（素问六节藏象论 脉要精微论）
故人迎一盛病在少阳，二盛病在太阳，三盛病在阳明，四盛以上为格阳。（素问六节藏象论。人迎，足阳明胃脉也，
在颈下夹结喉旁一寸五分。一盛二盛，犹言一倍二倍，谓以人迎寸口相较，或此大于彼，或彼大于此，而有三倍四倍之
殊也。禁服篇曰∶寸口主中，人迎主外，两者相应，俱往俱来，若引绳大小齐等，春夏人迎微大，秋冬寸口微大，如是
者命曰平人。故人迎寸口而至于盛衰相倍者，乃不免于病矣。然人迎候阳，故一盛在少阳，胆与三焦也。二盛在太阳，
膀胱小肠也。三盛在阳明，胃与大肠也。四盛以上者，以阳脉盛极而阴无以通，故曰格阳。此义终始、禁服二篇，分别
尤详，见针刺类二十八、九。又经脉篇所载亦明，见疾病类十。）寸口一盛病在厥阴，二盛病在少阴，三盛病在太阴，四
盛以上为关阴。（寸口，手太阴肺脉也。寸口候阴，故一盛在厥阴，肝与心主也。二盛在少阴，心与肾也。三盛在太阴，
脾与肺也。四盛以上者，以阴脉盛极而阳无以交，故曰关阴。终始、禁服二篇详义同前。）人迎与寸口俱盛四倍以上为关
格，关格之脉羸，不能极于天地之精气则死矣。（俱盛四倍以上，谓盛于平常之脉四倍也。物不可以过盛，盛极则败。凡
脉盛而至于关格者，以阴阳离绝，不能相营，故至羸败。极，尽也。精气，天禀也。言不能尽其天年而夭折也。脉度篇
曰∶邪在腑则阳脉不和，阳脉不和则气留之，气留之则阳气盛矣。阳气太盛则阴不利，阴脉不利则血留之，血留之则阴
气盛矣。阴气太盛则阳气不能荣也，故曰关。阳气太盛则阴气弗能荣也，故曰格。阴阳俱盛，不得相荣，故曰关格。关
格者，不得尽期而死也。愚按∶关格脉证，本经垂训极明，世人病此不少；而历代医师，每各立名目以相传训，甚至并
其大义而失之，其谬甚矣。夫所谓关格者，阴阳否绝，不相荣运，乖羸离败之候也。故人迎独盛者，病在三阳之腑也。
寸口独盛者，病在三阴之脏也。盖太阴行气于三阴，而气口之脉，亦太阴也。阳明行气于三阳，而人迎之脉，在结喉之
旁也。故古法诊三阳之气于人迎，诊三阴之气于寸口。如四时气篇曰∶气口候阴，人迎候阳。正此谓也。其于关格之证，
则以阴阳偏盛之极，而或见于人迎，或见于气口，皆孤阳之逆候，实真阴之败竭也。故六腑之阴脱者曰格阳，格阳者，
阳格于阴也。五脏之阴脱者曰关阴，关阴者，阴拒乎阳也。脏腑之阴俱脱，故云关格。然既曰阴阳关格，必其彼此痞绝，
似当阴阳对言，而余皆谓之阴脱者何也？正以脉盛之极为无阴，无阴则无根，而孤阳浮露于外耳，凡犯此者，必死无疑。
余尝于蒯司马、田宗伯辈见之，其脉则坚盛至极，其证则喘息日增，甚至手颈通身之脉，俱为振动不已，是皆酒色伤精
所致，终至不救。故本神篇曰∶五脏主藏精者也，不可伤，伤则失守而阴虚，阴虚则无气，无气则死矣。其即关阴格阳
之谓欤？又按∶关格之脉，如六节藏象、脉度、终始、禁服、经脉等篇，言之再四。盖恐其难明，故宣而又宣，诚重之
也。而后世诸贤，鲜有得其旨者，岂皆未之察耶？夫人迎在头，系阳明表脉，故人迎倍大者曰格阳。寸口在手，系太阴
里脉，故寸口倍大者曰关阴。此以阴阳痞绝，气不相营，故名关格，不可易也。而三难曰∶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，脉当见九分而浮，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，脉当见一寸而沉，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。故仲景宗之曰∶在尺为关，在寸为格；关则不得小便，格则吐逆。夫人迎四倍，
寸口四倍，既非尺寸之谓，而曰吐逆者，特隔食一证耳，曰不得小便者，特癃闭一证耳，二证未必至死，何两经谆谆特
重之若是耶？继自王叔和以后，俱莫能辨，悉以尺寸言关格，而且云左为人迎，右为气口，以致后世惑乱，遂并阴阳表
里大义尽皆失之。迨及东垣之宗脉经者，则亦以左为人迎，右为气口。曰气口之脉，大四倍于人迎，此清气反行浊道也，
故曰格。人迎之脉，大四倍于气口，此浊气反行清道也，故曰关。其宗仲景者，则亦曰格则吐逆，关则不便。甚至丹溪
则特立关格一门，曰此证多死，寒在上，热在下，脉两寸俱盛四倍以上。夫两寸俱盛四倍，又安得为寒在上热在下耶？
其说愈乖，其义愈失，致使后学茫然莫知所辨，欲求无误，其可得乎？独近代马玄台知诸子之非，而谓关格之义，非隔
食癃闭之证，曰呜呼痛哉！轩岐之旨乎。秦张王李朱，后世业医者所宗，尚与内经渺然如此，况能使后世下工，复知关
格为脉体而非病名也，又焉能决关格脉之死生，治关格脉之病证，及治隔证闭癃证而无谬也哉？此马子之言诚是矣，然
观其诸篇之注，则亦未详经义，谬宗叔和，仍以左为人迎，右为气口，竟置阳明胃脉于乌有，而仍失本经表里阴阳根本
对待之义，此其复为误也。故于阴阳别论中三阳在头三阴在手之义，竟皆谬注。呜呼！玄台哀前人之误，而余复哀其误，
所谓后人而复哀后人也。使余之后人，又复有哀余之误者，余诚不自知其非，而今日之言，乃又不如无矣。
岐伯曰∶反四时者，有余为精，不足为消。（素问脉要精微论。此言四时阴阳，脉之相反者，亦为关格也。禁服篇曰∶
春夏人迎微大，秋冬寸口微大，如是者命曰平人。以人迎为阳脉而主春夏，寸口为阴脉而主秋冬也。若其反者，春夏气
口当不足而反有余，秋冬人迎当不足而反有余，此邪气之有余，有余者反为精也。春夏人迎当有余而反不足，秋冬寸口
当有余而反不足，此血气之不足，不足者日为消也。）应太过，不足为精；应不足，有余为消。阴阳不相应，病名曰关格。
（如春夏人迎应太过，而寸口之应不足者反有余而为精，秋冬寸口应太过，而人迎之应不足者反有余而为精，是不足者
为精也。春夏寸口应不足，而人迎应有余者反不足而为消，秋冬人迎应不足，而寸口应有余者反不足而为消，是有余者
为消也。应不足而有余者，邪之日盛；应有余而不足者，正必日消。若此者，是为阴阳相反，气不相营，皆名关格。前
二应字平声，后一应字去声。）
（《素问·六节藏象论》、《脉要精微论》）
所以，人迎脉（足阳明胃经之脉，位于颈部结喉旁）搏动比寸口脉（手太阴肺经之脉，位于手腕桡动脉处）大一倍，病在少阳（胆与三焦）；大两倍，病在太阳（膀胱与小肠）；大三倍，病在阳明（胃与大肠）；大四倍以上，称为格阳（阳气极盛而阴气无法通达）。
（注：人迎脉是足阳明胃经的脉，位于颈部结喉旁一寸五分处。“一盛”、“二盛”，即指一倍、两倍的意思，是指比较人迎脉和寸口脉的大小，或者此脉大于彼脉，或者彼脉大于此脉，从而有三倍、四倍的差异。《灵枢·禁服篇》说：“寸口脉主要反映内脏的情况，人迎脉主要反映体表的情况，两者应当相应，共同往来，像拉紧的绳子一样大小相等。春夏季节人迎脉略微偏大，秋冬季节寸口脉略微偏大，像这样的人称为平人（健康人）。所以，如果人迎脉和寸口脉出现盛衰相差悬殊的情况，就难免患病了。然而人迎脉候察阳气，所以一倍盛在少阳，即胆和三焦；两倍盛在太阳，即膀胱和小肠；三倍盛在阳明，即胃和大肠。四倍盛以上，是因为阳脉盛极而阴气无法通达，所以叫作格阳。这一含义在《终始篇》和《禁服篇》中分别阐述得尤为详细，见针刺类第二十八、二十九条。另外《经脉篇》所载也很明确，见疾病类第十条。）
寸口脉搏动比人迎脉大一倍，病在厥阴（肝与心包络）；大两倍，病在少阴（心与肾）；大三倍，病在太阴（脾与肺）；大四倍以上，称为关阴（阴气极盛而阳气无法交合）。
（注：寸口脉是手太阴肺经的脉。寸口脉候察阴气，所以一倍盛在厥阴，即肝和心包络；两倍盛在少阴，即心和肾；三倍盛在太阴，即脾和肺。四倍盛以上，是因为阴脉盛极而阳气无法交合，所以叫作关阴。《终始篇》和《禁服篇》中的详细含义同上。）
如果人迎脉和寸口脉都盛大超过平常脉象四倍以上，称为关格。关格的脉象羸弱败坏，不能尽享天地赋予的自然寿命就会死亡。
（注：俱盛四倍以上，是指比平常的脉象盛大四倍。事物不可以过度盛大，盛极则败坏。凡是脉象盛大到关格程度的，是因为阴阳离绝，不能相互滋养，所以导致羸弱败坏。“极”，就是尽的意思。“精气”，指天赋的生命力。意思是说不能尽其天年而夭折。《灵枢·脉度篇》说：“邪气在腑则阳脉不和，阳脉不和则气停留，气停留则阳气盛大。阳气太盛则阴气不利，阴气不利则血停留，血停留则阴气盛大。阴气太盛则阳气不能荣养，所以叫作‘关’。阳气太盛则阴气不能荣养，所以叫作‘格’。阴阳都盛大，不能相互荣养，所以叫作‘关格’。关格的人，不能活到预定的期限而死。”
我按语：关格的脉证，本经（《内经》）的训诫非常明确，世人患此病者不少；但历代医师，往往各自设立名目来相传教导，甚至连大义都丢失了，错误很大。所谓关格，是阴阳否塞隔绝，不能相互荣运，是乖违羸弱离败的征候。所以人迎脉单独盛大，病在三阳之腑；寸口脉单独盛大，病在三阴之脏。大概太阴肺经将气行于三阴，而气口脉也属于太阴；阳明胃经将气行于三阳，而人迎脉位于结喉旁边。所以古法诊察三阳之气在人迎，诊察三阴之气在寸口。如《灵枢·四时气篇》说：“气口候阴，人迎候阳。”正是这个意思。至于关格的证候，是由于阴阳偏盛到了极点，要么见于人迎，要么见于气口，这都是孤阳逆乱的征候，实际上是真阴的败竭。所以六腑的阴气脱失叫做格阳，格阳，就是阳气格拒于阴气之外。五脏的阴气脱失叫做关阴，关阴，就是阴气拒绝于阳气之内。脏腑的阴气都脱失，所以叫关格。既然叫阴阳关格，必定是彼此痞塞隔绝，似乎应当阴阳对举而言，而我却都称之为阴脱，为什么呢？正是因为脉象盛大至极是因为无阴，无阴则无根，导致孤阳浮露于外罢了。凡是犯此病的人，必死无疑。我曾经在蒯司马、田宗伯等人身上见到过，他们的脉象坚硬盛大到了极点，症状则是喘息日益加重，甚至手腕、颈部、全身之脉，都在振动不止，这都是因酒色损伤精气所致，最终无法救治。所以《灵枢·本神篇》说：“五脏是主藏精气的器官，不可受伤，受伤则失守而导致阴虚，阴虚则无气，无气就会死亡。”这说的不就是关阴格阳吗？
我又按：关格的脉，如在《六节藏象论》、《脉度》、《终始》、《禁服》、《经脉》等篇中，反复说了多次。大概是担心它难以明白，所以宣扬又宣扬，确实是很重视它。但后世的各位贤人，很少能领会其旨意，难道都是没有考察吗？人迎脉在头部，属于阳明表脉，所以人迎脉比寸口脉大两倍的叫格阳。寸口脉在手上，属于太阴里脉，所以寸口脉比人迎脉大两倍的叫关阴。这是因为阴阳痞塞隔绝，气不能相互营卫，所以名叫关格，这是不可更改的。
但是《难经·三难》说：“脉有太过，有不及，有阴阳相乘，有覆有溢，有关有格，这是什么意思呢？”回答是：关之前的部位，是阳气的变动处，脉象应当显现九分且浮，超过这个限度法度上叫太过，减少这个限度法度上叫不及，于是向上到达鱼际为溢，为外关内格，这是阴气上乘的脉象。关以后的部位，是阴气的变动处，脉象应当显现一寸且沉，超过这个限度法度上叫太过，减少这个限度法度上叫不及，于是向下进入尺部为覆，为内关外格，这是阳气上乘的脉象。所以张仲景遵循这一说法说：“在尺部为关，在寸部为格；关则小便不通，格则呕吐逆乱。”
然而，人迎脉大四倍，寸口脉大四倍，这既不是指尺寸部位的脉，而如果说“吐逆”，那只是隔食这一种证候而已；如果说“不得小便”，那只是癃闭这一种证候而已。这两种证候未必致死，为什么这两篇经文如此谆谆告诫特别重视呢？从王叔和以后，都不能辨别，全都用尺寸部位来说关格，而且说左脉为人迎，右脉为气口，导致后世迷惑混乱，于是连阴阳表里的根本大义都丢失了。等到李东垣推崇《脉经》时，也是以左脉为人迎，右脉为气口。他说：气口脉比人迎脉大四倍，这是清气反而运行在浊道，所以叫格。人迎脉比气口脉大四倍，这是浊气反而运行在清道，所以叫关。那些遵循张仲景学说的人，也说格则吐逆，关则不便。甚至朱丹溪专门设立关格一门，说此证多死，寒在上，热在下，脉象两寸都盛大四倍以上。既然两寸都盛大四倍，又怎么能说是寒在上热在下呢？他的说法越发违背常理，义理越发丢失，致使后学茫然不知如何辨别，想要寻求无误，怎么可能呢？
只有近代的马玄台知道诸家之说有误，认为关格的含义，不是隔食癃闭的证候，说：“呜呼！痛哉！这是违背了轩岐（黄帝、岐伯）的宗旨啊！”秦越人、张仲景、王叔和、李东垣、朱丹溪，是后世业医者所尊崇的，尚且与《内经》的原意相差如此之大，何况能使后辈低水平的医生，重新知道关格是脉象而非病名呢？又怎么能判断关格脉的死生，治疗关格脉的病证，以及治疗隔证、闭癃证而不犯错呢？马先生的话确实是正确的，然而观察他对各篇的注释，也没有详细阐明经义，错误地尊崇王叔和，仍然以左脉为人迎，右脉为气口，竟然置阳明胃脉于不存在，从而再次失去了本经表里阴阳根本对待的意义，这是他再次犯的错误。所以在《阴阳别论》中关于“三阳在头，三阴在手”的意义，竟然都做了错误的注释。唉！马先生哀叹前人的错误，而我又哀叹他的错误，这就是所谓的“后人复哀后人”。假使我的后人，又有哀叹我的错误的，我实在不知道自己是否错了，而今天的话，还不如不说的好。
岐伯说：与四时相反者，有余表现为精气亢盛，不足表现为正气消损。（注：《素问·脉要精微论》。这里说的是四时阴阳，脉象与之相反的，也属于关格。《灵枢·禁服篇》说：“春夏人迎脉略微偏大，秋冬寸口脉略微偏大，像这样的人称为平人。以人迎为阳脉而主司春夏，寸口为阴脉而主司秋冬。如果相反，春夏时节寸口脉应当不足反而有余，秋冬时节人迎脉应当不足反而有余，这是邪气有余，有余的反面表现为精气（此处指邪气盛实）；春夏时节人迎脉应当有余反而不足，秋冬时节寸口脉应当有余反而不足，这是血气不足，不足的方面每日都在消损。）
应当脉象太过，却表现为不足，这是精气（邪气）有余；应当脉象不足，却表现为有余，这是正气消损。阴阳不相呼应，病名叫做关格。
（注：如春夏人迎脉应当太过，而寸口脉应当不足反而有余而表现为精气（邪气）盛，秋冬寸口脉应当太过，而人迎脉应当不足反而有余而表现为精气（邪气）盛，这是不足的一方被邪气占据而显有余。春夏寸口脉应当不足，而人迎脉应当有余反而不足而表现为消损，秋冬人迎脉应当不足，而寸口脉应当有余反而不足而表现为消损，这是有余的一方反而消损。应当不足而反有余的，是邪气日益强盛；应当有余而反不足的，是正气必然日益消损。像这种情况，就是阴阳相反，气不能相互营卫，都名为关格。前两个“应”字读平声，后一个“应”字读去声。）
(Su Wen: Chapter 6, Six Sections and Zang-Fu Manifestations; Chapter 13, Essential Refinements of the Pulse)
Therefore, when the Renying pulse (Renying, the pulse of the Foot-Yangming Stomach meridian, located beside the laryngeal prominence on the neck) is one-fold stronger than the Cunkou pulse (Cunkou, the pulse of the Hand-Taiyin Lung meridian, located at the radial artery of the wrist), the disease is in Shaoyang (Gallbladder and Sanjiao); when it is two-fold stronger, the disease is in Taiyang (Bladder and Small Intestine); when it is three-fold stronger, the disease is in Yangming (Stomach and Large Intestine); when it is four-fold or more stronger, it is termed Ge Yang (Excess Yang where Yin cannot penetrate).
(Note: Renying is the pulse of the Foot-Yangming Stomach meridian, located 1.5 cun lateral to the laryngeal prominence. "One-fold" and "two-fold" refer to one times and two times, respectively, indicating a comparison between the Renying and Cunkou pulses, where one may be larger than the other, showing differences of three or four times. The Jin Fu chapter states: "Cunkou primarily reflects internal conditions, while Renying primarily reflects external conditions. They should correspond, moving together as if drawn by a rope of equal tension. In spring and summer, Renying is slightly larger; in autumn and winter, Cunkou is slightly larger. Such a person is called a healthy individual (Ping Ren). Thus, if Renying and Cunkou show significant disparity in strength, illness is inevitable. However, Renying observes Yang; hence, one-fold excess is in Shaoyang, i.e., Gallbladder and Sanjiao; two-fold excess is in Taiyang, i.e., Bladder and Small Intestine; three-fold excess is in Yangming, i.e., Stomach and Large Intestine. Four-fold or more excess occurs because Yang pulses are excessively strong while Yin cannot penetrate, hence termed Ge Yang. This meaning is elaborated in detail in the Zhong Shi and Jin Fu chapters, see Acupuncture Category 28-29. Also, the Jing Mai chapter explains this clearly, see Disease Category 10.)
When the Cunkou pulse is one-fold stronger than the Renying pulse, the disease is in Jueyin (Liver and Pericardium); when it is two-fold stronger, the disease is in Shaoyin (Heart and Kidney); when it is three-fold stronger, the disease is in Taiyin (Spleen and Lung); when it is four-fold or more stronger, it is termed Guan Yin (Excess Yin where Yang cannot interact).
(Note: Cunkou is the pulse of the Hand-Taiyin Lung meridian. Cunkou observes Yin; hence, one-fold excess is in Jueyin, i.e., Liver and Pericardium; two-fold excess is in Shaoyin, i.e., Heart and Kidney; three-fold excess is in Taiyin, i.e., Spleen and Lung. Four-fold or more excess occurs because Yin pulses are excessively strong while Yang cannot interact, hence termed Guan Yin. The detailed meanings in Zhong Shi and Jin Fu are the same as above.)
If both Renying and Cunkou pulses are excessively strong, exceeding normal strength by four-fold or more, it is termed Guan Ge (Guan and Ge). The Guan Ge pulse is weak and degenerated; if it cannot fully utilize the essence and qi of heaven and earth, death will ensue.
(Note: "Exceeding by four-fold" means being four times stronger than the normal pulse. Things cannot be excessively strong; extreme excess leads to decay. Whenever the pulse becomes so strong as to reach Guan Ge, it is because Yin and Yang have separated and can no longer nourish each other, leading to weakness and decay. "Ji" means exhaustion. "Jing Qi" refers to innate vitality. It means failing to complete one's natural lifespan and dying prematurely. The Mai Du chapter states: "Pathogens in the Fu organs cause Yang pulse disharmony; Yang pulse disharmony causes Qi stagnation; Qi stagnation leads to excessive Yang. Excessive Yang makes Yin unfavorable; Yin unfavorability causes Blood stagnation; Blood stagnation leads to excessive Yin. Excessive Yin prevents Yang from nourishing, hence termed 'Guan' (Obstruction). Excessive Yang prevents Yin from nourishing, hence termed 'Ge' (Rejection). When both Yin and Yang are excessive and cannot nourish each other, it is termed 'Guan Ge'. Those with Guan Ge die before their appointed time."
My commentary: The pulse and symptoms of Guan Ge are clearly instructed in the original classics (Nei Jing), yet many people suffer from this disease. However, physicians through the ages have often established their own names for transmission, even losing the fundamental meaning, which is a great error. What is meant by Guan Ge is the blockage and separation of Yin and Yang, inability to mutually nourish and circulate, representing a state of deviation, weakness, and disintegration. Therefore, if only Renying is excessive, the disease is in the Three-Yang Fu organs; if only Cunkou is excessive, the disease is in the Three-Yin Zang organs. Generally, Taiyin distributes Qi to the Three-Yin, and the Qi Kou pulse also belongs to Taiyin; Yangming distributes Qi to the Three-Yang, and the Renying pulse is located beside the larynx. Thus, ancient methods diagnosed the Qi of the Three-Yang at Renying and the Qi of the Three-Yin at Cunkou. As the Si Shi Qi chapter states: "Qi Kou observes Yin, Renying observes Yang." This is precisely what is meant. Regarding Guan Ge syndromes, they arise from extreme excess of Yin or Yang, appearing either at Renying or at Qi Kou. These are all signs of lone Yang rebellion, actually representing the depletion of True Yin. Therefore, depletion of Yin in the Six Fu organs is called Ge Yang; Ge Yang means Yang is rejected by Yin. Depletion of Yin in the Five Zang organs is called Guan Yin; Guan Yin means Yin rejects Yang. Since Yin in both Zang and Fu is depleted, it is called Guan Ge. Although it is called Yin-Yang Guan Ge, implying mutual blockage, why do I refer to them all as Yin depletion? Precisely because extreme pulse excess indicates absence of Yin; without Yin, there is no root, causing lone Yang to float externally. Anyone suffering this will undoubtedly die. I have observed this in individuals like Ku Sima and Tian Zongbo; their pulses were extremely hard and strong, symptoms included increasing wheezing, and even pulses throughout the wrists, neck, and body vibrated incessantly. All these were caused by damage to essence from alcohol and sexual indulgence, ultimately proving incurable. Thus, the Ben Shen chapter states: "The Five Zang store essence; they must not be injured. Injury leads to loss of control and Yin deficiency; Yin deficiency leads to lack of Qi; lack of Qi leads to death." Does this not refer to Guan Yin and Ge Yang?
Furthermore, Guan Ge pulses are discussed repeatedly in chapters such as Liu Jie Zang Xiang, Mai Du, Zhong Shi, Jin Fu, and Jing Mai. This repetition likely stems from concern that the concept is difficult to understand, emphasizing its importance. Yet few later sages grasped its true intent. Was it due to lack of observation? Renying is in the head, belonging to the Yang-Biao (Exterior) pulse of Yangming; thus, Renying twice as large is called Ge Yang. Cunkou is in the hand, belonging to the Yin-Li (Interior) pulse of Taiyin; thus, Cunkou twice as large is called Guan Yin. This is named Guan Ge because Yin and Yang are blocked and separated, and Qi cannot mutually nourish. This definition is immutable.
However, Nan Jing Chapter 3 states: "Pulses have excess, deficiency, Yin-Yang interaction, Fu (overturning), Yi (overflowing), Guan (obstruction), and Ge (rejection). What does this mean?" The answer is: Before the Guan point, Yang moves; the pulse should appear at nine fen and floating. Exceeding this is termed Taiguo (Excess); falling short is termed Bují (Deficiency). If it rises to the Yuji area, it is Yi (Overflow), constituting External Guan and Internal Ge, a pulse of Yin encroaching. After the Guan point, Yin moves; the pulse should appear at one cun and deep. Exceeding this is Taiguo; falling short is Bují. If it sinks into the Chi area, it is Fu (Overturning), constituting Internal Guan and External Ge, a pulse of Yang encroaching. Thus, Zhang Zhongjing followed this saying: "In Chi it is Guan; in Cun it is Ge. Guan results in inability to urinate; Ge results in vomiting and reversal."
Yet, Renying four-fold and Cunkou four-fold do not refer to Cun-Chi positions. Saying "vomiting" refers only to Ge Shi (Food Impediment); saying "inability to urinate" refers only to Long Bi (Dysuria). These conditions do not necessarily lead to death. Why did the original texts emphasize them so heavily? From Wang Shuhe onwards, distinctions were lost, and Guan Ge was explained solely via Cun-Chi positions, claiming Left is Renying and Right is Qi Kou, causing confusion and loss of Yin-Yang and Exterior-Interior principles. Later, Li Dongyuan, following Mai Jing, also claimed Left is Renying and Right is Qi Kou. He stated: If Qi Kou is four times larger than Renying, clear Qi flows in turbid pathways, hence Ge. If Renying is four times larger than Qi Kou, turbid Qi flows in clear pathways, hence Guan. Those following Zhongjing also said Ge causes vomiting and Guan causes difficulty in passing stool. Zhu Danxi even established a specific category for Guan Ge, stating it is mostly fatal, with Cold above and Heat below, and pulses in both Cun positions exceeding four-fold. If both Cun pulses exceed four-fold, how can it be Cold above and Heat below? His theory deviates further, losing meaning, leaving students confused. How can errors be avoided?
Only recently, Ma Xuantai realized the errors of others, stating Guan Ge does not refer to Ge Shi or Long Bi, lamenting: "Alas! Painful! This violates the principles of Xuanti (Yellow Emperor and Qibo)." Qin Yueren, Zhang Zhongjing, Wang Shuhe, Li Dongyuan, and Zhu Danxi are revered by later physicians, yet their interpretations differ so much from Nei Jing. How can lower-level physicians know Guan Ge is a pulse pattern, not a disease name? How can they judge life/death by Guan Ge pulse, treat Guan Ge pulse conditions, or treat Ge and Bi syndromes without error? Mr. Ma's words are correct. However, his annotations fail to detail the classic meaning, erroneously following Wang Shuhe, still using Left as Renying and Right as Qi Kou, ignoring the Yangming Stomach pulse, and losing the fundamental Yin-Yang and Exterior-Interior opposition of the original text. This is another error. In his annotations on Yin Yang Bie Lun regarding "Three-Yang in Head, Three-Yin in Hand," he made erroneous comments. Alas! Mr. Ma mourned predecessors' errors, and I mourn his errors—this is "later generations mourning later generations." If my descendants mourn my errors, I may not realize my faults, and today's words might be better left unsaid.
Qibo said: Those contrary to the Four Seasons, with excess manifest as Jing (Essence/Spirit abundance [of pathogen]), with deficiency manifest as Xiao (Consumption [of healthy Qi]). (Note: Su Wen: Mai Yao Jing Wei Lun. This discusses pulses contrary to the Yin-Yang of the Four Seasons, which also constitute Guan Ge. Jin Fu chapter states: "Spring/Summer Renying slightly large, Autumn/Winter Cunkou slightly large" defines a healthy person. Renying is Yang pulse governing Spring/Summer; Cunkou is Yin pulse governing Autumn/Winter. If contrary: In Spring/Summer, Cunkou should be deficient but is excessive; in Autumn/Winter, Renying should be deficient but is excessive. This is pathogenic excess; excess manifests as Jing (here referring to pathogenic fullness). In Spring/Summer, Renying should be excessive but is deficient; in Autumn/Winter, Cunkou should be excessive but is deficient. This is blood-Qi deficiency; deficiency manifests daily as Xiao (consumption).)
Should be Taiguo (Excess), but is Bují (Deficiency), this is Jing (pathogenic excess); Should be Bují, but is Taiguo, this is Xiao (healthy consumption). Yin and Yang do not correspond; the disease is named Guan Ge.
(Note: For example, in Spring/Summer, Renying should be Taiguo, but Cunkou, which should be Bují, is instead excessive and manifests as Jing (pathogen). In Autumn/Winter, Cunkou should be Taiguo, but Renying, which should be Bují, is instead excessive and manifests as Jing. Here, the deficient side shows excess due to pathogens. In Spring/Summer, Cunkou should be Bují, but Renying, which should be excessive, is deficient and manifests as Xiao. In Autumn/Winter, Renying should be Bují, but Cunkou, which should be excessive, is deficient and manifests as Xiao. Here, the excessive side shows consumption. When deficiency appears as excess, pathogens grow daily; when excess appears as deficiency, healthy Qi declines daily. Such cases represent contrary Yin and Yang, non-interacting Qi, all named Guan Ge. The first two 'Ying' (correspond) are pronounced level tone; the last 'Ying' is pronounced departing tone.)