（第一）难（去声下同）曰。十二经（中）皆有动脉（处）独（照上皆字）取寸口。（手鱼后却行一寸即经渠大渊二
穴之分）以决五脏六腑死生吉凶之（诊）法。何谓也。然（然然诺之然此书字例下皆仿此）寸口者。（诸）脉之大会（地）
手太阴（肺）之脉动也。（素问云五味入口藏于胃以养五脏气气口亦太阴也是以五脏六腑之气味皆出于胃变见于气口又云
气口成寸以决死生）
按此篇开卷第一义。寸口一名气口。又名脉口。凡诊脉之法。灵素所述。盖非一道。或以气口人迎言。或以三部天
人地言。或寸脉尺肤。相对言之。人有肾原之气。胃阳之气。此难所言。独主胃气。盖水谷入口。则脉道以通。无病则
冲和之气自见。若有病则随其邪之浅深。各为脉变。凡人身者。一原气焉耳。故其有病也。诸经皆为此变动。况肺朝百
脉。脉会大渊。则全为胃气之先容。此所以不取他脉。而独取寸口。以决脏腑之死生者。然明诊脉之要。专在此耳。
人一呼脉行三寸。（左右各一寸半下同）一吸脉行三寸。呼吸定息。脉行六寸。人一日一夜。凡一万三千五百息。脉
行五十度。周于身。漏（刻）水下百刻。荣卫行阳（昼）二十五度。行阴（夜）亦二十五度。为一（大）周也。故五十
度复（回）会于手太阴。（大渊之地）寸口者。五脏六腑之所终始。故（诊）法取于寸口也。
此承上节言。诸脉会于寸口。凡血气之一周身者。以满水计。则二刻。以息数。则二百七十。以脉度。则一十六丈
二尺。是特示昼夜五十营之理尔。若夫诊脉之法。则素问所谓一呼再动。一吸再动。呼吸定息。脉五动。润以大息。是
也。盖举壮岁无病者。以为准焉。至若老幼。则无拘是法。当知老自老。幼自幼。固有血气盛衰之分。而脉亦为之增减。
故料五动内外。以定平脉。是言外之意也。且察脉之变。藉医之气息为法。故素问曰。常以不病调病患。是也。此段虽
未言及诊脉之法。然其意亦暗寓中矣。
（第二）难曰。脉有尺寸。（二部）何谓也。然。尺寸者。脉之大要会也。（前曰大会此曰大要会可见要一字有差别）
从关（手腕后高骨处）至尺（泽）是尺（肤）内阴之所治也。从关至鱼际（大指掌骨际）是寸口内阳之所治也。故分寸
（口）为尺。分尺（肤）为寸。故阴得尺（肤）内一寸。（动脉）阳得寸（口）内九分。（动脉）尺寸（二部）终始一寸
九分。故曰尺寸也。（此篇始以鱼后一寸九分之动通称寸关尺三部）
按一难已举一部寸口。以决脏腑之死生者。以肺朝百脉。非若余十一经之比。盖取太极未分之象焉。此篇分寸尺立
论者。脉中既有阴阳进退之理。故于一脉中分关前关后。以立尺寸阴阳之位。盖见太极分为两仪之象也。故九为寸阳。
十为尺阴。立关以为寸尺之界。合则一寸九分。即三指点按之位也。孙思邈以寸关尺三部。为岐伯之言。然内经无所见
焉。其有尺寸之名者。尺是尺之肤肉。寸即寸口一部之脉。分寸口尺内为三部者。盖难经之所创也。圭斋欧阳氏云。切
脉于手之寸口。其法自秦越人始。蕲水庞安常。亦谓越人取手太阴之行。度鱼际后一寸九分。以配阴阳之数。此说俱为
得之。滑注所引。即释字家说。非古义也。一二难统论建三部之义。
（第三旧十八）难曰。脉（经脉之脉）有三部。部有四经。手有太阴阳明。足有太阳少阴。为上下部。何谓也。然
手太阴（肺）阳明（大肠）金也。足少阴（肾）太阳（膀胱）水也。金生水（母子之行）水流下行。而不能上。故在下
部也。足厥阴（肝）少阳（胆）水也。生手太阳（小肠）少阴（心）火火炎上行。而不能下。故为上部。手心主（心包）
少阳（三焦）火。生足太阴脾阳明（胃）土。土主中宫。故在中部也。此皆五行子母。更相生养者也。
按此难见旧本第十八篇。以予观之。正似错简在彼。何则。此难所言。盖配列脏腑部位于寸关尺者。明矣。一二难
始分三部。而未配脏腑脉位。至三四难。则既论平病死等脉。所谓阴阳相乘。及心肺俱浮。肾肝俱沉等语。当按何处以
得之乎。故移是难于此。则知三部各立脏腑分发也。其分发之说。诸家纷纷。似不合于经意。予窃考寸关尺三部之诊。
八十一篇中。唯有左得之右得之。及右手脉等语。而未尝闻有配列脏腑于左右尺寸之说。如其左寸心右寸肺等说。西晋
王叔和为之嚆矢。唐宋元明诸家。咸从其旗号。愈穿愈凿。愈繁愈杂。至若取素问尺内两旁季胁云云一节。以为三部左
右分发之义。则大失古义。岂非一犬吠虚。万犬传声邪。至明中叶赵继宗李时珍辈。厌其繁芜。略从简约。虽然。赵氏
唯得土主中宫之旨。李氏唯通部有四维之义耳。宋王诚叔独谓以心肺俱浮。肾肝俱沉。脾在中州为正。至于他分两手部
位。及脏腑脉。并时分见于尺寸。皆以为王氏脉经之非。可谓千古卓见矣。惜乎众口烁金。遂使脱锥之才。坐下客之列。
余善其说之近乎古。故时举寓推毂之意云。
（第四旧十六）难曰。脉有三部九候。有阴阳。（旧本四难）有轻重。（旧本五难）有六十首。（旧本十难）有（张世
贤本
有有字故补之）一脉变为四时。（旧本十五难）离圣久远。各自是其（诊）法。何以别之。
按此问辞出旧本第十六难。然无答辞。疑是缺文乎今考前后篇。推以移之于此。
脉有三部九候。各何主之。然。三部者。寸关尺也。九候者。浮中沉也。上部（寸）法天。主胸以上。至头之有疾
也。中部（关）法人。主膈以下至脐之有疾。下部（尺）法地。主脐以下至足之有疾也。审而（针）刺之者也。
按此一节。出旧本第十八难中。脉有三部九候。如何主之十字。谢坚白以为衍文。然是特更端之辞。下编多见此例。
则置亦无妨焉。素问分头面手足为天人地三部。每部候三穴。合为九候。而扁鹊便以寸关尺为三部。每部浮中沉。合为
九候。义若相悖。然其致一也。盖扁鹊之意。于内经诸篇。率皆去繁就简。约示其义者。每每皆然。故在此篇。亦唯言
两寸法天。心肺主之。两尺法地。肾肝主之。两关法人。脾心包主之。审而刺之。言分三部九候而针刺之。
上部（寸）有脉。下部（尺）无脉。其人（必）当（有）吐。不吐者死。上部无脉。下部有脉。虽困（倦）无能为
害。所以然者。人之有尺（脉）譬如（二字旧本误在人之有尺之上今从滑注移于此）树之有根。枝叶（比寸）虽枯槁。
根本（比尺）将自生。脉有根本。人有元气。故知不死。（此一节旧本误出于第十四难之末今以文理考则当属于上文故僭
移于此）
按此因上文言上下部脉自有本末之理。所谓上部有脉。下部无脉者。是主邪气。故有未必有。无未必无。益是饮食
隔塞中焦。不得磨旋。则上焦不清。下焦不通。故脉溢上而侵心肺之分。是以其人当吐。然则上部有脉。是谓有邪脉也。
其无脉者。亦当一旦隔塞而不见焉。若既有吐。则上下俱通。而其无脉处。还复相见。若夫不吐则下焦无气。而肾肝殆
绝。故曰死矣。上部无脉。下部有脉者。是主正气。故无是真无。有是真有。盖虽上焦受邪。心肝为是渐虚。然下焦未
衰。肾肝之气。犹有茁然者。纵使枝叶枯槁。然根本既已有气。则何死之有。故曰虽困无能为害。此篇有无二字。特有
二义。若为一例观之。则不啻局促不通。反失立论之旨。何者。下部已无脉。而上部独有焉。则外关内格惟肖。上部脉
绝。而下部独见焉。则内关外格何别。滑注所载诸说。随文为解。未曾免疑。学人审诸。
（第五旧四）难曰。脉有阴阳之法。何谓也。然。呼出心与肺。（寸）吸入肾与肝。（尺）呼（寸）吸（尺）之间。
脾受谷味也。其脉在中。（关）浮者阳也。（表）沉者阴也。（里）故曰阴阳也。心肺俱浮。何以别之。（起一浮分为两象
之间）然浮而大散者。心也。（阳中之阳）浮而短涩者。肺也。（阳中之阴）肾肝俱沉。何以别之。（又一沉分为两象）然
牢而长者肝也。（阴中之阳）按之濡。举指来实者。肾也。（阴中之阴）脾者中州。故其脉在中。（不浮不沉阴阳界限故谓
之中）是阴阳之法也。
按此篇立论。心肺脉俱浮。见寸为常。肾肝脉沉。见尺为常。脾脉。见于两关。不偏不倚。故曰其脉在中。中者。
关位也。此不言寸尺。专以呼吸言者。盖前篇既论三部各配五脏位置。故此独以呼吸言。越人已谓肾间动气。呼吸之门。
则呼自齐下阅历诸脏。而出于鼻。吸亦自鼻孔入达五脏。而极于齐下。所谓呼出心肺。吸入肾肝者。亦互文耳。自此而
下。专言脉象。此篇先举浮沉二脉。以示表里阴阳。
脉有一阴一阳。（沉滑）一阴二阳。（沉滑长）一阴三阳。（浮滑长时一沉）有一阳一阴。（浮涩）一阳二阴（长沉涩）
一阳三阴。（沉涩短时一浮）如此之言。寸口（三部）有六脉俱动邪。然。此言者。非有六脉俱动也。谓浮沉长短滑涩也。
（上所谓六脉是也）浮者阳也。滑者阳也。长者阳也。沉者阴也。短者阴也。涩者阴也。
所谓一阴一阳者。谓脉来沉（体）而滑（兼加）也。一阴二阳者。谓脉来沉（体）滑而长（兼）也。一阴三阳者。
谓脉来浮滑而长。（变脉）时一沉（本脉）也。（以上三件脉状阴脉为体阳脉兼见）所谓一阳一阴者。谓脉来浮（体）而
涩（兼）也。一阳二阴者。谓脉来长（体）而沉涩（兼）也。一阳三阴者。谓脉来沉涩而短。（变）时一浮（本）也。（此
三件阳脉为体阴脉乘之）各以其（部）经所在。名病顺逆也。（阳位见阳脉阴位见阴脉是顺阳位见阴脉阴位见阳脉是逆）
按因上节浮沉二脉。并滑涩长短四脉。凡此六者。为脉之纲领而候之。古之义也。内经以缓急大小滑涩为六脉。其
义亦同。各随其时宜尔。盖有一阴一阳。至一阴三阳。则是谓阴虚阳盛。自微至着之象。即无水之证。所谓盛水之主。
以制阳光。是也。自一阳一阴。至一阳三阴。则谓阳虚阴盛。自渐至极之状。即无火之证。所谓益火之原。以消阴翳。
是也。至于时一沉浮。则阴阳衰竭之极。而无有挽回之候。故曰。名病之逆顺也。
（第六旧同）难曰脉有阴盛阳虚。阳盛阴虚。何谓也。然浮之（轻取）损小。（不足）沉之（重取）实大。（有余下
同）故曰阴盛阳虚。沉之损小。浮之实大。故曰阳盛阴虚。是阴阳虚实之意也。
按此篇与旧本五十八难第三节之文似同。而其义自别。彼所谓阳虚阴盛。阳盛阴虚。乃指伤寒表里之证。此则承上
篇浮沉。以定阴阳虚实之诊法。读者勿以其偶同混读焉。
（第七旧九）难曰。何以别知脏腑之病耶。然。数者腑也。（属阳）迟者脏也。（属阴）数（浮沉强弱）则为热。（表
里虚实）迟（浮沉强弱）则为寒。（表里虚实）诸阳（脉）为热（证）诸阴（脉）为寒（证）故以别知脏腑之病也。
按此难举数迟二脉。以别脏腑之病。前篇既揭浮沉二脉。分发四脏。此篇即标数迟以决脏腑寒热者。以浮沉虚实四
字。蒙此二脉。引伸以求其义。则此难秘旨。自然明矣。所谓数者腑。迟者脏。数则为热。迟则为寒四句。滑注无明解。
诸家纷纷。犹未决者。盖不深味之耳。何者。数未必得为腑病。迟未必得为脏病。盖有热则腑脏脉皆数。有寒则脏腑脉
皆迟。故下文云。数则为热。迟则为寒。由之观之。浮数则表热。沉数则里热。虚数是阴虚内热。实数是阳实发热。迟
脉亦各有浮沉虚实四变。脏寒腑寒。俱皆见焉。或问此篇数迟二脉。似在脏腑有所印定。然则无脏病属热腑病属寒之证
欤。答曰。数迟二脉。分发脏腑。固其所也。而病之变易。脉与之化。则脏亦见数。腑亦见迟。何有定体。数迟易地。
可以见此篇之妙。庞氏所谓引而不发者。是也。
（第八旧五）难曰。脉有轻重。（手法）何谓也。然。初持脉。如三菽之重。（浮○菽豆之别名菽有大小则未可知用
何豆为准盖其实则借以分段耳读者勿泥）与皮毛相得者。肺部也。如六菽之重。（浮）与血脉相得者。心部也。如九菽之
重。（浮沉之中）与肌肉相得者。脾部也。如十二菽之重。（沉）与筋平者。肝部也。按之至骨。（沉）举指来疾（前难作
实为是）者。肾部也。故曰轻重也。
按菽法轻重凡五候。虽内经无明文。然应象论略有言曰。善治者治皮毛。其次治肌肤。其次治筋脉。此亦诊家伺邪
浅深之一也。又痹论所述五痹之候。亦非此法。则无所分别。盖每部分诊之。则在寸三菽六菽。关乃九菽。尺乃十二菽。
与至骨大意。滑注所言浮中沉之义。而分于皮脉肉筋骨者。凡以病有此五分故耳。此难所以立菽法轻重者然欤。
（第九旧七）难曰。经（见素问平人气象论其文半脱）言少阳之（脉）至（进）乍大（阳）乍小。（阴）乍短（阴）
乍长。（阳下文同）阳明之至。浮大而短。太阳之至洪大而长。太阴之至。紧大而长。少阴之至紧细而微。厥阴之至。沉
(First Difficulty) It is asked: Among the twelve meridians, there are pulsating points in all of them. Why is it that only the "Cunkou" (Inch Position) pulse at the wrist is taken as the diagnostic method to determine the life and death, good fortune and misfortune of the five zang organs and six fu organs? The answer is: The Cunkou is the great convergence point of all pulses, which is where the pulse of the Hand-Taiyin Lung meridian beats. The *Suwen* states: "When the five flavors enter the mouth, they are stored in the stomach to nourish the qi of the five zang organs. The Qikou (also known as Cunkou) also belongs to the Taiyin meridian. Therefore, the qi and flavor of the five zang and six fu organs all originate from the stomach and manifest in the Qikou." It also states: "The Qikou forms the Cun pulse, used to decide life and death."
Commentary: This passage presents the first major principle of the book. The Cunkou is also called the Qikou or Maikou. The methods of pulse diagnosis described in the *Linghu* and *Suwen* are not limited to one approach. Some compare the Qikou with the Renying; some discuss the three positions of Heaven, Man, and Earth; some contrast the Cun pulse with the Chi skin. The human body possesses the Yuan Qi of the Kidney and the Yang Qi of the Stomach. This difficulty emphasizes the Wei Qi (Stomach Qi). Generally, when food and water enter the mouth, the pulse channels become unobstructed. In the absence of disease, the harmonious Qi naturally manifests. If disease exists, the pulse changes according to the depth of the pathogenic factor. Essentially, the human body is but a collection of Yuan Qi. When illness occurs, all meridians undergo changes. Moreover, the Lung governs all vessels, and the Meeting Point of Vessels is at Dayuan. Thus, the Cunkou pulse is entirely a precursor of the Stomach Qi. This is why other pulses are not taken, but only the Cunkou is selected to determine the life and death of the zang and fu organs. However, elucidating the essence of pulse diagnosis lies specifically here.
In one exhalation, the pulse travels three cun (one and a half cun for each hand, same below); in one inhalation, the pulse also travels three cun. Between exhalation and inhalation (fixed breath), the pulse travels six cun. In one day and night, a person breathes 13,500 times, and the pulse circulates fifty times around the body. The clepsydra drips for one hundred marks. Ying (Nutrient) and Wei (Defensive) qi travel twenty-five times in Yang (day) and twenty-five times in Yin (night), constituting one great cycle. Thus, after fifty cycles, the pulse returns to meet at the Hand-Taiyin Lung meridian (at Dayuan). The Cunkou is the beginning and end of the qi and blood of the five zang and six fu organs; therefore, the diagnostic method selects the Cunkou.
Commentary: This follows the previous section, stating that all pulses converge at the Cunkou. The amount of qi and blood circulating once around the body, if measured by water volume, takes two marks of time; by breath count, it is 270 breaths; by pulse distance, it is sixteen zhang and two chi. This specifically illustrates the principle of fifty circuits during day and night. As for the method of pulse diagnosis, it refers to what the *Suwen* says: two beats per exhalation, two beats per inhalation, five beats between fixed breaths, occasionally adjusted by a long breath. This uses the healthy state of a young adult as the standard. For the elderly and children, this rule does not strictly apply. One must know that the elderly and children have inherent differences in the prosperity and decline of qi and blood, and their pulses increase or decrease accordingly. Thus, observing the five beats and internal/external conditions to determine the normal pulse is the implied meaning. Furthermore, observing pulse variations relies on the doctor's breath rhythm as a standard, hence the *Suwen* states: "Usually, use the breath of a healthy person to calibrate the patient's pulse." Although this section does not explicitly describe the technique of pulse diagnosis, its intent is implicitly contained within.
(Second Difficulty) It is asked: The pulse has Cun and Chi positions. What does this mean? The answer is: Cun and Chi are the great essential convergence of the pulse. (The previous text said "Great Convergence," here it says "Great Essential Convergence," showing a difference in the character "Essential"). From Guan (the high bone behind the wrist) to Chi Ze direction, this is the area governed by Yin within the Chi skin. From Guan to Yuji (the edge of the metacarpal bone of the thumb), this is the area governed by Yang within the Cun Kou. Therefore, the Cun Kou is divided into Chi, and the Chi skin is divided into Cun. Thus, Yin occupies one cun within the Chi skin (arterial range), and Yang occupies nine fen within the Cun Kou (arterial range). The Cun and Chi sections together measure one cun and nine fen from start to finish, hence the name Cun-Chi. (This chapter begins to refer to the arterial movement one cun and nine fen behind Yuji collectively as the three positions: Cun, Guan, and Chi).
Commentary: The First Difficulty already mentioned the single position of Cun Kou to determine the life and death of zang and fu organs, because the Lung governs all vessels, unlike the other eleven meridians, perhaps taking the image of undifferentiated Taiji. This chapter establishes Cun and Chi because within the pulse there is the principle of Yin-Yang advance and retreat. Therefore, within one pulse, the areas before and after Guan are divided to establish the positions of Cun, Chi, Yin, and Yang, reflecting the image of Taiji dividing into Two Powers. Thus, nine represents Cun-Yang, ten represents Chi-Yin, and Guan is established as the boundary between Cun and Chi. Together they measure one cun and nine fen, which is the position for three-finger palpation. Sun Simiao considered the three positions of Cun, Guan, and Chi to be words of Qibo, but they are not found in the *Neijing*. Where the names Cun and Chi appear, "Chi" refers to the flesh of the Chi region, and "Cun" refers to the pulse of the Cun Kou alone. Dividing Cun Kou and Chi Ne into three parts was likely created by the *Nanjing*. Ouyang Xiu (Guizhai) stated that cutting the pulse at the Cun Kou of the hand began with Qin Yue-ren (Bian Que). Pang Anchang of Qishui also said that Yue-ren measured one cun and nine fen behind Yuji along the Hand-Taiyin meridian to match the numbers of Yin and Yang. Both views are correct. The commentary by Hua Shou cites lexicographers' explanations, which are not the ancient meaning. The First and Second Difficulties collectively discuss the establishment of the three positions.
(Third Difficulty, Old Version Chapter 18) It is asked: The pulse has three positions, and each position has four meridians. The Hand has Taiyin and Yangming; the Foot has Taiyang and Shaoyin, divided into upper and lower positions. What does this mean? The answer is: Hand-Taiyin (Lung) and Yangming (Large Intestine) belong to Metal. Foot-Shaoyin (Kidney) and Taiyang (Bladder) belong to Water. Metal generates Water (mother-son relationship). Water flows downward and cannot go up, so they are in the lower position. Foot-Jueyin (Liver) and Shaoyang (Gallbladder) [Text says Water, logically Wood] generate the Fire of Hand-Taiyang (Small Intestine) and Shaoyin (Heart). Fire flares upward and cannot go down, so they are in the upper position. Hand-Xinzhong (Pericardium) and Shaoyang (Sanjiao) belong to Fire. Fire generates the Earth of Foot-Taiyin (Spleen) and Yangming (Stomach). Earth governs the Central Palace, so it is in the middle position. These are all relationships of mutual generation and nourishment among the Five Elements' mother and son.
Commentary: This difficulty appears in Chapter 18 of the old version. In my opinion, it seems to be a misplaced slip of bamboo slips there. Why? The content of this difficulty clearly matches the arrangement of zang and fu organs in the Cun, Guan, and Chi positions. The First and Second Difficulties initially divided the three positions without assigning zang and fu pulse locations. By the Third and Fourth Difficulties, discussions on normal and dead pulses, such as Yin-Yang mutual invasion, and Heart/Lung both floating, Kidney/Liver both sinking, arise. Where would these be obtained from? Therefore, moving this difficulty here reveals that each of the three positions independently establishes the distribution of zang and fu organs. Regarding the theory of distribution, various schools argue纷纭, which seems inconsistent with the scriptural intent. I privately examined the diagnosis of the three positions of Cun, Guan, and Chi in the eighty-one chapters. There are only mentions of "obtained on the left," "obtained on the right," and "right-hand pulse," but never a theory of distributing zang and fu organs to the left and right Cun-Chi. The theory of Left-Cun governing Heart and Right-Cun governing Lung was pioneered by Wang Shuhe of the Western Jin Dynasty. Scholars of the Tang, Song, Yuan, and Ming dynasties followed his banner, becoming more speculative and complicated. To cite the *Suwen* passage about the sides of the Chi Nei and Ji Xie as the basis for left-right distribution is a great loss of ancient meaning. Is this not like one dog barking at nothing, followed by ten thousand dogs? In the mid-Ming Dynasty, Zhao Jizong and Li Shizhen grew tired of the complexity and simplified it. Although Zhao only grasped the gist of "Earth governs the Central Palace," and Li only understood the meaning of "Four Dimensions of the Position," Wang Chengshu of the Song Dynasty alone argued that Heart and Lung both floating, Kidney and Liver both sinking, and Spleen in the Central Province is correct. He considered the distributions of hands, positions, zang-fu pulses, and time-based appearances in Cun-Chi to be errors of Wang Shuhe's *Mai Jing*. This can be called a profound insight for millennia. Unfortunately, gossip melts gold, causing him to sit in the rank of a guest despite his talent. I appreciate his proximity to ancient truth, so I often mention it to express my support.
(Fourth Difficulty, Old Version Chapter 16) It is asked: The pulse has three positions and nine inspections, Yin and Yang, lightness and heaviness, sixty heads (Zhang Shixian edition adds "You"), and one pulse changing into four seasons (Old Version Chapter 15). Far from the sages, each adheres to their own methods. How can they be distinguished?
Commentary: This question comes from Old Version Chapter 16, but lacks an answer. It is suspected to be missing text. Now, examining the preceding and following chapters, I infer it should be moved here.
The pulse has three positions and nine inspections. What do they each govern? The answer is: The three positions are Cun, Guan, and Chi. The nine inspections are Floating, Middle, and Deep. The Upper Position (Cun) corresponds to Heaven, governing diseases from the chest above to the head. The Middle Position (Guan) corresponds to Man, governing diseases from below the diaphragm to the navel. The Lower Position (Chi) corresponds to Earth, governing diseases from below the navel to the feet. Examine them carefully and treat with acupuncture.
Commentary: This section originates from the ten characters "Pulse has three positions and nine inspections, how do they govern?" in Old Version Chapter 18. Xie Jianbai considered it superfluous text, but it is merely a transitional phrase. Such examples are common in the latter part of the book, so placing it here is acceptable. The *Suwen* divides the head, face, hands, and feet into Heaven, Man, and Earth three positions, inspecting three acupoints in each, totaling nine inspections. Bian Que, however, took Cun, Guan, and Chi as the three positions, and Floating, Middle, and Deep as the nine inspections. The meanings seem contradictory but aim at the same result. Bian Que's intention was generally to simplify the *Neijing*, removing complexity to show the essence. Thus, in this chapter, he only states that the two Cun correspond to Heaven, governed by Heart and Lung; the two Chi correspond to Earth, governed by Kidney and Liver; the two Guan correspond to Man, governed by Spleen and Pericardium. "Examine and puncture" means to puncture according to the division of three positions and nine inspections.
If there is pulse in the Upper Position (Cun) but no pulse in the Lower Position (Chi), the person will surely vomit. If they do not vomit, they will die. If there is no pulse in the Upper Position but pulse in the Lower Position, although exhausted, it will not cause harm. The reason is that having a Chi pulse in a person is like a tree having roots. Although the branches and leaves (compared to Cun) may wither, the root (compared to Chi) will naturally regenerate. The pulse has a root; the person has Yuan Qi. Therefore, it is known that they will not die. (This section was erroneously placed at the end of Chapter 14 in the old version. Based on textual logic, it belongs to the above context, so I have presumptuously moved it here.)
Commentary: This follows the previous discussion on the origin and end of upper and lower pulses. The case of "pulse in upper, no pulse in lower" indicates pathogenic factors. Thus, having pulse doesn't necessarily mean life, and lacking pulse doesn't necessarily mean death. If food and drink block the Middle Jiao, preventing rotation and transformation, the Upper Jiao becomes unclear, and the Lower Jiao blocked. Thus, pulse overflows upward, invading the Heart and Lung regions, causing vomiting. Having pulse in the upper position is called having a pathogenic pulse. The lack of pulse there is due to sudden blockage. If vomiting occurs, upper and lower connect, and the absent pulse reappears. If no vomiting occurs, the Lower Jiao lacks Qi, and Kidney and Liver are nearly extinct, hence death. Conversely, "no pulse in upper, pulse in lower" indicates righteous Qi. Thus, no pulse is truly absent, and pulse is truly present. Although the Upper Jiao is affected and Heart/Liver gradually weaken, the Lower Jiao is not depleted, and Kidney/Liver Qi remains robust. Even if branches wither, as long as the root has Qi, there is no death. Hence, exhaustion causes no harm. The words "have" and "lack" in this chapter have dual meanings. Viewing them uniformly leads to a narrow interpretation, losing the thesis's purpose. If the lower pulse is absent but upper exists, it resembles external closure and internal gridlock. If upper pulse is absent but lower exists, how is it different from internal closure and external gridlock? Hua Shou's annotations offer various interpretations but fail to resolve doubts. Students should examine this carefully.
(Fifth Difficulty, Old Version Chapter 4) It is asked: What is the method of Yin and Yang in the pulse? The answer is: Exhalation comes from Heart and Lung (Cun). Inhalation enters Kidney and Liver (Chi). Between exhalation and inhalation, the Spleen receives grain flavors, and its pulse is in the middle (Guan). Floating is Yang (Exterior). Deep is Yin (Interior). Hence, it is called Yin and Yang. Heart and Lung pulses both float. How to distinguish them? The answer is: Floating, large, and scattered is the Heart pulse (Yang within Yang). Floating, short, and choppy is the Lung pulse (Yin within Yang). Kidney and Liver pulses both sink. How to distinguish them? The answer is: Firm and long is the Liver pulse (Yang within Yin). Soft upon pressing, but solid upon lifting the finger is the Kidney pulse (Yin within Yin). The Spleen is in the Central Province, so its pulse is in the middle (neither floating nor deep, the boundary of Yin and Yang, thus called Middle). This is the method of Yin and Yang.
Commentary: This chapter establishes that Heart and Lung pulses floating in the Cun is normal; Kidney and Liver pulses sinking in the Chi is normal; Spleen pulse appearing in both Guans, neither biased nor leaning, is called "Middle." Middle refers to the Guan position. Not mentioning Cun and Chi, but focusing on respiration, is because the previous chapter discussed the three positions matching five zang organs. Here, only respiration is used. Yue-ren (Bian Que) stated that the動氣 (Moving Qi) in the inter-kidney area is the gate of respiration. Exhalation travels from below the navel through various organs to the nose; inhalation enters from the nose to the five zang organs and reaches below the navel. "Exhalation from Heart/Lung, inhalation to Kidney/Liver" is a rhetorical device. From here on, it focuses on pulse images. This chapter first raises Floating and Deep pulses to indicate Exterior/Interior and Yin/Yang.
There is One-Yin-One-Yang (Deep-Slippery), One-Yin-Two-Yang (Deep-Slippery-Long), One-Yin-Three-Yang (Floating-Slippery-Long, occasionally Deep), One-Yang-One-Yin (Floating-Choppy), One-Yang-Two-Yin (Long-Deep-Choppy), One-Yang-Three-Yin (Deep-Choppy-Short, occasionally Floating). Does this mean six pulses beat simultaneously in the Cunkou? The answer is: This refers not to six simultaneous pulses, but to the six qualities: Floating, Deep, Long, Short, Slippery, Choppy. Floating is Yang, Slippery is Yang, Long is Yang; Deep is Yin, Short is Yin, Choppy is Yin.
"One-Yin-One-Yang" means the pulse is Deep (substance) and Slippery (addition). "One-Yin-Two-Yang" means Deep (substance), Slippery, and Long (additions). "One-Yin-Three-Yang" means Floating, Slippery, and Long (changed pulse), occasionally Deep (original pulse). (These three pulse states take Yin as substance and Yang as addition). "One-Yang-One-Yin" means Floating (substance) and Choppy (addition). "One-Yang-Two-Yin" means Long (substance) and Deep-Choppy (additions). "One-Yang-Three-Yin" means Deep-Choppy and Short (changed), occasionally Floating (original). (These three take Yang as substance and Yin as invasion). According to their respective meridian locations, judge the prognosis of the disease. (Yang position seeing Yang pulse is favorable; Yin position seeing Yin pulse is favorable. Yang position seeing Yin pulse, or Yin position seeing Yang pulse, is unfavorable).
Commentary: Following the previous section on Floating/Deep and Slippery/Choppy/Long/Short, these six are the guidelines of pulse diagnosis, an ancient meaning. The *Neijing* lists Slow/Rapid, Large/Small, Slippery/Choppy as six pulses, with similar meaning, adapted to seasons. One-Yin-One-Yang to One-Yin-Three-Yang indicates Yin deficiency and Yang excess, progressing from mild to severe, akin to "Water Deficiency," treated by "Strengthening Water to control Yang." One-Yang-One-Yin to One-Yang-Three-Yin indicates Yang deficiency and Yin excess, progressing to extreme, akin to "Fire Deficiency," treated by "Augmenting Fire to dispel Yin Shadows." Occasional alternating Floating/Deep indicates extreme depletion of Yin and Yang with no hope of recovery, hence judging the disease as unfavorable.
(Sixth Difficulty, Same as Old Version) It is asked: What is meant by Pulse with Yin Excess and Yang Deficiency, and Yang Excess and Yin Deficiency? The answer is: Light pressure (Floating) yields a diminished/small pulse (deficiency), while heavy pressure (Deep) yields a solid/large pulse (excess). Hence, Yin Excess and Yang Deficiency. Heavy pressure (Deep) yields diminished/small, while light pressure (Floating) yields solid/large. Hence, Yang Excess and Yin Deficiency. This is the meaning of Yin/Yang Deficiency/Excess.
Commentary: This passage resembles Chapter 58, Section 3 of the old version, but the meaning differs. That passage refers to exterior/interior syndromes of Cold Damage. This one continues the previous discussion on Floating/Deep to determine Yin/Yang Deficiency/Excess diagnosis. Readers should not confuse them due to superficial similarity.
(Seventh Difficulty, Old Version Chapter 9) It is asked: How to distinguish zang and fu diseases? The answer is: Rapid pulse belongs to Fu (Yang). Slow pulse belongs to Zang (Yin). Rapid indicates Heat (exterior/interior/deficiency/excess). Slow indicates Cold (exterior/interior/deficiency/excess). All Yang pulses indicate Heat syndromes; all Yin pulses indicate Cold syndromes. Thus, they distinguish zang and fu diseases.
Commentary: This difficulty uses Rapid and Slow pulses to distinguish zang/fu diseases. The previous chapter highlighted Floating/Deep for four zang organs; this chapter uses Rapid/Slow to decide zang/fu cold/heat. Covering these with Floating/Deep/Deficiency/Excess clarifies the secret intent. The statement "Rapid is Fu, Slow is Zang, Rapid is Heat, Slow is Cold" lacks clear explanation in Hua Shou's notes, and scholars disagree, likely due to lack of deep reflection. Rapid does not necessarily mean Fu disease, nor Slow necessarily Zang disease. Heat makes both zang and fu pulses rapid; Cold makes both slow. Thus, Floating-Rapid is Exterior Heat, Deep-Rapid is Interior Heat, Deficient-Rapid is Yin Deficiency Internal Heat, Solid-Rapid is Yang Excess Fever. Slow pulse also has Floating/Deep/Deficiency/Solid variations, applicable to both Zang and Fu Cold. Question: Does this imply no Zang diseases are Hot or Fu diseases are Cold? Answer: Distributing Rapid/Slow to Zang/Fu is the norm, but diseases change, and pulses adapt. Zang can show Rapid, Fu can show Slow. There is no fixed form. Interchanging Rapid and Slow reveals the subtlety of this chapter. Pang's description of "leading without releasing" applies here.
(Eighth Difficulty, Old Version Chapter 5) It is asked: What is meant by lightness and heaviness of the pulse? The answer is: Initially holding the pulse, with the weight of three beans (Floating ○ Bean is another name for dou; size varies, so it's just a segment marker, do not be pedantic), touching the skin and hair, is the Lung pulse. With the weight of six beans (Floating), touching the blood vessels, is the Heart pulse. With the weight of nine beans (Between Floating and Deep), touching the muscles, is the Spleen pulse. With the weight of twelve beans (Deep), level with the tendons, is the Liver pulse. Pressing to the bone, lifting the finger to feel a rapid pulse (previous difficulty said "Solid," which is correct), is the Kidney pulse. Hence, it is called lightness and heaviness.
Commentary: The bean method has five levels of inspection. Although not explicit in the *Neijing*, the *Pi Bu Lun* mentions: "Good treatment treats the skin and hair; next, muscles and skin; next, tendons and vessels." This is also a method for physicians to gauge the depth of pathogens. The *Bi Lun*'s five bi syndromes do not use this method. Generally, for separate position diagnosis: Cun uses three and six beans; Guan uses nine; Chi uses twelve and pressing to bone. This aligns with Hua Shou's Floating/Middle/Deep and Skin/Vessel/Muscle/Tendon/Bone divisions, likely because diseases manifest in these five layers. This establishes the bean method for lightness/heaviness.
(Ninth Difficulty, Old Version Chapter 7) It is asked: The *Jing* (see *Suwen: Ping Ren Qi Xiang Lun*, text partially lost) says the Shaoyang pulse fluctuates: suddenly large (Yang), suddenly small (Yin), suddenly short (Yin), suddenly long (Yang, same below). The Yangming pulse is Floating, Large, and Short. The Taiyang pulse is Surging, Large, and Long. The Taiyin pulse is Tight, Large, and Long. The Shaoyin pulse is Tight, Fine, and Micro. The Jueyin pulse is Deep.