四维，四肢也。相代，相继为肿也。四肢为诸阳所实之处，相继为肿者，气馁而行不齐
也，故曰“阳气乃竭”。
玉机真脏论云∶脾脉太过，则令人四肢不举；其不及，则令人九窍不通。《灵枢》本神
篇云
∶脾气虚则四肢不用；实则腹胀、泾溲不利。盖脾虚则营卫涸竭，不能行其气于四肢，而为
之不举；脾实则营卫遏绝，亦不能行其气于四肢，而为之不举。九窍亦然。两经互言之者，
所以穷其变也。
胃脉搏坚而长，其色赤，当病折髀。胃土太过，而火复益之，腑阳独盛，脏阴受伤，则
髀痛如折也。
水液混浊，有脾经谷气不化，湿热下流；亦有因肺金气衰，而便液停凝。盖肺司州都之
气化，中气不足，则溲便为之变。未可执其“皆属于热”之一语而施治也。
巨阳主气，故先受邪；少阴与其为表里也，得热则上从之，从之则厥也。故有风热小恙
，而
亦面赤、足冷者。如是则解外之邪，必靖内之气，设徒与表药，真阳随越，故曰表里刺之，
饮之服汤。
煎厥，即热厥也。火迫于下，气逆于上，为厥逆而热烦也。溃溃乎若坏都， 乎不可
止者，言其精神散败，若土之崩，若水之放，而不可复收之、掩之也。
四维，指的是四肢。相代，指相继出现肿胀。四肢是诸阳经气血充盛之处，相继发生肿胀，是因为阳气衰馁、运行不齐所致，所以说“阳气乃竭”。
《素问·玉机真脏论》说：脾脉太过，就会使人四肢不能抬举；若脾脉不及，就会使人九窍不通。《灵枢·本神篇》说：脾气虚则四肢不能使用；若脾气实，则会出现腹胀、大小便不利。大概脾虚时，营卫之气枯竭，不能将气输送到四肢，从而导致四肢不能抬举；脾实时，营卫之气被遏止隔绝，同样不能将气输送到四肢，也导致四肢不能抬举。九窍的情况也是如此。这两部经典互相阐述，是为了穷尽病机的变化。
胃脉搏动坚实而长，面色发红，应当患髀部疼痛如折断的病。这是胃土之气太过，火气又随之亢盛，腑中阳气独盛，损伤了脏阴，所以髀部疼痛如同折断一般。
水液浑浊，有的是因为脾经谷气不化，湿热下注；也有的是因为肺金之气衰弱，导致小便停滞凝结。肺主管州都之气的化生，中气不足，就会导致小便和大便异常。不可拘泥于“皆属于热”这一句话来施治。
巨阳（太阳经）主一身之气，所以最先受邪；少阴经与太阳经互为表里，受热邪后，病气从上从之，从而形成厥证。所以有因风热小病，而出现面赤、足冷的情况。像这种情况，要解除体表的邪气，必须安定体内的正气，如果只用解表药，真阳就会随之外越，所以说要表里同刺，并服用汤药。
煎厥，就是热厥。火热逼迫于下，气逆乱于上，导致厥逆且伴有烦热。病情溃败的样子就像堤坝崩溃，浩浩荡荡不可遏制，是说人的精神散乱败坏，就像泥土崩塌、水流泛滥一样，无法再收回或掩盖。
心脉不及，就会使人心中烦闷，向上表现为咳嗽吐痰，向下表现为气泄。所谓气泄，是指气随着大便失禁而流失。脾肠的疾病，也就是气利，这是由于火气不足，导致脾土受病。
The "Four Dimensions" (Siwei) refer to the four limbs. "Xiangdai" (mutual succession/replacement) refers to swelling occurring successively in these areas. The four limbs are where the Qi of all Yang meridians is abundant. Successive swelling indicates that the Qi is deficient and its movement is irregular, hence it is said that "Yang Qi is exhausted."
The *Suwen: Yuji Zhenzang Lun* states: If the Spleen pulse is excessive, it causes inability to move the four limbs; if it is deficient, it causes obstruction of the nine orifices. The *Lingshu: Benshen* chapter states: When Spleen Qi is deficient, the four limbs cannot be used; when Spleen Qi is excess, abdominal distension and difficulty in urination and defecation occur. Generally, when Spleen Qi is deficient, Ying and Wei Qi are depleted and cannot transport Qi to the four limbs, resulting in immobility; when Spleen Qi is excess, Ying and Wei Qi are obstructed and also fail to transport Qi to the four limbs, resulting in immobility. The same applies to the nine orifices. These two classics discuss this from complementary perspectives to exhaustively explain pathological variations.
If the Stomach pulse is firm and long, and the complexion is red, one should suffer from pain in the thigh as if broken. This occurs when Stomach Earth Qi is excessive, and Fire further exacerbates it, causing solitary flourishing of Fu Yang and injury to Zang Yin, leading to thigh pain resembling a fracture.
Turbid body fluids may result from the failure to transform grain Qi in the Spleen meridian, with damp-heat flowing downward; or they may result from the decline of Lung Metal Qi, causing stagnation and coagulation of urine. The Lung governs the Qi transformation of the "Zhou Du" (bladder/urinary reservoir). When Middle Qi is insufficient, urination and defecation become abnormal. One must not rigidly apply treatment based solely on the phrase "all belong to heat."
Juyang (Greater Yang/Taiyang) governs Qi and thus is the first to receive pathogenic factors. Shaoyin (Lesser Yin) is interior-exterior paired with it. When heat enters, it follows upward, leading to Jue (reversal/cold extremities). Thus, even minor wind-heat ailments can present with a red face and cold feet. In such cases, resolving exterior pathogens requires calming internal Qi. If only exterior-releasing medicines are used, True Yang will escape outwardly. Hence, it is stated that both exterior and interior points should be needled, and decoctions should be administered.
Jian Jue (Decoction Jue) is synonymous with Re Jue (Heat Jue). Fire forces downward while Qi rebels upward, causing reversal with irritability and heat. The condition deteriorates rapidly like a breached dam, vast and unstoppable, indicating that spirit and essence are scattered and ruined, akin to collapsing earth or overflowing water, irretrievable and uncontainable.
If the Heart pulse is deficient, it causes mental restlessness, upper symptoms of coughing and expectoration, and lower symptoms of Qi leakage. "Qi leakage" means Qi escapes with stool. Diseases of the Spleen and intestines, known as Qi Li (Qi diarrhea), arise from insufficient Fire affecting Earth.