则阴偏胜而阳不足也。阳明胃脉。胃中阴多。故食饮自可。少阴脉微滑者。当阴部见阳
脉。则阳偏胜而阴不足也。以阳凑阴分。故曰阴实。股与阴。少阴之部也。今阳热凑阴。
必熏发津液。泄达于外。股内汗出。而阴下湿也。
王宇泰云。翕奄沉三字。状得滑字最好。夫翕者、合也。奄者、忽也。当脉气合聚
而盛之时。奄忽之间。即已沉去。是名滑也。仲景恐人误认滑为沉。故下文又曰。滑
者。紧之浮名也。曰沉。曰浮。若异而同。观上文紧者如转索无常也一句。则知浮为
转索无常之浮。非轻手便得有常之名也。沉为翕奄之沉。非重取乃得一定之说也。仲景
下字。具有史笔。不可草草看过。
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。
假令咳者。坐饮冷水。故令脉紧也。假令下利。以胃中虚冷。故令脉紧也。
金匮要略曰。寒令脉急。经曰。诸紧为寒。
王宇泰云。阳舒缓。阴缩急故也。
寸口卫气盛。名曰高。
高者。暴狂而微。内经曰。阴不胜其阳。则脉流薄疾。并乃狂。卫为阳气。卫盛而
暴狂者。阴不胜阳也。针经曰。卫气者。所以温分肉。充皮毛。肥腠理。司开阖者也。卫
气盛为狂者。气盛于外也。
王宇泰云。如脉来浮而有力是也。
荣气盛。名曰章。
章者、暴泽而光。荣者、血也。荣华于身者也。荣盛。故身暴光泽也。
张卿子云。此章字。责其暴着也。成注暴泽而光。安得为病脉。
高章相搏。名曰纲。
纲者、身筋急脉直。荣卫俱盛。则筋络满急。
王宇泰云。纲总也。
张卿子云。总满盈也。以荣卫俱盛。正与下损字反。
卫气弱。名曰 。
者、心中气动迫怯。卫出上焦。弱则上虚。而心中气动迫怯也。
荣气弱。名曰卑。
卑者、心中常自羞愧。针经曰。血者、神气也。血弱则神弱。故常自羞愧。
王宇泰云。如按之沉而无力是也。
张卿子云。高者、卫盛于外。卑者、荣弱于内。
卑相搏。名曰损。
损者、五脏六腑之虚 也。卫以护阳。荣以养阴。荣卫俱虚。则五脏六腑。失于滋养。致俱乏气虚 也。
卫气和。名曰缓。
缓者、四肢不能自收。卫气独和。不与荣气相谐。则荣病。内经曰。目受血而能视。
足受血而能步。掌受血而能握。指受血而能摄。四肢不收。由荣血病。不能灌养故也。
荣气和。名曰迟。
迟者、身体重。但欲眠也。荣气独和。不与卫气相谐。则卫病。身体重而眠。欲眠
者。卫病而气不敷布也。
迟缓相搏。名曰沉。
沉者、腰中直。腹内急痛。但欲卧。不欲行。荣气独和于内。卫气独和于外。荣卫
不相和谐。相搏而为病。腰中直者。卫不和于外也。腹内痛者。荣不和于内也。但欲卧
不欲行者。荣卫不营也。
张卿子云。迟缓之脉。多属平和。又以荣卫内外分贴。故缓贴阳。迟贴阴。又以迟
缓二字。与浮躁反。故下曰沉。俗所谓沉静之意。善读书者。会其意可也。
寸口脉缓而迟。缓则阳气长。其色鲜。其颜光。其声商。毛发长。迟则阴气盛。骨
髓生。
血满。肌肉紧薄鲜硬。阴阳相抱。荣卫俱行。刚柔相搏。名曰强也。
缓为胃脉。胃合卫气。卫温分肉。充皮毛。肥腠理。司开阖。卫和气舒。则颜色光
润。声清毛泽矣。迟为脾脉。脾合荣气。荣养骨髓。实肌肉。濡筋络。利关节。荣和
血满。则骨正髓生。肌肉紧硬矣。荣卫调和。二气相抱。而不相戾。荣卫流通。刚柔相
得。是为强壮。
唐不岩云。此释上三句之义。并结高章以下一 脉法。故复提寸口二字。谓高章
失之盛。 卑失之弱。唯荣卫和平。斯脉法迟缓。审能知迟缓之脉。阴阳相抱。刚柔相
搏。断而名之为强。则无误于纲与损二者之患矣。
趺阳脉滑而紧。滑者胃气实。紧者脾气强。持实击强。痛还自伤。以手把刃。坐作
疮也。
趺阳之脉。以候脾胃。滑则谷气实。是为胃实。紧则阴气胜。是为脾强。以脾胃一
实一强而相搏击。故令痛也。若一强一弱相搏。则不能作痛。此脾胃两各强实相击。腑
脏自伤而痛。譬若以手把刃而成疮。岂非自贻其害乎。
张卿子云。玩后趺阳脉数条。一云大而紧。当即下利。又云紧而浮。膈气乃下。又
曰趺阳脉滑则为哕。责虚取实。此为医咎。皆本虚寒。故此亦脾胃之为实为强。非真实
真强也。如不剂量邪正。以实持之。以强击之。误于攻削。乃自取伤耳。故重叹之。即
此为医咎同意。痛字。惜之也。
王宇泰云。此则敦阜太过之脉也。
王三阳云。胃中有食。脾中有寒。皆有余也。是以相搏。若脾气自强。胃中虽实。自
然消谷。岂能病乎。
寸口脉浮而大。浮为虚。大为实。在尺为关。在寸为格。关则不得小便。格则吐逆。
经曰。浮为虚。内经曰。大则病进。浮则为正气虚。大则为邪气实。在尺则邪气关
闭下焦。里气不得下通。故不得小便。在寸。则邪气格拒上焦。使食不得入。故吐逆。
丹溪云。浮大之脉属阳。见于寸者。阳气偏盛。阴不得配之也。为格主吐逆。此无
阴则呕。见于尺者。阴血不足。阳往乘之也。为关主不得小便。此东垣滋肾之意。
趺阳
脉伏而涩。伏则吐逆。水谷不化。涩则食不得入。名曰关格。
伏则胃气伏而不宣。中焦关格。正气壅塞。故吐逆而水谷不化。涩则脾气涩而
不布。邪气拒于上焦。故食不得入。
张卿子云。玩二条。脉浮而大。脉伏而涩。正相反。皆名关格。皆为吐逆。一则言
不得小便。一则言食不得入。浮者见病于下。伏者见病于上。趺阳寸口。上下正别。
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。
痂癞者。眉少发稀。身有干疮而醒臭。内经曰。脉风成厉。
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。
卫为阳。荣为阴。弱者、卫气微。阳气不足也。迟者、荣中寒。经中客邪也。荣客
寒邪。搏而发热也。阳气内微。心内虽饥。饥而虚满。不能食也。
缓迟弱迟虽止一字之异。却千里之隔。
趺阳脉大而紧者。当即下利。为难治。
大为虚。紧为寒。胃中虚寒。当即下利。下利脉当微小。反紧者。邪胜也。故云难
治。
经曰。下利脉大者。为未止。
王损庵云。大为实。大为虚。上下纷纷。更易不一者。只要识得虚者正气虚。实者
邪气实之义。
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。
弱者、阳气不足。阳能消谷。阳气不足。则不能消化谷食。缓者、胃气有余。则胃
中有未消谷物也。故使噫而吞酸。食卒不下。气填于膈上也。金匮要略曰。中焦未和。
不能消谷。故令噫。
张卿子云。胃气有余。即经云陈气二字。不必指定未消谷物说。下文噫而吞酸。
气填膈上。又曰缓者胃气实。实则谷消而水化也。正是治之以兰。除陈气之证。
趺
阳脉紧而浮。浮为气。紧为寒。浮为腹满。紧为绞痛。浮紧相搏。肠鸣而转。转即气动。
膈气乃下。少阴脉不出。其阴肿大而虚也。
浮为胃气虚。紧为脾中寒。胃虚则满。脾寒则痛。虚寒相搏。肠鸣而转。转则膈中
之气。因而下泄也。若少阴脉不出。则虚寒之气。至于下焦。结于少阴。而聚于阴器。
不得发泄。使阴肿大而虚也。
寸口脉微而涩。微者、卫气不行。涩者、荣气不足。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。
人养三焦者血也。护三焦者气也。荣卫俱损。不能相将而行。三焦无所根据仰。身体
为之顽痹而不仁。内经曰。荣气虚而不仁。针经曰。卫气不行。则为不仁。荣为血。血
不足。则烦疼。荣属心。荣弱心虚。则口难言。卫为阳。阳微则恶寒。卫为气。气虚则
数欠。三焦因荣卫不足。无所根据仰。其气不能归其部。金匮要略曰。上焦竭。善噫。上
焦受中焦气。中焦未和。不能消谷。故令噫耳。下焦竭。即遗溺失便。以上焦在膈上物
未化之分也。不归者。不至也。上焦之气。不至其部。则物未能传化。故噫而酢吞。中
焦在胃之中。主腐熟水谷。水谷化则思食。中焦之气不归其部。则水谷不化。故云不能
消谷引食。下焦在膀胱上口。主分别清浊。溲、小便也。下焦不归其部。不能约制溲便。
故遗溲。
趺阳脉沉而数。沉为实。数消谷。紧者病难治。
沉为实者。沉主里也。数消谷者。数为热也。紧为肝脉。见于脾部。木来克土。为
鬼
贼相刑。故云难治。
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。而寒栗咳逆。唾腥。吐涎沫也。
卫为气。面色黄者。卫气衰也。荣为血。面色青者。荣血衰也。荣行脉中为根。卫
行脉外为叶。荣为阴。卫为阳。荣为根。卫为叶。根叶俱微。则阴阳之气内衰。致生寒
栗而咳逆。唾腥。吐涎沫也。
王宇泰云。子能令母虚。肺主气。气虚。则脾色见于面而黄。心主血。血衰。则肝
色见于面而青。肺臭腥脾液涎也。
趺阳脉浮而芤。浮者、卫气衰。芤者、荣气伤。其身体瘦。肌肉甲错。浮芤相搏。
宗气衰微。四属断绝。
经曰。卫气盛。名曰高。高者、暴狂而肥。荣气盛。名曰章。章者、暴泽而光。其
身体瘦而不肥者。卫气衰也。肌肉甲错而不泽者。荣气伤也。宗气者。三焦归气也。四
属者。皮肉脂髓也。荣卫衰伤。则宗气亦微。四属失所滋养。致断绝矣。
寸口脉微而缓。微者、卫气疏。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。荣盛则其肤必疏。三焦绝经。名曰血崩。
卫为阳。微为亡阳。脉微者。卫气疏。卫温分肉。肥腠理。卫气既疏。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。胃中谷消水化。而为血气。今卫疏荣盛。是荣气强而卫气弱也。卫气弱者。
外不能固密皮肤。而谓之气疏。内则不能卫护其血。而血为之崩。经、常也。三焦者、气
之道路。卫气疏。则气不循常度。三焦绝其常度也。
张卿子云。玩实字。乃胃病也。实则谷消而水化。是胃虚。不能使水谷入经。循其
脉道。故外则肤空。内则血崩。荣盛二字。谓不能与卫和。肤疏二字。谓不能固其荣。非
云荣强而卫弱也。
唐不岩云。既言悍气为卫。精气为荣。则荣卫者。水谷精悍之气所成。岂独单言水
不能化血。即单言谷。亦岂有化气之理。经文语意甚圆。即引经淫精于脉。合和于血。
亦不似成氏水谷二字。截然两分也。
此 专言卫气虚之脉。卫虚则外不能固肤。内不能统血。虽有胃中水谷所化
之血脉。而亦无统摄矣。故曰三焦绝经。名曰血崩。
趺阳脉微而紧。紧为寒。微则为虚。微紧相搏。则为短气。
中虚且寒。气自短矣。
少阴脉弱而涩。弱者微烦。涩者厥逆。
烦者、热也。少阴脉弱者、阴虚也。阴虚则发热。以阴部见阳脉。非大虚也。故生
微烦。厥逆者。四肢冷也。经曰。阴阳不相顺接。便为厥。厥者。手足厥冷是也。少阴
脉涩者。阴气涩。不能与阳相顺相接。故厥逆也。
王宇泰曰。此 不当作二证。
趺阳脉不出。脾不上下。身冷肤硬。
脾胃为荣卫之根。脾能上下。则水谷消磨。荣卫之气得以行。脾气虚衰。不能上下。
则荣卫之气。不得通营于外。故趺阳脉不出。身冷者。卫气不温也。肤硬者。荣血不濡
也。
少阴脉不至。肾气微。少精血。奔气促迫。上入胸膈。宗气反聚。血结心下。阳气
退下。热归阴股。与阴相动。令身不仁。此为尸厥。当刺期门巨阙。
尸厥者。为其从厥而生。形无所知。其状若尸。故名尸厥。少阴脉不出。则厥气客
于肾。而肾气微。少精血。厥气上奔。填塞胸膈。壅遏阳气。使宗气反聚。而血结心下。
针经曰。五谷入于胃。其糟粕津液宗气。分为三隧。宗气积于胸中。出于喉咙。以贯心
肺而行呼吸。又曰。荣气者。泌其津液。注之于脉。化而为血。以营四末。今厥气大甚。
宗气反聚而不行。则绝其呼吸。血结心下而不流。则四体不仁。阳气为厥气所壅。不能
宣发。退下至阴股间。与阴相动。仁者、柔也。不仁者、言不柔和也。为寒热痛痒俱不
觉知者也。阳气外不为使。内不得通。荣卫俱不能行。身体不仁。状若尸也。内经曰。
厥气上行。满脉去形。刺期门者。以通心下结血。刺巨阙者。以行胸中宗气。血气流通。
厥气退则苏矣。
这就是阴气偏盛而阳气不足的情况。阳明胃脉，由于胃中阴气较多，所以饮食正常。少阴脉象微滑，如果在阴部见到阳脉，就是阳气偏盛而阴气不足。因为阳气凑集于阴分，所以称为“阴实”。大腿和阴部，是少阴经所主的部位。现在阳热之气凑集于阴部，必然熏蒸津液，使其向外泄出，导致大腿内侧出汗，阴部潮湿。
王宇泰说：“翕奄沉”这三个字，最能形容“滑”脉的特征。“翕”是合的意思，“奄”是忽（忽然）的意思。当脉气聚合旺盛的时候，忽然之间，脉势就沉下去了，这就叫做滑脉。张仲景恐怕人们误把滑脉当作沉脉，所以下文又说：“滑脉，是紧脉的浮象。”说沉，说浮，看似不同实则相同。看上文“紧脉像转索一样无常”这一句，就知道浮是指那种像转索一样无常的浮，不是轻取就能得到的有常之浮；沉是指那种翕忽之间的沉，不是重按才能得到的固定之说。张仲景用字，具有史家笔法，不可草率看过。
问：曾经被人诘难，紧脉是从哪里来的？老师说：假如出现亡汗，或者呕吐，因为肺里有寒，所以导致脉紧。假如咳嗽的人，是因为喝了冷水，所以导致脉紧。假如下利的人，是因为胃中虚冷，所以导致脉紧。
《金匮要略》说：寒冷时节脉象急迫。《内经》说：各种紧脉都主寒证。
寸口脉卫气旺盛，名叫“高”。
所谓“高”，是突然发狂且身体消瘦。《内经》说：阴不能胜阳，则脉流急疾，进而发狂。卫属于阳气，卫气旺盛而突然发狂，是因为阴不能胜阳。《针经》说：卫气，是用来温煦肌肉、充实皮毛、肥满腠理、主管开阖的。卫气旺盛而导致发狂，是因为气盛于体表。
王宇泰说：就像脉来浮而有力就是这样。
营气旺盛，名叫“章”。
所谓“章”，是突然润泽而有光泽。营就是血，是荣华于身体的。营气旺盛，所以身体突然变得光泽。
张卿子说：这个“章”字，是责备其暴着（突然显现）。成无己注解说“暴泽而光”，怎么能算是病脉呢？
“高”与“章”相搏结，名叫“纲”。
所谓“纲”，是身体筋脉拘急、脉道挺直。营卫都旺盛，那么筋络就会充满而拘急。
王宇泰说：“纲”就是总括的意思。
张卿子说：就是总括满盈的意思。因为营卫都旺盛，正好与下面的“损”字相反。
卫气虚弱，名叫“代”（原文缺字，据上下文及中医理论补为“代”或类似含义，此处依原文留白或意译为虚弱之象，根据后文解释为心中气动迫怯，通常指代脉或弱脉之象，此处依原文结构处理）：
所谓“代”（此处指代一种脉象状态），是心中气动、迫促胆怯。卫气出于上焦，虚弱则上焦空虚，所以心中气动、迫促胆怯。
营气虚弱，名叫“卑”。
所谓“卑”，是心中常常自感羞愧。《针经》说：血就是神气。血弱则神弱，所以常常自感羞愧。
王宇泰说：就像按之沉而无力就是这样。
“卑”与其他脉象相搏结，名叫“损”。
所谓“损”，是五脏六腑的虚损。卫用来护卫阳气，营用来滋养阴气。营卫都虚弱，那么五脏六腑就会失去滋养，导致都缺乏气力而虚损。
卫气和调，名叫“缓”。
所谓“缓”，是四肢不能自主收持。只有卫气和调，不与营气和谐，那就是营有病。《内经》说：眼睛得到血的滋养就能视物，脚得到血的滋养就能行走，手掌得到血的滋养就能握持，手指得到血的滋养就能摄取。四肢不能收持，是由于营血有病，不能灌溉滋养的缘故。
营气和调，名叫“迟”。
所谓“迟”，是身体沉重，只想睡觉。只有营气和调，不与卫气和谐，那就是卫有病。身体沉重而想睡，之所以想睡，是因为卫气有病，气机不能敷布。
“缓”与“迟”相搏结，名叫“沉”。
所谓“沉”，是腰部挺直，腹内急痛，只想躺卧，不想行走。营气独和于内，卫气独和于外，营卫不相和谐，相搏结而生病。腰部挺直，是因为卫不和于外。腹内疼痛，是因为营不和于内。只想躺卧不想行走，是因为营卫不能运行。
张卿子说：“缓”和“迟”的脉象，多属于平和之脉。又因为将营卫内外分别对应，所以“缓”贴附于阳，“迟”贴附于阴。又因为“迟”、“缓”二字，与浮躁相反，所以下面说“沉”，就是世俗所说的沉静之意。善于读书的人，领会其中的意思就可以了。
寸口脉缓而迟。缓则阳气生长，面色鲜艳，容颜光亮，声音清商，毛发茂盛。迟则阴气旺盛，骨髓生成，血液充盈，肌肉紧薄鲜硬。阴阳相互抱合，营卫共同运行，刚柔相互搏结，名叫“强”。
缓是胃脉，胃合应卫气。卫气温煦肌肉，充实皮毛，肥满腠理，主管开阖。卫气和舒，那么颜色光润，声音清亮，毛发润泽。迟是脾脉，脾合应营气。营气滋养骨髓，充实肌肉，濡润筋络，利通关节。营和气足血满，那么骨骼端正髓质生成，肌肉紧硬。营卫调和，二气相抱而不相违背。营卫流通，刚柔相得，这就是强壮。
唐不岩说：这是解释上面三句的含义，并总结“高”、“章”以下的脉法，所以再次提起“寸口”二字。意思是“高”、“章”失之于过盛，“代”、“卑”失之于过弱。只有营卫和平，才是迟缓之脉。如果能审察知道迟缓之脉，阴阳相抱，刚柔相搏，断然命名为“强”，就不会犯“纲”与“损”两种疾病的祸患了。
趺阳脉滑而紧。滑代表胃气实，紧代表脾气强。以实击强，疼痛反过来伤害自己，就像用手握住刀刃，自己造成疮伤一样。
趺阳脉，是用来候察脾胃的。滑则谷气实，这是胃实。紧则阴气胜，这是脾强。因为脾胃一实一强而相互搏击，所以导致疼痛。如果是一强一弱相搏，就不能产生疼痛。这是脾胃两者都强实相互撞击，脏腑自我损伤而疼痛。譬如用手握住刀刃而成疮，难道不是自己招致祸害吗？
张卿子说：玩味后面关于趺阳脉的几条论述，有一条说大而紧，应当立即下利。又有一条说紧而浮，膈间之气才下行。又一条说趺阳脉滑则是呃逆。责罚虚证而采取治疗实证的错误方法，这是医者的过失。这些都是本于虚寒，所以这里说的脾胃之为实为强，并非真实的实和真正的强。如果不衡量邪正虚实，以实对待它，以强攻击它，错误地采用攻削之法，乃是自我取伤罢了。所以重重叹息。这与前面说的“此为医咎”同意。“痛”字，是惋惜的意思。
王宇泰说：这是敦阜太过（土气过盛）的脉象。
王三阳说：胃中有食积，脾中有寒，都是有余的表现。所以相互搏击。如果脾气自强，胃中虽然实，自然能消化谷物，怎么会生病呢？
寸口脉浮而大。浮代表虚，大代表实。在尺部出现叫“关”，在寸部出现叫“格”。关则小便不通，格则呕吐逆反。
经文说：浮为虚。《内经》说：大为病进。浮则是正气虚，大则是邪气实。在尺部，则邪气关闭下焦，里气不得下通，所以小便不通。在寸部，则邪气格拒上焦，使食物不得进入，所以呕吐逆反。
丹溪说：浮大的脉属于阳。见于寸部的，是阳气偏盛，阴气不能配合它。为“格”，主呕吐逆反。这是无阴则呕。见于尺部的，是阴血不足，阳气前往乘袭它。为“关”，主小便不通。这是东垣滋肾的意思。
趺阳脉伏而涩。伏则呕吐逆反，水谷不化。涩则食物不得进入，名叫“关格”。
伏则胃气潜伏而不能宣通，中焦关格，正气壅塞，所以呕吐逆反而水谷不化。涩则脾气涩滞而不能布散，邪气拒于上焦，所以食物不得进入。
张卿子说：玩味这两条，脉浮而大，脉伏而涩，正相反，都名叫“关格”，都表现为呕吐逆反。一条说小便不通，一条说食物不得进入。浮者见病在下，伏者见病在上。趺阳脉和寸口脉，上下正相对别。
脉浮而大，浮为风虚，大为气强。风邪与正气相搏结，必定形成瘾疹，身体瘙痒。瘙痒的名叫“泄风”，时间久了变成痂癞。
痂癞，是眉毛稀少头发稀疏，身上有干疮而且散发臭气。《内经》说：脉风成为厉（恶疮）。
寸口脉弱而迟。弱代表卫气微弱，迟代表营中有寒。营是血，血寒则发热。卫是气，气微弱则心里感觉饥饿，饥饿却感到虚满，不能进食。
卫为阳，营为阴。弱，是卫气微弱，阳气不足。迟，是营中有寒，是经中的客邪。营受寒邪侵袭，搏结而发热。阳气内微，心里虽然饥饿，但饥饿却感到虚满，不能进食。
“缓迟弱迟”虽然只差一个字，却相差千里。
大为虚，紧为寒。胃中虚寒，应当立即下利。下利的脉应当微小，反而见紧脉，是邪胜，所以说难治。
经文说：下利脉大的，表示病未停止。
王损庵说：大为实，大为虚，上下纷纷，更易不一的，只要识别出虚者是正气虚，实者是邪气实的意义即可。
寸口脉弱而缓。弱代表阳气不足，缓代表胃气有余。嗳气而吞酸，食物突然不下，气填塞在膈上。
弱，是阳气不足。阳能消化谷物，阳气不足，则不能消化谷物食物。缓，是胃气有余，则胃中有未消化的谷物。所以导致嗳气而吞酸，食物突然不下，气填塞在膈上。《金匮要略》说：中焦未和，不能消化谷物，所以导致嗳气。
张卿子说：胃气有余，就是经文所说的“陈气”二字，不必指定为未消化的谷物来说。下文说嗳气而吞酸，气填膈上，又说“缓者胃气实”，实则是谷物消而水液化。这正是用兰草去除陈气的证候。
趺阳脉紧而浮，浮为气，紧为寒。浮导致腹满，紧导致绞痛。浮紧相搏结，肠鸣转动。转动则气动，膈间之气才下行。少阴脉不出，阴器肿大而松弛。
浮为胃气虚，紧为脾中寒。胃虚则胀满，脾寒则疼痛。虚寒相搏结，肠鸣转动。转动则膈中的气，因而向下泄出。如果少阴脉不出，则虚寒之气，至于下焦，结于少阴，而聚于阴器，不得发泄，使阴器肿大而松弛。
寸口脉微而涩。微，是卫气不行。涩，是营气不足。营卫不能相互扶持，三焦无所仰赖，身体麻木不仁。营气不足则烦疼，口难言。卫气虚则恶寒，频繁打哈欠。三焦不归其部。上焦不归的，嗳气而吞酸。中焦不归的，不能消化谷物引食。下焦不归的，则遗尿失禁。
人养护三焦靠的是血，护卫三焦靠的是气。营卫都受损，不能相互扶持而行，三焦无所凭借仰赖，身体为之顽痹而不仁。《内经》说：营气虚则不仁。《针经》说：卫气不行，则为不仁。营是血，血不足，则烦疼。营属心，营弱心虚，则口难言。卫为阳，阳微则恶寒。卫为气，气虚则频繁打哈欠。三焦因营卫不足，无所凭借仰赖，其气不能归其部。《金匮要略》说：上焦竭，善嗳气。上焦受中焦气，中焦未和，不能消谷，所以令嗳气。下焦竭，即遗溺失便。以上焦在膈上，是食物未化分的部分。不归，是不至。上焦之气，不至其部，则食物未能传化，所以嗳气而吞酸。中焦在胃之中，主腐熟水谷。水谷化则思食，中焦之气不归其部，则水谷不化，所以说不能消谷引食。下焦在膀胱上口，主分别清浊。溲，是小便。下焦不归其部，不能约制溲便，所以遗溲。
沉为实，是因为沉主里。数能消谷，是因为数为热。紧为肝脉，见于脾部，木来克土，为鬼贼相刑，所以说难治。
寸口脉微而涩。微，是卫气衰。涩，是营气不足。卫气衰，面色黄。营气不足，面色青。营为根，卫为叶。营卫俱微，则根叶枯槁，而寒战咳逆，唾吐腥血，吐涎沫。
卫为气，面色黄，是卫气衰。荣为血，面色青，是荣血衰。荣行脉中为根，卫行脉外为叶。荣为阴，卫为阳。荣为根，卫为叶。根叶俱微，则阴阳之气内衰，导致生寒战而咳逆，唾吐腥血，吐涎沫。
王宇泰说：子能令母虚。肺主气，气虚，则脾色见于面而黄。心主血，血衰，则肝色见于面而青。肺臭腥，脾液涎。
趺阳脉浮而芤。浮，是卫气衰。芤，是荣气伤。身体瘦弱，肌肉甲错。浮芤相搏结，宗气衰微，四属断绝。
经文说：卫气盛，名叫“高”。高者，突然发狂且肥胖。营气盛，名叫“章”。章者，突然润泽而有光泽。身体瘦而不肥的，是卫气衰。肌肉甲错而不润泽的，是荣气伤。宗气，是三焦归聚之气。四属，是皮肉脂髓。荣卫衰伤，则宗气也微弱。四属失去滋养，导致断绝。
寸口脉微而缓。微，是卫气疏。疏则皮肤空松。缓，是胃气实。实则是谷物消化而水液转化。
谷物进入胃，脉道乃行。水液进入经脉，血液乃成。营盛则皮肤必疏，三焦绝经，名叫血崩。
卫为阳，微为亡阳。脉微，是卫气疏。卫气温煦肌肉，肥满腠理。卫气既疏，皮肤不得温肥，则空虚。经文说：缓者胃气有余。有余为实，所以说缓者胃气实。《内经》说：食入于胃，淫精于脉，是谷物进入胃，脉道乃行。《针经》说：饮而液渗于络，合和于血，是水液进入经脉，血液乃成。胃中谷消水化，而为血气。现在卫疏营盛，是营气强而卫气弱。卫气弱的，外不能固密皮肤，而称为气疏。内则不能卫护其血，而血为之崩。经，是常。三焦，是气的道路。卫气疏，则气不循常度，三焦绝其常度。
张卿子说：玩味“实”字，乃是胃病。实则是谷消而水化，是胃虚，不能使水谷进入经脉，循其脉道，所以外则肤空，内则血崩。“荣盛”二字，是说不能与卫和。“肤疏”二字，是说不能固其荣，不是说荣强而卫弱。
唐不岩说：既然说悍气为卫，精气为荣，那么荣卫，是水谷精悍之气所成，岂独单说水不能化血？即单说谷，岂有化气之理？经文语意很圆满，即引用经文“淫精于脉，合和于血”，也不像成氏将水谷二字截然两分。
这里专门讲卫气虚的脉。卫虚则外不能固肤，内不能统血。虽然有胃中水谷所化的血脉，但也无统摄了。所以说三焦绝经，名叫血崩。
烦，是热。少阴脉弱，是阴虚。阴虚则发热，因为阴部见阳脉，不是大虚，所以生微烦。厥逆，是四肢冷。经文说：阴阳不相顺接，便为厥。厥，是手足厥冷。少阴脉涩，是阴气涩，不能与阳相顺相接，所以厥逆。
王宇泰说：这不当作两个证候。
脾胃为营卫之根。脾能上下，则水谷消磨，营卫之气得以行。脾气虚衰，不能上下，则营卫之气，不得通营于外。所以趺阳脉不出。身冷，是卫气不温。肤硬，是荣血不濡。
少阴脉不至，肾气微，少精血，奔气促迫，上入胸膈，宗气反聚，血结心下，阳气退下，热归阴股，与阴相动，令身不仁，此为尸厥。当刺期门、巨阙。
尸厥，是因为从厥而生，形体无知，其状若尸体，所以名叫尸厥。少阴脉不出，则厥气客于肾，而肾气微，少精血。厥气上奔，填塞胸膈，壅遏阳气，使宗气反聚，而血结心下。《针经》说：五谷入于胃，其糟粕津液宗气，分为三隧。宗气积于胸中，出于喉咙，以贯心肺而行呼吸。又说：荣气者，泌其津液，注之于脉，化而为血，以营四末。现在厥气大甚，宗气反聚而不行，则绝其呼吸。血结心下而不流，则四体不仁。阳气为厥气所壅，不能宣发，退下至阴股间，与阴相动。仁者，柔也。不仁者，言不柔和也，为寒热痛痒俱不觉知者也。阳气外不为使，内不得通，荣卫俱不能行，身体不仁，状若尸体。《内经》说：厥气上行，满脉去形。刺期门，以通心下结血。刺巨阙，以行胸中宗气。血气流通，厥气退则苏醒。
This is a condition where Yin is excessively dominant and Yang is insufficient. The Maiyang (Stomach) pulse, due to an abundance of Yin in the Stomach, allows for normal appetite and digestion. If the Shaoyin (Kidney) pulse appears slightly slippery (Hua, 滑), indicating that a Yang-type pulse is present in a Yin region, it signifies that Yang is excessively dominant and Yin is insufficient. Because Yang Qi congregates in the Yin division, this is termed "Yin Excess" (Yin Shi, 阴实). The thighs and genitalia are the regions governed by the Shaoyin channel. Now, with Yang-heat congregating in the Yin area, it inevitably steams and evaporates body fluids, causing them to exude outward. This results in sweating inside the thighs and dampness in the genitalia.
Wang Yutai stated: The three characters "Xi Yan Chen" (翕奄沉 - fluttering, sudden, sinking) best describe the character of the Slippery (Hua, 滑) pulse. "Xi" means closing or gathering; "Yan" means suddenly. When the Qi of the pulse gathers and becomes vigorous, it suddenly sinks away. This is called Slippery. Zhang Zhongjing feared people might mistake Slippery for Sinking, so he further stated below: "Slippery is the floating name of Tight." Saying Sinking, saying Floating, they seem different but are essentially the same. Looking at the previous sentence "Tight is like a turning rope, irregular," one knows that Floating here refers to an irregular floating like a turning rope, not a regular floating obtained by light palpation. Sinking refers to a sudden sinking like "Xi Yan," not a fixed sinking obtained only by heavy pressure. Zhang Zhongjing's choice of words possesses the precision of a historian; do not read it carelessly.
Question: I was once challenged regarding where the Tight (Jin, 紧) pulse comes from. The Master said: Suppose there is profuse sweating or vomiting due to cold in the Lungs, this causes the Tight pulse. Suppose there is coughing due to drinking cold water, this causes the Tight pulse. Suppose there is diarrhea due to deficiency-cold in the Stomach, this causes the Tight pulse.
The *Jin Gui Yao Lue* says: Cold makes the pulse urgent/tight. The *Classic* says: All Tight pulses indicate Cold.
Wang Yutai said: This is because Yang is relaxed while Yin contracts and tightens.
When the Wei Qi (Defensive Qi) at the Cun Kou (Radial artery) is vigorous, it is named "Gao" (High).
"Gao" implies sudden mania and emaciation. The *Nei Jing* states: When Yin cannot overcome Yang, the vessels flow rapidly, leading to mania. Wei belongs to Yang Qi. When Wei is vigorous and causes sudden mania, it is because Yin cannot overcome Yang. The *Zhen Jing* (Needle Classic) states: Wei Qi warms the muscles, fills the skin and hair, plumps the interstices, and controls opening and closing. Mania caused by vigorous Wei Qi indicates Qi excess on the exterior.
Wang Yutai said: This is like a pulse that floats and is forceful.
When the Ying Qi (Nutritive Qi) is vigorous, it is named "Zhang" (Manifest/Clear).
"Zhang" implies sudden luster and radiance. Ying is Blood, which nourishes the body. When Ying is vigorous, the body suddenly becomes lustrous.
Zhang Qingzi said: The character "Zhang" here criticizes its sudden manifestation. Cheng Wuji's annotation "suddenly lustrous and radiant" – how can this be considered a pathological pulse?
When "Gao" and "Zhang" interact, it is named "Gang" (Cord/Tendon).
"Gang" implies stiff tendons and straight vessels in the body. When both Ying and Wei are vigorous, the meridians become full and tense.
Wang Yutai said: "Gang" means total or comprehensive.
Zhang Qingzi said: It means total fullness. Since Ying and Wei are both vigorous, it is the opposite of the term "Sun" (Loss/Deficiency) below.
When Wei Qi is weak, it is named [Character Missing in Text, implied as Dai or similar weak state].
This state involves internal agitation, urgency, and timidity. Wei Qi originates from the Upper Jiao. Weakness leads to Upper Jiao deficiency, causing internal agitation and timidity.
When Ying Qi is weak, it is named "Bei" (Low/Humble).
"Bei" implies constant feelings of shame and guilt. The *Zhen Jing* states: Blood is the spirit. When blood is weak, the spirit is weak, leading to constant feelings of shame.
Wang Yutai said: This is like a pulse that sinks upon pressure and is powerless.
Zhang Qingzi said: "Gao" is Wei excess on the exterior; "Bei" is Ying deficiency on the interior.
When "Bei" interacts with other pulses, it is named "Sun" (Loss/Deficiency).
"Sun" refers to the deficiency of the Zang-Fu organs. Wei protects Yang; Ying nourishes Yin. When both Ying and Wei are deficient, the Zang-Fu organs lose nourishment, resulting in a general lack of Qi and deficiency.
When Wei Qi is harmonious, it is named "Huan" (Slow/Lax).
"Huan" implies the inability of the four limbs to hold themselves. If only Wei Qi is harmonious and does not harmonize with Ying Qi, then Ying is diseased. The *Nei Jing* states: The eyes see when nourished by blood; the feet walk when nourished by blood; the palms grasp when nourished by blood; the fingers manipulate when nourished by blood. Inability to hold the limbs is due to Ying blood disease, failing to irrigate and nourish.
When Ying Qi is harmonious, it is named "Chi" (Slow).
"Chi" implies heaviness of the body and drowsiness. If only Ying Qi is harmonious and does not harmonize with Wei Qi, then Wei is diseased. Heaviness and drowsiness occur because Wei Qi is diseased and its distribution is impaired.
When "Huan" and "Chi" interact, it is named "Chen" (Deep).
"Chen" implies a straight waist, acute abdominal pain, desire to lie down, and unwillingness to walk. Ying Qi harmonizes internally, Wei Qi harmonizes externally, but they do not harmonize with each other, creating pathology. A straight waist indicates Wei disharmony on the exterior. Abdominal pain indicates Ying disharmony on the interior. Desire to lie down and unwillingness to walk indicates failure of Ying and Wei to circulate.
Zhang Qingzi said: Huan and Chi pulses often belong to a peaceful state. By associating Ying and Wei with interior/exterior, Huan is associated with Yang, and Chi with Yin. Furthermore, since Chi and Huan are opposite to restlessness, the term "Chen" (Deep) is used below, meaning quietness/calmness as commonly understood. Those who read well will grasp the intent.
At the Cun Kou, if the pulse is Huan (Slow/Lax) and Chi (Slow):
Huan indicates Yang Qi growing; the complexion is fresh, face radiant, voice clear, and hair long. Chi indicates Yin Qi abundant; marrow generates, blood fills, and muscles are firm and thin. When Yin and Yang embrace, Ying and Wei circulate together, and Gang (Hard) and Rou (Soft) interact, it is named "Qiang" (Strong).
Huan is the Stomach pulse; Stomach combines with Wei Qi. Wei Qi warms muscles, fills skin/hair, plumps interstices, and controls opening/closing. Harmonious Wei Qi results in a radiant complexion, clear voice, and glossy hair. Chi is the Spleen pulse; Spleen combines with Ying Qi. Ying Qi nourishes marrow, fills muscles, moistens tendons, and benefits joints. Harmonious Ying Qi results in full blood, correct bones, generated marrow, and firm muscles. When Ying and Wei are harmonious, embracing without conflict, circulating freely, and achieving Gang-Rou balance, this is strength.
Tang Buyan said: This explains the meaning of the previous three sentences and summarizes the pulse method from Gao/Zhang onwards, hence reiterating "Cun Kou." It means Gao/Zhang are excessive, while Dai/Bei are deficient. Only when Ying and Wei are peaceful is the pulse Huan/Chi. Understanding that Huan/Chi pulses represent Yin-Yang embracing and Gang-Rou interacting, and naming this "Qiang" (Strength), avoids the pitfalls of Gang and Sun.
At the Fu Yang (Dorsalis Pedis) artery, if the pulse is Hua (Slippery) and Jin (Tight):
Hua indicates Stomach Qi excess; Jin indicates Spleen Qi strength. Attacking strength with excess hurts oneself, like holding a blade and cutting oneself, creating a wound.
Fu Yang pulse observes the Spleen and Stomach. Hua means grain Qi is excess, i.e., Stomach excess. Jin means Yin Qi dominates, i.e., Spleen strength. The interaction between Stomach excess and Spleen strength causes pain. If one were strong and the other weak, pain would not result. Here, both Spleen and Stomach are strong/excess, clashing and injuring the organs, causing pain. Like holding a blade to create a wound, is this not self-inflicted harm?
Zhang Qingzi said: Reviewing subsequent Fu Yang pulse descriptions: one says large and tight implies immediate diarrhea; another says tight and floating allows diaphragmatic Qi to descend; another says slippery Fu Yang pulse implies hiccups. Treating deficiency as excess is a medical error. These cases are fundamentally deficiency-cold. Thus, the "excess" and "strength" mentioned here for Spleen/Stomach are not true excess/strength. Failing to assess pathogenic vs. healthy Qi, and attacking with excess/strength methods, leads to self-injury. Hence the sigh. This aligns with "this is a medical error." The word "pain" expresses pity/regret.
Wang Yutai said: This is the pulse of "Dun Fu" (Piling Up/Excess Earth).
Wang Sanyang said: Food retention in the Stomach and cold in the Spleen are both surplus conditions, hence they clash. If Spleen Qi is strong, even with Stomach excess, grains are naturally digested; how could illness arise?
At the Cun Kou, if the pulse is Fu (Floating) and Da (Large):
Fu indicates deficiency; Da indicates excess. At the Chi position, it is called "Guan" (Closed); at the Cun position, it is called "Ge" (Rejecting). Guan leads to urinary retention; Ge leads to vomiting and regurgitation.
The Classic states: Fu is deficiency. The *Nei Jing* states: Da indicates disease progression. Fu indicates healthy Qi deficiency; Da indicates pathogenic Qi excess. At Chi, pathogenic Qi closes the Lower Jiao, preventing interior Qi from descending, causing urinary retention. At Cun, pathogenic Qi rejects the Upper Jiao, preventing food intake, causing vomiting.
Danxi said: Fu-Da pulses belong to Yang. Seen at Cun, Yang Qi is overly dominant, and Yin cannot match it. This is Ge, main symptom vomiting. This is vomiting due to Yin deficiency. Seen at Chi, Yin blood is insufficient, and Yang attacks it. This is Guan, main symptom urinary retention. This reflects Dong Yuan's idea of nourishing Kidney Yin.
At the Fu Yang artery, if the pulse is Fu (Hidden) and Se (Choppy):
Fu leads to vomiting and undigested food/water. Se leads to inability to ingest food. This is named "Guan Ge" (Closed-Rejecting).
Fu means Stomach Qi is hidden and not disseminated; Middle Jiao Guan Ge causes righteous Qi stagnation, leading to vomiting and indigestion. Se means Spleen Qi is stagnant and not distributed; pathogenic Qi rejects the Upper Jiao, leading to inability to eat.
Zhang Qingzi said: Comparing these two: Fu-Da and Fu-Se are opposites, yet both are named Guan Ge and present with vomiting. One has urinary retention; the other has inability to eat. Fu shows disease below; Fu (Hidden) shows disease above. Fu Yang and Cun Kou pulses distinguish upper and lower.
If the pulse is Fu (Floating) and Da (Large), where Fu indicates Wind-Deficiency and Da indicates Qi-Strength:
Wind and Qi clash, forming urticaria (wind rashes) and itching. Itching is named "Xie Feng" (Leaking Wind). Long-term, it becomes scabs and leprosy-like lesions.
Scabs/leprosy involve sparse eyebrows/hair, dry sores on the body, and foul odor. The *Nei Jing* states: Pulse wind becomes leprosy.
At the Cun Kou, if the pulse is Ruo (Weak) and Chi (Slow):
Ruo indicates Wei Qi is faint; Chi indicates Cold in Ying. Ying is Blood; Blood cold causes fever. Wei is Qi; Faint Qi causes hunger in the heart/mind. Due to emptiness and fullness, eating is impossible.
Wei is Yang; Ying is Yin. Ruo means Wei Qi is faint, Yang insufficiency. Chi means Cold in Ying, an external pathogen in the channels. Ying hosting cold pathogen clashes and causes fever. Internal Yang deficiency causes mental hunger, but emptiness/fullness prevents eating.
Although "Huan-Chi-Ruo-Chi" differs by only one character, the difference is vast.
If the Fu Yang pulse is Da (Large) and Jin (Tight), diarrhea should occur immediately, making it difficult to treat.
Da indicates deficiency; Jin indicates cold. Stomach deficiency-cold leads to immediate diarrhea. Diarrhea pulses should be small/fine; seeing Jin instead indicates pathogen dominance, hence difficult to treat.
The Classic states: Large pulse in diarrhea means the disease has not stopped.
Wang Sun'an said: Whether Da is excess or deficiency, amidst confusion, one must recognize that deficiency refers to healthy Qi deficiency, and excess refers to pathogenic Qi excess.
At the Cun Kou, if the pulse is Ruo (Weak) and Huan (Slow/Lax):
Ruo indicates Yang Qi insufficiency; Huan indicates Stomach Qi excess. Belching and acid regurgitation occur; food suddenly fails to go down; Qi fills the diaphragm.
Ruo means Yang Qi insufficiency. Yang digests grains; insufficiency prevents digestion. Huan means Stomach Qi excess, implying undigested grains remain. Thus belching, acid regurgitation, food blockage, and Qi filling the diaphragm. The *Jin Gui Yao Lue* states: Middle Jiao disharmony prevents grain digestion, causing belching.
Zhang Qingzi said: "Stomach Qi excess" refers to the classic term "Chen Qi" (Old/Stagnant Qi), not just undigested grains. Belching, acid regurgitation, and Qi filling the diaphragm, along with "Huan means Stomach Qi excess" (where excess means grains digest and water transforms), corresponds to the treatment using orchids to remove stagnant Qi.
If the Fu Yang pulse is Jin (Tight) and Fu (Floating):
Fu indicates Qi; Jin indicates Cold. Fu causes abdominal fullness; Jin causes colic. Fu-Jin clash causes bowel sounds and rotation. Rotation moves Qi, allowing diaphragmatic Qi to descend. If the Shaoyin pulse does not appear, the genitals swell and feel flaccid.
Fu indicates Stomach Qi deficiency; Jin indicates Spleen cold. Stomach deficiency causes fullness; Spleen cold causes pain. Deficiency-cold clash causes bowel sounds and rotation, leading to diaphragmatic Qi descending. If Shaoyin pulse is absent, deficiency-cold Qi reaches the Lower Jiao, knots in Shaoyin, and gathers in the genitalia, unable to vent, causing genital swelling and flaccidity.
At the Cun Kou, if the pulse is Wei (Micro) and Se (Choppy):
Wei means Wei Qi does not move; Se means Ying Qi is insufficient. Ying and Wei cannot support each other; the Three Jiao has no reliance. The body experiences numbness and insensitivity. Ying insufficiency causes vexation and pain, difficulty speaking. Wei deficiency causes aversion to cold and frequent yawning. The Three Jiao fails to return to its sector. Upper Jiao failure causes belching and acid regurgitation. Middle Jiao failure prevents grain digestion and food intake. Lower Jiao failure causes urinary incontinence.
Humans nourish the Three Jiao with Blood and protect it with Qi. When Ying and Wei are damaged and cannot support each other, the Three Jiao lacks foundation, causing body numbness. The *Nei Jing* states: Ying deficiency leads to insensitivity. The *Zhen Jing* states: Wei Qi non-movement leads to insensitivity. Ying is Blood; insufficiency causes vexation/pain. Ying belongs to Heart; Ying weakness/Heart deficiency causes speech difficulty. Wei is Yang; Yang micro causes cold aversion. Wei is Qi; Qi deficiency causes yawning. Due to Ying/Wei insufficiency, the Three Jiao lacks foundation, and its Qi fails to return to its sector. The *Jin Gui Yao Lue* states: Upper Jiao exhaustion leads to belching. Upper Jiao receives Qi from Middle Jiao; Middle Jiao disharmony prevents digestion, causing belching. Lower Jiao exhaustion leads to incontinence. Upper Jiao is above the diaphragm, dealing with untransformed substances. "Not returning" means not arriving. If Upper Jiao Qi does not arrive, substances cannot transform, causing belching/acid. Middle Jiao is in the Stomach, rotting/cooking food. Transformed food creates appetite; if Middle Jiao Qi does not arrive, food is not digested, hence inability to digest/eat. Lower Jiao is above the bladder, separating clear/turbid. "Sou" is urine. If Lower Jiao Qi does not arrive, it cannot control urine, causing incontinence.
If the Fu Yang pulse is Chen (Deep) and Shu (Rapid):
Chen indicates Excess; Shu digests grains. Jin (Tight) makes the disease difficult to treat.
Chen indicates Excess because Deep governs Interior. Shu digests grains because Rapid indicates Heat. Jin is the Liver pulse; seen in the Spleen sector, Wood overcomes Earth, representing a "Ghost Thief" punishment, hence difficult to treat.
At the Cun Kou, if the pulse is Wei (Micro) and Se (Choppy):
Wei means Wei Qi declines; Se means Ying Qi is insufficient. Wei decline causes yellow complexion. Ying insufficiency causes green complexion. Ying is the Root; Wei is the Leaf. Both Wei and Ying micro leads to root/leaf withering, chills, cough, spitting bloody saliva, and drooling.
Wei is Qi; yellow face indicates Wei decline. Ying is Blood; green face indicates Ying decline. Ying flows in vessels (Root); Wei flows outside vessels (Leaf). Ying is Yin; Wei is Yang. Root/Leaf both micro means internal decline of Yin/Yang Qi, causing chills, cough, bloody sputum, and drool.
Wang Yutai said: The child causes the mother to weaken. Lung governs Qi; Qi deficiency shows Spleen color (yellow) on the face. Heart governs Blood; Blood decline shows Liver color (green) on the face. Lung smells fishy; Spleen fluid is saliva.
If the Fu Yang pulse is Fu (Floating) and Kou (Hollow):
Fu means Wei Qi declines; Kou means Ying Qi is injured. The body becomes thin; muscles show crisscross scales (keratosis). Fu-Kou clash leads to Zong Qi (Pectoral Qi) decline and severance of the Four Attachments.
The Classic states: Wei vigor is "Gao" (mania/fat); Ying vigor is "Zhang" (luster). Body thinness indicates Wei decline. Muscle scaling/lack of luster indicates Ying injury. Zong Qi is the gathered Qi of the Three Jiao. Four Attachments are skin, flesh, fat, and marrow. Ying/Wei damage leads to Zong Qi weakness and severance of nourishment to the Four Attachments.
At the Cun Kou, if the pulse is Wei (Micro) and Huan (Slow/Lax):
Wei means Wei Qi is loose/spared; looseness leads to empty skin. Huan means Stomach Qi is excess; excess means grains digest and water transforms.
Grains entering the Stomach allow vessel pathways to function. Water entering the meridians forms blood. Ying excess leads to loose skin; Three Jiao severs its channels, named Blood Collapse.
Wei is Yang; Micro indicates Yang loss. Micro pulse means Wei Qi is loose. Wei warms muscles/plumps interstices. Loose Wei Qi fails to warm/plump skin, causing emptiness. The Classic states: Huan means Stomach Qi excess. Excess is real, so Huan means Stomach Qi excess. The *Nei Jing* states: Food enters Stomach, essence floods vessels, so grain entry activates vessel pathways. The *Zhen Jing* states: Drink enters collaterals, mixes with blood, so water entry forms blood. Stomach digests grains/water into blood/Qi. Now Wei is loose, Ying is excess, meaning Ying is strong and Wei is weak. Weak Wei fails to secure skin externally (Qi looseness) and protect blood internally (Blood collapse). "Jing" means constant/routine. Three Jiao is the pathway of Qi. Wei looseness means Qi does not follow routine; Three Jiao severs its routine.
Zhang Qingzi said: Examining the character "Shi" (Excess/Real), it indicates Stomach disease. "Shi" means grains digest and water transforms, but here it implies Stomach deficiency failing to send water/grains into meridians/vessels, causing external skin emptiness and internal blood collapse. "Ying Excess" means failure to harmonize with Wei. "Skin Looseness" means failure to secure Ying, not that Ying is strong and Wei is weak.
Tang Buyan said: Since Han Qi is Wei and Jing Qi is Ying, Ying/Wei are formed from the refined essence of grains/water. How can water alone not form blood? Or grain alone not form Qi? The text's logic is complete. Citing "Essence floods vessels, mixes with blood" does not separate water and grain rigidly as Cheng Shi did.
This section specifically discusses Wei Qi deficiency pulses. Wei deficiency fails to secure skin externally and control blood internally. Even with blood vessels formed from Stomach water/grains, there is no control. Hence, Three Jiao severs its routine, named Blood Collapse.
If the Fu Yang pulse is Wei (Micro) and Jin (Tight):
Jin indicates Cold; Wei indicates Deficiency. Wei-Jin clash leads to shortness of breath.
Middle deficiency and cold naturally cause shortness of breath.
If the Shaoyin pulse is Ruo (Weak) and Se (Choppy):
Ruo causes slight vexation; Se causes Jue (Cold extremities).
Vexation is heat. Shaoyin Ruo indicates Yin deficiency. Yin deficiency causes fever. Seeing Yang pulse in Yin region is not severe deficiency, hence slight vexation. Jue means cold limbs. The Classic states: Yin and Yang fail to connect smoothly, leading to Jue. Jue is cold hands/feet. Shaoyin Se indicates Yin Qi stagnation, failing to connect smoothly with Yang, hence Jue.
Wang Yutai said: This should not be treated as two separate syndromes.
If the Fu Yang pulse does not appear, Spleen fails to ascend/descend, body is cold, skin is hard.
Spleen/Stomach are the roots of Ying/Wei. Spleen ascending/descending digests grains, allowing Ying/Wei to circulate. Spleen Qi deficiency/failure to ascend/descend prevents Ying/Wei from nourishing the exterior. Hence Fu Yang pulse is absent. Body cold indicates Wei Qi not warming. Skin hardness indicates Ying Blood not moistening.
If the Shaoyin pulse does not appear, Kidney Qi is micro, Essence/Blood are scant. Rushing Qi presses upward into chest/diaphragm, Zong Qi gathers inversely, Blood knots under the heart. Yang Qi retreats downward, heat returns to inner thighs, moving with Yin, causing body insensitivity. This is Corpse Jue (Shi Jue). Needles should be applied to Qimen and Juque.
Corpse Jue arises from Jue. The form is unaware, resembling a corpse, hence the name. Shaoyin pulse absence means Jue Qi lodges in Kidney, Kidney Qi is micro, Essence/Blood scant. Jue Qi rushes up, blocking chest/diaphragm, stifling Yang Qi, causing Zong Qi to gather inversely and Blood to knot under the heart. The *Zhen Jing* states: Five grains enter Stomach; dregs, fluids, and Zong Qi divide into three tunnels. Zong Qi accumulates in chest, exits throat, penetrates Heart/Lungs, governs respiration. Also: Ying Qi secretes fluids, notes into vessels, transforms into blood, nourishes four extremities. Now Jue Qi is severe, Zong Qi gathers and stops, severing respiration. Blood knots under heart and stops flowing, causing limb insensitivity. Yang Qi is stifled by Jue Qi, cannot disperse, retreats to inner thighs, moves with Yin. "Ren" means soft/gentle. "Bu Ren" means not gentle, i.e., no sensation to cold, heat, pain, or itch. Yang Qi is not used externally nor connected internally; Ying/Wei cannot circulate. Body is insensitive, resembling a corpse. The *Nei Jing* states: Jue Qi ascends, fills vessels, separates from form. Needling Qimen unblocks blood knot under heart. Needling Juque moves Zong Qi in chest. When blood/Qi circulate and Jue Qi recedes, the patient revives.