（素问三部九候论）
帝曰∶决死生奈何？（谓因其形证脉息，而欲预知其死生也。）岐伯曰∶形盛脉细，少气不足以息者危。（形盛脉细
而少气不足以息者，外有余而中不足，枝叶盛而根本虚也，故危亡近矣。）形瘦脉大，胸中多气者死。（形体消瘦而脉反
大、胸中反多气者，阴不足而阳有余也。阴形既败，孤阳无独留之理，故死。）形气相得者生。（体貌为形，阴也；营运
属气，阳也。阴主静，阳无阴不成；阳主动，阴无阳不生。故形以寓气，气以运形，阴阳当和，不得相失。如形盛脉大，
形瘦脉细，皆为相得；相得者生，反此者危也。）参伍不调者病。（三以相参，伍以相类，谓之不调。凡或大或小，或迟
或疾，往来出入而无常度者，皆病脉也。）三部九候皆相失者死。（三部九候义，见前第五。皆相失者，谓失其常，如下
文乍疏乍数、失时、真脏、脱肉、七诊之类皆是也，故死。）上下左右之脉，相应如参舂者病甚。上下左右相失，不可数
者死。（上下左右，即三部九候而各有左右也。参舂，谓大数而鼓，如杵之舂，阳极之脉也，故曰病甚。甚至息数相失，
而不可以数计者，死。脉法曰∶人一呼脉再至、一息脉亦再至曰平，三至曰离经，四至曰脱精，五至曰死，六至曰命尽。
今相失而不可数，盖不止于五六至矣，必死可知。舂，书容切。数，上声。）中部之候虽独调，与众脏相失者死。中部之
候相减者死。（三部之脉，上部在头，中部在手，下部在足。此言中部之脉虽独调，而头足众脏之脉已失其常者，当死。
若中部之脉减于上下二部者，中气大衰也，亦死。）目内陷者死。（五脏六腑之精气，皆上注于目而为之精，目内陷者，
阳精脱矣，故必死。）以左手足上，上去踝五寸按之，庶右手足当踝而弹之，（手足之络皆可取而验之。手踝之上，手太
阴肺络也。足踝之上，足太阴脾络也。肺藏气而主治节，脾属上而主灌溉，故可取之以察吉凶。踝，胡寡切。）其应过五
寸以上，蠕蠕然者不病；其应疾，中手浑浑然者病；中手徐徐然者病；其应上不能至五寸，弹之不应者死。（应，动也。
应过五寸以上，气脉充也。蠕蠕，虫行貌，谓其 滑而匀和也，是为不病之脉。疾，急疾也。浑浑，浊乱也。徐徐，迟
缓也。不能至五寸者，气脉衰。弹之不应者，气脉绝。故微则为病，而甚则为死也。蠕音如。）是以脱肉身不去者死。（脾
胃竭则肌肉消，肝肾败则筋骨惫，肉脱身重，死期至矣。不去者，不能动摇来去也。）中部乍疏乍数者死。（中部，两手
脉也。乍疏乍数者，气脉败乱之兆也，故死。）其脉代而钩者，病在络脉。（代而钩者，俱应夏气，而夏气在络也。）九候
之相应也，上下若一，不得相失。（上下若一，言其大小迟疾皆贵乎和平也。）一候后则病，二候后则病甚，三候后则病
危。所谓后者，应不俱也。（应不俱者，脉失常度，逆顺无伦也。）察其腑脏，以知死生之期。（死生之期，察其克贼生王
而可知也。）必先知经脉，然后知病脉。（经者常脉，病者变脉；不知其常，不足以知变也。）真脏脉见者胜死。（真脏脉
义见后。胜死，谓遇其胜已之时而死，如肝见庚辛、脾见甲乙之类是也。）足太阳气绝者，其足不可屈伸，死必戴眼。（足
太阳之脉，下者合 中，贯 内，出外踝之后；上者起目内 ，其脉有通项入于脑者正属目本，名曰眼系。故太阳气绝
者，血枯筋急，足不可屈伸，而死心戴眼。戴眼者，睛上视而瞪也。 音篆。瞪，曹庚切。）帝曰∶冬阴夏阳奈何？（言
死时也。）岐伯曰∶九候之脉，皆沉细悬绝者为阴，主冬，故以夜半死。盛躁喘数者为阳，主夏，故以日中死。（夜半者，
一日之冬也。阴尽阳生，故阴极者死。日中者，一日之夏也，阳尽阴生，故阳极者死。）是故寒热病者，以平旦死。（平
旦者，一日之春，阴阳之半也。故寒热病者，亦于阴阳出入之时而死。）热中及热病者，以日中死。（以阳助阳，真阴竭
也。）病风者，以日夕死。（日夕者，一日之秋也。风木同气，遇金而死。）病水者，以夜半死。（亥子生王，邪盛极也。）
其脉乍疏乍数、乍迟乍疾者，日乘四季死。（脉变不常者，中虚无主也。日之四季，辰戌丑未也。四季为五行之墓地，故
败竭之脏，遇之而死。）形肉已脱，九候虽调犹死。（脾主肌肉，为五脏之本。未有脾气脱而能生者，故九候虽调亦死。）
七诊虽见，九候皆从者不死。（七诊义见前章第六。从，顺也。谓脉顺四时之令，及得诸经之体者，虽有独大独小等脉，
不至死也。）所言不死者，风气之病及经月之病，似七诊之病而非也，故言不死。（风者，阳病也。故偶感于风，则阳分
之脉或大或疾。经月者，常期也。故适值去血，则阴分之脉或小或迟，或为陷下。此皆似七诊之脉而实非也，皆不可以
言死。然则非外感及经月之病而得七诊之脉者，非吉兆也。）若有七诊之病，其脉候亦败者死矣，必发哕噫。（此承上文
而言风气经月之病，本非七诊之类；若其果系脉息证候之败者，又非不死之比。然其死也，必发哕噫。盖哕出于胃，土
气败也。噫出于心，阴邪胜也。哕，于决切，呃逆也。噫，伊芳、隘二音，嗳气也。）必审问其所始病，与今之所方病，而
后各切循其脉，视其经络浮沉，以上下逆从循之。（凡诊病之道，必问其始病者，察致病之由也。求今之方病者，察见在
之证也。本末既明，而后切按其脉，以参合其在经在络，或浮或沉，上下逆从，各因其次以治之也。）其脉疾者不病，其
脉迟者病，脉不往来者死，皮肤着者死。（疾言力强有神。迟言气衰不足。若脉不往来者，阴阳俱脱。皮肤着者，血液已
尽，谓皮肤枯槁着骨也。）帝曰∶其可治者奈何？岐伯曰∶经病者治其经，（经脉为里，支而横者为络。治其经，谓即其
经而刺之也。）孙络病者治其孙络血，（络之小者为孙，即络脉之别而浮于肌肤者也。经脉篇曰∶诸刺络脉者，急取之以
泻其邪而出其血，留之发为痹也。故曰治其血。）血病身有痛者治其经络。（血病而身痛者，不止于孙络，而经亦有滞也，
当随其经络而刺之。）其病者在奇邪，奇邪之脉则缪刺之。（奇邪者。不入于经而病于络也。邪客大络。则左注右，右注
左，其气无常处，故当缪刺之。详针刺类三十。）留瘦不移，节而刺之。（留，病留滞也。瘦，形消瘦也。不移，不迁动
也。凡病邪久留不移者，必于四肢八溪之间有所结聚，故当于节之会处，索而刺之，斯可平也。）上实下虚，切而从之，
索其结络脉，刺出其血，以见通之。（上实下虚，有所隔也，故当切其脉以求之，从其经以取之，索其络脉之有结滞者，
刺出其血，结滞去而通达见矣。）瞳子高者太阳不足，戴眼者太阳已绝，此决死生之要，不可不察也。（瞳子高者，目上
视也。戴眼者，上视之甚而定直不动也。此重明上文足太阳之证，而分其轻重以决死生也。）手指及手外踝、五指留针。
（本节义不相属，及前节单言太阳而不及他经，必皆古文之脱简。）
黄帝问道：如何根据脉象和证候来判定病人的生死？（意思是依据病人的形体、证候、脉象和呼吸，预先判断其生死。）岐伯回答说：如果形体壮盛但脉象细弱，气息短少不足以喘息，这是危重的征象。（形体壮盛而脉象细弱且气短不足以息，说明外表看似有余而内部正气不足，如同枝叶茂盛而树根虚弱，所以离死亡不远了。）如果形体消瘦但脉象洪大，胸中感觉气多壅滞，这是死证。（形体消瘦而脉象反而大、胸中反而感觉气多，说明阴精不足而阳气有余。阴形的根基既已败坏，孤阳不可能单独留存，所以会死亡。）如果形与气相协调，就能生存。（体貌称为“形”，属阴；生理功能活动称为“气”，属阳。阴主静，没有阳则阴无法形成；阳主动，没有阴则阳无法产生。所以形依附于气，气推动形，阴阳应当和谐，不能相互背离。例如形体壮盛而脉象洪大，形体消瘦而脉象细弱，都称为“相得”；相得者生，与此相反者则危重。）如果脉象参差错乱、不调匀，就是病态。（三候互相参照，五候互相类比，称之为不调。凡是脉象或大或小，或迟或快，往来出入没有固定规律的，都是病脉。）如果三部九候的脉象都失常，就会死亡。（三部九候的含义，见前文第五篇。所谓“皆相失”，是指失去了正常的规律，如下文提到的忽疏忽数、失时、真脏脉、脱肉、七诊等情形都属于此类，所以会死亡。）上下左右各部的脉象，相互呼应如杵舂米一样急促有力的，病情严重。上下左右脉象失调，无法计数的，会死亡。（上下左右，即指三部九候中每一部都有左右两侧的脉象。参舂，指脉象大而鼓动有力，像木杵舂米一样，是阳极之脉，所以说病情严重。甚至呼吸次数与脉搏次数失调，无法计数计算的，就会死亡。脉法说：人一呼脉搏跳动两次，一吸脉搏也跳动两次，称为平脉；三至为离经之脉，四至为脱精之脉，五至为死脉，六至为命尽之脉。现在脉象失调且无法计数，大概不止五六至了，必然死亡。舂，读音同“充”。数，读上声。）中部（手部）的脉象虽然单独调匀，但如果与其他脏腑（头足部）的脉象失调，也会死亡。中部脉象比上下两部减弱，也会死亡。（三部的脉象，上部在头部，中部在手部，下部在足部。这里说手部的脉象虽然单独调匀，但头部和足部其他脏腑的脉象已经失常，应当死亡。如果手部的脉象比上下两部都弱，说明中气大衰，也会死亡。）眼睛内陷的，会死亡。（五脏六腑的精气，都向上注于目而形成眼神，眼睛内陷，说明阳精已脱，所以必然死亡。）用左手在患者足背上，距离脚踝五寸处按压，同时用右手在患者足踝处弹击，（手足的络脉都可以取来验证。手踝之上，是手太阴肺经的络脉。足踝之上，是足太阴脾经的络脉。肺藏气并主治节，脾属土并主灌溉，所以可以取此部位来观察吉凶。踝，读音同“旱”。）如果反应震动超过五寸以上，感觉蠕蠕滑利均匀的，表示没有病；如果反应急促，手感浑浑浊乱的，表示有病；如果反应迟缓的，表示有病；如果反应达不到五寸，弹击无反应的，会死亡。（应，指脉动。反应超过五寸以上，说明气脉充盛。蠕蠕，像虫子爬行的样子，指脉象滑利而匀和，这是无病的脉象。疾，指急疾。浑浑，指浊乱。徐徐，指迟缓。达不到五寸的，说明气脉衰弱。弹击无反应的，说明气脉断绝。所以脉微则为病，脉极甚则为死。蠕，读音如“儒”。）因此，身体肌肉脱消但身体尚能活动的，会死亡。（脾胃衰竭则肌肉消减，肝肾败坏则筋骨疲惫，肌肉脱消且身体沉重，死期将至。不去者，指不能动摇走动。）中部脉象忽疏忽数的，会死亡。（中部，指两手脉象。忽疏忽数，是气脉败乱的征兆，所以死亡。）脉象代而钩的，病在络脉。（代而钩，都对应夏季之气，而夏气在络脉。）九候的脉象相应，上下如一，不能相互失调。（上下如一，是说脉象的大小、迟疾都贵在和平。）一候脉迟则病，二候脉迟则病重，三候脉迟则病危。所谓“后”，是指脉动不应期延长。（应不俱，指脉象失去常度，逆顺无序。）通过观察脏腑，可以知道死亡的期限。（死亡的期限，通过观察五行生克乘侮的关系可知。）必须先知常脉（经脉），然后才能知病脉。（常脉是正常脉，病脉是异常脉；不知道常脉，就不足以了解变脉。）出现真脏脉的，遇到克制它的时令就会死亡。（真脏脉的含义见后文。胜死，指遇到克制本脏的时令而死，如肝见庚辛日、脾见甲乙日等情形。）足太阳经气竭绝的，双脚不能屈伸，死亡时眼睛上视。（足太阳经脉，下行者合于腘中，贯穿腓肠肌内侧，出于外踝之后；上行者起于目内眦，其中有通入脑部的脉络正属于目本，名叫眼系。所以太阳经气绝时，血枯筋急，脚不能屈伸，而死时戴眼。戴眼，指眼球上视而瞪直。篆，音篆。瞪，曹庚切。）黄帝问道：冬季阴、夏季阳的情况是怎样的？（指死亡的时间。）岐伯回答说：九候的脉象，都沉细悬绝的是阴脉，主冬，所以常在夜半死亡。脉象盛大躁动、喘促数急的是阳脉，主夏，所以常在日中死亡。（夜半，是一天的冬季。阴尽阳生，所以阴极者死。日中，是一天的夏季，阳尽阴生，所以阳极者死。）因此寒热病患者，常在平旦死亡。（平旦，是一天的春季，阴阳各半。所以寒热病患者，也在阴阳出入之时死亡。）热中及热病患者，常在日中死亡。（以阳助阳，导致真阴枯竭。）患风病的，常在傍晚死亡。（傍晚，是一天的秋季。风与木同气，遇到金气而死。）患水病的，常在夜半死亡。（亥子时水生旺，邪气盛极。）脉象忽疏忽数、忽迟忽快的，常在四季的最后一天（辰戌丑未时）死亡。（脉变不常，说明中虚无主。日的四季，指辰、戌、丑、未时。四季是五行的墓地，所以败竭之脏，遇到此时而死。）形体肌肉已经脱消，即使九候脉象调匀也会死亡。（脾主肌肉，是五脏的根本。没有脾气脱消还能生存的，所以即使九候脉象调匀也会死亡。）七诊脉象虽然出现，但如果九候脉象顺应四时规律就不会死亡。（七诊的含义见前章第六。从，指顺。指脉象顺应四时命令，以及符合各经本体，虽然有独大独小等脉象，也不会死亡。）所说的不死情况，是指风气之病及月经期间的病，看似七诊之病而非真七诊，所以说不死。（风，属阳病。所以偶尔感受风邪，阳分之脉可能或大或疾。经月，指正常经期。所以正值去血时，阴分之脉可能或小或迟，或为陷下。这些都看似七诊之脉而实际上不是，都不能说是死证。然而，如果不是外感风邪及经期之病而出现七诊脉象的，就不是吉兆。）如果有七诊之病，其脉候也已败坏，就会死亡，必定会出现呃逆和嗳气。（这是承接上文而言，风气经月之病，本来不属于七诊之类；如果确实是脉息证候败坏的，又不属于不死的情况。然而其死亡时，必定发哕噫。哕出于胃，是土气败坏。噫出于心，是阴邪胜盛。哕，于决切，即呃逆。噫，伊芳、隘二音，即嗳气。）必须详细询问病人最初发病的情况，以及现在正在发生的病症，然后分别切按脉象，观察经络的浮沉，以此推究上下逆从的关系。（凡诊病之道，必须询问始病者，考察致病的原因。求问今之方病者，考察现在的症状。本末既然明确，然后切按其脉，以参合其在经在络，或浮或沉，上下逆从，各自根据其次序进行治疗。）脉象疾速的无病，脉象迟缓的有病，脉象不往来的会死亡，皮肤枯槁着骨的会死亡。（疾言指体力强而有神。迟言指气衰不足。如果脉象不往来，说明阴阳俱脱。皮肤着骨，说明血液已尽，指皮肤枯槁附着于骨头。）黄帝问道：那些可治的病例是怎样的？岐伯回答说：经脉病的治疗经脉，（经脉为里，分支横出的为络。治其经，指就在经脉上进行针刺。）孙络病的治疗孙络出血，（络脉中小者为孙，即络脉之别而浮于肌肤者。《经脉篇》说：凡刺络脉者，急取之以泻其邪而出其血，留之会发为痹症。所以说治其血。）血病而身体疼痛的，治疗其经络。（血病而身痛，不仅在于孙络，经脉也有阻滞，应当随其经络进行针刺。）病在奇邪的，奇邪的脉象应用缪刺法治疗。（奇邪，指不入于经而病于络。邪客于大络，则左注右，右注左，其气无常处，所以应当缪刺。详见针刺类第三十篇。）久病消瘦且病位不移的，在关节处针刺。（留，指病邪留滞。瘦，指形体消瘦。不移，指不迁移变动。凡病邪久留不移者，必在四肢八溪之间有所结聚，所以应当在关节交会处，寻找并针刺，这样才能平复。）上实下虚的，切脉并从其经索求，寻找结滞的络脉，刺出其血，以见到通畅为止。（上实下虚，是有阻隔，所以应当切脉以求之，从其经以取之，寻找络脉中有结滞者，刺出其血，结滞去除而通达显现。）瞳孔上视的是太阳经气不足，戴眼的是太阳经气已绝，这是决断生死的关键，不可不仔细考察。（瞳子高，指目上视。戴眼，指上视更甚而定直不动。这是重申上文足太阳的证候，并区分轻重以决断生死。）手指及手外踝、五指留针。（本节意义与前文不相连属，且前节单言太阳而不及他经，必定是古文中的脱简。）
Huangdi asked: How can one determine life and death? (This means to predict life or death in advance based on the patient's physical appearance, symptoms, pulse, and respiration.) Qibo replied: If the body is robust but the pulse is fine and thin, and there is shortness of breath insufficient for respiration, the condition is critical. (A robust body with a fine pulse and shortness of breath indicates apparent excess externally but deficiency internally, like abundant branches and leaves but a weak root; thus, death is near.) If the body is emaciated but the pulse is large, and there is a sensation of excessive Qi in the chest, it is a fatal sign. (Emaciation with a contrary large pulse and excessive Qi in the chest indicates Yin deficiency and Yang excess. Since the Yin form has collapsed, solitary Yang cannot survive alone; thus, death ensues.) If the Form and Qi are harmonious, the patient will live. (Physical appearance is "Form," belonging to Yin; physiological activity is "Qi," belonging to Yang. Yin is static, and without Yang, Yin cannot form; Yang is active, and without Yin, Yang cannot generate. Thus, Form houses Qi, and Qi moves Form; Yin and Yang must be harmonious and not lose each other. For example, a robust body with a large pulse, or an emaciated body with a fine pulse, are both considered "harmonious." Harmonious means life; contrary means critical.) If the pulses are irregular and uncoordinated, it is a disease. (Referring to three and five pulses for comparison and classification, termed "uncoordinated." Any pulse that varies in size or speed, coming and going without regularity, is a pathological pulse.) If all Nine Pulses (Sanbu Jiuhou) are disordered, death occurs. (The meaning of Sanbu Jiuhou is seen in Part 5 earlier. "All disordered" means losing normal rhythm, such as intermittent rapidity/slowness, loss of timing, Zang-Fu pulses, flesh wasting, and the Seven Diagnoses mentioned below; thus, death ensues.) If the pulses above, below, left, and right respond to each other like the pounding of a mortar, the disease is severe. If they are disordered and uncountable, death occurs. ("Above, below, left, right" refers to the left and right pulses at each of the Three Regions. "Pounding" refers to a large, forceful pulse like a pestle striking, indicating extreme Yang; thus, the disease is severe. If even the respiratory rate and pulse rate are disordered and uncountable, death occurs. Pulse theory states: Two beats per exhalation and two per inhalation is normal; three beats is deviation from the channel; four beats is essence depletion; five beats is death; six beats is end of life. Now, if disordered and uncountable, exceeding five or six beats, death is certain. Chong, pronounced like "chong." Shuo, pronounced with rising tone.) If the Middle Region pulse is individually coordinated but disordered relative to other Zang-Fu organs (Head and Foot regions), death occurs. If the Middle Region pulse is weaker than the Upper and Lower regions, death occurs. (The Three Regions' pulses are located at the Head (Upper), Hand (Middle), and Foot (Lower). Here, although the hand pulse is coordinated, if the head and foot pulses are abnormal, death is expected. If the hand pulse is weaker than the upper and lower, it indicates severe decline of Middle Qi; thus, death ensues.) Sunken eyes indicate death. (Essence-Qi of the Five Zang and Six Fu organs ascends to the eyes to form the spirit. Sunken eyes indicate the exhaustion of Yang Essence; thus, death is inevitable.) Press with the left hand five cun above the ankle on the patient's leg, and while doing so, flick the ankle area with the right hand. (Collaterals of hands and feet can be tested here. Above the wrist, it is the Luo-connecting vessel of the Hand Taiyin Lung Channel. Above the ankle, it is the Luo-connecting vessel of the Foot Taiyin Spleen Channel. The Lung stores Qi and governs regulation; the Spleen belongs to Earth and governs irrigation; thus, this site can be used to observe auspicious or inauspicious signs. Huai, pronounced like "han.") If the vibration response exceeds five cun and feels smooth and uniform (like worms moving), there is no disease. If the response is rapid and feels turbid/muddled to the touch, there is disease. If the response is slow, there is disease. If the response does not reach five cun, or if flicking produces no response, death occurs. (Ying refers to movement. Response exceeding five cun indicates abundant Qi and vessels. Ruru describes a worm-like motion, indicating smooth and harmonious pulse, which is non-pathological. Ji means rapid. Hunhun means turbid/disordered. Xuxu means slow. Failure to reach five cun indicates weak Qi/vessels. No response indicates exhausted Qi/vessels. Thus, slight weakness is disease, extreme weakness is death. Ru, pronounced like "ru".) Therefore, if muscles have wasted away but the body can still move, death occurs. (Spleen and Stomach exhaustion leads to muscle wasting; Liver and Kidney failure leads to bone/tendon fatigue. Wasted muscles and heavy body indicate approaching death. "Bu qu" means inability to move/walk.) Intermittent rapidity and slowness in the Middle Region pulse indicates death. (Middle Region refers to the pulses of both hands. Intermittent rapidity/slowness is a sign of chaotic Qi/vessel collapse; thus, death ensues.) A pulse that is alternating (Dai) and hook-shaped (Gou) indicates disease in the Collaterals. (Dai and Gou correspond to Summer Qi, which resides in the Collaterals.) The Nine Pulses should correspond, being uniform above and below, without disorder. ("Uniform above and below" means size and speed should be peaceful/harmonious.) One region delayed indicates disease; two regions delayed indicates severe disease; three regions delayed indicates critical illness. "Delayed" refers to prolonged intervals between beats. (Ying bu ju means losing normal rhythm, lacking order in reversal and compliance.) By observing the Zang-Fu organs, one can know the time of death. (The time of death can be known by observing the cycles of generation and restriction among the Five Elements.) One must first know the Normal Pulse (Jing Mai) before knowing the Disease Pulse. (Normal pulse is constant; disease pulse is variable. Without knowing the constant, one cannot understand the variable.) Appearance of True Zang Pulses indicates death when encountering the controlling element. (Meaning of True Zang Pulses is seen later. "Sheng Si" means dying when meeting the element that controls it, e.g., Liver appearing on Geng/Xin days, Spleen on Jia/Yi days.) Exhaustion of Foot Taiyang Qi causes inability to flex/extend the legs, and death with upward staring eyes. (Foot Taiyang channel descends to join the popliteal fossa, passes through the calf, exits behind the lateral malleolus; ascends from the inner canthus. There is a pathway entering the brain connected to the eye base, called the Eye System. Thus, Taiyang Qi exhaustion causes blood dryness and tendon tension, leg immobility, and death with Daiyan. Daiyan means eyes fixed upward. Zhuan, sound Zhuan. Deng, Cao Geng qie.) Huangdi asked: What about Winter Yin and Summer Yang? (Referring to time of death.) Qibo replied: If all Nine Pulses are deep, fine, and suspended/extinct, it is Yin, governing Winter, so death occurs at midnight. If pulses are盛大 (sheng), restless, panting, and rapid, it is Yang, governing Summer, so death occurs at noon. (Midnight is Winter of the day. Yin ends, Yang generates; thus, extreme Yin dies. Noon is Summer of the day; Yang ends, Yin generates; thus, extreme Yang dies.) Therefore, patients with Cold-Heat diseases die at dawn. (Dawn is Spring of the day, half Yin and half Yang. Thus, Cold-Heat patients die during the transition of Yin and Yang.) Patients with Heat-in-the-Middle or Heat diseases die at noon. (Yang aids Yang, exhausting True Yin.) Patients with Wind diseases die at dusk. (Dusk is Autumn of the day. Wind shares affinity with Wood; it dies upon encountering Metal.) Patients with Water diseases die at midnight. (Hai/Zi hours water is prosperous; pathogenic factor is extremely strong.) Pulses that are intermittently sparse/rapid or slow/fast die during the Four Seasons (Chen/Xu/Chou/Wei hours). (Irregular pulses indicate central emptiness and lack of mastery. Four Seasons refer to Chen, Xu, Chou, Wei hours. These hours are the graveyards of the Five Elements; thus, exhausted organs die then.) If flesh and muscles have wasted away, death occurs even if the Nine Pulses are coordinated. (Spleen governs muscles and is the root of Five Zang. No one survives Spleen Qi exhaustion; thus, even coordinated Nine Pulses cannot prevent death.) Although the Seven Diagnoses appear, if the Nine Pulses comply (follow seasonal norms), death does not occur. (Seven Diagnoses meaning is in Chapter 6 earlier. Cong means compliance. If pulses follow seasonal commands and channel bodies, even if some are unusually large/small, death does not ensue.) The statement "does not die" refers to Wind diseases and menstrual conditions, which resemble Seven Diagnoses but are not true Seven Diagnoses, hence "no death." (Wind is Yang disease. Occasional wind exposure may cause Yang branch pulses to be large or rapid. Menstruation is a regular period. During blood loss, Yin branch pulses may be small, slow, or sunken. These resemble Seven Diagnoses but are not real; thus, they do not indicate death. However, if Seven Diagnosis pulses appear without external wind or menstruation, it is not an auspicious sign.) If Seven Diagnosis diseases are present AND the pulse condition is also exhausted, death occurs, accompanied by hiccupping and belching. (Continuing from above: Wind/menstrual conditions are not Seven Diagnoses; if truly exhausted pulses/symptoms exist, it is not "no death." Death involves hiccups/belching. Hiccups originate from Stomach, indicating Earth Qi failure. Belching originates from Heart, indicating Yin evil excess. Yue, Yu Jue qie, hiccup. Yi, Yi Fang/Ai sounds, belching.) One must carefully ask about the initial onset and current symptoms, then palpate pulses separately, observing the floating/sinking of meridians to trace upward/downward reversals/compliance. (Diagnosis requires asking about onset to find causes, and current symptoms to assess present state. Once origin and end are clear, palpate pulses to integrate meridian/collateral status, floating/sinking, and directional flow, treating accordingly.) Rapid pulses indicate no disease; slow pulses indicate disease; absent pulses indicate death; skin adhering to bone indicates death. (Ji implies strength and spirit. Chi implies Qi deficiency. Absent pulses mean Yin/Yang exhaustion. Skin adhering to bone means blood exhaustion, i.e., withered skin clinging to bone.) Huangdi asked: What about treatable cases? Qibo replied: Treat Jing-channel diseases by needling the Jing channels. (Jing channels are interior; branching transversely are Luos. Treating Jing means needling directly into the channel.) Treat Sunluo diseases by bleeding the Sunluo. (Small Luos are Sunluo, distinct Luos floating on skin. *Jingmai* chapter says: Acute needling of Luos to drain evil and release blood; retention causes Bi syndrome. Thus, treat the blood.) Blood diseases with body pain are treated by needling the Jing and Luo channels. (Blood disease with pain involves not just Sunluo but also Jing channel stagnation; needle along the channels.) Diseases caused by Odd Evil (Qi Xie) are treated with Miu Ci (lateral needling). (Odd Evil enters Luos, not Jing. Evil in Large Luos shifts left/right unpredictably; thus, use Miu Ci. See Needling Category 30.) Chronic wasting diseases with fixed locations are treated by needling at joints. (Liu means stagnation; Shou means emaciation; Bu yi means fixed. Long-standing pathogens stagnate in the Eight Valleys of limbs; seek and needle at joint intersections to resolve.) Upper Excess and Lower Deficiency: palpate and follow the channel, seek obstructed Luo vessels, bleed them to restore flow. (Upper Excess/Lower Deficiency implies blockage; palpate to locate, follow channels to extract, seek obstructed Luos, bleed to remove obstruction and restore patency.) High pupils (Tongzi Gao) indicate Taiyang deficiency; Daiyan indicates Taiyang exhaustion. This is key to determining life/death and must be examined carefully. (Tongzi Gao means upward gaze. Daiyan means severe upward fixation. This reiterates Foot Taiyang signs, distinguishing severity for prognosis.) Retain needles in fingers, lateral malleolus of hand, and five fingers. (This section seems disconnected; previous part only mentioned Taiyang. Likely missing text in ancient version.)