一难曰。十二经中皆有动脉。独取寸口。以决五脏六腑死生吉凶之法。何谓也。然。寸口者。脉之
大会。手太阴之脉动也。
此章总冒五脏六腑十二经动脉。俱会于寸口。下文分晰十二经脉。一日夜五十会于寸口。荣卫血气。一
日夜会于寸口也。十二经者。手太阳手阳明手少阳足太阳足阳明足少阳为阳六经。从手走头。从头走
足。手太阴手少阴手厥阴足太阴足少阴足厥阴为阴六经。从足走胸。从胸走手。此十二经脉所行之直
路也。手太阴者。肺也。肺朝百脉。所以十二经统会于此。故曰寸口脉之大会也。
人一呼脉行三寸。一吸脉行三寸。呼吸定息。脉行六寸。人一日夜凡一万三千五百息。脉行五
十度周于身。
二刻为一度。二百七十息。脉行十六丈二尺为一周。一日夜五十周于寸口。下文言荣卫一周于寸口。
漏水下百刻。荣卫行阳二十五度。从寅至申。行阴二十五度。从申至寅。为一周也。故五十度复
会于手太阴寸口者。二刻一度。百刻五十度。行毕而复会。五脏六腑之终始。故取法于寸口也。
凡人之通身血脉。无处不周。无刻不运。谓呼吸定息。脉行六寸者。指手太阴肺脉为首而会也。譬如念佛
数珠有首有尾。转动一粒。则粒粒俱转。然自始至终。必以首粒为主。而定其数。犹肺脉为首行六寸。而通
身之脉莫不尽行六寸也。但十二经因各行其道。所以较荣卫速。一日夜五十周于身。而于寸口亦五十
会也。至荣卫血气。从中焦注手太阴肺。从肺注手阳明大肠。大肠注足阳明胃。从胃注足太阴脾。从脾注
手少阴心。从心注手太阳小肠。小肠注足太阳膀胱。膀胱注足少阴肾。从肾注手厥阴胞络。胞络注手少
阳三焦。三焦注足少阳胆。从胆注足厥阴肝。从肝复注于肺。此一日夜遍行于十二经。所以迟。故止行一
周。而于寅时在寸口亦一会也。
二难曰。脉有尺寸。何谓也。然。尺寸者。脉之大要会也。从关至尺。是尺内阴之所治也。从关至鱼
际。是寸口内阳之所治也。故分寸为尺。分尺为寸。
此章明寸阳尺阴。定三部脉之分寸也。寸脉名曰一寸。实在九分。阳数九也。尺脉名曰一尺。实在取一尺
中之一寸。分于部位。阴数十也。合阴阳之数。共长一寸九分。分寸为尺者。分寸内之三分为关部。分尺为
寸者。分尺内之四分为关部。则寸关尺每部应各得六分。三六一寸八分。余一分发在关前。即左名人迎。
右名气口也。经但言尺寸而不言关者。关居尺寸之中。而受尺寸所分之地。故不言关。而关在其中矣。
故阴得尺中一寸。阳得寸内九分。尺寸终始。一寸九分。故曰尺寸也。
此申明上文之义。以起下章。定十二经之脉位于寸关尺也。
三难（三难误列十八难）曰。脉有三部（寸关尺）部有四经。（每部四经共十二经）手有太阴（肺）阳明。（大肠）
足有太阳（膀胱）少阴。（肾）为上下部何谓也。
此以肺与大肠膀胱与肾。上下之脏腑问者。以起下文。定十二经之脉位于两手六部也。
然。手太阴（肺）阳明（大肠）金也。足少阴（肾）太阳（膀胱）水也。金生水。水流下行而不能上。故在下部也。
足厥阴（肝）少阳（胆）木也。生手太阳（小肠）少阴（心）火也。火炎上行而不能下。故为上部。手心主（厥阴胞络）
少阳（三焦）火。生足太阴（脾）阳明（胃）土。土主中宫。故在中部也。此皆五行子母更相生养者也。
两手寸口统属太阴。所以脉位从太阴起。手太阴。肺经也。手阳明。大肠经也。肺与大肠相为表里。俱属金。金位
居西。肺位在上。所以当在右寸也。足少阴。肾经也。足太阳。膀胱经也。肾与膀胱相为表里。俱属水。水位居北。
肾位在下。肺金生之。水流下而不能上。所以当在左尺也。足厥阴。肝经也。足少阳。胆经也。肝与胆
相为表里。俱属木。木位居东。肝位在左，肾水生之。木不能远水。所以当在于左关也。手太阳。小肠经也。手
少阴。心经也。心与小肠相为表里。俱属火。火位居南。心位在上。肝木生之。火炎上而不能下。所以当在左
寸也。手心主。即手厥阴胞络也。手少阳。三焦也。二经相为表里。同命门俱属相火。君火在上。臣火在下。所
以当在右尺也。足太阴脾经也。足阳明胃经也。脾与胃相为表里。俱属土。相火代君行令生之。土位居中。
所以当在右关也。此皆五行子母相生者也。以脏腑分发脉位。是天造地设。后人各执偏见。持论纷纷。使
学人难凭。如喻嘉言李士材张介宾相因而言大小肠配两寸为非。改配尺为是。又云。此非出于难经。乃
高阳生伪诀。又云。二肠不洁之腑。不应配心肺清高之脏。又云。按内经上竟上者。胸喉中事也。下竟下者。
少腹腰股膝胫足中事也。殊不知素问云。尺内两旁。则季胁也。尺外以候肾。尺里以候腹。中附上。左。外以
候肝。内以候膈。右。外以候胃。内以候脾。上附上。右。外以候肺。内以候胸中。左。外以候心。内以候膻中等句。
此候脉位之说也。亦并无二肠膀胱之定位。此内经专主五脏。以定脉位。而略于腑者。正见腑必随脏。脏必通腑也。至
上竟上下竟下二句。是审病之所也。下文三部主疾。即是其义。何可借此牵扯。且人之脏腑。
俱应五行。如大肠属庚金。肺属辛金。庚辛一气也。小肠属丙火。心属丁火。丙丁一气也。故越人定十二经
之脉位。遵内经之手配手足配足。皆应五行一气之理。今以一脏腑分持于两手。岂非错乱五行乎。以右
寸手阳明大肠改配左尺足少阴肾位。岂非混杂手足乎。若云二肠不洁之腑。不应配心肺清高之脏。则手太阳小肠之经。
手阳明大肠之经。亦不应上至于头矣。余意三子之见。不过就脏腑高下而论。孰意越人
已揭高下及不净之义于四十难。剖晰极明。岂诸公未见难经之全文耶。抑见之而不解耶。抑好奇而故为之驳耶。抑驳之
而虑后人不服。而云高阳生之伪诀耶。
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。（此段以脉候病）上部法天。主胸以
上至头之有疾也。中部法人。主膈以下至脐之有疾也。下部法地。主脐以下至足之有疾也。审
而刺之者也。（此段按上下部位针病）
此言寸关尺三部。俱有浮中沉之三候。每部各三候。而为九候也。此则用药主治也。上中下三部。言人身上中下
三停也。九候言每停分天地人三部。此则用针主治也。故用审而刺之者也。坊本误人为下部法而应乎地。
四难曰。脉有阴阳之法。何谓也。然。呼出心与肺。吸入肾与肝。呼吸之间。脾受谷味也。（别刻云受谷味三字亦赘
辞余谓最紧要盖中州有谷味能主乎呼吸也）其脉在中。浮者阳也。沉者阴也。故曰阴阳也。
此章言脉之阴阳。虽在于尺寸。然阴阳之气。又在于浮沉。如心肺居上。阳也。呼出必由之。肾肝居下。阴也。
吸入必归之。脾受谷味而在中。则呼出吸入无不因之。故诊脉之法。浮取乎心肺之阳。沉取乎
肾肝之阴。而中应乎脾胃也。曰阴阳。则脾土居中。兼乎阴阳矣。前章以脏腑定于脉位。此下言脏腑应乎脉
位。乃见经文先后层次。向因误列而晦也。
心肺俱浮。何以别之。然。浮而大散者心也。浮而短涩者肺也。肝肾俱沉。何以别之。然。牢而长
者肝也。按之濡举指来实者肾也。脾主中州。故其脉在中。是阴阳之法也。
此言浮中沉按取阴阳之法。下文复明六脉阴阳之义。
脉有一阴一阳。一阴二阳。一阴三阳。有一阳一阴。一阳二阴。一阳三阴。如此之言。寸口有六脉
俱动耶。然。此言者。非有六脉俱动也。谓浮沉长短滑涩也。浮滑长。阳也。沉短涩。阴也。所谓一阴一
阳者。谓脉来沉而滑也。（左尺为顺右寸为逆）一阴二阳者。谓脉来沉滑而长也。（左关为顺右关为逆）一阴三阳者。谓
脉来浮滑而长。时一沉也。（左寸为顺右尺为逆）所谓一阳一阴者。谓脉
来浮而涩也。（右寸为顺左关为逆）一阳二阴者。谓脉来长而沉涩也。（左关为顺右关为逆）一阳三阴者。谓脉来沉涩而
短。时一浮也。（左尺为顺右寸为逆）各以其经所在名病逆顺也。
此一节言阴阳之脉。合心肺肾肝之逆顺。经所在。即十二经之所在也。假如一阴一阳之脉。沉而滑也。见
于左尺。肾与膀胱之经为顺。见于左寸。心与小肠之经为逆。亦相克之意也。六部仿此。左三部沉滑居多。
阳中之阴也。右三部浮涩居多。阴中之阳也。
五难曰。脉有轻重。何谓也。然。初持脉如三菽之重。与皮毛相得者。肺部也。如六菽之重。与血脉
相得者。心部也。如九菽之重。与肌肉相得者。脾部也。如十二菽之重。与筋平者。肝部也。按之至
骨。举指来疾者。肾部也。故曰轻重也。
此承上章言浮中沉之按法。候肺心脾肝肾之部也。
六难曰。脉有阴盛阳虚。阳盛阴虚。何谓也。然。浮之损小。沉之实大。故曰。阴盛阳虚。沉之损小。浮之实大。
故曰。阳盛阴虚。是阴阳虚实之意也。
此章亦承上章以浮中沉之按法。察阴阳虚盛之义也。损小实大者。虚脉盛脉之纲领也。学人自当会意而推展之。
七难曰。经言少阳之至。乍大乍小。乍短乍长。阳明之至。浮大而短。太阳之至。洪大而长。太阴之至。紧大而长。
少阴之至。紧细而微。厥阴之至。沉短而敦。（敦迫也阳将动也）此六者。是平脉也。将病脉耶。然。
皆王脉也。其气以何月各王几日。然。冬至后。复得甲子少阳王。（十一月甲子至正月）复得甲子阳明王。（正月甲子
至三月）复得甲子太阳王。（三月甲子至五月）复得甲子太阴王。（五月甲子至七月）复得甲子少阴王。（七月甲子至九月）
复得甲子厥阴王。（九月甲子至十一月）王各六十日。六六三百六十日。以成一岁。此三阴三阳之王时日大要也。
此章详言六气之旺脉。然三阳三阴经之旺脉。亦可以此类推。
八难曰。寸口脉平而死者。何谓也。然。诸十二经脉者。皆系于生气之原。所谓生气之原者。
谓十二经之根本也。谓肾间动气也。此五脏六腑之本。十二经之根。呼吸之门。三焦之原。一名守
邪之神。故气者人之根本也。根绝则茎叶枯矣。寸口脉平而死者。生气独绝于内也。
此章首明命门三焦一气同原之义。所谓生气之原者。即两肾中间命门原也。呼出气起于此。吸
入气纳于此。故十二经脉之气。皆系于此。所以为五脏六腑之本。十二经之根。呼吸之门。三焦之原也。人有此原
气。邪气不能伤其身。守于内。而充于外。故曰守邪之神。若此气绝。犹草木之根绝。茎叶即
枯。虽寸口脉平。必死。若此气未绝。虽寸口脉无。亦不死也。是即十四难之上部无脉。下部有脉。虽困无能为害也。
九难曰。何以别知脏腑之病耶。然。数者腑也。迟者脏也。数则为热。迟则为寒。诸阳为热。
诸阴为寒。故以别知脏腑之病也。
此章专重分别脏腑之病。言数脉腑也。迟脉脏也。数则腑病为热。迟则脏病为寒。诸阳皆属于腑为热。诸
阴皆属于脏为寒。以此分别脏腑之病。无遗也。后人议数则为热句。似有未妥。每见阳虚之病。
脉亦急数。投桂附而即平。殊不知数则为热。数字即腑字也。迟则为寒。迟字即脏字也。甚矣。读古人书未经苦心体
会。岂可轻议哉。此章但言脏腑不同。不言病与虚实。故下章申明脉病诊虚实之义。
十难曰。人有三虚三实。何谓也。然。有脉之虚实。有病之虚实。有诊之虚实也。脉之虚实者。濡者
为虚。紧牢者为实。病之虚实者。出者为虚。入者为实。言者为虚。不言者为实。缓者为虚。
急者为实。诊之虚实者。濡（濡软也）者为虚。牢（牢硬也）者为实。痒者为虚。痛者为实。外
痛内快为外实内虚。内痛外快为内实外虚。故曰虚实也。
此结上文脉病三虚三实也。然虚之一字。最重者肾。故下章详言肾气尽之脉也。
十一难曰。经言脉不满五十动而一止。一脏无气者。何脏也。然。人吸者随阴入。呼者
因阳出。今吸不能至肾。至肝而还。故知一脏无气者。肾气先尽也。（吸者。阳随阴入。呼者。阴因阳出。阳不能荣于下。
惟至肝而还者。因肾气先尽。而不能受吸入之气也。故有
下章汲汲乎补肾之法。或四十三十动一止。又当以肝脾之气类推也。）
十二难曰。经言。东方实。西方虚。泻南方。补北方。何谓也。然。金木水火土。当更相平。东方木也。西方金也。
木欲实。金当平之。火欲实。水当平之。土欲实。木当平之。金欲实。火当平之。水欲实。土当平之。东方者肝也。则
知肝实。西方者肺也。则知肺虚。泻南方火。补北方水。南方火。火者木之子也。北方水。水者木之母也。水胜火。子
能令母实。母能令子虚。故泻火补水。欲令金不得平木也。经曰。不能治其虚。何问其余。此之谓也。（读此章乃见补肾
之法。出自越人。盖因肾水足。则金不耗。而肺不虚。肾水足。则木得养。而肝不燥。肝不燥。则木不侮脾而脾足。脾
第一难说：十二经脉中都有动脉搏动，唯独选取寸口脉，来判定五脏六腑的死生吉凶，这是什么意思呢？回答说：寸口，是脉气大会聚的地方，属于手太阴肺经的动脉。
这一章总括了五脏六腑十二经脉的动脉，都汇聚于寸口。下文将详细分析十二经脉，一昼夜五十次会合于寸口，营卫血气也在一昼夜会合于寸口。十二经脉中，手太阳、手阳明、手少阳、足太阳、足阳明、足少阳为阳经六条，从手走向头，从头走向足；手太阴、手少阴、手厥阴、足太阴、足少阴、足厥阴为阴经六条，从足走向胸，从胸走向手。这是十二经脉运行的直路。手太阴经对应肺脏。肺朝百脉，所以十二经脉统汇于此，因此说寸口是脉气的大会聚处。
人每呼气一次，脉气运行三寸；每吸气一次，脉气运行三寸。呼吸定息（一呼一吸之间），脉气运行六寸。人一昼夜共呼吸一万三千五百次，脉气运行五十周遍全身。
两刻钟为一度，二百七十息，脉气运行十六丈二尺为一周。一昼夜在寸口会合五十周。下文讲到营卫一周于寸口，漏水下百刻，营气行于阳分二十五度，从寅时到申时；行于阴分二十五度，从申时到寅时，这是一周。所以五十周后再次会合于手太阴寸口，是因为两刻一度，百刻五十度，行完再会合，这是五脏六腑的始终规律，所以取法于寸口脉。
大凡人的全身血脉，无处不周流，无时不运行。所谓“呼吸定息，脉行六寸”，是指以手太阴肺脉为首而会合。譬如念佛用的数珠，有首有尾，转动一粒，则粒粒俱转。然而自始至终，必须以首粒为主，来确定总数。就像肺脉为首行六寸，而全身之脉无不各自行六寸。只是十二经脉各自走其道路，所以比营卫运行速度快。一昼夜在全身运行五十周，而在寸口也会合五十次。至于营卫血气，从中焦注入手太阴肺经，从肺经注入手阳明大肠经，从大肠经注入足阳明胃经，从胃经注入足太阴脾经，从脾经注入手少阴心经，从心经注入手太阳小肠经，从小肠经注入足太阳膀胱经，从膀胱经注入足少阴肾经，从肾经注入手厥阴心包络经，从心包络经注入手少阳三焦经，从三焦经注入足少阳胆经，从胆经注入足厥阴肝经，从肝经再注入肺经。这样一昼夜遍行于十二经脉，所以速度较慢。因此只运行一周，而在寅时在寸口也只有一次会合。
第二难说：脉有寸和尺，是什么意思呢？回答说：寸和尺，是脉气的主要会合点。从关部到尺部，是尺内阴气所治理的部位；从关部到鱼际，是寸口内阳气所治理的部位。所以分寸为尺，分尺为寸。
这一章阐明寸属阳、尺属阴，确定三部脉的寸、关、尺分部。寸脉名叫一寸，实际长度是九分，因为阳数是九。尺脉名叫一尺，实际取一尺中的一寸，按部位划分，阴数是十。合阴阳之数，共长一寸九分。所谓“分寸为尺”，是将寸内的三分定为关部；“分尺为寸”，是将尺内的四分定为关部。这样寸、关、尺每部应各得六分，三六一寸八分，余下一分发在关前，即左名人迎，右名气口。经文只说尺寸而不说关，是因为关位于尺寸之中，接受尺寸所分的部位，所以不说关，而关就在其中了。所以阴得尺中一寸，阳得寸内九分，尺寸终始共一寸九分，所以叫尺寸。
这里申明上文的意义，以引出下一章，确定十二经脉的脉位位于寸、关、尺。
第三难（注：原书误列为十八难）说：脉有三部（寸、关、尺），每部有四经（每部四经共十二经）。手有太阴（肺）、阳明（大肠），足有太阳（膀胱）、少阴（肾），这作为上部和下部，是什么意思呢？
这里以肺与大肠、膀胱与肾的上下脏腑关系提问，以引出下文，确定十二经脉的脉位位于两手六部。
回答说：手太阴（肺）和阳明（大肠）属金，足少阴（肾）和太阳（膀胱）属水。金生水，水流向下而不能向上，所以在下部。足厥阴（肝）和少阳（胆）属木，生手太阳（小肠）和少阴（心）的火。火炎上而不能下行，所以在上部。手心主（厥阴心包络）和少阳（三焦）属火，生足太阴（脾）和阳明（胃）的土。土主中宫，所以在中部。这都是五行子母相生相养的关系。
两手寸口统属于太阴，所以脉位从太阴开始。手太阴是肺经，手阳明是大肠经。肺与大肠互为表里，都属金，金位居西，肺位在上，所以应当在右寸。足少阴是肾经，足太阳是膀胱经。肾与膀胱互为表里，都属水，水位居北，肾位在下，由肺金所生，水流下而不能上，所以应当在左尺。足厥阴是肝经，足少阳是胆经。肝与胆互为表里，都属木，木位居东，肝位在左，由肾水生养，木不能远离水，所以应当在左关。手太阳是小肠经，手少阴是心经。心与小肠互为表里，都属火，火位居南，心位在上，由肝木生养，火炎上而不能下，所以应当在左寸。手心主即手厥阴心包络，手少阳是三焦。这两经互为表里，同命门俱属相火，君火在上，臣火在下，所以应当在右尺。足太阴是脾经，足阳明是胃经。脾与胃互为表里，都属土，相火代君行令生之，土位居中，所以应当在右关。这都是五行子母相生的关系。以脏腑分配脉位，是天造地设。后人各执偏见，持论纷纷，使学习者难以凭信。如喻嘉言、李士材、张介宾等人沿袭说法，认为大小肠配两寸是错误的，改配尺部才是正确的。又说，这不是出自《难经》，而是高阳生的伪诀。又说，大肠和小肠是不洁净的腑，不应配心肺清高的脏。又说，按照《内经》“上竟上者，胸喉中事也；下竟下者，少腹腰股膝胫足中事也”。殊不知《素问》说：“尺内两旁，则季胁也。尺外以候肾，尺里以候腹。中附上，左外以候肝，内以候膈；右外以候胃，内以候脾。上附上，右外以候肺，内以候胸中；左外以候心，内以候膻中”等句，这是候脉位的说法。这也并没有大肠、小肠、膀胱的固定位置。《内经》专门主于五脏，以确定脉位，而对腑略去，正是见腑必随脏，脏必通腑的道理。至于“上竟上、下竟下”两句，是审察病所在部位的意思。下文三部主疾，就是其含义。怎么可以借此牵扯？况且人的脏腑，都应五行。如大肠属庚金，肺属辛金，庚辛一气；小肠属丙火，心属丁火，丙丁一气。所以越人（扁鹊）确定十二经脉的脉位，遵循《内经》的手配手足配足的原则，都应五行一气之理。现在将一个脏腑分持于两手，难道不是错乱五行吗？将右寸的手阳明大肠改配左尺的足少阴肾位，难道不是混杂手足吗？如果说大肠、小肠是不洁净的腑，不应配心肺清高的脏，那么手太阳小肠经、手阳明大肠经，也不应上行至头部了。我的意见，这三人的见解，不过是就脏腑的高下来论述，谁料想越人已在第四十难中揭示了高下及不净的含义，剖析极其明白，难道诸位先生没见到《难经》全文吗？还是见到了却不理解？还是好奇而故意驳斥？还是驳斥后担心后人不服，而说是高阳生的伪诀呢？
脉有三部九候，各自主管什么疾病呢？回答说：三部，指寸、关、尺。九候，指浮、中、沉。（此段以脉候病）上部法天，主管胸部以上至头部的疾病。中部法人，主管膈以下至脐部的疾病。下部法地，主管脐以下至足部的疾病。审察后针刺治疗。（此段按上下部位针病）
这里讲寸、关、尺三部，都有浮、中、沉三候。每部各三候，共为九候。这是用药主治的方法。上、中、下三部，指人身上的上、中、下三停。九候指每停分天、地、人三部。这是用针主治的方法。所以说要审察后针刺。坊间版本误将“人”写为“下部法而应乎地”。
第四难说：脉有阴阳的法度，是什么意思呢？回答说：呼气出，关联心和肺；吸气入，关联肾和肝。呼吸之间，脾受纳水谷精微。（别刻本云“受谷味”三字也是赘辞，我认为最紧要，盖中州有谷味能主宰呼吸。）脉象在中。浮取为阳，沉取为阴。所以叫阴阳。
这一章讲脉的阴阳，虽然在于寸和尺，但阴阳之气，又在于浮和沉。如心和肺居上，属阳，呼气必经由此；肾和肝居下，属阴，吸气必归于此。脾受纳水谷精微而在中，则呼气和吸气无不依赖它。所以诊脉的方法，浮取以候心肺之阳，沉取以候肾肝之阴，而中取应乎脾胃。说阴阳，则脾土居中，兼乎阴阳。前章以脏腑定于脉位，此下讲脏腑应乎脉位，才见经文的先后层次，先前因误列而晦涩。
心和肺的脉都浮，如何区别呢？回答说：浮而大散的是心脉，浮而短涩的是肺脉。肝和肾的脉都沉，如何区别呢？回答说：牢而长的是肝脉，按之濡软、举指来实的是肾脉。脾主中州，所以其脉在中。这就是阴阳的法度。
这里讲浮、中、沉按取的阴阳法度。下文再明确六脉阴阳的意义。
脉有一阴一阳、一阴二阳、一阴三阳，有一阳一阴、一阳二阴、一阳三阴。像这样的话，寸口有六脉同时跳动吗？回答说：这话不是说有六脉同时跳动，而是指浮、沉、长、短、滑、涩。浮、滑、长为阳，沉、短、涩为阴。所谓一阴一阳，指脉来沉而滑。（左尺为顺，右寸为逆）。一阴二阳，指脉来沉、滑而长。（左关为顺，右关为逆）。一阴三阳，指脉来浮、滑而长，偶尔一次沉。（左寸为顺，右尺为逆）。所谓一阳一阴，指脉来浮而涩。（右寸为顺，左关为逆）。一阳二阴，指脉来长而沉、涩。（左关为顺，右关为逆）。一阳三阴，指脉来沉、涩而短，偶尔一次浮。（左尺为顺，右寸为逆）。根据各经所在的部位来判断病的逆顺。
这一段讲阴阳之脉，结合心、肺、肾、肝的逆顺。经所在，即十二经所在的部位。假如一阴一阳的脉，沉而滑，见于左尺，肾与膀胱之经为顺；见于左寸，心与小肠之经为逆，这也是相克的意思。六部仿照此类。左三部沉滑居多，是阳中之阴；右三部浮涩居多，是阴中之阳。
第五难说：脉有轻重，是什么意思呢？回答说：初持脉时，如三颗豆子重的力度，与皮毛相得的，是肺脉。如六颗豆子重的力度，与血脉相得的，是心脉。如九颗豆子重的力度，与肌肉相得的，是脾脉。如十二颗豆子重的力度，与筋平齐的，是肝脉。按之至骨，举指来疾的，是肾脉。所以叫轻重。
这里承接上一章讲浮、中、沉的按法，以候肺、心、脾、肝、肾的脉位。
第六难说：脉有阴盛阳虚、阳盛阴虚，是什么意思呢？回答说：浮取损小，沉取实大，所以叫阴盛阳虚。沉取损小，浮取实大，所以叫阳盛阴虚。这是阴阳虚实的意思。
这一章也承接上一章以浮、中、沉的按法，考察阴阳虚盛的意义。损小、实大是虚脉、盛脉的纲领。学习者自当领会意旨而推展。
第七难说：经文说少阳之至，乍大乍小，乍短乍长；阳明之至，浮大而短；太阳之至，洪大而长；太阴之至，紧大而长；少阴之至，紧细而微；厥阴之至，沉短而敦。（敦，迫也，阳将动也）。这六种，是平脉吗？将要生病的脉吗？回答说：都是旺脉。它们的气在何月各旺几日呢？回答说：冬至后，复得甲子日，少阳旺。（十一月甲子至正月）。复得甲子日，阳明旺。（正月甲子至三月）。复得甲子日，太阳旺。（三月甲子至五月）。复得甲子日，太阴旺。（五月甲子至七月）。复得甲子日，少阴旺。（七月甲子至九月）。复得甲子日，厥阴旺。（九月甲子至十一月）。各旺六十日，六六三百六十日，构成一岁。这是三阴三阳旺时日的大要。
这一章详言六气的旺脉。然三阳三阴经的旺脉，也可以此类推。
第八难说：寸口脉平和却死了，是什么意思呢？回答说：所有的十二经脉，都系于生气之原。所谓生气之原，就是十二经的根本。所谓肾间动气。这是五脏六腑的本源，十二经的根基，呼吸的门户，三焦的原动力。又名守邪之神。所以气是人的根本。根绝则茎叶枯死。寸口脉平和却死了，是因为生气独绝于体内。
这一章首先阐明命门、三焦一气同原的意义。所谓生气之原，即两肾中间的命门原。呼出气起于此，吸入气纳于此。所以十二经脉之气，都系于此。所以为五脏六腑之本，十二经之根，呼吸之门，三焦之原。人有此元气，邪气就不能伤害身体，守于内而充于外，所以叫守邪之神。如果此气绝，犹如草木根绝，茎叶即枯。虽寸口脉平，必死。如果此气未绝，虽寸口脉无，亦不死。这就是第十四难所说的上部无脉，下部有脉，虽困也无能为害。
第九难说：如何分别知道脏腑的疾病呢？回答说：数脉属腑，迟脉属脏。数则为热，迟则为寒。诸阳为热，诸阴为寒。所以以此分别知道脏腑的疾病。
这一章专重分别脏腑的疾病。言数脉属腑，迟脉属脏。数则腑病为热，迟则脏病为寒。诸阳皆属于腑为热，诸阴皆属于脏为寒。以此分别脏腑的疾病，没有遗漏。后人议论“数则为热”一句，似有不妥。常见阳虚之病，脉也急数，投桂枝、附子而即平。殊不知“数则为热”，数字即腑字；“迟则为寒”，迟字即脏字。读古人书未经苦心体会，岂可轻议哉！这一章只讲脏腑不同，不讲病与虚实，所以下一章申明脉病诊虚实之义。
第十难说：人有三虚三实，是什么意思呢？回答说：有脉的虚实，有病的虚实，有诊的虚实。脉的虚实，濡软者为虚，紧牢者为实。病的虚实，出者为虚，入者为实。言者为虚，不言者为实。缓者为虚，急者为实。诊的虚实，濡软（濡软也）者为虚，牢硬（牢硬也）者为实。痒者为虚，痛者为实。外痛内快为外实内虚，内痛外快为内实外虚。所以叫虚实。
这里总结上文脉、病、诊三虚三实。然而虚之一字，最重的是肾，所以下章详言肾气尽之脉。
第十一难说：经文说脉不满五十动而一止，一脏无气，是哪一脏呢？回答说：人吸气时，气随阴而入；呼气时，气因阳而出。现在吸气不能至肾，至肝而还，所以知道一脏无气，是肾气先尽。（吸气时，阳随阴入；呼气时，阴因阳出。阳不能荣于下，惟至肝而还，是因为肾气先尽，而不能受吸入之气。所以下章汲汲乎补肾之法。或四十、三十动一止，又当以肝脾之气类推。）
第十二难说：经文说：东方实，西方虚，泻南方，补北方，是什么意思呢？回答说：金、木、水、火、土，应当更相平衡。东方属木，西方属金。木欲实，金当平之；火欲实，水当平之；土欲实，木当平之；金欲实，火当平之；水欲实，土当平之。东方者肝，则知肝实；西方者肺，则知肺虚。泻南方火，补北方水。南方火，火者木之子也；北方水，水者木之母也。水胜火，子能令母实，母能令子虚。故泻火补水，欲令金不得平木。经文说：不能治其虚，何问其余。就是这个意思。（读此章乃见补肾之法，出自越人。盖因肾水足，则金不耗，而肺不虚；肾水足，则木得养，而肝不燥；肝不燥，则木不侮脾而脾足。脾
Difficulty 1 states: Among the twelve meridians, all have pulsating arteries. Why is only the Cun Kou (Cun Kou pulse, located at the radial artery) selected to determine the life and death, auspiciousness and inauspiciousness of the Zang-Fu organs? The response is: Cun Kou is the great assembly of pulses, belonging to the pulsating artery of the Hand Taiyin Lung Meridian.
This chapter summarizes that the arterial pulses of the five Zang and six Fu organs and the twelve meridians all converge at Cun Kou. The following text will analyze the twelve meridians in detail; within one day and night, they meet at Cun Kou fifty times, and the Ying (Nutritive) and Wei (Defensive) Qi and blood also converge at Cun Kou within one day and night. Among the twelve meridians, the Hand Taiyang, Hand Yangming, Hand Shaoyang, Foot Taiyang, Foot Yangming, and Foot Shaoyang are the six Yang meridians, running from the hand to the head, and from the head to the foot. The Hand Taiyin, Hand Shaoyin, Hand Jueyin, Foot Taiyin, Foot Shaoyin, and Foot Jueyin are the six Yin meridians, running from the foot to the chest, and from the chest to the hand. This is the direct path of the twelve meridians. The Hand Taiyin meridian corresponds to the Lung organ. The Lung governs all vessels, so the twelve meridians converge here; thus, it is said that Cun Kou is the great assembly of pulses.
In one exhalation, the pulse travels three cun; in one inhalation, the pulse travels three cun. Between a complete breath cycle (exhalation and inhalation), the pulse travels six cun. In one day and night, a person breathes 13,500 times, and the pulse circulates fifty times around the body.
Two ke (ancient time units) constitute one degree, involving 270 breaths, during which the pulse travels sixteen zhang and two chi for one circuit. Within one day and night, it meets at Cun Kou fifty times. The following text mentions that Ying and Wei Qi complete one circuit at Cun Kou over one hundred ke of water clock measurement. Ying Qi travels through the Yang aspects twenty-five degrees, from Yin hour to Shen hour; it travels through the Yin aspects twenty-five degrees, from Shen hour to Yin hour, constituting one circuit. Thus, after fifty circuits, it reconvenes at the Hand Taiyin Cun Kou because two ke equal one degree, and one hundred ke equal fifty degrees; upon completion, it reconvenes. This represents the beginning and end of the five Zang and six Fu organs, hence the method of taking the pulse at Cun Kou.
Generally, the blood vessels of the entire body circulate everywhere and operate at all times. The statement "between a complete breath cycle, the pulse travels six cun" refers to the convergence starting with the Hand Taiyin Lung Meridian. It is like a Buddhist prayer bead, which has a head and a tail; turning one bead turns all beads. However, from beginning to end, the first bead must be the main reference to determine the total count. Similarly, since the Lung meridian leads the movement of six cun, all pulses in the body effectively travel six cun. However, because the twelve meridians follow their own paths, their speed differs from that of Ying and Wei Qi. They circulate fifty times around the body in one day and night, and also meet at Cun Kou fifty times. As for Ying, Wei, blood, and Qi, they flow from the Middle Jiao into the Hand Taiyin Lung Meridian, then to the Hand Yangming Large Intestine Meridian, then to the Foot Yangming Stomach Meridian, then to the Foot Taiyin Spleen Meridian, then to the Hand Shaoyin Heart Meridian, then to the Hand Taiyang Small Intestine Meridian, then to the Foot Taiyang Bladder Meridian, then to the Foot Shaoyin Kidney Meridian, then to the Hand Jueyin Pericardium Meridian, then to the Hand Shaoyang Sanjiao Meridian, then to the Foot Shaoyang Gallbladder Meridian, then to the Foot Jueyin Liver Meridian, and finally back to the Lung Meridian. This completes a circulation through the twelve meridians in one day and night, which is why it is slower. Therefore, it completes only one circuit, meeting once at Cun Kou during the Yin hour.
Difficulty 2 states: What is meant by the Cun (Inch) and Chi (Foot) positions of the pulse? The response is: Cun and Chi are the major assemblies of the pulse. From the Guan (Bar) position to the Chi position is the area governed by Yin within Chi. From the Guan position to the Yuji (LU10) point is the area governed by Yang within Cun. Hence, Cun is divided to form Chi, and Chi is divided to form Cun.
This chapter clarifies that Cun belongs to Yang and Chi belongs to Yin, defining the division of the three positions (Cun, Guan, Chi). The Cun pulse is named one Cun but actually measures nine fen, as nine is the number of Yang. The Chi pulse is named one Chi but actually measures one Cun within that span, divided by position, where ten is the number of Yin. Combining the numbers of Yin and Yang, the total length is one Cun and nine fen. "Dividing Cun to form Chi" means dividing the inner three fen of Cun to define the Guan position. "Dividing Chi to form Cun" means dividing the inner four fen of Chi to define the Guan position. Thus, each of the Cun, Guan, and Chi positions should measure six fen. Three times six equals one Cun and eight fen, leaving one fen remaining before the Guan, which is named Renying on the left and Qikou on the right. The classic mentions only Cun and Chi, not Guan, because Guan lies between them, receiving the divisions from both; thus, Guan is implied without being explicitly stated. Therefore, Yin obtains one Cun from Chi, and Yang obtains nine fen from Cun. The start and end of Cun and Chi total one Cun and nine fen, hence the term "Cun Chi."
This reiterates the previous meaning to introduce the next chapter, determining the pulse positions of the twelve meridians at Cun, Guan, and Chi.
Difficulty 3 (erroneously listed as Difficulty 18 in some editions) states: The pulse has three positions (Cun, Guan, Chi), and each position has four meridians (four meridians per position totaling twelve meridians). The Hand has Taiyin (Lung) and Yangming (Large Intestine); the Foot has Taiyang (Bladder) and Shaoyin (Kidney). How do these constitute the upper and lower parts?
This question uses the relationship of the upper and lower Zang-Fu organs (Lung/Large Intestine and Bladder/Kidney) to lead into the determination of the pulse positions of the twelve meridians in the six positions of both hands.
The response is: The Hand Taiyin (Lung) and Yangming (Large Intestine) belong to Metal. The Foot Shaoyin (Kidney) and Taiyang (Bladder) belong to Water. Metal generates Water; water flows downward and cannot rise, hence they are in the lower part. The Foot Jueyin (Liver) and Shaoyang (Gallbladder) belong to Wood. Wood generates the Fire of the Hand Taiyang (Small Intestine) and Shaoyin (Heart). Fire flares upward and cannot descend, hence they are in the upper part. The Hand Jueyin Pericardium and Shaoyang (Sanjiao) belong to Fire. Fire generates the Earth of the Foot Taiyin (Spleen) and Yangming (Stomach). Earth governs the Central Palace, hence it is in the middle part. These are all relationships of mutual generation and nourishment among the Five Elements via parent-child connections.
Both hands' Cun Kou positions are dominated by Taiyin, so the pulse positions begin with Taiyin. The Hand Taiyin is the Lung Meridian, and the Hand Yangming is the Large Intestine Meridian. The Lung and Large Intestine are exterior-interior pairs, both belonging to Metal. Metal is positioned in the West, and the Lung is positioned superiorly, so it corresponds to the Right Cun. The Foot Shaoyin is the Kidney Meridian, and the Foot Taiyang is the Bladder Meridian. The Kidney and Bladder are exterior-interior pairs, both belonging to Water. Water is positioned in the North, and the Kidney is positioned inferiorly, generated by Lung Metal; water flows down and cannot rise, so it corresponds to the Left Chi. The Foot Jueyin is the Liver Meridian, and the Foot Shaoyang is the Gallbladder Meridian. The Liver and Gallbladder are exterior-interior pairs, both belonging to Wood. Wood is positioned in the East, and the Liver is positioned on the left, nourished by Kidney Water; wood cannot be far from water, so it corresponds to the Left Guan. The Hand Taiyang is the Small Intestine Meridian, and the Hand Shaoyin is the Heart Meridian. The Heart and Small Intestine are exterior-interior pairs, both belonging to Fire. Fire is positioned in the South, and the Heart is positioned superiorly, generated by Liver Wood; fire flares up and cannot descend, so it corresponds to the Left Cun. The Hand Jueyin Pericardium and Hand Shaoyang Sanjiao are exterior-interior pairs, sharing the Minister Fire with the Mingmen. The Sovereign Fire is superior, and the Minister Fire is inferior, so they correspond to the Right Chi. The Foot Taiyin is the Spleen Meridian, and the Foot Yangming is the Stomach Meridian. The Spleen and Stomach are exterior-interior pairs, both belonging to Earth. The Minister Fire acts on behalf of the Sovereign to generate Earth. Earth is positioned in the center, so it corresponds to the Right Guan. These are all relationships of mutual generation among the Five Elements. Assigning pulse positions based on Zang-Fu organs is naturally ordained. Later scholars held biased views and argued endlessly, confusing students. For instance, Yu Jiayan, Li Shicai, and Zhang Jingbin followed each other in claiming that pairing the Large and Small Intestines with the two Cun positions was incorrect and that pairing them with the Chi positions was correct. They claimed this did not originate from the *Nan Jing* but was a forgery by Gao Yangsheng. They argued that the Large and Small Intestines are unclean Fu organs and should not be paired with the pure and lofty Zang organs of the Heart and Lung. They also cited the *Nei Jing*: "What reaches the top concerns the chest and throat; what reaches the bottom concerns the lower abdomen, waist, thighs, knees, shins, and feet." Little did they know that the *Su Wen* states: "On both sides inside the Chi position are the costal regions. Outside the Chi position observes the Kidney; inside the Chi position observes the abdomen. Attaching to the middle, outside on the left observes the Liver; inside observes the diaphragm. Outside on the right observes the Stomach; inside observes the Spleen. Attaching to the top, outside on the right observes the Lung; inside observes the chest cavity. Outside on the left observes the Heart; inside observes the Danzhong." These sentences describe pulse observation positions. There is no fixed position mentioned for the Large Intestine, Small Intestine, or Bladder. The *Nei Jing* focuses primarily on the five Zang organs to determine pulse positions, neglecting the Fu organs, precisely to show that Fu organs follow Zang organs, and Zang organs connect to Fu organs. The phrases "reaches the top" and "reaches the bottom" refer to locating the disease site. The subsequent section on diseases associated with the three positions illustrates this meaning. How can one stretch these interpretations? Moreover, human Zang-Fu organs all correspond to the Five Elements. For example, the Large Intestine is Geng Metal, and the Lung is Xin Metal; Geng and Xin share one Qi. The Small Intestine is Bing Fire, and the Heart is Ding Fire; Bing and Ding share one Qi. Thus, Yue Ren (Bian Que) determined the pulse positions of the twelve meridians, following the *Nei Jing*'s principle of matching Hand to Hand and Foot to Foot, all corresponding to the unity of Five Elements Qi. To divide one Zang-Fu pair across both hands is to confuse the Five Elements. To change the Right Cun (Hand Yangming Large Intestine) to the Left Chi (Foot Shaoyin Kidney) is to mix Hand and Foot meridians. If one argues that the unclean intestines should not pair with the pure heart and lung, then the Hand Taiyang Small Intestine Meridian and Hand Yangming Large Intestine Meridian should not ascend to the head either. My view is that these three scholars merely discussed based on the vertical height of the organs. Who would have thought that Yue Ren had already clearly revealed the meanings of height/low and cleanliness/uncleanness in Difficulty 40? Did these gentlemen not see the full text of the *Nan Jing*? Or did they see it but not understand? Or were they curious and deliberately refuting it? Or did they refute it and fear future generations would not accept it, thus attributing it to Gao Yangsheng's forgery?
The pulse has three positions and nine inspections, each governing what? The response is: The three positions are Cun, Guan, and Chi. The nine inspections are Floating, Middle, and Deep pressing. (This section uses pulse inspection to diagnose disease.) The upper part models Heaven and governs diseases from the chest up to the head. The middle part models Humanity and governs diseases from the diaphragm down to the navel. The lower part models Earth and governs diseases from the navel down to the feet. Examine carefully and apply acupuncture. (This section applies acupuncture based on upper/middle/lower positions.)
This explains that each of the Cun, Guan, and Chi positions has three inspections (Floating, Middle, Deep), totaling nine inspections. This method is used for herbal treatment. The upper, middle, and lower parts refer to the upper, middle, and lower thirds of the body. The nine inspections refer to dividing each third into Heaven, Earth, and Man sections. This method is used for acupuncture treatment. Hence, it says to examine carefully and apply acupuncture. Editions mistakenly read "Ren" (Human) instead of "Lower part models Earth."
Difficulty 4 states: What is the method of Yin and Yang in the pulse? The response is: Exhalation relates to the Heart and Lung; inhalation relates to the Kidney and Liver. Between breaths, the Spleen receives grain flavors. (Other editions claim "receives grain flavors" is redundant, but I consider it crucial, as the Central Region's grain flavor governs respiration.) The pulse is in the middle. Floating indicates Yang; Deep indicates Yin. Hence, it is called Yin and Yang.
This chapter discusses the Yin and Yang of the pulse. Although Yin and Yang are located in Cun and Chi, the Qi of Yin and Yang is manifested in Floating and Deep pressures. The Heart and Lung reside superiorly and are Yang; exhalation passes through them. The Kidney and Liver reside inferiorly and are Yin; inhalation returns to them. The Spleen receives grain flavors and resides in the middle, facilitating both exhalation and inhalation. Therefore, the method of pulse diagnosis involves floating pressure to observe the Yang of the Heart and Lung, deep pressure to observe the Yin of the Kidney and Liver, and middle pressure to correspond to the Spleen and Stomach. Speaking of Yin and Yang, the Spleen Earth resides in the center, encompassing both Yin and Yang. The previous chapter fixed Zang-Fu positions in the pulse; this chapter explains how Zang-Fu correspond to pulse positions, revealing the sequence and hierarchy of the text, which was previously obscured by misordering.
The Heart and Lung pulses are both Floating. How to distinguish them? The response is: Floating, large, and scattered is the Heart pulse; Floating, short, and choppy is the Lung pulse. The Liver and Kidney pulses are both Deep. How to distinguish them? The response is: Firm and long is the Liver pulse; soft upon pressing but firm upon lifting is the Kidney pulse. The Spleen governs the central region, so its pulse is in the middle. This is the method of Yin and Yang.
This explains the Yin and Yang method of Floating, Middle, and Deep pressing. The following text clarifies the Yin and Yang meaning of the six pulses.
There are pulses described as One Yin One Yang, One Yin Two Yang, One Yin Three Yang, One Yang One Yin, One Yang Two Yin, and One Yang Three Yin. Does this mean six pulses beat simultaneously at Cun Kou? The response is: This does not mean six pulses beat simultaneously. It refers to Floating, Deep, Long, Short, Slippery, and Choppy qualities. Floating, Slippery, and Long are Yang; Deep, Short, and Choppy are Yin. "One Yin One Yang" means the pulse comes Deep and Slippery. (Left Chi is favorable, Right Cun is unfavorable). "One Yin Two Yang" means the pulse comes Deep, Slippery, and Long. (Left Guan is favorable, Right Guan is unfavorable). "One Yin Three Yang" means the pulse comes Floating, Slippery, and Long, occasionally Deep. (Left Cun is favorable, Right Chi is unfavorable). "One Yang One Yin" means the pulse comes Floating and Choppy. (Right Cun is favorable, Left Guan is unfavorable). "One Yang Two Yin" means the pulse comes Long, Deep, and Choppy. (Left Guan is favorable, Right Guan is unfavorable). "One Yang Three Yin" means the pulse comes Deep, Choppy, and Short, occasionally Floating. (Left Chi is favorable, Right Cun is unfavorable). The reversibility or favorability of the disease is named according to the meridian location.
This section discusses Yin-Yang pulses in relation to the favorability of the Heart, Lung, Kidney, and Liver. "Meridian location" refers to the locations of the twelve meridians. For example, if a One Yin One Yang pulse (Deep and Slippery) appears at the Left Chi, it is favorable for the Kidney and Bladder meridians; if it appears at the Left Cun, it is unfavorable for the Heart and Small Intestine meridians, indicating a controlling relationship. The other five positions follow this pattern. The left three positions having mostly Deep and Slippery pulses represent Yin within Yang. The right three positions having mostly Floating and Choppy pulses represent Yang within Yin.
Difficulty 5 states: What is meant by the lightness and heaviness of holding the pulse? The response is: Initially holding the pulse with the weight of three beans, touching the skin and hair, indicates the Lung position. With the weight of six beans, touching the blood vessels, indicates the Heart position. With the weight of nine beans, touching the muscles, indicates the Spleen position. With the weight of twelve beans, level with the tendons, indicates the Liver position. Pressing to the bone, with a quick rebound upon lifting, indicates the Kidney position. Hence, it is called lightness and heaviness.
This continues the previous chapter's discussion on Floating, Middle, and Deep pressing methods to inspect the Lung, Heart, Spleen, Liver, and Kidney positions.
Difficulty 6 states: What is meant by Excess Yin and Deficient Yang, and Excess Yang and Deficient Yin in the pulse? The response is: When pressed lightly (Floating), the pulse is diminished and small; when pressed deeply, it is solid and large. This is called Excess Yin and Deficient Yang. When pressed lightly (Floating), the pulse is solid and large; when pressed deeply, it is diminished and small. This is called Excess Yang and Deficient Yin. This expresses the meaning of Yin/Yang and Deficiency/Excess.
This chapter also continues the previous chapter's use of Floating, Middle, and Deep pressing to investigate the meaning of Yin/Yang Excess and Deficiency. Diminished/small and Solid/large are the guidelines for Deficient and Excess pulses. Students should comprehend and expand upon this.
Difficulty 7 states: The classics say: The arrival of Shaoyang is suddenly large, suddenly small, suddenly short, suddenly long. The arrival of Yangming is Floating, large, and short. The arrival of Taiyang is Surging, large, and long. The arrival of Taiyin is Tight, large, and long. The arrival of Shaoyin is Tight, fine, and minute. The arrival of Jueyin is Deep, short, and敦 (Dun, meaning pressing/solid, indicating Yang is about to move). Are these six types Ping (Normal) pulses? Or pulses indicating impending disease? The response is: They are Wang (Prosperous) pulses. In which months and for how many days does each Qi prosper? The response is: After the Winter Solstice, upon reaching a Jiazi day, Shaoyang prospers (from Jiazi in the 11th month to the 1st month). Upon reaching another Jiazi day, Yangming prospers (from Jiazi in the 1st month to the 3rd month). Upon reaching another Jiazi day, Taiyang prospers (from Jiazi in the 3rd month to the 5th month). Upon reaching another Jiazi day, Taiyin prospers (from Jiazi in the 5th month to the 7th month). Upon reaching another Jiazi day, Shaoyin prospers (from Jiazi in the 7th month to the 9th month). Upon reaching another Jiazi day, Jueyin prospers (from Jiazi in the 9th month to the 11th month). Each prospers for sixty days. Six times sixty equals three hundred and sixty days, completing one year. This is the general rule for the timing of the prosperity of the Three Yin and Three Yang.
This chapter details the prosperous pulses of the Six Qi. The prosperous pulses of the Three Yang and Three Yin meridians can be inferred similarly.
Difficulty 8 states: Cun Kou pulse is peaceful, yet the person dies. What is the meaning? The response is: All twelve meridians are connected to the Source of Vital Qi. The Source of Vital Qi is the root of the twelve meridians, known as the Moving Qi between the Kidneys. This is the root of the five Zang and six Fu organs, the root of the twelve meridians, the gate of respiration, and the source of the Sanjiao. It is also called the Spirit that Guards against Evil. Therefore, Qi is the root of human life. If the root is severed, the stems and leaves wither. If Cun Kou pulse is peaceful but the person dies, it is because the Source of Vital Qi is alone severed internally.
This chapter first clarifies the doctrine that the Mingmen and Sanjiao share the same origin. The Source of Vital Qi refers to the Yuan Qi in the Mingmen between the two kidneys. Exhaled Qi originates here; inhaled Qi is stored here. Thus, the Qi of the twelve meridians is connected here, making it the root of the five Zang and six Fu organs, the root of the twelve meridians, the gate of respiration, and the source of the Sanjiao. If a person has this Original Qi, evil Qi cannot harm the body; it guards internally and fills externally, hence called the Spirit that Guards against Evil. If this Qi is exhausted, like the roots of grass and trees dying, the stems and leaves wither. Even if the Cun Kou pulse is peaceful, death is certain. If this Qi is not exhausted, even if the Cun Kou pulse is absent, death will not occur. This corresponds to Difficulty 14, which states that if there is no pulse in the upper part but pulse in the lower part, even if critically ill, it is not fatal.
Difficulty 9 states: How to differentiate diseases of the Zang and Fu organs? The response is: Rapid pulses indicate Fu organs; Slow pulses indicate Zang organs. Rapid indicates Heat; Slow indicates Cold. All Yang indicates Heat; all Yin indicates Cold. Thus, one can differentiate diseases of the Zang and Fu organs.
This chapter focuses on differentiating Zang and Fu diseases. Rapid pulse indicates Fu; Slow pulse indicates Zang. Rapid implies Fu disease is Heat; Slow implies Zang disease is Cold. All Yang belongs to Fu and indicates Heat; all Yin belongs to Zang and indicates Cold. Using this, one can differentiate Zang and Fu diseases without omission. Later scholars criticized the phrase "Rapid indicates Heat," finding it inappropriate. Often, in cases of Yang Deficiency, the pulse is also rapid, and administering Guizhi Tang (Cinnamon Twig Decoction) and Fuzi (Prepared Aconite Root) brings balance. They fail to realize that "Rapid" here implies Fu, and "Slow" implies Zang. How profound! Reading ancient texts requires careful contemplation; how can one lightly criticize? This chapter only discusses the difference between Zang and Fu, not the nature of the disease or Deficiency/Excess, hence the next chapter clarifies the meaning of diagnosing Deficiency and Excess through pulse and disease.
Difficulty 10 states: Humans have Three Deficiencies and Three Excesses. What is meant? The response is: There is Pulse Deficiency/Excess, Disease Deficiency/Excess, and Diagnostic Deficiency/Excess. Pulse Deficiency/Excess: Soft (Ru) is Deficiency; Tight and Firm (Jin Lao) is Excess. Disease Deficiency/Excess: Outward manifestation is Deficiency; Inward manifestation is Excess. Speaking indicates Deficiency; Silence indicates Excess. Slow indicates Deficiency; Urgent indicates Excess. Diagnostic Deficiency/Excess: Soft (Ru, meaning soft) is Deficiency; Firm (Lao, meaning hard) is Excess. Itching indicates Deficiency; Pain indicates Excess. External pain with internal comfort is External Excess and Internal Deficiency; Internal pain with external comfort is Internal Excess and External Deficiency. Hence, it is called Deficiency and Excess.
This concludes the previous discussion on Pulse, Disease, and Diagnostic Three Deficiencies and Three Excesses. Among Deficiency, the most critical is Kidney Deficiency, hence the next chapter details the pulse of Kidney Qi exhaustion.
Difficulty 11 states: The classics say the pulse stops after fewer than fifty beats, indicating one Zang organ has no Qi. Which Zang organ? The response is: Inhalation follows Yin inward; exhalation follows Yang outward. Now, inhalation cannot reach the Kidney, returning at the Liver. Thus, knowing one Zang organ has no Qi, it is the Kidney Qi that is exhausted first. (Inhalation: Yang follows Yin inward; Exhalation: Yin follows Yang outward. Yang cannot nourish the lower, returning only at the Liver because Kidney Qi is exhausted first and cannot receive inhaled Qi. Hence, the next chapter urgently prescribes methods to tonify the Kidney. If the pulse stops after forty or thirty beats, one should infer based on Liver and Spleen Qi.)
Difficulty 12 states: The classics say: East is Excess, West is Deficient; Drain the South, Tonify the North. What is the meaning? The response is: Metal, Wood, Water, Fire, and Earth should balance each other. East is Wood; West is Metal. If Wood becomes Excess, Metal should balance it. If Fire becomes Excess, Water should balance it. If Earth becomes Excess, Wood should balance it. If Metal becomes Excess, Fire should balance it. If Water becomes Excess, Earth should balance it. East is the Liver, so Liver is Excess. West is the Lung, so Lung is Deficient. Drain Southern Fire, Tonify Northern Water. Southern Fire is the Child of Wood. Northern Water is the Mother of Wood. Water controls Fire. The Child can make the Mother Excess; the Mother can make the Child Deficient. Thus, draining Fire and tonifying Water aims to prevent Metal from balancing Wood. The classics say: "If you cannot treat the Deficiency, why ask about the rest?" This is what it means. (Reading this chapter reveals that the method of tonifying the Kidney originates from Yue Ren. Because sufficient Kidney Water prevents Metal from being depleted, keeping the Lung from Deficiency. Sufficient Kidney Water nourishes Wood, preventing the Liver from Dryness. If the Liver is not dry, Wood does not insult the Spleen, and the Spleen becomes sufficient. The Spleen...)