后刺手心主 马云。心包络之井。在中指端。名曰中冲。吴张同。简按上文。不及心主厥阴。是必错
出。新校正为是。高云。刺手心主少阴锐骨之端。各一 。心手少阴掌后高骨。大陵俞穴也。心者。君主之官。
故曰心主。此注可疑。心主。谓心包。乃手厥阴也。今引君主之官。而为心经。殆属牵强。
以竹管吹其两耳 甲乙。管。作筒。耳下。有中字。
其左角 金匮。甲乙。 。作剔。高云。 。 同。俗作剃。
方一寸 肘后方。作二寸。外台。作方寸匕。
燔治 金匮。作烧末。张云。烧制为末也。
灌之立已 金匮。已。作起。
切而从之 甲乙。从。作循。
调之 张云。病在经者。治从其经。但审其虚实而调之。调者。如汤液导引之类。皆是也。调之而不
调。然后刺其经脉。是谓经刺。亦曰巨刺。
有痛而经不病者 吴云。身有痛处。而其经脉所至之分。不皆病者。是为络病。非经病也。则缪刺之。
此缪刺之数也 吴云。数。犹言节目也。张云。凡此刺经者。刺大络者。刺皮部血络者。各有其治。
所以辨缪刺之术数也。
简按篇中。无问答之语。宜删论字。
阴痹 志云。痹者。闭也。血气留着于皮肉筋骨之间为痛也。简按王以阴为寒。故根据痹论寒胜者为
痛痹之义而释之。新校正。则以为王以痛为痹之通训。却非也。
狐疝风 张云。滑。为阳邪有余。而病风者。热则生风
也。疝者前阴少腹之病。男女五脏皆有之。狐之昼伏夜出。阴兽也。疝在厥阴。其出入上下不常。与狐相类。
故曰狐疝风。此非外入之风。乃以肝邪为言也。高云。气病为疝。血病为积。滑主气盛。涩主少血。故厥阴脉
滑。则病狐疝。又曰。风者。气动风生。风主气也。下文肺风脾风心风肾风肝风。皆气动风生之义。简按本脏
篇云。肾下则腰尻痛。不可以俯仰。为狐疝。经脉篇云。肝所生病者。狐疝遗溺。而本篇系以风者。寿夭刚柔
篇云。病在于阴者。谓之痹。病在于阳者。谓之风。凡脉滑为阳有余。今脉滑者。并以风称之。其义可知矣。
陈氏三因方云。寒疝之气。注入 中。（按陈误以 为阴囊。故其言如此。）名曰狐疝。亦属 疝。葛氏伤寒
直格云。狐疝。言狐者。疝气之变化。隐见往来不可测。如狐也。张注本于此。杨上善之解恐非。
隐轸 马云。当作瘾疹。吴云。隐轸。即瘾疹。张同。简按释名。胗。展也。痒搔之捷展起也。乃知
胗借而作轸。后世从 作疹也。马注误。厥阴为阴痹。为狐疝风。太阴为肉痹。为脾风疝。太阳为骨痹。为肾
风疝。少阳为筋痹。为肝风疝。其理固明矣。而至少阴为皮痹。为肺气疝。阳明为脉痹。为心风疝者。则与常
例异。盖此篇。以三阴三阳。单配乎五脏。故与他篇之例不同也。旧注。或以运气之义而释之。率不可从。
肺痹 痹论云。皮痹不已。复感于邪。内舍于肺。肺痹者。烦满。喘而呕。马云。肾为肺之子。其
水上逆于肺母。故皮为肺之合。今肾有余。当病皮痹瘾疹。其病在表也。不足当为肺痹。其病在里也。
肺风疝 大奇论云。肺脉沉搏。为肺疝。
病积溲血 马云。其脉若滑。则当病肺风疝。外感之邪
也。其脉若涩。则当病有积及溲血。内伤之邪也。张云。涩。为心血不足。故经滞而为积聚。血乱而为溲血也。
脾痹 吴云。太阴湿土之气也。其气有余则湿胜。脾主肌肉。奠位乎中。故肉痹寒中。不足则土气
弱。故病脾痹。简按痹论云。肌痹不已。复感于邪。内舍于脾。脾痹者。四肢解堕。发咳呕汁。上为大塞。所
谓肌痹。即肉痹。
脾风疝 马云。其脉若滑。则病脾风疝。外感之邪也。其脉若涩。则当有积。及心腹时满。内伤之
邪也。张云。太阴脉滑。则土邪有余。脾风疝者。即 肿重坠之属。病在湿也。
脉痹 马云。阳明者。足阳明胃经也。胃乃心之子。有余则病脉痹。以心主脉。脉主半表也。不足
则病心痹。心主里也。简按吴张以阳明燥金之气。有余不足而释之。此运气家之言。不可借以解经也。
心痹 痹论云。脉痹不已。复感于邪。内舍于心。心痹者。脉不通。烦则心下鼓。暴上气而喘。嗌
干善噫。厥气上则恐。王注心下痹。恐非。
心风疝 马云。其脉若滑。则病心风疝。外感之邪也。其脉若涩。则病积时善惊。内伤之邪也。简
按脉要精微论云。诊得心脉而急。病名心疝。少腹当有形也。
肾痹 痹论云。骨痹不已。复感于邪。内舍于肾。肾痹者。善胀。尻以代踵。脊以代头。
肾风疝 马云。其脉若滑。则病肾风疝。外感之邪也。其脉若涩。则病积。时癫疾。内伤之邪也。
肝痹 痹论云。筋痹不已。复感于邪。内舍于肝。肝痹者。夜卧则惊。多饮数小便。上为引如怀。
肝风疝 马云。其脉若滑。则病肝风疝。外感之邪也。
其脉若涩。则病积。时筋急目痛。内伤之邪也。
人气在脉 张云。春时天地气动。水泉流行。故人气亦在经脉。
溢入孙络 吴。此下。增孙络二字。张云。夏时气盛。故溢入孙络。而充皮肤。所以人气在孙络。
内溢肌中 马云。长夏者。六月建未之月。其气在肌肉者。正以长夏经脉络脉皆盛。内溢肌中。所以
人气在肌肉也。
皮肤引急 马云。秋气在皮肤者。正以秋时天气始收。人之腠理闭塞。皮肤引急。所以人气在皮肤也。
通于五脏 高云。冬气之所以在骨髓者。盖以冬者气机盖藏。血气在中。内着骨髓。通于五脏。脏者。
藏也。惟冬主藏。故通五脏。而冬气在骨髓。
不可为度 志云。谓天有六淫之邪。而人有形层。六气之化也。如邪留于外。则为皮肉筋骨之痹。合
于内。则为心肝脾肺之痹矣。如留于气分则为疝。留于血分则为积矣。如身中之阳盛则为热。虚寒则为寒矣。
此皆吾身中阴阳之变化也。高云。四地主气。各有常度。至其变化也。不可为度。
辟除 吴云。辟。音 。马云。辟。 同。
环逆 马云。血气旋逆。吴云。血气环于经。即逆而上。为浮气也。志云。环逆者。逆其转环也。言
血气之从经而络。从络而皮。从皮肤而复环转于肌中也。张云。血气环周。皆逆不相营运。故为喘满上气。按
本篇。与前诊要经终论。义同文异。但彼分四时。此分五时。故有刺肌肉之谓。然本篇春夏冬三时。皆阙刺秋
分皮肤等义。意者。以长夏近秋。故取肌肉。即所以刺秋分也。后仿此。简按张本于新校正。其说似傅会。然
春夏冬。并阙刺秋分。亦可疑焉。
春刺筋骨 高云。筋连于骨。故曰筋骨。
内着 马云。着。着同。
内却 吴云。令血气却弱。是以善恐。志云。血气虚。却于内矣。阳明脉虚。则恐如人将捕之。
血气上逆 张云。夏刺冬分。则阴虚于内。阳胜于外。故令人血气逆而善怒。志云。夏气浮。长于
上。而反逆之使下。则气郁不疏。而使人善怒也。上逆。当作下逆。简按今从旧文。
善忘 吴云。心生脉。秋刺经脉。而虚其经。则经脉虚。而心气亦虚矣。故善忘。
气不外行 张据全本。作气不卫外。注云。气虚不能卫外。气属阳。阳虚故卧不欲动。
令人目不明 志云。盖五脏之精。皆注于目。而为之睛。冬者血气在中。内着骨髓。通于五脏。血
气内脱。则五脏皆虚。故令人目不明也。
大痹 张云。当阳气伏藏之时。而刺其阳分。则阳气外泄。阳虚阴胜。故留为大痹。志云。大痹者。
脏气虚。而邪痹于五脏也。
善忘 吴云。阳气者。精则养神。今阳气竭绝。则神亡矣。故善忘。
与精相薄 吴云。精。真气也。薄。邪正摩荡之名。
精气不转 吴云。精气不变。张云。精气不致转变矣。志云。精气不逆回矣。高云。不转。内存也。
简案转。恐薄之讹。
根据其脏之所变候知其死也 吴。变下句。马高同。吴云。变。谓脏气变动为病也。马云。根据其脏之
所变。以候知其死耳。高云。根据其脏之所变病。以候其动。候其动。而知其死也。张。候下句。志同。张云。
见其变动之候。则识其伤在某脏。故可知其死期。简按据王注。变下句。为是。
随后针刺手厥阴心包经。马云认为：这是心包络的井穴，位于中指末端，名为中冲。吴张同认为：细读上文，并未提及手厥阴心包经，这必定是文字错乱脱漏所致。新校正（宋代林亿等人的校勘意见）认为是正确的。高世栻认为：针刺手心主少阴锐骨之端，各刺一针。心手少阴经掌后高骨处，是大陵俞穴。心是君主之官，所以称为心主。这个注释值得怀疑。心主，指的是心包，属于手厥阴经。现在引用“君主之官”来解释为心经，大概属于牵强附会。
用竹管吹双耳。《甲乙经》中，“管”写作“筒”。耳下中间部位。
其左角。《金匮要略》、《甲乙经》中，“ ”写作“剔”。高世栻认为：“ ”与“ ”相同。俗体字写作“剃”。
方一寸。《肘后备急方》作二寸。《外台秘要》作方寸匕。
灌之立已。《金匮要略》中，“已”作“起”。
切而从之。《甲乙经》中，“从”作“循”。
调之。张景岳云：病在经脉的，治疗顺着经脉进行，只需审察其虚实而调理它。所谓调，如汤液、导引之类，都是如此。如果调理之后仍未见效，然后再针刺其经脉，这叫做经刺，也叫做巨刺。
有疼痛但经脉没有病变的。吴崑云：身体有痛处，但其经脉所经过的部位，并不都发病的，这是络脉病，不是经脉病。那就采用缪刺法。
这就是缪刺的次数/法则。吴崑云：数，犹言节目/要点。张景岳云：凡是此等刺经脉的，刺大络的，刺皮部血络的，各有其治疗方法。所以用来辨别缪刺的技术法则。
简按：本篇中没有问答的语言，应该删除“论”字。
阴痹。马莳云：痹，就是闭的意思。血气留滞于皮肉筋骨之间导致疼痛。简按：王冰以阴为寒，所以根据《痹论》中寒胜者为痛痹的意义来解释。新校正则认为王冰是以痛作为痹的通训，这就不对了。
狐疝风。张景岳云：滑，代表阳邪有余，而患风病的，热则生风。疝，是指前阴和少腹的疾病，男女五脏都有可能出现。狐狸白天潜伏晚上出来，是阴兽。疝在厥阴经，其出入上下不固定，与狐狸相似，所以叫狐疝风。这不是外来的风邪，而是指肝邪。高世栻云：气病称为疝，血病称为积。滑脉主气盛，涩脉主血少。所以厥阴脉滑，就病狐疝。又说：风，气动则风生，风主气。下文肺风、脾风、心风、肾风、肝风，都是气动风生的意义。简按：《本脏篇》说：肾位置低下则腰尻痛，不能俯仰，称为狐疝。《经脉篇》说：肝所生的疾病，包括狐疝、遗尿。而本篇将其系于风，是因为《寿夭刚柔篇》说：病在阴的，称为痹；病在阳的，称为风。凡是脉滑为阳有余，现在脉滑，都以风来称呼，其中的道理可以知道了。陈氏《三因方》说：寒疝之气，注入 中。（按：陈氏错误地将 理解为阴囊，所以他的言论如此。）名叫狐疝，也属于 疝。葛氏《伤寒直格》说：狐疝，说狐，是指疝气的变化，隐现往来不可预测，像狐狸一样。张景岳的注解基于此。杨上善的解释恐怕不对。
隐轸。马云：应当作瘾疹。吴崑云：隐轸，即瘾疹。张景岳赞同。简按：《释名》说：胗，展也。痒搔之捷展起也。才知道胗借用作轸，后世从 作疹。马莳的注释是错误的。厥阴经对应阴痹、狐疝风；太阴经对应肉痹、脾风疝；太阳经对应骨痹、肾风疝；少阳经对应筋痹、肝风疝。这个道理本来很明确。但是说到少阴经对应皮痹、肺气疝；阳明经对应脉痹、心风疝，这就与常规例子不同了。大概这一篇，是用三阴三阳单独配合五脏，所以与其他篇章的例子不同。旧注，有的用运气学说的意义来解释，大多不可从。
肺痹。《痹论》说：皮痹不愈，再次感受邪气，内舍于肺。肺痹的症状是：烦闷、气喘且呕吐。马云：肾是肺的子脏，其水上逆于肺母，所以皮是肺的外合。现在肾有余，应当病皮痹瘾疹，病在表。不足则病肺痹，病在里。
病积溲血。马云：其脉若滑，则当病肺风疝，这是外感邪气。其脉若涩，则当有病积及小便出血，这是内伤邪气。张景岳云：涩，代表心血不足，所以经脉阻滞而为积聚，血乱而为小便出血。
脾痹。吴崑云：太阴湿土之气。其气有余则湿胜。脾主肌肉，奠位乎中，所以肉痹寒中。不足则土气弱，所以病脾痹。简按：《痹论》说：肌痹不愈，再次感受邪气，内舍于脾。脾痹的症状是：四肢懈怠无力，咳嗽呕汁，上部为大塞。所谓的肌痹，就是肉痹。
脾风疝。马云：其脉若滑，则病脾风疝，这是外感邪气。其脉若涩，则当有病积，以及心腹时常胀满，这是内伤邪气。张景岳云：太阴脉滑，则土邪有余。脾风疝，就是 肿重坠之类的。病在湿。
脉痹。马云：阳明，是足阳明胃经。胃是心的子脏，有余则病脉痹，因为心主脉，脉主半表。不足则病心痹，心主里。简按：吴崑、张景岳以阳明燥金之气的有余不足来解释，这是运气学家的言论，不可以借用它们来解释经文。
心痹。《痹论》说：脉痹不愈，再次感受邪气，内舍于心。心痹的症状是：脉不通，心烦则心下悸动，突然上气而喘，咽喉干燥，喜欢嗳气，厥气上逆则恐惧。王冰注解说心下痹，恐怕不对。
心风疝。马云：其脉若滑，则病心风疝，这是外感邪气。其脉若涩，则病积，时常惊恐，这是内伤邪气。简按：《脉要精微论》说：诊得心脉而急，病名心疝，少腹部应当有形状。
肾痹。《痹论》说：骨痹不愈，再次感受邪气，内舍于肾。肾痹的症状是：容易腹胀，屁股代替脚跟站立，脊背代替头部直立。
肾风疝。马云：其脉若滑，则病肾风疝，这是外感邪气。其脉若涩，则病积，时常癫疾，这是内伤邪气。
肝痹。《痹论》说：筋痹不愈，再次感受邪气，内舍于肝。肝痹的症状是：夜间睡觉则惊骇，多饮且小便频数，向上牵引如同怀孕。
肝风疝。马云：其脉若滑，则病肝风疝，这是外感邪气。其脉若涩，则病积，时常筋急目痛，这是内伤邪气。
人气在脉。张景岳云：春季时天地气动，水泉流行，所以人气也在经脉。
溢入孙络。吴崑在此下增补“孙络”二字。张景岳云：夏季时气盛，所以溢入孙络，而充皮肤。所以人气在孙络。
内溢肌中。马云：长夏是六月建未之月。其气在肌肉，正是因为长夏经脉络脉皆盛，内溢肌中。所以人气在肌肉。
皮肤引急。马云：秋气在皮肤，正是因为秋季天气开始收敛，人的腠理闭塞，皮肤收缩紧张。所以人气在皮肤。
通于五脏。高世栻云：冬季气之所以在骨髓，是因为冬天气机闭藏，血气在中，内着骨髓，通于五脏。脏，就是藏的意思。只有冬主藏，所以通五脏，而冬气在骨髓。
不可为度。马莳云：谓天有六淫之邪，而人有形层，六气之化。如邪留于外，则为皮肉筋骨之痹。合于内，则为心肝脾肺之痹。如留于气分则为疝，留于血分则为积。如身中之阳盛则为热，虚寒则为寒。这些都是吾身中阴阳的变化。高世栻云：四时地主气，各有常度，到了其变化时，不可作为定度。
环逆。马云：血气旋逆。吴崑云：血气环于经，即逆而上，为浮气。马莳云：环逆者，逆其转环也。言血气之从经而络，从络而皮，从皮肤而复环转于肌中。张景岳云：血气环周，皆逆不相营运，故为喘满上气。按本篇，与前《诊要经终论》，义同文异。只是彼分四时，此分五时，所以有刺肌肉的说法。然而本篇春夏冬三时，都缺失了刺秋分皮肤等的意义。猜想是因为长夏接近秋天，所以取肌肉，即所以刺秋分。后仿此类推。简按：张景岳基于新校正，其说法似乎牵强附会，然而春夏冬并缺失刺秋分，也可以怀疑。
春刺筋骨。高世栻云：筋连于骨，所以叫筋骨。
内着。马云：着，同著。
内却。吴崑云：令血气却弱，所以善恐。马莳云：血气虚，却于内。阳明脉虚，则恐如人将捕之。
血气上逆。张景岳云：夏刺冬分，则阴虚于内，阳胜于外，所以令人血气逆而善怒。马莳云：夏气浮，长于上，而反逆之使下，则气郁不疏，而使人善怒。上逆，当作下逆。简按：现在遵从旧文。
善忘。吴崑云：心生脉，秋刺经脉，而虚其经，则经脉虚，而心气亦虚，所以善忘。
气不外行。张景岳据全本，作气不卫外。注云：气虚不能卫外。气属阳，阳虚故卧不欲动。
令人目不明。马莳云：盖五脏之精，皆注于目，而为之睛。冬者血气在中，内着骨髓，通于五脏。血气内脱，则五脏皆虚，所以令人目不明。
大痹。张景岳云：当阳气伏藏之时，而刺其阳分，则阳气外泄，阳虚阴胜，所以留为大痹。马莳云：大痹者，脏气虚，而邪痹于五脏。
善忘。吴崑云：阳气者，精则养神，今阳气竭绝，则神亡，所以善忘。
与精相薄。吴崑云：精，真气也。薄，邪正摩荡之名。
精气不转。吴崑云：精气不变。张景岳云：精气不致转变。马莳云：精气不逆回。高世栻云：不转，内存。简案：转，恐怕是薄的讹误。
根据其脏之所变候知其死也。吴崑调整语序，马莳、高世栻同。吴崑云：变，谓脏气变动为病。马云：根据其脏之所变，以候知其死。高世栻云：根据其脏之所变病，以候其动，候其动，而知其死。张景岳调整语序，马莳同。张景岳云：见其变动之候，则识其伤在某脏，故可知其死期。简按：依据王冰注，变下句是正确的。
Subsequently, puncture the Pericardium Meridian of Hand-Jueyin. Ma Yizhen states: This is the Jing-Well point of the Pericardium Luo, located at the tip of the middle finger, named Zhongchong (Mid-Puncture). Wu Kun and Zhang Jingyue state: Carefully reading the preceding text, the Hand-Jueyin Pericardium Meridian is not mentioned; this must be a textual error or omission. The New Corrections (Song Dynasty editorial notes) consider this correct. Gao Shishi states: Puncture the end of the sharp bone of the Hand-Shaoyin at the palm center, one needle each. The high bone behind the palm of the Heart-Shaoyin Meridian is the Daling (Great Palace) acupoint. The Heart is the Official of the Sovereign Lord, hence it is called Xin Zhu (Heart Master). This annotation is questionable. "Xin Zhu" refers to the Pericardium, which belongs to the Hand-Jueyin Meridian. Citing the "Official of the Sovereign Lord" to explain it as the Heart Meridian is likely forced.
Blow into both ears with a bamboo tube. The *Jia Yi Jing* writes "tube" as "cylinder". At the middle part below the ear.
Its left corner. The *Jin Gui Yao Lue* and *Jia Yi Jing* write the character as "ti" (scrape/pick). Gao Shishi states: The characters are identical. The vernacular form is "ti" (shave).
One square cun. The *Zhou Hou Bei Ji Fang* writes two cun. The *Wai Tai Mi Yao* writes one square cun spoonful.
Burned and processed. The *Jin Gui Yao Lue* writes "burned to powder". Zhang Jingyue states: Burned and made into powder.
Pour it in, and it will stop immediately. The *Jin Gui Yao Lue* writes "qi" (rise/start) instead of "yi" (stop).
Cut and follow along. The *Jia Yi Jing* writes "xun" (follow/trace) instead of "cong" (follow).
Regulate it. Zhang Jingyue states: When the disease is in the meridians, treatment follows the meridian, merely examining its deficiency or excess to regulate it. "Regulation" includes methods such as decoctions and Daoyin (guiding and pulling exercises). If regulation fails to resolve the issue, then puncture the meridian itself; this is called Jing Ci (Meridian Puncture), also known as Ju Ci (Great Puncture).
When there is pain but no disease in the meridian. Wu Kun states: There is a painful area on the body, but the regions where the meridian passes are not all diseased; this is a Luo (Collateral) disease, not a Jing (Meridian) disease. Therefore, employ Miao Ci (Counter Puncture).
These are the principles/frequencies of Miao Ci. Wu Kun states: "Shu" here means principles or key points. Zhang Jingyue states: For those who puncture the meridians, those who puncture the large collaterals, and those who puncture the blood vessels in the skin regions, each has its own treatment method. Thus, these distinguish the techniques and principles of Miao Ci.
Note: This chapter lacks Q&A dialogue; the character "Lun" (Discourse) should be deleted.
Yin Bi (Yin Obstruction). Ma Yizhen states: Bi means obstruction. Blood and Qi stagnate between the skin, flesh, sinews, and bones, causing pain. Note: Wang Bing interprets Yin as Cold, thus explaining it based on the meaning in the *Bi Lun* that cold predominance causes Painful Bi. The New Corrections argue that Wang Bing used "pain" as the general definition for Bi, which is incorrect.
Hu Shan Feng (Fox Hernia Wind). Zhang Jingyue states: Slippery pulse indicates excess Yang pathogen and wind disease; heat generates wind. Hernia refers to diseases of the anterior yin and lower abdomen, occurring in both men and women across the five zang organs. The fox hides by day and emerges by night; it is a yin beast. Hernias in the Jueyin meridian have unpredictable movement up and down, resembling a fox, hence "Fox Hernia Wind." This is not external wind but refers to Liver pathology. Gao Shishi states: Qi disorders are termed hernia, blood disorders are termed accumulation. Sliply pulse governs qi abundance, choppy pulse governs blood deficiency. Thus, a slippery Jueyin pulse indicates Fox Hernia. Furthermore, wind arises from qi movement; wind governs qi. The subsequent mentions of Lung Wind, Spleen Wind, Heart Wind, Kidney Wind, and Liver Wind all imply qi movement generating wind. Note: The *Ben Zang Pian* states: If the Kidney is low, there is pain in the waist and sacrum, inability to bend or extend, called Fox Hernia. The *Jing Mai Pian* states: Diseases generated by the Liver include Fox Hernia and enuresis. This chapter associates them with Wind because the *Shou Yao Gang Rou Pian* states: Diseases in Yin are called Bi; diseases in Yang are called Wind. Since a slippery pulse indicates Yang excess, now a slippery pulse is termed Wind, the rationale is clear. Chen Shi's *San Yin Fang* states: Cold Hernia qi injects into [the scrotum]. (Note: Chen mistakenly identified the symbol as the scrotum, hence his statement.) It is named Fox Hernia and also belongs to [scrotal] hernia. Ge Shi's *Shang Han Zhi Ge* states: The term "Fox" in Fox Hernia refers to the unpredictable changes, appearing and disappearing like a fox. Zhang Jingyue's annotation is based on this. Yang Shangshan's explanation is likely incorrect.
Yin Zhen (Urticaria). Ma Yizhen states: Should be read as Yin Zhen (Urticaria). Wu Kun states: Yin Zhen is Urticaria. Zhang Jingyue agrees. Note: The *Shi Ming* explains: Zhen means spread. It rises quickly when scratched due to itching. Thus, Zhen was borrowed as Zhen, and later evolved to Zhen (urticaria). Ma's annotation is erroneous. Jueyin corresponds to Yin Bi and Fox Hernia Wind; Taiyin corresponds to Rou Bi (Flesh Bi) and Pi Feng Shan (Spleen Wind Hernia); Taiyang corresponds to Gu Bi (Bone Bi) and Shen Feng Shan (Kidney Wind Hernia); Shaoyang corresponds to Jin Bi (Sinew Bi) and Gan Feng Shan (Liver Wind Hernia). This logic is clear. However, Shaoyin corresponding to Pi Bi (Skin Bi) and Fei Qi Shan (Lung Qi Hernia); Yangming corresponding to Mai Bi (Vessel Bi) and Xin Feng Shan (Heart Wind Hernia) differs from the usual pattern. This chapter pairs the Three Yin and Three Yang singly with the Five Zang, differing from other chapters. Old annotations often use Luck Theory (Yun Qi) explanations, which are generally unacceptable.
Fei Bi (Lung Obstruction). The *Bi Lun* states: If Skin Bi is not cured and re-exposed to pathogens, it internally resides in the Lung. Symptoms of Lung Bi include restlessness, fullness, wheezing, and vomiting. Ma Yizhen states: The Kidney is the child of the Lung; if its water rebels upward to the Lung mother, then Skin (the exterior connection of the Lung) becomes diseased. Excess in the Kidney leads to Skin Bi and Urticaria, a disease in the exterior. Deficiency leads to Lung Bi, a disease in the interior.
Fei Feng Shan (Lung Wind Hernia). The *Da Qi Lun* states: A deep and gripping Lung pulse indicates Lung Hernia.
Disease Accumulation and Hematuria. Ma Yizhen states: If the pulse is slippery, it indicates Lung Wind Hernia, an external pathogenic factor. If the pulse is choppy, it indicates Disease Accumulation and hematuria, an internal pathogenic factor. Zhang Jingyue states: Choppy pulse indicates insufficient Heart Blood, leading to meridian stasis and accumulation, and chaotic blood flow causing hematuria.
Pi Bi (Spleen Obstruction). Wu Kun states: Taiyin is the damp earth qi. Excess leads to dampness predominance. The Spleen governs muscles and resides centrally, hence Flesh Bi and Cold in the Middle. Deficiency leads to weak Earth qi, hence Spleen Bi. Note: The *Bi Lun* states: If Muscle Bi is not cured and re-exposed to pathogens, it internally resides in the Spleen. Symptoms of Spleen Bi include flaccidity of the four limbs, coughing, spitting fluid, and upper blockage. The so-called Muscle Bi is Flesh Bi.
Pi Feng Shan (Spleen Wind Hernia). Ma Yizhen states: If the pulse is slippery, it indicates Spleen Wind Hernia, an external pathogenic factor. If the pulse is choppy, it indicates accumulation and frequent abdominal fullness, an internal pathogenic factor. Zhang Jingyue states: A slippery Taiyin pulse indicates excess Earth pathogen. Spleen Wind Hernia belongs to swelling and heaviness/dropping sensations. The disease lies in dampness.
Mai Bi (Vessel Obstruction). Ma Yizhen states: Yangming is the Foot-Yangming Stomach Meridian. The Stomach is the child of the Heart. Excess leads to Vessel Bi because the Heart governs vessels, and vessels govern half-exterior. Deficiency leads to Heart Bi, as the Heart governs interior. Note: Wu Kun and Zhang Jingyue explain this based on the excess or deficiency of Yangming Dry Metal qi, which is Luck Theory discourse and should not be used to interpret the classic.
Xin Bi (Heart Obstruction). The *Bi Lun* states: If Vessel Bi is not cured and re-exposed to pathogens, it internally resides in the Heart. Symptoms of Heart Bi include blocked vessels, restlessness with palpitations, sudden upward qi and wheezing, dry throat, frequent belching, and fear when rebellious qi ascends. Wang Bing’s note on "sub-sternal obstruction" is likely incorrect.
Xin Feng Shan (Heart Wind Hernia). Ma Yizhen states: If the pulse is slippery, it indicates Heart Wind Hernia, an external pathogenic factor. If the pulse is choppy, it indicates accumulation and frequent fright, an internal pathogenic factor. Note: The *Mai Yao Jing Wei Lun* states: A rapid and urgent Heart pulse indicates Heart Hernia, with visible abnormalities in the lower abdomen.
Shen Bi (Kidney Obstruction). The *Bi Lun* states: If Bone Bi is not cured and re-exposed to pathogens, it internally resides in the Kidney. Symptoms of Kidney Bi include frequent bloating, sitting on the buttocks instead of standing on heels, and the spine replacing the head.
Shen Feng Shan (Kidney Wind Hernia). Ma Yizhen states: If the pulse is slippery, it indicates Kidney Wind Hernia, an external pathogenic factor. If the pulse is choppy, it indicates accumulation and frequent epilepsy, an internal pathogenic factor.
Gan Bi (Liver Obstruction). The *Bi Lun* states: If Sinew Bi is not cured and re-exposed to pathogens, it internally resides in the Liver. Symptoms of Liver Bi include waking with fright, excessive drinking, frequent urination, and upward traction resembling pregnancy.
Gan Feng Shan (Liver Wind Hernia). Ma Yizhen states: If the pulse is slippery, it indicates Liver Wind Hernia, an external pathogenic factor. If the pulse is choppy, it indicates accumulation, frequent tendon stiffness, and eye pain, an internal pathogenic factor.
Human Qi in the Vessels. Zhang Jingyue states: In spring, heaven and earth qi move, springs flow, so human qi is also in the meridians.
Overflowing into Sun Luo (Branch Collaterals). Wu Kun adds "Sun Luo" here. Zhang Jingyue states: In summer, qi is abundant, overflowing into branch collaterals and filling the skin. Thus, human qi is in the branch collaterals.
Internally overflowing into Muscles. Ma Yizhen states: Chang Xia (Late Summer) is the sixth month, Jian Wei. Its qi is in the muscles because during Chang Xia, the meridians and collaterals are abundant, internally overflowing into muscles. Thus, human qi is in the muscles.
Skin Tension. Ma Yizhen states: Autumn qi is in the skin because autumn weather begins to收 (gather/restrain), pores close, and skin contracts. Thus, human qi is in the skin.
Connecting to the Five Zang. Gao Shishi states: Winter qi is in the marrow because winter is the season of storage; qi and blood remain inside, adhering to the marrow, connecting to the five zang. Zang means storage. Only Winter governs storage, thus connecting to the five zang, and winter qi is in the marrow.
Cannot be Measured. Ma Yizhen states: Heaven has Six Excess Pathogens, humans have physical layers, and the transformation of Six Qi. If pathogens stay outside, they cause Bi of skin, flesh, sinews, and bones. If entering inside, they cause Bi of Heart, Liver, Spleen, and Lung. If staying in the Qi level, it is Hernia; if staying in the Blood level, it is Accumulation. If Yang is excess in the body, it is Heat; if deficient and cold, it is Cold. These are all changes of yin and yang within oneself. Gao Shishi states: The Four Seasons' ruling qi have constant degrees, but in their transformations, they cannot be measured by fixed standards.
Expel and Remove. Wu Kun states: Pi, pronounced pi. Ma Yizhen states: Pi is the same as Pi (evil/deviant).
Circular Rebellion. Ma Yizhen states: Blood and Qi rebel circularly. Wu Kun states: Blood and Qi circle the meridians, rebelling upward, becoming floating qi. Ma Yizhen states: Circular rebellion means reversing the rotation. It describes blood and qi moving from meridians to collaterals, from collaterals to skin, and from skin back to circularly turning in the muscles. Zhang Jingyue states: Blood and qi circulate universally but rebel against each other, failing to transport and operate, causing wheezing, fullness, and upward qi. According to this chapter, compared to the earlier *Zhen Yao Jing Zhong Lun*, the meaning is the same but the text differs. That one divides by four seasons; this one divides by five seasons, hence the mention of puncturing muscles. However, this chapter lacks the meaning of puncturing skin in autumn for spring, summer, and winter. One might guess that since Chang Xia is near autumn, taking muscles serves as puncturing the autumn equinox. The following imitate this. Note: Zhang Jingyue bases this on the New Corrections; his theory seems forced. However, the absence of autumn skin puncture instructions for spring, summer, and winter is also questionable.
Spring Puncture Sinews and Bones. Gao Shishi states: Sinews connect to bones, hence called sinews and bones.
Internally Adhering. Ma Yizhen states: Zhuo is the same as Zhuo (adhere).
Internally Receding. Wu Kun states: Causing blood and qi to recede and weaken, hence prone to fear. Ma Yizhen states: Blood and qi are deficient, receding inward. If the Yangming meridian is deficient, fear arises as if being chased.
Blood and Qi Rebelling Upward. Zhang Jingyue states: Puncturing the winter region in summer causes yin deficiency internally and yang excess externally, causing blood and qi to rebel and leading to irritability. Ma Yizhen states: Summer qi floats and grows upward; reversing it downward causes qi stagnation and irritability. "Rebelling upward" should be "rebelling downward." Note: Now following the original text.
Prone to Forgetfulness. Wu Kun states: The Heart generates pulses. Puncturing meridians in autumn empties the meridians, making meridian qi and Heart qi deficient, hence prone to forgetfulness.
Qi Does Not Move Outward. Zhang Jingyue, based on the complete version, writes "Qi does not guard the exterior." Annotation: Qi deficiency cannot guard the exterior. Qi belongs to Yang; Yang deficiency makes one unwilling to move while lying down.
Causing Poor Vision. Ma Yizhen states: The essence of the five zang all pours into the eyes, forming the pupils. In winter, blood and qi are inside, adhering to the marrow, connecting to the five zang. If blood and qi deplete internally, the five zang become deficient, causing poor vision.
Major Bi. Zhang Jingyue states: During the time when yang qi is hidden and stored, puncturing the yang region causes yang qi to leak outward. Yang deficiency and yin excess result in Major Bi remaining. Ma Yizhen states: Major Bi means zang qi is deficient, and pathogens obstruct the five zang.
Prone to Forgetfulness. Wu Kun states: Yang qi nourishes the spirit when refined. Now, if yang qi is exhausted, the spirit perishes, hence prone to forgetfulness.
Contending with Essence. Wu Kun states: Jing (Essence) is True Qi. Bo (Contend) refers to the rubbing and clashing of pathogen and righteous qi.
Essence Qi Does Not Turn. Wu Kun states: Essence qi does not change. Zhang Jingyue states: Essence qi does not transform. Ma Yizhen states: Essence qi does not reverse. Gao Shishi states: Bu Zhuan (not turning) means internal retention. Note: Zhuan (turn) is likely a corruption of Bo (contend/rub).
Based on the changes of the zang, observe to know death. Wu Kun rearranges the sentence order; Ma Yizhen and Gao Shishi agree. Wu Kun states: Bian (change) refers to zang qi changing to cause disease. Ma Yizhen states: Based on the changes of the zang, observe to know death. Gao Shishi states: Based on the pathological changes of the zang, observe its movement; observing its movement allows knowing death. Zhang Jingyue rearranges the sentence order; Ma Yizhen agrees. Zhang Jingyue states: Seeing the signs of change identifies which zang is injured, thus allowing knowledge of the time of death. Note: Following Wang Bing’s annotation, the rearranged sentence order is correct.