吴云。古之帝王。闻一善道。着之方策。以纪其事。谓之玉版。简按贾谊新书云。书之玉版。藏之金柜。
置之宗庙。以为后世戒。汉司马迁传。金柜玉版。图籍散乱。如淳注。玉版。刻玉版。书为文本
也。
揆度奇恒 马云。病能论云。揆度者。切度之也。奇恒者。言奇病也。所谓奇者。使奇病不得以四时
死也。恒者。得以四时死也。所谓揆者。方切求之也。言切求其脉理也。度者。得其病处。以四时度之也。
道在于一 马云。一者何也。以人之有神也。吴张同。
神转不回 马云。回者。却行而不能前也。玉机真脏论云。帝曰。吾得脉之大要。天下至数。五色脉
变。揆度奇恒。道在于一。神转不迥。迥则不转。乃失其机。至数之要。迫近以微。着之玉版。藏之脏腑。每
旦读之。名曰玉机。此篇用回字。彼从 。义当参考。张云。回。逆而邪也。简按回 同字。
至数之要迫近以微 高云。至数之要。迫近而在于色脉。以微而在于神机。色脉神机。可以着之玉版。
容色 吴云。容。面容也。简按全本作客色。近是。
在其要 高云。在。察也。所谓色变者。面容之色。见于上下左右。当各察其浅深顺逆之要。简按在。
察也。见尔雅释诂。
汤液主治十日已 高云。汤液者。五谷之汤液。十日已者。十干之天气周。而病可已。即移精变气论。
所谓汤液十日以去八风五痹之病者。是也。
必齐主治二十一日已 高云。齐。合也。即汤液醪醴论。所谓必齐毒药攻其中者。是也。二十日。则
十干再周。二十一日。再周环复。其病可已。马云。齐。后世作剂。
醪酒主治百日已 马云。醪酒者。入药于酒中。如腹中论有鸡矢醴之谓。高云。醪酒。乃熟谷之液。
其性 悍滑疾。营运荣卫。通调经脉。故百日病已。百日则十干十周。气机大复也。
百日尽已 吴云。言至于百日之期。则命尽而死。张云。百日尽则时更气易。至数尽而已。上节言病
已。此言命已也。不可混看。高云。尽已。气血皆终也。简按王林二家注并误。
上为逆下为从 马云。色见于上。病势方炎。故为逆。色见于下。病势已衰。故为从。灵五色篇云。
其色上行者。病益甚。其色下行。如云彻散者。病方已。
女子右为逆左为从 志云。按方盛衰论云。阳从左。阴从右。盖男子之血气从左旋。女子之血气从右
转。是以男子之色见于右。而从左散者。顺也。女子之色见于左。而从右散者。顺也。
阴阳反他 张云。作。旧作他。误也。今改之。反作。如四气调神论。所谓反顺为逆也。
在权衡相夺 张云。谓度其轻重。而夺之使平。犹权衡也。高云。夺其逆于右者从左。逆于左者从
右。如汤液主治。必齐主治。醪酒主治。皆权衡相夺之义。简按马为察脉之浮沉之义。非。
奇恒事也揆度事也 张云。阴阳反作者。即奇恒事也。权衡相夺者。即揆度事也。
搏脉痹 寒热之交 张云。搏脉。为邪盛正衰。阴阳乖乱之脉。故为痹。为 。为或寒或热之交也。
简按王以寒热之交。为搏脉痹 之病由。然与下文之例不合。当从张注。
脉孤为消气 张云。脉孤者。孤阴孤阳也。孤阳者。洪大之极。阴气必消。孤阴者。微弱之甚。阳
气必消。故脉孤为消气也。高云。脉者气血之先。脉孤则阳气内损。故为消气。孤。谓弦钩毛石少胃气也。
虚泄为夺血 张云。脉虚兼泄者。必亡其阴。故虚泄为夺血也。高云。虚泄。谓脉气内虚不鼓动也。
简按吴本。泄。
作涩。非。
孤为逆虚为从 高云。脉孤而无胃气而真元内脱。故为逆。虚泄而少血液。则血可渐生。故为从。
行奇恒之法 高云。人有奇恒之病。而揆度其脉。是行奇恒之法也。
八风四时之胜 吴云。八风。八方之风。四时。春夏秋冬也。胜。各以所王之时而胜也。终而复始。
主气不变也。言天之常候如此。高云。八方之风主四时。各有所胜。如东风主春木而胜土。南风主夏火而胜金。
西风主秋金而胜木。北风主冬水而胜火。四隅中土而胜八风。四时之胜。各主其时。循环无端。故终而复始。
逆行一过不复可数 吴云。过。差也。张云。设或气令失常。逆行一过。是为回则不转。而至数繁
乱。无复可以数计矣。过。失也。喻言人之色脉。一有失调。则奇恒反作。变态百出。亦不可以常数计也。此
则天人至数之论。要在逆从之间。察其神而毕矣。
吴云：古代的帝王，听到一种善道，就把它写在方策上，用来记录这件事，称之为“玉版”。简按：贾谊《新书》中说：“把书刻在玉版上，藏在金柜里，放置在宗庙中，作为后世的警戒。”《汉书·司马迁传》中提到：“金柜玉版中的图籍散乱。”如淳注释说：“玉版，是刻字的玉板，用来书写文本。”
揆度奇恒：马云说：《病能论》中说：“揆度，就是切脉测度。奇恒，说的是奇病。所谓‘奇’，是指那些不随四时规律而死亡的疾病；所谓‘恒’，是指那些随四时规律而死亡的疾病。所谓‘揆’，就是切脉探求其理；所谓‘度’，就是确定病变的部位，并用四时的规律来衡量它。”
道在于一：马云说：“一”是什么？是指人的神气。吴张同注。
神转不回：马云说：“回”，是倒退而不能前进的意思。《玉机真脏论》中说：“黄帝说：我得到了脉诊的要领，这是天下最高的数理。五色的变化、脉象的变化、揆度奇恒的道理，都在于‘一’。神气运转而不逆转，如果逆转就不能运转，这样就失去了生机。最高数理的要领，迫近于细微之处，记载在玉版上，藏在脏腑之中，每天早晨诵读，名叫《玉机》。”本篇使用“回”字，彼篇从“迥”字，意义应当参考对照。张云说：“回”，是逆乱和邪气。简按：“回”与“迥”是同字。
至数之要迫近以微：高云说：“至数之要”，迫近于色脉；“以微”，在于神机。色、脉、神机，可以记载在玉版上。
容色：吴云说：“容”，指面容。简按：全本作“客色”，这种说法更接近原意。
在其要：高云说：“在”，是观察的意思。所谓“色变”，是指面容的颜色，出现在上下左右各个部位，应当分别观察其浅深、顺逆的要领。简按：“在”，意为观察，见《尔雅·释诂》。
汤液主治十日已：高云说：“汤液”，是五谷煮成的汤液。“十日已”，是指十天干循环一周，天气周而复始，病就可以痊愈。这就是《移精变气论》中所说的“用汤液十天来去除八风五痹的疾病”，就是这个意思。
必齐主治二十一日已：高云说：“齐”，通“剂”，合也。即《汤液醪醴论》中所说的“必须用齐（剂）毒药攻其中”。二十天，则是十天干再循环一周；二十一天，则是再循环一周并复归原点，病就可以痊愈。马云说：“齐”，后世写作“剂”。
醪酒主治百日已：马云说：“醪酒”，是将药物放入酒中，如《腹中论》中提到的鸡矢醴。高云说：“醪酒”，是熟谷的液体，其性质剽悍滑疾，营运营卫，通调经脉，所以一百天病愈。一百天则是十天干循环十周，气机大大恢复。
百日尽已：吴云说：“言至于百日期满，则生命终结而死。”张云说：“百日尽则时令更替，气机改变，至数穷尽而已。”上一节说的是病愈，这一节说的是命终，不可混淆观看。高云说：“尽已”，气血都终结了。简按：王冰和林亿的注解都错了。
上为逆下为从：马云说：“色见于上”，病势正盛，所以为逆；“色见于下”，病势已衰，所以为从。《灵枢·五色》篇中说：“颜色向上行的，病加重；颜色向下行的，像云雾消散一样，病将要痊愈。”
女子右为逆左为从：志云说：“按《方盛衰论》所说：阳从左，阴从右。大概男子的血气从左旋转，女子的血气从右转。因此男子面色见于右侧，而从左侧散开的，是顺；女子面色见于左侧，而从右侧散开的，是顺。”
阴阳反他：张云说：“作‘反’，旧作‘他’，是错误的。现在改正。”“反”作“反”，如《四气调神大论》中所说的“反顺为逆”。
在权衡相夺：张云说：“意思是衡量病情的轻重，然后剥夺其偏盛使其平衡，就像权衡一样。”高云说：“夺其逆于右者从左，逆于左者从右。”如汤液主治、必齐主治、醪酒主治，都是权衡相夺的意义。简按：马莳认为是察脉浮沉的意义，不对。
奇恒事也揆度事也：张云说：“阴阳反作，就是奇恒的事；权衡相夺，就是揆度的事。”
搏脉痹 寒热之交：张云说：“搏脉”，是邪气盛正气衰，阴阳乖乱的脉象，所以表现为痹证，或寒或热的交替。简按：王冰认为寒热之交是搏脉痹的病由，但与下文的体例不合，应当遵从张景岳的注解。
脉孤为消气：张云说：“脉孤”，是孤阴或孤阳。孤阳，洪大到了极点，阴气必然消耗；孤阴，微弱到了极点，阳气必然消耗。所以脉孤会导致消气。高云说：“脉是气血的先导”，脉孤则阳气内损，所以称为消气。“孤”，是指弦、钩、毛、石脉中缺少胃气。
虚泄为夺血：张云说：“脉虚兼有泄泻”，必然亡失阴液，所以虚泄导致夺血。高云说：“虚泄”，是指脉气内部虚弱不能鼓动。简按：吴崑本中，“泄”写作“涩”，是不对的。
孤为逆虚为从：高云说：“脉孤而没有胃气，真元内脱，所以为逆；虚泄而血液少，但血液可以逐渐生成，所以为从。”
行奇恒之法：高云说：“人有奇恒之病，而揆度其脉，这就是施行奇恒的方法。”
八风四时之胜：吴云说：“八风”，是八方之风；“四时”，是春夏秋冬。“胜”，是各以其所旺之时而克胜。终而复始，主气不变。说的是天的常规气候如此。高云说：“八方之风主四时，各有克胜。如东风主春木而克土，南风主夏火而克金，西风主秋金而克木，北风主冬水而克火。四隅的中土克胜八方之风。四时的克胜，各主其时，循环无端，所以终而复始。”
逆行一过不复可数：吴云说：“过”，是差错的意思。张云说：“假如气令失常，逆行一次，这就是‘迥则不转’，而至数繁乱，不再可以计数了。”“过”，是过失的意思。比喻人的色脉，一旦失调，则奇恒反作，变态百出，也不可以用常数来计算了。这则是天人至数的论述，关键在于逆从之间，观察其神气就可以了。
Wu Yun: Ancient emperors, upon hearing a beneficial principle, would inscribe it on bamboo slips or wooden tablets to record the event, calling it the "Jade Tablet" (Yuban). Commentary: Jia Yi's *New Book* states: "Inscribe the text on jade tablets, store them in golden cabinets, place them in ancestral temples, as a warning for future generations." The *Biography of Sima Qian* in the *Book of Han* mentions: "The charts and records in the golden cabinets and jade tablets were scattered and disordered." Ru Chun's annotation explains: "Jade tablet refers to carved jade plates used for writing texts."
**Kui Du Qi Heng (Measuring the Extraordinary and Constant):** Ma Yun states: In the *Treatise on Disease Manifestations*, it is said: "Kui" (measuring) refers to palpating and estimating. "Qi Heng" refers to extraordinary diseases. What is meant by "extraordinary" (Qi) is that such diseases do not die according to the seasonal cycles. What is meant by "constant" (Heng) is that they do die according to the seasonal cycles. "Kui" implies cutting and seeking the pulse principles; "Du" implies identifying the location of the disease and measuring it against the four seasons.
**The Dao Lies in One:** Ma Yun asks: What is "One"? It refers to the Spirit (Shen) of humans. Wu Zhang provides the same note.
**Spirit Turns Without Reversing:** Ma Yun explains: "Reversing" (Hui) means retreating without advancing. In the *Treatise on the True Visceral Pulse of the Jade Machine*, the Yellow Emperor says: "I have obtained the essentials of pulse diagnosis, which are the highest numbers in the world. The changes in the five colors and pulses, the measurement of the extraordinary and constant, all lie in 'One'. The Spirit turns without reversing; if it reverses, it does not turn, thus losing its opportunity. The essence of these highest numbers is close and subtle, recorded on jade tablets, stored within the viscera, read every morning, named the *Jade Machine*." This chapter uses the character "Hui", while that chapter uses "Jiong"; their meanings should be cross-referenced. Zhang Jingyue states: "Hui" denotes reversal and pathogenic factors. Commentary: "Hui" and "Jiong" are variant characters.
**The Essence of Highest Numbers is Close and Subtle:** Gao Shiwei states: The essence of the highest numbers is proximate in the complexion and pulse; subtlety lies in the Spirit mechanism. Complexion, pulse, and Spirit mechanism can be recorded on jade tablets.
**Complexion and Color:** Wu Yun states: "Rong" refers to the facial appearance. Commentary: The complete text reads "Ke Se" (Guest Color), which is likely more accurate.
**Its Essence:** Gao Shiwei states: "Zai" means to observe. Regarding "color changes," the facial color appears in the upper, lower, left, and right areas; one must observe the essence of their shallowness, depth, compliance, and opposition. Commentary: "Zai" means to observe, as seen in the *Erya - Shigu*.
**Decoctions Cure in Ten Days:** Gao Shiwei states: "Tang Ye" refers to decoctions made from grains. "Cure in ten days" refers to the cycle of the Ten Heavenly Stems completing one round, after which the disease can be cured. This corresponds to the *Treatise on Shifting Spirit and Changing Qi*, which mentions using decoctions for ten days to eliminate diseases caused by the Eight Winds and Five Bi syndromes.
**Formulas Cure in Twenty-One Days:** Gao Shiwei states: "Qi" (齊) means combination, referring to the *Treatise on Decoctions and Malt Liquor*: "Must use Qi (formulas) with toxic drugs to attack the interior." Twenty days represent two cycles of the Ten Heavenly Stems; twenty-one days represent a full cycle return, after which the disease can be cured. Ma Yun notes: "Qi" is written as "Ji" (Dose/Formulation) in later times.
**Malt Liquor Cures in One Hundred Days:** Ma Yun states: "Lao Jiu" refers to medicinal wine, such as the Chicken Manure Sweet Wine mentioned in the *Treatise on Abdominal Diseases*. Gao Shiwei states: "Lao Jiu" is liquid from fermented grains. Its nature is fierce, slippery, and rapid; it circulates Ying and Wei, unblocks meridians, so the disease cures in one hundred days. One hundred days represents ten cycles of the Ten Heavenly Stems, indicating a major recovery of Qi mechanism.
**End of One Hundred Days:** Wu Yun states: "This means that when the period of one hundred days ends, life ends and death occurs." Zhang Jingyue states: "When one hundred days end, seasons change and Qi transforms; the highest numbers are exhausted." The previous section discusses the cure of disease; this section discusses the end of life; they should not be confused. Gao Shiwei states: "End" means both Qi and Blood are exhausted. Commentary: The annotations by Wang Bing and Lin Yi are incorrect.
**Upward is Reversal, Downward is Compliance:** Ma Yun states: If color appears upward, the disease trend is intense, hence "Reversal". If color appears downward, the disease trend is declining, hence "Compliance". The *Color Chapter* of *Ling Shu* states: "If color moves upward, the disease worsens; if color moves downward like dispersing clouds, the disease is about to heal."
**For Women, Right is Reversal, Left is Compliance:** Zhi states: According to the *Treatise on Excess and Deficiency Abundance*, Yang follows the left, Yin follows the right. Men's Qi and Blood rotate from the left; women's Qi and Blood rotate from the right. Therefore, if a man's color appears on the right but dissipates from the left, it is compliant. If a woman's color appears on the left but dissipates from the right, it is compliant.
**Yin and Yang Reverse:** Zhang Jingyue states: It should be written as "Fan" (Reverse); "Ta" was an error in old texts. Now corrected. "Fan" means reverse, as in the *Treatise on Regulating the Spirit According to the Four Seasons*: "Reversing compliance leads to reversal."
**Weighing and Counteracting:** Zhang Jingyue states: This means assessing severity and counteracting excess to achieve balance, like using a steelyard. Gao Shiwei states: Counteract the reversal on the right by following the left, and the reversal on the left by following the right. The treatments using decoctions, formulas, and malt liquor all embody the meaning of weighing and counteracting. Commentary: Ma Shi interprets this as observing the floating and sinking of the pulse, which is incorrect.
**Extraordinary Matters and Measuring Matters:** Zhang Jingyue states: "Yin and Yang reversing" belongs to the matter of the Extraordinary (Qi Heng). "Weighing and counteracting" belongs to the matter of Measuring (Kui Du).
**Pulse Beating with Bi Syndrome and Alternating Cold and Heat:** Zhang Jingyue states: "Bo Mai" (Beating Pulse) indicates pathogenic excess and healthy deficiency, with chaotic Yin and Yang, leading to Bi syndrome or alternating cold and heat. Commentary: Wang Bing considers alternating cold and heat as the cause of Bo Mai Bi, but this contradicts the structure of subsequent text; Zhang's annotation should be followed.
**Isolated Pulse Leads to Consumed Qi:** Zhang Jingyue states: An "isolated pulse" indicates isolated Yin or isolated Yang. Extreme isolated Yang (surging and large) consumes Yin; extreme isolated Yin (weak and minute) consumes Yang. Thus, an isolated pulse leads to consumed Qi. Gao Shiwei states: The pulse is the precursor of Qi and Blood; an isolated pulse damages internal Yang, hence "consumed Qi". "Isolated" refers to the Chu, Gou, Mao, and Shi pulses lacking Stomach Qi.
**Deficiency and Diarrhea Lead to Depleted Blood:** Zhang Jingyue states: A deficient pulse accompanied by diarrhea inevitably leads to the loss of Yin fluids, hence "depleted blood". Gao Shiwei states: "Deficiency and diarrhea" refers to internal weakness of pulse Qi failing to surge. Commentary: Wu Kun's edition writes "Xie" (Diarrhea) as "Se" (Astringent/Sluggish), which is incorrect.
**Isolation is Reversal, Deficiency is Compliance:** Gao Shiwei states: An isolated pulse lacks Stomach Qi and true Yuan Qi escapes internally, hence "Reversal". Deficiency and diarrhea with little blood allow blood to gradually regenerate, hence "Compliance".
**Practicing the Method of the Extraordinary:** Gao Shiwei states: Humans have extraordinary diseases; measuring their pulse constitutes practicing the method of the Extraordinary.
**Victory of Eight Winds and Four Seasons:** Wu Yun states: "Eight Winds" are winds from eight directions; "Four Seasons" are Spring, Summer, Autumn, Winter. "Victory" (Sheng) means each season overcomes based on its ruling element. They cycle endlessly, with dominant Qi remaining unchanged. This describes the constant climate of Heaven. Gao Shiwei states: The eight winds govern the four seasons, each having specific overcoming relationships. East wind governs Spring Wood and overcomes Earth; South wind governs Summer Fire and overcomes Metal; West wind governs Autumn Metal and overcomes Wood; North wind governs Winter Water and overcomes Fire. Central Earth at the four corners overcomes the eight winds. The victories of the four seasons each govern their respective times, cycling endlessly, thus ending and beginning again.
**One Passage of Reversal Cannot Be Counted Again:** Wu Yun states: "Guo" means deviation. Zhang Jingyue states: If the Qi order becomes abnormal and reverses even once, this is "reversing prevents turning," causing the highest numbers to become chaotic and no longer countable. "Guo" means fault. Metaphorically, if human complexion and pulse deviate even slightly, extraordinary and constant distinctions reverse, producing hundreds of anomalies that cannot be calculated by standard numbers. This discussion on the highest numbers of Heaven and Humanity lies in the distinction between reversal and compliance; observing the Spirit suffices.