，右寸肺、关脾、尺命，亦言直也；三菽肺，六菽心，九菽脾，十二菽肝，按之至骨肾，亦
言横也。升降出入，虽分横直，统归于阴阳之嘘吸而已。人病虚劳，直气不能布于周身。若
阴气先伤，则吸力先微，内不能至肾，至肝而还，而有骨痿之事矣；若阳气先伤，则呼力先
微，外不能至肺，至心而还，而有皮聚毛悴之事矣。所谓肝肾心肺者，谓分野之表里浅深也
。如是则脉行十六丈二尺为一周者，其数有不盈矣；不盈则升降出入之期促，故脉数也。《
难经》论损至之脉曰∶一呼三至，至一呼六至，此至之脉也；一呼一至，至四呼一至，此损
之脉也。至脉从下上，损脉从上下。损脉之为病，始于皮聚毛落，而极于骨痿不能起于床；
反此者至之为病也。从下上者，皮聚而毛落者死；从上下者，骨痿不能起于床者死∶穷之于
其极也。卢子由曰∶脉来之损至，即脉至之疾徐，至固不离乎至，损岂独外于至乎?是盖疑
虚损之脉，必数而无迟也。扁鹊亦曰；一呼脉四至以上，谓痹者脱脉气，谓失十六丈二尺一
周之常经也。然虚损脉迟者甚多，但其情不同。脉数者，血液先败，塞其气道，气悍而不通
，故短促也；脉迟者，血液未败，而真气之力不能劲达，如人行路遥，力倦而欲息也。是其
病始于气，而未坏有形之血液，故易治，补其气而血自生也；气不能周，反见脉数者，是血
坏而气无所归，故难治，补其气而血愈壅也。是故初病即见脉数者，是因痹致虚，血病累气
，故曰从下损上，即由里而表也；先脉迟而渐见脉数者，是因虚致痹，气病累血，故曰从上
损下，即由表而里也。至于气不能至肾至肺，非全无气也，正气为邪气所据，不能应期而至
耳!若全无气，则一脏气绝，五脏俱无以自存矣。此劳痹之大义也。积聚、痈疽、麻木、疼
痛之痹，在经络之中，只是两头有气，中间隔塞，其本未伤，疏之而即复矣。譬如一管之中
，
有物结之，去其结而气自行矣。此实痹之大义也。实痹之治无论矣。劳痹之治，《难经》有
曰∶损其肺者，益其气；损其心者，调其荣卫；
损其脾者，调其饮食，适其寒温；损其肝者，缓其中；损其肾者，益其精。此皆以虚言之也
。而劳痹之为病，往往虚实夹杂。仲景治血痹风气百疾，有薯蓣丸，是补其虚也；有大黄
虫丸，是攻其实也。更有外邪久结，证同虚损，如徐灵胎所谓风寒不醒成劳病者。近日凡病
咳嗽，辄称肺热，桑叶、麦冬，摇笔即来。生地、知母，满纸俱是。于是阳气日衰，风寒与
水饮合力盘踞膻中，渐致夜不伏枕，涎中带红，头面 肿，呼吸喘促，饮食呕逆，大便溏泄
，而危矣。故今之病五苓、青龙证者，无不逼入劳损，覆辙相寻，至死不悟。张景岳曰∶外
感之邪未除，而留伏于经络；饮食之滞不消，而积聚于脏腑。或郁结逆气，有不可散；或顽
痰瘀血，有所留藏，病久致羸，似形不足，不知病本未除，还当治本。若误用补，必益其病
矣。医能明此，其寡过矣乎!
大抵治病必先求邪气之来路，而后能开邪气之去路。病在升降，举之、抑之；病在出入
，疏
之、固之。或病在升降而斡旋于出入，或病在出入而斡旋于升降。气之上逆，下不纳也；气
之下陷，上不宣也；气之内结，外不疏也；气之外泄，内不谐也。故赵晴初曰∶人身内外作
两层，上下作两截，而内外上下，每如呼吸而动相牵引。譬如攻下而利，是泄其在内之下截
，而上截之气即陷，内上即空，其外层之表气连邪内入，此结胸之根也。譬如发表而汗，是
疏其在外之上截，而在内之气跟出，内上即空，其内下之阴气上塞，此痞闷之根也。故在上
禁过汗，在内慎攻下，此阴阳盈虚消长之理也。
抑吾尤有默会之旨，不欲为外人道，而不得不道也。《内经》以升降出入关于生长壮老
己者
，何也?本草称日能松物，以絮久曝日中，则松矣，是日有提摄之力也。凡物皆向日，不独
葵、藿也。非物有知，日有摄力也。人在日下，其气亦为日所提摄矣。物置地上，久则下陷
，以地心有吸力也。人在地上，其气亦为地所吸引矣。至于气之往来于空中，更无一息之
或间
。庄子曰∶人在风中。仲景曰∶人因风气而生长。人为风所鼓荡，其气之出入不待言矣。人
之初生，合父精母血而成形。其体象地，各有自具之吸力。其力多藏于五脏及骨髓之中，故
气能自固于体中而不散也。及其生也，则上为日所摄，下为地所吸，中为风所鼓荡，而日长
日壮矣。及其衰也，摄之久而气渐上脱矣，吸之久而气渐下脱矣，鼓荡之久而气渐外散矣，
故为老为已也。大抵三气之中，惟地之吸力最强，故人死则体重，以本体不能自主，全为地
所吸也。又人死，其尸不可见日，恐复为日气所提摄而尸走也。生人不可与尸骑牛临面，生
人身有吸力，恐尸中游气未尽，二气相感而相吸，而亦有尸走之事也。是说也，前人未言，
得毋骇俗乎?夫人劳则气动，而心劳则五脏之吸力皆疏，故气易散，而易老易已也。人静则
气固而心静，则五脏之吸力尤固，故气常完而多寿难老也。然则明于斯义，是亦养生之助也
，而又何骇乎?痹论曰∶阴气者，静则神藏，躁则消亡。生气通天曰∶阳气者，静则养神，
柔则养筋。大惑论曰∶心劳则魂魄散，志意乱。故经脉别论叙五脏喘汗之事，而申其戒曰∶
四时之病，常起于过用也。故曰∶无形无患，与道协议，惟真人也。
（切脉时，）右手的寸部对应肺、关部对应脾、尺部对应命门，这也是在说明“直”的概念；轻取三菽之重候肺气，六菽之重候心气，九菽之重候脾气，十二菽之重候肝气，按至骨面候肾气，这也是在说明“横”的概念。升降出入运动，虽然分为横向和纵向，但统归于阴阳的呼吸吐纳罢了。人患虚劳病时，直行之气不能布散于全身。如果阴气先受伤，则吸气之力先微弱，气息向内不能到达肾脏，到达肝脏便返回，从而出现骨痿的症状；如果阳气先受伤，则呼气之力先微弱，气息向外不能到达肺部，到达心脏便返回，从而出现皮毛枯聚憔悴的症状。这里所说的肝肾心肺，是指脏腑分野的表里浅深关系。如果是这样，那么脉气运行十六丈二尺为一周的说法，其数值就不够充盈了；不充盈则升降出入的周期急促，所以脉搏频率快。《难经》论述损脉和至脉时说：一呼脉跳三次，甚至一呼脉跳六次，这是至脉；一呼脉跳一次，甚至四呼才脉跳一次，这是损脉。至脉的病势是从下向上发展，损脉的病势是从上向下发展。损脉所致的疾病，始于皮毛枯落，极至于骨痿不能起床；相反的情况则是至脉所致疾病的特征。从下向上发展的，若出现皮毛枯落者死；从上向下发展的，若出现骨痿不能起床者死：这是因为病势穷尽到了极点。卢子由说：脉来的损伤与至极，即脉至的疾徐变化，至脉固然不离“至”的概念，损脉难道独自在“至”之外吗？这大概是怀疑虚损的脉象，必定是数脉而没有迟脉。扁鹊也说：一呼脉跳四次以上，称为痹证或脱脉气，是指失去了十六丈二尺一周的常规经脉运行。然而虚损病中脉迟的情况很多，只是病情不同。脉数的，是因为血液先败坏，堵塞了气道，气机悍急而不通畅，所以短促；脉迟的，是因为血液未败坏，而真气的力量不能强劲通达，就像人行路遥远，力气疲倦想要休息一样。这种病始于气分，而未损坏有形的血液，所以容易治疗，补气则血自生；气不能周流，反而出现脉数的，是血已败坏而气无所依附，所以难治，补气则血更加壅滞。因此，初病就见到脉数的，是因痹证导致虚损，血病累及气，所以说“从下损上”，即由里而表；先见脉迟而后逐渐出现脉数的，是因虚损导致痹证，气病累及血，所以说“从上损下”，即由表而里。至于气不能到达肾脏和肺部，并非完全没有气，而是正气被邪气占据，不能按时到达！如果完全没有气，则一脏气绝，五脏都无法存留了。这就是劳痹的大义。积聚、痈疽、麻木、疼痛等痹证，位于经络之中，只是两头有气，中间隔塞不通，其根本未伤，疏通后即可恢复。譬如一根管子中，有物体结塞，去掉结塞物而气自然通行。这是实痹的大义。实痹的治疗无需多言。劳痹的治疗，《难经》说：损伤肺的，补益其气；损伤心的，调和营卫；损伤脾的，调节饮食，适应寒温；损伤肝的，舒缓其中焦郁结；损伤肾的，补益其精。这些都是针对虚证而言的。而劳痹这种疾病，往往是虚实夹杂。张仲景治疗血痹风气百疾，有用薯蓣丸，这是补其虚；有大黄䗪虫丸，这是攻其实。更有外邪久结，症状类似虚损，如徐灵胎所说风寒不解成劳病者。近日凡是咳嗽病症，都称肺热，桑叶、麦冬，挥笔即用。生地、知母，满纸皆是。于是阳气日渐衰微，风寒与水饮合力盘踞膻中，逐渐导致夜间不能安卧，唾液中带红，头面浮肿，呼吸喘促，饮食呕吐逆反，大便溏泄，从而陷入危境。所以现在患五苓散证、青龙汤证的人，无不逼迫进入劳损境地，重蹈覆辙，至死不悟。张景岳说：外感邪气未除，而留伏于经络；饮食停滞不消，而积聚于脏腑。或有郁结逆气，不可消散；或有顽痰瘀血，有所留藏，病久导致身体消瘦，看似形不足，不知病本未除，还应当治本。如果误用补法，必定加重病情。医生能明白这个道理，大概就能少犯错误了吧！
大抵治病必须先探求邪气的来路，然后才能开通邪气的去路。病在升降方面，用升提或降抑的方法；病在出入方面，用疏泄或固涩的方法。或者病在升降而在出入之间斡旋，或者病在出入而在升降之间斡旋。气机上逆，下部不能纳气；气机下陷，上部不能宣发；气机内结，外部不能疏泄；气机外泄，内部不能协调。所以赵晴初说：人身内外分为两层，上下分为两截，而内外上下，常常像呼吸一样相互牵引。譬如攻下后导致腹泻，这是泄其在内的下截，而上截之气随即下陷，内上部即空虚，外层之表气连带邪气内入，这是结胸的根源。譬如发表后出汗，这是疏泄其在外部的上截，而在内之气跟随外出，内上部即空虚，内下部之阴气上塞，这是痞闷的根源。所以在上的部位禁止过度发汗，在里的部位谨慎攻下，这是阴阳盈虚消长的道理。
况且我还有默会于心之意旨，不想对外人道出，却不得不道出。《内经》将升降出入与生长壮老已联系起来，为什么呢？本草书称太阳能松物，把棉絮长久暴露在日光下，就会变松，这说明太阳有提摄之力。凡物都朝向太阳，不只是向日葵和豆类植物如此。并非物有知觉，而是太阳有摄力。人在日光下，其气也被太阳提摄。物品放置在地上，久了则会下陷，因为地心有吸力。人在地上，其气也被大地吸引。至于气在空中的往来，更是一息不间断。庄子说：人在风中。张仲景说：人因风气而生长。人被风鼓荡，其气的出入不言而喻。人的初生，结合父精母血而成形体。其体象地，各有自身具备的吸力。这种力量多藏于五脏及骨髓之中，所以气能在体内自我固守而不散逸。等到人成长，则上为太阳所摄，下为大地所吸，中为风所鼓荡，因而日益强壮。等到人衰老，摄之久远则气渐向上脱失，吸之久远则气渐向下脱失，鼓荡之久远则气渐向外散逸，所以变老乃至死亡。大抵这三种气中，只有大地的吸力最强，所以人死后体重，因为本体不能自主，完全被大地所吸引。另外人死后，尸体不可见日光，恐怕再次被日气提摄而导致尸走。活人不可与尸体骑牛面对面，活人身有吸力，恐怕尸体中游气未尽，二气相感而相吸，也可能发生尸走之事。这种说法，前人未曾言及，恐怕会惊骇世俗吧？人劳作则气动，而心劳则五脏的吸力皆疏泄，所以气易散逸，而易老易死。人安静则气固守而心静，则五脏的吸力尤其坚固，所以气常完整而多寿难老。既然明白了这个义理，这也是养生的帮助，又有什么可惊骇的呢？《痹论》说：阴气者，静则神藏，躁则消亡。《生气通天论》说：阳气者，静则养神，柔则养筋。《大惑论》说：心劳则魂魄散，志意乱。所以《经脉别论》叙述五脏喘汗之事，并申述告诫说：四季的疾病，常起于过用。所以说：无形无患，与道协议，只有真人能做到。
(Radial pulse palpation,) the Cun position of the right hand corresponds to the Lung, the Guan position to the Spleen, and the Chi position to the Mingmen (Gate of Life), which also refers to "verticality"; light pressure equivalent to three beans' weight assesses Lung Qi, six beans' weight Heart Qi, nine beans' weight Spleen Qi, twelve beans' weight Liver Qi, and pressing to the bone assesses Kidney Qi, which also refers to "horizontalness". The movements of ascending, descending, exiting, and entering, although divided into horizontal and vertical aspects, are ultimately unified by the inhalation and exhalation of Yin and Yang. When a person suffers from Xu Lao (Deficiency Consumption Disease), the vertical Qi cannot distribute throughout the body. If Yin Qi is injured first, the force of inhalation becomes weak first; the Qi fails to reach inwardly to the Kidneys and returns upon reaching the Livers, resulting in Gu Wei (Bone Withering). If Yang Qi is injured first, the force of exhalation becomes weak first; the Qi fails to reach outwardly to the Lungs and returns upon reaching the Hearts, resulting in Pi Ju Mao Cui (Withered Skin, Hair, and Fur). The mention of Liver, Kidney, Heart, and Lung here refers to the superficial and deep levels within their respective territorial domains. In this case, the measurement of pulse Qi circulating sixteen zhang and two chi for one cycle would be insufficient; insufficiency leads to an accelerated cycle of ascending, descending, exiting, and entering, hence the rapid pulse. The *Nan Jing* discusses Sun (Damaged) and Zhi (Excessive) pulses: three beats per exhalation, up to six beats per exhalation, constitute the Zhi pulse; one beat per exhalation, down to one beat per four exhalations, constitutes the Sun pulse. The progression of Zhi disease moves upward from below, while that of Sun disease moves downward from above. Diseases caused by Sun pulses begin with withered skin and falling hair, culminating in bone withering where the patient cannot rise from bed; conversely, diseases caused by Zhi pulses exhibit opposite characteristics. Progression from below upward, if accompanied by withered skin and falling hair, results in death; progression from above downward, if accompanied by bone withering preventing rising from bed, results in death: this is because the pathology has reached its extreme. Lu Ziyu stated: The damage and excess in the arrival of the pulse correspond to the speed and slowness of the pulse's arrival. The Zhi pulse inherently involves "Zhi" (excess/arrival); does the Sun pulse exist outside of "Zhi"? This likely stems from the suspicion that deficiency-damage pulses must always be rapid (Shu) and never slow (Chi). Bian Que also said: Four or more beats per exhalation indicate Bi Syndrome or Tu Mai Qi (Pulse Qi Depletion), signifying a loss of the normal circulation of sixteen zhang and two chi per cycle. However, many deficiency-damage cases present with a slow pulse, though the conditions differ. A rapid pulse indicates that blood has deteriorated first, blocking the Qi channels; the Qi becomes fierce and obstructed, leading to shortness and rapidity. A slow pulse indicates that blood has not yet deteriorated, but the power of True Qi cannot penetrate vigorously, akin to a traveler growing weary after a long journey and wishing to rest. Such illness originates in Qi without damaging有形 (form/blood), making it easier to treat; tonifying Qi allows Blood to generate naturally. When Qi fails to circulate yet presents with a rapid pulse, it signifies that Blood has deteriorated and Qi has no refuge, making it difficult to treat; tonifying Qi causes further Blood stagnation. Therefore, a rapid pulse appearing at the onset of illness indicates Bi causing deficiency, where Blood pathology affects Qi, termed "damage from below affecting above," i.e., from interior to exterior. A slow pulse initially followed by gradual rapidity indicates deficiency causing Bi, where Qi pathology affects Blood, termed "damage from above affecting below," i.e., from exterior to interior. Regarding Qi failing to reach the Kidneys and Lungs, it is not that there is absolutely no Qi, but rather that Zheng Qi (Upright Qi) is occupied by Xie Qi (Pathogenic Qi) and cannot arrive on schedule. If there were truly no Qi, one Zang organ would lose its Qi, and all five Zang organs would fail to sustain themselves. This is the major principle of Lao Bi (Consumption Bi). Accumulations, abscesses, numbness, and pain classified as Bi syndromes reside within the meridians; Qi exists at both ends but is blocked in the middle, while the root remains undamaged. Unblocking restores flow immediately. It is like a tube obstructed by a knot; removing the knot allows Qi to flow freely. This is the major principle of Shi Bi (Excess Bi). Treatment for Shi Bi needs no elaboration. For Lao Bi treatment, the *Nan Jing* states: Damage to the Lung requires augmenting its Qi; damage to the Heart requires regulating Ying and Wei (Nutritive and Defensive Qi); damage to the Spleen requires adjusting diet and adapting to cold and warmth; damage to the Liver requires soothing its center; damage to the Kidney requires augmenting its Essence. These all address deficiency. However, Lao Bi often presents with mixed deficiency and excess. Zhang Zhongjing treated Blood Bi and myriad wind diseases with Shuyu Wan to tonify deficiency, and Dahuang Zhechong Wan to attack excess. Furthermore, prolonged external pathogen accumulation may mimic deficiency consumption, as described by Xu Lingtai regarding wind-cold transforming into consumption. Recently, coughs are invariably diagnosed as Lung Heat, with Sang Ye (Folium Mori) and Maidong (Radix Ophiopogonis) prescribed indiscriminately. Shengdi (Radix Rehmanniae) and Zhimu (Rhizoma Anemarrhenae) fill the prescriptions. Consequently, Yang Qi declines daily, allowing wind-cold and fluid retention to coalesce in the Danzhong (Chest), gradually leading to insomnia, hemoptysis, facial edema, dyspnea, vomiting, diarrhea, and critical danger. Thus, patients presenting with Wu Ling San or Qing Long Tang patterns today inevitably progress to consumption, repeating past mistakes until death without realization. Zhang Jingyue stated: External pathogens lingering in meridians; food stagnation accumulating in viscera; constrained rebellious Qi unresolvable; stubborn phlegm and blood stasis retained. Prolonged illness leads to emaciation, resembling form-deficiency, yet the root cause remains untreated. Misusing tonification will only worsen the condition. Physicians who understand this will commit fewer errors.
Generally, treating disease requires first identifying the path of the pathogen's entry, then opening the path of its exit. For disorders of ascending/descending, employ lifting or suppressing methods; for disorders of exiting/entering, employ dispersing or consolidating methods. One may regulate exiting/entering to resolve ascending/descending issues, or regulate ascending/descending to resolve exiting/entering issues. Rebellious Qi fails to be grasped by the lower Jiao; sinking Qi fails to be dispersed by the upper Jiao; internal stagnation fails to be dispersed externally; external leakage fails to harmonize internally. Zhao Qingchu stated: The human body functions in two layers (inner/outer) and two sections (upper/lower), with inner/outer and upper/lower interacting like respiration. For instance, purgation causing diarrhea drains the lower-inner section, causing upper-inner Qi to sink, creating emptiness above, allowing exterior Qi and pathogens to enter internally, forming the root of Jie Xiong (Chest Binding). Dispersion inducing sweat drains the upper-outer section, causing internal Qi to follow outward, creating emptiness above internally, allowing lower-inner Yin Qi to block upward, forming the root of Pi Men (Stagnant Oppression). Therefore, excessive sweating is prohibited for upper disorders, and cautious purgation is required for interior disorders, reflecting the principles of Yin-Yang fullness/emptiness and waxing/waning.
Furthermore, I have insights understood silently, which I do not wish to share with outsiders, yet feel compelled to reveal. Why does the *Nei Jing* link ascending/descending/exiting/entering to growth, strength, aging, and decline? Materia Medica notes that sunlight loosens objects; cotton exposed to sun for long periods becomes loose, indicating the Sun possesses a lifting/grasping force. All things face the sun, not just sunflowers and beans. Objects lack consciousness, but the Sun has a grasping power. Humans under the sun have their Qi lifted by it. Objects placed on earth sink over time due to Earth's gravitational attraction; humans on earth have their Qi attracted by it. Qi moving through the air never ceases for even a breath. Zhuangzi said: "Humans are in the wind." Zhang Zhongjing said: "Humans grow due to wind energy." Humans are buffeted by wind, so their exiting/entering is self-evident. Human birth combines father's essence and mother's blood to form the body. The body resembles earth, possessing inherent attractive forces. These forces reside mostly within the five Zang organs and bone marrow, allowing Qi to remain secure within the body without scattering. Upon life, the upper is grasped by the Sun, the lower attracted by the Earth, and the middle buffeted by wind, leading to daily strengthening. Upon decline, prolonged grasping causes Qi to escape upward; prolonged attraction causes Qi to escape downward; prolonged buffeting causes Qi to scatter outward, resulting in old age and death. Among these three forces, Earth's attraction is strongest; thus, corpses are heavy because the body loses autonomy and is fully absorbed by the Earth. Corpse exposure to sunlight is avoided lest Sun Qi lift the corpse again. Living persons should not ride oxen facing corpses; living persons possess attractive force, potentially attracting residual Qi from the corpse, possibly causing corpse movement. This theory was unspoken by predecessors and may shock the vulgar. Labor agitates Qi; mental labor scatters the attractive forces of the five Zang organs, causing Qi to scatter easily, leading to early aging and death. Stillness consolidates Qi; mental stillness strengthens the attractive forces of the five Zang organs, preserving Qi, promoting longevity, and delaying aging. Understanding this aids health preservation; why fear it? The *Bi Lun* states: "Yin Qi, when still, guards the Spirit; when restless, dissipates." The *Sheng Qi Tong Tian Lun* states: "Yang Qi, when still, nourishes the Spirit; when soft, nourishes the sinews." The *Da Huo Lun* states: "Mental labor scatters Hun and Po, confuses Zhi and Yi." Thus, the *Jing Mai Bie Lun* describes panting and sweating of the five Zang organs, warning: "Diseases of the four seasons often arise from overuse." Hence: "Formless and free of harm, agreeing with the Dao, only the True Person achieves this."