按而在久。踝上者。谓去踝五寸以上。而及于承山。以下者。谓承山以下。而至去踝五寸之间。盖以左手之三指。于踝
上五寸。承山以下。以候太阳之气。以察病之死生。故下文曰。足太阳气绝者。其足不可屈伸。死必戴眼。盖九针之要。
候气为先。足太阳为诸阳主气也。）其应过五寸以上。蠕蠕然者不病。其应疾中手浑浑然者病。中手徐徐然者病。（应去
声蠕而宣切。蠕蠕微动貌。气之和也。其应疾而中手浑浑然者。急疾而太过也。徐徐然者。气之不及也。故皆主病。）其
应上不能至五寸。弹之不应者死。（生气绝于下。故不能上应也。）是以脱肉身不去者死。（是以者。承上文而言。脱肉者。
皮肉宛焦而弱也。身不去者。开折而暴病留于身也。言正气虚而肉脱。邪留于身而不去者死也。）中部乍疏乍数者死。（太
阳之气者。论先天之少阳。荣卫气血者。乃后天水谷之精气。中部乍数乍疏者。中焦之生气欲绝也。）其脉代而钩者。病
在络脉。（夫血脉生于心而输于脾。代乃脾脉。钩乃心脉。此复申明候足上中部者。候中下二焦之生气。如病在络脉者。
其脉代而钩也。）九候之相应也。上下若一。不得相失。一候后则病。二候后则病甚。三候后则病危。所谓后者。应不俱
也。（夫人生有形。不离阴阳。天地合气。别为九野。是以九候之相应也。上下若一。不得相失。一候不应。是天地人之
气。失其一矣。故主病。二候后不应。是三部之中。失其二矣。故主病甚。三候后不应。是三者皆失。故主病危。）察其
腑脏。以知死生之期。（腑为阳。脏为阴。知阳者。知病之所从来。知阴者。知死生之期。）必先知经脉。然后知病脉。
知经脉之死生出入。而后知病脉之所从来。详经脉别论。真脏脉见者。胜死。（真脏脉见者。至其所胜克之日时而死。）
足太阳气绝者。其足不可屈伸。死必戴眼。（此复结上文。其应上不能至五寸。弹之不应者。足太阳之气绝也。足太阳主
筋。阳气者。柔则养筋。是以太阳气绝。筋挛急而足不可屈伸。太阳之脉。起于目内 。为目上刚。脉系绝。故死必戴
眼。张二中云。足不可屈伸。太阳之气绝也。死必戴眼。太阳之脉绝也。）帝曰。冬阴夏阳奈何。岐伯曰。九候之脉。
皆沉细悬绝者为阴。主冬。故以夜半死。盛躁喘数者为阳。主夏。故以日中死。（此复问冬阴夏阳。以人应之奈何。按九
针论曰。五者音也。音者冬夏之分。分于子午。阴与阳别。寒与热争。两气相搏。盖言冬至之子。阴之极也。阴极而一
阳初生。阴气始下。夏至之午。阳之极也。阳极而一阴初生。阳气始下。是阴阳之气。分于子午也。至春分之时。阳气
直上。阴气直下。秋分之时。阴气直上。阳气直下。是阴阳离别也。寒热者。阴阳之气也。阴阳分别。而复有交合。故
寒与热争。而两气相搏也。此言三部九候之中。有天地阴阳四时五行之气。若九候之脉皆沉细。而绝无阳气之和。此为
阴而主冬。故死于夜半之子。如盛躁喘数。而无阴气之和。此为阳而主夏。故死于日中之午。皆阴阳偏绝之为害也。）是
故寒热病者。以平旦死。热中及热病者。以日中死。病风者。以日夕死。病水者。以夜半死。其脉乍疏乍数。乍迟乍疾
者。日乘四季死。（是故者。承上文而言也。寒热病者。阴阳相乘。而为寒为热也。本经云。因于露风。乃生寒热。病风
者。亦为寒热病也。平旦日夕。系阴阳两分之时。寒热者。乃阴阳两伤之病。是以应时而死。热中热病者。阳盛之极。
故死于日中之午。病水者。阴寒之邪。故死于夜半之中。土位中央。王于四季。其脉乍疏乍数。乍疾乍迟。乃土气败而
不能灌溉四脏。故死于辰戌丑未之时也。）形肉已脱。九候虽调。犹死。（形归气。气生形。形气已败。血脉虽调犹死。
意言七诊之死。因气而见于脉。非血脉之为病也。故下文云。其脉候亦败者死。）七诊虽见。九候皆从者。不死。（七诊
者。谓沉细悬绝。盛躁喘数。寒热。热中。病风。病水。土绝于四季也。九候皆从者。谓上下若一。无独大独小也。）所
言不死者。风气之病。及经月之病。似七诊之病而非也。故言不死。（此言七诊者。乃阴阳之气。自相分离。是以应时而
死。若因邪病而有似乎七诊者。不死也。风气之病。病风也。病风而阴阳相离。期以日夕死。如病风而阴阳和平。九候
若一。不死也。经月之病。病水也。病水而沉细悬绝。期以夜半死。病水而阴阳和平。九候皆从。不死也。盖言七诊之
死。死于阴阳分离。不因邪病。而有应时之死也。）若有七诊之病。其脉候亦败者。死矣。必发哕噫。（此复申明七诊之
病。以脉候为凭。盖脉者病气之见。胃不输精。故胃败而其脉亦败者。病气而脉亦从之俱病也。脉病则其胃败者。其声
哕。胃气逆而上也。逆则九候必绝。将死之脉也。）必审问其所始病。与今之所方病。而后各切循其脉。视其经络浮沉。
以上下逆从循之。（始病者。病久而深也。方病者。新受之邪。病之浅也。各切循其脉者。切其病之在阴在阳。在脏在脉
也。夫病久者。其脉沉而逆。方病者。其脉从而浮。故当视其经络浮沉。以上下之逆从循之。）其脉疾者不病。其脉迟者
病。脉不往来者死。皮肤着者死。（夫邪伤经脉。则脉数疾。故其脉疾者。知不病在七诊也。阴阳脏气受伤。则其脉迟。
故脉迟者。知其病在七诊也。脉不往来者。有七诊之病。而脉候亦败也。皮肤着者。病久而肉脱也。根结篇曰。皮肤薄
着。毛腠夭焦。予之期死。此言方病而伤于形身经络者不死。病久而伤五脏阴阳之气者死。故曰。经病者。治其经。孙
络病者。治其孙络血。若五脏阴阳之气。已绝于内。而欲以针石治其外者。未之有也。）帝曰。其可治者奈何。岐伯曰。
经病者。治其经。孙络病者。治其孙络血。（灵枢经曰。经脉为里。支而横者为络。络之别者为孙络。言病在经者。刺其
经。病在孙络者。去其孙络血。盖病在孙络。其邪更浅。故当出其血而泻之。）血病身有痛者。治其经络。（血病者。邪
传舍于络脉。在络之时。痛于肌肉。故身有痛也。盖言病在经之深者。治其经病。在孙络之浅者。治其孙络。病在经络
浅深之间。而痛及于肌肉者。治其经与络也。）其病者在奇邪。奇邪之脉。则缪刺之。（奇邪者。邪不入于经。流溢于大
络。而生奇病也。夫邪客大络者。左注右。右注左。上下左右。与经相干。而布于四末。其气无常处。不入于经俞。故
宜缪刺之。缪刺者。以左取右。以右取左也。）留瘦不移。节而刺之。（留瘦不移者。留淫日深。着于骨髓。故即于节而
刺之。盖病在脉络者取之脉。病在骨节者治其节也。）上实下虚。切而从之。索其结络脉。刺出其血。以见通之。（刺节
真邪篇曰。大经调者。谓之不病。虽病谓之自已也。一经上实下虚而不通者。此必有横络盛加于大经。令之不通。视而
泻之。此所谓解结也。是以上实下虚者。有横络盛加于经。以致上下不通。而有盛实也。切而从之者。切其某经之所阻。
而从治之也。索其结络者。索其横络之结。而刺出其血。以见通之者。视而泻之也。以上言病在经脉者。为可治也。）瞳
子高者。太阳不足。戴眼者。太阳已绝。此决死生之要。不可不察也。（夫九针九候之道。贵在神与气。心藏神而为阳中
之太阳。肾为生气之原。而膀胱为之表里。是以独候手足之太阳者。太阳主诸阳之气也。瞳子高者。乃太阳之神气不足。
盖手太阳之脉。上颊至败者。其音嘶。）手指及手外踝上五指。留针。（此复申明瞳子高者。太阳不足于上也。手太阳之
脉。起于小指之端。循手外侧。上腕出踝中。外踝上者。在手外侧踝上也。五趾者。第五之小指也。言太阳不足。当于
手指及外踝上之后溪。五趾之少泽上。留针以补之。盖候足太阳之气者。于足上去踝五寸而弹之。补手太阳者。当于手
外踝上五趾而取之。此手足之经气。交相贯通。先不足于上。而后绝于下也。张二中曰。泻者出血。补者留针。）
（左手三指按在踝上五寸、承山穴以下的位置，用来候察足太阳经的气机，以判断疾病的生死预后。所以下文说：足太阳经气衰竭的人，双脚不能屈伸，死亡时必定两眼上翻直视。这是九针诊法的关键，以候察经气为首要任务。足太阳经是统领诸阳经之气的。）如果脉搏跳动超过五寸以上，且微微蠕动的，说明身体无病；如果脉搏跳动急促，触手感觉浑浑厚厚的，说明有病；如果触手感觉徐徐缓弱的，也说明有病。（“应”读去声，“蠕”音同“而宣”，形容微微颤动的样子，这是气机调和的表现。脉搏跳动急促且触手浑浑厚厚的，是气机急疾且太过；触手徐徐缓弱的，是气机不及。所以这两种情况都主病。）如果脉搏跳动向上不能到达五寸，弹击后没有反应的，说明死亡。（这是因为下部的生气已经断绝，所以不能向上呼应。）因此，肌肉脱失消瘦但身体尚能活动的，会死亡。（“是以”承接上文而言。“脱肉”是指皮肉干枯焦弱；“身不去”是指关节开折且暴病邪气滞留于体内。意思是正气虚弱导致肌肉脱失，邪气滞留体内无法去除的，会死亡。）中部脉象忽快忽慢的，说明死亡。（足太阳之气，论述的是先天的少阳之气；营卫气血，则是后天水谷精微化生的精气。中部脉象忽快忽慢，说明中焦的生气即将断绝。）如果脉象代而钩，说明病在络脉。（血脉由心生，输布于脾。代脉是脾脉，钩脉是心脉。这里再次申明候察足部上、中、下三部的脉象，是为了候察中、下二焦的生气。如果病在络脉，其脉象就会表现为代而钩。）九候脉象应当相互呼应，上下协调一致，不能有所缺失。一候脉象不应，说明有病；两候脉象不应，说明病重；三候脉象不应，说明病危。所谓“后”，就是脉象不能同时相应。（人拥有形体，离不开阴阳。天地合气，分为九野。所以九候脉象应当相互呼应，上下协调一致，不能有所缺失。一候不应，是天、地、人三气失去其一，所以主病。两候不应，是三部之中失去其二，所以主病重。三候不应，是三者皆失，所以主病危。）通过察验脏腑，可以预知死亡的期限。（腑属阳，脏属阴。了解阳气，就知道病邪的来源；了解阴气，就知道死亡的期限。）必须先了解正常经脉的脉象，然后才能了解病脉。了解了正常经脉的死生出入规律，然后才能了解病脉的来源。详见《经脉别论》篇。真脏脉出现的，会在被克制的时日死亡。（真脏脉出现，意味着到了其所胜克之日时就会死亡。）足太阳经气衰竭的人，双脚不能屈伸，死亡时必定两眼上翻直视。（这里再次总结上文：脉搏跳动向上不能到达五寸，弹击后没有反应的，就是足太阳经气衰竭。足太阳经主管筋脉，阳气柔和则滋养筋脉。所以太阳经气衰竭，筋脉拘挛紧急，导致双脚不能屈伸。足太阳经脉起于目内眦，上行至目上，脉系断绝，所以死亡时必定两眼上翻直视。张二中说：双脚不能屈伸，是太阳经气衰竭；两眼上翻直视，是太阳经脉断绝。）黄帝问：冬季属阴，夏季属阳，这如何理解？岐伯回答：九候脉象，如果都沉细悬绝的，属于阴，主冬，所以会在夜半死亡；如果脉象盛大躁动、喘促数急的，属于阳，主夏，所以会在日中死亡。（这里再次询问冬阴夏阳与人体相应的道理。按《九针论》所说：五音对应五行，音有冬夏之分，分于子午之时。阴与阳有别，寒与热相争，两气相互搏结。这是说冬至的子时，是阴气极盛的时候，阴极则一阳初生，阴气开始下行；夏至的午时，是阳气极盛的时候，阳极则一阴初生，阳气开始下行。这就是阴阳之气分于子午。到了春分之时，阳气直上，阴气直下；秋分之时，阴气直上，阳气直下。这就是阴阳离别。寒热是阴阳之气，阴阳分别后又会有交合，所以寒与热相争，两气相搏。这是在说三部九候之中，蕴含着天地阴阳四时五行之气。如果九候脉象都沉细，完全没有阳气的调和，这就属于阴而主冬，所以死于夜半的子时；如果脉象盛大躁动、喘促数急，而没有阴气的调和，这就属于阳而主夏，所以死于日中的午时。这都是因为阴阳偏绝造成的危害。）因此，寒热病的人，会在平旦死亡；热中病及热病的人，会在日中死亡；患风病的人，会在日夕死亡；患水病的人，会在夜半死亡；脉象忽快忽慢、忽迟忽疾的，会在四季交替之时（辰、戌、丑、未时）死亡。（“是故”承接上文而言。寒热病，是阴阳相互乘袭，表现为寒或热。本经说：因受风寒露气侵袭，就会产生寒热病。患风病的人，也是寒热病。平旦和日夕，是阴阳两分之时。寒热病，是阴阳两伤的病，所以应时而死。热中病和热病，是阳气盛极，所以死于日中的午时。水病，是阴寒之邪，所以死于夜半之中。土位居中，旺于四季。脉象忽快忽慢、忽疾忽迟，是土气败坏而不能灌溉四脏，所以死于辰、戌、丑、未之时。）如果形体肌肉已经脱失，即使九候脉象调和，也会死亡。（形依赖气而生，气生成形。如果形气已经败坏，即使血脉调和也会死亡。意思是七诊所示的死证，是因为气衰而在脉象上表现出来，并非血脉本身的病变。所以下文说：如果脉候也败坏的，就会死亡。）如果出现了七诊的死脉，但九候脉象都协调顺从的，不会死亡。（七诊，是指沉细悬绝、盛大躁动喘数、寒热、热中、病风、病水、土绝于四季这些脉象。九候皆从，是指上下脉象协调一致，没有独大独小的现象。）所说的不死，是指风气之病，以及月经期间的病，看起来像七诊的病，但其实不是。所以说不会死亡。（这里说七诊的死证，是由于阴阳之气自相分离，所以应时而死。如果是因邪气致病而类似七诊脉象的，不会死亡。风气之病，即病风。如果病风且阴阳相离，预期在日夕死亡；但如果病风且阴阳和平，九候脉象协调一致，就不会死亡。经月之病，即病水。如果病水且脉象沉细悬绝，预期在夜半死亡；但如果病水且阴阳和平，九候脉象协调顺从，就不会死亡。意思是说七诊的死证，死于阴阳分离，并非因邪气致病而有应时之死的情况。）如果有七诊的死脉，且脉候也败坏的，就会死亡。必定会出现呃逆嗳气。（这里再次申明七诊的病，以脉候为依据。脉是病气的表现。如果胃不能输送精气，说明胃气败坏，那么脉象也会随之败坏，这是病气和脉象一同败坏。脉病且胃气败坏，声音就会发出呃逆，这是胃气上逆。气逆则九候脉气必绝，这是将死的脉象。）必须详细询问疾病最初发生的时间，以及现在正在发生的病症，然后分别切循他们的脉象，观察经络脉气的浮沉，以此来判断上下逆从的关系。（始病，是指患病日久且病位深。方病，是指新受的邪气，病位浅。分别切循脉象，是切诊病邪在阴在阳、在脏在脉。患病久的人，脉象沉而逆；新患病的人，脉象顺而浮。所以应当观察经络脉气的浮沉，来推断上下逆从的关系。）如果脉象疾速的，说明无病；如果脉象迟缓的，说明有病；如果脉象不往来流动的，说明死亡；如果皮肤枯槁着骨的，说明死亡。（邪气伤害经脉，会导致脉数疾，所以脉象疾速的，知道病不在七诊的死证范围内。阴阳脏气受伤，会导致脉迟，所以脉象迟缓的，知道病在七诊的死证范围内。脉不往来流动，是有七诊的病且脉候也败坏。皮肤枯槁着骨，是患病日久且肌肉脱失。《根结》篇说：皮肤薄而枯槁，毛发夭折焦枯，给予的预后是死期。这里说的是新病伤及形身经络的不死，患病日久伤及五脏阴阳之气的会死。所以说：经脉病的，治疗经脉；孙络病的，治疗孙络出血。如果五脏阴阳之气已经在内部断绝，却想用针石治疗外部，是不可能的。）黄帝问：那些可以治疗的怎么办呢？岐伯回答：经脉病的，治疗经脉；孙络病的，治疗孙络出血。（《灵枢经》说：经脉为里，分支横出的叫络，络的分支叫孙络。意思是病在经脉的，刺经脉；病在孙络的，去除孙络的血。因为病在孙络，邪气更浅，所以应当放出血液来泻除邪气。）血病且身体疼痛的，治疗其经络。（血病，是邪气传舍于络脉。在络脉的时候，疼痛波及肌肉，所以身体疼痛。意思是病在经脉深处的，治疗经病；病在孙络浅处的，治疗孙络；病在经络浅深之间，且疼痛波及肌肉的，治疗经和络。）病位在奇邪的，奇邪的脉象，就用缪刺法治疗。（奇邪，是指邪气不入于经脉，流溢于大络，而产生奇病。邪气客留于大络，左注右，右注左，上下左右，与经脉相互干扰，并布散于四肢末端。其气无常处，不入于经俞，所以适宜用缪刺法。缪刺，就是左病取右，右病取左。）病程迁延消瘦且病位固定的，在节穴刺治。（留瘦不移，是指邪气留滞淫溢日久深入，附着于骨髓，所以就在节穴刺治。意思是病在脉络的取脉，病在骨节的治节。）上部实下部虚的，切按脉象并顺着脉势寻找，索求结聚的络脉，刺出其血液，以使气血通畅。（《刺节真邪》篇说：大经调和的，叫作无病，即使有病也会自愈。一经上部实下部虚而不通的，这一定有横络盛满加于大经之上，导致不通。视其情况而泻之，这就是所谓的解结。所以上部实下部虚的，是因为横络盛满加于经脉，导致上下不通而出现盛实。切而从之，是切按某经受阻之处，并顺着治之。索其结络，是索求横络的结聚，刺出其血。以见通之，是视其情况而泻之。以上说的是病在经脉的，是可以治疗的。）眼球上视不能转动的，是太阳经气不足；两眼上翻直视的，是太阳经气已绝。这是决断生死的关键，不可不仔细察验。（九针九候的道理，贵在神与气。心藏神，为阳中之太阳；肾为生气之源，膀胱为其表里。所以单独候察手足太阳经，是因为太阳经统领诸阳之气。眼球上视不能转动，是太阳的神气不足。手太阳经脉，上行至颊，如果声音嘶哑，说明脉气已衰。）手指及手外踝上五指处，留针。（这里再次申明眼球上视不能转动，是太阳经气在上部不足。手太阳经脉，起于小指端，沿手外侧，上行至腕，出踝中。手外踝上，是指在手外侧的踝上。五指，是指第五个小趾。意思是太阳经气不足，应当在手指及外踝上的后溪穴、小趾端的少泽穴留针以补益。候察足太阳经气，是在足上去踝五寸处弹击；补益手太阳经气，应当在手外踝上五指处取穴。这是手足经气相互贯通，先在上部不足，而后在下部断绝。张二中说：泻法出血，补法留针。）
(With the three fingers of the left hand pressing on the area five cun above the ankle and below Chengshan (BL57), one observes the Qi of the Foot-Taiyang channel to examine the life and death of the disease. Hence, the following text states: When the Qi of the Foot-Taiyang channel is exhausted, the feet cannot flex or extend, and death is accompanied by upward deviation of the eyes (Daiyan). This is the essence of the Nine Needles diagnostic method, where observing Qi comes first. The Foot-Taiyang channel governs the Qi of all Yang channels.) If the pulse response extends more than five cun upwards and moves slightly like a worm (Ruru), there is no disease. If the pulse response is rapid and feels浑浑 (Hunhun) under the fingers, there is disease. If it feels 徐徐 (Xuxu) under the fingers, there is also disease. ("Ying" is pronounced with the falling tone; "Ru" sounds like "Er Xuan", describing a slight trembling motion, indicating harmonious Qi. A rapid pulse that feels Hunhun indicates excessive and urgent Qi; a pulse that feels Xuxu indicates insufficient Qi. Thus, both indicate disease.) If the pulse response cannot reach five cun upwards and does not respond to flicking, death occurs. (This is because the vital Qi at the lower part has been exhausted, so it cannot respond upwards.) Therefore, if the flesh is wasted but the body remains movable, death will occur. ("Yi Shi" connects to the previous text. "Tuo Rou" refers to skin and muscle becoming dry, withered, and weak. "Shen Bu Qu" refers to joint dislocation and acute pathogenic factors lingering in the body. It means that when righteous Qi is deficient leading to muscle wasting, and pathogenic factors linger in the body without departing, death will occur.) If the middle pulse is intermittently fast and slow, death will occur. (The Qi of the Foot-Taiyang channel discusses the congenital Shaoyang Qi; Ying and Wei Qi and Blood are the refined essence from postnatal food and water. An intermittent fast and slow middle pulse indicates that the vital Qi of the Middle Jiao is about to be exhausted.) If the pulse is Dai (intermittent) and Gou (hooked), the disease is in the Luo (Collateral) vessels. (Blood vessels are generated by the Heart and transported by the Spleen. Dai pulse is the Spleen pulse, and Gou pulse is the Heart pulse. This reiterates that examining the upper, middle, and lower parts of the foot pulses is to observe the vital Qi of the Middle and Lower Jiao. If the disease is in the Luo vessels, the pulse will be Dai and Gou.) The nine pulses should correspond to each other, being uniform above and below, without deviation. If one pulse position fails to respond, there is disease; if two fail, the disease is severe; if three fail, the disease is critical. "Failing to respond" means they do not respond simultaneously. (Humans possess form, inseparable from Yin and Yang. Heaven and Earth combine Qi, dividing into nine regions. Thus, the nine pulses should correspond, being uniform above and below, without deviation. If one pulse does not respond, it means the Qi of Heaven, Earth, and Man has lost one aspect, hence disease. If two fail to respond, two aspects among the three parts are lost, hence severe disease. If three fail to respond, all three are lost, hence critical disease.) By examining the Zang and Fu organs, one can know the time of death. (Fu organs are Yang, Zang organs are Yin. Knowing Yang reveals the origin of the disease; knowing Yin reveals the time of death.) One must first know the normal Jing (Meridian) pulses, then know the disease pulses. Only after understanding the life, death, entry, and exit of normal Jing pulses can one understand the origin of disease pulses. See detailed discussion in *Bie Lun of Jing Mai*. When the True Zang pulse appears, death occurs on the day controlled by the element that overcomes it. (When the True Zang pulse appears, death occurs at the time/day corresponding to its overcoming element.) When the Qi of the Foot-Taiyang channel is exhausted, the feet cannot flex or extend, and death is accompanied by upward deviation of the eyes. (This summarizes the above: if the pulse response cannot reach five cun upwards and does not respond to flicking, it indicates exhaustion of the Foot-Taiyang Qi. The Foot-Taiyang channel governs sinews. Yang Qi nourishes sinews when soft and flexible. Thus, when Taiyang Qi is exhausted, sinews become spasmodic and tight, making the feet unable to flex or extend. The Taiyang channel originates at the inner canthus and ascends to the supraorbital region; when the channel connection is severed, death is accompanied by upward deviation of the eyes. Zhang Erzhong said: Inability to flex or extend the feet indicates exhaustion of Taiyang Qi; upward deviation of the eyes indicates severance of the Taiyang channel.) The Yellow Emperor asked: Winter is Yin, Summer is Yang, how does this apply? The Qibo replied: If all nine pulse positions are Chen Xi (deep and fine) and Xuan Jue (hanging and cut off), this is Yin, governing Winter, so death occurs at midnight. If the pulses are Sheng Zao (vigorous and restless) and Chuan Shu (panting and rapid), this is Yang, governing Summer, so death occurs at noon. (This re-asks about the correspondence of Winter Yin and Summer Yang to humans. According to *Jiu Zhen Lun*: The five tones correspond to seasons, divided between Zi (midnight) and Wu (noon). Yin and Yang are distinct, Cold and Heat contend, and the two Qi interact. This means Zi at Winter Solstice is the extreme of Yin; when Yin reaches its extreme, one Yang is born, and Yin Qi begins to descend. Wu at Summer Solstice is the extreme of Yang; when Yang reaches its extreme, one Yin is born, and Yang Qi begins to descend. Thus, Yin and Yang Qi divide at Zi and Wu. At Spring Equinox, Yang Qi goes straight up, Yin Qi goes straight down; at Autumn Equinox, Yin Qi goes straight up, Yang Qi goes straight down. This is the separation of Yin and Yang. Cold and Heat are Yin and Yang Qi; after separating, they intersect again, hence Cold and Heat contend and the two Qi interact. This refers to the presence of Heaven-Earth Yin-Yang Four Seasons Five Elements Qi within the Three Parts and Nine Positions. If all nine pulses are deep and fine, lacking the harmony of Yang Qi, this is Yin governing Winter, so death occurs at Zi (midnight). If vigorous, restless, panting, and rapid, lacking the harmony of Yin Qi, this is Yang governing Summer, so death occurs at Wu (noon). These are harms caused by the extreme deviation of Yin or Yang.) Therefore, those with Han Re (Cold-Heat) diseases die at Ping Dan (early morning); those with Re Zhong (Heat in the Middle) and Re Bing (Heat Disease) die at Ri Zhong (noon); those with Feng Bing (Wind Disease) die at Ri Xi (evening); those with Shui Bing (Water Disease) die at Ye Ban (midnight); those whose pulses are intermittently fast and slow, or intermittent slow and rapid, die during the four earth phases (Chen, Xu, Chou, Wei hours). ("Shi Gu" connects to the previous text. Han Re diseases result from Yin and Yang mutual invasion, manifesting as Cold or Heat. The Classic states: Exposure to wind and cold generates Cold-Heat. Wind disease is also a Cold-Heat disease. Ping Dan and Ri Xi are times of Yin-Yang division. Han Re diseases involve injury to both Yin and Yang, hence death corresponds to the time. Re Zhong and Re Bing represent extreme Yang excess, so death occurs at Wu (noon). Shui Bing involves Yin-Cold pathogens, so death occurs at Ye Ban (midnight). Earth resides in the center and prospers in the four seasons. Pulses that are intermittently fast/slow or rapid/slow indicate failure of Earth Qi to irrigate the four Zang organs, so death occurs at Chen, Xu, Chou, Wei times.) If form and flesh have already wasted away, even if the nine pulses are harmonious, death will still occur. (Form relies on Qi for generation; Qi generates form. If form and Qi are already ruined, even if blood vessels are harmonious, death occurs. This implies that the death signs of the Seven Diagnoses appear in the pulse due to Qi deficiency, not primarily due to blood vessel pathology. Hence the following text says: If the pulse condition is also ruined, death will occur.) If the Seven Diagnoses are present, but the nine pulses all follow harmoniously, death will not occur. (The Seven Diagnoses refer to Chen Xi Xuan Jue, Sheng Zao Chuan Shu, Han Re, Re Zhong, Feng Bing, Shui Bing, and Earth exhaustion in the four seasons. "Nine pulses all follow" means uniformity above and below, without any single pulse being excessively large or small.) The statement "death will not occur" refers to Wind diseases and menstrual diseases, which resemble the Seven Diagnoses but are not actually them. Hence, it is said they will not die. (This explains that the Seven Diagnoses signify self-separation of Yin and Yang Qi, leading to time-specific death. If symptoms resemble the Seven Diagnoses due to pathogenic factors, death will not occur. Wind disease: if Wind disease involves separation of Yin and Yang, death is expected at evening; but if Yin and Yang are peaceful and nine pulses are uniform, death will not occur. Menstrual/Water disease: if Water disease presents with Chen Xi Xuan Jue, death is expected at midnight; but if Yin and Yang are peaceful and nine pulses follow harmoniously, death will not occur. This means the Seven Diagnoses lead to death due to Yin-Yang separation, not merely due to pathogenic factors causing time-specific death.) If there are diseases of the Seven Diagnoses, and the pulse condition is also ruined, death will occur. There will definitely be hiccuping and belching. (This reiterates that the diseases of the Seven Diagnoses rely on pulse conditions as evidence. Pulse is the manifestation of disease Qi. If the Stomach fails to transport essence, Stomach Qi is ruined, and thus the pulse is also ruined; this means both disease Qi and pulse are ruined together. If the pulse is diseased and Stomach Qi is ruined, the voice produces hiccups, indicating rebellious Stomach Qi. Rebellion leads to severance of the nine pulses, which is a dying pulse.) One must carefully inquire about when the disease first started and what the current symptoms are, then palpate their pulses individually, observing the floating and sunken nature of the meridians to determine the upward/downward and rebellious/compliant directions. ("Shi Bing" refers to long-standing and deep disease. "Fang Bing" refers to newly acquired pathogens and shallow disease. Palpating pulses individually involves checking if the disease is in Yin or Yang, Zang or Meridian. Long-standing disease presents with deep and rebellious pulses; new disease presents with compliant and floating pulses. Thus, one should observe meridian floating/sunkenness to deduce upward/downward rebellious/compliant directions.) If the pulse is rapid, there is no disease. If the pulse is slow, there is disease. If the pulse does not flow back and forth, death will occur. If the skin adheres tightly to the bone, death will occur. (Pathogens injuring meridians cause rapid pulses, so rapid pulses indicate the disease is not among the Seven Diagnoses. Injury to Yin-Yang Zang Qi causes slow pulses, so slow pulses indicate the disease is among the Seven Diagnoses. Pulse not flowing back and forth means having Seven Diagnosis diseases with ruined pulse conditions. Skin adhering to bone indicates long-standing disease with muscle wasting. *Gen Jie* chapter states: Thin and withered skin, withered and scorched hair and pores, indicates a fatal prognosis. This distinguishes that new diseases injuring form, body, and meridians do not cause death, while long-standing diseases injuring the Yin-Yang Qi of the five Zang organs cause death. Hence: For Jing meridian diseases, treat the Jing; for Sun Luo collateral diseases, treat the Sun Luo by bleeding. If the Yin-Yang Qi of the five Zang organs is already exhausted internally, attempting to treat externally with needles and stones is impossible.) The Yellow Emperor asked: How can those who are curable be treated? Qibo replied: For Jing meridian diseases, treat the Jing. For Sun Luo collateral diseases, treat the Sun Luo by bleeding. (*Ling Shu* states: Jing meridians are interior; branches crossing horizontally are Luo collaterals; branches of Luo are Sun collaterals. This means for diseases in Jing, needle the Jing; for diseases in Sun Luo, remove blood from Sun Luo. Since disease in Sun Luo is shallower, one should bleed to drain it.) For blood diseases accompanied by body pain, treat the Jing and Luo. (Blood disease implies pathogens have transferred to the Luo collaterals. During this stage, pain affects muscles, causing body pain. This means for deep diseases in Jing, treat the Jing disease; for shallow diseases in Sun Luo, treat the Sun Luo; for diseases between Jing and Luo depths affecting muscles with pain, treat both Jing and Luo.) For diseases located in Qi Xie (Odd/Strange Pathogens), use Miao Ci (Contralateral Puncture) for Qi Xie pulses. (Qi Xie refers to pathogens that do not enter the Jing meridians but overflow into the Da Luo (Great Collaterals), generating strange diseases. When pathogens lodge in Great Collaterals, they move from left to right and right to left, interacting with meridians above and below, distributing to the four extremities. Their location is variable, not entering Jing acupoints, so Miao Ci is appropriate. Miao Ci involves treating the left side for right-sided ailments and vice versa.) For lingering emaciation with fixed locations, puncture at the joints. (Lingering emaciation with fixed location means pathogens linger deeply over time, attaching to bone marrow, so one should puncture at the joints. This means for diseases in collaterals, take from the pulse; for diseases in bone joints, treat the joints.) For upper excess and lower deficiency, palpate and follow the pulse, seek out knotted Luo vessels, puncture to release blood, thereby restoring circulation. (*Ci Jie Zhen Xie* chapter states: Harmonized major meridians indicate no disease, or self-healing even if diseased. If one meridian has upper excess and lower deficiency with blockage, there must be盛 (full/excess) Heng Luo (transverse collaterals) adding pressure to the major meridian, causing blockage. Visualize and drain it; this is called "Untying the Knot." Thus, upper excess and lower deficiency result from Heng Luo fullness adding to the meridian, causing blockage and excess. "Palpate and follow" means palpating the blocked meridian and treating accordingly. "Seek knots" means finding the knot in the Heng Luo and puncturing to release blood. "Restore circulation" means visualizing and draining. The above states that diseases in Jing meridians are curable.) High position of the pupils indicates Taiyang insufficiency; upward deviation of the eyes indicates Taiyang exhaustion. This is the key to determining life and death and must be carefully examined. (The way of Nine Needles and Nine Positions values Shen (Spirit) and Qi. The Heart stores Shen and is the Taiyang within Yang; the Kidney is the source of vital Qi, with the Bladder as its exterior-interior pair. Thus, specifically observing Hand and Foot Taiyang is because Taiyang governs the Qi of all Yang channels. High position of pupils indicates insufficiency of Taiyang Shen Qi. The Hand Taiyang channel ascends to the cheek; hoarseness indicates declining channel Qi.) Retain the needle at the fingers and five cun above the hand outer ankle. (This reiterates that high position of pupils indicates Taiyang insufficiency in the upper part. The Hand Taiyang channel originates at the tip of the little finger, follows the lateral hand, ascends to the wrist, and exits the ankle. "Hand outer ankle above" refers to above the lateral ankle on the hand. "Five toes/fingers" refers to the fifth little toe/finger. It means when Taiyang is insufficient, one should retain the needle at Houxi (SI3) above the hand outer ankle and Shaoze (SI1) at the little finger tip to tonify. Observing Foot Taiyang Qi involves flicking five cun above the foot ankle; tonifying Hand Taiyang involves taking points five cun above the hand outer ankle/little finger. This shows the interconnection of Hand and Foot meridian Qi: insufficiency first in the upper part, then exhaustion in the lower part. Zhang Erzhong said: Draining releases blood; tonifying retains the needle.)