二十四难曰∶手足三阴三阳气已绝，何以为候？可知其吉凶不？
然∶足少阴
气绝，则骨枯。少阴者，冬脉也，伏行而温于骨髓。故骨髓不温，则肉不着骨，骨肉不相亲，则肉濡
而却，肉濡而却，故齿长而枯，发无润泽，无润泽者，骨先死。戊日笃，己日死。
此承上文手足三阴三阳气绝必有其候，引《灵枢·经脉篇》错杂言之也。足少阴，肾脉也，肾主
冬，故云冬脉也。肾主内营骨髓，故云伏行而温于骨髓也。濡，软也。却，退缩也。肾气已绝，骨肉不
相亲，则齿龈之肉结缩，故齿渐长而枯燥也。肾主藏精而化血，发者血之余，肾之精气绝，故发不润泽
也。戊己，土也。肾，水也。土克水，故云戊日笃，己日死也。
足太阴气绝，则脉不荣其口唇。口唇者，肌肉之本也。脉不荣，则肌肉不滑泽；肌肉不滑泽则肉
满；肉满则唇反；唇反则肉先死。甲日笃，乙日死。
足太阴，脾脉也。脾主肌肉，脾开窍于口，其华在唇四白，脉不荣，则太阴之气绝，故肌肉不滑泽，
肉满唇反也。甲乙，木也。脾，土也。木克土，故云甲日笃，乙日死也。
足厥阴气绝，则筋缩引卵与舌。厥阴者，肝脉也。肝者，筋之合也。筋者，聚于阴器而络于舌本，
故脉不荣则筋缩急，筋缩急则引卵与舌。故舌卷卵缩，则筋
先死。庚日笃，辛日死。
足厥阴，肝脉也。其华在爪，其充在筋，其脉循阴器而络于舌本，脉不营则厥阴之气绝，故筋急
舌卷而卵缩也。庚辛，金也。肝，木也。金克木，故云庚日笃，辛日死也。
手太阴气绝，则皮毛焦。太阴者，肺也，行气温于皮毛者也。气弗荣则皮毛焦；皮毛焦，则津液
去；津液去，则皮节伤；皮节伤，则皮枯毛折。毛折者，则毛先死。丙日笃，丁日死。
手太阴，肺脉也。其华在毛，其充在皮，脉不营，则皮毛焦。肺主气，气主薰肤泽毛，太阴气绝，
故津液去，则皮枯毛折而节伤也。丙丁，火也。肺，金也。火克金，故云丙日笃，丁日死也。
手少阴气绝，则脉不通。少阴者，心脉也，心者，脉之合也。脉不通则血不流，血不流则色泽去，
故面黑如黧，此血先死。壬日笃，癸日死。
手少阴，心脉也。心主血脉，其荣色也，其华在面。心气绝，则脉不通，血不流而色泽去矣。
面黑如黧，黧，黑黄色而无润泽也，言心血不能营于面，则黄黑而无光华也。壬癸，水也。心，
火也。水克火，故云壬日笃，癸日死也。
按∶手三阴，今释太阴，少阴，而独遗手厥阴者，何也？盖包络与心同候，言心气绝，则包络
之气亦绝，其诊既同，不必别解。故《灵枢·经脉篇》亦无手厥阴之候也。
三阴气俱绝者，则目眩转，目瞑；目瞑者为失志；失志者则志先死。死即目瞑也。
三阴者，手足三阴脉，此五脏之脉也。五脏者，人之根本也。目眩者，眩乱而见之不真也。转者，目
或反背，或朝上，或左右侧也。目瞑者，盲而无所见也。此三阴气绝，精神俱去之候。失志者，人之五志，
各属一脏，肝志怒，心志喜，脾志思，肺志忧，肾志恐。今三阴已绝，五脏皆失其志，故无喜怒忧思恐，
五志俱亡，故曰失志即死也。
六阳气俱绝者，则阴与阳相离，阴阳相离，则腠理泄，绝汗乃出，大如贯珠，转出不流，则气先死。
旦占夕死，夕占旦死。
六阳者，手足三阳也。阴与阳相离者，阴阳隔绝不相附也。夫阳气卫外，则腠理密；阳气绝，
则腠理不固，阴不可独留，故毛孔皆开，阴气亦从腠理而泄矣。甚则绝汗出，大如贯珠者，言身体汗出着
肉，如缀珠而不流散。故曰贯珠也。气属于阳，阳绝，故气先死也。
按∶《灵枢·经脉篇》无三阳分候之法，止有总论六阳气绝一节，若终始篇及《素问·诊要经终论》，
俱载三阳绝候法。今既以三阴三阳为问，当引经文以证明之，补其未备。太阳之脉，其终也，戴眼反折，
螈，其色白，绝汗乃出，出则死矣。少阳终者，耳聋，百节皆纵，目HT 绝系，绝系一日半死。其死也，
色先青白，乃死矣。阳明终者，口目动作，善惊妄言，色黄，其上下经盛而不仁，则终矣。此三阳脉绝之状
也。夫太阳之气主皮毛。气绝于皮，故色白，而
绝汗出也。少阳主骨，百节尽纵，则少阳之气绝，少阳属肾，肾藏志，目系绝者，志先死矣。阳明之脉，
挟口承目，故口目动作，乃其经气欲绝也。善惊妄言，阳明之神气外出也，色黄，阳明之土气外脱也。
上下经盛，胃气绝而无柔和之象也。肌肤不仁，则营卫之气绝矣。
第二十四难说：手足三阴经和三阳经的气血已经断绝，会有什么征候？可以判断其吉凶吗？
回答说：足少阴肾经的气血断绝，就会出现骨骼枯槁。少阴经对应冬季的脉象，潜行于体内而温煦骨髓。所以骨髓得不到温煦，肌肉就不能附着在骨骼上，骨肉不能相互亲近，肌肉就会松弛萎缩并退缩；肌肉松弛退缩，所以牙齿显得变长且干枯，头发失去润泽；头发没有润泽，说明骨气先死。在戊日病情加重，在己日死亡。
这是承接上文手足三阴三阳气绝必有征候的内容，引用《灵枢·经脉篇》中交错论述的文字。足少阴是肾脉，肾主管冬季，所以说它是冬脉。肾主管内部营养骨髓，所以说它潜行而温煦骨髓。濡，意思是软。却，意思是退缩。肾气已经断绝，骨肉不相亲近，那么齿龈的肉就会收缩，所以牙齿逐渐显得长且枯燥。肾主藏精并能化生血液，头发是血的余气所生，肾的精气断绝，所以头发不润泽。戊和己属土。肾属水。土克水，所以说戊日病情加重，己日死亡。
足太阴脾经的气血断绝，脉气就不能荣养口唇。口唇是肌肉的根本。脉气不能荣养，肌肉就不滑润光泽；肌肉不滑润光泽，肌肉就会肿胀饱满；肌肉肿胀饱满，嘴唇就会翻卷外翻；嘴唇翻卷外翻，说明肌肉之气先死。在甲日病情加重，在乙日死亡。
足太阴是脾脉。脾主管肌肉，脾开窍于口，其荣华表现在口唇四周的白色区域，脉气不能荣养，就是太阴经的气血断绝，所以肌肉不滑润光泽，肌肉肿胀、嘴唇翻卷。甲和乙属木。脾属土。木克土，所以说甲日病情加重，乙日死亡。
足厥阴肝经的气血断绝，就会出现筋脉拘挛，牵引睾丸和舌头。厥阴经是肝脉。肝是筋的汇聚之处。筋汇聚于生殖器并联络于舌根，所以脉气不能荣养就会导致筋脉拘急，筋脉拘急就会牵引睾丸和舌头。所以舌头卷缩、睾丸上缩，说明筋气先死。在庚日病情加重，在辛日死亡。
足厥阴是肝脉。其荣华表现在指甲，其充养部位在筋，其经脉循行经过生殖器并联络于舌根，脉气不能营养，就是厥阴经的气血断绝，所以筋脉拘急、舌头卷缩、睾丸上缩。庚和辛属金。肝属木。金克木，所以说庚日病情加重，辛日死亡。
手太阴肺经的气血断绝，就会出现皮毛焦枯。太阴经对应肺，肺运行气并温煦皮毛。气不能荣养，皮毛就会焦枯；皮毛焦枯，津液就会流失；津液流失，皮节就会受损；皮节受损，皮肤就会干枯、毛发折断。毛发折断，说明毛气先死。在丙日病情加重，在丁日死亡。
手太阴是肺脉。其荣华表现在毛发，其充养部位在皮肤，脉气不能营养，皮毛就会焦枯。肺主气，气主要熏蒸皮肤、润泽毛发，太阴肺气断绝，所以津液流失，导致皮肤干枯、毛发折断且关节受损。丙和丁属火。肺属金。火克金，所以说丙日病情加重，丁日死亡。
手少阴心经的气血断绝，就会出现血脉不通。少阴经是心脉，心是血脉的汇聚之处。血脉不通，血液就不能流动；血液不流动，面色就会失去光泽，所以面色黑得像黑炭一样，这是血气先死。在壬日病情加重，在癸日死亡。
手少阴是心脉。心主管血脉，其荣华表现为面色，其光华表现在面部。心气断绝，就会血脉不通，血液不流动而面色失去光泽。面黑如黧，黧是指黑黄色而没有润泽，意思是心血不能荣养面部，所以呈现黄黑色而没有光华。壬和癸属水。心属火。水克火，所以说壬日病情加重，癸日死亡。
按语：手三阴经，现在解释了太阴和少阴，唯独遗漏了手厥阴经，为什么呢？因为心包络与心的征候相同，说心气断绝，那么心包络的气也断绝，它们的诊察方法既然相同，就不必另外解释。所以《灵枢·经脉篇》也没有手厥阴经的征候记载。
如果三阴经的气血都断绝，就会出现头晕眼花、视物旋转、眼睛闭合；眼睛闭合是因为神志丧失；神志丧失，说明志气先死。死亡时表现为眼睛闭合。
三阴经，指手足三阴脉，这是五脏的脉象。五脏是人体的根本。目眩，是指眩晕混乱、视物不清。转，是指眼球或向后仰，或向上翻，或向左右侧斜。目瞑，是指失明而看不见东西。这是三阴经气血断绝，精神全部离去的征候。失志，是指人的五种情志，各归属于一个脏器，肝的情志是怒，心的情志是喜，脾的情志是思，肺的情志是忧，肾的情志是恐。现在三阴经已经断绝，五脏都失去了其对应的情志，所以没有喜怒忧思恐，五种情志全部消亡，所以说失志即意味着死亡。
如果六阳经的气血都断绝，就会出现阴气与阳气分离，阴阳分离，腠理就会开泄，绝汗就会流出，汗珠大如串联的珠子，转动流出但不流淌扩散，这说明阳气先死。早上预测到晚上就会死，晚上预测到早上就会死。
六阳经，指手足三阳经。阴与阳相离，是指阴阳隔绝而不依附。阳气护卫体表，腠理就致密；阳气断绝，腠理就不坚固，阴气不能单独留存，所以毛孔全部张开，阴气也从腠理泄露出去。严重时出现绝汗，大如串联的珠子，意思是身体出汗沾着皮肤，像缀着的珠子而不流散。所以叫作贯珠。气属于阳，阳气断绝，所以阳气先死。
按语：《灵枢·经脉篇》没有三阳经分别征候的方法，只有总论六阳气绝的一节，如果《终始篇》及《素问·诊要经终论》，都记载了三阳经气绝的征候法。现在既然以三阴三阳为提问，应当引用经文来证明，补充其未完备之处。太阳经的脉气终结时，会出现两眼上视、角弓反张、抽搐，面色苍白，绝汗流出，流出后就死亡了。少阳经终结时，会出现耳聋，全身关节松弛无力，目系断绝，目系断绝一天半后死亡。死亡时，面色先青白，然后死亡。阳明经终结时，会出现口眼抽动，容易惊恐、胡言乱语，面色发黄，上下经脉充盈但肌肤麻木不仁，这就终结了。这是三阳经脉气断绝的状态。太阳经的气主管皮毛。气在皮毛断绝，所以面色白，并且出现绝汗。少阳经主管骨骼，全身关节完全松弛，说明少阳经的气断绝，少阳隶属于肾，肾藏志，目系断绝，说明志气先死。阳明经的脉，挟持口部、承托眼部，所以口眼抽动，是其经气将要断绝的表现。容易惊恐、胡言乱语，是阳明的神气向外脱逸的表现，面色黄，是阳明的土气向外脱逸的表现。上下经脉充盈，是胃气断绝而没有柔和之象的表现。肌肤麻木不仁，是营卫之气断绝的表现。
Chapter 24 states: When the Qi of the three Yin and three Yang meridians of the hands and feet is exhausted, what are the signs? Can their prognosis be determined?
The response is: When the Qi of the Foot Shaoyin (Kidney Meridian) meridian is exhausted, the bones become withered. Shaoyin corresponds to the winter pulse; it runs deep within and warms the bone marrow. Therefore, if the bone marrow is not warmed, the flesh cannot adhere to the bones. If the flesh and bones do not adhere closely, the flesh becomes soft and retracts. Due to this retraction of the flesh, the teeth appear elongated and dry, and the hair loses its luster. The loss of luster in the hair indicates that the Qi of the bones has died first. The condition will worsen on Wu days and death will occur on Ji days.
This passage follows up on the previous discussion that the exhaustion of Qi in the three Yin and three Yang meridians must have specific signs, citing the interleaved text from *Ling Shu: Jing Mai* (Spiritual Pivot: Meridians). The Foot Shaoyin is the Kidney meridian; the Kidney governs winter, hence it is called the winter pulse. The Kidney governs internal nourishment of the bone marrow, hence it is said to run deep and warm the bone marrow. "Ru" means soft. "Que" means retracting. When Kidney Qi is exhausted, the flesh and bones lose their connection, causing the gingival flesh to contract. Thus, the teeth gradually appear longer and dry. The Kidney stores Essence and transforms Blood; hair is considered the surplus of Blood. When the Kidney's Essence and Qi are exhausted, the hair loses its luster. Wu and Ji belong to Earth. The Kidney belongs to Water. Since Earth overcomes Water, it is stated that the condition worsens on Wu days and death occurs on Ji days.
When the Qi of the Foot Taiyin (Spleen Meridian) meridian is exhausted, the vessels fail to nourish the lips. The lips are the root of the muscles. If the vessels are not nourished, the muscles will not be smooth and lustrous. If the muscles are not smooth and lustrous, they become full and swollen. If the muscles become full and swollen, the lips will evert. If the lips evert, the Qi of the flesh dies first. The condition will worsen on Jia days and death will occur on Yi days.
The Foot Taiyin is the Spleen meridian. The Spleen governs the muscles, opens into the mouth, and its brilliance manifests in the white area around the lips. If the vessels are not nourished, it signifies the exhaustion of Taiyin Qi, resulting in muscles that are not smooth and lustrous, muscle swelling, and lip eversion. Jia and Yi belong to Wood. The Spleen belongs to Earth. Since Wood overcomes Earth, it is stated that the condition worsens on Jia days and death occurs on Yi days.
When the Qi of the Foot Jueyin (Liver Meridian) meridian is exhausted, there will be tendon contraction pulling on the scrotum and tongue. Jueyin is the Liver meridian. The Liver is the convergence of tendons. Tendons converge at the genitalia and connect to the base of the tongue. Therefore, if the vessels are not nourished, the tendons will become tight and contracted. If the tendons are tight and contracted, they will pull on the scrotum and tongue. Thus, when the tongue curls and the testicles retract, the Qi of the tendons dies first. The condition will worsen on Geng days and death will occur on Xin days.
The Foot Jueyin is the Liver meridian. Its brilliance manifests in the nails, and it nourishes the tendons. Its vessel circulates through the genitalia and connects to the base of the tongue. If the vessels do not nourish, it signifies the exhaustion of Jueyin Qi, resulting in tight tendons, a curled tongue, and retracted testicles. Geng and Xin belong to Metal. The Liver belongs to Wood. Since Metal overcomes Wood, it is stated that the condition worsens on Geng days and death occurs on Xin days.
When the Qi of the Hand Taiyin (Lung Meridian) meridian is exhausted, the skin and hair become scorched and dry. Taiyin corresponds to the Lung, which circulates Qi and warms the skin and hair. If Qi fails to nourish, the skin and hair become scorched. If the skin and hair become scorched, body fluids are lost. If body fluids are lost, the joints of the skin are damaged. If the skin joints are damaged, the skin becomes dry and hair breaks. Hair breaking indicates that the Qi of the hair dies first. The condition will worsen on Bing days and death will occur on Ding days.
The Hand Taiyin is the Lung meridian. Its brilliance manifests in the hair, and it nourishes the skin. If the vessels are not nourished, the skin and hair become scorched. The Lung governs Qi; Qi primarily steams the skin and moistens the hair. When Taiyin Lung Qi is exhausted, body fluids are lost, leading to dry skin, broken hair, and damaged joints. Bing and Ding belong to Fire. The Lung belongs to Metal. Since Fire overcomes Metal, it is stated that the condition worsens on Bing days and death occurs on Ding days.
When the Qi of the Hand Shaoyin (Heart Meridian) meridian is exhausted, the vessels become obstructed. Shaoyin is the Heart meridian; the Heart is the convergence of vessels. If the vessels are obstructed, blood does not flow. If blood does not flow, the complexion loses its luster. Consequently, the face appears black like charcoal; this indicates that the Qi of blood dies first. The condition will worsen on Ren days and death will occur on Gui days.
The Hand Shaoyin is the Heart meridian. The Heart governs blood and vessels, its brilliance is in the color, and its manifestation is on the face. When Heart Qi is exhausted, the vessels become obstructed, blood does not flow, and the complexion loses its luster. "Black like Li" refers to a dark yellow-black color without luster, meaning that Heart Blood fails to nourish the face, resulting in a dull yellow-black hue. Ren and Gui belong to Water. The Heart belongs to Fire. Since Water overcomes Fire, it is stated that the condition worsens on Ren days and death occurs on Gui days.
Note: Regarding the three Yin meridians of the hand, the Taiyin and Shaoyin are explained here, but the Hand Jueyin is omitted. Why? Because the Pericardium (Bao Luo) shares the same signs as the Heart. Stating that Heart Qi is exhausted implies that Pericardium Qi is also exhausted. Since their diagnostic methods are identical, no separate explanation is needed. Therefore, *Ling Shu: Jing Mai* also does not record signs for the Hand Jueyin meridian.
If the Qi of the three Yin meridians is completely exhausted, there will be dizziness, vertigo, and closed eyes. Closed eyes indicate the loss of Zhi (Will/Spirit); loss of Zhi indicates that the Zhi Qi dies first. Death is manifested by closed eyes.
The three Yin meridians refer to the three Yin meridians of the hand and foot, which correspond to the five Zang organs. The five Zang organs are the root of human life. Dizziness (Xuan) refers to confusion and unclear vision. "Zhuan" refers to the eyeballs turning backward, upward, or to the sides. "Ming" refers to blindness where nothing can be seen. These are signs that the Qi of the three Yin meridians is exhausted and the Spirit has departed. Loss of Zhi refers to the five emotional dispositions, each belonging to one organ: Liver governs Anger, Heart governs Joy, Spleen governs Pensiveness, Lung governs Worry, and Kidney governs Fear. Now that the three Yin meridians are exhausted, the five Zang organs have lost their respective dispositions, so there is no anger, joy, worry, pensiveness, or fear. With all five dispositions perished, it is said that loss of Zhi leads to death.
If the Qi of the six Yang meridians is completely exhausted, Yin and Yang will separate. When Yin and Yang separate, the interstices (Cou Li) will leak, and "Jue Han" (desperate sweat) will emerge. The sweat drops will be large like beads strung together, rolling out but not flowing away. This indicates that Yang Qi dies first. Predicted in the morning, death occurs in the evening; predicted in the evening, death occurs in the morning.
The six Yang meridians refer to the three Yang meridians of the hand and foot. Separation of Yin and Yang means they are isolated and do not attach to each other. Yang Qi guards the exterior, keeping the interstices dense. When Yang Qi is exhausted, the interstices are not secure, and Yin cannot remain alone. Thus, all pores open, and Yin Qi also leaks out through the interstices. In severe cases, desperate sweat emerges, large like beads, meaning the sweat adheres to the skin like attached beads without scattering. Hence, it is called "Guan Zhu" (strung beads). Qi belongs to Yang; when Yang Qi is exhausted, Yang Qi dies first.
Note: *Ling Shu: Jing Mai* does not contain methods for distinguishing the signs of the three Yang meridians separately, only a general discussion on the exhaustion of the six Yang Qi. However, *Zhong Shi* and *Su Wen: Zhen Yao Jing Zhong Lun* both record the signs of exhaustion for the three Yang meridians. Since the question concerns the three Yin and three Yang, scriptural citations should be used to prove this and supplement the incomplete sections. When the Taiyang meridian reaches its end, there is retroversion of the eyes, opisthotonos, convulsions, pale complexion, and emergence of desperate sweat; once the sweat emerges, death ensues. When the Shaoyang meridian reaches its end, there is deafness, flaccidity of all joints, and severance of the visual system; severance of the visual system leads to death in one and a half days. At death, the complexion turns blue-white before death. When the Yangming meridian reaches its end, there are movements of the mouth and eyes, frequent fright, delirious speech, yellow complexion, and fullness in the upper and lower channels with insensitivity of the skin; this marks the end. These are the states of exhaustion of the three Yang meridians. Taiyang Qi governs the skin and hair. Exhaustion of Qi in the skin results in a pale complexion and desperate sweat. Shaoyang governs the bones; complete flaccidity of all joints indicates exhaustion of Shaoyang Qi. Shaoyang is affiliated with the Kidney, which stores Zhi; severance of the visual system indicates that Zhi Qi dies first. The Yangming meridian flanks the mouth and supports the eyes; thus, movements of the mouth and eyes indicate the impending exhaustion of its channel Qi. Frequent fright and delirious speech represent the outward escape of Yangming Shen (Spirit); a yellow complexion represents the outward escape of Yangming Earth Qi. Fullness in the upper and lower channels indicates exhaustion of Stomach Qi without any sign of gentleness. Insensitivity of the skin and flesh indicates exhaustion of Ying and Wei Qi.