47.未达天道之常变, 反谓气运不相应, 既识一定之常理, 再审不定
变化情, 任尔百千杂合病, 要在天时地化中, 知其要者一言毕, 不得
其旨散无穷.
【注】近世医者, 皆谓五运六气与岁不应, 置而不习, 是未达天道之
常变也. 时之常者, 如春温, 夏热, 秋凉, 冬寒也. 日之常者, 早凉
,午热, 暮温, 夜寒也. 时之变者, 春不温, 夏不热, 暑不蒸, 秋不
凉,冬不寒也. 日之变者, 早温, 午寒, 暮凉, 夜热也. 但学医者,
欲达常变之道, 当先识一定主客之理, 次审不定变化猝然之情, 然后
知百千杂合之气为病, 俱莫能逃天时地化之理也. 虽或有不应, 亦当
审察与天时何时, 地化何化, 人病何病相同, 即同彼时, 彼化, 彼病
而施治之, 乃无差谬. 此知其要者, 一言而终也. 为医者可不于运气
中一加意耶? 附: 冲阳诸脉穴位: 冲阳穴──在足跗上五寸, 去陷骨
二寸骨间动脉. 太渊穴──在掌后内侧, 横纹头动脉中. 太溪穴──
在足内踝后五分, 跟骨上动脉陷中. 太冲穴──在足大指本节二寸间
,动脉应手陷中. 神门穴──在掌后锐骨端陷中
..附:
47. 如果不通晓天道运行中常规与变化的规律，反而认为五运六气与岁序不相符合，（从而忽视运气学说）。既然已经认识了相对固定的常理，再进一步审察那些不定的、瞬息万变的情况，那么，任凭病人患有成百上千种复杂的合病，关键在于将其置于天时气候与地理环境的变化中去考量。懂得其中要领的人，用一句话就能概括完毕；不得其精髓的人，则会在无穷无尽的困惑中迷失。
【注】近世的医生，都声称五运六气与实际年份的气候不相符，于是放置一边不再学习，这是没有通达天道中“常”与“变”的道理。时间的“常”，比如春天温暖、夏天炎热、秋天凉爽、冬天寒冷。一天的“常”，比如早晨凉快、中午热、傍晚温和、夜晚寒冷。时间的“变”，比如春天不温暖、夏天不炎热、暑天不闷热、秋天不凉爽、冬天不寒冷。一天的“变”，比如早晨温和、中午寒冷、傍晚凉爽、夜晚炎热。但是学医的人，想要通达常与变的道理，应当先认识相对固定的主气与客气之理，其次审察那些不定的、突发的变化情况，然后才知道成百上千种复杂交织的气机致病，都不能逃脱天时与地化（地理气候）的规律。虽然有时会有不相符的情况，也应当审察这与天时的哪个阶段、地化的哪种变化、人的哪种病症相同，就按照那个时间、那种变化、那种病症来施治，这样就不会出现差错。这就是所谓“懂得要领的人，一句话就能终结（问题）”。作为医生，难道不在运气学说上多加留意吗？
附：冲阳等脉的穴位：冲阳穴——在足背上方五寸，距离陷谷穴二寸的骨间动脉处。太渊穴——在手腕后方内侧，横纹头处的动脉中。太溪穴——在内踝后方五分，跟骨上方的动脉凹陷中。太冲穴——在大脚趾本节（第一跖趾关节）后方二寸间，动脉应手的凹陷中。神门穴——在手腕后方锐骨（豌豆骨）端的凹陷中。
47. If one does not comprehend the constancy and variability of the Heavenly Dao (natural laws), but instead claims that the Five Movements and Six Qi do not correspond to the annual cycle, thereby neglecting these theories; once one has grasped the fixed principles of constancy, one must then examine the unpredictable and sudden changes. Regardless of how many complex combined diseases a patient may suffer from, the key lies in understanding them within the context of celestial timing and earthly transformations. He who understands the essence can summarize it in a single statement; he who misses the point will be lost in infinite confusion.
[Note] Physicians in recent times often claim that the Five Movements and Six Qi do not align with actual yearly conditions, and thus abandon their study. This demonstrates a failure to understand the constancy and variability of the Heavenly Dao. The "constancy" of seasons includes: spring warmth, summer heat, autumn coolness, and winter cold. The "constancy" of daily cycles includes: morning coolness, midday heat, evening mildness, and nighttime cold. The "variability" of seasons includes: spring lacking warmth, summer lacking heat, absence of stifling heat, autumn lacking coolness, and winter lacking cold. The "variability" of daily cycles includes: morning mildness, midday cold, evening coolness, and nighttime heat. However, those studying medicine who wish to master the way of constancy and variability must first understand the fixed principles of Host (Zhu) and Guest (Ke) Qi, and then carefully examine unpredictable, sudden changes. Only then can they realize that the myriad complex combinations of pathogenic Qi causing disease cannot escape the laws of celestial timing and earthly transformation. Even when discrepancies occur, one must investigate which phase of celestial timing, which type of earthly transformation, and which specific human pathology correspond to the situation. Treatment should then be administered according to that time, transformation, and pathology, ensuring no errors. This is what is meant by "he who knows the essentials needs only one word to conclude." Should physicians not pay close attention to the theory of Movements and Qi?
Appendix: Acupoints of the Chongyang and other pulses:
Chongyang (ST42) — Located five cun above the dorsum of the foot, two cun distal to Xiangu (ST43), in the depression of the interosseous artery.
Taiyuan (LU9) — Located at the radial end of the transverse crease of the wrist, on the medial side, in the depression where the pulse is palpable.
Taixi (KI3) — Located five fen posterior to the medial malleolus, in the depression of the artery above the calcaneus.
Taichong (LR3) — Located two cun proximal to the metatarsophalangeal joint of the great toe, in the depression where the pulse is palpable.
Shenmen (HT7) — Located in the depression at the ulnar end of the transverse crease of the wrist, adjacent to the pisiform bone.