马云。能。音耐。礼乐记。故不耐无乐。其耐作能。灵枢阴阳二十五人篇。皆有能字。古盖耐能通用。
阴阳应象大论云。病之形能也。盖病之形状耐受。故此以病能名篇。张兆璜云。病能者。言奇病之形能也。简
按吴释前篇病能云。能。犹形也。此解为是。
胃脘痈 吴云。吸门之下。贲门之上。受纳水谷之脘。名曰胃脘。简按圣济总录云。夫阴阳升降。
则荣卫流通。气逆而隔。则留结为痈。胃脘痈者。由寒气隔阳。热聚胃口。寒热不调。故血肉腐坏。以气逆于
胃。故胃脉沉细。以阳气不得下通。故颈人迎甚盛。令人寒热如疟。身皮甲错。或咳或呕。或唾脓血。观伏梁
之病。亦有挟胃脘内痈者。以其裹大脓血。居肠胃之外故也。方附于一百二十九卷。
当候胃脉 滑云。即脉要精微。附上右外。以候胃也。马云。右关。吴张志同。简按附上右外。
尺肤之位。而非脉之分位。以寸关尺。配五脏六腑者。难经以后之说。此言胃脉者。必别有所候。
逆者 甲乙。作气逆者。
人迎甚盛 张云。即终始篇等所云。人迎三盛。病在阳明之谓。
精有所之寄则安 吴本。作精有所倚。则卧不安。注云。脏。阴也。主静。故脏有伤损。则有不足
之患。阴精有所偏倚。则有亢甚之害。均之令人夜不安也。简按诸家顺文解释。
义难通。吴据甲乙而删改。但精字仍旧文。殆为明晰。今从之。
不能悬其病 吴云。不能悬其病于空。使之不我疾也。马云。悬者。绝也。按逆调论第六节。有不得
卧而息有音者。诸证尤详。但此曰不安。则不能安寝也。与彼有异。
偃卧 高云。正卧也。评热论云。不能正偃者。胃中不和也。故举而复问。
肺者脏之盖也 痿论云。肺者。脏之长也。心之盖也。灵九针论云。五脏之应天者肺。肺者。五脏六
腑之盖也。
右脉沉而紧左脉浮而迟 马云。此当见于两尺也。吴张同。简按本经无寸关尺之说。此特言左右尔。
必非两尺之谓也。
不然 马吴张并仍甲乙。然。作知。志高从旧文释之。故属强解。
此逆四时 志云。脉合四时。故冬诊之。左右脉皆当沉紧。今左脉反浮而迟。是逆四时之气矣。
病在肾颇关在肺 吴云。关。关系也。志云。肾主冬气。而又反浮在左。故当主病在肾。颇关涉于
肺。当为腰痛之病。简按甲乙。无关字。奇病论云。其盛在胃。颇在肺。句法正同。
肾为腰痛之病也 甲乙。无肾字。
颈痈 痈疽篇云。发于颈者。名曰夭疽。其痈大而赤黑。不急治。则热气下入渊腋。前伤任脉。内
薰肝肺。十余日而死矣。
其真安在 吴云。真。正治之法也。简按当仍甲乙作其治。
异等 志云。等。类也。高云。颈痈之名虽同。而在气
在血。则异类也。
痈气之息 马云。以小针开除。而去病者。正以痈间有气顿息。不至甚也。吴。息。改 。云。 。
腐肉也。针。铍针也。所以去针肉。张云。息。止也。痈有气结。而留止不散者。治宜甲针以开除其气。气行
则痈愈矣。高云。颈痈。而气之止息者。其病在气。宜以针开通其气。而除去之。此气息成痈。而有针刺之真
法也。颈痈而气盛血聚者。其病在血。宜石刺出血而泻之。此血聚成痈。而有石刺之真法也。此所以同病异治。
而皆已也。简按说文。 。寄肉也。徐锴曰。息者。身外生之也。故古谓赊赁生举钱。为息钱。旋生土为息壤
也。方言。作KT 。王释为死肉。吴则为腐肉。无所考据。张注允当。今从之。
同病异治也 吴。此下。补肤顽内陷者。宜灸以引之十字。云。以上文有其问。故僭补之。张兆璜云。
陷下者。又宜灸。始言针灸。而后止言针石者。盖此篇。论五脏之相传。而肾脏之气。已传于肝。故止宜针宜
石。设或有回陷于肾者。又常灸之。此虽不明言。盖欲人意会。读者宜潜心参究。不可轻忽一字。简按吴补固
僭矣。而张注亦凿。俱不可从。
狂 灵癫狂篇云。狂始发。少卧不饥。自高贤也。自辨智也。自尊贵也。善骂詈。日夜不休。通评
虚实论云。癫疾厥狂。久逆之所生也。又千金方云。狂风骂詈。挝斫人。名热阳风。即怒狂也。
暴折而难决 马云。此人者。因猝暴之顷。有所挫折。而事有难决。志不得伸。吴云。暴折而抑之。
不得剖决。志云。决。流行也。高云。决。散也。简按吴注为是。
阳明者常动 马云。灵动输篇。言是阳明独动不休。故凡冲阳。（即跗阳）地仓。大迎。下关。人
迎。气冲之类。皆有动
脉不止。而冲阳为尤甚。
巨阳少阳不动 吴云。巨阳。有委中。昆仑。少阳。有悬钟。听会。其脉皆不甚动。于其不甚动者。
反动大疾。此阳厥善怒。而狂之候也。
动大疾 马云。大。当作长。简按非也。
夫食入于阴 张云。五味入口。而化于脾。食入于阴也。藏于胃以养五脏气长气于阳也。
生铁洛 张云。即炉冶间锤落之铁屑也。其属金。其气寒而重。最能坠热开结。平木火之邪。故可
以下气疾。除怒狂也。凡药中用铁精。铁华粉。针砂。铁锈水之类。皆同此意。简按本草经。作铁落。唐本注
云。落。是铁皮滋液。黑于余铁。陶谓可以染皂。云是铁浆。误矣。苏颂图经云。铁落者。锻家烧铁赤沸。砧
上打落细皮屑。俗呼为铁花。是也。初炼去矿。用以铸 器物者。为生铁。再三销拍。可以作 者。为 铁。
亦谓之熟铁。此说是也。别录云。铁落。一名铁液。故王云。为铁浆非。是生铁液也。高云。洛。烙同。烙饮
者。转赤为乌也。赤而乌。可以平巨阳之气。迂谬尤甚。圣济总录云。铁落。染皂铁浆。是。上一味。每服重
汤内温一盏饮之。食后。此不读王注及唐本。乃袭陶谬也。
为饮 张云用水研浸。可以为饮。简按唐本注云。诸铁疗病。并不入丸散。皆煮取浆用之。此云为
饮。亦煮取浆者与。
下气疾也 吴云。寒而镇重。故下气速。气下则不厥逆矣。志云。铁乃乌金。能伐肝木。故下肝气
之疾速也。李时珍云。阳气怫郁。而不得疏越。少阳胆木。挟三焦少阳相火。巨阳阴火上行。故使人易怒如狂。
其巨阳少阳之动脉。可诊之也。夺其食。不使胃火复助其邪也。饮以生铁落。金以制
木也。木平则火降。故曰下气疾速气即火也。简按列子汤问。吴楚之国。有大木焉。其名为 。（音柚）碧树
而冬生。实丹而味酸。食其皮汁。已愤厥之疾。张湛注云。气疾也。梁书姚察传。自免忧后。因加气疾。盖愤
厥。乃阳厥之类。而气疾所指不一。凡狂易癫眩。惊悸痫 。心神不定之证。宜概称气疾焉。若以疾训速。或
为效验疾速之义。或为逆气疾速之谓。乖谬亦甚。
泽泻术各十分麋衔五分 张云。泽泻。味甘淡。性微寒。能渗利湿热。白术。味甘苦气温。能补中燥
湿止汗。麋衔。即薇衔。一名无心草。南人呼为吴风草。味苦平微寒。主治风湿。十分者。倍之也。五分者。
减半也。简按苏颂云。凡古方云术者。乃白术也。此方。圣济。名泽泻汤。三因。名麋衔汤。并用白术。马云。
术。即苍术非也。麋衔。本经作薇衔。一名麋衔。唐本注云。一名鹿衔草。言鹿有疾。衔此草瘥。陈嘉谟云。
麋鹿有疾。衔此草瘥。素问之名。因此出。时珍云。据苏说。则薇衔麋衔。当作鹿衔也。此说误。麋鹿一类。
不必改作鹿。刘HT 采天名精。活 。遂有活鹿草之名。麋。果鹿之误乎。活鹿草。当作活 草也。圣济。十分
作二两半。五分作一两一分。陶氏序录云。古秤惟有铢两。而无分名。今则以十黍为一铢。六铢为一分。四分
为一两。然则四分为一两者。六朝以降之事。而此经云分者。非分两之分。总录误尔。三因。十分。作一两。
五分作半两。乃与张注符矣。
合以三指撮 吴云。合。修合也。三指撮。言如三指宽一撮也。简按陶序例。一撮者。四刀圭也。
刀圭者。十分方寸匕之一。准如梧桐子大也。此云三指撮者。乃一方寸匕余也。张云。合以三指。用三指撮合。
以约其数。而为煎剂也。
考经文。此谓散药。张注谬尔。圣济云。上三味。捣罗为散。每服二钱匕。沸汤调。食后服。三因亦云。上为
末。每服二钱。酒饮任调下。食前服。
为后饭 马云。药在饭后也。误。
所谓深之细者 高。以下二十四字。移于前颈痈之下。上经者以下六十九字。移于前在阴阳奇恒中之
下。而为之注释。率属牵强。不可从。
马云说：“能”，读音同“耐”。《礼记·乐记》中说：“故不耐无乐。”其中的“耐”字写作“能”。《灵枢·阴阳二十五人篇》中也有“能”字。古代大概“耐”和“能”是通用的。
《素问·阴阳应象大论》说：“病之形能也。”意思是疾病的形状和耐受表现，因此用“病能”作为这一篇的篇名。张兆璜说：“病能”，是指奇异疾病的形态和表现。
按：吴崑解释前一篇的“病能”说：“能”，就是“形”的意思。这种解释是正确的。
胃脘痈 吴崑说：“吸门之下，贲门之上，受纳水谷的胃部，叫做胃脘。”按：《圣济总录》说：“阴阳升降，则营卫流通；气逆而阻隔，则留结成为痈。胃脘痈，是由于寒气隔绝阳气，热气聚集在胃口，寒热不调，导致血肉腐败。因为气逆于胃，所以胃脉沉细；因为阳气不能下行通达，所以颈部人迎穴处脉搏盛大。使人出现像疟疾一样的寒热症状，皮肤干枯如鳞甲交错，或者咳嗽、呕吐，或者吐出脓血。观察伏梁病的病症，也有夹杂胃脘内部痈肿的，因为它包裹着大量的脓血，位于肠胃之外。方剂附在一百二十九卷。”
应当候察胃脉 滑寿说：“即《脉要精微论》中提到的‘附上右外’，以此来候察胃脉。”马云说：“指右关脉。”吴崑和张志聪持相同观点。按：所谓“附上右外”，指的是尺肤诊法的位置，而不是切脉的部位。用寸、关、尺来配属五脏六腑，是《难经》以后的说法。这里所说的胃脉，必定有其他的候察部位。
人迎甚盛 张志聪说：“即《终始篇》等文中所说的‘人迎三盛’，是指病在阳明经的情况。”
精有所之寄则安 吴崑的本子，写作“精有所倚，则卧不安”。注解说：“脏，属阴，主静，所以脏有损伤，就会有不足的祸患；阴精如果有偏倚，就会有亢盛的害处。都导致让人夜间睡眠不安。”按：各家顺着文意解释，义理难以通顺。吴崑依据《甲乙经》进行了删改，但保留了“精”字，显得更为明晰，现在采纳他的说法。
不能悬其病 吴崑说：“不能将病悬空于空中，使之不伤害我身体。”马云说：“悬，就是断绝的意思。”按《逆调论》第六节，有关于不能卧倒且呼吸有声的症状，诸证尤为详细。但这里说的是“不安”，则是不能安稳入睡，与彼处有所不同。
偃卧 高世栻说：“正卧，即仰卧。”《评热论》说：“不能正偃（仰卧）的，是因为胃中不和。”所以举出再加以询问。
肺者脏之盖也 《痿论》说：“肺，是脏之长，心的盖子。”《灵枢·九针论》说：“五脏对应天的脏器是肺，肺，是五脏六腑的盖子。”
右脉沉而紧左脉浮而迟 马云说：“这应当出现在两尺脉上。”吴崑和张志聪持相同观点。按：本经没有寸、关、尺的说法，这里特指左右两侧而言，必定不是指两尺脉。
不然 马云、吴崑、张志聪都沿袭《甲乙经》，将“然”解释为“知”。高世栻从旧文解释，所以属于牵强附会。
此逆四时 张志聪说：“脉象符合四时变化，所以在冬季诊脉时，左右脉都应当沉紧。现在左脉反而浮而迟，这是违背了四时的气候。”
病在肾颇关在肺 吴崑说：“关，是关系的意思。”张志聪说：“肾主冬气，而又反浮在左侧，所以应当主病在肾，颇涉猎于肺，应当是腰痛的病。”按：《甲乙经》中没有“关”字。《奇病论》说：“其盛在胃，颇在肺。”句法完全相同。
颈痈 《痈疽篇》说：“发于颈部的，名叫夭疽。它的痈大而色赤黑，如果不及时治疗，热气就会向下进入渊腋，向前损伤任脉，向内熏蒸肝肺，十多天后就会死亡。”
其真安在 吴崑说：“真，指正治的方法。”按：应当仍依《甲乙经》作“其治”。
异等 张志聪说：“等，是类别的意思。”高世栻说：“颈痈的名称虽然相同，但在气或在血，则是不同的类别。”
痈气之息 马云说：“用小针开除，而去掉病邪的，正是因为痈间有气停顿休息，不至于严重。”吴崑将“息”改为“腐”，说：“腐，是腐肉。针，是铍针。用来去除腐肉。”张志聪说：“息，是停止的意思。痈有气结，停留不散，治疗应当用铍针以开除其气，气行则痈痊愈。”高世栻说：“颈痈，如果气止息，病在气，宜用针开通其气并除去它。这是气息停滞成痈，而有针刺的真法。颈痈如果气盛血聚，病在血，宜用石针刺出血以泻之。这是血聚成痈，而有石针刺血的真法。这就是同病异治，而都能治愈的原因。”按：《说文解字》中，“腐”是寄生的肉。徐锴说：“息，是身外生长的。”所以古代称赊贷生息的钱为息钱，旋转生长的土为息壤。《方言》中，王念孙解释为死肉，吴崑解释为腐肉，都没有确凿证据。张志聪的注解恰当，现在采纳他的说法。
同病异治也 吴崑在此下补入“肤顽内陷者，宜灸以引之”十字。说：“以上文有其问，所以僭越补充。”张兆璜说：“陷下的，又适宜艾灸。开始提到针灸，而后只说针石，大概是因为本篇论述五脏的相传，而肾脏之气已传于肝，所以只适宜针石。假设有回陷于肾的，又常需艾灸。这虽不明言，大概是希望读者心领神会。读者应潜心研究，不可轻视一字。”按：吴崑的补充固然僭越，而张志聪的注解也过于穿凿，都不可以采纳。
狂 《灵枢·癫狂篇》说：“狂病刚开始发作时，少睡且不饥饿，自认为贤能，自认为明智，自认为尊贵，喜欢骂詈，日夜不停。”《通评虚实论》说：“癫疾厥狂，是由久逆所产生。”又《千金方》说：“狂风骂詈，殴打砍人，名叫热阳风，也就是怒狂。”
暴折而难决 马云说：“这个人，因为在猝暴之时，有所挫折，而事情难以决断，意志不得伸展。”吴崑说：“暴折而压抑他，不得剖决。”张志聪说：“决，是流行的意思。”高世栻说：“决，是散开的意思。”按：吴崑的注释是正确的。
阳明者常动 马云说：“《灵枢·动输篇》说，只有阳明经独自跳动不休。所以凡是冲阳（即跗阳）、地仓、大迎、下关、人迎、气冲等穴位，都有动脉不止，而冲阳穴最为明显。”
巨阳少阳不动 吴崑说：“巨阳经有委中、昆仑穴，少阳经有悬钟、听会穴，它们的脉象都不怎么跳动。在这些不怎么跳动的地方，反而跳动大且急，这是阳厥善于发怒，以及狂证的征候。”
夫食入于阴 张志聪说：“五味入口，而在脾化，这是食入于阴。藏于胃以滋养五脏之气，这是在阳生长气。”
生铁洛 张志聪说：“就是冶炼炉锤落的铁屑。它属金，气寒而重，最能坠热开结，平抑木火之邪，所以可以下气疾，消除怒狂。凡药中使用铁精、铁华粉、针砂、铁锈水之类的，都是同样的用意。”按：《本草经》作“铁落”。《唐本草注》说：“落，是铁皮滋液，比其余的铁黑。陶弘景说可以染皂，说是铁浆，错了。”苏颂《图经》说：“铁落，是锻家烧铁红沸，在砧上打落的细皮屑，俗呼为铁花，是对的。初炼去矿，用以铸造器物的是生铁；再三销拍，可以作……的是熟铁，也叫熟铁。这个说法是对的。《别录》说：铁落，一名铁液。所以王冰说它是铁浆是不对的，它是生铁液。高世栻说：洛，同烙。烙饮，是转赤为乌。赤而乌，可以平巨阳之气，更是迂腐荒谬。《圣济总录》说：铁落，是染皂铁浆，是对的。上一味药，每服用热水温一盏饮用，饭后服。这是因为没读王冰注及《唐本草》，而是沿袭陶弘景的错误。”
为饮 张志聪说：“用水研浸，可以做成饮剂。”按：《唐本草注》说：“各种铁疗病，都不入丸散，都是煮取浆液使用。这里说为饮，也是煮取浆液吧？”
下气疾也 吴崑说：“寒而镇重，所以下气迅速。气下则不厥逆了。”张志聪说：“铁乃乌金，能伐肝木，所以下肝气之疾迅速。”李时珍说：“阳气怫郁，而不能疏越，少阳胆木挟带三焦少阳相火，巨阳阴火上行的缘故，所以使人易怒如狂。其巨阳少阳的动脉，可以诊察到。夺其食，不让胃火再次助长邪气。饮以生铁落，是用金来制木。木平则火降，所以说下气疾速。气即火也。”按：《列子·汤问》说，吴楚之国，有大木，名叫柚。碧树而冬天生长，果实红色而味酸。吃它的皮汁，可以治愈愤厥的病。张湛注说：“气疾也。”《梁书·姚察传》说，自免去忧后，因而加气疾。大概愤厥，是阳厥之类，而气疾所指不一。凡狂易、癫眩、惊悸痫、心神不定之证，宜概称为气疾。如果把“疾”训为“速”，或者是效验疾速的意思，或者是逆气疾速的意思，就乖谬得很了。
泽泻术各十分麋衔五分 张志聪说：“泽泻，味甘淡，性微寒，能渗利湿热。白术，味甘苦气温，能补中燥湿止汗。麋衔，即薇衔，一名无心草，南方人呼为吴风草，味苦平微寒，主治风湿。十分者，是加倍的意思。五分者，是减半的意思。”按：苏颂说：“凡古方云术者，乃是白术。此方，《圣济总录》名泽泻汤，《三因方》名麋衔汤，都用白术。”马云说：“术，即苍术，非也。”麋衔，《本经》作薇衔，一名麋衔。《唐本草注》说：“一名鹿衔草。说鹿有病，衔此草而愈。”陈嘉谟说：“麋鹿有病，衔此草而愈，《素问》之名，因此而出。”李时珍说：“据苏颂之说，则薇衔麋衔，当作鹿衔。这个说法错误。麋鹿是一类，不必改作鹿。刘禹锡采天名精，活……遂有活鹿草之名。麋，果真是鹿之误吗？活鹿草，应当作活……草。”《圣济总录》十分作二两半，五分作一两一分。陶氏序录说：“古秤惟有铢两，而无分名。今则以十黍为一铢，六铢为一分，四分为一两。然而四分为一两者，是六朝以降的事，而此经云分者，非分两之分，《总录》错了。”《三因方》十分作一两，五分作半两，才与张志聪的注解相符。
合以三指撮 吴崑说：“合，是修合的意思。三指撮，是说像三指宽的一撮。”按：陶弘景序例说：“一撮者，四刀圭也。刀圭者，十分方寸匕之一，准如梧桐子大。这里说三指撮，乃一方寸匕余。”张志聪说：“合以三指，用三指撮合，以约其数，而为煎剂。”考经文，此谓散药，张志聪的注解错误。《圣济总录》说：“上三味，捣罗为散，每服二钱匕，沸汤调，食后服。”《三因方》也说：“上为末，每服二钱，酒饮任调下，食前服。”
所谓深之细者 高世栻将以下二十四字，移于前“颈痈”之下；将“上经者”以下六十九字，移于前“在阴阳奇恒”中之下，而为之注释，率属牵强，不可从。
Ma Yun stated: "Neng" (能), pronounced as "Nai" (耐). In the *Book of Rites: Music* (*Liji Yueling*), it is written, "Therefore, one who cannot endure has no music." Here, "Nai" is written as "Neng". The *Ling Shu: Yin Yang Twenty-Five Person Types* chapter also contains the character "Neng". In ancient times, "Nai" and "Neng" were likely interchangeable.
The *Su Wen: Yin Yang Ying Xiang Da Lun* states: "The form and manifestation of disease" (Bing zhi xing neng ye). This refers to the shape and endurance of the disease, which is why this chapter is titled "Disease Manifestations" (Bing Neng). Zhang Zhaohuang said: "Bing Neng" refers to the forms and manifestations of rare diseases.
Commentary: Wu Kun explained the "Bing Neng" in the previous chapter as: "Neng" means "Xing" (form/shape). This explanation is correct.
Stomach Epigastrium Carbuncle (Wei Wan Yong): Wu Kun said: "Below the Hinge Gate (Xi Men) and above the Pylorus (Ben Men), the stomach that receives water and grain is called the Stomach Epigastrium (Wei Wan)." Commentary: The *Sheng Ji Zong Lu* states: "When Yin and Yang ascend and descend properly, Ying and Wei circulate freely; when Qi rebels and obstructs, stagnation and knotting occur, forming a carbuncle. The Stomach Epigastrium Carbuncle arises from cold qi isolating Yang, causing heat to gather at the stomach opening. Due to the disharmony of cold and heat, flesh and blood rot. Because Qi rebels in the stomach, the stomach pulse is deep and fine. Because Yang Qi cannot descend and communicate, the Renying point on the neck pulses vigorously. This causes chills and fever resembling malaria, skin dryness with scales, coughing or vomiting, or expectoration of pus and blood. Observing the condition of Fuliang (Voluta Mass), there are cases involving internal carbuncles of the stomach epigastrium, because it encases large amounts of pus and blood located outside the intestines and stomach. Formulas are attached in Volume 129."
One should observe the Stomach Pulse: Hua Shuo said: "This refers to 'Fushang Youwai' mentioned in the *Mai Yao Jingwei Lun*, used to observe the stomach pulse." Ma Yun said: "It refers to the Right Guan position." Wu Kun and Zhang Zhicong held the same view. Commentary: "Fushang Youwai" refers to the location for skin palpation (Chifu diagnosis), not the pulse taking site. The association of Cun, Guan, and Chi positions with the five Zang and six Fu organs is a theory from later texts like the *Nan Jing*. The "stomach pulse" mentioned here must refer to another observation site.
Rebellion (Ni): The *Jia Yi Jing* reads "Qi rebellion" (Qi ni zhe).
Renying Pulse Vigorous (Renying shen sheng): Zhang Zhicong said: "This refers to what is said in chapters such as *Zhong Shi*: 'Renying three-fold excess,' indicating disease in the Yangming meridian."
When Essence has a place to reside, it is peaceful (Jing you suo zhi ji ze an): Wu Kun's version reads "Jing you suo yi, ze wo bu an" (When essence has a bias, sleep is uneasy). The annotation states: "Zang organs belong to Yin, governing stillness. Thus, damage to Zang organs leads to deficiency; if Yin essence is biased, it leads to hyperactivity. Both cause restless sleep at night." Commentary: Various schools interpreted this literally, making the meaning difficult to understand. Wu Kun revised it based on the *Jia Yi Jing* but retained the character "Jing," making it clearer. I adopt his view.
Cannot suspend the disease (Bu neng xuan qi bing): Wu Kun said: "Cannot suspend the disease in the void so that it does not harm me." Ma Yun said: "Xuan means to sever." Commentary: The *Ni Diao Lun* Chapter 6 details symptoms such as inability to lie down with noisy breathing. However, here it says "uneasy," referring to the inability to sleep peacefully, which differs from the other text.
Supine Position (Yan wo): Gao Shixi said: "Proper lying down, i.e., supine." The *Ping Re Lun* states: "Inability to lie supine indicates disharmony in the stomach." Hence, it is raised for further inquiry.
The Lung is the Cover of the Viscera (Fei zhe zang zhi gai ye): The *Wu Lun* states: "The Lung is the Chief of the Zang organs and the Cover of the Heart." The *Ling Shu: Jiu Zhen Lun* states: "Among the five Zang organs corresponding to Heaven is the Lung; the Lung is the Cover of the five Zang and six Fu organs."
Right Pulse Deep and Tight, Left Pulse Floating and Slow (You mai chen er jin, zuo mai fu er chi): Ma Yun said: "This should be seen in both Chi positions." Wu Kun and Zhang Zhicong agreed. Commentary: The original classic does not discuss Cun, Guan, and Chi positions; this specifically refers to left and right sides, certainly not referring to the two Chi positions.
Otherwise (Bu ran): Ma Yun, Wu Kun, and Zhang Zhicong followed the *Jia Yi Jing*, interpreting "Ran" as "Zhi" (know). Gao Shixi interpreted from the old text, which is considered forced.
This goes against the Four Seasons (Ci ni si shi): Zhang Zhicong said: "Pulses conform to the four seasons. Therefore, when diagnosing in winter, both left and right pulses should be deep and tight. Now, the left pulse is floating and slow, which goes against the Qi of the four seasons."
Disease in the Kidney, somewhat related to the Lung (Bing zai shen po guan fei): Wu Kun said: "Guan means relationship." Zhang Zhicong said: "The Kidney governs Winter Qi, yet floats on the left. Thus, the primary disease is in the Kidney, but involves the Lung, likely manifesting as lower back pain." Commentary: The *Jia Yi Jing* lacks the character "Guan." The *Qi Bing Lun* states: "Its excess is in the Stomach, somewhat in the Lung," with identical syntax.
Kidney is the disease of lower back pain (Shen wei yao tong zhi bing ye): The *Jia Yi Jing* lacks the character "Shen."
Neck Carbuncle (Jing Yong): The *Yong Ju Pian* states: "Those arising in the neck are called Tian Ju. The carbuncle is large, red, and black. If not treated urgently, heat qi descends into Yuanye, damages the Ren Mai anteriorly, and internally steams the Liver and Lung. Death occurs within ten days."
Where lies the true method? (Qi zhen an zai): Wu Kun said: "Zhen refers to the correct treatment method." Commentary: It should follow the *Jia Yi Jing* reading "Qi Zhi" (its treatment).
Different Categories (Yi deng): Zhang Zhicong said: "Deng means category." Gao Shixi said: "Although the name Neck Carbuncle is the same, if the pathology is in Qi or in Blood, they are different categories."
Qi of Carbuncle Resting (Yong qi zhi xi): Ma Yun said: "Using a small needle to open and remove the pathogen works because the Qi in the carbuncle is stagnant/resting, not severe." Wu Kun changed "Xi" to "Fu" (rotten), stating: "Fu means rotten flesh. Needle refers to Pi needle, used to remove rotten flesh." Zhang Zhicong said: "Xi means stop. When Qi knots in a carbuncle and stays without dispersing, treatment should use a Pi needle to open and release the Qi. Once Qi moves, the carbuncle heals." Gao Shixi said: "For a neck carbuncle where Qi stops, the disease is in Qi, suitable for needle therapy to open and remove Qi. This is the true method for acupuncture when Qi stagnation forms a carbuncle. For a neck carbuncle where Qi is excessive and Blood gathers, the disease is in Blood, suitable for stone needle bleeding to drain it. This is the true method for stone needle therapy when Blood gathering forms a carbuncle. This explains treating the same disease differently, yet curing both." Commentary: The *Shuo Wen Jie Zi* defines "Fu" as parasitic flesh. Xu Kai stated: "Xi means growing outside the body." Hence, ancient texts call interest money "Xi Qian" and fertile soil "Xi Rang." Wang Niansun interpreted a term in *Fang Yan* as dead flesh, while Wu Kun interpreted it as rotten flesh, lacking evidence. Zhang Zhicong's annotation is appropriate, so I adopt it.
Treating the Same Disease Differently (Tong bing yi zhi ye): Wu Kun added ten characters below this: "For skin hardness and depression, moxibustion should be used to guide [the Qi]." He stated: "Since there was a question above, I presumptuously added this." Zhang Zhaohuang said: "Depressed conditions are also suitable for moxibustion. Initially mentioning acupuncture and moxibustion, then only discussing needles and stones, implies that since this chapter discusses the transmission of the Five Zang organs, and Kidney Qi has transmitted to the Liver, only needles and stones are suitable. If there is a re-depression in the Kidney, moxibustion is commonly used. Although not explicitly stated, readers should infer this. One should study carefully and not neglect any word." Commentary: Wu Kun's addition is presumptuous, and Zhang Zhicong's annotation is overly pedantic; neither should be adopted.
Mania (Kuang): The *Ling Shu: Dian Kuang Pian* states: "When mania first starts, the patient sleeps little, feels no hunger, considers themselves virtuous, wise, and noble, curses frequently, day and night without rest." The *Tong Ping Xu Shi Lun* states: "Epilepsy and manic reversal arise from long-term rebellion." Also, the *Qian Jin Fang* states: "Wild cursing and beating people is called Re Yang Feng, which is also angry mania."
Sudden frustration and difficulty in resolution (Bao zhe er nan jue): Ma Yun said: "This person, due to sudden trauma, faced obstacles where matters were hard to resolve, and their will could not be expressed." Wu Kun said: "Suddenly frustrated and suppressed, unable to be resolved." Zhang Zhicong said: "Jue means flow." Gao Shixi said: "Jue means disperse." Commentary: Wu Kun's note is correct.
Yangming is always moving (Yang ming zhe chang dong): Ma Yun said: "The *Ling Shu: Dong Shu Pian* states that only the Yangming meridian moves continuously. Therefore, points such as Chongyang (also known as Fuyang), Dicang, Daying, Xiaguan, Renying, and Qichong all have pulsating arteries, with Chongyang being the most prominent."
Juyang and Shaoyang do not move (Ju yang shao yang bu dong): Wu Kun said: "Juyang meridian has Weizhong and Kunlun points; Shaoyang meridian has Xuanzhong and Tinghui points. Their pulses do not move significantly. In these areas where pulses do not move significantly, if they suddenly move large and fast, this is a sign of Yang Jue (anger rebellion) and mania."
Moving Large and Fast (Dong da ji): Ma Yun said: "Da should be read as 'Chang' (long)." Commentary: Incorrect.
When food enters the Yin (Fu shi ru yu yin): Zhang Zhicong said: "The five flavors enter the mouth and transform in the Spleen; this is food entering the Yin. Stored in the Stomach to nourish the Qi of the five Zang organs; this is generating Qi in the Yang."
Raw Iron Falling (Sheng Tie Luo): Zhang Zhicong said: "These are iron filings hammered off in smelting furnaces. They belong to Metal, have cold and heavy Qi, and can best sink heat, open knots, and calm Wood and Fire pathogens. Thus, they can reduce rapid Qi movement and eliminate angry mania. Medicines using Iron Essence, Iron Flower Powder, Needle Sand, or Iron Rust Water share this intent." Commentary: The *Ben Cao Jing* writes "Tie Luo." The *Tang Ben Cao Zhu* states: "Luo refers to the black liquid coating on iron sheets, darker than other iron. Tao Hongjing claimed it could dye black and called it iron slurry, which is wrong." Su Song's *Tu Jing* states: "Tie Luo refers to the fine flakes hammered off red-hot iron by smiths, commonly called iron flowers, which is correct. Raw iron is used for casting after initial smelting; repeatedly refined iron is wrought iron, also called ripe iron. This view is correct. The *Bie Lu* states: Tie Luo is also named Tie Ye. Thus, Wang Bing calling it iron slurry is incorrect; it is raw iron liquid. Gao Shixi claimed 'Luo' is the same as 'Lao' (branding), implying turning red to black to calm Juyang Qi, which is even more absurd. The *Sheng Ji Zong Lu* states: Tie Luo is iron slurry for dyeing black, which is correct. Take one portion, warm in hot water, drink one cup after meals. This ignores Wang Bing's note and the *Tang Ben Cao*, merely copying Tao's error."
Make into a Drink (Wei Yin): Zhang Zhicong said: "Grind with water and soak to make a drink." Commentary: The *Tang Ben Cao Zhu* states: "Various iron treatments are not used in pills or powders but boiled to extract the liquid/slurry. Saying 'make into a drink' implies boiling to extract slurry as well?"
Reducing Rapid Qi Movement (Xia qi ji ye): Wu Kun said: "Cold and heavy, thus reducing Qi rapidly. When Qi descends, rebellion ceases." Zhang Zhicong said: "Iron is Black Gold, capable of subduing Liver Wood, thus rapidly reducing Liver Qi disorders." Li Shizhen said: "When Yang Qi is depressed and cannot diffuse, the Shaoyang Gallbladder Wood carries the Sanjiao Shaoyang Ministerial Fire, and Juyang Yin Fire ascends, causing irritability and mania. The pulses of Juyang and Shaoyang can be diagnosed. Deprive them of food to prevent Stomach Fire from aiding the pathogen. Drink Raw Iron Falling to use Metal to control Wood. When Wood is balanced, Fire descends. Hence, it reduces Qi rapidly. Qi is Fire." Commentary: The *Liezi: Tang Wen* mentions a tree in Wu and Chu called You, green in winter, with red sour fruit. Eating its peel and juice cures Fen Jue (frustrated rebellion). Zhang Zhan annotated: "Qi disorder." The *Book of Liang: Biography of Yao Cha* mentions developing Qi disorder after removing worry. Fen Jue is likely a type of Yang Jue, and Qi disorder covers various conditions including mania, epilepsy, dizziness, palpitations, and mental instability. Interpreting "Ji" as "fast" (speed of effect or speed of rebellious Qi) is erroneous.
Alisma, Atractylodes each one part, Elsholtzia half part (Zexie Shu ge shi fen, Mi Xian wu fen): Zhang Zhicong said: "Alisma (Zexie) is sweet, bland, slightly cold, promoting damp-heat drainage. Atractylodes (Baizhu) is sweet, bitter, warm, tonifying the center, drying dampness, and stopping sweating. Mi Xian is the same as Wei Xian, also called Wuxin Cao or Wufeng Cao in the south, bitter, neutral, slightly cold, treating wind-dampness. 'Ten parts' means double; 'five parts' means half." Commentary: Su Song stated: "In ancient formulas, 'Shu' refers to Baizhu (White Atractylodes). This formula is named Zexie Tang in *Sheng Ji Zong Lu* and Mixian Tang in *San Yin Fang*, both using Baizhu." Ma Yun said: "Shu refers to Cangzhu (Coarse Atractylodes), which is incorrect." *Ben Cao Jing* writes Wei Xian, also named Mi Xian. *Tang Ben Cao Zhu* states: "Also named Luxian Cao (Deer Foot Grass). It is said deer eat this grass when sick and recover." Chen Jiamo said: "Elk and deer eat this grass when sick and recover, hence the name in *Su Wen*." Li Shizhen said: "Based on Su Song, Wei Xian and Mi Xian should be Luxian Cao. This view is wrong. Elk and deer are similar; there is no need to change to Deer. Liu Yuxi collected Tian Ming Jing and revived... leading to the name Huolu Cao (Living Deer Grass). Is Mi truly an error for Deer? Huolu Cao should be written as Hu... Cao." *Sheng Ji Zong Lu* converts ten parts to 2.5 liang and five parts to 1.1 liang. Tao's Preface states: "Ancient weights had only Zhu and Liang, no Fen. Later, ten grains equal one Zhu, six Zhu equal one Fen, four Fen equal one Liang. However, four Fen equaling one Liang is a post-Six Dynasties development. The 'Fen' in this classic is not a unit of weight; the *Zong Lu* is mistaken." *San Yin Fang* converts ten parts to 1 liang and five parts to 0.5 liang, matching Zhang Zhicong's note.
Combine with Three-Finger Pinch (He yi san zhi cuo): Wu Kun said: "He means compounding. San Zhi Cuo means a pinch as wide as three fingers." Commentary: Tao Hongjing's Preface states: "One Cuo equals four Dao Gui. Dao Gui is one-tenth of a Fang Cun Bi, sized like a paulownia seed. This 'three-finger pinch' is slightly more than one Fang Cun Bi." Zhang Zhicong said: "Combine using three fingers, pinching together to approximate the quantity for decoction." Examining the classic text, this refers to powder medicine; Zhang's annotation is erroneous. *Sheng Ji Zong Lu* states: "Crush the three ingredients into powder, take two Qian Bi per dose, mix with boiling water, take after meals." *San Yin Fang* also states: "Powder, take two Qian per dose, mix with wine, take before meals."
After Eating (Wei hou fan): Ma Yun said: "Medicine taken after meals." Error.
What is meant by 'Deep and Subtle' (Suo wei shen zhi xi zhe): Gao Shixi moved the following twenty-four characters under the previous "Neck Carbuncle" section, and moved the sixty-nine characters under "Shang Jing Zhe" under the previous "Zai Yin Yang Qi Heng" section, annotating them. This is forced and should not be adopted.