下，脐下，肾之位也。）其病∶逆气，（下气不藏则逆上。）小腹急痛，（肾治于下，故病在小腹。）泄如下重，（滑氏云∶“如
读为而”。肾主二阴，下重，气下坠不收也。）足胫寒而逆。（《灵·经脉篇》足少阴肾之脉“循内踝之后，别入跟中，以
上内”，故病如此。有是者肾也，无是者非也。）
十七难曰∶经言病或有死，或有不治自愈，或连年月不已。（此亦错引经语，非经之全文也。）其死生（一作生死）
存亡，可切脉而知之耶？
然∶可尽知也，诊病若闭目不欲见人者，（此肝病现证，肝与胆合，肝病则胆虚，故闭目不欲见
人。）脉当得肝脉强急而长，（此肝之本脉。）而反得肺脉浮短而涩者，死也。（证属木，脉属金，为克贼也。）病若开目而
渴，心下牢者，（此心病现证。心主热，热甚则开目而渴也。）脉当得紧实而数，（此心之本脉。）而反得沉涩（一作濡）
而微者，死也。（此肾之本脉。证属火，脉属水，为克贼也。）病若吐血，复鼽衄血者，脉当沉细，而反浮大而牢者，死
也。（此又一义，不以生克言，所谓病虚脉实，故死也。《灵·玉版篇》云∶“衄而不止，脉大，是三逆”，即此义也。）病
若谵言妄语，身当有热，脉当洪大，而反手足厥冷，脉沉细而微者，死也。（此则病实脉虚也。手足厥冷，兼证言之也。）
病若大腹而泄者，脉当微细而涩，反紧大而滑者，死也。（此亦病虚脉实也。《灵·玉版篇》云∶“腹鸣而满，四肢清，泄，
其脉大，是二逆也。”）
十八难曰∶脉有三部，部有四经，（三部，寸、关、尺也。四经，两手寸、关、尺各候一脏一腑也。）手有太阴、阳
明，（手太阴属肺，手阳明属大肠，皆诊于右寸。）足有太阳、少阴，（足太阳属膀胱，足少阴属肾，皆诊于左尺。）为上
下部，（右寸为上，左尺为下。）何谓也？
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。（此言左右手循环相生者也。）足厥阴、少阳（足厥阴属肝，少阳属胆，皆诊于左关。）木也，生手太阳、少阴
火，（手太阳属小肠，手少阴属心，皆诊于左寸。火炎上行而不能下，故为上部。手心主、少阳火，（手心主，即手厥阴
心包络也。手少阳属三焦。推本文之义，则宜诊于右尺。）生足太阴、阳明土，（足太阴属脾，足阳明属胃，皆诊于右关。）
土主中宫，故在中部也。此皆五行子母更相生养者也。（以上释三部、四经上下之义，下文又论所主之病也。）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。（三部各有浮、中、沉，故为九也。）上部法
天，主胸以上至头之有疾也；（此又不以经络，以部位言。）中部法人，主膈以下至脐之有疾也；下部法地，（此四字一作
尺为下部，法而应乎地。）主脐以下至足之有疾也。（即《素·脉要精微论》所云∶上竟上者，胸、喉中事也。下竟下者，
少腹、腰、股、膝、胫、足中事也。“但其候脉法，与此微别。”）审而刺之者也。（谓审其病之上下而刺其所在，则针不
误施也。《本义》谢氏谓“此一节，当是十六难中答辞”，与下文又不相属，其说近是。）
人病有沉滞久积聚，可切脉而知之耶？
然∶诊病（一本无病字）在右胁有积气，（积气，积聚之气也。）得肺脉结，（右
胁，肺之部也。结，为积聚之脉。《素·平人气象论》云∶“结而横，有积矣。”）脉结甚则积甚，结微则积微。诊不得肺
脉，而右胁有积气者，何也？
然∶肺脉虽不见，右手当（一作脉）沉伏。（沉伏，亦积气之脉。右手统指三部言，则肺脉
亦在其中。又右手气口脉所以候里也。）其外痼疾同法耶？将异也？（痼疾，凡肌肉筋骨间久留不去之病皆是，以其不在
脏腑故曰外。）
然∶结者，脉来去时一止，无常数，（无常数，乃为结脉之象。若有常数者，或四十动一止，或三十动一
止，乃代脉，主死，不但有积矣。盖结脉之所由生，以积聚在内，脉道不通，故其现脉如此。）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。（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。（病脉不相应，乃真气已漓，血脉不
相联属，故云死也。）
十九难曰∶经言脉有逆顺，男女有恒，而反者，何谓也？（得其脉为顺，不得其脉为逆。恒，常也，谓各有一定之
法也。反，谓上下之强弱相反，如下文所云也。经文无考。）
然∶男子生于寅，寅为木。阳也。女子生于申，申为金，阴也。（此推本天地初生男女之理而言，以明脉之所以异也。）
然∶男得女脉为不足，病在内，（男得阴脉，则阳陷于阴，故为不足。内，谓心腹
之内。阳气入阴，则病见于阴位也。）左得之，病在左，右得之，病在右，随脉言之也。（此又以脉之左右，验病之左右
也。）女得男脉为太过，病在四肢，（女得阳脉，则阴越于阳，故为有余。四肢属乎阳，阴气从阳，则病见于阳位也。）左
得之，病在左，右得之，病在右，随脉言之。此之谓也，（阳道全而阴道半，故阳得阴脉为不足，阴得阳脉为有余也。）
二十难曰∶经言脉有伏匿，伏匿于何脏而言伏匿耶？（引经言无考。伏匿，谓不见于本位，反藏匿于他部而见其脉
也。
然∶谓阴阳更相乘、更相伏也。（言不拘于一脏也。）脉居阴部，而反阳脉见者，为阳乘阴也；（阳脉，即下文浮滑而
长是也。）脉虽时沉涩而短，此谓阳中伏阴也。（言阳虽乘阴，而阴犹伏于阳内也。）脉居阳部，而反阴脉见者，为阴乘阳
也；（阴脉，即上文沉涩而短是也。）脉虽时浮滑而长，此谓阴中伏阳也。重阳者狂，重阴者癫。（此又因阴阳之伏匿而极
言之。重阳、重阴，言不止伏匿，阴皆变为阳，阳皆变为阴也。狂者阳疾，癫者阴疾，邪气既盛，至伤其神，故其病如
此。《素·病能论》云∶“有病怒狂者，……生于阳也。）”脱阳者见鬼，脱阴者目盲。（此又因重阴、重阳而及之。鬼属阴，
阳既脱，则纯乎阴，故见鬼。目得血而能视，阴既脱，则血不营于目，故目盲。此则重阴、重阳之反也。）
二十一难曰∶经言人形病，脉不病，曰生；脉病。形不病，曰死。何谓也？
然∶人形病，脉不病，非有不病者也，
谓息数不应脉数也。（言非脉之真不病也。盖诊病以不病调病患，一呼二至，一吸二至，脉数之常。若其人既病，则呼吸
不齐，不能与脉数相应，或脉迟而其人之息适缓，或脉数而其人之息适促，医者不能审之，遂以为无病，而实不然也。
又或医者之息不能自调，与病者相应，则迟数不辨，故误以为不病，亦通，经文无考。）此大法。
二十二难曰∶经言脉有是动，有所生病，一脉辄（一本无辄字）变为二病者，何也？（此亦非经之全文，乃约经语
以成文者也。此脉字，指经脉言。是动、所生病，见《灵·经脉篇》。二病，指经文“是动”以下所举之病，及“所生病”
以下所举之病，有此二者之殊也。）
然∶经言是动者，气也；所生病者，血也。（言脉之动者，气为之，而所生病者，则
血为之也。）邪在气，气为是动；邪在血，血为所生病。（此又言气血之所以病，则皆因乎邪也。）气主 之，血主濡之。
（，煦也，熏蒸之义。濡，滋润之义。）气留而不行者，（不能 也。）为气先病也；血壅（一作滞）而不濡者，（壅，
凝滞也。）为血后病也。故先为是动，后所生也。（言邪之中人，必先伤乎气而气病，然后及乎血而血病，故云一脉变二
病也。）
二十三难曰∶手足三阴三阳，脉之度数，可晓以不？
然∶手三阳之脉，（三阳，《灵·脉度篇》作“六阳”。）从手至
头，（手三阳之脉皆从指末起而终于头。）长五尺，五六合三丈。（五六，合两手言之也。）手三阴之脉，从手至胸中，（手
三阴之脉亦从指末起而至胸中。）长三尺五寸，三六一丈八尺，五六三尺，合二丈一尺。足三阳之脉，从足至头，（足三
阳从足趾起至头。）长八尺，六八四丈八尺。足三阴之脉，从足至胸，（足三阴从足趾、足心起至胸。）长六尺五寸，六六
三丈六尺，五六三尺，合三丈九尺。人两足跷脉，从足至目，长七尺五寸，二七一丈四尺，二五一尺，合一丈五尺。（跷
脉属奇经。）
然∶
经脉者，行血气，通阴阳，以营于身者也。其始从中焦，注手太阴、阳明；（营出于中焦，故脉从中焦始。）阳明注足阳
明、太阴；太阴注手少阴、太阳；太阳注足太阳、少阴；少阴注手心主、少阳；少阳注足少阳、厥阴；厥阴复还注手太
阴。
别络十五，皆因其原，（脉所注为原。《灵·九针十二原篇》云∶“……原者，五脏之所以禀三百六十五节气味也。”
盖谓五脏之气，皆会于此，而别络之气，亦因乎此也。）如环无端，转相灌溉，朝于寸口、人迎，（寸口，见第一难。人
迎，即左手之寸口脉也。朝，如朝觐之朝，谓会聚于此，复禀气以出也。）以处百病，而决死生也。（处，揆度也，即第
一难独取寸口以决死生之义。）经云∶明知终始，阴阳定矣。何谓也？（见《灵·终始篇》。）
然∶终始者，脉之纪也。（《终
始篇》云∶“终始者，经脉为纪。”）寸口、人迎，阴阳之气，通于朝使，（朝，见上。使，言相为用也。寸口为阴，人迎
为阳。）如环无端，故曰始也。终者，三阴三阳之脉绝，绝则死。死各有形，（死形，见下二十四难。）故曰终也。
二十四难曰∶手足三阴三阳气已绝，何以为候？（候，以证验之也。）可知其吉凶不？
然∶足少阴气绝，则骨枯。（以
下皆言其候也。《素·六节脏象论》云∶肾“其充在骨”，）少阴者，冬脉也，伏行而温于骨髓。（肾脉应冬，其气敛藏于
内。）故骨髓不温，即肉不着骨；骨肉不相亲，即肉濡而却；（濡，滞也。经作“软而却。”却，退缩也。）肉濡而却，故
齿长而枯，（枯，经作“垢”。齿肉却则龈上宣，故齿长。枯，不泽也。齿者，骨之余，故以此验之。）发无润泽；（《六节
脏象论》云∶肾“其华在发。”）无润泽者，骨先死。戊日笃，己日死。口唇者，肌肉
之本也。（《六节脏象论》云∶脾“其华在唇四白，其充在肌”。）脉不营，则肌肉不滑泽；肌肉不滑泽，则肉满；肉满，
则唇反；（满，浮肿也。肉肿，则唇亦肿而反出于外也。）
唇反，则肉先死。甲日笃，乙日死。（经文有“木胜土也”四字）足厥阴气绝，即（一作则）筋缩引卵与舌卷。（引，
牵引也。《经脉篇》云，厥阴之脉“循阴器”，又云，“循喉咙之后”，又云，“环唇内”。《六节脏象论》云∶肝“其华在爪，
其充在筋”。）厥阴者，肝脉也。肝者，筋之合也。筋者，聚于阴器而络于舌本。（《素问·厥论》∶“前阴者，宗筋之所聚”。）
故脉不营，则筋缩急；筋缩急，即引卵与舌，故舌卷卵缩，此筋先死。庚日笃，辛日死。（经文有“金胜木也”四字）手
太阴气绝，即（一作则）皮毛焦。（《六节脏象论》云∶肺“其华在毛，其充在皮”。）太阴者，肺也，行气温于皮毛者也。
气弗营，则皮毛焦；皮毛焦，则津液去；津液去，则皮节伤；皮节伤，则皮枯毛折；（皮枯之皮，经文作“爪”。折，萎
也。）毛折者，则毛先死。丙日笃，丁日死。（经文有“火胜金也”四字）手少阴气绝，则脉不通；脉不通，则血不流；（《六
节脏象论》∶心“其华在面，其充在血脉。”）血不流，则色（一本无色字）泽去，故面色黑如黧，（黧，黑黄色也。）此血
先死。壬日笃，癸日死。（经文有“水胜火也”四字）三阴气俱绝，则目眩转，目瞑，（《灵·大惑论》云∶“五脏六腑之
精，皆上注于目而为之精”，前二十难云∶“脱阴者目盲”，亦此义也。眩，经作“系”。）
二十五难曰∶有十二经，五脏六腑十一耳，其一经者，何等经也？（《灵·九针论》∶“五藏∶心藏神，肺藏魄，肝藏
魂，脾藏意，肾藏精与志也。”六腑，小肠、大肠、胃、胆、膀胱、三焦，主出纳水谷，如府库之司出入，故曰府也。）
然∶一经者，手少阴与心主别脉也。心主与三焦为表里，（《灵·九针论》∶“足阳明、太阴为表里，少阳、厥阴为表
里，
太阳、少阴为表里，……手阳明、太阴为表里，少阳、心主为表里，太阳、少阴为表里”。别脉，谓心主本心之宫城，宜
与心为表里，乃反别与三焦为表里，别为一经，故成十二经也。三焦，上焦、中焦、下焦也。）俱有名而无形，故言经有
十二也。
（位于下腹部，是肾脏所在的部位。）其病症：气逆上冲，（下焦之气不能潜藏，反而向上逆行。）小腹拘急疼痛，（肾气主司下部，所以病变出现在小腹。）腹泻且伴有肛门坠胀感，（滑寿认为：“如”字通“而”。肾主管前后二阴，肛门坠胀是因为气机下陷无法收摄。）足胫部寒冷且感觉逆冷。（《灵枢·经脉篇》记载足少阴肾经的循行路线是“沿着内踝后方，分支进入脚跟，再向上进入小腿内侧”，所以会出现上述病症。具备这些症状的是肾病，不具备则不是。）
第十七难说：医经中说疾病有的会导致死亡，有的不治疗也能自愈，有的长年累月不好。（这是错误地引用了经文，并非经文的完整原文。）判断病人的生死存亡，可以通过切脉来知晓吗？
回答说：可以完全知晓。如果病人闭着眼睛不想见人，（这是肝病的典型表现，肝与胆相表里，肝病导致胆气虚弱，所以闭眼不想见人。）脉象应当出现肝脉的特征，即强劲、紧急且长，（这是肝脏的本脉。）但如果反而出现肺脉的特征，即浮浅、短促且涩滞，就会死亡。（证候属木，脉象属金，金克木，属于相克贼害的关系。）如果病人睁着眼睛并且口渴，心下部痞硬结实，（这是心脏病的典型表现。心主热，热势严重所以睁眼且口渴。）脉象应当出现紧实且数的特征，（这是心脏的本脉。）但如果反而出现沉涩（一说为濡）且微弱的脉象，就会死亡。（这是肾脏的本脉。证候属火，脉象属水，水克火，属于相克贼害的关系。）如果病人吐血，又发生鼻出血或口腔出血，脉象应当沉细，但如果反而出现浮大且坚实的脉象，就会死亡。（这是另一种情况，不从五行生克角度解释，而是所谓病虚脉实，所以死亡。《灵枢·玉版篇》说：“鼻出血不止，脉象大，这是三逆”，就是这个意思。）如果病人胡言乱语，身体应当发热，脉象应当洪大，但如果反而手足冰冷，脉象沉细且微弱，就会死亡。（这是病实证候但脉象虚弱的情况。手足冰冷是兼夹的症状。）如果病人腹部胀大且腹泻，脉象应当微细且涩，但如果反而出现紧大而滑的脉象，就会死亡。（这也是病虚脉实的情况。《灵枢·玉版篇》说：“肠鸣腹胀，四肢清冷，腹泻，脉象大，这是二逆。”）
第十八难说：脉象分为三部，每部有四条经脉，（三部是指寸、关、尺。四经是指两手寸、关、尺各对应一个脏和一个腑。）手经有太阴、阳明，（手太阴属肺，手阳明属大肠，都在右寸诊察。）足经有太阳、少阴，（足太阳属膀胱，足少阴属肾，都在左尺诊察。）这被称为上部和下部，这是什么意思呢？
回答说：手太阴、阳明属金，足少阴、太阳属水，金生水，水流向下而不能上行，所以在下部。（这里讲的是左右手循环相生的关系。）足厥阴、少阳属木，（足厥阴属肝，少阳属胆，都在左关诊察。）木生手太阳、少阴火，（手太阳属小肠，手少阴属心，都在左寸。火性炎上而不能下行，所以属于上部。手厥阴心包络、手少阳也属火，（手厥阴即手厥阴心包络。手少阳属三焦。根据本文的意思，应当在右尺诊察。）生足太阴、阳明土，（足太阴属脾，足阳明属胃，都在右关。）土居中宫，所以在中部。这都是五行母子相生养育的关系。（以上解释了三部、四经上下划分的意义，下文又讨论各自所主的病症。）脉象有三部九候，各自主司什么？
回答说：三部是指寸、关、尺。九候是指浮、中、沉。（每一部都有浮、中、沉三种取脉方法，所以称为九候。）上部效法天，主司胸部以上至头部的疾病；（这里不按经络划分，而是按身体部位来说。）中部效法人，主司膈以下至脐部的疾病；下部效法地，（这四个字有的版本作“尺为下部，法而应乎地”。）主司脐以下至足部的疾病。（即《素问·脉要精微论》所说的：“上竟上者，指胸、喉中的事情。下竟下者，指少腹、腰、股、膝、胫、足中的事情。”“只是它的诊脉方法，与此略有不同。”）仔细审察后施以针刺。（意思是审察疾病的上下位置而针刺相应的部位，就不会误施针术。《本义》谢氏认为“这一节，应该是第十六难的答辞”，与下文又不连贯，这种说法接近正确。）
回答说：诊察发现右侧胁肋部有积气，（积气，就是积聚的气。）脉象出现肺脉结象，（右胁是肺的部位。结脉，是积聚的脉象。《素问·平人气象论》说：“脉结而横，是有积聚。”）脉结得厉害，积聚就严重；脉结得轻微，积聚就轻微。如果没有诊到肺脉，但右侧胁肋部有积气，为什么呢？
回答说：虽然不见肺脉，但右手脉应当沉伏。（沉伏脉，也是积气的脉象。右手统指三部脉而言，那么肺脉也在其中。另外，右手气口脉是用来诊察里证的。）外部的顽固性疾病也是这样吗？还是有所不同呢？（痼疾，凡是肌肉筋骨间久留不去的疾病都叫痼疾，因为它不在脏腑内，所以叫外。）
回答说：结脉，脉搏来时偶尔停跳一次，没有固定的规律，（没有固定规律，才是结脉的形象。如果有固定规律，比如四十动停一次，或者三十动停一次，那是代脉，主死，不仅仅是因为有积聚。结脉产生的原因，是因为体内有积聚，脉道不通畅，所以呈现这样的脉象。）这叫结脉。伏脉，脉搏运行在筋下。浮脉，脉搏运行在肉上行。左右表里，法则都是如此。（意思是结脉和伏脉表示病在里，结脉和浮脉表示病在表，结脉在右边病也在右边，结脉在左边病也在左边，以此类推，那么内外左右积聚痼疾，结脉相同而浮伏不同，所以说法则都是如此。）假如脉象结伏，但体内没有积聚；脉象浮结，但体外没有痼疾；有积聚但脉象不结伏，有痼疾但脉象不浮结，这是脉象与病情不相适应，病情与脉象不相符合，这是死症。（病与脉不相应，是因为真气已经耗散，血脉不再相连属，所以说是死症。）
第十九难说：医经中说脉象有逆顺，男女有常规，如果相反，是什么意思呢？（得到相应的脉象为顺，得不到相应的脉象为逆。恒，就是常，谓各有固定的法则。反，谓上下强弱相反，如下文所说。经文已不可考。）
回答说：男子生于寅年，寅属木，属阳。女子生于申年，申属金，属阴。（这是追溯天地初生男女的道理来说明脉象之所以不同的原因。）
回答说：男子得到女脉（阴脉），是阳气不足，病在内脏，（男子得到阴脉，说明阳气陷入阴分，所以为不足。内，指心腹之内。阳气入阴，则病症表现在阴位。）左手诊得此脉，病在左边；右手诊得此脉，病在右边，随着脉象的位置来判断。（这是又通过脉象的左右，来验证病位的左右。）女子得到男脉（阳脉），是阴气太过，病在四肢，（女子得到阳脉，说明阴气越出阳分，所以为有余。四肢属阳，阴气从阳，则病症表现在阳位。）左手诊得此脉，病在左边；右手诊得此脉，病在右边，随着脉象的位置来判断。这就叫做逆顺。（阳道全而阴道半，所以阳得到阴脉为不足，阴得到阳脉为有余。）
第二十难说：医经中说脉象有伏匿，伏匿是在哪个脏器而言的呢？（引用的经文已不可考。伏匿，谓脉象不见于本位，反而隐藏在其他部位而出现。）
回答说：是指阴阳互相乘袭、互相潜伏。（意思是不局限于某一个脏。）脉象位于阴部（尺部），却出现阳脉（浮滑而长），这叫阳乘阴；（阳脉，即下文提到的浮滑而长。）脉象虽然有时沉涩而短，这叫阳中伏阴。（意思是阳虽然乘袭阴，但阴仍然潜伏在阳的内部。）脉象位于阳部（寸部），却出现阴脉（沉涩而短），这叫阴乘阳；（阴脉，即上文提到的沉涩而短。）脉象虽然有时浮滑而长，这叫阴中伏阳。重阳的人发狂，重阴的人发癫。（这是又因阴阳的伏匿而极端化地论述。重阳、重阴，说不止是伏匿，阴全部变为阳，阳全部变为阴。狂是阳疾，癫是阴疾，邪气既盛，以至于损伤神志，所以病症如此。《素问·病能论》说：“有病怒狂的，……是由于阳邪引起的。”）脱阳的人看见鬼，脱阴的人眼睛失明。（这是又因重阴、重阳而连带提到的。鬼属阴，阳气既脱，则纯乎阴，所以看见鬼。眼睛得到血液滋养才能视物，阴气既脱，则血液不能滋养眼睛，所以眼睛失明。这是重阴、重阳的反面情况。）
第二十一难说：医经中说人形体有病，脉象无病，称为生；脉象有病，形体无病，称为死。这是什么意思呢？
回答说：人形体有病，脉象无病，并不是真的没有病，（而是指呼吸次数与脉搏次数不相适应。）（意思是脉象并非真的没病。大概诊病是以正常的呼吸来调节观察病患，一呼脉跳两次，一吸脉跳两次，是脉数的常态。如果这个人既已生病，则呼吸不齐，不能与脉数相应，或者脉迟而其人的呼吸恰好缓慢，或者脉数而其人的呼吸恰好急促，医生如果不能审察清楚，就以为没病，其实不然。又或者医生的呼吸不能自我调节，与病人相应，则迟数分辨不清，所以误以为没病，这也讲得通，经文已不可考。）这是大的法则。
第二十二难说：医经中说脉有“是动”病，“所生病”，一条经脉往往变成两种病，为什么呢？（这也不是经文的完整原文，而是概括经文语句形成的文字。这里的脉字，指经脉。是动、所生病，见于《灵枢·经脉篇》。二病，指经文中“是动”以下所列的病，以及“所生病”以下所列的病，有这两种的区别。）
回答说：经文说“是动”病，是气的问题；“所生病”，是血的问题。（意思是脉的变动，由气引起，而所发生的病症，则由血引起。）邪气在气分，气发生“是动”病；邪气在血分，血发生“所生病”。（这又说明了气血之所以生病，都是因为邪气。）气主温煦，血主濡润。（温煦，有熏蒸的意义。濡润，滋润的意义。）气停留而不能运行，（不能温煦。）是气先生病；血壅滞（一说为滞）而不能濡润，（壅，凝滞的意思。）是血后生病。所以先是“是动”，后是“所生”。（意思是邪气侵入人体，必先伤气而气病，然后波及血而血病，所以说一条经脉变成两种病。）
第二十三难说：手足三阴三阳经脉的长度，可以说明吗？
回答说：手三阳经，（三阳，《灵枢·脉度篇》作“六阳”。）从手到头，（手三阳经都是从手指末端起，终于头部。）长五尺，两手合计三丈。（五六，合两手来说。）手三阴经，从手到胸中，（手三阴经也从手指末端起而至胸中。）长三尺五寸，三六一丈八尺，加上两手合计的五尺，共二丈一尺。足三阳经，从足到头，（足三阳经从足趾起至头。）长八尺，六八四丈八尺。足三阴经，从足到胸，（足三阴经从足趾、足心起至胸。）长六尺五寸，六六三丈六尺，加上两手合计的五尺，共三丈九尺。人的两足跷脉，从足到目，长七尺五寸，二七一丈四尺，加上两手合计的五尺，共一丈五尺。（跷脉属于奇经。）
回答说：经脉，是运行血气，沟通阴阳，以营养全身的东西。它起始于中焦，注入手太阴、阳明经；（营气出于中焦，所以脉从中焦开始。）阳明经注入足阳明、太阴经；太阴经注入手少阴、太阳经；太阳经注入足太阳、少阴经；少阴经注入手厥阴心包络、少阳经；少阳经注入足少阳、厥阴经；厥阴经又返还注入手太阴经。
别络十五，都源于原穴，（脉气灌注的地方叫原。《灵枢·九针十二原篇》说：“……原穴，是五脏禀受三百六十五节气味的地方。”大概意思是五脏之气，都汇聚于此，而别络之气，也依赖于这里。）像环一样没有端点，相互灌溉，朝会于寸口和人迎，（寸口，见第一难。人迎，即左手寸口脉。朝，如同朝觐的朝，谓汇聚于此，再次禀受气而出。）以此来诊治百病，决断生死。（处，揆度，即第一难独取寸口以决断生死的意义。）经文说：明白终始，阴阳就确定了。这是什么意思呢？（见于《灵枢·终始篇》。）
回答说：终始，是脉的纲纪。（《终始篇》说：“终始，以经脉为纲纪。”）寸口、人迎，阴阳之气，相通于朝使，（朝，见上。使，言相互为用。寸口为阴，人迎为阳。）像环一样没有端点，所以叫始。终，是三阴三阳经脉断绝，断绝了就死亡。死亡各有形态，（死形，见下二十四难。）所以叫终。
第二十四难说：手足三阴三阳经的气已经断绝，有什么征候？（候，以证验之。）可以知道吉凶吗？
回答说：足少阴气绝，则骨骼枯槁。（以下都在讲述征候。《素问·六节脏象论》说：肾“其充在骨”。）少阴经，是冬脉，潜行而温暖骨髓。（肾脉应冬季，其气敛藏于内。）所以骨髓不温暖，肌肉就不能附着于骨；骨肉不相亲附，肌肉就会松弛退缩；（濡，滞的意思。经文作“软而却”。却，退缩的意思。）肌肉松弛退缩，所以牙齿显得长且枯槁，（枯，经文作“垢”。齿肉退缩则牙龈上宣，所以牙齿显得长。枯，不润泽的意思。齿是骨的余气，所以以此验证。）头发没有润泽；（《六节脏象论》说：肾“其华在发”。）没有润泽，说明骨先死。戊日加重，己日死亡。口唇，是肌肉的根本。（《六节脏象论》说：脾“其华在唇四白，其充在肌”。）脉气不能营养，则肌肉不滑泽；肌肉不滑泽，则肌肉肿胀；肌肉肿胀，则嘴唇翻卷；（满，浮肿的意思。肉肿，则嘴唇也肿而反出于外。）
嘴唇翻卷，说明肉先死。甲日加重，乙日死亡。（经文有“木胜土也”四个字）足厥阴气绝，则筋收缩牵引睾丸和舌头卷曲。（引，牵引的意思。《经脉篇》说，厥阴经“循阴器”，又说，“循喉咙之后”，又说，“环唇内”。《六节脏象论》说：肝“其华在爪，其充在筋”。）厥阴经，是肝脉。肝，是筋的结合处。筋，聚集于前阴而联络于舌根。（《素问·厥论》：“前阴者，宗筋之所聚”。）所以脉气不能营养，则筋收缩紧急；筋收缩紧急，就牵引睾丸和舌头，所以舌头卷曲、睾丸收缩，这是筋先死。庚日加重，辛日死亡。（经文有“金胜木也”四个字）手太阴气绝，则皮毛枯焦。（《六节脏象论》说：肺“其华在毛，其充在皮”。）太阴经，是肺，运行气以温养皮毛。气不能营养，则皮毛枯焦；皮毛枯焦，则津液流失；津液流失，则皮节受伤；皮节受伤，则皮肤枯槁毛发折断；（皮枯之皮，经文作“爪”。折，萎的意思。）毛发折断，说明毛先死。丙日加重，丁日死亡。（经文有“火胜金也”四个字）手少阴气绝，则脉不通；脉不通，则血不流；（《六节脏象论》：心“其华在面，其充在血脉”。）血不流，则色泽消失，所以面色黑得像黑炭，（黧，黑黄色。）这是血先死。壬日加重，癸日死亡。（经文有“水胜火也”四个字）三阴经气全部断绝，则头晕眼花，眼睛闭合，（《灵枢·大惑论》说：“五脏六腑的精气，都上注于目而成为瞳神”，前二十难说：“脱阴的人眼睛失明”，也是这个意思。眩，经文作“系”。）
第二十五难说：有十二经脉，但五脏六腑只有十一个，那多出来的一条经脉，是什么经呢？（《灵枢·九针论》：“五脏：心藏神，肺藏魄，肝藏魂，脾藏意，肾藏精与志也。”六腑，小肠、大肠、胃、胆、膀胱、三焦，主出纳水谷，像府库管理出入，所以叫府。）
回答说：多出来的一条，是手少阴经与心主（心包络）的别脉。心主与三焦互为表里，（《灵枢·九针论》：“足阳明、太阴为表里，少阳、厥阴为表里，太阳、少阴为表里，……手阳明、太阴为表里，少阳、心主为表里，太阳、少阴为表里”。别脉，谓心主本是心的宫城，应当与心互为表里，乃反而别与三焦互为表里，别为一经，所以成为十二经脉。三焦，上焦、中焦、下焦。）两者都有名而无实质形态，所以说经脉有十二条。
(Below, at the lower abdomen, is the location of the Kidney.) Its diseases: rebellious Qi (rebellious Qi), (when the Qi below fails to store, it rebels upward.) acute pain in the lower abdomen, (the Kidney governs the lower part, so the disease manifests in the lower abdomen.) diarrhea with a sensation of heaviness and bearing down (bearing down sensation), (Mr. Hua said: "Ru" reads as "er". The Kidney governs the two yin orifices; bearing down indicates Qi sinking and failing to hold.) coldness and reversal coldness in the feet and shins. (The *Ling Shu · Jing Mai Chapter* states that the Foot Shaoyin Kidney meridian "follows behind the medial malleolus, branches into the heel, and goes up internally", hence the disease presents thus. Having these signs indicates Kidney disease; not having them indicates otherwise.)
Chapter 17 says: The classics state that some diseases lead to death, some heal without treatment, and some persist for years. (This is also a misquotation of the classic text, not the full original text.) Can one know life and death, survival and demise, by palpating the pulse?
It is replied: One can know it completely. If a patient closes their eyes and does not wish to see people, (this is a presenting syndrome of Liver disease; the Liver and Gallbladder are interior-exterior partners; Liver disease leads to deficient Gallbladder Qi, hence closing eyes and avoiding people.) the pulse should present as a Liver pulse, strong, tight, and long, (this is the intrinsic pulse of the Liver.) but if instead a Lung pulse, floating, short, and choppy, is found, death will occur. (The syndrome belongs to Wood, the pulse to Metal; Metal overacts on Wood, constituting a destructive relationship.) If a patient opens their eyes and feels thirsty, with a firm obstruction in the heart region, (this is a presenting syndrome of Heart disease; the Heart governs heat; excessive heat causes open eyes and thirst.) the pulse should be tight, solid, and rapid, (this is the intrinsic pulse of the Heart.) but if instead a deep, choppy (or soggy), and faint pulse is found, death will occur. (This is the intrinsic pulse of the Kidney. The syndrome belongs to Fire, the pulse to Water; Water overacts on Fire, constituting a destructive relationship.) If a patient vomits blood and also suffers from epistaxis or oral bleeding, the pulse should be deep and fine, but if instead a floating, large, and firm pulse is found, death will occur. (This is another principle, not discussed in terms of generation and restriction, but rather "deficient disease with excess pulse," which leads to death. The *Ling Shu · Yu Ban Chapter* says: "Epistaxis that does not stop, with a large pulse, this is the third adverse sign," which is the same meaning here.) If a patient speaks deliriously and妄语 (makes nonsensical statements), the body should have heat, and the pulse should be洪大 (surging and large), but if instead the hands and feet are cold, and the pulse is deep, fine, and faint, death will occur. (This is an excess disease with a deficient pulse. Cold hands and feet are mentioned as a concurrent symptom.) If a patient has abdominal distension and diarrhea, the pulse should be faint, fine, and choppy, but if instead a tight, large, and slippery pulse is found, death will occur. (This is also a deficient disease with an excess pulse. The *Ling Shu · Yu Ban Chapter* says: "Borborygmus and fullness, cold limbs, diarrhea, with a large pulse, this is the second adverse sign.")
Chapter 18 says: There are three positions in the pulse, each position having four meridians, (The three positions are Cun, Guan, Chi. The four meridians refer to each Cun, Guan, and Chi position on both hands corresponding to one Zang organ and one Fu organ.) the Hand meridians include Taiyin and Yangming, (Hand Taiyin belongs to the Lung, Hand Yangming belongs to the Large Intestine, both are diagnosed at Right Cun.) the Foot meridians include Taiyang and Shaoyin, (Foot Taiyang belongs to the Bladder, Foot Shaoyin belongs to the Kidney, both are diagnosed at Left Chi.) these are called the upper and lower parts. What does this mean?
It is replied: Hand Taiyin and Yangming belong to Metal; Foot Shaoyin and Taiyang belong to Water. Metal generates Water; water flows downward and cannot go up, hence they are in the lower part. (This discusses the cyclic generation between left and right hands.) Foot Jueyin and Shaoyang belong to Wood, (Foot Jueyin belongs to the Liver, Shaoyang belongs to the Gallbladder, both are diagnosed at Left Guan.) Wood generates Hand Taiyang and Shaoyin Fire, (Hand Taiyang belongs to the Small Intestine, Hand Shaoyin belongs to the Heart, both are diagnosed at Left Cun. Fire flares upward and cannot descend, hence they are in the upper part. Hand Jueyin Pericardium and Hand Shaoyang also belong to Fire, (Hand Jueyin is the Pericardium of the Heart. Hand Shaoyang belongs to the Sanjiao. Based on the context, they should be diagnosed at Right Chi.) generating Foot Taiyin and Yangming Earth, (Foot Taiyin belongs to the Spleen, Foot Yangming belongs to the Stomach, both are diagnosed at Right Guan.) Earth governs the Central Palace, hence they are in the middle part. These are all the mutual generation and nourishment of the Five Elements through mother-son relationships. (The above explains the meaning of the upper and lower divisions of the three positions and four meridians; the following text discusses the diseases governed by them.) The pulse has three positions and nine inspections. What does each govern?
It is replied: The three positions are Cun, Guan, and Chi. The nine inspections are Floating, Middle, and Deep. (Each of the three positions has Floating, Middle, and Deep, hence nine.) The upper part models Heaven and governs diseases from the chest up to the head; (This is stated by body part, not by meridian.) the middle part models Humanity and governs diseases from below the diaphragm to the navel; the lower part models Earth, (these four characters appear in some versions as "Chi is the lower part, modeling and responding to Earth.") governing diseases from below the navel to the feet. (This corresponds to what is said in the *Su Wen · Mai Yao Jing Wei Lun*: "Shang Jing Shang refers to matters of the chest and throat. Xia Jing Xia refers to matters of the lower abdomen, waist, thighs, knees, shins, and feet." "However, its pulse diagnosis method differs slightly from this.") One must examine carefully before applying acupuncture. (Meaning: examine the upper and lower locations of the disease and needle accordingly, so as not to apply needles erroneously. Xie Shi in the *Ben Yi* believes "this section should be the answer to Chapter 16," which does not connect well with the following text; his view is close to being correct.)
Can one know chronic stagnation and long-standing accumulations by palpating the pulse?
It is replied: When diagnosing, if there is accumulated Qi in the right hypochondrium, (Accumulated Qi refers to the Qi of accumulation,) the Lung pulse presents as Jie (knotted). (The right hypochondrium is the area of the Lung. Jie pulse is the pulse of accumulation. The *Su Wen · Ping Ren Qi Xiang Lun* says: "Jie and horizontal indicates accumulation.") If the Jie pulse is severe, the accumulation is severe; if slight, the accumulation is slight. If the Lung pulse is not obtained, but there is accumulated Qi in the right hypochondrium, why is this?
It is replied: Although the Lung pulse is not seen, the Right Hand pulse should be Fu (hidden/deep) and Chen (deep). (Chen and Fu pulses are also pulses of accumulated Qi. "Right hand" generally refers to the three positions, so the Lung pulse is included within it. Also, the Qi Kou pulse on the right hand is used to diagnose interior conditions.) Is the method for external stubborn diseases the same? Or is it different? (Stubborn diseases refer to any illness lingering in muscles, sinews, bones, and joints for a long time; because it is not in the Zang-Fu organs, it is called external.)
It is replied: Jie means the pulse comes and goes with occasional stops, without a fixed number, (No fixed number is the image of the Jie pulse. If there is a fixed number, such as stopping every forty beats or every thirty beats, it is a Dai pulse, indicating death, not just accumulation. The reason for the Jie pulse is that there is accumulation inside, blocking the pulse channels, hence the pulse presents thus.) it is named Jie. Fu means the pulse runs beneath the sinews. Floating means the pulse runs above the flesh. This applies to left and right, exterior and interior. (Meaning: Jie and Fu indicate disease in the interior; Jie and Floating indicate disease in the exterior; Jie on the right indicates disease on the right; Jie on the left indicates disease on the left. By inferring from this, for internal/external, left/right accumulations and stubborn diseases, the Jie pulse is the same, but Floating/Fu differ, hence "the method is the same.") If the pulse is Jie and Fu, but there is no internal accumulation; if the pulse is Floating and Jie, but there is no external stubborn disease; if there is accumulation but the pulse is not Jie and Fu; if there is stubborn disease but the pulse is not Floating and Jie, this is pulse not corresponding to disease, and disease not corresponding to pulse, which is a fatal condition. (When disease and pulse do not correspond, it means the True Qi has dissipated and the blood vessels are no longer connected, hence it is called fatal.)
Chapter 19 says: The classics state that pulses have Ni (reverse) and Shun (smooth), and men and women have constant patterns, but what does it mean when they are reversed? (Obtaining the appropriate pulse is Shun; not obtaining it is Ni. Heng means constant, referring to fixed methods. Fan means reverse, referring to the opposition of strength above and below, as described below. The original text is lost.)
It is replied: Men are born in Yin, Yin is Wood, Yang. Women are born in Shen, Shen is Metal, Yin. (This traces the principles of heaven and earth giving birth to men and women to explain why pulses differ.)
It is replied: If a man obtains a woman's pulse (Yin pulse), it indicates insufficiency, and the disease is internal, (If a man obtains a Yin pulse, Yang sinks into Yin, hence insufficiency. Internal refers to inside the heart and abdomen. When Yang enters Yin, the disease manifests in Yin positions.) if obtained on the left, the disease is on the left; if on the right, the disease is on the right, following the pulse position. (This uses the left/right of the pulse to verify the left/right of the disease.) If a woman obtains a man's pulse (Yang pulse), it indicates excess, and the disease is in the four limbs, (If a woman obtains a Yang pulse, Yin exceeds into Yang, hence excess. The four limbs belong to Yang; when Yin follows Yang, the disease manifests in Yang positions.) if obtained on the left, the disease is on the left; if on the right, the disease is on the right, following the pulse position. This is called it. (The Way of Yang is complete, the Way of Yin is half; hence Yang obtaining Yin pulse is insufficiency, Yin obtaining Yang pulse is excess.)
Chapter 20 says: The classics state that pulses have Fu Ni (hidden and concealed). In which Zang organ is Fu Ni discussed? (The cited classic text is lost. Fu Ni means the pulse is not seen in its proper position but hides and appears in other positions.)
It is replied: It refers to Yin and Yang mutually overacting and mutually hiding. (Meaning it is not confined to one Zang organ.) If the pulse is in the Yin position (Chi), but Yang pulses appear, this is Yang overacting on Yin; (Yang pulse refers to the floating, slippery, and long pulse mentioned below.) although the pulse is sometimes deep, choppy, and short, this is Yin hidden within Yang. (Meaning although Yang overacts on Yin, Yin still hides within Yang.) If the pulse is in the Yang position (Cun), but Yin pulses appear, this is Yin overacting on Yang; (Yin pulse refers to the deep, choppy, and short pulse mentioned above.) although the pulse is sometimes floating, slippery, and long, this is Yang hidden within Yin. Extreme Yang leads to Mania (Kuang); extreme Yin leads to Catatonia (Dian). (This further elaborates on the extremes of Yin/Yang hiding. Extreme Yang/Yin means not just hiding, but Yin fully transforming to Yang, and Yang fully transforming to Yin. Kuang is a Yang disease, Dian is a Yin disease; when pathogenic Qi is excessive, it damages the Spirit, hence the disease presents thus. The *Su Wen · Bing Neng Lun* says: "Those who suffer from anger and mania... arise from Yang.") Those who lose Yang see ghosts; those who lose Yin go blind. (This follows from extreme Yin/Yang. Ghosts belong to Yin; if Yang is lost, it is purely Yin, hence seeing ghosts. Eyes see only when nourished by Blood; if Yin is lost, Blood does not nourish the eyes, hence blindness. This is the reverse of extreme Yin/Yang.)
Chapter 21 says: The classics state that if the body is diseased but the pulse is not, it is life; if the pulse is diseased but the body is not, it is death. What does this mean?
It is replied: Body diseased, pulse not diseased, does not mean the pulse is truly not diseased, (but refers to the respiration rate not matching the pulse rate.) (Meaning the pulse is not truly healthy. Generally, diagnosis uses normal respiration to adjust observation of the patient: two beats per exhalation, two beats per inhalation is the normal pulse rate. If the person is sick, respiration may be irregular and not match the pulse rate; or the pulse may be slow while respiration is appropriately slow, or pulse fast while respiration is appropriately rapid. If the doctor cannot examine this carefully, they assume no disease, but this is incorrect. Alternatively, if the doctor's own respiration is not regulated and matches the patient's, they cannot distinguish slow/fast, mistakenly thinking there is no disease; this interpretation is also plausible, though the original text is lost.) This is the general principle.
Chapter 22 says: The classics state that pulses have "Shi Dong" (is moving) and "Suo Sheng Bing" (diseases generated by it); how does one meridian become two diseases? (This is also not the full original text, but a summary of classic phrases. The word "pulse" here refers to the meridians. "Shi Dong" and "Suo Sheng Bing" are found in the *Ling Shu · Jing Mai Chapter*. The two diseases refer to the diseases listed under "Shi Dong" and those listed under "Suo Sheng Bing," which have distinct differences.)
It is replied: The classics say "Shi Dong" relates to Qi; "Suo Sheng Bing" relates to Blood. (Meaning the movement of the pulse is caused by Qi, while the diseases generated are caused by Blood.) Pathogen in Qi causes "Shi Dong"; pathogen in Blood causes "Suo Sheng Bing". (This again explains that Qi and Blood diseases arise due to pathogens.) Qi primarily provides warmth (Xu); Blood primarily provides nourishment (Ru). (Warmth implies steaming/heating. Ru implies moistening/nourishing.) If Qi stays and does not flow, (failing to warm,) it is Qi disease first; if Blood is obstructed (or stagnant) and does not nourish, (Obstruction means stagnation,) it is Blood disease later. Hence, first "Shi Dong," then "Suo Sheng." (Meaning when pathogens invade, they first injure Qi causing Qi disease, then affect Blood causing Blood disease, hence one meridian becomes two diseases.)
Chapter 23 says: Can the lengths of the Hand and Foot Three Yin and Three Yang meridians be explained?
It is replied: The Hand Three Yang meridians, (Three Yang, written as "Six Yang" in *Ling Shu · Mai Du Chapter*.) run from hand to head, (Hand Three Yang meridians start from finger tips and end at the head.) five chi long; multiplied by six (two hands times three meridians), totaling three zhang. (Five and six refers to combining both hands.) The Hand Three Yin meridians run from hand to chest center, (Hand Three Yin meridians also start from finger tips and reach the chest center.) three chi five cun long; three times six is one zhang eight chi, plus five chi for both hands, totaling two zhang one chi. The Foot Three Yang meridians run from foot to head, (Foot Three Yang start from toe tips to head.) eight chi long; six times eight is four zhang eight chi. The Foot Three Yin meridians run from foot to chest, (Foot Three Yin start from toe tips/soles to chest.) six chi five cun long; six times six is three zhang six chi, plus five chi for both hands, totaling three zhang nine chi. The two Foot Qiao meridians of a person run from foot to eye, seven chi five cun long; two times seven is one zhang four chi, plus five chi for both hands, totaling one zhang five chi. (Qiao meridians belong to the Extraordinary Vessels.)
It is replied: The meridians circulate Qi and Blood, connect Yin and Yang, and nourish the body. They begin at the Middle Jiao, injecting into Hand Taiyin and Yangming; (Nourishment originates from the Middle Jiao, hence the pulse starts there.) Yangming injects into Foot Yangming and Taiyin; Taiyin injects into Hand Shaoyin and Taiyang; Taiyang injects into Foot Taiyang and Shaoyin; Shaoyin injects into Hand Jueyin Pericardium and Shaoyang; Shaoyang injects into Foot Shaoyang and Jueyin; Jueyin returns to inject into Hand Taiyin.
The fifteen Collateral Vessels all originate from the Yuan Source points, (Where Qi gathers is the Yuan source. The *Ling Shu · Jiu Zhen Shi Er Yuan Chapter* says: "...The Yuan source is where the Five Zang organs receive the Qi and flavors of the three hundred sixty-five solar terms." Basically, the Qi of the Five Zang organs converges here, and the Qi of the collateral vessels depends on this.) like a ring without end, irrigating each other, gathering at Cun Kou and Ren Ying, (Cun Kou, see Chapter 1. Ren Ying is the Cun Kou pulse on the left hand. Chao, like paying court, means gathering here to receive Qi again and exit.) to treat all diseases and determine life and death. (Chu means to estimate/judge, i.e., the meaning in Chapter 1 of taking only Cun Kou to determine life and death.) The classic says: Knowing the beginning and end, Yin and Yang are determined. What does this mean? (Seen in *Ling Shu · Zhong Shi Chapter*.)
It is replied: Beginning and End are the discipline of the pulse. (The *Zhong Shi Chapter* says: "Beginning and End, the meridians are the discipline.") Cun Kou and Ren Ying, the Qi of Yin and Yang, communicate through court and envoy, (Chao, see above. Shi means mutual use. Cun Kou is Yin, Ren Ying is Yang.) like a ring without end, hence called Beginning. End means the meridians of Three Yin and Three Yang are severed; severance means death. Death has various forms, (Forms of death, see next Chapter 24.) hence called End.
Chapter 24 says: How can we know the signs when the Qi of the Hand and Foot Three Yin and Three Yang meridians is severed? (Hou means to verify with symptoms.) Can we know auspiciousness or inauspiciousness?
It is replied: When the Qi of Foot Shaoyin severs, bones wither. (Below describes the signs. The *Su Wen · Liu Jie Zang Xiang Lun* says: The Kidney "fills the bones".) Shaoyin is the Winter pulse, running deep and warming the marrow. (Kidney pulse corresponds to Winter; its Qi stores inward.) Thus, if marrow is not warmed, flesh does not adhere to bone; if flesh and bone are not intimate, flesh becomes flaccid and retracts; (Ru means stagnation. The text writes "soft and retracts." Que means retract.) Flesh flaccid and retracting causes teeth to appear long and withered, (Withered, the text writes "dirty/filthy." When gum flesh retracts, gums recede, making teeth appear long. Withered means lacking luster. Teeth are the surplus of bone, hence verified by this.) hair loses luster; (The *Liu Jie Zang Xiang Lun* says: The Kidney "flourishes in the hair".) Losing luster means bone dies first. Disease worsens on Wu days, dies on Ji days. Lips are the root of muscle. (The *Liu Jie Zang Xiang Lun* says: The Spleen "flourishes in the lips and white surrounding area, fills the muscles".) If pulse does not nourish, muscles are not smooth/lustrous; if muscles are not smooth/lustrous, muscles swell; if muscles swell, lips evert; (Man means edema/swelling. If flesh swells, lips also swell and evert outward.)
Lips everting means flesh dies first. Disease worsens on Jia days, dies on Yi days. (The text has "Wood overacts on Earth" four characters.) When the Qi of Foot Jueyin severs, sinews contract, pulling the testicles and tongue. (Yin means pull. The *Jing Mai Chapter* says the Jueyin meridian "follows the genitalia," also says, "follows behind the throat," also says, "circles the inside of the lips." The *Liu Jie Zang Xiang Lun* says: The Liver "flourishes in the nails, fills the sinews".) Jueyin is the Liver meridian. The Liver is the convergence of sinews. Sinews gather at the genitalia and connect to the root of the tongue. (The *Su Wen · Jue Lun*: "The anterior yin is the gathering place of the Zong sinews".) Thus, if pulse does not nourish, sinews contract and tighten; sinews contracting and tightening pulls testicles and tongue, hence tongue curls and testicles retract; this is sinew dying first. Disease worsens on Geng days, dies on Xin days. (The text has "Metal overacts on Wood" four characters.) When the Qi of Hand Taiyin severs, skin and hair become dry/brittle. (The *Liu Jie Zang Xiang Lun* says: The Lung "flourishes in hair, fills the skin".) Taiyin is the Lung, circulating Qi to warm skin and hair. If Qi does not nourish, skin and hair become brittle; if skin and hair become brittle, fluids depart; if fluids depart, skin joints are injured; if skin joints are injured, skin withers and hair breaks; (Skin withering, the text writes "nails". Zhe means wither/break.) Hair breaking means hair dies first. Disease worsens on Bing days, dies on Ding days. (The text has "Fire overacts on Metal" four characters.) When the Qi of Hand Shaoyin severs, pulses do not flow; if pulses do not flow, Blood does not circulate; (The *Liu Jie Zang Xiang Lun*: The Heart "flourishes in the face, fills the blood vessels".) If Blood does not circulate, luster disappears, hence facial color is black like charcoal, (Li means black-yellow.) this is Blood dying first. Disease worsens on Ren days, dies on Gui days. (The text has "Water overacts on Fire" four characters.) When the Qi of all Three Yin meridians severs, dizziness and spinning occur, eyes close, (The *Ling Shu · Da Huo Lun* says: "The essence of the Five Zang and Six Fu organs all ascend to the eyes to form the pupil," Chapter 20 said: "Those who lose Yin go blind," which is the same meaning. Xuan, the text writes "xi".)
Chapter 25 says: There are twelve meridians, but Five Zang and Six Fu organs total eleven. Which meridian is the extra one? (The *Ling Shu · Jiu Zhen Lun*: "Five Zang: Heart stores Shen, Lung stores Po, Liver stores Hun, Spleen stores Yi, Kidney stores Jing and Zhi." Six Fu organs: Small Intestine, Large Intestine, Stomach, Gallbladder, Bladder, Sanjiao, mainly receiving and discharging food and fluids, like storehouses managing entry and exit, hence called Fu.)
It is replied: The extra one is the separate pulse of Hand Shaoyin and the Heart Master (Pericardium). The Heart Master and Sanjiao are interior-exterior partners, (The *Ling Shu · Jiu Zhen Lun*: "Foot Yangming and Taiyin are interior-exterior, Shaoyang and Jueyin are interior-exterior, Taiyang and Shaoyin are interior-exterior... Hand Yangming and Taiyin are interior-exterior, Shaoyang and Heart Master are interior-exterior, Taiyang and Shaoyin are interior-exterior". Separate pulse means the Heart Master is originally the palace city of the Heart, should be interior-exterior with the Heart, but instead is separately interior-exterior with the Sanjiao, forming a separate meridian, hence becoming twelve meridians. Sanjiao refers to Upper, Middle, and Lower Jiao.) Both have names but no substantial form, hence it is said there are twelve meridians.