一难曰∶十二经中皆有动脉，（十二经，手足三阴三阳也。动脉，脉之动现于外，如手太阴天府、云门之类，按之其
动亦应手是也。）独取寸口，以决五脏六腑死生吉凶之法，何谓也？（寸口，即太渊、经渠穴之分，兼两手上中下三部脉
也。）
然∶寸口者，脉之大会，手太阴之脉动也，（会，聚也。手太阴，肺之经也。大会，《灵·动输篇》云∶“胃为五脏六
腑之海，其气清上注于肺，肺气从太阴而行之，其行也，以息往来”是也。又《灵·经脉篇》云，手太阴之脉，“循鱼际，
出大指之端。”）人一呼脉行三寸，一吸脉行三寸，呼吸定息，脉行六寸。人一日一夜凡一万三千五百息，脉行五十度周
于身。（呼，出气也。吸，内气也。《灵·五十营篇》∶“人经脉上下、左右、前后二十八脉，周身十六丈二尺，……呼吸
定息，气行六寸。……二百七十息，气行十六丈二尺，……一周于身，……一万三千五百息，气行五十营于身”。度，过
也，犹言过一次也。二十八脉实数，详《灵·脉度篇》。）
漏水下百刻，（按《隋志》刻漏始于黄帝。一昼一夜定为百刻，浮箭于壶内，以水减刻出，分昼夜之长短。）营卫行
阳二十五度，行阴亦二十五度，为一周也，（营卫，《灵·营卫生会篇》云∶“人受气于谷，谷入于胃，以传于肺，五脏六
腑，皆以受气，其清者为营，浊者为卫，营在脉中，卫在脉外”是也。合言脉，则营卫在其中矣。日行阳而夜行阴，昼
夜各二十五度，则五十度为一周也。盖昼夜有长短，此举其中而言。其行阳行阴、起止出入之法，详《灵·卫气行篇》。）
故五十度复会于手太阴。寸口者，五脏六腑之所终始，故法取于寸口也。（起于手太阴，止于手太阴，故曰终始。五脏六
腑之气皆现于此，故取寸口可以决生死吉凶也。《灵·营卫生会篇》云∶“营出于中焦，卫出于下焦。帝曰∶愿闻三焦之
所出。岐伯曰∶上焦出胃上口，并咽贯膈，……循太阴之分而行，还至阳明，上至舌，下足阳明，常与营俱行于阳二十
五度，行于阴亦二十五度，一周也，故五十度而复大会于手太阴矣。”此营卫之常度也。）
二难曰∶脉有尺寸，何谓也？
然∶尺寸者，脉之大要会也。（尺寸详下文。要会，言要切之地、会聚之处也。）从关
至尺是尺内，阴之所治也；从关至鱼际是寸口内，阳之所治也。（关者，尺寸分界之地，《脉诀》所谓高骨为关是也。关
下为尺，主肾肝而沉，故属阴。鱼际，大指本节后内廉大白肉名曰鱼，其赤白肉分界即鱼际也。关上为寸口，主心肺而
浮，故属阳治理也。）
故分寸为尺，分尺为寸。（此二句释尺寸二字极明晓。言关上分去一寸，则余者为尺；关下分去一尺，则余者为寸，
此言尺寸之所以得名也。）故阴得尺中一寸，阳得寸内九分。（此二句又于尺寸之中分其长短之位，以合阴阳之数。一寸
为偶数，九分为奇数也。盖关以下至尺泽。皆谓之尺，而诊脉则止候关下一寸；关以上至鱼际皆谓之寸，而诊脉止候关
上九分，故曰尺中一寸，寸内九分也。）尺寸终始，一寸九分，故曰尺寸也。（此又合尺寸之数而言。然得一寸不名曰寸，
得九分不名曰分者，以其在尺之中、在寸之中也。）
三难曰∶脉有太过，有不及，有阴阳相乘，有覆有溢，有关有格，何谓也？（太过、不及，病脉也。阴乘阳，则阴
过而犯阳；阳乘阴，则阳过而犯阴，此太过不及之甚。覆、溢、关、格，又相乘之甚者也。）
然∶关之前者，
阳之动也，脉当见九分而浮。（关前为阳，见上文。浮。阳之象也。）过者，法曰太过∶减者，法曰不及。遂上鱼为溢，
（过，
谓浮出九分也。减，谓浮不至九分也。鱼，即鱼际。上鱼，浮至鱼际，太过之甚也。溢，满而出于外也。）为外关内格，
此阴乘之脉也。（关格，据三十七难言阳气太甚，则阴气不得相营，故曰关；阴气太盛，则阳气不得相营，故曰格。则此
云外关者，外而阳盛越于外；内格者，内而阴盛距于内也。阴乘，阴气上乘阳位也。）关以后者，阴之动也，脉当见一寸
而沉。（关后为阴。沉，阴之象也。）过者，法曰太过；减者，法曰不及。遂入尺为覆，（过，谓沉过一寸也。减，谓沉不
及一寸也。尺，一寸后尺中也。覆，反而倾也。）为内关外格，此阳乘之脉也。（内关，谓阳反在下，居阴之位，外格，
谓阴反上越，居阳之位也，阳乘，阳气下入阴中也。）故曰覆溢。是其真脏之脉，人不病而死也。（真脏之脉，谓脏气已
绝。其真形独现于外，不必有疾病而可决其必死也。按此当与三十七难合观之。）
四难曰∶脉有阴阳之法，何谓也？（阴阳，谓脉之属于阴、属于阳也。）
然∶呼出心与肺，吸入肾与肝，呼吸之间，
脾受谷味也，（心肺在上部，故出气由之，属阳。肾肝在下部，故入气归之，属阴。脾主中宫，故司出入之间也。受谷味，
即因胃气以至手太阴之义。）
其脉在中。（在中，介乎阴阳之间也。）浮者阳也，沉者阴也，故曰阴阳也。（浮为表，故属阳。沉为里，故属阴。）
心肺俱浮，何以别之？（呼出心与肺，故俱浮。别，分别也。）
然∶浮而大散者心也，浮而短涩者肺也。（心属火，故其
象大散；肺属金，故其象短涩，此心肺之本脉，而浮则其所同者也。）肾肝俱沉，何以别之？（吸入肾与肝，故俱沉。）
然∶牢而长者肝也，按之濡，举指来实者肾也。（肝属木，故其象牢而长。肾属水，故其象濡而实。水体外柔而内刚也。）
脾者中州，故其脉在中。是阴阳之法也。（在中，不沉不浮之间也。此以上释阴阳之义已明，下文又于阴阳之中交互言之
也。）脉有一阴一阳，一阴二阳，一阴三阳；有一阳一阴，一阳二阴，一阳三阴。如此之言，寸口有六脉俱动耶？（俱动，
言三阴三阳尽见也，六脉见下文。）
然∶此言者，非有六脉俱动也，谓浮、沉、长、短、滑、涩也。（此即所谓六脉也。
浮者在上，沉者在下，长者过本位，短者不及本位，滑者流利，涩者凝滞。浮、沉、长、短以形言，滑、涩以质言也。）
浮者阳也，滑者阳也，长者阳也；沉者阴也，短者阴也，涩者阴也。（此所谓三阴三阳也。）所谓一阴一阳者，谓脉来沉
而滑也，一阴二阳者，谓脉来沉滑而长也，一阴三阳者，谓脉来浮滑而长，时一沉也；所谓一阳一阴者，谓脉来浮而涩
也，一阳二阴者，谓脉来长而沉涩也，一阳三阴者，谓脉来沉涩而短，时一浮也。（此六脉互见之象也。然此举其例而言，
亦互相错综，非一定如此也，但浮沉可以相兼，而滑涩短长不得并见，亦所当晓也。）各以其经所在，名病逆顺也。（上
文言脉之形体，而未尝断吉凶，此乃言其断法也。其经，手足三阴三阳也。逆顺，如心脉宜浮，肾脉宜沉则为顺，若心
脉反沉，肾脉反浮则为逆，此又见脉无定体，因经而定顺逆。其法则两经备言之。）
五难曰∶脉有轻重，何谓也？（浮而无力为轻，沉而有力为重。）
然∶初持脉，如三菽之重，与皮毛相得者，肺部也。
（持脉，即按脉也。菽，豆之总名。三菽之重，言其力与三菽等也。皮毛相得，言其浮至皮毛之分也。肺脉最轻，故其
象如此。）如六菽之重，与血脉相得者，心部也。如九菽之重，与肌肉相得者，脾部也。如十二菽之重，与筋平者，肝部
也。按之至骨，举指来疾者，肾部也，（血脉、肌肉、筋、骨，递沉而下，故脉之轻重，以此为准。盖肺居最上，心次之，
脾次之，肝又次之，肾居最下。至骨，沉之至也。举指来疾，言其有力而急迫，即四难“举指来实”之义也。）
六难曰∶脉有阴盛阳虚，阳盛阴虚，何谓也？（此与上文脉有阴阳之法不同。上文言脉之属于阴、属于阳，平脉也；
此则言阴分之脉与阳分之脉，有太过、不及，病脉也。）
然∶浮之损小，沉之实大，故曰阴盛阳虚。沉之损小，浮之实大，
故曰阳盛阴虚。（浮脉主阳，沉脉主阴，损小则气血衰，实大则气血盛。）是阴阳虚实之意也。
七难曰∶经言少阳之至，乍大乍小，乍短乍长；阳明之至，浮大而短；太阳之至，洪大而长；（少阳阳气尚微，离阴
未远，故其脉无定。阳明之阳已盛，然尚未极，故浮大而短。太阳之阳极盛，故洪大而长。至，言其气至而脉应也。）太
阴之至，紧大而长；少阴之至，紧细而微；厥阴之至，沉短而敦。（太阴为阴之始，故有紧象，而尚有长大之阳脉也。少
阴之阴渐盛，故紧细而微。厥阴阴之至，故沉短而敦，阴脉之极也。）此六者，是平脉邪？将病脉邪？（平脉，本然之脉
也。病脉，有过之脉也。）
然∶皆王脉也。（王脉，得其时而气应生王也。）其气以何月，各王几日？
然∶冬至之后得甲子少阳王，（自古历元皆
起于冬至，其日必以甲子，然岁周三百六十五日四分日之一，则日有零余，每岁递差，至日不必皆当甲子，此云冬至后
得甲子者，乃指至日之当甲子者言也。至日当甲子，至立春后十五日历一甲，木气始盛，故曰少阳王也。若至日不当甲
子，少阳之王大概以六十日，不复以甲子为限。）复得甲子阳明王，复得甲子太阳王，复得甲子太阴王，复得甲子少阴王，
复得甲子厥阴王。（少阳之阳尚微。阳明则阳已盛。太阳则阳极盛，极则阴生而太阴用事；太阴之阴尚微，少阴则阴已盛，
厥阴则阴极盛，极则阳生，如是无已。）王各六十日，（甲子至甲子，则六十日一周也。）六六三百六十日，以成一岁。此
三阳三阴之王时日大要也。（时指月言，日指日数言，以终上文何月几日之问。）
八难曰∶寸口脉平而死者，何谓也？（平，谓脉不病也。）
然∶诸十二经脉者，皆系于生气之原。所谓生气之原者，
谓十二经之根本也，谓肾间动气也。（十二经见上。系，连属也。十二经之气皆从此出，故谓之根本。肾间，两肾之中间
也。动气，气所开合出入之处，即所谓命门也。其说详三十六难中。）此五脏六腑之本，十二经脉之根，呼吸之门，三焦
之原。一名守邪之神。（吸入肾与肝，故为呼吸之门，即所谓动气是也。三焦与肾同候，而肾属下焦，故曰三焦之原，谓
三焦所从出也。守邪未详。或谓元气既足，则邪不能伤，故曰守邪，未知是否。）故气者，人之根本也，根绝则茎叶枯矣。
（气，即原气也。原气在人，犹草木之有根本，若草木根绝，则茎叶枯落，人之原气，亦犹是也。）寸口脉平而死者，生
气独绝于内也。（言内之生气已绝，则虽其外之脉甚平，而终不免于死也。）
九难曰∶何以别知脏腑之病耶？
然∶数者腑也，迟者脏也。（腑属阳、脏属阴故也。）数则为热，迟则为寒。（此二句
释所以迟数之义。）诸阳为热，诸阴为寒。（此二句又释所以数属腑、迟属脏之义。诸阴诸阳，又推言之也。故以别知脏
腑之病也。）
十难曰∶一脉为十变者，何谓也？（一脉十变，谓一脏之脉其变有十，如下文所云也。）
然∶（五邪刚柔相逢之意也。
五邪，五脏五腑之邪也。刚柔，五脏为柔，五腑为刚。相逢，为脏邪干脏，腑邪干腑也。下文详之。）假令心脉急甚者，
肝邪干心也；心脉微急者，胆邪干小肠也；心脉大甚者，，心邪自干心也；心脉微大者，小肠邪自干小肠也；心脉缓甚者，
脾邪干心也；心脉微缓者，胃邪干小肠也，心脉涩甚者，肺邪干心也；心脉微涩者，大肠邪干小肠也，心脉沉甚者，肾
邪干心也；心脉微沉者，膀胱邪干小肠也。（此所谓十变也。盖脏干脏则脉甚，腑干腑则脉微。急、大、缓、涩、沉，乃
五脏之本脉，见何脏之脉，则知何脏之干也。候小肠于心脉者，《素·血气形志篇》云∶“手太阳与少阴为表里”故也。
余脏配合亦准此。）五脏各有刚柔邪，故令一脉辄变为十也。（此二句乃推言之，举心以为例，则五脏皆然，故曰各有、
曰辄变也。）
十一难曰∶经言脉不满五十动而一止，一脏无气者，何谓（一作脏）也？（《灵·根结篇》云∶“五十动而不一代者，
五脏皆受气。四十动一代者，一脏无气，三十动一代者，二脏无气。二十动一代者，三脏无气。十动一代者，四脏无气。
不满十动一代者，五脏无气”。此引经文而约言之也。无气，谓其气已绝，故脉行至此，则断而不续也）。
然∶人吸者随
阴入，呼者因阳出。（吸入肾与肝，故吸随阴入。呼出心与肺，故呼因阳出。）今吸不能至肾，至肝而还，（人一呼脉再动，
一吸脉再动，言呼吸者，以脉由呼吸以行也。脉动未终而止，因以知吸不能至肾也。）故知一脏无气者，肾气先尽也。（不
能至肾，故为肾气尽。）
十二难曰∶经言五脏脉已绝于内，用针者反实其外；五脏脉已绝于外，用针者反实其内。内外之绝，何以别之？（经
文见《灵·九针十二原篇》。）
然∶五脏脉已绝于内者，肾肝脉绝于内也，而医反补其心肺；五脏脉已绝于外者，心肺脉
第一难说：十二经脉中都有动脉（十二经，即手三阴、手三阳、足三阴、足三阳。动脉，指脉搏跳动显现于体表，如手太阴肺经的天府穴、云门穴等部位，按压时脉搏跳动应手），唯独选取寸口脉（寸口，即太渊、经渠穴所在的部位，兼指两手的手、关、尺三部脉象），以此来判断五脏六腑的死生吉凶，这是什么道理呢？
回答说：寸口是脉气的会合之处，是手太阴肺经的动脉所在。（“会”，意为汇聚。手太阴，即肺经。所谓大会，《灵枢·动输篇》说：“胃是五脏六腑的海，其清气上注于肺，肺气跟随太阴经运行，它的运行，随着呼吸而往来。”这正是此意。另外《灵枢·经脉篇》说，手太阴肺经，“沿着鱼际，出于大拇指尖端。”）人一次呼气，脉气运行三寸；一次吸气，脉气运行三寸；一呼一吸之间（定息），脉气运行六寸。人一天一夜共呼吸一万三千五百次，脉气在体内循环五十周。（“呼”，是呼气。“吸”，是吸气。《灵枢·五十营篇》说：“人的经脉上下、左右、前后共二十八条，环绕全身长十六丈二尺，……一呼一吸之间，气行六寸。……二百七十息，气行十六丈二尺，……在周身循环一周，……一万三千五百息，气在周身运行五十周。”“度”，是经过的意思，犹言经过一次。二十八条经脉的实际长度，详见《灵枢·脉度篇》。）
漏壶滴水一百刻（据《隋书·天文志》，刻漏始于黄帝。一昼夜定为百刻，将浮箭置于壶内，通过水位的减少来显示刻度，以区分昼夜长短），营气和卫气在阳分运行二十五周，在阴分也运行二十五周，合起来为一周（营卫，《灵枢·营卫生会篇》说：“人受气于水谷，水谷进入胃中，进而传送给肺，五脏六腑都从中获得精气，其中清柔的部分成为营气，浊悍的部分成为卫气，营气行于脉中，卫气行于脉外。”这就是此意。合称脉时，营卫都在其中了。白天行于阳分，夜晚行于阴分，昼夜各二十五周，则五十周为完整的一周。因为昼夜有长短之分，这里说的是平均情况。其行于阳、行于阴以及起止出入的方法，详见《灵枢·卫气行篇》。）
所以五十周后，脉气重新会合于手太阴肺经。寸口是五脏六腑气血终结和起始的地方，所以诊脉法取之于寸口。（起于手太阴，止于手太阴，所以叫终始。五脏六腑的气血都表现于此，所以取寸口可以决断生死吉凶。《灵枢·营卫生会篇》说：“营气产生于中焦，卫气产生于下焦。黄帝问：希望了解三焦之气出自何处。岐伯说：上焦出于胃的上口，并咽部贯穿膈肌，……沿着太阴经的分野运行，返回至阳明经，上至舌根，下行至足阳明经，常与营气一起行于阳分二十五周，行于阴分二十五周，这是一周，所以五十周后再次会合于手太阴肺经。”这是营卫运行的常规规律。）
第二难说：脉有寸和尺，是什么意思呢？
回答说：寸和尺，是脉诊的关键会合点。（尺寸的具体内容见下文。要会，指切脉的重要部位、气血会聚之处。）从关部到尺部是尺内，是阴气所治理的范围；从关部到鱼际是寸口内，是阳气所治理的范围。（关部，是寸和尺的分界处，《脉诀》所谓的高骨就是关部。关下为尺，主肾和肝，脉象沉，所以属阴。鱼际，是大拇指本节内侧白色肌肉名为“鱼”的地方，其赤白肉交界处即为鱼际。关上为寸口，主心和肺，脉象浮，所以属阳而治理之。）
所以把寸分为尺，把尺分为寸。（这两句解释“尺寸”二字非常明白。意思是说，从关部向上分去一寸，剩下的就是尺；从关部向下分去一尺，剩下的就是寸，这是说尺寸得名的原因。）所以阴气占据尺中一寸，阳气占据寸内九分。（这两句又在尺寸之中划分长短的位置，以符合阴阳之数。一寸为偶数，九分为奇数。大概从关以下至尺泽，都称为尺，但诊脉只候关下一寸；从关以上至鱼际都称为寸，但诊脉只候关上九分，所以说尺中一寸，寸内九分。）尺寸从头到尾，共长一寸九分，所以叫尺寸。（这又是综合尺寸之数而言。然而得到一寸不叫寸，得到九分不叫分，是因为它们在尺之中、在寸之中。）
第三难说：脉有太过，有不及，有阴阳相乘，有覆有溢，有关有格，这是什么意思？（太过、不及，是病脉。阴乘阳，则阴气过盛而侵犯阳位；阳乘阴，则阳气过盛而侵犯阴位，这是太过不及的严重情况。覆、溢、关、格，又是相乘的严重表现。）
回答说：关部之前，是阳气的活动部位，脉象应当显现九分且浮。（关前为阳，见上文。浮，是阳的征象。）超过这个标准，法律规定叫太过；减弱这个标准，法律规定叫不及。如果脉气上达鱼际为溢（超过，指浮出九分之外。减弱，指浮不到九分。鱼，即鱼际。上鱼，指脉浮至鱼际，是太过之极。溢，满而出于外），这叫外关内格，这是阴气上乘的脉象。（关格，根据第三十七难的说法，阳气太甚，则阴气不能与之相营，所以叫关；阴气太盛，则阳气不能与之相营，所以叫格。那么这里说的外关，是指外在阳气盛越于外；内格，是指内在阴气盛拒于内。阴乘，指阴气上乘阳位。）关部之后，是阴气的活动部位，脉象应当显现一寸且沉。（关后为阴。沉，是阴的征象。）超过这个标准，法律规定叫太过；减弱这个标准，法律规定叫不及。如果脉气深入尺部以下为覆（超过，指沉过一寸。减弱，指沉不及一寸。尺，指一寸后的尺中部。覆，反而倾覆），这叫内关外格，这是阳气下乘的脉象。（内关，指阳气反居下部，处于阴位；外格，指阴气反上越，处于阳位。阳乘，指阳气下入阴中。）所以说覆和溢。这是真脏脉，人即使没有生病也会死亡。（真脏脉，指脏气已经绝灭。其真形单独显露于外，不必有疾病就可以断定必死。按此应当结合第三十七难一起观看。）
第四难说：脉有阴阳的法度，是什么意思呢？（阴阳，指脉象属于阴或属于阳。）
回答说：呼气时，气由心与肺发出；吸气时，气归入肾与肝；呼吸之间，脾接受水谷的精微（心肺在上部，所以呼气由此出，属阳。肾肝在下部，所以吸气归于此，属阴。脾主中宫，所以主管出入之间。受谷味，即因胃气而至手太阴肺经的意思。）其脉象位于中间。（在中，介乎阴阳之间。浮脉属阳，沉脉属阴，所以叫阴阳。）（浮为表，故属阳。沉为里，故属阴。）
心和肺的脉象都浮，如何区别它们呢？（呼气由心与肺出，所以都浮。别，即分别。）
回答说：浮而大散的，是心脉；浮而短涩的，是肺脉。（心属火，所以其象大散；肺属金，所以其象短涩，这是心肺的本脉，而浮则是它们的共同特征。）
肾和肝的脉象都沉，如何区别它们呢？（吸气归肾与肝，所以都沉。）
回答说：牢而长的，是肝脉；按之柔软，举指时感觉坚实的，是肾脉。（肝属木，所以其象牢而长。肾属水，所以其象濡而实。水体外柔而内刚。）
脾位于中州，所以其脉象在中间。这就是阴阳的法度。（在中，不沉不浮之间。以上解释了阴阳的意义已经很明确，下文又在阴阳之中交互论述。）脉有一阴一阳，一阴二阳，一阴三阳；有一阳一阴，一阳二阴，一阳三阴。这样的话，寸口会有六条脉同时跳动吗？（俱动，指三阴三阳全部显现，六脉见下文。）
回答说：这里说的，并不是有六条脉同时跳动，而是指浮、沉、长、短、滑、涩这六种脉象。（这就是所谓的六脉。浮在上，沉在下，长超过本位，短不及本位，滑流利，涩凝滞。浮、沉、长、短是从形态来说，滑、涩是从质地来说。）
浮是阳，滑是阳，长是阳；沉是阴，短是阴，涩是阴。（这就是所谓的三阴三阳。）所谓一阴一阳，指脉来沉而滑；一阴二阳，指脉来沉、滑而长；一阴三阳，指脉来浮、滑、长，偶尔出现一次沉；所谓一阳一阴，指脉来浮而涩；一阳二阴，指脉来长、沉、涩；一阳三阴，指脉来沉、涩、短，偶尔出现一次浮。（这是六脉互见的征象。然而这只是举例说明，也是互相错综，并非一定如此，只要知道浮沉可以相兼，而滑涩短长不得并见，也就明白了。）根据脉象所在的经络，来判定病的逆顺。（上文讲脉的形体，而没有判断吉凶，这里讲的是判断方法。其经，指手足三阴三经。逆顺，如心脉宜浮，肾脉宜沉则为顺，若心脉反沉，肾脉反浮则为逆，这也显示出脉没有固定的形体，要因经而定顺逆。其法则在两经中都有详细论述。）
第五难说：脉有轻重的区别，是什么意思呢？（浮而无力为轻，沉而有力为重。）
回答说：初持脉时，如三颗豆子的重量，与皮毛相得的，是肺部的脉。（持脉，即按脉。菽，豆的总名。三菽之重，指力度相当于三颗豆子。皮毛相得，指浮至皮毛之分。肺脉最轻，所以其象如此。）如六颗豆子的重量，与血脉相得的，是心部的脉。如九颗豆子的重量，与肌肉相得的，是脾部的脉。如十二颗豆子的重量，与筋平齐的，是肝部的脉。按之至骨，举指时感觉疾速有力的，是肾部的脉，（血脉、肌肉、筋、骨，依次下沉，所以脉的轻重以此为准。大概肺居最上，心次之，脾次之，肝又次之，肾居最下。至骨，是沉取到了极点。举指来疾，指其有力而急迫，即第四难中“举指来实”的意思。）
第六难说：脉有阴盛阳虚，阳盛阴虚，是什么意思呢？（这与上文脉有阴阳的法度不同。上文讲脉属于阴、属于阳，是平脉；这里讲阴分之脉与阳分之脉，有过盛、不足的情况，是病脉。）
回答说：轻取（浮）脉象损小，重取（沉）脉象实大，所以叫阴盛阳虚。重取（沉）脉象损小，轻取（浮）脉象实大，所以叫阳盛阴虚。（浮脉主阳，沉脉主阴，损小则气血衰，实大则气血盛。）这就是阴阳虚实的意思。
第七难说：经文说少阳之至，脉象乍大乍小，乍短乍长；阳明之至，脉象浮大而短；太阳之至，脉象洪大而长；（少阳阳气尚微弱，离阴不远，所以其脉无定形。阳明之阳已盛，但尚未至极，所以浮大而短。太阳之阳极盛，所以洪大而长。至，指其气至而脉相应。）太阴之至，脉象紧大而长；少阴之至，脉象紧细而微；厥阴之至，脉象沉短而敦厚。（太阴为阴之始，所以有紧象，而尚有长大之阳脉。少阴之阴渐盛，所以紧细而微。厥阴为阴之极，所以沉短而敦厚，是阴脉的极致。）这六种脉象，是平脉呢？还是病脉呢？（平脉，是本然的脉象。病脉，是有过盛的脉象。）
回答说：都是王脉（当令之脉）。（王脉，得其时而气应生旺。）这些气在什么月份，各当令几日？
回答说：冬至之后遇到甲子日，少阳当令，（自古历元都起于冬至，那一日必定是甲子，然而一年三百六十五又四分之一日，所以日子有零余，每年递差，到至日不一定都是甲子，这里说冬至后得甲子，是指至日恰好是甲子的情况。至日是甲子，到立春后十五日经历一个甲子周期，木气始盛，所以叫少阳当令。如果至日不是甲子，少阳当令大概以六十天计算，不再以甲子为限。）再遇到甲子日，阳明当令，再遇到甲子日，太阳当令，再遇到甲子日，太阴当令，再遇到甲子日，少阴当令，再遇到甲子日，厥阴当令。（少阳之阳尚微弱。阳明则阳已盛。太阳则阳极盛，极则阴生而太阴用事；太阴之阴尚微弱，少阴则阴已盛，厥阴则阴极盛，极则阳生，如此循环不已。）每个当令六十天，（从甲子到下一个甲子，正好六十天一周。）六六三百六十天，构成一岁。这是三阳三阴当令时日的大概规律。（时指月言，日指日数言，用来回答上文何月几日的问题。）
第八难说：寸口脉象平和却死了，是什么原因呢？（平，指脉不病。）
回答说：所有的十二经脉，都系连于生气之原。所谓生气之原，就是十二经的根本，也就是肾间动气。（十二经见上文。系，连属。十二经之气皆从此出，所以叫根本。肾间，两肾中间。动气，气所开合出入之处，即所谓命门。其说法详见第三十六难。）这是五脏六腑的根本，十二经脉的根源，呼吸的门户，三焦的原动力。又名守邪之神。（吸入肾与肝，所以为呼吸之门，即所谓动气。三焦与肾同候，而肾属下焦，所以叫三焦之原，谓三焦所从出。守邪未详。有人说是元气充足，则邪不能伤，所以叫守邪，不知是否正确。）所以气，是人的根本，根绝则茎叶枯矣。（气，即原气。原气在人，犹如草木有根本，如果草木根绝，则茎叶枯落，人的原气，也是如此。）寸口脉象平和却死了，是因为生气独绝于内。（意思是内部的生气已绝，那么虽然外面的脉象很平和，终究不免于死。）
第九难说：凭什么来辨别脏腑的疾病呢？
回答说：数脉属腑，迟脉属脏。（腑属阳、脏属阴的缘故。）数脉则为热，迟脉则为寒。（这两句解释之所以迟数的原因。）诸阳脉主热，诸阴脉主寒。（这两句又解释之所以数属腑、迟属脏的原因。诸阴诸阳，是进一步推论。所以以此来辨别脏腑的病。）
第十难说：一脉变为十变，是什么意思呢？（一脉十变，指一脏之脉其变化有十种，如下文所说。）
回答说：（这是五邪刚柔相逢的意思。五邪，指五脏五腑之邪。刚柔，五脏为柔，五腑为刚。相逢，指脏邪干犯脏，腑邪干犯腑。下文详细说明。）假如心脉急甚者，是肝邪干犯心；心脉微急者，是胆邪干犯小肠；心脉大甚者，是心邪自干心；心脉微大者，是小肠邪自干小肠；心脉缓甚者，是脾邪干犯心；心脉微缓者，是胃邪干犯小肠；心脉涩甚者，是肺邪干犯心；心脉微涩者，是大肠邪干犯小肠；心脉沉甚者，是肾邪干犯心；心脉微沉者，是膀胱邪干犯小肠。（这就是所谓的十变。大概脏干脏则脉象显著，腑干腑则脉象轻微。急、大、缓、涩、沉，乃五脏的本脉，见到何脏之脉，就知道是何脏在干犯。候小肠于心脉，是因为《素问·血气形志篇》说：“手太阳与少阴为表里”。其余脏腑配合也依此类推。）五脏各有刚柔之邪，所以使得一脉辄变为十。（这两句是推论，举心为例，则五脏皆然，所以说各有、曰辄变。）
第十一难说：经文说脉不满五十动而有一次停顿，是一脏无气，这是什么意思（一作脏）呢？（《灵枢·根结篇》说：“五十动而不一代者，五脏皆受气。四十动一代者，一脏无气，三十动一代者，二脏无气。二十动一代者，三脏无气。十动一代者，四脏无气。不满十动一代者，五脏无气”。这里引用经文而概括地说。无气，指其气已绝，所以脉行至此，则断而不续。）
回答说：人吸气时，气随阴而入；呼气时，气因阳而出。（吸入肾与肝，所以吸随阴入。呼出心与肺，所以呼因阳出。）现在吸气不能到达肾，到肝就回来了（人一呼脉跳两次，一吸脉跳两次，说呼吸，是因为脉随呼吸而行。脉动未终而止，因此知道吸气不能至肾），所以知道一脏无气，是肾气先尽。（不能至肾，所以为肾气尽。）
第十二难说：经文说五脏脉已绝于内，用针的人反而充实其外；五脏脉已绝于外，用针的人反而充实其内。内外之绝，如何区别？（经文见《灵枢·九针十二原篇》。）
Difficulty 1 states: Among the twelve meridians, there are all pulsating arteries (The twelve meridians refer to the three Yin and three Yang meridians of the hands and feet. Pulsating artery refers to the pulse beating manifesting externally, such as at Tianfu or Yunmen points of the Hand-Taiyin Lung Meridian; pressing these areas makes the movement felt by the finger.), yet we exclusively select the Cun-Kou pulse (Cun-Kou refers to the area of Taiyuan and Jingqu points, encompassing the upper, middle, and lower sections of both wrists) to determine the life, death, auspiciousness, and inauspiciousness of the Zang and Fu organs. What is the reason for this?
It is answered: The Cun-Kou is the great gathering point of pulses, where the Hand-Taiyin Lung Meridian moves. ("Gathering" means convergence. The Hand-Taiyin is the meridian of the Lung. As stated in *Ling Shu: Dong Shu*: "The Stomach is the sea of the five Zang and six Fu organs; its clear Qi ascends to the Lung. Lung Qi travels along the Taiyin meridian... it moves with respiration." This is the meaning. Furthermore, *Ling Shu: Jing Mai* states that the Hand-Taiyin meridian "follows the Thenar eminence and emerges at the tip of the thumb.") In one exhalation, the pulse Qi travels three cun; in one inhalation, it travels three cun. Between a full breath cycle, the pulse Qi travels six cun. A person breathes 13,500 times in a day and night, and the pulse Qi circulates fifty times around the body. ("Exhalation" is breathing out. "Inhalation" is breathing in. *Ling Shu: Wu Shi Ying* states: "The human body has twenty-eight meridians up, down, left, right, front, and back, encircling the body with a length of 16 zhang 2 chi... between breath cycles, Qi travels six cun... after 270 breaths, Qi travels 16 zhang 2 chi... completing one circuit around the body... after 13,500 breaths, Qi completes fifty circuits." "Du" means to pass through, i.e., to go through once. The actual number of twenty-eight meridians is detailed in *Ling Shu: Mai Du*.)
Over one hundred ke (water clock units) (According to *Sui Shu*, water clocks originated from the Yellow Emperor. A day and night are divided into one hundred ke. An arrow floats in a pot, and as water drains, the marks indicate the passage of time, distinguishing day and night lengths.), Ying (Nutritive) and Wei (Defensive) Qi travel twenty-five circuits in the Yang aspects and twenty-five circuits in the Yin aspects, making one complete cycle. (Ying and Wei: *Ling Shu: Ying Wei Sheng Hui* states: "Humans receive Qi from grain. Grain enters the Stomach and transmits to the Lung. All five Zang and six Fu organs receive Qi. The clear part becomes Ying Qi, residing within the vessels; the turbid part becomes Wei Qi, residing outside the vessels." This is the meaning. When speaking of pulses collectively, Ying and Wei are included. Daytime Qi travels in Yang, nighttime Qi travels in Yin. Twenty-five circuits each for day and night make fifty circuits for one cycle. Since day and night vary in length, this describes the average. The methods of traveling in Yang/Yin and their starting/ending points are detailed in *Ling Shu: Wei Qi Xing*.)
Therefore, after fifty circuits, the Qi reconvenes at the Hand-Taiyin. The Cun-Kou is the beginning and end of the Qi of the five Zang and six Fu organs; thus, the method selects the Cun-Kou. (Starting and ending at the Hand-Taiyin, hence called "Zhong Shi". The Qi of the five Zang and six Fu organs manifests here, so selecting Cun-Kou can determine life/death and fortune/misfortune. *Ling Shu: Ying Wei Sheng Hui* states: "Ying Qi originates from the Middle Jiao, Wei Qi originates from the Lower Jiao. The Yellow Emperor asked about the origins of the Three Jiao. Qibo said: The Upper Jiao exits the upper opening of the Stomach, passes through the pharynx and diaphragm... follows the Taiyin division, returns to the Yangming, ascends to the tongue, descends to the Foot-Yangming, and always travels with Ying Qi for twenty-five circuits in Yang and twenty-five in Yin, constituting one cycle. Thus, after fifty circuits, they meet again at the Hand-Taiyin." This is the normal regulation of Ying and Wei.)
Difficulty 2 states: There are Cun and Chi in the pulse. What does this mean?
It is answered: Cun and Chi are the major convergence points of the pulse. (Details on Cun and Chi follow. "Yao Hui" refers to the critical location and gathering place.) From the Guan (Bar) point to the Chi (Cubit) position is the Chi interior, governed by Yin; from the Guan point to the Yuji (Fish Border) is the Cun (Inch) interior, governed by Yang. (The Guan point is the boundary between Cun and Chi, known as the high bone mentioned in *Mai Jue*. Below Guan is Chi, governing Kidney and Liver, with a deep pulse, thus belonging to Yin. Yuji is the white flesh named "Fish" on the medial side of the first metacarpophalangeal joint; the border between red and white flesh is Yuji. Above Guan is Cun-Kou, governing Heart and Lung, with a floating pulse, thus belonging to Yang.)
Therefore, dividing Cun creates Chi, and dividing Chi creates Cun. (These two sentences explain "Cun" and "Chi" clearly. It means taking one cun away from above Guan leaves Chi; taking one chi away from below Guan leaves Cun. This explains the naming.) Thus, Yin occupies one cun in the Chi section, and Yang occupies nine fen in the Cun section. (This divides the length within Cun and Chi to align with Yin-Yang numbers. One cun is an even number, nine fen is an odd number. Generally, from Guan down to Chize is called Chi, but pulse diagnosis only checks one cun below Guan. From Guan up to Yuji is called Cun, but pulse diagnosis only checks nine fen above Guan. Hence, "one cun in Chi, nine fen in Cun".) The total length of Cun and Chi from start to finish is one cun and nine fen, hence called Cun-Chi. (This combines the numbers of Cun and Chi. However, obtaining one cun is not called just "Cun", and nine fen is not called just "Fen", because they are within the Chi section and Cun section respectively.)
Difficulty 3 states: There are pulses of excess (Tai Guo), deficiency (Bu Ji), Yin overcoming Yang, Fu (covering/reversing), Yi (overflowing), Guan (closing), and Ge (blocking). What does this mean? (Tai Guo and Bu Ji are pathological pulses. Yin overcoming Yang means Yin exceeds and invades Yang; Yang overcoming Yin means Yang exceeds and invades Yin, representing severe excess/deficiency. Fu, Yi, Guan, and Ge represent severe overcoming.)
It is answered: Before the Guan point is the movement of Yang; the pulse should appear nine fen and be floating. (Before Guan is Yang. Floating is the image of Yang.) Exceeding this standard is termed Tai Guo (Excess); falling short is termed Bu Ji (Deficiency). If the pulse rises to the Yuji, it is called Yi (Overflowing) (Exceeding means floating beyond nine fen. Falling short means floating less than nine fen. Yuji is the Fish Border. Rising to Yuji indicates extreme excess. Yi means full and overflowing outwards). This is called Wai Guan Nei Ge (External Closing, Internal Blocking), which is a pulse of Yin overcoming. (Regarding Guan-Ge, Difficulty 37 states: If Yang Qi is too excessive, Yin cannot interact, called Guan; if Yin Qi is too excessive, Yang cannot interact, called Ge. Here, External Guan means Yang excess surges outward; Internal Ge means Yin excess blocks inward. Yin overcoming means Yin Qi ascends to the Yang position.) After the Guan point is the movement of Yin; the pulse should appear one cun and be deep. (After Guan is Yin. Deep is the image of Yin.) Exceeding this is Tai Guo; falling short is Bu Ji. If the pulse sinks into the Chi, it is called Fu (Covering/Reversing) (Exceeding means sinking beyond one cun. Falling short means sinking less than one cun. Chi is the section after one cun. Fu means reversing/tipping over). This is called Nei Guan Wai Ge (Internal Closing, External Blocking), which is a pulse of Yang overcoming. (Internal Guan means Yang reverses to the lower position, occupying Yin's place; External Ge means Yin reverses upward, occupying Yang's place. Yang overcoming means Yang Qi descends into Yin.) Therefore, it is called Fu and Yi. These are True Zang pulses; a person may die without apparent disease. (True Zang pulse means Zang Qi is exhausted. Its true form appears alone externally; death can be predicted regardless of other diseases. This should be read together with Difficulty 37.)
Difficulty 4 states: There is a method of Yin and Yang in pulses. What does this mean? (Yin and Yang refer to pulses belonging to Yin or Yang.)
It is answered: Exhalation involves the Heart and Lung; inhalation involves the Kidney and Liver. Between breaths, the Spleen receives the essence of grain. (Heart and Lung are superior, so exhalation comes from them, belonging to Yang. Kidney and Liver are inferior, so inhalation returns to them, belonging to Yin. Spleen governs the Central Palace, managing the interval of entry and exit. Receiving grain essence implies receiving Stomach Qi to reach the Hand-Taiyin.) Their pulse is in the middle. (In the middle, between Yin and Yang. Floating is Yang, Deep is Yin, hence Yin and Yang.) (Floating is exterior, thus Yang. Deep is interior, thus Yin.)
Both Heart and Lung pulses are floating; how to distinguish them? (Exhalation from Heart/Lung makes both float. Distinguish means to differentiate.)
It is answered: Floating, large, and scattered is the Heart pulse; floating, short, and choppy is the Lung pulse. (Heart belongs to Fire, so its image is large and scattered; Lung belongs to Metal, so its image is short and choppy. These are the fundamental pulses of Heart and Lung, while floating is their common trait.)
Both Kidney and Liver pulses are deep; how to distinguish them? (Inhalation to Kidney/Liver makes both deep.)
It is answered: Firm and long is the Liver pulse; soft upon pressure but firm when lifting the finger is the Kidney pulse. (Liver belongs to Wood, so its image is firm and long. Kidney belongs to Water, so its image is soft yet firm internally. Water is soft outside but hard inside.)
Spleen is in the Central Province, so its pulse is in the middle. This is the method of Yin and Yang. (In the middle, neither deep nor floating. The above explains Yin-Yang clearly; the following discusses interaction within Yin-Yang.)
There are pulses of one Yin one Yang, one Yin two Yang, one Yin three Yang; one Yang one Yin, one Yang two Yin, one Yang three Yin. Does this mean six pulses move simultaneously at Cun-Kou? (Simultaneous movement means all three Yin and three Yang are visible.)
It is answered: This does not mean six pulses move simultaneously, but refers to Floating, Deep, Long, Short, Slippery, and Choppy. (These are the so-called six pulses. Floating is upper, Deep is lower, Long exceeds the position, Short falls short of the position, Slippery is fluent, Choppy is stagnant. Floating, Deep, Long, Short describe shape; Slippery, Choppy describe texture.)
Floating is Yang, Slippery is Yang, Long is Yang; Deep is Yin, Short is Yin, Choppy is Yin. (These are the three Yin and three Yang.) So-called "One Yin One Yang" means the pulse comes Deep and Slippery; "One Yin Two Yang" means Deep, Slippery, and Long; "One Yin Three Yang" means Floating, Slippery, and Long, occasionally appearing Deep. "One Yang One Yin" means Floating and Choppy; "One Yang Two Yin" means Long, Deep, and Choppy; "One Yang Three Yin" means Deep, Choppy, and Short, occasionally appearing Floating. (These are images of mixed pulses. This is an example; they interweave and are not fixed. Note that Floating and Deep can combine, but Slippery/Choppy and Long/Short cannot coexist.) Based on the meridian involved, name the disease as Ni (Reverse) or Shun (Smooth). (The previous text discussed pulse forms without judging fortune; this discusses judgment. The meridians are the hand and foot three Yin and three Yang. Reverse/Smooth: e.g., Heart pulse should be Floating, Kidney pulse should be Deep for Smooth; if Heart is Deep and Kidney is Floating, it is Reverse. This shows pulses have no fixed form and depend on the meridian for judgment.)
Difficulty 5 states: There is lightness and heaviness in pulses. What does this mean? (Light is floating and weak; Heavy is deep and strong.)
It is answered: Initially holding the pulse with the weight of three beans, touching the skin and hair, is the Lung pulse. (Holding the pulse means pressing. Bean is a general term for legumes. Weight of three beans means force equivalent to three beans. Touching skin/hair means floating to the skin level. Lung pulse is lightest, hence this image.) With the weight of six beans, touching the blood vessels, is the Heart pulse. With the weight of nine beans, touching the muscles, is the Spleen pulse. With the weight of twelve beans, level with the tendons, is the Liver pulse. Pressing to the bone, with a quick response upon lifting the finger, is the Kidney pulse. (Blood vessels, muscles, tendons, bones descend in depth, so pulse lightness/heaviness is based on this. Lung is highest, then Heart, Spleen, Liver, Kidney lowest. To the bone is the deepest press. Quick response means strong and urgent, same meaning as "firm upon lifting" in Difficulty 4.)
Difficulty 6 states: There is Yin Excess Yang Deficiency, and Yang Excess Yin Deficiency. What does this mean? (This differs from the Yin-Yang method above. The above discussed pulses belonging to Yin/Yang as normal; this discusses pathological excess/deficiency in Yin/Yang branches.)
It is answered: If Floating pulse is damaged/small and Deep pulse is solid/large, it is called Yin Excess Yang Deficiency. If Deep pulse is damaged/small and Floating pulse is solid/large, it is called Yang Excess Yin Deficiency. (Floating pulse governs Yang, Deep pulse governs Yin. Damaged/small means Qi/Blood decline; Solid/large means Qi/Blood abundance.) This is the meaning of Yin-Yang Deficiency-Excess.
Difficulty 7 states: The Classics say: Shaoyang to the peak, pulses suddenly large, suddenly small, suddenly short, suddenly long; Yangming to the peak, pulses Floating, Large, and Short; Taiyang to the peak, pulses洪 (Vast/Surging), Large, and Long; (Shaoyang Yang Qi is still slight, close to Yin, so pulse is不定 (variable). Yangming Yang is already abundant but not extreme, so Floating, Large, Short. Taiyang Yang is extremely abundant, so Vast, Large, Long. "To the peak" means Qi arrives and pulse responds.) TAIyin to the peak, pulses Tight, Large, and Long; Shaoyin to the peak, pulses Tight, Fine, and Micro; Jueyin to the peak, pulses Deep, Short, and敦 (Solid/Round). (Taiyin is start of Yin, so has Tight image but still has Long/Large Yang pulse. Shaoyin Yin gradually increases, so Tight, Fine, Micro. Jueyin is extreme of Yin, so Deep, Short, Solid, extreme of Yin pulse.) Are these six normal pulses or pathological pulses? (Normal pulse is natural; Pathological pulse is excessive.)
It is answered: They are Wang (Dominant/Seasonal) pulses. (Wang pulse means Qi corresponds to the season of dominance.) In which month, and for how many days does each dominate?
It is answered: After Winter Solstice, when Jiazi day arrives, Shaoyang dominates. (Ancient calendars start from Winter Solstice, which must be Jiazi. However, a year is 365.25 days, causing drift, so Solstice isn't always Jiazi. "Jiazi after Solstice" refers to when Solstice is Jiazi. On Jiazi Solstice, after 15 days post-Lichun (Spring Start), a Jiazi cycle completes, Wood Qi begins to flourish, hence Shaoyang dominates. If Solstice is not Jiazi, Shaoyang dominance lasts roughly 60 days, not limited by Jiazi.) When Jiazi day arrives again, Yangming dominates; again, Taiyang; again, Taiyin; again, Shaoyin; again, Jueyin. (Shaoyang Yang is slight. Yangming Yang is abundant. Taiyang Yang is extreme; extreme generates Yin, so Taiyin acts. Taiyin Yin is slight; Shaoyin Yin is abundant; Jueyin Yin is extreme; extreme generates Yang. This cycle continues endlessly.) Each dominates for sixty days. (From Jiazi to next Jiazi is sixty days, one cycle.) Six times sixty is 360 days, forming a year. This is the general rule of Three Yang and Three Yin dominance periods. (Month refers to time, Days refers to duration, answering the previous question.)
Difficulty 8 states: Cun-Kou pulse is peaceful, yet the person dies. What is the reason? (Peaceful means pulse is not diseased.)
It is answered: All twelve meridians are connected to the Source of Life Qi. The Source of Life Qi is the root of the twelve meridians, also known as the Moving Qi between the Kidneys. (Twelve meridians seen above. Connected means linked. Qi of twelve meridians originates here, hence root. Between Kidneys is the space between the two kidneys. Moving Qi is where Qi opens/closes/exits/enters, i.e., Mingmen. Detailed in Difficulty 36.) This is the root of five Zang and six Fu organs, the root of twelve meridians, the gate of respiration, and the source of Sanjiao. Also called the Spirit guarding against Evil. (Inhalation to Kidney/Liver makes it the gate of respiration, i.e., Moving Qi. Sanjiao matches Kidney, Kidney is Lower Jiao, so it is source of Sanjiao. Guarding Evil is unclear. Some say sufficient Yuan Qi prevents evil invasion, hence "Guarding Evil". Uncertain.) Thus, Qi is the root of humans; if the root perishes, stems and leaves wither. (Qi is Yuan Qi. Yuan Qi in humans is like roots in plants; if roots perish, stems/leaves wither; human Yuan Qi is the same.) Cun-Kou pulse is peaceful yet death occurs because the Life Qi is uniquely severed internally. (Meaning internal Life Qi is exhausted; even if external pulse is peaceful, death is inevitable.)
Difficulty 9 states: How to distinguish Zang and Fu diseases?
It is answered: Rapid pulses belong to Fu, Slow pulses belong to Zang. (Fu is Yang, Zang is Yin.) Rapid indicates Heat, Slow indicates Cold. (Explains why Slow/Rapid.) All Yang pulses indicate Heat, all Yin pulses indicate Cold. (Further explains why Rapid belongs to Fu and Slow to Zang. All Yin/Yang extends the reasoning. Thus, to distinguish Zang/Fu diseases.)
Difficulty 10 states: One pulse changes ten times. What does this mean? (One pulse ten changes means one Zang pulse has ten variations, as described below.)
It is answered: (This refers to the meeting of Five Evils with Gang-Rou. Five Evils are evils of five Zang and five Fu. Gang-Rou: Five Zang are Rou (Soft), Five Fu are Gang (Hard). Meeting means Zang evil invading Zang, Fu evil invading Fu. Detailed below.) For example, if Heart pulse is extremely Urgent, it is Liver evil invading Heart; if Heart pulse is slightly Urgent, it is Gallbladder evil invading Small Intestine; if Heart pulse is extremely Large, it is Heart evil invading Heart; if Heart pulse is slightly Large, it is Small Intestine evil invading Small Intestine; if Heart pulse is extremely Relaxed, it is Spleen evil invading Heart; if Heart pulse is slightly Relaxed, it is Stomach evil invading Small Intestine; if Heart pulse is extremely Choppy, it is Lung evil invading Heart; if Heart pulse is slightly Choppy, it is Large Intestine evil invading Small Intestine; if Heart pulse is extremely Deep, it is Kidney evil invading Heart; if Heart pulse is slightly Deep, it is Bladder evil invading Small Intestine. (This is the ten changes. Zang invading Zang makes pulse significant; Fu invading Fu makes pulse slight. Urgent, Large, Relaxed, Choppy, Deep are fundamental pulses of five Zangs. Seeing which pulse indicates which Zang is invading. Observing Small Intestine via Heart pulse is because *Su Wen: Xue Qi Xing Zhi* says: "Hand-Taiyang and Hand-Shaoyin are exterior-interior." Other pairings follow this.) Each Zang has Gang-Rou evils, causing one pulse to change ten times. (These two sentences generalize, using Heart as example, so all Zangs are the same, hence "each has" and "changes".)
Difficulty 11 states: The Classics say the pulse stops before fifty beats, indicating one Zang has no Qi. What does this mean? (*Ling Shu: Gen Jie* states: "Fifty beats without interruption means five Zangs receive Qi. Forty beats with one interruption means one Zang has no Qi... Ten beats with one interruption means four Zangs have no Qi. Less than ten beats with one interruption means five Zangs have no Qi." This cites and summarizes the Classic. No Qi means Qi is exhausted, so pulse flow breaks here.)
It is answered: Inhalation follows Yin entering; Exhalation follows Yang exiting. (Inhalation to Kidney/Liver, so follows Yin. Exhalation from Heart/Lung, so follows Yang.) Now inhalation cannot reach the Kidney, returning at the Liver. (One exhalation two beats, one inhalation two beats. Speaking of respiration relates to pulse movement. Pulse stops before completion, knowing inhalation doesn't reach Kidney.) Thus, knowing one Zang has no Qi, it is Kidney Qi that is exhausted first. (Cannot reach Kidney, so Kidney Qi is exhausted.)
Difficulty 12 states: The Classics say if Five Zang pulses are exhausted internally, acupuncturists mistakenly tonify externally; if Five Zang pulses are exhausted externally, acupuncturists mistakenly tonify internally. How to distinguish internal and external exhaustion? (Classic cited from *Ling Shu: Jiu Zhen Shi Er Yuan*.)
It is answered: Five Zang pulses exhausted internally means Kidney and Liver pulses are exhausted internally, yet doctors mistakenly tonify Heart and Lung; Five Zang pulses exhausted externally means Heart and Lung pulses