诊视之要，在于经脉。春夏秋冬，各有所刺，所以治其经脉也。不知者，反之所以伤其经脉也；
十二经脉之败，乃经脉之终也，故曰诊要经终也。
黄帝问曰∶诊要何如？
此问诊要，下问经终，故以名篇。
岐伯对曰∶正月二月，天气始方，地气始发，人气在肝。
方，犹位也。正月二月天气从阴而阳，故天气始位。地气从下而上，故地气始发。肝主春木，故人气在肝。
三月四月，天气正方，地气定发，人气在脾。
三月四月，天气由东而南，始正其位，故天气正方，地气由生而
长，发无余蕴，故地气定发。土生万物，于人为脾，故人气在脾。
五月六月，天气盛，地气高，人气在头。
五月六月，天暑地炎，天暑故天气盛。地炎故地气高。谓气机上而不下也，人气在头，亦上而不下之谓也。
七月八月，阴气始杀，人气在肺。
春夏为阳，秋冬为阴。七月八月，天地之气自阳而始阴，故阴气始有肃杀之意。肺主秋金，故人气在肺。
九月十月，阴气始冰，地气始闭，人气在心。
九月十日，自秋而冬，阴气凝聚，始有作冰之意。地气收敛，始有闭藏之机。人气在心合于手少阴也。
十一月十二月，冰复，地气合，人气在肾。
复，犹伏也。十一月十二月，水冰气状，故冰伏。地气归藏，故地气合，肾水之气主于冬，故人
气在肾，合于足少阴也。
故春刺散俞，及与分理，血出而止，甚者传气，间者环也。
散，上声。间，去声，下俱同。散俞，络脉之俞也。分理，分肉之腠理也。春气始生，故春刺络脉
之散俞及与分肉之腠理间。血出则经络通而止针。如病甚者，当深取而传导其气，若虚实相间
者，以针传气，而即环转也。
夏刺络俞，见血而止，尽气闭环，痛病必下。
终俞，孙络之俞也。夏气开张，故浅刺络俞，微见其血而止针，若尽传其气，反闭其环转之机，而
痛病必下人矣。
秋刺皮肤，循理上下同法，神变而止。
秋时人气在肺，肺主皮肤，故秋刺皮肤，气机始收。故循皮肤之纹理而刺之，或刺上，或刺下，皆
同于皮肤循理之法。故上下同法，若气机环转，则神气内变，而止针。
冬刺俞窍于分理，甚者直下，间者散下。
俞窍乃俞穴之窍，冬气闭藏，其刺宜深，故冬刺俞穴之窍。在于窍之分理，病甚者，循俞直下，
虚实相间者，循经散下。
春夏秋冬，各有所刺，法其所在。
总结上文之意。上文春夏秋冬，人气各有所在。春夏秋冬，浅深各有所刺。此言春夏秋冬，各有
所刺，即法其人气之所在，以为刺也。
春刺夏分，脉乱气微，入淫骨髓，病不能愈，令人不嗜食，又且少气。
分去声，下同。春夏秋冬各有所刺，若春刺夏分，必气妄伤，心合脉，故脉乱，脉乱则气无所附，故
气微。脉乱气微，邪反内入，故入淫骨髓，而春病不能愈。夫脉乱必令人不嗜食。盖食气入
胃，浊气归心，淫精于脉也，不但气微，又且少气。
春刺秋分，筋挛逆气，环为咳嗽，病不愈，令人时惊，又且哭。
春到秋分，肺气妄伤。筋挛，肝病也。筋挛逆气，肝病而逆于肺也。肝病逆肺，故转为咳嗽，环犹
转也，春刺秋分，故夏病不愈。东方肝木，其病发惊骇，故令人时惊。肝藏魂，肺藏魄，魂魄
不安，故又且邪哭。
春刺冬分，邪气着藏，令人胀，病不愈，又且欲言语。
着，旧本讹着，今改，下缴着同，藏如字。春刺冬分，肾气妄伤，肾主冬藏，故邪气着藏。水寒为病，故
令人胀。刺失其宜，故春病不愈，言为心声，又且欲言语，不但病足少阴，兼病手少阴也，凡此皆春刺之失也。
夏刺春分，病不愈，令人懈惰。
夏刺春分，则夏病不愈。长夏属土，故令人懈惰。
夏刺秋分，病不愈，令人心中欲无言，惕惕如人将捕之。
夏刺秋分，则夏病不愈，夏火属心，心虚，故令人心中欲无言，不但无言，且惕惕如人将捕之。
夏刺冬分，病不愈，令人少气，时欲怒。
夏刺冬分，则夏病不愈，夏月阳气外张，故令人少气。气虚，则肝血无所附，故时欲怒，凡此皆夏刺之失也。
秋刺春分，病不已，令人惕然欲有所为，起而忘之。
秋刺春分，则秋病不已。秋主收、刺春分、反导其气血上行，故令人惕然。肺位居高，治节出焉，故
欲有所为。收气反散，故起而忘之。
秋刺夏分，病不已，令人益嗜卧，又且善梦。
秋刺夏分，则秋病不已。夏日人倦嗜卧，秋刺夏分，则令人益
嗜卧。嗜卧阴也，梦为阴中之阴，既嗜卧矣，又且善梦。
秋刺冬分，病不已，令人洒洒时寒。
秋刺冬分，则秋病不已，冬时水旺气寒，冬脉虚，故令人洒洒时寒。凡此皆秋刺之失也。
冬刺春分，病不已，令人欲卧不能眠，眠而有见。
冬刺春分，则冬病不已、卧眠者，闭藏之象。冬刺春分，故欲卧而不能眠。气机外泄，故眠而有见。
有见，以无为有也。
冬刺夏分，病不愈，气上，发为诸痹。
冬刺夏分，则冬病不愈，气上者，阳因而上，开泄之意也。发为诸痹者，冬气应藏而反
开泄，留连时日，发为风寒湿诸痹之证也。
冬刺秋分，病不已，令人善渴。
冬刺秋分，则冬病不已，冬时水精内藏，刺秋分，则水精外泄于皮毛，故令人善渴，凡此皆冬刺之失也。
凡刺胸腹者，必避五脏。
春夏秋冬，刺失其分，则伤五脏之气。故凡刺胸腹之皮部者，
必避五脏真元之气，当从之使出，不可逆之使入也。
中心者，环死。
中，去声。下中脾肾肺膈皆同。若逆之使入，中伤心气者，周时环转而死。盖阳中之太阳，心也，如
天之日，一日一周，今不能周，故环死。
中脾者，五日死。
脾者，土也，五乃土之生数，故中伤脾气者五日死。
中肾者，七日死。
肾者，水也，天一生水，地六成之，合而为七，故中伤肾气者，七日伤。
中肺者，五日死。
肺者，金也，干为金，为天。《易系》曰，天数五，地数五。
故中脾者五日死，此中肺气者，亦五日死。言五脏不及肝者，或简
脱也。
中膈者，皆为伤中，其病虽愈，不过一岁，必死。
五脏之气，皆以胸膈以出入，故中伤膈气者，皆为伤中，其外病虽愈，亦不过一岁必死。一岁，尽
四时五行之气也。
刺避五脏者，知逆从也。所谓从者，膈与脾肾之处，不知者反之。
处，去声。上文云凡刺胸膜者，必避五脏。此申明刺避五脏者，知逆从之道也。所谓从者乃膈
与脾肾之处，盖膈为阳，居上，脾属土，居中。肾为阴，居下，知膈与脾肾之处，则知上下出入之
度，故为从。若不知膈与脾肾之处宜上反下，宜出反入；不知者，反之则为逆矣。
刺胸腹者，必以布缴着之，乃从单布上刺。刺之不愈，复刺，
刺针必肃，刺肿摇针，经刺勿摇，此刺之道也。
又申明凡刺胸腹者，必以布缴着之，乃从单布上刺，是刺之至浅也。刺之不愈，复刺者，言刺布不
愈，当去布复刺也。刺针必肃者，复刺之针，必宜端肃，不若刺布之放纵也。刺肿摇针者，肌肉
壅肿，则宜摇针以泻之。若肌肉不肿而为经脉之刺，仍宜端肃，而勿摇。此刺胸腹必避五脏之要道也。
此一节言四时各有所刺。刺失其宜，则病不愈，刺伤五脏，则死有期，而为诊视之要也。
帝曰∶愿闻十二经脉之终奈何？
上文刺伤五脏乃无形之气机，非有形之经脉，故帝复愿闻十二经脉之终。
岐伯曰∶太阳之脉，其终也戴眼、反折、螈 、其色白，绝汗乃出，出则死矣。
太阳之脉，手足太阳之经脉也。终，绝也，戴眼，目上视也。反折，背反张也。螈 ，手足抽掣也。
手太阳之脉，止于目内 ，足太阳之脉，起于目内 ，故其终也，戴眼。太阳行身之背，故其
终也，反折。手太阳之脉，循臂上肩，足太阳之脉，贯臀入 ，故
其终也，螈 。手太阳主液，液脱血亡，故其色白。经脉终而汗出，则为绝汗，绝汗出则死矣。
少阳终者，耳聋、百节皆纵、目寰绝系。绝系，一日半死。其死也，色先青白，乃死矣。
寰，旧本讹HT ，今改。手足少阳之脉，从耳后入耳中，出走耳前，故其终也，耳聋。《灵枢·经脉论》
云，胆足少阳之脉，主骨所生病。节者，骨之交，故其终也，百节皆纵。手少阳之脉止于目
锐，足少阳之脉，起于目锐 ，故其终也，目寰绝系。谓目之寰宇与眼系相绝，不相维系也。系绝经终，
故一日半死。《刺禁论》云，刺中胆者一日半死。色先青白者，日半之前，先见木受金刑之色，乃死矣。
阳明终者，口目动作，善惊，妄言，色黄，其上下经盛，不仁，则终矣。
足阳明经脉，起于鼻 中，上连于目，下连于口，故口目动作，动作牵引歪斜也。善惊，所谓闻木音
则惕然而惊也。妄言，所谓甚则上高而歌也。色黄，土气外呈也。上下经盛，谓口目动作，
善惊妄言色黄，皆足阳明经脉之病。从足而手，从下而上，则其上下经盛，手经足经皆病也。不仁者，身
冷肤硬，阳明之经脉皆终矣。
少阴终者，面黑齿长而垢，腹胀闭，上下不通而终矣。
面黑，水气上泄也。齿长，骨属外浮也。垢，面齿不荣也。腹胀闭，少阴神机不从中土而转输也。
手经足经不相通贯，则上下不通，而少阴之经脉皆终矣。
太阴终者，腹胀闭，不得息，善噫，善呕。呕则逆，逆则面赤。不逆则上下不通，不通则面
黑，皮毛焦而终矣。
腹胀闭，足太阴脾气不升也。不得息，手太阴肺气不降也。善噫，脾病也。善呕，土虚也。呕则逆，
不能四布也。逆则面赤，火色外呈，土无生源也。若不上逆则地气不升，故上下不通，不通则
土不制水，故面黑；土不生金，故皮毛焦，而太阴之经脉皆终矣。
厥阴终者，中热、嗌干、善溺、心烦，甚则舌卷卵上缩而终
矣。
溺，鸟去声。卷，上声，余篇卷同。手厥阴心包之脉，起于胸中，故中热，足厥阴肝脉为病，则嗌干
善溺。手厥阴心包为病则心烦，此厥阴经脉之病，非经脉之绝。甚则舌卷，厥阴之脉绝于上
也。卵上缩，厥阴之脉绝于下也。如是则厥阴之经脉皆终矣。
此十二经之所败也。
手足六经之终，乃十二经脉之终，故曰此十二经之所败也。
此一节承上文五脏气机内逆，而论十二经脉之终，所以为“诊要经终”也。
诊察的关键，在于经脉。春、夏、秋、冬四季，各有其特定的针刺方法，这是为了调理相应的经脉。如果不了解这些规律，反而会因为错误的针刺而损伤经脉；
十二经脉的气血衰竭，就是经脉的终结，所以这篇名为《诊要经终》。
黄帝问道：诊察的要领是怎样的？
这一段主要讲述问诊的要领，下文讲述经脉的终结，因此用这个名称作为篇名。
岐伯回答说：正月、二月，天气开始由阴转阳，地气开始升发，人体的气血运行在肝脏。
“方”，意思是位置。正月、二月，天气从阴寒转向阳气生发，所以天气开始处于生发之位。地气从地下向上升腾，所以地气开始升发。肝对应春季的木气，所以人体气血汇聚于肝。
三月、四月，天气位置端正（气候稳定），地气完全升发，人体的气血运行在脾脏。
三月、四月，天气由东方转向南方，开始确立其正位，所以天气位置端正；地气由生长走向繁盛，发散没有剩余的能量，所以地气完全升发。土能生化万物，在人体对应脾脏，所以人体气血汇聚于脾。
五月、六月，天气盛大炎热，地气高扬，人体的气血运行在头部。
五月、六月，天暑地炎，因为天热所以天气盛大；因为地热所以地气高扬。这里指气机向上而不向下，人体气血运行在头部，也是指气机向上而不向下的意思。
七月、八月，阴气开始产生肃杀之意，人体的气血运行在肺脏。
春夏属于阳，秋冬属于阴。七月、八月，天地之气由阳转阴，所以阴气开始有肃杀的意思。肺对应秋季的金气，所以人体气血汇聚于肺。
九月、十月，阴气开始凝结如冰，地气开始闭藏，人体的气血运行在心脏。
九月、十月，由秋季进入冬季，阴气凝聚，开始有结冰的迹象。地气收敛，开始有闭藏的机理。人体气血运行在心中，与手少阴心经相合。
十一月、十二月，冰层复盖，地气归藏，人体的气血运行在肾脏。
“复”，意思是潜伏。十一月、十二月，水结成冰，气势潜伏。地气回归闭藏，所以地气闭合。肾水之气主宰冬季，所以人体气血汇聚于肾，与足少阴肾经相合。
所以春季针刺要选取散俞穴，以及分肉之间的腠理，见血就停止针刺，病情严重的要传导经气，病情轻浅的要环转行针。
“散”读上声，“间”读去声，下文相同。“散俞”是指络脉的腧穴。“分理”是指分肉之间的腠理。春气始生，所以春季针刺络脉的散俞以及分肉之间的腠理。出血则经络通畅，即可停针。如果病邪深重，应当深取以传导其经气；如果虚实夹杂，则以针导气，并随即环转针具。
夏季针刺络脉的腧穴，见到微血就停止，彻底传导经气以闭环转之机，疼痛之病必然下行消散。
“终俞”是指孙络的腧穴。夏气开张，所以浅刺络脉的腧穴，微微见血就停针。如果彻底传导经气，反而闭塞了环转的机能，那么疼痛的病邪必然内陷深入。
秋季针刺皮肤，遵循纹理，上下部位采用同样的方法，神气发生变化就停止针刺。
秋季人气在肺，肺主司皮肤，所以秋季针刺皮肤，气机开始收敛。因此顺着皮肤的纹理进行针刺，无论是刺上部还是下部，都同于顺皮理针刺的方法。所以上下采用同样的方法，如果气机环转，神气在内发生变化，就停止针刺。
冬季针刺腧穴的窍道，位于分肉之间，病情严重的直下进针，病情轻浅的分散进针。
“俞窍”是腧穴的孔窍。冬气闭藏，针刺应当深，所以冬季针刺腧穴的窍道。位于窍道的分理之间，病邪深重的，顺着腧穴直下进针；虚实夹杂的，顺着经脉分散进针。
春、夏、秋、冬四季，各有其特定的针刺方法，要效法气血所在的部位。
总结上文的意思。上文提到春夏秋冬，人气各有所在。春夏秋冬，深浅各有所刺。这里说春夏秋冬各有其刺，即效法人气所在的位置来进行针刺。
如果在春季针刺夏季对应的部位，会导致脉象紊乱、气息微弱，邪气侵入骨髓，疾病不能痊愈，使人食欲不振，并且气短。
“分”读去声，下文相同。春夏秋冬各有其刺，如果在春季针刺夏季对应的部位，必定妄伤正气。心合于脉，所以脉象紊乱；脉乱则气无所依附，所以气息微弱。脉乱气微，邪气反而内入，侵入骨髓，导致春季的疾病不能痊愈。脉乱必然导致人不爱进食。大概是因为食物进入胃中，浊气归于心，滋养精气于脉中，不仅气微弱，而且气短。
如果在春季针刺秋季对应的部位，会导致筋脉拘挛、气机上逆，环绕喉咙咳嗽，疾病不能痊愈，使人时常惊恐，并且哭泣。
春季针刺到秋季对应的部位，肺气被妄伤。筋脉拘挛是肝病的表现。筋脉拘挛且气机上逆，是肝病逆传于肺。肝病逆犯肺，所以转为咳嗽，“环”意为环绕，春季针刺秋季对应的部位，所以夏季的疾病不能痊愈。东方属肝木，肝病发作时容易惊骇，所以使人时常惊恐。肝藏魂，肺藏魄，魂魄不安，所以又会邪哭。
如果在春季针刺冬季对应的部位，邪气附着于内脏，使人腹胀，疾病不能痊愈，并且想要说话。
“着”，旧本误作“着”，今改正，下文“着”同此义。“藏”按字面读。春季针刺冬季对应的部位，肾气被妄伤。肾主冬季闭藏，所以邪气附着于内脏。水寒致病，所以使人腹胀。针刺失当，所以春季的疾病不能痊愈。言语是心声的表现，又想要说话，说明不仅病在足少阴肾经，也兼及手少阴心经。凡此种种，都是春季针刺的错误。
如果在夏季针刺春季对应的部位，疾病不能痊愈，使人懈怠懒惰。
夏季针刺春季对应的部位，则夏季的疾病不能痊愈。长夏属土，所以使人懈怠懒惰。
如果在夏季针刺秋季对应的部位，疾病不能痊愈，使人心中想沉默不语，恐惧得像有人要抓捕他一样。
夏季针刺秋季对应的部位，则夏季的疾病不能痊愈。夏季火气对应心脏，心气虚弱，所以使人心中想沉默不语，不仅不想说话，而且恐惧得像有人要抓捕他一样。
如果在夏季针刺冬季对应的部位，疾病不能痊愈，使人气短，时常想要发怒。
夏季针刺冬季对应的部位，则夏季的疾病不能痊愈。夏季阳气外张，所以使人气短。气虚，则肝血无所依附，所以时常想要发怒。凡此种种，都是夏季针刺的错误。
如果在秋季针刺春季对应的部位，疾病不愈，使人惊恐不安，想做某事，起身却忘记了。
秋季针刺春季对应的部位，则秋季的疾病不愈。秋季主收敛，针刺春季对应的部位，反而引导气血上行，所以使人惊恐。肺位居高，治理调节功能由此产生，所以想做某事。收敛之气反而散失，所以起身却忘记了。
如果在秋季针刺夏季对应的部位，疾病不愈，使人更加嗜睡，并且多梦。
秋季针刺夏季对应的部位，则秋季的疾病不愈。夏日人疲倦嗜睡，秋季针刺夏季对应的部位，所以使人更加嗜睡。嗜睡属阴，梦为阴中之阴，既然已经嗜睡，又多梦。
如果在秋季针刺冬季对应的部位，疾病不愈，使人时时感到寒冷战栗。
秋季针刺冬季对应的部位，则秋季的疾病不愈。冬季水旺气寒，冬季脉象虚，所以使人时时感到寒冷战栗。凡此种种，都是秋季针刺的错误。
如果在冬季针刺春季对应的部位，疾病不愈，使人想躺卧却不能入睡，睡着后会有幻觉。
冬季针刺春季对应的部位，则冬季的疾病不愈。躺卧睡眠是闭藏的象征。冬季针刺春季对应的部位，所以想躺卧却不能入睡。气机外泄，所以睡着后会有幻觉。“有见”，是指将无视为有。
如果在冬季针刺夏季对应的部位，疾病不能痊愈，气机上逆，引发各种痹证。
冬季针刺夏季对应的部位，则冬季的疾病不能痊愈。气机上逆，是因为阳气因上而行，有开泄的意思。引发各种痹证，是因为冬气应当闭藏反而开泄，滞留时日，引发风寒湿等各种痹证。
如果在冬季针刺秋季对应的部位，疾病不愈，使人容易口渴。
冬季针刺秋季对应的部位，则冬季的疾病不愈。冬季水精内藏，针刺秋季对应的部位，则水精外泄于皮毛，所以使人容易口渴。凡此种种，都是冬季针刺的错误。
凡是针刺胸腹部的，必须避开五脏。
春夏秋冬，如果针刺失当，就会损伤五脏之气。所以凡是针刺胸腹部的皮部，必须避开五脏的真元之气，应当顺应其气机外出，不可逆势使其内入。
如果刺中心脏，一周时后死亡。
“中”读去声，下文中的脾、肾、肺、膈皆同。如果逆势使邪气内入，刺中心脏元气的人，经过一周时（12小时）环转而死。盖因心为阳中之太阳，像天上的太阳，一日一周天，现在心气不能周流，所以一周时后死亡。
如果刺中脾脏，五日后死亡。
脾属土，五是土的生成数，所以刺伤脾气的人五日后死亡。
如果刺中肾脏，七日后死亡。
肾属水，天一生水，地六成之，合而为七，所以刺伤肾气的人七日后死亡。
如果刺中肺脏，五日后死亡。
肺属金，干卦象征金，象征天。《易经·系辞》说，天数五，地数五。
所以刺中脾脏五日后死亡，刺中肺气的人也五日后死亡。文中没有提及刺中肝脏的情况，可能是简略或脱漏。
如果刺中膈膜，都会损伤中气，即使外表的病好了，也不超过一年，必定死亡。
五脏之气，都通过胸膈出入，所以刺伤膈膜之气，都会损伤中气，虽然体表的病好了，也不超过一年必定死亡。“一岁”是指尽四时五行之气的时间。
针刺避开五脏，是因为知道逆从的道理。所谓“从”，是指膈与脾肾的位置，不知道这些的人就会相反。
“处”读去声。上文说凡是刺胸膜者，必须避开五脏。这里申明针刺避开五脏，是知晓逆从之道。所谓“从”，是指了解膈与脾肾的位置。盖因膈为阳，居上；脾属土，居中；肾为阴，居下。知晓膈与脾肾的位置，就知道上下出入的法度，所以称为“从”。如果不知道膈与脾肾的位置，宜上反下，宜出反入；不知道这些的人，反过来做就是“逆”了。
针刺胸腹部，必须先用布巾覆盖固定，然后隔着单层布进行针刺。如果针刺后病未愈，再次针刺。
再次申明凡是刺胸腹者，必须用布巾覆盖固定，然后从单层布上进行针刺，这是针刺极浅的方法。如果刺布（浅刺）后病未愈，再次针刺，是说去掉布巾重新针刺。针刺时必须严肃庄重，治疗肿胀时要摇动针具，治疗经脉病不要摇动，这就是针刺的道理。
这一节讲述了四时各有其特定的针刺方法。如果针刺失当，疾病就不能痊愈；如果刺伤五脏，就有确定的死期，这就是诊察的关键。
黄帝说：我想听听十二经脉终结时的表现是怎样的？
上文提到的刺伤五脏是无形的和气机，不是有形的经脉，所以黄帝又询问十二经脉的终结。
岐伯说：太阳经脉终结时，会出现两眼上视、身体角弓反张、抽搐、面色苍白，绝汗流出，流出后就死亡了。
太阳经脉，包括手太阳和足太阳经脉。“终”，即断绝。“戴眼”，指眼睛上视不能转动。“反折”，指背部向后反张呈角弓反张状。“螈”（huò yè），指手足抽搐。手太阳经脉止于目内眦，足太阳经脉起于目内眦，所以其终结时，出现戴眼。太阳经行于身背，所以其终结时，出现反折。手太阳经脉循行手臂上肩，足太阳经脉贯穿臀部入腘窝，所以其终结时，出现抽搐。手太阳主液，液脱血亡，所以面色苍白。经脉终结而出汗，称为绝汗，绝汗流出就死亡了。
少阳经脉终结时，会出现耳聋、全身关节松弛无力、眼球固定直视、眼系断绝。眼系断绝，一天半后死亡。死亡时，面色先青后白，然后死亡。
“寰”（kuàng），旧本误作其他字，今改正。手足少阳经脉，从耳后进入耳中，走出耳前，所以其终结时，出现耳聋。《灵枢·经脉论》说，胆足少阳经脉，主治骨骼相关的疾病。节，是骨头的交会处，所以其终结时，全身关节松弛无力。手少阳经脉止于目锐眦，足少阳经脉起于目锐眦，所以其终结时，出现眼球固定直视、眼系断绝。意思是眼球的视野与眼系相互断绝，不再维系。眼系断绝，经脉终结，所以一天半后死亡。《刺禁论》说，刺中胆经，一天半后死亡。面色先青后白，是在一天半之前，先出现木受金克的颜色，然后死亡。
阳明经脉终结时，会出现口眼歪斜抽动，容易惊恐，胡言乱语，面色发黄，上下经脉搏动亢盛，肢体麻木不仁，这就终结了。
足阳明经脉，起于鼻翼旁，上行连于目，下行连于口，所以口眼歪斜抽动，指动作牵引导致歪斜。容易惊恐，所谓听到木音就惊恐的样子。胡言乱语，所谓严重时登高而歌。面色发黄，是土气外现。上下经脉亢盛，指口眼抽动、易惊、胡言乱语、色黄，都是足阳明经脉的病证。从足到手，从下到上，所以上下经脉亢盛，手经和足经都病了。麻木不仁，指身体冷、皮肤硬，阳明经脉都终结了。
少阴经脉终结时，会出现面色发黑、牙齿显得长且污垢堆积、腹胀闭塞、上下不通，这就终结了。
面色发黑，是水气上泛。牙齿显得长，是骨属外露浮起。污垢，指面部和牙齿失去荣润。腹胀闭塞，是少阴的神机不能从中焦土气转输。手经和足经不相贯通，所以上下不通，少阴经脉都终结了。
太阴经脉终结时，会出现腹胀闭塞，呼吸困难，频繁嗳气，频繁呕吐。呕吐则气逆，气逆则面色发红。如果不逆，则上下不通，不通则面色发黑，皮毛枯焦，这就终结了。
腹胀闭塞，是足太阴脾气不升。呼吸困难，是手太阴肺气不降。频繁嗳气，是脾病。频繁呕吐，是土虚。呕吐则气逆，不能四布。气逆则面色发红，是火色外现，土没有生源。如果不向上逆，则地气不升，所以上下不通，不通则土不能制水，所以面色发黑；土不生金，所以皮毛枯焦，太阴经脉都终结了。
厥阴经脉终结时，会出现心中发热、咽喉干燥、小便频数、心烦，严重时舌卷缩、睾丸上缩，这就终结了。
“溺”读鸟去声，“卷”读上声，余篇中的“卷”同此音。手厥阴心包经脉，起于胸中，所以心中发热。足厥阴肝脉生病，则咽喉干燥、小便频数。手厥阴心包生病则心烦，这是厥阴经脉的病，不是经脉的断绝。严重时舌卷缩，是厥阴经脉在上部断绝。睾丸上缩，是厥阴经脉在下部断绝。像这样，厥阴经脉都终结了。
这就是十二经脉的衰竭。
手足六经的终结，就是十二经脉的终结，所以说这是十二经脉的衰竭。
这一节承接上文五脏气机内逆的内容，论述十二经脉的终结，所以称为“诊要经终”。
The essence of diagnosis lies in the meridians. Spring, summer, autumn, and winter each have their specific acupuncture methods, which are used to regulate the corresponding meridians. Those who do not understand this will instead injure the meridians through incorrect needling;
The exhaustion of the Qi and Blood in the Twelve Primary Meridians constitutes the termination of the meridians; hence, this chapter is titled "Essentials of Diagnosis and Termination of the Meridians" (Zhen Yao Jing Zhong).
The Yellow Emperor asked: What are the essentials of diagnosis?
This section primarily discusses the essentials of inquiry, followed by the discussion on the termination of the meridians; thus, it is named accordingly.
Qi Bo replied: In the first and second lunar months, the Heaven Qi begins to transition from Yin to Yang, and the Earth Qi begins to ascend. The human Qi resides in the Liver.
"Fang" means position. In the first and second months, Heaven Qi transitions from coldness to the generation of Yang, so Heaven Qi begins to assume its generative position. Earth Qi ascends from below, so Earth Qi begins to rise. The Liver corresponds to the Wood Qi of Spring; therefore, human Qi gathers in the Liver.
In the third and fourth lunar months, Heaven Qi stabilizes in its correct position, and Earth Qi fully ascends. The human Qi resides in the Spleen.
In the third and fourth months, Heaven Qi moves from East to South, establishing its proper position, so Heaven Qi is stable. Earth Qi progresses from growth to flourishing, releasing all accumulated energy, so Earth Qi fully ascends. Earth generates all things and corresponds to the Spleen in the human body; therefore, human Qi gathers in the Spleen.
In the fifth and sixth lunar months, Heaven Qi is abundant and hot, and Earth Qi rises high. The human Qi resides in the head.
In the fifth and sixth months, the weather is hot and the ground is warm. Due to the heat, Heaven Qi is abundant; due to the warmth, Earth Qi rises. This refers to the upward movement of Qi without descending. Human Qi residing in the head also signifies Qi moving upward without descending.
In the seventh and eighth lunar months, Yin Qi begins to exert a withering influence, and the human Qi resides in the Lungs.
Spring and Summer belong to Yang; Autumn and Winter belong to Yin. In the seventh and eighth months, the Qi of Heaven and Earth transitions from Yang to Yin, so Yin Qi begins to exhibit a withering quality. The Lungs correspond to the Metal Qi of Autumn; therefore, human Qi gathers in the Lungs.
In the ninth and tenth lunar months, Yin Qi begins to condense like ice, and Earth Qi begins to close and store. The human Qi resides in the Heart.
In the ninth and tenth months, transitioning from Autumn to Winter, Yin Qi condenses, showing signs of freezing. Earth Qi converges, initiating the mechanism of storage. Human Qi resides in the Heart, harmonizing with the Hand-Shaoyin Heart Meridian.
In the eleventh and twelfth lunar months, ice covers the surface, and Earth Qi returns to storage. The human Qi resides in the Kidneys.
"Fu" means latent. In the eleventh and twelfth months, water freezes, and the Qi is latent. Earth Qi returns to storage, so Earth Qi closes. The Qi of Kidney Water governs Winter; therefore, human Qi gathers in the Kidneys, harmonizing with the Foot-Shaoyin Kidney Meridian.
Therefore, in Spring, one should needle the Scattered Shu points (San Shu) and the interstices between muscle bundles (Fen Li). Stop when blood appears. For severe cases, transmit the Qi deeply; for mild or mixed deficiency-excess cases, rotate the needle.
"San" is pronounced with the rising tone; "Jian" with the departing tone, as in the following text. "San Shu" refers to the Shu points of the collateral vessels. "Fen Li" refers to the interstices between muscle bundles. Since Spring Qi begins to generate, Spring needling targets the San Shu of collateral vessels and the interstices of muscle bundles. Bleeding ensures the meridian and collaterals are unblocked, allowing for needle withdrawal. If the pathogen is deep-seated, one should needle deeply to transmit the Qi; if there is a mix of deficiency and excess, one transmits Qi with the needle and immediately rotates it.
In Summer, one should needle the Luo Shu points. Stop when slight bleeding appears. Fully transmit the Qi to close the rotational mechanism; pain conditions will necessarily subside.
"Zhong Shu" refers to the Shu points of the Sun (branchial) collaterals. Summer Qi opens outward, so one needles the Luo Shu points superficially, stopping when slight bleeding appears. If one fully transmits the Qi, one might inadvertently close the rotational mechanism, causing pain pathogens to sink inward.
In Autumn, one should needle the skin, following the texture. The method is the same for upper and lower parts. Stop when the Shen (Spirit) changes.
In Autumn, human Qi resides in the Lungs, which govern the skin. Therefore, Autumn needling targets the skin, as Qi mechanisms begin to收 (gather/converge). One needles along the skin's texture, whether above or below, following the same principle of needling along the skin lines. Thus, the method is consistent for upper and lower regions. When Qi rotates and the Shen changes internally, stop needling.
In Winter, one should needle the apertures of the Shu points located in the interstices of muscle bundles. For severe cases, insert straight down; for mild or mixed cases, disperse the insertion.
"Yu Qiao" refers to the apertures of the Shu points. Winter Qi is closed and stored, so needling should be deep. Thus, in Winter, one needles the apertures of the Shu points within the interstices. For severe pathogens, needle straight down along the Shu point; for mixed deficiency-excess, disperse the needling along the meridian.
Spring, Summer, Autumn, and Winter each have specific needling methods, based on the location of the Qi.
This summarizes the preceding text. As mentioned earlier, human Qi resides in different locations during the four seasons, and needling depth varies. Here, it states that each season has its specific needling, which follows the location of human Qi.
If one needles the Summer sector during Spring, the pulse becomes chaotic and Qi weakens. Pathogens invade the bone marrow, the disease cannot be cured, appetite decreases, and Qi becomes deficient.
"Fen" is pronounced with the departing tone, as in the following text. Each season has its specific needling. Needling the Summer sector in Spring recklessly injures Zheng Qi. The Heart correlates with the pulse, so the pulse becomes chaotic. Chaotic pulse means Qi has no attachment, so Qi becomes weak. Chaotic pulse and weak Qi allow pathogens to enter internally, invading the bone marrow, preventing the cure of Spring diseases. Chaotic pulse inevitably leads to loss of appetite. Food enters the Stomach, turbid Qi returns to the Heart, and essence nourishes the pulse. Not only is Qi weak, but it is also deficient.
If one needles the Autumn sector during Spring, tendons contract, Qi rebels upward, leading to coughing around the throat. The disease cannot be cured, causing frequent fright and crying.
Needling the Autumn sector in Spring recklessly injures Lung Qi. Tendon contraction is a Liver condition. Contraction with rebellious Qi indicates Liver pathology rebelling against the Lungs. Liver rebellion into the Lungs causes coughing. "Huan" means circular/around. Needling the Autumn sector in Spring prevents the cure of Summer diseases. The East belongs to Liver Wood; Liver disease manifests as fright. Hence, frequent fright. The Liver stores Hun (Ethereal Soul), and the Lungs store Po (Corporeal Soul). Disharmony of Hun and Po leads to pathological weeping.
If one needles the Winter sector during Spring, pathogens adhere to the Zang organs, causing abdominal distension. The disease cannot be cured, and there is an urge to speak.
"Zhuo" was erroneously written in old editions; corrected here. "Cang" is read literally. Needling the Winter sector in Spring recklessly injures Kidney Qi. The Kidneys govern Winter storage, so pathogens adhere to the Zang. Cold-water pathology causes abdominal distension. Improper needling prevents the cure of Spring diseases. Speech is the voice of the Heart. The urge to speak indicates pathology not only in the Foot-Shaoyin Kidney Meridian but also involving the Hand-Shaoyin Heart Meridian. These are all errors of Spring needling.
If one needles the Spring sector during Summer, the disease cannot be cured, causing lethargy and lassitude.
Needling the Spring sector in Summer prevents the cure of Summer diseases. Late Summer belongs to Earth, causing lethargy.
If one needles the Autumn sector during Summer, the disease cannot be cured, causing a desire for silence in the heart, and fear as if someone were about to capture them.
Needling the Autumn sector in Summer prevents the cure of Summer diseases. Summer Fire corresponds to the Heart. Heart deficiency causes a desire for silence and fear as if being pursued.
If one needles the Winter sector during Summer, the disease cannot be cured, causing Qi deficiency and frequent anger.
Needling the Winter sector in Summer prevents the cure of Summer diseases. Summer Yang Qi expands outward, causing Qi deficiency. Qi deficiency leaves Liver Blood without support, causing frequent anger. These are all errors of Summer needling.
If one needles the Spring sector during Autumn, the disease does not resolve, causing anxiety, a desire to act, but forgetting upon standing up.
Needling the Spring sector in Autumn prevents the resolution of Autumn diseases. Autumn governs gathering; needling the Spring sector reversely guides Qi and Blood upward, causing anxiety. The Lung resides high and governs regulation, creating the desire to act. Gathering Qi scatters instead, causing forgetfulness upon standing.
If one needles the Summer sector during Autumn, the disease does not resolve, causing increased somnolence and frequent dreaming.
Needling the Summer sector in Autumn prevents the resolution of Autumn diseases. People are tired and sleepy in Summer; needling the Summer sector increases somnolence. Somnolence is Yin; dreams are Yin within Yin. Having somnolence, one also dreams frequently.
If one needles the Winter sector during Autumn, the disease does not resolve, causing shivering and chills.
Needling the Winter sector in Autumn prevents the resolution of Autumn diseases. Winter Water is prosperous and cold; the Winter pulse is deficient, causing shivering and chills. These are all errors of Autumn needling.
If one needles the Spring sector during Winter, the disease does not resolve, causing a desire to lie down but inability to sleep, and visual hallucinations during sleep.
Needling the Spring sector in Winter prevents the resolution of Winter diseases. Lying down and sleeping represent storage. Needling the Spring sector in Winter creates a desire to lie down but inability to sleep. Qi mechanism leaks outward, causing hallucinations during sleep. "You Jian" means perceiving nothing as something.
If one needles the Summer sector during Winter, the disease does not resolve, causing Qi to rebel upward and manifest as various Bi syndromes.
Needling the Summer sector in Winter prevents the resolution of Winter diseases. Qi rebelling upward occurs because Yang Qi moves upward, indicating opening and leakage. Manifesting as various Bi syndromes occurs because Winter Qi should store but instead opens and leaks. Lingering over time, it manifests as Wind-Cold-Damp Bi syndromes.
If one needles the Autumn sector during Winter, the disease does not resolve, causing excessive thirst.
Needling the Autumn sector in Winter prevents the resolution of Winter diseases. Winter stores Water Essence internally. Needling the Autumn sector causes Water Essence to leak externally to the skin and hair, causing excessive thirst. These are all errors of Winter needling.
When needling the chest and abdomen, one must avoid the Five Zang Organs.
If needling is improper during the four seasons, the Qi of the Five Zang Organs is injured. Therefore, when needling the skin sectors of the chest and abdomen, one must avoid the True Yuan Qi of the Five Zang Organs. One should follow the Qi as it exits, not force it inward.
If the Heart is pierced, death occurs after one cycle (12 hours).
"Zhong" is pronounced with the departing tone, as for the Spleen, Kidney, Lung, and Diaphragm below. If forcing pathogens inward pierces the Heart Qi, death occurs after one cycle. The Heart is Yang within Yang, like the sun, completing one circuit daily. Since it cannot complete the circuit, death occurs after one cycle.
If the Spleen is pierced, death occurs after five days.
The Spleen belongs to Earth; five is the generating number of Earth. Piercing Spleen Qi causes death after five days.
If the Kidney is pierced, death occurs after seven days.
The Kidney belongs to Water. Heaven generates One Water, Earth completes it with Six. Together they make seven. Piercing Kidney Qi causes death after seven days.
If the Lung is pierced, death occurs after five days.
The Lung belongs to Metal. The Qian trigram represents Metal and Heaven. The *I Ching* states: "Heaven's numbers are five, Earth's numbers are five."
Thus, piercing the Spleen causes death after five days; piercing Lung Qi also causes death after five days. The text omits mention of piercing the Liver, likely due to omission or textual loss.
If the Diaphragm is pierced, it injures the Middle Jiao. Even if external symptoms resolve, death will occur within one year.
The Qi of the Five Zang Organs enters and exits through the chest and diaphragm. Piercing Diaphragm Qi injures the Middle. Although external diseases may resolve, death will occur within one year. "One year" refers to the completion of the Four Seasons and Five Phases.
Avoiding the Five Zang Organs in needling demonstrates knowledge of following and opposing ("Cong" and "Ni"). "Following" refers to the positions of the Diaphragm, Spleen, and Kidneys. Those who do not know these positions act oppositely.
"Chu" is pronounced with the departing tone. The text previously stated that needling the thoracic membrane requires avoiding the Five Zang Organs. This clarifies that avoiding the Zang Organs shows understanding of following and opposing. "Following" means knowing the positions of the Diaphragm, Spleen, and Kidneys. The Diaphragm is Yang, residing above; the Spleen is Earth, residing in the center; the Kidney is Yin, residing below. Knowing these positions allows one to understand the degrees of ascending/descending and exiting/entering, hence "following." Ignorance leads to reversing appropriate directions (e.g., downward instead of upward, inward instead of outward), which is "opposing."
When needling the chest and abdomen, cover the area with cloth, then needle through a single layer of cloth. If the condition does not improve, re-needle.
This reiterates that needling the chest and abdomen requires covering with cloth and needling through a single layer, representing very superficial needling. If needling through the cloth fails to cure, remove the cloth and re-needle. Needles must be handled with solemnity. For swelling, shake the needle to drain; for meridian needling without swelling, maintain solemnity and do not shake. This is the essential method for avoiding the Five Zang Organs when needling the chest and abdomen.
This section explains that each of the four seasons has specific needling methods. Improper needling prevents cure; injuring the Five Zang Organs leads to a determined time of death. This constitutes the essence of diagnosis.
The Yellow Emperor said: I wish to hear about the termination of the Twelve Primary Meridians.
The previous section discussed injuring the Qi mechanism of the Five Zang Organs, which is formless. The Emperor now asks about the termination of the有形 (form/have shape) meridians.
Qi Bo said: When the Taiyang Meridian terminates, symptoms include eyes fixed upward (Dai Yan), opisthotonos (Fan Zhe), convulsions (Huo Ye), pale complexion, and emergence of Ji Han (extreme sweat). Once Ji Han appears, death ensues.
Taiyang Meridian refers to the Hand-Taiyang and Foot-Taiyang meridians. "Zhong" means termination/extinction. "Dai Yan" means eyes staring upward. "Fan Zhe" means back arching backward. "Huo Ye" means convulsions of limbs. The Hand-Taiyang Meridian ends at the inner canthus; the Foot-Taiyang Meridian begins at the inner canthus; thus, termination presents as Dai Yan. Taiyang runs along the back; thus, termination presents as Fan Zhe. Hand-Taiyang runs along the arm to the shoulder; Foot-Taiyang passes through the buttocks to the popliteal fossa; thus, termination presents as convulsions. Hand-Taiyang governs fluids. Fluid depletion and blood loss cause pallor. Termination of meridians with sweating produces Ji Han (extreme sweat); once Ji Han appears, death occurs.
When the Shaoyang Meridian terminates, symptoms include deafness, flaccidity of all joints, fixed gaze with severed eye connections (Mu Kuang Jue Xi). Severed eye connections lead to death in one and a half days. At death, the complexion turns blue-white before death.
"Kuang" was erroneous in old editions; corrected here. Hand and Foot Shaoyang meridians enter the ear from behind, exit in front. Thus, termination presents as deafness. *Ling Shu: Jing Mai Lun* states: Gallbladder Foot-Shaoyang Meridian governs bone diseases. Joints are intersections of bones; thus, termination presents as flaccidity of all joints. Hand-Shaoyang ends at the outer canthus; Foot-Shaoyang begins at the outer canthus; thus, termination presents as fixed gaze and severed eye connections. This means the orbital field and eye system disconnect. Disconnection of the system and termination of meridians leads to death in one and a half days. *Ci Jin Lun* states: Piercing the Gallbladder Meridian causes death in one and a half days. Blue-white complexion appears before death, showing Wood受 Metal punishment color, then death occurs.
When the Yangming Meridian terminates, symptoms include twitching of the mouth and eyes, frequent fright, delirious speech, yellow complexion, and hyperactivity of the upper and lower meridians. Numbness indicates final termination.
Foot-Yangming Meridian begins at the side of the nose, connects to the eyes above, and the mouth below. Thus, twitching of mouth and eyes involves traction and deviation. Frequent fright refers to startling at the sound of wood. Delirious speech refers to climbing high and singing in severe cases. Yellow complexion is the manifestation of Earth Qi. Hyperactivity of upper and lower meridians refers to the symptoms of mouth/eye twitching, fright, delirium, and yellow color being diseases of the Foot-Yangming Meridian. From foot to hand, from lower to upper, both hand and foot meridians are diseased. Numbness, characterized by cold body and hard skin, indicates the Yangming meridians have terminated.
When the Shaoyin Meridian terminates, symptoms include black complexion, elongated teeth with dirt accumulation, abdominal distension and closure, and blockage of upper and lower passages.
Black complexion indicates Water Qi floating upward. Elongated teeth indicate Bone elements floating outward. Dirt indicates lack of nourishment to face and teeth. Abdominal distension and closure indicate Shaoyin Shen Ji (Divine Mechanism) failing to transport via the Central Earth. Disconnection between Hand and Foot meridians causes blockage of upper and lower passages, terminating the Shaoyin meridians.
When the Taiyin Meridian terminates, symptoms include abdominal distension and closure, dyspnea, frequent belching, and frequent vomiting. Vomiting causes rebellion; rebellion causes red face. If not rebellious, upper and lower blockage causes black face, dry skin and hair, and termination.
Abdominal distension and closure indicate Foot-Taiyin Spleen Qi failing to ascend. Dyspnea indicates Hand-Taiyin Lung Qi failing to descend. Frequent belching is a Spleen disease. Frequent vomiting indicates Earth deficiency. Vomiting causes rebellion, preventing Qi distribution. Rebellion causes red face, showing Fire color externally, indicating Earth lacks a source. If not rebellious, Earth Qi does not ascend, causing blockage. Blockage means Earth cannot control Water, causing black face; Earth fails to generate Metal, causing dry skin and hair, terminating the Taiyin meridians.
When the Jueyin Meridian terminates, symptoms include internal heat, dry throat, frequent urination, and vexation. In severe cases, tongue curling and testicular retraction occur, leading to termination.
"Niao" is pronounced with the departing tone; "Juan" with the rising tone. Hand-Jueyin Pericardium Meridian begins in the chest, causing internal heat. Foot-Jueyin Liver Meridian disease causes dry throat and frequent urination. Hand-Jueyin Pericardium disease causes vexation. These are Jueyin meridian diseases, not yet termination. Severe tongue curling indicates Jueyin Meridian termination above. Testicular retraction indicates Jueyin Meridian termination below. This constitutes the termination of the Jueyin meridians.
This is the exhaustion of the Twelve Meridians.
The termination of the six pairs of Hand and Foot meridians constitutes the termination of the Twelve Primary Meridians; hence, it is called the exhaustion of the Twelve Meridians.
This section follows the previous discussion on internal reversal of Five Zang Qi mechanisms and discusses the termination of the Twelve Meridians, fulfilling the theme of "Essentials of Diagnosis and Termination of the Meridians."