《素问》曰∶阴气盛于上则下虚，下虚则腹胀满。又曰∶阳气盛于上，则下气重上而邪
气逆
，逆则阳气乱，阳气乱则不知人。此二段乃岐伯分答黄帝问厥，或令人腹满，或令人昏不知
人二语之辞。所谓阴气者，下气也。下气而盛于上，则下反无气矣；无气则不化，故腹胀满
也。所谓下气者，即阴气也。阳气上盛，则阴气上奔，阴从阳之义也。邪气亦即阴气，以其
失正而上奔，即为邪气。邪气亦即阴气，以其失正而上奔，即为邪气。邪气既逆，阳气乃乱
。气治则明，乱则昏，故不知人也。《甲乙经》削“阳气盛于上”五字，而增“腹满”二字
于“下虚则腹胀满”之下，“则下气重上”之上。林氏云∶当从《甲乙》，谓未有阴气盛于
上，而又阳气盛于上者。二公并未体认分答语辞，故其言如此，殆所谓习而弗察者耶！
心脉搏坚而长，当病舌卷不能言；其软而散者，当消环自己。按“搏坚而长”者，太过
之脉
。心象火，而脉萦舌；心火有余，故病舌卷不能言也。“软而散”者，不足之脉。心者生之
本，神之处；心不足则精神为消，如卑 、遗亡、恐惧之类是也。“环自己”者，言经气以
次相传，如环一周，复至其本位，而气自复，病自已也。诊要经终论云∶刺中心者，环死。
义与此同。“环自已”者，经尽气复则生；“环死”者，经尽气绝则死也。《甲乙经》“环
”作“渴”，非。
推而外之，内而不外，有心腹积也；推而内之，外而不内，身有热也；下而不上，头项
痛也
；按之至骨，脉气少者，腰脊痛而身有痹也。《甲乙经》“上而不下”作“下而不上”，“
下而不上”作“上而不下”，非。盖“上而不下”者，上盛而下虚，下虚则下无气，故腰足
冷；“下而不上”者，有降而无升，不升则上不荣，故头项痛也。经文前二段是有余之病，
故受病处脉自着；后二段是不足之病，故当病之处脉反衰。按之至骨而脉气少，为腰脊痛而
身有痹者，亦不足之诊也。经文虚实互举，深切诊要，自当从古。
《素问》说：阴气在上部过盛，则下部虚弱，下部虚弱就会出现腹部胀满。又说：阳气在上部过盛，则下部的之气重复上逆而邪气上逆，气逆则阳气紊乱，阳气紊乱就会使人昏迷不省人事。这两段话是岐伯分别回答黄帝关于“厥”证的提问，即有的导致腹部胀满，有的导致昏不知人。所谓的阴气，是指下部的正气。下部的正气如果上逆并盛于上部，那么下部反而就没有气了；没有气就不能运化，所以出现腹部胀满。所谓的下气，就是阴气。阳气在上部过盛，阴气就会向上奔涌，这是阴随阳动的道理。邪气也就是阴气，因为它失去了正常的运行方向而上逆，就称为邪气。邪气既然上逆，阳气才会紊乱。气机调畅则神志清明，气机紊乱则神志昏蒙，所以会昏迷不省人事。《甲乙经》删去了“阳气盛于上”五个字，而在“下虚则腹胀满”之下、“则下气重上”之上增加了“腹满”二字。林氏说：应当遵从《甲乙经》，认为不会有阴气盛于上的同时，又出现阳气盛于上的情况。这两位先生并没有体察到这是分别回答的语辞，所以他们的言论如此，这大概就是所说的习以为常而不加审察吧！
心脉搏动坚实而长，应当患病表现为舌卷缩不能言语；如果脉象软弱而散漫，应当患消渴病，经过一个周期（环）后自己痊愈。按，“搏坚而长”属于太过之脉。心象火，且脉络环绕舌头；心火有余，所以出现舌卷缩不能言语的症状。“软而散”属于不足之脉。心是生命的根本，也是神志所在之处；心气不足则精神消耗，如同卑怯、遗失、恐惧等表现一样。“环自己”的意思是，言经气依次相传，像圆环一样运行一周，重新回到本位，气自然恢复，病也就好了。《诊要经终论》说：针刺误中心脏，经过一个周期（环）就会死亡。其义理与此相同。“环自已”意思是经气尽而复生则存活；“环死”意思是经气尽而绝灭则死亡。《甲乙经》将“环”写作“渴”，是不正确的。
推按脉象向外取之，若脉气内陷而不能外达，说明有心腹积滞；推按脉象向内取之，若脉气外浮而不能内敛，说明身体有发热；脉象向下沉而不向上浮，说明头项疼痛；按压至骨部，脉气微弱不足的，说明腰脊疼痛且身体有痹证。《甲乙经》将“上而不下”改为“下而不上”，将“下而不上”改为“上而不下”，这是错误的。大概“上而不下”的意思，是上部盛实而下部虚弱，下部虚弱则下部无气，所以腰足寒冷；“下而不上”的意思，是有降而无升，不升则上部得不到荣养，所以头项疼痛。经文前两段讲述的是有余的病证，所以受病的部位脉象自然显著；后两段讲述的是不足的病证，所以发病的部位脉象反而衰弱。按压至骨部而脉气少，诊断为腰脊痛且身体有痹证，这也是不足的诊断表现。经文虚实互举，深切地揭示了诊脉的要领，自然应当遵从古本。
The *Suwen* (Basic Questions) states: "When Yin qi is excessive in the upper part, the lower part becomes deficient; when the lower part is deficient, abdominal distension and fullness occur." It also states: "When Yang qi is excessive in the upper part, the Qi from below repeatedly ascends and pathogenic Qi rebels upward; rebellion causes Yang qi to become chaotic, and chaotic Yang qi leads to loss of consciousness." These two passages are Qibo's separate answers to Huangdi's inquiries regarding Jue syndrome (reversal syndrome), specifically addressing why it sometimes causes abdominal fullness and sometimes causes coma with loss of consciousness. The so-called "Yin qi" refers to the righteous Qi in the lower part. When the righteous Qi from below rebels and becomes excessive in the upper part, the lower part is left without Qi; without Qi, transformation fails, thus causing abdominal distension and fullness. The so-called "lower Qi" is indeed Yin qi. When Yang qi is excessive in the upper part, Yin qi rushes upward, following the principle that Yin follows Yang. Pathogenic Qi is also Yin qi; because it loses its proper course and rushes upward, it is termed pathogenic Qi. Since the pathogenic Qi rebels, Yang qi becomes chaotic. When Qi is regulated, clarity prevails; when chaotic, dizziness and confusion occur, hence the loss of consciousness. The *Jiayi Jing* (Classical Canon of the Yellow Emperor) deleted the five characters "Yang qi is excessive in the upper part" and added the two characters "abdominal fullness" after "lower part is deficient then abdominal distension and fullness occurs" and before "then lower Qi repeatedly ascends." Lin Shi said: One should follow the *Jiayi Jing*, arguing that there cannot be a situation where Yin qi is excessive in the upper part while simultaneously Yang qi is excessive in the upper part. These two scholars failed to recognize that these were separate responses, hence their remarks. This is likely what is meant by being accustomed to something without careful examination!
If the Heart pulse is firm, long, and forceful, one should expect disease manifesting as tongue retraction and inability to speak; if the pulse is soft and scattered, one should expect Xiao Ke (wasting-thirst syndrome), which will resolve itself after one cycle. By "firm, long, and forceful," it refers to an Excess pulse. The Heart corresponds to Fire, and its vessels surround the tongue; excess Heart Fire therefore causes tongue retraction and inability to speak. "Soft and scattered" refers to a Deficient pulse. The Heart is the root of life and the residence of Shen (Spirit); Heart deficiency leads to the consumption of spirit, similar to manifestations of timidity, loss, or fear. "Huan zi ji" (cycle returns to self) means that the Jing Qi (Channel Qi) transmits sequentially, circulating like a ring for one complete cycle, returning to its original position, allowing Qi to recover naturally and the disease to heal. The *Zhenyao Jingzhong Lun* (Treatise on the Essentials of Needling and the Termination of Channels) states: "If needling accidentally pierces the Heart, death occurs after one cycle." The meaning here is identical. "Huan zi ji" means recovery through the completion of the channel cycle and restoration of Qi; "Huan si" means death due to the exhaustion of the channel cycle and cessation of Qi. The *Jiayi Jing* writes "Huan" as "Ke" (thirst), which is incorrect.
Pushing outward [to assess the exterior], if the Qi is internal but does not reach the exterior, there is accumulation in the Heart and abdomen; pushing inward [to assess the interior], if the Qi is external but does not penetrate inward, there is heat in the body; downward but not upward indicates headache and neck pain; pressing down to the bone with scanty Qi indicates lumbar and spinal pain accompanied by Bi syndrome (obstruction). The *Jiayi Jing* changed "upward but not downward" to "downward but not upward," and "downward but not upward" to "upward but not downward," which is incorrect. Generally, "upward but not downward" implies excess in the upper part and deficiency in the lower part; lower deficiency means lack of Qi in the lower part, resulting in cold waist and feet. "Downward but not upward" implies descending without ascending; failure to ascend means the upper part lacks nourishment, resulting in headache and neck pain. The first two paragraphs of the classic text describe Excess diseases, so the pulse at the affected site is naturally prominent; the latter two paragraphs describe Deficient diseases, so the pulse at the diseased site is correspondingly weak. Pressing to the bone with scanty Qi, diagnosing lumbar/spinal pain and Bi syndrome, is also a sign of Deficiency. The classic text juxtaposes Excess and Deficiency, deeply revealing the essentials of diagnosis, and thus naturally ought to follow the ancient texts.