黄帝问曰。平人何如。（平人、平常无病之人。无病之人。自有平常之脉。反常则为病矣。故曰平人气象论。气者。
经脉之气。象者。脉之形象也。）岐伯对曰。人一呼脉再动。一吸脉亦再动。呼吸定息。脉五动。闰以太息。命曰平人。
平人者不病也。（出气曰呼。入气曰吸。一呼一吸为一息。平人之脉。一呼再动。一息再动。呼吸定息。脉计五动。盖闰
以太息。故五动也。闰、余也。太息者。呼吸定息之时。有余不尽。而脉又一动。如岁余之有闰也。盖人之呼吸。乃阴
阳之气。出入循环。有若寒暑往来而成岁。故宜闰以太息之有余。）当以不病调病患。医不病。故为病患平息以调之为法。
不病者其息平。病者其息乱。医者不病。故为病患平息以调之。是为候诊之法。人一呼。脉一动。一吸。脉一动曰少
气。（荣气宗气行于脉外。卫气行于脉中。荣卫相将。脉随气转。人一呼一动。一吸一动。减于平人过半。故主气之衰微。）
人一呼脉三动。一吸脉三动而躁。尺热曰病温。尺不热脉滑曰病风。脉涩曰痹。（一息之中。脉六动者。气之太过也。躁、
急也。吸而躁者。有余之邪。从外而内也。温病者。冬伤于寒。至春发为温病。冬伤于风。至春发为风温。此皆伏匿之
邪。由内而外。从阴而阳。故尺中热也。风为阳邪。伤人阳气。故尺不热。气分之邪。留而不去。则迫于经。故脉滑也。
痹者闭也。邪积而不行。故脉涩泣也。盖言从内而外者为温病。从外而内者为风邪。留着于外内之间者为痹也。上节言
不及者。缘正气衰少。此言太过者。乃邪气有余。而有余之邪。又有阴阳外内出入之别。）人一呼吸四动以上曰死。脉绝
不至曰死。乍疏乍数曰死。（四动以上。太过之极也。脉绝不至。不及之极也。乍疏乍数。或太过。或不及。气之乱也。
此皆不平之甚。故为死脉。以上论脉平者。命曰平人。太过不及则病。剧者死矣。）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。（此论四时之脉。当以胃气为本也。平人之常。受气于谷。谷入于胃。五脏六腑。皆以
受气。故胃者平人之常气也。人无胃气。是生机已绝。绝则死矣。）春胃微弦曰平。弦多胃少曰肝病。但弦无胃曰死。（胃
气者。中土柔和之气也。弦乃东方春木之象。微乃胃气之和。故春得胃气而脉微弦曰平。弦多而少柔和之气曰肝病。但
弦无胃曰死。杨元如曰。春胃微弦者。言四时之中。有此胃气。由胃气而养此五脏之真。此节以四时而合于五脏。末
节以五脏之气。而合于四时。）胃而有毛曰秋病。毛甚曰今病。（毛为秋脉。属金。如春虽得微弦之平脉。而兼有轻浮之
毛。此金来克木。至秋金令之时。则当病矣。如毛脉过甚。此木受金刑。当主即病。此复言四时之脉。各有所主之气。
如见克贼之脉。虽有胃气。而亦能为病也。）脏真散于肝。肝藏筋膜之气也。（上脏叶脏下脏叶脏脏真者。真脏所藏之神
也。神在脏为肝。在体为筋。言真脏之神散于肝。而主藏筋膜之气。如春木微弦之脉。乃因胃气而至于手太阴。故曰脉
不得胃气。肝不弦。肾不石。是弦钩毛石之脉。亦皆胃气之所生。）夏胃微钩曰平。钩多胃少曰心病。但钩无胃曰死。
（钩乃南方夏火之象。微则柔和之胃气也。夏得胃气而脉微钩曰平。钩甚而少微和之气曰心病。但钩无胃曰死。）胃而有
石曰冬病。石甚曰今病。（石乃冬令之脉。微钩而带石。乃火中有水。至冬水气所主之时而为病矣。如水气太甚。此火受
水克。当即病矣。）脏真通于心。心藏血脉之气也。（夏脏之元真通于心。而主藏血脉之气。）长夏胃微 弱曰平。弱多胃
少曰脾病。但代无胃曰死。（ 叶软。长夏湿土主气。微 弱者。中土柔和之气也。代者。相离之脉。盖脾主四季。四时
有交相更代之气。是以柔和相离。脾之平脉也。如但代而无微 之和。此胃气已绝。故为死脉。盖脾之得以灌溉于四脏
者。由胃气之所生。故但代无胃曰死。） 弱有石曰冬病。弱甚曰今病。（ 弱有石。是所不胜之水气。反来侮土。至冬
时水气反虚而为病矣。弱甚者。脾气太弱。当主即病。盖言乘侮太甚者即病。而本气虚者。亦即病也。）脏真濡于脾。脾
藏肌肉之气也。（土藏之元真濡于脾。而主藏肌肉之气。杨元如曰。肝主疏泄。故曰散。心主血脉。故曰通。脾主灌溉。
故曰濡。肺脏居尊。故曰高。肾为水脏。故曰下。）秋胃微毛曰平。毛多胃少曰肺病。但毛无胃曰死。（毛乃秋金之脉。
微则柔和之胃气也。秋得胃气。而脉微毛曰平。毛多而少柔和之气曰肺病。但毛无胃曰死。）毛而有弦曰春病。弦甚曰今
病。（毛而有弦。是所不胜之木气。反来侮金。则木虚其本位矣。至春当木旺之时。而木气反虚。是以为病。所谓侮反受
邪。寡于畏也。弦甚者乘侮太过。而金气当即病矣。按平脉篇曰。脉有相乘。有纵有横。水行乘火。金行乘木。名曰纵。
火行乘水。木行乘金。名曰横。是四时之中。皆有纵有横。纵者。虽得胃气而所不胜乘之。故曰。胃而有毛。胃而有石。
横者。脏气不足而所胜妄行。故曰毛而有弦。石而有钩。此脏气横行。是以本位虚而反招仇复。按四季长夏之中。文义
三换。当知四时之气。皆有纵有横。有客气甚而有本气虚也。）脏真高于肺。以行荣卫阴阳也。（金藏之元真。高居于肺。
而主行荣卫阴阳。肺主周身之气。而朝百脉也。元如曰。相传之官。燮理阴阳。宣布政令。）冬胃微石曰平。石多胃少曰
肾病。但石无胃曰死。（石乃冬藏之脉。微则柔和之胃气也。肾得胃气而脉微石曰平。石多而少柔和之气曰肾病。但石而
无胃气曰死。）石而有钩曰夏病。钩甚曰今病。（石而有钩。火侮水也。立夏火气反虚。而为病矣。若乘侮太甚。当主
今病。）脏真下于肾。肾藏骨髓之气也。（水藏之元真。下藏于肾。而主藏骨髓之气。五营运大论曰。肾生骨髓。髓生肝。）
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。（此言五脏之脉。资生于胃。而胃气之通于五脏者。
乃宗气也。宗气者。胃腑水谷之所生。积于胸中。上出喉咙。以司呼吸。行于十二经隧之中。为脏腑经脉之宗。故曰宗
气。胃之大络。贯膈络肺。出于左乳下。而动应衣者。乃胃腑宗气之所出。此脉以候宗气者也。杨元如曰。首句之其
动应衣。跟着脉宗气而言。言乳下之应衣而动者。此宗气所出之脉也。后句之其动应衣。跟着宗气泄也而言。言动而应
衣。此宗气外泄。盖动之甚矣。）盛喘数绝者。则病在中。结而横有积矣。绝不至曰死。乳之下。其动应衣。宗气泄也。
（此言四时胃少曰病者。宗气之为病也。五脏无胃气曰死者。宗气或绝于内。而或泄于外也。宗脉贯膈络肺。如喘盛而
乳下之脉数绝者。宗气病于膻中也。如脉结而有止者。虚里之横络有积滞也。是胃气少而为五脏之病者。宗气之有虚有
实也。如虚里之脉绝不至者。胃腑之生气绝于内也。乳之下其动甚而应衣者。宗气欲泄于外也。此无胃气而为五脏之死
脉也。）欲知寸口太过与不及。寸口之脉。中手短者曰头痛。寸口脉中手长者曰足胫痛。寸口脉中手促上击者曰肩背痛。
寸口脉沉而坚者曰病在中。寸口脉浮而盛者曰病在外。寸口脉沉而弱曰寒热。及疝瘕少腹痛。寸口脉沉而横曰胁下有积。
腹中有横积痛。寸口脉沉而喘曰寒热。（此以寸口而候外因之病也。夫寸为阳。尺为阴。外为阳。内为阴。皮肉筋骨为阳。
腹中胁内为阴。盖天地四时之气。从外而内。由阳而阴。故以寸口之浮沉。以候外因之外内也。寸口之脉。中手短者。
此惟在寸之阳部。故主头痛。诸阳气之在上也。寸口脉中手长者。寸脉直下于尺中。此阳邪直行于下部。故主足胫痛也。
中手促上击者。浮而搏击应手。此阳邪不上不下。故主在肩背之中也。此以外邪在于形身之外。而有上中下之分也。沉
为在里。浮主在外。寸口脉沉而坚。主病邪坚积在里。若浮而盛。主邪病在外。此以寸口之浮沉。而别外邪之在形身之
外内也。寸为阳。沉为阴。寸口脉沉而弱。此正气虚而阳邪直入于里阴。阴阳相乘。故主寒热。阳邪入里。故又主疝瘕
而少腹痛也。此缘正气弱而阳邪直入于里阴之下也。胁下主身半之中。腹中为形身之里。寸口脉沉而横。是外邪入于里
阴之中。故主胁下腹中有横积也。邪气上逆则喘。寸口脉沉而喘。此外因之阳邪。入于里阴而上逆。阴阳相搏。故为寒
热。此又以寸口之沉。候外因之邪。入于里阴。而亦有上中下之别也。莫子晋曰。春胃微弦。夏胃微钩。乃天地四时之
气。而合于人之五脏也。是以天地四时之邪。亦从外而内。故当以寸口之浮沉别之。）脉盛滑坚者曰病在外。脉小实而坚
者曰病在内。脉小弱以涩。谓之久病。脉滑浮而疾者。谓之新病。脉急者曰疝瘕。少腹痛。脉滑曰风。脉涩曰痹。缓而
滑曰热中。盛而紧曰胀。（此复以寸关尺之三部。而候病之外内新故也。曰脉盛脉小者。概左右三部而言也。夫以寸口之
浮沉。以候病之外内上下者。候表里阴阳之气也。盖天地四时之邪。始伤气分。留而不去。则入于经。然亦有始终留于
气分者。有即转入于经者。邪之中人。变幻不一。故当以脉征之。是以气分之邪。只见寸口之浮沉长短。如入于经。则
有滑涩紧急之形象矣。夫脉乃阴血。气分之阳邪入经。阴阳相搏。其脉则滑。是以脉盛滑者病在外。有余之病。故坚而
有力也。夫经脉外络形身。内连脏腑。病在内者。故小实而坚也。此以三部之盛滑小实。而分别邪正之在外在内也。始
受之病。邪正相持。故滑浮而疾。久则血脉已伤。故小弱以涩也。诸急为寒。故主疝瘕在内。滑主阳热。故主风邪在阳。
此又以三部之急滑。以别邪病之在阳络阴络也。痹者闭也。风寒湿邪。皆能为痹。或在于皮肉筋骨之间。或内舍于五脏
六腑。故痹病于外内之间者。其脉皆主涩也。缓为脾脉。滑则热盛于中。紧则为寒。故主腹胀也。此外因之邪。入于腹
中。而有寒热之分也。）脉从阴阳病易已。脉逆阴阳病难已。脉得四时之顺曰病无他。脉反四时。及不间脏曰难已。（所
谓阴阳者。气血外内上下也。言脏腑之脉。阴阳并交。雌雄相应。内外循环。此为顺也。如阴阳反逆。其病为难愈。脉
得四时之顺者。春脉微弦。夏脉微钩。此得四时生气之顺。而无他变也。反四时者。春胃而有毛。夏胃而有石也。间脏
者。相生而传也。不间脏者。相克而传也。如外淫之邪。始伤皮毛。则内合于肺。肺欲传肝。而肾间之。肾欲传心。而
肝间之。肝欲传脾。而心间之。心欲传肺。而脾间之。脾欲传肾。而肺间之。此节乃总结上文之义。）臂多青脉曰脱血。
（此论内因之病。自内而外。从尺而寸。由血而经。经而气也。臂多青脉者。臂内浮见之络脉多青。盖因血脱而不华于
色也。灵枢经曰。脉急者。尺之皮肤亦急。脉缓者。尺之皮肤亦缓。故善调尺者。不待于寸。善调脉者。不待于色。能
参合而行之。可为上工。）尺脉缓涩。谓之解 安卧。脉盛谓之脱血。尺涩脉滑。谓之多汗。尺寒脉细。谓之后泄。脉尺
粗常热者。谓之热中。（此以尺部而候五脏之病也。缓为脾脉。涩主脏气不足。解 、懈惰也。此脾脏之为病也。尺属阴
而主血。脉宜沉静。盛者。肝脏之火盛而血不藏也。灵枢诊尺篇曰。尺肤涩者。风痹也。夫邪迫于经。其脉则滑。以风
之阳邪。闭于皮肤之间。而迫于经脉。故主多汗。所谓阳加于阴谓之汗。汗乃阴之液也。此以诊尺而知肺合之表汗也。
诊尺篇曰。尺肤寒。其脉小者泄。少气。夫阳气生于阴中。尺肤寒。生阳之气少矣。阳气衰于下。故主虚泄。泄则亡阴。
故脉细也。此以诊尺而知肾藏之生阳。下焦之虚泄也。尺肤粗常热者。火热下行。故主热中。此诊尺而知心火之下行也。
夫阴阳气血。由阴而阳。从下而上。是以诊尺而知病之外内上下也。）肝见庚辛死。心见壬癸死。脾见甲乙死。肺见丙丁
死。肾见戊己死。是谓真脏见者死。（此论真脏脉见而死于胜克之时日也。夫五脏之气。地之五行所生。地之五行。天之
十干所化。是以生于五行。而死于十干也。按此节当在篇末。辟辟如弹石曰肾死之下。误脱在此者也。杨元如曰。此章
引灵枢诊尺篇之文。以证诊尺之义。而灵枢篇内。亦无此节文。宜改正为是。）颈脉动喘疾咳曰水。目内微肿如卧蚕起之
状曰水。溺黄赤安卧者黄胆。已食如饥者胃疸。面肿曰风。足胫肿曰水。目黄者曰黄胆。（此以视疾而知其病也。按此节
引灵枢论疾诊尺之文。少加删改。以证诊尺之义。上节论诊尺。此节言论疾。所谓无视色持脉。独调其尺。以言其病。
从外知内也。是以见颈脉动疾。目内微肿。足胫肿者。知水病之在里也。溺赤安卧。已食如饥者。知为黄胆胃疸也。面
Huangdi asked: What is meant by "Ping Ren" (Normal Person)? (A Ping Ren refers to a person who is ordinarily free from disease. A person free from disease naturally possesses an ordinary pulse; if the pulse is abnormal, it indicates illness. Hence, this chapter is titled "Discussion on the Phenomena of Normal Persons." "Qi" refers to the Qi of the meridians; "Xiang" refers to the image of the pulse.)
Qibo replied: When a person exhales, the pulse beats twice; when they inhale, the pulse also beats twice. At the pause between breaths, the pulse beats five times in total, regulated occasionally by a deep sigh (Tai Xi). This is called a "Ping Ren."
A Ping Ren is one who is not ill. (Exhaling is called Hu, inhaling is called Xi. One exhalation and one inhalation constitute one Xi. The pulse of a normal person beats twice per exhalation and twice per inhalation. At the pause between breaths, the pulse counts five beats. This is because of the occasional deep sigh acting as a surplus, hence five beats. "Run" means surplus. "Tai Xi" refers to the moment between breaths where the breath has excess and is not yet finished, causing the pulse to beat once more, similar to having a leap month in a year. Human respiration is the circulation of Yin and Yang Qi, entering and exiting, much like the cycle of cold and heat forming a year, so it is appropriate to have the surplus of a deep sigh.)
One should use the state of the healthy person to calibrate the judgment of the patient's pulse. If the physician is not ill, they use their own steady respiration to compare with the patient's pulse, which serves as the method for diagnosis. Those who are not ill have steady breathing; those who are ill have chaotic breathing. Since the physician is not ill, they use their steady breathing to adjust to the patient; this is the method of observing the pulse.
If a person's pulse beats once per exhalation and once per inhalation, it is called "Shao Qi" (Deficient Qi). (Ying Qi and Zong Qi circulate outside the vessels, while Wei Qi circulates inside. Ying and Wei follow each other, and the pulse turns with the Qi. Beating once per exhalation and once per inhalation is more than half less than that of a normal person, thus indicating the decline of Qi.)
If a person's pulse beats three times per exhalation and three times per inhalation, and is rapid and restless, with heat in the Chi (wrist) area, it is a Wen Bing (Warm Disease); if the Chi area is not hot but the pulse is slippery, it is a Feng Bing (Wind Disease); if the pulse is choppy, it is a Bi Syndrome (Obstruction). (Six beats per Xi indicate excessive Qi. "Zao" means rapid/restless. Restlessness during inhalation indicates excess pathogenic factors invading from the exterior to the interior. Warm diseases arise from Cold contracted in winter manifesting as Warm Disease in spring; Wind contracted in winter manifesting as Wind-Warmth in spring. These are latent pathogens moving from interior to exterior, from Yin to Yang, hence heat in the Chi area. Wind is a Yang pathogen damaging Yang Qi, hence no heat in the Chi area. Pathogens in the Qi level lingering without departing press upon the collaterals, resulting in a slippery pulse. Bi means obstruction. Accumulated pathogens failing to move result in a choppy and stagnant pulse. Generally, pathogens moving from interior to exterior are Warm Diseases; those moving from exterior to interior are Wind Pathogens; those lingering between interior and exterior are Bi Syndromes. The previous section discussed deficiency of righteous Qi; this section discusses excess of pathogenic Qi, noting that excess pathogens have distinctions in Yin/Yang and interior/exterior movement.)
If the pulse beats four or more times per breath cycle, it indicates a fatal condition; if the pulse ceases and does not return, it indicates death; if the pulse is intermittently slow and rapid, it indicates death. (Four or more beats represent the extreme of excess. Cessation of the pulse represents the extreme of deficiency. Intermittent slowness and rapidity indicate chaotic Qi. All these are extremely unbalanced pulses, hence termed fatal pulses. Above, we discussed balanced pulses, called Ping Ren; excess or deficiency leads to illness; severe cases lead to death.)
The normal Qi of a Ping Ren is derived from the Stomach. The Stomach is the source of normal Qi for Ping Ren. If a person lacks Stomach Qi, it is called Ni (Reversal), and reversal leads to death. (This discusses that the pulses of the four seasons should be based on Stomach Qi. The normal state of a Ping Ren receives Qi from grain. Grain enters the Stomach, and the Five Zang and Six Fu organs all receive Qi from it; thus, the Stomach is the source of normal Qi. Lack of Stomach Qi means vitality is severed; severance leads to death.)
In Spring, a pulse with slight Guan Qi (Stomach Qi) and slightly Xian (Wiry) quality is Ping (Normal); if Xian is prominent and Guan Qi is scant, it indicates Liver disease; if there is only Xian without Guan Qi, it indicates death. (Guan Qi is the soft and harmonious Qi of Central Earth. Xian is the image of East Wood in Spring. Slightness represents the harmony of Guan Qi. Thus, obtaining Guan Qi in Spring results in a slightly wiry pulse, which is normal. Prominent wiriness with little softness indicates Liver disease. Only wiriness without Guan Qi indicates death. Yang Yuanru stated: "Spring Guan Qi slightly wiry" means that within the four seasons, this Guan Qi exists, nourishing the true Qi of the Five Zang through Guan Qi. This section combines the four seasons with the Five Zang; the final section combines the Qi of the Five Zang with the four seasons.)
If the Spring pulse contains Mao (Floating) qualities, illness will occur in Autumn; if Mao is very pronounced, illness occurs now. (Mao is the Autumn pulse, belonging to Metal. Although Spring obtains the slightly wiry normal pulse, if it also has light floating Mao qualities, this is Metal overcoming Wood. When Autumn Metal rules, illness will occur. If Mao pulse is excessive, Wood suffers Metal's punishment, and illness should occur immediately. This reiterates that each season's pulse has its ruling Qi; if a controlling pulse appears, even with Guan Qi, illness can result.)
The True Qi of the Zang scatters into the Liver, and the Liver stores the Qi of the sinews/fascia. (The "Zhen Zang" refers to the Spirit stored by the True Zang. Spirit in the Zang corresponds to Liver, in the body to sinews. It states that the True Zang's Spirit scatters into the Liver, primarily storing the Qi of sinews. For example, the slightly wiry pulse of Spring Wood reaches the Hand Taiyin Lung Meridian due to Guan Qi. Thus, if a pulse lacks Guan Qi, the Liver pulse will not be wiry, nor will the Kidney pulse be Stone-like. Wiry, Hook, Mao, and Stone pulses are all generated by Guan Qi.)
In Summer, a pulse with slight Guan Qi and slightly Gou (Hooked/Curved) quality is Ping; if Gou is prominent and Guan Qi is scant, it indicates Heart disease; if there is only Gou without Guan Qi, it indicates death. (Gou is the image of South Fire in Summer. Slightness represents the soft Guan Qi. Obtaining Guan Qi in Summer results in a slightly hooked pulse, which is normal. Excessive hooking with little softness indicates Heart disease. Only hooking without Guan Qi indicates death.)
If the Summer pulse contains Shi (Stone/Deep) qualities, illness will occur in Winter; if Shi is very pronounced, illness occurs now. (Shi is the pulse of Winter command. Slightly hooked with Shi qualities indicates Water within Fire. Illness will occur when Winter Water rules. If Water Qi is excessive, Fire suffers Water's control, and illness should occur immediately.)
The True Qi of the Zang connects to the Heart, and the Heart stores the Qi of the blood vessels. (The primal true Qi of the Summer Zang connects to the Heart, primarily storing the Qi of blood vessels.)
In Late Summer, a pulse with slight Guan Qi and weak quality is Ping; if Weak is prominent and Guan Qi is scant, it indicates Spleen disease; if there is only Dai (Intermittent) pulse without Guan Qi, it indicates death. (Weak implies softness. Late Summer is ruled by Damp Earth. Slight weakness is the soft Qi of Central Earth. Dai pulse refers to a pulse that pauses and fails to return immediately. The Spleen rules the four seasons, and the four seasons have alternating replacement Qi, hence the soft, intermittent pulse is the normal pulse of the Spleen. If there is only Dai pulse without slight softness, Guan Qi is exhausted, hence it is a fatal pulse. The Spleen irrigates the four Zang organs due to the generation of Guan Qi; thus, only Dai without Guan Qi indicates death.)
If the Late Summer pulse contains Shi qualities, illness will occur in Winter; if Weak is very pronounced, illness occurs now. (Weak containing Shi indicates the conquering Water Qi rebelling against Earth. Illness will occur when Winter Water Qi becomes deficient. If Weak is excessive, Spleen Qi is too weak, and illness should occur immediately. Generally, excessive乘侮 (overcoming/rebelling) causes immediate illness, and deficiency of original Qi also causes immediate illness.)
The True Qi of the Zang moistens the Spleen, and the Spleen stores the Qi of the muscles. (The primal true Qi of Earth moistens the Spleen, primarily storing the Qi of muscles. Yang Yuanru stated: The Liver governs dispersion, hence "scatters"; the Heart governs blood vessels, hence "connects"; the Spleen governs irrigation, hence "moistens"; the Lung resides in honor, hence "high"; the Kidney is the Water Zang, hence "low".)
In Autumn, a pulse with slight Guan Qi and slightly Mao (Floating) quality is Ping; if Mao is prominent and Guan Qi is scant, it indicates Lung disease; if there is only Mao without Guan Qi, it indicates death. (Mao is the Autumn Metal pulse. Slightness represents soft Guan Qi. Obtaining Guan Qi in Autumn results in a slightly floating pulse, which is normal. Prominent floating with little softness indicates Lung disease. Only floating without Guan Qi indicates death.)
If the Autumn pulse contains Xian (Wiry) qualities, illness will occur in Spring; if Xian is very pronounced, illness occurs now. (Autumn pulse containing Xian indicates the conquering Wood Qi rebelling against Metal, leaving Wood deficient in its proper position. When Spring arrives and Wood should be prosperous, Wood Qi is actually deficient, causing illness. This is what is meant by "rebellion meets retaliation, lacking fear." Excessive Xian indicates excessive rebellion, and Metal Qi should suffer illness immediately. According to the "Ping Mai Pian": Pulses have mutual overacting, involving Zong (Vertical) and Heng (Horizontal). Water overacting on Fire, Metal overacting on Wood is called Zong; Fire overacting on Water, Wood overacting on Metal is called Heng. In the four seasons, there are both Zong and Heng. Zong means although Guan Qi is present, the conquering element acts upon it, hence "Guan with Mao" or "Guan with Shi." Heng means Zang Qi is insufficient and the conquered element acts recklessly, hence "Mao with Xian" or "Shi with Gou." This is Zang Qi acting horizontally; thus, deficiency in the proper position invites revenge. In the four seasons and Late Summer, the text changes meaning three times; one must understand that the Qi of the four seasons has both Zong and Heng, where guest Qi is excessive leading to deficiency of original Qi.)
The True Qi of the Zang is high in the Lung, governing the circulation of Ying, Wei, Yin, and Yang. (The primal true Qi of Metal resides high in the Lung, primarily governing the circulation of Ying, Wei, Yin, and Yang. The Lung governs the Qi of the whole body and commands the hundred vessels. Yuanru stated: The Lung is the official of transmission, balancing Yin and Yang and promulgating orders.)
In Winter, a pulse with slight Guan Qi and slightly Shi (Stone/Deep) quality is Ping; if Shi is prominent and Guan Qi is scant, it indicates Kidney disease; if there is only Shi without Guan Qi, it indicates death. (Shi is the pulse of Winter storage. Slightness represents soft Guan Qi. Obtaining Guan Qi in Winter results in a slightly deep pulse, which is normal. Prominent depth with little softness indicates Kidney disease. Only depth without Guan Qi indicates death.)
If the Winter pulse contains Gou (Hooked) qualities, illness will occur in Summer; if Gou is very pronounced, illness occurs now. (Winter pulse containing Gou indicates Fire rebelling against Water. At Start of Summer, Fire Qi is actually deficient, causing illness. If rebellion is excessive, illness should occur immediately.)
The True Qi of the Zang descends to the Kidney, and the Kidney stores the Qi of the bone marrow. (The primal true Qi of Water descends and stores in the Kidney, primarily storing the Qi of bone marrow. The "Wu Yun Yun Da Lun" states: Kidney generates bone marrow, bone marrow generates Liver.)
The great Luo vessel of the Stomach is named Xuli, penetrating the diaphragm, connecting to the Lung, emerging below the left breast. Its pulsation can move clothing; this is the Zong Qi within the pulse. (This discusses that the pulses of the Five Zang are nourished by the Stomach, and the Stomach Qi communicating with the Five Zang is Zong Qi. Zong Qi is generated from water and grain in the Stomach, accumulating in the chest, emerging upward from the throat to govern respiration, and circulating within the twelve meridian tunnels, serving as the master of the Zang organs and meridians, hence called Zong Qi. The great Luo of the Stomach penetrates the diaphragm, connects to the Lung, emerges below the left breast, and its pulsation moving clothing is the exit of Zong Qi from the Stomach organ. This pulse is used to observe Zong Qi. Yang Yuanru stated: The first sentence "its pulsation moves clothing" follows "pulse Zong Qi," meaning the pulsation below the breast moving clothing is the pulse from which Zong Qi exits. The second sentence "its pulsation moves clothing" follows "Zong Qi leakage," meaning pulsation moving clothing indicates Zong Qi leaking outward, indicating severe pulsation.)
If the pulsation is rapid with frequent interruptions, the disease is in the middle; if the pulse is knotted and hard, there is accumulation; if the pulse ceases and does not return, it is death; if pulsation below the breast is vigorous enough to move clothing, it is leakage of Zong Qi. (This discusses diseases caused by Zong Qi when Guan Qi is scant in the four seasons. Death due to lack of Guan Qi in the Five Zang occurs when Zong Qi either ceases internally or leaks externally. The Zong pulse penetrates the diaphragm and connects to the Lung. If panting is severe and the pulse below the breast frequently interrupts, Zong Qi is diseased in the Danzhong. If the pulse is knotted with stops, there is accumulation in the horizontal collaterals of Xuli. This shows that when Guan Qi is scant causing Zang disease, Zong Qi has deficiency and excess conditions. If the Xuli pulse ceases and does not return, the vital Qi of the Stomach organ is severed internally. If pulsation below the breast is severe and moves clothing, Zong Qi is about to leak externally. These are fatal Zang pulses due to lack of Guan Qi.)
To know the excess and deficiency of the Cun Kou (Radial) pulse: If the Cun Kou pulse feels short upon palpation, it indicates headache; if it feels long, it indicates pain in the lower legs; if it feels rapid and strikes upward against the fingers, it indicates shoulder and back pain; if it is deep and firm, the disease is internal; if it is superficial and vigorous, the disease is external; if it is deep and weak, it indicates chills and fever, as well as Shan Jia (hernia/lump) and lower abdominal pain; if it is deep and transverse, there is accumulation under the hypochondrium and transverse accumulation pain in the abdomen; if it is deep and rapid/panting, it indicates chills and fever. (This uses Cun Kou to diagnose diseases caused by external factors. Cun is Yang, Chi is Yin; exterior is Yang, interior is Yin; skin, flesh, tendons, bones are Yang; abdomen and hypochondrium are Yin. Generally, the Qi of heaven and earth and the four seasons moves from exterior to interior, from Yang to Yin. Thus, using the floating/sinking of Cun Kou diagnoses the interior/exterior of external diseases. A short Cun Kou pulse is only in the Yang portion of Cun, hence headache, representing Yang Qi above. A long Cun Kou pulse extends straight to Chi, indicating Yang pathogen moving directly to the lower part, hence lower leg pain. Rapid and striking upward indicates floating and beating against the hand, Yang pathogen neither up nor down, hence shoulder/back pain. This distinguishes external pathogens in the body by upper/middle/lower positions. Deep indicates interior, superficial indicates exterior. Deep and firm Cun Kou indicates pathogenic accumulation in the interior; superficial and vigorous indicates pathogenic disease in the exterior. This distinguishes external pathogens in the body's interior/exterior by floating/sinking. Cun is Yang, deep is Yin. Deep and weak Cun Kou indicates righteous Qi deficiency with Yang pathogen entering interior Yin directly, Yin-Yang conflict, hence chills/fever. Yang pathogen entering interior also causes Shan Jia and lower abdominal pain due to righteous Qi weakness allowing Yang pathogen to enter lower interior Yin. Hypochondrium governs the middle of the body; abdomen is the interior of the form. Deep and transverse Cun Kou indicates external pathogen entering interior Yin, hence transverse accumulation in hypochondrium/abdomen. Pathogen reversing upward causes panting; deep and rapid Cun Kou indicates external Yang pathogen entering interior Yin and reversing upward, Yin-Yang conflict, hence chills/fever. This again uses deep Cun Kou to diagnose external pathogens entering interior Yin, distinguishing upper/middle/lower. Mo Zijin stated: Spring pulse slightly wiry, Summer pulse slightly hooked, are the Qi of heaven and earth combining with human Five Zang. Thus, pathogens of heaven and earth also move from exterior to interior, distinguished by Cun Kou floating/sinking.)
Vigorous, slippery, and firm pulses indicate disease in the exterior; small, solid, and firm pulses indicate disease in the interior; small, weak, and choppy pulses indicate chronic disease; slippery, superficial, and rapid pulses indicate acute disease; urgent pulses indicate Shan Jia and lower abdominal pain; slippery pulses indicate Wind; choppy pulses indicate Bi syndrome; slow and slippery pulses indicate Heat in the Middle; vigorous and tight pulses indicate distension. (This again uses the three positions of Cun, Guan, Chi to diagnose exterior/interior and new/old diseases. "Vigorous" and "small" refer generally to the left and right three positions. Using Cun Kou floating/sinking diagnoses exterior/interior/up/down of disease, observing the Qi of exterior/interior and Yin/Yang. Generally, pathogens of heaven and earth initially injure the Qi level; if lingering, they enter the meridians. Some remain in the Qi level, some enter meridians immediately. Pathogens affecting humans vary, so one must verify via pulse. Thus, Qi level pathogens show only Cun Kou floating/sinking/length; if entering meridians, there are slippery/choppy/urgent/tight images. Pulse belongs to Yin Blood; Yang pathogen of Qi level entering meridians creates Yin-Yang conflict, resulting in slippery pulse. Thus, vigorous/slippery pulses indicate exterior disease, excess disease, hence firm and forceful. Meridians connect exteriorly to the body and interiorly to Zang/Fu; disease in the interior results in small/solid/firm pulses. This distinguishes exterior/interior pathogens by vigorous/slippery vs. small/solid/firm three-position pulses. Newly acquired disease, pathogen and righteous Qi contend, hence slippery/superficial/rapid; after time, blood vessels are injured, hence small/weak/choppy. All urgent pulses indicate Cold, hence Shan Jia in interior. Slippery indicates Yang Heat, hence Wind pathogen in Yang. This distinguishes Yang/Yin collateral diseases by urgent/slippery three-position pulses. Bi means obstruction. Wind, Cold, Damp pathogens cause Bi. They may be in skin/flesh/tendons/bones or internal to Zang/Fu. Bi diseases between interior/exterior have choppy pulses. Slow is Spleen pulse; slippery indicates Heat in Middle; tight indicates Cold, hence distension. This shows external pathogens entering abdomen with Cold/Heat distinctions.)
Pulses following Yin/Yang are easily cured; pulses opposing Yin/Yang are difficult to cure. Pulses conforming to the four seasons indicate no other complications; pulses opposing the four seasons, and those skipping the generating Zang (directly attacking conquering Zang), are difficult to cure. (Yin/Yang refers to Qi/Blood, exterior/interior, up/down. Zang/Fu pulses intersecting Yin/Yang, corresponding male/female, circulating interior/exterior is Shun (Smooth). If Yin/Yang is reversed, disease is hard to heal. Conforming to four seasons means Spring slightly wiry, Summer slightly hooked, obtaining the smoothness of four-season generating Qi without other changes. Opposing four seasons means Spring pulse with Mao, Summer pulse with Shi. Jian Zang (Intervening Zang) refers to transmission via generation. Bu Jian Zang refers to transmission via conquest. For example, external evil initially injures skin/hair, then internally combines with Lung. If Lung transmits to Liver, Kidney intervenes; if Kidney to Heart, Liver intervenes; if Liver to Spleen, Heart intervenes; if Heart to Lung, Spleen intervenes; if Spleen to Kidney, Lung intervenes. This section summarizes the preceding meaning.)
Many blue vessels on the arm indicate blood loss. (This discusses internal diseases moving from interior to exterior, from Chi to Cun, from Blood to Meridian, from Meridian to Qi. Many blue vessels on the arm mean many visible collaterals appear blue. This is because blood loss fails to nourish the complexion. Ling Shu states: Urgent pulse means Chi skin is urgent; slow pulse means Chi skin is slow. Thus, one skilled in diagnosing Chi skin needs not wait for Cun; one skilled in diagnosing pulse needs not wait for color observation. Combining these three makes a superior physician.)
Chi pulse slow and choppy indicates lethargy and desire to lie down; vigorous pulse indicates blood loss; Chi choppy and pulse slippery indicates profuse sweating; Chi cold and pulse fine indicates diarrhea; Chi coarse and often hot indicates Heat in the Middle. (This uses Chi to diagnose Zang diseases. Slow is Spleen pulse; choppy indicates Zang Qi deficiency. Xie Tui (lethargy) indicates Spleen disease. Chi belongs to Yin and governs Blood; pulse should be calm. Vigorous pulse indicates Liver Fire excess and blood failing to store. Ling Shu Zhi Chi Pian states: Chi skin choppy indicates Wind-Bi. Pathogen pressing on meridians makes pulse slippery. Yang Wind pathogen closing skin and pressing meridians causes profuse sweating. "Yang added to Yin is Sweat"; sweat is Yin fluid. Diagnosing Chi reveals Lung's exterior sweat. Zhi Chi Pian states: Chi skin cold, pulse small indicates diarrhea and shortness of breath. Yang Qi is born in Yin; Chi skin cold means little Yang Qi generated. Yang Qi declining below causes deficiency diarrhea. Diarrhea loses Yin, hence fine pulse. Diagnosing Chi reveals Kidney's generated Yang and lower Jiao deficiency diarrhea. Chi skin coarse and often hot indicates Fire-Heat descending, hence Heat in Middle. Diagnosing Chi reveals Heart Fire descending. Yin/Yang/Qi/Blood move from Yin to Yang, bottom to top; thus, diagnosing Chi reveals disease exterior/interior/up/down.)
Liver pulse appearing on Geng/Xin days (Metal days) indicates death; Heart pulse on Ren/Gui days (Water days) indicates death; Spleen pulse on Jia/Yi days (Wood days) indicates death; Lung pulse on Bing/Ding days (Fire days) indicates death; Kidney pulse on Wu/Ji days (Earth days) indicates death. This is called appearance of True Zang pulse, which indicates death. (This discusses True Zang pulse appearing and dying on days of being conquered. Zang Qi is born of Earth's Five Elements. Earth's Five Elements are transformed by Heaven's Ten Stems. Thus, born of Five Elements, dying by Ten Stems. Note: This section should be at the end, after "Pi Pi Ru Dan Shi Yue Shen Si," mistakenly placed here. Yang Yuanru stated: This chapter cites Ling Shu Zhi Chi Pian to prove Chi diagnosis, but Ling Shu lacks this text; it should be corrected.)
Neck vessel pulsation with panting and rapid cough indicates Water disease; eyes slightly swollen like a sleeping silkworm indicate Water disease; yellow urine with lying down indicates Jaundice; feeling hungry after eating indicates Stomach Jaundice; facial swelling indicates Wind disease; lower leg swelling indicates Water disease; yellow eyes indicate Jaundice. (This diagnoses disease through observation. This section cites Ling Shu Lun Ji Zhi Chi with minor edits to prove Chi diagnosis. Previous section discussed Chi diagnosis; this section discusses visual diagnosis. It says not just looking at color and holding pulse, but solely adjusting Chi to speak of disease, knowing interior from exterior. Thus, seeing neck vessel pulsation, eye swelling, leg swelling indicates Water disease in interior. Yellow urine, lying down, hunger after eating indicates Jaundice and Stomach Jaundice. Facial swelling...)