马云。别。彼劣切。内言太阳阳明少阳太阴少阴厥阴之脉。各有分别。故名篇。吴云。言经脉别有所论
出于常谭之外也。简按马注五脏别论云。别。如字。此乃五脏之别是一论。此解为是。而于阴阳别论。却读为
彼劣切。乃与此篇并误。
脉亦为之变乎 张云。脉。以经脉血气。统言之也。志云。脉乃血气之府。气逆则喘。血液为汗。故
帝问脉。而伯答其喘汗焉。
夜行则喘出于肾 吴云。此下四条言喘。后五条言汗。气血之分也。肾受气于亥子。故夜行则劳骨
损阴。喘出于肾。
淫气病肺 张云。淫气者。阴伤则阳胜。气逆为患也。肺肾为母子之脏。而少阴之脉。上入肺中。
故喘出于肾。则病苦于肺。
有所堕恐喘出于肝 简按恐。为肾志。王谓生于肝。未知何据。诸家亦欠详。
度水跌仆 马云。度。渡同。跌。音迭。仆。音付。
摇体劳苦汗出于脾 吴云。摇体劳苦。用力勤作也。脾主四肢。故汗出于脾。高云。伤脾主之肌肉。
故汗出于脾。不言肺者。以汗皆出于肺主之皮肤也。
浊气归心 张云。浊。言食气之浓者也。如阴阳清浊篇曰。受谷者浊。受气者清。是也。心主血脉。
故食气归心。则精气浸淫于脉也。
行气于府 吴。府上。增玄字。注云。毛属肺气。脉属心血。毛脉合其精。则行气于玄府。是为卫气。
玄府。腠理也。志云。血独盛。则淡渗皮肤生毫毛。夫皮肤主气。经脉主血。毛脉合精者。血气相合也。六腑
为阳。故先受气。高云。皮毛百脉。合肺输之精。而行气于六腑也。简按马张仍王注。以腑为膻中。其义虽详
备。以膻中为腑。经无明文。况下文云。留于四脏。志高之义似是。故姑从之。吴添玄字。玄府。腠理也。大
误。玄府。汗空也。与腠理自异。
府精神明留于四脏 高云。六腑之精。合心藏之神明。留于肺肝脾肾四脏也。马云。始行于手太阴
肺经。通于心肝
脾肾之四脏。而四脏之精。皆其所留是气也。李云。留。当作流。吴云。四脏。形之四脏。一头角。二耳目。
三口齿。四胸中也。简按吴注误。
归于权衡 吴云。言其平等。而无低昂也。高云。权衡秤物。而得其平也。言脉之浮沉出入。阴阳和平。
气口成寸 汪昂云。此脉之所由来也。气口亦名寸口。百脉之大要会也。马注。与鱼际相去一寸。故
名成寸。张注。分尺为寸。按脉前为寸。后为尺。中为关。此云成寸。盖兼关尺而言之也。医者由此察脉知病。
以决人之死生也。李云。脏腑既平。必朝宗于气口。成一寸之脉。以决死生也。
饮入于胃 马云。按饮入于胃以下。乃言饮而不言食。李东垣脾胃论。朱丹溪纂要书。不考上文为食。
乃改为饮食入胃。则于下输膀胱。水精四布之义。大背矣。殊不知上文之食。含蓄饮义。而下文之饮。必难以
兼食也。何诸医书皆宗李朱。而不考经旨矣。
游溢 吴云。游。流行也。溢。涌溢也。张云。游。浮游也。
水精四布五经并行 张云。水因气生。气为水母。凡肺气所及。则水精布焉。然水名虽一。而清浊有
分。清者为精。精如雨露。浊者为水。水如江河。故精归五脏。水归膀胱。而五经并行矣。五经。五脏之经络也。
阴阳揆度 马云。五脏并行乎。水精真有合于四时五脏。及古经阴阳揆度等篇之常义也。志云。揆
度。度数也。总结上文。而言经脉之道。合于四时五行之次序。阴阳出入之度数。以为经脉之经常。
太阳脏独至 高云。三阳主六腑。腑能藏物。亦谓之脏。张云。此言脏气不和。而有一脏太过者。
气必独至。诸证不同。针治亦异也。吴云。独见太阳脉象。下文象三阳而浮。是。
下输 马吴张并云。膀胱经之输穴束骨。肾经之输穴太溪。高云。太阳之脉。起于足小指之至阴。故
当取之下输。俞。输穴也。
重并也 志云。两阳合于前。故曰阳明。阳明之独至。是太少重并于阳明。阳盛故阴虚矣。
当泻阳补阴取之下输 马吴张并云。阳明之输陷谷。太阴之输太白。高云。阳明之脉。起于足大指
次指之厉兑。故当取之下输。
前卒大取之下输 马吴张并云。卒。猝同。下输。谓临泣也。高云。少阳起于足小指次指之窍阴。
故亦当取之下输。
一阳之过也 马云。过者。病也。张云。此释独至之义。为一脏之太过。举少阳而言。则太阳阳明
之独至者。其为三阳二阳之太过可知也。一阳。少阳也。
五脉气少 征四失论云。诊不中五脉。吴云。五脏皆受气于脾而后治。若胃气不调于脾。则诸脉皆
失其母。无以受气。故气少也。
宜治其下输 马吴张并云。补足阳明之陷谷。泻足太阴之太白。
一阳独啸少阳厥也 马张据新校正。一阳作二阴。少阳作少阴。张云。独啸。独炽之谓。盖啸为阳
气所发。阳出阴中。相火上炎。则为少阴热厥。而阳并于上。故心肝脾肺四脉。为之争张。而其气则归于肾。
故曰独啸。志云。夫气激于喉中而浊。谓之言。气激于舌端而清。为之啸。盖气郁而欲伸出之。简按啸。说文。
吹声也。诗笺。蹙口而出声。唐
孙广啸旨云。气激于舌而清。谓之啸。王云。耳中鸣如啸声。马吴根据之。于义不允。当从张注。
宜治其经络 马张并云。太阳经穴昆仑。络穴飞扬。少阴经穴复溜。络穴大钟。
厥阴之治也 张云。治。主也。
真虚 心 张云。肝邪独至。真气必虚。木火相干。故心为 痛。高云。真虚。犹言真假。 。忧也。
言厥阴治之真假。当忧心以审之。即太阴之用心省真也。简按 。与 （阴阳别论）之 同义。高注迂僻不可从。
调食和药治在下输 张云。调和药食。欲其得宜。用针治之。乃在下输厥阴之输。名曰大冲。愚按此
篇何以知其皆言足经。盖以下输二字。为可知也。亦如热论篇。伤寒言足不言手之义。又如诸经皆言补泻。而
惟少阳一阴不言者。以少阳承三阳而言。一阴承三阴而言。因前贯后。义实相同。虚补实泻。皆可理会也。至
若一阴调食和药一句。盖亦总结上文而言。不独一经为然。古经多略。当会其意。
象三阳而浮也 张云。太阳之象三阳者。阳行于表。阳之极也。故脉浮于外。志云。象者。像也。
三阳。阳盛之气也。言太阳脏脉。象阳盛之气而浮也。
一阳脏者滑而不实也 马云。少阳为阳之里阴之表。所谓半表半里者。是也。其脏为阳之初生。故
脉体滑而不实。象一阳之为初阳也。
象大浮也 马云。阳明虽为太阳之里。而实为少阳之表。比之滑而不实者。则大而浮矣。仿佛乎太
阳之浮也。
言伏鼓也 马云。太阴则入于阴分。脉虽始伏。而实鼓击于手。未全沉也。
肾沉不浮也 马云。二阴虽相搏而至。然肾脉沉而不浮
也。由是观之。则厥阴为沉之甚。又非二阴比矣。张云。详此明言二阴之脉象。而前无二阴之至。前有一阴之
至。而此无一阴之脉。信为古经之脱简。而上文一阳少阳之误。即此节也。○吴云。此篇。自太阳脏独至以下。
言经脉证象。自是一家。故云别论。
Ma Yun stated: "Bie" (separation/distinction) is pronounced as "bi lie qie". The text discusses the meridians of Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, and Jueyin, each having its own distinctions, hence the chapter is named "Bie" (Distinction). Wu Yun stated: The discussion on meridians here is special, lying beyond common discourse. Jian An (editor's note): In the annotation for *Wu Zang Bie Lun* (Treatise on the Distinctions of the Five Zang Organs), Ma noted that "Bie" should be read with its original pronunciation. This refers to a separate treatise on the distinctions of the five Zang organs, which is a correct interpretation. However, in *Yin Yang Bie Lun* (Treatise on the Distinctions of Yin and Yang), it was read as "bi lie qie", which is an error similar to this chapter.
Will the pulse also change accordingly? Zhang Yun stated: "Mai" (pulse/meridian) refers generally to the meridians and the qi and blood within them. Zhi Yun stated: The pulse is the residence of qi and blood. When qi rebels, it causes panting; blood transforms into sweat. Therefore, when the Yellow Emperor asked about the pulse, Bo Gao answered regarding panting and sweating.
Panting arising from the Kidney during night walking. Wu Yun stated: The following four points discuss panting, and the subsequent five points discuss sweat, distinguishing between qi and blood. The Kidney receives qi during the Hai and Zi hours. Thus, night walking fatigues the bones and damages yin, causing panting to arise from the Kidney.
Luan Qi (excessive pathogenic qi) causes disease in the Lung. Zhang Yun stated: Luan Qi refers to a state where yin injury leads to yang excess, and rebellious qi becomes a disaster. The Lung and Kidney are mother-son organs. Moreover, the Foot-Shaoyin Kidney meridian ascends into the Lung. Therefore, when panting arises from the Kidney, it causes suffering and disease in the Lung.
Panting arising from the Liver due to falling or fear. Jian An noted: Fear is the emotion of the Kidney. Wang Bing claimed fear originates from the Liver, but the basis is unknown. Other annotations also lack detail.
Wading through water and falling. Ma Yun stated: "Du" is synonymous with "Du" (to cross). "Die" is pronounced like "die". "Pu" is pronounced like "fu".
Sweat arising from the Spleen due to bodily movement and laborious work. Wu Yun stated: Moving the body and working hard implies strenuous effort. The Spleen governs the four limbs, so sweat arises from the Spleen. Gao Yun stated: Injury to the muscles governed by the Spleen causes sweat to arise from the Spleen. The Lung is not mentioned because sweat is expelled through the skin governed by the Lung.
Turbid qi returns to the Heart. Zhang Yun stated: Turbid refers to the dense qi derived from food. As stated in the *Yin Yang Qing Zhuo Pian* (Chapter on Clear and Turbid Yin and Yang): "What receives grain is turbid; what receives air is clear." The Heart governs the blood vessels. Therefore, when food qi returns to the Heart, essence qi permeates the vessels.
Qi circulates in the Fu organs. Wu added the character "Xuan" (mysterious/profound) after "Fu". The annotation states: Hair belongs to Lung qi, and vessels belong to Heart blood. When hair and vessels combine their essence, qi circulates in the Xuan Fu (Mysterious Portal), which is Wei Qi (Defensive Qi). Xuan Fu refers to the Cou Li (interstices). Zhi Yun stated: If blood is particularly abundant, it渗 (permeates) the skin and generates hair. Skin governs qi, and meridians govern blood. The combination of hair and vessel essence signifies the union of qi and blood. The Six Fu organs are yang, so they receive qi first. Gao Yun stated: The skin, hair, and hundred vessels combine with the essence transmitted by the Lung and circulate qi in the Six Fu organs. Jian An noted: Ma and Zhang followed Wang Bing’s annotation, interpreting "Fu" as Dan Zhong (Conception Vessel center). Although detailed, calling Dan Zhong a Fu organ lacks explicit textual support. Furthermore, the text later mentions "remaining in the Four Zang," suggesting Gao’s interpretation is more plausible, so I tentatively adopt it. Wu’s addition of "Xuan" and identifying Xuan Fu as Cou Li is a major error. Xuan Fu refers to sweat pores, distinct from Cou Li.
The essence and spirit of the Fu organs remain in the Four Zang. Gao Yun stated: The essence of the Six Fu organs combines with the Spirit (Shen) of the Heart and remains in the Lung, Liver, Spleen, and Kidney. Ma Yun stated: It initially circulates in the Hand-Taiyin Lung meridian and connects to the Heart, Liver, Spleen, and Kidney. The essence of these four Zang organs is where this qi remains. Li Yun stated: "Liu" (remain) should be read as "Liu" (flow). Wu Yun stated: The Four Zang refer to the形体 (physical form) Zang: 1. Head horns, 2. Eyes and ears, 3. Mouth and teeth, 4. Chest and abdomen. Jian An noted: Wu’s annotation is incorrect.
Returning to equilibrium (Weight and Balance). Wu Yun stated: This means equality, without high or low fluctuations. Gao Yun stated: Like weighing objects to achieve balance. It refers to the pulse’s floating and sinking, entering and exiting, indicating harmonious yin and yang.
The Qi Kou forms the Cun pulse. Wang Ang stated: This is the origin of the pulse. Qi Kou is also called Cun Kou, the great convergence of all pulses. Ma’s annotation states: It is one cun away from Yu Ji, hence named Cun. Zhang’s annotation states: Dividing Chi into Cun. In pulse diagnosis, the front is Cun, the back is Chi, and the middle is Guan. Here, "forming Cun" likely refers to both Guan and Chi. Physicians examine the pulse to understand pathology and determine life and death. Li Yun stated: Once the zang-fu are harmonious, they must converge at the Qi Kou, forming a one-cun pulse to decide life and death.
Drinking enters the Stomach. Ma Yun stated: From "Drinking enters the Stomach" onwards, only drinking is discussed, not eating. Li Dongyuan’s *Pi Wei Lun* (Treatise on the Spleen and Stomach) and Zhu Danxi’s *Zuan Yao Shu* failed to verify that the preceding text referred to food, changing it to "food and drink enter the Stomach." This contradicts the meaning of "water essence distributing everywhere" in the following text. The preceding "food" implicitly includes "drink," but the following "drink" cannot easily encompass "food." Why do medical texts revere Li and Zhu while ignoring the classic’s intent?
You Yi (Floating and Overflowing). Wu Yun stated: You means circulating; Yi means overflowing. Zhang Yun stated: You means floating.
Water essence distributes everywhere, and the Five Meridians run together. Zhang Yun stated: Water is generated by qi, and qi is the mother of water. Wherever Lung qi reaches, water essence is distributed. Although water has one name, it has clear and turbid distinctions. The clear part is essence, like rain and dew; the turbid part is water, like rivers and lakes. Thus, essence returns to the Five Zang, and water returns to the Bladder, allowing the Five Meridians to run together. The Five Meridians refer to the meridians of the Five Zang.
Yin Yang Kui Du (Measuring and Estimating). Ma Yun stated: The Five Zang operate together, and water essence truly aligns with the seasons, the Five Zang, and the general principles of ancient classics like *Yin Yang Kui Du*. Zhi Yun stated: Kui Du refers to numerical degrees. Summarizing the above, it states that the way of meridians conforms to the sequence of seasons and five elements, and the degrees of yin-yang entry and exit, serving as the constant of meridians.
Taiyang Zang arrives alone. Gao Yun stated: The Three Yang govern the Six Fu organs. Fu organs can store substances, so they are also called Zang. Zhang Yun stated: This describes disharmony of Zang qi, where one Zang is excessive. The qi will arrive alone, presenting different symptoms, requiring different acupuncture treatments. Wu Yun stated: Seeing only the Taiyang pulse image, as described below as "resembling Three Yang and floating," is correct.
Lower Shu point. Ma, Wu, and Zhang all stated: The Shu point of the Bladder meridian is Shugu; the Shu point of the Kidney meridian is Taixi. Gao Yun stated: The Taiyang meridian starts at Zhiyin on the little toe, so one should take its lower Shu point. Shu refers to the Shu point.
Chong Bing (Double Conjunction). Zhi Yun stated: Two Yangs combine anteriorly, hence Yangming. Yangming’s solitary arrival is Taiyang and Shaoyang doubly joining Yangming. Yang excess leads to yin deficiency.
One should drain Yang and tonify Yin, taking the Lower Shu point. Ma, Wu, and Zhang all stated: The Shu point of Yangming is Xian Gu; the Shu point of Taiyin is Bai Hu. Gao Yun stated: The Yangming meridian starts at Lidui on the second toe, so one should take the lower Shu point.
Anterior sudden large pulse, take the Lower Shu point. Ma, Wu, and Zhang all stated: Zu is synonymous with Cu (sudden). Lower Shu refers to Lin Qi. Gao Yun stated: Shaoyang starts at Qiaoyin on the second toe, so one should also take the lower Shu point.
This is the excess of One Yang. Ma Yun stated: Guo means disease. Zhang Yun stated: This explains the meaning of solitary arrival, referring to the excess of one Zang. Taking Shaoyang as an example, the solitary arrival of Taiyang and Yangming implies the excess of Three Yang and Two Yang. One Yang is Shaoyang.
Qi of the Five Pulses is deficient. *Zheng Si Shi Lun* (Treatise on Four Diagnostic Errors) states: Diagnosis does not match the Five Pulses. Wu Yun stated: All Five Zang receive qi from the Spleen before being regulated. If Stomach qi fails to regulate the Spleen, all pulses lose their source and cannot receive qi, resulting in qi deficiency.
It is appropriate to treat their Lower Shu points. Ma, Wu, and Zhang all stated: Tonify Xian Gu of Yangming; drain Baihu of Taiyin.
One Yang whistles alone, indicating Shaoyue (Shaoyin Jue). Ma and Zhang, based on the New Correction, read "One Yang" as "Two Yin" and "Shaoyang" as "Shaoyin." Zhang Yun stated: Duxiao (whistling alone) means burning alone. Whistling is emitted by yang qi. When yang emerges from yin and ministerial fire flares upward, it becomes Shaoyin Heat Jue, with yang merging upward. Thus, the pulses of the Heart, Liver, Spleen, and Lung compete, while the qi returns to the Kidney, hence "whistling alone." Zhi Yun stated: Qi agitated in the throat and becoming turbid is called speech; qi agitated at the tip of the tongue and becoming clear is called whistling. It is the desire of stagnant qi to extend. Jian An noted: *Shuo Wen* defines xiao as blowing sound; *Shi Jian* defines it as making sound with pursed lips. Sun Guang’s *Xiao Zhi* in Tang Dynasty states: Qi agitated at the tongue and becoming clear is called whistling. Wang Bing stated: Ringing in the ears like whistling. Ma and Wu followed this, which is inappropriate. Zhang’s annotation should be followed.
It is appropriate to treat their meridians and collaterals. Ma and Zhang both stated: Taiyang meridian point Kunlun, collateral point Feiyang; Shaoyin meridian point Fuliou, collateral point Dazhong.
Treatment of Jueyin. Zhang Yun stated: Zhi means governing.
True deficiency, Heart pain. Zhang Yun stated: When Liver pathogen arrives alone, true qi must be deficient. Wood and fire interfere, causing Heart pain. Gao Yun stated: True deficiency means true and false. You means sorrow. It means assessing the truth and falsehood of Jueyin treatment with care, similar to Taiyin’s careful examination of true qi. Jian An noted: "Heart pain" has the same meaning as in *Yin Yang Bie Lun*. Gao’s annotation is pedantic and should not be followed.
Regulate diet and medicine, treatment at the Lower Shu point. Zhang Yun stated: Regulating medicine and diet aims for appropriateness. Acupuncture treatment is applied at the Lower Shu point of Jueyin, named Dachong. My analysis: How do we know this chapter refers only to foot meridians? The term "lower shu" indicates this. Similarly, in *Re Lun*, cold damage refers only to foot meridians. Also, while other meridians discuss tonification and drainage, Shaoyang and One Yin do not, because Shaoyang follows Three Yang, and One Yin follows Three Yin, connecting front and back with identical meaning. Deficiency is tonified, excess is drained, which is understandable. The phrase "One Yin regulates diet and medicine" likely summarizes the previous text and applies to all, not just one meridian. Ancient classics are often concise; one must grasp the intent.
Resembling Three Yang and floating. Zhang Yun stated: Taiyang resembles Three Yang because yang moves on the exterior, representing the extreme of yang, so the pulse floats externally. Zhi Yun stated: Xiang means resembling. Three Yang refers to qi of yang excess. It means the Taiyang Zang pulse resembles the qi of yang excess and floats.
One Yang Zang pulse is slippery but not solid. Ma Yun stated: Shaoyang is the interior of yang and exterior of yin, known as half-exterior half-interior. Its Zang represents the initial birth of yang, so the pulse body is slippery but not solid, symbolizing One Yang as initial yang.
Resembling large and floating. Ma Yun stated: Yangming is the interior of Taiyang but the exterior of Shaoyang. Compared to the slippery-but-not-solid pulse, it appears large and floating, resembling Taiyang’s floating pulse.
Described as deep and drumming. Ma Yun stated: Taiyin enters the yin branch. Although the pulse initially appears deep, it actually drums against the fingers and is not completely sunk.
Kidney pulse is deep and not floating. Ma Yun stated: Although Two Yin arrive together, the Kidney pulse is deep and not floating. From this, we see that Jueyin is the deepest, surpassing Two Yin. Zhang Yun stated: Detailed here are the pulse images of Two Yin, but there was no mention of Two Yin arriving earlier. There was mention of One Yin arriving, but no mention of One Yin pulse here. This confirms missing slips in the ancient classic. The error of "One Yang Shaoyang" in the previous text lies in this section. ○ Wu Yun stated: From "Taiyang Zang arrives alone" onwards, this chapter discusses meridian syndrome images, constituting a unique school of thought, hence called "Bie Lun" (Distinct Treatise).