指上如汤沸涌时。旦占夕死定无疑。尾掉摇摇头不动。鱼翔肾绝亦如期。去疾来迟势劈
劈。
命绝脉来如弹石。三阳谷气久虚空。胃气分明屋漏滴。散乱还同解索形。髓竭骨枯见两尺。
虾游状如虾蟆游。魂去行尸定生忧。雀啄连连来数急。脾无谷气定难留。欲知心绝并荣绝。
如刀压力细推求。更有肺枯并胃乏。如麻蹙促至无休。指下浑然如转豆。三光正气已漂流。
洞虚子曰。虾游雀啄代止之脉。故名死症。须知痰气关格者。时复有之。若非谙练数历
未
免根据经断病。而贻笑于大方也。盖病势消铄殆尽者。其气不能相续。如虾游水动。屋漏滴点
而无至者。死脉也。其或痰凝气滞。关格不通。则其脉固有不动者。有三两路乱动。时有
时无者。或尺寸亦有亦无者。有关脉绝骨不见者。或时动而大小不常者。有平居之人。忽然
而然者。有素禀痰病。而不时而然者。有僵仆卒中而然者。皆非死脉也。
五十不止身无病。数内有止皆知定。
止犹代脉也。脉来五十动而不见一止者。无病也。五十配天地造化之数。易系辞曰。大
衍之
数五十。五十乃备。一乃数之始。十乃数之极。人之脉息。昼夜循环。五脏脉一动循一脏。
五动循环五脏。遍五十动。是十次五数。循环遍则数皆极处。而不见止者。五脏皆平。故无
病也。
四十一止一脏绝。却后四年多没命。三十一止即三年。二十一止二年应。十五一止一年殂。
以下有止看暴病。
四十动而见一止者。是一脏欠动脉之极数。故知一脏绝也。先绝肾经。何以言之。夫天
一生
水。肾属水。生成之一数也。人之五脏所生。先生乎肾。肾水主肝脉。肝木生心火。命门火
生脾土。脾土生肺金。所以先绝肾。期应四年而死。三十动而见止者。两脏欠动脉之极数。
是知肾与肝二经无气。期应三年而死。二十动而止者。三脏欠动脉之极数。是肾肝心三脏无
气。期应二年而死。十五动而一止者。知肾脾肝心四脏皆无气。期应一年而绝也。
新注云。上言脉之动止。未知诊切何部而取据。谨按素问难经云。每于平旦寅时。日未
出。
饮食未进。血气未乱。医者可以存神定意。心无外驰。诊于指下。右手寸口。默数脉息至止
以决之。夫寸口者。右手气口也。内经曰。气口何以独为五脏主。岐伯曰。胃者水谷之海。
六腑之大源也。五味入口。藏于胃。变现于气口。又曰。脉会太渊。寸口是太渊穴也。是
知寸口为脉大会之处。故能决断五脏六腑生死吉凶矣。
手指下感觉脉搏像沸水一样涌动感。如果在早晨诊察到这种脉象，傍晚就会死亡，这是确定的无疑的。如果脉象尾部跳动、摇头晃脑而不动，这是鱼翔脉，表示肾气绝灭，死期将至。如果脉象去时急速、来势迟缓，气势猛烈如劈裂之声，这是命绝脉，脉来像弹石一样坚硬。如果三阳经的谷气长久虚空，胃气分明得像屋漏滴水一样点滴而下且间隔不均，或者散乱如同解开的绳索形状，这是髓竭骨枯的表现，见于两尺脉。
虾游脉的形状像虾蟆在水中游动，这是魂魄离去、行尸走肉之象，必定令人担忧。雀啄脉连连急数，这是脾无谷气，必定难以留住生命。如果想要知道心绝和荣血绝的情况，需要用刀压力般的手法细细推求。还有肺枯和胃气匮乏的情况，脉象如麻子般细促急促，至数没有休止。指下感觉浑然一体像转动豆子一样，这是三光正气已经漂流散失。
洞虚子说：虾游、雀啄、代止这些脉象，所以称为死症。必须知道痰气关格的患者，有时也会出现类似的脉象。如果不是经验丰富、阅历深厚的人，难免会拘泥于经典条文来判断疾病，而被高明的人所嘲笑。大概病情消耗殆尽的人，其气不能相续，就像虾在水中游动、屋漏滴水点而没有规律，这是死脉。如果是痰凝气滞，关格不通，那么脉象本来就有不动的时候，有三两条路乱动，时有时无，或者寸部和尺部也有时无，有脉绝骨节处不见脉动的，或者时而跳动大小不固定的，有平时健康的人突然出现的，有素来患有痰病而不定时出现的，有猝然僵仆中邪而出现的，这些都不是死脉。
五十次搏动中没有一次停顿，身体就没有疾病；如果有停顿在五十次之内，都知道是定死的征兆。
这里的“止”类似于代脉。脉搏来去五十次而不见一次停顿的，是没有疾病的。五十这个数字配合天地造化的数目，《易经·系辞》说：大衍之数五十。五十才算完备。一是数的开始，十是数的极限。人的脉息，昼夜循环，五脏的脉搏每动一次对应一个脏器，五动循环五脏，遍满五十次，这是十个五次循环，循环遍满则数字都到了极限，而不见停顿的，说明五脏都平和，所以没有疾病。
四十一次停顿（即四十动一止）是一脏气绝，之后四年多会丧命。三十一次停顿（即三十动一止）是三年。二十一次停顿（即二十动一止）是两年。十五次停顿（即十五动一止）是一年死亡。
以下有停顿的要看是否是暴病。
四十次搏动见到一次停顿的，是一脏欠缺动脉的极限数目，所以知道是一脏气绝。首先绝的是肾经，为什么这样说？因为天一生水，肾属水，是生成之一数。人的五脏所生，先生于肾。肾水主肝脉，肝木生心火，命门火生脾土，脾土生肺金。所以先绝肾，预期四年而死。三十次搏动见到停顿的，是两脏欠缺动脉的极限数目，这是知道肾与肝二经无气，预期三年而死。二十次搏动停顿的，是三脏欠缺动脉的极限数目，这是肾、肝、心三脏无气，预期二年而死。十五次搏动停顿一次的，知道肾、脾、肝、心四脏皆无气，预期一年而绝。
新注云：上面所说的脉的动止，不知道诊切哪个部位作为依据。谨按《素问》、《难经》所说，通常在平旦寅时，太阳未出，饮食未进，血气未乱之时，医者可以存神定意，心无外驰，在指下诊察。右手寸口，默数脉息至停顿以决断。夫寸口者，就是右手的气口。《内经》说：气口为什么独为五脏之主？岐伯说：胃是水谷之海，六腑的大源。五味入口，藏于胃，变现于气口。又说：脉会太渊，寸口就是太渊穴。因此知道寸口是脉大会聚的地方，所以能决断五脏六腑的生死吉凶了。
When the pulse feels like boiling water surging under the fingers, if observed in the morning, death is certain by evening. If the tail of the pulse trembles and shakes without moving steadily, this is the "Fish Swimming" (Yuxiang) pulse, indicating Kidney Qi exhaustion and an approaching death. When the pulse departs rapidly but arrives slowly, with a forceful momentum like splitting wood, this is the "Life-Extinguishing" pulse, arriving hard like a flicking stone. When the Gu Qi (Grain Qi) of the Three Yang channels has been empty for a long time, and the Stomach Qi is distinct yet dripping like a leaking roof drop by drop, or scattered and chaotic like untied ropes, these are signs of Marrow Exhaustion and Bone Withering, seen in the Two Chi pulses.
The "Shrimp Swimming" (Xiayou) pulse resembles a toad swimming; it indicates the departure of the Soul and the state of a walking corpse, bringing definite sorrow. The "Sparrow Pecking" (Quezhao) pulse comes in rapid, continuous pecks; this indicates Spleen lacks Grain Qi and life is difficult to retain. To know the conditions of Heart Exhaustion and Ying Blood Exhaustion, one must seek them by pressing firmly as if with a knife and pushing carefully. Furthermore, Lung Withering and Stomach Deficiency present with a pulse like hemp seeds—fine, constrained, and rapid without rest. Under the fingers, it feels completely uniform like rolling beans, indicating that the Zheng Qi (Upright Qi) of the Three Lights has already drifted away.
Master Dongxu said: The pulses of Shrimp Swimming, Sparrow Pecking, and Dai (Intermittent) stop are named "Death Syndromes." One must know that patients with Phlegm-Qi Guan Ge (Obstruction and Reversal) may occasionally exhibit such pulses. Unless one is experienced and well-traveled in practice, one might blindly follow classical texts to diagnose diseases, thereby becoming a laughingstock among experts. Generally, when the disease process has consumed almost all vitality, the Qi cannot continue sequentially, resembling shrimp swimming in water or drops from a leaking roof without regularity; this is a Death Pulse. However, if there is Phlegm coagulation and Qi stagnation causing Guan Ge obstruction, the pulse may naturally remain still at times, move chaotically in two or three channels, appear and disappear intermittently, or be absent at the Cun and Chi positions. There may be cases where the Guan pulse is absent and bone visibility is prominent, or where the pulse beats irregularly in size. These can occur suddenly in healthy individuals, sporadically in those prone to Phlegm disorders, or after sudden collapse and stroke. None of these are Death Pulses.
Fifty beats without any pause indicate the body is free of disease. Any pause within fifty beats signifies a fatal prognosis.
Here, "pause" is similar to the Dai pulse. If the pulse beats fifty times without seeing a single pause, there is no disease. The number fifty corresponds to the numbers of Heaven and Earth's creation. The *Xi Ci* commentary on the *I Ching* states: "The Great Expansion Number is fifty." Fifty represents completeness. One is the beginning of numbers, ten is the limit. Human respiration and pulse circulation day and night; each beat of the Five Zang pulses corresponds to one organ. Five beats cycle through the five organs. After fifty beats, this constitutes ten cycles of five. When the cycle is complete, the numbers reach their limit. Without pauses, the Five Zang are balanced, hence no disease.
A pause after forty-one beats (one pause in forty beats) indicates one Zang is exhausted, leading to death after four years. A pause after thirty-one beats (one pause in thirty beats) indicates death in three years. A pause after twenty-one beats (one pause in twenty beats) indicates death in two years. A pause after fifteen beats (one pause in fifteen beats) indicates death in one year.
For pauses below this threshold, one must examine whether it is an acute illness.
Seeing one pause in forty beats means one Zang lacks the extreme number of arterial movement, indicating one Zang is exhausted. It begins with the Kidney channel. Why? Because Heaven generates Water, and the Kidney belongs to Water, corresponding to the generative number one. The Five Zangs are born from the Kidney first. Kidney Water governs the Liver pulse; Liver Wood generates Heart Fire; Mingmen Fire generates Spleen Earth; Spleen Earth generates Lung Metal. Thus, the Kidney exhausts first, with a predicted death in four years. Seeing a pause in thirty beats means two Zangs lack the extreme number, indicating Qi deficiency in both Kidney and Liver channels, with predicted death in three years. Seeing a pause in twenty beats means three Zangs lack the extreme number, indicating Qi deficiency in Kidney, Liver, and Heart, with predicted death in two years. Seeing one pause in fifteen beats indicates Qi deficiency in four Zangs: Kidney, Spleen, Liver, and Heart, with predicted death in one year.
New annotation says: Regarding the above discussion of pulse beats and pauses, it is unclear which position was palpated for evidence. According to the *Su Wen* and *Nan Jing*, one should typically diagnose during Yin hour at dawn, before sunrise and before eating, when blood and Qi are undisturbed. The physician should concentrate spirit and intent, keeping the mind from wandering externally, and diagnose under the fingers. The Right Hand Cun Kou (Inch Port), also known as the Qi Kou (Qi Port), allows silent counting of pulse beats to determine pauses. The *Nei Jing* asks: Why does the Qi Kou alone serve as the master of the Five Zangs? Qibo answers: The Stomach is the Sea of Water and Grain, the great source of the Six Fu organs. Flavors enter the mouth, are stored in the Stomach, and manifest in the Qi Kou. It is also stated: "Pulses converge at Taiyuan"; Cun Kou is the Taiyuan acupoint. Therefore, Cun Kou is the gathering place of pulses and can determine the life and death, auspiciousness and inauspiciousness of the Five Zang and Six Fu organs.