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損 至 脈 之 病 證 及 其治 法  theory of confirmation of disease from damage of pulse

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十 四 難   14th difficult issue

Shí sì nán
論 損 至 脈 之 病 證 及 其治 法 theory of confirmation of disease from damage of pulse
Lùn sǔn zhì mài zhī bìng zhèng jí qí zhì fǎ
十 四 難 曰 : 14th difficult issue says
Shí sì nán yuē
脈 有 損 至 , pulse may have loss and extra pulsations
Mài yǒu sǔn zhì
何 謂 也 ? 然 : How explain that? explanation
Hé wèi yě? Rán
至 之 脈 , extra bits of pulse
Zhì zhī mài
一 呼 再 至曰 平 ,for one exhale two extra bits they say it is normal 6x9+2x9=54+18=72 b/min
Yī hū zài zhì yuē píng
 三 至 曰 離 經 ,three extra bits per pulse’s exhale they say disease leaves meridian 54+3x9=81 b/min
Sān zhì yuē lí jīng  
 四 至 曰 奪 精 , four extra bits per pulse’s exhale they say about loss of jing essence 54+4x9=90 b/min
Sì zhì yuē duó jīng
五 至 曰 死 , five extra bits per pulse’s exhale they say about the death 54+5x9= 99 b/min
Wǔ zhì yuē sǐ
六 至 曰 命 絕 , six extra bits per pulse’s exhale life exhausted 54+6x9= 108 b/min
Liù zhì yuē mìng jué
此 至 之 脈 也 。 so they say about extra bits of pulse
Cǐ zhì zhī mài yě
何 謂 損 ? what missing pulsations mean?
Hé wèi sǔn?
一 呼 一 至 曰 離 經 , one pulse’s exhales of bit’s unit is missing they say disease leaves meridian 54-9=45 b/min
Yī hū yīzhì yuē lí jīng
再 呼 一 至曰 奪 精 , two pulse’s exhales of bit’s unit is missing of jing essence 54-18= 36 b/min
Zài hū yīzhì yuē duó jīng
三 呼 一 至 曰 死 , three pulse’s exhales of bit’s unit is missing they say about the death 54-27= 27 b/min
Sān hū yīzhì yuē sǐ
四 呼 一 至 曰 命 絕 , four pulse’s exhales of bit’s unit is missing they say life is exhausted 54-36= 18 b/min
Sì hū yīzhì yuē mìng jué
此 損 之 脈 也。 It is about missing bits
Cǐ sǔn zhī mài yě
至 脈 從 下 上 , extra bit’s pulsations arrive from bottom to the top
Zhì mài cóng xià shàng
損 脈 從 上 下 也 。lost bit’s pulsations arrive are from the top to the bottom
Sǔn mài cóng shàng xià yě
損 脈 之 為 病 柰 何 ? 然 : so what are diseases of such pulse damage? Explanation
Sǔn mài zhī wèi bìng nài hé? Rán
一 損 損 於 皮 毛 ,one missing unit damages in skin and hair
Yī sǔn sǔn wū pí máo
 皮 聚 而 毛 落 。skin becomes wrinkly and hairs fall
Pí jù ér máo luò
二 損 損 於 血 脈 , two missing units harm blood and vessels
Èr sǔn sǔn wū xuè mài
血 脈 虛 少 , blood and vessels do not fill and become empty
Xuè mài xū shǎo
不 能 榮 於 五 藏 六 府 。can’t send rong to five zan and six fu
Bù néng róng wū wǔ cáng liù fǔ
三 損 損 於 肌 肉 , three missing units harm flesh and muscles
Sān sǔn sǔn wū jīròu
肌 肉 消 瘦 , flesh and muslces become thin and weak
Jī ròu xiāo shòu
飲 食 不 能 為 肌 膚 。 drink and food can’t be sent to the flesh and skin
Yǐn shí bù néng wèi jī fū
四 損 損 於 筋 , four missing units damage muscles
Sì sǔn sǔn wū jīn
筋 緩 不 能 自 收 持 。 muscles can’t grasp and hold
Jīn huǎn bù néng zì shōu chí
五 損 損 於 骨 , five missing units harm bones
Wǔ sǔn sǔn wū gǔ
骨 痿 不 能 起 於 床 。bones atrophy and patients can’t rise from bed
 Gǔ wěi bù néng qǐ wū chuáng
反 此 者, when pulse is opposite
Fǎn cǐ zhě
至 於 收 病 也 。 so diseases of extra pulse’s bits appear
Zhì wū shōu bìng yě
從 上 下 者 , from the top to the bottom until
Cóng shàng xià zhě
骨 痿 不 能 起 於 床 者 死 。 bones atrophy, patient can’t rise from bad and die
Gǔ wěi bù néng qǐ wū chuáng zhě sǐ
從 下上 者 , from down to the top until
Cóng xià shàng zhě
皮 聚 而 毛 落 者 死 。skin becomes wrinkly and hair fall, patient dies
Pí jù ér máo luò zhě sǐ
治 損 之 法 柰 何 ? 然 : what are the examples of treatment of missing bits? explanation

Zhì sǔn zhī fǎ nài hé? Rán
損 其 肺 者 ,when loss of lung pulse
 Sǔn qí fèi zhě
益 其 氣 ; increase it’s qi
Yì qí qì
損 其 心 者 ,when loss of the heart pulse
Sǔn qí xīn zhě
調 其 榮 衛 ; tune rong and wei
Diào qí róng wèi
損 其 脾 者 , when it is a spleen pulse loss
Sǔn qí pí zhě
調 其 飲 食 , normalise drink and food
Diào qí yǐn shí
適 其 寒 溫 ; normalising cold and hot
Shì qí hán wēn
損 其 肝 者, when it is a spleen pulse loss
Sǔn qí gān zhě
緩 其 中 ; revive the middle
Huǎn qí zhōng
損 其 腎 者 , when it is a loss of the kidney pulse
Sǔn qí shèn zhě
益 其 精 。 increase the essence
Yì qí jīng
​此 治 損 之 法 也 。this is a rule of loss

Cǐ zhì sǔn zhī fǎ yě
 有 一 呼 再 至 ,one exhale may have two extra bits
 Yǒu yī hū zài zhì
一 吸 再 至 ; or one inhale may have two extra bits
Yī xī zài zhì

有 一 呼 三 至 ,one exhale may have three extra bits
Yǒuyī hū sān zhì
一 吸 三 至 ;or one inhale may have three extra bits
Yī xī sān zhì
有 一 呼 四 至 , one exhale may have four extra bits
Yǒuyī hū sìzhì
一 吸 四 至 ; or one inhale may have four extra bits
Yī xī sìzhì
有 一 呼 五 至 , one exhale may have five extra bits
Yǒu yī hū wǔ zhì
一 吸 五 至 ; or one inhale may have five extra bits
Yī xī wǔ zhì
有 一呼 六 至 , one exhale may have six extra bits
Yǒu yī hū liù zhì
一 吸 六 至 ; or one inhale may have six extras bits
Yī xī liù zhì
有 一 呼 一 至 , one exhale may miss bit’s unit
Yǒuyī hū yīzhì
一 吸 一 至 ;or one inhale may miss bit’s unit
Yī xī yīzhì
有 再 呼 一至 ,two exhales may miss bit’s unit
Yǒu zài hū yīzhì
再 吸 一 至 ; or two inhales may miss bit’s unit
Zài xī yīzhì
再 呼 吸 再 至 。two exhales and two inhales  may miss two bit’s unit
Zài hūxī zài zhì
脈 來 如 此 , so knowing this pulse
Mài lái rúcǐ
何 以 別 知 其 病也 。how we can diagnose disease
Héyǐ bié zhī qí bìng yě
然 : 脈 來 一 呼 再 至 , Explanation, pulse produces one exhale and two extra bits
Rán: Mài lái yī hū zài zhì
一 吸 再 至 , or one inhale and two extra bits 54+ 2x9= 72 b/min
Yī xī zài zhì
不 大 不 小 曰 平 。 not large not small means leveled
Bù dà bù xiǎo yuē píng
一 呼三 至 , one exhale three extra bits or
Yī hū sān zhì
一 吸 三 至 , one inhale three extra bits 54+9x3=81
Yī xī sān zhì
為 適 得 病 , it is how disease starts
Wèi shì dé bìng
前 大 後 小 , in front pulse is large, behind is small
Qián dà hòu xiǎo
即 頭 痛 目 眩 ,immediate headache and blurry vision
Jí tóu tòng mù xuàn
前 小 後 大 ,in front pulse is small, behind is large
Qián xiǎo hòu dà
即 胸 滿 短 氣 。 immediate chest tightness and short breath
Jí xiōng mǎn duǎn qì
一 呼 四 至 , per one exhale four extra bits or
Yī hū sì zhì
一 吸 四 至 , per one inhale four extra bits 54+ 9x4=90
Yī xī sì zhì
病 欲 甚, diseas increases
Bìng yù shén
脈 洪 大 者 , so pulse is vast and large
Mài hóng dà zhě
苦 煩 滿 , patient feels bitter taste, agitated and fullness
Kǔ fán mǎn
沉 細 者 , pulse deep and thin
Chén xì zhě
腹 中 痛 ,pain inside the abdominal area
Fù zhōng tòng
滑 者 傷 熱 ,and slippery, disease of harmfull heat
Huá zhě shāng rè
濇者 中 霧 露 。if  grating middle is respiratory condition
Sè zhě zhōng wù lù
一 呼 五 至 , per one exhale five extra bits or
Yī hū wǔ zhì
一 吸 五 至 ,per one inhale five extra bits 54+9x5=99
Yī xī wǔ zhì
其 人 當 困 ,so patients become tired and sleepy
Qí rén dāng kùn
沉 細 夜 加,deep and thin increasing at night
Chén xì yè jiā
浮 大 晝 加 , superficial and large increasing during the day
Fú dà zhòu jiā
不 大 不 小 , no large and not small
Bù dà bù xiǎo
雖 困 可 治 , despite being tired it can be treated
Suī kùn kě zhì
其 有 大 小 者 為 難 治。But if it is large and small it is difficult to treat
Qí yǒu dà xiǎo zhě wéi nán zhì
一 呼 六 至 , per one exhale six extra bits or
Yī hū liù zhì
一 吸 六 至 , per one inhale six extra bits 54+ 9x6= 108
Yī xī liù zhì
為 死 脈 也 , it is death of pulse, full stop
Wèi sǐ mài yě
沉 細 夜 死 , deep and thin patient will die at night
Chén xì yè sǐ
浮 大 晝死 。 superficial and large patient will die during the day
Fú dà zhòu sǐ
一 呼 一 至 , one exhale misses one bit’s unit
Yī hū yī zhì
一 吸 一 至 , or one inhale misses one bit’s unit 54- 9 = 45 b/min
Yī xī yīzhì
名 曰 損 ,named as a damage
Míng yuē sǔn
人 雖 能 行 , despite of that patient can move
Rén suī néng xíng
猶 當 著床 ,he still need stay in bed
Yóu dāng zhe chuáng
所 以 然 者 ,he does so
Suǒ yǐ rán zhě
血 氣 皆 不 足 故 也 。because blood and qi together are not sufficient buzu
Xuèqì jiē bù zú gù yě
再 呼 一 至 , two exhales miss one pulse’s unit or
Zài hū yīzhì
再 吸 一 至, two inhales miss one pulse’s unit 54-18=36 b/min
Zài xī yī zhì
吸 呼 再 至 ,inhale and exhale misses two bit’s units 54- 18-18= 18 b/min
Xī hū zài zhì
名 曰 無 魂 ,known as no spirit
Míng yuē wú hún
無 魂 者 , absence of spirit
Wú hún zhě
當 死 也 ,is a death
Dāng sǐ yě
人 雖 能 行 ,despite patient can move
Rén suī néng xíng
名 曰 行 尸 。is known as walking dead
Míng yuē xíng shī
上 部 有 脈 , if upper section has pulse
Shàng bù yǒu mài
下 部 無 脈 , and lower section has no pulse
Xià bù wú mài
其 人 當 吐 ,so patient will be vomiting
Qí rén dāng tǔ
 不 吐 者 死 。but without vomiting it is death
 Bù tǔ zhě sǐ
上 部 無 脈 , if upper section has no pulse
Shàng bù wú mài
下 部 有 脈 , but lower section has pulse
Xià bù yǒu mài
雖 困 無 能 為 害 。despite patient is tired, there is no harm
Suī kùn wú néng wéi hài
所 以 然 者 , so according to that
Suǒ yǐ rán zhě
譬 如 人 之 有尺 , as example man has chi
Pì rú rén zhī yǒu chǐ
樹 之 有 根 , as tree has it’s root
Shù zhī yǒu gēn
枝 葉 雖 枯 槁 , branches and leaves will dry out
Zhī yè suī kū gǎo
根 本 將 自 生 。but root and base will continue to live
Gēn běn jiāng zì shēng
脈 有 根 本 ,pulse has it’s root and base
Mài yǒu gēn běn
人 有 元 氣 ,when patient has basic yuan qi
Rén yǒu yuán qì
故 知 不 死 。so it is known that patient will not die
Gù zhī bù sǐ
!4th difficult issue explains particular cases of extra pulse bits and missing pulse bits. This difficulty is linked to the first difficult issue where is and explanation of amount of pulse's breaths and pulsations per each pulse's breath. Each case of extra bits and missing bits is converted from bits per pulse breath into bits per minute b/min 
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