（素问平人气象论）
岐伯曰∶脉从阴阳病易已，脉逆阴阳病难已。（素问平人气象论。阴病得阴脉，阳病得阳脉，谓之从，从者易已；脉
病相反者为逆，逆者难已。）脉得四时之顺，曰病无他；脉反四时及不间脏，曰难已。（春得弦，夏得钩，秋得毛，冬得
石，谓之顺四时，虽曰有病，无他虞也。脉反四时，义如下文，及不间脏，皆为难已。不间脏者，如木必乘土则肝病传
脾，土必乘水则脾病传肾之类，是皆传其所胜，不相假借，脉证得此，均名鬼贼，其气相残，为病必甚。若间其所胜之
脏而传其所生，是谓间脏，如肝不传脾而传心，心不传肺而传脾，其气相生，虽病亦微。故标本病传论曰，间者并行，
指间脏而言也；甚者独行，指不间脏而言也。五十三难曰∶七传者死，间脏者生。七传者，传其所胜也。间脏者，传其
所生也。皆此之谓。考之吕氏注五十三难曰∶间脏者，间其所胜之脏而相传也。心胜肺，脾间之；脾胜肾，肺间之；肺
胜肝，肾间之；肾胜心，肝间之；肝胜脾，心间之。此谓传其所生也。其说亦通。又玉机真藏论曰∶五脏有病，则各传
其所胜。不治，法三月若六月，若三日若六日，传五脏而当死，是顺传所胜之次。即此不间脏之义也。详藏象类二十四。
间，去声。）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。（逆，反也。从，顺也。凡脉之逆
从四时者，虽未有真脏之形见，若春夏以木火之令，脉当浮大而反见瘦小，秋冬以金水之令，脉当沉细而反见浮大者，
是皆逆四时也。）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。（风热者，阳邪
也，脉宜大而反静；泄而脱血，伤其阴也，脉宜虚而反实；病在脏中，脉当有力而反虚；病在肌表，脉当浮滑而反涩坚
者，皆为相反难治之证，亦犹脉之反四时也。）人以水谷为本，故人绝水谷则死，脉无胃气亦死。所谓无胃气者，但得真
脏脉，不得胃气也。所谓脉不得胃气者，肝不弦、肾不石也。（人生所赖者水谷，故胃气以水谷为本，而五脏又以胃气为
本。若脉无胃气，而真脏之脉独见者死，即前篇所谓但弦无胃、但石无胃之类是也。然但弦但石虽为真脏，若肝无气则
不弦，肾无气则不石，亦由五脏不得胃气而然，与真脏无胃者等耳。）
黄帝曰∶（素问玉机真藏论。）凡治病察其形气色泽，脉之盛衰，病之新故，乃治之无后其时。（察其形气色泽、脉之
盛衰、病之新故者，是即六十一难所谓望闻问切之法也。既得病情，盒饭速治，若后其时，病必日深，此切戒之词也。）
形气相得，谓之可治；（形盛气盛，形虚气虚，是相得也。）色泽以浮，谓之易已；（泽，润也。浮，明也。颜色明润者，
病必易已也。）脉从四时，谓之可治；（脉顺四时者，其气和，故可治。）脉弱以滑，是有胃气，命曰易治，取之以时。（谷
气来也徐而和，故脉弱以滑者，是得胃气，命曰易治也。）形气相失，谓之难治；（形盛气虚，气盛形虚，皆为相失。此
下四节，皆言难治也。）色夭不泽，谓之难已；（夭，晦恶也。不泽，枯焦也。）肺实以坚，谓之益甚；（邪气来也紧而疾，
故实以坚者，病必益甚。）脉逆四时，为不可治。（脉逆四时，义如下文。）必察四难而明告之。（形气色脉，如上四节之
难治者，谓之四难。必察其详而明告病家，欲其预知吉凶，庶无后怨。）所谓逆四时者，春得肺脉，夏得肾脉，秋得心脉，
冬得脾脉，其至皆悬绝沉涩者，命曰逆四时。（春得肺脉，金克木也。夏得肾脉，水克火也。秋得心脉，火克金也。冬得
脾脉，土克水也。加之悬绝沉涩，则阴阳偏绝，无复充和之胃气矣，是逆四时之脉也。）未有脏形，于春夏而脉沉涩，秋
冬而脉浮大，名曰逆四时也。病热脉静，泄而脉大，脱血而脉实，病在中脉实坚，病在外脉不实坚者，皆难治。（此节与
上文平人气象论者略同。盖言脉与时逆者为难治，脉与证逆者亦难治也。如病热脉静者，阳证得阴脉也。泄而脉大、脱
血而脉实者，正衰而邪进也。此义与前大同。惟病在中脉实坚、病在外脉不实坚者皆难治，与上文平人气象论者似乎相
反。但上文云病在中脉虚，言内积之实者，脉不宜虚也；此云病在中脉实坚，言内伤之虚者，脉不宜实坚也。前云病在
外脉涩坚，言外邪之盛者，不宜涩坚，以涩坚为沉阴也；此言病在外脉不实坚，言外邪方炽者，不宜无力，以不实坚为
无阳也。四者之分，总皆正不胜邪之脉，故曰难治。词若相反，理则实然，新校正以谓经误，特未达其妙耳。）
（《素问·平人气象论》）
岐伯说：脉象与阴阳属性相顺的，病容易痊愈；脉象与阴阳属性相逆的，病难以痊愈。（《素问·平人气象论》注：阴证出现阴脉，阳证出现阳脉，称为“从”，顺则易愈；脉象与病情相反的称为“逆”，逆则难愈。）脉象顺应四时变化规律的，称为病无他变；脉象违背四时规律及出现“不间脏”传变的，称为难愈。（春季脉弦，夏季脉钩，秋季脉毛，冬季脉石，这叫做顺应四时，即使说有病，也没有其他忧虑。脉象违背四时，含义见下文，以及“不间脏”，都属难愈。“不间脏”是指，如木必克土，则肝病传脾；土必克水，则脾病传肾之类，这都是传其所胜之脏，不相假借，脉证如此，均名为“鬼贼”，其气相互残害，为病必然严重。若间隔其所胜之脏而传其所生之脏，这叫“间脏”，如肝不传脾而传心，心不传肺而传脾，其气相生，虽有病也轻微。所以《标本病传论》说：“间者并行”，指间脏而言；“甚者独行”，指不间脏而言。《难经·五十三难》说：“七传者死，间脏者生。”七传，是传其所胜之脏。间脏，是传其所生之脏。都是这个意思。考察吕氏注解《难经·五十三难》说：“间脏者”，是间隔其所胜之脏而相传。心克肺，脾间隔其中；脾克肾，肺间隔其中；肺克肝，肾间隔其中；肾克心，肝间隔其中；肝克脾，心间隔其中。这叫做传其所生之脏。这种说法也通。又《玉机真藏论》说：“五脏有病，则各传其所胜。”如果不治疗，法度上是三个月或六个月，或者三天或六天，传遍五脏就会死亡，这是顺传所胜的顺序。即此“不间脏”的含义。详见《藏象类》二十四。间，读去声。）脉象有顺应或违背四时的情况，虽然尚未见到真脏脉的形态，但春夏季节脉象反而瘦小，秋冬季节脉象反而浮大，这叫做违背四时。（逆，是反的意思。从，是顺的意思。凡是脉象违背或顺应四时的，虽然还没有真脏脉形态出现，但如果春夏以木火当令，脉应当浮大而反而见瘦小；秋冬以金水当令，脉应当沉细而反而见浮大的，这些都是违背四时。）风热病而脉象静弱，泄泻脱血而脉象实大，病在体内而脉象虚软，病在体表而脉象涩坚的，都难治，这叫做违背四时。（风热，是阳邪，脉宜大反而静；泄泻脱血，损伤阴液，脉宜虚反而实；病在脏腑内部，脉当有力反而虚；病在肌表，脉当浮滑反而涩坚的，都是相反难治的证候，也如同脉象违背四时一样。）人以水谷为根本，所以人断绝水谷就会死亡，脉中无胃气也会死亡。所谓无胃气，就是只见到真脏脉，而没有胃气。所谓脉中没有胃气，就是肝脉不弦、肾脉不石。（人生存依赖水谷，所以胃气以水谷为本，而五脏又以胃气为本。如果脉中无胃气，而真脏脉单独出现的就会死，即前篇所说的“但弦无胃”、“但石无胃”之类。然而，仅见弦或仅见石虽为真脏，但如果肝无气则不显弦象，肾无气则不显石象，也是因为五脏得不到胃气所致，与真脏无胃的情况等同。）
黄帝说：（《素问·玉机真藏论》）凡治病要观察患者的形体、气息、色泽，脉象的盛衰，病情的新久，然后进行治疗，不要错过时机。（观察形体、气息、色泽、脉象盛衰、病情新久，这就是《难经·六十一难》所说的望、闻、问、切之法。既然了解了病情，就应当迅速治疗，如果延误时机，病情必定日益加深，这是切切的告诫之词。）形与气相协调，称为可治；（形盛气盛，形虚气虚，这是相协调。）色泽明润，称为易愈；（泽，是润泽的意思。浮，是明亮的意思。颜色明润的，病必容易痊愈。）脉象顺应四时，称为可治；（脉顺四时，说明气和，所以可治。）脉象弱而滑利，这是有胃气，称为易治，应把握时机治疗。（谷气到来徐缓平和，所以脉弱而滑利的，是得到胃气，称为易治。）形与气不相协调，称为难治；（形盛气虚，气盛形虚，都是不相协调。以下四节，都是讲难治的情况。）面色枯槁晦暗无光泽，称为难愈；（夭，是晦恶的意思。不泽，是枯焦的意思。）肺脉实而坚，称为病益加重；（邪气来势紧促急疾，所以实而坚的，病必更加严重。）脉象违背四时，为不可治。（脉违背四时，含义见下文。）必须仔细审查这四种难治的情况并明确告知患者。（形、气、色、脉，像上述四节所述的难治情况，称为“四难”。必须详细审查并明确告知病人家属，让他们预先知道吉凶，以免日后产生怨恨。）所谓违背四时，是指春季得肺脉，夏季得肾脉，秋季得心脉，冬季得脾脉，其脉搏皆悬绝沉涩的，叫做违背四时。（春季得肺脉，是金克木。夏季得肾脉，是水克火。秋季得心脉，是火克金。冬季得脾脉，是土克水。再加上悬绝沉涩，则阴阳偏绝，不再有充和的胃气，这就是违背四时的脉象。）尚未见到真脏脉形态，但在春夏季节脉象沉涩，秋冬季节脉象浮大，叫做违背四时。发热病而脉象静弱，泄泻而脉象大，脱血而脉象实，病在体内而脉象实坚，病在体外而脉象不实坚的，都难治。（这一节与上文《平人气象论》的内容大致相同。大概是说脉与时令相逆的为难治，脉与证候相逆的也难治。如发热病脉静，是阳证得阴脉。泄泻而脉大、脱血而脉实，是正气衰而邪气进。这个含义与前文大同。只有病在体内脉实坚、病在体外脉不实坚都难治，与上文《平人气象论》似乎相反。但上文说病在体内脉虚，是说内积之实证，脉不宜虚；这里说病在体内脉实坚，是说内伤之虚证，脉不宜实坚。前文说病在体外脉涩坚，是说外邪盛者，不宜涩坚，因为涩坚属沉阴；这里说病在体外脉不实坚，是说外邪正炽者，不宜无力，因为不实坚属无阳。这四种区分，总归都是正气不胜邪气的脉象，所以说难治。言辞看似相反，道理实则如此，新校正认为经文有误，只是未能通达其中的奥妙罢了。）
(Su Wen, Ping Ren Qi Xiang Lun)
Qibo said: When the pulse conforms to Yin and Yang, the disease is easy to cure; when the pulse contradicts Yin and Yang, the disease is difficult to cure. (Commentary on Su Wen, Ping Ren Qi Xiang Lun: A Yin syndrome presenting with a Yin pulse, or a Yang syndrome presenting with a Yang pulse, is called "Cong" (Following/Conforming), which indicates ease of recovery. When the pulse contradicts the condition, it is called "Ni" (Rebellious/Opposite), indicating difficulty in recovery.) When the pulse follows the regularity of the four seasons, it is said that there are no other complications; when the pulse rebels against the four seasons or involves "Jian Zang" (Intervening Viscera) transmission, it is said to be difficult to cure. (A wiry pulse in Spring, a hook-like pulse in Summer, a hairy pulse in Autumn, and a stone-like pulse in Winter are called conforming to the four seasons. Even if illness is present, there is no cause for concern. The meaning of rebelling against the four seasons is as described below. "Bu Jian Zang" (Not Intervening Viscera) also denotes difficulty in cure. "Bu Jian Zang" refers to situations such as Wood necessarily overcoming Earth, where Liver disease transmits to the Spleen; or Earth necessarily overcoming Water, where Spleen disease transmits to the Kidney. In these cases, the disease transmits to the organ it overcomes, without intercession. Such pulse and symptom patterns are named "Gui Zei" (Ghost Thieves), where the Qi mutually destroys each other, resulting in severe illness. If the disease transmits to the organ it generates by intervening through the organ it overcomes, this is called "Jian Zang". For example, the Liver does not transmit to the Spleen but to the Heart; the Heart does not transmit to the Lung but to the Spleen. Since their Qi generates each other, even if illness occurs, it is mild. Therefore, the *Biao Ben Bing Zhuan Lun* states: "For mild conditions, both paths operate together," referring to Jian Zang; "For severe conditions, only one path operates alone," referring to Bu Jian Zang. The *Nan Jing, Chapter 53* states: "Seven transmissions lead to death, intervening viscera lead to life." Seven transmissions refer to transmitting to the organ overcome. Intervening viscera refer to transmitting to the organ generated. All these refer to this principle. Examining Lu's commentary on *Nan Jing, Chapter 53*: "Jian Zang" means intervening through the overcome organ during transmission. Heart overcomes Lung, Spleen intervenes; Spleen overcomes Kidney, Lung intervenes; Lung overcomes Liver, Kidney intervenes; Kidney overcomes Heart, Liver intervenes; Liver overcomes Spleen, Heart intervenes. This is called transmitting to the organ generated. This explanation is also valid. Furthermore, the *Yu Ji Zhen Zang Lun* states: "When the five Zang organs are diseased, they each transmit to what they overcome." If untreated, according to standard rules, within three months or six months, or three days or six days, after transmitting through all five Zang organs, death ensues. This is the sequential transmission of overcoming, i.e., the meaning of "Bu Jian Zang". See detailed discussion in *Zang Xiang Lei*, Section 24. 'Jian' is pronounced with the departing tone.) There are pulses that rebel or conform to the four seasons. Even without the manifestation of true Zang pulses, if the pulse is thin/small in Spring and Summer, and floating/large in Autumn and Winter, this is called rebelling against the four seasons. ('Ni' means opposite/rebel. 'Cong' means following/conforming. Regarding pulses rebelling or conforming to the four seasons: although true Zang pulse forms have not yet appeared, if in Spring and Summer, when Wood and Fire commands prevail, the pulse should be floating and large but instead appears thin and small; or in Autumn and Winter, when Metal and Water commands prevail, the pulse should be deep and fine but instead appears floating and large—these are all rebellions against the four seasons.) Wind-heat presenting with a quiet pulse, diarrhea and blood loss presenting with a solid pulse, interior disease presenting with a deficient pulse, and exterior disease presenting with a choppy and firm pulse are all difficult to treat; this is called rebelling against the four seasons. (Wind-heat is a Yang pathogen; the pulse should be large but is instead quiet. Diarrhea and blood loss injure Yin; the pulse should be deficient but is instead solid. Disease in the interior Zang organs should present with a forceful pulse but is instead deficient. Disease in the muscle-surface should present with a floating and slippery pulse but is instead choppy and firm. These are all contradictory and difficult-to-treat syndromes, similar to pulses rebelling against the four seasons.) Humans rely on water and grain as their root; thus, humans die when cut off from water and grain, and death also occurs when the pulse lacks Stomach Qi. What is meant by lacking Stomach Qi is that only the true Zang pulse is obtained, without Stomach Qi. What is meant by the pulse lacking Stomach Qi is that the Liver pulse is not wiry and the Kidney pulse is not stone-like. (Human life depends on water and grain; therefore, Stomach Qi takes water and grain as its root, and the five Zang organs take Stomach Qi as their root. If the pulse lacks Stomach Qi and only the true Zang pulse appears alone, death results—this is like the previously mentioned "only wiry without Stomach Qi" or "only stone-like without Stomach Qi". However, although merely wiry or merely stone-like constitutes a true Zang pulse, if the Liver lacks Qi, it will not appear wiry; if the Kidney lacks Qi, it will not appear stone-like. This is also due to the five Zang organs failing to receive Stomach Qi, being equivalent to the state of true Zang pulses lacking Stomach Qi.)
Huangdi said: (Su Wen, Yu Ji Zhen Zang Lun) In treating any disease, one must observe the patient's form, Qi, color, and luster, the excess or deficiency of the pulse, and whether the disease is new or old, then proceed with treatment without delaying the appropriate time. (Observing form, Qi, color, luster, pulse excess/deficiency, and disease duration corresponds to the methods of inspection, auscultation/olfaction, inquiry, and palpation described in Nan Jing, Chapter 61. Once the condition is understood, treatment should be administered promptly. Delaying the timing will cause the disease to deepen daily; this is a stern warning.) When form and Qi are harmonious, it is called treatable. (Excessive form with excessive Qi, or deficient form with deficient Qi, indicates harmony.) When color and luster are bright and moist, it is called easily curable. ('Ze' means moist/lustrous. 'Fu' means bright/clear. Bright and lustrous complexion indicates the disease will likely resolve easily.) When the pulse conforms to the four seasons, it is called treatable. (Pulses conforming to the four seasons indicate harmonious Qi, hence treatable.) When the pulse is weak and slippery, it indicates the presence of Stomach Qi and is called easy to treat; treatment should be timed appropriately. (The arrival of Grain Qi is slow and harmonious; thus, a weak and slippery pulse indicates the acquisition of Stomach Qi, termed easy to treat.) When form and Qi are discordant, it is called difficult to treat. (Excessive form with deficient Qi, or excessive Qi with deficient form, both indicate discordance. The following four sections all discuss difficult-to-treat conditions.) When the complexion is dull, dark, and lacks luster, it is called difficult to cure. ('Yao' means dull and ugly. 'Bu Ze' means withered and scorched.) When the Lung pulse is full and firm, it indicates the disease is worsening. (The arrival of pathogenic Qi is tight and rapid; thus, a full and firm pulse indicates the disease will surely worsen.) When the pulse rebels against the four seasons, it is untreatable. (Meaning of rebelling against the four seasons is as described below.) One must carefully examine these four difficulties and clearly inform the patient. (The difficulties regarding form, Qi, color, and pulse as described in the previous four sections are called the "Four Difficulties." One must investigate them in detail and clearly advise the patient's family, allowing them to anticipate good or bad outcomes, thereby avoiding future resentment.) What is meant by rebelling against the four seasons is obtaining the Lung pulse in Spring, the Kidney pulse in Summer, the Heart pulse in Autumn, and the Spleen pulse in Winter, where the pulse beats are suspended, isolated, deep, and choppy; this is called rebelling against the four seasons. (Obtaining the Lung pulse in Spring represents Metal overcoming Wood. Obtaining the Kidney pulse in Summer represents Water overcoming Fire. Obtaining the Heart pulse in Autumn represents Fire overcoming Metal. Obtaining the Spleen pulse in Winter represents Earth overcoming Water. Added to the suspended, isolated, deep, and choppy qualities, this indicates extreme deviation of Yin and Yang, with no remaining harmonious Stomach Qi; this is the pulse rebelling against the four seasons.) Even without the manifestation of true Zang pulses, if the pulse is deep and choppy in Spring and Summer, and floating and large in Autumn and Winter, this is called rebelling against the four seasons. Fever presenting with a quiet pulse, diarrhea presenting with a large pulse, blood loss presenting with a solid pulse, interior disease presenting with a solid and firm pulse, and exterior disease presenting with a non-solid and non-firm pulse are all difficult to treat. (This section is slightly similar to the earlier text in Ping Ren Qi Xiang Lun. It implies that pulses rebelling against the season are difficult to treat, and pulses rebelling against the symptoms are also difficult to treat. For instance, fever with a quiet pulse indicates a Yang syndrome receiving a Yin pulse. Diarrhea with a large pulse or blood loss with a solid pulse indicates righteous Qi declining while pathogenic factors advance. This meaning is largely consistent with the previous text. The only difference is that interior disease with a solid/firm pulse and exterior disease with a non-solid/non-firm pulse are both considered difficult to treat, which seems contrary to the earlier Ping Ren Qi Xiang Lun. However, the earlier text stating "interior disease with a deficient pulse" refers to internal accumulation of excess pathogens, where a deficient pulse is inappropriate. Here, stating "interior disease with a solid/firm pulse" refers to internal injury causing deficiency, where a solid/firm pulse is inappropriate. The earlier text stating "exterior disease with a choppy/firm pulse" refers to abundant external pathogens, where a choppy/firm pulse is inappropriate because choppy/firm belongs to sinking Yin. Here, stating "exterior disease with a non-solid/non-firm pulse" refers to raging external pathogens, where weakness is inappropriate because non-solid/non-firm indicates lack of Yang. The distinction among these four cases collectively points to pulses where righteous Qi cannot overcome pathogenic factors, hence "difficult to treat." Although the wording seems contradictory, the underlying logic is consistent. The New Correction suggests an error in the classic text, but this fails to grasp the subtlety.)