（素问玉机真藏论）
大骨枯 ，大肉陷下，胸中气满，喘息不便，其气动形，期六月死；真藏脉见，乃予之期日。（大骨大肉，皆以通身
而言。如肩脊腰膝，皆大骨也；尺肤臀肉，皆大肉也。肩垂项倾，腰重膝败者，大骨之枯 也。尺肤既削，臀肉必枯，
大肉之陷下也。肾主骨，骨枯则肾败矣。脾主肉，肉陷则脾败矣。肺主气，气满喘息则肺败矣。气不归原，形体振动，
孤阳外浮而真阴亏矣。三阴亏损，死期不出六月。六月者，一岁阴阳之更变也。若其真脏脉已见，则不在六月之例，可
因克贼之日而定其期矣。）大骨枯 ，大肉陷下，胸中气满，喘息不便，内痛引肩项，期一月死；真脏见，乃予之期日。
（内痛引肩项，病及心经矣。较前已甚，期一月死。一月者，斗建移而气易也。）大骨枯 ，大肉陷下，胸中气满，喘息
不便，内痛引肩项，身热，脱肉破 ，真脏见，十月之内死。（身热者，阴气去也。脱肉者，肌肉消尽也。破 者，卧久
骨露而筋肉败也。是为五脏俱伤，而真脏又见，当十日内死。十日者，天干尽而旬气易也。月字误，当作日。 ，劬允
切，筋肉结聚之处也。启玄子曰∶肘膝后肉如块者。）大骨枯 ，大肉陷下，肩髓内消，动作益衰，真脏来见，期一岁死；
见其真脏，乃予之期日。（骨枯肉陷，脾肾已亏，兼之肩髓内消，动作益衰，虽诸证未全，真脏未见，然败竭已兆，仅支
一年，岁易气新，不能再振矣。若一见真脏，乃可必其死期也。来见误，当作未见。）大骨枯 ，大肉陷下，胸中气满，
腹内痛，心中不便，肩项身热，破 脱肉，目匡陷，真脏见，目不见人立死；其见人者，至其所不胜之时则死。（五脏败
证俱见，而目匡陷、真脏见、目不见人者，神气已脱，故当立死。若其见人者，神气犹在，故必待克贼之时而死也。）急
虚，身中卒至，五脏绝闭，脉道不通，气不往来，譬于堕溺，不可为期；其脉绝不来，若人一息五六至，其形肉不脱，
真脏虽不见，犹死也。（急虚者，言元气暴伤而忽甚也。故其邪中于身，必猝然而至譬之堕者溺者，旦时莫测，有不可以
常期论也。若脉绝不至，或一呼五六至者，皆脏气竭而命当尽也，故不必其形肉脱而真脏见，如上文以渐衰惫而死有期
也。中，去声。卒，猝同。息字误，当作呼。）真肝脉至中外急，如循刀刃责责然，如按琴瑟弦，色青白不泽，毛折乃死。
（此下皆言真脏脉也。肝之真脏如刀刃、如琴瑟弦者，言细急坚搏而非微弦之本体也。青本木色，而兼白不泽者，金克
木也。五脏率以毛折死者，皮毛得血气而充，毛折则精气败矣，故皆死。下同。）真心脉至坚而搏，如循薏苡子累累然，
色赤黑不泽，毛折乃死。（坚而搏，如循薏苡子者，短实坚强而非微钩之本体，心脉之真脏也。赤本火色，而兼黑不泽者，
水克火也，故死。毛折义如前。）真肺脉至大而虚，如以毛羽中人肤，色白赤不泽，毛折乃死。（大而虚，如以毛羽中人
肤，浮虚无力之甚，而非微毛之本体，肺脉之真脏也。白本金色，而兼赤不泽者，火克金也，故死。）真肾脉至搏而绝，
如指弹石辟辟然，色黑黄不泽，毛折乃死。（搏而绝，搏之甚也。如指弹石辟辟然，沉而坚也。皆非微石之本体，而为肾
脉之真脏也。黑本水色，兼黄不泽者，土克水也，故死。）真脾脉至，弱而乍数乍疏，色黄青不泽，毛折乃死。（弱而乍
数乍疏，则和缓全无，而非微 弱之本体，脾脉之真脏也。黄本土色而兼青不泽者，木克土也，故死。）诸真脏脉见者，
皆死不治也。（无胃气者即名真脏，皆为不治之脉。）黄帝曰∶见真脏曰死何也？岐伯曰∶五脏者皆禀气于胃，胃者五脏
之本也。（胃为水谷之海，以养五脏，故为之本。）脏气者，不能自致于手太阴，必因于胃气，乃至于手太阴也。（谷入于
胃，以传于肺，五脏六腑皆以受气，故脏气必因于胃气，乃得至于手太阴，而脉则见于气口，此所以五脏之脉，必赖胃
气以为之主也。）故五脏各以其时自为，而至于手太阴也。（以时自为，如春而但弦、夏而但钩之类，皆五脏不因于胃气，
即真脏之见也。）故邪气胜者精气衰也，故病甚者，胃气不能与之俱至于手太阴，故真脏之气独见，独见者病胜脏也，故
曰死。帝曰∶善。（凡邪气盛而正气竭者，是病胜脏也，故真脏之邪独见。真脏独用者，胃气必败，故不能与之俱至于手
太阴，则胃气不见于脉，此所以为危兆也。）
《素问·玉机真藏论》
大骨枯槁，大肉陷下，胸中气满，喘息困难，呼吸时气息震动形体，预计六个月后死亡；若出现真脏脉（无胃气的脉象），则根据五行相克的日子确定具体死期。（所谓“大骨”和“大肉”，是指全身而言。如肩、脊、腰、膝等部位都是大骨；尺肤及臀部肌肉都是大肉。肩膀下垂、颈部倾斜、腰部沉重、膝盖衰败，这是大骨枯槁的表现。尺肤消瘦，臀部肌肉必然干枯，这是大肉陷下的表现。肾主骨，骨枯则肾气败坏；脾主肉，肉陷则脾气败坏；肺主气，气满喘息则肺气败坏。气不能归根于原处，形体振动，是孤阳外浮而真阴亏损。三阴经亏损，死期不出六个月。六个月是一年阴阳更替变化的周期。如果真脏脉已经出现，就不在六个月的常规例子里，可以根据相克的日子来定其死期。）
大骨枯槁，大肉陷下，胸中气满，喘息困难，内部疼痛牵引至肩颈，预计一个月后死亡；若出现真脏脉，则根据日子确定死期。（内部疼痛牵引肩颈，说明病邪已波及心经。比前一种情况更严重，预计一个月后死亡。一个月对应北斗斗柄移动方位改变、气候之气转换的时间。）
大骨枯槁，大肉陷下，胸中气满，喘息困难，内部疼痛牵引至肩颈，身体发热，肌肉消脱，皮肤破裂露出筋骨，出现真脏脉，十个月之内死亡。（身体发热，说明阴气离去；肌肉消脱，说明肌肉完全消耗；皮肤破裂露出筋骨，说明久卧导致骨骼外露且筋肉败坏。这是五脏都受伤，且真脏脉出现，应当在十日内死亡。十日是一个天干循环结束、旬气转换的时间。“月”字是误写，应当作“日”。，“劬允”切音，指筋肉结聚的地方。启玄子说：肘部和膝部后面的肉像块状堆积的。）
大骨枯槁，大肉陷下，肩髓内部消减，动作日益衰弱，真脏脉出现，预计一年后死亡；若见到真脏脉，则根据日子确定死期。（骨枯肉陷，说明脾肾已亏虚，加上肩髓内部消减，动作日益衰弱，虽然各种证候尚未全部显现，真脏脉也未出现，但败竭的迹象已经显露，仅能支撑一年，等到岁气更新，精气便不能再振奋。如果一见真脏脉，就可以确切知道死期了。“来见”是误写，应当作“未见”。）
大骨枯槁，大肉陷下，胸中气满，腹内疼痛，心中憋闷不适，肩颈身体发热，皮肤破裂露出筋骨，肌肉消脱，眼眶凹陷，出现真脏脉，若看不见人则立即死亡；若能看见人，则死于其所不胜（被克制）的时候。（五脏败坏的证候都出现了，加上眼眶凹陷、真脏脉出现、看不见人，说明神气已经脱失，所以应当立即死亡。如果能看见人，说明神气还在，所以一定要等到被克制的时辰才会死亡。）
急虚证，元气突然暴伤，五脏绝闭，脉道不通，气机不往来，就像从高处坠落或溺水一样，无法预测具体的死期；如果脉搏断绝不来，或者人一呼一吸间脉搏跳动五六次，虽然形体肌肉没有消脱，真脏脉也没有出现，也是死证。（急虚，是说元气突然受到严重损伤。所以邪气侵入身体，必定猝然发作，就像坠落或溺水的人，早晨的情况难以预料，不能用常规的期限来讨论。如果脉搏断绝不至，或者一呼一吸间脉搏跳动五六次，都是脏气竭尽、生命即将终结的表现，所以不一定非要等到形体肌肉消脱、真脏脉出现，才像上面所说那样逐渐衰惫而死。中，读去声。卒，同“猝”。息字是误写，应当作“呼”。）
真肝脉到来，中外皆紧急，像触摸刀刃那样锐利，又像按压琴瑟弦那样紧绷，面色青白而无光泽，毛发枯折就会死亡。（以下都在讲真脏脉。肝脏的真脏脉像刀刃、像琴瑟弦，是说脉象细急坚搏，而不是微弦的正常本体。青色本是木色，却兼有白色且无光泽，是金克木的表现。五脏大多因毛发枯折而死，因为皮毛依赖气血充盈，毛发枯折说明精气败坏，所以都会死亡。下文同理。）
真心脉到来，坚硬而搏指，像触摸薏苡子那样颗粒累累，面色赤黑而无光泽，毛发枯折就会死亡。（坚硬而搏指，像触摸薏苡子，是短实坚强而非微钩的正常本体，这是心脉的真脏脉。赤色本是火色，却兼有黑色且无光泽，是水克火的表现，所以死亡。毛发枯折的含义如前所述。）
真肺脉到来，大而空虚，像毛羽中人肌肤那样轻浮无力，面色白赤而无光泽，毛发枯折就会死亡。（大而空虚，像毛羽中人肌肤，是浮虚无力的极致，而不是微毛的正常本体，这是肺脉的真脏脉。白色本是金色，却兼有红色且无光泽，是火克金的表现，所以死亡。）
真肾脉到来，搏动有力而似断绝，像手指弹石那样辟辟作响，面色黑黄而无光泽，毛发枯折就会死亡。（搏动有力而似断绝，是搏动非常剧烈。像手指弹石那样辟辟作响，是沉而坚硬的脉象。这些都不是微石的正常本体，而是肾脉的真脏脉。黑色本是水色，兼有黄色且无光泽，是土克水的表现，所以死亡。）
真脾脉到来，虚弱且忽快忽慢，面色黄青而无光泽，毛发枯折就会死亡。（虚弱且忽快忽慢，说明平和舒缓之气全无，而不是微弱正常的本体，这是脾脉的真脏脉。黄色本是土色，却兼有青色且无光泽，是木克土的表现，所以死亡。）
凡是真脏脉出现的，都是死证，不可治疗。（没有胃气的脉就称为真脏脉，都是不可治疗的脉象。）
黄帝说：见到真脏脉就说会死，为什么呢？岐伯说：五脏的功能都依赖于胃气，胃是五脏的根本。（胃是水谷之海，用来滋养五脏，所以被称为根本。）脏气本身不能直接到达手太阴肺经，必须借助胃气，才能到达手太阴肺经。（食物进入胃，传送到肺，五脏六腑都从中受纳气机，所以脏气必须依靠胃气，才能到达手太阴肺经，脉象也就显现在气口，这就是五脏的脉象必须赖胃气作为主宰的原因。）所以五脏各自在其对应的时令表现出相应的脉象，然后反映到手太阴肺经。（按时令自行表现，如春天只现弦脉、夏天只现钩脉等，这些都是五脏不依赖胃气，即真脏脉出现的情况。）所以邪气胜则精气衰，病情严重时，胃气不能随邪气一同到达手太阴肺经，因此真脏之气单独显现。单独显现说明病邪胜过脏气，所以说会死。黄帝说：说得好。（凡是邪气盛而正气竭尽的，就是病胜脏，所以真脏的邪气单独显现。真脏独用，说明胃气必然败坏，所以不能随邪气一同到达手太阴肺经，这样胃气就不显现在脉象中，这就是危重的征兆。）
*Suwen: Yujī Zhēnzàng Lùn* (Plain Questions: Treatise on the Jade Machine and True Visceral Pulse)
When the large bones are withered and the large muscles have sunken, there is fullness of qi in the chest, difficult breathing, and the movement of qi causes the body to tremble; death is expected within six months. If the Zang-Viscera Pulse (pulse devoid of Stomach Qi) appears, then the specific day of death can be determined based on the days of elemental overcoming. (The terms "large bones" and "large muscles" refer to the whole body. For example, the shoulders, spine, waist, and knees are all large bones; the skin of the forearm and the muscles of the buttocks are all large muscles. Drooping shoulders, inclined neck, heavy waist, and failing knees indicate the withering of large bones. When the skin of the forearm becomes emaciated and the buttock muscles must wither, this indicates the sinking of large muscles. The Kidneys govern the bones; when bones wither, Kidney essence fails. The Spleen governs the muscles; when muscles sink, Spleen Qi fails. The Lungs govern Qi; when Qi is full and breathing is labored, Lung Qi fails. When Qi does not return to its root and the body trembles, it signifies solitary Yang floating externally and True Yin being deficient. With the depletion of the Three Yin channels, death will occur within six months. Six months represent the cycle of Yin-Yang transformation in a year. However, if the Zang-Viscera Pulse has already appeared, it falls outside the six-month rule; the time of death can be predicted according to the days of elemental overcoming.)
When the large bones are withered and the large muscles have sunken, there is fullness of qi in the chest, difficult breathing, internal pain radiating to the shoulders and neck; death is expected within one month. If the Zang-Viscera Pulse appears, then the specific day of death can be determined. (Internal pain radiating to the shoulders and neck indicates that the disease has affected the Heart channel. This condition is more severe than the previous one, and death is expected within one month. One month corresponds to the shift of the Big Dipper's direction and the change of climatic Qi.)
When the large bones are withered and the large muscles have sunken, there is fullness of qi in the chest, difficult breathing, internal pain radiating to the shoulders and neck, body heat, emaciation of flesh, and cracking of the skin exposing the bones; if the Zang-Viscera Pulse appears, death will occur within ten months. (Body heat indicates the departure of Yin Qi. Emaciation of flesh means the complete consumption of muscle tissue. Cracking of the skin exposing bones refers to long-term recumbency causing bones to show and muscles/tendons to deteriorate. This represents injury to all five Zang organs combined with the appearance of the Zang-Viscera Pulse; death should occur within ten days. Ten days mark the completion of the Heavenly Stems cycle and the change of the ten-day period. The character "month" is an error and should be "day." , pronounced 'qú yǔn', refers to areas where muscles and tendons cluster. Qixuanzi said: "Where the flesh behind the elbows and knees forms lumps.")
When the large bones are withered and the large muscles have sunken, the marrow of the shoulders internally diminishes, physical movements become increasingly weak, and the Zang-Viscera Pulse appears; death is expected within one year. If the Zang-Viscera Pulse is seen, then the specific day of death can be determined. (Withered bones and sunken muscles indicate deficiency of the Spleen and Kidneys. Coupled with the internal diminution of shoulder marrow and increasing weakness of movement, even if other symptoms are not fully manifested and the Zang-Viscera Pulse has not yet appeared, the signs of exhaustion are already evident. Life may be prolonged for only one year until the annual Qi changes, after which vitality cannot be restored again. If the Zang-Viscera Pulse appears immediately, the time of death can be certain. "Lai jian" (come to see) is an error and should be "wei jian" (not yet seen).)
When the large bones are withered and the large muscles have sunken, there is fullness of qi in the chest, abdominal pain, mental distress, heat in the shoulders, neck, and body, cracking of the skin exposing bones, emaciation of flesh, and sunken eye sockets; if the Zang-Viscera Pulse appears and the patient cannot see people, death occurs immediately. If the patient can still see people, death will occur during the time element that overcomes their dominant element. (When all signs of Zang organ failure are present, along with sunken eye sockets, the Zang-Viscera Pulse, and inability to recognize people, it indicates that Shen Spirit has departed, so death is immediate. If the patient can still see people, it indicates that Shen Spirit remains, so death will wait until the time of elemental overcoming.)
In cases of sudden deficiency (Ji Xu), Yuan Qi is abruptly injured, the Five Zang organs close off, the pulse channels are blocked, and Qi does not circulate. This is like falling from a height or drowning; the time of death cannot be precisely predicted. If the pulse ceases completely, or if the pulse beats five or six times per respiration, even if the form and flesh have not emaciated and the Zang-Viscera Pulse has not appeared, death will still occur. (Sudden deficiency refers to abrupt and severe injury to Yuan Qi. Thus, pathogenic factors strike the body suddenly, like those who fall or drown, where morning conditions are unpredictable and cannot be judged by standard timelines. If the pulse is absent or beats five to six times per breath, it indicates exhaustion of Zang Qi and impending death. Therefore, one does not need to wait for emaciation or the appearance of the Zang-Viscera Pulse as described in gradual decline. Zhong is pronounced with the departing tone. Cu is synonymous with cu (sudden). Xi is an error and should be hu (breath/exhalation).)
The True Liver Pulse arrives tense and urgent inside and out, feeling like tracing a knife edge—sharp and resonant—or pressing a zither string. The complexion is blue-white and dull. When hair breaks, death ensues. (The following sections describe the Zang-Viscera Pulses. The True Liver Pulse resembling a knife edge or zither string indicates a thin, urgent, firm, and forceful quality, distinct from the normal slight wiry pulse. Blue is the color of Wood; appearing white and dull indicates Metal overcoming Wood. All five Zang organs die when hair breaks because hair and skin are nourished by Blood and Qi; broken hair signifies the failure of Essence and Qi, hence death. The same applies below.)
The True Heart Pulse is firm and beating, feeling like tracing Coix seeds (Job's tears) clustered together. The complexion is red-black and dull. When hair breaks, death ensues. (Firm and beating, like tracing Coix seeds, indicates short, solid, strong, and hard qualities, distinct from the normal slight hook pulse; this is the True Heart Pulse. Red is the color of Fire; appearing black and dull indicates Water overcoming Fire, hence death. The meaning of hair breaking is as stated previously.)
The True Lung Pulse is large and empty, feeling like a feather brushing against human skin. The complexion is white-red and dull. When hair breaks, death ensues. (Large and empty, like a feather brushing skin, indicates extreme floating, void, and powerless qualities, distinct from the normal slight hairy pulse; this is the True Lung Pulse. White is the color of Metal; appearing red and dull indicates Fire overcoming Metal, hence death.)
The True Kidney Pulse is forceful yet seemingly severed, sounding like fingers striking stone—crackling. The complexion is black-yellow and dull. When hair breaks, death ensues. (Forceful yet seemingly severed indicates extreme forcefulness. Like fingers striking stone crackling, it is deep and hard. These are not the normal slight stone pulse but the True Kidney Pulse. Black is the color of Water; appearing yellow and dull indicates Earth overcoming Water, hence death.)
The True Spleen Pulse is weak and intermittently rapid and slow. The complexion is yellow-green and dull. When hair breaks, death ensues. (Weak and intermittently rapid and slow indicates a complete lack of harmony and slowness, distinct from the normal slight weak pulse; this is the True Spleen Pulse. Yellow is the color of Earth; appearing green and dull indicates Wood overcoming Earth, hence death.)
Whenever the Zang-Viscera Pulse appears, it is invariably fatal and untreatable. (A pulse without Stomach Qi is named the Zang-Viscera Pulse; all such pulses are untreatable.)
Huangdi asked: Why does seeing the Zang-Viscera Pulse mean death? Qibo replied: The Five Zang organs all derive Qi from the Stomach; the Stomach is the foundation of the Five Zang. (The Stomach is the sea of water and grain, nourishing the Five Zang organs, thus serving as their foundation.) Zang Qi cannot reach the Hand-Taiyin Lung Meridian on its own; it must rely on Stomach Qi to arrive at the Hand-Taiyin. (Food enters the Stomach and transmits to the Lungs; the Five Zang and Six Fu organs all receive Qi from it. Therefore, Zang Qi must rely on Stomach Qi to reach the Hand-Taiyin Lung Meridian, where the pulse manifests at the Qi Kou. This is why the pulses of the Five Zang organs must rely on Stomach Qi as their master.) Thus, each Zang organ expresses itself according to its season, manifesting at the Hand-Taiyin. (Expressing itself according to season, such as only showing a wiry pulse in Spring or only a hook pulse in Summer, indicates that the Zang organs do not rely on Stomach Qi; this is the appearance of the Zang-Viscera Pulse.) Therefore, when pathogenic factors prevail, essential Qi declines. In severe illness, Stomach Qi cannot accompany the pathogen to reach the Hand-Taiyin Lung Meridian; thus, the Qi of the Zang-Viscera appears alone. Its solitary appearance means the disease overcomes the Zang organs, hence death. Huangdi said: Excellent. (Whenever pathogenic factors are excessive and righteous Qi is exhausted, the disease overcomes the Zang. Thus, the evil of the Zang-Viscera appears alone. When the Zang-Viscera functions exclusively, Stomach Qi must be ruined, preventing it from reaching the Hand-Taiyin Lung Meridian with the pathogen. Consequently, Stomach Qi does not appear in the pulse, which is why this is a critical omen.)