心之合脉也 张云。心主血。血行脉中。故合于脉。吴云。心主血而藏神。脉则血体而神用。故心合脉。
其主肾也 吴云。其以之为主。而畏者肾也。志云。心主火。而受制于肾水。是肾乃心脏生化之主。
故其主肾也。
凝泣 熊音。上兼陵反。结也。下音涩。不滑也。马云。泣。涩同。吴同。杨慎外集云。素问。脉泣
则血虚。又云。寒气入经而稽迟。泣而不行。又云。多食咸。则脉凝泣而变色。泣音义与涩同。按说文。 。
（音丽）水不利也。 与。泪同。泣。亦水不利也泣。与涩同。亦可互证。
胝KT 而唇揭 吴云。肉粗疏胝KT 。而唇掀揭也。张云。胝。皮浓也。手足骈胝之谓。通雅云。
胝。皮肉生茧不仁也。
KT。脯也。简按巢源。有四肢发胝候。广韵。胼胝。皮上坚也。KT 。集韵。仄遇切。皱也。盖胝KT 者。
敛缩之义。肉在皮里。肉之敛缩。不可得而见。唇为肉之外候。以其掀揭。而知肉之敛缩。故言肉胝KT 而唇
揭。若为胼胝之类。则不通。
此五味之所合也五脏之气 简按当从太素。也字移气下。
故色见 吴。故。改败。非。
草兹 志云。兹。蓐席也。草兹者。死草之色。青而带白也。简按尔雅释器。蓐谓之兹。郭注。公羊
传曰。属负兹。兹者。蓐席也。史记仓公传。望之杀然黄。察之如死青之兹。俱可以确志聪之解耳。马王诸家。
以滋释之果然。则岂枯泽之色乎。并不可从。
黄如枳实 张云。黄黑不泽也。
黑如炱 千金翼。炱下有煤字。五行大义。作水苔。非。
赤如 血 说文。 。凝血也。
蟹腹 蟹黄。见本草。（李时珍云。腹中之黄。应月盈亏。）
如以缟裹朱 脉经。缟。作绵。禹贡。厥篚玄纤缟。孔传。玄。黑缯。缟。白缯。纤。细也。小尔
雅。缯之精者。曰缟。通雅。缟。子虚赋注。缟。鲜支。今所谓素 。以石辗缯。色光泽也。诗豳风。我朱孔
阳。为公子裳。毛传。朱。深 也。孔氏疏。士冠礼裳注云。凡染绛。一入谓之 。再入谓之 。三入谓之 。
朱则四入矣。朱色深于 。故云朱深 也。志云。荣色隐见于皮肤之间。有若缟裹者也。
裹红 说文。红。帛赤白色。释名。红。绛也。白色之似绛者。
裹绀 说文。绀。帛深青扬赤色。释名。绀。含也。青而含赤色也。简按王注薄青。不知何据。马
注本于说文。
栝楼实 马云。楼。蒌同。
裹紫 说文。紫。帛青赤色。论语皇疏。北方间色。
诸脉者皆属于目 大惑论云。五脏六腑之精气。皆上注于目。而为之精。口问篇云。目者。宗脉之
所聚也。
此四肢八溪之朝夕也 张云。四肢者。两手两足也。八溪者。手有肘与腋。足有 与 也。此四肢
之关节。故称为溪。朝夕者。言人之诸脉髓筋血气。无不由此出入。而朝夕营运不离也。邪客篇曰。人有八虚。
皆机关之室。真气之所过。血络之所游。即此之谓。一曰。朝夕。即潮汐之义。言人身血气往来。如海潮之消
长。早曰潮。晚曰汐者。亦通。吴云。朝夕。会也。古者君臣朝会谓之朝。夕会谓之夕。谓脉髓筋血气五者。
与四肢八溪。相为朝夕。而会见也。简按张前说似允当。盖溪者。筋骨罅隙之谓。王充论衡云。投一寸之针。
布一丸之艾。于血脉之溪。笃病有瘳。
肝受血而能视 李氏脾胃论。肝。作目。
指受血而能摄 说文。摄。引持也。庄子 箧云。必摄缄HT 。固扃 。摄字之义与此同。张云。
按血气者。人之神也。而此数节。皆但言血。而不言气。何也。盖气属阳而无形。血属阴而有形。而人之形体。
以阴而成。如九针篇曰。人之所以生成者。血脉也。营卫生会篇曰。血者。神气也。平人绝谷篇曰。血脉和则
精神乃居。故皆言血者。谓神根据形生。用自体出也。
为痹 王注 字。释音。音顽。广韵。痹也。字汇。手足麻痹也。简按痹病所指极广。故加 字。
明其麻痹之痹。（后世顽麻顽痹之顽。本是 字。盖根据音同。而称之者。）志云。金匮要略曰。血痹病从何得
之。师曰。汗出。卧不时动摇。加被微风遂得之。汗出者。言卫气之虚于外也。卧则卫归于阴。出则血行于外。
加被风吹。则血凝于皮肤。而为痹矣。要略云。血痹。外证
身体不仁。如风痹状。志以痹为血痹。王则为 痹。义互相发焉。
不得反其空 马云。空。与孔同。不得反其空穴。志云。空。骨空也。骨空者。节之交三百六十五穴
会。络脉之渗灌诸节者也。血行于皮肤。不得反循于穴会。故为痹厥也。吴张仍王注。简按志注似与下文相顺承。
大谷十二分 张云。大谷者。言关节之最大者也。在手者肩肘腕。在足者踝膝腕。四肢各有三节。是
为十二分。分。处也。按此即上文八溪之义。夫既曰溪。何又曰谷。如气穴论曰。肉之大会为谷。小会为溪。
肉分之间。溪谷之会。以行荣卫。以会大气。是溪谷虽以小大言。而为气血之会则一。故可以互言也。上文单
言之。故止云八溪。此节与下文小溪三百五十四名。相对为言。故云大谷也。诸注（王马吴同。）以大谷十二
分。为十二经脉之部分者。皆非。志云。分者。肉分而有纹理也。
小溪三百五十四名 张云。小溪者。言通身骨节之交也。小针解曰。节之交三百六十五会者。络脉
之渗灌诸节者也。简按子华子云。一身之为骨。凡三百六十五节。即此义也。志云。名。穴名也。盖肉分之间。
而有交会。交会之处。而有穴名也。马吴张俱根据王注。四改三。志高仍旧文。非是。
少十二俞 吴云。俞。十二经之俞也。十二俞。不在三百五十三名之内。故言少十二俞。张云。谓
十二脏之俞。如肺俞心俞之类。是也。此除十二俞。皆通于脏气者。不在小溪之列。马同。高云。十二俞。即
大谷十二分。是也。简按新校正云。别本。及全元起本。太素。俞。作关。知高注尤是。
卫气之所留止 张云。凡此溪谷之会。本皆卫气留止之
所。若其为病。则亦邪气所客之处也。简按诸家仍王义。张注似允。
缘而去之 张云。治以针石。必缘其所在。取而去之。缘。因也。简按诸家仍王义。张注似允。
先建其母 吴云。建。立也。母。应时胃气也。如春脉微弦。夏脉微钩。长夏脉微软。秋脉微毛。冬
脉微石。谓之中和。而有胃气。土为万物之母。故谓之母也。若弦甚。则知其病始于肝。钩甚。则知其病始于
心。软甚。则知其病始于脾。毛甚。则知其病始于肺。石甚。则知其病始于肾。故曰。欲知其始。先建其母。
马云。母者。五脏相乘之母也。张云。母。病之因也。不知其母。则标本弗辨。故当先建其母。如下文某脏某
经之谓。高云。母。病本也。简按吴主王义。似是。
五脉 经脉别论云。五脉气少。胃气不平。三阴也。征四失论云。诊不中五脉。
巅疾 脉要精微论云。厥成为巅疾。
过在 马云。过者。病也。凡内经以人之有病。如人之有过误。故称之曰过。脉要精微论云。故乃可
诊有过之脉。此非过与不及之过。亦非经过之过。乃指病而言也。吴云。过。责其过也。言有上件病证。责其
过在少阴巨阳。志云。实者邪实。虚者正虚。是以头痛巅疾。乃邪气实于上。而使正气虚于下也。盖邪之中人。
始于皮毛气分。留而不去。则转入于经。是以过在巨阳少阴之经。而甚则入肾。盖经络受邪。则内干脏腑矣。
简按下文云。病在膈中。过在手巨阳少阴。则知吴义长矣。
徇蒙招尤 吴。徇。作 。云。 。音眩。目动也。目半合谓之蒙。全合谓之冥。尤。 同。招尤。
摇动不定也。张云。徇。亦作巡。行视貌。蒙。茫昧也。招。掉摇也。尤。
甚也。目无光则 昧不明。头眩动。则招尤不定。滑云。徇蒙招尤。当作 招摇。 蒙。谓目瞬动而蒙昧。
下文目冥。是也。招摇。谓头振掉而不定也。（要旨同）简按本事方。招尤。作招摇。沈承之云。尤。与摇同。
徇蒙者。如以物蒙其首。招摇不定。皆晕之状也。志高并云。徇。 同。 眩。古字通。见扬雄剧秦美新文。
盖徇。 同。眩也。尤。摇同。不必改字也。（张氏医通云。徇蒙招尤。目瞑耳聋。肝虚风动也。六君子。加
钩藤。羌。防。芎。归。甘菊。）
目冥 高云。冥。瞑同。
支鬲 胁 吴云。支。支离而痛也。张云。支。隔塞也。志云。支。支络。鬲。内膈也。简按支。
技同。王注六元正纪支痛云。支。拄妨也。诸注并非。广雅。 。胁也。
咳嗽上气 吴云。声出于肺。谓之咳。咳而连声。谓之嗽。上气。浮肿也。张云。上气。喘急也。
简按周礼天官疾医职。嗽上气。郑注。上气。逆喘也。吴以上气为浮肿。误。咳嗽详义。见于咳论。
脉之小大滑涩浮沉 简按邪气脏腑病形云。调其脉之缓急小大滑涩。四难云。浮沉长短滑涩。俱举脉
之大纲而言之耳。
五脏相音 张云。相。形相也。音。五音也。相音。如阴阳二十五人篇。所谓木形之人。比于上角
之类。又如肝音角。心音征。脾音宫。肺音商。肾音羽。若以胜负相参。臧否自见。五而五之。二十五变。凡
耳聪心敏者。皆可意会而识也。简按王不释相字。得张注而义明。志云。五脏之相。合于五音。发而为声。此
亦主王注也。马云。人有相与音。虽见于外。而五脏主其中。吴云。相音。五音相为循环也。俱义未允。
赤脉之至也 吴。赤下句。马云。赤白青黄黑之下。俱当读。诊人之色已赤矣。及其脉之至也。涌盛
如喘之状。张云。此下即所以合脉色也。
心痹 简按郑玄易通卦验注云。痹者。气不达为病。王注盖本于此。
喘而浮 脉经。浮下有大字。注云。喘。疑作濡。
惊有积气 吴云。上虚。肺自虚也。下实。心在肺下而为邪。谓之实也。盖肺金不足。则心火乘其虚。
而克贼之。惊。心实而惊。肺受火邪。失其治节。故有积气在胸中。简按诸注以惊为上虚。吴独以为实。恐非。
甲乙。作为积气在胸中。盖积气在胸中。心神不安。故惊。似义易通。
喘而虚 马云。其脉喘。当为虚。吴云。有积气在胸中。令人喘而虚也。志云。膻中之正气反虚。故
为虚喘也。简按王注以喘为病。吴志从之。为是矣。
寒热 张云。金火相争。金胜则寒。火胜则热也。吴同。志云。脏真高于肺。主行荣卫阴阳。阴阳虚
乘。则为往来之寒热也。
使内 高云。得之醉而使邪气之内入也。简按此解不通。
长而左右弹 甲乙。而下有弦字。脉经。弹下有诊曰二字。张云。言两手俱长。而弦强也。弹。搏击之义。
厥疝 高云。腹中。脾部也。有厥气。乃土受木克。土气厥逆。而不达也。土受木克。故不名曰脾痹。
名曰厥疝。疝。肝病也。简按脾痹。见四时刺逆从论。
女子同法 高云。女子无疝。肝木乘脾之法则同也。志云。男女气血相同。受病亦属同法。故于中央
土脏。而曰女子同法者。欲类推于四脏也。简按志注凿矣。
得之疾使四肢汗出当风 吴云。脾主四肢。胃主四末。
疾使四肢。则劳而汗易出。风乘土虚。客于其部。故见上件诸证。高云。得之疾。犹言得之外疾。简按高注牵强。
上坚而大 张云。上。言尺之上。即尺外以候肾也。志云。上坚者。坚大在上。而不沉也。汪昂云。
上字未解。简按诸注未允。汪以为未详。实然。
五色之奇脉 简按据甲乙。衍之奇脉三字。
面青目青 目青。诸本作目赤。当改。
心与脉相合。张云：心主血，血液运行于脉管之中，所以心与脉相合。吴云：心主血并藏神，脉是血的形体而神是脉的功能作用，所以心与脉相合。
心的制约者是肾。吴云：以肾为制约者，是因为心所畏惧的是肾。志云：心属火，而受制于肾水，因此肾是心脏生化功能的根本制约者，所以说心的制约者是肾。
凝滞涩结。熊音：上字兼读“陵”的反切音，意为结聚；下字读“涩”，意为不滑利。马云：泣与涩同义。吴同此说。杨慎《外集》云：《素问》中说“脉泣则血虚”，又说“寒气入经而稽迟，泣而不行”，还说“多食咸，则脉凝泣而变色”。泣的音义与涩相同。按《说文解字》：“ ，音丽，指水流通不畅。” 与“泪”字相同。“泣”也是水流通不畅的意思，泣与涩同义，也可以互相印证。
肌肉僵硬紧缩且嘴唇掀揭。吴云：肌肉粗糙疏松如茧，导致嘴唇掀揭。张云：胝，指皮厚。即手足生老茧的情况。《通雅》云：胝，指皮肉生茧而失去知觉。
KT（皱缩），指脯肉。简按：《诸病源候论》中有“四肢发胝候”，《广韵》解释胼胝为皮肤坚硬。KT，《集韵》注仄遇切，意为皱纹。大概“胝KT”是收敛紧缩的意思。肉在皮里，肉的收敛紧缩无法直接看见，嘴唇是肌肉的外在表现，通过嘴唇的掀揭，可以知道内部肌肉的收敛紧缩，所以说“肉胝KT而唇揭”。如果理解为像胼胝那样的老茧，就不通了。
这是五味与五脏之气相合的道理。简按：应当依从《太素》，将“也”字移至“气”字之下。
所以面色显现。吴：将“故”改为“败”，不对。
像枯草席的颜色。志云：兹，指蓐席。草兹，是死草的颜色，青中带白。简按：《尔雅·释器》说：“蓐谓之兹。”郭璞注：“《公羊传》说‘属负兹’，兹就是蓐席。”《史记·仓公列传》说：“望之杀然黄，察之如死青之兹。”都可以证实志高的解释。马、王等各家，用“滋”来解释，如果是这样，难道是干枯无泽的颜色吗？都不足取。
黄色像枳实。张云：黄黑而无光泽。
黑色像烟灰。《千金翼方》中“炱”下有“煤”字。《五行大义》作“水苔”，不对。
红色像凝血。《说文解字》：“ ，凝血也。”
像蟹腹。蟹黄，见《本草纲目》。（李时珍说：腹中的黄色，对应月亮的盈亏。）
像白绢包裹着朱砂。《脉经》中，“缟”作“绵”。《禹贡》说：“厥篚玄纤缟。”孔安国传：“玄，黑色的丝织品；缟，白色的丝织品；纤，细也。”《小尔雅》说：“缯的精者，叫做缟。”《通雅》引《子虚赋》注：“缟，鲜支，今所谓的素，是用石碾磨过的丝织品，色泽光亮。”《诗经·豳风》：“我朱孔阳，为公子裳。”毛传：“朱，深红也。”孔氏疏：“《士冠礼》裳注说：凡染绛色，一入称为 ，再入称为 ，三入称为 。朱则是四入了。朱色比 更深，所以说朱是深 色。”志云：荣色隐现于皮肤之间，好像有白绢包裹着一样。
包裹着红。《说文解字》：“红，帛赤白色。”《释名》：“红，绛也。白色中似绛色的。”
包裹着绀。《说文解字》：“绀，帛深青扬赤色。”《释名》：“绀，含也。青而含赤色。”简按：王冰注为薄青，不知依据什么。马莳注本于《说文》。
栝楼实。马云：楼，与蒌同。
包裹着紫。《说文解字》：“紫，帛青赤色。”《论语皇疏》：“北方间色。”
所有的脉都归属于目。《大惑论》说：五脏六腑的精气，都上注于目，从而形成眼的精气。《口问篇》说：目，是宗脉汇聚的地方。
这是四肢八溪气血朝夕运行的规律。张云：四肢，指两手两足。八溪，手有肘和腋，足有 和 。这是四肢的关节，所以称为溪。朝夕，是说人的经脉骨髓筋血气，无不由此出入，并且日夜营运不停。《邪客篇》说：人有八虚，都是机关所在之处，真气经过的地方，血络游行的地方，就是这个意思。另一种说法：朝夕，即潮汐的意思，说人身血气往来，像海潮的消长，早叫潮，晚叫汐，也通。吴云：朝夕，会合的意思。古时候君臣早晨会合叫朝，傍晚会合叫夕。是说脉髓筋血气这五种物质，与四肢八溪，相互朝夕会合。简按：张前面的说法似乎更妥当。大概“溪”是指筋骨缝隙的意思。王充《论衡》说：投一寸长的针，布一丸艾绒，在血脉的溪处，重病可以得到治愈。
肝得到血的滋养就能视物。李东垣《脾胃论》：肝，当作目。
手指得到血的滋养就能握持。《说文解字》：摄，引持也。《庄子·箧》说：“必摄缄HT，固扃 ”，摄字的意义与此相同。张云：按血气，是人的神志基础，而这几节文字，只说血，不说气，为什么呢？大概气属阳而没有形体，血属阴而有形体，而人的形体是由阴构成的。如《九针篇》说：人之所以生成，靠的是血脉。《营卫生会篇》说：血，是神气的基础。《平人绝谷篇》说：血脉调和则精神才能安居。所以都说血，是说神根据形产生，功能从本体发出。
成为顽痹。王冰注： 字，解释读音，音顽。《广韵》：痹也。《字汇》：手足麻痹。简按：痹病所指范围极广，所以加 字，明确它是麻痹的痹。（后世顽麻顽痹的顽，本是 字，大概是根据音同而称呼的。）志云：《金匮要略》说：血痹病是怎么得的？老师说：汗出，睡觉时不时动摇，加上被微风侵袭就得了。汗出，是说卫气虚弱于外。睡觉时卫气归于阴，醒来则血行于外，加上风吹，则血凝于皮肤，而成为痹。《要略》说：血痹的外证，身体不仁，像风痹的样子。志认为痹是血痹，王冰认为是 痹，意义互相补充。
不能返回其空窍。马云：空，与孔同。不能返回其空穴。志云：空，骨空也。骨空，是关节交会处的三百六十五个穴位会合之处，是络脉渗灌各个关节的地方。血行于皮肤，不能反向循行于穴位会合处，所以成为痹厥。吴、张仍依王冰注。简按：志的注释似乎与下文相顺承。
大谷十二分。张云：大谷，指最大的关节。在手的是肩、肘、腕，在足的是踝、膝、腕。四肢各有三节，这就是十二分。分，就是处所。按此即上文八溪的意义。既然叫溪，为什么又叫谷？如《气穴论》说：肉的大会合叫谷，小会合叫溪。肉分之间，溪谷的会合，用来运行营卫，汇聚大气。所以溪谷虽然以小大区分，但作为气血会合之处是一样的，所以可以互称。上文单说，所以只说八溪，这一节与下文小溪三百五十四名相对，所以说大谷。诸家（王、马、吴相同）以大谷十二分为十二经脉的部分，都不对。志云：分，是肉分而有纹理。
小溪三百五十四名。张云：小溪，指全身骨节的交会。《小针解》说：节之交三百六十五会，是络脉渗灌各个关节的地方。简按：《子华子》说：一身骨头，共三百六十五节，就是这个意思。志云：名，是穴名。大概在肉分之间，有交会之处，交会之处，就有穴名。马、吴、张都根据王冰注，将四改为三，志高保留原文，是不对的。
少十二俞。吴云：俞，是十二经的俞穴。十二俞，不在三百五十三名之内，所以说少十二俞。张云：指十二脏的俞，如肺俞、心俞之类。除去这十二俞，其余都与脏气相通，不在小溪之列。马同此说。高云：十二俞，就是大谷十二分。简按：新校正说：别本及全元起本、《太素》，俞作关，知道高注尤其正确。
卫气停留止息的地方。张云：凡是这些溪谷的会合，本来都是卫气停留的地方，如果发生病变，也是邪气客居的地方。简按：诸家仍依王冰义，张注似乎妥当。
顺着它的位置去除它。张云：治疗用针石，必须顺着邪气所在的地方，取而去除它。缘，因也。简按：诸家仍依王冰义，张注似乎妥当。
先确立其母。吴云：建，立也。母，应时的胃气。如春脉微弦，夏脉微钩，长夏脉微软，秋脉微毛，冬脉微石，这叫中和，而有胃气。土是万物的母亲，所以叫母。如果弦甚，就知道病始于肝；钩甚，就知道病始于心；软甚，就知道病始于脾；毛甚，就知道病始于肺；石甚，就知道病始于肾。所以说：想知道病的起始，先确立其母。马云：母，是五脏相乘的母亲。张云：母，是病的成因。不知道母，就无法分辨标本，所以应当先确立其母，如下文某脏某经的说法。高云：母，是病本。简按：吴主张王冰义，似乎是正确的。
五脉。《经脉别论》说：五脉气少，胃气不平，是三阴病。《征四失论》说：诊察不符合五脉。
巅疾。《脉要精微论》说：厥逆成为巅疾。
病在……马云：过，是病。凡是《内经》说人有病，就像人有错误，所以称之为过。《脉要精微论》说：所以可以诊察有过之脉。这里的过不是过与不及的过，也不是经过的过，而是指病。吴云：过，责备其过错。说有上述病证，责备其过在少阴巨阳。志云：实证是邪气实，虚证是正气虚。所以头痛巅疾，是邪气实于上，而使正气虚于下。大概邪气中人，始于皮毛气分，停留不去，就转入于经。所以过在巨阳少阴之经，严重时入肾。大概经络受邪，就会内干脏腑。简按：下文说：病在膈中，过在手巨阳少阴，可知吴义更长。
徇蒙招尤。吴：徇，作 ，云： ，音眩，目动也。目半合叫蒙，全合叫冥。尤， 同。招尤，摇动不定。张云：徇，也作巡，行视貌。蒙，茫昧也。招，掉摇也。尤，甚也。目无光则 昧不明，头眩动，则招尤不定。滑云：徇蒙招尤，当作 招摇。 蒙，谓目瞬动而蒙昧，下文目冥，就是这种情况。招摇，谓头振掉而不定。（要旨相同）简按：《本事方》中，招尤作招摇。沈承之说：尤，与摇同。徇蒙者，像有东西蒙住头部，招摇不定，都是晕的状态。志高并云：徇， 同。 眩，古字通，见扬雄《剧秦美新》文。大概徇， 同，眩也。尤，摇同，不必改字。（《张氏医通》说：徇蒙招尤，目瞑耳聋，肝虚风动也。用六君子汤，加钩藤、羌活、防风、川芎、当归、甘菊。）
目冥。高云：冥，瞑同。
支鬲胁。吴云：支，支离而痛。张云：支，隔塞也。志云：支，支络，鬲，内膈也。简按：支，技同。王冰注《六元正纪》支痛说：支，拄妨也。诸注都不对。《广雅》： ，胁也。
咳嗽上气。吴云：声出于肺，叫咳。咳而连声，叫嗽。上气，浮肿。张云：上气，喘急。简按：《周礼·天官·疾医职》：嗽上气，郑注：上气，逆喘。吴以上气为浮肿，误。咳嗽详细含义，见于《咳论》。
脉的小大滑涩浮沉。简按：《邪气脏腑病形》说：调其脉之缓急小大滑涩，《四难》说：浮沉长短滑涩，都是举脉的大纲而言。
五脏相音。张云：相，形相也。音，五音也。相音，如《阴阳二十五人篇》所谓木形之人，比于上角之类。又如肝音角，心音征，脾音宫，肺音商，肾音羽。如果以胜负相参，臧否自见。五而五之，二十五变，凡是耳聪心敏的人，都可以意会而识。简按：王冰不解释相字，有了张注而意义明了。志云：五脏之相，合于五音，发而为声。这也主王冰注。马云：人有相与音，虽见于外，而五脏主其中。吴云：相音，五音相为循环。俱义未允。
赤脉之至。吴：赤下句。马云：赤白青黄黑之下，俱当读。诊人之色已赤矣，及其脉之至也，涌盛如喘之状。张云：此下即所以合脉色。
心痹。简按：郑玄《易通卦验》注说：痹者，气不达为病。王冰注大概本于此。
喘而浮。《脉经》：浮下有大字。注云：喘，疑作濡。
惊有积气。吴云：上虚，肺自虚也。下实，心在肺下而为邪，谓之实。大概肺金不足，则心火乘其虚，而克贼之。惊，心实而惊，肺受火邪，失其治节，故有积气在胸中。简按：诸注以惊为上虚，吴独以为实，恐非。《甲乙经》作“作为积气在胸中”，大概积气在胸中，心神不安，故惊，似乎义理容易通达。
喘而虚。马云：其脉喘，当为虚。吴云：有积气在胸中，令人喘而虚。志云：膻中之正气反虚，故为虚喘。简按：王冰注以喘为病，吴、志从之，是对的。
寒热。张云：金火相争，金胜则寒，火胜则热。吴同。志云：脏真高于肺，主行营卫阴阳，阴阳虚乘，则为往来之寒热。
使内。高云：得之醉而使邪气之内入。简按：此解不通。
长而左右弹。《甲乙经》：而下有弦字。《脉经》：弹下有诊曰二字。张云：言两手俱长，而弦强。弹，搏击之义。
厥疝。高云：腹中，脾部也。有厥气，乃土受木克，土气厥逆，而不达。土受木克，故不名曰脾痹，名曰厥疝。疝，肝病。简按：脾痹，见《四时刺逆从论》。
女子同法。高云：女子无疝，肝木乘脾之法则同。志云：男女气血相同，受病亦属同法，故于中央土脏，而曰女子同法者，欲类推于四脏。简按：志注凿矣。
得之疾使四肢汗出当风。吴云：脾主四肢，胃主四末。疾使四肢，则劳而汗易出，风乘土虚，客于其部，故见上件诸证。高云：得之疾，犹言得之外疾。简按：高注牵强。
上坚而大。张云：上，言尺之上，即尺外以候肾。志云：上坚者，坚大在上，而不沉。汪昂云：上字未解。简按：诸注未允，汪以为未详，实然。
五色之奇脉。简按：据《甲乙经》，衍之奇脉三字。
面青目青。目青，诸本作目赤，当改。
The heart corresponds to the vessels (Mai, blood vessels). Zhang Yun: The heart governs Blood (Xue), and Blood circulates within the vessels; therefore, the heart corresponds to the vessels. Wu Yun: The heart governs Blood and houses the Spirit (Shen); the vessel is the physical form of Blood, while the Spirit is its functional manifestation; thus, the heart corresponds to the vessels.
Its controlling organ is the Kidney (Shen). Wu Yun: It regards the Kidney as its controller because what the Heart fears is the Kidney. Zhi Yun: The Heart belongs to Fire but is controlled by Kidney Water; thus, the Kidney is the fundamental controller of the Heart's generation and transformation, hence it is said that "its controlling organ is the Kidney."
Congealed and astringent (Qi Se). Xiong Yin: The first character combines the reverse-cut pronunciation of "Ling," meaning congealed or knotted; the second character is pronounced "Se," meaning not smooth. Ma Yun: Qi is synonymous with Se. Wu agrees. Yang Shen's *Waiji* states: In *Suwen*, it says "When vessels are astringent, Blood becomes deficient"; it also says "When Cold pathogen enters the meridians and lingers slowly, it congeals and does not flow"; and again, "Excessive consumption of salty taste causes vessels to congeal and become astringent, leading to discoloration." The sound and meaning of Qi are identical to Se. According to *Shuowen Jiezi*: " , pronounced Li, refers to water flowing obstructively." It is the same as the character for tears (Lei). "Qi" also means water flowing obstructively; Qi is synonymous with Se, and they can corroborate each other.
Muscles stiffen and contract (Zhi KT) while the lips peel back. Wu Yun: Muscles are rough and loose like calluses, causing the lips to peel back. Zhang Yun: Zhi refers to thickened skin, such as calluses on hands and feet. *Tongya* states: Zhi refers to skin and flesh developing calluses and losing sensation.
KT refers to dried meat. Jian An: *Zhoubing Yuanhou Lun* has a section on "Symptoms of Calluses on Four Limbs." *Guangyun* explains Pianzhi as hard skin. KT, according to *Jiyun*, is pronounced Ze Yu Qie, meaning wrinkles. Generally, "Zhi KT" implies contraction and shrinking. Flesh lies beneath the skin; its contraction cannot be seen directly. The lips are the external manifestation of muscle; through their peeling back, one knows of the internal muscular contraction. Thus, it is said "muscles stiffen and contract while lips peel back." If interpreted as mere calluses like Pianzhi, it would be illogical.
This is how the Five Flavors (Wu Wei) combine with the Qi of the Five Zang Organs. Jian An: Following *Tai Su*, the particle "Ye" should be moved after "Qi."
Thus, colors manifest. Wu: Changing "Gu" (Therefore) to "Bai" (Defeat) is incorrect.
Like the color of withered grass mats. Zhi Yun: Zi refers to rush mats. Cao Zi is the color of dead grass, greenish-white. Jian An: *Erya · Shi Qi* states: "Rush mats are called Zi." Guo Pu's commentary: "'Chu Fu Zi' in *Gongyang Zhuan*; Zi refers to rush mats." *Shiji · Cang Gong Liezhuan* states: "Looking at it, it appears yellowish-dull; examining it, it resembles the dead-green Zi of withered grass." This confirms Zhi Gao's interpretation. Ma, Wang, and others interpret it as "Zi" (nourishment/moisture); if so, would it not be a dry and lusterless color? Their interpretations are unacceptable.
Yellow like the fruit of Acanthopanacis Trifidi Radix et Rhizoma (Zhi Shi). Zhang Yun: Yellow-black and lusterless.
Black like soot (Tai). *Qianjin Yifang* adds the character "Mei" (coal) after "Tai." *Wuxing Dayi* writes "Water moss," which is incorrect.
Red like coagulated blood. *Shuowen Jiezi*: " , coagulated blood."
Like crab abdomen. Crab roe, see *Bencao*. (Li Shizhen says: The yellow inside the abdomen corresponds to the waxing and waning of the moon.)
Like vermilion wrapped in white silk (Gao). *Maijing*: "Gao" is written as "Mian" (cotton/silk floss). *Yugong* states: "Its basket contains black and fine white silk (Gao)." Kong Anguo's commentary: "Xuan is black silk; Gao is white silk; Xian is fine." *Xiaoerya* states: "The finest silk is called Gao." *Tongya* cites *Zixu Fu* commentary: "Gao is Xianzhi, what is now called Su, silk polished with stone, possessing lustrous color." *Shijing · Bin Feng*: "My vermilion is very bright, made into clothes for the young lord." Mao's Commentary: "Zhu is deep red." Kong's Subcommentary: "*Shi Guan Li* skirt annotation says: Dyeing crimson, one dip is called , two dips is called , three dips is called . Zhu involves four dips. Zhu is deeper than , thus Zhu is deep ." Zhi Yun: Ying Qi color hides and manifests between the skin, resembling something wrapped in white silk.
Wrapped in Red (Hong). *Shuowen Jiezi*: "Hong, white-red silk." *Shiming*: "Hong is Jiang (crimson). White silk resembling Jiang."
Wrapped in Gan (Deep blue with a reddish tint). *Shuowen Jiezi*: "Gan, deep blue silk with a reddish tint." *Shiming*: "Gan means containing. Blue containing red." Jian An: Wang Bing's note "thin blue" lacks basis. Ma Shi's note follows *Shuowen*.
Fruit of Trichosanthis Fructus (Gualou Shi). Ma Yun: Lou is the same as Lou.
Wrapped in Purple (Zi). *Shuowen Jiezi*: "Zi, blue-red silk." *Lunyu Huangshu*: "Intermediate color of the North."
All vessels belong to the eyes. *Da Huo Lun* states: The essence of the Five Zang and Six Fu organs all ascend to the eyes to form the visual essence. *Kou Wen Pian* states: The eyes are the gathering place of the Zong Mai (Major Vessels).
This is the daily cycle of the Four Limbs and Eight Xi (Creeks). Zhang Yun: Four limbs refer to two hands and two feet. Eight Xi refer to elbows and axillae in the hands, and [knees] and ankles in the feet. These are the joints of the four limbs, hence called Xi. Zhaoxi (Morning and Evening) means that the body's meridians, marrow, sinews, Blood, and Qi all enter and exit from here, operating day and night without ceasing. *Xie Ke Pian* states: Humans have eight Xu (Empty places), which are chambers of mechanisms, where True Qi passes and Blood collaterals travel; this is what is meant. Another view: Zhaoxi refers to tides. Human Blood and Qi flow like the ebb and flow of sea tides; morning is Chao (tide), evening is Xi (ebb tide), which is also acceptable. Wu Yun: Zhaoxi means meeting. In ancient times, ministers meeting the ruler in the morning was called Zhao, and in the evening was called Xi. It means the five substances (vessels, marrow, sinews, Blood, Qi) meet with the four limbs and eight Xi day and night. Jian An: Zhang's previous explanation seems more appropriate. Generally, "Xi" refers to gaps in sinews and bones. Wang Chong's *Lunheng* states: Inserting a one-cun needle, applying a pill of moxa, into the Xi of blood vessels, severe illnesses can be cured.
The Liver receives Blood and enables vision. Li Dongyuan's *Piwei Lun*: Liver, should be Eye.
The fingers receive Blood and enable grasping. *Shuowen Jiezi*: She means to hold or pull. *Zhuangzi · Qie* states: "Must tightly bind and secure locks," the meaning of She is the same here. Zhang Yun: According to Blood and Qi, these are the basis of human Spirit. But these sections only mention Blood, not Qi. Why? Qi belongs to Yang and is formless; Blood belongs to Yin and has form. Human形体 (physical body) is formed by Yin. As *Jiu Zhen Pian* states: What generates humans is Blood vessels. *Ying Wei Sheng Hui Pian* states: Blood is the foundation of Spirit Qi. *Ping Ren Jue Gu Pian* states: When Blood vessels are harmonious, Spirit resides. Thus, speaking of Blood implies that Spirit is generated based on Form, and function emerges from the substance.
Becoming Wan Bi (Stiff Paralysis). Wang Bing's note: The character , explained as pronounced Wan. *Guangyun*: Bi disease. *Zihui*: Numbness and paralysis of hands and feet. Jian An: Bi disease covers a wide range, so the character is added to specify it as paralytic Bi. (Later, the character for stubborn numbness/paralysis, originally , was used due to homophony.) Zhi Yun: *Jin Gui Yao Lue* asks: How is Blood Bi obtained? The Master says: Sweating, moving during sleep, plus exposure to slight wind causes it. Sweating indicates deficiency of Wei Qi externally. During sleep, Wei Qi returns to Yin; upon waking, Blood flows externally. Wind exposure causes Blood to congeal in the skin, resulting in Bi. *Yao Lue* states: External signs of Blood Bi include body insensitivity, resembling Wind Bi. Zhi considers Bi as Blood Bi, while Wang Bing considers it as Wan Bi; their meanings complement each other.
Cannot return to its apertures. Ma Yun: Kong is the same as Kong (hole/aperture). Cannot return to its apertures. Zhi Yun: Kong refers to Bone Apertures (Gu Kong). Bone apertures are the 365 meeting points of joints, where collateral vessels seep into various joints. Blood flows in the skin and cannot return along the aperture meetings, thus becoming Bi and Jue (cold extremities). Wu and Zhang follow Wang Bing's note. Jian An: Zhi's note seems consistent with the following text.
Twelve Major Valleys (Da Gu). Zhang Yun: Da Gu refers to the largest joints. In the hands: shoulder, elbow, wrist. In the feet: ankle, knee, wrist. Each limb has three segments, totaling twelve divisions (Fen). Fen means location. This aligns with the previous concept of Eight Xi. Since it is called Xi, why is it also called Gu? *Qi Xue Lun* states: Large muscle gatherings are called Gu, small ones are called Xi. Between muscle divisions, the convergence of Xi and Gu conducts Ying and Wei Qi and gathers Grand Qi. Thus, although Xi and Gu differ in size, they both serve as convergences for Qi and Blood, allowing interchangeable use. The previous text mentioned only Eight Xi; this section contrasts with the following "Small Xi 354 names," hence called Da Gu. Various commentators (Wang, Ma, Wu) interpreting Twelve Major Valleys as parts of the Twelve Meridians are incorrect. Zhi Yun: Fen refers to muscle divisions with texture.
Three Hundred Fifty-Four Small Xi Names. Zhang Yun: Small Xi refers to joint intersections throughout the body. *Xiao Zhen Jie* states: The 365 joint intersections are where collateral vessels seep into joints. Jian An: *Zihuazi* states: The body has 365 bone joints, which is the same meaning. Zhi Yun: Ming refers to acupoint names. At muscle intersections, there are convergence points, and at these points, there are acupoint names. Ma, Wu, and Zhang follow Wang Bing's note, changing four to three. Zhi Gao retains the original text, which is incorrect.
Missing Twelve Shu (Transport) Points. Wu Yun: Shu refers to the Transport points of the Twelve Meridians. The Twelve Shu are not included in the 353 names, hence "missing Twelve Shu." Zhang Yun: Refers to the Back-Shu points of the Twelve Zang organs, such as Fei Shu, Xin Shu, etc. Excluding these Twelve Shu, the rest connect with Zang Qi and are not listed among Small Xi. Ma agrees. Gao Yun: Twelve Shu are the Twelve Major Valleys. Jian An: Xin Zheng Xiao notes: Other editions and Quan Yuanqi Ben, *Tai Su* write Guan instead of Shu, indicating Gao's note is particularly correct.
Where Wei Qi stays and stops. Zhang Yun: All these convergences of Xi and Gu are originally places where Wei Qi stays. If pathology occurs, these are also places where Pathogenic factors reside. Jian An: Various commentators follow Wang Bing's meaning; Zhang's note seems appropriate.
Follow and remove them. Zhang Yun: Treatment with needles and stones must follow the location of the pathogen to remove it. Yuan means according to/following. Jian An: Various commentators follow Wang Bing's meaning; Zhang's note seems appropriate.
First establish its Mother. Wu Yun: Jian means establish. Mu (Mother) refers to the Stomach Qi corresponding to the season. E.g., Spring pulse slightly wiry, Summer pulse slightly hook-like, Late Summer pulse slightly soft, Autumn pulse slightly floating/hairy, Winter pulse slightly deep/stony. This is called neutralized and possesses Stomach Qi. Earth is the mother of all things, hence called Mother. If wiry excessively, disease starts in Liver; hook excessively, in Heart; soft excessively, in Spleen; hairy excessively, in Lung; stony excessively, in Kidney. Thus: To know the beginning, first establish the Mother. Ma Yun: Mother is the generating element of the Five Zang. Zhang Yun: Mother is the cause of the disease. Without knowing the Mother, Root and Branch cannot be distinguished, so one must first establish the Mother, as in the following text regarding specific Zang and Meridian. Gao Yun: Mother is the root of the disease. Jian An: Wu supports Wang Bing's view, which seems correct.
Five Pulses. *Jing Mai Bie Lun* states: Five Pulses lacking Qi, Stomach Qi unbalanced, indicates Three Yin disease. *Zheng Si Shi Lun* states: Diagnosis not matching the Five Pulses.
Dian Ji (Mania/Epilepsy). *Mai Yao Jing Wei Lun* states: Jue transforms into Dian Ji.
Fault/Locus of Disease. Ma Yun: Guo means disease. Whenever *Neijing* mentions human disease, it compares it to human error, calling it Guo. *Mai Yao Jing Wei Lun* states: Thus, one can diagnose pulses with Guo. This Guo is not excess/deficiency nor passing through, but refers to disease. Wu Yun: Guo means blaming the fault. Having the above symptoms, blame the fault in Shaoyin and Juyang. Zhi Yun: Excess is Pathogenic excess, Deficiency is Healthy Qi deficiency. Thus, headache and Dian Ji are Pathogenic excess above and Healthy Qi deficiency below. Pathogens entering humans start in hair pores and Qi level; lingering, they enter meridians. Thus, the fault is in Juyang and Shaoyin meridians, and severely enters the Kidney. Meridian pathogens affect internal Zang-Fu. Jian An: The following text says "Disease in Diaphragm, fault in Hand Juyang and Shaoyin," proving Wu's view is superior.
Xun Meng Zhao You (Dizziness and Trembling). Wu: Xun, written as , pronounced Xuan, eye movement. Half-closed eyes is Meng, fully closed is Ming. You is the same as . Zhao You means trembling/unstable. Zhang Yun: Xun also written as Xun, looking around. Meng means vague/confused. Zhao means shaking. You means severe. Eyes lacking light become dim/vague; head dizzy/trembling becomes unstable. Hua Yun: Xun Meng Zhao You should be read as Xuan Zhao Yao. Xuan Meng refers to eye blinking and confusion, as in the following text "Mu Ming." Zhao Yao refers to head shaking and instability. (*Yao Zhi* agrees). Jian An: *Benshi Fang* writes Zhao Yao for Zhao You. Shen Chengzhi says: You is the same as Yao. Xun Meng is like having something covering the head, Zhao Yao is unstable; all are states of dizziness. Zhi Gao states: Xun is the same as . Xuan and Gu characters are interchangeable, seen in Yang Xiong's *Ju Qin Mei Xin Wen*. Basically, Xun is the same as , meaning Xuan. You is the same as Yao, no need to change characters. (*Zhang Shi Yi Tong* says: Xun Meng Zhao You, closing eyes and deafness, indicates Liver deficiency and Wind stirring. Use Liu Jun Zi Tang, add Gouteng, Qianghuo, Fangfeng, Chuanxiong, Danggui, Ganju.)
Mu Ming (Blindness/Darkness). Gao Yun: Ming is the same as Ming (close eyes/dark).
Zhi Ge Xie (Distension and Obstruction in Hypochondrium). Wu Yun: Zhi means distending pain. Zhang Yun: Zhi means obstruction. Zhi Yun: Zhi refers to collateral branches, Ge refers to internal diaphragm. Jian An: Zhi is the same as Zhi (branch/support). Wang Bing's note on *Liu Yuan Zheng Ji* Zhi Tong says: Zhi means supporting/obstructing. Other notes are incorrect. *Guangya*: , hypochondrium.
Ke Sou Shang Qi (Cough and Rebellious Qi). Wu Yun: Sound coming from Lung is Ke. Coughing continuously is Sou. Shang Qi is edema/swelling. Zhang Yun: Shang Qi is panting/asthma. Jian An: *Zhou Li · Tian Guan · Ji Yi Zhi*: Sou Shang Qi, Zheng Zhu: Shang Qi is rebellious panting. Wu's interpretation of Shang Qi as edema is wrong. Detailed meaning of cough is in *Ke Lun*.
Pulse Small, Large, Slippery, Rough, Floating, Sunken. Jian An: *Xie Qi Zang Fu Bing Xing* states: Regulate pulse speed, small/large, slippery/rough. *Si Nan* states: Floating/sunken, long/short, slippery/rough. These all describe general pulse characteristics.
Wu Zang Xiang Yin (Five Zang Forms and Sounds). Zhang Yun: Xiang means physical form. Yin means Five Tones. Xiang Yin, as in *Yin Yang Er Shi Wu Ren Pian*, Wood-type people correspond to Upper Jue tone. E.g., Liver tone Jue, Heart tone Zhi, Spleen tone Gong, Lung tone Shang, Kidney tone Yu. Comparing wins and losses reveals good and bad. Five multiplied by five yields twenty-five variations. Anyone with keen hearing and mind can understand this. Jian An: Wang Bing did not explain Xiang; with Zhang's note, the meaning is clear. Zhi Yun: Five Zang forms combine with Five Tones, emitting sound. This also supports Wang Bing's note. Ma Yun: Humans have forms and sounds; though visible externally, Five Zang govern internally. Wu Yun: Xiang Yin means Five Tones cycle mutually. Both views are unsatisfactory.
Chi Mai Zhi Ye (Arrival of Red Pulse). Wu: Sentence starts after Chi. Ma Yun: After Red, White, Green, Yellow, Black, one should read. Diagnosing person's color already red, and when pulse arrives, surging like panting. Zhang Yun: Below this combines pulse and color.
Xin Bi (Heart Bi). Jian An: Zheng Xuan's *Yi Tong Gua Yan* note: Bi means Qi blockage causing disease. Wang Bing's note likely derives from this.
Chuan Er Fu (Panting and Floating). *Maijing*: There is a large character after Fu. Note: Chuan suspected to be Ru (Soft).
Jing You Ji Qi (Startle with Accumulated Qi). Wu Yun: Upper deficiency, Lung self-deficiency. Lower excess, Heart below Lung acting as pathogen, called excess. Lung Metal insufficient allows Heart Fire to exploit deficiency and attack. Startle results from Heart excess; Lung suffers Fire pathogen, loses regulation, thus accumulated Qi in chest. Jian An: Commentators view Startle as upper deficiency; Wu alone views it as excess, likely incorrect. *Jia Yi Jing* reads "Accumulated Qi in chest arises." Accumulated Qi in chest disturbs Heart Spirit, causing startle; this interpretation is easier to accept.
Chuan Er Xu (Panting and Deficiency). Ma Yun: Its pulse panting should be deficiency. Wu Yun: Accumulated Qi in chest causes panting and deficiency. Zhi Yun: Zheng Qi of Dan Zhong reversely becomes deficient, thus Deficient Panting. Jian An: Wang Bing views Chuan as disease; Wu and Zhi agree, which is correct.
Han Re (Cold and Heat). Zhang Yun: Metal and Fire contend. Metal winning causes Cold; Fire winning causes Heat. Wu agrees. Zhi Yun: Zhen Zang is highest in Lung, governing circulation of Ying, Wei, Yin, and Yang. Yin/Yang deficiency and mutual invasion cause alternating Cold and Heat.
Shi Nei (Penetration/Internalization). Gao Yun: Obtained from drunkenness allowing Pathogenic Qi to penetrate inward. Jian An: This explanation is illogical.
Chang Er Zuo You Tan (Long and Pulsating Left and Right). *Jia Yi Jing*: Character Xian (Wiry) follows below. *Maijing*: Two characters "Zhen Yue" follow Tan. Zhang Yun: Means both hands are long and wiry-strong. Tan means striking/beating.
Jue Shan (Jue Hernia). Gao Yun: Abdomen is Spleen region. Presence of Jue Qi means Earth is overcome by Wood, Earth Qi rebels and fails to reach. Overcome by Wood, hence not named Pi Bi, but Jue Shan. Shan is Liver disease. Jian An: Pi Bi is seen in *Si Shi Ci Ni Cong Lun*.
Nv Zi Tong Fa (Women Follow Same Method). Gao Yun: Women do not have Shan, but the rule of Liver Wood overcoming Spleen is the same. Zhi Yun: Men and women have same Blood and Qi, diseases fall under same methods. Thus for Central Earth Zang, saying Women follow same method aims to extrapolate to Four Zang. Jian An: Zhi's note is overly rigid.
Obtained from rapid exertion of four limbs, sweating, and exposure to wind. Wu Yun: Spleen governs four limbs, Stomach governs four extremities. Rapid exertion leads to labor and easy sweating. Wind exploits Spleen deficiency, lodging in the region, causing aforementioned symptoms. Gao Yun: De Zhi Ji, means obtaining external illness. Jian An: Gao's note is forced.
Shang Jian Er Da (Upper Firm and Large). Zhang Yun: Shang refers to upper Chi position, i.e., outer Chi to inspect Kidney. Zhi Yun: Shang Jian means firm and large in upper part, not sinking. Wang Ang says: Meaning of Shang character unclear. Jian An: Notes are unsatisfactory; Wang's uncertainty is justified.
Qi Mai of Five Colors. Jian An: According to *Jia Yi Jing*, characters "Zhi Qi Mai" are superfluous.
Mian Qing Mu Qing (Face Green, Eyes Green). Mu Qing, most versions read Mu Chi (Eye Red), should be corrected.