阴阳之变无穷，故其称名亦异。此篇以真脏为阴，以胃脘为阳，与诸篇之言阴阳大别，故以别论名篇焉。
但其中所定死期，不可执泥。盖人非轩岐，其言恐难凿凿，是以并皆节略云。
黄帝问曰∶人有四经十二从，何谓？岐伯对曰∶四经应四时，十二从应十二月，十二月应十二脉。（按∶
四经即肝心肺肾，独缺脾者，以土分王于四季，脾不主时，故言四经而脾自在其中，非五脏之外别有四经也。
从，附从也。脉之正曰经，附曰从。经专指脏，从则兼腑而言，亦犹合之为四时，分之则为十二月也。从，
去声。）
脉有阴阳，知阳者知阴，知阴者知阳。（深知则备识其变易。）凡阳有五，五五二十五阳。（五阳谓五脏
之阳气也。五脏应时，各形一脉，一脉之内，包总五脏之阳，五五相乘，故二十五阳也。）所谓阴者，真脏也。
见则为败，败必死也。（五脏为阴，故∶曰阴者真脏也。按∶五脏诚为阴矣，然阴何以即谓之真脏？真字之
解，注不明言，止将真脏脉象引HT ，殊欠发挥。窃谓真者本色之谓。五脏为阴，六腑为阳，凡阳必得阴而生，
阴必得阳而化。经曰∶“阴平阳秘，精神乃治。”今脉如肝之至，中外急如循刀刃等，是止有阴急而无阳和，
为五脏之真，本色独见，脏气已败，焉得不死。真字之解，然乎否耶？）所谓阳者，胃脘之阳也。（胃脘之阳，
人迎之气也。人迎在结喉两旁，动脉应手。其脉之动，常左小而右大。左小常以候脏，右大常以候腑。一云胃
胞之阳，非也。）别于阳者，知病处也；别于阴
者，知死生之期。（阳者卫外而为固，然外邪所中，别于阳则知病处；阴者藏神而内守，若考真正成败，别于
阴则知死生之期。）三阳在头，三阴在手，所谓一也。（……头谓人迎，手谓气口，两者相应，俱往俱来，
小大齐等，名曰平人，故言所谓一也。按∶所谓一，言皆可以知病之生死也。）谨熟阴阳，无与众谋。（按∶
潜心理会之谓谨，洞彻无疑之谓熟，阴阳之变不能眩吾心，则诸病迎刃而解矣。若以阴为阳，以阳为阴，是曰
众人。众人庸庸，有败无功。无与众谋，圣贤之心，英雄之言哉。）
所谓阴阳者，去者为阴，至者为阳；静者为阴，动者为阳；迟者为阴，数者为阳。（……按∶此言脉体之
有阴阳也。与前所言略异，当分别观之。）
曰∶二阳之病发心脾，有不得隐曲，女子不月。（二阳，谓阳明胃及大肠之脉也。隐曲，隐蔽委曲之事也。
按∶注又谓男子则脾受之而味不化，故少精；女子则心受之而血不流，故不月。分心脾为男女各受立说，窃尝
疑之。惟王安道论之最确，其言曰∶“二阳，阳明也。……发心脾犹言延及于心脾也。脾胃为合，胃病而及脾，
理固宜矣。大肠与心，本非合也，今大肠而及心何哉？盖胃为受纳之腑，大肠为传化之腑。食入于胃，浊气归心，
饮入于胃，输精于脾者，以胃之能纳，大肠之能化耳。肠胃既病，则不能受、不能化，心脾何所资乎。心脾既无
所资，则无所运化而生精血矣。故肠胃有病，心脾受之，则男为少精，女为不月矣。心脾当总言男女，不当分
说，至隐曲不月，方可分说耳。若如王氏之言，则男之精独资于脾而不资于心，女之血独资于心而不资于脾，
有是理乎！……经本曰男女皆有心脾之病，但在男子则隐曲不利，女子则月事不来尔。”安道此论，精确不易。
余初阅原注正欲改定，读溯洄集见之，无以易也，因仍之。）其传为风消，其传为息贲者，死不治。（言其深
久者也。胃病深久，传入于脾，故为风热以消削。大肠病甚，传入于肺，为喘息而上贲。然肠胃脾肺，
兼及于心，三脏二腑，互相克薄，故死不治。按∶自此以下六段，阴阳经发病，王注俱兼手足经脉言。而
马玄台以为单指足经，盖泥于传足不传手之说，误矣。当以注言为正。）
曰∶三阳为病发寒热，下为痈肿，及为痿厥 。（三阳，谓太阳小肠及膀胱之脉也。小肠之脉起于手，
循臂绕肩 ，上头。膀胱之脉，从头别下背，贯臀，入 中，循 。故在上为病，则发寒热；在下为病，则为
痈肿 及为痿厥。 ， 疼也。痿，无力也。厥，足冷，即气逆也。按∶ 音善，足肚也。 音渊，酸疼也。）
其传为索泽，其传为颓疝。（按，索，消索也。泽，润泽也。热久则肌肤枯燥而无润泽之气，膀胱主表故也。
颓疝，睾丸重坠，俗名小肠气是也。疝者寒气不行之病，小肠主火，病久则经虚而寒壅于其中，故传为颓疝也。）
曰∶一阳发病，少气，善咳，善泄。（一阳，谓少阳胆及三焦之脉也。胆气乘胃故善泄，三焦内病故少气，
阳上熏肺故善咳。何故？心火内应也。）其传为心掣，其传为隔。（按∶胆者木也，胆病不已，木郁火闭，心
气厄塞，若以手掣之者然。隔，闭塞不通也，三焦主气，灌注一身，循环上下，病久不愈，则上下之气闭塞
不通矣。）
二阳一阴发病，主惊骇，背痛，善噫，善欠，名曰风厥。（一阴，谓厥阴心主及肝之脉也。按∶二阳胃与
大肠，一阴肝与心主，其云发病，盖合四经而皆病，故见证有此四端。注单解肝与心主而不及二阳，且解善欠
作肾气乘之，偏矣。夫肝病则惊，心病则背痛而噫，胃病则噫而欠。又肝，木也。大肠，金也。金气凌木，则惊
且骇矣。惊骇则风动，木金火土，四气逆乱，是为风厥也。）
二阴一阳发病，善胀，心满，善气。（二阴，谓少阴心肾之脉也。按∶二阴心与肾，一阳胆与三焦。三焦
主气，气治则上下周流，气病则壅闭不通。今四经之病，胀满善气，似专属于三焦。而不知三焦者，决渎之官，
水道出焉，上通气于心，下泄气于肾，而中则取决于胆。故四者皆病，则为胀为满，上壅下滞，气聚不行，而
有似于三焦一经
之病也。注言胆肾同逆，三焦不行，同逆二字既无着落，单说三焦亦偏。）
三阳三阴发病，为偏枯痿易，四肢不举。（按∶三阴，注不明指何经，而且以偏枯属三阴不足，痿易属三
阳有余。偏枯固不足矣，痿弱而至变易无常，是又岂有余者，真可怪也。夫三阴者，太阴脾与肺也。脾统血，
脾病则血少而偏枯；肺主气，肺病则气虚而痿弱。易者变易不定，或手已而足，或足已而手，故云四肢不举也。
然四肢者，诸阳之本也。太阳小肠膀胱为阳经之一，小肠主受化物，膀胱主藏津液。二者同病，则一身乏灌
溉之资，而筋络干槁，此皆足以致偏枯痿废之病者也。余谓此节之注，视二阳发病之注，其误更甚。夫以安道
之贤，但知解分发之非，而又不能纠三阳有余之谬，此中缺陷，可胜补哉！）
鼓一阳曰钩，鼓一阴曰毛，鼓阳胜急曰弦，鼓阳至而绝曰石，阴阳相过曰溜。（按∶此盖言阴阳为病之邪脉也。
然钩为心脉，毛为肺脉，弦为肝脉，石为肾脉，而溜则义无可考。今取鼓一阳等语观之，既非状其脉之形似，
又非指其病之因由，实无意义，故注与诸家虽曲为之解，终未见其明确也。余谓素问中如此之类，不必强解，
存之可也。）阴争于内，阳扰于外，魄汗未藏，四逆而起，起则熏肺，使人喘鸣。（……按∶此言阴阳纷扰，
以致气逆而为喘急之病者，肺病之一端也。阴主内，阳主外，内外争扰，则气乱而汗大泄，汗愈泄则气愈乱。
四逆非四肢厥逆，言诸经之气，奔迸逼肺，致令喘急叫呼也。注谓金鼓不已，以致肺病，是顶上文，误矣。
魄汗，解已见前。未藏，谓汗出不止也。喘鸣者，气急则喘，喘急则有呼吸之声也。）是故刚与刚，阳气破散，
阴气乃消亡。（……刚谓阳也，盛极不久存，而阳气自散，阳已破败，阴不独存，故阳气破散，阴气亦消亡。
按∶注解精矣，但前节言阴阳争扰则病肺，而此节则言两阳相并，为纯阳而无阴也。然刚即阳也，不言阳与阳，
而言刚与刚者，两阳相并，暴悍之气，阳之亢也，是一说也。若其人已病阳强之症，而医
复补其阳，或轻投参术，或误用姜附，是亦谓之刚与刚，保无破散消亡之患乎。）
死阴之属，不过三日而死；生阳之属，不过四日而已。（按∶原本作四日而死，详上下文义，误矣。全元
起注本作四日而已，今从之。）所谓生阳死阴者，肝之心谓之生阳，（母来亲子，故曰生阳，非惟以木生火，
亦自阳气主生尔。）心之肺谓之死阴，（阴主刑杀，火复乘金，金得火亡，故云死。）肺之肾谓之重阴，（亦
母子也，以俱为阴气，故曰重阴。）肾之脾谓之辟阴，死不治。（按∶辟阴解，注不明快。辟犹僻也。肾，少
阴也。脾，太阴也。肾病并脾，偏僻于阴矣，与肺之肾谓之重阴同意。夫人生于阳而死于阴，故其为病也，
得阳则轻，得阴则重。木火之病何以生？阳也。心之肺，肺之肾，肾之脾，何以死？皆阴之属也。知阳之所以
生，则知阴之所以死矣。）
结阳者，肿四肢。（以四肢为诸阳之本故。）结阴者，便血一升，（阴主血故。）再结二升，三结三升。
（按，结者，聚而不散之谓。阳主气，阴主血。热结阳分，则气壅于四肢而浮肿；热结阴分，则血动下行而见
于二便，且视其结之深浅而血异焉。）阴阳结斜，多阴少阳曰石水，少腹肿。（按∶同一结也，此何以言结
斜？斜字之解，注不明言。夫斜犹偏也，偏于阳则热，偏于阴则寒。既阴阳并结矣，而其气之所结，或偏于阴，
是多阴而少阳，为阴寒凝结，名曰石水。石水者，水气凝结如石，少腹股足肿硬之类是也。）二阳结，谓之消。
胃及大肠俱热结也。肠胃藏热则喜消水谷。三阳结，谓之隔。（小肠膀胱俱热结也。小肠结热则血脉燥，膀
胱热则津液涸，故隔塞而不便泻。）三阴结，谓之水。（脾肺之脉俱寒结也。脾肺寒结则气化为水。）一阴一
阳结，谓之喉痹。（三焦心主，脉并络喉，气热内结，故为喉痹。）阴搏阳别，谓之有子。（按，子者，男女
之通称。阴谓尺脉，阳谓寸脉也。阴脉滑数，搏击独异，是为女子；阳脉滑动，与众相别，是为男子。阴阳宜
分发男女，若如注所言，则混沦而无辨矣。据云尺脉搏击，与寸口殊别，阳气挺然，则为有子。既知尺为阴矣，
尺脉搏击，何云阳气挺然？！若阳气挺然，则当是男子，而女子竟无诊法。启玄为先医宗匠，其误乃至于此。）
阴阳虚，肠辟死。（按∶阴阳虚者，气血两亏之人也。如病他证，犹可平补。若犯下利脓血之证，则阴更乏竭，
阳必耗散无余，未有不死者也。辟音 。）阳加于阴，谓之汗。（按∶谓寸关浮大，加倍于尺脉，是邪气外达，
其人必发汗。所以然者，凡邪得阴则内伏，得阳则外出也。注云“阳上搏，阴固之”等语，殊不可解。）阴虚
阳搏，谓之崩。（……阴脉不足，阳脉盛搏，则内崩而血流下。按∶阴虚则水涸不能制火，阳愈躁动，内扰其
阴，而血为之不宁，其人必有崩漏之患矣。）
阴阳的变化无穷无尽，因此其名称也各不相同。本篇以真脏脉为阴，以胃脘之气为阳，与其他篇章中论述的阴阳概念有显著区别，所以用“别论”来命名这篇。
但是其中所确定的死亡期限，不可拘泥固执。因为人并非黄帝（轩辕）或岐伯，他们的言论恐怕难以完全确凿无疑，因此对此都进行了节略处理。
黄帝问道：人有四经和十二从，这是什么意思？岐伯回答说：四经对应四季，十二从对应十二月，十二月对应十二经脉。（按语：四经即肝、心、肺、肾四条经脉，唯独缺少脾经，是因为土行旺于四季之末，脾不单独主令一时，所以说四经而脾自然包含在其中，并非在五脏之外另有四经。从，意为附从。脉的正经称为经，附属于经的称为从。经专指脏，从则兼指腑而言，这也如同合起来是四季，分开则是十二月一样。从，读去声。）
脉有阴有阳，懂得阳就能懂得阴，懂得阴就能懂得阳。（深入理解就能全面识别其变化。）凡是阳有五类，五五相乘就是二十五阳。（五阳指的是五脏的阳气。五脏对应四季，各形成一脉，每一脉之中总括了五脏的阳气，五五相乘，所以称为二十五阳。）所谓阴，指的是真脏脉。出现真脏脉就意味着脏腑败坏，败坏必然导致死亡。（五脏属阴，所以说：所谓阴者，就是真脏脉。按语：五脏确实属阴，但为什么直接称之为真脏呢？“真”字的解释，注家没有明确说明，只是引用了真脏脉的脉象，缺乏充分阐发。我认为“真”是指本色。五脏属阴，六腑属阳，凡阳必依赖阴而生，阴必依赖阳而化。经文说：“阴平阳秘，精神乃治。”现在脉象像肝脏的脉气到来时，内外紧急如循摸刀刃等，这是只有阴急而没有阳和，表现为五脏的本色独现，脏气已经败坏，怎么能不死呢？对“真”字的这种解释，是否合理呢？）所谓阳，指的是胃脘的阳气。（胃脘的阳气，就是人迎脉的气象。人迎穴位于结喉两旁，动脉应手跳动。其脉动通常左侧小右侧大。左侧小常用来候察脏气，右侧大常用来候察腑气。另一种说法认为是胃胞的阳气，这是错误的。）辨别阳分病变，可以知道病位所在；辨别阴分病变，可以知道死生的期限。（阳分护卫体表而固密，然而外邪侵袭，通过辨别阳分就可以知道病位；阴分藏守神气而内守，如果要考察真正的成败，通过辨别阴分就可以知道死生的期限。）三阳经的气血汇聚于头部，三阴经的气血汇聚于手部，这叫做“一”。（……头指人迎脉，手指气口脉，两者相应，共同往来，大小相等，称为平人，所以说这叫“一”。按语：所谓“一”，是说都可以用来判断疾病的生死。）务必熟练掌握阴阳理论，不要与普通人商量。（按语：潜心领会叫做“谨”，透彻无疑叫做“熟”，如果阴阳的变化不能迷惑我们的心，那么各种疾病就能迎刃而解。如果把阴当作阳，把阳当作阴，这就叫众人。众人平庸无能，只会失败而无功。不与众人商量，这是圣贤的心胸，英雄的话语啊。）
所谓阴阳，离去的是阴，到来的是阳；安静的是阴，躁动的是阳；迟缓的是阴，急促的是阳。（……按语：这里说的是脉体本身的阴阳属性。与前文所说的略有不同，应当分别看待。）
又说：二阳经发病，根源在心脾，会出现难以启齿的隐曲之事（指性功能或排泄障碍），女子月经闭止。（二阳，指阳明胃经及大肠经的脉象。隐曲，指隐蔽委曲的事情。按语：原注又认为男子则是脾受病导致食物不消化，所以精少；女子则是心受病导致血液不流通，所以月经不来。将心脾分为男女各自受病立论，我曾对此表示怀疑。只有王安道的论述最为确切，他说：“二阳，就是阳明经。……‘发心脾’意思是延及于心脾。脾胃互为表里，胃病波及脾，道理固然适宜。大肠与心，本来不是表里关系，现在大肠病波及心是怎么回事？盖因胃是受纳之腑，大肠是传化之腑。食物进入胃，浊气归于心；饮水进入胃，精气输布于脾，这是因为胃能受纳，大肠能传化的缘故。肠胃既然生病，就不能受纳、不能传化，心脾有什么可依赖的呢？心脾既然没有依赖，就无法运化而产生精血了。所以肠胃有病，会波及心脾，导致男子精少，女子月经不来。心脾应当总体说来不分男女，至于隐曲不利和月经不来，才可以分开来说。如果像王氏所说，那么男子的精只依赖脾而不依赖心，女子的血只依赖心而不依赖脾，有这样的道理吗！……经文原本是说男女都有心脾的病，只是在男子表现为隐曲不利，在女子表现为月经不来罢了。”安道的这个论述，精确无误。我起初阅读原注正想修改，读到《溯洄集》见到此论，无法更改，于是保留下来。）病情传变发展为风消（肌肉消瘦），或者传变为息贲（喘息上逆），就会死亡且无法治疗。（说的是病情深久的情况。胃病日久，传入脾脏，所以产生风热以消削肌肉。大肠病严重，传入肺脏，导致喘息而上逆。然而肠胃脾肺，兼及心脏，三脏二腑互相克制侵迫，所以死亡且无法治疗。按语：从这里以下的六段，关于阴阳经发病，王冰的注都兼指手足经脉而言。而马莳认为单指足经，大概是拘泥于“传足不传手”的说法，是错误的。应当以王注为准。）
又说：三阳经发病，表现为寒热，下部发生痈肿，以及痿厥。（三阳，指太阳小肠经及膀胱经的脉象。小肠经的脉起于手，沿手臂绕肩，上头。膀胱经的脉从头部分开下行背部，贯穿臀部，入腘中，沿小腿后侧下行。所以在上部发病，就表现为寒热；在下部发病，就表现为痈肿以及痿厥。腨，是小腿肚疼痛。痿，是无力。厥，是脚冷，也就是气逆。按语：腨音善，指小腿肚。腨音渊，指酸痛。）病情传变发展为索泽（肌肤干枯无润泽），或者传变为颓疝。（按语：索，是消索的意思。泽，是润泽的意思。热久则肌肤枯燥而没有润泽之气，因为膀胱主表。颓疝，是睾丸重坠，俗称小肠气。疝是寒气不行导致的病，小肠主火，病久则经脉虚弱而寒气壅滞在其中，所以传变为颓疝。）
又说：一阳经发病，表现为少气，容易咳嗽，容易腹泻。（一阳，指少阳胆经及三焦经的脉象。胆气侵犯胃故容易腹泻，三焦内部有病故少气，阳气上熏肺故容易咳嗽。为什么呢？因为心火在内相应。）病情传变为心掣（心脏牵拉痛），或者传变为膈（膈塞不通）。（按语：胆属木，胆病不已，木郁火闭，心气受阻，好像用手牵拉一样。膈，是闭塞不通，三焦主气，灌注全身，循环上下，病久不愈，则上下之气闭塞不通了。）
二阳和一阴经发病，主要表现为惊骇，背痛，容易嗳气，容易呵欠，名叫风厥。（一阴，指厥阴心包络及肝经的脉象。按语：二阳是胃与大肠，一阴是肝与心包络，说它们发病，大概是这四条经都病了，所以症状有这四个方面。原注只解释了肝与心包络而未涉及二阳，且将善欠解释为肾气乘之，偏颇了。肝病则惊，心病则背痛而嗳气，胃病则嗳气而欠。另外，肝属木，大肠属金。金气凌犯木，则既惊且骇。惊骇则风动，木金火土四气逆乱，这就是风厥。）
二阴和一阳经发病，容易腹胀，心下满闷，容易叹气。（二阴，指少阴心经和肾经的脉象。按语：二阴是心与肾，一阳是胆与三焦。三焦主气，气机调畅则上下周流，气机有病则壅闭不通。现在这四条经的病，胀满、善气，似乎专门归属于三焦。却不知道三焦是决渎之官，水道由此而出，上通气于心，下泄气于肾，而中间取决于胆。所以这四者都病，就会胀满，上壅下滞，气聚不行，而有类似三焦一经生病的样子。原注说胆肾同逆，三焦不行，“同逆”二字既无着落，单说三焦也偏颇。）
三阳和三阴经发病，表现为偏枯（半身不遂）、痿易（肢体萎弱且变换无常）、四肢不能举动。（按语：三阴，原注不明确指哪条经，而且将偏枯归因于三阴不足，将痿易归因于三阳有余。偏枯固然是不足，但痿弱到了变幻无常的地步，这难道是有余吗？真是奇怪。夫三阴，指太阴脾与肺。脾统血，脾病则血少而偏枯；肺主气，肺病则气虚而痿弱。易，是变易不定，有时手好了脚好，有时脚好了手好，所以说四肢不能举动。然而四肢是诸阳之本。太阳小肠膀胱为阳经之一，小肠主受纳化物，膀胱主贮藏津液。二者同病，则一身缺乏灌溉的资源，而筋络干枯槁槁，这都是导致偏枯痿废疾病的原因。我认为这一节的注释，比第二节“二阳发病”的注释错误更甚。像王安道那样贤能的人，只知道纠正分发解释的错误，却又不能纠正“三阳有余”的谬误，其中的缺陷，哪里补得完呢！）
鼓动一阳脉象叫做钩，鼓动一阴脉象叫做毛，鼓动阳胜急迫脉象叫做弦，鼓动阳至而绝脉象叫做石，阴阳相过脉象叫做溜。（按语：这大概说的是阴阳为病的邪脉。然而钩是心脉，毛是肺脉，弦是肝脉，石是肾脉，而溜的意义无可考证。现在看“鼓一阳”等语句，既不是描述脉的形状相似，也不是指出病因，实在没有意义，所以原注和各家的解释虽然勉强为之，最终也没见明确。我认为《素问》中这类内容，不必强行解释，保留即可。）阴气争于内，阳气扰于外，魄汗（大汗）未能收敛，四肢厥逆而起，四肢厥逆起来则热气熏肺，使人喘鸣。（……按语：这里说的是阴阳纷扰，导致气逆而为喘急的疾病，这是肺病的一种表现。阴主内，阳主外，内外争扰，则气乱而大汗淋漓，汗越泄气越乱。这里的“四逆”不是指四肢厥逆，而是说各经之气奔迸逼肺，导致喘急叫呼。原注说是金鼓不已以致肺病，是承接上文，是错误的。魄汗的解释已见前文。未藏，指汗出不止。喘鸣，是气急则喘，喘急则有呼吸的声音。）因此，刚与刚相加（两阳相并），阳气破散，阴气也就消亡。（……刚指阳，盛极不久存，阳气自散，阳已破败，阴不独存，所以阳气破散，阴气也消亡。按语：注解很精辟，但前一节说阴阳争扰则病肺，而这一节说两阳相并，为纯阳而无阴。然而刚就是阳，不说阳与阳，而说刚与刚，是因为两阳相并，暴悍之气，是阳的亢盛，这是一种说法。如果病人已经患有阳强之症，医生又补其阳，或者轻投人参白术，或者误用干姜附子，这也叫刚与刚，难道没有破散消亡的祸患吗？）
属于死阴的，不超过三天就会死亡；属于生阳的，不超过四天而已。（按语：原本作“四日而死”，详察上下文义，是错误的。全元起注本作“四日而已”，现在采用这个说法。）所谓生阳死阴，是指：肝传给心叫做生阳，（母来生子，所以叫生阳，不仅是因为木生火，也是因为阳气主生。）心传给肺叫做死阴，（阴主刑杀，火复乘金，金被火克亡，所以叫死。）肺传给肾叫做重阴，（也是母子关系，因为都属阴气，所以叫重阴。）肾传给脾叫做辟阴，（死不治）。（按语：辟阴的解释，原注不清楚。辟通僻。肾，是少阴。脾，是太阴。肾病并及脾，偏僻于阴了，与肺传给肾叫重阴同意。人生于阳而死于阴，所以患病时，得阳则轻，得阴则重。木火之病为什么生？因为属阳。心传给肺，肺传给肾，肾传给脾，为什么死？都属于阴。知道阳之所以生，就知道阴之所以死了。）
阳气结聚于阳分，会导致四肢肿胀。（因为四肢是诸阳之本。）阴气结聚于阴分，会导致便血一升，（阴主血所以如此。）再结聚则二升，三结聚则三升。（按语：结，是聚而不散的意思。阳主气，阴主血。热结于阳分，则气壅滞于四肢而浮肿；热结于阴分，则血动下行而从二便排出，且视结聚的深浅而血量不同。）阴阳结斜（偏结），多阴少阳叫做石水，少腹肿胀。（按语：同样是结，这里为什么说结斜？斜字的解释，原注不明言。斜犹偏也，偏于阳则热，偏于阴则寒。既然阴阳并结，而其气之所结，或偏于阴，是多阴而少阳，为阴寒凝结，名叫石水。石水，是水气凝结如石，少腹股足肿硬之类就是。）二阳经结聚，叫做消渴。（胃及大肠俱热结也。肠胃藏热则喜欢消耗水谷。）三阳经结聚，叫做膈证。（小肠膀胱俱热结也。小肠结热则血脉燥，膀胱热则津液涸，所以隔塞而不能大便泻。）三阴经结聚，叫做水病。（脾肺之脉俱寒结也。脾肺寒结则气化失常而为水。）一阴一阳经结聚，叫做喉痹。（三焦心包络，脉并络喉，气热内结，所以为喉痹。）阴脉搏击有力而与阳脉有别，叫做怀孕。（按语：子，是男女的通称。阴指尺脉，阳指寸脉也。阴脉滑数，搏击独异，这是女子；阳脉滑动，与众相别，这是男子。阴阳宜分开指代男女，如果像原注所言，则混沦而无分辨了。据云尺脉搏击，与寸口殊别，阳气挺然，则为怀孕。既然知道尺为阴，尺脉搏击，为什么说阳气挺然？！如果阳气挺然，则应当是男子，而女子竟没有诊法。启玄子作为先代医宗匠，其错误竟然到了这种地步。）
阴阳两虚，患肠辟（痢疾）则会死亡。（按语：阴阳虚，是气血两亏的人。如果患其他病症，还可以平补。如果犯下利脓血的证候，则阴更乏竭，阳必耗散无余，没有不死的。）阳加于阴，叫做汗。（按语：谓寸关浮大，加倍于尺脉，是邪气外达，其人必发汗。之所以这样，是因为凡邪气得阴则内伏，得阳则外出。原注说“阳上搏，阴固之”等话，特别不可理解。）阴虚而阳脉搏动有力，叫做崩漏。（……阴脉不足，阳脉盛搏，则内崩而血流下。按语：阴虚则水涸不能制火，阳愈躁动，内扰其阴，而血为之不宁，其人必有崩漏之患矣。）
The changes of Yin and Yang are infinite, therefore their names also vary. This chapter regards the Zang-Organ Pulse (Zhen Zang Mai) as Yin and the Stomach Qi (Wei Wan Zhi Yang) as Yang, which differs significantly from the discussions of Yin and Yang in other chapters; hence it is named "Bie Lun" (Differentiated Discussion).
However, the death periods specified therein should not be rigidly adhered to. Since humans are not Huangdi (Yellow Emperor) or Qibo, their statements may not be entirely indisputable; thus, they have been summarized and abridged here.
The Yellow Emperor asked: "Humans have Four Channels (Si Jing) and Twelve Attachments (Shi Er Cong). What does this mean?" Qibo replied: "The Four Channels correspond to the Four Seasons, the Twelve Attachments correspond to the Twelve Months, and the Twelve Months correspond to the Twelve Meridians." (Commentary: The Four Channels refer to the Liver, Heart, Lung, and Kidney meridians. The Spleen is omitted because Earth governs the last 18 days of each season, and the Spleen does not rule a specific season alone; thus, mentioning the Four Channels implies the Spleen is included within them, rather than there being four channels outside the Five Zang Organs. 'Cong' means attachment. The main pulse is called 'Jing' (Channel), and the attached pulse is called 'Cong'. 'Jing' refers specifically to the Zang organs, while 'Cong' includes both Zang and Fu organs. This is similar to how combining them yields the Four Seasons, while separating them yields the Twelve Months. 'Cong' is pronounced with the departing tone.)
Pulses have Yin and Yang. To understand Yang is to understand Yin, and to understand Yin is to understand Yang. (Deep understanding allows for comprehensive recognition of their transformations.) There are five types of Yang, and five times five equals twenty-five Yang. (The five Yangs refer to the Yang Qi of the Five Zang Organs. Each Zang organ corresponds to a season and forms one pulse; within each pulse, the Yang Qi of all five Zang organs is encompassed. Thus, five times five results in twenty-five Yangs.) What is referred to as Yin is the Zang-Organ Pulse (Zhen Zang Mai). Its appearance indicates deterioration, and deterioration inevitably leads to death. (The Five Zang Organs belong to Yin, hence it is said: 'What is Yin is the Zang-Organ Pulse.' Commentary: Although the Five Zang Organs are indeed Yin, why are they directly called 'True Zang'? The commentary does not clearly explain the character 'Zhen' (True), merely citing the pulse image of the Zang-Organ Pulse, lacking sufficient elaboration. I propose that 'Zhen' refers to the true nature/color. The Five Zang Organs are Yin, and the Six Fu Organs are Yang. All Yang must be born through Yin, and Yin must be transformed by Yang. The Classic states: 'When Yin is balanced and Yang is secure, spirit and vitality are regulated.' Now, if the pulse arrives like the Liver's pulse—urgent inside and out, like touching a blade—it shows only Yin urgency without Yang harmony. This reveals the true nature of the Five Zang Organs alone, indicating that the Zang Qi has deteriorated. How can one not die? Is this explanation of 'Zhen' reasonable?) What is referred to as Yang is the Yang of the Stomach Chamber (Wei Wan Zhi Yang). (The Yang of the Stomach Chamber refers to the Qi at the Renying point. The Renying point is located on both sides of the larynx, where the artery beats palpably. Its pulsation is usually smaller on the left and larger on the right. The smaller left pulse often reflects Zang Qi, and the larger right pulse often reflects Fu Qi. Another theory claims it is the Yang of the stomach cavity, which is incorrect.) Distinguishing Yang lesions allows one to know the location of the disease; distinguishing Yin lesions allows one to know the period of life or death. (Yang protects the exterior and secures the body. When external pathogens invade, distinguishing Yang reveals the disease site. Yin stores the Spirit and guards internally. To examine true success or failure, distinguishing Yin reveals the prognosis of life or death.) The Qi of the Three Yang meridians gathers at the head, and the Qi of the Three Yin meridians gathers at the hand; this is called 'One'. (...The head refers to the Renying pulse, and the hand refers to the Qikou pulse. These two correspond, coming and going together, equal in size, termed a 'Ping Ren' (Normal Person); hence it is said to be 'One'. Commentary: 'One' means that both can be used to determine the life or death of diseases.) One must diligently master Yin and Yang and not consult with the masses. (Commentary: 'Jin' (Diligent/Careful) means deep contemplation; 'Shu' (Proficient) means thorough clarity without doubt. If the changes of Yin and Yang cannot confuse the mind, then various diseases will be resolved easily. Confusing Yin with Yang and Yang with Yin constitutes the 'masses'. The masses are mediocre, achieving failure without merit. Not consulting the masses is the mindset of sages and heroes.)
Regarding Yin and Yang: That which departs is Yin, that which arrives is Yang; that which is still is Yin, that which moves is Yang; that which is slow is Yin, that which is rapid is Yang. (...Commentary: This describes the Yin-Yang attributes inherent in the pulse body itself. It differs slightly from previous discussions and should be viewed separately.)
It is stated: Diseases of the Two Yang meridians originate in the Heart and Spleen, manifesting as difficult-to-disclose issues (sexual or excretory dysfunction) and amenorrhea in women. (Two Yang refers to the pulses of the Yangming Stomach and Large Intestine meridians. 'Yinqu' refers to hidden or delicate matters. Commentary: The original note suggests that in men, the Spleen is affected leading to poor digestion and scanty essence; in women, the Heart is affected leading to blood stagnation and amenorrhea. Dividing Heart and Spleen pathology by gender is questionable. Wang Andao's argument is most accurate: 'Two Yang is Yangming... "Originating in Heart and Spleen" means extending to the Heart and Spleen. Spleen and Stomach are interior-exterior pairs; Stomach disease affecting the Spleen is logical. However, the Large Intestine and Heart are not paired. Why does Large Intestine disease affect the Heart? The Stomach is the palace of reception, and the Large Intestine is the palace of transmission. Food enters the Stomach, turbid Qi goes to the Heart; water enters the Stomach, refined essence goes to the Spleen. This relies on the Stomach's ability to receive and the Large Intestine's ability to transform. If the intestines and stomach are diseased, they cannot receive or transform, leaving the Heart and Spleen without resources. Without resources, the Heart and Spleen cannot transport and transform to produce essence and blood. Thus, intestinal and stomach diseases affect the Heart and Spleen, causing scanty essence in men and amenorrhea in women. Heart and Spleen should be discussed collectively for both genders; only the specific symptoms of Yinqu and amenorrhea should be differentiated. If Wang's view were correct, men's essence would rely solely on the Spleen and not the Heart, and women's blood solely on the Heart and not the Spleen—is this logical? ...The Classic originally states that both men and women suffer Heart-Spleen disease, but in men it manifests as Yinqu dysfunction, and in women as amenorrhea.' Andao's discussion is precise and unchangeable. I initially intended to revise the original note, but upon reading *Suhui Ji*, I found no better explanation and retained it.) If the condition transmits to become Feng Xiao (wasting-thirst with muscle emaciation) or Xi Ben (asthma with upward rebellion), death occurs and is untreatable. (This refers to prolonged and deep disease. Chronic Stomach disease transmitting to the Spleen generates wind-heat that consumes muscles. Severe Large Intestine disease transmitting to the Lung causes asthma and upward rebellion. The intestines, stomach, spleen, and lungs, along with the Heart, mutually oppress each other, leading to death and incurability. Commentary: From this section onwards regarding the six paragraphs of Yin-Yang meridian diseases, Wang Bing's notes cover both hand and foot meridians. Ma Xuan Tai's view that they refer only to foot meridians is erroneous, likely due to adherence to the 'foot-transmission only' theory. Wang Bing's note should be considered correct.)
It is stated: Diseases of the Three Yang meridians manifest as chills and fever, sores and swellings below, and Wei Jue (flaccidity and cold extremities). (Three Yang refers to the pulses of the Taiyang Small Intestine and Bladder meridians. The Small Intestine meridian starts at the hand, runs along the arm, around the shoulder, and up to the head. The Bladder meridian descends from the head down the back, through the buttocks, into the popliteal fossa, and down the calf. Disease above manifests as chills and fever; disease below manifests as sores, swellings, flaccidity, and cold extremities. Shuan refers to pain in the calf muscle. Wei means weakness. Jue means cold feet, i.e., rebellious Qi. Commentary: Shuan (sound shan) refers to the calf muscle. Shuan (sound yuan) refers to soreness/pain.) If the condition transmits to become Suo Ze (dry skin lacking moisture) or Tui Shan (scrotal hernia)... (Commentary: Suo means wasting away. Ze means moisture. Prolonged heat causes dry, rough skin lacking moisture because the Bladder governs the exterior. Tui Shan refers to heavy, drooping testicles, commonly known as 'small intestine qi'. Shan is a disease caused by stagnant cold Qi. The Small Intestine governs Fire; prolonged illness weakens the meridians, allowing cold to stagnate within, transmitting to Tui Shan.)
It is stated: Disease of the One Yang meridian manifests as shortness of breath, frequent coughing, and frequent diarrhea. (One Yang refers to the pulses of the Shaoyang Gallbladder and Sanjiao meridians. Gallbladder Qi invading the Stomach causes diarrhea; internal Sanjiao disease causes shortness of breath; Yang Qi steaming the Lung causes coughing. Why? Because of internal correspondence with Heart Fire.) If the condition transmits to become Xin Che (pulling sensation in the heart) or Ge (obstruction)... (Commentary: The Gallbladder belongs to Wood. Untreated Gallbladder disease leads to Wood stagnation and Fire closure, obstructing Heart Qi, feeling like a pulling sensation. Ge means obstruction. The Sanjiao governs Qi, circulating throughout the body. Prolonged disease causes obstruction of Qi between upper and lower jiao.)
Disease of the Two Yang and One Yin meridians primarily manifests as fright and terror, back pain, frequent belching, and frequent yawning, named Feng Jue (Wind Reversal). (One Yin refers to the pulses of the Jueyin Pericardium and Liver meridians. Commentary: Two Yang are Stomach and Large Intestine; One Yin is Liver and Pericardium. Saying they cause disease implies all four meridians are involved, hence these four symptoms. The original note only explains Liver and Pericardium, ignoring Two Yang, and attributes yawning to Kidney Qi invasion, which is biased. Liver disease causes fright; Heart disease causes back pain and belching; Stomach disease causes belching and yawning. Furthermore, Liver is Wood, Large Intestine is Metal. Metal Qi oppressing Wood causes fright and terror. Fright and terror stir Wind. The reversal of Wood, Metal, Fire, and Qi constitutes Feng Jue.)
Disease of the Two Yin and One Yang meridians manifests as distension, chest fullness, and frequent sighing. (Two Yin refers to the pulses of the Shaoyin Heart and Kidney meridians. Commentary: Two Yin are Heart and Kidney; One Yang is Gallbladder and Sanjiao. The Sanjiao governs Qi. When Qi is regulated, it flows freely; when diseased, it becomes obstructed. The current diseases of these four meridians—distension, fullness, sighing—seem to belong exclusively to the Sanjiao. However, the Sanjiao is the official of drainage, the source of water passages, connecting Qi to the Heart above, draining Qi to the Kidney below, and depending on the Gallbladder in the middle. Thus, disease in all four leads to distension and fullness, upper congestion and lower stagnation, Qi accumulation without movement, resembling a Sanjiao meridian disease. The note saying Gallbladder and Kidney reverse together and Sanjiao fails to move leaves 'reverse' undefined and focusing solely on Sanjiao is biased.)
Disease of the Three Yang and Three Yin meridians manifests as hemiplegia (Pian Ku), variable flaccidity (Wei Yi), and inability to move the limbs. (Commentary: The original note does not specify which Three Yin meridians, attributing hemiplegia to Three Yin deficiency and variable flaccidity to Three Yang excess. Hemiplegia is indeed deficiency, but flaccidity becoming unpredictable is hardly excess. Truly strange. The Three Yin here refer to the Taiyin Spleen and Lung. The Spleen governs Blood; Spleen disease leads to blood deficiency and hemiplegia. The Lung governs Qi; Lung disease leads to Qi deficiency and flaccidity. 'Yi' means changeable/unstable; sometimes the hand recovers while the leg remains paralyzed, or vice versa, hence inability to move limbs. However, the limbs are the root of all Yang. The Taiyang Small Intestine and Bladder are Yang meridians. The Small Intestine receives and transforms; the Bladder stores fluids. Disease in both deprives the body of irrigation, causing dry sinews and tendons, leading to hemiplegia and flaccidity. I believe the note for this section is even more erroneous than the note for 'Two Yang Disease'. Even Wang Andao, who corrected the distribution error, failed to correct the 'Three Yang Excess' fallacy. How can such defects be fully remedied!)
Beating One Yang pulse is called Gou (Hook); beating One Yin pulse is called Mao (Feather); beating Yang-excess urgent pulse is called Xian (Bowstring); beating Yang-extreme dying pulse is called Shi (Stone); Yin-Yang interlacing pulse is called Liu (Slippery/Flowing). (Commentary: This likely describes pathological pulses of Yin-Yang disease. Gou is Heart pulse, Mao is Lung pulse, Xian is Liver pulse, Shi is Kidney pulse, but the meaning of Liu is unverified. Observing phrases like 'beating One Yang', it neither describes pulse shape nor etiology, lacking clear meaning. Thus, although original and other notes force interpretations, none are clear. I believe such content in *Suwen* need not be forced into interpretation; preserving it is acceptable.) Yin contends internally, Yang disturbs externally. Po Han (profuse sweating) fails to consolidate. Si Ni (extremity cold/reversal) arises. Upon arising, heat steams the Lung, causing wheezing and rattling. (...Commentary: This describes Yin-Yang chaos leading to Qi rebellion and acute asthma, a manifestation of Lung disease. Yin governs interior, Yang governs exterior. Internal/external contention causes Qi chaos and profuse sweating. More sweat leads to more Qi chaos. Here, 'Si Ni' does not mean limb coldness, but rather Qi from various meridians rushing to the Lung, causing acute wheezing and shouting. The note claiming endless metal-drumming causes Lung disease misinterprets the preceding text. 'Po Han' was explained previously. 'Wei Cang' means continuous sweating. 'Chuan Ming' means wheezing due to air hunger and audible breathing sounds.) Therefore, Gang with Gang (Yang combined with Yang) causes Yang Qi to break and scatter, and Yin Qi to perish. (...Gang refers to Yang. Extreme prosperity does not last; Yang Qi scatters naturally. Once Yang is broken, Yin cannot exist alone, so both Yang and Yin perish. Commentary: The note is profound, but the previous section said Yin-Yang contention harms the Lung, while this section says two Yangs combine, creating pure Yang without Yin. 'Gang' is Yang. Saying 'Gang with Gang' instead of 'Yang with Yang' implies two Yangs combining, representing violent, fierce Qi, which is Yang hyperactivity. Another perspective: If a patient already suffers from Yang-strength syndrome, and the doctor tonifies Yang, or lightly uses Ginseng/Atractylodes, or mistakenly uses Ginger/Aconite, this is also 'Gang with Gang', risking breakdown and perishing.)
Those belonging to Death Yin die within three days; those belonging to Life Yang survive no more than four days. (Commentary: The original text says 'die within four days', which contradicts the context and is erroneous. Quan Yuanqi's edition says 'survive no more than four days', which is adopted here.) Regarding Life Yang and Death Yin: Liver transmitting to Heart is called Life Yang (Mother generating Child, hence Life Yang; not only Wood generating Fire, but also Yang Qi governing generation). Heart transmitting to Lung is called Death Yin (Yin governs punishment/death; Fire attacking Metal, Metal destroyed by Fire, hence Death). Lung transmitting to Kidney is called Chong Yin (Heavy Yin) (Also Mother-Child relationship, but both belong to Yin Qi, hence Heavy Yin). Kidney transmitting to Spleen is called Pi Yin (Deviant Yin), death and untreatable. (Commentary: The explanation of Pi Yin in the note is unclear. Pi means deviant/perverse. Kidney is Shaoyin; Spleen is Taiyin. Kidney disease involving Spleen is deviant toward Yin, consistent with Lung-to-Kidney being Heavy Yin. Humans are born from Yang and die from Yin. Thus, illness gets lighter with Yang and heavier with Yin. Why do Wood-Fire diseases generate? They belong to Yang. Why do Heart-to-Lung, Lung-to-Kidney, Kidney-to-Spleen transmissions result in death? They all belong to Yin. Knowing why Yang generates, one knows why Yin kills.)
Yang Qi knotting leads to swelling of the four limbs. (Because limbs are the root of all Yang.) Yin Qi knotting leads to bloody stool of one sheng. (Yin governs Blood.) Second knotting leads to two sheng, third knotting leads to three sheng. (Commentary: 'Jie' (Knot) means gathering without dispersing. Yang governs Qi, Yin governs Blood. Heat knotting in Yang division causes Qi stagnation in limbs and edema; heat knotting in Yin division causes blood movement downward appearing in stool/urine, with volume varying by depth of knotting.) Yin-Yang knotting obliquely (biased), with much Yin and little Yang, is called Shi Shui (Stone Water), with swelling of the lower abdomen. (Commentary: It is the same 'knotting', why 'oblique/biased'? 'Xie' means biased. Biased toward Yang is heat; biased toward Yin is cold. Since Yin and Yang both knot, but the Qi knots biased toward Yin, it is much Yin and little Yang, constituting Yin-cold coagulation, named Shi Shui. Stone Water is water Qi coagulating like stone, such as hard swelling of lower abdomen and groin.) Two Yang knotting is called Xiao (Wasting-Thirst). (Heat knotting in Stomach and Large Intestine. Heat stored in intestines/stomach increases consumption of water and grain.) Three Yang knotting is called Ge (Obstruction). (Heat knotting in Small Intestine and Bladder. Heat knot in Small Intestine dries blood vessels; heat in Bladder dries fluids, causing obstruction and constipation.) Three Yin knotting is called Shui (Water Disease). (Cold knotting in Spleen and Lung meridians. Cold knot in Spleen/Lung disrupts Qi transformation into water.) One Yin and One Yang knotting is called Hou Bi (Throat Bi). (Sanjiao and Pericardium meridians connect to the throat. Internal heat knotting causes Throat Bi.) Yin pulse beats distinctly different from Yang pulse is called You Zi (Pregnancy). (Commentary: 'Zi' is a general term for child/offspring. Yin refers to Chi pulse, Yang refers to Cun pulse. Yin pulse slippery and rapid, beating distinctly, indicates female; Yang pulse sliding, distinct from others, indicates male. Yin/Yang should distinguish genders. If following the note, it becomes indistinguishable. The note says Chi pulse beats distinctly, Cun pulse stands firm, indicating pregnancy. If Chi is Yin, why say Chi pulse beating indicates Yang standing firm?! If Yang stands firm, it should indicate male, leaving no diagnostic method for females. Qixuanzi, a master physician, erred thus.)
Yin and Yang both deficient, suffering Chang Pi (dysentery) leads to death. (Commentary: Yin-Yang deficiency means Qi and Blood depletion. For other diseases, mild tonification suffices. But for dysentery with pus and blood, Yin exhausts further, Yang dissipates completely, inevitably leading to death. 'Pi' pronounced [pi].) Yang added to Yin is called Han (Sweat). (Commentary: Cun-Guan floating and large, double the Chi pulse, indicates pathogenic Qi moving outward, causing sweating. Why? Pathogens hide internally with Yin and move outward with Yang. The note saying 'Yang attacks above, Yin consolidates' is incomprehensible.) Yin deficient and Yang pulse beats forcefully is called Beng (Metrorrhagia/Metrorrhea). (...Insufficient Yin pulse, vigorous Yang pulse leads to internal collapse and downward bleeding. Commentary: Yin deficiency means fluid depletion failing to control Fire; Yang becomes restless, disturbing Yin internally, causing blood instability, leading to metrorrhagia/menorrhagia.)