枢机运转。可兆生死。
注曰。脾胃者。是关格。亦号枢机也。故脾者。运水谷。滋荣四肢。胃者受纳水谷。营运百脉。流注于人迎气口。
三脉周流。十二经而复大会于胃也。乃脾胃之脉绝与不绝。则可以明其吉凶死生之兆矣。
春土气之绝者。三年仲秋之日死。
注曰。春脉不见长。只见弦紧者。土气衰。而胃脉将绝也。应肝属木。生数三。故得三年。至仲秋金旺应时。其人
必死。何也。其病肝之疾形见左胁下。自仲秋间。金气旺动。至秋加呕逆。至秋变喘息气厥。至仲秋金气旺。木气绝。
故知死。
夏土气之绝者。二年仲冬之日死。
注曰夏脉不见大。只见浮洪者。土气衰。而胃将绝也。应在心属火。生数二。故得二年。仲冬水旺应时。其人必死。
何也。其病心之积形。见心胁间。自仲夏间动。至秋加喘息气急。至仲冬水气旺。火气灭。又土气绝。故知死。
秋土气之绝者。四年仲夏之日死。
注曰。秋脉不见细。只见毛涩者。土气变而胃脉将绝也。应肺属金。生数四。故得四年。至仲夏火旺应时。其人必
死。何也。其病肺之积形。见右胁下。自仲秋间动。至仲夏间变。腹虚鸣喘逆呕吐。至仲夏火气旺。金气消。又土气绝。
故主死也。
冬土气之绝者。一年仲夏之日死。
注曰。冬脉不见弱。只见沉滑者。土气衰。而胃脉将绝也。应在肾为水。生数一。故得一年。至仲夏土旺应时。其
人必死。何也。其肾积形。见在右胁后脊膂之间。动无定位自仲夏间动。至春和喘呼气逆。小腹胀满。夜梦鬼交。至仲
夏土气旺。水气涸。又土气先绝。是故死也。
土寄旺于四季。至四仲而气先胜。
注曰。土气正位。寄旺四季。故每至四季之月。土气先胜胃。金木水火不可无土也。土寄中央。以湿土之气。滋荣
万物。故有四时之旺。九天呈上。帝所居之位也。凡胃脉绝。而返应于仲夏死。何也。谓胃之胜土。居高位而克水也。
土主胃脉。当绝于冬。若仲冬之时。弱脉不见。至仲夏之时。火土相应子母同居。故至仲夏之时。土胜水绝。故知必死
也。
春脉弦紧而毛。返见八缓而止者。九日死。
注曰。春脉应弦紧而长。不见长而见毛者。胃气将绝也。返见八缓而止者。至九日当死。何也。八者木数。九者金
数。肝气自胜。胃气将绝。金又胜木。故九日死。
夏脉浮洪而滑。返见七涩而止者。六日死。
注曰。夏脉浮洪而大。不见大而见滑者。胃气将绝也。返见七涩而止者。至六日当死。何也七者火数。六者水数也。
心气自盛。胃气将绝也。水又胜火。故至六日死。
秋脉毛涩而钩。返见九细而止者。七日死。
注曰。秋脉应毛涩而细。不见细而见钩者。胃气将绝也。返见九细而止者。七日当死。何也。九者。金数也。七者。
火数也肺气自盛胃气将绝。火又胜金故七日死。
冬脉浮滑而缓。返见六洪而止者。五日死。
注曰。冬脉应沉滑而弱。不见弱不见缓者。胃气将绝也。返见六洪而止者。五日当死。何也。六者永数也。五者土
数也。肾气自盛。胃气将绝也。土又胜水。故五日死。
病应四时。不见胃脉者不治。
注曰。凡十二经。十五络。八脉受客邪而生诸病。若应四时不见胃脉。土气绝。则无生气。当死。春弦紧而不长。
夏浮洪而不大。秋毛涩而不细。冬沉滑而不弱。此四时不见胃气之脉也。病者必死。故人以胃气为百脉之主也。
枢机运转，可以预示生死。
注释说：脾胃，是关格（指阴阳之气隔绝不通的危重证候），也被称为枢机。所以脾的功能是运化水谷，滋养四肢；胃的功能是受纳水谷，营运全身经脉，气血流注于人迎穴和气口脉。
这三脉（人迎、气口、趺阳等，此处泛指主要诊脉部位）周流全身，十二经脉最终汇聚于胃。因此，通过观察脾胃之脉是否断绝，就可以明白吉凶生死的征兆。
春季土气断绝的，在第三年仲秋时节死亡。
注释说：春季脉象不见缓和之长，只见弦紧，这是土气衰弱，胃脉即将断绝的表现。对应肝脏属木，其生数为三，所以能维持三年。到了仲秋金气旺盛应时而至，此人必然死亡。为什么呢？因为病在肝，症状表现为左胁下不适。从仲秋开始，金气旺盛发动，到秋季加重出现呕吐逆气，再到秋季变为喘息气厥。到了仲秋金气极旺之时，木气断绝，所以知道会死。
夏季土气断绝的，在第二年仲冬时节死亡。
注释说：夏季脉象不见洪大，只见浮洪，这是土气衰弱，胃脉即将断绝的表现。对应心脏属火，其生数为二，所以能维持二年。到了仲冬水气旺盛应时而至，此人必然死亡。为什么呢？因为病在心之积，症状表现于心胁之间。从仲夏开始发作，到秋季加重出现喘息气急。到了仲冬水气旺盛之时，火气熄灭，同时土气也断绝，所以知道会死。
秋季土气断绝的，在第四年仲夏时节死亡。
注释说：秋季脉象不见细弱，只见毛涩，这是土气变异而胃脉即将断绝的表现。对应肺脏属金，其生数为四，所以能维持四年。到了仲夏火气旺盛应时而至，此人必然死亡。为什么呢？因为病在肺之积，症状表现在右胁下。从仲秋开始发作，到仲夏时节变化，出现腹部虚鸣、喘息逆气、呕吐。到了仲夏火气旺盛之时，金气消亡，同时土气也断绝，所以主死。
冬季土气断绝的，在第一年仲夏时节死亡。
注释说：冬季脉象不见沉弱，只见沉滑，这是土气衰弱而胃脉即将断绝的表现。对应肾脏为水，其生数为一，所以能维持一年。到了仲夏土气旺盛应时而至，此人必然死亡。为什么呢？因为肾积的症状，表现在右胁后脊背之间，动无定处。从仲夏开始发作，到春季和暖时出现喘息呼气逆乱、小腹胀满、夜间梦遗鬼交。到了仲夏土气旺盛之时，水气枯竭，同时土气先前已断绝，因此死亡。
土气寄旺于四季（每季最后一个月），到了四仲月（春分、夏至、秋分、冬至所在的月份）土气先胜。
注释说：土气正位，寄旺于四季，所以每到四季之月，土气先胜胃。金、木、水、火都不能没有土。土寄居中央，以湿土之气滋养万物，所以有四时的旺相。九天呈上，是帝君所居之位。凡是胃脉断绝，反而应在仲夏死亡。为什么呢？这是因为胃土胜气，居高位而克伐肾水。土主胃脉，本当在冬季断绝。如果在仲冬之时，弱脉不见，到了仲夏之时，火土相应，子母同居，所以到了仲夏之时，土胜水绝，因此知道必死。
注释说：春季脉象应弦紧而长，不见长而见毛象，这是胃气将断绝的表现。反而出现八缓而停止的，到九日应当死亡。为什么呢？八是木数，九是金数。肝气自盛，胃气将绝，金又克木，所以九日死。
注释说：夏季脉象浮洪而大，不见大而见滑，这是胃气将断绝的表现。反而出现七涩而停止的，到六日应当死亡。为什么呢？七是火数，六是 water 数。心气自盛，胃气将绝，水又克火，所以到六日死。
注释说：秋季脉象应毛涩而细，不见细而见钩象，这是胃气将断绝的表现。反而出现九细而停止的，七日应当死亡。为什么呢？九是金数，七是火数。肺气自盛，胃气将绝，火又克金，所以七日死。
冬季脉象浮滑且缓，反而出现六洪而停止的，五日后死亡。
注释说：冬季脉象应沉滑而弱，不见弱也不见缓，这是胃气将断绝的表现。反而出现六洪而停止的，五日应当死亡。为什么呢？六是 water 数，五是土数。肾气自盛，胃气将绝，土又克水，所以五日死。
病症顺应四时，但不见胃脉的，无法治疗。
注释说：凡是十二经脉、十五络脉、奇经八脉感受外邪而产生各种疾病，如果顺应四时却不见胃脉，说明土气断绝，就没有生气，应当死亡。春季脉弦紧而不长，夏季脉浮洪而不大，秋季脉毛涩而不细，冬季脉沉滑而不弱。这四种情况都是不见胃气之脉。患病者必然死亡。所以人以胃气作为百脉的主宰。
The pivot mechanism rotates, which can foreshadow life and death.
Annotation states: The Spleen and Stomach are Guan Ge (a critical syndrome characterized by the obstruction of Yin and Yang Qi), also referred to as the Pivot Mechanism. Therefore, the Spleen's function is to transport and transform food and fluids, nourishing the four limbs; the Stomach's function is to receive and decompose food and fluids, circulating throughout the hundred vessels, with flow and distribution occurring at the Renying (ST9) and Qikou (LU9) pulses.
These three pulses circulate continuously, and the twelve meridians eventually converge at the Stomach. Thus, by observing whether the pulses of the Spleen and Stomach are severed or intact, one can discern the omens of auspiciousness, inauspiciousness, life, and death.
If Earth Qi is severed in Spring, death will occur in the second month of Autumn of the third year.
Annotation states: In Spring, if the pulse does not show a long and gentle quality but only appears wiry and tight, it indicates that Earth Qi is declining and the Stomach pulse is about to sever. This corresponds to the Liver, which belongs to Wood, with a generation number of three; hence, survival for three years. When Metal Qi becomes prosperous and responds to the season in mid-Autumn, the person will inevitably die. Why? Because the disease resides in the Liver, manifesting as discomfort under the left hypochondrium. Starting from mid-Autumn, when Metal Qi becomes active, symptoms worsen in Autumn with vomiting and rebellious Qi, progressing to panting and Qi syncope. By mid-Autumn, when Metal Qi is at its peak, Wood Qi is severed, thus indicating death.
If Earth Qi is severed in Summer, death will occur in the second month of Winter of the second year.
Annotation states: In Summer, if the pulse does not appear large and surging but only floating and full, it indicates that Earth Qi is declining and the Stomach pulse is about to sever. This corresponds to the Heart, which belongs to Fire, with a generation number of two; hence, survival for two years. When Water Qi becomes prosperous and responds to the season in mid-Winter, the person will inevitably die. Why? Because the disease is an accumulation in the Heart, manifesting between the heart and hypochondrium. It begins to stir in mid-Summer, worsening in Autumn with panting and rapid breathing. By mid-Winter, when Water Qi is prosperous, Fire Qi extinguishes, and simultaneously Earth Qi is severed, thus indicating death.
If Earth Qi is severed in Autumn, death will occur in the second month of Summer of the fourth year.
Annotation states: In Autumn, if the pulse does not appear fine and thin but only feathery and rough, it indicates that Earth Qi is altered and the Stomach pulse is about to sever. This corresponds to the Lung, which belongs to Metal, with a generation number of four; hence, survival for four years. When Fire Qi becomes prosperous and responds to the season in mid-Summer, the person will inevitably die. Why? Because the disease is an accumulation in the Lung, manifesting under the right hypochondrium. It begins to stir in mid-Autumn, changing in mid-Summer with abdominal rumbling, panting, rebellious Qi, and vomiting. By mid-Summer, when Fire Qi is prosperous, Metal Qi dissipates, and simultaneously Earth Qi is severed, thus indicating death.
If Earth Qi is severed in Winter, death will occur in the second month of Summer of the first year.
Annotation states: In Winter, if the pulse does not appear deep and weak but only deep and slippery, it indicates that Earth Qi is declining and the Stomach pulse is about to sever. This corresponds to the Kidney, which is Water, with a generation number of one; hence, survival for one year. When Earth Qi becomes prosperous and responds to the season in mid-Summer, the person will inevitably die. Why? Because the Kidney accumulation manifests between the right hypochondrium and the spine, moving without fixed location. It begins to stir in mid-Summer, worsening in Spring with panting, reversed exhalation, lower abdominal distension, and nocturnal emissions accompanied by dreams of sexual intercourse. By mid-Summer, when Earth Qi is prosperous, Water Qi dries up, and since Earth Qi was previously severed, death ensues.
Earth Qi is parasitically prosperous during the four seasons (the last month of each season), and prevails before the arrival of the four mid-months (Spring Equinox, Summer Solstice, Autumn Equinox, Winter Solstice).
Annotation states: Earth Qi holds its central position and is parasitically prosperous in the four seasons. Therefore, in every month of the four seasons, Earth Qi prevails over the Stomach. Metal, Wood, Water, and Fire cannot exist without Earth. Earth resides in the Center, nourishing all things with damp Earth Qi, thus having prosperity in the four seasons. The Nine Heavens present above, representing the position of the Emperor. Whenever the Stomach pulse is severed, death should correspond to mid-Summer. Why? Because the conquering Earth of the Stomach occupies a high position and overcomes Water. Earth governs the Stomach pulse and should theoretically be severed in Winter. If in mid-Winter the weak pulse is absent, and by mid-Summer, Fire and Earth correspond, with mother and son residing together, then by mid-Summer, Earth prevails and Water is severed, thus indicating inevitable death.
If the Spring pulse is wiry, tight, and feathery, but reverses to show eight slowness and stops, death occurs in nine days.
Annotation states: The Spring pulse should be wiry, tight, and long. If the long quality is absent and only feathery qualities appear, it indicates that Stomach Qi is about to sever. If it reverses to show eight slowness and stops, death occurs on the ninth day. Why? Eight is the number of Wood, and nine is the number of Metal. Liver Qi self-prospers, while Stomach Qi is about to sever. Metal overcomes Wood, thus death occurs in nine days.
If the Summer pulse is floating, full, and slippery, but reverses to show seven roughness and stops, death occurs in six days.
Annotation states: The Summer pulse is floating, full, and large. If the large quality is absent and only slippery qualities appear, it indicates that Stomach Qi is about to sever. If it reverses to show seven roughness and stops, death occurs on the sixth day. Why? Seven is the number of Fire, and six is the number of Water. Heart Qi self-prospers, while Stomach Qi is about to sever. Water overcomes Fire, thus death occurs in six days.
If the Autumn pulse is feathery, rough, and hooked, but reverses to show nine fineness and stops, death occurs in seven days.
Annotation states: The Autumn pulse should be feathery, rough, and fine. If the fine quality is absent and only hooked qualities appear, it indicates that Stomach Qi is about to sever. If it reverses to show nine fineness and stops, death occurs on the seventh day. Why? Nine is the number of Metal, and seven is the number of Fire. Lung Qi self-prospers, while Stomach Qi is about to sever. Fire overcomes Metal, thus death occurs in seven days.
If the Winter pulse is floating, slippery, and slow, but reverses to show six fullness and stops, death occurs in five days.
Annotation states: The Winter pulse should be deep, slippery, and weak. If neither weak nor slow qualities appear, it indicates that Stomach Qi is about to sever. If it reverses to show six fullness and stops, death occurs on the fifth day. Why? Six is the number of Water, and five is the number of Earth. Kidney Qi self-prospers, while Stomach Qi is about to sever. Earth overcomes Water, thus death occurs in five days.
Diseases that follow the four seasons but lack the Stomach pulse are incurable.
Annotation states: Whenever the twelve meridians, fifteen collaterals, and eight extraordinary vessels are invaded by pathogenic factors causing various diseases, if the pulse conforms to the four seasons yet lacks the Stomach pulse, it signifies that Earth Qi is severed, leaving no vital energy, leading to death. A Spring pulse that is wiry and tight but not long; a Summer pulse that is floating and full but not large; an Autumn pulse that is feathery and rough but not fine; and a Winter pulse that is deep and slippery but not weak—these four conditions represent the absence of Stomach Qi in the pulse. Patients with these signs will inevitably die. Therefore, humans regard Stomach Qi as the master of the hundred vessels.