金匮要略云。石水。其脉自沉。外证腹满不喘。尤怡注。石水。水之聚而不行也。因阴之盛。而结于少腹。故
沉而不喘。张氏医通云。越脾加术汤发之。
消 马云。按此篇止谓消。至脉要精微论。有瘅成为消中。奇病论。有转为消渴。灵邪气脏腑病形
篇。本经通评虚
实论。皆曰消瘅。气厥论。有肺消膈消。种种不同。其间各有所指。
隔 马云。俗亦谓之干隔。简按上文王注。隔塞不便。而此亦云。隔塞而不便泻。则似云便闭之证。
志高作膈。
水 马云。平人气象论。颈脉动喘疾咳。曰水。目裹微肿。如卧蚕起之状。曰水。又曰。足胫肿曰水。
灵水胀篇。水始起也。目裹微肿。如新卧起之状。又宣明五气论。灵九针论。皆曰。下焦溢为水。此皆本篇所
谓水也。
喉痹 张云。痹者。闭也。简按春秋繁露云。阴阳之动。使人足病喉痹。痹者。闭也。本出于中藏经。
阴搏阳别 吴云。此以下论脉也。简按王注以阴阳为尺寸。诸家皆从之。而高特云。言阴气过盛。搏
击于内。不与阳和。似乎别出。此不以脉候而解者。盖以经文无脉字也。脉分尺寸。 乎难经。而灵素所无。
故以阴阳为尺寸者。其无稽尤甚。然征之于后世。有与王注符者。儒门事亲。载胡王之妻。病脐下积块。呕食
面黄。肌瘦而不月。或谓之干血气。治之无效。戴人见之曰。孕也。其人不信。再三求治于戴人。与之平药。
以应其意。终不肯下毒药。后月到果胎也。人问何以别之。戴人曰。尺脉洪大也。素问阴阳别论。所谓阴搏阳
别之脉。试之于今。往往有验。王义虽与经旨相左。实不可废焉。（李云。言阴脉搏动。与阳脉迥别也。阴阳
二字。所包者广。以左右言。则左为阳。右为阴。以部位言。则寸为阳。尺为阴。以九候言。则浮为阳。沉为
阴。旧说。以尺脉洪实为阴。与寸阳脉迥别。似矣。然则手少阴脉动甚。亦在寸也。何取于阳别之旨乎。故必
会通诸种阴阳。而后可决也。○三因方云。搏者。近也。阴脉逼近于下。阳脉别出于上。阴中见阳。乃知阳施
阴化。法当有子也。简按妇人良方。亦与此说同。似未妥。）
肠辟 简按王为开肠洞泄之义。拘矣。马吴诸家。并从新校正作 。吴云。阴阳。指尺寸而言。虚。
谓脉来浮而无
根也。肠 。后泄血沫也。是。
阳加于阴谓之汗 张云。阳。言脉体。阴。言脉位。汗液属阴。而阳加于阴。阴气泄矣。故阴脉多阳
者多汗。
阳虚阴搏 诸本。作阴虚阳搏。是。当改。
夕时死 吴云。水火俱搏。谓之阴阳争。夕时。不阴不阳。邪争之会也。故死。
平旦死 宋本。马本。无平旦二字。赵府本。熊本。吴张本。并有之。张云。平旦者。木火王极。而
邪更甚。故死。
三日死 张云。三阳。手太阳小肠。足太阳膀胱也。水一火二。故死在三日。其死之速者。以既搏旦
鼓。阳邪之盛极也。
三阴三阳俱搏 吴云。三阴。脾及肺也。三阳。小肠及膀胱也。四经皆无阳和之气。故脉来俱见急搏。
心腹满发尽 吴云。心病于上。脾病于中。小肠膀胱病于下。故今心腹皆满尽极也。发尽胀满之极也。
简按志作心满腹发尽。非。
隐曲不利 简按高释上文云。不得为房帏之隐曲也。而至此章则云。小肠之火气。发泄已尽。不得
有所隐曲也。隐。幽隐。曲。曲匿。与上文不得隐曲不同也。未知何义。如王注。亦于上文。则以隐蔽委曲释
之。于此章则云。便泻也。如张注则云。阴道不利也。盖推张之意。凡下焦运化之用。总谓之隐曲。然则二便
通利。亦在其中欤。王注风论。与前节同。
五日死 吴云。五为土数。万物所归。今四经俱病。三焦俱伤。故不能逃乎五日也。
其病温 高云。以阳明之阳。而见温热之病。阳亢津竭。故死不治。病温二字。熊本。吴本。作气
滥。吴云。口气臭
败。则清阳已绝。简按字书。滥。溢也。故以气滥为口臭。甚奇。
不过十日死 马云。十日者。地四生金。天五生土。止九日。而十则九日之余也。
《金匮要略》说：石水（一种以腹部肿胀坚硬如石为特征的病证），其脉象自然沉伏，外在症状是腹部胀满但不气喘。尤怡注释：石水，是水液积聚而不流通。因为阴气过盛，凝结在少腹部位，所以脉象沉伏且不气喘。《张氏医通》说：用越脾加术汤来发散治疗。
消渴病 马云说：按此篇只提到“消”（指消渴病的早期或轻症表现）。到了《脉要精微论》，有“瘅成为消中”（热邪炽盛发展为中消）的说法；《奇病论》有“转为消渴”的说法；《灵枢·邪气脏腑病形篇》和《本经·通评虚实论》，都称为“消瘅”（泛指各种消渴类疾病）；《气厥论》中有肺消、膈消等不同类型。种种情况各不相同，其间各自有所特指。
膈证 马云说：俗话也称之为干膈（指吞咽困难、饮食难下的病证）。简要分析上文王冰的注解说：“隔塞不便”，而这里也说“隔塞而不便泻”，则似乎是指大便闭塞不通的病证。高世栻写作“膈”。
水病 马云说：《平人气象论》中说：颈部脉搏跳动、气喘且咳嗽急促的，叫做水病；眼睑微微浮肿，像卧蚕起来的样子，叫做水病；又说：足胫部肿胀叫做水病。《灵枢·水胀篇》说：水病刚开始发生时，眼睑微微浮肿，像刚睡醒时的样子。又《宣明五气论》、《灵枢·九针论》都说：下焦水液溢出形成水病。这些都是本篇所说的水病。
喉痹 张云说：痹，就是闭塞的意思。简要分析《春秋繁露》说：阴阳之气的变动，使人患足病和喉痹。痹，就是闭塞的意思。这原本出自《中藏经》。
阴搏阳别 吴云：以下论述脉象。简要分析王冰注解说将阴阳理解为寸尺脉位，各家都遵从这一说法，唯独高世栻说：这是指阴气过盛，在内搏击，不与阳气调和，似乎另有一种解释。这种不以脉候来解释的方法，大概是因为经文里没有“脉”字。脉分尺寸，见于《难经》，而在《灵枢》、《素问》中没有记载。所以把阴阳理解为寸尺脉位的说法，更是无稽之谈。然而验证于后世医学，有与王冰注解说相符的情况。《儒门事亲》记载胡王的妻子，患有脐下积块，呕吐食物，面色发黄，肌肉消瘦且停经，有人说是干血气（瘀血阻滞导致的闭经等病症），治疗无效。戴人（张从正）见到后说：是怀孕。那人不相信，再三请求戴人治疗，戴人给她平和的药物以顺应她的心意，她始终不肯服用猛烈的药物。后来到了月份果然分娩了。有人问如何辨别，戴人说：尺脉洪大。这就是《素问·阴阳别论》所说的“阴搏阳别”的脉象，试用于今天，往往有效。王冰的解释虽然与经旨相左，但实际上不可废弃。（李云说：意思是阴脉搏动，与阳脉截然不同。阴阳二字，包含的范围很广。从左右来说，左为阳，右为阴；从部位来说，寸为阳，尺为阴；从九候来说，浮为阳，沉为阴。旧时说尺脉洪实为阴，与寸口阳脉截然不同，似乎有理。然而手少阴脉动甚，也在寸口，为何取法于“阳别”的宗旨呢？所以必须融会贯通各种阴阳理论，然后才能决断。○《三因方》说：搏，是接近的意思。阴脉逼近于下，阳脉别出于上，阴中见阳，就知道是阳施阴化，法度上应当有子嗣。简要分析《妇人良方》也与这个说法相同，似乎不太妥当。）
肠辟（痢疾的一种，此处指便脓血） 简要分析王冰解释为开肠洞泄（严重的腹泻）的意思，拘泥了。马莳、吴崑诸家，都跟随新校正作“䐜”（音同“丹”，指痢疾）。吴云：阴阳，指寸尺脉而言；虚，谓脉来浮取而无根底。肠䐜，是后排泄血沫的症状。
阳加于阴谓之汗 张云说：阳，指脉体；阴，指脉位。汗液属阴，而阳加于阴，阴气外泄了。所以阴脉多阳者容易出汗。
夕时死 吴云：水火之气共同搏击，叫做阴阳争。傍晚时分，既非纯阴也非纯阳，是邪气争斗汇聚的时刻。所以死亡。
平旦死 宋本、马本，没有“平旦”二字。赵府本、熊本、吴本、张本，都有。张云说：平旦（清晨），木火之气旺盛至极，而邪气更加严重，所以死亡。
三日死 张云说：三阳，指手太阳小肠经、足太阳膀胱经。水一火二，所以死于第三天。死亡迅速的原因，是因为已经搏击且鼓动，阳邪盛极所致。
三阴三阳俱搏 吴云说：三阴，指脾脏和肺脏；三阳，指小肠和膀胱。这四条经脉都没有阳气调和之气，所以脉象都表现为急迫搏击。
心腹满发尽 吴云说：心病在上，脾病在中，小肠膀胱病在下，所以现在心腹部都胀满到了极点。“发尽”指胀满到了极点。简要分析高世栻写作“心满腹发尽”，是不对的。
隐曲不利 简要分析高世栻解释上文说：不能进行房事的隐秘曲折之事。而到了这一章则说：小肠的火气，发泄已尽，不能有所隐蔽曲折。“隐”指幽隐，“曲”指曲匿，与上文“不得隐曲”不同。不知道是什么含义。如王冰注解说，对于上文，则以隐蔽委曲来解释；对于这一章，则说是大小便排泄不畅。如张景岳注解说则是阴道不利。推测张景岳的本意，凡是下焦运化的功能，总称为隐曲。那么二便通利，也包含在其中吗？王冰在《风论》中的注解说，与前节相同。
五日死 吴云说：五是土的成数，万物所归之处。现在四条经脉都患病，三焦都受伤，所以不能逃过第五天而死。
其病温 高云说：以阳明经的阳气，而出现温热的病证，阳亢津液枯竭，所以死亡且无法治愈。“病温”二字，熊本、吴本，写作“气滥”。吴云说：口气臭败，说明清阳之气已经断绝。简要分析字书中，“滥”意为溢出，所以把“气滥”解释为口臭，非常奇特。
不过十日死 马云说：十天，地四生金，天五生土，止于九日，而十日是九日的余数。
*Jingui Yaolue* states: Shishui (a disease characterized by abdominal swelling and hardness like stone) presents with a naturally deep pulse. The external symptoms are abdominal fullness without panting. You Yi's commentary: Shishui refers to water accumulation that does not circulate. Due to the excess of Yin, it knots in the lower abdomen; therefore, the pulse is deep and there is no panting. *Zhangshi Yitong* states: Treat it with Yuepi Jia Zhu Tang (Yuepi Decoction with Atractodis Rhizoma) to disperse it.
Xiaoke Disease (Wasting-Thirst Syndrome): Ma Yun says: According to this chapter, it only mentions "Xiao" (referring to early or mild manifestations of wasting-thirst). In *Maiyao Jingwei Lun*, there is mention of "Dan becoming Xiaozhong" (heat pathogen intensifying into middle-jiao wasting-thirst); in *Qibing Lun*, there is mention of "transforming into Xiaoke"; in *Lingshu: Xieqi Zangfu Bingxing Pian* and *Benjing: Tongping Xushi Lun*, all refer to it as "Xiaodan" (a general term for various wasting-thirst diseases); in *Qijue Lun*, there are different types such as Feixiao (lung wasting-thirst) and Gexiao (diaphragm wasting-thirst). These situations vary greatly, each having its specific reference.
Ge Syndrome (Obstruction Syndrome): Ma Yun says: Colloquially also referred to as Gan Ge (dry obstruction, referring to difficulty swallowing and inability to ingest food). Brief analysis of Wang Bing's previous commentary: "Ge sai bu bian" (obstructed and inconvenient), and here it also says "Ge sai er bu bian xie" (obstructed and inconvenient to purge), which seems to refer to constipation. Gao Shishi wrote it as "Ge".
Shui Disease (Water Retention Disease): Ma Yun says: *Pingren Qixiang Lun* states: If the neck pulse beats, accompanied by panting and rapid coughing, it is called Shui disease; if the eyelids swell slightly, resembling the shape of a lying silkworm rising, it is called Shui disease; it also states: Swelling of the calves and shins is called Shui disease. *Lingshu: Shuizhang Pian* states: When Shui disease begins, the eyelids swell slightly, resembling the appearance after just waking up. Also, *Xuanming Wuqi Lun* and *Lingshu: Jiuzhen Lun* both state: Overflow from the Lower Jiao forms water. These are all the Shui diseases mentioned in this chapter.
Houbi (Throat Bi/Obstruction): Zhang Yun says: Bi means closure/blockage. Brief analysis of *Chunqiu Fanchu*: Movement of Yin and Yang causes people to suffer from foot disease and Houbi. Bi means closure. This originally comes from *Zhongzang Jing*.
Yin Bo Yang Bie (Yin Pulsation Distinct from Yang): Wu Yun says: The following discusses pulse diagnosis. Brief analysis of Wang Bing's commentary interprets Yin and Yang as Cun and Chi positions, which all schools follow. However, Gao specifically claims: It speaks of Yin Qi being excessive, striking internally, and not harmonizing with Yang, seemingly offering a separate explanation. This interpretation not based on pulse signs likely stems from the absence of the character "pulse" in the original text. Pulse division into Cun and Chi appears in *Nanjing*, but is absent in *Lingshu* and *Suwen*. Thus, interpreting Yin and Yang as Cun and Chi is even more baseless. However, verifying against later medicine, there are cases consistent with Wang Bing's commentary. *Rumen Shiqin* records Hu Wang's wife, who had a mass below the umbilicus, vomiting food, yellow complexion, emaciation, and amenorrhea. Some diagnosed it as Ganzhi Qi (Dry Blood Qi syndrome causing amenorrhea etc.), but treatment failed. Dai Ren (Zhang Congzheng) saw her and said: It is pregnancy. She did not believe him. After repeatedly seeking treatment from Dai Ren, he gave her mild medicines to appease her, and she refused to take harsh drugs. Later, at the due month, she indeed gave birth. When asked how to distinguish it, Dai Ren said: The Chi pulse is surging and large. This is the pulse of "Yin Bo Yang Bie" described in *Suwen: Yin Yang Bie Lun*. Testing it today often yields accurate results. Although Wang Bing's meaning differs from the scriptural intent, it cannot be discarded. (Li Yun says: It means the Yin pulse beats distinctly different from the Yang pulse. The terms Yin and Yang encompass a broad range. Speaking of left and right, Left is Yang, Right is Yin; speaking of positions, Cun is Yang, Chi is Yin; speaking of Nine Palpations, Floating is Yang, Deep is Yin. Old theories stating that a surging and solid Chi pulse is Yin, distinct from the Cun Yang pulse, seem plausible. However, if the Hand-Shaoyin pulse beats strongly, it is also at the Cun position. Why rely on the principle of "Yang Distinction"? Therefore, one must integrate various Yin-Yang theories before making a judgment. ○ *Sanyin Fang* states: Bo means approaching. The Yin pulse approaches from below, while the Yang pulse emerges separately from above. Seeing Yang within Yin indicates Yang applying and Yin transforming, suggesting conception is possible according to therapeutic principles. Brief analysis: *Furen Liangfang* agrees with this view, which seems inappropriate.)
Chang Pi (Intestinal Dysentery/Blood Stool): Brief analysis: Wang Bing's interpretation as "open intestines with洞泄 (profuse diarrhea)" is too rigid. Ma Shi, Wu Kun, and others followed the New Correction to read it as "Dan" (referring to dysentery). Wu Yun says: Yin and Yang refer to Cun and Chi positions. "Xu" (deficiency) means the pulse feels floating without root. Chang Dan involves passing bloody froth in stool.
Yang Jia Yu Yin Wei Zhi Han (When Yang Adds to Yin, it is Called Sweat): Zhang Yun says: Yang refers to the pulse body/form; Yin refers to the pulse position. Sweat fluid belongs to Yin. When Yang adds to Yin, Yin Qi leaks out. Therefore, when the Yin pulse has many Yang characteristics, sweating occurs easily.
Yang Xu Yin Bo: All versions read "Yin Xu Yang Bo", which is correct. It should be corrected.
Death at Evening: Wu Yun says: Water and Fire Qi strike each other, called Yin-Yang struggle. Evening time is neither purely Yin nor purely Yang; it is the convergence of evil struggle. Hence, death occurs.
Death at Dawn: Song Edition, Ma Edition, lack the characters "Pingdan" (Dawn). Zhao Mansion Edition, Xiong Edition, Wu Edition, Zhang Edition, all include them. Zhang Yun says: At dawn, Wood and Fire Qi reach their peak, and the pathogen becomes even stronger, hence death.
Death in Three Days: Zhang Yun says: San Yang refers to Hand-Taiyang Small Intestine and Foot-Taiyang Bladder. Water is one, Fire is two, hence death occurs on the third day. The speed of death is because the Yang pathogen has struck and surged, reaching extreme abundance.
San Yin San Yang Ju Bo (All Three Yin and Three Yang Strike Together): Wu Yun says: San Yin refers to Spleen and Lung. San Yang refers to Small Intestine and Bladder. These four meridians lack Yang-harmonizing Qi, so the pulse appears urgent and striking in all.
Xin Fu Man Fa Jin (Heart and Abdominal Fullness Reaches Extremity): Wu Yun says: Heart disease is upper, Spleen disease is middle, Small Intestine and Bladder disease are lower. Thus, heart and abdomen are now fully full to the extreme. "Fa jin" means reaching the extremity of distension. Brief analysis: Gao Shishi wrote "Xin Man Fa Jin" (Heart full, abdomen reaches extremity), which is incorrect.
Yin Qu Bu Li (Difficulty in Secret/Hidden Functions): Brief analysis: Gao explains the previous text as inability to engage in sexual intercourse ("hidden and secret matters"). But in this chapter, he says: The fire Qi of the Small Intestine has been exhausted, unable to maintain any hidden/secrecy. "Yin" implies hiddenness, "Qu" implies concealment, differing from the previous "cannot be hidden." The meaning is unclear. Wang Bing's commentary interprets the previous text as concealment and tactfulness, but for this chapter, interprets it as difficult defecation/urination. Zhang Jingyue's commentary says it refers to vaginal obstruction. Inferring Zhang's intent, all functions of Lower Jiao transformation are collectively called "Yin Qu." Does this include smooth urination and defecation? Wang Bing's commentary in *Feng Lun* is the same as the previous section.
Death in Five Days: Wu Yun says: Five is the number of Earth, where all things return. Now that four meridians are diseased and the Triple Burner is injured, death cannot escape the fifth day.
Qi Bing Wen (His Illness is Warmth): Gao says: With Yang Ming Yang Qi presenting as a warm-heat disease, Yang hyperactivity and fluid exhaustion lead to untreatable death. The characters "Bing Wen" (illness warmth), in Xiong Edition and Wu Edition, are written as "Qi Lan" (Gas Overflow). Wu Yun says: Rotten breath indicates that Clear Yang Qi has already perished. Brief analysis: In dictionaries, "Lan" means overflow. Thus, interpreting "Qi Lan" as bad breath is very peculiar.
Death Within Ten Days: Ma Yun says: Ten days. Earth Four generates Metal, Heaven Five generates Earth. It stops at nine days, and ten is the remainder of nine.