十五难曰∶经言春脉弦，夏脉钩，秋脉毛，冬脉石、是王脉耶？将病脉也？
然∶弦、钩、毛、石者，
四时之脉也。春脉弦者，肝，东方木也，万物始生，未有枝叶，故其脉之来濡弱而长，故曰弦。夏脉钩者，
心，南方火也，万物之所茂，垂枝布叶，皆下曲如钩，故其脉之来疾去迟，故曰钩。秋脉毛者，肺，西方
金也，万物之所终，草木华叶，皆秋而落，其枝独在，若毫毛也，故其脉之来轻虚以浮，故曰毛。冬脉
石者，肾，北方水也，万物之所藏也，盛冬之时，水凝如石，故其脉之来沉濡而滑，故曰石，此四时之脉也。
经，谓《素问·平人气象论》、《玉机真藏论》，此参错其文而为篇也。四时之脉，谓脉之应乎四时，
即旺脉也。春脉弦者，肝为木而主筋，万物始生之初，其脉濡弱而长，是弦之正象，否则即为太过不及也。
夏脉钩者，心属火而主血脉，其脉来疾者，其来少急而劲，气之升而上也；去迟者，其去少缓而弱，气之降
而下也，此所谓下曲如钩也。秋脉毛者，肺属金而主皮毛，秋木凋零，其枝独在若毫毛，言其四面无所辅，
而体又甚轻也。冬脉石者，肾属水而主骨，冬气敛聚，故沉而濡滑，水之象也，此四时之脉。然脏腑之与五
行，各有所属，而春夏秋冬脉，皆以木为喻者，盖惟木能因时变迁也。
如有变奈何？
然∶春脉弦，反者为病。何谓反？
然∶其气来实强，是谓太过，病在外；气来虚微，是谓不
及，病在内。脉来厌厌聂聂，如循榆叶曰平；益实而滑，如循长竿曰病；急而劲益强，如新张弓弦曰死。春
脉微弦曰平，弦多胃气少曰病，但弦无胃气曰死，春以胃气为本。夏脉钩，反者为病，何谓反？
然∶其气来实强，是谓太过，病在外；气来虚微，是谓不及，病在内。其脉来累累如环，如循琅
曰平；来而益数，如鸡举足曰病；前曲后居，如操带钩曰死。夏脉微钩曰平，钩多胃气少曰病，但
钩无胃气曰死，夏以胃气为本。秋脉毛，反者为病。何谓反？
然∶其气来实强，是谓太过，病在外；
气来虚微，是谓不及，病在内。其脉来蔼蔼如车盖，按之益大曰平；不上不下，如循鸡羽曰病；按之
萧索，如风吹毛曰死。秋脉微毛曰平，毛多胃气少曰病，但毛无胃气曰死，秋以胃气为本。冬脉石，
反者为病。何谓反？
然∶其气来实强，是谓太过，病在外；气来虚微，是谓不及，病在内。脉来上大
下兑，濡滑如雀之喙曰平；啄啄连属，其中微曲曰病；来如解索，去如弹石曰死。冬脉微石曰平，
石多胃气少曰
病，但石无胃气曰死，冬以胃气为本。
如有变，谓逆四时而失其常度也。春脉当微弦，其来濡弱而长，反是者为病。实强为太过，阳气盛而发于表
也，故病在外，令人善忘，眩冒癫疾。虚微为不及，阴气不足，而怯于中也，故病在内，令人胸痛引背，下则两
胁满。厌厌聂聂，如循榆叶，乃微弦而有和缓胃气也，故曰平。益实而滑，如循长竿，乃弦多胃少也，故曰
病。急而劲益强，如新张弓弦，乃但弦无胃气，即所谓真脏脉也，故曰死。夏脉当微钩，来疾而去迟，反是者为
病。实强者为太过，病在外，令人身热而肤痛，为浸淫。虚微者为不及，病在内，令人烦心，上见咳唾，下为气
泄。脉来累累如环，如循琅 ，乃微钩而有和缓胃气也，故曰平。来而益数，如鸡举足，乃钩多胃少也，故曰病。
前曲后居，如操带钩，乃但钩无胃气也，故曰死。秋脉当微毛，其来轻虚以浮，反是者为病。实强者为太过，
病在外，令人逆气而背痛愠愠然。虚微者为不及，病在内，令人喘，呼吸少气而咳，上气见血，下闻病音。脉来
蔼蔼如车盖，按之益大者，以其轻软微毛而有和缓胃气也，故曰平。不上不下，如循鸡羽，乃毛多胃少也，故曰
病。按之萧索，如风吹毛，乃但毛无胃气也，故曰死。冬脉当微石，其来沉濡而微坚，反是者为病。实强者为太
过，病在外，令人懈 ，脊脉痛而少气不欲言。虚微者为不及，病在内，令人心悬如饥， 中清，脊中痛，少腹满，
小便变。脉来上大下兑，濡滑如雀喙者，乃微石而有和缓胃气也，故曰平。
啄啄连属，其中微曲，乃石多胃少也，故曰病。来如解索，去如弹石，乃但石无胃气也，故曰死。是四时之脉，
皆以胃气为本，故有胃气则生，胃气少则病，无胃气则死也。
按∶《素问·平人气象论》曰∶平肝脉来， 弱招招，如揭长竿末梢，曰肝平。平肺脉来，厌厌聂聂，如
落榆荚，曰肺平。此两句，形容肝之平脉，濡柔和缓微弦之义；肺之平脉、浮薄轻虚微毛之义，此却以肺平引
为肝平。又曰∶病心脉来，喘喘连属，其中微曲，曰心病；实而盈数，如鸡举足，曰脾病。今以脾病引为心病。
如乌之喙，脾之死脉，引为肾之平脉。若此多与经文有异。冯氏谓越人欲使脉之易晓，重立其义尔。然读是篇者，
当与《素问》参观。
胃者，水谷之海也，主禀。四时皆以胃气为本，是为四时之变病，死生之要会也。
胃属土，位居中央，万物归之，故云水谷之海。旺于四时，水火金木，无不待是以生，为四时变病之要会，
故云主禀四时也。
脾者，中州也，其平和不可得见，衰乃见耳。来如雀之喙，如水之下漏，是脾衰之见也。
脾受谷味，在四脏之中，故不可见。盖脾寄旺于四季，不得独主于四时，四脏平和，则脾脉在中，衰乃始见。
雀喙，言其坚锐而无冲和之气也。水下漏，言其断续无常，散动而复止也。
此《素问·玉机真藏论》所谓脾者土也。孤脏以灌溉四旁者也，善者不可得见，恶者可见之
义也。
Chapter 15 states: The classics say that the spring pulse is *xian* (string-like), the summer pulse is *gou* (hook-like), the autumn pulse is *mao* (feather-like), and the winter pulse is *shi* (stone-like). Are these pulses of prosperity (*Wang Mai*, prosperous pulses corresponding to seasons) or pulses of disease?
The response is: *Xian*, *gou*, *mao*, and *shi* are the pulses corresponding to the four seasons.
The spring pulse is *xian* because the Liver belongs to Wood in the East. When all things begin to sprout, they have not yet developed branches and leaves; thus, the pulse comes forth soft, weak, and long, hence it is called *xian*.
The summer pulse is *gou* because the Heart belongs to Fire in the South. All things flourish at this time; hanging branches and spread leaves curve downward like a hook. Thus, the pulse comes rapidly and departs slowly, hence it is called *gou*.
The autumn pulse is *mao* because the Lung belongs to Metal in the West. All things reach their end here; flowers and leaves wither and fall in autumn, leaving only the branches alone, resembling fine hairs. Thus, the pulse comes light, empty, and floating, hence it is called *mao*.
The winter pulse is *shi* because the Kidney belongs to Water in the North. All things are stored away at this time. In deep winter, water freezes hard as stone. Thus, the pulse comes sinking, soft, and slippery, hence it is called *shi*. These are the pulses of the four seasons.
By "Classics," we refer to *Su Wen: Ping Ren Qi Xiang Lun* (Plain Questions: Discussion on the Pulse Phenomena of Normal Persons) and *Su Wen: Yu Ji Zhen Zang Lun* (Plain Questions: Discussion on the True Viscera Pulses from the Jade Machine). The texts from these chapters are interwoven to form this chapter. The "pulses of the four seasons" refer to pulses responding to the four seasons, which are also known as *Wang Mai* (prosperous pulses).
When the spring pulse is *xian*, the Liver, being Wood, governs the sinews. At the initial stage when all things begin to grow, the pulse is soft, weak, and long; this is the correct image of *xian*. Otherwise, it indicates either excess (*Tai Guo*) or deficiency (*Bu Ji*).
When the summer pulse is *gou*, the Heart, being Fire, governs the blood vessels. The rapid coming of the pulse indicates slight urgency and strength, representing the ascending of Yang Qi; the slow departing indicates slight slowness and weakness, representing the descending of Yin Qi. This is what is meant by "curving downward like a hook."
When the autumn pulse is *mao*, the Lung, being Metal, governs the skin and hair. In autumn, trees wither, leaving only branches like fine hairs, implying there is no support on any side and the body is very light.
When the winter pulse is *shi*, the Kidney, being Water, governs the bones. Winter Qi converges and gathers, so the pulse is sinking, soft, and slippery, reflecting the image of water. These are the pulses of the four seasons.
However, while Zang-Fu organs and the Five Elements have specific correspondences, the pulses of spring, summer, autumn, and winter are all metaphorically compared to Wood. This is likely because only Wood can change according to the seasons.
What if there are variations?
The response is: The spring pulse should be *xian*; deviation from this indicates disease. What is meant by deviation?
The response is: If the Qi comes solid and strong, it is called *Tai Guo* (Excess), and the disease is external. If the Qi comes deficient and faint, it is called *Bu Ji* (Deficiency), and the disease is internal.
If the pulse comes gentle and continuous, like touching elm leaves, it is called Normal (*Ping*). If it becomes more solid and slippery, like touching a long bamboo pole, it is called Diseased (*Bing*). If it comes urgent, strong, and rigid, like a newly drawn bowstring, it is called Fatal (*Si*).
A spring pulse that is slightly *xian* is Normal; one where *xian* is prominent but Stomach Qi is scant is Diseased; one that is purely *xian* without Stomach Qi is Fatal. Spring relies on Stomach Qi as its foundation.
The summer pulse should be *gou*; deviation indicates disease. What is meant by deviation?
The response is: If the Qi comes solid and strong, it is called *Tai Guo*, and the disease is external. If the Qi comes deficient and faint, it is called *Bu Ji*, and the disease is internal.
If the pulse comes continuously linked like a ring, like touching polished jade, it is called Normal. If it comes faster, like a chicken lifting its foot, it is called Diseased. If the front part curves and the back part stays rigid, like holding a belt hook, it is called Fatal.
A summer pulse that is slightly *gou* is Normal; one where *gou* is prominent but Stomach Qi is scant is Diseased; one that is purely *gou* without Stomach Qi is Fatal. Summer relies on Stomach Qi as its foundation.
The autumn pulse should be *mao*; deviation indicates disease. What is meant by deviation?
The response is: If the Qi comes solid and strong, it is called *Tai Guo*, and the disease is external. If the Qi comes deficient and faint, it is called *Bu Ji*, and the disease is internal.
If the pulse comes grand like a chariot canopy, and feels larger upon pressure, it is called Normal. If it neither rises nor falls, like touching a chicken feather, it is called Diseased. If it feels desolate upon pressure, like wind blowing through hair, it is called Fatal.
An autumn pulse that is slightly *mao* is Normal; one where *mao* is prominent but Stomach Qi is scant is Diseased; one that is purely *mao* without Stomach Qi is Fatal. Autumn relies on Stomach Qi as its foundation.
The winter pulse should be *shi*; deviation indicates disease. What is meant by deviation?
The response is: If the Qi comes solid and strong, it is called *Tai Guo*, and the disease is external. If the Qi comes deficient and faint, it is called *Bu Ji*, and the disease is internal.
If the pulse is large above and small below, soft and slippery like a bird's beak, it is called Normal. If it pecks continuously with a slight curve in the middle, it is called Diseased. If it comes like untying a tangled rope and departs like striking a stone, it is called Fatal.
A winter pulse that is slightly *shi* is Normal; one where *shi* is prominent but Stomach Qi is scant is Diseased; one that is purely *shi* without Stomach Qi is Fatal. Winter relies on Stomach Qi as its foundation.
"Variation" refers to going against the four seasons and losing normal measure.
The spring pulse should be slightly *xian*, coming soft, weak, and long. Deviation from this indicates disease. Solid and strong indicates Excess, where Yang Qi is abundant and manifests externally, causing disease in the exterior, leading to forgetfulness, dizziness, vertigo, and epilepsy. Deficient and faint indicates Deficiency, where Yin Qi is insufficient and weakness lies internally, causing disease in the interior, leading to chest pain radiating to the back and fullness in both hypochondria below.
Gentle and continuous like touching elm leaves indicates slight *xian* with harmonious Stomach Qi, hence Normal. More solid and slippery like touching a long bamboo pole indicates excessive *xian* and scant Stomach Qi, hence Diseased. Urgent, strong, and rigid like a new bowstring indicates pure *xian* without Stomach Qi, i.e., the True Viscera Pulse (*Zhen Zang Mai*), hence Fatal.
The summer pulse should be slightly *gou*, coming rapid and departing slow. Deviation indicates disease. Solid and strong indicates Excess, disease in the exterior, causing fever and skin pain, leading to spreading sores (*Jin Yin*). Deficient and faint indicates Deficiency, disease in the interior, causing vexation in the heart, coughing and spitting upwards, and gas leakage downwards.
Continuous like a ring, like touching jade, indicates slight *gou* with harmonious Stomach Qi, hence Normal. Faster like a chicken lifting its foot indicates excessive *gou* and scant Stomach Qi, hence Diseased. Front curved and back rigid like holding a belt hook indicates pure *gou* without Stomach Qi, hence Fatal.
The autumn pulse should be slightly *mao*, coming light, empty, and floating. Deviation indicates disease. Solid and strong indicates Excess, disease in the exterior, causing rebellious Qi and dull back pain. Deficient and faint indicates Deficiency, disease in the interior, causing panting, shortness of breath, cough, hemoptysis upwards, and pathological sounds heard downwards.
Grand like a chariot canopy, feeling larger upon pressure, indicates light, soft, slightly *mao* with harmonious Stomach Qi, hence Normal. Neither rising nor falling like touching a chicken feather indicates excessive *mao* and scant Stomach Qi, hence Diseased. Desolate upon pressure like wind blowing hair indicates pure *mao* without Stomach Qi, hence Fatal.
The winter pulse should be slightly *shi*, coming sinking, soft, and slightly firm. Deviation indicates disease. Solid and strong indicates Excess, disease in the exterior, causing lassitude, pain in the spinal meridians, shortness of breath, and reluctance to speak. Deficient and faint indicates Deficiency, disease in the interior, causing a feeling of emptiness like hunger, coldness in the diaphragm, pain in the spine, fullness in the lower abdomen, and abnormal urination.
Large above and small below, soft and slippery like a bird's beak, indicates slight *shi* with harmonious Stomach Qi, hence Normal. Pecking continuously with a slight curve in the middle indicates excessive *shi* and scant Stomach Qi, hence Diseased. Coming like untying a tangled rope and departing like striking a stone indicates pure *shi* without Stomach Qi, hence Fatal.
Thus, the pulses of the four seasons all rely on Stomach Qi as their foundation. Therefore, presence of Stomach Qi means life, scarcity means disease, and absence means death.
Commentary: *Su Wen: Ping Ren Qi Xiang Lun* states: "The normal Liver pulse comes soft and swaying, like raising the tip of a long bamboo pole; this is called Normal Liver Pulse." "The normal Lung pulse comes gentle and continuous, like falling elm seeds; this is called Normal Lung Pulse." These two sentences describe the meaning of the normal Liver pulse as soft, harmonious, relaxed, and slightly *xian*; and the normal Lung pulse as floating, thin, light, empty, and slightly *mao*. However, here the Normal Lung Pulse is cited to explain the Normal Liver Pulse. It also states: "The diseased Heart pulse comes panting and continuous, with a slight curve in the middle; this is Heart Disease. Solid, full, and rapid, like a chicken lifting its foot; this is Spleen Disease." Now, Spleen Disease is cited to explain Heart Disease. The pulse like a crow's beak, which is the fatal pulse of the Spleen, is cited as the normal pulse of the Kidney. Such instances differ significantly from the original text. Feng Shi believed that Yue Ren (Qin Yueren/Bian Que) re-established the meanings to make the pulses easier to understand. However, readers of this chapter should consult it alongside *Su Wen*.
The Stomach is the sea of water and grain, primarily nourishing the four seasons. Since all four seasons rely on Stomach Qi as their foundation, this is the key intersection for seasonal variations in disease and the determination of life and death.
The Stomach belongs to Earth, positioned in the center, to which all things return; hence it is called the sea of water and grain. It prospers in the four seasons; Water, Fire, Metal, and Wood all depend on it to grow. As the key to seasonal disease variations, it is said to nourish the four seasons.
The Spleen is the Central Plain. Its peaceful state cannot be seen; it is only visible when declining. A pulse like a bird's beak or like water dripping from a leak is a sign of Spleen decline.
The Spleen receives the flavors of grain. Among the four Zang organs, it is therefore not distinctly visible. The Spleen寄旺 (prospers寄寓) in each of the four seasons and does not solely govern any single season. When the four Zang organs are peaceful, the Spleen pulse is hidden within; it only appears when the Spleen declines.
"Bird's beak" implies firmness and sharpness without harmonious Qi. "Water dripping" implies irregularity, discontinuity, scattering movement followed by cessation.
This corresponds to the meaning in *Su Wen: Yu Ji Zhen Zang Lun*: "The Spleen belongs to Earth. It is the solitary Zang organ that irrigates the four sides. Its good [healthy] state cannot be seen; its bad [pathological] state is visible."