邪气盛则实，精气夺则虚。五实死，五虚死。脉盛，皮热，腹胀，前后不通，闷瞀，此谓五实；脉细，
皮寒，气少，泄利前后，饮食不入，此谓五虚。其时有生者，何也？曰∶浆粥入胃，泄注止，则虚者活；
身汗，得后利，则实者活。（何以得粥入泄止，何以得汗与利，是必有望于医者。）
气血以并，阴阳相倾，气乱于卫，血逆于经，血气离居，一实一虚。
血并于阴，气并于阳，故为惊狂。（阴不胜其阳，脉流薄疾，并乃狂。三阳积并，发为惊狂。邪入于
阳，重阳则狂，诸文皆指阳气喷激也。）
血并于阳，气并于阴，乃为炅中。（炅即炯字，热也。此阳气内郁也。）
血并于上，气并于下，心烦惋，善怒。（此阳气下抑也。）
血并于下，气并于上，乱而善忘。（此孤阳亢逆，阴津不能上濡也。）
血气并走于上，则为大厥，厥则暴死，气复返则生，不返则死矣。
血气者，喜温而恶寒，寒则泣不能流，温则消而去之。（宜用温散温下，不可温补。）
是故气之所并为血虚，血之所并为气
虚。何者？有者为实，无者为虚，故气并则无血，血并则无气。血与气相失，故为虚焉。络之与孙脉，俱输
于经，血与气并，故为实焉。夫阴与阳，皆有俞会，阳注于阴，阴满之外，阴阳匀平，以充其形，九候若一，
命曰平人。（上虚实。以上《素问》。）
喜怒不测，饮食不节，阴气不足，阳气有余，营气不行，（所谓气行血止也。阴津不足以载血，使之
滑利，而阳气之悍者涌来，血遂拥挤而成痈疽。）发为痈疽。阴阳不通，两热相搏，（是血愈拥挤，而悍气
亦不得通，故蒸而为脓矣。）乃化为脓。脓成，十死一生。其白眼青，黑眼小，一逆也。纳药而呕，二逆也。
腹痛渴甚，三逆也。肩项中不便，四逆也。音嘶色脱，五逆也。除此五者，为顺也。
（今疡科有五善七恶之说，义即本此。上痈疽顺逆。）
热病脉静，汗已出，脉躁盛，是一逆也。病泄，脉洪大，是二逆也。着痹不移， 肉破，身热，脉偏绝，
是三逆也。淫而夺形，身热，色夭然白，及后下血 ，血 笃重，
是四逆也。（淫，马注谓好色，非也。凡遗精漏浊下利自盗汗皆是。）寒热夺形，脉坚搏，是五逆也。
腹胀，身热，脉大，一逆也。腹鸣而满，四肢清，泄，脉大，二逆也。衄而不止，脉大，三逆也。咳且溲
血，脱形，其脉小劲，四逆也。咳，脱形，身热，脉小以疾，五逆也。如是者，不过十五日而死矣。
腹大胀，四末清，脱形，泄甚，一逆也。腹胀，便血，脉大，时绝，二逆也。咳，溲血，形肉脱，脉
搏，三逆也。
呕血胸满引背，脉小而疾，四逆也。咳呕，腹胀，且飧泄，其脉绝，五逆也。如是者，不及一时而死矣。（
上杂病顺逆。）
热病不可刺者有九。所谓勿刺者，有死征也。一曰汗不出，大颧发赤，哕者死。二曰泄而腹满甚者死。
三曰目不明，热不已者死。四曰老人、婴儿热而腹满者死。五曰汗不出，呕，下血者死。六曰舌本烂，热不
已者死。七曰咳而衄，汗不出，出不至足者死。八曰髓热者死。九曰热而痉者死。腰
折，螈 ，齿噤 也。凡此九者，不可刺也。其可刺者急刺之，不汗且泄。（上热病顺逆。以上《灵枢》。）
邪气亢盛则表现为实证，精气耗损则表现为虚证。出现五种实证征象者死，出现五种虚证征象者死。脉象盛大，皮肤发热，腹部胀满，大小便不通畅，胸闷视物昏花，这称为五实；脉象细弱，皮肤发冷，气息微弱，大小便泄利不止，饮食无法入口，这称为五虚。其中有时有存活的可能，为什么呢？回答说：如果米粥能进入胃中，泄泻停止，那么虚证患者就能存活；如果身体出汗，大小便得以通利，那么实证患者就能存活。（为什么能喝进粥且泄泻停止，为什么能出汗且二便通利，这必须寄希望于医生的治疗。）
气血相互偏聚，阴阳相互倾轧，气在卫分紊乱，血在经脉逆乱，血与气分离居住，形成一处实、一处虚的状态。
血偏聚于阴分，气偏聚于阳分，因此产生惊骇狂躁的症状。（阴不能制约阳，脉流急迫快速，阳气并盛则发为狂症。三阳经之气积聚并盛，发为惊狂。邪气侵入阳分，重阳则狂，各种文献都指阳气喷涌激荡所致。）
血偏聚于阳分，气偏聚于阴分，因此产生体内灼热的症状。（炅即炯字，意为热。这是阳气内郁所致。）
血偏聚于上部，气偏聚于下部，导致心烦意乱，容易愤怒。（这是阳气被抑制在下所致。）
血偏聚于下部，气偏聚于上部，导致神志混乱且容易遗忘。（这是孤阳亢逆，阴津不能上行濡养所致。）
气血同时上冲，则发生大厥证，厥证发作时如同暴死，若气能返回则生，若不返回则死。
血和气，喜欢温暖而厌恶寒冷，寒冷则血液凝涩不能流动，温暖则凝滞消散而去。（适宜使用温散或温下法，不可单纯温补。）
因此，气偏聚之处血就虚，血偏聚之处气就虚。为什么呢？有者为实，无者为虚，所以气并聚则血虚，血并聚则气虚。血与气分离失和，所以表现为虚。络脉与孙脉，都将气血输送到经脉，血与气相并聚集，所以表现为实。阴与阳，都有腧穴交会，阳注入阴，阴充满之外，阴阳匀平，以充实形体，九候脉象一致，这称为平人。（以上论述虚实。以上内容出自《素问》。）
喜怒无常，饮食不节制，阴气不足，阳气有余，营气运行不畅，（所谓气行则血止，此处意指阴津不足以承载血液使其滑利，而阳气之悍烈者涌来，血液遂拥挤而成痈疽。）从而发生痈疽。阴阳不通，两热相搏，（这是血液更加拥挤，而悍气也不能通畅，故蒸腾化为脓液。）于是化为脓。脓成之后，十死一生。如果白眼青黑，黑眼瞳孔缩小，这是一逆。服药后呕吐，是二逆。腹痛且极度口渴，是三逆。肩项部活动不便，是四逆。声音嘶哑，面色枯槁，是五逆。除了这五种情况，其余为顺证。（现今外科有五善七恶的说法，其义理即源于此。以上论述痈疽的顺逆。）
热病脉象静缓，汗已出，但脉象反而躁动盛大，是一逆。患泄泻病，脉象洪大，是二逆。着痹不移，肌肉溃破，身体发热，脉象一侧断绝，是三逆。因房劳过度而形体消瘦，身体发热，面色枯白，以及随后便血，血色深重，是四逆。（淫，马莳注认为是指好色，不对。凡是遗精、漏浊、下利、自盗汗等都算作此类。）寒热交作而形体消瘦，脉象坚劲搏指，是五逆。
腹部胀满，身体发热，脉象盛大，是一逆。腹中鸣响且胀满，四肢清冷，泄泻，脉象盛大，是二逆。鼻出血不止，脉象盛大，是三逆。咳嗽且小便带血，形体脱失，脉象小而强劲，是四逆。咳嗽，形体脱失，身体发热，脉象小且快，是五逆。像这样的情况，不超过十五日就会死亡。
腹部胀大，四肢清冷，形体脱失，泄泻严重，是一逆。腹部胀满，大便带血，脉象盛大，时而断绝，是二逆。咳嗽，小便带血，肌肉消脱，脉象搏指有力，是三逆。
呕血，胸部胀满牵引背部，脉象小而快，是四逆。咳嗽呕吐，腹部胀满，且完谷不化之泄泻，脉象断绝，是五逆。像这样的情况，不到一个时辰就会死亡。（以上论述杂病的顺逆。）
热病有九种不可针刺的情况。所谓不可针刺，是因为有死亡的征兆。第一种：不出汗，两侧颧骨发红，呃逆的，死。第二种：泄泻且腹部胀满严重的，死。第三种：眼睛视物不明，热势不退的，死。第四种：老人、婴儿发热且腹部胀满的，死。第五种：不出汗，呕吐，便血的，死。第六种：舌根腐烂，热势不退的，死。第七种：咳嗽且鼻出血，不出汗，或者出汗不到足部的，死。第八种：髓热的，死。第九种：发热且痉挛的，死。腰背反折，肢体抽搐，牙齿紧闭。凡此九种情况，不可针刺。那些可以针刺的，要紧急针刺，以使汗出且泄泻停止。（以上论述热病的顺逆。以上内容出自《灵枢》。）
When pathogenic factors are exuberant, it manifests as excess (Shi); when essence and qi are depleted, it manifests as deficiency (Xu). Death occurs with the five excesses; death occurs with the five deficiencies. Pulse is surging, skin is hot, abdomen is distended, anterior and posterior orifices are blocked (urination and defecation are obstructed), chest feels stifled and vision is blurred—this is called the five excesses. Pulse is fine, skin is cold, breath is scanty, diarrhea and incontinence occur at both orifices, food and drink cannot be taken in—this is called the five deficiencies. Why do some cases survive? It is said: If gruel enters the stomach and diarrhea stops, the deficient patient lives; if the body sweats and bowels/bladder become unobstructed, the excess patient lives. (How can gruel enter and diarrhea stop? How can sweating and unobstruction occur? This must depend on the physician's treatment.)
When qi and blood aggregate together, yin and yang tilt against each other; qi becomes chaotic in the Wei (Defensive) level, and blood reverses in the meridians; blood and qi separate from their proper residence, resulting in one area of excess and one of deficiency.
When blood aggregates in Yin and qi aggregates in Yang, it leads to fright and mania. (When Yin cannot overcome Yang, the pulse flows rapidly and forcefully; aggregation leads to mania. Accumulation and aggregation of the Three Yang channels lead to fright and mania. When pathogenic factors enter Yang, excessive Yang leads to mania; all texts refer to the surging and agitation of Yang Qi.)
When blood aggregates in Yang and qi aggregates in Yin, it leads to internal heat (Jiong Zhong). (Jiong means hot. This is due to internal stagnation of Yang Qi.)
When blood aggregates above and qi aggregates below, it causes mental restlessness and irritability. (This is due to the suppression of Yang Qi downward.)
When blood aggregates below and qi aggregates above, it causes confusion and forgetfulness. (This is due to lone Yang hyperactivity and rebellion, where Yin fluids fail to ascend and moisten.)
When blood and qi rush upward together, it results in Great Jue (syncope/collapse); Jue presents as sudden death-like state. If Qi returns, life is preserved; if it does not return, death ensues.
Blood and Qi prefer warmth and dislike cold. Cold causes them to congeal and fail to flow; warmth causes them to dissipate and move away. (Warm dispersing or warm purging methods should be used; pure warming tonification is inappropriate.)
Therefore, where Qi aggregates, Blood is deficient; where Blood aggregates, Qi is deficient. Why? Presence constitutes excess, absence constitutes deficiency. Thus, Qi aggregation leaves Blood absent (deficient), and Blood aggregation leaves Qi absent (deficient). When Blood and Qi lose harmony, it is termed deficiency. Collaterals and Sun vessels transport both into the main meridians; when Blood and Qi aggregate there, it is termed excess. Yin and Yang both have Shu (Transporting) points and Hui (Meeting) points. Yang pours into Yin, Yin fills outwardly; when Yin and Yang are balanced, they fill the form, and the nine pulses are uniform—this is called a healthy person (Ping Ren). (Discusses excess and deficiency above. Content from *Su Wen*.)
Unpredictable emotions and irregular diet lead to insufficient Yin Qi and surplus Yang Qi, causing Ying (Nutritive) Qi to fail to circulate. (As stated, "when Qi moves, Blood stops"—here implying that insufficient Yin fluids cannot carry Blood smoothly, while the fierce nature of Yang Qi surges forward, causing Blood congestion leading to carbuncles and ulcers). Carbuncles and ulcers develop. When Yin and Yang are blocked and two heats clash, (Blood becomes more congested, and fierce Qi cannot circulate freely, thus steaming into pus.) Pus forms. With formed pus, ten die for every one survivor. If the whites of the eyes appear blue-green and the pupils shrink, this is the first adverse sign (Ni). Vomiting after taking medicine is the second adverse sign. Abdominal pain with extreme thirst is the third adverse sign. Inconvenience in shoulders and neck is the fourth adverse sign. Hoarseness and sallow complexion is the fifth adverse sign. Excluding these five, it is considered favorable (Shun). (The modern surgical school's theory of Five Favors and Seven Evils originates from this. Discusses favorable and adverse signs of carbuncles/ulcers above.)
In heat diseases, if the pulse is quiet but becomes rapid and surging after sweating, this is the first adverse sign. If diarrhea accompanies a洪大 (Surging/Large) pulse, this is the second adverse sign. In fixed Bi syndrome with muscle erosion, fever, and an absent pulse on one side, this is the third adverse sign. Emaciation due to sexual excess, fever, sallow-white complexion, followed by hematochezia with dark, heavy blood, is the fourth adverse sign. ("Yin" here refers to sexual excess per Ma Zhen, but incorrectly; it includes nocturnal emission, leukorrhea, dysentery, and spontaneous night sweats.) Emaciation due to alternating chills and fever, with a firm and gripping pulse, is the fifth adverse sign.
Abdominal distension, fever, and a large pulse constitute the first adverse sign. Bowel sounds with fullness, cold limbs, diarrhea, and a large pulse constitute the second adverse sign. Unstopping epistaxis with a large pulse constitutes the third adverse sign. Cough with hematuria, emaciation, and a small yet forceful pulse constitute the fourth adverse sign. Cough, emaciation, fever, and a small yet rapid pulse constitute the fifth adverse sign. In such cases, death occurs within fifteen days.
Abdominal distension, cold extremities, emaciation, and severe diarrhea constitute the first adverse sign. Abdominal distension, bloody stool, large pulse that intermittently disappears constitutes the second adverse sign. Cough, hematuria, loss of flesh, and a gripping pulse constitute the third adverse sign.
Hematemesis with chest fullness radiating to the back, and a small yet rapid pulse, constitute the fourth adverse sign. Cough, vomiting, abdominal distension, and undigested diarrhea with an absent pulse constitute the fifth adverse sign. In such cases, death occurs within less than one double-hour (shi). (Discusses favorable and adverse signs of miscellaneous diseases above.)
There are nine conditions in heat diseases where acupuncture is contraindicated. These contraindications indicate fatal signs. First: No sweat, redness on the cheekbones, and hiccups indicate death. Second: Diarrhea with severe abdominal fullness indicates death. Third: Unclear vision with persistent heat indicates death. Fourth: Fever with abdominal fullness in the elderly or infants indicates death. Fifth: No sweat, vomiting, and hematochezia indicate death. Sixth: Ulceration of the tongue root with persistent heat indicates death. Seventh: Cough with epistaxis, no sweat, or sweat that does not reach the feet indicates death. Eighth: Marrow heat indicates death. Ninth: Heat with spasms indicates death. The spine bends backward, limbs twitch, and teeth clench. All nine conditions are contraindications for acupuncture. For those suitable for acupuncture, needle urgently to induce sweating and resolve diarrhea. (Discusses favorable and adverse signs of heat diseases above. Content from *Ling Shu*.)