十三难曰。经言见其色而不得其脉。反得相胜之脉者。即死。得相生之脉者病。即自已色之与脉。当参相应。为之
奈何。然。五脏有五色。皆见于面。亦当与寸口尺内相应。假令色青。其脉当弦而急。
吕曰。色青、肝也。弦急者肝脉。是谓相应也。虞曰。色青脉弦。中外相应也。素问曰。肝部在目下。于此视色以
参脉证。
色赤其脉浮大而散。
吕曰。色赤、心也。浮大而散。心脉也。是谓相应。虞曰。色赤脉大。色脉相应也。素问曰。心部在口。视色合脉。
色黄。其脉中缓而大。
吕曰。色黄者、脾也。中缓而大。脾脉也。虞曰。此色脉相应也。素问曰。脾部在唇。色见其中。以应脉状。
色白。其脉浮涩而短。
吕曰。白者、肺也。浮涩而短。肺脉也。虞曰。肺部见于阙庭。两眉上也。
色黑。其脉沉涩而滑。
吕曰。色黑者、肾色也。肾主水。水性沉。肾亦在五脏之下。故其脉沉濡而滑。虞曰。肾色之见于肌皮。在面取其
地阁。
此所谓五色之与脉。当参相应也。
吕曰。此正经自病不中他邪故也。虞曰。谓应本经虚实之证也。丁曰。经言色青脉弦而急。色赤脉浮而散。色黄脉
中缓而大。色白脉浮涩而短。色黑脉沉濡而滑。此是五脏色脉皆相应。谓正经自病无他色也。脉相则所以言当参相应也。
脉数。尺之皮肤亦数。
丁曰。数即心也。所以臂内皮肤热也。
脉急。尺之皮肤亦急。
丁曰。急者、臂内经络满实。所以坚急也。
脉缓。尺之皮肤亦缓。
丁曰。缓者、肌肉消。故皮肤亦缓弱也。
脉涩。尺之皮肤亦涩。
丁曰。肺主燥。所以臂内皮肤亦涩也。
脉滑。尺之皮肤亦滑。
丁曰。肾主水。其脉滑。所以臂内皮肤亦滑也。此五者。皮肤滑涩急缓数。又与色脉参同也。吕曰。此谓阴阳脏腑
浮沉滑涩相应也。
五脏各有声色臭味。当与寸口尺内相应。
丁曰。其言相应者。脉数、色赤、皮肤热。此是心之一脏。色脉皮肤参相应也。脉急、青色、皮肤经络坚急而青。
（此
二字疑衍文。）此是肝之一脏。色脉皮肤参相应也。脉缓、色黄、皮肤缓。此是脾之一脏。色脉皮肤参相应也。脉涩、色
白、皮肤涩。此是肺之一脏。色脉皮肤参相应也。脉滑色黑、皮肤滑。此是肾之一脏。色脉皮肤参相应也。凡诊脉者。
先须循臂之内外。然后诊脉视色也。虞曰。肝脉弦。其色青。其声呼。其臭膻。其味酸。心脉洪。其色赤。其声笑。其
臭焦。其味苦。脾脉缓。其色黄。其声歌。其臭香。其味甘。肺脉涩。其色白。其声哭，其臭腥。其味辛。肾脉沉。其
色黑。其声呻。其臭腐。其味咸。此谓相应也。
其不相应者病也。
虞曰。相应、谓正经自病也。假令肝病。脉弦。色青。多呼。好膻。喜酸。此曰自病也。不相应者。乃如下说。假
令肝病。脉涩。色白。多哭。好腥。喜辛。此曰相反。声色臭味。皆见肺之证候。金之贼木。此曰贼邪。不相应。必死
也。
假令色青。其脉浮涩而短。若大而缓为相胜。浮大而散。若小而滑为相生也。
吕曰。色青者、肝也。浮涩而短者、肺也。肺胜肝为贼邪。若大而缓。为脾脉也。肝胜脾。故言相胜也。浮大而散。
心脉也。心为肝之子。若小而滑。肾脉也。肾为肝之母。肝为肾之子。
其脉当弦急。其色当青。即为顺也。色青脉涩者、逆也。脉若大而缓。是肝胜于脾也。其病甚。故云相胜。若脉浮大而
散。若小而滑。是为相生也。
经言知一为下工。知二为中工。知三为上工。上工者十全九。中工者十全八。下工者十全六。此之谓也。
吕曰。五脏一病辄有五。今经载肝家一脏为例耳。解一脏为下工。解二脏为中工。（按史记正义引此文。二作三。）
解五脏为上工。丁曰。上工者。谓全知色脉皮肤三法相生相胜本始。故治病十全其九。中工知二。谓不能全收。故治病
十全得八。下工知一。谓不解明于全法。一心治已病。故十全得六也。虞曰。工者。万学万全乃曰工也。凡为医者。穷
难经。察脉之浮沉脏腑虚实。通素问。知经脉往来。针之补泻。穷本草。识药之寒温气味所归。全此三家。然后治病。
可曰知三为上工也。医不三世。不服其药。谓非工也。素问曰。五脏之象。可以类推。五脏相错。可以意识。此可曰工
也。
十四难曰。脉有损至。何谓也。然。至之脉。一呼再至曰平。
吕曰。平者。谓平调之脉也。丁曰。平者、无过之脉也。虞曰。人之呼吸。曰阴阳也。一呼一吸。谓之一息。经言
一呼再至。一吸再至。谓之平脉也。人呼吸法阴阳。一息法一年。一息脉动四至。四至法四时。一呼脉行三寸法三阳。
一吸脉行三寸法三阴。故曰平也。
三至曰离经。
吕曰。经言再至曰平。三至曰离经。不如经言也。其人必病。丁曰。谓加于阴之二倍。故曰离经。虞曰。经者、常
也。谓脉离常经之所。细而言之。人一呼脉行三寸。一吸脉行三寸。呼吸定息。脉行六寸。一日一夜。一万三千五百息。
脉行八百一十丈。乃为一周。后从始起之经再行。令一呼脉三至。脉行四寸半。一吸三至。脉行四寸半。一息脉行九寸。
三日一夜一万三千五百息。脉行一千二百一十五丈。过于半脉。不在所起之经再起。故曰离经也。举一例以拟之。如人
一日周行百里。却从初行之处再行。曰平。今一日却一百五十里。过于五十里。不在周而复始之处再行。故曰离经也。
四至曰夺精。
吕曰。其人短困夺精者。鼻目唇口精候色夺诊见也。丁曰。谓加于阴四倍。故曰夺精。虞曰。平脉一息行六寸。今
夺精之脉。一息行一尺二寸。此乃一日一夜息数。乃行两日夜脉度数。尺寸脉。诸夫为数脉者、阳气乱。况阳为病。颇
亦狂言。颜色恍欢。（欢疑惚）吕氏言鼻目唇口精候色夺者非也。夫人纳五味。味归形。形归气。气归精。今一息四至。
乃阳气乱。故脉数。数则气耗。耗则精无所归。犹如夺去。故曰夺精。如人一日行一百里。今一日行二百里。气疲乏则
耗也。
五至曰死。
吕曰。其人病证候已见。脉复加一至。定当死也。虞曰。此比平脉一倍过半。四至已是夺精。五至。其死明矣。丁
曰。为加于阴六倍。故曰死也。
六至曰命绝。此死之脉。
吕曰。不出日死。虞曰。五至。死之渐也。六至。今死矣。此言死之脉也。（按原本此下误衍必是言至之脉也七字。
今删之。）必是言至之脉。恐写之误。可合下文。（按此下似有脱字。）
何谓损。一呼一至曰离经。
丁曰。为阴加于阳四倍也。虞曰。前之至脉离经。谓脉行过半。此之损脉离经。谓脉行减半。以下吸养于呼也。
二呼一至曰夺精。
丁曰。谓阴加于阳六倍也。虞曰。平人脉。一日一夜。五十周身。今二呼而脉一至。一日一夜。不及一十三周身。
脉只行及二百二丈五尺。其人气耗血枯。神惨色夭。精华犹如夺去。
三呼一至曰死。
虞曰。平人之脉。三呼脉六至。一日一夜。八百一十丈。无危。今三呼脉一至。脉口行一寸半。一日一夜。只行及
六十七丈五尺。不及五周身。（按此数误。当云行一百三十五丈。不及九周身。）如此之候死可待也。
四呼一至曰命绝。此谓损之脉也。
虞曰。四呼当八至。今四呼脉一至。一日一夜。不及四周身。（按当云不及七周身。）气血已尽。脏败神去。故命绝
也。
至脉从下上。损脉从上下也。
吕曰。至脉从下上者。谓脉动稍增。上至六。至多而呼少。损脉从上下者。谓脉动稍减至一。呼多而至少也。
损脉之为病奈何。然。一损损于皮毛。皮聚而毛落。
虞曰。一损损肺。肺主皮毛。故皮聚而毛落也。
二损损于血脉。血脉虚少。不能荣于五脏六腑也。（别本无也字。与上文一例。）
虞曰。二损损血脉。是知心受之。心主血。今则心血枯。不能荣于五脏六腑也。
三损损于肌肉。肌肉消瘦。饮食不为肌肤。
虞曰。脉之三损损于脾。脾者、受纳五味。以化生五气脏腑。以长肌肤。今既损。故味不化。则肌肉消瘦也。
四损损于筋。筋缓不能自收持。
虞曰。四损损肝。病乃如是。素问曰。其有伤筋纵。若其不容容。容、不收持也。
五损损于骨。骨痿不能起于床。反此者至于收病也。
虞曰。今之五损损于肾。肾主骨故骨痿不能起于床。素问曰。肾热则腰脊不举。骨枯髓减。发为骨痿。痿者、无力
也。吕曰。收者、取也。经但载损家病。不载至家病。至家者。诸阳六腑病。六腑病。苦头痛身热。忽特不利。与损家
病异。今反载损家病证。故损脉于此受病。非是至家病也。
从上下者。骨痿不能起于床者死。
吕曰。从肺损至骨。五脏俱尽。故死。肺在上也。虞曰。至此推穷损家病证。一损肺。二损心。三损脾。四损肝。
五损肾。乃如第五难脉轻重菽数下损之肾也。
从下上者。皮聚而毛落者死。
吕曰。从肾损之肺。亦复五脏俱尽。故死也。此是损家病证。非至家病证。肾在下故也。
治损之法奈何。然。损其肺者。益其气。
吕曰。肺主气。今损。故当以针药益其气也。丁曰。肺者、主其气。故损即补之以针。补其手太阴经中俞大渊穴也。
以辛味佐不足。即是益其气也。
损其心者。调其荣卫。
吕曰。心者、荣卫之本。今损当以针药调之。丁曰心者、主荣卫。故损即补之以针。补其手少阴经中井。手厥阴经
中井。是其母。手少冲。手中冲。亦是其母。以苦味佐之。此调其荣卫之现也。虞曰。心主血。血为忧愁。思虑伤于心。
因兹致损。凡人血流据气。气动根据血。宣调荣卫。节忧愁思虑以治之。
损其脾者。调其饮食。适寒温。（别本适下有其字。与上句一例。）
吕曰。脾主饮食。今其气衰损。谷不消化。故当调适寒温也。丁曰。脾损则调其饮食。适其寒温。谓脾主意思。故
顺其意思饮食。适其寒温也。虞曰。脾化水谷以生气血。今见脾损。饮食不为肌肉。宜调节饮食。无令伤脾也。适其寒
温者。启玄子谓春凉食、夏冷食、秋温食、冬热食也。本经曰。饮食劳倦伤脾也。
损其肝者。缓其中。
吕曰。肝主怒。其气急。故以针药以缓其中。丁曰。肝主怒。以甘缓其中。以土味和其肝。当补足厥阴合曲泉穴是
也。虞曰。怒则气逆。脉乃强急。以凭方术。以缓其中。素问曰。肝苦急。急食甘以缓之。又曰。宜食甘。粳米生肉枣
葵味皆甘。甘性缓也。
损其肾者。益其精。此治损之法也。
吕曰。肾主精。今损。故以针药补益其精气。丁曰。益其精者。以咸味补之。当补足少阴经中复溜穴。是其母也。
虞曰。耗周过多。（按周字疑当作用。）而致损肾。宜凭咸味以补精华。
脉有一呼再至。一吸再至。有一呼三至。一吸三至。有一呼四至。一吸四至。有一呼五至。一吸五至。有一呼六至。
一吸六至。
虞曰。此重明前之至脉病证。乃如后说。
有一呼一至。一吸一至。有再呼一至。再吸一至。有呼吸再至。（按此五字疑衍。）
虞曰。此重明损脉。轻重生死当如后说。
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。一呼三至。一吸三至。为适得病。
虞曰。脉三至曰离经。反于常经。知病始得。
前大后小。即头痛目眩。
虞曰。病在三阳。
前小后大。即胸满短气。
丁曰。前大者、为寸外大也。后小者、寸内小也。寸前大则头痛目眩。寸后大者。胸满短气。经言寸部法天。主胸
以上至头有疾故也。虞曰。病在三阴。
一呼四至。一吸四至。病欲甚。
虞曰。脉病反常经。法曰夺精之脉。脉大。法曰浑浑。革至如涌泉者。病进欲甚之理明也。
脉洪大者。苦烦满。
虞曰。病在三阳。阳盛烦满。
沉细者。腹中痛。
虞曰。病在三阴。阴主于内。故腹中病也。
滑者伤热。
虞曰。脉动如徐前却流利替替然。热盛于气。其脉滑也。
涩者中雾露。
虞曰。涩脉状如刀刮竹。寒盛于血。故脉乃涩也。
一呼五至。一吸五至。其人当困。
虞曰。脉一息十至。气血劳走不困。受为生死。如下说。
沉细夜加。浮大昼加。
虞曰。阴脉细沉。夜加可验。阳脉浮大。昼甚可加。（按此加字当作知。）
不大不小。虽困可治。其有大小者。为难治。
虞曰。极大。阳大盛。必减。极小。阴水弱。必竭。故曰难治。
一呼六至。一吸六至。为死脉也。
虞曰。三倍于常。阳气乱极。故曰死也。
沉细夜死。
虞曰。阴绝使然。
浮大昼死。
虞曰。阳绝如是。
一呼一至。一吸一至。名曰损。
虞曰。此损至离经之脉证。
人虽能行。犹当着床。所以然者。血气皆不足故也。再呼一至。呼吸再至。（按此句当云再吸一至。）名曰无魂。无
魂者、当死也。人虽能行。名曰行尸。
虞曰。寻此至数。与前义相违。亦恐错简也。魂属阳。阳主生。今脉形如是减损。乃知阳绝。阳绝则魂去。故人死
也。
Chapter 13 states: The medical classics say that if one observes the facial color but does not find the corresponding pulse, and instead finds a pulse that is mutually overcoming (Xiang Sheng), death will ensue; if a mutually generating pulse is found, although there is illness, it will resolve itself soon. Facial color and pulse should correspond with each other through mutual reference. How is this so?
The answer is: The Five Zang organs correspond to five colors, all of which manifest on the face, and they should also correspond with the pulses at the Cun Kou (inch position) and Chi positions. For example, if the facial color is green, the pulse should be wiry (Xian) and rapid/tight (Ji).
Lu Guang says: Green color belongs to the Liver; wiry and tight are the pulses of the Liver. This is called correspondence.
Yu Shu says: Green color and wiry pulse indicate correspondence between the interior and exterior. The *Su Wen* (Basic Questions) states: The Liver's region is below the eyes; by observing the color in this area, one can correlate the pulse and symptoms.
If the facial color is red, the pulse should be floating (Fu), large (Da), and scattered (San).
Lu Guang says: Red color belongs to the Heart; floating, large, and scattered are the pulses of the Heart. This is called correspondence.
Yu Shu says: Red color and large pulse indicate correspondence between color and pulse. The *Su Wen* states: The Heart's region is at the mouth; observe the color to harmonize with the pulse.
If the facial color is yellow, the pulse should be moderate/slow (Zhong Huan) and large.
Lu Guang says: Yellow color belongs to the Spleen; moderate and large are the pulses of the Spleen.
Yu Shu says: This is correspondence between color and pulse. The *Su Wen* states: The Spleen's region is at the lips; the color appears therein, responding to the pulse condition.
If the facial color is white, the pulse should be floating, choppy (Se), and short (Duan).
Lu Guang says: White color belongs to the Lung; floating, choppy, and short are the pulses of the Lung.
Yu Shu says: The Lung's region manifests in the Que Ting area, above the eyebrows.
If the facial color is black, the pulse should be deep (Chen), choppy, and slippery (Hua).
Lu Guang says: Black is the color of the Kidney. The Kidney governs Water; water nature is sinking, and the Kidney is also below the other five Zang organs, hence its pulse is deep, soft (Ru), and slippery.
Yu Shu says: The Kidney's color manifests on the skin and muscle; on the face, it is located at the Di Ge (chin).
This is what is meant by the five colors and pulses corresponding through mutual reference.
Lu Guang says: This is because the regular meridians are self-diseased without invasion by other pathogens.
Yu Shu says: It refers to the deficiency and excess syndromes of the primary meridian.
Ding Deyong says: The classics state that green color corresponds to wiry and tight pulse, red to floating and scattered, yellow to moderate and large, white to floating, choppy, and short, and black to deep, soft, and slippery. This means the colors and pulses of the five Zang organs all correspond, indicating self-disease of the regular meridians without other mixed colors. The pulses are inter-referenced, hence it is said they should correspond.
If the pulse is rapid (Shu), the skin at the Chi position (forearm near wrist) also feels hot.
Ding Deyong says: Rapid pulse corresponds to the Heart, hence the skin inside the arm is hot.
If the pulse is tight (Ji), the skin at the Chi position also feels tense.
Ding Deyong says: Tight pulse indicates fullness and excess in the meridians of the inner arm, hence the skin is firm and tense.
If the pulse is slow/loose (Huan), the skin at the Chi position also feels loose.
Ding Deyong says: Slow pulse indicates wasting of muscles, hence the skin is also loose and weak.
If the pulse is choppy (Se), the skin at the Chi position also feels rough.
Ding Deyong says: The Lung governs dryness, hence the skin inside the arm is also rough.
If the pulse is slippery (Hua), the skin at the Chi position also feels smooth.
Ding Deyong says: The Kidney governs Water, its pulse is slippery, hence the skin inside the arm is also smooth. These five conditions—the smoothness or roughness, tension or looseness, and heat or cold of the skin—also correspond with the color and pulse.
Lu Guang says: This refers to the correspondence of Yin and Yang, Zang and Fu, floating and deep, slippery and choppy.
Each of the five Zang organs has specific sounds, colors, odors, and tastes, which should correspond with the pulses at the Cun Kou and Chi positions.
Ding Deyong says: By "correspondence," for instance, rapid pulse, red color, and hot skin belong to the Heart; color, pulse, and skin correspond mutually. Tight pulse, green color, and firm/tense skin with greenish hue in the meridians (the character "Ci" is suspected to be an interpolation) belong to the Liver; color, pulse, and skin correspond mutually. Slow pulse, yellow color, and loose skin belong to the Spleen; color, pulse, and skin correspond mutually. Choppy pulse, white color, and rough skin belong to the Lung; color, pulse, and skin correspond mutually. Slippery pulse, black color, and smooth skin belong to the Kidney; color, pulse, and skin correspond mutually. In all pulse diagnoses, one must first palpate the inside and outside of the arm, then diagnose the pulse and observe the color.
Yu Shu says: The Liver pulse is wiry, its color is green, its sound is crying out (Hu), its odor is musky (Shan), and its taste is sour. The Heart pulse is surging (Hong), its color is red, its sound is laughing, its odor is burnt, and its taste is bitter. The Spleen pulse is slow, its color is yellow, its sound is singing, its odor is fragrant, and its taste is sweet. The Lung pulse is choppy, its color is white, its sound is weeping, its odor is fishy, and its taste is pungent. The Kidney pulse is deep, its color is black, its sound is groaning, its odor is putrid, and its taste is salty. This is called correspondence.
If they do not correspond, there is disease.
Yu Shu says: Correspondence refers to self-disease of the regular meridians. For example, in Liver disease, the pulse is wiry, color is green, there is much crying out, preference for musky odor, and liking for sour taste; this is called self-disease. Non-correspondence is described as follows: For example, in Liver disease, the pulse is choppy, color is white, there is much weeping, preference for fishy odor, and liking for pungent taste; this is called opposition. The sound, color, odor, and taste all present signs of the Lung. Metal overcomes Wood; this is called "Thief Evil" (Ze Xie). Non-correspondence leads to death.
For example, if the facial color is green, the pulse should be floating, choppy, and short. If the pulse is large and slow, it is overcoming (Xiang Sheng); if the pulse is floating, large, and scattered, or small and slippery, it is generating (Xiang Sheng).
Lu Guang says: Green color belongs to the Liver; floating, choppy, and short belong to the Lung. Lung overcomes Liver, constituting Thief Evil. If the pulse is large and slow, it is the Spleen pulse. Liver overcomes Spleen, hence it is called overcoming. Floating, large, and scattered is the Heart pulse; Heart is the son of Liver. If the pulse is small and slippery, it is the Kidney pulse; Kidney is the mother of Liver, and Liver is the son of Kidney.
The pulse should be wiry and tight, and the color should be green; this is called Smooth (Shun). Green color with choppy pulse is called Reverse (Ni). If the pulse is large and slow, Liver overcomes Spleen; the disease is severe, hence it is called overcoming. If the pulse is floating, large, and scattered, or small and slippery, this is called generating.
The classics state: Knowing one aspect makes one a lower-grade physician (Xia Gong); knowing two aspects makes one a middle-grade physician (Zhong Gong); knowing three aspects makes one an upper-grade physician (Shang Gong). The Shang Gong cures nine out of ten cases; the Zhong Gong cures eight out of ten; the Xia Gong cures six out of ten. This is what is meant.
Lu Guang says: One disease in the five Zang organs presents five ways. The classic here uses the Liver as an example. Explaining one Zang organ makes one a Xia Gong; explaining two Zang organs makes one a Zhong Gong. (According to the *Justice of Sima Qian*, "two" is written as "three".) Explaining all five Zang organs makes one a Shang Gong.
Ding Deyong says: The Shang Gong completely understands the principles of generation and overcoming among color, pulse, and skin methods, thus curing nine out of ten cases. The Zhong Gong knows two aspects but cannot fully grasp them, thus curing eight out of ten. The Xia Gong knows only one aspect, does not understand the complete methods, and focuses only on treating existing diseases, thus curing six out of ten.
Yu Shu says: A "Gong" (expert) is one whose knowledge and skills are perfect. Any physician must exhaustively study the *Nan Jing*, observe the floating/deep nature of pulses and deficiency/excess of Zang/Fu; master the *Su Wen*, understand the flow of meridians and needle tonification/reduction; exhaustively study the *Ben Cao* (Materia Medica), recognize the cold/warm properties, flavors, and meridian tropism of herbs. Possessing these three areas of knowledge allows one to treat diseases and be called a Shang Gong who knows three aspects. "A physician of three generations, do not take his medicine" implies that those not trained properly are not true experts. The *Su Wen* states: The images of the five Zang organs can be inferred by analogy; the interrelations of the five Zang organs can be understood through consciousness. This can be called being an expert.
Chapter 14 states: Pulses have Sun (Loss) and Zhi (Increase) types. What does this mean?
The answer is: Regarding Zhi pulses, two beats per exhalation and two beats per inhalation constitute a Ping (Normal) pulse.
Lu Guang says: Ping refers to a balanced and harmonious pulse.
Ding Deyong says: Ping refers to a pulse without excess or deficiency.
Yu Shu says: Human respiration embodies Yin and Yang. One exhalation and one inhalation constitute one Xi (breath cycle). The classics state that two beats per exhalation and two beats per inhalation constitute a Ping pulse. Human respiration follows Yin-Yang laws; one Xi corresponds to one year; four beats per Xi correspond to the Four Seasons. Three Cun traveled per exhalation corresponds to the Three Yang; three Cun traveled per inhalation corresponds to the Three Yin. Hence it is called Ping.
Three beats per exhalation and three beats per inhalation constitute Li Jing (Departing from the Meridian/Canon).
Lu Guang says: The classics state two beats is Ping, three beats is Li Jing, meaning it deviates from the canonical norm. The person must be ill.
Ding Deyong says: It adds twice the amount of the Yin pulse, hence called Li Jing.
Yu Shu says: Jing refers to the constant norm. It means the pulse has departed from the normal meridian path. Specifically, one exhalation moves the pulse three Cun, one inhalation moves it three Cun; during the pause between breaths, the pulse moves six Cun. In one day and night, with 13,500 breaths, the pulse travels 810 Zhang, completing one circulation. After returning to the starting meridian, if it moves four and a half Cun per exhalation and four and a half Cun per inhalation (nine Cun per Xi), in three days and nights (13,500 breaths), it travels 1,215 Zhang, exceeding half a circulation and not restarting at the original meridian point. Hence it is called Li Jing. To illustrate: If a person walks 100 Li in a day and restarts from the beginning, it is Ping. If they walk 150 Li in a day, exceeding 50 Li and not restarting at the completion point, it is called Li Jing.
Four beats per exhalation and four beats per inhalation constitute Duo Jing (Depletion of Essence).
Lu Guang says: The person is short of breath and exhausted, with depletion of essence manifested in the nose, eyes, lips, and mouth. Diagnosis reveals this depletion.
Ding Deyong says: It adds four times the amount of the Yin pulse, hence called Duo Jing.
Yu Shu says: The Ping pulse moves six Cun per Xi. Now, the Duo Jing pulse moves one Chi (10 Cun) per Xi. Based on the number of breaths in a day and night, this equals the pulse degree of two days and nights. For Chi and Cun pulses, any pulse counted as rapid indicates chaotic Yang Qi. Moreover, Yang diseases often involve delirious speech and fluctuating complexion. ("Huan" is suspected to be "Hu"). Lu's statement about nasal/ocular/lip/mouth essence depletion is incorrect. Humans ingest five flavors; flavors return to form; form returns to Qi; Qi returns to essence. Now, four beats per Xi indicates chaotic Yang Qi, hence rapid pulse. Rapid pulse consumes Qi; consumption leaves no place for essence to return, as if snatched away, hence called Duo Jing. Like walking 100 Li in a day versus 200 Li; fatigue leads to consumption.
Five beats per exhalation and five beats per inhalation constitute Si (Death) pulse.
Lu Guang says: The patient's pathological signs are already visible, and the pulse increases by one beat; death is certain.
Yu Shu says: This is more than double the Ping pulse. Four beats is already Duo Jing; five beats clearly indicates death.
Ding Deyong says: It adds six times the amount of the Yin pulse, hence called Death.
Six beats per exhalation and six beats per inhalation constitute Ming Jue (Life Extinction). This is a dying pulse.
Lu Guang says: Death will occur within the day.
Yu Shu says: Five beats is the gradual approach to death. Six beats means death occurs now. This describes the dying pulse. (Note: The original text erroneously interpolates "Bi shi yan zhi zhi mai ye" [It must be speaking of the Increase pulse] seven characters; deleted here.) It likely refers to the Zhi pulse, possibly a copying error, to be combined with the following text. (Note: There seems to be a missing character here.)
What is Sun (Loss)? One beat per exhalation and one beat per inhalation constitutes Li Jing.
Ding Deyong says: Yin adds four times to Yang.
Yu Shu says: The previous Zhi pulse Li Jing means the pulse travels past half; this Sun pulse Li Jing means the pulse travels half. The subsequent inhalation nourishes the exhalation.
Two exhalations for one beat and two inhalations for one beat constitute Duo Jing.
Ding Deyong says: Yin adds six times to Yang.
Yu Shu says: The Ping pulse circulates the body 50 times in a day and night. Now, with one beat per two exhalations/inhalations, it circulates less than 13 times in a day and night. The pulse travels only 202 Zhang and 5 Chi. The person's Qi is depleted, Blood is dry, spirit is bleak, and complexion is premature aging; essence is as if snatched away.
Three exhalations for one beat and three inhalations for one beat constitute Si (Death) pulse.
Yu Shu says: The Ping pulse has six beats per three exhalations, traveling 810 Zhang in a day and night, without danger. Now, with one beat per three exhalations, the pulse mouth travels only 1.5 Cun, totaling 67 Zhang and 5 Chi in a day and night, less than five circulations. (Note: This number is erroneous; it should state 135 Zhang, less than nine circulations.) Such signs await death.
Four exhalations for one beat and four inhalations for one beat constitute Ming Jue. This is called the Sun pulse.
Yu Shu says: Four exhalations should have eight beats; now with one beat, it circulates less than four times in a day and night. (Note: Should state less than seven circulations.) Qi and Blood are exhausted, Zang organs fail, and Spirit departs; hence Life Extinction.
Zhi pulses develop from bottom to top; Sun pulses develop from top to bottom.
Lu Guang says: Zhi pulse from bottom to top means the pulse movement slightly increases, reaching up to six beats, most frequent with few exhalations. Sun pulse from top to bottom means the pulse movement slightly decreases to one beat, many exhalations with few beats.
How does the Sun pulse cause disease?
The answer is: First Loss damages the skin and hair; skin gathers and hair falls out.
Yu Shu says: First Loss damages the Lung; the Lung governs skin and hair, hence skin gathers and hair falls.
Second Loss damages the Blood vessels; blood vessels become deficient and scarce, unable to nourish the five Zang and six Fu organs. (Alternative version omits "ye", consistent with previous sentences.)
Yu Shu says: Second Loss damages blood vessels, indicating Heart involvement. The Heart governs Blood; now Heart Blood is枯竭 (exhausted), unable to nourish the five Zang and six Fu organs.
Third Loss damages the muscles; muscles waste away, and food intake does not transform into flesh.
Yu Shu says: Third Loss damages the Spleen. The Spleen receives the five flavors and transforms them into five Qi to nourish Zang/Fu and grow flesh. Now damaged, flavors do not transform, leading to muscle wasting.
Fourth Loss damages the tendons; tendons relax and cannot maintain themselves.
Yu Shu says: Fourth Loss damages the Liver; the disease is thus. The *Su Wen* states: If tendons are injured and relaxed, they cannot contain/support. "Rong" means inability to hold.
Fifth Loss damages the bones; bone萎 (Wei/atrophy) prevents rising from bed. Reversing this leads to the stage of collecting disease.
Yu Shu says: Current Fifth Loss damages the Kidney; the Kidney governs bones, hence bone Wei prevents rising from bed. The *Su Wen* states: Kidney heat causes inability to lift waist and spine; bones wither, marrow decreases, developing bone Wei. Wei means weakness.
Lu Guang says: Shou (Collect) means to take. The classics only record Sun family diseases, not Zhi family diseases. Zhi family diseases are illnesses of the Six Fu organs (Yang). Six Fu diseases suffer from headache and body heat, sudden special obstruction, differing from Sun family diseases. Here, Sun family diseases are recorded, so the Sun pulse suffers disease here, not the Zhi family disease.
Developing from top to bottom, bone Wei preventing rising from bed leads to death.
Lu Guang says: From Lung Loss to Bone, all five Zang organs are exhausted, hence death. The Lung is superior.
Yu Shu says: Tracing the Sun family diseases here: First Loss Lung, Second Loss Heart, Third Loss Spleen, Fourth Loss Liver, Fifth Loss Kidney, similar to the Kidney Loss under the bean-count method in Chapter 5.
Developing from bottom to top, skin gathering and hair falling leads to death.
Lu Guang says: From Kidney Loss to Lung, all five Zang organs are exhausted, hence death. This is Sun family disease, not Zhi family disease, because the Kidney is inferior.
What is the method for treating Loss diseases?
The answer is: For Lung Loss, benefit its Qi.
Lu Guang says: The Lung governs Qi; now damaged, one should use needles and herbs to benefit its Qi.
Ding Deyong says: The Lung governs Qi; thus, when damaged, tonify with needles, specifically the Shu-stream point Dayuan of the Hand Taiyin Meridian. Assist insufficiency with Pungent flavor, which benefits Qi.
For Heart Loss, regulate Ying and Wei.
Lu Guang says: The Heart is the root of Ying and Wei; now damaged, regulate with needles and herbs.
Ding Deyong says: The Heart governs Ying and Wei; thus, when damaged, tonify with needles, specifically the Jing-well points of the Hand Shaoyin and Hand Jueyin meridians, which are its mother points. Shaochong (Hand Shaoyin) and Zhongchong (Hand Jueyin) are also mother points. Assist with Bitter flavor; this is the manifestation of regulating Ying and Wei.
Yu Shu says: The Heart governs Blood; Blood is associated with sorrow and worry. Worry injures the Heart, causing damage. Generally, blood flow relies on Qi, and Qi movement relies on Blood. Regulate Ying and Wei, and control sorrow and worry to treat it.
For Spleen Loss, regulate diet and adapt to cold and warmth. (Alternative version adds "qi" after "shi", consistent with previous sentence.)
Lu Guang says: The Spleen governs diet; now Qi is weak and damaged, grains do not digest, hence one must regulate and adapt to cold and warmth.
Ding Deyong says: Spleen Loss requires regulating diet and adapting to cold and warmth. The Spleen governs intention/thought, so follow dietary intentions and adapt to cold and warmth.
Yu Shu says: The Spleen transforms water and grain to generate Qi and Blood. Now seeing Spleen Loss, food does not become flesh; adjust diet to avoid injuring the Spleen. Adapting to cold and warmth: Qixuanzi suggests cool food in spring, cold in summer, warm in autumn, hot in winter. The *Ben Jing* states: Diet and fatigue injure the Spleen.
For Liver Loss, soothe the interior (relax the mind/qi).
Lu Guang says: The Liver governs anger; its Qi is urgent, hence use needles and herbs to soothe the interior.
Ding Deyong says: The Liver governs anger; soothe the interior with Sweet flavor, harmonize the Liver with Earth flavor, and tonify the He-sea point Ququan of the Foot Jueyin Meridian.
Yu Shu says: Anger causes Qi rebellion and strong/tight pulse; use medical arts to soothe the interior. The *Su Wen* states: The Liver suffers from urgency; eat Sweet to relieve it. Also: Eat Sweet; rice, fresh meat, dates, and okra are all Sweet; Sweet nature is soothing.
For Kidney Loss, benefit its Essence. This is the method for treating Loss diseases.
Lu Guang says: The Kidney governs Essence; now damaged, use needles and herbs to tonify its Essence and Qi.
Ding Deyong says: To benefit Essence, tonify with Salty flavor, specifically the Jing-River point Fuliou of the Foot Shaoyin Meridian, which is its mother point.
Yu Shu says: Excessive usage leads to Kidney Loss; rely on Salty flavor to tonify essence.
Pulses include two beats per exhalation and two per inhalation; three beats per exhalation and three per inhalation; four beats per exhalation and four per inhalation; five beats per exhalation and five per inhalation; six beats per exhalation and six per inhalation.
Yu Shu says: This reiterates the previous Zhi pulse diseases, as described below.
One beat per exhalation and one per inhalation; two exhalations for one beat and two inhalations for one beat; breathing twice for one beat. (Note: These five characters are suspected to be interpolated.)
Yu Shu says: This reiterates the Sun pulse; severity and life/death are as described below.
Given such pulses, how to distinguish the disease?
The answer is: Pulse with two beats per exhalation and two per inhalation, neither large nor small, is Ping (Normal). Three beats per exhalation and three per inhalation indicates recent onset of disease.
Yu Shu says: Three beats is Li Jing, contrary to the constant meridian; knowing disease has just begun.
Front large and back small indicates headache and dizziness.
Yu Shu says: Disease in the Three Yang.
Front small and back large indicates chest fullness and shortness of breath.
Ding Deyong says: Front large means Cun external is large; back small means Cun internal is small. Large front Cun causes headache and dizziness; large back Cun causes chest fullness and shortness of breath. The classics state the Cun position corresponds to Heaven, governing diseases from the chest up to the head.
Yu Shu says: Disease in the Three Yin.
Four beats per exhalation and four per inhalation indicates worsening disease.
Yu Shu says: Pulse disease contrary to the meridian; the law calls it Duo Jing pulse. Large pulse, law calls Hunhun,革 (Ge) arriving like a gushing spring; the principle of worsening disease is clear.
Surging (Hong Da) pulse indicates suffering from vexation and fullness.
Yu Shu says: Disease in Three Yang; Yang excess causes vexation and fullness.
Deep and thin (Chen Xi) pulse indicates abdominal pain.
Yu Shu says: Disease in Three Yin; Yin governs the interior, hence abdominal disease.
Slippery (Hua) pulse indicates injury from Heat.
Yu Shu says: Pulse movement is fluent and alternating like flowing water; Heat excess in Qi makes the pulse slippery.
Choppy (Se) pulse indicates exposure to fog and dew (Cold-Damp).
Yu Shu says: Choppy pulse feels like a knife scraping bamboo; Cold excess in Blood makes the pulse choppy.
Five beats per exhalation and five per inhalation indicates the person should be exhausted.
Yu Shu says: Ten beats per Xi; Qi and Blood labor but do not exhaust; receiving determines life and death, as described below.
Deep and thin worsens at night; floating and large worsens during the day.
Yu Shu says: Yin pulse is thin and deep, verifiable by worsening at night. Yang pulse is floating and large, noticeable by worsening during the day. (Note: "Jia" [add/worsen] should likely be "Zhi" [know].)
Neither large nor small, though exhausted, is treatable. If sizes vary, it is difficult to treat.
Yu Shu says: Extremely large, Yang excess, must decrease. Extremely small, Yin water weak, must deplete. Hence difficult to treat.
Six beats per exhalation and six per inhalation is a dying pulse.
Yu Shu says: Triple the normal; Yang Qi is chaotically extreme, hence called death.
Deep and thin dies at night.
Yu Shu says: Caused by Yin extinction.
Floating and large dies during the day.
Yu Shu says: Caused by Yang extinction.
One beat per exhalation and one per inhalation is named Sun (Loss).
Yu Shu says: This is the Sun pulse departing from the meridian syndrome.
Although the person can walk, they should still lie in bed. The reason is that both Qi and Blood are insufficient.
Two exhalations for one beat and two inhalations for one beat. (Note: This sentence should read "one inhalation for one beat".) Named Wu Hun (No Soul). Wu Hun means death is imminent. Although the person can walk, they are called a "Walking Corpse."
Yu Shu says: Searching this beat count contradicts the previous meaning, suggesting possible misplaced bamboo slips. Soul belongs to Yang; Yang governs life. Now the pulse shape is diminished thus, indicating Yang extinction. Yang extinction means Soul departs, hence the person dies.