平按∶此篇自篇首至名曰逆四时，见《素问》卷六第十九《玉机真脏论》篇，又见《甲乙经》
卷四《经脉》第一下编。自黄帝问于岐伯曰脉其四时至持脉之大法也，见《素问》卷五第十七《脉
要精微论》篇，《甲乙》同上。又自是故阴盛则梦涉大水至肺气甚则梦哀，见《甲乙》卷六第八
《正邪袭内生梦大论》。自春得秋脉至末，见《素问》卷七第二十三《宣明五气篇》，又见《甲乙》
卷四《经脉》第一中篇。
凡治病，察其形气色泽，脉之盛衰，病之新故，乃治之，无后其时。（形之肥瘦，气之大小，
色之泽夭，脉之盛衰，病之新故，凡疗病者，以此五诊，诊病使当，为合其时，不当，为后其时
也。）形气相得，谓之可治；（形瘦气大，形肥气小，为不相得；形肥气大，形瘦气小，为相得
也。）脉色泽以浮，谓之易已；（其病患五色，
浮轻润泽，其病易已。平按∶《素问》无脉字。）脉顺四时，谓之可治；（四时王脉，皆有胃气，
无他来克，故曰顺时。平按∶顺《素问》作从。）脉弱以滑，是有胃气，命曰易治，趣之以时。
（四时之脉皆柔弱滑者，谓之胃气，根据此疗病，称曰合时也。平按∶“趣之以时”《素问》作“取
之以时”，《甲乙》作“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，必察四难而明告之，勿趣以时。（此之四诊，趣之
为难，可明告病患，宜以变常设于疗法，不得根据常趣之以时也。平按∶谓之不治《素问》作为不
可治，无“勿趣以时”句。《甲乙》无必察四难以下十二字。）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，命曰逆四时，未有脏形，（四时皆得胜来克己
之脉，己脉悬绝沉涩，失四时和脉，虽未有病脏之形，不可疗也。平按∶命曰《甲乙》作名曰。）
春夏脉沉涩，秋冬而脉浮大，（此脉反四时也。平按∶《素问》、《甲乙》春上有于字。浮大下
《素问》有“名曰逆四时也”六字。）病热脉 静，（热病脉须热而躁也，今反寒而静。 ，寒
也。平按∶《素问》、《甲乙》无 字。）泄而脉大，（人之泄利，脉须小细，今为洪大也。）脱
血而脉实病在中，（人之脱血，脉须虚弱，今反强实，病在中也。）而脉实坚病在外，（脱血脉
实坚，病在外也。）而脉不实坚为难治，名曰逆四时。（脱血而脉不实不坚，难疗也。以上七诊，
皆逆四时也。平按∶为难治《素问》作皆难治。又按《素问》新校正云∶“按《平人气象论》云
病在中脉虚，病在外脉涩坚，与此相反，此经误，彼论为得。自未有脏形春夏至此，与《平人气
象论》相重，注义备于彼。”）
黄帝问于岐伯曰∶脉其四时动，奈何知？病所在，奈何知？病之所变，奈何知？病乍在内，
奈何知？病乍在外，奈何知？请问此六者，可得闻乎？（六，谓六问。此中唯有五问，当是脱一
问也。平按∶《素问》请上无知字，六作五。据本篇下经文“此六者持脉之大法”，应作六。杨
注云当是脱一问，于义正合。）岐伯对曰∶请言其与天转运。（量下答中，文当有六，故为六合
也。人身合天，故请言人身与天合气转运之道也。平按∶与天转运《素问》作与天转运大也。）
夫万物之外，六合之内，天地之变，阴阳之应，（万物各受一形，自万物一形之外，从于六合苞
裹之内，皆是天地为其父母，变化而生，故万物皆与天地之气应而合也。平按∶《素问》无夫字。
《甲乙》无夫万物之外五字。）彼春之暖，为夏之暑，（春夏者，阴气终始也。春之三月，阳气
之始，气和日暖。夏之三月，阳盛暑热，乃是春暖增长为之也。平按∶注阴气终始，阴字当是阳字
之误。）彼秋之急，为冬之怒，（秋冬者，阴气终始也。秋之三月，阴气之始，风高气切，故名
为急。冬之三月，阴气严烈，乃是秋凉增长为之也。平按∶急《素问》、《甲乙》作忿，王注云∶
忿一作急。注气切，切字恐是劲字之误。）四变之动，脉与之上下。（暖暑急怒，是天之运四气
变动，人之经脉，与彼四气上下变动亦不异也。春夏之脉，人迎大于寸口，故为上也；寸口小于
人迎，故为下也。秋冬之脉，寸口大于人迎，故为上也；人迎小于寸口，故为下也。此乃盛衰为上
下也，此答初问也。平按∶注秋冬之脉至故为下也五句，袁刻脱，根据原抄补入。）以春应中规，
夏应中矩，（春三月时，少阳之气用，万物始生未正，故曰应规也。夏三月时，太阳之气用，万
物长正，故曰应矩也。）秋应中
衡，冬应中权。（秋三月时，少阴之气用，万物长极，故曰应衡也。冬三月时，太阴之气用，万
物归根，故曰应权也。平按∶衡原抄作冲，注同，谨根据《素问》、《甲乙》作衡。）是故冬至四
十五日，阳气微上，阴气微下；（冬至以后，阳气渐长，故曰微上；阴气渐降，故曰微下也。）
夏至四十五日，阳气微下，阴气微上。（夏至以后，阴气渐长，故曰微上；阳气渐降，故曰微下
也。）阴阳有时，与脉为期，期而相失，知脉所分，分之有期，故知死时。（阴阳以有四时，四
时与脉为期，为期在于四时相得失处，即知四时之脉，分在四时之际，脉分四时有期，则死生之
期可知，此答第二病所在也。平按∶知脉所分，知字原抄作和，谨根据《素问》、《甲乙》及本注
作知。）微妙在脉，亦不可不察，察之有纪，从阴阳始，（欲知人之死生者，无胜察之妙，察脉
纲纪，必以阴阳为本也。平按∶《素问》、《甲乙》无亦字。）始之有经，从五行生，（阴阳本始，
有十二经脉也。十二月经脉，从五行生也。）生之有度，四时为数，（五行生十二经脉，各有法
度。脉从五行生，木生二经。足厥阴、足少阳也。火生四经，手少阴、手太阳、手厥阴、手少阳也。
土生二经，足太阴、足阳明也。金生二经，手太阴、手阳明也。水生二经，足少阴、足太阳也。此
为五行生十二经脉。法度者，春有二经，夏有四经，季夏有二经，秋有二经，冬有二经，故十二
经脉以四时为数也。平按∶《素问》数作宜，新校正云∶按《太素》宜作数。）循数勿失，与天地
如一，得一之诚，以知死生。（于寸关尺三部之中，循十二经之脉，得其弦钩浮营四时之气而不
失错，与天地气宜然为一，如此则能了知死生之期也。平按∶循数《素问》作补泻，诚作情。自
“始之有经”至“以知死生”，《甲乙》无此八句。）是故声合五音，色合五行，脉合阴阳。
（人之音声，合于五音，人之形色，合于五行，人之脉气，合于阴阳，此答第三知病之所
变也。平按∶注知病，知字原抄作之，据上经文宜作知。）是故阴盛则梦涉大水恐惧，阳盛则梦
大火燔灼，阴阳俱盛则梦相杀毁伤；上盛则梦飞扬，（平按∶《素问》、《甲乙》无扬字。）下
盛则梦堕坠；（平按∶《素问》、《甲乙》无坠字。）甚饱则梦予，甚饥则梦取；肝气甚则梦怒，
肺气甚则梦哀；（平按∶甚《素问》《甲乙》作盛。《素问》哀作哭，《甲乙》作哭泣恐惧飞扬。）
短虫多则梦众，长虫多则梦相击破伤。（凡梦有三种∶人有吉凶，先见于梦，此为征梦也；思想
情深，因之见梦，此为想梦也；因其所病，见之于梦，此为病梦也。此十一种梦，皆病梦也，并
因阴阳气之盛衰、内有饥饱、肝肺气盛、长短虫多以为梦也。此所以因伤致梦，即以梦为诊也，
此为梦诊，可为四答问之脱也。平按∶《甲乙》无短长虫多二句，《素问》新校正云∶详此二句，
亦不当出此，应他经脱简文也。）是故持脉有道，虚静为保。（持脉之道，虚心不念他事，凝神
静虑，以为自保，方可得知脉之浮沉、气之内外也。平按∶《甲乙》无是故二字，保作宝。）春
日浮，如鱼之游在皮；夏日在肤，沉沉乎万物有余；（春时阳气初开，脉从骨髓流入经中，上至
于皮，如鱼游水，未能周散。夏时阳气荣盛，脉从经溢入孙络肤肉之中，如水流溢，沉沉盛长，
万物亦然，茂盛有余。此答第五病在外也。平按∶皮《素问》、《甲乙》作波。）秋日下肤，蛰虫
将去；冬日在骨，蛰虫固密，君子居室。（秋日阳气从肤渐伏于内，故曰下肤。蛰虫趣暖入穴，
故曰将去。是时阴气从内出在皮肤，腠理将开也。冬日阳气内伏，蛰虫闭户固密，君子去堂居室，
人之脉气行骨，故持脉者深按得之。此答第六病乍在内也。平按∶固《素问》、《甲乙》作周。）
故曰知内者按而纪之，知外者终而始之。（秋冬脉气为阴在内，故按得纲纪；春夏脉气为阳在外，
故趣得终始也。春夏之
脉为秋冬脉终，即为阳之始也。）此六者，持脉之大法也。（以为诊脉大法。）
春得秋脉，夏得冬脉，秋得春脉，冬得夏脉，阴出之阳，阳病善怒不治，是谓五邪，皆同命
死不治。（春得秋脉，夏得冬脉，皆贼邪来乘也。秋得春脉，冬得夏脉，虽是微邪来乘，以秋冬得
之，阴出之阳交争者，不疗也。平按∶《素问》夏得冬脉下有“长夏得春脉”五字，秋得春脉作
秋得夏脉，冬得夏脉作冬得长夏脉，阴出上有“名曰”二字，《甲乙》同。又《甲乙》死不治上
无命字。）
【平按】：本篇从篇首至“名曰逆四时”，见于《素问》卷六第十九《玉机真脏论》篇，又见于《甲乙经》卷四《经脉》第一下编。从“黄帝问于岐伯曰脉其四时至持脉之大法也”，见于《素问》卷五第十七《脉要精微论》篇，《甲乙经》同上。又从“是故阴盛则梦涉大水”至“肺气甚则梦哀”，见于《甲乙经》卷六第八《正邪袭内生梦大论》。从“春得秋脉”至末尾，见于《素问》卷七第二十三《宣明五气篇》，又见于《甲乙经》卷四《经脉》第一中篇。
凡是治病，必须观察病人的形体、气色、色泽，脉象的盛衰，疾病的久暂，然后进行治疗，不要错过时机。（形体的肥瘦，气的强弱，颜色的枯润，脉象的盛衰，疾病的新旧，凡是有治疗疾病的人，依靠这五种诊察方法，使诊断恰当，就是合乎时机；如果不恰当，就是错过了时机。）形体与气相协调，称为可治；（形体消瘦而气盛，或形体肥胖而气弱，为不相协调；形体肥胖而气盛，或形体消瘦而气弱，为相协调。）脉象、颜色、光泽呈现浮象，称为容易痊愈；（病人面色浮轻润泽，病容易痊愈。平按：《素问》中没有“脉”字。）脉象顺应四时变化，称为可治；（四季的王脉，都含有胃气，没有他行克制，所以叫顺时。平按：“顺”在《素问》中作“从”。）脉象柔弱而滑利，这是有胃气，叫做容易治疗，应及时施治。（四季的脉象都柔弱滑利的，叫做胃气，根据这个来治疗疾病，叫做合乎时机。平按：“趣之以时”在《素问》中作“取之以时”，在《甲乙经》中作“治之趋之，无后其时。”）形体与气不相协调，称为难治；面色枯槁不润泽，称为难愈；脉象实而坚，称为病情加重；脉象违背四时变化，称为不治，必须仔细考察这四种难治的情况并明确告知病人，不要急于按时令施治。（这四种诊察，难以合宜，可以明确告知病人，应当变通常规设立疗法，不得拘泥于常理按时令施治。平按：“谓之不治”在《素问》中作“为不可治”，没有“勿趣以时”一句。《甲乙经》没有“必察四难”以下的十二个字。）所谓违背四时，是指春季出现肺脉，夏季出现肾脉，秋季出现心脉，冬季出现脾脉，它们的脉象都悬绝沉涩，叫做违背四时，即使还没有显现出脏腑病变的征象，（四季都出现克制自己的脉象，己方脉象悬绝沉涩，失去了四时和缓的脉象，虽然没有病脏的形证，也不可治疗。平按：“命曰”在《甲乙经》中作“名曰”。）春夏季节脉象沉涩，秋冬季节脉象浮大，（这种脉象违背了四时规律。平按：《素问》、《甲乙经》在“春”上有“于”字。“浮大”下《素问》有“名曰逆四时也”六个字。）患热病而脉象静缓，（热病的脉象应该热躁，现在反而寒静。 ，寒的意思。平按：《素问》、《甲乙经》没有 字。）腹泻而脉象洪大，（人患泄泻，脉象应该细小，现在却是洪大。）失血而脉象实，病位在里，（人失血，脉象应该虚弱，现在反而强实，病在里。）脉象实坚，病位在外，（失血而脉象实坚，病在外。）脉象不实不坚却为难治，叫做违背四时。（失血而脉象不实不坚，难治疗。以上七种诊察，都是违背四时的表现。平按：“为难治”在《素问》中作“皆难治”。另外按《素问》新校正说：“按《平人气象论》说病在中脉虚，病在外脉涩坚，与此相反，此经文有误，彼论正确。从‘未有脏形’到‘春夏至此’，与《平人气象论》重复，注释义理备见于彼处。”）
黄帝问岐伯说：脉象随四时变动，如何知道？病位所在，如何知道？病情的变化，如何知道？病忽然在体内，如何知道？病忽然在体表，如何知道？请问这六点，可以讲给我听吗？（六，指六个问题。这里只有五个问题，应该是脱漏了一个问题。平按：《素问》在“请”上没有“知”字，“六”作“五”。根据本篇下文“此六者持脉之大法”，应作“六”。杨上善注说应该是脱漏了一个问题，这在义理上是正确的。）岐伯回答说：请让我谈谈人体与天地之气转运的道理。（衡量下面的回答，文意应该有六项，所以说是六合。人身合于天，所以请讲人身与天合气转运的道理。平按：“与天转运”在《素问》中作“与天转运大也”。）
万物之外，六合之内，天地的变化，阴阳的感应，（万物各自承受一种形态，从万物这一形态之外，包裹在六合之内，都是天地作为父母，变化而生成的，所以万物都与天地之气相应合。平按：《素问》没有“夫”字。《甲乙经》没有“夫万物之外”五个字。）那春天的温暖，成为夏天的暑热，（春夏两季，是阳气的始终。春季三个月，是阳气的开始，气候温和日暖。夏季三个月，阳气旺盛暑热，这是春暖增长形成的。平按：注中说“阴气终始”，“阴”字可能是“阳”字的误写。）那秋天的急劲，成为冬天的严酷，（秋冬两季，是阴气的始终。秋季三个月，是阴气的开始，风高气劲，所以名叫急。冬季三个月，阴气严烈，这是秋凉增长形成的。平按：“急”在《素问》、《甲乙经》中作“忿”，王冰注说：忿一作急。注中说“气切”，“切”字恐怕是“劲”字的误写。）四时的变动，脉象随之上下起伏。（暖、暑、急、怒，是天的运行导致四气变动，人的经脉，与这四气上下变动也不异。春夏的脉象，人迎脉大于寸口脉，所以上；寸口脉小于人迎脉，所以下。秋冬的脉象，寸口脉大于人迎脉，所以上；人迎脉小于寸口脉，所以下。这是以盛衰为上下的意思，这是回答第一个问题。平按：注中从“秋冬之脉”到“故为下也”五句，袁刻本脱漏，根据原抄本补入。）春脉应合圆规（规），夏脉应合矩尺（矩），（春季三个月，少阳之气主事，万物开始生长但未端正，所以叫应规。夏季三个月，太阳之气主事，万物生长端正，所以叫应矩。）秋脉应合秤衡（衡），冬脉应合秤锤（权）。（秋季三个月，少阴之气主事，万物生长至极，所以叫应衡。冬季三个月，太阴之气主事，万物归根，所以叫应权。平按：“衡”原抄本作“冲”，注同，谨根据《素问》、《甲乙经》改为“衡”。）所以冬至后四十五天，阳气微微上升，阴气微微下降；（冬至以后，阳气逐渐增长，所以叫微上；阴气逐渐下降，所以叫微下。）夏至后四十五天，阳气微微下降，阴气微微上升。（夏至以后，阴气逐渐增长，所以叫微上；阳气逐渐下降，所以叫微下。）阴阳各有定时，与脉象有期限，过了期限而脉象失常，就能知道脉象的分属，分属各有期限，所以能知道死亡的时间。（阴阳有四时，四时与脉象有期限，期限在于四时得失之处，即知四时之脉，分属于四时之际，脉分四时有期限，那么死生的期限可知，这是回答第二个问题“病所在”。平按：“知脉所分”，“知”字原抄本作“和”，谨根据《素问》、《甲乙经》及本注改为“知”。）脉象的精妙细微，也不能不考察，考察它有纲纪，从阴阳开始，（想要知道人的死生，没有比考察更精妙的了，考察脉象的纲纪，必须以阴阳为本。平按：《素问》、《甲乙经》没有“亦”字。）开始有经脉，从五行产生，（阴阳的本始，有十二经脉。十二月令的经脉，从五行产生。）产生有法度，以四时为数量，（五行产生十二经脉，各有法度。脉从五行生，木生二经：足厥阴、足少阳。火生四经：手少阴、手太阳、手厥阴、手少阳。土生二经：足太阴、足阳明。金生二经：手太阴、手阳明。水生二经：足少阴、足太阳。这是五行生十二经脉。法度方面，春季有二经，夏季有四经，长夏有二经，秋季有二经，冬季有二经，所以十二经脉以四时为数量。平按：《素问》“数”作“宜”，新校正说：按《太素》“宜”作“数”。）遵循法度不失误，与天地一致，得到这一真诚，就能知道死生。（在寸、关、尺三部之中，循行十二经的脉象，得到弦、钩、浮、营四时之气而不失误错，与天地气宜然为一，如此就能了知死生的期限。平按：“循数”在《素问》中作“补泻”，“诚”作“情”。从“始之有经”到“以知死生”，《甲乙经》没有这八句。）所以声音符合五音，颜色符合五行，脉象符合阴阳。（人的音声，合于五音，人的形色，合于五行，人的脉气，合于阴阳，这是回答第三个问题“知病之所变”。平按：注中说“知病”，“知”字原抄本作“之”，据上文经文宜作“知”。）所以阴气盛则梦见渡大水恐惧，阳气盛则梦见大火燃烧，阴阳俱盛则梦见互相杀戮毁伤；上部气盛则梦见飞扬，（平按：《素问》、《甲乙经》没有“扬”字。）下部气盛则梦见坠落，（平按：《素问》、《甲乙经》没有“坠”字。）吃得很饱则梦见送人东西，非常饥饿则梦见取人东西；肝气盛则梦见发怒，肺气盛则梦见悲哀哭泣；（平按：“甚”在《素问》《甲乙经》中作“盛”。《素问》“哀”作“哭”，《甲乙经》作“哭泣恐惧飞扬”。）腹内小虫多则梦见众人，腹内大虫多则梦见互相击打受伤。（凡是梦有三种：人有吉凶，先见于梦，这叫征梦；思想情深，因此见梦，这叫想梦；因为所患病痛，见之于梦，这叫病梦。这十一种梦，都是病梦，并且因阴阳气的盛衰、内有饥饱、肝肺气盛、长短虫多而形成梦境。这是因为伤病导致做梦，即以梦作为诊断，这叫梦诊，可以作为第四个问题的补充。平按：《甲乙经》没有“短长虫多”两句，《素问》新校正说：详查这两句，也不应当出现在这里，应是其他经书脱落的简文。）所以诊脉有道，虚心安静是保证。（诊脉之道，虚心不想其他事情，凝神静虑，以此自保，才可以得知脉象的浮沉、气的内外。平按：《甲乙经》没有“是故”二字，“保”作“宝”。）春脉浮，像鱼游动在皮肤之间；夏脉在肤，沉沉乎万物有余；（春季阳气初开，脉从骨髓流入经中，上至于皮，像鱼游水，未能周散。夏季阳气荣盛，脉从经溢入孙络肤肉之中，像水流溢，沉沉盛长，万物亦然，茂盛有余。这是回答第五个问题“病在外”。平按：“皮”在《素问》、《甲乙经》中作“波”。）秋脉下肤，像蛰虫将要离去；冬脉在骨，像蛰虫固密，君子居于室内。（秋季阳气从肤渐伏于内，所以叫下肤。蛰虫趋向温暖进入洞穴，所以叫将去。这时阴气从内出在皮肤，腠理将要开。冬季阳气内伏，蛰虫闭户固密，君子离开厅堂居于室内，人的脉气行于骨，所以诊脉者深按才能得之。这是回答第六个问题“病乍在内”。平按：“固”在《素问》、《甲乙经》中作“周”。）所以说，了解体内的脉象要深按以得其纲纪，了解体表的脉象要由终始来把握。（秋冬脉气为阴在内，所以按得纲纪；春夏脉气为阳在外，所以趣得终始。春夏的脉为秋冬脉的终结，即为阳的开始。）这六点，是诊脉的大法。（作为诊脉大法。）
春季出现秋季的脉象，夏季出现冬季的脉象，秋季出现春季的脉象，冬季出现夏季的脉象，阴出转阳，阳病善于发怒且不可治，这叫做五邪，都同样性命难保不可治。（春季出现秋季的脉象，夏季出现冬季的脉象，都是贼邪来乘袭。秋季出现春季的脉象，冬季出现夏季的脉象，虽然是微邪来乘袭，但在秋冬季节出现，阴出转阳交争的，不可治疗。平按：《素问》在“夏得冬脉”下有“长夏得春脉”五个字，“秋得春脉”作“秋得夏脉”，“冬得夏脉”作“冬得长夏脉”，“阴出”上有“名曰”二字，《甲乙经》同。另外《甲乙经》在“死不治”上没有“命”字。）
[Ping An]: This section, from the beginning of the chapter to "named contrary to the four seasons," is found in *Suwen* (Basic Questions), Volume 6, Chapter 19, "Yuji Zhenzang Lun" (Treatise on the True Viscera and the Jade Machine), and also in *Jiaying Jing* (A-B Classic), Volume 4, "Jingmai" (Meridians), Part 1, Lower Section. From "Huangdi asked Qibo: How do pulses move with the four seasons..." to "the great method of holding pulses," it is found in *Suwen*, Volume 5, Chapter 17, "Maiyao Jingwei Lun" (Treatise on the Essence and Subtlety of Pulses), and *Jiaying Jing* is the same. Also, from "Therefore, when Yin is excessive, one dreams of wading through great water..." to "...when Lung Qi is excessive, one dreams of sorrow," it is found in *Jiaying Jing*, Volume 6, Chapter 8, "Zhengxie Xi Nei Sheng Meng Da Lun" (Great Treatise on Righteous Evil Invading Internally and Generating Dreams). From "Spring pulse of Autumn..." to the end, it is found in *Suwen*, Volume 7, Chapter 23, "Xuanming Wuqi Pian" (Chapter on Manifesting the Five Qi), and also in *Jiaying Jing*, Volume 4, "Jingmai" (Meridians), Part 1, Middle Section.
In all cases of treating disease, one must observe the patient's form, Qi, color, and luster; the excess or deficiency of the pulse; and whether the disease is new or old. Then treatment is administered without delaying the appropriate time. (The fatness or thinness of the form, the strength or weakness of Qi, the freshness or witheredness of color, the excess or deficiency of the pulse, and the newness or chronicity of the disease—these five diagnostic aspects are used by those who treat diseases. If the diagnosis is accurate, it conforms to the time; if not, it misses the time.) When form and Qi are harmonious, it is called treatable. (When the form is thin but Qi is abundant, or the form is fat but Qi is deficient, they are disharmonious; when the form is fat and Qi is abundant, or the form is thin and Qi is deficient, they are harmonious.) When the pulse, color, and luster appear floating, it is called easy to recover. (If the patient's complexion is floating, light, and lustrous, the disease will be easily resolved. Ping An: The character "pulse" is absent in *Suwen*.) When the pulse conforms to the four seasons, it is called treatable. (The ruling pulses of the four seasons all contain Stomach Qi [Wei Qi, a sign of healthy digestive function and vitality] and are not overcome by other elements, hence called conforming to the season. Ping An: "Conform" is written as "Follow" in *Suwen*.) When the pulse is weak and slippery, it indicates the presence of Stomach Qi [Wei Qi], and is named easy to treat; act promptly according to the timing. (When the pulses of all four seasons are weak and slippery, this is called Stomach Qi [Wei Qi]. Treating based on this is considered conforming to the time. Ping An: "Act promptly according to the time" is written as "Take it according to the time" in *Suwen*, and as "Treat it and hasten it, do not delay the time" in *Jiaying Jing*.) When form and Qi are disharmonious, it is called difficult to treat; when the complexion is withered and lacks luster, it is called difficult to heal; when the pulse is solid and hard, it indicates the condition is worsening; when the pulse contradicts the four seasons, it is called untreatable. One must carefully examine these four difficulties and clearly inform the patient, and not act hastily according to the seasonal timing. (These four diagnostic signs are difficult to manage appropriately; one should clearly inform the patient and adopt flexible treatment methods rather than rigidly adhering to standard seasonal treatments. Ping An: "Called untreatable" is written as "is untreatable" in *Suwen*, lacking the phrase "do not act hastily according to the time." *Jiaying Jing* lacks the twelve characters following "must examine the four difficulties".) What is meant by contradicting the four seasons is: finding the Lung pulse in Spring, the Kidney pulse in Summer, the Heart pulse in Autumn, and the Spleen pulse in Winter, where the pulses are all hanging, isolated, deep, and choppy. This is named contradicting the four seasons. Even without visible signs of visceral pathology, (When all four seasons show the pulse that overcomes one's own element, and one's own pulse is hanging, isolated, deep, and choppy, losing the harmonious pulse of the four seasons, although there are no visible forms of diseased viscera, it cannot be treated. Ping An: "Named" is written as "Called" in *Jiaying Jing*.) In Spring and Summer, the pulse is deep and choppy; in Autumn and Winter, the pulse is floating and large. (This pulse contradicts the four seasons. Ping An: *Suwen* and *Jiaying Jing* have the character "at" before "Spring." Below "floating and large," *Suwen* has six characters: "named contradicting the four seasons.") In febrile disease, the pulse is quiet. (In heat disease, the pulse should be hot and restless; now it is cold and quiet. , means cold. Ping An: The character is absent in *Suwen* and *Jiaying Jing*.) In diarrhea, the pulse is large. (In human diarrhea, the pulse should be small and fine; now it is洪大 [large and expansive].) In blood loss, the pulse is solid, and the disease is internal. (In blood loss, the pulse should be weak; now it is strong and solid, indicating the disease is internal.) With a solid and hard pulse, the disease is external. (In blood loss, a solid and hard pulse indicates the disease is external.) But if the pulse is not solid and hard, it is difficult to treat, named contradicting the four seasons. (In blood loss, if the pulse is not solid and hard, it is difficult to treat. The above seven diagnostics all contradict the four seasons. Ping An: "Difficult to treat" is written as "all difficult to treat" in *Suwen*. Additionally, according to the New Correction in *Suwen*: "According to 'Pingren Qixiang Lun' [Treatise on Normal People's Pulse and Phenomena], it says for disease inside the pulse is empty, for disease outside the pulse is choppy and hard, which is opposite to this. This scripture has an error, while that treatise is correct. From 'without visceral form' to 'Spring and Summer here,' it overlaps with 'Pingren Qixiang Lun'; the explanatory meaning is fully contained therein.")
Huangdi asked Qibo: How do we know how pulses move with the four seasons? How do we know the location of the disease? How do we know the changes of the disease? How do we know if the disease is suddenly internal? How do we know if the disease is suddenly external? I ask about these six points; may I hear them? (Six refers to six questions. There are only five questions here; one question is likely missing. Ping An: *Suwen* lacks the character "know" after "please," and writes "five" instead of "six." Based on the text below "these six are the great method of holding pulses," it should be "six." Yang Shangshan notes that a question is likely missing, which fits the logic.) Qibo replied: Let me speak of its connection with Heaven's rotation. (Considering the answer below, the text should have six items, hence "six unions." The human body corresponds to Heaven, so let me explain the way the human body's Qi connects with Heaven's rotation. Ping An: "With Heaven's rotation" is written as "With Heaven's rotation great" in *Suwen*.)
Outside all things, within the Six Directions [North, South, East, West, Up, Down], are the changes of Heaven and Earth and the responses of Yin and Yang. (Each thing receives a specific form. Outside this form of all things, encompassed within the Six Directions, Heaven and Earth act as parents, creating change and birth. Thus, all things correspond and combine with the Qi of Heaven and Earth. Ping An: *Suwen* lacks the character "Fu." *Jiaying Jing* lacks the five characters "Fu Wanwu zhi wai".) That spring warmth becomes summer heat. (Spring and Summer are the beginning and end of Yang Qi. The three months of Spring are the start of Yang Qi, with gentle air and warm days. The three months of Summer see abundant Yang Qi and intense heat, formed by the growth of spring warmth. Ping An: The note says "end of Yin Qi"; "Yin" is likely a typo for "Yang".) That autumn urgency becomes winter severity. (Autumn and Winter are the beginning and end of Yin Qi. The three months of Autumn are the start of Yin Qi, with high wind and sharp air, hence named urgency. The three months of Winter see severe Yin Qi, formed by the growth of autumn coolness. Ping An: "Urgency" is written as "Anger" in *Suwen* and *Jiaying Jing*; Wang Bing notes: Anger is alternatively Urgency. The note says "Qi Qie"; "Qie" is likely a typo for "Jin" [strong/tough].) The movement of the four changes causes the pulse to rise and fall. (Warmth, heat, urgency, and severity are the movements of Heaven causing changes in the four Qi. Human meridians change up and down similarly to these four Qi. In Spring and Summer, the Renying pulse is larger than the Cunkou pulse, hence "up"; Cunkou is smaller than Renying, hence "down." In Autumn and Winter, Cunkou is larger than Renying, hence "up"; Renying is smaller than Cunkou, hence "down." This defines up and down by excess and deficiency. This answers the first question. Ping An: The five sentences from "Renmai of Autumn and Winter" to "hence down" were omitted in Yuan's edition; inserted here based on the original manuscript.) Spring corresponds to the compass [Gui, representing roundness/circle]; Summer corresponds to the square [Ju, representing right angles/square]. (In the three months of Spring, Shaoyang Qi [Lesser Yang] is active; all things begin to grow but are not yet upright, hence corresponding to the compass. In the three months of Summer, Taiyang Qi [Greater Yang] is active; all things grow upright, hence corresponding to the square.) Autumn corresponds to the balance [Heng, representing weighing/balance]; Winter corresponds to the plumb bob/weight [Quan, representing weight/heaviness]. (In the three months of Autumn, Shaoyin Qi [Lesser Yin] is active; all things reach their peak of growth, hence corresponding to the balance. In the three months of Winter, Taiyin Qi [Greater Yin] is active; all things return to the root, hence corresponding to the weight. Ping An: "Heng" was originally written as "Chong" in the manuscript; corrected to "Heng" based on *Suwen* and *Jiaying Jing*.) Therefore, forty-five days after the Winter Solstice, Yang Qi rises slightly, and Yin Qi descends slightly. (After the Winter Solstice, Yang Qi gradually grows, hence "slightly rises"; Yin Qi gradually declines, hence "slightly descends.") Forty-five days after the Summer Solstice, Yang Qi descends slightly, and Yin Qi rises slightly. (After the Summer Solstice, Yin Qi gradually grows, hence "slightly rises"; Yang Qi gradually declines, hence "slightly descends.") Yin and Yang have their times, and the pulse has its period. If the period passes and the pulse deviates, one can know the division of the pulse. Since the divisions have periods, one can know the time of death. (Yin and Yang follow the four seasons; the four seasons set the period for the pulse. By observing the gains and losses relative to the four seasons, one knows the pulse's division into the four seasons. Since the pulse's division into the four seasons has a limit, the time of life and death can be known. This answers the second question, "location of disease." Ping An: "Know the pulse's division"; "Know" was originally "He"; corrected to "Know" based on *Suwen*, *Jiaying Jing*, and the note.) The subtlety lies in the pulse, which must not be ignored. Examination has principles, starting with Yin and Yang. (To know life and death, nothing is more subtle than examination. The principle of examining the pulse must take Yin and Yang as the foundation. Ping An: *Suwen* and *Jiaying Jing* lack the character "also".) The beginning has meridians, generated from the Five Elements [Wu Xing]. (The origin of Yin and Yang has the Twelve Meridians [Twelve Primary Channels]. The meridians of the twelve months are generated from the Five Elements.) Generation has rules, measured by the four seasons. (The Five Elements generate the Twelve Meridians, each with its rules. Pulses are generated from the Five Elements: Wood generates two meridians: Foot Jueyin and Foot Shaoyang. Fire generates four meridians: Hand Shaoyin, Hand Taiyang, Hand Jueyin, Hand Shaoyang. Earth generates two meridians: Foot Taiyin and Foot Yangming. Metal generates two meridians: Hand Taiyin and Hand Yangming. Water generates two meridians: Foot Shaoyin and Foot Taiyang. This is the Five Elements generating the Twelve Meridians. Regarding rules: Spring has two meridians, Summer has four, Late Summer has two, Autumn has two, Winter has two. Thus, the Twelve Meridians are counted by the four seasons. Ping An: *Suwen* writes "Shu" as "Yi"; New Correction says: According to *Tai Su*, "Yi" should be "Shu".) Follow the rules without error, align with Heaven and Earth, attain sincerity, and know life and death. (Among the Cun, Guan, and Chi positions, following the Twelve Meridians' pulses, obtaining the Four Seasons' Qi of String [Xian], Hook [Gou], Floating [Fu], and Nourishing [Ying] without error, becoming one with the suitability of Heaven and Earth, thus one can understand the time of life and death. Ping An: "Follow the number" is written as "Tonify and Reduce" in *Suwen*; "Sincerity" as "Emotion/Qing". From "The beginning has meridians" to "know life and death," these eight sentences are absent in *Jiaying Jing*.) Therefore, sound matches the Five Tones [Wu Yin], color matches the Five Elements [Wu Xing], and pulse matches Yin and Yang. (Human voice matches the Five Tones; human form and color match the Five Elements; human pulse Qi matches Yin and Yang. This answers the third question, "knowing disease changes." Ping An: The note says "Zhi Bing"; "Zhi" was originally "Zhi" [of]; corrected to "Zhi" [know] based on the preceding text.) Therefore, when Yin is excessive, one dreams of wading through great water and feeling fear; when Yang is excessive, one dreams of great fire burning; when both Yin and Yang are excessive, one dreams of killing and injuring each other; when Upper [Jueyin/Taiyang] is excessive, one dreams of flying upward; (Ping An: *Suwen* and *Jiaying Jing* lack the character "Yang".) when Lower [Shaoyin/Shao Yang] is excessive, one dreams of falling; (Ping An: *Suwen* and *Jiaying Jing* lack the character "Zhui".) when very full, one dreams of giving; when very hungry, one dreams of taking; when Liver Qi is excessive, one dreams of anger; when Lung Qi is excessive, one dreams of sorrow and crying; (Ping An: "Shen" [excessive/severe] is written as "Sheng" [abundant/excessive] in *Suwen* and *Jiaying Jing*. *Suwen* writes "Ai" as "Ku" [cry]; *Jiaying Jing* writes "Kuqi Kongju Feiyang" [crying, fear, flying].) when many short worms [small intestinal parasites] exist, one dreams of crowds; when many long worms [large intestinal parasites] exist, one dreams of fighting and injury. (There are three types of dreams: omens where good or bad fortune appears first in the dream, called Omen Dreams; dreams arising from deep thoughts, called Thought Dreams; and dreams arising from existing illness, called Illness Dreams. These eleven types of dreams are all Illness Dreams, caused by the excess or deficiency of Yin and Yang Qi, internal hunger or fullness, excess of Liver and Lung Qi, and abundance of short or long worms. This is dreaming due to injury/illness, using dreams for diagnosis, called Dream Diagnosis, which can serve as a supplement to the fourth question. Ping An: *Jiaying Jing* lacks the last two sentences. *Suwen* New Correction says: Upon detail, these two sentences should not appear here; they are likely fragments from another classic's bamboo slips.) Therefore, holding the pulse has a Way; emptiness and stillness are the guarantee. (The Way of holding the pulse requires an empty mind free from other thoughts, concentrating spirit and calming thoughts for self-preservation, so as to perceive the pulse's floating/sinking and Qi's internal/external. Ping An: *Jiaying Jing* lacks "Therefore"; "Bao" is written as "Bao" [treasure].) Spring pulse floats, like a fish swimming in the skin; Summer pulse is in the flesh, heavy and abundant like all things. (In Spring, Yang Qi initially opens; the pulse flows from Marrow into Meridians, rising to the skin, like a fish swimming in water, unable to spread widely. In Summer, Yang Qi is lush and abundant; the pulse overflows from Meridians into Sun-Luo [minute collaterals] and flesh, like water overflowing, heavy and growing, just as all things are lush and abundant. This answers the fifth question, "disease external." Ping An: "Pi" [skin] is written as "Bo" [wave] in *Suwen* and *Jiaying Jing*.) Autumn pulse goes down to the skin, like hibernating insects preparing to leave; Winter pulse is in the bone, like hibernating insects sealed tightly, and gentlemen stay indoors. (In Autumn, Yang Qi gradually retreats inward from the skin, hence "down to the skin." Hibernating insects seek warmth and enter holes, hence "preparing to leave." At this time, Yin Qi emerges from within to the skin, and pores are about to open. In Winter, Yang Qi is hidden internally; hibernating insects seal doors tightly; gentlemen leave halls to stay indoors. Human pulse Qi travels in the bones, so the examiner must press deeply to feel it. This answers the sixth question, "disease suddenly internal." Ping An: "Gu" [solid] is written as "Zhou" [complete/circular] in *Suwen* and *Jiaying Jing*.) Thus it is said: To know the internal, press to find the structure; to know the external, follow from end to beginning. (Autumn and Winter pulse Qi is Yin and internal, so pressing reveals the structure; Spring and Summer pulse Qi is Yang and external, so following reveals the beginning and end. Spring and Summer pulses are the end of Autumn and Winter pulses, i.e., the beginning of Yang.) These six points are the great method of holding pulses. (As the great method of pulse diagnosis.)
Finding the Autumn pulse in Spring, the Winter pulse in Summer, the Spring pulse in Autumn, and the Summer pulse in Winter; Yin emerging to Yang, Yang disease prone to anger and untreatable, is called the Five Evils [Wu Xie], all sharing the same fate of death and untreatability. (Finding Autumn pulse in Spring and Winter pulse in Summer are attacks by Zai Xie [Thieving/Overcoming Evils]. Finding Spring pulse in Autumn and Summer pulse in Winter, though slight evils attacking, occur in Autumn/Winter where Yin emerges to Yang and struggles, making it untreatable. Ping An: *Suwen* adds five characters "Late Summer gets Spring pulse" after "Summer gets Winter pulse"; "Autumn gets Spring pulse" is written as "Autumn gets Summer pulse"; "Winter gets Summer pulse" as "Winter gets Late Summer pulse"; "Yin Chu" has two characters "Ming Yue" [named] before it; *Jiaying Jing* is the same. Also, *Jiaying Jing* lacks the character "Ming" before "Si Bu Zhi" [death untreatable].)