心主神明多不受邪，故肾传之心，心即复反传而行之肺，肺病故发寒热。病从内发，故法当三岁死，
三岁死者，此病传所胜之次也。肾因传心，水胜火也，心复传肺，火胜金也，一岁则金胜木，二岁则木胜
土，三岁则土胜水，传五脏而当死。上文五脏相通，移皆有次者，相生之次也，此病之次，乃相胜之次也。
然其卒发者，不必治其传，或其传化有不以次，不以次入者，忧恐悲喜怒，令不得以其次，故令人
有大病矣。因而喜大，虚则肾气乘矣，怒则肝气乘矣，悲则肺气乘矣，恐则脾气乘矣，忧则心气
乘矣，此其道也。故病有五，五五二十五变，及其传化。传，乘之名也。
卒，音促。下同。肺病发寒热，然其寒热卒发者，乃外邪暴至，不必治其传，言不必以心脏传肺之法，
而治之也。上文肾因传心，心复传肺，此病之次也。或其传化有不以次，所以不必次入者，乃忧恐悲喜怒，
五志内伤，令不得以其次，故令人有大病矣。或因而喜大，心气内虚，则肾气乘心矣。或因而怒大，肝气内逆，
则肝气乘脾矣。或因而悲大，肺气内郁，则肺气乘肝矣。或因而恐大，肾气内虚，则脾气乘肾矣。或因而
忧大，肺气内虚，则心气乘肺矣。此五志内动，传化之道也。五志层五脏，故病有五，一脏有
五脏之传，故五五二十五变，及其传化，所谓传者，即肾气乘，肝气乘，肺气乘，脾气乘，心气乘，故曰传，
乘之名也。不言脾情也，脾土寄王于四脏也，悲言肺情者，言不但肝怒有余，本气乘于
他脏，即肺悲不足，本气亦乘于他脏也。
大骨枯槁，大肉陷下，胸中气满，喘息不变，其气动形，期六月死，真脏脉见，乃予之期日。
便，平声。见，音现。予，与同。下俱仿此。大骨大肉，两臂两股之骨肉也。大骨枯槁，肾病也。
大肉陷下，脾病也。胸中气满，喘息不便，肺病也。便，犹利也。下文重言，义俱仿此。其气
动形，言喘息不便，则气之出入不利，身形为之振动也。期六月死者，能冬不能夏，能夏不能冬，半岁
而死也。真脏脉见者，即下文真脏至，如循刀刃责责然等是也。乃予之期日者，即《平人气象论》，
肝见庚辛死等是也。五脏真气，转而不回，真脏脉见，则回而不转，故死也。
大骨枯槁，大肉陷下，胸中气满，喘息不便，内痛引肩项，期一月死。真脏见，乃予之期日。
承上文肾病脾病肺病，而言内痛引于肩之项，则循经而病于风府，故期一月死。盖卫气之行，循
于经脉，一日一夜，大会于风府，日下一节，二十一日，至于伏衡，三十日出于缺盆，不能复会
于风府，则死，若真脏脉见，乃予之期日。
大骨枯槁，大肉陷下，胸中气满，喘息不便，内痛引肩项，身热，脱肉破 ，真脏见，十月之内，死。
肌腠曰肉，脂膏曰 。承上文肾病脾病肺病风府病言兼身热，脱肉破 ，则阴血虚而中土败，若真脏
脉见，则十日之内死，土之生数五，成数十，十日之内，不逾土数也。
大骨枯槁，大肉陷下，肩髓内消，动作益衰，真脏未见，期一岁死，见其真脏，乃予之期日。
未旧本误来今改。肩髓内消，动作益衰，言始则痛引肩项，今则肩髓内消，始则脱肉破 ，动作已衰，
今则动作益衰，承上文而更进也。真脏未见，期一岁周环则死，若见其真脏，乃予之期日。
大骨枯槁，大肉陷下，胸中气满，腹内痛，心中不便，肩项身热，破 脱肉，目眶陷，真脏见，
目不见人，立死，其见人者，至
其所不胜之时，则死。
见人之见，如字。肾病骨枯，脾病肉陷，肺病气满，肝木乘脾，则腹内痛，神气内虚，则心中不便。
此承上文之意，而言五脏皆病也。肩项，所痛引肩项也；肩项身热，破 脱肉，亦承上文而言
也。目眶陷，则阳明胃气并绝，若真脏脉见，目不见人，神气先亡，故立死。其见人者，神气未亡，至
其所不胜之时，则死。时，一日十二时也。
急虚、身中、卒至，五脏绝闭，脉道不通，气不往来，譬于堕溺，不可为期，其脉绝不来，若人
一息五六至，其形肉不脱，真脏虽不见，犹死也。
中，去声。承上文之意，而言人有急病，刻时射死，难以脉诊，不可与之期日也。急虚，正气一时暴
虚也。身中，外邪陡中于身也。卒至，客邪卒至于脏也。此病脏真之神机，不病经脉之有
形，故五脏之气，一时绝闭，周身脉道，一时不通。气机环转，一时不相往来，库卒之病，死于倾刻，譬于
堕溺，不可为期。急虚之病，其脉内脱，则绝不来，其脉外脱，则平人一息，脉五六至，其
形肉虽不脱，其真脏虽不见，而犹之死也。此举一时暴死，不可为期，不必真脏脉见，所以补上文未尽之义。
真肝脉至，中外急，如循刀刃，责责然，如按琴瑟弦，色青白不泽，毛折乃死。真心脉至，坚而搏，
如循薏苡子，累累然，色赤黑不泽，毛折乃死。真肺脉至，大而虚，如以毛羽中人肤，色白赤
不泽，毛折乃死。真肾脉至，搏而绝，如指弹石，辟辟然，色黑黄不泽，毛折乃死。真脾脉至，弱
而乍数乍疏，色黄青不泽，毛折乃死。诸真脏脉见者，皆死不治也。
折，音舌。中人之中，去声。弹，平声。数，音朔。所谓真脏脉见者，如真肝脏之脉至，则中外劲急，其劲
急也，如循刀刃，责责然，责责，不流通也。如按琴瑟弦，按之一线，不柔和也。有绝脉必有绝色，故色青白
不泽，青者肝之色，白者金刑木也。夫脉自内以达外，故真脏脉见，必皆毛折乃死，所以然者，本末皆尽也。
如真心脏之脉至，则坚而搏，坚者牢实，搏者搏击，复如循薏苡子，累累然者，坚急而无根也。色赤黑不泽，
水刑火也，亦必毛折乃死。如真肺脏之脉至，则大而虚，谓无本也，如以毛羽中人肤，谓无末也，色白赤不
泽，火刑金也，亦必毛折乃死。若真肾脏之脉至，则搏而绝，搏者，转索之状，搏而绝者，转索而若断也。
如指弹石，辟辟然者，硬而呆实，无胃气也，色黑黄不泽，土刑水也，亦必毛折乃死。如真脾脏之脉至，脏
气虚，故脉弱，不能达于四脏，故乍数乍疏，色青黄不泽，木刑土也。亦必毛折乃死。此明真
脏之脉象，必本末皆尽而后死，亦补上文未尽之义。
黄帝曰，见真脏曰死，何也？
真脏之脉，藏而不见，见则必死，帝既反复详明，更欲推其所以死之故，故探诸岐伯以发明之。
岐伯曰∶五脏者，皆禀气于胃，胃者五脏之本也。脏气者，不能自致于手太阴，必因于胃气，乃
至于手太阴也。故五脏各以其时，自为而至于手太阴也。故邪气胜者，精气衰也。故病甚者，胃
气不能与之俱至于手太阴。故真脏之气独见，独见者，病胜脏也，故曰死。帝曰∶善。
真脏者，脉无胃气也。夫五脏者，皆禀气于胃，是胃者，乃五脏之本也。肺朝百脉，手太阴主之，然
脏气者，不能自致于手太阴，必因于胃气，乃至于手太阴也。故肝心脾肺肾五脏，各以其时，自为弦钩毛
石之脉，而至于手太阴也。故邪气胜者，由于五脏之精气衰也。故病甚者，胃气不能与之俱至于手太阴，
脉无胃气，故真脏之气，独见于脉。独见者，病气胜于脏也。病气胜脏，故曰
死。此亦回则不转，乃失其机之义，故帝曰善。此一节，帝承玉机之义，而申明真脏也。
黄帝曰∶凡治病，察其形气色泽，脉之盛衰，病之新故，乃治之，无复其时。
帝既明玉机真脏之义，而形气色脉，皆有神机，故复言之，凡治病者，必察其形之与气，及色之
润泽，脉之盛衰，与病之新故，
乃立法以治之，更须无后其时。
形气相得，谓之可治。色泽以浮，谓之易已。脉从四时，谓之
可治。肺弱以滑，是有谓气，命曰易治，取之以时。
易，去声。试以形气色脉之顺者言之。形气和谐而相得，病可治也。面色润泽外浮，病易已也。春
弦夏钩，秋浮冬营，脉从四时，病可治也。脉弱以滑，是有胃气，病易治也。形气色脉皆顺，
虽久病亦为可治。治之无后其时，故曰取之以时。
形气相失，谓之难治，色夭不清，谓之难已。脉实以坚，谓之益甚，脉逆四时，为不可治，必
察四难而明告之。
四难，形气色脉也。试以形气色脉之逆者言之，形弱气强，形强气弱，是相失也，病必难治。面色
火折，无有润泽，病必难已。脉实以坚，是无胃气，病必益甚。脉逆四时，脏气受刑，病不可
治。形气色脉皆逆，虽新病亦不可治。告之无后其时，故必察四难而明告之。无容缓也。
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，于春夏而脉沉涩，秋冬而脉浮大，名曰逆四时也。
申明上文所谓脉逆四时者，春得肺脉，金刑木也。夏得肾脉，水刑火也。秋得心脉，火刑金也。冬
得脾脉，土刑水也。其脉之至，皆悬绝无根，或沉涩不起者，是无胃气，命曰逆四时也。未有
脏形者，至春夏而脉未弦钩，至秋冬而脉未浮营也。春生夏长，于春夏而脉沉涩。秋收冬藏，于秋冬而
脉浮大，亦名曰逆四时也。
病热脉静，泄而脉大，脱血而脉实，病在中；脉坚实，病在外；脉不坚实者，皆难治。
脉病相反，亦谓之逆。病热则气血不和，今病热而脉静，下泄则土气内虚，今泄而脉大；脱血，则阴
津下泄，今脱血而脉实，病在中，则正气虚，今病在中，脉实坚，病在外，则邪气实。今病在
外，脉不实坚，此脉病相反，即逆四时，故皆难治。
黄帝曰∶余闻虚实，以决死生，愿闻其情。
帝既明形气色脉之要，而形气色脉，有虚有实，有死有生，故探诸岐伯以明之。
岐伯曰∶五实死，五虚死。
五实，五脏之邪气实也。五虚，五脏之正气虚也。病干脏气，虚实皆能死也。
帝曰∶息闻五实五虚。岐伯曰∶脉盛皮热，腹胀，腹胀，前后不通，闷瞀，此谓五实。脉细，皮
寒，气少，泄利前后，饮食不入，此谓五虚。
督，音茂，余篇同。脉者，心之主也。心受邪，故脉盛。皮者，肺之主也，肺受邪，故皮热，腹者
脾之主也，脾受邪，故腹胀。肾开窍于前后二阴，肾受邪，故前后不通。肝开窍于目，肝受邪，故闷
瞀。闷，郁也。瞀，目不明也。此谓五实。心气虚，则脉细。肺气虚，则皮寒。肝气虚，则气少。肾气虚，
则泄利前后。脾气虚，则饮食不入，此谓五虚。
帝曰∶其时有生者，何也？岐伯曰∶浆粥入胃，泄注止，则虚者活。身汗得后利，则实者活，此其候也。
五脏之气，生于胃土，主于三焦，胃土调和，则浆粥入胃，泄注止，如是则虚者活。三焦通
畅于外，则身汗，通畅于内，则得后利，如是则实者活。此其虚实死生之候也。
此一节，论形气色脉，虚实死生，以终玉机真脏之义。
心脏主宰神明，大多不易受邪气侵袭。因此，当病气从肾传至心时，心又会将其反向传行至肺，导致肺部发病，从而出现寒热症状。疾病由内而发，所以按照规律应当在三年内死亡。所谓三年后死亡，是因为这是疾病按照“相克”顺序传变的次序：肾传心，是水克火；心再传肺，是火克金；第一年金克木，第二年木克土，第三年土克水，传遍五脏则致死。上文所说的“五脏相通，移皆有次”，指的是相生（滋养）的次序；而这里的疾病传变次序，则是相克（制约）的次序。
然而，如果是突然发作的疾病，不必拘泥于治疗其传变规律；或者疾病的传变没有按照固定次序进行，这是因为忧、恐、悲、喜、怒等情志因素，使得病情不能按部就班地发展，从而导致严重的疾病。如果因为大喜而导致心气内虚，肾气就会乘虚侵犯心脏；大怒导致肝气上逆，肝气就会乘虚侵犯脾脏；大悲导致肺气郁结，肺气就会乘虚侵犯肝脏；大恐导致脾气虚弱，脾气就会乘虚侵犯肾脏；大忧导致心气不足，心气就会乘虚侵犯肺脏。这就是其中的道理。所以疾病有五种，每脏又有五脏的传变，共二十五种变化，涉及疾病的传变过程。“传”，就是“乘”的意思。
“卒”，读音同“促”。下文相同。肺病表现为寒热，但如果这种寒热是突然发作的，那是外邪猛烈袭击所致，不必拘泥于治疗其传变规律，意思是说不必用治疗心脏传肺的方法来治疗它。上文说肾传心、心传肺，这是疾病的正常次序。或者其传变不按次序，之所以不按次序传入，是因为忧、恐、悲、喜、怒这五志内伤，使得病情不能按部就班，从而导致严重疾病。或者因为大喜，心气内虚，肾气就乘袭心脏；或者因为大怒，肝气内逆，肝气就乘袭脾脏；或者因为大悲，肺气内郁，肺气就乘袭肝脏；或者因为大恐，肾气内虚，脾气就乘袭肾脏；或者因为大忧，肺气内虚，心气就乘袭肺脏。这是五志内动引起的传变规律。五志对应五脏，所以病有五种，一脏有五脏的传变，所以五五二十五种变化，涉及其传变过程。所谓“传”，即肾气乘、肝气乘、肺气乘、脾气乘、心气乘，所以说“传”是“乘”的名称。文中没有单独论述脾的情志，因为脾土寄旺于其他四脏之中。提到悲伤是肺的情志，意在说明不仅肝怒有余会导致本气乘袭他脏，即使肺悲不足，本气也会乘袭他脏。
如果大骨枯槁，大肉陷下，胸中气满，喘息不利，气息震动身形，预期六个月后死亡。如果出现真脏脉，就可以给出具体死亡日期。
“便”，读平声。“见”，音同“现”。“予”，通“与”。下文都仿照此例。大骨大肉，指两臂和两腿的骨肉。大骨枯槁，是肾病；大肉陷下，是脾病；胸中气满，喘息不利，是肺病。“便”，意为通畅。下文重复的话，意思都仿照此例。其气震动身形，是说喘息不利，导致气的出入不畅，身形随之振动。预期六个月死亡，是指能过冬不能过夏，或能过夏不能过冬，半年而死。真脏脉出现，即下文所说的真脏脉至，如触摸刀刃般锐利坚硬等情形。于是给予死亡日期，即《平人气象论》中所说的肝见庚辛日死等情形。五脏真气，流转而不回转，一旦真脏脉出现，就回转而不再流转，所以死亡。
如果大骨枯槁，大肉陷下，胸中气满，喘息不利，内部疼痛牵引肩颈，预期一个月后死亡。如果出现真脏脉，就可以给出具体死亡日期。
承接上文肾病、脾病、肺病，如果说内部疼痛牵引肩颈，那就是沿着经脉病及风府穴，所以预期一个月后死亡。大概卫气的运行，循行于经脉，一天一夜，在风府穴大会一次，每天下降一节，二十一天到达伏兔穴，三十天出于缺盆穴，如果不能再次在风府穴大会，就会死亡。如果真脏脉出现，就给予死亡日期。
如果大骨枯槁，大肉陷下，胸中气满，喘息不利，内部疼痛牵引肩颈，身体发热，肌肉消瘦脱失，皮肤破裂，真脏脉出现，预期十个月内死亡。
肌理腠理称为“肉”，脂膏称为“䐃”。承接上文肾病、脾病、肺病、风府病而言，兼有身体发热，肌肉消瘦脱失，皮肤破裂，说明阴血虚衰且中焦脾胃败坏。如果真脏脉出现，则十日内死亡。土的生成数是五，成数是十，十日内死亡，不超过土的成数。
如果大骨枯槁，大肉陷下，肩髓内部消减，动作日益衰弱，真脏脉尚未出现，预期一年后死亡；如果出现真脏脉，就给予死亡日期。
“未”字旧本误作“来”，今改正。肩髓内部消减，动作日益衰弱，是说起初只是疼痛牵引肩颈，现在则肩髓内部消减；起初肌肉消瘦脱失，动作已经衰弱，现在动作更加衰弱，这是承接上文更进一步的情况。真脏脉尚未出现，预期一年周期届满则死；如果看到真脏脉，就给予死亡日期。
如果大骨枯槁，大肉陷下，胸中气满，腹内疼痛，心中不适，肩颈身体发热，肌肉消瘦脱失，眼眶凹陷，真脏脉出现，眼睛看不见人，立即死亡；如果还能看见人，到了其所不胜的时辰，就会死亡。
“见”字的读音，如同字面。肾病导致骨骼枯槁，脾病导致肌肉陷下，肺病导致气满，肝木乘袭脾土，导致腹内疼痛，神气内虚，导致心中不适。这是承接上文之意，说明五脏都已患病。肩颈，指疼痛牵引肩颈；肩颈身体发热，肌肉消瘦脱失，也是承接上文而言。眼眶凹陷，说明阳明胃气并绝。如果真脏脉出现，眼睛看不见人，神气先亡，所以立即死亡。如果还能看见人，神气未亡，到了其所不胜的时辰，就会死亡。时辰，指一天十二个时辰。
急虚、身中、卒至，五脏闭绝，脉道不通，气机不往来，如同坠落溺水，无法预测死亡时间。如果脉搏断绝不来，或者人一息脉搏跳动五六次，虽然形体肌肉没有脱失，真脏脉也没有出现，仍然会死亡。
“中”，去声。承接上文之意，是说人有急病，短时间内射杀致死，难以通过脉诊预测，不能给予死亡日期。急虚，是正气一时暴虚；身中，是外邪陡然中伤身体；卒至，是客邪突然到达脏腑。这些疾病关乎脏腑真元的神机，而不在于经脉的有形病变，所以五脏之气一时闭绝，周身脉道一时不通。气机环转，一时不相往来，仓猝之病，死于顷刻，如同坠落溺水，无法预测时间。急虚之病，如果脉气内脱，则断绝不来；如果脉气外脱，则平人一息脉搏跳动五六次。虽然形体肌肉没有脱失，真脏脉没有出现，但仍然会死亡。这是列举一时暴死、无法预测时间的情况，不一定非要真脏脉出现，以此补充上文未尽的含义。
真肝脉到来时，脉象中外紧急，如同触摸刀刃，责责然作响，如同按压琴瑟弦，面色青白无光泽，毫毛折断则死。真心脉到来时，脉象坚硬而搏击有力，如同触摸薏苡子，累累然，面色赤黑无光泽，毫毛折断则死。真肺脉到来时，脉象大而空虚，如同羽毛中人肌肤，面色白赤无光泽，毫毛折断则死。真肾脉到来时，脉象搏动而断绝，如同手指弹石，辟辟然，面色黑黄无光泽，毫毛折断则死。真脾脉到来时，脉象微弱且忽快忽慢，面色黄青无光泽，毫毛折断则死。所有真脏脉出现的，都是死症，不可治愈。
“折”，音同“舌”。“中人”的中，去声。“弹”，平声。“数”，音同“朔”。所谓真脏脉出现，如真肝脏脉到来，则中外劲急，这种劲急，如同触摸刀刃，责责然，表示气血不流通。如同按压琴瑟弦，按之只有一线之感，不柔和。有绝脉必有绝色，所以面色青白无光泽，青色是肝的颜色，白色是金克木的表现。脉气自内达外，所以真脏脉出现，必定伴随毫毛折断才死，原因在于根本和末梢都竭尽了。如真心脏脉到来，则坚硬而搏击，坚者牢实，搏者搏击，又如同触摸薏苡子，累累然，表示坚急而无根。面色赤黑无光泽，是水克火的表现，也必定毫毛折断才死。如真肺脏脉到来，则大而空虚，谓之本无，如同羽毛中人肌肤，谓之末无，面色白赤无光泽，是火克金的表现，也必定毫毛折断才死。若真肾脏脉到来，则搏动而断绝，搏者，如转索之状，搏而绝者，如转索而若断。如同手指弹石，辟辟然，表示硬而呆实，无胃气，面色黑黄无光泽，是土克水的表现，也必定毫毛折断才死。如真脾脏脉到来，脏气虚，所以脉弱，不能通达四脏，所以忽快忽慢，面色黄青无光泽，是木克土的表现。也必定毫毛折断才死。这里阐明真脏的脉象，必须根本和末梢都竭尽而后死，这也补充了上文未尽的含义。
真脏脉藏而不露，一旦显露则必死。黄帝既然反复详明，更想推究其必死的缘故，所以询问岐伯以阐明之。
岐伯说：五脏都禀受胃气，胃是五脏的根本。脏气不能自己到达手太阴肺经，必须依赖胃气，才能到达手太阴。所以五脏各自在其对应的时令，自行显现脉象并到达手太阴。所以邪气胜则精气衰。所以病重时，胃气不能随脏气一起到达手太阴。所以真脏之气单独显现，单独显现，是病气胜过脏气，所以说死。黄帝说：好。
真脏脉，就是脉中没有胃气。五脏都禀受胃气，所以胃是五脏的根本。肺朝百脉，由手太阴主司，但脏气不能自己到达手太阴，必须依赖胃气，才能到达手太阴。所以肝、心、脾、肺、肾五脏，各自在其时令，自行呈现弦、钩、毛、石之脉，并到达手太阴。所以邪气胜，是由于五脏精气衰。所以病重时，胃气不能随脏气一起到达手太阴，脉中没有胃气，所以真脏之气单独在脉中显现。单独显现，是病气胜于脏气。病气胜脏，所以说死。这也是“回则不转，乃失其机”的道理，所以黄帝说：好。这一节，黄帝承接玉机的意义，而申述真脏脉的道理。
黄帝说：凡是治病，观察病人的形体、气色、色泽，脉象的盛衰，疾病的久新，然后进行治疗，不要错过时机。
黄帝既已阐明玉机真脏的意义，而形、气、色、脉都有神机，所以再次强调，凡治病的人，必须观察其形体与气，以及色的润泽，脉的盛衰，与病的久新，然后立法治疗，还必须不要错过时机。
形与气相得，叫做可治。色泽浮润，叫做易愈。脉象顺应四时，叫做可治。脉弱而滑，是有胃气，名叫易治，要把握治疗时机。
“易”，去声。试以形、气、色、脉顺的情况来说。形与气和谐而相得，病可治。面色润泽外浮，病易愈。春弦、夏钩、秋浮、冬营，脉象顺应四时，病可治。脉弱而滑，是有胃气，病易治。形、气、色、脉皆顺，即使是久病也可治。治疗不落后于时机，所以说把握治疗时机。
形与气相失，叫做难治，面色枯槁不清，叫做难愈。脉实而坚，叫做病益重，脉象违背四时，叫做不可治，必须察辨这四种困难并明确告知病人。
四难，指形、气、色、脉。试以形、气、色、脉逆的情况来说，形弱气强，形强气弱，是相失，病必难治。面色枯槁，无有润泽，病必难愈。脉实而坚，是无胃气，病必加重。脉违背四时，脏气受刑，病不可治。形、气、色、脉皆逆，即使是新病也不可治。告知不落后于时机，所以必须察辨四难并明确告知。不容迟缓。
所谓违背四时，是春季得肺脉，夏季得肾脉，秋季得心脉，冬季得脾脉，其脉象皆悬绝无根或沉涩，名叫违背四时。没有脏气应时的脉形，在春夏季节脉象沉涩，秋冬季节脉象浮大，名叫违背四时。
申述上文所谓脉违背四时，春季得肺脉，是金克木。夏季得肾脉，是水克火。秋季得心脉，是火克金。冬季得脾脉，是土克水。其脉到来，皆悬绝无根，或沉涩不起，是无胃气，名叫违背四时。没有脏气应时的脉形，到春夏季节脉未呈弦钩，到秋冬季节脉未呈浮营。春生夏长，在春夏季节脉象沉涩；秋收冬藏，在秋冬季节脉象浮大，也叫违背四时。
患热病而脉象静，腹泻而脉象大，失血而脉象实，病在内而脉象坚实，病在外而脉象不实坚，都属于难治。
脉与病相反，也叫逆。患热病则气血不和，如今患热病而脉静；腹泻则土气内虚，如今腹泻而脉大；失血则阴津下泄，如今失血而脉实；病在内，则正气虚，如今病在内而脉实坚；病在外，则邪气实，如今病在外而脉不实坚。这些脉与病相反，即违背四时，所以都难治。
黄帝既已明白形、气、色、脉的要领，而形、气、色、脉有虚有实，有死有生，所以询问岐伯以阐明之。
五实，是五脏的邪气实。五虚，是五脏的正气虚。病干犯脏气，虚实都能致死。
黄帝说：请听五实五虚的具体情况。岐伯说：脉象盛大，皮肤发热，腹部胀满，前后二便不通，胸闷目眩，这叫五实。脉象细弱，皮肤寒冷，气短，大小便泄利不止，饮食不入，这叫五虚。
“瞀”，音茂，余篇同。脉，是心的主司。心受邪，所以脉盛。皮，是肺的主司，肺受邪，所以皮热。腹，是脾的主司，脾受邪，所以腹胀。肾开窍于前后二阴，肾受邪，所以前后不通。肝开窍于目，肝受邪，所以闷瞀。闷，是郁结。瞀，是目不明。这叫五实。心气虚，则脉细。肺气虚，则皮寒。肝气虚，则气少。肾气虚，则泄利前后。脾气虚，则饮食不入，这叫五虚。
黄帝说：其中有时能活的，是什么原因？岐伯说：浆粥进入胃中，泄泻停止，那么虚证就能活。身体出汗，大小便通畅，那么实证就能活，这就是征候。
五脏之气，生于胃土，主于三焦。胃土调和，则浆粥入胃，泄泻停止，这样虚证就能活。三焦通畅于外，则身体出汗；通畅于内，则大小便通畅，这样实证就能活。这就是虚实死生的征候。
这一节，论述形、气、色、脉，虚实死生，以终结玉机真脏篇的意义。
The Heart governs Shen Ming (Spirit/Mind) and is generally not easily invaded by pathogenic factors. Therefore, when a disease transmits from the Kidney to the Heart, the Heart will reverse-transmit it to the Lung, causing Lung pathology and manifesting as aversion to cold and fever. Since the disease originates internally, according to the pattern, death should occur within three years. The reason for death after three years lies in the sequence of transmission following the "mutual overcoming" (Ke) cycle: The Kidney transmits to the Heart, representing Water overcoming Fire; the Heart then transmits to the Lung, representing Fire overcoming Metal; in the first year, Metal overcomes Wood; in the second year, Wood overcomes Earth; and in the third year, Earth overcomes Water. Once transmitted through all five Zang organs, death ensues. The earlier statement that "the five Zang organs are interconnected, and shifts have their sequence" refers to the sequence of mutual generation (Sheng). The sequence of disease transmission here, however, follows the sequence of mutual overcoming.
However, if the disease manifests suddenly, one need not treat based on its transmission pattern. Or, if the transmission does not follow a fixed order, it is because emotional factors such as worry, fear, grief, joy, and anger prevent the disease from developing sequentially, leading to severe illness. If excessive joy leads to internal deficiency of Heart Qi, Kidney Qi will invade the Heart. If excessive anger causes Liver Qi to rebel upward, Liver Qi will invade the Spleen. If excessive grief causes Lung Qi to stagnate, Lung Qi will invade the Liver. If excessive fear causes Spleen Qi to become deficient, Spleen Qi will invade the Kidney. If excessive worry causes Heart Qi to be insufficient, Heart Qi will invade the Lung. This is the principle involved. Thus, there are five types of diseases, and each organ has transmissions involving the other five organs, resulting in twenty-five variations concerning disease transmission. "Transmission" (Chuan) is synonymous with "invading/overcoming" (Cheng).
"Cu" (sudden) is pronounced like "Cu". The same applies below. Lung disease manifests as aversion to cold and fever. However, if these symptoms appear suddenly, it is due to a violent attack by external pathogens, and one need not treat based on transmission patterns. This means one should not use the method for treating Heart transmitting to the Lung. The earlier mention of Kidney transmitting to Heart and Heart transmitting to Lung represents the normal sequence of disease. If transmission does not follow this sequence, it is because the internal injury of the Five Emotions prevents sequential development, leading to severe disease. For instance, excessive joy causes internal deficiency of Heart Qi, allowing Kidney Qi to invade the Heart. Excessive anger causes internal rebellion of Liver Qi, allowing Liver Qi to invade the Spleen. Excessive grief causes internal stagnation of Lung Qi, allowing Lung Qi to invade the Liver. Excessive fear causes internal deficiency of Kidney Qi, allowing Spleen Qi to invade the Kidney. Excessive worry causes internal deficiency of Lung Qi, allowing Heart Qi to invade the Lung. This is the pathway of transmission caused by the movement of the Five Emotions. The Five Emotions correspond to the Five Zang organs; thus, there are five diseases, and each organ involves transmission from the other five, resulting in twenty-five variations. "Transmission" refers to Kidney Qi invading, Liver Qi invading, Lung Qi invading, Spleen Qi invading, and Heart Qi invading; hence, "transmission" is named "invading." The text does not separately discuss the emotion of the Spleen because Spleen Earth is distributed among the other four organs. Mentioning grief as the emotion of the Lung indicates that not only does excess Liver anger cause its own Qi to invade other organs, but even deficiency of Lung grief causes its own Qi to invade other organs.
If the large bones are withered and atrophic, the large muscles are sunken, the chest is distended with Qi, breathing is difficult and labored, and the breath causes the body to tremble, death is expected in six months. If the Zhen Zang Mai (True Organ Pulse) appears, a specific date of death can be given.
"Pian" is read as a level tone. "Xian" sounds like "Xian" (appear). "Yu" is interchangeable with "Yu" (give). The following examples follow this rule. "Large bones and large muscles" refer to the flesh and bone of the arms and thighs. Withered large bones indicate Kidney disease. Sunken large muscles indicate Spleen disease. Chest fullness and difficult breathing indicate Lung disease. "Pian" means smooth or unobstructed. The repetition below follows this meaning. "Qi moving the form" means that due to difficult breathing, the movement of Qi is obstructed, causing the physical body to tremble. Death in six months implies an inability to survive the summer if one survives winter, or vice versa, leading to death in half a year. The appearance of the Zhen Zang Mai refers to the description later in the text, such as feeling like touching a knife edge. Giving the date of death refers to statements in the *Ping Ren Qi Xiang Lun* (Treatise on the Normal Person's Phenomena), such as Liver appearing on Geng/Xin days leading to death. When the True Qi of the five Zang organs flows without returning, and the Zhen Zang Mai appears, it returns but does not flow, leading to death.
If the large bones are withered, the large muscles are sunken, the chest is full of Qi, breathing is difficult, internal pain radiates to the shoulders and neck, death is expected in one month. If the Zhen Zang Mai appears, a specific date of death can be given.
Continuing from the previous discussion of Kidney, Spleen, and Lung diseases, if internal pain radiates to the shoulders and neck, it indicates the disease has followed the meridians to the Fengfu point, hence death is expected in one month. Generally, the Wei Qi (Defensive Qi) circulates through the meridians, gathering at the Fengfu point once every day and night, descending one section daily. After twenty-one days, it reaches the Futu point; after thirty days, it emerges from the Quepen point. If it cannot gather again at the Fengfu point, death occurs. If the Zhen Zang Mai appears, a date of death is given.
If the large bones are withered, the large muscles are sunken, the chest is full of Qi, breathing is difficult, internal pain radiates to the shoulders and neck, the body is hot, muscles waste away, and the skin cracks, and the Zhen Zang Mai appears, death is expected within ten months.
Muscle tissue is called "Rou," and fat is called "Peng." Continuing from the previous discussion of Kidney, Spleen, Lung, and Fengfu diseases, the addition of body heat, muscle wasting, and cracked skin indicates deficiency of Yin blood and failure of the Middle Jiao (Spleen/Stomach). If the Zhen Zang Mai appears, death occurs within ten days. The generative number of Earth is five, and the completed number is ten. Death within ten days does not exceed the completed number of Earth.
If the large bones are withered, the large muscles are sunken, the marrow of the shoulders dissipates internally, movements become increasingly weak, and the Zhen Zang Mai has not yet appeared, death is expected in one year. If the Zhen Zang Mai appears, a specific date of death can be given.
"Wei" was erroneously printed as "Lai" in old editions and is corrected here. Dissipation of shoulder marrow and increasing weakness of movement mean that initially, pain radiated to the shoulders and neck, but now the shoulder marrow is dissipated. Initially, muscles wasted and movements were weak, but now movements are increasingly weak, indicating progression from the previous context. If the Zhen Zang Mai has not appeared, death is expected upon the completion of a one-year cycle. If the Zhen Zang Mai is seen, a date of death is given.
If the large bones are withered, the large muscles are sunken, the chest is full of Qi, there is abdominal pain, discomfort in the heart region, heat in the shoulders, neck, and body, muscle wasting, and sunken eye sockets, and the Zhen Zang Mai appears, if the person cannot see others, they will die immediately. If they can still see others, they will die during the time element that overcomes them.
The pronunciation of "Jian" (see) is as written. Kidney disease causes bone withering, Spleen disease causes muscle sinking, and Lung disease causes Qi fullness. Liver Wood invading Spleen Earth causes abdominal pain. Internal deficiency of Shen Qi causes discomfort in the heart region. This continues the previous theme, stating that all five Zang organs are diseased. "Shoulders and neck" refers to pain radiating to them. Heat in the shoulders, neck, and body, along with muscle wasting, also continues the previous context. Sunken eye sockets indicate the exhaustion of Yangming Stomach Qi. If the Zhen Zang Mai appears and the person cannot see others, Shen Qi perishes first, leading to immediate death. If they can still see others, Shen Qi has not perished, and they will die during the time element that overcomes them. A "time element" refers to the twelve two-hour periods of the day.
Acute deficiency, sudden invasion by pathogens, and abrupt onset lead to the closure and blockage of the five Zang organs, obstruction of the pulse channels, and cessation of Qi circulation. This is like falling into water or drowning, making prognosis impossible. If the pulse ceases completely, or if the pulse beats five to six times per breath in a healthy person, even if the flesh and form are not wasted and the Zhen Zang Mai is not visible, death will still occur.
"Zhong" is pronounced with a departing tone. Continuing the previous meaning, acute diseases can kill quickly, making pulse diagnosis difficult for prognosis. "Ji Xu" (acute deficiency) refers to a sudden, temporary collapse of Zheng Qi (Upright Qi). "Shen Zhong" refers to external pathogens suddenly striking the body. "Cu Zhi" refers to guest pathogens abruptly reaching the Zang organs. These diseases affect the divine mechanism of the Zang Yuan (True Yuan) rather than the tangible meridians. Thus, the Qi of the five Zang organs closes temporarily, and the pulse channels throughout the body become blocked. The circular circulation of Qi stops temporarily. Such sudden diseases cause death in an instant, like falling or drowning, making prediction impossible. In cases of acute deficiency, if the pulse collapses inward, it ceases completely. If it collapses outward, the pulse may beat five to six times per breath. Even if the flesh is not wasted and the Zhen Zang Mai is not visible, death will still occur. This illustrates sudden death where prognosis is impossible, noting that the Zhen Zang Mai does not necessarily need to appear, thereby supplementing the previous incomplete meaning.
When the True Liver Pulse arrives, it is tense inside and out, sounding like rubbing a knife edge (Ze Ze Ran), or pressing a lute string. The complexion is blue-white and dull. When the hair follicles break, death occurs. When the True Heart Pulse arrives, it is firm and beating, like rolling hemp seeds (Lei Lei Ran). The complexion is red-black and dull. When the hair follicles break, death occurs. When the True Lung Pulse arrives, it is large and empty, like a feather brushing against the skin. The complexion is white-red and dull. When the hair follicles break, death occurs. When the True Kidney Pulse arrives, it is beating and severed, like fingers snapping stones (Pi Pi Ran). The complexion is black-yellow and dull. When the hair follicles break, death occurs. When the True Spleen Pulse arrives, it is weak and intermittent (alternating between rapid and slow). The complexion is yellow-blue and dull. When the hair follicles break, death occurs. All appearances of the Zhen Zang Mai indicate incurable death.
"Zhe" sounds like "She". "Zhong" in "Zhong Ren" is a departing tone. "Dan" is a level tone. "Shuo" sounds like "Shuo". The so-called appearance of the Zhen Zang Mai: When the True Liver Pulse arrives, it is tense inside and out. This tension is like rubbing a knife edge, indicating stagnant flow. Like pressing a lute string, it feels like a single line, lacking softness. An absolute pulse must be accompanied by an absolute complexion. Thus, the complexion is blue-white and dull. Blue is the color of the Liver; white indicates Metal overcoming Wood. Since pulse Qi travels from inside to outside, the appearance of the Zhen Zang Mai must be accompanied by the breaking of hair follicles before death, because both root and branch are exhausted. When the True Heart Pulse arrives, it is firm and beating. Firm means solid; beating means striking. Like rolling hemp seeds, it indicates rigidity without root. Red-black dull complexion indicates Water overcoming Fire. Hair follicle breaking precedes death. When the True Lung Pulse arrives, it is large and empty, indicating lack of root. Like a feather brushing the skin, it indicates lack of branch. White-red dull complexion indicates Fire overcoming Metal. Hair follicle breaking precedes death. When the True Kidney Pulse arrives, it is beating and severed. Beating resembles twisting a rope; severed means the rope seems broken. Like fingers snapping stones, it is hard and rigid, lacking Stomach Qi. Black-yellow dull complexion indicates Earth overcoming Water. Hair follicle breaking precedes death. When the True Spleen Pulse arrives, the organ Qi is deficient, so the pulse is weak and cannot reach the four other organs, hence intermittent. Yellow-blue dull complexion indicates Wood overcoming Earth. Hair follicle breaking precedes death. This clarifies that the Zhen Zang pulse image requires both root and branch to be exhausted before death, supplementing the previous incomplete meaning.
Huangdi said: Seeing the Zhen Zang Mai indicates death. Why?
The Zhen Zang Mai is hidden; when it appears, death is certain. Having explained this repeatedly, Huangdi wishes to deduce the reason for death and asks Qibo to elucidate.
Qibo said: The five Zang organs all receive Qi from the Stomach. The Stomach is the root of the five Zang organs. The Qi of the Zang organs cannot reach the Hand Taiyin (Lung Meridian) on its own; it must rely on Stomach Qi to reach the Hand Taiyin. Therefore, each of the five Zang organs manifests its pulse at its respective season and reaches the Hand Taiyin. When pathogenic factors prevail, Jing Qi (Essence Qi) declines. In severe disease, Stomach Qi cannot accompany the Zang Qi to reach the Hand Taiyin. Thus, the Qi of the Zhen Zang appears alone. Appearing alone means the disease Qi overcomes the Organ Qi, hence death. Huangdi said: Excellent.
The Zhen Zang Mai is a pulse devoid of Stomach Qi. The five Zang organs all receive Qi from the Stomach; thus, the Stomach is the root of the five Zang organs. The Lungs govern all pulses, presided over by the Hand Taiyin. However, Zang Qi cannot reach the Hand Taiyin independently; it relies on Stomach Qi. Thus, the Liver, Heart, Spleen, Lung, and Kidney each manifest their respective pulse qualities (Wiry, Hook, Floating, Stone) at their seasons and reach the Hand Taiyin. When pathogens prevail, it is due to the decline of Zang Jing Qi. In severe disease, Stomach Qi cannot accompany Zang Qi to the Hand Taiyin. Devoid of Stomach Qi, the Zhen Zang Qi appears alone in the pulse. Appearing alone means Disease Qi overcomes Organ Qi. Disease Qi overcoming Organ Qi leads to death. This aligns with the principle that "returning without turning results in loss of opportunity." Hence, Huangdi said: Excellent. This section, Huangdi reiterates the meaning of Yu Ji regarding the Zhen Zang Mai.
Huangdi said: In treating any disease, observe the patient's form, Qi, color, and luster, the flourishing or declining state of the pulse, and whether the disease is new or old, then treat accordingly, without delaying the appropriate time.
Having clarified the meaning of Yu Ji and Zhen Zang, and recognizing that form, Qi, color, and pulse all possess the Divine Mechanism, Huangdi reiterates: In treating disease, one must observe the form and Qi, the luster of the color, the strength of the pulse, and the novelty of the disease, then establish treatment methods, ensuring not to miss the opportune moment.
If form and Qi are harmonious, it is called treatable. If the color is floating and lustrous, it is called easily curable. If the pulse conforms to the four seasons, it is called treatable. A pulse that is weak and slippery indicates the presence of Stomach Qi and is named easily treated; seize the timing for treatment.
"Yi" is pronounced with a departing tone. Considering favorable conditions of form, Qi, color, and pulse: Harmonious form and Qi indicate treatability. Floating and lustrous facial color indicates easy recovery. Wiry in Spring, Hook in Summer, Floating in Autumn, and Stone in Winter—pulses conforming to the four seasons indicate treatability. A weak and slippery pulse indicates Stomach Qi and easy treatment. If form, Qi, color, and pulse are all favorable, even chronic diseases are treatable. Treating without delay is called seizing the timing.
If form and Qi are discordant, it is called difficult to treat. If the complexion is sallow and unclear, it is called difficult to cure. If the pulse is excess and hard, the condition worsens. If the pulse contradicts the four seasons, it is untreatable. One must examine these four difficulties and clearly inform the patient.
The "four difficulties" refer to form, Qi, color, and pulse. Considering unfavorable conditions: Form weak with Qi strong, or form strong with Qi weak, indicates discordance and difficulty in treatment. A sallow, dull complexion without luster indicates difficulty in curing. An excess and hard pulse indicates lack of Stomach Qi and worsening condition. A pulse contradicting the four seasons indicates Zang Qi being overcome and untreatability. If form, Qi, color, and pulse are all contradictory, even new diseases are untreatable. Informing without delay requires examining the four difficulties clearly. There is no room for hesitation.
What is meant by contradicting the four seasons? It is obtaining the Lung pulse in Spring, the Kidney pulse in Summer, the Heart pulse in Autumn, and the Spleen pulse in Winter. If these pulses are suspended, absent, deep, and choppy, it is called contradicting the four seasons. Without the typical pulse shape of the organ, having a deep and choppy pulse in Spring and Summer, or a floating and large pulse in Autumn and Winter, is also called contradicting the four seasons.
Elaborating on contradicting the four seasons: Lung pulse in Spring indicates Metal overcoming Wood. Kidney pulse in Summer indicates Water overcoming Fire. Heart pulse in Autumn indicates Fire overcoming Metal. Spleen pulse in Winter indicates Earth overcoming Water. Pulses that are suspended, rootless, deep, or choppy indicate lack of Stomach Qi and are called contradicting the four seasons. "Without typical pulse shape" means failing to show Wiry/Hook pulses in Spring/Summer or Floating/Stone pulses in Autumn/Winter. Spring generates and Summer grows; deep/choppy pulses in Spring/Summer contradict this. Autumn harvests and Winter stores; floating/large pulses in Autumn/Winter contradict this, also called contradicting the four seasons.
Heat disease with a quiet pulse, diarrhea with a large pulse, blood loss with a solid pulse, interior disease with a solid pulse, exterior disease with a non-solid pulse—all are difficult to treat.
Pulse and disease contrary to each other is also called contradiction. Heat disease implies disharmony of Qi and Blood; a quiet pulse in heat disease is contradictory. Diarrhea implies internal deficiency of Earth Qi; a large pulse in diarrhea is contradictory. Blood loss implies downward leakage of Yin fluids; a solid pulse in blood loss is contradictory. Interior disease implies deficiency of Righteous Qi; a solid/hard pulse in interior disease is contradictory. Exterior disease implies excess of Pathogenic Qi; a non-solid/non-hard pulse in exterior disease is contradictory. These contradictions between pulse and disease, akin to contradicting the four seasons, make them all difficult to treat.
Huangdi said: I have heard that determining excess and deficiency allows one to decide life and death. I wish to hear the details.
Having understood the essentials of form, Qi, color, and pulse, and recognizing their variations in excess and deficiency leading to life or death, Huangdi asks Qibo to clarify.
Qibo said: Five Excesses lead to death; Five Deficiencies lead to death.
Five Excesses refer to excess pathogenic Qi in the five Zang organs. Five Deficiencies refer to deficiency of righteous Qi in the five Zang organs. Disease affecting Zang Qi can lead to death regardless of excess or deficiency.
Huangdi said: Please explain the Five Excesses and Five Deficiencies. Qibo said: A surging pulse, hot skin, abdominal distension, obstruction of urination and defecation, and chest oppression with dizziness constitute the Five Excesses. A fine pulse, cold skin, shortness of breath, diarrhea and incontinence of urine and feces, and inability to eat or drink constitute the Five Deficiencies.
"Mao" is pronounced "Mao", same as in other chapters. The pulse is governed by the Heart. Pathogens invading the Heart cause a surging pulse. Skin is governed by the Lung. Pathogens invading the Lung cause hot skin. The abdomen is governed by the Spleen. Pathogens invading the Spleen cause abdominal distension. The Kidneys open into the anterior and posterior orifices. Pathogens invading the Kidneys cause obstruction of urination and defecation. The Liver opens into the eyes. Pathogens invading the Liver cause oppression and dizziness ("Mao" means depression; "Mu" means blurred vision). This constitutes the Five Excesses. Deficiency of Heart Qi causes a fine pulse. Deficiency of Lung Qi causes cold skin. Deficiency of Liver Qi causes shortness of breath. Deficiency of Kidney Qi causes diarrhea and incontinence. Deficiency of Spleen Qi causes inability to eat or drink. This constitutes the Five Deficiencies.
Huangdi said: Under what circumstances can there be survival? Qibo said: If gruel and porridge enter the stomach and diarrhea stops, the deficient patient lives. If the body sweats and urination/defecation becomes free, the excess patient lives. These are the signs.
The Qi of the five Zang organs is generated by Stomach Earth and governed by the San Jiao. If Stomach Earth is harmonious, gruel enters the stomach, and diarrhea stops, allowing the deficient patient to live. If the San Jiao is unobstructed externally, the body sweats; if unobstructed internally, urination and defecation become free, allowing the excess patient to live. These are the signs of life and death in excess and deficiency.
This section concludes the discussion on form, Qi, color, pulse, excess, deficiency, life, and death, finalizing the meaning of the *Yu Ji Zhen Zang Lun*.