吴云。此篇言阴阳。与常论不同。自是一家议论。故曰别论。简按有五脏别论。经脉别论。吴义为长。
马云。据篇中有别于阳者。知病处也等语。则别当彼劣切。非也。
四经十二从 马云。四经者。肝心肺肾为四经。而不言脾者。寄旺于四经之中也。十二从者。手有
三阴三阳。足有三阴三阳。而十二经脉之行。相顺而不悖也。吴云。十二从。十二支也。十二支不复主事。但
从顺于四经。故曰十二从也。张云。从者。即手之三阴。从脏走手等义。简按四经虽无明据。当从王注。如十
二从。则从王吴之义。为十二辰十二支。则至人有二字而穷矣。若根据马张之说。而为三阴三阳。则至下文云应
十二脉而穷矣。宜置于阙如之例。
凡阳有五五五二十五阳 高云。凡阳有五。肝心脾肺肾。皆有和平之阳脉也。五五二十五阳者。肝
脉应春。心脉应夏。脾脉应长夏。肺脉应秋。肾脉应冬。春时。而肝心脾肺肾之脉。皆有微弦之胃脉。夏时。
而肝心脾肺肾之脉。皆有微钩之胃脉。长夏。而肝心脾肺肾之脉。皆有微缓之胃脉。秋时。而肝心脾肺肾之脉。
皆有微毛之胃脉。冬时。而肝心脾肺肾之脉。皆有微石之胃脉。是五五二十五阳。
所谓阳者胃脘之阳也 志云。所谓二十五阳者。乃胃脘所生之阳气也。胃脘者。中焦之分。主化水
谷之精气。以资养五脏者也。四时五脏之脉。皆得微和之胃气。故为二十五
阳也。简按王注。为人迎之气。误。
别于阳者知病处也 吴云。言能别于阳和之脉。则一部不和。便知其部有病。是能知乎病处也。
别于阴者知死生之期 吴云。别真脏之阴脉者。则知其死于克贼。持于相生。如肝病真阴脉见。死于
庚辛。心病真阴脉见。死于壬癸。下文。肝至悬绝急。十八日死之类。皆是也。
三阳在头三阴在手 张云。三阳在头。指人迎也。三阴在手。指气口也。太阴阳明论曰。阳明者。表
也。为之行气于三阳。盖三阳之气。以阳明胃气为本。而阳明动脉曰人迎。在结喉两旁一寸五分。故曰三阳在
头。又曰。足太阴者。三阴也。为之行气于三阴。盖三阴之气。以太阴脾气为本。然脾脉本非气口。何云在手。
如五脏别论曰。五味入口。藏于胃。以养五脏气。而变见于气口。气口亦太阴也。故曰三阴在手。上文以真脏
胃气言阴阳。此节以人迎气口言阴阳。简按此本于王注。更为详备。而汪心谷则以手足三阴三阳经解之。以毁
王注。其理益晦。（汪说。出古今医统内经要旨。）滑云。三阳当作二阳。谓结喉两旁人迎脉。以候足阳明胃
气。三阴谓气口。以候手太阴肺气也。胃为五脏之本。肺为百脉之宗也。此说亦有所见。故附于此。（马志高
并本于汪氏。以经脉流注解之。吴则为三部九候之义。并不明晰。）
别于阳者知病忌时别于阴者知死生之期 滑云。二句申前说。或直为衍文亦可。
所谓阴阳者 吴云。所谓。世所谓也。意若曰此众谋之阴阳。非吾之所谓阴阳也。简按上文既云所
谓阴者真脏也。所谓阳者胃脘之阳也。而此亦云所谓阴阳者。故吴有此解。然考其语势。似不必然矣。
真脉之脏脉 滑作真脏之脉。要旨。汪氏云。真脉之脏脉者。谓真脏脉之至数。以分五脏之属也。
肝至悬绝急 滑云。愚谓悬绝。如悬丝之微而欲绝也。王注。如悬物之绝去。似指代脉言也。要旨。
汪氏云。至。脉之应也。悬绝。止绝也。急。劲也。张云。悬绝急者。全失和平。而弦搏异常也。志云。悬绝
者。真脏孤悬而绝。无意气之阳和也。急者肝死脉。来急益劲。如张弓弦也。简按张志之解似是。
脾至悬绝四日死 高云。土位中央。灌溉四旁。上火下水。左木右金。土气不能四应。故四日死。简
按王注不及脾独死于生数之义。故取高说而补之。马论天干之五行相克。其间多有不合。宜遵王意。
二阳之病发心脾 张云。二阳。阳明也。为胃与大肠二经。然大肠小肠。皆属于胃。故此节所言。则
独重在胃耳。盖胃与心。母子也。人之情欲。本以伤心。母伤则害及其子。胃与脾。表里也。人之劳倦。本以
伤脾。脏伤则病连于腑。故凡内而伤精。外而伤形。皆能病及于胃。此二阳之病。所以发于心脾也。简按王履
云。肠胃有病。心脾受之。发心脾。犹言延及于心脾也。滑云。青田老人谓。心脾当作肺脾。下文风消脾病。
息贲者肺病。深为有理。今详经文。张注为是。
不得隐曲女子不月 张云。不得隐曲。阳道病也。夫胃为水谷气血之海。主化营卫而润宗筋。如厥论
曰。前阴者。宗筋之所聚。太阴阳明之所合也。痿论曰。阴阳总宗筋之会。会于气冲。而阳明为之长。然则精
血下行。生化之本。惟阳明为最。今化原既病。则阳道外衰。故不得隐曲。其在女子。当为不月。亦其候也。
王氏注曰。夫肠胃发病。心脾受之。心受之则血不流。脾受之则味不化。然心脾何以受肠胃之病。
未免牵强。不可不察。隐曲二字。本经见者凡五。皆指阳道为言。以类察之。可得其义。吴云。俯首谓之隐。
鞠躬谓之曲。简按吴说未见明据。今从张注。要旨云。汪氏质疑注。肢体为之劲急。而不能伸曲也。吴盖本此。
风消 诸家皆仍王注。为枯瘦之义。独汪心谷为上消渴。风消二字。他无所考。未知孰是。今两存之。
（圣济总录。载治方。出第十三卷。）
息贲 马云。贲。奔同。喘息上奔痰嗽无宁。此非肺积之息贲。乃喘息而贲。张云。胃病则肺失所养。
故气息奔急。气竭于上。由精亏于下。败及五脏。故死不治。
张云。足肚酸疼。曰 。简按列子。心 体烦。 。烦郁也。与此义殊。
索泽 楼英云。索泽。即仲景所谓皮肤甲错也。简按诸注。皆从王义。吴独作索睾。注云。睾。音高。
索。引也。睾。肾丸也。控睾二字。内经中凡四见。或云腰脊控睾。未有单言控睾。而为病名者。则吴说不为得矣。
颓疝 马云。与 同。简按 。 同。本作 。诗周南。我马虺 。尔雅。作虺颓。释名云。阴肿曰
。气下 也。又曰。疝言诜也。诜诜然引小腹急痛也。乃经脉篇 疝。脉解篇疝。五色篇 阴。并同。一切
经音义云。丸颓。又作HT 。阴病也。原病式云。 疝。小腹控卵。肿急绞痛也。朱震亨云。 疝。其形阴囊肿
缒。如升如斗。不痒不痛。是也。吴云。颓。顽也。颓疝。肾丸大而不疼。顽然不害者也。颓。坠也。今训顽。
未见所据。
心掣 吴云。心引而动也。张云。心动不宁。若有所引。名曰心掣。志云。心虚而掣痛。简按圣济
总录云。心火胥应而不宁。其动若掣者。乃其证也。冯兆张锦囊秘录云。古无
怔忡之名。名曰心掣者。是也。下文曰。其传为膈。志说似是。
隔 张云。以木乘土。脾胃受伤。乃为隔证。如邪气脏腑病形篇曰。脾脉微急为膈中。风论曰。胃风
之状。食饮不下。鬲塞不通。上膈篇曰。食饮入而还出者。皆隔之谓。简按王注欠详。
惊骇 张云。肝胃二经。皆生惊骇。如金匮真言论曰。东方通于肝。其病发惊骇。经脉篇曰。足阳明
病。闻木声则惕然而惊。
背痛 马云。二经之脉。胃自头以行于足。肝自足走腹。皆无与于背者。而此曰背痛。意者阴病必行
于阳也。张云。背痛者。手足阳明之筋。皆夹脊也。汪昂云。按四经皆与背无涉。而云背痛。未详。
噫 马云。气转也。又饱出息也。脉解篇所谓。上走心为噫者。阴盛而上走于阳明。阳明络属心。故
上走心为噫也。口问篇。寒气客于胃。厥逆从下上散。复出于胃。故曰噫。观此则胃心之病。宜发为噫。张云。
噫。嗳气也。（详见宣明五气篇。）
欠 马云。气相引也。经脉篇。胃脉为病。有数欠。宣明五气。九针论。皆曰肾为欠。今曰善欠者。
胃之病也。张云。欠。呵欠也。简按说文。欠。张口气悟也。象气从儿。上出之形。
风厥 张云。风厥之义不一。如本篇者。言二阳一阴发病。名曰风厥。言胃与肝也。其在评热病论者。
言太阳少阴病也。在五变篇者。曰。人之善病风厥漉汗者。肉不坚腠理疏也。简按又见史仓公传。
心满 简按满。懑同。
善气 志云。善气者。太息也。心系急则气道约。故太息以伸出之。简按礼记。勿气。郑注。谓不鼻
息也。乃志聪之义为得矣。马吴张高并不注。
三阳三阴发病 志云。太阳太阴之为病也。太阳为诸阳主气而主筋。阳气虚则为偏枯。阳虚而不能养
筋。则为痿。脾属四肢。故不举也。
痿易 张云。痿弱不支。左右相掉易也。马云。左右变易为痿也。简按俱非也。易。是狂易之易。不
如平常也。王注是。
鼓一阳曰钩 志云。钩。当作弦。此论四经之脉。以应四时也。鼓。动也。一阳之气初升。故其脉如
弦之端直。以应春生之气也。高同。
鼓阳胜急曰弦 志云。弦。当作钩。阳气正盛。故其脉来盛去悠。如钩之急。以应夏热之气也。高同。
鼓阳至而绝曰石 志云。至者为阳。阳气伏藏。故脉虽鼓至而断绝。以应冬藏之气也。滑云。当作鼓。
阴至而绝。此四者。盖亦真脏脉也。简按鼓阳。作鼓阴。近是。然以四者为真脏脉。恐非。
阴阳相过曰溜 志云。溜。滑也。阴阳相遇。其脉则滑。长夏之时。阳气微下。阴气微上。阴阳相遇。
故脉滑也。此言人有四经。以应四时之气也。张云。阴阳相过。谓流通平顺也。脉名曰溜。其气来柔缓而和。
应脾脉也。简按志以溜为滑。本于吴注。马云。溜。作流。灵本输篇。溜于鱼际。其义主流。盖溜流古通。不
必改字。滑云。如水之溜而不收。即下文关格之类。非。又按鼓一阳以下二十九字。与上下文。不相顺接。是
它篇错简在此尔。
起则熏肺使人喘鸣 张云。此兼表里。以言阴阳之害也。
表里不和。则或为脏病。阴争于内也。或为经病。阳扰于外也。魄汗未藏者。表不固也。四逆而起者。阳内竭
也。其至正不胜邪。则上熏及肺。今人气喘声鸣。此以营卫下竭。孤阳上浮。其不能免矣。
阴之所生和本曰和 吴本。上和字下句。注意与王同。张云。阴者。五脏之真阴也。阴之所以生者。
以脏气和。脏气之和。以阴阳之和也。不和则为争为扰。为刚为淖。而病由兴矣。志云。阴之所生之阳脉。与
所本之阴脉。相和而始。名曰和。高云。独阳不生。独阴不长。阴之所生。和本曰和。言阴之所以能生万物者。
以阴和而复。本于阳和也。简按此二句。旨义尤幽深。不能辄领会。故举数说尔。
淖则刚柔不和 吴云。此言偏阴之害。淖。谓阴气太过。而潦淖也。张云。淖。谓寒湿妄行。阴气胜
也。简按行针篇。血气淖泽滑利。春秋繁露。夫物愈淖。而愈易变动摇荡也。淮南原道训。甚淖而 。注。 。
亦淖也。 粥多沉者。曰 。淖。广韵。奴教切。说文。泥也。一切经音义引字林。濡甚曰淖。吴张为阴气有
余之义。为是。志高并云。淖。和也。误。本经释音。淖。音淘。水朝宗于海。此以淖为HT 。HT 即俗作潮。亦误。
不过四日而死 简按马张根据新校正之说。死。作已。是。志高仍原文云。以阳脏相生而传。故不过四
日之偶数而死。以阴脏相克而传。故不过三日之奇数而死也。以三四奇偶之数。固然死者。犹云生阳。其义不通。
辟阴 简按王注辟并。乃辟读为僻。僻。偏也。而上辟水升之解未允。张云。辟。放辟也。土本制水。
而水反侮脾。水无所畏。是谓辟阴。此说似是。马云。乘所不胜。阴以侮阴。谓之辟阴。吴云。辟。邪辟也。
肾为水。脾为土。土胜水为正。今肾水反侮于脾。不得其正。故曰辟阴。此解亦未允。
结阳者肿四肢 马云。结者。气血不疏畅也。吴云。阳。手足六阳也。其脉行于四肢之表。若有结邪。
则四肢脉气壅滞。故肿。圣济总录云。夫热胜则肿。而四肢为诸阳之本。阳结于外。不得行于阴。则邪热菀于
四肢。故其证为肿。况邪在六腑。则阳脉不和。阳脉不和。则气留之。以其气留。故为肿也。（犀角汤。犀角。
玄参。连翘。柴胡。升麻。木通。沉香。射干。甘草。芒硝。麦门冬。上水煎。）
结阴者便血一升 马云。营气属阴。营气化血。以奉生身。惟阴经既结。则血必瘀蓄。而初结则一升。
再结则二升。三结则三升。结以渐而加。则血以渐而多矣。圣济总录云。夫邪在五脏。则阴脉不和。阴脉不和。
则血留之。结阴之病。以阴气内结。不得外行。血无所禀。渗入肠间。故便血也。（地榆汤。地榆。甘草。缩
砂仁。水煎。）
阴阳结斜 马云。斜。邪同。灵动输篇。有少阴之大络。循阴股内廉。邪入 中。则古盖斜邪通用。
志云。结斜者。偏结于阴阳之间也。简按志注非。吴张高并同马义。
石水 马云。阴气多而阳气少。即阴盛阳虚也。则阳不能入之阴。而内之所聚者。为石水。灵邪气脏
腑病形篇云。肾脉微大为石水。起脐以下。至小腹 然。上至胃脘。死不治。张云。石水。沉坚在下。简按
吴云：这篇论述阴阳，与通常的论述不同，是自成一家之言，所以称为“别论”。简按：有《五脏别论》、《经脉别论》，吴氏的解释更为恰当。
马云：根据篇中有“别于阳者，知病处也”等语句，那么“别”字应当读作“彼劣切”（biè），不是这个意思。
四经十二从：马云：所谓“四经”，是指肝、心、肺、肾四条经脉，而不提脾脏，是因为脾脏寄旺于这四条经脉之中。“十二从”，是指手有三阴三阳，足有三阴三阳，十二条经脉的运行，相互顺承而不违背。吴云：“十二从”即十二地支。十二地支不再单独主事，只是顺从于四经，所以叫“十二从”。张云：“从”的意思，就是手之三阴从脏走向手等含义。简按：“四经”虽然没有明确的依据，但应当遵从王冰的注释。至于“十二从”，则遵从王冰和吴崑的说法，认为是十二辰、十二地支，这样加上“至人”二字就解释不通了。如果依据马莳和张景岳的说法，认为是三阴三阳，那么到了下文说“应十二脉而穷尽”时，又无法解释了。适宜将其置于存疑的情况。
凡阳有五，五五二十五阳：高云：所谓“凡阳有五”，是指肝、心、脾、肺、肾，都有和平的阳脉。“五五二十五阳”，是指肝脉对应春季，心脉对应夏季，脾脉对应长夏，肺脉对应秋季，肾脉对应冬季。在春季，肝、心、脾、肺、肾的脉象，都带有微弦的胃气；在夏季，肝、心、脾、肺、肾的脉象，都带有微钩的胃气；在长夏，肝、心、脾、肺、肾的脉象，都带有微缓的胃气；在秋季，肝、心、脾、肺、肾的脉象，都带有微毛的胃气；在冬季，肝、心、脾、肺、肾的脉象，都带有微石的胃气。这就是五五二十五阳。
所谓阳者，胃脘之阳也：志云：所谓“二十五阳”，乃是胃脘所生的阳气。胃脘属于中焦，主要消化水谷的精气，来滋养五脏。四季五脏的脉象，都能得到微和的胃气，所以称为二十五阳。简按：王冰注解说这是人迎之气，是错误的。
别于阳者，知病处也：吴云：意思是如果能辨别出平和的阳脉，那么某一部脉不和，就能知道该部位有病，这就是能知道病变的部位。
别于阴者，知死生之期：吴云：能辨别真脏之阴脉的人，就能知道病人死于相克之时，或维持于相生之时。例如肝病出现真阴脉，死于庚辛日；心病出现真阴脉，死于壬癸日。下文中“肝至悬绝急，十八日死”之类，都是这种情况。
三阳在头，三阴在手：张云：“三阳在头”，指人迎脉。“三阴在手”，指气口脉。《太阴阳明论》说：阳明经是表，为它向三阳输送气机。大概三阳之气，以阳明胃气为本，而阳明动脉叫做人迎，位于结喉两旁一寸五分，所以说“三阳在头”。又说：足太阴是三阴，为它向三阴输送气机。大概三阴之气，以太阴脾气为本。然而脾脉本来不是气口，为什么说“在三阴在手”呢？如《五脏别论》说：五味入口，藏于胃，以滋养五脏之气，而变化显现于气口。气口也是太阴经，所以说“三阴在手”。上文是以真脏脉和胃气来谈论阴阳，这一节是以人迎和气口来谈论阴阳。简按：这原本基于王冰的注释，更加详细完备。而汪昂则以手足三阴三阳经来解释，以此诋毁王冰的注释，其道理更加晦涩。（汪氏的观点出自《古今医统内经要旨》。）滑寿云：“三阳”应当作“二阳”，指结喉两旁的人迎脉，用来候察足阳明胃气。“三阴”指气口，用来候察手太阴肺气。胃是五脏的根本，肺是百脉的宗主。这种说法也有见地，所以附记在这里。（马莳、高世栻都基于汪氏的观点，用经脉流注来解释。吴崑则是三部九候的意义，都不够明晰。）
别于阳者，知病忌时；别于阴者，知死生之期：滑寿云：这两句是申述前面的说法，或者直截说是衍文也可以。
所谓阴阳者：吴云：所谓，是世人所说的意思。意谓这些众人的谋略中的阴阳，不是我所说的阴阳。简按：上文既然说了“所谓阴者，真脏也”，“所谓阳者，胃脘之阳也”，这里又说“所谓阴阳者”，所以吴氏有这样的解释。然而考察其语势，似乎不一定如此。
真脉之脏脉：滑寿本作“真脏之脉”。《要旨》汪氏云：所谓“真脉之脏脉”，是指真脏脉的至数，以此来区分五脏所属。
肝至悬绝急：滑寿云：我认为“悬绝”，像悬丝一样微弱而欲断绝。王冰注解说：像悬挂之物断绝离去，似乎是指代脉而言。《要旨》汪氏云：至，是脉的应合。悬绝，是止绝。急，是劲急。张景岳云：悬绝急，是完全失去了和平，弦搏异常。张志聪云：悬绝，是真脏孤悬而断绝，没有意气之阳和。急，是肝的死脉，来势急迫且强劲，像拉开的弓弦一样。简按：张志聪的解释似乎是正确的。
脾至悬绝，四日死：高世栻云：土位居中，灌溉四方，上火下水，左木右金。土气不能四应，所以四日死。简按：王冰的注释没有涉及到脾脏独自死于生数（四）的含义，所以采用高世栻的说法来补充。马莳论述天干五行相克，其中多有不符合之处，应当遵循王冰的意思。
二阳之病发心脾：张景岳云：二阳，是阳明经。包括胃和大肠两条经脉。但是大肠小肠都属于胃，所以这一节所说的，唯独重在胃。胃与心，是母子关系。人的情欲，本来会伤心，母伤则害及其子。胃与脾，是表里关系。人的劳倦，本来会伤脾，脏伤则病连及腑。所以凡是内而伤精，外而伤形，都能病及于胃。这就是二阳之病，所以发于心脾。简按：王履说：肠胃有病，心脾受之。“发心脾”，犹言延及于心脾。滑寿云：青田老人认为，“心脾”应当作“肺脾”。下文“风消”是脾病，“息贲”是肺病，非常有道理。现在详细考证经文，张景岳的注释是正确的。
不得隐曲，女子不月：张景岳云：“不得隐曲”，是阳道生病。胃是水谷气血的海，主要化生营卫并滋润宗筋。如《厥论》说：前阴，是宗筋汇聚的地方，是太阴和阳明经的结合处。《痿论》说：阴阳总汇于宗筋，汇聚于气冲穴，而由阳明经统领。既然这样，精血下行，生化之本，只有阳明经最重要。现在化源既已生病，那么阳道在外衰弱，所以“不得隐曲”。对于女子来说，应当表现为“不月”（月经不来），也是其征候。王氏注解说：肠胃发病，心脾受之。心受之则血不流动，脾受之则味不消化。然而心脾为什么会受到肠胃的病，未免牵强，不可不仔细考察。“隐曲”二字，在本经中出现五次，都指阳道而言，类比考察，可以得其意义。吴崑云：俯首叫做隐，鞠躬叫做曲。简按：吴氏的说法未见明确依据，现在遵从张景岳的注释。《要旨》云：汪氏质疑注解说，肢体变得僵硬紧急，而不能伸屈。吴崑大概基于此。
风消：各家都沿袭王冰的注释，解释为枯瘦的意思。唯独汪昂认为是上消渴症。“风消”二字，没有其他考证，不知道哪个正确。现在两者并存。（《圣济总录》记载治疗方剂，出自第十三卷。）
息贲：马云：贲，通奔。喘息上奔，痰嗽不停。这不是肺积的息贲，而是喘息而贲。张景岳云：胃病则肺失去滋养，所以气息奔急。气竭于上，是由于精亏于下，败坏波及五脏，所以死不治。
（原文此处有缺漏或错简，关于“足肚酸疼”的部分）：张云：小腿肚酸痛，叫做……简按《列子》：“心烦体烦”，……是烦郁的意思。与此义不同。
索泽：楼英云：“索泽”，就是张仲景所说的“皮肤甲错”。简按：各家注释都遵从王冰的意思。唯独吴崑作“索睾”，注解说：睾，音高。索，引也。睾，睾丸。控睾二字，在《内经》中出现四次。有人说腰脊控睾，没有单言控睾作为病名的。那么吴氏的说法就不对了。
颓疝：马云：与……同。简按：……同。本作……。《诗·周南》：“我马虺頽”。《尔雅》作“虺颓”。《释名》说：阴肿曰……。气下……也。又说：疝言诜也。诜诜然牵引小腹急痛。这与《经脉篇》的……疝，《脉解篇》的疝，《五色篇》的……阴，都相同。《一切经音义》说：丸颓，又作……，阴病也。《原病式》说：……疝，小腹控卵，肿急绞痛。朱震亨云：……疝，其形阴囊肿垂，如升如斗，不痒不痛，就是这个。吴崑云：颓，顽也。颓疝，睾丸大而不疼，顽然不害。颓，坠也。现在训释为顽，未见依据。
心掣：吴崑云：心脏牵引而动。张景岳云：心动不宁，好像有所牵引，叫做心掣。张志聪云：心虚而掣痛。简按《圣济总录》说：心火胥应而不宁，其动若掣者，就是它的证候。冯兆张《锦囊秘录》说：古无怔忡之名，叫做心掣的，就是这个。下文中说：其传为膈。张志聪的说法似乎是正确的。
膈：张景岳云：以木乘土，脾胃受伤，就成为膈证。如《邪气脏腑病形篇》说：脾脉微急为膈中。《风论》说：胃风的状况，饮食不下，膈塞不通。《上膈篇》说：饮食入而还出者，都叫膈。简按：王冰的注释不够详细。
惊骇：张景岳云：肝胃两经，都产生惊骇。如《金匮真言论》说：东方通于肝，其病发惊骇。《经脉篇》说：足阳明病，听到木声则惕然而惊。
背痛：马云：两条经脉的脉气，胃经自头行于足，肝经自足走腹，都与背部无关，而这里说背痛。我想大概是阴病必行于阳。张景岳云：背痛，是手足阳明之筋，都夹脊而行。汪昂云：按四条经都与背无关，而说背痛，不详。
噫：马云：气转也。又是饱食后出息。《脉解篇》所谓：上走心为噫，是阴盛而上走于阳明，阳明络属心，所以上走心为噫。《口问篇》：寒气客于胃，厥逆从下上散，复出于胃，所以叫噫。看这些，则胃心的病，宜发为噫。张景岳云：噫，嗳气。（详见《宣明五气篇》。）
欠：马云：气相引也。《经脉篇》：胃脉为病，有多次呵欠。《宣明五气》、《九针论》都说肾为欠。这里说善欠，是胃的病。张景岳云：欠，呵欠。简按《说文》：欠，张口气悟也。象气从儿上出之形。
风厥：张景岳云：风厥的意义不止一种。如本篇所说，指二阳一阴发病，名叫风厥，指胃与肝。在《评热病论》中，指太阳少阴病。在《五变篇》中说：人之善病风厥漉汗者，肉不坚腠理疏也。简按又在史迁《仓公传》中出现。
心满：简按：满，通懑。
善气：张志聪云：善气，是太息。心系急则气道约，所以太息以伸出之。简按《礼记》：勿气，郑玄注：谓不鼻息也。乃张志聪的意义为得。马莳、吴崑、张景岳、高世栻都不注。
三阳三阴发病：张志聪云：太阳太阴之为病。太阳为诸阳主气而主筋，阳气虚则为偏枯，阳虚而不能养筋，则为痿。脾属四肢，所以不举。
痿易：张景岳云：痿弱不支，左右相掉易。马云：左右变易为痿。简按：都不对。易，是狂易之易，不如平常。王冰的注释是对的。
鼓一阳曰钩：张志聪云：钩，当作弦。这是论四经之脉，以应四时。鼓，动也。一阳之气初升，所以其脉如弦之端直，以应春生之气。高世栻同。
鼓阳胜急曰弦：张志聪云：弦，当作钩。阳气正盛，所以其脉来盛去悠，如钩之急，以应夏热之气。高世栻同。
鼓阳至而绝曰石：张志聪云：至者为阳，阳气伏藏，所以脉虽鼓至而断绝，以应冬藏之气。滑寿云：当作鼓阴至而绝。这四者，大概是真脏脉。简按：将“鼓阳”作“鼓阴”，接近正确。然而认为这四者是真脏脉，恐怕不对。
阴阳相过曰溜：张志聪云：溜，滑也。阴阳相遇，其脉则滑。长夏之时，阳气微下，阴气微上，阴阳相遇，所以脉滑。这是说人有四经，以应四时之气。张景岳云：阴阳相过，谓流通平顺。脉名叫溜，其气来柔缓而和，应脾脉。简按：张志聪以溜为滑，本于吴崑的注释。马云：溜，作流。《灵枢·本输篇》：溜于鱼际，其义主流。盖溜流古通，不必改字。滑寿云：如水之溜而不收，即下文关格之类，非。又按“鼓一阳”以下二十九字，与上下文不相顺接，是其他篇章的错简在此处。
起则熏肺，使人喘鸣：张景岳云：这是兼表里，以言阴阳的危害。表里不和，则或为脏病，阴争于内；或为经病，阳扰于外。魄汗未藏者，表不固。四逆而起者，阳内竭。其至正不胜邪，则上熏及肺。今人气喘声鸣，这是因为营卫下竭，孤阳上浮，不能避免。
阴之所生，和本曰和：吴崑本：上和字下句。注意与王冰同。张景岳云：阴，是五脏的真阴。阴之所以生者，以脏气和。脏气之和，以阴阳之和。不和则为争为扰，为刚为淖，而病由兴。张志聪云：阴之所生之阳脉，与所本之阴脉，相和而始，名叫和。高世栻云：独阳不生，独阴不长。阴之所生，和本曰和。言阴之所以能生万物者，以阴和而复，本于阳和。简按：这两句，旨义尤其幽深，不能轻易领会，所以列举几种说法。
淖则刚柔不和：吴崑云：这是说偏阴的危害。淖，谓阴气太过，而潦淖。张景岳云：淖，谓寒湿妄行，阴气胜。简按：《行针篇》：血气淖泽滑利。《春秋繁露》：夫物愈淖，而愈易变动摇荡。《淮南·原道训》：甚淖而骀。注：骀，亦淖也。粥多沉者，曰……淖。《广韵》：奴教切。《说文》：泥也。《一切经音义》引《字林》：濡甚曰淖。吴崑、张景岳认为是阴气有余的意思，是正确的。张志聪、高世栻都说：淖，和也。错误。《本经释音》：淖，音淘。水朝宗于海。这是以淖为……，……即俗作潮，也错误。
不过四日而死：简按：马莳、张景岳根据新校正的说法，死，作已，是正确的。张志聪、高世栻仍原文说：以阳脏相生而传，所以不过四日之偶数而死。以阴脏相克而传，所以不过三日之奇数而死。以三四奇偶之数，固然死者，犹云生阳，其义不通。
辟阴：简按：王冰注辟并，乃辟读为僻。僻，偏也。而上辟水升之解未允。张景岳云：辟，放辟也。土本制水，而水反侮脾，水无所畏，是谓辟阴。此说似是。马云：乘所不胜，阴以侮阴，谓之辟阴。吴崑云：辟，邪辟也。肾为水，脾为土，土胜水为正。今肾水反侮于脾，不得其正，故曰辟阴。此解亦未允。
结阳者，肿四肢：马云：结者，气血不疏畅。吴崑云：阳，手足六阳。其脉行于四肢之表，若有结邪，则四肢脉气壅滞，故肿。《圣济总录》云：夫热胜则肿，而四肢为诸阳之本。阳结于外，不得行于阴，则邪热菀于四肢，故其证为肿。况邪在六腑，则阳脉不和。阳脉不和，则气留之。以其气留，故为肿。（犀角汤：犀角、玄参、连翘、柴胡、升麻、木通、沉香、射干、甘草、芒硝、麦门冬。上水煎。）
结阴者，便血一升：马云：营气属阴，营气化血，以奉生身。惟阴经既结，则血必瘀蓄，而初结则一升，再结则二升，三结则三升。结以渐而加，则血以渐而多。《圣济总录》云：夫邪在五脏，则阴脉不和。阴脉不和，则血留之。结阴之病，以阴气内结，不得外行，血无所禀，渗入肠间，故便血也。（地榆汤：地榆、甘草、缩砂仁。水煎。）
阴阳结斜：马云：斜，邪同。《灵动输篇》有少阴之大络，循阴股内廉，邪入……中，则古盖斜邪通用。张志聪云：结斜者，偏结于阴阳之间。简按：张志聪的注释不对。吴崑、张景岳、高世栻都同马莳的意思。
石水：马云：阴气多而阳气少，即阴盛阳虚。则阳不能入之阴，而内之所聚者，为石水。《灵枢·邪气脏腑病形篇》云：肾脉微大为石水，起脐以下，至小腹……然，上至胃脘，死不治。张景岳云：石水，沉坚在下。简按
Wu Yun: This chapter discusses Yin and Yang, differing from common discussions; it presents a unique perspective, hence the title "Bie Lun" (Distinct Discussion). Note: There are chapters titled "Zang Bie Lun" (Distinct Discussion of Zang Organs) and "Jing Mai Bie Lun" (Distinct Discussion of Meridians); Wu's interpretation is more appropriate.
Ma Yun: Based on phrases in the chapter such as "Distinguishing from Yang allows one to know the location of disease," the character "Bie" should be pronounced as "bie" (biè), not in its usual sense.
Si Jing Shi Er Cong (Four Meridians and Twelve Followings): Ma Yun: The "Four Meridians" refer to the Liver, Heart, Lung, and Kidney meridians; the Spleen is omitted because it thrives within these four meridians. "Twelve Followings" refers to the three Yin and three Yang meridians of the hand and foot; the twelve meridian pathways proceed in harmony without contradiction. Wu Yun: "Twelve Followings" refers to the twelve Earthly Branches. The twelve branches no longer govern independently but follow the four meridians, hence called "Twelve Followings." Zhang Jingyue: "Cong" means, for example, the three Yin meridians of the hand moving from the Zang organs to the hands. Note: Although there is no explicit evidence for "Four Meridians," Wang Bing's commentary should be followed. Regarding "Twelve Followings," following Wang Bing and Wu Kun's view that they are the twelve Earthly Branches makes the phrase "Zhi Ren" (Perfect Man) nonsensical. If one follows Ma Shih and Zhang Jingyue's view that they refer to the three Yin and three Yang, it contradicts the later text stating they correspond to twelve pulses. Therefore, this point should remain unresolved.
Fan Yang You Wu, Wu Wu Er Shi Wu Yang (There are Five Yangs, Five Times Five Make Twenty-Five Yangs): Gao Shishi: "Five Yangs" refers to the peaceful Yang pulses of the Liver, Heart, Spleen, Lung, and Kidney. "Twenty-Five Yangs" means: The Liver pulse corresponds to Spring, Heart to Summer, Spleen to Late Summer, Lung to Autumn, and Kidney to Winter. In Spring, the pulses of all five Zang organs exhibit a slight wiry (Xian) Stomach Qi; in Summer, a slight hook-like (Gou) Stomach Qi; in Late Summer, a slight moderate (Huan) Stomach Qi; in Autumn, a slight floating (Mao) Stomach Qi; and in Winter, a slight stone-like (Shi) Stomach Qi. This constitutes twenty-five Yangs.
Suo Wei Yang Zhe, Wei Wan Zhi Yang Ye (What is meant by Yang is the Yang of the Stomach and Intestines): Zhang Zhicong: The "twenty-five Yangs" refer to the Yang Qi generated by the Stomach and Intestines. The Stomach and Intestines belong to the Middle Jiao, responsible for digesting food and fluids to nourish the five Zang organs. The pulses of the five Zang organs across the four seasons all possess a mild and harmonious Stomach Qi, thus termed twenty-five Yangs. Note: Wang Bing's annotation identifying this as the Qi of the Renying (Human Welcome) pulse is incorrect.
Bie Yu Yang Zhe, Zhi Bing Chu Ye (Distinguishing from Yang allows one to know the location of disease): Wu Kun: This means that if one can distinguish the harmonious Yang pulse, any disharmony in a specific pulse position indicates disease at that location, thereby knowing where the disease lies.
Bie Yu Yin Zhe, Zhi Si Sheng Zhi Qi (Distinguishing from Yin allows one to know the time of death or survival): Wu Kun: One who can distinguish the Yin pulses of the True Zang organs knows that death occurs during periods of overcoming (Ke) and survival during periods of generating (Sheng). For instance, if the True Yin pulse of the Liver appears, death occurs on Geng/Xin days; if the True Yin pulse of the Heart appears, death occurs on Ren/Gui days. Later texts mention cases like "Liver pulse hanging isolated and rapid, death in eighteen days," which illustrate this principle.
San Yang Zai Tou, San Yin Zai Shou (Three Yang are at the Head, Three Yin are at the Hand): Zhang Jingyue: "Three Yang at the Head" refers to the Renying pulse. "Three Yin at the Hand" refers to the Qikou pulse. The *Taiyin Yangming Lun* states: The Yangming meridian is exterior and distributes Qi to the three Yang meridians. Essentially, the Qi of the three Yang meridians originates from the Yangming Stomach Qi. The arterial pulse of Yangming is called Renying, located 1.5 cun lateral to the laryngeal prominence, hence "Three Yang at the Head." Furthermore, the Foot-Taiyin is the Three Yin, distributing Qi to them. Essentially, the Qi of the three Yin meridians originates from the Taiyin Spleen Qi. However, the Spleen pulse is not the Qikou pulse; why say "Three Yin at the Hand"? The *Zang Bie Lun* states: Flavors enter the mouth, are stored in the Stomach to nourish the Zang Qi, and manifest at the Qikou. The Qikou is also Taiyin, hence "Three Yin at the Hand." The previous section discussed Yin and Yang via True Zang and Stomach Qi; this section discusses them via Renying and Qikou. Note: This elaborates on Wang Bing's commentary. Wang Ang interpreted it via the hand-foot three Yin and three Yang meridians, criticizing Wang Bing, which made the meaning obscure. (Wang's view is from *Gu Jin Yi Tong Nei Jing Yao Zhi*.) Hua Shou stated: "Three Yang" should be "Two Yang," referring to the Renying pulse at the neck to assess Foot-Yangming Stomach Qi. "Three Yin" refers to the Qikou pulse to assess Hand-Taiyin Lung Qi. The Stomach is the root of the five Zang organs; the Lung is the leader of the hundred vessels. This view has merit and is recorded here. (Ma Shih and Gao Shishi followed Wang Ang, explaining via meridian flow. Wu Kun explained via the Three Parts and Nine Counts method, neither being clear.)
Bie Yu Yang Zhe, Zhi Bing Ji Shi; Bie Yu Yin Zhe, Zhi Si Sheng Zhi Qi (Distinguishing from Yang allows one to know contraindicated times for disease; distinguishing from Yin allows one to know the time of death or survival): Hua Shou: These two sentences reiterate the previous explanation or may be interpolations.
Suo Wei Yin Yang Zhe (What is meant by Yin and Yang): Wu Kun: "Suo Wei" refers to what the world generally means. It implies that these commonly understood Yin and Yang are not what I mean. Note: Since the text previously defined "What is meant by Yin is the True Zang" and "What is meant by Yang is the Yang of the Stomach," Wu Kun offers this explanation. However, examining the context, this interpretation seems unnecessary.
Zhen Mai Zhi Zang Mai (The Pulse of the True Zang Organ): Hua Shou reads it as "Zhen Zang Zhi Mai" (Pulse of the True Zang). *Yao Zhi* (by Wang Ang): The "pulse of the true Zang organ" refers to the rate and rhythm of the True Zang pulse, used to differentiate the five Zang organs.
Gan Zhi Xuan Jue Ji (When the Liver pulse hangs isolated and is rapid): Hua Shou: "Xuan Jue" means extremely weak and about to sever, like a hanging thread. Wang Bing interprets it as an object falling away, likely referring to a substitute pulse. *Yao Zhi* (Wang Ang): "Zhi" means the pulse's response. "Xuan Jue" means cessation. "Ji" means forceful/rigid. Zhang Jingyue: "Xuan Jue Ji" indicates a complete loss of harmony, with abnormal wiry and pounding qualities. Zhang Zhicong: "Xuan Jue" means the True Zang is isolated and severed, lacking the Yang-harmonizing Qi. "Ji" is the death pulse of the Liver, coming rapidly and forcefully, like a drawn bowstring. Note: Zhang Zhicong's explanation seems correct.
Pi Zhi Xuan Jue, Si Ri Si (When the Spleen pulse hangs isolated, death occurs in four days): Gao Shishi: Earth resides in the center, irrigating the four directions. Fire is above, Water below, Wood left, Metal right. If Earth Qi cannot respond to the four directions, death occurs in four days. Note: Wang Bing did not explain why Spleen specifically dies on the number four (a birth number), so Gao's view is adopted. Ma Shih's discussion on Heavenly Stems and Five Element overcoming contains errors; Wang Bing's intent should be followed.
Er Yang Zhi Bing Fa Xin Pi (Diseases of Two Yang originate in the Heart and Spleen): Zhang Jingyue: "Two Yang" refers to the Yangming meridian, comprising the Stomach and Large Intestine. However, since the Large and Small Intestines belong to the Stomach, this section emphasizes the Stomach. The Stomach and Heart have a mother-son relationship. Emotional desires harm the Heart; if the mother (Heart) is harmed, the son (Stomach) is affected. The Stomach and Spleen have an interior-exterior relationship. Labor and fatigue harm the Spleen; if the Zang (Spleen) is harmed, the Fu (Stomach) is involved. Thus, internal injury to essence and external injury to form both affect the Stomach. Hence, diseases of Two Yang originate in the Heart and Spleen. Note: Wang Lv stated: Diseases of the intestines and stomach affect the Heart and Spleen. "Fa Xin Pi" means extending to the Heart and Spleen. Hua Shou noted: An elder from Qingtian suggested "Heart Spleen" should be "Lung Spleen," citing later references to "Feng Xiao" (Wind Wasting) as Spleen disease and "Xi Ben" (Breath Accumulation) as Lung disease, which is reasonable. However, upon detailed examination, Zhang Jingyue's annotation is correct.
Bu De Yin Qu, Nv Zi Bu Yue (Inability to perform secret acts, women do not menstruate): Zhang Jingyue: "Bu De Yin Qu" refers to dysfunction of the male organ. The Stomach is the sea of water and grain, transforming Ying and Wei Qi to moisten the Zongjin (General Tendon). The *Jue Lun* states: The anterior yin is the gathering place of Zongjin, combining Taiyin and Yangming. The *Wei Lun* states: Yin and Yang gather at Zongjin, converging at the Chongmai, led by Yangming. Thus, the descent of essence and blood relies most on Yangming. If the source of transformation is diseased, Yang function declines externally, leading to "Bu De Yin Qu." In women, this manifests as "Bu Yue" (amenorrhea). Wang Shi's commentary suggests intestinal/stomach disease affects Heart/Spleen, causing blood stasis or poor digestion, but this connection is forced and requires scrutiny. The term "Yin Qu" appears five times in the classic, always referring to sexual function; analogy clarifies its meaning. Wu Kun defined "Yin" as bowing the head and "Qu" as bending the body. Note: Wu's view lacks evidence; Zhang Jingyue's interpretation is adopted. *Yao Zhi* notes Wang Ang questioned this, suggesting limb stiffness preventing movement; Wu Kun likely based his view on this.
Feng Xiao (Wind Wasting): Most commentators follow Wang Bing, interpreting it as emaciation/withering. Only Wang Ang interprets it as Upper Xiao (Thirst-Diabetes). Without further evidence, both views are retained. (*Sheng Ji Zong Lu*, Vol. 13).
Xi Ben (Breath Accumulation): Ma Yun: "Ben" is synonymous with "Run" (rush). Panting rushes upward, with incessant coughing and phlegm. This is not the lung accumulation named Xi Ben, but panting that rushes. Zhang Jingyue: Stomach disease deprives the Lung of nourishment, causing rapid breathing. Qi exhausts above due to essence deficiency below, corrupting the five Zang organs, leading to untreatable death.
(Zhu - Calf pain): Zhang Jingyue: Soreness and pain in the calf muscle... Note: *Liezi* mentions "heart vexed, body vexed," where ... means vexation/depression, which differs in meaning here.
Suo Ze (Withered Skin): Lou Ying: "Suo Ze" is what Zhang Zhongjing calls "skin resembling fish scales" (Jia Cuo). Note: Most annotations follow Wang Bing. Only Wu Kun reads it as "Suo Gao" (pulling the testicles), annotating: Gao sounds like 'gao', Suo means pull, Gao means testicle. The phrase "Kong Gao" appears four times in *Neijing*, usually as "waist/spine pulling testicles." No single mention of "Kong Gao" as a disease name exists, so Wu Kun's view is likely incorrect.
Tui Shan (Flaccid Hernia): Ma Yun: Same as ... Note: ... is the same. Originally written as ... *Shi Jing*: "My horse is weary/falling." *E Ya*: "Hui Tui." *Shi Ming*: Swelling of the genitals is ... Gas sinks down ... Also: Shan means drawing/pulling, referring to severe lower abdominal pain. This matches ... Shan in *Jing Mai Pian*, Shan in *Mai Jie Pian*, and ... Yin in *Wu Se Pian*. *Yi Qie Jing Yin Yi*: Testicular swelling is ... a genital disease. *Yuan Bing Shi*: ... Shan involves lower abdominal pain radiating to the testicles, swelling and severe pain. Zhu Zhenheng: ... Shan presents as scrotal swelling and drooping, like a measuring cup, without itching or pain. Wu Kun: Tui means stubborn/hard. Tui Shan means enlarged testicles without pain, hard and unharmed. Tui also means falling. Current interpretation as "stubborn" lacks basis.
Xin Che (Heart Pulling): Wu Kun: The heart pulls and moves. Zhang Jingyue: Restless heart movement, as if being pulled, is called Xin Che. Zhang Zhicong: Heart deficiency causes pulling pain. Note: *Sheng Ji Zong Lu* describes heart fire responding restlessly, with movements resembling pulling. Feng Zhaozhang (*Jin Nang Mi Lu*) states ancient texts lacked the term "Zheng Chong" (Palpitations) and called it "Xin Che." The later text says "it transmits to Ge" (Diaphragm). Zhang Zhicong's view seems plausible.
Ge (Diaphragm/Obstruction): Zhang Jingyue: Wood overacting on Earth injures the Spleen and Stomach, causing Ge syndrome. *Xie Qi Zang Fu Bing Xing Pian*: Slight urgency in Spleen pulse indicates Ge Zhong. *Feng Lun*: Wind attacking the Stomach causes inability to swallow, obstruction in the diaphragm. *Shang Ge Pian*: Food entering and immediately regurgitating is called Ge. Note: Wang Bing's commentary is insufficient.
Jing Hai (Fright and Awe): Zhang Jingyue: Both Liver and Stomach meridians generate fright. *Jin Gui Zhen Yan Lun*: East corresponds to Liver, disease manifests as fright. *Jing Mai Pian*: Foot-Yangming disease causes sudden fright upon hearing wood sounds.
Bei Tong (Back Pain): Ma Yun: The Stomach meridian runs from head to foot; the Liver meridian runs from foot to abdomen. Neither relates to the back, yet this text mentions back pain. Perhaps Yin diseases must traverse Yang? Zhang Jingyue: Back pain involves the sinews of Hand and Foot Yangming, which flank the spine. Wang Ang: None of the four meridians relate to the back; mentioning back pain is unclear.
Yi (Belching): Ma Yun: Movement of Qi. Also, exhaling after eating. *Mai Jie Pian*: "Moving up to the Heart causes Yi" occurs when Yin excess moves up to Yangming, which connects to the Heart. *Kou Wen Pian*: Cold qi invading the Stomach causes rebellious Qi to rise and exit the Stomach, causing Yi. Thus, Stomach/Heart diseases cause Yi. Zhang Jingyue: Yi means belching. (See *Xuan Ming Wu Qi Pian*).
Qian (Yawning): Ma Yun: Qi drawing together. *Jing Mai Pian*: Stomach meridian disease includes frequent yawning. *Xuan Ming Wu Qi* and *Jiu Zhen Lun* state the Kidney governs yawning. Here, frequent yawning indicates Stomach disease. Zhang Jingyue: Qian means yawning. Note: *Shuo Wen*: Qian means opening the mouth to breathe, depicting air exiting upwards.
Fang Jue (Wind Jue): Zhang Jingyue: "Fang Jue" has multiple meanings. In this chapter, it refers to disease of Two Yang and One Yin, named Fang Jue, involving the Stomach and Liver. In *Ping Re Bing Lun*, it refers to Taiyang and Shaoyin. In *Wu Bian Pian*, it refers to those prone to wind-induced sweating due to loose flesh and pores. Note: Also appears in Sima Qian's biography of Cang Gong.
Xin Man (Chest Fullness): Note: Man is synonymous with Men (vexation/fullness).
Shan Qi (Frequent Sighing): Zhang Zhicong: Shan Qi means deep sighing (Tai Xi). When the Heart tie is tight, the airway contracts, causing sighing to release tension. Note: *Li Ji*: "Do not sigh," Zheng Xuan注解: means not breathing through the nose. Zhang Zhicong's interpretation is preferred. Ma, Wu, Zhang, and Gao did not annotate.
San Yang San Yin Fa Bing (Disease Onset of Three Yang and Three Yin): Zhang Zhicong: Disease of Taiyang and Taiyin. Taiyang governs Yang Qi and sinews. Yang deficiency leads to hemiplegia; inability to nourish sinews leads to flaccidity. Spleen governs limbs, hence immobility.
Wei Yi (Flaccidity and Change): Zhang Jingyue: Flaccidity and weakness, changing sides. Ma Yun: Changing left and right leads to flaccidity. Note: Both are incorrect. "Yi" refers to "Kuang Yi" (madness/change), meaning deviation from normal. Wang Bing's annotation is correct.
Gu Yi Yang Yue Gou (Beating One Yang is called Hook): Zhang Zhicong: Gou should be Xian (Wiry). This discusses four meridians corresponding to four seasons. Gu means movement. As Yang Qi initially rises, the pulse is straight like a wire, corresponding to Spring growth. Gao Shishi agrees.
Gu Yang Sheng Ji Yue Xian (Beating Yang Excess and Urgency is called Wire/Wiry): Zhang Zhicong: Xian should be Gou (Hook). When Yang Qi is peak, the pulse comes strong and departs slowly, urgent like a hook, corresponding to Summer heat. Gao Shishi agrees.
Gu Yang Zhi Er Jue Yue Shi (Beating Yang Arrival and Severance is called Stone): Zhang Zhicong: Zhi means Yang. Yang Qi hides, so although the pulse beats and arrives, it severs, corresponding to Winter storage. Hua Shou: Should be "Beating Yin arrival and severance." These four are likely True Zang pulses. Note: Reading "Gu Yang" as "Gu Yin" is closer to correct. However, considering these four as True Zang pulses is likely incorrect.
Yin Yang Xiang Guo Yue Liu (Yin and Yang Intersecting is called Sliding/Flowing): Zhang Zhicong: Liu means sliding/hua. When Yin and Yang meet, the pulse slides. In Late Summer, Yang Qi descends slightly, Yin Qi ascends slightly; their meeting causes a sliding pulse. This refers to four meridians corresponding to four seasons. Zhang Jingyue: Yin-Yang intersection means smooth circulation. The pulse is named Liu, arriving soft and harmonious, corresponding to the Spleen pulse. Note: Zhang Zhicong derives Liu as hua from Wu Kun. Ma Yun: Liu means flow. *Ling Shu: Ben Shu*: "Liu at Yuji," implying flow. Liu and Liu were interchangeable anciently. Hua Shou: Like water flowing uncontrollably, similar to Guan Ge mentioned later, which is incorrect. Also, the twenty-nine characters from "Gu Yi Yang" do not connect smoothly with the context, suggesting a misplaced slip from another chapter.
Qi Ze Xun Fei, Shi Ren Chan Ming (Rising steams into the Lungs, causing wheezing and roaring): Zhang Jingyue: This discusses the harm of Yin and Yang involving both interior and exterior. Disharmony between interior and exterior leads to either Zang disease (Yin conflict internally) or Meridian disease (Yang disturbance externally). Uncontained sweat indicates insecure exterior. Cold extremities rising indicate internal exhaustion of Yang. When righteous Qi fails to overcome pathogenic Qi, it steams upward to the Lungs. Current wheezing and roaring result from exhaustion of Ying and Wei below and floating of solitary Yang above.
Yin Zhi Suo Sheng, He Ben Yue He (What Yin generates, harmonizing with the root is Harmony): Wu Kun's edition places "He" at the start of the next sentence, aligning with Wang Bing. Zhang Jingyue: Yin is the true Yin of the five Zang organs. What generates Yin is the harmony of Zang Qi. Zang Qi harmony stems from Yin-Yang harmony. Disharmony leads to conflict, disturbance, rigidity, and dampness, giving rise to disease. Zhang Zhicong: The Yang pulse generated by Yin and the Yin pulse it roots in must harmonize to be called "He." Gao Shishi: Solitary Yang does not generate; solitary Yin does not grow. "Yin Zhi Suo Sheng, He Ben Yue He" means Yin generates all things because Yin harmonizes and returns to Yang harmony. Note: These two sentences are profound and difficult to grasp immediately; various interpretations are listed.
Nao Ze Gang Rou Bu He (Dampness leads to Rigidity and Softness Disharmony): Wu Kun: Discusses the harm of excessive Yin. Nao means excessive Yin Qi, like flooding. Zhang Jingyue: Nao means cold-dampness acting recklessly, Yin Qi prevailing. Note: *Xing Zhen Pian*: Blood and Qi are nao ze (moist and slippery). *Chun Qiu Fan Lu*: The more nao, the easier to move and shake. *Huai Nan Zi*: Shen nao er dai. Annotation: Dai is also nao. Porridge with too much sediment is called ... Nao. *Guang Yun*: Pronounced 'nao'. *Shuo Wen*: Mud. *Yi Qie Jing Yin Yi* citing *Zi Lin*: Extremely wet is nao. Wu Kun and Zhang Jingyue interpret it as excess Yin Qi, which is correct. Zhang Zhicong and Gao Shishi define Nao as "harmonious," which is wrong. *Ben Jing Shi Yin*: Nao pronounced 'tao'. Water flows to the sea. Interpreting Nao as ... (tide) is also wrong.
Bu Guo Si Ri Er Si (Death within four days): Note: Ma Shih and Zhang Jingyue, following the New Correction, read "Si" (death) as "Yi" (already/end), which is correct. Zhang Zhicong and Gao Shishi stick to the original text: Transmission via generating cycles among Yang Zang takes even numbers (four days); transmission via overcoming cycles among Yin Zang takes odd numbers (three days). Attributing death solely to numerical parity (odd/even) while claiming "Sheng Yang" (Generating Yang) logic is flawed.
Bi Yin (Deviant Yin): Note: Wang Bing annotates Bi as Pi (deviant/perversion). Pi means biased. His explanation of "Bi Water Rising" is unsatisfactory. Zhang Jingyue: Bi means lawless/deviant. Earth normally controls Water, but Water insults the Spleen, fearless, called Bi Yin. This view seems plausible. Ma Yun: Overcoming the unconquerable, Yin insulting Yin is called Bi Yin. Wu Kun: Bi means evil/deviant. Kidney is Water, Spleen is Earth. Earth controlling Water is correct. Now Kidney Water insults Spleen, deviating from correctness, hence Bi Yin. This explanation is also unsatisfactory.
Jie Yang Zhe, Zhong Si Zhi (Accumulation in Yang causes swelling of the four limbs): Ma Yun: Jie means stagnation of Qi and Blood. Wu Kun: Yang refers to the six Yang meridians of hand and foot, running on the exterior of the four limbs. Pathogenic accumulation causes Qi stagnation in limb meridians, resulting in swelling. *Sheng Ji Zong Lu*: Heat excess causes swelling; limbs are the root of all Yang. Yang accumulation externally prevents entry into Yin, trapping pathogenic heat in limbs, causing swelling. Moreover, pathogens in Six Fu organs cause Yang meridian disharmony. Yang disharmony causes Qi retention, leading to swelling. (Xijiao Tang: Rhinoceros Horn, Scrophularia, Forsythia, Bupleurum, Cimicifuga, Akebia, Agarwood, Belamcanda, Licorice, Mirabilite, Ophiopogon. Decoct in water.)
Jie Yin Zhe, Bian Xue Yi Sheng (Accumulation in Yin causes bloody stool, one sheng): Ma Yun: Ying Qi belongs to Yin, transforms into blood to nourish the body. Once Yin meridians accumulate, blood stasis forms. Initial accumulation loses one sheng; second, two sheng; third, three sheng. Gradual accumulation leads to gradual blood loss. *Sheng Ji Zong Lu*: Pathogens in five Zang organs cause Yin meridian disharmony. Yin disharmony causes blood retention. Jie Yin disease involves internal Yin accumulation preventing outward flow; blood lacks direction and渗 (seeps) into the intestines, causing bloody stool. (Diyu Tang: Sanguisorba, Licorice, Amomum. Decoct in water.)
Yin Yang Jie Xie (Yin and Yang Accumulate and Deviate): Ma Yun: Xie is synonymous with Xie (Evil). *Ling Shu: Dong Ling Shu* mentions a large collateral of Shaoyin running along the inner thigh; if evil enters ..., then anciently Xie and Xia were interchangeable. Zhang Zhicong: Jie Xie means accumulating partially between Yin and Yang. Note: Zhang Zhicong's annotation is incorrect. Wu Kun, Zhang Jingyue, and Gao Shishi agree with Ma Yun.
Shi Shui (Stone Water): Ma Yun: More Yin Qi, less Yang Qi, i.e., Yin excess and Yang deficiency. Yang cannot enter Yin, accumulating internally as Stone Water. *Ling Shu: Xie Qi Zang Fu Bing Xing Pian*: Fine and large Kidney pulse indicates Stone Water, starting below the navel to the lower abdomen..., ascending to the epigastrium, untreatable death. Zhang Jingyue: Stone Water is heavy and firm in the lower part. Note