张锡驹曰：浮大之脉在于尺，则为关阴，阴气不能施化，故不得小便。浮大之脉在于
寸，则为格阳，阳气不能宣通，故吐逆。
@@@
脉浮而滑，浮为阳，滑为实，阳实相搏，其脉数疾，卫气失度，浮滑之脉数疾，发热
汗出者，此为不治。
【注】
浮为阳，滑为实，阳实相搏，其脉行于脉外者，数且疾矣。卫气行疾，荣气行迟，荣
卫不相辅而行，故曰失度。浮、滑、数、疾，有余之脉，见发热无汗有余之证，脉证
相合则为可治 ；若见发热汗出不足之证，脉证不合，不治明矣。
【集注】
成无己曰：浮、滑、数、疾之脉，发热汗出解者，邪气退也。若不解者，正气脱也，
必不可治。经曰：脉阴阳俱盛大，汗出不解者死。
@@@
脉浮而数，浮为风，数为虚，风为热，虚为寒，风虚相搏，则洒淅恶寒也。
【按】
数为虚之「虚」字，当是「热」字。「风为热，虚为寒」二句当是衍文。风虚相搏之
「虚」字，亦当是「热」字。
【注】
风寒在表则脉浮紧，风热在表则脉浮数，表受风邪，故洒淅恶寒也。
@@@
诸脉浮数，当发热而洒淅恶寒，若有痛处，饮食如常者，蓄积有脓也。
【注】
诸脉浮数，谓寸、关、尺六脉俱浮数也。浮则为风，数则为热，风热遏郁于表，则当
发热而洒淅恶寒也。若有隐痛之处，饮食如常者，非表邪之诊，乃内痈蓄积有脓之诊
，于此知浮数之脉，不可概为风热也。
【集注】
王肯堂曰：人身有焮肿痛楚处，未有不自觉者，此条所言，必是内痈，故曰：蓄积有
脓也。如胃脘痈，肺痈，肠痈，皆各有辨，而胃痈之脉，人迎反盛，未有不误以为伤
寒者，故宜察之。
程应旄曰：脉证似伤寒，若不于若有痛处，饮食如常之证参酌，而误以辛温发散，助
其阳热，否则误以寒凉彻热，遏住邪气，滋害深矣。
张璐曰：若为焮肿，为热壅经络；若无肿处，必邪留藏府，随内外而发痈脓也。
@@@
脉浮而大，浮为风虚，大为气强，风气相搏，必成瘾疹，身体为痒，痒者名泄风，久
久为痂癞。
【注】
六脉俱浮而大，浮为风虚，大为气强，强者热也，风热相搏，必成瘾疹也。身体为痒
，痒者肌虚，热气外薄故也，名为泄风，若久不愈，则成痂癞。痂癞，疥，癣、疠、
癞之类是也。
【集注】
成无己曰：痂癞者，疠风也，眉少发稀，身有干疮而腥臭，经云：脉风成疠是也。
朱震亨曰：经云：诸痒为虚，血燥不荣肌腠，所以痒也。
方有执曰：经云：外在腠理，则为泄风。
@@@
寸口诸微亡阳，诸濡亡血，诸弱发热，诸紧为寒，诸乘寒者则为厥，郁冒不仁，以胃
无谷气，脾涩不通，口急不能言，战而栗也。
【按】
濡，浮而无力，候阳虚也，岂有亡血之理？弱，沉而无力，候阴虚也，岂止发热而已
？诸濡亡血，当是诸濡卫虚；诸弱发热，当是诸弱荣虚。
【注】
寸口者，指寸、关、尺三部而言也。诸微，谓凡病见微脉，皆亡阳也。诸濡，谓凡病
见濡脉，皆卫虚也。诸弱，谓凡病见弱脉，皆荣虚也。诸紧，谓凡病见紧脉，皆为寒
也。诸乘寒者，谓诸微濡弱脉，亡阳荣卫不足之人，一病即见残贼。紧脉则为寒乘病
厥也。厥于中者，郁冒昏迷，不知痛痒；厥于经者，战栗口噤不能言语，以平日胃虚
损谷，脾虚不运，中虚不胜外邪也。
【集注】
程知曰：诸乘寒者，则以阳极虚，而阴寒直乘之也，故为厥逆。其所以昏冒不知人，
强直而无觉者，则以胃无谷气，脾不流通，故使口噤不能言，外战内栗而厥也。
@@@
问曰：曾为人所难，紧脉从何而来？师曰：假令亡汗若吐，以肺里寒，故令脉紧也；
假令欬者 ，坐饮冷水，故令脉紧也；假令下利，以胃中虚冷，故令脉紧也。
【注】
此详申上条，诸亡阳荣卫不足之人，而见紧脉之义也。曾为人所难，问紧脉为寒实之
诊，虚冷亦见紧脉，是从何而来也？师曰：假令其亡汗表虚，若吐胸虚，下利里虚，
寒邪乘虚为病，或外感寒邪，或内饮冷水，或中寒阴化，皆令脉紧也。若与浮同见，
无汗，则为伤寒实邪；有汗，则为亡阳虚邪。与沉同见，腹痛不便，则为中寒实邪，
腹痛下利，则为中寒虚邪。由此推之，凡诸实脉从虚化者，即未可谓之实矣。
【集注】
程应旄曰：紧则为寒，称曰乘脉，今复列之残贼何义？曰：虚则为人乘，实则乘人，
凡脉皆然，不独紧也。
@@@
寸口脉微，尺脉紧，其人虚损多汗，知阴常在，绝不见阳也。
【注】
上条以浮沉见微紧，此条以寸尺见微紧，皆阴盛阳亡之诊，故曰：知阴常在，绝不见
阳也。祗曰：虚损多汗者，略言之也。
【集注】
程知曰：言寸微、尺紧为虚损多汗之证也。寸微弱为亡阳，尺紧疾为阴胜，阴胜于内
，阳绝于外，故为虚损多汗。
@@@
师曰：病人脉微而涩者，此为医所病也。大发其汗，又数大下之，其人亡血，病当恶
寒，后乃发热，无休止时。夏月盛热，欲着复衣，冬月盛寒，欲裸其身，所以然者，
阳微则恶寒，阴弱则发热，此医发其汗，使阳气微，又大下之，令阴气弱，五月之时
，阳气在表，胃中虚冷，以阳气内微，不能胜冷，故欲着复衣。十一月之时，阳气在
里，胃中烦热，以阴气内弱，不能胜热，故欲裸其身。又阴脉迟涩，故知血亡也。
【按】
「又阴脉迟涩，故知血亡也」二句，与上文义不属，非有阙文，即是衍文。
【注】
病人脉微而涩，询之为医大发其汗，又数大下之，所以致此病也。其人亡血，略辞也
，谓亡其血气也。气亡则阳微，阳微则恶寒；血亡则阴弱，阴弱则发热；阳微阴弱，
故病当恶寒后乃发热也。轻者邪不留连，遇所不胜时则愈；重者无休止时，即遇所不
胜尤甚也。然恶寒虽遇夏月盛热，欲着复衣，所以然者，五月之时，阳气在外，胃中
虚冷，大发其汗，令阳气微，故不胜寒也。发热虽遇冬月盛寒，欲裸其身，所以然者
，十一月之时，阳气在内，胃中烦热，又数下之，令阴气弱，故不能胜热也。此即论
中所谓热在骨髓，寒在皮肤；寒在骨髓，热在皮肤，沉痼寒热之病也。
【集注】
王肯堂曰：非必遇夏乃寒，遇冬乃热也，此但立其例，论其理耳。
@@@
寸口脉微而缓，微者卫气□，疏则其肤空，缓则胃气实，实则谷消而水化也，谷入于
胃，脉道乃行，水入于经，其血乃成。荣盛则其肤必□，三焦绝经，名曰血崩。
【注】
寸口脉微而缓，微者卫气□，□则其表空虚也；缓者胃气实，实则消化水谷也。壳入
于胃，脉道之气乃行；水入于经，脉络之血乃成。今荣愈而盛卫愈□，血愈多而气愈
少，气血失其经常之道，故曰：三焦绝经。气不能制血，血不能归经，故血妄行而崩
也。
【集注】
成无己曰：卫气者，温分肉，肥腠理，卫气既□，皮肤不得温，肥则空虚也。经曰：
缓者胃气有余，有余为实，故云：缓者胃气实。『内经』曰：食入于胃，淫精于脉，
是谷入于胃，脉道乃行也。『针经』曰：饮而液渗于络，合和于血，是水入于经，其
血乃成也。经，常也。三焦者气之道路，卫气□则气不循常度，故三焦绝其常度也。
方有执曰：□言不能固护，实犹言强也。谷入于胃，至其血乃成，乃承上文谷消而水
化也。阴血大下，而曰崩者，言其不能止静，如山坏之势也。
@@@
寸口脉微而涩，微者卫气不行，涩者荣气不逮，荣卫不能相将，三焦无所仰，身体痹
不仁，荣气不足，则烦疼口难言，卫气虚，则恶寒数欠，三焦不归其部，上焦不归者
，噫而酢吞；中焦不归者，不能消谷引食；下焦不归者，则遗溲。
【注】
凡经脉内外、荣卫也，藏府内外、三焦也，故经曰：荣行脉中，卫行脉外。上焦心肺
主之，中焦脾胃主之，下焦肝肾主之。分而言之，荣也，卫也，三焦也；合而言之，
皆本乎一气之流行，随其所在而得名也。脉微而涩，荣卫不足，不足则荣卫不能相将
而行，三焦无所仰赖，故身体周痹不仁。荣气不足，故身烦疼，口难言语；卫气不足
，故恶寒数欠也。上焦司降，降者清中之浊；下焦司升，升者浊中之清；中焦司升降
，清者令其上升，浊者令其下降。今荣卫不相将而行，三焦无所仰赖，故不能各归其
部，而失其职矣。上焦不归，则浊气不降，噫气而吞酸；中焦不归，则升降相违，故
不能消谷引食；下焦不归，则清气不升，故不能约束而遗溲也。
@@@
寸口脉微而涩，微者卫气衰，涩者荣气不足，卫气衰，面色黄，荣气不足，面色青。
荣为根，卫为叶，荣卫俱微，则根叶枯槁，而寒栗欬逆，唾腥吐涎沫也。
【注】
此详申荣卫上焦之证也。面色黄青，荣卫不足之色也。恶寒而栗，欬嗽唾腥，吐痰涎
沫，肺损之证也。肺主皮毛，皮毛者，荣卫之所居，故肺损则皮聚而毛落，荣卫枯槁
也。
【集注】
成无己曰：荣行脉中为根，卫行脉外为叶，根叶俱微，则阴阳之气衰也。
@@@
寸口脉弱而迟，弱者卫气微，迟者荣中寒，荣为血，血寒则发热，卫为气，气微者，
心内饥，饥而虚满，不能食也。
【按】
条末「心内饥，饥而虚满不能食」句，此是论脾胃，不关荣卫。故弱者卫气微，当是
「阳气微」；迟者荣中寒，当是「脾中寒」，上下文义始属。荣为血，血寒则发热，
岂有血寒发热之理乎？卫为气，气微者，当是阳气微。脾中寒者，心内饥，阅下条言
胃气有余，自知。
【注】
此详申荣卫中焦之证也。缓以候胃，迟以候脾；胃主纳谷，脾主化谷，故能食者胃也
，能化者脾也。今阳微中寒，脾胃俱病，所以心内虽饥，饥而虚满不能食也。
【集注】
方有执曰：饥而虚满者，阳主化谷，卫阳衰微不化谷，故虚满而不能食也。
@@@
寸口脉弱而缓，弱者阳气不足，缓者胃气有余，噫而吞酸，食卒不下，气填于膈上也
。
【注】
此又详申中焦之证。寸口脉弱而缓，弱者阳气不足，缓者胃气有余，不足则脾失健运
，有余则胃强能食。此胃强脾弱，所以虽能食而不能消化也，故使吞酸而噫，食卒不
化，气填胀闷于膈中也。
【集注】
方有执曰：阳气以胃中之阳气言，不足则不能化谷；胃气以胃中之谷气言，有余言有
宿食也。有宿食则郁而生热，故噫饱而吞酸，此盖以饮食之内伤者言也。
@@@
趺阳脉迟而缓，胃气如经也。趺阳脉浮而数，浮则伤胃，数则动脾，此非本病，医特
下之所为也。荣卫内陷，其数先微，脉反但浮，其人必大便□，气噫而除。何以言之
？本以数脉动脾，其数先微，故知脾气不治，大便□，气噫而除，今脉反浮，其数改
微，邪气独留，心中则饥，邪热不杀谷，潮热发渴，数脉当迟缓，脉因前后度数如法
，病者则饥，数脉不时，则生恶疮也。
【注】
此已下辨趺阳之脉、少阴之脉也。趺阳一名冲阳，在脚背上，去陷骨三寸脉动处，乃
是阳明胃经之动脉也。少阴一名太溪，在足内踝后跟骨上脉动处，乃足少阴肾经之动
脉也。趺阳、少阴，乃古诊法，越人以十二经虽皆有动脉，独取寸口以决死生者，以
寸口乃脉之大要会也。然此法不行久矣。设有危急之病，寸口脉不见，诊此以决死生
可也。若在平时，总不如以关脉为趺阳，尺脉为少阴，更为愈也。如趺阳胃脉迟而和
缓，是胃气不病，如经脉也，今趺阳脉浮而数，按之无力，浮以候府，浮而无力，则
为伤胃；沉以候藏，数而无力，则为伤脾。询之病者，特为医下之所为，以致荣卫之
气内陷。其先数脉变微，为脾弱也；浮脉仍浮反甚，为胃强也。胃强则邪气独留，故
大便□，潮热发渴也；脾弱则脾气不运，故邪热不能杀谷，虽饥不食，气噫而快也。
医者前后施治如法，而浮数之脉，自当迟缓如经，则饥欲食，病者愈也；若施治失宜
，数脉终始不退，则生恶疮也。
【集注】
方有执曰：恶疮与屎脓虽不同，其为血热则皆然也。
程知曰：此言趺阳脉迟缓，妄下则有浮数之变也。
@@@
趺阳脉浮而涩，少阴脉如经者，其病在脾，法当下利，何以知之？若脉浮大者，气实
血虚也，今趺阳脉浮而涩，故知脾气不足，胃气虚也，以少阴脉弦而浮才见，此为调
脉，故称如经也。若反滑而数者，故知当屎脓也。
【按】
「若脉浮大者，气实血虚也」二句，与上文义不属，当是衍文。少阴脉弦而浮，岂可
谓如经乎？当改，「沉而滑」字。
【注】
脾肾皆病下利，今趺阳胃脉浮涩，少阴肾脉如常，是病在脾不在肾也，何以知之？浮
为阳，以候胃；涩为阴，以候脾，浮与涩合，故知脾气不足，胃气虚也。以少阴脉见
沉而滑，故称如经也。若沉滑而数者，是阳邪伤阴，故知当屎脓血也。
【集注】
张锡驹说：脉象浮大且位于尺部，称为“关阴”，这是因为阴气不能正常施化，所以导致小便不通。脉象浮大且位于寸部，称为“格阳”，这是因为阳气不能宣通，所以导致呕吐逆气。
@@@
脉象浮而滑，浮代表阳，滑代表实，阳与实相互搏结，脉搏变得快速急疾，卫气失去常度。如果浮滑的脉象表现为快速急疾，同时伴有发热和汗出，这属于难治之症（不治）。
【注】
浮为阳，滑为实，阳与实相互搏结，脉气运行于脉外，脉搏就会既快又急。卫气运行迅速，营气运行缓慢，营气和卫气不能相辅而行，所以称为“失度”。浮、滑、数、疾，都是有余的脉象；如果见到发热无汗这种有余的症状，脉证相符，则是可治的；如果见到发热汗出这种不足的症状，脉证不符，显然属于不治之症。
【集注】
成无己说：出现浮、滑、数、疾的脉象，如果发热汗出后病解，说明邪气退去。如果病不解，说明正气脱失，必然不可治愈。经文说：脉象阴阳两部都盛大，汗出后病仍不解除的，会死亡。
@@@
脉象浮而数，浮代表风，数代表虚，风代表热，虚代表寒，风与虚相互搏结，就会出现洒淅恶寒（怕冷颤抖）的症状。
【按】
数脉主虚中的“虚”字，应当是“热”字。“风为热，虚为寒”这两句可能是衍文（多余的文字）。风虚相搏中的“虚”字，也应当是“热”字。
【注】
风寒在表则脉象浮紧，风热在表则脉象浮数，体表受风邪侵袭，所以出现洒淅恶寒的症状。
@@@
各种脉象浮数，应当出现发热和洒淅恶寒的症状，如果有疼痛的部位，但饮食如常，这是体内蓄积有脓疡的表现。
【注】
各种脉象浮数，是指寸、关、尺三部脉都浮数。浮则为风，数则为热，风热郁遏在体表，就应当出现发热和洒淅恶寒。如果有隐痛之处，但饮食如常，这就不是表证的诊断，而是内痈蓄积有脓的诊断，从这里可知浮数的脉象，不能一概认为是风热。
【集注】
王肯堂说：人身如有红肿疼痛的地方，没有自己不感觉到的，这条所说的，必定是内痈，所以说：蓄积有脓。如胃脘痈、肺痈、肠痈，都有各自的辨别方法，而胃痈的脉象，人迎脉反而盛大，没有不误以为是伤寒的，所以应该仔细察辨。
程应旄说：脉证类似伤寒，如果不参考“若有痛处，饮食如常”这些症状进行斟酌，而误用辛温发散的方法，会助长阳热；或者误用寒凉清热的方法，会遏制邪气，造成的危害就很深了。
张璐说：如果是红肿，是热邪壅滞经络；如果没有肿处，必定是邪气留在脏腑，随内外而发为痈脓。
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脉象浮而大，浮代表风虚，大代表气强，风与气相互搏结，一定会形成瘾疹（荨麻疹），身体瘙痒，瘙痒的病名叫泄风，时间久了会变成痂癞（疥癣等皮肤病）。
【注】
六部脉都浮而大，浮代表风虚，大代表气强，强就是热，风热相互搏结，一定会形成瘾疹。身体瘙痒，是因为肌肉虚弱，热气向外迫近所致，名叫泄风，如果久不痊愈，就会变成痂癞。痂癞，包括疥、癣、疠、癞这类疾病。
【集注】
成无己说：痂癞就是疠风，眉毛稀少头发稀疏，身上有干疮且腥臭，经文说：脉风成疠就是这个意思。
朱震亨说：经文说：各种瘙痒都是因为虚，血燥不能滋养肌肤腠理，所以会痒。
方有执说：经文说：外在腠理，就成为泄风。
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寸口脉微，是亡阳；脉濡，是亡血；脉弱，是发热；脉紧，是寒；凡是受寒邪侵犯的，就会发生厥逆，出现郁冒（昏闷）和不仁（麻木不知痛痒），因为胃中没有谷气，脾运涩滞不通，导致口急不能说话，身体战栗发抖。
【按】
濡脉，浮而无力，候的是阳虚，哪里有亡血的道理？弱脉，沉而无力，候的是阴虚，哪里只是发热而已？“诸濡亡血”，应当是“诸濡卫虚”；“诸弱发热”，应当是“诸弱荣虚”。
【注】
寸口，指寸、关、尺三部而言。诸微，谓凡病见到微脉，都是亡阳。诸濡，谓凡病见到濡脉，都是卫虚。诸弱，谓凡病见到弱脉，都是荣虚。诸紧，谓凡病见到紧脉，都是为寒。诸乘寒者，谓那些微、濡、弱脉，亡阳、荣卫不足的人，一旦生病就会见到残贼之脉。紧脉则是寒邪乘虚导致的病厥。厥在中焦，会出现郁冒昏迷，不知痛痒；厥在经脉，会出现战栗、口噤不能言语，这是因为平日胃虚损谷，脾虚不运，中焦虚弱不能抵御外邪。
【集注】
程知说：诸乘寒者，是因为阳极虚，而阴寒直接乘袭它，所以发生厥逆。之所以昏冒不知人，强直而无知觉，是因为胃没有谷气，脾不流通，所以使口噤不能言，外战内栗而发生厥逆。
@@@
问：曾经被人诘难，紧脉是从哪里来的？老师说：假如亡汗或者呕吐，因为肺里有寒，所以令脉紧；假如咳嗽，因为喝了冷水，所以令脉紧；假如下利，因为胃中虚冷，所以令脉紧。
【注】
这是详细申述上一条，那些亡阳、荣卫不足的人，却见到紧脉的意义。曾被人诘难，是问紧脉作为寒实的诊断，虚冷也见紧脉，是从哪里来的呢？老师说：假如其亡汗表虚，或者呕吐胸虚，下利里虚，寒邪乘虚致病，或是外感寒邪，或是内饮冷水，或是中寒阴化，都会令脉紧。如果紧脉与浮脉同见，无汗，就是伤寒实邪；有汗，就是亡阳虚邪。如果紧脉与沉脉同见，腹痛不便，就是中寒实邪；腹痛下利，就是中寒虚邪。由此推论，凡是各种实脉从虚转化而来的，就不能称之为实了。
【集注】
程应旄说：紧则为寒，称为乘脉，现在又列为残贼脉，这是什么意义？回答说：虚则被人乘袭，实则乘袭别人，所有脉象都是这样，不仅仅只有紧脉。
@@@
寸口脉微，尺脉紧，这个人虚损多汗，可知阴气常在，阳气绝而不见。
【注】
上一条以浮沉见微紧，这一条以寸尺见微紧，都是阴盛阳亡的诊断，所以说：可知阴常在，绝不见阳。只说：虚损多汗，是简略的说法。
【集注】
程知说：说寸微、尺紧是虚损多汗的证候。寸微弱为亡阳，尺紧疾为阴胜，阴胜于内，阳绝于外，所以为虚损多汗。
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老师说：病人脉微而涩，这是医生治疗造成的病患。大发其汗，又多次峻下，这个人亡血，病应当恶寒，后来才发热，没有停止的时候。夏月盛热，想穿厚衣，冬月盛寒，想裸露身体，之所以这样，是因为阳微则恶寒，阴弱则发热，这是医生发其汗，使阳气微，又大下之，令阴气弱，五月之时，阳气在表，胃中虚冷，因为阳气内微，不能胜冷，所以想穿厚衣。十一月之时，阳气在里，胃中烦热，因为阴气内弱，不能胜热，所以想裸露身体。又阴脉迟涩，所以知道血亡。
【按】
“又阴脉迟涩，故知血亡也”这两句，与上文意义不连贯，不是有缺文，就是衍文。
【注】
病人脉微而涩，询问得知是因为医生大发其汗，又多次峻下，所以导致此病。其人亡血，是略辞，谓亡其血气。气亡则阳微，阳微则恶寒；血亡则阴弱，阴弱则发热；阳微阴弱，所以病当恶寒后乃发热。轻者邪不留连，遇到所不胜的时候则愈；重者无休止时，即使遇到所不胜更严重。然而恶寒虽然遇夏月盛热，想穿厚衣，之所以这样，是因为五月之时，阳气在外，胃中虚冷，大发其汗，令阳气微，所以不胜寒。发热虽然遇冬月盛寒，想裸露身体，之所以这样，是因为十一月之时，阳气在内，胃中烦热，又多次下之，令阴气弱，所以不能胜热。这就是《论》中所说的热在骨髓，寒在皮肤；寒在骨髓，热在皮肤，沉痼寒热的病。
【集注】
王肯堂说：不一定遇夏才寒，遇冬才热，这只是立其例，论其理罢了。
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寸口脉微而缓，微者卫气□（固护/虚弱），疏则其肤空，缓者胃气实，实则谷消而水化也，谷入于胃，脉道乃行，水入于经，其血乃成。荣盛则其肤必□（充/实），三焦绝经，名曰血崩。
【注】
寸口脉微而缓，微者卫气□（虚弱），□（虚弱）则其表空虚；缓者胃气实，实则消化水谷。壳（谷）入于胃，脉道之气乃行；水入于经，脉络之血乃成。今荣愈而盛卫愈□（虚），血愈多而气愈少，气血失其经常之道，故曰：三焦绝经。气不能制血，血不能归经，故血妄行而崩也。
【集注】
成无己说：卫气者，温分肉，肥腠理，卫气既□（虚弱），皮肤不得温，肥则空虚也。经文说：缓者胃气有余，有余为实，故云：缓者胃气实。《内经》说：食入于胃，淫精于脉，是谷入于胃，脉道乃行。《针经》说：饮而液渗于络，合和于血，是水入于经，其血乃成。经，常也。三焦者气之道路，卫气□（虚弱）则气不循常度，故三焦绝其常度。
方有执说：□言不能固护，实犹言强也。谷入于胃，至其血乃成，乃承上文谷消而水化。阴血大下，而曰崩者，言其不能止静，如山坏之势。
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寸口脉微而涩，微者卫气不行，涩者荣气不逮，荣卫不能相将，三焦无所仰，身体痹不仁，荣气不足，则烦疼口难言，卫气虚，则恶寒数欠，三焦不归其部，上焦不归者，噫而酢吞；中焦不归者，不能消谷引食；下焦不归者，则遗溲。
【注】
凡经脉内外、荣卫也，藏府内外、三焦也，故经说：荣行脉中，卫行脉外。上焦心肺主之，中焦脾胃主之，下焦肝肾主之。分而言之，荣也，卫也，三焦也；合而言之，皆本乎一气之流行，随其所在而得名。脉微而涩，荣卫不足，不足则荣卫不能相将而行，三焦无所仰赖，故身体周痹不仁。荣气不足，故身烦疼，口难言语；卫气不足，故恶寒数欠。上焦司降，降者清中之浊；下焦司升，升者浊中之清；中焦司升降，清者令其上升，浊者令其下降。今荣卫不相将而行，三焦无所仰赖，故不能各归其部，而失其职。上焦不归，则浊气不降，噫气而吞酸；中焦不归，则升降相违，故不能消谷引食；下焦不归，则清气不升，故不能约束而遗溲。
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寸口脉微而涩，微者卫气衰，涩者荣气不足，卫气衰，面色黄，荣气不足，面色青。荣为根，卫为叶，荣卫俱微，则根叶枯槁，而寒栗欬逆，唾腥吐涎沫。
【注】
这是详细申述荣卫上焦的证候。面色黄青，是荣卫不足的颜色。恶寒而栗，欬嗽唾腥，吐痰涎沫，是肺损的证候。肺主皮毛，皮毛者，荣卫之所居，故肺损则皮聚而毛落，荣卫枯槁。
【集注】
成无己说：荣行脉中为根，卫行脉外为叶，根叶俱微，则阴阳之气衰。
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寸口脉弱而迟，弱者卫气微，迟者荣中寒，荣为血，血寒则发热，卫为气，气微者，心内饥，饥而虚满，不能食。
【按】
条末“心内饥，饥而虚满不能食”句，这是论脾胃，不关荣卫。故“弱者卫气微”，应当是“阳气微”；“迟者荣中寒”，应当是“脾中寒”，上下文义始属。荣为血，血寒则发热，哪有血寒发热的道理？卫为气，气微者，应当是阳气微。脾中寒者，心内饥，阅下条言胃气有余，自知。
【注】
这是详细申述荣卫中焦的证候。缓以候胃，迟以候脾；胃主纳谷，脾主化谷，故能食者胃也，能化者脾也。今阳微中寒，脾胃俱病，所以心内虽饥，饥而虚满不能食。
【集注】
方有执说：饥而虚满者，阳主化谷，卫阳衰微不化谷，故虚满而不能食。
@@@
寸口脉弱而缓，弱者阳气不足，缓者胃气有余，噫而吞酸，食卒不下，气填于膈上也。
【注】
这又是详细申述中焦的证候。寸口脉弱而缓，弱者阳气不足，缓者胃气有余，不足则脾失健运，有余则胃强能食。此胃强脾弱，所以虽能食而不能消化，故使吞酸而噫，食卒不化，气填胀闷于膈中。
【集注】
方有执说：阳气以胃中之阳气言，不足则不能化谷；胃气以胃中之谷气言，有余言有宿食。有宿食则郁而生热，故噫饱而吞酸，这是以饮食之内伤而言。
@@@
趺阳脉迟而缓，胃气如经也。趺阳脉浮而数，浮则伤胃，数则动脾，这不是本病，是医生特别用下法造成的。荣卫内陷，其数先微，脉反但浮，其人必大便□（硬/秘），气噫而除。为什么这样说？本来以数脉动脾，其数先微，故知脾气不治，大便□（硬/秘），气噫而除，现在脉反浮，其数改微，邪气独留，心中则饥，邪热不杀谷，潮热发渴，数脉当迟缓，脉因前后度数如法，病者则饥，数脉不时，则生恶疮。
【注】
这以下辨趺阳之脉、少阴之脉。趺阳一名冲阳，在脚背上，去陷骨三寸脉动处，乃是阳明胃经之动脉。少阴一名太溪，在足内踝后跟骨上脉动处，乃是足少阴肾经之动脉。趺阳、少阴，是古诊法，越人以十二经虽皆有动脉，独取寸口以决死生者，以寸口乃脉之大要会。然此法不行久矣。设有危急之病，寸口脉不见，诊此以决死生可也。若在平时，总不如以关脉为趺阳，尺脉为少阴，更为好。如趺阳胃脉迟而缓和，是胃气不病，如经脉也，现在趺阳脉浮而数，按之无力，浮以候府，浮而无力，则为伤胃；沉以候藏，数而无力，则为伤脾。询问病人，特为医下之所为，以致荣卫之气内陷。其先数脉变微，为脾弱；浮脉仍浮反甚，为胃强。胃强则邪气独留，故大便□（硬/秘），潮热发渴；脾弱则脾气不运，故邪热不能杀谷，虽饥不食，气噫而快。医者前后施治如法，而浮数之脉，自当迟缓如经，则饥欲食，病者愈；若施治失宜，数脉终始不退，则生恶疮。
【集注】
方有执说：恶疮与屎脓虽不同，其为血热则皆然。
程知说：此言趺阳脉迟缓，妄下则有浮数之变。
@@@
趺阳脉浮而涩，少阴脉如经者，其病在脾，法当下利，何以知之？若脉浮大者，气实血虚也，现在趺阳脉浮而涩，故知脾气不足，胃气虚也，以少阴脉弦而浮才见，此为调脉，故称如经。若反滑而数者，故知当屎脓。
【按】
“若脉浮大者，气实血虚也”两句，与上文意义不连贯，应当是衍文。少阴脉弦而浮，岂可称为如经？应当改为，“沉而滑”字。
【注】
脾肾皆病下利，现在趺阳胃脉浮涩，少阴肾脉如常，是病在脾不在肾，何以知之？浮为阳，以候胃；涩为阴，以候脾，浮与涩合，故知脾气不足，胃气虚。以少阴脉见沉而滑，故称如经。若沉滑而数，是阳邪伤阴，故知当屎脓血。
【集注】
Zhang Xiju stated: When the Fu Da (Floating and Large) pulse is located at the Chi (Cun, Guan, Chi - specifically Chi position), it is called "Guan Yin" (Closing Yin). This indicates that Yin Qi cannot perform its transformation functions, resulting in an inability to urinate. When the Fu Da (Floating and Large) pulse is located at the Cun (Cun, Guan, Chi - specifically Cun position), it is called "Ge Yang" (Gridlock Yang). This indicates that Yang Qi cannot circulate freely, resulting in vomiting and regurgitation.
@@@
A pulse that is Floating and Slippery: Floating represents Yang, and Slippery represents Excess. When Yang and Excess contend with each other, the pulse becomes Rapid and Urgent, and the Wei Qi (Defensive Qi) loses its normal regulation. If a Floating and Slippery pulse manifests as Rapid and Urgent, accompanied by fever and sweating, this condition is considered untreatable.
[Annotation]
Floating represents Yang, and Slippery represents Excess. When Yang and Excess contend, the pulse qi moves outside the vessels, becoming both Rapid and Urgent. Wei Qi (Defensive Qi) moves swiftly, while Ying Qi (Nutritive Qi) moves slowly. Since Ying Qi and Wei Qi do not support each other in their movement, it is termed "loss of regulation." Floating, Slippery, Rapid, and Urgent are all pulses indicating Excess. If these pulses are accompanied by symptoms of Excess such as fever without sweating, the pulse and symptoms correspond, making the condition treatable. However, if fever and sweating (symptoms of Deficiency) are present, the pulse and symptoms do not correspond, clearly indicating an untreatable condition.
[Collected Annotations]
Cheng Wuji stated: With Floating, Slippery, Rapid, and Urgent pulses, if fever and sweating lead to resolution, it means the pathogenic factor has receded. If the disease does not resolve, it means the healthy Qi has collapsed, and it is certainly untreatable. The Classic states: "When the pulses at both Yin and Yang positions are fully full, and sweating does not resolve the disease, death will occur."
@@@
A pulse that is Floating and Rapid: Floating represents Wind, and Rapid represents Deficiency. Wind represents Heat, and Deficiency represents Cold. When Wind and Deficiency contend with each other, it results in aversion to cold with shivering (Sa Xi E Han).
[Commentary]
The character "Deficiency" (Xu) in "Rapid represents Deficiency" should be "Heat". The two sentences "Wind represents Heat, Deficiency represents Cold" are likely interpolations. The "Deficiency" (Xu) in "Wind and Deficiency contend" should also be "Heat".
[Annotation]
When Wind-Cold is on the exterior, the pulse is Floating and Tight; when Wind-Heat is on the exterior, the pulse is Floating and Rapid. Since the exterior is affected by Wind pathogen, Sa Xi E Han (aversion to cold with shivering) occurs.
@@@
For various pulses that are Floating and Rapid, one should expect fever and Sa Xi E Han (aversion to cold with shivering). If there is a painful area but dietary intake remains normal, this indicates the accumulation of pus internally.
[Annotation]
"Various pulses Floating and Rapid" refers to the Cun, Guan, and Chi pulses all being Floating and Rapid. Floating indicates Wind, and Rapid indicates Heat. When Wind-Heat is constrained at the exterior, fever and Sa Xi E Han should occur. If there is hidden pain but dietary intake remains normal, this is not a diagnosis of exterior pathogen, but rather a diagnosis of internal abscess with accumulated pus. From this, we know that Floating and Rapid pulses cannot be generally assumed to be Wind-Heat.
[Collected Annotations]
Wang Kentang stated: If there were external redness, swelling, and pain, the patient would undoubtedly feel it themselves. What is described here must be an internal abscess, hence it says: "accumulation of pus." Conditions like stomach abscess, lung abscess, and intestinal abscess have distinct differentiations. For stomach abscess, the Renying pulse is often prominent, and it is frequently mistaken for Taiyang disease, so careful examination is required.
Cheng Yingmao stated: The pulse and symptoms resemble Taiyang disease. If one fails to consider the signs of "possible pain site" and "normal diet," and mistakenly uses acrid-warm dispersing methods, it will aid the Yang heat. Alternatively, mistakenly using cold-cool methods to clear heat will trap the pathogen, causing deep harm.
Zhang Lu stated: If there is redness and swelling, it is due to heat stagnating in the meridians; if there is no swelling, the pathogen must remain in the zang-fu organs, manifesting as abscesses and pus depending on whether it is internal or external.
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A pulse that is Floating and Large: Floating represents Wind-Deficiency, and Large represents Strong Qi. When Wind and Qi contend with each other, it inevitably leads to wind-rashes (Urticaria), and the body becomes itchy. Itching is named "Xie Feng" (Leaking Wind); if prolonged, it develops into scaly crusts and leprosy-like conditions.
[Annotation]
When all six pulses are Floating and Large, Floating represents Wind-Deficiency, and Large represents Strong Qi. Strong implies Heat. When Wind and Heat contend, wind-rashes inevitably form. Body itching occurs because the muscles are deficient and heat forces outward from the exterior; this is named "Xie Feng." If it persists for a long time without healing, it becomes Jia Lai (scaly crusts). Jia Lai includes conditions like scabies, tinea, leprosy, and similar dermatological disorders.
[Collected Annotations]
Cheng Wuji stated: Jia Lai refers to Leprosy (Li Feng), characterized by sparse eyebrows and hair, dry sores on the body with a foul odor. The Classic says: "Pulse Wind becomes Li," which is exactly this.
Zhu Zhenheng stated: The Classic says: "All itching is due to Deficiency." Dry blood fails to nourish the muscle and interstices, hence the itching.
Fang Youzhi stated: The Classic says: "At the exterior interstices, it becomes Xie Feng."
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At the Cunkou (Radial Artery), various Micropulses indicate Loss of Yang; various Ru (Soft/Flaccid) pulses indicate Loss of Blood; various Ruo (Weak) pulses indicate Fever; various Jin (Tight) pulses indicate Cold. Various cases where Cold invades result in Jue (Cold Reversal), Yu Mao (Dizziness/Confusion), and Bu Ren (Numbness/Lack of sensation). This is because the Stomach lacks Grain Qi, the Spleen is stagnant and unsmooth, leading to oral tightness and inability to speak, trembling, and chattering.
[Commentary]
Ru pulse is Floating and forceless, indicating Yang Deficiency; how can it indicate Loss of Blood? Ruo pulse is Deep and forceless, indicating Yin Deficiency; how can it only indicate Fever? "Various Ru pulses indicate Loss of Blood" should be "Various Ru pulses indicate Wei Qi Deficiency"; "Various Ruo pulses indicate Fever" should be "Various Ruo pulses indicate Ying Qi Deficiency."
[Annotation]
"Cunkou" refers to the three positions: Cun, Guan, and Chi. "Various Micropulses" means that whenever a Micro pulse appears in any disease, it indicates Loss of Yang. "Various Ru pulses" means that whenever a Ru pulse appears, it indicates Wei Qi Deficiency. "Various Ruo pulses" means that whenever a Ruo pulse appears, it indicates Ying Qi Deficiency. "Various Jin pulses" means that whenever a Jin (Tight) pulse appears, it indicates Cold. "Various cases where Cold invades" refers to individuals with Micro, Ru, and Ruo pulses, who have lost Yang and lack Ying and Wei Qi; upon falling ill, they immediately show residual pathogenic pulses. The Jin pulse indicates Cold invading and causing Jue (Reversal). Jue in the center causes dizziness, confusion, coma, and insensitivity to pain and touch; Jue in the meridians causes trembling, chattering, and locked jaw preventing speech. This is because daily Stomach deficiency impairs grain processing, Spleen deficiency impairs transportation, and central deficiency cannot withstand external pathogens.
[Collected Annotations]
Cheng Zhi stated: In cases where Cold invades, it is because Yang is extremely deficient, allowing Yin-Cold to directly invade, thus causing Jue Ni (Cold Reversal). The reason for dizziness, confusion, loss of consciousness, stiffness, and lack of sensation is that the Stomach lacks Grain Qi and the Spleen does not circulate, causing locked jaw and inability to speak, external trembling, internal chattering, and Jue.
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Question: I have been challenged before; where does the Jin (Tight) pulse come from? Master said: Suppose there is profuse sweating or vomiting; due to Cold in the Lung interior, the pulse becomes Tight. Suppose there is coughing; due to drinking cold water, the pulse becomes Tight. Suppose there is diarrhea; due to Empty-Cold in the Stomach, the pulse becomes Tight.
[Annotation]
This elaborates on the previous section regarding why individuals with Loss of Yang and insufficient Ying-Wei Qi might present with a Jin (Tight) pulse. The challenge asks: Jin pulse is a sign of Cold-Excess, yet Empty-Cold also presents with Jin pulse; where does this come from? The Master said: Suppose there is surface deficiency from loss of sweat, chest deficiency from vomiting, or interior deficiency from diarrhea. Pathogenic Cold takes advantage of the deficiency to cause disease, whether through external contraction of Cold, internal consumption of cold water, or internal transformation of Cold-Yin, all can cause a Tight pulse. If seen with a Floating pulse and no sweating, it is Taiyang Cold-Disease Excess pathogen; if with sweating, it is Yang-Loss Deficient pathogen. If seen with a Deep pulse, abdominal pain, and constipation, it is Zhong-Han (Middle Jiao Cold) Excess pathogen; if with abdominal pain and diarrhea, it is Zhong-Han Deficient pathogen. By deduction, any Excess pulse transforming from Deficiency cannot simply be called Excess.
[Collected Annotations]
Cheng Yingmao stated: Jin indicates Cold, called "Cheng Mai" (Invading Pulse). Why is it listed among the Residual/Traumatic pulses? Answer: Deficiency allows others to invade; Excess invades others. This applies to all pulses, not just Jin.
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Cunkou pulse is Micro, Chi pulse is Tight. The person suffers from deficiency and wasting with excessive sweating. One knows that Yin is constantly present, and Yang is absolutely absent.
[Annotation]
The previous section discussed Micro and Tight pulses appearing via Floating and Deep qualities; this section discusses them appearing via Cun and Chi positions. Both are diagnoses of Yin Excess and Yang Loss, hence it says: "One knows Yin is constantly present, and Yang is absolutely absent." Saying "deficiency and wasting with excessive sweating" is a brief statement.
[Collected Annotations]
Cheng Zhi stated: This describes Cun Micro and Chi Tight as signs of deficiency, wasting, and excessive sweating. Cun Micro and Weak indicates Loss of Yang; Chi Tight and Rapid indicates Yin Excess. Yin Excess inside, Yang Absence outside, thus resulting in deficiency, wasting, and excessive sweating.
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Master said: When a patient's pulse is Micro and Se (Choppy), this is iatrogenic illness caused by the physician. Profuse sweating was induced, followed repeatedly by severe purgation. The patient has lost Blood. The illness should involve aversion to cold, followed later by fever, with no cessation. In the hot summer months, the patient desires to wear thick clothes; in the cold winter months, the patient desires to strip naked. The reason is: Yang Micro causes aversion to cold; Yin Weak causes fever. This is because the physician induced sweating, making Yang Qi Micro, and then purged severely, making Yin Qi Weak. In the fifth month, Yang Qi is at the exterior, and the Stomach is empty-cold. Because internal Yang is Micro and cannot overcome cold, the patient desires thick clothes. In the eleventh month, Yang Qi is in the interior, and the Stomach is vexed-heat. Because internal Yin is Weak and cannot overcome heat, the patient desires to strip naked. Furthermore, the Yin pulse is Slow and Se (Choppy), hence we know Blood has been lost.
[Commentary]
The last two sentences, "Furthermore, the Yin pulse is Slow and Se (Choppy), hence we know Blood has been lost," do not connect logically with the preceding text. They are either missing text or interpolations.
[Annotation]
The patient's pulse is Micro and Se (Choppy). Inquiry reveals this was caused by the physician inducing profuse sweating and repeatedly performing severe purgation. "Loss of Blood" is a shorthand for loss of Blood and Qi. Loss of Qi leads to Yang Micro; Yang Micro causes aversion to cold. Loss of Blood leads to Yin Weak; Yin Weak causes fever. With Yang Micro and Yin Weak, the illness involves aversion to cold followed by fever. In mild cases, the pathogen does not linger and resolves when encountering the controlling element; in severe cases, there is no cessation, worsening even when encountering the controlling element. Although aversion to cold occurs in hot summer, the desire for thick clothes arises because in the fifth month, Yang Qi is at the exterior, and the Stomach is empty-cold. Profuse sweating made Yang Qi Micro, so it cannot withstand cold. Although fever occurs in cold winter, the desire to strip naked arises because in the eleventh month, Yang Qi is in the interior, and the Stomach is vexed-heat. Repeated purgation made Yin Qi Weak, so it cannot withstand heat. This corresponds to the discussion in the Treatise: "Heat in the marrow, cold in the skin; cold in the marrow, heat in the skin," referring to chronic, entrenched alternating cold and heat diseases.
[Collected Annotations]
Wang Kentang stated: It is not necessarily that cold occurs only in summer and heat only in winter; this merely establishes the principle and discusses the theory.
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Cunkou pulse is Micro and Huan (Slow/Relaxed). Micro indicates Wei Qi [Deficiency], and if deficient, the skin is empty. Huan indicates Stomach Qi is Solid/Full. When Full, grains are digested and water is transformed. Grains entering the Stomach allow the Mai Dao (Vessel pathways) to flow; water entering the Jing (Vessels) allows Blood to form. When Ying (Nutritive) Qi is abundant, the skin must be [Solid]; San Jiao (Triple Burner) cuts off the Jing (Vessels/Norms), named Xue Beng (Blood Flooding/Metrorrhagia).
[Annotation]
Cunkou pulse is Micro and Huan. Micro indicates Wei Qi [Deficiency]; [Deficiency] makes the exterior empty. Huan indicates Stomach Qi is Full; Full means digesting grains and water. Grains entering the Stomach allow Qi in the vessel pathways to flow; water entering the Jing allows Blood in the collaterals to form. Now, Ying Qi becomes abundant while Wei Qi becomes [Deficient]; more Blood but less Qi. Qi and Blood lose their normal course, hence "San Jiao cuts off the Norms." Qi cannot control Blood, and Blood cannot return to the vessels, hence Blood flows recklessly and floods.
[Collected Annotations]
Cheng Wuji stated: Wei Qi warms the flesh and plumps the interstices. If Wei Qi is [Deficient], the skin cannot be warmed and plumped, thus becoming empty. The Classic says: "Huan means Stomach Qi is surplus." Surplus means Full, hence "Huan means Stomach Qi is Full." The *Neijing* says: "Food enters the Stomach, its essence overflows into the vessels," meaning grains entering the Stomach allow vessel pathways to flow. The *Zhenjing* says: "Drinks seep into the collaterals and mix with Blood," meaning water entering the Jing allows Blood to form. "Jing" means Norm/Constant. The San Jiao is the pathway of Qi. If Wei Qi is [Deficient], Qi does not follow the norm, hence San Jiao cuts off its norm.
Fang Youzhi stated: [Deficient] means unable to protect firmly; Full still means strong. Grains entering the Stomach until Blood forms follows the previous sentence about grains digesting and water transforming. "Beng" (Flooding) describes massive Yin Blood loss, indicating it cannot stop, like a mountain collapsing.
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Cunkou pulse is Micro and Se (Choppy). Micro indicates Wei Qi does not move; Se (Choppy) indicates Ying Qi does not reach. Ying and Wei cannot support each other, and the San Jiao has nothing to rely upon. The body experiences Bi (Obstruction) and Bu Ren (Numbness). Ying Qi insufficiency causes vexing pain and difficulty speaking; Wei Qi deficiency causes aversion to cold and frequent yawning. The San Jiao does not return to its sector. If the Upper Jiao does not return, there is belching and acid regurgitation; if the Middle Jiao does not return, it cannot digest grains and draw in food; if the Lower Jiao does not return, there is urinary incontinence.
[Annotation]
Regarding meridians and interstices, there is Ying and Wei; regarding Zang-Fu and interstices, there is San Jiao. Hence the Classic says: "Ying moves within the vessels, Wei moves outside." The Upper Jiao is governed by Heart and Lung; the Middle Jiao by Spleen and Stomach; the Lower Jiao by Liver and Kidney. Separately, there is Ying, Wei, and San Jiao; collectively, they all stem from the circulation of one Qi, named according to their location. A Micro and Se (Choppy) pulse indicates Ying and Wei insufficiency. Insufficiency means Ying and Wei cannot support each other in movement, and the San Jiao has no reliance, causing general Bi obstruction and numbness. Ying Qi insufficiency causes vexing body pain and difficulty speaking; Wei Qi insufficiency causes aversion to cold and frequent yawning. The Upper Jiao governs descending (descending the turbid part of the clear); the Lower Jiao governs ascending (ascending the clear part of the turbid); the Middle Jiao governs both ascending and descending (making the clear ascend and the turbid descend). Now, Ying and Wei do not support each other, and the San Jiao has no reliance, so it cannot return to its respective sectors and loses its function. If the Upper Jiao does not return, turbid Qi does not descend, causing belching and acid regurgitation. If the Middle Jiao does not return, ascending and descending contradict each other, so it cannot digest grains and ingest food. If the Lower Jiao does not return, clear Qi does not ascend, so it cannot constrain and results in urinary incontinence.
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Cunkou pulse is Micro and Se (Choppy). Micro indicates Wei Qi decline; Se (Choppy) indicates Ying Qi insufficiency. Wei Qi decline leads to a yellow complexion; Ying Qi insufficiency leads to a bluish-green complexion. Ying is the Root, Wei is the Leaf. If both Ying and Wei are Micro, the roots and leaves wither, leading to cold chills, coughing, and reversal, spitting fishy saliva, and expelling frothy sputum.
[Annotation]
This elaborates on the symptoms of Ying and Wei affecting the Upper Jiao. Yellow and green complexions are colors of Ying and Wei insufficiency. Aversion to cold with chills, coughing, spitting fishy saliva, and expelling frothy sputum are signs of Lung damage. The Lung governs skin and hair; skin and hair are the dwelling places of Ying and Wei. Thus, Lung damage causes skin contraction and hair loss, leading to Ying and Wei withering.
[Collected Annotations]
Cheng Wuji stated: Ying moving within vessels is the Root; Wei moving outside vessels is the Leaf. If roots and leaves are both Micro, the Qi of Yin and Yang declines.
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Cunkou pulse is Weak and Chi (Slow). Weak indicates Wei Qi is Micro; Chi (Slow) indicates Cold in Ying. Ying is Blood; Blood Cold causes fever. Wei is Qi; Qi Micro causes hunger in the heart/mind, emptiness and fullness despite hunger, and inability to eat.
[Commentary]
The end of the section, "hunger in the heart/mind, emptiness and fullness despite hunger, inability to eat," discusses the Spleen and Stomach, not Ying and Wei. Therefore, "Weak indicates Wei Qi is Micro" should be "Yang Qi is Micro"; "Chi indicates Cold in Ying" should be "Cold in the Spleen," so the context connects. Ying is Blood; how can Blood Cold cause fever? Wei is Qi; "Qi Micro" should be "Yang Qi Micro." Cold in the Spleen causes hunger in the heart/mind; reading the next section about Stomach Qi having surplus clarifies this.
[Annotation]
This elaborates on the symptoms of Ying and Wei affecting the Middle Jiao. Huan (Slow/Relaxed) diagnoses the Stomach; Chi (Slow) diagnoses the Spleen. The Stomach governs receiving grains; the Spleen governs transforming grains. Thus, the ability to eat belongs to the Stomach, and the ability to transform belongs to the Spleen. Now, with Yang Micro and Middle Cold, both Spleen and Stomach are diseased. Therefore, although there is hunger in the mind, emptiness and fullness prevent eating despite hunger.
[Collected Annotations]
Fang Youzhi stated: Emptiness and fullness despite hunger: Yang governs transforming grains. If Wei Yang declines and fails to transform grains, it results in emptiness, fullness, and inability to eat.
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Cunkou pulse is Weak and Huan (Slow/Relaxed). Weak indicates Yang Qi insufficiency; Huan indicates Stomach Qi has surplus. There is belching and acid regurgitation, sudden inability to swallow food, and Qi filling the upper Diaphragm.
[Annotation]
This further elaborates on Middle Jiao symptoms. Cunkou pulse is Weak and Huan. Weak indicates Yang Qi insufficiency; Huan indicates Stomach Qi has surplus. Insufficiency means the Spleen loses healthy transportation; surplus means the Stomach is strong and capable of eating. This is Stomach Strength and Spleen Weakness. Thus, although able to eat, digestion fails, causing acid regurgitation and belching, sudden failure of food to digest, and Qi filling and bloating the Diaphragm.
[Collected Annotations]
Fang Youzhi stated: "Yang Qi" refers to the Yang Qi in the Stomach; insufficiency means it cannot transform grains. "Stomach Qi" refers to the Grain Qi in the Stomach; surplus means retained food. Retained food stagnates and generates heat, causing belching, fullness, and acid regurgitation. This discusses internal injury from diet.
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Duyang pulse is Chi (Slow) and Huan (Relaxed); this is Stomach Qi following the normal channel. Duyang pulse is Floating and Shu (Rapid). Floating injures the Stomach; Rapid agitates the Spleen. This is not the original disease but is caused by the physician's inappropriate purgation. Ying and Wei sink inward. The Rapid pulse first becomes Micro, but the pulse reversely becomes only Floating. The person will definitely have hard stools, belching, and relief. Why say this? Originally, the Rapid pulse agitated the Spleen; since the Rapid pulse first became Micro, we know the Spleen Qi is disordered, hard stools occur, and belching brings relief. Now the pulse reversely becomes Floating, and the Rapid pulse changes to Micro. The pathogenic factor remains alone. The mind feels hungry, but pathogenic Heat cannot digest grains. There is tidal fever and thirst. The Rapid pulse should become Slow and Relaxed. If the pulse degrees before and after follow the method, the patient will feel hungry and want to eat, and the disease will heal. If the Rapid pulse does not cease at the proper time, malignant sores will arise.
[Annotation]
From here below, we differentiate Duyang and Shaoyin pulses. Duyang, also known as Chongyang, is located on the dorsum of the foot, three cun anterior to the malleolus at the pulsation point, representing the arterial pulse of the Yangming Stomach Meridian. Shaoyin, also known as Taixi, is located behind the medial malleolus at the pulsation point, representing the arterial pulse of the Foot-Shaoyin Kidney Meridian. Duyang and Shaoyin are ancient diagnostic methods. Yue (Bian Que) stated that although all twelve meridians have arterial pulses, he exclusively took the Cunkou to determine life and death because Cunkou is the great convergence of pulses. However, this method has not been practiced for a long time. In critical illnesses where the Cunkou pulse is not visible, diagnosing these can determine life and death. In ordinary times, it is better to use the Guan pulse as Duyang and the Chi pulse as Shaoyin. If the Duyang Stomach pulse is Chi (Slow) and Huan (Relaxed), the Stomach Qi is not diseased, like the normal channel. Now, the Duyang pulse is Floating and Rapid. Pressing it reveals forcelessness. Floating diagnoses the Fu organs; Floating and forceless indicates Stomach injury. Deep diagnoses the Zang organs; Rapid and forceless indicates Spleen injury. Inquiry reveals the patient was subjected to purgation by the physician, causing Ying and Wei Qi to sink inward. The previous Rapid pulse changing to Micro indicates Spleen Weakness; the Floating pulse remaining Floating and intensified indicates Stomach Strength. Stomach Strength means pathogenic factors remain alone, causing hard stools, tidal fever, and thirst. Spleen Weakness means Spleen Qi does not transport, so pathogenic Heat cannot digest grains; although hungry, the patient does not eat, and belching brings relief. If the physician treats appropriately before and after, the Floating and Rapid pulses should naturally become Slow and Relaxed like the normal channel, the patient will feel hungry and want to eat, and the disease will heal. If treatment is improper and the Rapid pulse never ceases, malignant sores will arise.
[Collected Annotations]
Fang Youzhi stated: Malignant sores and pus in stool are different, but both are due to Blood Heat.
Cheng Zhi stated: This discusses how improper purgation of a Chi (Slow) and Huan (Relaxed) Duyang pulse leads to Floating and Rapid changes.
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Duyang pulse is Floating and Se (Choppy); Shaoyin pulse follows the normal channel. The disease is in the Spleen. According to the method, there should be diarrhea. How do we know this? If the pulse is Floating and Large, it indicates Qi Excess and Blood Deficiency. Now, the Duyang pulse is Floating and Se (Choppy), hence we know Spleen Qi is insufficient and Stomach Qi is deficient. Because the Shaoyin pulse shows Xian (Wiry) and Floating only slightly, this is a harmonious pulse, hence called "following the normal channel." If it reversely becomes Slippery and Rapid, we know there will be pus in the stool.
[Commentary]
The two sentences, "If the pulse is Floating and Large, it indicates Qi Excess and Blood Deficiency," do not connect logically with the preceding text and are likely interpolations. Can a Shaoyin pulse of Xian (Wiry) and Floating be called "following the normal channel"? It should be corrected to "Deep and Slippery."
[Annotation]
Both Spleen and Kidney diseases can cause diarrhea. Now, the Duyang Stomach pulse is Floating and Se (Choppy), while the Shaoyin Kidney pulse is normal. This indicates the disease is in the Spleen, not the Kidney. How do we know? Floating is Yang, diagnosing the Stomach; Se (Choppy) is Yin, diagnosing the Spleen. The combination of Floating and Se (Choppy) indicates Spleen Qi insufficiency and Stomach Qi deficiency. Because the Shaoyin pulse appears Deep and Slippery, it is called "following the normal channel." If it is Deep, Slippery, and Rapid, it indicates Yang pathogen injuring Yin, hence we know there will be pus and blood in the stool.
[Collected Annotations]