余尝读洁古表里诸论。言言合理。字字入微。深得叔和之旨。但含蕴幽
元。难以晓畅。每欲为之诠释。而捉笔无从。偶于广陵市肆中。得一写本。
捧读之。乃洁古表里诸论之释义也。亡其姓氏。不知出自谁手。而乃逐
节疏钞。亦自可观。但于鲁鱼亥豕之文。未见具眼。如七表脉交变略例
论中有云。夫标本者。太阴有标本之化数语。要知太阴之阴字。乃太阳
之阳字传刻之误耳。释之者。纵不便为之窜改以校前贤。亦不当为之
强释以误后学。且不达内经标本之旨。而以太阳属君火。太阴标寒本
热等语。悖谬极矣。然而诠注之苦心。不可泯灭。余姑存之。取其长而略
其短。至于分条析理。注述详明。殆有望于后之君子云。
七表者。浮芤滑实弦紧洪也。八里者。微沉缓涩迟伏濡弱也。
凡奇数。阳之数也。七道表脉皆属阳。其邪从前而外来者。谓之实邪。主
发越而去之。其脉先自外。而渐传于内。初起脉见浮紧洪。发散之后。或
见弦滑实。若是人素禀弱。又或有内伤者。其人迎脉必芤。此皆阳脉也。
凡偶数。阴之数也。八道里脉。皆属阴。其邪从后而内入者。又云。内踝而
入者。谓之虚邪。必须温中理中之法治之。故沉脉中见迟伏缓涩濡弱
也。若单见微缓之脉。此乃表里俱虚矣。
按七表脉。以浮脉先定其表。其余六道。俱在浮中见。八里脉以沉脉先
定其里。其余七道。俱在沉中见。
七表阳也。八里阴也。表脉多见于左。而客随主变。（客为不应得之脉也。）
邪在外为表证。为阳。为客邪。客病为本所变者。是本经不应得之脉。因
正气复。则邪气自退。本经脉复又如至。故曰客随主变。
里脉多见于右。又而主随客变。（主脉者。本脏正脉也。）
邪在内为里证。为阴。为主病。本病为客所变者。是本经应得之脉。因邪
气传里。则正气为邪所制。本经为不应得之脉变焉。故曰主随客变也。
按本经脉。各藏本脉也。为主客邪。不能侵其本经。是本经正气不受其
邪。则客病退矣。是主能变客。
左手三部所主温风寒也。温风寒病得于外。
温风寒。是天地时行之气。时或温气流行。时或风邪播动。时或厉气凝
寒。此皆外来之邪。从表而入者。岂不为病得于外耶。
按温风寒为天地厉气。从外所感。由天之五运之气而时行者。岂不为
得之于外。
右手三部所主于燥湿暑也。燥湿暑病生于内。
燥湿暑者。是阳明燥金生火。太阴湿土生湿。暑者。热邪也。天地交泰之
后。令亢阳一伏。阴土湿气交蒸。而为暑。阳明为湿土相蒸。而亦为暑热
也。岂不为病在于内耶。
此脉法之大概。及其互相变见。或表脉见之于右。或里脉见之于左。或阴
阳更相乘。或阴阳更相伏。或一脉为十变。（一为阳。十为阴。）脉理精微。非一言可尽。
然其要不越乎阴阳五行而已。
此脉法之大概。承上文而言。见得表里三部。所主温风寒燥湿暑。互相
交互。或七表证见八里脉。八里证见七表脉。此其互相变化。自是主随
客变。客随主变。或邪气盛。而正气为邪气所乘。正气胜。而邪气为正气
所伏。或阴证见而为阳。或阳证变而为阴。两相变化。由阴阳两相摄伏。
正谓天一生水。地二生火。天三为少阳。地四为少阴。天五为阳明。地六
为厥阴。天七为太阳。地八为太阴。天九阳极而生阴。三阴伏内。地十阴
极而生阳。一阳初动。故曰一脉为十变也。天地阴阳。二气之理。生生不
已。变化无穷。故阴阳相乘相伏。互相交而又互相化也。变则成天地阴
阳乘伏之制。化则为阴阳五行和合之义也。经曰。脉理精微。非一言可
尽者正此谓也。
按互相变见。谓表里之脉。互相传变不一。或左手得右脉。或右得左手
脉。总之阳与阴气交感。在阴证得阳脉。阳证得阴脉。有阴阳相乘相伏。
以生变化故曰一脉而为十变也。非一宗脉变为十宗脉之说。举其大
概之说也。当临证之时。各类而推之一脉未必一脉。可终其证也。
表脉有七里脉有八。共十五脉也。五行分之。各得三脉。三五一十五也。
五脏属五行。金木水火土也。每藏脉有三部。浮中沉三法也。浮以审其
外。沉以审其内。中则内外之关。以审其表里阴阳虚实之理。各脏得三
脉。五脏合而言之一十五脉也。详见下文。
浮涩弱属金。弦紧伏属木。滑沉濡属水。芤实洪属火。微缓迟属土每三部
俱有轻重之分。至于五行当更相平。一有不平者。客即见焉。
此言各藏本经脉。每藏脉形有三分辨虚实。肺脉本令浮。实则涩。虚则
弱。肝脉本令弦。实则紧。虚则伏。肾脉本令沉。实则滑。虚则濡。心脉本令
洪实则实。虚则芤。脾脉本令缓。实则微。虚则迟。（当云实则迟。虚则微。）所以分别轻
重。即分别虚实也。五行各得本令平和之脉。则无病矣。一见轻重之异。
即生病焉。
按评云。表里共十五道脉。五行分开一看。即所谓金木水火土解。注中
分辨五脏虚实。在轻之中本藏。是本合正藏。但有不应得之脉。即为病
也。部部要分辨。临诊详察之。
或谓内伤则善矣。谓外感莫或之当耶。殊不知天地之间。六气根据于五运。
人身即小天地。外邪所感。莫不从其内而见焉。假令外感风湿。（亦当云温）则木
火有余。而土金不足。水不能制乎火矣。外感乃外邪所感。致五行不平也。
夫内伤不过五内受伤。五脏认其损益。善治者。易以治之。然或有内伤
而兼外感者。则难以胜其证。岂知内以审其五行所亏。外以察其风温
寒所感之邪。详其受证。在何经何脏腑。则莫不见焉。经云外感风温之
邪。则木火有余。肝藏邪既胜。而脾肺二经受其制。土中金气为木所乘。
土无短水以生。则木气干上。而君火随盛。肾中源流之水。不能上升矣。
盖四脏相乘。五行损其二。何以得其安和而平也。
按评云。或谓内伤之语。言五行分辨。在内伤之病。可以易推。若或外感。
犹恐客邪之脉。或见七表。或见八里。难以推测。本合正脉之虚实。以谓
莫或之当耶。此之说也。果外感之证。文中假云云。根据于五脏本脉。各类
而推。则知金水木火土之理。次明虚实贼微正之邪。而又审察弦洪涩
缓沉为主脉。而令本藏非弦非洪。非涩非缓非沉。是本部不应得之脉。
为客邪之标病也。非本病主脉也。以是推详。何得错乱。
内伤乃五内自伤。五行自不能平也。
五内心肝脾肺肾。是也。内伤乃五脏亏损。或七情所感。六欲所伤。五行
金木水火土。相克相贼。自是不能安和而平也。
先明金水木火土之理。次察虚实贼微正之邪。更复辨其部分之浮中沉。
而又当详审乎主脉客脉之相合。何为主。弦（肝）洪（心）涩（肺）缓（脾）沉（肾）是也。
何为客。本部不应得之脉皆客也。能如是。然后内伤外感。主客标本之病。
是者是。非者非。夫何差错之有。
天地五行相生。金生水。水生木。木生火。火生土。土生金。金生水不已。故
天地位焉。万物育焉。一有不然。则阴阳不和。五行必致。虚实不平。或又
为贼微正三邪所感。如金克木。木克土。土克水。水克火。火克金。皆贼邪
也。至于微邪正邪。如夫乘妻。子扶母。母抑子之类。可审辨而推察之。须
有浮中沉三看之法。而当知其本部应得之脉。是为主脉。若不应得之
脉。则为客脉也。当审而明之。然后内伤何脏。何脏虚。何脏实。与两脏之
相干相乘。相抑相扶。皆知轻重之分。外感是贼邪。实邪微邪正邪。或在
标。或在本。则是非立见。指下了然。何有差错。
我曾阅读洁古先生关于表里脉象的各种论述，句句合乎道理，字字细致入微，深得王叔和的精髓。但这些论述含蓄深奥，难以透彻理解。我每次想要为之解释阐述，提笔时却不知从何说起。偶然在广陵的市场中，得到一本手抄本，捧读之下，原来是洁古先生表里诸论的释义。虽然不知道作者是谁，但他逐节疏解抄录，也自有可观之处。只是对于书中因传刻错误导致的文字讹误（如“鲁鱼亥豕”之误），作者缺乏辨别的眼力。例如在《七表脉交变略例论》中有这样的话：“夫标本者，太阴有标本之化”，要知道这里的“太阴”的“阴”字，是“太阳”的“阳”字在传刻时的错误。解释的人，即使不便为此篡改前贤的文字以校勘，也不应当强行解释而误导后学。而且这也不符合《内经》中关于标本的理论，反而将太阳归属于君火，认为太阴标寒本热等说法，极其荒谬悖理。然而，注解者的苦心不可磨灭，我姑且保留此书，取其长处而忽略其短处。至于分条析理、注释详明，希望寄托于后来的君子吧。
所谓七表脉，是指浮、芤、滑、实、弦、紧、洪这七种脉象。所谓八里脉，是指微、沉、缓、涩、迟、伏、濡、弱这八种脉象。
凡是奇数，都是阳的数目。七种表脉都属于阳。邪气从前方向外侵入的，称为实邪，治疗主用发散的方法使其离去。如果脉象先从外部出现，逐渐向内传变，初起时脉象表现为浮、紧、洪，发散之后，或者出现弦、滑、实。如果这个人原本体质虚弱，或者有内伤，其人迎脉必然出现芤脉。这些都属于阳脉。
凡是偶数，都是阴的数目。八种里脉都属于阴。邪气从后方向内侵入的，又说从内踝方向进入的，称为虚邪，必须用温中理中的法治疗。所以在沉脉中见到迟、伏、缓、涩、濡、弱的脉象。如果单独见到微、缓的脉象，这是表里都虚了。
按：诊察七表脉，先用浮脉来确定病在表，其余六种脉象都在浮脉的中取或沉取中显现。诊察八里脉，先用沉脉来确定病在里，其余七种脉象都在沉脉中显现。
七表脉属阳，八里脉属阴。表脉多见于左手，而客脉随主脉变化。（客脉指不应出现的脉象。）邪气在外部为表证，属阳，属客邪。客病是由本经正气变化所致的，是本经不应出现的脉象。因为正气恢复，邪气自然消退，本经脉象恢复如初，所以说“客随主变”。
里脉多见于右手，并且主脉随客脉变化。（主脉指本脏的正脉。）邪气在内部为里证，属阴，为主病。本病被客邪所改变，是本经应该出现的脉象。因为邪气传入里部，正气被邪气制约，本经出现不应出现的脉象变化，所以说“主随客变”。
按：本经脉，各脏拥有自己的本脉。对于主脉和客邪，不能侵犯本经。如果是本经正气不受邪气侵扰，那么客病就会退去。这就是主脉能改变客脉。
温风寒，是天地间时令流行的气候。有时温热之气流行，有时风邪播动，有时厉气凝结寒冷。这些都是外来的邪气，从体表而入，难道不是病得之于外吗？
按：温风寒属于天地的厉气，从外部感受，由天之五运之气按时令流行，难道不是得之于外吗？
燥、湿、暑，是阳明燥金生火，太阴湿土生湿。暑，是热邪。天地交泰之后，亢盛的阳气潜伏，阴土湿气交蒸，从而形成暑。阳明受湿土相蒸，也成为暑热。难道不是病在于内吗？
这是脉法的大概，以及它们互相变化的情况。或者表脉出现在右手，或者里脉出现在左手，或者阴阳互相乘袭，或者阴阳互相潜伏，或者一种脉象发生十种变化。（一代表阳，十代表阴。）脉理精微，不是一句话能说尽的。但其要点离不开阴阳五行罢了。
这是脉法的大概，承接上文而言，显示出表里三部所主的温、风、寒、燥、湿、暑，互相交互。或者七表证出现八里脉，八里证出现七表脉，这是它们互相变化，自然是主随客变、客随主变。或者邪气盛，正气被邪气乘袭；正气胜，邪气被正气潜伏。或者阴证变为阳，或者阳证变为阴，两者互相变化，由阴阳互相摄伏。正谓“天一生水，地二生火，天三为少阳，地四为少阴，天五为阳明，地六为厥阴，天七为太阳，地八为太阴，天九阳极而生阴，三阴伏于内；地十阴极而生阳，一阳初动。”所以说“一脉为十变”。天地阴阳，是二气的道理，生生不息，变化无穷。所以阴阳互相乘袭潜伏，互相交错又互相转化。变则成为天地阴阳乘伏的制度，化则为阴阳五行和合的意义。经文说：“脉理精微，非一言可尽”，正是这个意思。
按：互相变见，是说表里脉象互相传变不一。或者左手出现右手的脉，或者右手出现左手的脉。总之是阳气与阴气交感。在阴证出现阳脉，阳证出现阴脉，有阴阳互相乘袭潜伏以产生变化，所以说“一脉而为十变”。这不是指一种宗脉变成十种宗脉的说法，而是举其大概的说法。当临证时，分类来推究，一种脉未必只对应一种脉，可以终结整个病症的分析。
表脉有七种，里脉有八种，共十五种脉象。按五行分开，每种元素各得三种脉象，三五相乘得十五。五脏属于五行，即金、木、水、火、土。每脏的脉象有三部，即浮、中、沉三种取法。浮取以审查外部，沉取以审查内部，中取则是内外之间的关隘，用以审查表里、阴阳、虚实的道理。各脏得到三种脉象，五脏合起来就是十五种脉象。详见下文。
浮、涩、弱属于金；弦、紧、伏属于木；滑、沉、濡属于水；芤、实、洪属于火；微、缓、迟属于土。每部脉都有轻重的区分。至于五行应当更加平衡，一旦有不平衡，客邪就会显现。
这里说的是各脏的本经脉象，每脏的脉形有三种表现以辨别虚实。肺脉本应浮，实则涩，虚则弱。肝脉本应弦，实则紧，虚则伏。肾脉本应沉，实则滑，虚则濡。心脉本应洪，实则实，虚则芤。脾脉本应缓，实则微，虚则迟。（应当说是实则迟，虚则微。）所以分别轻重，也就是分别虚实。五行各得其本令平和的脉象，就没有病了。一见轻重不同，就生病了。
按：评论说，表里共十五种脉象，按五行分开一看，就是所谓的金木水火土的解释。注中分辨五脏虚实，在于轻重之中辨别本脏。本合正藏，但如果有不应出现的脉象，就是病了。各部都要分辨，临诊时要详细考察。
有人说内伤就好了，说外感没有适当的治法吗？殊不知天地之间，六气基于五运。人身就是小天地，外邪所感，没有不从内部显现出来的。假如外感风湿（也应当说是温），则木火有余，而土金不足，水不能制约火。外感乃是外邪所感，导致五行不平衡。
内伤不过是五脏受伤，五脏认清其损益，善于治疗的，容易治愈。然而如果有内伤兼外感的，就难以胜任治疗。哪里知道内要审查五行所亏损的，外要察知风温寒所感的邪气，详细分析受证的部位，在何经何脏腑，那么就没有看不见的。经文说外感风温之邪，则木火有余，肝脏邪气既盛，而脾肺二经受其制约。土中金气被木所乘，土无水源以生，则木气干犯上部，而君火随之旺盛。肾中源流之水，不能上升了。
大概四脏互相乘袭，五行损伤其二，怎么能得到安和平衡呢？
按：评论说，“或谓内伤”这句话，意思是讲五行分辨，在内伤的疾病上，可以容易推究。如果是外感，还恐怕客邪的脉象，或者出现七表，或者出现八里，难以推测。本合正脉的虚实，说没有适当的治法吗？这种说法，如果是外感之证，文中假设所说的话，根据五脏本脉，各类来推究，就知道金水木火土的道理，其次明确虚实贼微正之邪，而又审察弦、洪、涩、缓、沉作为主脉，如果本脏不是弦、不是洪、不是涩、不是缓、不是沉，是本部不应出现的脉象，为客邪的标病，不是本病的主脉。以此推详，怎么会错乱。
五脏即心、肝、脾、肺、肾。内伤乃是五脏亏损，或因七情所感，或因六欲所伤，五行金木水火土，互相克制相贼，自己不能安和平衡。
先明白金水木火土的道理，其次察辨虚实贼微正之邪，再分辨部分的浮中沉，而又应当详细审察主脉客脉的相合。什么为主？弦（肝）、洪（心）、涩（肺）、缓（脾）、沉（肾）是也。什么是客？本部不应出现的脉象都是客脉。能这样做，然后内伤外感，主客标本的病，对的判断为对，错的判断为错，怎么会有差错呢？
天地五行相生，金生水，水生木，木生火，火生土，土生金，金生水不已。所以天地位焉，万物育焉。一旦有不如此，则阴阳不和，五行必致虚实不平。或者又被贼、微、正三邪所感。如金克木，木克土，土克水，水克火，火克金，都是贼邪。至于微邪、正邪，如夫乘妻、子扶母、母抑子之类，可以审辨而推察。须有浮中沉三看之法，而当知其本部应得的脉象，是为主脉。若不应得的脉象，则为客脉。应当审察明白，然后内伤何脏，何脏虚，何脏实，与两脏的相干、相乘、相抑、相扶，都知道轻重的区分。外感是贼邪，实邪、微邪、正邪，或在标，或在本，则是非立见，指下了然，怎么会有差错。
I once read Jiegu's various discussions on exterior and interior pulse patterns. Every sentence was reasonable, every word meticulous, deeply grasping the essence of Wang Shuhe. However, these discussions were implicit and profound, difficult to understand clearly. Each time I wanted to interpret them, I found myself at a loss when picking up my pen.偶然ly, in the markets of Guangling, I obtained a handwritten copy. Upon reading it, I realized it was an explanation of Jiegu's discussions on exterior and interior pulses. Although the author's surname is lost and their identity unknown, their line-by-line commentary was worthy of appreciation. Yet, they lacked the discernment to identify textual errors caused by copying mistakes (such as "Lu Yu Hai Shi" errors). For instance, in the "Discussion on Examples of Interchange of Seven Exterior Pulses," it states: "Regarding the root and branch, Taiyin has the transformation numbers of root and branch." One must know that the character "Yin" in "Taiyin" here is a printing error for "Yang" in "Taiyang." The explainer, even if hesitant to alter the words of former sages for correction, should not have forced an interpretation that would mislead later scholars. Moreover, this does not align with the theory of root and branch in the *Neijing*, and instead incorrectly attributes Ministerial Fire to Taiyang and claims Taiyin has cold as its branch and heat as its root, which is extremely absurd. Nevertheless, the painstaking effort of the annotator cannot be erased. I shall preserve it for now, taking its strengths while overlooking its weaknesses. As for analyzing principles item by item and providing detailed annotations, I leave this hope to future scholars.
The so-called Seven Exterior Pulses refer to Floating (Fu), Knifelike (Kou), Slippery (Hua), Full/Excess (Shi), Wiry (Xian), Tight (Jin), and Surging (Hong). The so-called Eight Interior Pulses refer to Faint (Wei), Deep (Chen), Slow (Huan), Choppy (Se), Delayed (Chi), Hidden (Fu), Soft (Ru), and Weak (Ruo).
Odd numbers are numbers of Yang. The seven exterior pulses all belong to Yang. When pathogenic factors invade from the front towards the outside, it is called Excess Pathogen (Shi Xie), and treatment primarily uses dispersing methods to expel them. If the pulse initially appears externally and gradually transmits inward, starting with Floating, Tight, or Surging pulses, after dispersing, one might see Wiry, Slippery, or Full pulses. If the person is constitutionally weak or has internal injury, their Renying (ST9) pulse will likely be Knifelike. These all belong to Yang pulses.
Even numbers are numbers of Yin. The eight interior pulses all belong to Yin. When pathogenic factors enter from the back into the interior, or enter from the medial malleolus, it is called Deficient Pathogen (Xu Xie), requiring treatment with warming the middle and regulating the middle methods. Thus, within Deep pulses, one may see Delayed, Hidden, Slow, Choppy, Soft, or Weak pulses. If only Faint or Slow pulses are seen alone, this indicates deficiency in both exterior and interior.
Note: To examine the Seven Exterior Pulses, one first determines the exterior using the Floating pulse; the remaining six types appear within the floating assessment. To examine the Eight Interior Pulses, one first determines the interior using the Deep pulse; the remaining seven types appear within the deep assessment.
The Seven Exterior Pulses are Yang; the Eight Interior Pulses are Yin. Exterior pulses are more commonly seen on the left hand, where Guest pulses change according to Host pulses. (Guest pulses refer to inappropriate pulses.) Pathogens outside constitute an Exterior Syndrome, belonging to Yang and External Guest Pathogens. A Guest disease is changed by the Host channel; it is a pulse inappropriate for the original channel. Because healthy Qi recovers, pathogenic Qi retreats naturally, and the channel pulse returns to normal, hence it is said that "Guest follows Host change."
Interior pulses are more commonly seen on the right hand, where Host pulses change according to Guest pulses. (Host pulse refers to the normal pulse of the Zang organ.) Pathogens inside constitute an Interior Syndrome, belonging to Yin and Primary Disease. The primary disease is altered by Guest pathogens; it is a pulse appropriate for the original channel. Because pathogens transmit to the interior, Healthy Qi is constrained by pathogens, and the original channel exhibits inappropriate pulse changes, hence it is said that "Host follows Guest change."
Note: The Host channel possesses its own Host pulse. It cannot be invaded by Host or Guest pathogens. If the Healthy Qi of the original channel is not affected by pathogens, the Guest disease will recede. This means the Host can change the Guest.
The three positions on the left hand mainly govern Warmth, Wind, and Cold diseases. Warmth, Wind, and Cold diseases arise from external contraction.
Warmth, Wind, and Cold are the seasonal qi of heaven and earth. Sometimes Warmth qi flows, sometimes Wind evil spreads, sometimes severe qi condenses into cold. These are all external pathogens entering from the surface. Are they not diseases acquired externally?
Note: Warmth, Wind, and Cold belong to the severe qi of heaven and earth, contracted from outside, circulating according to the Five Movements of Heaven. Are they not acquired externally?
The three positions on the right hand mainly govern Dryness, Dampness, and Summerheat diseases. Dryness, Dampness, and Summerheat diseases originate internally.
Dryness, Dampness, and Summerheat: Yangming Dry Metal generates Fire, Taiyin Damp Earth generates Dampness. Summerheat is Heat Pathogen. After heaven and earth interact, excessive Yang hides, and Yin Earth dampness steams, forming Summerheat. Yangming, steamed by Damp Earth, also becomes Summerheat-Heat. Are they not diseases located internally?
This is the general principle of pulse methodology and their mutual variations. Or exterior pulses appear on the right, or interior pulses appear on the left; or Yin and Yang mutually overcome each other, or mutually subdue each other; or one pulse undergoes ten transformations. (One represents Yang, Ten represents Yin.) Pulse principles are subtle and profound, not exhaustible by a single statement. However, the key lies nowhere else but Yin and Yang and the Five Elements.
This is the general principle of pulse methodology, continuing from the previous text, showing that the exterior and interior three positions govern Warmth, Wind, Cold, Dryness, Dampness, and Summerheat, interacting with each other. Or Seven Exterior syndromes show Eight Interior pulses, Eight Interior syndromes show Seven Exterior pulses; this is their mutual variation, naturally Host following Guest change, Guest following Host change. Or pathogens are abundant, and Healthy Qi is overcome by pathogens; Healthy Qi prevails, and pathogens are subdued by Healthy Qi. Or Yin syndromes transform into Yang, or Yang syndromes transform into Yin, changing mutually due to Yin and Yang mutually subduing each other. As stated: "Heaven generates Water with One, Earth generates Fire with Two; Heaven Three is Shaoyang, Earth Four is Shaoyin, Heaven Five is Yangming, Earth Six is Jueyin, Heaven Seven is Taiyang, Earth Eight is Taiyin. Heaven Nine reaches extreme Yang and generates Yin, with Three Yins hiding inside; Earth Ten reaches extreme Yin and generates Yang, with One Yang moving initially." Hence it is said "one pulse undergoes ten transformations." The principles of heaven and earth Yin and Yang are the qi of two forces, generating life endlessly, changing infinitely. Thus Yin and Yang mutually overcome and subdue, interweaving and transforming. Variation forms the system of heaven and earth Yin-Yang overcoming and subduing; transformation embodies the harmony of Yin-Yang and Five Elements. The Classic says: "Pulse principles are subtle and profound, not exhaustible by a single statement," which is exactly what this means.
Note: Mutual variation refers to the different transmissions between exterior and interior pulses. Or the left hand obtains the right hand's pulse, or the right hand obtains the left hand's pulse. In short, Yang and Yin qi interact. In Yin syndromes, Yang pulses appear; in Yang syndromes, Yin pulses appear. Due to Yin and Yang mutually overcoming and subduing to generate changes, it is said "one pulse becomes ten transformations." This is not a theory that one category of pulse transforms into ten categories, but a generalization. When treating clinically, classify and deduce; one pulse does not necessarily correspond to only one pulse type, allowing the completion of syndrome analysis.
There are seven exterior pulses and eight interior pulses, totaling fifteen pulses. Divided by the Five Elements, each element gets three pulses; 3 times 5 equals 15. The Five Zang organs belong to the Five Elements: Metal, Wood, Water, Fire, Earth. Each Zang has three pulse positions: Floating, Middle, and Deep. Floating examines the exterior, Deep examines the interior, and Middle serves as the gateway between interior and exterior, examining the principles of exterior-interior, Yin-Yang, and deficiency-excess. Each Zang obtains three pulses; the Five Zangs together make fifteen pulses. See below for details.
Floating, Choppy, and Weak belong to Metal; Wiry, Tight, and Hidden belong to Wood; Slippery, Deep, and Soft belong to Water; Knifelike, Full, and Surging belong to Fire; Faint, Slow, and Delayed belong to Earth. Each position has distinctions of light and heavy pressure. The Five Elements should be balanced; if there is any imbalance, Guest pathogens will appear.
This discusses the Host pulses of each Zang. Each Zang pulse shape has three aspects to distinguish deficiency and excess. Lung pulse naturally floats; Full is Choppy, Deficient is Weak. Liver pulse naturally wiry; Full is Tight, Deficient is Hidden. Kidney pulse naturally deep; Full is Slippery, Deficient is Soft. Heart pulse naturally surging; Full is Full, Deficient is Knifelike. Spleen pulse naturally slow; Full is Faint, Deficient is Delayed. (It should be said Full is Delayed, Deficient is Faint.) Thus, distinguishing light and heavy pressure is distinguishing deficiency and excess. If the Five Elements each possess their natural balanced pulse, there is no disease. Once light/heavy differences appear, disease arises.
Note: The commentary states that the fifteen exterior-interior pulses, when divided by the Five Elements, explain Metal, Wood, Water, Fire, and Earth. The annotation distinguishes Zang deficiency and excess through light and heavy pressures. The normal pulse of the specific Zang is the Host. But if an inappropriate pulse appears, it indicates disease. Each position must be distinguished; careful examination is required during clinical diagnosis.
Some say internal injury is fine, but ask if external contraction lacks proper treatment? Little do they know that within heaven and earth, the Six Qi are based on the Five Movements. The human body is a small heaven and earth. External pathogens contracted manifest from within. Suppose external contraction of Wind-Damp (also Warmth), then Wood and Fire are excessive, while Earth and Metal are insufficient, and Water cannot control Fire. External contraction is caused by external pathogens, leading to imbalance in the Five Elements.
Internal injury merely involves damage to the five viscera; the five Zangs recognize their gain and loss. A skilled practitioner finds it easy to treat. However, if internal injury is accompanied by external contraction, it is difficult to manage. How can one know to examine internally which Five Elements are deficient, and externally observe the Wind, Warmth, and Cold pathogens contracted? By detailing the syndrome location in specific meridians and Zang-Fu organs, nothing remains unseen. The Classic states that external contraction of Wind-Warmth pathogens leads to excess Wood and Fire. With Liver pathogen prevailing, Spleen and Lung meridians are controlled. Metal within Earth is overcome by Wood. Without Earth's source to generate Water, Wood qi attacks upward, and Ministerial Fire flourishes accordingly. The water source in the Kidneys cannot ascend.
Generally, four Zangs mutually overcome each other, damaging two of the Five Elements. How can peace and balance be achieved?
Note: The commentary says, "Or speak of internal injury," meaning that discussing Five Element differentiation makes internal injury diseases easier to deduce. If external contraction occurs, one fears Guest pulse manifestations appearing as either Seven Exterior or Eight Interior pulses, making deduction difficult. Regarding the deficiency/excess of the normal Host pulse, asking if there is no proper treatment? This view suggests that for external contraction syndromes, as hypothetically stated in the text, by basing deductions on the five Zang Host pulses and classifying them, one understands the principles of Metal, Water, Wood, Fire, and Earth. Then clarify the pathogens of Excess, Deficiency, Overcoming, Minor, and Normal types. Furthermore, examine Wiry, Surging, Choppy, Slow, and Deep as Host pulses. If the Zang does not exhibit Wiry, Surging, Choppy, Slow, or Deep, but shows inappropriate pulses for that position, these are Guest pathogen marker diseases, not the primary Host pulse disease. Deducing thus, how could confusion arise?
Internal injury is self-damage to the five viscera, causing the Five Elements to lose balance.
The five inner organs are Heart, Liver, Spleen, Lung, and Kidney. Internal injury refers to Zang deficiency, caused by emotional disturbances (Seven Emotions) or desires (Six Desires). The Five Elements Metal, Wood, Water, Fire, Earth mutually overcome and harm each other, unable to maintain peace and balance.
First clarify the principles of Metal, Water, Wood, Fire, and Earth; then inspect pathogens of Excess, Deficiency, Overcoming, Minor, and Normal; further differentiate the positions of Floating, Middle, and Deep; and carefully examine the combination of Host and Guest pulses. What is Host? Wiry (Liver), Surging (Heart), Choppy (Lung), Slow (Spleen), Deep (Kidney). What is Guest? Any inappropriate pulse in that position is a Guest pulse. By doing so, for internal and external injuries, Host/Guest and Root/Branch diseases, correct judgments are made, errors avoided.
Heaven and Earth Five Elements generate each other: Metal generates Water, Water generates Wood, Wood generates Fire, Fire generates Earth, Earth generates Metal, Metal generates Water endlessly. Thus heaven and earth find their places, and all things are nurtured. If anything deviates, Yin and Yang become disordered, and the Five Elements inevitably result in imbalance of deficiency and excess. Or one is affected by the three pathogens of Overcoming, Minor, and Normal. For example, Metal overcomes Wood, Wood overcomes Earth, Earth overcomes Water, Water overcomes Fire, Fire overcomes Metal; these are all Overcoming Pathogens (Ze Xie). As for Minor and Normal pathogens, such as husband overcoming wife, child supporting mother, mother suppressing child, etc., these can be examined and deduced. One must use the method of examining Floating, Middle, and Deep, knowing the appropriate pulse for that position is the Host pulse. If inappropriate pulses appear, they are Guest pulses. One must examine and clarify this. Then, knowing which Zang is injured internally, which is deficient, which is excessive, and how two Zangs interact, overcome, suppress, or support each other, one understands the degree of severity. External contraction involves Overcoming Pathogens; Excess, Minor, and Normal pathogens may be at the Branch or Root. Thus right and wrong are immediately visible, clear under the fingers, leaving no room for error.