客问内经阴阳别论所言。二阳之病发心脾。三阳为病发寒热。一阳发病少气诸例。俱
论脉法之阴阳。王太仆误作经脉注解。观其提纲。悉从脉有阴阳一句而来。次言知阳者知阴。知阴者知阳。凡
阳有五。五五二十五阳。即仲景大浮数动滑为阳。以五脏之脉。各有大浮数动滑。是为五五二十五阳也。不言
五五二十五阴者。先言知阳者知阴。则沉涩弱弦微之阴。可不言而喻也。答曰。读书虽要认定提纲。一气贯彻
。然中间转折。尤宜活看。不可执着。盖脉有阴阳句。岐伯原是答黄帝人有四经十二从等问。所言凡阳有五。
五五二十五阳。是言五脏之阳气。应时鼓动于脉。五五相乘。为二十五阳。与玉机真藏之故病有五。五五二十五
变。异名同类。夫脉法之阴阳。原不离乎经脉之阴阳。况下文所言。三阳在头。三阴在手。得非明言经脉阴阳
之确据乎。若以脉有阴阳。为通篇之提纲。皆附会于脉。未免支离牵强。殊失先圣立言之旨矣。曷知阴阳别论
。原从阴阳应象。阴阳离合。鱼贯而下。皆论经脉之阴阳。又为提纲中之挈领。可不体会其全。妄讥先辈乎。
旅泊苕溪。偶检嘉言先生仲景脉法解。坐有同人谓石顽曰。夫脉之显著共闻者。尚
且指下难明。况乎险奥幽微。人所共昧。如高章纲 卑损之脉。既非恒有之象。何长沙博采古训。以眩耳目。
喻子曲为释辞。以夸博识乎。答曰。此古圣至微至显之的诀。不能晦藏于密。一时为之阐发。岂故为诡异以欺
后世耶。其所谓纲者。诸邪有余之纲领。损者。诸虚积渐之损伤。恐人难于领悟。乃以高章 卑四字。体贴
营卫之盛衰。虽六者并举。而其所主。实在纲损二脉也。以其辞简义深。末由窥测。喻子独出内照。发明其义。
惜乎但知高章为高章取象。 卑为 卑措辞。不知高章为纲脉之纪。 卑为损脉之基耳。盖高者。自尺内上溢
于寸。指下涌涌。既浮且大。而按之不衰。以卫出下焦。行胃上口。至手太阴。故寸口盛满。因以高字名之。
章者。自筋骨外显于关。应指 。既动且滑。而按之益坚。以营出中焦。亦并胃口而出上焦。故寸关实满。
因以章字目之。纲者。高章兼该之象。故为相搏。搏则邪正交攻。脉来数盛。直以纲字揭之。 者。寸口微滑
。而按之软弱。举指瞥瞥。似数而仍力微。以卫气主表。表虚不能胜邪。故有似乎心中怵惕之状。因以 字喻
之。卑者。诸脉皆不应指。常兼沉涩之形。而按之隐隐。似伏而且涩难。以营气主里。里虚则阳气不振。故脉
不显。有似外家婢之卑屑不能自主。故以卑字譬之。损者。 卑交参之谓。故为相搏。搏则邪正俱殆。脉转衰微
。直以损字呼之。而损脉之下。复有迟缓沉三者。言阿阿徐缓。而按之沉实。为营卫俱和。阴阳相抱之象。不
过借此以显高章等脉。大都高章纲 卑损之脉。皆从六残贼来。其浮滑之脉。气多上升而至于高。弦紧之脉。
邪必外盛而至于章。沉涩之脉。阳常内陷而至于卑。非阴寒脉沉。不传他经之比。凡此六者。能为诸脉作病。
故谓残贼。纵邪气盛满。而汗下克削太过。皆能致虚。虚则脉来 。按之力微。逮所必至。至于高章相搏。
未有不数盛者。 卑
相搏。未有不弦劲者。所以沉伏之中。尺内时见弦细搏指。则为损脉来至。必难治也。详高 之脉。往往见于
寸口。章脉每多显于趺阳。卑脉恒于少阴见之。然 卑之脉。寸口趺阳未尝不有也。高章之脉。尺内少阴。从
未一见耳。观后寸口趺阳少阴诸条。皆言高章 卑之病。其阴阳死生之大端。端不出大浮数动滑为阳。沉涩弱
弦微为阴之总纲。以其非专言伤寒脉法。故长沙另辑平脉法篇。隶诸辨脉法下。由是余昔诠释缵论。略未之及
。兹因同人下问。不觉为之饶舌。
客人问《内经·阴阳别论》中提到的：“二阳之病发心脾”、“三阳为病发寒热”、“一阳发病少气”等例子，都是论述脉法中的阴阳。王冰（号太仆）错误地将其注解为经脉的阴阳。看他的提纲，完全是从“脉有阴阳”这一句引申出来的。接着说“知阳者知阴，知阴者知阳”，凡是阳脉有五种，五五相乘就是二十五种阳脉。这就是张仲景所说的“大、浮、数、动、滑”为阳脉，因为五脏的脉象各有这五种表现，所以称为五五二十五阳。没有提“五五二十五阴”，是因为前面说了“知阳者知阴”，那么沉、涩、弱、弦、微这五种阴脉，就可以不言而喻了。
我回答说：读书虽然要认定提纲，一气贯通，但中间的转折，尤其应该灵活看待，不可固执拘泥。“脉有阴阳”这句话，岐伯原本是回答黄帝关于“人有四经十二从”等问题时说的。所谓“凡阳有五，五五二十五阳”，是说五脏的阳气应时而鼓动于脉象之中，五五相乘，成为二十五阳。这与《玉机真藏论》中提到的“故病有五，五五二十五变”，名称不同但实质同类。脉法的阴阳，原本就不脱离经脉的阴阳。况且下文所说“三阳在头，三阴在手”，这不是明确指出了经脉阴阳的确凿证据吗？如果把“脉有阴阳”作为全篇的提纲，都附会于脉法，未免支离破碎、牵强附会，大大失去了先圣立言的本意。怎么知道《阴阳别论》原来是承接《阴阳应象大论》、《阴阳离合论》，如鱼贯般依次而下，都是在论述经脉的阴阳，并且是提纲中的关键要领。如果不体会其整体含义，就妄加讥讽先辈，是不对的。
我在苕溪旅居漂泊时，偶然翻阅嘉言先生对仲景脉法的解说。座中有位同僚对我说：“石顽啊，那些脉象显著、众所周知的，尚且在指下难以辨明，何况那些险奥幽微、众人都不明白的脉象呢？像高、章、纲、卑、损这些脉象，既然不是恒常出现的脉象，为什么长沙太守张仲景广泛采集古训，用来迷惑人的耳目？喻子又曲解文辞来炫耀自己的博学吗？”
我回答说：这是古代圣人极其精微又极其显明的确切诀窍，不能晦涩地隐藏起来，一时之间加以阐发，难道是故意搞诡异来欺骗后世吗？他们所说的“纲”，是各种邪气有余的纲领；“损”，是各种虚证逐渐积累的损伤。恐怕人们难以领悟，于是用“高、章、卑”三个字，来体贴营卫盛衰的情况。虽然列举了六种脉象，但其主旨实在在于“纲”和“损”这两类脉象。因为这些言辞简练而义理深奥，外人无法窥测其底细，只有喻子独自向内观照，阐明了其中的义理。可惜他只知道“高、章”是用来取象，“卑”是用来措辞，却不知道“高、章”是纲脉的纪纲，“卑”是损脉的基础。
所谓“高”，是指脉气自尺部向上溢出至寸部，指下感觉涌涌然，既浮且大，重按也不衰减。这是因为卫气出于下焦，经过胃的上口，上行至手太阴肺经，所以寸口脉盛满，因此用“高”字命名。
所谓“章”，是指脉气自筋骨之外显现于关部，应指有力，既跳动又滑利，重按更加坚实。这是因为营气出于中焦，也并胃口而出上焦，所以寸部和关部实满，因此用“章”字称呼。
所谓“纲”，是高和章兼有的脉象，所以表现为邪正相搏，搏结则邪正交攻，脉来快速盛大，直接用“纲”字揭示。
所谓“瞥”（注：原文此处似缺字或为“瞥”之通假/异体，结合上下文“瞥瞥”形容微弱），是指寸口脉微滑，重按软弱，轻举手指时感觉脉象飘忽不定，似乎快但仍然力量微弱。这是因为卫气主表，表虚不能抵御邪气，所以有类似心中恐惧惊惕的状态，因此用“瞥”字比喻。
所谓“卑”，是所有脉象都不应指，常兼有沉涩的形态，重按时隐隐约约，似乎伏而且涩难寻。这是因为营气主里，里虚则阳气不振，所以脉象不显，有类似外家婢女卑微琐碎、不能自主的样子，因此用“卑”字作比。
所谓“损”，是瞥和卑交替参杂的意思，所以也是邪正相搏，搏结则邪气和正气都危险，脉转衰微，直接用“损”字称呼。而在损脉之下，又有迟、缓、沉三种情况，说的是脉来阿阿徐缓，重按沉实，这是营卫调和、阴阳相抱的象，不过是借此来显示高、章等脉罢了。
大体上，高、章、纲、瞥、卑、损这些脉象，都是从六淫残贼之邪而来。其浮滑的脉象，气多上升而至“高”；弦紧的脉象，邪气必外盛而至“章”；沉涩的脉象，阳气常内陷而至“卑”。这不同于阴寒脉沉而不传他经的情况。以上这六种脉象，能导致各种脉象生病，所以称为“残贼”。即使邪气盛满，如果汗法、下法、克削之法太过，都会导致虚弱。虚弱则脉来瞥瞥，重按力量微弱，这是必然的结果。至于高、章相搏，没有不快速盛大的；瞥、卑相搏，没有不弦劲的。所以在沉伏之中，尺部时常出现弦细搏指的脉象，这就是损脉到来的征兆，必定难以治疗。
详细来看，高、瞥的脉象，往往见于寸口；章脉多在趺阳脉显现；卑脉常在少阴脉见到。然而瞥、卑的脉象，在寸口、趺阳也未尝没有。高、章的脉象，在尺部、少阴脉却从未见过一次。观察后面寸口、趺阳、少阴诸条，都在讲高、章、瞥、卑的病证，其阴阳生死的大端，终究不出“大、浮、数、动、滑为阳，沉、涩、弱、弦、微为阴”这个总纲。因为它不是专门论述伤寒脉法的，所以张仲景另外编辑了《平脉法》篇，隶属于《辨脉法》之下。由此，我过去诠释《缵论》时，略微没有涉及这些内容。这次因为同僚向下询问，不觉为之饶舌多说了一番。
A guest asked about the examples mentioned in the *Neijing* (Classic of Internal Medicine) · *Yin Yang Bie Lun* (Treatise on Distinguishing Yin and Yang), such as "Diseases of Er Yang originate from Heart and Spleen," "Diseases of San Yang manifest as chills and fever," and "Disease of Yi Yang manifests as shortness of breath." These are all discussions regarding Yin and Yang in pulse diagnosis. Wang Bing (courtesy name Taipu) mistakenly annotated them as referring to the Yin and Yang of the meridians. Looking at his outline, it is entirely derived from the phrase "Pulses have Yin and Yang." He then states, "He who knows Yang knows Yin; he who knows Yin knows Yang." There are five types of Yang pulses, and five times five makes twenty-five Yang pulses. This refers to Zhang Zhongjing's statement that "Large, Floating, Rapid, Moving, and Slippery" constitute Yang pulses. Since each of the five Zang organs has these five pulse manifestations, they are called the twenty-five Yang pulses. The text does not mention "twenty-five Yin pulses" because, having stated "he who knows Yang knows Yin," the five Yin pulses—Deep, Choppy, Weak, Wiry, and Fine—can be understood without explicit explanation.
I replied: Although reading requires identifying the main theme and maintaining coherence, one must view the transitions flexibly and avoid rigid attachment. The phrase "Pulses have Yin and Yang" was originally spoken by Qibo in response to Huangdi's questions about "the human body having four meridians and twelve conformities." When it says "There are five types of Yang pulses, and five times five makes twenty-five Yang pulses," it refers to the Yang Qi of the five Zang organs surging in the pulses according to the seasons. Five times five results in twenty-five Yangs. This is similar in substance but different in name to the "five chronic diseases and twenty-five transformations" mentioned in the *Yu Ji Zhen Zang Lun* (Treatise on Jade Machine and True Viscera). The Yin and Yang of pulse methods inherently do not depart from the Yin and Yang of the meridians. Moreover, the subsequent statement "San Yang is at the head, San Yin is at the hand" serves as clear evidence of meridian Yin and Yang. If "Pulses have Yin and Yang" were taken as the overarching theme for the entire chapter, forcing all interpretations onto pulse methods alone, it would be fragmented and forced, greatly deviating from the intent of the ancient sages. How can we know that the *Yin Yang Bie Lun* originally followed sequentially from the *Yin Yang Ying Xiang Da Lun* (Great Treatise on Yin and Yang Corresponding to Phenomena) and the *Yin Yang Li He Lun* (Treatise on Yin and Yang Separation and Union), discussing the Yin and Yang of the meridians throughout? It serves as a key guideline within the outline. One should not blindly ridicule predecessors without comprehending the whole context.
While residing temporarily at Tiao Xi, I happened to review Mr. Jiayan's commentary on Zhongjing's pulse methods. A colleague present said to me, "Shiwan, even those pulse manifestations that are prominent and widely known are difficult to discern under the fingers, let alone those that are perilous, profound, subtle, and obscure, which most people fail to understand. Regarding pulses such as Gao (High), Zhang (Manifest), Gang (Net/Rope), Bei (Low/Humble), and Sun (Damaged), since they are not constant appearances, why did Zhang Zhongjing of Changsha extensively collect ancient teachings to dazzle the eyes and ears? Did Yu Zi distort the words merely to boast of his erudition?"
I replied: These are the precise secrets of the ancient sages, extremely subtle yet extremely evident. They cannot be hidden away in obscurity and are elucidated at this moment. Was it done deliberately to deceive later generations with诡异的 (bizarre) claims? What they call "Gang" is the general principle of excess pathogens; "Sun" is the gradual damage of various deficiency syndromes. Fearing that people would find it difficult to comprehend, they used the characters "Gao," "Zhang," and "Bei" to describe the flourishing and decline of Ying (Nutritive) and Wei (Defensive) Qi. Although six types are listed together, the main focus lies actually in the "Gang" and "Sun" pulses. Because the language is concise and the meaning deep, outsiders could not fathom it. Only Yu Zi, through introspection, clarified its meaning. Unfortunately, he only knew that "Gao" and "Zhang" were used for imagery and "Bei" for wording, failing to realize that "Gao" and "Zhang" are the markers of the Gang pulse, while "Bei" is the foundation of the Sun pulse.
"Gao" refers to the pulse overflowing from the Chi (Cun) position upwards to the Cun (Inch) position. Under the fingers, it feels surging, both floating and large, and does not diminish upon heavy pressure. This is because Wei Qi originates from the Lower Jiao, passes through the upper orifice of the Stomach, and ascends to the Hand Taiyin Lung Meridian, causing fullness at the Cun Kou (Radial Artery). Hence, it is named "Gao."
"Zhang" refers to the pulse appearing externally from the tendons and bones at the Guan (Middle) position. It responds to touch with strength, beating and slippery, becoming firmer upon heavy pressure. This is because Ying Qi originates from the Middle Jiao, also exits via the stomach orifice to the Upper Jiao, resulting in fullness at both the Cun and Guan positions. Hence, it is termed "Zhang."
"Gang" is a combination of Gao and Zhang. Thus, it represents the struggle between pathogenic factors and healthy Qi. When they contend, healthy and pathogenic Qi attack each other, and the pulse comes rapidly and abundantly. Therefore, it is directly revealed by the term "Gang."
"Pie" (Note: The original text likely implies a specific descriptor for weak/floating pulse, often associated with 'pie pie' meaning fleeting) refers to the Cun Kou pulse being slightly slippery but weak upon heavy pressure. Upon light lifting of the finger, the pulse feels fleeting. It seems rapid but still lacks strength. This is because Wei Qi governs the exterior; when the exterior is deficient and cannot resist pathogens, there is a sensation akin to fear or palpitations in the heart. Hence, it is metaphorically described as "Pie."
"Bei" refers to pulses that do not respond to touch, often accompanied by Deep and Choppy qualities. Upon heavy pressure, they feel faint, seemingly Hidden and difficult to locate due to choppy flow. This is because Ying Qi governs the interior; when the interior is deficient, Yang Qi fails to rise, so the pulse is not prominent. It resembles the humble and subservient nature of a servant girl who cannot act independently. Hence, it is compared to "Bei."
"Sun" refers to the intermingling of Pie and Bei. Thus, it also involves contention, where both pathogenic and healthy Qi are endangered, and the pulse turns weak and minute. Therefore, it is directly called "Sun." Below the Sun pulse, there are also Slow, Moderate, and Deep variations. These describe a pulse that is leisurely and slow, firm upon heavy pressure, representing harmonious Ying and Wei Qi and embracing Yin and Yang. This is merely used to highlight the Gao and Zhang pulses.
Generally, the pulses of Gao, Zhang, Gang, Pie, Bei, and Sun all stem from the Six Pathogenic Factors (Residual and Harrowing evils). Floating and Slippery pulses indicate Qi rising to "Gao"; Wiry and Tight pulses indicate external excess reaching "Zhang"; Deep and Choppy pulses indicate internal sinking of Yang reaching "Bei." This differs from Yin-Cold pulses that remain Deep and do not transmit to other meridians. All six of these can cause pathological changes in various pulses, hence they are called "Residual and Harrowing." Even if pathogenic Qi is abundant, excessive sweating, purging, or harsh reduction can lead to deficiency. Deficiency results in a "Pie" pulse, which is weak upon heavy pressure, a inevitable outcome. When Gao and Zhang contend, the pulse is invariably rapid and abundant; when Pie and Bei contend, the pulse is invariably wiry and vigorous. Therefore, within Deep and Hidden pulses, if Wiry and Fine pulses beating against the fingers are occasionally seen at the Chi position, this indicates the arrival of the Sun pulse, which is difficult to treat.
Specifically, Gao and Pie pulses are often seen at the Cun Kou; Zhang pulses mostly appear at the Fu Yang (Dorsalis Pedis); Bei pulses are commonly found at the Shao Yin. However, Pie and Bei pulses are not absent at Cun Kou and Fu Yang. Conversely, Gao and Zhang pulses are rarely, if ever, seen at the Chi position or Shao Yin. Observing the subsequent sections on Cun Kou, Fu Yang, and Shao Yin, they all discuss diseases related to Gao, Zhang, Pie, and Bei. The major principles of Yin-Yang life and death ultimately do not exceed the general outline: "Large, Floating, Rapid, Moving, Slippery are Yang; Deep, Choppy, Weak, Wiry, Fine are Yin." Since this is not exclusively about Shaoyang pulse diagnosis, Zhang Zhongjing separately compiled the *Ping Mai Fa* (Method of Normal Pulses) section, subordinate to the *Bian Mai Fa* (Differentiation of Pulses). Consequently, when I previously interpreted the *Zuan Lun*, I barely touched upon these matters. Now, prompted by my colleague's inquiry, I find myself speaking at length.