马云。评。论也。内论病有虚实之义。故名篇。吴云。通。普也。高云。犹言统论虚实也。
邪气盛则实精气守则虚 张云。邪气有微甚。故邪盛则实。正气有强弱。故精夺则虚。夺。失也。二
句为病治之大纲。其辞似显。其义甚微。最当详辨。（此以下。论说精确。医家所宜识。以文繁今省之。）李
云。盛则实者。邪气方张。名为实证。夺则虚者。亡精失血。用力劳神。名为内夺。汗之下之。吐之清之。名
为外夺。气怯神疲。名为虚证。简按邪气之客于人身。其始必乘精气之虚而入。已入而精气旺。与邪气俱盛则
为实。如伤寒胃家实证。是也。若夫及邪入而客。精气不能与之相
抗。为邪气所夺则为虚。如伤寒直中证。是也。马云。邪气盛者。外感也。正气虚者。内伤也。此说不可从。
气逆者足寒也 张云。气逆不行。则无以及于四肢。阳虚于下。故足寒也。
余脏皆如此 马云。此肺虚。而非相克之时则生。如春秋冬。是也。如遇相克之时则死。如夏时之火。
是也。余脏虚者。其生死亦如此而已。夫帝问虚实。而伯先以虚为对。未及于实也。张云。一曰。肺王于秋。
当秋而气虚。金衰甚也。故死。于义亦通。
寸脉急而尺缓 简按王云。脉急。谓脉口也。而不解尺缓之义。诸家俱为尺中之脉。非也。论疾诊尺
篇云。审尺之缓急小大滑涩。邪气脏腑病形篇云。脉缓者。尺之皮肤亦缓。尺缓。即尺肤缓纵之谓。此节以脉
口诊经。以尺肤诊络。盖经为阴为里。乃脉道也。故以脉口诊之。络为阳为浮而浅。故以尺肤诊之。义为明晰。
马以经与寸为阳。以络与尺为阴。此本于后世寸阳尺阴之说者。与经旨相畔。张则云。本节之义。重在经络。
不在尺寸。俱不知尺是尺肤之谓也。下文脉口寒而尺寒。尺热满。脉口寒涩。义并同。吴。尺缓。改作尺脉紧。尤误。
故曰 吴删二字。简按以下止可以长久也三十一字。疑是错简。若移于下文滑则生涩则死也之下。则
文理顺接焉。
脉口热而尺寒也 志云。寒热者。尺寸之肤寒热。而应于经络也。络脉外连皮肤。为阳主外。经脉内
连脏腑。为阴主内。经云。荣出中焦。卫出下焦。卫气先行皮肤。先充络脉。络脉先盛。卫气已平。营气内满。
而经脉大盛。经脉之虚实也。以气口知之。故以尺肤候络。而以寸候经。高云。经气有余。则脉口肤热。络气
不足。而尺肤寒也。以寸肤候
经。以尺肤候络。简按脉口热。根据下文寒涩而推之。谓脉滑也。志高以尺为尺肤。极是。然以脉口为寸肤者。
经文中无明证。
秋冬为逆 张云。阳虚者。畏阴胜之时。马云。秋冬属阴。合络与尺。简按马注误。
尺热满 志本。热。作脉。误。
春夏死秋冬生也 张云。阴虚者。畏阳胜之时。按王氏曰。春夏阳气高。故脉口热尺中寒为顺。秋冬
阳气下。故尺中热脉口寒为顺。此说若为近理。而观内经论脉诸篇。则但言阴阳浮沉随气候。初未闻有以尺寸
盛衰分四时也。学人于此不辨。恐反资多歧之惑。马云。春夏应经与寸。简按马注亦误。
灸阴刺阳刺阴灸阳 张云。此正以络主阳。经主阴。灸所以补。刺所以泻也。简按王注阴阳经络。互
误。吴马遂为灸泻刺补之解。太误。志高皆仍张义。今从之。高云。此以灸刺。通于上文。则上文治主病者。
亦当通于此矣。
脉气上虚尺虚 简按当从新校正。下文历举脉虚气虚尺虚之状。明是脱误。张志高仍旧文释之。义却晦矣。
言无常 张云。脉要精微论曰。言而微。终日乃复言者。此夺气也。志云。宗气虚。而语言无接续也。
简按志本于杨上善。
尺虚 简按谓尺肤脆弱。论疾诊尺篇云。尺肉弱者。解 安卧。乃与步行 然同义。诸家以尺为寸关
尺之尺。误。
然 张云。 。音匡。 然。怯弱也。说文。 。怯也。
不象阴也 吴云。脉者。血之府。脉虚者。亡血可知。故云不象阴也。张云。脉虚者。阴亏之象。高云。若脉
虚者。
浮泛于上。有阳无阴。不能效于阴也。
寒气暴上 张云。此指伤寒之属也。
实而逆则死 张云。邪盛者脉当实。实而兼滑。得阳脉也。故生。若见阴脉为逆。故死。按玉机真
脏论云。脉弱以滑。是有胃气。命曰易治。脉逆四时。为不可治。
春秋则生冬夏则死 张云。脉之实满。邪有余也。手足寒者。阴逆在下。头热者。阳邪在上。阴阳
乖离。故为上实下虚之病。春秋为阴阳和平之候。得其和气。故可以生。冬夏乃阴阳偏胜之时。阳剧于夏。阴
剧于冬。故死。
浮而涩 吴云。涩为无血。浮而身热。为邪盛。为孤阳。此不必问其四时而皆死也。马云。此前后
无问答之语。疑为错简欤。简按据新校正注。其为错简无疑焉。
其形尽满 志云。形。谓皮肤肌腠。盖经脉之内。有有形之血。是以无形之气乘之。肌腠之间。主
无形之气。是以有形之水乘之。而为肿胀也。高云。形。身也。满。犹实也。简按王吴以形为头角耳目口齿胸
中之形藏。非也。
不应也 简按尺肤涩。与脉急大坚。不相应也。邪气脏腑病形篇云。色脉与尺之相应也。如桴鼓影
响之相应也。
从者手足温也 张云。四肢为诸阳之本。故阳邪盛者。手足当温为顺。若手足寒冷。则以邪盛于外。
气虚于内。正不胜邪。所以为逆。
乳子而病热 吴云。乳下婴儿也。张云。此统言小儿之内外证也。病热脉悬小者。阳证阴脉。本为大禁。
寒则死 简按论疾诊尺篇云。婴儿病。头毛皆逆上者必死。大便赤飧泄。脉小手足寒者。难已。温易已。
乳子中风 张云。此言小儿之外感也。风热中于阳分。为喘鸣肩息者。脉当实大。但大而缓。则胃气
存。邪渐退。
故生。实而急。则真脏见。病曰进。故死。志云。肩息者。呼吸摇肩也。风热之邪。始伤皮毛。喘鸣肩息。是
风热盛。而内干肺气宗气。故脉实大也。简按此后世所谓马脾风之属。卫生宝鉴云。风热喘促。闷乱不安。俗
谓之马脾风。）
肠 便血 吴云。肠 。滞下也。利而不利之谓。便血。赤利也。马云。肠 者。大小肠有所辟积。
而生诸证。故肠 为总名。有等。俗名肠风下血。有粪前来者。为近血。粪后来者。为远血。今兹肠 便血。
凡下血皆是。志云。肠 者。邪僻积于肠间。而为便利也。经言阳络伤则血外溢。血外溢则衄血。阴络伤则血
内溢。血内溢则便血。肠胃之络伤。则血溢于肠外。肠外有寒汁沫。与血相搏。则合并凝聚。而积成矣。是以
肠便血者。阴络之血溢也。肠 下白沫者。肠外之寒汁沫也。肠 下脓血者。汁沫与血相搏。并合而下者也。
夫便血。阴泄于内也。发热。阳脱于外也。本经曰。阴阳虚肠 死。此阴阳血气之相离也。张云。肠 一证。即
今之所谓痢疾也。自仲景而后。又谓之滞下。（按滞下之称。范汪诸方己载之。见于外台秘要。仲景书无考。张
言恐杜撰。）
身热则死寒则生 简按病源候论血痢门。举此二句。知巢氏以肠 便血。为血痢也。
脉沉则生脉浮则死 高云。泄 下白沫。寒汁下泄。脉沉则血气内守。故生。脉浮则血气外驰。故
死。简按病源候论云。痢色白。食不消。谓之寒中也。诊其脉。沉则生。浮则死。知巢氏以下白沫。为寒痢也。
肠 下脓血 吴云。赤白并下也。马云。邪气脏腑病形篇。谓之瘕泄。难经谓之大瘕泄。后世曰痢。
脉悬绝则死滑大则生 高云。其脉悬绝则内脱。生阳不升。故死。脉滑大则阴阳和合。血气充盛。故
生。简按病源
候论脓血痢门。引此二句。知巢氏以下脓血。为脓血痢也。
身不热脉不悬绝 高云。上文言身热则死。又言脉悬绝则死。帝承上文之意。而言身不热。脉不悬绝。何如。
悬涩 高云。悬绝之渐也。简按病源候论。以身不热以下二十四字。载水谷痢门。
脉搏大滑 吴云。搏。过于有力也。此为肝实。大为气有余。滑为血有余。故久自已。简按吴注似是。
而至下文实则死穷矣。
虚则可治实则死 汪云。愚按上文云。脉搏大滑。久自已。夫搏大滑。似属实也。下文云。虚则可治。
实则死。上下文义。似相反戾。意恐搏大滑中。兼有虚豁状耶。徐云。虚则可治。实则死。与搏而滑大相反。
搏而滑。非实也。正滑泛而跃也。故自已。马云。搏大。滑中带虚。可治。若带实则邪气有余。乃死候也。简
按上文云坚急。乃实之谓。
消瘅 张云。消瘅者。三消之总称。谓内热消中。而肌肤消瘦也。吴云。消瘅。消中而热。善饮善食。
简按脉要精微论云。瘅成为消中。五变篇云。热则消肌肤。故为消瘅。皆可以证。
脉实大病久可治 滑云。经言实大病久可治。注意谓久病血气衰。脉不当实。以为不可治。又巢氏曰。
脉数大者生。细小浮者死。又云。沉小者生。实牢大者死。前后所论。甚相矛盾。可见脉难尽凭。必须参之以
症。方可以决其死生也。徐云。脉当微弱者生。兹为实大者可治。似相反也。愚谓当时传刻者之误耳。吴云。
脉实大。则真气未漓。虽久可治。脉悬小坚。则胃气已绝。病久则死。志云。消瘅。五脏之精液虚于内也。癫。
乃阴实于外。故虚则可治。瘅乃精虚于内。故实者可治。简按徐本于王义。吴志虽似允当。竟不如徐之
诊病有所征也。
帝曰春亟治经络 志高并云。帝曰。当作岐伯曰。简按上文帝曰形度以下十六字。王既谓错简也。志
高则以春亟以下。为上文答语。故改岐伯曰。不可从。亟。王训急。音棘。诸家并同。此恐非是。盖孟子亟问
亟馈鼎肉之亟。音 。频数也。马云。春时治病。治其各经之络穴。
经 马云。夏则治其各经之 穴。
六腑 志云。治六腑者。取之于合也。胃合于三里。大肠合入于巨虚上廉。小肠合入于巨虚下廉。三
焦合入于委阳。膀胱合入于委中央。胆合入于阳陵泉。盖五脏内合于六腑。六腑外合于原俞。秋气降收。渐入
于内。故宜取其合。以治六腑也。
少针石也 张云。冬寒阳气闭塞。脉不易行。故当用药。而少施针石。此用针之大法也。
不得顷时回 吴云。不得顷时迟回。简按回。读犹徘徊低徊之回。（俳回。谓踟 不进也。低徊。
纡衍貌。史记孔子赞。低徊留之不能去。）迟缓之义。吴注为得。甲乙。无时字。
三 马。 。音贿。张云。刺瘢曰 。三 。三刺也。志云。 者。皮肤肿起之象。针眼微肿如
小疮。故曰 也。简按说文。 。 也。志说未见所据。
缨脉 马云。人迎水突气舍等穴。张同。吴云。不言其经者。约而言之。不必拘其经也。
掖痈 甲乙。掖。作腋。马云。掖。腋同。简按痈疽篇。发于腋下。赤坚者。名曰米疽。刘涓子鬼
遗方云。内疚疽。发两腋下及臂。并两手掌中。后世外科书。谓之腋发。
足少阳五 马云。渊液穴也。张云。渊腋。辄筋也。吴云。足少阳胆经。行于两胁。故掖肿刺之。
手心主三 马云。天地穴也。
大骨之会 简按马仍王注。志云。谓臂骨交会之处。尺泽间也。当从王注。
暴痈筋软 简按志云。暴痈者。言毒瓦斯更深。为毒凶暴。误也。今从王注。软。说文。衣戚也。广雅。
缩也。熊音。如衮反。缩也。王注软急。即缩急也。甲乙作濡。马云。软同。同吴。云筋柔软也。并误。
胞气不足 吴云。阴汗不尽者。是阴胞之气不足。太阳失卫。故汗不止也。简按胞。脬同。所谓阴胞。
盖指膀胱。高为血海。非也。
治在经输 张云。如手太阴肺经。太渊为输之类也。简按马以列缺为肺经之输。误也。甲乙。经上。
有其字。
腹暴满 高云。腹中卒暴而满。太阴脾土病也。按之不下。既满且硬。不应指而下也。
太阳经络者 宋本。作手太阳。简按王注。太阳。谓（原本作为。今改。）
手太阳也 知手字是后人所添。志高从宋本。误。王引中诰图经。文与甲乙全同。
胃之募也 六十七难云。五脏募皆在阴。滑寿注。在腹为阴。则谓之募。在背为阳。则谓之俞。募。
犹募结之募。言经气之聚于此也。简按吴吕广撰募 经。见甲乙注。李时珍八脉考释音。募。音暮。与膜同。
（详义见疟论募原注。）此四字。甲乙无。盖是衍文。
少阴俞 马云。肾俞穴。此本属足太阳膀胱经。然曰少阴者。以肾为足少阴也。张云。少阴俞。即
肾俞也。肾为胃关。故亦当取之。系足太阳经穴。去脊两旁各一寸五分。共为三寸。
圆利针 高云。九针十二原论曰。针大如 。且圆且锐。
中身微大。以取暴气。盖肾俞两旁。不可深刺。故用 针。泄肾脏之水气。以治腹满。
霍乱 志。霍。作藿。未知何据。吴云。手挥霍。而目 乱。名曰霍乱。简按此属臆解。病源候论云。
霍乱者。由人温凉不调。阴阳清浊二气。有相干乱之时。其乱在于肠胃之间者。因遇饮食而变。发则心腹绞痛。
其有先心痛者先吐。先腹痛者则先痢。心腹并痛者。则吐痢俱发。霍乱。言其病。挥霍之间。便致撩乱也。文
Ma Yun states: "Ping" (evaluate) means "Lun" (discuss). This chapter discusses the meaning of deficiency and excess in diseases, hence its title *Tong Ping Xu Shi Lun* (General Discussion on Evaluating Deficiency and Excess). Wu Yun states: "Tong" (through/universal) means "Pu" (universal/general). Gao Yun states: It means a general discussion on deficiency and excess.
When pathogenic factors are abundant, it is an excess condition; when essence and qi are depleted, it is a deficiency condition. Zhang Yun states: Pathogenic factors vary in severity; thus, an abundance of pathogens constitutes an excess condition. Zheng Qi (Righteous Qi) varies in strength; thus, depletion of Jing Essence constitutes a deficiency condition. "Duo" (deprive/deplete) means loss. These two sentences serve as the general outline for treating diseases. The wording appears straightforward, but the underlying principles are subtle and require careful discrimination. (The following content is precise and should be recognized by physicians; due to length, it is omitted here.) Li Yun states: An abundance of pathogens leading to excess refers to the state where pathogens are flourishing, termed an Excess Syndrome. Depletion of essence leading to deficiency refers to internal depletion caused by loss of Jing Blood, excessive physical labor, or mental exhaustion. Depletion caused by sweating, purging, vomiting, or clearing is termed external depletion. Symptoms such as timidity of Qi and fatigue of Shen constitute a Deficiency Syndrome. Jian An notes: When pathogens invade the human body, they initially take advantage of deficiencies in Jing Qi to enter. After entry, if Jing Qi is robust and contends with the pathogens, both becoming hyperactive, it forms an Excess condition, such as the Stomach Excess condition in Shang Han (Cold Damage). If, after invasion, Jing Qi cannot resist the pathogens and is deprived by them, it forms a Deficiency condition, such as the direct transmission to Sha Yin (Lesser Yin) in Shang Han. Ma Yun states: Abundance of pathogens indicates exterior contraction, while deficiency of Zheng Qi indicates interior injury. This view is unacceptable.
Qi rebellion results in cold feet. Zhang Yun states: When Qi rebels and fails to circulate, it cannot reach the four limbs. Yang Qi deficiency in the lower part causes cold feet.
The conditions of other Zang organs follow this pattern. Ma Yun states: This refers to Lung deficiency. If it does not occur during the time of mutual overcoming (such as Spring, Autumn, Winter), recovery occurs. If it occurs during the time of mutual overcoming (such as Summer Fire overcoming Metal), death ensues. The prognosis for deficiency in other Zang organs follows the same principle. The Emperor asked about deficiency and excess, but Bo Gao first answered regarding deficiency, omitting excess. Zhang Yun states: One interpretation is that the Lung prospers in Autumn. If Lung Qi is deficient in Autumn, it indicates severe decline of Metal Qi, leading to death. This explanation is also logically consistent.
Cun Kou pulse is rapid/tight, while Chi skin is lax/loose. Jian An notes: Wang Bing’s commentary defines "pulse rapid/tight" as referring to the Cun Kou pulse but does not explain "Chi lax." Various schools interpret this as the pulse at the Chi position, which is incorrect. *Lun Ji Zhen Chi Pian* states: "Examine the laxity, tightness, size, and slipperiness of the Chi skin." *Xie Qi Zang Fu Bing Xing Pian* states: "Where the pulse is lax, the Chi skin is also lax." "Chi lax" refers to the laxity of the Chi skin. This section uses the Cun Kou to diagnose Jing meridians and the Chi skin to diagnose Luo vessels. Jing meridians belong to Yin and Interior, being the pathways of vessels, hence diagnosed via Cun Kou. Luo vessels belong to Yang, Exterior, and Superficial, hence diagnosed via Chi skin. The principle is clear. Ma Yun classifies Jing meridians and Cun Kou as Yang, and Luo vessels and Chi as Yin, based on the later theory of "Cun Yang, Chi Yin," which contradicts the original intent of the Classic. Zhang Yun states: The focus of this section is on Jing and Luo meridians, not on Cun and Chi positions; they failed to realize that "Chi" refers to Chi skin. The subsequent mentions of "Cun Kou cold and Chi cold," "Chi heat and fullness," and "Cun Kou cold and choppy" share the same logic. Wu changed "Chi lax" to "Chi pulse tight," which is even more erroneous.
Therefore it is said. Wu deleted these two characters. Jian An notes: The following thirty-one characters up to "can maintain longevity" are suspected to be misplaced bamboo slips (cuo jian). If moved below "Slippery implies survival, Choppy implies death," the text would flow logically.
Cun Kou heat and Chi skin cold. Zhi Gao states: Cold and heat refer to the temperature of the Cun and Chi skin, reflecting upon the meridians. Luo vessels connect externally to the skin, belonging to Yang and governing the exterior. Jing vessels connect internally to the Zang-Fu, belonging to Ying and governing the interior. The Classic states: "Ying Qi emerges from the Middle Jiao, Wei Qi emerges from the Lower Jiao." Wei Qi moves first into the skin, filling the Luo vessels. Once Luo vessels are full and Wei Qi is balanced, Ying Qi fills the interior, and Jing vessels become abundant. The deficiency or excess of Jing vessels is known via the Qi Kou (Cun Kou). Thus, Chi skin observes Luo vessels, and Cun Kou observes Jing vessels. Gao Yun states: Excess of Jing Qi causes heat at the Cun Kou skin; deficiency of Luo Qi causes cold at the Chi skin. Observing Jing via Cun skin and Luo via Chi skin. Jian An notes: Inferring from the subsequent mention of "cold and choppy," "Cun Kou heat" implies a slippery pulse. Zhi Gao’s identification of "Chi" as Chi skin is very accurate. However, his identification of "Cun Kou" as Cun skin lacks explicit evidence in the text.
Autumn and Winter constitute reversal. Zhang Yun states: Those with Yang deficiency fear times of Yin dominance. Ma Yun states: Autumn and Winter belong to Yin, combining with Luo vessels and Chi skin. Jian An notes: Ma’s commentary is incorrect.
Chi skin heat and fullness. In Zhi Gao’s version, "heat" is written as "pulse," which is an error.
Death in Spring and Summer, Survival in Autumn and Winter. Zhang Yun states: Those with Yin deficiency fear times of Yang dominance. According to Wang Shi: In Spring and Summer, Yang Qi is high; thus, heat at Cun Kou and cold at Chi is favorable. In Autumn and Winter, Yang Qi descends; thus, heat at Chi and cold at Cun Kou is favorable. While this seems reasonable, reviewing various chapters on pulse diagnosis in the *Nei Jing*, it only discusses the floating and sinking of Yin and Yang according to climate, never mentioning the division of the four seasons by the prosperity or decline of Cun and Chi positions. Scholars who fail to distinguish this may become confused by divergent interpretations. Ma Yun states: Spring and Summer correspond to Jing meridians and Cun Kou. Jian An notes: Ma’s commentary is also incorrect.
Moxibustion on Yin, Acupuncture on Yang; Acupuncture on Yin, Moxibustion on Yang. Zhang Yun states: This correctly identifies Luo vessels as governing Yang and Jing vessels as governing Yin. Moxibustion tonifies; acupuncture sedates. Jian An notes: Wang Bing’s commentary confused Yin and Yang Jing/Luo. Wu and Ma interpreted this as moxibustion for sedation and acupuncture for tonification, which is greatly mistaken. Zhi Gao followed Zhang’s interpretation, which is adopted here. Gao Yun states: The moxibustion and acupuncture mentioned here connect to the preceding text; thus, the treatment of the primary disease mentioned above should also apply here.
Pulse Qi deficiency above, Chi deficiency below. Jian An notes: Following the New Correction, the subsequent listing of pulse, Qi, and Chi deficiencies clearly indicates missing text. Zhi Gao explained the original text, making the meaning obscure.
Speech irregularities. Zhang Yun states: *Mai Yao Jing Wei Lun* says: "Speaking faintly, taking all day to speak again, this is Qi depletion." Zhi Gao states: Deficiency of Zong Qi leads to discontinuous speech. Jian An notes: Zhi Gao relies on Yang Shangshan.
Chi skin deficiency. Jian An notes: Refers to fragile Chi skin. *Lun Ji Zhen Chi Pian* states: "Those with weak Chi flesh suffer from flaccidity and desire to lie down, walking unsteadily." This has the same meaning as "Kuang Ran." Various schools mistakenly interpret "Chi" as the Chi position of the Cun-Guan-Chi pulse.
Kuang Ran. Zhang Yun states: "Kuang" sounds like "Kuang." "Kuang Ran" means timid and weak. *Shuo Wen Jie Zi*: "Kuang, timid."
Not resembling Yin. Wu Yun states: The pulse is the residence of blood. Pulse deficiency indicates blood loss, hence "not resembling Yin." Zhang Yun states: Pulse deficiency is a sign of Yin deficiency. Gao Yun states: If the pulse is deficient, it floats superficially, having Yang without Yin, unable to emulate Yin.
Sudden upward movement of Cold Qi. Zhang Yun states: This refers to conditions belonging to Shang Han.
Excess combined with Reversal leads to death. Zhang Yun states: When pathogens are abundant, the pulse should be Excess. If Excess and Slippery, it is a Yang pulse, indicating survival. If a Yin pulse appears, it is Reversal, indicating death. According to *Yu Ji Zhen Zang Lun*: "Weak and slippery pulse indicates Stomach Qi, called easy to treat. Pulse reversing the Four Seasons is incurable."
Survival in Spring and Autumn, Death in Winter and Summer. Zhang Yun states: Full and solid pulse indicates excess pathogens. Cold hands and feet indicate Yin reversal below; heat in the head indicates Yang pathogen above. Yin and Yang separation results in Upper Excess and Lower Deficiency. Spring and Autumn are times of Yin-Yang balance, obtaining harmonious Qi, thus survival. Winter and Summer are times of Yin-Yang imbalance; extreme Yang in Summer and extreme Yin in Winter lead to death.
Floating and Choppy. Wu Yun states: Choppy indicates lack of blood. Floating with body heat indicates pathogen abundance and solitary Yang. In this case, regardless of the season, death ensues. Ma Yun states: There is no question-and-answer context here; suspect misplaced text. Jian An notes: According to New Correction notes, this is undoubtedly misplaced text.
Body completely full/swollen. Zhi Gao states: "Xing" (form/body) refers to skin and muscle interstices. Inside the Jing vessels, there is tangible blood, so intangible pathogens invade. Between muscle interstices, intangible pathogens reside, so tangible water-dampness invades, causing swelling. Gao Yun states: "Xing" means body; "Man" (full) means excess. Jian An notes: Wang Bing and Wu Kun interpreted "Xing" as facial features or chest organs, which is incorrect.
Not corresponding. Jian An notes: Choppy Chi skin does not correspond to the rapid, large, and firm pulse. *Xie Qi Zang Fu Bing Xing Pian* states: "The correspondence between color, pulse, and Chi skin is like drumstick and sound, shadow and object."
Favorable signs include warm hands and feet. Zhang Yun states: The four limbs are the root of all Yang. Thus, when Yang pathogens are abundant, warm hands and feet are favorable. Cold hands and feet indicate pathogens abundant externally and Zheng Qi deficient internally, where Zheng Qi cannot overcome pathogens, constituting Reversal.
Nursing infant suffering from Heat. Wu Yun states: Infants under nursing age. Zhang Yun states: This generally refers to internal and external syndromes in children. Heat disease with a hanging-small pulse is a Yang syndrome with Yin pulse, a major contraindication. Cold leads to death. Jian An notes: *Lun Ji Zhen Chi Pian* states: "Infants with hair standing on end will die. Red diarrhea with undigested food, small pulse, and cold hands/feet are difficult to cure. Warmth makes it easy to cure."
Nursing infant struck by Wind. Zhang Yun states: This refers to exterior contraction in children. Wind-Heat invading Yang levels causes wheezing, barking cough, and shoulder breathing. The pulse should be Excess-Large. If Large and Slow, Stomach Qi remains, pathogens recede, and survival occurs. If Excess and Rapid, True Zang pulses appear, disease progresses, and death ensues. Zhi Gao states: Shoulder breathing means shaking shoulders during respiration. Wind-Heat initially damages skin and hair; wheezing and shoulder breathing indicate severe Wind-Heat interfering with Lung Qi and Zong Qi, hence the Excess-Large pulse. Jian An notes: This corresponds to what later generations called "Ma Pi Feng" (Horse Spleen Wind). *Wei Sheng Bao Jian* states: "Wind-Heat causing panting, restlessness, and discomfort is commonly called Ma Pi Feng."
Chang Pi (Intestinal Dysentery) with bloody stool. Wu Yun states: Chang Pi refers to dysentery (Zhi Xia). Difficulty in defecation despite urge is Chang Pi. Bloody stool is red dysentery. Ma Yun states: Chang Pi refers to accumulation in the large and small intestines causing various symptoms. It is a general term. Types include intestinal wind with bleeding. Bleeding before stool is proximal bleeding; bleeding after stool is distal bleeding. Here, Chang Pi with bloody stool includes all types of rectal bleeding. Zhi Gao states: Chang Pi is evil accumulation in the intestines causing loose stools. The Classic states: "Injury to Yang Luo causes external bleeding (epistaxis); injury to Yin Luo causes internal bleeding (hematochezia)." Injury to intestinal Luo vessels causes blood to overflow outside the intestines. Cold fluid and foam outside the intestines mix with blood, coagulating into masses. Thus, Chang Pi with bloody stool is bleeding from Yin Luo. Chang Pi with white mucus is cold fluid outside the intestines. Chang Pi with pus and blood is mixed fluid and blood flowing out. Bloody stool is Yin leakage internally; fever is Yang collapse externally. The Classic states: "Yin and Yang deficiency in Chang Pi leads to death." This is the separation of Yin-Yang and Qi-Blood. Zhang Yun states: Chang Pi is what is now called dysentery. After Zhang Zhongjing, it was also called Zhi Xia. (Note: The term Zhi Xia appears in Fan Wang’s formulas, cited in *Wai Tai Mi Yao*; Zhang’s claim that it is absent in Zhongjing’s works is likely fabricated.)
Body heat leads to death; cold leads to survival. Jian An notes: *Bing Yuan Hou Lun* cites these two lines in the Blood Dysentery section, indicating Chao Yuanfang considered Chang Pi with bloody stool as blood dysentery.
Deep pulse leads to survival; floating pulse leads to death. Gao Yun states: Diarrhea with white mucus indicates cold fluid draining. Deep pulse means Qi and Blood remain internal, hence survival. Floating pulse means Qi and Blood scatter externally, hence death. Jian An notes: *Bing Yuan Hou Lun* states: "White dysentery, indigestion, called Cold Center. Pulse deep leads to survival, floating leads to death." This shows Chao Yuanfang considered white mucus as cold dysentery.
Chang Pi with pus and bloody stool. Wu Yun states: Mixed red and white discharge. Ma Yun states: *Xie Qi Zang Fu Bing Xing Pian* calls it Jia Xie; *Nan Jing* calls it Da Jia Xie; later generations call it Li (Dysentery).
Hanging-Absolute pulse leads to death; Slippery-Large pulse leads to survival. Gao Yun states: Hanging-Absolute pulse indicates internal collapse, Sheng Yang does not rise, hence death. Slippery-Large pulse indicates Yin-Yang harmony and abundant Qi-Blood, hence survival. Jian An notes: *Bing Yuan Hou Lun* cites these lines in the Pus and Blood Dysentery section, indicating Chao Yuanfang considered pus and blood as suppurative dysentery.
No body heat, no Hanging-Absolute pulse. Gao Yun states: The previous text stated body heat leads to death and Hanging-Absolute pulse leads to death. The Emperor, following this context, asks about cases with no body heat and no Hanging-Absolute pulse.
Hanging-Choppy. Gao Yun states: A gradual stage of Hanging-Absolute. Jian An notes: *Bing Yuan Hou Lun* places the twenty-four characters from "no body heat" in the Water and Grain Dysentery section.
Pulse beats large and slippery. Wu Yun states: "Bo" (beat/palpate vigorously) means overly forceful. This indicates Liver Excess. Large means Qi excess; Slippery means Blood excess. Thus, it heals itself over time. Jian An notes: Wu’s commentary seems plausible, but the subsequent text says "Excess leads to death," which contradicts.
Deficiency allows treatment; Excess leads to death. Wang Yun states: I observe the previous text says "Pulse beats large and slippery, heals over time." Large and slippery seems like Excess. The next text says "Deficiency allows treatment, Excess leads to death." The meanings seem contradictory. Perhaps "Large and Slippery" contains elements of deficiency? Xu Yun states: "Deficiency allows treatment, Excess leads to death" contradicts "Beats and Slippery-Large." Beating and Slippery is not Excess; it is slippery and leaping, hence self-healing. Ma Yun states: Large and beating, with Slippery containing deficiency, is treatable. If Slippery contains Excess, pathogen abundance leads to death. Jian An notes: The previous text mentions "firm and rapid," which defines Excess.
Xiao Dan (Consumption Fever). Zhang Yun states: Xiao Dan is the general term for the Three Consumptions, referring to internal heat consuming the middle and emaciation of muscles and skin. Wu Yun states: Xiao Dan involves consumption in the middle with heat, polydipsia, and polyphagia. Jian An notes: *Mai Yao Jing Wei Lun* states: "Dan becomes Xiao Zhong." *Wu Bian Pian* states: "Heat consumes muscles and skin," hence called Xiao Dan. Both can serve as proof.
Pulse Excess, long-standing disease allows treatment. Hua Yun states: The Classic says "Pulse Excess, long-standing disease allows treatment." The note implies that in long-standing disease, Qi and Blood decline, so the pulse should not be Excess, implying incurability. Chao Shi states: "Numerous and Large pulse indicates survival; Fine, Small, and Floating pulse indicates death." Also: "Deep and Small indicates survival; Firm, Solid, and Large indicates death." These arguments contradict, showing pulses cannot be relied upon solely; symptoms must be consulted to determine survival or death. Xu Yun states: Weak and fine pulses indicate survival; currently, Large and Excess pulses allow treatment, which seems contradictory. I believe this is a transcription error. Wu Yun states: Large and Excess pulse means True Qi is not scattered; even with long illness, it is treatable. Hanging, Small, and Firm pulse means Stomach Qi is exhausted; long illness leads to death. Zhi Gao states: Xiao Dan is deficiency of essence and fluids in the five Zang internally. Dian is Excess of Yin externally, so deficiency allows treatment. Dan is deficiency of essence internally, so Excess allows treatment. Jian An notes: Xu follows Wang’s interpretation. Although Wu and Zhi seem appropriate, Xu’s diagnostic approach is more practical.
The Emperor said: In Spring, urgently treat the Jing-Luo. Zhi Gao annotates: "The Emperor said" should be "Qi Bo said." Jian An notes: Wang Bing considered the sixteen characters from "The Emperor said Xing Du" as misplaced. Zhi Gao treated "Spring Urgently" as the answer to the previous question, changing it to "Qi Bo said," which is unacceptable. "Ji" (urgent/frequent): Wang Bing interprets as urgent, sound "Ji." All schools agree. This is likely incorrect. In Mencius, "Ji Wen" and "Ji Kui Ding Rou," "Ji" sounds like "Ji," meaning frequent. Ma Yun states: Treating diseases in Spring involves treating the Luo points of each meridian.
Jing Shu. Ma Yun states: In Summer, treat the Shu points of each meridian.
Six Fu Organs. Zhi Gao states: To treat Six Fu organs, select He-Sea points. Stomach combines at San Li; Large Intestine combines at Ju Xu Shang Lian; Small Intestine combines at Ju Xu Xia Lian; San Jiao combines at Wei Yang; Bladder combines at Wei Zhong; Gallbladder combines at Yang Ling Quan. Five Zang combine internally with Six Fu; Six Fu combine externally with Yuan and Shu points. Autumn Qi descends and gathers, entering inward; thus, He-Sea points are suitable for treating Six Fu organs.
Few needles and stones. Zhang Yun states: In winter cold, Yang Qi is closed, and pulse circulation is difficult. Therefore, medication should be used, and needle/stone therapy minimized. This is the great method of acupuncture.
Cannot linger for a moment. Wu Yun states: Cannot delay for a moment. Jian An notes: "Hui" reads like "pai huai" (linger/hesitate). "Pai Hui" means hesitating to advance; "Di Huai" means lingering. *Shi Ji: Confucius Biography*: "Di Huai liu zhi bu neng qu" (lingering to stay, unable to leave). Meaning is slowness/delay. Wu’s annotation is correct. *Jia Yi Jing* omits the character "shi" (time).
San Zu. Ma: "Zu" sounds like "Hui." Zhang Yun states: Pricking until scar formation is called "Zu." "San Zu" means three pricks. Zhi Gao states: "Zu" is the image of skin swelling; the needle hole swells slightly like a small sore, hence called "Zu." Jian An notes: *Shuo Wen Jie Zi*: "Zu, pickled vegetables." Zhi Gao’s explanation lacks basis.
Ying Mai. Ma Yun states: Ren Ying, Shui Tu, Qi She, and other acupoints. Zhang agrees. Wu Yun states: Not specifying the meridian is a generalization; one need not be rigid about the meridian.
Ye Yong (Axillary Carbuncle). *Jia Yi Jing* writes "Ye" as "Xi" (axilla). Ma Yun states: "Ye" is identical to "Xi." Jian An notes: *Yong Ju Pian* states: Eruption in the axilla, red and hard, is named Mi Ju. Liu Juanzi’s *Gui Yi Fang* states: Nei Jiu Ju erupts in both axillae, arms, and palms. Later surgical texts call it Ye Fa.
Foot-Shao Yang San Zu. Ma Yun states: Yuan Ye acupoint. Zhang Yun states: Yuan Ye, Zhe Jin. Wu Yun states: Foot-Shao Yang Gallbladder Meridian runs along the hypochondrium; thus, axillary swelling is treated by needling.
Hand-Xin Zhu San Zu. Ma Yun states: Tian Jing acupoint.
Meeting of the Great Bone. Jian An notes: Ma follows Wang Bing. Zhi Gao states: Refers to the junction of arm bones, between Chi Ze. Should follow Wang Bing.
Sudden Yong with soft/flaccid sinews. Jian An notes: Zhi Gao states: Sudden Yong means deeper toxin,凶暴 (ferocious/violent). This is incorrect. Follow Wang Bing. "Ruan" (soft): *Shuo Wen*: "Clothing tight/constricted." *Guang Ya*: "Shrink." Xiong pronunciation: reverse of "Gun," meaning shrink. Wang Bing’s "Ruan Ji" means shrinkage and tension. *Jia Yi Jing* writes "Ru." Ma Yun states: "Ruan" is the same as "Ruan," agreeing with Wu’s "sinews are soft/flaccid." Both are incorrect.
Bao Qi Insufficiency. Wu Yun states: Incomplete sweating from the yin area indicates insufficiency of Bao Qi. Tai Yang loses protection, hence sweat does not stop. Jian An notes: "Bao" is identical to "Pao" (bladder). "Yin Bao" likely refers to the Bladder. Gao’s interpretation as Sea of Blood is incorrect.
Treatment at Jing Shu. Zhang Yun states: For example, Tai Yuan is the Shu point of Hand-Tai Yin Lung Meridian. Jian An notes: Ma Yun incorrectly identifies Lie Que as the Lung Shu point. *Jia Yi Jing* has the character "qi" (its) before "Jing."
Sudden abdominal fullness. Gao Yun states: Sudden abdominal fullness is a disease of Tai Yin Spleen Earth. Pressing does not depress; it is full and hard, not yielding to pressure.
Tai Yang Jing Luo. Song Edition writes "Hand Tai Yang." Jian An notes: Wang Bing’s annotation: "Tai Yang" refers to (originally 'as', now corrected to) Hand Tai Yang. The character "Hand" was added by later scholars. Zhi Gao followed the Song Edition, which is incorrect. Wang Yinzhong’s *Tu Jing* matches *Jia Yi Jing* exactly.
Mu Point of the Stomach. *Nan Jing 67* states: Five Zang Mu points are all in Yin. Hua Shou’s annotation: In the abdomen is Yin, called Mu; in the back is Yang, called Shu. "Mu" is like "Mu Jie" (knot/gathering), indicating Qi gathering here. Jian An notes: Wu Lu Guang wrote *Mu Jing*, cited in *Jia Yi Jing* notes. Li Shizhen’s *Ba Mai Kao* explains pronunciation: "Mu" sounds like "Mu," identical to "Mo" (membrane). (See detailed meaning in *Nu Lun* Mo Yuan annotation.) These four characters are absent in *Jia Yi Jing*, likely interpolated text.
Shao Yin Shu. Ma Yun states: Shen Shu acupoint. This originally belongs to Foot-Tai Yang Bladder Meridian, but is called Shao Yin because the Kidney is Foot-Shao Yin. Zhang Yun states: Shao Yin Shu is Shen Shu. The Kidney is the gate of the Stomach, so it should also be selected. It is a Foot-Tai Yang meridian point, 1.5 cun lateral to the spine, totaling 3 cun.
Yuan Li Needle. Gao Yun states: *Jiu Zhen Er Shi Er Yuan Lun* states: The needle is as thick as a cow’s tail hair, round and sharp, slightly larger in the middle, used to drain sudden Qi. Since Shen Shu sides cannot be deeply needled, the Yuan Li needle is used to drain Kidney Water-Qi to treat abdominal fullness.
Huo Luan (Colic Disorder/Vomiting and Diarrhea). Zhi writes "Huo" as "Huo" (patchouli), unknown basis. Wu Yun states: Hand waving and eyes confused is called Huo Luan. Jian An notes: This is speculative. *Bing Yuan Hou Lun* states: Huo Luan arises from improper temperature regulation, causing interference and confusion between Yin-Yang and Clear-Turbid Qi. When confusion occurs in the intestines and stomach, triggered by diet, it manifests as heart and abdominal colic. Heart pain precedes vomiting; abdominal pain precedes diarrhea. Simultaneous heart and abdominal pain causes simultaneous vomiting and diarrhea. "Huo Luan" describes the disease, causing chaos within a moment of hand-waving. Text