马云。篇内首三节。论邪气入于脏腑。第四节论病形。故名篇。
邪气之中人高也 志云。邪气者。风雨寒暑。天之邪也。故中人也高。湿乃水土之气。故中于身
半以下。此天地之邪。中于人身。而有上下之分。
溜于腑 甲乙溜作留。马云溜当作流。下文溜于经亦同。
异名同类 张云。经脉相贯合一。本同类也。然上下左右部位。各有所属。则阴阳之名异矣。
诸阳之会（止）则下少阳 张云。此言邪之中于阳经也。手足六阳。俱会于头面。故为诸阳之
会。凡足之三阳从头走足故。中于面。则自胸、腹、下行于阳明经也。中于项。则
自脊、背、下行于太阳经也。中于颊。则自胁、肋、下行于少阳经也。脉遍周身者。惟足六经耳。故但言足也。
若饮食 甲乙作热饮食足。
其中于膺、背、两胁 亦中其经 史云。一作其中于肩、背两胁。亦下其经。张云。膺在前。阳
明经也。背在后。太阳经也。两胁在侧。少阳经也。中此三阳经。与上同。
其阴 张云。臂 内廉曰阴。手足三阴之所行也。
淖泽 史云。淖、泽也。泽液非。张云。柔润也。
不能客 史云。客一本作容。简案、甲乙作容。俱通。
邪之中人脏奈何 甲乙作邪之中脏者奈何。
愁忧恐惧（止）而上行 张云。此下言邪之中于五脏也。然必其内有所伤。而后外邪得以入之。
心藏神。忧愁恐惧则神怯。故伤心也。肺合皮毛。其脏畏寒。形寒饮冷。故伤肺也。若内有所伤。而外复有感。
则中外皆伤。故气逆而上行。在表则为寒热疼痛。在里则为喘咳呕哕等病。汪云。形寒伤外。饮寒伤内。素问
咳论云。其寒饮食入胃则肺寒。肺寒则外内合邪。与此文义正同。今人惟知形寒为外伤寒。而不知饮冷为内伤
寒。讹为阴证非也。凡饮冷者。虽无房事。而亦每患伤寒也。若房事饮冷而患伤寒。亦有在三阳经者。当从阳
症论治。不得便指为阴症也。世医不明。妄以热剂投之。杀人多矣。特揭出以告人。气逆上行。故有发热头痛
诸证。简案、气逆。甲乙作气迎。非。
伤肝 张云。肝藏血。其志为怒。其经行胁下也。
有所击仆（止）则伤肾 百病始生篇。黄帝曰。其生于阴者奈何。岐伯曰。忧思伤心。重寒伤
肺。忿怒伤肝。醉以入房。汗出当风伤脾。用力过度。若入房汗出浴则伤肾。张云。脾主肌肉。饮食击仆者。
伤其肌肉。醉后入房。汗出当
风者。因于酒食。故所伤皆在脾。肾主精与骨。用力举重则伤骨。入房过度则伤精。汗出浴水。则水邪犯其本
脏。故所伤在肾。简案、击仆与下文所谓异。
得往 张云。往、进也。
卒寒 张云。卒、猝同。
空窍 张云。空、孔同。
精阳气上走于目 张云。精阳气者。阳气之精华也。故曰。五脏六腑之精气。皆上注于目而为之精。
其别气 张云。别气者。旁行之气也。气自两侧上行于耳。气达则窍聪。所以能听。
其宗气 张云。宗气。大气也。宗气积于胸中。上通于鼻而行呼吸。所以能臭。
为臭 简案、臭、 同。许救切。说文以鼻就臭也。亦作嗅 。
其浊气 张云。浊气、谷气也。谷入于胃。气达于唇舌。所以知味。
皆上熏于面 张云。凡诸气之津液。皆上熏于面。如脉度篇曰。五脏常内阅于上七窍也。故肺气通
于鼻。心气通于舌。肝气通于目。脾气通于口。肾气通于耳。此五脏之气。皆上通于七窍。不独诸阳经络。乃
得上头也。
天气甚寒 简案、诸本及甲乙作大热甚寒。但张本与此同。上文曰天寒。而不曰天热。则作天气甚
寒为是。四十七难云。人面独能耐寒者何也。然人头者。诸阳之会也。诸阴脉皆至颈、胸中、而还。独诸阳脉
皆上至头耳。故令面耐寒也。张揭数证驳难经。今不繁引。
虚邪之中身也 八正神明论云。虚邪者。八正之虚邪气也。正邪者。身形若用力汗出。腠理开。逢
虚风。其中人
也微。故莫知其情。莫见其形。又管能篇文。与本篇略同。
命曰明（止）命曰工 张云。六十一难曰。望而知之谓之神。闻而知之谓之圣。问而知之谓之工。
切脉而知之谓之巧。盖本诸此。
与尺之相应也 甲乙作与尺之皮肤相应也。据下文皮肤二字正系缺文。甲乙为是。
桴鼓 简案、桴、 同。音浮。击鼓槌也。汉李寻传。犹 鼓之相应是也。
本末根叶之出候也 志云。夫精明五色者。气之华也。乃五脏五行之神气而见于色也。脉者荣血之
所循行也。尺者谓脉外之气血。循手阳明之络。而变见于尺肤。脉内之血气。从手太阴之经。而变见于尺寸。
此皆胃腑五脏所生之气血。本末根叶之出候也。
形肉 志云。谓尺肤也。知色脉与尺之三者。则神且明矣。
见其色（止）则已矣 张云。不得其脉。言不得其合色之正脉也。相胜之脉。如青色得毛脉。以
金克木之类是也。相生之脉。如青色得石脉。以水生木之类是也。
调其脉之缓、急、小、大、滑、涩 张云。缓、急、以至数言。小、大、滑、涩、以形体言。滑、不
涩也。往来流利。如盘走珠。涩、不滑也。虚细而迟。往来觉难。如雨沾沙。如刀刮竹。六者相为对待。调此
六者。则病变可以定矣。调、察也。
贲而起 甲乙作大字。更有脉沉者。尺之皮肤亦沉一句。据上文举六者则为剩文。张云。贲、忿奔
二音。大也。沸起也。论疾诊尺篇曰。审其尺之缓、急、小、大、滑、涩。肉之坚、脆。而病形定矣。义与此
同。简案、十三难云。脉
数、尺之皮肤亦数。脉急、尺之皮肤亦急。脉缓、尺之皮肤亦缓。脉涩、尺之皮肤亦涩。脉滑、尺之皮肤亦滑。
亦此义也。
故善调尺者（止）十全六 张云。此正本末根叶之义也以尺寸言则尺为根本寸为枝叶。以脉色言。
则脉为根本。色为枝叶。故善调尺者。不待于寸。善调脉者。不待于色也。然必能参合三者而兼行之。更为本
末皆得。而万无一失。简案、十三难云。经言知一为下工。知二为中工。知三为上工。上工者十全九。中工者
十全八。下工者十全六。周礼天官医师职云。岁终稽其医事。则以制其食。十全为上。十失一次之。十失二次
之。十失三次之。十失四为下。
心脉急 楼氏纲目云。谓色赤脉钩而急也。张云。急者弦之类。
张云。急主风寒。心主血脉。故心脉急甚。则为 。筋脉引急曰 。弛长曰 。 、炽寄
系三音。 音纵。
缓甚为狂笑 张云。心气热则脉纵缓。故神散而为狂笑。心在声为笑也。
微缓为伏梁（止）唾血 志云。伏梁乃心下有余之积。故微主邪薄于心下也。心主血。热则上
溢而时唾血也。简案、经筋篇云。手少阴之筋病。内急成伏梁。唾血脓者。死不治。
大甚为喉 甲乙作喉 。 、脉经作喉介。马云。心火充溢。喉中 然有声。简案、 字书无
义。下文云。喉中 然唾出。素咳论云。喉中 如梗状。介、芥古通。乃芥 之芥。喉间有物。有防碍之
谓。 唯是介字从口者。必非有声之义。
心痹 见五脏生成篇及痹论。
善泪出 张云。以手少阴之脉。挟咽喉。连目系也。
小甚为善哕 张云。阳张虚而胃土寒。故善哕。
微小为消瘅 马云。血液枯燥。病为消瘅。志云。消瘅者。三消之证。简案、张为肌肤消瘦之义。非。
心疝 见脉要精微论。四时刺逆从篇大奇论。
喑 张云。心脉涩甚。则血气滞于上。声由阳发。滞则为喑。
血溢 张云。涩当伤血也。简案。吐衄血之属。
维厥 史云。经络有阳维、阴维。故有维厥。马同。张云。四维厥逆也。以四肢为诸阳之本。而
血衰气滞也。
耳鸣颠疾 志云。南方赤色。入通于心。开窍于耳。心气虚。故耳鸣颠疾。简案、甲乙颠作癫。
颠、癫、 、三字并通。
肺脉急甚 楼氏云。谓色白脉毛而急也。
癫疾 张云。风邪胜也。木反乘金。故生癫疾。
微急（止）息肉不通 马云。皆肺气不足。风邪有余所致也。
多汗 张云。皮毛不固。故表虚而多汗。志云。缓则热甚。故多汗。
痿 志云。肺热叶焦。则为痿也。鼠 。寒热病也。其本在脏。其末在脉。肺主百脉。是以微
缓之有热。微涩之有寒。皆为鼠 。在颈腋之间。简案、脉经无 字。
偏风 志云。本经曰。偏枯身偏不用。病在分腠之间。盖病在皮肤。则为寒热。病在血脉。为寒
热鼠 。在分腠。则为偏风。肺主周身之气而朝百脉也。腠理开。故头以下汗出不可止。头以下者。颈、项、
胸、背之间。脉之外部也。
简案、脉经注云。一作漏风。据汗出不可止。作漏风近是。
胫肿 张云。心火烁肺。真阴必涸。故为胫肿。
肺痹 见痹论及五脏生成篇。喻氏法律云。肺痹心膈窒塞。上气不下。盖肺为相传之官。治节行
焉。管领周身之气。无微不入。是肺痹即为气痹明矣。
起恶日光 张云。以气分火盛而阴精衰也。志云。日光太阳之火。阴血少故恶日光。金畏火也。
脉经作起腰内三字。
为泄 论疾诊尺篇云。尺肤寒。其脉小者泄少气。张云。阳气虚而腑不固。病当为泄。志云。肺
与大肠为表里也。
消瘅 张云。金衰则水弱。故为消瘅。志云。肺主津。水之生原也。
息贲 张云。气血皆实热。故为息贲上气。息贲、喘急也。贲、音奔。
上下出血 张云。上言口鼻。下言二阴也。
涩甚（止）善酸矣 张云。涩脉因于伤血。肺在上焦。故涩甚当为呕血。若其微涩。气当有滞。
故为鼠 。在颈腋间。气滞则阳病。血伤则阴虚。故下不胜其上。而足膝当酸软也。酸、音酸。
肝脉急甚 楼氏云。谓色青脉弦而急也。
恶言 甲乙注。一作妄言。志云。肝主语。在志为怒。张云。言多嗔恶也。
肥气 张云。以木邪伤土。故为肥气在胁下。胁下者肝之经也。五十六难杨注云。肥气者肥盛也。
言肥气聚于左胁之下如覆杯。突出如肉。肥盛之状也。小儿多有此病。
善呕 志云。食气入胃。散精于肝。缓主多热。热则
肝气逆。故善呕。简案、马张以缓为脾脉。恐误。
水瘕痹也 甲腋无也字。是。志云。水瘕痹者。亦食饮之所积也。简案、盖水癖癖饮之类。痹、闭也。
大甚为内痈（止）为消瘅 志云。本经曰。喜怒不测。饮食不节。阴气不足。阳气有余。荣气不行。
乃发为痈。大主肝气盛。盛则郁怒而不得疏达。故为内痈。呕、衄、肝气逆于上也。阴缩、肝气逆于下也。肝
脉抵少腹。上注肺。咳引小腹者。经气逆于上下也。小者血气皆少。少则木火盛。故多饮及为消瘅也。简案、
肝痹见痹论及五脏生成篇。
疝 张云。热壅于经。故为 疝。
遗溺 张云。以肝火在下。而疏泄不禁也。
溢饮 志云。饮留于四肢。则经脉阻滞。故脉涩。脉经作淡饮。
挛筋痹 甲乙作 挛筋。张云。皆血不足以养筋也。
脾脉急甚为 张云。木乘土也。脾主肢体。而风气客之。故为 。
膈中 马云。木邪侮土。其在上为膈中。食饮入而还出。脾气不上通也。本经上膈篇云。气为上膈。
食饮入而复出。
后沃沫 志云。不能游溢津液。上归于肺。四布于皮毛。故涎沫之从口出也。简案、马云。在下为
去后沃沫。脾气不下疏也。误。
缓甚（止）若无病 张云。脾脉宜缓。而缓甚则热。脾主肌肉四肢。故脾热则为肉痿。及为厥逆。
若微缓而为风痿。四肢不用者。以土弱则生风也。痿弱在经。而脏无恙。故心慧然若无病。
击仆 张云。脾主中气。脾脉大甚为阳极。阳极则阴脱。故如击而仆地。楼氏云。凡病偏枯。必
先仆倒。故内经连名称为击仆偏枯也。
疝气 张云。以湿热在经。而前阴为太阴阳明之所合也。简案、他四脏举积名。而此独云疝气可
疑。脉经作痞气。是。五十六难云。脾之积名曰痞气。在胃脘。覆大如盘。久不愈。令人四肢不收。发黄胆。
饮食不为肌肤。杨注。痞、否也。言否结成积也。
腹里大脓血 张云。腹里大者。以脓血在肠胃之外。亦脾气壅滞所致。简案、脉经无腹字。里、
作裹。素腹中论云。伏梁裹大脓血。居肠胃之外。此则痞气而裹大脓血。在肠胃之外也。
寒热 张云。中焦之阳气不足也。志云。血气虚也。
消瘅 志云。脾虚而不能为胃行其津液。故为消瘅。
癃 张云。脾脉滑甚。太阴实热也。太阴合宗筋。故为 癃疝。
蝎 张云。其微滑湿热在脾。湿热薰蒸。故生诸虫。及为腹热。简案、 、 、蛔、并音回。
说文。 、腹中长虫。尔雅注。蝎、木中蠹虫。刘勰新论云。身之有欲。如树之有蝎。
涩甚（止）下脓血 张云。脾脉涩甚而为肠 。微涩而为内 。及多下脓血者。以涩为气滞血伤。
而足太阴之别入络肠胃也。肠 、内 。远近之分耳。一曰下肿病。盖即疝漏之属。简案、脉经肠 作肠颓。
内作内溃。（甲乙同颓作 注云 一作溃）盖二证各别。肠 四种 病之一。见千金方内 则。马亦以溃字
释之。然不详其为何证。张云。疝漏之属。姑仍之。
Ma Yun states: The first three sections of this chapter discuss the invasion of pathogenic factors into the Zang and Fu organs; the fourth section discusses the manifestations of disease. Hence, the chapter is named "Pathogenic Factors, Zang-Fu Organs, and Disease Manifestations."
Pathogenic factors attack the upper part of the body. The commentary *Zhi* notes: By "pathogenic factors," we refer to wind, rain, cold, and heat, which are heavenly pathogenic factors. Therefore, they attack the upper part of the body. Dampness is the Qi of earth and water, so it attacks the lower half of the human body. These are pathogenic factors of heaven and earth; when invading the human body, they have distinctions between upper and lower locations.
Flowing into the Fu organs. In the *Jia Yi Jing*, "liu" (flow) is written as "liu" (stay). Ma Yun argues that "liu" should be read as "liu" (flow). The same applies to "flowing into the meridians" later in the text.
Different names but the same category. Zhang Yun: The meridians interconnect and form a unity, originally belonging to the same category. However, since the upper, lower, left, and right locations each have their specific affiliations, the names of Yin and Yang differ.
The meeting point of all Yang meridians... then descends to Shaoyang. Zhang Yun: This refers to pathogenic factors invading the Yang meridians. The six Yang meridians of the hand and foot all converge at the head and face, hence called the "meeting point of all Yang meridians." All three Yang meridians of the foot run from the head to the feet. Therefore, if attacked on the face, the pathogen descends from the chest and abdomen into the Yangming meridian; if attacked on the nape, it descends from the spine and back into the Taiyang meridian; if attacked on the cheek, it descends from the flanks and ribs into the Shaoyang meridian. Only the six foot meridians have pulse qi circulating throughout the entire body. Thus, only the foot meridians are discussed here.
Regarding diet. The *Jia Yi Jing* reads "hot beverages and food."
Attacking the Ying (chest), back, and lateral hypochondrium. It also attacks the corresponding meridians. Shi Yun: One version reads attacking the shoulder, back, and lateral hypochondrium, descending into their respective meridians. Zhang Yun: The Ying is anterior, belonging to the Yangming meridian; the back is posterior, belonging to the Taiyang meridian; the lateral hypochondrium is lateral, belonging to the Shaoyang meridian. Attacking these three Yang meridians is the same as described above.
As for the Yin meridians. Zhang Yun: The medial aspect of the arm is called Yin, where the three Yin meridians of the hand and foot travel.
Moist and lubricating. Shi Yun: Na and Ze mean moist/lubricating. "Ze ye" (ze fluid) is incorrect. Zhang Yun: Refers to softness and moisture.
Cannot accommodate (host) the pathogen. Shi Yun: Ke (guest/host) is written as Rong (contain) in one version. Brief note: The *Jia Yi Jing* writes "Rong"; both are acceptable.
How do pathogenic factors invade the Zang organs? The *Jia Yi Jing* reads "How do pathogenic factors invade the Zang organs?"
Sorrow, worry, fear... ascend upwards. Zhang Yun: The following text discusses pathogenic factors invading the Five Zang organs. However, there must be internal injury first before external pathogenic factors can enter. The Heart stores Shen (Spirit); sorrow and fear cause Shen to become weak, thus injuring the Heart. The Lung combines with skin and hair; its organ fears cold. External cold on the body or drinking cold liquids injures the Lung. If there is internal injury and external contraction simultaneously, both interior and exterior are injured, causing Qi to rebel and ascend. On the exterior, this manifests as chills, fever, and pain; on the interior, as wheezing, coughing, vomiting, and hiccups. Wang Yun: External cold injures the exterior; cold drinks injure the interior. The *Su Wen: Cough Treatise* states: "Cold food and drink entering the stomach causes Lung cold; Lung cold leads to combined external and internal pathogens." This aligns perfectly with the meaning of this text. Modern practitioners only know that external cold is an external injury but fail to realize that cold drinks constitute an internal cold injury, erroneously classifying them as Yin syndromes. Anyone consuming cold drinks may suffer from Cold Damage even without sexual activity. If Cold Damage occurs after sexual activity and consumption of cold drinks, it may still involve the Three Yang meridians and should be treated as a Yang syndrome, not immediately labeled as a Yin syndrome. Physicians ignorant of this often recklessly administer hot remedies, causing many deaths. I highlight this to warn others. Due to rebellious Qi ascending, symptoms such as fever and headache arise. Brief note: "Qi rebellion" is written as "Qi meeting" in the *Jia Yi Jing*, which is incorrect.
Injuring the Liver. Zhang Yun: The Liver stores Blood, its emotion is anger, and its meridian runs along the hypochondrium.
Being struck or fallen... then injures the Kidney. In the *Chapter on the Origin of All Diseases*, Huangdi asks: How do diseases originate from Yin? Qibo answers: Worry and thought injure the Heart; severe cold injures the Lung; anger injures the Liver; intercourse while drunk with sweat exposed to wind injures the Spleen; excessive physical effort, or bathing with sweat after intercourse, injures the Kidney. Zhang Yun: The Spleen governs muscles; injuries from eating, striking, or falling damage the muscles. Intercourse after drunkenness, sweating, and exposure to wind involves wine and food, so the injury lies in the Spleen. The Kidney governs Essence and bones; lifting heavy weights damages bones; excessive intercourse damages Essence; bathing with sweat allows Water pathogen to invade its home organ, so the injury lies in the Kidney. Brief note: "Striking and falling" differs from what follows below.
To go forward (advance). Zhang Yun: Wang means advance.
Suddenly cold. Zhang Yun: Cu is identical to "cu" (sudden).
Empty orifices. Zhang Yun: Kong is identical to "kong" (hole/orifice).
Essence and Yang Qi flow upward to the eyes. Zhang Yun: Essence and Yang Qi refer to the essence of Yang Qi. Thus it is said: The essence and Qi of the Five Zang and Six Fu organs all ascend to the eyes to form vision.
Its separate Qi. Zhang Yun: Separate Qi refers to Qi flowing sideways. Qi ascends from the sides to the ears; when Qi reaches, the orifice becomes clear, enabling hearing.
Its Zong Qi (Gathering Qi). Zhang Yun: Zong Qi is Great Qi. Zong Qi accumulates in the chest, connects upward to the nose, and governs respiration, enabling smell.
For smell (olfaction). Brief note: Chou is identical to "xiu" (smell). Pronounced Xu Jiu. The *Shuo Wen* explains it as bringing the nose to the odor. Also written as "xiu".
Its turbid Qi. Zhang Yun: Turbid Qi refers to Grain Qi. Grain enters the Stomach, and Qi reaches the lips and tongue, enabling taste.
All steam upward onto the face. Zhang Yun: The fluids and Qi of all types steam upward onto the face. As stated in the *Mai Du Chapter*: The Five Zang organs constantly inspect the seven upper orifices internally. Thus, Lung Qi connects to the nose, Heart Qi to the tongue, Liver Qi to the eyes, Spleen Qi to the mouth, and Kidney Qi to the ears. The Qi of these five Zang organs all connects upward to the seven orifices, not just the Yang meridians reaching the head.
Heavenly weather is very cold. Brief note: Most editions and the *Jia Yi Jing* read "Great heat and severe cold," but Zhang's edition matches this text. Since the previous text mentions "Heavenly cold" and not "Heavenly heat," reading it as "Heavenly weather is very cold" is correct. The *Nan Jing 47* asks: Why can the human face alone resist cold? The answer is: The head is the meeting point of all Yang meridians. All Yin meridians reach the neck and chest and return; only the Yang meridians ascend to the head and ears, allowing the face to resist cold. Zhang lists several arguments refuting the *Nan Jing*; I will not cite them extensively here.
Deficient pathogenic factors invading the body. The *Ba Zheng Shen Ming Lun* states: Deficient pathogenic factors refer to the deficient Qi of the Eight Norms. Regular pathogenic factors occur when the body exerts force, sweats, opens the cou li (pores), and encounters deficient wind. The invasion is slight, so one does not perceive its nature or see its form. This passage is similar to the *Guan Neng Chapter*.
Named Ming (Bright)... Named Gong (Skillful). Zhang Yun: The *Nan Jing 61* states: Knowing through observation is Shen (Divine); knowing through listening/smelling is Sheng (Sage); knowing through questioning is Gong (Skillful); knowing through pulse palpation is Qiao (Clever). This likely originates from here.
Corresponding to the Chi (wrist) area. The *Jia Yi Jing* reads "corresponding to the skin of the Chi area." Based on the subsequent mention of "skin," this phrase was missing in earlier versions; the *Jia Yi Jing* is correct.
Drumstick and drum. Brief note: Fu is identical to "fu" (drumstick). Pronounced Fu. A drumstick used for beating drums. Han Dynasty Li Xun Biography: "Like a drumstick responding to a drum."
The indications emerging from the root and branches, trunk and leaves. Zhi Yun: The clarity and five colors are the splendor of Qi, manifesting the divine Qi of the Five Zang and Five Elements in the complexion. The Mai (pulse) is where Ying Blood circulates. Chi refers to the Qi and Blood outside the pulse, changing and appearing in the Chi skin via the Luo vessels of the Hand-Yangming meridian. The Qi and Blood inside the pulse change and appear in the Cun and Chi positions via the Jing meridians of the Hand-Taiyin meridian. These are all Qi and Blood generated by the Stomach Fu and Five Zang organs, representing the indications of roots/branches and trunks/leaves.
Form and flesh. Zhi Yun: Refers to the Chi skin. Knowing the combination of color, pulse, and Chi makes one wise and clear.
Seeing the color... then it is finished. Zhang Yun: "Not obtaining the pulse" means not obtaining the correct pulse corresponding to the color. Pulses of mutual overcoming, such as getting a Mao (feather-like) pulse for a Green color, represent Metal overcoming Wood. Pulses of mutual generation, such as getting a Shi (stone-like) pulse for a Green color, represent Water generating Wood.
Regulate the pulse's slow, rapid, small, large, slippery, and choppy qualities. Zhang Yun: Slow and rapid refer to frequency; small, large, slippery, and choppy refer to shape. Slippery means not choppy. It flows smoothly back and forth, like pearls rolling in a plate. Choppy means not slippery. It is empty, fine, and slow, difficult to move back and forth, like rain soaking sand or a knife scraping bamboo. These six oppose each other. Regulating these six allows the determination of pathological changes. Tiao means to examine.
Surging and rising. The *Jia Yi Jing* reads "Large character." There is another sentence: "If the pulse is deep, the Chi skin is also deep." Given the previous listing of six qualities, this seems redundant. Zhang Yun: Ben has pronunciations Fen and Ben, meaning large and boiling up. The *Lun Ji Zhen Chi Chapter* states: Examine the Chi skin's slow, rapid, small, large, slippery, and choppy qualities, and the firmness or fragility of the flesh, to determine the disease manifestation. The meaning is the same. Brief note: The *Nan Jing 13* states: If the pulse is rapid, the Chi skin is also rapid; if rapid/tense, the Chi skin is tense; if slow, the Chi skin is slow; if choppy, the Chi skin is choppy; if slippery, the Chi skin is slippery. This shares the same principle.
Therefore, those skilled in regulating the Chi... perfect six out of ten. Zhang Yun: This confirms the meaning of root/branch and trunk/leaf. Regarding Cun and Chi positions, Chi is the root, and Cun is the branch; regarding pulse and color, the pulse is the root, and color is the branch. Therefore, those skilled in examining the Chi need not rely on the Cun; those skilled in examining the pulse need not rely on color. However, one must integrate all three and practice them together to grasp both root and branch, ensuring no mistakes. Brief note: The *Nan Jing 13* states: The Classic says knowing one is a Lower Physician, knowing two is a Middle Physician, knowing three is an Upper Physician. An Upper Physician cures nine out of ten; a Middle Physician cures eight out of ten; a Lower Physician cures six out of ten. The *Zhou Li: Tian Guan: Physician Office* states: At year-end, reviewing medical affairs determines their salary. Ten successes is best; one failure is next; two failures is next; three failures is next; four failures is worst.
Heart pulse extremely tense. Lou's Gang Mu states: Refers to red color and hook-shaped, tense pulse. Zhang Yun: Tense is similar to Xian (bowstring).
Zhang Yun: Tenseness indicates Wind-Cold. The Heart governs Blood vessels; thus, an extremely tense Heart pulse leads to spasm and flaccidity. Tension pulling tendons is called Si (spasm); relaxation and elongation is called Zhong (flaccidity). Si, Chi, Ji are three pronunciations. Zhong is pronounced Zong.
Extremely relaxed leads to manic laughter. Zhang Yun: Heart Qi heat causes the pulse to relax and slacken, leading to scattered Spirit and manic laughter. The sound of the Heart is laughter.
Slightly relaxed indicates Fu Liang (sub-diaphragmatic mass)... spitting blood. Zhi Yun: Fu Liang is an accumulation excess below the heart; "slightly" indicates pathogen pressing against the sub-diaphragm. The Heart governs Blood; heat causes it to overflow upward, resulting in occasional spitting of blood. Brief note: The *Jing Jin Chapter* states: Disease of the Hand-Shaoyin tendon channel, internal tension forming Fu Liang, spitting blood and pus indicates incurable death.
Extremely large indicates throat obstruction. The *Jia Yi Jing* reads "throat jie." Bi, Mai Jing writes "throat jie." Ma Yun: Heart fire overflows, causing a bi sensation in the throat with sound. Brief note: The character "bi" has no meaning in dictionaries. Later text says: Spitting out with a bi sensation in the throat. *Su Wen: Cough Treatise* says: Throat feels blocked like a stalk. Jie and Jie are anciently interchangeable, referring to the seed of a mustard plant, implying an object in the throat causing obstruction. The character "bi" with the mouth radical certainly does not imply sound.
Heart Bi (Obstruction). See *Wu Zang Sheng Cheng Chapter* and *Bi Lun*.
Prone to tearing. Zhang Yun: Because the Hand-Shaoyin meridian flanks the throat and connects to the eye system.
Extremely small leads to frequent hiccups. Zhang Yun: Yang expands due to deficiency, and Stomach Earth becomes cold, hence frequent hiccups.
Extremely minute indicates Xiao Dao (wasting-thirst). Ma Yun: Blood and fluids are dry, leading to wasting-thirst. Zhi Yun: Xiao Dao refers to the three wasting-thirst syndromes. Brief note: Zhang interprets it as emaciation of skin and flesh, which is incorrect.
Heart Shan (Hernia). See *Mai Yao Jing Wei Lun*, *Si Shi Ci Ni Cong Chapter*, and *Da Qi Lun*.
Aphonia. Zhang Yun: Extremely choppy Heart pulse causes Qi and Blood to stagnate upward. Voice originates from Yang; stagnation leads to aphonia.
Blood hemorrhage. Zhang Yun: Choppy pulse indicates Blood injury. Brief note: Includes hematemesis and epistaxis.
Wei Jue (Contraction of the Vessels). Shi Yun: The meridians have Yang Wei and Yin Wei, hence Wei Jue. Ma agrees. Zhang Yun: Contraction of the four extremities. Since the four limbs are the root of all Yang meridians, this results from Blood deficiency and Qi stagnation.
Tinnitus and epilepsy. Zhi Yun: Southern Red Color enters and communicates with the Heart, opening into the ears. Heart Qi deficiency causes tinnitus and epilepsy. Brief note: *Jia Yi Jing* writes Dian instead of Dian. Dian, Dian, and Dian are interchangeable.
Lung pulse extremely tense. Lou's states: Refers to white color and Mao (feather-like), tense pulse.
Epilepsy. Zhang Yun: Wind pathogen prevails. Wood counter-attacks Metal, thus generating epilepsy.
Slightly tense... polypus obstruction. Ma Yun: Both result from Lung Qi insufficiency and excess Wind pathogen.
Excessive sweating. Zhang Yun: Skin and hair are not secure, leading to exterior deficiency and excessive sweating. Zhi Yun: Relaxation indicates severe heat, hence excessive sweating.
Atrophy and limpness. Zhi Yun: Lung heat scorches the leaves, leading to atrophy. Shu Lou is a cold-heat disease. Its root is in the Zang, its branch in the meridians. The Lung governs the hundred meridians; thus, slight relaxation with heat or slight choppy with cold both lead to Shu Lou in the neck and axilla. Brief note: *Mai Jing* lacks the character "Pi".
Hemiplegia/Wind. Zhi Yun: The Classic states: Hemiplegia, inability to use one side of the body, disease lies between the fen cou (muscle intervals). Disease in the skin causes cold-heat; disease in the blood vessels causes cold-heat and Shu Lou; disease in the fen cou causes hemiplegia/wind. The Lung governs the Qi of the whole body and directs the hundred meridians. When cou li open, sweat below the head cannot stop. "Below the head" refers to the neck, nape, chest, and back, the external part of the meridians.
Brief note: *Mai Jing* annotation says: Alternatively written as Lou Feng (Leaking Wind). Given "sweat cannot stop," Lou Feng is closer to the truth.
Calf swelling. Zhang Yun: Heart fire scorches the Lung, True Yin must dry up, thus causing calf swelling.
Lung Bi. See *Bi Lun* and *Wu Zang Sheng Cheng Chapter*. Yu Shi's Legal Principles states: Lung Bi causes blockage in the heart and diaphragm, with upward Qi failing to descend. The Lung is the official of transmission, governing regulation, managing the Qi of the whole body, penetrating every detail; thus, Lung Bi is clearly Qi Bi.
Fear of sunlight. Zhang Yun: Due to Fire prosperity in the Qi division and decline of Yin Essence. Zhi Yun: Sunlight is Solar Fire; low Yin Blood causes fear of sunlight; Metal fears Fire. *Mai Jing* adds the characters "starts from waist inside."
Diarrhea. The *Lun Ji Zhen Chi Chapter* states: Cold Chi skin and small pulse indicate diarrhea and Qi deficiency. Zhang Yun: Yang Qi deficiency and unstable Fu organs lead to diarrhea. Zhi Yun: The Lung and Large Intestine are exterior-interior pairs.
Wasting-thirst. Zhang Yun: Metal decline leads to Water weakness, thus wasting-thirst. Zhi Yun: The Lung governs Jin Ye (fluids), the source of Water.
Xi Ben (Panting/Suffocation). Zhang Yun: Both Qi and Blood are excess and hot, thus causing Xi Ben and upward Qi. Xi Ben means panting urgency. Ben is pronounced Ben.
Bleeding from above and below. Zhang Yun: Above refers to mouth and nose; below refers to the two yin orifices.
Extremely choppy... prone to soreness. Zhang Yun: Choppy pulse results from Blood injury. The Lung is in the Upper Jiao; thus, extremely choppy pulse should cause vomiting blood. If slightly choppy, Qi stagnates, leading to Shu Lou in the neck and axilla. Qi stagnation causes Yang pathology; Blood injury causes Yin deficiency; thus, the lower cannot support the upper, and knees and legs feel sore and weak. Suan is pronounced Suan.
Liver pulse extremely tense. Lou's states: Refers to green color and Xian (bowstring), tense pulse.
Disliking speech. *Jia Yi Jing* annotation: Alternatively written as Wang Yan (delirious speech). Zhi Yun: The Liver governs speech, its emotion is anger. Zhang Yun: Speaking with much irritation/dislike.
Fei Qi (Fleshy Mass). Zhang Yun: Wood pathogen injures Earth, thus Fei Qi forms under the hypochondrium. The hypochondrium is the Liver meridian. Yang's commentary on *Nan Jing 56* states: Fei Qi means fleshy abundance. It gathers under the left hypochondrium like an inverted cup, protruding like meat, in a state of fleshy abundance. Children often have this disease.
Prone to vomiting. Zhi Yun: Food Qi enters the Stomach, disperses essence to the Liver. Relaxation indicates much heat; heat causes Liver Qi to rebel, hence prone to vomiting. Brief note: Ma and Zhang interpret relaxation as the Spleen pulse, which is likely incorrect.
Water Jia Bi (Abdominal Mass). The character "ye" is absent in the axillary text, which is correct. Zhi Yun: Water Jia Bi is also an accumulation from food and drink. Brief note: Likely similar to Shui Pi (water retention) or Pi Yin (accumulated fluid). Bi means closure.
Extremely large indicates internal abscess... wasting-thirst. Zhi Yun: The Classic states: Unpredictable joy and anger, irregular diet, Yin Qi insufficiency, Yang Qi excess, Ying Qi stagnation, leading to abscess formation. "Large" indicates Liver Qi prosperity. Prosperity leads to depression and anger without smooth flow, thus internal abscess. Vomiting and epistaxis indicate Liver Qi rebelling upward. Yin retraction indicates Liver Qi rebelling downward. The Liver meridian reaches the lower abdomen and pours into the Lung; cough drawing pain to the lower abdomen indicates Qi rebellion up and down. "Small" indicates both Blood and Qi are scarce. Scarcity leads to Wood-Fire prosperity, hence excessive drinking and wasting-thirst. Brief note: Liver Bi is seen in *Bi Lun* and *Wu Zang Sheng Cheng Chapter*.
Shan (Hernia). Zhang Yun: Heat obstructs the meridian, thus causing Shan hernia.
Urinary incontinence. Zhang Yun: Liver fire is below, leading to uncontrolled drainage.
Yi Yin (Overflowing Drink). Zhi Yun: Fluid retained in the four limbs blocks the meridians, hence the pulse is choppy. *Mai Jing* reads "Dan Yin."
Tendon cramping and tendon Bi. The *Jia Yi Jing* reads "Tendon cramping." Zhang Yun: Both result from Blood insufficient to nourish tendons.
Spleen pulse extremely tense leads to spasm. Zhang Yun: Wood overacts on Earth. The Spleen governs limbs and body; Wind pathogen invades, thus causing spasm.
Ge Zhong (Diaphragmatic Obstruction). Ma Yun: Wood pathogen insults Earth; when located above, it is Ge Zhong. Food and drink enter and return out; Spleen Qi fails to ascend. The Classic *Shang Ge Chapter* states: Qi causes Upper Ge, food and drink enter and return out.
Posterior profuse saliva. Zhi Yun: Unable to circulate and overflow Jin Ye, ascend to return to the Lung, and distribute to skin and hair, thus saliva flows from the mouth. Brief note: Ma Yun: Located below, it is posterior profuse saliva, Spleen Qi fails to descend. Incorrect.
Extremely relaxed... as if healthy. Zhang Yun: Spleen pulse should be relaxed; extreme relaxation indicates heat. The Spleen governs muscles and four limbs; thus, Spleen heat causes Muscle Atrophy and Jue Ni (reversal cold). If slightly relaxed leading to Wind Atrophy and limb paralysis, it is because Earth weakness generates Wind. Atrophy lies in the meridians, while the Zang organs are intact, hence the Heart remains clear as if healthy.
Striking and falling. Zhang Yun: The Spleen governs Middle Qi; extremely large Spleen pulse indicates Extreme Yang; Extreme Yang leads to Yin collapse, thus falling as if struck. Lou's states: Any case of hemiplegia must first involve falling; hence the Inner Classic links the name as Striking-Falling Hemiplegia.
Shan Qi (Hernia Qi). Zhang Yun: Damp-Heat in the meridian, and the anterior yin is the convergence of Taiyin and Yangming. Brief note: It is suspicious that the other four Zang list accumulation names, while this one only says Shan Qi. *Mai Jing* reads "Pi Qi," which is correct. *Nan Jing 56* states: The accumulation of the Spleen is named Pi Qi, located in the epigastrium, covering a large area like a plate. If not cured for long, it causes limb inactivity, jaundice, and food failing to nourish the flesh. Yang's commentary: Pi means Pi (blocked), indicating blockage forming an accumulation.
Large abdominal abscess and blood. Zhang Yun: "Large abdominal" means abscess and blood are outside the intestines and stomach, also caused by Spleen Qi stagnation. Brief note: *Mai Jing* lacks the character "Fu" (abdomen). "Li" is written as "Guo" (wrap). *Su Wen: Fu Zhong Lun* states: Fu Liang wraps large abscess and blood, residing outside the intestines and stomach. This is Pi Qi wrapping large abscess and blood outside the intestines and stomach.
Chills and fever. Zhang Yun: Insufficient Yang Qi in the Middle Jiao. Zhi Yun: Qi and Blood deficiency.
Wasting-thirst. Zhi Yun: Spleen deficiency fails to transport Jin Ye for the Stomach, thus wasting-thirst.
Long Shan (Difficulty Urinating/Hernia). Zhang Yun: Extremely slippery Spleen pulse indicates Taiyin Excess Heat. Taiyin combines with Zong Jin (tendons), thus causing Long Shan hernia.
Abdominal insects. Zhang Yun: Slightly slippery indicates Damp-Heat in the Spleen; Damp-Heat steaming generates various worms and abdominal heat. Brief note: Nao, Hui, and Xie are all pronounced Hui. *Shuo Wen*: Nao, long worms in the abdomen. *Er Ya* annotation: Xie, wood-boring insect. Liu Xie's *Xin Lun* states: Desires in the body are like borers in trees.
Extremely choppy... passing pus and blood. Zhang Yun: Extremely choppy Spleen pulse leads to Chang Pi (dysentery); slightly choppy leads to Nei Kui (internal ulceration); frequent passing of pus and blood occurs because choppy indicates Qi stagnation and Blood injury, and the collateral of Foot-Taiyin enters and connects to the intestines and stomach. Chang Pi and Nei Kui are merely differences in distance. Another view calls it Xia Zhong disease, likely belonging to Shan Lou (hernia fistula). Brief note: *Mai Jing* writes Chang Tui for Chang Pi, and Nei Kui for Nei Kui. (*Jia Yi* same, Tui annotated as Kui). These two conditions are distinct. Chang Tui is one of four diseases, seen in *Qian Jin Fang* Nei Kui section. Ma also interprets Kui, but does not detail the condition. Zhang Yun: Belongs to Shan Lou; I retain this interpretation.