一至。（旧本此下有呼吸再至四字直削去）名曰无魂。无魂者。当死也。（谓损脉夺精○旧本此下剩出入虽能行名曰行尸
八字疑是衍文）
按此一说。滑氏曰。经络血气。为邪所中自外得之证。而与上节言五脏病者稍异焉。以余观之。则不然。何者。前
已言呼而不言吸。举脉之动数。而不及形状。是乃申明其义。而谓不大不小。前大后小。前小后大。及洪大沉细滑涩等
类。皆审其脉状者。可以见已。其所谓头痛目眩。胸满短气。苦烦满。腹中痛。及伤热中雾露等证。是乃举其病态。昭
昭乎明矣。若夫伤热中雾露等症。盖一时自外兼加者。而所谓内伤挟外感是也耳。五脏之病。其根深。其发缓。矿日弥
久。动涉岁月。非一朝一夕之谓也。故其间或有外邪触冒。则脉从而变矣。滑氏因其有外邪之病。而谓与前节异。几乎
粗已。盖前所言。则五脏部分之病。而唯见其概。此所言者。具述其详。一呼一至。名曰损。以下文理不属。似有阙漏。
故不可强解。今窍 括。姑 其义云。
（第十四旧十一）难曰。经（灵枢第五篇）言脉不满五十动而一止。（中止而不动）一脏无气者。何脏也。然。人吸
者随阴（肾肝）入。呼者因阳（心肺）出。今吸不能至肾。至肝而还。故知一脏无气者。肾气先尽。
按脉一息五至。不大不小。则五脏和平无病之脉也。然一息间至微至眇。无有形影。故以十息五十动。候脏气虚竭。
灵枢曰。五十动而可不一代者。五脏皆受气。四十动而一代者。一脏无气。此难本此。而以不满五十动变文。代作止。
少异耳。义固相因。盖五十动减一二。亦属脏气之虚。灵枢连言五脏。此篇独言一脏者。盖举一反三之意也。且灵枢唯
谓一脏二脏。则未知为何脏。故扁鹊特发问答以实之。令后人知所谓一脏。即从下数之。其无气亦自肾脏始者。可以见
已。
（第十五旧十三）难曰。经（灵枢第四篇）言。见其（脏）色而不得其（脏）脉。反得相胜之脉者。（色脉相克）即
死。得相生之脉者。（色脉母子）病即自已。色之与脉。当参相应。（桴鼓影响）为之奈何。（问色脉相胜相生之义）然。
五脏有五色。皆见于面。（此一节旧本误出第三节今改移于此）当于寸口尺内（尺之皮肤）相应。其不应者病也。假令色
青。（肝）其脉浮涩而短。（肺）若大而缓。（脾）为相胜。浮大而散。（心）若小而滑。（肾）为相生也。（是第一答）假
令色青。（肝）其脉当弦而急。（木）色赤。（心）其脉浮大而散。（火）色黄。（脾）其脉中缓而大。（土）色白。（肺）其
脉浮涩而短。（金）色黑。（肾）其脉沉濡而滑。（水）此所谓五色之与脉。当参相应也。（是第二答故移下项）五脏各有
声臭味液。（五色与脉相应既出前段故此削色字补液字）亦当与寸口尺内相应。（此九字旧本误出第一说今移置此）脉数
（大）尺之皮肤亦数。（肉热）脉急（弦）尺之皮肤亦急。（肉张）脉缓（弱）尺之皮肤亦缓。（肉软）脉涩（短）尺之皮
肤亦涩。（肉干）脉滑（实）尺之皮肤亦滑。（肉润○此一节旧本出第二节今移于此）经言。知一（脉）为下工。知二（色
脉）为中工。知三（色脉尺肉）为上工。上工者（神且明）十全九。中工者（为神）十全八。（灵枢作七）下工者（为工）
十全六。此之谓也。
按灵枢云。夫色脉与尺之相应。如桴鼓影响之相应。不得相失也。此篇问答。由此而发。盖剿取于灵枢中色脉尺肉
之诊。表章其义。凡诊病之要。脉虽为之主。然兼色与尺肤候之为上工。古之道也。夫五行之道。互有生克。固有其理。
疾病始至。则权衡既失。而轩轾乃见矣。色脉及尺。共相生者为顺。相克者为逆。逆则病不归一。故难治。顺则证无二
岐。故易疗。色脉尺肉之外。又有声臭味液之候。可见古先圣贤之诊。详且尽矣。色脉及尺三焉者。脉为之主。色尺为
之羽翼。故本篇第一二节。脉兼色言。第三节脉兼尺言。由此观之。所谓声臭味液四焉者。亦皆色尺之旁诊。而不可以
阙焉。此篇徒举声臭味液之目。而不及其HT 。然时举
其目者。属诊候之法。故不可以废尔。读者勿见以为衍。详见三十
四篇。周礼天官医曰。十全为上工。十失一次之。失二次之。失三次之。失四为下工。此篇及灵枢。谓上工全九者。点
下一等。以见戒意。即合周礼失一之品。全八与周礼失二合。灵枢全七。与周礼失三合。在此篇特陟一等。亦教励之意
也。其七与八。在周礼则共是中工之品。义并无异。全六为下工。周礼灵枢皆同矣。
（第十六旧同）难曰。（此下旧本出脉有三部九候云云三十五字问与答不相属似错简其三十五字问辞今移篇首以为序
次所谓阴阳轻重六十首一脉为四时等义皆例其后则文义当相属此难当别有问古文脱简不可知故姑阙如）然。是其病有内
外证。（初答）其病为之奈何。（再问）然。假令得肝脉。（弦急）其外证。面青（肝胆色）善洁（胆）善怒。（肝）其内
证。齐左有动气。按之牢若痛。其病四肢满。闭淋溲（小便）便难。（大便）转筋。有是者肝（病）也。无是者非（肝）
也。假令得心脉。（大数）其外证。面赤。（心小肠也）口干。（舌热）喜笑。（心）其内证。齐上有动气。按之牢若痛。
其病烦心。心痛掌中热而 。有是者。心（病）也。无是者。非（心）也。假令得脾脉。（缓弱）其外证面黄（脾胃色）
善噫。（胃）善思善味。（脾）其内证。当齐有动气。按之牢若痛。其病腹胀满。食不消。体重节痛。怠惰嗜卧。四肢不
收。有是者脾（病）也。无是者非（脾）也。假令得肺脉。（短涩）其外证。面白（肺大肠色）善嚏。悲愁不乐。欲哭。
（肺）其内证。齐右有动气。按之牢若痛。其病喘咳。洒淅寒热。有是者肺（病）也。无是者非（肺）也。假令得肾脉。
（沉）其外证。面黑。（肾膀胱色）善恐（肾）善（旧本脱今补之）欠。（肾）其内证。齐下有动气。按之牢若痛。其病
逆气。小腹急痛。泄如（如读为而）下重。足胫寒而逆。有是者肾（病）也。无是者非（肾）也。
按此篇所言内外证。非谓病证表里。即谓诊候内外也。何则。面青善洁善怒。岂止外证。四肢满。闭淋溲便难。转
筋。岂止内证。余可类推。所谓外证者。医坐病患之侧。以为望闻也。内证者。亲逼病患。按腹诊脉。以为问切也。概
而言之。肝曰面青善洁。心曰面赤口干。脾曰面黄善思善味。肺曰面白怨愁不乐。肾曰面黑善恐。是即望也。肝曰善怒。
心曰善笑。脾曰善噫。肺曰善嚏。肾曰善欠。是即闻也。肝曰四肢满闭。心曰烦心心痛。脾曰腹胀满。肺曰喘咳寒热。
肾曰逆气。小腹急痛。是即问也。肝曰脐左有动气。心曰脐上。脾曰当脐。肺曰脐右。肾曰脐下。是即切也。望闻问切
之义。详见第六十一难。但彼所言。则特举其义。以示医者。此则直对病患。以实其事焉。由之观之。所谓证者。言证
据之证。而非言病证之证也。明矣。滑注随文解之。内外证之义。不审何义。读者察诸。
（第十七旧同）难曰。经（内经无所见）言。病或有死。或有不治自愈。或连年月不已。其死生存亡。可切脉而知
之耶。然。可尽知也。诊病若闭目不欲见人者。脉当得肝脉。弦急而长。（本脏脉名曰从从者当愈）而反得肺脉。浮短而
涩者。死也。（相克脉名曰逆逆者当死）病若开目而渴。心下牢者。脉当得紧实而数。（阳病见阳脉吉）而反得沉涩而微
者。死也。（阳病见阴脉凶）病若吐血复鼽衄血者。脉当（脉与病合）沉细。（阴病见阴脉）而反浮大而牢者。死也。（阴
病见阳脉）病若谵言妄语。身当有热。脉当洪大。（实病见实脉未危）而反手足厥逆。脉沉细而微者。死也。（实病见虚
脉危）病若大腹而泄者。脉当微细而涩。（虚病见虚脉）而反紧大而滑者。死也。（虚病见实脉）
按此篇所问三件。而答止见死证一节。他无所见。疑是脱简。王文洁云。肝病见其本脏脉。则病自已。若见相克脉。
乃死。余可类推。据王说。则自已之证。含蓄在其中。滑注云。第十八难所谓人病沉滞久积聚一条。当此篇连年月而不
已之答。文错简在彼。今且从之。旧本第十六至十八难。各篇问答。殊不相蒙。疑是古经残缺。不然。则吕广重篇粗耳。
今因滑氏诸家之说。移易正文。略 其义尔。
人病有沉滞久积聚。可切脉而知之邪。（应连年月不已之问）然。诊在右胁（肺部）有积气。得肺脉（短涩）结。脉
结甚则积（气）甚。结微则（积）气微。诊不得肺脉（结）而右胁有积气者。何也。然。肺脉虽不见。右手（三部）脉
当沉伏。其外（形体）痼疾同法耶。将异也。然。内有积气。脉当结伏。外有痼疾。脉当浮结。（以上十六字旧本脱落今
因后节补之）结者。脉来去时一止无常数。名曰结也。伏者。脉行筋下也。浮者。脉在肉上行也。左右（手）表里。（浮
沉）法皆如此。假令脉结伏者。内无积聚。（聚疑气字下同）脉浮结者。外无痼疾。有积聚。脉不结伏。有痼疾。脉不浮
结。为脉不应病。病不应脉。是为死病也。
按此旧本第十八难。文义具前注末节然字下。古经脱内有积气云云十六字。近世浪华林见宜难经或问中。既已补入。
今从之。
（第十八旧十九）难曰。经言脉有逆（女脉寸弱尺盛）顺。（男脉寸盛尺弱）男女有恒（男上盛女下盛有定位）而反
者。何谓也。
按女脉为逆。男脉为顺。顺者属春夏生气。从下而上达。逆者属秋冬生气。从上而下行。此谓男女有常也。如滑注
所言。则逆顺与反。其义不分。失问答之义。何者。此难所问。凡逆顺与反。自是二义。答辞亦分为二件。学人思诸。
然男子生于寅。（春气始升）寅为木。（发生）阳也。女子生于申。（秋气始降）申为金。（ 敛）阴也。故男脉在关
上。（寸）女脉在关下。（尺）是以男子尺脉恒弱。（寸脉盛）女子尺脉恒盛。（寸脉弱）是其常（理）也。
按此第一件之答辞。谓男女自然。有逆顺之分也。寅为木。阳也者。谓建寅月阳气始出于地。而万物生气。皆在于
上。自寅至未。六支配于春夏。而皆阳也。申为金。阴也者。建申月阳气下降。而阴始用事。庶类之生气。皆入于地。
自申至丑。六支配于秋冬。而皆阴也。寅申说。诸家泥矣。不可从也。
反者。男得女脉。（寸弱尺盛）女得男脉（寸盛尺弱）也。其为病何如。然。男得女脉为不足。病在内。（阴分）左
（脉）得之。病在左（部）右（脉）得之。病在右（部）（下同）随脉言之也。女得男脉为太过。病在四肢。（阳分）左
得之。病在左。右得之。病在右。随脉言之。此之谓也。
按此第二答。此篇太过不及。主心肺肾肝言。即气血之偏虚偏实也。所谓男得女脉。寸弱尺盛。譬犹春夏阳气不上
腾。而滞于地下。则阴有余。阳不足。故病在内。内者。谓阴部有HT 也。
女得男脉为太过。寸盛尺弱。谓阴不足。阳有
余。犹秋冬阳不下降。而留于地上。故病在四肢。谓心肺部有事也。上左右。指脉位。下左右。指脏部言之。
（第十九旧二十）难曰。经（今无所见）言。脉有伏匿。伏匿于何脏。而言伏匿耶。然。谓阴阳更相乘。更相伏也。
脉居阴部。（尺）而反阳脉（浮滑长）见者。为阳乘阴也。脉虽时沉涩而短。（三脉皆阴是伏）此谓阳（乘）中伏阴也。
脉居阳部。（寸）而反阴脉（沉涩短）见者。为阴乘阳也。脉虽时浮滑而长。（三脉皆阳）此谓阴（乘）中伏阳也。
按伏匿字。出素问调神论。然非脉名。滑注辨此篇伏匿。与三难复溢同异。然彼乃复溢对待而言。此则伏与乘相配
而言。其义本异。所谓伏匿者。唯伏也。故云更相伏乘。是亦阴阳有余不足之义。接前篇言。然与前篇义有差别。所谓
脉居阳部。而反阴脉见。则知阴部亦盛也。然则三部皆阴盛之脉。而其阴乘时阳仅见者。此伏阳也。将为重阴之渐。脉
居阴部。反阳脉见。则知阳部亦盛也。阳中时仅见阴脉。此伏阴也。将为重阳之渐。凡狂癫之证。共是五脏偏虚偏实之
所由生焉。其在外邪。亦有所偏。实则为狂为癫。可以见已。
重阳者狂。（阳实）重阴者癫。（阴实）脱阳者见鬼。（独阴之极）脱阴者目盲。（孤阳之极）
按此篇滑注。以为五十九难狂癫之文。错简出于此。以予观之。弗然。彼所论则脏气偏实之所生。病从内也。此即
伤寒热病阳症阴症等所见。病从外也。故见鬼目盲乃死。彼所谓狂癫。正气自失。精神放散。不归本舍。历年之久。犹
尚未已。岂有目盲见鬼之危急乎。学人察诸。
（第二十旧二十一）难曰。经言。人形病（外证）脉不病。（胃气存）曰生。脉病（胃气亡）形不病。（内证）曰死。
何谓也。然。人形病脉不病。非有不病者也。（脉亦似病）谓息数（属病势）不应脉数也。（属生气）此大法。
One beat per breath. (The old edition had the four characters "two breaths per beat" here, which were directly deleted.) This is called "No Soul." One with No Soul will die. (Referring to the damage pulse depriving the essence ○ The old edition has an extra eight characters "although entering and exiting can move, it is called a walking corpse" here, suspected to be interpolations.)
Regarding this statement, Hua Shou said: The meridians, collaterals, blood, and qi are attacked by pathogenic factors from the exterior, which is a condition acquired externally, slightly different from the discussion of Zang organ diseases in the previous section. However, in my view, this is not the case. Why? Previously, only exhalation was mentioned without inhalation, focusing on the frequency of the pulse movement rather than its shape. This serves to clarify the meaning, stating that pulses that are neither large nor small, anteriorly large and posteriorly small, anteriorly small and posteriorly large, as well as those resembling flooding-large, deep-thin, slippery, or choppy types, are all assessments of pulse morphology, which makes the point clear. As for symptoms such as headache and dizziness, chest fullness and shortness of breath, bitter sensation of fullness, abdominal pain, as well as injuries from heat or mist/dew, these enumerate the pathological states clearly. Conditions like injury from heat or mist/dew are likely acute external additions, i.e., internal injury complicated by external contraction. Diseases of the five Zang organs have deep roots and slow onset, lasting for days and years, not occurring overnight. Thus, occasionally external pathogens may invade, causing the pulse to change accordingly. Hua Shou argued that because there is an external pathogen here, it differs from the previous section, which is almost crude. Generally, what was stated before referred to diseases of the five Zang parts, presenting only a general overview; what is stated here details them specifically. One beat per exhalation is called "Damage." The following text does not flow logically and seems to have omissions, so it cannot be forcibly interpreted. Now, summarizing, I tentatively expound its meaning.
(14th Difficulty, Old Edition 11th Difficulty) Question: The Classic (Ling Shu, Chapter 5) states that if the pulse stops once before fifty beats, one Zang organ lacks Qi. Which Zang organ is it? Answer: When a person inhales, Qi follows Yin (Kidney, Liver) inward; when exhaling, Qi exits via Yang (Heart, Lung). Now, inhalation cannot reach the Kidney but returns at the Liver. Therefore, we know that the Zang organ lacking Qi is the Kidney, whose Qi is exhausted first.
Note: A pulse of five beats per respiration, neither large nor small, indicates harmonious Five Zang organs without disease. However, within one respiration, the movement is extremely subtle and formless. Thus, observing fifty beats over ten respirations assesses the depletion of Zang Qi. Ling Shu states: If there are fifty beats without a intermittent pulse, all five Zang organs receive Qi; if there is an intermittent pulse every forty beats, one Zang organ lacks Qi. Nan Jing derives from this but varies the wording to "fewer than fifty beats" and changes "intermittent pulse" (Dai Mai) to "stop." The meaning remains consistent. Reducing two or three beats from fifty also belongs to Zang Qi deficiency. Ling Shu mentions all five Zang organs collectively, whereas this chapter mentions only one Zang organ, implying drawing inferences about other cases from one instance. Moreover, Ling Shu merely says "one or two Zang organs," leaving it unknown which ones. Therefore, Bian Que initiated this Q&A to specify that "one Zang organ" refers to counting from below, and the lack of Qi begins with the Kidney, which clarifies the matter.
(15th Difficulty, Old Edition 13th Difficulty) Question: The Classic (Ling Shu, Chapter 4) states: If the complexion is observed but the corresponding pulse is not found, and instead a controlling (overcoming) pulse is obtained (Complexion and Pulse mutually overcoming), death ensues. If a generating pulse is obtained (Complexion and Pulse in mother-son relationship), the illness will resolve. Complexion and pulse should correspond mutually (like a drumstick striking a drum or an object casting a shadow). How should this be done? (Asking about the meaning of complexion-pulse overcoming and generating relationships.) Answer: The five Zang organs have five complexions, all visible on the face. (This section was erroneously placed in Section 3 in the old edition and is moved here.) They should correspond at the Cun Kou and Chi areas (skin near Chi Ze). Non-correspondence indicates disease. For example, if the complexion is green (Liver), and the pulse is floating, choppy, and short (Lung), or large and moderate (Spleen), this is mutual overcoming. If the pulse is floating, large, and scattered (Heart), or small and slippery (Kidney), this is mutual generation. (First answer.) For example, if the complexion is green (Liver), the pulse should be wiry and rapid (Wood). If the complexion is red (Heart), the pulse should be floating, large, and scattered (Fire). If yellow (Spleen), the pulse should be moderate and large within (Earth). If white (Lung), the pulse should be floating, choppy, and short (Metal). If black (Kidney), the pulse should be deep, soft, and slippery (Water). This is what is meant by the correspondence of the five complexions and pulses. (Second answer, hence moved down.) The five Zang organs also have sounds, odors, tastes, and fluids. (Since complexion-pulse correspondence was already stated, "complexion" is removed and "fluid" added.) These should also correspond with the Cun Kou and Chi skin. (These nine characters were erroneously in the first explanation in the old edition and are moved here.) A rapid (large) pulse corresponds to rapid (hot flesh) Chi skin; a tense (wiry) pulse corresponds to tense (tight flesh) Chi skin; a slow (weak) pulse corresponds to slow (soft flesh) Chi skin; a choppy (short) pulse corresponds to choppy (dry flesh) Chi skin; a slippery (solid) pulse corresponds to slippery (moist flesh) Chi skin. (This section was in Section 2 in the old edition and is moved here.) The Classic states: Knowing one aspect (pulse) makes a lower-grade physician; knowing two aspects (complexion, pulse) makes a middle-grade physician; knowing three aspects (complexion, pulse, Chi skin) makes an upper-grade physician. An upper-grade physician (divine and bright) cures nine out of ten; a middle-grade physician (spiritual) cures eight out of ten (Ling Shu says seven); a lower-grade physician (craftsman) cures six out of ten. This is what is meant.
Note: Ling Shu states: The correspondence of complexion, pulse, and Chi skin is like the response of a drumstick to a drum or an object to its shadow; they must not be lost. The Q&A in this chapter originates from this. It extracts the diagnostic methods of complexion, pulse, Chi, and flesh from Ling Shu to highlight their significance. In diagnosing illness, although the pulse is primary, combining complexion and Chi skin observation characterizes an upper-grade physician, following ancient tradition. The Way of the Five Elements involves mutual generation and overcoming, possessing inherent logic. At the onset of disease, balance is lost, revealing heaviness and lightness. Mutual generation among complexion, pulse, and Chi is favorable (Shun); mutual overcoming is unfavorable (Ni). Unfavorable conditions make the disease multifaceted and difficult to treat; favorable conditions make the presentation unified and easier to treat. Beyond complexion, pulse, Chi, and flesh, there are observations of sound, odor, taste, and fluid, showing that the diagnostic methods of ancient sages were detailed and comprehensive. Among complexion, pulse, and Chi, the pulse is primary, while complexion and Chi serve as wings. Thus, Sections 1 and 2 discuss pulse combined with complexion; Section 3 discusses pulse combined with Chi. From this, the four aspects of sound, odor, taste, and fluid are also auxiliary diagnoses to complexion and Chi, and cannot be omitted. This chapter lists only the categories of sound, odor, taste, and fluid without detailing them. However, frequently listing these categories pertains to diagnostic methods and cannot be discarded. Readers should not consider them interpolations; see Chapter 34 for details. Zhou Li, Tian Guan Medical Department states: Perfect cure rate is upper-grade; one failure is next; two failures is next; three failures is next; four failures is lower-grade. This chapter and Ling Shu state that an upper-grade physician cures nine out of ten, lowering the standard slightly to show caution, aligning with Zhou Li's one-failure category. Curing eight aligns with two failures; curing seven (Ling Shu) aligns with three failures. This chapter elevates the standard slightly, indicating encouragement. Seven and eight in Zhou Li belong to the middle-grade category, with no difference in meaning. Curing six is lower-grade, consistent in both Zhou Li and Ling Shu.
(16th Difficulty, Same as Old Edition) Question: (The old edition had thirty-five characters here regarding "pulse having three sections and nine inspections," which did not match the question and answer, suggesting misplaced text. These thirty-five characters of questioning are now moved to the beginning of the chapter as an introduction. Concepts like Yin-Yang weight, sixty chapters, one pulse for four seasons, etc., follow as examples, making the text coherent. This difficulty likely had a separate original question lost in textual omission, so it is left blank.) Answer: The disease has exterior and interior signs. (First answer.) What is the nature of this disease? (Second question.) Answer: Suppose the Liver pulse is obtained (wiry and urgent). Its exterior signs include a green face (Liver/Gallbladder color), cleanliness obsession (Gallbladder), and anger (Liver). Its interior signs include pulsating Qi at the left of the umbilicus, firm and painful upon pressure. The disease manifests as limb fullness, urinary retention, difficult defecation, and muscle cramps. Having these indicates Liver disease; lacking them indicates non-Liver disease. Suppose the Heart pulse is obtained (large and frequent). Its exterior signs include a red face (Heart/Small Intestine), dry mouth (tongue heat), and excessive laughter (Heart). Its interior signs include pulsating Qi above the umbilicus, firm and painful upon pressure. The disease manifests as vexatious heart, heart pain, and heat in the palms. Having these indicates Heart disease; lacking them indicates non-Heart disease. Suppose the Spleen pulse is obtained (moderate and weak). Its exterior signs include a yellow face (Spleen/Stomach color), belching (Stomach), and excessive thinking/tasting (Spleen). Its interior signs include pulsating Qi at the umbilicus, firm and painful upon pressure. The disease manifests as abdominal distension, indigestion, heavy body and joint pain, lethargy, and inability to gather the limbs. Having these indicates Spleen disease; lacking them indicates non-Spleen disease. Suppose the Lung pulse is obtained (short and choppy). Its exterior signs include a white face (Lung/Large Intestine color), frequent sneezing, sorrow/unhappiness, and desire to cry (Lung). Its interior signs include pulsating Qi at the right of the umbilicus, firm and painful upon pressure. The disease manifests as wheezing/coughing, chills/fevers. Having these indicates Lung disease; lacking them indicates non-Lung disease. Suppose the Kidney pulse is obtained (deep). Its exterior signs include a black face (Kidney/Bladder color), fearfulness (Kidney), and yawning (Kidney) (missing in old edition, now supplemented). Its interior signs include pulsating Qi below the umbilicus, firm and painful upon pressure. The disease manifests as rebellious Qi, acute pain in the lower abdomen, diarrhea with a sense of heaviness below, and cold/reversal in the calves. Having these indicates Kidney disease; lacking them indicates non-Kidney disease.
Note: The "exterior and interior signs" mentioned in this chapter do not refer to the superficial/deep nature of the disease symptoms, but rather to the exterior/interior nature of the diagnostic methods. Why? Are green face, cleanliness, and anger only exterior signs? Are limb fullness, urinary retention, difficult defecation, and cramps only interior signs? The rest can be inferred similarly. "Exterior signs" refer to the doctor sitting beside the patient for inspection (Wang) and listening/smelling (Wen). "Interior signs" refer to closely examining the patient, pressing the abdomen, and taking the pulse for inquiry (Wen) and palpation (Qie). Broadly speaking, Liver: green face, cleanliness; Heart: red face, dry mouth; Spleen: yellow face, thinking, tasting; Lung: white face, sorrow; Kidney: black face, fear—these constitute Inspection. Liver: anger; Heart: laughter; Spleen: belching; Lung: sneezing; Kidney: yawning—these constitute Listening/Smelling. Liver: limb fullness; Heart: vexatious heart/pain; Spleen: abdominal distension; Lung: cough/chills; Kidney: rebellious Qi/lower abdominal pain—these constitute Inquiry. Liver: pulsating Qi left of umbilicus; Heart: above umbilicus; Spleen: at umbilicus; Lung: right of umbilicus; Kidney: below umbilicus—these constitute Palpation. The meanings of Inspection, Listening/Smelling, Inquiry, and Palpation are detailed in the 61st Difficulty. There, the meanings are highlighted to instruct physicians; here, they are applied directly to patients to verify facts. Thus, "signs" here refer to evidence/signs, not disease symptoms, which is clear. Hua Shou's commentary interprets this contextually; the meaning of "exterior and interior signs" is unclear; readers should investigate.
(17th Difficulty, Same as Old Edition) Question: The Classic (not seen in Nei Jing) states: Some illnesses result in death, some heal spontaneously without treatment, and some persist for months or years. Can the life and death outcomes be known through pulse diagnosis? Answer: It can be fully understood. If a patient closes their eyes and avoids looking at people, the pulse should be the Liver pulse, wiry, urgent, and long (Organ-specific pulse named Cong/Following; Following implies recovery). If instead, the Lung pulse is obtained, floating, short, and choppy, death ensues (Controlling pulse named Ni/Opposing; Opposing implies death). If a patient opens their eyes, feels thirsty, and has a firm mass below the heart, the pulse should be tight, solid, and rapid (Yang disease seeing Yang pulse is auspicious). If instead, a deep, choppy, and thin pulse is obtained, death ensues (Yang disease seeing Yin pulse is ominous). If a patient vomits blood and suffers nosebleeds, the pulse should be deep and thin (Yin disease seeing Yin pulse). If instead, it is floating, large, and firm, death ensues (Yin disease seeing Yang pulse). If a patient speaks deliriously and hallucinates, the body should be hot, and the pulse should be flooding and large (Excess disease seeing excess pulse is not critical). If instead, the extremities are cold/reversed, and the pulse is deep, thin, and minute, death ensues (Excess disease seeing deficiency pulse is critical). If a patient has a large abdomen and diarrhea, the pulse should be micro, thin, and choppy (Deficiency disease seeing deficiency pulse). If instead, it is tight, large, and slippery, death ensues (Deficiency disease seeing excess pulse).
Note: This chapter asks three questions but answers only with fatal conditions, omitting others, suggesting textual loss. Wang Wenjie stated: If Liver disease shows its own organ pulse, the illness resolves; if it shows a controlling pulse, death occurs. The rest can be inferred. According to Wang, the resolution conditions are implicitly included. Hua Shou noted: The 18th Difficulty's mention of "prolonged stagnation and accumulation" corresponds to the answer for "persisting for months/years" in this chapter, with misplaced text there. We follow this interpretation. The Q&A in the old editions of Difficulties 16-18 seem disconnected, suggesting ancient texts were incomplete or Lu Guang rearranged them clumsily. Based on Hua Shou and others, we have adjusted the main text and briefly explained the meaning.
Can prolonged stagnation and accumulation be diagnosed by pulse? (Corresponding to the question of persisting for months/years.) Answer: Diagnosis reveals accumulated Qi in the right hypochondrium (Lung area), obtaining a Lung pulse (short and choppy) that is knotted (Jie). Severe knotting indicates severe accumulation; slight knotting indicates slight accumulation. If the Lung pulse (knotting) is not obtained but there is accumulated Qi in the right hypochondrium, why? Answer: Although the Lung pulse is absent, the Right Hand (three positions) pulse should be hidden (Fu). Is the chronic external disease the same method? Or different? Answer: Internal accumulation presents with knotted/hidden pulses; external chronic disease presents with floating/knotted pulses. (The sixteen characters above were missing in the old edition and are supplemented based on the following section.) Knotted means the pulse stops irregularly during its course. Hidden means the pulse runs beneath the tendons. Floating means the pulse runs above the flesh. The methods for Left/Right and Superficial/Deep apply similarly. If the pulse is knotted/hidden, there is no internal accumulation. If the pulse is floating/knotted, there is no external chronic disease. If there is accumulation but the pulse is not knotted/hidden, or if there is chronic disease but the pulse is not floating/knotted, the pulse does not match the disease, and the disease does not match the pulse; this is a fatal condition.
Note: This is the 18th Difficulty in the old edition, with the meaning located after the word "Ran" in the notes of the previous section. Ancient texts missed the sixteen characters starting with "internal accumulation." Lin Jianyi's "Nan Jing Huo Wen" from Nangwa has supplemented this, and we follow it.
(18th Difficulty, Old Edition 19th Difficulty) Question: The Classic states that pulses have contrary (Female pulse: Cun weak, Chi strong) and compliant (Male pulse: Cun strong, Chi weak) patterns. Men and women have constant patterns (Men upper strong, lower weak; Women upper weak, lower strong with fixed positions) but sometimes reverse them. What does this mean?
Note: Female pulse being contrary and male pulse being compliant. Compliant relates to the vital Qi of Spring/Summer, rising from below to above. Contrary relates to the vital Qi of Autumn/Winter, descending from above to below. This is the constancy of men and women. As Hua Shou noted, the meanings of contrary/compliant and reverse are indistinguishable, losing the intent of the Q&A. Why? The question distinguishes between contrary/compliant and reverse as two separate concepts. The answer also addresses them separately. Students should ponder this.
Answer: Men are born under Yin (start of Spring Qi rises). Yin represents Wood (generation) and Yang. Women are born under Shen (start of Autumn Qi descends). Shen represents Metal (gathering/concealing) and Yin. Therefore, the Male pulse is primarily at Guan/Cun (upper). The Female pulse is primarily at Guan/Chi (lower). Thus, the Male Chi pulse is consistently weak (Cun strong). The Female Chi pulse is consistently strong (Cun weak). This is their normal state (Li).
Note: This is the answer to the first part, stating that men and women naturally have distinctions of contrary/compliant. Yin represents Wood and Yang, meaning in the month of Yin, Yang Qi begins to emerge from the earth, and the vital Qi of all things resides above. From Yin to Wei, the six branches correspond to Spring/Summer and are all Yang. Shen represents Metal and Yin, meaning in the month of Shen, Yang Qi descends, and Yin begins to function. The vital Qi of myriad things enters the earth. From Shen to Chou, the six branches correspond to Autumn/Winter and are all Yin. The interpretations of Yin and Shen by various schools are rigid and should not be followed.
Reverse means: Men obtaining the Female pulse (Cun weak, Chi strong); Women obtaining the Male pulse (Cun strong, Chi weak). What are the pathological implications? Answer: For men, obtaining the Female pulse indicates insufficiency, with disease in the interior (Yin aspect). If obtained on the Left (pulse), the disease is on the Left (side); if on the Right (pulse), the disease is on the Right (side), following the pulse description. For women, obtaining the Male pulse indicates excess, with disease in the four limbs (Yang aspect). If obtained on the Left, disease is on the Left; if on the Right, disease is on the Right. Following the pulse description, this is the meaning.
Note: This is the second answer. The excess/insufficiency discussed here pertains to Heart, Lung, Kidney, and Liver, representing the bias of Qi and Blood towards deficiency or excess. "Men obtaining Female pulse" (Cun weak, Chi strong) is like Spring/Summer Yang Qi failing to ascend and stagnating underground, resulting in excess Yin and insufficient Yang, hence disease in the interior. Interior refers to the Yin aspect having...
"Women obtaining Male pulse" is excess, with strong Cun and weak Chi, indicating insufficient Yin and excess Yang, like Autumn/Winter Yang Qi failing to descend and remaining on the surface, hence disease in the four limbs. This implies issues in the Heart/Lung areas. Upper/Lower refers to pulse positions; Left/Right refers to Zang locations.
(19th Difficulty, Old Edition 20th Difficulty) Question: The Classic (not seen currently) states that pulses have hiding/concealing (Fu Ni). Hiding in which Zang organ is referred to as hiding/concealing? Answer: It refers to Yin and Yang mutually attacking and mutually hiding. When the pulse resides in the Yin position (Chi) but Yang pulses (floating, slippery, long) appear, it is Yang attacking Yin. Although the pulse is sometimes deep, choppy, and short (the three pulses are all Yin, thus hiding), this is called Yin hiding within Yang attack. When the pulse resides in the Yang position (Cun) but Yin pulses (deep, choppy, short) appear, it is Yin attacking Yang. Although the pulse is sometimes floating, slippery, and long (the three pulses are all Yang), this is called Yang hiding within Yin attack.
Note: The term "Fu Ni" appears in Su Wen, Tiao Shen Lun, but it is not a pulse name. Hua Shou distinguished the Fu Ni in this chapter from the Fu Yi in the 3rd Difficulty. In the latter, Fu and Yi are contrasting terms; here, Fu and Cheng (attack) are paired, so their meanings differ fundamentally. "Fu Ni" here refers only to Fu (hiding). Hence, it is called mutual hiding and attacking, reflecting the principle of Yin/Yang excess and deficiency. Connecting to the previous chapter, yet differing in meaning. If the pulse resides in the Yang position but Yin pulses appear, it indicates that the Yin position is also abundant. Thus, all three positions show Yin abundance, but Yin attacks while Yang is barely visible; this is hiding Yang, a precursor to extreme Yin. If the pulse resides in the Yin position but Yang pulses appear, it indicates that the Yang position is also abundant. Yang attacks while Yin is barely visible; this is hiding Yin, a precursor to extreme Yang. All cases of mania and depression arise from the bias of the five Zang organs towards deficiency and excess. External pathogens also have biases; excess leads to mania or depression, which can be understood.
Extreme Yang results in mania (Yang excess). Extreme Yin results in depression (Yin excess). Loss of Yang results in seeing ghosts (extreme solitary Yin). Loss of Yin results in blindness (extreme solitary Yang).
Note: Hua Shou's commentary suggests that the text on mania and depression from the 59th Difficulty was misplaced here. In my view, this is incorrect. The 59th Difficulty discusses diseases arising from Zang Qi excess, originating internally. This chapter discusses conditions seen in cold damage and febrile diseases, involving Yang and Yin syndromes, originating externally. Thus, seeing ghosts and blindness indicate death. The mania and depression mentioned in the 59th Difficulty involve loss of healthy Qi, scattering of spirit, and failure to return to the origin, lasting for years without resolution; how could they present with the critical symptoms of blindness and seeing ghosts? Students should investigate.
(20th Difficulty, Old Edition 21st Difficulty) Question: The Classic states: If the body shows disease (exterior signs) but the pulse does not (Stomach Qi exists), it is termed survival. If the pulse shows disease (Stomach Qi is lost) but the body does not (interior signs), it is termed death. What does this mean? Answer: When the body is diseased but the pulse is not, it does not mean the pulse is truly healthy. (The pulse may seem diseased.) It means the respiratory rate (reflecting disease trend) does not correspond to the pulse rate (reflecting vital Qi). This is the general principle.