肾脉急甚 楼氏云。谓色黑脉石而急也。
骨癫疾 见癫狂篇。甲乙作骨痿癫疾。
沉厥 马云。盖风邪入肾则为厥。而肾气不足。则当沉滞而无知也。
奔豚 志云。虚气反逆。故为奔豚。阴寒在下。故足不收。肾开窍于二阴。气虚不化。故不得前
后也。张云。按五十六难曰。肾之积名曰奔豚。发于少腹。上至心下。若豚状。或上或下无时。其义本此。简
案、骨空论云。督脉生病。从少腹上冲心而痛。不得前后。为冲疝。又史仓公传云。涌疝、令人不得前后溲。
盖皆奔豚也。
折脊 志云。督脉属肾。贯脊。缓则督脉懈弛。故脊折也。简案、楼氏纲目脊痛门。引本经文。
知是脊痛之谓。犹折髀折腰之折。
洞 甲乙作洞泄。脉经作洞下。简案、根结篇。仓廪无所输膈洞。此谓洞泄与膈证也。张则见下
嗌还出之文。以为上出之义。则似为膈证不可从。盖洞即史所谓 风。仓公云。 风者。饮嗌下仓而辄出不留。
又云。 风之状。饮食下嗌辄后之。又云。即数十出。还出即后之之谓。其为洞泄、洞下、明矣。
阴痿 马云。火盛水衰。当为阴痿也。
石水（止）不治 张云。若其微大。肾阴亦虚。阴虚则不化。不化则气停水积而为石水。若至胃脘。
则水邪盛极。反乘土藏。泛滥无制。故死不治。石水义见素阴阳别论大奇论。 、音垂。重坠也。腕、当作脘。
诸本并讹。
洞泄 消瘅。马云。肾气甚衰。无以主下焦。而为洞泄。亦水不配火。当为消瘅之证也。
癃 骨痿。 志云。肾有热。则为小便闭癃。为睾
丸肿 。骨痿。坐不能起。热伤肾气也。
目无所见 志云。热伤骨精也。甲乙见下有见黑丸三字。脉经视见黑花四字。
大痈 志云。血气皆始于肾。涩则血气阻滞。故为大痈。
不月沉痔 志云。气血不行。故为女子不月。为沉痔。简案、沉痔盖谓痔之沉滞不已者。
诸急 张云。急者弦紧之谓。仲景曰。脉浮而紧者。名曰弦也。紧则为寒。成无己曰。紧则阴气
胜。故凡紧急之脉多风寒。而气化从乎肝也。简案、气化从乎肝。不可信据。下仿此。
缓者 张云。缓者纵缓之状。非后世迟缓之谓。仲景曰。缓则阳气长。又曰。缓者胃气有余。故
凡纵缓之脉多中热。而气化从乎脾胃也。
大者 张云。大为阳有余。阳盛则阴衰。故多气少血。仲景曰。若脉浮大者。气实血虚也。故脉
之大者多浮阳。而气化从乎心也。
小者 张云。近于微细。在阳为阳虚。在阴为阴弱。脉体属阴。而气化从乎肾也。
滑者 张云。滑脉为阳。气血实也。故为阳气盛而微有热。仲景曰。滑者胃气实。玉机真藏论曰。
脉弱以滑。是有胃气。故滑脉从乎胃也。
涩者 张云。涩为气滞。为血少。气血俱虚。则阳气不足。故微有寒也。仲景曰。涩者荣气不足。
亦血少之谓。而此曰多血。似乎有误。观下文刺涩者。无令其血出少可知矣。涩脉近毛。故气化从乎肺也。
刺涩者（止）以和其脉 张云。脉涩者。气涩俱少。难于
得气。故宜必中其脉。而察其逆顺。久留疾按。而无出其血。较之诸刺。更宜详慎者。以脉涩本虚。而恐伤其
真气耳。循、音巡。摩按也。 、委、伟二音。刺瘢也。
调以甘药也 张云。愚按此节。阴阳形气俱不足者。调以甘药。甘之一字。圣人用意深矣。盖药
食之入。必先脾胃。而后五脏得禀其气。胃气强则五脏俱盛。胃气弱则五脏俱衰。胃属土而喜甘。伟中气不足
者。非甘温不可。土强则金王。金王则水充。此所以土为万物之母。而阴阳俱虚者。必调以甘药也。
入安连过 张云。五脏六腑。皆有五 。五 之所入为合。即各经之合穴也。然手之三阳。复有
连属上下气脉相通者。亦谓之合。故此以入安连过为问。甲乙作入安从道。
属于腑者也 张云。此下言六阳之经。内属于腑。因以明手之三阳。下合在足也。
荥输（止）治内腑 张云。荥 气轻浮浅。故可治外经之病。合则气脉深入。故可治内腑之病。
巨虚上廉 马云。此本足阳明胃经之穴。其实为大肠之合。前本输篇有云。复下三里三寸为巨虚上
廉。复下上廉三寸为巨虚下廉。大肠属上廉。小肠属下廉。张云。大肠手阳明也。本经之合。在曲池也。其下
则合于足阳明之巨虚上廉也。
巨虚下廉 张云。小肠手太阳也。本经之合在小海。其下 则合于足阳明之巨虚下廉。
委阳 张云。三焦手少阳也。本经之合在天井。其下 则合于足太阳之委阳穴。按、大肠、小肠、
三焦、皆手三阳之经。然大小肠为下焦之腑。连属于胃。其经虽在上。而气脉不离于下。故合于足阳明之巨虚
上下廉。三焦为孤独之
腑。其于三部九候。无所不统。故经之在上者属手。 之在下者居足。所以十二经中。惟此手之三阳乃有下 。
故本输篇曰。大肠小肠皆属于胃。三焦下 。在于足小趾之前少阳之后。出于 中外廉。名曰委阳。即此谓也。
屈伸而索之 马云。屈其体以觅承扶之阴纹。伸其体以度委阳之分寸。（委阳在趺下一寸六分承
扶在尻臀下陷纹中）
正竖膝予之齐 张云。谓正身蹲坐。使两膝齐也。
委阳之阳 马云。古人谓外为表。又名之曰阳。张云。当作委中之阳。盖委中之外廉。即阳陵泉
之穴也。
揄申而从之 马云。必揄扬以申其手足善取之耳。张云。揄、引也。申、明也。取外经者在荥输。
然亦必引正详明。方可从而治也。揄音余。简案、揄、引也。见说文。张注骨空论。折使揄臂亦同。今从之。
志云。揄、音于。引也。抒也。伸舒其四体。使经脉之流通也。
鱼络血 张云。手阳明之脉。行于手鱼之表。简案、血络论云。血脉者盛。坚横以赤。上下无常
处。小者如针。大者如箸。则而泻之万全也。
竖陷者 甲乙作坚若陷者是。志。竖作坚。张云。两跗之上。脉即冲阳也。竖者坚而实。陷者弱
而虚。皆足阳明胃脉之病。
切痛而鸣濯濯 马云。切痛者痛之紧也。濯濯者肠中有水。而往来气冲。则有声也。
冬日重感 张本日作曰。注云当作月。
支两胁 支、甲乙作 。
控睾而痛时窘之后 马云。睾音皋。阴丸。小肠近小肠之内。后附腰脊。下连睾丸。故小腹痛。
腰脊控引睾丸而痛。痛时窘甚。而欲往去后也。张云。不得大小便。而时窘
之后。盖即疝之属也。
当耳前（止）此其候也 张云。皆手太阳之经。故其病如此。
腹气满 甲乙腹下有张字。
亦见于脉 马云。脉必下陷。当取此穴以刺之。志云。其脉亦见于皮部。当取之委阳。
小便偏肿 诸本作小腹是。但张与此同。
肩上热 甲乙肩作眉。注云一作肩。
皆热若脉陷 甲乙无若脉陷三字。简案、此系剩文。当删。
善太息 志云。胆气不升。故太息以伸出之。
口苦呕宿汁 简案、即呕胆。见奇病论。
心下澹澹。恐人将捕之 甲乙恐上有善字。恐下有如字。千金恐下有如字。张云。澹澹、失意
貌。简案、澹、 同。 、集韵动也。经脉篇。心主之脉。是动则心中 大动。又至真要大论。太阳司天。
寒淫所胜。则心澹澹大动。并是跳动貌。张注非。
然数唾 、千金作介介。唾上甲乙有咳字。简案、马张并云。 然有声也。非。义见
上文喉 注。
在足少阳之本末 甲乙在上有候字。张云。在腑为本。在经为末也。志云。足少阳经脉之本在
下。其末在颈嗌之间。
陷下者灸之 经脉篇云。陷下则灸之。张云。陷下者为不足。故宜灸。
其寒热者 志云。少阳之枢证也。当以经取之。少阳之经气。外内出入者也。
必中气穴 志云。气穴者。腑气所注之经穴。故中气
穴。则针游于巷。即气穴论之所谓游针之居。
肉节 张云。肉有节界。其谓肉节。
针染（一作游）于巷 马云。气脉相通。即素问气穴论游针之居也。（如名气冲穴为气街而卫
气篇有胸气腹头气胫气皆有街则巷即街之义）张云。染、着也。巷、道也。中其气穴。则针着脉道而经络通。
简案、染作游为是。
反还内着 马云。与真气相搏而乱。邪反内着。
肾脉急甚：楼氏说，是指面色黑、脉象如石般坚硬且紧急。
骨癫疾：在《癫狂》篇中有记载。《甲乙经》写作“骨痿癫疾”。
沉厥：马云说，大概是风邪侵入肾脏导致厥证。而肾气不足，就会出现沉滞且无知觉的症状。
奔豚：志氏说，虚气上逆，所以称为奔豚。阴寒之气在下部，所以双脚不能收持。肾开窍于前后二阴，气虚不能气化，所以大小便不通畅。张云说，按《难经·五十六难》所说，肾脏的积病名叫奔豚，发作于少腹，向上冲至心下，像小猪奔跑的样子，或上或下没有定时。这里的含义原本出自此处。简案，《骨空论》说，督脉生病，从少腹向上冲心并疼痛，大小便不通，这叫冲疝。又《史记·仓公传》说，涌疝使人大小便不通。大概这些都是奔豚。
折脊：志氏说，督脉属于肾，贯穿脊柱。如果弛缓，则督脉懈怠松弛，所以出现脊背折断样的疼痛。简案，楼氏《纲目》脊痛门引用本经文，知道这是指脊痛，就像“折髀”、“折腰”中的“折”字一样。
洞（泄）：《甲乙经》作“洞泄”，《脉经》作“洞下”。简案，《根结》篇说：“仓廪无所输膈洞。”这里指的是洞泄和膈证。张氏看到下文“嗌还出”的文字，认为这是指食物上出的意思，那么似乎应该是膈证，不可从之。大概“洞”即史游《急就章》所说的“飧风”。仓公说：“飧风者，饮食入咽随即泻出不留。”又说：“飧风的症状，饮食下咽随即排出。”又说：“即使几十次出入，也是指刚吃进去就排出的意思。”这显然是洞泄、洞下，很明确了。
阴痿：马云说，火盛水衰，应当是阴痿。
石水（止）不治：张云说，如果脉微大，肾阴也虚。阴虚则不能气化，不化则气停水积而形成石水。如果水邪到达胃脘，则水邪极盛，反而乘袭脾土脏腑，泛滥无制，所以死亡不治。石水的含义见《素问·阴阳别论》和《大奇论》。“石”音垂，意为重坠。“腕”当作“脘”，各本都错了。
洞泄 消瘅：马云说，肾气非常衰弱，无法主宰下焦，从而发生洞泄。这也是水不配火，应当是消瘅的证候。
癃 骨痿：志氏说，肾有热，就会小便闭阻癃闭，睾丸肿胀。骨痿，坐起困难。这是热损伤了肾气。
目无所见：志氏说，热损伤了骨髓精气。《甲乙经》在“见”下有“见黑丸”三字，《脉经》作“视见黑花”四字。
大痈：志氏说，血气都始于肾，涩滞则血气阻滞，所以形成大痈。
不月沉痔：志氏说，气血不行，所以女子月经不来，形成沉痔。简案，沉痔大概是指痔疮沉滞不止的情况。
诸急：张云说，“急”是指弦紧的脉象。仲景说：“脉浮而紧的，名叫弦。”紧则为寒。成无己说：“紧则阴气胜。”所以凡是紧急的脉多因风寒，而气化归属于肝。简案，“气化从乎肝”的说法，不可信据，下文仿此例。
缓者：张云说，“缓”是纵缓的状态，不是后世所说的迟缓。仲景说：“缓则阳气长。”又说：“缓者胃气有余。”所以凡是纵缓的脉多属中热，而气化归属于脾胃。
大者：张云说，“大”为阳有余，阳盛则阴衰，所以多气少血。仲景说：“如果脉浮大的，是气实血虚。”所以脉大的多属浮阳，而气化归属于心。
小者：张云说，“小”近于微细，在阳分是阳虚，在阴分是阴弱。脉体属阴，而气化归属于肾。
滑者：张云说，滑脉属阳，气血充实。所以是阳气盛而有微热。仲景说：“滑者胃气实。”《玉机真脏论》说：“脉弱而滑，是有胃气。”所以滑脉归属于胃。
涩者：张云说，涩是气滞，血少。气血俱虚，则阳气不足，所以微有寒。仲景说：“涩者荣气不足。”也就是血少的意思。而这里说“多血”，似乎有误。看下文刺涩脉时，“无令其血出少”可知。涩脉近皮毛，所以气化归属于肺。
刺涩者（止）以和其脉：张云说，脉涩的人，气涩且俱少，难以得气。所以必须中取脉位，观察逆顺，久留针并快速按压，不要使其出血。比起其他刺法，更应详慎，因为脉涩本属虚，恐怕损伤真气罢了。“循”，音巡，摩按的意思。“瘢”，音委、伟二音，刺瘢痕。
调以甘药也：张云说，我按此节，阴阳形气都不足的，用甘药调理。“甘”这一个字，圣人的用意很深啊。大概药物食物进入体内，必须先经过脾胃，然后五脏才能禀受其气。胃气强则五脏都盛，胃气弱则五脏都衰。胃属土而喜甘。对于中气不足的人，非甘温不可。土强则金旺，金旺则水充。这就是为什么土是万物之母，而阴阳俱虚的人，必须用甘药调理的原因。
入安连过：张云说，五脏六腑，都有五个腧穴。五腧之所入为合，就是各经的合穴。然而手三阳经，又有连接上下、气脉相通的，也称为合。所以这里以“入安连过”发问。《甲乙经》作“入安从道”。
属于腑者也：张云说，下面讲的是六阳经，内属于腑，借此说明手三阳经的下合穴在足部。
荥输（止）治内腑：张云说，荥穴和气轻浮浅，所以可治疗外经的病。合穴则气脉深入，所以可治疗内腑的病。
巨虚上廉：马云说，这本来是足阳明胃经的穴位，其实是大肠的下合穴。前文《本输》篇说：“再向下三里三寸为巨虚上廉，再向下上廉三寸为巨虚下廉。大肠属上廉，小肠属下廉。”张云说，大肠是手阳明经。本经的合穴在曲池。其下合穴则在足阳明的巨虚上廉。
巨虚下廉：张云说，小肠是手太阳经。本经的合穴在小海。其下合穴则在足阳明的巨虚下廉。
委阳：张云说，三焦是手少阳经。本经的合穴在天井。其下合穴则在足太阳的委阳穴。按，大肠、小肠、三焦，都是手三阳经。然而大小肠为下焦之腑，连属于胃。它们的经脉虽然在上，但气脉不离于下，所以合于足阳明的巨虚上下廉。三焦是孤独的腑，它在三部九候中，无所不统。所以经脉在上者属手，下合穴在足者居足。因此在十二经中，只有这三条手阳经才有下合穴。所以《本输》篇说：“大肠小肠皆属于胃。三焦的下合穴，在于足小趾之前、少阳之后，出于腓中外廉，名叫委阳。”就是这个意思。
屈伸而索之：马云说，屈曲身体以寻找承扶穴的阴纹，伸直身体以度量委阳穴的分寸。（委阳在足背下一寸六分，承扶在尻臀下的陷纹中）
正竖膝予之齐：张云说，意思是端正身体蹲坐，使两膝平齐。
委阳之阳：马云说，古人称外为表，又名之为阳。张云说，应当作“委中之阳”。大概委外的外廉，就是阳陵泉的穴位。
揄申而从之：马云说，必须揄扬以伸展手足，善于取穴罢了。张云说，“揄”是引的意思，“申”是明的意思。取外经的病在荥穴和输穴。但也必须引导端正、详细明确，才可以进而治疗。“揄”音余。简案，“揄”是引的意思，见于《说文》。张氏注《骨空论》“折使揄臂”也是同样的意思。现在遵从他的说法。志氏说，“揄”音于，是引、抒的意思。伸展四肢，使经脉流通。
鱼络血：张云说，手阳明经的脉，行于手鱼际的表面。简案，《血络论》说：“血脉盛，坚横且赤，上下无常处，小的如针，大的如箸，依照这个法则泻血，万全。”
竖陷者：《甲乙经》作“坚若陷者是”。志氏认为“竖”作“坚”。张云说，两足背之上，脉即是冲阳脉。“竖”是坚而实，“陷”是弱而虚，都是足阳明胃脉的病。
切痛而鸣濯濯：马云说，“切痛”是疼痛紧迫的意思。“濯濯”是肠中有水，往来气冲，所以有声。
冬日重感：张本作“曰”。注说应当作“月”。
支两胁：“支”，《甲乙经》作“”。
控睾而痛时窘之后：马云说，“睾”音皋，即阴丸。小肠靠近小腹内部，后面附着腰脊，下面连接睾丸。所以小腹痛，腰脊牵引睾丸而痛，痛时非常窘迫，想要去大便。张云说，大小便不通，且时常窘迫想解大便，大概就是疝的一类。
当耳前（止）此其候也：张云说，这都是手太阳经的病，所以病症如此。
腹气满：《甲乙经》“腹”下有“张”字。
亦见于脉：马云说，脉必下陷，应当取此穴来刺它。志氏说，其脉也见于皮部，应当取委阳穴。
小便偏肿：诸本都作“小腹是”。但张本与此相同。
肩上热：《甲乙经》“肩”作“眉”。注说一作“肩”。
皆热若脉陷：《甲乙经》无“若脉陷”三字。简案，这是多余的文字，应当删除。
善太息：志氏说，胆气不升，所以通过太息来伸出（舒展）它。
口苦呕宿汁：简案，即呕胆，见《奇病论》。
心下澹澹，恐人将捕之：《甲乙经》“恐”上有“善”字。“恐”下有“如”字。《千金方》“恐”下有“如”字。张云说，“澹澹”是失意的样子。简案，“澹”与“憺”同。“憺”，《集韵》解释为动。《经脉》篇说：“心主之脉，是动则心中憺憺大动。”又《至真要大论》说：“太阳司天，寒淫所胜，则心澹澹大动。”都是跳动的样子。张注不对。
啮然数唾：《千金方》作“介介”。唾字上，《甲乙经》有“咳”字。简案，马、张都说是“啮然有声”，不对。义理见上文“喉痹”注。
在足少阳之本末：《甲乙经》“在”上有“候”字。张云说，在腑为本，在经为末。志氏说，足少阳经脉的本在下，其末在颈咽之间。
陷下者灸之：《经脉》篇说：“陷下则灸之。”张云说，陷下者为不足，所以宜灸。
其寒热者：志氏说，这是少阳的枢机证。应当以经取之。少阳的经气，是外内出入的。
必中气穴：志氏说，气穴，是腑气所注入的经穴。所以中取气穴，则针游于巷，即《气穴论》所说的“游针之居”。
肉节：张云说，肉有节界，这就叫肉节。
针染（一作游）于巷：马云说，气脉相通，即《素问·气穴论》所说的“游针之居”。（如果说气冲穴为气街，而《卫气》篇有胸气、腹气、头气、胫气皆有街，则巷即街的意思）。张云说，“染”是着的意思，“巷”是道的意思。中取气穴，则针着脉道而经络通。简案，“染”作“游”是对的。
反还内着：马云说，与真气相搏而乱，邪气反而向内附着。
Excessive tension of the Kidney pulse: Lou stated that this refers to a black complexion and a pulse that is hard like stone and tense.
Bone Dian Ji (bone-type epilepsy): Recorded in the "Dian Kuang" chapter. The *Jia Yi Jing* writes it as "Gu Wei Dian Ji" (bone atrophy with epilepsy).
Chen Jue (deep cold reversal): Ma Yun stated that wind pathogen invading the Kidney leads to Jue syndrome. When Kidney Qi is deficient, there will be deep stagnation and loss of sensation.
Ben Tun (running piglet): Zhi stated that deficient Qi reverses upward, hence called Ben Tun. Yin-cold resides below, causing the feet to fail to hold firm. The Kidney opens into the two yin orifices; Qi deficiency fails to transform fluids, resulting in difficulty urinating and defecating. Zhang Yun stated that according to Chapter 56 of the *Nan Jing*, the accumulation disease of the Kidney is named Ben Tun. It originates in the lower abdomen, rushes up to the epigastrium, resembling a running piglet, moving up or down without fixed timing. This meaning originates here. In my notes, the *Gu Kong Lun* states that when the Du Mai (Governing Vessel) is diseased, Qi rushes from the lower abdomen up to the heart causing pain, with inability to pass urine and stool, called Chong Shan (rushing hernia). Also, in Sima Qian's biography of Cang Gong, Yong Shan is described as causing inability to pass urine and stool. These are all likely forms of Ben Tun.
Zhe Ji (broken spine): Zhi stated that the Du Mai belongs to the Kidney and penetrates the spine. If lax, the Du Mai becomes slack, leading to the sensation of the spine breaking. In my notes, Lou's *Gang Mu* under the section on back pain cites this text, indicating this refers to back pain, similar to the use of "break" in "broken thigh" or "broken waist".
Dong (diarrhea): The *Jia Yi Jing* writes "Dong Xie" (profuse diarrhea), and the *Mai Jing* writes "Dong Xia". In my notes, the *Gen Jie* chapter says "The granaries fail to transport, leading to Diaphragm Dong." This refers to Dong Xie (profuse diarrhea) and Ge Zheng (diaphragmatic disorder). Zhang interpreted the phrase "returning out from the throat" as indicating regurgitation, suggesting it should be Ge Zheng, which I cannot accept. Generally, "Dong" refers to what Shi You called "Sun Feng" in his works. Cang Gong said, "In Sun Feng, food and drink enter the throat and immediately exit without staying." He also said, "The symptom of Sun Feng is that after swallowing food, it is immediately expelled." And again, "Even if it happens dozens of times, it refers to immediate expulsion after eating." Thus, it is clearly Dong Xie or Dong Xia.
Yin Wei (impotence): Ma Yun stated that when Fire is excessive and Water is deficient, it results in Yin Wei.
Shi Shui (Stone Water) (stop) untreatable: Zhang Yun stated that if the pulse is slightly large, Kidney Yin is also deficient. Yin deficiency leads to failure of transformation; failure of transformation causes Qi stagnation and water accumulation, forming Shi Shui. If the water pathogen reaches the stomach cavity, the water evil becomes extremely abundant, counter-attacking the Earth organs (Spleen/Stomach), flooding without restraint, thus leading to death and being untreatable. The meaning of Shi Shui is found in the *Su Wen* chapters "Yin Yang Bie Lun" and "Da Qi Lun". "Shi" sounds like "chui", meaning heavy and sinking. "Wan" should be "Wan" (epigastrium/stomach cavity); all editions have an error here.
Dong Xie Xiao Dan (Profuse Diarrhea and Wasting-Thirst): Ma Yun stated that when Kidney Qi is severely deficient, it cannot govern the Lower Jiao, resulting in Dong Xie. This is also Water failing to match Fire, manifesting as symptoms of Xiao Dan (Wasting-Thirst).
Long Gu Wei (Urinary Obstruction and Bone Atrophy): Zhi stated that Heat in the Kidney leads to urinary obstruction (Long) and testicular swelling. Gu Wei (Bone Atrophy) presents as inability to sit up and stand due to Heat damaging Kidney Qi.
Mu Wu Suo Jian (Inability to See): Zhi stated that Heat damages the essence of the bones/marrow. The *Jia Yi Jing* adds three characters "seeing black spots" after "see", and the *Mai Jing* writes "seeing black flowers".
Da Yong (Large Abscess): Zhi stated that Blood and Qi both originate from the Kidney. Stagnation causes Blood and Qi to block, resulting in a Da Yong.
Bu Yue Chen Zhi (Amenorrhea and Deep Hemorrhoids): Zhi stated that when Blood and Qi do not flow, women experience amenorrhea (Bu Yue) and develop Chen Zhi (deep hemorrhoids). In my notes, Chen Zhi likely refers to hemorrhoids that are deep-seated and persistent.
Zhu Ji (Various Tense Pulses): Zhang Yun stated that "Ji" refers to Xuan (wiry) and Jin (tight) pulses. Zhongjing said, "A floating and tight pulse is named Xuan." Tight indicates Cold. Cheng Wuji said, "Tight indicates excess Yin Qi." Therefore, most tense pulses are due to Wind-Cold, and Qi transformation relates to the Liver. In my notes, the statement "Qi transformation relates to the Liver" is not reliable; the following examples follow this pattern.
Huan Zhe (Relaxed Pulse): Zhang Yun stated that "Huan" refers to a relaxed and loose state, not the slow rate understood in later periods. Zhongjing said, "Huan indicates Yang Qi is growing." He also said, "Huan indicates excess Stomach Qi." Therefore, most relaxed pulses indicate internal Heat, and Qi transformation relates to the Spleen and Stomach.
Da Zhe (Large Pulse): Zhang Yun stated that "Da" indicates excess Yang. Yang excess leads to Yin deficiency, resulting in abundant Qi and deficient Blood. Zhongjing said, "If the pulse is floating and large, it indicates Qi excess and Blood deficiency." Therefore, large pulses mostly indicate floating Yang, and Qi transformation relates to the Heart.
Xiao Zhe (Small Pulse): Zhang Yun stated that "Xiao" is close to Wei (fine) and Xi (thin). In the Yang aspect, it indicates Yang deficiency; in the Yin aspect, it indicates Yin weakness. Since the pulse body belongs to Yin, Qi transformation relates to the Kidney.
Hua Zhe (Slippery Pulse): Zhang Yun stated that the Slippery pulse belongs to Yang, indicating substantial Blood and Qi. Thus, it indicates abundant Yang Qi with slight heat. Zhongjing said, "Hua indicates substantial Stomach Qi." The *Yu Ji Zhen Zang Lun* states, "Weak and slippery pulse indicates the presence of Stomach Qi." Therefore, the Slippery pulse relates to the Stomach.
Se Zhe (Choppy Pulse): Zhang Yun stated that Se indicates Qi stagnation and deficient Blood. When both Qi and Blood are deficient, Yang Qi is insufficient, leading to slight cold. Zhongjing said, "Se indicates deficient Ying Qi," which means deficient Blood. However, the text here mentions "abundant blood," which seems erroneous. Observing the instruction for needling Se pulses, "do not let blood flow out excessively," confirms this. The Se pulse is near the skin surface, so Qi transformation relates to the Lung.
Ci Se Zhe (Stop) Yi He Qi Mai (To harmonize the pulse): Zhang Yun stated that in cases of Se pulse, Qi is stagnant and both Qi and Blood are scarce, making it difficult to obtain Deqi. Therefore, one must needle the pulse directly, observe the reverse and smooth conditions, retain the needle for a long time, and press quickly without bleeding. Compared to other needling methods, greater caution is required because the Se pulse indicates underlying deficiency, and we fear damaging the True Qi. "Xun" sounds like "xun", meaning massage and pressing. "Ban" has pronunciations "wei" and "wei", referring to needling scars.
Tiao Yi Gan Yao Ye (Regulate with Sweet Medicines): Zhang Yun stated, "Regarding this section, when Yin-Yang, Form, and Qi are all deficient, regulate with sweet medicines." The character "Sweet" reveals the profound intention of the Sages. Generally, medicines and foods must first pass through the Spleen and Stomach before the Five Zang organs can receive their Qi. Strong Stomach Qi leads to prosperity in all Five Zang; weak Stomach Qi leads to decline in all Five Zang. The Stomach belongs to Earth and favors Sweetness. For those with insufficient Middle Qi, non-sweet-warm herbs are ineffective. Strengthening Earth makes Metal prosperous; prospering Metal fills Water. This is why Earth is the mother of all things, and those with dual deficiency of Yin and Yang must be regulated with sweet medicines.
Ru An Lian Guo (Enter, Peace, Connect, Pass): Zhang Yun stated that the Five Zang and Six Fu organs each have five Shu points. The point where Qi enters is the He-Sea point. However, the Three Yang meridians of the Hand also have connections between upper and lower parts with communicating Qi and vessels, also called He-Sea. Hence the question "Ru An Lian Guo". The *Jia Yi Jing* writes "Ru An Cong Dao".
Shu Yu Fu Zhe Ye (Belonging to the Fu Organs): Zhang Yun stated that the following discusses the Six Yang meridians internally belonging to the Fu organs, thereby clarifying that the He-Sea points of the Three Yang meridians of the Hand are located on the Foot.
Xing Shu (Stop) Zhi Nei Fu (Treating Internal Fu Organs): Zhang Yun stated that Xing and Shu points have light, floating, and shallow Qi, thus treating diseases of the exterior meridians. He-Sea points have Qi and vessels penetrating deeply, thus treating diseases of the internal Fu organs.
Ju Xu Shang Lian (Upper Great Empty): Ma Yun stated that this is originally a point on the Foot Yangming Stomach Meridian, but actually serves as the He-Sea point of the Large Intestine. The earlier *Ben Shu* chapter states: "Three cun below San Li is Ju Xu Shang Lian; three cun below Shang Lian is Ju Xu Xia Lian. Large Intestine corresponds to Shang Lian, Small Intestine to Xia Lian." Zhang Yun stated that the Large Intestine is the Hand Yangming meridian. Its primary He-Sea point is Qu Chi. Its lower He-Sea point is Ju Xu Shang Lian on the Foot Yangming.
Ju Xu Xia Lian (Lower Great Empty): Zhang Yun stated that the Small Intestine is the Hand Taiyang meridian. Its primary He-Sea point is Xiao Hai. Its lower He-Sea point is Ju Xu Xia Lian on the Foot Yangming.
Wei Yang: Zhang Yun stated that the San Jiao is the Hand Shaoyang meridian. Its primary He-Sea point is Tian Jing. Its lower He-Sea point is Wei Yang on the Foot Taiyang. Note: Large Intestine, Small Intestine, and San Jiao are all Hand Three Yang meridians. However, the Large and Small Intestines are Fu organs of the Lower Jiao, connected to the Stomach. Although their meridians are upper, their Qi and vessels do not depart from the lower, so they combine with Ju Xu Shang/Xia Lian on the Foot Yangming. San Jiao is the solitary Fu organ, governing all aspects of the Three Parts and Nine Holdings. Therefore, meridians above belong to the Hand, and lower He-Sea points reside on the Foot. Among the twelve meridians, only these three Hand Yang meridians have lower He-Sea points. Thus, the *Ben Shu* chapter states: "Large Intestine and Small Intestine both belong to the Stomach. The lower He-Sea point of San Jiao is located anterior to the little toe of the foot and posterior to the Shaoyang, emerging from the lateral side of the calf, named Wei Yang." This is what is meant.
Qu Shen Er Suo Zhi (Bend and Extend to Search): Ma Yun stated, "Bend the body to find the crease of Yinwen at Chengfu; extend the body to measure the distance of Wei Yang." (Wei Yang is 1.6 cun below the dorsum; Chengfu is in the depression under the buttocks).
Zheng Shu Zi Zhi Qi (Upright Knees to Align Them): Zhang Yun stated, "This means sitting upright with knees bent, keeping both knees level."
Wei Yang Zhi Yang (Yang of Wei Yang): Ma Yun stated, "Ancients referred to the exterior as Surface, also naming it Yang." Zhang Yun stated, "It should read 'Yang of Weizhong'. The lateral margin outside Weizhong is the point Yanglingquan."
Yu Shen Er Cong Zhi (Draw and Extend to Follow): Ma Yun stated, "One must draw and extend the limbs to properly locate the points." Zhang Yun stated, "'Yu' means to draw/pull; 'Shen' means clear/explicit. To treat exterior meridian diseases, use Xing and Shu points. But one must also guide correctly and clarify explicitly before proceeding with treatment." "Yu" sounds like "yu". In my notes, "Yu" means to draw, as seen in *Shuo Wen*. Zhang's annotation on *Gu Kong Lun* "Zhe Shi Yu Bi" is the same. I follow him now. Zhi stated, "'Yu' sounds like 'yu', meaning to draw, express, and extend the four limbs to make meridians flow smoothly."
Yu Luo Xue (Fish Network Blood): Zhang Yun stated, "The Hand Yangming meridian runs on the surface of the Hand Yu (thenar eminence)." In my notes, the *Xue Luo Lun* states: "When blood vessels are abundant, they are firm, transverse, red, and located variably. Small ones are like needles, large ones like chopsticks. Following this pattern to bleed ensures complete safety."
Shu Xian Zhe (Firm and Depressed): The *Jia Yi Jing* writes "Jian Ruo Xian Zhe Shi". Zhi considers "Shu" as "Jian" (firm). Zhang Yun stated, "On the dorsum of both feet, the pulse is Chongyang. 'Shu' (firm) indicates solidity and reality; 'Xian' (depressed) indicates weakness and deficiency. Both are diseases of the Foot Yangming Stomach meridian."
Qie Tong Er Ming Zhuo Zhuo (Tight Pain and Gurgling Sounds): Ma Yun stated, "'Qie tong' means tight pain. 'Zhuo zhuo' describes water in the intestines with Qi rushing back and forth, producing sound."
Dong Ri Chong Gan (Winter Re-exposure to Pathogens): Zhang's edition writes "Yue" (month). The annotation says it should be "Yue".
Zhi Liang Xie (Supporting Both Hypochondria): "Zhi", the *Jia Yi Jing* writes "".
Kong Gao Er Tong Shi Jiong Zhi Hou (Pulling Testicles with Pain and Frequent Urgency to Defecate): Ma Yun stated, "'Gao' sounds like 'gao', meaning testicles. The Small Intestine is near the interior of the small abdomen, attaching posteriorly to the lumbar spine, connecting inferiorly to the testicles. Thus, lower abdominal pain, lumbar spine pulling the testicles causing pain, and during pain, severe urgency to defecate." Zhang Yun stated, "Inability to pass urine and stool, with frequent urgency to defecate, is likely a type of Hernia."
Dang Er Qian (Stop) Ci Qi Hou Ye (At the Front of the Ear... This is its sign): Zhang Yun stated, "These are all diseases of the Hand Taiyang meridian, hence the symptoms are as such."
Fu Qi Man (Abdominal Qi Fullness): The *Jia Yi Jing* has the character "Zhang" after "Fu".
Yi Jian Yu Mai (Also Manifests in the Pulse): Ma Yun stated, "The pulse must be depressed; one should take this point to needle." Zhi stated, "Its pulse also manifests in the skin region; one should take Wei Yang."
Xiao Bian Pian Zhong (Unilateral Swelling of Urination): All editions write "Xiao Fu Shi" (lower abdomen is...). But Zhang's edition agrees with the current text.
Jian Shang Re (Heat on the Shoulder): The *Jia Yi Jing* writes "Mei" (eyebrow) for "Jian". The annotation says one version is "Jian".
Jie Re Ruo Mai Xian (All Heat If Pulse is Depressed): The *Jia Yi Jing* lacks the three characters "Ruo Mai Xian". In my notes, this is redundant text and should be deleted.
Shan Tai Xi (Frequent Sighing): Zhi stated, "Gallbladder Qi does not ascend, hence sighing to extend/release it."
Kou Ku Ou Su Zhi (Bitter Mouth and Vomiting Old Fluids): In my notes, this is "Ou Dan" (vomiting bile), seen in the *Qi Bing Lun*.
Xin Xia Dan Dan, Kong Ren Jiang Bu Zhi (Palpitations in the Heart Region, Fear of Being Caught): The *Jia Yi Jing* has "Shan" before "Kong" and "Ru" after "Kong". The *Qian Jin Fang* has "Ru" after "Kong". Zhang Yun stated, "'Dan dan' is the appearance of frustration/loss." In my notes, "Dan" is the same as "Dan". "Dan", in *Ji Yun*, means movement. The *Jing Mai* chapter states: "When the Heart Master meridian moves, the heart palpitates greatly." Also, the *Zhi Yao Da Yao Lun* states: "When Shaoyang rules the Heaven, and Cold overcomes, the heart palpitates greatly." Both refer to a jumping/palpitating sensation. Zhang's note is incorrect.
Nie Ran Shuo Tuo (Chattering and Frequent Spitting): The *Qian Jin Fang* writes "Jie Jie". Before "Tuo", the *Jia Yi Jing* has "Ke" (cough). In my notes, Ma and Zhang say "Nie ran" means sound, which is incorrect. The meaning is seen in the annotation for "Hou Bi" above.
Zai Zu Shao Yang Zhi Ben Mo (At the Root and Tip of the Foot Shaoyang): The *Jia Yi Jing* has "Hou" before "Zai". Zhang Yun stated, "In the Fu organs is the Root, in the meridians is the Tip." Zhi stated, "The Root of the Foot Shaoyang meridian is below, and its Tip is between the neck and throat."
Xian Xia Zhe Jiu Zhi (Depressed Ones Are Moxa-ed): The *Jing Mai* chapter states: "If depressed, moxa them." Zhang Yun stated, "Depression indicates deficiency, thus moxibustion is suitable."
Qi Han Re Zhe (Those with Cold and Heat): Zhi stated, "This is the pivot syndrome of Shaoyang. One should treat by taking the meridian. The Qi of the Shaoyang meridian enters and exits externally and internally."
Bi Zhong Qi Xue (Must Hit the Qi Acupoints): Zhi stated, "Qi acupoints are the meridian points where Fu Qi pours in. Thus, hitting the Qi acupoint allows the needle to wander in the alley, i.e., the 'dwelling of wandering needles' mentioned in the *Qi Xue Lun*."
Rou Jie (Muscle Nodes): Zhang Yun stated, "Muscles have boundaries/joints; this is called Rou Jie."
Zhan Ran (One Version You) Yu Xiang (Needle Enters the Alley): Ma Yun stated, "Qi and vessels communicate, which is the 'dwelling of wandering needles' from the *Su Wen Qi Xue Lun*." (If one calls the Qichong point the Qi Street, and the *Wei Qi* chapter mentions streets for Chest Qi, Abdominal Qi, Head Qi, and Shin Qi, then 'Alley' means 'Street'). Zhang Yun stated, "'Ran' means to attach; 'Xiang' means path. Hitting the Qi acupoint attaches the needle to the vessel path, unblocking the meridians." In my notes, writing "Ran" as "You" is correct.
Fan Huan Nei Zhuo (Reversing Back and Internally Attaching): Ma Yun stated, "Contending with True Qi and causing chaos, the pathogen reverses back and internally attaches."