吴据全元起。改为决死生论。
众多博大 志云。离合真邪论曰。余闻九针九篇。夫子乃因而九之。九九八十一篇。余尽通其意矣。
此盖言先立针经八十一篇。论九针之道。然众多博大。不可胜数。故愿闻要道。○吴以黄帝问曰余闻九针于夫
子以下九十九字。为冗文。
属子孙 马云。属。嘱同。张云。属。付也。
着之骨髓 马云。着。着同。张云。着。纪也。
歃血 马云。歃。孟子云。束牲载书。而不歃血。简按左传正义云。凡盟礼。杀牲歃血。告誓神明。
若有背违。欲令神加殃咎。使如此牲也。礼曲礼疏。割牲左耳。盛以珠盘。又取血。盛以玉敦。用血为盟书。
书成乃歃血读书。熊音。歃。音霎。
更立 宋本。立。作互。马志并同。
九野 吴云。九州之分野。张云。即洛书九宫。禹贡九州之义。简按淮南原道训。上通九天。下贯九
野。高诱注云。九天。八方中央也。九野亦如之。又天文训。天有九野。九千九百九十九隅。去地五亿万里。
注云。九野。九天之野也。王注据尔雅。未允。
有下部有中部有上部 吴本。作有上部有中部有下部。
指而导之乃以为真 张云。必受师之指授。庶得其真也。高云。必以指循切。而按导之。乃为部候之
真。简按张注似是。真。当质。王注。有礼曰疑事无质质成也之文。明是字之误。吴本。直改作质。盖据王注。
两额之动脉 张云。额旁动脉。当颔厌之分。足少阳脉气所行也。简按马以为瞳子 听会等处。非。
两颊之动脉 张云。即地仓大迎之分。足阳明脉气所行也。
耳前之动脉 张云。即和 之分。手少阳脉气所行也。
形藏四 志云。胃与大肠小肠膀胱。藏有形之物也。高同。简按形藏四。诸家并仍王义。然头角耳
目口齿。理不宜谓之藏。考周礼天官疾医职云。参之以九藏之动。郑注。正藏五。又有胃膀胱大肠小肠。志注
有所据。今从之。
去其血脉 马云。去其脉中之结血。吴云。谓去其瘀血之在脉者。盖瘀血壅塞脉道。必先去之。而后
能调其气之虚实也。
如参舂 高云。此上彼下。彼上此下。不相合也。
目内陷者死 张云。五脏六腑之精气。皆上注于目。而为之精。目内陷者。阳精脱矣。故必死。吴
移下文足太阳气绝者。其足不可屈伸。死必戴眼十六字。次于目内陷者死之下。
独热者病独寒者病 简按诸家不注。盖热乃滑之谓。寒乃紧之谓。志云。寒热者。三部皮肤之寒热也。
恐非是。
独陷下者病 志云。沉陷而不起也。独大独疾独热者。大过也。独小独迟独陷下者。不及也。
以左手足上上 甲乙。手下。有于左二字。无一上字。吴改作以左手于病者足上上去踝。
庶右手足 甲乙。庶。作以。无足字。并与新校正所引异。吴改作以右手取病者足。诸家皆仍原文释
之。志云。此候生阳之气。以知病之死生也。张云。手足之络。皆可取而验之。手踝之上。手太阴肺络也。足
踝之上。足太阴脾络也。肺藏气。而主治节。脾属土。而主灌溉。故可取之以察吉凶。简按诸家随文诠释。虽
其义略通。然不若文本甲乙为正。而注意以吴为允。
其应 马云。凡曰应者。应医工之指下也。
蠕蠕然 熊音。蠕。而 切。虫行貌。张云。谓其软滑而匀和也。
浑浑然 马云。当作混混。不清也。简按混。浑。古通用。淆杂也。老子。浑兮其如浊。不必改字。
是以脱肉 甲乙。无是以二字。似是。
身不去者 简按马注刺要论体解 然不去矣云。不能行动而去也。张云。不能动摇来去也。乃并仍王
注。志云。邪留于身。而不去者死也。非。
其脉代而钩 高云。代者。乍疏之象也。代而钩者。乍数之象也。承上文乍疏乍数而言。若其脉代
而钩者。乃经络内外不通。故病在络脉。不死也。
一候后则病 志云。一候不应。是天地人之气失其一矣。故主病。高云。脉有浮中沉三候。一候后者。
浮以候之。脉
不应指。不应则病矣。简按以三部为浮中沉。 于难经。便取而释之。非。
先知经脉 吴云。经常不病之脉。
以平旦死 吴云。平旦之际。昏明始判之时。阴阳交会之期也。故寒热交作之病。以斯时死。
以日夕死 张云。日夕者。一日之秋也。风木同气。遇金而死。高云。病风者。秋金肃杀之气。病
于肺也。日夕。乃申酉之时。肺金主气。肺脏病。故以日夕死。
七诊虽见 简按七诊。诸家仍王义。为前文独小独大等之义。无复异论。而志云。七诊。谓沉细悬
绝盛躁喘数寒热热中病风病水。土绝于四季也。乃至下文风起之病。似七诊之病。而穷矣。熊宗立脉决云。七
诊者。诊宜平旦。一也。阴气未动。二也。阳气未散。三也。饮食未进。四也。经脉未盛。五也。络脉调匀。
六也。气血未乱。七也。张则谓。此七者。焉得皆谓之诊。总之一平旦诊法耳。后世遂尔谬传。竟致失其本原矣。
似七诊之病而非也 张云。风者。阳病也。故偶感于风。则阳分之脉。或大或疾。经月者。常期也。
故适值去血。则阴分之脉。或小或迟。或为陷下。此皆似七诊之脉。而实非也。皆不可以言死。然则非外感及
经月之病。而得七诊之脉者。非吉兆也。
脉候亦败者死矣 张云。此承上文。而言风气经月之病。本非七诊之类。若其果系脉息证候之败者。
又非不死之比。简按王以脉候为脉应。张则为脉息证候。王注似是。
以上下逆从循之 张云。上下逆从。各因其次。以治之也。简按循。盖因循病之所在而治之义。与
上文切循其脉之循自异。
孙络病者治其孙络血 灵脉度篇云。经脉为里。支而横者为络。络之别者为孙。盛而血者。疾诛之。
简按新校正。引甲乙。络病者治其络血。无二孙字。今甲乙无血字。
在奇邪 马云。其有奇邪者。不正之邪。适然所中者。吴云。奇邪。奇经之邪。张云。奇邪者。不入
于经。而病于络也。邪客大络。则左注右。右注左。其气无常处。故常缪刺之。简按马。在。读为有。
留瘦不移 吴。改瘦作 。注云。 。论语人焉 哉之 。匿也。言病邪留匿而不移。简按通评虚实
论。瘦留着。滑。改瘦作 。吴亦从之。并似不稳。
节而刺之 张云。凡病邪久留不移者。必于四肢八溪之间。有所结聚。故当于节之会处。索而刺之。
志高同。简按当从王注。
见通之 新校正。引甲乙。是。
瞳子高者 张云。瞳子高者。目上视也。戴眼者。上视之甚。而定直不动也。马云。此章（二十五
字）为第八节之脱简。吴直移之于前文足太阳气绝者云云之后。
手指及手外踝上五指留针 马云。王注以为错简者。是也。愚疑是第七节中手徐徐然下之脱简。简
按此一句。吴以为血实于上之治法。志高并以为刺手太阳。而补足太阳之治。俱不可从。
Wu Kun, relying on Quan Yuanqi's interpretation, changed the chapter title to "Jue Si Sheng Lun" (Treatise on Determining Life and Death).
Ma Shi's commentary states: In the "Li He Zhen Xie Lun" (Treatise on Separating True from Pathogenic Factors), it is said: "I have heard that there are nine chapters on the Nine Needles, and the Master expanded them into eighty-one chapters of nine times nine. I have thoroughly understood their meaning." This likely refers to the prior establishment of the "Zhen Jing" (Classic of Acupuncture) consisting of eighty-one chapters, discussing the principles of the Nine Needles. However, the content is vast and numerous, beyond counting; therefore, [the Emperor] wishes to hear the essential principles. ○ Wu Kun considers the ninety-nine characters starting from "The Yellow Emperor asked: I have heard of the Nine Needles from the Master..." as redundant text.
Ma Shi's commentary states: "Shu" (属) is identical to "Zhu" (嘱), meaning to entrust or instruct. Zhang Jingyue's commentary states: "Shu" means to deliver or commit.
Ma Shi's commentary states: "Zhuo" (着) is identical to "Zhuo" (著), meaning to record or inscribe. Zhang Jingyue's commentary states: "Zhuo" means to record or document.
Ma Shi's commentary states: "Sha Xue" (歃血 - smearing blood), Mencius said: "Binding the victim and placing the covenant upon it, without smearing blood." Xiong Zongli, citing the *Zhengyi* (Correct Meaning) of the *Zuo Zhuan*, stated: For all alliance rituals, a victim is slaughtered and blood is smeared [on the lips] to swear before the gods. If one violates the oath, may the gods inflict calamity upon such a person, just as upon this victim. The *Subcommentary* to the *Qu Li* chapter of the *Book of Rites* states: The left ear of the victim is cut off and placed in a pearl dish; blood is taken and placed in a jade vessel. A covenant book is written using the blood. After the book is completed, the participants smear blood [on their lips] and read the covenant. Xiong Zongli provides the pronunciation for "Sha": it sounds like "Sa".
In the Song edition, the character "Li" (立) is written as "Hu" (互). Ma Shi and Gao Shishi share this view.
Wu Kun's commentary states: "Jiu Ye" (九野 - Nine Fields) refers to the celestial divisions corresponding to the Nine Provinces. Zhang Jingyue's commentary states: It refers to the Nine Palaces of the Luo Shu and the concept of the Nine Provinces in the *Yu Gong*. Xiong Zongli cites the *Yuan Dao Xun* (Chapter on Original Principles) of the *Huainanzi*: "Reaching up to the Nine Heavens, penetrating down through the Nine Fields." Gao You's commentary states: "Nine Heavens" refers to the eight directions plus the center. "Nine Fields" is similar. Furthermore, the *Tian Wen Xun* (Chapter on Astronomy) states: "Heaven has Nine Fields, with 9,999 corners, five hundred million li away from the earth." The commentary states: "Nine Fields" are the fields of the Nine Heavens. Wang Bing relied on the *Erya*, which I consider insufficiently accurate.
Some versions read "You Xia Bu, You Zhong Bu, You Shang Bu" (There is the lower part, middle part, upper part). Wu Kun's version reads "You Shang Bu, You Zhong Bu, You Xia Bu".
Zhang Jingyue's commentary states: One must receive instruction from the teacher to attain the true essence. Gao Shishi's commentary states: One must use fingers to trace and press, guiding the pulse, to find the true nature of the section palpation. Xiong Zongli notes that Zhang's annotation seems reasonable. The character "Zhen" (真 - true) should likely be "Zhi" (质 - substance/evidence). Wang Bing's commentary includes the text "Rites say: Doubtful matters lack substance; substance leads to resolution," clearly indicating a textual error. Wu Kun's version directly changes it to "Zhi", likely based on Wang Bing's note.
Zhang Jingyue's commentary states: The arterial pulse on the side of the forehead is located at the Han Yan point, where the Qi of the Foot Shaoyang meridian travels. Xiong Zongli notes that Ma Shi's identification with Tongziliao and Tinghui points is incorrect.
Zhang Jingyue's commentary states: This refers to the Dicang and Daying points, where the Qi of the Foot Yangming meridian travels.
Zhang Jingyue's commentary states: This refers to the Heliao point, where the Qi of the Hand Shaoyang meridian travels.
Ma Shi's commentary states: "Xing Cang Si" (Four Viscera of Form) refers to the Stomach, Large Intestine, Small Intestine, and Bladder, as they store有形 (form/material) substances. Gao Shishi agrees. Xiong Zongli notes: Regarding "Xing Cang Si", most scholars follow Wang Bing's interpretation. However, head horns, ears, eyes, mouth, and teeth should not logically be called "Cang" (storehouses). Examining the *Zhou Li · Tian Guan · Ji Yi Zhi* (Office of Physicians): "Refer to the movements of the Nine Cang." Zheng Xuan's commentary states: "Five principal Cang, plus Stomach, Bladder, Large Intestine, and Small Intestine." Ma Shi's annotation has basis, so I adopt it.
Ma Shi's commentary states: Remove the knotted blood within the vessels. Wu Kun's commentary states: This refers to removing stasis within the vessels. Since stasis blocks the vessel pathways, it must be removed first before regulating the deficiency and excess of Qi.
Gao Shishi's commentary states: This describes an alternating up-and-down movement, where one rises while the other falls, lacking harmony.
Zhang Jingyue's commentary states: The essence and spirit of the Zang and Fu organs all ascend to the eyes, manifesting as their luster. If the eyes sink inward, it indicates the depletion of Yang essence, thus leading to death. Wu Kun moved the sixteen characters "When the Qi of the Foot Taiyang is exhausted, the legs cannot bend or extend, and death involves upward fixed gaze" to follow immediately after "If the eyes sink inward, death ensues."
Xiong Zongli notes: Most commentators did not annotate this. Presumably, "Heat" refers to a slippery pulse, and "Cold" refers to a tight pulse. Ma Shi's commentary states: Cold and heat refer to the temperature of the skin in the three positions. I fear this is incorrect.
Ma Shi's commentary states: Sunken and unrising. Unusually large, rapid, or hot pulses indicate excess; unusually small, slow, or sunken pulses indicate deficiency.
The *Jia Yi Jing* reads "Shou Xia" (under the hand), with the characters "Yu Zuo" (at the left), omitting "Yi Shang". Wu Kun revised it to "Use the left hand above the patient's foot, above the ankle."
The *Jia Yi Jing* reads "Shu" (庶) as "Yi" (以), omitting "Zu" (foot). This differs from the citation in the New Corrections. Wu Kun revised it to "Use the right hand to take the patient's foot." Most scholars still interpret the original text. Ma Shi's commentary states: This is to observe the Qi of generation to know life and death in disease. Zhang Jingyue's commentary states: The collaterals of the hands and feet can all be taken for verification. Above the wrist is the Lung collateral of the Hand Taiyin; above the ankle is the Spleen collateral of the Foot Taiyin. The Lung stores Qi and governs regulation; the Spleen belongs to Earth and governs irrigation. Thus, they can be used to observe auspiciousness and inauspiciousness. Xiong Zongli notes: While various interpretations are roughly coherent, the *Jia Yi Jing* text is correct, and Wu Kun's annotation is more appropriate.
Ma Shi's commentary states: Whenever "Ying" (response) is mentioned, it refers to responding to the physician's finger pressure.
Xiong Zongli provides the pronunciation: "Ru" (蠕), pronounced "Er Zhi Qie", describing the motion of insects crawling. Zhang Jingyue's commentary states: It describes the pulse as soft, smooth, and harmonious.
Ma Shi's commentary states: It should be written as "Hun Hun" (混混), meaning unclear. Xiong Zongli notes: "Hun" and "Hun" were interchangeable in ancient times, meaning mixed or confused. The *Laozi* says: "Vague and indistinct like turbid water." There is no need to change the character.
The *Jia Yi Jing* omits "Shi Yi" (Therefore/Thus), which seems correct.
Xiong Zongli notes: In his commentary on "Ti Jie Biao Ran Bu Qu Yi" (Body disjoined, seemingly unable to depart) in the *Ci Yao Lun*, Ma Shi states: Unable to move and leave. Zhang Jingyue states: Unable to shake or come and go. Both follow Wang Bing's commentary. Ma Shi's commentary states: If pathogenic factors remain in the body and do not depart, death ensues. This is incorrect.
Gao Shishi's commentary states: "Dai" (intermittent) pulse appears as irregular intervals; "Dai Er Gou" (Intermittent and Hook-like) appears as rapid. Following the previous text regarding intermittent and rapid pulses: If the pulse is Dai and Gou, it indicates blockage inside and outside the meridians, so the disease is in the collaterals, and death does not occur.
Ma Shi's commentary states: If one position fails to respond, it means the Qi of Heaven, Earth, and Man has lost one aspect, hence indicating disease. Gao Shishi's commentary states: The pulse has three positions: Floating, Middle, and Deep. "One position late" refers to using the Floating method to palpate, but the pulse does not respond to the finger. Non-response indicates disease. Xiong Zongli notes: Interpreting the Three Positions as Floating, Middle, and Deep borrows from the *Nan Jing* and is inappropriate here.
Wu Kun's commentary states: The pulse of a healthy person who rarely gets sick (Ping Mai / Normal Pulse).
Wu Kun's commentary states: At dawn (Ping Dan), when darkness and light begin to separate, and Yin and Yang intersect. Therefore, diseases involving alternating cold and heat die at this time.
Zhang Jingyue's commentary states: Evening (Ri Xi) corresponds to Autumn in a day. Wind and Wood share the same Qi, dying when encountering Metal. Gao Shishi's commentary states: Patients with wind diseases suffer from the肃杀 (desolating/killing) Qi of Autumn Metal affecting the Lung. Evening corresponds to Shen and You hours, when Lung Metal governs Qi. With Lung disease, death occurs in the evening.
Xiong Zongli notes: Regarding "Qi Zhen" (Seven Diagnoses), scholars follow Wang Bing's interpretation, referring to the previously mentioned unique small, unique large, etc., with no further debate. However, Ma Shi's commentary lists "Qi Zhen" as deep, fine, suspended/extreme, excessive, restless, panting, rapid, cold, heat, heat in the center, wind disease, water disease, and Earth exhaustion in the four seasons. Even the wind-rising diseases mentioned later seem to exhaust the categories of Qi Zhen. Xiong Zongli's *Mai Jue* states: The seven diagnoses refer to conditions suitable for diagnosis at dawn: 1. Yin Qi not yet active; 2. Yang Qi not yet scattered; 3. Food not yet consumed; 4. Meridian Qi not yet vigorous; 5. Collateral Qi regulated; 6. Blood and Qi not yet disturbed; 7... Zhang Jingyue argues: How can these seven conditions all be called "Diagnoses"? They are essentially a single dawn diagnostic method. Later generations transmitted this erroneously, losing the original source.
Zhang Jingyue's commentary states: Wind is a Yang disease. Thus, occasional exposure to wind causes the Yang branch pulse to be either large or rapid, which is normal. If accompanied by blood loss, the Yin branch pulse becomes small or slow, or sunken. These resemble the pulses of the Seven Diagnoses but are not actually so. None should be considered fatal. However, if one does not have external contraction or menstrual conditions but exhibits the pulses of the Seven Diagnoses, it is not an auspicious sign.
Zhang Jingyue's commentary states: This continues the previous discussion, stating that wind and menstrual diseases do not belong to the category of the Seven Diagnoses. If the pulse and symptoms are truly degenerated, it is not comparable to non-fatal cases. Xiong Zongli notes: Wang Bing interpreted "Mai Hou" (Pulse Signs) as pulse correspondence, while Zhang Jingyue interpreted it as pulse and symptom signs. Wang Bing's annotation seems more plausible.
Zhang Jingyue's commentary states: Up and down, reversal and compliance, each follows its sequence for treatment. Xiong Zongli notes: "Xun" (follow/trace) here implies treating according to the location of the disease, differing from the "Xun" (palpate) in "Qie Xun Qi Mai" (Palpate the pulse) mentioned earlier.
The *Ling Shu · Mai Du Pian* states: Meridians are the interior; branches extending horizontally are Luo (Collaterals); distinct branches of Luo are Sun (Sun Collaterals). If swollen with blood, eliminate it quickly. Xiong Zongli notes: The New Corrections cite the *Jia Yi Jing*, reading "Luo Bing Zhe Zhi Qi Luo Xue" (For Luo disease, treat its Luo blood), omitting the two "Sun" characters. The current *Jia Yi Jing* lacks the character "Xue" (blood).
Ma Shi's commentary states: Those with "Qi Xie" (Odd/Strange Pathogens) are不正 (incorrect/unorthodox) pathogens that accidentally strike. Wu Kun's commentary states: Qi Xie refers to pathogens of the Extraordinary Vessels. Zhang Jingyue's commentary states: Qi Xie does not enter the main meridians but affects the collaterals. When pathogens lodge in the Large Collaterals, they flow from left to right and right to left, having no fixed location, hence Miao Ci (Misaligned Needling) is commonly used. Xiong Zongli notes: Ma Shi reads "Zai" (在) as "You" (有 - to have/exist).
Wu Kun changed "Shou" (瘦 - emaciated/thin) to "Lou" (瘘 - flaccid/hidden), noting that "Lou" corresponds to "Sou" (廋 - to hide) in the *Analects* ("Where can a man's character be hidden?"). It means pathogenic factors linger and hide without moving. Xiong Zongli notes: The *Tong Ping Xu Shi Lun* mentions "Shou Liu Zhuo" (Thin lingering stagnation). Hua Shou changed "Shou" to "Lou", and Wu Kun followed suit, both seeming unstable.
Zhang Jingyue's commentary states: For pathogenic factors that linger long-term without moving, they must accumulate between the Eight Xi Caves of the four limbs. Therefore, one should seek and needle at the junctions of the joints. Ma Shi and Gao Shishi agree. Xiong Zongli notes: One should follow Wang Bing's annotation.
The New Corrections cite the *Jia Yi Jing*, confirming this as correct.
Zhang Jingyue's commentary states: "Tong Zi Gao" (High Pupil) refers to upward gaze of the eyes. "Dai Yan" (Fixed Upward Gaze) is extreme upward gaze, fixed and immobile. Ma Shi's commentary states: This chapter (twenty-five characters) is a missing slip from the eighth section. Wu Kun directly moved it after the text regarding "Exhaustion of Foot Taiyang Qi".
Ma Shi's commentary states: Wang Bing considered it a misplaced slip, which is correct. I suspect it is a missing slip from the seventh section regarding "Hand slowly descending". Xiong Zongli notes: Wu Kun interprets this sentence as a treatment method for excess blood in the upper body. Ma Shi and Gao Shishi interpret it as needling the Hand Taiyang and tonifying the Foot Taiyang. Neither interpretation should be followed.