马云。按此篇论病。大抵出于灵枢经脉篇。诸经为病。篇内曰所谓者。正以古有是语。而今述之也。高云。
六气主时。始于厥阴。终于太阳。此举三阳三阴经脉之病。则太阳主春。正月为春之首。太阳为阳之首也。少
阳主秋。九月为秋之终。少阳为阳之终也。阳明主夏。五月为夏之中。阳明居阳之中也。三阴经脉。外合三阳。
雌雄相应。太阴合阳明。故主十一月。十一月。冬之中也。少阴合太阳。故主十月。十月冬之首也。厥阴合少
阳。故主三月。三月。春之终也。太阴为阴中之至阴。故又主十二月。十二月。阴中之至阴也。错举六经之病。
复以三阳三阴。主四时之月。而错综解之。所以为脉解也。
肿腰 痛 。熊。音谁。张同。马吴音疽。张云。尻臀也。高本。肿。一字句。云。六元正纪大
论曰。太阳终之气。则病腰 痛。故太阳经脉之病。有肿以及腰 痛也。简按 从肉。音谁。其音疽者。睢鸠
之睢。从且。马吴误。 。说文。尻也。汉东方朔传。连 尻。注。臀也。盖 从肉。故王释为臀肉。此四字。
即与厥论肿首头重。着至教论。干嗌喉塞。字法正同。高注非。
正月太阳寅 志云。太阳为诸阳主气。生于膀胱水中。故以太阳之气为岁首。（杨慎丹铅录云。考
纬书。谓三皇三世。伏羲建寅。神农
建丑。黄帝建子。至禹建寅。宗伏羲。商建丑。宗神农。周建子。宗黄帝。所谓正朔三而改也。简按此云正月
太阳寅。明是黄帝建寅。而非建子。纬书之言。难信据也。杨氏好读内经。盍论及于此耶。）
病偏虚为跛者 高本。病上。有所谓二字。云。旧本。所谓二字。误传出也下。今改正。偏虚。犹偏
枯。大奇论云。肾雍则髀 大。跛易偏枯。故申明所谓病偏虚为跛者。
东解地气而出也 东。宋本。作冻。马吴高志并同。解下句。吴删而字。云。冻解。解冻也。高云。
地冻始解。地气从下而上出也。张云。正月东风解冻。简按东。作冻。则而字不妥。盖谓阳气自东方。解地气
之冻。而上出也。
所谓偏虚者 所谓二字。从高而删之。为是。
盛上而跃故耳鸣也 高云。经筋篇云。手太阳之筋。其病应耳中鸣。故申明所谓耳鸣者。乃阳气万物。
盛上而跃。跃则振动。故耳鸣也。
狂巅疾 张云。巅。癫同。按经脉篇。足太阳经脉条下。作癫。盖古所通用也。所谓甚者。言阳邪盛
也。阳邪实于阳经。则阳尽在上。阴气在下。上实下虚。故当为狂癫之病。
浮为聋 高云。经脉篇曰。手太阳之脉。入耳中。所生病者。耳聋。故申明所谓浮为聋者。是逆气上
浮。而为聋。皆在气也。简按马云。脉浮则聋。非。
故为喑也 张云。声由气发。气者阳也。阳盛则声大。阳虚则声微。若阳盛已衰。故喑哑不能言也。
内夺 吴云。内。谓房劳也。夺。耗其阴也。
喑俳 张云。俳。音排。无所取义。误也。当作痱。正韵。音沸。废也。内夺者。夺其精也。精夺则
气夺而厥。故声喑于上。体废于下。元阳大亏。病本在肾。肾脉上挟舌本。下走足心。故为是病。高云。俳。
痱同。音肥。喑痱者。口
无言。而四肢不收。故曰此肾虚也。简按楼氏纲目。引本节及王注。俳。作痱。张注。盖原于此。灵热病篇云。
痱之为病也。身无痛者。四肢不收。志乱不甚。其言微知。可治。甚则不能言。不可治也。楼氏纲目云。痱。
废也。痱。即偏枯之邪气深者。痱与偏枯。是二疾。以其半身无气营运。故名偏枯。以其手足废而不收。或名
痱。或偏废。或全废。皆曰痱也。汉贾谊传云。辟者一面病。痱者一方病。师古注。辟。足病。痱。风病也。
（本出于说文。）由此观之。痱。即仲景中风篇。所谓邪入于脏。舌即难言者。盖痱是病名。偏风是所因。偏
枯是病证。必非有别也。吴云。俳。阳事废也。非。圣济总录。有喑俳门。载治舌喑不能言。足废不能用。肾
虚弱。其气厥不至舌下。地黄饮子等方。具于五十一卷。
少阴不至者厥也 张云。此释上文内夺而厥之义也。少阴者。肾脉也。与太阳为表里。若肾气内夺。
则少阴不至。少阴不至者。以阴虚无气。无气则阳衰。致厥之由也。简按王注太阴之气。逆上而行。可疑。
心之所表也 马云。胆之脉行于胁。而心之脉出于腋。为心之表。故为心胁痛也。张云。少阳属木。
木以生火。故邪之盛者。其本在胆。其表在心。表者。标也。简按张注仍王义。今从之。
九月阳气尽 高云。若九月之时。阳气已尽。而阴气方盛。少阳火气不盛。不能为心之表。故有心
胁痛之病也。
阴气藏物也 张云。阴邪凝滞。藏伏阳中。喜静恶动。故反侧则痛。高云。经脉篇曰。足少阳病。
不能转侧。故申明所谓不可反侧者。九月阴气方盛。阴气所以藏物也。物藏则不动。故少阳经脉。有不可反侧
之病也。
草木毕落而堕 文选。潘岳寡妇赋。木落叶而陨枝。李
善注云。毛苌诗传曰。陨。坠也。千金方。蒲黄汤主疗。小儿落床堕地。
气盛而阳之下长 吴云。气盛。气盛于阴也。之。往也。下。下体也。阳之下。谓阳气往下。如少阳
之脉。出膝外廉。行于两足。是也。长。生长也。阳为动物。长于两足。故令跃。
相薄 张云。薄。气相薄也。吴云。薄。摩荡也。
水火相恶 高云。厥。为阴为水。乃水火相恶。又木能生火。故闻木音。则惕然而惊也。简按本节所
解。与阳明脉解篇异义。
所谓客孙脉云云 高云。出处未详。大抵皆阳明之病。孙脉。孙络脉也。
其孙络太阴也 高云。阳明之脉。不从下行。而并于上。并于上者。则其孙络之脉。合脾之大络。而
为太阴也。阳明并于上。故头痛鼻鼽。孙络太阴。故腹肿也。简按此一句难通。故吴改作其头之孙络。腹之太
阴也十字。张以为太阴者。言阴邪之盛。非阴经之谓。俱臆见也。高注稍妥。姑从之。
上走心而为噫 马云。宣明五气论曰。心为噫。又口问篇云。寒气客于胃。厥逆从下上散。复出于胃。
故为噫。夫素问言心。而灵枢言胃。则此篇兼言阴气走于胃。胃走于心。见三经相须。而为噫也。（三经。谓
心脾胃。）
故呕也 张云。脾胃相为表里。胃受水谷。脾不能运。则物盛满而溢。故为呕。
得后与气 熊音。得后。谓得大便也。气。谓快气。马云。后者。圊也。气者。肛门失气也。张同。
云。阳气出。则阴邪散。故快然如衰。一阳下动。冬至候也。故应十一月之气。简按吴云。气。谓嗳气。误。
阳气皆伤 吴云。伤者。抑而不扬之意。高云。承秋之肃杀也。
呕咳上气喘也 张云。阳根于阴。阴根于阳。互相倚也。若阴中无阳。沉而不升。则孤阳在上。浮而
不降。无所根据从。故为呕咳上气喘也。按前章。列本节义于手太阴肺病条下。此则言于肾经。正以肺主气。肾
主精。精虚则气不归元。即无所根据从之义。简按此原于吴注。而更详焉。
色色 马高云。二字衍文。吴改作邑邑。云。愁苦不堪貌。张云。当作邑邑。不安貌。秋气至。微霜
下。万物俱衰。阴阳未定。故内无所主。而坐起不常。目则KT KT 无所见。以阴肃阳衰。精气内夺。故应深
秋十月之候。简按邑邑。与悒悒通。史记商君传云。安能邑邑。待数十百年。悒。说文。不安也。张注本此。
志载高说云。色色。犹种种也。色色不能犹言种种不能自如也。此解不通。今从张注。
阴阳内夺 志云。秋气始至。则阳气始下。而未盛于内。阴气正出。而阴气内虚。则阴阳之气。夺于内矣。
煎厥 吴云。阳气不治者。阳气不舒也。肝气当治。而未得者。木性不得条达也。肝志怒。故善怒。
煎厥者。怒志煎熬厥逆也。张云。按煎厥一证。在本篇。言阳虚阴盛。在生气通天论。言阴虚阳盛。可见煎厥
有阴阳二证。简按此与少阴。不相干涉。乃属少阳厥阴之病。则为可疑。诸家不言及于此者。何。高独以少阴
君火之阳气不治而释之。此乃运气家之言。竟不免牵强焉。张以阳气不治。为阳虚。不可从。
阳气入 吴云。阳邪入薄于肾。故善恐。张云。阴气将藏未藏。而阳邪入之。阴阳相薄。则伤肾而
为恐。马云。宣明五气篇曰精气并于肾。则为恐也。
胃无气故恶闻食臭也 张云。胃无气。胃气败也。胃气
所以败者。肾为胃关。肾中真火不足。不能温养化原。故胃气虚。而恶闻食臭也。此即经脉篇。饥不欲食之义。
故变于色也 张云。色以应日。阳气之华也。阴胜于阳。则面黑色变。故应秋气。此即经脉篇。面如
漆柴之义。高云。地色。地苍之色。如漆柴也。因秋时肃杀之气。内夺其精华。故至冬。则变于色而黑如地色也。
咳则有血者阳脉伤也 高云。经脉篇云。肾病咳唾则有血。故申明所谓咳则有血者。乃阴血乘于阳位。
阳脉不归于阴。故曰阳脉伤也。阴血乘阳。脉不归阴。则阳脉满。十月之时。阳气未盛于上。未当盛时而脉满。
则阳气内逆。故满则咳。咳则有血。而且见于鼻也。张云。阳脉伤者。上焦之脉伤也。盖肾脉。上贯肝膈。入
肺中。故咳则血见于口。衄则血见于鼻也。
疝 高云。犹 疝也。言高肿也。经脉篇云。厥阴病。丈夫 疝。妇人少腹肿。简按王氏资生经
云。千金曰。气冲主 。明堂下经曰。治 疝。则是 。即 疝也。巢源云。 者。阴核气结肿大也。详见于
阴阳别论颓疝注。
厥阴者辰也 张云。辰。季春也。五阳一阴。阴气将尽。故属厥阴。阴邪居于阳末。则为 疝少腹
肿。故应三月之气。
三月一振 吴云。振。物性鼓动也。张云。阳气振也。高云。经脉篇云。厥阴病。腰痛不可以俯仰。
故申明所谓腰脊痛。不可以俯仰者。三月之时。振动发生。草木向荣而华秀。故三月一振荣华。生机虽盛。犹
未畅达。故万物一皆俯而不仰也。
一俯而不仰也 马云。凡俯者不可以仰。仰者不可以俯。故肝应其时。腰痛之病。俯仰似难也。
所谓 癃疝肤胀 高云。出处未详。大抵皆厥阴之病。
。 疝也。癃。溺闭也。 癃疝肤胀者。阴器肿。不得小便。则肤胀也。简按灵水胀篇云。肤胀者。寒气客
于皮肤之间。 然不坚。腹大身尽肿。皮浓。按其腹。 而不起。腹皮不变。此其候也。
曰阴亦盛 曰。吴本作由。张云。此复明癃疝肿胀之由。在阴邪盛也。阴盛则阳气不行。故为此诸证。
张兆璜云。曰所谓。曰者者。是设为之问辞。下文是答辞。故增一曰字以别之。简按上文。并无增一曰字者。
特于末节而有之。可疑。吴本似是。而吴云。阴亦盛者。言阳固盛。而阴亦盛也。此注恐非。亦字。承上文
疝及腰脊痛而下之。盖与平人气象论。一呼脉再动。一吸脉亦再动之亦同义。
嗌干 马云。阴阳相薄。而在内为热中。在上为嗌干也。高云。经脉篇云。足厥阴病。甚则嗌干。手
厥阴病。心中热。
马云说：按此篇论述疾病，大体上源于《灵枢·经脉》篇。各经发病，篇中所谓“所谓者”，正是引用古已有之的语句，而今加以阐述。高世栻说：
六气主时，始于厥阴，终于太阳。此处列举三阳三阴经脉的病证，则太阳主春，正月是春季之首，太阳为阳气之首；少阳主秋，九月是秋季之终，少阳为阳气之终；阳明主夏，五月是夏季之中，阳明居阳气之中。三阴经脉，外合三阳，雌雄相应。太阴合阳明，故主十一月，十一月是冬季之中；少阴合太阳，故主十月，十月是冬季之首；厥阴合少阳，故主三月，三月是春季之终。太阴为阴中之至阴，故又主十二月，十二月是阴中之至阴。错举六经的病证，又以三阳三阴主管四时的月份，错综复杂地解释它，这就是所谓的“脉解”。
腰尻肿痛（腰部和臀部肿胀疼痛）。熊氏注音为“谁”（shuí），张介宾认为音同“疽”（jū）。马云、吴崑注音为“疽”。张介宾说：尻即臀部。高世栻本将“肿”字单独成句，云：《素问·六元正纪大论》说：“太阳终之气，则病腰尻痛。”所以太阳经脉的病，有从腰部肿胀到臀部疼痛的情况。简按：“尻”字从肉，音“谁”，其音读作“疽”是错误的，那是“睢鸠”的“睢”字，从“且”旁。马云、吴崑误了。“尻”，《说文解字》解释为尾骨/臀部。汉代东方朔传中有“连尻”一词，注解说即臀部。大概因为“尻”从肉部，所以王冰注释为臀肉。这四个字（指前文提到的症状描述），与《厥论》中的“肿首头重”、《著至教论》中的“干嗌喉塞”，用字法完全相同。高世栻的注解不正确。
正月，太阳对应寅月。《志》书说：太阳为诸阳之主气，生于膀胱水中，所以以太阳之气作为岁首。（杨慎在《丹铅录》中说：考证纬书，称三皇三世，伏羲建寅历，神农建丑历，黄帝建子历，到大禹建寅历，效法伏羲；商朝建丑历，效法神农；周朝建子历，效法黄帝。这就是所说的“正朔三而改”。简按：这里说正月太阳对应寅月，明显是黄帝建寅历，而不是建子历。纬书的话，难以采信。杨氏喜好研读《内经》，为何不讨论这一点呢？）
病见偏侧虚弱导致跛行。高世栻本在“病”字上有“所谓”二字，云：旧本中“所谓”二字是误传出来的，下面改正。偏虚，就像偏枯（半身不遂）。《素问·大奇论》说：“肾雍则髀肿，跛易偏枯。”所以申述所谓“病偏虚为跛者”的意思。
东风解冻地气而出。东字，宋本作“冻”，马云、吴崑、高世栻、张介宾均同。解字属下句。吴崑删去“而”字，云：冻解，即解冻。高世栻说：地冻开始解冻，地气从下向上出。张介宾说：正月东风解冻。简按：如果“东”作“冻”，那么“而”字不妥当。大概是说阳气自东方来，解除地气的冻结，而上出。
所谓偏虚者。“所谓”二字，从高世栻之说删去，是对的。
盛上而跃，所以耳鸣。高世栻说：《灵枢·经筋》篇说：“手太阳之筋，其病应耳中鸣。”所以申述所谓耳鸣，是因为阳气像万物一样，盛大向上跳跃，跳跃则振动，所以耳鸣。
狂癫疾。张介宾说：巅，通癫。按《灵枢·经脉》篇，足太阳经脉条下，写作“癫”。大概古代通用。所谓“甚者”，是说阳邪盛。阳邪实于阳经，则阳气尽在上部，阴气在下部，上实下虚，所以应当发生狂癫的疾病。
脉浮导致耳聋。高世栻说：《灵枢·经脉》篇说：“手太阳之脉，入耳中，所生病者，耳聋。”所以申述所谓“浮为聋”，是逆气上浮，而导致耳聋，都在气方面。简按马云说：脉浮则聋，不对。
所以声音嘶哑不能言。张介宾说：声音由气发出，气属阳。阳盛则声音洪亮，阳虚则声音微弱。如果阳盛之后衰退，所以声音嘶哑不能说话。
内夺。吴崑说：内，指房劳。夺，耗损其阴精。
喑痱（失音兼肢体废用）。张介宾说：俳，音排，没有取义，是错误。应当作“痱”，《正韵》音沸，意为废。内夺，是夺其精气。精夺则气夺而厥逆，所以在上面声音嘶哑，在下面身体废用，元阳大亏，病本在肾。肾脉上挟舌根，下走足心，所以发生这种病。高世栻说：俳，通痱，音肥。喑痱，是指口不能言，而四肢不收引。所以说这是肾虚。简按楼氏《纲目》引用本节及王冰注，俳作痱。张介宾的注解，大概源于此。《灵枢·热病》篇说：“痱之为病也，身无痛者，四肢不收，志乱不甚，其言微知，可治；甚则不能言，不可治也。”楼氏《纲目》说：痱，就是废。痱，就是偏枯中邪气深重的情况。痱与偏枯，是两种病，因为它们半身无气营运，所以名叫偏枯；因为它们手足废用不收引，或者名叫痱，或者偏废，或者全废，都叫痱。汉代贾谊传中说：“辟者一面病，痱者一方病。”师古注解说：辟，足病；痱，风病。（原本出于《说文解字》）。由此看来，痱，就是张仲景《中风》篇中所说的邪入于脏，舌头僵硬难言的情况。大概痱是病名，偏风是病因，偏枯是病证，必定没有区别。吴崑说：俳，指阳事废用，不对。《圣济总录》有喑痱门，记载治疗舌喑不能言，足废不能用的方剂，如地黄饮子等，都在第五十一卷。
少阴脉不至，就是厥逆。张介宾说：这是解释上文内夺而厥的意义。少阴，就是肾脉。与太阳互为表里。如果肾气内夺，则少阴脉不至。少阴脉不至，是因为阴虚无气，无气则阳衰，导致厥逆的原因。简按：王冰注解说太阴之气逆上而行，值得怀疑。
心之所表。马云说：胆之脉行于胁肋，而心之脉出于腋下，为心的表部，所以有心胁痛。张介宾说：少阳属木，木能生火，所以邪气盛的，其本在胆，其表在心。表，就是标。简按：张介宾的注解仍沿袭王冰的意思，现在采纳他的说法。
九月阳气尽。高世栻说：如果在九月的时候，阳气已尽，而阴气正盛，少阳火气不盛，不能为心的表卫，所以有心胁痛的病。
阴气藏物。张介宾说：阴邪凝滞，藏伏于阳中，喜静恶动，所以翻身侧卧则痛。高世栻说：《灵枢·经脉》篇说：“足少阳病，不能转侧。”所以申述所谓“不可反侧”，是因为九月阴气正盛，阴气所以能藏物。物被藏则不动，所以少阳经脉有病，表现为不可翻身侧卧。
草木全部凋落而下坠。出自《文选》潘岳《寡妇赋》：“木落叶而陨枝。”李善注解说：毛苌《诗传》说：“陨，坠也。”《千金方》中，蒲黄汤主治小儿落床堕地受伤。
气盛而阳气向下生长。吴崑说：气盛，指气盛于阴。之，往也。下，指下体。阳之下，谓阳气往下，如少阳之脉，出于膝外侧，行于两足，就是这样。长，生长也。阳为动物，生长于两足，所以使人跳跃。
相薄。张介宾说：薄，指气相迫近。吴崑说：薄，摩擦激荡。
水火相恶。高世栻说：厥，属阴属水，乃是水火相恶。又木能生火，所以听到木音，就惊恐不安。简按：本节所解释的，与《阳明脉解》篇意义不同。
所谓客于孙脉等等。高世栻说：出处不详。大体都是阳明的病。孙脉，即孙络脉。
其孙络归于太阴。高世栻说：阳明之脉，不从下行，而并聚于上。并聚于上，则其孙络之脉，合于脾之大络，而为太阴。阳明并聚于上，所以头痛、鼻流清涕。孙络归于太阴，所以腹部肿胀。简按：这一句很难讲通，所以吴崑改为“其头之孙络，腹之太阴”十字。张介宾认为太阴，是指阴邪之盛，不是指阴经。都是主观臆断。高世栻的注解稍好，暂且采纳。
上行至心而为嗳气。马云说：《素问·宣明五气论》说：“心为嗳。”又《灵枢·口问》篇说：“寒气客于胃，厥逆从下上散，复出于胃，故为嗳。”既然《素问》言心，而《灵枢》言胃，那么此篇兼言阴气走于胃，胃气走于心，显示这三经相互依存，而产生嗳气。（三经，指心、脾、胃。）
所以呕吐。张介宾说：脾胃互为表里，胃受纳水谷，脾不能运化，则食物充满而溢出，所以呕吐。
得大便和排气后。熊氏注音：得后，指得到大便。气，指快气。马云说：后者，指厕所。气者，肛门失气（放屁）。张介宾同。云：阳气出，则阴邪散，所以感觉轻松如同病减。一阳初动，是冬至的候象，所以应合十一月的气。简按：吴崑说：气，指嗳气，错误。
阳气皆伤。吴崑说：伤者，压抑而不扬的意思。高世栻说：承接秋天的肃杀之气。
呕吐、咳嗽、上气喘急。张介宾说：阳根于阴，阴根于阳，互相倚靠。如果阴中没有阳，沉潜而不升，则孤阳在上，浮越而不降，无所依托，所以发生呕吐、咳嗽、上气喘急。按前一章，将此节意义列在手太阴肺病条下，这里则言于肾经，正是因为肺主气，肾主精，精虚则气不归元，就是无所依托的意思。简按：这源于吴崑的注解，而更加详细。
色色（形容愁苦不安的样子）。马云、高世栻说：这两个字是衍文。吴崑改为“邑邑”，云：愁苦不堪的样子。张介宾说：当作“邑邑”，不安的样子。秋气至，微霜落下，万物俱衰，阴阳未定，所以内心无所主，而坐起无常。眼睛视物模糊不清，因为阴肃杀而阳衰，精气内夺，所以应合深秋十月的候象。简按：“邑邑”，与“悒悒”通。《史记·商君传》说：“安能邑邑，待数十百年？”悒，《说文解字》：不安也。张介宾的注解基于此。《志》书记录高世栻的说法：“色色”，犹种种也。“色色不能”犹言“种种不能自如”。这种解释不通，现在采纳张介宾的注解。
阴阳内夺。《志》书说：秋气始至，则阳气始下，而未盛于内。阴气正出，而阴气内虚，则阴阳之气，在内被夺。
煎厥。吴崑说：阳气不治，指阳气不舒展。肝气当治而未得，指木性不得条达。肝志怒，所以容易发怒。煎厥，指怒志煎熬导致厥逆。张介宾说：按煎厥一证，在本篇，言阳虚阴盛；在《生气通天论》，言阴虚阳盛。可见煎厥有阴阳两种证型。简按：这与少阴无关，属于少阳厥阴的病，这就可疑了。各家都不提及于此，为什么？只有高世栻以少阴君火的阳气不舒来解释，这是运气学家的言论，终究不免牵强。张介宾以阳气不治为阳虚，不可从。
阳气入。吴崑说：阳邪入，迫于肾，所以容易恐惧。张介宾说：阴气将藏未藏，而阳邪入之，阴阳相搏，则伤肾而为恐。马云说：《素问·宣明五气》篇说：“精气并于肾，则为恐。”
胃无气，所以厌恶闻食物的气味。张介宾说：胃无气，指胃气败坏。胃气所以败坏，是因为肾为胃之关，肾中真火不足，不能温养化源，所以胃气虚，而厌恶闻食物的气味。这就是《灵枢·经脉》篇中“饥不欲食”的意义。
所以面色改变。张介宾说：面色应合日光，是阳气的荣华。阴胜于阳，则面色变黑，所以应合秋气。这就是《灵枢·经脉》篇中“面如漆柴”的意义。高世栻说：地色，地苍之色，如漆柴。因秋时肃杀之气，内夺其精华，所以到了冬天，则面色改变而黑如地色。
咳嗽则有血，是阳脉受伤。高世栻说：《灵枢·经脉》篇说：“肾病咳唾则有血。”所以申述所谓“咳则有血”，是阴血乘于阳位，阳脉不归于阴，所以叫阳脉伤。阴血乘阳，脉不归阴，则阳脉满。十月之时，阳气未盛于上，在未当盛时而脉满，则阳气内逆，所以满则咳，咳则有血，而且见于鼻。张介宾说：阳脉伤者，指上焦之脉伤。大概肾脉，上贯肝膈，入肺中，所以咳则血见于口，衄血则血见于鼻。
疝。高世栻说：犹大疝也，言高肿。《灵枢·经脉》篇说：“厥阴病，丈夫疝，妇人少腹肿。”简按：王氏《资生经》说：《千金方》说：气冲穴主治疝。《明堂下经》说：治疝。则是，即疝。巢元方《诸病源候论》说：疝，指阴核气结肿大。详见于《素问·阴阳别论》颓疝注。
厥阴对应辰月。张介宾说：辰，指季春。五阳一阴，阴气将尽，所以属厥阴。阴邪居于阳末，则为疝、少腹肿，所以应合三月的气。
三月一振。吴崑说：振，指物性鼓动。张介宾说：阳气振作。高世栻说：《灵枢·经脉》篇说：“厥阴病，腰痛不可以俯仰。”所以申述所谓“腰脊痛，不可以俯仰”，是在三月之时，振动发生，草木向荣而开花秀色，所以三月一振荣华。生机虽盛，犹未畅达，所以万物都俯而不仰。
一俯而不仰。马云说：凡是俯的不能仰，仰的不能俯，所以肝应其时，腰痛之病，俯仰似乎都困难。
所谓癃疝肤胀。高世栻说：出处不详。大体都是厥阴的病。疝，是大疝。癃，是小便闭塞。癃疝肤胀，指阴器肿，不得小便，则皮肤肿胀。简按：《灵枢·水胀》篇说：“肤胀者，寒气客于皮肤之间，窅然不坚，腹大身尽肿，皮厚，按其腹，窅而不起，腹皮不变。”这是它的征候。
曰阴亦盛。曰字，吴崑本作“由”。张介宾说：这是再次阐明癃疝肿胀的原因，在于阴邪盛。阴盛则阳气不行，所以发生这些证候。张兆璜说：“曰所谓”，“曰”字是设为问辞，下文是答辞，所以增一“曰”字以区别。简按：上文并没有增一“曰”字的地方，特别在末节才有，可疑。吴崑本似乎是正确的，但吴崑说：“阴亦盛”，指阳固盛，而阴亦盛。这个注解恐怕不对。“亦”字，承上文“疝”及“腰脊痛”而下之，大概与《素问·平人气象论》中“一呼脉再动，一吸脉亦再动”的“亦”字同义。
咽干。马云说：阴阳相搏，而在内为热中，在上为咽干。高世栻说：《灵枢·经脉》篇说：“足厥阴病，甚则嗌干。手厥阴病，心中热。”
Ma Yun stated: According to this chapter's discussion on diseases, it largely originates from the *Ling Shu: Jing Mai* (Meridian) chapter. Regarding diseases of various meridians, the phrase "so-called" in the text refers to quoting ancient sayings and elaborating upon them now. Gao Shishi stated:
The Six Qi govern the seasons, starting with Jue Yin and ending with Tai Yang. Here, the diseases of the Three Yang and Three Yin meridians are listed. Tai Yang governs Spring; the first month is the beginning of Spring, and Tai Yang is the head of Yang. Shao Yang governs Autumn; the ninth month is the end of Autumn, and Shao Yang is the end of Yang. Yang Ming governs Summer; the fifth month is the middle of Summer, and Yang Ming resides in the middle of Yang. The Three Yin meridians correspond externally to the Three Yang, matching in yin and yang polarity. Tai Yin combines with Yang Ming, thus governing the eleventh month; the eleventh month is the middle of Winter. Shao Yin combines with Tai Yang, thus governing the tenth month; the tenth month is the beginning of Winter. Jue Yin combines with Shao Yang, thus governing the third month; the third month is the end of Spring. Tai Yin is the extreme Yin within Yin, thus also governing the twelfth month; the twelfth month is the extreme Yin within Yin. By alternately citing the diseases of the Six Meridians and assigning the months of the four seasons to the Three Yang and Three Yin, they are explained in a complex manner; this is what is meant by "Mai Jie" (Explanation of Pulse).
Swelling and pain in the lower back and buttocks (Yao Kao Zhong Tong). Xiong pronounced it as "shui", Zhang Binglin considered it homophonous with "ju". Ma Yun and Wu Kun pronounced it as "ju". Zhang Binglin said: "Kao" refers to the buttocks. In Gao Shishi's edition, "Zhong" (swelling) is treated as a separate sentence, stating: The *Su Wen: Liu Yuan Zheng Ji Da Lun* says, "At the final phase of Tai Yang, diseases of Yao Kao pain occur." Therefore, diseases of the Tai Yang meridian include swelling from the waist to pain in the buttocks. Briefly noted: The character "Kao" consists of the flesh radical and is pronounced "shui"; pronouncing it as "ju" is incorrect, which belongs to the character "Sui" (from the bird name "Sui Jiu") with the "Qie" radical. Ma Yun and Wu Kun were mistaken. "Kao", according to the *Shuo Wen Jie Zi*, refers to the coccyx/buttocks. In the Han Dynasty biography of Dongfang Shuo, there is a mention of "Lian Kao", annotated as buttocks. Since "Kao" has the flesh radical, Wang Bing interpreted it as buttock flesh. These four characters follow the same character usage patterns as "Swollen head and heavy head" in the *Jue Lun* and "Dry throat and blocked larynx" in the *Zhi Zhi Jiao Lun*. Gao Shishi's annotation is incorrect.
In the first month, Tai Yang corresponds to the Yin branch. The *Zhi* book states: Tai Yang is the master Qi of all Yang meridians, born from the water of the Bladder, hence Tai Yang Qi is regarded as the beginning of the year. (Yang Shen in *Dan Qian Lu* stated: Examining apocryphal texts, it is said that among the Three Sovereigns and Three Kings, Fu Xi established the Yin calendar, Shennong established the Chou calendar, Huangdi established the Zi calendar, and Yu returned to the Yin calendar, following Fu Xi; Shang followed Chou, following Shennong; Zhou followed Zi, following Huangdi. This is called 'changing the calendar three times'. Briefly noted: Here it says Tai Yang corresponds to Yin in the first month, clearly indicating Huangdi established the Yin calendar, not Zi. Apocryphal texts are unreliable. Why did Mr. Yang, who loved reading the *Nei Jing*, not discuss this?)
Disease presenting as unilateral deficiency leading to limping. Gao Shishi's edition had the words "so-called" above "disease", stating: In old editions, "so-called" was erroneously transmitted; corrected below. "Pian Xu" (unilateral deficiency) is similar to "Pian Ku" (hemiplegia). The *Su Wen: Da Qi Lun* says, "Kidney congestion causes thigh swelling, limping, and hemiplegia." Thus, it explains the meaning of "disease of unilateral deficiency resulting in limping".
East wind thaws, allowing Earth Qi to emerge. The character "Dong" (East) is written as "Dong" (Freeze/Ice) in Song editions; Ma Yun, Wu Kun, Gao Shishi, and Zhang Binglin agree. The word "Jie" (thaw/unbind) belongs to the next sentence. Wu Kun deleted the character "Er" (and), stating: "Dong Jie" means thawing ice. Gao Shishi said: When ground ice begins to thaw, Earth Qi emerges from below upwards. Zhang Binglin said: In the first month, east wind thaws the ice. Briefly noted: If "Dong" is read as "freeze", then "Er" is inappropriate. It likely means Yang Qi comes from the East, thaws the freezing of Earth Qi, and emerges upwards.
Regarding "unilateral deficiency". Deleting the words "so-called" follows Gao Shishi and is correct.
Excess rising and leaping causes tinnitus. Gao Shishi said: The *Ling Shu: Jing Jin* chapter states, "Diseases of the Hand Tai Yang tendon manifest as ringing in the ears." Thus, it explains that the so-called tinnitus is due to Yang Qi, like all things, becoming excessive, rising, and leaping; leaping causes vibration, hence tinnitus.
Manic and epileptic disorders. Zhang Binglin said: "Dian" is interchangeable with "Dian" (epilepsy). In the *Ling Shu: Jing Mai* chapter, under the Foot Tai Yang meridian section, it is written as "Dian". They were generally used interchangeently in ancient times. "So-called severe cases" refers to an excess of Yang pathogenic factors. When Yang pathogens fill the Yang meridians, Yang Qi accumulates entirely in the upper body while Yin Qi remains below, creating upper excess and lower deficiency, thus leading to manic or epileptic diseases.
Pulse floating leads to deafness. Gao Shishi said: The *Ling Shu: Jing Mai* chapter states, "The Hand Tai Yang pulse enters the ear; diseases produced include deafness." Thus, it explains that "floating pulse causing deafness" results from rebellious Qi floating upward, affecting the Qi aspect. Briefly noted: Ma Yun stated that "pulse floating causes deafness" is incorrect.
Therefore, aphonia (loss of voice). Zhang Binglin said: Voice is emitted by Qi; Qi belongs to Yang. Excess Yang produces loud voice; deficient Yang produces faint voice. If Yang excess declines, aphonia and inability to speak result.
Internal depletion. Wu Kun said: "Nei" refers to sexual exhaustion. "Duo" means consuming Yin essence.
Aphonia and Fei (limp paralysis). Zhang Binglin said: "Pai" is pronounced "pai" and has no specific meaning, being an error. It should be written as "Fei", pronounced "fei" in the *Zheng Yun*, meaning waste/disuse. Internal depletion depletes essence. Essence depletion leads to Qi depletion and reversal, causing aphonia above and bodily disuse below. Primordial Yang is severely deficient, with the root disease in the Kidney. The Kidney meridian ascends alongside the tongue root and descends to the sole of the foot, causing such diseases. Gao Shishi said: "Pai" is interchangeable with "Fei", pronounced "fei". Aphonia and Fei refer to inability to speak and limbs failing to move. Thus, it is said to be Kidney deficiency. Briefly noted: Lou Shi's *Gang Mu* cites this section and Wang Bing's commentary, writing "Fei" instead of "Pai". Zhang Binglin's note likely derives from this. The *Ling Shu: Re Bing* chapter states: "In Fei disease, the body has no pain, limbs do not move, mind is confused but not severely, speech is faint but understandable, treatable; if severe, unable to speak, untreatable." Lou Shi's *Gang Mu* says: Fei means waste. Fei is the deeper stage of pathogenic factors in Pian Ku. Fei and Pian Ku are two conditions; because one half of the body lacks Qi circulation, it is named Pian Ku; because hands and feet are wasted and immobile, it is named Fei, whether partial or total waste, all called Fei. The Han Dynasty Jia Yi Biography states: "Pi affects one side, Fei affects one side." Shigu annotated: Pi is a foot disease; Fei is a wind disease (originally from *Shuo Wen*). From this, Fei corresponds to Zhang Zhongjing's description in the *Wind Stroke* chapter of pathogenic factors entering the zang organs, causing tongue stiffness and difficulty speaking. Fei is the disease name, Pian Feng is the cause, Pian Ku is the symptom; they are undoubtedly the same. Wu Kun said: Pai refers to impotence, which is incorrect. The *Sheng Ji Zong Lu* has a section on Aphonia and Fei, recording treatments for tongue aphonia and foot disuse due to Kidney deficiency, such as Dihuang Yinzi, found in Volume 51.
When the Shao Yin pulse does not reach, it is Jue (reversal cold). Zhang Binglin said: This explains the meaning of internal depletion leading to Jue. Shao Yin is the Kidney meridian, exterior-interior paired with Tai Yang. If Kidney Qi is internally depleted, the Shao Yin pulse does not reach. Shao Yin pulse not reaching is due to Yin deficiency lacking Qi; lacking Qi leads to Yang decline, causing Jue. Briefly noted: Wang Bing's commentary that Tai Yin Qi rebels upward is questionable.
The exterior of the Heart. Ma Yun said: The Gallbladder meridian runs along the hypochondrium, while the Heart meridian emerges from the axilla, serving as the exterior of the Heart, hence heart-hypochondriac pain. Zhang Binglin said: Shao Yang belongs to Wood; Wood generates Fire. Thus, where pathogens are excessive, the root is in the Gallbladder, and the exterior is in the Heart. Exterior refers to the manifestation/superficial level. Briefly noted: Zhang Binglin's note follows Wang Bing's meaning; adopted here.
Yang Qi ends in the ninth month. Gao Shishi said: If in the ninth month, Yang Qi is exhausted and Yin Qi is flourishing, Shao Yang Fire Qi is not strong enough to serve as the exterior of the Heart, leading to heart-hypochondriac pain.
Yin Qi stores things. Zhang Binglin said: Yin pathogens are stagnant and hidden within Yang, preferring stillness over movement, hence turning sideways causes pain. Gao Shishi said: The *Ling Shu: Jing Mai* chapter states, "Diseases of the Foot Shao Yang involve inability to turn sideways." Thus, it explains "inability to turn sideways" occurs because in the ninth month Yin Qi is flourishing; Yin Qi stores things. Things stored do not move, hence Shao Yang meridian disease manifests as inability to turn sideways.
Grass and trees fall completely. From Pan Yue's *Widow's Ode* in *Wen Xuan*: "Trees drop leaves and branches fall." Li Shan's annotation cites Mao Chang's *Shi Zhuan*: "Yun means fall." The *Qian Jin Fang* records Puhuang Tang treating injuries from falling off beds.
Qi is abundant, and Yang Qi grows downward. Wu Kun said: "Qi sheng" means Qi is abundant relative to Yin. "Zhi" means going. "Xia" means lower body. "Yang xia" refers to Yang Qi moving downward, such as the Shao Yang meridian emerging from the lateral knee and running along both legs. "Zhang" means growth. Yang is active, growing in the legs, causing jumping.
Mutual pressure. Zhang Binglin said: Bo means Qi pressing against each other. Wu Kun said: Bo means rubbing and agitating.
Water and Fire hate each other. Gao Shishi said: Jue is Yin and Water, representing Water and Fire hating each other. Wood generates Fire, so hearing Wood sounds causes sudden fear. Briefly noted: The explanation in this section differs from the *Yang Ming Mai Jie* chapter.
Regarding pathogens lodging in Sun meridians, etc. Gao Shishi said: Origin unknown. Generally these are Yang Ming diseases. Sun meridians refer to Sun collateral vessels.
Its Sun collaterals connect to Tai Yin. Gao Shishi said: The Yang Ming meridian does not descend but merges upward. Merging upward means its Sun collateral vessels combine with the large Luo vessel of the Spleen, becoming Tai Yin. Yang Ming merging upward causes headache and nasal discharge. Sun collaterals connecting to Tai Yin causes abdominal swelling. Briefly noted: This sentence is difficult to interpret. Wu Kun changed it to "Sun collaterals of the head, Tai Yin of the abdomen". Zhang Binglin believed Tai Yin referred to the excess of Yin pathogens, not the Yin meridian. Both are speculative. Gao Shishi's note is slightly better; tentatively adopted.
Ascending to the Heart causing belching. Ma Yun said: The *Su Wen: Xuan Ming Wu Qi Lun* states, "The Heart produces belching." The *Ling Shu: Kou Wen* chapter states, "Cold pathogens lodge in the Stomach, rebellious Qi rises from below and scatters, re-emerging from the Stomach, causing belching." Since *Su Wen* mentions the Heart and *Ling Shu* mentions the Stomach, this chapter implies Yin Qi travels to the Stomach, Stomach Qi travels to the Heart, showing the interdependence of these three meridians (Heart, Spleen, Stomach) in producing belching.
Therefore, vomiting. Zhang Binglin said: Spleen and Stomach are exterior-interior partners. The Stomach receives food and drink; if the Spleen cannot transport, food accumulates and overflows, causing vomiting.
After obtaining defecation and passing gas. Xiong annotated: "De Hou" means obtaining bowel movement. "Qi" means relieving gas. Ma Yun said: "Hou" refers to the toilet. "Qi" refers to anal flatulence. Zhang Binglin agreed. He stated: When Yang Qi exits, Yin pathogens disperse, feeling relieved as if the illness has subsided. The movement of One Yang is the sign of Winter Solstice, corresponding to the Qi of the eleventh month. Briefly noted: Wu Kun said "Qi" refers to eructation, which is incorrect.
All Yang Qi is injured. Wu Kun said: "Shang" means suppressed and not flourishing. Gao Shishi said: Following the austere and killing energy of Autumn.
Vomiting, coughing, upper body asthma/wheezing. Zhang Binglin said: Yang roots in Yin, Yin roots in Yang, relying on each other. If Yin lacks Yang, sinking without ascending, solitary Yang floats above without descending, having no foundation, causing vomiting, coughing, and upper body asthma. Previously, this section was listed under Hand Tai Lung disease; here it is discussed regarding the Kidney meridian because the Lung governs Qi and the Kidney governs Essence. Essence deficiency causes Qi to fail to return to its source, meaning having no foundation. Briefly noted: This derives from Wu Kun's note, expanded further.
Se Se (describing sorrowful anxiety). Ma Yun and Gao Shishi said: These two characters are superfluous. Wu Kun changed them to "Yi Yi", meaning unbearable sorrow. Zhang Binglin said: Should be "Yi Yi", meaning uneasy. When Autumn Qi arrives, light frost falls, all things decline, Yin and Yang are unsettled, so the interior lacks direction, sitting and rising irregularly. Eyes see blurrily ("Ku Ku") because Yin is austere and Yang is weak, essence and Qi are internally depleted, corresponding to the deep Autumn tenth month. Briefly noted: "Yi Yi" is interchangeable with "Yi Yi". *Records of the Grand Historian: Lord Shang* says, "How can one wait decades anxiously?" *Yi*, per *Shuo Wen*, means unrest. Zhang Binglin's note is based on this. The *Zhi* book records Gao Shishi's view: "Se Se" is like "Zhong Zhong". "Se Se bu neng" means "various things cannot be done freely". This explanation is illogical; Zhang Binglin's note is adopted.
Internal depletion of Yin and Yang. The *Zhi* book states: When Autumn Qi begins, Yang Qi starts to descend but is not yet abundant internally. Yin Qi emerges, but internal Yin is deficient, so Yin and Yang Qi are depleted internally.
Jian Jue (Frying Reversal). Wu Kun said: "Yang Qi zhi" means Yang Qi is not free-flowing. Liver Qi should be regulated but fails, meaning Wood nature cannot stretch and reach. Liver emotion is anger, hence prone to anger. Jian Jue refers to anger frying and causing reversal. Zhang Binglin said: Regarding Jian Jue, this chapter describes Yang deficiency and Yin excess, while *Sheng Qi Tong Tian Lun* describes Yin deficiency and Yang excess. Thus, Jian Jue has Yin and Yang syndromes. Briefly noted: This is unrelated to Shao Yin, belonging to Shao Yang and Jue Yin diseases, which is suspicious. Why do experts not mention this? Only Gao Shishi explains it via Shao Yin Minister Fire Yang Qi not being regulated, which is theory of Five Movements and Six Qi, ultimately forced. Zhang Binglin interpreting "Yang Qi zhi" as Yang deficiency is unacceptable.
Yang Qi enters. Wu Kun said: Yang pathogens enter and press on the Kidney, causing fear. Zhang Binglin said: Yin Qi is about to store but hasn't, and Yang pathogens enter. Yin and Yang clash, injuring the Kidney and causing fear. Ma Yun said: The *Su Wen: Xuan Ming Wu Qi* chapter states, "Essence Qi combining with the Kidney causes fear."
Stomach lacks Qi, hence aversion to the smell of food. Zhang Binglin said: Stomach lacking Qi means Stomach Qi is failing. Stomach Qi fails because the Kidney is the gate of the Stomach; insufficient true fire in the Kidney cannot warm and nourish the transformation source, causing Stomach Qi deficiency and aversion to food smells. This corresponds to the meaning in the *Ling Shu: Jing Mai* chapter of "hungry but not wanting to eat".
Therefore, complexion changes. Zhang Binglin said: Complexion reflects the sun, the brilliance of Yang Qi. Yin exceeding Yang causes black facial color change, corresponding to Autumn Qi. This corresponds to "face like lacquered charcoal" in the *Ling Shu: Jing Mai* chapter. Gao Shishi said: Earth color, dark earth color, like lacquered charcoal. Due to Autumn's austere Qi internally depleting essence, by Winter, the complexion changes to black like earth.
Coughing with blood indicates injury to Yang meridians. Gao Shishi said: The *Ling Shu: Jing Mai* chapter states, "Kidney disease coughing expectorates blood." Thus, it explains that "coughing with blood" is Yin blood mounting on Yang positions, Yang meridians not returning to Yin, hence called Yang meridian injury. Yin blood mounting on Yang, meridians not returning to Yin, causes Yang meridian fullness. In the tenth month, Yang Qi is not yet abundant above; when the pulse is full before the time of abundance, Yang Qi rebels internally, causing fullness, coughing, blood in sputum, and epistaxis. Zhang Binglin said: Injury to Yang meridians refers to injury to Upper Jiao meridians. The Kidney meridian passes through the liver and diaphragm into the lungs, so coughing brings blood from the mouth, and nosebleeds bring blood from the nose.
Han (hernia/swelling). Gao Shishi said: Similar to large hernia, referring to high swelling. The *Ling Shu: Jing Mai* chapter states, "Jue Yin disease, men suffer from hernia, women have lower abdominal swelling." Briefly noted: Wang Shi's *Zi Sheng Jing* cites *Qian Jin Fang*: Qichong point treats hernia. *Ming Tang Xia Jing* treats hernia. Thus, this is hernia. Chao Yuanfang's *Zhu Bing Yuan Hou Lun* states: Hernia refers to swelling of the testicles due to Qi knotting. See details in the annotation for Tui Han in *Su Wen: Yin Yang Bie Lun*.
Jue Yin corresponds to the Chen month. Zhang Binglin said: Chen refers to late Spring. Five Yangs and one Yin, Yin Qi is nearly exhausted, thus belonging to Jue Yin. Yin pathogens residing at the end of Yang cause hernia and lower abdominal swelling, corresponding to the Qi of the third month.
One vibration in the third month. Wu Kun said: Zhen means the nature of objects vibrating. Zhang Binglin said: Yang Qi vibrates. Gao Shishi said: The *Ling Shu: Jing Mai* chapter states, "Jue Yin disease, lower back pain preventing bending and stretching." Thus, it explains "lower back and spine pain, inability to bend or stretch" occurs because in the third month, vibration arises, grass and trees flourish and bloom. Hence, third month sees vibrant growth. Although life force is strong, it is not yet fully smooth, so all things bow down but do not look up.
Bowing down but not looking up. Ma Yun said: What bows cannot look up, what looks up cannot bow. Thus, when Liver corresponds to its season, lower back pain makes bending and stretching difficult.
So-called Long Han and Fu Zhang (distension). Gao Shishi said: Origin unknown. Generally these are Jue Yin diseases. Han is large hernia. Long is urinary retention. Long Han Fu Zhang refers to genital swelling, inability to urinate, leading to skin distension. Briefly noted: The *Ling Shu: Shui Zhang* chapter states: "Fu Zhang is caused by cold pathogens lodging between the skin, hollow and not firm, abdomen large, whole body swollen, skin thick, pressing the abdomen leaves an indentation that does not rise immediately, abdominal skin unchanged." This is its presentation.
It is said Yin is also abundant. The character "Yue" (said) is written as "You" (by) in Wu Kun's edition. Zhang Binglin said: This clarifies the cause of Long Han and swelling lies in Yin pathogen excess. Yin excess prevents Yang Qi from circulating, causing these symptoms. Zhang Zhaohuang said: "Yue suo wei" (It is said so-called), "Yue" sets up a question, and the following text is the answer, hence adding "Yue" to distinguish. Briefly noted: There is no added "Yue" earlier, only at the end, which is suspicious. Wu Kun's edition seems plausible, but Wu Kun's comment that "Yin also abundant" means Yang is solidly abundant and Yin is also abundant is likely incorrect. The character "Yi" (also) connects to the preceding "Han" and "lower back/spine pain", similar to the "Yi" in "One breath, pulse beats twice; one inhalation, pulse also beats twice" in the *Ping Ren Qi Xiang Lun*.
Dry throat. Ma Yun said: Yin and Yang clash; internally it becomes heat in the center, externally/above it causes dry throat. Gao Shishi said: The *Ling Shu: Jing Mai* chapter states, "Foot Jue Yin disease, severe cases cause dry throat. Hand Jue Yin disease, heat in the heart."