俱夺者，此久病也；（神与气俱衰也。）征其脉与五色俱不夺者，此新
病也。（……神与气俱强也。）
尺内两旁，则季胁也，（尺内，谓尺泽之内也。两旁，各谓尺之外侧也。季胁近肾，尺主之，故尺内两旁
则季胁也。）尺外以候肾，尺里以候腹中。（按∶尺外，注谓尺之外侧，尺里，注谓尺之内侧，是与上言两旁
无异，误矣。盖两旁以横开言，外里以上下直接处言，此兼左右两手也。）附上，左外以候肝，内以候膈，右
外以候胃，内以候脾。（按∶此举两关而言也。关虽居中，然亦有内外焉，内者关之上半部，外者关之下半部。
关上联寸，故云附上，附上，附寸也。）上附上，右外以候肺，内以候胸中，左外以候心，内以候膻中。（按∶
此举两寸而言也。寸位本上，上联鱼际，故云上附上。然前言关脉以上半部为内，下半部为外，而寸脉则反是
者，盖合三部而论，关居中间为内，尺寸居两头为外也。灵兰秘典论曰∶“膻中者，臣使之官，喜乐出焉。”
注云位在两乳间，是也。此注云是嗌，误矣。）
前以候前，后以候后。（按∶王注分上前为左寸口，下前为胸之前膺及气海，上后为右寸口，下后为胸之
后背及气管，其言怪诞不经。余谓此与下二段皆总上三节寸关尺而言，此言前后者，以三部言，寸为前，尺为后，
诊寸以候心肺之疾，诊尺以候两肾之疾也；以一部言，上半部为前，下半部为后，如诊右外候肺，内候胸中，
左外候心，内候膻中之类是也。此以脉之部分，诊脏腑之疾病，就内而言，盖脉有三部，部各有前后，故云前
后也。下节言脉之上下而分发胸喉腰足者，是以脉诊一身之疾病，就外而言，故云竟上竟下也。）上竟上者，
胸喉中事也；下竟下者，少腹腰股膝胫足中事也。（上竟上，至鱼际也；下竟下，谓尽尺之脉动处也。按∶此节
总论一身，而止言上下，要之胸喉以下，少腹以上，中部所主之事，在不言中矣。注但顺文平释，全未发明。）
粗大者，阴不足，阳有余，为热中也。（粗大谓脉洪大
也，脉洪为热，故云热中。按∶粗大者，浮大有力之脉，是为实火，不但热浮于外而已，故谓之热中。）来疾
去徐，上实下虚，为厥巅疾。来徐去疾，上虚下实，谓恶风也。故中恶风者，阳气受也。（按∶疾，急数也。
徐，缓弱也。脉之至曰来，回曰去，来主上，去主下。实者邪气实也，虚者正气虚也。邪实于上，故病逆于顶
巅；气虚于上，故风邪易入而为恶风之病。然风之得以中人者，非真风之恶也，阳虚不能捍邪故也。）有脉俱
沉细数者，少阴厥也。（尺中有脉沉细数者，是肾少阴气逆也。尺脉不当见数，有数故言厥也。俱沉细数者，
言左右尺中也。按∶沉细而缓，肾之平脉也，数则为火。今沉细兼数，是阴虚水亏而火上逆，名曰少阴厥。
厥，逆而上也，所谓阴虚火动是矣。）沉细数散者，寒热也。（按∶沉细为阴，数散为阳，阴阳相杂，故其为
病或寒或热也。）浮而散者为 仆。（脉浮为虚，散为不足，气虚而血不足，故为头眩而仆倒也。按∶ 音瞬。）
诸浮不躁者，皆在阳，则为热；其有躁者在手。（言大法也。阳为水气，故为热。）诸细而沉者皆在阴，则
为骨痛；其有静者在足。（阴主骨，故骨痛。按∶浮为阳为热，沉细为阴为骨痛，此易明也。其有躁者在手，
静者在足二句，注作手阳脉、足阴脉解，未确。其中必有脱误，阙疑可也。）数动一代者，病在阳之脉也，泄
及便脓血。（代，止也。按∶凡血必随气而行，代则气断续而血内壅，血内壅则小大二便皆见脓血矣。）
诸过者切之，涩者阳气有余也，滑者阴气有余也。（阳有余则血少，故脉涩，阴有余则血多，故脉滑也。）
阳气有余为身热无汗，阴气有余为多汗身寒，阴阳有余则无汗而寒。（按，身热无汗者，火盛而气闭，外感伤
寒，阳分病也。多汗身寒者，气虚自汗，治宜温补者也。阳盛无汗，阴盛身寒，治宜温散，仲景
之用附子细辛汤是也。证治之妙，可即是而推矣。）
推而外之，内而不外，有心腹积也。（按∶浮按不见，沉着于内，心腹之间必有蓄积。）推而内之，外而
不内，身有热也。（按∶重按不见，脉浮于外，邪热在表也。）推而上之，下而不上，腰足清也。推而下之，
上而不下，头项痛也。（按∶上谓寸，下谓尺也。寸主头项，尺主腰足。是故上推之而病脉见于下，是下部虚寒；
下推之而病脉见于上，为火升头项。知脉之升降浮沉，则知病之所在而可以施治矣。王本推而上之，上而不下，
推而下之，下而不上，误矣。按甲乙经，推而上之作下而不上，推而下之作上而不下，是也。今改从之。）按
之至骨，脉气少者，腰脊痛而身有痹也。（阴气大过故尔。按∶重按之而脉微欲绝者，是为阳虚无气，命门火
衰，在腰脊则阴寒而痛，在身中必有不知痛痒处也。）
如果神气都衰败，这是久病；（神与气都衰弱。）如果脉象和面色都没有明显变化，这是新病。（……神与气都强盛。）
尺部内侧两旁，对应季胁，（尺内，指尺泽穴以内的部位。两旁，各指尺部的外侧。季胁靠近肾脏，尺脉主之，所以尺部内侧两旁对应季胁。）尺部外侧候肾，尺部内侧候腹中。（按：尺外，注解说为尺部的外侧，尺里，注解说为尺部的内侧，这与上面所说的“两旁”没有区别，是错误的。大概“两旁”是从横向展开来说的，“外里”是从上下直接对应的部位来说的，这里兼论左右两手。）关部上方，左手外侧候肝，内侧候膈，右手外侧候胃，内侧候脾。（按：这里举两关脉而言。关脉虽然居中，但也有内外之分，内者指关脉的上半部，外者指关脉的下半部。关上连接寸脉，所以说“附上”，附上，就是附于寸脉。）再往上到寸部，右手外侧候肺，内侧候胸中，左手外侧候心，内侧候膻中。（按：这里举两寸脉而言。寸位本来在上，上连鱼际，所以说“上附上”。然而前面说关脉以上半部为内，下半部为外，而寸脉则相反，这是因为合三部而论，关居中间为内，尺寸居两头为外。《灵兰秘典论》说：“膻中者，臣使之官，喜乐出焉。”注解说位置在两乳之间，是对的。此注解说在咽喉，是错误的。）
前部候身体前侧，后部候身体后侧。（按：王冰注区分上前为左寸口，下前为胸之前膺及气海，上后为右寸口，下后为胸之后背及气管，其言论怪诞不经。我认为这和下两段都是总括上面三节寸、关、尺而言，这里说的“前后”，是从三部来说，寸为前，尺为后，诊寸脉以候心肺的疾病，诊尺脉以候两肾的疾病；从一部来说，上半部为前，下半部为后，如诊右外候肺，内候胸中，左外候心，内候膻中之类是也。这是以脉的部位，诊察脏腑的疾病，就内部而言，脉有三部，每部各有前后，所以说“前后”。下节讲脉的上下而分发胸喉腰足，是以脉诊察一身疾病，就外部而言，所以说“竟上竟下”。）寸脉上部到头端，对应胸喉中的事；尺脉下部到底端，对应少腹、腰、股、膝、胫、足中的事。（“上竟上”，至鱼际处；“下竟下”，谓尽尺部的脉搏跳动处。按：这一节总论一身，只讲了上下，总之胸喉以下，少腹以上，中部所主管的事情，不言自明了。注家只是顺文平释，完全没有阐明深意。）
脉象粗大，是阴不足，阳有余，属于热中。（粗大指脉洪大，脉洪为热，所以说热中。按：粗大者，是浮大有力的脉，这是实火，不仅仅是热浮于外而已，所以叫热中。）脉来急去缓，是上实下虚，为厥逆巅顶之疾。脉来缓去急，是上虚下实，称为恶风。所以中恶风的人，是阳气受邪。（按：疾，急数也。徐，缓弱也。脉之到来叫“来”，回去叫“去”，来主上，去主下。实者是邪气实，虚者是正气虚。邪实于上，所以病逆于头顶；气虚于上，所以风邪易入而成为恶风的病。然而风之所以能中人，并非真风可恶，而是阳虚不能抵御外邪的缘故。）如果左右尺脉都沉细数，是少阴厥逆。（尺中有脉沉细数的，是肾少阴气逆。尺脉不应当见数，因为有数所以说是厥。俱沉细数，是说左右尺中。按：沉细而缓，是肾的正常脉象，数则为火。现在沉细兼数，是阴虚水亏而火上逆，名叫少阴厥。厥，逆而上也，所谓阴虚火动是了。）脉沉细而散，是寒热错杂。（按：沉细为阴，数散为阳，阴阳相杂，所以其病或寒或热。）脉浮而散，会导致仆倒。（脉浮为虚，散为不足，气虚而血不足，所以头眩而仆倒。按：仆音瞬。）
所有浮脉而不躁动的，病都在阳分，则为热；如果有躁动的，在手经。（这是讲一般规律。阳为水气，所以为热。）所有细而沉的脉，病都在阴分，则为骨痛；如果有静象的，在足经。（阴主骨，所以骨痛。按：浮为阳为热，沉细为阴为骨痛，这很容易明白。至于“其有躁者在手，静者在足”两句，注家解释为手阳脉、足阴脉，不准确。其中必有脱漏错误，存疑即可。）脉数动且间歇（代脉），是病在阳分的脉，会有泄泻及便脓血。（代，止也。按：凡血必随气而行，代则气断续而血内壅，血内壅则大小二便皆见脓血。）
各种异常脉象都要切诊，涩脉是阳气有余，滑脉是阴气有余。（阳有余则血少，所以脉涩，阴有余则血多，所以脉滑。）阳气有余表现为身热无汗，阴气有余表现为多汗身寒，阴阳有余则无汗且寒。（按：身热无汗，是火盛而气闭，外感伤寒，属于阳分病。多汗身寒，是气虚自汗，治疗宜温补。阳盛无汗，阴盛身寒，治疗宜温散，张仲景使用附子细辛汤就是例子。证治的精妙，可以由此推演。）
将脉势向外推（轻取），如果脉象内敛而不外显，说明有心腹积滞。（按：浮取和重按都看不见，脉沉着于内，心腹之间必有蓄积。）将脉势向内推（重按），如果脉象外浮而不内敛，说明身体有热。（按：重按看不见，脉浮于外，邪热在表。）将脉势向上推，如果脉象向下而不向上，说明腰足寒冷。将脉势向下推，如果脉象向上而不向下，说明头项疼痛。（按：上指寸，下指尺。寸主头项，尺主腰足。所以上推而病脉见于下，是下部虚寒；下推而病脉见于上，为火升头项。知道脉的升降浮沉，就知道病的所在从而可以施治了。王冰本中“推而上之，上而不下，推而下之，下而不上”是错误的。按《甲乙经》，推而上之作“下而不上”，推而下之作“上而不下”，才是对的。现在改正依从它。）重按至骨，脉气微弱的，是腰脊痛且身体有痹症。（阴气大过所致。按：重按时脉微欲绝，这是阳虚无气，命门火衰，在腰脊则因阴寒而痛，在身体其他部位必有不知痛痒的地方。）
If both Shen (Spirit) and Qi (Vital Energy) are depleted, this indicates a chronic disease. (Both Shen and Qi are in a state of decline.) If the pulse and the five complexions show no significant change, this indicates an acute disease. (...Both Shen and Qi are strong.)
The inner sides on both flanks of the Chi position correspond to the hypochondrium. (Chi Nei refers to the area within Chi Ze [LU-5]. The two flanks refer to the lateral aspects of each Chi position. Since the hypochondrium is near the Kidneys, and the Chi pulse governs them, the inner sides on both flanks of the Chi position correspond to the hypochondrium.) The outer aspect of Chi observes the Kidneys, while the inner aspect of Chi observes the abdominal cavity. (Commentary: Zhuang's commentary defines "Chi Wai" as the lateral side of Chi and "Chi Li" as the medial side of Chi, which is identical to the previously mentioned "two flanks," thus erroneous. "Two flanks" describes the horizontal spread, whereas "outer/inner" here refers to the vertical alignment directly corresponding above and below, encompassing both left and right hands.) Above the Guan position, the left outer aspect observes the Liver, and the inner aspect observes the Diaphragm; the right outer aspect observes the Stomach, and the inner aspect observes the Spleen. (Commentary: This refers to the two Guan pulses. Although Guan is central, it has inner and outer divisions: the inner part is the upper half of the Guan, and the outer part is the lower half. Guan connects to Cun, hence "Fu Shang" (attached above), meaning attached to Cun.) Further up at the Cun position, the right outer aspect observes the Lungs, and the inner aspect observes the Chest Middle Jiao; the left outer aspect observes the Heart, and the inner aspect observes the Dan Zhong (Pericardium). (Commentary: This refers to the two Cun pulses. Cun is originally superior and connects to Yu Ji [LU-10], hence "Shang Fu Shang." However, while Guan was defined with upper half as inner and lower half as outer, Cun reverses this because when considering all three positions together, Guan is central (inner), while Cun and Chi are at the ends (outer). *Ling Shu: Mi Dian Lun* states: "Dan Zhong is the official of the messenger, from whom joy and pleasure arise." Commentary places it between the two breasts, which is correct. This commentary's claim that it is the throat is incorrect.)
The anterior part observes the anterior body, and the posterior part observes the posterior body. (Commentary: Wang Bing’s commentary distinguishes upper anterior as left Cun Kou, lower anterior as the anterior chest and Qi Hai, upper posterior as right Cun Kou, and lower posterior as the posterior chest and airway, which is bizarre and baseless. I believe these paragraphs summarize the previous sections on Cun, Guan, and Chi. Here, "anterior/posterior" refers to the three positions: Cun is anterior, Chi is posterior. Diagnosing Cun observes diseases of the Heart and Lungs; diagnosing Chi observes diseases of the two Kidneys. Within one position, the upper half is anterior, the lower half is posterior, e.g., observing Lung via right outer and Chest Middle Jiao via right inner, Heart via left outer and Dan Zhong via left inner. This uses pulse locations to diagnose Zang-Fu diseases internally. Since there are three positions, each having anterior and posterior parts, it says "anterior and posterior." The next section discusses pulse distribution to chest, throat, waist, and feet, diagnosing whole-body diseases externally, hence "end to top/end to bottom.") Pulse extending to the upper end (Shang Jing Shang) concerns matters of the chest and throat; pulse extending to the lower end (Xia Jing Xia) concerns matters of the lower abdomen, waist, thighs, knees, shins, and feet. ("Shang Jing Shang" reaches Yu Ji; "Xia Jing Xia" means the end of the pulsation at Chi. Commentary: This section summarizes the whole body, mentioning only upper and lower. Essentially, matters governed by the middle region—below the chest/throat and above the lower abdomen—are implied. Commentators merely explained the text literally without elucidating the deeper meaning.)
A coarse and large pulse indicates Yin deficiency and Yang excess, resulting in Heat in the Middle. (Coarse and large refers to a洪 [Hong] or surging pulse; surging indicates heat, hence Heat in the Middle. Commentary: Coarse and large refers to a floating, large, and forceful pulse, indicating Excess Fire, not merely heat floating on the exterior, hence called Heat in the Middle.) A pulse that comes rapidly and goes slowly indicates Upper Excess and Lower Deficiency, manifesting as Jue (reversal) disease affecting the vertex. A pulse that comes slowly and goes rapidly indicates Upper Deficiency and Lower Excess, termed aversion to wind. Thus, those suffering from aversion to wind have their Yang Qi affected. (Commentary: Ji means rapid/frequent; Xu means slow/weak. Lai (coming) refers to the arrival of the pulse, Qu (going) refers to its retreat. Lai governs the upper, Qu governs the lower. Excess refers to pathogenic excess; Deficiency refers to healthy Qi deficiency. Pathogenic excess in the upper causes rebellion at the vertex; Healthy Qi deficiency in the upper allows wind pathogens to easily enter, causing aversion to wind. Wind enters humans not because wind itself is evil, but because Yang deficiency fails to resist pathogens.) If pulses in both Chi positions are deep, fine, and rapid, it indicates Shaoyin Jue (reversal). (Deep, fine, and rapid pulse in Chi indicates reversal of Shaoyin Kidney Qi. Chi pulse should not be rapid; the presence of rapidness indicates Jue. "Both deep, fine, and rapid" refers to both left and right Chi. Commentary: Deep, fine, and slow is the normal pulse of the Kidney; rapid indicates Fire. Deep, fine, and rapid together indicate Yin deficiency with water depletion and counter-flowing Fire, named Shaoyin Jue. Jue means reversing upward, i.e., Yin deficiency with Fire agitation.) A deep, fine, and scattered pulse indicates alternating cold and heat. (Commentary: Deep and fine are Yin; rapid and scattered are Yang. Yin and Yang mixed result in alternating cold and heat symptoms.) A floating and scattered pulse leads to collapse (Pu). (Floating indicates deficiency; scattered indicates insufficiency. Qi deficiency and Blood insufficiency lead to dizziness and collapse. Note: Pu sounds like "shun".)
All floating pulses without restlessness belong to Yang, indicating heat; if there is restlessness, it is in the Hand meridians. (This states the general principle. Yang relates to Water Qi, hence heat.) All fine and deep pulses belong to Yin, indicating bone pain; if there is stillness, it is in the Foot meridians. (Yin governs bones, hence bone pain. Commentary: Floating is Yang/heat, deep/fine is Yin/bone pain, which is clear. The phrases "restlessness in Hand" and "stillness in Foot" were interpreted by commentators as Hand-Yang and Foot-Yin pulses, which is inaccurate. There must be textual corruption; better to leave as doubtful.) A pulse that is rapid, moving, and intermittent (Dai pulse) indicates disease in Yang, accompanied by diarrhea and pus/blood in stool. (Dai means stopping. Commentary: Blood follows Qi; Dai implies Qi interruption and internal blood stasis. Internal blood stasis manifests as pus and blood in both urination and defecation.)
Various abnormal pulses must be palpated. Sease (Se) pulse indicates Yang Qi excess; Slippery (Hua) pulse indicates Yin Qi excess. (Yang excess leads to Blood deficiency, hence Se pulse; Yin excess leads to Blood abundance, hence Hua pulse.) Yang Qi excess manifests as body heat and absence of sweating; Yin Qi excess manifests as excessive sweating and cold body; Excess of both Yin and Yang manifests as absence of sweating and cold. (Commentary: Body heat without sweat indicates Fire excess closing Qi, external contraction of Cold, a Yang branch disease. Excessive sweating with cold body indicates Qi deficiency spontaneous sweating, requiring warming and tonification. Yang excess without sweat, Yin excess with cold body, requires warming and dispersing, e.g., Zhang Zhongjing’s use of Fuzi Xixin Decoction. The subtleties of syndrome differentiation and treatment can be deduced from this.)
Pushing the pulse outward (superficial pressure): if the pulse does not appear outwardly but remains inward, there is accumulation in the Heart and Abdomen. (Commentary: Not seen on superficial or deep pressure, sinking inward indicates accumulation in the Heart and Abdomen.) Pushing the pulse inward (deep pressure): if the pulse appears outwardly but not inwardly, there is heat in the body. (Commentary: Not seen on deep pressure, floating outwardly indicates pathogenic heat in the Exterior.) Pushing the pulse upward: if the pulse moves downward rather than upward, the waist and feet are cold. Pushing the pulse downward: if the pulse moves upward rather than downward, there is pain in the head and neck. (Commentary: Up refers to Cun, Down refers to Chi. Cun governs head/neck; Chi governs waist/feet. Thus, pushing up reveals pathology in the lower part (deficiency-cold); pushing down reveals pathology in the upper part (Fire rising to head/neck). Understanding pulse ascent/descent and floating/sinking locates the disease for treatment. Wang Bing’s version "Push up, up not down; push down, down not up" is erroneous. According to *Jia Yi Jing*, "Push up" corresponds to "down not up," and "push down" corresponds to "up not down," which is correct. We adopt this correction.) Pressing to the bone: if the pulse energy is weak, there is pain in the waist and spine and bi-syndrome in the body. (Caused by excessive Yin Qi. Commentary: Pulse nearly imperceptible upon deep pressing indicates Yang deficiency and lack of Qi, decline of Mingmen Fire. In the waist/spine, this causes cold pain; in the body, it causes areas of insensitivity to pain and itch.)