虞曰。肝木脾土。脾主四肢。木病则土无所畏。故四肢闭满。玉机真脏论曰。脾太过。令人四肢不举。癃溲便难转
筋。有是者肝也。无是者非也。
丁曰。肝者、东方木也。其治在左应震。齐左有动气。按之牢若痛。其病四肢满闭者。谓肢节挛 也。淋溲便难者、
足厥阴上系舌本。下环于阴器。故淋溲便难也。其转筋者、谓肝含血以养筋。故病即转筋也。有此内外证。即肝也。无
是者。非也。虞曰。癃溲、谓小府涩也。便难。大府所注难也。谓肝脉循于阴器。故癃溲也。肝肾主下部。肝病则气逆
不行于下。故便难也。肝属木也。木曰曲直。筋乃象之。今肝病。故转筋也。吕曰。外证者。腑之候。胆者清净之腑。
故面青善洁。若衣被饮食不洁者。其人便欲怒。胆色青。故面青怒也。（按此怒字疑衍。）其内证者、肝之证。肝者、东
方为青龙。在左方。故肝之证在齐左。
假令得心脉。其外证。面赤。口干。喜笑。
丁曰。外证者、手太阳之脉为外经。故有病即见于外。其应火。故病即外热、口干、喜笑。是其外证也。虞曰。心
脉浮大而散。心属火。火性炎上。故面亦口干也。心在声为笑也。
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。心也。无是者。非也。
丁曰。心者、南方火也。其位在离。故齐上有动气。其病烦心、心痛、掌中热而 者。心病即烦痛、故 。臂内掌
中热而 者。是其内证也。有其证者。心之病。无其证者。即非也。虞曰。心之积名曰伏梁。在齐上。火之生热。心为
五脏之君。四脏有病。心主知之。尚有痛状。何况本经自病耶。常痛、乃心包脉也。正心不受病。病则旦占夕死。夕占
旦死。重明受病。则心包络。乃手厥阴之脉。出两手中指之端。不入掌心。屈名指取之。 名劳宫 。心包病。则掌中
热而 心。吕曰。外证者。小肠手太阳脉为热。故令口干。阳主躁。故喜笑也。其内证者心。心在前为朱雀。故证在齐
上也。
假令得脾脉。
虞曰。脾脉中缓而大。
其外证面黄善噫。
丁曰。其外证面黄。阳明为胃之经。故见色黄。外之证也。虞曰。脾、土也。在变动为噫。
善思。
虞曰。脾者在志为思也。
善味。
虞曰。脾主甘受味。故善味。
其内证。当齐有动气。按之牢若痛。
虞曰。脾之积。名曰痞气。当齐之中。
其病。腹胀满。食不消。体重。节痛。怠堕嗜卧。四肢不收。有是者。脾也。无是者。非也。
丁曰。内证者、足太阴脾也。当齐有动气者。脾主中州也。其病腹满。食不消。体重节痛。怠堕嗜卧。四肢不收。
皆为土。土静、故有此证。前注言外证面黄而不解余说者。为善噫。善味者、是脾也。今腹胀满。食不消。即是胃也。
胃为水谷之海。病即食不消。体重节痛。怠堕嗜卧。四肢不收。皆是见外证也。今却言内证也。此经所说。文至不明。
未敢尽注其说。以俟后贤。虞曰。湿气胜则令人彭胀。阳气在下。食乃不消。得主内。病则如是。脾属土。土性安静。
故知是土主四肢。病乃四肢不收。吕曰。外证、足阳明胃脉之证。胃气实。谷气消。即多所思。欲饮食。胃气虚。食不
消。气力虚羸。其人感思虑。内证者、脾也。脾在中央。故证当齐。齐者、又阴阳之中。故其脉在脾也。
假令得肺脉。其外证。面白善嚏。悲愁不乐。欲哭。
丁曰。其外证者、手阳明之经。大肠为肺之腑也。故善嚏。悲愁不乐。欲哭。此外之证也。虞曰。肺脉浮短而涩。
面白。乃金之色也。肺主皮毛。皮毛外感寒。内合于肺。故嚏也。悲者、肺之志也。脾土肺金。脾为肺母。脾主歌。子
病母忧。故不乐。在声为哭。
其内证。齐右有动气。按之牢若痛。其病。喘嗽、洒淅寒热。有是者。肺也。无是者。非也。
丁曰。其言内证者。手太阴之经。应西方金在兑。故言齐右有动气也。其为喘嗽洒淅寒热者。故知内证也。虞曰。
肺之积。名曰息贲。在右胁下。肺主皮毛。今寒气外感于皮毛。内合于肺。则气道涩。故喘而咳。肺主气。外候于皮毛。
肺虚则洒淅寒。肺实则热而闷。故云寒热也。吕曰。外证者、大肠脉也。乃手阳明之脉。为肺之腑。气通于鼻。故善嚏。
肺主秋。秋、愁也。故其病悲哭。内证者。肺之证。肺主皮毛。有寒则洒淅咳嚏。肺在西方。为白虎。主右方。故证在
齐右。
假令得肾脉。其外证。面黑、喜恐欠。
丁曰。其外证者。太阳膀胱之经。故为外经也。故有病则色黑。面黑喜恐欠也。虞曰。沉濡面滑。肾之脉也。黑色、
肾之色也。在志曰恐。巨阳虚则欠。
其内证。齐下有动气。按之牢若痛。
虞曰。肾之积。名曰贲豚。在齐下。故云在齐下。（按以前四条例之。此五字疑衍。）
其病逆气。少腹急痛。泄如下重。足胫寒而逆。有是者。肾也。无是者。非也。
丁曰。其内证者、肾王于冬。应北方。故在齐之下也。其病。逆气。少腹急痛。泄如下重。其泄者为大瘕。泄而里
急后重也。此内之证也。虞曰。肾气不足。伤于冲脉。故气逆肾者。足少阴之脉。循少腹与足厥阴足太阴三阴交于齐下。
今病。故少腹急痛也。五泄之候。肾为后重泄。肾者、胃之关。今气虚。故为下重泄。谓食毕思急圊。足内踝上五寸间。
乃足少阴之动脉。故足胫寒而逆。通评虚实论曰。气逆者、足寒也。吕曰。外证、足太阳膀胱脉也。其人善欠者。其人
善恶寒。若胫寒。身体洒洒而寒。故其善欠。（按此其字疑衍。）肾与手少阳。俱主候心。故善恐。其内证者。肾王于冬。
主北方玄武。故证在齐下。虞曰。经言是其病有内外证。推寻至此。惟肝脉平证。善洁二字是表证。心脉不见手太阳外
证。脾脉中有善噫。是外证。肺脉亦无手阳明之证。肾脉中只有欠一字。是足太阳不足之证。五脏推之。黄帝素问并言
皆只足脏之证也。越人言其外证者、取其形见于外也。吕氏所注。多不该经旨。
十七难曰。经言病或有死。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。肝脉强急而长。
丁曰。此是肝之病证。故脉强急而长。杨曰。强急犹弦急。虞曰。肝木之脉。弦软而长。今见强急。病乃如是。
而反得肺脉浮短而涩者。死也。
丁曰。浮短涩者。是肺脉。此者金当胜木。故知死也。杨曰。肝为木。肺为金。肝病得肺脉。真鬼来克。金胜木。
故必死也。
病若开目而渴。心下牢者。脉当得紧实而数。反得沉濡而微者。死也。
丁曰。心之病证。今反见肾脉。心火肾水。水来克火。故知死也。杨曰。心病得肾脉。水胜火。故死也。按之短实
而数。有似切绳。谓之紧也。按之短小不动摇。若有若无。轻手乃得。重手不得。谓之微也。虞曰。病开目而渴。心下
牢。脉又紧实而数。此曰阳病得阳脉。脉不相反。今见沉濡而微。谓阳病得阴脉。故曰死也。
病若吐血。复鼽衄血者。脉当沉细而反。浮大而牢者。死也。
丁曰。此者肺脉之病证。今反见心脉。心火肺金。火来胜金。故知死也。虞曰。血属阴。吐血衄血。脉得沉细。此
谓脉与病相应。今反浮大而牢。与病相反。故死也。
病若谵言妄语。身当有热。脉当洪大。而手足厥逆。脉沉细而微者。死也。
丁曰。此病是心病之证。今反手足厥。脉沉细而微者。是水胜火。即知死也。杨曰。按之迟但小谓之细。
虞曰。肺主声。心主言。今脉洪大。是知热乘于心。肺邪受之。故谵言妄语。肺主皮毛。今邪客于卫气。不得宣通。
乃身热。夫如是。病与脉相应。今手足厥逆。脉沉细而微。阳病得阴脉。故云必死也。
病若大腹而泄者。脉当微细而涩。反紧大而滑者。死也。
丁曰。此病脾土之证候。紧大滑者是肝。木来胜土。故知死也。此经不言肾。水之证。阙此一脏也。杨曰。凡此五
者。病脉相反。故为必死。经云。五逆者死。此之谓也。虞曰。湿气胜则胀。脾不禁故泄。脉微细涩。病脉相承。紧大
而滑。此曰相反。如此之候。其死明矣。
十八难曰。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。阳明金也。足
少阴。太阳水也。金生水。水流下行而不能上。故在下部也。
丁曰。夫脉有三部者。寸关尺也。若合两手言之。即六部也。每部之内。各有二经。六部之内。合为十二经。今此
云四经者。是谓手太阳阳明。与足太阳少阴。此四经者。法水火之性。各有纲纪。而不能变通上下。余八经在手生足。
在足生手。所以经言部有四也。是右手寸口。肺与大肠应金生左尺水也。足太阳少阴水。其性润下。故不能上生于手。
而生左足厥阴少阳木。此二部皆是足之经纪。所以言在下部也。是左尺水。生左关木。杨曰。手太阴、肺脉也。肺为诸
脏上盖。其治在右方。故在右手上部也。手阳明。大肠脉。是肺之府。故随肺居上部焉。足少阴肾脉。肾为水。肺之子。
水流趣于肾。又最居于下。故为左手下部也。足太阳膀胱。为肾之府。故随肾居下部焉。经言脉有三部。部有四经者。
谓总两手而言之也。两手各有三部。部各有二经。两手上部合四也。中下二部亦复如此。三四十二。则十二经也。肺金
居上而下生肾水。故肺肾在左右手上下部也。
足厥阴少阳木也。生手太阳少阴火。火炎上行而不能下。故为上部。
丁曰。手太阳少阴。应左寸君火。火上（按此上字疑当作性。）炎上。不能下生足。而生手心主少阳火。是生右尺相
火也。杨曰。足厥阴。肝脉也。肝治在左方。故为左手之下部。足少阳胆者。为肝之府。故随肝居下部也。手太阳。小
肠脉。为心之府。故随心居上部焉。
手心主少阳火。生足太阴阳明土。土主中宫。故在中部也。
丁曰。是相火应其灰火也。中部者、右关也。生右寸。金也。杨曰。手心主心包络脉也。手少阳。三焦脉也。故合
为左手中部。足太阴。脾脉也。足阳明。胃脉也。故合为右手中部。此经作如此分别。若根据脉经配二部。又与此不同也。
虞曰。经言手心主少阳火。生足太阴阳明土。土主中宫。故在右手中部。惟只言火生土之意。不言手心主少阳。在左手
中部。惟只取其相生言之也。今明三部相生之意如此。右手尺中少阳火。生关上阳明土。关上阳明土。却生寸口太阴金。
寸口太阴金。却生左手尺中少阴水。左手尺中少阴水。却生左手关上厥阴木。关上厥阴木。却生左手寸口少阴火。却又
别心主火。故心主生足太阴阳明土也。此乃五行相生之意耳。又足厥阴与足太阴。何以居于左右两手关部中。胃脾太阴。
脾脉居于中州。乃在右手关上也。又足厥阴木。木者根生于地。枝叶长于天。亦阴阳共焉。故亦在左中部也。
此皆五行子母更相生养者也。
丁曰。言此皆五行更相生养者。是谓右寸金生左尺水。水生左关木。木生左寸君火。君火生右尺相火。相火生右关
土。而后生右寸金。故言子母更相生养者也。
脉有三部九候。各何所主之。然。三部者、寸关尺也。九候者。浮中沉也。
丁曰。前顺五行而言之生养。即逆三部而反到。所以经别问各何所主也。杨曰。寸口、阳也。关中、部也。尺中、
阴也。此三部各有浮中沉三候。三三九候也。故曰。九浮为阳。沉为阴。中者胃气也。虞曰。一部之中有三候。浮者为
腑。沉者为脏。中者、乃是中焦之脉也。假令寸口浮为腑。沉为脏。中为中焦。皆仿此用之。
上部法天。主胸以上至头之有疾也。
丁曰。两手寸口。皆为上部。即寸外主头。寸内主胸中。是头皆一指下。前后言病。左右同法也。杨曰。所谓自膈
以上为上焦也。
中部法人。主膈以下至齐之有疾也。
丁曰。言左右两关也。第二指半指以前。言膈下。半指之后。主齐上。左右同。杨曰。所谓自膈以下为中焦也。
下部法地。主齐以下至足之有疾也。
丁曰。下部左右两尺。第三指半指之前。主齐下有疾。半指之后。以候至足之有疾。杨曰。所谓自齐以下至足为下
焦也。
审而刺之者也。
丁曰。刺字当作次第之次。此是审三部各有内外。主从头至足之有疾也。故知刺字传文误也。杨曰。用针者。必当
审详三部九候病之所在。然后各根据其源而刺之也。
人病有沉滞久积聚。可切脉而知之耶。然。诊在右胁有积气。得肺脉结。脉结甚则积甚。结微则气微。诊不得肺脉。
而右胁有积气者何也。然。肺脉虽不见。右手脉当沉伏。
丁曰。病久积聚。可切脉而知之者。五脏六腑。皆有积聚。今云右胁有积气。当肺脉见。如是脉不见。亦沉伏。详
经之意。脉浮、行于肉上（按原本于误肾。又误在下句首。今改正。）脉沉、行于筋下。其浮行于肉上而无常数而止者。
名曰结也。其沉行于筋下时上。名曰伏也。伏者脏病积也。浮结者。腑病聚也。两手三部。各有浮沉结伏而言病也。今
Yu stated: The Liver belongs to Wood, and the Spleen belongs to Earth. The Spleen governs the four limbs. If Liver-Wood is diseased, it fails to restrain Spleen-Earth (Note: The original text logic implies a specific interaction where Wood disease affects Earth's stability), resulting in obstruction and fullness in the four limbs. The *Yu Ji Zhen Zang Lun* states: "Excessive Spleen-Qi causes the limbs to be unable to move, urinary retention, difficult defecation, and tendon cramping. Those with these signs have Liver disease; those without do not."
Ding stated: The Liver is located in the East and belongs to Wood. Its regulatory qi is on the left, corresponding to the Zhen trigram of the Bagua. If there is pulsating Qi at the left side of the umbilicus, which feels firm and painful upon palpation, this indicates Liver pathology. The term "fullness and obstruction of the four limbs" refers to joint contracture. Strangury and difficult urination occur because the Foot Jueyin Liver Meridian ascends to connect with the root of the tongue and descends to circle the external genitalia. Tendon cramping occurs because the Liver stores Blood to nourish the tendons; thus, when diseased, tendons cramp. The presence of these internal and external signs confirms Liver disease; their absence rules it out.
Yu stated: "Longzhou" (urinary retention) refers to涩 (astringency/difficulty) in the Bladder (Small Fu). Difficult defecation refers to difficulty in the Large Intestine (Large Fu). Since the Liver Meridian passes through the genitalia, urinary difficulties arise. The Kidney and Liver govern the lower body. Liver disease causes Qi rebellion, preventing it from descending to the lower jiao, leading to difficult defecation. The Liver belongs to Wood; Wood is characterized by bending and straightening, and tendons reflect this nature. Therefore, Liver disease results in tendon cramping.
Lü stated: External signs are indicators of Fu organ pathology. The Gallbladder is a clear and pure Fu organ; thus, the complexion is green, and the person values cleanliness. If clothes, bedding, or food are unclean, the person becomes angry. Since the Gallbladder color is green, the face appears green and anger ensues. (Note: The character "anger" here may be an interpolation.) Internal signs are symptoms of the Liver itself. The Liver is the Azure Dragon of the East, located on the left; hence, Liver signs manifest at the left side of the umbilicus.
Suppose the Liver pulse is obtained. Its external signs include: red complexion, dry mouth, and a tendency to laugh.
Ding stated: External signs arise because the Hand-Taiyang Small Intestine Meridian runs superficially; thus, pathology manifests externally. Corresponding to Fire, disease presents as external heat, dry mouth, and laughter. These are its external signs.
Yu stated: The Heart pulse is floating, large, and scattered. The Heart belongs to Fire; Fire flares upward, causing a red complexion and dry mouth. The Heart manifests in sound as laughter.
Its internal signs include: pulsating Qi above the umbilicus, feeling firm and painful upon palpation. Symptoms include vexation, heart pain, and heat in the palms with a sensation of emptiness. Presence of these signs indicates Heart disease; absence rules it out.
Ding stated: The Heart is located in the South and belongs to Fire, corresponding to the Li trigram, hence pulsating Qi above the umbilicus. Vexation, heart pain, and palm heat/emptiness result from Heart pathology causing pain and emptiness. Heat and emptiness in the inner arm and palm constitute internal signs. Presence confirms Heart disease; absence denies it.
Yu stated: The accumulation of the Heart is named Fuliang, located above the umbilicus. Fire generates heat. The Heart is the Sovereign of the Five Zang organs; if other Zangs are diseased, the Heart perceives it. Even so, there are pain symptoms, let alone primary meridian disease. Chronic pain belongs to the Pericardium Meridian. The true Heart does not accept disease; if it does, death follows quickly (morning diagnosis leads to evening death, and vice versa). The double explanation indicates the Pericardium (Hand-Jueyin Pericardium Meridian) is affected, emerging at the tips of the middle fingers, not entering the palm. Bending the ring finger locates Laogong (PC8). Pericardium disease causes palm heat and emptiness.
Lü stated: External signs involve heat in the Hand-Taiyang Small Intestine Meridian, causing dry mouth. Yang is active and restless, causing laughter. Internal signs are Heart pathology. The Heart is the Vermilion Bird in the front; thus, signs appear above the umbilicus.
Suppose the Spleen pulse is obtained.
Yu stated: The Spleen pulse is moderate, slow, and large.
Its external signs include: yellow complexion and frequent belching.
Ding stated: The yellow complexion arises because the Yangming Stomach Meridian is involved, manifesting yellow. This is an external sign.
Yu stated: The Spleen belongs to Earth; in terms of movement/change, it manifests as belching.
Excessive thinking.
Yu stated: The Spleen governs thought in the emotions.
Appetite for flavors.
Yu stated: The Spleen governs sweet taste and accepts all flavors, hence an appetite for flavors.
Its internal signs include: pulsating Qi directly at the umbilicus, feeling firm and painful upon palpation.
Yu stated: The accumulation of the Spleen is named Piqi, located in the center of the umbilicus.
Symptoms include: abdominal distension, indigestion, heaviness of the body, joint pain, lethargy and desire to sleep, and inability to hold the four limbs. Presence of these signs indicates Spleen disease; absence rules it out.
Ding stated: Internal signs belong to the Foot-Taiyin Spleen Meridian. Pulsating Qi at the umbilicus occurs because the Spleen governs the Central Region. Abdominal distension, indigestion, heaviness, joint pain, lethargy, and limb weakness are due to Earth. Earth is quiet, hence these signs. The previous note mentioned external yellow complexion but did not explain others to highlight belching and flavor preference as Spleen traits. Current symptoms of distension and indigestion actually point to the Stomach. The Stomach is the Sea of Water and Grain; disease causes indigestion, heaviness, joint pain, lethargy, and limb weakness, which are external signs. Yet this text calls them internal. The wording here is unclear; I dare not fully annotate it, waiting for future scholars.
Yu stated: Excess Dampness causes bloating. Yang Qi being below prevents proper digestion. When the dominant factor is internal, disease manifests thus. The Spleen belongs to Earth; Earth is quiet, governing the limbs. Disease results in limb weakness.
Lü stated: External signs are Foot-Yangming Stomach Meridian pathology. Excess Stomach Qi digests grain, leading to excessive thought and desire to eat. Deficient Stomach Qi causes indigestion, weakness, and mental fatigue. Internal signs are Spleen pathology. The Spleen is central, so signs are at the umbilicus, the midpoint of Yin and Yang, hence the pulse relates to the Spleen.
Suppose the Lung pulse is obtained. External signs include: white complexion, frequent sneezing, sadness, sorrow, unhappiness, and desire to cry.
Ding stated: External signs involve the Hand-Yangming Large Intestine Meridian. The Large Intestine is the Fu of the Lung, hence sneezing. Sadness, sorrow, and crying are external signs.
Yu stated: The Lung pulse is floating, short, and choppy. White is the color of Metal. The Lung governs skin and hair; external cold affecting skin/hair internally combines with the Lung, causing sneezing. Sadness is the emotion of the Lung. Spleen-Earth is the mother of Lung-Metal. Mother worries when child is sick, hence unhappiness. In sound, it manifests as crying.
Internal signs include: pulsating Qi at the right side of the umbilicus, feeling firm and painful upon palpation. Symptoms include wheezing, coughing, and alternating chills and fever. Presence indicates Lung disease; absence rules it out.
Ding stated: Internal signs refer to the Hand-Taiyin Lung Meridian, corresponding to West Metal and the Dui trigram, hence pulsating Qi at the right umbilicus. Wheezing, coughing, and chills/fever confirm internal signs.
Yu stated: The accumulation of the Lung is named Xiben, located under the right hypochondrium. The Lung governs skin and hair; external cold invading skin/hair internally combines with the Lung, obstructing airways, causing wheezing and coughing. The Lung governs Qi and manifests externally on skin/hair. Lung deficiency causes chills; excess causes heat and oppression, hence chills and fever.
Lü stated: External signs are Large Intestine (Hand-Yangming) Meridian pathology, the Fu of the Lung, connecting Qi to the nose, hence sneezing. The Lung governs Autumn; Autumn is associated with sorrow, hence sadness and crying. Internal signs are Lung pathology. The Lung governs skin/hair; cold causes chills, cough, and sneezing. The Lung is in the West, the White Tiger, governing the right side, hence signs at the right umbilicus.
Suppose the Kidney pulse is obtained. External signs include: black complexion, fearfulness, and yawning.
Ding stated: External signs involve the Taiyang Bladder Meridian, an exterior meridian. Disease manifests as black complexion, fear, and yawning.
Yu stated: Deep, soft, and slippery pulse is the Kidney pulse. Black is the color of the Kidney. Fear is the emotion of the Kidney. Deficiency of the Great Yang (Taiyang) causes yawning.
Internal signs include: pulsating Qi below the umbilicus, feeling firm and painful upon palpation.
Yu stated: The accumulation of the Kidney is named Bentun, located below the umbilicus. Hence "below the umbilicus." (Note: Referencing previous examples, these five characters may be interpolated.)
Symptoms include: rebellious Qi, acute pain in the lower abdomen, diarrhea with a sensation of rectal tenesmus, and coldness/reversal in the calves. Presence indicates Kidney disease; absence rules it out.
Ding stated: Internal signs relate to the Kidney flourishing in Winter, corresponding to the North, hence below the umbilicus. Rebellious Qi, lower abdominal pain, and diarrhea with tenesmus constitute internal signs.
Yu stated: Insufficient Kidney Qi injures the Chong Mai, causing rebellious Qi. The Kidney is the Foot-Shaoyin Meridian, passing through the lower abdomen and intersecting with Foot-Jueyin and Foot-Taiyin meridians below the umbilicus. Disease causes lower abdominal pain. Among the five types of diarrhea, the Kidney is associated with tenesmus. The Kidney is the gate of the Stomach; Qi deficiency causes heavy diarrhea (urgency after eating). At 5 cun above the medial malleolus lies the Foot-Shaoyin arterial pulse, causing calf coldness and reversal. The *Tong Ping Xu Shi Lun* states: "Rebellious Qi leads to cold feet."
Lü stated: External signs are Foot-Taiyang Bladder Meridian pathology. Yawning indicates sensitivity to cold. If calves are cold, the body feels chilly, hence yawning. (Note: "Qi" may be interpolated.) The Kidney and Hand-Shaoyang both monitor the Heart, hence fear. Internal signs relate to the Kidney in Winter, governing North Xuanwu, hence signs below the umbilicus.
Yu stated: Analyzing the text regarding internal/external signs: only the Liver ping pulse has "values cleanliness" as an external sign. The Heart pulse lacks Hand-Taiyang external signs. The Spleen pulse has "frequent belching" as an external sign. The Lung pulse lacks Hand-Yangming signs. The Kidney pulse has only "yawning," indicating Foot-Taiyang deficiency. Comparing the Five Zangs, the *Huangdi Sùwèn* mentions only Foot-Zang signs. Yue Ren (Bian Que) stated external signs are those manifesting outwardly. Lü’s annotations often miss the essence of the classic.
Chapter 17 states: The classic says some diseases cause death, some heal spontaneously, and some persist for years. Can pulse diagnosis determine life and death? Reply: It can be fully known. If a patient closes their eyes and avoids people, the pulse should be strong, tense, and long (Liver pulse).
Ding stated: This is a Liver disease sign, hence the strong, tense, long pulse.
Yang stated: Strong and tense resembles string-tightness.
Yu stated: The Liver-Wood pulse should be soft, string-like, and long. Seeing strong and tense indicates such pathology. If instead a floating, short, and choppy Lung pulse is found, death ensues.
Ding stated: Floating, short, and choppy is the Lung pulse. Metal overcomes Wood, hence death.
Yang stated: Liver is Wood, Lung is Metal. Liver disease with Lung pulse indicates "True Ghost" overcoming; Metal overcomes Wood, hence certain death.
If a patient opens their eyes, feels thirsty, and has hardness below the heart, the pulse should be tight, solid, and rapid. If instead a deep, soft, and faint pulse is found, death ensues.
Ding stated: Heart disease presenting with Kidney pulse (Water overcoming Fire) indicates death.
Yang stated: Heart disease with Kidney pulse means Water overcomes Fire, hence death. Tightness is felt as short, solid, and rapid like pressing a rope. Faintness is short, small, unshakable, present with light pressure but absent with heavy pressure.
Yu stated: Thirst, eye-opening, and subcardiac hardness with a tight, solid, rapid pulse indicate Yang disease with Yang pulse (no contradiction). A deep, soft, faint pulse indicates Yang disease with Yin pulse, hence death.
If a patient vomits blood and suffers epistaxis, the pulse should be deep and fine. If instead a floating, large, and firm pulse is found, death ensues.
Ding stated: Lung disease presenting with Heart pulse (Fire overcoming Metal) indicates death.
Yu stated: Blood belongs to Yin. Hematemesis and epistaxis with a deep, fine pulse indicate correspondence between pulse and disease. A floating, large, firm pulse contradicts the disease, hence death.
If a patient speaks deliriously and妄语 (nonsense), the body should be hot, and the pulse洪大 (surging/large). If instead hands and feet are cold and the pulse is deep, fine, and faint, death ensues.
Ding stated: Heart disease presenting with cold extremities and deep, fine, faint pulse indicates Water overcoming Fire, hence death.
Yang stated: Slow and small upon palpation is defined as fine.
Yu stated: The Lung governs sound, the Heart governs speech. A surging pulse indicates heat attacking the Heart, with Lung pathogen involvement, causing delirium. The Lung governs skin/hair; pathogen lodging in Wei Qi prevents circulation, causing fever. Here, disease and pulse correspond. Cold extremities with deep, fine, faint pulse indicate Yang disease with Yin pulse, hence certain death.
If a patient has abdominal distension and diarrhea, the pulse should be micro, fine, and choppy. If instead tight, large, and slippery, death ensues.
Ding stated: Spleen-Earth pathology with tight, large, slippery pulse (Liver/Wood overcoming Earth) indicates death. The text omits Kidney/Water pathology, missing one Zang.
Yang stated: In all five cases, disease and pulse contradict, ensuring death. The classic states: "Five reversals lead to death."
Yu stated: Excess Dampness causes distension; Spleen failure causes diarrhea. Micro, fine, choppy pulses match the disease. Tight, large, slippery pulses contradict. Such signs clearly indicate death.
Chapter 18 states: Pulses have three positions, each with four meridians. Hands have Taiyin and Yangming; Feet have Taiyang and Shaoyin, constituting upper and lower parts. What does this mean? Reply: Hand-Taiyin and Yangming belong to Metal; Foot-Shaoyin and Taiyang belong to Water. Metal generates Water; water flows down and cannot rise, hence they are in the lower part.
Ding stated: Three positions are Cun, Guan, Chi. Considering both hands, there are six positions. Each position contains two meridians, totaling twelve. "Four meridians" refers to Hand-Taiyang/Yangming and Foot-Taiyang/Shaoyin. These four follow Water/Fire natures and cannot interchange upper/lower. The other eight meridians generate from hand to foot and foot to hand, hence "four per position." Right Cun/Kou corresponds to Lung/Large Intestine (Metal), generating Left Chi Water. Foot-Taiyang/Shaoyin Water is moist and downward, unable to rise to the hand, but generates Left Foot Jueyin/Shaoyang Wood. These two positions are foot-related, hence "lower part." Left Chi Water generates Left Guan Wood.
Yang stated: Hand-Taiyin is Lung pulse. Lung is the canopy of Zangs, regulated on the right, hence right hand upper part. Hand-Yangming is Large Intestine pulse, Fu of Lung, hence upper part. Foot-Shaoyin is Kidney pulse; Kidney is Water, child of Lung. Water flows to Kidney, situated lowest, hence left hand lower part. Foot-Taiyang Bladder is Fu of Kidney, hence lower part. "Three positions, four meridians" refers to both hands. Two hands × three positions × two meridians = twelve meridians. Lung Metal resides upper and generates Kidney Water below, hence Lung/Kidney in upper/lower parts of both hands.
Foot-Jueyin/Shaoyang belong to Wood, generating Hand-Taiyang/Shaoyin Fire. Fire flares up and cannot descend, hence upper part.
Ding stated: Hand-Taiyang/Shaoyin correspond to Left Cun Jun Fire. Fire (note: "up" likely "nature") flares up, cannot generate foot meridians, but generates Hand-Shaoyin Master/Pericardium and Shaoyang Fire, generating Right Chi Minister Fire.
Yang stated: Foot-Jueyin is Liver pulse, regulated left, hence left lower part. Foot-Shaoyang Gallbladder is Fu of Liver, hence lower part. Hand-Taiyang Small Intestine is Fu of Heart, hence upper part.
Hand-Shaoyin Master/Shaoyang belong to Fire, generating Foot-Taiyin/Yangming Earth. Earth governs Central Palace, hence middle part.
Ding stated: This is Minister Fire corresponding to ash fire. Middle part is Right Guan. Generates Right Cun Metal.
Yang stated: Hand-Shaoyin Master is Pericardium pulse; Hand-Shaoyang is Sanjiao pulse, combining for left middle part. Foot-Taiyin is Spleen pulse; Foot-Yangming is Stomach pulse, combining for right middle part. This classification differs from *Mai Jing*.
Yu stated: The text says Hand-Shaoyin Master/Shaoyang Fire generates Foot-Taiyin/Yangming Earth, residing in right middle part, focusing only on Fire generating Earth, omitting Hand-Shaoyin Master in left middle part, using only generation logic. Clarifying three-part generation: Right Chi Minister Fire generates Right Guan Yangming Earth; Right Guan Earth generates Cun Taiyin Metal; Cun Metal generates Left Chi Shaoyin Water; Left Chi Water generates Left Guan Jueyin Wood; Left Guan Wood generates Left Cun Shaoyin Fire. Distinctly, Heart Master generates Foot-Taiyin/Yangming Earth. This is Five Elements generation. Why are Foot-Jueyin and Foot-Taiyin in both hands' Guan positions? Spleen pulse governs Central Earth, residing in Right Guan. Foot-Jueyin Wood takes root in earth and grows to heaven, sharing Yin/Yang, hence also in left middle part.
These are mutual generation and nourishment among Five Elements parents and children.
Ding stated: Mutual generation refers to Right Cun Metal generating Left Chi Water, Water generating Left Guan Wood, Wood generating Left Cun Jun Fire, Jun Fire generating Right Chi Minister Fire, Minister Fire generating Right Guan Earth, then returning to Right Cun Metal. Hence "parent-child mutual generation."
Pulses have three positions and nine inspections. What do they govern? Reply: Three positions are Cun, Guan, Chi. Nine inspections are Floating, Middle, Deep.
Ding stated: Following Five Elements generation inversely returns to three positions, hence the question.
Yang stated: Cun is Yang; Guan is Position; Chi is Yin. Each has Floating, Middle, Deep inspections (3x3=9). Nine floats are Yang; deep is Yin; middle is Stomach Qi.
Yu stated: One position has three inspections: Floating is Fu, Deep is Zang, Middle is Middle Jiao pulse. E.g., Cun floating is Fu, deep is Zang, middle is Middle Jiao. Apply similarly elsewhere.
Upper part models Heaven, governing diseases from chest to head.
Ding stated: Both hands' Cun are upper part. Cun outer governs head; Cun inner governs chest. Head is within one finger's width. Diagnosis methods are same for left/right/front/back.
Yang stated: Above diaphragm is Upper Jiao.
Middle part models Humanity, governing diseases from diaphragm to umbilicus.
Ding stated: Refers to left/right Guan. Half-finger anterior to second finger governs below diaphragm; posterior half governs above umbilicus. Same for left/right.
Yang stated: Below diaphragm is Middle Jiao.
Lower part models Earth, governing diseases from umbilicus to feet.
Ding stated: Lower part left/right Chi. Third finger half-position anterior governs below umbilicus; posterior half governs to feet.
Yang stated: Below umbilicus to feet is Lower Jiao.
Examine and puncture accordingly.
Ding stated: "Ci" (puncture) should be "Ci" (sequence/order). This examines internal/external aspects of three positions, governing diseases from head to feet. Thus, "ci" is a textual error.
Yang stated: Acupuncturists must examine three positions and nine inspections to locate disease, then puncture according to origin.
Can chronic stagnation and accumulations be diagnosed by pulse? Reply: Accumulated Qi in right hypochondrium yields Knotted Lung pulse. Severe knotting indicates severe accumulation; slight knotting indicates slight Qi. If Lung pulse is not found but right hypochondrium has accumulated Qi, why? Reply: Though Lung pulse is absent, right hand pulse should be deep and hidden.
Ding stated: Chronic accumulations in Zang-Fu can be diagnosed by pulse. Right hypochondrium accumulation should show Lung pulse. If absent, it is still deep/hidden. Examining the text: Floating pulse runs above flesh; Deep pulse runs below sinews. Floating pulse stopping irregularly above flesh is called Knotted. Deep pulse rising intermittently below sinews is called Hidden. Hidden indicates Zang accumulation; Floating-Knotted indicates Fu aggregation. Both hands/three positions have floating/deep/knotted/hidden variations indicating disease. Now