚实在
其中矣。
络满经虚 络虚经满
《素问·通评虚实论》又曰∶所谓重实者，言大热病，气热脉满，是谓重实。经络皆实，是寸脉急而尺
缓也，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。络气不足，经气有余
者，脉口热而尺寒也，秋冬为逆，春夏为从。经虚络满者，尺热满，脉口寒涩也，此春夏死，秋冬生也。络满
经虚，灸阴刺阳；经满络虚，刺阴灸阳。
此承上言邪盛为实者，以明脉象而辨证之逆从也。如大热病，气热而脉满，其邪与气血相并，则谓之重实
也。经在营分主血，络在卫分主气，经络皆实，则气血皆受邪，寸脉急强而尺和缓者，以经络皆受邪，营卫之
气上逆也。滑者，气血流利，其邪易解，为从；涩者，邪与气血胶结，难解，为逆也。夫虚实者，阴阳气血偏
倾，皆从其物类而始。如阴邪从于阴，则阴实而阳虚，阳邪从于阳，则阳实而阴虚，阳为卫为气，阴为营为血
也。若无邪伤而阴阳气血和平，周流于五脏骨肉，自然滑利而无瘀涩之病，可以长久而生也。若邪客于经，则
经气有余，络气不足，经为营，营行脉中，故脉口热而现数脉也；络为卫，卫行脉外，络虚，故尺肤寒也。此
所谓从阴阳之类者也。脉口，统指两手寸夫尺之脉，亦名寸口，亦名气口。以脉数知为热，而经有余也；
尺肤不热知为寒，而络不足也。若尺亦以脉言，岂有一脉流行，而分寒热两截者乎？且言络不足，明指卫气之
行脉外者，岂非尺肤乎？若上文滑涩二字，统该脉与尺肤而言，故又言五脏骨肉滑利，可以长久也。其络不足，
经有余者，阴已偏胜，又遇秋冬阴旺，则阳偏绝，故为逆，春夏阳旺得助，故为从也。其经虚络满者，可类推
矣。故络满经虚者，当灸阴补经，刺阳泻络；经满络虚者，当刺阴泻经，灸阳补络，而用药之法亦然矣。
经络营卫皆虚
帝曰∶何谓重虚？岐伯曰∶脉气上虚尺虚，是谓重虚。虚谓气虚者，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。
此承上言精气夺为虚者，以辨脉证也。经络皆虚，谓之重虚，上云气虚者，肺虚也，言其虚无常处也，或
虚在经络，或虚在脏腑，而统曰肺虚，以肺主一身之气故也。今明重虚之义，而经络皆虚，经络皆虚，则阴阳
皆虚，阴阳皆虚，则营卫脏腑俱在其中矣。是故尺肤虚软，则卫虚而络虚，其行步 然者，怯弱之状也；脉虚
者，经虚也，经虚则营血虚，营血为阴，脉本沉静柔和而充满，今其虚也，脉或空大，或强急，不象阴柔之脉
也。凡此重虚者，其脉与尺肤滑者，气血流利，尚可培养而生；如涩者，气血皆枯，并有邪滞，则死矣。此滑
涩二字，与上节同义。上节言从逆，即生死之兆也。
辨生死
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。帝曰∶脉实满，手足寒，头热
何如？岐伯曰∶春秋则生，冬夏则死。脉浮而涩，涩而
身有热者死。
此言精气夺者，中阳无权，阴寒邪气，自内暴逆而上，脉满而实者，大而有力，无柔和之气也。若有滑象，
气血尚活可生，如实而且逆者，现五行相克之真脏脉也，故死。又如脉满实，手足寒，头热者，中无阳和敷布
四肢，其气厥逆直上，故手足寒而头热，是阴阳乖格，不相交通，势将偏亢而偏绝。如春令阳初升，秋令阳初
降，尚可调之使和而生；若冬夏阴阳偏旺之时，以身中之偏，而遇气候之偏，则必偏绝而死也。脉浮者，阳露
于外，阳性流利而反涩者，阳气败矣，阳败而反身热，此精气夺甚，正如残灯余焰，阴阳两竭，故死也。
其形尽满者，脉急大坚，尺涩而不应也，如是者，从则生，逆则死。帝曰∶何谓从逆？岐伯曰∶所谓从者，
手足温也；所谓逆者，手足寒也。
小便不利，水湿泛滥而脾土虚弱，就会出现腹胀、完谷不化的泄泻。这是因为肾为寒水之脏，寒水之气克制脾土，这就叫做“肾实”，所谓“实”就是有余的意思，这与上编相互阐明其道理旨趣。
黄帝说：我已经了解了虚实的表现形态，不知道它们是如何产生的？岐伯说：气与血相并，阴阳相互偏倾，气在卫分紊乱，血在经脉中逆乱，血和气分离居所，导致一处实、一处虚。如果血并入阴分，气并入阳分，就会发生惊狂；如果血并入阳分，气并入阴分，就会产生灼热感于中焦；如果血并聚于上部，气并聚于下部，就会心烦意乱、易怒；如果血并聚于下部，气并聚于上部，就会神志错乱、喜欢遗忘。
这段话讲的是阴阳气血相互偏倾、相并的情况。“倾”就是偏侧的意思。偏倾且相并，所以互有虚实。大概卫气主司气，营血主司血，如果气在卫分紊乱，那么血就不随气循行而逆乱于营分，由此血和气各自离开原本的位置而相并。气并入血，则血实气虚；血并入气，则血虚气实。血并入阴经，气并入阳经，则阴阳经络不相通调和，发为惊狂的病证；血并入阳经，气并入阴经，则阴阳互相争斗，发为炅中（灼热），炅，就是灼热的意思；血并走于上焦，气并走于下焦，就会心烦悲恼且易怒，惋，就是悲恼的意思；血并聚于下焦，气并聚于上焦，就会神志混乱、喜忘，这就是所谓的独火扰乱了神明。大抵因为阴阳互根互用，以化生气血，所以气行则血随，气乱则血逆，气阻则血瘀，气热则血耗，气寒则血凝，气衰则血少，血少则阴不能胜阳而血热，气衰则阳不能胜阴而气寒，气旺则血多，血多则阳不能胜阴而血凉，气旺则阴不能胜阳而气热。这是气血阴阳的盛衰寒热，进而变生各种疾病的原因。
黄帝说：血并入阴分，气并入阳分，像这样血气分离居所，哪一个是实？哪一个是虚？岐伯说：血和气，喜欢温暖而厌恶寒冷，寒冷则血液凝涩不能流动，温暖则凝滞消散而去。因此，气所并的地方血就虚，血所并的地方气就虚。黄帝说：人所拥有的，不过是血与气罢了。现在说血并为虚，气并为虚，难道就没有实了吗？岐伯说：有的就是实，没有的就是虚，所以气并则无血，血并则无气，现在血气相互失守，所以称为虚；但是络脉和孙络都输送气血到经脉，如果血与气相并，那就是实了。
血与气，一起向上走，就会发生大厥，厥证会导致突然死亡，如果气能回复下行则生，不能回复则死。
寒和热，是阴阳的偏盛之气。阴阳平衡，则气血温和，流行而没有祸患。如果寒性凝敛，所以气血受寒则凝涩而不流，泣，就是涩的意思，温暖它则寒邪消去，气血才能调和。如果不调和，就一定会相互偏倾相并，比如气并入阳导致血虚，血并入阴导致气虚，因为偏并于一边，就有一实一虚的情况。大概气血在经络中流行，内外输注，循环不已，细小的叫孙络，络脉和孙络的气血，都输送到十二经脉，以运行周身。如果血与气并聚在一处，这一处就为实。所以如果并聚于上，则上实，上实则下虚而发生大厥，厥证导致突然死亡，气能回复则生，不能回复则死。然而之所以会相互偏倾相并，必定有外感、内伤的原因，一定要探求其原因来调理。这应当与脏腑门《太阴阳明论》中所说的更虚更实的道理，参合观察。
黄帝说：实证是从什么途径来的？虚证是从什么途径去的？虚实的要领，希望听听其中的缘故。岐伯说：阴与阳，都有腧穴交会，阳气注入阴分，阴气满溢之外，阴阳匀平，以充实形体，三部九候的脉象一致，这叫作平人。邪气的产生，有的生于阴，有的生于阳。生于阳的，得之于风雨寒暑；生于阴的，得之于饮食居处、阴阳喜怒（情志）。
凡是疾病必须辨别阴阳虚实作为纲要。阴阳经络有腧穴交会，气血由之互相贯注，阳经注入阴经，阴经满溢，又归于阳经，脉中脉外，营卫脏腑，表里周流，阴阳匀平，以充实形体，所以其三部九候的脉象，若一气贯通而不参差，这样叫作平人，是无病的人。至于邪气的产生，外感风雨寒暑，则先伤阳分，等到久了深入，才伤于阴；如果是饮食起居、情欲喜怒，则先伤气血脏腑，属于阴分。这是以表里分阴阳，作为生病的开端。
外感内伤各分阴阳
黄帝说：风雨伤害人体是怎样的？岐伯说：风雨伤害人，先客居于皮肤，传入孙络，孙络满了，则传入络脉，络脉满了，则输注到大经脉，血气与邪气，一起客居于分腠之间，其脉坚大，所以叫作实。实，就是外表坚硬充满，不可按压，按压则痛。黄帝说：寒湿伤害人体是怎样的？岐伯说：寒湿中人，皮肤松弛不收，肌肉坚紧，营血凝涩，卫气离去，所以叫作虚。虚，就是聂辟（馁乏）气不足，按压则气足以温之，所以舒适而不痛。
这是以外邪的阴阳来分虚实。风为阳邪，所以先客居于皮肤卫分，卫为阳也，进入孙络，而传至络脉，然后输注于大经营分血脉之中，则血气与邪气并居于分腠之间，其脉坚大，所以叫作实。实，是因为邪结在脉中而外表坚硬充满，所以不可按压，按压则痛。如果是寒湿阴邪所伤，皮肤弛缓而不收，因为卫阳不固，阴邪得以伤及肌肉，而营血居于肉中，所以肌肉坚紧而营血涩，所以叫作虚，这是由于阳气虚。聂辟，是馁乏的样子，《灵枢·根结篇》说：血气枯竭，肠胃聂辟。这是以阴邪伤阳，按压则阳动，足以温之，所以舒适而不痛。
黄帝说：阴分产生实证是怎样的？岐伯说：喜怒不节制，则阴气上逆，上逆则下虚，下虚则阳气走之，所以叫作实了。黄帝说：阴分产生虚证是怎样的？岐伯说：喜则气下，悲则气消，消则脉空虚，因寒饮食，寒气熏满，则血泣气去，所以叫作虚了。
这是讲内伤的虚实。喜怒不节制，则心志扰动，使阴气上逆而下虚，下虚则阳气走之者，也是从上走也，即前面所说的血与气并，所以叫作实了。如果喜则气下行，悲则气消耗，所以脉空虚，因寒饮食的寒气，乘虚熏满于中，则血得寒而凝涩，阳气因之而去，所以叫作虚了。大抵怒则气逆为实，喜与悲则气下消为虚。皆由情志妄动，致阴阳偏倾而为虚实，下文更详细明白地阐述。一说喜则气散，恐则气下，盖气散也从下泄也。
黄帝说：经文说阳虚则外寒，阴虚则内热，阳盛则外热，阴盛则内寒，不知道其中的原因。岐伯说：阳受气于上焦，以温煦皮肤分肉之间，现在寒气在外，则上焦不通，上焦不通，则寒气独留于外，所以寒栗。黄帝说：阴虚生内热是怎样的？岐伯说：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，所以内热。黄帝说：阳盛生外热是怎样的？岐伯说：上焦不通利，则皮肤致密，腠理闭塞，玄府不通，卫气不得泄越，所以外热。黄帝说：阴盛生内寒是怎样的？岐伯说：厥气上逆，寒气积于胸中而不泻，不泻则温气去，寒独留，留则血凝涩，凝则脉不通，其脉盛大以涩，所以中寒。
这里阐明阴阳、表里、虚实、寒热的病，统括外感、内伤而言。阳受气于上焦，是说卫阳出于胸中之宗气而行于脉外，以温煦皮肤分肉之间，现在因为外感寒气，则上焦阳气不得通行，而寒气独留于外者，是卫阳虚而发寒栗，所以叫作阳虚则外寒；阴虚生内热，是有所劳倦，致使形气衰少，胃中谷气不盛，而清阳不周布于上焦，则浊壅不降，下脘因之不通，胃气郁而成热，热气熏胸中，是因劳扰耗津液，所以叫作阴虚生内热；阳盛生外热，是因为上焦之气不得通利，致使皮肤致密，腠理闭塞，玄府不通，玄府者，毛窍也，因为外邪闭郁，卫阳实而不能泄越，所以叫作阳盛则外热；阴盛生内寒，是因为情志妄动，其气厥逆不顺，而耗伤阳和，其阴寒积于胸中而不泻，则温气去而寒独留，其血因寒而凝涩，脉者血之府，血凝故脉不通畅而盛大以涩也，这是因阳伤而阴浊壅盛，以成中寒之病，所以叫作阴盛则内寒。大概外寒外热，同是外感的病，如仲景所论述，而有阴阳虚实不同；内热内寒，同是内伤的病，如仲景所论述，而有伤津液、伤阳和的差异。《内经》举其纲要，而仲景详细辨证治疗，为后学津梁，所以仲景说撰用《素问》，其所论述都本于《内经》义理。后学虽然领悟《内经》义理，而不读仲景之书，一定不能善用，所以仲景是中古的医圣。近世很少有人知道仲景之道，所以医风日益趋于低下。
五脏为本
黄帝说：先生讲虚实有十种，生于五脏，五脏五脉而已。那十二经脉，都产生其病，现在先生只讲五脏。那十二经脉，都联络三百六十五节，节有病，必波及经脉，经脉的病，都有虚实，怎么合起来看？岐伯说：五脏，本来与六腑互为表里，经络支节，各生虚实，病所在的位置，随之调理。病在脉，调之血；病在血，调之络；病在气，调之卫；病在肉，调之分肉；病在筋，调之筋；病在骨，调之骨。
五脏各有虚实，所以共有十种。黄帝是指前面所说的五有余五不足的话而问，谓五脏止有阴经五脉，而阴阳共有十二经，经皆有络，络有三百六十五节，凡有病必遍被于经络，皆有虚实之分，现在只讲五脏的虚实，怎么合十二经络、三百六十五节的数呢？岐伯言脏腑经络，本出一源，五脏与六腑为表里，是脏为根，腑为干，经络血脉等都像枝叶，则经络支节的病的虚实，总不出五脏的虚实，所以随其病之所居而调之，则一以贯之了。如病在脉，调之血的，因为脉为血之府，而属于营，血脉，心所主也；病在血，调之络的，因为血在络中，故络伤则血溢，上面说的脉即经脉，经络血脉，本属一体，以其道路而言，名经络，以其流行而言名血脉；病在气，调之卫的，卫气行于脉外而固表，肺所主也，因为它昼则行阳二十五度，夜则行阴二十五度，如不循度，为不调；病在肉，调之分肉的，肌肉脾所主，统属营卫，故当运脾以通调营卫，其分肉自和矣；病在筋，调之筋的，筋肝所主也，使肝气血调和，则筋病自愈矣；病在骨，调之骨的，骨肾所主也，使肾脏阴阳充足，精气周流，则骨病自愈也。所以营卫气血、经络支节、肌肉筋骨之病，总不外乎五脏，审察五脏的虚实，而凡病的虚实就在其中了。
络满经虚 络虚经满
《素问·通评虚实论》又说：所谓重实，是说大热病，气热脉满，这叫重实。经络皆实，是寸脉急而尺缓也，滑则顺，涩则逆。夫虚实，都从其物类开始，所以五脏骨肉滑利，可以长久。络气不足，经气有余的，脉口热而尺寒也，秋冬为逆，春夏为从。经虚络满的，尺热满，脉口寒涩也，此春夏死，秋冬生。络满经虚，灸阴刺阳；经满络虚，刺阴灸阳。
这里承接上文说邪盛为实者，以明脉象而辨证之逆从。如大热病，气热而脉满，其邪与气血相并，则叫作重实。经在营分主血，络在卫分主气，经络皆实，则气血皆受邪，寸脉急强而尺和缓者，因为经络皆受邪，营卫之气上逆。滑者，气血流利，其邪易解，为顺；涩者，邪与气血胶结，难解，为逆。夫虚实，是阴阳气血偏倾，皆从其物类而始。如阴邪从于阴，则阴实而阳虚，阳邪从于阳，则阳实而阴虚，阳为卫为气，阴为营为血。若无邪伤而阴阳气血和平，周流于五脏骨肉，自然滑利而无瘀涩之病，可以长久而生。若邪客于经，则经气有余，络气不足，经为营，营行脉中，故脉口热而现数脉；络为卫，卫行脉外，络虚，故尺肤寒。这叫作从阴阳之类。脉口，统指两手寸尺之脉，亦名寸口，亦名气口。以脉数知为热，而经有余；尺肤不热知为寒，而络不足。若尺也以脉言，岂有一脉流行，而分寒热两截者？且言络不足，明指卫气之行脉外者，岂非尺肤？若上文滑涩二字，统该脉与尺肤而言，故又言五脏骨肉滑利，可以长久。其络不足，经有余，阴已偏胜，又遇秋冬阴旺，则阳偏绝，故为逆，春夏阳旺得助，故为从。其经虚络满，可类推。故络满经虚，当灸阴补经，刺阳泻络；经满络虚，当刺阴泻经，灸阳补络，而用药之法亦然。
经络营卫皆虚
黄帝说：什么叫重虚？岐伯说：脉气上虚尺虚，叫作重虚。虚谓气虚，言无常也。尺虚，行步跛然；脉虚，不象阴也。如此者，滑则生，涩则死。
这里承接上文说精气夺为虚者，以辨脉证。经络皆虚，叫作重虚，上面说气虚，是肺虚，言其虚无常处，或虚在经络，或虚在脏腑，而统曰肺虚，以肺主一身之气。今明重虚之义，而经络皆虚，经络皆虚，则阴阳皆虚，阴阳皆虚，则营卫脏腑俱在其中。是故尺肤虚软，则卫虚而络虚，其行步跛然者，怯弱之状；脉虚，是经虚，经虚则营血虚，营血为阴，脉本沉静柔和而充满，今其虚，脉或空大，或强急，不象阴柔之脉。凡此重虚，其脉与尺肤滑者，气血流利，尚可培养而生；如涩者，气血皆枯，并有邪滞，则死。此滑涩二字，与上节同义。上节言从逆，即生死之兆。
辨生死
黄帝说：寒气暴上，脉满而实，怎样？岐伯说：实而滑则生，实而逆则死。黄帝说：脉实满，手足寒，头热，怎样？岐伯说：春秋则生，冬夏则死。脉浮而涩，涩而身有热者死。
这里说精气夺者，中阳无权，阴寒邪气，自内暴逆而上，脉满而实，大而有力，无柔和之气。若有滑象，气血尚活可生，如实而且逆，现五行相克之真脏脉，故死。又如脉满实，手足寒，头热，中无阳和敷布四肢，其气厥逆直上，故手足寒而头热，是阴阳乖格，不相交通，势将偏亢而偏绝。如春令阳初升，秋令阳初降，尚可调之使和而生；若冬夏阴阳偏旺之时，以身中之偏，而遇气候之偏，则必偏绝而死。脉浮，阳露于外，阳性流利而反涩，阳气败矣，阳败而反身热，此精气夺甚，正如残灯余焰，阴阳两竭，故死。
Urination is difficult, water-dampness overflows while Spleen Earth is deficient, leading to abdominal distension and undigested food diarrhea. This is because the Kidney is the Zang organ of Cold Water; when Cold Water overwhelms Earth, it is called "Kidney Excess." "Excess" here means surplus, which clarifies the principles alongside the previous section.
Yin-Yang, Qi, and Blood Interacting through Tilting and Merging
The Yellow Emperor said: I have heard of the forms of Deficiency and Excess, but do not know how they arise. Qibo replied: When Qi and Blood merge, and Yin-Yang tilt against each other, Qi becomes chaotic in the Wei (Defensive) level, and Blood rebels in the meridians. Qi and Blood separate from their original residences, resulting in one area being Excess and another Deficient. If Blood merges into Yin and Qi merges into Yang, it leads to fright and mania; if Blood merges into Yang and Qi merges into Yin, it results in internal burning heat; if Blood gathers in the upper part and Qi gathers in the lower part, it causes vexation, sorrow, and irritability; if Blood gathers in the lower part and Qi gathers in the upper part, it leads to confusion and forgetfulness.
This passage discusses the tilting and merging of Yin-Yang, Qi, and Blood. "Tilting" refers to deviation or bias. Due to this biased merging, there is mutual presence of Excess and Deficiency. Generally, Wei Qi governs Qi, and Ying (Nutritive) Blood governs Blood. If Qi is chaotic in the Wei level, Blood will not follow Qi's circulation and will rebel in the Ying level. Consequently, Qi and Blood depart from their natural residences and merge. When Qi merges with Blood, Blood becomes Excess and Qi becomes Deficient; when Blood merges with Qi, Blood becomes Deficient and Qi becomes Excess. If Blood merges into Yin meridians and Qi merges into Yang meridians, the Yin and Yang meridians lose harmony, leading to disorders like fright and mania. If Blood merges into Yang meridians and Qi merges into Yin meridians, Yin and Yang contend, causing "Jiong Zhong" (internal burning heat); "Jiong" means scorching heat. If Blood rushes to the Upper Jiao and Qi rushes to the Lower Jiao, it causes vexation, sorrow, and anger; "Wan" means sorrowful distress. If Blood gathers in the Lower Jiao and Qi gathers in the Upper Jiao, it causes mental confusion and forgetfulness, described as a solitary fire disturbing the Spirit. Fundamentally, Yin and Yang are mutually rooted and used to generate Qi and Blood. Thus, when Qi moves, Blood follows; when Qi is chaotic, Blood rebels; when Qi is obstructed, Blood stasis occurs; when Qi is hot, Blood is consumed; when Qi is cold, Blood coagulates; when Qi declines, Blood diminishes. When Blood is insufficient, Yin cannot overcome Yang, leading to Blood heat; when Qi declines, Yang cannot overcome Yin, leading to Qi cold. When Qi is vigorous, Blood is abundant; when Blood is abundant, Yang cannot overcome Yin, leading to cool Blood; when Qi is vigorous, Yin cannot overcome Yang, leading to hot Qi. These fluctuations in the prosperity, decline, cold, and heat of Qi, Blood, Yin, and Yang give rise to various diseases.
The Yellow Emperor asked: If Blood merges into Yin and Qi merges into Yang, and thus Qi and Blood separate from their residences, which is Excess and which is Deficient? Qibo answered: Qi and Blood prefer warmth and dislike cold. Cold causes them to congeal and fail to flow, while warmth dissipates the congestion. Therefore, where Qi merges, Blood is Deficient; where Blood merges, Qi is Deficient. The Yellow Emperor asked: What humans possess is merely Blood and Qi. Now you say that merging of Blood leads to Deficiency, and merging of Qi leads to Deficiency. Is there no Excess? Qibo replied: That which is present is Excess; that which is absent is Deficient. Thus, where Qi merges, Blood is absent; where Blood merges, Qi is absent. Since Qi and Blood have lost each other, it is considered Deficiency. However, Luo (Collateral) vessels and Sun-Luo (Sun-Collateral) vessels all transport Qi and Blood to the main meridians. If Blood and Qi merge together, it constitutes Excess.
If Blood and Qi both rush upward, it results in Da Jue (Great Revulsion), which can cause sudden death. If Qi returns downward, life is preserved; if it does not return, death ensues.
Cold and Heat are the biased energies of Yin and Yang. When Yin and Yang are balanced, Qi and Blood are mild and circulate without harm. If Cold causes condensation and contraction, Qi and Blood become sluggish and cease to flow. "Qi" (congealing/sluggishness) means friction; warming resolves the cold, allowing Qi and Blood to harmonize. If they do not harmonize, they will tilt and merge. For instance, Qi merging into Yang causes Blood Deficiency, and Blood merging into Yin causes Qi Deficiency, creating one Excess and one Deficiency due to the bias on one side. Qi and Blood circulate in the meridians, exchanging internally and externally in an endless cycle. The finest branches are Sun-Luos. The Qi and Blood in Luo and Sun-Luo vessels are transported to the Twelve Main Meridians to nourish the whole body. Wherever Blood and Qi merge, that location becomes Excess. Thus, if they merge upward, the Upper Jiao becomes Excess and the Lower Jiao becomes Deficient, leading to Great Revulsion and sudden death. If Qi returns, life is saved; otherwise, death occurs. However, such tilting and merging must stem from external invasions or internal injuries, and treatment must address the root cause. This should be studied in conjunction with the principles of alternating Deficiency and Excess discussed in the *Taiyin Yangming Lun* chapter of the Zang-Fu section.
The Yellow Emperor asked: From what path does Excess come? From what path does Deficiency go? I wish to hear the rationale behind the essentials of Deficiency and Excess. Qibo replied: Yin and Yang both have Shu (Transport) and Hui (Meeting) acupoints. Yang Qi flows into Yin, and Yin fills outward. When Yin and Yang are even and balanced, they fill the form, and the pulses at the nine positions are uniform; this is called a Healthy Person. Pathogens arise either from Yin or from Yang. Those arising from Yang result from wind, rain, cold, and summer-heat. Those arising from Yin result from diet, lifestyle, and emotional extremes (joy, anger).
All diseases must be differentiated by Yin-Yang and Deficiency-Excess as the primary guidelines. Yin-Yang meridians have intersecting acupoints where Qi and Blood interpenetrate. Yang meridians inject into Yin, Yin meridians overflow back to Yang. Inside and outside the vessels, Ying and Wei, Zang and Fu, circulate superficially and deeply. When Yin and Yang are balanced and fill the form, the pulses at the three regions and nine positions appear unified without discrepancy, defining a Healthy Person free of disease. Regarding the origin of pathogens: external invasion by wind, rain, cold, and summer-heat first injures the Yang aspect; only after prolonged penetration does it injure Yin. Conversely, improper diet, lifestyle, and emotional disturbances (joy, anger) first injure Qi, Blood, Zang, and Fu, belonging to the Yin aspect. This uses the exterior-interior distinction to define Yin-Yang as the beginning of disease.
External Invasions and Internal Injuries Differentiated by Yin-Yang
The Yellow Emperor asked: How do wind and rain injure the human body? Qibo replied: Wind and rain first lodge in the skin, then transmit to the Sun-Luo vessels. When Sun-Luos are full, they transmit to Luo vessels. When Luo vessels are full, they transport to the large meridians. Qi, Blood, and pathogens gather between the muscle intervals (Feng Cou). The pulse becomes firm and large, hence termed Excess. Excess means the exterior is firm and full; pressing causes pain. The Yellow Emperor asked: How do cold and dampness injure the body? Qibo replied: Cold and dampness cause the skin to relax and fail to contract, muscles to become tight, Ying Blood to congeal, and Wei Qi to depart. Hence, it is termed Deficiency. Deficiency means a state of weakness and Qi insufficiency; pressing provides Qi to warm the area, bringing comfort and relieving pain.
This differentiates Excess and Deficiency based on the Yin-Yang nature of external pathogens. Wind is a Yang pathogen, so it first lodges in the skin and Wei level (Yang). It enters Sun-Luos, transmits to Luo vessels, and then to the large meridians' Ying level and blood vessels. There, Qi and Blood merge with pathogens in the Feng Cou, making the pulse firm and large, hence Excess. Because pathogens knot in the vessels, the exterior feels firm and full, causing pain upon pressure. If injured by Cold-Damp (Yin pathogens), the skin relaxes due to insecure Wei Yang. Yin pathogens injure muscles where Ying Blood resides, causing tight muscles and sluggish Ying Blood, hence Deficiency due to Yang Qi deficiency. "Nie Pi" describes a state of depletion, as stated in the *Lingshu: Genjie Chapter*: "When Qi and Blood are exhausted, the intestines and stomach are depleted." Here, Yin pathogens injure Yang; pressing stimulates Yang movement to provide warmth, resulting in comfort without pain.
The Yellow Emperor asked: How does Yin generate Excess? Qibo replied: Unregulated joy and anger cause Yin Qi to reverse upward. Upward reversal leads to Lower Deficiency. When the Lower is Deficient, Yang Qi rushes to fill the void, resulting in Excess. The Yellow Emperor asked: How does Yin generate Deficiency? Qibo replied: Joy causes Qi to sink; grief causes Qi to dissipate. Dissipation leaves the vessels empty. If combined with cold food and drink, cold qi fills the interior, causing Blood to congeal and Qi to depart, resulting in Deficiency.
This explains internal injury-induced Deficiency and Excess. Unregulated emotions disturb the Heart Mind, causing Yin Qi to reverse upward and the Lower Jiao to become Deficient. As Yang Qi rushes to fill this void (also moving upward), it mirrors the earlier concept of Qi and Blood merging, hence termed Excess. Joy causes Qi to descend, grief causes Qi to consume, leaving vessels empty. Cold from diet fills the interior vacuity, causing Blood to congeal and Qi to depart, hence Deficiency. Generally, Anger causes Qi reversal (Excess), while Joy and Grief cause Qi sinking/dissipation (Deficiency). All result from emotional excess disrupting Yin-Yang balance, leading to Deficiency and Excess, as detailed later. One view states Joy scatters Qi, Fear sinks Qi; scattering also involves downward leakage.
Yang Deficiency Causes Exterior Cold; Yin Deficiency Causes Interior Heat; Yang Excess Causes Exterior Heat; Yin Excess Causes Interior Cold
The Yellow Emperor asked: The classics state that Yang Deficiency causes exterior cold, Yin Deficiency causes interior heat, Yang Excess causes exterior heat, and Yin Excess causes interior cold. I do not understand the mechanism. Qibo replied: Yang receives Qi from the Upper Jiao to warm the skin and muscle intervals. Now, if cold pathogenic factors remain outside, the Upper Jiao becomes blocked. Blockage prevents Yang Qi from circulating, leaving cold to linger exclusively on the exterior, causing chills. This is why Yang Deficiency leads to exterior cold. The Yellow Emperor asked: How does Yin Deficiency generate interior heat? Qibo replied: Fatigue deforms Qi and reduces vitality. Grain Qi becomes insufficient. The Upper Jiao fails to function, and the Lower Wan (stomach outlet) becomes obstructed. Stomach Qi generates heat, which steams the chest, causing interior heat. The Yellow Emperor asked: How does Yang Excess generate exterior heat? Qibo replied: If the Upper Jiao is not smooth, the skin becomes dense, pores close, and the Xuan Fu (pores) block. Wei Qi cannot vent, causing exterior heat. The Yellow Emperor asked: How does Yin Excess generate interior cold? Qibo replied: Rebellious Qi rises, and cold accumulates in the chest without dispersing. Without dispersion, warming Qi departs, leaving cold alone. Cold causes Blood to congeal and stagnate, blocking the vessels. The pulse becomes large and choppy, indicating interior cold.
This clarifies diseases of Yin-Yang, exterior-interior, Deficiency-Excess, and cold-heat, covering both external invasions and internal injuries. "Yang receives Qi from the Upper Jiao" refers to Wei Yang emerging from Zong Qi in the chest to circulate outside the vessels and warm the skin and muscles. External cold blocks Upper Jiao Yang Qi, leaving cold on the exterior; this is Wei Yang Deficiency causing chills, hence "Yang Deficiency causes exterior cold." "Yin Deficiency generates interior heat" results from fatigue depleting form and Qi, reducing Grain Qi. Clear Yang fails to distribute to the Upper Jiao, causing turbid stagnation and obstruction of the Lower Wan. Stomach Qi stagnates and generates heat, steaming the chest due to fluid consumption from labor, hence "Yin Deficiency generates interior heat." "Yang Excess generates exterior heat" occurs because Upper Jiao Qi is obstructed, making skin dense and pores closed. External pathogens trap Wei Yang, preventing venting, hence "Yang Excess causes exterior heat." "Yin Excess generates interior cold" stems from emotional disturbance causing Qi rebellion and damaging Yang harmony. Yin-cold accumulates in the chest and does not disperse, driving away warming Qi and leaving cold alone. Blood congeals due to cold; since vessels are the residence of Blood, congestion makes the pulse large and choppy. This is Yang damage leading to Yin-turbidity excess, forming interior cold, hence "Yin Excess causes interior cold." Exterior cold/heat are external invasions with varying Yin-Yang/Deficiency-Excess patterns as discussed by Zhang Zhongjing. Interior heat/cold are internal injuries differing in whether they injure fluids or Yang harmony. The *Neijing* provides the outline, while Zhang Zhongjing details syndrome differentiation and treatment, serving as a bridge for students. Zhang stated he used the *Suwen*; his theories are based on *Neijing* principles. Students who grasp *Neijing* theory but ignore Zhang’s works cannot apply them effectively, making Zhang the Sage of Medicine of the Middle Antiquity. Few today understand Zhang’s Way, causing medical standards to decline.
Five Zang Organs as the Root
The Yellow Emperor asked: You mentioned ten types of Deficiency and Excess originating from the Five Zang organs and their five pulses. Yet all twelve meridians produce diseases. Why do you speak only of the Five Zang? The twelve meridians connect to 365 joints. Joint diseases affect meridians, which have Deficiency and Excess. How do these align? Qibo replied: The Five Zang are inherently linked to the Six Fu organs as interior-exterior pairs. Meridians, collaterals, and joints each develop Deficiency and Excess. Treatment follows the location of the disease. Disease in the vessels: regulate Blood. Disease in Blood: regulate Collaterals. Disease in Qi: regulate Wei. Disease in flesh: regulate muscle spaces. Disease in sinews: regulate sinews. Disease in bones: regulate bones.
Each Zang has Deficiency and Excess, totaling ten cases. The Emperor referred to the earlier "five Excesses and five Deficiencies," questioning how the five Yin meridians of the Zang relate to the twelve Yin-Yang meridians, their collaterals, and 365 joints, all subject to Deficiency-Excess differentiation. Qibo explained that Zang-Fu and meridians share a common source. Zang and Fu are interior-exterior; Zang is the root, Fu is the trunk, and meridians/blood vessels are branches. Thus, Deficiency-Excess in meridians and joints ultimately reflects Zang Deficiency-Excess. Treatment targets the specific location. For vessel disease, regulating Blood works because vessels are the residence of Blood, associated with Ying, governed by the Heart. For Blood disease, regulating Collaterals works because Blood resides in collaterals; collateral injury causes bleeding. "Vessels" here refers to main meridians; meridians and blood vessels are one entity, named differently based on pathway vs. flow. For Qi disease, regulating Wei works because Wei Qi circulates outside vessels to secure the exterior, governed by the Lung. It travels 25 cycles in Yang during the day and 25 in Yin at night; deviation indicates disharmony. For flesh disease, regulating muscle spaces works because muscles are governed by the Spleen, encompassing Ying and Wei; strengthening the Spleen harmonizes Ying and Wei, soothing muscle spaces. For sinew disease, regulating sinews works because sinews are governed by the Liver; harmonizing Liver Qi and Blood heals sinew disorders. For bone disease, regulating bones works because bones are governed by the Kidney; sufficient Kidney Yin-Yang and circulating Essence heal bone disorders. Thus, disorders of Ying-Wei-Qi, meridians-joints, and muscles-sinews-bones all stem from the Five Zang. Examining Zang Deficiency-Excess reveals the Deficiency-Excess of all diseases.
Full Collaterals, Empty Meridians; Empty Collaterals, Full Meridians
The *Suwen: Tongping Xu Shi Lun* states: "Chong Shi" (Double Excess) refers to severe heat diseases where Qi is hot and pulses are full. If both meridians and collaterals are Excess, the Cun pulse is rapid/tight while the Chi pulse is slow/relaxed. Smoothness indicates favorable prognosis; choppy indicates unfavorable. Deficiency and Excess originate from their respective categories. If the Five Zang and bones/flesh are smooth and agile, longevity is possible. If Collateral Qi is Deficient and Meridian Qi is Excess, the Mai Kou (pulse at wrist) is hot while Chi skin is cold. This is unfavorable in Autumn/Winter but favorable in Spring/Summer. If Meridians are Deficient and Collaterals are Full, Chi is hot/full while Mai Kou is cold/choppy. This is fatal in Spring/Summer but survivable in Autumn/Winter. For Full Collaterals/Empty Meridians: moisturize Yin, puncture Yang. For Empty Collaterals/Full Meridians: puncture Yin, moisturize Yang.
This continues the discussion on pathogen excess causing Excess, using pulse signs to differentiate favorable/unfavorable outcomes. In severe heat, Qi is hot and pulses full, meaning pathogens merge with Qi and Blood, termed Double Excess. Meridians belong to Ying/Blood; Collaterals belong to Wei/Qi. If both are Excess, both Qi and Blood are affected. Rapid Cun and relaxed Chi indicate rebellious Ying-Wei Qi. Smoothness implies fluid Qi and Blood, allowing easy pathogen resolution (favorable). Choppyness implies pathogens stuck with Qi and Blood, hard to resolve (unfavorable). Deficiency/Excess arise from Yin-Yang/Qi-Blood bias following their categories. Yin pathogens cause Yin Excess/Yang Deficiency; Yang pathogens cause Yang Excess/Yin Deficiency. Yang is Wei/Qi; Yin is Ying/Blood. Without pathogens, balanced Yin-Yang/Qi-Blood circulates smoothly in Zang and bones/flesh, ensuring longevity. If pathogens invade Meridians, Meridian Qi is Excess, Collateral Qi is Deficient. Meridians are Ying, flowing inside vessels, causing hot/rapid Mai Kou pulses. Collaterals are Wei, flowing outside vessels; Collateral Deficiency causes cold Chi skin. This follows Yin-Yang categorization. "Mai Kou" generally refers to Cun-Chi pulses at the wrist, also called Cun Kou or Qi Kou. Rapid pulse indicates heat and Meridian Excess. Cold Chi skin indicates cold and Collateral Deficiency. If "Chi" referred only to pulse, it would be illogical to have one pulse showing both hot and cold. "Collateral Deficiency" clearly points to Wei Qi outside vessels, i.e., Chi skin. "Smooth/Choppy" applies to both pulse and Chi skin, explaining why smooth Zang/bones ensure longevity. For Collateral Deficiency/Meridian Excess, Yin is already dominant; encountering Autumn/Winter (Yin prosperous) leads to Yang extremity (unfavorable). Spring/Summer (Yang prosperous) aids recovery (favorable). Meridian Deficiency/Collateral Fullness can be inferred similarly. Thus, for Full Collaterals/Empty Meridians, moisten Yin to tonify Meridians, puncture Yang to drain Collaterals. For Empty Collaterals/Full Meridians, puncture Yin to drain Meridians, moisten Yang to tonify Collaterals. Medicinal methods follow the same logic.
Deficiency of Meridians, Collaterals, Ying, and Wei
The Yellow Emperor asked: What is Chong Xu (Double Deficiency)? Qibo replied: When both the upper pulse and Chi region show Deficiency, it is Double Deficiency. "Qi Deficiency" means variability in presentation. "Chi Deficiency" manifests as unsteady gait. "Pulse Deficiency" lacks the characteristics of Yin. In such cases, smoothness indicates survival; choppyness indicates death.
This follows the statement that "exhaustion of Essence-Qi is Deficiency," differentiating pulse and symptoms. Deficiency of both meridians and collaterals is Double Deficiency. Earlier "Qi Deficiency" referred to Lung Deficiency, as the Lung governs all Qi, so deficiency may appear anywhere in meridians or Zang-Fu. Clarifying Double Deficiency: if meridians and collaterals are both Deficient, then Yin and Yang are both Deficient, encompassing Ying, Wei, Zang, and Fu. Soft Chi skin indicates Wei and Collateral Deficiency; unsteady gait shows weakness. Pulse Deficiency indicates Meridian Deficiency, leading to Ying-Blood Deficiency. Ying-Blood is Yin; normally pulses are calm, soft, and full. In Deficiency, pulses may be hollow/large or rigid/tense, lacking the soft Yin character. In Double Deficiency, if pulse and Chi skin are smooth, Qi and Blood are still fluid, allowing recovery through nourishment. If choppy, Qi and Blood are exhausted with pathogenic stagnation, leading to death. "Smooth/Choppy" here shares the meaning of the previous section: favorable/unfavorable signs indicate life/death.
Differentiating Life and Death
The Yellow Emperor asked: If cold pathogenic factors suddenly rise, and pulses are full and Excess, what happens? Qibo replied: If Excess and smooth, survival; if Excess and rebellious (reverse), death. The Yellow Emperor asked: If pulses are full and Excess, hands and feet are cold, and head is hot, what happens? Qibo replied: Survival in Spring/Autumn; death in Winter/Summer. If pulses are floating and choppy, and choppy with body heat, death ensues.
This addresses exhaustion of Essence-Qi, where Central Yang lacks power, allowing Yin-cold pathogens to violently reverse upward. Pulses are full and Excess (large and forceful, lacking gentleness). If smooth, Qi and Blood are still active, indicating survival. If Excess and rebellious, it shows true Zang pulses of elemental overcoming, indicating death. In cases of full/excess pulses, cold extremities, and hot head, Central Yang fails to distribute warmth to limbs, causing Qi rebellion upward. This creates Yin-Yang separation and lack of communication, leading to extreme imbalance. In Spring/Autumn, when Yang initially rises or falls, regulation can restore harmony and save life. In Winter/Summer, when Yin-Yang are naturally extreme, combining bodily imbalance with climatic extremity leads to fatal separation. Floating pulses expose Yang on the exterior; Yang should be fluid, but choppyness indicates Yang collapse. Body heat with collapsed Yang signifies severe Essence-Qi exhaustion, like a dying lamp's final flame, with both Yin and Yang exhausted, leading to death.
If the form is completely full, pulses are rapid, large, and firm, while Chi is choppy and unresponsive, survival depends on compliance with trends, death on rebellion. The Yellow Emperor asked: What defines compliant vs. rebellious? Qibo replied: Compliant means warm hands and feet; rebellious means cold hands and feet.