余得一缓字诀，以决病之死生吉凶。凡遇噎膈反胃，脉未有不缓者，其将何以决之？余用是三思焉。因其
脉之缓，而知其脾无恙焉，肾无恙焉，心、肝、肺无恙焉。惟是一眚之累，居于要地，遂积成莫疗之 。即其
脉以思其症，绳以理而溯其源，经曰∶金木者，生成之终始（《河图》∶天一生水，地二生火，即干元大生，
坤元广生之纲领，故水火之功用亦足以维系乎天象地舆。至土以五十居中，寄旺于四时。尤其彰明较着者，惟
天三生甲木，地八乙成之，乃滋生之始事。所谓一生二，二生
三，三生万物者，此也。地四生辛金，天九庚成之，乃集成之终事，所谓战乎干、劳乎坎、成言乎艮者，此也。
故木气司权，丰草绿缛而争茂、佳术葱龙而可悦。金气司权，草拂之而色变，木遭之而叶脱）。物之化，从
乎生，物之成，从乎杀。生杀之机犹权衡之不可轻重也。人生百年，一大春秋耳。年当杖乡杖国，正值秋月之
天，由是阳明之庚金，其气化为燥，由下冲上，冲于阑门、幽门，谓之反胃，朝食暮吐或隔宿方吐；冲于贲门
谓之膈，即食即吐；冲于吸门谓之噎，食难下咽。燥之所冲，门遂为之枯槁，叶黄禾熟之候，纵日暄风动，露
滋雨润，而欲转其青焉，抑已难矣。经曰∶“三阳结（手阳明大肠、足太阳膀胱、手太阳小肠），谓之膈”。
不独指阳明经。亦思三阳同居下位，岂有一阳结（阳明金燥），而二阳不随之而结者乎（膀胱与小肠津液，随
之而枯）？所以吐沫、刺痛、羊粪，总由于燥结然耳。东垣通幽汤（秦归身、升麻、桃仁、红花、炙草一钱，
生地、熟地五分）其理最为深邃，存其方可矣。丹溪禁辛燥（丁香、白蔻、砂仁、半夏、陈皮之类），虽其义
极为晓畅，存其语可矣。若喻嘉言、李士材于是症，一则商其补脾补肾，未悟其脉；一则酌其下气坠痰，未达
其症。然则，此症无可治乎？曰∶非也。年未登五十，燥非其时，或为醇酒所伤，或为煎熬所中，以润燥为主
（牛羊乳、童便、芦根、韭菜汁、陈酒、茅根之类。经验方∶酒大黄、桃仁、归尾，炼蜜为丸，茅根汁汤送下），
兼用四子之书，多有得愈者。悟到秋来金恋木，翻然方见艳阳天（后天坎离用事，升居乾坤之位，于是八卦
各易其位。震木居离火之位，震为苍龙，龙从火里出；兑金居坎水之位，兑为白虎，虎向水中生。龙跃虎腾，
金木交并，木之欣欣向荣者，不畏金而反爱金，虽历夏而秋，常在春三、二月之天）。
（司马石渭中，端方正直，同砚两载，来往数十年如一日也。年近五旬，酷嗜浓味鱼腥，胸间隐隐作痛，
食入即吐。人到知心，刻期取效。心转疑惑，觉古所传之方，一无可用，乃会丹溪之意，日服芦根汤而愈。游
湘未悟，于今三年，是夜援笔成论，顿兴我以暮云春树之感。）
我得到一个“缓”字的诀窍，用来决断疾病的生死吉凶。凡是遇到噎膈反胃（指吞咽困难、胸膈阻塞或食入即吐的病证），脉象没有不呈现缓象的，这该如何判断呢？我对此反复思考。因为脉象缓，所以知道脾脏无病，肾脏无病，心脏、肝脏、肺脏也无病。唯独是一个小病灶的牵连，位于关键部位，于是积结成无法治疗的疾病。根据脉象来推想症状，依据道理来追溯源头，《黄帝内经》说：金和木，是生成过程的终始（《河图》记载：天一生水，地二生火，这是乾元大生、坤元广生的纲领，所以水火的功能也足以维系天地景象。至于土数五十居中，寄旺于四季。尤其明显的是，天三生甲木，地八乙成之，这是滋生的开始。所谓一生二，二生三，三生万物，就是这个道理。地四生辛金，天九庚成之，这是集成的终结，所谓在乾卦交战、在坎卦劳苦、在艮卦完成，就是这个道理。所以当木气主事时，丰草碧绿茂盛争荣，佳术葱茏可爱；当金气主事时，草被拂过就变色，树遭遇它就落叶）。万物的变化，顺从于生长；万物的成就，顺从于肃杀。生长与肃杀的机枢，就像秤锤一样不可偏轻重。人活百年，不过是一个大的春秋罢了。到了五十岁（杖乡杖国之年），正值秋天的天气，由此阳明经的庚金之气，其性质化为燥，由下向上冲，冲到阑门、幽门，称为反胃，早晨吃晚上吐，或者隔宿才吐；冲到贲门，称为膈，食物刚吃下去就吐出来；冲到吸门，称为噎，食物难以咽下。燥气所冲之处，门户因此干枯萎缩，就像叶子发黄、禾苗成熟的时节，纵然日晒风动，露水滋润雨水润泽，想要让它转青，也已经很难了。《黄帝内经》说：“三阳结滞（手阳明大肠经、足太阳膀胱经、手太阳小肠经气机郁结），叫做膈”。不仅仅指阳明经。我也想到三阳经同居下位，难道有一个阳经结滞（阳明金燥），另外两个阳经不随之而结滞的吗（膀胱与小肠的津液，随之枯竭）？所以吐沫、刺痛、大便像羊粪一样干结，总归是由于燥结罢了。李东垣的通幽汤（当归身、升麻、桃仁、红花、炙甘草一钱，生地、熟地五分）它的道理最为深邃，保留这个方子就可以了。朱丹溪禁止使用辛燥药物（丁香、白豆蔻、砂仁、半夏、陈皮之类），虽然他的义理非常清晰明白，保留他的话就可以了。至于喻嘉言、李士材对于这种病症，一个商讨补脾补肾，没有领悟到脉象的真意；一个斟酌降气坠痰，没有通达病症的本质。那么，这种病症就没有办法治疗了吗？我说：不是这样。如果年龄不到五十岁，燥气并非主令之时，或者是被醇酒所伤，或者是被体内煎熬所中，以润燥为主（牛羊乳、童便、芦根、韭菜汁、陈酒、茅根之类。经验方：酒大黄、桃仁、归尾，炼蜜为丸，用茅根汁送服），兼用四子之书（指道家或养生类书籍，此处语境稍显晦涩，结合后文可能指代某种调理思路或特定医家著作，但原文未明示具体书名，故仅译意），大多能痊愈。悟到秋来金恋木（金气收敛而不克伐木气），翻然方见艳阳天（后天坎离用事，升居乾坤之位，于是八卦各易其位。震木居离火之位，震为苍龙，龙从火里出；兑金居坎水之位，兑为白虎，虎向水中生。龙跃虎腾，金木交并，木之欣欣向荣者，不畏金而反爱金，虽历夏而秋，常在春三、二月之天）。
司马石渭中，品行端正方正，与我同窗两载，来往数十年如一日。年近五十，酷嗜浓味鱼腥之物，胸部隐隐作痛，食物吃进去就吐出来。人们都知心切，期望立刻见效。我心里反而疑惑，觉得古来流传的方子，没有一个可用，于是领会丹溪的意思，每天服用芦根汤而痊愈。我在游湘地区未能领悟此理，到现在三年了，这天夜里提笔写成这篇论述，顿时兴起我对友人思念之情（引用杜甫“暮云春树”典故，表达对友人的怀念）。
I have obtained the secret of the "slow" (Huan) pulse to determine the life, death, auspiciousness, and inauspiciousness of diseases. Whenever encountering Yige Fanwei (dysphagia, food impaction, and regurgitation), the pulse is invariably slow. How should one judge it? I have pondered this repeatedly. Because the pulse is slow, I know that the Spleen is healthy, the Kidney is healthy, and the Heart, Liver, and Lungs are also healthy. Only a minor ailment has affected a critical location, accumulating into an incurable disease. By inferring symptoms from the pulse and tracing the origin according to principles, the Classics state: Metal and Wood represent the beginning and end of generation and completion (The *Hetu* [River Map] states: Heaven generates Water with One, Earth generates Fire with Two; this is the outline of Qianyuan's great generation and Kunyuan's extensive generation, so the functions of Water and Fire are sufficient to sustain the celestial and terrestrial phenomena. As for Earth with fifty residing in the center, it thrives寄旺 in the four seasons. What is particularly evident is that Heaven generates Jia Wood with Three, and Earth completes Yi Wood with Eight, which is the beginning of nourishment and growth. This is what is meant by "One generates Two, Two generates Three, Three generates all things." Earth generates Xin Metal with Four, and Heaven completes Geng Metal with Nine, which is the final stage of integration. This corresponds to "struggling in Qian, laboring in Kan, and completing words in Gen." Therefore, when Wood Qi holds power, lush grass grows green and茂密 competing for vitality, and fine herbs are verdant and pleasing. When Metal Qi holds power, grass changes color upon brushing, and trees shed leaves upon encounter). The transformation of things follows growth; the completion of things follows destruction/salvaging. The mechanism of growth and destruction is like the balance beam of a scale, where weight cannot be favored on either side. A human lifespan of a hundred years is but one great Spring and Autumn. When reaching the age of fifty (the age of receiving the staff at home and in the state), one enters the season of autumn. At this time, the Geng Metal Qi of the Yangming Meridian transforms into dryness. Rushing upward from below, it strikes the Lanmen and Youmen, called Fanwei (regurgitation); food eaten in the morning is vomited in the evening, or after a night. Striking the Fenmen, it is called Ge (impaction); food is vomited immediately after eating. Striking the Ximen, it is called Ye (choking); food is difficult to swallow. Where the dryness strikes, the gates become withered and shriveled. It is like the time when leaves turn yellow and crops ripen; even with sun exposure, wind movement, dew nourishment, and rain moistening, it is already difficult to make them turn green again. The Classics say: "The binding of the Three Yangs (Hand-Yangming Large Intestine, Foot-Taiyang Bladder, Hand-Taiyang Small Intestine) is called Ge." This does not refer only to the Yangming Meridian. I also consider that the Three Yangs reside in the lower position; if one Yang binds (Yangming Metal Dryness), will the other two Yangs not bind along with it? (The fluids of the Bladder and Small Intestine wither accordingly.) Thus, vomiting saliva, stabbing pain, and stool resembling sheep dung are all due to dryness binding. Li Dongyuan's Tongyou Decoction (Danggui Shen [Angelica Sinensis Root], Shengma [Cimicifugae Rhizoma], Taoren [Prunus Persica Seed], Honghua [Carthami Flos], Zhi Gancao [Prepared Licorice Root] 1 qian, Shengdi Huang [Rehmanniae Radix] and Shudi Huang [Prepared Rehmanniae Radix] 5 fen) has the most profound principle; retaining this formula is sufficient. Zhu Danxi prohibited the use of acrid-drying herbs (such as Dingxiang [Caryophylli Flos], Baikouren [Amomi Fructus Rotundus], Sharen [Tsaoko Fructus], Banxia [Pinelliae Rhizoma], Chenpi [Citri Reticulatae Pericarpium]). Although his reasoning is very clear, retaining his words is sufficient. As for Yu Jiayan and Li Shicai regarding this disease, one discussed tonifying the Spleen and Kidney without comprehending the pulse; the other considered descending Qi and precipitating phlegm without understanding the pathology. So, is there no treatment for this disease? I say: No. If the age is not yet fifty, and dryness is not the dominant factor, or if injured by strong wine, or harmed by internal simmering/fire, the main treatment should be moistening dryness (such as cow/sheep milk, Tongbian [Child's Urine], Lugeng [Phragmitis Rhizoma], Jiucui Zhi [Chinese Chive Juice], Chenjiu [Aged Wine], Maogen [Imperatae Rhizoma]. Empirical Formula: Jiu Dahuang [Wine-processed Rheum Palmatum Rhizome], Taoren [Prunus Persica Seed], Guiwei [Angelica Sinensis Tail], refined honey made into pills, taken with Maogen juice decoction). Combining this with the teachings of the "Four Masters" books, many recover. Realizing that in autumn, Metal cherishes Wood, one suddenly sees the bright sunny sky (Post-heaven Kan and Li take effect, ascending to the positions of Qian and Kun, thus the Eight Trigrams change their positions. Zhen Wood resides in the position of Li Fire; Zhen is the Azure Dragon, the dragon emerges from fire; Dui Metal resides in the position of Kan Water; Dui is the White Tiger, the tiger is born from water. The dragon leaps and the tiger soars, Metal and Wood intersect. Wood, flourishing and thriving, does not fear Metal but rather loves it; although passing through summer and autumn, it remains in the weather of spring's third and second months).
Sima Shi Weizhong was upright and honest, my classmate for two years, interacting for decades as if it were one day. Near fifty years old, he had a strong preference for rich-flavored fish and seafood, suffering from dull pain in the chest and immediate vomiting after eating. People knew his heart was anxious and expected quick results. I, however, became doubtful, feeling that none of the ancient formulas were applicable. Understanding Danxi's intent, I prescribed Lugeng Tang [Reed Shoot Decoction] daily, and he recovered. I failed to comprehend this during my travels in Xiang, and now, three years later, I write this treatise by night, suddenly filled with feelings of longing for my friend (referencing Du Fu's poem "Evening Clouds and Spring Trees").