在变动为忧 张云。心藏神。神有余则笑。不足故忧。志云。心独无俞。故变动在志。心气并于肺则忧。
在窍为舌 吴云。舌惟有窍。故辨百味。简按此说奇。当从王义。
热伤气 苦伤气 二气字。根据太素作脉。义极稳。
脾生肉 五行大义云。肉是身上之土地。
在声为歌 志云。脾志思。思而得之。则发声为歌。
在变动为哕 张云。哕。于决切。呃逆也。马云。灵枢口问篇。帝有问哕问噫之异。王注以哕为噫
者非。宣明五气篇志注。哕。呃逆也。哕哕。车銮声。言呃声之有伦序。故曰哕。简按说文。哕。气牾也。杨
上善解为气忤。盖同义。（气忤。坊本作气折。宋本作忤。是。）
西方生燥 志云。西方主秋金之令。故其气生燥。
肺生皮毛 管子云。肺生革。
在声为哭 虞庶注难经云。肺属金。金。商也。商。伤也。主于秋。秋。愁也。故在志则悲哭。此
之谓也。（秋者。愁也。出尚书大传。）
热伤皮毛寒胜热 据太素。热作燥。寒作热。热作燥。为是。
在声为呻 张云。气郁则呻吟。肾之声也。志云。呻者。伸也。肾气在下。故声欲太息。而伸出之。
寒伤血燥胜寒 据太素。血作骨。燥作湿。为是。张云。
若以五行正序。当云湿胜寒。但寒湿同类。不能相胜。故曰燥胜寒也。诸所不同如此。盖因其切要者为言也。
此说却难凭。
咸伤血 据太素。血作骨。为是。
左右者阴阳之道路也 志云。在天地六合。东南为左。西北为右。阴阳二气。于上下四旁。昼夜环转。
而人之阴阳。亦同天地之气。昼夜循环。故左右为阴阳之道路。
水火者阴阳之征兆也 马云。王注释天元纪大论云。征。信也。验也。兆。先也。言水火之寒热彰信。
阴阳之先兆也。吴云。阴阳不可见。水火则其有征而兆见者也。
阴阳者万物之能始也 能始二字难解。高云。易曰。坤以简能。干知大始。（出于系辞。原文云。干
知大始。坤作成物。干以易知。坤以简能。宋注。知。犹主也。文少异。）此之谓也。今姑从之。
腠理闭 高。闭。作开。简按若作开。则至下文汗不出而穷矣。
仰 马云。喘息粗气。不得其平。故身为之 仰。 。俯也。张云。喘粗不得卧。故为 仰。（ 。
俯同。音仆。又音免。）
烦冤 马云。冤。音婉。张云。冤。郁而乱也。高云。屈抑也。简按楚辞。蹇蹇之烦冤。王逸注。
冤。屈也。
能冬不能夏 马云。能。音耐。礼记礼运。圣人耐以天下为一家。其耐作能盖古以能耐通用。灵阴
阳二十五人篇。亦有能作耐。简按家语。食水者善游能寒。汉晁错传。能暑能寒。
身寒汗出 张云。阳衰则表不固。故汗出。脉要精微论亦曰。阳气有余。为身热无汗。阴气有余。
为多汗身寒。
身常清 集韵。清。与清同。寒也。
更胜之变 张云。更胜。迭为胜负也。即阴胜阳病。阳
胜阴病之义。
病之形能也 吴云。病之见证。谓之病形。能冬能夏。谓之病能。马云。帝以法阴阳为问。而伯以
阴阳偏胜为病者言之。正以见阴阳不可不法也。简按吴说误。能与态同。详见病能论。
七损八益 王注欠详。诸家亦无确说。本邦前辈所解。殆似得经旨。因备录于下。曰。天真论云。
女子五七。阳明脉衰。六七三阳脉衰于上。七七任脉衰。此女子有三损也。丈夫五八肾气衰。六八阴气衰于上。
七八肝气衰。八八肾气衰齿落。此丈夫有四损也。三四合为七损矣。女子七岁肾气盛。二七天癸至。三七肾气
平均。四七筋骨坚。此女子有四益也。丈夫八岁肾气实。二八肾气盛。三八肾气平均。四八筋骨隆盛。此丈夫
有四益也。四四合为八益矣。
不知用此则早衰之节也 吴云。知七损八益盛衰之期。而行持满之道。则阴寒阳热。二者可调。不
知用此。则早衰之节次也。下文遂言早衰之节。简按王注。用。谓房色。义难晓。
年四十 吴云。此言早衰之节也。志云。男子以八为期。故四十而居半。简按五八肾气始衰。乃二
八八八之中。故谓半也。
阴痿 吴云。痿。与萎同。草木衰而萎也。阴痿。阴事弱也。简按巢源。作阴萎。汉书胶西于王端
传。阴痿。一近妇人病数月。师古注。痿。音萎。
气大衰 千金。作气力大衰。
故同出而名异耳 吴云。同得天地之气以成形。谓之同出。有长生不寿之殊。谓之名异。简按千金。
无故字。老子第一章。此两者同出而异名。同谓之玄。
智者察同愚者察异 高云。察同者。于同年未衰之日。而省察之。智者之事也。察异者。于强老各异
之日。而省察之。愚者之事也。
身体轻强 王弘义云。上文曰。体重。耳目不聪明。此节曰。耳目聪明。身体强健。又见其阴阳互相资益之妙。
恬 之能 千金。能。作味。
从欲快志于虚无之守 千金。作纵欲快志得于虚无之守。张云。从欲。如孔子之从心所欲也。快志。
如庄子之乐全得志也。虚无之守。守无为之道也。
天不足西北 淮南天文训。昔者共工与颛顼争为帝。怒而触不周之山。天柱折地维绝。天倾西北。故
日月星辰移焉。地不满东西。故水潦尘埃归焉。河图括地象云。西北为天门。东南为地户。注。天不足西北。
是天门。地不满东南。是地户。
天有精地有形 马云。在上为天。其气至精。在下为地。其体成形。简按春秋繁露。气之清者为精。
庄子。形本生于精。
天有八纪 高云。春夏秋冬。二分二至。八节之大纪也。
地有五里 高云。五里。东南西北中。五方之道里也。马云。里。当从理。简按里理。盖古通用。不必改。
上配天以养头 灵邪客篇。天圆地方。人头圆足方以应之。
中傍人事 志云。节五味。适五志。以养五脏之大和。
天气通于肺 张云。天气。清气也。谓呼吸之气。清气通于五脏。由喉而先入肺。太阴阳明论曰。喉主天气。
地气通于嗌 甲乙。嗌。作咽。张云。地气。浊气也。
谓饮食之气。浊气通于六腑。由嗌而先入胃。嗌。咽也。太阴阳明论曰。咽主地气。其义皆同。嗌。音益。
谷气通于脾 甲乙。千金。及五行大义。谷作 。简按王注。谷空虚。诸家亦为山谷之气。盖地气既
为水谷之气。若以谷为 。则义相重。故从原文。然其说率属牵强。宜从甲乙等。而为水谷之气。 谷。古通
用。汉王莽传。 风迅疾。注。即谷风也。
为水注之气 张云。言水气之注也。如目之泪。鼻之涕。口之津。二阴之尿秽。皆是也。虽耳若无
水。而耳中津气。湿而成垢。是即水气所致。气至水必至。水至气必至。故言水注之气。简按外台引删蘩论。
作水注之于气。又五行大义引本经。作九窍为水。法天之纪。用地之理。则灾祸去矣。今由此则注乃法之讹。
气乃纪之误。而之上有天字。文义似顺承矣。然法天之纪。用地之理。则灾祸去矣三句。与下文故不法天之纪。
不用地之理。则灾祸至矣三句。虽语意相反。然却是重复。萧氏引他书文。极为精核。不知是古文果如此否。
张氏以倒字法释之。颇觉允当。姑从之。
暴气象雷 赵府本。熊本。气。作风。马云。一本作暴风。于雷字不通。宜从气字。张云。天有雷
霆。火郁之发也。人有刚暴。怒气之逆也。故语曰。雷霆之怒。
水谷之寒热 吴云。五味贵于中和。寒则阴胜。热则阳胜。阳胜生热。阴胜生寒。皆能害乎肠胃也。
简按王说执拘。
从阴引阳从阳引阴 志云。阴阳气血。外内左右。交相贯通。故善用针者。从阴而引阳分之邪。从
阳而引阴分之气。简按义见灵枢终始禁服四时气篇。及六十七难。
以右治左以左治右 张云。缪刺之法也。
以我知彼 志云。以我之神。得彼之情。
见微则过 宋本。则。作得。高云。过。失也。病始于微萌。而得其过失之所在。简按张云。则。度
也。盖读为测者非。○徐云。从阴引阳二句。言在上者治下。在下者治上。以我知彼。欲体察也。以表知里。
达内外也。过与不及。总结上文。观夫阴阳左右表里之过与不及也。善用针者。不待病形已具。方知过与不及。
若微见征兆。便知其过。其明如此。用针岂有危殆哉。
善诊者 马云。诊。视验也。诊之为义。所该者广。凡望闻问切等法。皆可以言诊也。简按孔平仲杂
说云。诊不止脉也。视物可以为诊。后汉王乔传。诏尚方诊视。是也。
审清浊而知部分 吴云。色清而明。病在阳分。色浊而暗。病在阴分。又面部之中有五部。以五行之色推之。
视喘息听音声 张。志。引金匮要略。详解之。当参考。
观权衡规矩而知病所主 甲乙。规上。有视字。主。作生。
按尺寸观浮沉滑涩 谓按尺肤而观滑涩。按寸口而观浮沉也。尺。非寸关尺之尺。古义为然。
以治无过 甲乙。治下。有则字。为五字一句。是也。
因其轻而扬之 徐云。因。从其所因也。因其邪气轻浮于表。而用气轻薄之剂。而发扬之。如伤寒
一二日用葛根之类。是也。
因其重而减之 张云。重者实于内。故宜减之。减者。泻也。
因其衰而彰之 张云。衰者。气血虚。故宜彰之。彰者。补之益之。而使气血复彰也。
形不足者温之以气 张云。此正言彰之之法。而在于药食之气味也。以形精言。则形为阳。精为阴。
以气味言。则
气为阳。味为阴。阳者。卫外而为固也。阴者。藏精而起亟也。故形不足者。阳之衰也。非气不足以达表而温
之。精不足者。阴之衰也。非味不足实中而补之。简按诸注以形为阴。故于温之之义而支矣。张注详备。今从之。
其高者因而越之 马云。谓吐之使上越也。
竭之 张云。竭。祛除也。谓涤荡之疏利之。可以治其下之前后也。李云。承气抵当之类。徐云。如
湿气胜而为濡泻等证。用五苓散之类。又如积痢在下。而为里急后重等证。用承气汤牵牛散之类。引而竭之也。
中满者泻之于内 吴云。中满。腹中满也。此不在高不在下。故不可越。亦不可竭。但当泻之于内。
消其坚满。是也。李云。内字与中字照应。
渍形以为汗 吴云。谓天气寒腠理密。汗不易出。则以辛散之物。煎汤渍其形体。覆而取汗也。徐
云。热邪内郁。宜于汗解。因其腠理干燥。而汗不得出者。以温水微渍形体。使之腠理滋润。以接其汗之出也。
今用热汤围浴。而出汗者。是也。
其在皮者汗而发之 张云。前言有邪者。兼经络而言。言其深也。此言在皮者。言其浅也。滑云。
二汗只是一义。然渍字轻。发字重也。简按滑注。似与经旨相乖矣。
其 悍者按而收之 吴云。 悍。卒暴也。按。谓按摩也。言卒然暴痛 悍之疾。则按摩而收之。
收。谓定其 悍也。简按张以按为察。李为制伏酸收。用如芍药之义。并非。
审其阴阳以别柔刚 李云。审病之阴阳。施药之柔刚。简按柔剂刚剂。见史仓公传。此说为是。
血实宜决之 张云。决。谓泄去其血。如决水之义。
气虚直HT 引之 甲乙。HT 。作掣。吴云。HT 。掣同。气虚。经气虚也。经络之气有虚。必有实处。宜
掣引其实者。济其虚者。刺法有此。张云。掣。挽也。气虚者。无气之渐。无气则死矣。故当挽回其气。而引
之使复也。如上气虚者。升而举之。下气虚者。纳而归之。中气虚者。温而补之。是皆掣引之义。简按张注虽
明鬯。不如吴氏之于经旨而切矣。（字书。HT 。音誓。牛两角竖者名HT 。）
在情志变动方面表现为忧愁。张云：心藏神。神有余则笑，不足所以忧愁。志云：心独无俞穴，所以变动在志。心气并入肺则忧愁。
在官窍方面表现为舌。吴云：舌只有窍，所以能辨别百味。简按此说奇特，应当遵从王冰的解释。
热邪伤气，苦味伤气。这两个“气”字，根据《太素》改为“脉”，义理极稳。
脾生肌肉。《五行大义》说：肉是身上的土地。
在声音方面表现为歌。志云：脾志为思，思而得之，则发声为歌。
在情志变动方面表现为呃逆（哕）。张云：哕，音决切，即呃逆。马云：《灵枢·口问篇》中黄帝有问哕与噫的区别，王注以哕为噫是错误的。《宣明五气篇》志注说：哕，就是呃逆。哕哕，是车铃的声音，形容呃声有伦序，所以叫哕。简按《说文解字》：哕，气逆也。杨上善解释为气忤，大概同义。（气忤，坊本作气折，宋本作忤，是正确的。）
西方产生燥气。志云：西方主秋金之令，所以其气生燥。
肺生皮毛。《管子》说：肺生革（皮肤）。
在声音方面表现为哭。虞庶注《难经》说：肺属金，金对应商音，商即伤，主于秋季，秋即愁，所以在志则为悲哭。说的就是这个意思。（秋者，愁也，出自《尚书大传》。）
热邪伤皮毛，寒胜热。据《太素》，热作燥，寒作热，热作燥，这是对的。
在声音方面表现为呻吟。张云：气郁则呻吟，是肾的声音。志云：呻，就是伸。肾气在下，所以声音想要长叹，从而伸出它。
寒邪伤血，燥胜寒。据《太素》，血作骨，燥作湿，这是对的。张云：如果按照五行正序，应该说湿胜寒。但寒湿同类，不能相胜，所以说燥胜寒。诸如此类的不同，大概是因其切要之处而言。这种说法却难以凭信。
咸味伤血。据《太素》，血作骨，这是对的。
左右是阴阳的道路。志云：在天地六合之中，东南为左，西北为右。阴阳二气，在上下四旁，昼夜环转，而人的阴阳，也同天地之气，昼夜循环，所以左右为阴阳的道路。
水火是阴阳的征兆。马云：王注释《天元纪大论》说：征，信也，验也。兆，先也。说水火之寒热彰显可信，是阴阳的先兆。吴云：阴阳不可见，水火则是其有征象和兆头可见的。
阴阳是万物的始基。能始二字难解。高云：《易》曰：坤以简能，干知大始。（出自《系辞》，原文云：干知大始，坤作成物，干以易知，坤以简能。宋注：知，犹主也。文字略有差异。）说的就是这个意思。现在暂且遵从它。
腠理闭。高：闭，作开。简按如果作开，那么到下文汗不出就穷尽了。
仰。马云：喘息粗气，不得其平，所以身体为之仰。俯也。张云：喘粗不得卧，所以为仰。（ ，俯同。音仆。又音免。）
烦冤。马云：冤，音婉。张云：冤，郁而乱也。高云：屈抑也。简按《楚辞》：蹇蹇之烦冤，王逸注：冤，屈也。
能冬不能夏。马云：能，音耐。《礼记·礼运》：圣人耐以天下为一家。其耐作能，盖古以能耐通用。《灵枢·阴阳二十五人篇》中，也有能作耐。简按《家语》：食水者善游能寒。汉晁错传：能暑能寒。
身寒汗出。张云：阳衰则表不固，所以汗出。《脉要精微论》也说：阳气有余，为身热无汗。阴气有余，为多汗身寒。
身常清。《集韵》：清，与清同。寒也。
更胜之变。张云：更胜，迭为胜负也。即阴胜阳病，阳胜阴病的意义。
病的形态和能力。吴云：病的见证，叫做病形。能冬能夏，叫做病能。马云：帝以法阴阳为问，而伯以阴阳偏胜为病者言之，正以见阴阳不可不法也。简按吴说错误。能与态同，详见《病能论》。
七损八益。王注欠详，诸家亦无确说。本邦前辈所解，殆似得经旨。因备录于下。曰：《天真论》云：女子五七，阳明脉衰，六七三阳脉衰于上，七七任脉衰，此女子有三损也。丈夫五八肾气衰，六八阴气衰于上，七八肝气衰，八八肾气衰齿落，此丈夫有四损也。三四合为七损矣。女子七岁肾气盛，二七天癸至，三七肾气平均，四七筋骨坚，此女子有四益也。丈夫八岁肾气实，二八肾气盛，三八肾气平均，四八筋骨隆盛，此丈夫有四益也。四四合为八益矣。
不知用此则早衰之节也。吴云：知七损八益盛衰之期，而行持满之道，则阴寒阳热，二者可调。不知用此，则早衰之节次也。下文遂言早衰之节。简按王注：用，谓房色，义难晓。
年四十。吴云：此言早衰之节也。志云：男子以八为期，故四十而居半。简按五八肾气始衰，乃二八至八八之中，故谓半也。
阴痿。吴云：痿，与萎同，草木衰而萎也。阴痿，阴事弱也。简按《巢源》作阴萎，《汉书·胶西于王端传》：阴痿，一近妇人病数月。师古注：痿，音萎。
气大衰。《千金》作气力大衰。
故同出而名异耳。吴云：同得天地之气以成形，谓之同出。有长生不寿之殊，谓之名异。简按《千金》无故字。《老子》第一章：此两者同出而异名，同谓之玄。
智者察同愚者察异。高云：察同者，于同年未衰之日，而省察之，智者之事也。察异者，于强老各异之日，而省察之，愚者之事也。
身体轻强。王弘义云：上文曰体重，耳目不聪明，此节曰耳目聪明，身体强健，又见其阴阳互相资益之妙。
恬 之能。《千金》：能，作味。
从欲快志于虚无之守。《千金》作纵欲快志得于虚无之守。张云：从欲，如孔子之从心所欲也。快志，如庄子之乐全得志也。虚无之守，守无为之道也。
天不足西北。《淮南子·天文训》：昔者共工与颛顼争为帝，怒而触不周之山，天柱折地维绝，天倾西北，故日月星辰移焉。地不满东西，故水潦尘埃归焉。《河图括地象》云：西北为天门，东南为地户。注：天不足西北，是天门。地不满东南，是地户。
天有精地有形。马云：在上为天，其气至精。在下为地，其体成形。简按《春秋繁露》：气之清者为精。《庄子》：形本生于精。
天有八纪。高云：春夏秋冬，二分二至，八节之大纪也。
地有五里。高云：五里，东南西北中，五方之道里也。马云：里，当从理。简按里理，盖古通用，不必改。
上配天以养头。《灵枢·邪客篇》：天圆地方，人头圆足方以应之。
中傍人事。志云：节五味，适五志，以养五脏之大和。
天气通于肺。张云：天气，清气也。谓呼吸之气。清气通于五脏，由喉而先入肺。《太阴阳明论》曰：喉主天气。
地气通于嗌。《甲乙》：嗌，作咽。张云：地气，浊气也。谓饮食之气。浊气通于六腑，由嗌而先入胃。嗌，咽也。《太阴阳明论》曰：咽主地气。其义皆同。嗌，音益。
谷气通于脾。《甲乙》、《千金》及《五行大义》，谷作 。简按王注：谷空虚，诸家亦为山谷之气，盖地气既为水谷之气，若以谷为 ，则义相重，故从原文。然其说率属牵强，宜从甲乙等，而为水谷之气。 谷，古通用。汉王莽传： 风迅疾，注：即谷风也。
为水注之气。张云：言水气之注也。如目之泪，鼻之涕，口之津，二阴之尿秽，皆是也。虽耳若无水，而耳中津气，湿而成垢，是即水气所致。气至水必至，水至气必至，故言水注之气。简按《外台》引删蘩论，作水注之于气。又《五行大义》引本经，作九窍为水，法天之纪，用地之理，则灾祸去矣。今由此则注乃法之讹，气乃纪之误，而之上有天字，文义似顺承矣。然法天之纪，用地之理，则灾祸去矣三句，与下文故不法天之纪，不用地之理，则灾祸至矣三句，虽语意相反，然却是重复。萧氏引他书文，极为精核，不知是古文果如此否。张氏以倒字法释之，颇觉允当，姑从之。
暴气象雷。赵府本、熊本，气，作风。马云：一本作暴风，于雷字不通，宜从气字。张云：天有雷霆，火郁之发也。人有刚暴，怒气之逆也。故语曰：雷霆之怒。
水谷之寒热。吴云：五味贵于中和，寒则阴胜，热则阳胜，阳胜生热，阴胜生寒，皆能害乎肠胃也。简按王说执拘。
从阴引阳从阳引阴。志云：阴阳气血，外内左右，交相贯通，故善用针者，从阴而引阳分之邪，从阳而引阴分之气。简按义见《灵枢·终始》、《禁服》、《四时气篇》，及《六十七难》。
以右治左以左治右。张云：缪刺之法也。
以我知彼。志云：以我之神，得彼之情。
见微则过。宋本，则，作得。高云：过，失也。病始于微萌，而得其过失之所在。简按张云：则，度也。盖读为测者非。○徐云：从阴引阳二句，言在上者治下，在下者治上。以我知彼，欲体察也。以表知里，达内外也。过与不及，总结上文。观夫阴阳左右表里之过与不及也。善用针者，不待病形已具，方知过与不及。若微见征兆，便知其过，其明如此。用针岂有危殆哉。
善诊者。马云：诊，视验也。诊之为义，所该者广。凡望闻问切等法，皆可以言诊也。简按孔平仲杂说云：诊不止脉也。视物可以为诊。后汉王乔传：诏尚方诊视，是也。
审清浊而知部分。吴云：色清而明，病在阳分。色浊而暗，病在阴分。又面部之中有五部，以五行之色推之。
视喘息听音声。张、志，引《金匮要略》，详解之，当参考。
观权衡规矩而知病所主。《甲乙》：规上，有视字。主，作生。
按尺寸观浮沉滑涩。谓按尺肤而观滑涩，按寸口而观浮沉也。尺，非寸关尺之尺，古义为然。
以治无过。《甲乙》：治下，有则字。为五字一句，是也。
因其轻而扬之。徐云：因，从其所因也。因其邪气轻浮于表，而用气轻薄之剂，而发扬之。如伤寒一二日用葛根之类，是也。
因其重而减之。张云：重者实于内，故宜减之。减者，泻也。
因其衰而彰之。张云：衰者，气血虚，故宜彰之。彰者，补之益之，而使气血复彰也。
形不足者温之以气。张云：此正言彰之之法，而在于药食之气味也。以形精言，则形为阳，精为阴。以气味言，则气为阳，味为阴。阳者，卫外而为固也。阴者，藏精而起亟也。故形不足者，阳之衰也，非气不足以达表而温之。精不足者，阴之衰也，非味不足实中而补之。简按诸注以形为阴，故于温之之义而支矣。张注详备，今从之。
其高者因而越之。马云：谓吐之使上越也。
竭之。张云：竭，祛除也。谓涤荡之疏利之，可以治其下之前后也。李云：承气抵当之类。徐云：如湿气胜而为濡泻等证，用五苓散之类。又如积痢在下，而为里急后重等证，用承气汤牵牛散之类，引而竭之也。
中满者泻之于内。吴云：中满，腹中满也。此不在高不在下，故不可越，亦不可竭，但当泻之于内，消其坚满，是也。李云：内字与中字照应。
渍形以为汗。吴云：谓天气寒腠理密，汗不易出，则以辛散之物，煎汤渍其形体，覆而取汗也。徐云：热邪内郁，宜于汗解，因其腠理干燥，而汗不得出者，以温水微渍形体，使之腠理滋润，以接其汗之出也。今用热汤围浴，而出汗者，是也。
其在皮者汗而发之。张云：前言有邪者，兼经络而言，言其深也。此言在皮者，言其浅也。滑云：二汗只是一义，然渍字轻，发字重也。简按滑注，似与经旨相乖矣。
其 悍者按而收之。吴云： 悍，卒暴也。按，谓按摩也。言卒然暴痛 悍之疾，则按摩而收之。收，谓定其 悍也。简按张以按为察，李为制伏酸收，用如芍药之义，并非。
审其阴阳以别柔刚。李云：审病之阴阳，施药之柔刚。简按柔剂刚剂，见史仓公传，此说为是。
血实宜决之。张云：决，谓泄去其血，如决水之义。
气虚直HT 引之。《甲乙》：HT ，作掣。吴云：HT ，掣同。气虚，经气虚也。经络之气有虚，必有实处，宜掣引其实者，济其虚者。刺法有此。张云：掣，挽也。气虚者，无气之渐，无气则死矣。故当挽回其气，而引之使复也。如上气虚者，升而举之，下气虚者，纳而归之，中气虚者，温而补之，是皆掣引之义。简按张注虽明鬯，不如吴氏之于经旨而切矣。（字书：HT ，音誓。牛两角竖者名HT 。）
In terms of emotional changes, it manifests as worry. Zhang Yun: The Heart stores the Shen (Spirit). When Shen is in excess, there is laughter; when deficient, there is worry. Zhi Yun: The Heart alone has no Shu points, so the change occurs in the Zhi (Will/Intent). When Heart Qi merges with Lung Qi, there is worry.
Regarding orifices, it manifests as the tongue. Wu Yun: The tongue only has an orifice, thus it can distinguish hundred flavors. Jian An: This explanation is peculiar; one should follow Wang Bing's interpretation.
Heat injures Qi, Bitter flavor injures Qi. The two characters "Qi" are corrected to "Mai" (Pulse) according to *Tai Su*, which makes the meaning very stable.
The Spleen generates flesh. *Wu Xing Da Yi* says: Flesh is the land of the body.
Regarding vocalizations, it manifests as singing. Zhi Yun: The Zhi of the Spleen is Si (Thinking). When one thinks and achieves something, sound is produced as singing.
In terms of emotional changes, it manifests as hiccups (Yue). Zhang Yun: Yue, pronounced Jue Qie, refers to hiccups. Ma Yun: In *Ling Shu: Kou Wen Pian*, the Yellow Emperor asked about the difference between Yue and Yi. Wang Bing's commentary identifying Yue as Yi is incorrect. The commentary on *Xuan Ming Wu Qi Pian* states: Yue refers to hiccups. Yue Yue is the sound of carriage bells, describing the rhythmic nature of hiccup sounds, hence called Yue. Jian An: According to *Shuo Wen Jie Zi*: Yue means rebellious Qi. Yang Shangshan interpreted it as Qi Wu (Qi rebellion), which is likely synonymous. (Qi Wu, in manuscript versions, is written as Qi Zhe; Song edition writes Wu, which is correct.)
The West generates Dryness. Zhi Yun: The West governs the command of Autumn Metal, so its Qi generates Dryness.
The Lungs generate skin and hair. *Guan Zi* says: The Lungs generate leather/skin.
Regarding vocalizations, it manifests as crying. Yu Shu's commentary on *Nan Jing* says: The Lungs belong to Metal, Metal corresponds to the Shang tone, Shang means injury, governing Autumn, and Autumn means sorrow. Thus, in terms of Zhi, it is grief and crying. This is what is meant. (Autumn means sorrow, from *Shang Shu Da Zhuan*.)
Heat injures skin and hair; Cold overcomes Heat. According to *Tai Su*, Heat is written as Dryness, Cold as Heat, and Heat as Dryness, which is correct.
Regarding vocalizations, it manifests as groaning. Zhang Yun: Qi stagnation leads to groaning, which is the sound of the Kidney. Zhi Yun: Shen means extension. Kidney Qi is below, so the voice desires a long sigh to extend it.
Cold injures Blood; Dryness overcomes Cold. According to *Tai Su*, Blood is written as Bone, and Dryness as Dampness, which is correct. Zhang Yun: If following the regular order of Five Elements, it should say Dampness overcomes Cold. But Cold and Dampness are of the same category and cannot overcome each other, hence it says Dryness overcomes Cold. Such differences arise from emphasizing essential points. However, this statement is difficult to rely on.
Salty flavor injures Blood. According to *Tai Su*, Blood is written as Bone, which is correct.
Left and Right are the pathways of Yin and Yang. Zhi Yun: Within the six directions of Heaven and Earth, Southeast is Left, Northwest is Right. Yin and Yang Qi circulate day and night in the upper, lower, and four sides. Human Yin and Yang also circulate day and night like Heaven and Earth Qi, so Left and Right are the pathways of Yin and Yang.
Water and Fire are the signs of Yin and Yang. Ma Yun: Wang Bing's commentary on *Tian Yuan Ji Da Lun* states: Zheng means trust/verification. Zhao means precursor. It means the cold and heat of Water and Fire are evident signs, precursors to Yin and Yang. Wu Yun: Yin and Yang are invisible, but Water and Fire have visible signs and precursors.
Yin and Yang are the beginning of all things. The characters Neng Shi are difficult to interpret. Gao Yun: *I Ching* says: Kun acts with simple ability, Qian knows the great beginning. (From *Xi Ci*, original text: Qian knows the great beginning, Kun creates things; Qian is known by ease, Kun by simple ability. Song commentary: Zhi means master. Text differs slightly.) This is what is meant. For now, we tentatively follow this.
Couli (interstices) close. Gao: Close, write as Open. Jian An: If written as Open, then reaching the next part where sweat does not come out would be exhausted.
Upward tilt. Ma Yun: Rapid breathing and coarse Qi, unable to find balance, causes the body to tilt upward. Fu (downward) is opposite. Zhang Yun: Rapid breathing prevents lying down, hence upward tilt. ( , Fu is the same. Pronounced Pu. Also pronounced Mian.)
Fan Yuan (distress and grievance). Ma Yun: Yuan, pronounced Wan. Zhang Yun: Yuan means chaotic depression. Gao Yun: Suppressed injustice. Jian An: *Chu Ci*: Jian Jian Zhi Fan Yuan, Wang Yi's commentary: Yuan means suppression.
Able in Winter, unable in Summer. Ma Yun: Neng, pronounced Nai. *Li Ji: Li Yun*: The sage endures (nai) the world as one family. Its nai is written as neng, implying ancient usage of nai/neng interchangeably. *Ling Shu: Yin Yang Er Shi Wu Ren Pian* also has neng written as nai. Jian An: *Jia Yu*: Those who eat water swim well and endure cold. Han Dynasty Chao Cuo's biography: Endure heat and endure cold.
Body cold with sweating. Zhang Yun: Yang deficiency leads to insecure exterior, hence sweating. *Mai Yao Jing Wei Lun* also says: Excess Yang Qi results in body heat without sweat. Excess Yin Qi results in excessive sweating and cold body.
Body often feels cool/chilly. *Ji Yun*: Qing is the same as Qing. Means cold.
Changes of alternating victory. Zhang Yun: Geng Sheng means alternating victory and defeat. That is, the meaning of Yin excess causing Yang disease, and Yang excess causing Yin disease.
The form and capability of disease. Wu Yun: The manifestations of disease are called Bing Xing (Disease Form). Able in Winter and Summer is called Bing Neng (Disease Capability). Ma Yun: The Yellow Emperor asked about modeling after Yin and Yang, and Bo [Qibo] spoke of diseases caused by Yin-Yang imbalance, precisely to show that Yin and Yang must be modeled. Jian An: Wu's statement is wrong. Neng is the same as Tai (State/Form), see detailed explanation in *Bing Neng Lun*.
Seven Damages and Eight Benefits. Wang Bing's commentary is insufficient, and other families have no definite explanation. Senior scholars of our country explained it, seemingly capturing the essence of the classic. Recorded below: *Tian Zhen Lun* says: Women at five times seven (35), Yangming Meridian declines; at six times seven (42), Three Yang Meridians decline above; at seven times seven (49), Ren Meridian declines. These are three damages for women. Men at five times eight (40), Kidney Qi declines; at six times eight (48), Yin Qi declines above; at seven times eight (56), Liver Qi declines; at eight times eight (64), Kidney Qi declines, teeth fall out. These are four damages for men. Three plus four equals Seven Damages. Women at seven years old, Kidney Qi prospers; at two times seven (14), Tian Gui arrives; at three times seven (21), Kidney Qi is balanced; at four times seven (28), sinews and bones are firm. These are four benefits for women. Men at eight years old, Kidney Qi is solid; at two times eight (16), Kidney Qi prospers; at three times eight (24), Kidney Qi is balanced; at four times eight (32), sinews and bones are robust. These are four benefits for men. Four plus four equals Eight Benefits.
Not knowing how to use this leads to the stages of premature aging. Wu Yun: Knowing the periods of growth and decline of Seven Damages and Eight Benefits, and practicing the way of maintaining fullness, allows Yin-Cold and Yang-Heat to be regulated. Not knowing how to use this leads to the stages of premature aging. The following text then discusses the stages of premature aging. Jian An: Wang Bing's commentary: Yong means sexual activity, the meaning is hard to understand.
Age forty. Wu Yun: This speaks of the stage of premature aging. Zhi Yun: Men take eight as the cycle, so at forty they are halfway. Jian An: At five times eight (40), Kidney Qi begins to decline, which is within the range of two times eight to eight times eight, hence called halfway.
Yin Wei (Impotence). Wu Yun: Wei is the same as Wei (Wither). Plants wither when declining. Yin Wei means weakness in sexual matters. Jian An: *Chao Yuan Fang* writes Yin Wei. *Han Shu: Jiaoxi Yu Wang Duan Zhuan*: Yin Wei, having intercourse with a woman once causes illness for months. Shigu commentary: Wei, pronounced Wei.
Qi greatly declines. *Qian Jin* writes Qi Li (Vitality/Energy) greatly declines.
Thus, they emerge from the same source but have different names. Wu Yun: Obtaining Heaven and Earth Qi to form shape is called emerging from the same source. Having differences in longevity vs. short life is called having different names. Jian An: *Qian Jin* lacks the character Wu (No/Without). *Laozi* Chapter 1: These two emerge from the same source but have different names, both are called mysterious.
The wise observe the commonality; the foolish observe the differences. Gao Yun: Observing commonality means examining oneself before decline at the same age, which is the task of the wise. Observing differences means examining oneself when strong vs. old, which is the task of the foolish.
Body light and strong. Wang Hongyi says: Above it said heavy body, ears and eyes not sharp; here it says ears and eyes sharp, body strong and healthy, again showing the wonder of Yin and Yang mutually supporting each other.
Tian ... Neng. *Qian Jin*: Neng, write as Wei (Flavor/Taste).
Following desires and satisfying wills in the guard of Emptiness. *Qian Jin* writes: Indulging desires and satisfying wills obtained in the guard of Emptiness. Zhang Yun: Following desires, like Confucius' following heart's desire. Satisfying wills, like Zhuangzi's joy in complete fulfillment. Guard of Emptiness means guarding the Way of Non-action.
Heaven is insufficient in the Northwest. *Huainanzi: Tian Wen Xun*: Once Gonggong fought Zhuanxu for the throne, and in anger struck Mount Buzhou. The pillar of heaven broke, the cord of earth severed. Heaven tilted northwest, so sun, moon, and stars moved there. Earth was incomplete in East-West, so waters and dust gathered there. *He Tu Kuo Di Xiang* says: Northwest is the Gate of Heaven, Southeast is the Door of Earth. Commentary: Heaven insufficient in Northwest is the Gate of Heaven. Earth incomplete in Southeast is the Door of Earth.
Heaven has Essence, Earth has Form. Ma Yun: Above is Heaven, its Qi is extremely refined. Below is Earth, its body takes form. Jian An: *Chunqiu Fan Lu*: Clear Qi becomes Essence. *Zhuangzi*: Form originally born from Essence.
Heaven has Eight Disciplines. Gao Yun: Spring, Summer, Autumn, Winter, Equinoxes, Solstices, these are the great disciplines of the eight solar terms.
Earth has Five Directions/Routes. Gao Yun: Wu Li refers to the routes of the five directions: Southeast, Southwest, Northeast, Northwest, Center. Ma Yun: Li should be read as Li (Principle/Reason). Jian An: Li and Li were generally interchangeable in ancient times, no need to change.
Above matches Heaven to nourish the head. *Ling Shu: Xie Ke Pian*: Heaven is round, Earth is square; human head is round, feet are square to correspond.
Middle follows human affairs. Zhi Yun: Regulate Five Flavors, adapt Five Zhi (Emotions), to nourish the great harmony of the Five Zang Organs.
Heavenly Qi connects with the Lungs. Zhang Yun: Heavenly Qi refers to Clear Qi, i.e., breath. Clear Qi connects with the Five Zang Organs, entering the Lungs first via the throat. *Tai Yang Yang Ming Lun* says: Throat governs Heavenly Qi.
Earthly Qi connects with Yi (Throat/Oropharynx). *Jia Yi*: Yi, write as Yan (Swallow/Throat). Zhang Yun: Earthly Qi refers to Turbid Qi, i.e., Qi of food and drink. Turbid Qi connects with the Six Fu Organs, entering the Stomach first via Yi. Yi means throat. *Tai Yang Yang Ming Lun* says: Pharynx governs Earthly Qi. Their meanings are the same. Yi, pronounced Yi.
Grain Qi connects with the Spleen. *Jia Yi*, *Qian Jin*, and *Wu Xing Da Yi*: Gu writes as . Jian An: Wang Bing's commentary: Gu empty/vast. Other families also interpret as Qi of valleys/mountains. Since Earthly Qi is already Qi of water and grain, if Gu is written as , the meaning overlaps, so follow the original text. However, this explanation is forced; better to follow *Jia Yi* etc., as Qi of water and grain. Gu is anciently interchangeable with . Han Dynasty Wang Mang Biography: Wind swift, commentary: i.e., Valley Wind.
As Qi of Water Pouring. Zhang Yun: Speaking of the pouring of Water Qi. Like tears from eyes, mucus from nose, saliva from mouth, urine/feces from lower orifices, all are examples. Although ears seem without water, the moisture and Qi in ears wet into wax, which is caused by Water Qi. Where Qi arrives, Water must arrive; where Water arrives, Qi must arrive. Hence speaking of Qi of Water Pouring. Jian An: *Wai Tai* cites *Shan Fan Lun*, writing Water Pouring onto Qi. Also *Wu Xing Da Yi* cites this classic, writing Nine Orifices as Water, modeling Heaven's Discipline, using Earth's Principle, then disasters depart. From this, Zhu is a corruption of Fa, Qi is a corruption of Ji, and Tian character above makes sense. However, the three sentences Modeling Heaven's Discipline... and the following three sentences Not modeling Heaven's Discipline... although opposite in meaning, are repetitive. Xiao's citation of other texts is very precise; unknown if ancient text was indeed like this. Zhang's explanation using inverted word method seems appropriate, tentatively following it.
Violent Qi resembles Thunder. Zhao Mansion Edition, Kumamoto Edition: Qi, write as Feng (Wind). Ma Yun: One version writes Violent Wind, which doesn't fit with Thunder character, should follow Qi character. Zhang Yun: Heaven has thunder and lightning, emission of stagnant Fire. Humans have violent temper, reversal of angry Qi. Hence saying: Anger of Thunder and Lightning.
Cold and Heat of Water and Grain. Wu Yun: Five Flavors value neutrality. Cold leads to Yin excess, Heat leads to Yang excess. Yang excess generates Heat, Yin excess generates Cold, all can harm intestines and stomach. Jian An: Wang's explanation is rigid.
Draw from Yin to guide Yang, draw from Yang to guide Yin. Zhi Yun: Yin-Yang, Qi-Blood, exterior-interior, left-right, interpenetrate each other. Thus, skilled acupuncturists draw pathogenic factors from Yang aspect drawing from Yin, and guide Yin Qi drawing from Yang. Jian An: Meaning seen in *Ling Shu: Zhong Shi*, *Jin Fu*, *Si Shi Qi Pian*, and *Nan Jing* Difficulty 67.
Treat right with left, treat left with right. Zhang Yun: Method of Miao Ci (Needle Pricking).
Know the other through myself. Zhi Yun: Using my Shen (Spirit) to obtain the condition of the other.
Seeing subtle signs then excess. Song Edition: Ze, write as De. Gao Yun: Guo means mistake/error. Disease starts from subtle sprouts, and obtaining the location of its error. Jian An: Zhang Yun: Ze means measure. Reading as Ce (Measure/Detect) is incorrect. ○ Xu Yun: The two sentences Draw from Yin... mean treating lower from upper, upper from lower. Know other through self, means desiring to examine. Know interior through exterior, means penetrating interior-exterior. Excess and insufficiency summarize the above. Observing excess and insufficiency of Yin-Yang, left-right, exterior-interior. Skilled acupuncturists do not wait for disease form to be established to know excess and insufficiency. If subtle signs appear, one immediately knows the excess, such clarity. How could acupuncture be dangerous?
Those skilled in diagnosis. Ma Yun: Zhen means visual examination. The meaning of Zhen is broad. All methods like observation, listening/smelling, inquiry, and palpation can be called Zhen. Jian An: Kong Pingzhong's Miscellaneous Sayings: Zhen is not just pulse. Observing objects can be Zhen. Later Han Dynasty Wang Qiao Biography: Edict to Imperial Workshop for visual examination, this is it.
Examine clear and turbid to know parts. Wu Yun: Color clear and bright, disease in Yang aspect. Color turbid and dark, disease in Yin aspect. Also, there are five parts in the face, deducing by Five Element colors.
Observe breathing and listen to voice sounds. Zhang, Zhi: Cite *Jin Gui Yao Lue*, explain in detail, should reference.
Observe Balance, Weight, Rule, and Compass to know the governing disease. *Jia Yi*: Above Gui, has Shi (See) character. Zhu, write as Sheng (Generate).
Press Cun and Chi to observe Floating, Sinking, Slippery, and Choppy. Refers to pressing Chi skin to observe Slippery/Choppy, pressing Cun Kou to observe Floating/Sinking. Chi does not refer to Cun-Guan-Chi of modern pulse diagnosis; this is the ancient meaning.
To treat without error. *Jia Yi*: Below Zhi, has Ze (Then) character. Makes five characters one sentence, which is correct.
Because it is light, disperse it. Xu Yun: Yin means following its cause. Because pathogenic Qi is light and floating on exterior, use light Qi agents to disperse it. Like using Ge Gen for Tai Yang disease in first two days, this is it.
Because it is heavy, reduce it. Zhang Yun: Heavy means excess internally, thus should be reduced. Reduction means purging.
Because it is declining, manifest it. Zhang Yun: Declining means Qi and Blood deficiency, thus should be manifested. Manifesting means tonifying and benefiting, making Qi and Blood recover manifestation.
For insufficiency of form, warm with Qi. Zhang Yun: This correctly explains the method of manifesting, lying in the Qi and Flavor of medicines and foods. Speaking of Form and Jing, Form is Yang, Jing is Yin. Speaking of Qi and Flavor, Qi is Yang, Flavor is Yin. Yang guards exterior and secures. Yin stores Jing and rises urgently. Thus, insufficiency of form is deficiency of Yang, without Qi insufficient to reach exterior and warm it. Insufficiency of Jing is deficiency of Yin, without Flavor insufficient to fill middle and tonify. Jian An: Other commentaries take Form as Yin, thus the meaning of warming is divergent. Zhang's commentary is detailed and complete, now following it.
For those high, induce vomiting to make them rise. Ma Yun: Means inducing vomiting to make them rise upward.
Exhaust it. Zhang Yun: Jie means remove. Means cleansing and draining, can treat anterior and posterior lower orifices. Li Yun: Like Cheng Qi and Di Dang formulas. Xu Yun: Like dampness excess causing soft diarrhea, using Wu Ling San. Or accumulation dysentery below causing tenesmus, using Cheng Qi Tang and Qian Niu San, leading and exhausting it.
For fullness in middle, purge internally. Wu Yun: Zhong Man means abdominal fullness. This is neither high nor low, thus cannot vomit, cannot exhaust, but should purge internally, dissipating hardness and fullness, this is it. Li Yun: Nei character corresponds with Zhong character.
Soak form to produce sweat. Wu Yun: Means when weather is cold and Couli tight, sweat not easy to come out, then use pungent dispersing substances, decoct soup to soak body, cover to induce sweat. Xu Yun: Heat pathogen internally stagnant, should resolve via sweat. Because Couli dry and sweat cannot come out, use warm water to slightly soak body, making Couli moist, to connect with sweat coming out. Now using hot water bath to produce sweat, this is it.
For those in skin, induce sweat to release. Zhang Yun: Previous saying having pathogen includes meridians, speaking of depth. This saying in skin speaks of shallowness. Hua Yun: Two types of sweating are one meaning, however Jie character is light, Fa character is heavy. Jian An: Hua's commentary seems contrary to classic intent.
For those fierce and violent, press and gather. Wu Yun: Gan Hao means sudden and violent. An means massage. Speaking of sudden violent pain Gan Hao disease, then massage and gather it. Gather means stabilizing Gan Hao. Jian An: Zhang takes An as observe, Li as subdue and astringe, using meaning like Shaoyao, both incorrect.
Examine Yin and Yang to distinguish Soft and Hard. Li Yun: Examine disease Yin and Yang, apply medicine Soft and Hard. Jian An: Soft and Hard agents seen in Shi Cang Gong Biography, this explanation is correct.
Blood excess should be drained. Zhang Yun: Jue means draining blood, like draining water.
Qi deficiency, pull and guide. *Jia Yi*: HT , write as Che. Wu Yun: HT , Che is same. Qi deficiency, Jing Qi deficiency. Meridian Qi has deficiency, must have excess place, should pull and guide the excess, supplement the deficiency. Acupuncture method has this. Zhang Yun: Che means pull. Qi deficiency is gradual loss of Qi, loss of Qi means death. Thus should retrieve Qi and guide it to restore. Like upper Qi deficiency, lift and raise; lower Qi deficiency, receive and return; middle Qi deficiency, warm and tonify, all are meaning of pulling and guiding. Jian An: Although Zhang's commentary is clear, it is not as cutting to classic intent as Wu's. (Character dictionary: HT , pronounced Shi. Bull with two upright horns named HT .)