《素问》作身有热也，《甲乙》作中有热也。）推而上之，上而不下，腰足 ；推而下之，下而
不上者，头项痛。（上为头项，下为腰足。推下向上，气不能下，故知腰足冷也。推上向下，气
不能上，故知头项痛也。平按∶《素问》 作清，《甲乙》同。上而不下《甲乙》作下而不上，
下而不上作上而不下。）按之至骨脉气少者，腰脊痛而身寒有
痹。（脉之沉细，按之至骨，少得其气，即知有寒，腰脊为痛，身寒痹也。平按∶《素问》身下
无寒字，《甲乙》同。）
黄帝曰∶请问脉之缓急小大滑涩之病形何如？（请问五脏之脉，各有六变，以候病形。）岐伯
曰∶臣请言五脏之变病也。心脉急甚者为螈；（心脉钩，脉缓大滑等三变为热，阳也；急小涩等
三变为寒，阴也。夏时诊得心脉如新张弦急甚者，寒也，筋脉急痛以为螈也。下言急者，皆如弦
急，非急疾也。平按∶变病《灵枢》作病变。《甲乙》无“臣请言五脏之变病也”九字。螈下
《灵枢》、《甲乙》有 字。）微急为心痛引背，食不下。（其心脉来，如弦微急，即脉微弦急，
心微寒，故心痛引背心输而痛，胸下寒，咽中不下食也。）缓甚为狂笑；（心脉缓甚者，缓为阳
也，缓甚热甚也，热甚在心，故发狂多笑。）微缓为伏梁在心下，上下行时唾血。（心脉微缓，
即知心下热聚，以为伏梁之病，大如人臂，从齐上至于心，伏在心下，下至于齐，如彼桥梁，故
曰伏梁。其气上下行来，冲心有伤，故时唾血。平按∶时上《灵枢》有行字，《甲乙》有行有二
字。）大甚为喉 ；（心脉至气甚，气上冲于喉咽，故使喉中 而鸣也。 ，古介反。）微大
为心痹引背，善泪出。（心脉微盛，发风湿之气，冲心为痹痛，痛后引背输及引目系，故喜泪出
也。平按∶《甲乙》泪下无出字。）小甚为善哕，（小为阴也，小甚，心之气血皆少，心气寒也。
心气寒甚，则胃咽气有聚散，故为哕也。哕，于月反。）微小为消瘅。（小而不盛曰微。小者，
阴也。心气内热而有寒来击，遂内热更甚，发为消瘅。瘅，热也。内热消瘦，故曰消瘅。瘅音丹。）
滑甚为善渴；（滑，阳也。阳气内盛，则中热喜渴也。）微滑为心疝引齐，少腹鸣。（阳气盛，内
有微热冲心之阴，遂发为心疝，痛引少腹肠鸣
者也。）涩甚为喑；（涩，阴也。涩者，血多气少。心主于舌，心脉血盛上冲于舌，故喑不能言
也。）微涩为血溢，维厥，耳鸣，癫疾。（微涩，血微盛也。血微盛者，溢于鼻口而出，故曰血
溢。维厥，血盛阳维脉厥也。阳维上冲则上实下虚，故为耳鸣癫疾。）
肺脉急为癫疾；（肺脉毛，脉有弦急，是为冷气上冲，阳 发热在上，上实下虚，故为癫疾。
平按∶急下《灵枢》、《甲乙》有甚字。）微急为肺寒热，怠惰，咳唾血，引腰背胸，若鼻宿肉
不通。（肺以恶寒弦急，即是有寒乘肺，肺阳与寒交战，则二俱作病，为肺寒热也。肺病不行于
气，身体怠惰。肺得寒，故发咳。咳甚伤中，故唾血。咳复引腰及背输而痛。肺病出气壅塞，因
即鼻中生于宿肉也。平按∶宿《灵枢》、《甲乙》作息。）缓甚为多汗；（缓为阳也，肺得热气，
外开腠理，故为多汗。）微缓为痿，漏风，头以下汗出不可止。（肺脉行于两手，肺得于热，故
手痿缓。又肺脉不上于头，故肺之热开腠，自头以下漏风汗不止也。平按∶漏风《灵枢》作 偏
风，《甲乙》同，止上无可字。）大甚为胫肿；（肺气甚，故曰肺大甚也。肺脉手太阴与足太阴
相通，足太阴行胫，故肺气热甚，上实下虚，故为胫肿也。）微大为肺痹引胸背，起恶日。（肺气
微大，又得秋时寒气，故发为痹痛，前引胸，后引背输。以是阴病，故引胸背，起不用见日光也。
恶，焉故反。平按∶《灵枢》、《甲乙》日下有光字。）小甚为泄，（肺之气血小甚，即是气寒，
即是胃气甚，不消水谷，故泄利矣。）微小为消瘅。（肠肺之气血微小也。虚寒伤肺，反为热病，
消肌肉也。）滑甚为息贲上气，（滑甚，阳气盛也。阳盛击阴为积，左右箱近膈，犹如覆杯，令
人上气喘
息，故曰息贲。贲，膈也，音奔。）微滑为上下出血。（阳气微盛则内伤络脉，络脉伤则上下出
血，阳络伤则上衄血，阴络伤则下泄血也。）涩甚为欧血；（气为阳也，血为阴也，涩为阳也，今
得涩脉，即知血盛冲于肺腑阳络，阳络伤便欧血也。平按∶欧《灵枢》、《甲乙》作呕。）微涩
为鼠 ，在颈支腋之间，下不胜其上，其能喜酸。（微涩，血微盛也。血微盛者，循肺腑手阳明
脉上胫为 ，又循肺手太阴脉下支腋之间为 ，其脉下虚不胜上实，金实遂欲克木，为味故喜酸
也。酸，木味也。平按∶其能喜酸《灵枢》作其应善酸矣，《甲乙》作甚能善酸。）
肝脉急甚为恶言；（诊得弦脉急者，是寒气来乘于肝，魂神烦乱，故恶出言语也。平按∶《灵
枢》甚下有者字。《甲乙》注云∶恶言一作忘言。）微急为肥气，在胁下若覆杯。（肝脉微急，
是肝受寒气，积在左胁之下，状若覆杯，名曰肥气。）缓甚为喜欧，（缓甚者，肝热气冲咽，故
喜欧也。平按∶喜欧《灵枢》、《甲乙》作善呕。）微缓为水、瘕、痹也。（阳气微热，肝气壅
塞，饮溢为水，或结为瘕，或聚为痹。）大甚为内痈，善呕衄；（大甚气盛，热气结为内痈也。
肝气上逆，故喜呕喜衄。）微大为肝痹阴缩，咳引少腹。（微大，少阳微盛击肝，乃为阴病肝痹
者也。阴寒故筋缩，又发肝咳，循厥阴下引少腹痛。平按∶阴缩，阴字原抄脱，谨据《灵枢》、
《甲乙》补入，袁刻作筋缩，据注应作筋缩。）小甚为多饮，（肝脉小甚，是为气血皆少，故渴
而多饮也。）微小为消瘅。（微小气血俱少，有寒气冲肝气，遂发热为瘅，消肌肉。）滑甚为颓
疝，（滑甚，少阳气盛也。少阳气盛则肝虚不足，发为颓疝，丈夫小腹中为块，下冲阴痛。平按∶
颓《灵枢》作 ，《甲乙》作 。）微滑为遗溺。（阳气微盛，阴虚不禁，故为遗寒也。平按∶
注寒，根据经文应作溺。）涩甚为溢饮，（肝脉涩者，肝气血多寒也。肝血多而寒，不得泄，溢入肠
胃皮肤之
外，故为溢饮也。）微涩为螈挛筋。（微涩，血多而寒，即厥阴筋寒，故螈急而挛也。平按∶《灵
枢》筋下有痹字。《甲乙》螈作 。）
脾脉急甚为螈 ；（诊得代脉急甚，多寒为病，手足引牵来去，故曰螈 也。平按∶《甲乙》
螈作 。）微急为鬲中食饮入而还出，后沃沫。（微急者，微寒也。脾气微寒，即脾胃中冷，故
食入还呕出，大便沃冷沫也。鬲中当咽，冷不受食也。平按∶鬲《灵枢》作膈。注即袁刻作则。）
缓甚为痿厥；（缓甚者，脾中虚热也。脾中主营四肢，脾气热不营，故曰四肢痿弱。厥，逆冷也。）
微缓为风痿，四肢不用，心慧然若无病。（微缓，脾中微热也。脾中有热受风，营其四肢，令其
痿弱不用。风不入心，故心慧然明了，安若无病。平按∶支《灵枢》、《甲乙》作肢。）大甚为
击仆；（脾脉大甚，是脾气盛血里，当是被击，或者倒仆有伤，故发此候。）微大为疝气，腹里
大脓血，在肠胃之外。（脾气微大，即知阴气内盛为疝，大腹里脓血，在肠胃之外也。）小甚为
寒热，（脾脉小甚，气血皆少，是病诸寒热病也。）微小为消瘅。（微小气血俱少，故多内热，
热消肌肉也。）滑甚为颓 ，（滑甚者，阳气盛热也。阴气虚弱，发为颓 。 ，淋也，音隆。
平按∶颓 《灵枢》、《甲乙》作 癃。）微滑为虫毒蛔蝎腹热。（微滑，阳气微盛有热也。蛔，
胡灰反，腹中长虫也。蝎，胡竭反，谓腹中虫如桑蠹也。阳盛有热，腹内生此二虫，为病绞作腹中。
平按∶注桑蠹袁刻作长蠹。）涩甚为肠颓；（颓，徒回反。脉涩，气少血多而寒，故冷气冲下，
广肠脱出，名曰肠颓，亦妇人带下病也。平按∶颓《灵枢》作溃，《甲乙》作 ，注云∶一作溃。）
微涩为内溃，多下脓血。（微涩，是血多聚于腹中，溃坏而下脓血也。）
肾脉急甚为骨癫疾；（诊得石脉急甚者，是谓寒气乘肾阳气走骨而上，上实下虚，故骨癫也。
平按∶《甲乙》骨下有痿字。）微急为沉厥，足不收，不得前后。（微急者，肾冷发沉厥之病，
足脚沉重逆冷不收，膀胱大肠壅闭，大小便亦不通。平按∶《灵枢》沉厥下有奔豚二字，《甲乙》
奔豚二字在沉厥上。）缓甚为折脊；（阳气盛热，阴气虚弱，肾受寒气，致令腰脊痛如折。）微
缓为洞，洞者食不化，下嗌还出。（肾脉从肾而上，贯肝膈，循喉咙，故肾有热气，则下津液不
通，上冲喉嗌，通洞不禁，其食入腹还出。平按∶二洞字下《甲乙》均有泄字。）大甚为阴痿；
（大甚多气少血，太阳气盛，少阴血少，精血少故阴痿不起也。平按∶注精字袁刻误作积，起下
脱也字。）微大为石水，起齐以下，至少腹垂垂然，上至胃管，死不治。（太阳气盛，血少，津
液不得下通，结而为水，在少腹之中。垂垂，少腹垂也。其水若至胃脘，盛极故死也。平按∶《灵
枢》少腹作小肠，垂垂作 ，管作腕。《甲乙》少腹作小腹。）小甚为洞泄，（肾气小甚，是
血气皆少也。肾之血气皆少，则上下俱冷，故食入口还出，故曰洞泄。）微小为消瘅。（血气俱
少，是谓阴虚阳盛，热为消瘅。）滑甚为 颓；（滑甚，太阳热甚，少阳虚而受寒，故为 颓也。
平按∶《灵枢》颓作 ，《甲乙》作痈 。）微滑为骨痿，坐不能起，起目毋所见。（微滑，太
阳微盛，热入骨髓，发为骨痿骨弱，坐不能起也。太阳自目内 而起，上冲于目，故目无见也。
平按∶《灵枢》、《甲乙》目上有则字。《甲乙》所见下有“视黑丸”三字。）涩甚为大痈；（涩
甚多血少气不宣 故聚为大痈）微涩为不月，沉痔。（微涩者，血微盛也。血多气少不通，故
女月经不得以时下也。又其气少血聚，复为广肠内痔也。沉，内也。）
黄帝曰∶病之六变者，刺之奈何？（问前五脉各有六变补泻之道。平按∶《甲乙》曰上无黄帝
二字，病之六变作病亦有甚变。）岐伯曰∶诸急者多寒，（脉之弦急，由于多寒，有甚有微，即
五脏急合有十种，故曰诸急。自余诸变，皆放此也。）缓者多热。（由其当藏多热，致脉迟缓。）
大者多气少血，（由其当藏气多血少，致令脉有洪大。）小者血气皆少。（由其当藏血气皆少，
故令脉衰小也。）滑者阳气盛，微有热；（由其当藏阳盛热微，故令脉有滑疾也。）涩者，多血
少气，微有寒。（由其当藏血多气少，微寒，故令脉涩。）是故刺急者，深内而久留之。（寒则
气深来迟，故深内而久留也。）刺缓者，浅内而疾发针，以其热。（热退气浅行疾，故浅内疾发。
平按∶以其热《灵枢》、《甲乙》作以去其热。）刺大者，微泻其气，毋出其血。（大者气多，
故须微泻；以其少血，故不出血。）刺滑者，疾发针而浅内之，以泻其阳气而去其热。（以其气
盛而微热，故浅内针仍疾发之。平按∶《甲乙》写作泻。）刺涩者，必中其脉，随其逆顺而久留
之，必先扪而循之，已发针，疾按其 ，毋令其血出，以和其脉。（脉涩，即多血也。以其多血，
故先须以手扪循，然后刺之中其脉血。随其逆冷者，久而留针。以其气少，恐其泄气，故发针已，
疾按其 。 ，于轨反，谓疮瘢之也。平按∶扪《灵枢》、《甲乙》作按，以发针，以作已。《甲
乙》其血出作出血，脉上有诸字。注逆冷，根据经文应作逆顺）。诸小者，阴阳形气俱不足，勿取以
针，调其甘药。（诸脉小者，五脏之阴，六腑之阳，及骨肉形，并其气海之气，四者皆悉虚少。
若引阴补阳，是则阴竭，引阳补阴，即使阳尽，阴阳既竭，形气又微，用针必死，宜以甘味之药
调其脾气，脾胃气和，即四脏可生也。平按∶小上《甲乙》无诸字。调其甘药《灵枢》作而调以
甘药也，《甲乙》作而调之以甘药。）
肝满肾满肺满，皆实，皆为肿∶（此三脏之满实，皆为痈肿。平按∶皆为肿《素问》、《甲
乙》作即为肿。）肺之痈，喘，两胁满；（肺以主气，故肺生痈有喘也。肺脉上膈近胁，故肺痈
胁满也。平按∶《素问》痈作雍，胁作 ，《甲乙》作胫，注云∶《素问》作 。）肝痈，两
满，卧则惊，不得小便；（两 ，谓在侧箱两肋下空处。肝腑足少阳脉行在胁下，故肝痈两 满
也。足少阳别脉上肝贯心，故热盛为痈，因即心惊也。肝脉环阴，故肝病热甚，不得小便。有本
作小和，字误。平按∶痈《素问》作雍。《甲乙》 作胁下二字。）肾痈， 下至少腹满，胫有
大小，髀 大跛，易，偏枯。（督脉上至十四椎，属于带脉，行两 ，故从两 至少腹满。以少
阴脉虚，受病行于两脚，故胫大小，脾 大跛。左右二脚更病，故为易也。又为偏枯病也。 称膝
《素问》中记载为“身体发热”，《甲乙经》中记载为“体内发热”。（此处原文有脱漏，结合上下文及杨上善注，应为描述脉象推按后的反应）。向上推按脉气，若气上行而不能下行，则腰足寒冷；向下推按脉气，若气下行而不能上行，则头项疼痛。（上指头项，下指腰足。向下推而气不能下行，所以知道腰足冷；向上推而气不能上行，所以知道头项痛。平康按：《素问》作“清”，《甲乙经》相同。《甲乙经》中“上而不下”作“下而不上”，“下而不上”作“上而不下”。）按压脉搏直到骨头，如果脉气微弱，则是腰脊疼痛且身体寒冷伴有痹证。（脉象沉细，按至骨部，得到的脉气很少，就知道有寒邪，导致腰脊疼痛，身体寒冷痹阻。平康按：《素问》中“身”字下无“寒”字，《甲乙经》相同。）
黄帝说：请问脉象的缓、急、小、大、滑、涩所对应的病状是怎样的？（请问五脏的脉象，各有六种变化，用来候察病状。）岐伯说：请允许我讲述五脏病变的情况。心脉急甚，表现为抽搐痉挛；（心脉如钩，脉象缓、大、滑等三种变化属热，为阳；急、小、涩等三种变化属寒，为阴。夏季诊得心脉像新张开的弓弦那样急甚者，是寒邪所致，筋脉拘急疼痛导致抽搐。下文所说的“急”，都像弦脉那样急，并非指脉搏跳动急促。平康按：《灵枢》中“变病”作“病变”。《甲乙经》没有“臣请言五脏之变病也”这九个字。《灵枢》、《甲乙经》在“螈”字下有“瘛”字。）心脉微急，表现为心痛牵引背部，饮食难以下咽。（心脉来去，像弦脉那样微急，即脉象微带弦急，心受微寒，所以心痛牵引背心俞穴处疼痛，胸下寒冷，咽喉中食物不下。）心脉缓甚，表现为狂笑不止；（心脉缓甚者，缓属阳，缓甚则热甚，热盛在心，所以发狂多笑。）心脉微缓，表现为伏梁病在心下，上下移动时咳唾血液。（心脉微缓，就知道心下热邪聚集，形成伏梁病，大小像人的手臂，从脐上至于心窝，伏在心下，下至于脐，像桥梁一样，所以叫伏梁。其气上下运行，冲击心脏造成损伤，所以时常咳唾血液。平康按：《灵枢》在“时”字上有“行”字，《甲乙经》在“行”字下有“二”字。）心脉大甚，表现为喉部阻塞有声；（心脉气盛，气上冲于喉咽，所以使喉中阻塞而有鸣声。噎，古音介反。）心脉微大，表现为心痹牵引背部，容易流泪。（心脉微盛，引发风湿之气，冲击心脏成为痹痛，痛后牵引背俞及目系，所以喜欢流泪。平康按：《甲乙经》“泪”字下无“出”字。）心脉小甚，表现为经常呃逆；（小属阴，小甚，心的气血都少，心气寒。心气寒甚，则胃咽之气有聚散，所以发生呃逆。哕，于月反。）心脉微小，表现为消瘅病。（小而不盛叫微。小属阴。心气内热又有寒邪来击，于是内热更甚，发为消瘅。瘅，就是热。内热消瘦，所以叫消瘅。瘅音丹。）心脉滑甚，表现为容易口渴；（滑，属阳。阳气内盛，则中焦热喜渴。）心脉微滑，表现为心疝牵引脐部，小腹鸣响。（阳气盛，内有微热冲击心之阴，于是发为心疝，痛引少腹肠鸣。）心脉涩甚，表现为失音；（涩，属阴。涩者，血多气少。心主舌，心脉血盛上冲于舌，所以失音不能说话。）心脉微涩，表现为血液溢出，维厥，耳鸣，癫疾。（微涩，血微盛。血微盛者，溢于鼻口而出，所以叫血溢。维厥，血盛阳维脉厥。阳维上冲则上实下虚，所以为耳鸣癫疾。）
肺脉急，表现为癫疾；（肺脉毛，脉有弦急，这是冷气上冲，阳气发热在上，上实下虚，所以为癫疾。平康按：《灵枢》、《甲乙经》在“急”字下有“甚”字。）肺脉微急，表现为肺寒热，倦怠乏力，咳嗽吐痰带血，牵引腰背胸部，或者鼻中生出息肉不通。（肺厌恶寒弦急，即有寒邪乘袭肺，肺阳与寒邪交战，两者都致病，称为肺寒热。肺病气机不行，身体倦怠。肺受寒，所以发咳。咳甚伤中，所以唾血。咳嗽又牵引腰及背俞疼痛。肺病出气壅塞，因而鼻中生出息肉。平康按：《灵枢》、《甲乙经》“宿”字作“息”。）肺脉缓甚，表现为多汗；（缓属阳，肺得热气，外开腠理，所以多汗。）肺脉微缓，表现为痿证，漏风，头部以下出汗止不住。（肺脉行于两手，肺受热，所以手痿缓。又肺脉不上于头，所以肺之热开腠理，自头以下漏风汗不止。平康按：《灵枢》“漏风”作“偏风”，《甲乙经》相同，“止”字上有“可”字。）肺脉大甚，表现为小腿肿胀；（肺气盛，所以叫肺大甚。肺脉手太阴与足太阴相通，足太阴行于胫，所以肺气热甚，上实下虚，所以为小腿肿胀。）肺脉微大，表现为肺痹牵引胸背，起身怕见日光。（肺气微大，又得秋时寒气，所以发为痹痛，前引胸，后引背俞。因为是阴病，所以牵引胸背，起身不愿见日光。恶，焉故反。平康按：《灵枢》、《甲乙经》“日”字下有“光”字。）肺脉小甚，表现为泄泻，（肺之气血小甚，即是气寒，即是胃气盛，不消化水谷，所以泄利。）肺脉微小，表现为消瘅。（肠肺之气血微小。虚寒伤肺，反为热病，消耗肌肉。）肺脉滑甚，表现为息贑上气，（滑甚，阳气盛。阳盛击阴为积，左右靠近膈膜，犹如倒扣的杯子，让人上气喘息，所以叫息贑。贑，膈也，音奔。）肺脉微滑，表现为上下出血。（阳气微盛则内伤络脉，络脉伤则上下出血，阳络伤则上部衄血，阴络伤则下部泄血。）肺脉涩甚，表现为呕血；（气为阳，血为阴，涩为阳，今得涩脉，就知道血盛冲击肺腑阳络，阳络伤便呕血。平康按：《灵枢》、《甲乙经》“欧”字作“呕”。）肺脉微涩，表现为鼠瘘，在颈部腋下之间，下肢无力不能支撑上身，口味偏好酸味。（微涩，血微盛。血微盛者，循肺腑手阳明脉上行至胫为瘘，又循肺手太阴脉下行至腋下为瘘，其脉下虚不胜上实，金实遂欲克木，因为味道所以喜酸。酸，木味也。平康按：《灵枢》“其能喜酸”作“其应善酸矣”，《甲乙经》作“甚能善酸”。）
肝脉急甚，表现为恶语；（诊得弦脉急者，是寒气来乘于肝，魂神烦乱，所以厌恶出言语。平康按：《灵枢》“甚”字下有“者”字。《甲乙经》注云：恶言一作忘言。）肝脉微急，表现为肥气，在胁下像倒扣的杯子。（肝脉微急，是肝受寒气，积聚在左胁之下，形状像倒扣的杯子，名叫肥气。）肝脉缓甚，表现为喜欢呕吐，（缓甚者，肝热气冲咽，所以喜欢呕吐。平康按：《灵枢》、《甲乙经》“喜欧”作“善呕”。）肝脉微缓，表现为水病、瘕病、痹病。（阳气微热，肝气壅塞，饮水溢出为水病，或结为瘕病，或聚为痹病。）肝脉大甚，表现为内痈，喜欢呕吐和衄血；（大甚气盛，热气结为内痈。肝气上逆，所以喜欢呕吐和衄血。）肝脉微大，表现为肝痹阴缩，咳嗽牵引少腹。（微大，少阳微盛击肝，乃为阴病肝痹。阴寒所以筋缩，又发肝咳，循厥阴下引少腹痛。平康按：“阴缩”，“阴”字原抄脱，谨据《灵枢》、《甲乙经》补入，袁刻作“筋缩”，据注应作“筋缩”。）肝脉小甚，表现为多饮，（肝脉小甚，是为气血皆少，所以渴而多饮。）肝脉微小，表现为消瘅。（微小气血俱少，有寒气冲肝气，遂发热为瘅，消耗肌肉。）肝脉滑甚，表现为颓疝，（滑甚，少阳气盛。少阳气盛则肝虚不足，发为颓疝，男子小腹中有块，下冲阴部疼痛。平康按：《灵枢》“颓”作“䐜”，《甲乙经》作“癃”。）肝脉微滑，表现为遗尿。（阳气微盛，阴虚不禁，所以为遗寒。平康按：注“寒”，根据经文应作“溺”。）肝脉涩甚，表现为溢饮，（肝脉涩者，肝气血多寒。肝血多而寒，不得泄，溢入肠胃皮肤之外，所以为溢饮。）肝脉微涩，表现为抽搐筋挛。（微涩，血多而寒，即厥阴筋寒，所以抽搐急而挛。平康按：《灵枢》“筋”字下有“痹”字。《甲乙经》“螈”作“瘛”。）
脾脉急甚，表现为抽搐掣引；（诊得代脉急甚，多寒为病，手足牵引来去，所以叫抽搐掣引。平康按：《甲乙经》“螈”作“瘛”。）脾脉微急，表现为膈中饮食入而还出，大便沃沫。（微急者，微寒。脾气微寒，即脾胃中冷，所以食入还呕出，大便沃冷沫。膈中当咽，冷不受食。平康按：《灵枢》“鬲”作“膈”。注即袁刻作“则”。）脾脉缓甚，表现为痿厥；（缓甚者，脾中虚热。脾中主营四肢，脾气热不营，所以叫四肢痿弱。厥，逆冷也。）脾脉微缓，表现为风痿，四肢不能用，心里清醒好像没病。（微缓，脾中微热。脾中有热受风，营其四肢，令其痿弱不用。风不入心，所以心慧然明了，安若无病。平康按：《灵枢》、《甲乙经》“支”字作“肢”。）脾脉大甚，表现为被击打仆倒；（脾脉大甚，是脾气盛血里，应当是被击打，或者倒仆有伤，所以发此候。）脾脉微大，表现为疝气，腹里大脓血，在肠胃之外。（脾气微大，就知道阴气内盛为疝，大腹里脓血，在肠胃之外。）脾脉小甚，表现为寒热，（脾脉小甚，气血皆少，是病诸寒热病。）脾脉微小，表现为消瘅。（微小气血俱少，所以多内热，热消肌肉。）脾脉滑甚，表现为颓癃，（滑甚者，阳气盛热。阴气虚弱，发为颓癃。癃，淋也，音隆。平康按：《灵枢》、《甲乙经》“颓癃”作“癃”。）脾脉微滑，表现为虫毒蛔蝎腹热。（微滑，阳气微盛有热。蛔，胡灰反，腹中长虫。蝎，胡竭反，谓腹中虫如桑蠹。阳盛有热，腹内生此二虫，为病绞作腹中。平康按：注“桑蠹”袁刻作“长蠹”。）脾脉涩甚，表现为肠颓；（颓，徒回反。脉涩，气少血多而寒，所以冷气冲下，广肠脱出，名叫肠颓，也是妇人带下病。平康按：《灵枢》“颓”作“溃”，《甲乙经》作“䐜”，注云：一作“溃”。）脾脉微涩，表现为内溃，多下脓血。（微涩，是血多聚于腹中，溃坏而下脓血。）
肾脉急甚，表现为骨癫疾；（诊得石脉急甚者，是谓寒气乘肾阳气走骨而上，上实下虚，所以骨癫。平康按：《甲乙经》“骨”字下有“痿”字。）肾脉微急，表现为沉厥，脚不收，大小便不通。（微急者，肾冷发沉厥之病，脚沉重逆冷不收，膀胱大肠壅闭，大小便亦不通。平康按：《灵枢》“沉厥”下有“奔豚”二字，《甲乙经》“奔豚”二字在“沉厥”上。）肾脉缓甚，表现为折脊；（阳气盛热，阴气虚弱，肾受寒气，致令腰脊痛如折断。）肾脉微缓，表现为洞泄，洞泄就是食物不消化，咽下后又吐出。（肾脉从肾而上，贯肝膈，循喉咙，所以肾有热气，则下津液不通，上冲喉嗌，通洞不禁，其食入腹还出。平康按：两个“洞”字下《甲乙经》均有“泄”字。）肾脉大甚，表现为阳痿；（大甚多气少血，太阳气盛，少阴血少，精血少所以阴茎痿不起。平康按：注“精”字袁刻误作“积”，“起”字下脱“也”字。）肾脉微大，表现为石水，从脐以下，至少腹垂垂然，上至胃管，死不治。（太阳气盛，血少，津液不得下通，结而为水，在少腹之中。垂垂，少腹垂也。其水若至胃脘，盛极所以死。平康按：《灵枢》“少腹”作“小肠”，“垂垂”作“𡱧”，“管”作“腕”。《甲乙经》“少腹”作“小腹”。）肾脉小甚，表现为洞泄，（肾气小甚，是血气皆少。肾之血气皆少，则上下俱冷，所以食入口还出，所以叫洞泄。）肾脉微小，表现为消瘅。（血气俱少，是谓阴虚阳盛，热为消瘅。）肾脉滑甚，表现为㿉颓；（滑甚，太阳热甚，少阳虚而受寒，所以为㿉颓。平康按：《灵枢》“颓”作“䐜”，《甲乙经》作“痈䐜”。）肾脉微滑，表现为骨痿，坐不能起，起来眼睛看不见。（微滑，太阳微盛，热入骨髓，发为骨痿骨弱，坐不能起。太阳自目内眦而起，上冲于目，所以目无见。平康按：《灵枢》、《甲乙经》“目”字上有“则”字。《甲乙经》“所见”下有“视黑丸”三字。）肾脉涩甚，表现为大痈；（涩甚多血少气不宣，所以聚为大痈）肾脉微涩，表现为女子月经不来，沉痔。（微涩者，血微盛。血多气少不通，所以女月经不得以时下。又其气少血聚，复为广肠内痔。沉，内也。）
黄帝说：病的六种变化，针刺治疗怎么样？（问前五脉各有六种变化的补泻之道。平康按：《甲乙经》“曰”上无“黄帝”二字，“病之六变”作“病亦有甚变”。）岐伯说：各种急脉多寒，（脉之弦急，由于多寒，有深有微，即五脏急合有十种，所以叫诸急。其余诸变，都仿照这个原理。）缓脉多热。（由其当藏多热，致脉迟缓。）大脉多气少血，（由其当藏气多血少，致令脉有洪大。）小脉血气皆少。（由其当藏血气皆少，故令脉衰小。）滑脉阳气盛，微有热；（由其当藏阳盛热微，故令脉有滑疾。）涩脉多血少气，微有寒。（由其当藏血多气少，微寒，故令脉涩。）所以刺急脉，要深进针并久留针。（寒则气深来迟，所以深进针并久留。）刺缓脉，要浅进针并快速出针，以去除其热。（热退气浅行疾，所以浅进针快出。平康按：《灵枢》、《甲乙经》“以其热”作“以去其热”。）刺大脉，微泻其气，不要放血。（大者气多，所以需要微泻；因其少血，所以不放血。）刺滑脉，快速出针并浅进针，以泻其阳气而去其热。（因其气盛而微热，所以浅进针仍快出。平康按：《甲乙经》写作“泻”。）刺涩脉，必须中其脉，随其逆顺而久留针，必须先扪摸循按，已出针，快速按压针孔，不要让血流出，以调和其脉。（脉涩，即多血。因其多血，所以先须用手扪循，然后刺之中其脉血。随其逆冷者，久而留针。因其气少，恐其泄气，所以出针后，快速按压针孔。䵣，于轨反，谓疮瘢之。平康按：《灵枢》、《甲乙经》“扪”作“按”，“以发针”作“已发针”，“以”作“已”。《甲乙经》“其血出”作“出血”，“脉”上有“诸”字。注“逆冷”，根据经文应作“逆顺”。）各种小脉，阴阳形气都不足，不要用针，用甘药调治。（诸脉小者，五脏之阴，六腑之阳，及骨肉形，并其气海之气，四者皆悉虚少。若引阴补阳，是则阴竭，引阳补阴，即使阳尽，阴阳既竭，形气又微，用针必死，宜以甘味之药调其脾气，脾胃气和，即四脏可生。平康按：《甲乙经》“小”上无“诸”字。《灵枢》“调其甘药”作“而调以甘药也”，《甲乙经》作“而调之以甘药”。）
肝满、肾满、肺满，都是实证，都表现为肿：（这三脏的满实，都是痈肿。平康按：《素问》、《甲乙经》“皆为肿”作“即为肿”。）肺痈，喘，两胁满；（肺主气，所以肺生痈有喘。肺脉上膈近胁，所以肺痈胁满。平康按：《素问》“痈”作“雍”，“胁”作“䏚”，《甲乙经》作“胫”，注云：《素问》作“䏚”。）肝痈，两胁满，卧则惊，不得小便；（两胁，谓在侧厢两肋下空处。肝腑足少阳脉行在胁下，所以肝痈两胁满。足少阳别脉上肝贯心，所以热盛为痈，因而心惊。肝脉环阴，所以肝病热甚，不得小便。有本作“小和”，字误。平康按：《素问》“痈”作“雍”。《甲乙经》“䏚”作“胁下”二字。）肾痈，髀下至少腹满，胫有大小，髀䯒大跛，易偏枯。（督脉上至十四椎，属于带脉，行两髀，所以从两髀至少腹满。以少阴脉虚，受病行于两脚，所以胫大小，脾䯒大跛。左右二脚更病，所以为易。又为偏枯病也。䯒称膝）
In the *Suwen*, it is recorded as "body heat," and in the *Jiayi Jing* (Systematic Classic of Acupuncture and Moxibustion), it is recorded as "internal heat." (The original text here has an omission; combined with Yang Shangshan's commentary, it should describe the reaction after pushing/pressing the pulse.) When pushing the pulse qi upwards, if the qi ascends but does not descend, there is coldness in the waist and feet; when pushing the pulse qi downwards, if the qi descends but does not ascend, there is pain in the head and neck. ("Up" refers to the head and neck, "down" refers to the waist and feet. Pushing down while the qi cannot descend indicates coldness in the waist and feet; pushing up while the qi cannot ascend indicates pain in the head and neck. Pingkang notes: The *Suwen* reads "clear/cool" (Qing), same as the *Jiayi Jing*. In the *Jiayi Jing*, "ascends but does not descend" is written as "descends but does not ascend," and vice versa.) If pressing the pulse until the bone reveals weak pulse qi, it indicates pain in the waist and spine accompanied by body coldness and Bi syndrome (obstruction syndrome). (A deep and thin pulse, where little qi is felt upon pressing to the bone, indicates cold pathogen causing pain in the waist and spine, body coldness, and obstruction. Pingkang notes: The *Suwen* lacks the character "cold" under "body," same as the *Jiayi Jing*.)
Yellow Emperor said: I ask about the pathological manifestations corresponding to the pulse qualities of slow (Huan), rapid/tight (Ji), small (Xiao), large (Da), slippery (Hua), and choppy (Se). (I ask about the six variations of the five Zang pulses used to diagnose pathology.) Qibo replied: Please allow me to discuss the pathological changes of the five Zang organs. If the Heart pulse is extremely tight (Ji), it manifests as convulsions and spasms (Chou Yuan); (The Heart pulse is like a hook; three variations—slow, large, slippery—are heat/Yang; three variations—tight, small, choppy—are cold/Yin. Diagnosing a Heart pulse that is extremely tight like a newly strung bowstring in summer indicates cold pathogen causing painful muscle spasms. The "tightness" mentioned below refers to the tension of a string-like pulse, not rapid beating speed. Pingkang notes: *Lingshu* reads "pathological changes" (Bian Bing) instead of "variation disease"; *Jiayi Jing* omits the nine characters "Chen Qing Yan Wu Zang Zhi Bian Bing Ye." *Lingshu* and *Jiayi Jing* add the character "Chi" (spasm) after "Yuan".) If the Heart pulse is slightly tight, it manifests as heart pain radiating to the back and difficulty swallowing food. (A Heart pulse coming and going with slight tension indicates slight cold in the Heart, causing heart pain radiating to the Back-Shu points, cold in the chest/lower chest, and inability to swallow food in the throat.) If the Heart pulse is extremely slow (Huan), it manifests as manic laughter; (Extreme slowness indicates extreme heat in the Heart, leading to mania and excessive laughing.) If the Heart pulse is slightly slow, it manifests as Fuliang (a fixed mass disease) located below the heart, with hemoptysis occurring as the condition moves up and down. (Slight slowness indicates heat accumulation below the heart forming Fuliang, shaped like an arm, extending from the umbilicus to the heart area. As this qi moves up and down, it injures the Heart, causing intermittent hemoptysis. Pingkang notes: *Lingshu* adds "xing" (move) before "shi" (time); *Jiayi Jing* adds two characters after "xing".) If the Heart pulse is extremely large, it manifests as throat obstruction with sound; (Excessive Heart qi rushing upward to the throat/pharynx causes obstruction and murmuring. "Ye" is pronounced jie.) If the Heart pulse is slightly large, it manifests as Xin Bi (Heart obstruction) radiating to the back and frequent tearing. (Slight excess triggers wind-dampness Qi attacking the Heart, causing Bi pain radiating to the back and eye meridians, leading to frequent tearing. Pingkang notes: *Jiayi Jing* omits "chu" after "lei".) If the Heart pulse is extremely small, it manifests as frequent hiccups (Yue); (Small indicates Yin; extreme smallness means both Heart Qi and Blood are deficient, leading to Cold Heart Qi. Severe Cold Heart Qi causes stagnation and dispersion of Qi in the Stomach and pharynx, resulting in hiccups. "Yue" is pronounced yue.) If the Heart pulse is slightly small, it manifests as Xiaodan (wasting-thirst disease). (Small without excess is called slight. Small indicates Yin. Internal Heat in the Heart combined with invading Cold makes the internal heat worse, causing Xiaodan. "Dan" means heat. Internal heat causes emaciation, hence Xiaodan. "Dan" is pronounced dan.) If the Heart pulse is extremely slippery, it manifests as frequent thirst; (Slippery indicates Yang. Excess internal Yang leads to middle-jiao heat and thirst.) If the Heart pulse is slightly slippery, it manifests as Xin Han (Heart hernia) radiating to the umbilicus and borborygmus in the lower abdomen. (Excess Yang with slight internal heat attacks the Yin of the Heart, causing Xin Han, pain radiating to the lower abdomen and intestinal sounds.) If the Heart pulse is extremely choppy, it manifests as aphonia; (Choppy indicates Yin. Choppy means more blood and less Qi. The Heart governs the tongue; excessive Heart blood rushing to the tongue causes aphonia and inability to speak.) If the Heart pulse is slightly choppy, it manifests as bleeding (Xue Yi), Wei Jue (collateral reversal), tinnitus, and epilepsy. (Slight choppy indicates slightly excessive blood. Slightly excessive blood overflows from the nose and mouth, called Xue Yi. Wei Jue refers to Yang Wei collateral reversal due to blood excess. Upward rush of Yang Wei causes upper excess and lower deficiency, leading to tinnitus and epilepsy.)
If the Lung pulse is tight, it manifests as epilepsy; (Lung pulse is feathery; string-like tightness indicates cold Qi rushing upward, with Yang heat above causing upper excess and lower deficiency, leading to epilepsy. Pingkang notes: *Lingshu* and *Jiayi Jing* add "shen" (extreme) after "ji".) If the Lung pulse is slightly tight, it manifests as Lung cold-heat, lethargy, coughing up bloody sputum, pain radiating to the waist, back, and chest, or nasal polyps causing obstruction. (Lung dislikes cold and tension; cold pathogen attacks Lung, causing conflict between Lung Yang and Cold, resulting in Lung cold-heat. Lung Qi fails to circulate, causing lethargy. Cold induces cough; severe cough damages the interior, causing bloody sputum. Cough also radiates pain to the waist and back. Lung Qi obstruction leads to nasal polyps. Pingkang notes: *Lingshu* and *Jiayi Jing* read "xi" (rest) instead of "su" (old).) If the Lung pulse is extremely slow, it manifests as profuse sweating; (Slowness indicates Yang. Lung heat opens the interstices, causing profuse sweating.) If the Lung pulse is slightly slow, it manifests as Wei syndrome (flaccidity), Lou Feng (wind leakage), and unstoppable sweating from the head downward. (Lung meridians run on the hands; Lung heat causes hand flaccidity. Lung meridians do not ascend to the head; Lung heat opens interstices, causing continuous sweating from the head down. Pingkang notes: *Lingshu* reads "pian feng" (partial wind) for "lou feng"; *Jiayi Jing* agrees; "ke" (can) appears before "zhi" (stop).) If the Lung pulse is extremely large, it manifests as swelling of the shins; (Excessive Lung Qi implies Lung excess. Hand Taiyin Lung meridian connects with Foot Taiyin Spleen meridian, which runs along the shin. Lung heat causes upper excess and lower deficiency, leading to shin swelling.) If the Lung pulse is slightly large, it manifests as Fei Bi (Lung obstruction) radiating to the chest and back, with aversion to sunlight upon rising. (Slight Lung excess combined with autumn cold causes Bi pain radiating to chest and back. Being a Yin disease, it causes aversion to sunlight. "Wu" is pronounced an gu fan. Pingkang notes: *Lingshu* and *Jiayi Jing* add "guang" (light) after "ri" (sun).) If the Lung pulse is extremely small, it manifests as diarrhea; (Extreme smallness of Lung Qi and Blood indicates Cold Qi and excessive Stomach Qi failing to digest food/water, causing diarrhea.) If the Lung pulse is slightly small, it manifests as Xiaodan. (Deficient Lung and Intestine Qi/Blood. Deficient cold damages Lung, transforming into heat disease that consumes muscle.) If the Lung pulse is extremely slippery, it manifests as Xi Ben (accumulation of breath) and rebellious Qi; (Extreme slipperiness indicates excess Yang. Yang excess attacks Yin, creating accumulation near the diaphragm like an inverted cup, causing wheezing and rebellious Qi. "Ben" refers to the diaphragm, pronounced ben.) If the Lung pulse is slightly slippery, it manifests as bleeding from above and below. (Slight Yang excess injures collaterals internally; damaged collaterals cause upper and lower bleeding. Injury to Yang collaterals causes epistaxis; injury to Yin collaterals causes lower bleeding.) If the Lung pulse is extremely choppy, it manifests as hematemesis; (Qi is Yang, Blood is Yin, Choppy is Yang. A choppy pulse indicates blood excess attacking Lung/Fei Yang collaterals, causing hematemesis. Pingkang notes: *Lingshu* and *Jiayi Jing* read "ou" (vomit) for "ou".) If the Lung pulse is slightly choppy, it manifests as Shu Liu (rat fistula) in the neck and axilla, lower limbs unable to support the upper body, and preference for sour taste. (Slight choppy indicates slightly excessive blood. Excessive blood follows Hand Yangming to the shin and Hand Taiyin to the axilla, forming fistulas. Lower deficiency cannot support upper excess; Metal excess suppresses Wood, causing preference for sour taste (Wood flavor). Pingkang notes: *Lingshu* reads "qi ying shan suan yi"; *Jiayi Jing* reads "shen neng shan suan".)
If the Liver pulse is extremely tight, it manifests as speaking ill words; (Tight string-like pulse indicates Cold attacking Liver, disturbing Hun spirit, causing aversion to speech. Pingkang notes: *Lingshu* adds "zhe" after "shen"; *Jiayi Jing* note says "e yan" is alternatively "wang yan".) If the Liver pulse is slightly tight, it manifests as Fei Qi (fat qi), a mass under the hypochondrium like an inverted cup. (Slight tightness indicates Liver cold accumulation in the left hypochondrium, shaped like an inverted cup, named Fei Qi.) If the Liver pulse is extremely slow, it manifests as frequent vomiting; (Extreme slowness indicates Liver heat rushing to the pharynx, causing frequent vomiting. Pingkang notes: *Lingshu* and *Jiayi Jing* read "shan ou" for "xi ou".) If the Liver pulse is slightly slow, it manifests as Water disease, Jia (mass), and Bi syndrome. (Slight Yang heat causes Liver Qi stagnation; fluid overflow becomes Water disease, knotting becomes Jia, gathering becomes Bi.) If the Liver pulse is extremely large, it manifests as internal abscess, with frequent vomiting and epistaxis; (Extreme largeness indicates excess Qi and heat forming internal abscess. Rebellious Liver Qi causes vomiting and epistaxis.) If the Liver pulse is slightly large, it manifests as Gan Bi (Liver obstruction) with genital retraction and cough radiating to the lower abdomen. (Slight largeness indicates Shaoyang heat attacking Liver, causing Yin disease Gan Bi. Cold causes tendon retraction; Liver cough follows Jueyin to lower abdomen pain. Pingkang notes: "Yin suo" missing "yin" in original, added per *Lingshu/Jiayi*; Yuan edition reads "jin suo", note suggests "jin suo".) If the Liver pulse is extremely small, it manifests as polydipsia; (Extreme smallness indicates deficient Qi and Blood, causing thirst and drinking.) If the Liver pulse is slightly small, it manifests as Xiaodan. (Deficient Qi and Blood with Cold attacking Liver generates heat, causing Xiaodan and muscle wasting.) If the Liver pulse is extremely slippery, it manifests as Tui Shan (hernia); (Extreme slipperiness indicates Shaoyang excess. Shaoyang excess causes Liver deficiency, leading to Tui Shan, a mass in the lower abdomen of men radiating pain to the genitals. Pingkang notes: *Lingshu* reads "chen"; *Jiayi Jing* reads "long".) If the Liver pulse is slightly slippery, it manifests as urinary incontinence. (Slight Yang excess with Yin deficiency fails to control, causing enuresis. Pingkang notes: Note "han" should be "ni" based on text.) If the Liver pulse is extremely choppy, it manifests as Yi Yin (overflowing drink); (Choppy Liver pulse indicates Liver Qi/Blood cold. Excess cold Blood cannot discharge, overflowing into intestines/skin, causing Yi Yin.) If the Liver pulse is slightly choppy, it manifests as convulsions and tendon cramps. (Slight choppy indicates excess Blood and cold, causing Jueyin tendon cold, convulsions, and cramps. Pingkang notes: *Lingshu* adds "bi" after "jin"; *Jiayi Jing* reads "chi" for "chou".)
If the Spleen pulse is extremely tight, it manifests as convulsive pulling; (Extremely tight Dai pulse indicates cold disease, causing pulling movements of limbs, called convulsive pulling. Pingkang notes: *Jiayi Jing* reads "chi" for "chou".) If the Spleen pulse is slightly tight, it manifests as food/drink regurgitation after entering the diaphragm, and foamy stools. (Slight tightness indicates slight cold. Spleen/Stomach cold causes regurgitation and cold foamy stool. Diaphragm at throat rejects cold food. Pingkang notes: *Lingshu* reads "ge" for "di"; note matches Yuan edition "ze".) If the Spleen pulse is extremely slow, it manifests as Wei Jue (flaccidity and reversal cold); (Extreme slowness indicates empty heat in Spleen. Spleen governs four limbs; heat prevents nourishment, causing limb flaccidity. Jue means reversal cold.) If the Spleen pulse is slightly slow, it manifests as Feng Wei (wind flaccidity), useless four limbs, but clear mind as if healthy. (Slight slowness indicates slight Spleen heat. Wind enters heat-filled Spleen, affecting limbs but not Heart, so mind remains clear. Pingkang notes: *Lingshu* and *Jiayi Jing* read "zhi" (limb) for "zhi" (support).) If the Spleen pulse is extremely large, it manifests as being struck and falling; (Extreme largeness indicates Spleen Qi excess in blood, resembling trauma from being struck or fallen. Pingkang notes: Text implies trauma history.) If the Spleen pulse is slightly large, it manifests as Shan Qi (hernia), large pus/blood in abdomen outside intestines. (Slight largeness indicates internal Yin excess causing hernia, with pus/blood in large abdomen.) If the Spleen pulse is extremely small, it manifests as cold-heat alternating; (Extreme smallness indicates deficient Qi/Blood, causing various cold-heat diseases.) If the Spleen pulse is slightly small, it manifests as Xiaodan. (Deficient Qi/Blood leads to internal heat consuming muscle.) If the Spleen pulse is extremely slippery, it manifests as Tui Long (difficulty urinating); (Extreme slipperiness indicates excess Yang heat. Weak Yin causes Tui Long. "Long" means strangury, pronounced long. Pingkang notes: *Lingshu* and *Jiayi Jing* read "long" for "tui long".) If the Spleen pulse is slightly slippery, it manifests as abdominal heat from worm poison (roundworms and silkworm moths). (Slight slipperiness indicates slight Yang heat. Roundworms (hui) and moth-like worms (xie) grow in warm abdomen, causing colic. Pingkang notes: Note "sang du" Yuan edition reads "chang du".) If the Spleen pulse is extremely choppy, it manifests as Chang Tui (intestinal prolapse); (Tui pronounced tui hui. Choppy pulse indicates deficient Qi/excess cold Blood. Cold Qi rushes down, causing rectal prolapse, also leukorrhea in women. Pingkang notes: *Lingshu* reads "kui"; *Jiayi Jing* reads "chen", note says alternatively "kui".) If the Spleen pulse is slightly choppy, it manifests as internal ulceration with frequent pus/blood discharge. (Slight choppy indicates blood pooling in abdomen, ulcerating and discharging pus/blood.)
If the Kidney pulse is extremely tight, it manifests as Gu Dian Ji (bone epilepsy); (Extremely tight Stone pulse indicates Cold attacking Kidney Yang, moving to bones, causing upper excess/lower deficiency, hence bone epilepsy. Pingkang notes: *Jiayi Jing* adds "wei" after "gu".) If the Kidney pulse is slightly tight, it manifests as Chen Jue (deep reversal cold), foot immobility, and inability to pass urine/stool. (Slight tightness indicates Kidney cold causing deep reversal cold, heavy/cold feet, bladder/intestine obstruction, and urinary/fecal retention. Pingkang notes: *Lingshu* adds "ben tun" after "chen jue"; *Jiayi Jing* places "ben tun" before "chen jue".) If the Kidney pulse is extremely slow, it manifests as broken spine pain; (Excess Yang heat, weak Yin, Kidney cold causes waist/spine pain like breaking.) If the Kidney pulse is slightly slow, it manifests as Dong Xie (hole diarrhea), where food is not digested and vomited back up. (Kidney meridian passes through Liver/Diaphragm/Throat. Kidney heat blocks fluids, rushing to throat, causing uncontrollable regurgitation. Pingkang notes: Both "dong" characters in *Jiayi Jing* have "xie".) If the Kidney pulse is extremely large, it manifests as impotence; (Large indicates much Qi, little Blood. Taiyang Qi excess, Shaoyin Blood deficiency, insufficient essence/blood causes impotence. Pingkang notes: Note "jing" Yuan edition misprints "ji"; "qi" misses "ye".) If the Kidney pulse is slightly large, it manifests as Shi Shui (stone water), starting from umbilicus to lower abdomen, hanging heavily, reaching stomach tube, fatal and untreatable. (Taiyang excess, Blood deficiency, fluids fail to descend, accumulating as water in lower abdomen. "Chui chui" describes hanging lower abdomen. If water reaches stomach, it is fatal. Pingkang notes: *Lingshu* reads "xiao chang" for "shao fu", "zhong" for "chui chui", "wan" for "guan"; *Jiayi Jing* reads "xiao fu".) If the Kidney pulse is extremely small, it manifests as Dong Xie; (Extreme smallness indicates deficient Qi/Blood. Cold throughout causes food regurgitation, hence Dong Xie.) If the Kidney pulse is slightly small, it manifests as Xiaodan. (Deficient Qi/Blood indicates Yin deficiency/Yang excess, heat causing Xiaodan.) If the Kidney pulse is extremely slippery, it manifests as Pi Tui; (Extreme slipperiness indicates Taiyang heat, Shaoyang cold deficiency, causing Pi Tui. Pingkang notes: *Lingshu* reads "chen"; *Jiayi Jing* reads "yong chen".) If the Kidney pulse is slightly slippery, it manifests as Gu Wei (bone flaccidity), inability to sit/rise, blindness. (Slight slipperiness indicates Taiyang heat entering marrow, causing bone weakness. Taiyang starts at inner canthus, ascending to eyes, causing blindness. Pingkang notes: *Lingshu* and *Jiayi Jing* add "ze" before "mu"; *Jiayi Jing* adds "shi hei wan" after "suo jian".) If the Kidney pulse is extremely choppy, it manifests as Da Yong (large abscess); (Extreme choppy indicates excess Blood, deficient Qi stagnation, forming large abscess.) If the Kidney pulse is slightly choppy, it manifests as amenorrhea and internal hemorrhoids. (Slight choppy indicates slightly excessive Blood. Blood excess/Qi deficiency causes menstrual delay. Qi deficiency/Blood pooling causes internal hemorrhoids. "Chen" means internal.)
Yellow Emperor said: How to needle the six variations of disease? (Asking about tonification/reduction methods for the six variations of the previous five pulses. Pingkang notes: *Jiayi Jing* lacks "Huang Di" before "yue"; "bing zhi liu bian" reads "bing yi you shen bian".) Qibo replied: All tight pulses indicate much cold; (String-tight pulse arises from cold, varying degrees exist across five Zangs, hence "all tight". Other variations follow this logic.) Slow pulses indicate much heat. (Internal organ heat causes slow pulse.) Large pulses indicate much Qi and little Blood. (Organ Qi excess/Blood deficiency causes large pulse.) Small pulses indicate deficient Qi and Blood. (Organ Qi/Blood deficiency causes small pulse.) Slippery pulses indicate excess Yang Qi with slight heat. (Organ Yang excess/slight heat causes slippery pulse.) Choppy pulses indicate much Blood and little Qi with slight cold. (Organ Blood excess/Qi deficiency/slight cold causes choppy pulse.) Therefore, for tight pulses, insert deeply and retain long. (Cold makes Qi deep/slow, requiring deep insertion and long retention.) For slow pulses, insert shallowly and withdraw quickly to remove heat. (Heat retreats, Qi is superficial/fast, requiring shallow insertion/quick withdrawal. Pingkang notes: *Lingshu* and *Jiayi Jing* read "yi qu qi re" for "yi qi re".) For large pulses, slightly reduce Qi, do not bleed. (Large pulses have much Qi, need slight reduction; little Blood, so no bleeding.) For slippery pulses, withdraw quickly and insert shallowly to reduce Yang Qi and remove heat. (Excess Qi/slight heat requires shallow insertion/quick withdrawal. Pingkang notes: *Jiayi Jing* writes "xie".) For choppy pulses, must hit the vessel, retain long following reversibility, first palpate and stroke, after withdrawing press the acupoint quickly to prevent bleeding and harmonize pulse. (Choppy pulse indicates much Blood. Palpate first, then pierce. Retain long for cold/reversal. Prevent Qi loss by pressing acupoint quickly after withdrawal. "Cui" pronounced gui, refers to scar/punctum. Pingkang notes: *Lingshu* and *Jiayi Jing* read "an" for "men"; "yi fa zhen" reads "yi fa zhen"; "yi" reads "yi"; *Jiayi Jing* reads "chu xue" for "qi xue chu"; "zhu" before "mai". Note "ni leng" should be "ni shun" based on text.) For all small pulses, Yin/Yang/Form/Qi are deficient; do not use needles, regulate with sweet medicines. (Small pulses indicate deficiency of Five Zang Yin, Six Fu Yang, flesh/bone form, and Sea of Qi Qi. Tonifying Yin with Yang exhausts Yin; tonifying Yang with Yin exhausts Yang. Death results from needling. Use sweet medicines to regulate Spleen/Stomach Qi, allowing other Zangs to recover. Pingkang notes: *Jiayi Jing* lacks "zhu" before "xiao"; *Lingshu* reads "er tiao yi gan yao ye"; *Jiayi Jing* reads "er tiao zhi yi gan yao".)
Liver fullness, Kidney fullness, Lung fullness, all excess, all manifest as swelling: (These three Zang fullness/excess conditions all result in carbuncles/swelling. Pingkang notes: *Suwen* and *Jiayi Jing* read "ji wei zhong" for "jie wei zhong".) Lung carbuncle, wheezing, bilateral hypochondriac fullness; (Lung governs Qi, so Lung carbuncle causes wheezing. Lung meridian crosses diaphragm near hypochondrium, so Lung carbuncle causes hypochondriac fullness. Pingkang notes: *Suwen* reads "yong" for "yong", "nie" for "xie"; *Jiayi Jing* reads "jing", note says *Suwen* reads "nie".) Liver carbuncle, bilateral [hypochondriac] fullness, waking startled when lying down, inability to urinate; ([Bilateral] refers to empty spaces under lateral ribs. Foot Shaoyang meridian runs under hypochondrium, so Liver carbuncle causes fullness. Shaoyang branch goes through Liver/Heart, so heat causes startle. Liver meridian circles genitals, so Liver heat causes urinary retention. Some editions read "xiao he", likely error. Pingkang notes: *Suwen* reads "yong" for "yong"; *Jiayi Jing* reads "xie xia" two characters for "nie".) Kidney carbuncle, [buttocks] to lower abdomen fullness, calves of different sizes, thighs/knees swollen and limping, alternating paralysis, hemiplegia. (Du meridian ascends to 14th vertebra, connects to Dai meridian, runs through buttocks, so buttocks to lower abdomen fullness. Shaoyin deficiency affects legs, causing calf size difference. Spleen/knee swelling causes limping. Alternating leg illness causes "yi". Also hemiplegia. "Kui" refers to knee)