四十难∶肝主色，心主臭，脾主味，肺主声，肾主液。其义难明。泉拟为之疏曰∶气之
蕴借
而征者为色，其发越而透者为臭，其搏击而出者为声，其团聚而流者为液。阳气者升于东，
升者阳之始也。尚被阴蒙，不得遽出，蕴借于中，而征中外，则为色。东位肝，故肝主色。
阳气者极于南，极者阳之泄也。盛阳充满，发越于上而为臭。南位心，故心主臭。阳气者衰
于西，阳消则阴长，阳不胜阴，反受其烁，则震荡而不靖，于是乎有声。西位肺，故肺主声
。阳气者伏于北，伏者团聚而不散，则酿之蒸之而液生焉。北位肾，故肾主液。阳气者和于
中央，和者阴阳平。阳主气，阴主质，气与质合而味生焉。中央位脾，故脾主味。五主之义
如此。
所谓重实者，言大热病气实脉满，是谓重实。
尺肤候周身之寒热。今云大热病，则尺实可知，故下文重虚一段，以尺虚对说。
经络皆实者，是脉急而尺缓也。
今本“脉急”作“寸脉急”。案注脉急，谓脉口急也，是王本原无“寸”字。脉谓脉口
，统三部言。尺谓尺肤。候经在脉口，候络在尺肤。后人误以尺缓为切法，因别脉急为寸
脉急，
而衍“寸”字。若经本有之，注不得截去之。
络气不足，经气有余者，脉热而尺寒也，秋冬为逆，春夏为从；经虚络满者，尺热满脉
寒涩也，此春夏死，秋冬生也。
今本脉热、脉寒涩“脉”下皆有“口”字。盖涉注中脉口热、脉口寒而误衍，今从《脉
经》削正。上文脉急而尺缓也，亦无“口”字。
何谓重虚？脉虚、气虚、尺虚，是谓重虚。
今本脉虚、气虚作“脉气上虚”。今从林校正。案重虚即重实之反，则当脉症亦反。脉
虚反
上脉满；气虚反上气实；尺虚反上大热病，以尺虚则身无大热可知也。王注言尺寸俱虚，详
其词旨，正释脉虚、尺虚，则王本原不误。
所谓气虚者，言无常也。
注∶寸虚则脉动无常。“寸”字乃“气”之误。气为脉气。明经文脉虚之“脉”，专谓
寸口
，尺虚之“尺”，专谓尺肤，而气虚之“气”，则统谓尺寸营运之气，义深且当。杨上善以
膻中不足释气虚，终不若王氏之精也。此注与上注尺寸俱虚相印，欲人互推以见义。写者误
“气”作“寸”，则难通矣。易一字义了。
尺虚者，行步 然。
行步 然者，寒懔不能自持之状。盖尺肤本候周身，尺虚则必身寒，与上文重实之大热
反对。缘经不质言而形容之，故浅人不得耳！今因注略，故补明之。
脉虚者，不象阴也。
注∶不象太阴之候也。何以言之？气口者脉之要会，手太阴之动也。详王意，读象为像
。《易》云∶象也者，像此者也。
寒气暴上，脉满而实。实而滑则生，实而逆则死。
实谓气实也。寒气暴上，则尺虚可知。上文重实、重虚二端，谓尺、气、脉三者之各极
一偏者，此节谓气、脉二者，如上重实而尺独异者。
脉实满，手足寒，头热，春秋则生，冬夏则死。
此节承上脉满实，而言其有寒有热者。
其形尽满者，脉急大坚，尺涩而不应也。如是者，从则生，逆则死。所谓从者，手足温
也。所谓逆者，手足寒也。
此气实而脉虚、尺虚者。此经明言尺涩，而以从、逆并言，见尺涩亦有手足温者。可证
上文手足寒为气虚，非尺虚，而脉实满、头热，为脉实、尺实也。
消瘅，脉实大，病久不可治；脉悬小坚，病久不可治。
今本脉实大病久下无“不”字。详注云∶久病气血衰，脉不当实大，故不可治。是王本
原有
“不”字。巢氏《病源》云∶消瘅之脉，实牢大者死，细小浮者死。巢说正据此经。而云实
牢大，云细小浮，则经“坚”字当在“大”字上无疑。且经文是帝问消瘅虚实，则岐伯当明
实脉、虚脉以对之。实坚大是实，悬小正是虚，问答相符。不当反列“坚”字于悬小，致令
虚实相乱。浮即悬，牢即坚。
第四十难：肝主司面色，心主司气味，脾主司味觉，肺主司声音，肾主司津液。其中的道理难以明白。我（滑寿）打算为它作疏解说：气蕴藉含蓄而显现于外的是面色，气发散透达而出的是气味，气搏击激荡而出的是声音，气团聚流动而成的是津液。阳气在东方升发，升发是阳气的起始阶段。此时尚被阴气蒙蔽，不能立刻透出，气在中焦蕴藉含蓄，进而显现于内外，就表现为面色。东方对应肝脏，所以肝主司面色。阳气在南方达到极盛，极盛意味着阳气的宣泄。盛满的阳气充满身体，向上发散透出而形成气味。南方对应心脏，所以心主司气味。阳气在西方衰退，阳气消退则阴气增长，阳气不能胜过阴气，反而受到阴气的煎熬，于是震荡而不安宁，这就产生了声音。西方对应肺脏，所以肺主司声音。阳气在北方潜伏，潜伏意味着团聚而不散，经过酝酿蒸腾而产生津液。北方对应肾脏，所以肾主司津液。阳气在中央调和，调和意味着阴阳平衡。阳主司气，阴主司形质，气与形质结合而产生味觉。中央对应脾脏，所以脾主司味觉。这五种主司的道理就是这样。
所谓“重实”，是指大热病，邪气盛实，脉象充实饱满，这就叫做重实。
尺肤（前臂内侧皮肤）可以候察周身寒热情况。现在说是大热病，那么尺肤坚实可知，所以下文关于“重虚”的一段，是用尺肤虚弱来对照说明的。
经络都呈现实证的，是指脉口急劲而尺肤缓软。
现在的版本中，“脉急”写作“寸脉急”。考察王冰的注释，脉急指的是脉口急劲，这说明王冰原本的版本没有“寸”字。“脉”指的是脉口，统指寸、关、尺三部而言。“尺”指的是尺肤。诊察经脉病变在脉口，诊察络脉病变在尺肤。后人错误地把“尺缓”理解为切脉的手法，因而把“脉急”单独解释为“寸脉急”，从而衍生了“寸”字。如果经文原本就有这个字，注释就不会删去它了。
络气不足，经气有余的，表现为脉口热而尺肤寒，秋冬季节出现这种情况属于逆证，春夏季节出现属于顺证；经气虚弱，络脉充盛的，表现为尺肤热满而脉口寒涩，这种情况春夏季节死亡，秋冬季节可生。
现在的版本中，“脉热”、“脉寒涩”的“脉”字下面都有“口”字。这大概是受注释中“脉口热”、“脉口寒”的影响而误加衍生的，现在依据《脉经》予以删正。上文提到的“脉急而尺缓也”，也没有“口”字。
什么叫“重虚”？脉象虚弱、气机虚弱、尺肤虚弱，这就叫做重虚。
现在的版本中，“脉虚”、“气虚”写作“脉气上虚”。现在依据林亿等人的校正本进行修正。考察重虚就是重实的反面，那么脉症也应该相反。脉虚反对于上文的脉满；气虚反对于上文的气实；尺虚反对于上文的大热病，因为尺肤虚弱就可以知道身体没有大热。王冰的注释说尺寸两部都虚弱，仔细推敲他的词意，正是解释脉虚和尺虚，那么王冰原本的版本并没有错误。
所谓气虚，是指表现无常定。
注释说：寸部虚弱则脉搏跳动无常。“寸”字是“气”字的误写。气就是脉气。明确经文中的“脉虚”之“脉”，专指寸口；“尺虚”之“尺”，专指尺肤；而“气虚”之“气”，则统指寸部和尺部营运的气，义理深刻且恰当。杨上善用膻中不足来解释气虚，终究不如王冰的精当。这条注释与上一条关于尺寸俱虚的注释相互印证，想要让人互相推演以见其义。抄写者误将“气”写成“寸”，就难以讲通了。改一个字，意义就清楚了。
尺虚，表现为行走时步履不稳的样子。
行走时步履不稳的样子，是畏寒战栗、不能自我支撑的状态。大概尺肤本来候察周身情况，尺肤虚弱则必然身体寒冷，这与上文重实的大热病形成反对。因为经文没有直白地说出，而是用形容的方式表达，所以浅薄的人不能理解！现在因为注释简略，所以补充阐明它。
脉虚，不像太阴的征象。
注释说：不像太阴的征候。为什么这样说？气口是脉象的要会，是手太阴肺经的搏动处。详细考察王冰的意思，读“象”为“像”。《易经》说：“象，就是模拟这个事物。”
寒气突然上逆，脉象满实。脉象实而滑利则生，脉象实而逆乱则死。
实指的是气实。寒气突然上逆，那么尺肤虚弱可知。上文的重实、重虚两端，说的是尺、气、脉三者各自偏极一端的情况，这一节说的是气和脉两者，如同上文的重实但尺肤独异的情况。
脉象实满，手足寒冷，头部发热，春秋季节出现这种情况可生，冬夏季节出现则死。
这一节承接上文的脉满实，来说明其中有寒有热的情况。
身形全部胀满的，脉象急大坚劲，尺肤涩滞且不应指。像这样的情况，顺证则生，逆证则死。所谓的顺证，是指手足温暖。所谓的逆证，是指手足寒冷。
这是气实而脉虚、尺虚的情况。这段经文明确说尺肤涩滞，却又同时谈论顺证和逆证，可见尺肤涩滞也有手足温暖的时候。这可以证明上文的手足寒冷是由于气虚，而不是尺虚；而脉实满、头热，则是脉实、尺实的表现。
消瘅病，脉象实大，病程长久不可治愈；脉象悬小坚劲，病程长久不可治愈。
现在的版本中，“脉实大病久”下面没有“不”字。详细考察注释说：久病气血衰败，脉象不应当实大，所以不可治愈。这说明王冰原本的版本是有“不”字的。巢元方《诸病源候论》说：消瘅病的脉象，实牢大的会死，细小浮的也会死。巢氏的说法正是依据这段经文。而且他说实牢大、细小浮，那么经文中的“坚”字应当在“大”字上面无疑。况且经文是皇帝询问消瘅的虚实，那么岐伯应当明确地用实脉、虚脉来对答。实坚大属于实，悬小正是虚，问答相符。不应当反过来把“坚”字列在“悬小”之后，致使虚实混淆。浮即悬，牢即坚。
Difficulty 40: The Liver governs complexion (Se, facial color), the Heart governs odor (Chou, smell), the Spleen governs taste (Wei, flavor), the Lungs govern voice (Sheng, sound), and the Kidneys govern fluids (Ye, body fluids). The meaning of this is difficult to understand. I propose to provide an exposition stating that: when Qi is contained and reserved, it manifests externally as complexion; when it is released and penetrates outward, it becomes odor; when it strikes and bursts forth, it produces sound; when it gathers and flows, it forms fluids. Yang Qi ascends in the East; ascending is the beginning of Yang. At this stage, it is still obscured by Yin and cannot emerge immediately. It remains contained within, manifesting internally and externally, thus becoming complexion. The East corresponds to the Liver, therefore the Liver governs complexion. Yang Qi reaches its peak in the South; peaking implies the release of Yang. When abundant Yang fills the body and releases upward, it becomes odor. The South corresponds to the Heart, therefore the Heart governs odor. Yang Qi declines in the West; as Yang wanes, Yin grows. Yang fails to overcome Yin and is instead scorched by it, causing agitation and unrest, thereby producing sound. The West corresponds to the Lungs, therefore the Lungs govern sound. Yang Qi lies dormant in the North; lying dormant means gathering without dispersing. Through fermentation and steaming, fluids are generated. The North corresponds to the Kidneys, therefore the Kidneys govern fluids. Yang Qi harmonizes in the Center; harmony implies a balance of Yin and Yang. Yang governs Qi, and Yin governs substance. When Qi and substance combine, taste is produced. The Center corresponds to the Spleen, therefore the Spleen governs taste. This is the principle behind these five governances.
The term "Zhong Shi" (Double Excess) refers to a severe heat disease where pathogenic Qi is excess and the pulse is full and robust. This is called Double Excess.
The Chi skin (skin on the inner forearm below the elbow) can observe the cold and heat of the whole body. Since it is stated as a severe heat disease, the firmness of the Chi skin can be inferred. Therefore, the following section on "Zhong Xu" (Double Deficiency) uses deficient Chi skin for contrast.
When both the Channels (Jing) and Collaterals (Luo) present excess patterns, it means the pulse at the Cun Kou (radial artery site) is rapid/tight while the Chi skin is relaxed/soft.
In current editions, "pulse tight" is written as "Cun pulse tight". Examining Wang Bing's commentary, "pulse tight" refers to the tightness of the Cun Kou, indicating that Wang's original text lacked the character "Cun". "Pulse" here refers to the Cun Kou, encompassing all three positions (Cun, Guan, Chi). "Chi" refers to the Chi skin. Observing Channel disorders is done at the Cun Kou, while observing Collateral disorders is done at the Chi skin. Later scholars mistakenly interpreted "Chi soft" as a palpation technique, leading them to interpret "pulse tight" specifically as "Cun pulse tight," thereby adding the character "Cun". If the original text had included this character, the commentary would not have omitted it.
When Luo Qi is deficient and Jing Qi is excessive, the Cun Kou is hot and the Chi skin is cold. This is contrary (Ni) in Autumn and Winter, but compliant (Cong) in Spring and Summer. When Jing Qi is deficient and Luo Qi is excessive, the Chi skin is hot and full while the Cun Kou is cold and choppy. In this case, death occurs in Spring and Summer, while survival is possible in Autumn and Winter.
In current editions, the characters "Kou" appear after "Mai" in "Mai Re" and "Mai Han Se". These were likely added erroneously due to the commentary mentioning "Mai Kou Re" and "Mai Kou Han". They have been corrected by removing them based on the *Mai Jing* (Pulse Classic). Similarly, the earlier phrase "Mai Ji Er Chi Huan" also lacks the character "Kou".
What is "Zhong Xu" (Double Deficiency)? It refers to a deficient pulse, deficient Qi, and deficient Chi skin. This is called Double Deficiency.
Current editions read "Mai Qi Shang Xu" for "Mai Xu" and "Qi Xu". We follow the correction by Lin Yi et al. Examining this, Zhong Xu is the opposite of Zhong Shi; thus, the symptoms should also be opposite. A deficient pulse contrasts with the full pulse mentioned earlier; deficient Qi contrasts with the excess Qi mentioned earlier; deficient Chi skin contrasts with the severe heat disease mentioned earlier, as deficient Chi skin indicates the absence of severe heat. Wang Bing's commentary states that both Cun and Chi positions are deficient. Analyzing his wording, he is explaining Mai Xu and Chi Xu, so Wang's original text was not erroneous.
The term "Qi Xu" (Qi Deficiency) refers to irregular manifestations.
Commentary: Deficiency at the Cun position causes irregular pulse movement. The character "Cun" is an error for "Qi". Qi refers to pulse Qi. Clarifying that the "Mai" in "Mai Xu" specifically refers to the Cun Kou, and the "Chi" in "Chi Xu" specifically refers to the Chi skin, while the "Qi" in "Qi Xu" generally refers to the circulating Qi of both Cun and Chi positions, provides a profound and appropriate meaning. Yang Shangshan explained Qi Xu as insufficiency of the Dan Zhong (Conception Vessel area), which is not as precise as Wang Bing's explanation. This commentary corroborates the previous one regarding deficiency in both Cun and Chi, encouraging mutual inference to grasp the meaning. A scribe mistakenly wrote "Cun" instead of "Qi", making the text unintelligible. Changing one character clarifies the meaning.
Chi Xu presents as unsteady gait.
Unsteady gait describes a state of shivering from cold and inability to support oneself. Since Chi skin observes the whole body, Chi Xu必然 leads to body coldness, opposing the severe heat of the earlier Zhong Shi. Because the text uses descriptive language rather than explicit statements, superficial readers fail to understand. Now, because the commentary is brief, we supplement this clarification.
Mai Xu does not resemble Tai Yin patterns.
Commentary: It does not resemble the signs of Tai Yin. Why? The Cun Kou is the meeting point of pulses, representing the movement of the Hand Taiyin Lung Meridian. Examining Wang Bing's intent, he reads "Xiang" as "Like/Appearance". The *I Ching* says: "Xiang means resembling this."
When Cold Qi suddenly rises, the pulse is full and excess. If the excess pulse is slippery, there is life; if the excess pulse is reversed/disordered, there is death.
"Excess" here refers to Qi excess. Sudden rising of Cold Qi implies deficient Chi skin. The previous sections on Zhong Shi and Zhong Xu discussed each of the three factors (Chi, Qi, Pulse) reaching an extreme bias individually. This section discusses the two factors, Qi and Pulse, similar to the earlier Zhong Shi where only the Chi differed.
If the pulse is full and excess, with cold hands and feet but a hot head, survival is possible in Spring and Autumn, while death occurs in Winter and Summer.
This section follows up on the full/excess pulse to discuss the coexistence of cold and heat.
When the physical form is completely full/distended, the pulse is rapid, large, and hard, while the Chi skin is choppy and unresponsive. In such cases, compliance leads to life, and contrariness leads to death. Compliance refers to warm hands and feet. Contrariness refers to cold hands and feet.
This describes a situation of Excess Qi but Deficient Pulse and Deficient Chi Skin. The text explicitly mentions choppy Chi skin yet discusses both compliance and contrariness, proving that choppy Chi skin can also present with warm hands and feet. This confirms that the cold hands and feet mentioned earlier were due to Qi deficiency, not Chi skin deficiency; whereas the full/excess pulse and hot head indicate Excess Pulse and Excess Chi Skin.
In Xiao Dan (Wasting-Thirst Disease), if the pulse is large and excess, and the disease has persisted for a long time, it is incurable. If the pulse is suspended, small, and hard, and the disease has persisted for a long time, it is incurable.
Current editions lack the character "Bu" (not) after "Mai Shi Da Bing Jiu". Detailed examination of the commentary states: "In chronic illness, Qi and Blood decline; the pulse should not be large and excess, hence it is incurable." This indicates Wang Bing's original text included the character "Bu". Chao Yuanfang's *Zhu Bing Yuan Hou Lun* states: "For Xiao Dan, a solid, firm, and large pulse indicates death; a fine, small, and floating pulse also indicates death." Chao's theory is based on this classic. Given he mentions solid/firm/large and fine/small/floating, the character "Jian" (hard) in the text must originally precede "Da" (large). Furthermore, since the Emperor asked about Excess and Deficiency in Xiao Dan, Qibo should have clearly responded with Excess and Deficient pulses. Solid, hard, and large constitute Excess; suspended and small constitute Deficiency, matching the question and answer. Placing "Jian" after "Xuan Xiao" confuses Excess and Deficiency. "Fu" (floating) is equivalent to "Xuan" (suspended), and "Lao" (firm) is equivalent to "Jian" (hard).