既足。土又可生金。金又生水。自此接续而生。莫不均藉补水之力。此天一生水之义也。若不明乎此。即经所谓不能治
其虚。何问其余。）
十三难曰。经言见其色。而不得其脉。反得相胜之脉者即死。得相生之脉者。病即自已。色之与脉。当参相应。为
之奈何。
此以色脉为问。下文详言色脉皮肤声音臭味相应之义。然。五脏有五色。皆见于面。亦当与寸口尺内相应。假令
色青（肝色）其脉当弦而急。（肝脉）色赤（心色）其脉浮大而散（心脉）色黄（脾色）其脉中缓而大（脾脉）色白（肺
色）其脉浮涩而短（肺脉）色黑（肾色）其脉沉濡而滑（肾脉）此谓五色之与脉。当参相应也（此概举五脏之色脉也。
下衣冠文物相应吉凶之义。此节精熟。则色脉生胜之理。自然了了。）脉数。尺之皮肤亦数。脉急。尺之皮肤亦急。脉缓。尺
之皮肤亦缓。脉涩。尺之皮肤亦涩。
脉滑。尺之皮肤亦滑。
此言脉与寸关尺皮肤相应之理。脉数。数字当作热字解。急字当作紧字解。缓字当作和字解。涩即干涩之谓。滑
即滑润之谓。此但言尺者。统乎手臂也。
五脏各有声色臭味。当与寸口尺内相应。其不相应者病也。
此言五脏各有相生相胜。当以声色臭味参之。如声呼色青。臭臊味酸者。肝也。声笑色赤。臭焦味苦者。心也。
声歌色黄。臭香味甘者。脾也。声哭色白。臭腥味辛者。肺也。声呻色黑。臭腐味咸者。肾也。察其声色臭味。
参合其脉之相生相胜。则知其病之生死矣。假令色白多哭。好辛臭腥。其脉弦而急者。是肺之声色臭味。
而见肝脉者。为相胜。则死。若见脾脉。此为相生。病即自已。若见肝之声色臭味而得脾脉。亦死也。
假令色青。（肝色）其脉浮涩而短。（肺脉）若大而缓。（脾脉）为相胜。浮大而散。（心脉）若小而
滑。（肾脉）为相生也。
此申明相生相胜之义。以肝脏为例而言也。假如青者。肝木之色也。浮涩短。肺金之脉也。为脉胜色。大而缓。
脾土之脉也。为色胜脉。浮大散。心火之脉也。为色生脉。小而滑。肾水之脉也。为脉生色。余脏仿此。
经言知一为下工，知二为中工。知三为上工。上工者。十全九。中工者。十全八。下工者。十全六。此之谓也。
此总结上文色脉生胜之理。缺一不可。知一者。知其色也。知二者。知其色与脉也。知三者。知其脉与声色臭味
之相生相胜也。
十四难曰。脉有损至。何谓也。然。至之脉。一呼再至曰平。（一息四至）三至曰离经。
（一息六至）四至曰夺精。（一息八至）五至曰死。（一息十至）六至曰命绝。（一息十二至）
此至之脉也。何谓损。一呼一至曰离经。（一息二至）二呼一至曰夺精。（一息一至）三呼一至曰死。（一息半一至）四呼
一至曰命绝。此损之脉也。至脉从下上。损脉从上下。
诊损至之脉。以医者之息数。定病者之至数。至脉从下上者。从肾而上也。损脉从上下者。从肺而下也。此言损至脉
大纲。损脉之为病。奈何。然。一损损于皮毛。皮聚而毛落。二损损于血脉。血脉虚少。不能荣于五脏
六腑也。三损损于肌肉。肌肉消瘦。饮食不能为肌肤。四损损于筋。筋缓不能自收持。五损损于骨。
骨痿不能起于床。反此者。至之脉病也。（至之脉向误至于收）从上下者。骨痿不能起于床者死。
（损脉病）从下上
者。皮聚而毛落者死。（至脉病）
此一节。指损至脉本原之久病。盖一损皮毛。病尚浅。五损于骨。病已深。
然有由骨而复反皮毛必死。所以虚劳脉数不治。
治损之法奈何。然。损其肺者。益其气。损其心者。调其荣卫。损其脾者。调其饮食。适其寒
温。损其肝者。缓其中。损其肾者。益其精。此治损之法也。
曰益。曰调。曰适。曰缓。此四法包括已尽。不立方而方在其中。此但言治损。不言治至者。若到
至脉已无治也。可不慎欤。
脉有一呼再至。一吸再至。有一呼三至。一吸三至。有一呼四至。一吸四至。有一呼五至。一吸五至。有一呼六至。一
吸六至。有一呼一至。一吸一至。有再呼一至。再吸一至。有呼吸不至。脉来如此。何以别知其病也。
此复举至损之脉为问。是指近病而言。以起下文也。然。脉来一呼再至。一吸再至。不大不小曰平。
此指一息四至之平脉。不大不小者。言不洪大不沉细也。一呼三至。一吸三至。为适得病。前大后小。即头痛目
眩。前小后大。即胸满短气。
此指一息六至之脉也。适。初也。言初得病也。前谓寸脉。后谓尺脉。寸大尺小者。邪在表也。寸小尺大者。邪
在里也。
一呼四至。一吸四至。病欲甚。脉洪大者。苦烦满。沉细者。腹中痛。滑数伤热。涩者中雾露。
此指一息八至之数脉也。欲甚将甚也。洪大而数者。邪在胸膈。沉细而数者。邪在腹中。滑数伤热邪。涩数中湿
邪也。
一呼五至。一吸五至。其人当困。沉细夜加。浮大昼加。不大不小。虽困可治。其有大小者。为难治。
此指一息十至之危脉也。困。病重也。沉细。阴将竭而夜重。浮大。阳将竭而昼重。所以不浮大。不沉细。虽重
而可治也。
一呼六至。一吸六至。为死脉也。沉细夜死。浮大昼死。
此一息十二至之死脉也。以上四节。俱指近病而言也。
一呼一至。一吸一至。名曰损。人虽能行。犹当着床。所以然者。血气皆不足故也。
此一息二至之脉也。人虽能行者。言初损肺。人必能行。因其能行而不治。则必渐及于心肝脾肾。血气俱损。而
着床也。
再呼一至。再吸一至。名曰无魂。无魂者。当死也。人虽能行。名曰行尸。
此一息一至之脉也。魂属真阳之气。阳气败绝。虽能行必死。故曰行尸。此二节复言损脉者
。明损脉非起于一朝一夕。或有初起病。得似损非损之脉。恐人误认。故以下文结之。
上部有脉。下部无脉。其人当吐。不吐者死。上部无脉。下部有脉。虽困无能为害。所以然者。譬如人之有尺。犹
树之有根。枝叶将槁枯。根本将自生。脉有根本。人有原气。故知不死。
此呼吸不至之脉也。上有下无。谓寸有尺无。因实邪一时闭塞。阻遏生气。吐则越其邪而升
其气。不吐者死。谓不用吐法者死也。此条越人恐误认损脉。故谆之晰之。夫损脉者迟脉也。
至脉者数脉也。不言迟数。而言损至者。盖以迟数之脉。统摄虚证实证。表证里证。无所不包。无法不备之总名也。如
首节言。至脉
始于一息四至。终于十二至。损脉始于一息二至。终于两息一至。此为本原证提纲而论也。至脉
从下上。损脉从上下。明至脉从肾阴虚竭。而及于肺气尽。损脉从肺气虚寒。而及于肾阳竭也。二
节明损脉之本原证起于肺。若失治必递及于心脾肝肾。其损脉必反而为至脉。因肾虚火燥。复由
肾而递及肝脾心肺而死。故曰反此者。至之脉病也。三节明调治本原诸法。言损于肺者。益其气。盖损肺即损气也。气
即命门之真气。真气损。则皮皴而毛发枯。故曰皮聚而毛落。治之当益其气。益则补益之谓也。气虚即阳虚。
补其阳气。则皮毛可以充实。若非理中桂附等类。何以补其阳。轻则补中益气等汤。庶可取用。
若不明损脉之义。又何能明治损之法。及至脉数气喘发咳晡热。方云肺虚。然后补肺保气。终无
成效矣。殊不知此是损脉失治。转到至脉不治之候也。又曰。损其心者。调其荣卫。盖损心即损血也。心为荣血之源。
肺为卫气之本。既损肺而复损其心。其气血不能荣养五脏六腑。当调而治
之。调者。取和调之义。有顾此兼彼之法。非比益之径行直遂也。如归脾汤异功散八珍汤十全大补等
汤。或六味八味等丸。消息病情。随宜投服。无不效也。若不明治损之义。必待脉数心烦。咽干
口燥。惊惕不寐。方谓心虚。投之温补。必不受也。滋补必碍脾也。此亦损脉失治。转到至脉不治
之候也。又曰。损其脾者。调其饮食。适其寒温。盖脾主中州。又主肌肉。消瘦则腠理不密。
不论寒温。感邪最易。故曰适其寒温。中州失职。则运化无权。易泄易滞。不特参苓
药在温补健脾。而于饮食。亦必节其饥饱。察其所宜。故曰调其饮食也。若不明至损之义。必待
饥不能食。
气急胀满。脉数双弦。方谓脾虚。用参 而胀满愈加。投桂附而虚烦转甚。此亦因损脉失治。转到
至脉不治之候也。又曰。损其肝者。缓其中。肝主筋。筋藉血。血虚则肝燥而筋纵。必大补心脾。使心能生血。脾能统
血。归脾养荣等汤。宜早投也。若不明至损之义。必待血枯脉数。手足难运。方
谓肝虚。然后议用前方。已无
及也。又曰。损其肾者益其精。骨属肾。精亏则髓枯骨痿。必益其精而髓自充。经曰。精不足者。补之以味。
味乃血肉浓味也。如鹿茸等类。兼地黄人参枸杞之属。俱能补精。若不明至损之义。必待真阴竭绝。虚火炎
蒸。脉数心烦。不能起床。及投之以养阴必泄。进之以养阳必燥。此皆不能会悟此篇之精义也。
至第四节。另以至损之脉为问者。别在五邪表里之症。不混于本原之证也。第五节言不洪大。
不沉细。不病之平脉也。第六节言寸脉洪大。尺脉沉细，表证里证也。第七节言尺寸俱洪大。尺
寸俱沉细。表热里热之证也。而又举洪大而滑者。必是伤热。沉细而涩者。必是中湿热也。第
八节言尺寸沉细。必是里热而
夜重。尺寸浮大。必是表热而昼重。又言不大不小。虽困可治者。此有邪退之机。重必转轻。而可
治也。若愈浮大。愈沉细。此病进之机。而难治也。是即第九节之沉细夜死。浮大昼死也，自四节至九
节。专以至脉提纲。明表里实邪之义也。第十节复叮咛损脉不可失治。如一息二至之脉。虽其人
能行。必当早治。苟因其能行而不治。必至着床不起。其所以不起者。因血气皆不足故也。第
十一节言一息二至失治。必至一息一至而不可治。或有能行。亦不过行尸耳。末节明急证无脉
之义。恐其混于损脉也。盖言下部无尺脉。必因骤中有形之实邪。壅塞而可吐也。若上部无寸脉。
或因偶中无形之虚邪。虽困无能为害也。而复归重于原气。总结全章之义也。中峰云。阅此论悟古人之治本原。大异于
今人。古人治可治之损脉。今人治不治之至脉。可慨也夫。
十五难曰。经言。春脉弦。夏脉钩。秋脉毛。冬脉石。是王脉耶。将病脉也。然。弦钩毛石
者。四时之脉也。春脉弦者。肝东方木也。万物始生。未有枝叶。故其脉之来。濡弱而长。故曰。
弦。夏脉钩者。心南方火也。万物之所茂。垂枝布叶。皆下曲如钩。故其脉之来。来疾去迟。故曰
钩。秋脉毛者。肺西方金也。万物之所终。草木华叶。皆经秋而落。其枝独在。若毫毛也。故其脉
之来。轻虚以浮。故曰毛。冬脉石者。肾北方水也。万物之所藏也。极冬之时。水凝如石。故其
脉之来。沉濡而滑。故曰石。此四时之脉也。
此章言四时之脉象。以起下文平脉病脉死脉之义。
如有变奈何。然。春脉弦。反者为病。何谓反。然。其气来实强。是谓太过。病在外。气来
虚微。是谓不及。病在内。气厌厌聂聂。如循榆叶。曰平。益实而滑。如循长竿。曰病。急而劲
益强。如张弓弦。曰死。
春脉微弦。曰平。弦多胃气少。曰病。但弦无胃气。曰死。春以胃气为本。
自此节以下。俱形容脉神。全在会悟自得。此即脉法中千手千眼。后人着诀。盈千万言。恐未
能道破一二也。脉因气行。气来即脉来也。下仿此。
夏脉钩。反者为病。何谓反。然。其气来实强。是谓太过。病在外。气来虚微。是谓不及。病在内。
其脉来累累如环。如循琅 。曰平。来而益数。如鸡举足者。曰病。前曲后居。如操带钩。曰死。夏脉微钩。
曰平。钩多胃气少。曰病。但钩无胃气。曰死。夏以胃气为本。
秋脉毛。反者为病。何谓反。然。其气来实强。是谓太过。病在外。气来虚微。是谓不及。病在
内。其脉来蔼蔼如车盖。按之益大。曰平。不上不下。如循鸡羽。曰病。按之萧索。如风吹毛。曰死。秋脉微毛。
曰平。毛多胃气少。曰病。但毛无胃气。曰死。秋以胃气为本。
冬脉石。反者为病。何谓反。然。气来实强。是谓太过。病在外。气来虚微。是谓不及。病在内。脉来上
大下兑。濡滑如雀之啄。曰平。啄啄连续。其中微曲。曰病。来如解索。去如弹石。曰死。冬脉微石。曰平。石多胃气
少。曰病。但石无胃气。曰死。冬以胃气为本。
以上四时之平脉。即有胃气之脉也。病脉即少胃气之脉也。死脉即无胃气之脉也。欲明脉神精义。当于平脉中参
悟。
胃者水谷之海。主禀四时。皆以胃气为本。是谓四时之变病。死生之要会也。
此言四时变病死生。皆藉胃气为主。
脾者中州也。其平和不可得见。衰乃见耳。来如雀之啄。如水之下漏。是脾衰之见也。
此总结上文四时之脉。合五脏之义也。脾属土。而分旺于四季。则四时之平脉。皆属于脾。故不
至此，土又能生金，金又能生水。如此循环接续而生，无不都借助于补水的力量。这就是“天一生水”的道理。如果不明白这个道理，就是《内经》所说的“不能治其虚，何问其余”。
第十三难说：经文说，看到病人的面色，却得不到相应的脉象，反而得到相克（相胜）的脉象，就会死亡；得到相生脉象的，病就会自然痊愈。面色与脉象，应当参合相应，这是为什么呢？
这里以色脉为问题，下文详细阐述色、脉、皮肤、声音、气味相互对应的道理。然而，五脏有五色，都表现在面部，也应当与寸口尺内的脉象相应。假如面色青（肝之色），脉象应当弦而急（肝之脉）；面色赤（心之色），脉象浮大而散（心之脉）；面色黄（脾之色），脉象中缓而大（脾之脉）；面色白（肺之色），脉象浮涩而短（肺之脉）；面色黑（肾之色），脉象沉濡而滑（肾之脉）。这叫做五色与脉象应当参合相应。（这是概举五脏的色脉。下面关于衣冠文物相应吉凶的意义，这一节精熟掌握，那么色脉相生相克的道理，自然清楚明了。）脉数，尺部的皮肤也感觉热；脉紧，尺部的皮肤也感觉紧张；脉缓，尺部的皮肤也感觉柔和；脉涩，尺部的皮肤也感觉干涩；脉滑，尺部的皮肤也感觉滑润。
这是说脉象与寸关尺皮肤相应的道理。脉数，“数”字当作“热”字解；“急”字当作“紧”字解；“缓”字当作“和”字解；“涩”即干涩的意思；“滑”即滑润的意思。这里只说尺部，是因为统括手臂而言。
五脏各有声、色、臭、味，应当与寸口尺内相应。如果不相应，就是病了。
这是说五脏各有相生相克的关系，应当以声、色、臭、味参合判断。如声音呼、面色青、气味臊、味道酸的是肝；声音笑、面色赤、气味焦、味道苦的是心；声音歌、面色黄、气味香、味道甘的是脾；声音哭、面色白、气味腥、味道辛的是肺；声音呻、面色黑、气味腐、味道咸的是肾。观察其声、色、臭、味，参合其脉的相生相克，就知道病的生死情况了。假如面色白，多哭，喜好辛腥气味，脉象却弦而急，这是肺的声、色、臭、味，却见到肝的脉象，属于相克（相胜），就会死亡。如果见到脾的脉象，这属于相生，病就会自然痊愈。如果见到肝的声、色、臭、味，却得到脾的脉象，也会死亡。
假如面色青（肝之色），脉象浮涩而短（肺之脉），如果脉象大而缓（脾之脉），属于相克；如果脉象浮大而散（心之脉），或者小而滑（肾之脉），属于相生。
这是申明相生相克的道理，以肝脏为例来说明。假如青色，是肝木的颜色。浮涩短，是肺金的脉象，属于脉克色（脉胜色）。大而缓，是脾土的脉象，属于色克脉（色胜脉）。浮大散，是心火的脉象，属于色生脉。小而滑，是肾水的脉象，属于脉生色。其他脏腑仿照此类推。
经文说：知道其中一项的是下工，知道两项的是中工，知道三项的是上工。上工治愈率十分之九，中工治愈率十分之八，下工治愈率十分之六。说的就是这个道理。
这是总结上文色脉相生相克的道理，缺一不可。知一，是只知道色。知二，是知道色与脉。知三，是知道脉与声、色、臭、味的相生相克。
第十四难说：脉有损脉和至脉，是什么意思呢？回答是：至脉，一呼脉跳两次叫平脉。（一息四至）一呼三次叫离经脉。（一息六至）一呼四次叫夺精脉。（一息八至）一呼五次叫死脉。（一息十至）一呼六次叫命绝脉。（一息十二至）
这是至脉。什么叫损脉？一呼一次叫离经脉。（一息二至）两呼一次叫夺精脉。（一息一至）三呼一次叫死脉。（一息半一至）四呼一次叫命绝脉。这是损脉。至脉从下往上发展，损脉从上往下发展。
诊察损脉和至脉，以医生的呼吸次数，来确定病人的脉搏次数。至脉从下往上，是从肾向上发展。损脉从上往下，是从肺向下发展。这是说损脉和至脉的大纲。损脉引起的疾病是怎样的呢？回答是：一损损伤皮毛，皮肤聚拢而毛发脱落；二损损伤血脉，血脉虚少，不能滋养五脏六腑；三损损伤肌肉，肌肉消瘦，饮食不能化为肌肤；四损损伤筋，筋弛缓不能自我收持；五损损伤骨，骨痿废不能起床。与此相反的情况，是至脉的病。（原文“至之脉向误至于收”为校勘注记）从上往下发展的（损脉病），骨痿不能起床的会死亡。（损脉病）从下往上发展的（至脉病），皮肤聚拢而毛发脱落的会死亡。（至脉病）
这一段，指出损脉和至脉是本原久病。一损皮毛，病尚浅；五损于骨，病已深。然而如果有由骨又反过来影响皮毛的，必然死亡，所以虚劳脉数是不治之症。
治疗损脉的方法是怎样的呢？回答是：损肺的，补益其气；损心的，调和其营卫；损脾的，调节饮食，适应寒温；损肝的，舒缓其中气；损肾的，补益其精。这就是治疗损脉的方法。
用“益”、“调”、“适”、“缓”这四个字，已经概括尽了，不立方剂而方义在其中。这里只说治损，不说治至，是因为到了至脉就已经没有治疗方法了，能不谨慎吗？
脉有一呼两次、一吸两次的；有一呼三次、一吸三次的；有一呼四次、一吸四次的；有一呼五次、一吸五次的；有一呼六次、一吸六次的；有一呼一次、一吸一次的；有两呼一次、两吸一次的；有呼吸间无脉动的。脉来如此，如何区别知道是什么病呢？
这是再次列举至脉和损脉作为问题，是指近病而言，为了引起下文。然而，脉来一呼两次、一吸两次，不大不小，叫平脉。
这是指一息四至的平脉。“不大不小”，是说既不洪大也不沉细。一呼三次、一吸三次，是刚开始得病。前大后小，就是头痛目眩；前小后大，就是胸满短气。
这是指一息六至的脉象。“适”，是初的意思。言刚开始得病。前指寸脉，后指尺脉。寸大尺小，邪在表；寸小尺大，邪在里。
一呼四次、一吸四次，病将要加重。脉象洪大的，苦于烦闷胀满；脉象沉细的，腹中痛；脉象滑数的，伤于热邪；脉象涩的，中雾露湿邪。
这是指一息八至的数脉。“欲甚”是将要严重。洪大而数，邪在胸膈；沉细而数，邪在腹中；滑数伤热邪；涩数中湿邪。
一呼五次、一吸五次，病人应当困顿。脉沉细的夜间加重，脉浮大的白天加重。脉不大不小，虽然困顿可治。脉有大小不一的，为难治。
这是指一息十至的危重脉象。“困”，是病重。沉细，阴将竭而夜间重；浮大，阳将竭而白天重。所以不浮大、不沉细，虽然重而可治。
一呼六次、一吸六次，是死脉。沉细的夜间死，浮大的白天死。
这是一息十二至的死脉。以上四节，都是指近病而言。
一呼一次、一吸一次，名叫损脉。人虽然能行走，但也应当卧床不起。之所以这样，是因为血气都不足。
这是一息二至的脉象。人虽然能行走，是说初损肺时，人必能行走。因为能行走而不治疗，就必定逐渐波及心肝脾肾，血气俱损，从而卧床不起。
两呼一次、两吸一次，名叫无魂。无魂的人，应当死亡。人虽然能行走，名叫行尸。
这是一息一至的脉象。魂属于真阳之气，阳气败绝，虽然能行必死。所以叫行尸。这两节再次说明损脉，明确损脉不是一朝一夕形成的。或许有初起病，得到似损非损的脉象，恐怕人误认，所以下文进行总结。
上部有脉，下部无脉，病人应当呕吐。不呕吐的会死亡。上部无脉，下部有脉，虽然困顿也无害处。之所以这样，譬如人有尺脉，就像树有根一样。枝叶将要枯槁，根本自然会生长。脉有根本，人有原气，所以知道不死。
这是呼吸间无脉动的脉象。上有下无，谓寸有尺无。因实邪一时闭塞，阻遏生气。吐则发散邪气而升发其气。不吐的会死亡，谓不用吐法的会死亡。这一条越人恐怕误认为损脉，所以谆谆告诫辨析。夫损脉是迟脉，至脉是数脉。不说迟数，而说损至，大概是以迟数之脉，统摄虚证实证、表证里证，无所不包，无法不备的总名。如首节所说，至脉始于一息四至，终于十二至；损脉始于一息二至，终于两息一至。这是为本原证提纲而论。至脉从下往上，损脉从上往下。明确至脉从肾阴虚竭，而及于肺气尽；损脉从肺气虚寒，而及于肾阳竭。第二节明确损脉的本原证起于肺，若失治必递及于心脾肝肾，其损脉必反而变为至脉，因肾虚火燥，复由肾而递及肝脾心肺而死。所以说“反此者，至之脉病也”。第三节明确调治本原诸法。言损于肺者，益其气。盖损肺即损气也。气即命门之真气。真气损，则皮皱而毛发枯，故曰皮聚而毛落。治之当益其气。“益”即补益的意思。气虚即阳虚，补其阳气，则皮毛可以充实。如果不是理中汤、桂枝附子等类，何以补其阳？轻则补中益气等汤，庶可取用。如果不明白损脉的意义，又怎能明治损之法？及至脉数气喘发咳午后发热，才说是肺虚，然后补肺保气，终无成效。殊不知这是损脉失治，转到至脉不治的候象。又说：损其心者，调其营卫。盖损心即损血也。心为荣血之源，肺为卫气之本。既损肺而复损其心，其气血不能荣养五脏六腑，当调而治之。“调”，取和调之义。有顾此兼彼之法，不像“益”那样径行直遂。如归脾汤、异功散、八珍汤、十全大补等汤，或六味、八味等丸，斟酌病情，随宜投服，无不有效。如果不明白治损的意义，必待脉数心烦、咽干口燥、惊惕不寐，才谓之心虚，投之温补，必不受纳。滋补必碍脾。这也是损脉失治，转到至脉不治的候象。又说：损其脾者，调其饮食，适其寒温。盖脾主中州，又主肌肉。消瘦则腠理不密，不论寒温，感邪最易。故曰适其寒温。中州失职，则运化无权，易泄易滞。不仅人参、茯苓等药在温补健脾，而对于饮食，也必节制饥饱，察其所宜。故曰调其饮食。如果不明白至损的意义，必待饥不能食、气急胀满、脉数双弦，才谓脾虚，用人参而胀满愈加，投桂附而虚烦转甚。这也是因损脉失治，转到至脉不治的候象。又说：损其肝者，缓其中。肝主筋，筋藉血。血虚则肝燥而筋纵。必大补心脾，使心能生血，脾能统血。归脾、养荣等汤，宜早投用。如果不明白至损的意义，必待血枯脉数、手足难运，才谓肝虚，然后议用前方，已来不及了。又说：损其肾者，益其精。骨属肾。精亏则髓枯骨痿。必益其精而髓自充。经曰：精不足者，补之以味。味乃血肉浓味。如鹿茸等类，兼地黄、人参、枸杞之属，俱能补精。如果不明白至损的意义，必待真阴竭绝、虚火炎蒸、脉数心烦、不能起床，及投之以养阴必泄，进之以养阳必燥。这都是不能会悟此篇精义的表现。
至第四节，另以至损之脉为问，别在五邪表里之症，不混于本原之证。第五节言不洪大、不沉细，是不病之平脉。第六节言寸脉洪大、尺脉沉细，是表证里证。第七节言尺寸俱洪大、尺寸俱沉细，是表热里热之证。而又举洪大而滑者，必是伤热；沉细而涩者，必是中湿热。第八节言尺寸沉细，必是里热而夜重；尺寸浮大，必是表热而昼重。又言不大不小，虽困可治者，此有邪退之机，重必转轻，而可治。若愈浮大，愈沉细，此病进之机，而难治。是即第九节的沉细夜死、浮大昼死。自四节至九节，专以至脉提纲，明表里实邪之义。第十节反复叮咛损脉不可失治。如一息二至之脉，虽其人能行，必当早治。苟因其能行而不治，必至着床不起。其所以不起者，因血气皆不足故。第十一节言一息二至失治，必至一息一至而不可治。或有能行，亦不过行尸耳。末节明急证无脉之义，恐其混于损脉。盖言下部无尺脉，必因骤中有形之实邪，壅塞而可吐。若上部无寸脉，或因偶中无形之虚邪，虽困无能为害。而复归重于原气，总结全章之义。中峰云：阅此论悟古人之治本原，大异于今人。古人治可治之损脉，今人治不治之至脉。可叹啊！
第十五难说：经文说，春脉弦，夏脉钩，秋脉毛，冬脉石，这是旺脉呢，还是病脉呢？回答是：弦、钩、毛、石，是四时的脉象。春脉弦，是因为肝属东方木。万物始生，未有枝叶，所以其脉之来，濡弱而长，所以叫弦。夏脉钩，是因为心属南方火。万物茂盛，垂枝布叶，皆下曲如钩，所以其脉之来，来疾去迟，所以叫钩。秋脉毛，是因为肺属西方金。万物终结，草木华叶，皆经秋而落，其枝独在，若毫毛，所以其脉之来，轻虚以浮，所以叫毛。冬脉石，是因为肾属北方水。万物收藏。极冬之时，水凝如石，所以其脉之来，沉濡而滑，所以叫石。这是四时的脉象。
这一章说四时的脉象，以引起下文平脉、病脉、死脉的意义。
如果有变化怎么办？回答是：春脉弦，反常的就是病。什么叫反常？回答是：其气来实强，这叫太过，病在外；其气来虚微，这叫不及，病在内。其脉气厌厌聂聂，像抚摸榆叶，叫平脉。更加实而滑，像抚摸长竿，叫病脉。急而劲益强，像张开的弓弦，叫死脉。春脉微弦，叫平脉。弦多胃气少，叫病脉。但弦无胃气，叫死脉。春以胃气为本。
从这一节以下，都是形容脉神，全在于会悟自得。这就是脉法中的千手千眼，后人著诀，成千上万言，恐怕未能道破一二。脉因气行，气来即脉来。下文仿照此例。
夏脉钩，反常的就是病。什么叫反常？回答是：其气来实强，这叫太过，病在外；其气来虚微，这叫不及，病在内。其脉来累累如环，像抚摸琅玕，叫平脉。来而益数，像鸡举足，叫病脉。前曲后居，像操带钩，叫死脉。夏脉微钩，叫平脉。钩多胃气少，叫病脉。但钩无胃气，叫死脉。夏以胃气为本。
秋脉毛，反常的就是病。什么叫反常？回答是：其气来实强，这叫太过，病在外；其气来虚微，这叫不及，病在内。其脉来蔼蔼如车盖，按之益大，叫平脉。不上不下，像抚摸鸡羽，叫病脉。按之萧索，像风吹毛，叫死脉。秋脉微毛，叫平脉。毛多胃气少，叫病脉。但毛无胃气，叫死脉。秋以胃气为本。
冬脉石，反常的就是病。什么叫反常？回答是：其气来实强，这叫太过，病在外；其气来虚微，这叫不及，病在内。其脉来上大下兑，濡滑如雀之啄，叫平脉。啄啄连续，其中微曲，叫病脉。来如解索，去如弹石，叫死脉。冬脉微石，叫平脉。石多胃气少，叫病脉。但石无胃气，叫死脉。冬以胃气为本。
以上四时的平脉，就是有胃气的脉。病脉就是少胃气的脉。死脉就是无胃气的脉。想要明白脉神的精义，应当在平脉中参悟。
胃是水谷之海，主禀受四时，都以胃气为本。这叫四时变病死生的关键。
这是说四时变病死生，都借胃气为主。
脾是中州，其平和不可得见，衰败时才显现。来如雀之啄，如水之下漏，是脾衰的显现。
这是总结上文四时的脉，合五脏的意义。脾属土，而分旺于四季，则四时的平脉，都属于脾，所以不……
Having been completed, Earth can again generate Metal. Metal can again generate Water. Thus, generation continues in succession. All of this relies on the power of supplementing Water. This is the meaning of "Heaven generates One and Water." If one does not understand this, it is as the Classic says: "If one cannot treat deficiency, why ask about the rest?"
Difficulty Thirteen states: The Classic says, "When you see the complexion but do not find the corresponding pulse, and instead find a pulse that overcomes (controls) [the organ corresponding to the complexion], death ensues. If you find a pulse that generates [the organ corresponding to the complexion], the disease will resolve itself." The complexion and the pulse should correspond when examined together. How should this be done?
This raises the issue of complexion and pulse. The following text details the meaning of the correspondence among complexion, pulse, skin, voice, and odor. However, the Five Zang organs have five complexions, all of which appear on the face, and they should also correspond with the pulse at Cun, Guan, and Chi positions. For example, if the complexion is green (Liver color), the pulse should be wiry and rapid (Liver pulse). If the complexion is red (Heart color), the pulse should be floating, large, and scattered (Heart pulse). If the complexion is yellow (Spleen color), the pulse should be moderate, slow, and large (Spleen pulse). If the complexion is white (Lung color), the pulse should be floating, choppy, and short (Lung pulse). If the complexion is black (Kidney color), the pulse should be deep, soft, and slippery (Kidney pulse). This is called the correspondence between the five complexions and the pulses. (This generally lists the complexions and pulses of the Five Zang organs. Regarding the significance of auspicious and inauspicious signs related to clothing and artifacts, mastering this section thoroughly will make the principles of pulse generation and overcoming clear.) When the pulse is rapid (heat), the skin at the Chi position also feels hot. When the pulse is tight, the skin at the Chi position also feels tense. When the pulse is relaxed (harmonious), the skin at the Chi position also feels soft. When the pulse is choppy, the skin at the Chi position also feels dry. When the pulse is slippery, the skin at the Chi position also feels smooth.
This explains the principle of correspondence between the pulse and the skin at Cun, Guan, and Chi. "Rapid" should be interpreted as "heat." "Tight" should be interpreted as "tight." "Relaxed" should be interpreted as "harmonious." "Choppy" refers to dryness. "Slippery" refers to smoothness. Here, only the Chi position is mentioned because it encompasses the entire arm.
Each of the Five Zang organs has its own voice, complexion, odor, and taste, which should correspond with the pulse at Cun, Guan, and Chi. If they do not correspond, it indicates disease.
This states that each of the Five Zang organs has relationships of generation and overcoming, which should be judged by combining voice, complexion, odor, and taste. For instance, a calling voice, green complexion, fishy odor, and sour taste indicate the Liver. A laughing voice, red complexion, scorched odor, and bitter taste indicate the Heart. A singing voice, yellow complexion, fragrant odor, and sweet taste indicate the Spleen. A crying voice, white complexion, fishy odor, and pungent taste indicate the Lung. A groaning voice, black complexion, putrid odor, and salty taste indicate the Kidney. By observing their voice, complexion, odor, and taste, and combining them with the generation and overcoming relationships of the pulse, one can determine the life or death prognosis of the disease. For example, if the complexion is white, there is much crying, and a preference for pungent and fishy odors, but the pulse is wiry and rapid, this represents the voice, complexion, odor, and taste of the Lung, yet the Liver pulse is seen. This is an overcoming relationship, so death ensues. If the Spleen pulse is seen, this is a generating relationship, and the disease will resolve itself. If the voice, complexion, odor, and taste of the Liver are observed, but the Spleen pulse is obtained, death also ensues.
For example, if the complexion is green (Liver color), but the pulse is floating, choppy, and short (Lung pulse), this is overcoming. If the pulse is large and slow (Spleen pulse), this is overcoming. If the pulse is floating, large, and scattered (Heart pulse), or small and slippery (Kidney pulse), this is generation.
This clarifies the meaning of generation and overcoming, using the Liver as an example. Green is the color of Liver Wood. Floating, choppy, and short is the pulse of Lung Metal; this is pulse overcoming complexion. Large and slow is the pulse of Spleen Earth; this is complexion overcoming pulse. Floating, large, and scattered is the pulse of Heart Fire; this is complexion generating pulse. Small and slippery is the pulse of Kidney Water; this is pulse generating complexion. The other organs follow this pattern.
The Classic says: "Knowing one aspect makes one a lower physician; knowing two aspects makes one a middle physician; knowing three aspects makes one an upper physician." An upper physician cures nine out of ten cases; a middle physician cures eight out of ten; a lower physician cures six out of ten. This is what is meant.
This summarizes the principles of complexion and pulse generation and overcoming mentioned above; none can be omitted. Knowing one means knowing only the complexion. Knowing two means knowing both complexion and pulse. Knowing three means knowing the generation and overcoming relationships among pulse, voice, complexion, odor, and taste.
Difficulty Fourteen states: There are Sun (diminished) pulses and Zhi (increased) pulses. What does this mean? Answer: In Zhi pulses, two beats per exhalation is considered normal (four beats per respiration). Three beats per exhalation is Li Jing (departing from the standard) (six beats per respiration). Four beats per exhalation is Duo Jing (depletion of essence) (eight beats per respiration). Five beats per exhalation is Si (death) (ten beats per respiration). Six beats per exhalation is Ming Jue (life extinction) (twelve beats per respiration).
These are the Zhi pulses. What are the Sun pulses? One beat per exhalation is Li Jing (two beats per respiration). One beat per two exhalations is Duo Jing (one beat per respiration). One beat per three exhalations is Si (one beat per 1.5 respirations). One beat per four exhalations is Ming Jue. These are the Sun pulses. Zhi pulses develop from below upwards; Sun pulses develop from above downwards.
To diagnose Sun and Zhi pulses, use the physician's breath count to determine the patient's pulse count. Zhi pulses developing from below upwards refer to progression from the Kidney upwards. Sun pulses developing from above downwards refer to progression from the Lung downwards. This outlines the general principles of Sun and Zhi pulses. How do diseases caused by Sun pulses manifest? Answer: First degree Sun damages the skin and hair; the skin gathers and hair falls out. Second degree Sun damages the blood vessels; the vessels become deficient and scant, unable to nourish the Five Zang and Six Fu organs. Third degree Sun damages the muscles; the muscles emaciate, and food cannot transform into flesh. Fourth degree Sun damages the sinews; the sinews relax and cannot hold themselves. Fifth degree Sun damages the bones; the bones become weak, and the patient cannot rise from bed. The opposite conditions describe Zhi pulse diseases. From above downwards (Sun pulse disease), bone weakness preventing rising from bed leads to death. From below upwards (Zhi pulse disease), skin gathering and hair falling out leads to death.
This section points out that Sun and Zhi pulses originate from chronic diseases of the root. First degree Sun affecting skin and hair is superficial; fifth degree Sun affecting bones is deep. However, if damage proceeds from bones back to affect skin and hair, death is certain. Therefore, deficiency consumption with a rapid pulse is untreatable.
How should Sun pulses be treated? Answer: For Lung damage, benefit the Qi. For Heart damage, harmonize Ying and Wei. For Spleen damage, regulate diet and adapt to cold and warmth. For Liver damage, soothe the interior. For Kidney damage, benefit the Essence. These are the methods for treating Sun pulses.
The terms "benefit," "harmonize," "adapt," and "soothe" encompass all methods. Formulas are implied without being explicitly stated. Here, only Sun pulses are discussed, not Zhi pulses, because once Zhi pulses appear, there is no treatment. Can one not be cautious?
There are pulses with two beats per exhalation and two per inhalation; three per exhalation and three per inhalation; four per exhalation and four per inhalation; five per exhalation and five per inhalation; six per exhalation and six per inhalation; one per exhalation and one per inhalation; one per two exhalations and one per two inhalations; and even no pulse during respiration. Given such pulse presentations, how can one distinguish the disease?
This reiterates Zhi and Sun pulses as questions, referring to recent illnesses to introduce the following text. However, a pulse with two beats per exhalation and two per inhalation, neither large nor small, is normal.
This refers to the normal pulse of four beats per respiration. "Neither large nor small" means neither flooding nor deep and fine. Three beats per exhalation and three per inhalation indicate the onset of disease. If the front (Cun) is large and the back (Chi) is small, there is headache and dizziness. If the front is small and the back is large, there is chest fullness and shortness of breath.
This refers to the pulse of six beats per respiration. "Shi" means initial. It indicates the beginning of illness. Front refers to Cun pulse; back refers to Chi pulse. Cun large and Chi small indicates pathogen in the exterior. Cun small and Chi large indicates pathogen in the interior.
Four beats per exhalation and four per inhalation indicate the disease is worsening. If the pulse is flooding, the patient suffers from vexation and fullness. If the pulse is deep and fine, there is abdominal pain. If the pulse is slippery and rapid, heat injury has occurred. If the pulse is choppy, mist and dew dampness have penetrated.
This refers to the rapid pulse of eight beats per respiration. "Yu shen" means approaching severity. Flooding and rapid indicates pathogen in the chest and diaphragm. Deep, fine, and rapid indicates pathogen in the abdomen. Slippery and rapid indicates heat pathogen injury. Choppy and rapid indicates damp pathogen penetration.
Five beats per exhalation and five per inhalation indicate the person should be distressed. Deep and fine pulses worsen at night; floating and large pulses worsen during the day. If the pulse is neither large nor small, although distressed, it is treatable. If the pulse varies in size, it is difficult to treat.
This refers to the critical pulse of ten beats per respiration. "Kun" means severe illness. Deep and fine indicates Yin exhaustion, worsening at night. Floating and large indicates Yang exhaustion, worsening during the day. Therefore, if not floating and large or deep and fine, although severe, it is treatable.
Six beats per exhalation and six per inhalation constitute a death pulse. Deep and fine leads to death at night; floating and large leads to death during the day.
This is the death pulse of twelve beats per respiration. The above four sections all refer to recent illnesses.
One beat per exhalation and one per inhalation is named Sun. Although the person can walk, they must eventually lie in bed. The reason is that both Blood and Qi are insufficient.
This is the pulse of two beats per respiration. That the person can walk refers to the initial stage of Lung damage, where walking is still possible. Because they can walk and are not treated, the condition gradually spreads to the Heart, Liver, Spleen, and Kidneys. Blood and Qi are all damaged, leading to bedridden status.
One beat per two exhalations and one per two inhalations is named Wu Hun (Loss of Soul). Those with Wu Hun should die. Although the person can walk, they are called "walking corpses."
This is the pulse of one beat per respiration. Hun belongs to True Yang Qi. When Yang Qi fails and perishes, death is inevitable even if walking is possible. Hence, "walking corpse." These two sections reiterate Sun pulses, clarifying that Sun pulses do not arise overnight. Perhaps in early stages, a pulse resembling Sun but not quite Sun appears, to prevent misidentification, hence the following summary.
Pulse present in the upper part but absent in the lower part indicates the person should vomit. If they do not vomit, death ensues. Pulse absent in the upper part but present in the lower part, although distressing, causes no harm. The reason is like a person having a Chi pulse, just as a tree has roots. Even if branches and leaves wither, the root will naturally sustain growth. Pulses have roots; humans have Yuan Qi. Therefore, death is avoided.
This refers to the pulse absent during respiration. Upper present, lower absent means Cun present, Chi absent. Due to sudden obstruction by substantial pathogens blocking vital energy, vomiting disperses the pathogen and raises the Qi. Failure to vomit leads to death. Yue Ren fears this might be mistaken for Sun pulses, so he clarifies it earnestly. Sun pulses are slow pulses; Zhi pulses are rapid pulses. Not speaking of slow and rapid, but of Sun and Zhi, implies that slow and rapid pulses comprehensively cover deficiency/excess and exterior/interior patterns, serving as a general term for all possibilities. As stated in the first section, Zhi pulses range from four to twelve beats per respiration; Sun pulses range from two beats down to one beat per two respirations. This discusses the outline of root syndromes. Zhi pulses develop from below upwards, indicating Kidney Yin deficiency progressing to Lung Qi exhaustion. Sun pulses develop from above downwards, indicating Lung Qi deficiency and cold progressing to Kidney Yang exhaustion. The second section clarifies that Sun pulse root syndromes originate in the Lung; if untreated, they progress to Heart, Spleen, Liver, and Kidneys. The Sun pulse may reverse into a Zhi pulse due to Kidney deficiency and fire dryness, progressing from Kidney to Liver, Spleen, Heart, and Lung, causing death. Hence, "the opposite indicates Zhi pulse disease." The third section clarifies treatment methods for root syndromes. Treating Lung damage involves benefiting Qi. Damaging the Lung damages Qi. Qi is the True Qi of the Mingmen. When True Qi is damaged, skin wrinkles and hair withers, hence "skin gathers and hair falls." Treatment should benefit Qi. "Benefit" means tonify. Qi deficiency is Yang deficiency. Tonifying Yang Qi fills the skin and hair. Without formulas like Lizhong Tang or Guizhi Fuzi, how can Yang be tonified? Mild cases may use Buzhong Yiqi Tang. If one does not understand the meaning of Sun pulses, how can one clearly treat them? Only when rapid pulse, asthma, cough, and afternoon fever appear, labeling it Lung deficiency, and then tonifying Lung and preserving Qi, is there no effect. This is actually Sun pulse mismanagement turning into untreatable Zhi pulse manifestations. Furthermore, treating Heart damage involves harmonizing Ying and Wei. Damaging the Heart damages Blood. The Heart is the source of Ying Blood; the Lung is the root of Wei Qi. Having damaged the Lung and then the Heart, Blood and Qi cannot nourish the Five Zang and Six Fu organs. Harmonization is required. "Harmonize" implies balancing, involving considering multiple aspects, unlike the direct action of "benefiting." Formulas like Guipi Tang, Yigong San, Bazhen Tang, Shiquan Dabu Tang, or Liuwei Wan, Bawei Wan, adjusted according to the condition, are effective. If one does not understand treating Sun pulses, waiting until rapid pulse, vexation, dry throat, insomnia, etc., label it Heart deficiency, and then administer warm tonics, they will be rejected. Nourishing tonics hinder the Spleen. This is also Sun pulse mismanagement turning into untreatable Zhi pulse manifestations. Furthermore, treating Spleen damage involves regulating diet and adapting to cold/warmth. The Spleen governs the Middle Jiao and muscles. Emaciation leads to loose interstices, making one susceptible to pathogens regardless of temperature. Hence, "adapt to cold/warmth." If the Middle Jiao fails, transportation and transformation lose power, leading to diarrhea or stagnation. Not only herbs like Renshen and Lingzhu tonify the Spleen, but diet must also be regulated regarding hunger/fullness and suitability. Hence, "regulate diet." If one does not understand Zhi/Sun meanings, waiting until inability to eat despite hunger, shortness of breath, distension, and double-string-like rapid pulse, labeling it Spleen deficiency, and using Renshen increases distension, while Guizhi/Fuzi increases deficiency vexation. This is also Sun pulse mismanagement turning into untreatable Zhi pulse manifestations. Furthermore, treating Liver damage involves soothing the interior. The Liver governs sinews, which rely on Blood. Blood deficiency leads to Liver dryness and sinew flaccidity. Greatly tonifying Heart and Spleen allows the Heart to generate Blood and the Spleen to control Blood. Early administration of Guipi or Yangrong tangs is appropriate. If one does not understand Zhi/Sun meanings, waiting until blood depletion, rapid pulse, and difficulty moving limbs, labeling it Liver deficiency, before discussing previous formulas, it is too late. Furthermore, treating Kidney damage involves benefiting Essence. Bones belong to the Kidney. Essence deficiency leads to marrow depletion and bone weakness. Benefiting Essence naturally replenishes marrow. The Classic says: "Where Essence is insufficient, tonify with flavor." Flavor refers to rich animal and meat substances. Such as Lurong (Deer Antler), combined with Dihuang, Renshen, Gouqi, all benefit Essence. If one does not understand Zhi/Sun meanings, waiting until True Yin exhaustion, defying fire steaming, rapid pulse, vexation, inability to rise from bed, and finding that yin-nourishing causes diarrhea and yang-nourishing causes dryness, these are failures to comprehend the essence of this chapter.
The fourth section raises Zhi and Sun pulses separately to distinguish five pathogens and exterior/interior symptoms from root syndromes. The fifth section describes non-flooding, non-deep/fine pulses as normal. The sixth section describes large Cun and deep/small Chi as exterior/interior syndromes. The seventh section describes large Cun and Chi, or deep/small Cun and Chi, as exterior heat and interior heat syndromes. It further states that flooding and slippery indicates heat injury; deep/small and choppy indicates damp-heat penetration. The eighth section states deep/small Cun and Chi indicate interior heat worsening at night; floating/large Cun and Chi indicate exterior heat worsening during the day. It also states that neither large nor small, although distressed, is treatable due to the potential for pathogen retreat and symptom relief. If increasingly floating/large or deep/small, the disease progresses and is difficult to treat. This corresponds to the ninth section's death at night for deep/small and day for floating/large. Sections four through nine focus on Zhi pulses to clarify exterior/interior excess pathogens. The tenth section reiterates that Sun pulses must not be left untreated. Even if the person can walk with a two-beats-per-respiration pulse, early treatment is necessary. Neglecting treatment due to ability to walk leads to bedridden status due to Blood and Qi insufficiency. The eleventh section states that neglecting two-beats-per-respiration leads to one-beat-per-respiration, which is untreatable. Walking capability becomes merely "walking corpse." The final section clarifies the meaning of urgent conditions with absent pulses to prevent confusion with Sun pulses. Absent Chi pulse below indicates sudden obstruction by substantial pathogens, treatable by vomiting. Absent Cun pulse above may indicate accidental exposure to formless deficient pathogens; although distressing, it causes no harm. Returning emphasis to Yuan Qi summarizes the chapter's meaning. Zhongfeng said: Reading this theory reveals that ancient physicians treated root syndromes differently from modern ones. Ancients treated treatable Sun pulses; moderns treat untreatable Zhi pulses. How lamentable!
Difficulty Fifteen states: The Classic says, Spring pulse is wiry, Summer pulse is hooked, Autumn pulse is hairy, Winter pulse is stone-like. Are these Wang (prosperous) pulses or Bing (disease) pulses? Answer: Wiry, hooked, hairy, and stone-like are the pulses of the four seasons. Spring pulse is wiry because the Liver belongs to Eastern Wood. When things begin to grow, there are no branches or leaves yet, so the pulse comes soft, weak, and long, hence "wiry." Summer pulse is hooked because the Heart belongs to Southern Fire. When things flourish, branches hang and leaves spread, curving downwards like hooks, so the pulse comes rapidly and departs slowly, hence "hooked." Autumn pulse is hairy because the Lung belongs to Western Metal. When things conclude, flowers and leaves fall after autumn, leaving only branches like hairs, so the pulse comes light, empty, and floating, hence "hairy." Winter pulse is stone-like because the Kidney belongs to Northern Water. When things are stored, in extreme winter, water freezes like stone, so the pulse comes deep, soft, and slippery, hence "stone-like." These are the pulses of the four seasons.
This chapter discusses the pulses of the four seasons to introduce the concepts of Ping (normal), Bing (disease), and Si (death) pulses.
What if there are changes? Answer: Spring pulse is wiry; reversal indicates disease. What is reversal? Answer: If the Qi comes solid and strong, it is called Taigu (excess), indicating disease in the exterior. If the Qi comes deficient and slight, it is called Buji (deficiency), indicating disease in the interior. If the pulse feels gentle and fluttering, like touching elm leaves, it is Ping (normal). If it becomes more solid and slippery, like touching a long bamboo pole, it is Bing (disease). If it is rapid, forceful, and increasingly strong, like a drawn bowstring, it is Si (death). A slightly wiry Spring pulse is Ping. More wiry than Stomach Qi is Bing. Only wiry without Stomach Qi is Si. Spring relies on Stomach Qi as the foundation.
From this section onwards, all describe the spirit of the pulse, requiring personal comprehension. This is the thousand-hands-thousand-eyes method of pulse diagnosis. Later generations wrote thousands of words of rhymes, yet likely failed to explain even a fraction. Pulse follows Qi; when Qi comes, the pulse comes. The following imitates this.
Summer pulse is hooked; reversal indicates disease. What is reversal? Answer: If the Qi comes solid and strong, it is Taigu, disease in the exterior. If the Qi comes deficient and slight, it is Buji, disease in the interior. If the pulse comes continuously like a ring, like touching lapis lazuli, it is Ping. If it comes increasingly rapid, like a chicken lifting its feet, it is Bing. If it curves forward and stays fixed backward, like holding a belt hook, it is Si. A slightly hooked Summer pulse is Ping. More hooked than Stomach Qi is Bing. Only hooked without Stomach Qi is Si. Summer relies on Stomach Qi as the foundation.
Autumn pulse is hairy; reversal indicates disease. What is reversal? Answer: If the Qi comes solid and strong, it is Taigu, disease in the exterior. If the Qi comes deficient and slight, it is Buji, disease in the interior. If the pulse comes abundant like a chariot canopy, increasing in size upon pressure, it is Ping. If it neither rises nor falls, like touching a chicken feather, it is Bing. If it feels desolate upon pressure, like wind blowing feathers, it is Si. A slightly hairy Autumn pulse is Ping. More hairy than Stomach Qi is Bing. Only hairy without Stomach Qi is Si. Autumn relies on Stomach Qi as the foundation.
Winter pulse is stone-like; reversal indicates disease. What is reversal? Answer: If the Qi comes solid and strong, it is Taigu, disease in the exterior. If the Qi comes deficient and slight, it is Buji, disease in the interior. If the pulse comes large above and small below, soft and slippery like a sparrow pecking, it is Ping. If it pecks continuously with slight curvature inside, it is Bing. If it comes like untying a rope and departs like flicking a stone, it is Si. A slightly stony Winter pulse is Ping. More stony than Stomach Qi is Bing. Only stony without Stomach Qi is Si. Winter relies on Stomach Qi as the foundation.
The normal pulses of the four seasons above are those with Stomach Qi. Disease pulses have less Stomach Qi. Death pulses have no Stomach Qi. To understand the profound meaning of pulse spirit, one must contemplate within the normal pulses.
The Stomach is the sea of water and grain, governing the four seasons, all relying on Stomach Qi as the foundation. This is the key intersection of seasonal variations, disease, and life/death.
This states that seasonal variations, disease, and life/death all depend primarily on Stomach Qi.
The Spleen is the Central Plain. Its peaceful state is invisible; only decline is visible. Coming like a sparrow pecking, or water leaking downwards, is the manifestation of Spleen decline.
This summarizes the pulses of the four seasons above, integrating the Five Zang organs. The Spleen belongs to Earth and prospers in each of the four seasons. Therefore, the normal pulses of the four seasons all belong to the Spleen, hence...