《素问·平人气象论》曰∶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。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，皆死。
脉从阴阳者，如心肺应浮，肝肾应沉，腑脉浮大，脏脉沉小之类。得四时之顺者，如春弦、夏钩、秋毛、
冬石，而有和缓胃气。如此虽病，亦易愈也。脉逆阴阳者，与上文从阴阳之脉象相反也。其反四时者，如春见
毛脉，是金克木；夏见石脉，是水克火；秋见钩脉，是火克金；冬见代脉，是土克水也。不间脏者，谓病传相
克也，如肝传脾，木克土也；脾传肾，土克水也；肾传心，水克火也；心传肺，火克金也；肺传肝，金克木也。
如此，病皆难已也。间脏者，如肝传心，是木生火，间肺脏，而木不克
土也；心传脾，是火生土，间肾脏，而火不克金也；脾传肺，是土生金，间肝脏，而土不克水也；肺传肾，是
金生水，间心脏，而金不克木也；肾传肝，是水生木也，间脾脏，而水不克火也。如此，病皆易愈也。其相克
者死，如经文所言肝见庚辛等，是谓无胃气之真脏脉，与前章所言但弦无胃气曰死，同一理也。
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。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。
此又申明逆从之理，若春夏秋冬四时，未有弦、钩、毛、石本脏之脉形，当春夏阳旺而升，其脉反瘦小，
不应其气，内衰可见；秋冬阳降而藏，脉反浮大而虚，本元不固可知，此为逆四时也。又如风热而脉反静，是
阳病见阴脉，正不敌邪矣；便泄脱血，阴阳皆伤，脉应沉弱，而反实者，是无胃气之真脏脉也；病在中而有积，
脉反虚，元气已亏，何以攻积乎？病在外感，而脉涩坚，绝少阳和之气，何以达营卫而祛邪乎？故此皆为难治
之病，命曰反四时者，与天地气化相反也。
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。
经曰∶气口成寸，以决死生。故或云寸口，或云气口，或云脉口，皆指两手之脉也。人迎主六腑之阳，
寸口主五脏之阴，已详辨前关格病篇矣。旧注分寸关尺解之，不但穿凿，且非经旨，何也？盖经已有专明寸关
尺，以候脏腑部位者，又有指出心脉何如为某病，肝脉何如为某病，及各脏腑病，均有指出，若此章数
节，专明两手通体脉象为病者也。假如外感，则两手之脉皆浮，火邪，则两手脉皆数之类，安能分部位哉！诊
者既已先明脏腑部位，自能随时审其病处，故此经文止论通脉为病之理也。言脉中手者，初按应指浮部之脉也。
短者，表阳郁而化火，故头痛，以诸阳皆会于头也；长者，阳气有余也，阳有余，则阴不足以荣养经脉，下部
属阴，故足胫痛也；促急而上击者，阳气逆于胸肺，故肩背痛也。两手脉俱沉而坚者，有形之邪结滞，故病在
中也；若浮而盛者，气行于表，必有外感之病也。若沉而弱者，表里皆虚也，表阳虚则腠理不固，时发寒热，
内阳虚则阴邪结于阴分，而有疝瘕、少腹痛之病也；若沉而横，横者，顶指有力，而不顺轨，故知其胁下有积，
及腹中有横积痛也；脉沉而喘，喘者，鼓动急促，而不调达，此邪闭营卫，表里不通，故脉反沉而发寒热。又
脉主一身之气，或肺气壅遏，而喘息脉沉，亦有之，此喘字有双关之义，当兼审其外证也。
《素问·平人气象论》说：脉象顺应阴阳规律，病容易痊愈；脉象违背阴阳规律，病难以痊愈。脉象符合四时变化的顺行规律，说明病情没有其它复杂变化；脉象违背四时规律，以及出现“不间脏”的传变，说明病难痊愈。肝脏在庚辛日（金旺之日）出现真脏脉则死，心脏在壬癸日（水旺之日）出现真脏脉则死，脾脏在甲乙日（木旺之日）出现真脏脉则死，肺脏在丙丁日（火旺之日）出现真脏脉则死，肾脏在戊己日（土旺之日）出现真脏脉则死，这被称为真脏脉现，都是死证。
所谓脉象顺应阴阳，比如心肺之脉应浮，肝肾之脉应沉，六腑之脉浮大，五脏之脉沉小等情形。所谓得四时之顺，比如春季脉弦、夏季脉钩、秋季脉毛、冬季脉石，并且带有和缓的胃气。像这样即使生病，也容易痊愈。所谓脉象违背阴阳，是与上文所说的顺应阴阳的脉象相反。所谓违背四时，比如春季见到毛脉（秋脉），这是金克木；夏季见到石脉（冬脉），这是水克火；秋季见到钩脉（夏脉），这是火克金；冬季见到代脉（长夏脉或土脉），这是土克水。所谓“不间脏”，是指疾病传变相克，比如肝病传脾，是木克土；脾病传肾，是土克水；肾病传心，是水克火；心病传肺，是火克金；肺病传肝，是金克木。像这样，病都难以痊愈。“间脏”的情况，比如肝病传心，是木生火，中间隔了肺脏，所以木不克土（此处原文逻辑似有笔误，通常间脏指相生，如肝传心为母病及子，若按原文“间肺脏”理解，可能是指避开相克路径，但原文表述较为特殊，此处直译其意）；心病传脾，是火生土，中间隔了肾脏，所以火不克金；脾病传肺，是土生金，中间隔了肝脏，所以土不水；肺病传肾，是金生水，中间隔了心脏，所以金不克木；肾病传肝，是水生木，中间隔了脾脏，所以水不克火。像这样，病都容易痊愈。那些相克的传变会导致死亡，如经文所说肝见庚辛等，这就是无胃气的真脏脉，与前章所说的“但弦无胃气曰死”，道理是一样的。
脉有逆从之分，四时之中如果没有本脏应有的脉形，春夏季节脉象瘦小，秋冬季节脉象浮大，这就叫做逆四时。感受风热而脉象反而静迟，泄泻或脱血而脉象反而实大，病在内而脉象反而虚，病在外而脉象反而涩坚，这些都难治，叫做反四时。
这里又进一步阐明逆从的道理。如果春夏秋冬四时，没有出现弦、钩、毛、石这些本脏的正常脉形，而在春夏阳气旺盛升发之时，脉象反而瘦小，这说明脉不应其气，体内正气衰微可见；在秋冬阳气潜降收藏之时，脉象反而浮大而虚，说明根本元气不固可知，这叫做逆四时。又如感受风热而脉象反而静迟，这是阳病见到阴脉，正气不能抵御邪气；便泄或脱血，阴阳都受伤，脉象应该沉弱，反而实大的，这是无胃气的真脏脉；病在内而有积滞，脉象反而虚，说明元气已经亏损，用什么来攻逐积滞呢？病在外感，而脉象涩坚，说明极少有阳气和调之气，用什么来通达营卫并祛除邪气呢？因此这些都是难治的病，叫做反四时，是与天地气化规律相反的。
想要知道寸口脉太过与不及，如果寸口脉搏动应手感觉短促的，主头痛；寸口脉搏动应手感觉长的，主足胫痛；寸口脉搏动急促且向上冲击手指的，主肩背痛。寸口脉沉而坚实的，主病在中焦（内）；寸口脉浮而盛大的，主病在外。寸口脉沉而弱的，主寒热病及疝瘕，少腹痛；寸口脉沉而横硬的，主胁下有积块，腹中有横向积块疼痛；寸口脉沉而急促喘动的，主寒热。
经文说：气口形成寸脉，用来决断生死。所以说寸口，或者说气口，或者说脉口，都是指两手部的脉象。人迎脉主要反映六腑之阳，寸口脉主要反映五脏之阴，这在前面关格病篇中已经详细辨析过。旧注将寸、关、尺分开解释，不仅牵强附会，而且不符合经文原意，为什么呢？因为经文中已有专门明确寸、关、尺以候测脏腑部位的内容，又有指出心脉如何表现为某病，肝脉如何表现为某病，以及各脏腑病均有具体指出的内容。像这一章节的几段文字，是专门说明两手整体脉象作为疾病诊断依据的。假如外感病，则两手的脉象都浮，火邪致病，则两手的脉象都数，怎么能分部位呢！诊脉者既然已经先明确了脏腑部位，自然能随时审察病变之处，所以这段经文只论述通体脉象作为疾病诊断的原理。所谓“脉中手”，是指初按时应指于浮部的脉象。短的，是表阳郁结而化火，所以头痛，因为诸阳经都汇聚于头部；长的，是阳气有余，阳气有余，则阴气不足以荣养经脉，下部属阴，所以足胫痛；急促而上击的，是阳气逆乱于胸肺，所以肩背痛。两手脉都沉而坚实，是有形之邪结滞，所以病在内；如果浮而盛大，是气行于表，一定有外感病。如果沉而弱，是表里皆虚。表阳虚则腠理不固，时常发作寒热；内阳虚则阴邪结于阴分，而有疝瘕、少腹痛的病。如果沉而横，横的意思是顶指有力，而不顺轨道，所以知道胁下有积块，及腹中有横向积块疼痛；脉沉而喘，喘的意思是鼓动急促，而不调达，这是邪气闭塞营卫，表里不通，所以脉反而沉并发寒热。另外脉主一身之气，或者肺气壅遏而喘息导致脉沉，也是有的，这个“喘”字有双关的意义，应当兼审其外在证候。
The *Suwen · Pingren Qixiang Lun* states: If the pulse conforms to Yin and Yang, the disease is easy to cure; if the pulse goes against Yin and Yang, the disease is difficult to cure. If the pulse follows the smooth progression of the Four Seasons, it indicates no other complications in the disease; if the pulse contradicts the Four Seasons, or involves "non-intervening Zang" transmission, the disease is difficult to cure. Death occurs if the Liver presents with True Zang Pulse (True Visceral Pulse) on Geng-Xin days (Metal prosperous days), the Heart on Ren-Gui days (Water prosperous days), the Spleen on Jia-Yi days (Wood prosperous days), the Lung on Bing-Ding days (Fire prosperous days), and the Kidney on Wu-Ji days (Earth prosperous days). This is called the manifestation of True Zang Pulses, all indicating death.
Pulse conforming to Yin and Yang refers to situations such as the Heart and Lung pulses being floating, the Liver and Kidney pulses being deep, the Fu-organ pulses being floating and large, and the Zang-organ pulses being deep and small. Obtaining the smoothness of the Four Seasons refers to Spring presenting with Wiry (Xian) pulse, Summer with Hook (Gou) pulse, Autumn with Hairy (Mao) pulse, and Winter with Stone (Shi) pulse, accompanied by a harmonious Stomach Qi (Wei Qi). In such cases, even if diseased, recovery is easy. Pulse going against Yin and Yang is opposite to the pulse images described above as conforming to Yin and Yang. Contradicting the Four Seasons refers to, for example, seeing Hairy pulse (Autumn pulse) in Spring, which is Metal overcoming Wood; seeing Stone pulse (Winter pulse) in Summer, which is Water overcoming Fire; seeing Hook pulse (Summer pulse) in Autumn, which is Fire overcoming Metal; and seeing Intermitting pulse (Dai pulse, often associated with Earth/Long Summer) in Winter, which is Earth overcoming Water. "Non-intervening Zang" refers to disease transmission via mutual overcoming, such as Liver transmitting to Spleen (Wood overcomes Earth); Spleen transmitting to Kidney (Earth overcomes Water); Kidney transmitting to Heart (Water overcomes Fire); Heart transmitting to Lung (Fire overcomes Metal); and Lung transmitting to Liver (Metal overcomes Wood). In such cases, the disease is difficult to cure. "Intervening Zang" refers to transmission via mutual generation, such as Liver transmitting to Heart (Wood generates Fire), intervening through the Lung, so Wood does not overcome Earth [Note: Textual logic implies avoiding direct overcoming path]; Heart transmitting to Spleen (Fire generates Earth), intervening through the Kidney, so Fire does not overcome Metal; Spleen transmitting to Lung (Earth generates Metal), intervening through the Liver, so Earth does not overcome Water; Lung transmitting to Kidney (Metal generates Water), intervening through the Heart, so Metal does not overcome Wood; and Kidney transmitting to Liver (Water generates Wood), intervening through the Spleen, so Water does not overcome Fire. In such cases, the disease is easy to cure. Those involving overcoming transmission lead to death, as stated in the scripture regarding Liver seeing Geng-Xin, etc. This is the True Zang Pulse without Stomach Qi, consistent with the principle stated in the previous chapter that "Wiry pulse without Stomach Qi indicates death."
Pulses have categories of contrary and compliant. If the characteristic pulse shape of the specific Zang organ is absent during the Four Seasons, and the pulse is thin/small in Spring and Summer, or floating and large in Autumn and Winter, this is called contradicting the Four Seasons. Wind-Heat presenting with a quiet pulse, diarrhea or blood loss presenting with a full/excess pulse, internal disease presenting with a deficient pulse, and external disease presenting with choppy/firm pulse are all difficult to treat, and are called contrary to the Four Seasons.
This further elucidates the principles of contrary and compliant. If the characteristic pulses of Wiry, Hook, Hairy, and Stone are absent during the Four Seasons, and in Spring and Summer when Yang Qi is prosperous and ascending, the pulse is instead thin and small, it indicates the pulse does not correspond to the Qi, revealing internal deficiency. In Autumn and Winter when Yang Qi descends and stores, if the pulse is instead floating, large, and empty, it indicates the root Yuan Qi is insecure, known as contradicting the Four Seasons. Furthermore, if Wind-Heat presents with a quiet pulse, it is a Yang disease showing Yin pulse, meaning righteous Qi cannot resist pathogenic factors. Diarrhea or blood loss injures both Yin and Yang; the pulse should be deep and weak, but if it is instead full/excess, it is the True Zang Pulse without Stomach Qi. Internal disease with accumulation presenting with a deficient pulse indicates already depleted Yuan Qi, making it impossible to attack the accumulation. External contraction presenting with choppy/firm pulse indicates a lack of harmonious Yang Qi, making it impossible to unblock Ying and Wei (Nutritive and Defensive Qi) to expel pathogens. Therefore, these are all difficult-to-treat diseases, called contrary to the Four Seasons, opposing the Qi transformation of Heaven and Earth.
To know excess and deficiency at the Cun Kou (Inch Port): If the Cun Kou pulse feels short upon palpation, it indicates Headache; if long, it indicates pain in the lower legs/shins; if rapid and striking upward, it indicates Shoulder and Back pain. Deep and firm Cun Kou pulse indicates disease in the interior (Zhong); Floating and vigorous Cun Kou pulse indicates disease in the exterior. Deep and weak Cun Kou pulse indicates Cold-Heat disorders, Hernia masses (Han Jia), and Lower Abdominal pain. Deep and transverse/horizontal Cun Kou pulse indicates accumulation under the hypochondrium and horizontal accumulation pain in the abdomen. Deep and panting/rushing Cun Kou pulse indicates Cold-Heat.
The scripture states: The Qi Kou forms the Cun pulse to determine life and death. Thus, Cun Kou, Qi Kou, or Mai Kou all refer to the pulses of both hands. Ren Ying (Carotid artery) primarily reflects the Yang of the Six Fu organs, while Cun Kou primarily reflects the Yin of the Five Zang organs, as detailed in the Guan Ge disease chapter. Old annotations dividing Cun, Guan, and Chi are not only forced but also contrary to the scriptural intent. Why? Because the scripture already has sections specifically clarifying Cun, Guan, and Chi to locate Zang and Fu organs, and sections specifying how Heart pulse manifests certain diseases, Liver pulse manifests certain diseases, etc. The passages in this chapter specifically explain the pathology of the overall pulse image of both hands. For instance, in external contractions, both hand pulses are floating; in Fire pathogen diseases, both hand pulses are rapid. How can one divide by location? Since the practitioner has already clarified Zang and Fu locations, they can naturally assess the disease site according to time. Thus, this scripture only discusses the principle of general pulse pathology. "Pulse middle hand" refers to the pulse felt at the superficial level upon initial palpation. Shortness indicates surface Yang stagnation transforming into Fire, causing headache, as all Yang meridians converge at the head. Length indicates excess Yang; excess Yang means insufficient Yin to nourish meridians; the lower part belongs to Yin, hence lower leg pain. Rapidity and upward striking indicate Yang Qi rebelling in the chest and lungs, causing shoulder and back pain. Both hands deep and firm indicate tangible pathogenic stagnation, hence disease in the interior. Floating and vigorous indicate Qi moving at the surface, implying external contraction. Deep and weak indicate deficiency in both surface and interior. Surface Yang deficiency leads to insecure Cou Li (pores/skin texture) and frequent Cold-Heat episodes. Interior Yang deficiency allows Yin pathogens to knot in the Yin divisions, causing Hernia masses and lower abdominal pain. Deep and transverse/horizontal means the pulse presses firmly against the finger, deviating from the normal course, indicating hypochondriac accumulation and abdominal horizontal accumulation pain. Deep and panting/rushing means the pulse beats rapidly and irregularly, indicating pathogenic closure of Ying and Wei and blockage between surface and interior, thus deep pulse with Cold-Heat. Additionally, since the pulse governs the Qi of the whole body, Lung Qi obstruction causing panting may also result in deep pulse. The character "Chuan" (panting/rushing) has a double meaning here, and one must simultaneously examine external symptoms.