蒋宝素曰：关格者，阴关于内，阳格于外，阴阳相离，关闭格绝之危证，乃呕吐反胃噎膈诸证之终也。《灵枢·终始篇》、禁服篇，俱以人迎气口自一盛二盛三盛至四盛以上为关格。脉度篇，不言人迎气口，直以阴气太盛，则阳气不能荣为关。阳气太盛，则阴气不能荣为格。阴阳俱盛，不得相荣为关格，则关格为证明矣。四时气篇，以膈塞不通，邪在胃脘，即人迎三盛，病在阳明名膈者，尚未至于格也。邪气藏府病形篇，以脾脉微急为膈中，食饮入而还出。上膈篇，以气为上膈，食饮入而还出，虫为下膈，食晬时乃出，即反胃转膈之证。《素问·六节藏象论》，亦以人迎寸口论关格，与终始、禁服二篇之义同。阴阳别论，以一阳发病，其传为隔。又云：三阳结为隔，即人迎一盛病在少阳，三盛病在阳明，膈塞不通，邪在胃脘之义。隔与膈通，未至于格也。脉要精微论，以脉反四时，阴阳不相应为关格，即终始篇之溢阳溢阴，禁服篇之春夏人迎微大，秋冬寸口微大，人迎倍于气口，气口倍于人迎之意。通评虚实论，以膈则闭绝，上下不通，即膈转关格之意。《难经》三难，以脉上鱼为溢，入尺为覆为关格，即终始、禁服二篇溢阳溢阴之意。三十七难，不言脉，直以五藏六府九窍阴阳不相荣为关格，与脉度篇同。《史记》仓公诊齐丞相舍人奴，望之杀然黄，察之如死青之兹，（《素问》云：青如草滋者死，黄如枳实者死。）乃内关之病，当至春鬲塞不通，不能食饮，法至夏泄血死，即脉度篇三十七难，阴脉不和，则血留之为关格之意。《金匮要略》以膈气虚脉乃数，数为客热，不能消谷，胃中虚冷故也。此膈气虚，胃中冷，则胃病，膈膜亦病，即三阳结谓之隔，隔塞不通，邪在胃脘之意。又脉弦者虚也，胃气无余，朝食暮吐，暮食朝吐，变为胃反。夫弦脉属木，即人迎一盛，病在少阳，一阳发病，其传为膈，由反胃传膈之意。又趺阳脉浮，浮则为虚，虚则伤脾，脾伤不磨，朝食暮吐，暮食朝吐，名曰胃反。又诸呕吐，谷不得下者，小半夏汤主之。又胃反呕吐者，大半夏汤主之。即脾病及胃，病在阳明，由呕吐进为反胃之证也。《伤寒论》以心脉下为本，大者则为关格不通，不得尿，即脉要精微论，应太过不足为精，应不足有余为消，阴阳不相应为关格之意。又寸口脉浮大，浮为虚，大为实，在尺为关，在寸为格，关则不得小便，（不得小便，人迎二盛，病在膀胱之时，津液先亏。三盛病在阳明，饮食愈少，津液就枯。至四倍以上，则食饮不下，州都液涸。及寸口一盛，厥阴肝木盗肾水。二盛少，阴肾水自病。三盛太阴脾土克肾水。至四倍以上，则肾水与膀胱津液俱竭。故不得小便，非癃闭可比） 格则吐逆。又下取趺阳脉伏而涩，伏则吐逆，水谷不化，涩则食不得入为关格，即终始、禁服二篇之溢阴为关，溢阳为格，《难经》上鱼为溢，入尺为覆，为关格之意。由吐逆水谷不化，食不得入，不得小便，即由呕吐而反胃，反胃而噎膈，噎膈而关格，亦人迎一盛少阳，二盛太阳，三盛阳明，四盛以上为格，及一阳发病，其传为膈，三阳结为隔之意。由是言之，呕吐即反胃噎膈关格之始，关格即噎膈反胃呕吐之终也。自王太仆以内格呕逆，食不得入，是有火也。病呕而吐，食入反出，是无火也。然则吐逆时，或能食，或不能食，岂时或有火，时或无火，此王氏未达经义也。巢元方窃《金匮要略》之意，以停水积饮在胃脘则藏冷，脾不磨则朝食暮吐，暮食朝吐为反胃。又窃通评虚实论之意，以三焦隔绝，津液不行，由忧患则气结为噎膈，分反胃噎膈为二门。盖不知反胃进为噎膈也。张子和讥巢氏始分病派，反失其本，引《内经》三阳结为隔，三阳解作大肠小肠膀胱，又引少阳所至为呕涌溢，食不下，又引肝移寒于心为狂膈中，又引人迎四盛以上为格，且言膈亦当为格，则似知噎膈进为关格，何不以三阳之结，为人迎三盛，病在阳明之证，少阳所至，肝移寒于心，为人迎一盛，病在少阳，及一阳发病，其传为膈之证，而反谓三阳乃大肠小肠膀胱，未符经旨。刘守真以呕涌溢，食不下，火气炎上，胃膈热甚，专主于热，是关格噎膈反胃呕吐之不分也。李东垣以左为人迎，右为气口，清气反行浊道为格，浊气反行清道为关。（清气反行浊道，即太阴肺之清气，反行阳明胃之浊道，即人迎四盛以上之格证。浊气反行清道，即阳明胃之浊气，反行太阴肺之清道，即寸口四盛以上之关证。清浊反行，犹良民化为盗贼。）论证则是，而反以左右分人近气口，盖不知人迎脉之所在也。朱丹溪以噎膈乃反胃之渐，而分关格另为一门，盖不知关格即噎膈之终也。陈无择、严用和分五膈五噎，创立形证，随五藏五志，犹舍尺寸而意短长，并不解关格噎膈反胃呕吐同归一体之证也。赵以德宗《灵枢》浊中有清，清中有浊之旨，而分胃有三脘，以邪在下脘，则血滞谷不消食之清浊不分为噎塞，变为呕吐。此盖知噎膈呕吐相通，而不知关格即呕吐噎膈之终也。王肯堂宗仲景关则不得小便，格则吐逆，以为格者拒扞其外入者不得内，关者闭塞其内出者不得泄，又以三阳结之隔为隔绝之证，而非关格。盖不知三阳结之隔，即人迎三盛，病在阳明之证，进而为关格也。又宗洁古呕吐即反胃膈气，又宗丹溪噎膈即反胃之渐，而又分呕吐膈气为二门，是不知呕吐进而为反胃，反胃进而为噎膈也。马仲化力辨关格为脉体，非证名，以《难经》仲景、王冰、东垣、丹溪为误更谬，以癃闭作关，则不得小便，可谓不揣其本而齐其末矣。且不知《灵枢》脉度篇及《难经》三十七难，直以关格为证名矣。张景岳蹈仲化之辙，以关格为脉体，又或为证名，又或为虚劳之别名，竟不知与呕吐反胃噎膈为一体，而分关格噎膈反胃呕吐为四门。何乃诸贤互相非是，致令病情颠倒，由其不能深考人迎脉在何处也。因著人迎辨，以原其故。
人迎辨（附刻） 蒋宝素曰：人迎气口，为脉之要会。关阴格阳，为证之权衡。《内经》本以人迎诊六府之阳，气口诊五藏之阴。人迎本足阳明胃脉，在结喉两旁，气口本手太阴肺脉，在两手太渊经渠穴处。关阴格阳为证名，溢阴溢阳为脉体，人迎气口为脉位。扁鹊推上鱼为溢，入尺为覆，为关格证之脉。长沙明吐逆食不得入，不得小便，为关格证之状。《脉经》《脉诀》以左为人迎，右为气口。滑伯仁以结喉两旁分人迎气口。马仲化以左手关上为人迎，右手关上为气口。关格为脉体，非证名，谓《难经》三难及三十七难，论关格覆溢证脉为非。长沙在尺为关，在寸为格，关则不得小便，格则吐逆为误。张景岳知人迎在结喉之旁，不达《内经》扁鹊、长沙之旨，反以马氏为是，皆非也。《内经》每以人迎气口并举，而论关格，其理最微，其旨最博。文凡四见，略有参差，各有所指。盖深忧后世之不达，姑言之重复详明如此。扁鹊亦忧后人不达经义，本禁服篇、终始篇关格证，而推覆溢脉之名。（脉有名则关格是证。）长沙亦忧后人不达经义，本覆溢脉而明关格证之状。（证有状则关格非脉。）盖证难辨者，莫难于关阴格阳。脉难辨者，莫难于人迎气口。是以黄、岐、扁鹊、长沙，反覆推明因证推脉之名，因脉明证之状，可谓详而密矣。观脉度篇及《难经》三十七难，论关格为证，忧彰明较著者，奈何不察。夫圣经垂训于后世，亦赖后贤阐发，故内经道统，扁鹊得之而讨论，长沙得之而推明。自汉以后，晋有皇甫士安，隋有全元起，唐有王冰，俱注释《内经》，多所发明，惟人迎气口诸条则略。自王叔和《脉经》，高阳生《脉诀》，不知经义人迎气口本旨，误以左为人迎，右为气口。后世悉宗其谬，如东垣、丹溪之明，亦信而不辨。人迎气口部位，尚且不明，关阴格阳证状，安能契合。遂致议论多歧，是非莫辨。至明马仲化注《内经》，人迎气口关格诸条，竭力条辨，反以扁鹊、长沙为误，亦宗左为人迎，右为气口谬说，妄言关格为脉体，非证名。张景岳集《类经》释人迎气口关格诸条，力辨人迎在结喉两旁，气口在两手太渊穴处诚是也。然又宗马氏指关格为脉体，非证名，以扁鹊、长沙论关格覆溢证脉为误。是脉体明，而证又晦。故经曰：知其要者，一言而终，不知其要，流散无穷。诚哉！是言也。谨列经义人迎气口关格覆溢证脉本旨，及诸家注释辨论，并附鄙见，条分于下。 人迎乃足阳明经胃脉，在结喉两旁，不在左手，总统三阳六府诸证，至四盛以上，以辨关格。按：《灵枢·经脉篇》曰：胃足阳明之脉，起于鼻之交頞中，（頞，鼻茎尽处、亦名山根。交頞、谓脉左右互交也。）旁约太阳之脉，（自鼻頞至目内眦睛明穴。）下循鼻外入上齿中，（自睛明，至承泣、四白、巨髎之分。）还出挟口环唇，（至地仓穴。）下交承浆，（任脉穴。）欲循颐后下廉，出大迎，（腮下为颔，颔下为颐，自地仓以下大迎。）循颊车，（本经穴。）上耳前，（下关穴。）过客主人，（少阳经穴。）循发际，（行悬厘、颔厌之分至头维，会于督脉神庭之次。）至额颅。（发际前。）其支者，（支犹水之有支。）从大迎前下人迎，（本经穴名。在结喉两旁一十五分，即人迎脉也。）循喉咙入缺盆，（本经穴。）下膈属胃络脾。（胃与脾相为表里。）其直者，从缺盆下乳内廉，（直谓直下而分行，从缺盆下行气户等穴至乳中乳根。）挟脐，（自乳根至天枢等穴。）入气街中。（气街即气冲。自外陵等穴至此，）其支者，起于胃口，下循腹里，下至气街中而合，（胃口乃胃之下口。《难经》所谓幽门是也。循腹里，过足少阴肓腧之外，此即上文支者之脉，由胃下行，与直者复合于气街之中，）以下髀关，低伏兔，下膝膑中，下循胫外廉，下足跗，入中指内间，髀，股也。抵，至也。髀关、伏兔，皆膝上穴名。自此由阴市诸穴以下行。膝盖名膑，骨名胫，足面名跗，三者即巨虚，冲阳等穴之次，乃循内庭入中指内间，而出厉兑。足阳明经止于此。其支者，下廉三寸而别，下入中指外间。其支者，别跗上，入大指间出其端。（廉，下廉也。下廉三寸，即丰隆穴是，为阳明别络。故下入中指外间。又其支者，自跗上冲阳穴，次别行入大指间，斜出足厥阴行间之次，循大指出其端，而接手足太阴经也。）是动则病洒洒振寒，胃中寒则胀满。为此诸病，盛则泻之。虚则补之。盛者，人迎大三倍于气口。虚者，人迎反小于气口也。大肠手阳明之脉，起于大指次指之端，终于上挟鼻孔。是动则病齿痛颈肿。为此诸病，盛则泻之。虚则补之。盛者，人迎大三倍于寸口。虚者，人迎反小于寸口也。小肠手太阳之脉，起于小指之端，终于至目内眦，斜络于颧。是动则病咽痛颔肿。为此诸病，盛则泻之。虚则补之。盛者，人迎大再倍于气口。虚者，人迎反小于寸口也。膀胱足太阳之脉，起于目内眦，终于至小指外侧。是动则病冲头痛。为此诸病，盛则泻之，虚则补之。盛者，人迎大再倍于寸口。虚者，人迎反小于寸口也。三焦手少阳之脉，起于小指次指之端，终于至目锐眦。是动则病耳聋。为此诸病，盛则泻之，虚则补之。盛者，人迎大一倍于寸口。虚者，人迎反小于寸口也。胆足少阳之脉，起于目锐眦，终于还爪甲，出三毛。是动则病口苦。为此诸病，盛则泻之。虚则补之。盛者，人迎大一倍于寸口。虚者，人迎反小于寸口也。按本篇以人迎胃脉，统察手足三阳六府诸病，与寸口肺脉相较倍数，合阴阳之数，察病之所在。手足阳明为三阳，故人迎大三倍于寸口者，为病在胃与大肠经也。手足太阳为二阳，故人迎大再倍于寸口者，为病在膀胱与小肠经也。手足少阳为一阳。故人迎大一倍于寸口者，为病在胆与三焦经也。以人迎胃脉统察六阳经者，以胃为诸脉之本源也。六府为阳，故以胃统六阳诸证，岂独以左手为言哉。若以左为人迎，则察六府之脉，皆当在左手，孰知本经胃脉循行之处，从不至左手，其曰从大迎前下人迎，乃切指人迎在结喉两旁，不在左手一证也。又动输篇，帝曰：足之阳明，何因而动？岐伯曰：胃气上注于肺，其悍气上冲头者，循咽上走空窍，循眼系，入络脑，出顑（音坎。《说文》：顑与颔同）。下客主人，循牙车，合阳明，并下人迎，此胃气别走于阳明者也。此以人迎为阳明胃脉，其曰胃气上注于肺，是胃为肺脉之根，肺为胃脉之干。寸口肺脉，能察人迎胃脉，为其根干相通故也。其悍气者，即胃气所生之卫气，循咽上走穴窍，循眼系出睛明穴，历攒竹、曲池、五处、承光、通天、络却等穴，入络于脑，复出颔下足少阳胆经之客主人，循本经之牙车，合于本经之经隧，并下本经之人迎。此虽卫气所行，即是内之胃气，出而别走于阳明之经隧。此以人迎胃脉动于结喉两旁，不在左手二证也。又本输篇，岐伯曰：缺盆之中，任脉也，名曰天突。一次任脉侧之动脉，足阳明也。按缺盆之中，任脉之侧，正是结喉之旁人迎脉处。又曰：足阳明，挟喉之动脉也。此明指人迎在结喉两旁，不在左手，三证也。又病能论，黄帝问曰：人病胃脘痈者，诊当何如？岐伯对曰：诊此者，当候胃脉。其脉当沉细，沉细者气逆，逆者人迎甚盛，甚盛则热。人迎者，胃脉也。此分明切指人迎为胃脉也。
Jiang Baosu said: Guan Ge syndrome is a critical condition where Yin is blocked internally and Yang is repelled externally, with Yin and Yang separating from each other, leading to closure and repulsion. It represents the terminal stage of various syndromes such as vomiting, regurgitation (Fan Wei), and dysphagia (Ye Ge). The *Ling Shu: Zhong Shi Pian* and *Jin Fu Pian* define Guan Ge by the Ren Ying pulse (Renying Mai) and Qi Kou pulse (Qikou Mai) being one-fold, two-fold, three-fold, and up to four-fold excessive. The *Ling Shu: Mai Du Pian* does not mention Ren Ying and Qi Kou but directly states that when Yin Qi is excessively strong, Yang Qi cannot nourish, which is called "Guan" (Closure); when Yang Qi is excessively strong, Yin Qi cannot nourish, which is called "Ge" (Repulsion). When both Yin and Yang are excessively strong and cannot mutually nourish, it is called Guan Ge, thus clarifying the syndrome. The *Ling Shu: Si Shi Qi Pian* describes "Ge" (Diaphragm obstruction) as blockage in the diaphragm with pathogenic factors in the stomach region, corresponding to the Ren Ying pulse being three-fold excessive, indicating disease in the Yangming channel; this has not yet reached the degree of "Ge" (Repulsion). The *Ling Shu: Xie Qi Zang Fu Bing Xing Pian* states that a slightly urgent Spleen pulse indicates "Ge Zhong" (Middle Diaphragm obstruction), where food and drink enter and then return out. The *Ling Shu: Shang Ge Pian* defines "Shang Ge" (Upper Diaphragm) as qi rebelling upward, causing food and drink to return out after ingestion; "Xia Ge" (Lower Diaphragm) caused by worms, where food takes a full day to exit, which corresponds to the syndromes of Fan Wei (Regurgitation) and Zhuan Ge (Turning Diaphragm). The *Su Wen: Liu Jie Zang Xiang Lun* also discusses Guan Ge using Ren Ying and Cun Kou pulses, consistent with the meanings in the *Zhong Shi* and *Jin Fu* chapters. The *Su Wen: Yin Yang Bie Lun* states that disease originating from One Yang transmits to "Ge" (Diaphragm). It further says: "Three Yangs knotted result in Ge," meaning the Ren Ying pulse is one-fold excessive with disease in the Shaoyang channel, and three-fold excessive with disease in the Yangming channel, implying blockage in the diaphragm and pathogenic factors in the stomach region. "Ge" (Diaphragm) and "Ge" (Repulsion) share characters but have not yet reached the state of Repulsion. The *Su Wen: Mai Yao Jing Wei Lun* defines Guan Ge as pulse patterns contrary to the four seasons, with Yin and Yang failing to correspond, which aligns with the concepts of Overflowing Yang and Overflowing Yin in the *Zhong Shi Pian*, and the slight excess of Ren Ying in spring/summer and Cun Kou in autumn/winter in the *Jin Fu Pian*, where Ren Ying is double or more than double Qi Kou, and vice versa. The *Su Wen: Tong Ping Xu Shi Lun* states that "Ge" leads to closure and blockage, with no communication between upper and lower, implying the progression from Ge to Guan Ge. The *Nan Jing: Chapter 3* defines pulse extending to the fish border as "Yi" (Overflow) and entering the Chi position as "Fu" (Cover), termed Guan Ge, consistent with the Overflowing Yang/Yin concepts in the *Zhong Shi* and *Jin Fu* chapters. *Nan Jing: Chapter 37* does not discuss pulses but directly states that the inability of the Five Zang and Six Fu organs and Nine Orifices to mutually nourish constitutes Guan Ge, consistent with the *Mai Du Pian*. In the *Records of the Grand Historian*, Cang Gong diagnosed the slave Wangzhi of the Prime Minister of Qi. The patient's face was yellow like dead grass, and his complexion resembled dead green vegetation. (*Su Wen* states: Death if green like grass roots, death if yellow like orange peel.) This is an internal Guan disease. By spring, he would suffer diaphragmatic blockage and inability to eat/drink; by law, he would die of hematochezia in summer. This aligns with the *Mai Du Pian* and *Nan Jing Ch. 37*: when Yin pulses are discordant, blood stagnates, constituting Guan Ge. The *Jin Gui Yao Lue* states that deficiency of Qi in the diaphragm results in a rapid pulse; rapidity indicates deficient heat, inability to digest grains, due to cold deficiency in the stomach. This deficiency of diaphragmatic Qi and cold in the stomach implies disease in the Stomach and Diaphragm, consistent with "Three Yangs knotted constitute Ge," meaning diaphragmatic blockage and pathogenic factors in the stomach. It further states that a wiry pulse indicates deficiency; with no surplus of Stomach Qi, morning food is vomited at night, and night food at morning, transforming into Wei Fan (Stomantic Regurgitation). A wiry pulse belongs to Wood, corresponding to Ren Ying pulse one-fold excessive, disease in Shaoyang, One Yang disease transmitting to Ge, progressing from Fan Wei to Ge. It also states that a floating Fu Yang pulse indicates deficiency; deficiency injures the Spleen. If the Spleen is injured and fails to grind, morning food is vomited at night, and night food at morning, named Wei Fan. Regarding various vomitings where grain cannot go down, Xiao Ban Xia Tang is the primary formula. For Wei Fan vomiting, Da Ban Xia Tang is the primary formula. This indicates Spleen disease affecting the Stomach, disease in Yangming, progressing from vomiting to Fan Wei. The *Shang Han Lun* states that if the Heart pulse base is low and large, it indicates Guan Ge blockage and inability to urinate, consistent with the *Mai Yao Jing Wei Lun*: exceeding expectations but lacking substance indicates essence depletion; lacking expectations but having excess indicates consumption; Yin and Yang failing to correspond constitutes Guan Ge. It also states that a floating and large Cun Kou pulse: floating indicates deficiency, large indicates excess. In Chi, it is Guan; in Cun, it is Ge. Guan means inability to urinate (when Ren Ying is two-fold excessive, disease in Bladder, fluids first depleted; three-fold excessive, disease in Yangming, less food intake, fluids dry up; four-fold excessive, no food/drink intake, fluids of Zhou Du exhausted; Cun Kou one-fold excessive, Jueyin Liver wood steals Kidney water; two-fold excessive, Shaoyin Kidney water diseased; three-fold excessive, Taiyin Spleen earth overcomes Kidney water; four-fold excessive, Kidney water and Bladder fluids exhausted. Thus inability to urinate is not comparable to Long Bi [difficulty urinating]). Ge means vomiting and reversal. Diagnosing the Fu Yang pulse below as deep and choppy: deep indicates vomiting and reversal, undigested food and water; choppy indicates inability to ingest food, constituting Guan Ge. This aligns with *Zhong Shi* and *Jin Fu*: Overflowing Yin is Guan, Overflowing Yang is Ge; *Nan Jing*: Up to fish border is Yi, entering Chi is Fu, constituting Guan Ge. From vomiting, undigested food/water, inability to ingest, inability to urinate, it progresses from vomiting to Fan Wei, Fan Wei to Ye Ge, and Ye Ge to Guan Ge. This also corresponds to Ren Ying one-fold excessive (Shaoyang), two-fold excessive (Taiyang), three-fold excessive (Yangming), and four-fold excessive above as Ge, as well as One Yang disease transmitting to Ge, and Three Yangs knotted as Ge. Therefore, vomiting is the beginning of Fan Wei, Ye Ge, and Guan Ge; Guan Ge is the end of Ye Ge, Fan Wei, and vomiting. Since Wang Bing stated that internal Ge with vomiting/reversal and inability to ingest indicates Fire, while vomiting with food returning out indicates No Fire. However, during vomiting/reversal, sometimes eating is possible, sometimes not. Does this mean Fire exists at times and not at others? This shows Wang Bing did not fully understand the scriptural meaning. Chao Yuanfang borrowed from *Jin Gui Yao Lue*, stating that retained water and accumulated fluids in the stomach cause coldness in the Zang, and Spleen failure to grind causes morning food vomited at night, night food at morning, defining Fan Wei. He also borrowed from *Tong Ping Xu Shi Lun*, stating that separation of San Jiao and failure of fluid circulation due to worry/qi knotting constitutes Ye Ge, dividing Fan Wei and Ye Ge into two categories. He failed to realize that Fan Wei progresses to Ye Ge. Zhang Zihe criticized Chao for starting to divide diseases, losing the root. He cited *Nei Jing*: "Three Yangs knotted constitute Ge," interpreting Three Yangs as Large Intestine, Small Intestine, and Bladder. He cited "Shaoyang arrival causes vomiting/gurgling, inability to eat." He cited "Liver transferring cold to Heart causes mania and middle Ge." He cited Ren Ying four-fold excessive above as Ge, and stated Ge should be read as Ge (Repulsion). This seems to know Ye Ge progresses to Guan Ge. Why not interpret the knotting of Three Yangs as Ren Ying three-fold excessive, disease in Yangming; Shaoyang arrival, Liver cold to Heart, as Ren Ying one-fold excessive, disease in Shaoyang, and One Yang disease transmitting to Ge? Instead, he claimed Three Yangs are Large Intestine, Small Intestine, and Bladder, contradicting the scriptures. Liu Shouzhen believed vomiting/gurgling and inability to eat are due to Fire flaring upward and severe heat in Stomach/Diaphragm, focusing solely on Heat, thus failing to distinguish Guan Ge, Ye Ge, Fan Wei, and Vomiting. Li Dongyuan considered Left as Ren Ying and Right as Qi Kou. Clear Qi reversing into turbid pathways is Ge; Turbid Qi reversing into clear pathways is Guan. (Clear Qi reversing into turbid pathways refers to Taiyin Lung clear Qi reversing into Yangming Stomach turbid pathways, i.e., Ren Ying four-fold excessive Ge syndrome. Turbid Qi reversing into clear pathways refers to Yangming Stomach turbid Qi reversing into Taiyin Lung clear pathways, i.e., Cun Kou four-fold excessive Guan syndrome. Reversal of clear/turbid is like good citizens becoming thieves.) His argument was correct, but he wrongly distinguished Ren Ying and Qi Kou by left/right, likely unaware of the location of the Ren Ying pulse. Zhu Danxi viewed Ye Ge as the gradual stage of Fan Wei but separated Guan Ge into another category, failing to realize Guan Ge is the end of Ye Ge. Chen Wuyue and Yan Yonghe divided Five Ges and Five Yes, creating morphological syndromes based on Five Zang and Five Emotions, akin to measuring length without rulers, failing to understand that Guan Ge, Ye Ge, Fan Wei, and Vomiting are manifestations of the same underlying condition. Zhao Yi De followed the *Ling Shu* principle that turbidity contains clarity and clarity contains turbidity, dividing the Stomach into three regions. Pathogens in the Lower Wan cause blood stasis, undigested grain, and indistinct clear/turbid food, leading to blockage and vomiting. He knew Ye Ge and Vomiting were connected but did not realize Guan Ge is the end of Vomiting and Ye Ge. Wang Kentang followed Zhang Zhongjing: Guan means inability to urinate, Ge means vomiting/reversal. He defined Ge as rejecting external entry preventing internal entry, and Guan as blocking internal exit preventing external release. He viewed the Ge from "Three Yangs knotted" as mere separation, not Guan Ge. He failed to see that the Ge from Three Yangs knotted is the Ren Ying three-fold excessive, Yangming disease syndrome, progressing to Guan Ge. He followed Jie Gu's view that Vomiting is Fan Wei and Diaphragmatic Qi, and Danxi's view that Ye Ge is the gradual stage of Fan Wei, yet separated Vomiting and Diaphragmatic Qi into two categories, failing to see Vomiting progresses to Fan Wei, and Fan Wei progresses to Ye Ge. Ma Zhonghua strongly argued that Guan Ge is a pulse pattern, not a syndrome name, calling *Nan Jing*, Zhongjing, Wang Bing, Dongyuan, and Danxi erroneous. He equated Long Bi (difficulty urinating) with Guan, stating inability to urinate, which is confusing the root with the branch. He ignored that *Ling Shu: Mai Du Pian* and *Nan Jing Ch. 37* explicitly define Guan Ge as a syndrome name. Zhang Jingyue followed Ma Zhonghua, viewing Guan Ge as a pulse pattern, sometimes a syndrome name, sometimes a synonym for Deficiency Labor, failing to see its unity with Vomiting, Fan Wei, and Ye Ge, instead dividing them into four categories. Why did these sages criticize each other, causing confusion in disease nature? Because they could not deeply investigate the location of the Ren Ying pulse. Thus, I wrote *Ren Ying Bian* to explore the cause.
*Ren Ying Bian* (Attached) Jiang Baosu said: Ren Ying and Qi Kou are the key intersections of pulses. Guan Yin (Blocking Yin) and Ge Yang (Repelling Yang) are the weights of syndromes. *Nei Jing* originally used Ren Ying to diagnose Six Fu organ Yang, and Qi Kou to diagnose Five Zang organ Yin. Ren Ying is fundamentally the Foot-Yangming Stomach pulse, located on both sides of the laryngeal prominence. Qi Kou is fundamentally the Hand-Taiyin Lung pulse, located at the Taiyuan and Jingqu acupoints on both wrists. Guan Yin Ge Yang is a syndrome name; Yi Yin Yi Yang (Overflowing Yin/Yang) is a pulse pattern; Ren Ying Qi Kou are pulse locations. Bian Que deduced that pulse reaching the fish border is Yi (Overflow), and entering Chi is Fu (Cover), representing the pulse of Guan Ge syndrome. Changsha (Zhang Zhongjing) clarified that vomiting/reversal, inability to ingest, and inability to urinate are the manifestations of Guan Ge syndrome. *Mai Jing* and *Mai Jue* identified Left as Ren Ying and Right as Qi Kou. Hua Borren divided Ren Ying and Qi Kou at the sides of the laryngeal prominence. Ma Zhonghua identified Left Guan as Ren Ying and Right Guan as Qi Kou. Guan Ge is a pulse pattern, not a syndrome name, claiming *Nan Jing Ch. 3* and *Ch. 37* discussions on Guan Ge, Fu, and Yi pulses/syndromes are incorrect. Changsha's definition of Chi as Guan and Cun as Ge, with Guan causing inability to urinate and Ge causing vomiting/reversal, is erroneous. Zhang Jingyue knew Ren Ying is at the laryngeal prominence but did not grasp the intent of *Nei Jing*, Bian Que, and Changsha, instead endorsing Ma's view, which is incorrect. *Nei Jing* frequently mentions Ren Ying and Qi Kou together when discussing Guan Ge; its principles are subtle and its scope broad. The text appears four times with slight variations, each pointing to different aspects. This repetition aims to warn future generations against misunderstanding. Bian Que, fearing future misunderstanding, derived the names of Fu and Yi pulses from the Guan Ge syndromes in *Jin Fu* and *Zhong Shi* chapters. (If pulse has a name, Guan Ge is the syndrome.) Changsha, fearing future misunderstanding, clarified the manifestations of Guan Ge syndrome based on Fu and Yi pulses. (If syndrome has manifestations, Guan Ge is not merely a pulse.) Syndromes are hardest to differentiate when distinguishing Guan Yin and Ge Yang. Pulses are hardest to differentiate when distinguishing Ren Ying and Qi Kou. Therefore, Huangdi, Qibo, Bian Que, and Changsha repeatedly explained deriving pulse names from syndromes and syndrome manifestations from pulses, which is detailed and precise. Observing *Mai Du Pian* and *Nan Jing Ch. 37*, which define Guan Ge as a syndrome, why ignore such clear evidence? Sacred texts provide guidance for posterity, relying on later sages to elucidate. Thus, the lineage of *Nei Jing* was discussed by Bian Que and elucidated by Changsha. After Han, Jin had Huangfu Mi, Sui had Quan Yuanqi, Tang had Wang Bing, all annotating *Nei Jing* with many insights, except for the Ren Ying and Qi Kou sections, which were brief. Since Wang Shuhe's *Mai Jing* and Gao Yangsheng's *Mai Jue*, misunderstanding the original meaning of Ren Ying and Qi Kou, erroneously identified Left as Ren Ying and Right as Qi Kou. Later generations followed this error, even bright minds like Dongyuan and Danxi accepted it without debate. Without clarifying the location of Ren Ying and Qi Kou, how can the manifestations of Guan Yin and Ge Yang be correctly matched? This led to divergent opinions and indistinguishable right and wrong. In Ming Dynasty, Ma Zhonghua annotated *Nei Jing*, meticulously analyzing Ren Ying, Qi Kou, and Guan Ge, yet erroneously critiqued Bian Que and Changsha, adhering to the false theory of Left=Ren Ying, Right=Qi Kou, and falsely claiming Guan Ge is a pulse pattern, not a syndrome name. Zhang Jingyue compiled *Lei Jing*, explaining Ren Ying, Qi Kou, and Guan Ge. He correctly identified Ren Ying at the laryngeal prominence and Qi Kou at Taiyuan. However, he followed Ma's view that Guan Ge is a pulse pattern, not a syndrome, and criticized Bian Que and Changsha's discussion of Guan Ge, Fu, and Yi pulses/syndromes as errors. Thus, the pulse pattern was clarified, but the syndrome remained obscure. As the scripture says: "He who knows the essentials concludes in one word; he who does not knows scatters infinitely." Truly spoken! Herein, I list the original meanings of Ren Ying, Qi Kou, Guan Ge, Fu, Yi, syndrome, and pulse from the scriptures, along with annotations and debates from various schools, and my own views, itemized below. Ren Ying is the Foot-Yangming Stomach pulse, located at the sides of the laryngeal prominence, not on the left hand. It governs all Three Yang and Six Fu syndromes, and at four-fold excess, distinguishes Guan Ge. According to *Ling Shu: Jing Mai Pian*: The Foot-Yangming Stomach meridian originates at the intersection of the nose bridge... Its branch descends from before Daying to Ren Ying... follows the throat to Quepen... descends through the diaphragm, connects with Stomach, and networks with Spleen... The straight branch descends from Quepen... passes the navel... enters Qijie... Another branch starts from the stomach mouth... descends through the abdomen... meets at Qijie... descends to Biguan... Fubu... kneecap... tibia... foot dorsum... enters between the toes... terminates at Lidui. Another branch separates three cun below... enters between the middle toes. Another branch separates on the dorsum... enters between the big toe... ends connecting with Hand-Taiyin. When moved, it causes chills, stomach cold, and distension. For these diseases, excess is drained, deficiency is tonified. Excess: Ren Ying is three times larger than Qi Kou. Deficiency: Ren Ying is smaller than Qi Kou. Hand-Yangming Large Intestine meridian... When moved, toothache, neck swelling... Excess: Ren Ying three times larger than Cun Kou. Deficiency: Ren Ying smaller than Cun Kou. Hand-Taiyang Small Intestine meridian... When moved, sore throat, jaw swelling... Excess: Ren Ying two times larger than Qi Kou. Deficiency: Ren Ying smaller than Qi Kou. Foot-Taiyang Bladder meridian... When moved, headache... Excess: Ren Ying two times larger than Cun Kou. Deficiency: Ren Ying smaller than Cun Kou. Hand-Shaoyang Sanjiao meridian... When moved, deafness... Excess: Ren Ying one time larger than Cun Kou. Deficiency: Ren Ying smaller than Cun Kou. Foot-Shaoyang Gallbladder meridian... When moved, bitter taste... Excess: Ren Ying one time larger than Cun Kou. Deficiency: Ren Ying smaller than Cun Kou. This chapter uses Ren Ying Stomach pulse to uniformly observe all Six Fu diseases of Hand and Foot Three Yangs, comparing multiples with Cun Kou Lung pulse, combining Yin-Yang numbers to locate disease. Hand-Foot Yangming are Three Yangs, so Ren Ying three times larger indicates disease in Stomach and Large Intestine. Hand-Foot Taiyang are Two Yangs, so Ren Ying two times larger indicates disease in Bladder and Small Intestine. Hand-Foot Shaoyang are One Yang, so Ren Ying one time larger indicates disease in Gallbladder and Sanjiao. Using Ren Ying Stomach pulse to observe Six Yang meridians is because Stomach is the source of all pulses. Six Fu are Yang, so Stomach governs all Six Yang syndromes, not just the left hand. If Left were Ren Ying, observing Six Fu pulses would all be on the left hand. But the Stomach meridian never reaches the left hand. The statement "from Daying front down to Ren Ying" clearly points to Ren Ying at the laryngeal prominence, not the left hand. Second proof from *Dong Shu Pian*: Emperor asked: Why does Foot-Yangming move? Qibo answered: Stomach Qi ascends to Lung... vigorous Qi rushes to head... follows throat... enters brain... exits under jaw... goes to Keyuzhuren... follows Jiache... merges with Yangming... and descends to Ren Ying. This confirms Ren Ying is Yangming Stomach pulse. "Stomach Qi ascends to Lung" means Stomach is the root of Lung pulse, Lung is the trunk of Stomach pulse. Cun Kou Lung pulse can observe Ren Ying Stomach pulse because their roots and trunks connect. The vigorous Qi is Wei Qi generated by Stomach Qi... follows throat... exits Jingming... passes Cuanzhu... Quchi... Wuchu... Chengguang... Tongtian... Luoque... enters brain... exits under jaw to Shaoyang Gallbladder's Keyuzhuren... follows Jiache... merges with meridian... and descends to Ren Ying. Although this is Wei Qi pathway, it is internal Stomach Qi exiting to Yangming meridian. This confirms Ren Ying moves at laryngeal prominence, not left hand. Third proof from *Ben Shu Pian*: Qibo said: In Quepen center is Ren Mai, named Tantu. Next to Ren Mai artery is Foot-Yangming. Quepen center, side of Ren Mai, is exactly Ren Ying at laryngeal prominence. Also: Foot-Yangming is the artery clamping the throat. This clearly points to Ren Ying at laryngeal prominence, not left hand. Fourth proof from *Bing Neng Lun*: Yellow Emperor asked: How to diagnose Stomach carbuncle? Qibo answered: Diagnose Stomach pulse. Pulse should be deep and fine. Deep/fine indicates Qi rebellion. Rebellion means Ren Ying is very excessive. Very excessive means heat. Ren Ying is Stomach pulse. This clearly identifies Ren Ying as Stomach pulse.