肾脉搏坚而长，则邪实于肾，其色黄而赤者，土制其水，水不胜火也；脉体实而正气虚，故当病折腰，
腰乃肾之外候也。其脉软而散，则心肾不交，故当病少血；水火皆虚，至令人血而不复也。
帝曰∶诊得心脉而急，此为何病？病形何如？
病发于内，形见于外，复举心脉之急，以探病形。
岐伯曰∶病名心疝，少腹当有形也。
心脉急，故名心疝。心疝之病，少腹当有形也。
帝曰∶何以言之？
心疝，何以多腹有形？
岐伯曰∶心为牡脏，小肠为之使，故曰少腹当有形也。
“为使”，皆去声。阳中之阳，心也，故心为牡脏。心络小肠，故小肠为之使。心疝，则小肠不
为之使，故曰少腹当有形也。举心与小肠，则凡脏与腑合之脉，可类推其因脏病腑矣。
帝曰∶诊得胃脉，病形何如？
五脏心为主，六腑胃为主。诊得胃脉有病，病形何如。
岐伯曰∶胃脉实则胀，虚则泄。
胃脉有余而实，则胀。胀，腹胀，脾实之病也。胃脉不足而虚，则泄。泄，溏泄，脾虚之病也。
举胃与脾，则凡腑与脏合之脉，可类推其因腑病脏矣。以上答帝知病所在之间者如此。
帝曰∶病成而变何谓？
以次言之，当论病之所变，故因问之。
岐伯曰∶风成为寒热，瘅成为消中，厥成为巅疾，久风为飧泄，脉风成为疠，病之变化，不可胜数。
胜，平声；数，上声。风者百病之长，善行数变，故风成则或为寒变，或为热变。瘅，火热病也。
瘅成则津液内竭，故为消中之变。厥，手足逆冷也。厥成则阴阳不和，气上不下，故为头痛巅疾
之变。春伤于风，至夏变为飧泄，故久风为飧泄。风伤经脉，变为癞疾之疠疡，故脉风成为疠。凡此
皆为病变，究之病之变化，不可胜数。
帝曰∶诸痈肿筋挛骨痛，此皆安全？
风成诸变，乃成于内而变于外，若诸痈肿，以及筋挛骨痛，则病已变于外，故问此皆安生。
岐伯曰∶此寒气之肿，八风之变也。
此寒气之肿，言痈肿之生于寒也。八风之变，言筋挛骨痛之生于风也。以明病之所生，即病之所变也。
帝曰，治之奈何？
治寒风之法奈何。
岐伯曰∶此四时之病，以其胜治之愈也。
寒风者，四时不正之邪。治之之法，当求其胜以治之，则愈也。如寒淫于内，治以甘热；风淫于内，
治以辛凉之义。
帝曰∶有故病五脏发动，因伤脉色，各何以知其久暴至之病乎？
人身之病，久暴不同，有五脏故病，发动于外，因伤脉色，非一时生变之暴病，各何以知其久
至与暴至之病乎。
岐伯曰∶悉乎哉问也，征其脉小，色不夺者，新病也；征其脉不夺，其色夺者，此久病也；征
其脉与五色俱夺者，此久病也；征其脉与五色俱不夺者，新病也。
论病变而及于久暴，病无遁情，是悉乎哉问也。病之发也，脉小色不夺，为新病之征；脉不夺其色夺，
为久病之征；脉色俱夺，亦久病之征；脉色俱不夺，亦新病之征。此病之见色脉，而有久暴也。
肝与肾脉并至，其色苍赤，当病毁伤，不见血，已见血，湿，若中水也。
当、中，俱去声。此举毁伤暴病，以足上文之义。肝与肾脉并至，肝主筋，肾主骨也；其色苍赤，
肝色苍，心色赤也；当病，暴病也∶毁伤，毁伤其筋骨也。毁伤筋骨，应不见血，若已见血，则
心气并伤，如汗出身湿，若中于水，水从汗孔而伤其心气也。当病毁伤，肝与肾脉所以并至也。已见血，
其色所以苍赤也。以上答帝知病所变之问者如此。
尺内两旁，则季胁也，尺外以候肾，尺里以候腹。
病之内外，随乎经脉，故举脉体以明之。尺内犹言尺中，两旁犹言左右，谓尺中左右两手之脉，则
主人身之季胁也。季胁，胁之尽处也。腰居季胁之外，故两手尺外以候肾。腹居季胁之内，故两
季尺里以候腹。脉气自下而上，故先论尺部之左右外内也。
中附上，左外以候肝，内以候膈；右外以候胃，内以候脾。
中附上者，自左右两尺中，而致于关上也。左外以候肝，内以候膈者，左手关部之外，以候肝脉；
关部之内，以候膈中脉也。右
外以候胃，内以候脾者，右手关部之外，以候胃脉；关部之内，以候脾脉也。脉气自下而中，故
次论关部之左右外内也。
上附上，右外以候肺，内以候胸中；左外以候心，内以候膻中。
上附上者，自左右两关上，而至于寸上也。右外以候肺，内以候胸中者，右手寸外以候肺脉；寸内以
候胸中脉也。左外以候心，内以候膻中者，左手寸脉以候心脉；寸内，以候心包之膻中脉也。
脉气自中而上，故终论寸部之左右外内也。
前以候前，后以候后。
脉有外内，复有前后。前以候前，尺前关前寸前，以候形身之
前也；后以候后，寸后关后尺后，以候形身之后也。
上竟上者，胸喉中事也；下竟下者，少腹腰股膝胫足中事也。
脉有外内前后，复有上下，是脉体之六合也。上竟上者，自寸上而竟上于鱼际也。喉主天气，位
居胸上，故为胸喉中事，乃上以候上也。下竟下者，自尺下而竟下于肘中也。足履乎地，股膝胫足，
居腰与少腹之下，故为少腹腰股膝胫足中事，乃下以候下也。
粗大者，阴不足阳有余，为热中也。来疾去徐，上实下虚，为厥巅疾；来徐去疾，上虚下实，为恶风也。
上文以脉体而候脏腑形身之位，此以脉象而候阴阳上下之病也。脉粗大者，乃阴气不足，阳气有余，
故为热中病也。热中，阳盛于内也。脉来疾去徐，来盛而去微也。来疾，故主上实；去徐，故主下虚。上
实下虚，则气惟上逆，阴阳不和，故为厥，厥，手足逆冷也；气惟上逆，上而不下，故为巅疾，犹言厥
成为巅疾也。脉来徐去疾，来微而去盛也。来徐，故主上虚；去疾，故主下实。上
虚下实，则经脉不和，故为恶风也。恶风，疠风也。
故中恶风者，阳气受也。有脉俱沉细数者，少阴厥也；沉细数散者，寒热也；浮而散者，为 仆。
中，去声。 ，瞬同，余篇仿此。此复举恶风厥热巅疾脉证，各有不同，以足上文未尽之义。恶厉
之风，伤其经脉，必从表入，故申
明中恶风者，始于阳气之受邪也。厥有阴阳，申明有脉俱软细而数者，非阳气上逆之厥，为少阴厥也。热
有阴阳，申明有脉软细而数散者，非粗大有余之阳热，为阴盛阳虚之寒热也。巅疾亦有阴阳，
实则有余，虚则不足，申明有脉浮而散者，非上实有余之巅疾，为里虚不足之 仆也。
诸浮不躁者，皆在阳，则为热；其有躁者，在手。诸细而沉者，皆在阴，则为骨痛；其有静者，在
足。数动一代者，病在阳之脉也，泄及便脓血。诸过者切之，涩者阳气有余也，滑者阴气有余
也。阳气有余，为身热无汗；阴气有余，为多汗身寒；阴阳有余，则无汗而寒。
此复以浮沉代涩滑之脉，而明阴阳内外之病也。左右三部诸脉，俱浮而不躁疾者，皆病在阳，阳病则
为外热。其有浮而躁疾者，亦在手之经脉。手，阳也。左右三部诸脉，细而沉者，皆病在阴，
阴病则内为骨痛。其有沉细而静者，亦在足之经脉。足，阴也。诸脉数动一代者，数动为阳，故病在阳之
脉也，数动一代，则阳中有阴，故当病泄及便脓血。诸有过之脉，必须切之，乃得其真，诸脉
涩者，内之阴血不足，阴血不足，则外之阳气有余也，诸脉滑者，阳气从阳入阴，阳气入阴，则内之阴气
有余也，阳气有余则病在阳，不得阴气以和之，故身热无汗。阴气有余，则病在阴，不得阳热以
相济，故多汗身寒。若阴阳皆有余，阳盛则无汗，阴盛则身寒，故无汗而寒。
推而外之，内而不外，有心腹积也。推而内之，外而不内，身有热也，推而上之，上而不下，腰足
清也。推而下之，下而不上，头项痛也。按之至骨，脉气少者，腰脊痛而身有痹也。
推，退平声。承上文上下外内之病，而言诊脉，亦有外内上下之法也。推而外之者，医之手指，向外
以按之。脉偏盛于内而不外，此有心腹之积病也。推而内之者，医之手指向内以按之，脉偏盛于
外而不内，此身形有邪热也。推而上之者，医之手指向寸关尺之上以按之，脉随应指，上而不下，此上盛
下虚，故腰足当清冷也。推
而下之者，医之手指向寸关尺之下以按之，脉随应指，下而不上，此下盛上虚，故头项当强痛也。若按
之至骨，不应于指，脉气少者，此阴盛阳虚，生阳之气不能上行，当腰脊痛而身有痹病也。承上文
上下外内之病，而言诊脉，亦有外内上下之法也，以上答帝知病乍在内乍在外之问者如此。
此一节，承上文五者之问，而一一以对，亦为脉要之精微也。
肾脉搏动坚实而长，说明邪气实于肾脏；若面色黄中带赤，是土（脾）克制水（肾），水不能胜火的表现；脉体虽实但正气已虚，因此应当发生折腰之病，因为腰部是肾脏的外在征候。若脉象软弱而散，说明心肾不交，因此应当患少血之病；水火二气皆虚，甚至导致血液枯竭而无法恢复。
黄帝说：诊察到心脉紧急，这是什么病？病症表现如何？
病症发于体内，症状显现于体表，再次提出心脉紧急的问题，以探求病症的具体形态。
岐伯说：病名叫做心疝，小腹部应当有有形之块。
心脉紧急，所以命名为心疝。患心疝病的人，小腹部应当有有形之块。
岐伯说：心脏属于牡脏（阳脏），小肠作为它的使道（配合脏腑），所以说小腹部应当有有形之块。
“为使”的“使”字读去声。心位于阳中之阳，所以称为牡脏。心的络脉连接小肠，所以小肠作为它的使道。患心疝时，小肠不再顺从作为使道的作用，所以说小腹部会有有形之块。举出心与小肠的关系，那么凡是脏与腑相合的脉象，都可以类推是因为脏的病影响了腑。
黄帝说：诊察到胃脉有病，病症表现如何？
五脏中心为主宰，六腑中胃为主受纳。诊察到胃脉有病，病症表现如何？
岐伯说：胃脉实则腹胀，虚则泄泻。
胃脉有余且实，就会腹胀。胀，指腹胀，这是脾实的病证。胃脉不足且虚，就会泄泻。泄，指溏泄，这是脾虚的病证。
举出胃与脾的关系，那么凡是腑与脏相合的脉象，都可以类推是因为腑的病影响了脏。以上回答了黄帝关于知晓疾病所在部位的提问，情况就是这样。
黄帝说：疾病形成后发生变化，是什么意思？
按顺序来说，应当论述疾病的变化，所以因此询问。
岐伯说：风邪久留成为寒热病，瘅热成为消中病，厥逆成为巅顶疾病，久风成为飧泄病，脉中风邪成为疠病，疾病的变化，数不胜数。
“胜”读平声，“数”读上声。风是百病的先导，善于运行且变化多端，所以风邪形成后，有的变为寒变，有的变为热变。瘅，是火热病。瘅热形成则津液在内枯竭，所以变成消中病。厥，是手足逆冷。厥逆形成则阴阳不和，气向上冲而不下降，所以变成头痛巅疾。春天伤于风，到了夏天变成飧泄，所以久风导致飧泄。风邪伤害经脉，变成癞疾类的疠疡，所以脉中风邪形成疠病。凡此种种都是病变，推究起来，疾病的变化，数不胜数。
黄帝说：各种痈肿、筋挛、骨痛，这些都是怎么产生的？
风邪形成的各种变化，是生于内而变于外，至于各种痈肿，以及筋挛骨痛，则是病已经变于外，所以问这些是怎么产生的。
岐伯说：这是寒气引起的肿胀，以及八风邪气变化所致。
所谓寒气之肿，是说痈肿生于寒邪。八风之变，是说筋挛骨痛生于风邪。以此说明疾病的产生，就是疾病的变化所在。
黄帝说：治疗它们的方法是怎样的？
治疗风寒邪气的方法是怎样的？
岐伯说：这是四时不正之气导致的疾病，用克制它的方法治疗就能痊愈。
寒风，是四时不正的邪气。治疗的方法，应当寻求能克制它的疗法来治疗，就能痊愈。比如寒邪淫溢于内，用甘热药治疗；风邪淫溢于内，用辛凉药治疗，就是这个道理。
黄帝说：如果有旧病，五脏发动，因而损伤了脉色，各用什么方法来判断是久病还是暴发的新病呢？
人身上的病，有久有暴，各不相同。有五脏的旧病，在外发动，因而损伤脉色，这不是一时生成的暴发新病，各用什么方法知道是久病还是暴发之病呢？
岐伯说：问得真详细啊！诊察脉象细小而面色未衰败的，是新病；诊察脉象未衰败而面色衰败的，是久病；诊察脉象与五色都衰败的，是久病；诊察脉象与五色都不衰败的，是新病。
论述病变涉及久病与新病，病情没有隐瞒之处，真是问得详细啊。疾病发作时，脉小色不夺，是新病的征象；脉不夺而色夺，是久病的征象；脉色俱夺，也是久病的征象；脉色俱不夺，也是新病的征象。这是通过观察色脉，而知晓疾病有久有暴。
肝脉与肾脉同时出现，面色苍中带赤，应当患有毁伤之病；如果没有见血，或者已经见血，伴有湿气，或者是中水邪。
“当”、“中”均读去声。这里列举毁伤的暴病，以补充上文的意义。肝脉与肾脉并至，肝主筋，肾主骨；面色苍赤，肝色苍，心色赤；应当患病，指暴病；毁伤，指毁伤了筋骨。毁伤筋骨，本应不见血，如果已经见血，则心气也一并受伤，如同出汗后身体湿润，像是中了水邪，水从汗孔进入伤害心气。应当患毁伤病，这就是肝与肾脉之所以并至的原因。已经见血，这就是面色之所以苍赤的原因。以上回答了黄帝关于知晓疾病变化的提问，情况就是这样。
尺部内侧两旁，对应季胁；尺部外侧候肾，尺部内侧候腹部。
疾病的内外，随经脉而定，所以举出脉体部位来阐明。尺内犹言尺中，两旁犹言左右，指尺部左右两手的脉，对应人体的季胁。季胁，是胁肋的尽头处。腰位于季胁之外，所以两手尺部外侧候肾。腹位于季胁之内，所以两手尺部内侧候腹。脉气自下而上，所以先论述尺部的左右内外。
中部附上（关部），左手外侧候肝，内侧候膈；右手外侧候胃，内侧候脾。
中附上者，是从左右两尺部延伸到关部。左手外侧候肝，内侧候膈，是指左手关部外侧，用来候肝脉；关部内侧，用来候膈中的脉。右手外侧候胃，内侧候脾，是指右手关部外侧，用来候胃脉；关部内侧，用来候脾脉。脉气自下而至中，所以接着论述关部的左右内外。
上部附上（寸部），右手外侧候肺，内侧候胸中；左手外侧候心，内侧候膻中。
上附上者，是从左右两关部延伸到寸部。右手外侧候肺，内侧候胸中，是指右手寸部外侧候肺脉；寸部内侧候胸中脉。左手外侧候心，内侧候膻中，是指左手寸脉候心脉；寸部内侧，候心包所在的膻中脉。
脉气自中而上，所以最后论述寸部的左右内外。
前部候身前，后部候身后。
脉有内外，又有前后。前部候身前，即尺前、关前、寸前，用来候形体身前的部位；后部候身后，即寸后、关后、尺后，用来候形体身后的部位。
上竟上（寸部之上），对应胸喉中的事；下竟下（尺部之下），对应少腹、腰、股、膝、胫、足中的事。
脉有内外前后，又有上下，这是脉体的六合关系。上竟上者，从寸部一直上到鱼际。喉主天气，位置在胸上，所以属于胸喉中的事，这是上以候上。下竟下者，从尺部一直下到肘中。脚踩在地上，股、膝、胫、足，位于腰与少腹之下，所以属于少腹、腰、股、膝、胫、足中的事，这是下以候下。
脉粗大，是阴不足阳有余，属于热中病。脉来急去缓，是上实下虚，属于厥逆和巅顶疾病；脉来缓去急，是上虚下实，属于恶风病。
上文通过脉体部位候脏腑形身的位置，此处通过脉象候阴阳上下之病。脉粗大，是阴气不足，阳气有余，所以是热中病。热中，是阳气盛于内。脉来疾去徐，是来盛去微。来疾，所以主上实；去徐，所以主下虚。上实下虚，则气只向上逆，阴阳不和，所以为厥，厥即手足逆冷；气只向上逆，上而不降，所以为巅疾，犹如前面说的“厥成为巅疾”。脉来徐去疾，是来微去盛。来徐，所以主上虚；去疾，所以主下实。上虚下实，则经脉不和，所以为恶风。恶风，即疠风。
所以中恶风者，是阳气受了邪。如果有脉象俱沉细数的，是少阴厥逆；脉象沉细数而散的，是寒热病；脉象浮而散的，是仆倒病。
“中”读去声。“ ”同“瞬”，其他篇章仿照此例。这里再次列举恶风、厥、热、巅疾的脉证，各有不同，以补充上文未尽之意。恶厉之风，伤害经脉，必从表入，所以申明中恶风者，始于阳气受邪。厥有阴阳，申明脉象软细而数的，不是阳气上逆之厥，而是少阴厥。热有阴阳，申明脉象软细而数散的，不是粗大有余之阳热，而是阴盛阳虚之寒热。巅疾亦有阴阳，实则有余，虚则不足，申明脉象浮而散的，不是上实有余之巅疾，而是里虚不足的仆倒病。
所有浮脉但不躁动的，都在阳分，则为热病；如果有躁动的，在手经。所有细而沉的脉，都在阴分，则为骨痛；如果有静象的，在足经。脉数动而时有间歇（代脉），病在阳分之脉，表现为泄泻及便脓血。所有异常的脉都要切按，涩脉是阳气有余，滑脉是阴气有余。阳气有余，表现为身热无汗；阴气有余，表现为多汗身寒；阴阳都有余，则无汗且身寒。
这里再次通过浮、沉、代、涩、滑等脉象，阐明阴阳内外之病。左右三部诸脉，都浮而不躁疾的，都是病在阳，阳病则为外热。如果有浮而躁疾的，也在手经。手属阳。左右三部诸脉，细而沉的，都是病在阴，阴病则内为骨痛。如果有沉细而静象的，也在足经。足属阴。诸脉数动而有代脉的，数动属阳，所以病在阳分之脉，数动一代，则阳中有阴，所以应当病泄泻及便脓血。所有有过失（异常）的脉，必须切按，才能得到真实情况。诸脉涩者，内之阴血不足，阴血不足，则外之阳气有余；诸脉滑者，阳气从阳入阴，阳气入阴，则内之阴气有余。阳气有余则病在阳，得不到阴气调和，所以身热无汗。阴气有余则病在阴，得不到阳热相助，所以多汗身寒。如果阴阳都有余，阳盛则无汗，阴盛则身寒，所以无汗而身寒。
推按脉象向外，脉气内敛不外达，是有心腹积滞病。推按脉象向内，脉气外浮不内敛，是身体有热病。推按脉象向上，脉气上逆不下行，是腰足清冷。推按脉象向下，脉气下行不上升，是头项疼痛。按之至骨，脉气微弱，是腰脊痛且身体有痹病。
“推”读退平声。承接上文上下外内之病，而言诊脉也有外内上下之法。推而外之，是医生手指向外按脉。脉偏盛于内而不外达，这是有心腹积病。推而内之，是医生手指向内按脉，脉偏盛于外而不内敛，这是身形有邪热。推而向上，是医生手指向寸关尺之上按脉，脉随应指，上而不下，这是上盛下虚，所以腰足应当清冷。推而向下，是医生手指向寸关尺之下按脉，脉随应指，下而不上，这是下盛上虚，所以头项应当强痛。如果按之至骨，不应于指，脉气少者，这是阴盛阳虚，生阳之气不能上行，应当腰脊痛且身体有痹病。承接上文上下外内之病，而言诊脉也有外内上下之法，以上回答了黄帝关于知晓疾病乍在内乍在外的提问，情况就是这样。
这一节，承接上文五个问题，一一作答，也是脉要的精微之处。
When the Kidney pulse is firm and long, it indicates that pathogenic factors are excessive in the Kidney; if the complexion is yellow with a reddish hue, it signifies that Earth (Spleen) controls Water (Kidney), and Water fails to overcome Fire; although the pulse body is solid, the healthy Qi is deficient, therefore one should suffer from "Zhe Yao" (waist injury/impairment), as the waist is the external manifestation of the Kidney. If the pulse is soft and scattered, it indicates a lack of communication between the Heart and Kidney, therefore one should suffer from blood deficiency; when both Water and Fire are deficient, it can even lead to exhaustion of blood that cannot be restored.
The Yellow Emperor said: Upon diagnosing an urgent Heart pulse, what disease is this? What are the clinical manifestations?
Diseases originate internally but manifest externally. By reiterating the urgency of the Heart pulse, we probe the specific form of the disease.
Qibo said: The disease is named "Xin Shan" (Heart Hernia), and there should be palpable masses in the lower abdomen.
Because the Heart pulse is urgent, it is named Heart Hernia. In cases of Heart Hernia, there should be palpable masses in the lower abdomen.
The Yellow Emperor said: Why do you say so?
Why does Heart Hernia often present with palpable masses in the abdomen?
Qibo said: The Heart is a Yang organ (Mu Zang), and the Small Intestine acts as its envoy; therefore, it is said that there should be palpable masses in the lower abdomen.
"Envoy" is pronounced with the departing tone. The Heart, located in the upper yang, is thus called a Yang organ. The Heart meridians connect to the Small Intestine, so the Small Intestine serves as its envoy. In Heart Hernia, the Small Intestine ceases to function as an envoy; hence, it is said that palpable masses appear in the lower abdomen. By citing the relationship between the Heart and Small Intestine, for any pulse corresponding to paired Zang-Fu organs, one can infer that disease in the Zang affects the Fu.
The Yellow Emperor said: Upon diagnosing a diseased Stomach pulse, what are the clinical manifestations?
Among the Five Zang organs, the Heart is the ruler; among the Six Fu organs, the Stomach is the primary receiver. Upon diagnosing a diseased Stomach pulse, what are the manifestations?
Qibo said: An excess Stomach pulse leads to distension; a deficient Stomach pulse leads to diarrhea.
An abundant and solid Stomach pulse causes abdominal distension. Distension refers to abdominal bloating, which is a disease of Spleen excess. A deficient and weak Stomach pulse causes loose stools. Diarrhea refers to watery stools, which is a disease of Spleen deficiency.
By citing the relationship between the Stomach and Spleen, for any pulse corresponding to paired Fu-Zang organs, one can infer that disease in the Fu affects the Zang. This answers the Yellow Emperor's inquiry regarding the location of diseases, as described above.
The Yellow Emperor said: What is meant by changes after a disease has formed?
Proceeding in order, we must discuss the transformations of diseases; thus, I ask this question.
Qibo said: Wind lingering becomes cold-heat disorders; Dan heat becomes Xiao Zhong (middle consumption); Jue reversal becomes Dian Ji (diseases of the vertex); prolonged wind becomes Sun Xie (undigested food diarrhea); wind in the vessels becomes Li disease (leprosy/malignant ulcers). The transformations of diseases are countless.
"Sheng" is pronounced with the level tone; "Shu" is pronounced with the rising tone. Wind is the leader of all diseases, agile in movement and changeable; thus, once wind forms, it may transform into cold or heat. Dan is a fire-heat disease. Once Dan forms, internal fluids are exhausted, leading to Xiao Zhong (middle consumption). Jue refers to cold extremities. Once Jue forms, Yin and Yang are disharmonious, with Qi ascending but not descending, leading to headache and Dian Ji (vertex diseases). Injury by wind in spring transforms into Sun Xie (diarrhea with undigested food) by summer; thus, prolonged wind causes Sun Xie. Wind damaging the vessels transforms into leprosy-like ulcers; thus, wind in the vessels leads to Li disease. All these are pathological changes; upon investigation, the transformations of diseases are indeed countless.
The Yellow Emperor said: Various abscesses, tendon spasms, and bone pain—how are these generated?
Transformations caused by wind arise internally and manifest externally. Regarding various abscesses, tendon spasms, and bone pain, the disease has already manifested externally; thus, I ask how these are generated.
Qibo said: These are swellings caused by Cold Qi and variations due to the Eight Winds.
"Swellings of Cold Qi" refers to abscesses arising from cold pathogens. "Variations of the Eight Winds" refers to tendon spasms and bone pain arising from wind pathogens. This clarifies that the origin of the disease is also its transformation.
The Yellow Emperor said: How should they be treated?
What is the method for treating cold and wind pathogens?
Qibo said: These are diseases caused by abnormal qi of the four seasons; they can be cured by using the controlling element to treat them.
Cold wind is the abnormal pathogen of the four seasons. The treatment method should seek the element that controls it to effect a cure. For example, if cold invades internally, treat with sweet-hot herbs; if wind invades internally, treat with pungent-cool herbs. This is the principle.
The Yellow Emperor said: If there is a pre-existing disease where the Five Zang organs activate, thereby affecting the pulse and complexion, how can one distinguish whether it is a chronic condition or an acute onset?
Diseases in the human body vary between chronic and acute. There are old diseases of the Five Zang organs activating externally, affecting the pulse and complexion. These are not sudden changes occurring at one moment. How can one distinguish between chronic and acute diseases?
Qibo said: Your question is very thorough! If the pulse is small and the complexion is unimpaired, it is a new disease; if the pulse is unimpaired but the complexion is impaired, it is a chronic disease; if both the pulse and the five colors are impaired, it is a chronic disease; if both the pulse and the five colors are unimpaired, it is a new disease.
Discussing disease transformations involving chronic and acute conditions reveals no hidden details; your question is indeed thorough. When a disease erupts, a small pulse with unimpaired complexion is a sign of a new disease; an unimpaired pulse with impaired complexion is a sign of a chronic disease; both pulse and complexion impaired are signs of a chronic disease; both pulse and complexion unimpaired are signs of a new disease. This is how observing color and pulse reveals whether a disease is chronic or acute.
If the Liver and Kidney pulses arrive simultaneously, and the complexion is cyan-red, one should suffer from trauma; whether bleeding has occurred or not, accompanied by dampness or water retention.
"Dang" and "Zhong" are pronounced with the departing tone. This cites acute trauma to supplement the previous text. Simultaneous arrival of Liver and Kidney pulses: the Liver governs tendons, the Kidney governs bones; cyan-red complexion: Liver color is cyan, Heart color is red; "should suffer" refers to acute illness; "trauma" refers to injury of tendons and bones. Trauma to tendons and bones should ideally show no blood; if blood is present, the Heart Qi is also injured, similar to sweating followed by body dampness, as if struck by water, where water enters through sweat pores and damages Heart Qi. One should suffer from trauma, which explains why the Liver and Kidney pulses arrive simultaneously. Blood presence explains the cyan-red complexion. This answers the Yellow Emperor's inquiry regarding disease transformations, as described above.
The inner side of the Chi position corresponds to the hypochondrium; the outer side of Chi observes the Kidney, and the inner side observes the abdomen.
Internal and external diseases follow the meridians; thus, pulse positions are cited to clarify this. "Chi Nei" means within the Chi section; "Liang Pang" means left and right. The pulses at the Chi position on both hands correspond to the hypochondrium of the body. The hypochondrium is the end of the ribs. The waist is outside the hypochondrium; therefore, the outer side of the Chi pulse on both hands observes the Kidney. The abdomen is inside the hypochondrium; therefore, the inner side of the Chi pulse on both hands observes the abdomen. Pulse Qi moves from bottom to top; thus, we first discuss the left-right and inner-outer aspects of the Chi position.
At the Guan position (mid-level attached): the left outer side observes the Liver, and the inner side observes the Diaphragm; the right outer side observes the Stomach, and the inner side observes the Spleen.
"Guan Shang Fu" refers to extending from the Chi position to the Guan position. Left outer observes Liver, inner observes Diaphragm: the outer side of the left Guan position observes the Liver pulse; the inner side of the Guan position observes the Diaphragm pulse. Right outer observes Stomach, inner observes Spleen: the outer side of the right Guan position observes the Stomach pulse; the inner side of the Guan position observes the Spleen pulse. Pulse Qi moves from bottom to middle; thus, we next discuss the left-right and inner-outer aspects of the Guan position.
At the Cun position (upper level attached): the right outer side observes the Lung, and the inner side observes the Chest Middle; the left outer side observes the Heart, and the inner side observes the Dan Zhong.
"Cun Shang Fu" refers to extending from the Guan position to the Cun position. Right outer observes Lung, inner observes Chest Middle: the outer side of the right Cun position observes the Lung pulse; the inner side observes the Chest Middle pulse. Left outer observes Heart, inner observes Dan Zhong: the left Cun pulse observes the Heart pulse; the inner side of the Cun position observes the Dan Zhong pulse of the Pericardium.
Pulse Qi moves from middle to top; thus, we finally discuss the left-right and inner-outer aspects of the Cun position.
The anterior part observes the anterior body, and the posterior part observes the posterior body.
Pulses have inner and outer aspects, as well as anterior and posterior. Anterior observes anterior: the anterior parts of Chi, Guan, and Cun observe the front of the body; posterior observes posterior: the posterior parts of Cun, Guan, and Chi observe the back of the body.
"Shang Jing Shang" (extending to the top of the Cun) concerns the chest and throat; "Xia Jing Xia" (extending to the bottom of the Chi) concerns the lower abdomen, waist, thigh, knee, shin, and foot.
Pulses have inner, outer, anterior, and posterior, as well as upper and lower, constituting the six harmonies of the pulse body. "Shang Jing Shang" extends from the Cun position up to the Yu Ji area. The throat governs heavenly Qi and is located in the upper chest; thus, it concerns the chest and throat, representing "upper observing upper." "Xia Jing Xia" extends from the Chi position down to the elbow. Feet tread on the ground; thighs, knees, shins, and feet are below the waist and lower abdomen; thus, they concern the lower abdomen, waist, thigh, knee, shin, and foot, representing "lower observing lower."
A coarse and large pulse indicates Yin deficiency and Yang excess, resulting in Re Zhong (internal heat). A pulse that comes rapidly and departs slowly indicates upper excess and lower deficiency, resulting in Jue (reversal cold) and Dian Ji (vertex disease); a pulse that departs rapidly and comes slowly indicates upper deficiency and lower excess, resulting in E Feng (aversion to wind).
The previous section used pulse positions to observe Zang-Fu and body locations; this section uses pulse qualities to observe Yin-Yang and upper-lower diseases. A coarse and large pulse indicates insufficient Yin Qi and excessive Yang Qi, hence Re Zhong disease. Re Zhong means Yang abundance internally. A pulse coming rapidly and departing slowly means strong arrival and weak departure. Rapid arrival indicates upper excess; slow departure indicates lower deficiency. Upper excess and lower deficiency cause Qi to reverse upward only, disrupting Yin-Yang harmony, leading to Jue (cold extremities); Qi reversing upward without descending leads to Dian Ji, echoing "Jue becomes Dian Ji." A pulse departing rapidly and coming slowly means weak arrival and strong departure. Slow arrival indicates upper deficiency; rapid departure indicates lower excess. Upper deficiency and lower excess disrupt meridian harmony, leading to E Feng. E Feng refers to Leprosy wind.
Therefore, contracting evil wind implies the Yang Qi was affected. If pulses are both deep, fine, and rapid, it indicates Shao Yin Jue; if deep, fine, rapid, and scattered, it indicates cold-heat disorder; if floating and scattered, it indicates collapse (Pu Dao).
"Zhong" is pronounced with the departing tone. "Shun" is identical to "Shun," following this pattern in other chapters. Here, the pulse signs for evil wind, Jue, heat, and Dian Ji are reiterated to show their differences, supplementing the previous text. Evil wind damages meridians, entering from the exterior; thus, contracting evil wind begins with the invasion of Yang Qi. Jue has Yin and Yang types: a soft, fine, and rapid pulse is not Yang Qi reversing upward, but Shao Yin Jue. Heat has Yin and Yang types: a soft, fine, rapid, and scattered pulse is not coarse and excessive Yang heat, but cold-heat disorder due to Yin excess and Yang deficiency. Dian Ji also has Yin and Yang types: excess is surplus, deficiency is lack; a floating and scattered pulse is not upper-excess Dian Ji, but collapse due to interior deficiency.
All floating pulses without agitation belong to Yang, indicating heat; if agitated, it involves the Hand meridians. All fine and deep pulses belong to Yin, indicating bone pain; if quiet, it involves the Foot meridians. A pulse that is rapid, active, and intermittent indicates disease in the Yang pulse, manifesting as diarrhea and pus/blood in stool. All abnormal pulses must be palpated; a choppy pulse indicates Yang excess, while a slippery pulse indicates Yin excess. Yang excess manifests as body heat and absence of sweat; Yin excess manifests as profuse sweating and cold body; if both Yin and Yang are excessive, there is absence of sweat and cold body.
Here, floating, deep, intermittent, choppy, and slippery pulses are used to clarify Yin-Yang and internal-external diseases. If all three positions on left and right are floating without agitation, the disease is in Yang, causing external heat. If floating and agitated, it involves the Hand meridians (Yang). If fine and deep, the disease is in Yin, causing internal bone pain. If fine, deep, and quiet, it involves the Foot meridians (Yin). Pulses that are rapid, active, and intermittent: rapid activity belongs to Yang, so the disease is in the Yang pulse. Rapid activity with intermittency means Yin within Yang, leading to diarrhea and pus/blood in stool. All abnormal pulses require palpation to ascertain truth. Choppy pulses indicate insufficient internal Yin blood; insufficient Yin blood leads to excessive external Yang Qi. Slippery pulses indicate Yang Qi entering Yin; Yang entering Yin leads to excessive internal Yin Qi. Excessive Yang Qi places disease in Yang, lacking Yin to harmonize it, causing body heat and no sweat. Excessive Yin Qi places disease in Yin, lacking Yang heat to assist it, causing profuse sweat and cold body. If both Yin and Yang are excessive, Yang abundance causes no sweat, Yin abundance causes cold body, resulting in no sweat and cold body.
Pushing outward, if the pulse remains internal and does not reach the exterior, there is accumulation in the heart and abdomen. Pushing inward, if the pulse reaches the exterior but not the interior, there is heat in the body. Pushing upward, if the pulse ascends but does not descend, the waist and feet are cold. Pushing downward, if the pulse descends but does not ascend, there is pain in the head and neck. Pressing to the bone, if pulse Qi is weak, there is pain in the waist and spine with bi syndrome in the body.
"Push" is pronounced with the level tone. Continuing from the discussion of upper/lower and outer/inner diseases, diagnosis also employs methods of pushing outward/inward and upward/downward. "Pushing outward" means pressing with fingers toward the exterior. If the pulse is predominantly internal and does not reach the exterior, there is accumulation in the heart and abdomen. "Pushing inward" means pressing fingers toward the interior. If the pulse is predominantly external and does not reach the interior, there is pathogenic heat in the body. "Pushing upward" means pressing toward the upper Cun/Guan/Chi positions. If the pulse responds by ascending but not descending, this is upper excess and lower deficiency, causing cold waist and feet. "Pushing downward" means pressing toward the lower Cun/Guan/Chi positions. If the pulse responds by descending but not ascending, this is lower excess and upper deficiency, causing stiff and painful head and neck. If pressing to the bone yields little pulse response, this is Yin excess and Yang deficiency, where vital Yang Qi cannot ascend, leading to waist/spine pain and body bi syndrome. Continuing from the discussion of upper/lower and outer/inner diseases, diagnosis employs methods of pushing outward/inward and upward/downward. This answers the Yellow Emperor's inquiry regarding diseases fluctuating between internal and external locations, as described above.
This section addresses the five questions mentioned previously, answering each in turn, illustrating the essence of pulse diagnosis.