立夏得洪大脉，是其本位，其人病身体苦疼重者，须发其汗。若明日身不疼不重者，不须发汗。若汗
自出者，明日便解矣。何以言之？立夏得洪大脉是其时脉，故使然也。四时仿此。
【注】凡四时之病，当以四时之脉期之。期之者，期其愈不愈也。立夏之日，得洪大脉，是其本位应得
之脉。其人病身体苦疼重者，须发其汗。若明日身不疼不重，虽脉仍洪大，必非邪脉，乃时脉也，不须再汗，
谓已解也。设若本日汗 然自出者，此解兆
已见，虽脉洪大，不须发汗，明日便自解矣。何以言之？立夏得洪大脉，是得其时脉故也。四时仿此。
【集注】方有执曰∶此言脉得应时而旺，则病有当解之时。举夏以例其余，示人推仿之意。
程知曰∶春弦、夏洪、秋毛、冬石，当其时得之，则为平脉，虽外感寒邪，但微汗出自愈耳！重则治之，
轻则不必治也。《内经》曰∶脉得四时之顺者。此也。
程应旄曰∶洪大为夏令之脉，亦为邪盛之脉，有病则从邪，无病则从令，解不解不须另辨。
西方肺脉，其形何似？师曰∶肺者金也，名太阴，其脉毛浮也。肺病自得此脉，若得缓迟者皆愈，若得数
者则剧。何以知之？数者南方火，火克西方金，法当痈肿，为难治也。
【注】西方属金，主秋令燥，在天为燥，在地为金，在人为肺，故曰∶肺者金也。名手太阴经，其脉当浮。
若得毛浮缓迟，此浮而有胃，是肺平脉也，虽有肺病，自易愈也。若得毛浮而少缓迟，此浮多胃少，是肺病脉
也。若得毛浮而无缓迟，此但浮无胃，是肺死脉也。若得毛浮而数，则为病剧。何以知之？数者南方火也，火
克西方金，法当发痈肿而难治也。
【集注】方有执曰∶肺主皮毛，上为华盖，故脉毛浮。缓迟者，脾土之脉也。兼得缓迟为愈者，肺金得土
为逢生也，法当痈脓者，金逢火化也。
北方肾脉，其形何似？师曰∶肾者水也，名曰少阴，其脉沉滑，是肾脉也。肾病自得沉滑而濡者，愈也。
【按】东南西方，皆有其文，惟缺北方，仿经文补之。
【注】北方属水，主冬令寒，在天为寒，在地为水，在人为肾，故曰肾者水也，名足少阴经，其脉当沉。
若得沉滑而濡，此沉而有胃，是肾平脉也，虽有肾病，自易愈也。若得沉滑而少濡和，此为沉多胃少，是肾病
脉也。若得沉而无滑濡，此但沉无胃，是肾死脉也。
问曰∶翕奄沉，名曰滑，何谓也？师曰∶沉为纯阴，翕为正阳，阴阳和合，故令脉滑，关尺自平。阳明脉
微沉，食饮自可。少阴脉微滑，滑者，紧之浮名也，此为阴实，其人必股内汗出，阴下湿也。
【按】“滑者紧之浮名也，此为阴实”二句，与上下之义不属，当是错简。
【注】此冬月之平脉也。若阳明关脉微沉而不滑，是失正阳，为胃不和，故其人食饮仅自可也。若少阴尺
脉微滑而不濡，是失纯阴，为肾不和，故其人汗出，阴下湿也。
问曰∶脉有相乘，有纵有横，有逆有顺，何谓也？师曰∶水行乘火，金行乘木，名曰纵；火行乘水，木
行乘金，名曰横；水行乘金，火行乘木，名曰逆；金行乘水，木行乘火，名曰顺也。
【注】此以人之五脉，候人五脏不平之诊法也。人之五脏，法天五行，肝木、心火、脾土、肺金、肾水，
此相属也。木生火，火生土，土生金，金生水，水生木，此相生也。木克土，土克水，水克火，火克金，金克
木，此相克也。相生者生，相克者死。人之脏气亦然，故其脉有相乘，有纵有横，有逆有顺也。水乘火，金乘
木，乘其所胜，是相克也，名曰纵。火乘水，木乘金，乘所不胜，是反侮也，名曰横。水乘金，火乘木，子乘
其母，是倒施也，名曰逆。金乘水，木乘火，母乘其子，是相生也，名曰顺。五脏之脉，肝弦、心洪、脾缓、
肺浮、肾沉，五脏各见本脉，自无病也。若见他脉，以此推之，纵者病甚，横者病微，逆者病虚，顺者病实也。
【集注】方有执曰∶乘，犹乘舟车之乘。纵，直也。横者，纵之对。顺，从也。逆者，顺之反。
程知曰∶非其时而得之，则为相乘，纵横为患最重，顺逆犹无大害也。
问曰∶何以知乘腑？何以知乘脏？师曰∶诸阳浮数为乘腑，诸阴迟涩为乘脏也。
【注】上条发明五脏相乘，纵横顺逆之脉，此条发明阴阳相乘，各从其类之诊。腑，阳也；浮数，阳也。
脏，阴也；迟涩，阴也。阳乘阳，阴乘阴，各从其类而相乘也。其阴邪乘阳，阳邪乘阴，腑邪乘脏，脏邪乘腑，
各以脉证错综参之，可类推矣。
【集注】方有执曰∶浮数阳也，以阳部而见阳脉，故知乘腑也。迟涩阴也，以阴部而见阴脉，故知乘脏也。
问曰∶濡弱何以反适十一头？师曰∶五脏六腑相乘，故令十一。
【注】此承上条，发明五脏六腑不平相乘之脉也。适者，至也。头者，数也。凡人若见濡弱之脉而相乘
者，是因我虚而彼乘及之也。越人只曰一脉辄为十变，何以至十一数也？越人遗包络、三焦，故十也。今五脏六
腑相乘，故十一也。然阴乘阳，阳乘阴，腑乘脏，脏乘腑，错而综之，岂止十一耶！
【集注】程知曰∶此总揭脉之大要，言脉得濡弱，则可以和适五脏六腑也。经曰∶呼吸者脉之头，濡弱
者，软和以滑，《内经》谓之有胃气也。五脏六腑之邪，不能不相乘，如金邪乘木，木邪乘火之类，惟诸相乘
中，有软和以滑之意，则为易愈，故濡弱可以和适十一脏脉气也。
问曰∶病有洒淅恶寒而复发热者何？答曰∶阴脉不足，阳往从之，阳脉不足，阴往乘之。曰∶何谓阳不
足？答曰∶假令寸口脉微，名曰阳不足，阴气上入阳中，则洒淅恶寒也。曰∶何谓阴不足？答曰∶尺脉弱，名
曰阴不足，阳气下陷于阴中，则发热也。
【注】此以寸、尺发明阴阳相乘为病之脉也。若脉紧无汗，洒淅恶寒发热者，是伤寒也。脉缓有汗，洒淅
恶寒发热者，是中风也。今寸脉微，洒淅恶寒者，是阳不足，阴气上乘，入于阳中也。尺脉弱，发热者，是阴
不足，阳气下陷入于阴中也。此内伤不足，阴阳相乘，有休止之恶寒发热，非外感有余，风寒中伤营卫，无休
止之恶寒发热也。
【集注】方有执曰∶阳先乎阴以陷入也，故曰从，讳之也。阴随于阳以上入也，故曰乘，伤之也。恶寒者，
阳不足以胜阴，而与阴俱化也；发热者，阴不足以胜阳，而从阳之化也。
程知曰∶此辨阴阳相乘之脉也。往来则阴阳之气，更盛更虚，阴并则寒，阳并则热矣。凡疟与往来寒热之
脉皆然也。
问曰∶脉有阳结、阴结者，何以别之？答曰∶其脉浮而数，能食，不大便者，此为实，名曰阳结也，期十
七日当剧；其脉沉而迟，不能食，身体重，大便反硬，名曰阴结也，期十四日当剧。
【注】上条以脉之寸、尺微弱，辨阴阳不足，此条以脉之浮沉有力，别阴阳结实为病之诊法也。脉浮大而
数，蔼蔼如车盖者，阳结实脉也；脉沉石而迟，累累如循长竿者，阴结实脉也。夫脉既可以别阴阳之结实，又
不可不以阴结、阳结之证而合阴结、阳结之脉相参看也。阳结证，身轻能食，阳能消谷也。不大便，期十七日
当剧者，阳体终燥，故迟三日也。阴结证，身重不能食，阴不能消谷也。不大便，期十四日当剧者，阴体终濡，
故早三日也。剧者谓不大便，里急下重，且满且痛，不可再待时日，宜早图之也，故或润窍以导之，软坚以下
之，不致临期燥屎巨硬，谷道难出，窘苦万状也。凡病后伤液，多有此证，阅历深者，自知之也。
【集注】程应旄曰∶不曰病有，而曰脉有，二气所禀，有偏胜也。阳结者，偏于阳而无阴以生液；阴结者，
偏于阴而无阳以化液。皆于脉之浮而数，沉而迟辨之也。
阳脉浮，阴脉弱者，则血虚，血虚则筋急也。其脉沉者，营气微也；其脉浮，而汗出如流珠者，卫气衰也。
【按】阳脉浮，其脉浮之二“浮”字，当是“濡”字，若是“浮”字，则与卫衰汗出如流珠之义不属。其
脉沉之“沉”字，当是“弱”字，若是“沉”字，则与血虚营气微之义不属。
【注】此以浮沉别阴阳不足为病之诊法也。阳脉濡，浮而无力脉也；阴脉弱，沉而无力脉也。其脉弱者，
营气微也，营微则血虚，故不止于发热，而且筋急也。其脉濡者，卫气衰也，卫衰则表不固，故不止于恶寒，
而且汗出如流珠也。
【集注】方有执曰∶沉以候里，荣行脉中，故衰微可知。浮以候表，卫行脉外，汗出如流珠，则表不固，
故衰备可知。
脉蔼蔼如车盖者，名曰阳结也。
【注】蔼蔼如车盖，形容脉之浮大有力，即前阳结浮数之脉也，因其有力而盛，故名曰阳结也。
【集注】程应旄曰∶脉蔼蔼如车盖者，形容其浮数中有拥上之象。
脉累累如循长竿者，名曰阴结也。
【注】累累如循长竿者，形容脉之沉石有力，即前阴结沉迟之脉也，因其有力而盛，故名曰阴结也。
【集注】程知曰∶累累如循长竿，直引强硬之貌，为阴气固结，阳不得而和之。前言阴结、阳结，盖指便
硬一证言之，此则专言脉象也。
脉瞥瞥如羹上肥者，阳气微也。
【注】瞥瞥如羹上肥者，形容脉之浮而无力，即前卫气衰之濡脉，故曰阳气微也。
脉绵绵如泻漆之绝者，亡其血也。
【注】绵绵如泻漆之绝者，形容脉之沉而无力，即前营气微之弱脉，故曰亡其血也。
【集注】成无己曰∶绵绵者，连绵而软也。如泻漆之绝者，前大而后细也。
脉萦萦如蜘蛛丝者，阳气衰也。
【注】萦萦如蜘蛛丝者，形容脉之细小，难于寻按，而浮、中、沉似有似无，即前阳不足之微脉，故曰阳气衰也。
【集注】方有执曰∶萦萦如蛛丝，牵惹旁旋，微细欲绝之状。
师曰∶寸脉下不至关，为阳绝；尺脉上不至关，为阴绝。此皆不治，决死也。若计其余命生死之期，期以
月节克之也。
【注】此以上发明平脉，已下皆死候之脉也。寸、关、尺三部脉之上下，以候阴阳五脏升降也。寸位乎上，
候心肺之阳，主升。升极而降，降不至关，是为孤阳，故曰∶寸脉下不至关，为阳绝也。尺位乎下，候肝肾之
阴，主降。降极而升，升不至关，是为独阴，故曰∶尺脉上不至关，为阴绝也。关位乎中，以候脾，界乎寸尺，
所以升降出入者也。今上下不至关，是升降出入息矣。故曰∶此皆不治，决死也。若阴阳已离，胃气未绝，尚
可计余命之期，期以月节克之，如经曰∶阴胜则阳绝，能夏不能冬；阳胜则阴绝，能冬不能夏。肝死于秋，心
死于冬，脾死于春，肺死于夏，肾死于长夏之类是也，推之于日于时亦然。
又未知何脏阴阳前绝，若阳气前绝，阴气后竭者，其人死，身色必青；阴气前绝，阳气后竭者，其人死，
身色必赤，腋下温，心
下热也。
【注】经曰∶人有两死，而无两生。有两死者，谓阴阳皆可死也；无两生者，谓阴阳不能独生也。故阳先
绝，阴后竭，死则身青而冷；阴先绝，阳后竭，死则身赤而温也。
【集注】成无己曰∶阳主热而色赤，阴主寒而色青。其人死已，身色青，则阴未离乎体，故知阴气后竭
也；身色赤，腋下温，心下热，则阳未离乎体，故知阳气后竭也。
程知曰∶阳气前绝，寒病；阴气前绝，热病也。寒热之治法一误。虽死尚有征验，诚可畏也。
师曰∶脉病患不病，名曰行尸。以无旺气，卒眩仆，不识人者，短命则死。人病脉不病，名曰内虚。以
无谷神，虽困无苦。
【注】脉者，人之根本也。脉病患不病者，谓外形不病，而见真脏病脉。其内本已绝，虽生犹死，不过
尸居余气耳！故曰∶行尺也。余气者，未尽五脏生旺之余气也，若旺气一退，即卒然眩仆不识人而死矣。若良
工早察于旺气未退之先而图之，未必无所补也。人病脉不病，谓外形羸瘦似病，其脉自和，以根本尚固，不过
谷气不充，名曰内虚，非行尸可比，虽困无害。胃气复，谷气充，自然安矣。谷神即谷气也。
【集注】方有执曰∶周氏云∶形体之中，觉见憔悴，精神昏愦，食不忻美，而脉得四时之从，无过、不
及之偏，是人病脉不病也。形体安和，而脉息乍大乍小，或至或损，弦紧浮滑，沉涩不一，残贼冲和之气，是
脉息不与形相应，乃脉病患不病也。
张锡驹曰∶谷神乃水谷所化之神，人赖此以资生也。内虚食少，谷气不充，即无谷神矣。故曰∶无害。
若无本然之胃神，安得谓之无害耶！
未知何脏先受其灾，若汗出发润，喘不休者，此为肺先绝也。
【注】此申上条不知何脏先绝，而详言其证也。肺主皮毛，肺绝汗出不流，故发润也；肺主气，肺绝张口气
出，不能复还也。故曰为肺先绝也。
【集注】成无己曰∶肺为气之主，为津液之帅。汗出发润者，津脱也；喘不休者，气脱也。
脉浮而洪，身汗如油，喘而不休，水浆不下，形体不仁，乍静乍乱，此为命绝也。
【注】身汗如油，液外亡也；喘而不休，气上脱也；水浆不下，胃气绝也；形体不仁，营卫败也；乍静乍
立夏时节出现洪大脉，这是该季节正常的脉象。如果病人身体疼痛且沉重，必须采用发汗的方法治疗。如果第二天身体不再疼痛和沉重，就不需要再发汗。如果病人自然出汗，那么第二天病情就会痊愈。为什么这样说呢？因为立夏时节出现洪大脉是顺应时令的脉象，所以会导致这种情况。其他三个季节的情况也依此类推。
【注】凡是四季的疾病，都应当根据四季的脉象来推测其预后（判断是否痊愈）。所谓“期”，就是预测其能否痊愈。立夏这一天，出现洪大脉，是当时应当出现的正常脉象。如果病人身体疼痛且沉重，必须发汗。如果第二天身体不疼也不重，即使脉象仍然洪大，那也不是病脉，而是顺应时令的脉象，不需要再发汗，说明病已经好了。假设当天自然大汗出，这说明病愈的迹象已经显现，虽然脉象洪大，也不需要发汗，第二天自然会痊愈。为什么这样说呢？因为立夏出现洪大脉，是得到了顺应时令的脉象的缘故。其他季节也仿照这个原则。
【集注】方有执说：这段话讲的是脉象顺应时令而旺盛，那么疾病就有当愈的时候。以夏季为例来类推其余季节，以此示人推演仿效的意思。
程知说：春季脉弦、夏季脉洪、秋季脉浮（毛）、冬季脉沉（石），在相应的季节出现这些脉象，就是平脉（正常脉）。即使是外感寒邪，只要微微出汗就能自愈！症状重的才需要治疗，症状轻的就不必治疗。《内经》说：“脉象顺应四时变化。”指的就是这种情况。
程应旄说：洪大脉是夏季的脉象，也是邪气盛盛的脉象。有病时脉象随邪气变化，无病时则随季节变化，判断病愈与否不需要另外辨别。
西方肺脏的脉象，形状像什么？老师说：肺属金，名为太阴经，其脉象表现为毛浮（轻浮如羽毛）。肺病患者如果自然得到这种脉象，若兼见缓迟脉则都会痊愈；若兼见数脉（快速）则病情加重。为什么这样知道呢？数脉属于南方火，火克西方金，按照医理应当发生痈肿，难以治疗。
【注】西方属金，主掌秋季燥气，在天为燥，在地为金，在人对应肺，所以说：肺属金。名为手太阴经，其脉应当浮。如果见到毛浮且缓迟，这种浮中有胃气（和缓之象），是肺的平脉，即使有肺病，也容易痊愈。如果见到毛浮但缓迟较少，这是浮多胃少，是肺的病脉。如果见到毛浮而没有缓迟，这只有浮象而无胃气，是肺的死脉。如果见到毛浮而数，则病情严重。为什么这样知道呢？数是南方火的脉象，火克西方金，按照医理应当发作痈肿且难治。
【集注】方有执说：肺主皮毛，位于上部如华盖，所以脉象毛浮。缓迟是脾土的脉象。兼得缓迟表示痊愈，是因为肺金得土生（土生金），法理上应当发生痈脓的是金遇火化（火克金）。
北方肾脏的脉象，形状像什么？老师说：肾属水，名为少阴经，其脉象沉滑，这就是肾脉。肾病患者如果自然得到沉滑而濡软的脉象，就会痊愈。
【按语】东南西方都有相关论述，唯独缺少北方的内容，仿照经文补入。
【注】北方属水，主掌冬季寒气，在天为寒，在地为水，在人对应肾，所以说肾属水，名为足少阴经，其脉应当沉。如果见到沉滑而濡软，这种沉中有胃气，是肾的平脉，即使有肾病，也容易痊愈。如果见到沉滑但濡和较少，这是沉多胃少，是肾的病脉。如果见到沉而没有滑濡，这只有沉象而无胃气，是肾的死脉。
问：脉象忽聚忽散称为滑，这是什么意思？老师说：沉代表纯阴，翕（聚合向上）代表正阳，阴阳调和，所以使脉象滑利，关部和尺部的脉象自然平和。阳明经的脉微沉，饮食正常。少阴经的脉微滑，滑是紧脉的浮取表现，这属于阴实，病人必定大腿内侧出汗，外阴潮湿。
【按语】“滑者紧之浮名也，此为阴实”这两句，与上下文义不符，可能是竹简错乱。
【注】这是冬季的平脉。如果阳明关脉微沉而不滑，是失去了正阳，导致胃不和，所以病人饮食仅能维持正常。如果少阴尺脉微滑而不濡，是失去了纯阴，导致肾不和，所以病人出汗，外阴潮湿。
问：脉有相乘（过度克制），有纵、横、逆、顺，是什么意思？老师说：水行乘火，金行乘木，名叫纵；火行乘水，木行乘金，名叫横；水行乘金，火行乘木，名叫逆；金行乘水，木行乘火，名叫顺。
【注】这是通过人的五脏脉象，来诊察五脏不平衡的方法。人的五脏，效法天地的五行，即肝木、心火、脾土、肺金、肾水，这是它们相互归属的关系。木生火，火生土，土生金，金生水，水生木，这是相生关系。木克土，土克水，水克火，火克金，金克木，这是相克关系。相生则生，相克则死。人的脏气也是如此，所以其脉有相乘，有纵、横、逆、顺。水乘火，金乘木，是乘其所胜（我克者），这是相克，名叫纵。火乘水，木乘金，是乘所不胜（克我者），这是反侮，名叫横。水乘金，火乘木，是子乘母（子盗母气或反向克制），这是倒施，名叫逆。金乘水，木乘火，是母乘子，这是相生，名叫顺。五脏的脉象，肝弦、心洪、脾缓、肺浮、肾沉，五脏各自出现本脏的脉象，就没有病。如果出现其他脉象，据此推断，纵者病重，横者病轻，逆者病虚，顺者病实。
【集注】方有执说：乘，如同乘坐车船。纵，直也。横是纵的对立面。顺，顺从也。逆是顺的反面。
程知说：不在其时而出现，就是相乘，纵横为患最重，顺逆尚且没有大害。
问：如何知道是乘腑？如何知道是乘脏？老师说：诸阳脉浮数为乘腑，诸阴脉迟涩为乘脏。
【注】上一条阐明了五脏相乘、纵横顺逆的脉象，这一条阐明了阴阳相乘、各从其类的诊法。腑，属阳；浮数，属阳。脏，属阴；迟涩，属阴。阳乘阳，阴乘阴，各从其类而相乘。如果是阴邪乘阳，阳邪乘阴，腑邪乘脏，脏邪乘腑，可以结合脉证错综参互推论。
【集注】方有执说：浮数属阳，在阳部见到阳脉，所以知道是乘腑。迟涩属阴，在阴部见到阴脉，所以知道是乘脏。
问：濡弱脉为何反而能对应十一头（指五脏六腑）？老师说：五脏六腑相乘，所以称为十一。
【注】这是承接上一条，阐明五脏六腑不平相乘的脉象。适，至也。头，数也。凡人如果见到濡弱之脉且出现相乘现象，是因为我虚而彼乘袭所致。越人（扁鹊）只说一脉辄为十变，为何达到十一之数呢？越人遗漏了包络和三焦，所以是十。现在五脏六腑相乘，所以是十一。然而阴乘阳，阳乘阴，腑乘脏，脏乘腑，错杂综合起来，岂止十一耶！
【集注】程知说：这是总括脉的大要，说脉得濡弱，就可以和适五脏六腑。经书说：“呼吸者脉之头。”濡弱者，软和以滑，《内经》称之为有胃气。五脏六腑的邪气，不能不相乘，如金邪乘木，木邪乘火之类，只有在各种相乘中，含有软和以滑之意，就容易痊愈，所以濡弱可以和适十一脏脉气。
问：疾病有洒淅恶寒（战栗怕冷）又复发热，是什么原因？回答说：阴脉不足，阳气往从之；阳脉不足，阴气往乘之。问：什么叫阳不足？回答说：假如寸口脉微，名叫阳不足，阴气上入阳中，就会洒淅恶寒。问：什么叫阴不足？回答说：尺脉弱，名叫阴不足，阳气下陷于阴中，就会发热。
【注】这是通过寸、尺脉来阐明阴阳相乘致病的脉象。如果脉紧无汗，洒淅恶寒发热，这是伤寒。脉缓有汗，洒淅恶寒发热，这是中风。现在寸脉微，洒淅恶寒，是阳不足，阴气上乘，进入阳分。尺脉弱，发热，是阴不足，阳气下陷进入阴分。这是内伤不足，阴阳相乘，有休止期的恶寒发热，不同于外感有余，风寒中伤营卫，无休止期的恶寒发热。
【集注】方有执说：阳先于阴陷入，所以说“从”，是避讳的说法。阴随阳以上入，所以说“乘”，是伤害的说法。恶寒，是因为阳不足以胜阴，而与阴一起化寒；发热，是因为阴不足以胜阳，而从阳化热。
程知说：这是辨析阴阳相乘的脉象。往来则阴阳之气，更盛更虚，阴并则寒，阳并则热。凡疟疾与往来寒热的脉象都是这样。
问：脉有阳结、阴结，如何区别？回答说：脉浮而数，能食，不大便的，这是实证，名叫阳结，预计十七日病情会加剧；脉沉而迟，不能食，身体沉重，大便反而硬的，名叫阴结，预计十四日病情会加剧。
【注】上一条通过脉的寸、尺微弱，辨析阴阳不足；这一条通过脉的浮沉有力，辨别阴阳结实致病的诊法。脉浮大而数，蔼蔼如车盖般的，是阳结实的脉象；脉沉石而迟，累累如循长竿般的，是阴结实的脉象。脉既可以辨别阴阳的结实，又不能不以阴结、阳结的证候结合阴结、阳结的脉象参看。阳结证，身轻能食，阳能消谷。不大便，预计十七日加剧的，是因为阳体终燥，所以推迟三日。阴结证，身重不能食，阴不能消谷。不大便，预计十四日加剧的，是因为阴体终濡，所以提前三日。加剧是指不大便，里急后重，胀满且痛，不能再等待时日，应当尽早处理，或者润窍导之，或者软坚下之，不至于临期燥屎巨大坚硬，肛门难出，窘苦万状。凡是病后伤津液，多有此证，阅历深的人自然知道。
【集注】程应旄说：不说病有，而说脉有，是因为二气禀赋有偏胜。阳结者，偏于阳而无阴以生津液；阴结者，偏于阴而无阳以化津液。都在脉的浮而数，沉而迟来辨别。
阳脉浮，阴脉弱的，则血虚，血虚则筋脉拘急。其脉沉的，是营气微弱；其脉浮，且汗出如流珠的，是卫气衰弱。
【按语】阳脉浮，其脉浮之二个“浮”字，应当是“濡”字，如果是“浮”字，则与卫衰汗出如流珠的意义不符。其脉沉的“沉”字，应当是“弱”字，如果是“沉”字，则与血虚营气微的意义不符。
【注】这是通过浮沉来辨别阴阳不足致病的诊法。阳脉濡，是浮而无力之脉；阴脉弱，是沉而无力之脉。其脉弱的，是营气微，营微则血虚，所以不仅发热，而且筋急。其脉濡的，是卫气衰，卫衰则表不固，所以不仅恶寒，而且汗出如流珠。
【集注】方有执说：沉以候里，营行脉中，所以衰微可知。浮以候表，卫行脉外，汗出如流珠，则表不固，所以衰弱备至可知。
脉蔼蔼如车盖的，名叫阳结。
【注】蔼蔼如车盖，形容脉象浮大有力，即前文阳结浮数之脉，因其有力而盛，所以名叫阳结。
【集注】程应旄说：脉蔼蔼如车盖，形容其浮数中有拥上之象。
脉累累如循长竿的，名叫阴结。
【注】累累如循长竿，形容脉象沉石有力，即前文阴结沉迟之脉，因其有力而盛，所以名叫阴结。
【集注】程知说：累累如循长竿，直引强硬之貌，为阴气固结，阳不得而和之。前言阴结、阳结，大概是指大便硬这一症状而言，这里则专门讲脉象。
脉瞥瞥如羹上肥的，是阳气微。
【注】瞥瞥如羹上肥，形容脉象浮而无力，即前文卫气衰之濡脉，所以说阳气微。
脉绵绵如泻漆之绝的，是亡血。
【注】绵绵如泻漆之绝，形容脉象沉而无力，即前文营气微之弱脉，所以说亡血。
【集注】成无己说：绵绵者，连绵而软也。如泻漆之绝者，前大而后细也。
脉萦萦如蜘蛛丝的，是阳气衰。
【注】萦萦如蜘蛛丝，形容脉象细小，难于寻按，而浮、中、沉似有似无，即前文阳不足之微脉，所以说阳气衰。
【集注】方有执说：萦萦如蛛丝，牵惹旁旋，微细欲绝之状。
老师说：寸脉下不到关部，为阳绝；尺脉上不到关部，为阴绝。这都是不治之症，决断为死证。如果要计算剩余寿命的生死期限，要根据月节相克来推算。
【注】以上阐明了平脉，以下都是死候之脉。寸、关、尺三部脉的上下，用来候察阴阳五脏的升降。寸位乎上，候心肺之阳，主升。升极而降，降不到关部，是为孤阳，所以说：寸脉下不到关部，为阳绝。尺位乎下，候肝肾之阴，主降。降极而升，升不到关部，是为独阴，所以说：尺脉上不到关部，为阴绝。关位乎中，以候脾，介于寸尺之间，是升降出入的枢纽。现在上下不到关部，是升降出入停止。所以说：这都是不治之症，决断为死证。如果阴阳已离，胃气未绝，还可以计算余命之期，根据月节相克来推算，如经书所说：阴胜则阳绝，能夏不能冬；阳胜则阴绝，能冬不能夏。肝死于秋，心死于冬，脾死于春，肺死于夏，肾死于长夏之类，推之于日于时也是这样。
又不知道何脏阴阳先绝，如果阳气先绝，阴气后竭的，其人死，身色必青；阴气先绝，阳气后竭的，其人死，身色必赤，腋下温，心下热。
【注】经书说：人有两死，而无两生。有两死者，谓阴阳皆可死；无两生者，谓阴阳不能独生。所以阳先绝，阴后竭，死则身青而冷；阴先绝，阳后竭，死则身赤而温。
【集注】成无己说：阳主热而色赤，阴主寒而色青。其人死已，身色青，则阴未离乎体，所以知道阴气后竭；身色赤，腋下温，心下热，则阳未离乎体，所以知道阳气后竭。
程知说：阳气先绝，是寒病；阴气先绝，是热病。寒热治法一误，虽死尚有征验，确实可畏。
老师说：脉象有病而人看似无病，名叫行尸。因为没有旺气，突然眩晕仆倒，不识人的，短命则死。人病而脉象无病，名叫内虚。因为没有谷神（胃气），虽然困顿但没有痛苦。
【注】脉，是人的根本。脉病患不病者，谓外形不病，而见真脏病脉。其内本已绝，虽生犹死，不过是尸居余气罢了！所以说行尸。余气者，未尽五脏生旺之余气也，如果旺气一退，就突然眩晕仆倒不识人而死。如果良医早在旺气未退之前图谋救治，未必没有补益。人病脉不病，谓外形羸瘦似病，其脉自和，因为根本尚固，不过是谷气不充，名叫内虚，不可与行尸相比，虽然困顿也无害。胃气恢复，谷气充盈，自然安泰。谷神即谷气。
【集注】方有执说：周氏说：形体之中，觉见憔悴，精神昏愦，食不忻美，而脉得四时之从，无过、不及之偏，是人病脉不病也。形体安和，而脉息乍大乍小，或至或损，弦紧浮滑，沉涩不一，残贼冲和之气，是脉息不与形相应，乃脉病患不病也。
张锡驹说：谷神乃水谷所化之神，人赖此以资生也。内虚食少，谷气不充，即无谷神矣。所以说无害。如果没有本然的胃神，怎能叫无害呢！
不知道何脏先受其灾，如果汗出发润，喘不休的，这是肺先绝。
【注】这是申述上一条不知何脏先绝，而详言其证候。肺主皮毛，肺绝汗出不流，故发润；肺主气，肺绝张口气出，不能复还。所以说为肺先绝。
【集注】成无己说：肺为气之主，为津液之帅。汗出发润者，津脱也；喘不休者，气脱也。
脉浮而洪，身汗如油，喘而不休，水浆不下，形体不仁，乍静乍乱，这是命绝。
【注】身汗如油，液外亡也；喘而不休，气上脱也；水浆不下，胃气绝也；形体不仁，营卫败也；乍静乍
In the summer solstice period, a flooding and large pulse (Hongda Mai, 洪大脉) appears, which is its proper position. If the patient suffers from body pain and heaviness, sweating therapy must be employed. If the next day the body no longer hurts or feels heavy, sweating therapy is unnecessary. If spontaneous sweating occurs, the condition will resolve the next day. Why is this so? Because a flooding and large pulse during the summer solstice period is the pulse corresponding to the season, hence this result. The same principle applies to the other four seasons.
[Annotation] For diseases occurring in any of the four seasons, one should predict their outcome based on the seasonal pulses. "Predicting" means forecasting whether recovery will occur. On the day of the summer solstice, obtaining a flooding and large pulse is the expected normal pulse for that time. If the patient suffers from body pain and heaviness, sweating therapy is required. If the next day the body is neither painful nor heavy, even if the pulse remains flooding and large, it is not a pathological pulse but a seasonal pulse; further sweating therapy is unnecessary, indicating resolution. Suppose there was spontaneous profuse sweating on that day; this shows signs of resolution have appeared. Although the pulse is flooding and large, sweating therapy is not needed, and the disease will resolve spontaneously the next day. Why say this? Because obtaining a flooding and large pulse at the summer solstice indicates acquiring the seasonal pulse. The other seasons follow this pattern.
[Collected Annotations] Fang Youzhi states: This passage discusses how when the pulse flourishes in accordance with the season, the disease has a time to resolve. It uses summer as an example to illustrate the rest, showing the intent for people to deduce and emulate.
Cheng Zhi states: In spring the pulse is wiry, in summer flooding, in autumn floating like hair, and in winter deep like stones. When these appear in their respective seasons, they are normal pulses. Even with external cold pathogen invasion, slight sweating leads to self-healing! Severe cases require treatment, mild cases do not. The *Neijing* says: "Pulses conforming to the four seasons." This refers to that.
Cheng Yingmao states: A flooding and large pulse is the pulse of summer, but also a pulse of excess pathogen. With disease, the pulse follows the pathogen; without disease, it follows the season. Determining resolution does not require separate differentiation.
What does the pulse of the Western Lung organ resemble? The Master said: The Lung belongs to Metal, named Taiyin, and its pulse is light and floating (Maofu, 毛浮). If a Lung disease patient naturally presents this pulse, and it is accompanied by a slow and delayed (Huanchi, 缓迟) quality, all will recover; if accompanied by a rapid (Shu, 数) quality, the condition worsens. How do we know this? Rapid is associated with Southern Fire; Fire overcomes Western Metal. According to medical principles, carbuncles and swellings should occur, making it difficult to treat.
[Annotation] The West belongs to Metal, governing the dryness of Autumn. In Heaven it is Dryness, in Earth it is Metal, and in Humans it corresponds to the Lung; thus, "The Lung belongs to Metal." Named the Hand-Taiyin Meridian, its pulse should be floating. If one observes Maofu with Huanchi, this floating contains Stomach Qi (harmonious quality), representing the normal Lung pulse. Even with Lung disease, recovery is easy. If Maofu appears with little Huanchi, this is excessive floating with little Stomach Qi, a pathological Lung pulse. If Maofu appears without Huanchi, this is only floating without Stomach Qi, a fatal Lung pulse. If Maofu appears with Shu, the illness is severe. How do we know? Shu is the pulse of Southern Fire; Fire overcomes Western Metal, leading to carbuncles and difficult treatment.
[Collected Annotations] Fang Youzhi states: The Lung governs skin and hair, located superiorly like a canopy, hence the Maofu pulse. Huanchi is the pulse of Spleen Earth. Obtaining Huanchi indicates recovery because Lung Metal receives generation from Earth (Earth generates Metal). Carbuncle/pus formation occurs due to Metal transforming under Fire (Fire overcomes Metal).
What does the pulse of the Northern Kidney organ resemble? The Master said: The Kidney belongs to Water, named Shaoyin, and its pulse is deep and slippery (Chenhua, 沉滑); this is the Kidney pulse. If a Kidney disease patient naturally obtains a deep, slippery, and soft (Ru, 濡) pulse, they will recover.
[Note] Texts exist for Southeast and West, but the North is missing; this section supplements it following the classic style.
[Annotation] The North belongs to Water, governing the cold of Winter. In Heaven it is Cold, in Earth it is Water, and in Humans it corresponds to the Kidney; thus, "The Kidney belongs to Water." Named the Foot-Shaoyin Meridian, its pulse should be deep. If one observes Chenhua with Ru, this deepness contains Stomach Qi, representing the normal Kidney pulse. Even with Kidney disease, recovery is easy. If Chenhua appears with little Ru harmony, this is excessive deepness with little Stomach Qi, a pathological Kidney pulse. If deepness appears without Hua/Ru, this is only deepness without Stomach Qi, a fatal Kidney pulse.
Question: What is meant by "Xi yan chen" (sudden gathering then sinking), called Slippery (Hua, 滑)? The Master said: Sinking represents pure Yin, Xi (gathering upward) represents correct Yang. When Yin and Yang harmonize, the pulse becomes slippery, and the Guan and Chi positions are naturally balanced. The Yangming pulse is slightly deep, and digestion is normal. The Shaoyin pulse is slightly slippery. Slippery is the floating name of the Tight (Jin, 紧) pulse; this constitutes Yin Excess. The patient will definitely have sweating inside the thighs and dampness in the genital area.
[Note] The phrases "Slippery is the floating name of the Tight pulse" and "This constitutes Yin Excess" do not fit the context and are likely misplaced bamboo slips.
[Annotation] This describes the normal pulse of winter. If the Yangming Guan pulse is slightly deep but not slippery, it loses Correct Yang, causing Stomach disharmony, so digestion is merely maintained. If the Shaoyin Chi pulse is slightly slippery but not Ru, it loses Pure Yin, causing Kidney disharmony, resulting in sweating and dampness in the genital area.
Question: What are mutual overcoming (Cheng, 乘), Zong (Vertical/Unrestrained), Heng (Horizontal/Rebellious), Ni (Reverse), and Shun (Smooth)? The Master said: Water overcoming Fire, and Metal overcoming Wood are called Zong; Fire overcoming Water, and Wood overcoming Metal are called Heng; Water overcoming Metal, and Fire overcoming Wood are called Ni; Metal overcoming Water, and Wood overcoming Fire are called Shun.
[Annotation] This is a diagnostic method using five organ pulses to observe imbalance in the five zang organs. Human five zang organs correspond to Heavenly Five Elements: Liver Wood, Heart Fire, Spleen Earth, Lung Metal, Kidney Water. This is their affiliation. Wood generates Fire, Fire generates Earth, Earth generates Metal, Metal generates Water, Water generates Wood; this is Mutual Generation. Wood overcomes Earth, Earth overcomes Water, Water overcomes Fire, Fire overcomes Metal, Metal overcomes Wood; this is Mutual Overcoming. Generation leads to life, overcoming leads to death. Human organ qi is the same, hence pulses show Cheng, Zong, Heng, Ni, and Shun. Water overcoming Fire, Metal overcoming Wood, is overcoming what one controls (Sheng), which is Mutual Overcoming, called Zong. Fire overcoming Water, Wood overcoming Metal, is overcoming what controls one (Bu Sheng), which is Reverse Insult, called Heng. Water overcoming Metal, Fire overcoming Wood, is child overcoming mother, which is Inverted Application, called Ni. Metal overcoming Water, Wood overcoming Fire, is mother overcoming child, which is Mutual Generation, called Shun. The five zang pulses are: Liver Wiry, Heart Flooding, Spleen Slow, Lung Floating, Kidney Deep. If each zang shows its own pulse, there is no disease. If other pulses appear, infer accordingly: Zong indicates severe disease, Heng indicates mild disease, Ni indicates deficiency disease, Shun indicates excess disease.
[Collected Annotations] Fang Youzhi states: Cheng means riding a boat or cart. Zong means straight. Heng is the opposite of Zong. Shun means compliance. Ni is the opposite of Shun.
Cheng Zhi states: Appearing out of season constitutes Cheng. Zong and Heng cause the heaviest harm; Ni and Shun cause little harm.
Question: How to know if it is overcoming the Fu organs? How to know if it is overcoming the Zang organs? The Master said: All Yang pulses that are floating and rapid indicate overcoming the Fu organs; all Yin pulses that are slow and choppy indicate overcoming the Zang organs.
[Annotation] The previous paragraph explained the pulses of five-zang mutual overcoming (Zong, Heng, Ni, Shun); this paragraph explains Yin-Yang mutual overcoming, each following its category. Fu organs are Yang; Floating/Rapid are Yang. Zang organs are Yin; Slow/Choppy are Yin. Yang overcoming Yang, Yin overcoming Yin, each follows its category. If Yin pathogen overcomes Yang, Yang pathogen overcomes Yin, Fu pathogen overcomes Zang, Zang pathogen overcomes Fu, one can deduce by combining pulse and symptoms.
[Collected Annotations] Fang Youzhi states: Floating/Rapid are Yang; seeing Yang pulse in Yang position indicates overcoming Fu. Slow/Choppy are Yin; seeing Yin pulse in Yin position indicates overcoming Zang.
Question: Why does the Soft-Weak (Ruruo, 濡弱) pulse correspond to eleven heads (organs)? The Master said: Because five zang and six fu mutually overcome, hence eleven.
[Annotation] This continues the previous point, explaining the pulses of five-zang and six-fu imbalance and mutual overcoming. Shi means arrival. Tou means number. If a person presents a Ruruo pulse with mutual overcoming, it is because internal deficiency allows external factors to overcome. Yue Ren (Bian Que) stated one pulse changes ten times; why eleven now? Yue Ren omitted Pericardium and Sanjiao, hence ten. Now with five zang and six fu, it is eleven. However, Yin overcoming Yang, Yang overcoming Yin, Fu overcoming Zang, Zang overcoming Fu, mixed and combined, exceeds eleven!
[Collected Annotations] Cheng Zhi states: This summarizes the essence of pulses. A Ruruo pulse indicates harmony among five zang and six fu. The Classics say: "Breathing is the head of the pulse." Ruruo means soft, harmonious, and slippery, called having Stomach Qi in the *Neijing*. Pathogens of five zang and six fu inevitably overcome each other (e.g., Metal pathogen overcoming Wood, Wood pathogen overcoming Fire). Only if there is a soft, harmonious, and slippery quality within these overcomings is recovery easy. Thus, Ruruo can harmonize the pulse qi of eleven organs.
Question: Why do patients experience chills (Saxie, 洒淅) followed by fever? Answer: When Yin pulse is deficient, Yang moves to follow it; when Yang pulse is deficient, Yin moves to overcome it. Question: What is Yang deficiency? Answer: If the Cun position pulse is micro (Wei, 微), it is called Yang deficiency. Yin qi enters Yang, causing Saxie chills. Question: What is Yin deficiency? Answer: If the Chi position pulse is weak (Ruo, 弱), it is called Yin deficiency. Yang qi sinks into Yin, causing fever.
[Annotation] This uses Cun and Chi positions to explain Yin-Yang mutual overcoming causing disease. If pulse is tight without sweat, Saxie chills/fever, it is Cold Damage (Shanghan). If pulse is slow with sweat, Saxie chills/fever, it is Wind Strike (Zhongfeng). Here, Cun pulse is micro with Saxie chills: Yang deficiency, Yin qi surges upward into Yang. Chi pulse is weak with fever: Yin deficiency, Yang qi sinks downward into Yin. This is internal injury/deficiency, Yin-Yang mutual overcoming, with paroxysmal chills/fever, unlike external excess where Wind-Cold injures Ying-Wei with continuous chills/fever.
[Collected Annotations] Fang Youzhi states: Yang falls into Yin first, hence "follow," a euphemism. Yin follows Yang upward, hence "overcome," implying injury. Chills occur because Yang cannot overcome Yin, merging with Yin to become cold. Fever occurs because Yin cannot overcome Yang, merging with Yang to become heat.
Cheng Zhi states: This differentiates Yin-Yang mutual overcoming pulses. Alternating implies Yin and Yang qi wax and wane; Yin merging causes cold, Yang merging causes heat. This applies to Malaria and alternating chills/fever pulses.
Question: There are Yang Jie (Yang Knotting) and Yin Jie (Yin Knotting) in pulses; how to distinguish them? Answer: Pulse floating and rapid, able to eat, constipation: this is Excess, named Yang Jie, expected to worsen on the 17th day. Pulse deep and slow, unable to eat, body heavy, stool hard: this is Yin Jie, expected to worsen on the 14th day.
[Annotation] The previous paragraph differentiated Yin-Yang deficiency via weak Cun/Chi pulses; this paragraph differentiates Yin-Yang Excess via strong Floating/Sinking pulses. Pulse floating, large, rapid, abundant like a chariot canopy is the Yang Jie solid pulse; pulse deep, stone-like, slow, continuous like touching a long pole is the Yin Jie solid pulse. Pulses differentiate Yin-Yang excess, but must be combined with symptoms. Yang Jie symptoms: light body, able to eat (Yang digests grain). Constipation, worsening on day 17: Yang nature is dry, hence delayed three days. Yin Jie symptoms: heavy body, unable to eat (Yin fails to digest grain). Constipation, worsening on day 14: Yin nature is moist, hence early three days. "Worsening" means severe constipation, tenesmus, fullness, pain, requiring immediate action—moistening or purging—to avoid hard stool blocking the anus. Post-illness fluid damage often causes this; experienced practitioners know well.
[Collected Annotations] Cheng Yingmao states: Saying "pulse has" rather than "disease has" implies constitutional bias. Yang Jie is biased toward Yang without Yin to generate fluids; Yin Jie is biased toward Yin without Yang to transform fluids. Differentiated by floating/rapid vs. deep/slow pulses.
If Yang pulse is floating and Yin pulse is weak, blood is deficient; blood deficiency causes tendon tension. If the pulse is deep, Ying Qi is faint. If the pulse is floating and sweat flows like pearls, Wei Qi is衰 (declining).
[Note] The two "floating" characters in "Yang pulse floating" should be "Soft" (Ru); otherwise, it conflicts with Wei decline and pearl-like sweat. The "deep" character should be "Weak" (Ruo); otherwise, it conflicts with blood deficiency and faint Ying Qi.
[Annotation] This uses Floating/Sinking to differentiate Yin-Yang deficiency. Yang pulse Ru is floating and forceless; Yin pulse Ruo is deep and forceless. Weak pulse indicates faint Ying Qi; faint Ying leads to blood deficiency, causing not just fever but tendon tension. Ru pulse indicates declining Wei Qi; declining Wei leads to insecure exterior, causing not just chills but pearl-like sweat.
[Collected Annotations] Fang Youzhi states: Deep examines interior; Ying circulates in vessels, so decline is known. Floating examines exterior; Wei circulates outside vessels; pearl-like sweat indicates insecure exterior, so decline is evident.
A pulse abundant like a chariot canopy is named Yang Jie.
[Annotation] Abundant like a chariot canopy describes a floating, large, and forceful pulse, i.e., the previous Yang Jie floating-rapid pulse. Due to its strength and abundance, it is named Yang Jie.
[Collected Annotations] Cheng Yingmao states: Abundant like a chariot canopy describes a floating-rapid pulse with an upward-surging image.
A pulse continuous like touching a long pole is named Yin Jie.
[Annotation] Continuous like touching a long pole describes a deep, stone-like, and forceful pulse, i.e., the previous Yin Jie deep-slow pulse. Due to its strength and abundance, it is named Yin Jie.
[Collected Annotations] Cheng Zhi states: Continuous like touching a long pole is straight, rigid, and stiff, indicating Yin Qi knotting, preventing Yang from harmonizing. Previous mentions of Yin/Yang Jie referred to constipation; here it specifically refers to pulse morphology.
A pulse fleeting like fat floating on soup indicates faint Yang Qi.
[Annotation] Fleeting like fat on soup describes a floating but forceless pulse, i.e., the previous Wei Qi decline Ru pulse, hence "faint Yang Qi."
A pulse continuous like the end of pouring lacquer indicates loss of blood.
[Annotation] Continuous like the end of pouring lacquer describes a deep but forceless pulse, i.e., the previous Ying Qi faint Ruo pulse, hence "loss of blood."
[Collected Annotations] Cheng Wuji states: Continuous means lingering and soft. Like the end of pouring lacquer means large initially then thin.
A pulse winding like a spider's silk indicates Yang Qi decline.
[Annotation] Winding like spider's silk describes a fine pulse, difficult to locate, appearing/disappearing in floating, middle, and deep levels, i.e., the previous Yang deficiency Micro pulse, hence "Yang Qi decline."
[Collected Annotations] Fang Youzhi states: Winding like spider silk is tangled and swirling, minute and nearly absent.
The Master said: If the Cun pulse does not reach down to the Guan position, it is Yang Extinction. If the Chi pulse does not reach up to the Guan position, it is Yin Extinction. These are untreatable and indicate death. To calculate the remaining lifespan, predict based on monthly/seasonal overcoming.
[Annotation] The above explained normal pulses; the following are death omens. Cun, Guan, Chi positions monitor Yin-Yang and Five Zang ascent/descent. Cun is superior, monitoring Heart/Lung Yang, governing ascent. Ascent peaks then descends; if descent doesn't reach Guan, it is Lone Yang, hence "Cun pulse not reaching Guan is Yang Extinction." Chi is inferior, monitoring Liver/Kidney Yin, governing descent. Descent peaks then ascends; if ascent doesn't reach Guan, it is Lone Yin, hence "Chi pulse not reaching Guan is Yin Extinction." Guan is central, monitoring Spleen, between Cun and Chi, governing ascent/descent/out/in. Now upper/lower don't reach Guan, meaning ascent/descent/out/in have ceased. Hence "untreatable, certain death." If Yin-Yang have separated but Stomach Qi remains, remaining life can be calculated by monthly/seasonal overcoming, e.g., *Classic* says: Yin excess leads to Yang extinction, tolerates Summer but not Winter; Yang excess leads to Yin extinction, tolerates Winter but not Summer. Liver dies in Autumn, Heart in Winter, Spleen in Spring, Lung in Summer, Kidney in Late Summer. Deduction applies to days and hours too.
If unknown which Zang's Yin-Yang extinguished first: If Yang extinguishes first and Yin exhausts later, the deceased body color will be green; if Yin extinguishes first and Yang exhausts later, the deceased body color will be red, with warm armpits and heat below the heart.
[Annotation] The Classic says: Humans have two deaths but no dual lives. Two deaths mean both Yin and Yang can die; no dual lives means Yin and Yang cannot survive alone. Thus, Yang first extinct, Yin later exhausted: death with green/cold body. Yin first extinct, Yang later exhausted: death with red/warm body.
[Collected Annotations] Cheng Wuji states: Yang governs heat and red color; Yin governs cold and green color. After death, green body means Yin hasn't left the body, so Yin exhausts later. Red body, warm armpits, heat below heart means Yang hasn't left the body, so Yang exhausts later.
Cheng Zhi states: Yang first extinct is Cold disease; Yin first extinct is Heat disease. Mistaking cold/heat treatment leads to death, yet signs remain, truly formidable.
The Master said: Pulse indicates disease but the person appears healthy is called "Walking Corpse." Lacking vigorous Qi, sudden dizziness/fainting and unconsciousness lead to short life and death. Person is diseased but pulse is normal is called "Internal Deficiency." Lacking Grain Spirit (Stomach Qi), though distressed, there is no suffering.
[Annotation] Pulse is the root of humans. Pulse indicates disease but person appears healthy means exterior is healthy but True Zang disease pulse appears. Internally already extinct, living yet dead, merely corpse-like remaining Qi! Hence "Walking Corpse." Remaining Qi is leftover vital Qi of five zangs. Once vigorous Qi retreats, sudden dizziness/fainting/unconsciousness and death occur. If skilled physicians act before vigorous Qi retreats, there may be benefit. Person diseased but pulse normal means emaciated exterior but harmonious pulse; root is solid, merely lacking Grain Qi, named Internal Deficiency, unlike Walking Corpse. Though distressed, no harm. If Stomach Qi recovers and Grain Qi fills, peace returns naturally. Grain Spirit is Grain Qi.
[Collected Annotations] Fang Youzhi states: Zhou said: Body looks haggard, spirit confused, poor appetite, but pulse conforms to four seasons without excess/deficiency deviation: this is person diseased, pulse normal. Body healthy but pulse fluctuates (large/small, fast/slow, wiry/tight/floating/slippery/deep/choppy), damaging harmonious Qi, pulse not matching form: this is pulse indicates disease, person healthy.
Zhang Xiju states: Grain Spirit is the spirit transformed from food/water, sustaining life. Internal deficiency, low intake, lack of Grain Qi means no Grain Spirit. Hence "no harm." Without inherent Stomach Spirit, how can it be harmless?
Unknown which Zang suffers first: If sweat makes hair wet and panting never stops, this is Lung Extinction first.
[Annotation] Elaborating on which Zang extinguishes first: Lung governs skin/hair; Lung extinction causes non-flowing sweat, wetting hair. Lung governs Qi; Lung extinction causes gasping air out, unable to return. Hence "Lung Extinction first."
[Collected Annotations] Cheng Wuji states: Lung is master of Qi and commander of Fluids. Wet hair sweat is Fluid exhaustion; unceasing panting is Qi exhaustion.
Pulse floating and flooding, sweat like oil, unceasing panting, inability to take fluids, insensitivity of body, alternating calm and chaotic: this is Life Extinction.
[Annotation] Sweat like oil: Fluid loss externally. Unceasing panting: Qi escaping upward. Unable to take fluids: Stomach Qi extinct. Body insensitivity: Ying-Wei ruined. Alternating calm/chaotic...