黄帝问曰。平人何如。（平人、平常无病之人。无病之人。自有平常之脉。反常则为病矣。故曰平人气象论。气者。
经脉之气。象者。脉之形象也。）岐伯对曰。人一呼脉再动。一吸脉亦再动。呼吸定息。脉五动。闰以太息。命曰平人。
平人者不病也。（出气曰呼。入气曰吸。一呼一吸为一息。平人之脉。一呼再动。一息再动。呼吸定息。脉计五动。盖闰
以太息。故五动也。闰、余也。太息者。呼吸定息之时。有余不尽。而脉又一动。如岁余之有闰也。盖人之呼吸。乃阴
阳之气。出入循环。有若寒暑往来而成岁。故宜闰以太息之有余。）当以不病调病患。医不病。故为病患平息以调之为法。
不病者其息平。病者其息乱。医者不病。故为病患平息以调之。是为候诊之法。人一呼。脉一动。一吸。脉一动曰少
气。（荣气宗气行于脉外。卫气行于脉中。荣卫相将。脉随气转。人一呼一动。一吸一动。减于平人过半。故主气之衰微。）
人一呼脉三动。一吸脉三动而躁。尺热曰病温。尺不热脉滑曰病风。脉涩曰痹。（一息之中。脉六动者。气之太过也。躁、
急也。吸而躁者。有余之邪。从外而内也。温病者。冬伤于寒。至春发为温病。冬伤于风。至春发为风温。此皆伏匿之
邪。由内而外。从阴而阳。故尺中热也。风为阳邪。伤人阳气。故尺不热。气分之邪。留而不去。则迫于经。故脉滑也。
痹者闭也。邪积而不行。故脉涩泣也。盖言从内而外者为温病。从外而内者为风邪。留着于外内之间者为痹也。上节言
不及者。缘正气衰少。此言太过者。乃邪气有余。而有余之邪。又有阴阳外内出入之别。）人一呼吸四动以上曰死。脉绝
不至曰死。乍疏乍数曰死。（四动以上。太过之极也。脉绝不至。不及之极也。乍疏乍数。或太过。或不及。气之乱也。
此皆不平之甚。故为死脉。以上论脉平者。命曰平人。太过不及则病。剧者死矣。）平人之常气禀于胃。胃者。平人之
常气也。人无胃气曰逆。逆者死。（此论四时之脉。当以胃气为本也。平人之常。受气于谷。谷入于胃。五脏六腑。皆以
受气。故胃者平人之常气也。人无胃气。是生机已绝。绝则死矣。）春胃微弦曰平。弦多胃少曰肝病。但弦无胃曰死。（胃
气者。中土柔和之气也。弦乃东方春木之象。微乃胃气之和。故春得胃气而脉微弦曰平。弦多而少柔和之气曰肝病。但
弦无胃曰死。杨元如曰。春胃微弦者。言四时之中。有此胃气。由胃气而养此五脏之真。此节以四时而合于五脏。末
节以五脏之气。而合于四时。）胃而有毛曰秋病。毛甚曰今病。（毛为秋脉。属金。如春虽得微弦之平脉。而兼有轻浮之
毛。此金来克木。至秋金令之时。则当病矣。如毛脉过甚。此木受金刑。当主即病。此复言四时之脉。各有所主之气。
如见克贼之脉。虽有胃气。而亦能为病也。）脏真散于肝。肝藏筋膜之气也。（上脏叶脏下脏叶脏脏真者。真脏所藏之神
也。神在脏为肝。在体为筋。言真脏之神散于肝。而主藏筋膜之气。如春木微弦之脉。乃因胃气而至于手太阴。故曰脉
不得胃气。肝不弦。肾不石。是弦钩毛石之脉。亦皆胃气之所生。）夏胃微钩曰平。钩多胃少曰心病。但钩无胃曰死。
（钩乃南方夏火之象。微则柔和之胃气也。夏得胃气而脉微钩曰平。钩甚而少微和之气曰心病。但钩无胃曰死。）胃而有
石曰冬病。石甚曰今病。（石乃冬令之脉。微钩而带石。乃火中有水。至冬水气所主之时而为病矣。如水气太甚。此火受
水克。当即病矣。）脏真通于心。心藏血脉之气也。（夏脏之元真通于心。而主藏血脉之气。）长夏胃微 弱曰平。弱多胃
少曰脾病。但代无胃曰死。（ 叶软。长夏湿土主气。微 弱者。中土柔和之气也。代者。相离之脉。盖脾主四季。四时
有交相更代之气。是以柔和相离。脾之平脉也。如但代而无微 之和。此胃气已绝。故为死脉。盖脾之得以灌溉于四脏
者。由胃气之所生。故但代无胃曰死。） 弱有石曰冬病。弱甚曰今病。（ 弱有石。是所不胜之水气。反来侮土。至冬
时水气反虚而为病矣。弱甚者。脾气太弱。当主即病。盖言乘侮太甚者即病。而本气虚者。亦即病也。）脏真濡于脾。脾
藏肌肉之气也。（土藏之元真濡于脾。而主藏肌肉之气。杨元如曰。肝主疏泄。故曰散。心主血脉。故曰通。脾主灌溉。
故曰濡。肺脏居尊。故曰高。肾为水脏。故曰下。）秋胃微毛曰平。毛多胃少曰肺病。但毛无胃曰死。（毛乃秋金之脉。
微则柔和之胃气也。秋得胃气。而脉微毛曰平。毛多而少柔和之气曰肺病。但毛无胃曰死。）毛而有弦曰春病。弦甚曰今
病。（毛而有弦。是所不胜之木气。反来侮金。则木虚其本位矣。至春当木旺之时。而木气反虚。是以为病。所谓侮反受
邪。寡于畏也。弦甚者乘侮太过。而金气当即病矣。按平脉篇曰。脉有相乘。有纵有横。水行乘火。金行乘木。名曰纵。
火行乘水。木行乘金。名曰横。是四时之中。皆有纵有横。纵者。虽得胃气而所不胜乘之。故曰。胃而有毛。胃而有石。
横者。脏气不足而所胜妄行。故曰毛而有弦。石而有钩。此脏气横行。是以本位虚而反招仇复。按四季长夏之中。文义
三换。当知四时之气。皆有纵有横。有客气甚而有本气虚也。）脏真高于肺。以行荣卫阴阳也。（金藏之元真。高居于肺。
而主行荣卫阴阳。肺主周身之气。而朝百脉也。元如曰。相传之官。燮理阴阳。宣布政令。）冬胃微石曰平。石多胃少曰
肾病。但石无胃曰死。（石乃冬藏之脉。微则柔和之胃气也。肾得胃气而脉微石曰平。石多而少柔和之气曰肾病。但石而
无胃气曰死。）石而有钩曰夏病。钩甚曰今病。（石而有钩。火侮水也。立夏火气反虚。而为病矣。若乘侮太甚。当主
今病。）脏真下于肾。肾藏骨髓之气也。（水藏之元真。下藏于肾。而主藏骨髓之气。五营运大论曰。肾生骨髓。髓生肝。）
胃之大络。名曰虚里。贯膈络肺。出于左乳下。其动应衣。脉宗气也。（此言五脏之脉。资生于胃。而胃气之通于五脏者。
乃宗气也。宗气者。胃腑水谷之所生。积于胸中。上出喉咙。以司呼吸。行于十二经隧之中。为脏腑经脉之宗。故曰宗
气。胃之大络。贯膈络肺。出于左乳下。而动应衣者。乃胃腑宗气之所出。此脉以候宗气者也。杨元如曰。首句之其
动应衣。跟着脉宗气而言。言乳下之应衣而动者。此宗气所出之脉也。后句之其动应衣。跟着宗气泄也而言。言动而应
衣。此宗气外泄。盖动之甚矣。）盛喘数绝者。则病在中。结而横有积矣。绝不至曰死。乳之下。其动应衣。宗气泄也。
（此言四时胃少曰病者。宗气之为病也。五脏无胃气曰死者。宗气或绝于内。而或泄于外也。宗脉贯膈络肺。如喘盛而
乳下之脉数绝者。宗气病于膻中也。如脉结而有止者。虚里之横络有积滞也。是胃气少而为五脏之病者。宗气之有虚有
实也。如虚里之脉绝不至者。胃腑之生气绝于内也。乳之下其动甚而应衣者。宗气欲泄于外也。此无胃气而为五脏之死
脉也。）欲知寸口太过与不及。寸口之脉。中手短者曰头痛。寸口脉中手长者曰足胫痛。寸口脉中手促上击者曰肩背痛。
寸口脉沉而坚者曰病在中。寸口脉浮而盛者曰病在外。寸口脉沉而弱曰寒热。及疝瘕少腹痛。寸口脉沉而横曰胁下有积。
腹中有横积痛。寸口脉沉而喘曰寒热。（此以寸口而候外因之病也。夫寸为阳。尺为阴。外为阳。内为阴。皮肉筋骨为阳。
腹中胁内为阴。盖天地四时之气。从外而内。由阳而阴。故以寸口之浮沉。以候外因之外内也。寸口之脉。中手短者。
此惟在寸之阳部。故主头痛。诸阳气之在上也。寸口脉中手长者。寸脉直下于尺中。此阳邪直行于下部。故主足胫痛也。
中手促上击者。浮而搏击应手。此阳邪不上不下。故主在肩背之中也。此以外邪在于形身之外。而有上中下之分也。沉
为在里。浮主在外。寸口脉沉而坚。主病邪坚积在里。若浮而盛。主邪病在外。此以寸口之浮沉。而别外邪之在形身之
外内也。寸为阳。沉为阴。寸口脉沉而弱。此正气虚而阳邪直入于里阴。阴阳相乘。故主寒热。阳邪入里。故又主疝瘕
而少腹痛也。此缘正气弱而阳邪直入于里阴之下也。胁下主身半之中。腹中为形身之里。寸口脉沉而横。是外邪入于里
阴之中。故主胁下腹中有横积也。邪气上逆则喘。寸口脉沉而喘。此外因之阳邪。入于里阴而上逆。阴阳相搏。故为寒
热。此又以寸口之沉。候外因之邪。入于里阴。而亦有上中下之别也。莫子晋曰。春胃微弦。夏胃微钩。乃天地四时之
气。而合于人之五脏也。是以天地四时之邪。亦从外而内。故当以寸口之浮沉别之。）脉盛滑坚者曰病在外。脉小实而坚
者曰病在内。脉小弱以涩。谓之久病。脉滑浮而疾者。谓之新病。脉急者曰疝瘕。少腹痛。脉滑曰风。脉涩曰痹。缓而
滑曰热中。盛而紧曰胀。（此复以寸关尺之三部。而候病之外内新故也。曰脉盛脉小者。概左右三部而言也。夫以寸口之
浮沉。以候病之外内上下者。候表里阴阳之气也。盖天地四时之邪。始伤气分。留而不去。则入于经。然亦有始终留于
气分者。有即转入于经者。邪之中人。变幻不一。故当以脉征之。是以气分之邪。只见寸口之浮沉长短。如入于经。则
有滑涩紧急之形象矣。夫脉乃阴血。气分之阳邪入经。阴阳相搏。其脉则滑。是以脉盛滑者病在外。有余之病。故坚而
有力也。夫经脉外络形身。内连脏腑。病在内者。故小实而坚也。此以三部之盛滑小实。而分别邪正之在外在内也。始
受之病。邪正相持。故滑浮而疾。久则血脉已伤。故小弱以涩也。诸急为寒。故主疝瘕在内。滑主阳热。故主风邪在阳。
此又以三部之急滑。以别邪病之在阳络阴络也。痹者闭也。风寒湿邪。皆能为痹。或在于皮肉筋骨之间。或内舍于五脏
六腑。故痹病于外内之间者。其脉皆主涩也。缓为脾脉。滑则热盛于中。紧则为寒。故主腹胀也。此外因之邪。入于腹
中。而有寒热之分也。）脉从阴阳病易已。脉逆阴阳病难已。脉得四时之顺曰病无他。脉反四时。及不间脏曰难已。（所
谓阴阳者。气血外内上下也。言脏腑之脉。阴阳并交。雌雄相应。内外循环。此为顺也。如阴阳反逆。其病为难愈。脉
得四时之顺者。春脉微弦。夏脉微钩。此得四时生气之顺。而无他变也。反四时者。春胃而有毛。夏胃而有石也。间脏
者。相生而传也。不间脏者。相克而传也。如外淫之邪。始伤皮毛。则内合于肺。肺欲传肝。而肾间之。肾欲传心。而
肝间之。肝欲传脾。而心间之。心欲传肺。而脾间之。脾欲传肾。而肺间之。此节乃总结上文之义。）臂多青脉曰脱血。
（此论内因之病。自内而外。从尺而寸。由血而经。经而气也。臂多青脉者。臂内浮见之络脉多青。盖因血脱而不华于
色也。灵枢经曰。脉急者。尺之皮肤亦急。脉缓者。尺之皮肤亦缓。故善调尺者。不待于寸。善调脉者。不待于色。能
参合而行之。可为上工。）尺脉缓涩。谓之解 安卧。脉盛谓之脱血。尺涩脉滑。谓之多汗。尺寒脉细。谓之后泄。脉尺
粗常热者。谓之热中。（此以尺部而候五脏之病也。缓为脾脉。涩主脏气不足。解 、懈惰也。此脾脏之为病也。尺属阴
而主血。脉宜沉静。盛者。肝脏之火盛而血不藏也。灵枢诊尺篇曰。尺肤涩者。风痹也。夫邪迫于经。其脉则滑。以风
之阳邪。闭于皮肤之间。而迫于经脉。故主多汗。所谓阳加于阴谓之汗。汗乃阴之液也。此以诊尺而知肺合之表汗也。
诊尺篇曰。尺肤寒。其脉小者泄。少气。夫阳气生于阴中。尺肤寒。生阳之气少矣。阳气衰于下。故主虚泄。泄则亡阴。
故脉细也。此以诊尺而知肾藏之生阳。下焦之虚泄也。尺肤粗常热者。火热下行。故主热中。此诊尺而知心火之下行也。
夫阴阳气血。由阴而阳。从下而上。是以诊尺而知病之外内上下也。）肝见庚辛死。心见壬癸死。脾见甲乙死。肺见丙丁
死。肾见戊己死。是谓真脏见者死。（此论真脏脉见而死于胜克之时日也。夫五脏之气。地之五行所生。地之五行。天之
十干所化。是以生于五行。而死于十干也。按此节当在篇末。辟辟如弹石曰肾死之下。误脱在此者也。杨元如曰。此章
引灵枢诊尺篇之文。以证诊尺之义。而灵枢篇内。亦无此节文。宜改正为是。）颈脉动喘疾咳曰水。目内微肿如卧蚕起之
状曰水。溺黄赤安卧者黄胆。已食如饥者胃疸。面肿曰风。足胫肿曰水。目黄者曰黄胆。（此以视疾而知其病也。按此节
引灵枢论疾诊尺之文。少加删改。以证诊尺之义。上节论诊尺。此节言论疾。所谓无视色持脉。独调其尺。以言其病。
从外知内也。是以见颈脉动疾。目内微肿。足胫肿者。知水病之在里也。溺赤安卧。已食如饥者。知为黄胆胃疸也。面
黄帝问道：所谓“平人”是指什么样的人？（平人，指平常没有疾病的人。没有疾病的人，自然拥有平常的脉象；如果脉象反常，就是生病了。所以这篇论述称为《平人气象论》。“气”，指的是经脉之气；“象”，指的是脉的形象。）
岐伯回答说：一个人呼气时脉搏跳动两次，吸气时脉搏也跳动两次。在呼吸交替停顿的瞬间，脉搏共跳动五次，这是通过偶尔的深长呼吸来调节的，这就叫做“平人”。
所谓平人，就是没有生病的人。（呼出气叫呼，吸入气叫吸。一次呼气和一次吸气合称为一息。平人的脉象，一呼脉动两次，一息脉动两次。在呼吸交替停顿的瞬间，脉搏计算为跳动五次。这是因为有偶尔的深长呼吸作为余数补充，所以是五次跳动。闰，即余数。太息，是指在呼吸交替停顿之时，气息有余未尽，脉搏又跳动一次，就像一年中多出一个闰月一样。大概人的呼吸，是阴阳之气的出入循环，如同寒暑往来构成一年一样，所以适宜用偶尔的深长呼吸来补足余数。）
应当以健康人的状态来调校判断病人的脉象。医生如果没有生病，就用自己平稳的呼吸去对照病人的脉搏，以此作为诊察的方法。没有生病的人，其呼吸平稳；生病的人，其呼吸紊乱。医生因为没有生病，所以用自己的平稳呼吸去调校病人，这就是候诊的方法。
如果一个人呼气时脉搏只跳动一次，吸气时脉搏也只跳动一次，这叫做“少气”。（营气和宗气行于脉外，卫气行于脉中。营卫相随，脉搏随着气的运行而转动。一呼脉动一次，一吸脉动一次，比平人减少了一半以上，所以主气衰微。）
如果一个人呼气时脉搏跳动三次，吸气时脉搏也跳动三次，并且脉象躁急，尺部皮肤发热，这是温病；尺部皮肤不发热，脉象滑利，这是风病；脉象涩滞，这是痹证。（一息之间，脉搏跳动六次，是气太过盛的缘故。躁，就是急迫的意思。吸气时脉象躁急，是有余的邪气从外部侵入内部。温病，是冬天感受寒邪，到春天发作成为温病；冬天感受风邪，到春天发作成为风温。这些都是潜伏隐匿的邪气，由内向外，从阴分向阳分发展，所以尺部皮肤发热。风是阳邪，损伤人体的阳气，所以尺部不发热。气分的邪气停留不去，就会逼迫经络，所以脉象滑利。痹，就是闭塞的意思。邪气积聚而不流通，所以脉象涩滞。大概意思是说，从内向外发展的属于温病，从外向内发展的属于风邪，停留在内外之间的属于痹证。上一节讲的是正气不足的情况，这一节讲的是邪气有余的情况，而有餘的邪气又有阴阳、内外出入的区别。）
如果一呼一吸脉搏跳动四次以上，叫做死证；脉搏断绝不再跳动，叫做死证；脉搏忽快忽慢，叫做死证。（跳动四次以上，是太过盛的极端表现。脉搏断绝不再跳动，是不及的极端表现。忽快忽慢，有时太过，有时不及，是气的紊乱。这些都属于极不平顺的脉象，所以称为死脉。以上论述了脉象平和的，称为平人；太过或不及就会生病；严重的就会死亡。）
平人正常的胃气禀受于胃。胃，是平人正常胃气的来源。人如果没有胃气，就叫做逆，逆者死。（这里论述四季的脉象，应当以胃气为本。平人的常态，是从饮食谷物中获取精气。谷物进入胃中，五脏六腑都从中获取精气，所以胃是平人正常胃气的来源。人如果没有胃气，说明生机已经断绝，绝则死。）
春季脉象带有柔和的胃气且微微弦硬，叫做平脉；弦硬多而柔和胃气少，叫做肝病；只有弦硬而没有柔和胃气，叫做死脉。（胃气，是中土柔和之气。弦是东方春木的脉象。微是胃气的调和表现。所以春季得到胃气而脉象微微弦硬，叫做平脉。弦硬多而柔和之气少，叫做肝病。只有弦硬而没有胃气，叫做死脉。杨元如说：春季脉象微弦，是说在四季之中，都有这种胃气存在，依靠胃气来滋养五脏的真气。这一节是将四季与五脏相配合，最后一节是将五脏之气与四季相配合。）
如果春季脉象中带有秋季的毛脉，到了秋天会生病；如果毛脉特别明显，现在就会生病。（毛脉是秋季的脉象，属金。虽然春季得到了微微弦硬的平脉，但如果兼有轻浮的毛脉，这是金来克木，等到秋天金气当令的时候，就会生病。如果毛脉过甚，这是木受到金的刑罚，应当主即刻生病。这里再次说明四季的脉象，各有其所主的气，如果见到克制我的脉象，即使有胃气，也会致病。）
脏真之气散布于肝，肝藏纳筋膜之气。（上叶脏下叶脏，这里的“脏真”，是指真脏所藏的神。神在脏对应肝，在体对应筋。说真脏之神散布于肝，而主要藏纳筋膜之气。如春季木气微微弦硬的脉象，是因为有了胃气才传导到手太阴肺经，所以说脉如果没有胃气，肝脉就不弦，肾脉就不石。弦、钩、毛、石这些脉象，也都是由胃气所生成的。）
夏季脉象带有柔和的胃气且微微钩曲，叫做平脉；钩曲多而柔和胃气少，叫做心病；只有钩曲而没有柔和胃气，叫做死脉。（钩是南方夏火的脉象。微则是柔和的胃气。夏季得到胃气而脉象微微钩曲，叫做平脉。钩曲过甚而缺少微和之气，叫做心病。只有钩曲而没有胃气，叫做死脉。）
如果夏季脉象中带有冬季的石脉，到了冬天会生病；如果石脉特别明显，现在就会生病。（石脉是冬季当令的脉象。微钩而带有石脉，是火中有水，等到冬季水气所主的时候就会生病。如果水气过甚，这是火受到水的克制，当即就会生病。）
脏真之气通达于心，心藏纳血脉之气。（夏季脏气的元真通达于心，而主要藏纳血脉之气。）
长夏季节脉象带有柔和的胃气且微弱，叫做平脉；微弱多而柔和胃气少，叫做脾病；只有代脉而没有柔和胃气，叫做死脉。（弱，通软。长夏湿土主气，微弱的脉象，是中土柔和之气。代脉，是指脉来中止、不能自还的脉象。大概脾主四季，四季有交相更替的气机，所以脉象柔和且有间歇，这是脾的平脉。如果只有代脉而没有微弱的柔和之气，这说明胃气已绝，所以是死脉。大概脾能够灌溉四脏，是由于胃气所生，所以只有代脉而没有胃气叫做死脉。）
如果长夏脉象中带有冬季的石脉，到了冬天会生病；如果微弱脉特别明显，现在就会生病。（微弱脉中带有石脉，是所不胜的水气反过来侮犯土气，等到冬季水气反而虚弱时就会生病。如果微弱脉过甚，这是脾气太弱，应当主即刻生病。大概意思是说，乘侮太过严重的即刻生病，而本气虚弱的，也即刻生病。）
脏真之气濡润于脾，脾藏纳肌肉之气。（土藏的元真濡润于脾，而主要藏纳肌肉之气。杨元如说：肝主疏泄，所以说“散”；心主血脉，所以说“通”；脾主灌溉，所以说“濡”；肺脏居尊位，所以说“高”；肾为水脏，所以说“下”。）
秋季脉象带有柔和的胃气且微微毛浮，叫做平脉；毛浮多而柔和胃气少，叫做肺病；只有毛浮而没有柔和胃气，叫做死脉。（毛脉是秋季金的脉象。微则是柔和的胃气。秋季得到胃气，而脉象微微毛浮，叫做平脉。毛浮多而柔和之气少，叫做肺病。只有毛浮而没有胃气，叫做死脉。）
如果秋季脉象中带有春季的弦脉，到了春天会生病；如果弦脉特别明显，现在就会生病。（秋季脉象中带有弦脉，是所不胜的木气反过来侮犯金气，那么木气在其本位就虚弱了。等到春天木气旺盛的时候，木气反而虚弱，因此生病。这就是所谓的“侮反受邪，寡于畏也”。弦脉过甚，是乘侮太过，金气当即就会生病。按《平脉篇》所说：脉有相乘，有纵有横。水行乘火，金行乘木，名叫纵；火行乘水，木行乘金，名叫横。这是在四季之中，都有纵有横。纵者，虽然得到胃气但被所不胜之气乘袭，所以说“胃而有毛”、“胃而有石”；横者，脏气不足而所胜之气妄行，所以说“毛而有弦”、“石而有钩”。这是脏气横行，所以本位虚弱反而招致仇敌报复。按四季和长夏之中，文义三次转换，应当知道四时之气，皆有纵有横，有客气盛而导致本气虚的情况。）
脏真之气高居于肺，以运行营卫阴阳之气。（金藏的元真，高居于肺，而主要运行营卫阴阳之气。肺主管周身之气，而朝会百脉。元如说：肺为相傅之官，燮理阴阳，宣布政令。）
冬季脉象带有柔和的胃气且微微石沉，叫做平脉；石沉多而柔和胃气少，叫做肾病；只有石沉而没有柔和胃气，叫做死脉。（石脉是冬季闭藏的脉象。微则是柔和的胃气。肾得到胃气而脉象微微石沉，叫做平脉。石沉多而柔和之气少，叫做肾病。只有石沉而没有胃气，叫做死脉。）
如果冬季脉象中带有夏季的钩脉，到了夏天会生病；如果钩脉特别明显，现在就会生病。（冬季脉象中带有钩脉，是火侮犯水。立夏时火气反而虚弱，从而生病。如果乘侮太过严重，应当主即刻生病。）
脏真之气下沉于肾，肾藏纳骨髓之气。（水藏的元真，下沉藏于肾，而主要藏纳骨髓之气。《五营运大论》说：肾生骨髓，髓生肝。）
胃的大络，名叫虚里，贯穿膈肌，联络肺脏，出于左侧乳下，搏动可以映现衣物，这是脉中的宗气。（这里论述五脏的脉象，资生于胃，而胃气通达于五脏的，就是宗气。宗气，是由胃腑水谷所化生，积聚在胸中，向上出于喉咙，以主持呼吸，运行于十二经隧之中，为脏腑经脉的宗主，所以叫宗气。胃的大络，贯穿膈肌，联络肺脏，出于左侧乳下，搏动可以映现衣物的，是胃腑宗气所发出的地方。这个脉是用来诊察宗气的。杨元如说：首句的“其动应衣”，是紧跟着“脉宗气”而言的，意思是说乳下部位映现衣物而搏动的，是宗气所发出的脉。后句的“其动应衣”，是紧跟着“宗气泄”而言的，意思是说搏动而映现衣物，这是宗气外泄，说明搏动非常剧烈。）
如果虚里搏动急促且时有中断，则病在中焦；脉结而且横坚，说明有积滞；脉绝不至，是死证；左侧乳下搏动剧烈以致映现衣物，是宗气外泄。（这里论述四季脉象中胃气少的情况，是宗气导致的疾病。五脏没有胃气导致死亡的，是宗气或在内部断绝，或在外部外泄。宗脉贯穿膈肌联络肺脏，如果喘促盛大且乳下的脉搏数次中断，是宗气病于膻中。如果脉象结而且有止歇，是虚里的横络有积滞。这是胃气少而导致五脏病变，表现为宗气的虚实证候。如果虚里的脉搏绝不至，是胃腑的生气在内部断绝。乳下搏动剧烈而映现衣物，是宗气要在外部外泄。这是没有胃气而导致的五脏死脉。）
想要了解寸口脉的太过与不及：寸口脉摸起来短的，主头痛；寸口脉摸起来长的，主足胫痛；寸口脉摸起来急促且向上搏击手指的，主肩背痛；寸口脉沉而坚实的，主病在体内；寸口脉浮而盛大的，主病在体表；寸口脉沉而弱的，主寒热，以及疝瘕、少腹痛；寸口脉沉而横的，主胁下有积滞，腹中有横向积滞疼痛；寸口脉沉而急促的，主寒热。（这里是通过寸口来诊察外因引起的疾病。寸为阳，尺为阴；外为阳，内为阴；皮肉筋骨为阳，腹中胁内为阴。大概天地四时之气，从外向内，由阳入阴，所以通过寸口脉的浮沉，来诊察外因病的内外情况。寸口脉摸起来短，这是因为只在寸部的阳分，所以主头痛，这是诸阳气在上部的表现。寸口脉摸起来长，是寸脉直下到尺中，这是阳邪直行于下部，所以主足胫痛。摸起来急促且向上搏击手指，是脉浮而搏击应手，这是阳邪不上不下，所以主病在肩背中间。这是以外邪在于形体之外，而有上中下的区别。沉表示在里，浮表示在外。寸口脉沉而坚实，主病邪坚实积聚在里；如果浮而盛大，主邪病在外。这是通过寸口脉的浮沉，来辨别外邪在形体的内外。寸为阳，沉为阴。寸口脉沉而弱，这是正气虚而阳邪直接侵入里阴，阴阳相乘，所以主寒热。阳邪入里，所以又主疝瘕和少腹痛。这是由于正气弱而阳邪直接侵入里阴之下。胁下主管身体半中，腹中是形体的内部。寸口脉沉而横，是外邪进入里阴之中，所以主胁下腹中有横向积滞。邪气上逆则喘，寸口脉沉而急促，这是外因的阳邪进入里阴而上逆，阴阳相搏，所以为寒热。这是又通过寸口脉的沉，来诊察外因之邪进入里阴，也有上中下的区别。莫子晋说：春脉微弦，夏脉微钩，这是天地四时之气，而与人的五脏相合。所以天地四时的邪气，也从外向内，因此应当通过寸口脉的浮沉来辨别。）
脉象盛大、滑利、坚实的，主病在体表；脉象细小、实而坚实的，主病在体内；脉象细小、软弱且涩滞的，叫做久病；脉象滑利、浮取且疾速的，叫做新病；脉象紧急的，主疝瘕、少腹痛；脉象滑利的，主风病；脉象涩滞的，主痹证；脉象缓而滑利的，主热中；脉象盛大而紧的，主胀满。（这里再次通过寸关尺三部，来诊察病证的表里、新旧。说脉盛脉小，是概指左右三部而言。通过寸口脉的浮沉，来诊察病证的表里上下，是候测表里阴阳之气。大概天地四时的邪气，起初伤害气分，停留不去，就会进入经络。但也有始终留在气分的，有立即转入经络的。邪气伤人，变幻不一，所以应当通过脉象来验证。因此气分的邪气，只见寸口脉的浮沉长短；如果进入经络，就有滑、涩、急、紧的形象。脉属于阴血，气分的阳邪进入经络，阴阳相搏，脉象就会滑利。所以脉象盛大滑利的是病在体表，是有余的病，所以坚实有力。经脉外连形体，内连脏腑，病在体内的，所以脉象细小实而坚实。这是通过三部的盛滑、小实，来分别邪正是在体表还是在体内。刚开始受到的病，邪正相持，所以脉滑浮而疾速；时间久了则血脉已伤，所以脉细小软弱且涩滞。所有紧急的脉象都主寒，所以主疝瘕在体内。滑利主阳热，所以主风邪在阳分。这是又通过三部的急滑，来辨别邪病是在阳络还是阴络。痹，就是闭塞。风寒湿邪，都能导致痹证。或者在皮肉筋骨之间，或者内舍于五脏六腑。所以痹病在内外之间的，其脉象都主涩滞。缓是脾脉，滑则主热盛于中，紧则主寒，所以主腹胀。这是外因之邪，进入腹中，而有寒热的区别。）
脉象顺应阴阳变化的，病容易痊愈；脉象违背阴阳变化的，病难痊愈。脉象符合四时规律的，病无其他变证；脉象违背四时规律，以及不经过相生之脏传变的（直接传克），病难痊愈。（所谓的阴阳，是指气血的内外上下。说脏腑的脉象，阴阳交错，雌雄相应，内外循环，这叫顺。如果阴阳反逆，病就难愈。脉象符合四时规律的，如春脉微弦，夏脉微钩，这是得到四时生气的顺遂，而没有其他变化。违背四时的，如春季脉象中有毛脉，夏季脉象中有石脉。间脏，是指相生而传变。不间脏，是指相克而传变。如外来的淫邪，起初伤害皮毛，则内合于肺。肺欲传肝，而有肾间隔；肾欲传心，而有肝间隔；肝欲传脾，而有心间隔；心欲传肺，而有脾间隔；脾欲传肾，而有肺间隔。这一节是总结上文的意义。）
手臂上青色的脉络很多，叫做脱血。（这里论述内因的疾病，从内向外，从尺部到寸部，由血到经，由经到气。手臂上青色脉络多，是臂内浮见的络脉多呈青色。大概是因为血脱而不能荣华于面色。《灵枢经》说：脉象紧急的，尺部的皮肤也紧急；脉象缓和的，尺部的皮肤也缓和。所以善于诊察尺肤的，不需要等待诊察寸口；善于诊察脉象的，不需要等待观察面色。能参合这三者而行医的，可称为上工。）
尺部脉象缓而涩，叫做懈惰安卧；脉象盛大，叫做脱血；尺部脉涩而脉滑，叫做多汗；尺部皮肤寒冷而脉细，叫做后泄（腹泻）；尺部皮肤粗大且经常发热，叫做热中。（这里通过尺部来诊察五脏的疾病。缓是脾脉，涩主脏气不足，解㑊（xiè tuǐ），即懈怠懒惰。这是脾脏的疾病。尺部属阴而主血，脉宜沉静。脉盛大，是肝脏之火盛而血不藏。《灵枢·诊尺篇》说：尺肤涩的，是风痹。邪气逼迫于经络，脉象就会滑利。由于风的阳邪闭阻于皮肤之间，而逼迫于经脉，所以主多汗。所谓“阳加于阴谓之汗”，汗是阴液。这是通过诊察尺部而知肺合之表汗。《诊尺篇》说：尺肤寒冷，脉小的，是泄泻、少气。阳气生于阴中，尺肤寒冷，说明生阳之气少了。阳气衰于下，所以主虚泄。泄泻则亡阴，所以脉细。这是通过诊察尺部而知肾藏的生阳和下焦的虚泄。尺肤粗大且经常发热，是火热下行，所以主热中。这是诊察尺部而知心火的下行。阴阳气血，由阴而阳，从下而上，所以通过诊察尺部而知病证的表里上下。）
肝脉见于庚辛日（金日）死，心脉见于壬癸日（水日）死，脾脉见于甲乙日（木日）死，肺脉见于丙丁日（火日）死，肾脉见于戊己日（土日）死，这叫做真脏脉出现，出现则死。（这里论述真脏脉出现，死于被克制的时日。五脏之气，由地之五行所生。地之五行，由天之十干所化。所以生于五行，而死於十干。按此节应当在篇末，《辟辟如弹石曰肾死》之下，误脱在此处。杨元如说：本章引用《灵枢·诊尺篇》的文字，来证明诊尺的意义，而《灵枢》篇内也没有这一节文字，应当改正为此。）
颈部动脉搏动且喘息急促咳嗽的，是水病；眼睛内部轻微肿胀像卧蚕起的形状，是水病；小便黄赤且嗜睡的，是黄疸；吃完饭却像饿一样的，是胃疸；面部浮肿的，是风病；足胫浮肿的，是水病；眼睛黄的，是黄疸。（这里通过视诊疾病来知晓病情。按此节引用《灵枢·论疾诊尺》的文字，稍加删改，以证明诊尺的意义。上一节论述诊尺，这一节论述视疾。所谓不只看面色和切脉，单独调治尺肤，来言说疾病，从外部知晓内部。所以见到颈部脉搏动疾，眼睛内部微肿，足胫浮肿，就知道是水病在里。小便赤色且嗜睡，吃完饭却像饥饿，就知道是黄疸和胃疸。面部浮肿……）
Huangdi asked: What is meant by "Ping Ren" (Normal Person)? (A Ping Ren refers to a person who is ordinarily free from disease. A person free from disease naturally possesses an ordinary pulse; if the pulse is abnormal, it indicates illness. Hence, this chapter is titled "Discussion on the Phenomena of Normal Persons." "Qi" refers to the Qi of the meridians; "Xiang" refers to the image of the pulse.)
Qibo replied: When a person exhales, the pulse beats twice; when they inhale, the pulse also beats twice. At the pause between breaths, the pulse beats five times in total, regulated occasionally by a deep sigh (Tai Xi). This is called a "Ping Ren."
A Ping Ren is one who is not ill. (Exhaling is called Hu, inhaling is called Xi. One exhalation and one inhalation constitute one Xi. The pulse of a normal person beats twice per exhalation and twice per inhalation. At the pause between breaths, the pulse counts five beats. This is because of the occasional deep sigh acting as a surplus, hence five beats. "Run" means surplus. "Tai Xi" refers to the moment between breaths where the breath has excess and is not yet finished, causing the pulse to beat once more, similar to having a leap month in a year. Human respiration is the circulation of Yin and Yang Qi, entering and exiting, much like the cycle of cold and heat forming a year, so it is appropriate to have the surplus of a deep sigh.)
One should use the state of the healthy person to calibrate the judgment of the patient's pulse. If the physician is not ill, they use their own steady respiration to compare with the patient's pulse, which serves as the method for diagnosis. Those who are not ill have steady breathing; those who are ill have chaotic breathing. Since the physician is not ill, they use their steady breathing to adjust to the patient; this is the method of observing the pulse.
If a person's pulse beats once per exhalation and once per inhalation, it is called "Shao Qi" (Deficient Qi). (Ying Qi and Zong Qi circulate outside the vessels, while Wei Qi circulates inside. Ying and Wei follow each other, and the pulse turns with the Qi. Beating once per exhalation and once per inhalation is more than half less than that of a normal person, thus indicating the decline of Qi.)
If a person's pulse beats three times per exhalation and three times per inhalation, and is rapid and restless, with heat in the Chi (wrist) area, it is a Wen Bing (Warm Disease); if the Chi area is not hot but the pulse is slippery, it is a Feng Bing (Wind Disease); if the pulse is choppy, it is a Bi Syndrome (Obstruction). (Six beats per Xi indicate excessive Qi. "Zao" means rapid/restless. Restlessness during inhalation indicates excess pathogenic factors invading from the exterior to the interior. Warm diseases arise from Cold contracted in winter manifesting as Warm Disease in spring; Wind contracted in winter manifesting as Wind-Warmth in spring. These are latent pathogens moving from interior to exterior, from Yin to Yang, hence heat in the Chi area. Wind is a Yang pathogen damaging Yang Qi, hence no heat in the Chi area. Pathogens in the Qi level lingering without departing press upon the collaterals, resulting in a slippery pulse. Bi means obstruction. Accumulated pathogens failing to move result in a choppy and stagnant pulse. Generally, pathogens moving from interior to exterior are Warm Diseases; those moving from exterior to interior are Wind Pathogens; those lingering between interior and exterior are Bi Syndromes. The previous section discussed deficiency of righteous Qi; this section discusses excess of pathogenic Qi, noting that excess pathogens have distinctions in Yin/Yang and interior/exterior movement.)
If the pulse beats four or more times per breath cycle, it indicates a fatal condition; if the pulse ceases and does not return, it indicates death; if the pulse is intermittently slow and rapid, it indicates death. (Four or more beats represent the extreme of excess. Cessation of the pulse represents the extreme of deficiency. Intermittent slowness and rapidity indicate chaotic Qi. All these are extremely unbalanced pulses, hence termed fatal pulses. Above, we discussed balanced pulses, called Ping Ren; excess or deficiency leads to illness; severe cases lead to death.)
The normal Qi of a Ping Ren is derived from the Stomach. The Stomach is the source of normal Qi for Ping Ren. If a person lacks Stomach Qi, it is called Ni (Reversal), and reversal leads to death. (This discusses that the pulses of the four seasons should be based on Stomach Qi. The normal state of a Ping Ren receives Qi from grain. Grain enters the Stomach, and the Five Zang and Six Fu organs all receive Qi from it; thus, the Stomach is the source of normal Qi. Lack of Stomach Qi means vitality is severed; severance leads to death.)
In Spring, a pulse with slight Guan Qi (Stomach Qi) and slightly Xian (Wiry) quality is Ping (Normal); if Xian is prominent and Guan Qi is scant, it indicates Liver disease; if there is only Xian without Guan Qi, it indicates death. (Guan Qi is the soft and harmonious Qi of Central Earth. Xian is the image of East Wood in Spring. Slightness represents the harmony of Guan Qi. Thus, obtaining Guan Qi in Spring results in a slightly wiry pulse, which is normal. Prominent wiriness with little softness indicates Liver disease. Only wiriness without Guan Qi indicates death. Yang Yuanru stated: "Spring Guan Qi slightly wiry" means that within the four seasons, this Guan Qi exists, nourishing the true Qi of the Five Zang through Guan Qi. This section combines the four seasons with the Five Zang; the final section combines the Qi of the Five Zang with the four seasons.)
If the Spring pulse contains Mao (Floating) qualities, illness will occur in Autumn; if Mao is very pronounced, illness occurs now. (Mao is the Autumn pulse, belonging to Metal. Although Spring obtains the slightly wiry normal pulse, if it also has light floating Mao qualities, this is Metal overcoming Wood. When Autumn Metal rules, illness will occur. If Mao pulse is excessive, Wood suffers Metal's punishment, and illness should occur immediately. This reiterates that each season's pulse has its ruling Qi; if a controlling pulse appears, even with Guan Qi, illness can result.)
The True Qi of the Zang scatters into the Liver, and the Liver stores the Qi of the sinews/fascia. (The "Zhen Zang" refers to the Spirit stored by the True Zang. Spirit in the Zang corresponds to Liver, in the body to sinews. It states that the True Zang's Spirit scatters into the Liver, primarily storing the Qi of sinews. For example, the slightly wiry pulse of Spring Wood reaches the Hand Taiyin Lung Meridian due to Guan Qi. Thus, if a pulse lacks Guan Qi, the Liver pulse will not be wiry, nor will the Kidney pulse be Stone-like. Wiry, Hook, Mao, and Stone pulses are all generated by Guan Qi.)
In Summer, a pulse with slight Guan Qi and slightly Gou (Hooked/Curved) quality is Ping; if Gou is prominent and Guan Qi is scant, it indicates Heart disease; if there is only Gou without Guan Qi, it indicates death. (Gou is the image of South Fire in Summer. Slightness represents the soft Guan Qi. Obtaining Guan Qi in Summer results in a slightly hooked pulse, which is normal. Excessive hooking with little softness indicates Heart disease. Only hooking without Guan Qi indicates death.)
If the Summer pulse contains Shi (Stone/Deep) qualities, illness will occur in Winter; if Shi is very pronounced, illness occurs now. (Shi is the pulse of Winter command. Slightly hooked with Shi qualities indicates Water within Fire. Illness will occur when Winter Water rules. If Water Qi is excessive, Fire suffers Water's control, and illness should occur immediately.)
The True Qi of the Zang connects to the Heart, and the Heart stores the Qi of the blood vessels. (The primal true Qi of the Summer Zang connects to the Heart, primarily storing the Qi of blood vessels.)
In Late Summer, a pulse with slight Guan Qi and weak quality is Ping; if Weak is prominent and Guan Qi is scant, it indicates Spleen disease; if there is only Dai (Intermittent) pulse without Guan Qi, it indicates death. (Weak implies softness. Late Summer is ruled by Damp Earth. Slight weakness is the soft Qi of Central Earth. Dai pulse refers to a pulse that pauses and fails to return immediately. The Spleen rules the four seasons, and the four seasons have alternating replacement Qi, hence the soft, intermittent pulse is the normal pulse of the Spleen. If there is only Dai pulse without slight softness, Guan Qi is exhausted, hence it is a fatal pulse. The Spleen irrigates the four Zang organs due to the generation of Guan Qi; thus, only Dai without Guan Qi indicates death.)
If the Late Summer pulse contains Shi qualities, illness will occur in Winter; if Weak is very pronounced, illness occurs now. (Weak containing Shi indicates the conquering Water Qi rebelling against Earth. Illness will occur when Winter Water Qi becomes deficient. If Weak is excessive, Spleen Qi is too weak, and illness should occur immediately. Generally, excessive乘侮 (overcoming/rebelling) causes immediate illness, and deficiency of original Qi also causes immediate illness.)
The True Qi of the Zang moistens the Spleen, and the Spleen stores the Qi of the muscles. (The primal true Qi of Earth moistens the Spleen, primarily storing the Qi of muscles. Yang Yuanru stated: The Liver governs dispersion, hence "scatters"; the Heart governs blood vessels, hence "connects"; the Spleen governs irrigation, hence "moistens"; the Lung resides in honor, hence "high"; the Kidney is the Water Zang, hence "low".)
In Autumn, a pulse with slight Guan Qi and slightly Mao (Floating) quality is Ping; if Mao is prominent and Guan Qi is scant, it indicates Lung disease; if there is only Mao without Guan Qi, it indicates death. (Mao is the Autumn Metal pulse. Slightness represents soft Guan Qi. Obtaining Guan Qi in Autumn results in a slightly floating pulse, which is normal. Prominent floating with little softness indicates Lung disease. Only floating without Guan Qi indicates death.)
If the Autumn pulse contains Xian (Wiry) qualities, illness will occur in Spring; if Xian is very pronounced, illness occurs now. (Autumn pulse containing Xian indicates the conquering Wood Qi rebelling against Metal, leaving Wood deficient in its proper position. When Spring arrives and Wood should be prosperous, Wood Qi is actually deficient, causing illness. This is what is meant by "rebellion meets retaliation, lacking fear." Excessive Xian indicates excessive rebellion, and Metal Qi should suffer illness immediately. According to the "Ping Mai Pian": Pulses have mutual overacting, involving Zong (Vertical) and Heng (Horizontal). Water overacting on Fire, Metal overacting on Wood is called Zong; Fire overacting on Water, Wood overacting on Metal is called Heng. In the four seasons, there are both Zong and Heng. Zong means although Guan Qi is present, the conquering element acts upon it, hence "Guan with Mao" or "Guan with Shi." Heng means Zang Qi is insufficient and the conquered element acts recklessly, hence "Mao with Xian" or "Shi with Gou." This is Zang Qi acting horizontally; thus, deficiency in the proper position invites revenge. In the four seasons and Late Summer, the text changes meaning three times; one must understand that the Qi of the four seasons has both Zong and Heng, where guest Qi is excessive leading to deficiency of original Qi.)
The True Qi of the Zang is high in the Lung, governing the circulation of Ying, Wei, Yin, and Yang. (The primal true Qi of Metal resides high in the Lung, primarily governing the circulation of Ying, Wei, Yin, and Yang. The Lung governs the Qi of the whole body and commands the hundred vessels. Yuanru stated: The Lung is the official of transmission, balancing Yin and Yang and promulgating orders.)
In Winter, a pulse with slight Guan Qi and slightly Shi (Stone/Deep) quality is Ping; if Shi is prominent and Guan Qi is scant, it indicates Kidney disease; if there is only Shi without Guan Qi, it indicates death. (Shi is the pulse of Winter storage. Slightness represents soft Guan Qi. Obtaining Guan Qi in Winter results in a slightly deep pulse, which is normal. Prominent depth with little softness indicates Kidney disease. Only depth without Guan Qi indicates death.)
If the Winter pulse contains Gou (Hooked) qualities, illness will occur in Summer; if Gou is very pronounced, illness occurs now. (Winter pulse containing Gou indicates Fire rebelling against Water. At Start of Summer, Fire Qi is actually deficient, causing illness. If rebellion is excessive, illness should occur immediately.)
The True Qi of the Zang descends to the Kidney, and the Kidney stores the Qi of the bone marrow. (The primal true Qi of Water descends and stores in the Kidney, primarily storing the Qi of bone marrow. The "Wu Yun Yun Da Lun" states: Kidney generates bone marrow, bone marrow generates Liver.)
The great Luo vessel of the Stomach is named Xuli, penetrating the diaphragm, connecting to the Lung, emerging below the left breast. Its pulsation can move clothing; this is the Zong Qi within the pulse. (This discusses that the pulses of the Five Zang are nourished by the Stomach, and the Stomach Qi communicating with the Five Zang is Zong Qi. Zong Qi is generated from water and grain in the Stomach, accumulating in the chest, emerging upward from the throat to govern respiration, and circulating within the twelve meridian tunnels, serving as the master of the Zang organs and meridians, hence called Zong Qi. The great Luo of the Stomach penetrates the diaphragm, connects to the Lung, emerges below the left breast, and its pulsation moving clothing is the exit of Zong Qi from the Stomach organ. This pulse is used to observe Zong Qi. Yang Yuanru stated: The first sentence "its pulsation moves clothing" follows "pulse Zong Qi," meaning the pulsation below the breast moving clothing is the pulse from which Zong Qi exits. The second sentence "its pulsation moves clothing" follows "Zong Qi leakage," meaning pulsation moving clothing indicates Zong Qi leaking outward, indicating severe pulsation.)
If the pulsation is rapid with frequent interruptions, the disease is in the middle; if the pulse is knotted and hard, there is accumulation; if the pulse ceases and does not return, it is death; if pulsation below the breast is vigorous enough to move clothing, it is leakage of Zong Qi. (This discusses diseases caused by Zong Qi when Guan Qi is scant in the four seasons. Death due to lack of Guan Qi in the Five Zang occurs when Zong Qi either ceases internally or leaks externally. The Zong pulse penetrates the diaphragm and connects to the Lung. If panting is severe and the pulse below the breast frequently interrupts, Zong Qi is diseased in the Danzhong. If the pulse is knotted with stops, there is accumulation in the horizontal collaterals of Xuli. This shows that when Guan Qi is scant causing Zang disease, Zong Qi has deficiency and excess conditions. If the Xuli pulse ceases and does not return, the vital Qi of the Stomach organ is severed internally. If pulsation below the breast is severe and moves clothing, Zong Qi is about to leak externally. These are fatal Zang pulses due to lack of Guan Qi.)
To know the excess and deficiency of the Cun Kou (Radial) pulse: If the Cun Kou pulse feels short upon palpation, it indicates headache; if it feels long, it indicates pain in the lower legs; if it feels rapid and strikes upward against the fingers, it indicates shoulder and back pain; if it is deep and firm, the disease is internal; if it is superficial and vigorous, the disease is external; if it is deep and weak, it indicates chills and fever, as well as Shan Jia (hernia/lump) and lower abdominal pain; if it is deep and transverse, there is accumulation under the hypochondrium and transverse accumulation pain in the abdomen; if it is deep and rapid/panting, it indicates chills and fever. (This uses Cun Kou to diagnose diseases caused by external factors. Cun is Yang, Chi is Yin; exterior is Yang, interior is Yin; skin, flesh, tendons, bones are Yang; abdomen and hypochondrium are Yin. Generally, the Qi of heaven and earth and the four seasons moves from exterior to interior, from Yang to Yin. Thus, using the floating/sinking of Cun Kou diagnoses the interior/exterior of external diseases. A short Cun Kou pulse is only in the Yang portion of Cun, hence headache, representing Yang Qi above. A long Cun Kou pulse extends straight to Chi, indicating Yang pathogen moving directly to the lower part, hence lower leg pain. Rapid and striking upward indicates floating and beating against the hand, Yang pathogen neither up nor down, hence shoulder/back pain. This distinguishes external pathogens in the body by upper/middle/lower positions. Deep indicates interior, superficial indicates exterior. Deep and firm Cun Kou indicates pathogenic accumulation in the interior; superficial and vigorous indicates pathogenic disease in the exterior. This distinguishes external pathogens in the body's interior/exterior by floating/sinking. Cun is Yang, deep is Yin. Deep and weak Cun Kou indicates righteous Qi deficiency with Yang pathogen entering interior Yin directly, Yin-Yang conflict, hence chills/fever. Yang pathogen entering interior also causes Shan Jia and lower abdominal pain due to righteous Qi weakness allowing Yang pathogen to enter lower interior Yin. Hypochondrium governs the middle of the body; abdomen is the interior of the form. Deep and transverse Cun Kou indicates external pathogen entering interior Yin, hence transverse accumulation in hypochondrium/abdomen. Pathogen reversing upward causes panting; deep and rapid Cun Kou indicates external Yang pathogen entering interior Yin and reversing upward, Yin-Yang conflict, hence chills/fever. This again uses deep Cun Kou to diagnose external pathogens entering interior Yin, distinguishing upper/middle/lower. Mo Zijin stated: Spring pulse slightly wiry, Summer pulse slightly hooked, are the Qi of heaven and earth combining with human Five Zang. Thus, pathogens of heaven and earth also move from exterior to interior, distinguished by Cun Kou floating/sinking.)
Vigorous, slippery, and firm pulses indicate disease in the exterior; small, solid, and firm pulses indicate disease in the interior; small, weak, and choppy pulses indicate chronic disease; slippery, superficial, and rapid pulses indicate acute disease; urgent pulses indicate Shan Jia and lower abdominal pain; slippery pulses indicate Wind; choppy pulses indicate Bi syndrome; slow and slippery pulses indicate Heat in the Middle; vigorous and tight pulses indicate distension. (This again uses the three positions of Cun, Guan, Chi to diagnose exterior/interior and new/old diseases. "Vigorous" and "small" refer generally to the left and right three positions. Using Cun Kou floating/sinking diagnoses exterior/interior/up/down of disease, observing the Qi of exterior/interior and Yin/Yang. Generally, pathogens of heaven and earth initially injure the Qi level; if lingering, they enter the meridians. Some remain in the Qi level, some enter meridians immediately. Pathogens affecting humans vary, so one must verify via pulse. Thus, Qi level pathogens show only Cun Kou floating/sinking/length; if entering meridians, there are slippery/choppy/urgent/tight images. Pulse belongs to Yin Blood; Yang pathogen of Qi level entering meridians creates Yin-Yang conflict, resulting in slippery pulse. Thus, vigorous/slippery pulses indicate exterior disease, excess disease, hence firm and forceful. Meridians connect exteriorly to the body and interiorly to Zang/Fu; disease in the interior results in small/solid/firm pulses. This distinguishes exterior/interior pathogens by vigorous/slippery vs. small/solid/firm three-position pulses. Newly acquired disease, pathogen and righteous Qi contend, hence slippery/superficial/rapid; after time, blood vessels are injured, hence small/weak/choppy. All urgent pulses indicate Cold, hence Shan Jia in interior. Slippery indicates Yang Heat, hence Wind pathogen in Yang. This distinguishes Yang/Yin collateral diseases by urgent/slippery three-position pulses. Bi means obstruction. Wind, Cold, Damp pathogens cause Bi. They may be in skin/flesh/tendons/bones or internal to Zang/Fu. Bi diseases between interior/exterior have choppy pulses. Slow is Spleen pulse; slippery indicates Heat in Middle; tight indicates Cold, hence distension. This shows external pathogens entering abdomen with Cold/Heat distinctions.)
Pulses following Yin/Yang are easily cured; pulses opposing Yin/Yang are difficult to cure. Pulses conforming to the four seasons indicate no other complications; pulses opposing the four seasons, and those skipping the generating Zang (directly attacking conquering Zang), are difficult to cure. (Yin/Yang refers to Qi/Blood, exterior/interior, up/down. Zang/Fu pulses intersecting Yin/Yang, corresponding male/female, circulating interior/exterior is Shun (Smooth). If Yin/Yang is reversed, disease is hard to heal. Conforming to four seasons means Spring slightly wiry, Summer slightly hooked, obtaining the smoothness of four-season generating Qi without other changes. Opposing four seasons means Spring pulse with Mao, Summer pulse with Shi. Jian Zang (Intervening Zang) refers to transmission via generation. Bu Jian Zang refers to transmission via conquest. For example, external evil initially injures skin/hair, then internally combines with Lung. If Lung transmits to Liver, Kidney intervenes; if Kidney to Heart, Liver intervenes; if Liver to Spleen, Heart intervenes; if Heart to Lung, Spleen intervenes; if Spleen to Kidney, Lung intervenes. This section summarizes the preceding meaning.)
Many blue vessels on the arm indicate blood loss. (This discusses internal diseases moving from interior to exterior, from Chi to Cun, from Blood to Meridian, from Meridian to Qi. Many blue vessels on the arm mean many visible collaterals appear blue. This is because blood loss fails to nourish the complexion. Ling Shu states: Urgent pulse means Chi skin is urgent; slow pulse means Chi skin is slow. Thus, one skilled in diagnosing Chi skin needs not wait for Cun; one skilled in diagnosing pulse needs not wait for color observation. Combining these three makes a superior physician.)
Chi pulse slow and choppy indicates lethargy and desire to lie down; vigorous pulse indicates blood loss; Chi choppy and pulse slippery indicates profuse sweating; Chi cold and pulse fine indicates diarrhea; Chi coarse and often hot indicates Heat in the Middle. (This uses Chi to diagnose Zang diseases. Slow is Spleen pulse; choppy indicates Zang Qi deficiency. Xie Tui (lethargy) indicates Spleen disease. Chi belongs to Yin and governs Blood; pulse should be calm. Vigorous pulse indicates Liver Fire excess and blood failing to store. Ling Shu Zhi Chi Pian states: Chi skin choppy indicates Wind-Bi. Pathogen pressing on meridians makes pulse slippery. Yang Wind pathogen closing skin and pressing meridians causes profuse sweating. "Yang added to Yin is Sweat"; sweat is Yin fluid. Diagnosing Chi reveals Lung's exterior sweat. Zhi Chi Pian states: Chi skin cold, pulse small indicates diarrhea and shortness of breath. Yang Qi is born in Yin; Chi skin cold means little Yang Qi generated. Yang Qi declining below causes deficiency diarrhea. Diarrhea loses Yin, hence fine pulse. Diagnosing Chi reveals Kidney's generated Yang and lower Jiao deficiency diarrhea. Chi skin coarse and often hot indicates Fire-Heat descending, hence Heat in Middle. Diagnosing Chi reveals Heart Fire descending. Yin/Yang/Qi/Blood move from Yin to Yang, bottom to top; thus, diagnosing Chi reveals disease exterior/interior/up/down.)
Liver pulse appearing on Geng/Xin days (Metal days) indicates death; Heart pulse on Ren/Gui days (Water days) indicates death; Spleen pulse on Jia/Yi days (Wood days) indicates death; Lung pulse on Bing/Ding days (Fire days) indicates death; Kidney pulse on Wu/Ji days (Earth days) indicates death. This is called appearance of True Zang pulse, which indicates death. (This discusses True Zang pulse appearing and dying on days of being conquered. Zang Qi is born of Earth's Five Elements. Earth's Five Elements are transformed by Heaven's Ten Stems. Thus, born of Five Elements, dying by Ten Stems. Note: This section should be at the end, after "Pi Pi Ru Dan Shi Yue Shen Si," mistakenly placed here. Yang Yuanru stated: This chapter cites Ling Shu Zhi Chi Pian to prove Chi diagnosis, but Ling Shu lacks this text; it should be corrected.)
Neck vessel pulsation with panting and rapid cough indicates Water disease; eyes slightly swollen like a sleeping silkworm indicate Water disease; yellow urine with lying down indicates Jaundice; feeling hungry after eating indicates Stomach Jaundice; facial swelling indicates Wind disease; lower leg swelling indicates Water disease; yellow eyes indicate Jaundice. (This diagnoses disease through observation. This section cites Ling Shu Lun Ji Zhi Chi with minor edits to prove Chi diagnosis. Previous section discussed Chi diagnosis; this section discusses visual diagnosis. It says not just looking at color and holding pulse, but solely adjusting Chi to speak of disease, knowing interior from exterior. Thus, seeing neck vessel pulsation, eye swelling, leg swelling indicates Water disease in interior. Yellow urine, lying down, hunger after eating indicates Jaundice and Stomach Jaundice. Facial swelling...)