三阳为经，二阳为维，一阳为游部。三阳者，太阳也，至手太阴而弦，浮而不沉，决以
度，察以心，合之阴阳之论。二阳者，阳明也，至手太阴弦而沉急不鼓，炅至以病皆死。一
阳者，少阳也，至手太阴上连人迎弦急悬不绝，此少阳之病也，搏阴则死。三阴者，六经之
所主也，交于太阴，伏鼓不浮，上空至心。二阴至肺，其气归于膀胱，外连脾胃。一阴独至
，经绝气浮不鼓，钩而滑。此六脉者，乍阴乍阳，交属相并，缪通五脏，合于阴阳。先至为
主，后至为客。三阳为父，二阳为卫，一阳为纪；三阴为母，二阴为雌，一阴为独使。二阳
一阴，阳明主脾（一本无脾字）病，不胜一阴，脉软而动，九窍皆沉。三阳一阴，太阳脉胜，
一阴不能止，内乱五脏，外为惊骇。二阴二阳，病在肺，少阳（一作阴）脉沉，胜肺伤脾，故外
伤四肢。二阴二阳皆交至，病在肾，骂詈妄行，癫疾为狂。二阴一阳，病出于肾，阴气客游
于心，脘下空窍，堤闭塞不通，四支别离。一阴一阳代绝，此阴气至心，上下无常，出入不
知，喉嗌干燥，病在土脾。二阳三阴，至阴皆在，阴不过阳，阳气不能止阴，阴阳并绝，浮
为血瘕，沉为脓 也。三阳独至者，是三阳并至，并至如风雨，上为癫疾，下为漏血病。三
阳者，至阳也。积并则为惊，病起如风霹雳，九窍皆塞，阳气滂溢，嗌干喉塞。并于阴则上
下无常，薄为肠 。此谓三阳直心，坐不得起卧者，身重，三阳之病也。
黄帝问曰∶脉有四时动奈何？岐伯对曰∶六合之内，天地之变，阴阳之应，彼春之暖，
为夏之暑，彼秋之忿，为冬之怒，四变之动，脉与之上下，以春应中规，夏应中矩，秋应中
衡，冬应中权。是故冬至四十五日，阳气微上，阴气微下；夏至四十五日，阴气微上，阳气
微下。阴阳有时，与脉为期，期而相失，如脉所分，分之有期，故知死时。微妙在脉，不
可不察，察之有纪，从阴阳始。是故声合五音，色合五行，脉合阴阳。持脉有道，虚静为宝。
春日浮，如鱼之游在波；夏日在肤，泛泛乎万物有余；秋日下肤，蛰虫将去；冬日在骨，蛰
虫周密，君子居室。故曰知内者，按而纪之；知外者，终而始之，此六者，持脉之大法也。
赤脉之至也，喘而坚，诊曰，有积气在中，时害于食，名曰心痹，得之外疾，思虑而心
虚，故邪从之。
白脉之至也，喘而浮，上虚下实，惊，为积气在胸中，喘而虚，名曰肺痹，寒热，得之
醉而使内也。
黄脉之至也，大而虚，有积气在腹中，有厥气，名曰厥疝，女子同法，得之疾使四肢汗
出当风。
青脉之至也，长而弦，左右弹，有积气在心下支 ，名曰肝痹，得之寒湿，与疝同
法，腰痛足清头痛（一本云头脉紧）。
黑脉之至也，上坚而大，有积气在少腹与阴，名曰肾痹，得之沐浴，清水而卧。
形气有余，脉气不足死；脉气有余，形气不足生；形气相得，谓之可治。脉弱以滑
，是有胃气，命曰易治，治之趋之，无后其时。形气相失，谓之难治；色夭不泽，谓之难已
；脉实以坚，谓之益甚；脉逆四时，谓之不治。所谓逆四时者，春得肺脉，夏得肾脉，秋得
心脉，冬得脾脉，其至皆悬绝沉涩者，名曰逆四时。未有脏形，于春夏而脉沉涩，秋冬而脉
浮大，病热脉静，泄而脉大，脱血而脉实，病在中而脉实坚，病在外而脉不实坚者，皆为难
治，名曰逆四时也。
曰∶愿闻虚实之要？曰∶气实形实，气虚形虚，此其常也，反此者病。谷盛气盛，谷虚
气虚，此其常也，反此者病。脉实血实，脉虚血虚，此其常也，反此者病。气盛身寒气虚
身热曰反，谷入多而气少曰反，谷不入而气多曰反，脉盛血少曰反，脉少血多曰反。气盛身
寒，得之伤寒；气虚身热，得之伤暑。谷入多而气少者，得之有所脱血，湿居其下也；谷入
少而气多者，邪在胃及与肺也。脉少血多者，饮中热也；脉大血少者，脉有风气，水浆不入
，此谓反也。夫实者气入也，虚者气出也。气实者热也，气虚者寒也。入实者，左
手开针孔也；入虚者，左手闭针孔也。
脉小色不夺者，新病也；脉不夺色夺者，久病也；脉与五色俱夺者，久病也；脉与五
色俱不夺者，新病也。肝与肾脉并至，其色苍赤，当病毁伤，不见血，已见血，湿若中水也
。尺内两傍则季胁也，尺外以候肾，尺里以候腹中。附上，左外以候肝，内以候鬲；右外以
候胃，内以候脾。上附上，右外以候肺，内以候胸中；左外以候心，内以候膻中。前以候前
，后以候后。上竟上者，胸喉中事也；下竟下者，少腹腰股膝胫中事也。粗大者，
阴不足，阳有余，为热中也。
腹胀身热脉大（一作小），是一逆也。腹鸣而满，四肢清泄脉大者，是二逆也；血衄不止
脉大者，是三逆也；咳且溲血脱形，脉小而劲者，是四逆也；咳脱形，身热脉小而疾者，是
五逆也。如是者，不过十五日死矣。腹大胀，四末清，脱形泄甚，是一逆也；腹胀便（一作
后）血，其脉大时绝，是二逆也；咳溲血，形肉脱，喘，是三逆也；呕血胸满引背，脉小而
疾，是四逆也；咳呕腹胀，且飧泄，其脉绝，是五逆也。如是者，不及一时而死矣。工不察
此者而刺之，是谓逆治。
治热病脉静汗已出，脉盛躁，是一逆也；病泄脉洪大，是二逆也；着痹不移，
肉破，身热，脉偏绝，是三逆也；淫而夺形，身热色夭然白，及后下血 ，笃重，是四
逆也；寒热夺形，脉坚搏，是五逆也。
五实死，五虚死。脉盛，皮热，腹胀，前后不通，闷瞀，是谓五实；脉细，皮寒，气少
，泄利前后，饮食不入，是谓五虚。浆粥入胃，泄注止，则虚者活，身汗得后利，则实者活
。此其候也。
心脉满大，痫 筋挛。肝脉小急，痫 筋挛。肝脉瞀闷，有所惊骇，脉不至若喑，
不治
。肝肾脉并沉为石水，并浮为风水，并虚为死，并小弦欲为惊。心脉揣（《素问
》揣作搏，下同）滑急为心疝。肺脉沉揣为肺疝。三阳急为瘕。二阴急为痫厥（一本作二阴急
为疝）。二阳
，血湿（《素问》作温）身热者死。心肝 亦下血，二脏同病者可治，其脉小沉涩为肠 ，
其身热者死，热甚（《素》作热见）七日死。胃脉沉鼓涩，胃外鼓大，心脉小坚急，皆鬲偏
枯。男子发左，女子发右。不喑舌转者，可治，三十日起。其从者，喑三岁起。年不满二十
者三岁死。脉至而揣，衄血身有热者死。脉来悬钩浮者为热（《素》作常脉）。 脉至而揣
名曰暴厥，暴厥者，不知与人言。脉至而数，使人暴惊，三四日自已。脉至浮合，浮合如
数，一息十至以上，是经气予不足也，微见九十日死。脉至如火薪然，是心精予夺也，草干
而死。脉至如丛棘（《素》作如散叶），是肝气予虚也，木叶落而死。脉至如省客，省客者
脉寒（一本作塞）如故也，是肾气予不足也，悬去枣华而死。脉至如丸泥，是胃精予不足也
，榆荚落而死。脉至如横格，是胆气予不足也，禾熟而死。脉至如弦缕，是胞精予不足也，病
善言，下霜而死，不言可治。脉至如交棘（《素》作交漆）交棘者，左右傍至也，微见三十
日而死。脉至如涌泉，浮鼓肌中，是太阳气予不足也，少气味，韭花生而死。脉至如颓土之
状，按之不足，是肌气予不足也，五色见黑白，累发而死。脉至如悬雍。悬雍者，浮揣切
之益大，是十二俞之气予不足也，水冻而死。脉至如偃刀。偃刀者，浮之小急，按之坚大，
五脏寒热（《素》作菀热），寒热独并于肾，如此其人不得坐，立春而死。脉至如丸，滑不着
（《素》作不直）手，丸滑不着者，按之不可得也，是大肠气予不足也，枣叶生而死。脉至
如舂者，令人善恐，不欲坐卧，行立常听，是小肠气予不足也，季秋而死。
三阳经作为经脉的主干，二阳经作为维系之脉，一阳经作为游行之部。所谓三阳，即太阳经，其脉气到达手太阴肺经部位时，脉象弦而浮，不沉，需通过法度来决断，用心观察，以符合阴阳的理论。所谓二阳，即阳明经，其脉气到达手太阴肺经部位时，脉象弦而沉急，搏动无力（鼓指不明显），若出现热邪盛极的情况，多属死证。所谓一阳，即少阳经，其脉气到达手太阴肺经部位时，向上连及人迎穴，脉象弦急如悬丝连绵不断，这是少阳经的病脉，若与阴脉相搏结，则主死。
三阴经是六经的主宰，脉气交于太阴经，脉象伏而鼓动不浮，脉气上达于心胸部位。二阴经的脉气到达肺部，其气归于膀胱，外部联系脾胃。一阴经的脉气单独到达时，经脉之气断绝，脉气浮散而无搏动感，脉象钩而滑。这六条经脉的脉象，忽阴忽阳，相互交错合并，错综地通连五脏，合于阴阳的变化。先至者为“主”，后至者为“客”。三阳经如同父亲，二阳经如同卫士，一阳经如同纲纪；三阴经如同母亲，二阴经如同雌性，一阴经如同独行的使者。
二阳（阳明）与一阴（厥阴）同见，若阳明主导而脾脏有病，不能制约一阴，脉象软弱而跳动，九窍都会沉滞不通。三阳（太阳）与一阴（厥阴）同见，若太阳脉气偏胜，一阴不能制止，会导致内脏五脏紊乱，外部表现为惊骇。二阴（少阴）与二阳（阳明）同见，病在肺，少阳（或作少阴）脉象沉，若偏胜则伤肺损脾，所以外部导致四肢受伤。二阴与二阳的脉气都交错而至，病在肾，患者会骂人、行为狂妄，发为癫疾狂症。二阴与一阳同见，病出于肾，阴气客居于心，脘下空窍闭塞不通，四肢分离无力。一阴与一阳代绝（脉搏间歇），这是阴气上至于心，脉气上下无常，出入不知规律，咽喉干燥，病在脾土。
二阳与三阴同见，至阴之气皆在，阴气不能胜过阳气，阳气不能制止阴气，阴阳之气并绝，脉浮者形成血瘕，脉沉者形成脓疡。三阳经脉气独至，是三阳经脉气合并而至，合并而至的气势如风雨般猛烈，上部发为癫疾，下部发为漏血病。三阳经即是至阳之经，积并则为惊骇，病起如风雷霹雳，九窍全部闭塞，阳气滂溢，咽喉干燥堵塞。若并入阴分，则上下无常，迫注肠道成为肠澼。这叫做三阳经直中心脏，坐立不安，身体沉重，这是三阳经的病证。
黄帝问道：脉象随四季变化如何表现？岐伯回答说：六合之内，天地的变化，阴阳的相应，那春天的温暖，变成夏天的暑热；那秋天的肃杀，变成冬天的严寒。四季变化的运动，脉象也随之升降，春天脉象应合乎规（圆转柔和），夏天应合乎矩（洪大有力），秋天应合乎衡（轻平如衡），冬天应合乎权（沉石如秤锤）。所以冬至后四十五日，阳气微微上升，阴气微微下降；夏至后四十五日，阴气微微上升，阳气微微下降。阴阳各有定时，与脉象的周期相应，如果到了期限而脉象失常，根据脉象所分的季节规律，就能知道死亡的时辰。脉理的微妙在于诊脉，不可不仔细考察，考察有纲领，从阴阳开始。所以声音对应五音，面色对应五行，脉象对应阴阳。诊脉有法则，虚静最为宝贵。
春季脉象浮在皮肤表面，像鱼在波纹中游动；夏季脉象在皮肤表层，泛泛然万物生长有余；秋季脉象下沉到皮肤之下，像冬眠的虫即将离去；冬季脉象深藏在骨中，像冬眠的虫严密包裹，君子居于室内。所以说，了解内部情况的，按压脉象以记录其特征；了解外部情况的，从头到尾综合判断。这六点，是诊脉的大法。
赤色脉象到来时，急促而坚实，诊断为体内有积聚之气，时常影响饮食，名叫心痹，得自外感疾病，因思虑过度导致心气虚弱，所以邪气乘虚而入。
白色脉象到来时，急促而浮浅，上部虚下部实，伴有惊悸，为积聚之气在胸中，气喘而虚弱，名叫肺痹，伴有寒热症状，得自醉酒后行房事。
黄色脉象到来时，大而虚，腹部有积聚之气，有逆乱之气，名叫厥疝，女子发病规律相同，得自剧烈活动四肢出汗后当风受邪。
青色脉象到来时，长而弦，左右弹指，心下有积聚之气支撑，名叫肝痹，得自寒湿之邪，与疝气治法相同，伴有腰痛、足冷、头痛（另一版本说头脉紧）。
黑色脉象到来时，上部坚实而大，少腹与阴部有积聚之气，名叫肾痹，得自沐浴后，用冷水清洗并卧睡。
形体之气有余，脉气不足，主死；脉气有余，形体之气不足，主生；形气相协调，称为可治。脉弱而滑，是有胃气的表现，名叫易治，治疗要及时，不要错过时机。形气不相协调，称为难治；面色枯槁无光泽，称为难愈；脉实而坚，称为病情加重；脉逆四时，称为不治。所谓逆四时，是指春天得肺脉，夏天得肾脉，秋天得心脉，冬天得脾脉，这些脉象都悬绝沉涩的，名叫逆四时。没有脏腑病变的征象，但在春夏季节脉象却沉涩，秋冬季节脉象却浮大，患热病而脉象安静，泄泻而脉象盛大，失血而脉象实大，病在内而脉象实坚，病在外而脉象不实坚的，都为难治，名叫逆四时。
问：希望听您讲讲虚实的关键？答：气实形实，气虚形虚，这是常态，与此相反的即为病。谷气盛则正气盛，谷气虚则正气虚，这是常态，与此相反的即为病。脉实血实，脉虚血虚，这是常态，与此相反的即为病。气盛身寒，气虚身热，这叫反常；进食多而气少，这叫反常；不吃东西而气多，这叫反常；脉盛血少，这叫反常；脉小血多，这叫反常。气盛身寒，得自伤寒；气虚身热，得自伤暑。进食多而气少的，得自失血，湿气居于下部；进食少而气多的，邪气在胃和肺。脉小血多的，是中焦有热；脉大血少的，脉中有风气，水浆不进，这叫反常。实证是气入，虚证是气出。气实者发热，气虚者发冷。补实的方法，左手张开针孔；补虚的方法，左手闭合针孔。
脉象不大，面色不衰，是新病；脉象衰大，面色改变，是久病；脉象与五色都衰败，是久病；脉象与五色都不衰败，是新病。肝脉与肾脉同时出现，面色苍赤，应当是外伤毁损，未见出血的，已经出血的，或是湿气侵袭，或是中水毒。尺部内侧两旁候季胁，尺部外侧候肾，尺部内侧候腹中。附上寸口，左外侧候肝，内侧候膈；右外侧候胃，内侧候脾。再往上，右外侧候肺，内侧候胸中；左外侧候心，内侧候膻中。前部候身前，后部候身后。尺部上段尽处，候胸喉中的事情；尺部下段尽处，候少腹腰股膝胫中的事情。脉象粗大的，是阴不足阳有余，为热中病。
腹胀身热脉大（一作小），是一逆；腹鸣而满，四肢清冷泄泻脉大的，是二逆；鼻衄不止脉大的，是三逆；咳嗽且小便出血，形体脱瘦，脉小而劲的，是四逆；咳嗽形体脱瘦，身热脉小而疾的，是五逆。像这样的，不超过十五天就会死亡。腹部胀大，四肢清冷，形体脱瘦泄泻严重，是一逆；腹胀便血，脉大时而断绝，是二逆；咳尿血，形体肌肉脱瘦，气喘，是三逆；呕血，胸部满闷牵引背部，脉小而疾，是四逆；咳嗽呕吐，腹胀，且完谷不化泄泻，脉绝，是五逆。像这样的，不到一个时辰就会死亡。医生不考察这些情况而进行针刺，这叫逆治。
治疗热病，脉象安静，汗已出，但脉象盛大躁动，是一逆；病泄泻而脉象洪大，是二逆；着痹不移，肌肉溃破，身热，脉象偏于一侧断绝，是三逆；淫邪夺形，身热面色枯白，以及随后下血，病势沉重，是四逆；寒热夺形，脉象坚硬搏指，是五逆。
五实死，五虚死。脉象盛大，皮肤发热，腹胀，大小便不通，胸闷目眩，这叫五实；脉象细弱，皮肤寒冷，气短，大小便泄利，饮食不入，这叫五虚。如果浆粥能进入胃中，泄泻停止，那么虚证者可活；如果身体出汗，大小便通利，那么实证者可活。这就是他们的征候。
心脉满大，发为癫痫、筋挛。肝脉小急，发为癫痫、筋挛。肝脉瞀闷，因受惊骇，脉不至或声音嘶哑，难以治愈。肝肾脉并沉为石水，并浮为风水，并虚为死证，并小弦欲发惊悸。心脉揣（《素问》作搏，下同）滑急为心疝。肺脉沉揣为肺疝。三阳脉急为瘕块。二阴脉急为痫厥（一本作二阴急为疝）。二阳脉……（原文此处似有缺漏或异文，结合上下文推测涉及湿热或温病），身热者死。心肝……亦下血，二脏同病者可治，其脉小沉涩为肠澼，其身热者死，热甚（《素》作热见）七日死。胃脉沉鼓涩，胃外鼓大，心脉小坚急，皆导致膈肌偏枯。男子发于左侧，女子发于右侧。不喑哑舌能转动者，可治，三十日起床。若喑哑者，三年才起。年龄不满二十岁的，三岁死。脉至而揣，衄血身有热者死。脉来悬钩浮者为热（《素》作常脉）。脉至而揣名曰暴厥，暴厥者，不知与人言语。脉至而数，使人突然惊恐，三四日自愈。
脉至浮合，浮合如数，一息十至以上，是经气给予不足的表现，轻微见到九十日死。脉至如火薪然，是心精被剥夺的表现，草干枯时死。脉至如丛棘（《素》作如散叶），是肝气给予虚弱的表现，树叶落下时死。脉至如省客，省客者脉寒（一本作塞）如故也，是肾气给予不足的表现，枣花悬挂脱落时死。脉至如丸泥，是胃精给予不足的表现，榆荚落下时死。脉至如横格，是胆气给予不足的表现，禾苗成熟时死。脉至如弦缕，是胞精给予不足的表现，病善言，下霜时死，不言者可治。脉至如交棘（《素》作交漆）交棘者，左右傍至也，微见三十日而死。脉至如涌泉，浮鼓肌中，是太阳气给予不足的表现，少气味，韭花生时死。脉至如颓土之状，按之不足，是肌气给予不足的表现，五色见黑白，累发而死。脉至如悬雍。悬雍者，浮揣切之益大，是十二俞之气给予不足的表现，水冻时死。脉至如偃刀。偃刀者，浮之小急，按之坚大，五脏寒热（《素》作菀热），寒热独并于肾，如此其人不得坐，立春而死。脉至如丸，滑不着（《素》作不直）手，丸滑不着者，按之不可得也，是大肠气给予不足的表现，枣叶生时死。脉至如舂者，令人善恐，不欲坐卧，行立常听，是小肠气给予不足的表现，季秋时死。
San Yang (Triple-Heater/Yang Brightness/Greater Yang channels) serves as the main trunk of the meridians, Er Yang (Yang Brightness channel) serves as the maintaining vessel, and Yi Yang (Shaoyang/Gallbladder channel) serves as the wandering part. San Yang refers to Taiyang (Greater Yang), where the pulse reaches the Hand-Taiyin Lung meridian; it is wiry, floating but not sinking, judged by standards, observed with the mind, and aligned with Yin-Yang theory. Er Yang refers to Yangming (Yang Brightness), where the pulse reaches the Hand-Taiyin Lung meridian; it is wiry, deep, rapid, and lacks vigorous beating (weak impulse); if heat arrives excessively, it indicates a fatal condition. Yi Yang refers to Shaoyang (Lesser Yang), where the pulse reaches the Hand-Taiyin Lung meridian and connects upward to the Renying point (ST 9); it is wiry, rapid, and suspended like an unbroken thread; this is a disease of the Shaoyang channel, and if it combats with Yin pulses, it indicates death.
San Yin (Three Yin channels) are the masters of the Six Meridians, intersecting with Taiyin; the pulse is deep, beating without floating, and its qi ascends to the heart. Er Yin (Shao Yin) reaches the lungs, its qi returns to the Bladder, and externally connects to the Spleen and Stomach. Yi Yin (Jue Yin) alone arrives; the meridian qi is severed, floating without beating, with a hook-like and slippery quality. These six pulses alternate between Yin and Yang, interweaving and merging, intricately connecting the Five Zang organs, and harmonizing with Yin and Yang. The one arriving first is the "Master," and the one arriving later is the "Guest." San Yang is like a father, Er Yang like a guard, Yi Yang like a discipline; San Yin is like a mother, Er Yin like a female, Yi Yin like a solitary messenger.
When Er Yang (Yangming) and Yi Yin (Jueyin) coexist, if Yangming dominates and the Spleen is diseased, unable to restrain Yi Yin, the pulse becomes soft and moving, causing all nine orifices to sink and obstruct. When San Yang (Taiyang) and Yi Yin (Jueyin) coexist, if the Taiyang pulse prevails and Yi Yin cannot stop it, internal chaos ensues in the Five Zang organs, and externally there is fright and terror. When Er Yin (Shaoyin) and Er Yang (Yangming) coexist, the disease is in the Lungs; if the Shaoyang (or Shaoyin per variant) pulse is deep and prevails, damaging the Lungs and Spleen, the extremities are injured externally. When Er Yin and Er Yang pulses both arrive intermixed, the disease is in the Kidneys; the patient curses and acts wildly, developing Mania (Dian Kuang). When Er Yin and Yi Yang coexist, the disease originates from the Kidneys; Yin Qi lodges in the Heart, blocking the empty spaces below the epigastrium, leading to separation and weakness of the four limbs. When Yi Yin and Yi Yang show intermittent absence (Dai Jue), Yin Qi reaches the Heart; the pulse varies unpredictably, entering and exiting without awareness, with dry throat and pharynx; the disease is in the Earthly Spleen.
When Er Yang and San Yin coexist, the Zhì Yin (Ultimate Yin) qi is present; if Yin cannot overcome Yang, and Yang cannot restrain Yin, and both Yin and Yang pulses cease, a floating pulse indicates Blood Mass (Xue Jia), while a deep pulse indicates Abscess (Nong Yu). When San Yang pulses arrive exclusively, it means the three Yang meridians merge; their arrival is like wind and rain, causing Mania above and bleeding leakage below. San Yang is the Ultimate Yang; accumulation and merging cause fright; the disease arises like wind and thunder, blocking all nine orifices, with overflowing Yang Qi, dry throat, and blocked pharynx. If merging into Yin, the pulse varies unpredictably, pressing into the intestines causing Dysentery (Chang Pi). This is called San Yang directly affecting the Heart; the patient cannot sit up or lie down comfortably, feeling heavy-bodied; this is a disease of San Yang.
The Yellow Emperor asked: How do pulses move according to the four seasons? Qibo replied: Within the six directions, changes of heaven and earth, responses of Yin and Yang—the warmth of spring becomes the heat of summer; the severity of autumn becomes the anger of winter. The movement of these four changes causes the pulse to rise and fall accordingly. Spring corresponds to the Compass (Gui - round and soft); Summer corresponds to the Square (Ju - large and forceful); Autumn corresponds to the Balance (Heng - light and level); Winter corresponds to the Weight (Quan - deep and heavy). Thus, forty-five days after the Winter Solstice, Yang Qi slightly ascends, and Yin Qi slightly descends; forty-five days after the Summer Solstice, Yin Qi slightly ascends, and Yang Qi slightly descends. Yin and Yang have their times, matching the pulse cycle. If they miss the timing, based on the pulse's division, one can know the time of death. The subtlety lies in the pulse; it must be examined. Examination has principles, starting from Yin and Yang. Thus, sound matches the Five Tones, color matches the Five Elements, and pulse matches Yin and Yang. There is a way to hold the pulse; emptiness and stillness are precious.
In spring, the pulse floats like a fish swimming in waves; in summer, it is at the skin surface, abundant like all things growing; in autumn, it sinks to the skin, like insects preparing to hibernate; in winter, it is in the bones, like insects tightly wrapped, and gentlemen stay indoors. Therefore, those who understand the interior press and record; those who understand the exterior conclude and begin. These six points are the great methods of pulse diagnosis.
When a Red pulse arrives, rapid and firm, it is diagnosed as accumulated Qi in the middle, occasionally harming digestion, named Heart Bi (Obstruction). It arises from external pathogens due to excessive worry causing Heart deficiency, allowing evil to enter.
When a White pulse arrives, rapid and floating, with upper deficiency and lower excess, accompanied by fright, it indicates accumulated Qi in the chest, with panting and deficiency, named Lung Bi, accompanied by chills and fever, arising from intercourse while drunk.
When a Yellow pulse arrives, large and deficient, with accumulated Qi in the abdomen and rebellious Qi, named Jue Shan (Rebellious Hernia), following the same pattern for women, arising from strenuous limb activity with sweating exposed to wind.
When a Green pulse arrives, long and wiry, vibrating left and right, with accumulated Qi supporting under the heart, named Liver Bi, arising from cold-dampness, sharing the method with Hernia, accompanied by lower back pain, cold feet, and headache (variant: tight head pulse).
When a Black pulse arrives, firm and large above, with accumulated Qi in the lower abdomen and yin region, named Kidney Bi, arising from bathing and sleeping after washing with cold water.
If Form-Qi is sufficient but Pulse-Qi is insufficient, death occurs; if Pulse-Qi is sufficient but Form-Qi is insufficient, life persists; if Form and Qi match, it is treatable. A weak and slippery pulse indicates Stomach Qi, termed easy to treat; treat promptly without delay. If Form and Qi mismatch, it is difficult to treat; if complexion is dull and lusterless, it is difficult to cure; if the pulse is solid and hard, it indicates worsening; if the pulse contradicts the four seasons, it is untreatable. Contradicting the four seasons means: Lung pulse in spring, Kidney pulse in summer, Heart pulse in autumn, Spleen pulse in winter, all hanging, extreme, deep, and choppy—this is contradicting the four seasons. Without organ signs, if the pulse is deep and choppy in spring/summer, or floating and large in autumn/winter; if heat disease has a quiet pulse, diarrhea has a large pulse, blood loss has a solid pulse, internal disease has a solid/firm pulse, external disease has a non-solid/non-firm pulse—all are difficult to treat, termed contradicting the four seasons.
Asked: What is the essence of Deficiency and Excess? Answer: Qi Excess with Form Excess, Qi Deficiency with Form Deficiency—this is normal; reversal indicates disease. Grain abundance leads to Qi abundance, grain scarcity leads to Qi scarcity—this is normal; reversal indicates disease. Pulse Excess with Blood Excess, Pulse Deficiency with Blood Deficiency—this is normal; reversal indicates disease. Qi Excess with Body Cold, Qi Deficiency with Body Heat—called reversal. Eating much but having little Qi—called reversal. Not eating but having much Qi—called reversal. Pulse Excess with Blood Deficiency—called reversal. Pulse Deficiency with Blood Excess—called reversal. Qi Excess with Body Cold arises from Cold Injury; Qi Deficiency with Body Heat arises from Summerheat Injury. Eating much but having little Qi arises from blood loss with dampness below; eating little but having much Qi arises from evil in the Stomach and Lungs. Pulse Deficiency with Blood Excess arises from heat in the drinker; Pulse Large with Blood Deficiency arises from Wind Qi in the pulse with no fluid intake—this is called reversal. Excess is Qi entering; Deficiency is Qi leaving. Qi Excess brings heat; Qi Deficiency brings cold. To tonify Excess, open the needle hole with the left hand; to tonify Deficiency, close the needle hole with the left hand.
Small pulse without color change indicates new disease; pulse not changed but color changed indicates old disease; both pulse and five colors changed indicate old disease; neither pulse nor five colors changed indicates new disease. Liver and Kidney pulses arriving together with pale-red complexion indicates injury/trauma; if no blood was seen, or if blood was seen, it may be dampness or water poisoning. The inner side of the Chi position flanks the hypochondrium; the outer Chi probes the Kidneys; the inner Chi probes the abdominal cavity. Above that, the left outer probes the Liver, inner probes the Diaphragm; the right outer probes the Stomach, inner probes the Spleen. Further up, the right outer probes the Lungs, inner probes the Chest Middle; the left outer probes the Heart, inner probes the Danzhong. Front probes the front, back probes the back. The end of the upper section probes the chest and throat; the end of the lower section probes the lower abdomen, waist, thighs, knees, and shins. Coarse/large pulse indicates Yin deficiency and Yang excess, resulting in Heat in the Middle.
Abdominal distension, body heat, and large pulse (variant: small) is the First Reversal. Abdominal rumbling and fullness, cold extremities, diarrhea, and large pulse is the Second Reversal. Unstopping nasal hemorrhage and large pulse is the Third Reversal. Coughing, hematuria, emaciation, and small/tense pulse is the Fourth Reversal. Coughing, emaciation, body heat, and small/rapid pulse is the Fifth Reversal. Such cases die within fifteen days. Abdominal distension, cold extremities, emaciation, severe diarrhea is the First Reversal; abdominal distension, hematochezia, large pulse with intermittent cessation is the Second Reversal; coughing/hematuria, emaciation, panting is the Third Reversal; vomiting blood, chest fullness radiating to back, small/rapid pulse is the Fourth Reversal; coughing/vomiting, abdominal distension, undigested stool diarrhea, absent pulse is the Fifth Reversal. Such cases die within less than one hour. Physicians who fail to observe this and apply acupuncture commit malpractice (Reverse Treatment).
Treating Heat Disease: Quiet pulse after sweating, yet pulse is large and restless is the First Reversal; diarrhea with洪大 (Hong Da/Large) pulse is the Second Reversal; fixed Bi with muscle wasting, body heat, and unilateral absent pulse is the Third Reversal; pathogenic depletion of form, body heat, sallow-white complexion, followed by hematochezia, severe condition is the Fourth Reversal; cold/heat depletion of form, firm/pounding pulse is the Fifth Reversal.
Five Excesses lead to death; Five Deficiencies lead to death. Large pulse, hot skin, abdominal distension, blockage of urination/defecation, chest oppression/dizziness—these are Five Excesses. Small pulse, cold skin, shortness of breath, diarrhea of urine/stool, inability to eat—these are Five Deficiencies. If gruel enters the stomach and diarrhea stops, the deficient patient lives; if sweat appears and bowels/bladder open, the excess patient lives. These are their signs.
Full-large Heart pulse indicates Epilepsy and tendon cramping. Small-rapid Liver pulse indicates Epilepsy and tendon cramping. Muddled/oppressed Liver pulse due to fright, absent pulse or aphonia—is untreatable. Deep Liver/Kidney pulses indicate Stone Water; Floating indicate Wind Water; Empty indicate Death; Small-wiry indicate impending Fright. Pounding-slippery-rapid Heart pulse indicates Heart Hernia. Deep-pounding Lung pulse indicates Lung Hernia. Rapid San Yang pulse indicates Mass (Zha). Rapid Er Yin pulse indicates Epileptic Convulsion (variant: Hernia). ... (Text fragment missing) ... Body heat indicates death. Heart/Liver ... also hematochezia; dual organ disease is treatable; small-deep-choppy pulse indicates Intestinal Dysentery; body heat indicates death; severe heat leads to death in seven days. Deep-beating-choppy Stomach pulse, externally large, small-firm-rapid Heart pulse—all indicate Hemiplegia (Ge Pian Ju). Left onset in men, right in women. No aphonia, tongue moves: treatable, recovery in 30 days. Aphonia: recovery in 3 years. Under 20 years old: death in 3 years. Pounding pulse with hematemesis/nasal bleed and body heat: death. Hanging-hook-floating pulse indicates Heat (variant: Normal Pulse). Pounding pulse named Sudden Syncope (Bao Jue); the syncope patient cannot speak. Rapid pulse causes sudden fright; self-recovers in 3-4 days.
Floating-combining pulse, resembling rapid, over ten beats per breath: Jing Qi insufficiency; slight appearance leads to death in 90 days. Pulse like burning firewood: Heart Essence deprivation; death when grass dries. Pulse like thorny bushes (variant: scattered leaves): Liver Qi deficiency; death when leaves fall. Pulse like a visiting official: pulse cold/blockage as before; Kidney Qi insufficiency; death when jujube flowers hang/fall. Pulse like a mud pellet: Stomach Essence insufficiency; death when elm pods fall. Pulse like a horizontal bar: Gallbladder Qi insufficiency; death when grain ripens. Pulse like string threads: Bao (Uterus) Essence insufficiency; talkative: death at frost; silent: treatable. Pulse like crossing thorns (variant: lacquer): coming from sides; slight appearance leads to death in 30 days. Pulse like a gushing spring, floating/beating in muscles: Taiyang Qi insufficiency; faint smell; death when leek flowers bloom. Pulse like collapsed earth, yielding to pressure: Muscle Qi insufficiency; black/white colors appear; recurrent attacks lead to death. Pulse like a uvula; uvula: floating/pounding/chopping makes it larger; Twelve Shu Qi insufficiency; death when water freezes. Pulse like an inverted knife; inverted knife: floating small-rapid, pressing firm-large; Five Zang cold-heat (variant: stagnated heat); cold-heat merging in Kidneys; patient cannot sit; death at Start of Spring. Pulse like a pill, smooth not sticking to hand (variant: not straight); pill-smooth not sticking: unobtainable on pressure; Large Intestine Qi insufficiency; death when jujube leaves grow. Pulse like pounding mortar: causes fear, unwillingness to sit/lie, listening while standing/walking; Small Intestine Qi insufficiency; death in Late Autumn.