宁郡陈养生为钱庄伙。失业境迫。一日倚藤椅仰卧。余见其似寐非寐。目半露而无神。面色 白。皮肤夭焦。肌肉
消瘦。喘息气促。余窃谓他友曰。观陈某之色。死期将不远矣。曰。何所见耶。余曰内经云。大骨枯槁。大肉陷下。胸
中气满喘息不便。毛悴色夭。死于冬。今其形与内经之论正合。其能免乎。且经又云。始富后贪。名曰失精。更无治法。
果于是冬而卒。
宁波郡庙一术士钱时成。设砚西首廊下。东廊下一相士徐君瑞海。自称熟读麻衣。是日余见钱面黄枯焦。一股
青惨之气如烟雾。余谓徐曰。君相士也。必能知人寿数。对面钱某可活几年。徐谛观之曰。照部位二三年耳。余曰。
吾不知部位。但观现下之色。内经云。黄如枳实者死。毛悴色夭。死于秋。是肠胃之气予不足也。此人必死于秋间
泻痢之疾。盖七八月大火西流。烁石流金。肺气益虚。肺与大肠相为表里。而阳明之土金泄气。其为必死无疑矣。
后果应余言。凡望色而决人之生死。须要察其神气。盖色为标。神为本也。如色虽枯而尚有神。则主病而不至死。
若神色俱败。气如烟雾之暗惨。死期可预决也。故为医者。安得不读内经耶。
乙酉秋。余在宁。有温州弁某就诊。年四十许。余切其脉浮部虚大。如羹上之肥。久按如鱼翔虾游之状。余问曾大
脱血否。曰无。然则心胸痛乎。曰无。问究竟何所苦耶。曰近日四肢略有酸重。犹幸胃口颇好。余无所苦。余曰。无病
而得如是之脉。大有可虑。四肢酸重。不过湿滞小恙。而况胃口尚好。何病之有。尔且商之高明。余不敢定方。伊芳微
笑而去。是冬闻其友云。一日赴友午饮。至夜觉头沉重。以为饮酒过多。灭灯就寝。次日日高未起。同伴呼之不应。
以手推之。则已僵矣。经云。脉病患不病。名曰行尸。凡人无大病而现真脏之脉。乃脏腑之气久已空虚。最宜留心。
不可轻与医治。抑或服药之后。病大发作。则必归咎于医。可不慎欤。
又杭垣陆点翁家一佣妇。绍郡人。年五十余。尻骨之上。一节突起。腰间患疮。溃久不敛。戊子春。就余诊之。六
部之脉。俱浮取空大。沉按无根。余知此症不治。乃致意点翁。嘱其婉言劝归养息。病愈仍可复来。佣妇如言回家。医
治
至秋似稍安而复来。点翁又邀余诊。脉象如初。余曰脉仍无根。须防暴脱。果至初冬而殁。
昔杭堇浦宗伯谓世医能杀人而不能起死人。然果能知其必死。虽不克起之而生。则亦断断不致杀人矣。夫
技而本于不致杀人。其生趣之流露于十指间者。可想见也。忆予先大人珠川府君。于学无所不窥。而医道尤
为讲求。每遇不救之病。必详推夫五行六气。而预决生死之期。今读真脏四案。不禁有父书散亡之感。（淞樵评）
徐淞樵曰。是册所治诸症。均非寻常平易者可比。而且按法施治。毫不自作聪明。以致失于一偏之见。洵可传
也。心禅初意。似以覆瓿之物。未敢问世。予怂恿再四。心禅始于翌日袖出质正。予虽不知医。而自幼备闻庭训。
受读灵枢素问诸书。于医理不无稍明。观其议论必穷夫源。讲求必极其奥。诚不愧医学入门之阶梯也。冥搜
静悟。由病而验。其方较之近今诸大家。何多让焉。予因略为点窜。归以付之梨枣。谓非一大快事哉。噫嘻。予乡
距省千里有奇。因事邂逅。与心禅商订者两月余矣。岂非前定之数。昔袁简斋先生自言于佛家因缘二字。平
生最为深信。予于此事亦不禁恍然大悟云。
【背景信息】
书名：一得集 章节：色现真脏预知死期二案 / 脉现真脏预断必死二案 类别：综合
宁波郡人陈养生是钱庄的伙计。失业后家境窘迫。一天，他倚靠在藤椅上仰卧着。我看见他似睡非睡，眼睛半睁却无神，面色苍白，皮肤枯槁焦黑，肌肉消瘦，呼吸急促。我私下对朋友说：“看陈某的气色，死期将不远了。”朋友问：“您是从哪里看出来的？”我说：“《内经》说：‘大骨枯槁（指骨骼显露干枯），大肉陷下（指肌肉萎缩凹陷），胸中气满喘息不便，毛悴色夭（毛发憔悴、面色枯槁），死于冬。’现在他的形体与《内经》的论述完全吻合，难道能幸免吗？况且经书又说：‘始富后贪，名曰失精（因过度耗损精气而致病），更无治法。’果然，他在当年冬天去世了。
宁波府城庙里有一位术士叫钱时成，在西侧走廊下摆弄砚台；东侧走廊下有一位相士徐君瑞海，自称熟读《麻衣相法》。那天我见到钱某面色黄而枯焦，一股青惨之气像烟雾一样笼罩着他。我对徐先生说：“您是相士，一定能知道人的寿命长短。看着对面的钱某，他能活几年？”徐先生仔细端详后说：“照部位来看，大概两三年吧。”我说：“我不懂看部位，只观察现在的脸色。《内经》说：‘黄如枳实者死（面色黄得像干瘪的枳实，主脾胃气绝），毛悴色夭，死于秋。’这是肠胃之气极度不足的表现。这个人必定会死于秋天的泻痢之疾。因为七八月盛夏过后，大火西流（指季节转换，气候由热转凉但余热尚存），烁石流金（形容天气炎热），肺气更加虚弱。肺与大肠相为表里，而阳明（胃与大肠）的土金之气泄越，这必然是死症无疑了。”后果然应验了我的话。凡是望色来判断人的生死，必须察其神气。因为色是表象，神是根本。如果颜色虽然枯败但还有神，则主病重但不致死。如果神色都败坏，气像烟雾那样昏暗惨淡，死期就可以预先断定。所以作为医生，怎么能不读《内经》呢？
乙酉年秋天，我在宁波。有一个温州的武官来就诊，年龄四十岁左右。我切诊他的脉象，浮取虚大，像羹汤上面的浮油；久按则感觉像鱼翔虾游（脉搏微弱无力，忽隐忽现）。我问：“曾经大量失血吗？”他说没有。“那么心胸疼痛吗？”他说没有。我又问：“到底有什么不舒服？”他说：“最近四肢略有酸重感，幸好胃口还不错，没有其他痛苦。”我说：“没有生病却出现这样的脉象，非常值得忧虑。四肢酸重不过是湿气阻滞的小毛病，何况胃口还好，有什么大病呢？你还是去咨询高明的大夫吧，我不敢轻易开方。”他微微一笑地离开了。那年冬天听他的朋友说，有一天去朋友家午宴饮酒，到了晚上觉得头沉重，以为是酒喝多了，吹灯睡觉。第二天太阳很高了还没起床，同伴叫他不应，用手推他，身体已经僵硬了。《内经》说：“脉病患不病，名曰行尸（脉象显示有病，但病人表面看似无病，称为行尸，预示即将死亡）。”凡是没有大病却出现真脏脉（脏腑真气外露的危重脉象），是因为脏腑之气早已空虚，最应该留心。不可轻率地进行医治，或者服药之后病情大发作，那就必然归咎于医生。能不谨慎吗？
另外，杭州陆点翁家里有一个佣妇，是绍兴人，五十多岁。尾骨上方有一节突起，腰部患有疮疡，溃烂很久不愈合。戊子年春天，她来找我诊治。六部脉象，浮取空大，沉按无根。我知道这个病症无法治愈，便郑重地告诉陆点翁，嘱咐他委婉地劝佣妇回家休养，病好了还可以再来。佣妇照言回家。经过医治到秋天似乎稍有好转又回来了。陆点翁又邀请我诊治，脉象和当初一样。我说：“脉仍然无根，必须防止突然虚脱。”果然在初冬去世了。
以前杭州翰林院侍读学士杭堇浦曾说，世间的医生能杀人而不能起死回生。然而如果真的知道病人必死，虽然不能救活让他生，但也绝对不会导致他死。技术如果不以不杀人为根本，那么十指间流露出的生机也就可想而知了。回忆我的父亲珠川府君，学问无所不窥探，尤其讲求医道。每次遇到无法救治的病，必定详细推演五行六气，从而预先决断生死之期。今天读到关于真脏色的四个案例，不禁有父亲著作散亡的感慨。（淞樵评）
徐淞樵说：这本书所治疗的诸种病症，都不是寻常平易的疾病可比拟的。而且按照法则施治，毫不自作聪明，以致失于一偏之见，确实可以流传。心禅起初似乎认为这是垫桌脚的东西，不敢问世。我怂恿再三，心禅才在第二天袖子里拿出来请我指正。我虽然不懂医，但自幼饱闻庭训，受读《灵枢》《素问》等书，对于医理不是不明白。看他的议论必定穷究本源，讲求必定极其深奥，诚不愧为医学入门的阶梯。冥思苦想，静默领悟，从病症验证疗效，他的方剂比起近年的各位大家，又有什么可逊色的呢？我因此稍微加以修改润色，回去交给刻版印刷，这难道不是一件大快人心的事吗？唉！我的家乡距离省城一千多里，因为事情偶然相遇，与心禅商讨订正了两个多月。这难道不是前定的命运吗？以前袁枚（字简斋）先生自称对佛家的“因缘”二字平生最为深信，我对这件事也不禁恍然大悟。
[Background Information]
Book: *Yi De Ji* (Collection of One's Own Insights)
Chapter: Two Cases of Predicting Death by True Zang Colors / Two Cases of Predicting Inevitable Death by True Zang Pulses
Category: Comprehensive
Chen Yangsheng, a resident of Ningbo Prefecture, was a clerk in a money exchange. After losing his job, his family fell into dire straits. One day, he was lying supine, leaning against a rattan chair. I observed that he appeared to be neither fully asleep nor awake; his eyes were half-open but lacked spirit. His complexion was pale, his skin withered and scorched-black, his muscles emaciated, and his breathing rapid and short. I privately remarked to my friends, "Judging by Mr. Chen's complexion, his time of death is not far off." They asked, "From what do you deduce this?" I replied, "The *Neijing* (Classic of Internal Medicine) states: 'When the great bones are withered and the great muscles sunken, when there is fullness in the chest accompanied by difficult breathing, when the hair is憔悴 (withered) and the color is 夭 (dull/lifeless), death occurs in winter.' His current physical condition perfectly matches the description in the *Neijing*. How could he possibly escape it? Furthermore, the classics state: 'One who was once wealthy but becomes greedy is named as having lost Jing (Essence); there is no further method of treatment.' Indeed, he passed away that winter.
In the temple of Ningbo Prefecture, a fortune-teller named Qian Shicheng was arranging inkstones under the western corridor, while a physiognomist, Xu Junruihai, stood under the eastern corridor, claiming to be well-versed in the *Mayi Xiangfa* (Mayi Physiognomy). That day, I saw that Qian's face was yellow, withered, and scorched, with a streak of blueish-green, gloomy aura resembling smoke surrounding him. I said to Mr. Xu, "You are a physiognomist and must be able to discern a person's lifespan. Looking at Mr. Qian opposite us, how many more years can he live?" Mr. Xu examined him closely and said, "Based on the facial regions, perhaps two or three years." I said, "I do not understand the methods of reading facial regions; I only observe the current complexion. The *Neijing* says: 'Yellow like dried Zhi Shi (immature bitter orange) indicates death; withered hair and dull color indicate death in autumn.' This signifies that the Qi of the intestines and stomach is extremely deficient. This person will surely die from dysentery or diarrhea in autumn. For in the seventh and eighth months, after the summer heat peaks, the Lung Qi becomes increasingly deficient due to the transition of seasons. The Lung and Large Intestine are exterior-interior partners, and the Earth and Metal energies of the Yangming (Stomach and Large Intestine) are leaking. Thus, death is undoubtedly certain." The outcome indeed confirmed my words. Whenever one judges life and death by observing color, one must inspect the Shen (Spirit). Color is the superficial manifestation, while Shen is the root. If the color is withered but Shen remains, the disease is severe but not fatal. If both color and Shen are exhausted, and the Qi appears dark and gloomy like smoke, the time of death can be predicted in advance. Therefore, how can a physician fail to study the *Neijing*?
In the autumn of the Yiyou year, I was in Ningbo. A military officer from Wenzhou came for consultation, aged about forty. When I palpated his pulse, the superficial layer felt empty and large, like the fat floating on soup; upon prolonged pressing, it felt like a fish swimming or a shrimp darting (weak, intermittent, and erratic). I asked, "Have you suffered massive blood loss?" He replied, "No." Then I asked, "Do you have chest pain?" He replied, "No." I asked again, "What exactly troubles you?" He said, "Recently, my limbs feel slightly sore and heavy. Fortunately, my appetite is quite good, and I have no other complaints." I said, "Having such a pulse without apparent illness is highly concerning. Soreness and heaviness in the limbs are merely minor ailments caused by dampness stagnation, especially since your appetite is still good. What serious illness could there be? You should consult a more eminent physician. I dare not prescribe medication." He smiled faintly and left. That winter, I heard from his friend that one day, after attending a lunch banquet at a friend's house, he felt heavy-headed at night, attributing it to excessive drinking, and went to sleep with the lights out. The next day, even when the sun was high, he had not risen. When his companions called to him without response and pushed him, they found him stiff and unresponsive. The *Neijing* states: "When the pulse indicates disease but the patient appears healthy, it is called a 'Walking Corpse'." Whenever a person without a major illness presents with a True Zang Pulse (a critical pulse indicating the exposure of the true energy of the Zang organs), it is because the Qi of the Zang organs has been empty for a long time. One must pay close attention and not lightly administer treatment. Otherwise, if the condition worsens significantly after taking medicine, blame will inevitably fall upon the physician. Can one not be cautious?
Additionally, there was a female servant in the household of Lu Dianweng in Hangzhou, originally from Shaoxing, over fifty years old. There was a protrusion above her sacrum, and she suffered from a wound on her waist that had ulcerated and failed to heal for a long time. In the spring of the Wuzi year, she came to me for diagnosis. Her pulses in all six positions felt empty and large upon superficial palpation, and rootless upon deep pressure. Knowing this condition was incurable, I earnestly informed Mr. Lu Dianweng, instructing him to gently persuade the servant to return home to rest. She could come back if her health improved. The servant followed the advice and returned home. After treatment, she seemed slightly better in autumn and returned. Mr. Lu invited me to diagnose her again, and her pulse remained unchanged. I said, "The pulse is still rootless; sudden collapse must be guarded against." Indeed, she died in early winter.
Previously, Hang Jinpu, a Grand Secretary in the Hanlin Academy of Hangzhou, stated that contemporary physicians can kill people but cannot raise the dead. However, if one truly knows that death is inevitable, although one cannot restore life, one certainly will not cause death. If medical skill is grounded in the principle of not causing death, the vitality emanating from one's fingertips can be imagined. I recall my father, Governor Zhuchuan, who explored all fields of learning and particularly emphasized medical arts. Whenever he encountered an incurable disease, he would meticulously deduce the Five Elements and Six Qi to predict the time of death. Reading these four cases regarding True Zang colors now, I cannot help but feel a sense of loss regarding my father's scattered writings. (Commentary by Songqiao)
Xu Songqiao commented: The various conditions treated in this book are not comparable to ordinary, straightforward diseases. Moreover, treatment is administered according to established principles, avoiding self-righteousness and one-sided views. It is truly worthy of transmission. Initially, Xinchan seemed to regard this manuscript as something fit only to cover pots, hesitating to publish it. After my repeated encouragement, Xinchan finally brought it out from his sleeve the next day for my correction. Although I am not a physician, I have been educated at home since childhood and studied texts such as the *Lingshu* and *Suwen*, so I possess some understanding of medical theory. Observing his discussions, which invariably trace issues to their origins, and his pursuit of profound depths, he truly deserves to be considered a ladder for entering the field of medicine. Through intense searching and quiet contemplation, verifying through clinical cases, his prescriptions compare favorably, if not superiorly, to those of major masters in recent times. I therefore made slight revisions and sent it to the printers. Is this not a great joy? Alas! My hometown is over a thousand li from the provincial capital. We met by chance and discussed and revised the work together for over two months. Could this not be predestined fate? Previously, Mr. Yuan Jianzhai (Yuan Mei) himself stated that he deeply believed in the Buddhist concept of "Yinyuan" (karmic affinity). Regarding this matter, I too cannot help but experience a sudden enlightenment.