吴云。前有奇病论。此言大奇论者。扩而大之也。高本。删论字。盖以无问答之语也。
皆实即为肿 张云。满。邪气壅滞。而为胀满也。此言肝肾肺经。皆能为满。若其脉实。当为浮肿。
而辨如下文也。简按王以满为脉气满实。考文理。张注为胜。王注痈肿。必是壅肿。传泻之讹耳。
肺之雍 马云。按甲乙经。雍。作痈。肺肝肾三经。不宜生痈。此雍。断宜作壅。盖言气之壅滞也。
吴张并云。雍。壅同。
喘而两 满 吴本。 。作胁。张云。 。音区。腋下胁也。
脚下至少腹 简按马志据原文。不改脚为 。却非。
跛易偏枯 张云。或为跛。或掉易无力。或偏枯不用。是皆肾经壅滞。不能营运所致。简按易。是
痿易狂易之易。谓跛而变易其常。王注恐谬。
心脉满大 张云。火有余也。心主血脉。火盛则血涸。故痫螈筋挛。
痫螈筋挛 甲乙。螈。作 。张云。痫。音间。癫痫也。螈。音炽。抽搐也。挛。音恋。拘挛也。
高云。神气不通于心包则痫。神气不行于骨节则螈。痫则筋挛于内。螈则筋挛于外也。简按下文云。二阴急为
痫厥。通评虚实论云。刺痫惊脉五。灵经筋篇云。痫螈及痉。寒热病篇云。暴挛痫眩。足不任。内经言痫者如
此。（详见通评虚实论注。）玉机真脏论云。筋脉相引而急。病名曰螈。王注。筋脉受热。而自跳掣。故名曰
螈。灵邪气脏腑病形篇云。心脉急甚者。为螈 。肝脉微涩。为螈挛筋痹。（螈 。详见诊要经终篇注。）并
与本篇互发。
肝脉小急 张云。小。为血不足。急。为邪有余。故为是病。夫痫螈筋挛一也。而心肝二经皆有之。
一以内热。一以风寒。寒热不同。血衰一也。故同有是病。
肝脉骛暴 熊音。骛。音务。奔也。志云。骛。疾走也。又乱驰也。简按后汉光武帝纪注。直骋曰
驰。乱驰曰骛。志注据此。
有所惊骇 马云。金匮真言论云。肝之病。发惊骇。
脉不至若喑 张云。此特一时之气逆耳。气通则愈矣。吴云。脉不至。在诸病为危剧。若其暴喑失声。
则是肝木厥逆。气壅不流。故脉不至耳。不必治之。厥还当自止。简按志圈脉上。别为一章。非。
小急不鼓皆为瘕 马云。瘕者。假也。块似有形。而隐见不常。故曰瘕。脉本急矣。而其急中甚小。
又不鼓击于手。则是沉也。必有积瘕在中。故脉不和缓耳。今三部之脉如此。皆可以即其本部。而决其为瘕也。
简按巢源云。瘕。假也。谓虚假可动也。又云。谓其有形。假而推移也。盖 瘕。分而言之。 。积也。瘕。
聚也。然 积亦可称瘕。气厥论。 瘕。阴阳类论。血瘕。邪气脏腑病形篇。水瘕。水胀篇。石瘕。厥病篇。
虫瘕。伤寒论。固瘕。神农本经。蛇瘕。仓公传。遗积瘕。蛲瘕之类。是也。说文云。瘕。女病也。盖根据于骨
空论。女子带下瘕聚。误为此说耳。郭璞注山海经瘕疾云。虫病也。此亦因有虫瘕蛲瘕而言。并不可从。李氏
必读云。瘕。遐也。历年遐远之谓也。历年遐远之病。岂止于瘕聚乎。
石水 张云。此言水病之有阴阳也。吴云。沉。脉行肌肉之下也。石水者。水凝不流。结于少腹。
其坚如石也。肾肝在下。居少腹之分。脉沉为在里。故肾肝俱沉。为石水之象。马云。水气凝结。如石之沉。
故名为石水也。阴阳别论。有阴阳结邪。多阴少阳。名曰石水。小腹肿。灵邪气脏腑病形篇。有肾脉微大。为
石水。起脐以下。至小腹睡睡然。上至胃脘。死不治。水胀篇。黄帝有石水之问。而岐伯无答。必有脱简。皆
是积聚之类。简按金匮要略云。石水。其脉自沉。外证腹满不喘。尤怡注云。石水。水之聚而不行也。因阴之
盛。而结于少腹。故沉而不喘。吴以为坚如石。误。（张氏
医通云。肾肝并沉。为石水。真武汤主之。）
风水 马云。蓄水冒风。发为肿胀。名曰风水。见评热论。水热穴论。灵论疾诊尺篇。张云。风水者。
游行四体。浮泛于上也。
并小弦欲惊 张云。肝肾并小。真阴虚也。小而兼弦。本邪胜也。气虚胆怯。故为欲惊。
皆为疝 马云。或结于少腹。或结于睾丸。或结于睾丸之上下两旁。肾肝二脉经历之所。皆是也。
积土以高硕者。曰山。疝有渐积之义。故名。简按说文云。疝。腹痛也。刘熙释名云。心痛曰疝。疝。诜也。
先诜诜然上而痛也。又曰。疝。诜也。诜诜引小腹急痛。颜师古急就篇注云。疝。腹中气疾。上下引也。金匮
要略云。腹痛。脉弦而紧。弦则卫气不行。即恶寒。紧则不欲食。邪正相搏。即为寒疝。楼氏纲目云。疝名虽
七。寒疝。即疝之总名也。
心疝 高云。心脉搏滑急。则心气受邪。故为心疝。脉要精微论曰。诊得心脉而急。病名心疝。少腹
当有形也。
肺疝 志云。肺脉当浮。而反沉搏。是肺气逆聚于内。而为肺疝矣。高云。肺疝。气疝也。简按四时
刺逆从论。肺风疝。有目无证。不可得而知。史仓公传云。气疝客于膀胱。难于前后溲。而溺赤。巢源。气疝。
乃七疝之一。腹中乍满乍减而痛。名曰气疝。高以为气疝者。盖肺主气故也。
三阳急为瘕三阴急为疝 志云。此言疝瘕之病。病三阴三阳之气。而见于脉也。子繇曰。瘕者。假也。
假物而成有形。疝字。从山。有艮止高起之象。故病在三阳之气者为瘕。三阴之气者为疝。玉师曰。瘕。在肠
胃之外。故三阳急。疝病五脏之气。故三阴急。马云。王注分瘕为血。疝为气者。未的当。知二病为气血相兼
也。简按三阳三阴。据下文二阴
二阳。王注为是。诸家亦仍王注。
二阴急为痫厥 马云。二阴者。心也。其脉来急。正以心经受寒。寒与血搏。发而为痫为厥。志云。
痫厥者。昏迷仆扑。卒不知人。简按痫厥。唯是痫病。志注为长。
二阳急为惊 张云。木邪乘胃。故发为惊。阳明脉解篇曰。胃者。土也。故闻木音而惊者。土恶木也。
是亦此义。○高本。以二阴以下十一字。移于前节若喑不治自已下。非。
为肠 久自已 吴云。外鼓者。脉形向外而鼓也。外鼓。有出表之象。故不必危之。久当自止也。
马云。此言心肝脾肾。皆为肠 。而有死生之分者。以脉与证验之也。肠 者。肠有所积。而下之也。然有下
血者。（即今所谓失血。）有下白沫者。（即今所谓去积。）有下脓血者。（即今之所谓痢。）病在于肠。均
谓之肠 也。简按高云。肠 。泄泻也。误。详见于通评虚实论。
肝脉小缓 张云。肝脉急大。则邪盛难愈。今脉小缓。为邪轻易治也。
血温身热者死 张云。肾居下部。其脉本沉。若小而搏。为阴气不足。而阳邪乘之。故为肠 下血。
若其血温身热者。邪火有余。真阴丧败也。故当死。
心肝 高云。言心脉肝脉不和。而病肠 也。亦如肾脉之肠 下血也。志云。此承上文。而言阴
血。盛者。虽受阳薄。尚为可治。盖重阴血以待阳也。夫心主生血。肝主藏血。是以心肝二脏。受阳盛之气。
而为肠 者。亦下血。如二脏同病。则阴血盛。而可以对待阳邪。故尚为可治之证。简按诸家仍王义。志意略
异。王注似妥。
皆鬲偏枯 吴云。凡脉贵于中和。胃脉沉鼓涩。偏于阴也。外鼓大。偏于阳也。心脉小坚急。亦偏
于阴也。鬲。阴阳闭绝也。偏枯。半身不用也。以其阴阳偏胜。故为证亦偏
绝也。张云。胃为水谷之海。心为血脉之主。胃气既伤。血脉又病。故致上下痞鬲。半身偏枯也。简按马云。
为膈证与偏枯。高改皆作背。并非。志云。鬲者。里之鬲肉。尤误。（张氏医通。赵以德云。胃与脾为表里。
胃之阳虚。则内从于脾。从脾则脾之阴盛。故胃脉沉鼓涩。涩者。少血多气之诊也。胃之阳盛。则脾之阴虚。
虚则不得与阳主内。反从其胃。越出部分。而鼓大于臂之外。大者。多气少血之候也。心者。元阳君主之宅。
生血生脉。今因元阳不足阴寒乘之。故心脉小坚急。小者。阳不足。坚急者。阴寒之象也。夫心胃之三等脉见
一。即为偏枯。心乃天真神机开发之本。胃乃谷气充天真之原。一有相失。则不能制其气。而宗气散。故分布
不周。不周经脉则偏枯。不周五脏则喑。喑者。肾与包络内绝也。
男子发左女子发右 张云。男子左为逆。右为从。女子右为逆。左为从。此逆证也。志云。从内而
发于外。故曰发。简按张注本于玉版论。为是。
不喑 张云。若声不喑。舌可转。则虽逆于经。未甚于脏。乃为可治。而一月当起。若偏枯而喑者。
肾气内竭而然。其病必甚。如脉解篇曰。内夺而厥。则为喑俳。此肾虚也。正以肾脉循喉咙。挟舌本故耳。简
按王注。原于奇病论。重身九月而喑之义而释之。恐谬。
其从者 张云。若男发于右。而不发于左。女发于左。而不发于右。皆谓之从。从。顺也。高云。
玉版论要曰。男子右为从。女子左为从。其从者。谓男子发于右。女子发于左。不同于上文之发也。简按王注。
左右互错。马吴志同。俱失经旨。
血衄 甲乙。作衄血。张云。搏脉弦强。阴虚者最忌之。凡诸人血鼻衄之疾。其脉搏而身热。真阴
脱败也。故当死。
悬钩浮 张云。失血之证多阴虚。阴虚之脉多浮大。故悬钩而浮。乃其常脉。无足虑也。悬者。不
高不下。不浮不
沉。如物悬空之义。脉虽浮钩。而未失中和之气也。简按悬。乃悬空无根之象。钩浮。乃阳盛阴虚之候。（十
五难云。脉之来疾去迟。故曰钩。吕广注云。阳盛其脉来疾。阴虚脉去迟也。脉从下上。至寸口疾。还尺中迟。
环曲如钩。）不似脉弦强而搏击于指。此乃亡血家之常脉。若释悬而为不浮不沉。则于钩浮之浮。其谓之何。
吴既误。而张袭之耳。吴又以常脉。为平人不病常脉。更误。
如喘 马云。喘者。气涌而不和。脉体如之。张云。如气之喘。言急促也。高云。喘。疾促不伦也。
脉至如喘。失其常度。故名曰暴厥。申明暴厥者。一时昏愦。不知与人言。简按如。甲乙。作而。如而通用。
（出于庄七年左传杜注。）下如数同。
浮合 张云。此下。皆言死期也。高云。浮合于皮肤之上。如汤沸也。诸家根据王注。
予不足也 熊音。予。与同。
微见 马云。微之为言。仅也。吴云。始见也。言始见此脉。便期九十日死。若见之已久。则不必九
十日矣。所以在九十日者。以时更季易。天道变。而人气从之也。志云。士宗曰。微。对显言。微现此脉。期
以九十日而死。若显露之。不超时日矣。后之交漆。亦犹是也。高云。微于皮肤之上。见此数极之脉。中按求
之。则不见也。故至九十日而死。经脉应月。一月一周。九十日者。三周也。简按士宗。即是高世 。前说似是。
予夺也 吴云。夺。失也。
草干 马云。心精被夺。火王于夏。犹有可支。至秋尽冬初。心气全衰。故曰草干而死。
如散叶 吴云。飘零不定之状也。木遇金而负。遇秋而凋。故深秋则死。志云。飘零虚散之象。简
按今甲乙。作丛棘。
省客 吴云。省问之客。张云。或去或来也。塞者。或无而止。鼓者。或有而搏。是肾原不固。而无
所主持也。
悬去枣华 张云。枣华之候。初夏时也。悬者。华之开。去者。华之落。言于枣华开落之时。火王而
水败。马云。悬去。犹俗云虚度也。吴移悬去于鼓字下。简按张注稳妥。
如丸泥 张云。泥弹之状。坚强短涩之谓。志云。往来流利如珠。曰滑。如丸泥者。无滑动之象。
榆荚落 张云。榆钱也。春深而落。木王之时。土败者死。马云。秋冬之交也。简按本草。苏颂云。
榆三月生荚。李时珍云。未生叶时。枝条间先生榆荚。形状似钱而小。色白成串。俗呼榆钱。据此则张注为胜。
如横格 张云。如横木之格于指下。长而且坚。是为木之真脏。而胆气之不足也。禾熟于秋。金令王
也。故木败而死。简按说文。格。木长貌。王释格为木。盖本于此。若张注。为横木之格于指下。则木之义。
于经文中无所取。不知其意果何如。（张注。全袭吴之误。）
如弦缕 马云。如弓弦之缕。犹俗之所谓弦线也。主坚急不和。奇病论云。胞脉者。系于肾。盖妇人
受胎之所。即胞络宫。张云。如弦之急。如缕之细。真元亏损之脉也。胞。子宫也。命门元阳之所聚也。胞之
脉系于肾。肾之脉系舌本。胞气不足。当静而无言。今反善言。是阴气不张。而虚阳外见。时及下霜。虚阳消
败而死矣。
如交漆 马吴高并云。交。当作绞。志云。交。绞也。张云。如写漆之交。左右傍至。缠绵不清也。
简按左右傍至也下。恐脱是其予不足也一句。故马云。脏腑俱虚。大体皆弱。吴云。阴阳乱也。志云。冲任之
脉绝也。高云。复申明胞精不足之意。率属臆解。今甲乙。漆。作棘。
三十日死 吴云。月魄之生死。以三十日为盈虚。故阴气衰者。不能过其期也。高云。经脉一周也。
少气味韭英而死 马。以少气为句。注云太阳为三阳。三阳主于外。今精气不足。故浮鼓肌中。而欲
Wu Yun: The preceding chapter is the "Treatise on Strange Diseases" (Qibing Lun). This chapter is called the "Treatise on Greatly Strange Diseases" (Daqi Lun), which expands and elaborates upon the previous content. The Gao edition deleted the character "Lun" (Treatise), likely because there are no Q&A dialogues in this text.
(Original) All solid [pulses] result in swelling.
Zhang Yun: "Man" (fullness/distension) refers to pathogenic qi stagnation causing distension. This states that the Liver, Kidney, and Lung meridians can all cause fullness. If the pulse is solid, edema should occur. The differentiation is as follows in the subsequent text. Jian An: Wang Bing interpreted "man" as pulse qi being full and solid. Examining the textual logic, Zhang Jingyue's annotation is superior. Wang's mention of "carbuncle swelling" must be a corruption of "stagnant swelling," and the characters "chuan xie" are errors.
(Original) Lung stagnation (Yong).
Ma Yun: According to the *Jia Yi Jing*, "Yong" is written as "Yong" (abscess/ulcer). The Lung, Liver, and Kidney meridians are not prone to generating abscesses. Here, "Yong" should definitely be read as "Yong" (obstruction/stagnation), referring to the stagnation of Qi. Wu Qian and Zhang Jingyue both state that "Yong" and "Yong" are synonymous.
(Original) Panting and bilateral [flank] fullness.
In the Wu edition, the character [missing] is written as "Xie" (flank). Zhang Yun: "[Character]" sounds like 'qu', referring to the flank under the armpit.
(Original) From the foot up to the lower abdomen.
Jian An: Ma Shi followed the original text without changing "foot" to "[character]", but this is incorrect.
(Original) Limping, alteration, or hemiplegia.
Zhang Yun: It may present as limping, or as tremors with weakness, or as hemiplegia. These are all caused by stagnation in the Kidney meridian, preventing normal circulation. Jian An: The character "Yi" is the same as in "Wei Yi" (atrophy and alteration) from the *Pi Bi Lun* and "Kuang Yi" (mania) from the *Re Bing Lun*, meaning limping accompanied by a change from the normal state. Wang Bing's annotation is likely erroneous.
(Original) Heart pulse full and large.
Zhang Yun: This indicates excess Fire. The Heart governs blood vessels; when Fire is excessive, blood becomes depleted, leading to epilepsy, convulsions, and tendon cramping.
(Original) Epilepsy, convulsions, and tendon cramping.
The *Jia Yi Jing* writes "Rong" as "[character]". Zhang Yun: "Xian" (epilepsy/seizure) sounds like 'jian'; "Rong" (convulsion/twitching) sounds like 'chi'; "Luan" (cramping/spasm) sounds like 'lian'. Gao Shishi states: When Shen Qi does not flow through the Pericardium, epilepsy occurs; when it does not flow through the bone joints, convulsions occur. Epilepsy involves internal tendon cramping, while convulsions involve external tendon cramping. Jian An: The following text says "Urgency in the Two Yin leads to epilepsy and syncope." The *Tong Ping Xu Shi Lun* says "Puncture the five pulses for epilepsy and fright." The *Ling Shu · Jing Jin Pian* mentions "epilepsy, convulsions, and spasms." The *Han Re Bing Pian* mentions "sudden cramping, epilepsy, dizziness, and inability to bear weight on the feet." The descriptions of epilepsy in the *Nei Jing* are as follows. (See notes on *Tong Ping Xu Shi Lun*.) The *Yu Ji Zhen Zang Lun* states: "When tendons and vessels pull and become urgent, the disease is named Rong." Wang Bing annotates: "Tendons and vessels receive heat and twitch involuntarily, hence named Rong." The *Ling Shu · Xie Qi Zang Fu Bing Xing Pian* states: "If the Heart pulse is extremely urgent, it results in Rong... If the Liver pulse is slightly choppy, it results in Rong, tendon cramping, and Bi syndrome." (See notes on *Zhen Yao Jing Zhong Pian* for "Rong".) These all mutually illuminate this chapter.
(Original) Liver pulse small and urgent.
Zhang Yun: "Small" indicates blood deficiency; "urgent" indicates excess pathogenic factors. Thus, these diseases arise. Although epilepsy, convulsions, and tendon cramping constitute one category of disease, both the Heart and Liver meridians exhibit it. One arises from internal heat, the other from wind-cold; although cold and heat differ, blood deficiency is the same. Hence, both can present with these symptoms.
(Original) Liver pulse rushing and violent.
Xiong Zongli provides pronunciation: "Wu" sounds like 'wu', meaning to run/gallop. Ma Shi annotates: "Wu" means to run fast, or to gallop chaotically. Jian An: The commentary on the *Book of Later Han · Annals of Emperor Guangwu* states: "Running straight is Chi; running chaotically is Wu." Ma's note is based on this.
(Original) Sudden fright and alarm.
Ma Yun: The *Jin Gui Zhen Yan Lun* states: "Diseases of the Liver manifest as fright and alarm."
(Original) Pulse absent or aphonia.
Zhang Yun: This is merely a temporary reversal of Qi. Once Qi flows smoothly, recovery occurs. Wu Qian states: Absent pulse is critical in many diseases. However, if it is sudden aphonia (loss of voice), it is due to Liver Wood reversing upward, with Qi stagnating and failing to flow, causing the pulse to be absent. No treatment is needed; when the reversal subsides, it will stop spontaneously. Jian An: Ma Shi circled above the word "pulse," treating it as a separate chapter, which is incorrect.
(Original) Small and urgent without pulsation indicate Jia masses.
Ma Yun: "Jia" means false. The mass appears有形 (having form) but comes and goes irregularly, hence "Jia." The pulse is originally urgent, but within the urgency, it is very small and does not beat against the fingers (does not pulse). This indicates a deep pulse. There must be accumulated Jia masses inside, so the pulse is not smooth and relaxed. Now that the pulses in all three positions are like this, one can judge them to be Jia masses based on their respective positions. Jian An: Chao Yuanfang states: "Jia means false, implying it is movable and illusory." He also says: "It has form but shifts position." Generally speaking, Zheng (fixed mass) and Jia (moving mass) are distinguished; Zheng is accumulation, Jia is gathering. However, Zheng can also be called Jia. The *Su Wen · Yin Yang Bie Lun* mentions Blood Jia; the *Xie Qi Zang Fu Bing Xing Pian* mentions Water Jia; the *Shui Zhang Pian* mentions Stone Jia; the *Jue Bing Pian* mentions Worm Jia; the *Shang Han Lun* mentions Solid Jia; the *Shen Nong Ben Cao Jing* mentions Snake Jia; the *Records of Master Cang Gong* mentions Residual Accumulation Jia and Ascaris Jia, etc. The *Shuo Wen Jie Zi* states: "Jia is a disease of women." This likely stems from a misinterpretation of the *Gu Kong Lun*'s phrase "women's leukorrhea and Jia masses." Guo Pu's commentary on *Shan Hai Jing* regarding Jia disease says it is a worm disease, which also derives from the existence of Worm Jia and Ascaris Jia, and should not be accepted. Li Shi's *Yi Zong Bi Du* states: "Jia means distant/prolonged, referring to a disease lasting many years." Can a disease lasting many years only refer to Jia masses?
(Original) Stone Water (Shi Shui).
Zhang Yun: This discusses water diseases having Yin and Yang aspects. Wu Qian states: The Deep pulse travels beneath the muscles. Stone Water is water congealing and failing to flow, knotting in the lower abdomen, hard as stone. The Kidney and Liver are located inferiorly, in the region of the lower abdomen. A deep pulse indicates interior pathology; thus, both Kidney and Liver pulses are deep, representing the image of Stone Water. Ma Yun: Water qi condenses and sinks like a stone, hence named Stone Water. The *Yin Yang Bie Lun* states: "Yin and Yang bind evil, with much Yin and little Yang, named Stone Water, with swelling in the lower abdomen." The *Ling Shu · Xie Qi Zang Fu Bing Xing Pian* states: "A slightly enlarged Kidney pulse indicates Stone Water, starting below the navel, swelling in the lower abdomen, extending up to the stomach; this is incurable and fatal." In the *Shui Zhang Pian*, Huangdi asks about Stone Water, but Qibo does not answer, implying missing bamboo slips. These are all types of accumulation. Jian An: The *Jin Gui Yao Lue* states: "Stone Water, its pulse is naturally deep, external signs include abdominal fullness without panting." You Yi annotates: "Stone Water is water gathering and failing to move. Due to excessive Yin, it knots in the lower abdomen, hence deep without panting." Wu Qian's interpretation of "hard as stone" is mistaken. (*Zhang Shi Yi Tong* states: "Deep pulses in both Kidney and Liver indicate Stone Water, treated with Zhen Wu Tang.")
(Original) Wind Water (Feng Shui).
Ma Yun: Water retention exposed to wind causes swelling, named Wind Water. Seen in the *Ping Re Bing Lun*, *Shui Re Xue Lun*, and *Ling Shu · Lun Ji Zhen Chi Pian*. Zhang Yun: Wind Water travels through the four limbs and floats superficially.
(Original) Both small and wiry, predisposed to fright.
Zhang Yun: Liver and Kidney pulses both small indicate True Yin deficiency. Small and wiry indicates pathogenic factor dominance. Qi deficiency and gallbladder timidity lead to a predisposition to fright.
(Original) All are Shan (hernia/pain).
Ma Yun: Some knot in the lower abdomen, some in the testicles, some above and below the testicles; these are all areas traversed by the Kidney and Liver meridians. Piled earth forming high mounds is called "Shan" (mountain). The term "Shan" (hernia) carries the meaning of gradual accumulation, hence the name. Jian An: The *Shuo Wen Jie Zi* states: "Shan is abdominal pain." Liu Xi's *Shi Ming* states: "Heart pain is called Shan. Shan, sound 'shen'. Pain rises first with a 'shen' sound." It also says: "Shan, sound 'shen'. 'Shen shen' pulls the lower abdomen into acute pain." Yan Shigu's commentary on the *Ji Jiu Pian* states: "Shan is an Qi disorder in the abdomen, pulling up and down." The *Jin Gui Yao Lue* states: "Abdominal pain, pulse wiry and tight. Wiry means Wei Qi does not flow, leading to aversion to cold. Tight means loss of appetite. Struggle between pathogen and righteous Qi results in Cold Shan." Lou's *Gang Mu* states: "Although there are seven names for Shan, Cold Shan is the general name for Shan."
(Original) Heart Shan.
Gao Shishi states: If the Heart pulse is slippery, rapid, and urgent, Heart Qi receives pathogenic influence, resulting in Heart Shan. The *Mai Yao Jing Wei Lun* states: "Diagnosing an urgent Heart pulse, the disease is named Heart Shan, and there should be palpable forms in the lower abdomen."
(Original) Lung Shan.
Ma Shi annotates: The Lung pulse should be floating; if it is instead deep and forceful, Lung Qi reverses and gathers internally, resulting in Lung Shan. Gao Shishi states: Lung Shan is Qi Shan. Jian An: The *Si Shi Ci Ni Cong Lun* mentions "Lung Wind Shan" but provides no symptoms, making it unknowable. The *Records of Master Cang Gong* states: "Qi Shan lodges in the bladder, causing difficulty in urination and defecation, with red urine." Chao Yuanfang states: Qi Shan is one of the Seven Shans, characterized by intermittent abdominal fullness, reduction, and pain. Gao Shishi considers it Qi Shan, likely because the Lung governs Qi.
(Original) Urgency in the Three Yang leads to Jia; urgency in the Three Yin leads to Shan.
Ma Shi annotates: This discusses Shan and Jia diseases affecting the Qi of the Three Yin and Three Yang, manifesting in the pulse. Zi You states: "Jia means false, taking form from borrowed substances. The character 'Shan' contains 'Mountain', suggesting a stopping and rising image. Thus, disease in the Qi of the Three Yang is Jia, and in the Three Yin is Shan." Yu Shi states: "Jia is outside the intestines and stomach, hence urgency in the Three Yang. Shan affects the Qi of the Five Zang organs, hence urgency in the Three Yin." Ma Yun: Wang Bing's division of Jia as Blood and Shan as Qi is inaccurate. One must know that these two diseases involve both Qi and Blood. Jian An: Referring to the subsequent text's "Two Yin and Two Yang," Wang Bing's annotation is correct. Various schools have retained Wang's annotation.
(Original) Urgency in the Two Yin leads to epilepsy and syncope.
Ma Yun: The Two Yin refers to the Heart. An urgent incoming pulse indicates the Heart Meridian has received Cold. Cold combats with Blood, manifesting as epilepsy and syncope. Ma Shi annotates: Epilepsy and syncope refer to coma and falling, suddenly losing consciousness. Jian An: Epilepsy and syncope specifically refer to epilepsy manifestations; Ma's note is more appropriate.
(Original) Urgency in the Two Yang leads to fright.
Zhang Yun: Wood pathogen attacking the Stomach causes fright. The *Ling Shu · Yang Ming Mai Jie Pian* states: "The Stomach is Earth. Therefore, hearing Wood sounds causes fright, as Earth fears Wood." This illustrates the same principle. ○ The Gao edition moved the eleven characters from "Two Yin" to after the previous section "if aphonia, no treatment needed, self-healing," which is incorrect.
(Original) Intestinal [accumulation/dysentery], long-term self-healing.
Wu Qian states: External pulsation means the pulse shape beats outward. External pulsation has the image of exiting the exterior, so it need not be considered critical; it will stop on its own after a long time. Ma Yun: This states that the Heart, Liver, Spleen, and Kidney can all present with intestinal [accumulation/dysentery], with distinctions between life and death, verified by pulse and symptoms. "Chang [accumulation/dysentery]" refers to accumulation in the intestines leading to downward discharge. There is bleeding (equivalent to modern hemorrhage), discharging white foam (equivalent to expelling accumulation), and discharging pus and blood (equivalent to modern dysentery). Disease in the intestines is collectively called Chang [accumulation/dysentery]. Jian An: Gao Shishi claims "Chang [accumulation/dysentery]" means diarrhea, which is incorrect. See *Tong Ping Xu Shi Lun*.
(Original) Liver pulse small and slow.
Zhang Yun: If the Liver pulse is urgent and large, pathogenic factors are excessive and difficult to cure. Now, the pulse is small and slow, indicating mild pathogenic factors and easy treatment.
(Original) Warm blood and body heat indicate death.
Zhang Yun: The Kidney resides inferiorly, and its pulse is naturally deep. If the pulse is small and beating, it indicates insufficient Yin Qi, allowing Yang pathogen to invade, resulting in intestinal [accumulation/dysentery] with bleeding. If the blood is warm and the body is hot, it indicates excess pathogenic fire and collapse of True Yin, indicating death.
(Original) Heart and Liver [intestinal accumulation/dysentery].
Gao Shishi states: This refers to disharmony of the Heart and Liver pulses, resulting in intestinal [accumulation/dysentery], similar to the Kidney pulse presenting with intestinal [accumulation/dysentery] and bleeding. Ma Shi annotates: This continues the previous text, stating that those with abundant Yin Blood can still be treated even if affected by Yang pathogen, as abundant Yin Blood waits for Yang to subside. The Heart generates blood, and the Liver stores blood. Thus, when the Heart and Liver receive excessive Yang Qi and present with intestinal [accumulation/dysentery], they also bleed. If both organs are diseased, Yin Blood is abundant and can counteract Yang pathogen, so it remains a treatable condition. Jian An: Most scholars follow Wang Bing's meaning, while Ma's note differs slightly. Wang's note seems more appropriate.
(Original) All involve Ge (blockage) and pian ku (hemiplegia).
Wu Qian states: Pulses ideally maintain harmony. The Stomach pulse is deep, beating, and choppy, leaning toward Yin; externally beating and large, leaning toward Yang. The Heart pulse is small, firm, and urgent, also leaning toward Yin. "Ge" refers to closure and isolation of Yin and Yang. "Pian ku" refers to hemiplegia. Due to Yin-Yang imbalance, the symptoms are also unbalanced/isolated. Zhang Yun: The Stomach is the sea of water and grain; the Heart is the master of blood vessels. With damaged Stomach Qi and diseased blood vessels, upper and lower blockage occurs, leading to hemiplegia. Jian An: Ma Yun interprets it as Ge syndrome and hemiplegia. Gao Shishi changed "all" to "back," which is incorrect. Ma Shi annotates: "Ge" refers to the internal diaphragm flesh, which is even more erroneous. (*Zhang Shi Yi Tong*: Zhao Yi De states: The Stomach and Spleen are exterior-interior partners. If Stomach Yang is deficient, it follows the Spleen, leading to Spleen Yin excess, hence the Stomach pulse is deep, beating, and choppy. Choppy indicates less blood and more Qi. If Stomach Yang is excessive, Spleen Yin is deficient. Deficiency prevents it from governing the interior with Yang, so it follows the Stomach, emerging beyond its sector, beating larger than the arm. Large indicates more Qi and less blood. The Heart is the residence of Original Yang and the Monarch. It generates blood and pulses. Now, due to insufficient Original Yang, Yin Cold invades, so the Heart pulse is small, firm, and urgent. Small indicates Yang deficiency; firm and urgent indicates Yin Cold. If any one of the Heart, Stomach, etc., pulses appears, hemiplegia ensues. The Heart is the root of Tian Zhen Shen Ji development; the Stomach is the source of谷物 Qi nourishing Tian Zhen. If they lose coordination, they cannot control Qi, causing Zong Qi to scatter. Distribution becomes uneven. Uneven distribution in meridians leads to hemiplegia; uneven distribution in the Five Zang organs leads to aphonia. Aphonia is internal isolation of the Kidney and Pericardium.)
(Original) Men manifest on the left, women on the right.
Zhang Yun: For men, left is reverse (ni), right is compliant (cong); for women, right is reverse, left is compliant. This is a reverse syndrome. Ma Shi annotates: Manifesting from inside to outside is called "fa" (manifest/emerge). Jian An: Zhang's note is based on the *Yu Ban Lun Yao* and is correct.
(Original) Without aphonia.
Zhang Yun: If the voice is not hoarse and the tongue can move, then although meridians are reversed, the Zang organs are not severely affected, making it treatable. Recovery should occur within one month. If hemiplegia is accompanied by aphonia, it is due to internal exhaustion of Kidney Qi, indicating severe disease. As the *Mai Jie Pian* states: "Internal depletion and reversal lead to aphonia and paralysis." This is Kidney deficiency. Precisely because the Kidney meridian circles the throat and clamps the base of the tongue. Jian An: Wang Bing's note originates from the *Qi Bing Lun*'s explanation of aphonia in the ninth month of pregnancy, which is likely erroneous.
(Original) Those who are compliant (cong).
Zhang Yun: If men manifest on the right and not the left, and women on the left and not the right, all are called "compliant" (cong). Compliant means smooth/favorable. Gao Shishi states: The *Yu Ban Lun Yao* says: "For men, right is compliant; for women, left is compliant." Those who are compliant mean men manifest on the right, women on the left, differing from the "manifest" mentioned earlier. Jian An: Wang Bing's note confuses left and right. Ma, Wu, and Ma Shi agree, all missing the essence of the classic.
(Original) Blood epistaxis (Nu).
The *Jia Yi Jing* writes "Nu Xue" (bleeding nose). Zhang Yun: Beating pulse, wiry and strong, is most taboo for Yin deficiency. In all cases of nasal bleeding, if the pulse beats forcefully and the body is hot, it indicates collapse of True Yin, signifying death.
(Original) Hanging, Hook, Floating.
Zhang Yun: Blood loss syndromes often involve Yin deficiency. Yin deficiency pulses are often floating and large. Thus, hanging, hook, and floating are their normal pulses, not worth worrying about. "Hanging" means neither high nor low, neither floating nor sunken, like an object suspended in air. Although the pulse is floating and hooked, it has not lost the Qi of harmony. Jian An: "Hanging" is the image of suspension without root. "Hook and floating" are signs of Yang excess and Yin deficiency. (*Nan Jing · Chapter 15* states: "Coming fast and going slow is called Hook." Lu Guang annotates: "Yang excess makes the pulse come fast; Yin deficiency makes it go slow. The pulse comes from below, fast at Cun, slow at Chi, curving like a hook.") It is unlike the wiry-strong pulse beating against the fingers. This is the normal pulse for those who have lost blood. If "hanging" is explained as neither floating nor sunken, how is the "floating" in "hook and floating" explained? Wu Qian was mistaken, and Zhang Jingyue copied his error. Wu Qian further mistook the normal pulse for the healthy person's pulse, which is another error.
(Original) Like panting.
Ma Yun: Panting is Qi surging and discordant; the pulse body is similar. Zhang Yun: Like Qi panting, meaning rapid and urgent. Gao Shishi states: Panting is rapid and urgent without order. The pulse arriving like panting loses its normal degree, hence named "Bao Jue" (Sudden Syncope). This clarifies that Bao Jue is temporary confusion and inability to speak. Jian An: "Ru" (like) is written as "Er" (and/then) in the *Jia Yi Jing*. "Ru" and "Er" are interchangeable (from Du Yu's commentary on *Zuo Zhuan*, Year 7 of Zhuang). The following "like rapid" is similar.
(Original) Floating and combined.
Zhang Yun: The following sections all discuss the time of death. Gao Shishi states: Floating and combined above the skin, like boiling soup. Various schools follow Wang Bing's note.
(Original) Giving and lacking.
Xiong Zongli provides pronunciation: "Yu" is the same as "Yu" (give).
(Original) Slight appearance.
Ma Yun: "Wei" means barely. Wu Qian states: Initially appearing. It means that seeing this pulse initially predicts death in ninety days. If seen for a long time, death need not wait ninety days. The reason for ninety days is that seasons change, Heavenly Dao varies, and Human Qi follows. Ma Shi annotates: Shizong says: "Wei" contrasts with "Xian" (manifest). Slightly appearing this pulse predicts death in ninety days. If manifest, death will not exceed that time. The later "jiao qi" is the same. Gao Shishi states: Slightly visible above the skin, seeing this extreme number pulse, pressing middle finds nothing. Hence death in ninety days. Meridians correspond to months, circling once per month. Ninety days is three cycles. Jian An: Shizong is Gao Shishi. The previous explanation seems plausible.
(Original) Giving and taking away.
Wu Qian states: "Duo" means loss.
(Original) Drying grass.
Ma Yun: Heart Essence is taken away. Fire dominates in Summer, offering some support. By late Autumn and early Winter, Heart Qi completely declines, hence "drying grass" signifies death.
(Original) Like scattered leaves.
Wu Qian states: State of drifting不定 (uncertainty). Wood yields to Metal, withers in Autumn, hence death in late Autumn. Ma Shi annotates: Image of drifting and void scattering. Jian An: Current *Jia Yi Jing* writes "cong ji" (thorny bushes).
(Original) Visiting guest.
Wu Qian states: Guest of inquiry. Zhang Yun: Coming and going. "Se" (blocked): sometimes absent and stopping. "Gu" (beating): sometimes present and beating. This indicates Kidney origin is unstable and lacks direction.
(Original) Hanging until jujube flowers fall.
Zhang Yun: Time of jujube flowers is early summer. "Hanging" is flower opening; "Qu" (going) is flower falling. Speaking of the time when jujube flowers open and fall, Fire dominates and Water fails. Ma Yun: "Hanging qu" is like colloquial "passing in vain." Wu Qian moved "hanging qu" under the character "gu." Jian An: Zhang's note is steady.
(Original) Like pill mud.
Zhang Yun: Shape of mud pellet, meaning firm, short, and choppy. Ma Shi annotates: Smooth and flowing like pearls is called Slippery. Like pill mud means lacking sliding imagery.
(Original) Elm pods fall.
Zhang Yun: Elm coins. Fall in deep Spring, when Wood dominates, Earth fails, leading to death. Ma Yun: Transition of Autumn and Winter. Jian An: *Ben Cao* Su Song states: Elm produces pods in March. Li Shizhen states: Before leaves grow, elm pods appear between branches, shaped like coins but small, white strings, commonly called elm coins. Based on this, Zhang's note is superior.
(Original) Like horizontal grid.
Zhang Yun: Like a horizontal wood blocking under the fingers, long and firm, representing the True Viscera of Wood and insufficiency of Gallbladder Qi. Grain ripens in Autumn, Metal command dominates. Hence Wood fails and dies. Jian An: *Shuo Wen*: "Ge" means long wood. Wang Bing interprets "Ge" as wood, likely based on this. If Zhang's note, interpreting as horizontal wood blocking under fingers, then the meaning of "Wood" in the text has no application, leaving his intent unknown. (Zhang's note fully copies Wu's error.)
(Original) Like string threads.
Ma Yun: Like threads of a bowstring, akin to common string lines. Indicates firm, urgent, and discordant. *Qi Bing Lun* states: "Bao Mai connects to the Kidney." Likely the place where women conceive, i.e., Bao Luo Palace. Zhang Yun: Urgent like string, thin like thread, represents depletion of True Yuan. "Bao" is the uterus, gathering of Mingmen Original Yang. Bao's pulse connects to the Kidney; Kidney's pulse connects to the base of the tongue. Bao Qi insufficiency should result in silence and lack of speech. Now conversing excessively, indicating Yin Qi not rising and Deficient Yang appearing externally. When frost falls, Deficient Yang collapses and dies.
(Original) Like mixing lacquer.
Ma, Wu, and Gao all state: "Jiao" should be "Jiao" (twist/knot). Ma Shi annotates: "Jiao" means twist. Zhang Yun: Like pouring lacquer twisting, coming from left and right, entangled and unclear. Jian An: Below "coming from left and right," it is feared that the sentence "shi qi yu bu zu ye" (this is giving and lacking) is missing. Hence Ma Yun states: Viscera and Bowels are all deficient, overall weak. Wu Qian states: Yin and Yang chaotic. Ma Shi annotates: Chong and Ren meridians severed. Gao Shishi states: Further explaining Bao Jing insufficiency. All belong to conjectural interpretations. Current *Jia Yi Jing* writes "qi" as "ji" (thorn).
(Original) Death in thirty days.
Wu Qian states: Life and death of moon soul depend on thirty days for waxing and waning. Thus, those with declining Yin Qi cannot exceed this period. Gao Shishi states: One cycle of meridians.
(Original) Lacking Qi, smelling leek greens, and dying.
Ma: Punctuates as "Lacking Qi." Annotation: Tai Yang is Three Yang, governing the exterior. Now Essence and Qi are insufficient, hence floating and beating in muscles, desiring...