（素问平人气象论）
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，如玉机真藏论曰∶脉弱以滑，是有胃气。终始篇曰∶邪气来也紧
而疾，谷气来也徐而和。是皆胃气之谓。大都脉代时宜无太过无不及，自有一种雍容和缓之状者，便是胃气之脉。）
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。（弦义见前章。按∶此前
后诸篇，皆以春弦夏钩秋毛冬石分四季所属者，在欲明时令之脉，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，而肝之真藏见也，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。）藏真散于肝，肝藏筋膜之气也。（春木用事，其气升散，故藏真之气散于肝，而肝之所藏
则筋膜之气也。金匮真言论曰∶东方青色，入通于肝，是以知病之在筋也。藏，上去声，下平声。后皆同。）
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。钩义见前章。）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，而心之真藏见也，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，（夏脉石甚则无胃气，火被水伤已深，故不必至冬，今即病矣。）藏真通于心，
心藏血脉之气也。（夏火用事，其气炎上，故藏真之气通于心，而心之所藏则血脉之气也。金匮真言论曰∶南方赤色，入
通于心，是以知病之在脉也。）
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。 ，软同。）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，见真藏也，故曰死。代脉详义见本类前第四章及疾病类
二十五。） 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。）弱甚
曰今病，（弱，当作石。长夏石甚者，火土大衰，故不必至冬，今即病矣。）藏真濡于脾，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。金匮真言论曰∶中央黄色，入通于脾，是以知病之在
肉也。）
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，类羽毛
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，而肺之真藏见也，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。）藏真高于肺，以行荣卫阴阳也。
（秋金用事，其气清肃，肺处上焦，故藏真之气高于肺，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，而肾之真藏见也，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，是水气大衰而火寡于畏，故不必至夏，今即病矣。）藏真下于肾，肾藏骨髓之气也。（冬
水用事，其气闭藏，故藏真之气下于肾，而肾之所藏，则骨髓之气也。金匮真言论曰∶北方黑色，入通于肾，是以知病
之在骨也。）
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，故上文四时之脉，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。经脉篇所载十五络，并此共十六络，详具十六
络穴图中。又脾为阴土义，详疾病类五十二。）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。数音朔。）结而横，有积矣；（胃气之出，必由左乳之下，若有停阻则结横为积，故凡患 者
多在左肋之下，因胃气积滞而然。如五十六难曰，肝之积名曰肥气在左胁下者，盖以左右上下分发五行而言耳，而此实
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。
愚按∶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，余常以纯甘壮水之剂，填
补真阴，活者多矣。然经言宗气之泄，而余谓真阴之虚，其说似左，不知者必谓谬诞，愚请竟其义焉。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。）
(Su Wen: Ping Ren Qi Xiang Lun)
The normal qi of a healthy person is derived from the Stomach; the Stomach is the root of the normal qi in a healthy person. If a person lacks Stomach qi, it is called "Ni" (Reversal), and the appearance of "Ni" indicates death. (Earth qi obtains the harmonious qi of heaven and earth, nourishing all things, and rules over the four seasons in turn, while the human Stomach corresponds to it. Generally, the normal state of a healthy person involves obtaining qi from food and grain; when grain enters the Stomach, the Zang and Fu organs all receive its qi. Therefore, the Stomach is the root of the Zang and Fu organs. This Stomach qi is indeed the normal qi of a healthy person, indispensable even for an instant; without it, there is "Ni", and with "Ni", there is death. The manifestation of Stomach qi in the pulse is described in Yu Ji Zhen Zang Lun as: "A pulse that is weak and slippery indicates the presence of Stomach qi." Zhong Shi Pian states: "When pathogenic qi arrives, it is tight and rapid; when grain qi (Stomach qi) arrives, it is slow and harmonious." These all refer to Stomach qi. Broadly speaking, pulses change according to the season but should not be excessive or deficient, possessing a naturally graceful and moderate quality; this is the pulse of Stomach qi.)
In spring, a pulse with a slight Xian (String-like) quality is called a Ping (Normal) pulse. (Spring Wood qi is prosperous, so the pulse should be Xian, but it should only be slightly Xian without being excessive, indicating the fullness and harmony of Spring Stomach qi; thus it is called Ping. The meaning of Xian is seen in the previous chapter. Note: In these preceding and following chapters, the pulses of Spring Xian, Summer Gou (Hook), Autumn Mao (Feather), and Winter Shi (Stone) are used to assign the four seasons. To explain seasonal pulses, this is necessary. However, pulse changes vary; some follow the season, others do not. Thus, if a Gou pulse appears in spring, it is a Summer pulse; if a Mao pulse appears in spring, it is an Autumn pulse; if a Shi pulse appears in spring, it is a Winter pulse. By observing changes, one can understand pathology, and flexibility lies with the practitioner, hence the subtlety of twenty-five variations. To say that spring must always be Xian and summer must always be Gou would severely miss the essence of Stomach qi.) If the Xian quality is prominent and Stomach qi is scant, it is called Liver disease. (Prominent Xian means excessively string-like. Scant Stomach qi means a lack of moderation. This indicates Liver pathogen excess and Stomach qi deficiency, hence Liver disease.) If there is only Xian without Stomach qi, it indicates death. (Only string-like tension without harmonious qi indicates that Spring Stomach qi has exhausted, revealing the True Zang pulse of the Liver; thus, it indicates death.) If there is Stomach qi combined with Mao (Feather-like) pulse, illness will occur in Autumn. (Mao pulse belongs to Autumn Metal. Appearing in Spring, it is a "Thief Pathogen". Since Stomach qi still exists, illness manifests later in Autumn.) If the Mao quality is severe, illness occurs now. (Severe Mao pulse in Spring indicates Wood injured by Metal; illness occurs immediately, without waiting for Autumn.) The Zhen Zhen (True Visceral) qi scatters into the Liver, which stores the qi of the sinews/fascia. (Spring Wood qi governs, its nature ascending and dispersing; thus, Zhen Zhen qi scatters into the Liver, and the Liver stores the qi of fascia. Jin Gui Zhen Yan Lun states: "East corresponds to Green, entering through the Liver"; therefore, we know disease affects the sinews. 'Zang' is pronounced with the departing tone, the second character with the level tone; this applies subsequently.)
In summer, a pulse with a slight Gou (Hook) quality is called a Ping (Normal) pulse. (Summer Fire qi is prosperous, so the pulse should be Gou, but it should only be slightly Gou without being excessive, indicating the harmony of Summer Stomach qi; thus it is called Ping. The meaning of Gou is seen in the previous chapter.) If the Gou quality is prominent and Stomach qi is scant, it is called Heart disease. (Prominent Gou means excessively hook-like. Scant Stomach qi means a lack of harmony. This indicates Heart Fire excess and Stomach qi deficiency, hence Heart disease.) If there is only Gou without Stomach qi, it indicates death. (Only hook-like prominence without harmonious qi indicates that Summer Stomach qi has exhausted, revealing the True Zang pulse of the Heart; thus, death.) If there is Stomach qi combined with Shi (Stone-like) pulse, illness will occur in Winter. (Shi pulse belongs to Winter Water. Appearing in Summer, it is a "Thief Pathogen". Since Stomach qi still exists, illness manifests later in Winter.) If the Shi quality is severe, illness occurs now. (Severe Shi pulse in Summer indicates absence of Stomach qi; Fire deeply injured by Water; illness occurs immediately, without waiting for Winter.) The Zhen Zhen qi connects to the Heart, which stores the qi of the blood vessels. (Summer Fire qi governs, its nature flaming upward; thus, Zhen Zhen qi connects to the Heart, and the Heart stores the qi of blood vessels. Jin Gui Zhen Yan Lun states: "South corresponds to Red, entering through the Heart"; therefore, we know disease affects the vessels.)
In late summer, a pulse with a slight Ruo (Weak/Soft) quality is called a Ping (Normal) pulse. (Late summer belongs to Earth. Although it primarily refers to the sixth month (Jian Wei), it actually encompasses the months of Chen, Xu, Chou, and Wei (the four seasons). During times when Earth qi governs the four seasons, the pulse should be Ruo, but it should only be slightly Ruo without being excessive, indicating the moderation of Late Summer Stomach qi; thus it is called Ping. 'Ruo' is synonymous with 'Ruan' [soft].) If the Ruo quality is prominent and Stomach qi is scant, it is called Spleen disease. (Prominent Ruo and scant Stomach qi mean excessively soft/weak pulse with insufficient Stomach qi. Appearing during Earth-governing times, it is Spleen disease.) If there is only Dai (Intermittent/Replacing) pulse without Stomach qi, it indicates death. ('Dai' means replacement. The Spleen governs the four seasons, so the pulse should replace/change with the seasons, but must always include moderate and soft qualities to be a normal Spleen pulse. If, during seasonal replacement, one sees only Xian, Gou, Mao, or Shi without Stomach qi, this is "only Dai without Stomach qi," revealing the True Zang pulse; thus, death. Detailed meaning of Dai pulse is in Chapter 4 of this category and Chapter 25 of Disease Category.) If Ruo pulse combines with Shi pulse, illness will occur in Winter. (Shi pulse belongs to Winter Water. Appearing in Late Summer when Yang qi is abundant, it indicates Fire and Earth qi decline allowing Water to overcome; illness manifests in Winter.) If Shi pulse is severe (Note: Text suggests 'Ruo' here should be read as 'Shi'), illness occurs now. (Severe Shi pulse in Late Summer indicates great decline of Fire and Earth; illness occurs immediately, without waiting for Winter.) The Zhen Zhen qi moistens the Spleen, which stores the qi of the muscles. (Late Summer damp Earth governs, its nature moistening; thus, Zhen Zhen qi moistens the Spleen, and the Spleen stores the qi of muscles. Jin Gui Zhen Yan Lun states: "Center corresponds to Yellow, entering through the Spleen"; therefore, we know disease affects the flesh.)
In autumn, a pulse with a slight Mao (Feather-like) quality is called a Ping (Normal) pulse. (Autumn Metal qi is prosperous, so the pulse should be Mao, but it should only be slightly Mao without being excessive, indicating the harmony of Autumn Stomach qi; thus it is called Ping. 'Mao' refers to a pulse that is floating and choppy, light and empty like a feather.) If the Mao quality is prominent and Stomach qi is scant, it is called Lung disease. (Prominent Mao and scant Stomach qi indicate Metal qi excess and lack of moderation, hence Lung disease.) If there is only Mao without Stomach qi, it indicates death. (Only Feather-like quality without Stomach qi indicates that Autumn Stomach qi has exhausted, revealing the True Zang pulse of the Lung; thus, death.) If Mao pulse combines with Xian quality, illness will occur in Spring. (Xian pulse belongs to Spring Wood. Appearing in Autumn, it indicates Metal qi decline allowing Wood to overcome; illness manifests in Spring when Wood qi is prosperous.) If Xian quality is severe, illness occurs now. (Severe Xian pulse in Autumn indicates great decline of Metal and Wood having no fear; illness occurs immediately, without waiting for Spring.) The Zhen Zhen qi is superior in the Lung, which distributes Ying (Nutrient) and Wei (Defensive) Qi and Yin-Yang. (Autumn Metal qi governs, its nature clear and肃 [solemn/clearing]; the Lung resides in the Upper Jiao. Thus, Zhen Zhen qi is superior in the Lung. The Lung governs Qi, and since Ying Qi moves within the vessels and Wei Qi moves outside, both are distributed by the Lung; thus, it distributes Ying, Wei, and Yin-Yang.)
In winter, a pulse with a slight Shi (Stone-like) quality is called a Ping (Normal) pulse. (Winter Water qi is prosperous, so the pulse should be deep and Shi, but it should only be slightly Shi without being excessive, indicating the harmony of Winter Stomach qi; thus it is called Ping. 'Shi' refers to a pulse that is deep and solid, like a stone sinking in water.) If the Shi quality is prominent and Stomach qi is scant, it is called Kidney disease. (Prominent Shi and scant Stomach qi indicate Water qi excess overcoming Earth, hence Kidney disease.) If there is only Shi without Stomach qi, it indicates death. (Only Stone-like quality without Stomach qi indicates that Winter Stomach qi has exhausted, revealing the True Zang pulse of the Kidney; thus, death.) If Shi pulse combines with Gou quality, illness will occur in Summer. (Gou pulse belongs to Summer Fire. Appearing in Winter, it indicates Water qi decline allowing Fire to insult/reverse-overcome; illness manifests in Summer when Fire qi is prosperous.) If Gou quality is severe, illness occurs now. (Severe Gou pulse in Winter indicates great decline of Water and Fire having no fear; illness occurs immediately, without waiting for Summer.) The Zhen Zhen qi descends to the Kidney, which stores the qi of the marrow and bones. (Winter Water qi governs, its nature storing and closing; thus, Zhen Zhen qi descends to the Kidney, and the Kidney stores the qi of bone marrow. Jin Gui Zhen Yan Lun states: "North corresponds to Black, entering through the Kidney"; therefore, we know disease affects the bones.)
The Great Luo vessel of the Stomach is named Xu Li (Empty Chamber). It penetrates the Diaphragm, connects to the Lung, emerges below the left breast, and its movement can be felt through the clothing; this is the Zong Qi (Pectoral/Gathering Qi) in the pulse. (Earth is the mother of all things, so the pulses of the four seasons above are all based on Stomach qi. This describes the Great Luo vessel where Stomach qi emerges, named Xu Li. Its pulse travels from the Stomach, through the Diaphragm, up to connect to the Lung, emerging below the left breast. Its movement is felt through clothing; it is the master of the twelve meridians, hence called Pulse Zong Qi. 'Zong' means master or root. Generally, Zong Qi accumulates in Dan Zhong (Conception Vessel at chest), transforms from water and grain, and emerges from the Stomach. The fifteen Luo vessels described in Jing Mai Pian, plus this one, make sixteen vessels in total, detailed in the diagram of Sixteen Luo Acupoints. Further discussion on the Spleen as Yin Earth is in Disease Category 52.) If Xu Li moves rapidly like panting, or frequently interrupts, then disease is in the Middle Jiao. (If Xu Li movement is vigorous like panting, or rapid and interrupted, it is due to Middle Qi failing to hold; thus, disease is in the Middle. 'Shu' is pronounced 'shuo'.) If it is knotted and horizontal, there is an accumulation/mass. (Stomach qi must exit below the left breast; if obstructed, it knots and becomes horizontal, forming an accumulation. Thus, patients with accumulation often have it below the left hypochondrium, caused by Stomach qi stagnation. As Nan Jing 56 states, the Liver's accumulation is named Fei Qi, located in the left hypochondrium; this is explained by distributing Five Elements to left/right/up/down, but practically, this is governed by Stomach qi.) If the pulse completely fails to arrive, it indicates death. (Absence of Xu Li pulse means extinction of Zong Qi; thus, certain death.) Below the breast, if the movement is vigorous enough to shake the clothing, it indicates leakage of Zong Qi. (The previous mention of "felt through clothing" referred to slight movement, seemingly touching the clothing, verifying Stomach qi in Xu Li. This mention of "felt through clothing" refers to vigorous movement, truly shaking with the clothing, indicating Zong Qi insecurity and massive external leakage, a sign of Middle Deficiency. I note: Xu Li pulsation is the root of deficiency diseases. Patients with Yin deficiency and consumptive diseases often have pulsation below the heart, along with palpitations and anxiety. People know it as heart beating but not as Xu Li movement. Slight movement indicates mild disease; severe movement indicates serious disease; one can judge severity by this. For such cases, I often use purely sweet, water-nourishing formulas to tonify True Yin, curing many. However, the Classic speaks of Zong Qi leakage, while I speak of True Yin deficiency; the theories seem contradictory. Those who do not understand will call it absurd. Let me explain fully. Grain enters the Stomach, transmits to the Lung, and Zang/Fu organs receive qi; this is Stomach qi transforming upward into Zong Qi. Qi is the mother of Water; when Qi gathers, Water generates; this is Lung Qi generating downward Kidney Water. Now, Stomach qi transmits to the Lung, but Kidney deficiency fails to grasp Qi; thus Zong Qi leaks upward, and Kidney Water exhausts downward. The more the Kidney is deficient, the less place for Qi to return; if Qi does not return, Yin becomes more deficient. Qi and Water are of the same kind and should aid each other. Therefore, to guide Qi back to its origin, there is only one method: Tonify Yin to match Yang.)