吴云。着。明也。圣人之教。谓之至教。
明堂 礼记明堂位。明堂也者。明诸侯之尊卑也。前汉郊祀志。武帝元封元年。济南人公玉带上
黄帝时明堂图。明堂制。详见大戴礼。白虎通。独断。
诵而颇能解 太平御览。颇。作不。
足以治群僚 张云。群僚之情易通。侯王之意难测。所以有不同也。马云。外纪载纪官。举相则王
侯。此时已有之。简按书皋陶谟。百僚师师。百工惟时。孔传。僚工。皆官也。
不足至侯王 足下。太平御览。有以字。
受树天之度 志云。所谓立端于始。表正于中。盖立端表。以测天之四时阴阳。星辰日月之度。
以着于经书。乃传于后世。高云。上古树八尺之臬。参日影之斜正长短。以定四时。故愿得受树天之度。以定
四时之阴阳。即以四时阴阳。合之星辰日月。分别明辨。以彰玑衡之经术。
四时阴阳合之 吴。改作合之四时阴阳。
疑于二皇 马吴张高。并据全本。疑。作拟。马云。二
皇者。伏羲神农也。吴云。神农常以医药为教。今又上通神农。着至言以为教。是神农既皇。又一皇也。高云。
不但上通神农。且拟于二皇。二皇。伏羲神农也。此伏羲神农黄帝之书。谓之三坟。一脉相传。言大道也。
疑殆 扁鹊传。拙者疑殆。论语。阙疑阙殆。
夫三阳天为业 马云。三阳。手太阳小肠经。足太阳膀胱经。业。事也。上下。手足也。三阳在人。
为表之表。其尊为父。事与天同。张云。此三阳者。统手足六阳为言。简按张以下文三阳独至。又云三阳者至
阳也之三阳。为太阳。此注非。
合而病至 马云。手足太阳经。不循常脉。合而为病。则阳气太盛。诸部阴阳各经。皆被偏害。吴
云。若上下之气。失其常道。不以应天为业。则必内患外邪。合而病至。而偏害于阴阳也。
三阳莫当 吴云。言其义无当于心也。诸家仍王义。
三阳独至 张云。此三阳独至者。虽兼手足太阳。而尤以足太阳为之主。故曰独至。
内无正 马云。正。亦期也。吴云。内无痛苦可正。正。预期也。张云。内无名目可正。高云。并于
外则外无期。譬于堕溺不可为期。并于内则内无正。神转不回。回则不转。乃失其正。
不中经纪 吴云。病不中经常纲纪。张同。简按诸家并仍王义。恐非。
诊无上下以书别 吴。七字句。诊云。诊无上下之殊。及可以书记先别者。张同。马云。书。即前阴
阳传也。志云。故不能以脉经上下编之书别。简按王注为稳当。
臣治疏愈说意而已 高云。说。作悦。治。理也。疏。
远也。谓理治其言。疏远愈甚。不过悦其大意而已。简按疏。王注为稀。诸家仍王意。今从之。
三阳者至阳也 张云。太阳。至盛之阳。故曰至阳。
积并则为惊 吴云。积并。数并也。惊。今之痫也。马云。二经积并。即手太阳之里为心。足太阳
之里为肾。心失神。肾失志。则皆为惊骇。
熊音劈历。吴云。霹雳同。病至如 之迅。简按张衡西京赋。 激而增响。是也。
滂溢 熊音。泛也。上普郎反。下逸。说文。滂。沛也。
干嗌喉塞 熊音。嗌。音益。咽也。吴云。阳气滂溢于诸经。干涸其嗌。而喉中壅塞。马云。其嗌
干。其喉塞。正以心肾之脉。皆上通于嗌喉也。
直心 吴。改作为病二字。马云。凡三阳并合。则必直当其心。张云。谓邪气直冲心膈也。高云。
三阳积并为病。谓之三阳直心。亢害已极。故坐不得起卧。志云。直。当也。
便身全 吴云。卧则经气约束。故身安全。马云。便是身患三阳之病之人也。简按马张志高。以坐
不得起卧者。为一句。注意率同。皆以全为辞。王为安全之义。恐非。然而不若甲乙作身重为胜矣。
且以知天下 张云。且。犹将也。谓欲知天下之要道。尤当别阴阳应四时。
阳言不别阴言不理 高云。阳。犹明也。阴。犹隐也。明言之。不能如黑白之别。隐言之。不能如
经纶之理。其中更有精微。
世主学尽矣 张云。邪并于阳则阳病。并于阴则阴病。阴阳俱病。故伤五脏。脏伤于内。则筋骨消
于外也。医道司人之命。为天下之所赖。故曰世主。不明不别。于道何有。
是使圣人之学泯矣。志云。传世之主。学尽矣。
肾且绝 吴云。此上。必有诸经衰绝之候。盖阙之。今惟存肾绝一条尔。简按此注是。高云。史臣记
雷公殚心帝教。而深思弗释也。公闻帝教。既竭心思。求之不得。中心如焚。一似肾且绝。可谓强解矣。
惋惋日暮 吴云。惋。音婉。肾者水脏。水畏土。日暮则阳明胃土主事。故惋惋不安。张云。真阴且
绝。故惋惋不已。忧疑终日。志云。惋惋。惊叹貌。
从容不出 吴云。肾主骨。骨气衰弱。故虽从容闲暇。不欲出户。
人事不殷 吴云。肾主喜静。故虽人事之来。不欲以身殷受也。志云。殷。盛也。高云。一切人事不
殷。殷。犹勤也。简按汉书平当传师古注。人事者。人情也。庄子。其不殷。注。殷。中也。此云人事不殷。
盖谓心志迷妄。与人情不相主当也。
吴云：“着”，意为明晓。圣人的教诲，称为“至教”。
明堂：出自《礼记·明堂位》。所谓明堂，是用来彰显诸侯尊卑的场所。前汉《郊祀志》记载，汉武帝元封元年，济南人公玉带上呈黄帝时期的明堂图。明堂的建制，详见于《大戴礼》、《白虎通》和《独断》。
诵而颇能解：据《太平御览》，“颇”字作“不”字。
足以治群僚：张云：群臣的情理容易沟通，侯王的心意难以揣测，所以有所不同。马云：《外纪》记载纪官之事，举荐宰相则涉及王侯，此时已有此制。简按：查考《尚书·皋陶谟》，“百僚师师，百工惟时”。孔安国传注：“僚”、“工”皆指官员。
不足至侯王：足下，《太平御览》中有“以”字。
受树天之度：《素问集注》云：所谓在起始处确立端点，在中部标示规范。大概是确立端点和标尺，用来测量天体四季阴阳、星辰日月的度数，将其著录于经书，从而流传后世。高云：上古时期树立八尺高的表（测影之竿），参验日影的斜正长短，以此确定四季。所以希望得到传授树立天度的方法，以定四季之阴阳，进而将四季阴阳与星辰日月相合，分别明辨，以彰显玑衡（古代观测天象的仪器）的经术。
疑于二皇：马、吴、张、高诸家均依据全本，将“疑”作“拟”。马云：二皇指的是伏羲和神农。吴云：神农常以医药作为教化，如今又上通神农，将深奥的言语作为教化，既然神农已是皇，又是一位皇。高云：不仅上通神农，而且比拟于二皇。二皇即伏羲和神农。这是伏羲、神农、黄帝三人的著作，称为《三坟》，一脉相传，阐述大道。
疑殆：《扁鹊传》有“拙者疑殆”。《论语》有“阙疑阙殆”。
夫三阳天为业：马云：三阳，指手太阳小肠经和足太阳膀胱经。“业”即事也。上下，指手足。三阳在人身上，是表中之表，其尊贵如同父亲，其事与天相同。张云：这里的三阳，统括手足六阳而言。简按：张氏以下文“三阳独至”及“三阳者至阳也”中的三阳理解为太阳，此注非是。
合而病至：马云：手足太阳经，若不循常脉，合并而为病，则阳气太盛，各部阴阳各经都受到偏害。吴云：如果上下之气，失去常道，不以顺应天道为业，则必然内患外邪，合并致病，从而偏害于阴阳。
三阳独至：张云：这所谓的三阳独至，虽然兼涉手足太阳，但尤其以足太阳为主，所以说独至。
内无正：马云：正，也是期许之意。吴云：内部没有痛苦可以预期，正即预期。张云：内部没有名目可以预期。高云：若并归于外，则外无期许，譬如堕入溺坑不可为期；若并归于内，则内无正定。神机运转而不回逆，回逆则不转，便失去了正定。
不中经纪：吴云：病不合乎经常纲纪。张同此说。简按：诸家仍依王冰注义，恐怕不对。
诊无上下以书别：吴氏断为七字句。诊云：诊断没有上下之分，以及可以用书记预先辨别者。张同此说。马云：书，即前文的阴阳传。志云：故不能以脉经上下编之书来辨别。简按：王冰注较为稳妥。
臣治疏愈说意而已：高云：说，通悦。治，治理。疏，遥远。谓治理其言辞，疏远愈甚，不过愉悦其大意罢了。简按：疏，王冰注为稀。诸家仍依王意，今从之。
积并则为惊：吴云：积并，多次兼并。惊，即现在的痫证。马云：二经积并，即手太阳之里为心，足太阳之里为肾。心神失守，肾志失守，则都会产生惊骇。
熊音劈历。吴云：霹雳同。病至如 之迅。简按：张衡《西京赋》：“ 激而增响”，即是此意。
滂溢：熊音。泛也。上读普郎反，下读逸。《说文》：滂，沛也。
干嗌喉塞：熊音。嗌，音益，咽也。吴云：阳气滂溢于诸经，干燥其嗌，导致喉中壅塞。马云：其嗌干，其喉塞，正因为心肾之脉，都上通于嗌喉。
直心：吴氏改作“为病”二字。马云：凡三阳合并，则必直冲当心。张云：谓邪气直冲心膈。高云：三阳积并为病，称为三阳直心，亢害已极，所以坐不得起卧。志云：直，当也。
便身全：吴云：卧则经气约束，故身体安全。马云：便是身患三阳之病的人。简按：马、张、高三家，以“坐不得起卧者”为一句，注意率同，皆以“全”为辞。王冰注为安全之义，恐怕不对。然而不如《甲乙经》作“身重”为好。
且以知天下：张云：且，犹将也。谓想要知晓天下的要道，尤其应当辨别阴阳应合四时。
阳言不别阴言不理：高云：阳，犹明也。阴，犹隐也。明言之，不能像黑白那样分明；隐言之，不能像经纶那样有条理。其中更有精微之处。
世主学尽矣：张云：邪并于阳则阳病，并于阴则阴病，阴阳俱病，所以损伤五脏。脏伤于内，则筋骨消损于外。医道掌管人的性命，被天下所依赖，所以称世主。如果不明不别，对于道还有什么呢？
是使圣人之学泯矣。志云：传世之主，学尽矣。
肾且绝：吴云：以上必有诸经衰绝之候，大概缺漏了，现在只存肾绝一条罢了。简按：此注是对的。高云：史臣记载雷公殚心于帝教，深思而不能释怀。公听闻帝教，既竭心思，求之不得，中心如火焚，一似肾且绝，可谓牵强附会。
惋惋日暮：吴云：惋，音婉。肾是水脏，水畏土，日暮时阳明胃土主事，所以惋惋不安。张云：真阴且绝，所以惋惋不已，忧疑终日。志云：惋惋，惊叹貌。
从容不出：吴云：肾主骨，骨气衰弱，所以即使从容闲暇，也不欲出户。
人事不殷：吴云：肾主喜静，所以即使有人事往来，也不欲以身殷勤承受。志云：殷，盛也。高云：一切人事不殷，殷，犹勤也。简按：《汉书·平当传》师古注：人事者，人情也。《庄子》其不殷，注：殷，中也。此处云人事不殷，盖谓心志迷妄，与人情不相主当也。
Wu states: "Zhuo" (着) means to understand clearly. The teachings of the Sages are called "Zhi Jiao" (Supreme Teaching).
Ming Tang (Hall of Light): Cited from *Li Ji* (Book of Rites), Chapter "Ming Tang Wei". The so-called Ming Tang is a place used to manifest the hierarchy among feudal lords. The *Jiao Si Zhi* (Records of Sacrifices) of the Former Han Dynasty records that in the first year of Yuankang during Emperor Wu's reign, Gong Yudan from Jinan presented a diagram of the Ming Tang from the time of the Yellow Emperor. The structure of the Ming Tang is detailed in *Da Dai Li Ji*, *Bai Hu Tong*, and *Du Duan*.
"Songs er po neng jie" (Recites and somewhat understands): According to *Taiping Yulan*, the character "po" (颇) is written as "bu" (不, not).
"Zu yi zhi qun liao" (Sufficient to govern the officials): Zhang states: The sentiments of the multitude of officials are easy to communicate, whereas the intentions of kings and nobles are difficult to fathom, hence the difference. Ma states: *Wai Ji* records the appointment of officials; selecting a chancellor involves kings and nobles, indicating this system existed at that time. Jian'an notes: Examining *Shang Shu* (Book of Documents), chapter "Gao Yao Mo": "The hundred officials were diligent, the hundred artisans were timely." Kong Anguo's commentary explains that "liao" and "gong" both refer to officials.
"Bu zu zhi hou wang" (Insufficient to reach kings and nobles): In *Taiping Yulan*, under "zu xia", there is the character "yi" (以).
"Shou shu tian zhi du" (Receive the establishment of the celestial degrees): *Su Wen Ji Zhu* states: This refers to establishing the starting point and marking the standard in the middle. It is generally about setting up markers to measure the degrees of the four seasons' yin and yang, stars, sun, and moon, recording them in scriptures to transmit to future generations. Gao states: In ancient times, an eight-chi gnomon was erected to observe the slant, straightness, length, and shortness of sun shadows to determine the four seasons. Thus, one wishes to receive the method of establishing celestial degrees to fix the yin and yang of the four seasons, combining them with stars, sun, and moon, distinguishing them clearly to elucidate the art of the armillary sphere.
"Si shi yin yang he zhi" (Combining the yin and yang of the four seasons): Wu changes it to "he zhi si shi yin yang".
"Yi yu er huang" (Resembling/Comparing to the Two Emperors): Ma, Wu, Zhang, and Gao all follow the complete text, reading "yi" (疑, doubt) as "ni" (拟, compare/resemble). Ma states: The Two Emperors refer to Fu Xi and Shen Nong. Wu states: Shen Nong often taught through medicine. Now, connecting upwards to Shen Nong, using profound words as teaching, since Shen Nong is already an Emperor, he is another Emperor. Gao states: Not only connecting upwards to Shen Nong, but also resembling the Two Emperors. The Two Emperors are Fu Xi and Shen Nong. These are the works of Fu Xi, Shen Nong, and the Yellow Emperor, called the *San Fen* (Three Burials), passed down in one line, expounding the Great Dao.
"Yi dai" (Doubt and danger): *Bi Que Zhuan* mentions "A clumsy practitioner doubts and fears." *Analects* mentions "Leave aside doubts and dangers."
"Fu san yang tian wei ye" (The Three Yangs take Heaven as their function): Ma states: San Yang refers to the Hand Taiyang Small Intestine Meridian and Foot Taiyang Bladder Meridian. "Ye" means affair or function. Upper and lower refer to hands and feet. In humans, the Three Yangs are the exterior of the exterior, their dignity is like that of a father, and their function is similar to Heaven. Zhang states: Here, San Yang refers collectively to the six Yang meridians of the hands and feet. Jian'an notes: Zhang interprets the San Yang below as Taiyang based on "San Yang Du Zhi" and "San Yang Zhe Zhi Yang Ye," which is incorrect for this annotation.
"He er bing zhi" (Combine and disease arrives): Ma states: If the Hand and Foot Taiyang meridians do not follow the normal pulse, and combine to cause disease, then Yang Qi becomes excessive, and all other Yin-Yang meridians suffer partial harm. Wu states: If the Qi of upper and lower loses its normal path and does not function by conforming to Heaven, internal evils and external pathogens will inevitably combine to cause disease, thereby harming Yin and Yang disproportionately.
"San yang mo dang" (The Three Yangs cannot be opposed/matched): Wu states: Meaning its principles do not align with the mind. Other schools still follow Wang Bing's interpretation.
"San yang du zhi" (The Three Yangs arrive alone): Zhang states: The so-called arrival of the Three Yangs alone, although involving both Hand and Foot Taiyang, is primarily dominated by the Foot Taiyang, hence called "arriving alone."
"Nei wu zheng" (Internally without rectitude/standard): Ma states: "Zheng" also means expectation. Wu states: Internally there is no pain to expect; "Zheng" means expectation. Zhang states: Internally there is no nameable condition to expect. Gao states: If combined externally, there is no external standard, like falling into a pit where no standard can be set; if combined internally, there is no internal rectitude. The Spirit turns without reversing; reversing means it does not turn, thus losing its rectitude.
"Bu zhong jing ji" (Not conforming to the classics and discipline): Wu states: The disease does not conform to constant principles and discipline. Zhang agrees. Jian'an notes: All schools follow Wang Bing's interpretation, which is likely incorrect.
"Zhen wu shang xia yi shu bie" (Diagnosis has no upper/lower distinction, distinguished by writing): Wu punctuates as a seven-character sentence. Zhen states: Diagnosis has no distinction between upper and lower, and those that can be distinguished beforehand by written records. Zhang agrees. Ma states: "Shu" refers to the Yin-Yang transmissions mentioned earlier. Zhi states: Therefore, one cannot distinguish them by compiling the pulse classics into books. Jian'an notes: Wang Bing's annotation is more stable.
"Chen zhi shu yu shuo yi er yi" (My governance is distant, merely explaining the gist): Gao states: "Shuo" is a variant of "Yue" (joy/delight). "Zhi" means to govern/manage. "Shu" means distant. It means managing the words, becoming more distant, merely delighting in the general meaning. Jian'an notes: "Shu" in Wang Bing's note means sparse/rare. Other schools follow Wang's intent, and I adopt this view.
"San yang zhe zhi yang ye" (The Three Yangs are the Ultimate Yang): Zhang states: Taiyang is the most abundant Yang, hence called "Ultimate Yang."
"Ji bing ze wei jing" (Accumulation and combination lead to fright): Wu states: "Ji bing" means frequent accumulation. "Jing" refers to epilepsy (Xian Zheng) in modern terms. Ma states: The accumulation of the two meridians implies the interior of the Hand Taiyang is the Heart, and the interior of the Foot Taiyang is the Kidney. If the Heart loses its Spirit and the Kidney loses its Will, both result in fright and terror.
"Pili" (Thunderclap): Xiong's pronunciation. Wu states: Same as Pili (thunderbolt). The disease arrives swiftly like . Jian'an notes: Zhang Heng's *Xi Jing Fu*: " stimulates and increases the sound," which is correct.
"Pang yi" (Overflowing): Xiong's pronunciation. Means spreading. First character read as Pu Lang fan, second as Yi. *Shuo Wen*: Pang means abundant.
"Gan yi hou sai" (Dry throat and blocked pharynx): Xiong's pronunciation. "Yi" sounds like Yi, meaning pharynx/throat. Wu states: Yang Qi overflows into the various meridians, drying the pharynx and causing blockage in the throat. Ma states: The dryness of the pharynx and blockage of the throat occur precisely because the meridians of the Heart and Kidney both ascend to connect with the pharynx and throat.
"Zhi xin" (Directly striking the Heart): Wu changes it to "wei bing" (as a disease). Ma states: Whenever the Three Yangs combine, they must directly strike the heart. Zhang states: Refers to evil qi rushing directly to the heart diaphragm. Gao states: Disease caused by the accumulation and combination of the Three Yangs is called "San Yang Zhi Xin." The hyperactivity and harm are extreme, so one cannot rise from sitting or lie down. Zhi states: "Zhi" means "dang" (to face/strike).
"Bian shen quan" (Facilitating bodily integrity/safety): Wu states: Lying down constrains the meridian Qi, thus ensuring bodily safety. Ma states: It refers to a person suffering from San Yang disease. Jian'an notes: Ma, Zhang, and Gao treat "those who cannot rise from sitting or lie down" as one sentence, with similar attention, interpreting "quan" as a suffix or state. Wang Bing interprets "quan" as safety, which is likely incorrect. However, it is better than the *Jia Yi Jing* reading it as "shen zhong" (heavy body).
"Qie yi zhi tian xia" (And thereby know the world): Zhang states: "Qie" means "jiang" (will/shall). It means desiring to know the essential Dao of the world, one must particularly distinguish Yin and Yang corresponding to the four seasons.
"Yang yan bu bie yin yan bu li" (Speaking of Yang, distinctions are unclear; speaking of Yin, reasoning is disordered): Gao states: "Yang" means bright/clear. "Yin" means hidden/obscure. Speaking clearly, it cannot be as distinct as black and white; speaking obscurely, it cannot be as orderly as woven silk. There are subtleties within.
"Shi zhu xue jin yi" (The learning of the worldly ruler is exhausted): Zhang states: Evil combining with Yang causes Yang disease, combining with Yin causes Yin disease, combining in both causes damage to the Five Zang organs. Damage to the Zang internally leads to wasting of sinews and bones externally. Medical Dao manages human life and is relied upon by the world, hence called "Worldly Ruler." If one is unclear and undistinguished, what is there of the Dao?
"Shi sheng ren zhi xue min yi" (Thus causing the Sage's learning to vanish). Zhi states: The rulers of transmitted generations have exhausted their learning.
"Shen qie jue" (Kidney is nearly exhausted): Wu states: Above, there must have been signs of exhaustion in various meridians, likely lost, now only the Kidney exhaustion section remains. Jian'an notes: This annotation is correct. Gao states: The historian recorded that Lei Gong devoted his heart to the Emperor's teaching, thinking deeply without resolution. Hearing the Emperor's teaching, having exhausted his mind, failing to find it, his heart burned like fire, resembling Kidney exhaustion. This is considered forced interpretation.
"Wan wan ri mu" (Anxious/Sighing at dusk): Wu states: "Wan" sounds like Wan. Kidney is a Water organ; Water fears Earth. At dusk, the Yangming Stomach Earth takes charge, hence anxious and uneasy. Zhang states: True Yin is nearly exhausted, hence sighing endlessly, worrying and doubting all day. Zhi states: "Wan wan" describes a look of amazement or sighing.
"Cong rong bu chu" (Leisurely but not going out): Wu states: Kidney governs bones; bone Qi is weak, so even in leisure, one does not wish to go out the door.
"Ren shi bu yin" (Human affairs are not busy/prosperous): Wu states: Kidney prefers quiet, so even when human affairs come, one does not wish to engage busily. Zhi states: "Yin" means abundant/prosperous. Gao states: All human affairs are not busy; "Yin" means diligent. Jian'an notes: *Han Shu* Ping Dang Zhuan, Shigu's commentary: Human affairs refer to human feelings. *Zhuangzi* "Qi bu yin," commentary: "Yin" means central/balanced. Here, "Ren shi bu yin" implies mental confusion and lack of alignment with human circumstances.