阳毒健乱四肢烦。面赤生花作点斑。狂言妄语如神鬼。下痢频多喉不安。汗出遍身应大差。鱼
口开张命欲翻。有药不辜但与服。能过七日渐须安。阴毒伤寒身体重。背强眼痛不堪任。小腹急痛
口青黑。毒瓦斯冲心转不禁。四肢厥冷惟思吐。咽喉不利脉细沉。若能速灸脐轮下。六日看过见喜深。
阴阳二毒。病有轻重。治有浅深。仲景略言于金匮要略。后世传述。备载诸书。亦难以二歌尽。
病源各不一。今歌本诊生死之脉。故不论病源。只论脉之生死。
腹胀浮大是出厄。虚小命殂须努力。
此篇大抵以脉病相应不应言生死。然亦不可专执。临病参考可也。如中恶腹胀脉紧细者生。浮
大者死之类。
下痢微小却为生。脉大浮洪无瘥日。
下痢脉欲绝者不死。杂色恶痢脉微弱。暴冷伤阳。脉细欲绝。冷热不调者。洪大易治。微迟小
细难治。
恍惚之病〔定颠〕（发为）狂。其脉实牢保安吉。寸关尺部沉细时。如此未闻人救得。
恍惚颠狂三病也。恍惚心不宁。阴颠而阳狂也。脉经曰。颠病脉虚可治。实则死。盖重阴为颠。谓
阴部内见沉涩微短脉。是阳脉不见而阴独盛。故为颠疾。经曰阴气从下。下虚上实。故作颠疾。
则沉细脉。是脉病相应而不逆矣。
消渴脉数大者活。虚小病深厄难脱。
三消之证内消渴一证。沉小者生。实坚大者死。此外如少阴自利而渴。脉必沉。中暑渴脉虚。
产后渴脉多弱。难专以虚小为渴之凶。
水气浮大得延生。沉细应当是死别。
水病之证不一。脉亦不一。三因方曰。沉伏相搏名曰水。盖沉者乃水之病脉。但风水皮水脉浮。
石水脉沉。黄汗沉迟。当参病原病证为断。况水病。肌肉为水所胀。脉元多沉。若脉出必死。脉病
相反也。今曰浮大延生。更宜参审。
霍乱之候脉微迟。气少不语大难医。三部浮洪必救得。古今课定更无疑。
病原曰脉伏及代而乱者。霍乱也。不乱犹可治。微细不可治。霍乱吐下。脉微迟。气息劣。口不欲言者。不
可治。脉经所无。脉诀自创之例也。通真子曰清浊相干霍乱时。脉如微细是相宜。不言气劣微迟小。
此候神工亦莫医。通真子注脉诀。不遵之而自作歌。一曰浮洪可救。一曰微细相宜。何哉。盖病原
不同。脉随而见。以病原参之。勿一例但曰霍乱而已也。
鼻衄吐血沉细宜。忽然浮大即倾危。
吐衄证中。有卒中恶吐血。脉沉数细者死。浮大疾快者生。又杂病衄责里热。伤寒衄责表热。表
热者脉必浮。
咳而尿血羸瘦形。其脉疾大命难任。咳血之脉沉弱吉。忽若实大死来侵。金疮血〔盛〕（出）虚
细活。急疾大数必危身。
此六句参错在后。今移于此。从失血类。
脉诀所论金疮。本于脉经、中藏经。皆论已出血之脉。若金疮未出血则又别。坠压内伤。坚强安。
小弱凶。顿仆内伤同。笞榜内有结血。实大生。虚小死。跌扑伤损。浮大易安谓血散外。沉细紧实多死。
谓恶血攻脏。
病患脉健不用治。健人脉病号行尸。
病患脉健。此云不用治者。是前形脉相反歌。何其谬也。
心腹痛脉沉细差。浮大弦长命必殂。
仲景曰。假令病患云腹内卒痛。浮而大。知其瘥也。何以知之。若里有病者脉当沉细。今浮大。
故知愈也。病原曰若其人不即愈者必当死。以脉病相反也。然心痛与腹痛各异。凡痛五脏相干。而
心痛脉各异见。惟真心痛不问脉。旦占夕死。夕占旦死。腹痛病原亦不一。虚寒、紧弦。积寒、
沉紧而实。肝肾弦大为寒痛。故知弦长亦难以死断。
头痛短涩应须死。浮滑风痰必易除。
脉诀此言。只可断风痰头痛一证而已。头痛具八经。又有伏暑、积聚、痰厥、伏痰、肾痰、产后
失血、风寒在脑、邪热上攻、气虚气攻、诸证不同。随证诊脉。断生死可也。
中风口噤迟浮吉。急实大数三魂孤。鱼口气粗难得瘥。面赤如妆不久居。中风发直口吐沫。喷药
闷乱起复苏。咽喉曳锯水鸡响。摇头上窜气长嘘。病患头面青黑暗。汗透毛端恰似珠。眼小目瞪不须治。
喘汗如油不可苏。
中风口噤至此皆言中风之死候。简易方云风邪中人。其状奄忽。故六脉多沉伏。亦有脉随气奔。
指下洪盛者。当此之际脉亦难辨。但以证参为是。中风。目闭口开。手撒遗尿。声如鼾睡者。必难疗。
内实腹胀痛满盈。心下牢强干呕频。手足烦热脉沉细。大小便涩死多真。
素问曰。五实死。脉盛、皮热、腹胀、前后不通、闷瞀。此谓五实。自汗得后利则实者活。今脉
诀增干呕。去闷瞀。又以脉沉细与病反。决以为死。此条宜参之内经。
外实内热吐相连。下清注谷转难安。忽然诊得脉洪大。莫费神功定不痊。
协热下利。胃热呕吐。脉亦洪大。不可遽以死断。
内外俱虚身冷寒。汗出如珠微呕烦。忽然手足脉厥逆。体不安宁必死拚。
素问曰。五虚死。脉细、皮寒、气少、泄利前后、饮食不入。若浆粥入胃泄注止。则虚者活。
今脉诀内外俱虚。与内经多异。全本脉经。
上气浮肿肩息频。浮滑之脉即相成。忽然微细应难救。神功用尽也无生。
脉经曰。上气面浮肿肩息。其脉大。不可治。加利甚者必死。今脉诀以微细为难救。似与脉经相悖。
上气喘急候何宁。手足温暖净滑生。反得寒涩脉厥逆。必知归死命须倾。
通真子改差无因作命须倾。贵协韵也。
中恶腹胀紧细生。若得浮大命逡巡。
脉经曰。卒中恶。吐血数升。脉沉数者死。浮大疾快者生。卒中恶。腹大。四肢满。脉大而缓者生。
紧大而浮者死。紧细而微亦生。然中恶之候。脉亦不等。鬼疰。脉滑。或紧长过寸。或尺寸有脉。
关中绝不至。或乍大乍小。乍长乍短。遁尸。三部紧急。或沉重不至寸。客忤三部皆滑洪大。
凡脉尺寸紧数形。又似钗直吐转增。此患蛊毒急须救。〔速求神药命难停〕（脉逢数软命延生。）
此文根据脉经换末句。
中毒洪大脉应生。细微之脉必危倾。吐血但出不能止。命应难返没痊平。
他证吐血。皆以沉细为生。惟中毒吐血。以洪大为生。
大凡要看生死门。太冲脉在即为凭。若动应神魂魄在。止便干休命不停。
铜人经太冲二穴土也。在足大趾本节后二寸。（或云一寸半）动脉陷中。凡诊太冲脉。可决男子病死生。足厥
阴脉之所注也。为俞。灵枢曰。胃之清气上注于肺。故气之过于寸口也。动而不止。其悍气上冲头
者。合阳明。并下人迎。故阴阳俱动俱静。若引绳。相倾者病。冲脉者。十二经之海也。与少阴之
大络起于肾下。出于气冲。循阴股内廉。邪入骨中。循胫骨内廉。并少阴之经。下入内踝之后。
入足下。其别者邪入踝。出属跗上。入大趾间。此脉之常动者也。经脉十二。而寸口人迎太冲独动不休。
故以此三处诊百病。决生死。灵枢作并足少阴之动脉。铜人作足厥阴之俞穴。皆冲脉之所合并而经过者。
其实以候冲脉也。仲景谓当时之人。握手不及足。故立趺阳太溪。以候胃肾之病。李 范引活人书所
列冲阳穴。以解太冲。失其穴矣。仲景以趺阳专诊足阳明。太溪专诊足少阴。
Yang poison (Yang Du) symptoms manifest as restlessness and irritability of the four limbs, facial redness with floral-like spots. The patient speaks deliriously, appearing as if possessed by spirits or ghosts. Accompanied by frequent diarrhea and throat discomfort. If sweating covers the whole body, the condition should improve significantly; if the anus opens wide, life is in peril. If there are medicines, they may be administered. If the patient can survive seven days, the condition should stabilize.
Yin poison (Yin Du) cold syndrome presents with a heavy body, stiffness in the back, and unbearable eye pain. There is acute lower abdominal pain, cyanosis of the lips and mouth. Toxic qi rushes to the heart, causing unbearable suffering. The four limbs are cold, with an urge to vomit, throat obstruction, and a fine, deep pulse. If moxibustion is applied rapidly below the umbilicus, improvement will be seen after six days.
Yang and Yin poisons vary in severity, and treatments differ in depth. Zhang Zhongjing briefly mentioned them in *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet). Later generations transmitted these accounts, detailing them in various books; two songs cannot exhaustively cover them.
Etiologies vary. This song focuses on diagnosing vital versus fatal pulses, thus not discussing etiology but only pulse diagnosis for determining life and death.
Abdominal distension with a floating and large pulse indicates escape from danger; a deficient and small pulse indicates impending death, requiring urgent effort to save.
Generally, this section determines life and death based on whether the pulse corresponds to the disease. However, one should not adhere rigidly to this; clinical reference is necessary. For example, in sudden evil invasion (Zhong E), abdominal distension with a tight and fine pulse indicates survival, while a floating and large pulse indicates death.
Dysentery with a minute and small pulse indicates survival; a large, floating, and flooding pulse indicates no hope of recovery.
In dysentery, a pulse that seems to disappear does not necessarily mean death. In mixed foul dysentery, a weak and minute pulse is favorable. Sudden cold damaging Yang leads to a fine pulse nearly disappearing; imbalance of cold and heat makes a flooding pulse easier to treat, while a minute, slow, small, and fine pulse is difficult to treat.
The condition of trance (Huang Hu), which refers to epilepsy and mania, with a solid and firm pulse ensures safety. If the cun, guan, and chi positions all show fine and deep pulses, such cases have rarely been saved.
Trance, epilepsy, and mania are three conditions. Trance refers to mental unrest; yin excess causes epilepsy, yang excess causes mania. *Mai Jing* states: Epilepsy with a deficient pulse is treatable; with a solid pulse, it is fatal. Heavy yin causes epilepsy, characterized by deep, choppy, minute, and short pulses in the yin positions, where yang pulses are absent and yin prevails, hence epilepsy. The classics state: Yin qi rises from below, lower deficiency and upper excess cause epilepsy. Thus, a fine and deep pulse indicates correspondence between pulse and disease without reversal.
Xiao Ke (Wasting and Thirsting) with a rapid and large pulse indicates survival; a deficient and small pulse indicates deep disease and difficulty in escape.
Among the three Xiao syndromes, internal wasting thirst with a deep and small pulse indicates survival; a solid, hard, and large pulse indicates death. Additionally, Shaoyin spontaneous diarrhea with thirst requires a deep pulse; heatstroke with thirst shows a deficient pulse; postpartum thirst often shows a weak pulse. One cannot solely rely on deficient and small pulses to judge thirst as ominous.
Water Qi (Shui Qi) edema with a floating and large pulse allows for extended life; a deep and fine pulse indicates death.
Water diseases vary, and so do their pulses. *Sanyin Fang* states: Deep and submerged pulses interacting indicate water. Deep is the pathological pulse for water, but Feng Shui (Wind Water) and Pi Shui (Skin Water) show floating pulses, Shi Shui (Stone Water) shows a deep pulse, and Huang Han (Yellow Sweat) shows a deep and slow pulse. Diagnosis must consider the specific etiology and syndrome. Moreover, in water disease, muscles are swollen by fluid, and pulses are originally mostly deep; if the pulse emerges (becomes floating and large), it is fatal due to pulse-disease mismatch. The statement that floating and large pulses allow survival requires careful consideration.
Huoluan (Colic-Restriction) with a minute and slow pulse. Scarcity of breath and inability to speak make it extremely difficult to treat. A floating and flooding pulse in all three positions indicates recoverability, confirmed by ancient and modern studies without doubt.
Etiology states: Pulse submerged, intermittent, and chaotic indicates Huoluan. If not chaotic, it is treatable; if minute and fine, it is untreatable. In Huoluan with vomiting and diarrhea, a minute and slow pulse, weak respiration, and reluctance to speak indicate untreatability. This view is original to *Mai Jue*, not found in *Mai Jing*. Tong Zhenzi noted: "When clear and turbid qi interfere causing Huoluan, a minute and fine pulse is appropriate. Without mentioning weak respiration or minute-slow-small pulse, even divine physicians cannot cure." Tong Zhenzi's commentary on *Mai Jue* differs from his own song: one says floating-flooding is curable, the other says minute-fine is appropriate. Why? Because etiologies differ, and pulses follow accordingly. One must refer to the etiology rather than simply labeling it Huoluan.
Epistaxis or hematemesis with a deep and fine pulse is suitable. A sudden floating and large pulse indicates imminent danger.
In vomiting and epistaxis, sudden evil invasion with hematemesis showing a deep, rapid, and fine pulse is fatal; a floating, large, rapid, and forceful pulse indicates survival. Also, miscellaneous disease epistaxis is attributed to interior heat, while cold damage epistaxis is attributed to exterior heat. Exterior heat implies a floating pulse.
Cough with hematuria and emaciation, with a rapid and large pulse, indicates life-threatening danger. Cough with blood expectoration and a deep-weak pulse is auspicious; suddenly becoming solid and large invites death. Traumatic wounds with bleeding, showing a deficient and fine pulse, indicate survival; a rapid, large, and numerous pulse endangers life.
These six lines were misplaced later; moved here under Hemorrhage.
*Mai Jue*'s discussion on traumatic wounds originates from *Mai Jing* and *Zhongzang Jing*, both discussing pulses after bleeding. If bleeding has not occurred, it is different. Internal injury from falling/pressure: strong pulse indicates safety, small/weak indicates danger. Similar for sudden falls. Internal bleeding from beating: solid/large pulse indicates survival, deficient/small indicates death. Sprains and bruises: floating/large pulse indicates ease of recovery (blood disperses externally); deep/fine/tight/solid pulse indicates many deaths (evil blood attacks viscera).
If a patient's pulse is robust, no treatment is needed; if a healthy person's pulse is diseased, they are called a "walking corpse."
The claim that a robust pulse in a sick patient needs no treatment contradicts the earlier song on pulse-form mismatch; how erroneous!
Heart and abdominal pain with a deep and fine pulse improves; a floating, large, wiry, and long pulse indicates certain death.
Zhang Zhongjing said: If a patient complains of sudden abdominal pain, and the pulse is floating and large, know that recovery is near. Why? Interior disease usually presents with deep and fine pulses. Now, since it is floating and large, recovery is indicated. Etiology states: If not immediately recovered, death is certain due to pulse-disease mismatch. However, heart pain and abdominal pain differ. Pain involving the five zang organs varies in pulse presentation. Only true heart pain ignores the pulse: diagnosed in the morning, dies by evening; diagnosed in the evening, dies by morning. Abdominal pain etiologies vary: deficiency-cold shows tight/wiry; accumulated cold shows deep/tight/solid; liver/kidney wiry-large indicates cold pain. Thus, a wiry-long pulse is not necessarily fatal.
Headache with a short and choppy pulse indicates death; a floating and slippery pulse indicates wind-phlegm, which is easily resolved.
This statement in *Mai Jue* applies only to wind-phlegm headache. Headaches involve eight meridians and include latent summerheat, accumulation, phlegm syncope, latent phlegm, kidney phlegm, postpartum hemorrhage, wind-cold in the brain, pathogenic heat attacking upward, qi deficiency, and qi rebellion. Diagnose the pulse according to the syndrome to determine life and death.
Stroke with jaw lock and a slow-floating pulse is auspicious; a rapid, solid, large, and numerous pulse indicates death. Gasping with coarse breathing is hard to cure; face red like makeup indicates short life. Stroke with straight neck, foaming at the mouth, medication causing confusion then revival. Sawing sound in throat, shaking head, upward gaze, long sigh. Patient's head and face dark blue/black, sweat penetrating hair follicles like pearls. Small eyes, fixed stare, untreatable; panting and oily sweat, unresuscitable.
From jaw lock onwards, these describe fatal signs of stroke. *Jianyi Fang* states: Wind evil invading humans acts suddenly, so six pulses are often submerged. Sometimes pulses surge with qi, feeling flooding under the fingers. At such times, pulse differentiation is difficult; rely on syndrome correlation. Stroke with closed eyes, open mouth, relaxed hands, urinary incontinence, and snoring sounds is difficult to treat.
Interior excess with abdominal distension and fullness, hardness below the heart, frequent dry heaving. Restless four limbs with a deep and fine pulse, difficulty in urination and defecation—death is highly probable.
*Suzhen* states: Five Excesses lead to death: surging pulse, hot skin, abdominal distension, blockage of front and rear, oppression and dizziness. These are Five Excesses. Survival occurs if sweating ensues and bowels/bladder open. *Mai Jue* adds dry heaving, removes oppression/dizziness, and judges death due to deep/fine pulse contradicting the disease. This clause should be cross-referenced with the *Neijing*.
Exterior excess with interior heat, continuous vomiting, clear watery stool with undigested food, worsening instability. Suddenly detecting a flooding and large pulse means no amount of skill can cure.
Heat-coupled diarrhea and stomach heat vomiting also show flooding pulses; do not hastily judge as fatal.
Interior and exterior deficiency with cold body, pearl-like sweat, slight vomiting, and irritability. Sudden reversal of four limbs and pulse indicates inevitable death.
*Suzhen* states: Five Deficiencies lead to death: fine pulse, cold skin, scant qi, diarrhea/incontinence, inability to eat/drink. Survival occurs if gruel enters the stomach and diarrhea stops. *Mai Jue*'s description of interior/exterior deficiency differs greatly from the *Neijing*, closely following *Mai Jing*.
Upper qi rising with edema and frequent shoulder breathing: floating and slippery pulses match. Suddenly minute and fine pulses are hard to save; even divine efforts yield no life.
*Mai Jing* states: Upper qi rising, facial edema, shoulder breathing with a large pulse is untreatable. With severe diarrhea, death is certain. *Mai Jue* considers minute/fine pulses hard to save, seemingly contradicting *Mai Jing*.
Upper qi panting urgently: warm hands and feet with clean/slipping pulse indicate survival. Cold/choppy pulse with reversal indicates approaching death.
Tong Zhenzi changed "cha" (difference) to "ming xu qing" (life must decline) for rhyme.
Sudden evil invasion with abdominal distension and tight/fine pulse indicates survival; floating/large pulse indicates impending death.
*Mai Jing* states: Sudden evil invasion with several shengs of hematemesis, deep/rapid pulse is fatal; floating/large/rapid/forceful pulse is survival. Sudden evil invasion with large abdomen, full limbs, large/slow pulse is survival; tight/large/floating pulse is death; tight/fine/micro pulse is also survival. However, pulses in sudden evil invasion vary. Gui Zhu (Ghost Attachment): slippery pulse, or tight/long exceeding cun, or pulses present at cun/chi but absent at guan, or fluctuating size/length. Dun Shi (Running Corpse): all three positions tight/urgent, or heavy/not reaching cun. Ke Wu (Guest Anger): all three positions slippery/flooding/large.
Whenever cun/chi pulses are tight/numerous and shape like a hairpin, with increased vomiting, this is Gu Du (Poison Worm) requiring urgent rescue. (Pulse meeting number/soft extends life.)
This text replaces the last line based on *Mai Jing*.
Poisoning with a flooding pulse indicates survival; a minute pulse indicates peril. Hematemesis that cannot stop indicates life cannot return, no recovery.
For other conditions, hematemesis with a deep/fine pulse indicates survival; only for poisoning-induced hematemesis does a flooding pulse indicate survival.
To generally examine the gate of life and death, the presence of the Taichong pulse is the evidence. If moving, spirit and soul remain; if stopped, life ends.
*Tongren Jing* states Taichong is Earth, located 2 cun (or 1.5 cun) behind the base of the big toe, in the depression of the arterial movement. Diagnosing the Taichong pulse determines male life and death. It is the entry point of the Foot Jueyin Meridian, acting as the Shu point. *Lingshu* states: Clear qi from the Stomach ascends to the Lung, so qi passing through the Cun Kou moves continuously. Its fierce qi rushing to the head combines with Yangming and descends to Renying. Thus, when Yin and Yang move or still together like pulling a rope, illness occurs. Chong Mai is the Sea of Twelve Meridians, originating below the Kidney with the Great Luo of Shaoyin, emerging at Qichong, following the inner aspect of the thigh, entering bone, following the inner tibia, joining Shaoyin, descending behind the medial malleolus, entering the sole. Its branch enters the ankle, emerges on the dorsum, enters between the big toes. This is the normally moving pulse. Among twelve meridians, Cun Kou, Renying, and Taichong move continuously, so these three sites diagnose hundred diseases and determine life/death. *Lingshu* describes it as joining the Foot Shaoyin artery; *Tongren* describes it as the Foot Jueyin Shu point. Both are where Chong Mai merges and passes; essentially, it monitors Chong Mai. Zhang Zhongjing noted that people of his time could not reach the foot when holding the wrist, so he established Duyang and Taixi to monitor Stomach and Kidney diseases. Li Fan cited Chongyang from *Huo Ren Shu* to explain Taichong, losing the correct acupoint. Zhang Zhongjing used Duyang specifically for Foot Yangming and Taixi specifically for Foot Shaoyin.