此言五脏脉法证治之大要也。篇中精义凡八段∶首段言五脏脉病，而论脾为孤脏，其义甚微；第二段言五
脏受传之次，所谓死于其所不胜也；三段言众病皆始于风，以次传入，变化无穷；四段言真脏死期有远近之不
同；五段言真脏脉之形象；六段言真脏所以独见之故，为篇中之要义；七段言诊视之法；末段言五实五虚，死
中求活之妙。逐节不同如此，而名篇之意，单揭真脏，盖真脏之脉，以别死生，医家要务。玉机云者，即金匮
名篇之意，皆珍重之辞也。
黄帝问曰∶春脉如弦，何如而弦？岐伯对曰∶春脉者肝也，东方木也，万物之所以始生也，故其气来软弱
轻虚而滑，端直以长，故曰弦。反此者病。（按∶越人云∶“万物始生，未有枝叶，故其脉来，濡弱而长。”
盖惟长则为弦，惟濡弱则弦而缓，弦缓故无病，反此则病矣。后俱仿此。）帝曰∶何如而反？岐伯曰∶其气来
实而强，此谓太过，病在外；其气来不实而微，此谓不及，病在中。（气余则病在于外，气少则病在于中也。
按∶吕广云∶“实强者阳气盛也，少阳当微弱，今更实强，谓之太过。阳处表，故令病在外。厥阴之气养于筋，
其脉弦，今更虚微，故曰不及。阴处中，故令病在内也。”）
帝曰∶春脉太过与不及，其病皆何如？岐伯曰∶太过则令人善忘，忽忽眩冒而巅疾；其不及则令人胸痛引
背，下则两胁 满。帝曰∶善！（忽忽，不爽也。眩谓目眩，视如转也。 谓腋下，胁也。忘当为怒字之误也。
按∶旧本作忘，注云是怒，今从之。盖肝主怒，故肝盛则善怒。肝属木而主风，故眩冒。肝脉上出额与督脉会
于巅，故巅疾。肝脉布胁，故胁 满，肝虚亦满，凡满不可即以为实也。 音区。）
夏脉如钩，何如而钩？岐伯曰∶夏脉者心也，南方火也，万物之所以盛长也，故其气来盛去衰，故曰钩。
反此者病。（按∶越人云∶“夏脉钩者，南方火也，万物之所盛，垂枝布叶，皆下曲如钩，故其脉来疾去迟。”
夫钩之为象，乃夏之平脉，经以盛衰为解，则似有病之脉。越人以疾迟注之，理不诬矣。然越人止言盛，经则言盛长，
盖盛则自无不长也。）帝曰∶何如而反？岐伯曰∶其气来盛去亦盛，此谓太过，病在外；（来盛去亦盛，是阳
之盛也，心气有余，是为太过。）其气来不盛，去反盛，此谓不及，病在中。（按∶新校正云∶“详越人肝心肺
肾四脏脉，俱以实强为太过，虚微为不及，与素问不同。”）帝曰∶夏脉太过与不及，其病皆何如？岐伯曰∶太
过则令人身热而肤痛，为浸淫；其不及则令人烦心，上见咳唾，下为气泄。帝曰∶善！（按∶心为牡脏而主火，
故太过则火盛而为病矣。身热肤痛者，火外灼也。浸淫者，汗也，火逼肺而为汗也。心虚则火动而烦，火动则
上炎于肺而咳，下入大肠，转魄门而为屁矣。然此本言心，而何以病必及于肺？盖火病则无所制而乱动以刑金也。）
秋脉如浮，何如而浮？岐伯曰∶秋脉者肺也，西方金也，万物之所以收成也，故其气来轻虚以浮，来急去
散，故曰浮。反此者病。（按∶越人云∶“秋脉毛者，西方金也，万物之所终，草木华叶，皆秋而落，其枝独
在，若毫毛也，故其脉来轻虚以浮，故曰毛。”盖物之轻者莫如毛，而秋脉轻浮，故以名也。然秋脉之所以轻
浮者，以秋当溽暑之后，去浊而清，唯清故轻，唯轻故浮。秋脉或言毛，此又言浮，同一理也。）帝曰∶何如
而反？岐伯曰∶其气来毛而中央坚，两旁虚，此谓太过，病在外；其气来毛而微，此谓不及，病在中。帝曰∶
秋脉太过与不及，其病皆何如？岐伯曰∶太过则令人逆气而背痛，愠愠然；其不及则令人喘，呼吸少气而咳，
上气见血，下闻病音。帝曰∶善！（按∶旁虚中坚，内实之象，故为太过。肺气内实，必挟邪有火，故上逆
而背痛。背为阳，气盛则并于阳。愠愠者，气凝滞而不散也。肺虚则气浮散而急促，故为喘为咳。肺虚亦喘咳，
世尽以实治者，非也。见血者，气浮血动也，病音注亦作喘息，误矣，盖气下泄而多屁，故云下闻也。）
冬脉如营，何如而营？岐伯曰∶冬脉者肾也，北方水也，万物之所以合藏也，故其气来沉以濡，故曰营。
反此者病。（按∶王本作沉以搏，甲乙经搏当作濡，濡古软
字，乃冬之平调脉。若沉而搏击于手，则冬脉之太过也。今改从之。又别篇肾脉并言石，而此言营，盖兵之驻
处曰营，又经营、营谋皆取固密之义，亦石之意也。）帝曰∶何如而反？岐伯曰∶其气来如弹石者，此谓太过，
病在外；其去如数者，此谓不及，病在中。（按∶肾脉宜石，而弹石则击指矣。肾脉沉细而缓，乃为平脉，如
数则阴虚矣。）帝曰∶冬脉太过与不及，其病皆何如？岐伯曰∶太过则令人解 ，脊脉痛而少气，不欲言；其
不及则令人心悬如病饥， 中清，脊中痛，少腹满，小便变。帝曰∶善！（按∶解 解已辨于前，但太过之脉，
病宜有余，而此见证并属不足，此何以故？丹溪云∶“阴常不足。”盖人自有生以后，火日动，水日亏，其所
谓太过者，不过脉象之搏击，正属水亏火动，非真肾气有余，故脉似太过而证皆不足也。如病饥者，水不制火
也。 中清者，肾虚故寒也。少腹满者，肾气溢而不藏也。小便变者，溺色黄赤，水涸则浊，世尽以为热而治
之以寒凉者，非也。）
帝曰∶四时之序，逆从之变异也，然脾脉独何主？岐伯曰∶脾脉者土也，孤脏，以灌四旁者也。（纳水谷，
化津液，溉灌于心肝肺肾也。以不正主四时，故谓之孤脏。按∶四脏偏守一隅，脾则居中四应，不主四时，乃
为四时之所宗。）帝曰∶然则脾善恶可得见之乎？岐伯曰∶善者不可得见，恶者可见。（按∶土王四季，随时
而转，其无病也，平平而已。一有所苦，则形于脉而证见焉。）帝曰∶恶者何如可见？岐伯曰∶其来如水之流
者，此谓太过，病在外；如鸟之喙者，此谓不及，病在中。（按∶脾脉太过，比之水流，当是浮洪脉也。鸟喙，
谓脾死脉，而止云不及，观者得其大意而已。）帝曰∶夫子言脾为孤脏，中央土以灌四旁，其太过与不及，
其病皆何如？岐伯曰∶太过则令人四肢不举；（按∶脾属土而主四
肢，湿胜则凝重而不可举，脾虽湿土，常恶湿也。）其不及则令人九窍不通，名曰重强。（……脾为孤脏以灌
四旁，今病则五脏不和，故九窍不通也。八十一难曰∶“五脏不和则九窍不通。”重谓脏气重迭，强谓气不和
顺。）
五脏受气于其所生，传之于其所胜，气舍于其所生，死于其所不胜。……此言气之逆行也，故死。（所谓
逆者，次如下说。）肝受气于心，传之于脾，气舍于肾，至肺而死。心受气于脾，传之于肺，气舍于肝，至肾
而死。脾受气于肺，传之于肾，气舍于心，至肝而死。肺受气于肾，传之于肝，气舍于脾，至心而死。肾受气
于肝，传之于心，气舍于肺，至脾而死。此皆逆死也。一日一夜五分之，此所以占死者之早暮也。（……朝主
甲乙，昼主丙丁，四季土主戊己，晡主庚辛，夜主壬癸，由此则死生之早暮可知也。按∶此五行生克之定例也。
王本云死生之早暮，甲乙经云占死者之早暮，详经文正言逆行死期，当以甲乙为是，从之。）
是故风者，百病之长也。（按∶生气通天论“风者百病之始”，言百病皆起于风。此云百病之长，言诸邪
以风为最也。其文虽殊，其义则同。）今风寒客于人，使人毫毛毕直，皮肤闭而为热，当是之时，可汗而发也。
（按∶阴阳应象大论曰∶“善治者治皮毛。”此之谓也。）或痹不仁，肿痛，当是之时，可汤熨及火灸刺而去
之。（热中血气，则 痹不仁。寒气伤形，故为肿痛。）弗治，病入舍于肺，名曰肺痹，发咳上气。（按∶宣
明五气论曰∶“邪入于阳则狂，邪入于阴则痹。”肺在变动为咳，咳则气上，故上气也。）弗治，肺即传而行之
肝，病名曰肝痹，一名曰厥，胁痛出食。（肺金伐木，气下入肝，故曰勿治行之肝也。肝气通胆，胆善为怒，
怒者气逆，故一名厥也。肝脉布胁，故胁痛。按∶出食，
注解不明。盖邪入于肝，则肝木盛而凌胃，故吐也。）当是之时，可按若刺耳。弗治，肝传之脾，病名曰脾风，
发瘅，腹中热，烦心，出黄。（肝应风木，胜脾土，土受风气，故曰脾风，盖为风气通肝而为名也。脾之为病，
善发黄瘅，故发瘅也。脾支别脉上膈注心，故腹中热而烦心，出黄色于便泻之中也。按∶出黄注单指便泻，偏
矣。盖黄为脾色，脾病则色见于外，凡身面发黄皆是也。）当此之时，可按，可药，可浴。弗治，脾传之肾，
病名曰疝瘕，少腹冤热而痛，出白，一名曰蛊。（按∶邪气入肾，聚而成形，故为疝瘕。肾之腑，膀胱也，膀
胱当少腹，热结膀胱，气不得出，若冤抑者然，故曰少腹冤热而痛。惟热在膀胱，故又溺出白液也。一名曰蛊，
注言“冤热内结，消铄脂肉，如虫之食，日内损削，故名曰蛊”，是也。）当此之时，可按，可药。弗治，肾
传之心，病筋脉相引而急，病名曰螈。（肾不足则水不生，水不生则筋燥急，故相引也。阴气内弱，阳气外燔，
筋脉受热而自跳掣，故名曰螈。按∶螈音炽，筋抽掣也。）当此之时，可灸，可药。勿治，满十日，法当死。
（至心而气极则如是矣，若复传行，当如下说。）肾因传之心，心即复反传而行之肺，发寒热，法当三岁死。（反
传于肺金，肺已再伤，故寒热也。三岁者，肺至肾一岁，肾至肝一岁，肝至心一岁，火又乘肺，故云三岁死。）
此病之次也。然其卒发者，不必治于传。（按∶以胜相传，则有次第之可数。若夫猝然而起，或暴感外邪，或
真元脱竭，病虽有因，实非传来，如伤寒之直中、中风之眩仆、杂病厥逆之类，但当考其致病之由，不必泥于
相传之次论治也。）或其传化有不以次。不以次入者，忧恐悲喜怒，令不得以其次，故令人有大病矣。（忧恐
悲喜怒，发无常分，触遇则发，故令病气亦不次而生。按∶此正解病之卒发者，五志之伤，蓄久忽发，初非循
序而来也，故病不以次。）
然猝发之病颇多，而经但以五志为言者，盖以人之为病，苟非本于七情内伤，虽危不死也。因而喜大虚，则
肾气乘矣。（按∶喜者心之志，过喜则心气虚，心虚则火弱而水邪乘心矣。）怒则肝气乘矣，（按∶怒者肝之
志，盛怒则肝气强急，必有乘脾之患矣。）悲则肺气乘矣，（按∶悲者肝之志，悲则金气急切，必有伐木之患
矣。）恐则脾气乘矣，（按∶恐者肾之志，恐极则肾弱，肾弱则水虚而土来制水矣。）忧则心气乘矣，（按∶
肺之志又为忧，过忧则肺伤，肺伤则金弱而火将乘之矣。此五者，盖言卒发为病也。然细观五者又是不同，
精气并而独盛，因而乘其所胜者，肝与肺也。过劳其气，以致虚极，因而见乘于其所不胜者，心与肾与肺也。
注俱蒙混不确，学人所当详审而分别之也。）此其道也。故病有五，五五二十五变，及其传化。传，乘之名也。
（五脏相并而各五之，五而乘之，则二十五变也。然其变化，以胜相传，传而不次，变化多端。按∶以上临
下，以强凌弱曰乘。邪之传也，正谓乘其所胜而侮之，以其势足相乘而后传之也。）
大骨枯槁，大肉陷下，胸中气满，喘息不便，其气动形，期六月死。真脏脉见，乃予之期日。（此肺之脏也。）
大骨枯槁，大肉陷下，胸中气满，喘息不便，内痛引肩项，期一月死。真脏见，乃予之期日。（此心之脏也。）
大骨枯槁，大肉陷下，胸中气满，喘息不便，内痛引肩项，身热，脱肉，破 ，真脏见，十月之内死。（ 者肉
之标，脾主肉，故肉如脱尽， 如破败，此脾之脏也。）大骨枯槁，大肉陷下，肩髓内消，动作益衰，真脏未
见，期一岁死。见其真脏，乃予之期日。（肩髓内消，谓缺盆深也。衰于动作，谓交接渐微。此肾之脏也。按∶
王本来见，全元起及甲乙经俱作未见，于义较确，今从之。）大骨枯槁，大肉陷下，胸中气满，腹内
痛，心中不便，肩项身热，破 脱肉，目匡陷，真脏见，目不见人，立死。其见人者，至其所不胜之时则死。
（肝主目，故目匡陷及不见人，立死也。不胜之时，谓于庚辛之月。此肝之脏也。）急虚，身中卒至，五脏绝
闭，脉道不通，气不往来，譬于堕溺，不可为期。（按∶人之所恃以生者，惟此一息之气耳。气治则安，气乖
则病，倘或元气亏竭，病起仓猝，眩仆厥绝，不省人事，此盖由于五脏之气，败绝无余，故九窍闭塞，而脉亦
为之壅闭也。脉既不通，气自不行而死矣。此等最为猝暴，犹如堕溺之死，出于意外也。）其脉绝不来，若人一
呼五六至，其形肉虽不脱，真脏虽不见，犹死也。（按∶脉绝不来者，无脉者也。一呼五六至者，数极者也。
无脉则真气绝，数极则本根脱，二者之象，亦犹卒至之类，无不立死，固无俟于形肉真脏等候为验也。注谓即
这段文字阐述了五脏脉法与证治的核心要义。篇中的精妙义理共分为八段：第一段论述五脏的脉象与病候，并指出脾为“孤脏”，其含义极为微妙；第二段讲述五脏疾病传变的次序，即所谓死于其所不胜（克制它的脏腑）之时；第三段说明众病多始于风邪，依次传入体内，变化无穷；第四段论述真脏脉出现时死期的远近差异；第五段描述真脏脉的具体形象；第六段解释真脏脉之所以单独显现的原因，这是本篇的关键义理；第七段讲述诊察的方法；最后一段论述五实与五虚证候中“死中求活”的奥妙。各节内容各不相同，但命名此篇的用意，在于突出“真脏”二字，因为真脏脉是辨别生死的关键，这是医家的重要职责。“玉机”之名，类似于《金匮》篇名的用意，都是表示珍重的言辞。
黄帝问道：春季的脉象像弦一样，什么样的脉象才称为弦？岐伯回答说：春脉对应肝脏，属于东方五行中的木，是万物开始生长的季节，所以它的脉气来势软弱、轻虚而滑利，端直且长，因此称为弦。如果与此相反，就是病脉。（按语：扁鹊说：“万物刚开始生长，还没有枝叶，所以脉象来得濡弱而长。”大概只有长才是弦脉，只有濡弱才能使弦脉显得缓和，弦而缓则无病，反之则为病。后文都仿照这个逻辑。）黄帝问：什么样的脉象算是相反呢？岐伯说：脉气来势坚实而强劲，这叫做“太过”，病在体表；脉气来势不实而微弱，这叫做“不及”，病在体内。（气有余则病在外，气不足则病在中。按语：吕广说：“实强是阳气盛的表现，少阳脉应当微弱，现在反而实强，称为太过。阳位于表，所以导致病在外。厥阴之气滋养筋脉，其脉呈弦象，现在反而虚微，所以称为不及。阴位于里，所以导致病在内。”）
黄帝问：春脉太过和不及，分别会导致什么病症？岐伯说：太过会让人容易发怒（注：原文误作“善忘”，据注改为“善怒”），恍惚眩晕甚至头部疾病；不及则会让人胸痛牵引背部，下部表现为两胁胀满。黄帝说：好！（“忽忽”指神志不爽。“眩”指目眩，视物旋转。“胁”指腋下肋骨处。“忘”当为“怒”字的误写。按语：旧本写作“忘”，注释说是“怒”，现在遵从它。因为肝主怒，所以肝气盛则易怒。肝属木而主风，所以会眩晕冒昧。肝脉上行至额头与督脉交会于头顶，所以会有头部疾病。肝脉分布于胁部，所以胁部胀满，肝虚也会胀满，凡是胀满不能立即认为是实证。“ 音区，指胁肋部。）
夏季的脉象像钩一样，什么样的脉象才称为钩？岐伯回答说：夏脉对应心脏，属于南方五行中的火，是万物盛大生长的季节，所以它的脉气来势盛大而去势衰弱，因此称为钩。如果与此相反，就是病脉。（按语：扁鹊说：“夏脉钩，是因为南方火，万物茂盛，枝叶下垂弯曲如钩，所以脉气来快去慢。”钩的形象，是夏季正常的脉象，经文用盛衰来解释，似乎像是有病的脉。扁鹊用疾迟来注解，道理没有错。然而扁鹊只说盛，经文说盛长，既然盛自然也就长了。）黄帝问：什么样的脉象算是相反呢？岐伯说：脉气来势盛大，去势也盛大，这叫做“太过”，病在体表；（来盛去亦盛，是阳气过盛，心气有余，这就是太过。）脉气来势不盛大，去势反而盛大，这叫做“不及”，病在体内。（按语：新校正说：“详细考察扁鹊对肝心肺肾四脏脉的描述，都以实强为太过，虚微为不及，这与《素问》不同。”）黄帝问：夏脉太过和不及，分别会导致什么病症？岐伯说：太过会让人身体发热且皮肤疼痛，发展为浸淫疮；不及会让人心烦，上部出现咳嗽吐痰，下部出现气泄（放屁）。黄帝说：好！（按语：心为阳脏而主火，所以太过则火盛而为病。身热肤痛，是火在体外灼烧。浸淫是指汗出，火逼迫肺津外泄为汗。心虚则火动而心烦，火动则上炎于肺引起咳嗽，下入大肠，通过魄门排出气体。然而这里讲的是心病，为什么病一定会波及到肺？因为火病则无人制约而乱动，进而刑克肺金。）
秋季的脉象像浮一样，什么样的脉象才称为浮？岐伯回答说：秋脉对应肺脏，属于西方五行中的金，是万物收获的季节，所以它的脉气来势轻虚而浮，来势急而去势散，因此称为浮。如果与此相反，就是病脉。（按语：扁鹊说：“秋脉毛，是因为西方金，万物终结，草木花叶都在秋天落下，只剩枝条，像毫毛一样，所以脉气来势轻虚而浮，因此称为毛。”物体中最轻的莫过于毛，而秋脉轻浮，所以以此命名。然而秋脉之所以轻浮，是因为秋天处于酷暑之后，去除浊重而变得清轻，唯清故轻，唯轻故浮。秋脉有时称毛，这里称浮，道理是一样的。）黄帝问：什么样的脉象算是相反呢？岐伯说：脉气像毛一样，中间坚实，两边虚弱，这叫做“太过”，病在体表；脉气像毛一样微弱，这叫做“不及”，病在体内。黄帝问：秋脉太过和不及，分别会导致什么病症？岐伯说：太过会让人气逆且背痛，心中郁闷不快；不及会让人气喘，呼吸短促且咳嗽，上部咳血，下部听到喘息声（或排气声）。黄帝说：好！（按语：旁虚中坚，是内实的象，所以为太过。肺气内实，必定挟带邪气或有火，所以上逆且背痛。背属阳，气盛则并入阳位。愠愠，指气凝滞不散。肺虚则气浮散而急促，所以喘咳。肺虚也会喘咳，世人全都用实证治疗，这是错误的。见血，是气浮血动的表现。“病音”注解说也是喘息，是错误的，应该是气下泄多屁，所以说下部能听到声音。）
冬季的脉象像营（沉石）一样，什么样的脉象才称为营？岐伯回答说：冬脉对应肾脏，属于北方五行中的水，是万物闭藏的季节，所以它的脉气来势沉而濡软，因此称为营。如果与此相反，就是病脉。（按语：王冰本作“沉以搏”，《甲乙经》中“搏”当作“濡”，“濡”古通“软”字，这是冬季平和调匀的脉象。如果沉而搏击手指，则是冬季脉象的太过。现在改正并遵从它。另外其他篇章讲肾脉兼称“石”，这里称“营”，大概军队驻扎的地方叫营，又经营、营谋都取固密的意思，也是石的含义。）黄帝问：什么样的脉象算是相反呢？岐伯说：脉气来时像弹石一样坚硬，这叫做“太过”，病在体表；脉气去时像数脉（快速）一样，这叫做“不及”，病在体内。（按语：肾脉宜如石，但如果像弹石击指，那就过头了。肾脉沉细而缓，才是平脉，如果去势如数，则是阴虚了。）黄帝问：冬脉太过和不及，分别会导致什么病症？岐伯说：太过会让人肢体懈怠弛缓，脊脉疼痛且少气，不想说话；不及会让人心里空虚像生病时的饥饿感，膈中清冷，脊中疼痛，小腹胀满，小便异常。黄帝说：好！（按语：“解 ”已在前面辨析过，但太过的脉象，病应当表现为有余，而这里的症状却都属于不足，这是什么原因？朱丹溪说：“阴常不足。”大概人自从出生以后，火日动，水日亏，所谓的太过，不过是脉象上的搏击有力，正属于水亏火动，并非真正的肾气有余，所以脉象看似太过而症状全是不足。如病饥，是水不制火。膈中清，是肾虚故寒。小腹胀满，是肾气溢出不藏。小便变，是尿色黄赤，水枯竭则浑浊，世人全都以为是热证而用寒凉药治疗，这是错误的。）
黄帝问：四季的顺序，有顺逆的变化，但是脾脉独自主什么呢？岐伯回答说：脾脉属土，是孤脏，负责灌溉四方（其他四脏）。（接纳水谷，化生津液，灌溉于心肝肺肾。因为不单独主宰某一个季节，所以称为孤脏。按语：四脏偏守一方，脾则居中应合四方，不主四时，却是四时所尊崇的。）黄帝问：那么脾的善脉和恶脉可以看出来吗？岐伯回答说：善脉看不出来，恶脉可以看出来。（按语：土旺于四季，随时间流转，如果没有病，只是平平而已。一旦有所痛苦，就会表现在脉象和症状上。）黄帝问：恶脉是什么样的可以看出来？岐伯回答说：脉气像水流一样奔涌，这叫做“太过”，病在体表；像鸟嘴一样尖锐硬直，这叫做“不及”，病在体内。（按语：脾脉太过，比作水流，应当是浮洪脉。鸟喙，指脾的死脉，这里只说不及，读者领会大意即可。）黄帝问：先生您说脾是孤脏，中央之土以灌溉四方，它的太过和不及，分别会导致什么病症？岐伯说：太过会让人四肢无法抬起；（按语：脾属土而主四肢，湿胜则沉重不可抬举，脾虽是湿土，却常常厌恶湿气。）不及会让人九窍不通，名叫“重强”。（……脾作为孤脏以灌溉四方，现在病了则五脏不和，所以九窍不通。《难经》第八十一难说：“五脏不和则九窍不通。”重指脏气重叠，强指气不和顺。）
五脏的病气从它所生的脏腑传来，传给它所克的脏腑，气停留于生它的脏腑，死于克它的脏腑。……这说的是气的逆行，所以会死。（所谓逆，顺序如下说。）肝受气于心，传给脾，气舍于肾，传到肺而死。心受气于脾，传给肺，气舍于肝，传到肾而死。脾受气于肺，传给肾，气舍于心，传到肝而死。肺受气于肾，传给肝，气舍于脾，传到心而死。肾受气于肝，传给心，气舍于肺，传到脾而死。这些都是逆传而死。一天一夜分为五个时段，借此可以占测死者是在早晨还是傍晚死亡。（……早晨主甲乙，白天主丙丁，四季末主戊己，傍晚主庚辛，夜晚主壬癸，由此可知死生的早晚。按语：这是五行生克的定例。王冰本写“死生之早暮”，《甲乙经》写“占死者之早暮”，详细考察经文正是在说逆行死期，应当以《甲乙经》为准，遵从它。）
所以风，是百病之首。（按语：《生气通天论》说“风者百病之始”，意思是百病都起于风。这里说“百病之长”，意思是各种邪气中风最厉害。虽然文字不同，意义相同。）现在风寒侵袭人体，使人毫毛全部竖起，皮肤闭塞而发热，在这个时候，可以用发汗的方法治疗。（按语：《阴阳应象大论》说：“善于治病的人治疗皮毛。”说的就是这个意思。）或者出现痹症、麻木、肿痛，在这个时候，可以用汤药熨敷及火灸针刺来去除病邪。（热邪郁结气血，则出现痹症麻木。寒气损伤形体，所以出现肿痛。）如果不治疗，病邪进入并停留在肺，名叫肺痹，发作咳嗽和气逆。（按语：《宣明五气论》说：“邪入于阳则狂，邪入于阴则痹。”肺在变动方面表现为咳，咳则气上，所以叫上气。）如果不治疗，肺随即传变给肝，病名叫肝痹，又名厥，伴有胁痛和呕吐。（肺金伐木，气下行入肝，所以说不治则传行于肝。肝气通于胆，胆易发怒，怒则气逆，所以又名厥。肝脉布于胁，所以胁痛。按语：“出食”注解不明。大概是邪气入肝，则肝木盛而凌犯胃，所以呕吐。）在这个时候，可以用按摩或刺耳放血的方法治疗。如果不治疗，肝传变给脾，病名叫脾风，发作黄疸，腹中热，心烦，排出黄色物质。（肝应风木，克制脾土，土受风气，所以叫脾风，大概是因为风气通于肝而得名。脾的病，容易发黄瘅，所以发作黄疸。脾的别脉上膈注入心，所以腹中热而心烦，大便中排出黄色物质。按语：“出黄”注解说仅指大便，偏颇了。黄是脾的颜色，脾病则颜色见于外，凡是身面发黄都是。）在这个时候，可以用按摩、药物或洗浴治疗。如果不治疗，脾传变给肾，病名叫疝瘕，小腹冤热而痛，排出白色液体，又名蛊。（按语：邪气入肾，聚而成形，所以为疝瘕。肾的腑是膀胱，膀胱位于小腹，热结膀胱，气不得出，像受冤屈压抑一样，所以叫小腹冤热而痛。只有热在膀胱，所以又溺出白液。又名蛊，注解说“冤热内结，消铄脂肉，像虫子吃食，每天损耗，所以叫蛊”，这是对的。）在这个时候，可以用按摩、药物治疗。如果不治疗，肾传变给心，出现筋脉相互牵引而拘急，病名叫螈（抽搐）。（肾不足则水不生，水不生则筋燥急，所以相互牵引。阴气内弱，阳气外燔，筋脉受热而自跳动抽搐，所以叫螈。按语：螈音炽，指筋抽掣。）在这个时候，可以用艾灸、药物治疗。如果不治，满十天，按规定应当死亡。（气传到心而极尽就是这样了，如果再传行，应当像下面所说的那样。）肾因传变给心，心随即又反传给肺，发作寒热，按规定三年后死亡。（反传于肺金，肺已再次受伤，所以寒热。三年，指肺至肾一年，肾至肝一年，肝至心一年，火又乘肺，所以说三年死。）这是病传的次序。然而突然发病的，不必拘泥于传变。（按语：以相胜相传，则有次第可数。如果是猝然兴起，或是暴感外邪，或是真元脱竭，病虽有原因，实际上并非传来，如伤寒的直中、中风的眩仆、杂病厥逆之类，只应当考察致病的原因，不必拘泥于相传的次序来论治。）或者其传化有不按次序的。不按次序传入的，是因为忧、恐、悲、喜、怒，使得病气不能按次序发生，所以让人患大病了。（忧恐悲喜怒，发作没有固定的分寸，遇到触发就发作，所以病气也不按次序而生。按语：这正是解释病的突然发作，五志的伤害，积蓄久了忽然发作，起初并不是循着次序来的，所以病不按次序。）
然而突然发病的病很多，而经文只提到五志，大概是因为人的病，如果不是基于七情内伤，即使危险也不会死。因而喜过度导致心气大虚，则肾气会乘虚而入。（按语：喜是心的志，过喜则心气虚，心虚则火弱而水邪乘心。）怒则肝气会乘虚而入，（按语：怒是肝的志，盛怒则肝气强急，必然有乘脾的祸患。）悲则肺气会乘虚而入，（按语：悲是肺的志，悲则金气急切，必然有伐木的祸患。注中误写为肝，此处纠正。）恐则脾气会乘虚而入，（按语：恐是肾的志，恐极则肾弱，肾弱则水虚而土来制水。）忧则心气会乘虚而入，（按语：肺的志又为忧，过忧则肺伤，肺伤则金弱而火将乘之。这五种情况，大概说的是突然发病。然而仔细观察这五种情况又是不同的，精气并聚而独盛，因而乘其所胜的是肝与肺。过劳其气，以致虚极，因而被其所不胜乘的是心与肾与肺。注解说得模糊不清，学者应当详细审查并加以区分。）这就是其中的道理。所以病有五种，五五二十五种变化，以及它们的传化。“传”是“乘”的名称。（五脏相并而各五之，五而乘之，则二十五变。然而其变化，以相胜相传，传而不次，变化多端。按语：以上临下，以强凌弱叫乘。邪气的传变，正是谓乘其所胜而侮之，以其势足相乘而后传之。）
大骨枯槁，大肉陷下，胸中气满，喘息不便，其气动形，预期六个月死亡。如果出现真脏脉，就给予具体的日期。（这是肺的真脏脉。）大骨枯槁，大肉陷下，胸中气满，喘息不便，内部疼痛牵引肩项，预期一个月死亡。出现真脏脉，就给予具体的日期。（这是心的真脏脉。）大骨枯槁，大肉陷下，胸中气满，喘息不便，内部疼痛牵引肩项，身体发热，肌肉脱尽，皮肤破裂，真脏脉出现，十月之内死亡。（ 是肉的标志，脾主肉，所以肉如脱尽， 如破败，这是脾的真脏脉。）大骨枯槁，大肉陷下，肩髓内部消耗，动作日益衰退，真脏脉未出现，预期一年死亡。出现真脏脉，就给予具体的日期。（肩髓内部消耗，指缺盆深陷。动作衰退，指房事渐少。这是肾的真脏脉。按语：王冰本有“见”字，全元起及《甲乙经》都作“未见”，在意义上更确切，现在遵从它。）大骨枯槁，大肉陷下，胸中气满，腹内痛，心中不适，肩项身热，皮肤破裂肌肉脱尽，眼眶凹陷，真脏脉出现，眼睛看不见人，立刻死亡。如果还能看见人，到了它所不胜的时候就会死亡。（肝主目，所以眼眶凹陷及看不见人，立刻死亡。不胜之时，指在庚辛月，即秋季。这是肝的真脏脉。）急虚，身体突然遭受重创，五脏绝闭，脉道不通，气不往来，就像堕入水中或从高處坠落一样，无法预测具体死期。（按语：人所依靠以生存的，只有这一息之气罢了。气调和则安，气乖违则病，倘若元气亏竭，病起仓猝，眩仆厥绝，不省人事，这大概是由于五脏之气败绝无余，所以九窍闭塞，而脉也随之壅闭。脉既不通，气自然不行而死。这种情况最为猝暴，犹如堕溺之死，出于意外。）如果脉绝不来，或者人一呼一吸间脉搏跳动五六次，虽然形体肌肉没有脱失，真脏脉也没有出现，仍然会死亡。（按语：脉绝不来，是没有脉。一呼五六至，是数脉到了极点。无脉则真气绝，数极则本根脱，这两种征象，也像猝然发病一类，无不立刻死亡，根本不需要等待形肉真脏的出现来验证。注解说即……）
This passage expounds on the core principles of pulse diagnosis and treatment for the five Zang organs. The profound meaning within the chapter is divided into eight sections: The first section discusses the pulse patterns and pathological manifestations of the five Zang organs, highlighting that the Spleen is the "solitary Zang organ," a concept with subtle implications; the second section outlines the sequence of disease transmission among the five Zang organs, specifically death occurring when the disease reaches the organ that overcomes it (Sheng Ke cycle); the third section explains that most diseases originate from Wind pathogen, transmitting sequentially with infinite variations; the fourth section discusses the varying timeframes to death indicated by the appearance of True Visceral Pulses (Zhen Zang Mai); the fifth section describes the specific characteristics of True Visceral Pulses; the sixth section elucidates why True Visceral Pulses appear exclusively, which is the key theoretical point of this chapter; the seventh section details diagnostic methods; and the final section discusses the subtleties of seeking life amidst death in cases of Five Excesses (Wu Shi) and Five Deficiencies (Wu Xu). Although each section differs, the title emphasizes "True Visceral" because these pulses are crucial for distinguishing life from death, a primary duty of physicians. The term "Yu Ji" (Jade Machine), similar to the naming convention in the *Jin Gui* chapters, signifies reverence and importance.
The Yellow Emperor asked: "The spring pulse resembles a bowstring. What constitutes a bowstring pulse?" Qi Bo replied: "The spring pulse corresponds to the Liver, which belongs to Wood in the East. It is the season when all things begin to grow. Therefore, its qi arrives soft, light, empty, slippery, straight, and long, hence called 'bowstring' (Xian). If it is contrary to this, it indicates disease." (Commentary: Bian Que stated, "When all things first begin to grow, before branches and leaves appear, the pulse arrives moist, weak, and long. Generally, only 'long' makes it a bowstring pulse; only when 'moist and weak' does the bowstring pulse become relaxed. A relaxed bowstring pulse indicates health; deviation indicates disease. The following sections follow this logic.) The Emperor asked: "What constitutes the contrary state?" Qi Bo said: "If the qi arrives solid and strong, this is called 'Excess' (Tai Guo), indicating disease in the exterior; if the qi arrives insubstantial and faint, this is called 'Deficiency' (Bu Ji), indicating disease in the interior." (Excess qi leads to exterior disease; deficient qi leads to interior disease. Commentary: Lu Guang said, "Solid and strong indicates flourishing Yang qi. The Shaoyang pulse should be faint; now it is solid and strong, termed Excess. Yang resides at the exterior, causing exterior disease. Jueyin qi nourishes the sinews, and its pulse is bowstring; now it is deficient and faint, termed Deficiency. Yin resides in the interior, causing interior disease.")
The Emperor asked: "For spring pulse Excess and Deficiency, what are the respective symptoms?" Qi Bo said: "Excess causes irritability (Note: Original text says 'forgetfulness,' corrected to 'irritability' based on commentary), dizziness, vertigo, and head disorders; Deficiency causes chest pain radiating to the back, and distension in both hypochondriac regions." The Emperor said: "Excellent!" ('Huhu' refers to mental confusion. 'Xuan' refers to vertigo, feeling as if spinning. 'Xie' refers to the hypochondriac region under the armpit. 'Wang' is likely a typo for 'Nu' (anger). Commentary: Old texts read 'Wang,' but annotations correct it to 'Nu.' Since the Liver governs anger, Liver excess leads to irritability. Liver belongs to Wood and governs Wind, causing vertigo. Liver meridians ascend to the forehead and meet the Du vessel at the vertex, causing head disorders. Liver meridians distribute to the hypochondrium, causing distension; even Liver deficiency can cause distension, so distension should not immediately be diagnosed as Excess. 'Xie' sounds like 'Qu'.)
The summer pulse resembles a hook. What constitutes a hook pulse? Qi Bo replied: "The summer pulse corresponds to the Heart, which belongs to Fire in the South. It is the season when all things flourish and grow. Therefore, its qi arrives vigorous and deploys weakly, hence called 'hook' (Gou). If it is contrary to this, it indicates disease." (Commentary: Bian Que said, "Summer pulse hook, due to Southern Fire, where all things flourish. Branches and leaves hang down and curve like hooks, so the pulse arrives fast and deploys slow. The image of a hook represents the normal summer pulse. The Jingmai interprets it via vigor and weakness, resembling a pathological pulse. Bian Que's interpretation of fast arrival and slow departure is logically sound. However, Bian Que only mentioned 'vigorous,' while the Jing mentions 'flourishing and growing.' Flourishing inherently implies growing.) The Emperor asked: "What constitutes the contrary state?" Qi Bo said: "If the qi arrives vigorous and deploys vigorously, this is called 'Excess,' indicating disease in the exterior; (Arriving and departing vigorously indicates excessive Yang, surplus Heart qi, i.e., Excess.) if the qi arrives insubstantial but deploys vigorously, this is called 'Deficiency,' indicating disease in the interior." (Commentary: Xin Zheng Jiao notes, "Examining Bian Que's descriptions of Liver, Heart, Lung, and Kidney pulses, he defines Excess as solid/strong and Deficiency as weak/faint, differing from the Su Wen.") The Emperor asked: "For summer pulse Excess and Deficiency, what are the respective symptoms?" Qi Bo said: "Excess causes fever and skin pain, developing into spreading sores (Jin Yin); Deficiency causes vexation, upper symptoms of coughing and expectoration, and lower symptoms of flatus." The Emperor said: "Excellent!" (Commentary: The Heart is a Yang organ governing Fire. Excess leads to fiery pathology. Fever and skin pain result from fire burning externally. Jin Yin refers to sweating, forced out by fire pressing on the Lungs. Heart deficiency leads to fire agitation and vexation; fire agitates and flares upward to the Lungs causing cough, and descends into the Large Intestine, exiting via the anal sphincter as gas. Why does Heart disease affect the Lungs? Because uncontrolled fire attacks Metal.)
The autumn pulse resembles floating. What constitutes a floating pulse? Qi Bo replied: "The autumn pulse corresponds to the Lung, which belongs to Metal in the West. It is the season of harvest. Therefore, its qi arrives light, empty, and floating, arriving swiftly and dispersing slowly, hence called 'floating' (Fu). If it is contrary to this, it indicates disease." (Commentary: Bian Que said, "Autumn pulse Mao (feather-like), due to Western Metal, where all things conclude. Grass and tree flowers and leaves fall in autumn, leaving only branches, like hairs. Thus, the pulse arrives light, empty, and floating, hence called 'Mao.' Nothing is lighter than hair, and the autumn pulse is light and floating, hence the name. The lightness and floating nature arise because autumn follows humid heat, clearing away turbidity to become clear and light. Clear leads to light, light leads to floating. Autumn pulse is sometimes called Mao, here called Fu; the principle is identical.) The Emperor asked: "What constitutes the contrary state?" Qi Bo said: "If the pulse feels like hair but is firm in the center and hollow on the sides, this is called 'Excess,' indicating disease in the exterior; if the pulse feels like hair but is faint, this is called 'Deficiency,' indicating disease in the interior." The Emperor asked: "For autumn pulse Excess and Deficiency, what are the respective symptoms?" Qi Bo said: "Excess causes rebellious qi and back pain, with a feeling of oppression; Deficiency causes asthma, shortness of breath, cough, hemoptysis (upper symptom), and audible respiratory or intestinal sounds (lower symptom)." The Emperor said: "Excellent!" (Commentary: Hollow sides and firm center indicate internal Excess. Internal Lung Excess implies pathogenic factors or fire, causing rebellious qi and back pain. The back is Yang; excess qi merges with Yang. Yunyun denotes stagnant qi. Lung deficiency leads to scattered, rapid qi, causing asthma and cough. While Lung deficiency causes asthma/cough, treating it solely as Excess is incorrect. Hemoptysis results from floating qi moving blood. 'Bing Yin' annotated as asthma is incorrect; it refers to lower expulsion of gas.)
The winter pulse resembles Ying (deep/stony). What constitutes a Ying pulse? Qi Bo replied: "The winter pulse corresponds to the Kidney, which belongs to Water in the North. It is the season of storage. Therefore, its qi arrives deep and soft, hence called 'Ying'." (Commentary: Wang Bing's edition reads 'deep and striking.' The *Jia Yi Jing* corrects 'striking' to 'soft' (Ru), an ancient variant of 'ruan' (soft), representing the balanced winter pulse. Deep and striking against the fingers indicates Winter Pulse Excess. This correction is adopted. Other chapters mention Kidney pulse as 'Stone'; here it is 'Ying.' 'Ying' refers to a military camp, implying solidity and density, consistent with 'Stone'.) The Emperor asked: "What constitutes the contrary state?" Qi Bo said: "If the qi arrives like bouncing stones, this is called 'Excess,' indicating disease in the exterior; if it deploys like a rapid pulse (Shu), this is called 'Deficiency,' indicating disease in the interior." (Commentary: Kidney pulse should resemble stone; bouncing stones is excessive. A normal Kidney pulse is deep, fine, and slow. Departing rapidly indicates Yin deficiency.) The Emperor asked: "For winter pulse Excess and Deficiency, what are the respective symptoms?" Qi Bo said: "Excess causes lethargy, spinal pain, shortness of breath, and reluctance to speak; Deficiency causes a sensation of hunger with an empty heart, coldness in the epigastrium, spinal pain, abdominal fullness, and abnormal urination." The Emperor said: "Excellent!" (Commentary: 'Jie Chi' was analyzed previously. Although Excess pulse suggests excess pathology, the symptoms here indicate deficiency. Why? Zhu Danxi stated, "Yin is often deficient." After birth, Fire moves daily, Water declines daily. The apparent 'Excess' is merely the striking quality of the pulse, reflecting Water deficiency and Fire agitation, not true Kidney Qi excess. Thus, the pulse seems Excess, but symptoms are Deficient. Hunger sensation is Water failing to control Fire. Epigastric cold is Kidney deficiency causing cold. Abdominal fullness is Kidney Qi overflowing and failing to store. Abnormal urination (yellow/red urine) occurs when Water is depleted and becomes turbid. Treating this as Heat with Cold herbs is incorrect.)
The Emperor asked: "Regarding the order of the four seasons and their variations of compliance and rebellion, what does the Spleen pulse alone govern?" Qi Bo replied: "The Spleen pulse belongs to Earth, the solitary Zang organ, responsible for irrigating the four directions (other Zang organs)." (It accepts food and water, transforms fluids, and irrigates the Heart, Liver, Lung, and Kidney. It does not govern a specific season, hence 'solitary.' Commentary: The four Zang organs occupy specific quarters; the Spleen centers and responds to all four, not governing a season but being revered by all seasons.) The Emperor asked: "Can the auspicious and inauspicious states of the Spleen be seen?" Qi Bo replied: "The auspicious state cannot be seen; the inauspicious state can be seen." (Commentary: Earth prospers in all four seasons, turning with time. Without disease, it is merely ordinary. Once afflicted, it manifests in the pulse and symptoms.) The Emperor asked: "How can the inauspicious state be seen?" Qi Bo said: "If the qi flows like water, this is called 'Excess,' indicating disease in the exterior; if it resembles a bird's beak, this is called 'Deficiency,' indicating disease in the interior." (Commentary: Spleen Excess compared to flowing water suggests a Floating-Hong pulse. Bird's beak refers to the dying Spleen pulse; here labeled Deficiency, readers should grasp the general idea.) The Emperor asked: "You stated the Spleen is the solitary Zang, Central Earth irrigating the four directions. What are the symptoms of its Excess and Deficiency?" Qi Bo said: "Excess causes inability to lift the limbs; (Commentary: Spleen belongs to Earth and governs the limbs. Dampness excess causes heaviness and immobility. Although Spleen is damp Earth, it dislikes dampness.) Deficiency causes obstruction of the nine orifices, named 'Chong Qiang' (Heavy Rigidity)." (...Since the Spleen irrigates the four directions, disease here causes disharmony among the five Zang, leading to orifice obstruction. *Nan Jing* Chapter 81 states, "Disharmony of the five Zang leads to obstruction of the nine orifices." Chong means overlapping Zang qi; Qiang means discordant qi.)
The five Zang receive qi from the organ that generates them, transmit it to the organ they overcome, retain it in the organ that generates them, and die when it reaches the organ that overcomes them... This describes reverse qi movement, leading to death. (The sequence of reversal is as follows.) Liver receives qi from Heart, transmits to Spleen, retains in Kidney, and dies upon reaching Lung. Heart receives qi from Spleen, transmits to Lung, retains in Liver, and dies upon reaching Kidney. Spleen receives qi from Lung, transmits to Kidney, retains in Heart, and dies upon reaching Liver. Lung receives qi from Kidney, transmits to Liver, retains in Spleen, and dies upon reaching Heart. Kidney receives qi from Liver, transmits to Heart, retains in Lung, and dies upon reaching Spleen. These are all reverse deaths. Dividing day and night into five parts allows prediction of whether death occurs in the morning or evening. (...Morning governs Jia/Yi, Day governs Bing/Ding, End-of-Season governs Wu/Ji, Evening governs Geng/Xin, Night governs Ren/Gui. From this, the timing of death can be known. Commentary: This is the fixed rule of Five Elements generation and overcoming. Wang Bing's text reads 'timing of life and death'; *Jia Yi Jing* reads 'predicting timing of death.' Detailed examination shows the text discusses reverse death timing, so *Jia Yi Jing* is preferred.)
Therefore, Wind is the chief of all diseases. (Commentary: *Sheng Qi Tong Tian Lun* says "Wind is the beginning of all diseases," meaning all diseases start from Wind. Here "chief" means Wind is the most prominent among pathogens. Though wording differs, meaning is the same.) When Wind-Cold invades the body, causing hair to stand erect and skin pores to close, generating heat, at this stage, diaphoresis (sweating) can be used. (Commentary: *Yin Yang Ying Xiang Da Lun* states, "The skilled healer treats the skin and hair." This refers to that principle.) If Bi syndrome, numbness, swelling, and pain occur, at this stage, hot compresses, moxibustion, and acupuncture can remove the pathogen. (Heat stagnating blood and qi causes Bi and numbness. Cold damaging form causes swelling and pain.) If untreated, the pathogen enters and settles in the Lung, named Lung Bi, manifesting as cough and rebellious qi. (Commentary: *Xuan Ming Wu Qi Lun* states, "Pathogen entering Yang causes mania; entering Yin causes Bi." Lung changes manifest as cough; cough involves rebellious qi, hence 'rebellious qi'.) If untreated, the Lung transmits to the Liver, named Liver Bi, also called Jue, with hypochondriac pain and vomiting. (Lung Metal attacks Wood; qi descends into Liver, hence 'if untreated, transmits to Liver.' Liver qi connects to Gallbladder, which is prone to anger; anger causes rebellious qi, hence 'Jue.' Liver meridians distribute to the hypochondrium, causing pain. Commentary: 'Chu Shi' (vomiting food) is unclear in annotations. Likely, pathogen in Liver causes Wood excess attacking Stomach, leading to vomiting.) At this stage, massage or ear pricking/bloodletting can be used. If untreated, Liver transmits to Spleen, named Pi Feng (Spleen Wind), manifesting as jaundice, abdominal heat, vexation, and yellow discharge. (Liver corresponds to Wind-Wood, overcoming Spleen-Earth. Earth receiving Wind qi is named Spleen Wind, named after Wind connecting to Liver. Spleen disease easily produces yellow jaundice. Spleen branch meridians ascend through diaphragm to Heart, causing abdominal heat and vexation, discharging yellow matter in stool. Commentary: 'Chu Huang' annotated only as stool is partial. Yellow is Spleen color; Spleen disease manifests externally as yellow complexion/jaundice.) At this stage, massage, herbs, or bathing can be used. If untreated, Spleen transmits to Kidney, named Shan Jia (Hernia/Mass), with painful heat in the lower abdomen resembling grievance, and white discharge, also named Gu. (Commentary: Pathogen entering Kidney gathers into form, creating Hernia/Mass. Kidney's fu organ is Bladder, located in lower abdomen. Heat binding Bladder prevents qi exit, feeling like grievance, hence 'painful heat resembling grievance.' Only heat in Bladder causes white urinary discharge. Named Gu, annotation explains: "Internal binding of grievous heat consumes flesh like insects eating, causing daily wasting, hence Gu.") At this stage, massage and herbs can be used. If untreated, Kidney transmits to Heart, causing sinew and vessel contraction and spasm, named Yuan (convulsion/twitching). (Kidney deficiency fails to generate Water; lack of Water causes dry, tight sinews, leading to contraction. Inner Yin is weak, Outer Yang burns; sinews/vessels受热 cause twitching, hence Yuan. Commentary: Yuan sounds like 'Chi', referring to sinew spasms.) At this stage, moxibustion and herbs can be used. If untreated, after ten days, death is expected according to protocol. (Qi reaches extremity at Heart, thus such outcome. If transmission continues, see below.) Kidney transmitting to Heart, Heart then reverses-transmits to Lung, manifesting chills and fever, expected death in three years. (Reverse transmission to Lung Metal, Lung injured twice, hence chills/fever. Three years: Lung to Kidney one year, Kidney to Liver one year, Liver to Heart one year, Fire then attacks Lung again, hence 'three years death.') This is the sequence of disease transmission. However, sudden onset diseases need not follow transmission rules. (Commentary: Transmission by overcoming has a sequence. Sudden onset, whether acute external invasion or collapse of primordial Qi, though having a cause, is not transmitted sequentially, e.g., direct strike in Cold Damage, fainting in Stroke, or reversal in miscellaneous diseases. One should investigate the cause, not rigidly apply transmission sequences.) Or transmission may not follow sequence. Non-sequential entry is caused by Worry, Fear, Sadness, Joy, Anger, disrupting order, leading to severe disease. (Emotions arise unpredictably upon trigger, causing disease qi to arise non-sequentially. Commentary: This explains sudden onset. Five Zhi injuries accumulate and suddenly erupt, not sequentially, hence non-sequential disease.)
Although many sudden diseases exist, the Jing mentions only the Five Zhi because human disease, unless rooted in Seven Emotions internal injury, will not be fatal despite severity. Excessive Joy causes extreme Heart Qi deficiency, allowing Kidney Qi to invade. (Commentary: Joy is Heart's emotion. Excessive Joy depletes Heart Qi; Heart deficiency weakens Fire, allowing Water pathogen to invade.) Anger allows Liver Qi to invade. (Commentary: Anger is Liver's emotion. Extreme Anger strengthens Liver Qi excessively, inevitably invading Spleen.) Sadness allows Lung Qi to invade. (Commentary: Sadness is Lung's emotion. Sadness makes Metal qi urgent, inevitably attacking Wood. Note: Annotation mistakenly wrote Liver; corrected here.) Fear allows Spleen Qi to invade. (Commentary: Fear is Kidney's emotion. Extreme Fear weakens Kidney; Kidney weakness leads to Water deficiency, allowing Earth to control Water.) Worry allows Heart Qi to invade. (Commentary: Lung's emotion is also Worry. Excessive Worry damages Lung; Lung damage weakens Metal, allowing Fire to invade. These five describe sudden disease. However, observing closely, they differ: Essence and Qi gathering and becoming excessive, thereby overcoming the controlled organ, applies to Liver and Lung. Overworking Qi to extreme deficiency, thereby being invaded by the controlling organ, applies to Heart, Kidney, and Lung. Annotations are vague; scholars must distinguish carefully.) This is the principle. There are five diseases, five times five making twenty-five transformations, and their transmission. "Transmission" is the name for "Overcoming" (Cheng). (Five Zang combining and multiplying by five, then overcoming, yields twenty-five transformations. Changes vary widely, transmitting without sequence. Commentary: Top overriding bottom, strong bullying weak is Cheng. Pathogen transmission is precisely overcoming the controlled and insulting it, transmitting only when strength allows overcoming.)
Great bones withered, great muscles sunken, chest full of qi, difficult breathing, body movements disturbing the form, expected death in six months. Appearance of True Visceral Pulse confirms the date. (This is the True Visceral Pulse of the Lung.) Great bones withered, great muscles sunken, chest full of qi, difficult breathing, internal pain radiating to shoulder and neck, expected death in one month. Appearance of True Visceral Pulse confirms the date. (This is the True Visceral Pulse of the Heart.) Great bones withered, great muscles sunken, chest full of qi, difficult breathing, internal pain radiating to shoulder and neck, body heat, muscle wasting, skin cracking, True Visceral Pulse appears, death within ten months. (Skin cracking/muscle wasting indicates Spleen, as Spleen governs flesh.) Great bones withered, great muscles sunken, shoulder marrow internally consumed, movements increasingly frail, True Visceral Pulse not yet appeared, expected death in one year. Appearance of True Visceral Pulse confirms the date. (Shoulder marrow consumption refers to hollowed supraclavicular fossa. Frail movements refer to decreased sexual activity. This is the True Visceral Pulse of the Kidney. Commentary: Wang Bing includes 'appeared'; Quan Yuanqi and *Jia Yi Jing* say 'not appeared,' which is more accurate. Adopted here.) Great bones withered, great muscles sunken, chest full of qi, abdominal pain, heart discomfort, shoulder/neck/body heat, skin cracking/muscle wasting, eye sockets sunken, True Visceral Pulse appears, eyes unable to see person, immediate death. If able to see person, death occurs at the time of the organ it cannot overcome. (Liver governs eyes; sunken sockets and blindness indicate immediate death. Time of overcoming refers to Geng/Xin months, i.e., Autumn. This is the True Visceral Pulse of the Liver.) Acute deficiency, sudden bodily collapse, five Zang closure, meridian blockage, qi stagnation, akin to falling or drowning, no specific timeframe can be predicted. (Commentary: Life depends on this breath of Qi. Harmonious Qi brings safety; discordant Qi brings disease. If primordial Qi collapses, disease strikes suddenly, causing fainting/reversal and unconsciousness, due to exhaustion of Zang Qi, closing nine orifices and blocking meridians. Blocked meridians stop Qi flow, leading to death. This is most sudden, like accidental drowning.) If pulse is absent, or if pulse beats five to six times per breath, even if form/flesh is intact and True Visceral Pulse not seen, death still occurs. (Commentary: Absent pulse means no pulse. Five-six beats per breath is extreme rapidity. No pulse means True Qi exhausted; extreme rapidity means root depleted. Both signs lead to immediate death,无需 waiting for flesh/pulse changes for verification. Annotation states...)