问曰∶何谓虚实?对曰∶邪气盛则实,精气夺则虚。重实者,肉大热,病气热,脉满,是谓重实。
问曰∶经络俱实,何如?对曰∶经络皆实,是寸脉急而尺缓也,皆当俱治。故曰滑则顺,涩则逆。夫虚实者,皆从
其物类始,五脏骨肉滑利,可以长久。寒气暴上,脉满实。实而滑,顺则生,实而涩,逆则死。形尽满,脉急大坚,尺
满而不应,顺则生,逆则死。所谓顺者,手足温。所谓逆者,手足寒也。
问曰∶何谓重虚?对曰∶脉虚,气虚、尺虚,是谓重虚也。所谓气虚者,言无常也;尺虚者,行步匡然也;脉虚者,
不象阴也。如此者,滑则生,涩则死。气虚者,肺虚也;气逆者,足寒也。非其时则生,当其时则死,余脏皆如此也。
脉实满,手足寒,头热者,春秋则生,冬夏则死。脉浮而涩,涩而身有热者,死。络气不足,经气有余,脉热而尺寒,
秋冬为逆,春夏为顺。经虚络满者,尺热满而寒涩,春夏死,秋冬生。络满经虚,灸阴刺阳;经满络虚,刺阴灸阳。
问曰∶秋冬无极阴,春夏无极阳,何谓也?对曰∶无极阳者,春夏无数虚阳明,阳明虚则狂。无极阴者,秋冬无数
虚太阴,太阴虚则死。上重实重虚部。
热病,所谓阳附阴者,腰以下至足热,腰以上寒,阴气下争,还心腹满者,死。所谓阴附阳者,腰以上至头热,腰
以下寒,阳气上争,还得汗者生。(上阴阳相附部)
问:什么是虚证和实证?
答:邪气亢盛就称为实证,精气耗损就称为虚证。所谓“重实”,是指肌肉大热,病势炽热,脉象充实满盛,这叫做重实。
问:如果经络都表现为实证,情况如何?
答:经络皆实证,表现为寸口脉急迫而尺部脉缓弱,此时应当对经络同时进行治疗。所以说,脉滑利为顺,脉涩滞为逆。虚实的变化,都是从事物的类别开始的,五脏和骨肉滑利通畅,生命就可以长久。寒气突然上逆,脉象满实。若脉实且滑利,为顺证则生;若脉实且涩滞,为逆证则死。形体全面胀满,脉象急大而坚牢,尺部脉满盛但按之不应指(或尺肤满盛而脉象不相应),顺证则生,逆证则死。所谓的顺证,是指手足温暖。所谓的逆证,是指手足寒冷。
问:什么是“重虚”?
答:脉象虚弱,气虚,尺部脉虚弱,这叫做重虚。所谓气虚,表现为言语无序、语无伦次;所谓尺虚,表现为行走时步履不稳、摇晃无力;所谓脉虚,表现为脉象不能反映阴血的充盈状态(即脉细弱无力)。出现这种情况,若脉滑利则生,若脉涩滞则死。气虚,即是肺虚;气逆,则足部发冷。若在非其当令的季节发病则生,若在其当令的季节发病则死,其他脏腑的情况也都与此类似。
若脉象实满,手足寒冷,头部发热,在春季和秋季发病可生,在冬季和夏季发病则死。若脉浮而涩,且身体伴有发热,为死证。络脉之气不足,经脉之气有余,脉象热而尺部寒冷,在秋冬季节为逆证,在春夏季节为顺证。经脉虚而络脉满的,尺部皮肤热满而脉象寒涩,在春夏季节死,在秋冬季节生。络脉满而经脉虚的,采用灸阴经、刺阳经的方法;经脉满而络脉虚的,采用刺阴经、灸阳经的方法。
问:为什么说“秋冬无极阴,春夏无极阳”,这是什么意思?
答:“无极阳”,是指在春夏季节没有过多的阳明经虚证,若阳明经虚弱则会导致狂症。“无极阴”,是指在秋冬季节没有过多的太阴经虚证,若太阴经虚弱则会导致死亡。(以上为重实重虚部分)
关于热病,所谓“阳附阴”,是指腰部以下至足部发热,腰部以上寒冷,这是阴气在下部争胜,并上逆导致心腹胀满的,为死证。所谓“阴附阳”,是指腰部以上至头部发热,腰部以下寒冷,这是阳气在上部争胜,若能得汗出者,为生证。(以上为阴阳相附部分)
Q: What are deficiency and excess?
A: When pathogenic factors are flourishing, it is termed excess (Shi); when essential qi is depleted, it is termed deficiency (Xu). "Heavy excess" refers to a condition where the flesh is intensely hot, the disease heat is severe, and the pulse is full and distended; this is called heavy excess.
Q: What if both the meridians and collaterals present with excess patterns?
A: If both meridians and collaterals are in excess, the pulse at the Cun position (distal wrist) is rapid/tight while the Chi position (proximal wrist) is slow/relaxed; treatment should address both simultaneously. Therefore, it is said that a slippery pulse indicates favorable prognosis (Shun), while a choppy pulse indicates unfavorable prognosis (Ni). The variations of deficiency and excess originate from the classification of things; if the five Zang organs and bones/flesh are smooth and unobstructed, longevity can be achieved. When cold qi suddenly ascends, the pulse becomes full and solid. If the pulse is solid yet slippery, it is favorable and life is preserved; if the pulse is solid yet choppy, it is unfavorable and death ensues. If the entire form is distended/full, and the pulse is rapid, large, and firm, but the Chi position is full yet does not respond to pressure (or Chi skin is full while the pulse does not correspond), it is favorable and life is preserved, but unfavorable leads to death. By "favorable," we mean warm hands and feet. By "unfavorable," we mean cold hands and feet.
Q: What is "heavy deficiency"?
A: A deficient pulse, Qi deficiency, and a deficient Chi pulse constitute "heavy deficiency." "Qi deficiency" manifests as disordered speech; "Chi deficiency" manifests as unsteady, swaying gait; "Pulse deficiency" means the pulse fails to reflect Yin essence (appearing thin and weak). In such cases, a slippery pulse indicates survival, while a choppy pulse indicates death. Qi deficiency corresponds to Lung deficiency; Qi rebellion results in cold feet. If the disease occurs out of season, there is hope for recovery; if it occurs during the season corresponding to the affected organ, death ensues. This principle applies similarly to other Zang organs.
If the pulse is solid and full, with cold hands and feet but a hot head, survival is possible in Spring and Autumn, but death occurs in Winter and Summer. If the pulse is floating and choppy, accompanied by fever, it is a death sign. When Collateral Qi is insufficient and Meridian Qi is in excess, the pulse feels hot while the Chi region is cold; this is unfavorable in Autumn and Winter, but favorable in Spring and Summer. When Meridians are deficient and Collaterals are full, the Chi skin is hot and full while the pulse is cold and choppy; death occurs in Spring and Summer, while survival is possible in Autumn and Winter. For Collateral excess and Meridian deficiency, moxa the Yin meridians and needle the Yang meridians; for Meridian excess and Collateral deficiency, needle the Yin meridians and moxa the Yang meridians.
Q: What is meant by "In Autumn and Winter, do not exhaust Yin; in Spring and Summer, do not exhaust Yang"?
A: "Do not exhaust Yang" means that in Spring and Summer, one should not have excessive deficiency of the Yangming Meridian; if Yangming is deficient, mania ensues. "Do not exhaust Yin" means that in Autumn and Winter, one should not have excessive deficiency of the Taiyin Meridian; if Taiyin is deficient, death ensues. (End of the section on Heavy Excess and Heavy Deficiency)
Regarding febrile diseases, "Yang attaching to Yin" refers to heat from the waist down to the feet, while the area above the waist is cold; this indicates Yin qi fighting below and rebelling upward to cause abdominal fullness, which is a death sign. "Yin attaching to Yang" refers to heat from the waist up to the head, while the area below the waist is cold; this indicates Yang qi fighting above. If sweating occurs, it indicates survival. (End of the section on Yin-Yang Attachment)