马云。第六节。有曰名曰玉机。内又论真脏脉。故名篇。
春肝如弦 肝。诸本作脉。当改。下同。
善忘 志云。经曰。气并于上。乱而喜忘。高云。肝脉太过。则令人善忘。伤寒论云。本有久瘀血。
故令喜忘。简按马吴张仍王注。作善怒。是。
巅疾 甲乙。作癫疾。（详义。见于脉要精微。）
其气来不盛去反盛 张云。言来则不足。去则有余。即消多长少之意。故扁鹊于春肝夏心秋肺冬
肾。皆以实强为太过。病在外。虚微为不及。病在内。辞虽异。而意则同也。简按新校正引难经文。谓与素问
不同。故张有此说。
肤痛为浸淫 甲乙。肤。作骨。非。吴云。浸淫。热不得去。浸渍而淫。邪热渐深之名。今之蒸热
不已。是也。简按宋玉风赋。夫风生于地。起于青 之末。浸淫溪谷。汉书五王传师古注。浸淫。犹渐染也。
当从王义。志云。浸淫。肤受之疮。火热盛也。此据金匮浸淫疮为解。亦非。
气泄 张云。心气不足而烦。心虚阳侵肺而咳唾。下为不固而气泄。高云。气泄。后气下泄也。
中央坚两旁虚 吴云。中央坚。浮而中坚也。张同。简按何氏医碥云。虚。犹散也。惟两旁散。而
中央不散。与上所谓去散者异矣。
愠愠然 脉经。作温温。熊音。愠愠。音 。含怒意。
马云。不舒畅也。简按盖此方书所谓背膊倦闷之谓。吴张并云。悲郁貌。非。
下闻病音 张云。谓喘息则喉下有声也。志云。虚气下逆。则闻呻吟之病音。吴。下。改及字。简按
下字不稳。姑从张义。
沉以抟故曰营 抟。当作搏。诸本作搏。注同。吴云。营。营垒之营。兵之守者也。冬至闭藏。脉来
沉石。如营兵之守也。马张并同。简按王注如营动。未详。高本。搏。作抟。云。抟。聚也。误。
其去如数 吴云。其实未数也。盖往来急疾。类于数耳。张云。动止疾促。营之不及也。盖数本属热。
而此真阴亏损之脉。亦必紧数。然愈虚则愈数。原非阳强实热之数。故云如数。则辨析之意深矣。
心悬如病饥 张云。真阴虚。则心肾不交。故令人心悬而怯。如病饥也。
释音。音蒸。熊本作眇。音亡沼反。一目小也。误。马。吴。音缈。张。音秒。甲乙注。音停。
通雅云。今唐韵。韵会。字汇。日月灯。皆遗 字。当音渺。
小便变 甲乙变下。有黄赤二字。张云。变者。谓或黄或赤。或为遗淋。或为癃闭之类。由肾水不足而然。
逆从之变异也 马云。循四时之序。谓之曰从。其有过与不及。而为诸病者。谓之曰逆。吴云。脉逆
其顺。则变异为病。高同。
如鸟之喙 新校正云。喙。别本作啄。简按难经。脾者。中州也。其平和不可得见。衰乃见耳。来如
雀之啄。如水之下漏。是脾之衰见也。据平人气象论。锐坚如鸟之喙。作喙为是。
重强 马云。重。平声。脾不和平。固为强矣。而九窍不通。则病邪方盛。名曰重强。此皆脾之恶可
见也。吴云。其不及则无冲和土气。五脏气争。而令九窍不通。名曰重强。言邪胜也。张云。重强。不柔和貌。
沉重拘强也。高云。是脾病。而上下四旁皆病。故名曰重强。强。不和也。简按诸说不知孰是。
瞿然 礼檀弓。曾子闻之瞿然。郑注云。惊变也。高云。惊顾貌。
再拜而稽首 吴本。删而字。
玉机 吴云。以玉为机。象天仪者也。其机斡旋不息。今曰神转不回。则亦玉机之斡旋耳。是故名之。
张云。玉机。以璇玑玉衡。可窥天道。而此篇神理。可窥人道。故以并言。而实则珍重之辞也。
舍于其所生 张云。舍。留止也。
三月若六月若三日若六日 张云。病不早治。必至相传。远则三月六月。近则三日六日。五脏传遍。
若三月而传遍。一气一脏也。六月而传遍。一月一脏也。三日者。昼夜各一脏也。六日者。一日一脏也。脏惟
五。而传遍以六者。假令病始于肺。一也。肺传肝。二也。肝传脾。三也。脾传肾。四也。肾传心。五也。心
复传肺。六也。是谓六传。
是顺传所胜之次 简按据新校正。此七字。王注错出。宜删去。马吴诸家。以为原文。非。
风者百病之长也 风论。骨空论。灵五色篇。通天篇。亦有此语。
出食 志云。食气入胃。散精于肝。肝气逆。故食反出也。高同。
发瘅 马云。发而为瘅。瘅者。热也。吴云。瘅。热中
之名。所谓瘅成为消中。是也。腹中热烦心。而出黄。亦详瘅之为证耳。志云。瘅。火瘅也。风淫湿土而成热。
故湿热而发瘅也。简按志聪盖以瘅为丹。广韵。火瘅。小儿病也。危氏得效方。以瘅为丹毒。知是起于宋元。
则不可从。
出黄 张云。肌体出黄。志云。火热下淫则溺黄。简按下文有出白之语。志注似是。
冤热 马云。烦冤作热。高云。冤热。热极无伸也。简按高以冤为冤屈之义。非。
出白 吴云。白。淫浊也。简按痿论云。入房太甚。宗筋弛纵。发为筋痿。及为白淫。此即出白也。
盅 吴云。虫蚀阴血之名。虫蚀阴血。令人多惑。而志不定。名曰蛊惑。故女惑男。亦谓之蛊。言
其害深入于阴也。此名曰蛊。其亦病邪深入。令人丧志之称乎。简按左传昭元年。医和曰。疾不可为也。是谓
近女室。疾如蛊。非鬼非食。惑以丧志。又曰。女阳物而晦时。淫则生内热惑蛊之疾。赵孟曰。何谓蛊。对曰。
蛊。淫溺惑乱之所生也。于文皿虫为蛊。谷之飞亦为蛊。在周易。女惑男。风落山。谓之蛊。皆同物也。
螈 熊音。尺世反。 同。（详义。见诊要经终篇。）马云。音异。后世作 。吴云。心主血脉。心
病则血燥。血燥则筋脉相引而急。手足拘挛。病名曰螈。张同。简按马以 为后世字。非。
满十日法当死 吴云。天干一周。五脏生意皆息。故死。
法当三岁死 滑云。三岁。当作三日。夫以肺病而来。各传所胜。至肾传心。法当十日死。及肾传之
心。心复传肺。正所谓一脏不复受再伤者也。又可延之三岁乎。吴本。岁。作哕。注云。当五岁气衰之时。三
哕则死。昂云。此亦言其
大较耳。吴注。改三岁作三哕。欠理。
怒则肝气乘矣 志云。肝。当作肺。
悲则肺气乘矣 志云。肺。当作肝。悲。当作思。简按悲。不必改。
及其传化 赵府本。熊本。及。作反。吴同。
大骨枯 大肉陷下 张云。大骨大肉。皆以通身而言。如肩脊腰膝。皆大骨也。尺肤臀肉。皆大肉
也。肩垂项倾。腰重膝败者。大藏之枯 也。尺肤既削。臀肉必枯。大肉之陷下也。马云。大骨者。即生气通
天论所谓高骨也。愚尝见一人有肾衰之疾。果于腰骨。高起寸余。此大骨枯 故也。简按张注是。
期六月死 张云。三阴亏损。死期不出六月。六月者。一岁阴阳之更变也。若其真脏已见。则不在
六月之例。可因克贼之日。而定其期矣。简按大骨枯 云云。凡五项。王注配于五脏释之。诸家则漫然为五脏
败注。今细玩之。不若王义为得矣。
内痛引肩项 吴云。心脏又坏矣。张云。病及心经。较前已甚。
破 释音。 。音郡。集韵。渠陨切。音窘。马云。 者。肉之分理也。吴云。 。肘膝髀厌高
起之处。病患为阴火所灼。昼夜不安其身。转侧多则 肉磨裂。简按灵寿夭刚柔篇云。肉 坚而有分者肉坚。
王注似是。史崧音释。腹中 脂（原出玉篇）高云。肌腠曰。肉脂膏曰 。
真脏见十月之内死 滑云。真脏见。恐当作未见。若见则十月之内。当作十日之内。马吴诸家并云。
月。当作日。
肩髓内消 志云。肩髓者。大椎之骨髓。上会于脑。是以项骨倾者。死不治也。
真脏来见 诸家从新校正。来。作未。
急虚身中卒至 吴云。急虚。暴绝也。中。邪气深入之名。卒至。卒然而至。不得预知之也。高云。
急虚。正气一时暴虚也。身中。外邪陡中于身也。卒至。客邪卒至于脏也。
五脏绝闭 吴云。绝。气绝也。闭。九窍塞也。
毛折 吴云。率以毛折死者。皮毛得卫气而充。毛折则卫气败绝。是为阴阳衰极。故死。志云。夫
脉气流经。经气归于肺。肺朝百脉。输精于皮毛。毛脉合精。而后行气于脏腑。是脏腑之气欲绝。而毛必折也。
责责然 高云。不流通也。
如循薏苡子 张云。短实坚强。而非微钩之本体。本草。图经云。薏苡。实青白色。形如珠子而稍
长。故人呼为薏苡珠子。小儿多以线穿如贯珠为戏。陶氏云。交趾者最大。彼土呼为 珠。
辟辟然 高云。硬而呆实。无胃气也。简案辟辟如弹石。又见平人气象论。
色泽以浮 张云。泽。润也。浮。明也。颜色明润者。病必易已也。
明告之 张云。明告病家。欲其预知吉凶。庶无后怨。
悬绝沉涩 高云。悬绝无根。或沉涩不起者。是无胃气。
病在中脉实坚病在外脉不实坚 张云。与上文平人气象论者。似乎相反。但上文云。病在中脉虚。
言内积之实者。脉不宜虚也。此云病在中脉实坚。言内伤之虚者。脉不宜实坚也。前云病在外脉涩坚。言外邪
之盛者。不宜涩坚。以涩坚为沉阴也。此言病在外。脉不实坚。言外邪方炽者。不宜无力。以不实坚为无阳也。
四者之分。总皆正不胜邪之脉。故曰难治。词若相反。理则实然。新校正以谓经误。特未达
其妙耳。简按马吴诸家。亦从原文。为与平人气象论别一义。然考经文。不若新校正以为误之妥贴矣。
五实死 薛云。五实五虚具者皆死。然气虚至尽。尽而死者。理当然也。若五实者。何以亦死。盖邪
之所凑。其气必虚。不脱不死。仍归于气尽耳。然虚实俱有真假。所当辨耳。
闷瞀 释音。瞀。音茂。吴。音务。张云。昏闷也。一曰。目不明。高云。闷。郁也。瞀。目不明也。
简按灵经脉篇。交两手理瞀。铜人注。引太素注云。瞀。低目也。玉篇。目不明貌。楚辞九章。中闷瞀之 。
王逸注。烦乱也。考数义。张为昏闷。似是。
马云：第六节中提到“名为玉机”，文中又论述了真脏脉，因此以此命名篇目。
春季肝脏的脉象像弦一样。原文中的“肝”字，各版本均作“脉”，应当改正。下文同此。
容易遗忘。高世栻注云：《内经》说：“气偏并于上部，神志紊乱而喜欢遗忘。”又说：“肝脉太过，就会使人容易遗忘。”《伤寒论》说：“原本就有久瘀血，所以导致喜欢遗忘。”马莳、吴崑、张景岳仍沿用王冰的注释，解释为“善于发怒”，这是正确的。
巅疾（头部疾病）。《甲乙经》中写作“癫疾”（癫痫）。其具体含义详见《脉要精微论》。
脉气来时不旺盛，去时反而旺盛。张景岳注云：意思是来则不足，去则有余，即消耗多而生长少的意思。所以扁鹊在论述春肝、夏心、秋肺、冬肾时，都以实强为太过，病在体表；以虚微为不及，病在体内。言辞虽然不同，但意思是一样的。按：新校正引用《难经》经文，谓与《素问》不同，所以张景岳有此说法。
皮肤疼痛并发展为浸淫疮（一种流黄水、蔓延全身的皮肤病）。《甲乙经》中“肤”字作“骨”，是不对的。吴崑注云：浸淫，指热邪不能去除，浸渍而泛滥，是邪热逐渐加深的名称。就像现在的蒸热不已的情况。按：宋玉《风赋》说：“风生于地，起于青蘋之末，浸淫溪谷。”《汉书·五王传》颜师古注：“浸淫，犹渐染也。”应当遵从王冰的解释。高世栻注云：浸淫，是皮肤受邪的疮疡，火热盛也。这是依据《金匮要略》中的浸淫疮来解释的，也不对。
气泄。张景岳注云：心气不足而烦躁，心虚阳气侵扰肺而咳嗽吐唾沫，下焦不固而气泄。高世栻注云：气泄，指后气下泄。
中央坚实，两旁虚弱。吴崑注云：中央坚实，指浮取而中间坚实。张景岳观点相同。按：何梦瑶《医碥》云：虚，就是散的意思。只有两旁散，而中央不散，这与上面所说的“去散”是不同的。
愠愠然（郁结不畅的样子）。《脉经》中写作“温温”。熊宗立注音：愠愠，音蕴，含有愤怒的意思。马云：不舒畅。按：这大概是方书中所说的背膊倦闷的意思。吴崑、张景岳都说是悲郁的样子，不对。
下部听到病的声音。张景岳注云：指喘息时喉下有声音。高世栻注云：虚气下逆，就会听到呻吟的病音。吴崑将“下”字改为“及”字。按：“下”字不够稳妥，暂且遵从张景岳的解释。
沉脉因为搏动有力所以称为营。抟（tuán），应当作“搏”。各版本均作“搏”，注文相同。吴崑注云：营，是营垒的营，是士兵防守的地方。冬至闭藏，脉来沉石，像营兵防守一样。马云、张景岳观点相同。按：王冰注解说像营动，不详。高世栻本，“搏”字作“抟”，解释说：抟，聚也。这是错误的。
脉去的时候像数脉。吴崑注云：其实并不数。大概往来急疾，类似于数脉罢了。张景岳注云：动止疾促，是营气的不及。大概数脉本属于热，而这种真阴亏损的脉，也必然紧数。然而越虚就越数，原本不是阳强实热的数脉，所以说“如数”，其中的辨析之意很深了。
心中悬空好像得了饥饿病。张景岳注云：真阴虚，则心肾不交，所以使人心中悬空而胆怯，好像得了饥饿病一样。
释音：音蒸。熊本作“眇”，音亡沼反，一只眼睛小。错误。马云、吴崑音缈。张景岳音秒。《甲乙经》注：音停。《通雅》云：现在《唐韵》、《韵会》、《字汇》中，日月灯等字都遗漏了“眇”字，应当音渺。
小便颜色改变。《甲乙经》在“变”字下有“黄赤”二字。张景岳注云：变，是指或者黄或者赤，或者为遗尿淋沥，或者为癃闭之类。这是由于肾水不足而造成的，是逆从的变异。
逆从之变异。马云：遵循四时的顺序，叫做从。如果有超过或不及，而导致各种疾病的，叫做逆。吴崑注云：脉逆其顺，则变异为病。高世栻观点相同。
像鸟的嘴喙。新校正云：喙，别本作“啄”。按：《难经》说：脾者，中州也。其平和不可得见，衰乃见耳。来如雀之啄，如水之下漏，是脾之衰见也。据《平人气象论》：“锐坚如鸟之喙”，作“喙”是正确的。
重强。马云：重，读平声。脾不和平，本来就已经强了，而九窍不通，则病邪正盛，名叫重强。这都是脾的恶候可见的表现。吴崑注云：其不及则没有冲和的土气，五脏之气相争，而导致九窍不通，名叫重强，言邪胜也。张景岳注云：重强，是不柔和的样子，沉重拘强也。高世栻注云：这是脾病，而上下四旁都病了，所以名叫重强。强，不和也。按：各种说法不知道哪个正确。
瞿然（惊视的样子）。《礼记·檀弓》：曾子闻之瞿然。郑玄注云：惊变也。高世栻注云：惊顾貌。
再拜而稽首。吴本删去了“而”字。
玉机。吴崑注云：以玉为机，象征天仪。其机斡旋不息。现在说“神转不回”，也就是玉机的斡旋罢了，所以这样命名。张景岳注云：玉机，以璇玑玉衡，可以窥探天道，而本篇的神理，可以窥探人道，所以并而言之，实际上是珍重的辞藻。
舍于其所生。张景岳注云：舍，留止也。
三月若六月若三日若六日。张景岳注云：病不早治，必至相传。远则三月六月，近则三日六日。五脏传遍。如果三月传遍，是一气一脏。如果六月传遍，是一月一脏。三日者，昼夜各一脏。六日者，一日一脏。脏只有五个，而传遍以六个计算，假如病始于肺，这是一。肺传肝，这是二。肝传脾，这是三。脾传肾，这是四。肾传心，这是五。心复传肺，这是六。这叫六传。
是顺传所胜之次。按：据新校正，这七个字是王冰注错出，应该删去。马云、吴崑各家认为是原文，不对。
风者是百病之长。《风论》、《骨空论》、《灵枢·五色》篇、《通天》篇，也有这句话。
食反出。高世栻注云：食气入胃，散精于肝，肝气逆，所以食物反而吐出。高世栻观点相同。
发瘅（热病）。马云：发而为瘅，瘅就是热。吴崑注云：瘅，是热中之名，所谓瘅成为消中，就是这个意思。腹中热烦心，而出黄，也详细说明了瘅作为证候的情况。高世栻注云：瘅，是火瘅。风淫湿土而成热，所以湿热而发瘅。按：高世栻大概把瘅当作丹毒。《广韵》：火瘅，是小儿病。危氏《得效方》把瘅当作丹毒，知道这是起于宋元时期，那么就不可以遵从。
出黄。张景岳注云：肌体出黄。高世栻注云：火热下淫则溺黄。按：下文有出白的说法，高注似是。
冤热。马云：烦冤作热。高世栻注云：冤热，热极无伸也。按：高世栻把冤当作冤屈之义，不对。
出白。吴崑注云：白，是淫浊。按：《痿论》说：入房太甚，宗筋弛纵，发为筋痿，及为白淫。这就是出白。
蛊。吴崑注云：虫蚀阴血之名。虫蚀阴血，令人多惑，而志不定，名叫蛊惑。所以女惑男，也叫蛊，言其害深入于阴。这个名叫蛊，也是病邪深入，令人丧志的说法吗？按：《左传·昭公元年》，医和说：疾不可为也，是谓近女室，疾如蛊。非鬼非食，惑以丧志。又说：女阳物而晦时，淫则生内热惑蛊之疾。赵孟说：何谓蛊？回答说：蛊，淫溺惑乱之所生也。从文字上看，皿中有虫为蛊，谷之飞也为蛊。在《周易》中，女惑男，风落山，谓之蛊，都是同类事物。
螈（抽搐）。熊宗立注音：尺世反。同“蕽”（详义，见《诊要经终》篇）。马云：音异，后世作“螈”。吴崑注云：心主血脉，心病则血燥，血燥则筋脉相引而急，手足拘挛，病名叫螈。张景岳观点相同。按：马云认为“螈”是后世字，不对。
法当三岁死。滑寿注云：三岁，应当作三日。夫以肺病而来，各传所胜，至肾传心，法当十日死。等到肾传之心，心复传肺，正所谓一脏不复受再伤者也。又可以延之三岁乎？吴本，“岁”字作“哕”，注云：当五岁气衰之时，三哕则死。昂云：这也是言其大概。吴注改“三岁”作“三哕”，欠理。
悲则肺气乘矣。高世栻注云：肺，应当作肝。悲，应当作思。按：悲不必改。
及其传化。赵府本、熊本，“及”字作“反”。吴崑同。
大骨枯。大肉陷下。张景岳注云：大骨大肉，都是以通身而言。如肩脊腰膝，都是大骨。尺肤臀肉，都是大肉。肩垂项倾，腰重膝败者，是大藏的枯。尺肤既削，臀肉必枯，是大肉的陷下。马云：大骨者，就是《生气通天论》所谓的高骨。我曾经见过一个人有肾衰的疾病，果然在腰骨处高起寸余，这就是大骨枯的原因。按：张注是正确的。
期六月死。张景岳注云：三阴亏损，死期不出六月。六月者，一岁阴阳之更变也。如果真脏脉已见，则不在六月的例，可以根据克贼之日，而定其期。按：大骨枯等五项，王冰注配于五脏解释。各家则漫然为五脏败注。现在仔细玩味，不如王义为得。
内痛引肩项。吴崑注云：心脏又坏了。张景岳注云：病及心经，较前已甚。
破腘。释音：腘，音郡。《集韵》：渠陨切，音窘。马云：腘者，肉之分理也。吴崑注云：腘，是肘膝髀厌高起之处。病患为阴火所灼，昼夜不安其身，转侧多则腘肉磨裂。按：《灵枢·寿夭刚柔》篇云：肉腘坚而有分者肉坚。王注似是。史崧音释：腹中脂（原出《玉篇》）高云：肌腠曰腘，肉脂膏曰腘。
真脏见十月之内死。滑寿注云：真脏见，恐当作未见。若见则十月之内，当作十日之内。马云、吴崑各家都说：月，应当作日。
肩髓内消。高世栻注云：肩髓者，大椎之骨髓，上会于脑。是以项骨倾者，死不治也。
真脏来见。诸家从新校正，来，作未。
急虚身中卒至。吴崑注云：急虚，暴绝也。中，邪气深入之名。卒至，卒然而至，不得预知之也。高世栻注云：急虚，正气一时暴虚也。身中，外邪陡中于身也。卒至，客邪卒至于脏也。
毛折。吴崑注云：率以毛折死者，皮毛得卫气而充。毛折则卫气败绝，是为阴阳衰极，故死。高世栻注云：夫脉气流经，经气归于肺，肺朝百脉，输精于皮毛。毛脉合精，而后行气于脏腑。是脏腑之气欲绝，而毛必折也。
如循薏苡子。张景岳注云：短实坚强，而非微钩之本体。《本草图经》云：薏苡，实青白色，形如珠子而稍长，故人呼为薏苡珠子。小儿多以线穿如贯珠为戏。陶氏云：交趾者最大，彼土呼为珠。
辟辟然。高世栻注云：硬而呆实，无胃气也。按：辟辟如弹石，又见于《平人气象论》。
色泽以浮。张景岳注云：泽，润也。浮，明也。颜色明润者，病必易已也。
病在中脉实坚，病在外脉不实坚。张景岳注云：与上文《平人气象论》者，似乎相反。但上文云：病在中脉虚，言内积之实者，脉不宜虚也。此云病在中脉实坚，言内伤之虚者，脉不宜实坚也。前云病在外脉涩坚，言外邪之盛者，不宜涩坚，以涩坚为沉阴也。此言病在外，脉不实坚，言外邪方炽者，不宜无力，以不实坚为无阳也。四者之分，总皆正不胜邪之脉，故曰难治。词若相反，理则实然。新校正以为经误，特未达其妙耳。按：马云、吴崑各家也从原文，认为与《平人气象论》别一义。然而考经文，不如新校正以为误之妥贴。
五实死。薛己注云：五实五虚具者皆死。然气虚至尽，尽而死者，理当然也。若五实者，何以亦死？盖邪之所凑，其气必虚，不脱不死，仍归于气尽耳。然虚实俱有真假，所当辨耳。
闷瞀。释音：瞀，音茂。吴崑音务。张景岳注云：昏闷也。一说：目不明。高世栻注云：闷，郁也。瞀，目不明也。按：《灵枢·经脉》篇：交两手理瞀。《铜人腧穴针灸图经》注引《太素》注云：瞀，低目也。《玉篇》：目不明貌。《楚辞·九章》：中闷瞀之忉怛。王逸注：烦乱也。考数义，张景岳说是昏闷，似是。
Ma Yun: The sixth section states, "It is named Yuji (Jade Machine)." Since the text also discusses Zangzhen Mai (True Visceral Pulse), it is named accordingly.
In spring, the Liver pulse resembles a string [taut and long]. The character "Liver" in the original text appears as "Pulse" in all editions; this should be corrected. The same applies to subsequent instances.
Prone to forgetfulness. Gao Shixi notes: The *Neijing* states, "When Qi deviates to the upper part, mental confusion leads to a propensity for forgetfulness." It further states, "An excessive Liver pulse causes forgetfulness." The *Shanghan Lun* states, "If there is pre-existing long-standing blood stasis, it leads to a propensity for forgetfulness." Ma Shi, Wu Kun, and Zhang Jingyue follow Wang Bing's commentary, interpreting it as "prone to anger," which is correct.
Dian Ji (Head diseases). The *Jiayi Jing* writes this as "Dian Ji" (Epilepsy). Its detailed meaning can be found in the *Mai Yao Jing Wei Lun*.
The Qi arrives weakly but departs strongly. Zhang Jingyue notes: This means arrival is insufficient while departure is excessive, implying consumption exceeds growth. Thus, Bian Que, when discussing Spring-Liver, Summer-Heart, Autumn-Lung, and Winter-Kidney, considers "excessive strength" as Tai Guo (Excess), indicating disease in the exterior; and "weak deficiency" as Bu Ji (Deficiency), indicating disease in the interior. Although the wording differs, the meaning is the same. Note: The Xin Zheng Xiao (New Corrections) cites the *Nan Jing*, stating it differs from the *Su Wen*, which explains Zhang's comment.
Skin pain developing into Jin Yin Chuang (a spreading skin ulcer with exudate). The *Jiayi Jing* reads "Bone" instead of "Skin," which is incorrect. Wu Kun notes: "Jin Yin" refers to heat that cannot dissipate, soaking and spreading; it is a term for gradually deepening pathogenic heat, similar to persistent steaming heat. Note: Song Yu's *Feng Fu* says, "Wind arises from the earth, starts at the tip of green duckweed, and infiltrates the valleys." Yan Shigu's annotation on the *Han Shu* says, "Jin Yin" means gradual infiltration. One should follow Wang Bing's interpretation. Gao Shixi interprets it based on the *Jin Gui Yao Lue*'s Jin Yin Chuang, which is incorrect.
Qi leakage. Zhang Jingyue notes: Insufficient Heart Qi causes irritability; Heart deficiency allows Yang to invade the Lung, causing coughing and spitting; lower Jiao instability leads to Qi leakage. Gao Shixi notes: Qi leakage refers to the downward discharge of post-natal Qi.
Central firmness, peripheral emptiness. Wu Kun notes: Central firmness refers to superficial palpation revealing firmness in the center. Zhang Jingyue agrees. Note: He Mengyao's *Yi Quan* states: "Empty" here means scattered. Only the periphery is scattered, while the center remains firm, which differs from the previously mentioned "departure scattering."
Wen Wen Ran (A feeling of depression or discomfort). The *Mai Jing* writes this as "Wen Wen." Xiong Zongli pronounces it as "Yun," implying anger. Ma Yun: Uncomfortable. Note: This likely refers to the sensation of heaviness and oppression in the back and shoulders described in medical formularies. Wu Kun and Zhang Jingyue describe it as a look of sorrow and depression, which is incorrect.
Hearing pathological sounds in the lower region. Zhang Jingyue notes: This refers to sounds in the throat during panting. Gao Shixi notes: Downward reversal of deficient Qi produces moaning sounds. Wu Kun changes "lower" to "and." Note: The character "lower" is unstable; we tentatively follow Zhang's interpretation.
Chen Mai (Deep Pulse) is called Ying because of its strong beating. "Tuan" should be read as "Bo" (beat/pulse). All editions read "Bo," and the commentary matches. Wu Kun notes: "Ying" refers to a military camp/garrison, where soldiers defend. At Winter Solstice, when storage occurs, the pulse comes deep and stone-like, like defending soldiers. Ma Yun and Zhang Jingyue agree. Note: Wang Bing's note "like Ying movement" is unclear. Gao Shixi's edition reads "Tuan" (gather), explaining it as gathering, which is an error.
The departure of the pulse resembles Shu Mai (Rapid Pulse). Wu Kun notes: It is actually not rapid. It simply moves quickly, resembling a rapid pulse. Zhang Jingyue notes: The quick stop and start indicates deficiency of Ying Qi. Generally, Shu Mai belongs to Heat, but this pulse of True Yin deficiency must also be tight and rapid. However, the more deficient it is, the more rapid it becomes; originally, it is not the rapidness of Yang excess and real heat. Hence, it is said to be "like rapid," showing deep analytical intent.
Heart feels suspended as if suffering from hunger. Zhang Jingyue notes: True Yin deficiency leads to lack of communication between Heart and Kidney, causing the heart to feel suspended and timid, as if suffering from hunger.
Pronunciation explanation: Pronounced "Zheng." Xiong's edition has "Miao" (small eye), pronounced "Wang Zhao Fan," which is wrong. Ma Yun and Wu Kun pronounce it "Miao." Zhang Jingyue pronounces it "Miao." The *Jiayi Jing* commentary says "Ting." *Tong Ya* states: Modern dictionaries like *Tang Yun*, *Yun Hui*, and *Zi Hui* omit the character for sun/moon/lamp, which should be pronounced "Miao."
Urination changes color. The *Jiayi Jing* adds "Yellow and Red" after "Change." Zhang Jingyue notes: Change refers to urine being yellow or red, or presenting as enuresis/dysuria, or strangury. This results from insufficiency of Kidney Water, representing a variation of reverse or compliant states.
Variations of Reverse and Compliant. Ma Yun: Following the sequence of the four seasons is called Compliant (Cong). Exceeding or falling short, leading to various diseases, is called Reverse (Ni). Wu Kun notes: If the pulse reverses its compliance, it transforms into pathology. Gao Shixi agrees.
Like a bird's beak. New Corrections state: "Hui" (beak), other editions have "Zhuo" (peck). Note: The *Nan Jing* states: Spleen is the central plain. Its peaceful state is invisible; only decline is seen. Arrival is like a sparrow pecking, water leaking down; this is the sign of Spleen decline. According to the *Ping Ren Qi Xiang Lun*: "Sharp and firm like a bird's beak," using "Hui" is correct.
Chong Qiang (Heavy Stiffness). Ma Yun: "Chong" is read with a level tone. Spleen is not peaceful, thus already stiff; plus nine orifices are blocked, pathogenic evil is flourishing, named Chong Qiang. These are visible signs of Spleen's aversion. Wu Kun notes: Deficiency lacks harmonious Earth Qi; Five Zang Qi contend, blocking nine orifices, named Chong Qiang, indicating pathogenic victory. Zhang Jingyue notes: Chong Qiang means not soft, heavy and stiff. Gao Shixi notes: It is Spleen disease affecting upper, lower, and four sides, hence Chong Qiang. Qiang means disharmony. Note: It is unclear which theory is correct.
Ju Ran (Startled look). *Li Ji · Tan Gong*: Zengzi heard it and looked startled. Zheng Xuan notes: Startled change. Gao Shixi notes: Look of surprise and looking around.
Bow twice and kowtow. Wu edition deletes the character "Er" (and).
Yuji (Jade Machine). Wu Kun notes: Using Jade as a machine symbolizes the celestial instrument. Its rotation never stops. Now saying "Spirit turns without returning" is also the rotation of the Jade Machine, hence the name. Zhang Jingyue notes: Yuji, using the armillary sphere, allows us to窥 (observe) Heavenly Dao; this chapter's spiritual principles allow us to observe Human Dao. Thus they are mentioned together, actually as terms of reverence.
Settles in what generates it. Zhang Jingyue notes: She means to stay/rest.
Three months, six months, three days, six days. Zhang Jingyue notes: If disease is not treated early, transmission will occur. Distantly, three or six months; closely, three or six days. When Five Zang are fully transmitted: If transmitted in three months, one Qi and one Zang per month. If in six months, one month per Zang. Three days: One Zang per day and night. Six days: One Zang per day. There are only five Zang, but transmission counts as six. For example, starting in Lung (1), Lung transmits to Liver (2), Liver to Spleen (3), Spleen to Kidney (4), Kidney to Heart (5), Heart returns to Lung (6). This is called Six Transmissions.
This follows the order of overcoming transmission. Note: According to New Corrections, these seven characters are misplaced Wang Bing commentary and should be deleted. Ma Yun and others consider them original text, which is incorrect.
Wind is the chief of a hundred diseases. This phrase also appears in *Feng Lun*, *Gu Kong Lun*, *Ling Shu · Wu Se Pian*, and *Tong Tian Pian*.
Food regurgitates. Gao Shixi notes: Food Qi enters the Stomach, disperses essence to the Liver. Liver Qi rebels, so food comes out inversely. Gao Shixi agrees.
Develops Dan (Heat Disease). Ma Yun: Developing into Dan, Dan means Heat. Wu Kun notes: Dan is the name for Heat in the Middle, as stated in "Dan becomes Xiao Zhong." Abdominal heat, vexation, and yellow discharge detail the syndrome of Dan. Gao Shixi notes: Dan is Fire Dan. Wind invades damp Earth generating heat, so damp-heat develops Dan. Note: Gao seems to equate Dan with Dan Du (carbuncle). *Guang Yun* says Fire Dan is a pediatric disease. Wei Shi's *De Xiao Fang* treats Dan as Dan Du, originating in Song/Yuan, so it should not be followed.
Discharges Yellow. Zhang Jingyue notes: Body discharges yellow. Gao Shixi notes: Fire-heat invading downward causes yellow urine. Note: Later text mentions discharging white, so Gao's note seems plausible.
Yuan Re (Oppressive Heat). Ma Yun: Vexation and oppression manifest as heat. Gao Shixi notes: Yuan Re is heat extreme without relief. Note: Gao interprets Yuan as grievance/wrong, which is incorrect.
Discharges White. Wu Kun notes: White refers to turbid discharge. Note: *Wei Lun* states: Excessive sexual activity flaccidizes Zong Jin, causing Sinew Wei and Bai Yin (white turbid discharge). This is the discharging of white.
Gu (Gourd/Worm Infestation). Wu Kun notes: A name for worms eroding Yin Blood. Worms eroding Yin Blood cause confusion and unsettled mind, named Gu Huo (Gu Confusion). Thus, women bewitching men is also called Gu, indicating harm penetrating deeply into Yin. This name Gu implies pathogenic evil penetrating deeply, causing loss of will. Note: *Zuo Zhuan · Zhao 1st Year*, Yi He says: Disease is incurable, related to women, disease like Gu. Not ghost, not food, confusion loses will. Also: Women are Yang objects but dark times; licentiousness generates internal heat and Gu disease. Zhao Meng asks: What is Gu? Answer: Gu is generated by licentiousness and confusion. Etymologically, insect in vessel is Gu; flying grain is Gu. In *I Ching*, woman bewitching man, wind falling mountain, is called Gu, all similar things.
Yuan (Convulsion). Xiong Zongli pronunciation: Chi Shi Fan. Same as "Shen" (see *Zhen Yao Jing Zhong Pian*). Ma Yun: Pronounced Yi, later written as Yuan. Wu Kun notes: Heart governs Blood vessels. Heart disease causes Blood dryness; dryness causes sinews/vessels to pull and tighten, limbs convulse, disease named Yuan. Zhang Jingyue agrees. Note: Ma considers Yuan a later character, which is incorrect.
After ten days, death is expected. Wu Kun notes: One cycle of Heavenly Stems, life of Five Zang ceases, hence death.
Death expected in three years. Hua Shou notes: "Three years" should be "three days." With Lung disease transmitting through overcoming cycles to Kidney then Heart, death is expected in ten days. Once Kidney transmits to Heart, and Heart returns to Lung, no Zang should suffer double injury. How could it last three years? Wu edition reads "Sui" (year) as "Yue" (hiccup), noting: At age five Qi decline, three hiccups mean death. Ang notes: This is just a general estimate. Wu's note changing "three years" to "three hiccups" is unreasonable.
Anger causes Liver Qi to overcome. Gao Shixi notes: Liver should be Lung.
Sorrow causes Lung Qi to overcome. Gao Shixi notes: Lung should be Liver. Sorrow should be Thought. Note: Sorrow need not be changed.
Regarding their transmission and transformation. Zhao Mansion Edition, Xiong Edition: "Ji" (and) is written as "Fan" (reverse). Wu Kun agrees.
Da Gu Ku (Great Bones Withered). Da Rou Xian Xia (Great Flesh Sunken). Zhang Jingyue notes: Great bones and flesh refer to the whole body. Shoulder, spine, waist, knees are great bones. Forearm skin and buttock flesh are great flesh. Drooping shoulders, tilting neck, heavy waist, failing knees indicate withering of Great Zang. If forearm skin is wasted, buttock flesh must wither, indicating sinking of great flesh. Ma Yun: Great bones refer to the high bones mentioned in *Sheng Qi Tong Tian Lun*. I once saw a person with Kidney decline disease, indeed with lumbar bones protruding over an inch, this is due to withering of great bones. Note: Zhang's note is correct.
Expected death in six months. Zhang Jingyue notes: San Yin deficiency, death within six months. Six months represents the annual change of Yin and Yang. If True Visceral Pulse is already seen, it does not fall under the six-month rule; the date can be determined by the day of overcoming/attacking. Note: The five items including "Great Bones Withered" etc., Wang Bing matched them to Five Zang explanations. Others vaguely attributed them to Five Zang failure. Careful study shows Wang's interpretation is superior.
Internal pain drawing to shoulder and neck. Wu Kun notes: Heart is again damaged. Zhang Jingyue notes: Disease reaches Heart Meridian, worse than before.
Po Gu (Popliteal Fossa Rupture/Splitting). Pronunciation: Gu, sound Jun. *Ji Yun*: Qu Yun Qie, sound Jiong. Ma Yun: Gu refers to muscle separations. Wu Kun notes: Gu is the raised area at elbow, knee, and thigh joints. Patient burned by Yin fire, uneasy day and night; frequent turning causes Gu flesh to rub and split. Note: *Ling Shu · Shou Yao Gang Rou* states: Muscle Gu firm with separation means firm flesh. Wang's note seems correct. Shi Song's phonetic gloss: Abdominal fat (from *Yu Pian*) Gao notes: Muscle texture is Gu, muscle fat is Gu.
True Visceral Pulse seen, death within ten months. Hua Shou notes: True Visceral Pulse seen, perhaps should be "not seen." If seen, "within ten months" should be "within ten days." Ma Yun and others say: Month should be Day.
Shoulder Marrow internally consumes. Gao Shixi notes: Shoulder marrow is the bone marrow of Da Zhui, connecting to brain. Thus, tilting neck bone means incurable death.
True Visceral Pulse arrives. Most scholars follow New Corrections, reading "Lai" (arrive) as "Wei" (not yet).
Ji Xu Shen Zhong Zu Zhi (Sudden Deficiency and Strike). Wu Kun notes: Ji Xu means sudden collapse. Zhong means pathogenic evil penetrating deeply. Zu Zhi means arriving suddenly, unforeseen. Gao Shixi notes: Ji Xu is sudden temporary collapse of Righteous Qi. Shen Zhong is external evil suddenly striking the body. Zu Zhi is guest evil suddenly reaching the Zang.
Five Zang absolute closure. Wu Kun notes: Jue means Qi cessation. Bi means nine orifices blocked.
Mao Zhe (Hair Breakage). Wu Kun notes: Those who die with hair breakage: Skin/hair rely on Wei Qi for nourishment. Hair breakage means Wei Qi failure, extreme Yin-Yang decline, hence death. Gao Shixi notes: Pulse Qi flows through meridians, meridian Qi returns to Lung. Lung faces all vessels, delivers essence to skin/hair. Hair and pulse combine essence, then Qi circulates in Zang-Fu. As Zang-Fu Qi desires to cease, hair must break.
Ze Ze Ran (Restless/Pounding sound). Gao Shixi notes: Non-circulating.
Like tracing Coix Seeds. Zhang Jingyue notes: Short, solid, firm, not the normal slight hook shape. *Ben Cao Tu Jing* says: Coix seeds are blue-white, pearl-like but slightly longer, hence called Coix Pearls. Children often thread them like beads. Tao says: Those from Jiaozhi are largest, called Pearl locally.
Pi Pi Ran (Hard and rigid sound). Gao Shixi notes: Hard and dull solid, lacking Stomach Qi. Note: Pi Pi like彈石 (popping stone) also appears in *Ping Ren Qi Xiang Lun*.
Color luster floats. Zhang Jingyue notes: Ze means moist. Fu means bright. Bright and moist color indicates disease will easily resolve.
Clearly inform them. Zhang Jingyue notes: Clearly inform the patient's family, so they know good/bad fortune in advance, avoiding future resentment.
Xuan Jue Chen Se (Suspension/Absence, Deep, Choppy). Gao Shixi notes: Suspension/Absence without root, or deep/choppy not rising, indicates lack of Stomach Qi.
Disease in interior, pulse solid/firm; Disease in exterior, pulse not solid/firm. Zhang Jingyue notes: Seems opposite to *Ping Ren Qi Xiang Lun*. But earlier it said: Disease in interior, pulse empty, meaning internal accumulation of excess should not have empty pulse. Here it says: Disease in interior, pulse solid/firm, meaning internal injury of deficiency should not have solid/firm pulse. Earlier it said: Disease in exterior, pulse choppy/firm, meaning external evil flourishing should not be choppy/firm (considered Yin). Here it says: Disease in exterior, pulse not solid/firm, meaning external evil raging should not be weak (considered lack of Yang). The distinction of these four cases all represent pulses where Righteous Qi cannot overcome Evil, hence difficult to treat. Words seem opposite, logic is true. New Corrections claim textual error, missing the subtlety. Note: Ma Yun and others follow original text, considering it a different meaning from *Ping Ren Qi Xiang Lun*. However, examining the text, New Corrections' view of error is more appropriate.
Five Excesses lead to death. Xue Ji notes: Both Five Excesses and Five Deficiencies lead to death. However, Qi deficiency to exhaustion leading to death is logical. Why do Five Excesses also lead to death? Where evil gathers, Qi must be deficient. Without depletion, death does not occur; it still returns to Qi exhaustion. However, Excess and Deficiency both have true/false aspects, which must be distinguished.
Men Mao (Vexation and Blurred Vision). Pronunciation: Mao, sound Mao. Wu Kun sound Wu. Zhang Jingyue notes: Vexation and dizziness. Another says: Eyes unclear. Gao Shixi notes: Men means depression/stagnation. Mao means eyes unclear. Note: *Ling Shu · Jing Mai* states: Cross hands to relieve Mao. *Tong Ren* commentary cites *Tai Su*: Mao means lowering eyes. *Yu Pian*: Appearance of unclear vision. *Chu Ci · Jiu Zhang*: Internal vexation and Mao. Wang Yi notes: Confused/disturbed. Considering meanings, Zhang's interpretation of vexation/dizziness seems plausible.