(吴注作虚实要论○次刺禁论之后)
气实形实气虚形虚。此其常也。反此者病。谷盛气盛。谷虚气虚此其常也。反此者病。
(谷
。纳谷也)脉实血实脉虚血虚此其常也。反此者病 气盛身寒。此谓反也。气虚身热此谓反
也。谷入多而气少。此谓反也。谷不入而气多。此谓反也。脉盛(阳实)血少(阴虚)此谓反也
。脉少(阳虚)血多(阴虚)此谓反也。气盛身寒。得之伤寒(寒伤形)气虚身热得之伤暑(暑伤
气)谷入多而气少者。得之有所脱血。湿居下也(气不生长)谷入少而气多者。邪在胃及肺也
。脉小血多者。饮中热也(或酒或饮。中于热也)脉大血少者。脉(中)有风气水浆不入。此之
谓也(此释上文反者为病之词)夫实者气入也(邪实)虚者。气出也(正气漏泄)气实者。热也(
阳盛)气虚者寒也(阳虚)入实者。右手开针空也(凡刺实。持针摇大其道是也)入虚者。左手
闭针空也(凡刺虚。以手推阖其门是也○此用针补泻法)
(次四时刺逆从论之后)
东方生风风生木。木生酸。酸生肝肝生筋筋生心(此原东方生生之理)其在天为玄。在人
为道
。在地为化。化生五味。道生智。玄生神。化生气(气由化生。物因气化)神在天为风。在地
为木。在体为筋。在气为柔(得木化者。其气柔软)在藏为肝。其性为暄(音萱温暖也)其德为
和。其用为动。其色为苍(浅青色)其化为荣(物色荣美)其虫毛(毛虫得木气)其政为散。其令
宣发其变摧拉(风气刚强是木之变。摧拉。折坏也)其眚(灾也)为陨(坠落也)其味为酸。其志
为怒(此东方之生化)怒伤肝。悲胜怒(悲忧为肺之志)风伤肝。燥胜风(金气胜木)酸伤筋辛胜
酸(此东方木气偏胜为病。平以西方金令也)南方生热热生火。火生苦。苦生心。心生血血生
脾(此原南方生生之理)其在天为热在地为火。在体为脉。在气为息(心主血脉)在藏为心。其
性为暑其德为显(明)其用为躁(动)其色为赤。其化为茂(万物茂盛)其虫羽(火性飞越)其政为
明。其令郁蒸其变炎烁(炎烁焦枯是火之变)其眚燔 (焚烧)其味为苦。其志为喜(此南方之
生化)喜伤心。恐胜喜热伤气寒胜热。苦伤气。咸胜苦(此南方火气偏胜为病。平以北方水令
也)中央生湿湿。生土。土生甘。甘生脾脾生肉。肉生肺(此原中央生生之理)其在天为湿。
在地为土。在体为肉。在气为充(土气充实)在藏为脾。其性静坚(土养万物)其德为濡。其用
为化其色为黄其化为盈(万物充盈)其虫 。(露体也)其政为谧(音密静也)其令云雨其变动注
(风动而注。湿胜而兼风木之化。亢承之理也)其眚淫溃(淫雨崩溃)其味为甘。其志为思(此
中央之生化)思伤脾怒胜思湿伤肉。风胜湿甘伤脾。酸胜甘(此中央土气偏胜为病。平以东方
木令也)西方生燥燥生金。金生辛。辛生肺。肺生皮毛。皮毛生肾(此原西方生生之理)其在
天为燥。在地为金。在体为皮毛。在气为成(金白坚成)在藏为肺。其性为凉。其德为清。其
用为固。其色为白。其化为敛(万物收敛)其虫介(皮甲坚固)其政为劲(金体刚劲)其令雾露其
变肃杀其青苍落(色苍败落。肃杀之令太过也)其味为辛。其志为忧(此西方之生化也)忧伤肺
。喜胜忧燥伤皮毛。热胜燥(旧本热伤皮毛。寒胜热。吴注改此)辛伤皮毛。苦胜辛(此西方
金气偏胜为病。平以南方火令也)北方生寒寒生水。水生咸咸生肾。肾生骨髓。髓生肝(此原
北方生生之理)其在天为寒在地为水。在体为骨。在气为坚。在藏为肾其性为懔(战栗)其德
为寒。其用为藏(旧本阙藏字)其色为黑其化为肃。其虫鳞。其政为静。其令霰(音线)雪(旧
本阙二字。吴注补霰。雪。一作闭塞)其变凝冽(寒凝严冽)其眚冰雹(音泊)其味为咸其志为
恐(此北方之生化也)恐伤肾。思胜恐寒伤血。燥胜寒。咸伤血。甘胜咸(此北方水气偏胜为
病。平以中央土令也)
五气更立。各有所先(应运之气)非其位则邪(木居火位。金居木位之类)当其位则正(
本位)
气相得则微(子居母位。母居子位)不相得则甚(胜已者与已所胜者)气有余则制已所胜。而侮
所不胜(如木既克土。而反侮金之类)其不及。则已所不胜。侮而乘之。已所胜。轻而侮之(
如
金既克木。而土反麦木之类)侮反受邪(始于侮彼求胜终则已反受邪)侮而受邪寡于畏也(畏。
谓克制也。五行之气。必有所畏惮。乃能守位。即六微旨大论承制之义)
（吴崑注本作《虚实要论》，排在《刺禁论》之后）
气盛则形体壮实，气虚则形体虚弱。这是正常情况。与此相反的就是病态。
饮食充足则气盛，饮食不足则气虚。这是正常情况。与此相反的就是病态。
脉象充实则血实，脉象虚弱则血虚。这是正常情况。与此相反的就是病态。
气盛而身体发冷，这叫做“反”。
气虚而身体发热，这叫做“反”。
饮食摄入多但气却少，这叫做“反”。
饮食摄入少但气却多，这叫做“反”。
脉象盛大（阳实）但血量少（阴虚），这叫做“反”。
脉象细小（阳虚）但血量多（阴虚），这叫做“反”。
气盛身寒，是由于伤寒（寒邪伤及形体）所致。
气虚身热，是由于伤暑（暑邪伤及气分）所致。
饮食摄入多而气少的，是由于失血所致，湿气居于下部（导致气不能生长）。
饮食摄入少而气多的，是由于邪气在胃和肺。
脉小但血多的，是由于饮酒或饮水中热邪所致（或饮酒或饮水，感受了热邪）。
脉大但血少的，是脉中有风气且水浆不入。以上这些解释上文所说的“反常即为病”的道理。
所谓实证，是邪气内入（邪气实）。
所谓虚证，是正气外泄（正气漏泄）。
气实的表现为热（阳盛）。
气虚的表现为寒（阳虚）。
针刺补法中的泻实，右手摇大针孔以出针（凡是针刺实证，持针摇大其道以便邪气排出）。
针刺补法中的补虚，左手闭合针孔以按压（凡是针刺虚证，用手推阖其门以防正气泄漏。此段讲述用针的补泻方法）。
（排在《四时刺逆从论》之后）
东方生风，风生木，木生酸，酸生肝，肝生筋，筋生心（此处推究东方生生不息的原理）。
在天为玄妙，在人体现为道，在地体现为化育。化育产生五味，道产生智慧，玄妙产生神机。
神机在天表现为风，在地表现为木，在人体形体表现为筋，在气表现为柔和（得木之气者，其气柔软）。
在脏腑归属于肝，其性质温暖（音萱，意为温暖），其德性为和顺，其作用为运动，其色为苍青（浅青色），其化育表现为繁荣（物色荣美），其对应的虫类为毛虫（得木气的虫类），其政令为疏散，其命令为宣发，其变异为摧折拉断（风气刚强是木的变异，摧拉即折断毁坏），其灾变为陨落（坠落），其味为酸，其情志为怒（此为东方的生化规律）。
怒伤肝，悲能胜怒（悲忧是肺的情志）。
风伤肝，燥能胜风（金气胜木）。
酸伤筋，辛能胜酸（此为东方木气偏胜致病，用西方金令来平抑）。
南方生热，热生火，火生苦，苦生心，心生血，血生脾（此处推究南方生生不息的原理）。
在天为热，在地为火，在人体形体为脉，在气为气息（心主血脉）。
在脏腑归属于心，其性质为暑，其德性为显明，其作用为躁动，其色为赤红，其化育为茂盛（万物茂盛），其对应的虫类为羽虫（火性飞越），其政令为光明，其命令为郁蒸，其变异为炎灼焦枯（炎烁焦枯是火的变异），其灾变为焚烧，其味为苦，其情志为喜（此为南方的生化规律）。
喜伤心，恐能胜喜。
热伤气，寒能胜热。
苦伤气，咸能胜苦（此为南方火气偏胜致病，用北方水令来平抑）。
中央生湿，湿生土，土生甘，甘生脾，脾生肉，肉生肺（此处推究中央生生不息的原理）。
在天为湿，在地为土，在人体形体为肉，在气为充盛（土气充实）。
在脏腑归属于脾，其性质静而坚（土养万物），其德性为濡润，其作用为化育，其色为黄，其化育为充盈（万物充盈），其对应的虫类为倮虫（露体无毛鳞甲），其政令为静谧（音密，意为静），其命令为云雨，其变异为注雨（风动而注雨，湿胜而兼有风木之化，亢承之理），其灾变为淫雨溃决（淫雨崩溃），其味为甘，其情志为思（此为中央的生化规律）。
思伤脾，怒能胜思。
湿伤肉，风能胜湿。
甘伤脾，酸能胜甘（此为中央土气偏胜致病，用东方木令来平抑）。
西方生燥，燥生金，金生辛，辛生肺，肺生皮毛，皮毛生肾（此处推究西方生生不息的原理）。
在天为燥，在地为金，在人体形体为皮毛，在气为成实（金白坚成）。
在脏腑归属于肺，其性质为凉，其德性为清肃，其作用为固摄，其色为白，其化育为收敛（万物收敛），其对应的虫类为介虫（皮甲坚固），其政令为刚劲（金体刚劲），其命令为雾露，其变异为肃杀，其灾变为青苍凋落（色苍败落，肃杀之令太过），其味为辛，其情志为忧（此为西方的生化规律）。
忧伤肺，喜能胜忧。
燥伤皮毛，热能胜燥（旧本为热伤皮毛，寒胜热，吴崑注改为热胜燥）。
辛伤皮毛，苦能胜辛（此为西方金气偏胜致病，用南方火令来平抑）。
北方生寒，寒生水，水生咸，咸生肾，肾生骨髓，髓生肝（此处推究北方生生不息的原理）。
在天为寒，在地为水，在人体形体为骨，在气为坚硬。
在脏腑归属于肾，其性质为凛冽（战栗），其德性为寒，其作用为闭藏（旧本缺“藏”字）。
其色为黑，其化育为肃杀，其对应的虫类为鳞虫，其政令为静，其命令为霰雪（旧本缺二字，吴崑注补“霰、雪”，一作闭塞）。
其变异为凝冽（寒凝严冽），其灾变为冰雹（音泊），其味为咸，其情志为恐（此为北方的生化规律）。
恐伤肾，思能胜恐。
寒伤血，燥能胜寒。
咸伤血，甘能胜咸（此为北方水气偏胜致病，用中央土令来平抑）。
五运之气更替站立，各有其所当先（顺应运行的气）。
不在其位则为邪气（如木居火位，金居木位之类）。
在其位则为正气（本位）。
气相得则病微（子居母位，母居子位）。
不相得则病重（胜己者与己所胜者）。
气有余则克制自己所能胜的，并欺侮自己所不胜的（如木既克土，而反侮金之类）。
气不及，则自己所不胜的欺侮并乘袭它，自己所胜的轻视并欺侮它（如金既克木，而土反侮木之类）。
欺侮别人最终会遭受邪气（开始是欺侮别人以求胜，最终是自己反而遭受邪气）。
被欺侮而遭受邪气，是因为缺乏畏惧（畏，指克制。五行之气，必有所畏惧忌惮，才能守住位置，即《六微旨大论》中承制之义）。
(Wu Kun's commentary titles this chapter "Discussion on Deficiency and Excess," placed after the "Discussion on Acupuncture Taboos.")
When Qi is excess, the form is solid; when Qi is deficient, the form is weak. This is the normal state. The opposite indicates disease.
When food intake is abundant, Qi is excess; when food intake is scanty, Qi is deficient. This is the normal state. The opposite indicates disease.
When the pulse is full, Blood is excess; when the pulse is empty, Blood is deficient. This is the normal state. The opposite indicates disease.
Excess of Qi with cold in the body is called "reversal."
Deficiency of Qi with heat in the body is called "reversal."
Abundant food intake but scanty Qi is called "reversal."
Scanty food intake but excessive Qi is called "reversal."
A surging pulse (Yang excess) with little Blood (Yin deficiency) is called "reversal."
A small pulse (Yang deficiency) with much Blood (Yin excess/deficiency context implies imbalance) is called "reversal."
Excess of Qi with cold in the body results from Cold Damage (Cold injuring the form).
Deficiency of Qi with heat in the body results from Summerheat Damage (Summerheat injuring Qi).
Abundant food intake but scanty Qi results from loss of Blood, with Dampness residing below (preventing Qi growth).
Scanty food intake but excessive Qi indicates pathogenic factors in the Stomach and Lung.
A small pulse with much Blood indicates heat within drinks (such as alcohol or beverages infected by heat).
A large pulse with little Blood indicates Wind Qi in the pulse and inability to ingest water/gruel. These explain the aforementioned principle that "reversal constitutes disease."
What is termed Excess is the entry of Evil Qi (pathogenic excess).
What is termed Deficiency is the exit of True Qi (leakage of healthy Qi).
Excess of Qi manifests as Heat (Yang excess).
Deficiency of Qi manifests as Cold (Yang deficiency).
In needling to drain Excess, the right hand opens the needle aperture (when treating excess, holding the needle and shaking it widens the channel to allow evil to exit).
In needling to tonify Deficiency, the left hand closes the needle aperture (when treating deficiency, pushing and closing the pore prevents true Qi from leaking. This section discusses acupuncture tonification and sedation methods).
(Placed after the "Discussion on Four Seasons' Adverse and Compliant Acupuncture.")
The East generates Wind; Wind generates Wood; Wood generates Sour; Sour generates Liver; Liver generates Sinews; Sinews generate Heart (explaining the generative principle of the East).
In Heaven, it is profound; in Humanity, it is Dao; in Earth, it is transformation. Transformation generates the Five Flavors; Dao generates Wisdom; Profoundness generates Spirit.
Spirit manifests as Wind in Heaven, as Wood in Earth, as Sinews in the Body, and as Softness in Qi (those receiving Wood Qi have soft Qi).
In the Zang organs, it corresponds to the Liver; its nature is warm; its virtue is harmony; its function is movement; its color is greenish-cyan; its transformation is flourishing (beautiful appearance of things); its associated insects are hairy insects (those obtaining Wood Qi); its administration is dispersion; its command is dissemination; its alteration is breaking and pulling (strong wind is the alteration of Wood, meaning breaking and destruction); its disaster is falling; its flavor is Sour; its emotion is Anger (this is the generation and transformation of the East).
Anger injures the Liver; Grief overcomes Anger (Grief and sorrow are the emotions of the Lung).
Wind injures the Liver; Dryness overcomes Wind (Metal Qi overcomes Wood).
Sour injures the Sinews; Pungent overcomes Sour (this addresses disease caused by excess Wood Qi of the East, balanced by the Metal command of the West).
The South generates Heat; Heat generates Fire; Fire generates Bitter; Bitter generates Heart; Heart generates Blood; Blood generates Spleen (explaining the generative principle of the South).
In Heaven, it is Heat; in Earth, it is Fire; in the Body, it is Vessels; in Qi, it is respiration (the Heart governs blood vessels).
In the Zang organs, it corresponds to the Heart; its nature is summer-heat; its virtue is illumination; its function is restlessness; its color is red; its transformation is luxuriance (abundance of all things); its associated insects are feathered insects (Fire nature flies high); its administration is brightness; its command is oppression and steaming; its alteration is scorching and withering (scorching and withering is the alteration of Fire); its disaster is burning; its flavor is Bitter; its emotion is Joy (this is the generation and transformation of the South).
Joy injures the Heart; Fear overcomes Joy.
Heat injures Qi; Cold overcomes Heat.
Bitter injures Qi; Salty overcomes Bitter (this addresses disease caused by excess Fire Qi of the South, balanced by the Water command of the North).
The Center generates Dampness; Dampness generates Earth; Earth generates Sweet; Sweet generates Spleen; Spleen generates Flesh; Flesh generates Lung (explaining the generative principle of the Center).
In Heaven, it is Dampness; in Earth, it is Earth; in the Body, it is Flesh; in Qi, it is fullness (Earth Qi is substantial).
In the Zang organs, it corresponds to the Spleen; its nature is quiet and firm (Earth nourishes all things); its virtue is moistening; its function is transformation; its color is yellow; its transformation is abundance (fullness of all things); its associated insects are naked insects (exposed bodies without hair or scales); its administration is tranquility; its command is clouds and rain; its alteration is pouring rain (wind moves and pours rain; dampness prevails combining with Wind-Wood transformation, following the principle of overcoming and bearing); its disaster is flooding and bursting (torrential rain collapse); its flavor is Sweet; its emotion is Pensiveness (this is the generation and transformation of the Center).
Pensiveness injures the Spleen; Anger overcomes Pensiveness.
Dampness injures Flesh; Wind overcomes Dampness.
Sweet injures the Spleen; Sour overcomes Sweet (this addresses disease caused by excess Earth Qi of the Center, balanced by the Wood command of the East).
The West generates Dryness; Dryness generates Metal; Metal generates Pungent; Pungent generates Lung; Lung generates Skin and Hair; Skin and Hair generate Kidney (explaining the generative principle of the West).
In Heaven, it is Dryness; in Earth, it is Metal; in the Body, it is Skin and Hair; in Qi, it is completion (Metal is white and firm/completed).
In the Zang organs, it corresponds to the Lung; its nature is cool; its virtue is clear; its function is consolidation; its color is white; its transformation is gathering/inward movement (things gather); its associated insects are shelled insects (hard shells); its administration is strength/firmness (Metal body is firm); its command is fog and dew; its alteration is solemn killing; its disaster is withering and falling (color fades and falls due to excessive solemn killing command); its flavor is Pungent; its emotion is Sorrow (this is the generation and transformation of the West).
Sorrow injures the Lung; Joy overcomes Sorrow.
Dryness injures Skin and Hair; Heat overcomes Dryness (Old text: Heat injures skin/hair, Cold overcomes Heat; Wu Kun's note changes to Heat overcomes Dryness).
Pungent injures Skin and Hair; Bitter overcomes Pungent (this addresses disease caused by excess Metal Qi of the West, balanced by the Fire command of the South).
The North generates Cold; Cold generates Water; Water generates Salty; Salty generates Kidney; Kidney generates Marrow; Marrow generates Liver (explaining the generative principle of the North).
In Heaven, it is Cold; in Earth, it is Water; in the Body, it is Bones; in Qi, it is hardness.
In the Zang organs, it corresponds to the Kidney; its nature is chilling (trembling); its virtue is cold; its function is storing/hiding (old text lacks "storing").
Its color is black; its transformation is solemnity; its associated insects are scaled insects; its administration is stillness; its command is sleet and snow (old text lacks two characters; Wu Kun adds "sleet, snow"; alternatively interpreted as closure).
Its alteration is freezing and biting cold (cold congeals and is severe); its disaster is hail; its flavor is Salty; its emotion is Fear (this is the generation and transformation of the North).
Fear injures the Kidney; Pensiveness overcomes Fear.
Cold injures Blood; Dryness overcomes Cold.
Salty injures Blood; Sweet overcomes Salty (this addresses disease caused by excess Water Qi of the North, balanced by the Earth command of the Center).
The Five Qi stand in turn, each having its precedence (Qi corresponding to the season).
If not in its proper position, it becomes Evil (e.g., Wood occupying Fire's position, Metal occupying Wood's position).
If in its proper position, it is Correct (original position).
If Qi are compatible, the effect is mild (Son occupies Mother's position, Mother occupies Son's position).
If Qi are incompatible, the effect is severe (those who overcome oneself and those whom one overcomes).
If Qi is in excess, it controls what it normally overcomes and insults what it cannot overcome (e.g., Wood overcomes Earth but also insults Metal).
If Qi is deficient, what normally overcomes it insults and exploits it, and what it normally overcomes lightly insults it (e.g., Metal normally overcomes Wood, but Earth insults Wood when Metal is weak).
Insulting others leads to suffering from Evil (starting by insulting others to seek victory, ultimately one suffers from Evil oneself).
Being insulted and suffering from Evil occurs due to a lack of fear/reverence (Fear here refers to restraint. The Qi of the Five Elements must have something they fear/revere to maintain their position, which aligns with the concept of control and subjugation in the "Great Treatise on the Six Micro-Axes").