通篇分三段∶首段言逐月人气之所在，二段言刺法宜忌，末段言十二经将死之证，为人生之终事。皆诸篇所
不载，诊病者不可不知，故曰诊要经终也。
黄帝问曰∶诊要何如？岐伯对曰∶正月二月，天气始方，地气始发，人气在肝。（按∶方，犹言初动，天气
初动于上，地气应之而发生也。盖春居四时之先，正月二月为一岁之首，天地之气，至此方萌生发之机，而为
化化生生之始也。人得天地之气，内通于肝，肝者木也，王于春而亦为五脏生气之始也。）三月四月，天气正
方，地气定发，人气在脾。（按∶由春入夏，天地之气方发者，至此大盛。三月辰土，四月巳火，火土养脾，
脾为元气之母，人气得之以资脏腑而生血气也。）五月六月，天气盛，地气高，人气在头。（天阳赫盛，地焰高
升，故言天气盛，地气高。火性炎上，故言人气在头也。）七月八月，阴气始杀，人气在肺。（按∶由夏转秋，
气渐肃杀，申酉之月，气王于金，金气合肺，故人气在肺。）九月十月，阴气始冰，地气始闭，人气在心。（按∶冰
犹凝也。秋尽冬初，收敛归藏，天地之气，由阳返阴，人身之火，尽摄合而还于心，故云人气在心也）十一月
十二月，冰复，地气合，人
气在肾。（……阳气深复，故气在肾也。夫气之变也，发生于木，长茂于土，盛高而上，肃杀于金，避寒于火，
伏藏于水，斯皆随顺阴阳之升沉也。五脏生成论曰∶“五脏之象，可以类推。”此之谓气类也。）春夏秋冬，
各有所刺，法其所在。（按∶义见水热穴论及四时刺逆从论中。）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。（心主脉，故脉乱气微。水受气于夏，肾主骨，故入淫于骨髓。心火微则胃土不足，
故不嗜食而少气也。按∶新校正云∶“四时刺逆从论云∶春刺络脉，血气外溢，令人少气。”）春刺秋分，筋
挛，逆气环为咳嗽，病不愈，令人时惊，又且哭。（木受气于秋，肝主筋，故刺秋分则筋挛也。若气环周，则
为咳嗽。肝主惊，故时惊。肺主气，故气逆，又且哭也。按∶四时刺逆从论云∶“春刺肌肉，血气环逆，令人
上气也。”）春刺冬分，邪气着藏，令人胀，病不愈，又且欲言语。（冬主阳气伏藏，故邪气着藏。肾实则胀，
故刺冬分则胀也。火受气于冬，心主言，故欲言语也。按∶四时刺逆从论云∶“春刺筋骨，血气内着，令人
腹胀。”）夏刺春分，病不愈，令人解堕。（肝养筋，肝气不足，故筋力解堕。按∶四时刺逆从论云∶“夏刺
经脉，血气乃竭，令人解堕。”）夏刺秋分，病不愈，令人心中欲无言，惕惕如人将捕之。（按∶误刺秋分，
则伤在肺矣。肺主气，肺伤则气馁弱而不能言。气馁弱，则怖畏而如人将捕之。注作肝解，误矣。）夏刺冬分，
病不愈，令人少气，时欲怒。（按∶四时刺逆从论亦言∶“夏刺筋骨，血气上逆，令人善怒。”怒主肝，肾伤
何以亦怒耶？盖肾者水也，肝者木也，木养于水，水虚无气，肝失所养，故怒也。）秋刺春分，病不已，令人
惕然欲有所为，起而忘之。（肝虚故也，刺不当也。按∶四时逆从论云∶“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。（心少气则脾气孤，故令嗜卧。心主梦，神为之，故令善梦。按∶四时刺逆从论云∶“秋刺络脉，
气不外行，令人卧不欲动。”）秋刺冬分，病不已，令人洒洒时寒。（按∶肾之表，足太阳也。太阳主恶寒，故
伤肾则时寒。又按四时刺逆从论曰∶“秋刺筋骨，血气内散，令人寒栗。”）冬刺春分，病不已，令人欲卧不
能眠，眠而有见。（肝气少，故令欲卧不能眠。肝主目，故眠而如见有物之形状也。按∶四时刺逆从论云∶冬刺
经脉，血气皆脱，令人目不明。）冬刺夏分，病不愈，气上发为诸痹。（泄脉气故也。按∶四时刺逆从论云∶“冬刺
络脉，血气外泄，留为大痹。”）冬刺秋分，病不已，令人善渴。（肺气不足，故发渴。按∶四时刺逆从论云∶“
冬刺肌肉，阳气竭绝，令人善渴。”渴非肺病，肺伤则少气而不能化水，故渴也。）
凡刺胸腹者，必避五脏。（心肺在膈上，肝肾在膈下，脾象土而居中，故刺胸腹必避之。五脏者，所以藏精
神魂魄意志，损之则五神去，神去则死至，故不可不慎也。）中心者环死，（气行如环之一周则死也，正谓周十
二辰也。按∶新校正云∶“刺禁论云一日死，其动为噫，与四时刺逆从论同。此经阙刺中肝死日，刺禁论云中肝五日
死，其动为语，与四时刺逆从论同。”）中脾者五日死，（土数五也。按∶刺禁论云中脾十日死，其动为吞，
与四时刺逆从论同。）中肾者七日死，（水成数六，水数毕，当至七日而死。按∶刺禁论云中肾六日死，其动为
嚏，四时刺逆从论云，中肾六日死，其动为嚏欠也。）中肺者五日死。（金生数四，金数毕，当至五日而死。
一云三日死，亦字误也。按∶刺禁论与四时刺逆从论并言三日死，皆误也，当以此为正。）中膈者皆为伤中，
其病虽愈，不过一岁必死。（……按∶膈当一身之中，五脏之气必归焉。五脏同主一年，故膈伤则五脏俱病，至
一岁必死也。）刺针必肃，（肃谓静肃，所以候气之存亡。）刺肿摇针，（以出大脓血故。）经刺勿摇，（经气不欲泄故。）此
刺之道也。
帝曰∶愿闻十二经脉之终奈何？（终谓尽也。）岐伯曰∶太阳之脉，其终也戴眼，反折 ，其色白，绝
汗乃出，出则死矣。（戴眼谓睛不转而仰视也。然足太阳脉，起于目内 ，上额交巅上，从巅入络脑，还出别
下项，循肩膊内，挟脊抵腰中。其支别者，下循足，至小趾外侧。手太阳脉，起于手小指之端，循臂上肩，入
缺盆。其支别者，上颊至目内 ，抵足太阳。按∶新校正云∶“甲乙经作斜络于颧。”）又其支别者，从缺盆，
循颈上颊，至目外 。故戴眼反折 色白绝汗乃出也。绝汗，谓汗暴出如珠而不流，旋复干也。太阳极则汗
出，故出则死。少阳终者耳聋，百节皆纵，目HT 绝系，一日半死，其死也。色先青白，乃死矣。（足少阳
脉，起于目锐 ，上抵头角，下耳后。其支别者，从耳后，入耳中，出走耳前。手少阳脉，其支别者，从耳后，
亦入耳中，出走耳前。故终则耳聋目HT 绝系也。少阳主骨，故气终则百节纵缓。色青白者，金木相薄也，故见
则死矣。HT 谓直视如惊貌。按∶注言少阳主骨。又HT ，旧音琼，注言直视如惊。窃谓皆误也。夫足少阳胆，
手少阳三焦，并不主骨。其言百节皆纵者，大筋弛也。目HT 绝系者，小筋断也。筋属肝，肝与胆合，腑病而
及于脏也。HT 者，环字之误，盖目之眶也。目系维于眶，系偏绝则斜眺，若环眶皆绝，则目定而不能运动，
故不数日即死也。）阳明终者，口目动作，善惊妄言，色黄，其上下经盛，不仁则终矣。（足阳明脉起于鼻交
中，下循鼻外，入上齿缝中，还出挟口环唇，下交承浆，却循颐后下廉，出大迎，循颊车，上耳前，过客主人，
循发际，至额颅。其支别者，从大迎前，下人迎，循喉咙，入缺盆，下膈。手阳明脉，起于手，循臂至肩，上出
于柱骨之会上，下入缺盆，络肺。其支别者，从缺盆，上颈贯颊，下入齿中，还出颊口，交人中，左之右，右
之左，上挟鼻孔，抵足阳明。故终则口目动作也。按∶阳明，胃与大肠也。动
作者，牵动不止，胃脉环口是也，目则义无所取，盖口动而与目相牵引，故云口目动作也。阳明病，闻木音则惕
然而惊，骂詈不避亲疏，病极则色外见，故将死则善惊妄言色黄也。上，人迎也，在结喉旁。下，跗阳也。盛
者，动而躁也。古者人将死，尝诊此以决之。不仁者，不知痛痒也。言诸证既见，而肌肉复不知痛痒，其死必矣。）
少阴终者，面黑齿长而垢，腹胀闭，上下不通而终矣。（手少阴气绝则血不流，足少阴气绝则骨不 。骨硬则龈
上宣，故齿长而积垢 ；血坏则皮色死，故面色如漆而不赤也。足少阴脉，从肾下贯肝膈，入肺中。手少阴脉，
起于心中，出属心系，下膈络小腹。故其终则腹胀闭，上下不通也。按∶王注云骨不 、骨硬，难经及甲乙经云
骨不濡则肉弗能着。注言手少阴脉络小腹，甲乙作络小肠。并通。）太阴终者，腹胀闭，不得息，善噫，善呕，
（足太阴脉，行从股内前廉，入腹属脾络胃，上膈。手太阴脉，起于中焦，下络大肠，还循胃口，上膈属肺。
故终则如是也。灵枢经曰∶足太阴之脉动则病，食则呕，腹胀善噫也。）呕则逆，逆则面赤，（呕则气逆故面赤。）
不逆则上下不通，不通则面黑、皮毛焦而终矣。（呕则上通，故但面赤。不呕则下已闭，上复不通，心气外燔，
故皮毛焦而终矣。何者？足太阴脉，支别者，复从胃别上膈，注心中。由是则皮毛焦，乃心气外燔而生也。）
厥阴终者，中热嗌干，善溺心烦，甚则舌卷卵上缩而终矣。（足厥阴络，循胫上睾结于茎。其正经入毛中，下
过阴器，上抵小腹，挟胃，上循喉咙之后，入颃颡。手厥阴脉，起于胸中，出属心包。故终则中热嗌干，善溺
心烦矣。灵枢经曰∶“肝者，筋之合也。筋者，聚于阴器而络于舌本。”故甚则舌卷卵上缩也。又以厥阴之脉
环阴器故尔。）此十二经之所败也。（按∶十二经之所以终尽者，以其精神败坏故也。）
全篇分为三段：首段论述每月人体正气所在的部位，二段论述针刺的适宜与禁忌，末段论述十二经脉将绝时的证候，这是关乎生命终结的重要事项。这些内容在其他篇章中未曾记载，诊治疾病的人不可不知，所以称为《诊要经终论》。
黄帝问道：诊断的关键是什么？岐伯回答说：正月、二月，天气刚开始升发，地气开始萌动，人体的正气在肝。（按语：方，意为初动，天气刚开始在上部发动，地气响应而发生生发之机。因为春季位于四季之首，正月、二月是一年的开端，天地之气在此时刚刚萌发生发的生机，成为化生万物、生生不息的开始。人禀受天地之气，内部通应于肝，肝属木，旺于春季，也是五脏生气开始的脏腑。）三月、四月，天气正当升发，地气确定发动，人体的正气在脾。（按语：由春入夏，天地之气正在发散的，到此时盛大旺盛。三月为辰土，四月为己火，火土滋养脾脏，脾为元气之母，人体正气借此资助脏腑而生血气。）五月、六月，天气盛大，地气高升，人体的正气在头部。（天阳炽盛，地焰高升，所以说天气盛，地气高。火性炎上，所以说人气在头部。）七月、八月，阴气开始肃杀，人体的正气在肺。（按语：由夏转秋，气候逐渐肃杀，申、酉之月，金气当令，金气合应于肺，所以人气在肺。）九月、十月，阴气开始结冰，地气开始闭藏，人体的正气在心。（按语：冰，意为凝结。秋尽冬初，收敛归藏，天地之气由阳返阴，人身之火，全部摄合并回归于心，所以说人气在心。）十一月、十二月，冰层复厚，地气闭合，人体的正气在肾。（……阳气深伏潜藏，所以气在肾。气的变化，发生于木，长茂于土，盛大高升于火，肃杀于金，避寒于水，伏藏于水，这都是顺应阴阳升降的道理。《五脏生成论》说：“五脏的象，可以类推。”说的就是这种气类相应。）春夏秋冬，各有相应的刺法，要依据正气所在的部位而定。（按语：义理见《水热穴论》及《四时刺逆从论》中。）春季刺夏季对应的部位，脉象紊乱，气息微弱，邪气深入骨髓，病不能痊愈，使人食欲不振，并且气短。（心主脉，所以脉乱气微。水受气于夏，肾主骨，所以邪气淫溢于骨髓。心火微弱则胃土不足，所以不嗜食而少气。按语：新校正说：“《四时刺逆从论》说：‘春刺络脉，血气外溢，令人少气。’”）春季刺秋季对应的部位，筋脉拘挛，逆气环绕导致咳嗽，病不痊愈，使人时常惊恐，并且哭泣。（木受气于秋，肝主筋，所以刺秋季对应的部位则筋挛。如果气环周运行，则为咳嗽。肝主惊，所以时惊。肺主气，所以气逆，并且哭泣。按语：《四时刺逆从论》说：“春刺肌肉，血气环逆，令人上气。”）春季刺冬季对应的部位，邪气附着于内脏，使人腹胀，病不痊愈，并且想要说话。（冬主阳气伏藏，所以邪气着藏。肾实则胀，所以刺冬季对应的部位则胀。火受气于冬，心主言，所以欲言语。按语：《四时刺逆从论》说：“春刺筋骨，血气内着，令人腹胀。”）夏季刺春季对应的部位，病不痊愈，使人懈怠无力。（肝养筋，肝气不足，所以筋力懈怠无力。按语：《四时刺逆从论》说：“夏刺经脉，血气乃竭，令人解堕。”）夏季刺秋季对应的部位，病不痊愈，使人心中想沉默不语，恐惧得像被人追捕一样。（按语：误刺秋季对应的部位，则伤在肺。肺主气，肺伤则气馁弱而不能言。气馁弱，则怖畏而如人将捕之。注解说作肝解，是错误的。）夏季刺冬季对应的部位，病不痊愈，使人少气，时常发怒。（按语：《四时刺逆从论》也说：“夏刺筋骨，血气上逆，令人善怒。”怒主肝，肾伤为什么也会怒呢？盖肾属水，肝属木，木养于水，水虚无气，肝失所养，所以怒。）秋季刺春季对应的部位，病不愈，使人惊恐想要有所作为，起来却忘记了。（肝虚的缘故，刺不当。按语：《四时逆从论》说：“秋刺经脉，血气上逆，令人善忘。”）秋季刺夏季对应的部位，病不愈，使人更加嗜睡，并且多梦。（心少气则脾气孤，所以令嗜卧。心主梦，神为之，所以令善梦。按语：《四时刺逆从论》说：“秋刺络脉，气不外行，令人卧不欲动。”）秋季刺冬季对应的部位，病不愈，使人洒洒然时时恶寒。（按语：肾之表，是足太阳膀胱经。太阳主恶寒，所以伤肾则时寒。又按《四时刺逆从论》说：“秋刺筋骨，血气内散，令人寒栗。”）冬季刺春季对应的部位，病不愈，使人想睡觉但不能安眠，睡着后会有幻觉。（肝气少，所以令欲卧不能眠。肝主目，所以眠而如见有物之形状。按语：《四时刺逆从论》说：冬刺经脉，血气皆脱，令人目不明。）冬季刺夏季对应的部位，病不愈，气上发为各种痹证。（泄脉气缘故。按语：《四时刺逆从论》说：“冬刺络脉，血气外泄，留为大痹。”）冬季刺秋季对应的部位，病不愈，使人容易口渴。（肺气不足，所以发渴。按语：《四时刺逆从论》说：“冬刺肌肉，阳气竭绝，令人善渴。”渴非肺病，肺伤则少气而不能化水，所以渴。）
凡是针刺胸腹的，必须避开五脏。（心肺在膈上，肝肾在膈下，脾象土而居中，所以刺胸腹必避开它们。五脏，是用来藏精、神、魂、魄、意、志的，损伤它们则五神离去，神去则死至，所以不可不慎。）刺中心脏的，一周后死亡（气行如环之一周则死也，正谓周十二辰。按语：新校正说：“《刺禁论》说一日死，其动为噫，与《四时刺逆从论》同。此经缺刺中肝死日，《刺禁论》中说肝五日死，其动为语，与《四时刺逆从论》同。”），刺中脾脏的，五日后死亡（土数五。按语：《刺禁论》中说脾十日死，其动为吞，与《四时刺逆从论》同），刺中肾脏的，七日后死亡（水成数六，水数毕，当至七日而死。按语：《刺禁论》中说肾六日死，其动为嚏，《四时刺逆从论》说，中肾六日死，其动为嚏欠也），刺中肺脏的，五日后死亡。（金生数四，金数毕，当至五日而死。一说三日死，也是字误。按语：《刺禁论》与《四时刺逆从论》并言三日死，都是错误的，应当以此为准。）刺中膈膜的，都算是伤了中气，病虽然好了，不超过一年必定死亡。（……按语：膈当一身之中，五脏之气必归焉。五脏同主一年，故膈伤则五脏俱病，至一岁必死也。）下针时必须严肃恭敬（肃谓静肃，所以候气之存亡），刺肿疡时要摇针（以出大脓血故），刺经脉时不要摇针（经气不欲泄故），这就是针刺的原则。
皇帝说：我想听听十二经脉将绝的情形是怎样的？（终谓尽也。）岐伯说：太阳经脉将绝时，表现为两眼上视不能转动，身体反折强直，面色苍白，绝汗流出，汗出则死亡。（戴眼谓睛不转而仰视也。然足太阳脉，起于目内眦，上额交巅上，从巅入络脑，还出别下项，循肩膊内，挟脊抵腰中。其支别者，下循足，至小趾外侧。手太阳脉，起于手小指之端，循臂上肩，入缺盆。其支别者，上颊至目内眦，抵足太阳。按语：新校正说：“《甲乙经》作斜络于颧。”）又其支别者，从缺盆，循颈上颊，至目外眦。故戴眼反折强直，色白绝汗乃出也。绝汗，谓汗暴出如珠而不流，旋复干也。太阳极则汗出，故出则死。少阳经脉将绝时，耳聋，全身关节松弛无力，眼睛直视如惊貌，系脉断绝，一日半死，死时面色先青白，然后死亡。（足少阳脉，起于目锐眦，上抵头角，下耳后。其支别者，从耳后，入耳中，出走耳前。手少阳脉，其支别者，从耳后，亦入耳中，出走耳前。故终则耳聋目HT 绝系也。少阳主骨，故气终则百节纵缓。色青白者，金木相薄也，故见则死矣。HT 谓直视如惊貌。按语：注言少阳主骨。又HT ，旧音琼，注言直视如惊。窃谓皆误也。夫足少阳胆，手少阳三焦，并不主骨。其言百节皆纵者，大筋弛也。目HT 绝系者，小筋断也。筋属肝，肝与胆合，腑病而及于脏也。HT 者，环字之误，盖目之眶也。目系维于眶，系偏绝则斜眺，若环眶皆绝，则目定而不能运动，故不数日即死也。）阳明经脉将绝时，口眼歪斜抽动，容易惊恐，胡言乱语，面色黄，人迎和跗阳两处经脉搏动盛躁，肌肉麻木不仁则死亡。（足阳明脉起于鼻交中，下循鼻外，入上齿缝中，还出挟口环唇，下交承浆，却循颐后下廉，出大迎，循颊车，上耳前，过客主人，循发际，至额颅。其支别者，从大迎前，下人迎，循喉咙，入缺盆，下膈。手阳明脉，起于手，循臂至肩，上出于柱骨之会上，下入缺盆，络肺。其支别者，从缺盆，上颈贯颊，下入齿中，还出颊口，交人中，左之右，右之左，上挟鼻孔，抵足阳明。故终则口目动作也。按语：阳明，胃与大肠也。动作者，牵动不止，胃脉环口是也，目则义无所取，盖口动而与目相牵引，故云口目动作也。阳明病，闻木音则惕然而惊，骂詈不避亲疏，病极则色外见，故将死则善惊妄言色黄也。上，人迎也，在结喉旁。下，跗阳也。盛者，动而躁也。古者人将死，尝诊此以决之。不仁者，不知痛痒也。言诸证既见，而肌肉复不知痛痒，其死必矣。）少阴经脉将绝时，面色黑，牙齿显得长且积垢，腹胀闭塞，上下不通而死亡。（手少阴气绝则血不流，足少阴气绝则骨不濡。骨硬则龈上宣，故齿长而积垢；血坏则皮色死，故面色如漆而不赤也。足少阴脉，从肾下贯肝膈，入肺中。手少阴脉，起于心中，出属心系，下膈络小腹。故其终则腹胀闭，上下不通也。按语：王注云骨不濡、骨硬，《难经》及《甲乙经》云骨不濡则肉弗能着。注言手少阴脉络小腹，《甲乙》作络小肠。并通。）太阴经脉将绝时，腹胀闭塞，呼吸困难，频繁嗳气，频繁呕吐，（足太阴脉，行从股内前廉，入腹属脾络胃，上膈。手太阴脉，起于中焦，下络大肠，还循胃口，上膈属肺。故终则如是也。《灵枢经》曰：足太阴之脉动则病，食则呕，腹胀善噫也。）呕吐则气逆，气逆则面赤，（呕则气逆故面赤。）如果不呕吐则上下不通，不通则面黑、皮毛枯焦而死亡。（呕则上通，故但面赤。不呕则下已闭，上复不通，心气外燔，故皮毛焦而终矣。何者？足太阴脉，支别者，复从胃别上膈，注心中。由是则皮毛焦，乃心气外燔而生也。）厥阴经脉将绝时，心中发热，咽喉干燥，小便频数，心烦，严重时舌卷缩，睾丸上缩而死亡。（足厥阴络，循胫上睾结于茎。其正经入毛中，下过阴器，上抵小腹，挟胃，上循喉咙之后，入颃颡。手厥阴脉，起于胸中，出属心包。故终则中热嗌干，善溺心烦矣。《灵枢经》曰：“肝者，筋之合也。筋者，聚于阴器而络于舌本。”故甚则舌卷卵上缩也。又以厥阴之脉环阴器故尔。）这就是十二经脉败绝的情形。（按语：十二经之所以终尽者，以其精神败坏故也。）
The entire text is divided into three sections: the first section discusses the location of vital Qi in each month, the second section discusses the indications and contraindications for acupuncture, and the final section discusses the signs of impending death when the twelve meridians are exhausted. These are matters concerning the end of life. Such content is not recorded in other chapters, so physicians must know them; hence it is called *Zhenyao Jingzhong Lun* (Treatise on the Essentials of Diagnosis and the Exhaustion of Meridians).
Huangdi asked: What are the essentials of diagnosis? Qibo replied: In the first and second months, the Qi of Heaven begins to rise, and the Qi of Earth begins to emerge. The human Qi resides in the Liver (Wood organ, associated with spring and growth). [Commentary: "Fang" means initial movement. Heaven's Qi initiates movement above, and Earth's Qi responds by generating growth. Spring precedes the four seasons; the first and second months are the beginning of the year. At this time, the Qi of Heaven and Earth just sprouts the mechanism of generation, becoming the start of transformation and endless creation. Humans receive the Qi of Heaven and Earth, internally connecting to the Liver. The Liver belongs to Wood, prospers in Spring, and is the beginning of the generating Qi of the five Zang organs.] In the third and fourth months, the Qi of Heaven is fully rising, and the Qi of Earth is firmly activating. The human Qi resides in the Spleen (Earth organ, source of Yuan Qi). [Commentary: Transitioning from Spring to Summer, the rising Qi of Heaven and Earth reaches its peak. The third month corresponds to Chen Earth, and the fourth to Si Fire. Fire and Earth nourish the Spleen. The Spleen is the mother of Yuan Qi; human Qi relies on it to nourish the Zang-Fu organs and generate Blood and Qi.] In the fifth and sixth months, the Qi of Heaven is abundant, and the Qi of Earth is high. The human Qi resides in the Head. [Heavenly Yang is intense, and earthly flames rise high, hence "Qi of Heaven is abundant, Qi of Earth is high." Fire nature flares upward, hence "human Qi resides in the head."] In the seventh and eighth months, Yin Qi begins to kill (wither/contract), and the human Qi resides in the Lungs (Metal organ, associated with autumn and descent). [Commentary: Transitioning from Summer to Autumn, the climate gradually becomes austere and killing. In the Shen and You months, Metal Qi dominates. Metal Qi corresponds to the Lungs, hence "human Qi resides in the Lungs."] In the ninth and tenth months, Yin Qi begins to freeze, and the Qi of Earth begins to close. The human Qi resides in the Heart (Fire organ, associated with winter storage). [Commentary: "Bing" means congeal. At the end of Autumn and beginning of Winter, things converge and store. The Qi of Heaven and Earth returns from Yang to Yin. The fire of the human body is gathered and returns to the Heart, hence "human Qi resides in the Heart."] In the eleventh and twelfth months, ice thickens, and the Qi of Earth closes. The human Qi resides in the Kidneys (Water organ, associated with deep storage). [Commentary: Yang Qi deeply hides, hence Qi is in the Kidney. Changes in Qi originate in Wood, flourish in Earth, become abundant and rise in Fire, become austere in Metal, avoid cold in Water, and hide in Water. This follows the ascending and descending of Yin and Yang. The *Wuzang Shengcheng Lun* states: "The images of the five Zang organs can be inferred by analogy." This refers to such correspondence of Qi categories.] Spring, Summer, Autumn, and Winter each have specific needling methods based on where the Qi resides. [Commentary: See *Shuire Xuelun* and *Sishi Ni Cong Lun*.] If one needles the Summer area during Spring, the pulse becomes chaotic, Qi becomes faint, pathogenic Qi penetrates into the bone marrow, the disease cannot be cured, causing loss of appetite and shortness of Qi. [Heart governs the pulse, hence chaotic pulse and faint Qi. Water receives Qi from Summer; Kidney governs bones, hence pathogenic Qi invades bone marrow. Weak Heart Fire leads to insufficient Stomach Earth, hence loss of appetite and shortness of Qi. Note: *Xin Zhengshuo* says: "*Sishi Ni Cong Lun* states: 'Needling collateral vessels in Spring causes blood and Qi to overflow externally, leading to shortness of Qi.'"] If one needles the Autumn area during Spring, tendons spasm, counterflow Qi causes coughing, the disease cannot be cured, causing frequent fright and weeping. [Wood receives Qi from Autumn; Liver governs tendons, hence needling the Autumn area causes tendon spasms. If Qi circulates inversely, it causes coughing. Liver governs fright, hence frequent fright. Lung governs Qi, hence counterflow Qi and weeping. Note: "*Sishi Ni Cong Lun* states: 'Needling muscle layer in Spring causes blood and Qi to reverse circularly, leading to upper Qi.'" ] If one needles the Winter area during Spring, pathogenic Qi attaches to the Zang organs, causing abdominal distension, the disease cannot be cured, and the patient desires to speak. [Winter governs the hiding of Yang Qi, hence pathogenic Qi attaches to Zang. Fullness in Kidney causes distension, hence needling the Winter area causes distension. Fire receives Qi from Winter; Heart governs speech, hence desire to speak. Note: "*Sishi Ni Cong Lun* states: 'Needling sinews and bones in Spring causes blood and Qi to adhere internally, leading to abdominal distension.'"] If one needles the Spring area during Summer, the disease cannot be cured, causing lethargy and weakness. [Liver nourishes tendons; insufficient Liver Qi causes tendons to relax and weaken. Note: "*Sishi Ni Cong Lun* states: 'Needling meridians in Summer causes blood and Qi to exhaust, leading to lethargy and weakness.'"] If one needles the Autumn area during Summer, the disease cannot be cured, causing a desire for silence in the heart, and a sense of terror as if being pursued. [Commentary: Erroneously needling the Autumn area injures the Lung. Lung governs Qi; Lung injury leads to weak Qi and inability to speak. Weak Qi leads to fear and the sensation of being pursued. The commentary interpreting this as Liver is incorrect.] If one needles the Winter area during Summer, the disease cannot be cured, causing shortness of Qi and frequent anger. [Note: "*Sishi Ni Cong Lun*" also says: "Needling sinews and bones in Summer causes blood and Qi to counterflow upward, leading to irritability." Anger is governed by Liver. Why does Kidney injury cause anger? Kidney is Water, Liver is Wood. Wood is nourished by Water. If Water is empty and lacks Qi, Liver loses nourishment, hence anger.] If one needles the Spring area during Autumn, the disease persists, causing a startled feeling of wanting to act, but forgetting upon standing. [Due to Liver deficiency; improper needling. Note: "*Sishi Ni Cong Lun*" states: "Needling meridians in Autumn causes blood and Qi to counterflow upward, leading to forgetfulness."] If one needles the Summer area during Autumn, the disease persists, causing increased drowsiness and frequent dreaming. [When Heart Qi is deficient, Spleen Qi becomes isolated, causing drowsiness. Heart governs dreams, Spirit creates them, hence frequent dreaming. Note: "*Sishi Ni Cong Lun*" states: "Needling collateral vessels in Autumn causes Qi not to move outward, leading to lying down without desire to move."] If one needles the Winter area during Autumn, the disease persists, causing shivering and frequent aversion to cold. [Commentary: The exterior of the Kidney is the Foot-Taiyang Bladder Meridian. Taiyang governs aversion to cold, hence Kidney injury causes frequent cold sensations. Also, "*Sishi Ni Cong Lun*" states: "Needling sinews and bones in Autumn causes blood and Qi to scatter internally, leading to chills."] If one needles the Spring area during Winter, the disease persists, causing a desire to sleep but inability to do so, and visual hallucinations while sleeping. [Insufficient Liver Qi causes desire to sleep but inability to rest. Liver opens into the eyes, hence seeing shapes while sleeping. Note: "*Sishi Ni Cong Lun*" states: "Needling meridians in Winter causes blood and Qi to both escape, leading to unclear vision."] If one needles the Summer area during Winter, the disease persists, causing various Bi syndromes due to Qi rising. [Due to leaking meridian Qi. Note: "*Sishi Ni Cong Lun*" states: "Needling collateral vessels in Winter causes blood and Qi to leak externally, remaining as major Bi."] If one needles the Autumn area during Winter, the disease persists, causing frequent thirst. [Insufficient Lung Qi causes thirst. Note: "*Sishi Ni Cong Lun*" states: "Needling muscle layer in Winter causes Yang Qi to exhaust, leading to frequent thirst." Thirst is not a Lung disease per se, but Lung injury leads to insufficient Qi and inability to transform fluids, hence thirst.]
Whenever needling the chest and abdomen, one must avoid the Five Zang organs. [Heart and Lung are above the diaphragm; Liver and Kidney are below. Spleen resembles Earth and is central. Thus, needling the chest and abdomen requires avoiding them. The Five Zang store Essence, Spirit, Hun, Po, Yi, and Zhi. Damaging them causes the Five Spirits to depart; when Spirits depart, death arrives. Therefore, caution is essential.] Needling the Heart directly leads to death within one cycle (a cycle refers to the circulation of Qi through the twelve double-hours). [Note: *Xin Zhengshuo* says: "*Cijin Lun* states death occurs in one day, with symptoms of belching, consistent with *Sishi Ni Cong Lun*. This chapter lacks the death day for needling the Liver; *Cijin Lun* states death in five days for Liver, with symptoms of speaking, consistent with *Sishi Ni Cong Lun*.]" Needling the Spleen directly leads to death in five days (Earth number is five). [Note: *Cijin Lun* states death in ten days for Spleen, with symptoms of swallowing, consistent with *Sishi Ni Cong Lun*.] Needling the Kidney directly leads to death in seven days (Water completion number is six; after Water numbers complete, death occurs on the seventh day). [Note: *Cijin Lun* states death in six days for Kidney, with symptoms of sneezing; *Sishi Ni Cong Lun* states death in six days for Kidney, with symptoms of sneezing and yawning.] Needling the Lung directly leads to death in five days. (Metal generation number is four; after Metal numbers complete, death occurs on the fifth day. Some say three days, which is a character error. Note: Both *Cijin Lun* and *Sishi Ni Cong Lun* state three days, which is erroneous; this text should be considered correct.) Needling the Diaphragm constitutes injury to the Middle Jiao. Even if the disease heals, death will occur within one year. [Commentary: The Diaphragm is at the center of the body, where Qi of the Five Zang converges. The Five Zang correspond to one year; thus, Diaphragm injury affects all Five Zang, leading to death within a year.] One must be solemn and respectful when inserting needles (Solemnity ensures waiting for the presence or absence of Qi). When needling swellings/abscesses, shake the needle (to drain large amounts of pus and blood). When needling meridians, do not shake the needle (to prevent leakage of meridian Qi). This is the way of needling.
The Emperor said: I wish to hear about the exhaustion of the twelve meridians. [Exhaustion means termination.] Qibo said: When the Taiyang Meridian exhausts, the eyes stare upward without moving, the body arches backward (opisthotonos), the complexion is white, absolute sweat appears, and death follows immediately. [Daiyan means eyes unable to turn, staring upward. Foot-Taiyang Meridian originates at the inner canthus, crosses the vertex, enters the brain, emerges to descend the neck, runs along the shoulder blades,夹 spine to the waist. Its branch descends the leg to the lateral side of the little toe. Hand-Taiyang Meridian originates at the lateral side of the little finger, runs up the arm to the shoulder, enters the supraclavicular fossa. Its branch ascends the cheek to the inner canthus, connecting to Foot-Taiyang. Note: *Jiayi Jing* reads "obliquely connects to the zygoma." Another branch from the supraclavicular fossa runs up the neck to the cheek, reaching the outer canthus. Hence Daiyan, opisthotonos, white complexion, and absolute sweat. Absolute sweat means sweat suddenly erupts like beads, does not flow, and quickly dries. Taiyang extreme leads to sweating, hence death upon sweating.] When the Shaoyang Meridian exhausts, deafness occurs, all joints become flaccid, the eyes stare fixedly (jingmu) with severed connections, death occurs in one and a half days. The complexion turns green and white before death. [Foot-Shaoyang Meridian originates at the outer canthus, ascends to the corner of the head, descends behind the ear. Its branch enters the ear, exits in front. Hand-Shaoyang branch also enters the ear and exits in front. Hence deafness and fixed eyes with severed connections. Shaoyang governs bones, hence joint flaccidity when Qi exhausts. Green and white complexion indicates Metal and Wood clashing, signifying death. "Jingmu" means staring fixedly like fear. Note: Commentary says Shaoyang governs bones. "Jingmu" old pronunciation is Qiong, commentary says staring like fear. I believe both are wrong. Foot-Shaoyang Gallbladder and Hand-Shaoyang Sanjiao do not govern bones. "All joints flaccid" refers to relaxation of large tendons. "Severed connections" refers to rupture of small tendons. Tendons belong to Liver; Liver combines with Gallbladder; Fu disease affects Zang. "Jingmu" is likely a typo for "Huan" (ring), referring to the eye socket. Eye connections attach to the socket; if one side severs, the eye deviates; if the ring socket severs completely, the eye fixes and cannot move, leading to death in a few days.] When the Yangming Meridian exhausts, the mouth and eyes twitch/spasm, frequent fright, delirious speech, yellow complexion, and excessive pulsation in the upper (Renying) and lower (Fuyang) vessels lead to insensibility and death. [Foot-Yangming Meridian originates at the nose, crosses the glabella, runs down the lateral nose, enters the upper gum, circles the lips, meets at Chengjiang, runs behind the jaw to Daying, along Jiache, up in front of the ear, passes Guanzhu, along the hairline to the forehead. Its branch goes down Renying, along the throat, into the supraclavicular fossa, below the diaphragm. Hand-Yangming Meridian originates at the hand, runs up the arm to the shoulder, emerges at the vertebral junction, enters the supraclavicular fossa, connects to the Lung. Its branch goes up the neck, through the cheek, into the teeth, emerges at the mouth, crosses the philtrum (left to right, right to left), runs alongside the nostrils to meet Foot-Yangming. Hence mouth and eye spasms. Note: Yangming refers to Stomach and Large Intestine. "Movement" means continuous pulling; Stomach meridian circles the mouth. Eyes have no specific function here, but mouth movement pulls the eyes, hence "mouth and eye movement." Yangming disease, hearing wood sounds causes fright, cursing without discrimination. Extreme disease shows external color, hence near death: fright, delirium, yellow color. Upper is Renying (beside larynx); Lower is Fuyang. "Sheng" means pulsating and restless. Ancients diagnosed these to determine death. "Insensibility" means lack of pain and itch sensation. Once these signs appear and muscles become insensible, death is certain.] When the Shaoyin Meridian exhausts, the face is black, teeth appear long and dirty, abdominal distension and closure occur, upper and lower passages are blocked, leading to death. [Hand-Shaoyin Qi exhaustion stops blood flow; Foot-Shaoyin Qi exhaustion fails to moisten bones. Hard bones cause gums to recede, making teeth look long and accumulate dirt; damaged blood causes skin color to die, making the face black like lacquer and lacking redness. Foot-Shaoyin Meridian descends from Kidney, pierces Liver and Diaphragm, enters Lung. Hand-Shaoyin Meridian originates in Heart, belongs to Heart system, descends through Diaphragm, connects to lower abdomen. Hence abdominal distension/closure and blockage of upper/lower passages. Note: Wang Bing commentary says "bones not moist/hard." *Nanjing* and *Jiayi Jing* say "if bones are not moist, flesh cannot adhere." Commentary says Hand-Shaoyin connects to lower abdomen; *Jiayi* says Small Intestine. Both are acceptable.] When the Taiyin Meridian exhausts, abdominal distension and closure occur, breathing difficulty, frequent belching, and frequent vomiting. [Foot-Taiyin Meridian runs along anterior medial thigh, enters abdomen, belongs to Spleen, connects to Stomach, ascends through Diaphragm. Hand-Taiyin Meridian originates at Middle Jiao, connects to Large Intestine, returns along stomach opening, ascends through Diaphragm, belongs to Lung. Hence these symptoms. *Ling Shu* states: "When Foot-Taiyin moves, disease occurs; eating causes vomiting, abdominal distension, frequent belching."] Vomiting causes counterflow Qi, counterflow Qi causes red face. [Vomiting causes Qi counterflow, hence red face.] If there is no vomiting, upper and lower passages are blocked; blockage causes black face and scorched skin/hair, leading to death. [If vomiting occurs, upper passage is open, hence only red face. If no vomiting, lower is closed, upper is also blocked. Heart Qi flares externally, hence scorched skin/hair. Why? Foot-Taiyin branch separates from Stomach, ascends through Diaphragm, pours into Heart. Thus scorched skin/hair results from external flare of Heart Qi.] When the Jueyin Meridian exhausts, internal heat and dry throat occur, frequent urination, vexation, and severely, tongue curling and testicles retracting, leading to death. [Foot-Jueyin Luo runs up the shin to the scrotum, knots at the penis. Main meridian enters pubic region, passes over genitalia, ascends to lower abdomen,夹 Stomach, ascends behind throat, enters Ying Sang. Hand-Jueyin Meridian originates in Chest, belongs to Pericardium. Hence internal heat, dry throat, frequent urination, vexation. *Ling Shu* states: "Liver is the union of tendons. Tendons gather at the genitalia and connect to the root of the tongue." Hence severe cases show tongue curling and testicular retraction. Also because Jueyin meridian circles the genitalia.] This is the exhaustion of the twelve meridians. [Note: The reason the twelve meridians terminate is due to the deterioration of Spirit and Essence.]