辞不可属事不可比森乎众也且汇萃钞
帝曰人年老而无子者材力尽耶（续材谓材 可以立身者）将天数然也（愚谓天癸之数也）岐伯曰女子七岁肾气盛齿
更发长（续老阳之数极于九少阳之数次于七女子为少阴之气故以少阳数隅之明阴阳气和乃能生成其形体故七岁肾气盛齿
更发长）二七而天癸至任脉通太冲脉盛月事以时下故有子（续癸北方水干名也任脉波脉皆奇经脉也肾气全盛冲任流通经
血流盈应时而下天真之气降与之从事故云天癸也然冲为血海任主胞胎二者相资能故有子谓月事者平和之气常以三旬而一
见也愆期谓之有病）三七肾气平均故真牙生而长极（续真牙谓牙之最后生者表牙齿为骨之余也）四七筋骨坚发长极身体
盛壮（续天癸七七而终年居四七材力之半故身体壮盛长极于斯）五七阳明脉衰面始憔发始堕（续手足阳明之脉气营于面
循发际至额颅故其衰也发堕而憔）六七三阳脉衰于上面皆憔发始白（续三阳之脉尽上于头故衰则面憔发白所以衰者妇人
有余于气不足于血以其经月数泄之故）七七任脉虚太冲脉衰少天癸竭地道不通故形坏而无子也（续经水绝止是为地道不
通冲任衰微故形坏无子丈夫八岁肾气实发长齿更（续老阴之数极于十少阴之数次于八男子为少阳之气故以少阴数合之易
曰天九地十是也）二八肾气盛天癸至精气溢泻阴阳和故能有子（续男子之质不同精血之形亦异阴静海满而去血阳动应合
而泄精二者通和故能有子易曰男女构精万物化生是也）三八肾气平均筋骨劲强故真牙生而长极四八筋骨隆盛肌肉满壮（续
丈夫天癸八八而终年居四八亦材力之半也）五八肾气衰发堕齿槁（续肾主于骨齿为骨余肾气既衰精无所养故发堕而齿干
枯）六八阳气衰竭于上面憔发鬓颁白（续阳气阳明之气也）七八肝气衰筋不能动天癸竭精少肾脏衰形体皆极八八则齿发
去（续肝气养筋肝衰故筋不能动肾气养骨肾衰故形体疲极天癸已竭故精少也阳气竭精气衰故齿发皆落矣非惟材力衰谢固
亦天数使然）肾者主水受五脏六腑之精而藏之故五脏盛乃能泻（续五脏六腑精气淫溢而渗灌于肾肾乃受而藏之此乃肾为
都会关司之所非肾一脏而独有精故曰五脏盛乃能泻也）今五脏皆衰筋骨解堕天癸尽矣故发鬓白身体重行步不正而无子尔
曰其有年已老而有子者何也（续言以非天癸之数也）曰此其天寿过度气脉常通而肾气有余也（续所禀天真之气本自有余
也）此虽有子男不过尽八八女不过尽七七而天地之精气皆竭矣（续老而生子子寿不能过天癸之数上古天真论）天食人以
五气地食人以五味（续天以五气食人者臊气凑肝焦气凑心香气凑脾腥气凑肺腐气凑肾也地以五味食人者酸味入肝苦味入
心甘味入脾辛味入肺咸味入肾也清阳化气而上为天浊阴成味而下为地故天食人以气地食人以味也经曰阳为气阴为味是
也）五气入鼻藏于心肺上使五色修明音声能彰五味入口藏于肠胃味有所藏以养五气气和而生津液相成神乃自生（续心荣
面色肺主音声故气藏于心肺上使五色修洁分朗音声彰着气为水母故味藏于肠胃内养五气五气和化津液方生津液与气相副
化成神气乃能生而宣化也六气藏象论）天气清静光明者也（愚谓天气清静故光明不竭人能清静则寿亦延长）藏德不止（止
一作上）故不下也（续四时成序七曜周行天不形言是藏德也德隐则应用不屈故不下也言天至尊高德犹见应况金生之道不
顺天乎）天明则日月不明邪害空窍（续大明见则小明灭故大明之德不可不藏天若自明则日月之明隐矣喻人当清静法道以
保天真苟离于道则虚邪入于空窍）阳气者闭塞地气者冒明（续阳谓天气亦风热也地气谓湿亦云雾也风热害人则九窍闭塞
雾湿为病则掩医清明取类者在天则日月不光在人则两目藏曜也）云雾不精则上应白露不下（续雾者云之类露者雨之类夫
阳盛则地不上应阴虚则天不下交故云雾不化精微之气上应于天而为白露不下之咎矣经曰地气上为云天气下为雨明二气交
合乃成雨露又曰至阴虚天气绝至阳盛地气不足明气不相召亦不能交合也）交通不表万物命故不施则名木多死（续表谓表
陈其状易曰天地 万物化醇然不表交通则为否也名谓名果珍木夫云雾不化其精微雨露不沾于原泽是为天气不降地气不
腾变化之道既亏生育之原斯泯故万物之命无禀而生然其死者则名木先应）恶气不发风雨不节白露不下则死槁不荣（续恶
谓害气也发谓发散节谓节度死谓蕴积槁谓枯槁言常气伏藏而不散风雨无度折伤复多槁物蕴积春不荣也岂惟其物独遇是而
有之人离于道亦有之矣故下文云）贼风数至豪雨数起天地四时不相保与道相失则未央绝灭（续不顺四时之和数犯八风之
害与道相失则天真之气未期失远而致灭亡央久也远也）唯圣人从之故身无奇病万物不失生气不竭（王注圣人法天地藏德
恬淡虚无精神内守病安从来又云从犹顺也谓顺四时之令也然四时之令不可逆之逆之则五脏内伤而他疾起矣）苍天之气清
净（续春为苍天发生之主）则志意治顺之则阳气固虽有贼邪弗能害也（亦以天道喻诸人也）此因时之序（以因天四时之
气序故贼邪之气不能害也）故圣人传精神服天气而通神明（流通精神不耗不治王注久服天真之气则妙用自通于神明也）
失之则内闭九窍外壅肌肉卫气散解（续失谓逆苍天清净之壅也卫气者合天之阳气也所以温分肉而充皮肤肥腠理而司开阖
故失其度则内闭九窍外壅肌肉以卫不宫运攸言散解也）此谓自伤气之削也（续夫逆苍天之气违清静之理使正真之气如削
去者非天降之人自为之尔）阳气者若天与日失其所则折寿而不彰（续此明阳前气之用也喻人之有阳若天之有日天失其所
则日不明人失其所则阳不固日则明则天暗阳不固则人夭）故天运当以日光明（喻人之生固其藉其阳气○愚谓天之营运不
息以藏隐其气而日月得以光明也生气通天论）阴气者静则神藏躁则消亡（续阴谓五神脏也言人安静不涉邪气则祥气宁而
内藏人即动冒邪气则神被害而离散藏无所守故曰消亡）饮食自倍肠胃乃伤（续脏以躁动致伤腑以食饮气损皆谓过用越旺
则受其邪也）岐伯曰根于中者命曰神机神去则机息根于外者命曰气立气止则化绝（诸有形之类根于中者生源击天其
所动浮皆神气为机发之主故其所为也物莫之知是机神舍去则机发动用之道息矣根于外若生源击地故其生长化虚收藏皆为
造化之气所应立故其所出也物亦莫知之是以气止息则生化结成之道绝灭矣其木火土金水燥湿液肾柔弱常易性不及乎外物
去生气离根化绝止则其常体性颜色皆必小变移其旧也六微旨论云出入废则神机化灭升降息则气立孤无故非出入则无以生
长壮老非升降则无以生长化收藏五常正大论）帝曰何谓三部岐伯曰有下部有中部有上部部各有三候候者有天有地有人也
必指而导之（必因师指引教导）乃以为真上部天两额之动脉（续在额两旁动应于手足少阳脉气所行）上部地两颊之动脉
（在鼻孔两旁近千巨 之分动应于手足阳明脉气所行）上部人耳前之动脉（在耳前陷者中动应于手手少阳脉气所行）中
部天手太阴也（肺脉也在掌后寸口中是谓经渠动应于手）中部地手阳明也（大胜脉也合谷之分动应于手）中部人手少阴
也（心脉也在掌后充骨之端神门之分动应于手灵枢经曰少阴无俞心不病乎曰其外经病而脏不病故独取其经中掌后锐骨之
端正谓此也）下部天足厥阴也（肝脉也在毛际外羊大下一寸半陷中五里之分卧而取之动应于手女子取太冲在足大趾本节
后二寸陷中是）下部地足少阴也（肾脉也在足内踝后跟骨上陷中太溪之内动应手）下部人足太阴也（脾脉也在鱼腹上越
筋间直上五里下门之分宽巩足单衣沉取乃得之动应于手○候胃气者当取足跗上冲阳之分动脉应手）故下部之天以候肝地
以候肾人以候脾胃之气（脾与胃以膜相连故兼候胃也）曰中部之候奈何曰亦有天亦有地亦有人天以候肺地以候胸中之气
（手阳明脉当其处经云肠胃同候故以候胸中也）人以候心曰上部以何候之曰亦有天亦有地亦有人天以候头角之气地以候
口齿之气人以候耳目之气（以位当耳前脉底于目外 故以候之）三部者各有天各有地各有人三而成天三而成地三而成人
三而三之合则为九九分为九野（谓邑外为郊郊外为甸甸外为牧牧外为林林外为HT HT 外为野言其远也详六节藏象论
云）九野为九脏（续以是故应天地之至数）故神藏五形藏四（续魂魄心意神皆五脏是也故曰神藏谓其形藏者皆如器外张
虚而不屈合藏于物故云形藏也愚谓徒有其器而无所藏此与宣明五脏篇生气通天论六节藏象论注重）合为九脏五脏已败其
色必夭夭必死矣（续夭谓死色异常之候也色者神之旗脏者神之舍故神去则脏败脏败则色则异常之候死也）曰泱死生奈何
曰形盛脉细少气不足以息者危（续形气相得谓之可治今脉细少气是为气弱体壮盛有余是谓形盛症不相扶故当危也危近死
犹有生者）形瘦脉大胸中多气者死（续此形气不足脉气有余故死凡此者形气不相得也）形气相得者生参伍不调者病（续
参谓参较伍谓类伍参较谓伍而有不调谓不率其常故病）三部九候皆相失者死（续失谓气候不相类也相失之候诊凡有七见
下文）上下左右之脉相应如参舂者病甚上下左右相失不可数者死（续上下左右三部九候凡十八诊也如参舂者谓大数而鼓
如参舂杵之上下也不可数者谓一息十至以上也）中部之候虽独调与众脏相失者死中部之候相减者死（续上部下部已不相
应中部独调亦知不久若减于上下亦是气衰故皆死也减谓偏小也）目内陷者死（续太阳脉起目内 目内陷太阳绝独言太阳
以其主诸阳之气）岐伯曰九候之相应也上下若一（续言迟速小大等也）不得相失一候后则病二候后则病甚三候后则病危
所谓后者应不俱也（俱犹同也一也）察其腑脏以知死生之期（续夫病入腑则愈入脏则死故死生期准察以知之）必先知经
脉然后知病脉（续经脉四时五脏之脉）帝曰何以病知之所在岐伯曰察九候独小者病独大者病独疾者病独迟者病独热者病
独寒者病独陷下者病（相失之候诊凡有七者此也然脉见七诊谓参伍不调随其独异以言其病）肉脱身不去者死（续谷气外
衰则肉如脱尽天真肉竭故身不能行）中部乍疏乍数者死（续气之散乱也）形肉已脱九候虽调犹死（续亦谓形气不相得也
证前肉脱身不去者九候虽平调亦死）帝曰冬阴夏阳奈何岐伯曰九候之脉（此九候以脉言寸关尺三部各有浮中沉三部合之
而为九也）皆沉细悬绝者为阴主冬故以夜半死盛疾喘数者为阳主夏故以日中死（续位无常居物极则反乾坤之文阴极则龙
战于野阳极则亢龙有亢是以阴阳极脉死于夜半日中也）是故寒热病者以平旦死（续亦物极则变也平旦木王木气为风故木
王之时寒热病死经曰因于露风乃生寒热故知寒热乃风薄所为也）热中即热病者以日中死（续阳之极也）病风者以日夕死
（续卯酉冲也愚谓寒热病者木气实也故木之王时死此病风者木气虚也酉则金王木虚金胜故病于酉也）病水者以夜半死（水
王故也）其脉乍疏乍数乍迟乍疾者日乘四季死（脾气内绝故日乘四季死）七认虽见九候皆从者不死（续若九候顺四时之
令虽七诊互见亦生）所言不死者风气之病及经月之病似七诊之病而非也故言不死（续风病之脉诊大而数经月之病脉小以
微虽候与七诊之状略同而死生之症乃异故不死也）若有七诊之病其脉候亦败者死者（续七诊虽见九候若从者不死若病同
七诊之状而脉应败乱纵九候皆顺犹不得生也）必发哕噫（续心为噫胃为哕胃精内竭神不守心故死之时发斯哕噫）必审问
其所以始病与今之所方病（续方正也当原始以要终）而后各切循其脉视其经络浮沉以上下逆从循之其脉疾者不病（脉经
盛故）脉迟者病（气不足故）脉不往来者死（精神去也）皮肤着者死（骨干枯也三部九候论）帝曰余知百病生于气也（续
气之为用虚实逆顺缓急皆能为病故问之）怒则气上喜则气缓悲则气消恐则气下寒则气收炅则气泄惊则气乱劳则气耗思则
气结九气不同何病之生岐伯曰怒则气逆甚则呕血及飧泄故气上矣（续怒则阳气逆上肝气乘脾故甚则呕血及飧泄何以明之
怒则面赤甚则色苍经曰盛怒不止则伤志明怒则气逆上而不下也）喜则志和气达营卫通利故气缓矣悲则心系急肺布叶举而
上焦不通营卫不散热气在中故气消矣（续悲则损于心心系急则动肺肺气击诸经逆故肺布而叶举）恐则精却却则上焦闭闭
则气还还则上焦胀故气不行矣（续恐则阳精却上而不下上故却则上焦闭也上焦既闭气不行流下焦阴气亦还回不散而聚为
胀也上焦固禁下焦气还各守一处故气不行也矣）寒则腠理闭气不行故气收矣（续腠谓津液渗泄之所理谓文理逢会之中闭
谓密闭气谓卫气行谓流行收谓收敛也身寒则卫气沉故皮肤文理及渗泄之处皆闭密而气不通行卫气收敛于中而不发散也）
炅则腠理开营卫通汗大泄故气泄矣（续人在阳则舒在阴则渗故热则肤腠开发营卫大通津液外渗而汗大泄）惊则心无所倚
言辞不可随意附会，事物不可强行类比，它们之间有着森严的界限。
黄帝说：人到了年老却没有生育能力，是因为精力耗尽了呢？还是因为天命如此呢？（续注：所谓“材”，指可以立身处世的能力；所谓“天数”，指天癸的定数。）
岐伯回答说：女子七岁时，肾气旺盛，牙齿更换，头发生长。（续注：老阳之数极于九，少阳之数次于七。女子属少阴之气，故以少阳之数对应之。这说明阴阳二气和合，才能生成形体，所以七岁时肾气盛，牙齿更换，头发生长。）十四岁时，天癸到来，任脉通畅，太冲脉旺盛，月经按时来潮，因此能够生育。（续注：“癸”是北方水的天干名。任脉、冲脉都是奇经八脉。此时肾气全盛，冲任二脉流通，经血充盈，应时而下，天真之气下降与之相随，所以叫“天癸”。然而冲为血海，任主胞胎，二者相互资助，所以能生育。所谓“月事”，是指平和之气常以三十天左右出现一次。如果过期不来，就叫做有病。）二十一岁时，肾气平均，智齿长出，身体发育达到极限。（续注：“真牙”指最后长出的牙齿，牙齿是骨之余。）二十八岁时，筋骨坚固，头发长到极点，身体最为强壮。（续注：天癸在七七四十九岁终结，此时处于四七二十八岁，精力只有一半，但身体壮盛，发育极限在此时达到。）三十五岁时，阳明脉开始衰退，面部开始憔悴，头发开始脱落。（续注：手足阳明经脉的气血滋养面部，循行发际至额颅，所以衰退时头发脱落且面容憔悴。）四十二岁时，三阳脉在面部衰退，面部憔悴，头发开始变白。（续注：三阳之脉都上行至头部，所以衰退时面部憔悴、头发变白。之所以衰退，是因为妇人相对于气而言有余，相对于血而言不足，因为月经定期失血所致。）四十九岁时，任脉虚衰，太冲脉气血减少，天癸枯竭，地道不通（指月经停止），所以形体衰老而不能生育了。（续注：经水绝止，这就是地道不通。冲任二脉衰微，所以形体坏败不能生育。）
男子八岁时，肾气充实，头发生长，牙齿更换。（续注：老阴之数极于十，少阴之数次于八。男子属少阳之气，故以少阴之数相合。《易经》说：天九地十，就是这个意思。）十六岁时，肾气旺盛，天癸到来，精气满溢而泄出，阴阳和合，所以能够生育。（续注：男子的体质不同，精与血的形态也有差异。阴静如海满则去血，阳动应合则泄精，二者通和所以能生育。《易经》说：男女构精，万物化生，就是这个意思。）二十四岁时，肾气平均，筋骨强劲有力，智齿长出，身体发育达到极限。三十二岁时，筋骨隆盛，肌肉丰满壮实。（续注：男子天癸在八八六十四岁终结，此时处于四八三十二岁，也是精力的一半。）四十岁时，肾气衰退，头发脱落，牙齿干枯。（续注：肾主骨，牙齿是骨之余。肾气既已衰退，精无所养，所以头发脱落且牙齿干枯。）四十八岁时，阳气衰竭于上面，面部憔悴，鬓角头发斑白。（续注：这里的阳气指阳明之气。）五十六岁时，肝气衰退，筋脉不能灵活运动，天癸枯竭，精液减少，肾脏衰退，形体极度疲乏。（续注：肝气养筋，肝衰故筋不能动；肾气养骨，肾衰故形体疲极。天癸已竭，所以精少。阳气竭，精气衰，所以牙齿头发都脱落了。这不仅是精力衰退，也是天命使然。）
肾，主管水液，接受五脏六腑的精气并储藏它，所以五脏精气旺盛，肾才能排泄。（续注：五脏六腑的精气淫溢而渗灌于肾，肾才接受并储藏它。这是因为肾是汇聚之地，是关司所在，并非只有肾这一脏独有精气，所以说“五脏盛乃能泻”。）现在五脏都衰退了，筋骨松弛懈怠，天癸耗尽了，所以鬓角头发变白，身体沉重，行走不稳，而且不能生育了。
黄帝问：那些年纪已经老了却还有生育能力的人，是怎么回事呢？（续注：言其不符合天癸的常规定数。）岐伯说：这是因为他们天赋寿命超过常人，气脉经常通畅，而且肾气有余。（续注：所禀受的天真之气本来就有盈余。）这样的人虽然能生育，但男子不超过八八六十四岁，女子不超过七七四十九岁，因为天地之精气都已经枯竭了。（出自《上古天真论》）
天用五气养育人，地用五味养育人。（续注：天以五气食人，臊气凑肝，焦气凑心，香气凑脾，腥气凑肺，腐气凑肾。地以五味食人，酸味入肝，苦味入心，甘味入脾，辛味入肺，咸味入肾。清阳化为气而上成为天，浊阴成味而下成为地，所以天以气食人，地以味食人。《内经》说：阳为气，阴为味，就是这个意思。）五气从鼻吸入，藏于心肺，向上使面色光泽明亮，声音洪亮清晰。五味入口，藏于肠胃，味道有所储藏，以滋养五气，五气和调而生津液，津液与气相成，神气自然产生。（续注：心荣润面色，肺主声音，所以气藏于心肺，向上使五色修洁明朗，音声彰着。气为水之母，所以味藏于肠胃，内养五气。五气和化生津液，方生津液与气相副，化成神气，才能生而宣化。出自《六节藏象论》）
天的天气是清静光明的。（愚按：天气清静所以光明不竭，人能清静，寿命也能延长。）它隐藏德行而不显露，所以不会坠落。（“止”一作“上”。续注：四季形成秩序，七星周行，天不形言，这是隐藏德行。德行隐晦则应用不屈，所以不会坠落。言天至尊高德，尚且见应，何况人之道不顺从天吗？）如果天自显其明，那么日月就不明亮了，邪气就会侵害空窍。（续注：大明显现则小明熄灭，所以大明的德行不可不隐藏。天若自明，则日月之明隐没。比喻人应当清静法道以保天真，如果离开道，则虚邪进入空窍。）
阳气闭塞，地气冒昧不明。（续注：阳指天气，也是风热；地气指湿，也是云雾。风热害人则九窍闭塞，雾湿为病则掩蔽清明。取类比象，在天则是日月无光，在人则是两目昏暗。）云雾如果不精微，则天上应降的白露就不会下来。（续注：雾是云的一类，露是雨的一类。阳盛则地气不上应，阴虚则天气不下交，所以云雾不化，精微之气上应于天，导致白露不下的咎责。《内经》说：地气上为云，天气下为雨，说明二气交合乃成雨露。又说：至阴虚天气绝，至阳盛地气不足，说明气不相召也不能交合。）
天地交通如果不表现，万物的生命就无法施予，那么高大的树木也会多死。（续注：“表”谓表陈其状。《易经》说：天地...万物化醇。如果不表交通则为否卦。名谓名果珍木。如果云雾不化，其精微雨露不沾原泽，这是天气不降、地气不腾，变化之道既亏，生育之源泯灭，所以万物的生命没有禀受而生。至于死亡的，则是高大的树木先应验。）恶气不散发，风雨不调节，白露不下降，则草木枯槁不荣。（续注：“恶”谓害气，“发”谓发散，“节”谓节度，“死”谓蕴积，“槁”谓枯槁。言常气伏藏而不散，风雨无度折伤复多，枯物蕴积，春天不荣。岂止是物体独自遇到这样，人离开道也会有这种情况，所以下文说。）
贼风频繁到来，暴雨频繁兴起，天地四时不相保全，与道相失，则生命未及中途就灭绝了。（续注：不顺四时之和，屡次犯八风之害。与道相失，则天真之气未期失远而致灭亡。“央”意为久，“远”意为远。）
只有圣人顺从它，所以身体没有怪病，万物不失生气，精气不竭。（王冰注：圣人法天地藏德，恬淡虚无，精神内守，病安从来。又说：从犹顺也，谓顺四时之令。然而四时之令不可逆，逆之则五脏内伤而他疾起矣。）
苍天的之气清净。（续注：春为苍天，是发生之主。）如果志意治理顺从它，则阳气固密，虽然有贼邪也不能伤害。（这也是以天道喻诸人。）这是顺应时间的次序。（因为顺应天四时之气序，所以贼邪之气不能伤害。）所以圣人传守精神，服纳天气，而通达神明。（流通精神不耗损。王冰注：久服天真之气，则妙用自通于神明。）
如果违背它，则内部闭塞九窍，外部壅滞肌肉，卫气散解。（续注：失谓逆苍天清净之壅。卫气者，合天之阳气也，所以温分肉而充皮肤，肥腠理而司开阖。所以失其度，则内闭九窍，外壅肌肉，因为卫气不运行，所以说散解。）这叫自我伤害，正气削弱。（续注：夫逆苍天之气，违清静之理，使正真之气如削去者，非天降之人自为之尔。）
阳气就像天和日一样，失去其所则折寿而不显。（续注：此明阳气之用。喻人之有阳若天之有日。天失其所则日不明，人失其所则阳不固。日则明则天暗，阳不固则人夭。）所以天的运转应当依靠日的光明。（喻人之生固其藉其阳气。○愚按：天之营运不息，以藏隐其气而日月得以光明也。出自《生气通天论》）
阴气安静则神气内藏，躁动则神气消亡。（续注：阴谓五神脏。言人安静不涉邪气则祥气宁而内藏，人即动冒邪气则神被害而离散，藏无所守，故曰消亡。）
饮食过量一倍，肠胃就会受伤。（续注：脏因躁动致伤，腑因食饮气损，皆谓过用越旺则受其邪也。）
岐伯说：根于体内的，名叫神机，神去则机息；根于体外的，名叫气立，气止则化绝。（诸有形之类，根于中者，生源击天，其所动浮皆神气为机发之主，故其所为也，物莫之知，是机神舍去则机发动用之道息矣。根于外若生源击地，故其生长化虚收藏皆为造化之气所应立，故其所出也，物亦莫知之。是以气止息则生化结成之道绝灭矣。其木火土金水燥湿液肾柔弱常易性不及乎外物去生气离根化绝止则其常体性颜色皆必小变移其旧也。《六微旨论》云：出入废则神机化灭，升降息则气立孤危。故非出入则无以生长壮老，非升降则无以生长化收藏。出自《五常政大论》）
黄帝问：什么叫三部？岐伯说：有下部、中部、上部，部各有三候，候者有天、地、人也。必须用手指引导诊察，（必须因师指引教导）才能认为是真确的。
上部天：两额旁的动脉。（续注：在额两旁，动应于手足少阳脉气所行。）
上部地：两颊旁的动脉。（在鼻孔两旁近巨髎之分，动应于手足阳明脉气所行。）
上部人：耳前的动脉。（在耳前陷者中，动应于手手少阳脉气所行。）
中部天：手太阴脉。（肺脉，在掌后寸口中，是谓经渠，动应于手。）
中部地：手阳明脉。（大肠脉，合谷之分，动应于手。）
中部人：手少阴脉。（心脉，在掌后锐骨之端神门之分，动应于手。《灵枢经》曰：少阴无俞，心不病乎？曰：其外经病而脏不病，故独取其经中掌后锐骨之端正，谓此也。）
下部天：足厥阴脉。（肝脉，在毛际外羊矢下一寸半陷中，五里之分，卧而取之，动应于手。女子取太冲，在足大趾本节后二寸陷中，是。）
下部地：足少阴脉。（肾脉，在足内踝后跟骨上陷中，太溪之内，动应手。）
下部人：足太阴脉。（脾脉，在鱼腹上越筋间直上五里下门之分，宽巩足单衣沉取乃得之，动应于手。○候胃气者当取足跗上冲阳之分，动脉应手。）
所以下部之天用以候肝，地用以候肾，人用以候脾胃之气（脾与胃以膜相连，故兼候胃也）。
问：中部的候法如何？答：也有天、地、人。天用以候肺，地用以候胸中之气（手阳明脉当其处，《经》云：肠胃同候，故以候胸中也）。人用以候心。
问：上部用什么候？答：也有天、地、人。天用以候头角之气，地用以候口齿之气，人用以候耳目之气（以位当耳前脉底于目外眦，故以候之）。
三部者，各有天、地、人。三而成天，三而成地，三而成人。三而三之，合则为九，九分为九野（谓邑外为郊，郊外为甸，甸外为牧，牧外为林，林外为... ... 外为野，言其远也。详《六节藏象论》云）。
九野为九脏。（续注：以是故应天地之至数。）
所以神藏有五，形藏有四。（续注：魂魄心意神皆五脏是也，故曰神藏。谓其形藏者，皆如器外张虚而不屈，合藏于物，故云形藏也。愚按：徒有其器而无所藏，此与《宣明五脏篇》、《生气通天论》、《六节藏象论》注重。）合为九脏。
五脏精气败坏，其面色必定夭折，面色夭折必定死亡。（续注：夭谓死色异常之候也。色者神之旗，脏者神之舍，故神去则脏败，脏败则色则异常之候死也。）
问：怎样判断死生？答：形体盛壮但脉细弱，少气不足以呼吸的，危险。（续注：形气相得谓之可治。今脉细少气，是为气弱体壮盛有余，是谓形盛症不相扶，故当危也。危近死，犹有生者。）
形体消瘦但脉大，胸中多气的，死。（续注：此形气不足，脉气有余，故死。凡此者形气不相得也。）
形气相得的，生；参伍不调的，病。（续注：参谓参较，伍谓类伍。参较谓伍而有不调，谓不率其常，故病。）
三部九候皆相失的，死。（续注：失谓气候不相类也。相失之候诊凡有七见，下文。）
上下左右之脉相应如舂米般的，病重；上下左右相失，无法计数的，死。（续注：上下左右三部九候凡十八诊也。如参舂者，谓大数而鼓，如参舂杵之上下也。不可数者，谓一息十至以上也。）
中部的脉虽单独调和，但与众脏相失的，死；中部的脉减弱的，死。（续注：上部下部已不应，中部独调，亦知不久。若减于上下，亦是气衰，故皆死也。减谓偏小也。）
眼睛内陷的，死。（续注：太阳脉起目内眦，目内陷，太阳绝。独言太阳，以其主诸阳之气。）
岐伯说：九候的相应，上下若一，不得相失。一候落后则病，二候落后则病甚，三候落后则病危。所谓后者，是应候不俱（俱犹同也，一也）。
察其脏腑，以知道死生的期限。（续注：夫病入腑则愈，入脏则死，故死生期准察以知之。）必须先知道经脉，然后才知道病脉。（续注：经脉四时五脏之脉。）
黄帝问：怎么知道病在哪里？岐伯说：察九候，独小者病，独大者病，独疾者病，独迟者病，独热者病，独寒者病，独陷下者病。（相失之候诊凡有七者，此也。然脉见七诊，谓参伍不调，随其独异以言其病。）
肌肉脱尽，身体不能移动的，死。（续注：谷气外衰则肉如脱尽，天真肉竭，故身不能行。）
中部的脉乍疏乍数的，死。（续注：气之散乱也。）
形肉已脱，九候虽调，犹死。（续注：亦谓形气不相得也。证前肉脱身不去者，九候虽平调亦死。）
黄帝问：冬季阴脉，夏季阳脉，是怎么回事？岐伯说：九候之脉，皆沉细悬绝的为阴，主冬，所以以夜半死；盛疾喘数的为阳，主夏，所以以日中死。（续注：位无常居，物极则反。乾坤之文，阴极则龙战于野，阳极则亢龙有悔，是以阴阳极脉死于夜半日中也。）
所以寒热病者在平旦死。（续注：亦物极则变也。平旦木王，木气为风，故木王之时寒热病死。《经》曰：因于露风，乃生寒热，故知寒热乃风薄所为也。）
热中即热病者，以日中死。（续注：阳之极也。）
病风者，以日夕死。（续注：卯酉冲也。愚按：寒热病者木气实也，故木之王时死。此病风者木气虚也，酉则金王，木虚金胜，故病于酉也。）
病水者，以夜半死。（水王故也。）
其脉乍疏乍数、乍迟乍疾的，日乘四季死。（脾气内绝，故日乘四季死。）
七诊虽见，九候皆顺的，不死。（续注：若九候顺四时之令，虽七诊互见，亦生。）
所言不死的，风气之病及经月之病，似七诊之病而非也，故言不死。（续注：风病之脉诊大而数，经月之病脉小以微，虽候与七诊之状略同，而死生之症乃异，故不死也。）
如果有七诊之病，其脉候亦败的，死。（续注：七诊虽见，九候若从者不死。若病同七诊之状而脉应败乱，纵九候皆顺，犹不得生也。）
必定发作哕逆和噫气。（续注：心为噫，胃为哕。胃精内竭，神不守心，故死之时发斯哕噫。）
必须审问其起初生病的原因和现在正在发生的病症。（续注：方正也，当原始以要终。）
然后分别切循其脉，视其经络浮沉，以上下逆从。循之其脉疾者不病（脉经盛故），脉迟者病（气不足故），脉不往来者死（精神去也），皮肤着骨者死（骨干枯也。出自《三部九候论》）。
黄帝说：我知道百病生于气。（续注：气之为用，虚实逆顺缓急皆能为病，故问之。）怒则气上，喜则气缓，悲则气消，恐则气下，寒则气收，炅则气泄，惊则气乱，劳则气耗，思则气结。九气不同，何病之生？
岐伯说：怒则气逆，甚则呕血及飧泄，故气上矣。（续注：怒则阳气逆上，肝气乘脾，故甚则呕血及飧泄。何以明之？怒则面赤，甚则色苍。《经》曰：盛怒不止则伤志明，怒则气逆上而不下也。）
喜则志和气达，营卫通利，故气缓矣。
悲则心系急，肺布叶举，而上焦不通，营卫不散热气在中，故气消矣。（续注：悲则损于心，心系急则动肺，肺气击诸经逆，故肺布而叶举。）
恐则精却，却则上焦闭，闭则气还，还则上焦胀，故气不行矣。（续注：恐则阳精却上而不下，上故却则上焦闭也。上焦既闭，气不行，流下焦阴气亦还回不散而聚为胀也。上焦固禁，下焦气还，各守一处，故气不行也矣。）
寒则腠理闭，气不行，故气收矣。（续注：腠谓津液渗泄之所，理谓文理逢会之中。闭谓密闭，气谓卫气，行谓流行，收谓收敛也。身寒则卫气沉，故皮肤文理及渗泄之处皆闭密而气不通行，卫气收敛于中而不发散也。）
炅则腠理开，营卫通，汗大泄，故气泄矣。（续注：人在阳则舒，在阴则渗，故热则肤腠开发，营卫大通，津液外渗而汗大泄。）
惊则心无所倚...
Words cannot be arbitrarily attached to matters, and things cannot be forcibly compared; there is a strict distinction among them.
The Yellow Emperor asked: When a person grows old and loses the ability to reproduce, is it because their vital energy (Jing-Qi) has been exhausted, or is it due to the natural decree of Heaven? (Supplementary note: "Cai" refers to the capacity to establish oneself in life; "Tian Shu" refers to the fixed cycle of Tian Gui.)
Biqi replied: At the age of seven, a girl's Kidney Qi becomes abundant, her teeth change, and her hair grows. (Supplementary note: The number of Old Yang reaches its limit at nine, while Young Yang follows at seven. Girls belong to the Shaoyin Qi, so they correspond to the number of Young Yang. This demonstrates that when Yin and Yang Qi harmonize, the physical form is generated. Thus, at seven, with abundant Kidney Qi, teeth change and hair grows.) At fourteen, Tian Gui arrives, the Ren Mai (Conception Vessel) becomes unobstructed, and the Chong Mai (Penetrating Vessel) becomes abundant. Menstruation occurs regularly, enabling reproduction. (Supplementary note: "Gui" is the Heavenly Stem associated with Water in the North. The Ren and Chong vessels are part of the Eight Extraordinary Vessels. At this stage, Kidney Qi is fully mature, allowing the flow of Chong and Ren vessels, filling the menstrual blood which descends on schedule. The innate true Qi descends with it, hence called "Tian Gui." The Chong vessel is the Sea of Blood, and the Ren vessel governs the uterus; their mutual support enables reproduction. "Menstruation" refers to the peaceful Qi appearing approximately every thirty days. If delayed, it indicates pathology.) At twenty-one, Kidney Qi is balanced, wisdom teeth emerge, and physical growth reaches its peak. (Supplementary note: "Zhen Ya" refers to the last teeth to grow; teeth are considered the surplus of bone.) At twenty-eight, sinews and bones become firm, hair reaches its maximum length, and the body is in its prime. (Supplementary note: Tian Gui ends at forty-nine (7x7). At twenty-eight (4x7), one possesses half of one's vitality, yet the body is robust, having reached its developmental peak.) At thirty-five, the Yangming Meridian begins to decline, the face starts to wither, and hair begins to fall out. (Supplementary note: The Qi and Blood of the Hand and Foot Yangming meridians nourish the face and extend to the forehead. Decline leads to hair loss and facial withering.) At forty-two, the Three Yang meridians decline on the face, causing facial withering and whitening of the hair. (Supplementary note: All Three Yang meridians ascend to the head; their decline causes facial withering and white hair. This decline occurs because women have an excess of Qi but a deficiency of Blood due to regular menstrual blood loss.) At forty-nine, the Ren Mai becomes deficient, the Chong Mai's Qi and Blood diminish, Tian Gui is exhausted, the "Earthly Way" (menstruation) ceases, the physical form deteriorates, and reproduction becomes impossible. (Supplementary note: The cessation of menstruation is the closure of the Earthly Way. With the decline of Chong and Ren, the form deteriorates.)
At eight years old, a boy's Kidney Qi becomes solid, his hair grows, and his teeth change. (Supplementary note: The number of Old Yin reaches its limit at ten, while Young Yin follows at eight. Boys belong to Shaoyang Qi, corresponding to the number of Young Yin. As stated in the *I Ching*: "Heaven is nine, Earth is ten.") At sixteen, Kidney Qi is abundant, Tian Gui arrives, essence overflows and is emitted, Yin and Yang harmonize, enabling reproduction. (Supplementary note: Male constitution differs; the forms of Jing and Blood vary. Yin is still like a full sea releasing blood; Yang is active, responding to union by emitting essence. Their harmony allows reproduction. As the *I Ching* states: "When male and female combine essence, all things are transformed.") At twenty-four, Kidney Qi is balanced, sinews and bones are strong, wisdom teeth emerge, and physical growth peaks. At thirty-two, sinews and bones are vigorous, muscles are full and robust. (Supplementary note: Tian Gui ends at sixty-four (8x8). At thirty-two (4x8), one possesses half of one's vitality.) At forty, Kidney Qi declines, hair falls out, and teeth become dry and brittle. (Supplementary note: The Kidney governs bone, and teeth are the surplus of bone. With declining Kidney Qi and lack of essence nourishment, hair falls and teeth dry out.) At forty-eight, Yang Qi declines on the upper body, the face withers, and the temples turn gray. (Supplementary note: Here, Yang Qi refers to Yangming Qi.) At fifty-six, Liver Qi declines, tendons lose mobility, Tian Gui is exhausted, essence decreases, Kidney Qi declines, and the physical form becomes extremely fatigued. (Supplementary note: Liver Qi nourishes tendons; liver decline causes tendon immobility. Kidney Qi nourishes bone; kidney decline causes physical exhaustion. With exhausted Tian Gui, essence is scarce. With depleted Yang Qi and essence, teeth and hair fall. This is not merely a decline in vitality but also the decree of Heaven.)
The Kidney governs water and receives the essence of the Five Zang and Six Fu organs to store it. Therefore, only when the essence of the Five Zang organs is abundant can the Kidney excrete it. (Supplementary note: The essence of the Five Zang and Six Fu organs overflows and seeps into the Kidney, which then stores it. The Kidney is the gathering place and gatekeeper, not possessing essence exclusively. Hence, "when the Five Zang are abundant, [the Kidney] can excrete.") Now, as the Five Zang organs decline, sinews and bones become lax, Tian Gui is exhausted, temples turn white, the body feels heavy, gait becomes unsteady, and reproduction ceases.
The Yellow Emperor asked: Why do some elderly people retain the ability to reproduce? (Supplementary note: This refers to cases deviating from the standard Tian Gui cycle.) Biqi replied: This is because their natural lifespan exceeds the norm, their Qi and pulses remain smooth and unobstructed, and their Kidney Qi remains sufficient. (Supplementary note: They were endowed with an inherent surplus of innate true Qi.) Although such individuals may reproduce, men do not exceed the age of sixty-four (8x8), and women do not exceed forty-nine (7x7), because the essence and Qi of Heaven and Earth are ultimately exhausted. (From *Shanggu Tianzhen Lun*)
Heaven nourishes humans with the Five Qi, and Earth nourishes humans with the Five Flavors. (Supplementary note: Heaven feeds humans with Five Qi: Sour Qi gathers in the Liver, Scorched Qi in the Heart, Fragrant Qi in the Spleen, Fishy Qi in the Lungs, and Rotten Qi in the Kidneys. Earth feeds humans with Five Flavors: Sour enters the Liver, Bitter enters the Heart, Sweet enters the Spleen, Pungent enters the Lungs, and Salty enters the Kidneys. Clear Yang transforms into Qi and ascends to become Heaven; Turbid Yin forms Flavor and descends to become Earth. Thus, Heaven feeds with Qi, and Earth feeds with Flavor. The Classic states: Yang is Qi, Yin is Flavor.) The Five Qi enter through the nose and are stored in the Heart and Lungs, uplifting to make the complexion bright and the voice resonant. The Five Flavors enter the mouth, are stored in the Stomach and Intestines, and nourish the Five Qi. When the Five Qi are harmonious, Body Fluids are generated; when Body Fluids and Qi complement each other, Spirit (Shen) is naturally produced. (Supplementary note: The Heart manifests in the complexion, and the Lungs govern the voice. Qi stored in the Heart and Lungs brightens the five colors and clarifies the voice. Qi is the mother of Water. Flavors stored in the Stomach and Intestines internally nourish the Five Qi. Harmonized Five Qi transform into Body Fluids, which combine with Qi to generate Shen Qi. From *Liu Jie Zang Xiang Lun*)
The Qi of Heaven is clear, quiet, and luminous. (I surmise: Because Heaven's Qi is clear and quiet, its luminosity is inexhaustible; if humans are clear and quiet, their lifespan will also be prolonged.) It hides its virtue without revealing itself, thus it does not fall. ("Zhi" is alternatively read as "Shang". Supplementary note: The four seasons form order, and the seven luminaries revolve. Heaven does not display itself; this is hiding its virtue. When virtue is hidden, its applications are unimpeded, so it does not fall. Heaven possesses supreme virtue yet responds appropriately; how much more should human conduct follow Heaven?) If Heaven displays its brightness, the Sun and Moon would lose their light, and evil Qi would invade the orifices. (Supplementary note: When the Great Brightness appears, the Lesser Brightness vanishes. Thus, the virtue of Great Brightness must be hidden. If Heaven displays itself, the Sun and Moon's light is obscured. This metaphorically advises humans to maintain clarity and quietude, following the Dao to preserve innate truth. Departing from the Dao allows empty evils to enter the orifices.)
If Yang Qi is blocked and Earth Qi is murky, clarity is obscured. (Supplementary note: Yang refers to Heavenly Qi, also Wind-Heat; Earth Qi refers to Dampness, also Fog/Mist. Wind-Heat harming humans blocks the nine orifices; Fog-Dampness causing illness obscures clarity. By analogy, in Heaven, the Sun and Moon lose their radiance; in humans, the eyes become dim.) If clouds and mist are not refined, the White Dew that should descend from Heaven will not fall. (Supplementary note: Mist is a type of cloud; Dew is a type of rain. If Yang is excessive, Earth Qi does not ascend to respond; if Yin is deficient, Heaven Qi does not descend to intersect. Thus, clouds and mist do not transform, and refined Qi fails to ascend, resulting in the failure of White Dew to descend. The Classic states: "Earth Qi ascends to become clouds; Heaven Qi descends to become rain," indicating that the intersection of two Qi forms dew and rain. It also states: "Extreme Yin cuts off Heaven Qi; Extreme Yang depletes Earth Qi," meaning if Qi does not attract, they cannot intersect.)
If Heaven and Earth do not communicate, the lives of all things cannot be sustained, and even majestic trees will perish. (Supplementary note: "Biao" means to manifest. The *I Ching* states: "Heaven and Earth... cause all things to mature perfectly." If communication is absent, it becomes the hexagram Pi (Stagnation). "Ming" refers to famous fruits and precious trees. If clouds and mist do not transform, and their refined essence/dew does not nourish the plains, it signifies Heaven Qi not descending and Earth Qi not ascending. The way of transformation is flawed, and the source of life is extinguished. Thus, the lives of all things lack sustenance. In death, majestic trees are the first to show signs.) If harmful Qi does not disperse, wind and rain are irregular, and White Dew does not fall, plants will wither and fail to flourish. (Supplementary note: "E" refers to harmful Qi; "Fa" to dispersion; "Jie" to regulation; "Si" to accumulation; "Gao" to withering. Constant Qi remains hidden and undispersed; wind and rain are unregulated, causing excessive damage. Withered matter accumulates, failing to flourish in spring. This applies not only to objects but also to humans who depart from the Dao, as mentioned below.)
If thief winds arrive frequently and torrential rains rise often, Heaven and Earth fail to preserve the four seasons, and humanity loses connection with the Dao, life will be cut short before its time. (Supplementary note: Disregarding the harmony of the four seasons and repeatedly suffering from the Eight Winds. Losing connection with the Dao causes innate true Qi to drift far from its proper state, leading to premature death. "Yang" implies longevity/extent; "Yuan" implies distance.)
Only the Sage follows this pattern; thus, his body suffers no strange diseases, all things retain their vital energy, and his essence is not exhausted. (Wang Bing's commentary: The Sage models Heaven and Earth's hidden virtue, remaining tranquil and empty, guarding spirit within. How could disease arise? Also: "Following" means complying, i.e., obeying the commands of the four seasons. However, these commands must not be violated; violation injures the internal Five Zang and triggers other diseases.)
The Qi of Cangtian (Azure Heaven) is pure and quiet. (Supplementary note: Spring is Cangtian, the master of generation.) If one's will and intent are governed and compliant, Yang Qi becomes secure. Even if thief邪 (evil pathogens) attack, they cannot harm. (This uses Heavenly Dao to illustrate human conduct.) This is adhering to the sequence of time. (By following the sequence of Heavenly Qi of the four seasons, thief邪 cannot harm.) Therefore, the Sage transmits spirit, absorbs Heavenly Qi, and connects with Divine Illumination. (Flowing spirit without depletion. Wang Bing's commentary: Long-term absorption of innate true Qi allows miraculous functions to naturally connect with Divine Illumination.)
If one violates this, the nine orifices close internally, muscles become obstructed externally, and Wei Qi scatters and dissolves. (Supplementary note: Violation refers to opposing the purity of Cangtian. Wei Qi combines with Heavenly Yang Qi, warming the flesh, filling the skin, thickening the interstices, and controlling opening/closing. Loss of measure leads to internal closure of nine orifices and external obstruction of muscles, as Wei Qi fails to circulate.) This is self-injury, weakening Zheng Qi. (Supplementary note: Opposing Heavenly Qi and violating quietude causes Zheng Qi to be stripped away, not by Heaven's decree, but by human action.)
Yang Qi is like Heaven and the Sun. If it loses its proper function, lifespan is shortened and brilliance is obscured. (Supplementary note: This illustrates the function of Yang Qi. Human Yang is like Heavenly Sun. If Heaven loses its function, the Sun is unclear; if humans lose their function, Yang is insecure. If the Sun is clear, Heaven is dark; if Yang is insecure, humans die young.) Therefore, the movement of Heaven relies on the brightness of the Sun. (Illustrating that human life depends on Yang Qi. ○ I surmise: Heaven's operation is ceaseless, hiding its Qi so that the Sun and Moon may shine. From *Sheng Qi Tong Tian Lun*)
Yin Qi, when quiet, stores Spirit; when agitated, Spirit dissipates and perishes. (Supplementary note: Yin refers to the Five Spirit Zang organs. Quietude without pathogenic invasion keeps Auspicious Qi calm and internally stored. Movement exposing one to pathogens harms Spirit, causing dispersion and loss of storage, hence "dissipation and perishing.")
Overeating damages the Stomach and Intestines. (Supplementary note: Zang organs are injured by agitation; Fu organs by food and drink. Both result from overuse and exceeding limits, inviting pathogens.)
Biqi said: Rooted within is called Shen Ji (Spirit Mechanism); if Spirit departs, the mechanism stops. Rooted without is called Qi Li (Qi Establishment); if Qi stops, transformation ceases. (Among all有形 (form-bearing) entities, those rooted within derive their source from Heaven; their movements and floating are primarily driven by Shen Qi as the master of mechanism. Thus, their actions are unknown to others. When Shen leaves the mechanism, the way of activation and use ceases. Those rooted without derive their source from Earth; their growth, transformation, storage, and collection respond to the creative Qi of nature. Thus, their emergence is also unknown to others. When Qi stops, the way of biochemical formation ceases. Wood, Fire, Earth, Metal, Water, Dryness, Dampness, Liquid, and Kidney are soft and weak, easily changing nature. If external living Qi leaves the root, transformation ceases, and the constant physical nature and color inevitably shift slightly from their original state. *Liu Wei Zhi Lun* states: "If exit and entry cease, Shen Ji is extinguished; if ascent and descent stop, Qi Li stands alone in danger." Therefore, without exit and entry, there is no growth, strengthening, aging, or dying; without ascent and descent, there is no growth, transformation, storage, or collection. From *Wu Chang Zheng Da Lun*)
The Yellow Emperor asked: What are the Three Parts? Biqi replied: There are Lower, Middle, and Upper parts. Each part has three observations (Hou), corresponding to Heaven, Earth, and Man. One must guide with fingers (requiring teacher's instruction) to ascertain the truth.
Upper Part Heaven: Arteries at both temples. (Supplementary note: Located on both sides of the forehead, responding to the Qi flow of Hand and Foot Shaoyang meridians.)
Upper Part Earth: Arteries at both cheeks. (Near Ju Liao, responding to the Qi flow of Hand and Foot Yangming meridians.)
Upper Part Man: Arteries in front of the ears. (In the depression in front of the ear, responding to the Qi flow of Hand Shaoyang meridian.)
Middle Part Heaven: Hand Taiyin Meridian. (Lung pulse, located at the radial styloid process in the Cun Kou area, known as Jing Qu, responding to the hand.)
Middle Part Earth: Hand Yangming Meridian. (Large Intestine pulse, at He Gu, responding to the hand.)
Middle Part Man: Hand Shaoyin Meridian. (Heart pulse, at the end of the ulnar styloid process in the Shen Men area, responding to the hand. *Ling Shu* states: "Shaoyin has no Shu points; does the Heart never get sick?" Answer: "Its exterior meridian may be diseased while the organ remains healthy; thus, we select only the exterior meridian point at the sharp bone of the wrist posterior, referring to this.")
Lower Part Heaven: Foot Jueyin Meridian. (Liver pulse, outside the pubic symphysis, 1.5 cun below Yang Shi, in the depression of Wu Li, taken while supine, responding to the hand. For women, take Tai Chong, 2 cun behind the metatarsophalangeal joint of the big toe, in the depression.)
Lower Part Earth: Foot Shaoyin Meridian. (Kidney pulse, behind the medial malleolus, in the depression above the calcaneus, at Tai Xi, responding to the hand.)
Lower Part Man: Foot Taiyin Meridian. (Spleen pulse, above the fish belly, between the tendons, straight up to the lower gate of Wu Li. Press deeply with wide, thin clothing to obtain it; responds to the hand. ○ To observe Stomach Qi, take the pulse at Chong Yang on the dorsum of the foot, where the artery responds to the hand.)
Thus, Lower Part Heaven observes the Liver; Earth observes the Kidney; Man observes Spleen and Stomach Qi (since Spleen and Stomach are connected by membranes, Stomach Qi is also observed).
Question: How is the Middle Part observed? Answer: It also has Heaven, Earth, and Man. Heaven observes the Lung; Earth observes Qi in the Chest (Hand Yangming meridian passes through this area; the Classic states "Intestines and Stomach are observed together," thus observing the chest). Man observes the Heart.
Question: How is the Upper Part observed? Answer: It also has Heaven, Earth, and Man. Heaven observes Qi in the head and horns (forehead/temples); Earth observes Qi in the mouth and teeth; Man observes Qi in the ears and eyes (positioned near the ear anterior to the outer canthus of the eye, thus used for observation).
The Three Parts each have Heaven, Earth, and Man. Three constitute Heaven, three constitute Earth, three constitute Man. Three times three equals Nine. Divided into Nine, they correspond to the Nine Fields (Outside the city is Jiao, outside Jiao is Dian, outside Dian is Mu, outside Mu is Lin, outside Lin is ... ... outside is Ye, indicating remoteness. See *Liu Jie Zang Xiang Lun*).
Nine Fields correspond to Nine Zang Organs. (Supplementary note: Thus responding to the ultimate numbers of Heaven and Earth.)
Therefore, there are Five Spirit Zang and Four Form Zang. (Supplementary note: Hun, Po, Xin, Yi, Shen all reside in the Five Zang, hence called Spirit Zang. Form Zang are like vessels, open outward, hollow inside, storing things, hence called Form Zang. I surmise: Having only the vessel without storage content emphasizes the importance found in *Xuan Ming Wu Zang Pian*, *Sheng Qi Tong Tian Lun*, and *Liu Jie Zang Xiang Lun*.) Together, they form Nine Zang.
If the essence of the Five Zang fails, the complexion will appear premature (Tao), and premature appearance indicates death. (Supplementary note: Tao refers to abnormal death-like complexion. Complexion is the flag of Spirit; Zang is the residence of Spirit. When Spirit leaves, Zang fails; when Zang fails, complexion becomes abnormal, indicating death.)
Question: How are life and death judged? Answer: If the body is robust but the pulse is fine/thin, with insufficient Qi to breathe, it is critical. (Supplementary note: When Form and Qi match, it is treatable. Here, fine pulse and scant Qi indicate weak Qi despite robust form, meaning Form and Syndrome do not support each other, hence critical. Critical implies near-death but potentially survivable.)
If the body is emaciated but the pulse is large, with excess Qi in the chest, it is death. (Supplementary note: Here, Form and Qi are insufficient, but Pulse Qi is excessive, hence death. Generally, mismatched Form and Qi leads to death.)
If Form and Qi match, life prevails; if they are irregular (Can Wu), disease exists. (Supplementary note: "Can" means comparison; "Wu" means grouping. Irregularity means deviation from normal patterns, hence disease.)
If all Nine Hous are discordant, it is death. (Supplementary note: Discordance means observational climates do not match. There are seven types of discordant observations described below.)
If pulses in upper/lower/left/right correspond like pounding rice, disease is severe; if they are discordant and uncountable, it is death. (Supplementary note: There are eighteen diagnoses across three parts and nine observations. "Like pounding rice" means rapid and forceful, like a pestle. "Uncountable" means more than ten breaths per respiration.)
If Middle Part pulse is alone harmonious but discordant with other Zang, it is death; if Middle Part pulse is diminished, it is death. (Supplementary note: If Upper/Lower parts do not correspond, even if Middle is harmonious, death is imminent. If diminished relative to Upper/Lower, it indicates Qi decline, hence death. "Diminished" means smaller on one side.)
If the eyes are sunken, it is death. (Supplementary note: Taiyang meridian originates at the inner canthus. Sunken eyes indicate Taiyang exhaustion. Taiyang is singled out because it governs all Yang Qi.)
Biqi said: The Nine Hous should correspond, acting as one, without discord. If one Hou lags, disease exists; if two lag, disease is severe; if three lag, disease is critical. "Lagging" means the responses are not simultaneous (Ju means same/unified).
Observe the Fu and Zang organs to determine the timing of death. (Supplementary note: Disease entering Fu heals; entering Zang dies. Thus, the timing of death can be known by observation.) One must first understand Normal Pulses before understanding Disease Pulses. (Supplementary note: Normal pulses relate to the four seasons and Five Zang.)
The Yellow Emperor asked: How do we know where the disease is? Biqi replied: Observe the Nine Hous. A pulse that is uniquely small, large, rapid, slow, hot, cold, or depressed indicates disease. (These seven discordant observations are the seven types mentioned. Pulse variations showing irregularity, depending on unique abnormalities, indicate disease.)
If muscles are wasted and the body cannot move, it is death. (Supplementary note: External decline of Grain Qi leads to muscle wasting; exhaustion of True Tian肉 (flesh) prevents movement.)
If Middle Part pulse is intermittently sparse and rapid, it is death. (Supplementary note: Indicates scattered Qi.)
If flesh and form are wasted, even if Nine Hous are harmonious, it is death. (Supplementary note: Also indicates mismatched Form and Qi. As previously noted, even if Nine Hous are flat/harmonious, if muscles are wasted, it is death.)
The Yellow Emperor asked: Winter Yin pulses and Summer Yang pulses—what does this mean? Biqi replied: If all Nine Hou pulses are deep, fine, and suspended/extreme, they are Yin, governing Winter, so death occurs at midnight. If pulses are vigorous, rapid, panting, and numerous, they are Yang, governing Summer, so death occurs at noon. (Supplementary note: Positions have no fixed abode; extremes reverse. Text of Qian/Kun: "At extreme Yin, dragons fight in the wild; at extreme Yang, the arrogant dragon regrets." Thus, extreme Yin/Yang pulses lead to death at midnight/noon.)
Therefore, patients with Cold-Heat diseases die at dawn. (Supplementary note: Also due to extremity reversal. Dawn is Wood's reign; Wood Qi is Wind. Thus, Cold-Heat diseases die during Wood's reign. The Classic states: "Due to exposure to wind, Cold-Heat arises," indicating Cold-Heat is caused by Wind invasion.)
Patients with Heat Zhong (internal heat) or Heat diseases die at noon. (Supplementary note: Extremity of Yang.)
Patients with Wind diseases die at dusk. (Supplementary note: Mao-You axis. I surmise: Cold-Heat patients have excess Wood Qi, dying in Wood's reign. Wind patients have deficient Wood Qi. You hour is Metal's reign; Wood deficiency allows Metal dominance, hence dying at You.)
Patients with Water diseases die at midnight. (Because Water reigns.)
If pulses are intermittently sparse/rapid or slow/fast, death occurs during the transition hours of the four seasons (Chen, Xu, Chou, Wei). (Spleen Qi is internally severed, hence death during these hours.)
If the Seven Diagnoses are present but all Nine Hous comply, death does not occur. (Supplementary note: If Nine Hous comply with the four seasons' commands, even if Seven Diagnoses appear alternately, life is preserved.)
What is meant by "not dying" refers to Wind diseases and Menstrual diseases, which resemble the Seven Diagnoses but are not, hence "not dying." (Supplementary note: Wind disease pulses are large and rapid; menstrual disease pulses are small and subtle. Although symptoms resemble the Seven Diagnoses, the prognosis differs, hence survival.)
If the Seven Diagnoses are present AND the pulse conditions are also failed/collapsed, it is death. (Supplementary note: If Seven Diagnoses appear but Nine Hous comply, death does not occur. If disease resembles Seven Diagnoses but pulses are chaotic/disordered, even if Nine Hous seem compliant, survival is impossible.)
There will definitely be hiccups (Yue) and belching (Yi). (Supplementary note: Heart manifests as Yi; Stomach as Yue. Exhaustion of Stomach essence and Spirit failing to guard the Heart causes these symptoms at death.)
One must carefully inquire about the initial cause of illness and current symptoms. (Supplementary note: "Fang Zheng" means currently. Seek the beginning to understand the end.)
Then, palpate the pulses separately, observe the meridians' floating/sinking, and analyze upward/downward and rebellious/compliant flows. Rapid pulses indicate no disease (pulse channel is abundant); slow pulses indicate disease (Qi is insufficient); pulses that do not come and go indicate death (Spirit has departed); skin adhering to bone indicates death (bone and tendon are withered. From *San Bu Jiu Hou Lun*).
The Yellow Emperor said: I know that hundred diseases arise from Qi. (Supplementary note: Qi's usage involves deficiency/excess, rebellion/compliance, slack/tight, all capable of causing disease, hence the question.) Anger causes Qi to ascend; Joy causes Qi to slacken; Grief causes Qi to consume; Fear causes Qi to sink; Cold causes Qi to contract; Heat causes Qi to leak; Fright causes Qi to scatter; Labor causes Qi to exhaust; Thought causes Qi to knot. The Nine Qi differ; what diseases arise?
Biqi said: Anger causes Qi to rebel; severely, it leads to vomiting blood and undigested stool diarrhea, hence Qi ascends. (Supplementary note: Anger causes Yang Qi to rebel upward; Liver Qi invades Spleen, leading to vomiting blood and diarrhea. How to verify? Anger causes red face; severely, blue/pale face. The Classic states: "Unrestrained anger injures Wisdom; anger causes Qi to rebel upward and not descend.")
Joy causes Will to harmonize, Qi to reach, Ying and Wei to flow smoothly, hence Qi slackens.
Grief causes Heart Tie to tighten, Lung leaves to expand and raise, Upper Jiao to block, Ying and Wei to not distribute heat, heat stays in the middle, hence Qi consumes. (Supplementary note: Grief injures Heart; tight Heart Tie moves Lung; Lung Qi strikes other meridions in rebellion, causing Lung expansion and leaf raising.)
Fear causes Essence to retreat; retreat causes Upper Jiao to close; closure causes Qi to return; return causes Upper Jiao to distend, hence Qi does not flow. (Supplementary note: Fear causes Yang Essence to retreat upward and not descend, closing Upper Jiao. Once closed, Qi cannot flow; Lower Jiao Yin Qi also returns, accumulating as distension. Upper Jiao is sealed, Lower Jiao Qi returns, each staying in place, hence Qi does not flow.)
Cold causes Cou Li (pores/striae) to close, Qi not to flow, hence Qi contracts. (Supplementary note: Cou refers to sites of fluid secretion; Li refers to intersecting lines. Closure is tight sealing; Qi is Wei Qi; Flow is circulation; Contract is convergence. Body cold makes Wei Qi sink, so skin striae and secretion sites close tightly, Qi does not circulate, and Wei Qi converges internally without dispersing.)
Heat causes Cou Li to open, Ying and Wei to flow, sweat to pour out, hence Qi leaks. (Supplementary note: In Yang, one is comfortable; in Yin, one perspires. Heat opens skin pores, Ying and Wei flow freely, fluids seep externally as heavy sweating.)
Fright causes the Heart to have no anchor...