《素问·脉要精微论》曰∶“尺内两旁，则季胁也。（季胁，小肋也。在胁下
两旁，为肾所近之处也。）尺外以候肾，尺里以候腹。（尺外者，尺脉前半部也。前以候
阳，后以候阴。背为阳，肾附背，故外以候肾。腹为阴，故里以候腹。所谓腹者，凡大小肠、膀胱、命门，皆
在其中矣。以下诸部，俱言左右，而此独不分者，以两尺皆主乎肾也。）中附上，左外以候肝，内以候膈。
（中附上者，言附尺之上而居乎中，即关脉也。左外者，言左关之前半部也；内者，言左关之
后半部也。肝为阴中之阳，而亦附近于背，故外以候肝；内以候膈，举一膈则中焦之膈膜、胆腑皆在其中矣。）
右外以候胃，内以候脾。（右关之前，所以候胃；右关之后，所以候脾。脾胃皆中州之官，而以表里
言之，则胃为阳，脾为阴，故外以候胃，内以候脾也。按寸口者，手太阴
也。太阴行气于三阴，故曰，‘三阴在手而主五脏’，所以本篇止言五脏，而不及六
腑。然胃亦腑也，而此独言之，何也？经所谓∶‘五脏皆禀气于胃，胃者，五脏之本
也。脏气者，不能自致于手太阴，必因于胃气，乃至于手太阴也。’故胃气当于此察
之。又《五脏别论》云∶‘五味入口，藏于胃，以养五脏气。气口，亦太阴也。是以五
脏六腑之气味，皆出于胃，变见于气口。’然则此篇虽止言胃，而脏腑之气亦无不见乎此矣。）上附上，右外以
候肺，内以候胸中。（上附上者，言上而又上，则寸脉也。五脏之位，惟肺最高，故右
寸之前以候肺，右寸之后以候胸中。胸中者，膈膜之上皆是也。）左外以候心，内以候膻中。
心肺皆居膈上，故左寸之前以候心，左
寸之后以候膻中。膻中者，心包络之别名也。
【按】五脏所居之
位，皆五行一定之理。火旺于南，故心居左寸；木旺于东，故肝居左关；金旺于西，
故肺居右寸；土旺于中，而寄位西南，故脾胃居右关。此即河图五行之次序也。
前以候前，后以候后。（此重申上下内外之义也。统而言之，寸为前，尺为后；分而言之，上半部为前，下
半部为后。盖言上以候上，下以候下也。）上竟上者，胸喉中事也。下竟下者，少腹腰股膝胫足中
事也。竟，尽也。言上而尽于上，在脉则尽于鱼际，在体则应乎胸喉也。下而尽
于下，在脉则尽于尺部，在体则应乎少腹腰膝足也。
【按】此章首言尺，
次言中附上而为关，又次言上附上而为寸，皆自内以及外者，盖以太阴之脉从胸走
手，以尺为根本，寸为枝叶也。故曰，凡人之脉，宁可有根而无叶，不可有叶而无
根。又按∶内外二字，诸家之注皆云内侧外侧。若以侧为言，必脉形扁阔矣，或
有两条亦可耳；不然，则于义不通矣。如前以候前，后以候后，上竟上，下竟下者，
皆内外之义也。观易卦六爻，自下而上，以上三爻为外卦，下三爻为内卦，则上下
内外之义昭然矣。或曰，浮取乎外，沉取乎内，于义亦通。然如外以候肺，内以候
胸中，外以候心，内以候膻中，是脏从外取，而腑从内候，则无是事矣。故不如从上下看为稳当也。
推而外之，内而不外，有心腹积也。（推者，察也，求也。凡诊脉必先推求于外。若但见沉脉而
无浮脉，是有内而无外矣，故知其病心腹之有积也。）推而内之，
外而不内，身有热也。（推求于内，浮而不沉，则病在外而非内矣，惟表有邪，故身有热也。）推而上之，
上而不下，腰足清也。（清者，冷也。推求于上部则脉强盛，下部则脉虚弱，
此上盛下虚，故腰足清冷也。上下有二义，以寸关尺言之，寸为上，尺为下也。）推而下之，下而不上，
头项痛也。（推求于下部，下部有力，上部无力，此清阳不能上升，故头项痛；或阳虚而阴凑之，亦头项痛也。）
按之至骨，脉气少者，腰脊痛而身有痹也。”（按之至骨，肾肝之分也。脉气少者，言无力也。
肾水虚，故腰脊痛；肝血亏，故身有痹痛也。）
【按】五脏六腑以暨心包络，共成十二经，分发于脉之六部，自有定理，莫可变乱，第详玩《内经》，
便昭然于心目矣。《内经》出胸、膈、腹三字，以分上中下而配寸关尺也。然腑不及胆者，寄于肝部也；不及大
小肠，膀胱者，统于腹中也，高阳生以大小肠列于寸上，不知大小肠皆在下焦腹中，乃欲越中焦而候之寸上，
误矣。彼不过因小肠脉络于心，大肠脉络于肺耳。然则肾之脉亦络于心，而遂以左寸候肾可乎！膻中为手
厥阴经，即心包络也。故经曰∶“左外以候心，内以候膻中。”（外，上也。
内，下也。义见上文注中。）又曰∶“膻中者，心主之宫城也。”又曰∶“心包络之脉，起于胸中，出属
心。”即此三段经文而细绎之，则膻中即是心包，
心包实为心府，昭确可据，而高阳生候于右尺，不亦妄乎！以丹溪之敏，
亦以包络、膻中分为二候，况其他哉！《内经》明称左右皆肾，而命门居
两肾之中。考《明堂》、《铜人》等经，命门一穴在督脉第十四椎下陷中，
两肾之间，且脉之应于指下，为有经络，循经络朝会于寸口，而《内经》并
无命门之经络，妄以穴名为脏，配列右尺，真是蒙昧千秋矣。三焦者，中
清之府，通行人身三元之气。三焦通，则周身之气皆通。故经曰∶“上焦
如雾，中焦如沤，下焦如渎。”王叔和分发于寸关尺，乃至当也。而高阳
生分隶于右尺，尤为谬妄，下文重言以申明之。
经曰∶“尺内两旁，则季胁也。尺外以候肾，尺里以候腹。中附上，左
外以候肝，内以候膈；右外以候胃，内以候脾。上附上，右外以候肺，内
以候胸中；左外以候心，内以候膻中。”此《内经》三部之候法也。腑不及
胆者，寄于肝也。不及大小肠、膀胱者，统于腹中也。至高阳生伪诀，以
大小肠列于寸上，以三焦配于左尺，以命门列于右尺，及厥阴膻中，竟置
而不言，又男女易位，故不可不为之辨。夫寸主上焦，以候胸中；关主中
焦，以候膈中；尺主下焦，以候腹中。此一身之定位，古今之通论也。大
小肠皆在下焦腹中，伪诀越中焦而候之寸部，有是理乎？伯仁见及于
此，以左尺主小肠、膀胱、前阴之病，右尺主大肠、后阴之病，可称千古只
眼。伪诀之误，特因心与小肠为表里，肺与大肠为表里，不知经络相为
表里，诊候自有定位，何可混耶！叛经者一也。《灵枢》曰∶“上焦出于胃
上口，并咽以上贯膈而布胸中。中焦亦并胃中，出上焦之后，泌糟粕，蒸
津液，化精微而为血。下焦者，别回肠，注于膀胱而渗入焉。水谷者，居
于胃中，成糟粕，下大肠而为下焦。”又曰∶“上焦如雾，中焦如沤，下焦如
渎。”由是则明以上中下分三焦矣。伪诀列于左尺，不亦妄乎？又曰，“密
理浓皮者，三焦浓；粗理薄皮者，三焦薄。”又曰∶“勇士者，三焦理横；怯
士者，三焦理纵。”由是则有形象矣。伪诀以为无形，不亦妄乎？叛经者
二也。《素问》曰∶“肝、心、脾、肺、肾五脏为阴，胆、胃、大小肠、三焦、膀
胱六腑为阳。”此止十一经耳，则手厥阴一经竟何在乎？又曰∶心者，君
主之官，神明出焉。肺者，相傅之官，治节出焉。肝者，将军之官，谋虑
出焉。胆者，中正之官，决断出焉。膻中者，臣使之官，喜乐出焉。脾胃
者，仓廪之官，五味出焉。大肠者，传导之官，变化出焉。小肠者，受盛
之官，化物出焉。肾者，作强之官，伎巧出焉。三焦者，决渎之官，水道
出焉。膀胱者，州都之官，津液藏焉，气化则能出矣。盖以膻中足十二
经之数，则配手厥阴经者，实膻中也。及《灵枢》叙经脉，又有包络而无膻
中。然曰“动则喜笑不休”，正与“喜乐出焉”之句相合。夫喜笑者，心
火所司，则知膻中与心应，即包络之别名也。《灵枢·邪客篇》曰∶“心者，
五脏六腑之大主，其脏坚固，邪弗能容；容之则心伤，心伤则神去，神去
则死矣。故诸邪之在心者，皆在心之包络。”独膻中称臣使者，君主之亲
臣也。由是察之，包络即为膻中，断无可疑。膻中以配心脏，自有确据。
乃伪诀竟不之及，则手厥阴为虚悬之位矣。叛经者三也。心、肝、脾、肺
俱各一候，惟肾脏而分两尺之候者，为肾有两枚，形如豇豆，分列于腰脊
之左右也。《刊误》以两尺候肾，深合经旨。《难经》、《脉诀》俱以左尺候
肾水，右尺候命门相火，误矣。考《明堂》等经，命门一穴在督脉第十四
椎下陷中两肾间。虽两肾水脏，而相火寓焉，盖一阳居二阴之间，所以
成乎坎也。独不思脉之应于指下者，为有经络，循经朝于寸口。详考《内
经》并无命门之经络也。既无经络，何以应诊而可列之右尺乎？虽然，
左阳右阴，天之常也。左水右火，地之理也。两尺之脉，左尺主肾中之
真阴，右尺主肾中之真阳，不可以左为肾、右为命门也。要知命门总主乎两肾者也。（右尺诊相火，亦通。）
《素问·脉要精微论》说：“尺部脉的内侧两旁，对应的是季胁。（季胁，即小肋。位于胁下两旁，是肾脏临近的部位。）尺部脉的外侧用来诊察肾脏，尺部脉的内侧用来诊察腹部。（尺部外侧，指的是尺脉的前半部分。前部候阳，后部候阴。背部属阳，肾脏依附于背部，所以外侧候肾。腹部属阴，所以内侧候腹。所说的腹部，包括大小肠、膀胱和命门都在其中了。以下各部位，都分左右，唯独这里不分的，是因为两尺脉都主司肾脏。）从尺部向上推至中部，左手脉的外侧用来诊察肝脏，内侧用来诊察膈膜。（中附上，指附着于尺脉之上而居于中间，也就是关脉。左外，指左关脉的前半部分；内，指左关脉的后半部分。肝属于阴中之阳，且也邻近背部，所以外侧候肝；内侧候膈，举出膈膜则中焦的膈膜、胆腑都在其中了。）右手脉的外侧用来诊察胃，内侧用来诊察脾。（右关之前，用来候胃；右关之后，用来候脾。脾胃都是中州的脏腑，如果从表里来说，胃为阳，脾为阴，所以外侧候胃，内侧候脾。按寸口脉，属于手太阴肺经。太阴经在三阴经中运行气机，所以说，‘三阴经在手上并主司五脏’，所以本篇只讲五脏，而不涉及六腑。然而胃也是腑，这里却单独提到它，为什么呢？经文所说：‘五脏的气都禀受于胃，胃是五脏的根本。脏气不能自己到达手太阴脉，必须借助胃气，才能到达手太阴脉。’所以应当在这里诊察胃气。又《五脏别论》说：‘五味入口，藏于胃，以滋养五脏之气。气口，也属于太阴经。因此五脏六腑的气味，都出于胃，变化显现于气口。’既然这样，这篇虽然只提到胃，但脏腑之气也没有不在此处显现的。）再向上推至上部，右手脉的外侧用来诊察肺，内侧用来诊察胸中。（上附上，指再往上，就是寸脉。五脏的位置，只有肺最高，所以右寸的前部候肺，右寸的后部候胸中。胸中，是指膈膜以上的部位。）左手脉的外侧用来诊察心，内侧用来诊察膻中。（心肺都居住在膈膜之上，所以左寸的前部候心，左寸的后部候膻中。膻中，是心包络的别名。）
【按语】五脏所在的位置，都是五行固定的道理。火旺于南方，所以心居左寸；木旺于东方，所以肝居左关；金旺于西方，所以肺居右寸；土旺于中央，而寄位西南，所以脾胃居右关。这就是河图五行的次序。前部候前，后部候后。（这是重申上下内外的含义。统而言之，寸为前，尺为后；分而言之，上半部为前，下半部为后。意思是上面候上面的病，下面候下面的病。）寸脉的上端尽处，对应的是胸喉中的病症。尺脉的下端尽处，对应的是少腹、腰、股、膝、胫、足中的病症。竟，就是尽的意思。说上而尽于上，在脉象上尽于鱼际，在身体上应乎胸喉。下而尽于下，在脉象上尽于尺部，在身体上应乎少腹、腰、膝、足。
【按语】这一章首先说尺脉，其次说中附上而为关脉，再次说上附上而为寸脉，都是从内到外，因为太阴经脉从胸走手，以尺为根本，寸为枝叶。所以说，凡人的脉象，宁可只有根而没有叶，不可有叶而没有根。另外，内外二字，各家注解都说内侧外侧。如果说侧，脉形一定是扁阔的，或者可以看作两条脉；否则，意义就不通了。如前以候前，后以候后，上竟上，下竟下，都是内外的含义。看易经卦象的六爻，自下而上，以上三爻为外卦，下三爻为内卦，那么上下内外的含义就清楚了。有人说，浮取在外，沉取在内，意义也通。但是像外以候肺，内以候胸中，外以候心，内以候膻中，如果是脏从外取，腑从内候，就没有这种事了。所以不如从上下来看比较稳妥。
将脉象向外推求（浮取），如果脉象沉伏而不浮（内而不外），说明有心腹积滞。（推，是察求的意思。凡诊脉必须先推求于外。如果只见沉脉而无浮脉，是有内而无外，所以知道病在心腹有积滞。）将脉象向内推求（沉取），如果脉象浮起而不沉（外而不内），说明身体有发热。（推求于内，脉浮而不沉，则病在外而非在内，只有体表有邪气，所以身体发热。）将脉象向上推求，如果上部脉盛而下部脉弱（上而不下），说明腰脚寒冷。（清，就是冷。推求上部则脉强盛，下部则脉虚弱，这是上盛下虚，所以腰脚清冷。上下有两层含义，以寸关尺而言，寸为上，尺为下。）将脉象向下推求，如果下部脉盛而上部脉弱（下而不上），说明头项疼痛。（推求下部，下部有力，上部无力，这是清阳不能上升，所以头项痛；或者是阳虚而阴寒凑之，也会头项痛。）按压脉象至骨，脉气微弱无力的，说明腰脊疼痛且身体有痹症。（按之至骨，是肝肾的分野。脉气少，指无力。肾水虚，所以腰脊痛；肝血亏，所以身体有痹痛。）
【按语】五脏六腑以及心包络，共构成十二经脉，分发于脉之六部，自有定规，不可变乱，只要详细研读《内经》，就在心中清晰明白了。《内经》提出胸、膈、腹三个字，来区分上中下并配合寸关尺。然而没有提到胆，是因为胆寄附于肝部；没有提到大小肠、膀胱，是因为它们统属于腹部。高阳生把大小肠列在寸脉上部，不知道大小肠都在下焦腹部，却想越过中焦而在寸上诊候，这是错误的。他不过是因小肠脉络于心，大肠脉络于肺罢了。那么肾的脉也络于心，难道就可以用左寸来候肾吗！膻中是手厥阴经，即心包络。所以经文说：“左手脉外侧候心，内侧候膻中。”（外，指上。内，指下。意义见上文注中。）又说：“膻中，是心主的宫城。”又说：“心包络的脉，起于胸中，出来属于心。”仅凭这三段经文细细推敲，那么膻中就是心包，心包实为心的府库，确凿有据，而高阳生在右尺诊候心包，不是妄谬吗！以朱丹溪的敏锐，也把包络、膻中分为两个诊候，何况其他人呢！《内经》明确称左右两尺都主肾，而命门位于两肾之间。考证《明堂》、《铜人》等经书，命门一穴在督脉第十四椎下的凹陷中，两肾之间。而且脉象应于指下的，必须有经络，循经络朝会于寸口，而《内经》并没有命门的经络，妄把穴名当作脏器，配列在右尺，真是蒙昧千秋啊。三焦，是中清之府，通行人身三元之气。三焦通畅，则周身之气皆通畅。所以经文说：“上焦如雾，中焦如沤，下焦如渎。”王叔和将其分发于寸关尺，是非常恰当的。而高阳生将其隶属于右尺，更是荒谬妄诞，下文重复言说以申明此理。
经文说：“尺部脉内侧两旁，对应季胁。尺部外侧候肾，内侧候腹。中附上，左手外侧候肝，内侧候膈；右手外侧候胃，内侧候脾。上附上，右手外侧候肺，内侧候胸中；左手外侧候心，内侧候膻中。”这是《内经》三部诊法。没有提到胆，是因为胆寄附于肝。没有提到大小肠、膀胱，是因为它们统属于腹部。至于高阳生的伪诀，把大小肠列在寸上，把三焦配在左尺，把命门列在右尺，以及厥阴膻中，竟然置之不谈，又把男女诊法互换，所以不得不为之辩驳。寸主上焦，以候胸中；关主中焦，以候膈中；尺主下焦，以候腹中。这是一身定位，古今的通论。大小肠都在下焦腹部，伪诀越过中焦而在寸部诊候，哪有这个道理？伯仁见识到了这一点，认为左尺主小肠、膀胱、前阴的病，右尺主大肠、后阴的病，可称为千古独具慧眼。伪诀的错误，特别因为心与小肠为表里，肺与大肠为表里，不知道经络相为表里，诊候自有定位，怎么可以混淆呢！这是违背经典的第一点。《灵枢》说：“上焦出于胃上口，并咽以上贯膈而布胸中。中焦亦并胃中，出上焦之后，泌糟粕，蒸津液，化精微而为血。下焦者，别回肠，注于膀胱而渗入焉。水谷，居于胃中，成糟粕，下大肠而为下焦。”又说：“上焦如雾，中焦如沤，下焦如渎。”由此明确以上中下分三焦。伪诀把它列在左尺，不是妄谬吗？又说，“纹理致密皮厚的，三焦厚；纹理粗糙皮薄的，三焦薄。”又说，“勇士，三焦纹理横；怯士，三焦纹理纵。”由此就有形象了。伪诀认为三焦无形，不是妄谬吗！这是违背经典的第二点。《素问》说：“肝、心、脾、肺、肾五脏为阴，胆、胃、大小肠、三焦、膀胱六腑为阳。”这只有十一经罢了，那么手厥阴一经在哪里呢？又说：心，是君主之官，神明由此出。肺，是相傅之官，治节由此出。肝，是将军之官，谋虑由此出。胆，是中正之官，决断由此出。膻中，是臣使之官，喜乐由此出。脾胃，是仓廪之官，五味由此出。大肠，是传导之官，变化由此出。小肠，是受盛之官，化物由此出。肾，是作强之官，伎巧由此出。三焦，是决渎之官，水道由此出。膀胱，是州都之官，津液藏于此，气化则能排出。大概以膻中补足十二经之数，那么配手厥阴经的，实际就是膻中。及至《灵枢》叙述经脉，又有包络而没有膻中。但是说“动则喜笑不休”，正好与“喜乐出焉”的句子相合。喜笑，是心火所主管，那么知道膻中与心相应，即是包络的别名。《灵枢·邪客篇》说：“心，是五脏六腑的大主，其脏坚固，邪气不能容纳；容纳则心伤，心伤则神去，神去则死。所以所有邪气在心方面的，都在心之包络。”唯独膻中被称为臣使，是君主的亲臣。由此考察，包络即为膻中，断无可疑。膻中以配心脏，自有确据。乃伪诀竟然不涉及，那么手厥阴就成了虚悬之位了。这是违背经典的第三点。心、肝、脾、肺各有一个诊候，唯独肾脏分在两尺诊候的，是因为肾有两个，形状像豇豆，分列于腰脊左右。《刊误》认为两尺候肾，深合经旨。《难经》、《脉诀》都以左尺候肾水，右尺候命门相火，这是错误的。考证《明堂》等经书，命门一穴在督脉第十四椎下凹陷中两肾间。虽然两肾是水脏，而相火寓居其中，盖是一阳居于二阴之间，所以形成坎卦。只是没考虑到脉象应于指下的，必须有经络，循经朝于寸口。详细考证《内经》并没有命门的经络。既然没有经络，凭什么应诊而可以列在右尺呢？虽然如此，左阳右阴，是天的常理。左水右火，是地的道理。两尺脉，左尺主肾中的真阴，右尺主肾中的真阳，不可以左为肾、右为命门。要知道命门总主两肾。（右尺诊相火，也说得通。）
The *Suwen: Pulse Essentials and Subtleties* states: "The inner sides of the chi (尺) pulse correspond to the jixie (季胁, hypochondriac region with small ribs). The outer side of the chi pulse is used to inspect the Kidney (Shen, 肾), and the inner side is used to inspect the abdomen (Fu, 腹). The 'outer side' refers to the anterior half of the chi pulse. The anterior part inspects Yang, and the posterior part inspects Yin. The back belongs to Yang, and the Kidney attaches to the back, hence the outer side inspects the Kidney. The abdomen belongs to Yin, hence the inner side inspects the abdomen. By 'abdomen,' it includes the Large Intestine (Dachang, 大肠), Small Intestine (Xiaochang, 小肠), Bladder (Pangguang, 膀胱), and Mingmen (命门, Gate of Vitality). For the following sections, left and right are distinguished, but here they are not, because both chi pulses govern the Kidneys. Moving up from the chi to the middle (zhong fushang, 中附上), the outer side of the left hand pulse inspects the Liver (Gan, 肝), and the inner side inspects the diaphragm (Ge, 膈). 'Zhong fushang' means attaching above the chi and residing in the middle, which is the guan (关) pulse. 'Left outer' refers to the anterior half of the left guan pulse; 'inner' refers to the posterior half. The Liver is Yin containing Yang and is also near the back, so the outer side inspects the Liver; the inner side inspects the Diaphragm. Mentioning the Diaphragm implies the mediastinal membrane and Gallbladder (Dan, 胆) of the Middle Jiao (Zhongjiao, 中焦) are included. The outer side of the right hand pulse inspects the Stomach (Wei, 胃), and the inner side inspects the Spleen (Pi, 脾). The anterior part of the right guan inspects the Stomach; the posterior part inspects the Spleen. The Spleen and Stomach are organs of the Central Earth (Zhongzhou, 中州). Speaking of exterior and interior, the Stomach is Yang and the Spleen is Yin, hence the outer side inspects the Stomach and the inner side inspects the Spleen. The cunkou (寸口, radial artery at the wrist) belongs to the Hand Taiyin Lung Meridian (Shou Taiyin Fei Jing, 手太阴肺经). The Taiyin circulates Qi among the three Yin meridians, hence it is said, 'The three Yin meridians are on the hands and govern the five Zang organs.' Thus, this chapter only mentions the five Zang organs and does not mention the six Fu organs. However, the Stomach is also a Fu organ, yet it is mentioned alone here. Why? The classic says, 'The Qi of the five Zang organs is derived from the Stomach; the Stomach is the root of the five Zang organs. The Qi of the Zang organs cannot reach the Hand Taiyin by itself; it must rely on Stomach Qi to reach the Hand Taiyin.' Therefore, Stomach Qi should be inspected here. Furthermore, the *Wuzangielun* says, 'Flavors enter the mouth and are stored in the Stomach to nourish the Qi of the five Zang organs. The Qikou (气口, radial pulse) also belongs to the Taiyin. Therefore, the Qi and flavors of the five Zang and six Fu organs all originate from the Stomach and manifest at the Qikou.' Thus, although this chapter only mentions the Stomach, the Qi of the Zang and Fu organs is all visible here. Moving up again to the upper section (shang fushang, 上附上), the outer side of the right hand pulse inspects the Lung (Fei, 肺), and the inner side inspects the chest center (Xiongzho ng, 胸中). 'Shang fushang' means moving further up, which is the cun (寸) pulse. Among the five Zang organs, the Lung is the highest. Hence, the anterior part of the right cun inspects the Lung, and the posterior part inspects the Chest Center. The Chest Center refers to everything above the diaphragm. The outer side of the left hand pulse inspects the Heart (Xin, 心), and the inner side inspects the Danzhong (膻中). The Heart and Lung reside above the diaphragm, so the anterior part of the left cun inspects the Heart, and the posterior part inspects the Danzhong. The Danzhong is another name for the Pericardium (Xinbaoluo, 心包络).
[Commentary] The positions of the five Zang organs follow the fixed principles of the Five Elements (Wuxing, 五行). Fire flourishes in the South, so the Heart resides in the left cun; Wood flourishes in the East, so the Liver resides in the left guan; Metal flourishes in the West, so the Lung resides in the right cun; Earth flourishes in the Center and is stationed in the Southwest, so the Spleen and Stomach reside in the right guan. This is the sequence of the He Tu Five Elements. The anterior part inspects the anterior, and the posterior part inspects the posterior. (This reiterates the meaning of upper/lower and inner/outer. Generally speaking, cun is anterior and chi is posterior; specifically, the upper half is anterior and the lower half is posterior. It means the upper part inspects upper diseases, and the lower part inspects lower diseases.) The extreme end of the upper pulse corresponds to matters of the chest and throat. The extreme end of the lower pulse corresponds to matters of the lower abdomen, waist, thigh, knee, shin, and foot. 'Jing' (竟) means 'end.' Saying 'upper to the extreme of the upper,' in the pulse it ends at the Yuji (鱼际, Fish Border) point, and in the body it corresponds to the chest and throat. 'Lower to the extreme of the lower,' in the pulse it ends at the chi section, and in the body it corresponds to the lower abdomen, waist, knees, and feet.
[Commentary] This chapter first discusses the chi pulse, then the zhong fushang as the guan pulse, and finally the shang fushang as the cun pulse, proceeding from inner to outer. This is because the Taiyin meridian runs from the chest to the hand, taking the chi as the root and the cun as the branches. Thus, it is said that in human pulses, one may have roots without branches, but never branches without roots. Additionally, regarding the terms 'inner' and 'outer,' commentators generally interpret them as medial and lateral sides. If interpreted as sides, the pulse shape would be flat and broad, or perhaps two lines could exist; otherwise, the meaning is unclear. Terms like 'anterior inspects anterior, posterior inspects posterior, upper extreme inspects upper, lower extreme inspects lower' all refer to the meaning of inner and outer. Observing the hexagrams of the I Ching, from bottom to top, the upper three lines form the Upper Trigram (Outer), and the lower three lines form the Lower Trigram (Inner); thus, the meanings of upper/lower and inner/outer become clear. Some say, floating pulse indicates exterior, deep pulse indicates interior, which also makes sense. However, if 'outer' inspects the Lung and 'inner' inspects the Chest Center, 'outer' inspects the Heart and 'inner' inspects the Danzhong, implying Zang organs are taken from the exterior and Fu organs from the interior, this is incorrect. Therefore, interpreting them from an upper/lower perspective is more appropriate.
Exerting pressure outward (floating inspection): if the pulse is deep and not floating (interior without exterior), there is accumulation in the heart and abdomen. ('Tui', push/exert, means to examine and seek. In pulse diagnosis, one must first seek outward. If only a deep pulse is seen without a floating pulse, there is interior without exterior, indicating disease with accumulation in the heart and abdomen.) Exerting pressure inward (deep inspection): if the pulse is floating and not deep (exterior without interior), the body has heat. (Seeking inward, if the pulse floats without sinking, the disease is in the exterior rather than the interior; only external pathogens cause bodily heat.) Exerting pressure upward: if the upper pulse is strong and the lower pulse is weak (upper without descending), the waist and feet are cold. ('Qing' means cold. Seeking the upper part shows a strong pulse, while the lower part shows a weak pulse; this is excess above and deficiency below, causing coldness in the waist and feet. 'Upper and lower' has two meanings: referring to cun/guan/chi, cun is upper and chi is lower.) Exerting pressure downward: if the lower pulse is strong and the upper pulse is weak (lower without ascending), there is pain in the head and neck. (Seeking the lower part, if the lower is forceful and the upper is weak, clear Yang cannot ascend, causing head and neck pain; or if Yang deficiency allows Yin to gather, head and neck pain also occurs.) Pressing to the bone, if the pulse Qi is scanty, there is pain in the waist and spine and bi-syndrome (numbness/pain) in the body. (Pressing to the bone relates to the Liver and Kidney. Scanty pulse Qi means weakness. Kidney Water deficiency causes waist and spine pain; Liver Blood deficiency causes body numbness and pain.)
[Commentary] The five Zang organs, six Fu organs, and Pericardium constitute the twelve meridians, distributed across the six pulse positions according to fixed rules that cannot be confused. Carefully studying the *Neijing* makes this clear. The *Neijing* uses the characters chest (Xiong, 胸), diaphragm (Ge, 膈), and abdomen (Fu, 腹) to distinguish upper, middle, and lower sections corresponding to cun, guan, and chi. The Gallbladder is omitted because it is attached to the Liver position; the Large Intestine, Small Intestine, and Bladder are omitted because they are collectively governed by the abdomen. Gao Yangsheng placed the Large and Small Intestines at the upper cun, not knowing they are in the lower jiao abdomen, attempting to inspect them at the upper cun bypassing the middle jiao, which is erroneous. He likely did so because the Small Intestine meridian connects to the Heart and the Large Intestine meridian connects to the Lung. But since the Kidney meridian also connects to the Heart, could the Left Cun inspect the Kidney! The Danzhong is the Hand Jueyin meridian, i.e., the Pericardium. Thus, the classic says, "Left outer inspects the Heart, inner inspects the Danzhong." ('Outer' means upper, 'inner' means lower, as explained previously.) It also says, "The Danzhong is the palace city of the Heart Master." And, "The Pericardium meridian originates in the chest center and emerges to belong to the Heart." From these three passages, it is evident that Danzhong is the Pericardium, and the Pericardium is indeed the mansion of the Heart, which is well-founded. Gao Yangsheng's placement at the Right Chi is absurd. Even Zhu Danxi, despite his acuity, separated the Pericardium and Danzhong into two positions; how much more so for others! The *Neijing* clearly states both left and right chi govern the Kidney, while the Mingmen is between the two kidneys. Examining classics like *Mingtang* and *Tongren*, the Mingmen acupoint is in the depression below the 14th thoracic vertebra of the Du Meridian, between the two kidneys. Moreover, pulses felt under the fingers must correspond to meridians that converge at the cunkou. The *Neijing* mentions no Mingmen meridian. Falsely treating an acupoint name as a zang organ and assigning it to the Right Chi is truly ignorant for millennia. The Sanjiao (Triple Burner) is the mansion of clear fluids, circulating the three Yuan Qi throughout the body. When the Sanjiao is open, Qi flows throughout the body. Thus, the classic says, "The Upper Jiao is like mist, the Middle Jiao is like fermentation, the Lower Jiao is like a ditch." Wang Shuhe's distribution of the Sanjiao to cun, guan, and chi is highly appropriate. Gao Yangsheng's assignment to the Right Chi is even more absurd; the following text reiterates this to clarify.
The classic says: "The inner sides of the chi pulse correspond to the jixie. The outer side of the chi inspects the Kidney, the inner side inspects the abdomen. Zhong fushang: Left outer inspects the Liver, inner inspects the diaphragm; Right outer inspects the Stomach, inner inspects the Spleen. Shang fushang: Right outer inspects the Lung, inner inspects the chest center; Left outer inspects the Heart, inner inspects the Danzhong." This is the three-position inspection method of the *Neijing*. The Gallbladder is omitted because it is attached to the Liver. The Large and Small Intestines and Bladder are omitted because they are governed by the abdomen. Gao Yangsheng's false mantra places the Large and Small Intestines at the upper cun, the Sanjiao at the left chi, and the Mingmen at the right chi, while ignoring the Jueyin Danzhong, and even swapping male and female positions. Therefore,辨析 (analysis/correction) is necessary. The cun governs the Upper Jiao and inspects the chest center; the guan governs the Middle Jiao and inspects the diaphragm; the chi governs the Lower Jiao and inspects the abdomen. This is the fixed position of the body and a universal theory of past and present. The Large and Small Intestines are in the lower jiao abdomen; can the false mantra really place them at the cun bypassing the middle jiao? Bo Ren realized this, stating that the Left Chi governs diseases of the Small Intestine, Bladder, and anterior orifice, and the Right Chi governs diseases of the Large Intestine and posterior orifice, earning him praise for his unique insight. The error of the false mantra stems from the exterior-interior relationship of the Heart-Small Intestine and Lung-Large Intestine. Not understanding that meridian exterior-interior relationships have specific diagnostic positions, one should not confuse them. This is the first deviation from the classic. The *Ling Shu* says: "The Upper Jiao issues from the upper orifice of the stomach, travels along the pharynx, pierces the diaphragm, and spreads in the chest. The Middle Jiao also lies within the stomach, emerging after the Upper Jiao, separating dregs, steaming fluids, transforming essence and microcosms into blood. The Lower Jiao separates from the ileum, pours into the Bladder, and seeps in. Food and water reside in the stomach, become dregs, pass down to the Large Intestine, and become the Lower Jiao." It also says, "The Upper Jiao is like mist, the Middle Jiao is like fermentation, the Lower Jiao is like a ditch." Thus, the Upper, Middle, and Lower Jiao are clearly defined by upper, middle, and lower positions. Placing the Sanjiao at the Left Chi is absurd. It also says, "Those with dense texture and thick skin have a thick Sanjiao; those with coarse texture and thin skin have a thin Sanjiao." And, "Warriors have horizontal Sanjiao textures; cowards have vertical Sanjiao textures." Thus, the Sanjiao has physical form. Claiming the Sanjiao is formless is absurd. This is the second deviation from the classic. The *Suwen* says: "The Liver, Heart, Spleen, Lung, and Kidney are five Yin Zang organs; the Gallbladder, Stomach, Large Intestine, Small Intestine, Sanjiao, and Bladder are six Yang Fu organs." This lists only eleven meridians. Where is the Hand Jueyin meridian? It also says: The Heart is the Official of the Sovereign, from whom Shenming (Spirit/Mind) emerges. The Lung is the Official of the Chancellor, from whom governance and regulation emerge. The Liver is the Official of the General, from whom strategy emerges. The Gallbladder is the Official of Justice, from whom decision-making emerges. The Danzhong is the Official of the Envoy, from whom joy and pleasure emerge. The Spleen and Stomach are the Officials of the Granary, from whom the five flavors emerge. The Large Intestine is the Official of Conduction, from whom transformation emerges. The Small Intestine is the Official of Reception, from whom processing emerges. The Kidney is the Official of Strength, from whom skill emerges. The Sanjiao is the Official of Drainage, from whom waterways emerge. The Bladder is the Official of the Metropolis, storing fluids, which are excreted through Qi transformation. Essentially, the Danzhong completes the count of twelve meridians; thus, the one paired with the Hand Jueyin meridian is actually the Danzhong. However, the *Ling Shu* describes the meridians mentioning the Pericardium but not the Danzhong. Yet, it says "movement leads to incessant laughter," which aligns with "joy and pleasure emerge." Laughter is governed by Heart Fire, indicating the Danzhong corresponds to the Heart and is another name for the Pericardium. The *Ling Shu: Xieke Pian* says: "The Heart is the Great Master of the five Zang and six Fu organs. Its organ is solid, and pathogens cannot accommodate themselves; if they do, the Heart is injured, Shen departs, and death ensues. Therefore, all pathogens affecting the Heart are located in the Pericardium." Only the Danzhong is called the Envoy, a close minister to the Sovereign. From this, it is observed that the Pericardium is the Danzhong, leaving no doubt. Pairing the Danzhong with the Heart has firm evidence. The false mantra ignores this, leaving the Hand Jueyin as a vacant position. This is the third deviation from the classic. The Heart, Liver, Spleen, and Lung each have one position. Only the Kidney is divided into two chi positions because there are two Kidneys, shaped like kidney beans, located on the left and right of the lumbar spine. The *Kanwu* states that both chins inspect the Kidney, deeply conforming to the classic's intent. The *Nanjing* and *Maijue* incorrectly state that the Left Chi inspects Kidney Water and the Right Chi inspects the Mingmen Minister Fire. Examining classics like *Mingtang*, the Mingmen acupoint is in the depression between the two kidneys below the 14th thoracic vertebra. Although both Kidneys are Water organs, Minister Fire resides within them, forming the Kan trigram with one Yang line between two Yin lines. One fails to consider that pulses felt under the fingers must correspond to meridians converging at the cunkou. Detailed examination of the *Neijing* reveals no Mingmen meridian. Without a meridian, how can it be diagnosed and listed at the Right Chi? Nevertheless, Left is Yang and Right is Yin, the constant of Heaven. Left is Water and Right is Fire, the principle of Earth. The two chi pulses: the Left Chi governs the True Yin within the Kidney, and the Right Chi governs the True Yang within the Kidney. One cannot equate Left with Kidney and Right with Mingmen. It must be known that the Mingmen governs both Kidneys overall. (Inspecting Minister Fire at the Right Chi is also acceptable.)