诊要者。诊度奇恒之要。经终者。六经之气已终。盖奇恒之道。论五脏之三阴。阴阳合并而成六。是其生五。其
终六也。
黄帝问曰。诊要何如。（此承上章而复问也。）岐伯对曰。正月二月。天气始方。地气始发。人气在肝。（伯言春者。
天气始开。地气始泄。而人气在肝。肝主东方寅卯木也。夫奇恒之势。乃六十首。盖以六十日而气在一脏为首。五脏相
通。而次序旋转者也。）三月四月。天气正方。地气定发。人气在脾。（三月四月。天地之气正盛。而人气在脾。辰巳二
月。足太阴阳明之所主也。）五月六月。天气盛。地气高。人气在头。（生长之气。从地而升。故肝而脾。脾而直上于巅
顶也。岁六甲而以五月六月在头者。只论五脏也。故曰奇恒五中。又曰章五中之情。按奇恒之道。论五脏之神气。五脏
者。三阴之所主也。人气在头者。厥阴与督脉会于巅。与五脏合而为三阴也。三之气。乃少阳相火所主。相火者。即厥
阴包络之火也。）七月八月。阴气始杀。人气在肺（始杀者。气始肃杀也。申酉二月属金。而人气在肺。）九月十月。阴
气始冰。地气始闭。人气在心。（收藏之气。从天而降。肺属干金而主天。为心脏之盖。故秋冬之气。从肺而心。心而肾
也。少阴主冬令。故先从手少阴而至于足少阴。王氏曰。火墓于戌。）十一月十二月。冰复。地气合。人气在肾。（冰复
者。一阳初复也。地气合者。地出之阳。复归于地。而与阴合也。肾主冬藏之气。故人气在肾。）故春刺散俞。及与分理。
血出而止。甚者传气。间者环也。（此言五脏之气。外循于皮肤络脉分肉而环转也。夫诊有十度。度人脉。度脏。度肉。
度筋。度俞。度阴阳气尽。度人脉者。言人之脉气。从奇恒之势。而有阴阳顺逆也。度脏者。度五脏之气。从内膈而外
出。不可逆刺以伤其脏也。度肉度筋度俞者。度五脏之气。外循于分肉俞络之间。各有浅深。而四时之刺法不同也。度
阴阳气尽者。言五脏之气。合于三阴三阳。而各有经终也。散俞、络脉之俞穴也。分理、分肉之腠理也。盖春气生升于
外。故当于散俞溪谷之间而浅刺之。血出则脉气通而病止矣。如逆之甚者。深取之而传导其气。轻者不待传气而即环转
矣。夫经俞络脉溪谷。各有三百六十五穴。皆脏腑之气所游行。是以四时之刺。或在皮肤。或在俞穴也。针经曰。刺之
气不至。无问其数。刺之而气至。乃去之。勿复针。刺之要。气至而有效。效之信。若风之吹云。明乎若见苍天。刺之
道毕矣。是以四时之刺。必候其气至之所在而刺之也。）夏刺络俞。见血而止。尽气闭环。痛病必下。（络俞者。孙络之
俞。见于皮肤之间。盖夏气浮长于外。而更宜浅刺者也。若尽传其气。则反闭其环转之机。而痛病于下矣。盖言经随气
转。夏时之气。浮越于外。气至即止。而不宜太过。此反结上文之义也。伤寒论曰。脏腑相连。其痛必下。言经气逆于
上。病必痛于下。谓其经络上下之相通也。）秋刺皮肤循理。上下同法。神变而止。（刺逆从论曰。秋气在皮肤。盖七月
八月。人气在肺。而肺主皮毛。是以或上或下。皆宜刺皮肤。循于肉理。神气变转而脉即循行矣。神者。五脏之神。即
转而不回之神气也。）冬刺俞窍于分理。甚者直下。间者散下。（俞窍。诸俞之穴窍。更深于散俞。而近于筋骨者也。分
理者。分肉之腠理。乃溪谷之会。溪谷属骨。而外连于皮肤。是以春刺分理者。外连皮肤之腠理也。冬刺俞窍于分理者。
近筋骨之腠理也。盖冬气闭藏。而宜于深刺也。直下者。循经而下针。欲深而留之也。散下者。循络而下针。言病之轻
者。不必太深也。此四时之序。气之所处。病之所舍。藏之所宜也。）春夏秋冬。各有所刺。法其所在。（此总结上文。
而言四时之刺法。各有浅深之所在也。）春刺夏分。脉乱气微。入淫骨髓。病不能愈。令人不嗜食。又且少气。（厥阴
心主主脉。无故而损之。故脉乱。血气外溢。故令人气微也。少阳主骨。厥阴不从标本。从少阳中见之化。故入淫骨髓
也。病不在夏分。故病不能愈。肝气仍逆。故令人不嗜食。肝主春生之气。故又且少气也。）春刺秋分。筋挛逆气。环为
咳嗽。病不愈。令人时惊。又且哭。（脏真高于肺。主行荣卫阴阳者也。荣卫气血。所以濡筋骨。利关节。病在肝而反伤
其肺。是以筋挛。血气环逆。故令人气逆而转为咳嗽也。东方肝木。其病发惊骇。肝藏魂。魂魄不安。故使人邪哭也。）
春刺冬分。邪气着脏。令人胀病不愈。又且欲言语。（春主生升。冬主闭藏。春刺冬分。反导其血气内着。故令人腹胀。
肝主语。故又且欲言语也。病不愈者。言四时所主之脏病不愈。又且者。言不惟病不愈而又有此证也。）夏刺春分。病不
愈。令人懈惰。（三月四月。人气在脾。脾病不愈。故令人懈惰。）夏刺秋分。病不愈。令人心中欲无言。惕惕如人将捕
之。（五月六月。人气在心主包络。心主言。心主不能代君行令。故心中欲无言。经曰。所谓恐如人将捕之者。秋气万物
未有毕去。阴气少。阳气入。阴阳相搏。故恐也。夏刺秋分。则阳气入而与阴相搏。故如人将捕之。）夏刺冬分。病不
愈。令人少气。时欲怒。（经曰。所谓少气善怒者。阳气不治。阳气不治。则阳气不得出。盖夏月阳气外张。而反逆归于
冬分。故不惟病不愈。而更令人少气善怒也。）秋刺春分。病不已。令人惕然。欲有所为。起而忘之。（秋主下降。刺春
分。是反导其血气上行。故令人惕然欲有所为。四时刺逆从论曰。秋刺经脉。血气上逆。令人善忘。）秋刺夏分。病不已。
令人益嗜卧。又且善梦。（秋气在皮肤气分。刺夏分之络脉。则气不外行。故令人益嗜卧。肺藏魄。经云。魂魄飞扬。使
人卧不安而喜梦。）秋刺冬分。病不已。令人洒洒时寒。（冬主闭藏。而反伤之。则血气内散。故令人寒栗也。）冬刺春分。
病不已。令人欲卧不能眠。眠而有见。（春令所以泄冬藏之气也。人卧则气归于阴。而反泄之。故令人欲卧不能眠。气行
于阳则目张。行于阴则目瞑。眠有所见者。目不得瞑也。）冬刺夏分。病不愈。气上发为诸痹。（冬主闭藏。夏令浮长。
气应藏而使之外泄。故发为诸痹。痹者闭也。气留闭于外而为痛也。）冬刺秋分。病不已。令人善渴。（肾藏津液。肺乃
水之化原。故善渴也。此言五脏之气。随时而升浮降沉。非五脏经脉之谓也。）凡刺胸腹者。必避五脏。（此言五脏之
神气。从内膈而外达于胸胁。从胸胁而环转于形身。故不可逆刺其膈。以伤其脏焉。内膈上连于胸。中连于腹。下连于
胁。脏气从此而外出。故曰。刺避五脏者。知逆从也。所谓从者。膈与脾肾之处。不知者反之。反之者。逆刺其所出之
神气也。）中心者环死。（环者。一周时也。盖日为阳。心为阳中之太阳。一昼一夜。日环转一周。故至周转而气终也。）
中脾者五日死。（五日者。土数终也。）中肾者七日死。（天乙生水。地六成之。七日者。生成之数终也。）中肺者五日死。
（天数五。地数五。肺属干金而主天。脾属坤土而主地。故皆死于五日也。只言四脏而不及肝者。或简脱也。杨元如曰。
五脏经脉。俱不上循于头。惟厥阴与督脉会于巅。故曰五月六月。人气在头。抑厥阴之气。不从胸胁外出。而直上于头
与。）中膈者。皆为伤中。其病虽愈。不过一岁必死。（五脏六腑之气。俱从内膈而外出于胸胁。故刺中膈者。皆为伤
中。一岁死者。尽五行六气之终而死也。按内膈上连胸之鸠尾。中两分于腹上。下连两旁季胁。后连脊之十一椎。刺中
膈者。即不中脏速死。其中脏腑之气。皆为所伤矣。行针者慎诸。莫子晋曰。此复兼六腑之气而言。即阴阳合并之义。
盖中脏气者死之速。中腑气者死之迟。）刺避五脏者。知逆从也。所谓从者。膈与脾肾之处。不知者反之。（避五脏者。
避五脏神气之所出也。五脏之气。所从而出者。膈与脾肾处也。膈者。胸膈之上。鸠尾处也。脾处者。胸骨两分之下。
交腹之处也。肾处者。两胁之下也。言五脏之气。从膈外出。旋转不回。若反刺之。是逆其气而伤其脏矣。）刺胸腹者。
必以布 着之。乃从单布上刺。刺之不愈复刺。刺针必肃。刺肿摇针。经刺勿摇。此刺之道也。（ 音激。此言刺胸腹者。
宜微针而浅刺之。勿使有伤膈气也。 、定也。以布定着于胸腹。乃从单布上刺之。盖欲其极浅也。不愈而复刺者。言
其至浅而或不得其气也。肃、静也。言气之难得。宜肃静其针以候焉。摇针者。刺之泻法也。肿乃邪实。故宜摇针以泻
其邪。经刺勿摇。守其正也。此补泻之法。刺之要道也。）帝曰。愿闻十二经脉之终。奈何。（此论脏腑阴阳之合并也。
所论五脏之气者。三阴之所主也。三阴之气。与三阳交并。阳气先至。阴气后至。合于十二经脉。内络脏腑。外络形身。
外内出入。循环无端。故曰。诊合微之事。追阴阳之变。不知并合。诊故不明。阴阳并交。至人之所行。当知五行而生
三气。三而三之。合为六气。六六之气。以应十二经脉。一经之气已终。是不复阴阳相贯。而环转无端矣。）岐伯曰。太
阳之脉。其终也。戴眼皮折 。其色白。绝汗乃出。出则死矣。（ 音契 音纵。戴眼、目上视也。反折、背反张也。
、手足屈伸也。足太阳之脉。起于目内 。挟脊抵腰中。手太阳之脉。循臂上肩。至目外 。太阳主筋而为诸阳主
气。阳气者。柔则养筋。太阳之经气已绝。是以筋脉急而戴眼反折。手足牵引也。手太阳主液。膀胱者。津液之所藏。
绝汗者。津液外亡也。色白者。亡血也。津液外脱。则血内亡矣。）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。（HT 音琼手足少阳经脉。皆循于耳。经气绝。故耳聋也。少阳主骨。诸节皆属
于骨。少阳气终。故百节皆纵。经络篇曰。少阳是主骨所生病者。诸节皆痛。HT 、目惊貌。手足少阳之脉。皆至目锐
。终则牵引于目。故目如惊而邪视也。绝系、目系绝也。少阳属肾。肾藏志。系绝则志先绝。故一日半死也。青者。
甲木之气外脱也。白者。三焦之荣内亡也。夫阳生于阴。色生于气。是以六经之气终而先见于色。）阳明终者。口目动作。
善惊。妄言。色黄。其上下经盛。不仁则终矣。（手足阳明之脉。皆挟口承目。故口目动作而牵引歪邪也。闻木音则惕然
而惊。是阳明之善惊也。骂詈不避亲疏。是阳明之妄言也。色黄、阳明之土气外脱也。上下经盛。胃气绝而无柔和之象
也。荣卫者。中焦水谷之所生。肌肤不仁者。荣卫之气绝也。）少阴终者。面黑。齿长而垢。腹胀闭。上下不通而终矣。
（心之华在面。面黑者。水气上乘。火气灭而水气脱矣。齿长而垢。骨气泄也。腹胀闭而上下不通者。心肾水火之气并
绝。而不能上下交通矣。）太阴终者。腹胀闭。不得息。善噫善呕。呕则逆。逆则面赤。不逆则上下不通。不通则面黑。
皮毛焦而终矣。（足太阴脉。入腹属脾。故为腹胀。手太阴脉。上膈属肺而主呼吸。故为不得息。胀满则升降难。不得
息则气道滞。故为噫为呕。呕则气逆于上。故为面赤。不逆则痞塞于中。故为上下不通。脾气败则无以制水。故黑色见
于面。肺气败则治节不行。故皮毛焦。）厥阴终者。中热嗌干。善溺。心烦。甚则舌卷卵上缩而终矣。此十二经之所败
也。（手厥阴心主之脉。起于胸中。出属心包络。足厥阴肝脉循喉咙。入颃颡。其下者。循阴股。入毛中。过阴器。厥阴
木火之气欲绝。故中热嗌干也。肝所生病者遗溺。善溺者。肝气下泄也。心烦者。包络之气上炎也。肝者筋之合。筋者
聚于阴器。而脉络于舌本。甚则舌卷囊缩而终矣。此十二经之所败。三阴三阳之气终也。按天之十干。化生地之五行。
地之五行。化生天之六气。五行生五脏。六气合六经。是六经之气。五脏之所生也。故曰诊要者。诊五行相生之要。经
终者。阴阳之气有终。盖言人之生于五行而终于六气也。莫子晋曰。地之五行。合天之十干。天之六气。合地之十二
支。此皆天地阴阳。互相生化之道。）
诊要，是诊断衡量异常病证的关键。经终，是指六经之气已经衰竭。大概奇恒之道，论述五脏中的三阴经，阴阳合并而成为六经，这是其生成于五（脏），终结于六（经）的道理。
黄帝问道：诊断的要领是怎样的？（这是承接上一章的内容再次发问。）岐伯回答说：正月、二月，天气开始方正（生发），地气开始萌动，人气在肝脏。（岐伯说春天时，天气开始开启，地气开始宣泄，而人气在肝。肝主东方寅卯木。那奇恒的形势，是以六十日为一个周期，气在一脏为首，五脏相通，次序旋转。）三月、四月，天气正盛，地气稳定发动，人气在脾脏。（三月、四月，天地之气正旺盛，而人气在脾。辰、巳两个月，是足太阴和足阳明所主的时候。）五月、六月，天气盛大，地气高升，人气在头部。（生长之气，从地上升起，所以由肝到脾，脾再直上至头顶。岁运六甲，而在五月、六月人气在头，只论及五脏。所以说“奇恒五中”，又说“章五中之情”。按奇恒之道，论述五脏的神气。五脏，是三阴经所主的。人气在头部，是因为厥阴与督脉会合于头顶，与五脏合而为三阴。三之气，是由少阳相火所主。相火，就是厥阴心包络之火。）七月、八月，阴气开始肃杀，人气在肺脏（所谓“始杀”，是指气开始肃杀。申、酉两个月属金，而人气在肺。）九月、十月，阴气开始结冰，地气开始闭藏，人气在心脏。（收藏之气，从天而降。肺属干金而主天，作为心脏的盖子，所以秋冬之气，从肺传至心，心传至肾。少阴主冬令，所以先从手少阴至于足少阴。王冰说：火墓于戌。）十一月、十二月，冰层复盖，地气闭合，人气在肾脏。（所谓“冰复”，是一阳初复。地气合，是指地中发出的阳气，又回归于地，与阴相合。肾主冬藏之气，所以人气在肾。）所以春季针刺散俞穴，以及分肉腠理，见血就停止，病情重的传导经气，病情轻的环转经气。（这是在讲五脏之气，外循行于皮肤、络脉、分肉之间并环转。诊法有十度：度量人脉、度量脏气、度量肌肉、度量筋腱、度量俞穴、度量阴阳之气尽处。度量人脉，是说人的脉气，随着奇恒的形势而有阴阳顺逆之分。度量脏气，是度量五脏之气，从内膈向外发出，不可逆刺以损伤其脏。度量肌肉、筋腱、俞穴，是度量五脏之气，外循行于分肉、俞络之间，各有深浅，而四时的刺法不同。度量阴阳之气尽，是说五脏之气，合于三阴三阳，而各有经气终结之时。散俞，是络脉的俞穴。分理，是分肉的腠理。因为春气生发升腾于外，所以应当在散俞、溪谷之间浅刺。见血则脉气通畅而病止。如果逆之且病情重者，深取以传导其气；轻者不必待传气而即环转。经俞、络脉、溪谷，各有三百六十五穴，都是脏腑之气游行之处，所以四时的针刺，有的在皮肤，有的在俞穴。《针经》说：针刺后气未至，不问次数；针刺后气已至，便停止，不再针刺。针刺的要领，在于气至而有效。有效的确证，如同风吹云散，明明白白见到苍天。针刺的道理至此完备了。因此四时的针刺，必须等候气至所在而刺之。）夏季针刺络俞，见血就停止，尽气闭环，痛病必向下。（络俞，是孙络的俞穴，见于皮肤之间。因为夏气浮长于外，更宜浅刺。如果尽传其气，反而闭塞其环转之机，而痛病在下。这是在说经随气转，夏时之气，浮越于外，气至即止，而不宜太过。这是反结上文的意思。《伤寒论》说：脏腑相连，其痛必下。是说经气逆于上，病必痛于下，指经络上下相通。）秋季针刺皮肤，遵循纹理，上下同法，神气变化就停止。（《刺逆从论》说：秋气在皮肤。大概七月、八月，人气在肺，而肺主皮毛，所以上下都宜刺皮肤，遵循肉理。神气变转而脉即循行。神，是五脏之神，即转而不回的神气。）冬季针刺俞窍于分理，病情重的直下，病情轻的散下。（俞窍，是诸俞的穴窍，比散俞更深，接近筋骨。分理，是分肉的腠理，是溪谷的会合处。溪谷属骨，外连皮肤。所以春刺分理，是外连皮肤的腠理。冬刺俞窍于分理，是近骨肉的腠理。因为冬气闭藏，宜于深刺。直下，是循经下针，欲深而留之。散下，是循络下针，言病轻者，不必太深。这是四时的次序，气所处的位置，病所停留的地方，脏所适宜的状态。）春夏秋冬，各有所刺，效法气所在的部位。（这是总结上文，说四时的刺法，各有深浅所在。）春刺夏分，脉乱气微，邪入淫骨髓，病不能愈，令人不嗜食，而且少气。（厥阴心主主脉，无故而损伤它，所以脉乱。血气外溢，所以令人气微。少阳主骨，厥阴不从标本，从少阳中见之化，所以邪入淫骨髓。病不在夏分，所以病不能愈。肝气仍逆，所以令人不嗜食。肝主春生之气，所以又且少气。）春刺秋分，筋挛逆气，环转为咳嗽，病不愈，令人时常惊骇，而且哭。（脏真高于肺，主行营卫阴阳。营卫气血，所以濡养筋骨，利关节。病在肝而反伤其肺，所以筋挛。血气环逆，所以令人气逆而转为咳嗽。东方肝木，其病发惊骇。肝藏魂，魂魄不安，所以使人邪哭。）春刺冬分，邪气附着于脏，令人胀病不愈，而且想说话。（春主生升，冬主闭藏。春刺冬分，反导其血气内着，所以令人腹胀。肝主语，所以又且想说话。病不愈，是说四时所主之脏的病不愈。“又且”是说不仅病不愈而又有此证。）夏刺春分，病不愈，令人懈怠懒惰。（三月、四月，人气在脾。脾病不愈，所以令人懈怠懒惰。）夏刺秋分，病不愈，令人心中想沉默不语，惊恐如有人将要捕捉他。（五月、六月，人气在心主包络。心主言，心主不能代君行令，所以心中想沉默不语。《内经》说：所谓恐如人将捕之者，是因为秋气万物尚未完全离去，阴气少，阳气入，阴阳相搏，所以产生恐惧。夏刺秋分，则阳气入而与阴相搏，所以如人将捕之。）夏刺冬分，病不愈，令人少气，时常想发怒。（《内经》说：所谓少气善怒者，是阳气不治。阳气不治，则阳气不得出。大概夏月阳气外张，而反逆归于冬分，所以不仅病不愈，而且更令人少气善怒。）秋刺春分，病不已，令人惊恐，想做些什么，起来却忘记了。（秋主下降。刺春分，是反导其血气上行，所以令人惊恐想做些什么。《四时刺逆从论》说：秋刺经脉，血气上逆，令人善忘。）秋刺夏分，病不已，令人更加嗜睡，而且多梦。（秋气在皮肤气分。刺夏分之络脉，则气不外行，所以令人更加嗜睡。肺藏魄。《内经》说：魂魄飞扬，使人卧不安而喜梦。）秋刺冬分，病不已，令人洒洒时时发冷。（冬主闭藏，而反伤之，则血气内散，所以令人寒栗。）冬刺春分，病不已，令人想睡而不能眠，睡了就有幻象。（春令所以泄冬藏之气。人卧则气归于阴，而反泄之，所以令人想睡而不能眠。气行于阳则目张，行于阴则目瞑。眠有所见，是眼睛不能闭合。）冬刺夏分，病不愈，气上发为各种痹证。（冬主闭藏，夏令浮长。气应藏而使之外泄，所以发为各种痹证。痹，就是闭。气留闭于外而为痛。）冬刺秋分，病不已，令人容易口渴。（肾藏津液，肺乃水之化原，所以容易口渴。这是在说五脏之气，随着时令而升浮降沉，不是指五脏经脉而言。）凡针刺胸腹者，必须避开五脏。（这是在说五脏的神气，从内膈外达于胸胁，从胸胁环转于形体身躯。所以不可逆刺其膈，以损伤其脏。内膈上连于胸，中连于腹，下连于胁。脏气从此外出，所以说：刺避五脏，就是知道逆从。所谓从，是指膈与脾肾的部位。不知道的则相反。反之，就是逆刺其所出的神气。）刺中心脏，一周时后死亡。（环，是一周的时间。日为阳，心为阳中之太阳，一昼一夜，日环转一周，所以至周转时气终。）刺中脾脏，五日死亡。（五日，是土数终。）刺中肾脏，七日死亡。（天乙生水，地六成之。七日，是生成之数终。）刺中肺脏，五日死亡。（天数五，地数五。肺属干金而主天，脾属坤土而主地，所以都死于五日。这里只言四脏而未及肝，或许是简略脱漏。杨元如说：五脏经脉，都不上循于头，只有厥阴与督脉会合于头顶，所以说五月、六月人气在头。抑或是厥阴之气，不从胸胁外出，而直上于头与。）刺中膈膜，都是损伤中气，即使病好了，不过一年必定死亡。（五脏六腑之气，俱从内膈外出于胸胁。所以刺中膈者，都是损伤中气。一岁死者，是尽五行六气之终而死。按内膈上连胸之鸠尾，中两分于腹上，下连两旁季胁，后连脊之十一椎。刺中膈者，即使不中脏速死，其中脏腑之气，都被损伤了。行针者务必谨慎。莫子晋说：这又兼及六腑之气而言，即阴阳合并之义。大概中脏气者死得快，中腑气者死得慢。）刺避五脏，就是知道逆从。所谓从，是指膈与脾肾的部位。不知道的则相反。（避五脏，是避五脏神气之所出。五脏之气，所从而出者，是膈与脾肾处。膈者，胸膈之上，鸠尾处。脾处者，胸骨两分之下，交腹之处。肾处者，两胁之下。是说五脏之气，从膈外出，旋转不回。若反刺之，是逆其气而伤其脏了。）针刺胸腹者，必须用布固定住，然后从单布上刺。刺之不愈再刺。持针必须肃静，刺肿疡摇针，刺经脉勿摇。这是针刺的道理。（音激。这是在说刺胸腹者，宜用微针而浅刺之，不要使有伤膈气。定也。以布固定着于胸腹，然后从单布上刺之。大概是想要极浅。不愈而复刺，是说其至浅而或许不得其气。肃，静也。是说气之难得，宜肃静其针以等候。摇针，是刺之泻法。肿乃邪实，所以宜摇针以泻其邪。经刺勿摇，守其正也。这是补泻之法，针刺的要道。）黄帝说：愿闻十二经脉的终绝，怎么样？（这是论脏腑阴阳之合并。所论五脏之气，是三阴所主。三阴之气，与三阳交并，阳气先至，阴气后至，合于十二经脉，内络脏腑，外络形身，外内出入，循环无端。所以说：诊合微之事，追阴阳之变，不知并合，诊故不明。阴阳并交，是至人之所行，应当知五行而生三气，三而三之，合为六气，六六之气，以应十二经脉。一经之气已终，是不复阴阳相贯，而环转无端了。）岐伯说：太阳经的脉气终绝时，戴眼（眼球上视），筋脉拘急抽搐，面色苍白，绝汗乃出，出汗就死亡了。（音契，音纵。戴眼，目上视。反折，背反张。手足屈伸。足太阳之脉，起于目内眦，挟脊抵腰中。手太阳之脉，循臂上肩，至目外眦。太阳主筋而为诸阳主气。阳气者，柔则养筋。太阳之经气已绝，所以筋脉急而戴眼反折，手足牵引。手太阳主液，膀胱者，津液之所藏。绝汗者，津液外亡也。色白者，亡血也。津液外脱，则血内亡矣。）少阳经终绝时，耳聋，全身关节松弛无力，眼球凝视不动，绝系一日半死，其死时，面色先青白，然后死亡。（音琼。手足少阳经脉，皆循于耳。经气绝，所以耳聋。少阳主骨，诸节皆属于骨。少阳气终，所以百节皆纵。《经络篇》说：少阳是主骨所生病者，诸节皆痛。HT，目惊貌。手足少阳之脉，皆至目锐眦，终则牵引于目，所以目如惊而邪视。绝系，目系绝也。少阳属肾，肾藏志。系绝则志先绝，所以一日半死。青者，甲木之气外脱也。白者，三焦之荣内亡也。夫阳生于阴，色生于气，所以六经之气终而先见于色。）阳明经终绝时，口目抽动歪斜，容易惊骇，胡言乱语，面色黄，其上下经脉盛躁，肌肤麻木不仁则终绝了。（手足阳明之脉，皆挟口承目，所以口目动作而牵引歪邪。闻木音则惕然而惊，是阳明之善惊。骂詈不避亲疏，是阳明之妄言。色黄，阳明之土气外脱也。上下经盛，胃气绝而无柔和之象。荣卫者，中焦水谷之所生。肌肤不仁者，荣卫之气绝也。）少阴经终绝时，面色黑，牙齿显得长且垢秽，腹胀闭塞，上下不通而终绝了。（心之华在面。面黑者，水气上乘，火气灭而水气脱矣。齿长而垢，骨气泄也。腹胀闭而上下不通者，心肾水火之气并绝，而不能上下交通矣。）太阴经终绝时，腹胀闭塞，呼吸困难，喜欢嗳气呕吐，呕则气逆，逆则面赤，不逆则上下不通，不通则面黑，皮毛枯焦而终绝了。（足太阴脉，入腹属脾，所以为腹胀。手太阴脉，上膈属肺而主呼吸，所以为不得息。胀满则升降难，不得息则气道滞，所以为噫为呕。呕则气逆于上，所以为面赤。不逆则痞塞于中，所以为上下不通。脾气败则无以制水，所以黑色见于面。肺气败则治节不行，所以皮毛焦。）厥阴经终绝时，心中发热，咽喉干燥，喜欢小便，心烦，严重时舌卷缩，睾丸上缩而终绝了。这是十二经气败绝的表现。（手厥阴心主之脉，起于胸中，出属心包络。足厥阴肝脉循喉咙，入颃颡，其下者，循阴股，入毛中，过阴器。厥阴木火之气欲绝，所以中热嗌干。肝所生病者遗溺，善溺者，肝气下泄也。心烦者，包络之气上炎也。肝者筋之合，筋者聚于阴器，而脉络于舌本。甚则舌卷囊缩而终绝。这是十二经之所败，三阴三阳之气终也。按天之十干，化生地之五行。地之五行，化生天之六气。五行生五脏，六气合六经。是六经之气，五脏之所生也。所以说：诊要者，诊五行相生之要。经终者，阴阳之气有终。大概说人生于五行而终于六气。莫子晋说：地之五行，合天之十干。天之六气，合地之十二支。这都是天地阴阳互相生化之道。）
Zhenyao (Essentials of Diagnosis) refers to the key principles for diagnosing and evaluating abnormal conditions. Jingzhong (Termination of the Meridians) indicates that the Qi of the Six Meridians has exhausted. The Dao of Qiheng (Extraordinary/Abnormal) discusses the Three Yin organs among the Five Zang, where Yin and Yang merge to form the Six Meridians; thus, it originates from Five (Zang) and terminates in Six (Meridians).
The Yellow Emperor asked: What are the essentials of diagnosis? (This question follows up on the previous chapter.) Qibo replied: In the first and second lunar months, the Qi of Heaven begins to generate, the Qi of Earth begins to sprout, and the Human Qi resides in the Liver. (Qibo explained that in spring, the Qi of Heaven opens, the Qi of Earth vents, and Human Qi is in the Liver. The Liver governs the East, corresponding to Yin-Mao Wood. The pattern of Qiheng consists of sixty cycles, with Qi residing in one Zang organ per cycle, rotating through the interconnected Five Zang.) In the third and fourth lunar months, the Qi of Heaven is fully established, the Qi of Earth stabilizes and activates, and the Human Qi resides in the Spleen. (In these months, the Qi of Heaven and Earth is at its peak, and Human Qi is in the Spleen, which corresponds to Chen-Si months governed by the Foot Taiyin and Foot Yangming meridians.) In the fifth and sixth lunar months, the Qi of Heaven is abundant, the Qi of Earth rises high, and the Human Qi resides in the Head. (The growing Qi ascends from the Earth, moving from Liver to Spleen, then straight up to the vertex. Regarding the Six Jia years, when Human Qi is in the head during the fifth and sixth months, it refers only to the Five Zang. Thus it is said "Qiheng involves Five" and "manifesting the nature of the Five Centers." According to Qiheng, it discusses the Shen (Spirit) Qi of the Five Zang, which are governed by the Three Yin. Human Qi is in the head because the Jueyin and Du Mai intersect at the vertex, combining with the Five Zang into Three Yin. The Third Qi is governed by Shaoyang Ministerial Fire, which is the fire of the Juexinpericardium.) In the seventh and eighth lunar months, Yin Qi begins to kill (wither), and Human Qi resides in the Lungs. ("Beginning to kill" means the Qi begins to be austere and killing. Shen-You months belong to Metal, and Human Qi is in the Lungs.) In the ninth and tenth lunar months, Yin Qi begins to freeze, the Qi of Earth closes, and Human Qi resides in the Heart. (The storing Qi descends from Heaven. The Lung belongs to Dry Metal and governs Heaven, acting as the canopy for the Heart. Thus, in autumn and winter, Qi moves from Lung to Heart, and from Heart to Kidney. Shaoyin governs winter, so it proceeds from Hand Shaoyin to Foot Shaoyin. Wang Bing stated: Fire is buried in Xu.) In the eleventh and twelfth lunar months, ice returns, the Qi of Earth combines, and Human Qi resides in the Kidneys. ("Ice returns" signifies the initial return of One Yang. "Qi of Earth combines" means the Yang emerging from the Earth returns to the Earth to combine with Yin. The Kidney governs the storing Qi of winter, so Human Qi is in the Kidney.) Therefore, in Spring, needle the San Shu points and Fenli (intermuscular spaces); stop when blood appears. For severe cases, transmit the Qi; for mild cases, circulate the Qi. (This describes how the Qi of the Five Zang circulates externally along the skin, collaterals, and intermuscular spaces. There are ten degrees of measurement: measuring pulse, Zang, flesh, sinews, Shu points, and the exhaustion of Yin-Yang Qi. Measuring pulse refers to the Yin-Yang reversibility of pulse Qi according to Qiheng patterns. Measuring Zang involves assessing Zang Qi moving from the inner diaphragm outward, avoiding reverse needling to prevent injury. Measuring flesh, sinews, and Shu points assesses the depth of Zang Qi circulation, varying by season. Measuring the exhaustion of Yin-Yang Qi refers to the termination of each meridian's Qi. San Shu are collateral Shu points; Fenli are intermuscular clefts. Since Spring Qi generates and rises outward, shallow needling at San Shu and Xigu (valleys) is appropriate. Blood flow unblocks the pulse Qi, stopping the disease. If contrary and severe, deep needling transmits Qi; if mild, Qi circulates without transmission. There are 365 points for meridians, collaterals, and valleys, where Zang-Fu Qi travels. Thus, seasonal needling varies between skin and Shu points. The *Classic of Acupuncture* states: If Qi does not arrive, needle repeatedly; if Qi arrives, stop. The essence of needling is Qi arrival for efficacy, like wind clearing clouds to reveal the blue sky. Seasonal needling must await Qi arrival.) In Summer, needle the Luo Shu points; stop when blood appears. Exhaust the Qi to close the ring; pain diseases will descend. (Luo Shu are Sunluo points visible in the skin. Summer Qi floats and grows outward, favoring shallow needling. Transmitting all Qi would close the rotational mechanism, causing pain below. This emphasizes that meridians follow Qi; Summer Qi floats outward, so stop upon Qi arrival to avoid excess. This echoes the earlier text. *Shanghan Lun* says: Organs are connected, pain manifests below. This means reversed Upper Qi causes lower pain due to meridian connectivity.) In Autumn, needle the skin following the grain; apply the same method above and below. Stop when Shen changes. (*Ni Cong Lun* states: Autumn Qi is in the skin. In the seventh and eighth months, Human Qi is in the Lungs, which govern skin and hair. Thus, needling skin following muscle grain is suitable regardless of location. Shen refers to the Five Zang Spirit, turning but not returning.) In Winter, needle the Shu Qiao (apertures) within the Fenli. For severe cases, needle straight down; for mild cases, scatter the needle. (Shu Qiao are deeper than San Shu, near bones and sinews. Fenli are intermuscular clefts, convergence of Xigu. Xigu belongs to bone, connecting externally to skin. Spring needling targets external skin clefts; Winter needling targets internal clefts near bones/sinews. Since Winter Qi stores, deep needling is suitable. "Straight down" means following the meridian deeply and retaining; "scatter" means following collaterals lightly for mild cases. This reflects the seasonal order, Qi location, disease residence, and Zang suitability.) Spring, Summer, Autumn, and Winter each have specific needling methods based on Qi location. (Summarizing that seasonal needling has specific depths.) Needling the Summer division in Spring causes chaotic pulse and faint Qi, pathogen invading marrow, incurable disease, loss of appetite, and shortness of breath. (Juexinpericardium governs pulse; damaging it causes chaos. External leakage of Blood-Qi causes faintness. Shaoyang governs bone; Jueyin follows Shaoyang transformation, leading to marrow invasion. Disease is not in Summer division, hence incurable. Liver Qi remains rebellious, causing anorexia. Liver governs Spring generation, hence shortness of breath.) Needling the Autumn division in Spring causes tendon cramping, rebellious Qi, circular coughing, incurable disease, frequent fright, and crying. (Visceral Truth surpasses Lung, governing Ying-Wei and Yin-Yang. Ying-Wei nourishes sinews/joints. Damaging Lung while diseased in Liver causes cramping. Circular reversal of Blood-Qi causes cough. Liver Wood causes fright. Liver houses Hun; unsettled Hun causes weeping.) Needling the Winter division in Spring causes pathogen adhering to Zang, abdominal distension, incurable disease, and desire to speak. (Spring generates/rises; Winter stores/closes. Needling Winter in Spring guides Blood-Qi inward, causing distension. Liver governs speech, hence desire to speak. "Incurable" means disease of the seasonally governed Zang persists. "Furthermore" implies additional symptoms beyond non-healing.) Needling the Spring division in Summer causes incurable disease and lethargy. (Third/Fourth months: Human Qi in Spleen. Spleen disease leads to lethargy.) Needling the Autumn division in Summer causes incurable disease, silence, and fear as if being hunted. (Fifth/Sixth months: Human Qi in Xinpericardium. Xinpericardium governs speech; unable to act for the Sovereign, hence silence. Fear arises from Autumn Qi remaining, weak Yin, entering Yang, and Yin-Yang struggle. Needling Autumn in Summer forces Yang entry, clashing with Yin, causing fear.) Needling the Winter division in Summer causes incurable disease, shortness of breath, and irritability. (*Neijing* states: Shortness of breath and anger result from disordered Yang. Summer Yang expands outward; reversing it to Winter causes shortness of breath and anger.) Needling the Spring division in Autumn causes incurable disease, alarm, desire to act, and forgetfulness upon rising. (Autumn descends. Needling Spring reverses Blood-Qi upward, causing alarm. *Si Shi Ni Cong Lun* states: Needling meridians in Autumn causes upward Qi reversal and forgetfulness.) Needling the Summer division in Autumn causes incurable disease, excessive sleepiness, and vivid dreams. (Autumn Qi is in skin/Qi level. Needling Summer Luo prevents Qi from moving outward, causing sleepiness. Lung houses Po; flying Po causes restless sleep and dreams.) Needling the Winter division in Autumn causes incurable disease and chills. (Winter stores; damaging it scatters Blood-Qi inward, causing chills.) Needling the Spring division in Winter causes incurable disease, inability to sleep despite wanting to, and visual hallucinations during sleep. (Spring releases Winter storage. Sleep returns Qi to Yin; releasing it prevents sleep. Yang Qi opens eyes; Yin Qi closes them. Hallucinations occur because eyes cannot close properly.) Needling the Summer division in Winter causes incurable disease and various Bi syndromes due to ascending Qi. (Winter stores; Summer floats/grows. Qi should store but is forced out, causing Bi (blockage/pain).) Needling the Autumn division in Winter causes incurable disease and thirst. (Kidney stores fluids; Lung is source of water metabolism, hence thirst. This refers to Zang Qi rising/falling with seasons, not just meridians.) When needling the chest and abdomen, always avoid the Five Zang. (Zang Shen Qi moves from inner diaphragm to chest/hypochondrium, then circulates the body. Reverse needling of the diaphragm injures Zang. Inner diaphragm connects to chest, abdomen, and hypochondrium. Avoiding Zang means knowing Reversal and Compliance. "Compliance" refers to locations of Diaphragm, Spleen, and Kidney. Ignorance leads to reversal, injuring outgoing Shen Qi.) Puncturing the Heart leads to death within one cycle (24 hours). (Heart is Yang among Yang; daily solar cycle completes in one day, so Qi ends at rotation.) Puncturing the Spleen leads to death in five days. (Five is the completion number of Earth.) Puncturing the Kidney leads to death in seven days. (Seven is the completion number of generation/transformation.) Puncturing the Lung leads to death in five days. (Lung governs Heaven/Metal; Spleen governs Earth/Earth; both die in five days. Omission of Liver may be textual loss. Yang Yuanru noted: Only Jueyin and Du Mai reach the head, explaining why Human Qi is in the head in 5th/6th months; Jueyin Qi rises directly rather than exiting via chest/hypochondrium.) Puncturing the Diaphragm injures Middle Qi; even if cured, death occurs within a year. (All Zang-Fu Qi exits via diaphragm to chest/hypochondrium. Injury here damages Middle Qi. Death within a year marks the end of Five Elements and Six Qi. Diaphragm connects to Jiuwei, abdomen, hypochondrium, and T11 vertebra. Even if Zang is not hit, Qi is damaged. Practitioners must be cautious. Mo Zijin added: This includes Six Fu organs, reflecting Yin-Yang merger. Zang injury kills faster; Fu injury kills slower.) Avoiding the Five Zang means knowing Reversal and Compliance. "Compliance" refers to Diaphragm, Spleen, and Kidney locations. Ignorance leads to reversal. (Avoiding Zang means avoiding their Shen Qi exit points. Exit points are Diaphragm, Spleen area, and Kidney area. Diaphragm is Jiuwei. Spleen area is below sternum/abdomen junction. Kidney area is below hypochondrium. Zang Qi rotates outward from diaphragm; reverse needling injures Zang.) When needling chest/abdomen, fix cloth firmly, then needle through single cloth. If ineffective, re-needle. Hold needle steadily. Shake needle for swelling; do not shake for meridian needling. This is the way of needling. (Use fine needles, shallow depth, protect diaphragm Qi. Cloth fixes position for extreme shallowness. Re-needling implies missed Qi due to shallowness. "Sù" means stillness/waiting for Qi. Shaking is draining method for excess/swelling. Not shaking maintains correctness. This covers tonification/draining essentials.) The Yellow Emperor asked: I wish to hear about the termination of the Twelve Meridians. (Discusses Yin-Yang merger. Five Zang Qi is governed by Three Yin. Three Yin merges with Three Yang; Yang arrives first, Yin later. They connect internally to Zang-Fu and externally to body, circulating endlessly. Diagnosis requires understanding this merger. Without it, diagnosis is unclear. Understanding Five Elements generating Three Qi, tripling to Six Qi, matching Twelve Meridians. Termination of one meridian breaks the Yin-Yang connection and endless circulation.) Qibo said: Termination of Taiyang: Eyes fixed upward (Daiyan), opisthotonos, white complexion,绝汗 (Juehan/absolute sweat) appears, and death follows. (Taiyang governs sinews and Yang Qi. Yang nourishes sinews. Termination causes spasm, Daiyan, opisthotonos, limb traction. Bladder stores fluids; Juehan is fluid loss. White color indicates blood loss. Fluid loss leads to blood depletion.) Termination of Shaoyang: Deafness, flaccidity of all joints, staring eyes (Huijing), death in one and a half days. Color turns cyan-white before death. (Shaoyang meridians pass ear; termination causes deafness. Shaoyang governs bones; termination causes joint flaccidity. Shaoyang connects to Kidney (Zhi); eye system severance leads to Zhi loss. Cyan indicates Wood Qi escape; white indicates Sanjiao Ying loss. Color reflects Qi termination.) Termination of Yangming: Mouth/eye deviation, frequent fright, delirious speech, yellow complexion, hyperactive upper/lower meridians, numbness, then death. (Yangming meridians surround mouth/eyes, causing deviation. Fright comes from Wood sound perception. Delirium involves impropriety. Yellow indicates Earth Qi escape. Hyperactive meridians show absent Stomach Qi softness. Numbness indicates Ying-Wei exhaustion.) Termination of Shaoyin: Black complexion, long/dirty teeth, abdominal distension/blockage, upper-lower obstruction, then death. (Face reflects Heart; black indicates Water overcoming Fire/Water escape. Long teeth indicate Bone Qi leakage. Blockage indicates Heart-Kidney Water-Fire disconnection.) Termination of Taiyin: Abdominal distension/blockage, dyspnea, belching, vomiting. Vomiting causes upward Qi reversal (red face); no reversal causes blockage (black face), dry skin/hair, then death. (Taiyin enters Spleen/Lung. Distension hinders ascent/descent. Dyspnea blocks airway. Belching/vomiting result from stagnation. Upward reversal causes red face; central blockage causes black face. Spleen failure allows Water dominance (black); Lung failure dries skin/hair.) Termination of Jueyin: Internal heat, dry throat, frequent urination, vexation. Severe cases: tongue curling, testicular retraction, then death. This is the败 (failure) of Twelve Meridians. (Jueyin meridians connect heart/pericardium/liver/genitals/throat. Fire/Wood Qi exhaustion causes heat/dryness. Liver disease causes urinary issues; downward leakage causes frequent urination. Pericardium fire causes vexation. Liver governs sinews gathering at genitals/tongue base. Curling/retraction signals terminal failure. This represents exhaustion of Three Yin/Yang Qi. Ten Heavenly Stems generate Five Earthly Elements; Five Elements generate Six Heavenly Qi; Six Qi combine Six Meridians; Five Elements generate Five Zang. Thus, Zang Qi generates Meridian Qi. Diagnosis focuses on Five Elements generation; Meridian termination focuses on Yin-Yang exhaustion. Life originates in Five Elements, ends in Six Qi. Mo Zijin noted: Earthly Elements match Heavenly Stems; Heavenly Qi matches Earthly Branches, illustrating mutual generation of Heaven-Earth Yin-Yang.)