与一分弦气俱动，为微弦也。三分并是弦气，竟无胃气，为见真脏也。见真脏死，其理至妙，请
陈其理，故曰何也。平按∶《素问》新校正引此注甚详。）答曰∶五脏者皆禀气于胃，胃者五脏
之本也。五脏不能自致于手太阴，必因于胃气，乃能至手太阴。（胃受水谷，变化精气而资五脏，
故五脏得至手太阴寸口，见于微弦也。）故五脏各以其时，自为而至手太阴。（五脏主于五时，
至其时也，其脏有病之甚者，胃气不与之居，不因胃气，以呼吸之力，独自至于太阴寸口，见于
真弦也。平按∶自字原缺，谨根据《素问》补。注不与之居，别本居作俱。）故邪气胜者精气衰。
（真脏脉弦不微、无胃气者，则知肝病胜也。肝病邪胜，则胃谷精气衰。）故病甚者，胃气不能
与之俱至于手太阴，故真脏之气独见。独见者，为病胜脏也，故曰死。黄帝目∶善。（真见病
甚，故致死也。平按∶自问曰见真脏至此，新校正谓全元起本在《太阴阳明表里》篇中，此乃王
氏所移。今检《素问·太阴阳明论》篇前后均在此篇，惟此一段在《玉机真脏论》中，其为王氏
所移益信。）
问曰∶脾病而四肢不用何也？（五脏皆连四肢，何因脾病独四肢不用也？平按∶脾字原缺，
谨根据《素问》补入。）答曰∶四肢皆禀气于胃，而不得径至，必因脾乃得禀。今脾病，不能为胃
行其津液，四肢不得禀水谷气，气日以衰，脉道不利，筋骨肌肉皆无气生，故不用焉。（土旺四
季，四季皆有土也；脾长四脏，四脏皆有脾也。何者？四肢百体禀气于胃，胃以水谷津液资四肢。
当用资四肢之时，胃气不能径到四肢，要因于脾，得水谷津液营卫之气，营于四肢，四肢禀承，
方得用也。若其脾病脉道不通，则筋骨肌肉无气以生，故不用也。平按∶径至袁刻误作俱至，
《素问》作至经，新校正云∶《太素》至经作径至，杨上善云∶胃以水谷资四肢，不能径至四肢，
要因于脾，得水谷津液，营卫于四肢。与此注合。不利《甲乙》作不通。皆无气生《素问》作皆
无气以生《甲乙》同。）问曰∶脾之不主时何也？答曰∶脾者土也，治中央，常以四时长四脏，
各十八日寄治，不得独主时，脾脏有常着土之精也。（四脏之本，皆为土也。十八日用，故曰寄
也。着，澄略反，在也。脾脏在土之精妙也。平按∶治中央《甲乙》作土者中央。不得独主时，
《甲乙》无得字，《素问》作不得独主于时也。脾脏有常着，《甲乙》作脾者土脏常着胃，《素
问》作脾脏者常着胃。）土者，主万物而法天地，故上下至头足，不得主时。（土为万物之质，
法于天地，与万物为质，故身与头手足为体，身不别主时。平按∶主《素问》、《甲乙》作生。
天地天字、主时二字原缺，谨根据《素问》、《甲乙》补。）问曰∶脾与胃也，以募相逆耳，而能
为之行津液何也？（脾阴胃阳，脾内胃外，其位各别，故相逆也。其别异，何能为胃行
津液气也？一曰相连，脾胃表里阴阳，募既相假，故曰相连也。平按∶以募相逆《素问》作以膜相连耳。新校正
云∶“按《太素》作以募相逆，杨上善云∶脾阴胃阳，脾内胃外，其位各异，故相逆也。”又注
故相下原抄缺二字，根据新校正所引，应作逆也二字。袁刻相上脱故字，逆下脱也字。又注阴阳募，
袁刻募误作前。）答曰∶足太阴，三阴也，脉贯胃属脾络嗌，故太阴为之行气于三阴。（嗌，于
末反，咽也。足太阴脉贯胃属脾，上行络嗌，其气强盛，能行三阴之脉，故太阴脉得三阴名也。
平按∶脉上《素问》、《甲乙》有其字。）阳明者，表也，五脏六腑之海也，亦为之行气于三阳。
脏腑各因其经而受气于阳明，故为胃行其津液。四肢不得禀水谷之气，日以益衰，阴道不利，筋
骨脉肉皆毋气以主，故不用焉。（阳明为阴阳脏腑之海，五脏六腑各因十二经脉受气于阳明，故
经脉得为胃行津液之气。四肢禀承四肢得□□经脉不□阳明，则阴脉不通，筋骨脉肉无气以主也。
平按∶阳明者表也，者表二字原缺，谨根据《素问》、《甲乙》补入。水谷下《素问》、《甲乙》
无之字。日以益衰《甲乙》作气日以衰。脉肉二字原缺，《素问》、《甲乙》作肌肉，根据本注应
作脉肉。）
与一分弦气同时搏动，称为微弦脉。如果三部脉全是弦气，完全没有胃气，就称为见到真脏脉。见到真脏脉预示死亡，其中的道理极其精妙，请阐述其原理，所以说“为什么呢”。（平按：《素问》新校正引用此注非常详细。）回答：五脏都禀受于胃气，胃是五脏的根本。五脏之气不能自行到达手太阴肺经的寸口部位，必须依赖胃气，才能到达手太阴。（胃接受水谷，变化出精气来滋养五脏，所以五脏之气得以到达手太阴寸口，表现为微弦之象。）因此，五脏各自在其所主的时令，独自到达手太阴。（五脏分别主司五个时令，到了相应的时令，如果该脏有病且病情严重，胃气就不与之共存，不依赖胃气，仅凭呼吸之力，独自到达太阴寸口，表现为真弦脉。平按：“自”字原文缺失，谨根据《素问》补入。注文中“不与之居”，别本“居”作“俱”。）所以邪气盛则精气衰。（真脏脉弦急而不柔和、没有胃气的，就知道是肝病邪胜。肝病邪气亢盛，则脾胃水谷精气衰弱。）所以病重的，胃气不能与之共同到达手太阴，因此真脏之气单独显现。单独显现，意味着病邪胜过脏气，所以说预后不良（死）。黄帝说：好。（真正见到病重，所以导致死亡。平按：从“问曰见真脏至此”，新校正认为全元起本在《太阴阳明表里》篇中，这是王氏移入此处。现在检查《素问·太阴阳明论》篇前后均在此篇，只有这一段在《玉机真脏论》中，这更加证实了是王氏所移。）
问：脾病导致四肢不能运动，为什么呢？（五脏都连接四肢，为什么脾病唯独导致四肢不能运动？平按：“脾”字原文缺失，谨根据《素问》补入。）回答：四肢都禀受于胃气，但不能直接到达，必须依赖脾才能禀受。现在脾病，不能为胃传输津液，四肢得不到水谷精气，气日渐衰弱，脉道不通利，筋骨肌肉都没有气产生，所以不能运动。（土旺于四季，四季都有土；脾滋养四脏，四脏都有脾的作用。为什么呢？四肢百体禀受于胃，胃以水谷津液滋养四肢。当需要滋养四肢时，胃气不能直接到达四肢，必须依靠脾，得到水谷津液和营卫之气，在四肢运行，四肢禀承这些气，才能发挥作用。如果脾病脉道不通，则筋骨肌肉没有气产生，所以不能运动。平按：“径至”袁刻误作“俱至”，《素问》作“至经”，新校正云：《太素》“至经”作“径至”，杨上善云：胃以水谷资养四肢，不能径直到达四肢，必须依靠脾，得到水谷津液，在四肢形成营卫之气。与此注相合。“不利”《甲乙经》作“不通”。“皆无气生”《素问》作“皆无气以生”，《甲乙经》同。）
问：脾不单独主令，为什么呢？回答：脾属土，治理中央，常在四季中滋养四脏，每季最后十八天寄治，不能单独主令，因为脾脏有着像土一样恒常的特性。（四脏的根本都是土。十八天使用，所以叫“寄”。着，音澄略反，意为存在。脾脏具有土的精妙特性。平按：“治中央”《甲乙经》作“土者中央”。“不得独主时”，《甲乙经》无“得”字，《素问》作“不得独主于时也”。“脾脏有常着”，《甲乙经》作“脾者土脏常着胃”，《素问》作“脾脏者常着胃”。）土，主宰万物并效法天地，所以在身上从头到足，不能单独主令。（土是万物的本质，效法天地，作为万物的质料，所以身体与头手足构成整体，身体不单独主令。平按：“主”《素问》、《甲乙经》作“生”。“天地”、“天”字、“主时”二字原文缺失，谨根据《素问》、《甲乙经》补入。）
问：脾与胃，虽然通过膜相连而位置相反，但能共同为胃传输津液，为什么呢？（脾阴胃阳，脾在内胃在外，它们的位置各不相同，所以说是相反的。它们的区别如此之大，怎么能共同为胃传输津液和气呢？另一种说法是相连，脾胃互为表里，阴阳互根，膜既相互借助，所以叫相连。平按：“以募相逆”《素问》作“以膜相连耳”。新校正云：“按《太素》作‘以募相逆’，杨上善云：脾阴胃阳，脾内胃外，其位各异，故相逆也。”又注文中“故相”下原抄缺二字，根据新校正所引，应作“逆也”二字。袁刻“相”上脱“故”字，“逆”下脱“也”字。又注“阴阳募”，袁刻“募”误作“前”。）回答：足太阴脾经，属于三阴经，脉贯串胃腑、属络脾脏、联络咽喉，所以太阴脾经为三阴经传输气。（嗌，音于末反，即咽部。足太阴脉贯串胃腑、属络脾脏，上行联络咽喉，其气强盛，能运行三阴之脉，所以太阴脉得名三阴。平按：“脉”上《素问》、《甲乙经》有“其”字。）阳明胃经，属于表，是五脏六腑的海，也为三阳经传输气。脏腑各因其经脉从阳明接受气，所以（胃/脾）能为胃传输津液。四肢得不到水谷之气，日渐更加衰弱，阴脉不通利，筋骨脉肉都没有气来主持，所以不能运动。（阳明是阴阳脏腑的海，五脏六腑各因十二经脉从阳明接受气，所以经脉能够为胃传输津液之气。四肢禀承……经脉不……阳明，则阴脉不通，筋骨脉肉无气来主持。平按：“阳明者表也”，“者表”二字原文缺失，谨根据《素问》、《甲乙经》补入。“水谷”下《素问》、《甲乙经》无“之”字。“日以益衰”《甲乙经》作“气日以衰”。“脉肉”二字原文缺失，《素问》、《甲乙经》作“肌肉”，根据本注应作“脉肉”。）
When the pulse beats with one part of the Xian (String-like) Qi, it is called slightly Xian. If all three positions exhibit only Xian Qi without any Stomach Qi, it is called seeing the True Zang Pulse. Seeing the True Zang Pulse indicates death; the principle behind this is extremely subtle. Please elaborate on the principle, hence the question "Why?". (Ping An: The New Correction in *Su Wen* cites this annotation in great detail.) Answer: The Five Zang Organs all derive their Qi from the Stomach; the Stomach is the root of the Five Zang Organs. The Qi of the Five Zang Organs cannot reach the Cunkou (Inch position) of the Hand Taiyin Lung Meridian by itself; it must rely on Stomach Qi to arrive at the Hand Taiyin. (The Stomach receives water and grain, transforms them into Essence-Qi to nourish the Five Zang Organs, thus allowing the Zang Qi to reach the Cunkou of the Hand Taiyin, manifesting as a slightly Xian pulse.) Therefore, each of the Five Zang Organs arrives at the Hand Taiyin independently during its respective season. (Each Zang governs one of the five seasons. When the appropriate season arrives, if the corresponding Zang is severely diseased, Stomach Qi does not reside with it. Without relying on Stomach Qi, driven solely by the force of respiration, the pathogenic Qi alone reaches the Cunkou of the Taiyin, manifesting as a true Xian pulse. Ping An: The character "Zi" (self) is missing in the original text; added here based on *Su Wen*. In the annotation, "Bu Yu Zhi Ju" (does not dwell with it), other editions have "Ju" as "Ju" (together).) Thus, when pathogenic factors prevail, Essential Qi declines. (A True Zang pulse that is Xian but not gentle, lacking Stomach Qi, indicates that Liver disease pathogenic factors are prevailing. When Liver disease pathogenic factors prevail, the Essence-Qi from food and drink in the Spleen and Stomach declines.) Therefore, in severe illness, Stomach Qi cannot accompany the Zang Qi to reach the Hand Taiyin, so the Qi of the True Zang appears alone. Appearing alone means the disease overcomes the Zang, hence it is said to be fatal. Huangdi said: Excellent. (Truly seeing severe disease leads to death. Ping An: From "Asking about seeing the True Zang" onwards, the New Correction states that the Quan Yuanqi edition placed this in the chapter *Tai Yin Yang Ming Biao Li*, but Wang Bing moved it here. Checking the chapters *Tai Yin Yang Ming Lun* before and after, they remain here, while this specific passage is found in *Yu Ji Zhen Zang Lun*, further confirming it was moved by Wang Bing.)
Question: Why does Spleen disease cause the four limbs to become immobile? (The Five Zang Organs are all connected to the four limbs; why does Spleen disease specifically cause immobility in the limbs? Ping An: The character "Pi" (Spleen) is missing in the original text; added here based on *Su Wen*.) Answer: The four limbs all derive their Qi from the Stomach, but they cannot receive it directly; they must rely on the Spleen to receive it. Now, because of Spleen disease, the Spleen cannot transport fluids for the Stomach. The four limbs do not receive Water-Grain Qi; their Qi declines day by day, the meridians become obstructed, and the sinews, bones, muscles, and flesh lack Qi generation, hence they become immobile. (Earth prospers in the four seasons, and Earth exists in every season; the Spleen nurtures the Four Zang Organs, and the Four Zang Organs contain the Spleen's function. Why? The four limbs and hundred bodies derive Qi from the Stomach, which uses Water-Grain fluids to nourish the limbs. When nourishment is needed for the limbs, Stomach Qi cannot reach them directly; it must rely on the Spleen to obtain Water-Grain fluids and Ying-Wei (Nutritive and Defensive) Qi, circulating them in the limbs. Only when the limbs receive these Qi can they function. If Spleen disease causes meridian obstruction, then sinews, bones, muscles, and flesh lack Qi generation, hence immobility. Ping An: "Jing Zhi" (reach directly) in Yuan edition is erroneously printed as "Ju Zhi"; *Su Wen* has "Zhi Jing". New Correction says: *Tai Su* "Zhi Jing" is written as "Jing Zhi". Yang Shangshan stated: The Stomach nourishes the limbs with Water-Grain but cannot reach them directly; it must rely on the Spleen to obtain Water-Grain fluids and form Ying-Wei Qi in the limbs. This matches this annotation. "Bu Li" (not favorable/smooth) in *Jia Yi Jing* is "Bu Tong" (blocked). "Jie Wu Qi Sheng" (all no Qi generation) in *Su Wen* is "Jie Wu Qi Yi Sheng", same as *Jia Yi Jing*.)
Question: Why does the Spleen not govern a specific season? Answer: The Spleen belongs to Earth, governs the Center, and constantly nourishes the Four Zang Organs throughout the four seasons. It governs for eighteen days in each season (a period of residence), and thus cannot exclusively govern a season. The Spleen organ possesses the constant essence of Earth. (The root of the Four Zang Organs is Earth. Because it is used for eighteen days, it is called "residence" or "寄" (ji). Zhuo, pronounced Cheng-lue fan, means existing. The Spleen organ contains the exquisite essence of Earth. Ping An: "Zhi Zhong Yang" in *Jia Yi Jing* is "Tu Zhe Zhong Yang". "Bu De Du Zhu Shi" (cannot exclusively govern a season), *Jia Yi Jing* lacks the character "De", *Su Wen* has "Bu De Du Zhu Yu Shi Ye". "Pi Zang You Chang Zhuo" (Spleen organ has constant existence), *Jia Yi Jing* has "Pi Zhe Tu Zang Chang Zhuo Wei", *Su Wen* has "Pi Zang Zhe Chang Zhuo Wei".) Earth governs all things and models Heaven and Earth; therefore, from head to foot in the body, it does not exclusively govern a season. (Earth is the substance of all things, modeling Heaven and Earth, serving as the substance for all things. Thus, the body, head, hands, and feet constitute a whole, and the body does not exclusively govern a season. Ping An: "Zhu" (govern) in *Su Wen* and *Jia Yi Jing* is "Sheng" (generate). The characters "Tian Di" (Heaven and Earth), "Tian" (Heaven), and "Zhu Shi" (govern season) were missing in the original text; added here based on *Su Wen* and *Jia Yi Jing*.)
Question: The Spleen and Stomach are connected by membranes and have opposite positions, yet how can they jointly transport fluids for the Stomach? (Spleen is Yin, Stomach is Yang; Spleen is internal, Stomach is external. Their positions are distinct, hence they are considered opposite. Given such difference, how can they jointly transport fluids and Qi for the Stomach? Another view is that they are connected; Spleen and Stomach are interior-exterior, Yin-Yang counterparts. Since the membranes mutually assist each other, they are called connected. Ping An: "Yi Mu Xiang Ni" (connected by membranes and opposite) in *Su Wen* is "Yi Mo Xiang Lian Er" (connected by membranes). New Correction says: "According to *Tai Su*, it reads 'Yi Mu Xiang Ni'. Yang Shangshan stated: Spleen is Yin, Stomach is Yang; Spleen is internal, Stomach is external; their positions differ, hence they are opposite." Also, two characters are missing after "Gu Xiang" in the original manuscript; based on the New Correction citation, they should be "Ni Ye" (opposite). Yuan edition missed "Gu" before "Xiang" and "Ye" after "Ni". Also, "Yin Yang Mu", Yuan edition erroneously printed "Mu" as "Qian".) Answer: Foot-Taiyin (Spleen Meridian) belongs to the Three Yin meridians. Its vessel penetrates the Stomach, connects to the Spleen, and links to the throat. Therefore, Taiyin transports Qi to the Three Yin meridians. (Ai, pronounced Yu-mo fan, means pharynx/throat. The Foot-Taiyin vessel penetrates the Stomach, connects to the Spleen, ascends to link the throat. Its Qi is strong and vigorous, capable of transporting Qi through the Three Yin meridians; thus, the Taiyin meridian bears the name of the Three Yin. Ping An: The character "Qi" is present before "Mai" (vessel) in *Su Wen* and *Jia Yi Jing*.) Yangming (Stomach Meridian) is exterior; it is the Sea of the Five Zang and Six Fu Organs, and it also transports Qi to the Three Yang meridians. Each Zang and Fu organ receives Qi from Yangming via its own meridian; therefore, (the Spleen/Stomach system) transports fluids for the Stomach. If the four limbs do not receive Water-Grain Qi, they decline increasingly day by day, the Yin vessels become obstructed, and sinews, bones, vessels, and flesh lack Qi to sustain them, hence they become immobile. (Yangming is the Sea of Yin-Yang and Zang-Fu organs. The Five Zang and Six Fu organs each receive Qi from Yangming via the Twelve Primary Meridians; thus, the meridians can transport Fluid-Qi for the Stomach. The limbs receive... [text damaged] ...meridians do not... Yangming, then Yin vessels are blocked, and sinews, bones, vessels, and flesh lack Qi to sustain them. Ping An: "Yangming Zhe Biao Ye" (Yangming is exterior), the characters "Zhe Biao" were missing in the original text; added here based on *Su Wen* and *Jia Yi Jing*. After "Shui Gu" (Water-Grain), *Su Wen* and *Jia Yi Jing* lack the character "Zhi". "Ri Yi Yi Shuai" (decline increasingly day by day) in *Jia Yi Jing* is "Qi Ri Yi Shuai". The characters "Mai Rou" (vessels and flesh) were missing in the original text; *Su Wen* and *Jia Yi Jing* have "Ji Rou" (muscles and flesh); based on this annotation, it should be "Mai Rou".)