十八难曰∶脉有三部，部有四经，手有太阴阳明，足有太阳少阴，为上下部，何谓也？
滑氏曰∶此篇立问之意，谓人有十二经脉，凡有三部，每部之中有四经，今手有太阴、阳明，足有太阳、
少阴，为上下部，何谓也？盖三部者，以寸关尺分上中下也。四经者，寸关尺两两
相比，则每部各有四经矣。手之太阴、阳明，足之太阳、少阴，为上下部者，肺居右寸，肾居左尺，
循环相资，肺高肾下，母子相望也。经云∶脏真高于肺，脏真下于肾是也。
然∶手太阴阳明，金也，足少阴太阳，水也。金生水，水流下行而不能上，故在下部也。足厥
阴少阳，木也，生手太阳少阴火，火炎上行而不能下，故为上部。手心主少阳火，生足太阴阳明土，
土主中宫，故在中部也。此皆五行子母更相生养者也。
手太阴肺、手阳明大肠属金，皆诊于右寸。足少阴肾、足太阳膀胱属水，皆诊于左尺。金生水，
水性流下，故在下部也。足厥阴肝、足少阳胆属木，皆诊于左关。手太阳小肠、手少阴心属火，皆
诊于左寸。木生火，火性炎上，故在上部也。手厥阴心包络、手少阳三焦属相火，当候于右尺。足
太阴脾、足阳明胃属土，当候于右关。火生土，土位居中，故在中部也。土复生金，此五行子母循
环生养三部四经上下之义也。
脉有三部九候，各何所主之？
然∶三部者，寸关尺也。九候者，浮中沉也。上部法天，主胸以
上至头之有疾也；中部法人，主膈以下至脐之有疾也；下部法地，主脐以下至足之有疾也。审而刺
之者也。
三部之中，各有浮中沉，是为九候。浮为阳，沉为阴，中者胃气也，所谓自膈以上为上焦也，
自膈以下为中焦也，自脐以下至足为下焦也。谢氏曰∶此一节当是十六难中答辞，错简在此，
而剩出（脉有三部九候，各何主之）十字。且（审而刺之），杨氏云为审病之所在而刺之，丁氏云、当
次第之次，纪氏则为刺候之义。各有至理，姑存备参。
人病有沉滞久积聚，可切脉而知之耶？
然∶诊在右胁有积气，得肺脉结，脉结甚则积甚，结微则气
微。诊不得肺脉，而右胁有积气者，何也？
然∶肺脉虽不见，右手脉当沉伏。
此病久积聚，可切脉而知之也。肺金右降、右胁，肺之部也。若右胁有积聚，则肺脉当结，结脉往
来缓，时一止复来，而无定数者是也。盖结为积聚之脉。《素问·平人气象论》曰∶结而横，有积矣。
然积有微甚，是以结甚则积甚，结微则气微也。设肺脉虽不见结，而右手脉当见沉伏，沉伏亦积聚脉，
右手统三部言，则肺脉亦在其中。又右手气口所以候里也。
其外痼疾同法耶？将异也？
然∶结者，脉来去时一止无常数，名曰结也。伏者，脉行筋下也。浮者，
脉在肉上行也。左右表里，法皆如此。
此承上文，复问外之痼疾，与内之积聚，法将同异也。痼疾者，凡肌肉筋骨间久留不去之病皆是，
以其不在脏腑，故曰外也。止无常数，结脉之象，若有常数，为代脉矣。盖结脉之所由生，以积聚在内，
脉道不通，故现脉如此也。伏脉轻手寻之不见，重按以指推筋着骨，乃得其脉形潜隐于骨间者是也。言
结伏则病在里，结浮则病在表，结在右，病亦在右，结在左，病亦在左。以此推之，则内外左右，积气
痼疾，其结脉虽同，而浮伏异也。故曰法皆如此。
假令脉结伏者，内无积聚。脉浮结者，外无痼疾，有积聚，脉不结伏，有痼疾，脉不浮结；为
脉不应病，病不应脉，是为死病也。
有是病必有是脉，内有积聚、脉宜伏结，外有痼疾，脉宜浮结。设见伏结、浮结之脉，而无伏
结、浮结之证，见伏结、浮结之证，而无伏结、浮结之脉，谓之脉不应病，病不应脉也。夫病脉不相应，
乃其气已离，血脉不相联属，故云死。然凡病与脉不相应者，皆为死候，不特积聚为然也。
第十八难说：脉诊有三部，每部有四条经脉，手部有太阴经和阳明经，足部有太阳经和少阴经，这构成了上部和下部，这是什么意思呢？
滑寿（滑氏）说：这一篇提出问题的意图，是说人有十二条经脉，总共分为三部，每一部中有四条经脉。现在手部的太阴、阳明经，足部的太阳、少阴经，被归为上部和下部，这是为什么呢？大概所谓“三部”，是指以寸、关、尺三个部位来划分上、中、下三焦。所谓“四经”，是指寸、关、尺三个部位两两相比配，那么每一部就各有四条经脉了。手太阴肺经、手阳明大肠经，足太阳膀胱经、足少阴肾经，被称为上部和下部，是因为肺脏位于右寸口，肾脏位于左尺部，二者循环相生资助，肺位高而肾位低，如同母子相望一样。医经中说：“五脏的真气，位置最高的是肺，最低的是肾”，说的就是这个道理。
然而，手太阴肺经和手阳明大肠经属金，足少阴肾经和足太阳膀胱经属水。金能生水，水性向下流动而不能上行，所以归属于下部。足厥阴肝经和足少阳胆经属木，木能生出手太阳小肠经和手少阴心经的火，火性炎上而不能下行，所以归属于上部。手厥阴心包络经和手少阳三焦经属相火，相火生足太阴脾经和足阳明胃经的土，土主宰中宫（脾胃），所以归属于中部。这都是五行中子母相生养育的关系。
手太阴肺经和手阳明大肠经属金，都在右寸口诊察。足少阴肾经和足太阳膀胱经属水，都在左尺部诊察。金生水，水性向下流，所以归属于下部。足厥阴肝经和足少阳胆经属木，都在左关部诊察。手太阳小肠经和手少阴心经属火，都在左寸口诊察。木生火，火性炎上，所以归属于上部。手厥阴心包络经和手少阳三焦经属相火，应当在右尺部候察。足太阴脾经和足阳明胃经属土，应当在右关部候察。火生土，土位居中央，所以归属于中部。土又能生金，这就是五行子母循环相生养育，解释三部四经上下分布的道理。
脉诊有三部九候，各自主管什么病症呢？
回答说：所谓的“三部”，是指寸、关、尺三部。所谓的“九候”，是指浮、中、沉三种指力。上部效法天，主管胸部以上至头部的疾病；中部效法人，主管膈肌以下至肚脐的疾病；下部效法地，主管肚脐以下至足部的疾病。需要仔细审察后进行针刺治疗。
在三部之中，每一部又各有浮、中、沉三种脉象，合起来就是九候。浮取属阳，沉取属阴，中取反映胃气的强弱。所谓自膈肌以上为上焦，自膈肌以下为中焦，自肚脐以下至足为下焦。谢氏说：这一段文字应当是《十六难》中的回答，因为竹简错乱而误置于此处，并且多出了“脉有三部九候，各何主之”这十个字。至于“审而刺之”这句话，杨氏认为是审察病邪所在之处而进行针刺，丁氏认为应当按次序排列，纪氏则认为是关于针刺候气的意义。各有各的道理，暂且保留以备参考。
回答说：如果在右胁下有积气，诊得肺脉出现结脉，脉象结代越严重，则积聚越严重；结代轻微，则积气也轻微。如果诊不到肺脉的结象，但右胁下有积气，这是什么原因呢？
回答说：虽然肺脉没有显现出结象，但右手整体的脉象应当表现为沉伏。
这种长期的积聚病，是可以切脉而知晓的。肺金之气向右下降，右胁是肺经所主的部位。如果右胁有积聚，肺脉应当出现结脉。结脉的特点是往来迟缓，偶尔有一次停顿后又恢复跳动，且停顿没有固定的规律。大概结脉是积聚病的脉象。《素问·平人气象论》说：“脉结而横，说明体内有积聚。”然而积聚有轻重之分，所以结脉明显则积聚重，结脉微弱则积气轻。假设肺脉虽然没有显现出结象，但右手脉应当见到沉伏之象。沉伏脉也是积聚病的脉象，“右手”统指右手的寸、关、尺三部，那么肺脉也在其中。另外，右手气口是用来诊察里证的。
外部的顽固性疾病与内部的积聚病，诊察方法是一样的还是不同的呢？
回答说：结脉，是指脉搏来时去时偶尔有一次停顿，且没有固定规律，称为结脉。伏脉，是指脉搏行于筋下深处。浮脉，是指脉搏行于肌肉表层。左右表里的诊察法则都是如此。
这是承接上文，再次询问外部的痼疾与内部的积聚病，其诊察方法是相同还是不同。痼疾，凡是肌肉筋骨间长久停留不去的疾病都算作此类，因为它们不在脏腑内部，所以称为“外”。结脉的特征是停顿没有固定规律，如果是停顿有固定规律，那就是代脉了。结脉产生的原因，是因为体内有积聚，导致脉道不通畅，所以呈现出这样的脉象。伏脉轻轻寻找不见，用力按压，推筋着骨，才能摸到潜隐在骨间的脉形。所以说，见到结脉和伏脉，说明病在里；见到结脉和浮脉，说明病在表；结脉出现在右手，病也在右侧；结脉出现在左手，病也在左侧。以此类推，无论是内外的积聚痼疾，虽然都可能出现结脉，但浮取和沉取的脉象特征是不同的。所以说诊察法则都是如此。
假如脉象呈现结伏，但体内没有积聚；或者脉象呈现浮结，但体外没有痼疾；如果有积聚病，脉象却不呈现结伏；如果有痼疾，脉象却不呈现浮结；这就叫做脉象与病症不相适应，病症与脉象不相符合，这是死证。
有什么样的病就一定有什么样的脉，体内有积聚，脉象适宜表现为伏结；体外有痼疾，脉象适宜表现为浮结。如果出现伏结或浮结的脉象，却没有相应的伏结或浮结的症状；或者出现了伏结或浮结的症状，却没有相应的脉象，这就叫脉不应病，病不应脉。病与脉不相应，是因为人体的正气已经离散，血脉不再相连属，所以说是死证。然而，凡是病与脉不相应的情况，都属于死候，不仅仅是积聚病如此。
Chapter 18 states: There are three positions (cun, guan, chi) in pulse diagnosis, and each position corresponds to four meridians. The hands have the Taiyin (Lung/Large Intestine) and Yangming (Large Intestine/Stomach) meridians, while the feet have the Taiyang (Bladder/Kidney) and Shaoyin (Kidney/Heart) meridians, constituting the upper and lower sections. What is the meaning of this?
Hua Shou (Master Hua) says: The intent of posing this question in this chapter is to explain that humans have twelve primary meridians, divided into three positions, with four meridians associated with each position. Now, the Taiyin and Yangming meridians of the hand, and the Taiyang and Shaoyin meridians of the foot, are classified as the upper and lower sections. Why is this so? Generally speaking, "three positions" refers to dividing the pulse into upper, middle, and lower sections based on the Cun (inch), Guan (bar), and Chi (cubit) locations. "Four meridians" means that by comparing the Cun, Guan, and Chi positions pairwise, each section encompasses four meridians. The Hand Taiyin Lung Meridian and Hand Yangming Large Intestine Meridian, along with the Foot Taiyang Bladder Meridian and Foot Shaoyin Kidney Meridian, are referred to as the upper and lower sections because the Lung resides at the right Cun position, and the Kidney resides at the left Chi position. They support each other in a cyclical manner; the Lung is high and the Kidney is low, gazing at each other like mother and child. As the classics state: "The true Qi of the Zang organs is highest in the Lung and lowest in the Kidney," which refers to this principle.
However, the Hand Taiyin Lung Meridian and Hand Yangming Large Intestine Meridian belong to Metal, while the Foot Shaoyin Kidney Meridian and Foot Taiyang Bladder Meridian belong to Water. Metal generates Water; water flows downward and cannot ascend, hence they are assigned to the lower section. The Foot Jueyin Liver Meridian and Foot Shaoyang Gallbladder Meridian belong to Wood. Wood generates the Fire of the Hand Taiyang Small Intestine Meridian and Hand Shaoyin Heart Meridian. Fire flares upward and cannot descend, hence they are assigned to the upper section. The Hand Jueyin Pericardium Meridian and Hand Shaoyang Sanjiao (Triple Burner) Meridian belong to Ministerial Fire. Ministerial Fire generates the Earth of the Foot Taiyin Spleen Meridian and Foot Yangming Stomach Meridian. Earth governs the Central Palace (Spleen and Stomach), hence it is assigned to the middle section. These all illustrate the mutual generation and nourishment between the generating (mother) and generated (child) elements within the Five Phases (Wu Xing).
The Hand Taiyin Lung Meridian and Hand Yangming Large Intestine Meridian belong to Metal and are both palpated at the right Cun position. The Foot Shaoyin Kidney Meridian and Foot Taiyang Bladder Meridian belong to Water and are both palpated at the left Chi position. Metal generates Water, and water nature flows downward, so they belong to the lower section. The Foot Jueyin Liver Meridian and Foot Shaoyang Gallbladder Meridian belong to Wood and are both palpated at the left Guan position. The Hand Taiyang Small Intestine Meridian and Hand Shaoyin Heart Meridian belong to Fire and are both palpated at the left Cun position. Wood generates Fire, and fire nature flares upward, so they belong to the upper section. The Hand Jueyin Pericardium Meridian and Hand Shaoyang Sanjiao Meridian belong to Ministerial Fire and should be observed at the right Chi position. The Foot Taiyin Spleen Meridian and Foot Yangming Stomach Meridian belong to Earth and should be observed at the right Guan position. Fire generates Earth, and Earth occupies the central position, so it belongs to the middle section. Earth then generates Metal. This illustrates the principle of the Five Phases' mother-child cycle generating and nourishing the three positions and four meridians in their upper and lower distributions.
Regarding the three positions and nine examinations (positions) of the pulse, what does each primarily indicate?
Response: The "three positions" refer to Cun, Guan, and Chi. The "nine examinations" refer to the superficial (Fu), moderate (Zhong), and deep (Chen) palpation techniques. The upper section models Heaven and indicates diseases from the chest up to the head. The middle section models Humanity and indicates diseases from below the diaphragm to the umbilicus. The lower section models Earth and indicates diseases from below the umbilicus to the feet. One must examine carefully before applying acupuncture.
Within each of the three positions, there are superficial, moderate, and deep palpations, totaling nine examinations. Superficial palpation represents Yang, deep palpation represents Yin, and moderate palpation reflects Stomach Qi. It is said that above the diaphragm is the Upper Jiao (Upper Burner), below the diaphragm is the Middle Jiao (Middle Burner), and from the umbilicus down to the feet is the Lower Jiao (Lower Burner). Mr. Xie stated: This paragraph likely belonged to the answer in Chapter 16 but was misplaced due to bamboo slip disorder, resulting in the extra ten characters "Mai you san bu jiu hou, ge he zhu zhi?" (There are three positions and nine examinations of the pulse; what does each indicate?). Regarding "Shen er ci zhi" (Examine carefully and puncture), Master Yang interpreted it as examining the location of the disease to apply puncture; Mr. Ding suggested it meant following a sequence; Mr. Ji interpreted it as the meaning of observing the pulse during puncture. Each has its own logic, so we preserve them for reference.
Can chronic stagnation and long-standing accumulations (Ji Ju) in patients be known through pulse diagnosis?
Response: If there is accumulated Qi in the right hypochondrium, and the Lung pulse presents as a Knotted pulse (Jie Mai), the more pronounced the knotting, the greater the accumulation; if the knotting is slight, the Qi stagnation is slight. If the Lung pulse does not show knotting, yet there is accumulated Qi in the right hypochondrium, why is this?
Response: Although the Lung pulse does not appear knotted, the overall pulse on the right hand should present as Deep and Hidden (Chen Fu).
This type of long-standing accumulation can indeed be known through pulse diagnosis. Lung Metal descends to the right; the right hypochondrium is the domain of the Lung. If there is an accumulation in the right hypochondrium, the Lung pulse should be knotted. A Knotted pulse is characterized by a slow rhythm with occasional irregular pauses. Generally, the Knotted pulse is indicative of accumulation. The *Su Wen: Ping Ren Qi Xiang Lun* states: "A knotted and transverse pulse indicates accumulation." However, accumulations vary in severity; thus, a pronounced knotted pulse indicates severe accumulation, while a slight one indicates mild Qi stagnation. Even if the Lung pulse does not show knotting, the right-hand pulse should exhibit a Deep and Hidden quality. The Deep and Hidden pulse is also a sign of accumulation. "Right hand" here refers generally to the three positions (Cun, Guan, Chi) of the right hand, encompassing the Lung pulse. Furthermore, the Qi Kou (radial artery) on the right hand is used to diagnose interior conditions.
Do external stubborn diseases (Gu Ji) follow the same diagnostic principles as internal accumulations, or are they different?
Response: A Knotted pulse is one where the pulse occasionally stops during its arrival and departure without a fixed pattern. A Hidden (Fu) pulse is one that lies beneath the tendons. A Superficial (Fu) pulse is one that lies on the surface of the flesh. The principles for the left and right sides, exterior and interior, are all similar.
This follows the previous text, re-asking whether the diagnostic methods for external stubborn diseases and internal accumulations are the same or different. Stubborn diseases refer to any condition lingering in muscles, sinews, bones, and joints for a long time. Because they are not within the Zang-Fu organs, they are called "external." An irregular pause characterizes the Knotted pulse; if the pause were regular, it would be a Intermittent pulse (Dai Mai). The Knotted pulse arises because internal accumulations obstruct the pulse channels. The Hidden pulse is not visible with light pressure; only with heavy pressure, pushing the tendons to the bone, can the pulse form hidden among the bones be felt. Therefore, Knotted and Hidden pulses indicate interior disease; Knotted and Superficial pulses indicate exterior disease. If the Knotted pulse is on the right, the disease is on the right; if on the left, the disease is on the left. By inference, for internal or external accumulations and stubborn diseases, although the Knotted pulse may be similar, the distinction between Superficial and Hidden palpation differs. Hence, it is said that the principles are all similar.
If the pulse is Knotted and Hidden, but there is no internal accumulation; or if the pulse is Superficial and Knotted, but there is no external stubborn disease; if there is an accumulation but the pulse is not Knotted or Hidden; if there is a stubborn disease but the pulse is not Superficial or Knotted—this is called "pulse not corresponding to disease, disease not corresponding to pulse," which signifies a fatal condition.
Where there is a specific disease, there must be a corresponding pulse. Internal accumulations should manifest as Hidden and Knotted pulses; external stubborn diseases should manifest as Superficial and Knotted pulses. If Hidden or Superficial-Knotted pulses appear without corresponding symptoms, or if such symptoms appear without corresponding pulses, it is termed "pulse not corresponding to disease, disease not corresponding to pulse." When disease and pulse do not correspond, it means the vital Qi has dispersed and the blood vessels are no longer connected, hence it is considered fatal. In fact, any case where disease and pulse do not correspond is a sign of death, not just in cases of accumulation.