奇病论云。瘅。谓热也。此章冠湿字。非是。汉书严助传。南方暑湿。近夏瘅热。（师古注。瘅。黄病也。误。）
王充论衡云。人形长七尺。形中有五常。有瘅热之病。深自克责。犹不能愈。又云。天地之有湛也。何以知不
如人之有水病也。其有旱也。何以知不如有瘅疾也。左传。荀偃瘅疽。（哀三年）史记。风瘅。肺消瘅。及本
经消瘅。瘅疟之类。皆单为热之义。熊音。瘅。多满反。俗作疸。病黄也。尤误。
厥成为巅疾 吴云。巅。癫同。古通用。气逆上而不已。则上实而下虚。故令忽然癫仆。今世所谓
五痫也。张云。或为疼痛。或为眩仆。而成顶巅之疾也。一曰。气逆则神乱。而病癫狂者。亦通。简按杨玄操
注难经云。癫。颠也。发即僵仆倒地。故有癫蹶之言。楼氏纲目云。以其病在头巅。故曰癫疾。是知癫痫之癫。
厥成癫疾。眩冒癫疾之巅。一疾也。王太仆误分癫为二疾。独孙真人始能一之。楼以癫巅为一疾。固是。以巅
为头巅之义。不可从。五脏生成篇。头痛巅疾。下虚上实。奇病论云。人生而有病巅疾者。方盛衰论。气上
不下。头痛巅疾。并是癫疾。当从吴注。
久风为飧泄 志云。风乃木邪。久则内干脾土。而成飧泄矣。故曰。春伤于风。邪气留连。乃为洞泄。
筋变骨痛 变。诸本作挛。当改。张云。此言诸病痈肿。而有兼筋挛骨痛者也。诸家以痈肿筋挛骨
痛。释为三证。殊失经意。观下文曰。此寒气之肿。则其所问在肿。义可知矣。
寒气之肿八风之变也 张云。惟风寒之变在经。所以兼筋骨之痛。今有大项风蛤蟆瘟之属。或为头
项咽喉之痈。或为肌肉之肿。正此类也。高云。此寒气之肿。言痈肿之生于寒也。八风之变。言筋挛骨痛之生
于风也。以明病之所生。即病之所变也。
以其胜治之愈也 志云。以五行气味之胜治之而愈也。如寒淫于内。治以甘热。如东方生风。风生
木。木生酸。辛胜酸之类。
征其脉 吴云。征。验也。
其色苍赤 张云。苍者。肝肾之色。青而黑也。赤者。心火之色。心主血也。脉见弦沉。而色苍赤
者。筋骨血脉俱病。故必当为毁伤也。简按苍。说文。草色也。青而黑。未知何据。
湿若中水也 张云。凡毁伤筋骨者。无论不见血已见血。其血必凝。其经必滞。气血凝滞。形必肿
满。或如湿气在经。而同于中水之状也。高云。毁伤筋骨。应不见血。若已见血。则心气并伤。如汗出身湿。
若中于水。水从汗孔。而伤其心气也。吴本。肝与肾以下二十五字。移于肾脉搏坚而长云云。至令不复也下。
注云。肝与肾脉并至。谓搏坚而长。又沉石也。其色当苍黑。今见色苍赤。则非肝肾病。当病毁伤不见血。盖
筋伤则色苍。脉伤则色赤。若已见血。则其搏坚而长。
或为湿饮。其脉沉下。或为水也。简按此一节。与上下文。不相顺承。疑有脱误。
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尺内两旁则季胁也 简按王注。尺内。谓尺泽之内也。此即诊尺肤之部位。平人气象论云。尺涩脉滑。
尺寒脉细。王注亦云。谓尺肤也。邪气脏腑病形篇云。善调尺者。不待
于寸。又云。夫色脉与尺之相应。如桴鼓影响之相应也。论疾诊尺篇云。尺肤泽。又云。尺肉弱。十三难云。
脉数尺之皮肤亦数。脉急尺之皮肤亦急。史记仓公传亦云。切其脉。循其尺。仲景云。按寸不及尺。皆其义也。
而其所以谓之尺者。说文。尺。十寸也。人手却十分动脉为寸口。十寸为尺。尺所以指。尺。规矩事也。从尸
从乙。乙。所识也。周制。寸尺咫寻常仞诸度量。皆以人之体为法。徐锴曰。家语曰。布指知尺。舒肱知寻。
（大戴礼云。布指知寸。布手知尺。舒肱知寻。）明是尺即谓臂内一尺之部分。而决非寸关尺之尺也。寸口分
寸关尺三部。 于难经。马张诸家。以寸关尺之尺释之。与经旨差矣。今据王义考经文。图左方。
以候腹中 张志高并以中字属下句。为中附上。是也。
左外以候肝内以候膈 何梦瑶医碥云。按心肺肝肾。脏也。反候于外。胸中膈膜。包裹此脏者也。反
候于内。恐传写之误。当以胃外脾内例之。易其位为是。简按此说有理。然旧经文果如此否。亦难必矣。
前以候前后以候后 简按前者。臂内阴经之分也。后者。臂外阳经之分也。论疾诊尺篇云。肘前独热
者。膺前热。肘后独热者。肩背热。即其义也。王以左为前。以右为后。诸家并从其说。非也。
上附上右外以候胃 宋本。胃。作肺。诸本同。当改。
膝胫足中事也 甲乙。无足字。
粗大者 简按此下。以脉象而候阴阳邪正之盛虚。与尺肤之义自别。
来疾去徐 滑氏诊家枢要云。来者。自骨肉之分。而出于皮肤之际。气之升也。去者。自皮肤之际。
而还于骨肉之分。气之降也。简按吴张仍滑氏。
上实下虚 吴云。脉自尺部。上于寸口。为上。自寸口下于尺部。为下。简按寸尺亦难经以后之见。
不可从。
厥巅疾 马云。其病当为厥疾。及巅疾焉。吴云。为厥逆癫仆之疾。高云。气惟上逆。上而不下。故
为巅疾。犹言厥成为巅疾也。
为恶风也故中恶风者 吴云。阴实阳虚。不任风寒。故令恶也。张云。恶。上去声。下入声。志云。
风为阳邪。伤人阳气。在于皮肤之间。风之恶厉者。从阳而直入于里阴。是以去疾下实。阳虚阴盛。为恶风也。
高云。恶风。疠风也。简按二恶字入声。志注是。
少阴厥也 张云。沉细者。肾之脉体也。兼数则热。阴中有火也。故为少阴之阳厥。
寒热也 高云。热有阴阳。申明有脉沉细。而数散者。非粗大有余之阳热。为阴盛阳虚之寒热也。简
按此亦虚劳寒热也。高注为是。而又有阴虚火动。其脉沉细数散者。必不可执一矣。
诸浮不躁者 张云。脉浮为阳。而躁则阳中之阳。故但浮不躁者。皆属阳脉。未免为热。若浮而兼躁。
乃为阳极。故当在手。在手者。阳中之阳。谓手三阳经也。此与终始篇。人迎一盛。病在足少阳。一盛而躁。
病在手少阳。义同。
诸细而沉者 张云。沉细为阴。而静则阴中之阴。故脉但沉细者。病在阴分。当为骨痛。若沉细而
静。乃为阴极。故当在足。在足者。阴中之阴。谓足三阴经也。
数动一代 吴云。数。阳脉也。阴固于外。阳战于内。则脉厥厥动摇。名曰动。脉五来一止。七来
一止。不复增减。名曰代。是为阳结。故病为滑泄下利。又为便脓血也。汪昂。数。读为去声。注云。马注。
数字。读作入声。数为热。故
便血。非。志云。阳热在经。故脉数动。热伤血分。故便脓血。经血下泄。故一代也。
诸过者 吴云。过。脉失其常也。
阴阳有余 马云。若滑涩兼见。而阴阳俱有余。则阳有余为无汗。阴有余为身冷。宜二证皆见也。
简按滑涩相反。岂有二脉俱见之理乎。
推而外之内而不外 张云。此下言察病之法。当推求于脉。以决其疑似也。凡病若在表。而欲求之
于外矣。然脉则沉迟不浮。是在内而非外。故知其心腹之有积也。推。音吹。诸释作推展之推者。非。简按吴
马诸家。仍王注。以推为推展之义。汪机遂以推为诊脉之一法。（见于脉诀刊误。附录。）并不可从。
推而内之外而不内 张云。凡病若在里。而欲推求于内矣。然脉则浮数不沉。是在外而非内。故知其
身之有热也。
推而上之上而不下 张云。凡推求于上部。然脉止见于上。而下部则弱。此以有升无降。上实下虚。
故腰足为之清冷也。
推而下之下而不上 张云。凡推求于下部。然脉止见于下。而上部则亏。此以有降无升。清阳不能上
达。故为头项痛也。按此二节。甲乙经。以上而不下。作下而不上。下而不上。作上而不下。似与上文相类而
顺。但既曰下而不上。则气脉在下。何以腰足反清。且本经前二节反言之。后二节顺言之也。一反一顺。两得
其义。仍当以本经为正。简按以上四节。张注明备。今从之。志云。推。详也。推详其脉气之偏于外内上下也。
是亦本于张义耳。
按之至骨脉气少者 高云。若按之至骨。不应于指。脉气少者。此阴盛阳虚。生阳之气。不能上行。
当腰脊痛。而
身有痹病也。承上文上下外内之病。而言诊脉亦有外内上下之法也。以上答帝知病乍在内乍在外之问者。如此。
《奇病论》中说：“瘅，是指热。”本章开头用“湿”字，是不对的。《汉书·严助传》记载：“南方暑湿，近夏瘅热。”（颜师古注释说：“瘅，是黄病。”这是错误的。）
王充在《论衡》中说：“人的身体长七尺，形体中有五常（指仁、义、礼、智、信，此处借指人体正常生理结构）。如果有瘅热这种病，自己深刻责备反省，仍然不能痊愈。”又说：“天地之间有湿气（湛），怎么知道不像人有水病呢？天有旱灾，怎么知道不像人有瘅疾呢？”《左传》记载：“荀偃患瘅疽。”（哀公三年）《史记》记载：“风瘅、肺消瘅，以及《本经》中的消瘅、瘅疟之类，都单独表示热的含义。”熊氏注音：“瘅，读多满反。”俗写作“疸”，指黄疸病，这也是错误的。
厥气上逆成为巅顶之疾。吴崑说：“巅，与‘癫’同，古时通用。气逆向上而不停止，就会上实下虚，所以导致突然昏倒仆地。就是现在所说的五痫。”张景岳说：“或者表现为疼痛，或者表现为眩晕仆倒，从而形成头顶的疾患。”另一种说法是：气逆则神志混乱，从而患癫狂病，这也通。简按：杨玄操注解《难经》说：“癫，就是颠。发作时就僵直仆倒在地，所以有‘癫蹶’的说法。”楼氏《纲目》说：“因为病位在头巅，所以叫癫疾。”由此可知，“癫痫”的“癫”，和“厥成癫疾”、“眩冒癫疾”中的“巅”，指的是同一种疾病。王冰错误地将癫分为两种病，只有孙思邈开始将它们统一。楼氏认为“癫”和“巅”是同一种病，这固然正确；但认为“巅”仅指头巅的含义，不可采纳。《五脏生成篇》说：“头痛巅疾，下虚上实。”《奇病论》说：“人生下来就患有巅疾的人。”《方盛衰论》说：“气上不下，头痛巅疾。”这些都是指癫疾，应当遵从吴崑的注释。
久风导致飧泄。张志聪说：“风属于木邪，时间久了内伤脾土，从而形成飧泄。”所以说：“春天伤于风，邪气留连不去，就会变成洞泄。”
筋变骨痛。“变”，各本作“挛”，应当改正。张景岳说：“这里说的是各种痈肿病症，兼有筋挛骨痛的。”各家将痈肿、筋挛、骨痛解释为三种证候，特别失去了经文的原意。看下文说：“这是寒气导致的肿胀”，那么所问的重点在于“肿”，意义就知道了。
寒气导致的肿胀和八风的变化。张景岳说：“只有风寒的变化在经络，所以兼有筋骨疼痛。现在有像大头瘟、蛤蟆瘟这类病，有的表现为头项咽喉的痈肿，有的表现为肌肉的肿胀，正是这一类。”高世栻说：“寒气之肿，是说痈肿生于寒。八风之变，是说筋挛骨痛生于风。”以此说明疾病的产生，就是疾病的表现形式。
用克制它的属性来治疗就能痊愈。张志聪说：“用五行气味相胜的方法来治疗就能痊愈。比如寒邪淫溢于内，用甘热药治疗；比如东方生风，风生木，木生酸，辛味能胜酸味之类的道理。”
征验其脉象。吴崑说：“征，是验证的意思。”
面色青赤。张景岳说：“苍色，是肝肾的颜色，青中带黑。赤色，是心火的颜色，心主血。脉象见弦沉，而面色青赤，说明筋骨血脉都有病，所以必定会有毁伤。”简按：《说文解字》中，“苍”是草色，青中带黑，不知依据是什么。
湿气如同中水一样。张景岳说：“凡是毁伤筋骨的，无论是否见血，血液必然凝滞，经脉必然阻滞。气血凝滞，形体必然肿胀。或者像湿气在经脉中，同于中水的状态。”高世栻说：“毁伤筋骨，应该不见血。如果已经见血，那么心气也并受损伤，就像出汗后身体潮湿，如同中了水邪。水从汗孔进入，伤害心气。”吴崑版本中，从“肝与肾”以下的二十五字，移到了“肾脉搏坚而长云云，至令不复也”之下。注解说：“肝与肾脉并至，谓搏动坚实而长，又沉石。其面色应当青黑。现在见到面色青赤，那就不是肝肾的病，而是病在毁伤不见血。大概筋伤则色苍，脉伤则色赤。如果已经见血，那么其脉搏坚实而长。”或者表现为湿饮，脉象沉下；或者表现为水病。简按：这一节，与上下文不连贯，怀疑有脱漏或错误。
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尺部内侧两旁对应季胁。简按：王冰注解说：“尺内，指尺泽穴以内。”这就是诊察尺肤的部位。《平人气象论》说：“尺涩脉滑，尺寒脉细。”王冰注也说：“指尺肤。”《邪气脏腑病形篇》说：“善于调治尺肤的，不需要等待寸口脉。”又说：“面色、脉象与尺肤的相应，就像鼓槌击鼓、影子随形那样相应。”《论疾诊尺篇》说：“尺肤润泽。”又说：“尺肉虚弱。”《难经·十三难》说：“脉数，尺的皮肤也数；脉急，尺的皮肤也急。”《史记·仓公传》也说：“切按其脉，循按其尺。”张仲景说：“按寸不及尺。”都是这个意思。至于为什么叫“尺”，《说文解字》说：“尺，十寸。”人手向后退十分处的动脉称为寸口，十寸称为尺。尺是用来指代规矩事物的。字形从尸从乙，乙是标识。周代的制度，寸、尺、咫、寻、仞等度量单位，都以人的身体为标准。徐锴说：“《家语》说：张开手指量知一尺，舒展手臂量知一寻。（《大戴礼记》说：张开手指量知一寸，张开手掌量知一尺，舒展手臂量知一寻。）”明摆着“尺”就是指手臂内侧一尺的部分，绝对不是寸、关、尺三部中的“尺”。寸口分为寸、关、尺三部，在《难经》中，马莳、张景岳等各家，用寸、关、尺的“尺”来解释，与经文原意相差甚远。现在根据王冰的解释考证经文，图左侧。
用来候察腹中的情况。张志聪、高世栻都把“中”字属下句，作“为中附上”，这是正确的。
左外侧候肝脏，内侧候膈膜。何梦瑶在《医碥》中说：“按心肺肝肾，都是脏。反而候察于外侧；胸中膈膜，包裹这些脏器的。反而候察于内侧，恐怕是传写错误。应当以胃在外、脾在内的例子类推，交换位置才是正确的。”简按：这个说法有理。但是旧经文果真如此吗？也很难确定。
前方候前，后方候后。简按：前者，是手臂内侧阴经的部分。后者，是手臂外侧阳经的部分。《论疾诊尺篇》说：“肘前独热者，膺前热。肘后独热者，肩背热。”就是这个意思。王冰以左为前，以右为后，各家都随从他的说法，这是不对的。
上方附接处，右侧外侧候胃。宋本中，“胃”写作“肺”，诸本相同，应当改正。
膝、胫、足中的事情。《甲乙经》中没有“足”字。
脉象粗大。简按：以下部分，是通过脉象来候察阴阳邪正的盛虚，与尺肤的意义自然不同。
脉来急促，去势缓慢。滑寿在《诊家枢要》中说：“来，是从骨肉之分，出于皮肤之际，是气的上升。去，是从皮肤之际，还于骨肉之分，是气的下降。”简按：吴崑、张景岳仍沿用滑氏的说法。
上实下虚。吴崑说：“脉自尺部，上行于寸口，称为上；自寸口下行于尺部，称为下。”简按：寸、尺也是《难经》以后的观点，不可采纳。
厥逆导致的巅顶之疾。马云说：“其病应当是厥疾，以及巅疾。”吴崑说：“是厥逆癫仆的疾病。”高世栻说：“气只上逆，上而不降，所以成为巅疾。”犹如前面说的“厥成为巅疾”。
因为恶风，所以中恶风者。吴崑说：“阴实阳虚，不能耐受风寒，所以导致恶风。”张景岳说：“恶，读去声；下文的‘恶’读入声。”张志聪说：“风是阳邪，伤人阳气，在于皮肤之间。风之恶厉者，从阳直接深入里阴。因此下部实，上部虚，阳虚阴盛，所以恶风。”高世栻说：“恶风，指疠风。”简按：两个“恶”字都读入声，张志聪的注释是正确的。
少阴经的厥逆。张景岳说：“沉细，是肾的脉体特征。兼见数脉则有热，阴中有火。所以成为少阴的阳厥。”
寒热。高世栻说：“热有阴阳之分。申明有脉象沉细而数散的，不是粗大有余的阳热，而是阴盛阳虚的寒热。”简按：这也是虚劳寒热。高氏注释是对的。但又有阴虚火动，其脉沉细数散的，绝不能固执一端。
所有浮脉但不躁动的。张景岳说：“脉浮属阳，而躁则是阳中之阳。所以但浮不躁的，都属于阳脉，未免有热。如果浮而兼躁，乃是阳极。所以病在手经。在手者，是阳中之阳，指手三阳经。”这与《终始篇》中“人迎脉大一倍，病在足少阳；大一倍且躁，病在手少阳”的道理相同。
所有细而沉的脉。张景岳说：“沉细属阴，而静则是阴中之阴。所以脉仅沉细的，病在阴分，应当为骨痛。如果沉细而静，乃是阴极。所以病在足经。在足者，是阴中之阴，指足三阴经。”
脉数、动、一代。吴崑说：“数，是阳脉。阴固于外，阳战于内，则脉厥厥动摇，名叫动。脉每五次跳动停一次，或七次跳动停一次，不再增减，名叫代。这是阳结。所以病表现为滑泄下利，又表现为便脓血。”汪昂说：“数，读去声。”注解说：“马注中，数字读作入声。数为热，所以便血，这是不对的。”张志聪说：“阳热在经，所以脉数动。热伤血分，所以便脓血。经血下泄，所以出现代脉。”
所有的异常脉象。吴崑说：“过，指脉失其常度。”
阴阳有余。马云说：“如果滑脉和涩脉兼见，而阴阳俱有余，那么阳有余表现为无汗，阴有余表现为身冷。这两证应当同时出现。”简按：滑脉和涩脉相反，哪里有二脉俱见的道理呢？
推求于外而不在内，推求于内而不在外。张景岳说：“以下讲察病的方法。应当通过推求脉象，来决断疑似之症。凡病若在表，想要推求于外，然而脉象却沉迟不浮，这是在内而不在外。所以知道心腹有积滞。推，音吹。各家解释作推展的推，是不对的。”简按：吴崑、马莳等各家，仍沿袭王冰注，以推为推展之义。汪机遂将推作为诊脉的一种方法（见于《脉诀刊误》附录）。都不可采纳。
推求于内而不在外，推求于外而不在内。张景岳说：“凡病若在里，想要推求于内，然而脉象却浮数不沉，这是在外而不在内。所以知道身体有热。”
推求于上而上不下，推求于下而下不上。张景岳说：“凡推求于上部，然而脉仅见于上，而下部则弱。这是因为有升无降，上实下虚，所以腰足清冷。”
推求于下而下不上，推求于上而上不下。张景岳说：“凡推求于下部，然而脉仅见于下，而上部则亏。这是因为有降无升，清阳不能上达，所以头项痛。”按：这两节，《甲乙经》中，将“以上而不下”作“下而不上”，“下而不上”作“上而不下”，似乎与上文相似且顺。但既然说“下而不上”，则气脉在下，为什么腰足反而清冷？况且本经前两节是反言，后两节是顺言。一反一顺，两得其义，仍应当以本经为正。简按：以上四节，张景岳的注释详尽完备，现在遵从他的说法。张志聪说：“推，是详察的意思。推详其脉气偏于外内上下。”这也是基于张景岳的观点罢了。
按之至骨，脉气少的。高世栻说：“如果按之至骨，不应于指，脉气少的，这是阴盛阳虚，生发之气不能上行，应当腰脊痛，并且身体有痹病。”承接上文关于上下内外病的论述，来说明诊脉也有外内上下之法。以上是回答黄帝关于病乍在内乍在外的提问。如此。
The *Qibing Lun* (Treatise on Rare Diseases) states: "Dan" refers to heat. The use of the character "Shi" (Dampness) at the beginning of this chapter is incorrect. The *Han Shu* (Book of Han), in the biography of Yan Zhu, records: "In the south, there is summer dampness and near summer 'dan' heat." (Yan Shigu's commentary states: "'Dan' is jaundice. This is an error.)
Wang Chong in *Lunheng* (Discourses Weighed in the Balance) states: "A human body is seven chi long, containing the Five Constants (referring to normal physiological structures). If one suffers from 'dan' heat disease, even if one deeply blames oneself, it still cannot be cured." He further states: "Just as heaven and earth have moisture ('Zhan'), how do we know it is not like humans having water disease? Just as there is drought, how do we know it is not like humans having 'dan' disease?" The *Zuo Zhuan* (Commentary of Zuo) records: "Xun Yan suffered from 'dan' carbuncle." (3rd year of Duke Ai). The *Shiji* (Records of the Grand Historian) records: "Wind 'dan', lung 'xiaodian' (wasting-thirst due to heat), as well as 'xiaodian' and 'dan nue' (malaria with high fever) mentioned in the *Neijing*, all singly denote the meaning of heat. Xiong's phonetic annotation: 'Dan' is pronounced 'duoman fan'. It is colloquially written as 'Dan' (Jaundice), referring to yellow disease. This is also an error.
Jue Qi (Rebellious Qi) ascending becomes a disease of the vertex. Wu Kun states: "'Dian' (Vertex) is identical to 'Dian' (Epilepsy/Insanity), used interchangeably in ancient times. When Qi rebels upward and does not cease, the upper becomes excess and the lower becomes deficient, causing sudden collapse and falling. This is what is now called the five types of epilepsy (Wuxian). Zhang Jingyue states: "It may manifest as pain, or as dizziness and collapse, thereby forming a disease of the vertex." Another view holds: "Qi rebellion causes mental confusion, leading to mania and epilepsy; this interpretation is also valid." Commentary notes: Yang Xuancao, annotating the *Nanjing* (Classic of Difficult Issues), states: "'Dian' means vertex. Upon onset, the patient stiffens and falls to the ground, hence the term 'Dianjue' (Epileptic fall). Lou Shi's *Gangmu* states: "Because the disease is located at the head vertex, it is called 'Dianji' (Disease of the Vertex)." From this, we know that the 'Dian' in 'Dianxian' (Epilepsy) and the 'Dian' in "Jue Cheng Dianji" (Jue Qi becoming vertex disease) and "Xuanmao Dianji" (Vertigo and vertex disease) refer to the same disease. Wang Bing erroneously divided 'Dian' into two diseases; only Sun Simiao began to unify them. Although Lou Shi was correct in equating 'Dian' and 'Dian' as one disease, his interpretation that 'Dian' solely refers to the anatomical vertex is unacceptable. The *Wuzang Shengcheng Pian* (Chapter on the Generation of the Five Viscera) states: "Headache and vertex disease, lower deficiency and upper excess." The *Qibing Lun* states: "Those born with vertex disease." The *Fang Sheng Shuai Lun* states: "Qi rises but does not descend, causing headache and vertex disease." These all refer to epilepsy/manic disorders, and Wu Kun's annotation should be followed.
Prolonged wind leads to undigested food diarrhea (Sungxie). Zhang Zhicong states: "Wind belongs to Wood pathogen. Over time, it internally damages Spleen Earth, resulting in Sungxie." Thus it is said: "If injured by wind in spring, the pathogen lingers, eventually becoming Dongxie (profuse watery diarrhea)."
Sinew changes and bone pain. The character "Bian" (Change) is written as "Luan" (Spasm/Cramp) in most editions and should be corrected. Zhang Jingyue states: "This refers to various abscesses and swellings accompanied by sinew spasms and bone pain. Previous commentators interpreted abscesses, sinew spasms, and bone pain as three separate syndromes, which greatly misses the intent of the classic. Looking at the following text: 'This is swelling caused by cold pathogen,' it is clear that the inquiry focuses on 'swelling,' revealing the meaning."
Swelling caused by cold pathogen and changes from the Eight Winds. Zhang Jingyue states: "Only changes from wind and cold affect the meridians, thus accompanying bone and sinew pain. Currently, diseases such as Big Head Plague and Mumps involve either abscesses of the head, neck, and throat, or swelling of the muscles; these are precisely of this category." Gao Shishi states: "'Swelling of cold pathogen' means abscesses arising from cold. 'Changes of the Eight Winds' means sinew spasms and bone pain arising from wind." This clarifies that the origin of the disease is its manifestation.
Cure it by treating with the overcoming element. Zhang Zhicong states: "Cure it by using the overcoming properties of the Five Elements and their flavors. For example, if cold invades internally, treat with sweet and hot substances. For instance, the East generates Wind; Wind generates Wood; Wood generates Sour flavor; Pungent flavor overcomes Sour flavor, and so on."
Verify the pulse. Wu Kun states: "'Zheng' means to verify or test."
Complexion is cyan-red. Zhang Jingyue states: "Cyan color is the color of Liver and Kidney, blackish-green. Red color is the color of Heart Fire; the Heart governs Blood. If the pulse is wiry and deep, and the complexion is cyan-red, it indicates pathology in sinews, bones, blood, and vessels; thus, there must be trauma/injury." Commentary notes: In *Shuowen Jiezi*, "Cang" refers to grass color, blackish-green. The basis for this is unclear.
Dampness resembles being struck by water. Zhang Jingyue states: "For any injury to sinews and bones, whether bleeding occurs or not, the blood will surely stagnate, and the meridians will surely be obstructed. Stagnation of Qi and blood causes the body to swell. It may resemble dampness in the meridians, appearing similar to being struck by water." Gao Shishi states: "Injury to sinews and bones should not involve bleeding. If bleeding has occurred, the Heart Qi is also damaged, similar to sweating and then feeling damp, as if struck by water. Water enters through sweat pores and damages Heart Qi." In Wu Kun's edition, the twenty-five characters starting from "Liver and Kidney" are moved below "Ren Mai Bo Jian Er Chang... until it never recovers." The annotation states: "When Liver and Kidney pulses arrive together, they are firm and long, and also deep and stone-like. The complexion should be cyan-black. Seeing cyan-red now indicates it is not a Liver/Kidney disease, but rather trauma without bleeding. Likely, sinew injury manifests as cyan color, vessel injury as red color. If bleeding has occurred, the pulse is firm and long." Or it presents as damp-fluid retention with a deep, sinking pulse; or it presents as water disease. Commentary notes: This section does not connect smoothly with the context above and below; there is suspected textual loss or error.
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The inner sides of the Chi area correspond to the hypochondrium. Commentary notes: Wang Bing annotates: "Chi Nei refers to the interior of the Chi Ze acupoint." This is the location for diagnosing the skin of the forearm (Chifu). The *Pingren Qixiang Lun* (Chapter on Normal People and Pulse Images) states: "Rough Chifu with slippery pulse, cold Chifu with fine pulse." Wang Bing also annotates: "Refers to Chifu." The *Xiéqì Zàngfǔ Bìngxíng Piān* (Chapter on Pathogenic Factors and Zang-Fu Diseases) states: "One who is skilled in regulating Chifu does not need to wait for the Cun pulse." It also states: "The correspondence between facial color, pulse, and Chifu is like the striking of a drum or the shadow following the form." The *Lun Ji Zhen Chi Pian* (Chapter on Discussing Diseases by Diagnosing Chifu) states: "Moist Chifu," and also: "Weak flesh at Chifu." *Nanjing* Chapter 13 states: "If the pulse is rapid, the skin of Chifu is also rapid; if the pulse is tight, the skin of Chifu is also tight." The *Shiji* Biography of Cang Gong also states: "Palpate the pulse, trace the Chifu." Zhang Zhongjing states: "Palpating Cun without reaching Chi." All these illustrate this concept. As for why it is called "Chi," *Shuowen Jiezi* states: "Chi is ten Cun." The arterial pulse at the wrist, ten Cun backward from the tip of the thumb, is called Cun Kou. Ten Cun constitutes Chi. Chi is used to indicate standards/rules. The character consists of 'Shi' (Corpse/Body) and 'Yi' (Mark). In Zhou dynasty systems, measures like Cun, Chi, Zhi, Xun, and Ren were all based on human body dimensions. Xu Kai states: "*Kongzi Jiayu* says: Spreading fingers knows one Chi; extending the arm knows one Xun. (*Da Dai Liji* says: Spreading fingers knows one Cun; spreading hand knows one Chi; extending arm knows one Xun.)" Clearly, "Chi" here refers to the one-Chi segment of the inner arm, absolutely not the "Chi" position in the Cun-Guan-Chi three positions. The Cun Kou is divided into Cun, Guan, and Chi. In the *Nanjing*, scholars like Ma Shi and Zhang Jingyue interpreted "Chi" using the Cun-Guan-Chi system, which deviates significantly from the original intent of the classic. Based on Wang Bing's interpretation and the text, looking at the left side of the diagram.
Used to observe the abdomen. Zhang Zhicong and Gao Shishi both attach the character "Zhong" (Middle) to the following sentence, reading it as "Wei Zhong Fu Shang" (Attach to the middle), which is correct.
Left exterior observes Liver; interior observes Diaphragm. He Mengyao in *Yiquan* states: "Heart, Lung, Liver, Kidney are Zang organs. They are observed externally; the thoracic diaphragm wraps these organs. Observing internally seems to be a transcription error. It should be analogized to Stomach external/Spleen internal, swapping positions would be correct." Commentary notes: This argument has merit. However, whether the old text was indeed so is hard to confirm.
Anterior observes anterior; posterior observes posterior. Commentary notes: Anterior refers to the Yin meridian aspect of the arm. Posterior refers to the Yang meridian aspect of the arm. The *Lun Ji Zhen Chi Pian* states: "Heat exclusively at the front of the elbow indicates heat in the chest/front; heat exclusively at the back of the elbow indicates heat in the shoulder/back." This illustrates the point. Wang Bing considered Left as Anterior and Right as Posterior; subsequent commentators followed him, which is incorrect.
Upper attachment, right exterior observes Stomach. In the Song edition, "Stomach" is written as "Lung"; all other editions agree, but it should be corrected to Stomach.
Matters of the knee, shin, and foot. The *Jiayi Jing* lacks the character "Foot".
Pulse is coarse and large. Commentary notes: Below this, the pulse image is used to observe the excess or deficiency of Yin/Yang, Evil, and Righteous Qi, which differs naturally from the meaning of Chifu.
Arrival is rapid, departure is slow. Shou Shou in *Zhenjia Shuyao* states: "Arrival" is from the depth of muscle/bone emerging to the surface of the skin, representing the rising of Qi. "Departure" is from the surface of the skin returning to the depth of muscle/bone, representing the descending of Qi. Commentary notes: Wu Kun and Zhang Jingyue follow Shou Shou's explanation.
Upper excess, lower deficiency. Wu Kun states: "Pulse rising from Chi position to Cun Kou is 'Up'; descending from Cun Kou to Chi position is 'Down'." Commentary notes: The distinction of Cun and Chi is a post-*Nanjing* concept and should not be adopted here.
Jue leading to vertex disease. Ma Yin states: "The disease should be Jue disease, and also vertex disease." Wu Kun states: "It is Jue Ni (rebellious Qi) and epileptic collapse disease." Gao Shishi states: "Qi only rebels upward and does not descend, thus becoming vertex disease." Similar to the previous statement "Jue becomes vertex disease."
Due to aversion to wind, thus those struck by evil wind. Wu Kun states: "Yin excess and Yang deficiency cannot withstand wind and cold, thus causing aversion." Zhang Jingyue states: "'Wu' (Aversion/Hate) is read with the departing tone (4th tone); the second 'Wu' is read with the entering tone (entering sound)." Zhang Zhicong states: "Wind is a Yang pathogen, damaging Yang Qi in the skin. Severe wind enters directly from Yang into Interior Yin. Therefore, the lower is excess, the upper is deficient; Yang deficiency and Yin excess cause aversion to wind." Gao Shishi states: "'Wu Feng' refers to Leprosy (Li Feng)." Commentary notes: Both instances of "Wu" are read with the entering tone; Zhang Zhicong's annotation is correct.
Shaoyin Jue. Zhang Jingyue states: "Deep and fine is the pulse characteristic of the Kidney. Accompanied by rapidity indicates heat, Fire within Yin. Thus it becomes Shaoyin Yang Jue."
Chills and fever. Gao Shishi states: "Heat has Yin and Yang aspects. Clarifying that a deep, fine, and scattered rapid pulse is not the excessive Yang heat of a coarse/large pulse, but rather chills and fever due to Yin excess and Yang deficiency." Commentary notes: This is also deficiency-labor chills and fever. Gao's annotation is correct. However, in cases of Yin deficiency with fire hyperactivity, the pulse may also be deep, fine, rapid, and scattered; one must not adhere rigidly to one view.
All floating pulses but not restless. Zhang Jingyue states: "Floating pulse belongs to Yang; restlessness is Yang within Yang. Therefore, floating without restlessness belongs to Yang pulses and inevitably involves heat. If floating and restless, it represents extreme Yang. Thus, the disease is in the Hand meridians. 'Hand' refers to Yang within Yang, i.e., the Three Yang Meridians of the Hand." This is consistent with the *Zhongshi Pian* (Chapter on End and Beginning): "Renying pulse one-fold excess, disease in Foot Shaoyang; one-fold excess and restless, disease in Hand Shaoyang."
All fine and deep pulses. Zhang Jingyue states: "Deep and fine belongs to Yin; stillness is Yin within Yin. Therefore, a pulse that is merely deep and fine indicates disease in the Yin division, likely bone pain. If deep, fine, and still, it represents extreme Yin. Thus, the disease is in the Foot meridians. 'Foot' refers to Yin within Yin, i.e., the Three Yin Meridians of the Foot."
Rapid, moving, and intermittent pulse. Wu Kun states: "Rapid is a Yang pulse. Yin is solidified externally, Yang battles internally, causing the pulse to tremble violently, named 'Dong' (Moving). If the pulse stops once after five beats, or once after seven beats, without further change, it is named 'Dai' (Intermittent). This is Yang knotting. Thus the disease manifests as slippery diarrhea/dysentery, and also bloody stool/pus." Wang Ang states: "'Shu' (Rapid) is read with the departing tone. Annotation notes: Ma's annotation reads 'Shu' with the entering tone. 'Shu' means heat, thus causing bloody stool; this is incorrect." Zhang Zhicong states: "Yang heat in the meridians causes rapid/moving pulse. Heat damages the Blood division, causing bloody stool/pus. Blood loss downward causes the intermittent pulse."
All abnormal pulses. Wu Kun states: "'Guo' means the pulse has lost its normal rhythm."
Yin and Yang both in excess. Ma Yin states: "If Slippery and Choppy pulses appear together, and both Yin and Yang are in excess, then Yang excess causes no sweat, and Yin excess causes cold body. Both symptoms should appear simultaneously." Commentary notes: Slippery and Choppy pulses are opposite; how can both appear simultaneously?
Push outward but not inward; push inward but not outward. Zhang Jingyue states: "Below discusses the method of examining disease. One must deduce via the pulse to resolve doubts. If the disease is in the Exterior, one seeks it in the Exterior; however, if the pulse is deep, slow, and not floating, it is in the Interior, not the Exterior. Thus, one knows there is accumulation in the Heart and Abdomen. 'Tui' (Push/Deduce) is pronounced 'Chui'. Interpreting it as 'pushing forward/expanding' is incorrect." Commentary notes: Wu Kun, Ma Shi, and others follow Wang Bing, interpreting 'Tui' as expanding. Wang Ji subsequently treated 'Tui' as a specific pulse diagnosis method (seen in *Maijue Kanwu* appendix). This is unacceptable.
Push inward but not outward; push outward but not inward. Zhang Jingyue states: "If the disease is in the Interior, one seeks it in the Interior; however, if the pulse is floating, rapid, and not deep, it is in the Exterior, not the Interior. Thus, one knows there is heat in the body."
Push upward but not downward; push downward but not upward. Zhang Jingyue states: "When seeking in the Upper part, if the pulse is only visible in the Upper, while the Lower is weak, this is due to ascending without descending, upper excess and lower deficiency, causing coldness in the waist and feet."
Push downward but not upward; push upward but not downward. Zhang Jingyue states: "When seeking in the Lower part, if the pulse is only visible in the Lower, while the Upper is deficient, this is due to descending without ascending, Clear Yang cannot reach the top, causing headache and neck pain." Note: In the *Jiayi Jing*, the phrases "Upward but not downward" and "Downward but not upward" are swapped compared to the main text, making them seem more parallel. However, if it is "downward but not upward," why would the waist and feet be cold if Qi/Pulse is in the lower? Furthermore, the first two sections of the classic speak inversely, while the latter two speak directly. One inverse, one direct, both capture the meaning. The main text should prevail. Commentary notes: Zhang Jingyue's annotations for these four sections are comprehensive; we follow him. Zhang Zhicong states: "'Tui' means detailed examination. Detailed examination of the bias of Qi pulse towards exterior/interior/up/down." This is also based on Zhang Jingyue's view.
Press to the bone, pulse Qi is scanty. Gao Shishi states: "If pressing to the bone yields no response to the finger, and pulse Qi is scanty, this is Yin excess and Yang deficiency. The generating Yang Qi cannot ascend upward. There should be lumbar/spinal pain and Bi syndrome in the body." This follows the discussion of diseases in up/down/out/in to explain that pulse diagnosis also has methods regarding exterior/interior/up/down. This answers the Emperor's question about diseases fluctuating between interior and exterior. Thus.