吕曰。夏心主。脉见浮大而散。今反弦。弦者、肝脉来干心也。杨曰。干。犹乘也。虞曰。母乘子曰虚邪。
心脉微急者。胆邪干小肠也。
吕曰。小肠、心之府。脉当浮大而洪。长而微弦者。胆脉也。虞曰。阳干于阳。阴干于阴。同气相求也。
心脉大甚者。心邪自干心也。
吕曰。心脉虽洪大。当以胃气为本。今无胃甚。（按甚字疑当作气。）故其脉大甚也。此为心自病。故言自干心也。
虞曰。此失时脉也。
心脉微大者。小肠邪自干小肠也。
吕曰。小肠、心之府。微大者、其脉小。为小肠自病。故言自干也。虞曰。小肠、太阳脉也。王于五六月。其脉洪
大而长。今得之微大。是知小肠之邪。自干小肠也。此曰正经自病。法曰正邪。故云自干也。
心脉缓甚者。脾邪干心也。
吕曰。缓者、脾脉乘心。故令心脉缓也。虞曰。心脉见缓甚。此曰子之乘母。法曰实邪。
心脉微缓者、胃邪干小肠也。
吕曰。胃脉小缓见于心部。小肠。心府。故言干之。虞曰。于心部中。轻手得之小缓是也。
心脉涩甚者。肺邪干心也。
吕曰。涩、肺脉故言干心也。虞曰。金反凌火。此曰微邪脉也。
心脉微涩者。大肠邪干小肠也。
吕曰。微涩、大肠脉。小肠。心府。故曰干也。
心脉沉甚者。肾邪干心也。
吕曰。沉者、肾脉。故言干也。虞曰。心火炎上。其脉本浮。今见沉形。水来克火。法曰贼邪也。
心脉微沉者、膀胱邪干小肠也。
吕曰。微沉者、膀胱脉也。小肠。心府。故言干也。
五脏各有刚柔邪。故令一脉辄变为十也。
吕曰。此皆夏王之时。心脉见如此者。为失时脉。杨曰。刚柔阴阳也。邪者、不正之名。非有身王气。而水来干身
为病者。通谓之邪也。虞曰。推此十变之候。乃五行胜复相加。故圣人谓之五邪也。五脏各有表里。更相乘之。一脉成
十。故十变也。有阳有阴。故曰刚柔也。于本位见他脉。故曰相逢干也。圣人乃以心一脏为例。其余皆可知也。丁曰。
其言肝邪干心。胆邪干小肠者。此皆虚邪干心也。心邪自干心。小肠邪自干小肠者。此皆为正邪也。脾邪干心。胃邪干
小肠者。此皆为实邪也。肺邪干心。大肠邪干小肠者。此皆微邪也，肾邪干心。膀胱邪干小肠者。此皆贼邪也。所谓刚
柔相逢者。则十杂也。其十杂者。甲与己合。甲为刚。己为柔。戊与癸合。戊为刚。癸为柔。丁与壬合。丁为刚。壬为
柔。丙与辛合。丙为刚。辛为柔。乙与庚合。乙为刚。庚为柔。凡刚柔相逢为病者。刚甚则为病重。柔甚则为病微。柔
逢刚。谓从所不胜于刚。故为病甚也。刚逢柔。谓从所胜于柔。故为病微也。其一脉十变之法。是师引此一部之中。二
经说此。五邪相干。为之十变。凡两手三部。各有二经六部之内。各有五邪十变也。故从其首。计其数。六部十变也。
数有六十。是谓六十首也。黄帝曰。先持阴阳。然后诊六十首之谓也。
十一难曰。经言脉不满五十动而一止。
吕曰。经言一脏五十动。五脏二百五十动。谓之平脉。不满五十动者。无有五十动也。是以一脏无气也。
一脏无气者、何脏也。然。人吸者随阴入。呼者因阳出。今吸不能至肾至肝而还。故知一脏无气者、肾气先尽也。
杨曰。按经言持其脉口。数其至也。五十动而不一代者。五脏皆受气。是为平和无病之人矣。四十动而一代者。一
脏无气。四岁死。三十动而一代者。二脏无气。三岁死。二十动而一代者。三脏无气。二岁死。十动而一代者。四脏无
气。一岁死。不满十动而一代者。五脏无气也。七日死。难经言止。本经言代。按止者、按之觉于指下而中止。名止。
代者、还尺中停久方来。名曰代也。止代虽两经不同。据其脉状亦不殊别。故两存之。虞曰。此与第八难生气独绝之义
略相似。八难言父母生气源。已绝于两肾之间。故云死也。此言一脏无气。言呼吸之间。肺行谷气。肾间父母之原气。
亦无谷气所养。原气渐耗。乃知四岁必死。故云肾气先尽也。丁曰。五十动者。是天地阴阳。以漏刻为制度。人之脉息。
为自有损益。故无常数。其益过于六十。心肺有余也。心肺有余。则肾肝不足也。其损者不及四十之数。则心肺不足。
乃肾肝有余也。今阳气虚少。故不满五十也。其言动而止者。谓吸不能至肾至肝而还。此是阳不荣于下。故肾气先绝也。
绝则止也。此法又与生气独绝于内同法也。
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。然。
五脏脉已绝于内者。肾肝气已绝于内也。而医反补其心肺。五脏脉已绝于外者。其心肺脉已绝于外也。（别本无其字。与
上文一例。）而医反补其肾肝。阳绝补阴。阴绝补阳。是谓实实虚虚。损不足。益有余。如此死者。医杀之耳。
吕曰。心肺所以在外者。其脏在膈上。上气外为荣卫。浮行皮肤血脉之中。故言绝于外也。肾肝所以在内者。其脏
在膈下。下气内养筋骨。故言绝于内也。丁曰。夫五脏内外者。为心肺在膈上。通于天气也。心主于脉。肺主于气。外
华荣于皮肤。故言外也。肾肝在下。通于地气。以藏精血。最于骨髓。心肺外绝。绝则皮聚毛落。肾肝内绝。绝则骨痿
筋缓，诊其脉。学人不能明于内外虚实。致使针药误投。所以实实虚虚。损不足。益有余。如此死者。是医杀之耳。
吕氏说：夏季对应心脏，脉象应当表现为浮大而散。现在反而出现弦脉。弦脉是肝脉，说明肝气干扰了心气。
杨氏说：“干”，就是“乘”（克制、侵犯）的意思。
吕氏说：小肠是心的腑，脉象应当浮大且洪盛，长而微带弦象，这是胆脉的表现。
虞氏说：阳邪侵犯阳位，阴邪侵犯阴位，这是同气相求的结果。
吕氏说：心脉虽然洪大，但应以胃气为本底。现在没有胃气，反而显得极大。（按语：原文中的“甚”字疑为“气”字之误。）所以脉象极大。这是心脏自身的病变，所以说心邪自我干扰心脏。
吕氏说：小肠是心的腑，脉象微大，实际上是指脉小。这是小肠自身的病变，所以说自我干扰。
虞氏说：小肠对应太阳经脉，旺于五月和六月，其脉象应当洪大且长。现在得到的是微大的脉象，由此可知是小肠的邪气自我干扰小肠。这叫做正经自病，法理上称为正邪，所以说自我干扰。
虞氏说：心脉见到极甚的缓象，这叫子脏乘袭母脏，法理上称为实邪。
吕氏说：胃脉的小缓之象出现在心部（寸口脉的心脉部位），小肠是心的腑，所以说干扰它。
虞氏说：心火炎上，其脉本应浮起。现在见到沉形，是水来克火，法理上称为贼邪。
吕氏说：这些都是夏季当令之时，心脉出现上述情况，属于违背时令的脉象。
杨氏说：刚柔指阴阳。邪，是不正的名称，并非指人体正气旺盛，而是外邪如水气等干扰人体导致疾病，通称为邪。
虞氏说：推究这十种变化的脉候，乃是五行胜复相互加临的结果，所以圣人称之为五邪。五脏各有表里关系，互相乘袭，一脉便形成十种变化，所以叫十变。有阳有阴，所以叫刚柔。在本位见到其他脉象，所以叫相逢干扰。圣人拿心脏这一脏作为例子，其余各脏都可以类推。
丁氏说：文中所说的肝邪干扰心、胆邪干扰小肠，这些都属于虚邪干扰心脏。心邪自我干扰心、小肠邪自我干扰小肠，这些都属于正邪。脾邪干扰心、胃邪干扰小肠，这些都属于实邪。肺邪干扰心、大肠邪干扰小肠，这些都属于微邪。肾邪干扰心、膀胱邪干扰小肠，这些都属于贼邪。所谓刚柔相逢，就是这十种杂合的情况。这十种杂合中，甲与己相合，甲为刚，己为柔；戊与癸相合，戊为刚，癸为柔；丁与壬相合，丁为刚，壬为柔；丙与辛相合，丙为刚，辛为柔；乙与庚相合，乙为刚，庚为柔。凡是刚柔相逢致病的情况，刚气偏盛则病重，柔气偏盛则病轻。柔气逢遇刚气的，是从属于被刚气所不胜的关系，所以病重。刚气逢遇柔气的，是从属于胜过柔气的关系，所以病轻。这一脉十变的方法，是老师引用本书中两篇经文来说明这个问题。五邪相互干扰，形成十变。凡两手三部脉，各有两条经脉六部脉位，每部脉位内都有五邪十变的情况。所以从头部开始计算数量，六部脉共有六十种变化，这就是所谓的“六十首”。黄帝说：先把握阴阳原则，然后诊察六十首脉象，说的就是这个道理。
第十一难说：经文记载脉搏不满五十次跳动就出现一次歇止。
吕氏说：经文说一脏脉跳动五十次，五脏共二百五十次跳动，称为平脉。不满五十次跳动的，是没有达到五十次跳动。因此是一脏无气。
问：哪一脏无气呢？回答：人吸气时，气随阴气进入体内；呼气时，气因阳气出于体外。现在吸气不能到达肾脏和肝脏就返回来了，所以知道一脏无气，是肾气最先耗尽。
杨氏说：按照经文所说，持守脉口，计数脉搏跳动。五十次跳动而没有一次代脉的，说明五脏都接受了气血，这是平和无病的人。四十次跳动出现一次代脉的，一脏无气，四年后死亡。三十次跳动出现一次代脉的，二脏无气，三年后死亡。二十次跳动出现一次代脉的，三脏无气，两年后死亡。十次跳动出现一次代脉的，四脏无气，一年后死亡。不满十次跳动就出现代脉的，五脏无气，七天后死亡。《难经》说的是“止”，《内经》说的是“代”。按语：止，是指按压手指下感觉脉搏中途停止，名叫止。代，是指脉搏回到尺部停留较长时间才来，名叫代。止和代虽然两部经典表述不同，但根据脉状来看也没有太大区别，所以两者并存。
虞氏说：这与第八难中“生气独绝”的意义大致相似。第八难说父母的生气源头，已经断绝于两肾之间，所以说死。这里说一脏无气，是指在呼吸之间，肺运行水谷精气，而肾间父母的原气，也没有水谷精气的滋养，原气逐渐消耗，从而知道四年后必死，所以说肾气最先耗尽。
丁氏说：五十次跳动，是天地阴阳以漏刻（计时器）为制度。人的脉息，自有增减损益，所以没有固定的常数。如果增加超过六十次，是心肺有余。心肺有余，则肾肝不足。如果减少不及四十次，则是心肺不足，乃至于肾肝有余。现在阳气虚弱稀少，所以不满五十次。文中说“动而止”，是指吸气不能到达肾脏和肝脏就返回。这是阳气不能荣养下部，所以肾气最先断绝。断绝就是停止。这种方法又与“生气独绝于内”的法度相同。
第十二难说：经文记载五脏脉在内部已经绝灭，用针的人反而充实外部；五脏脉在外部已经绝灭，用针的人反而充实内部。内部的绝灭和外部的绝灭，如何区分呢？回答：五脏脉在内部已经绝灭，是指肾肝之气在内部已经绝灭，而医生反而补益心肺。五脏脉在外部已经绝灭，是指心肺之脉在外部已经绝灭。（别本没有“其”字，与上文体例一致），而医生反而补益肾肝。阳绝却补阴，阴绝却补阳，这叫作“实实虚虚”，损害不足的，增益有余的。像这样导致死亡的，是医生杀死了病人。
吕氏说：心肺之所以称为在外，是因为它们的脏器在膈肌之上，上焦之气向外化为营卫，浮行于皮肤血脉之中，所以说绝于外。肾肝之所以称为在内，是因为它们的脏器在膈肌之下，下焦之气向内滋养筋骨，所以说绝于内。
丁氏说：五脏的内与外，是因为心肺在膈肌之上，通应于天气。心主脉，肺主气，外在荣华于皮肤，所以称为外。肾肝在下，通应于地气，储藏精血，深藏于骨髓。心肺外绝，绝灭则皮毛枯聚脱落；肾肝内绝，绝灭则骨痿筋缓。诊察脉象时，学习者如果不能明辨内外虚实，致使针药误投，所以造成实实虚虚，损害不足，增益有余。像这样导致死亡的，是医生杀死了病人。
Lu stated: In summer, the Heart is dominant. The pulse should appear floating, large, and scattered (Fudashang Mai). Now it appears wiry (Xian Mai). A wiry pulse is the Liver pulse; this indicates that Liver Qi is interfering with Heart Qi.
Yang stated: "Gan" (interfere) means to overcome or invade (Cheng).
Yu stated: When the Mother organ's Qi invades the Child organ, it is called Deficient Evil (Xu Xie).
If the Heart pulse is slightly urgent (Wei Ji), it is Gallbladder Evil interfering with the Small Intestine.
Lu stated: The Small Intestine is the Fu organ of the Heart. The pulse should be floating, large, and vigorous (Hong), long, and slightly wiry, which represents the Gallbladder pulse.
Yu stated: Yang evil interferes with Yang positions, and Yin evil interferes with Yin positions; this is due to the attraction of similar energies (Tong Qi Xiang Qiu).
If the Heart pulse is extremely large (Da Shen), it is Heart Evil interfering with the Heart itself.
Lu stated: Although the Heart pulse is vigorous and large, it should be rooted in Stomach Qi (Wei Qi). Now there is no Stomach Qi, but rather an excessive appearance. (Note: The character "Shen" [extreme] in the original text is suspected to be a typo for "Qi"). Therefore, the pulse appears extremely large. This is a disease of the Heart itself, hence it is said that Heart Evil interferes with the Heart itself.
Yu stated: This is a pulse contrary to the season (Shi Shi Mai).
If the Heart pulse is slightly large (Wei Da), it is Small Intestine Evil interfering with the Small Intestine itself.
Lu stated: The Small Intestine is the Fu organ of the Heart. A slightly large pulse actually refers to a small pulse. This is a disease of the Small Intestine itself, hence it is said to interfere with itself.
Yu stated: The Small Intestine corresponds to the Taiyang pulse, which dominates in the fifth and sixth months. Its pulse should be vigorous, large, and long. Now obtaining a slightly large pulse indicates that Small Intestine Evil is interfering with the Small Intestine itself. This is called Zheng Jing Zi Bing (Self-disease of the regular meridians), and according to the principles, it is called Zheng Xie (Regular Evil), hence it is said to interfere with itself.
If the Heart pulse is excessively slow/relaxed (Huan Shen), it is Spleen Evil interfering with the Heart.
Lu stated: A slow/relaxed pulse is the Spleen pulse; the Spleen pulse overcomes the Heart, thus causing the Heart pulse to become slow/relaxed.
Yu stated: If the Heart pulse shows an excessive slow/relaxed quality, this is called the Child organ overcoming the Mother organ, and according to the principles, it is called Excess Evil (Shi Xie).
If the Heart pulse is slightly slow/relaxed (Wei Huan), it is Stomach Evil interfering with the Small Intestine.
Lu stated: The slight slowness/relaxation of the Stomach pulse appears in the Heart position (Cun Kou pulse Heart position). Since the Small Intestine is the Fu organ of the Heart, it is said to interfere with it.
Yu stated: Within the Heart pulse position, feeling slight slowness/relaxation upon light palpation is what is meant.
If the Heart pulse is excessively choppy (Se Shen), it is Lung Evil interfering with the Heart.
Lu stated: A choppy pulse is characteristic of the Lung pulse; hence it is said to interfere with the Heart.
Yu stated: Metal counter-attacks Fire; this is called Micro Evil Pulse (Wei Xie Mai).
If the Heart pulse is slightly choppy (Wei Se), it is Large Intestine Evil interfering with the Small Intestine.
Lu stated: Slight chopiness is the Large Intestine pulse. Since the Small Intestine is the Fu organ of the Heart, it is said to interfere.
If the Heart pulse is excessively deep (Chen Shen), it is Kidney Evil interfering with the Heart.
Lu stated: A deep pulse is the Kidney pulse; hence it is said to interfere.
Yu stated: Heart Fire flares upward, so its pulse should originally be floating. Now seeing a deep form indicates Water overcoming Fire; according to the principles, this is called Thief Evil (Ze Xie).
If the Heart pulse is slightly deep (Wei Chen), it is Bladder Evil interfering with the Small Intestine.
Lu stated: Slight depth is the Bladder pulse. Since the Small Intestine is the Fu organ of the Heart, it is said to interfere.
Each of the Five Zang organs has Gang (Hard/Yang) and Rou (Soft/Yin) evils, thus causing one pulse type to transform into ten variations.
Lu stated: These all occur during the time when Summer is dominant. If the Heart pulse appears as described above, it is a pulse contrary to the season.
Yang stated: Gang and Rou refer to Yin and Yang. "Evil" is a name for abnormality; it does not refer to the body's own righteous Qi being abundant, but rather external evils (such as Water Qi) interfering with the body to cause disease, collectively termed Evil.
Yu stated: Deduced from these ten variations of pulse conditions, it is the mutual addition of the Five Elements' victory and recovery cycles. Thus, the Sages call them the Five Evils. Each Zang organ has exterior-interior relationships, mutually overcoming each other, so one pulse forms ten variations, hence called Ten Variations. There is Yang and Yin, hence called Gang and Rou. Seeing other pulses at the primary position is called meeting and interfering. The Sage uses the Heart as an example; the others can be inferred similarly.
Ding stated: What is said about Liver Evil interfering with the Heart and Gallbladder Evil interfering with the Small Intestine are all cases of Xu Xie (Deficient Evil) interfering with the Heart. Heart Evil interfering with the Heart and Small Intestine Evil interfering with the Small Intestine are cases of Zheng Xie (Regular Evil). Spleen Evil interfering with the Heart and Stomach Evil interfering with the Small Intestine are cases of Shi Xie (Excess Evil). Lung Evil interfering with the Heart and Large Intestine Evil interfering with the Small Intestine are cases of Wei Xie (Micro Evil). Kidney Evil interfering with the Heart and Bladder Evil interfering with the Small Intestine are cases of Ze Xie (Thief Evil). The so-called "Gang Rou Xiang Feng" refers to the ten mixed states. Among these ten mixed states: Jia combines with Ji, Jia is Gang, Ji is Rou; Wu combines with Gui, Wu is Gang, Gui is Rou; Ding combines with Ren, Ding is Gang, Ren is Rou; Bing combines with Xin, Bing is Gang, Xin is Rou; Yi combines with Geng, Yi is Gang, Geng is Rou. In cases where Gang and Rou meet to cause disease, if Gang is excessive, the disease is severe; if Rou is excessive, the disease is mild. Rou meeting Gang means submitting to what cannot overcome Gang, hence the disease is severe. Gang meeting Rou means submitting to what overcomes Rou, hence the disease is mild. The method of one pulse transforming into ten is cited by the Master from two chapters in this work. The five evils interfering with each other create ten variations. In both hands, across three positions, there are two meridians and six pulse positions. Within each of the six positions, there are five evils and ten variations. Counting from the beginning, the six positions yield sixty variations, which is called "Sixty Shou" (Sixty Heads/Sections). The Yellow Emperor said: First grasp Yin and Yang, then diagnose the Sixty Shou; this is what is meant.
Chapter 11 states: The Classics mention that the pulse stops after fewer than fifty beats.
Lu stated: The Classics say that one Zang organ pulses fifty times, and the five Zang organs pulse two hundred and fifty times, which is called a Normal Pulse (Ping Mai). Fewer than fifty beats means failing to reach fifty beats. Therefore, one Zang organ lacks Qi.
Question: Which Zang organ lacks Qi? Answer: When a person inhales, Qi enters following Yin; when exhaling, Qi exits following Yang. Now, inhalation cannot reach the Kidneys and Liver before returning. Thus, we know that when one Zang organ lacks Qi, it is the Kidney Qi that is exhausted first.
Yang stated: According to the Classics, holding the pulse at the mouth (Mai Kou) and counting its beats: if there are fifty beats without a single Dai Mai (Intermittent Pulse), the five Zang organs have received Qi, indicating a peaceful, disease-free person. Forty beats with one Dai Mai indicate one Zang organ lacks Qi, leading to death in four years. Thirty beats with one Dai Mai indicate two Zang organs lack Qi, leading to death in three years. Twenty beats with one Dai Mai indicate three Zang organs lack Qi, leading to death in two years. Ten beats with one Dai Mai indicate four Zang organs lack Qi, leading to death in one year. Fewer than ten beats with one Dai Mai indicate five Zang organs lack Qi, leading to death in seven days. The *Nan Jing* uses the term "Zhi" (Stop), while the *Nei Jing* uses "Dai". Note: "Zhi" refers to the sensation under the finger that the pulse stops midway, named Zhi. "Dai" refers to the pulse returning to the Chi position and pausing for a long time before coming again, named Dai. Although the two classics differ in terminology, the pulse condition is not significantly different, so both are preserved.
Yu stated: This is roughly similar in meaning to the concept of "Sheng Qi Du Jue" (Vital Qi Alone Cut Off) in Chapter 8. Chapter 8 states that the source of the parents' vital Qi has been cut off between the two kidneys, hence death. Here, stating that one Zang organ lacks Qi refers to the fact that within respiration, the Lungs distribute Grain Qi, but the Yuan Qi of the parents in the Kidney region also lacks nourishment from Grain Qi. As the Yuan Qi gradually depletes, we know death will occur in four years, hence it is said that Kidney Qi is exhausted first.
Ding stated: Fifty beats correspond to the system of Heaven and Earth's Yin and Yang measured by clepsydra (water clock). Human pulse rhythm has its own increases and decreases, so there is no fixed number. If it exceeds sixty beats, it indicates excess in the Heart and Lungs. Excess in Heart and Lungs implies deficiency in the Kidneys and Liver. If it falls below forty beats, it indicates deficiency in the Heart and Lungs, implying excess in the Kidneys and Liver. Now, because Yang Qi is deficient and scarce, it is fewer than fifty beats. The phrase "movement then stop" refers to inhalation not reaching the Kidneys and Liver before returning. This is Yang failing to nourish the lower part, hence Kidney Qi is cut off first. Cutting off means stopping. This method is consistent with the principle of "Vital Qi Alone Cut Off Internally."
Chapter 12 states: The Classics state that if the pulses of the five Zang organs are already extinct internally, the acupuncturist erroneously tonifies the exterior; if the pulses of the five Zang organs are already extinct externally, the acupuncturist erroneously tonifies the interior. How can internal extinction and external extinction be distinguished? Answer: If the pulses of the five Zang organs are extinct internally, it means the Qi of the Kidneys and Liver is extinct internally, yet the physician erroneously tonifies the Heart and Lungs. If the pulses of the five Zang organs are extinct externally, it means the pulses of the Heart and Lungs are extinct externally (The alternative version omits the character "Qi", consistent with the previous text), yet the physician erroneously tonifies the Kidneys and Liver. Tonifying Yin when Yang is extinct, and tonifying Yang when Yin is extinct, is called "Shi Shi Xu Xu" (Making the Excess Excess and the Deficient Deficient), damaging what is insufficient and benefiting what is excessive. Death resulting from such actions is murder by the physician.
Lu stated: The Heart and Lungs are considered "external" because their organs are located above the diaphragm. The Upper Jiao Qi transforms outward into Ying and Wei (Nutritive and Defensive Qi), floating within the skin and blood vessels, hence it is said to be extinct externally. The Kidneys and Liver are considered "internal" because their organs are located below the diaphragm. The Lower Jiao Qi nourishes internally the sinews and bones, hence it is said to be extinct internally.
Ding stated: The internal and external aspects of the five Zang organs exist because the Heart and Lungs are above the diaphragm, connecting with Heavenly Qi. The Heart governs the vessels, and the Lungs govern Qi, manifesting externally as luster on the skin, hence they are called external. The Kidneys and Liver are below, connecting with Earthly Qi, storing Essence and Blood, deeply hidden in the bone marrow. Extinction of the Heart and Lungs externally leads to accumulation of skin and falling hair; extinction of the Kidneys and Liver internally leads to bone萎 (atrophy/flaccidity) and loose sinews. When diagnosing the pulse, if students fail to clearly distinguish between internal/external and deficiency/excess, causing erroneous needle and drug administration, they result in making the excess excess and the deficient deficient, damaging the insufficient and benefiting the excessive. Death resulting from this is murder by the physician.