肿者。知为风水也。此又不待持脉。而知其病也。杨元如曰。诊尺而知解 多汗之病在外。视疾而知水饮黄胆之病在内。
故曰论疾诊尺。谓论证视尺。皆可以知病。又曰。此章论诊尺。若以手少阴心脉言之。于二经之旨皆不合矣。）妇人手少
阴脉动甚者。妊子也。（此复言诊尺之微妙。非惟知病。而妇人之妊子。亦可以分别也。子、男子也。以妇人之两手尺部
候之。若左手之少阴肾脉动盛者。当妊子。以左男而右女也。）脉有逆从。四时未有脏形。春夏而脉瘦。秋冬而脉浮大。
命曰逆四时也。（从、顺也。后章论五脏之气。外合于四时。故虽未有春弦夏钩秋毛冬石之脏形。而阴阳出入之大概。不
可逆也。）风热而脉静。泄而脱血脉实。病在中。脉虚。病在外。脉涩坚者。皆难治。命曰反四时也。（夫天地有四时
之寒暑。而人之气血。有浮大沉瘦之阴阳。即受病之脉气。亦有外内虚实之相应。是以脉不应病者。命曰反四时也。如
风热之病。气应浮动。而脉反静。泄脱之病。气应虚散。而脉反实。病在中者。气应沉实。而脉反虚。病在外者。气应
升浮。而脉反坚涩。此脉证之不相应者。正气乱也。故为难治。高士宗曰。此以脉病之虚实。知反四时。上章云。反四
时者有余。为精不足为消。亦以精水之有余不足为反四时。是反逆二字有别矣。故曰反四时有正应。不在四脉气论上。）
人以水谷为本。故人绝水谷则死。脉无胃气亦死。所谓无胃气者。但得真脏脉。不得胃气也。所谓脉不得胃气者。肝不
弦。肾不石也。（此言五脏元真之气。亦皆胃腑水谷之所生也。五脏者。皆禀气于胃。胃气者。水谷之所资生。故人以水
谷为本。胃绝水谷则死。脉无胃气亦死也。所谓无胃气者。真脏脉见。而不得微和之气也。又非惟微和之为胃气也。即
真脏之脉。亦胃气之所生也。故曰脏气者。不能自致于手太阴。必因于胃气。乃至于手太阴也。故五脏各以其时。自为
而至于手太阴者。春为弦。夏为钩。秋为毛。冬为石。皆得胃气而为之也。故曰。脉不得胃气者。肝不弦。肾不石也。
是以前章论四时之脉。得胃气之和者。命曰平人。后章论五脏之真。亦四时以胃气为本也。）太阳脉至。洪大以长。少阳
脉至。乍数乍疏。乍短乍长。阳明脉至。浮大而短。（此言阳明胃气。不独行于五脏。而亦行气于三阳也。夫脾与胃。以
膜相运耳。是以胃气之行于五脏者。由脾气之转输。故太阴为之行气于三阴。阳明者表也。五脏六腑之海也。亦为之行
气于三阳。是以脏腑各因其经。而受气于阳明焉。故太阳之洪大。阳气之盛也。少阳之乍忽。初生之象也。阳明之浮大
而短者。两阳合明。阳盛而间于二阳之间也。此三阳之气。亦胃腑之所生也。）夫平心脉来。累累如连珠。如循琅 。
曰心平。夏以胃气为本。（此言脏真之脉。四时以胃气为本也。累累如连珠者。滑利如珠。连绵相贯。心脏和平之象也。
琅、美石之似珠者。取其温润而柔滑也。此脏真之脉。柔 和平者。得四时之胃气也。前节以四时胃气。资于脏真。
故曰。春胃微弦。夏胃微钩。此节以五脏之真。得四时胃气。故曰平心脉来。夏以胃气为本。平肺脉来。秋以胃气为本。
是以脉象之少有不同也。盖弦钩毛石者。脏真之气象也。如连珠。如榆荚者。脏真之体象也。杨元如曰。前论四时之气
生五脏。故肝而心。心而脾。序四时之相生。此论五脏之真合四时。故心而肺。肺而肝。序五行之相制。制则生化也。）
病心脉来。喘喘连属。其中微曲。曰心病。死心脉来。前曲后居。如操带钩。曰心死。（喘喘、急疾貌。喘喘连属。心
气不安也。曲者。钩之象。其中微曲。心气虚也。故当主心病。居、不动也。曲而不动。如操带钩。无如珠生动之象矣。）
平肺脉来。厌厌聂聂。如落榆荚。曰肺平。秋以胃气为本。（厌厌、安静貌。聂聂、轻小也。落、降收也。如榆荚者。轻
薄而中不虚。盖肺脉虽主收降轻虚之象。而资生于脾土。是以有如榆荚之轻而中不虚也。）病肺脉来。不上不下。如循鸡
羽。曰肺病。死肺脉来。如物之浮。如风吹毛。曰肺死。（不上不下。往来涩滞也。如循鸡羽。较之榆荚。更属轻虚。其
中又不得生我之土象。而反有贼我之木体。故主肺病。如物之浮。虚无根也。如风吹毛。散乱剧也。）平肝脉来。 弱招
招。如揭长竿末梢。曰肝平。春以胃气为本。（ 弱、初生柔和之气也。以手相呼曰招。招招、乍起乍伏之象。形容其初
生之脉象也。长竿梢末。长而 也。此皆本于胃气。故脏真之脉。得以柔 和平。）病肝脉来。盈实而滑。如循长竿。曰
肝病。死肝脉来。急益劲。如新张弓弦。曰肝死。（盈实则非 弱招招之象矣。如循长竿。非若梢末之 弱矣。滑脉如珠。
弦长带滑。如竿之有节矣。辨脉篇曰。累累如循长竿者。名阴结也。此肝气病而阻结也。急益劲。如新张弓弦。强劲之
剧。胃气绝也。）平脾脉来。和柔相离。如鸡践地。曰脾平。长夏以胃气为本。（和柔、中土柔和之气也。相离、时一代
也。盖脾为孤脏。中央土以贯四旁。故柔和之中。而有相离之代散也。鸡足有四爪。践地极和缓。形容脾土之灌溉四脏。
有如鸡之践地。和缓而四散也。）病脾脉来。实而盈数。如鸡举足。曰脾病。（实而盈数。阜实而无柔和之气也。如鸡举
足。拳而收敛。不能灌溉于四脏也。）死脾脉来。锐坚如乌之喙。如鸟之距。如屋之漏。如水之流。曰脾死。（喙音诲。
如
乌之喙者。坚止而无柔和相离之象也。如鸟之距者。较鸡举足更拳急也。如屋之漏者。点滴稀疏。而不能灌溉也。如水
之流者。湿土之气四散也。盖言脾主中和之气。如太过不及之甚者。皆为死脉也。）平肾脉来。喘喘累累如钩。按之而坚。
曰肾平。冬以胃气为本。（喘喘累累。沉石生动之象也。如钩者。浮而中空。水之体也。按之坚石。石之象也。莫子晋曰。
琅、石之美者。钩乃心之脉也。心脉如循琅 。肾脉如钩者。心肾水火之气。互相交济者也。）病肾脉来。如引葛。
按之益坚。曰肾病。死肾脉来。发如夺索。辟辟如弹石。曰肾死。（如葛如索者。木象也。盖沉石者肾之本体。如引葛而
按之益坚。是肾气不藏而外泄矣。如夺索者。如引葛而更坚劲矣。如弹石者。无喘累生动之气。肾之死象也。）
Swelling indicates Wind-Water (Feng Shui, a condition characterized by edema and wind-pathogen). This diagnosis can be made without palpating the pulse. Yang Yuanru stated: Palpating the Chi area (distal forearm skin) reveals diseases with excessive sweating located in the exterior; observing clinical manifestations reveals diseases involving Fluid Retention (Shui Yin) and Jaundice (Huang Dan) located in the interior.
Therefore, the chapter "Discussing Diseases by Examining the Chi Area" implies that both syndrome differentiation and Chi area examination allow for disease identification. It is also stated: This chapter discusses examining the Chi area. Interpreting it solely through the perspective of the Hand-Shaoyin Heart pulse would contradict the principles of these two meridians.) In women, a pronounced pulsation at the Hand-Shaoyin pulse point (Shenmen, HT7) indicates pregnancy. (This further explains the subtlety of Chi area examination: it not only identifies pathology but also distinguishes pregnancy in women. "Zi" refers to a male fetus. Examination is performed on the Chi region of both wrists of the woman. If the Kidney pulse (Taixi, KI3) at the left Chi position is vigorous, she is likely carrying a male fetus, based on the principle that the left corresponds to males and the right to females.)
Pulses may be in accordance (Cong) or contrary (Ni) to norms. When the specific organ pulses of the four seasons have not yet fully manifested, if the pulse is thin and small during Spring and Summer, or floating and large during Autumn and Winter, this is termed "contrary to the Four Seasons." ("Cong" means following/compliant. Later chapters discuss how Qi of the Five Zang organs corresponds externally to the Four Seasons. Thus, even if the specific seasonal organ pulses—Spring String-like (Xian), Summer Hook-like (Gou), Autumn Hairy-like (Mao), Winter Stone-like (Shi)—are not present, the general pattern of Yin-Yang emergence and withdrawal must not be violated.)
If a Wind-Heat pathogen presents with a quiet/soft pulse, or if Diarrhea/Exsanguination presents with an excess/firm pulse; if internal disease presents with a deficient pulse, or external disease presents with a choppy/firm pulse—all are difficult to treat and are termed "contrary to the Four Seasons." (Heaven and Earth have the cold and heat of the Four Seasons, while human Qi and Blood exhibit floating-large or sinking-thin Yin-Yang variations. Even pathological pulse Qi has corresponding internal-external and deficiency-excess relationships. Therefore, when the pulse does not correspond to the disease, it is termed "contrary to the Four Seasons." For example, in Wind-Heat disease, Qi should float/be active, but the pulse is quiet; in Diarrhea/Exsanguination, Qi should be deficient/scattered, but the pulse is excess; in internal disease, Qi should sink/be firm, but the pulse is deficient; in external disease, Qi should rise/be floating, but the pulse is choppy/firm. This mismatch between pulse and symptoms indicates disorder of Healthy Qi (Zheng Qi), making treatment difficult. Gao Shizong stated: Here, the deficiency/excess of pulse and disease reveals violation of seasonal norms. The previous chapter stated: "Those contrary to the Four Seasons have Excess; Jing-Essence deficiency leads to consumption." This also uses the excess or deficiency of Jing-Water as contrary to the seasons. Thus, "Fan" (reverse/opposite) and "Ni" (contrary/rebellious) have distinct meanings. Hence, "Fan Si Shi" (Contrary to Four Seasons) has proper correspondence, distinct from mere discussion of four-pulse Qi dynamics.)
Humans rely on Water and Grain (nutrition) as their foundation. Thus, humans die when cut off from Water and Grain, and they die when the pulse lacks Stomach Qi (Wei Qi). "Lacking Stomach Qi" means only the True Organ Pulse (Zhen Zang Mai) is seen, without the harmonizing Stomach Qi. Specifically, lacking Stomach Qi manifests as the Liver failing to show its string-like quality and the Kidney failing to show its stone-like quality. (This states that the Original Qi of the Five Zang organs is generated from the Water and Grain processed by the Stomach-Fu. The Five Zang organs all receive Qi from the Stomach. Stomach Qi is derived from nourishment. Thus, humans rely on Water and Grain; if Stomach Qi is cut off from nourishment, death ensues; if the pulse lacks Stomach Qi, death ensues. "Lacking Stomach Qi" means the True Organ Pulse appears without the subtle, harmonizing Qi. Moreover, it is not just the subtle harmony that constitutes Stomach Qi; even the True Organ Pulses are generated by Stomach Qi. Therefore, Organ Qi cannot reach the Hand-Taiyin Lung meridian on its own; it must rely on Stomach Qi to arrive at the Hand-Taiyin. Thus, each Zang organ manifests its seasonal pulse at the Hand-Taiyin location according to its time: Spring is String-like, Summer is Hook-like, Autumn is Hairy-like, Winter is Stone-like. All are achieved through the presence of Stomach Qi. Hence, "pulse lacking Stomach Qi" means the Liver does not show string-like qualities and the Kidney does not show stone-like qualities. As discussed in the previous chapter, pulses with harmonious Stomach Qi are called "Ping Ren" (Healthy Person); later chapters discuss the True Organs, emphasizing that the Four Seasons are rooted in Stomach Qi.)
The Taiyang pulse arrives: large, forceful, and long. The Shaoyang pulse arrives: sometimes rapid, sometimes slow; sometimes short, sometimes long. The Yangming pulse arrives: floating, large, and short. (This describes how Yangming Stomach Qi circulates not only through the Five Zang organs but also through the Three Yang meridians. Spleen and Stomach are connected by membranes and interact dynamically. Thus, Stomach Qi circulating through the Zang organs is transported by Spleen Qi. Therefore, the Taiyin Spleen meridian distributes Qi to the Three Yin meridians. Yangming Stomach meridian governs the exterior and is the Sea of the Five Zang and Six Fu organs; it also distributes Qi to the Three Yang meridians. Consequently, Zang and Fu organs receive Qi from Yangming along their respective meridians. Thus, the Taiyang pulse's largeness and forcefulness indicate abundant Yang Qi. The Shaoyang pulse's variability indicates nascent Qi. The Yangming pulse's floating, largeness, and shortness reflect the convergence of two Yangs (Yangming), where Yang is abundant and situated between the two Yangs. These Three Yang Qi patterns are also generated by the Stomach-Fu.)
A healthy Heart pulse arrives continuously like linked pearls, smooth and warm like touching Langgan (beautiful jade/stones). This is a healthy Heart pulse; in Summer, Stomach Qi is fundamental. (Continuous like linked pearls means smooth and flowing like beads, interconnected, representing a harmonious Heart. Langgan refers to beautiful stones resembling pearls, chosen for their warm and smooth texture. This True Organ pulse, being soft and harmonious, reflects the acquisition of Four Seasons' Stomach Qi. The previous section discussed how Four Seasons' Stomach Qi nourishes the True Organs, stating: "Spring Stomach slightly String-like, Summer Stomach slightly Hook-like." This section discusses how the True Organs acquire Four Seasons' Stomach Qi, stating: "A healthy Heart pulse arrives; in Summer, Stomach Qi is fundamental.")
A healthy Lung pulse arrives quietly and lightly, like falling elm seeds. This is a healthy Lung pulse; in Autumn, Stomach Qi is fundamental. ("Yanyan" means quiet/calm; "Nienie" means light/small; "Luo" means descending/gathering. Like elm seeds, it is light/thin but not hollow internally. Although the Lung pulse primarily reflects descending and light emptiness, it is nourished by Spleen Earth, hence appearing light like elm seeds but solid within.)
A diseased Lung pulse arrives neither ascending nor descending, rough like touching a chicken feather. This is Lung disease. A dying Lung pulse floats like an object adrift or scatters like hair blown by wind. This is Lung death. (Neither ascending nor descending indicates sluggish flow. Touching a chicken feather is lighter/thinner than an elm seed, lacking the generating Earth image and instead showing the conquering Wood structure, indicating Lung disease. Floating like an object indicates rootlessness. Scattering like wind-blown hair indicates severe dispersion.)
A healthy Liver pulse arrives softly and variably, like holding the tip of a long bamboo pole. This is a healthy Liver pulse; in Spring, Stomach Qi is fundamental. ("Ruoruo" refers to the soft Qi of early growth. "Zhaozhao" describes a rising and falling motion, depicting the nascent pulse. The tip of a long pole is long and soft. All stem from Stomach Qi, allowing the True Organ pulse to remain soft and harmonious.)
A diseased Liver pulse arrives full, solid, and slippery, like touching a long pole. This is Liver disease. A dying Liver pulse arrives urgent and tense, like a newly drawn bowstring. This is Liver death. (Fullness contradicts the soft/variable nature. Touching a long pole contrasts with the soft tip. Slippery pulses are bead-like; a string-like pulse with slipperiness resembles a jointed pole. The *Bian Mai Pian* states: "Continuous like touching a long pole is named Yin Jie (Yin Knot)," indicating Liver Qi pathology with obstruction. Urgent and tense like a new bowstring indicates extreme strength and absence of Stomach Qi.)
A healthy Spleen pulse arrives harmonious and soft with intermittent pauses, like a chicken walking on ground. This is a healthy Spleen pulse; in Late Summer, Stomach Qi is fundamental. ("Herou" is the soft Qi of Central Earth. "Xiangli" refers to occasional pauses. The Spleen is the solitary Zang, Central Earth connecting the four directions; thus, within softness, there are intermittent pauses. A chicken has four claws and walks very gently, illustrating the Spleen Earth irrigating the four Zang organs, spreading out gently and widely.)
A diseased Spleen pulse arrives solid, full, and rapid, like a chicken lifting its foot. This is Spleen disease. (Solid, full, and rapid indicates abundance without softness. Lifting the foot implies curling/constricting, unable to irrigate the four Zang organs.)
A dying Spleen pulse arrives sharp and hard like a crow's beak, like a bird's claw, like water dripping from a leaking roof, or like flowing water. This is Spleen death. ("Hui" sounds like 'hui'. Like a crow's beak: hard and static, lacking softness and intermittent pauses. Like a bird's claw: more curled and urgent than a chicken lifting its foot. Like a leaking roof: sparse drops, unable to irrigate. Like flowing water: damp Earth Qi scattering. This signifies that the Spleen governs balanced Qi; extremes of excess or deficiency result in death pulses.)
A healthy Kidney pulse arrives rapidly and continuously like a hook, firm upon pressure. This is a healthy Kidney pulse; in Winter, Stomach Qi is fundamental. ("Chuan chuan lei lei" indicates deep, stone-like vitality. "Like a hook" suggests floating and hollow in the center, reflecting the nature of Water. Firm upon pressure reflects the nature of Stone. Mo Zijin noted: Langgan is beautiful stone; the Hook pulse belongs to the Heart. Heart pulse like touching Langgan, Kidney pulse like a hook, represents the mutual interaction of Heart-Kidney Water-Fire Qi.)
A diseased Kidney pulse feels like pulling a vine, becoming harder upon pressure. This is Kidney disease. A dying Kidney pulse feels like pulling a rope in contention, sounding crisp like striking stone. This is Kidney death. (Like vines/ropes reflects Wood imagery. Deep/stone is the Kidney's essence; pulling a vine and hardening indicates Kidney Qi failing to store and leaking outward. Like pulling a rope in contention is harder than pulling a vine. Striking stone lacks the vital "chuan lei" movement, representing the death sign of the Kidney.)