平旦 张云。平旦者。阴阳之交也。阳主昼。阴主夜。阳主表。阴主里。凡人身营卫之气。一昼一
夜。五十周于身。昼则行于阳分。夜则行于阴分。迨至平旦。复皆会于寸口。营卫生会篇曰。平旦阴尽。而阳
受气矣。日中而阳陇。日西而阳衰。日入阳尽。而阴受气矣。故诊法当于平旦初寤之时。
阴气未动阳气未散 滑云。愚谓平旦未劳于事。是以阴气未扰动。阳气未耗散。
有过之脉 马云。盖人之有病。如事之有过误。故曰有过之脉。全经仿此。张云。有过。言脉不得
中。而有过失也。
切脉动静 张云。切者。以指按索之谓。切脉之动静。诊阴阳也。简按望闻问三者。临病患乃可知
焉。唯脉非切近其体肤。不能诊之。故谓之切脉。王以切近解之。为是。杨玄操难经注。切。按也。
精明 马云。王注为足太阳经睛明穴。由下文所以视万物别黑白等语观之。则主目言为正。盖精明主
神气言。舍目亦无以见之。况末云则精衰矣。岂精衰之精。尚可以穴言乎。孟子曰。存乎人者。莫良于眸子。
胸中正则眸子 焉者。是也。吴云。目中眸子。精神也。
参伍 张云。以三相较。谓之参。以伍相类。谓之伍。盖彼此反观。异同互证。而必欲搜其隐微之谓。
易曰。参伍以变。错综其数。通其变。即此谓也。（出上系辞。）滑云。以色脉脏腑形气。参合比伍也。简按
荀子曰。窥敌制胜。欲伍以参。又曰。参伍明谨施赏刑。杨 注云。参伍。犹错杂也。
血之府也 李云。营行脉中。故为血府。然行是血者。实气为之司也。逆顺篇云。脉之盛衰者。所以
候血气之虚实。则知此举一血。而气在其中。即下文气治气病。义益见矣。
上盛则气高下盛则气胀 吴云。脉之升者为上。上盛则病气高。高。粗也。脉之降者为下。下盛则病
气胀。张云。上盛者。邪壅于上也。气高者。喘满之谓。下盛者。邪滞于下。故腹为胀满。简按诸家以上下。
为寸尺之义。而内经有寸口之称。无分三部而为寸关尺之说。乃以难经以降之见读斯经。并不可从。此言上下
者。指上部下部之诸脉。详见三部九候论。气高。全本作气鬲。史记仓公传。气鬲病。使人烦懑。食不下。时沤沫。
代则气衰 马云。脉来中止。不能自还者。为代。代则正气已衰。故不能自还也。犹人负重。以至中
途。而力乏不前。欲求代于人者耳。张云。脉多更改不常者曰代。气虚无主也。简按马注仍王义。而申明伤寒
论脉经之旨者。史仓公云。不平而代。又云。代者。时参击。乍躁乍大也。张守节正义云。动不定曰代。此可
确张说也。代脉有三义。见张氏
脉神草。
涩则心痛 马云。脉来如刀刮竹。（出虞庶）而往来甚难者曰涩。涩则心血不足。而有时作痛也。张
云。涩为血少气滞。故为心痛。
浑浑革至如涌泉 张云。革至。如皮革之坚硬也。志云。革至者。扃易于平常也。高云。革至如涌
泉。应指杂还之意。汪机云。愚谓此则溢脉类也。与仲景弦大虚芤之革不同。简按文选七发注。浑浑。波相随
貌。革。集韵。音殛。急也。礼檀弓。夫子之病革矣。甲乙。脉经。乍绰绰。（诗传。宽也。）义相乖。
绵绵 张云。绵绵如写漆。（出辨脉篇）及如弓弦之断绝者。皆真气已竭。故死。高云。软散无伦
之意。诗大雅疏。微细之辞。
精明五色 吴云。精明见于目。五色显于面。皆为气之光华。
白裹朱 宋本脉经。白。作帛。沉本脉经作绵。马云。白。当作帛。诸本作白。非。张云。白裹朱。
隐然红润而不露也。
赭 张云。代赭也。色赤而紫。说文。赭。赤土也。
苍璧 白虎通。璧者。外圆象天。内方象地。尔雅。肉倍好谓之璧。
地苍 脉经。作炭。张云。地之苍黑。枯暗如尘。
其寿不久也 吴云。精微象见。言真元精微之气。化作色相。毕见于外。更无藏蓄。是真气脱也。
故寿不久。○高本。夫精明者所以视万物云云二十九字。移其去如弦死下。非。
伤恐者 吴云。伤。悲伤。恐。惧也。伤为肺志。恐为
肾志。盖肺气不利则悲。湿土刑肾则恐也。张云。伤恐者。肾受伤也。志云。恐为肾志。如肾气不藏。而反胜
于中。则伤动其肾志矣。简按推下文例。者字。当在言下。
终日乃复言 志云。气不接续也。伤寒论曰。实则谵语。虚则郑声。郑声者。重语也。
门户不要 张云。要。约束也。幽门（胃下口）阑门（大肠小肠之会）魄门。皆仓廪之门户。门户不
能固则肠胃不能藏。所以泄利不禁。脾脏之失守也。
五脏者身之强也 吴本作五腑。注云。下文所言五腑者。乃人身恃之以强健。简按吴注似是。高接前
段。为五脏者中之守也之结语。恐非。
头者精明之府 张云。五脏六腑之精气。皆上升于头。以成七窍之用。故头为精明之府。高云。人身
精气。上会于头。神明上出于目。故头者。精明之府。
头倾视深 吴云。视深。视下也。又目陷也。张云。头倾者。低垂不能举也。视深者。目陷无光也。
背者胸中之府 马云。胸在前。背在后。而背悬五脏。实为胸中之府。张云。背乃脏俞所系。故为胸中之府。
肩随 楼氏纲目。作肩垂。
肾将惫矣 熊音。惫。蒲拜反。病也。吴云。惫。与败同。坏也。
偻附 吴云。偻。曲其身也。附。不能自步。附物而行也。简按马。附读为俯。为是。左传昭七年。正考
父一命而偻。再命而伛。三命而俯。杜注。俯共于伛。伛共于偻。又HT 同。说文。HT 。 病也。广雅。HT 。短
也。
岐伯曰反四时者云云 张云。此言四时阴阳脉之相反者。亦为关格也。禁服篇曰。春夏人迎微大。秋
冬寸口微大。如
是者。命曰平人。以人迎为阳脉。而主春夏。寸口为阴脉。而主秋冬也。若其反者。春夏气口当不足。而反有
余。秋冬人迎当不足。而反有余。此邪气之有余。有余者。反为精也。春夏人迎当有余。而反不足。秋冬寸口
当有余。而反不足。此血气之不足。不足者。日为消也。如春夏人迎应太过。而寸口之应不足者。反有余。而
为精。秋冬寸口应太过。而人迎之应不足者。反有余。而为精。是不足者为精也。春夏寸口应不足。而人迎应
有余者。反不足。而为消。秋冬人迎应不足。而寸口应有余者。反不足。而为消。是有余者为消也。应不足而
有余者。邪之日盛。应有余而不足者。正必日消。若此者。是为阴阳相反。气不相营。皆名关格。简按此一顷
三十九字。与前后文。不相顺承。疑是它篇错简。且精消二字。其义不大明。姑从张注。
脉其四时动 甲乙。无其字。
请言其与天运转大也 高云。人之阴阳升降。如天运之环转广大。故曰请言其与天运转大也。
彼秋之忿为冬之怒 成无己注伤寒例云。秋忿为冬怒。从肃而至杀也。马云。按彼春之暖四句。又
见至真要大论。张仲景伤寒论引之。
脉与之上下 马云。上下者。浮沉也。
以春应中规 高云。所以与之上下者。春时天气始生。脉应软弱浮滑。则圆转而中规之度矣。马云。
规者。所以为圆之器也。春脉软弱轻虚而滑。如规之象。圆活而动。
夏应中矩 马云。矩者。所以为方之器也。夏脉洪大滑数。如矩之象。方正而盛。
秋应中衡 张云。衡。平也。秤。横也。秋气万物俱成平于地面。故应中衡。而人脉应之。所以浮
毛而见于外也。
冬应中权 张云。权。秤锤也。冬气闭藏。故应中权。而人脉应之。所以沉石而伏于内也。凡兹规矩
权衡者。皆发明阴阳升降之理。以合乎四时脉气之变象也。简按淮南时则训云。制度阴阳。大制有六度。天为
绳。地为准。春为规。夏为衡。秋为矩。冬为权。虽与此章有不同者。而以规矩权衡配四时。当时已有其说。
不唯医经也。
知脉所分 张云。期而相失者。谓春规夏矩秋衡冬权。不合于度也。知脉所分者。谓五脏之脉。各有
所属也。分之有期者。谓衰王各有其时也。知此者。则知死生之时矣。
故知死时 时。别本作期。
始之有经 吴云。始之有经常之道。简按始之以下三十三字。甲乙无之。又是知阴盛则梦以下七十八
字亦同。新校正有误置之说。今删此一百字。则文意贯通。似甲乙为正。论梦一节。见灵淫邪发梦篇。及列子
穆王篇。
与天地如一 易曰。天道亏盈而益谦。地道变盈而流谦。
上盛 简按王注。上。上声。诸家读如字。
下盛 简按王注。下。去声。诸家读如字。
梦予 熊音。予。上声。与同。
虚静为保 简按甲乙。作宝。盖保。葆。宝。古通用。史记留侯世家。见谷城山下黄石。取而葆之。
注。史记珍宝字皆作葆。征四失论。从容之葆。
泛泛乎 吴云。泛泛然充满于指。简按说文。泛。浮也。通作 。
蛰虫 熊音。蛰。直力反。虫藏也。
知外者终而始之 马云。能观其色而验之。有终始生克之异。（此仍王意）吴云。切脉之道。有终有
始。始则浮取之。终则沉取之。浮以候外。沉以候内。终而始之。谓既取其沉。
复察于浮。浮沉相较。高注同。张云。内。言脏气。脏象有位。故可按而纪之。外。言经气。经脉有序。故可
终而始之。简按灵终始篇。终始者。经脉为纪。张义似允。
故曰 熊本。吴本。无此二字。
此六者 马云。春夏秋冬内外六者。张同。高云。内外按纪终始。
持脉之大法 法下。甲乙有也字。
当消环自已 马云。若软而散。则刚脉渐柔。当完一周之时。而病自已矣。吴。消下句。志高同。志
云。灵枢云。心脉微小为消瘅。盖心液不足。则火郁而为消渴之病。心藏神。得神机环转。而病自已也。按甲
乙。环。作渴。（脉经同）高同。张云。软散者。心气将和也。消。尽也。环。周也。谓期尽一周。而病自已
矣。愚按搏击之脉。皆肝邪盛也。肝本属水。而何五脏皆畏之。盖五脏皆以胃气为本。脉无胃气则死。凡木强
者土必衰。脉搏者胃多败。故坚搏为诸脏所忌。兹心脉搏坚而长者。以心脏之胃气不足。而邪有余也。搏之微。
则邪亦微。搏之甚。则几于真脏矣。故当以搏之微甚。而察病之浅深。后四脏者仿此。汪昂云。志聪注。消。
谓消渴。非。徐氏要旨云。搏坚皆为大过。软而散。皆为不及。五脏各因大过不及而病也。
当病灌汗 灌。脉经作漏。吴云。汗多如灌水也。张云。肺虚不敛。汗出如水。
至令不复散发也 张云。汗多亡阳。故不可更为发散也。脉经。发下无也字。注云。六字疑衍。
色不青 滑云。当作其色青。简按此说非是。当从王注。
色泽 张云。肝木不足。脾湿胜之。湿在肌肤。故颜色光泽。志云。金匮要略云。夫病水人。面目
鲜泽。盖水溢于
皮肤。故其色润泽也。
溢饮 金匮要略云。饮水流行。归于四肢。当汗出而不汗出。身体疼重。谓之溢饮。
易入肌皮肠胃之外 滑云。易。当作溢。简按以理推之。宜云肌皮之中。肠胃之外。而肌皮即是肠
胃之外。故云尔。脉经亦易作溢。
折髀 吴云。折伤其髀。筋损血伤。故见肝木之脉。诸注仍王义。
食痹 痹下。脉经。有髀痛二字。吴云。谓食积痹痛也。简按至真要大论王注云。食痹。谓食已心
下痛。阴阴然不可名也。不可忍也。吐出乃止。此为胃气逆。而不下流也。又张云食痹者。食入不化。入则闷
痛呕汁。必吐出乃止。李氏医宗必读有治法。
其软散 脉经。软下。有而字。
色不泽者 志云。五脏元真之气。脾所主也。湿热太过。则色黄脉盛。而少气矣。其不及。当病足
胫肿。脾气虚。故足肿也。若水状而非水病。故其色不泽。
其色黄而赤 张云。邪脉干肾。肾必衰。其色黄赤。为火土有余。而肾不足。
折腰 吴云。伤折其腰。损其肉与脉。肉病故黄。脉病故赤也。简按刺腰痛论云。解脉。令人腰痛。
如引带。如折腰状。以此观之。吴说似是。但以黄赤。分肉与脉。恐非。
心疝 圣济总录云。夫脏病必传于腑。今心不受邪。病传于腑。故小肠受之。为疝而痛。少腹当有
形也。世之医者。以疝为寒湿之疾。不知心气之厥。亦能为疝。心疝者。当兼心气以治之。方具于九十四卷。
大奇论云。心脉搏滑急。为心疝。四时刺逆从论云。滑则病心风疝。邪气脏腑病形篇云。
心疝。引脐小腹鸣。
心为牡脏 灵顺气一日分为四时篇。亦有此文。张云。牡。阳也。心属火。而居于膈上。故曰牡脏。
简按吴本。牡。作牝。注云。牝。阴也。大误。灵枢。肺为牝脏。
寒热 简按寒热。盖虚劳寒热之谓。即后世所称风劳。下文云。沉细数散者。寒热也。次篇云。寸
口沉而喘。曰寒热。及灵论疾诊尺篇。寒热病篇。风论等。所论皆然。又喻昌医门法律。以以下五条。为胃风
变证。各处一方。误甚。
瘅成为消中 马云。瘅者。热也。吴云。瘅。热邪也。积热之久。善食而饥。名曰消中。简按王注
[Pingdan (Early Morning)] Zhang Yun: Pingdan is the time when Yin and Yang intersect. Yang governs the day, Yin governs the night; Yang governs the exterior, Yin governs the interior. The Ying (Nutrient) and Wei (Defensive) Qi of the human body circulates fifty times through the body in one day and night. During the day, it travels through the Yang aspects; at night, it travels through the Yin aspects. Upon reaching Pingdan, they all converge again at the Cun Kou (Radial Artery). The *Ying Sheng Hui Pian* states: "At Pingdan, Yin Qi is exhausted, and Yang Qi receives Qi." At midday, Yang Qi is abundant; at sunset, Yang Qi declines; upon entering the sun, Yang Qi is exhausted, and Yin Qi receives Qi. Therefore, pulse diagnosis should be performed at the time of early morning awakening.
[Yin Qi Unmoved, Yang Qi Undispersed] Hua Yun: I believe that at Pingdan, before laboring on affairs, Yin Qi is not yet disturbed, and Yang Qi is not yet dissipated.
[Overly Abnormal Pulse] Ma Yun: Generally, when a person falls ill, it is like committing an error or mistake in affairs; hence it is called an "overly abnormal pulse" (pulse indicating deviation from normality). This phrasing is consistent throughout the classic. Zhang Yun: "Guo you" (having faults/errors) refers to the pulse failing to be moderate and correct, exhibiting deviations.
[Palpating Pulse Movement and Stillness] Zhang Yun: "Qie" (palpate) means to press and explore with fingers. Palpating the movement and stillness of the pulse is for diagnosing Yin and Yang. Briefly observing, listening, and asking are methods known only when facing the patient. Only the pulse requires close proximity to the body surface to be diagnosed, hence it is called "Qie Mai" (Palpating the Pulse). Wang Bing's interpretation of "Qie" as "close proximity" is correct. Yang Xuancao, in his commentary on the *Nan Jing*, states: "Qie" means to press.
[Jing Ming (Clarity and Brightness)] Ma Yun: Wang Bing annotated this as the Jing Ming acupoint of the Foot-Taiyang Bladder Meridian. However, judging from the subsequent text regarding "seeing all things and distinguishing black and white," it is correct to interpret this primarily referring to the eyes. "Jing Ming" mainly refers to Shen Qi (Spiritual Qi); without the eyes, there is no way to perceive it. Moreover, the end of the passage says "then Jing (Essence) declines." Could this "Jing" still refer to an acupoint? Mencius said: "Among observations of a person, none is better than looking at the pupils. If the chest is upright, the pupils are bright." This is what is meant. Wu Yun: The pupils in the eyes represent Spirit.
[Can Wu (Interweaving/Comparison)] Zhang Yun: Comparing by threes is called "Can"; classifying by fives is called "Wu." It generally means mutually reflecting upon each other, cross-verifying similarities and differences, and striving to uncover hidden subtleties. The *I Ching* says: "Can Wu changes, interlacing their numbers." Understanding change is precisely this. (From *Xi Ci Shang*). Hua Yun: Integrating and comparing Color, Pulse, Zang-Fu, Form, and Qi. Brief Note: Xunzi said: "To spy on the enemy and achieve victory, one must use 'Wu' combined with 'Can'." He also said: "Clear and cautious application of rewards and punishments through Can Wu." Yang's commentary notes: "Can Wu" is like interlacing or mixing.
[The Mansion of Blood] Li Yun: Ying Qi flows within the vessels, so the vessels are the mansion of blood. However, what actually moves the blood is Qi. The *Ni Shun Pian* states: "The flourishing and declining of the pulse serves to observe the deficiency and excess of Blood and Qi." Thus, we know that mentioning "Blood" here implies Qi is included within it. The meanings of "Qi governing" and "Qi disease" in the following text become even clearer.
[Upper Excess leads to High Qi, Lower Excess leads to Distension] Wu Yun: The rising aspect of the pulse is "Upper." Upper excess indicates pathological Qi is "high" (coarse/bulky). The descending aspect is "Lower." Lower excess indicates pathological Qi causes distension. Zhang Yun: Upper excess means pathogenic factors obstruct the upper part. "High Qi" refers to panting and fullness. Lower excess means pathogenic factors stagnate in the lower part, causing abdominal distension. Brief Note: Various commentators interpret Upper and Lower as Cun and Chi positions. However, the *Nei Jing* mentions "Cun Kou" but does not divide it into three parts (Cun, Guan, Chi). Reading this classic using post-*Nan Jing* views is inadvisable. Here, Upper and Lower refer to the pulses of the upper and lower regions of the body, detailed in the *San Bu Jiu Hou Lun*. "Qi Gao" (High Qi), in the complete text, is written as "Qi Ge" (Qi obstruction). The *Records of the Grand Historian: Biography of Cang Gong* records: "Qi Ge disease causes irritability, inability to eat, and frequent spitting of foam."
[Dai Pulse indicates Qi Decline] Ma Yun: When the pulse stops and cannot return spontaneously, it is called "Dai" (Interruption). Dai indicates that Righteous Qi has declined, hence it cannot return spontaneously. It is like a person carrying a heavy load who reaches the midpoint, runs out of strength, and cannot proceed, wishing for someone to take over. Zhang Yun: A pulse that changes frequently and irregularly is called "Dai," indicating Qi deficiency and lack of mastery. Brief Note: Ma's note follows Wang Bing's meaning but clarifies the principles of the *Shang Han Lun* and *Mai Jing*. *Shi Ji Cang Gong* says: "Uneven and Dai." It also says: "Dai pulses strike intermittently, sometimes rapid, sometimes large." Zhang Shoujie's Justice commentary states: "Irregular movement is Dai." This confirms Zhang's view. The Dai pulse has three meanings, see Zhang's *Mai Shen Cao*.
[Se Pulse leads to Heart Pain] Ma Yun: A pulse coming like a knife scraping bamboo (from Yu Shu), where the flow is very difficult, is called "Se" (Choppy). Se indicates insufficient Heart Blood, leading to occasional pain. Zhang Yun: Se is due to Blood deficiency and Qi stagnation, thus causing Heart pain.
[Hun Hun Ge Zhi Ru Yong Quan (Turbid, Firm Arrival Like a Gushing Spring)] Zhang Yun: "Ge Zhi" (Firm arrival) feels hard like leather. Zhi notes: "Ge Zhi" differs from the ordinary. Gao notes: "Ge Zhi like a gushing spring" implies a chaotic, swirling sensation under the finger. Wang Ji notes: I consider this similar to the Yi Mai (Overflowing Pulse). It differs from the "Ge" pulse described by Zhongjing as String-taut, Large, Empty, and Floating. Brief Note: Commentary on *Wen Xuan Qi Fa*: "Hun Hun" describes waves following each other. "Ge," in *Ji Yun*, is pronounced "ji," meaning urgent/hasty. *Li Ji Tan Gong* says: "Master's illness was Ge." *Jia Yi Jing* and *Mai Jing* read it as "Zha Chuo Chuo" (*Shi Zhuan*: relaxed/wide). The meanings contradict.
[Mian Mian (Continuous and Fine)] Zhang Yun: "Mian Mian" like pouring lacquer (from *Bian Mai Pian*) or like a broken bowstring, both indicate exhaustion of True Qi, hence death. Gao Yun: Meaning soft, scattered, and lacking order. *Shi Jing Da Ya Shu*: A term for minuteness.
[Jing Ming and Five Colors] Wu Yun: "Jing Ming" appears in the eyes; "Five Colors" manifest on the face. Both are the radiance of Qi.
[Bai Guo Zhu (White Wrapping Vermilion)] Song edition of *Mai Jing*: "Bai" is written as "Bo" (Silk). Chen edition of *Mai Jing* writes "Mian" (Cotton). Ma Yun: "Bai" should be "Bo." All versions writing "Bai" are incorrect. Zhang Yun: "Bai Guo Zhu" implies a hidden rosy redness not fully exposed.
[Zhe (Red Earth/Hematite)] Zhang Yun: Dai Zhe (Hematite). Color is red-purple. *Shuo Wen*: "Zhe" is red earth.
[Cang Bi (Green Jade Disc)] *Bai Hu Tong*: "Bi" is round outside symbolizing Heaven, square inside symbolizing Earth. *Er Ya*: "When flesh is double the hole, it is called Bi."
[Di Cang (Earth Green/Dark)] *Mai Jing* writes "Tan" (Charcoal). Zhang Yun: The dark green-black of earth, dry and dim like dust.
[Its Life Span Will Not Be Long] Wu Yun: The appearance of subtle essences means the True Yuan Jing Wei Qi transforms into visible color phases, fully manifesting externally with no further storage. This is the depletion of True Qi. Hence, life span will not be long. ○ Gao edition moved the 29 characters starting with "Fu Jing Ming Zhe..." below "Ru Xian Si," which is incorrect.
[Shang Kong (Injury and Fear)] Wu Yun: "Shang" is sorrow/grief; "Kong" is fear. "Shang" is the emotion of the Lung; "Kong" is the emotion of the Kidney. Generally, if Lung Qi is unsmooth, there is grief; if Wet Earth attacks the Kidney, there is fear. Zhang Yun: "Shang Kong" refers to injury to the Kidney. Zhi notes: "Kong" is the Kidney's emotion. If Kidney Qi fails to store and instead overacts internally, it injures the Kidney's emotion. Brief Note: Inferring from the following text structure, the character "Zhe" should likely follow "Yan."
[Speaking Only After a Whole Day] Zhi notes: Qi is not continuous. *Shang Han Lun* states: "Excess leads to delirious speech; Deficiency leads to Zheng Sheng (repetitive speech)." Zheng Sheng is repetitive speech.
[Doors and Gates Lack Restraint] Zhang Yun: "Yao" means restraint. You Men (lower opening of Stomach), Lan Men (confluence of Large and Small Intestines), and Po Men (anus) are all gates of the granaries. If doors and gates cannot secure, the intestines and stomach cannot store, leading to uncontrollable diarrhea and dysentery. This is a failure of the Spleen organ.
[The Five Zang Organs Are the Strength of the Body] Wu version reads "Wu Fu." Annotation: The "Five Fu" mentioned below refers to what the human body relies upon for robustness. Brief Note: Wu's annotation seems reasonable. Gao connects it to the previous paragraph as a conclusion to "The Five Zang Organs Are the Guardians Within," which is likely incorrect.
[The Head Is the Mansion of Jing Ming] Zhang Yun: The Essence-Qi of the Five Zang and Six Fu organs all ascend to the head to form the functions of the seven orifices. Thus, the head is the mansion of Jing Ming. Gao Yun: Human Essence-Qi converges at the head; Spirit manifests through the eyes. Thus, the head is the mansion of Jing Ming.
[Tilted Head and Sunken Eyes] Wu Yun: "Shi Shen" means looking downward. Also refers to sunken eyes. Zhang Yun: "Tou Qing" means hanging low and unable to lift. "Shi Shen" means sunken eyes without luster.
[The Back Is the Mansion of the Chest] Ma Yun: The chest is in front, the back is behind, and the back suspends the five Zang organs, truly serving as the mansion of the chest. Zhang Yun: The back is connected to the Shu points of the Zang organs, thus it is the mansion of the chest.
[Jian Sui (Shoulder Drooping)] Lou's *Gang Mu* reads "Jian Chui" (Shoulder Drooping).
[Kidney Is About to Exhaust] Xiong pronunciation: "Bei," pronounced Pu Bai fan, meaning sick/exhausted. Wu Yun: "Bei" is synonymous with "Bai" (decay/ruin).
[Lou Fu (Hunchbacked and Leaning)] Wu Yun: "Lou" means bending the body. "Fu" means being unable to walk independently, leaning on objects to move. Brief Note: Ma reads "Fu" as "Fu" (bending forward), which is correct. *Zuo Zhuan Zhao Gong 7th Year*: "Zheng Kaofu bowed once at first appointment, hunched twice at second, and leaned thrice at third." Du Pre's commentary: "Leaning corresponds to hunching; hunching corresponds to bowing." Also, "HT" is same as "Fu." *Shuo Wen*: "HT" means sickness. *Guang Ya*: "HT" means short/stunted.
[Qi Bo Said: Opposing the Four Seasons...] Zhang Yun: This discusses pulses opposing the Yin-Yang of the four seasons, which also constitutes Guan Ge (Obstruction and Repletion). *Jin Fu Pian* states: "In Spring and Summer, Ren Ying pulse is slightly larger; in Autumn and Winter, Cun Kou pulse is slightly larger. Such persons are named Ping Ren (Healthy Persons)." Ren Ying is the Yang pulse, governing Spring and Summer; Cun Kou is the Yin pulse, governing Autumn and Winter. If reversed: In Spring and Summer, Qi Kou should be deficient but is instead replete; this is Excess of Pathogenic Qi. Repletion implies "Jing" (Solidity/Abundance). In Spring and Summer, Ren Ying should be replete but is deficient; in Autumn and Winter, Cun Kou should be replete but is deficient. This is Deficiency of Blood and Qi. Deficiency implies daily consumption ("Xiao"). If Ren Ying should be excessive in Spring/Summer, but Cun Kou (which should be deficient) is instead replete and becomes "Jing"; if Cun Kou should be excessive in Autumn/Winter, but Ren Ying (which should be deficient) is instead replete and becomes "Jing": This is Deficiency turning into Jing. If Cun Kou should be deficient in Spring/Summer, but Ren Ying (which should be replete) is instead deficient and becomes "Xiao"; if Ren Ying should be deficient in Autumn/Winter, but Cun Kou (which should be replete) is instead deficient and becomes "Xiao": This is Repletion turning into Xiao. Should be deficient but is replete: Pathogenic Qi grows daily. Should be replete but is deficient: Righteous Qi consumes daily. Such cases are Yin-Yang opposition, Qi failing to nourish each other, all named Guan Ge. Brief Note: These thirty-nine characters do not connect smoothly with preceding and following texts; suspect misplaced slips from another chapter. The meanings of "Jing" and "Xiao" are unclear. Tentatively following Zhang's annotation.
[The Pulse Moves According to the Four Seasons] *Jia Yi Jing* omits the character "Qi."
[Please Speak of Its Great Rotation Like Heaven] Gao Yun: The rise and fall of human Yin and Yang are like the vast circular rotation of heaven. Hence, "Please speak of its great rotation like heaven."
[That Autumn's Anger Becomes Winter's Wrath] Cheng Wuji's commentary on *Shang Han Li* states: "Autumn anger becomes Winter wrath," moving from肃 (Solemnity/Restriction) to Sha (Killing). Ma Yun: Referring to the four lines "That Spring's Warmth...", also found in *Zhi Yao Yao Da Lun*, cited by Zhang Zhongjing in *Shang Han Lun*.
[Pulse Moves Up and Down With It] Ma Yun: "Up and Down" refers to Floating and Deep.
[Spring Corresponds to the Compass (Gui)] Gao Yun: What makes them move up and down correspondingly: In Spring, heavenly Qi begins to generate; the pulse should be soft, weak, floating, and slippery, thus round and turning, conforming to the degree of the Compass. Ma Yun: Gui is the instrument for drawing circles. Spring pulse is soft, weak, light, void, and slippery, resembling the image of a compass—round, active, and moving.
[Summer Corresponds to the Square Ruler (Ju)] Ma Yun: Ju is the instrument for drawing squares. Summer pulse is洪 (Vast), large, slippery, and rapid, resembling the image of a ruler—square and vigorous.
[Autumn Corresponds to the Steelyard Beam (Heng)] Zhang Yun: Heng means level. The beam of a scale is horizontal. In Autumn Qi, all things mature and lie flat on the ground. Thus, it corresponds to Heng, and the human pulse responds by being floating and hairy, appearing on the exterior.
[Winter Corresponds to the Weight (Quan)] Zhang Yun: Quan is the weight (counterweight) of a scale. Winter Qi is closed and stored. Thus, it corresponds to Quan, and the human pulse responds by being deep and stony, hiding within. All these rules, compasses, squares, beams, and weights elucidate the principles of Yin-Yang rise and fall, aligning with the changing images of Four-Season Pulse Qi. Brief Note: *Huainanzi Shi Ze Xun* states: "Regulating Yin and Yang, the great system has six measures. Heaven is the Cord, Earth is the Level. Spring is the Compass, Summer is the Beam, Autumn is the Square, Winter is the Weight." Although differing from this chapter, pairing Rules/Compasses/Squares/Weights with the Four Seasons existed then, not just in medical classics.
[Knowing the Division of Pulses] Zhang Yun: "Missing the mark by expectation" refers to Spring Compass, Summer Square, Autumn Beam, Winter Weight failing to meet standards. "Knowing the division of pulses" means knowing that the pulses of the Five Zang organs each have their specific associations. "Division having periods" means decline and flourishing each have their times. Knowing this allows one to know the time of death and life.
[Thus Knowing the Time of Death] "Shi" (Time), alternative versions read "Qi" (Period).
[Beginning Has Constants] Wu Yun: Beginning has constant ways/principles. Brief Note: The 33 characters from "Shi Zhi" onwards are absent in *Jia Yi Jing*. Similarly, the 78 characters from "Furthermore, knowing Yin excess dreams..." are also missing. New Correction suggests erroneous placement. Deleting these 100 characters makes the text coherent, suggesting *Jia Yi Jing* is correct. The section on dreams is found in *Ling Shu: Yin Xie Fa Meng Pian* and *Lie Zi: Mu Wang Pian*.
[One with Heaven and Earth] *I Ching* says: "Heaven's Way diminishes the Full and benefits the Modest; Earth's Way alters the Full and flows toward the Modest."
[Upper Excess] Brief Note: Wang Bing's annotation: "Shang" (Upper) is read with the Rising Tone. Other families read it as the standard character.
[Lower Excess] Brief Note: Wang Bing's annotation: "Xia" (Lower) is read with the Departing Tone. Other families read it as the standard character.
[Dream Giving] Xiong pronunciation: "Yu," read with Rising Tone, same as "Yu" (Give).
[Emptiness and Stillness Ensure Preservation] Brief Note: *Jia Yi Jing* reads "Bao" (Treasure). Generally, "Bao," "Bao," and "Bao" were interchangeable in ancient times. *Shi Ji Liu Hou Shi Jia*: "Saw yellow stone under Mount Gucheng, took it and preserved it." Annotation: In *Shi Ji*, characters for treasure are all written as "Bao." *Zheng Si Shi Lun*: "Calm preservation."
[Fan Fan Hu (Floating and Vague)] Wu Yun: Feeling full and floating under the fingers. Brief Note: *Shuo Wen*: "Fan" means float. Interchangeable with "Fan."
[Zhe Chong (Hibernating Insects)] Xiong pronunciation: "Zhe," Zhi Li fan, insects hiding.
[Knowing the Exterior, One Ends and Begins Again] Ma Yun: Observing color and verifying it reveals differences in End-Beginning and Generation-Overcoming. (Following Wang's intent). Wu Yun: The way of palpating pulse has an end and a beginning. Beginning is superficial palpation; End is deep palpation. Superficial observes the exterior; Deep observes the interior. Ending and beginning again means after taking the deep pulse, one re-examines the superficial. Comparing superficial and deep, Gao's note agrees. Zhang Yun: Interior refers to Zang Qi. Zang manifestations have locations, so they can be pressed and recorded. Exterior refers to Jing Qi. Meridians have order, so one can end and begin again. Brief Note: *Ling Shu Zhong Shi Pian*: "Zhong Shi refers to meridians as the record." Zhang's interpretation seems appropriate.
[Gao Yue (Therefore It Is Said)] Kun edition, Wu edition omit these two characters.
[These Six Factors] Ma Yun: Spring, Summer, Autumn, Winter, Interior, Exterior—these six. Zhang agrees. Gao Yun: Interior/Exterior, pressing/recording, ending/beginning.
[The Great Method of Holding the Pulse] Below "Fa," *Jia Yi Jing* adds "Ye" (particle).
[It Should Dissipate and Circulate, Healing Itself] Ma Yun: If soft and scattered, the rigid pulse gradually becomes soft. When one cycle completes, the disease heals itself. Wu, Xiao sentence, Zhi Gao agree. Zhi notes: *Ling Shu* states: "Heart pulse minute and small indicates Xiao Dan." Essentially, Heart Fluid deficiency leads to Fire stagnation causing Xiao Ke (Wasting-Thirst) disease. Heart houses Spirit; obtaining Spirit mechanism circular rotation heals the disease. According to *Jia Yi Jing*, "Huan" is written as "Ke" (*Mai Jing* agrees). Gao agrees. Zhang Yun: Soft and scattered means Heart Qi is about to harmonize. Xiao means finish. Huan means cycle. It means when the period of one cycle ends, the disease heals itself. My opinion: Beating pulses indicate Liver Pathogen excess. Liver belongs to Water, why do all Five Zang fear it? Basically, all Five Zang rely on Stomach Qi. Pulse without Stomach Qi leads to death. Whenever Wood is strong, Earth must weaken. Pulse beating strongly indicates Stomach defeat; thus, hardness/beating is taboo for all Zang. Here, Heart pulse beats firmly and is long because Heart Stomach Qi is insufficient while Pathogen is excessive. Slight beating means slight pathogen; severe beating approaches True Zang pulse. Thus, one should examine disease depth by severity of beating. The next four Zang follow this. Wang Ang notes: Zhi Cong's annotation, "Xiao" refers to Xiao Ke, which is incorrect. Xu's *Yao Zhi* states: Beating/Firm are all major excess; Soft/Scattered are all major deficiency. The Five Zang each suffer disease due to major excess or deficiency.
[Should Suffer From Irrigating Sweat] "Guan," *Mai Jing* writes "Lou" (Leak). Wu Yun: Sweat profuse like pouring water. Zhang Yun: Lung deficiency fails to consolidate, sweat flows like water.
[Until Now, No Longer Disperse It] Zhang Yun: Profuse sweat depletes Yang, therefore one must not disperse further. *Mai Jing*: No "Ye" character after "Fa." Annotation: Six characters suspected to be superfluous.
[Color Not Cyan] Hua Yun: Should be "Qi Se Qing" (Its color is cyan). Brief Note: This explanation is incorrect; should follow Wang Bing's annotation.
[Color Luster] Zhang Yun: Liver Wood is insufficient, Spleen Dampness overcomes it. Dampness in skin/flesh causes color luster. Zhi notes: *Jin Gui Yao Lue* states: "Patients with water disease have fresh and lustrous faces." Essentially, water overflows skin, so color is lustrous.
[Yi Yin (Overflowing Drink)] *Jin Gui Yao Lue* states: "Drinking water flows, returning to limbs. Should sweat but does not sweat; body aches and feels heavy. This is called Yi Yin."
[Easily Enters Outside Muscle Skin and Intestines/Stomach] Hua Yun: "Yi" should be "Yi" (Overflow). Brief Note: Reasoning suggests it should say "Inside Muscle Skin, Outside Intestines/Stomach," and since Muscle Skin is indeed outside Intestines/Stomach, it is stated thus. *Mai Jing* also writes "Yi" as "Yi."
[Zhe Bi (Broken Thigh)] Wu Yun: Broken thigh, tendon damaged, blood injured, thus Liver Wood pulse appears. Annotations still follow Wang Bing.
[Shi Bi (Food Obstruction)] Below "Bi," *Mai Jing* adds "Bi Tong" (Thigh pain). Wu Yun: Refers to food accumulation obstruction pain. Brief Note: *Zhi Yao Yao Da Lun* Wang Bing annotation: "Shi Bi" means pain below the heart after eating, indistinctly unbearable, stopping only after vomiting. This is Stomach Qi reversing and not flowing down. Zhang Yun: "Shi Bi" means food enters but does not digest, causing stifling pain and vomiting juice upon entry, stopping only after vomiting. Li's *Yi Zong Bi Du* has treatment methods.
[Its Softness and Scattered Nature] *Mai Jing*: Adds "Er" (And) below "Ruan."
[Color Without Luster] Zhi notes: The Original Qi of the Five Zang is governed by Spleen. Excessive Damp-Heat causes Yellow color, Surging pulse, and Shortness of Qi. Insufficiency leads to swelling of feet and shins. Spleen Qi deficiency causes foot swelling. If it looks like water but is not water disease, its color lacks luster.
[Color Yellow and Red] Zhang Yun: Pathogenic pulse invades Kidney; Kidney must decline. Yellow-red color indicates Fire and Earth excess, and Kidney insufficiency.
[Zhe Yao (Broken Waist)] Wu Yun: Broken waist, damaging flesh and pulse. Flesh disease causes yellow; pulse disease causes red. Brief Note: *Ci Yao Tong Lun* states: "Jie Mai causes lower back pain, like pulling a belt, like breaking the waist." Viewing this, Wu's theory seems plausible. But dividing yellow/red between flesh and pulse is likely incorrect.
[Xin Shan (Heart Hernia)] *Sheng Ji Zong Lu* states: "Zang diseases must transmit to Fu. Now Heart does not accept pathogen; disease transmits to Fu, thus Small Intestine accepts it, causing hernia pain, with shape visible in lower abdomen. Physicians of the world treat hernia as Cold-Damp disease, unaware that Heart Qi reversal can also cause hernia. For Xin Shan, one must treat combining Heart Qi. Formula provided in Volume 94." *Da Qi Lun* states: "Heart pulse beating slippery and rapid indicates Heart Hernia." *Si Shi Ci Ni Cong Lun* states: "Slippery indicates Heart Wind Hernia." *Xie Qi Zang Fu Bing Xing Pian* states: "Heart Hernia draws to umbilicus, lower abdomen sounds."
[Heart Is a Yang Organ] *Ling Shu Shun Qi Yi Ri Fen Wei Si Shi Pian* also contains this text. Zhang Yun: "Mu" means Yang. Heart belongs to Fire and resides above the diaphragm, hence called Yang Organ. Brief Note: Wu version writes "Mu" as "Pin." Annotation: "Pin" means Yin. Major error. *Ling Shu*: "Lung is Pin Organ."
[Han Re (Cold and Heat)] Brief Note: "Han Re" likely refers to Consumption-Cold-Heat, i.e., Feng Lao (Wind Consumption) later termed. Next text: "Deep, fine, rapid, scattered indicates Cold and Heat." Next chapter: "Cun Kou deep and panting indicates Cold and Heat." And *Ling Shu Lun Ji Zhen Chi Pian*, *Han Re Bing Pian*, *Feng Lun*, etc., all discuss similarly. Also, Yu Chang's *Yi Men Fa Lv* treats the following five items as variations of Wei Feng (Stomach Wind), prescribing separate formulas for each, which is very mistaken.
[Dan Becomes Xiao Zhong] Ma Yun: "Dan" means Heat. Wu Yun: "Dan" is Heat Pathogen. Prolonged accumulation of heat, good appetite but hungry, named Xiao Zhong. Brief Note: Wang Bing's annotation...