十二日死。肾至悬绝七日死。脾至悬绝四日死。悬绝者。绝无阳明之胃气。而真脏孤悬也。）帝曰。癫疾何如。岐伯曰。
脉搏大滑。久自已。脉小坚急。死不治。（此论五脏之外合为病。而有虚实也。灵枢经曰。肺脉急甚为癫疾。肾脉急甚为
骨癫疾。又曰。骨癫疾者。 齿诸俞分肉皆满。而骨居汗出。烦 。呕多沃沫。气下泄。不治。筋癫疾者。身倦挛急。
呕多沃沫。气下泄。不治。脉癫疾者。暴仆。四肢之脉皆胀而纵。呕多沃沫。气下泄。不治。是肺合之形。肾合之骨。
心合之脉。肝合之筋。为病于外。而有死生之分。脉搏大者。气盛于外。故生。小坚急者。气泄于下。故死。）帝曰。癫
疾之脉。虚实何如。岐伯曰。虚则可治。实则死。（经曰。重阴则癫。盖癫乃血实之证。故治癫疾者。泻出其血。置于瓠
壶之中。是以脉坚实者死。脉滑大者生。上节之大小者。论气之虚实。此言血脉之虚实。盖癫乃阴盛之病。故宜气盛而
不宜血实也。）帝曰。消瘅虚实何如。岐伯曰。脉实大。病久可治。脉悬小坚。病久不可治。（此论五脏之内因。而有
虚实也。少俞曰。五脏皆柔弱者。善病消瘅。消瘅者。五脏之精气皆虚。转而为热。热则消肌肉。故为消瘅也。脉实大
者。精血尚盛。故为可治。脉悬小者。精气渐衰。故为难治。上节论五脏之外实。此论五脏之内虚。灵枢病形篇。五脏
之脉微小为消瘅。朱永年曰。癫瘅之病。皆曰久者。盖癫因久实。瘅因久虚之所致也。）帝曰。形度骨度脉度筋度。
何以知其度也。（此言五脏之外合。各有度数。而应于四时者也。经曰。形寒饮冷则伤肺。谓皮毛肤腠为形。而内合于肺
者也。骨者肾之合。脉者心之合。筋者肝之合。然皆有浅深俞穴之度数。帝问何以知其度而刺之乎。）帝曰。春亟治经络。
夏亟治经俞。秋亟治六腑。冬则闭塞。闭塞者。用药而少针石也。（伯言五脏之气。合于四时。而刺度之各有浅深也。亟、
急也。春气生升。故亟取络脉。夏取分腠。故宜治经俞。盖经俞隐于肌腠间也。治六腑者。取之于合也。胃合于三里。
大肠合。入于巨虚上廉。小肠合。入于巨虚下廉。三焦合。入于委阳。膀胱合。入于委中央。胆合。入于阳陵泉。盖五
脏内合于六腑。六腑外合于原俞。秋气降收。渐入于内。故宜取其合以治六腑也。冬时之气。闭藏于内。故宜用药而少
针石。盖针石治外。毒药治内者也。帝曰。当作岐伯曰。）所谓少针石者。非痈疽之谓也。（此论痈疽之虚实也。言
痈疽之患。荣卫血气并实。皮肉筋骨皆伤。非若四时之有浅深。冬时之少针石也。）痈疽不得顷时回。（痈者拥也。疽者
阻也。谓热毒外壅内阻。宜即刺之。不得迟延时顷。而使邪毒之回转也。）痈不知所。按之不应手。乍来乍已。刺手太阴
旁三 。与缨脉各二。（ 音贿。此言痈毒之在气分者。宜刺手太阴足阳明也。毒在气分。故痈不知所。毒瓦斯流传。故脉
按之不应手。而乍来乍已也。腋内动脉。手太阴也。名曰天府。宜刺太阴动脉之旁各三 。手太阴之主气也。 者。皮
肤肿起之象。言刺在络脉之旁。/皮肤之间。气随针出。而针眼微肿如小疮。故曰 也。盖皮肤溪谷之间。亦有三百六十
五穴会。毒在气分。故宜刺在皮肤。而不刺经络也。缨脉、结缨处两旁之动脉。人迎穴间。乃卫气别走阳明之道路也。
四时气篇曰。风 肤胀。为五十七 。取皮肤之血者。尽取之。）掖痈大热。刺足少阳五。刺而热不止。刺手心主三。刺
手太阴经络者。大骨之会各三。（此言痈毒之在血分者。宜刺足少阳手心主也。掖痈者。谓在两旁之腋间。足厥阴少阳之
分也。经云。阳气有余。荣气不行。乃发为痈。阴阳不通。两热相搏。乃化为脓。毒在血分。故大热也。厥阴主血。故
从其所合而泻之。如刺之而热不止者。宜刺手心主之脉以泻之。心主主火而主血脉也。本输篇曰。腋下三寸。手心主也。
名曰天池。盖宜刺此也。夫肺朝百脉。而主行荣卫阴阳。若欲刺手太阴之经络者。宜刺在大骨之会各三。谓臂骨交会之
处。尺泽间也。骨之大会曰谷。络脉之渗灌诸节者也。）暴痈筋 。随分而痛。魄汗不尽。胞气不足。治在经俞。（ 软
同。此言痈毒之在筋骨间者。宜刺其经俞也。暴痈者。言毒瓦斯更深。为毒凶暴。筋 者。筋为热邪所伤也。随分而痛者。
在于分肉之处而痛。谓不肿痛于外。而隐然痛于内也。热毒在深。故表汗不出。骨伤髓消。故胞气不足也。宜治在经俞
者。随其所痛之处而深取之也。夫痈毒之患。或外因风寒之邪。或内因喜怒不测。五脏外合之皮肉筋骨。胃腑所生之荣
卫血气。皆为邪毒盛而正气虚。故当审其阴阳虚实以刺之也。张兆璜曰。皮肉筋骨皆伤。故为暴痈。皮伤故魄汗不尽。
骨伤故胞气不足。）腹暴满。按之不下。取手太阳经络者。胃之募也。少阴俞去脊椎三寸旁五。用圆利针。（此论中焦
之虚实也。经云。胃病者。腹胀满。腹暴满而按之不下。胃之实证也。宜取手太阳之经络。太阳之络。乃胃之募也。盖
小肠为受盛之府。故从手太阳以泻其胃焉。又肾者。胃之关也。关门不利。则聚水而为胀。故曰当刺足少阴之俞焉。手
太阳之络。名曰支正。在上腕五寸间。足少阴之俞。在脊下第十四椎。两旁各开一寸五分。故曰三寸旁也。圆利针者。
且圆且利。以取暴气者也。或曰脊椎两旁。各开三寸。名曰志室。亦足少阴之俞也。）霍乱。刺俞旁五。足阳明及上旁三。
（霍乱者。胃为邪干。胃气虚逆也。夫阳明胃土。藉足少阴之气以合化。故宜刺少阴俞旁以补之。五者追而济之。渐至
于骨也。又及上刺阳明俞旁三。三者先浅刺绝皮。以出阳邪。后刺深之。以出阴邪。最后极深入于分肉之间。以致谷气。
邪气出而谷气至。则胃气和而霍乱止矣。上节用泻。故曰圆利。此法用补。故不去针。徐公遐曰。取足少阴者。当刺骨。
三刺而至分肉。是五则至骨矣。）刺痫惊脉五。（此论刺五行之实证也。痫惊者。痫 筋挛。或外感六气。或内伤七情。
或饮食生痰。或大惊卒恐。病涉五脏五行。故当取其五脉。徐公遐曰。病涉五行。故有作猪犬牛羊之鸣者。）针手太
阴各五。刺经太阳五。刺手少阴经络旁者一。足阳明一。上踝五寸刺三针。（按九针之制。皆所以泻邪者也。此刺五脉之
实。故首句曰针手太阴。末句曰刺三针。谓当以针泻之。而不宜补之也。针手太阴。泻金实也。针太阳五。泻水实也。
针手少阴。泻火实也。针足阳明。泻土实也。上踝五寸。乃足少阳光明穴。刺三针以泻木实。盖脏腑相连。阴阳相合。
故或刺脏之经。或泻腑之络。朱永年曰。心肺居上为阳。故从脏。肝胃脾居下为阴。故从腑。盖五脉之阴邪。宜从阳以
泻出。朱圣公曰。太阳不言手足。知其为手乎为足乎。曰。上文曰手太阴。下文曰手少阴。则其为足也可知。若接上句
而为手太阳。则下句不必复云手矣。五刺之中。曰手。曰足。曰太阳。曰足上。宜细玩之。正见其经言错综之妙。）凡
治消瘅仆击偏枯痿厥。气满发逆。肥贵人则膏粱之疾也。隔塞闭绝。上下不通。则暴忧之病也。暴厥而聋。偏塞闭不通。
内气暴薄也。不从内外中风之病。故瘦留着也。 跛。寒风湿之病也。此言百病之始生也。皆生于风雨寒暑。阴阳喜怒。
饮食居处。大惊卒恐。则血气分离。阴阳破散。经络厥绝。脉道不通。阴阳相逆。卫气稽留。经脉空虚。血气不次。乃
失其常。故有为消瘅癫仆诸证。然皆有表有里。有实有虚。更贵更贱。或逆或从。皆当详审其脏腑经俞。三部九候。而
治以补泻也。凡治消瘅。五脏之内虚也。仆击、癫痫之外实也。偏枯、邪气之在上也。痿厥、清气之在下也。气满发逆。
浊气之在中也。贵人者。形乐而肌肤盛重。在贵人则为膏粱之浊。溜于肠胃。以致气满而发逆也。隔塞闭绝。中焦之气
不通也。上下不通。上下之气闭塞也。忧、郁也。三焦不通。五郁之为病也。暴厥而聋。厥气上逆。上窍不通也。偏塞
闭结。厥气下逆。下窍不通也。此内气暴薄。而为外窍之不通也。如不从内之忧怒。外之中风。而多病夭者。此缘形弱
气衰。墙基卑薄。故肌肉瘦而皮肤薄着也。 、足也。跛、行不正而偏费也。此风寒湿邪。皆能为此疾也。夫阳受风气。
阴受湿气。伤于风者。上先受之。伤于湿者。下先受之。然阳病者。上行极而下。阴病者。下行极而上。是以 跛之疾。
亦有因风邪之所致。盖言邪随气转。而外内上下之无常也。此言百病之生。皆有虚有实。然总不外乎内因于七情饮食。
外因于暑湿风寒。及不内外因之瘦留薄着也。徐公遐曰。 跛为风寒湿之病者。乃反结邪气在上。清气在下之义。知
跛之有风邪。则知偏枯之亦有湿邪矣。黄帝曰。黄胆暴痛癫疾厥狂。久逆之所生也。五脏不平。六腑闭塞之所生也。
头痛耳鸣。九窍不利。肠胃之所生也。（此言脏腑阴阳。表里上下。交相输应者也。如黄胆者。湿热内郁而色病见于外也。
暴痛者。五脏之气不平。卒然而为痛也。癫疾厥狂。阴阳偏胜之为病也。此皆阴阳五行之气。久逆不和之所生也。夫五
脏之气。久逆而不得和平者。六腑闭塞之所生也。六腑不和。则九窍为之不利。盖脏腑阴阳。表里相应。是以证见于外
者。病本于内。闭塞于内者。而外窍为之不通。盖言百病之生。总不外乎表里阴阳。血气虚实。读者无仅视为瘅疸。癫
痫、痈疽、肠 之虚实可也。徐公遐曰。此节照应首节气虚者肺虚也之义。首节论邪病之从外而内。此节言凡病之从
内而外。张兆璜曰。伯谓虚实。皆从物类始。帝言凡病由于内生。君臣反复咨论。各有其道。此篇论血气之生始出入。
外内虚实。乃医学之大纲。学人宜细心体认。）
（若肾脉出现悬绝之象，）十二日后死亡。肾脉至悬绝，七日后死亡。脾脉至悬绝，四日后死亡。所谓悬绝，是指完全没有阳明胃气，而真脏之气孤悬无依。（黄帝问：癫疾的症状如何？岐伯答：）脉搏大而滑利，病程虽久也能自行痊愈；脉搏小、坚急，则死亡且难以治疗。（这一段论述五脏与形体外合而发病，有虚实的区别。《灵枢经》说：肺脉急甚为癫疾。肾脉急甚为骨癫疾。又说：骨癫疾患者，牙齿各俞穴及分肉部位都胀满，骨骼显露，出汗，心烦，呕吐大量涎沫，气向下泄脱，属于不治之症。筋癫疾患者，身体疲倦拘挛，呕吐大量涎沫，气向下泄脱，属于不治之症。脉癫疾患者，突然仆倒，四肢的脉络都胀大弛纵，呕吐大量涎沫，气向下泄脱，属于不治之症。这是肺合皮、肾合骨、心合脉、肝合筋，在外部发病，而有生死区别的情况。脉搏大的，说明气盛于外，所以能生；脉搏小坚急的，说明气泄于下，所以死。）黄帝问：癫疾的脉象，虚实情况怎样？岐伯答：虚证可以治疗，实证则死亡。（《内经》说：重阴则发癫疾。大概癫疾是血实的病证，所以治疗癫疾，要泻出其血液，置于瓠壶之中，因此脉象坚实者死，脉象滑大者生。上一节讨论的是气的虚实，这里说的是血脉的虚实。大概癫疾是阴盛的病，所以适宜气盛而不宜血实。）黄帝问：消瘅病的虚实情况怎样？岐伯答：脉象实大，病久仍可治疗；脉象悬小坚劲，病久则不可治疗。（这一段论述五脏内部因素导致的虚实。少俞说：五脏都柔弱的人，容易患消瘅病。消瘅病，是五脏的精气都虚弱，转化而为热邪，热邪则消耗肌肉，所以称为消瘅。脉象实大的，说明精血尚且旺盛，所以可治；脉象悬小的，说明精气逐渐衰败，所以难治。上一节论述五脏的外部实证，这一节论述五脏的内部虚证。《灵枢·病形篇》说：五脏的脉微小为消瘅。朱永年说：癫疾和瘅病，都说病程久的，大概是因为癫疾因久实所致，瘅病因久虚所致。）黄帝问：形度、骨度、脉度、筋度，凭什么来知道它们的度数呢？（这是在说五脏与形体外合，各有度数，并对应四时。经文说：形体受寒、饮食生冷会伤肺，是说皮毛肤腠属于形，而内合于肺。骨是肾的外合，脉是心的外合，筋是肝的外合。然而它们都有浅深俞穴的度数。黄帝问如何根据这些度数进行针刺。）黄帝问：春季急于治疗经络，夏季急于治疗经俞，秋季急于治疗六腑，冬季则闭塞。所谓闭塞，是指用药而少用针石。（张志聪按语：这是说五脏之气与四时相合，而针刺的度数各有深浅。亟，就是急的意思。春气生发上升，所以急于取络脉；夏季取分腠，所以适宜治疗经俞。因为经俞隐于肌腠之间。治疗六腑，是取它们的合穴。胃合于足三里，大肠合于上巨虚，小肠合于下巨虚，三焦合于委阳，膀胱合于委中，胆合于阳陵泉。大概五脏内合于六腑，六腑外合于原穴和俞穴。秋气降收，渐渐入内，所以适宜取合穴来治疗六腑。冬季时的气候，闭藏于内，所以适宜用药而少用针石。大概针石治外，毒药治内。）黄帝问：应当改为岐伯曰。所谓少用针石，不是指痈疽这类病。（这一段论述痈疽的虚实。说痈疽的病患，营卫血气都实盛，皮肉筋骨都受伤，不像四时有深浅之分，也不像冬季那样少用针石。）痈疽不能片刻拖延。（痈，是壅塞的意思；疽，是阻隔的意思。说是热毒外壅内阻，应当立即刺破，不能迟延片刻，而使邪毒回转。）对于不知道痈肿具体位置的，按压不应手感波动，忽起忽落的，针刺手太阴肺经旁侧三处，以及缨脉两旁各两处。（“ ”音贿。这是在说痈毒在气分的，适宜刺手太阴和足阳明经。毒在气分，所以痈肿不知道具体位置；毒气流传，所以脉象按压不应手感波动，而忽起忽落。腋内的动脉，是手太阴经，名叫天府，适宜刺太阴动脉的旁边各三处。“ ”，是皮肤肿起的形象，说针刺在络脉的旁边、皮肤之间，气随针出，而针眼微肿如小疮，所以叫“ ”。大概皮肤溪谷之间，也有三百六十五个穴位交会。毒在气分，所以适宜刺在皮肤，而不刺经络。缨脉，是结缨处两旁的动脉，在人迎穴间，是卫气别走阳明经的道路。《四时气篇》说：风邪导致皮肤肿胀，作为五十七个“ ”，取皮肤中的血，全部刺出。）腋下痈肿且大热，针刺足少阳胆经五处。如果针刺后热不退，针刺手心主心包经三处。如果要刺手太阴肺经的经络，是在大骨交会处各刺三处。（这是在说痈毒在血分的，适宜刺足少阳和手心主经。掖痈，是说在两腋之间，是足厥阴和足少阳的分界。经文说：阳气有余，荣气不行，于是发为痈。阴阳不通，两热相搏，于是化为脓。毒在血分，所以大热。厥阴主血，所以从其相合之处而泻之。如果针刺后热还不止，适宜刺手心主的脉以泻之。心主主火而主血脉。《本输篇》说：腋下三寸，是手心主经，名叫天池，大概适宜刺这里。肺朝百脉，而主行营卫阴阳，如果想要刺手太阴的经络，适宜刺在大骨交会处各三处。谓臂骨交会之处，尺泽之间。骨的会穴叫谷，是络脉渗灌各个关节的地方。）突发痈肿伴筋脉拘急，随着部位疼痛，魄汗不止，胞气不足，治疗在经俞。（“ ”同“软”。这是在说痈毒在筋骨间的，适宜刺其经俞。暴痈，是说毒气更深，毒势凶暴。筋“ ”，是说筋被热邪所伤。随分而痛，是说在分肉之处疼痛，谓不在外部肿痛，而在内部隐隐作痛。热毒在深处，所以表汗不出。骨伤髓消，所以胞气不足。适宜治疗在经俞，是说随着疼痛的部位而深取。夫痈疽的病患，或是外因风寒之邪，或是内因喜怒无常，五脏外合的皮肉筋骨，胃腑所生的营卫血气，都为邪毒盛而正气虚，所以应当审察其阴阳虚实来针刺。张兆璜说：皮肉筋骨都受伤，所以为暴痈。皮伤所以魄汗不止，骨伤所以胞气不足。）腹部突然胀满，按压不下降，取手太阳小肠经的络穴，即胃的募穴。足少阴肾经的俞穴，距离脊椎三寸旁开五处，使用圆利针。（这一段论述中焦的虚实。经文说：胃病，腹胀满。腹部突然胀满而按压不下降，是胃的实证。适宜取手太阳的经络，太阳的络，就是胃的募穴。大概小肠是受盛之府，所以从手太阳经以泻其胃。又肾是胃的关，关门不利，则聚水而为胀，所以说当刺足少阴的俞。手太阳的络，名叫支正，在上腕五寸间。足少阴的俞，在脊下第十四椎，两旁各开一寸五分，所以说三寸旁。圆利针，既圆又利，用来取除暴气。有人说脊椎两旁，各开三寸，名叫志室，也是足少阴的俞。）霍乱，刺俞穴旁边五处，足阳明胃经及上旁三处。（霍乱，是胃被邪气干扰，胃气虚逆。夫阳明胃土，借助足少阴之气以合化，所以适宜刺少阴俞旁以补之。五是追而济之，渐渐至于骨。又及上刺阳明俞旁三，三是先浅刺穿透表皮，以出阳邪，后刺深之，以出阴邪，最后极深入于分肉之间，以致谷气。邪气出而谷气至，则胃气和而霍乱止。上一节用泻法，所以叫圆利。此法用补法，所以不去针。徐公遐说：取足少阴者，当刺骨。三刺而至分肉，是五则至骨了。）针刺痫惊脉五处。（这一段论述刺五行之实证。痫惊，是痫病筋挛，或外感六气，或内伤七情，或饮食生痰，或大惊卒恐，病涉五脏五行，所以应当取其五脉。徐公遐说：病涉五行，所以有发出猪犬牛羊叫声的。）针刺手太阴肺经各五处，刺手太阳小肠经五处，刺手少阴心经经络旁一处，足阳明胃经一处，上踝五寸处刺三针。（按九针的制度，都是用来泻邪的。这里刺五脉之实，所以首句说针手太阴，末句说刺三针，谓应当以针泻之，而不宜补之。针手太阴，是泻金实。针太阳五，是泻水实。针手少阴，是泻火实。针足阳明，是泻土实。上踝五寸，是足少阳光明穴，刺三针以泻木实。大概脏腑相连，阴阳相合，所以或刺脏之经，或泻腑之络。朱永年说：心肺居上为阳，所以从脏。肝胃脾居下为阴，所以从腑。大概五脉之阴邪，宜从阳以泻出。朱圣公说：太阳不言手足，知其为手还是足？说：上文说手太阴，下文说手少阴，那么其为足也可知。如果接上句而为手太阳，则下句不必再云手了。五刺之中，曰手，曰足，曰太阳，曰足上，宜细玩味，正见其经文错综之妙。）凡是治疗消瘅、仆击、偏枯、痿厥、气满发逆，富贵之人则是膏粱之疾。隔塞闭绝，上下不通，则是暴忧之病。突然厥逆而耳聋，偏塞闭不通，是内气突然迫薄所致。不从内外中风之病，而是消瘦留着之病。 跛，是寒风湿之病。这是在说百病的始生，都生于风雨寒暑、阴阳喜怒、饮食居处、大惊卒恐。则血气分离，阴阳破散，经络厥绝，脉道不通，阴阳相逆，卫气稽留，经脉空虚，血气不次，乃失其常，所以有为消瘅、癫仆诸证。然皆有表有里，有实有虚，更贵更贱，或逆或从，都应当详审其脏腑经俞、三部九候，而治以补泻。凡是治疗消瘅，是五脏之内虚。仆击、癫痫，是外部实证。偏枯，是邪气在上。痿厥，是清气在下。气满发逆，是浊气在中。贵人，形体安乐而肌肤盛重，在贵人则为膏粱之浊，流于肠胃，以致气满而发逆。隔塞闭绝，是中焦之气不通。上下不通，是上下之气闭塞。忧，是郁结。三焦不通，是五郁之为病。突然厥逆而耳聋，是厥气上逆，上窍不通。偏塞闭结，是厥气下逆，下窍不通。这是内气暴薄，而为外窍之不通。如不从内之忧怒，外之中风，而多病夭折者，这是因为形体弱、气衰，墙基卑薄，所以肌肉瘦而皮肤薄着。 ，足也。跛，行走不正而偏废。这是风寒湿邪，都能为此疾。夫阳受风气，阴受湿气。伤于风者，上先受之。伤于湿者，下先受之。然而阳病者，上行极而下；阴病者，下行极而上。是以 跛之疾，也有因风邪所致。大概是说邪随气转，而外内上下无常。这是在说百病的生，皆有虚有实，然而总不外乎内因于七情饮食，外因于暑湿风寒，及不内外因之瘦留薄着。徐公遐说： 跛为风寒湿之病，乃是反结邪气在上，清气在下的意义。知跛之有风邪，则知偏枯之亦有湿邪了。黄帝说：黄疸、暴痛、癫疾、厥狂，是久逆之所生。五脏不平，是六腑闭塞之所生。头痛耳鸣，九窍不利，是肠胃之所生。（这是在说脏腑阴阳、表里上下交相输应。如黄疸，是湿热内郁而色病见于外。暴痛，是五脏之气不平，卒然而为痛。癫疾厥狂，是阴阳偏胜之为病。这些都是阴阳五行之气，久逆不和之所生。夫五脏之气，久逆而不得和平，是六腑闭塞之所生。六腑不和，则九窍为之不利。大概脏腑阴阳，表里相应，所以证见于外者，病本于内；闭塞于内者，而外窍为之不通。大概是说百病的生，总不外乎表里阴阳、血气虚实，读者不要仅视为瘅疸、癫痫、痈疽、肠 的虚实而已。徐公遐说：此节照应首节气虚者肺虚之义。首节论邪病之从外而内，此节言凡病之从内而外。张兆璜说：伯谓虚实，皆从物类始。帝言凡病由于内生。君臣反复咨论，各有其道。此篇论血气之生始出入，外内虚实，乃医学之大纲，学人宜细心体认。）
(If the Kidney pulse exhibits "Xuan Jue" (suspension and isolation), death occurs after twelve days. If the Kidney pulse reaches Xuan Jue, death occurs after seven days. If the Spleen pulse reaches Xuan Jue, death occurs after four days. The term "Xuan Jue" refers to the complete absence of Stomach Qi from the Yangming channel, leaving the True Zang Qi isolated and suspended.) The Yellow Emperor asked: What are the manifestations of Dian Ji (epilepsy/mania)? Qibo replied: If the pulse is large and slippery, although the disease has lasted long, it will recover spontaneously. If the pulse is small, firm, and rapid, death is inevitable and untreatable. (This section discusses diseases arising from the external correspondence of the Five Zang organs, involving deficiency and excess. The *Ling Shu* states: An urgent Lung pulse indicates Dian Ji. An urgent Kidney pulse indicates Gu Dian Ji (bone epilepsy). It further states: In bone epilepsy, all acupoints around the teeth and intermuscular spaces are full, bones protrude, sweating occurs, irritability is present, excessive vomiting of saliva happens, and Qi leaks downward; this is untreatable. In tendon epilepsy, the body is fatigued with spasms and stiffness, excessive vomiting of saliva occurs, and Qi leaks downward; this is untreatable. In pulse epilepsy, sudden collapse occurs, pulses in the four limbs are distended and flaccid, excessive vomiting of saliva happens, and Qi leaks downward; this is untreatable. These describe the external manifestations of Lung corresponding to skin, Kidney to bone, Heart to vessels, and Liver to tendons, which have distinctions between life and death. A large pulse indicates Qi abundance on the exterior, hence survival. A small, firm, and rapid pulse indicates Qi leakage downward, hence death.) The Yellow Emperor asked: Regarding the pulse of Dian Ji, how do deficiency and excess present? Qibo replied: Deficiency can be treated; excess leads to death. (The classic states: Heavy Yin leads to Dian Ji. Dian Ji is essentially a condition of Blood excess. Therefore, treating Dian Ji involves draining blood into a gourd vessel. Hence, a firm pulse indicates death, while a slippery and large pulse indicates life. The previous section discussed the deficiency and excess of Qi; this section discusses the deficiency and excess of Blood vessels. Dian Ji is a disease of Yin excess, so it favors Qi abundance rather than Blood excess.) The Yellow Emperor asked: How do deficiency and excess present in Xiao Dan (wasting-thirst disorder)? Qibo replied: A solid and large pulse allows treatment even if the disease is chronic; a suspended, small, and firm pulse makes treatment impossible even if the disease is not yet chronic. (This section discusses internal deficiency and excess of the Five Zang organs. Shaoyu stated: Those with weak Five Zang organs are prone to Xiao Dan. Xiao Dan arises when the essence and Qi of the Five Zang are deficient, transforming into heat. Heat consumes muscle tissue, hence the name Xiao Dan. A solid and large pulse indicates that essence and blood are still abundant, making it treatable. A suspended and small pulse indicates gradual decline of essence and Qi, making it difficult to treat. The previous section discussed external excess of the Five Zang; this section discusses internal deficiency. The *Ling Shu: Bing Xing* chapter states: Microscopic and small pulses of the Five Zang indicate Xiao Dan. Zhu Yongnian noted: Both Dian Ji and Dan diseases often involve chronicity; Dian Ji results from chronic excess, while Dan disease results from chronic deficiency.) The Yellow Emperor asked: Regarding the measurements of Form (Xing), Bone (Gu), Pulse (Mai), and Tendon (Jin), how can one know their degrees? (This explains that the external correspondences of the Five Zang organs have specific degrees corresponding to the Four Seasons. The classic states: Cold exposure and cold drinks injure the Lung. This means skin, hair, and pores constitute the Form, internally corresponding to the Lung. Bones correspond externally to the Kidney, vessels to the Heart, and tendons to the Liver. However, each has specific depths and acupoint degrees. The Yellow Emperor asks how to determine these degrees for acupuncture.) The Yellow Emperor asked: In Spring, urgently treat the collaterals; in Summer, urgently treat the Jing-Stream points; in Autumn, urgently treat the Six Fu organs; in Winter, there is closure. Closure means using medicine and sparing needles and stones. (Zhang Zhicong's commentary: This states that the Qi of the Five Zang corresponds to the Four Seasons, and acupuncture depth varies. "Ji" means urgent. Spring Qi generates and ascends, so urgently selecting collateral vessels is appropriate. Summer selection focuses on intermuscular spaces, suitable for treating Jing-Stream points, as these points lie hidden within the muscle layers. Treating the Six Fu organs involves selecting their He-Sea points. The Stomach He-Sea is Zusanli; Large Intestine He-Sea is Shangjuxu; Small Intestine He-Sea is Xiajuxu; San Jiao He-Sea is Weiyang; Bladder He-Sea is Weizhong; Gallbladder He-Sea is Yanglingquan. Generally, the Five Zang internally correspond to the Six Fu, and the Six Fu externally correspond to Yuan and Shu points. Autumn Qi descends and gathers, moving inward, so selecting He-Sea points to treat the Six Fu is appropriate. Winter climate closes and stores inward, so using medicine and sparing needles/stones is appropriate. Needles and stones treat the exterior; drugs treat the interior.) The Yellow Emperor asked: It should read "Qibo said." The phrase "sparing needles and stones" does not refer to Carbuncles and Ulcers. (This section discusses the deficiency and excess of Carbuncles and Ulcers. It states that in carbuncle and ulcer conditions, Ying and Wei Qi and Blood are both excess, injuring skin, flesh, tendons, and bones. This differs from the seasonal variations in depth or the winter practice of sparing needles/stones.) Carbuncles and ulcers must not be delayed for even a moment. ("Yong" means obstruction; "Ju" means blockage. This refers to heat toxins obstructing externally and blocking internally. Immediate puncture is required without delay to prevent the pathogenic toxin from reversing.) For unknown carbuncle locations, where palpation yields no fluctuation, and swelling appears and disappears suddenly, puncture three points beside the Hand Taiyin channel and two points on each side of the Ying Mai (cervical artery). ("Hui" is the pronunciation. This describes carbuncle toxins in the Qi level, suitable for puncturing the Hand Taiyin and Foot Yangming channels. Toxin in the Qi level causes uncertainty in location; spreading toxin causes pulses that do not fluctuate upon pressure and appear/disappear suddenly. The arterial pulse in the axilla belongs to the Hand Taiyin channel, named Tianfu. Puncturing three points beside the Taiyin arterial pulse is appropriate. " " denotes skin swelling. Puncturing beside the collateral vessels, between skin layers, allows Qi to exit with the needle, causing slight swelling at the needle site like a small sore, hence the term " ". There are 365 acupoint intersections in the skin and muscle valleys. Since the toxin is in the Qi level, puncturing the skin is appropriate rather than the meridians. Ying Mai refers to the arterial pulse on both sides of the knotting area of the collar tie, located near the Renying point, which is the pathway where Wei Qi branches to the Yangming channel. The *Si Shi Qi* chapter states: Wind causing skin swelling requires treating fifty-seven " " points by extracting blood from the skin.) For large, hot carbuncles in the armpit, puncture five points on the Foot Shaoyang channel. If heat persists after puncture, puncture three points on the Hand Shaoyin (Pericardium) channel. If treating the Hand Taiyin meridian/collateral, puncture three points at the Great Bone Intersection. (This describes carbuncle toxins in the Blood level, suitable for puncturing the Foot Shaoyang and Hand Shaoyin channels. Armpit carbuncles occur in the lateral axillary region, the junction of Foot Jueyin and Foot Shaoyang. The classic states: Excess Yang Qi and stagnation of Ying Qi lead to carbuncles. Blockage of Yin and Yang causes two heats to clash, forming pus. Toxin in the Blood level causes high heat. Jueyin governs Blood, so draining from its corresponding channel is appropriate. If heat persists, puncturing the Hand Shaoyin meridian drains the fire. The Pericardium governs Fire and Blood vessels. The *Ben Shu* chapter states: Three cun below the axilla is the Hand Shaoyin channel, named Tianchi, which is an appropriate puncture site. The Lung directs all vessels and governs the movement of Ying, Wei, Yin, and Yang. When treating the Hand Taiyin meridian/collateral, puncture three points at the Great Bone Intersection, specifically where arm bones intersect, near Chize. The intersection of bones is called Gu, where collaterals permeate joints.) Sudden carbuncles with tendon softness/spasms, pain according to the affected part, unceasing Po Han (sweat associated with the Lungs), and insufficient Bao Qi (Kidney/Essence Qi) should be treated at the Jing-Shu points. ("Ruan" is synonymous with " ". This describes carbuncle toxins between tendons and bones, suitable for treating Jing-Shu points. "Bao Yong" implies deeper toxin and violent nature. Tendon "ruan" indicates tendon injury by heat pathogens. Pain "according to the part" means pain within the intermuscular spaces, not swelling externally but deep internal pain. Deep heat toxin prevents surface sweating. Bone injury and marrow depletion cause insufficient Bao Qi. Treating at Jing-Shu points means deep needling at the painful site. Carbuncle etiology includes external Wind-Cold or internal emotional disturbances. Pathogens overwhelm Zheng Qi in the skin, flesh, tendons, and bones corresponding to the Zang, and in the Ying/Blood generated by the Stomach Fu. One must examine Yin/Yang and deficiency/excess to needle accordingly. Zhang Zhaohuang noted: Injury to skin, flesh, tendons, and bones constitutes Bao Yong. Skin injury causes unceasing Po Han; bone injury causes insufficient Bao Qi.) Sudden abdominal fullness that does not decrease upon pressure: take the Luo-connecting point of the Hand Taiyang channel, which is the Mu-Alarming point of the Stomach. The Shu-point of the Foot Shaoyin channel, three cun from the spine and five cun lateral, use a Yuanli needle. (This discusses middle Jiao deficiency and excess. The classic states: Stomach disease presents as abdominal fullness. Sudden fullness unrelieved by pressure is Stomach excess. Taking the Hand Taiyang Luo point, which is the Stomach Mu point, is appropriate. The Small Intestine is the receiving organ, so draining the Stomach via the Hand Taiyang is logical. The Kidney is the gate of the Stomach; if the gate fails, water accumulates causing distension. Thus, needling the Foot Shaoyin Shu point is indicated. The Hand Taiyang Luo point is named Zhengzheng, five cun above the wrist. The Foot Shaoyin Shu point is at the 14th thoracic vertebra, 1.5 cun lateral, described here as "three cun lateral". The Yuanli needle is round and sharp, used to remove sudden Qi. Some say the Zhishi points, three cun lateral to the spine, are also Foot Shaoyin Shu points.) For Huo Luan (cholera-like syndrome), puncture five points beside the Shu points, the Foot Yangming channel, and three points superiorly. (Huo Luan results from pathogenic interference with the Stomach, causing deficiency and rebellious Stomach Qi. Yangming Earth relies on Foot Shaoyin Qi for transformation, so supplementing via the Shaoyin Shu vicinity is appropriate. "Five" represents chasing and assisting, reaching the bone. "Three" superiorly involves shallow puncture through the skin to expel Yang pathogens, deeper puncture to expel Yin pathogens, and finally deep insertion into muscle layers to restore Gu Qi. When pathogens exit and Gu Qi arrives, Stomach Qi harmonizes and Huo Luan stops. The previous section used draining (Yuanli); this method uses tonification, retaining the needle. Xu Gongxia noted: Needling Foot Shaoyin reaches the bone. Three punctures reach the muscles; thus, five punctures reach the bone.) Puncture five points on the pulses related to Epileptic Convulsions. (This discusses treating excess in the Five Elements. Epileptic convulsions may arise from external Six Qi, internal Seven Emotions, dietary phlegm, or sudden fright. The disease involves the Five Zang and Five Elements, so taking five pulses is appropriate. Xu Gongxia noted: Involvement of the Five Elements can manifest as animal-like cries.) Puncture five points on the Hand Taiyin channel. Puncture five points on the Jing-Taiyang channel. Puncture one point beside the Hand Shaoyin meridian/collateral. Puncture one point on the Foot Yangming. Puncture three needles at five cun above the ankle. (According to the Nine Needles system, all are designed to drain pathogens. Here, treating excess in five pulses begins with Hand Taiyin and ends with three needles, indicating draining rather than tonifying. Needling Hand Taiyin drains Metal excess. Needling Taiyang five times drains Water excess. Needling Hand Shaoyin drains Fire excess. Needling Foot Yangming drains Earth excess. Five cun above the ankle is the Guangming point of Foot Shaoyang; three needles drain Wood excess. Organs connect, Yin and Yang combine, so sometimes Zang meridians are needled, sometimes Fu collaterals drained. Zhu Yongnian stated: Heart and Lung are upper Yang, so follow Zang. Liver, Stomach, and Spleen are lower Yin, so follow Fu. Yin pathogens in the five pulses should be drained via Yang. Zhu Shenggong commented: "Taiyang" without hand/foot specification implies Foot Taiyang based on context (Hand Taiyin and Hand Shaoyin mentioned previously). If it were Hand Taiyang, "Hand" would be repeated. The variation in terms highlights the complexity of the text.) Generally, treating Xiao Dan, Pu Ji (sudden stroke/fainting), Pian Ku (hemiplegia), Wei Jue (atrophy/cold limbs), and Qi Man Fa Ni (fullness/rebellious Qi): For wealthy/noble individuals, these are disorders of rich food and drink. Ge Sai Bi Jue (blockage/intestinal obstruction) and lack of communication between upper and lower result from sudden sorrow. Sudden Jue with deafness, partial blockage, and closed orifices result from sudden internal Qi pressure. Diseases not caused by external Wind or internal emotions, but characterized by emaciation and lingering, are due to thinness and adherence. Bo Bi (limping) is caused by Cold, Damp, and Wind. This section explains the origin of hundred diseases: they arise from Wind, Rain, Cold, Heat, Yin-Yang, emotions, diet, lifestyle, sudden fright, or terror. This leads to separation of Blood and Qi, dispersion of Yin and Yang, severance of meridians, blockage of pulse pathways, reversal of Yin and Yang, stagnation of Wei Qi, emptiness of meridians, and disorder of Blood and Qi, losing normalcy. Thus, symptoms like Xiao Dan, Dian, and Pu arise. All have exterior/interior, excess/deficiency, noble/base, or rebellious/compliant aspects. One must carefully examine Zang-Fu, meridians, acupoints, and the Three Regions and Nine Pulses, treating with tonification or drainage. Treating Xiao Dan addresses internal Zang deficiency. Pu Ji and Dian Ji address external excess. Pian Ku addresses pathogenic Qi in the upper. Wei Jue addresses clear Qi sinking in the lower. Qi Man Fa Ni addresses turbid Qi in the middle. Noble individuals, enjoying ease and having robust flesh, accumulate turbidity from rich foods in the intestines and stomach, leading to Qi fullness and rebellion. Ge Sai Bi Jue indicates middle Jiao Qi blockage. Upper/lower不通 indicates closure of upper and lower Qi. Sorrow implies depression. San Jiao blockage causes Five Depressions. Sudden Jue with deafness indicates rebellious Qi ascending, blocking upper orifices. Partial blockage indicates rebellious Qi descending, blocking lower orifices. This is internal Qi pressure causing external orifice blockage. If not due to internal emotion or external wind, but frequent illness and short life, it is due to weak form, depleted Qi, low "wall base" (facial structure), thin muscles, and adherent skin. "Bi" refers to feet. "Bo" refers to abnormal gait. Cold, Damp, and Wind can all cause this. Yang receives Wind; Yin receives Damp. Wind injuries affect the upper first; Damp injuries affect the lower first. However, Yang diseases ascend to extreme then descend; Yin diseases descend to extreme then ascend. Thus, limping can also be caused by Wind. This illustrates that pathogens follow Qi, and exterior/interior, upper/lower dynamics are variable. Hundred diseases have deficiency and excess, rooted in internal Seven Emotions/Diet, external Wind/Cold/Damp/Heat, or non-internal/external factors like emaciation. Xu Gongxia noted: Limping due to Cold-Damp-Wind reflects pathogens settling in the upper and clear Qi in the lower. Knowing Wind causes limping implies Damp contributes to hemiplegia. The Yellow Emperor said: Jaundice, sudden pain, Dian Ji, Jue Kuang arise from prolonged rebellion. Unease of the Five Zang arises from blockage of the Six Fu. Headache, tinnitus, and dysfunction of the nine orifices arise from the intestines and stomach. (This explains the mutual transmission of Zang-Fu Yin-Yang, interior-exterior, and upper-lower. Jaundice results from internal damp-heat manifesting externally. Sudden pain results from abrupt Zang Qi imbalance. Dian Ji and Jue Kuang result from Yin-Yang dominance. These arise from prolonged disharmony of Yin-Yang and Five Elements Qi. Prolonged Zang Qi imbalance stems from Six Fu blockage. Six Fu disharmony causes nine orifice dysfunction. Zang-Fu Yin-Yang correspond internally and externally; external symptoms originate internally; internal blockage causes external orifice dysfunction. Readers should not view this merely as deficiency/excess of Xiao Dan, Jaundice, Dian Ji, Carbuncles, or intestinal issues. Xu Gongxia noted: This section echoes the opening statement that Qi deficiency relates to Lung deficiency. The opening discusses external pathogens entering inward; this section discusses internal diseases manifesting outward. Zhang Zhaohuang noted: Qibo began with deficiency/excess from material classes; the Emperor discussed internal origins. The dialogue explores different paths. This chapter outlines the generation, entry, and exit of Blood and Qi, and exterior-interior deficiency/excess, serving as a general outline of medicine. Students should study it carefully.)