高云。调。调和也。逆调。逆其寒热水火荣卫之气。不调和也。寒热逆调。则为烦为痹。水火逆调。则
为肉烁。为挛节。荣卫逆调。则为肉苛。脏气逆调。则为息喘也。
痹气 圣济总录云。夫阳虚生外寒。阴盛生内寒。人身阴阳偏胜。则自生寒热。不必外伤于邪气也。
痹气内寒者。以气痹而血不能运。阳虚而阴自胜也。故血凝泣而脉不通。其证。身寒如从水中出也。方出于二
十卷中。吴云。痹气者。气不流畅。而痹着也。
如炙如火 吴云。如炙。自苦其热。如薰炙也。如火。人探其热。如探火也。简按当从太素之文。下文同。
两阳相得 马云。四肢属阳。风亦属阳。一逢风寒。两阳相得。张同。志云。四肢者。阳明之所主也。
两阳。阳明也。两阳合明。故曰阳明。相得者。自相得而为热也。简按马注为是。
不能生长 简按谷梁传云。独阴不生。独阳不长。正此之义也。
内烁 熊音。烁。书药反。
以水为事 志云。肾气胜者。肾水之气胜也。以水为事者。膀胱之水胜也。谓其人水寒之气偏胜。简
按马张仍王注。为纵欲之义。考文义恐不然。
肾脂枯不长 高云。是人有寒者。平素肾气胜。肾气胜。则以水为事。故太阳阳气衰。太阳阳气衰。
则为孤阴。孤阴不长。故肾脂枯不长。
一水不能胜两火 高云。七字在下。误重于此。衍文也。简按此前注所未发。今从此。
肾孤脏也 高云。寒甚至骨。宜冻栗矣。所以不能冻栗者。肾水生肝木。肝为阴中之阳。故肝一阳也。
少阴合心火。心为阳中之阳。故心二阳也。肾为阴中之阴。故肾孤脏也。一阳二阳。火也。孤脏。水也。今一水
不能胜二火。故虽寒甚至骨。而不能冻栗也。寒在于骨。病名曰骨痹。骨痹者。骨节拘挛。是人当挛节也。此
言水火逆调。而独阳不生。则为肉烁。孤阴不长。则为挛节也。简按诸家不知前文一水不能胜两火七字衍文。
以阳盛阴虚为解。故文理乖违。不能贯通。得高注而义始显。
苛 吴云。苛。胡歌切。麻木不仁也。张云。顽木沉重之谓。简按王注 重。考。 顽。同音。广韵。
。 痹。五还切。知是王氏以苛为顽麻之义。说文。苛。小草也。盖
麻痹者。病在皮上。尤细琐者。故取义于苛细。曲礼。疾痛苛痒。可以见耳。志云。苛。虐也。谓近衣絮。而
苛虐如故也。不可从。
营气虚卫气实也 马云。营气者。阴气也。运于内。为阳之守。故其气虚。卫气者。阳气也。运于外。
为阴之使。故其气实。太阴阳明论曰。阳道实。阴道虚。此即本节之义。张云。卫气实者。言肌肉本无恙也。简
按下文云。营气虚则不仁。卫气虚则不用。营卫俱虚。则不仁且不用。则此七字不相冒。恐是衍文。前注似牵强。
不仁且不用 张云。不仁。不知痛痒寒热也。不用。不能举动也。简按肉苛与不仁自有分。以肉苛而
顽麻。故不知痛痒而不仁。吴云。不仁。麻木顽痹也。误。马云。不仁者果核中有仁。惟肉无所知。则若有不能
如仁有生意矣。凿亦甚。
肉如故也 甲乙。作肉如苛也。马云。其肉未必有减于昔也。张云。肌肉如故。言肌肉本无恙也。
高云。肉苛如故也。简按答语无苛字。当从甲乙之文。
曰死 吴云。志不足以帅形气。人虽犹存。夭其生理矣。死其一肢一肉。是为死之徒也。张云。人之
身体在外。五志在内。虽肌肉如故。而神气失守。则外虽有形。而中已无主。若彼此不相有也。故当死。简按
吴以死为死肌之死。张注似允当。
不得卧不得行 滑云。多一不字。
下经 简按史记。仓公受脉书上下经于阳庆。盖此书也。
不安 张云。反复不宁之谓。今人有过于饱食。或病胀满者。卧必不安。此皆胃气不和之故。按上
文所问。不得卧而息无音者。义亦同。此故不复答。
息有音也 张云。病不在胃。亦不在脏。故起居如故。气逆于肺之络脉者。病浅而微。故但为息有
音耳。上文所问。有卧行而喘者。义亦类此。故不复答。
主卧与喘也 张云。水病者。其本在肾。其末在肺。故为不得卧。卧则喘者。标本俱病也。上文所问。
有不得卧。不能行。而喘者。义类此节。故不复答。本篇所论。喘息不得卧者。有肺胃肾三脏之异。在肺络者。
起居如故。而息有音也。病之微者也。在胃者。不得卧。而息有音也。甚于肺者也。在肾者。不得卧。卧则喘
也。又其甚者。夫息有音者。即喘之渐。喘出于肾。则病在根本矣。故愈深者。必愈甚。凡虚劳之喘。义亦犹
此。有不可不察也。简按首帝所问者六。而岐伯所答者三。王氏以为古之脱简。张则以为义自含蓄。本无阙文。
而吴则补凡三条。八十四字。志云。后人有言简脱者。有增补其文者。圣人立言。浑然 括。或言在意中。或
意在言表。奈何后学不细心体认。而妄增臆论耶。可谓知言矣。
高云：调，意为调和。逆调，指违背了寒、热、水、火、营、卫之气的正常调和状态。寒热之气逆乱失调，就会表现为烦躁和痹证；水火之气逆乱失调，就会导致肌肉消烁、关节拘挛；营气与卫气逆乱失调，就会导致肌肤麻木不仁（肉苛）；脏腑之气逆乱失调，就会导致呼吸喘促。
痹气：《圣济总录》说：阳气虚弱则产生外寒，阴气盛极则产生内寒。人体阴阳偏胜，自然会产生寒热，不一定非要受到外界邪气的侵袭。痹气导致的内寒，是因为气机闭塞而血液不能运行，阳气虚弱而阴气自盛。所以血液凝滞涩少而脉道不通。其症状是身体寒冷，就像刚从水中出来一样。此方出自第二十卷中。吴云：痹气，是指气机不流畅而阻滞不通。
如炙如火：吴云：如炙，是自己苦于热感，如同被熏烤一样；如火，是人去探试热感，如同探摸火焰一样。简按：应当遵从《太素》的文本，下文相同。
两阳相得：马云：四肢属阳，风邪也属阳。一旦遇到风寒，两阳相结合。张同志云：四肢，是阳明经所主。两阳，即阳明。两阳合明，所以称为阳明。相得，是指相互结合而产生热象。简按：马注是正确的。
不能生长：简按：《谷梁传》说：独阴不生，独阳不长。正是这个意思。
内烁：熊音：烁，读音为“书药反”。
以水为事：志云：肾气胜，是指肾水之气偏胜。以水为事，是指膀胱之水气偏胜。意思是此人水寒之气偏胜。简按：马、张仍沿用王冰注，解释为纵欲的意思。考证文义恐怕不是这样。
肾脂枯不长：高云：这个人有寒症，平素肾气偏胜。肾气偏胜，就导致以水为事（水寒偏胜）。所以太阳阳气衰微。太阳阳气衰微，就成为孤阴。孤阴不能生长，所以肾精枯竭而不能长养。
一水不能胜两火：高云：这七个字在下文，误重于此，是衍文。简按：此前注释未曾指出这一点，现在采纳此说。
肾孤脏也：高云：寒气甚至骨髓，应该冻得战栗。之所以不能冻得战栗，是因为肾水生肝木，肝为阴中之阳，所以肝有一个阳；少阴合心火，心为阳中之阳，所以心有两个阳。肾为阴中之阴，所以肾是孤脏。一个阳、两个阳，都是火；孤脏，是水。现在一点水不能胜过两团火，所以虽然寒气深入骨髓，却不能冻得战栗。寒在骨，病名叫做骨痹。骨痹，就是骨节拘挛。这个人应当有关节拘挛的症状。这里说的是水火逆乱失调，而独阳不生，就会导致肌肉消烁；孤阴不长，就会导致关节拘挛。简按：各家不知道前文“一水不能胜两火”这七个字是衍文，将其解释为阳盛阴虚，所以文理乖违，不能贯通。得到高的注解后，义理才显现出来。
苛：吴云：苛，读音为“胡歌切”，意为麻木不仁。张云：顽木沉重之意。简按：王注中的“重”，考据显示与“顽”同音，《广韵》中“痹”读作“五还切”。可知王氏是以苛为顽麻之义。《说文解字》：苛，是小草。大概麻痹是病在皮上，尤其细琐，所以取义于苛细。《曲礼》：“疾痛苛痒”，可以见到这一点。志云：苛，是虐害之意。谓靠近衣絮，而苛虐如故。不可从。
营气虚卫气实也：马云：营气，是阴气，运行于内，作为阳的守备，所以其气虚；卫气，是阳气，运行于外，作为阴的使者，所以其气实。《太阴阳明论》说：阳道实，阴道虚。这就是本节的含义。张云：卫气实，是说肌肉本来没有病变。简按：下文说：营气虚则不仁，卫气虚则不用，营卫俱虚，则不仁且不用。那么这七个字不相统摄，恐怕是衍文。前注似乎牵强。
不仁且不用：张云：不仁，不知痛痒寒热；不用，不能举动。简按：肉苛与不仁自有分别。因为肉苛而顽麻，所以不知痛痒而不仁。吴云：不仁，是麻木顽痹。错误。马云：不仁者，如果核中有仁，只有肉无所知，就好像不能像仁那样有生机一样。这也太穿凿了。
肉如故也：《甲乙经》作“肉如苛也”。马云：其肉未必比从前减少。张云：肌肉如故，是说肌肉本来没有病变。高云：肉苛如故也。简按：答语中没有“苛”字，应当遵从《甲乙经》的文本。
曰死：吴云：意志不足以统帅形气，人虽然还存在，但夭折了其生理机能。死，是指一部分肢体或肌肉死亡，这是死之徒。张云：人的身体在外，五志在内。虽然肌肉如故，但神气失守，则外虽有形，而中已无主，若彼此不相拥有。所以当死。简按：吴将死解释为死肌之死，张注似乎更恰当。
不得卧不得行：滑云：多了一个“不”字。
下经：简按：《史记》记载，仓公从阳庆那里接受了《脉书》上下经。大概就是这本书。
不安：张云：反复不宁之意。现在有人过于饱食，或者患有胀满病，睡觉一定不安稳。这都是胃气不和的缘故。按上文所问，不得卧而息无音者，意义也相同。所以不再回答。
息有音也：张云：病不在胃，也不在脏，所以起居如常。气逆于肺之络脉，病浅而轻微，所以只是呼吸有声音而已。上文所问，有卧行而喘者，意义也类似。所以不再回答。
主卧与喘也：张云：水病，其本在肾，其末在肺，所以导致不得卧。卧则喘者，是标本都病了。上文所问，有不得卧，不能行，而喘者，意义与此节类似。所以不再回答。本篇所论述的喘息不得卧，有肺、胃、肾三脏的不同。在肺络的，起居如常，而呼吸有声音，是病轻微的。在胃的，不得卧，而呼吸有声音，比肺病严重。在肾的，不得卧，卧则喘，又更严重。呼吸有声音，就是喘的开始。喘出于肾，则病在根本了。所以越深的病，必然越严重。凡是虚劳的喘，意义也大致如此。有不可不察的地方。简按：首先黄帝问了六个问题，而岐伯回答了三个。王冰认为是古书的脱简。张则认为意义含蓄，原本没有缺文。而吴则补上了凡三条，八十四字。志云：后人有说简牍脱落的，有增补其文的。圣人立言，浑然一体。有的意在意中，有的意在言表。为何后学不细心体认，而妄加臆测评论呢？可以说是知言了。
Gao Yun: "Tiao" (調) means harmonization. "Ni Tiao" (逆調) refers to the violation of the normal harmonious state of Cold, Heat, Water, Fire, Ying (Nutritive), and Wei (Defensive) Qi. When Cold and Heat Qi are disordered, it manifests as irritability and Bi syndrome (obstruction syndrome); when Water and Fire Qi are disordered, it leads to emaciation of flesh and joint contracture; when Ying and Wei Qi are disordered, it results in numbness and insensitivity of the skin and muscles (Rou Ke); when Zang-Fu Qi is disordered, it causes panting and wheezing.
Bi Qi (痹氣): The *Shengji Zonglu* states: Yang deficiency generates external cold, Yin excess generates internal cold. When human Yin and Yang are imbalanced, cold and heat arise spontaneously, without necessarily being caused by external pathogenic factors. Internal cold caused by Bi Qi occurs because Qi stagnation prevents blood circulation, leading to Yang deficiency and subsequent Yin excess. Consequently, blood becomes stagnant and sluggish, and the vessels become obstructed. The symptoms include a body feeling cold, as if emerging from water. This prescription appears in Volume 20. Wu comments: "Bi Qi" refers to Qi that is not flowing smoothly and is thus blocked.
Like roasting and like fire: Wu comments: "Like roasting" implies suffering from heat internally, as if being smoked or roasted; "like fire" implies seeking out heat, as if probing a fire. Jian An suggests following the text of the *Tai Su*. The same applies below.
Two Yangs combining: Ma Yun states: The four limbs belong to Yang, and wind also belongs to Yang. Upon encountering wind-cold, the two Yangs combine. Zhang Tongzhi says: The four limbs are governed by the Yangming channel. The "two Yangs" refer to Yangming. Two Yangs combined and brightened constitute Yangming. "Xiang De" means they interact to generate heat. Jian An considers Ma's annotation correct.
Unable to grow: Jian An cites the *Guliang Zhuan*: "Solitary Yin does not generate, solitary Yang does not nourish." This expresses the meaning here.
Internal scorching: Xiong phonetically notes: "Shuo" (爍) is pronounced with the fanqie spelling "shu-yao".
Engaged with water: Zhi Yun: Excess of Kidney Qi refers to the excess of Kidney Water Qi. Being "engaged with water" refers to the excess of Bladder Water Qi. It means the person has an excess of cold-water Qi. Jian An notes that Ma and Zhang follow Wang Bing's annotation, interpreting this as indulgence in sexual activity. However, examining the context, this interpretation seems unlikely.
Kidney essence dries up and fails to nourish: Gao Yun: This person suffers from cold. Normally, Kidney Qi is excessive. Due to excessive Kidney Qi, there is an engagement with water (excess cold-water). Thus, Taiyang Yang Qi declines. Decline of Taiyang Yang Qi leads to solitary Yin. Solitary Yin cannot grow/nourish, so Kidney essence dries up and fails to nourish.
One water cannot overcome two fires: Gao Yun: These seven characters appear later in the text and are erroneously repeated here; they are interpolations. Jian An notes that previous commentators had not pointed this out, and now adopts this view.
The Kidney is a solitary organ: Gao Yun: If cold penetrates to the bone, one should shiver from cold. The reason for not shivering is that Kidney Water generates Liver Wood. The Liver is Yang within Yin, so the Liver possesses one Yang. Shaoyin combines with Heart Fire; the Heart is Yang within Yang, so the Heart possesses two Yangs. The Kidney is Yin within Yin, so the Kidney is a solitary organ. One Yang and two Yangs represent Fire; the solitary organ represents Water. Now, one unit of water cannot overcome two units of fire. Therefore, even though cold reaches the bone, one does not shiver. Cold in the bone is named Bone Bi. Bone Bi involves joint contracture. This person will have joint contracture. This passage discusses the disorder of Water and Fire, where solitary Yang does not generate (leading to flesh emaciation) and solitary Yin does not grow (leading to joint contracture). Jian An states that various commentators failed to recognize that "one water cannot overcome two fires" was an interpolation, instead interpreting it as Yang excess and Yin deficiency, causing logical inconsistencies. Only with Gao's annotation does the meaning become clear.
Ke (苛): Wu comments: "Ke" is pronounced "hu-ge qie," meaning numbness and insensitivity. Zhang comments: It means stiff, wooden heaviness. Jian An examines Wang Bing's note on "heavy," noting phonetic similarities with "wan" (stiff/numb). The *Guangyun* dictionary pronounces "bi" as "wu-han qie." This indicates Wang Bing interpreted "Ke" as stiff numbness. The *Shuowen Jiezi* defines "Ke" as small grass. Numbness affects the skin, which is fine and minute, hence the metaphor of "Ke" (small/grass-like). The *Qu Li* mentions "pain, itching, and Ke," illustrating this concept. Zhi Yun interprets "Ke" as cruelty/harassment, suggesting that even near clothing, the sensation remains harsh. This interpretation is rejected.
Ying Qi is deficient, Wei Qi is excess: Ma Yun states: Ying Qi is Yin, circulating internally, guarding Yang, thus its Qi is deficient. Wei Qi is Yang, circulating externally, serving Yin, thus its Qi is excess. The *Tai Yang Yang Ming Lun* states: "The pathway of Yang is excess, the pathway of Yin is deficient." This aligns with this section. Zhang comments: "Wei Qi is excess" means the muscles themselves are healthy. Jian An notes that the text later states: "Ying deficiency leads to numbness, Wei deficiency leads to immobility, both deficient leads to numbness and immobility." Therefore, these seven characters do not govern the following text and are likely interpolations. Previous annotations seem forced.
Numbness and immobility: Zhang comments: "Numbness" means lack of sensation to pain, itch, cold, and heat; "immobility" means inability to move. Jian An distinguishes between Rou Ke and numbness. Rou Ke causes stiffness and numbness, leading to lack of sensation. Wu incorrectly defines numbness as stiff numbness. Ma Yun offers a pedantic explanation comparing it to the kernel of a nut, which is overly speculative.
Muscles remain as before: The *Jia Yi Jing* reads "muscles remain like Ke." Ma Yun: The flesh has not necessarily diminished compared to before. Zhang Yun: "Muscles remain as before" means the muscles were originally healthy. Gao Yun: "Rou Ke remains as before." Jian An notes the answer lacks the character "Ke," so the *Jia Yi Jing* reading should be followed.
Says death: Wu comments: Willpower cannot command form and Qi. Although the person exists, their physiological life is cut short. Death here refers to the death of a limb or muscle, marking a path to death. Zhang Yun: The body is external, the Five Wills are internal. Even if muscles are intact, loss of Shen (Spirit) means the interior has no master while the exterior retains form, creating a disconnect. Thus, death ensues. Jian An prefers Zhang's interpretation over Wu's focus on dead tissue.
Unable to lie down, unable to walk: Hua Yun: There is an extra "bu" (not).
Xia Jing: Jian An cites the *Records of the Grand Historian*, where Cang Gong received the *Mai Shu Shang Xia Jing* from Yang Qing. This is likely that book.
Unease: Zhang Yun: Refers to restlessness and agitation. People who overeat or suffer from distension often sleep uneasily due to Stomach Qi disharmony. Regarding the earlier question about inability to lie down without noisy breathing, the meaning is similar, so it is not answered again.
Breathing with sound: Zhang Yun: The disease is neither in the Stomach nor the Zang organs, so daily activities remain normal. Qi rebels in the collaterals of the Lung; the disease is superficial and mild, resulting only in noisy breathing. The earlier question about lying/walking with panting is similar, so it is not answered again.
Lying down and panting: Zhang Yun: Water diseases originate in the Kidney but manifest in the Lung, causing inability to lie down. Panting upon lying down indicates both root and branch are diseased. The earlier question regarding inability to lie down, walk, and pant is similar, so it is not answered again. This chapter discusses panting and inability to lie down involving the Lung, Stomach, and Kidney. In the Lung collaterals, daily life is normal but breathing is noisy (mild). In the Stomach, inability to lie down with noisy breathing is more severe. In the Kidney, inability to lie down and panting upon lying down is even more severe. Noisy breathing is the precursor to panting. Panting originating from the Kidney indicates disease at the root. Deeper diseases are more severe. Deficiency-type panting follows similar logic. This requires careful observation. Jian An notes Huangdi asked six questions, and Qibo answered three. Wang Bing attributed this to missing bamboo slips. Zhang argued the meaning is implicit and no text is missing. Wu added three passages totaling 84 characters. Zhi Yun commented that later scholars either lost slips or added text arbitrarily. The Sage's words are coherent; some meanings are implicit, others explicit. Later scholars should not speculate rashly. This is insightful commentary.