上部有脉。下部无脉。其人当吐。不吐者死。上部无脉。下部有脉。虽困无能为害也。所以然者。譬如人之有尺。
树之有根。（按滑氏本义云。譬如二字。当在有尺下。）枝叶虽枯槁。根本将自生。脉有根本。人有元气。故知不死。
丁曰。经言脉有从上下者。是谓五脏之气。不相荣养。致令有此损至也。五脏之气。随呼吸上下。递相荣养。其心
肺主气。脉则随吸而荣其肾肝。其吸不能至肾至肝者。盖肾先损。则病骨痿也。其肾肝不荣于上。故先病其肺。病则皮
聚毛落也。其损甚者皆死。一呼再至曰平。一呼三至。即是阳加于阴二倍也。适得病也。其脉洪大曰离经。前大者、谓
寸外大也。后小者、谓寸内小也。前小者、寸外小也。后大者、寸内大也。前大后小。则头痛目眩。前小后大。即胸满
短气。经曰。上部法天。以候胸以上至头。素问曰。寸外以前。主头角耳目。寸内以后。主胸中。关以上。主膈下胁旁。
关内以后。主腹中。尺外以前。主脐下。尺内以后。主至足下。凡左右有此大小随部言之。一呼四至。谓阳气加阴四倍。
故曰夺精也。二呼一至者。是阴加于阳四倍。亦曰夺精。其浮大者。阳病甚。苦烦满也。加于滑者。伤于热极也。其沉
细者。阴病甚。所以腹中痛也。加于涩者。中雾露所作也。一呼五至。一吸五至。沉细则夜甚。浮大则昼甚。其有内外
大小者。游魂也。此不可疗。其数至愈增愈减者死。上部有脉。下部无脉。其人自当发吐。其不吐。是气独绝于内也。
上部无脉。下部有脉。虽困无能为害者。谓神不守也。（按不字疑当作内。）神昏如鱼掉尾者死。杨曰。上部寸口。下部
尺中也。虞曰。此又明人禀父母之元气也。
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。
吕曰。春、万物始生。未有枝叶。形状正直如弦。故脉法之也。丁曰。春脉弦者。微弦曰平。平者、谓有胃气。胃
者、土也。能成于四方。间于四旁。故四时脉见。弦钩毛石。皆当微见。即是有胃气也。但独见四时之脉者。皆无胃气
也。
夏脉钩者。心南方火也。万物之所盛。垂枝布叶。皆下曲如钩。故其脉之来疾去迟。故曰钩。
吕曰。心脉法火。曲如钩。又阳盛。其脉来疾。阴虚。脉去迟也。脉从下上至寸口疾。还尺中迟。寸口滑不泄。故
令其脉环曲如钩。
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。若其脉之来。轻虚以浮。故曰毛。
吕曰。肺浮在上。其气主皮毛。故令其脉浮如毛也。
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。
吕曰。肾脉法水。水凝如石。又伏行温于骨髓。故其脉实牢如石也。
此四时之脉也。如有变奈何。然。春脉弦。反者为病。何谓反。
丁曰。反者、为见秋脉如毛。是谓肝病。
然。其气来实强。是谓太过。病在外。
吕曰。实强者、阳气盛也。少阳当微弱。今更实强。谓太过。阳主表。故令其病在外也。丁曰。病在外者。是少阳。
其脉微弦。今实强者。是胆有余。面青好怒。是肝木之外证也。
气来虚微。是谓不及。病在内。
吕曰。厥阴之气养于筋。其脉弦。今更虚微。故曰不及。阴处中。故令其病在内。丁曰。病在内者。肝不足也。肝
含血养筋。不足则筋缓。溲便难。是肝之内证也。虞曰。太过之脉。谓不至而至。不及之脉。谓脉息虚微。太过。眩冒
颠疾。其不及。则令人胸痛。引背下。则两胁胀满也。
气来厌厌聂聂。如循榆叶。曰平。
吕曰。春少阴厥阴俱合主。其脉之来。如春风吹榆叶。濡弱而调。故曰平脉也。
益实而滑。如循长竿。曰病。
吕曰。此谓弦多胃气少也。丁曰。长而不软。故若循竿。是为病也。
急而劲益强。如新张弓弦。曰死。
吕曰。此谓但弦。无胃气也。丁曰。谓强急而紧细。故曰如新张弓弦也。
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。
吕曰。胃主水谷。故人禀胃气。丁曰。胃者、水谷之海。五脏皆受气于谷。胃者主禀四方。故以胃气而为本也。（按
而字疑衍）
夏脉钩。反者为病。何谓反。
丁曰。谓脉来石滑。如冬之脉。故曰反。
然。其气来实强。是谓太过。病在外。
吕曰。实强者、太阳受气盛也。太阳者、浮散。今反实强。故曰太过也。丁曰。其外者、太阳小肠为腑。故病在外。
其面赤喜笑。是心火之外证也。
气来虚微。是谓不及。病在内。
吕曰。手少阴主血脉。其气尚平实。今反见虚微。故曰不及也。丁曰。少阴心。夏盛王。今反虚微。是谓不及。不
及则病在内。喜笑其神不守。虞曰。少阴心脉。本平实。今反虚微。故曰不及也。太阳小肠。脉本浮大。今反实强。曰
太过也。其太过不及之证。乃如下说。玉机真脏论曰。夏脉太过。其病身热而肤痛。为浸淫。其不及者。令人烦心。上
见咳嗽。下为气泄也。
其脉来。累累如环。如循琅 。曰平。
吕曰。心满实。累累如人指循琅 者。是金银 钏之物劲也。此皆实之类也。故云平。丁曰。言心脉满实。累累如
连珠。其言循琅 者。谓琅 是玉与珠类贯如环之象也。
来而益数。如鸡举足者曰病。
吕曰。心脉但当浮散。不当数也。鸡举足者。喻其数也。丁曰。心脉但当浮散。今又加其至数。即病。故喻其脉如
鸡举足走也。
前曲后居。如操带钩。曰死。
吕曰。后居谓之后直。如人革带之钩。前曲后直也。是谓但钩无胃气。丁曰。操者、执也。如手执革带前钩曲无力
也。后居。倨而不动劲有。故曰死也。
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。
吕曰。胃者。中州。主养于四脏也。
秋脉微毛。反者为病。何谓反。然。气来实强。是谓太过。病在外。
吕曰。肺脉者当微毛。今更实强。故曰病在外。丁曰。外者、谓手阳明太阴也。故外证面白善嚏。悲愁不乐。皮毛
干燥。此是肺金之外证也。
气来虚微。是谓不及。病在内。
吕曰。肺脉轻。虚浮如毛。今按之益虚微。是无胃气。故病在内。丁曰。病在内者。手太阴肺也。其内证。喘咳、
洒淅寒热。此是肺金之内证也。虞曰。太过不及。病如下说。玉机真脏论曰。秋脉太过。则令人逆气。而背痛愠愠然。
秋脉不及。则令人喘。呼吸少气。上气见血。下闻病音。
其脉来。蔼蔼如车盖。按之益大。曰平。
吕曰。车盖、乃小车之盖。轻浮。蔼蔼然也。按之益大。有胃气。故曰平也。丁曰。如车之曲盖偃蔼之状。故曰平
也。
不上不下。如循鸡羽。曰病。
吕曰。如循鸡羽者。是其气虚微。胃气少。故曰病。丁曰。手太阴肺金。乘夏余阳。故其脉上。又其气当于下降。
今不上不下。如循鸡羽者。但当涩涩然。故曰病也。
按之消索。如风吹毛。曰死。
吕曰。此无胃气。丁曰。风吹毛者。飘腾不定无归之象。故曰如风吹毛而死也。
秋脉微毛为平。毛多胃气少曰病。但毛无胃气曰死。秋以胃气为本。
吕曰。四脏皆须禀胃气也。
冬脉石。反者为病。何谓反。然。其气来实强。是谓太过。病在外。
吕曰。冬脉当沉濡。今反实强。故曰太过。太过者。阳脉病。故言病在外也。丁曰。反者、冬得长夏之脉。长夏者。
土也。胃土脉缓而微曲。故病也。在外者。是足太阳之经也。面黑善恐欠。是其肾水之外证也。
气来虚微。是谓不及。病在内。
吕曰。冬脉沉濡。今反虚微。故言不及。不及者、阴病在内也。丁曰。足少阴肾脉也。主水王冬。其脉沉濡而滑。
今虚微少气。是谓不及。病在内。其内证。气逆小腹急。痛泄如下重。此肾水内证也。虞曰。冬脉太过。则令人解 。
谓似病不病也。春脉痛而少气不欲言也。冬脉不及。则令人心如悬病饥。 中清。脊中痛。少腹满。小便变也。
脉来上大下兑。濡滑如雀之喙。曰平。（按原本喙误啄。并后音释亦误。然注云许秽切。则为喙字明矣。今改正。）
吕曰。上大者、足太阳。下兑者、足少阴。阴阳得所。为胃气强。故谓之平。雀喙、谓本大末兑也。丁曰。肾脉本
性濡滑。今诊之。应手而大。去而小。故曰上大下兑。喻如雀喙。是谓平也。
啄啄连属。其中微曲。曰病。
吕曰。啄啄者、不息。故谓之连属。其中微曲。是脾来乘肾。脉缓而曲。故病。丁曰。啄啄谓如雀。啄啄连连时止。
肾衰之病也。
来如解索。去如弹石。曰死。
吕曰。解索谓虚缦无根本也。来迟去疾。故曰弹石也。丁曰。诊之应手如脱解之索。无力也。去疾而如弹石，是肾
死也。
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。胃者、水谷之海也。主禀四时。故皆以胃气为
本。是谓四时之变病。死生之要会也。
虞曰。胃属土。土者、五也。万物归之。故曰水谷之海。一年王辰戌丑未。故曰主禀四时。谓弦钩毛石。四时之经。
皆得胃气为本。若胃气少则人病。若无胃气则人死。故曰四时变病。死生之要会也。万物非土孕育。则形质不成也。易
曰。坤浓载物。德合无疆。
脾者、中州也。其平和不可得见。衰乃见耳。来如雀之啄。如水之下漏。是脾之衰见也。
吕曰。脾寄王四季。故不言王言平和。脉不见。其衰病见耳。其脉见如屋之漏。如雀之啄。如水之下漏。皆肾来乘
脾。故使衰病。肝乘脾则死。肾不胜脾。故但病也。丁曰。脾者、成于四方。故平常不见。衰乃见。如雀之啄。如水之
滴漏。虞曰。如水之漏。乃是脾脉太过。如雀之啄。是谓脾脉不及。太过则令人四肢不举。不及则令人九窍不通。故平
和不可得见。衰乃见也。
十六难曰。脉有三部九候。
吕曰。三部者、寸关尺也。九候者、上部三候。中部三候。下部三候。三三如九也。丁曰。三部者、寸关尺也。九
候者、浮中沉也。是一难之所演也。虞曰，三部法三才。故有天地人。三部之中。亦各有天地人。因而成九。上部天。
以候头角。上部之人。以候耳目。上部之地。以候口齿。中部之天。以候肺。中部之人。以候心。中部之地。以候胸中
之气。下部之天。以候肝。下部之人。以候脾胃。下部之地。以候肾。故曰三部九候也。
有阴阳。
吕曰。寸口者、阳脉见九分而浮。尺部者、阴脉见一寸而沉。丁曰。阴阳者、是二难。尺寸皆阴阳前后上下之法也。
虞曰。三部之中。各有一阴一阳。来者为阳。去者为阴。察阳者知病之所有。察阴者知死生之期也。
有轻重。
吕曰。肺如三菽之重。是谓轻肾脉。按之至骨。如十五菽之重。是谓重也。丁曰。轻重者、是五难。言轻重之法也。
虞曰。凡切阳脉。乃轻手取。谓阳脉浮也。切阴脉。乃重手取。谓阴脉沉也。故曰轻重也。
有六十首。
吕曰。首、头首也。盖三部从头者。脉辄有六十首。丁曰。六十首者、是十难。经一脉变为十是也。虞曰。六十首
者。乃一脉变为四时是也。谓春脉弦。夏脉钩。秋脉毛。冬脉石。季夏及四季脉缓。逐四时之休王。一脉变为五十二经。
内成六十首也。
一脉变为四时。
吕曰。是手太阴之动。以决四时逆顺吉凶之法也。丁曰。十五难是言四时以胃气为本。况经脉十二经。谓脉随四时
之变换。非手太阴也。虞曰。凡切脉。始起于六脉。谓浮沉长短滑涩也。乃三阴三阳之脉也。六脉趣四时之变。故有二
十四脉形焉。今六十首。乃备言手足三阴三阳。合之为十二脉。随弦钩毛石变之为时经。合之为六十脉。故曰一脉变为
四时。
离圣久远。各自是其法。何以别之。
吕曰。言三部是一法。九候是一法。阴阳是一法。轻重是一法。六十首是一法。言法象无多。难可分别。故言之此
难也。丁曰。离圣人久远者。为越人时去圣逾远也。各自是其法者。为前所演其法也。故曰各自是其法也。
然。是其病有内外证。
吕曰。法象无多。或变为四时。难可分别。故以中外别其病。以名之难也。丁曰。是字当作视物之视。上文言视病
之法。不与诊法同。故云别也。然字者、是越人自答之语也。言使人视其精明五色。循按察之左右。即知内外之证。故
知是字当作视物字用。此是字传写之错误也。虞曰。一脏一腑。乃一表一里。腑之病主于外。故有外证。脏之病主于内。
故有内证也。
其病为之奈何。然。假令得肝脉。
虞曰。肝脉弦软而长。
其外证善洁。面青善怒。
足少阳胆者、腑也。故有病则见于外也。又胆为清净之腑。故善洁也。主于外。见面青也。又胆为中正之官。主决
断。故善怒也。
其内证齐左有动气。按之牢若痛。
虞曰。五积之候。肝之积名曰肥气。在齐之左也。
其病四肢满闭。
The pulse is palpable in the upper part (Cun position), but absent in the lower part (Chi position). The patient should vomit; if they do not vomit, death will ensue. If the pulse is absent in the upper part but present in the lower part, although the patient is weak, it poses no fatal threat. This is because, just as a person has a foundation or a tree has roots: even if the branches and leaves wither, the root system will naturally regenerate. Since the pulse has a root, the person possesses Yuan Qi (Primordial Qi); therefore, death can be ruled out.
Ding stated: The Classic mentions that when Qi flows from above to below, it indicates that the Qi of the Five Zang organs fails to nourish each other, leading to such extreme damage. The Qi of the Five Zang organs moves up and down with respiration, mutually nourishing one another sequentially. The Heart and Lung govern Qi; the pulse nourishes the Liver and Kidney during inhalation. If inhalation cannot reach the Kidney and Liver, it is because the Kidney is damaged first, resulting in Bone Withering disease. When the Qi of the Kidney and Liver fails to nourish the upper body, the Lung becomes diseased first, manifesting as gathered skin and falling hair. Severe damage leads to death. Two beats per exhalation indicate a Normal Pulse. Three beats per exhalation indicate Yang added to Yin by double, signifying the onset of illness. A洪大 (Hóng Dà, Vast and Large) pulse is called Lí Jīng (Departing from the Channel). "Front large, back small" refers to the outer Cun being large and the inner Cun being small. "Front small, back large" refers to the outer Cun being small and the inner Cun being large. Front large and back small causes headache and dizziness. Front small and back large causes chest fullness and shortness of breath. The Classic states: The Upper part corresponds to Heaven, observing the area from the chest upwards to the head. The Su Wen states: The area before the outer Cun governs the temples, ears, and eyes; the area after the inner Cun governs the chest; above the Guan (Bar) position governs below the diaphragm and beside the ribs; inside the Guan position governs the abdomen; the area before the outer Chi governs below the umbilicus; the area after the inner Chi governs down to the soles of the feet. These size variations apply to both left and right hands according to their positions. Four beats per exhalation indicate Yang added to Yin by four times, hence called Duó Jīng (Depletion of Essence). One beat every two exhalations indicates Yin added to Yang by four times, also called Duó Jīng. A floating and large pulse indicates severe Yang pathology, suffering from irritability and fullness. A slippery pulse indicates injury from extreme heat. A deep and fine pulse indicates severe Yin pathology, causing abdominal pain. A choppy pulse indicates injury from fog and dew pathogens. Five beats per exhalation and five per inhalation: if deep and fine, symptoms worsen at night; if floating and large, symptoms worsen during the day. Variations in internal/external and large/small indicate You Hun (Wandering Soul) disease, which is incurable. A pulse that increases and then decreases in frequency indicates death. If the pulse is present in the upper part but absent in the lower part, the patient should naturally vomit. If they do not vomit, it means Qi is exclusively severed internally. If the pulse is absent in the upper part but present in the lower part, despite weakness, it is harmless, indicating Shen (Spirit) does not reside within. (Note: "Bu" [not] is suspected to be a typo for "Nei" [inside].) Shen confusion resembling a fish wagging its tail indicates death.
Yang stated: The upper part refers to the Cun Kou (Inch Port), and the lower part refers to the Chi Zhong (Foot Center). Yu stated: This further clarifies the Yuan Qi inherited from parents.
Difficulty 15 states: The Classic says Spring pulse is Xian (String-like), Summer pulse is Gou (Hook-like), Autumn pulse is Mao (Feather-like), and Winter pulse is Shi (Stone-like). Are these Wang Mai (Prosperous Pulses) or Bing Mai (Disease Pulses)? The answer is: Xian, Gou, Mao, and Shi are the Normal Pulses of the Four Seasons. The Spring pulse is Xian because the Liver belongs to Wood in the East; all things begin to grow without branches or leaves, so the pulse comes soft, weak, and long, hence called Xian.
Lü stated: In Spring, all things begin to grow without branches or leaves, straight like a string, so the pulse method imitates this. Ding stated: The Spring pulse is Xian; a slight Xian is Normal. Normal means there is Wei Qi (Stomach Qi). The Stomach belongs to Earth, capable of completing the four directions, situated among the four sides. Thus, when the pulses of the four seasons appear—Xian, Gou, Mao, Shi—they should all appear slightly, indicating the presence of Wei Qi. If only the seasonal pulses appear without Wei Qi, it indicates absence of Wei Qi.
The Summer pulse is Gou because the Heart belongs to Fire in the South, where all things flourish. Hanging branches and spreading leaves curve downwards like hooks; thus, the pulse comes swiftly and departs slowly, hence called Gou.
Lü stated: The Heart pulse imitates Fire, curving like a hook. Yang excess makes the pulse come swiftly; Yin deficiency makes it depart slowly. The pulse rises swiftly from Chi to Cun and returns slowly to Chi; Cun is slippery and unexhausted, making the pulse ring-curved like a hook.
The Autumn pulse is Mao because the Lung belongs to Metal in the West, where all things conclude. Flowers and leaves fall in autumn, leaving only branches like hairs. If the pulse comes light, void, and floating, it is called Mao.
Lü stated: The Lung pulse floats upward; its Qi governs skin and hair, making the pulse float like hair.
The Winter pulse is Shi because the Kidney belongs to Water in the North, where all things are stored. In deep winter, water freezes like stone; thus, the pulse comes deep, soft, and slippery, hence called Shi.
Lü stated: The Kidney pulse imitates Water, freezing like stone, and lies hidden warming the bone marrow; thus, the pulse is solid and firm like stone.
These are the Normal Pulses of the Four Seasons. What happens if there are changes? The answer is: The Spring pulse is Xian; the opposite indicates disease. What is meant by opposite?
Ding stated: Opposite means seeing an Autumn-like Mao pulse, which indicates Liver disease.
The answer is: If the Qi comes solid and strong, it is called Tai Guo (Excess), and the disease is external.
Lü stated: Solid and strong indicates Yang excess. Shaoyang should be weak; now it is solid and strong, called Excess. Yang governs the exterior, so the disease is external. Ding stated: Disease in the exterior involves Shaoyang, whose pulse is slightly Xian. Now being solid and strong indicates Gallbladder excess. Green face and anger are external signs of Liver Wood.
If the Qi comes void and weak, it is called Bu Ji (Deficiency), and the disease is internal.
Lü stated: Jueyin Qi nourishes tendons, and its pulse is Xian. Now being void and weak is called Deficiency. Yin resides in the middle, so the disease is internal. Ding stated: Disease in the interior indicates Liver insufficiency. The Liver stores blood and nourishes tendons; insufficiency leads to flaccid tendons and difficult urination/defecation, which are internal signs of the Liver. Yu stated: Excess pulse means arriving before the season; Deficient pulse means void and weak respiration. Excess causes dizziness, fainting, and convulsions; Deficiency causes chest pain radiating to the back and distension in the hypochondrium.
A pulse coming gently and softly, like touching elm leaves, is Normal.
Lü stated: In Spring, Shaoyin and Jueyin jointly govern. The pulse comes like spring wind blowing elm leaves, soft, weak, and harmonious, hence called Normal Pulse.
A pulse becoming more solid and slippery, like touching a long bamboo pole, is Disease.
Lü stated: This indicates much Xian and little Wei Qi. Ding stated: Long and not soft, like touching a pole, is Disease.
A pulse urgent and increasingly strong, like a newly strung bowstring, is Death.
Lü stated: This indicates only Xian without Wei Qi. Ding stated: Strong, urgent, and tight/thin, like a newly strung bowstring.
Spring pulse slightly Xian is Normal; much Xian with little Wei Qi is Disease; only Xian without Wei Qi is Death. Spring takes Wei Qi as the root.
Lü stated: The Stomach governs water and grain, so humans inherit Wei Qi. Ding stated: The Stomach is the Sea of Water and Grain; the Five Zang receive Qi from grain. The Stomach governs the four directions, so Wei Qi is the root. (Note: "Er" [and] is suspected to be superfluous.)
Summer pulse Gou; the opposite is Disease. What is opposite?
Ding stated: The pulse comes Shi and slippery, like the Winter pulse, hence called opposite.
The answer is: If the Qi comes solid and strong, it is Tai Guo (Excess), and the disease is external.
Lü stated: Solid and strong indicates Taiyang Qi excess. Taiyang is floating and scattered; now being solid and strong is called Excess. Ding stated: Disease in the exterior involves the Taiyang Small Intestine as the Fu organ, so the disease is external. Red face and laughter are external signs of Heart Fire.
If the Qi comes void and weak, it is Bu Ji (Deficiency), and the disease is internal.
Lü stated: Hand-Shaoyin governs blood vessels, and its Qi is normally solid. Now appearing void and weak is called Deficiency. Ding stated: Shaoyin Heart prospers in Summer; now being void and weak is Deficiency. Deficiency means disease in the interior. Laughter indicates Spirit not residing. Yu stated: Shaoyin Heart pulse should be solid; now void and weak is Deficiency. Taiyang Small Intestine pulse should be floating and large; now solid and strong is Excess. The manifestations of Excess and Deficiency are as follows. The Yu Ji Zhen Zang Lun states: Summer Excess pulse causes body heat and skin pain, manifesting as infiltrating sores; Deficiency causes vexation, cough above, and qi leakage below.
A pulse coming continuously like a ring, like touching Langgan (agate/jade), is Normal.
Lü stated: Heart pulse full and solid, continuous like touching agate, resembles the firmness of gold/silver bracelets. These are images of solidity, hence Normal. Ding stated: Heart pulse full and solid, continuous like pearls. Touching agate refers to jade and pearls threaded like a ring.
A pulse coming faster, like a chicken lifting its feet, is Disease.
Lü stated: Heart pulse should be floating and scattered, not rapid. Chicken lifting feet symbolizes rapidity. Ding stated: Heart pulse should be floating and scattered; now increased frequency indicates disease, likened to a chicken walking.
Curved front and straight back, like holding a belt hook, is Death.
Lü stated: Straight back is like a leather belt hook. Curved front and straight back indicates only Gou without Wei Qi. Ding stated: Cao means holding. Like holding a belt hook with no strength in the front. Back is rigid and unmoving, hence Death.
Summer pulse slightly Gou is Normal; much Gou with little Wei Qi is Disease; only Gou without Wei Qi is Death. Summer takes Wei Qi as the root.
Lü stated: The Stomach is the Central Region, nourishing the four Zang.
Autumn pulse slightly Mao; the opposite is Disease. What is opposite? The answer is: If the Qi comes solid and strong, it is Tai Guo (Excess), and the disease is external.
Lü stated: Lung pulse should be slightly Mao; now solid and strong is Disease in the exterior. Ding stated: Exterior refers to Hand-Yangming and Hand-Taiyin. External signs include pale face, sneezing, sorrow, and dry skin/hair, which are external signs of Lung Metal.
If the Qi comes void and weak, it is Bu Ji (Deficiency), and the disease is internal.
Lü stated: Lung pulse is light, void, and floating like Mao. Pressing reveals more voidness, indicating no Wei Qi, so disease is internal. Ding stated: Disease in the interior involves Hand-Taiyin Lung. Internal signs include wheezing, cough, chills, and fever, which are internal signs of Lung Metal. Yu stated: Excess and Deficiency diseases are as follows. The Yu Ji Zhen Zang Lun states: Autumn Excess causes reverse Qi and warm back pain. Autumn Deficiency causes wheezing, shortness of breath, hemoptysis, and abnormal sounds below.
A pulse coming abundant like a carriage canopy, expanding upon pressure, is Normal.
Lü stated: Carriage canopy is light and floating. Expanding upon pressure indicates Wei Qi, hence Normal. Ding stated: Like the curved shape of a carriage canopy, hence Normal.
Neither rising nor falling, like touching chicken feathers, is Disease.
Lü stated: Touching chicken feathers indicates void Qi and little Wei Qi, hence Disease. Ding stated: Hand-Taiyin Lung Metal exploits residual Summer Yang, so the pulse rises. Qi should descend. Now neither rising nor falling, like touching chicken feathers, is merely choppy, hence Disease.
Pressing until it vanishes, like wind blowing hair, is Death.
Lü stated: This is absence of Wei Qi. Ding stated: Wind blowing hair signifies drifting without return, hence Death.
Autumn pulse slightly Mao is Normal; much Mao with little Wei Qi is Disease; only Mao without Wei Qi is Death. Autumn takes Wei Qi as the root.
Lü stated: The four Zang must inherit Wei Qi.
Winter pulse Shi; the opposite is Disease. What is opposite? The answer is: If the Qi comes solid and strong, it is Tai Guo (Excess), and the disease is external.
Lü stated: Winter pulse should be deep and soft; now solid and strong is Excess. Excess is Yang pathology, hence disease in the exterior. Ding stated: Opposite means receiving Changxia (Late Summer) pulse in Winter. Changxia is Earth. Stomach Earth pulse is slow and slightly curved, hence disease. Exterior involves Foot-Taiyang meridian. Black face, fear, and yawning are external signs of Kidney Water.
If the Qi comes void and weak, it is Bu Ji (Deficiency), and the disease is internal.
Lü stated: Winter pulse is deep and soft; now void and weak is Deficiency. Deficiency is Yin disease in the interior. Ding stated: Foot-Shaoyin Kidney pulse governs Water and prospers in Winter. Its pulse is deep, soft, and slippery. Now void and weak with little Qi is Deficiency. Disease in the interior includes reverse Qi, lower abdominal urgency/pain/diarrhea, which are internal signs of Kidney Water. Yu stated: Winter Excess causes lethargy (seeming ill but not). Spring Excess causes pain and reluctance to speak. Winter Deficiency causes heart feeling empty like hunger, cold epigastrium, spinal pain, lower abdominal fullness, and urinary changes.
Pulse large above and narrow below, soft and slippery like a sparrow's beak, is Normal. (Note: Original text had "Zhuo" [peck], corrected to "Hui" [beak] based on pronunciation note.)
Lü stated: Large above is Foot-Taiyang; narrow below is Foot-Shaoyin. Yin and Yang are balanced, indicating strong Wei Qi, hence Normal. Sparrow beak means large base and narrow tip. Ding stated: Kidney pulse is naturally soft and slippery. Palpated, it is large on arrival and small on departure, called Large Above Narrow Below, likened to a sparrow beak, hence Normal.
Pecking continuously, slightly curved in the middle, is Disease.
Lü stated: Pecking means non-stop, hence continuous. Slight curvature in the middle indicates Spleen overcoming Kidney, pulse slow and curved, hence Disease. Ding stated: Pecking like a sparrow, intermittent, indicates Kidney decline.
Coming like untied cords, departing like flicking stones, is Death.
Lü stated: Untied cords mean void and loose without root. Coming slow and departing fast is Flicking Stones. Ding stated: Palpated like untied rope, powerless. Departing fast like flicking stones indicates Kidney death.
Winter pulse slightly Shi is Normal; much Shi with little Wei Qi is Disease; only Shi without Wei Qi is Death. Winter takes Wei Qi as the root. The Stomach is the Sea of Water and Grain, governing the four seasons, so all take Wei Qi as the root. This is the key to seasonal disease variations and life/death.
Yu stated: Stomach belongs to Earth, central among Five Elements. All things return to it, hence Sea of Water and Grain. It prospers in Chen, Xu, Chou, Wei months, governing the four seasons. Xian, Gou, Mao, Shi all depend on Wei Qi. Little Wei Qi causes disease; no Wei Qi causes death. Hence seasonal variations are the key to life and death. Without Earth nurturing, form cannot be completed. The I Ching states: Kun carries things厚德载物, virtue matches the boundless.
Spleen is the Central Region. Its normal state is invisible; only decline is seen. Coming like a sparrow pecking, or water leaking, indicates Spleen decline.
Lü stated: Spleen prospers in the four seasons, so it speaks of peace rather than prosperity. Pulse is not seen; only disease is seen. Pulse like roof leak, sparrow peck, or water leak indicates Kidney overcoming Spleen, causing decline. Liver overcoming Spleen causes death; Kidney failing to overcome Spleen causes only disease. Ding stated: Spleen completes the four directions, so it is usually unseen; decline is seen. Like sparrow peck or water drip. Yu stated: Water leak indicates Spleen Excess; sparrow peck indicates Spleen Deficiency. Excess causes inability to lift limbs; Deficiency causes obstruction of nine orifices. Hence normal is unseen; decline is seen.
Difficulty 16 states: Pulse has Three Parts and Nine Probes.
Lü stated: Three Parts are Cun, Guan, Chi. Nine Probes are three in Upper, Middle, and Lower parts. Three times three equals nine. Ding stated: Three Parts are Cun, Guan, Chi. Nine Probes are Floating, Middle, Deep. This elaborates Difficulty 1. Yu stated: Three Parts correspond to Heaven, Earth, Man. Each part has Heaven, Earth, Man, forming nine. Upper Heaven probes head/temples; Upper Man probes eyes/ears; Upper Earth probes mouth/teeth. Middle Heaven probes Lung; Middle Man probes Heart; Middle Earth probes chest Qi. Lower Heaven probes Liver; Lower Man probes Spleen/Stomach; Lower Earth probes Kidney. Hence Three Parts and Nine Probes.
There is Yin and Yang.
Lü stated: Cun Kou shows Yang pulse floating at nine fen; Chi section shows Yin pulse sinking at one cun. Ding stated: Yin and Yang refer to Difficulty 2, the method of sizes and positions. Yu stated: Each of the three parts has one Yin and one Yang. Arrival is Yang, departure is Yin. Observing Yang reveals disease presence; observing Yin reveals time of death.
There is Lightness and Heaviness.
Lü stated: Lung is like the weight of three beans, called Light Kidney pulse. Pressing to bone, like fifteen beans, is Heavy. Ding stated: Lightness and heaviness refer to Difficulty 5, describing pressing methods. Yu stated: Cutting Yang pulse requires light touch (floating); cutting Yin pulse requires heavy touch (sinking). Hence Lightness and Heaviness.
There are Sixty Heads.
Lü stated: Head means beginning. From the three parts, there are sixty heads. Ding stated: Sixty heads refer to Difficulty 10, one pulse changing into ten. Yu stated: Sixty heads refer to one pulse changing into four seasons. Spring Xian, Summer Gou, Autumn Mao, Winter Shi, Late Summer/Four Seasons Huan. Following seasonal prosperity, one pulse changes into fifty-two channels, forming sixty heads internally.
One pulse changes into four seasons.
Lü stated: This is the movement of Hand-Taiyin, determining seasonal reversal and fortune. Ding stated: Difficulty 15 states four seasons take Wei Qi as root. Regarding twelve meridians, pulse changes with seasons, not just Hand-Taiyin. Yu stated: Pulse cutting starts with six pulses: Floating, Sinking, Long, Short, Slippery, Choppy, belonging to Three Yin and Three Yang. Six pulses follow seasonal changes, yielding twenty-four pulse forms. Now sixty heads fully describe Hand and Foot Three Yin and Three Yang, combining into twelve pulses, changing with Xian, Gou, Mao, Shi into seasonal channels, totaling sixty pulses. Hence one pulse changes into four seasons.
Far from the Sages, each claims their method correct. How to distinguish?
Lü stated: Three Parts is one method, Nine Probes is one method, Yin/Yang is one method, Lightness/Heaviness is one method, Sixty Heads is one method. Methods are few, hard to distinguish, hence this difficulty. Ding stated: Far from Sages means Yue Ren was far from the Sage era. Each claiming correctness refers to previously elaborated methods.
However, the disease has internal and external signs.
Lü stated: Methods are few, possibly changing into seasons, hard to distinguish. Thus, distinguish disease by interior/exterior, making naming difficult. Ding stated: "Shi" [this] should be "Shi" [observe]. Previous text discusses observing disease methods, different from diagnosis, hence "distinguish". "Ran" [however] is Yue Ren's self-answer. Observe spirit and five colors, press and check left/right to know internal/external signs. Thus "Shi" should be used as "observe". This is a transcription error. Yu stated: One Zang and one Fu constitute one Interior and one Exterior. Fu disease manifests externally (external signs); Zang disease manifests internally (internal signs).
How to handle the disease? However, assuming we obtain the Liver pulse.
Yu stated: Liver pulse is Xian, soft, and long.
External signs: Cleanliness preference, green face, anger.
Foot-Shaoyang Gallbladder is a Fu organ. Disease manifests externally. Gallbladder is a clear/pure Fu, hence preference for cleanliness. Governs exterior, showing green face. Gallbladder is the Official of Justice, governing decision, hence anger.
Internal signs: Moving Qi to the left of the navel, firm and painful upon pressure.
Yu stated: Sign of Five Accumulations, Liver accumulation named Fei Qi, located to the left of the navel.
Disease: Limb fullness and closure.