太过，病在外；如鸟之喙者，此谓不及，病在中。（如水之流者，滑而动也。如鸟之喙者，锐而短也。
太过病在外，不及病在中。喙，音诲， 也。）太过则令人四肢不举，其不及则令人九窍不通，
名曰重强。（脾土太过病在外，故令人四肢不举，以脾主四肢而湿胜之也。不及病在中，故令人九窍不通，
以脾气弱则四脏皆弱而气不行也。重强，不柔和貌，沉重拘强也。其来如水之流，滔滔洪盛者，其太过也。溅
溅不返者，其将竭也。均谓之流，一盛一危，迥然有异。如太过则令人四肢不举，以在外之标言之，若脾虚
不能胜湿者，则不可言太过矣。溅，音笺，浅而疾也。）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。（土得天地中和之气，长养万物，分王四时。而人胃应之；凡平人之常受气于谷，
谷入于胃，五脏六腑，皆以受气，故胃为脏腑之本。此胃气者，实平人之常气，有不可以一刻无者，无则为
逆，逆则死矣。胃气之见于脉者徐而和，无太过不及，自有一种雍容和缓之状者也。）春胃微弦曰平，（
春令木王，其脉当弦，但宜微弦而不至太过，是得春胃之充和也，故曰平。春弦、夏钩、秋毛、冬石，分四
季所属者，明时令之脉，不得不然也。然脉之迭见，有随时者，有不随时者。故或春而见钩，便是夏脉；春
而见毛，便是秋脉；春而见石，便是冬脉。因变知病，圆活在人，故有二十五变之妙。若谓春必弦，夏必钩，
则殊失胃气之精义矣。）弦多胃少曰肝病，（弦多者，过于弦也；胃少者，少和缓也。是肝邪之胜，胃气之
衰，故为肝病。）但弦无胃曰死，（但有弦急，而无充和之气者，是春时胃气已绝，而肝之真脏见也，故
曰死。）胃而有毛曰秋病，（毛为秋脉属金，春时得之，是为贼邪，以胃气尚存，故至
秋而后病。）毛甚曰今病，（春脉毛甚，则木被金伤，故不必至秋，今即
病矣。）脏真散于肝，肝藏筋膜之气也。（春木用事，其气升散，故脏真之气散于肝，而肝之所藏，则筋膜之
气也。藏，上、去声，下平声。）夏胃微钩曰平，（夏令火王，其脉当钩，但宜微钩，而不至太过，是得
夏胃之和也，故曰平。）钩多胃少曰心病，（钩多者，过于钩也；胃少者，少充和也。是心火偏胜，胃气
偏衰，故为心病。）但钩无胃曰死，（但有钩盛，而无平和之气者，是夏时胃气已绝，而心之真脏见也，故死。）
胃而有石曰冬病，（石为冬脉属水，夏时得之，是为贼邪，以胃气尚存故至冬而后病。）石甚曰今病，（
夏脉石盛，则无胃气，火被水伤已深，故不必至冬，今即病矣。）脏真通于心，心藏血脉之气也。（夏火用
事，其气炎上，故脏真之气通于心，而心之所藏，则血脉之气也。）长夏胃微 弱曰平，（长夏属土，虽
主建未之六月，然实兼辰、戌、丑、未四季之月为言也。四季土王之时，脉当 弱，但宜微有 弱，而不
至太过，是得长夏胃气之和缓也，故曰平。）弱多胃少曰脾病，（弱多胃少，则过于弱而胃气不足，以土王之
时而得之，故为脾病。）但代无胃曰死。（代，更代也。脾主四季，脉当随时而更，然必欲皆兼和 ，方得
脾脉之平。若四季相代而但弦、但钩、但毛、但石，是但代无胃，见真脏也，故曰死。） 弱有石曰冬病，（
石为冬脉属水，长夏阳气正盛，而见沉石之脉，以火土气衰而水反乘也，故至冬而病。）石甚曰今病，（长夏
石甚者，火土大衰，故不必至冬，今即病矣。）脏真濡于脾，脾藏肌肉之气也。（长夏湿土用事，其气濡润，
故脏真之气濡于脾，而脾之所藏，则肌肉之气也。）秋胃微毛曰平，（秋令金王，其脉当毛，但宜微毛而不
至太过，是得秋胃之和也，故曰平。毛者，脉来浮涩，得羽毛之轻虚也。）毛多胃少曰肺病，（毛多胃少，是
金气偏胜，而少和缓之气也，故为肺病。）但毛无胃曰死，（但毛无胃，是秋时胃气已绝，而肺之真脏见也，
故死。）毛而有弦曰春病，（弦为春脉属木，秋时得之，以金气衰而木反乘也，故至春木王时而病。）
弦甚曰今病，（秋脉弦甚，是金气大衰，而木寡于畏。
故不必至春，今即病矣。）脏真高于肺，以行荣卫阴阳也。（秋金用事，其气清肃，肺处上焦，故脏真之气
高于肺。肺主乎气，而营行脉中、卫行脉外者，皆自肺宣布，故以行营卫阴阳也。）冬胃微石曰平，（
冬令水王，脉当沉石，但宜微石而不至太过，是得冬胃之和也，故曰平。石者，脉来沉实，如石沉水之谓。）
石多胃少曰肾病，（石多胃少，是水气偏胜，反乘土也，故为肾病。）但石无胃曰死，（但石无胃，是冬
时胃气已绝，而肾之真脏见也，故死。）石而有钩曰夏病，（钩为夏脉属火，冬时得之，以水气衰而火反
侮也，故至夏火王时而病。）钩甚曰今病，（冬脉钩甚，其水气大衰，而火寡于畏，故不必至夏，今即病矣。）
脏真下于肾，肾藏骨髓之气也。（冬水用事，其气闭藏，故脏真之气下于肾，而肾之所藏，则骨髓之气也。）
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。（土为万物之母，故四时之脉，
皆以胃气为主。此言胃气所出之大络，名曰虚里，其脉从胃贯膈，上络于肺，而出左乳之下，其动应于衣，
是为十二经脉之宗，故曰“脉宗气也”。宗，主也，本也。盖宗气积于膻中，化于水谷，而出于胃也。）
盛喘数绝者，则病在中。（若虚里动甚而如喘，或数急而兼断绝者，由中气不守
而然，故曰“病在中”。）结而横，有积矣。（胃气之出，必出左乳之下。若有停阻，则结横为积。故
凡患症者，多在左肋之下，因胃气积滞而然。如肝之积名曰肥气，在左胁下者，以左右上下分发五行而言耳。
此实胃气所主也。）绝不至曰死。（虚里脉绝者，宗气绝也，故必死。）乳之下，其动应衣，宗气泄也。（
前言应衣者，言其微动，似乎应衣，可验虚里之胃气。此言应衣者，言其大动，真有若与衣俱振者，是宗
气不固而大泄于外，中虚之候也。按，虚里跳动，最为虚损病本，故凡患阴虚劳怯，则心下多有跳动，
及为惊悸慌张者，是即此证。人止知其心跳，而不知为虚里之动也。但动之微者，病尚微，动之甚者，病
则甚，亦可因此以察病之轻重。凡患此者，当以纯甘壮水之剂填补真阴。夫谷入于胃，以传于肺，
五脏六腑，皆以受气，是由胃气而上为宗气也。气为水母，气聚则水生，是由肺气而下生肾水也。今胃气传
之肺，而肾虚不能纳，故宗气泄于上。则肾水竭于下。肾愈虚则气愈无所归，气不归则阴愈虚矣。气水同
类，当求相济，故凡欲纳气归原者，惟有补阴以配阳一法。）脉从阴阳，病易已；脉逆阴阳，病难已。（阴
病得阴脉，阳病得阳脉谓之从，从者易已。脉病相反者为逆，逆者难已。）脉得四时之顺曰病无他，脉反
四时及不间脏曰难已。（春得弦，夏得钩，秋得毛，冬得石，谓之顺四时，虽曰有病，无他虞也。脉反四时及
不间脏，皆为难已。不间脏者，如木必乘土，则肝病传脾，土必乘水，则脾病传肾之类，是皆传其所胜，
不相假借。脉证得此，均名鬼贼，其气相残，其病必甚。若间其所胜之脏而传其所生，是谓间脏，如肝不
传脾而传心，心不传肺而传脾，其气相生，虽病亦微。间者并行，指间脏而言也；甚者独行，指不间脏而言
也。七传者死，间脏者生。七传者，传其所胜也；间脏者，传其所生也。如心胜肺。脾间之；脾胜肾，肺
间之；肺胜肝，肾间之；肾胜心，肝间之；肝胜脾，心间之之谓也。五脏有病，则各传其所胜，不治，法三
月，若六月，若三日，若六日，传五脏而当死，是顺传所胜之次，即此“不间脏”之谓也。
间，去声。）脉有逆从四时，未有脏形，春夏而脉瘦，秋冬而脉浮大，命曰逆四时也。（逆从四时者，虽
未有真脏之形见，若春夏以木火之令，脉当浮大而反见瘦小，秋冬以金水之令，脉当沉细而反见浮大，
是皆逆四时也。）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。（风
热者，阳邪也，脉宜大而反静；泄而脱血，伤其阴也，脉宜虚而反实；病在脏中，脉当有力
而反虚；病在肌表，脉当浮滑而反涩坚者，皆为相反难治之证，亦由脉之反四时也。）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。（人生所赖者水谷，故胃气以水谷为本，而
五脏又以胃气为本。若脉无胃气，而真脏之脉独见者死。然但弦、但石，虽为真脏，若肝无气则不弦，肾
无气则不石，亦由五脏不得胃气而然，与真脏无胃者等耳。）凡治病，察其形气色泽，脉之盛衰，病之新故，
乃治之，无后其时。（察其形气色泽，脉之盛衰病之新故者，所谓望、闻、问、切之法也。既得病情，
盒饭速治。若后其时，病必自深。）形气相得，谓之可治；（形盛气盛，形虚气虚，是相得也。）色泽以浮，谓
之易已；（泽，润也。浮，明也。颜色明润者，病必易已也。）脉从四时，谓之可治；（脉顺四时者，其气
盛，故可治。）脉弱以滑，是有胃气，命曰易治，取之以时。（谷气来也徐而和，故脉弱以滑者，是得胃气，
命曰易治也。）形气相失，谓之难治；（形盛气虚，气盛形虚，皆为相失。此下四节，皆言难治也。）色夭
不泽，谓之难已∶（夭，晦恶也。不泽，枯焦也。）脉实以坚，谓之益甚；（邪气来也紧而疾，故实以坚者，
病必益甚。）脉逆四时，为不可治。（脉逆四时，贼克也。）必察四难而明告之。（形气色脉，如上四节之
难治者，谓之“四难”。必察其详而明告之，庶无后怨。）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。（春得肺脉，金克木也；夏得肾脉，水克火也；秋得心
脉，火克金也；冬得脾脉，土克水也。加之悬绝沉涩，则阴阳偏绝，无复充和之胃气矣。）未有脏形，
于春夏而脉沉涩，秋冬而脉浮大，名曰逆四时也。病热脉静，泄而脉大，脱血而脉实，病在中脉实坚，病在
外脉不实坚者，皆难治。（病在中脉实坚，病在外脉不实坚者，皆难治。病在中脉虚，言内积之实者脉不宜
虚也；病在中脉实坚，言内伤之虚者脉不宜实坚也；病在外脉涩坚，言外邪之盛者不宜涩坚，以涩坚为沉阴
也；病在外脉不实坚，言外邪方炽者不宜无力，以不实坚为无阳也。四者之分，总皆正不胜邪之脉，故曰难治。
反复推详以申明之，与前节词若相反，而理则同也。）夫平心脉来，累累如连珠，如循琅 ，曰心平。（琅
，玉而有光者。脉来中手如连珠，如琅 者，言其盛满滑利，即微钩之义也，是为心之平脉。前分四时，
已悉五脏平、病、死脉，此则详言其形也。琅 ，音良干。）夏以胃气为本，（钩而和也。）病心脉来，喘喘
连属，其中微曲，曰心病；（喘喘连属，急促相仍也。其中微曲，即钩多胃少之义，故曰“心病”。）死心脉
来，前曲后居，如操带钩，曰心死。（操，持也。前曲者，谓轻取则坚强而不柔；后居者，谓重取则
牢实而不动，如持革带之钩而全失充和之气，是但钩无胃也，故曰“心死”。）平肺脉来，厌厌聂聂，如落榆
荚，曰肺平。（厌厌聂聂，众苗秀齐貌。如落榆荚，轻浮和缓貌。即微毛之义也。是为肺之平脉。聂，鸟结
切。）秋以胃气为本，（毛而和也。）病肺脉来，不上不下，如循鸡羽，曰肺病；（不上不下，往来涩滞也。
如循鸡羽，轻浮而虚也。亦毛多胃少之义，故曰“肺病”。）死肺脉来，如物之浮，如风吹毛，曰
肺死。（如物之浮，空虚无根也。如风吹毛，散乱无绪也。亦但毛无胃之义，故曰“肺死”。）平肝脉来，
弱招招，如揭长竿末梢，曰肝平。（招招，犹迢迢也。揭，高举也。高揭长竿，梢必柔 ，即和缓弦长
之义，是为肝之平脉。）春以胃气为本，（弦而和也。）病肝脉来，盈实而滑，如循长竿，曰肝病；（盈实而
滑，弦之甚过也。如循长竿，无末梢之和 也。亦弦多胃少之义，故曰“肝病”。）死肝脉来，急
益劲，如新张弓弦，曰肝死。（劲，强急也。如新张弓弦，弦之甚也。亦但弦无胃之义，故曰“肝死”。）
平脾脉来，和柔相离，如鸡践地，曰脾平。（和柔，雍容不迫也。相离，匀净分明也。如鸡践地，从
容轻缓也。此即充和之气，亦微 弱之义，是谓脾之平脉。）长夏以胃气为本，（ 而和也。）病脾脉来，
实而盈数，如鸡举足，曰脾病；（实和盈数，强急不和也。如鸡举足，轻疾不缓也。前言弱多胃少，
此言实而盈数，皆失中和之气，故曰“脾病”。）死脾脉来，锐坚如鸟之喙，如鸟之距，如屋之漏，
如水之流，曰脾死。（鸟喙、鸟
Excessive pulse indicates disease in the exterior; a pulse sharp and short like a bird's beak is termed "deficient," indicating disease in the interior. (A pulse flowing like water is slippery and moving. A pulse like a bird's beak is sharp and short. Excess leads to disease in the exterior, deficiency to disease in the interior. "Beak" [Hui] refers to being sharp and short.) Excess causes the limbs to become immobile; deficiency causes the nine orifices to become obstructed. This condition is called "Chong Qiang" (Heavy Stiffness). (Spleen Earth excess affects the exterior, causing limb immobility, as the Spleen governs the limbs and dampness prevails. Deficiency affects the interior, causing obstruction of the nine orifices, as weak Spleen Qi leads to weakness in the other four Zang organs and stagnation of Qi flow. Chong Qiang describes a state of heaviness and stiffness without flexibility. A pulse coming like a surging river indicates excess. A pulse sounding like shallow, rapid splashing indicates impending exhaustion. Both are termed "flowing," yet one signifies abundance while the other signifies danger, showing distinct differences. If excess causes limb immobility, this is described from the perspective of exterior branch symptoms; if it is due to Spleen deficiency failing to overcome dampness, it cannot be termed excess. "Jian" [Jian] refers to shallow and rapid water flow.)
The normal Qi of a healthy person is derived from the Stomach; the Stomach is the source of normal Qi. A person without Stomach Qi is termed "Ni" (Rebellious), and those with Ni die. (Earth receives the harmonious Qi of Heaven and Earth to nourish all things and governs the four seasons. The human Stomach corresponds to this; all healthy people derive Qi from grain. Grain enters the Stomach, and the Five Zang and Six Fu organs receive Qi from it. Thus, the Stomach is the root of the Zang and Fu organs. This Stomach Qi is indeed the normal Qi of a healthy person, indispensable for even a moment; its absence constitutes Ni, leading to death. Stomach Qi manifested in the pulse is slow and harmonious, lacking neither excess nor deficiency, possessing a naturally graceful and relaxed quality.)
In Spring, a pulse slightly wiry [Xian] is called Ping (Normal). (Spring Wood Qi is dominant, so the pulse should be wiry, but only slightly so, not excessive. This reflects the harmonious充盈 [fullness] of Spring Stomach Qi, hence termed Normal. Spring Wiry, Summer Hook, Autumn Feather, Winter Stone correspond to the four seasons, clarifying that seasonal pulses are inevitable. However, pulse changes may or may not follow the seasons. Thus, a Hook pulse in Spring is a Summer pulse; a Feather pulse in Spring is an Autumn pulse; a Stone pulse in Spring is a Winter pulse. Understanding disease through these variations allows for flexible diagnosis, hence the subtlety of twenty-five variations. To insist that Spring must be wiry and Summer must be hook-like would significantly miss the essence of Stomach Qi.)
Wiry pulse with less Stomach Qi indicates Liver disease. (Wiry excess means overly wiry; less Stomach Qi means lacking harmony. This indicates Liver pathogen dominance and Stomach Qi decline, thus termed Liver disease.) A wiry pulse without Stomach Qi indicates death. (Only wiry and urgent, lacking harmonious Qi, indicates that Spring Stomach Qi has perished and the True Zang pulse of the Liver appears, hence death.)
Stomach Qi present with a Feather pulse indicates illness in Autumn. (Feather is the Autumn pulse belonging to Metal. Appearing in Spring, it is a "Thief Evil." Because Stomach Qi still exists, illness manifests only in Autumn.) A very strong Feather pulse indicates current illness. (Strong Feather pulse in Spring implies Wood injured by Metal, so illness occurs now, not waiting for Autumn. Zhen Zhen [True Essence] Qi scatters into the Liver; the Liver stores the Qi of sinews and fascia. (Spring Wood acts, its Qi ascending and scattering, so Zhen Zhen Qi scatters into the Liver, which stores the Qi of sinews and fascia. "Zang" is pronounced with rising tone here, and level tone later.)
In Summer, a pulse slightly hook-like [Gou] is called Ping (Normal). (Summer Fire Qi is dominant, so the pulse should be hook-like, but only slightly, not excessive. This reflects the harmony of Summer Stomach Qi, hence termed Normal.) Hook pulse with less Stomach Qi indicates Heart disease. (Hook excess means overly hook-like; less Stomach Qi means lacking harmony. This indicates Heart Fire excess and Stomach Qi decline, thus termed Heart disease.) A hook pulse without Stomach Qi indicates death. (Only hook-like and vigorous, lacking peaceful Qi, indicates that Summer Stomach Qi has perished and the True Zang pulse of the Heart appears, hence death.)
Stomach Qi present with a Stone pulse indicates illness in Winter. (Stone is the Winter pulse belonging to Water. Appearing in Summer, it is a "Thief Evil." Because Stomach Qi still exists, illness manifests only in Winter.) A very strong Stone pulse indicates current illness. (Strong Stone pulse in Summer implies no Stomach Qi, Fire deeply injured by Water, so illness occurs now, not waiting for Winter. Zhen Zhen Qi connects to the Heart; the Heart stores the Qi of blood vessels. (Summer Fire acts, its Qi flaming upward, so Zhen Zhen Qi connects to the Heart, which stores the Qi of blood vessels.)
In Late Summer, a pulse slightly alternating/weak [Dai/Ruo] is called Ping (Normal). (Late Summer belongs to Earth. Although primarily referring to the sixth month [Wei], it actually encompasses the months of Chen, Xu, Chou, and Wei, representing the four seasons. During Earth-dominant times, the pulse should be Dai/Ruo, but only slightly so, not excessive. This reflects the harmony of Late Summer Stomach Qi, hence termed Normal.) Dai/Ruo pulse with less Stomach Qi indicates Spleen disease. (Dai/Ruo excess with less Stomach Qi means overly Dai/Ruo and insufficient Stomach Qi. Obtained during Earth-dominant time, it is termed Spleen disease.) A Dai pulse without Stomach Qi indicates death. ("Dai" means alternating. The Spleen governs the four seasons, so the pulse should alternate with them, but must always include harmony to be a normal Spleen pulse. If the four seasons alternate showing only Wiry, only Hook, only Feather, or only Stone, this is Dai without Stomach Qi, revealing the True Zang, hence death.)
Dai/Ruo pulse with Stone pulse indicates illness in Winter. (Stone is the Winter pulse belonging to Water. In Late Summer when Yang Qi is abundant, seeing a deep Stone pulse indicates Fire and Earth Qi decline allowing Water to overact, so illness manifests in Winter.) Very strong Stone pulse indicates current illness. (Strong Stone pulse in Late Summer indicates severe Fire and Earth decline, so illness occurs now, not waiting for Winter. Zhen Zhen Qi moistens the Spleen; the Spleen stores the Qi of muscles. (Late Summer damp Earth acts, its Qi moistening, so Zhen Zhen Qi moistens the Spleen, which stores the Qi of muscles.)
In Autumn, a pulse slightly feather-like [Mao] is called Ping (Normal). (Autumn Metal Qi is dominant, so the pulse should be feather-like, but only slightly, not excessive. This reflects the harmony of Autumn Stomach Qi, hence termed Normal. "Mao" means the pulse comes floating and choppy, light and void like falling feathers.) Feather pulse with less Stomach Qi indicates Lung disease. (Feather excess with less Stomach Qi indicates Metal Qi excess and lack of harmony, thus termed Lung disease.) A feather pulse without Stomach Qi indicates death. (Only feather-like without Stomach Qi indicates Autumn Stomach Qi has perished and the True Zang pulse of the Lung appears, hence death.)
Feather pulse with Wiry pulse indicates illness in Spring. (Wiry is the Spring pulse belonging to Wood. Appearing in Autumn, it indicates Metal Qi decline allowing Wood to overact, so illness manifests in Spring when Wood is dominant.) Very strong Wiry pulse indicates current illness. (Strong Wiry pulse in Autumn indicates severe Metal decline and Wood lacking restraint, so illness occurs now, not waiting for Spring. Zhen Zhen Qi rises above the Lung to circulate Ying and Wei and Yin-Yang. (Autumn Metal acts, its Qi clear and肃 [solemn]. The Lung resides in the Upper Jiao, so Zhen Zhen Qi rises above the Lung. The Lung governs Qi, and Ying circulating in vessels and Wei circulating outside vessels are all announced by the Lung, thus governing the circulation of Ying, Wei, Yin, and Yang.)
In Winter, a pulse slightly stone-like [Shi] is called Ping (Normal). (Winter Water Qi is dominant, so the pulse should be deep and stone-like, but only slightly, not excessive. This reflects the harmony of Winter Stomach Qi, hence termed Normal. "Shi" means the pulse comes deep and solid, like a stone sinking in water.) Stone pulse with less Stomach Qi indicates Kidney disease. (Stone excess with less Stomach Qi indicates Water Qi excess overacting on Earth, thus termed Kidney disease.) A stone pulse without Stomach Qi indicates death. (Only stone-like without Stomach Qi indicates Winter Stomach Qi has perished and the True Zang pulse of the Kidney appears, hence death.)
Stone pulse with Hook pulse indicates illness in Summer. (Hook is the Summer pulse belonging to Fire. Appearing in Winter, it indicates Water Qi decline allowing Fire to insult, so illness manifests in Summer when Fire is dominant.) Very strong Hook pulse indicates current illness. (Strong Hook pulse in Winter indicates severe Water decline and Fire lacking restraint, so illness occurs now, not waiting for Summer. Zhen Zhen Qi descends to the Kidney; the Kidney stores the Qi of bone marrow. (Winter Water acts, its Qi storing and closing, so Zhen Zhen Qi descends to the Kidney, which stores the Qi of bone marrow.)
The great collateral of the Stomach is named Xuli [Empty Well], piercing the diaphragm and connecting to the Lung, emerging below the left breast. Its movement makes clothes tremble; it is the Pulse of Zong Qi (Pectoral Qi). (Earth is the mother of all things, so all four-season pulses prioritize Stomach Qi. This states the great collateral where Stomach Qi emerges, named Xuli. Its pulse travels from the Stomach, pierces the diaphragm, connects upward to the Lung, and emerges below the left breast. Its movement makes clothes tremble, making it the master of the twelve meridians, hence "Pulse of Zong Qi." Zong means master/root. Zong Qi accumulates in the Danzhong [Chest Center], transforms from grain/water, and emerges from the Stomach.)
If Xuli moves rapidly like panting or is frequent and interrupted, disease is in the interior. (If Xuli moves excessively like panting, or frequently and urgently with interruptions, it results from Middle Qi failing to hold, hence "disease in the interior.") If the pulse knots and extends horizontally, there is accumulation. (Stomach Qi must emerge below the left breast. If blocked, it knots and extends horizontally, forming accumulation. Thus, patients with masses often have them below the left hypochondrium due to Stomach Qi stagnation. For example, the Liver accumulation named Feiqi [Fat Qi] is below the left hypochondrium, explained by distributing Five Elements to left/right/up/down. This is actually governed by Stomach Qi.) If the pulse ceases and does not return, it indicates death. (Absence of Xuli pulse means Zong Qi has perished, hence certain death.) Movement below the breast making clothes tremble indicates leakage of Zong Qi. (The previous mention of "making clothes tremble" referred to slight movement verifying Stomach Qi in Xuli. This mention refers to violent movement truly shaking the clothes, indicating Zong Qi is unsecured and leaking outward, a sign of Middle Deficiency. Note: Xuli pulsation is the root of deficiency diseases. Patients with Yin-deficiency consumption often have pulsation below the heart or palpitations/anxiety, which is this syndrome. People know it as heart beating but not as Xuli movement. Slight movement indicates mild disease; severe movement indicates severe disease. One can judge disease severity by this. Patients should use pure sweet and water-nourishing formulas to tonify True Yin. Grain enters the Stomach, transmits to the Lung, and the Five Zang/Six Fu receive Qi; this is Zong Qi rising from Stomach Qi. Qi is the mother of Water; when Qi gathers, Water generates; this is Kidney Water generating downward from Lung Qi. Now Stomach Qi transmits to Lung, but Kidney deficiency fails to grasp it, so Zong Qi leaks upward. Thus Kidney Water exhausts downward. The more Kidney deficient, the less Qi has a home; if Qi does not return, Yin becomes more deficient. Qi and Water are similar; they should aid each other. Thus, to guide Qi back to its origin, the only method is tonifying Yin to match Yang.)
If the pulse follows Yin-Yang, the disease is easy to cure; if the pulse opposes Yin-Yang, the disease is hard to cure. (Yin disease getting Yin pulse, Yang disease getting Yang pulse is termed "Cong" [Following]; Following means easy cure. Pulse opposite to disease is termed "Ni" [Opposing]; Opposing means hard cure.) If the pulse conforms to the four seasons, the disease has no other complications; if the pulse opposes the four seasons or involves non-intervening Zang, it is hard to cure. (Spring Wiry, Summer Hook, Autumn Feather, Winter Stone is termed conforming to four seasons. Even if diseased, there is no worry. Opposing four seasons and non-intervening Zang are both hard to cure. Non-intervening Zang means, e.g., Wood inevitably overacts on Earth, so Liver disease transmits to Spleen; Earth overacts on Water, so Spleen disease transmits to Kidney. These transmit to what they conquer, without borrowing. Such pulse/syndrome combinations are called "Ghost Thief," where Qi destroys each other, and disease is severe. If transmitting to the generating Zang instead of the conquered Zang, it is termed "Intervening Zang," e.g., Liver transmits to Heart instead of Spleen, Heart to Lung instead of Spleen. Their Qi generates each other; though diseased, it is mild. "Jian" [Intervening] proceeds together, referring to intervening Zang; "Shen" [Severe] proceeds alone, referring to non-intervening Zang. Seven transmissions lead to death; intervening Zang leads to life. Seven transmissions transmit to what they conquer; intervening Zang transmits to what they generate. E.g., Heart conquers Lung, Spleen intervenes; Spleen conquers Kidney, Lung intervenes; Lung conquers Liver, Kidney intervenes; Kidney conquers Heart, Liver intervenes; Liver conquers Spleen, Heart intervenes. When Five Zang are diseased, they each transmit to what they conquer. Without treatment, within three months, six months, three days, or six days, transmitting through five Zang leads to death. This is the order of順 [smooth] transmission to what they conquer, i.e., "non-intervening Zang." Jian, departing tone.)
Pulses may oppose or follow the four seasons. Without True Zang form appearing, if pulses are thin/small in Spring/Summer and floating/large in Autumn/Winter, it is termed opposing the four seasons. (Opposing/following four seasons: even without True Zang form, if Spring/Summer [Wood/Fire command] pulses should be floating/large but appear thin/small, and Autumn/Winter [Metal/Water command] pulses should be deep/fine but appear floating/large, these all oppose the four seasons.) Wind-heat with quiet pulse, diarrhea/blood loss with full pulse, interior disease with empty pulse, exterior disease with choppy/firm pulse are all hard to treat, termed opposing the four seasons. (Wind-heat is Yang pathogen; pulse should be large but is quiet. Diarrhea/blood loss injures Yin; pulse should be empty but is full. Interior disease pulse should be forceful but is empty. Exterior disease pulse should be floating/slipping but is choppy/firm. All are opposite/hard-to-treat syndromes, also due to opposing four seasons.) Humans rely on water and grain as their root; thus, humans die without water/grain, and those without Stomach Qi in pulse also die. What is meant by "no Stomach Qi" is obtaining only True Zang pulse, not Stomach Qi. What is meant by "pulse lacking Stomach Qi" is Liver not wiry, Kidney not stone. (Humans rely on water/grain, so Stomach Qi relies on water/grain, and Five Zang rely on Stomach Qi. If pulse lacks Stomach Qi and only True Zang pulse appears, death ensues. However, only wiry or only stone, though True Zang, if Liver has no Qi it is not wiry, if Kidney has no Qi it is not stone. This also results from Five Zang lacking Stomach Qi, equal to True Zang without Stomach Qi.)
In treating all diseases, observe form, Qi, color, luster, pulse strength/decline, and disease newness/oldness, then treat, without delaying the time. (Observing form, Qi, color, luster, pulse strength/decline, and disease newness/oldness is the method of Inspection, Auscultation/Olfaction, Inquiry, and Palpation. Once disease condition is known, treat quickly. Delaying leads to deepening disease.) If Form and Qi match, it is treatable. (Form full/Qi full, Form empty/Qi empty is matching.) If color and luster are bright, it is easy to cure. (Luster means moist. Bright means clear. Bright and moist color means disease will easily cure.) If pulse follows four seasons, it is treatable. (Pulse following four seasons means Qi is abundant, hence treatable.) If pulse is weak and slipping, it has Stomach Qi, termed easy to treat, treated in due time. (Grain Qi arrives slowly and harmoniously, so weak and slipping pulse indicates Stomach Qi, termed easy to treat.)
If Form and Qi mismatch, it is hard to treat. (Form full/Qi empty, Qi full/Form empty is mismatch. The following four sections all discuss hard-to-treat cases.) If color is dull and not lustrous, it is hard to cure. (Dull means dark/ugly. Not lustrous means withered/dry.) If pulse is full and firm, it is increasingly severe. (Pathogenic Qi arrives tight and rapid, so full and firm pulse means disease will increasingly severe.) If pulse opposes four seasons, it is untreatable. (Pulse opposing four seasons is thief conquest.) Must examine the four difficulties and clearly inform the patient. (Form, Qi, Color, Pulse as in the four difficult sections above are termed "Four Difficulties." Must examine details and clearly inform, to avoid future regret.)
What is termed opposing the four seasons is: Spring getting Lung pulse, Summer getting Kidney pulse, Autumn getting Heart pulse, Winter getting Spleen pulse, where the pulse is suspended, absolute, deep, and choppy, termed opposing the four seasons. (Spring Lung pulse: Metal conquers Wood. Summer Kidney pulse: Water conquers Fire. Autumn Heart pulse: Fire conquers Metal. Winter Spleen pulse: Earth conquers Water. Plus suspended/absolute/deep/choppy, Yin-Yang is partially severed, no remaining harmonious Stomach Qi.) Without True Zang form appearing, if pulse is deep/choppy in Spring/Summer and floating/large in Autumn/Winter, it is termed opposing the four seasons. Disease heat with quiet pulse, diarrhea with large pulse, blood loss with full pulse, interior disease with full/firm pulse, exterior disease with not-full/not-firm pulse are all hard to treat. (Interior full/firm, exterior not-full/not-firm are hard to treat. Interior empty pulse means internal accumulation excess should not have empty pulse. Interior full/firm pulse means internal injury deficiency should not have full/firm pulse. Exterior choppy/firm pulse means external pathogen excess should not have choppy/firm, as choppy/firm is deep-Yin. Exterior not-full/not-firm pulse means external pathogen raging should not be powerless, as not-full/not-firm is Yang-less. The distinction of these four is total Zheng [Righteous] failing to overcome Xie [Pathogen] pulse, hence hard to treat. Repeated reasoning clarifies this; words seem opposite to previous section, but principle is same.)
Normal Heart pulse comes continuously like pearls, like touching Langgan [agate], called Heart Ping (Normal). (Langgan is jade with luster. Pulse coming like pearls, like Langgan, means full, slippery, and smooth, i.e., slight Hook meaning, this is Heart Normal pulse. Previous four seasons covered all Five Zang Ping/Bing/Si pulses; this details the form. Langgan, sound Lianggan.) Summer prioritizes Stomach Qi (Hook and harmonious). Diseased Heart pulse comes panting and continuous, slightly curved in middle, called Heart Bing (Disease). (Panting continuous means urgent succession. Slightly curved middle means Hook excess/Stomach Qi deficiency, hence "Heart Disease".) Dead Heart pulse comes curved at front and fixed at back, like holding a belt hook, called Heart Si (Death). (Hold means grasp. Front curved means light pressure is hard/unyielding. Back fixed means heavy pressure is solid/motionless, like holding a leather belt hook losing all harmony. This is Hook without Stomach Qi, hence "Heart Death".)
Normal Lung pulse comes gentle and fluttering, like falling elm seeds, called Lung Ping (Normal). (Gentle/fluttering means seedlings growing evenly. Like falling elm seeds means light, floating, and harmonious. i.e., slight Mao [Feather] meaning. This is Lung Normal pulse. Nie, sound Niao jie qie.) Autumn prioritizes Stomach Qi (Mao and harmonious). Diseased Lung pulse comes neither up nor down, like touching chicken feather, called Lung Bing (Disease). (Neither up nor down means rough and stagnant flow. Like touching chicken feather means light, floating, and empty. Also Mao excess/Stomach Qi deficiency, hence "Lung Disease".) Dead Lung pulse comes like floating object, like wind blowing hair, called Lung Si (Death). (Like floating object means empty without root. Like wind blowing hair means scattered without order. Also Mao without Stomach Qi, hence "Lung Death".)
Normal Liver pulse comes long and graceful, like holding the tip of a long pole, called Liver Ping (Normal). (Long/graceful means distant. Hold means raise high. Holding long pole high, tip must be soft, i.e., harmonious, wiry, and long meaning. This is Liver Normal pulse.) Spring prioritizes Stomach Qi (Wiry and harmonious). Diseased Liver pulse comes full, solid, and slippery, like touching long pole, called Liver Bing (Disease). (Full/solid/slippery is excessive wiry. Like touching long pole lacks tip harmony. Also Wiry excess/Stomach Qi deficiency, hence "Liver Disease".) Dead Liver pulse comes urgent and strong, like newly strung bowstring, called Liver Si (Death). (Strong means rigid/urgent. Like newly strung bowstring is extreme wiry. Also Wiry without Stomach Qi, hence "Liver Death".)
Normal Spleen pulse comes harmonious and soft, distinct, like chicken walking on ground, called Spleen Ping (Normal). (Harmonious/soft means graceful/unhurried. Distinct means neat/clear. Like chicken walking means leisurely/light/slow. This is harmonious Qi, also slight Dai/Ruo meaning, termed Spleen Normal pulse.) Late Summer prioritizes Stomach Qi (Dai and harmonious). Diseased Spleen pulse comes full,盈 [full/plump], and rapid, like chicken lifting foot, called Spleen Bing (Disease). (Full/plump/rapid is rigid/unharmonious. Like chicken lifting foot is light/fast/unslow. Previous said Dai/Ruo excess/Stomach Qi deficiency; this says full/plump/rapid. Both lose neutral/harmonious Qi, hence "Spleen Disease".) Dead Spleen pulse comes sharp and firm like bird beak, like bird spur, like leaking roof, like flowing water, called Spleen Si (Death). (Bird beak, bird spur...)