此天之常数 马云。灵枢五音五味篇。谓少阴常多血少气。厥阴常多气少血。九针篇。谓太阴常多血少
气。与此不同。须知灵枢多误。当以此节为正。观末节出血气之多少。正与此节照应。岂得为讹。吴云。诸经之
血气多少。乃天之常数然也。简按气血多少。徐氏要旨。以运气释之。志高亦有解。率似傅会。此宜存而不论焉。
伺之所欲 马云。肝欲散。心欲软之类。吴云。如风寒暑湿燥火。病患有恶之者。有欲之黄。伺察其
所欲。则知其病在何经矣。简按诸注与马同。当以马为胜。
欲知背俞 张云。此亦取五脏之俞。而量之有法也。背俞。即五脏之俞。以其在足太阳经。而出于背。
故总称为背
俞。其度量之法。先以草横量两乳之间。中半折折之。又另以一草比前草。而去其半。取齐中折之数。乃竖立
长草。横置短草于下。两头相拄。象△三隅。乃举此草。以量其背。令一隅居上。齐脊中之大椎。其在下两隅。
当三椎之间。即肺俞穴也。
大椎 甲乙云。在第一椎陷者中。外台云。大椎。平肩斜齐高硕者。是也。仍不得侵项分取之。则非
也。上接项骨。下肩齐。在椎骨节上。是。余穴尽在节下。
复下一度心之俞也 张云。复下一度。谓以上隅。齐三椎肺俞之中央。其下两隅。即五椎之间。心之俞也。
复下一度左角肝之俞也 张云。复下一度。皆如前法。递相降也。简按马云。第五椎间。宜为膈俞穴。
今云然者误。此说却非。
是谓五脏之俞 吴云。此取五脏俞法。与甲乙经不合。盖古人别为一家者也。张云。此法。与灵枢背
篇。及甲乙经。铜人等书。皆不相合。其中未必无误。或古时亦有此别一家法也。仍当以背 篇。及甲乙等
书者为是。
病生于咽嗌 张云。形苦志苦。必多忧思。忧则伤肺。思则伤脾。脾肺气伤。则虚而不行。气必滞矣。
脾肺之脉。上循咽嗌。故病生于咽嗌。如人之悲忧过度。则喉咙哽咽。食饮难进。思虑过度。则上焦痞隔。咽
中核塞。即其征也。简按高云。咽纳水谷。嗌司呼吸。是误矣。咽嗌俱纳水谷。太阴阳明论云。喉主天气。嗌
主地气。可以证也。咽嗌。今本甲乙。作咽喝。注云。一作困竭。据形苦志苦。作困竭者极是。
百药 马云。此与灵枢九针论同。但彼曰甘药者是。而此曰百药者误。高云。灵枢终始篇云。阴阳
俱不足。补阳则
阴竭。泻阴则阳脱。如此者。可将以甘药。不可饮以至剂。即此义也。简按邪气脏腑病形篇云。阴阳形气俱不
足。勿取以针。而调以甘药也。益知上文咽嗌。为困竭之误。
形数惊恐 马云。世有形体劳苦。数受惊恐。则志亦不乐。其经络不通。而不仁之病生。高云。惊恐。
因惊致恐。志之苦也。经络不通。劳其经络。形之苦也。形数惊恐。经络不通。即上文形苦志苦也。简按形字
可疑。王吴张志并不注及。据马高注。形下添一苦字。义略通。
经络不通 九针论。作筋脉不通。
不仁 马云。谓 重而不知寒热痛痒也。张云。顽痹软弱也。简按不仁。即神农本经死肌。后世所谓
木是。 乃顽痹。后世所谓麻是。二证不同。然麻者必木。木者多麻。故王注以下。并以 痹释之。（当与诊
要经终篇参看。）
醪药 甲乙。药。作醴。
This is the constant law of Heaven. Ma Shi states that *Ling Shu: Wu Yin Wu Wei Pian* says Shaoyin usually has abundant blood and deficient qi, while Jueyin usually has abundant qi and deficient blood; *Jiu Zhen Pian* says Taiyin usually has abundant blood and deficient qi, which differs from this text. One must know that *Ling Shu* contains many errors, and this section should be regarded as correct. The final section discussing the abundance and deficiency of blood and qi corresponds exactly with this section, so how can it be considered an error? Wu Kun states that the abundance and deficiency of blood and qi in the various meridians are the constant laws of Heaven. Danbo Yuanjian notes: Regarding the issue of blood and qi abundance, Xu Dachun explained it using the theory of Five Movements and Six Qi in his *Yi Zong Yao Zhi*, and Zhi Gao also provided interpretations, but these seem like forced associations. This matter should be preserved for discussion but not definitively resolved here.
"Sì" (observing/examining) refers to "what is desired." Ma Shi explains this as concepts such as the Liver desiring dispersion and the Heart desiring softness. Wu Kun explains that regarding the six pathogenic factors—Wind, Cold, Summer-heat, Dampness, Dryness, and Fire—some patients detest them, while others may favor them. By observing what the patient desires or dislikes, one can determine which meridian the disease resides in. Danbo Yuanjian notes: Various commentaries agree with Ma Shi, and Ma Shi’s interpretation is superior.
To understand the Back-Shu points, Zhang Jingyue states: This also involves taking the Back-Shu points of the five Zang organs, but there is a specific method for measurement. "Back-Shu" refers to the Back-Shu points of the five Zang organs. Because they are located on the Foot-Taiyang Bladder Meridian and emerge from the back, they are collectively called Back-Shu points. The method of measurement is as follows: First, take a stalk of grass and measure horizontally between the two nipples, then fold it in half. Take another stalk of grass, make it half the length of the previous one, and find its midpoint as the standard number. Then, stand the long grass vertically and place the short grass horizontally beneath it, with the two ends touching, forming a triangle (like three corners). Lift this grass assembly to measure the back, positioning one corner at the top, aligned with the Dazhui point on the spine. The two lower corners should fall between the third vertebrae, which is the Feishu (Lung Back-Shu) point.
Dazhui [GV14]: *Jia Yi Jing* states it is in the depression below the first thoracic vertebra. *Wai Tai Mi Yao* states that Dazhui is level with the height where the shoulder slopes. It must not be taken by encroaching into the neck region, otherwise it is incorrect. It connects above to the cervical bones and aligns with the shoulders below, situated on the vertebral joints. This is correct. All other points are located below the vertebral joints.
Moving down one unit distance again is the Back-Shu point of the Heart. Zhang Jingyue states: "Moving down one unit" means aligning the upper corner with the center of the Feishu point at the third vertebra; the two lower corners will then be between the fifth vertebrae, which is the Back-Shu point of the Heart.
Moving down one unit distance again, the left corner corresponds to the Back-Shu point of the Liver. Zhang Jingyue states: "Moving down one unit" follows the same method as before, descending sequentially. Danbo Yuanjian notes: Ma Shi argues that the space between the fifth vertebrae should be the Geshu (Diaphragm Back-Shu) point. The statement in the current text is therefore incorrect. This explanation is indeed wrong.
This is referred to as the Back-Shu points of the five Zang organs. Wu Kun states: This method for locating the Back-Shu points of the five Zang organs does not accord with *Jia Yi Jing*. It is likely that the ancients had a separate school of thought. Zhang Jingyue states: This method does not accord with *Ling Shu: Bei Shu Pian*, nor with *Jia Yi Jing*, *Tong Ren*, or other texts. There may well be errors within it, or perhaps there was indeed a separate ancient method. However, one should still regard the accounts in *Bei Shu Pian* and *Jia Yi Jing* as correct.
Diseases arising in the pharynx and esophagus. Zhang Jingyue states: Physical hardship and mental distress lead to excessive worry and overthinking. Worry injures the Lung, and overthinking injures the Spleen. When the Qi of the Spleen and Lung is injured, it becomes deficient and fails to circulate, causing Qi stagnation. The meridians of the Spleen and Lung ascend along the pharynx and esophagus; thus, diseases arise in the pharynx and esophagus. For example, when a person is excessively sad, the throat becomes choked, making eating and drinking difficult; when overthinking, the Upper Jiao becomes blocked, causing a sensation of a lump in the throat. These are the signs. Danbo Yuanjian notes: Gao Shishi claimed that the pharynx receives food and drink while the esophagus governs respiration, which is incorrect. Both the pharynx and esophagus receive food and drink. *Su Wen: Yin Yang Ying Xiang Da Lun* states: "The larynx governs Heavenly Qi, and the esophagus governs Earthly Qi," which serves as proof. Furthermore, in the current edition of *Jia Yi Jing*, "Yan Yi" (pharynx and esophagus) is written as "Yan He," with a note saying "alternatively read as Kun Jie" (exhaustion/depletion). Given the context of "physical hardship and mental distress," reading it as "Kun Jie" is highly appropriate.
Hundred Medicines. Ma Shi states: This is identical to *Ling Shu: Jiu Zhen Lun*, except that the latter says "Sweet Medicine" (Gan Yao), whereas here it says "Hundred Medicines," which is erroneous. Gao Shishi states: *Ling Shu: Zhong Shi Pian* says: "When both Yin and Yang are deficient, tonifying Yang leads to exhaustion of Yin, and draining Yin leads to depletion of Yang. In such cases, sweet medicine may be used, but strong/potent medicines should not be drunk." This conveys the same meaning. Danbo Yuanjian notes: *Ling Shu: Xie Qi Zang Fu Bing Xing Pian* states: "When Yin, Yang, Form, and Qi are all deficient, do not use needles, but regulate with sweet medicine." This further confirms that the earlier mention of "Yan Yi" was a textual error for "Kun Jie."
Form frequently subjected to fright and terror. Ma Shi states: There are people whose bodies endure physical hardship and who frequently suffer from fright and terror, leading to mental unhappiness. Their meridians become obstructed, giving rise to diseases of numbness and insensitivity. Gao Shishi states: Fright and terror, caused by fright leading to fear, constitute suffering of the Spirit (Zhi). Obstruction of the meridians and strain upon them constitute suffering of the Form. "Form frequently subjected to fright and terror, meridians obstructed" corresponds to the aforementioned "physical hardship and mental distress." Danbo Yuanjian notes: The character "Xing" (Form) is questionable. Wang Bing, Wu Kun, and Zhang Jingyue did not comment on it. Based on the annotations of Ma Shi and Gao Shishi, adding the character "Ku" (hardship/suffering) after "Xing" makes the meaning roughly coherent.
Meridians obstructed. *Jiu Zhen Lun* reads this as "Sinews and vessels obstructed."
Insensitivity (Bu Ren). Ma Shi states: It refers to heaviness of the body accompanied by a lack of sensation to cold, heat, pain, or itch. Zhang Jingyue states: It refers to stubborn bi-syndrome and weakness. Danbo Yuanjian notes: "Bu Ren" (insensitivity) refers to what *Shen Nong Ben Cao Jing* calls "dead flesh" (Si Ji), commonly known in later times as "Mu" (wood-like numbness). "Bi" (obstruction/pain) refers to stubborn bi-syndrome, commonly known in later times as "Ma" (tingling/numbness). These two conditions are different. However, those with tingling necessarily have wood-like numbness, and those with wood-like numbness often have tingling. Therefore, commentators following Wang Bing interpreted "Bi" broadly to cover both. (This should be cross-referenced with *Su Wen: Zhen Yao Jing Zhong Pian*.)
Lao Yao (Fermented medicinal wine). In *Jia Yi Jing*, the character "Yao" (medicine) is written as "Li" (sweet fermented wine).