春时之阳气方盛。阴气方衰。秋时之阴气方盛。阳气方衰。此天气之盛衰也。少者之气方盛。老者之气方衰。此人
气之盛衰也。
雷公请问气之多少。何者为逆。何者为从。（气之多少。问阴阳之气。有多有少。逆者。谓四时老少之气逆行。从、
顺也。）黄帝答曰。阳从左。阴从右。老从上。少从下。是以春夏归阳为生。归秋冬为死。反之。则归秋冬为生。是以气
多少。逆皆为厥。（四时之气。春夏为阳。秋冬为阴。阳从左者。谓春夏之气。从左而行于右。阴从右者。谓秋冬之气。
从右而行于左。老者之气。从上而下。犹秋气之从上而方衰于下。少者之气。从下而上。犹春气之从下而方盛于上。是
以春夏之气。归于阳之从左而右。气之顺也。故为生气。归于秋冬之从右而左。气之逆也。故为死气。反之。谓秋冬之
气。归于阴之从右而左为生。归于春夏之从左而右为逆。是以气之无论多少。逆者皆为厥也。此节总提四时老少之气。
而先论其天气之顺逆焉。闵士先曰。此与五常政大论。春气始于左。秋气始于右。春气始于下。秋气始于上同义。）问曰。
有余者厥耶。（复问人气之逆。乃有余者厥耶。）答曰。一上不下。寒厥到膝。少者秋冬死。老者秋冬生。（一者。一阴之
气也。一上不下。寒厥到膝。阴气自下而上。从井而至合也。阴气上行。秋冬之令也。故老者为顺。少者为逆。此盖以
人之阴阳。而应天地之四时也。）气上不下。头痛巅疾。（气者。一阳之气也。气上不下。头痛巅疾。阳气自下而直上于
巅顶也。愚谓此下当有少者春夏生。老者春夏死句。或简脱耶。按此二节。论人之阴阳二气。自下而上。以应天之四时。
年之老少。重在不下二字。盖一日之中。一时之间。阴阳出入。上下循环。有四时老少之气。如上而不下。则为厥逆矣。
岂果寒厥到膝。而老者秋冬可生。是以下文所云。倪仲玉问曰。论阴气曰寒厥到膝。论阳气曰头痛巅疾。是阳气之直上
于巅顶。而阴气止至于膝耶。曰。非也。阴阳二气。上下相同。犹天之寒暑往来。四时之收藏生长。夫肌腠气分为阳。
经脉血分为阴。阴气生于阳。阳气生于阴。故曰所出为井者。阳气从阴而出于脉外之处为井也。所入为合者。阴气从阳
分而入于经脉之中。亦从井至合。而与营血相会。故曰。所入为合。盖自井至合。则五行之气已周。复散行而上也。试
观寒厥之病。始于肘膝而不能回阳。则渐至额颅皆冷。此阴阳血气生始出入之要道。学人不可不细加参求。）求阳不得。
求阴不审。五部隔无征。若居旷野。若伏空室。绵绵乎属不满日。（夫老从上。少从下。此老幼百年之四时也。阳从左。
阴从右。此天地一岁之四时也。朝则为春。日中为夏。日入为秋。夜半为冬。此一日之有四时也。是老者一岁之中有春
夏。一日之中有春夏。少者一岁之中有秋冬。一日之中有秋冬。能顺一岁一日之四时。则百岁之气皆顺矣。岂老者止行
秋冬之令。而少者单行春夏乎。此盖以天之四时。合人之阴阳。以人之顺逆。应天之四时。是以不明天地人参合之道。
求阳而不得其气。求阴而不能审其微。以五部而候五时之气。若隔绝而无征验矣。夫四时之气。生于五方。人之形身。
乃神气之屋宇。若居旷野。不知四时之气也。若伏空室。不知人之阴阳也。绵绵乎天道之细微也。属、合也。不知天道
之微。而欲合人之阴阳。尚不能满一日之四时。而况能知有岁之阴阳乎。是以少气之厥。形之于梦。而合于四时。更见
其微渺之极也。）是以少气之厥。令人妄梦。其极至迷。（少气之厥。气虚而上逆也。梦者。魂魄神气之所游荡。是以上
行其极而至迷。迷者。远而迷也。夫有余之厥。自下而上。少气之厥。令人妄梦。而合于四时。是四时之气。合五脏之
神。五脏之阴阳。下行至足。阳气起于足五趾之表。阴气起于足五趾之里。循足上行。见于经脉。应于四时。）三阳绝。
三阴微。是为少气。（绝者。阳不与阴合也。五脏之阴气。不得阳气以和之。则三阴微。而五脏之气少矣。）是以肺气虚。
则使人梦见白物。见人斩血藉藉。得其时。则梦见兵战。（白物、金之象也。斩血。刑伤也。藉藉、野狼藉也。得其时、谓
得其秋令之时。则梦见兵战。盖得时气之助。而金气盛也。此先言秋冬而后言春夏。意谓天地之气。寒来则暑往。暑往
则寒来。日月营运。□□□□□复妇二审复也。）肾气虚。则使人梦见舟船溺人。得其时。则梦伏水中。若有畏恐。（海
山有弱水。虽芥羽亦沉溺。梦见舟船溺人。肾水之处弱也。得冬令之水气。故梦伏水中。若有畏恐。肾志虚也。）肝气虚。
则梦见菌香生草。得其时。则梦伏树下不敢起。（菌香、香蕈之小者。盖虽有生气而无根。梦伏树下。得春令之木气也。
不敢起者。虽得时气之助。而亦不能胜。）心气虚。则梦救火阳物。得其时。则梦燔灼。（救火、心气虚也。阳物、龙也。
乃龙雷之火游行也。得其时气之助。则君相二火并炎。故梦燔灼。倪仲玉曰。灼乃昭明之象。君火也。烧炙曰燔。在地
之火也。）脾气虚。则梦饮食不足。得其时。则梦筑垣盖屋。凡此五脏气虚。阳气有余。阴气不足。合之五诊。调之阴阳。
以在经脉。（脾气虚则梦取。故为饮食不足。梦筑垣盖屋。得时令之土气也。凡此五脏气虚。乃阳气有余。阴气不足。当
合之五诊。调之阴阳。以在经脉。而合于四时。）诊有十度。度人脉。度脏。度肉。度筋。度俞。度阴阳气。尽。人病自
具。脉动无常。散阴颇阳。脉脱不具。诊无常行。诊必上下。度民。君。卿。受师不卒。使术不明。不察逆从。是为妄
行。持雌失雄。弃阳附阴。不知并合。诊故不明。传之后世。反论自章。（此言持诊之道。四时五诊之外。而更有十度也。
度、度量也。十度者。度人脉。度脏。度肉。度筋。度俞。度阴阳气。度上下。度民。度君。度卿也。度人脉者。度人
合天地而成三部九候也。度脏者。度五脏之奇恒逆从也。度肉者。度人之形与气。相任则寿。不相任则夭。皮与肉相果
则寿。不相果则夭。如病而形肉脱者死。度筋者。手足三阴三阳之筋。各有所起。经于形身。病则宜用燔针劫刺也。度
俞者。五脏五俞。五五二十五俞。六腑六俞。六六三十六俞。经脉十二。络脉十五。凡二十七气以上下。所出为井。所
溜为荥。所注为俞。所行为经。所入为合。二十七气所行。皆在五俞也。度阴阳气者。度脏腑表里阴阳之气。尽者。谓
尽此法。而人病自具也。脉动无常。散在阴而又颇在阳。此病在情志。是以阴阳莫测。脉脱不具。必问而后得之。度上
下者。度气之通于天。病之变化也。度民者。度其尝富后贫。暴乐暴苦也。度君者。度王公大人。骄恣纵欲。禁之则逆
其志。顺之则加其病。当告之以其败。语之以其善。导之以其所便。开之以其所苦。人之情。莫不恶死而乐生。恶有不
听者乎。度卿者。度其尝贵后贱。封君败伤。故贵脱势。及欲侯王。是以受师不卒。使术不明。不察逆从。是为妄行。
持雌失雄。弃阳附阴。不知并合。诊故不明。传之后世。反论自章。雌雄、谓阴阳之配合。并合、血气之合并也。）至阴
虚。天气绝。至阳盛。地气不足。（水热穴论曰。肾者。至阴也。至阴者。盛水也。解精微论曰。积水者。至阴也。至阴
者。肾之精也。盖在天为气。在下为水。在气为阳。在肾为精。气生于水。阳生于精。是以至阴虚。天气绝。至阳者。
天之阳也。天地之气。日月营运。寒暑往来。交相和平者也。如天气盛。则地气不足矣。按太阴阳明篇曰。阳者。天气
也。主外。阴者。地气也。主内。故阳道实。阴道虚。故喉主天气。咽主地气。阳受风气。阴受湿气。是人之阴阳上下。
表里气血。以配天地之阴阳者也。）阴阳并交。至人之所行。阴阳并交者。阳气先至。阴气后至。（阴阳并交者。谓阴阳
寒暑之交相出入也。阳气先至者。谓四时之气。始于一阳初动。邵子之诗曰。冬至子之半。天心无改移。一阳初动处。
万物未生时。元酒味方淡。太音声正稀。此言如不信。更请问 牺。即此义也。至人者。和于阴阳。调于四时。呼吸精
气。独至守神。而复归于无极。故曰。阴阳并交。至人之所行。）是以圣人持诊之道。先后阴阳而持之。奇恒之势。乃六
十首。诊微合之事。追阴阳之变。章五中之情。其中之论。取虚实之要。定五度之事。知此乃足以诊。（先后阴阳而持之
者。按尺寸以候脉之来去也。奇恒之势。各以六十为首。即诊要经终。脉解诸篇所论是也。合微之事者。声合五音。色
合五行。脉合阴阳也。阴阳之变者。天地阴阳之气。有德化政令。变易灾眚也。五中之情。五内之情志也。取虚实之要。
定五度之事者。取虚实而定五度也。五度者。度神之有余有不足。气有余有不足。血有余有不足。形有余有不足。志有
余有不足也。又有五实死。五虚死。其时有生者。如浆粥入胃。泄注止。则虚者活。身汗得后利。则实者活。此皆圣人
持诊之要道。不可不知也。）是以切阴不得阳。诊消亡。得阳不得阴。守学不湛。知左不知右。知右不知左。知上不知下。
知先不知后。故治不久。知丑知善。知病知不病。知高知下。知坐知起。知行知止。用之有纪。诊道乃具。万世不殆。
起所有余。知所不足。（湛音耽。持诊之道。有阴阳逆从。有左右前后。上下之诊。论在脉要精微篇中。湛、甚也。丑善、
脉证之有善恶也。有余之病。则起而行。不足之病。多坐而卧。知起之所为有余。则知所以不足。盖知此即可以知彼。
知一可以知十也。）度事上下。脉事因格。是以形弱气虚死。形气有余。脉气不足死。脉气有余。形气不足生。（此言持
诊之道。当兼度其形气也。事者。谓其通变也。上下者。气之通于天。病之变化也。格、穷究也。言当先度其上下之通
变。因而穷究其脉之通变。是以形弱气虚者死。此又无论其脉之平与不平。度其形气而知其死矣。形气有余。脉气不足
者死。脉气有余。形气不足者生。是当以形证脉气通变审之。而后可必其死生也。）是以诊有大方。坐起有常。出入有行。
以转神明。必清必静。上观下观。司八正邪。别五中部。按脉动静。循尺滑涩。寒温之意。视其大小。合之病能。逆从
以得。复知病名。诊可十全。不失人情。故诊之。或视息视意。故不失条理。道甚明察。故能长久。不知此道。失经绝
理。亡言妄期。此谓失道。（转神明者。运已之神。以候彼之气也。上观下观者。若视深渊。若迎浮云也。八正者。日月
星辰。四时之气也。别五中部。先别五脏之脉也。按脉动静。候其浮沉迟数也。循尺滑涩。寒温之意。谓脉滑者。尺之
皮肤亦滑。脉涩者。尺之皮肤亦涩。尺肤滑其淖泽者。风也。尺肤涩者。风痹也。尺肤热甚。脉甚躁者。病温也。尺肤
寒。其脉小者。泄少气。尺肤炬然。先热后寒者。寒热也。尺肤先寒。久大之而热者。亦寒热也。故善调尺者。不待于
寸。善调脉者。不待于色。能参合而行之者。可以为上工也。视其脉之大小。合之病能。病能者。奇恒之病也。逆从者。
神转不回。回则不转也。名□□之实也。能正其□□□□□诊有十全。参其人情矣。视息者。候呼吸之往来。脉之去至
也。视意者。闭户塞牖。系之病者。数问其情。以从其意。得神者昌。失神者亡。亡言者。亡妄之言。不知诊道。妄与
生死之期。此失经绝理。是谓失道矣。）
春季时，阳气正旺盛，阴气正衰弱；秋季时，阴气正旺盛，阳气正衰弱。这是自然界气候的盛衰变化。年少者的正气正旺盛，年老者的正气正衰弱。这是人体正气的盛衰变化。
雷公请问：人体之气的多少如何区分？什么是逆证，什么是从证（顺证）？（所谓气的多少，是询问阴阳之气的多寡。逆，是指四季老少之气运行方向相反；从，即顺。）黄帝回答说：阳从左行，阴从右行，老从上降，少从上升。因此，春夏之气归于阳为生，归于秋冬为死；反之，若秋冬之气归于阴为生，归于春夏为逆。所以，无论气的多少，凡是逆乱的都会导致厥证。（四时之气，春夏属阳，秋冬属阴。阳从左者，指春夏之气从左向右运行；阴从右者，指秋冬之气从右向左运行。老者之气，自上而下，如同秋气从上向下逐渐衰退于下；少者之气，自下而上，如同春气从下向上逐渐旺盛于上。因此，春夏之气归于阳，顺应从左向右的运行规律，气机顺畅，故为生气；归于秋冬，顺应从右向左的运行规律，气机逆乱，故为死气。反之，指秋冬之气归于阴，顺应从右向左为生机；归于春夏，顺应从左向右则为逆乱。因此，无论气的多少，凡是逆乱的都会导致厥证。这一节总括了四季老少之气，先论述天气的顺逆。闵士先说：这与《五常政大论》中“春气始于左，秋气始于右；春气始于下，秋气始于上”的意义相同。）问道：有余导致的厥证是怎样的？（再次询问人气逆乱，是否因有余而致厥？）回答：一阴之气上行而不下降，会导致寒厥至膝。年少者在秋冬季节死亡，年长者在秋冬季节生存。（“一”指一阴之气。一上不下，寒厥至膝，说明阴气自下而上，从井穴行至合穴。阴气上行，符合秋冬的时令特征。因此，对年长者来说是顺证，对年少者是逆证。这大概是以人的阴阳来对应天地的四时。）
阳气上行而不下降，会导致头痛和头顶疾病。（这里的“气”指一阳之气。气上不下，头痛巅疾，说明阳气自下直冲头顶。我认为此处下文应当有“少者春夏生，老者春夏死”的句子，或许是简略脱漏了。按此两节内容，论述人的阴阳二气自下而上，以应天地的四时和年龄的老少，重点在于“不下”二字。因为在一日之中、一时之间，阴阳出入，上下循环，具有四季老少之气的特点。如果气只上不下，就会发生厥逆。难道真的是寒厥至膝，且年长者在秋冬就能生存吗？所以下文倪仲玉问道：论述阴气时说寒厥至膝，论述阳气时说头痛巅顶，这是阳气直上巅顶，而阴气只止于膝盖吗？回答说：不是的。阴阳二气上下运行是相同的，就像天地的寒暑往来、四季的收藏生长一样。肌腠和气分为阳，经脉和血分为阴。阴气生于阳，阳气生于阴。所以说“所出为井”，是指阳气从阴分出于脉外的地方叫井穴；“所入为合”，是指阴气从阳分进入经脉之中，也从井穴行至合穴，与营血相会。所以说“所入为合”。从井穴到合穴，五行之气已经周流一遍，然后分散上行。试看寒厥的病，开始于肘膝部位不能回阳，则逐渐导致额头和颅骨皆冷。这是阴阳血气生始出入的要道，学习的人不可不仔细参悟探究。）
求索阳气却不得其法，审察阴气却不明确，五脏五部的征象隔绝而无验证，就像居住在旷野，又像伏在空室之中，天道细微难测，连绵不绝却不到一天。（“老从上，少从下”，这是老幼百年生命周期的四个阶段。“阳从左，阴从右”，这是天地一年中的四个季节。早晨为春，中午为夏，日落为秋，夜半为冬，这是一日中的四个季节。年长者在一岁中有春夏，在一日中也有春夏；年少者在一岁中有秋冬，在一日中也有秋冬。如果能顺应一岁和一日的四时变化，那么百年的气机都顺畅了。难道年长者只行秋冬之令，而年少者只行春夏之令吗？这大概是将天地的四时与人的阴阳相结合，以人的顺逆来应合天地的四时。如果不明白天地人相合的道理，求索阳气却得不到其气，求索阴气而不能审察其微细，用五脏五部来候察五时之气，就会像隔绝了一样没有验证。四时之气生于五方，人的形体是神气的屋宇。如果像居住在旷野，就不知道四时之气；如果像伏在空室，就不知道人的阴阳。天道细微难测，想要结合人的阴阳，尚且不能满一日之四时，更何况能知道一年的阴阳呢？因此，少气导致的厥证，会表现为妄梦，并与四时相合，更加显示出其微渺至极。）
因此，少气导致的厥证，使人做荒诞的梦，严重时甚至昏迷。（少气之厥，是气虚而上逆。梦是魂魄神气游荡的结果，所以上行至极点而导致昏迷。迷，就是远而迷失。有余之厥，病势自下而上；少气之厥，使人做妄梦，并与四时相合。这说明四时之气与五脏之神相合，五脏的阴阳下行至足底，阳气起于足五趾的表面，阴气起于足五趾的里面，沿足部上行，见于经脉，应于四时。）
三阳绝，三阴微，这就是少气。（“绝”，指阳不与阴相合。五脏的阴气，得不到阳气的调和，就会导致三阴微弱，五脏之气减少。）
因此，肺气虚，就会梦见白色物体，看见被人斩杀、鲜血狼藉的景象，如果遇到对应的时令，就会梦见兵战。（白色物体，是金的象征。斩血，代表刑伤。藉藉，形容野狼藉般杂乱。得其时，指得到秋季的时令，就会梦见兵战。这是因为得时令之气的帮助，金气旺盛。这里先言秋冬后言春夏，意思是天地之气，寒来则暑往，暑往则寒来，日月运行……复妇二审复也。）
肾气虚，就会梦见舟船溺水之人，如果遇到对应的时令，就会梦见趴在水中，好像充满畏惧恐惧。（海山有弱水，即使是芥菜籽般的羽毛也会沉溺。梦见舟船溺水，说明肾水之处虚弱。得到冬季的水气，所以梦见趴在水中，好像充满畏惧恐惧，这是肾志虚弱。）
肝气虚，就会梦见菌香和小草生长，如果遇到对应的时令，就会梦见趴在树下不敢起来。（菌香，是小香蕈。虽然有生气但没有根。梦见趴在树下，是得到春季的木气。不敢起来，是因为虽然得时令之气的帮助，但也无法胜任。）
心气虚，就会梦见救火或阳物，如果遇到对应的时令，就会梦见焚烧灼热。（救火，表示心气虚。阳物，指龙，是龙雷之火游行。得到时令之气的帮助，君火和相火一起燃烧，所以梦见焚烧灼热。倪仲玉说：灼是昭明的象征，属于君火；烧炙叫做燔，属于地之火。）
脾气虚，就会梦见饮食不足，如果遇到对应的时令，就会梦见筑墙盖房。（脾气虚则梦取，所以梦见饮食不足。梦见筑墙盖房，是得时令的土气。凡此五脏气虚，乃是阳气有余，阴气不足。应当结合五诊，调治阴阳，依据经脉的变化。）
诊察有十度，度量人脉，度量脏，度量肉，度量筋，度量俞，度量阴阳气，如此则人的病情自然具备。脉动无常，散在阴而又偏颇在阳，脉象脱落不完整，诊察就没有常规可循。诊察必须上下兼顾，度量民众，度量君主，度量卿大夫。如果跟随老师学习未结业，医术就不高明，不考察逆从关系，这就叫做妄行。持雌失雄，弃阳附阴，不知道合并参详，诊察自然不明。流传给后世，反而使谬论彰显。（这里讲持诊之道，除了四时五诊之外，还有十度。度，即度量。十度包括：度人脉、度脏、度肉、度筋、度俞、度阴阳气、度上下、度民、度君、度卿。度人脉，是度量人合于天地形成的三部九候。度脏，是度量五脏的奇恒逆从。度肉，是度量人的形体与气，相互匹配则长寿，不匹配则夭折，皮肉紧密则长寿，不紧密则夭折，如生病而形肉脱失者死。度筋，手足三阴三阳的筋各有起点，经过形体，生病则宜用燔针劫刺。度俞，五脏有五俞，共二十五俞；六腑有六俞，共三十六俞；经脉十二，络脉十五，共二十七气上下运行。所出为井，所溜为荥，所注为俞，所行为经，所入为合。二十七气运行，都在五俞之中。度阴阳气，是度量脏腑表里阴阳之气。尽，指尽用此法，则人病自然具备。脉动无常，散在阴又偏颇在阳，这是情志病，所以阴阳莫测。脉象脱落不完整，必须询问后才能得知。度上下，是度量气通于天，病的变化。度民，是度量其曾富后贫，突然快乐突然痛苦。度君，是度量王公大人骄纵欲望，禁止则违背其意志，顺从则加重病情，应当告知其败坏后果，告诉其好处，引导其便利，开导其痛苦。人之常情，无不恶死乐生，哪有不听劝告的呢？度卿，是度量其曾贵后贱，封君败伤，所以贵去势失，以及想侯王的心态。因此，跟随老师学习未结业，医术不明，不察逆从，是为妄行。持雌失雄，弃阳附阴，不知并合，诊故不明，传之后世，反论自章。雌雄，指阴阳配合；并合，指血气合并。）
至阴虚，天气绝；至阳盛，地气不足。（《水热穴论》说：肾，是至阴。至阴，盛水。《解精微论》说：积水者，是至阴。至阴，是肾之精。在天为气，在下为水，在气为阳，在肾为精。气生于水，阳生于精。所以至阴虚，天气就绝。至阳，是天之阳。天地之气，日月运行，寒暑往来，交相和平。如果天气盛，地气就不足。按《太阴阳明篇》说：阳，是天气，主外；阴，是地气，主内。所以阳道实，阴道虚。喉主天气，咽主地气。阳受风气，阴受湿气。这是人的阴阳上下、表里气血，配合同天地的阴阳。）
阴阳并交，是至人的修行方法。阴阳并交，指阳气先到，阴气后到。（阴阳并交，指阴阳寒暑交替出入。阳气先到，指四时之气始于一阳初动。邵雍的诗说：“冬至子之半，天心无改移。一阳初动处，万物未生时。元酒味方淡，太音声正稀。此言如不信，更请问牺。”即此义。至人，是与阴阳和谐，调适四时，呼吸精气，独守精神，而复归于无极。所以说，阴阳并交，是至人的修行。）
因此圣人持诊之道，先后审视阴阳而把握它。奇恒之势，以六十首为纲领，诊察微妙相合之事，追索阴阳的变化，阐明五脏的情志。其中的理论，取虚实的关键，确定五度的事务。懂得这些就足以进行诊察。（先后阴阳而持之，是按尺寸脉来候察脉的来去。奇恒之势，各以六十为首，即《诊要经终》、《脉解》等篇所论述的。合微之事，声音合五音，面色合五行，脉象合阴阳。阴阳的变化，指天地阴阳之气有德化政令、变易灾眚。五中之情，指五脏的情志。取虚实之要，定五度之事，指取虚实而定五度。五度，指度量神的有余不足，气的有余不足，血的有余不足，形的有余不足，志的有余不足。又有五实死、五虚死，但有时有生机，如浆粥入胃，泄注止，则虚者活；身汗得后利，则实者活。这些都是圣人持诊的要道，不可不知。）
因此，切阴脉不得阳脉，诊察消亡；得阳脉不得阴脉，学问不精深。知左不知右，知右不知左，知上不知下，知先不知后，所以治疗不能持久。知丑知善，知病知不病，知高知下，知坐知起，知行知止，运用有纪律，诊道才具备，万世不殆。从有余之处探起，知晓不足之处。（湛音耽。持诊之道，有阴阳逆从，有左右前后、上下之诊，论述在《脉要精微篇》中。湛，甚也。丑善，指脉证的善恶。有余的病，则起身行动；不足的病，多坐卧。知道起身是有余的表现，就知道什么是不足。懂得这个就可以懂得那个，懂一可以知十。）
度量事情上下，脉事因此可穷究。因此，形弱气虚者死，形气有余而脉气不足者死，脉气有余而形气不足者生。（这里讲持诊之道，应当兼度形气。事，指通变。上下，指气通于天，病的变化。格，穷究。言当先度量上下之通变，进而穷究脉的通变。因此形弱气虚者死，这无论脉平或不平，度量形气而知其死。形气有余，脉气不足者死；脉气有余，形气不足者生。应当以形证脉气通变来审察，然后可必知其死生。）
因此诊察有大方，坐起有常规，出入有行度，以运转神明，必须清静。上观下观，司察八正邪气，辨别五中部脉，按脉动静，循尺滑涩，体会寒温之意，视其大小便，合之病能。逆从得以掌握，再知病名，诊可十全，不失人情。所以诊察，有的观察呼吸，有的观察心意，所以不失条理。道很明察，所以能长久。不懂此道，背离经典绝灭理法，胡言乱语妄定死期，这叫失道。（转神明，是运用自己的神，以候察彼处的气。上观下观，像看深渊，像迎浮云。八正，指日月星辰、四时之气。别五中部，先辨别五脏之脉。按脉动静，候其浮沉迟数。循尺滑涩，寒温之意，谓脉滑者，尺肤亦滑；脉涩者，尺肤亦涩。尺肤滑而淖泽，是风；尺肤涩，是风痹；尺肤热甚，脉甚躁，是温病；尺肤寒，脉小，是泄泻少气；尺肤炬然，先热后寒，是寒热；尺肤先寒，久按之大热，也是寒热。所以善于调尺的，不待于寸；善于调脉的，不待于色。能参合而行的，可以为上工。视其脉之大小，合之病能。病能，指奇恒之病。逆从，指神转不回，回则不转。名……之实。能正其……诊有十全，参其人情。视息，候呼吸往来，脉之去至。视意，闭户塞牖，系之病者，数问其情，以从其意。得神者昌，失神者亡。亡言，指亡妄之言。不知诊道，妄与生死之期，这是失经绝理，谓之失道矣。）
In spring, the Yang Qi (Yang Energy) is flourishing while the Yin Qi (Yin Energy) is waning; in autumn, the Yin Qi is flourishing while the Yang Qi is waning. This represents the fluctuation of celestial climate. The Qi of the young is flourishing, while the Qi of the elderly is waning. This represents the fluctuation of human vitality.
Lei Gong asked: How are the degrees of Qi distinguished? What constitutes a "Ni" (Rebellious/Counterflow) pattern and what constitutes a "Cong" (Compliant/Following) pattern? (The degree of Qi refers to the inquiry into the abundance or scarcity of Yin and Yang Qi. "Ni" refers to the counterflow of the Qi of the seasons and ages; "Cong" means compliance or following.) The Yellow Emperor answered: Yang follows from the left, Yin follows from the right; the elderly follow descending from above, the young follow ascending from below. Therefore, the Qi of Spring and Summer归属于 Yang leads to life, while归属于 Autumn and Winter leads to death; conversely, if the Qi of Autumn and Winter归属于 Yin leads to life, and归属于 Spring and Summer is rebellious. Thus, regardless of the abundance or scarcity of Qi, any rebellion results in Jue (Syncope/Cold Extremities). (The Qi of the four seasons: Spring and Summer belong to Yang, Autumn and Winter belong to Yin. "Yang from the left" means the Qi of Spring and Summer moves from left to right; "Yin from the right" means the Qi of Autumn and Winter moves from right to left. The Qi of the elderly descends from above, similar to Autumn Qi declining from above downwards; the Qi of the young ascends from below, similar to Spring Qi flourishing from below upwards. Thus, the Qi of Spring and Summer归属于 Yang, following the compliant movement from left to right, is smooth Qi, hence generating Qi;归属于 Autumn and Winter, following the rebellious movement from right to left, is rebellious Qi, hence dying Qi. Conversely, it means the Qi of Autumn and Winter归属于 Yin, compliant from right to left, generates life;归属于 Spring and Summer, compliant from left to right, is rebellious. Therefore, whether Qi is abundant or scarce, rebellion leads to Jue. This section summarizes the Qi of the four seasons and ages, first discussing the compliance or rebellion of celestial Qi. Min Shixian stated: This shares the same meaning as *Wu Chang Zheng Da Lun*: "Spring Qi begins on the left, Autumn Qi begins on the right; Spring Qi begins below, Autumn Qi begins above.") He asked: Is the Jue caused by excess? (Further inquiring about the rebellion of human Qi, is it due to excess?) The answer is: If one Yin Qi ascends but does not descend, Cold Jue reaches the knees. The young die in Autumn and Winter, while the elderly survive in Autumn and Winter. ("One" refers to the Qi of One Yin. Ascending without descending, Cold Jue reaches the knees, indicating Yin Qi ascending from below, moving from Jing-Well points to He-Sea points. Yin Qi ascending conforms to the command of Autumn and Winter. Thus, for the elderly, this is compliant; for the young, it is rebellious. This likely corresponds human Yin and Yang to the four seasons of heaven.)
If Yang Qi ascends but does not descend, it causes headache and disorders at the vertex. (Here, "Qi" refers to the Qi of One Yang. Qi ascending without descending, causing headache and vertex disorders, indicates Yang Qi rising straight to the vertex from below. I believe there should be a sentence below: "The young survive in Spring and Summer, the elderly die in Spring and Summer," which may have been omitted. These two sections discuss how human Yin and Yang Qi ascend from below to correspond to the four seasons and age. The emphasis is on "not descending." Within a day or an hour, Yin and Yang exit and enter, cycling up and down, possessing the Qi of four seasons and ages. If Qi only ascends and does not descend, Jue rebellion occurs. Does it really mean Cold Jue reaches the knees, allowing the elderly to survive in Autumn and Winter? Hence, Ni Zhongyu asks below: Discussing Yin Qi, it says Cold Jue reaches the knees; discussing Yang Qi, it says headache at the vertex. Does this mean Yang Qi goes straight to the vertex, while Yin Qi stops at the knees? The answer is no. The upper and lower movements of Yin and Yang Qi are identical, just like the alternation of cold and heat in heaven and earth, and the storage and growth of the four seasons. Muscle tissue and Qi division belong to Yang; meridians and blood division belong to Yin. Yin Qi is born from Yang, and Yang Qi is born from Yin. Thus, "what exits is Jing-Well" refers to the place where Yang Qi exits Yin and emerges outside the vessels, called Jing-Well. "What enters is He-Sea" refers to Yin Qi entering the meridians from the Yang division, also moving from Jing-Well to He-Sea to meet Ying-Blood. Thus, "what enters is He-Sea." From Jing-Well to He-Sea, the Qi of the Five Elements has circulated completely, then disperses and ascends. Observe the disease of Cold Jue: it starts at the elbows and knees and cannot return Yang, gradually leading to coldness in the forehead and skull. This is the crucial path of the birth, entry, and exit of Yin-Yang and Blood-Qi. Students must carefully investigate this.)
Seeking Yang yields nothing; examining Yin lacks clarity. The signs of the five departments are isolated and unverifiable, like dwelling in a wilderness or lying in an empty room, with the subtle Way of Heaven stretching endlessly yet lasting less than a day. ("Elderly from above, young from below" refers to the four stages of a century-long life. "Yang from left, Yin from right" refers to the four seasons of a year. Morning is Spring, noon is Summer, sunset is Autumn, midnight is Winter—these are the four seasons of a day. The elderly have Spring and Summer within a year and within a day; the young have Autumn and Winter within a year and within a day. If one can comply with the four seasons of a year and a day, the Qi of a hundred years will be compliant. Can it be that the elderly only follow the command of Autumn and Winter, while the young only follow Spring and Summer? This integrates the four seasons of heaven with human Yin and Yang, using human compliance/rebellion to respond to heavenly seasons. Without understanding the integration of Heaven, Earth, and Man, seeking Yang fails to obtain its Qi, and seeking Yin fails to examine its subtleties. Using the five departments to observe the Qi of the five times results in isolation and lack of verification. The Qi of the four seasons is born in the five directions; the human body is the house of Spirit and Qi. Dwelling in the wilderness implies ignorance of seasonal Qi; lying in an empty room implies ignorance of human Yin and Yang. The Way of Heaven is subtle; attempting to integrate human Yin and Yang without knowing the subtleties of Heaven cannot even cover the four seasons of a day, let alone know the Yin and Yang of a year. Thus, Jue caused by deficient Qi manifests as wild dreams, aligning with the four seasons, showing extreme subtlety.)
Therefore, Jue caused by deficient Qi makes people dream wildly, and at its extreme, leads to confusion. (Jue of deficient Qi is Qi deficiency with rebellious ascent. Dreams are the wandering of Hun, Po, and Shen Qi; thus, ascending to the extreme leads to confusion. Confusion is being lost in distance. Jue of excess rises from below; Jue of deficient Qi causes wild dreams aligning with the four seasons. This shows that the Qi of the four seasons combines with the Spirits of the Five Zang organs. The Yin and Yang of the Five Zang descend to the feet: Yang Qi originates from the exterior of the five toes, Yin Qi from the interior, ascending along the feet, appearing in the meridians, and responding to the four seasons.)
When the Three Yang are exhausted and the Three Yin are minute, this is called Deficient Qi. ("Exhausted" means Yang does not combine with Yin. The Yin Qi of the Five Zang, lacking Yang Qi to harmonize it, becomes minute, resulting in deficient Qi of the Five Zang.)
Therefore, when Lung Qi is deficient, one dreams of white objects, seeing people slaughtered with blood scattered everywhere. If encountering the corresponding season, one dreams of battles. (White objects symbolize Metal. Slaughtered blood represents punishment/injury. Scattered describes chaos. "Encountering the time" means receiving the command of Autumn, leading to dreams of battle because Metal Qi is strengthened by seasonal aid. Here, Autumn/Winter are mentioned before Spring/Summer, implying that Heavenly Qi alternates: cold comes, heat goes; heat goes, cold comes. Sun and moon operate...)
When Kidney Qi is deficient, one dreams of boats capsizing and people drowning. If encountering the corresponding season, one dreams of lying submerged in water, feeling fear. (Weak waters in seas and mountains sink even light feathers. Dreaming of drowning indicates weakness in Kidney Water. Receiving Winter Water Qi leads to dreaming of submersion and fear, reflecting weak Kidney Will.)
When Liver Qi is deficient, one dreams of mushrooms and grass growing. If encountering the corresponding season, one dreams of lying under trees, afraid to rise. (Mushrooms are small fungi; though alive, they lack roots. Dreaming of lying under trees reflects receiving Spring Wood Qi. Afraid to rise indicates inability to withstand the seasonal aid despite receiving it.)
When Heart Qi is deficient, one dreams of fighting fires or seeing Yang objects. If encountering the corresponding season, one dreams of burning and scorching. (Fighting fire indicates Heart Qi deficiency. Yang object refers to dragons, representing roaming Dragon-Thunder Fire. With seasonal aid, Ministerial and Sovereign Fires blaze, causing dreams of burning. Ni Zhongyu said: Scorching is the image of brightness, belonging to Sovereign Fire; roasting is called Fan, belonging to Earth Fire.)
When Spleen Qi is deficient, one dreams of insufficient food and drink. If encountering the corresponding season, one dreams of building walls and houses. (Deficient Spleen Qi leads to dreams of taking, hence insufficient food/drink. Dreaming of building walls/houses reflects receiving seasonal Earth Qi. All these cases of Five Zang Qi deficiency involve Excess Yang and Deficient Yin. They should be combined with the Five Diagnostics, regulating Yin and Yang according to the meridians.)
Diagnosis involves ten measurements: measuring pulse, Zang organs, flesh, sinews, Shu points, and Yin-Yang Qi. Doing so reveals the patient's condition naturally. Pulse movement is irregular; scattering in Yin and deviating in Yang indicates emotional illness, making Yin-Yang unpredictable. If pulse is absent/incomplete, inquiry is necessary. Measuring up and down assesses Qi connecting to Heaven and disease changes. Measuring commoners assesses sudden wealth/poverty or joy/sorrow. Measuring rulers assesses arrogant nobles whose desires must be guided rather than suppressed. Measuring ministers assesses those who fell from power or seek status. Thus, incomplete apprenticeship leads to unclear techniques, failure to observe compliance/rebellion, reckless action, losing balance between Yin/Yang, ignoring combination, unclear diagnosis, transmitting errors, and validating fallacies. (This discusses diagnostic principles beyond the four seasons and five diagnostics, adding ten measurements. Measurement includes: pulse, Zang, flesh, sinews, Shu, Yin-Yang, up/down, commoners, rulers, ministers. Measuring pulse checks the Three Parts and Nine Positions conforming to Heaven/Earth. Measuring Zang checks normal/abnormal patterns of the Five Zang. Measuring flesh checks body/Qi compatibility for longevity. Measuring sinews checks origins of Twelve Meridians' sinews for cauterization. Measuring Shu checks Twenty-Eight Qi pathways through Jing-Well, Ying-Spring, Shu-Stream, Jing-River, He-Sea points. Measuring Yin-Yang checks Zang-Fu exterior-interior Qi. "Complete" means mastering this method reveals disease. Irregular pulse scattering in Yin/deviating in Yang suggests emotional etiology. Measuring up/down assesses celestial connection/disease evolution. Measuring commoners/rulers/ministers addresses psychosocial factors. Yin/Yang pairing and Qi/Blood merging are essential for accurate diagnosis.)
Extreme Yin deficiency cuts off Heavenly Qi; Extreme Yang abundance depletes Earthly Qi. (*Shui Re Xue Lun* states: Kidney is Extreme Yin, storing Water. *Jie Jing Wei Lun* states: Accumulated water is Extreme Yin, the essence of Kidney. In Heaven it is Qi, in Earth it is Water; in Qi it is Yang, in Kidney it is Essence. Qi is born from Water, Yang from Essence. Thus, Extreme Yin deficiency cuts off Heavenly Qi. Extreme Yang is Heavenly Yang. Heaven and Earth Qi alternate harmoniously. If Heavenly Qi is abundant, Earthly Qi is deficient. *Tai Yin Yang Ming Pian* states: Yang is Heavenly Qi, external; Yin is Earthly Qi, internal. Yang path is solid, Yin path is hollow. Throat governs Heavenly Qi, pharynx governs Earthly Qi. Yang receives Wind, Yin receives Dampness. Human Yin-Yang, interior-exterior, Blood-Qi correspond to Heaven-Earth Yin-Yang.)
Yin and Yang intersecting is the practice of the Perfect Person. Intersection means Yang arrives first, Yin follows. (Intersection refers to the interplay of Yin-Yang and cold-heat. Yang arriving first means Four Seasons Qi begin with the initial movement of Yang. As Shao Yong's poem says: "At the midpoint of Winter Solstice... One Yang initially moves..." The Perfect Person harmonizes with Yin-Yang, adjusts to four seasons, breathes Essence, guards Spirit, and returns to Wuji. Thus, Yin-Yang intersection is the Perfect Person's practice.)
Therefore, Sages diagnose by prioritizing Yin and Yang. The patterns of Normal and Abnormal consist of sixty chapters. Diagnosing subtle combinations traces Yin-Yang changes and clarifies Five Internal Emotions. The theory takes the essence of Deficiency/Excess and establishes the Five Measurements. Knowing this suffices for diagnosis. (Prioritizing Yin-Yang involves checking Cun/Cun pulses. Normal/Abnormal patterns use sixty chapters as guides, as in *Zhen Yao Jing Zhong* and *Mai Jie*. Combining subtleties matches voice to Five Tones, color to Five Elements, pulse to Yin-Yang. Yin-Yang changes involve transformations and disasters. Five Internal Emotions refer to Zang emotions. Taking Deficiency/Excess essence determines the Five Measurements: Spirit, Qi, Blood, Form, Will. Five Excess deaths and Five Deficiency deaths exist, but survival is possible if Stomach Qi recovers (e.g., soup enters stomach, diarrhea stops) or Excess resolves (sweat, bowel movement). These are key diagnostic principles.)
If cutting Yin yields no Yang, decline and death occur; obtaining Yang but not Yin indicates shallow learning. Knowing Left but not Right, Right but not Left, Up but not Down, First but not Last, leads to ineffective treatment. Knowing ugly/good, sick/healthy, high/low, sitting/standing, walking/stopping, with discipline, completes the diagnostic Way, ensuring safety for generations. Starting from Excess, identify Deficiency. (Zhan means profound. Diagnostic Way includes Yin-Yang compliance, Left/Right, Up/Down, detailed in *Mai Yao Jing Wei Pian*. Ugly/Good refers to pulse/syndrome quality. Excess diseases involve rising/moving; Deficiency diseases involve sitting/lying. Knowing rising indicates Excess, thus identifying Deficiency. Understanding one understands all.)
Measuring events up and down allows thorough pulse analysis. Therefore, Weak Form/Deficient Qi leads to death; Excess Form/Qi with Deficient Pulse leads to death; Excess Pulse with Deficient Form/Qi leads to life. (Diagnostic Way requires assessing Form and Qi. "Events" refer to adaptability. Up/Down refers to celestial Qi/disease change. Ge means exhaustive investigation. Assessing Up/Down adaptability exhaustively investigates pulse adaptability. Weak Form/Deficient Qi dies regardless of pulse. Excess Form/Qi with Deficient Pulse dies; Excess Pulse with Deficient Form/Qi lives. Form must confirm Pulse adaptability to predict life/death.)
Diagnosis has great principles: regular sitting/standing, orderly entry/exit, transforming Spirit, requiring clarity and stillness. Observe up and down, monitor Eight Regular Evils, distinguish Five Central Regions, palpate pulse dynamics, check Chi skin for slipperiness/roughness and temperature, observe urination/defecation, combine with disease capabilities. Mastering compliance/rebellion identifies disease names, achieving perfect diagnosis without missing human factors. Some diagnoses observe breathing (Shi Xi), others observe intent (Shi Yi), maintaining order. The Way is clear and enduring. Ignoring it abandons classics and logic, leading to false prophecies, which is losing the Way. (Transforming Spirit uses one's Shen to observe others' Qi. Observing up/down is like viewing abyss/clouds. Eight Regulars are Sun/Moon/Stars/Seasons. Distinguishing Five Centers checks Zang pulses. Palpating dynamics checks floating/sinking/rapid/slow. Checking Chi skin correlates with pulse: slippery pulse = slippery skin (Wind); rough skin = Bi syndrome; hot skin + rapid pulse = Warm disease; cold skin + small pulse = Diarrhea/Deficiency; hot then cold = Alternating Cold/Heat. Skilled practitioners rely on Chi/Pulse/Sight integration. Shi Xi observes breath/pulse rhythm. Shi Yi closes doors, questions patient gently to follow intent. Obtaining Shen brings prosperity; losing Shen brings death. False words ignore diagnostic Way, predicting death arbitrarily, abandoning classics/logic, termed losing the Way.)