(首节)
邪气盛则实。精气夺则虚 气虚者。肺虚也。气逆者。足寒也(气逆不行。则无以及于
四肢
。阳虚于下故足寒)非其时则生当其时则死。余脏皆如此(心肝脾肾各有衰旺之时。例皆同也
。吴注时当旺之时也。如夏月人皆气虚。冬月人皆足寒。皆非肺旺之时。故生。若当秋而气
虚。则金衰于当旺时也。故死○类经注曰。以肺虚而遇秋冬。非相贼之时故生。若当春则金
木不和。病必甚。当夏则金虚受克。病必死也。于义似通)所谓重实者。言大热病。气热脉
满。是谓重实(证脉皆热)经络皆实是寸脉急而尺缓。(吴注作紧)滑则从(阳气胜也)涩则逆也
(阴邪胜)络气不足经气有余者。脉口热而尺寒也。秋冬为逆(阳虚者畏阴胜之时)春夏为从。
治主病者(义见下文)经虚络满者。尺热满。脉口寒涩也。此春夏死。秋冬生也(阴虚者。畏
阳盛之时)络满经虚。灸阴刺阳。经满络虚。刺阴灸阳(此正以络主阳。经主阴。灸所以补。
刺所以泻也)脉气上虚尺虚(甲乙经作脉虚气虚尺虚。吴注同)是谓重虚所谓气虚者。言无常
也(上虚为气虚故言语轻微)尺虚者。行步 然(尺虚为阴虚故行步 然怯弱也。)
乳子而病热(阳证)脉悬小者何如(悬绝而小阴脉也)曰。手足温则生。寒则死 乳子中风
热喘
为
则生(阴气无伤)脉浮则死 肠 下脓血何如(赤白并下)脉悬绝则死。滑大则生(滑为阴血。
大为阳气)癫疾何如。脉搏大滑。久自已(气血俱有余)脉小坚实。死不治(肝之真藏脉也)癫
疾之脉。虚则可治(言邪气微)实则死(言邪气气盛)消瘅虚实何如(消中而热善饮善食也)脉实
大。(血气尚盛)病久可治。脉悬小坚。病久不可治。
(首节)
邪气亢盛就表现为实证。精气耗损就表现为虚证。气虚，是指肺气虚弱。气机逆乱，则足部寒冷（气机逆乱不能下行，就无法到达四肢，因为下部阳气虚弱，所以足冷）。在非肺旺的季节出现这些症状可以生存，在肺旺的季节出现这些症状则会死亡。其他脏腑的情况也都是这样（心、肝、脾、肾各有其旺盛和衰弱的时节，举例来说都是一样的。吴注：所谓“当”，是指正值该脏旺盛的时节。例如夏天人们都容易气虚，冬天人们都容易足冷，这都不是肺脏旺盛的时候，所以能生存。如果正值秋季而气虚，那就是金气在应当旺盛的时候反而衰弱，所以会死亡○《类经》注解说：因为肺虚而遇到秋冬季节，不是相克制的时节，所以生存。如果遇到春季，则金木不和，病情必然加重；如果遇到夏季，则金虚受火克制，病情必然致死。这种解释在义理上似乎通顺）。
所谓“重实”，是指大热病，气分热盛，脉象满实，这就叫做重实（证候和脉象都表现为热）。经络都实证，表现为寸口脉急紧而尺部脉缓（吴注作紧）。脉滑表示顺证（阳气胜），脉涩表示逆证（阴邪胜）。络气不足而经气有余的，表现为脉口热而尺部寒。在秋冬季节属于逆证（阳虚者畏惧阴胜的时节），在春夏季节属于顺证。治疗应针对主病（义理见下文）。经虚而络满的，表现为尺部热满，脉口寒涩。这种情况在春夏季节死亡，在秋冬季节生存（阴虚者畏惧阳盛的时节）。络满而经虚的，灸阴经刺阳经；经满而络虚的，刺阴经灸阳经（这正是以络主阳、经主阴的道理，灸法用来补益，刺法用来泻实）。脉气上部虚、尺部虚（《甲乙经》作脉虚、气虚、尺虚，吴注相同），这就叫做重虚。
所谓气虚，是指言语轻微无常（上部虚为气虚，所以言语声音轻微）。尺部虚，是指行走时步履不稳怯弱（尺部虚为阴虚，所以行走时步履怯弱无力）。
婴儿患热病，脉象悬绝而小，情况如何？回答说：手足温暖就能生存，手足寒冷就会死亡。婴儿感受风邪发热，气喘，汗出，就能生存（阴气没有受损）；如果脉浮，就会死亡。肠道下脓血情况如何（赤白痢疾并下）？脉象悬绝就会死亡，脉象滑大就能生存（滑代表阴血充足，大代表阳气充足）。癫疾情况如何？脉搏大而滑，时间久了自然痊愈（气血俱有余）；脉搏小而坚实，是死证，无法治疗（这是肝脏的真脏脉）。癫疾的脉象，虚的就可以治疗（说明邪气微弱），实的就会死亡（说明邪气盛极）。消瘅病的虚实情况如何（消中症，内热盛，善饮善食）？脉象实大，（说明血气尚且旺盛），病程长的也可以治疗；脉象悬小坚，病程长的不可治疗。
(First Section)
When pathogenic factors are exuberant, it manifests as Excess (Shi). When essential qi is depleted, it manifests as Deficiency (Xu). Qi deficiency refers to Lung Qi deficiency. Qi rebellion results in cold feet (when Qi rebels and fails to descend, it cannot reach the four extremities; due to Yang deficiency in the lower part, the feet become cold). If these symptoms occur when it is not the season of the Lung's prosperity, the patient may survive; if they occur during the season of the Lung's prosperity, the patient will die. The same principle applies to other Zang organs (the Heart, Liver, Spleen, and Kidney each have their respective seasons of prosperity and decline, as illustrated by the examples above. Wu’s commentary: "Dang" refers to the time when the organ is naturally prosperous. For instance, in summer, people tend to have Qi deficiency; in winter, they tend to have cold feet. These are not times when the Lung is prosperous, so survival is possible. However, if Qi deficiency occurs in autumn, it means Metal Qi is weak during its time of natural prosperity, leading to death. *Ling Shu* commentary states: Because the Lung is deficient and encounters Autumn or Winter, which are not seasons of mutual overcoming, the patient survives. If encountering Spring, Metal and Wood are disharmonious, and the disease will worsen. If encountering Summer, the deficient Metal suffers from Fire overcoming it, and the disease will be fatal. This interpretation seems logically sound).
The term "Chong Shi" (Double Excess) refers to a severe heat disease where Qi is hot and the pulse is full and excess. This is called Double Excess (both syndrome and pulse indicate Heat). When both meridians and collaterals are in an Excess state, the pulse at the Cun Kou (radial artery) is rapid/tight while the Chi position is slow (Wu’s commentary reads "tight"). A slippery pulse indicates a favorable prognosis (Yang Qi prevails), whereas a choppy pulse indicates an unfavorable prognosis (Yin pathogen prevails). In cases where Collateral Qi is deficient but Meridian Qi is excessive, the pulse at the Cun Kou is hot while the Chi position is cold. This pattern is unfavorable in Autumn and Winter (those with Yang deficiency fear the Yin-exuberant seasons) but favorable in Spring and Summer. Treatment should target the primary pathology (see below for explanation). In cases of Meridian Deficiency and Collateral Excess, the Chi position is hot and full, while the Cun Kou is cold and choppy. Such patients will die in Spring and Summer but survive in Autumn and Winter (those with Yin deficiency fear the Yang-exuberant seasons). For Collateral Excess and Meridian Deficiency, moxa should be applied to Yin meridians and needles used on Yang meridians. For Meridian Excess and Collateral Deficiency, needles should be used on Yin meridians and moxa applied to Yang meridians (this follows the principle that Collaterals govern Yang and Meridians govern Yin; moxibustion tonifies, while needle discharge reduces). When both upper pulse Qi and Chi pulse are deficient (as recorded in *Jia Yi Jing* as pulse deficiency, Qi deficiency, and Chi deficiency, consistent with Wu’s commentary), this is called "Chong Xu" (Double Deficiency).
Qi deficiency manifests as abnormal speech (upper deficiency leads to Qi deficiency, resulting in faint speech). Chi deficiency manifests as unsteady gait (Chi deficiency implies Yin deficiency, leading to timid and weak walking).
For an infant suffering from heat disease with a pulse that is suspended and small, what is the prognosis? It is said: If the hands and feet are warm, the infant will survive; if cold, the infant will die. If an infant contracts wind-heat, experiences wheezing, and sweats, they will survive (Yin Qi remains undamaged); however, if the pulse is floating, they will die. Regarding dysentery with pus and blood in the stool (mixed red and white discharge): if the pulse is suspended, death ensues; if the pulse is slippery and large, survival is expected (slipperiness indicates sufficient Yin blood, largeness indicates sufficient Yang Qi). What about epilepsy? If the pulse is large and slippery, the condition will resolve spontaneously over time (indicating abundant Qi and Blood). If the pulse is small and firm, it is a fatal and untreatable condition (this is the True Organ Pulse of the Liver). For epilepsy, a deficient pulse indicates treatability (pathogenic factors are mild), while an excess pulse indicates death (pathogenic factors are extremely vigorous). Regarding the Excess and Deficiency patterns of Xiao Dan (Wasting-Thirst/Emaciation disorders, characterized by internal heat, polydipsia, and polyphagia): if the pulse is Excess and Large (Blood and Qi are still robust), even long-standing cases can be treated. If the pulse is Suspended, Small, and Firm, long-standing cases are untreatable.