能另求脾土之平脉也。然脾之衰也。则有雀啄下漏之可见矣。
十六难曰。脉有三部九候。有阴阳。有轻重。有六十首。一脉变为四时。离圣久远。各自是
其法。何
以别之。然。是其病有内外证。
此越人谓去古轩岐既久。医者各执己见。各立成法。将何以别其是非耶。脉有三部。至变
为四时。俱各立之成法也。谓不必别其孰是孰非。但以下文病之内外证。辨别脉之是非。则轩岐
之旨。言言可据矣。即此可见轩岐而下。中流砥柱之书。惟此为最也。六十首古经名。
其病为之奈何。然。假令得肝脉。其外证。善洁。面青善怒。其内证。脐左有动气。按之牢若痛。其病四肢满闭。
淋溲便难。转筋。有是者肝也。无是者非也。
此诊得肝之病脉也。肝脏清净。故善洁。面青。肝之色也。善怒。肝之志也。肝属木而左。
故脐左有动气。牢坚硬也。肝病肝气不行。故四肢满闭。淋溲。小便淋沥而不快也。便难。大便难也。转筋。筋急也。
有肝之色。辨肝之证。是肝之脉也。下仿此。
假令得心脉。其外证。面赤口干喜笑。其内证。脐上有动气。按之牢若痛。其病烦心。心痛。掌中热而 。有是者
心也。无是者非也。
此心色心病心脉也。心在上。故动气在上。 音噎。张注有声无物。心中热。故发 。则当于决切为是。俟考正。
假令得脾脉。其外证。面黄善噫。善思善味。其内证。当脐上有动气。按之牢若痛。其病腹胀满。食不消。体重节痛。
怠惰嗜卧。四肢不收。有是者脾也。无是者非也。
此脾色脾脉脾病也。脾位居中。故动气当脐。
假令得肺脉。其外证。面白善嚏。悲愁不乐欲哭。其内证。脐右有动气。按之牢若痛。其病喘咳。洒淅寒热。有是
者肺也。无是者非也。
此肺色脉肺肺病也。右属肺。故动气在右。肺主皮毛。故寒热。
假令得肾脉。其外证。面黑善恐欠。其内证。脐下有动气。按之牢若痛。其病逆气。小腹急痛。泄如下重。（泄如下
重即泄而下重而如古通）足胫寒而逆。有是者肾也。无是者非也。
此肾色肾脉肾病也。肾在下。故动气在下。欠者气相引也。泄如下重者。大便时。腰下沉而窘也。以上五条。言
五脏脉色病之定体。证字病字俱有内外之义。
十七难曰。经言病或有死。或有不治自愈。或连年月不已。其生死存亡。可切脉而知之耶。然。可尽知也。
此言或有死。即下文之相克脉。不治自愈。即十三难之相生脉。或连年月。即五十五难积聚病之相应脉。
故曰可尽知也。
诊病若闭目不欲见人者。脉当得肝脉。弦急而长。而反得肺脉。浮涩而短者。死也。（证虚脉实）
此节论金克木之脉。下四节。兼参证实脉虚。脉实证虚之义。
病若开目而渴。心下牢者。脉当得紧实而数。而反得沉涩而微者。死也。（证实脉虚）
此肝心二经之病。应得紧实数之肝心脉。反得沉濡微之肾肺脉。则金水来克木火。故当死也。
病若吐血复鼽衄血者。脉当沉细。而反浮大而牢者。死也（证虚脉实）。
肺主气。血为气配。凡吐衄必由于肺。必伤于气。则脉当沉细为顺。反得浮大牢之火脉。则火来克金。故死也。
病若谵言妄语。身当有热。脉当洪大。而反手足厥冷。脉沉细而微者。死也。（证实脉虚）
证属阳。应得洪大属火之脉顺。若反得沉细属水之脉。则水来克火。故死也。是即阳病见阴脉者死。其理同也。
病若大腹泄者。脉当微细而涩。反紧大而滑者。死也（证虚脉实）
脾病则士虚。应得微细涩脉。微细涩心肺之脉也。火生土。土生金。则吉。反得紧大滑脉。紧大滑肝肾之脉
也。木克土。水克火。故死也。以上言克制则死。以起下章关格克制之义。
十八难（误列三难）曰。脉有太过。有不及。有阴阳相乘。有覆有溢。有关有格。何谓也。然。关之前者。阳之
动也。脉当九分而浮。过者。法曰太过。减者。法曰不及。遂上鱼为溢。为外关内格。此阴乘之脉也。
关以后者。阴之动也。脉当一寸而沉。过者。法曰太过。减者。法曰不及。遂入尺为覆。为内关外格。
此阳乘之脉也。（三十七难一有发明当参看。）
全章之义。只重关格二字。曰太过。曰不及。曰阴阳相乘。曰覆溢。俱是关格之注脚。故先论脉位之阴阳。寸
为阳。尺为阴。次论脉体之阴阳。浮为阳。沉为阴。如寸部得浮大之脉。覆下而至尺部。即为阳太过。直浮至
尺之尽头处为格。阳脉即阳乘阴也。如尺部而得沉实之脉。溢上而至寸部。即为阴太过。直沉至寸之尽
头处为关。阴脉即阴乘阳也。减者。谓寸部而得沉脉。为阳不及。尺部而得浮脉。为阴不及。故法曰不及。又
关者。阴太盛。阳气不能交。故曰关。阴格者。阳太盛。阴气不能通。故曰格阳。此纯阴纯阳无和气之硬脉也。若一手
得之。浮大名格。沉实名关。若两手得之。则名关格。即下文之真脏脉。不病而死也。浮脉为阳。浮过者。自寸而下。
浮过关部一二分也。若浮而和。不得为病脉。不和则为阳盛。曰太过者。阳太过也。减者。关前九分当浮而反沉之谓也。
曰不及者。阳不及也。若沉过关部而直至鱼际。为外关内格。此即尺阴之脉。乘于寸阳之位也。沉脉为阴。沉过者。自
尺而上。沉过关部一二分也。若沉而和。不得为病脉。不和则为阴盛。曰太过者。阴太过也。减者。关后一寸当沉。而
反浮之谓也。曰不及。阴不及也。若浮过关部而直至尺内。为内关外格。此即寸阳之脉。乘尺阴之位也。总之。关格之
义。不外乎阴阳相乘之为害也。
故曰覆溢。是其真脏之脉。人不病而死也。
覆则内关外格。如水从上流下。溢则外关内格。如水由下溢上。此孤阴独阳。乃真脏之脉。无胃气以和者也。人
不病而死者。言不待久病而速死也。两手脉俱极浮极大为覆。两手脉俱极沉极实为溢。是即关格并见。必死之脉也。覆
即格阳。溢即关阴。此以尺寸之阴阳论也。若以两手论之。又当分左右为阴阳。则格阳在右。便是阳乘阴。关阴在左。
便是阴乘阳。故两手得之。方可谓关格脉也。
十九难曰。脉有逆顺。男女有恒而反者。何谓也。然。男子生于寅。寅为木阳也。女子生于申。申为金阴也。故男
脉在关上。女脉在关下。是以男子尺脉恒弱。女子尺脉恒盛。是其常也。反者。男
得女脉。女得男脉也。
此章言男女之脉。合阴阳之理。以别弱盛之常道。木数三也。故男子阳生于寅。金数四也。
故女子阴生于申。男当阳旺者。旺于寸阳之位。故曰在关上。女当阴旺者。旺于尺阴之位。
故曰在关下。若男寸弱。女寸盛。则病矣。义在下文。后人解男生于寅。女生于申。从胎
元而论。皆因看板生字故也。
其为病何如。然。男得女脉为不足。病在内。左得之病在左。右得之病在右。随脉言之也。
女得男脉为太过。病在四肢。左得之病在左。右得之病在右。随脉言之。此之谓也。
此言阴阳反常之脉。谓男得女脉为不足者。寸脉弱阳气不足于内。故病在内也。左寸脉弱病
在左。右寸脉弱病在右。若女得男脉为太过者。寸脉盛阳气有余于外。故病在四肢也。左寸脉盛
病在左。右寸脉盛病在右矣。此章论病。只论寸脉。不论尺脉者何也。盖人之有尺。犹树之有根。欲其盛
而不可得也。若男得女脉指尺盛。岂可谓之不足乎。女得男脉指尺弱。岂可谓之太过乎。旧注以男脉
为春夏。女脉为秋冬。与本文毫无干涉矣。
二十难曰。经言脉有伏匿。伏匿于何脏。而言伏匿耶。然。谓阴阳更相乘更相伏也。脉居阴部。而
反阳脉见者。为阳乘阴也。脉虽时沉涩而短。此为阳中伏阴也。脉居阳部。而反阴脉见者。为阴
乘阳也。脉虽时浮滑而长。此谓阴中伏阳也。
此章言阴阳相乘之中。又有相伏之义。如尺部而见浮滑长之脉。乃阳乘于阴也。于浮滑长脉
之中。偶杂沉涩短之脉。此谓阳中伏阴也。寸部而见沉涩短之脉。乃阴乘阳也。于沉涩短脉之中。偶杂浮滑长之脉。
此谓阴中伏阳也。此脉法之最细者。注中言其大纲。读者当会悟而推展之。
重阳者狂。重阴者癫。脱阳者见鬼。脱阴者目盲。
此承上文而言。若阳部而见阳脉。宜也。设阴部亦见阳脉。则谓重阳。阴部而见阴脉。宜也。设
阳部亦见阴脉。则谓重阴。重阳则阴部失滋燥之权。阳邪飞越而狂矣。重阴则阳部失宣和之令。阴邪
郁结而癫矣。人身之阴阳偏胜。则病偏极。而至于纯阴纯阳。并无伏匿之机。必至脱阳则见鬼。
脱阴则目盲也。
二十一难曰。经言人形病脉不病。曰生。脉病形不病。曰死。何谓也。然。人形病脉不病。
非有不病者也。谓息数不应脉数也。此大法也。
此章发明气血先后受病之义。以起下章之意也。言形病脉不病者。非脉不病也。盖病患之息
数不与其脉数相符也。假令邪入于气。气属阳而应于表。则形先病而息先乱。脉必随后应之。非
脉能不病也。谓形先病而息数不应脉数也。假令邪入于血。血属阴而隐于里。则形后病而息后乱。然脉已病
也。非形能不病。谓脉先病而脉数不应息数也。此即气血先后受病之大法也。曰生者。病在表腑也。
曰死者。病在里脏也。坊本云。医者不能调息以应病者之脉数。真不经语也。
二十二难曰。经言脉有是动。有所生病。一脉辄变为二病者。何也。然。经言是动者气也。
所生病者血也。邪在气。气为是动。邪在血。血为所生病。
此章言血病必由于气病。气者血之帅也。脉者气之充也。气先病脉即应之。故经言是动者
气也。血后病。病可验之。故曰所生病者血也。邪在气已见脉。邪在血又见于病。故有一脉辄
变为二病之问也。下文详言所以气先病血后病之故。
气主 之。血主濡之。气留而不行者。谓气先病也。血滞而不濡者。谓血后病也。故先为是动。后所生也。
。煦也。犹蒸也。濡。犹润也。气先留而不行。然后血滞而不濡。故气先为是动于脉。而血后所
生于病也。
二十三难曰。手足三阴三阳。脉之度数。可晓以不。然。手三阳之脉。从手至头。合三丈。
手三阴之脉。从手至胸中。合二丈一尺。足三阳之脉。后足至头。合四丈八尺。足三阴之脉。从
足至胸。合三
丈九尺。人两足跷脉。从足至目。合一丈五尺。督任脉各长四尺五寸。合九尺。凡脉共长
一十六丈二尺。此所谓经脉长短之数也。
此章言脉起长短之数。即一难之二百七十息。脉行一度。共长十六丈二尺为一周。一日夜
一万三千五百息。脉行五十周义同。
经脉十二。络脉十五。何始何穷也。然。经络者。行血气。通阴阳。以荣于身者也。其始从中
焦。注手太阴阳明。阳明注足阳明太阴。太阴注手少阴太阳。太阳注足太阳少阴。少阴注手心
主少阳。少阳注足少阳厥阴。厥阴复还注手太阴。别络十五。皆因其原。如环无端。转相灌溉。朝于
寸口人迎。以处百病而决死生也。
此节即一难之荣卫行阳二十五度。行阴亦二十五度。其注始于肺而终于肝。一日夜一周之义也
。其络脉十五。不与十二经直行而注脏腑。乃各因十二经之原穴。傍行于十二经脉之外。流注
于诸穴。循环不已。朝于寸口人迎之脉。以处百病之吉凶也。手足二字俱贯下。如手太阴阳明。
即手太阴手阳明也。足阳明太阴。即足阳明足太阴也。诸穴之所。详六十六难。
经曰。明知终始。阴阳定矣。何谓也。然。终始者。脉之纪也。寸口人迎。阴阳之气通于朝使。
（喻朝使之臣往来无
阻也）如环无端。故曰始也。终者三阴三阳之脉绝。绝则死。死各有形。故曰终也。
此一节承上决死生之义。而问脉之终始。以起下章脉绝之形。盖常言终始者。不过谓脉之纪
也。今言死生之终始者。谓左右人迎寸口脉。阴阳之气。循环不已。人之生机皆始于此。故曰
始也。三阴三阳之脉绝。人之生机皆终于此。故曰终也。但三阴三阳脉绝。形各不同。义在下章。
二十四难曰。手足三阴三阳气已绝。何以为候。可知其吉凶不。然。足少阴气绝。（气绝
即脉绝下仿此）则骨枯。少阴者。冬脉也。伏行而温于骨髓。故骨髓不温。即肉不着骨。骨肉不
相亲。即肉濡而却（濡滞也却不就也）肉濡而却。故齿长而枯。发无润泽。无润泽者。骨先死。戊
日笃。己日死。
此章言脉绝之义。足少阴属北方肾。肾主冬。气当敛藏。故脉当着骨伏行。伏行者。如潜伏
而行也。所以诊肾脉按之至骨。肾者水也。戊己土也。土克水。故死也。
足太阴气绝。则脉不荣于口唇。口唇者。肌肉之本也。脉不荣。则肌肉不滑泽。肌肉不滑泽。则
肉满。（满懑同败也）肉满则唇反。唇反则肉先死。甲日笃。乙日死。
足太阴脾也。脾主肌肉。所以诊脾脉。与肌肉相等。脾属土。甲乙属木。木克土。故死也。
足厥阴气绝。则筋缩引卵与舌卷。厥阴者。肝脉也。肝者。筋之合也。筋者。聚于阴器而
络于舌本。
能够另外探求脾土的正常脉象吗？然而，当脾脏功能衰退时，就会出现如雀啄般急促或像水向下滴漏那样的脉象。
《难经·十六难》说：脉诊有三部九候之分，包含阴阳属性，有轻取重取之别，共有六十种脉象分类，一种脉象随四季变化而改变。由于距离圣人的时代久远，医生们各自坚持自己的见解，建立各自的诊疗法则，那么该如何辨别其中的是非对错呢？回答说：这要看疾病是否有外在和内在的证候表现。
这里越人（扁鹊）指出，自从轩辕黄帝、岐伯的时代过去很久以后，医生们各执己见，各自确立成法，那用什么来辨别是非呢？脉诊分为三部，随着季节变化呈现不同特征，这些都是各自建立的成法。说不必去辨别谁是谁非，只要通过下文所说的疾病内外证候，来辨别脉象诊断的是非，那么轩辕黄帝、岐伯的宗旨，每一句话都可以作为依据了。从这里就可以看出，在轩辕黄帝之后，能作为中流砥柱的经典著作，只有这一部最为重要。“六十首”是古代医经的名称。
疾病的状况是怎样的呢？回答说：假如诊得肝脉，其外在证候表现为爱干净、面色发青、容易发怒；其内在证候表现为肚脐左侧有搏动感，按压时感觉坚硬且疼痛。其病症表现为四肢胀满闭塞、小便淋漓不畅、大便困难、筋脉拘挛抽搐。具备这些症状的就是肝病，不具备的就不是肝病。
这是诊断肝脏病变的脉象。肝脏性质清净，所以患者爱干净；面色发青，这是肝对应的颜色；容易发怒，这是肝对应的情志。肝属木，方位在左，所以肚脐左侧有搏动感，“牢”指坚硬。肝病导致肝气运行不畅，所以出现四肢胀满闭塞。“淋溲”指小便淋漓而不畅快；“便难”指大便困难；“转筋”指筋脉拘急痉挛。具备肝的颜色、辨明肝的证候，就是肝脉。以下各脏仿照此例。
假如诊得心脉，其外在证候表现为面色红赤、口干、喜欢笑；其内在证候表现为肚脐上方有搏动感，按压时感觉坚硬且疼痛。其病症表现为心烦、心痛、手掌心发热并伴有噎塞感。具备这些症状的就是心病，不具备的就不是心病。
这是心的颜色、心病和心脉的表现。心脏位于上部，所以搏动感应在上部。“噎”音同“咽”，张注解释为有声无物，心中热盛，所以引发噎塞，这应当在切脉诊断上加以确认，等待考证修正。
假如诊得脾脉，其外在证候表现为面色发黄、经常打嗝、多思虑、味觉敏感；其内在证候表现为肚脐正上方有搏动感，按压时感觉坚硬且疼痛。其病症表现为腹部胀满、食物不消化、身体沉重、关节疼痛、倦怠懒动、嗜睡、四肢无力收持。具备这些症状的就是脾病，不具备的就不是脾病。
这是脾的颜色、脾脉和脾病的表现。脾脏位居中部，所以搏动感应在肚脐处。
假如诊得肺脉，其外在证候表现为面色苍白、经常打喷嚏、悲伤忧愁、不快乐想哭；其内在证候表现为肚脐右侧有搏动感，按压时感觉坚硬且疼痛。其病症表现为气喘咳嗽、忽冷忽热。具备这些症状的就是肺病，不具备的就不是肺病。
这是肺的颜色、脉象和肺病的表现。右侧属肺，所以搏动感应在右侧。肺主皮毛，所以会出现寒热症状。
假如诊得肾脉，其外在证候表现为面色黑、容易恐惧、频繁呵欠；其内在证候表现为肚脐下方有搏动感，按压时感觉坚硬且疼痛。其病症表现为气逆、小腹急痛、腹泻且有下坠感（“泄如下重”即腹泻时肛门下坠沉重，通假字用法）、足胫寒冷且逆冷。具备这些症状的就是肾病，不具备的就不是肾病。
这是肾的颜色、肾脉和肾病的表现。肾脏位于下部，所以搏动感应在下部。“欠”指呵欠，是气息相互牵引所致。“泄如下重”指排便时腰部下沉且窘迫。以上五条论述了五脏脉象、颜色和病症的固定规律。“证”字和“病”字都包含内在和外在的含义。
《难经·十七难》说：医经中说，有的病会致死，有的病不治疗也能自愈，有的病长年累月不好。其生死存亡，可以通过切脉知道吗？回答说：可以完全知晓。
这里说的“有的病会致死”，即下文提到的相克脉象；“不治疗也能自愈”，即第十三难中提到的相生脉象；“长年累月不好”，即第五十五难中积聚病相应的脉象。所以说可以完全知晓。
如果病人闭眼不愿见人，脉象应当得到肝脉，表现为弦急而长，却反而得到肺脉，表现为浮涩而短，这是死证。（证候虚而脉象实）
这一节论述金克木的脉象。下面四节兼参证候与脉象虚实的关系，即脉证实虚、脉虚证实的道理。
如果病人睁眼口渴，心窝部坚硬，脉象应当得到紧实而数的脉象，却反而得到沉涩而微的脉象，这是死证。（证候实而脉象虚）
这是肝、心两经的疾病，应当得到紧实数的肝心脉，却反而得到沉濡微的肾肺脉，那么金水之气来克制木火之气，所以应当死亡。
如果病人吐血又发生鼻衄（qiú nǜ，鼻出血），脉象应当沉细，却反而浮大而坚实，这是死证（证候虚而脉象实）。
肺主气，血由气配合。凡是吐衄血必定源于肺，必定伤及气，所以脉象应当沉细为顺。如果反而得到浮大坚实的火脉，那么火气来克金，所以死亡。
如果病人胡言乱语，身体应当发热，脉象应当洪大，却反而手足冰冷，脉象沉细而微，这是死证（证候实而脉象虚）。
证候属阳，应当得到洪大属火的脉象才顺。如果反而得到沉细属水的脉象，那么水气来克火，所以死亡。这就是阳病见到阴脉者死，道理相同。
如果病人腹部巨大且腹泻，脉象应当微细而涩，却反而紧大而滑，这是死证（证候虚而脉象实）。
脾病则土气虚弱，应当得到微细涩的脉象。微细涩是心肺的脉象，火生土，土生金，则为吉兆。如果反而得到紧大滑的脉象，紧大滑是肝肾的脉象，木克土，水克火，所以死亡。以上论述了因克制而导致死亡，以此引出下一章关格克制的意义。
《难经·十八难》（误列为第三难）说：脉象有过盛的，也有不足的，有阴阳相互乘袭，有覆脉和溢脉，有关脉和格脉。这是什么意思呢？回答说：关之前的部位，是阳气活动的区域，脉象应当深九分而浮。超过这个深度，法度上称为太过；减少这个深度，法度上称为不及。如果脉象上达鱼际，称为溢，称为外关内格，这是阴气乘袭阳气的脉象。
关之后的部位，是阴气活动的区域，脉象应当深一寸而沉。超过这个深度，法度上称为太过；减少这个深度，法度上称为不及。如果脉象深入尺部，称为覆，称为内关外格，这是阳气乘袭阴气的脉象。（第三十七难对此有所阐发，应当参考阅读。）
全章的意义，只重在“关格”二字。所谓的太过、不及、阴阳相乘、覆溢，都是关格的注解。所以先论述脉位的阴阳，寸部为阳，尺部为阴；其次论述脉体的阴阳，浮为阳，沉为阴。如果在寸部得到浮大的脉象，向下延伸到达尺部，这就是阳太过，一直浮到尺部的尽头处称为格，阳脉即是阳乘阴。如果在尺部得到沉实的脉象，向上延伸到达寸部，这就是阴太过，一直沉到寸部的尽头处称为关，阴脉即是阴乘阳。所谓“减”，是指寸部得到沉脉，称为阳不及；尺部得到浮脉，称为阴不及。所以法度上称为不及。另外，“关”是指阴气太盛，阳气不能交通，所以叫关；“格”是指阳气太盛，阴气不能通达，所以叫格阳。这是纯阴纯阳、没有和气调和的硬脉。如果一只手诊得这种脉，浮大名为格，沉实名关。如果两只手都诊得，则称为关格，即下文所说的真脏脉，即使没有生病也会死亡。浮脉属阳，浮过头，自然从寸部向下，浮过关部一二分的位置。如果浮而柔和，不能算作病脉；如果不柔和，则是阳盛，称为太过，即阳太过。所谓“减”，是指关前九分应当浮而反见沉，称为不及，即阳不及。如果沉过关部直至鱼际，称为外关内格，这是尺部的阴脉乘占了寸部的阳位。沉脉属阴，沉过头，自然从尺部向上，沉过关部一二分的位置。如果沉而柔和，不能算作病脉；如果不柔和，则是阴盛，称为太过，即阴太过。所谓“减”，是指关后一寸应当沉而反见浮，称为不及，即阴不及。如果浮过关部直至尺部内部，称为内关外格，这是寸部的阳脉乘占了尺部的阴位。总之，关格的意义，不外乎阴阳相互乘袭造成的危害。
所以说，覆脉和溢脉，是真脏脉，人即使没有生病也会死亡。
覆脉如同内关外格，像水从上往下流；溢脉如同外关内格，像水从下往上溢出。这是孤阴独阳，属于真脏脉，没有胃气来调和。人没生病就死亡的，意思是说不需要久病就会迅速死亡。两手脉象都极浮极大称为覆，两手脉象都极沉极实称为溢，这就是关格并见，是必死的脉象。覆即格阳，溢即关阴，这是以尺寸部位的阴阳来论述的。如果以两手来论述，又应当分左右为阴阳，那么格阳在右，就是阳乘阴；关阴在左，就是阴乘阳。所以两手都得这种脉，才可以称为关格脉。
《难经·十九难》说：脉象有逆顺之分，男女有恒定的规律但有时相反，这是什么意思呢？回答说：男子生于寅时，寅属木，为阳；女子生于申时，申属金，为阴。所以男子的脉象在关上显盛，女子的脉象在关下显盛。因此男子的尺脉通常较弱，女子的尺脉通常旺盛，这是常态。相反的，就是男子得到女脉，女子得到男脉。
这一章论述男女脉象，符合阴阳之理，用来辨别弱盛的常道。木数为三，所以男子阳气生于寅；金数为四，所以女子阴气生于申。男子应当阳气旺盛，旺盛于寸部阳位，所以说在关上；女子应当阴气旺盛，旺盛于尺部阴位，所以说在关下。如果男子寸脉弱，女子寸脉盛，那就是病了，含义在下文。后人解释男生于寅、女生于申，是从胎元角度论述的，都是因为看字面意思产生的误解。
由此产生的病症是怎样的呢？回答说：男子得到女脉，表示不足，病在内脏。左手诊得病在左侧，右手诊得病在右侧，根据脉象位置来说明。女子得到男脉，表示太过，病在四肢。左手诊得病在左侧，右手诊得病在右侧，根据脉象位置来说明。这就是所说的情况。
这是论述阴阳反常的脉象。说男子得到女脉为不足，是因为寸脉弱，阳气不足于内，所以病在内脏。左寸脉弱病在左，右寸脉弱病在右。如果女子得到男脉为太过，是因为寸脉盛，阳气有余于外，所以病在四肢。左寸脉盛病在左，右寸脉盛病在右。这一章论述病症，只论寸脉，不论尺脉，为什么呢？大概因为人的尺脉就像树的根一样，希望它旺盛而不可得。如果男子得到女脉指尺脉盛，难道可以说是不足吗？女子得到男脉指尺脉弱，难道可以说是太过吗？旧注将男脉解释为春夏，女脉解释为秋冬，与本文毫无关系。
《难经·二十难》说：医经中说脉象有伏匿，伏匿在哪一脏，为什么说伏匿呢？回答说：是指阴阳相互乘袭、相互潜伏。脉位在阴部（尺部），却反而出现阳脉，称为阳乘阴。脉象虽然时而沉涩而短，这叫做阳中伏阴。脉位在阳部（寸部），却反而出现阴脉，称为阴乘阳。脉象虽然时而浮滑而长，这叫做阴中伏阳。
这一章论述在阴阳相乘之中，又有相互潜伏的含义。例如尺部出现浮滑长的脉象，乃是阳乘于阴。在浮滑长的脉象之中，偶尔夹杂沉涩短的脉象，这叫阳中伏阴。寸部出现沉涩短的脉象，乃是阴乘阳。在沉涩短的脉象之中，偶尔夹杂浮滑长的脉象，这叫阴中伏阳。这是脉法中最细致的部分，注释中只讲了大纲，读者应当领会并推展它。
这是承接上文而言。如果在阳部见到阳脉，是适宜的。假设阴部也见到阳脉，则称为重阳。在阴部见到阴脉，是适宜的。假设阳部也见到阴脉，则称为重阴。重阳则阴部失去滋润燥湿的权力，阳邪飞越而导致狂症。重阴则阳部失去宣通调和的命令，阴邪郁结而导致癫症。人身上的阴阳偏胜，就会病至极点，以至于纯阴纯阳，并没有潜伏隐匿的机制，必然导致脱阳则见鬼，脱阴则失明。
《难经·二十一难》说：医经中说人形体有病而脉象无病，称为可生；脉象有病而形体无病，称为可死。这是什么意思呢？回答说：人形体有病而脉象无病，并不是真的脉象无病，而是指呼吸次数与脉搏次数不相适应。这是大法。
这一章阐明气血先后受病的意义，以引出下一章的内容。所谓形病脉不病，并不是脉象真的无病。大概是病人的呼吸次数与其脉搏次数不相符。假如邪气侵入气分，气属阳而应于体表，那么形体先病而呼吸先乱，脉象必定随后应合，并不是脉象能不病，而是说形体先病而呼吸次数不应合脉搏次数。假如邪气侵入血分，血属阴而隐于体内，那么形体后病而呼吸后乱，然而脉象已经病了，并不是形体能不病，而是说脉象先病而脉搏次数不应合呼吸次数。这就是气血先后受病的大法。说“生”，是因为病在表腑；说“死”，是因为病在里脏。坊间刻本说：“医者不能调整呼吸以应合病人的脉搏次数”，真是荒谬不经的话。
《难经·二十二难》说：医经中说脉有“是动”病，有“所生病”，一脉却变成两种病，为什么呢？回答说：医经中说“是动”病属于气，“所生病”属于血。邪气在气，气发生变动即为“是动”；邪气在血，血发生病变即为“所生病”。
这一章论述血病必定由于气病。气是血的统帅，脉是气的充养。气先病，脉象随即应合，所以医经说“是动”病属于气。血后病，病症可以验证，所以说是“所生病”属于血。邪气在气，已经在脉象上显现；邪气在血，又在病症上显现，所以有一脉变为二病的问题。下文详细论述气先病血后病的原因。
气主要具有温煦作用，血主要具有濡润作用。气停留而不能运行，称为气先病。血停滞而不能濡润，称为血后病。所以先为是动，后为所生。
“煦”意为温暖，犹如蒸腾。濡，犹如滋润。气先停留而不能运行，然后血停滞而不能濡润，所以气先在脉象上表现为是动，而血后来表现为所生。
《难经·二十三难》说：手足三阴三阳经脉的长度度数，可以说明白吗？回答说：手三阳经脉，从手至头，合计三丈。手三阴经脉，从手至胸中，合计二丈一尺。足三阳经脉，从足后至头，合计四丈八尺。足三阴经脉，从足至胸，合计三丈九尺。人体两足跷脉，从足至目，合计一丈五尺。督脉和任脉各长四尺五寸，合计九尺。所有经脉共长十六丈二尺。这就是经脉长短的数量。
这一章论述经脉起止长短的数量，即第一难中二百七十息，脉行一度，共长十六丈二尺为一周，一日一夜一万三千五百息，脉行五十周，意义相同。
十二经脉和十五络脉，从哪里开始，到哪里终结呢？回答说：经络，是运行血气，沟通阴阳，以滋养身体的。它们起始于中焦，注入手太阴肺经和手阳明大肠经，阳明经注入足阳明胃经和足太阴脾经，太阴经注入手少阴心经和手太阳小肠经，太阳经注入足太阳膀胱经和足少阴肾经，少阴经注入手厥阴心包经和手少阳三焦经，少阳经注入足少阳胆经和足厥阴肝经，厥阴经又返还注入手太阴肺经。别络十五条，都顺着原穴，如环无端，互相灌溉，汇聚于寸口和人迎脉，以此来诊治百病并决断生死。
这一节即第一难中营气行阳二十五度，行阴亦二十五度，其灌注始于肺终于肝，一日一夜一周的意义。十五络脉，不与十二经脉直行灌注脏腑，而是各自顺着十二经的原穴，旁行于十二经脉之外，流注于各个穴位，循环不已，汇聚于寸口和人迎脉，以此来决断百病的吉凶。手足二字贯穿下文，如手太阴阳明，即手太阴和手阳明。足阳明太阴，即足阳明和足太阴。诸穴的具体情况，详见第六十六难。
医经说：明白终始，阴阳就能确定了。这是什么意思呢？回答说：终始，是脉的纲纪。寸口和人迎，阴阳之气通于朝使（比喻朝中之臣往来无阻），如环无端，所以叫始。终是指三阴三阳的脉气断绝，断绝就会死亡，死亡各有形态，所以叫终。
这一节承接上文言决断生死的意义，而询问脉的终始，以引出下一章脉绝的形态。常说终始，不过是谓脉的纲纪。现在说死生的终始，是指左右人迎寸口脉，阴阳之气循环不已，人的生机都始于这里，所以叫始。三阴三阳的脉气断绝，人的生机都终于这里，所以叫终。但是三阴三阳脉气断绝，形态各不相同，含义在下章。
《难经·二十四难》说：手足三阴三阳的气已经断绝，有什么征候？可以知道吉凶吗？回答说：足少阴气绝（气绝即脉绝，以下仿照此例），则骨骼枯槁。少阴经是冬脉，潜伏运行而温煦骨髓，所以骨髓不温，肌肉就不附着于骨，骨肉不相亲，肌肉萎缩退缩。肌肉萎缩退缩，所以牙齿显得长而枯槁，头发没有润泽。没有润泽，说明骨气先死。戊日病情加重，己日死亡。
这一章论述脉绝的意义。足少阴属北方肾，肾主冬，气应当敛藏，所以脉应当着骨伏行。伏行，如同潜伏而行。所以诊肾脉要按至骨。肾属水，戊己属土，土克水，所以死亡。
足太阴气绝，则脉气不能荣养口唇。口唇是肌肉的根本。脉气不能荣养，则肌肉不滑泽。肌肉不滑泽，则肌肉败坏。肌肉败坏则嘴唇翻卷。嘴唇翻卷，说明肉气先死。甲日病情加重，乙日死亡。
It is possible to separately seek the normal pulse of Spleen Earth. However, when the Spleen declines, manifestations such as the Sparrow-pecking pulse (Quezhuo Mai) or the Leaking pulse (Xialou Mai) become visible.
Chapter 16 states: "The pulse has three regions and nine positions, possesses Yin and Yang attributes, involves light and heavy pressure, comprises sixty categories, and one pulse type transforms across the four seasons. Since the time of the Sages has passed long ago, each practitioner adheres to their own views and establishes their own methods. How can one distinguish right from wrong?" The response is: This depends on whether the disease presents with external and internal signs.
Here, Yue Ren (Bian Que) points out that since the era of Xuanyuan (Yellow Emperor) and Qibo has passed for a long time, physicians hold divergent views and establish independent methods. How then can one discern correctness? Pulse diagnosis is divided into three regions, and pulses transform according to the four seasons; these are all established methods. It is unnecessary to debate which method is correct or incorrect. By using the external and internal signs of diseases described below to verify the correctness of pulse diagnosis, the principles of Xuanyuan and Qibo can be substantiated in every statement. From this, it is evident that among texts following the Yellow Emperor, this work stands as the most pivotal pillar. "Sixty Chapters" refers to an ancient medical classic.
What are the conditions of the disease? The response is: Suppose one obtains the Liver pulse. Its external signs include a preference for cleanliness, a bluish complexion, and irritability. Its internal signs include pulsation at the left side of the umbilicus, which feels firm and painful upon palpation. The symptoms manifest as fullness and obstruction in the four limbs, dysuria with dribbling, difficult defecation, and tendon spasms. If these signs are present, it is a Liver disease; if absent, it is not.
This describes the diagnostic pulse for Liver pathology. The Liver organ is pure and clear, hence the patient's preference for cleanliness. A bluish complexion corresponds to the color of the Liver. Irritability corresponds to the emotional association of the Liver. As the Liver belongs to Wood and is associated with the left direction, pulsation occurs at the left side of the umbilicus. "Firm" indicates hardness. In Liver disease, Liver Qi fails to circulate, leading to fullness and obstruction in the four limbs. "Lin Sou" refers to painful, incomplete urination; "Bian Nan" refers to difficult defecation; "Zhuan Jin" refers to tendon cramping. The presence of Liver colors and identification of Liver signs confirm the Liver pulse. The following organs follow this pattern.
Suppose one obtains the Heart pulse. Its external signs include a reddish complexion, dry mouth, and excessive laughter. Its internal signs include pulsation above the umbilicus, which feels firm and painful upon palpation. The symptoms manifest as vexation, heart pain, and heat in the palms accompanied by a sensation of choking (Ye). If these signs are present, it is a Heart disease; if absent, it is not.
This describes the color, disease, and pulse of the Heart. The Heart resides superiorly, hence the pulsation is felt superiorly. "Ye" sounds like "Yan"; Zhang's annotation explains it as having sound but no substance. Due to heat in the heart, this choking sensation arises, which should be verified through pulse diagnosis pending further correction.
Suppose one obtains the Spleen pulse. Its external signs include a yellowish complexion, frequent belching (Yi), excessive thinking, and heightened taste sensitivity. Its internal signs include pulsation directly above the umbilicus, which feels firm and painful upon palpation. The symptoms manifest as abdominal distension, indigestion, heaviness of the body, joint pain, lethargy, drowsiness, and inability to control the four limbs. If these signs are present, it is a Spleen disease; if absent, it is not.
This describes the color, pulse, and disease of the Spleen. The Spleen occupies the central position, hence the pulsation is felt at the umbilicus.
Suppose one obtains the Lung pulse. Its external signs include a pale complexion, frequent sneezing, sorrow, unhappiness, and a desire to cry. Its internal signs include pulsation at the right side of the umbilicus, which feels firm and painful upon palpation. The symptoms manifest as wheezing and coughing, and alternating chills and fever. If these signs are present, it is a Lung disease; if absent, it is not.
This describes the color, pulse, and disease of the Lung. The right side corresponds to the Lung, hence the pulsation is felt on the right. The Lung governs the skin and hair, hence the occurrence of chills and fever.
Suppose one obtains the Kidney pulse. Its external signs include a blackish complexion, fearfulness, and frequent yawning. Its internal signs include pulsation below the umbilicus, which feels firm and painful upon palpation. The symptoms manifest as rebellious Qi, acute pain in the lower abdomen, diarrhea with a sensation of heaviness/tenesmus (Xie Ru Xia Zhong), and coldness with reversal in the calves and shins. If these signs are present, it is a Kidney disease; if absent, it is not.
This describes the color, pulse, and disease of the Kidney. The Kidney resides inferiorly, hence the pulsation is felt inferiorly. Yawning is caused by the drawing of Qi. "Diarrhea with heaviness" refers to the sinking sensation and distress in the waist during defecation. The above five paragraphs describe the fixed patterns of the Five Zang pulses, colors, and diseases. The characters "sign" (Zheng) and "disease" (Bing) both encompass internal and external meanings.
Chapter 17 states: "Medical classics say that some diseases lead to death, some heal without treatment, and some persist for years. Can the life and death, survival and demise, be known by palpating the pulse?" The response is: "It can be fully understood."
The mention of "some diseases lead to death" refers to the mutually overcoming pulses mentioned below. "Healing without treatment" refers to the mutually generating pulses in Chapter 13. "Persisting for years" refers to the corresponding pulses for accumulation diseases in Chapter 55. Thus, it is said that it can be fully understood.
If a patient closes their eyes and does not wish to see people, the pulse should correspond to the Liver pulse—wiry, rapid, and long. If instead, the Lung pulse is obtained—floating, choppy, and short—it indicates death. (Deficient condition with Excess pulse.)
This section discusses the Metal overcoming Wood pulse. The following four sections also consider the relationship between Excess/Deficient conditions and pulses.
If a patient opens their eyes, feels thirsty, and has a firm mass in the epigastrium, the pulse should be tight, solid, and rapid. If instead, a deep, choppy, and faint pulse is obtained, it indicates death. (Excess condition with Deficient pulse.)
These are diseases of the Liver and Heart meridians, which should present with tight, solid, and rapid Liver and Heart pulses. Instead, obtaining deep, soft, and faint Kidney and Lung pulses means Metal and Water overcome Wood and Fire, indicating death.
If a patient vomits blood and suffers from epistaxis, the pulse should be deep and fine. If instead, a floating, large, and firm pulse is obtained, it indicates death. (Deficient condition with Excess pulse.)
The Lung governs Qi, and Blood is coordinated by Qi. Vomiting and nasal bleeding must originate from the Lung and injure Qi; thus, the pulse should be deep and fine to be favorable. Obtaining a floating, large, and firm Fire pulse instead means Fire overcomes Metal, indicating death.
If a patient speaks deliriously and hallucinates, the body should have fever, and the pulse should be surging and large. If instead, the hands and feet are cold, and the pulse is deep, fine, and faint, it indicates death. (Excess condition with Deficient pulse.)
The condition belongs to Yang and should present with a surging, large Fire pulse to be favorable. Obtaining a deep, fine Water pulse instead means Water overcomes Fire, indicating death. This is the same principle as "Yang disease presenting with Yin pulse leads to death."
If a patient has a large abdomen and diarrhea, the pulse should be faint, fine, and choppy. If instead, a tight, large, and slippery pulse is obtained, it indicates death. (Deficient condition with Excess pulse.)
In Spleen disease, Earth is deficient, and the pulse should be faint, fine, and choppy. Faint, fine, and choppy are pulses of the Heart and Lung; Fire generates Earth, and Earth generates Metal, which is auspicious. Obtaining a tight, large, and slippery pulse instead implies pulses of the Liver and Kidneys; Wood overcomes Earth, and Water overcomes Fire, indicating death. The above discusses death due to overcoming, leading into the meaning of Guan Ge (Obstruction and Rejection) overcoming in the next chapter.
Chapter 18 (erroneously listed as Chapter 3) states: "The pulse has excess (Tai Guo) and deficiency (Bu Ji), mutual overcoming of Yin and Yang, Fu (Reversal) and Yi (Overflow), Guan (Barrier) and Ge (Rejection). What do these mean?" The response is: "Anterior to the Guan (Cun) position is the realm of Yang movement. The pulse should be nine fen deep and floating. Exceeding this depth is termed 'Excess' by law; falling short is termed 'Deficiency' by law. If it rises to the Yuji point, it is called 'Yi' (Overflow), constituting External Barrier and Internal Rejection. This is the pulse of Yin overcoming Yang."
"Posterior to the Guan position is the realm of Yin movement. The pulse should be one cun deep and sunken. Exceeding this depth is termed 'Excess'; falling short is termed 'Deficiency'. If it sinks into the Chi position, it is called 'Fu' (Reversal), constituting Internal Barrier and External Rejection. This is the pulse of Yang overcoming Yin." (Chapter 37 elaborates on this and should be consulted.)
The core meaning of this chapter focuses on "Guan Ge." Terms like Excess, Deficiency, mutual overcoming of Yin and Yang, Fu, and Yi are all annotations of Guan Ge. First, the Yin-Yang nature of pulse positions is discussed: Cun is Yang, Chi is Yin. Second, the Yin-Yang nature of pulse bodies is discussed: Floating is Yang, Sunken is Yin. If a floating, large pulse is found at the Cun position and extends down to the Chi position, it is Yang Excess. Extending to the very end of the Chi position is called Ge (Rejection); Yang pulse is Yang overcoming Yin. If a deep, solid pulse is found at the Chi position and extends up to the Cun position, it is Yin Excess. Extending to the very end of the Cun position is called Guan (Barrier); Yin pulse is Yin overcoming Yang. "Deficiency" refers to a sunken pulse at the Cun position (Yang Deficiency) and a floating pulse at the Chi position (Yin Deficiency). Furthermore, "Guan" means Yin is too abundant, preventing Yang from communicating. "Ge" means Yang is too abundant, preventing Yin from penetrating. These are hard pulses of pure Yin or pure Yang without harmonious Qi. If obtained in one hand, floating and large is Ge, deep and solid is Guan. If obtained in both hands, it is called Guan Ge, i.e., the True Zang pulse mentioned below, leading to death even without illness. Floating is Yang; exceeding the float naturally moves from Cun downward, passing the Guan position by one or two fen. If floating and harmonious, it is not a pathological pulse; if not harmonious, it indicates Yang abundance, termed Excess (Yang Tai Guo). "Deficiency" means the Cun position, nine fen anterior to Guan, should be floating but is instead sunken, termed Deficiency (Yang Bu Ji). If sunken past the Guan position to the Yuji point, it is External Barrier/Internal Rejection, where Chi Yin pulse occupies the Cun Yang position. Sunken is Yin; exceeding the sink naturally moves from Chi upward, passing the Guan position by one or two fen. If sunken and harmonious, it is not pathological; if not harmonious, it indicates Yin abundance, termed Excess (Yin Tai Guo). "Deficiency" means the position one cun posterior to Guan should be sunken but is instead floating, termed Deficiency (Yin Bu Ji). If floating past the Guan position to the interior of the Chi position, it is Internal Barrier/External Rejection, where Cun Yang pulse occupies the Chi Yin position. In summary, the meaning of Guan Ge lies solely in the harm caused by the mutual overcoming of Yin and Yang.
Therefore, Fu and Yi are True Zang pulses; a person may die without prior illness.
Fu resembles Internal Barrier/External Rejection, like water flowing down from above. Yi resembles External Barrier/Internal Rejection, like water overflowing upward from below. These are isolated Yin or solitary Yang, representing True Zang pulses without Stomach Qi to harmonize them. "Dying without illness" means rapid death without prolonged illness. Both hands showing extremely floating and large pulses is Fu; both hands showing extremely deep and solid pulses is Yi. This is Guan Ge appearing together, a pulse of certain death. Fu is Ge Yang; Yi is Guan Yin, discussed here based on the Yin-Yang of Cun and Chi. If discussed based on both hands, Left and Right represent Yin and Yang respectively. Ge Yang on the right is Yang overcoming Yin; Guan Yin on the left is Yin overcoming Yang. Thus, obtaining this in both hands constitutes the Guan Ge pulse.
Chapter 19 states: "There are contrary and compliant pulses. Men and women have constant patterns that sometimes reverse. What does this mean?" The response is: "Men are born in Yin (Tiger), which is Wood and Yang. Women are born in Shen (Monkey), which is Metal and Yin. Therefore, men's pulses are prominent above the Guan, and women's pulses are prominent below the Guan. Hence, men's Chi pulses are typically weak, and women's Chi pulses are typically strong. This is the norm. The reverse is when men obtain women's pulses and women obtain men's pulses."
This chapter discusses male and female pulses in accordance with Yin-Yang theory to distinguish the norms of weakness and strength. Wood number is three, so male Yang is born in Yin. Metal number is four, so female Yin is born in Shen. Men should have vigorous Yang, prominent in the Cun Yang position, hence "above Guan." Women should have vigorous Yin, prominent in the Chi Yin position, hence "below Guan." If men have weak Cun pulses or women have strong Cun pulses, it indicates disease, as explained below. Later interpretations claiming men are born in Yin and women in Shen refer to fetal origin, arising from literal reading of the characters.
What are the resulting diseases? The response is: "When a man obtains a woman's pulse, it indicates insufficiency, and the disease is internal. If found on the left, the disease is on the left; if on the right, the disease is on the right, depending on the pulse location."
"When a woman obtains a man's pulse, it indicates excess, and the disease is in the four limbs. If found on the left, the disease is on the left; if on the right, the disease is on the right, depending on the pulse location. This is what is meant."
This discusses abnormally reversed Yin-Yang pulses. A man obtaining a woman's pulse indicates insufficiency because the Cun pulse is weak, signifying insufficient Yang internally, hence internal disease. Weak left Cun pulse indicates disease on the left; weak right Cun pulse indicates disease on the right. A woman obtaining a man's pulse indicates excess because the Cun pulse is strong, signifying surplus Yang externally, hence disease in the four limbs. Strong left Cun pulse indicates disease on the left; strong right Cun pulse indicates disease on the right. Why does this chapter discuss only Cun pulses and not Chi pulses? The Chi pulse is like the root of a tree; it should be robust and cannot be otherwise. If a man obtaining a woman's pulse implies a strong Chi pulse, how can it be called insufficiency? If a woman obtaining a man's pulse implies a weak Chi pulse, how can it be called excess? Old annotations equating male pulses with Spring/Summer and female pulses with Autumn/Winter are irrelevant to this text.
Chapter 20 states: "Medical classics say the pulse has 'Fu Ni' (Hidden/Lodged). In which Zang organ does it lodge, and why is it called hidden?" The response is: "It refers to the mutual overcoming and mutual hiding of Yin and Yang. When the pulse is in the Yin region (Chi) but Yang pulses appear, it is Yang overcoming Yin. Although the pulse is sometimes deep, choppy, and short, this is called 'Yin Hidden within Yang.' When the pulse is in the Yang region (Cun) but Yin pulses appear, it is Yin overcoming Yang. Although the pulse is sometimes floating, slippery, and long, this is called 'Yang Hidden within Yin.'"
This chapter discusses the meaning of mutual hiding within mutual overcoming. For example, if floating, slippery, and long pulses appear in the Chi region, it is Yang overcoming Yin. Within these floating, slippery, and long pulses, if deep, choppy, and short pulses occasionally appear, it is called "Yin Hidden within Yang." If deep, choppy, and short pulses appear in the Cun region, it is Yin overcoming Yang. Within these deep, choppy, and short pulses, if floating, slippery, and long pulses occasionally appear, it is called "Yang Hidden within Yin." This is the most subtle aspect of pulse diagnosis. The commentary provides the general outline; readers should comprehend and expand upon it.
"Double Yang leads to mania; Double Yin leads to depression. Loss of Yang leads to seeing ghosts; Loss of Yin leads to blindness."
This follows the previous discussion. If Yang pulses appear in the Yang region, it is appropriate. If Yin regions also show Yang pulses, it is called Double Yang. If Yin pulses appear in the Yin region, it is appropriate. If Yang regions also show Yin pulses, it is called Double Yin. Double Yang causes the Yin region to lose its moistening function, allowing Yang pathogens to fly away, resulting in mania. Double Yin causes the Yang region to lose its ventilating and harmonizing command, causing Yin pathogens to stagnate, resulting in depression. Extreme imbalance of Yin and Yang in the body leads to extreme pathology, reaching pure Yin or pure Yang without any hidden mechanism. This inevitably leads to Loss of Yang (seeing ghosts) and Loss of Yin (blindness).
Chapter 21 states: "Medical classics say: If the body is diseased but the pulse is healthy, it indicates life; if the pulse is diseased but the body is healthy, it indicates death. What does this mean?" The response is: "When the body is diseased but the pulse appears healthy, it is not that the pulse is truly healthy, but rather that the respiratory rate does not correspond to the pulse rate. This is the general principle."
This chapter elucidates the principle of Qi and Blood being affected sequentially, leading into the next chapter. "Body diseased, pulse healthy" does not mean the pulse is truly healthy. It means the patient's respiratory rate does not match the pulse rate. If pathogenic factors enter the Qi level, Qi belongs to Yang and corresponds to the exterior. The body becomes diseased first, and respiration becomes disordered first. The pulse will subsequently respond; it is not that the pulse remains unaffected, but rather that the body is diseased first while the respiratory rate does not match the pulse rate. If pathogenic factors enter the Blood level, Blood belongs to Yin and hides in the interior. The body becomes diseased later, and respiration becomes disordered later. However, the pulse is already diseased; it is not that the body remains unaffected, but rather that the pulse is diseased first while the pulse rate does not match the respiratory rate. This is the general principle of sequential affliction of Qi and Blood. "Life" indicates disease in the Exterior and Fu organs. "Death" indicates disease in the Interior and Zang organs. Folk editions claim: "Physicians cannot adjust their breathing to match the patient's pulse rate," which is absurd nonsense.
Chapter 22 states: "Medical classics say the pulse has 'Shi Dong' (Is Moving) diseases and 'Suo Sheng Bing' (So Generates Disease) conditions. Why does one pulse transform into two diseases?" The response is: "The classics state that 'Shi Dong' relates to Qi, and 'Suo Sheng Bing' relates to Blood. When evil is in Qi, Qi moves ('Shi Dong'). When evil is in Blood, Blood generates disease ('Suo Sheng Bing')."
This chapter discusses how Blood diseases necessarily stem from Qi diseases. Qi is the commander of Blood, and the pulse is filled by Qi. Qi diseases occur first, and the pulse responds immediately; thus, the classics say "Shi Dong" relates to Qi. Blood diseases occur later, and the pathology is verifiable; thus, "Suo Sheng Bing" relates to Blood. Evil in Qi manifests in the pulse; evil in Blood manifests in symptoms. Hence the question of one pulse becoming two diseases. The following text details why Qi is affected before Blood.
"Qi primarily warms; Blood primarily nourishes. Qi stagnating and failing to circulate is Qi disease first. Blood stagnating and failing to nourish is Blood disease second. Hence, first comes 'Shi Dong', then 'Suo Sheng'."
"Warmth" (Xu) means warming, like steaming. "Nourish" (Ru) means moistening. Qi stagnates first and fails to circulate, then Blood stagnates and fails to nourish. Thus, Qi first manifests as 'Shi Dong' in the pulse, and Blood subsequently manifests as 'Suo Sheng' in disease.
Chapter 23 states: "Can the lengths and measures of the Hand and Foot Three Yin and Three Yang meridians be explained?" The response is: "The Hand Three Yang meridians run from hand to head, totaling three zhang. The Hand Three Yin meridians run from hand to the chest center, totaling two zhang and one chi. The Foot Three Yang meridians run from foot posterior to head, totaling four zhang and eight chi. The Foot Three Yin meridians run from foot to chest, totaling three zhang and nine chi. The two Foot Qiao meridians run from foot to eye, totaling one zhang and five chi. The Du and Ren meridians are each four chi and five cun, totaling nine chi. All meridians combined total sixteen zhang and two chi. This is the count of meridian lengths."
This chapter discusses the starting points and lengths of meridians, consistent with Chapter 1's concept of 270 breaths per cycle, where the pulse travels one degree, totaling sixteen zhang and two chi for one circuit. In one day and night, there are 13,500 breaths, and the pulse completes 50 circuits, which is the same meaning.
"The Twelve Meridians and Fifteen Collaterals: Where do they start and where do they end?" The response is: "Meridians and collaterals transport Qi and Blood, connect Yin and Yang, and nourish the body. They begin at the Middle Jiao, injecting into the Hand Taiyin and Hand Yangming. Yangming injects into Foot Yangming and Foot Taiyin. Taiyin injects into Hand Shaoyin and Hand Taiyang. Taiyang injects into Foot Taiyang and Foot Shaoyin. Shaoyin injects into Hand Jueyin and Hand Shaoyang. Shaoyang injects into Foot Shaoyang and Foot Jueyin. Jueyin returns to inject into Hand Taiyin. The fifteen collateral vessels follow their source points, forming a circle without end, irrigating each other, and converging at the Cun Kou and Ren Ying pulses to diagnose hundred diseases and determine life and death."
This section corresponds to Chapter 1's description of Ying Qi traveling 25 cycles in Yang and 25 cycles in Yin, starting from the Lung and ending at the Liver, completing one cycle in a day and night. The fifteen collaterals do not travel straight to the Zang-Fu organs like the twelve meridians but branch off from the Yuan-Source points of the twelve meridians, running alongside them, circulating through various acupoints endlessly, and converging at the Cun Kou and Ren Ying pulses to judge the fortune and misfortune of diseases. The terms "Hand" and "Foot" apply to the following pairs: Hand Taiyin/Yangming refers to Hand Taiyin and Hand Yangming; Foot Yangming/Taiyin refers to Foot Yangming and Foot Taiyin. Details of the acupoints are found in Chapter 66.
"The Classics say: Knowing the beginning and end, Yin and Yang are determined. What does this mean?" The response is: "'Beginning and End' are the chronicles of the pulse. Cun Kou and Ren Ying allow Yin and Yang Qi to communicate freely (like ministers moving without obstruction), forming a circle without end, hence 'Beginning'. 'End' refers to the cessation of the Three Yin and Three Yang meridians. Cessation leads to death, and death has distinct forms, hence 'End'."
This section continues the theme of determining life and death, asking about the beginning and end of the pulse to introduce the forms of pulse cessation in the next chapter. Generally, "beginning and end" refers to the chronicle of the pulse. Here, discussing the beginning and end of life and death refers to the left and right Ren Ying and Cun Kou pulses, where Yin and Yang Qi circulate endlessly. Human vitality begins here, hence "Beginning". The cessation of the Three Yin and Three Yang meridians marks the end of human vitality, hence "End". However, the cessation of the Three Yin and Three Yang meridians presents different forms, as explained in the next chapter.
Chapter 24 states: "What are the signs when the Qi of the Hand and Foot Three Yin and Three Yang meridians ceases? Can good or bad omens be known?" The response is: "When the Qi of Foot Shaoyin ceases (Qi cessation means pulse cessation, following this pattern), the bones become withered. Shaoyin is the Winter pulse, lying dormant and warming the marrow. If the marrow is not warmed, the flesh does not adhere to the bone, and bone and flesh lose intimacy. The flesh shrinks and recedes. Consequently, the teeth appear long and withered, and the hair loses luster. Lack of luster indicates Bone Qi has died first. The condition worsens on Wu days and dies on Ji days."
This chapter discusses the meaning of pulse cessation. Foot Shaoyin belongs to the North Kidney. The Kidney governs Winter, and Qi should store and conceal. Thus, the pulse should lie dormant against the bone. "Lying dormant" means moving secretly. Hence, diagnosing the Kidney pulse requires pressing to the bone. Kidney belongs to Water; Wu and Ji belong to Earth. Earth overcomes Water, hence death.
"When the Qi of Foot Taiyin ceases, the pulse fails to nourish the lips. The lips are the root of the muscles. If the pulse fails to nourish, the muscles lose smoothness. If the muscles lose smoothness, they become rotten. Rotten muscles cause the lips to invert. Lip inversion indicates Muscle Qi has died first. The condition worsens on Jia days and dies on Yi days."
Foot Taiyin is the Spleen, which governs muscles. Diagnosing the Spleen pulse correlates with muscle condition. Spleen belongs to Earth; Jia and Yi belong to Wood. Wood overcomes Earth, hence death.
"When the Qi of Foot Jueyin ceases, the tendons contract, pulling the testicles and tongue inward. Jueyin is the Liver pulse. The Liver is the convergence of tendons. Tendons gather at the genitalia and connect to the base of the tongue."