黄帝问曰。何谓虚实。（此亦承上章而复问也。）岐伯对曰。邪气盛则实。精气夺则虚。（邪气者。风寒暑湿之邪。精
气者。荣卫之气也。盖邪气有微盛。故邪盛则实。正气有强弱。故精夺则虚。夺、失也。或为邪所夺也。）帝曰。虚实
何如。岐伯曰。气虚者。肺虚也。气逆者。足寒也。非其时则生。当其时则死。（伯言虚实者。皆从物类始。如肺主气。
其类金。五行之气。先虚于外。而后内伤五脏。盖邪从表入里。在外之气血骨肉。先为邪病所虚。是以骨肉滑利。则邪
不内侵。而里亦实。表气虚则内伤五脏。而里亦虚。此表里之虚实也。如气逆于上。则下虚而足寒。此上下之虚实也。
如值其生旺之时。则生。当其胜克之时则死。此四时之虚实也。）余脏皆如此。（夫肝主筋。其类木。心主血。其类火。
脾主肉。其类土。肺主气。其类金。肾主骨。其类水。盖五脏之气。外合于五行。五行之气。岁应于四时。故皆有生旺
克胜之气。而各有死生之分。）帝曰。何谓重实。岐伯曰。所谓重实者。言大热病。气热脉满。是谓重实。重平声。
大热者。邪气盛也。气为阳。血脉为阴。邪盛而气血皆伤。故为重实。此论血气之阴阳虚实也。徐公遐曰。重实则其中
有重虚。故上文曰。虚实何如。下文曰。夫虚实者。帝曰。经络俱实何如。何以治之。（此论经络之阴阳虚实也。夫肤腠
气分为阳。经络血分为阴。然经络又有深浅阴阳之别。所谓阳中有阴。阴中有阳也。）岐伯曰。经络皆实。是寸脉急而尺
缓也。皆当治之。（邪盛于经。则寸口脉急。缓为内热。热在于络。则尺脉缓也。皆当以针取之。此以寸尺而候血脉之阴
阳也。）故曰。滑则从。涩则逆也。（滑主气血皆盛。故为从。涩主血气皆少。故为逆。朱圣公曰。故曰者。为阴阳血气
邪正而言也。）夫虚实者。皆从其物类始。故五脏骨肉滑利。可以长久也。（五行者。天地之阴阳也。五脏者。人之阴阳
也。易曰。方以类聚。物以群分。皮肉筋骨。五脏之外合也。金木水火土。五脏之外类也。夫邪之中人。始于皮肤。次
于肌肉。留而不去。则入于经脉。以及于筋骨。故邪之中人。先从其物类始。是以壮者之血气盛。其肌肉滑。气道通。
荣卫之行。不失其常。可以长久其天命。如五脏不坚。使道不长。空外以张。数中风寒。血气虚。脉不通。真邪相攻。
乱而相引。故不寿而尽也。徐公遐曰。邪气实则正气虚。故曰。夫虚实者。朱圣公曰。此复结首章之义。张兆璜曰。此
篇论邪实者。先从外而内。正虚者。亦先外而内。如木败者先叶落而后枝枯。故用诊尺之法。诊尺之法。先从外而内也。）
帝曰。络气不足。经气有余。何如。（不足者。精气夺。有余者。邪气盛。此邪去络而入于经也。）岐伯曰。络气不足。
经气有余者。脉口热而尺寒也。（此论经络之气虚实也。寒热者。尺寸之肤寒热。而应于经络也。络脉外连皮肤为阳主外。
经脉内连脏腑为阴主内。经云。荣出中焦。卫出下焦。卫气先行皮肤。先充络脉。络脉先盛。卫气已平。营气乃满。而
经脉大盛。经脉之虚实也。以气口知之。故以尺肤候络。而以寸候经。）秋冬为逆。春夏为从。治主病者。（夫邪气之从
外而内。犹藉正气之从内而外以 御。使邪仍从肤表而出。秋冬之气降沉。不能使邪外散。故为逆。春夏之气生浮。故
为从也。邪病在经。当从其经而取之。此论外因之虚实也。）帝曰。经虚络满何如。（此论内因之虚实也。）岐伯曰。经
虚络满者。尺脉满。脉口寒涩也。（尺脉热满。故主络满。脉口寒涩。故主经虚。）此春夏死。秋冬生也。（春夏之气。
生长于外。气惟外弛。而根本虚脱。故死。秋冬之气。收藏于内。故生。盖外因之病。宜神机外运。内因之病。宜根本
实坚。）帝曰。治此者奈何。岐伯曰。络满经虚。灸阴刺阳。经满络虚。刺阴灸阳。（络为阳。经为阴。刺者泻其盛满之
气。灸者启其陷下之阳。盖不足者病。而太过者亦为病也。）帝曰。何谓重虚。（此论脉气皆虚也。上节论经络之实。
即可类推于虚。此篇论气分之虚。亦可类推于实。）岐伯曰。脉气上虚。尺虚。是谓重虚。（血者。神气也。荣气宗气。
行于脉中。卫气行于脉外。故曰脉气。盖以气口之脉。可以候血。而可以候气也。上虚者。寸口之脉气虚也。尺虚者。
脉气虚于下也。上下皆虚。故曰重虚。朱永年曰。气逆于上而足寒者。上实下虚也。此上下皆虚。故谓重虚。）帝曰。何
以治之。（谓何以补其虚也。）岐伯曰。所谓气虚者。言无常也。尺虚者。行步 然。（ 音匡。气者。谓阳明所生之荣卫
宗气也。经曰。谷始入于胃。其精微者。先出于胃之两焦。以溉五脏。别出两行荣卫之道。其大气之搏而不行者。积于
胸中。命曰气海。出于肺。循喉咙以司呼吸。是阳气者。阳明之所生也。言无常者。宗气虚而语言无接续也。针经曰。
尽泻三阳之气。令病患 然。 、虚怯也。谓阳明之气虚于上。则言语无常。阳明之气虚于下。则令人行步 然。盖气
从太阴。出注手阳明。上行注足阳明。下行至跗上。故曰。身半以上。手太阴阳明皆主之。身半以下。足太阴阳明皆主
之。按帝问何以治之。而伯答以所病之因。盖知阳气生始之原。则知所以治矣。此论后天之主气也。针经曰。用针之
类。在于调气。气积于胃。以通荣卫。各经其道。宗气流于海。其下者注于气街。其上者走于息道。故厥在手足。宗气
不下。脉中之血凝而留止。徐公遐曰。此注当与九候论之地以候胸中之气注合参。）脉虚者。不象阴也。（气为阳。血
脉为阴。阳明之生气为阳。少阴之精气为阴。盖言以寸尺之脉。以候阳明之生气。而不效象其阴之虚也。朱圣公问曰。
上节以尺肤而候络脉之阴。此以寸尺之脉而候气分之阳。岂以皮肤候血脉。而反以脉候气耶。曰。经言善调尺者。不待
于寸。脉急者。尺之皮肤亦急。脉缓者。尺之皮肤亦缓。盖阴阳虚实之气。由脏腑而达于经脉。由经脉而出于肤表。以
尺肤之缓急滑涩而候脏腑血气之虚实者。是犹以色诊也。上节以络脉在皮之部。故以尺肤审之。此候脉气之虚实。故以
寸尺之脉诊也。论疾诊尺篇曰。尺肤寒。其脉小者。泄少气。是尺肤尺诊。皆可以候气候血也。诊候之道。通变无穷。
不可执一而论。惟会心者明之。张兆璜曰。此节论荣卫宗气之生于阳明。言气虚之脉。不象阴虚之少精血。）如此者。滑
则生。涩则死也。（夫气生于阳明。而发原在肾。少阴之气。上与阳明相合。阴阳相搏。其脉则滑。搏则化水谷之精微而
气生矣。故主生。涩主少气。生原已绝。故死。）帝曰。寒气暴上。脉满而实。何如。岐伯曰。实而滑则生。实而逆则
死。（此承上文之意而复问也。盖脉气生于胃腑。而发原在于少阴。是以上节论生气之原。此以下复论发原之始。夫肾脏
主水。在气为寒。寒气暴上者。水寒之气暴上。而满于脉也。实而滑者。得阳明之气相和。故生。逆者。少阴之生气已
绝。故死。盖寒气上乘。则真气反下逆矣。平脉篇曰。少阴脉弱而涩。弱者微烦。涩者厥逆。谓少阴之气不生。而手足
逆冷也。王子方曰。水寒之气暴上。曰脉满而实。少阴之气暴上。而曰脉实满。阴寒之气。皆实满于脉。而各有意存焉。
朱圣公曰。水寒之气暴上。则少阴之真气不升。故先论其寒气。而后论其真气。后又复论其水气也。）帝曰。脉实满。
手足寒头热。何如。岐伯曰。春秋则生。冬夏则死。（肾主生气之原。膀胱为太阳之府。脉实满者。少阴之寒气充于外也。
手足寒者。少阴之生气虚于内也。头热者。太阳之气。发越于上也。肾与膀胱。阴阳并交。咸主生气。若盛于外。则反
虚于内矣。春时阳气微上。阴气微下。秋时阴气微上。阳气微下。阴阳二气。交相资生。故主生。冬时阴气尽出于外。
夏时阳气尽虚于内。故主死。言阴阳之根气。不可虚脱者也。徐公遐曰。是以圣人春夏养阳。秋冬养阴。以从其根。
王芳侯曰。少阴之气。上与阳明相合。化生荣卫。行于脉中。若真阴之气。直溢于脉。则反虚其根矣。）脉浮而涩。涩而
身有热者死。（脉浮而涩。阴越于外而虚于内也。涩而身热。阳脱于内而弛于外也。此复言阴阳之根气脱者。皆为死证。
非但冬夏死而春秋可生。上节论无形之水气溢于脉中。故脉满而实。下节论有形之水邪溢于脉外。故形尽满。水气溢
者少精血。故宜脉滑。水邪溢者生气衰。故宜手足温。此论下焦之生气外脱。）帝曰。其形尽满何如。（肾为水脏。在气
为寒。上节论寒气暴上。此复论其水体泛溢故其形尽满也。形谓皮肤肌腠。盖经脉之内。有有形之血。是以无形之气乘
之。肌腠之间。主无形之气。是以有形之水乘之。而为肿胀也。）岐伯曰。其形尽满者。脉急大坚。尺涩而不应也。（诸
急为寒。寒水充溢于形身。故脉急而坚大。水邪外溢。则少阴之正气不升。故尺涩而不应也。灵枢经曰。脉坚大以涩者
胀也。）如是者。故从则生。逆则死。（夫少阴之气。从下而上。合于阳明。戊癸合而化火。火土之气。故有如是之证者。
得少阴之气。仍从下而上者生。逆而下者死。）帝曰。何谓从则生。逆则死。岐伯曰。所谓从者。手足温也。所谓逆者。
手足寒也。（手足温者。少阴之生气复也。生气复则火土之气渐旺。水寒之邪渐消。手足寒者。少阴之生气已绝。故死。
以上论生阳之气。发原于下焦。如寒水之邪实。则真阴之气虚。）帝曰。乳子而病热。脉悬小者。何如。（夫病热者。
皆伤寒之类也。凡伤于寒。藉阳气以化热。热虽盛不死。然阳气生于精水之中。男子八岁。女子七岁。肾气始实。乳子
天癸未至。肾气未盛。故帝复有此问焉。夫心主脉而资生于肾。心肾水火之气。上下时交。肾气不能上资于心。则心悬
如病饥。而寸口之脉悬绝小者。肾气未盛也。）岐伯曰。手足温则生。寒则死。（伯答乳子之生阳。藉后天之气也。四肢
皆禀气于胃。故阳受气于四末。是以手足温者。胃气尚盛。故生。寒则胃气已绝。故死。夫水谷入于胃。津液各走其道。
肾为水脏。受五脏之精而藏之。是先天之精。犹藉后天之所资益者也。又别出两行荣卫之道。其大气之搏而不行者。名
曰宗气。积于胸中。上出于肺。以司呼吸。是四肢之原俞。又受资于胃腑所生之荣卫宗气。是以手足温者生。寒者死。
朱
永年曰。当知少阴阳明之气。皆主手足之寒温。医者不可不审。）帝曰。乳子中风热。喘鸣肩息者。脉何如。岐伯曰。
喘鸣肩息者。脉实大也。缓则生。急则死。（此复论后天所生之宗气。而亦不可伤也。宗气者。五脏六腑。十二经脉之宗
始。故曰宗气。肩息者。呼吸摇肩也。风热之邪。始伤皮毛。喘鸣肩息。是风热盛而内干肺气宗气。故脉实大也。夫脉
之所以和缓者。得阳明之胃气也。急则胃气已绝。故死。徐公遐曰。水谷之精。虽藉先天之气以生化。然先天之气。又
藉水谷之精以相资。是以天癸至。肾气盛。齿发长。筋骨坚。皆受后天之养。非但于乳子也。故复设此问焉。上节论下
焦之根气。此论上焦之生气。皆由中焦之所生。）帝曰。肠 便血何如。岐伯曰。身热则死。寒则生。（上节言气之虚
实。此复论其血焉。肠 者。邪僻积于肠间。而为便利也。经言阳络伤则血外溢。血外溢则衄血。阴络伤则血内溢。血
内溢则便血。肠胃之络伤。则血溢于肠外。肠外有寒汁沫。与血相搏。则合并凝聚。而积成矣。是以肠 便血者。阴络
之血溢也。肠 下白沫者。肠外之寒汁沫也。肠 下脓血者。汁沫与血相搏。并合而下者也。夫便血。阴泄于内也。发
热。阳脱于外也。本经曰。阴阳虚。肠 死。此阴阳血气之相离也。朱圣公问曰。灵枢经论。恐为积聚而言也。曰。
百病之生也。皆起于内伤外感。不外乎气血阴阳。如留蓄于肠外。则为五积。便痢则为下积矣。）帝曰。肠 下白沫何如。
岐伯曰。脉沉则生。脉浮则死。（下白沫者。阴液下注。故脉沉者为顺。如脉浮是经气下泄。脉气上浮。此经脉相离。故
为死证。）帝曰。肠 下脓血何如。岐伯曰。脉悬绝则死。滑大则生。（夫血脉始于足少阴肾。生于足阳明胃。主于手少
阴心。输于足太阴脾。悬绝者。足少阴之阴液绝也。滑大者。足少阴之生气盛也。）帝曰。肠 之属。身不热。脉不悬
绝。何如。岐伯曰。滑大者曰生。悬涩者曰死。（此复申明血气之生原。又重在阳明之胃气也。身不热者。阳不外脱也。
脉不悬绝。阴不下绝也。悬涩者。阳明之生气已脱。故死。辨脉篇曰。趺阳脉浮而涩。故知脾气不足。胃气虚也。悬则
胃气绝矣。）以脏期之。（胃气已绝。则真脏之脉见矣。故当以脏期之。肝至悬绝十八日死。心至悬绝九日死。肺至悬绝
黄帝问道：什么是虚证和实证？（这是承接上一章的内容再次发问。）岐伯回答说：邪气亢盛就表现为实证，精气耗损就表现为虚证。（所谓邪气，是指风、寒、暑、湿等致病因素；所谓精气，是指营气和卫气。因为邪气有轻微与强盛的分别，所以邪气盛就是实证；正气有强弱之分，所以精气耗夺就是虚证。“夺”意为丧失，也可能是被邪气所剥夺。）黄帝说：虚实的情况具体是怎样的呢？岐伯说：气虚，指的是肺脏虚弱；气逆，表现为足部寒冷。如果在非其当令的季节发病则生，在当令的季节发病则死。（岐伯的意思是，论述虚实，都是从物类属性开始讲的。比如肺主气，其五行属性为金。五行的气，先在外部虚弱，然后内伤五脏。大概邪气从体表侵入体内，在体表的血、气、骨、肉，先被邪气病邪所虚损。因此，如果骨肉滑利，邪气就不能内侵，内部也就充实；如果表气虚弱，就会内伤五脏，内部也就虚弱。这就是表里之间的虚实关系。比如气逆于上，则下部空虚而足部寒冷，这是上下之间的虚实关系。如果遇到其旺盛生长的季节，则生；遇到其受克制胜克的季节，则死。这是四时之间的虚实关系。）其他脏腑的情况也都像这样。（肝主筋，其五行属性为木；心主血，其五行属性为火；脾主肉，其五行属性为土；肺主气，其五行属性为金；肾主骨，其五行属性为水。大概五脏之气，外合于五行。五行的气，每年对应四时的变化。所以都有生长旺盛和受克制胜的气机，因而各有生死的不同界限。）黄帝说：什么叫重实？岐伯说：所谓重实，说的是大热病，气分热盛且脉象满实，这就叫重实。“重”读平声。大热，意味着邪气亢盛。气属于阳，血脉属于阴。邪气亢盛导致气血都受伤，所以称为重实。这是在论述血气的阴阳虚实。徐公遐说：重实之中包含着重虚，所以上文说“虚实情况如何”，下文说“夫虚实者……”。黄帝说：经络都实证是怎么回事？怎么治疗？（这是在论述经络的阴阳虚实。肤腠和气分为阳，经络和血分为阴。然而经络又有深浅阴阳的区别，所谓阳中有阴，阴中有阳。）岐伯说：经络都实证，表现为寸口脉急而尺部脉缓。都应该进行治疗。（邪气盛于经脉，则寸口脉急；缓表示内有热。热在于络脉，则尺脉缓。都应该用针刺来取治。这是通过寸部和尺部来候察血脉的阴阳。）所以说：脉滑顺则预后好，脉涩逆则预后差。（滑脉主气血皆盛，所以为顺；涩脉主血气皆少，所以为逆。朱圣公说：所谓“故曰”，是就阴阳、血气、邪正而言的。）凡是虚实，都是从其物类属性开始的。所以五脏和骨肉滑利，就可以长久生存。（五行，是天地的阴阳。五脏，是人的阴阳。《易经》说：“方以类聚，物以群分。”皮、肉、筋、骨，是五脏的外合。金、木、水、火、土，是五脏的外类。邪气伤人，始于皮肤，次于肌肉，停留不去，则进入经脉，进而波及筋骨。所以邪气伤人，先从其物类属性开始。因此，身体强壮的人，血气旺盛，肌肉滑利，气道通畅，营卫的运行不失常态，可以长久地享有天命。如果五脏不坚固，鼻窍不长，鼻孔外露张开，经常感受风寒，血气虚弱，脉道不通，真气与邪气相互攻伐，紊乱相引，所以不能长寿而早亡。徐公遐说：邪气实则正气虚，所以说“夫虚实者……”。朱圣公说：这是重申首章的意义。张兆璜说：本篇论述邪实者，先从外而内；正虚者，也是先外而内。就像树木衰败，先落叶后枯枝。所以用诊察尺肤的方法，诊尺之法，也是先从外而内。）黄帝说：络气不足，经气有余，怎么样？（不足，是精气耗夺；有余，是邪气亢盛。这是邪气离开络脉而进入经脉的表现。）岐伯说：络气不足，经气有余的，表现为脉口热而尺部皮肤寒。（这是在论述经络之气的虚实。寒热，是指寸尺部位的皮肤寒热，并应于经络。络脉外连皮肤，属阳主外；经脉内连脏腑，属阴主内。医经说：营气出于中焦，卫气出于下焦。卫气先行于皮肤，先充盈络脉，络脉先盛，卫气已平，营气乃满，而经脉大盛。经脉的虚实，可以通过气口知道。所以用尺肤候察络脉，用寸口候察经脉。）秋冬季节发病为逆，春夏季节发病为从。治疗主要病变的经脉。（邪气从外侵入体内，还要借助正气从内向外以抵御，使邪气仍从肤表排出。秋冬之气沉降，不能使邪气外散，所以为逆；春夏之气生发浮越，所以为从。邪病在经脉，应当从其所属的经脉进行取治。这是在论述外因的虚实。）黄帝说：经虚络满怎么样？（这是在论述内因的虚实。）岐伯说：经虚络满的，表现为尺脉满实，脉口寒涩。（尺脉热满，所以主络满；脉口寒涩，所以主经虚。）这种病在春夏季节死亡，在秋冬季节生存。（春夏之气，生长于外，气只向外弛散，而根本虚脱，所以死。秋冬之气，收藏于内，所以生。大概外因的疾病，宜神机外运；内因的疾病，宜根本实坚。）黄帝说：治疗这种情况该怎么办？岐伯说：络满经虚，灸阴经刺阳经；经满络虚，刺阴经灸阳经。（络属阳，经属阴。刺法是为了泻去盛满之气，灸法是为了开启陷下的阳气。大概不足是病，太过也是病。）黄帝说：什么叫重虚？（这是在论述脉气皆虚。上一节论述经络之实，即可类推于虚。本篇论述气分之虚，亦可类推于实。）岐伯说：上部脉气虚，尺部脉气虚，这叫重虚。（血，是神气的基础。营气、宗气行于脉中，卫气行于脉外，所以叫脉气。大概通过气口之脉，既可以候血，也可以候气。上虚，是指寸口脉气虚；尺虚，是指脉气在下部虚。上下都虚，所以叫重虚。朱永年说：气逆于上而足寒，是上实下虚。这里是上下皆虚，所以叫重虚。）黄帝说：怎么治疗它？（意思是怎么补益它的虚损。）岐伯说：所谓气虚，表现为言语无常。尺部虚，表现为行走不稳。（“匡”音。气，指阳明所生的营卫宗气。医经说：食物刚进入胃，其中的精微物质，先出于胃的两焦，以灌溉五脏，别出两行营卫之道。其中大气搏结而不运行的，积聚于胸中，名叫气海，出于肺，循喉咙以司呼吸。这阳气，是由阳明所生。言语无常，是因为宗气虚而不能接续。针经说：尽泻三阳之气，令病人站立不稳。“伾”意为虚怯。是说阳明之气虚于上，则言语无常；阳明之气虚于下，则令人行走不稳。大概气从太阴出来，注入手阳明，上行注入足阳明，下行至足背。所以说：身半以上，手太阴、手阳明都主之；身半以下，足太阴、足阳明都主之。按黄帝问怎么治疗，而岐伯回答病因，大概是知道了阳气生成的源头，就知道怎么治疗了。这是在论述后天之主气。针经说：用针的道理，在于调气。气积聚于胃，以通营卫，各经其道。宗气流于海，其下者注于气街，其上者走于息道。所以厥逆在手足，是因为宗气不下，脉中之血凝滞留止。徐公遐说：这段注释应当与《九候论》中“地以候胸中之气”互相参看。）脉虚的，不象阴脉。（气为阳，血脉为阴。阳明之生气为阳，少阴之精气为阴。大概是用寸尺之脉，来候察阳明之生气，而不效象其阴之虚。朱圣公问：上一节用尺肤候察络脉之阴，这一节用寸尺之脉候察气分之阳，难道是用皮肤候血脉，反而用脉候气吗？回答说：医经说善于调尺的人，不依赖于寸。脉急，尺之皮肤也急；脉缓，尺之皮肤也缓。大概阴阳虚实之气，由脏腑达于经脉，由经脉出于肤表。通过尺肤的缓急滑涩来候察脏腑血气的虚实，这犹如色诊一样。上一节因为络脉在皮之部，所以用尺肤审察。这一节候察脉气的虚实，所以用寸尺之脉诊察。《论疾诊尺篇》说：尺肤寒，其脉小，是泄泻少气。可见尺肤和尺诊，都可以候气候血。诊候之道，通变无穷，不可执一而论，只有会心的人才能明白。张兆璜说：这一节论述营卫宗气生于阳明，言气虚之脉，不象阴虚之少精血。）像这样的情况，脉滑则生，脉涩则死。（气生于阳明，而发源在肾。少阴之气，上与阳明相合，阴阳相搏，其脉则滑。搏则化水谷之精微而气生，所以主生。涩主少气，生原已绝，所以死。）黄帝说：寒气突然上冲，脉满而实，怎么样？岐伯说：实而滑则生，实而逆则死。（这是承接上文的意思再次发问。大概脉气生于胃腑，而发源在于少阴。所以上一节论述生气之源，这一节以下又复论发源之始。肾脏主水，在气为寒。寒气暴上，是水寒之气暴上，而满于脉。实而滑，是得到阳明之气相和，所以生。逆，是少阴之生气已绝，所以死。大概寒气上乘，则真气反下逆。《平脉篇》说：少阴脉弱而涩，弱者微烦，涩者厥逆。是说少阴之气不生，而手足逆冷。王子方说：水寒之气暴上，说脉满而实；少阴之气暴上，说脉实满。阴寒之气，皆实满于脉，而各自有意存焉。朱圣公说：水寒之气暴上，则少阴之真气不升，所以先论其寒气，而后论其真气，后又复论其水气。）黄帝说：脉实满，手足寒头热，怎么样？岐伯说：春秋季节生，冬夏季节死。（肾主生气之源，膀胱为太阳之府。脉实满，是少阴之寒气充于外。手足寒，是少阴之生气虚于内。头热，是太阳之气发越于上。肾与膀胱，阴阳并交，都主生气。若盛于外，则反虚于内。春时阳气微上，阴气微下；秋时阴气微上，阳气微下。阴阳二气，交相资生，所以主生。冬时阴气尽出于外，夏时阳气尽虚于内，所以主死。是说阴阳的根气，不可虚脱。徐公遐说：所以圣人春夏养阳，秋冬养阴，以从其根。王芳侯说：少阴之气，上与阳明相合，化生荣卫，行于脉中。若真阴之气，直溢于脉，则反虚其根。）脉浮而涩，涩而身有热的，死。（脉浮而涩，是阴越于外而虚于内。涩而身热，是阳脱于内而弛于外。这是再次说明阴阳之根气脱者，皆为死证，不仅仅是冬夏死而春秋可生。上一节论述无形之水气溢于脉中，所以脉满而实；下一节论述有形之水邪溢于脉外，所以形尽满。水气溢者少精血，所以宜脉滑；水邪溢者生气衰，所以宜手足温。这是在论述下焦之生气外脱。）黄帝说：身形完全肿胀怎么样？（肾为水脏，在气为寒。上一节论述寒气暴上，这里又论述其水体泛溢所以身形完全肿胀。形指皮肤肌腠。大概经脉之内，有有形之血，是以无形之气乘之；肌腠之间，主无形之气，是以有形之水乘之，而为肿胀。）岐伯说：身形完全肿胀的，脉象急大坚，尺部涩而不应。（诸急为寒。寒水充溢于形身，所以脉急而坚大。水邪外溢，则少阴之正气不升，所以尺涩而不应。《灵枢经》说：脉坚大以涩者，胀也。）像这样的情况，顺则生，逆则死。（少阴之气，从下而上，合于阳明。戊癸合而化火，火土之气，所以有如是之证。得少阴之气，仍从下而上者生；逆而下者死。）黄帝说：什么叫顺则生，逆则死？岐伯说：所谓顺，是手足温暖。所谓逆，是手足寒冷。（手足温，是少阴之生气恢复。生气复则火土之气渐旺，水寒之邪渐消。手足寒，是少阴之生气已绝，所以死。以上论述生阳之气，发源于下焦。如寒水之邪实，则真阴之气虚。）黄帝说：婴儿患热病，脉象悬小，怎么样？（患热病，都是伤寒之类。凡伤于寒，藉阳气以化热，热虽盛不死。然而阳气生于精水之中。男子八岁，女子七岁，肾气始实。婴儿天癸未至，肾气未盛，所以黄帝再次有此问。心主脉而资生于肾，心肾水火之气，上下时交。肾气不能上资于心，则心悬如病饥，而寸口之脉悬绝小，是肾气未盛。）岐伯说：手足温则生，寒则死。（岐伯回答婴儿的生阳，藉赖后天之气。四肢都禀气于胃，所以阳受气于四末。因此手足温，是胃气尚盛，所以生。寒则是胃气已绝，所以死。水谷进入胃，津液各走其道。肾为水脏，受五脏之精而藏之，是先天之精，犹藉后天之所资益。又别出两行营卫之道，其大气搏结而不运行的，名叫宗气，积聚于胸中，上出于肺，以司呼吸。这是四肢的原俞，又受资于胃腑所生之营卫宗气。所以手足温者生，寒者死。朱永年说：应当知道少阴、阳明之气，都主手足之寒温，医者不可不审。）黄帝说：婴儿患中风热，喘鸣肩息的，脉怎么样？岐伯说：喘鸣肩息的，脉实大。缓则生，急则死。（这是再次论述后天所生之宗气，也不可损伤。宗气，是五脏六腑、十二经脉的宗始，所以叫宗气。肩息，是呼吸摇肩。风热之邪，始伤皮毛，喘鸣肩息，是风热盛而内干肺气宗气，所以脉实大。脉之所以和缓，是得到阳明之胃气。急则是胃气已绝，所以死。徐公遐说：水谷之精，虽藉先天之气以生化，然而先天之气，又藉水谷之精以相资。所以天癸至，肾气盛，齿发长，筋骨坚，都受后天之养，不仅仅是在婴儿身上。所以再次设此问。上一节论述下焦之根气，这一节论述上焦之生气，都由中焦所生。）黄帝说：肠澼便血怎么样？岐伯说：身热则死，寒则生。（上一节言气之虚实，这里又论述其血。肠澼，是邪僻积于肠间，而为便利。医经说阳络伤则血外溢，血外溢则衄血；阴络伤则血内溢，血内溢则便血。肠胃之络伤，则血溢于肠外。肠外有寒汁沫，与血相搏，则合并凝聚，而积成矣。所以肠澼便血，是阴络之血溢。肠澼下白沫，是肠外之寒汁沫。肠澼下脓血，是汁沫与血相搏，并合而下。便血，是阴泄于内。发热，是阳脱于外。本经说：阴阳虚，肠澼死。这是阴阳血气之相离。朱圣公问：《灵枢经》论述，恐怕是为积聚而言。回答说：百病的产生，都起于内伤外感，不外乎气血阴阳。如留蓄于肠外，则为五积；便痢则为下积。）黄帝说：肠澼下白沫怎么样？岐伯说：脉沉则生，脉浮则死。（下白沫，是阴液下注，所以脉沉者为顺。如脉浮是经气下泄，脉气上浮，此经脉相离，所以为死证。）黄帝说：肠澼下脓血怎么样？岐伯说：脉悬绝则死，滑大则生。（血脉始于足少阴肾，生于足阳明胃，主于手少阴心，输于足太阴脾。悬绝，是足少阴之阴液绝。滑大，是足少阴之生气盛。）黄帝说：肠澼这类病，身不热，脉不悬绝，怎么样？岐伯说：滑大者曰生，悬涩者曰死。（这是再次申明血气的生原，又重在阳明之胃气。身不热，是阳不外脱。脉不悬绝，是阴不下绝。悬涩，是阳明之生气已脱，所以死。《辨脉篇》说：趺阳脉浮而涩，故知脾气不足，胃气虚。悬则胃气绝矣。）以脏期之。（胃气已绝，则真脏之脉见。所以当以脏期之。肝至悬绝十八日死，心至悬绝九日死，肺至悬绝……）
Huangdi asked, saying: What are deficiency and excess? (This question follows up on the previous chapter.) Qibo replied, saying: When pathogenic factors are flourishing, it is excess; when essence and qi are depleted, it is deficiency. (Pathogenic factors refer to wind, cold, summerheat, and dampness. Essence and qi refer to Ying-Wei Qi. Since pathogenic factors vary in degree, their flourishing constitutes excess; since healthy qi varies in strength, the depletion of essence constitutes deficiency. "Depletion" means loss, or being deprived by pathogens.) Huangdi said: How are deficiency and excess manifested? Qibo said: Deficiency of Qi refers to Lung deficiency. Qi rebellion manifests as cold feet. If occurring out of season, there is survival; if occurring in season, there is death. (Qibo meant that discussions of deficiency and excess begin with the classification of things. For example, the Lung governs Qi and corresponds to Metal. The Qi of the Five Elements first becomes deficient externally, then internally injures the Zang organs. Pathogens enter from the exterior to the interior; the blood, Qi, bones, and flesh at the exterior are first made deficient by pathogenic diseases. Therefore, if bones and flesh are smooth and supple, pathogens cannot invade internally, and the interior remains full; if exterior Qi is deficient, it internally injures the Zang organs, and the interior becomes deficient. This is the deficiency and excess between interior and exterior. If Qi rebels upward, the lower part becomes empty and feet become cold; this is the deficiency and excess between upper and lower. If encountering a time of growth and prosperity, there is survival; if encountering a time of overcoming and suppression, there is death. This is the deficiency and excess among the Four Seasons.) The other Zang organs follow this pattern. (The Liver governs sinews and corresponds to Wood; the Heart governs Blood and corresponds to Fire; the Spleen governs flesh and corresponds to Earth; the Lung governs Qi and corresponds to Metal; the Kidney governs bones and corresponds to Water. The Qi of the Five Zang organs corresponds externally to the Five Elements. The Qi of the Five Elements responds to the Four Seasons annually. Thus, each has phases of growth/prosperity and overcoming/suppression, leading to different outcomes of life and death.) Huangdi asked: What is called "Chong Shi" (Double Excess)? Qibo said: By "Chong Shi," we mean severe heat disease, where Qi is hot and the pulse is full and solid; this is called Chong Shi. "Chong" is pronounced with the level tone. Severe heat indicates flourishing pathogens. Qi belongs to Yang, and blood vessels belong to Yin. Flourishing pathogens injure both Qi and Blood, hence it is called Double Excess. This discusses the Yin-Yang deficiency and excess of Blood and Qi. Xu Gongxia said: Within Double Excess lies Double Deficiency, which is why the text previously asked "How are deficiency and excess?" and later states "As for deficiency and excess..." Huangdi asked: What if both the Collaterals and Meridians are in an excess state? How should they be treated? (This discusses the Yin-Yang deficiency and excess of the Meridians. Skin pores and Qi division belong to Yang; Meridians and Blood division belong to Yin. However, meridians also have differences in depth and Yin-Yang, meaning Yang contains Yin, and Yin contains Yang.) Qibo said: When both Collaterals and Meridians are in excess, the Cun pulse is rapid/tight while the Chi pulse is slow/relaxed. Both should be treated. (When pathogens flourish in the meridians, the Cun-kou pulse is rapid/tight; slowness/relaxation indicates internal heat. Heat in the collaterals makes the Chi pulse relaxed. Both should be treated with acupuncture. This uses the Cun and Chi positions to inspect the Yin-Yang of blood vessels.) Therefore it is said: Smooth pulses indicate favorable prognosis; choppy pulses indicate unfavorable prognosis. (Smooth pulses indicate abundant Qi and Blood, hence favorable; choppy pulses indicate scarce Qi and Blood, hence unfavorable. Zhu Shenggong said: The phrase "Therefore it is said" refers to Yin-Yang, Blood-Qi, pathogens, and healthy Qi.) All cases of deficiency and excess begin with their respective elemental categories. Therefore, if the Five Zang organs and bones/flesh are smooth and supple, one can live long. (The Five Elements are the Yin-Yang of Heaven and Earth. The Five Zang organs are the Yin-Yang of humans. The I Ching says: "Categories gather together, things group by kind." Skin, flesh, sinews, and bones are external correspondences of the Zang organs. Metal, Wood, Water, Fire, and Earth are external categories of the Zang organs. Pathogens attacking humans start at the skin, then move to muscles; if lingering, they enter the meridians and reach sinews and bones. Thus, pathogen attack begins with their elemental category. Therefore, robust individuals have abundant Qi and Blood, smooth muscles, unobstructed Qi pathways, and normal Ying-Wei circulation, allowing them to fulfill their lifespan. If the Five Zang organs are not firm, nasal passages are short, nostrils flare open, frequent exposure to wind-cold occurs, Qi and Blood are deficient, pulses are obstructed, true Qi and pathogens clash chaotically, leading to premature death. Xu Gongxia said: When pathogens are excessive, healthy Qi is deficient, hence "As for deficiency and excess..." Zhu Shenggong said: This reiterates the meaning of the opening chapter. Zhang Zhaohuang said: This chapter discusses how excess pathogens enter from exterior to interior, and how healthy deficiency also starts from exterior to interior, like trees losing leaves before branches wither. Hence the method of inspecting the Chi skin, which proceeds from exterior to interior.) Huangdi asked: What if Collateral Qi is deficient and Meridian Qi is excessive? (Deficiency means depletion of essence; excess means flourishing pathogens. This indicates pathogens leaving the collaterals and entering the meridians.) Qibo said: In cases of deficient Collateral Qi and excessive Meridian Qi, the Mai-kou (Cun-kou) is hot while the Chi skin is cold. (This discusses the deficiency and excess of Qi in meridians and collaterals. Cold and heat refer to the temperature of the skin at Cun and Chi positions, corresponding to meridians and collaterals. Collaterals connect externally to skin, belonging to Yang and governing the exterior; meridians connect internally to Zang-fu, belonging to Yin and governing the interior. The Classics state: Ying Qi emerges from the Middle Jiao, Wei Qi emerges from the Lower Jiao. Wei Qi moves first through the skin, filling the collaterals; once collaterals are full and Wei Qi stabilizes, Ying Qi fills, and meridians become highly prosperous. The deficiency/excess of meridians is known via the Qi-kou. Hence, Chi skin inspects collaterals, while Cun inspects meridians.) Occurrence in Autumn/Winter is unfavorable; occurrence in Spring/Summer is favorable. Treat the primary diseased area. (Pathogens entering from exterior to interior rely on healthy Qi moving from interior to exterior to resist, allowing pathogens to exit via the skin surface. Autumn/Winter Qi descends and sinks, unable to disperse pathogens outward, hence unfavorable; Spring/Summer Qi rises and floats, hence favorable. If disease is in the meridians, treat according to the affected meridian. This discusses exogenous deficiency and excess.) Huangdi asked: What if Meridians are deficient and Collaterals are excessive? (This discusses endogenous deficiency and excess.) Qibo said: In cases of deficient Meridians and excessive Collaterals, the Chi pulse is full/solid, while the Mai-kou is cold and choppy. (Chi pulse heat/fullness indicates excessive collaterals; Mai-kou cold/choppy indicates deficient meridians.) Death in Spring/Summer; survival in Autumn/Winter. (Spring/Summer Qi grows outward; Qi only relaxes outward, causing root depletion, hence death. Autumn/Winter Qi stores inward, hence survival. Generally, exogenous diseases benefit from Shen-Ji (Spirit Mechanism) moving outward; endogenous diseases benefit from a solid root.) Huangdi asked: How to treat this? Qibo said: For excessive collaterals and deficient meridians, moxa Yin meridians and needle Yang meridians; for excessive meridians and deficient collaterals, needle Yin meridians and moxa Yang meridians. (Collaterals are Yang, Meridians are Yin. Needling drains excessive Qi; moxibustion raises sunken Yang. Deficiency is disease, but excess is also disease.) Huangdi asked: What is called "Chong Xu" (Double Deficiency)? (This discusses universal pulse Qi deficiency. The previous section discussed Meridian/Collateral excess, inferable to deficiency. This section discusses Qi-level deficiency, inferable to excess.) Qibo said: Upper pulse Qi deficiency and Chi pulse Qi deficiency is called Double Deficiency. (Blood is the basis of Shen-Qi. Ying Qi and Zong Qi flow within vessels; Wei Qi flows outside vessels, hence "Pulse Qi." The Qi-kou pulse can inspect both Blood and Qi. "Upper deficiency" refers to Cun-kou pulse Qi deficiency; "Chi deficiency" refers to pulse Qi deficiency in the lower part. Both upper and lower are deficient, hence Double Deficiency. Zhu Yongnian said: Qi rebelling upward with cold feet is Upper Excess/Lower Deficiency. Here, both upper and lower are deficient, hence Double Deficiency.) Huangdi asked: How to treat it? (Meaning how to tonify the deficiency.) Qibo said: Regarding Qi deficiency, speech is irregular. Chi deficiency manifests as unsteady gait. ("Kuang" sound. Qi refers to Ying-Wei Zong Qi generated by Stomach-Meridian of Foot-Yangming. The Classics say: Food enters the Stomach; its refined essences emerge from the two Jiaos of the Stomach to nourish the Zang organs, separating into two paths of Ying and Wei. The great Qi that gathers without flowing accumulates in the Chest Sea, named Qi Hai, emerging from the Lung, traveling along the throat to govern respiration. This Yang Qi is generated by Yangming. Irregular speech indicates Zong Qi deficiency failing to sustain continuity. The Needle Classic says: Draining all Three-Yang Qi causes patients to stand unsteadily. "Pi" means weak/cowardly. It means Yangming Qi deficiency above causes irregular speech; Yangming Qi deficiency below causes unsteady gait. Qi flows from Taiyin to Hand-Yangming, ascending to Foot-Yangming, descending to the dorsum of the foot. Thus: Above the waist, Hand-Taiyin and Hand-Yangming govern; below the waist, Foot-Taiyin and Foot-Yangming govern. Huangdi asked how to treat, and Qibo answered with the cause, implying that knowing the origin of Yang Qi generation reveals the treatment. This discusses Post-Heaven Main Qi. The Needle Classic says: The principle of needling lies in regulating Qi. Qi accumulates in the Stomach to connect Ying and Wei, following their respective channels. Zong Qi flows to the Sea; downward it pours into Qichong; upward it travels to the respiratory tract. Thus, Jue-Ni in hands and feet occurs because Zong Qi does not descend, causing blood in vessels to stagnate. Xu Gongxia said: This annotation should be cross-referenced with "Di Yi Hou Xiong Zhong Zhi Qi" in the Nine Inspections Chapter.) Pulse deficiency does not resemble Yin pulses. (Qi is Yang, Blood vessels are Yin. Yangming's generating Qi is Yang; Shaoyin's essence Qi is Yin. Using Cun-Chi pulses to inspect Yangming's generating Qi does not reflect its Yin deficiency. Zhu Shenggong asked: The previous section used Chi skin to inspect Collateral Yin; this section uses Cun-Chi pulses to inspect Qi-level Yang. Does skin inspect blood vessels while pulse inspects Qi? Answer: The Classics say those skilled at adjusting Chi do not rely on Cun. Rapid pulse means Chi skin is also tight; slow pulse means Chi skin is also relaxed. Yin-Yang deficiency/excess Qi reaches meridians from Zang-fu, and exits skin from meridians. Inspecting Zang-fu/Blood-Qi deficiency/excess via Chi skin relaxation/tightness/smoothness/choppiness is like color diagnosis. Previous section inspected Collaterals in skin layer via Chi skin; this section inspects Pulse Qi deficiency/excess via Cun-Chi pulses. "Lun Ji Zhen Chi Pian" says: Cold Chi skin with small pulse indicates diarrhea and Qi deficiency. Thus Chi skin and Chi pulse inspection can both inspect climate and blood. Diagnostic methods are infinite and variable; do not adhere to one view. Only those who understand intuitively will see clearly. Zhang Zhaohuang said: This section discusses Ying-Wei Zong Qi generated by Yangming; Qi deficiency pulses do not resemble Yin deficiency with scanty essence/blood.) In such cases, smooth pulses indicate survival; choppy pulses indicate death. (Qi generates in Yangming but originates in Kidney. Shaoyin Qi combines with Yangming; Yin-Yang struggle makes the pulse smooth. Struggle transforms grain essences into Qi, hence survival. Choppy indicates Qi deficiency; origin of life is exhausted, hence death.) Huangdi asked: Cold Qi suddenly ascends, pulse is full and solid. How is this? Qibo said: Solid and smooth indicates survival; solid and reversed indicates death. (This continues the previous inquiry. Pulse Qi generates in Stomach Fu but originates in Shaoyin. Previous section discussed origin of generating Qi; this section discusses the beginning of origin. Kidney governs Water, associated with Cold in Qi. Sudden ascent of Cold Qi is sudden ascent of Water-Cold Qi filling the vessels. Solid and smooth indicates harmony with Yangming Qi, hence survival. Reversed indicates Shaoyin generating Qi is exhausted, hence death. Cold Qi surging upward causes True Qi to reverse downward. "Ping Mai Pian" says: Weak and choppy Shaoyin pulse—weak indicates slight vexation, choppy indicates Jue-Ni. Shaoyin Qi failing to generate leads to cold extremities. Wang Zifang said: Sudden ascent of Water-Cold Qi is described as "pulse full and solid"; sudden ascent of Shaoyin Qi is described as "pulse solid and full." Yin-Cold Qi fills vessels, each carrying specific implications. Zhu Shenggong said: Sudden ascent of Water-Cold Qi prevents Shaoyin True Qi from rising, so Cold Qi is discussed first, then True Qi, then Water Qi again.) Huangdi asked: Pulse full and solid, cold hands and feet, hot head. How is this? Qibo said: Survival in Spring/Autumn; death in Winter/Summer. (Kidney is origin of generating Qi; Bladder is Fu organ of Taiyang. Pulse full and solid indicates Shaoyin Cold Qi filling the exterior. Cold hands/feet indicate Shaoyin Generating Qi deficient internally. Hot head indicates Taiyang Qi venting upward. Kidney and Bladder interact Yin-Yang, both governing generating Qi. If excessive externally, it becomes deficient internally. Spring: Yang Qi slightly ascends, Yin Qi slightly descends. Autumn: Yin Qi slightly ascends, Yang Qi slightly descends. Yin-Yang Qi mutually support, hence survival. Winter: Yin Qi entirely exits outward; Summer: Yang Qi entirely deficient internally, hence death. This emphasizes that root Qi of Yin-Yang must not be depleted. Xu Gongxia said: Thus Sages nourish Yang in Spring/Summer and Yin in Autumn/Winter, following the root. Wang Fanghou said: Shaoyin Qi combines with Yangming to generate Ying-Wei, flowing in vessels. If True Yin Qi directly overflows into vessels, it depletes the root.) Floating and choppy pulse, choppy with body heat: Death. (Floating and choppy pulse: Yin escapes outward, deficient internally. Choppy with body heat: Yang escapes internally, relaxes outward. This reiterates that exhaustion of Yin-Yang root Qi is a death sign, not just death in Winter/Summer but survival in Spring/Autumn. Previous section discussed formless Water Qi overflowing into vessels (pulse full/solid); next section discusses formless Water Evil overflowing outside vessels (full swelling). Water Qi overflow implies scanty essence/blood, favoring smooth pulse; Water Evil overflow implies declining generating Qi, favoring warm extremities. This discusses Lower Jiao generating Qi escaping outward.) Huangdi asked: What if the body is fully swollen? (Kidney is Water Zang, associated with Cold. Previous section discussed sudden Cold Qi ascent; here discusses water body flooding causing full body swelling. "Body" refers to skin and muscle clefts. Inside meridians is form-blood; formless Qi acts upon it. Between muscle clefts governs formless Qi; formless Water acts upon it, causing distension/swelling.) Qibo said: Full body swelling presents with rapid, large, firm pulse; Chi position is choppy and unresponsive. (All rapid pulses indicate Cold. Cold Water flooding the body makes pulse rapid and firm/large. Water evil overflowing externally prevents Shaoyin True Qi from rising, making Chi choppy and unresponsive. "Ling Shu Jing" says: Firm, large, and choppy pulse indicates distension.) In such cases, favorable indicates survival; unfavorable indicates death. (Shaoyin Qi moves upward from below, combining with Yangming. Wu-Gui combine to transform Fire; Fire-Earth Qi produces such symptoms. Getting Shaoyin Qi still moving upward from below indicates survival; reversing downward indicates death.) Huangdi asked: What defines favorable survival and unfavorable death? Qibo said: Favorable means warm hands and feet. Unfavorable means cold hands and feet. (Warm hands/feet indicate recovery of Shaoyin Generating Qi. Recovery of generating Qi makes Fire-Earth Qi gradually prosperous and Water-Cold evil gradually dissipate. Cold hands/feet indicate Shaoyin Generating Qi is exhausted, hence death. Above discusses Sheng-Yang Qi originating in Lower Jiao. If Cold-Water evil is excessive, True Yin Qi is deficient.) Huangdi asked: Infant suffering from heat disease, pulse is suspended and small. How is this? (Heat diseases are similar to Cold Damage. Injury by Cold relies on Yang Qi to transform into heat; even if heat is severe, death does not ensue. However, Yang Qi is born within Jing-Water. Boys at age eight, girls at age seven, Kidney Qi begins to solidify. Infants have not yet reached Tian Gui, Kidney Qi is not vigorous, hence Huangdi asks again. Heart governs pulse and is nourished by Kidney; Heart-Kidney Water-Fire Qi interacts上下. If Kidney Qi cannot nourish Heart upward, Heart hangs like hunger, and Cun-kou pulse is suspended/extreme/small, indicating Kidney Qi is not yet vigorous.) Qibo said: Warm hands and feet indicate survival; cold indicates death. (Qibo answers that infant Sheng-Yang relies on Post-Heaven Qi. Limbs receive Qi from Stomach; Yang receives Qi at the four ends. Thus, warm hands/feet indicate Stomach Qi is still vigorous, hence survival. Cold indicates Stomach Qi is exhausted, hence death. Food/water enters Stomach, fluids go their ways. Kidney is Water Zang, storing essence of Five Zang; this Pre-Heaven essence still relies on Post-Heaven supplementation. Two paths of Ying-Wei separate; great Qi gathering without flowing is named Zong Qi, accumulating in Chest, emerging from Lung to govern respiration. These limb Yuan-Shu points are also nourished by Ying-Wei Zong Qi generated by Stomach Fu. Thus warm hands/feet survive, cold die. Zhu Yongnian said: Know that Shaoyin and Yangming Qi govern warmth/cold of hands/feet; physicians must examine carefully.) Huangdi asked: Infant suffering from Wind-Heat, panting, wheezing, shoulder breathing. How is the pulse? Qibo said: Panting, wheezing, shoulder breathing present with solid-large pulse. Slow indicates survival; rapid indicates death. (This re-discusses Post-Heaven generated Zong Qi, which must not be injured. Zong Qi is the ancestor of Five Zang, Six Fu, and Twelve Meridians, hence named Zong Qi. Shoulder breathing means breathing involves shoulder movement. Wind-Heat initially injures skin/hair; panting/wheezing/shoulder breathing indicates Wind-Heat is flourishing and internally interfering with Lung Qi and Zong Qi, hence solid-large pulse. Pulse smoothness comes from Yangming Stomach Qi. Rapid means Stomach Qi is exhausted, hence death. Xu Gongxia said: Grain essences rely on Pre-Heaven Qi for transformation, but Pre-Heaven Qi relies on grain essences for support. Thus when Tian Gui arrives, Kidney Qi is vigorous, teeth/hair grow, sinews/bones strengthen, all nourished by Post-Heaven, not just in infants. Hence this question is posed. Previous section discussed Lower Jiao root Qi; this section discusses Upper Jiao generating Qi, both produced by Middle Jiao.) Huangdi asked: Chang Pi with bloody stool. How is this? Qibo said: Body heat indicates death; cold indicates survival. (Previous section discussed Qi deficiency/excess; here discusses Blood. Chang Pi means pathogenic accumulation in intestines causing loose stools. Classics say: Injury to Yang Luo causes external blood overflow (epistaxis); injury to Yin Luo causes internal blood overflow (hematochezia). Injury to Gut/Stomach Luo causes blood overflow outside intestines. Cold fluid foam outside intestines clashes with blood, coagulating into masses. Thus Chang Pi with bloody stool is Yin Luo blood overflow. Chang Pi with white mucus is cold fluid foam outside intestines. Chang Pi with pus/blood is foam clashing with blood, exiting together. Bloody stool is Yin leaking internally. Fever is Yang escaping externally. The Classic says: Yin-Yang deficiency, Chang Pi dies. This is separation of Yin-Yang Blood-Qi. Zhu Shenggong asked: "Ling Shu Jing" discussion seems to refer to accumulations. Answer: Diseases arise from internal injury and external invasion, never outside Yin-Yang Blood-Qi. Accumulation outside intestines forms Five Accumulations; dysentery forms Lower Accumulation.) Huangdi asked: Chang Pi with white mucus. How is this? Qibo said: Deep pulse indicates survival; floating pulse indicates death. (White mucus indicates Yin fluids draining downward; deep pulse is favorable. Floating pulse indicates Meridian Qi draining downward and Pulse Qi floating upward, separation of meridians, hence death.) Huangdi asked: Chang Pi with pus and blood. How is this? Qibo said: Suspended-extreme pulse indicates death; smooth-large pulse indicates survival. (Blood vessels begin in Foot-Shaoyin Kidney, generate in Foot-Yangming Stomach, governed by Hand-Shaoyin Heart, transported by Foot-Taiyin Spleen. Suspended-extreme indicates Foot-Shaoyin Yin fluid exhaustion. Smooth-large indicates Foot-Shaoyin generating Qi prosperity.) Huangdi asked: Chang Pi type, no body heat, no suspended-extreme pulse. How is this? Qibo said: Smooth-large indicates survival; suspended-choppy indicates death. (This reiterates origin of Blood-Qi, emphasizing Yangming Stomach Qi. No body heat means Yang does not escape externally. No suspended-extreme means Yin does not exhaust downward. Suspended-choppy means Yangming generating Qi is exhausted, hence death. "Bian Mai Pian" says: Fu-Yang pulse floating and choppy indicates Spleen Qi deficiency and Stomach Qi deficiency. Suspended means Stomach Qi exhaustion.) Expect death according to Zang organ timing. (Stomach Qi exhausted, True Zang pulse appears. Thus expect death by Zang timing. Liver suspended-extreme dies in 18 days; Heart suspended-extreme dies in 9 days; Lung suspended-extreme...)