经、引肺脉一经于此言之也。杨曰。往来缓而时一止复来。谓之结也。脉结甚者。是诊脉之状也。结甚者此结训积。犹
言脉结甚则积甚。脉积微则积微。其言积隐也。虞曰。结脉主块积。其脉动而中止。小数有还反动。故曰结也。其积之
大小。随诊言之也。杨曰。诊虽不得肺脉浮短而涩。但右手脉当沉伏。即右胁有积气矣。肺治在右也。极重指着骨乃得。
故谓伏脉也。
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。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。
丁曰。人心有所思慕。脉亦结。心无所思。内外无病。其脉伏结。此者形不病而脉病。故知死矣。杨曰。脉与病不
相应为逆者。难治。故曰是死病也。
旧经注云。手心主心包络脉也。手少阳。三焦脉也。故合为左手中部。足太阴。脾脉也。足阳明。胃脉也。故合为
右手中部。此经作如此分别。若根据脉经配三部。又与此不同也。（此即前手心主少阳节之杨注也。下条中又备引其文。复
衍于此。甚属无谓。姑根据原本存之。）
旧经有此。前注 牾。具列此图。以正其文。杨氏曰。手心主心包络脉。手少阳三焦脉也。故合为左手上部。足太
阴脾脉也。足阳明胃脉也。故合为右手中部。此经作如此分别。若根据脉经配三部。又与此不同。夫此法。杨氏不能明其
理。故言不同也。是师将三部反倒配合五行六气而言之。师谓此寸尺反倒。又问三部各何所主。经云。上部法天。主胸
以上至头有疾。中部法人。主膈下至齐上有疾。下部法地。主齐以下至足有疾。故云审而次之者也。又王叔和将自左寸
逆行言之曰。左心小肠肝胆肾。右肺大肠脾胃命。女人反此背看之。尺脉第三同断病。盖两尺反倒。同主齐以下至足有
疾。故扁鹊云审而次之。王叔和云用心仔细须寻趁。
\r图\pt40a10.bmp\r
手太阳少阴火火炎上而不能下生手心主少阳火足厥阴少阳木木生火
手太阳少阴君火
足太阳少阴水水流下而不能上行生足厥阴少阳木
手心主少阳相火生足太阴阳明土土复生金足太阴阳明土土生手太阴阳明金
手太阴阳明金金生
足太阳少阴水
十九难曰。经言脉有逆顺。男女有常而反者。何谓也。然。男子生于寅。寅为木阳也。女子生于申。申为金阴也。
杨曰。元气起于子。人之所生也。男从子左行三十。之巳。（按此二字疑衍。）女从子右行二十。俱至于巳。为夫妇
怀妊也。古者男子三十。女年二十。然后行嫁娶。法于此也。十月而生男。从巳至寅左行为十月。故男行年起于丙寅。
女从巳右行至申。为十月。故女行年起于壬申。所以男子生于寅。女子生于申。虞曰。经言男子生于寅。女子生于申。
谓其父母之年会合于巳上。男左行十月。至寅而生。女右行十月。至申而生也。小运人言男一岁起于丙寅。女一岁起于
壬申。难经不言起而言生。谓生下已为一岁矣。丙壬二干。水火也。水火为万物之父母。寅申二支。金木也。为生物成
实之终始。木胞在申。金胞在寅。二气自胞相配。故用寅申也。金生于巳。巳与申合。故女子取申木。生于亥。亥与寅
合。故男子取寅。所以男年十岁。顺行在亥。女年十岁。逆行亦在亥。男年十六天癸至。左行至巳。巳者申之生气。女
年十四天癸至。右行亦在巳。（按根据其说推之。女年十四。在未不在巳也。此句误。）与男年同在本宫生气之位。阴阳相
配。乃成夫妇之道。故有男女也。上古天真论曰。男二八而天癸至。精气溢泻。阴阳和。故能有子。杨氏言男三十。行
年在巳。方娶于此。非也。女二七天癸至。任脉通。冲脉盛。月事以时下。故能有子。杨氏言女二十右行之巳方嫁。于
此义非矣。杨氏之言。但合古礼行夫妇嫁娶之法，又与本经天癸之数相违也。况圣人于此十九难中。论男女配合之道。
阴阳交会之所。言天癸之至数。知脉盛于上下。推之强弱。诊其有余不及。若止言三十而娶。二十而嫁。于本经延医之
道。凭何根据。
故男脉在关上。女脉在关下。是以男子尺脉恒弱。女子尺脉恒盛。是其常也。
丁曰。其言男子女人尺脉者。是阴阳之根本也。逆顺者为阳抱阴生。阴抱阳生也。三阳始生于立春。建寅。故曰男
生于寅、木阳也。三阴生于立秋。七月建申。故言女生于申、金阴也。男子之气。始于少阳。极于太阳。所以男子尺脉
恒弱而寸脉阳也。（按此阳字疑当作强。）女子之气。始于太阴。极于厥阴。女子尺脉浮而寸脉沉。故云男脉在关上。女
脉在关下。此是男女逆顺有常而反也。杨曰。男子阳气盛。故尺脉弱。女子阴气盛。故尺脉强。此是其常性。
反者、男得女脉。女得男脉也。其为病何如。然。男得女脉为不足。病在内。左得之病则在左。右得之病则在右。
随脉言之也。女得男脉为太过。病在四肢。左得之病则在左。右得之病则在右。随脉言之。此之谓也。
丁曰。男得女脉言不足者。是阴不足。即阳入乘之。故阳不见于寸口。而反见尺内。阴气主内。不足。故知病即在
内。女得男脉为太过。病在四肢者。女子尺脉本浮。更加见于寸。是谓太过。阳主外。故病在四肢。随其脉左右言之。
左得之病在左。右得之病在右也。杨曰。男得女脉为阴气盛。阴主内。故病在内。女得男脉为阳气盛。（按此下似脱阳字。）
主四肢。故病在四肢也。虞曰。寸口曰阳。男以阳用事。今见阴脉反于天常。故病发于内。女以阴用事。今寸口却见阳
脉。亦是反于天常。故病在四肢。素问曰。四肢为诸阳之本也。
经脉，是引用肺脉这一条来阐述这个道理。杨氏说：脉搏往来迟缓，偶尔停止后又恢复跳动，称为结脉。结脉严重的情况，是指诊脉时的形态。所谓“结甚”，这里的“结”解释为积聚，就像说脉象结滞严重则体内积聚严重，脉象积聚轻微则体内积聚轻微。这种说法比较隐晦。虞氏说：结脉主病为体内有块状积聚。其脉动而中止，脉率稍快且有回返之象，所以称为结脉。其积聚的大小，随着诊察的情况而言。杨氏说：虽然诊察时没有发现肺脉典型的浮、短、涩特征，但右手脉应当沉伏，这就意味着右胁部有积气。因为肺的治所在右侧。必须重按至骨才能触及，所以称为伏脉。
外部的顽固疾病，治疗方法相同吗？还是有所不同呢？回答是：是的。结脉，指脉搏来去时偶尔停止，没有固定的规律，名叫结脉。伏脉，指脉搏行于筋下。浮脉，指脉搏行于肉上。左右表里的法则都是如此。假如脉象结伏，但体内没有积聚；脉象浮结，但体外没有顽固疾病；如果有积聚而脉象不结伏，有顽固疾病而脉象不浮结，这就是脉象与病情不相适应，病情与脉象不相符合，这属于死证。
丁氏说：人心有所思慕，脉象也会呈现结象；心无所思，内外无病，其脉象却呈现伏结，这是形体没有病而脉象有病，所以知道是死证。杨氏说：脉象与病情不相适应属于逆证，难以治疗，所以说这是死证。
旧经注云：手厥阴心包络脉，手少阳三焦脉，所以合为左手中部。足太阴脾脉，足阳明胃脉，所以合为右手中部。这部《难经》作如此分别。如果根据《脉经》配属三部，又与此不同。（这正是前文手心主少阳节中杨氏的注释。下条中又详细引用了这段文字，再次重复于此，实属多余，姑且依据原本保留。）
旧经有此内容，与前注相抵触，特列出此图，以校正经文。杨氏说：手厥阴心包络脉，手少阳三焦脉，所以合为左手上部。足太阴脾脉，足阳明胃脉，所以合为右手中部。这部《难经》作如此分别。如果根据《脉经》配属三部，又与此不同。这种方法，杨氏未能阐明其原理，所以说不同。这是老师将三部颠倒配合五行六气来论述。老师称此处的寸尺颠倒，又问三部各自主管什么，《难经》说：上部法天，主管胸以上至头部的疾病；中部法人，主管膈下至脐上的疾病；下部法地，主管脐以下至足部的疾病。所以说要审慎地依次排列。另外王叔和从左侧寸口逆行来说：左手对应心、小肠、肝、胆、肾，右手对应肺、大肠、脾、胃、命门。女性与此相反，从背面来看。尺脉第三同断疾病。大概两尺颠倒，共同主管脐以下至足部的疾病。所以扁鹊说审慎地依次排列，王叔和说要用心仔细寻找趁势。
[图片]
手太阳、少阴（火）火炎上而不能下行生手心主、少阳（火）。足厥阴、少阳（木）木生火。
手太阳、少阴（君火）。
足太阳、少阴（水）水流下而不能上行生足厥阴、少阳（木）。
手心主、少阳（相火）生足太阴、阳明（土）。土复生金。足太阴、阳明（土）土生手太阴、阳明（金）。
手太阴、阳明（金）金生水。
足太阳、少阴（水）。
第十九难说：经言脉有逆顺，男女有常理而反常的，是什么道理呢？回答说：男子生于寅，寅为木，属阳。女子生于申，申为金，属阴。
杨氏说：元气起始于子，这是人所出生的根本。男子从子位向左运行三十岁，到达巳位。（按：此二字疑为衍文。）女子从子位向右运行二十岁，也到达巳位，此时夫妇怀妊。古时候男子三十岁，女子二十岁，然后举行嫁娶仪式，法则基于此。十月而生男，从巳到寅向左运行为十月，所以男子的行年起于丙寅。女子从巳向右运行到申，为十月，所以女子的行年起于壬申。因此男子生于寅，女子生于申。
虞氏说：经言男子生于寅，女子生于申，是指其父母之年会在巳上相合。男子向左运行十月，至寅而生；女子向右运行十月，至申而生。小运人说法：男子一岁起于丙寅，女子一岁起于壬申。《难经》不说起而说生，是指生下后已满一岁。丙、壬二干，代表水火。水火是万物的父母。寅、申二支，代表金木。是生物成实的终始。木的胞宫在申，金的胞宫在寅。二气自胞宫相配，所以用寅申。金生于巳，巳与申合，所以女子取申。木生于亥，亥与寅合，所以男子取寅。因此男子十岁，顺行在亥；女子十岁，逆行也在亥。男子十六岁天癸至，左行至巳，巳是申的生气之位；女子十四岁天癸至，右行也在巳。（按：根据其说法推算，女子十四岁应在未而不在巳，此句有误。）与男子同年处于本宫的生气之位，阴阳相配，才成就夫妇之道，所以有男女之分。《上古天真论》说：男子二八（十六岁）天癸至，精气溢泻，阴阳和，故能有子。杨氏说男子三十岁，行年在巳，才在此娶妻，这是不对的。女子二七（十四岁）天癸至，任脉通，冲脉盛，月事按时而下，故能有子。杨氏说女子二十岁右行至巳才在此出嫁，这与义理不符。杨氏的话，只符合古代礼制中夫妇嫁娶的法度，又与本经关于天癸的数目相违背。况且圣人在此第十九难中，论述男女配合之道，阴阳交会之处，谈及天癸到来的数目，知晓脉气盛衰于上下，推究强弱，诊察有余不及。如果只说三十而娶，二十而嫁，对于本经延医之道，凭借什么根据？
所以男脉在关上，女脉在关下。因此男子尺脉恒弱，女子尺脉恒盛，这是常态。
丁氏说：所说的男子女人尺脉，是阴阳的根本。逆顺是指阳抱阴生，阴抱阳生。三阳始于立春，建寅，所以说男生于寅，木属阳。三阴生于立秋，七月建申，所以说女生于申，金属阴。男子之气，始于少阳，极于太阳，所以男子尺脉恒弱而寸脉阳。（按：此阳字疑当作强。）女子之气，始于太阴，极于厥阴，女子尺脉浮而寸脉沉，所以说男脉在关上，女脉在关下。这是男女逆顺有常而反常的表现。
杨氏说：男子阳气盛，所以尺脉弱；女子阴气盛，所以尺脉强。这是其本性。
反常者，指男子得女脉，女子得男脉。其病症如何呢？回答说：男子得女脉为不足，病在内。左手得之病则在左，右手得之病则在右。随脉象而言。女子得男脉为太过，病在四肢。左手得之病则在左，右手得之病则在右。随脉象而言。这就是所谓的。
丁氏说：男子得女脉言不足，是指阴不足，即阳入乘之，所以阳不见于寸口，而反见于尺内。阴气主内，不足，所以知道病即在內。女子得男脉为太过，病在四肢，是因为女子尺脉本浮，更加见于寸口，这叫太过。阳主外，所以病在四肢。随其脉左右而言，左得之病在左，右得之病在右。
杨氏说：男子得女脉为阴气盛，阴主内，所以病在内。女子得男脉为阳气盛。（按：此处似脱“阳”字。）主四肢，所以病在四肢。
虞氏说：寸口曰阳，男子以阳用事，今见阴脉反于天常，所以病发于内。女子以阴用事，今寸口却见阳脉，也是反于天常，所以病在四肢。《素问》说：四肢为诸阳之本也。
The meridians refer to citing the Lung meridian passage to explain this principle. Yang states: The pulse comes and goes slowly, occasionally stopping and then resuming, is called Jie (Knotted) pulse. In cases of severe Jie pulse, this refers to the condition during pulse diagnosis. "Severe Jie" here interprets "Jie" as accumulation, meaning that if the pulse is severely knotted, the internal accumulation is severe; if the pulse accumulation is slight, the internal accumulation is slight. This statement is somewhat implicit. Yu states: Jie pulse indicates the presence of mass-like accumulations in the body. The pulse beats but stops intermittently, with a slightly rapid rate and a returning sensation, hence it is called Jie pulse. The size of the accumulation varies according to the diagnostic findings. Yang states: Although the typical floating, short, and choppy characteristics of the Lung pulse are not detected, the right-hand pulse should be deep and hidden (Fu), indicating the presence of stagnant Qi in the right hypochondrium. This is because the Lung's governance is located on the right. It requires heavy pressure to reach the bone to be felt, thus it is called Fu (Hidden) pulse.
Regarding external chronic diseases, is the treatment method the same or different? The answer is affirmative. Jie pulse refers to the pulse stopping occasionally during its coming and going without a fixed pattern, named Jie pulse. Fu pulse refers to the pulse traveling beneath the tendons. Floating pulse refers to the pulse traveling above the flesh. The principles for left/right and superficial/deep are all like this. For instance, if the pulse is Jie and Fu, but there is no internal accumulation; or if the pulse is Floating and Jie, but there is no external chronic disease; or if there is an accumulation but the pulse is not Jie/Fu, or there is a chronic disease but the pulse is not Floating/Jie, this constitutes a mismatch between pulse and disease, and disease and pulse, which indicates a fatal condition.
Ding states: When the heart harbors thoughts or yearnings, the pulse may also present as Jie. If the heart has no thoughts and there is no internal or external illness, yet the pulse presents as Fu and Jie, this is a case where the form is healthy but the pulse is diseased, thus indicating a fatal prognosis. Yang states: A mismatch between pulse and disease is considered a counter-flow (Ni) pattern, which is difficult to treat, hence it is said to be a fatal disease.
Old commentaries state: The Pericardium Meridian of Hand-Jueyin and the Sanjiao Meridian of Hand-Shaoyang combine to form the middle position of the left hand. The Spleen Meridian of Foot-Taiyin and the Stomach Meridian of Foot-Yangming combine to form the middle position of the right hand. This classic makes such distinctions. If one follows the *Mai Jing* (Pulse Classic) to assign the three positions, it differs from this. (This is precisely Yang's annotation from the previous section on Hand-Jueyin and Shaoyang. It is cited again in detail in the following section, repeated here redundantly, but retained here based on the original text.)
The old classic contains this content, which contradicts the previous annotations. This diagram is listed to correct the text. Yang states: The Pericardium Meridian of Hand-Jueyin and the Sanjiao Meridian of Hand-Shaoyang combine to form the upper position of the left hand. The Spleen Meridian of Foot-Taiyin and the Stomach Meridian of Foot-Yangming combine to form the middle position of the right hand. This classic makes such distinctions. If one follows the *Mai Jing* to assign the three positions, it differs from this. Yang failed to clarify the rationale behind this method, hence stating they differ. The Master inverted the three positions to correspond with the Five Elements and Six Qi. The Master referred to this inversion of Cun and Chi, and asked what each of the three positions governs. The classic states: The upper position corresponds to Heaven, governing diseases from the chest upwards to the head. The middle position corresponds to Humanity, governing diseases from below the diaphragm to above the navel. The lower position corresponds to Earth, governing diseases from below the navel to the feet. Hence it says to examine and arrange them in order. Additionally, Wang Shuhe described it in reverse order starting from the left Cun: Left corresponds to Heart, Small Intestine, Liver, Gallbladder, Kidney; Right corresponds to Lung, Large Intestine, Spleen, Stomach, Mingmen. Women are the reverse, viewed from the back. The third Chi pulse diagnoses similarly. Generally, the inverted two Chi pulses jointly govern diseases from below the navel to the feet. Thus Bian Que said to examine and arrange them in order, and Wang Shuhe said to use careful attention to find the trend.
[Image]
Hand Taiyang and Shaoyin (Fire): Fire flares upward and cannot descend to generate Hand Jueyin and Shaoyang (Fire). Foot Jueyin and Shaoyang (Wood): Wood generates Fire.
Hand Taiyang and Shaoyin (Ministerial Fire).
Foot Taiyang and Shaoyin (Water): Water flows downward and cannot ascend to generate Foot Jueyin and Shaoyang (Wood).
Hand Jueyin and Shaoyang (Ministerial Fire) generates Foot Taiyin and Yangming (Earth). Earth regenerates Metal. Foot Taiyin and Yangming (Earth) generates Hand Taiyin and Yangming (Metal).
Hand Taiyin and Yangming (Metal) generates Water.
Foot Taiyang and Shaoyin (Water).
Difficulty 19 states: The classics say pulses have contrary and compliant patterns. Men and women have normal patterns that may be reversed. What does this mean? The response is: Men are born in Yin; Yin represents Wood and Yang. Women are born in Shen; Shen represents Metal and Yin.
Yang states: Yuan Qi originates at Zi, which is the root of human birth. Men travel thirty years from Zi moving left to arrive at Si. (Note: These two characters are suspected to be interpolations.) Women travel twenty years from Zi moving right to arrive at Si, at which point husband and wife conceive. In ancient times, men married at thirty and women at twenty, following this law. Ten months later, a male child is born; moving left from Si to Yin takes ten months, so the male's annual cycle begins at Bing Yin. Women move right from Si to Shen, taking ten months, so the female's annual cycle begins at Ren Shen. Therefore, men are born in Yin, and women in Shen.
Yu states: The classics saying men are born in Yin and women in Shen refers to the convergence of their parents' years at Si. Men travel left for ten months to be born in Yin; women travel right for ten months to be born in Shen. According to Xiao Yun theory: Men start age one at Bing Yin, women at Ren Shen. The *Nan Jing* uses "born" rather than "start," implying one year old after birth. Bing and Ren represent Water and Fire, the parents of all things. Yin and Shen represent Metal and Wood, the beginning and end of biological maturation. The womb of Wood is in Shen, the womb of Metal is in Yin. The two Qi pair from their wombs, hence Yin and Shen are used. Metal is born at Si, and Si combines with Shen, so women take Shen. Wood is born at Hai, and Hai combines with Yin, so men take Yin. Thus, at age ten, men proceed forward to Hai; women proceed backward to Hai. At age sixteen, Tian Gui arrives for men, moving left to Si, which is the vital energy position of Shen. At age fourteen, Tian Gui arrives for women, moving right also to Si. (Note: Based on this reasoning, women at fourteen should be at Wei, not Si; this sentence is erroneous.) They occupy the vital energy position of their respective palaces in the same year. Yin and Yang combine to establish the way of marriage, hence there are men and women. *Shanggu Tianzhen Lun* states: At age sixteen (2x8), Tian Gui arrives for men, essence overflows, Yin and Yang harmonize, thus procreation is possible. Yang stated that men marry at thirty when their annual cycle reaches Si, which is incorrect. At age fourteen (2x7), Tian Gui arrives for women, Ren Mai opens, Chong Mai flourishes, menstruation occurs regularly, thus procreation is possible. Yang stated that women marry at twenty when their cycle reaches Si moving right, which contradicts this principle. Yang's words only align with ancient ritual laws of marriage but contradict the numbers of Tian Gui in this classic. Moreover, in Difficulty 19, the Sage discusses the way of male-female pairing, the intersection of Yin and Yang, and the timing of Tian Gui arrival, knowing pulse abundance or deficiency above and below, inferring strength or weakness, and diagnosing excess or insufficiency. If one only speaks of marrying at thirty and twenty, on what basis does this relate to the medical principles of this classic?
Therefore, the male pulse is above Guan, and the female pulse is below Guan. Consequently, the Chi pulse in men is consistently weak, while in women it is consistently strong; this is the norm.
Ding states: The mention of Chi pulses in men and women refers to the root of Yin and Yang. Compliance and contrariety refer to Yang embracing Yin to generate, and Yin embracing Yang to generate. Three Yang begin at Lichun, establishing Yin, hence it is said men are born in Yin, Wood being Yang. Three Yin begin at Liqiu, the seventh month establishing Shen, hence it is said women are born in Shen, Metal being Yin. Male Qi begins with Shaoyang and peaks with Taiyang, so the male Chi pulse is consistently weak and the Cun pulse is Yang. (Note: This character "Yang" is suspected to mean "Strong".) Female Qi begins with Taiyin and peaks with Jueyin; the female Chi pulse is floating and the Cun pulse is sunken, hence it is said the male pulse is above Guan and the female pulse is below Guan. This represents the compliance and contrariety of men and women.
Yang states: Men have abundant Yang Qi, so the Chi pulse is weak. Women have abundant Yin Qi, so the Chi pulse is strong. This is their natural nature.
Contrary patterns refer to men receiving female pulses and women receiving male pulses. What are the pathologies? The response is: When a man receives a female pulse, it indicates insufficiency, with disease internal. If found on the left, the disease is on the left; if on the right, the disease is on the right, depending on the pulse. When a woman receives a male pulse, it indicates excess, with disease in the four limbs. If found on the left, the disease is on the left; if on the right, the disease is on the right, depending on the pulse. This is what is meant.
Ding states: Saying a man receiving a female pulse indicates insufficiency means Yin insufficiency, allowing Yang to invade. Thus, Yang is not seen at Cun Kou but appears in Chi. Yin Qi governs the interior; insufficiency implies disease is internal. When a woman receives a male pulse indicating excess, disease is in the four limbs, because the female Chi pulse is naturally floating; if it additionally appears at Cun, it is called excess. Yang governs the exterior, so disease is in the four limbs. Depending on the left or right pulse: left finding implies left disease, right finding implies right disease.
Yang states: A man receiving a female pulse indicates abundant Yin Qi, which governs the interior, so disease is internal. A woman receiving a male pulse indicates abundant Yang Qi. (Note: The character "Yang" seems missing here.) Yang governs the four limbs, so disease is in the four limbs.
Yu states: Cun Kou is Yang. Men operate using Yang; seeing a Yin pulse now is contrary to heavenly norms, so disease arises internally. Women operate using Yin; seeing a Yang pulse at Cun Kou now is also contrary to heavenly norms, so disease is in the four limbs. *Su Wen* states: The four limbs are the root of all Yang.