素问·通评虚实论 Comprehensive Discourse on Deficiency and Excess
黄帝问曰：何谓虚实。歧伯对曰：邪气盛则实，精气夺则虚。帝曰：虚实何如。歧伯曰：气虚者肺虚也，气逆者足寒也，非其时则生，当其时则死。馀藏皆如此。帝曰：何谓重实。歧伯曰：所谓重实者，言大热病，气热脉满，是谓重实。帝曰：经络俱实何如，何以治之。歧伯曰：经络皆实，是寸脉急而尺缓也，皆当治之，故曰：滑则从，涩则逆也。夫虚实者，皆从其物类始，故五藏骨肉滑利，可以长久也。帝曰：络气不足，经气有馀，何如。歧伯曰：络气不足，经气有馀者，脉口热而尺寒也，秋冬为逆，春夏为从，治主病者。帝曰：经虚络满何如。歧伯曰：经虚络满者，尺热满脉口寒涩也，此春夏死秋冬生也。帝曰：治此者奈何。歧伯曰：络满经虚，灸阴刺阳；经满络虚，刺阴灸阳。帝曰：何谓重虚。歧伯曰：脉气上虚尺虚，是谓重虚。帝曰：何以治之。歧伯曰：所谓气虚者，言无常也。尺虚者，行步恇然。脉虚者，不象阴也。如此者，滑则生，涩则死也。
帝曰：寒气暴上，脉满而实何如。歧伯曰：实而滑则生，实而逆则死。帝曰：脉实满，手足寒，头热，何如。歧伯曰：春秋则生，冬夏则死。脉浮而涩，涩而身有热者死。帝曰：其形尽满何如。歧伯曰：其形尽满者，脉急大坚，尺涩而不应也，如是者，故从则生，逆则死。帝曰：何谓从则生，逆则死。歧伯曰：所谓从者，手足温也。所谓逆者，手足寒也。帝曰：乳子而病热，脉悬小者何如。歧伯曰：手足温则生，寒则死。帝曰：乳子中风热，喘鸣肩息者，脉何如。歧伯曰：喘鸣肩息者，脉实大也，缓则生，急则死。帝曰：肠澼便血何如。歧伯曰：身热则死，寒则生。帝曰：肠澼下白沫何如。歧伯曰：脉沈则生，脉浮则死。帝曰：肠澼下脓血何如。歧伯曰：脉悬绝则死，滑大则生。帝曰：肠澼之属，身不热，脉不悬绝何如。歧伯曰：滑大者曰生，悬涩者曰死，以藏期之。帝曰：癫疾何如。歧伯曰：脉搏大滑，久自已；脉小坚急，死不治。帝曰：癫疾之脉，虚实何如。歧伯曰：虚则可治，实则死。帝曰：消瘅虚实何如。歧伯曰：脉实大，病久可治；脉悬小坚，病久不可治。
帝曰：形度骨度脉度筋度，何以知其度也。帝曰：春亟治经络，夏亟治经俞，秋亟治六府，冬则闭塞。闭塞者，用药而少针石也。所谓少针石者，非痈疽之谓也，痈疽不得顷时回。痈不知所，按之不应手，乍来乍已，刺手太阴傍三痏与缨脉各二。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。暴痈筋緛，随分而痛，魄汗不尽，胞气不足，治在经俞。腹暴满，按之不下，取手太阳经络者，胃之募也，少阴俞去脊椎三寸傍五，用员利针。霍乱，刺俞傍五，足阳明及上傍三。刺痫惊脉五，针手太阴各五，刺经太阳五，刺手少阴经络傍者一，足阳明一，上踝五寸刺三针.
凡治消瘅仆击，偏枯痿厥，气满发逆，肥贵人，则高梁之疾也。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，故瘦留著也。跖跛，寒风湿之病也。黄帝曰：黄疸暴痛，癫疾厥狂，久逆之所生也。五藏不平，六府闭塞之所生也。头痛耳鸣，九窍不利，肠胃之所生也.
Huangdi asked: What is meant by deficiency and excess? Qibo replied: When the pathogenic qi is exuberant, this is excess; when the essential qi is despoiled, this is deficiency. Huangdi said: What are deficiency and excess like? Qibo said: When qi is deficient, it is the lung that is deficient; when qi rebels upward, the feet become cold. If this occurs out of its proper season, the patient lives; if it occurs in its proper season, the patient dies. The same holds for the other viscera. Huangdi said: What is meant by double excess? Qibo said: What is called double excess refers to a case of great heat disease, where the qi is hot and the pulse is full — this is called double excess. Huangdi said: What of a case where both the channels and the network vessels are excess — how is it treated? Qibo said: When both channels and network vessels are excess, the inch pulse is tense while the cubit pulse is slack; both must be treated. Hence it is said: a slippery pulse indicates a favorable course, a rough pulse an adverse one. Deficiency and excess both follow from the nature of the affected substance; thus when the five viscera, bones, and flesh are smooth and well-ordered, one may enjoy long life. Huangdi said: What of a case where the qi of the network vessels is insufficient while the qi of the channels is surplus? Qibo said: When the network qi is insufficient and the channel qi is surplus, the pulse at the wrist opening is hot while the cubit is cold; this is adverse in autumn and winter, favorable in spring and summer — treat according to the governing disease. Huangdi said: What of a case where the channels are deficient and the network vessels full? Qibo said: When the channels are deficient and the network vessels full, the cubit is hot and full while the wrist-opening pulse is cold and rough; such a patient dies in spring and summer and lives in autumn and winter. Huangdi said: How is this treated? Qibo said: When the network vessels are full and the channels deficient, moxa the yin and needle the yang; when the channels are full and the network vessels deficient, needle the yin and moxa the yang. Huangdi said: What is meant by double deficiency? Qibo said: When the pulse qi is deficient above and the cubit is deficient, this is called double deficiency. Huangdi said: How is this treated? Qibo said: What is called deficient qi means the pulse lacks constancy. A deficient cubit means the patient walks with a faltering, unsteady gait. A deficient pulse means it does not resemble what is proper to yin. In such cases, a slippery pulse means life; a rough pulse means death.
Huangdi said: What of a case where cold qi suddenly surges upward and the pulse is full and excess? Qibo said: If excess is accompanied by a slippery pulse, the patient lives; if excess is accompanied by a rebellious pulse, the patient dies. Huangdi said: What of a case where the pulse is excess and full, the hands and feet are cold, and the head is hot? Qibo said: In spring and autumn the patient lives; in winter and summer the patient dies. If the pulse is floating and rough, and this roughness is accompanied by bodily heat, the patient dies. Huangdi said: What of a case where the whole body is swollen and full? Qibo said: When the whole body is full, the pulse is tense, large, and hard, while the cubit is rough and fails to respond; in such a case, a favorable course means life, an adverse course means death. Huangdi said: What is meant by a favorable course meaning life, and an adverse course meaning death? Qibo said: What is called favorable is when the hands and feet are warm. What is called adverse is when the hands and feet are cold. Huangdi said: What of a nursing infant afflicted with heat disease, whose pulse is suspended and small? Qibo said: If the hands and feet are warm, the child lives; if cold, the child dies. Huangdi said: What of a nursing infant struck by wind-heat, panting, wheezing, and heaving the shoulders in breath — what is the pulse like? Qibo said: When panting, wheezing, and heaving the shoulders, the pulse is excess and large; if moderate, the child lives; if tense, the child dies. Huangdi said: What of intestinal flux with blood in the stool? Qibo said: If the body is hot, the patient dies; if cold, the patient lives. Huangdi said: What of intestinal flux discharging white froth? Qibo said: If the pulse is sunken, the patient lives; if floating, the patient dies. Huangdi said: What of intestinal flux discharging pus and blood? Qibo said: If the pulse is suspended and cut off, the patient dies; if slippery and large, the patient lives. Huangdi said: What of cases akin to intestinal flux where the body is not hot and the pulse is not suspended and cut off? Qibo said: If the pulse is slippery and large, this indicates life; if suspended and rough, this indicates death — the time of crisis being determined according to the viscus involved. Huangdi said: What of epilepsy? Qibo said: If the pulse strikes large and slippery, the disease resolves of itself in time; if the pulse is small, hard, and tense, it is fatal and cannot be treated. Huangdi said: In the pulse of epilepsy, what of deficiency and excess? Qibo said: If deficient, it can be treated; if excess, the patient dies. Huangdi said: In wasting-thirst disease, what of deficiency and excess? Qibo said: If the pulse is excess and large, even a disease of long standing can be treated; if the pulse is suspended, small, and hard, a disease of long standing cannot be treated.
Huangdi said: As for the measurement of the body's form, the measurement of the bones, the measurement of the vessels, and the measurement of the sinews — how is one to know these measures? Huangdi said: In spring, one urgently treats the channels and network vessels; in summer, one urgently treats the channel transport points; in autumn, one urgently treats the six bowels; in winter, the pores are sealed shut. When they are sealed shut, one employs medicinal decoctions and uses needle and stone but sparingly. What is meant by using needle and stone sparingly does not apply to abscesses and welling-sores, for abscesses and welling-sores permit no delay of even a moment. When an abscess's location is unclear, so that pressing upon it evokes no response beneath the hand, and it comes and goes suddenly, needle three points beside the Hand Greater Yin channel, and two points each at the tasseled vessels. For a great, hot armpit abscess, needle five points of the Foot Lesser Yang; if after needling the heat does not subside, needle three points of the Hand Ruler of the Heart, and needle three points each at the meeting of the great bone along the Hand Greater Yin channel and its network vessels. For a sudden abscess with the sinews drawn taut, causing pain that follows the divisions of the flesh, with the essence-sweat not fully spent and the qi of the bladder insufficient, treatment lies at the channel transport points. For sudden abdominal fullness that does not yield to pressure, select the network vessel of the Hand Greater Yang, which is the alarm point of the stomach, and the transport point of the Lesser Yin, five fen to the side of the spine, three cun from the vertebrae, using the round, sharp needle. For sudden turmoil disorder, needle five points beside the transport points, and three points at the Foot Yang Brightness and above it to the side. For epilepsy and fright, needle five points of the vessel, needle five points each of the Hand Greater Yin, needle five points of the Greater Yang channel, needle one point beside the network vessel of the Hand Lesser Yin, one point of the Foot Yang Brightness, and needle three needles five cun above the ankle.
In general, when treating wasting-thirst, sudden collapse, hemiplegia, wilting and reversal, and fullness of qi with rebellious ascent — these are diseases of the rich and noble who feast on fine grain and rich meat. Obstruction and blockage in the region of the diaphragm, with upper and lower failing to communicate, are diseases born of sudden excessive worry. Sudden fainting together with deafness, and one-sided blockage and closure without free passage, arise from a sudden clash of the internal qi. Illnesses that arise neither from within nor from wind striking from without are those in which emaciation lingers and settles. Limping and lameness of the foot are diseases of cold, wind, and dampness. Huangdi said: Jaundice, sudden pain, epilepsy, fainting, and mania are generated by prolonged rebellious qi. Disharmony of the five viscera is generated by blockage and closure of the six bowels. Headache and ringing in the ears, with the nine orifices failing to function smoothly, are generated by disorders of the intestines and stomach.