短而敦（重）此六者。是平脉邪。将病脉邪。然。皆王脉也。其气以何月各王几日。然。冬至之后得甲子。（统六十日下
同）少阳王。复得甲子。阳明王。复得甲子。太阳王。复得甲子。太阴王。复得甲子。少阴王。复得甲子。厥阴王。王
各六十日。六六三百六十日。以成一岁。此三阳三阴之旺时日大要也。
按平病死三脉外。别有王脉。盖王之为义。在天地。则自冬至一阳来复后。每得一甲子。六十日。阳气始动。以序
升浮。至于纯阳建巳月而极矣。自夏至一阴始。亦每六十日。阴气主事。以次降沉。至于纯阴建亥月而极矣。在人经脉。
冬至后六十日。少阳王气至。以次逮乎阳明太阳。自里出表。气之升而浮也。夏至后六十日。太阴王气至。以次迁于少
阴厥阴。自外之内。气之降而沉也。盖自冬至每六十日。以次推之。则一岁中王凡六变。似合六气营运之道。然六气者。
以厥阴为先。大寒节为始。则其义亦异。因审考之。从少阳至于太阳。则一阳动于地下。而六阳偏于上之象。从太阴至
于厥阴。则一阴见于上。而六阴极于下之象。故阳脉之王。乃始于少阳。而终于太阳。阴脉之王。则从太阴而至厥阴者。
可以见已。滑注泥后得二字。为甲子为冬至以后甲子之日。殊不知此六甲之义。而统言六十日。古言为然。
（第十旧同）难曰。一（脏腑）脉为十（病）变者。何谓也。然五邪（虚实贼微正）刚（脏邪气甚）柔（腑邪气微）
相逢之意也。假令心脉急甚者。（为螈 ）肝邪干心也。（从后来为虚邪）心脉微急者。（为心痛引脊食不下）胆邪干小肠
也。心脉大甚者。（为喉 ）心邪自干心也。（自病为正邪）心脉微大者。（为心痹引脊善泪出）小肠邪自干小肠也。心脉
缓甚者。（为狂笑）脾邪干心也。（从前来为实邪）心脉微缓者。（为伏梁在心下上下行时吐血）胃邪干小肠也。心脉涩甚
者（为喑）肺邪干心也。（从所胜来为微邪）心脉微涩者。为血溢维厥耳鸣巅疾。大肠邪干小肠也。心脉沉（灵枢作滑为
是下同）甚者。（为善喝）肾邪干心也。（从所不胜来为贼邪）心脉微沉者。（为心疝引齐小腹鸣）膀胱邪干小肠也。五脏
各有刚柔邪。故令一脉辄变为十也。
按寸关尺每一部有腑逢腑。脏逢脏之脉。变是谓刚柔相逢。所谓缓急大滑涩五脉。各有微甚。分为十变。则左右三
部。合为六十变。分而言之。则一脏五邪。五五二十五病。故素问曰。五五二十五变。又曰。二十五阳。腑病亦然。总
而言之。则为五十变。以余观之。在病证则脏腑合为五十变。据灵枢则以缓急大小滑涩。分微甚言之。总合为六十变。
丁德用以此篇为六十首。实得其理焉。第四十九篇论虚实贼微正五病。是即其脉例也。灵枢第四篇曰。调其脉之缓急小
大滑涩。而病变定矣。又曰。诸小者。阴阳形气俱不足。勿取以针。而调以甘药也。今越人时省小脉。而取五脉者。盖
难经专示用针立功之妙已。
（第十一旧十五）难曰。经（素问平人玉玑二篇）言。春（肝）脉弦。夏（心）脉钩。秋（肺）脉毛。冬（肾）脉
石。是王脉耶。将病脉也。然。弦钩毛石者。四时之脉也。（因胃气有无以分平病死）春脉弦者。肝东方木也。万物始生。
未有枝叶。（比类下同）故其脉之来。濡弱而长。故曰弦。夏脉钩者。心南方火也。万物之所茂。垂枝布叶。皆下曲如钩。
故其脉之来疾去迟。故曰钩。秋脉毛者。肺西方金也。万物之所终。草木华叶。皆秋而落。其枝独在。若毫毛也。故其
脉之来。轻虚以浮。故曰毛。冬脉石者。肾北方水也。万物之所藏也。盛冬之时。水凝如石。故其脉之来。沉濡而滑。
故曰石。此四时之脉也。（以上明弦钩毛石之名义）如有变奈何。然。春（肝）脉弦。反（常）者为病。何谓反。然。其
气来实强。是谓太过。病在外。气来虚微。是谓不及。病在内。气来厌厌聂聂。如循榆叶。曰平。（多胃气下同）益实而
滑。如循长竿。曰病。（少胃气下同）急而劲益强。如新张弓弦曰死。（无胃气下同）春脉微弦。曰平。弦多胃气少。曰
病。但弦无胃气。曰死。春以胃气为本。夏（心）脉钩。反者为病。何谓反。然。其气来实强。是谓太过。病在外。气
来虚微。是谓不及。病在内。其脉来累累如环。如循琅 。曰平。来而益数。如鸡举足。曰病。前曲后居。如操带钩。
曰死。夏脉微钩。曰平。钩多胃气少。曰病。但钩无胃气。曰死。夏以胃气为本。秋（肺）脉毛。反者为病。何谓反。
然。其气来实强。是谓太过。病在外。气来虚微。是谓不及。病在内。其脉来蔼蔼如车盖。按之益大。曰平。不上不下。
如循鸡羽。曰病。按之萧索。如风吹毛。曰死。秋脉微毛。曰平。毛多胃气少。曰病。但毛无胃气。曰死。秋以胃气为
本。冬（肾）脉石。反者为病。何谓反。然。其气来实强。是谓太过。病在外。气来虚微。是谓不及。病在内。脉来上
大下兑。（上下二字疑古文误倒置）濡滑而如雀之啄。（当作喙）曰平。啄啄连属。其内微曲。曰病。来如解索。去如弹
石。曰死。冬脉微石。曰平。石多胃气少。曰病。但石无胃气。曰死。冬以胃气为本。
按厌厌聂聂。若循榆叶者。上文所谓濡弱而长之谓也。形容如是者。专主胃气言之。诊脉之法。固医家之关键。苟
非脉。则安能决病之虚实。经云。脉者血气之先。故古圣之于脉也。谆谆反复。比类象物。以传后世。且脉本无定体。
随时更改。自非圣人。其孰能如是形容。下文所谓累累蔼蔼啄啄等字。不可忽诸。此段太过不及之病。详见素问。宜互
参看。
胃者。水谷之海。主禀。四时皆以胃气为本。是谓四时之变病。死生之要会也。脾者。中州也。其平和不可得见。
衰乃见耳。来如雀之啄。如水之下漏。是脾衰见也。
按此结上文。谓胃者水谷之海者。以诸脉皆主谷病也。谷气即胃气。故曰死生之要会也。脾之和平。不可得见者。
以寄旺四脏脉中故也。雀啄屋漏。所谓真脏独见是也。胃谓生气。脾谓死脉。盖互文耳。夫脾胃者。一气也。运化水谷。
二者相随为用。故承上文以谓生之徒。二者为之。死之徒。亦二者为之。学人察诸。此应上所问。一脉变为四时之答。
（第十二旧三）难曰。脉有太过。（实）有不及。（虚）有阴阳相乘。（脉将变之兆）有覆（阳极）有溢。（阴极）有
关（阴盛四倍）有格。（阳盛四倍）何谓也。（七件脉名从内经中采摘来发问）然。关之前（寸）者。阳（脉）之动也。
脉当见九分（本位）而浮。过者（过于本位）法曰太过。减者（减于本位下同）法曰不及。遂（进也下同）上鱼（际）
为溢。（直上之势）为外关内格。此阴乘（阳位）之脉也。关以后（尺）者。阴（脉）之动也。脉当见一寸（本位）而沉。
过者法曰太过。减者法曰不及。遂入尺为覆。（直下之势）为内关外格。此阳乘（阴位）之脉也。故曰覆溢。是其真脏（无
胃气）之脉。人不病而死也。
按此篇所问脉状。曰太过。曰不及。曰阴阳相乘。曰覆。曰溢。曰关。曰格。以七有字。分七件答辞。唯言太过不
及与覆溢。以断病死之分。其阴阳相乘及关格字。皆象所以为覆溢之形。详考内经。曰溢阴溢阳。曰关阴格阳。俱是人
迎寸口四盛以上之脉。而阴阳亢极之名也。盖在阴必曰关。在阳必曰格。而溢乃阴阳相通言之。独覆一脉。内经无所见。
后世字脱耶。抑越人因溢脉对出耶。此未可知矣。盖此篇覆溢者。即内经所谓关格也。此难所谓关格。乃谓阴阳相乘之
病势。字同而义异。或问。然则此篇关格字面。何如着落。曰。观夫于溢脉。曰外关内格。覆脉亦曰内关外格。则知覆
溢者。是即真脏死脉。而外见此脉。则内亦有腑脏互相关格之变矣。素问曰。阴阳不相应。病名曰关格。可见关格不止
脉名。故四明陈氏云。关者二便闭而不通。格者食饮拒而不下。是也。后世方书中。有关格病。知覆溢是孤阴独阳之脉
名。而关格唯 其阴阳失位之势耳。然则以关格为病名。盖权舆于此篇者欤。
（第十三旧十四）难曰。脉有损（似迟）至。（似数）何谓也。然。至（病）之脉。一呼再至。曰平。（举例）三至
（一息六动）曰离经。（适得病）四至（一息八动）曰夺精。（病将甚）五至（一息十动）曰死。（难治）六至（一息十二
动）曰命绝。（必死）此至之脉也。何谓损。一呼一至（一息二动）曰离经。再呼一至（一息一动）曰夺精。三呼一至（一
息半一动）曰死。四呼一至（二息一动）曰命绝。此损之脉也。至脉（病）从下（肾肝）上。（心肺）损脉从上（心肺）
下（肝肾）也。
按至者进。损者退。所谓损至。即数迟之意也。第七难既言数迟。然彼专为分脏腑寒热言之。此谓下部阴虚。而阴
中之阳升。为至。上部阳虚。而阳中之阴降。为损。皆自渐至极之义也。离经夺精之解。滑注得之。五至曰死。六至曰
命绝。大义虽无殊。因脉动之多寡观之。则有分界。盖死与命绝。自有缓急之差。可知已。
损脉之为病奈何。然。一损（肺邪）损于皮毛。（肺之合）皮聚而毛落。（外候）二损（心邪）损于血脉。（心之合）
血脉虚少。不能荣五脏六腑。（外候）三损（脾邪）损于肌肉。（脾之合）肌肉消瘦。饮食不能为肌肤。（外候）四损（肝
邪）损于筋。（肝之合）筋缓不能自收持。（外候）五损（肾邪）损于骨。（肾之合）骨痿不能起于床。（外候）反此者。
至脉之病也。（旧本于收二字误）从上（肺心）下（肝肾）者。骨痿不能起于床者死。从下（肾肝）上（心肺）者。皮聚
而毛落者死。治损之法奈何。然。损其肺者益其气。（气虚者宜升提）损其心者调其荣卫。（血气者人之神宜调）损其脾
者调其饮食。适其寒温。（水谷由脾以营四脏）损其肝者缓其中。（养血）损其肾者益其精。（补之以味）此治损之法也。
（反此者至脉之治也）
按此举损病一例。以该至脉之病。皆各候其所主部分。以知何脏之为病也。然损病始于皮聚。而终乎骨痿者。是顺
境而易知焉。至病自骨痿至皮聚。则是逆境难见。何者。损病皮聚者。得病之始。骨痿病极之候。今以损之极。为至病
之始。以损之始。为至之终。滑注无明解。初学不得无疑。曹氏脉歌云。损脉之病。过三则死。至脉之病亦然。可谓得
此难言外之意者。盖所谓三者。指脾损。病过脾而下抵肝肾则死。至病亦过脾而上。至心肺则死。然则治损至之大法。
在病不及脾之前。可知矣。又按内经论气血二虚。率主脾肾。难经举肺与肾。明分气血二因。而脾脏独为气血二病之彀
率者。以发经之余蕴。肺曰益气。肺主皮毛。所谓气者。指外卫独行者。经曰。形不足者温之以气。是也。心曰调荣卫。
心主血。输诸经脉中。从营往来。谓之并行。卫气亦心之化也。经曰。血气者。人之神是也。周仲立卫字为衍者。非也。
脾曰调其饮食。适其寒温。脾已有损。则胃中水谷难化。故调熟菜白粥。易化以与之。且适其好寒好温情。莫强其所不
好。为前所谓饮食不能为肌肤云尔。是治脾之要也。滑注。春夏食凉食寒等语。此平人养生之要也。而若病患有不好。
则何以能为与之。岂非强乎。肝曰缓其中。中者志也。礼云虚中。孟子云热中。义与此同。皆指志言。肝志主怒也。缓
者。以甘缓之。经曰。肝苦急。急食甘以缓之。是也。肾曰益其精。肾主水。受五脏六腑之精。而藏之。经曰。精不足
者补之以味。是也。
脉有一呼再至。一吸再至。（平脉）有一呼三至。一吸三至。（离经）有一呼四至。一吸四至。（夺精）有一呼五至。
一吸五至。（死脉）有一呼六至。一吸六至。（命绝○以上审至脉之动）有一呼一至。一吸一至。（离经）有再呼一至。再
吸一至。（夺精○旧本有呼吸再至五字滑注以为衍文今削去按第一节有三呼四呼之目则于此节似有所阙然观下文言再呼
一至曰无魂当死则于损病不历三呼四呼之久而死者明也）脉来如此。何以别知其病也。然。脉来一呼再至。一吸再至。
不大不小。曰平。（无过不及）一呼三至。一吸三至。为适得病。（谓至脉离经）前（寸）大后（尺）小。即头痛目眩。（气
逆头上）前小后大。即胸满短气。（邪塞胸中）一呼四至。一吸四至。病欲甚。（谓至脉夺精）脉洪大者。苦烦满。（邪在
上部）沉细者腹中痛。（邪在下部）滑者伤热。（阳气受病）涩者中雾露。（阴血受病）一呼五至。一吸五至。其人当困。
（谓死脉）沉细夜加（倍）浮大昼加（倍）不大不小。（谓气未竭）虽困可治。其有大小者为难治。（胃气已绝）一呼六
至。一吸六至。为死脉也。（命绝）沉细夜死。浮大昼死。（以上谓至脉）一呼一至。一吸一至。名曰行尸。（旧本损字疑
误故削去此下古经错乱文理不属）人虽能行。犹当着床。所以然者。血气皆不足故也。（所谓损脉离经）再呼一至。再吸
Short and heavy pulse. These six types of pulses. Are they healthy pulses (Ping Mai) or pre-disease pulses? The answer is: They are all Wang pulses (Wang Mai, flourishing pulses corresponding to the season). In which months does their Qi flourish, and for how many days each? The answer is: After the Winter Solstice, when a Jiazi day arrives. (This covers sixty days, as mentioned below). Shaoyang (Lesser Yang) flourishes. When another Jiazi day arrives, Yangming (Greater Yang) flourishes. When another Jiazi day arrives, Taiyang (Greater Yin/Yang transition) flourishes. When another Jiazi day arrives, Taiyin (Greater Yin) flourishes. When another Jiazi day arrives, Shaoyin (Lesser Yin) flourishes. When another Jiazi day arrives, Jueyin (Terminal Yin) flourishes. Each meridian flourishes for sixty days. Six times sixty equals three hundred and sixty days, completing one year. This is the general principle of the flourishing times of the Three Yang and Three Yin meridians.
Commentary: Besides the healthy, diseased, and dying pulses, there are distinct flourishing pulses (Wang Mai). The meaning of "Wang" (flourishing/prosperous) in heaven and earth is that after the Winter Solstice, when Yang Qi begins to recover, every sixty days (one Jiazi cycle), Yang Qi starts to move and rises sequentially. It reaches its peak in the fourth month (Ji month) when Yang is pure. From the Summer Solstice, when Yin Qi begins, also every sixty days, Yin Qi takes charge and sinks sequentially. It reaches its peak in the tenth month (Hai month) when Yin is pure. In human meridians, sixty days after the Winter Solstice, Shaoyang flourishing Qi arrives, subsequently reaching Yangming and Taiyang, moving from interior to exterior, representing the rising and floating of Qi. Sixty days after the Summer Solstice, Taiyin flourishing Qi arrives, subsequently reaching Shaoyin and Jueyin, moving from exterior to interior, representing the sinking and descending of Qi. Generally,推算ating from the Winter Solstice every sixty days, the flourishing Qi changes six times in a year. This seems to align with the operation of the Six Qi. However, the Six Qi start with Jueyin at the Great Cold solar term, so the rationale differs. Therefore, examining carefully: From Shaoyang to Taiyang, it represents one Yang moving underground while the Six Yangs lean upwards. From Taiyin to Jueyin, it represents one Yin appearing above while the Six Yins sink to the bottom. Thus, the flourishing of Yang pulses starts with Shaoyang and ends with Taiyang; the flourishing of Yin pulses goes from Taiyin to Jueyin, which can be understood. Hua Shou's commentary clung to the phrase "obtained later," interpreting it as Jiazi days after the Winter Solstice, not realizing this refers to the meaning of six Jiazi cycles, collectively stating sixty days. This was the ancient way of speaking. (Same as Old Edition 10).
Question: What is meant by one pulse undergoing ten transformations? Answer: This refers to the meeting of Five Evils (Xu/Deficiency, Shi/Excess, Zei/Thief, Wei/Micro, Zheng/Correct), Gang (Strong/Fu organ evil being intense), and Rou (Soft/Zang organ evil being mild). For example, if the Heart pulse is extremely rapid/tight (Ji Shen), (manifesting as spasms), it is Liver Evil invading the Heart. (Coming from the future generates Deficient Evil/Xu Xie). If the Heart pulse is slightly rapid/tight (Wei Ji), (manifesting as heart pain radiating to the spine and inability to eat), it is Gallbladder Evil invading the Small Intestine. If the Heart pulse is extremely large (Da Shen), (manifesting as throat obstruction), it is Heart Evil invading the Heart itself. (Self-disease is Correct Evil/Zheng Xie). If the Heart pulse is slightly large (Wei Da), (manifesting as heart bi radiating to the spine and frequent tearing), it is Small Intestine Evil invading the Small Intestine itself. If the Heart pulse is extremely slow/relaxed (Huan Shen), (manifesting as manic laughter), it is Spleen Evil invading the Heart. (Coming from the past generates Excess Evil/Shi Xie). If the Heart pulse is slightly slow/relaxed (Wei Huan), (manifesting as Fu Liang mass under the heart moving up and down with occasional hematemesis), it is Stomach Evil invading the Small Intestine. If the Heart pulse is extremely choppy (Se Shen), (manifesting as aphonia), it is Lung Evil invading the Heart. (Coming from the conquered element generates Micro Evil/Wei Xie). If the Heart pulse is slightly choppy (Wei Se), manifesting as blood extravasation, cold limbs, tinnitus, and head diseases, it is Large Intestine Evil invading the Small Intestine. If the Heart pulse is extremely deep (Chen Shen) (Ling Shu reads Slippery/Hua, which is correct, same below), (manifesting as excessive thirst), it is Kidney Evil invading the Heart. (Coming from the conquering element generates Thief Evil/Ze Xie). If the Heart pulse is slightly deep (Wei Chen), (manifesting as heart hernia radiating to the umbilicus and lower abdomen with borborygmus), it is Bladder Evil invading the Small Intestine. Each Zang has Gang and Rou evils, thus causing one pulse to transform into ten variations.
Commentary: At each position of Cun, Guan, and Chi, there are pulses where Fu meets Fu and Zang meets Zang, changing; this is called the meeting of Gang and Rou. The five pulses of Huan, Ji, Da, Hua, and Se each have slight and severe degrees, forming ten transformations. Thus, left and right positions combine for sixty transformations. Separately, one Zang has five evils, five times five equals twenty-five diseases. Hence Su Wen says: Five times five equals twenty-five transformations. It also says: Twenty-five Yangs. The same applies to Fu diseases. In summary, it is fifty transformations. In my view, regarding disease patterns, Zang and Fu combine for fifty transformations. According to Ling Shu, distinguishing by Huan, Ji, Da, Xiao, Hua, Se in terms of slightness and severity totals sixty transformations. Ding Deyong considered this chapter to have sixty verses, truly grasping the principle. Chapter 49 discusses the five diseases of Xu, Shi, Zei, Wei, and Zheng, which are the examples of these pulses. Ling Shu Chapter 4 says: Adjust the pulse's Huan/Ji, Da/Xiao, Hua/Se, and the disease changes will be determined. It also says: For all small pulses, both Yin-Yang and Form-Qi are insufficient; do not use needles, but regulate with sweet medicines. Now Yue Ren frequently examines small pulses and takes the five pulses, likely because Nan Jing specifically demonstrates the wonders of achieving merit through acupuncture.
(Old Edition 11, originally 15) Question: Jing (Su Wen chapters Ping Ren Qi Xiang Lun and Yu Ji Zhen Zang Lun) states: Spring (Liver) pulse is Xian (String-like); Summer (Heart) pulse is Gou (Hook-like); Autumn (Lung) pulse is Mao (Feather-like); Winter (Kidney) pulse is Shi (Stone-like). Are these flourishing pulses or disease pulses? Answer: Xian, Gou, Mao, and Shi are the pulses of the four seasons. (Distinguished by the presence or absence of Stomach Qi). Spring pulse Xian: Liver belongs to East Wood. All things begin to grow, without branches or leaves. (Analogy follows). Thus, its pulse comes soft, weak, and long, hence called Xian. Summer pulse Gou: Heart belongs to South Fire. All things flourish, hanging branches and spreading leaves curve downwards like hooks. Thus, its pulse comes fast and departs slowly, hence called Gou. Autumn pulse Mao: Lung belongs to West Metal. All things terminate, grass and tree flowers and leaves fall in autumn, leaving only branches, resembling fine hairs. Thus, its pulse comes light, void, and floating, hence called Mao. Winter pulse Shi: Kidney belongs to North Water. All things are stored. In deep winter, water freezes like stone. Thus, its pulse comes deep, soft, and slippery, hence called Shi. These are the pulses of the four seasons. (Above clarifies the names and meanings of Xian, Gou, Mao, Shi). What if there are changes? Answer: Spring (Liver) pulse Xian; deviation from normal indicates disease. What is deviation? Answer: If Qi comes solid and strong, it is called Guo Tai (Excessive), disease is external. If Qi comes void and slight, it is called Bu Ji (Insufficient), disease is internal. If Qi comes gently and softly, like touching elm leaves, it is Ping (Healthy). (Contains much Stomach Qi, same below). More solid and slippery, like touching a long bamboo pole, it is Bing (Diseased). (Contains little Stomach Qi, same below). Rapid, forceful, and increasingly strong, like a newly strung bowstring, it is Si (Death). (No Stomach Qi, same below). Spring pulse slightly Xian is Ping. Many Xian, little Stomach Qi is Bing. Only Xian, no Stomach Qi is Si. Spring relies on Stomach Qi as the root. Summer (Heart) pulse Gou; deviation indicates disease. What is deviation? Answer: If Qi comes solid and strong, it is Guo Tai, disease external. If Qi comes void and slight, it is Bu Ji, disease internal. If pulse comes continuously like a ring, like touching lapis lazuli, it is Ping. Coming increasingly rapid, like a chicken lifting its foot, it is Bing. Bent forward and rigid backward, like holding a belt hook, it is Si. Summer pulse slightly Gou is Ping. Many Gou, little Stomach Qi is Bing. Only Gou, no Stomach Qi is Si. Summer relies on Stomach Qi as the root. Autumn (Lung) pulse Mao; deviation indicates disease. What is deviation? Answer: If Qi comes solid and strong, it is Guo Tai, disease external. If Qi comes void and slight, it is Bu Ji, disease internal. If pulse comes abundant like a chariot canopy, pressing makes it larger, it is Ping. Neither rising nor falling, like touching a chicken feather, it is Bing. Pressing feels desolate, like wind blowing feathers, it is Si. Autumn pulse slightly Mao is Ping. Many Mao, little Stomach Qi is Bing. Only Mao, no Stomach Qi is Si. Autumn relies on Stomach Qi as the root. Winter (Kidney) pulse Shi; deviation indicates disease. What is deviation? Answer: If Qi comes solid and strong, it is Guo Tai, disease external. If Qi comes void and slight, it is Bu Ji, disease internal. Pulse comes large above and narrow below (The characters Shang/Xia may be inverted in the original text), soft, slippery, and like a sparrow pecking (Should be beak). It is Ping. Pecking continuously, internally slightly curved, it is Bing. Coming like untying a rope, departing like flicking a stone, it is Si. Winter pulse slightly Shi is Ping. Many Shi, little Stomach Qi is Bing. Only Shi, no Stomach Qi is Si. Winter relies on Stomach Qi as the root.
Commentary: "Yan Yan Nie Nie, like touching elm leaves" refers to what was previously called "soft, weak, and long." Describing such a pulse specifically refers to Stomach Qi. The method of pulse diagnosis is indeed the key for physicians. Without mastering pulse, how can one determine the deficiency or excess of disease? The classic says: Pulse is the precursor of Blood and Qi. Therefore, ancient sages repeatedly explained pulse, using analogies and imagery to transmit to posterity. Pulse has no fixed form; it changes with time. Only a sage could describe it thus. The words "Lei Lei," "Ai Ai," "Zhuo Zhuo" etc., in the following text should not be ignored. The diseases of Guo Tai and Bu Ji in this section are detailed in Su Wen; consult them mutually.
Stomach is the sea of water and grain, primarily receiving nutrients. The four seasons all rely on Stomach Qi as the root. This is called the key intersection of seasonal disease changes and life/death. Spleen is the central region. Its peaceful state cannot be seen; it appears only when declining. Pulse coming like a sparrow pecking, or water dripping from a leak, indicates Spleen decline.
Commentary: This concludes the previous text. Saying Stomach is the sea of water and grain implies that all pulses relate to grain diseases. Grain Qi is Stomach Qi, hence it is the key to life and death. The peaceful state of Spleen cannot be seen because it flourishes within the pulses of the Four Zangs. Sparrow pecking and house leaking refer to the exclusive appearance of True Zang pulses. Stomach signifies Life Qi, Spleen signifies Death Pulse; this is likely mutual textual variation. Spleen and Stomach are one Qi. Transforming water and grain, the two work together. Thus, continuing the previous text: Those leading to life, the two accomplish it; those leading to death, the two also accomplish it. Students should observe this. This answers the previous question about one pulse transforming into four seasons.
(Old Edition 12, originally 3) Question: Pulse has Guo Tai (Excess), Bu Ji (Deficiency), Yin Yang Xiang Cheng (Mutual Overcoming), Fu (Inverted), Yi (Overflow), Guan (Closed), Ge (Blocked). What does this mean? (Seven pulse names extracted from Nei Jing to ask). Answer: Before the Guan (Cun position), it is the movement of Yang pulse. Pulse should appear at nine fen (standard position) and float. Exceeding the standard position is legally called Guo Tai. Reducing below the standard position is legally called Bu Ji. Advancing up to the Yu Ji (thenar eminence) is Yi (Overflow). (Straight upward momentum). It is External Guan Internal Ge. This is Yin overcoming Yang position pulse. After the Guan (Chi position), it is the movement of Yin pulse. Pulse should appear at one cun (standard position) and sink. Exceeding the standard position is legally called Guo Tai. Reducing below the standard position is legally called Bu Ji. Advancing into Chi is Fu (Inverted). (Straight downward momentum). It is Internal Guan External Ge. This is Yang overcoming Yin position pulse. Therefore, Fu and Yi are their True Zang (No Stomach Qi) pulses. People die without apparent illness.
Commentary: The pulse conditions asked in this chapter are: Guo Tai, Bu Ji, Yin Yang Xiang Cheng, Fu, Yi, Guan, Ge. Using seven "You" (Has) characters, it answers in seven parts. Only Guo Tai, Bu Ji, and Fu/Yi are used to distinguish between life and death. The terms Yin Yang Xiang Cheng and Guan/Ge describe the shapes forming Fu and Yi. Detailed examination of Nei Jing mentions Yi Yin/Yi Yang and Guan Yin/Ge Yang, which are pulses of Ren Ying and Cun Kou exceeding fourfold strength, named as extreme Yin-Yang hyperactivity. Generally, in Yin it is called Guan, in Yang it is called Ge, while Yi refers to Yin-Yang communication. Only Fu pulse is not seen in Nei Jing. Is it a later textual omission? Or did Yue Ren create it opposite to Yi pulse? This is unknown. Generally, Fu and Yi in this chapter correspond to Guan Ge in Nei Jing. The Guan Ge in this Nan Jing refers to the pathological trend of Yin-Yang mutual overcoming. Same words, different meanings. One might ask: How then does the term Guan Ge in this chapter apply? Answer: Observing Yi pulse described as External Guan Internal Ge, and Fu pulse as Internal Guan External Ge, we know Fu and Yi are True Zang death pulses. Appearing externally, it implies internal mutual Guan Ge changes between Fu and Zang. Su Wen says: When Yin and Yang do not correspond, the disease is named Guan Ge. Thus, Guan Ge is not just a pulse name. So Chen Shiming said: Guan means closure of urine and feces; Ge means rejection of food and drink. This is correct. Later medical formularies have Guan Ge disease. Knowing Fu and Yi are names of isolated Yin and Yang pulses, while Guan Ge is merely the state of Yin-Yang displacement. However, taking Guan Ge as a disease name likely originated from this chapter.
(Old Edition 13, originally 14) Question: Pulse has Sun (Loss/Decrease) and Zhi (Arrival/Increase). What does this mean? Answer: Zhi (Disease) pulse: Two beats per exhalation is Ping (Healthy). Three beats per exhalation (Six beats per respiration cycle) is Li Jing (Leaving the Canon). Four beats per exhalation (Eight beats per cycle) is Duo Jing (Depriving Essence). Five beats per exhalation (Ten beats per cycle) is Si (Death). Difficult to treat. Six beats per exhalation (Twelve beats per cycle) is Ming Jue (Life Extinction). Must die. This is Zhi pulse. What is Sun? One beat per exhalation (Two beats per cycle) is Li Jing. Two exhalations per beat (One beat per cycle) is Duo Jing. Three exhalations per beat (One beat per half cycle) is Si. Four exhalations per beat (One beat per two cycles) is Ming Jue. This is Sun pulse. Zhi pulse (disease) moves from Lower (Liver/Kidney) to Upper (Heart/Lung). Sun pulse moves from Upper (Heart/Lung) to Lower (Liver/Kidney).
Commentary: Zhi means advance, Sun means retreat. Sun and Zhi mean rapid and slow respectively. Chapter 7 discussed rapid and slow, but specifically for distinguishing Zang-Fu cold and heat. Here it refers to Lower body Yin deficiency with Yin-Yang ascending as Zhi. Upper body Yang deficiency with Yang-Yin descending as Sun. Both imply gradual progression to extremity. The explanation of Li Jing and Duo Jing is accurate in Hua Shou's notes. Five beats is death, six beats is life extinction. The general principle is similar, but observing the number of beats provides distinction. Death and life extinction have differences in urgency.
What are the diseases of Sun pulse? Answer: First Sun (Lung Evil) damages skin and hair. (Lung's correspondence). Skin gathers and hair falls. (External sign). Second Sun (Heart Evil) damages blood vessels. (Heart's correspondence). Blood vessels become deficient and few, unable to nourish Five Zang and Six Fu. (External sign). Third Sun (Spleen Evil) damages muscles. (Spleen's correspondence). Muscles emaciate, food cannot transform into flesh. (External sign). Fourth Sun (Liver Evil) damages tendons. (Liver's correspondence). Tendons relax, unable to hold themselves. (External sign). Fifth Sun (Kidney Evil) damages bones. (Kidney's correspondence). Bone atrophy, unable to rise from bed. (External sign). Opposite to this is the disease of Zhi pulse. (Old edition error at "hold"). Moving from Upper (Lung/Heart) to Lower (Liver/Kidney): Bone atrophy, unable to rise from bed, leads to death. Moving from Lower (Liver/Kidney) to Upper (Lung/Heart): Skin gathers and hair falls, leads to death. How to treat Sun disease? Answer: Damage Lung, benefit Qi. (Qi deficiency suitable for lifting). Damage Heart, regulate Ying and Wei. (Blood and Qi are the spirit of man, suitable for regulation). Damage Spleen, regulate diet, adapt to cold and warmth. (Water and grain nourish Four Zangs via Spleen). Damage Liver, soothe the center. (Nourish blood). Damage Kidney, benefit Essence. (Tonify with flavor). This is the method for treating Sun disease. (Opposite is treatment for Zhi pulse).
Commentary: This gives an example of Sun disease to cover Zhi pulse disease. Each observes its corresponding part to know which Zang is diseased. Sun disease starts with skin gathering and ends with bone atrophy; this is a順境 (favorable/easy-to-know) path. Zhi disease goes from bone atrophy to skin gathering; this is an逆境 (adverse/difficult-to-see) path. Why? Skin gathering in Sun disease is the beginning of illness; bone atrophy is the extreme sign. Now, the extreme of Sun is the beginning of Zhi disease; the beginning of Sun is the end of Zhi. Hua Shou's note lacks clear explanation, causing doubt for beginners. Cao's Pulse Song says: Sun disease death after passing three stages. Zhi disease is the same. This captures the implicit meaning of Nan Jing. The "three" refers to Spleen damage. Disease passing Spleen and descending to Liver/Kidney leads to death. Zhi disease also passes Spleen and ascends to Heart/Lung leading to death. Thus, the major method for treating Sun and Zhi is before the disease reaches Spleen, which can be known. Also, Nei Jing discusses Qi and Blood deficiency mainly focusing on Spleen and Kidney. Nan Jing cites Lung and Kidney to clearly distinguish Qi and Blood causes, while Spleen alone serves as the hub for both Qi and Blood diseases, expounding the remaining depth of the classics. Lung says benefit Qi; Lung governs skin and hair. Qi here refers to the independent external defense. Classic says: For insufficiency of form, warm with Qi. This is the meaning. Heart says regulate Ying and Wei; Heart governs blood, transmitting to meridians, circulating with Ying. Wei Qi is also transformed by Heart. Classic says: Blood and Qi are the spirit of man. Zhou Zhongli considers "Wei" a superfluous character, which is incorrect. Spleen says regulate diet, adapt to cold/warmth. If Spleen is damaged, stomach water/grain is hard to digest. Thus, provide cooked vegetables and white porridge, easy to digest. Adapt to preferences for cold/warmth, do not force what is disliked. This corresponds to "food cannot transform into flesh." This is the key to treating Spleen. Hua Shou's note on eating cool/cold foods in spring/summer is for healthy people's preservation. But if patients dislike it, how can one give it? Would it not be forcing? Liver says soothe the center. Center refers to Will (Zhi). Li Ji says empty center; Mencius says hot center. Meaning is the same, referring to Will. Liver Will governs anger. Soothe means using sweet to relax. Classic says: Liver suffers from tension, eat sweet to relax. This is the meaning. Kidney says benefit Essence. Kidney governs water, receiving essence from Five Zang and Six Fu and storing it. Classic says: For insufficiency of essence, tonify with flavor. This is the meaning.
Pulse has two beats per exhalation, two beats per inhalation. (Healthy pulse). Three beats per exhalation, three beats per inhalation. (Li Jing). Four beats per exhalation, four beats per inhalation. (Duo Jing). Five beats per exhalation, five beats per inhalation. (Death pulse). Six beats per exhalation, six beats per inhalation. (Life extinction ○ Above examines Zhi pulse movements). One beat per exhalation, one beat per inhalation. (Li Jing). Two exhalations per beat, two inhalations per beat. (Duo Jing ○ Old edition had "respiration two beats" five characters, Hua Shou considered them superfluous and removed them. Note: Since the first section lists three and four exhalations, this section seems incomplete. However, observing the text below saying "two exhalations per beat means soulless, must die," it is clear that in Sun disease, death occurs without waiting for three or four exhalations.) Pulse comes thus, how to distinguish the disease? Answer: Pulse comes two beats per exhalation, two beats per inhalation, neither large nor small, is Ping. (Neither excess nor deficiency). Three beats per exhalation, three beats per inhalation, is just getting sick. (Refers to Zhi pulse Li Jing). Front (Cun) large, Back (Chi) small, immediately headache and dizziness. (Qi reversing to head). Front small, Back large, immediately chest fullness and shortness of breath. (Evil blocking chest). Four beats per exhalation, four beats per inhalation, disease wants to worsen. (Refers to Zhi pulse Duo Jing). Pulse Hong Da (Vast and Large), suffers from vexation and fullness. (Evil in upper part). Chen Xi (Deep and Fine), abdominal pain. (Evil in lower part). Hua (Slippery), injured by heat. (Yang Qi affected). Se (Choppy), affected by fog and dew. (Yin Blood affected). Five beats per exhalation, five beats per inhalation, person should be exhausted. (Refers to Death pulse). Chen Xi night increases (double), Fu Da day increases (double), neither large nor small. (Qi not yet exhausted). Although exhausted, can be treated. If varying sizes, difficult to treat. (Stomach Qi exhausted). Six beats per exhalation, six beats per inhalation, is Death pulse. (Life extinction). Chen Xi dies at night, Fu Da dies during day. (Above refers to Zhi pulse). One beat per exhalation, one beat per inhalation, named Xing Shi (Walking Corpse). (Old edition "Sun" character suspected error, thus removed. Below ancient text is disordered, logic disjointed). Person can walk, yet should lie in bed. The reason is Blood and Qi are both insufficient. (Refers to Sun pulse Li Jing). Two exhalations per beat, two inhalations