平人气象者，无病患之脉气与脉象也。欲识平人之脉，当以病脉死脉参之，欲识病脉死脉当
以胃脉准之。五脏四时之脉，皆以胃气为本，盖五脏之气，生于胃，而胃腑之气，生于水谷也。
黄帝问曰∶平人何如？
承上编脉要精微，而问平人之脉也。
岐伯对曰∶人一呼，脉再动。一吸，脉再动，呼吸定息，脉五动，闰以太息，命曰
平人。平人者，不病也。
一呼一吸为一息，平人之脉一呼再动，一吸再动，合呼吸定息之时，亦当一动，故脉五动。所以为五
动者，乃闰以太息，如积余成闰，在于息之太过也。命曰，不病之平人。
常以不病，调病患，医不病，故为病患平息以调之为法。
上为，去声。不病则呼吸均调，病则短长乖错，故常以医之不病，而平息以调病患之脉，是为诊候之法。
人一呼，脉一动，一吸，脉一动，曰少气。
一呼脉一动，一吸脉一动，减于平人过半，故曰少气，谓正气衰微也。
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。
躁，犹疾也。滑，流利也。涩，凝滞也。人一呼脉三动，一吸脉三动，而为躁疾之脉也，脉躁疾
而尺肤热，则曰病温。尺肤不热，脉不躁疾，其脉流利而滑，则曰病风。其脉不滑，凝滞而涩，则曰痹病也。
人一呼，脉四动以上，曰死。脉绝不至，曰死。乍疏乍数，曰死。
数，音朔，下同。人一呼，脉四动以上，则太过之极。脉绝不
至，则不及之极，乍疏乍数，则错乱之极，故皆曰死。
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。
平人受谷以生，故平人之常气禀于胃，胃者，即平人之常气也。谷入于胃，五脏六腑，皆以受气，
故人无胃气而绝食，则曰逆，逆者死。
春胃微弦，曰平。弦多胃少，曰肝病。但弦无胃，曰死。胃而有毛，曰秋病。毛甚，曰今
病。脏真散于肝，肝藏筋膜之气也。
肝之藏如字，下心脾肾之藏同。胃者，中土柔和之气，五脏四时之所需也。春得胃脉，其脉微弦，
则曰平脉。弦多胃少，则曰肝病。但弦无胃；则曰死脉。胃而有毛者，其脉微弦，兼得轻浮之毛
脉也。毛乃秋脉，见于春时，金虚其位，故至秋当病。若毛脉过甚，木受金刑，不必至秋，今当病也。夫肝
之所以为弦脉者，乃脏真之神气散于肝，而肝复藏筋膜之气也。
夏胃微钩，曰平。钩多胃少，曰心病。但钩无胃，曰死。胃而有石，曰冬病。石甚，曰今病。
脏真通于心，心藏血脉之气也。
夏得胃脉，其脉微钩，则曰平脉。钩多胃少，则曰心病。但钩无胃，则曰死脉。胃而有石者，其
脉微钩，兼得下沉之石脉也。夏得冬脉，水虚其位，故曰冬病。石甚，则火受水刑，故今病也。夫
心之所以为钩脉者，乃脏真之神气通于心，而心复藏血脉之气也。
长夏胃微软弱，曰平。弱多胃少，曰脾病。但代无胃，曰死。软弱有石，曰冬病。弱甚，
曰今病。脏真濡于脾，脾藏肌肉之气也。
长夏得胃脉，而微软弱，则曰平脉。弱多胃少，则曰脾病。代，软弱之极也。软弱极而无胃气，则
曰死脉。软弱有石者，以明水气乘土，至冬水气内虚，故曰冬病。弱甚，则脾脉大虚，故今病
也。夫脾脉之所以为软弱者，乃脏真之神气濡于脾，而脾复藏肌肉之气也。
秋胃微毛，曰平。毛多胃少，曰肺病。但毛无胃，曰死，毛而
有弦，曰春病。弦甚，曰今病。脏真高于肺，以行荣卫阴阳也。
秋得胃脉，其脉微毛，则曰平脉。毛多胃少，则曰肺病。但毛无胃，则曰死脉。毛而有弦者，木气乘
金，至春木气内虚，故曰春病。若弦甚，则木气虚而乘侮至，故今病也。夫肺之所以为毛脉
者，乃脏真之神气高于肺，肺朝百脉，以行荣卫阴阳也。
冬胃微石，曰平。石多胃少，曰肾病。但石无胃，曰死。石而有钩，曰夏病。钩甚，曰今病。
脏真下于肾，肾藏骨髓之气也。
冬得胃脉，其脉微石，则曰平脉。石多胃少，则曰肾病。但石无胃，则曰死脉。石而有钩者，火气
乘水，至夏火气内虚，故曰夏病。若钩甚，亦本气虚而乘侮至，故今病也。夫肾之所以为石脉
者，乃脏真之神气下于肾，而肾复藏骨髓之气也。盖肝主疏泄，故曰散。心主血脉，故曰通。脾主灌溉，故曰
濡。肺位居上，故曰高。肾为水脏，故曰下也。春言胃而有毛，金刑木也。夏言胃而有
石，水刑火也。长夏秋冬，一言软弱有石，一言毛而有弦，一言石而有钩，皆我胜者而反乘之。盖胜我者
刑之，由于本气之虚，我胜者乘之，亦由本气之虚也。又春夏今病，皆言受克，长夏今病，则言本虚，秋冬今
病，则言乘侮，以明受克乘侮，皆因本气之虚，错综其意，欲人彼此互推，知其由也。
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。
五脏之脉，资生于胃，胃为中土，气通四旁，故胃之大络，名曰虚里。大络，胃外之络脉也。虚里，
四通之义也。其络，中贯膈、上络肺，横出于左乳之下，其动则外应于衣，是经脉之宗气
也。是知胃络，不但通四旁，贯膈络肺，而且合于宗气，此言胃络之平气也。
盛喘数绝者，则病在中，结而横，有积矣。
盛喘而数，其气欲绝者，是宗气不上出于肺，以司呼吸，则其病在膈中也。病在膈中，故宗气内结
而横逆，结而横，则膈中有积矣，此言胃络之病气也。
绝不至，曰死。乳之下，其动应衣，宗气泄也。
宗气脱而绝不至，则曰死。所以然者，以宗气出于乳之下，其动应衣，今绝不至，是宗气泄也。泄，
犹脱也。此言胃络之死气也。是不但五脏之脉，有平脉病脉死脉；而宗气之脉，亦有平气病气死气也。
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。
上三中，去声。横，去声。胃脉属土，位居关部，上寸下尺，亦以胃气为本，故举寸口尺中之脉以明
之。欲知寸口太过与不及之脉病，须以长短浮沉之脉而知之。寸口之脉，中于手指之下，脉气
短者，短则气虚。不及于上，故头痛，头痛正虚于上也。寸口脉中于手指之下，脉气长者，长则气盛，太
过于下，故足胫痛。足胫痛邪实于下也。寸口脉中于手指之下，脉气促，而上击者，促则内
虚，不及于内，上击则外实，太过于外，故肩背痛。肩背痛，内虚外实也。寸口脉沉而坚者，太过于内也，
故病在中。寸口脉，浮而盛者，太过于外也，故病在外。寸口脉，沉而弱者，不及于内也，
故为寒热及疝瘕，而少腹痛。寸口脉，沉而横者，太过于内也。故胁下有积。而腹中亦有横积痛，寸口脉，
沉而喘者，或太过，或不及，故但为寒热，寒热之证，有有余，有不足也。横，横逆。喘，
喘急。横与喘，言脉之形象，非谓病也。
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，脉滑者曰风。脉涩者，曰痹。缓而滑，曰热中。盛而紧，曰胀。
此复言太过不及之脉病，以足上文未尽之意。脉盛滑坚，则阳
气太过，故曰病在外。脉小实而坚，则阴气太过，故曰病在内。脉小
弱以涩，则气血不及，故谓久病。脉滑浮而疾，则气血太过，故谓新病。疝瘕少腹痛，有虚有实，上文
寸口脉沉弱，病疝瘕少腹痛，乃正气不足也。此脉急而曰疝瘕少腹痛，乃邪气有余也。脉滑为风
者，风为阳邪，善行数变，故脉滑也。脉涩为痹者，痹主闭拒，血气凝滞，故脉涩也。脉缓而滑者，土
气内虚，阳热过盛，故曰热中。脉盛而紧者，土气有余，邪气内实，故曰胀也。此论太过不及
之脉，而知有余不足之病，不但寸口为然，所以足上文未尽之意者如此。
脉从阴阳，病易已。脉逆阴阳，病难已。脉得四时之顺，曰病
无它。脉反四时，及不间脏，曰难已。
易、间，皆去声。太过不及之脉，而有有余不足之病，尤贵阴阳之相从，故脉从阴阳，其病易已，脉逆
阴阳，其病难已，所谓脉从阴阳者，脉得四时之顺也。顺者，春弦、夏钩、秋毛、冬石也。
得顺，则虽病无他；无他，无他变也。所谓脉逆阴阳者，脉反四时也。反者，胃而有毛，胃而有石，毛
而有弦，石而有钩也。间脏者，外淫之邪，始伤皮毛，肺先受之，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，乃子母相生，脏
不受刑，今不间脏，则脏受刑，故病难已。
臂多青脉，曰脱血。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。
解，懈同。 ，音亦。余篇解、 同。上文诊寸口而知病之所在，此诊尺脉而知病之所在也。自此
至妇人妊子，其辞意与《灵枢·论疾诊尺》论大略相同。臂多青脉者，自尺脉而至于臂，臂内络
脉之色多青也。肝色青，肝藏血，臂多青脉，则知肝血不能热肉充肤，淡渗皮毛，故曰脱血。若尺脉缓涩，
则气血内虚，故谓之解 安卧。解 ，犹懈怠，安卧，犹嗜卧也。不但臂多青脉曰脱血，若
尺脉强盛，则阴气不和，亦谓之脱血。尺涩，尺肤涩也。脉滑，尺
脉滑也，肤涩脉滑，则气机从阴出阳，故谓之多汗。尺寒，尺肤寒也。脉细，尺脉细也。肤寒脉细，则生
阳之气不能外达，故谓之后泄。粗，犹大也，尺粗，尺脉大也。常热，肤常热也。脉粗肤热，
则阳气有余，故谓之热中。此诊尺脉尺肤，而知病之所在也。
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。
溺，鸟，去声。更有不待诊尺，但论疾而知其病之所在者，如颈脉动喘疾咳，则知水气内动，故曰水。
目内微肿，如卧蚕起之状，则知水气外呈，故亦曰水。若溺黄赤安卧，则知湿热在中，而为黄
疸。已食如饥，则知邪热在中，而成胃疸。论其面肿，则知风动于上，故曰风，论其足胫肿，则知水动
于下，故曰水。所谓黄胆者，不但溺黄赤安卧，必目黄者，始曰黄胆。上文未言目黄，故重言以
申明之。此论疾而知其病之所在也。
妇人，手少阴动甚者，妊子也。
少阴尺脉也，诊尺之法，即知病之所在，亦可知妇人之有妊。妇人两手少阴脉动甚者，则知肾气有余，
感天一所生之气，故妊子也。
脉有逆从，四时未有藏形。春夏而脉瘦，秋冬而脉浮大，命曰逆四时也。
脉有逆从，即上文脉从阴阳，脉逆阴阳之谓也。四时未有藏形，至春夏而脉未弦钩，至秋冬而脉未毛
石也。春生夏长，其气外盛，而脉反瘦，秋收冬藏，其气内敛，而脉反浮大，与时不顺，命曰逆四时也。
风热而脉静，泄而脱血，脉实，病在中，脉虚，病在外。脉涩坚者，皆难治。命曰反四时也。
有病之脉，亦贵阴阳外内之相应。如风热之病，阳气盛也。脉应洪大，而反静，泄而脱血，阴虚病也。
脉应内虚，而反实，病在中，则邪实于内，脉应沉实，而反虚。病在外，则邪盛于外，脉应
浮大，而反涩坚，此脉不应病，病不应脉，皆为难治。亦命曰反四时也。
人以水谷为本，故人绝水谷，则死。脉无胃气，亦死。所谓无胃气者，但得真脏脉，不得胃气也。所谓脉不得
胃气者，肝不弦，肾不石也。
人籍水谷以生，是人以水谷为本。人非水谷不生，故人绝水谷则死。人绝水谷则死，而脉无胃气
亦死。所谓无胃气者，但得真脏脉，不得柔和之胃气也。所谓脉不得胃气者，至春而肝不微弦，至
冬而肾不微石也。此脉本于胃，而胃本于水谷也。
太阳脉至，洪大以长。少阳脉至，乍数乍疏，乍短乍长。阳明脉至，浮大而短。
此举三阳之脉象，以明胃气合于三阳之六腑。下文平脉病脉死脉，以明胃气合于三阴之五脏也。太阳，
巨阳也。太阳脉至，则洪大以长，此阳气有余，而主开之象也。少阳，初阳也，少阳脉至，
则乍数乍疏，乍短乍长，此初阳渐生，而主枢之象也。阳明，二阳也。阳明脉至，则浮大而短，浮大，阳
也。浮大而短，阳明主阖之象也。三阳主六腑，胃气合于六腑，故举三阳之脉以明之。
夫平心脉来，累累如连珠，如循琅 ，曰心平。夏以胃气为本，病心脉来，喘喘连属，其中
微曲，曰心病。死心脉来，前曲后居，如操带钩，曰心死。
五脏有平脉、病脉、死脉，皆以胃气为本。夫平心脉来，其脉来累累然如连珠之滑利，复如循琅 之
平和，心脉如是，则心气通调，如曰心平。心主夏火，故夏以胃气为本。若病心脉来，其脉喘
平人气象，指的是没有患病的正常人的脉气和脉象。想要了解平人的脉象，应当用病脉和死脉来参照；想要识别病脉和死脉，应当以胃气脉作为标准。五脏在四季中的脉象，都以胃气为根本，因为五脏之气源于胃，而胃腑之气则源于水谷精微。
岐伯回答说：人每呼气一次，脉搏跳动两次；每吸气一次，脉搏也跳动两次。在一呼一吸之间（定息），脉搏再跳动一次，这样合计五次跳动。如果加上偶尔的深长呼吸（太息）作为补充，就像历法中积余成闰一样，这就称为平人。所谓平人，就是没有疾病的人。
一呼一吸称为一息。平人的脉象是一呼脉动两次，一吸脉动两次，加上呼吸转换停顿时的这一次跳动，所以脉搏共跳动五次。之所以说是五次跳动，是因为有“闰以太息”的情况，即像积累余数成为闰月一样，体现在呼吸的稍长之中。这被称为不生病的平人。
通常以健康无病之人的呼吸节奏，来调校和衡量病患的脉象。医生自身无病，所以以自身平稳的呼吸次数作为标准，来调节和判断病患的脉象，这就是诊脉的方法。
“上”字读去声。无病之人呼吸均匀调和，患病之人呼吸长短错乱。因此，常以医生无病且呼吸平稳的状态，作为调校病患脉象的标准，这就是诊候的方法。
人每呼气一次，脉搏只跳动一次；每吸气一次，脉搏也只跳动一次，这叫做少气。
一呼脉动一次，一吸脉动一次，比平人减少了一半以上，所以称为少气，意思是正气衰微。
人每呼气一次，脉搏跳动三次；每吸气一次，脉搏也跳动三次，且脉势躁急，尺部皮肤发热，这叫做温病。如果尺部皮肤不热，脉象滑利，这叫做风病。如果脉象涩滞，这叫做痹证。
“躁”，就是疾速的意思。“滑”，指流利。“涩”，指凝滞。人一呼脉动三次，一吸脉动三次，属于躁疾的脉象。如果脉象躁疾且尺肤发热，就称为温病。如果尺肤不热，脉象不躁疾，而是流利滑润，就称为风病。如果脉象不滑，反而凝滞涩涩，就称为痹病。
人每呼气一次，脉搏跳动四次以上，这叫做死脉。脉搏完全停止不再跳动，这叫做死脉。脉搏忽快忽慢，杂乱无章，这叫做死脉。
“数”音同朔，下文相同。人一呼脉动四次以上，是太过到了极点。脉搏绝迹不至，是不及到了极点。忽疏忽数，是错乱到了极点，所以都称为死脉。
平人的常气禀受于胃；胃，就是平人的常气。人如果没有了胃气，就叫作逆，逆者必死。
平人依靠摄入谷物生存，所以平人的常气禀受于胃，胃就是平人的常气。食物进入胃中，五脏六腑都能从中汲取精气。所以人如果没有胃气而断绝饮食，就叫作逆，逆者必死。
春季脉象带有柔和的弦意，称为平脉。弦象多而胃气少，称为肝病。只有弦象而没有胃气，称为死脉。脉象中带有毛（浮）象，预示秋季会生病。毛象特别明显，表示现在就会生病。脏真之神气散布于肝，肝藏纳筋膜之气。
“藏”字按本音读，心、脾、肾的“藏”字同理。胃气是中土柔和之气，是五脏四季所必需的。春季得到胃脉，脉象微带弦意，就称为平脉。弦多胃少，就称为肝病。只有弦而无胃气，就称为死脉。脉象中有毛象，是指脉象微弦，兼有轻浮的毛脉。毛脉是秋季的脉象，出现在春季，说明金气虚位，所以到秋天应当生病。如果毛脉过甚，木受金克，不必等到秋天，现在就会生病。肝之所以呈现弦脉，是因为脏真之神气散布于肝，而肝又收藏筋膜之气。
夏季脉象带有柔和的钩（洪）意，称为平脉。钩象多而胃气少，称为心病。只有钩象而没有胃气，称为死脉。脉象中带有石（沉）象，预示冬季会生病。石象特别明显，表示现在就会生病。脏真之神气通达于心，心藏纳血脉之气。
夏季得到胃脉，脉象微带钩意，就称为平脉。钩多胃少，就称为心病。只有钩而无胃气，就称为死脉。脉象中有石象，是指脉象微钩，兼有下沉的石脉。夏季出现冬季的脉象，说明水气虚位，所以称为冬病。石象过甚，说明火受水克，所以现在就会生病。心之所以呈现钩脉，是因为脏真之神气通达于心，而心又收藏血脉之气。
长夏季节脉象带有柔和的软弱意，称为平脉。弱象多而胃气少，称为脾病。只有代（软弱至极）象而没有胃气，称为死脉。软弱中带有石象，预示冬季会生病。弱象特别明显，表示现在就会生病。脏真之神气濡润于脾，脾藏纳肌肉之气。
长夏得到胃脉，脉象微软弱，就称为平脉。弱多胃少，就称为脾病。代，是软弱到了极点。软弱至极且无胃气，就称为死脉。软弱中带有石象，说明水气乘犯脾土，到了冬季水气内虚，所以称为冬病。弱象过甚，说明脾脉大虚，所以现在就会生病。脾脉之所以呈现软弱，是因为脏真之神气濡润于脾，而脾又收藏肌肉之气。
秋季脉象带有柔和的毛（浮）意，称为平脉。毛象多而胃气少，称为肺病。只有毛象而没有胃气，称为死脉。毛象中带有弦象，预示春季会生病。弦象特别明显，表示现在就会生病。脏真之神气高于肺，通过肺运行营卫阴阳之气。
秋季得到胃脉，脉象微带毛意，就称为平脉。毛多胃少，就称为肺病。只有毛而无胃气，就称为死脉。毛象中带有弦象，说明木气乘犯肺金，到了春季木气内虚，所以称为春病。如果弦象过甚，说明木气虚而受到乘侮，所以现在就会生病。肺之所以呈现毛脉，是因为脏真之神气高于肺，肺朝百脉，运行营卫阴阳之气。
冬季脉象带有柔和的石（沉）意，称为平脉。石象多而胃气少，称为肾病。只有石象而没有胃气，称为死脉。石象中带有钩象，预示夏季会生病。钩象特别明显，表示现在就会生病。脏真之神气下归于肾，肾藏纳骨髓之气。
冬季得到胃脉，脉象微带石意，就称为平脉。石多胃少，就称为肾病。只有石而无胃气，就称为死脉。石象中带有钩象，说明火气乘犯肾水，到了夏季火气内虚，所以称为夏病。如果钩象过甚，也是本气虚而受到乘侮，所以现在就会生病。肾之所以呈现石脉，是因为脏真之神气下归于肾，而肾又收藏骨髓之气。
大概肝主疏泄，所以叫“散”。心主血脉，所以叫“通”。脾主灌溉，所以叫“濡”。肺位居上焦，所以叫“高”。肾为水脏，位置在下，所以叫“下”。春季说脉中有毛，是金克木。夏季说脉中有石，是水克火。长夏、秋冬，一说软弱有石，一说毛而有弦，一说石而有钩，都是胜我之气反过来乘犯我。大概胜我之气克伐我，是由于本气虚弱；我胜之气乘犯我，也是因为本气虚弱。另外，春夏季说现在生病，都是讲受克；长夏季说现在生病，则是讲本虚；秋冬季说现在生病，则是讲乘侮。这是为了说明受克、乘侮都是因为本气虚弱，错综其意，希望人们彼此互相推究，知道其中的缘由。
胃的大络，名叫虚里，贯穿膈肌，联络肺部，出于左侧乳下，其搏动可以映现衣物，这是宗气的表现。
五脏的脉象，资生于胃。胃属中土，气通四方，所以胃的大络，名叫虚里。大络，是胃之外的络脉。虚里，有四通八达的含义。这络脉，中间贯穿膈肌，向上联络肺，横向出于左乳之下，其搏动外应衣物，这是经脉的宗气。由此可知，胃络不仅通四方、贯膈络肺，而且合于宗气，这里说的是胃络的正常脉气。
如果搏动盛大急促甚至欲绝，说明病在中焦。脉结滞且横逆，说明有积聚。
搏动盛大且急促，气欲断绝，这是宗气不能上出于肺以主持呼吸，所以病在膈中。病在膈中，所以宗气内结而横逆，结滞横逆，说明膈中有积聚，这里说的是胃络的病态脉气。
脉搏绝迹不至，称为死脉。在乳房下方，搏动剧烈至映动衣物，这是宗气外泄。
宗气脱失而绝迹不至，就称为死脉。之所以这样，是因为宗气出于乳下，其搏动外应衣物，如今绝迹不至，这是宗气外泄。泄，就是脱失的意思。这里说的是胃络的死绝脉气。这不仅说明五脏的脉有平、病、死之分，宗气的脉也有平气、病气、死气之分。
想要知道寸口脉的太过与不及，如果寸口脉按之感觉短，称为头痛。寸口脉按之感觉长，称为足胫痛。寸口脉按之促急，向上冲击手指，称为肩背痛。寸口脉沉而坚实，称为病在中焦。寸口脉浮而盛大，称为病在外表。寸口脉沉而弱，称为寒热病，以及疝瘕、少腹痛。寸口脉沉而横，称为胁下有积聚，腹中有横积疼痛。寸口脉沉而喘急，称为寒热病。
“上”、“横”均读去声。胃脉属土，位于关部，上接寸口，下连尺部，也以胃气为根本，所以列举寸口和尺部的脉象来说明。想要知道寸口脉太过与不及的脉病，必须通过长短浮沉的脉象来判断。寸口脉，按在手指下，脉气短的，短则气虚，气不及于上部，所以头痛，头痛是因为上部正虚。寸口脉，按在手指下，脉气长的，长则气盛，气过于下部，所以足胫痛，足胫痛是因为下部邪实。寸口脉，按在手指下，脉气促急且向上冲击的，促则内虚，气不及于内，上击则外实，气过于外，所以肩背痛，肩背痛是内虚外实。寸口脉沉而坚，是气过于内，所以病在中焦。寸口脉浮而盛，是气过于外，所以病在体表。寸口脉沉而弱，是气不及于内，所以为寒热及疝瘕、少腹痛。寸口脉沉而横，是气过于内，所以胁下有积聚，腹中也有横积痛。寸口脉沉而喘急，或太过或不及，所以仅表现为寒热，寒热证有有余和不足之分。横，指横逆。喘，指喘急。横与喘，描述的是脉的形象，并非指病症本身。
脉象盛大、滑利、坚实的，称为病在外表。脉象小、实、坚实的，称为病在内里。脉象小、弱、涩的，称为久病。脉象滑、浮、疾速的，称为新病。脉象紧急的，称为疝瘕、少腹痛。脉象滑的，称为风病。脉象涩的，称为痹证。脉象缓而滑的，称为热中。脉象盛大而紧的，称为胀满。
这里再次论述太过与不及的脉病，以补充上文未尽之意。脉盛滑坚，说明阳气太过，所以称病在外表。脉小实坚，说明阴气太过，所以称病在内里。脉小弱涩，说明气血不及，所以称为久病。脉滑浮疾，说明气血太过，所以称为新病。疝瘕少腹痛，有虚有实。上文提到寸口脉沉弱致疝瘕少腹痛，是正气不足。此处脉急致疝瘕少腹痛，是邪气有余。脉滑为风，因为风为阳邪，善行数变，所以脉滑。脉涩为痹，因为痹主闭拒，气血凝滞，所以脉涩。脉缓而滑，说明土气内虚，阳热过盛，所以称为热中。脉盛而紧，说明土气有余，邪气内实，所以称为胀满。这里论述通过太过不及的脉，来知晓有余不足的病，不仅寸口脉如此，以此补充上文未尽之意。
脉象顺应阴阳变化，病容易痊愈。脉象违背阴阳变化，病难痊愈。脉象顺应四时规律，称为病无他变。脉象违背四时规律，以及传经不经过相克之脏（间脏），称为难愈。
“易”、“间”均读去声。太过不及的脉，伴有有余不足的病，尤其重视阴阳的相从。所以脉从阴阳，病易已；脉逆阴阳，病难已。所谓脉从阴阳，就是脉得四时之顺。顺，指春弦、夏钩、秋毛、冬石。得到顺脉，虽然生病也无他变；无他变，就没有其他变证。所谓脉逆阴阳，就是脉反四时。反，指胃而有毛，胃而有石，毛而有弦，石而有钩。间脏，是指外来的淫邪，起初损伤皮毛，肺先受之。肺欲传肝，而有肾间隔其间；肾欲传心，而有肝间隔其间；肝欲传脾，而有心间隔其间；心欲传肺，而有脾间隔其间；脾欲传肾，而有肺间隔其间。这是子母相生，脏不受刑克。如今不间脏，则脏直接受刑克，所以病难愈。
手臂上青色脉络明显，称为脱血。尺脉缓涩，称为懈惰嗜卧。脉象盛大，称为脱血。尺部皮肤涩而脉滑，称为多汗。尺部皮肤寒而脉细，称为后泄（腹泻）。尺部脉粗大且经常发热，称为热中。
“解”同“懈”。“ ”音亦。其他篇章中“解”、“ ”意思相同。上文通过诊察寸口来知病所在，此处通过诊察尺脉来知病所在。从此处到妇人妊子，其文意与《灵枢·论疾诊尺》大致相同。手臂多青脉，是从尺脉至于手臂，臂内侧络脉颜色多青。肝色青，肝藏血，手臂多青脉，说明肝血不能温热肌肉、充盈肌肤、淡渗皮毛，所以称为脱血。如果尺脉缓涩，说明气血内虚，所以称为懈惰嗜卧。懈惰，就是懈怠；安卧，就是嗜睡。不但手臂多青脉称为脱血，如果尺脉强盛，说明阴气不和，也称为脱血。尺涩，指尺肤涩。脉滑，指尺脉滑。肤涩脉滑，说明气机从阴出阳，所以称为多汗。尺寒，指尺肤寒。脉细，指尺脉细。肤寒脉细，说明生阳之气不能外达，所以称为后泄。粗，就是大。尺粗，指尺脉大。常热，指尺肤常热。脉粗肤热，说明阳气有余，所以称为热中。这是通过诊察尺脉和尺肤，来知晓病所在。
颈部动脉搏动，气喘咳嗽急迫，称为水气病。眼睑内部微微肿胀，像卧蚕起的样子，称为水气病。小便黄赤且嗜睡的，称为黄疸。吃完饭却像没吃饱一样饿的，称为胃疸。面部浮肿，称为风病。足胫浮肿，称为水气病。眼睛发黄，称为黄疸。
“溺”音鸟，读去声。还有不需要诊察尺脉，仅通过症状就能知道病所在的，如颈部动脉搏动、气喘、咳嗽急迫，就知道水气内动，所以称为水气病。眼睑内部微肿，像卧蚕起的样子，就知道水气外现，所以也称为水气病。如果小便黄赤且嗜睡，就知道湿热在中焦，而为黄疸。吃完饭还觉得饿，就知道邪热在中焦，而成胃疸。论述面部浮肿，就知道风邪动于上，所以称为风病。论述足胫浮肿，就知道水气动于下，所以称为水气病。所谓的黄疸，不但要有小便黄赤嗜睡，必须有眼睛发黄，才称为黄疸。上文未提及目黄，故重复强调以申明之。这是通过症状来知晓病所在。
妇女手少阴脉（神门穴处）搏动明显的，是怀孕。
少阴指尺脉。诊察尺脉的方法，既能知病所在，也能知妇人是否怀孕。妇人两手少阴脉搏动明显的，说明肾气有余，感应天一生成之气，所以怀孕。
脉有逆从，四时未见相应的脏脉形态。春夏季节脉象瘦小，秋冬季节脉象浮大，称为逆四时。
脉有逆从，即上文所说的脉从阴阳、脉逆阴阳。四时未有脏形，指到了春夏脉未显弦钩，到了秋冬脉未显毛石。春生夏长，其气外盛，而脉反瘦小；秋收冬藏，其气内敛，而脉反浮大，与时令不顺，称为逆四时。
感受风热而脉象静迟，泄泻或脱血而脉象实，病在中焦而脉虚，病在外表而脉涩坚，这些脉象都难治，称为反四时。
有病之脉，也贵在阴阳内外相应。如风热病，阳气盛，脉应洪大，而反静；泄泻或脱血，阴虚病，脉应内虚，而反实；病在中焦，邪实于内，脉应沉实，而反虚；病在外表，邪盛于外，脉应浮大，而反涩坚。这些脉不应病，病不应脉，都难治。也称为反四时。
人以水谷为根本，所以人断绝水谷就会死亡。脉中没有胃气，也会死亡。所谓无胃气，就是只能见到真脏脉，见不到胃气。所谓脉不得胃气，就是肝脉不弦，肾脉不石。
人依靠水谷生存，所以人以水谷为本。人没有水谷就不能生存，所以人断绝水谷就会死。人断绝水谷会死，脉无胃气也会死。所谓无胃气，就是只得到真脏脉，得不到柔和的胃气。所谓脉不得胃气，就是到了春季肝脉不微弦，到了冬季肾脉不微石。此脉本于胃，而胃本于水谷。
太阳脉至，脉象洪大且长。少阳脉至，脉象忽快忽慢，忽短忽长。阳明脉至，脉象浮大且短。
这里列举三阳的脉象，以说明胃气合于三阳之六腑。下文论述平脉、病脉、死脉，以说明胃气合于三阴之五脏。太阳，即巨阳。太阳脉至，洪大且长，这是阳气有余，主开的象。少阳，初阳。少阳脉至，乍数乍疏，乍短乍长，这是初阳渐生，主枢的象。阳明，二阳。阳明脉至，浮大而短，浮大为阳，浮大而短是阳明主阖的象。三阳主六腑，胃气合于六腑，所以举三阳之脉来说明。
正常的心的脉象，来时累累如连珠，如同抚摸琅玕玉一般，称为心平。夏季以胃气为本。病心的脉象，来时喘喘相连属，其中微曲，称为心病。死心的脉象，来时前曲后居，如同拿着带钩的腰带，称为心死。
五脏有平脉、病脉、死脉，都以胃气为本。正常的心脉，来时累累然如连珠般滑利，又如抚摸琅玕玉般平和，心脉如此，则心气通调，称为心平。心主夏火，所以夏季以胃气为本。如果是病心的脉象，来时喘喘相连属，其中微曲，称为心病。死心的脉象，来时前曲后居，如同拿着带钩的腰带，称为心死。
Ping Ren Qi Xiang (The Pulse and Manifestation of a Healthy Person) refers to the pulse qi and pulse manifestation of a person without disease. To understand the pulse of a healthy person, one should refer to the pulses of the sick and the dying; to identify the pulses of the sick and the dying, one must use the Stomach pulse (Stomach Qi pulse) as the standard. The pulses of the Five Zang organs across the four seasons are all rooted in Stomach Qi, because the Qi of the Five Zang organs is generated by the Stomach, and the Qi of the Stomach Fu organ is generated from water and grain (nutrients).
Huang Di asked: What constitutes a Ping Ren (healthy person)?
This follows the previous chapter "Mai Yao Jing Wei" (Essential Refinements of Pulse Diagnosis), inquiring about the pulse of a healthy person.
Qi Bo replied: When a person exhales once, the pulse beats twice; when they inhale once, the pulse also beats twice. During the pause between inhalation and exhalation (Ding Xi), the pulse beats one more time. Adding occasional deep sighs (Tai Xi) as a supplement, much like accumulating remainders to form a leap month in the calendar, this is called a Ping Ren. A Ping Ren is one who is not diseased.
One exhalation and one inhalation constitute one Xi (respiratory cycle). For a healthy person, the pulse beats twice per exhalation and twice per inhalation. Including the beat during the transition pause of breathing, the total is five beats. The reason it is described as five beats is due to the "leap via deep sigh," meaning it manifests in slightly longer breaths. This is termed a non-diseased Ping Ren.
Typically, one uses the respiratory rhythm of a healthy, disease-free individual to calibrate and assess the pulse of a patient. Since the physician is free of disease, they use their own steady breathing rate as a standard to regulate and judge the patient's pulse; this is the method of pulse diagnosis.
"The upper" (Shang) is pronounced with the departing tone. A healthy person has uniform and harmonious respiration, whereas a sick person has irregular and disordered breathing. Therefore, one commonly uses the physician's disease-free state and steady breathing as a benchmark to adjust the patient's pulse, which constitutes the method of diagnostic observation.
If a person's pulse beats only once per exhalation and once per inhalation, it is called Shao Qi (Deficient Qi).
Pulse beating once per exhalation and once per inhalation is more than half less than that of a healthy person, hence called Shao Qi, indicating that the Zheng Qi (Upright Qi) is weak and declining.
If a person's pulse beats three times per exhalation and three times per inhalation, and the pulse is restless (Zao), with heat in the Chi (wrist crease area), it is called Wen Bing (Warm Disease). If the Chi area is not hot, but the pulse is slippery (Hua), it is called Feng Bing (Wind Disease). If the pulse is choppy (Se), it is called Bi Syndrome (Obstruction Syndrome).
"Zao" means rapid/frenetic. "Hua" means smooth/fluent. "Se" means stagnant/coarse. A pulse beating three times per exhalation and three times per inhalation belongs to the frenetic pulse category. If the pulse is frenetic and the skin at the Chi area is hot, it is termed Warm Disease. If the Chi skin is not hot and the pulse is not frenetic, but rather fluent and slippery, it is termed Wind Disease. If the pulse is not slippery but instead stagnant and choppy, it is termed Bi Syndrome.
If a person's pulse beats four or more times per exhalation, it is called Si Mai (Death Pulse). If the pulse ceases completely and does not return, it is called Death. If the pulse is intermittently slow and rapid, chaotic, it is called Death.
"Shuo" (rapid) is pronounced like "Shuo," same for subsequent mentions. A pulse beating four or more times per exhalation represents excess reaching the extreme. Absence of pulse represents deficiency reaching the extreme. Intermittent slowness and rapidity represent disorder reaching the extreme. Thus, all are termed Death.
The normal Qi of a healthy person is derived from the Stomach; the Stomach is the normal Qi of a healthy person. If a person lacks Stomach Qi, it is called Ni (Rebellion/Contrary), and those with Ni will die.
Healthy people survive by ingesting grains; thus, their normal Qi is derived from the Stomach. The Stomach is indeed the normal Qi of a healthy person. Food enters the Stomach, and the Five Zang and Six Fu organs all receive its Qi. Therefore, if a person loses Stomach Qi and stops eating, it is called Ni, and those with Ni will die.
In Spring, the pulse with a slight string-like quality (Xian) accompanied by Stomach Qi is called Ping Mai (Normal Pulse). If the string-like quality is excessive and Stomach Qi is deficient, it indicates Liver Disease. If there is only string-like quality without Stomach Qi, it indicates Death. If the pulse has Stomach Qi but also exhibits a floating/hair-like (Mao) quality, illness will occur in Autumn. If the Mao quality is severe, illness occurs immediately. The Zhen Zhen Shen Qi (True Spirit Qi of the Zang) disperses into the Liver, and the Liver stores the Qi of the sinews and fascia.
"Cang" (store) is read according to its original pronunciation; the "Cang" characters for Heart, Spleen, and Kidney follow the same rule. Stomach Qi is the gentle and soft Qi of Central Earth, which is necessary for the Five Zang organs across the four seasons. In Spring, obtaining the Stomach pulse with a slight string-like quality is a Normal Pulse. Excessive string-like quality and deficient Stomach Qi indicate Liver Disease. Only string-like quality without Stomach Qi indicates a Death Pulse. A pulse with Mao quality means it is slightly string-like yet possesses the light and floating Mao pulse. The Mao pulse is the pulse of Autumn appearing in Spring; since Metal occupies a deficient position, illness will occur in Autumn. If the Mao pulse is excessive, Wood suffers Metal's punishment, and illness will occur immediately, not waiting for Autumn. The reason the Liver presents a string-like pulse is that the True Spirit Qi of the Zang disperses into the Liver, and the Liver stores the Qi of the sinews and fascia.
In Summer, the pulse with a slight hook-like (Gou/Hong) quality accompanied by Stomach Qi is called Normal Pulse. If the hook-like quality is excessive and Stomach Qi is deficient, it indicates Heart Disease. If there is only hook-like quality without Stomach Qi, it indicates Death. If the pulse has Stomach Qi but also exhibits a stone-like (Shi/Chen) quality, illness will occur in Winter. If the Shi quality is severe, illness occurs immediately. The Zhen Zhen Shen Qi connects to the Heart, and the Heart stores the Qi of the blood vessels.
In Summer, obtaining the Stomach pulse with a slight hook-like quality is a Normal Pulse. Excessive hook-like quality and deficient Stomach Qi indicate Heart Disease. Only hook-like quality without Stomach Qi indicates a Death Pulse. A pulse with Shi quality means it is slightly hook-like yet possesses the sinking Shi pulse. Obtaining a Winter pulse in Summer indicates Water occupies a deficient position, hence termed Winter Disease. If the Shi quality is excessive, Fire suffers Water's punishment, hence illness occurs immediately. The reason the Heart presents a hook-like pulse is that the True Spirit Qi of the Zang connects to the Heart, and the Heart stores the Qi of the blood vessels.
In Late Summer, the pulse with a slight soft and weak (Ruan Ruo) quality accompanied by Stomach Qi is called Normal Pulse. If the weak quality is excessive and Stomach Qi is deficient, it indicates Spleen Disease. If there is only Dai (extreme weakness/intermittent) quality without Stomach Qi, it indicates Death. If the softness/weakness has a Stone quality, illness will occur in Winter. If the weakness is severe, illness occurs immediately. The Zhen Zhen Shen Qi moistens the Spleen, and the Spleen stores the Qi of the muscles.
In Late Summer, obtaining the Stomach pulse with a slight soft and weak quality is a Normal Pulse. Excessive weakness and deficient Stomach Qi indicate Spleen Disease. Dai represents the extreme of weakness. Extreme weakness without Stomach Qi indicates a Death Pulse. Softness/weakness with Stone quality indicates Water Qi attacking Earth; when Winter arrives and Water Qi is internally deficient, illness occurs, hence termed Winter Disease. Severe weakness indicates the Spleen pulse is greatly deficient, hence illness occurs immediately. The reason the Spleen pulse presents as soft and weak is that the True Spirit Qi of the Zang moistens the Spleen, and the Spleen stores the Qi of the muscles.
In Autumn, the pulse with a slight hair-like (Mao/Floating) quality accompanied by Stomach Qi is called Normal Pulse. If the Mao quality is excessive and Stomach Qi is deficient, it indicates Lung Disease. If there is only Mao quality without Stomach Qi, it indicates Death. If the Mao quality has a String-like (Xian) quality, illness will occur in Spring. If the Xian quality is severe, illness occurs immediately. The Zhen Zhen Shen Qi is superior to the Lungs, facilitating the circulation of Ying (Nutrient) and Wei (Defensive) Qi and Yin-Yang.
In Autumn, obtaining the Stomach pulse with a slight Mao quality is a Normal Pulse. Excessive Mao quality and deficient Stomach Qi indicate Lung Disease. Only Mao quality without Stomach Qi indicates a Death Pulse. Mao quality with String-like quality indicates Wood Qi attacking Metal; when Spring arrives and Wood Qi is internally deficient, illness occurs, hence termed Spring Disease. If the Xian quality is excessive, Wood Qi is deficient and subjected to attack/rebellion, hence illness occurs immediately. The reason the Lungs present a Mao pulse is that the True Spirit Qi of the Zang is superior to the Lungs; the Lungs govern all vessels and circulate Ying, Wei, and Yin-Yang Qi.
In Winter, the pulse with a slight stone-like (Shi/Sinking) quality accompanied by Stomach Qi is called Normal Pulse. If the Shi quality is excessive and Stomach Qi is deficient, it indicates Kidney Disease. If there is only Shi quality without Stomach Qi, it indicates Death. If the Shi quality has a Hook-like (Gou) quality, illness will occur in Summer. If the Gou quality is severe, illness occurs immediately. The Zhen Zhen Shen Qi descends to the Kidneys, and the Kidneys store the Qi of the bone marrow.
In Winter, obtaining the Stomach pulse with a slight Shi quality is a Normal Pulse. Excessive Shi quality and deficient Stomach Qi indicate Kidney Disease. Only Shi quality without Stomach Qi indicates a Death Pulse. Shi quality with Hook-like quality indicates Fire Qi attacking Water; when Summer arrives and Fire Qi is internally deficient, illness occurs, hence termed Summer Disease. If the Gou quality is excessive, it is also due to root Qi deficiency leading to attack/rebellion, hence illness occurs immediately. The reason the Kidneys present a Shi pulse is that the True Spirit Qi of the Zang descends to the Kidneys, and the Kidneys store the Qi of the bone marrow.
Generally, the Liver governs dispersion and drainage, hence termed "San" (Disperse). The Heart governs blood vessels, hence termed "Tong" (Connect/Flow). The Spleen governs irrigation, hence termed "Ru" (Moisten). The Lungs reside in the upper jiao, hence termed "Gao" (High). The Kidneys are Water organs located inferiorly, hence termed "Xia" (Low). In Spring, mentioning Mao in the pulse indicates Metal punishing Wood. In Summer, mentioning Shi indicates Water punishing Fire. In Late Summer and the autumn/winter seasons, mentioning softness/weakness with Stone, Mao with String, or Stone with Hook, all indicate the element that normally conquers me is counter-attacking. Generally, the element that conquers me punishes me due to my root Qi deficiency; the element I normally conquer attacks me also due to my root Qi deficiency. Furthermore, in Spring and Summer, mentioning immediate illness refers to being conquered; in Late Summer, mentioning immediate illness refers to root deficiency; in Autumn and Winter, mentioning immediate illness refers to attack/rebellion. This clarifies that being conquered or attacked/rebelled against is all due to root Qi deficiency. The meanings are interwoven to encourage mutual deduction, so one may understand the cause.
The great collateral of the Stomach is named Xu Li (Empty Well). It penetrates the diaphragm, connects to the Lungs, and emerges below the left breast. Its movement can be seen through the clothing; this is the Zong Qi (Gathering Qi).
The pulses of the Five Zang organs are nourished by the Stomach. The Stomach belongs to Central Earth, and its Qi communicates to all directions. Thus, the great collateral of the Stomach is named Xu Li. Great collateral refers to the collaterals outside the Stomach. Xu Li implies four-way communication. This collateral penetrates the diaphragm centrally, connects to the Lungs superiorly, and emerges horizontally below the left breast. Its movement responds externally to the clothing; this is the Zong Qi of the meridians. From this, we know that the Stomach collateral not only communicates to all directions and penetrates/connects to the diaphragm and Lungs, but also combines with Zong Qi. This describes the normal Qi of the Stomach collateral.
If the movement is vigorous, panting, and frequently interrupted, the disease is in the middle jiao. If the pulse is knotted and horizontal, there is an accumulation (Ji).
Vigorous and frequent panting with impending cessation indicates that Zong Qi cannot ascend out of the Lungs to govern respiration; thus, the disease is in the diaphragm region. With disease in the diaphragm, Zong Qi knots internally and rebels horizontally. Knotting and horizontal rebellion indicate accumulation in the diaphragm. This describes the pathological Qi of the Stomach collateral.
If the pulse ceases completely and does not return, it is called Death. Below the breast, if the movement is vigorous enough to move the clothing, it indicates leakage of Zong Qi.
If Zong Qi escapes and ceases completely, it is called Death. The reason is that Zong Qi emerges below the breast, and its movement responds to the clothing. Now, if it ceases completely, it indicates leakage of Zong Qi. "Xie" (leak) means escape/depletion. This describes the death Qi of the Stomach collateral. This shows that not only do the pulses of the Five Zang organs have normal, pathological, and death states, but the pulse of Zong Qi also has normal, pathological, and death states.
To know whether the Cun Kou (Radial artery at the wrist) pulse is excessive or deficient: If the Cun Kou pulse feels short upon palpation, it indicates Headache. If the Cun Kou pulse feels long upon palpation, it indicates Pain in the lower legs and shins. If the Cun Kou pulse feels rapid/crisp (Cu) and strikes upward, it indicates Shoulder and Back Pain. If the Cun Kou pulse is deep (Chen) and firm, it indicates Disease in the interior (Middle Jiao). If the Cun Kou pulse is superficial (Fu) and vigorous, it indicates Disease in the exterior. If the Cun Kou pulse is deep and weak, it indicates Cold-Heat alternations, as well as Shan Jia (Hernia/Mass) and pain in the lower abdomen. If the Cun Kou pulse is deep and horizontal, it indicates Accumulation under the hypochondrium and horizontal accumulation pain in the abdomen. If the Cun Kou pulse is deep and panting/rushing (Chuan), it indicates Cold-Heat alternations.
"Shang" and "Heng" are both pronounced with the departing tone. The Stomach pulse belongs to Earth and resides at the Guan position, connecting above to Cun and below to Chi, also rooted in Stomach Qi. Thus, the pulses of Cun and Chi are cited to clarify this. To know the excessive and deficient pulse diseases of Cun Kou, one must discern them through short/long, superficial/deep pulses. If the Cun Kou pulse feels short under the fingers, shortness indicates Qi deficiency, failing to reach the upper part, hence headache (deficiency in the upper part). If the Cun Kou pulse feels long under the fingers, length indicates Qi excess, exceeding the lower part, hence pain in the lower legs/shins (excess pathogen in the lower part). If the Cun Kou pulse feels rapid/crisp and strikes upward under the fingers, crispness indicates internal deficiency, failing inward, while striking upward indicates external excess, exceeding outward, hence shoulder and back pain (internal deficiency, external excess). If the Cun Kou pulse is deep and firm, it is excessive inward, hence disease in the interior. If the Cun Kou pulse is superficial and vigorous, it is excessive outward, hence disease in the exterior. If the Cun Kou pulse is deep and weak, it is deficient inward, hence cold-heat, Shan Jia, and lower abdominal pain. If the Cun Kou pulse is deep and horizontal, it is excessive inward, hence accumulation under the hypochondrium and horizontal accumulation pain in the abdomen. If the Cun Kou pulse is deep and rushing, it is either excessive or deficient, hence merely cold-heat (which has excess and deficiency aspects). "Heng" means horizontal rebellion. "Chuan" means rushing/panting. Heng and Chuan describe the pulse image, not the disease itself.
A pulse that is vigorous, slippery, and firm indicates Disease in the exterior. A pulse that is small, solid, and firm indicates Disease in the interior. A pulse that is small, weak, and choppy indicates Chronic Disease. A pulse that is slippery, superficial, and rapid indicates New Disease. A tense pulse indicates Shan Jia and lower abdominal pain. A slippery pulse indicates Wind Disease. A choppy pulse indicates Bi Syndrome. A slow and slippery pulse indicates Heat in the Middle. A vigorous and tight pulse indicates Distension.
This reiterates the pulse diseases of excess and deficiency to complete the meaning of the previous text. A vigorous, slippery, and firm pulse indicates Yang Qi excess, hence disease in the exterior. A small, solid, and firm pulse indicates Yin Qi excess, hence disease in the interior. A small, weak, and choppy pulse indicates Qi and Blood deficiency, hence chronic disease. A slippery, superficial, and rapid pulse indicates Qi and Blood excess, hence new disease. Shan Jia and lower abdominal pain can be either deficient or excess. The earlier mention of deep and weak Cun Kou pulse causing Shan Jia/lower abdominal pain was due to righteous Qi deficiency. Here, a tense pulse causing Shan Jia/lower abdominal pain is due to pathogenic excess. A slippery pulse indicates Wind because Wind is a Yang pathogen that moves quickly and changes often, hence the pulse is slippery. A choppy pulse indicates Bi because Bi involves blockage and rejection, with coagulated Qi and Blood, hence the pulse is choppy. A slow and slippery pulse indicates internal deficiency of Earth Qi and excessive Yang Heat, hence Heat in the Middle. A vigorous and tight pulse indicates excess Earth Qi and internal pathogenic solidity, hence distension. This discusses knowing excess/deficiency diseases through excess/deficiency pulses. This applies not only to Cun Kou, thereby completing the previous text's meaning.
If the pulse follows Yin-Yang principles, the disease is easy to cure. If the pulse opposes Yin-Yang principles, the disease is difficult to cure. If the pulse conforms to the順 (Shun/Smoothness) of the four seasons, it is said the disease has no other complications. If the pulse reverses the four seasons, or if the transmission skips the intervening Zang (Jian Zang), it is said to be difficult to cure.
"Yi" and "Jian" are both pronounced with the departing tone. Regarding excessive/deficient pulses with excess/deficiency diseases, it is crucial that Yin and Yang correspond. Thus, if the pulse follows Yin-Yang, the disease is easily cured; if it opposes, it is difficult. "Following Yin-Yang" means the pulse conforms to the four seasons. Smoothness refers to Spring String, Summer Hook, Autumn Hair, Winter Stone. Conforming to smoothness means even if diseased, there are no other complications (no other transformations). "Opposing Yin-Yang" means the pulse reverses the four seasons. Reversal refers to Stomach pulse with Mao, Stomach pulse with Shi, Mao pulse with Xian, Shi pulse with Gou. Jian Zang (intervening Zang) means external evil initially damages the skin and hair, and the Lungs are affected first. If the Lungs transmit to the Liver, the Kidney intervenes; if the Kidneys transmit to the Heart, the Liver intervenes; if the Liver transmits to the Spleen, the Heart intervenes; if the Heart transmits to the Lungs, the Spleen intervenes; if the Spleen transmits to the Kidneys, the Lungs intervene. This is mother-son generation, where Zang organs do not suffer punishment. Now, if there is no intervening Zang, the Zang suffers punishment directly, hence the disease is difficult to cure.
Prominent blue veins on the arms indicate Blood Loss. A slow and choppy Chi pulse indicates Lassitude and desire to lie down. A vigorous pulse indicates Blood Loss. A coarse Chi skin with a slippery pulse indicates Profuse Sweating. A cold Chi skin with a fine pulse indicates Delayed Diarrhea (Hou Xie). A coarse pulse at the Chi position with constant heat indicates Heat in the Middle.
"Jie" is the same as "Xie" (Lassitude). " " (Yi) is pronounced "Yi". In other chapters, "Jie" and " " are the same. The previous section diagnosed disease location via Cun Kou; this section diagnoses via Chi pulse. From here to "Women Pregnant," the meaning is roughly similar to "Ling Shu: Lun Ji Zhen Chi." Prominent blue veins on the arms, from Chi pulse up to the arm, show many blue colors in the arm's collateral vessels. The Liver color is blue, and the Liver stores Blood. Prominent blue veins indicate Liver Blood cannot warm the flesh, fill the skin, or permeate the pores, hence Blood Loss. If the Chi pulse is slow and choppy, it indicates internal deficiency of Qi and Blood, hence lassitude and desire to lie down. Lassitude means slackness; An Wo means嗜卧 (desire to sleep). Not only prominent blue veins indicate Blood Loss; if the Chi pulse is strong, indicating disharmony of Yin Qi, it is also called Blood Loss. Chi Se refers to coarse Chi skin. Mai Hua refers to slippery Chi pulse. Coarse skin and slippery pulse indicate Qi mechanism moving from Yin to Yang, hence profuse sweating. Chi Han refers to cold Chi skin. Mai Xi refers to fine Chi pulse. Cold skin and fine pulse indicate Sheng Yang Qi cannot reach the exterior, hence delayed diarrhea. "Cu" (coarse) means large. Chi Cu means large Chi pulse. Chang Re means constantly hot Chi skin. Large pulse and hot skin indicate excess Yang Qi, hence Heat in the Middle. This diagnoses disease location via Chi pulse and Chi skin.
Movement in the neck pulse with panting and rapid cough indicates Water Disease. Slight swelling inside the eyes, resembling a silkworm lying down, indicates Water Disease. Yellow-red urine with lassitude indicates Jaundice. Feeling hungry after eating indicates Stomach Jaundice. Facial swelling indicates Wind Disease. Swelling of the lower legs and shins indicates Water Disease. Yellow eyes indicate Jaundice.
"Niao" (urine) is pronounced "Niao," departing tone. There are cases where one knows the disease location without diagnosing the Chi pulse, simply by discussing symptoms. Neck pulse movement with panting and rapid cough indicates internal movement of Water Qi, hence Water Disease. Slight eye swelling like a silkworm indicates external manifestation of Water Qi, hence Water Disease. Yellow-red urine with lassitude indicates Damp-Heat in the Middle, resulting in Jaundice. Feeling hungry after eating indicates Pathogenic Heat in the Middle, resulting in Stomach Jaundice. Discussing facial swelling indicates Wind moving upward, hence Wind Disease. Discussing leg swelling indicates Water moving downward, hence Water Disease. Regarding Jaundice, besides yellow-red urine and lassitude, one must have yellow eyes to be termed Jaundice. The previous text did not mention yellow eyes, so it is repeated to clarify. This discusses knowing disease location via symptoms.
If the Shao Yin pulse (on the hand) is vigorous, it indicates Pregnancy.
Shao Yin refers to the Chi pulse. The method of diagnosing the Chi pulse can reveal disease location and also determine if a woman is pregnant. Vigorous Shao Yin pulses in both hands of a woman indicate surplus Kidney Qi, sensing the Qi generated by Tian Yi (Heaven One), hence pregnancy.
Pulses have reversal and conformity. The four seasons lack the corresponding Zang shape. In Spring and Summer, the pulse is thin/small; in Autumn and Winter, the pulse is floating and large. This is called Reversing the Four Seasons.
"Pulse reversal and conformity" refers to the previously mentioned pulse following/opposing Yin-Yang. "Four seasons lack Zang shape" means in Spring and Summer the pulse lacks String/Hook qualities, and in Autumn/Winter it lacks Hair/Stone qualities. Spring generates and Summer grows, with Qi flourishing outward, yet the pulse is thin; Autumn harvests and Winter stores, with Qi converging inward, yet the pulse is floating and large. This does not accord with the season, hence called Reversing the Four Seasons.
Wind-Heat with a quiet pulse, Diarrhea/Blood Loss with a solid pulse, Interior Disease with a deficient pulse, Exterior Disease with a coarse and firm pulse—these are all difficult to treat. This is called Reversing the Four Seasons.
Disease pulses require correspondence between Yin/Yang and Interior/Exterior. For Wind-Heat, Yang Qi is abundant; the pulse should be洪大 (Hong Da/Vigorous and Large), but is quiet. For Diarrhea/Blood Loss, Yin Qi is deficient; the pulse should be internally deficient, but is solid. For Interior Disease, pathogen is solid inside; the pulse should be deep and solid, but is deficient. For Exterior Disease, pathogen is abundant outside; the pulse should be superficial and large, but is coarse and firm. These pulses do not match the disease, and the disease does not match the pulse; all are difficult to treat. Also called Reversing the Four Seasons.
Humans rely on water and grain as their foundation; thus, if humans cut off water and grain, they die. If the pulse lacks Stomach Qi, it also dies.所谓 "No Stomach Qi" means obtaining only the True Zang Pulse without Stomach Qi.所谓 "Pulse lacking Stomach Qi" means the Liver pulse is not String-like, and the Kidney pulse is not Stone-like.
Humans depend on water and grain for life; thus, humans take water and grain as their foundation. Without water and grain, humans cannot live; thus, cutting off water and grain leads to death. Cutting off water and grain leads to death, and pulse lacking Stomach Qi also leads to death. "No Stomach Qi" means obtaining only the True Zang Pulse, lacking the gentle Stomach Qi. "Pulse lacking Stomach Qi" means in Spring the Liver pulse is not slightly String-like, and in Winter the Kidney pulse is not slightly Stone-like. This pulse originates from the Stomach, and the Stomach originates from water and grain.
The Tai Yang pulse arrives: Vigorous, Large, and Long. The Shao Yang pulse arrives: Intermittently rapid and slow, intermittently short and long. The Yang Ming pulse arrives: Superficial, Large, and Short.
This lists the pulse images of the Three Yang meridians to clarify how Stomach Qi combines with the Six Fu organs of the Three Yang. The following discussion of normal, pathological, and death pulses clarifies how Stomach Qi combines with the Five Zang organs of the Three Yin. Tai Yang is Ju Yang (Great Yang). Tai Yang pulse arriving is Vigorous, Large, and Long; this is an image of excess Yang Qi governing opening. Shao Yang is Chu Yang (Initial Yang). Shao Yang pulse arriving is intermittent rapid/slow, short/long; this is an image of initial Yang gradually generating, governing pivoting. Yang Ming is Er Yang (Second Yang). Yang Ming pulse arriving is Superficial, Large, and Short; Superficial and Large are Yang; Superficial, Large, and Short is the image of Yang Ming governing closing. The Three Yang govern the Six Fu organs; Stomach Qi combines with the Six Fu organs, hence the Three Yang pulses are cited to clarify this.
The normal Heart pulse comes: Cumulative like connected pearls, like smoothing Lang Gan jade, called Heart Ping (Normal). In Summer, Stomach Qi is the foundation. The pathological Heart pulse comes: Panting and continuous, slightly curved within, called Heart Bing (Disease). The death Heart pulse comes: Curved at the front and fixed at the back, like handling a belt hook, called Heart Si (Death).
The Five Zang organs have normal, pathological, and death pulses, all rooted in Stomach Qi. The normal Heart pulse comes: Cumulatively like connected pearls, smooth, and like smoothing Lang Gan jade, peaceful. If the Heart pulse is like this, Heart Qi is unobstructed, called Heart Ping. The Heart governs Summer Fire, hence Summer takes Stomach Qi as the foundation. If it is the pathological Heart pulse, coming panting and continuous, slightly curved within, it is called Heart Disease. The death Heart pulse comes: Curved at the front and fixed at the back, like handling a belt hook, called Heart Death.