《素问·脉要精微论》岐伯曰∶万物之外，六合之内，天地之变，阴阳之应，彼春之暖，为夏之暑，彼
秋之忿，为冬之怒，四变之动，脉与上下，以春应中规，夏应中矩，秋应中衡，冬应中权。
此言脉象应乎四时阴阳之气化也。寒为阴，热为阳，二气流行，自微而盛。故自暖而热，热极则凉，阳极
生阴也；寒极则温，阴极生阳也。四时迭运，而人身阴阳之气，随之进退，而现象于脉，如规矩衡权，上下相
应，准而有度。如脉不应气候，而有太过不及、相生相克，即可辨其病之轻重吉凶也。
是故冬至四十五日，阳气微上，阴气微下；夏至四十五日，阴气微上，阳气微下。阴阳有时，与脉为期，
期而相失，知脉所分，分之有期，故知死时。
此即申明上文之义也。冬至四十五日，立春节也，阳气微出
于地上，阴气微下于地中，万物生机发动，而脉由石变弦，以应春阳之气；夏至四十五日，立秋节也，阴气微
出于地上，阳气微下于地中，万物长足而成实，脉即由钩而变毛，以应秋收之气也。阳气由微而盛，则弦脉变
钩，钩者，浮洪也；阴气由微而盛，则毛脉变石，石者，沉实也。此阴阳升降流行，生化万物，故有四时之不
同，与脉相应如期会者。若期而相失，知脉气与天地气化分离，故不相应。视其分离有期，或相生相克，即可
知其死生之时日，如春见秋脉，金克木为死，见冬脉，水生木可生也。
微妙在脉，不可不察，察之有纪，从阴阳始，始之有经，从五行生，生之有度，四时为宜，补泻勿失，与
天地如一，得一之精，以知死生。是故声合五音，色合五行，脉合阴阳。
此言疾病死生微妙之理，全在察脉，察之必有纪律，非可凭臆揣度，要从阴阳生化之理为始，知始而后，
则有经常变化不同，皆从五行出生，如冬至阳生，夏至阴生，木旺于春，火旺于夏，金旺于秋，水旺于冬，土
旺四季，此阴阳四时之常度也。如阴阳有偏胜，则五行有生克，遂变化致病，故必调之，合四时之宜，应补应
泻而勿错失，与天地生化之理如一，得其精一之理，可以知逆顺死生之道也。若声从气发，色由气彰，气根于
五脏，五脏具五行之性，脉为气血之先形，是故声音色脉，必皆合乎五行阴阳生化之理，不合则病，败象见则
死矣。
反四时者，有余为精，不足为消。应太过，不足为精；应不足，有余为消。阴阳不相应，病名曰关格。
此言脉象反四时气化之理也。言有余为精，不足为消者，谓人身阴阳之气，合四时气化而消长者，若春夏
阳长阴消，秋冬阳
消阴长，脉象随四时而不同也。如其应当太过，而反不足，为精伤，而气不生长也；应当不足，而反有余，
为本元消败，虚阳发露之假象也。故曰∶阴阳不相应，病名曰关格。关格者，死不可治也。此节经文，向在前
万物之外一节以先，余细详上下义理，必是错简，故特移此，义理方合。
是故持脉有道，虚静为保。春日浮，如鱼之游在波；夏日在肤，泛泛乎万物有余；秋日下肤，蛰虫将去；
冬日在骨，蛰虫周密，君子居室。故曰∶知内者，按而纪之；知外者，终而始之。此六者，持脉之大法。
此言切脉之要道，当虚心静气，医者虚心则明察，病者气静则脉准，可保无错失也。盖脉理之妙，难以言
宣，喻如鱼游虫蛰种种，形容其气血流行出入之象，亦即弦钩毛石之意也。必深思默究，悟其神理，指下方能
明察。故知身内之气化者，按脉象阴阳五行而纪之，其理自见；知身外之气化者，观时序流行，终始之道，与
人身无不相应，而内伤外感，昭然可辨。以四时之气化，合人身之内外，此六者，为持脉之大纲要法也。此结
上文诸节之旨，下乃详叙诊脉部位也。
《素问·脉要精微论》中，岐伯说：在万物之外、天地六合之内，天地的变化与阴阳的相应，正如那春天的温暖演变为夏天的暑热，那秋天的肃杀演变为冬天的严寒。四季气候的变动，脉象也随之上下相应：春天脉象应合乎规（圆规，指脉象圆润流畅），夏天脉象应合乎矩（曲尺，指脉象洪大方正），秋天脉象应合乎衡（秤杆，指脉象轻浮平衡），冬天脉象应合乎权（秤锤，指脉象沉实稳重）。
这是说明脉象应当顺应四时阴阳之气的变化。寒属于阴，热属于阳，阴阳二气流行，由微弱逐渐变得强盛。所以从温暖到炎热，热极则转为凉爽，这是阳极生阴；寒极则转为温和，这是阴极生阳。四季更替运行，人体的阴阳之气也随之消长进退，并显现于脉象之中，就像规矩衡权一样，上下相应，准确而有法度。如果脉象不顺应气候，出现太过或不及、相生相克异常的情况，就可以辨别疾病的轻重和吉凶。
因此，冬至后的四十五天内，阳气微微上升，阴气微微下降；夏至后的四十五天内，阴气微微上升，阳气微微下降。阴阳的变化有固定的时节，脉象也有相应的周期，如果到了时节脉象却不相符，就能知道脉气所属的类别；既然分类有期，就能预知死亡的时间。
这是对上文意义的进一步阐明。冬至后四十五天是立春节，阳气微微出于地面之上，阴气微微沉入地中，万物的生机开始发动，脉象由冬季的“石”脉转变为春季的“弦”脉，以顺应春阳之气；夏至后四十五天是立秋节，阴气微微出于地面之上，阳气微微沉入地中，万物长足并结实成熟，脉象就由夏季的“钩”脉转变为秋季的“毛”脉，以顺应秋收之气。阳气由微弱变得强盛，脉象就从“弦”变为“钩”，“钩”是指脉象浮而洪大；阴气由微弱变得强盛，脉象就从“毛”变为“石”，“石”是指脉象沉而坚实。这就是阴阳升降流行、化生万物的道理，所以有四时不同的气候，以及与脉象如期相应的规律。如果到了时节脉象却不相符，说明脉气与天地气化分离，所以不相适应。观察这种分离是否有定期，或者出现相生相克的逆乱，就可以知道生死的具体时日，例如春天见到秋天的脉象，是金克木，主死；见到冬天的脉象，是水能生木，主生。
脉象的精妙之处，不可不仔细考察。考察脉象要有纲纪，从阴阳开始；起始要有经典依据，从五行生化而来；生化有定度，以顺应四时为适宜，补泻手法不要失误，要与天地自然保持一致，掌握了这一精微之理，就能知晓生死。因此，声音符合五音，面色符合五行，脉象符合阴阳。
这是说明疾病生死微妙之理，全在于诊察脉象。诊察必须有纪律，不能凭主观臆测，要从阴阳生化的道理作为起点。知道了起点之后，就有常规的变化不同，这些都从五行出生，例如冬至时阳气始生，夏至时阴气始生，木气旺盛于春季，火气旺盛于夏季，金气旺盛于秋季，水气旺盛于冬季，土气旺盛于四季末月，这是阴阳四时的常规法度。如果阴阳出现偏胜，则五行之间产生生克关系，从而变化致病，所以必须调理，顺应四时的适宜，该补则补，该泻则泻，不要错失时机，与天地生化的道理保持一致，掌握其精一之理，就可以了解逆顺生死之道。如果声音由气发出，面色由气彰显，而气根源于五脏，五脏具备五行的特性，脉象是气血运行的先兆表现，所以声音、面色、脉象，都必须合乎五行阴阳生化的道理，如果不合就会生病，出现败象就会死亡。
违背四时规律的，有余表现为精气过盛，不足表现为精气消耗。应当脉象太过而反见不足，是精气损伤，气不能生长；应当脉象不足而反见有余，是本元消败，虚阳外越的假象。所以说：阴阳之气不相呼应，病名叫做关格。关格病，是死证，无法治愈。这段经文，原本可能在“万物之外”一节之前，我仔细推敲上下文理，认为这一定是竹简错乱所致，所以特意将其移至此地，义理才相符顺。
因此，诊脉有一定的法则，以虚心静气为保准。春天的脉象浮在表面，像鱼在水中游动；夏天的脉象在皮肤表层，泛泛然如同万物茂盛有余；秋天的脉象下沉至皮肤之下，像冬眠的虫类即将离去；冬天的脉象深达于骨，像冬眠的虫类严密潜伏，君子也安居室内。所以说：了解体内情况的，通过按脉象来记录分析；了解体外情况的，通过观察时序的终始循环。这六点，是诊脉的大法。
这是说明切脉的要道，医生应当虚心静气，病人应当气息平静。医生虚心就能明察秋毫，病人气静则脉象准确，可以保证没有错失。脉理的奥妙，难以用言语完全表达，比喻如鱼游、虫蛰等种种现象，来形容气血流行出入的状态，也就是弦、钩、毛、石脉的意思。必须深思默究，领悟其中的神理，手指才能明察秋毫。所以，了解体内气化的人，通过按脉象结合阴阳五行来纪述分析，道理自然显现；了解体外气化的人，观察时序的流行和终始之道，发现它与人身无不相应，这样内伤和外感就昭然可辨了。将四时的气化与人身内外相结合，这六点，就是诊脉的大纲要法。这是总结上文各节的宗旨，下文将详细叙述诊脉的部位。
In the *Suwen: Treatise on the Essential Subtleties of Pulse Diagnosis*, Qibo stated: Beyond all things and within the six directions (Heaven, Earth, and the four cardinal directions), amidst the changes of Heaven and Earth and their correspondence with Yin and Yang, just as the warmth of spring evolves into the heat of summer, and the severity of autumn transforms into the wrath of winter, the movements of the four seasonal changes are mirrored in the pulse. In spring, the pulse should correspond to the compass (Gui, indicating a round and smooth quality); in summer, to the square (Ju, indicating a broad and upright quality); in autumn, to the balance beam (Heng, indicating a light and balanced quality); and in winter, to the weight (Quan, indicating a deep and solid quality).
This explains that the pulse image should respond to the Qi transformation of Yin and Yang across the four seasons. Cold belongs to Yin, and heat belongs to Yang. The circulation of these two Qi energies progresses from subtle to vigorous. Thus, from warmth to heat, extreme heat generates coolness, which is Yang reaching its extremum and generating Yin; extreme cold generates warmth, which is Yin reaching its extremum and generating Yang. As the four seasons rotate, the Yin and Yang Qi of the human body advances and retreats accordingly, manifesting in the pulse like the compass, square, balance, and weight—responding to each other above and below, accurately and with measure. If the pulse does not accord with the climate, exhibiting excess or deficiency, or abnormal generation and restriction relationships, one can distinguish the severity and prognosis of the disease.
Therefore, forty-five days after the Winter Solstice, Yang Qi subtly ascends while Yin Qi subtly descends; forty-five days after the Summer Solstice, Yin Qi subtly ascends while Yang Qi subtly descends. Yin and Yang have their specific times, and the pulse has its corresponding cycle. If they miss this timing, one can identify the classification of the pulse; since the classification has its period, one can know the time of death.
This further clarifies the meaning of the preceding text. Forty-five days after the Winter Solstice marks the Beginning of Spring (Lichun). Yang Qi subtly emerges above the ground, and Yin Qi subtly sinks below it. The vital energy of all things begins to stir, and the pulse changes from the "Stone" (Shi) pulse to the "Bowstring" (Xian) pulse to accord with the Qi of Spring Yang. Forty-five days after the Summer Solstice marks the Beginning of Autumn (Liqiu). Yin Qi subtly emerges above the ground, and Yang Qi subtly sinks below it. All things grow fully and become substantial. The pulse changes from the "Hook" (Gou) pulse to the "Feather" (Mao) pulse to accord with the Qi of Autumn Harvest. As Yang Qi grows from subtle to vigorous, the Bowstring pulse changes to the Hook pulse; the Hook pulse refers to a floating and surging quality. As Yin Qi grows from subtle to vigorous, the Feather pulse changes to the Stone pulse; the Stone pulse refers to a deep and solid quality. This is the principle of Yin and Yang ascending and descending, circulating, and transforming all things. Hence, there are different seasonal climates and pulses that correspond to them at the appointed times. If the pulse does not correspond when the time arrives, it indicates that the pulse Qi has separated from the Heaven and Earth Qi transformation, hence failing to correspond. By observing whether this separation follows a pattern or involves abnormal generation and restriction, one can determine the day and time of life or death. For example, seeing an Autumn pulse in Spring represents Metal restricting Wood, indicating death; seeing a Winter pulse in Spring represents Water generating Wood, indicating survival.
The subtlety lies in the pulse; it must not be neglected. Examination must have discipline, starting with Yin and Yang. The beginning must follow classics, deriving from the generation of the Five Elements. Generation has its limits, suited to the four seasons. Tonification and sedation must not be missed, aligning with Heaven and Earth as one. Grasping this essence allows one to know life and death. Therefore, sounds harmonize with the Five Tones, complexions harmonize with the Five Elements, and pulses harmonize with Yin and Yang.
This discusses the subtle principles of disease, life, and death, which reside entirely in examining the pulse. Examination must have rules and cannot rely on speculation. It must begin with the principles of Yin-Yang transformation. Knowing the beginning reveals constant changes derived from the Five Elements. For instance, Yang arises at the Winter Solstice, Yin arises at the Summer Solstice; Wood is prosperous in Spring, Fire in Summer, Metal in Autumn, Water in Winter, and Earth in the transitional periods of the four seasons. This is the standard measure of Yin, Yang, and the four seasons. If Yin and Yang exhibit excessive dominance, the Five Elements undergo generation and restriction, leading to pathological changes. Therefore, regulation is necessary, adhering to the suitability of the four seasons, applying tonification or sedation without error, aligning with the transformative principles of Heaven and Earth. Mastering this unified essence allows one to understand the path of reversal, compliance, life, and death. Since voice emanates from Qi, complexion manifests from Qi, and Qi roots in the Zang organs, which possess the nature of the Five Elements, and the pulse is the precursor manifestation of Blood and Qi, therefore, voice, complexion, and pulse must all conform to the transformative principles of the Five Elements and Yin-Yang. Deviation leads to disease; signs of collapse indicate death.
Opposing the four seasons, excess manifests as refined essence (overabundance), while deficiency manifests as consumption. Responding to excess but showing deficiency indicates injury to essence and failure of Qi to grow; responding to deficiency but showing excess indicates the depletion of the root origin and the false appearance of deficient Yang emerging. Thus it is said: When Yin and Yang do not correspond, the disease is named Guan Ge (Obstruction and Repletion). Guan Ge is a fatal condition that cannot be treated. This section of the classic originally likely appeared before the "Beyond all things" paragraph. After carefully analyzing the logic above and below, I believe it was a bamboo slip error, so I have specifically moved it here for logical coherence.
Therefore, holding the pulse requires a method, with emptiness and stillness as the safeguard. In spring, the pulse floats, like fish swimming in waves; in summer, it is at the skin level, abundant like flourishing all things; in autumn, it sinks below the skin, like hibernating insects preparing to leave; in winter, it reaches the bone, like hibernating insects tightly concealed, and gentlemen stay indoors. Thus it is said: To know what is internal, press and record the pulse; to know what is external, observe the cycle of end and beginning. These six points are the great methods of pulse diagnosis.
This explains the essential way of palpating the pulse. The physician must be empty-minded and calm; if the physician is empty-minded, observation is clear. The patient must have calm Qi; if the patient's Qi is calm, the pulse is accurate, ensuring no errors. The subtlety of pulse theory is hard to express in words. Metaphors such as fish swimming and insects hibernating describe the phenomena of Qi and Blood circulation and entry/exit, which also imply the meanings of Xian, Gou, Mao, and Shi pulses. One must ponder deeply and investigate silently to comprehend the spiritual principles, allowing the fingers to perceive clearly. Thus, those who understand internal Qi transformation analyze and record based on pulse images, Yin-Yang, and the Five Elements, revealing the principles naturally. Those who understand external Qi transformation observe the flow of time and the way of beginning and end, finding no disconnect with the human body, thereby clearly distinguishing internal injuries and external infections. Integrating the Qi transformation of the four seasons with the internal and external aspects of the human body, these six points constitute the major outline of pulse diagnosis. This concludes the purport of the previous sections; the following will detail the locations for pulse diagnosis.