《难经·十三难》曰∶上部有脉，下部无脉，其人当吐，不吐者死；上部无脉，下部有脉，虽困无能为
害。所以然者，脉之有尺，譬如树之有根，枝叶虽枯槁，根本将自生。脉有根本，人有元气，故知不死。
此越人论脉之生于中胃，寸生于尺，阳生于阴也。夫脏气者，不能自至于手太阴，必因于胃气，乃至于手太
阴也。尺者，脉之根也，故善调尺者，不待于寸。是
以上部有脉，下部无脉，其人当主吐伤中胃，而见此脉也。若不因吐而见此脉者，生气已绝于内，即所谓
寸口脉平而死者是已。故上部无脉，下部有脉，如树之有根，虽困无害。上下文义，一气呵成。张氏图注
云∶凡人之脉，上部有而下部无，乃邪实在上，生气不得通达，故当吐其邪而升其气，否则源塞，故知必
死。是张氏以上节论邪，下节论正，一段气脉，分为两截矣。且邪壅于上，而下气不得疏达者，下部之脉
必有力而沉紧，未有气壅于下，而反无脉者也。若以无根之脉，而再令吐之，是促之速死矣。予尝诊霍乱
之脉，寸尺皆无，脉复者生，不复则死。要知始吐之时，先下部无脉，待师至诊之，并上部皆无矣。越人
注《难经》八十一篇，乃采摘《内经》设为辩难，虽义理明显，然其中亦有错误。若再疏注差讹，又为越
人之罪人矣。噫！着述难，而笺释亦不易易。
《难经·第十三难》说：寸部（上部）有脉，尺部（下部）无脉，病人应当呕吐；如果不呕吐的就会死亡；寸部无脉，尺部有脉，虽然病情危重但不会造成危害。之所以这样，是因为脉象中的尺部脉，就像树木有树根一样，即使枝叶干枯凋谢，树根尚存则生命自会再生。脉象有根本，人就有元气，所以知道不会死亡。
这是扁鹊（越人）论述脉象产生于中焦胃气，寸脉生于尺脉，阳脉生于阴脉的道理。脏腑之气，不能自行到达手太阴肺经，必须依赖胃气的推动，才能到达手太阴肺经。尺部脉是脉的根本，所以善于调治尺部脉的人，不需要等到寸部脉出现（即只要尺脉存在，就有生机）。因此，寸部有脉而尺部无脉，这通常是病人因呕吐损伤了中焦胃气，从而出现这种脉象。如果不是因为呕吐而出现这种脉象，说明体内的生气已经断绝，这就是所谓的“寸口脉象看似平和但人却死亡”的情况。所以，寸部无脉而尺部有脉，就像树木有根一样，虽然困顿但无大碍。上下文的文义，是一气呵成的。
张氏在图注中说：凡是人的脉象，上部有脉而下部无脉，这是邪气实盛于上部，生气不能通达，所以应当通过吐法祛除邪气并升发正气，否则源头堵塞，所以知道必然死亡。张氏将上一节论述邪气，下一节论述正气，把一段连贯的气脉分成了两截。而且，如果邪气壅滞于上，导致下部气机不能疏达，下部的脉象必定有力且沉紧，没有气机壅滞于下反而无脉的道理。如果用无根的脉象，再令其使用吐法，这是加速其死亡。我曾诊治霍乱的脉象，寸部和尺部都没有脉，脉象恢复的就能生还，不恢复的就会死亡。要知道在刚开始呕吐的时候，先是下部无脉，等到医生到来诊察时，连上部也没有脉了。
扁鹊在注释《难经》第八十一篇时，是采摘《内经》的内容设为辩难问答，虽然义理明显，但其中也有错误。如果再加以疏漏和错误的注解，就成了扁鹊的罪人了。唉！著书立说很难，而笺注解释也不容易啊。
*The Nan Jing (Classic of Difficult Issues), Chapter 13, states: When the pulse is present in the upper portion (Cun position) but absent in the lower portion (Chi position), the patient should vomit; if they do not vomit, death ensues. If the pulse is absent in the upper portion but present in the lower portion, although the condition is critical, it poses no fatal threat. The reason for this is that the Chi pulse is like the root of a tree; even if the branches and leaves wither and die, as long as the root remains, life will naturally regenerate. Since the pulse has its root, and the person has their Yuan Qi (Primordial Qi), we know they will not die.
This refers to Bian Que (Yue Ren) discussing how the pulse originates from the Stomach Qi in the Middle Jiao, where the Cun pulse arises from the Chi pulse, and Yang pulses arise from Yin pulses. The Qi of the Zang organs cannot reach the Hand-Taiyin Lung Meridian on its own; it must rely on the Stomach Qi to arrive at the Hand-Taiyin Lung Meridian. The Chi position is the root of the pulse; therefore, one who is skilled in regulating the Chi pulse does not need to wait for the Cun pulse [to appear]. Thus, when there is a pulse in the upper portion but none in the lower portion, it indicates that the Middle Jiao Stomach Qi has been damaged by vomiting, resulting in this pulse presentation. If this pulse appears without prior vomiting, it means the Sheng Qi (Vital Qi) within has already severed, which is what is meant by "the Cun Kou pulse appears normal yet the patient dies." Therefore, when the upper portion lacks a pulse but the lower portion has one, it is like a tree having roots; although the patient is debilitated, there is no fatal danger. The context and meaning flow as a single, coherent breath.
Zhang’s diagrammatic annotation states: Whenever a person’s pulse shows presence in the upper portion and absence in the lower portion, it signifies that pathogenic factors are excess and located in the upper region, preventing the free circulation of Vital Qi. Therefore, one should employ the Vomiting Method (Fa Han/Vomit) to expel the pathogen and ascend the Qi; otherwise, the source becomes blocked, indicating certain death. Zhang divided this continuous passage into two separate parts, treating the first section as discussing Pathogens and the second as discussing Zheng Qi (Upright Qi). Furthermore, if pathogens obstruct the upper region, preventing the lower Qi from dispersing, the lower pulse would necessarily be forceful, deep, and tight; there is no scenario where Qi stagnation occurs in the lower region resulting in an absent pulse. To apply the Vomiting Method to a rootless pulse would only hasten death. I have once diagnosed the pulse of Huoluan (Cholera-like disease), where both the Cun and Chi positions were absent. If the pulse returns, the patient lives; if it does not return, the patient dies. One must understand that at the onset of vomiting, the lower pulse disappears first; by the time the physician arrives to diagnose, the upper pulse has also vanished.
When Bian Que annotated Chapter 81 of *The Nan Jing*, he extracted content from *Huang Di Nei Jing (The Yellow Emperor's Inner Canon)* to set up dialectical questions. Although the principles are clear, there are errors within. To add further erroneous annotations would make one a sinner against Bian Que. Alas! Writing original works is difficult, and annotating them is equally challenging.