二十一难曰∶经言人形病脉不病曰生，脉病形不病曰死，何谓也？
然∶人形病脉不病，非有不
病者也，谓息数不应脉数也。此大法。
形病脉不病曰生者，人以脉为主，设其人形体羸瘦，精神困倦，不可谓之无病也。诊其脉，惟
息数不应脉数，虽营卫有伤，而不见至损死绝之脉，虽病必生，必其脏腑无恙也。脉病形不病曰死
者，设其人肌肉不减，饮食如常，不可谓之有病也。诊其脉，则代革频见，虽不病亦死，以其脏腑
已坏，不可救药也。经言无考。仲景辨脉篇曰∶脉病患不病，名曰行尸，以无王气，卒眩仆不省人
者，短命则死。人病脉不病，名曰内虚，以无谷气，虽困无害。即此义欤！
二十二难曰∶经言脉有是动，有所生病，一脉辄变为二病者，何也？
然∶经言
是动者，气也；所生病者，血也。邪在气，气为是动；邪在血，血为所生病。气主 之，血主濡之。
气留而不行者，为气先病也；血壅而不濡者，为血后病也。故先为是动，后所生病也。
脉谓十二经隧之脉，每脉中有二病者，有在气在血之分也。邪在气，气为是而动；邪在血，血为
所生病，是脉之动者气为之，而所生病者，血为之也。气病传血，故曰一脉变为二病也。 ，煦也。
气主 之者，谓气煦嘘往来，薰蒸于皮肤分肉也。濡，润也。血主濡之者，谓血濡润筋骨，滑利关节，
荣养脏腑也。然气留而不行，则血亦壅而不濡，气在外。血在内，外先受邪，则内亦从之而病，故曰
先为是动，后所生病也。
上第一卷，一难至二十二难，论脉。
第二十一难说：医经中说，人形体有病而脉象无病的是可生，脉象有病而形体无病的是必死，这是什么意思呢？
回答说：人形体有病而脉象无病，并不是指没有病，而是指呼吸次数与脉搏跳动次数不相适应。这是诊治的大法。
所谓“形体有病而脉象无病曰生”，是因为人以脉象为主，假如这个人形体消瘦，精神困倦，不能说他没病。诊察他的脉象，只是呼吸次数与脉搏跳动次数不相适应，虽然营卫之气受损，但没有出现至损、死绝等危重脉象，虽然生病也必定能生存，这是因为脏腑没有损伤的缘故。
所谓“脉象有病而形体无病曰死”，假如这个人肌肉没有减少，饮食如常，不能说他有病。但诊察他的脉象，则代脉（间歇脉）和革脉（浮大中空之脉）频繁出现，即使形体看似没病也必死，因为他的脏腑已经败坏，无法救治了。这种说法在经典中难以考证。张仲景《辨脉篇》说：“脉象有病而形体无病，名叫‘行尸’，因为没有王气，突然眩晕跌倒不省人事的，短命就会死亡。人形体有病而脉象无病，名叫‘内虚’，因为没有谷气，虽然困苦但不会立即致死。”大概就是这个意思吧！
第二十二难说：医经中说脉有“是动”和“所生病”，一条经脉往往演变成两种病证，为什么呢？
回答说：医经中说，“是动”属于气分；“所生病”属于血分。邪气在气分，气分发生变动而为“是动”；邪气在血分，血分受病而为“所生病”。气主要起温煦作用，血主要起濡润作用。
气停留而不能运行，是气先发病；血壅滞而不能濡润，是血后发病。所以先出现“是动”，后出现“所生病”。
这里的脉是指十二经脉的脉道，每条脉中有两种病证，是有在气分和血分的区别。邪气在气分，气分发生变动；邪气在血分，血分发生病变。这就是脉的变动由气引起，而所发生的疾病由血引起的道理。气病传变给血，所以说一条经脉演变成两种病证。“燠”（yù），就是温暖的意思。“气主燠之”，是说气的嘘吸往来，薰蒸于皮肤和肌肉之间。“濡”，就是滋润的意思。“血主濡之”，是说血濡润筋骨，滑利关节，荣养脏腑。
然而气停留而不能运行，那么血也会壅滞而不能濡润。气在外，血在内，外部先受邪气，内部也会随之生病，所以说先出现“是动”，后出现“所生病”。
以上是第一卷，从第一难到第二十二难，论述脉学。
Chapter 21 states: The classics say that if a person's physical form shows signs of disease but the pulse does not, they will survive; if the pulse shows signs of disease but the physical form does not, they will die. What is the meaning of this?
The response is: When a person's physical form appears diseased but the pulse seems normal, it does not mean there is no disease; rather, it refers to a discrepancy between the respiratory rate and the pulse rate. This is a general principle.
Regarding "physical form diseased, pulse normal indicates survival": The pulse is primary. If a person is emaciated and mentally exhausted, one cannot claim they are without disease. Upon examining their pulse, if only the respiratory rate fails to correspond with the pulse rate, although the Ying (Nutritive) and Wei (Defensive) Qi are damaged, as long as critical or terminal pulses (such as Zhi Sun or Si Jue pulses) are not observed, the patient will likely survive because the Zang-Fu organs remain intact.
Regarding "pulse diseased, physical form normal indicates death": If a person's muscles have not wasted away and their diet remains normal, one might assume they are healthy. However, if examination reveals frequent Dai (intermittent) and Ge (floating, large, and hollow) pulses, death is inevitable despite the apparent lack of somatic symptoms, because the Zang-Fu organs are already ruined and incurable. This specific phrasing is difficult to verify in ancient texts. Zhang Zhongjing's *Pulse Differentiation Chapter* states: "When the pulse indicates disease but the body does not, it is called 'Walking Corpse' (Xing Shi); lacking Wang Qi (Prosperous Qi), sudden dizziness, collapse, and loss of consciousness lead to early death. When the body shows disease but the pulse does not, it is called 'Internal Deficiency' (Nei Xu); lacking Gu Qi (Grain Qi), though distressed, immediate death is avoided." Does this align with the previous explanation?
Chapter 22 states: The classics mention that pulses exhibit "Shi Dong" (Is Moving) and "Suo Sheng Bing" (Diseases Produced). Why does a single meridian often manifest as two types of diseases?
The response is: The classics state that "Shi Dong" pertains to Qi, while "Suo Sheng Bing" pertains to Blood. When pathogenic factors affect Qi, Qi undergoes movement/change, constituting "Shi Dong"; when pathogenic factors affect Blood, Blood becomes diseased, constituting "Suo Sheng Bing". Qi primarily provides warming (Yu), while Blood primarily provides moistening (Ru).
When Qi stagnates and fails to circulate, it is considered an initial Qi disorder; when Blood is obstructed and fails to moisten, it is considered a subsequent Blood disorder. Therefore, "Shi Dong" occurs first, followed by "Suo Sheng Bing".
Here, "pulse" refers to the vessels of the Twelve Meridians. Each vessel presents two types of disorders, distinguished by whether they reside in the Qi level or the Blood level. Pathogens in Qi cause Qi to move abnormally; pathogens in Blood cause Blood to become diseased. Thus, the movement of the pulse is driven by Qi, while the resulting pathology is driven by Blood. As Qi disorders transmit to Blood, it is said that one meridian transforms into two diseases.
"Yu" means warmth. "Qi primarily provides Yu" refers to the inhalation and exhalation of Qi, steaming and warming the skin and muscle layers. "Ru" means moistening. "Blood primarily provides Ru" refers to Blood moistening sinews and bones, lubricating joints, and nourishing the Zang-Fu organs.
However, if Qi stagnates and fails to circulate, Blood will also become obstructed and fail to moisten. Qi resides externally, and Blood resides internally. If the exterior is first affected by pathogens, the interior will subsequently follow suit in becoming diseased. Hence, "Shi Dong" occurs first, followed by "Suo Sheng Bing".
This concludes Volume I, Chapters 1 through 22, which discuss Pulse Diagnosis.