厥阴有余病阴痹。不足病生热痹。滑则病狐疝风。涩则病少腹积气。（此论六气之内合于五脏也。曰厥阴、少阴、太
阳、少阳。论六气之为病也。曰皮肉筋骨脉者。因六气而及于五脏之外合也。曰心肝脾肺肾者。因六气而及于五脏之次
也。有余者。多气少血。不足者。血气皆少。滑者阳气盛。微有热。涩者多血少气。微有寒。痹者。闭也。血气留着于
皮肉筋骨之间而为痛也。气病之谓疝。血病之谓积。盖气盛而生热。则为疝痛。血多而凝泣。故成积也。厥阴者。阴之
极也。阴极而阳生。得中见少阳之火化。故有寒有热也。厥阴主春生风木之气。故首论厥阴焉。张兆璜问曰。厥阴止
曰寒热。而以少阳病筋病肝者何也。曰此论病在六气。而及于五脏者也。厥阴不从标本。从乎中也。从中者。以中气为
化也。）少阴有余病皮痹隐轸。不足病肺痹。滑则病肺风疝。涩则病积溲血。太阴有余病肉痹寒中。不足病脾痹。滑则
病痹风疝。涩则病积。心腹时满。阳明有余病脉痹。身时热。不足病心痹。滑则病心风疝。涩则病积时善惊。太阳有余
病骨痹身重。不足病肾痹。滑则病肾风疝。涩则病积。善时巅疾。少阳有余病筋痹胁满。不足病肝痹。滑则病肝风疝。
涩则病积。时筋急目痛。（三阴三阳。有多血少气者。有多气少血者。惟阳明血气皆多。盖血气之生于阳明也。荣血行于
脉中。乃阳明水谷之精。上归于心。淫精于脉。脉气归于肺。肺朝百脉。输精于皮毛。毛脉合精。行气于腑。腑者。在
外之皮肉筋骨也。腑精与神明相合。而通于五脏。气复归于权衡。此脉气之生始出入也。是以阳明之有余不足。则为脉
痹心痹。心主脉而上归于肺。肺主皮毛。毛脉合精于皮肤之间。是以少阴之为皮痹肺痹也。脉气散于皮毛。复从太阴所
主之肉。少阳所主之筋。太阳所主之骨。而内通于五脏。是以有余而在外。则为肉痹筋痹骨痹。不足而陷于内。则为脾
痹肝痹肾痹矣。至气有余于内而为热。则为疝。血有余于内而为寒。则为积矣。故所谓风者。热所生也。所谓身重者。
病在气也。所谓溲血腹满。善惊目痛者。病在血也。此三阴三阳所主之血气。生始出入。各有太过不及之为病也。愚按
此章无问答之起句。乃伯承上章而言。）是故春气在经脉。夏气在孙络。长夏气在肌肉。秋气在皮肤。冬气在骨髓中。（此
承上文而言脉气之随四时生长收藏。外出于皮肤。内通于五脏。环转之无端也。）帝曰。余愿闻其故。岐伯曰。春者天气
始开。地气始泄。冻解冰释。水行经通。故人气在脉。夏者经满气溢。入孙络受血。皮肤充实。长夏者。经络皆盛。内
溢肌中。秋者天气始收。腠理闭守塞。皮肤引急。冬者盖藏。血气在中。内着骨髓。通于五脏。（夫经脉为里。支而横者
为络。络之别者为孙。是血气之从经脉而外溢于孙络。从孙络而充于皮肤。从皮肤而复内溢于肌中。从肌肉而着于骨髓。
通于五脏。是脉气之散于脉外。而复内通于五脏也。夫天为阳。地为阴。阴阳合而血气始生。肾主冬令之水而为生气之
原。阳明乃血气所生之府。故曰谷入于胃。脉道乃行。水入于经。而血乃成。然藉肾中之生气。戊癸合化。而后生此水
谷之精微。故天气开。地气泄。冻解冰释。水行经通。肾脏之冬令。已得春生之气。而人气始在脉。是人气之通于天也。
故曰春生夏长。秋收冬藏。是气之常也。人亦应之。以一日分为四时。朝则为春。日中为夏。日入为秋。夜半为冬。朝
则人气始生。日中人气长。夕则人气收。夜半人气在脏。人与天地参也。愚按缪刺篇。论卫气先行皮肤。先充络脉。络
脉先盛。故卫气已平。荣气乃满。而经脉大盛。是卫气之通于脉内也。此篇言血气之从经而络。从络而皮。复从皮肤肌
肉而内着骨髓。通于五脏。是荣血之行于脉外也。当知荣行脉中。卫行脉外者。论通体之经脉也。至于血气之生始出入。
营于脉中。渗于脉外。充肤热肉。生毫毛。内入于募原而通于脏腑。表里上下。无处不周。医者能洞悉血气之原流。而
后能导邪病之 却。故帝曰。经脉者。人之所以生。病之所以成。人之所以治。病之所以起。学之所始。工之所止也。
粗之所易。上之所难也。习上乘者。可不于针刺诸篇。用心求之。）是故邪气者。常随四时之气血而入客也。至其变化。
不可为度。然必从其经气。辟除其邪。除其邪。则乱气不生。（邪气者。在天六淫之邪也。四时之血气者。春气在经脉。
夏气在孙络。长夏气在肌肉。秋气在皮肤。冬气在骨髓中也。至其变化。不可为度者。谓天有六淫之邪。而人有形层六
气之化也。如邪留于外。则为皮肉筋骨之痹。合于内。则为心肝脾肺之痹矣。如留于气分则为疝。留于血分则为积矣。
如身中之阳盛则为热。虚寒则为寒矣。此皆吾身中阴阳虚实之变化也。然必从其四时之经气。辟除其邪。则变乱之气不
生矣。）帝曰。逆四时而生乱气奈何。岐伯曰。春刺络脉。血气外溢。令人少气。春刺肌肉。血气环逆。令人上气。春刺
筋骨。血气内着。令人腹胀。（此言血气之随时环转。自有出入之度。不可使之妄行也。夫刺者。所以取气也。春气在经
脉。而取之于络脉。则血气外溢。而令人少气矣。至于肌肉。则血气环逆。而令人上气矣。环逆者。逆其环转也。言血
气之从经而络。从络而皮。从皮肤而复环转于肌中也。至于筋骨。则血气内着。而令人腹胀矣。王芳侯曰。此后添出
筋字。盖以四时六气而言。则春主筋。而少阳主筋。以形层而言。则皮而肉。肉而筋。筋而骨也。）夏刺经脉。血气乃竭。
令人解 。夏刺肌肉。血气内却。令人善恐。夏刺筋骨。血气上逆。令人善怒。（夏气盛长。而血气已外出于孙络矣。若
再取之于经脉。则血气内竭。而令人懈惰也。血脉出于阳明。外溢于肌腠。夏气在孙络。而使之溢于肌中。则血气虚却
于内矣。阳明脉虚。则恐如人将捕之。夏气浮长于上。而反逆之使下。则气郁不疏。而使人善怒也。上逆当作下逆。）秋
刺经脉。血气上逆。令人善忘。秋刺络脉。气不外行。令人卧不欲动。秋刺筋骨。血气内散。令人寒栗。（秋令降收。而
反令其生长。故使血气上逆。而令人善忘也。血气从络脉而充于皮肤。从皮肤而内溢于肌肉。秋刺络脉。则血气不外行
于皮肤肌肉之间。故令人卧不欲动。盖肌肉者。脾所主也。脾病者。嗜卧不欲动。夫秋令始降。而反取之筋骨。使血气
散于内。而令人寒栗矣。按秋气在皮肤。长夏之气在肌肉。长夏者。夏秋之交也。此篇论经脉之气。从经脉而外出于
孙络。从孙络而充于皮肤。从皮肤而内溢于肌中。从肌中而着于筋骨。是皮肤尚属出机。至肌肉始属回转之降令。故此
章以肌肉主秋令者。从脉气之环转故也。）冬刺经脉。血气皆脱。令人目不明。冬刺络脉。内气外泄。留为大痹。冬刺肌
肉。阳气竭绝。令人善忘。（冬主闭藏。以奉春生之气。应藏而反泄之。故使血气皆脱于内。而令人目不明。盖五脏之精。
皆注于目而为之睛。冬者血气在中。内着骨髓。通于五脏。血气内脱。则五脏皆虚。故令人目不明也。冬刺络脉。则内
气外泄。而留为大痹。大痹者。脏气虚而邪气痹于五脏也。阳气生于阴中。出于肌腠。至冬令之时。复归于阴藏。冬刺
肌肉。是取所藏之气于肌腠之外。故使阳气竭绝于内。而令人善忘也。）凡此四时刺者。大逆之病。不可不从也。反之则
生乱气相淫病焉。（凡逆刺其四时之经气。则变生大病。故不可不从也。乱气、变乱之气也。相淫者。血气淫 也。此言
不从四时之气。则正气变乱而为病也。）故刺不知四时之经。病之所生。以从为逆。正气内乱。与精相薄。（此言邪气者。
常随四时之气血而入客也。故不知四时之经。病之所生。以从为逆。使正气内乱。而邪与精相薄矣。此篇重在六经之气
血。还转出入。宜顺而不宜逆。故上节先论正气为病。此始论其邪。下节复论其正气。）必审九候。正气不乱。精气不转。
（此言知四时之逆从者。必审察其九候也。九候者。有天有地有人。在天主气。在地主血。在人主脉。知血气经脉出入
之源流。则正气不致内乱。而精气不逆回矣。）帝曰。善。刺五脏。中心一日死。其动为噫。中肝五日死。其动为语。
中肺三日死。其动为咳。中肾六日死。其动为嚏欠。中脾十日死。其动为吞。刺伤人五脏必死。其动则根据其脏之所变候。
知其死也。（刺五脏者。谓刺伤其五脏之气也。盖三阴三阳之六气。名合于皮肉筋骨脉。脉肉筋骨。内合于五脏。如病肺
痹肺风。脾痹脾疝。则当取气于皮。取气于肉。不可逆刺以伤其脏真。故曰。刺伤人五脏必死。各根据其藏之所变候。而
知其死期。盖刺五脏。则动其脏气。动脏气。则变候见于外矣。按五脏外合五时。六经上应六气。诊要经终篇。以六
气应五脏而终于六经。此篇以六经应四时而终于五脏。诊要篇以经脉之生于五脏。而外合于六经。此篇以经脉之本于六
气。而内连于五脏。盖脉气之循于皮肉筋骨。内合五行。外合六气。外内之交。相生始出入者也。是以一篇之章句虽同。
而旨意各别。学人宜分析体会。不可以其重而忽之。张兆璜曰。诊要篇论逆刺其脏气之所出。而中伤五脏。故曰。凡刺
胸腹者。必避五脏。此篇论刺六经之内入而中伤五脏。故曰内通五脏。刺五脏中心一日死。谓刺外合之皮肉筋骨脉。而
不可中伤其脏也。）
厥阴经气有余，会引发阴痹；不足，则产生热痹。脉象滑利，易患狐疝或风病；脉象涩滞，易患少腹部积气。（这段论述六气内合于五脏的情况。提到厥阴、少阴、太阳、少阳，是论述六气致病的情况。提到皮、肉、筋、骨、脉，是因六气而涉及五脏的外合部位。提到心、肝、脾、肺、肾，是因六气而涉及五脏的次序。所谓“有余”，是多气少血；所谓“不足”，是血气都少。脉滑，说明阳气盛，微有热；脉涩，说明多血少气，微有寒。痹，就是闭塞的意思，血气滞留于皮肉筋骨之间从而产生疼痛。气病称为疝，血病称为积。大概气盛而生热，就会发生疝痛；血多而凝滞，所以形成积块。厥阴，是阴气的极点。阴极则阳生，得到中见少阳的火化，所以既有寒证又有热证。厥阴主管春季生发的风木之气，所以首先论述厥阴。张兆璜问道：厥阴只说寒热，为什么把少阳的病、筋的病、肝的病也归入其中呢？回答说：这是论述病在六气，进而涉及五脏。厥阴不从标本，而从乎中气。所谓从中，就是以中气为化源。）
少阴经气有余，会引发皮痹和隐疹（皮肤瘙痒起疙瘩）；不足，会引发肺痹。脉滑，易患肺风疝；脉涩，易患积证和小便出血。太阴经气有余，会引发肉痹和寒中（内脏寒冷）；不足，会引发脾痹。脉滑，易患痹风和疝；脉涩，易患积证，心腹时常胀满。阳明经气有余，会引发脉痹和身体时常发热；不足，会引发心痹。脉滑，易患心风疝；脉涩，易患积证，时常容易惊恐。太阳经气有余，会引发骨痹和身体沉重；不足，会引发肾痹。脉滑，易患肾风疝；脉涩，易患积证，时常发生头顶部的疾病。少阳经气有余，会引发筋痹和胁肋胀满；不足，会引发肝痹。脉滑，易患肝风疝；脉涩，易患积证，时常筋脉拘急、眼睛疼痛。（三阴三阳经脉，有多血少气的，也有多气少血的，只有阳明经血气皆多。大概血气生于阳明。营血运行于脉中，乃是阳明水谷的精微，上行归于心脏，浸润滋养于脉中，脉气归于肺脏，肺朝百脉，输布精微于皮毛，毛与脉中的精气相合，运行气于腑，腑是指外部的皮肉筋骨。腑的精气与神明相合，而通达于五脏，气又回归到平衡状态，这是脉气生成的始末出入过程。因此，阳明的有余和不足，就会导致脉痹和心痹。心主脉并向上归于肺，肺主皮毛，毛与脉的精气相合于皮肤之间，因此少阴会导致皮痹和肺痹。脉气散于皮毛，再经过太阴所主的肌肉、少阳所主的筋、太阳所主的骨，而内部通达于五脏。因此，邪气有余而在外部，就会形成肉痹、筋痹、骨痹；邪气不足而陷入内部，就会形成脾痹、肝痹、肾痹。至于气有余于内而产生热，就会形成疝；血有余于内而产生寒，就会形成积。所以所谓的“风”，是由热产生的；所谓的“身重”，是病在气分；所谓的“小便出血、腹满、容易惊恐、眼睛疼痛”，是病在血分。这三阴三阳所主管的血气，其生成、始末、出入，各有太过和不及导致的疾病。我按语：这一章没有问答的起始句，是伯高承接上一章而言。）
因此，春气存在于经脉，夏气存在于孙络（细小的络脉），长夏（夏秋之交）气存在于肌肉，秋气存在于皮肤，冬气存在于骨髓中。（这是承接上文而言脉气随着四季的生长收藏，向外出于皮肤，向内通达于五脏，循环运转没有终点的规律。）
黄帝说：我希望听听其中的缘故。岐伯说：春天，天气开始开泄，地气开始发散，冰冻解冻，水流通畅，经脉随之流通，所以人气在经脉。夏天，经脉气血充盈溢出，流入孙络接受血液，皮肤充实。长夏时节，经络气血都旺盛，向内溢于肌肉之中。秋天，天气开始收敛，腠理闭合守固，皮肤紧缩。冬天，万物闭藏，血气在中焦，内注于骨髓，通达于五脏。（经脉为里，分支横出的为络，络的别支为孙，这是血气从经脉向外溢于孙络，从孙络充养于皮肤，从皮肤再向内溢于肌肉，从肌肉内注于骨髓，通达于五脏的过程，这是脉气散布于脉外，再重新内通于五脏。天为阳，地为阴，阴阳结合血气才产生。肾脏主管冬季的水，作为生气的源头，阳明是水谷气血生成的府库，所以说谷物进入胃中，脉道才能运行，水液进入经脉，血液才能形成。然而借助肾中的生气，戊癸合化，然后产生这些水谷的精微。所以天气开泄，地气发散，冰冻解冻，水流通畅，经脉流通，肾脏的冬令，已经得到了春生的气机，而人气开始在经脉中，这是人气与天道相通。所以说春生、夏长、秋收、冬藏，这是气的常规。人也顺应它，将一天分为四时，早晨为春，中午为夏，日落为秋，夜半为冬。早晨人气开始生发，中午人气增长，傍晚人气收敛，夜半人气在脏。人与天地参同。我按语：《缪刺篇》论述卫气先行于皮肤，先充满络脉，络脉先旺盛，所以卫气已平复，营气才充盈，而经脉盛大，这是卫气通于脉内。本篇论述血气从经到络，从络到皮，再从皮肤肌肉向内注于骨髓，通达于五脏，这是营血行于脉外。应当知道营行脉中、卫行脉外，是论述整体的经脉。至于血气的生成始末出入，营气在脉中营运，渗出于脉外，充养肌肤，温暖肌肉，生长毫毛，向内进入募原而通达脏腑，表里上下，无处不周遍。医生如果能透彻了解血气的源流，然后才能引导祛除邪病。所以黄帝说：经脉，是人之所以生存、病之所以形成、人之所以治疗、病之所以好转的根本，是学习的开始，是工匠技艺的止境。粗工容易忽视，上工难以掌握。学习上乘医术的人，难道不在针刺各篇中用心探求吗？）
因此，邪气常常随着四时的气血变化而入客体内。到了它的变化程度，无法用固定的标准衡量，但必须顺从其经气，辟除邪气。除去邪气，就不会产生乱气。（邪气，是指在天六淫之邪。四时的血气，指春气在经脉，夏气在孙络，长夏气在肌肉，秋气在皮肤，冬气在骨髓中。所谓“至其变化，不可为度”，是说天有六淫之邪，人有形层六气的变化。如邪气留于外部，就形成皮肉筋骨之痹；合于内部，就形成心肝脾肺之痹。如留于气分就形成疝，留于血分就形成积。如身体中阳气盛就形成热，虚寒就形成寒。这些都是我们身体中阴阳虚实的变化。然而必须顺从四时的经气，辟除邪气，那么变乱之气就不会产生了。）
黄帝说：违背四时而导致乱气，是怎么回事？岐伯说：春天刺络脉，血气外溢，使人气短。春天刺肌肉，血气环逆，使人气逆上喘。春天刺筋骨，血气内着，使人腹胀。（这说的是血气随着时间循环运转，自有出入的限度，不能让它妄行。刺法，是用来取气的。春气在经脉，却取之于络脉，那么血气外溢，使人气短。至于肌肉，血气环逆，使人气逆上。环逆，就是逆其环转。说血气从经到络，从络到皮，从皮肤再环转于肌中。至于筋骨，血气内着，使人腹胀。王芳侯说：这里后来添出了“筋”字，大概是以四时六气而言，则春主筋，而少阳主筋；以形体层次而言，则是皮、肉、筋、骨。）
夏天刺经脉，血气枯竭，使人懈怠无力。夏天刺肌肉，血气内却，使人容易恐惧。夏天刺筋骨，血气上逆，使人容易愤怒。（夏气盛长，而血气已外出于孙络了。如果再取之于经脉，则血气内竭，使人懈怠。血脉出于阳明，外溢于肌腠，夏气在孙络，而使之溢于肌中，则血气虚却于内。阳明脉虚，则恐惧如被人追捕。夏气浮长于上，反而逆之使下，则气郁不疏，使人容易愤怒。原文“上逆”当作“下逆”。）
秋天刺经脉，血气上逆，使人容易遗忘。秋天刺络脉，气不外行，使人嗜卧不想动。秋天刺筋骨，血气内散，使人寒战发抖。（秋令降收，反而令其生长，所以使血气上逆，使人容易遗忘。血气从络脉充于皮肤，从皮肤内溢于肌肉。秋天刺络脉，则血气不外行于皮肤肌肉之间，所以使人嗜卧不想动。大概肌肉是脾所主的。脾病的人，嗜卧不想动。夫秋令始降，反而取之筋骨，使血气散于内，使人寒战发抖。按：秋气在皮肤，长夏之气在肌肉。长夏，是夏秋之交。本篇论述经脉之气，从经脉外出于孙络，从孙络充于皮肤，从皮肤内溢于肌中，从肌中注于筋骨。这说明皮肤尚属出机，至肌肉始属回转的降令。所以本章以肌肉主秋令，是从脉气环转的角度来说的。）
冬天刺经脉，血气皆脱，使人眼睛看不清。冬天刺络脉，内气外泄，停留成为大痹。冬天刺肌肉，阳气竭绝，使人容易遗忘。（冬天主闭藏，以奉春生之气，应藏而反泄之，所以使血气皆脱于内，使人眼睛看不清。大概五脏的精气，都灌注于眼睛而形成瞳神。冬天血气在中，内注骨髓，通达五脏。血气内脱，则五脏皆虚，所以使人眼睛看不清。冬天刺络脉，则内气外泄，停留成为大痹。大痹，是脏气虚而邪气痹于五脏。阳气生于阴中，出于肌腠，至冬令之时，复归于阴藏。冬天刺肌肉，是取所藏之气于肌腠之外，所以使阳气竭绝于内，使人容易遗忘。）
凡是这四时刺法，都是大逆之病，不可不顺从常法。反之，就会产生乱气相互侵淫的疾病。（凡是逆刺其四时的经气，则变生大病，所以不可不顺从。乱气，是变乱之气。相淫，是血气淫乱。这说不从四时之气，则正气变乱而为病。）
因此，针刺不知道四时的经脉规律，以及病的产生原因，把顺从当作违背，正气内部混乱，与精气相搏。（这说的是邪气常常随着四时的气血而入客体内。所以不知道四时的经脉，病的产生原因，把顺从当作违背，使正气内部混乱，而邪气与精气相搏。这篇重在六经的气血还转出入，宜顺而不宜逆。所以上节先论正气为病，此处才开始论邪气，下节又论正气。）
必须审慎诊察九候，正气才不会混乱，精气才不会逆回。（这说的是知道四时逆从的人，必须审察其九候。九候，有天、地、人。在天主气，在地主血，在人主脉。知道血气经脉出入的源流，则正气不会内部混乱，而精气也不会逆回了。）
黄帝说：好。针刺伤害五脏，中心一日死，其表现为嗳气；中肝五日死，其表现为多言；中肺三日死，其表现为咳嗽；中肾六日死，其表现为打喷嚏和呵欠；中脾十日死，其表现为吞咽动作。针刺伤及人的五脏必定死亡，其表现则根据该脏所变的征候，可以知道其死亡的时间。（刺五脏，是谓刺伤了五脏之气。大概三阴三阳的六气，名称合于皮肉筋骨脉，脉肉筋骨，内部合于五脏。如病肺痹肺风，脾痹脾疝，则应当取气于皮，取气于肉，不可逆刺以损伤其脏真。所以说：针刺伤及人的五脏必定死亡。各自根据其脏所变的征候，而知道其死期。大概刺五脏，则动其脏气，动脏气，则变候见于外。按：五脏外合五时，六经上应六气。《诊要经终篇》以六气应五脏而终于六经，本篇以六经应四时而终于五脏。《诊要篇》以经脉生于五脏而外合于六经，本篇以经脉本于六气而内连于五脏。大概脉气循行于皮肉筋骨，内合五行，外合六气，外内交互，相生始末出入。所以一篇的章句虽然相同，而旨意各不相同。学习者应当分析体会，不可以因为重复而忽视它。张兆璜说：《诊要篇》论述逆刺其脏气之所出而中伤五脏，所以说：凡刺胸腹者，必避五脏。本篇论述刺六经之内入而中伤五脏，所以说内通五脏。刺五脏中心一日死，是谓刺外合之皮肉筋骨脉，而不可中伤其脏。）
When the Jueyin (Liver/Pericardium) qi is in excess, it causes Yin Bi (painful obstruction syndrome of the yin aspect); when deficient, it causes Heat Bi. A slippery pulse indicates Hu Shen Feng (fox hernia and wind disease); a choppy pulse indicates accumulation of qi in the lower abdomen. (This discusses the internal correspondence of the Six Qi with the Five Zang organs. Mentioning Jueyin, Shaoyin, Taiyang, and Shaoyang refers to the diseases caused by the Six Qi. Mentioning skin, flesh, sinews, bones, and vessels refers to their external correspondences with the Five Zang organs due to the Six Qi. Mentioning Heart, Liver, Spleen, Lung, and Kidney refers to the sequence of the Five Zang organs due to the Six Qi. "Excess" means abundant qi and scarce blood; "deficiency" means both blood and qi are scarce. A slippery pulse indicates abundant yang qi and slight heat; a choppy pulse indicates abundant blood and scarce qi, with slight cold. "Bi" means obstruction; pain arises when blood and qi stagnate between the skin, flesh, sinews, and bones. Disease of qi is termed "Shan" (hernia), and disease of blood is termed "Ji" (accumulation). Generally, excessive qi generates heat, leading to Shan pain; excessive blood coagulates, forming Ji masses. Jueyin represents the extreme of yin. When yin reaches its extreme, yang is born, receiving the fire transformation of the intermediate Shaoyang, thus presenting both cold and heat syndromes. Jueyin governs the spring generating wind-wood qi, so it is discussed first. Zhang Zhaohuang asked: Jueyin only mentions cold and heat; why are the diseases of Shaoyang, sinews, and Liver included? The answer is: This discusses disease in the Six Qi extending to the Five Zang organs. Jueyin does not follow the root or branch but follows the intermediate qi. Following the intermediate means transforming via the intermediate qi.)
When the Shaoyin (Heart/Kidney) qi is in excess, it causes Pi Bi (skin obstruction) and Yin Zhen (hidden rashes/urticaria); when deficient, it causes Lung Bi. A slippery pulse indicates Lung Wind Shan; a choppy pulse indicates accumulation and hematuria. When the Taiyin (Spleen) qi is in excess, it causes Rou Bi (flesh obstruction) and Han Zhong (internal cold); when deficient, it causes Spleen Bi. A slippery pulse indicates Bi Wind and Shan; a choppy pulse indicates accumulation with occasional fullness of the heart and abdomen. When the Yangming (Large Intestine/Stomach) qi is in excess, it causes Mai Bi (vessel obstruction) and frequent body heat; when deficient, it causes Heart Bi. A slippery pulse indicates Heart Wind Shan; a choppy pulse indicates accumulation with frequent fright. When the Taiyang (Small Intestine/Bladder) qi is in excess, it causes Gu Bi (bone obstruction) and heavy body; when deficient, it causes Kidney Bi. A slippery pulse indicates Kidney Wind Shan; a choppy pulse indicates accumulation with frequent disorders of the vertex (top of the head). When the Shaoyang (Gallbladder/Triple Burner) qi is in excess, it causes Jin Bi (sinew obstruction) and hypochondriac fullness; when deficient, it causes Liver Bi. A slippery pulse indicates Liver Wind Shan; a choppy pulse indicates accumulation with frequent sinew stiffness and eye pain. (The Three Yin and Three Yang meridians have varying ratios of blood and qi; some have abundant blood and scarce qi, others abundant qi and scarce blood. Only the Yangming meridian has abundant blood and qi. Blood and qi are generated from Yangming. Ying blood circulates within the vessels, derived from the essence of water and grain from Yangming, ascending to the Heart, nourishing the vessels. Vessel qi returns to the Lung, which directs all vessels, distributing essence to the skin and hair. Hair and vessel essence combine, circulating qi through the Fu organs. Fu organs refer to the external skin, flesh, sinews, and bones. Fu essence combines with Shen Ming (spiritual brightness) and connects to the Five Zang organs. Qi returns to balance. This describes the origin, entry, and exit of vessel qi. Thus, Yangming excess or deficiency leads to Mai Bi and Heart Bi. The Heart governs vessels and ascends to the Lung; the Lung governs skin and hair. Hair and vessel essence combine at the skin level, hence Shaoyin causes Pi Bi and Lung Bi. Vessel qi disperses into skin and hair, then passes through Taiyin-governed flesh, Shaoyang-governed sinews, and Taiyang-governed bones, internally connecting to the Five Zang organs. Therefore, excess externally causes Rou Bi, Jin Bi, and Gu Bi; deficiency internally sinking causes Spleen Bi, Liver Bi, and Kidney Bi. Qi excess internally generates heat, causing Shan; blood excess internally generates cold, causing Ji. Thus, "Wind" is generated by heat; "Heavy body" indicates disease in qi; "Hematuria, abdominal fullness, fright, and eye pain" indicate disease in blood. These are the diseases caused by excess or deficiency in the generation, origin, entry, and exit of blood and qi governed by the Three Yin and Three Yang. Note: This chapter lacks an introductory question-answer format, continuing from the previous chapter.)
Therefore, Spring qi resides in the Jing-Main vessels; Summer qi resides in the Sun-Luo (collateral) vessels; Late Summer qi resides in the muscles; Autumn qi resides in the skin; Winter qi resides in the bone marrow. (This continues the discussion on how vessel qi follows the growth, flourishing, harvesting, and storage of the four seasons, emerging externally to the skin and internally connecting to the Five Zang organs, cycling endlessly.)
The Yellow Emperor said: I wish to hear the reason. Qibo said: In Spring, heavenly qi begins to open, earthly qi begins to disperse, ice melts, water flows, and meridians become unobstructed. Thus, human qi resides in the vessels. In Summer, vessel qi fills and overflows, entering Sun-Luo vessels to receive blood, making the skin robust. In Late Summer, both vessel and collateral qi are vigorous, overflowing internally into the muscles. In Autumn, heavenly qi begins to gather, pores close and seal, and the skin becomes tight. In Winter, things are hidden; blood and qi remain in the interior, anchoring in the bone marrow and connecting to the Five Zang organs. (Meridians are the interior; branches crossing horizontally are Luo vessels; distinct branches of Luo are Sun vessels. This is the process of blood and qi overflowing from Jing-Mains to Sun-Luos, filling the skin, returning internally to muscles, anchoring in bone marrow, and connecting to the Five Zang organs. This is vessel qi dispersing outside vessels and re-entering the Five Zang organs. Heaven is Yang, Earth is Yin; blood and qi arise from their union. The Kidneys govern winter water as the source of vital qi. Yangming is the repository where blood and qi are generated. Thus, when food enters the stomach, the vessel pathways flow; when water enters the vessels, blood forms. Relying on the vital qi in the Kidneys, Wu-Gui combination transforms, producing the essence of water and grain. Thus, heavenly opening and earthly dispersal lead to melting ice and flowing water, unblocking meridians. The Kidney's winter phase already receives spring-generating qi, so human qi begins in the vessels. This is human qi communicating with Heaven. Hence, "Spring generates, Summer flourishes, Autumn harvests, Winter stores" is the constant pattern of qi. Humans also respond to it. Dividing one day into four phases: morning is Spring, noon is Summer, sunset is Autumn, midnight is Winter. Morning qi begins to generate; noon qi grows; evening qi gathers; midnight qi resides in the Zang organs. Humans participate with Heaven and Earth. Note: The *Miao Ci* chapter discusses Wei qi moving first in the skin, filling Luo vessels first. When Luo vessels are full, Wei qi is balanced, Ying qi fills, and Jing-Mains become vigorous. This is Wei qi communicating inside the vessels. This chapter discusses blood and qi moving from Jing to Luo, from Luo to skin, from skin/muscles internally to bone marrow, connecting to the Five Zang organs. This is Ying blood moving outside the vessels. One must understand that "Ying moves in vessels, Wei moves outside vessels" refers to the whole-body meridians. Regarding the generation, origin, entry, and exit of blood and qi: Ying circulates in vessels, seeps outside vessels, fills the skin, warms the flesh, grows hair, enters internally to the Mu-Yuan (source) and connects to the Zang-Fu organs. It permeates everywhere inside and outside, above and below. If a physician thoroughly understands the source and flow of blood and qi, they can guide away pathogenic diseases. Thus, the Yellow Emperor said: Meridians are the basis of life, the cause of disease, the method of treatment, and the recovery from disease. They are the beginning of learning and the limit of skill. Crude physicians find them easy; superior physicians find them difficult. Those pursuing supreme skills must study the acupuncture chapters diligently.)
Therefore, pathogenic qi often enters and lodges in the body following the changes of blood and qi in the four seasons. Its variations cannot be measured by fixed standards, but one must follow the Jing-Main qi to dispel the pathogen. Once the pathogen is removed, chaotic qi will not arise. (Pathogenic qi refers to the Six Excesses of Heaven. Four-season blood and qi refer to Spring qi in vessels, Summer qi in Sun-Luos, Late Summer qi in muscles, Autumn qi in skin, and Winter qi in bone marrow. "Variations cannot be measured" means Heaven has Six Excess pathogens, and humans have transformations of the six qi in their form layers. If pathogen remains externally, it causes Bi of skin, flesh, sinews, and bones; if it combines internally, it causes Bi of the Heart, Liver, Spleen, Lung, and Kidney. If it stays in the qi level, it causes Shan; if it stays in the blood level, it causes Ji. If yang is excessive in the body, it causes heat; if deficient and cold, it causes cold. These are all variations of yin-yang and deficiency-excess within oneself. However, one must follow the four-season Jing-Main qi to dispel the pathogen, so that chaotic qi does not arise.)
The Yellow Emperor said: How does violating the four seasons generate chaotic qi? Qibo said: Puncturing Luo vessels in Spring causes blood and qi to overflow externally, leading to shortness of breath. Puncturing muscles in Spring causes blood and qi to reverse cyclically, leading to upward rushing of qi. Puncturing sinews and bones in Spring causes blood and qi to anchor internally, leading to abdominal distension. (This states that blood and qi cycle with time, having limits of entry and exit, and should not move recklessly. Puncture aims to extract qi. Spring qi is in the Jing-Mains; puncturing Luo vessels causes blood and qi to overflow externally, leading to shortness of breath. Puncturing muscles causes cyclic reversal of blood and qi, leading to upward qi rush. Cyclic reversal means opposing the cycle. It means blood and qi move from Jing to Luo, from Luo to skin, and cycle back to muscles. Puncturing sinews and bones causes blood and qi to anchor internally, leading to abdominal distension. Wang Fanghou noted: The character "sinew" was added later. Discussing four seasons and six qi, Spring governs sinews, and Shaoyang governs sinews. Discussing physical layers, it is skin, then flesh, then sinew, then bone.)
Puncturing Jing-Mains in Summer depletes blood and qi, leading to lethargy. Puncturing muscles in Summer causes blood and qi to retreat internally, leading to fearfulness. Puncturing sinews and bones in Summer causes blood and qi to reverse upward, leading to irritability. (Summer qi flourishes, and blood and qi have already emerged externally to Sun-Luos. Puncturing Jing-Mains further depletes blood and qi internally, causing lethargy. Vessels originate from Yangming and overflow externally to muscle clefts. Summer qi is in Sun-Luos; forcing it to overflow into muscles causes blood and qi to vacate internally. Vacant Yangming vessels cause fear as if being chased. Summer qi floats and grows upward; reversing it downward causes qi stagnation, leading to irritability. "Upward reversal" in the text should likely be "downward reversal".)
Puncturing Jing-Mains in Autumn causes blood and qi to reverse upward, leading to forgetfulness. Puncturing Luo vessels in Autumn prevents qi from moving externally, leading to drowsiness and lack of desire to move. Puncturing sinews and bones in Autumn causes blood and qi to scatter internally, leading to chills. (Autumn governs descending and gathering; reversing this promotes growth, causing blood and qi to reverse upward, leading to forgetfulness. Blood and qi fill the skin from Luo vessels and overflow internally to muscles. Puncturing Luo vessels in Autumn prevents blood and qi from moving externally to skin and muscles, causing drowsiness. Muscles are governed by the Spleen. Spleen disease causes drowsiness and reluctance to move. Autumn begins to descend; puncturing sinews and bones scatters blood and qi internally, causing chills. Note: Autumn qi is in the skin; Late Summer qi is in the muscles. Late Summer is the transition between Summer and Autumn. This chapter discusses vessel qi moving from Jing-Mains to Sun-Luos, filling the skin, overflowing internally to muscles, and anchoring in sinews and bones. Skin belongs to the exiting mechanism; muscles belong to the turning and descending command. Thus, this chapter assigns muscles to Autumn based on the cyclical nature of vessel qi.)
Puncturing Jing-Mains in Winter causes depletion of both blood and qi, leading to blurred vision. Puncturing Luo vessels in Winter causes internal qi to leak externally, remaining as major Bi. Puncturing muscles in Winter exhausts yang qi, leading to forgetfulness. (Winter governs closure and storage, supporting Spring generation. Storing but instead leaking causes blood and qi to deplete internally, leading to blurred vision. Essence of the Five Zang organs pours into the eyes to form the pupils. In Winter, blood and qi are in the interior, anchoring in bone marrow and connecting to the Five Zang organs. Internal depletion of blood and qi makes the Five Zang deficient, causing blurred vision. Puncturing Luo vessels in Winter leaks internal qi externally, remaining as major Bi. Major Bi is deficiency of Zang qi with pathogen obstructing the Five Zang organs. Yang qi is born in yin and emerges from muscle clefts. In Winter, it returns to yin storage. Puncturing muscles in Winter extracts stored qi from outside the muscle clefts, exhausting internal yang qi and causing forgetfulness.)
These four-season punctures are major violations. One must not deviate from the correct approach. Deviating results in chaotic qi mutually contaminating and causing disease. (Violating the four-season Jing-Main qi generates severe diseases; thus, one must follow the norm. Chaotic qi refers to disordered qi. Mutual contamination refers to the turbidity of blood and qi. This states that failing to follow the four-season qi causes righteous qi to become disordered and diseased.)
Therefore, if one does not know the Jing-Mains of the four seasons and the origin of disease, treating compliance as violation, righteous qi becomes internally chaotic, clashing with essence. (This reiterates that pathogenic qi enters following the four-season blood and qi. Not knowing the four-season Jing-Mains and disease origins, treating compliance as violation, causes righteous qi to become chaotic, with pathogens clashing with essence. This chapter emphasizes the circulation, entry, and exit of qi and blood in the Six Meridians, favoring compliance over violation. The previous section discussed righteous qi pathology; this section discusses pathogens; the next section discusses righteous qi again.)
One must carefully examine the Nine Palpations. Righteous qi will not be chaotic, and essence will not reverse. (This states that those who understand the compliance and violation of the four seasons must examine the Nine Palpations. The Nine Palpations include Heaven, Earth, and Man. Heaven governs qi, Earth governs blood, and Man governs vessels. Knowing the source and flow of blood, qi, and vessel entry/exit ensures righteous qi does not become chaotic and essence does not reverse.)
The Yellow Emperor said: Excellent. Puncturing the Five Zang organs: Hitting the Heart causes death in one day, with symptoms of belching. Hitting the Liver causes death in five days, with symptoms of excessive talking. Hitting the Lung causes death in three days, with symptoms of coughing. Hitting the Kidney causes death in six days, with symptoms of sneezing and yawning. Hitting the Spleen causes death in ten days, with symptoms of swallowing. Puncturing and injuring the Five Zang organs of humans inevitably leads to death. The symptoms manifest according to the transformations of the injured Zang, allowing one to predict the time of death. (Puncturing the Five Zang organs means injuring the qi of the Five Zang organs. The Six Qi of the Three Yin and Three Yang correspond to skin, flesh, sinews, bones, and vessels. Vessels, flesh, sinews, and bones internally correspond to the Five Zang organs. For example, Lung Bi and Lung Wind, Spleen Bi and Spleen Shan, require taking qi from the skin and flesh. One must not puncture inversely to injure the true Zang qi. Thus, it is said: Puncturing and injuring the Five Zang organs inevitably leads to death. Predicting death time relies on the transformation signs of each Zang. Puncturing the Five Zang organs agitates Zang qi; agitated Zang qi manifests externally as transformation signs. Note: The Five Zang externally correspond to the Five Seasons; the Six Meridians internally correspond to the Six Qi. The *Zhen Yao Jing Zhong* chapter aligns Six Qi with Five Zang ending in Six Meridians; this chapter aligns Six Meridians with Four Seasons ending in Five Zang. The *Zhen Yao* chapter derives vessels from Five Zang externally combining with Six Meridians; this chapter derives vessels from Six Qi internally connecting to Five Zang. Vessel qi circulates through skin, flesh, sinews, and bones, internally combining with Five Elements and externally combining with Six Qi. External and internal interactions drive generation and movement. Although the phrasing in this chapter may resemble others, the intent differs. Students should analyze and comprehend carefully, not neglect it due to repetition. Zhang Zhaohuang said: The *Zhen Yao* chapter discusses inverse puncture of Zang qi exit points injuring the Five Zang, stating: When puncturing the chest and abdomen, one must avoid the Five Zang. This chapter discusses internal penetration of Six Meridians injuring the Five Zang, stating: Internally connecting to the Five Zang. Hitting the Heart causes death in one day refers to puncturing the externally corresponding skin, flesh, sinews, bones, and vessels without injuring the Zang.)