是急虚卒至之脉，误矣。王本一息，按新校正云∶“人一息脉五六至，何得为死，息当为呼。”是也，今从之。）
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。真心脉至，坚而搏，如循
薏苡子累累然，色赤黑不泽，毛折，乃死。真肺脉至，大而虚，如以羽毛中人肤，色白赤不泽，毛折，乃死。
真肾脉至，搏而绝，如指弹石辟辟然，色黑黄不泽，毛折，乃死。真脾脉至，弱而乍数乍疏，色黄青不泽，毛
折，乃死。诸真脏脉见者，皆死不治也。（按∶杨上善云∶无余物和杂，故名真也。五脏之气，皆胃气和之，
不得独用。如至刚不得独用，独用则折，和柔用之即固也。如弦是肝脉、微弦为平和。所谓微弦者，谓二分胃气，
一分弦气也。若三分并是弦而无胃气，为真脏见也。余准此。杨说是矣，但以分数为喻，未免支离。所谓胃气
者，和缓也。弦而和缓，便是有胃气。若纯是弦急，是名真脏也。）
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，故五脏禀焉。）脏气者不能自致于手太阴，必因于胃气乃至于手
太阴也。（按∶手太阴者，手太渊，寸关尺也。人非水谷不生活，故五脏必资胃气以为养，水谷之气行，而后
五脏之得失，变见于寸口矣。甲乙经曰∶“人以胃气为本，脉亦以胃气为本。”是也。）故五脏各以其时自为
而至于手太阴也。（按∶五脏分主四时，苟得胃气，则合于时而顺脉见，苟失胃气，则逆于时而死脉出也。）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！（按∶邪气胜故病甚，病甚则水谷不入于胃，而脉自无和缓之气，于是贼邪之形独见而为但代矣。）
帝曰∶凡治病，察其形气色泽，脉之盛衰，病之新故，乃治之无后其时。（必欲先时而取之。）形气相得，
谓之可治。（气盛形盛，气虚形虚，是相得也。）色泽以浮，谓之易已。（……气色浮润，气血相营，故易已。）
脉弱以滑，是有胃气，命曰易治，取之以时……。（候可取之时而取之，则万举万全。按∶此弱滑二字是好字
面，弱者无强急之形，滑者无枯涩之意也。）脉实以坚，谓之益甚。（按∶实坚者，强硬而无柔和之气也。
纯阳无阴，其病必日进矣。）脉逆四时，谓不可治。……所谓逆四时者，……春夏而脉沉涩，秋冬而脉浮大，
命曰逆四时也。（按∶此言脉与时反也。）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。（按∶此言脉与证相反也。但病在中二句，与平人气象论不同。彼云病在中脉虚，谓内有
实积而脉反虚。此则言原本已虚，而脉反强盛也。彼云病在外脉涩坚，谓邪盛脉不宜沉涩。此则言邪在表，脉不
当无力也。其言虽殊，总是虚实相反之意。新校正反以为误，则真误矣。）
黄帝曰∶余闻虚实以决死生，愿闻其情。岐伯曰∶五实死，五虚死。帝曰∶愿闻五实五虚。岐伯曰∶脉盛，
皮热，腹胀，前后不通，闷瞀，此谓五实。（实谓邪气盛实。然脉盛，心也；皮热，肺也；腹胀，脾也；前后
不通，肾也；闷瞀，肝也。）脉细，皮寒，气少，泄利前后，饮食不入，此谓五虚。虚谓真气不足也。然脉细，
心也；皮寒，肺也；气少，肝也；泄利前后，肾也；饮食不入，脾也。帝曰∶其时有生者何也？岐伯曰∶浆
粥入胃，泄注止，则虚者活；身汗得后利，则实者活。此其候也。（按∶虚者所宝在元气，实者所恶在贼邪
故也。）
这就是那种因极度虚弱而突然发作的脉象，（如果将其判断为死脉）是错误的。王冰注本中作“一息”，根据新校正的注释说：“人每一呼吸脉搏跳动五六次，怎么能说是死脉呢？‘息’字应当解释为‘呼’。”这是正确的，现在采纳这个说法。）
真肝脉出现时，脉象中外皆急，如同触摸刀刃那样锐利扎手，又像按压琴瑟的弦一样紧绷，面色青白而无光泽，毫毛枯折，这是死证。真心脉出现时，脉象坚硬且搏指，如同触摸薏苡子那样颗粒累累、坚硬不移，面色赤黑而无光泽，毫毛枯折，这是死证。真肺脉出现时，脉象大而虚浮，如同羽毛轻中人肤，面色白赤而无光泽，毫毛枯折，这是死证。真肾脉出现时，脉象搏动有力但断续欲绝，如同手指弹石那样辟辟作响、坚硬无柔，面色黑黄而无光泽，毫毛枯折，这是死证。真脾脉出现时，脉象微弱且忽快忽慢，面色黄青而无光泽，毫毛枯折，这是死证。凡是真脏脉显现的，都是死证，无法治疗。（按：杨上善说：“没有其余杂气混杂，所以称为‘真’。五脏之气，都必须依赖胃气的调和才能发挥作用，不能单独使用。就像刚强之气不能单独使用，单独使用就会折断，若能柔和地运用它就能稳固。比如弦脉是肝脉，微带弦意则是平和之脉。所谓微弦，是指二分胃气，一分弦气。如果三分全是弦气而没有胃气，就是真脏脉显现了。其余脏腑以此类推。杨上的说法是正确的，但用分数来比喻，未免有些支离破碎。所谓的胃气，就是和缓之意。弦而兼有和缓，就是有胃气。如果纯粹是弦急，就称为真脏脉了。）
黄帝说：“见到真脏脉就说会死，为什么呢？”岐伯说：“五脏都禀受于胃气，胃是五脏的根本。（胃是水谷之海，所以五脏都依赖它滋养。）脏气本身不能独自到达手太阴肺经的寸口脉，必须借助胃气的作用才能到达手太阴。（按：手太阴指的是手太渊穴处的寸、关、尺三部。人没有水谷精微就不能生存，所以五脏必须依靠胃气来供养，水谷之气运行后，五脏的得失变化才会反映在寸口脉上。《甲乙经》说：“人以胃气为本，脉也以胃气为本。”这是对的。）所以五脏各自在其所主的时令季节，带着胃气反映到手太阴脉上。（按：五脏分别主管四季，如果有胃气，则顺应时令而见顺脉；如果失去胃气，则违背时令而见死脉。）所以邪气盛行的时候，精气必然衰败。因此病情严重的患者，胃气不能随同脏气一起到达手太阴脉，所以真脏之气单独显露。单独显露，说明病邪战胜了脏气，所以说会死。
黄帝说：“好！（按：因为邪气盛所以病重，病重则水谷不能进入胃中，于是脉象自然失去了和缓之气，此时贼邪的形状单独显现，表现为但代脉而无胃气。）”
黄帝说：“大凡治病，要观察患者的形体与气息、色泽，脉象的盛衰，疾病的久暂，然后进行治疗，不要错过时机。（一定要在疾病可治之前采取措施。）形体与气息相协调，叫做可治。（气盛形盛，气虚形虚，这叫相得。）色泽明润浮泽，叫做容易痊愈。（……气色浮润，气血相互营卫，所以容易痊愈。）脉象弱而滑利，这是有胃气的表现，命名为易治，要在合适的时机施治……。（等待可以治疗的时机而施治，就能万举万全。按：这里的‘弱’和‘滑’二字是好字眼，弱是指没有强急之形，滑是指没有枯涩之意。）脉象实而坚劲，叫做病情加重。（按：实坚是指强硬而没有柔和之气。纯阳无阴，病情必定日益进展。）脉象违背四时规律，叫做不可治。……所谓违背四时，是指……春夏季节脉象反而沉涩，秋冬季节脉象反而浮大，这叫做逆四时。（按：这是说脉象与时令相反。）患热病而脉象静迟；患泄泻而脉象盛大；失血过多而脉象坚实；病位在里而脉象实坚；病位在表而脉象不实不坚的。都属于难治。（按：这是说脉象与证候相反。但关于‘病在中’这两句，与《平人气象论》不同。那篇说病在里脉应虚，是指内有实积而脉反虚。这里说的是原本已虚，而脉反强盛。那篇说病在表脉应涩坚，是指邪盛脉不应沉涩。这里说的是邪在表，脉不应无力。虽然说法不同，总之都是虚实相反的意旨。新校正反而认为是误文，那才是真的错了。）”
黄帝说：“我听说通过虚实来判断死生，希望听听其中的详情。”岐伯说：“五实死，五虚死。”黄帝说：“希望听听什么是五实五虚。”岐伯说：“脉象盛大，皮肤发热，腹部胀满，大小便不通，胸闷目眩，这叫做五实。（实是指邪气盛实。其中脉盛对应心；皮热对应肺；腹胀对应脾；前后不通对应肾；闷瞀对应肝。）脉象细微，皮肤发冷，气短少言，大小便泄利不止，饮食不能入口，这叫做五虚。虚是指真气不足。其中脉细对应心；皮寒对应肺；气少对应肝；泄利前后对应肾；饮食不入对应脾。”黄帝说：“这些情况中有时能存活，为什么呢？”岐伯说：“如果能喝进浆粥，泄泻停止，那么虚证患者就能活；如果身体出汗，二便通利，那么实证患者就能活。这就是判断存活的征象。（按：虚证患者宝贵的是元气，实证患者厌恶的是贼邪，所以如此。）”
This refers to the pulse of sudden onset due to extreme deficiency, and judging it as a death pulse is incorrect. Wang Bing's edition states "one breath," but according to the New Corrections (Xin Zheng), "If a person's pulse beats five or six times per breath, how can it be considered a death pulse? The character 'xi' (breath) should be interpreted as 'hu' (exhalation)." This is correct, and we adopt this interpretation here.)
When the True Liver Pulse appears, the pulse is tense both internally and externally, sharp like touching a blade, or tight like pressing the string of a qin or se; the complexion is blue-white without luster, and the body hair withers and breaks—this indicates death. When the True Heart Pulse appears, the pulse is hard and pounding, granular like rolling Yi Yi Zi (Coicis Semen, Job's tears); the complexion is red-black without luster, and the body hair withers and breaks—this indicates death. When the True Lung Pulse appears, the pulse is large and empty, light like a feather brushing against the skin; the complexion is white-red without luster, and the body hair withers and breaks—this indicates death. When the True Kidney Pulse appears, the pulse is forceful yet intermittent, sounding like fingers snapping on stone (pi pi sound); the complexion is black-yellow without luster, and the body hair withers and breaks—this indicates death. When the True Spleen Pulse appears, the pulse is weak and irregular, alternating between rapid and slow; the complexion is yellow-green without luster, and the body hair withers and breaks—this indicates death. Whenever any of the True Zang Pulses manifest, the condition is fatal and untreatable. (Note: Yang Shangshan stated, "Because there are no other mixed energies, it is called 'True.' The Qi of the Five Zang organs relies on Stomach Qi for harmony and cannot function independently. Just as rigid energy cannot function alone—if used exclusively, it breaks; if used harmoniously, it stabilizes. For instance, the Xian (Wiry) pulse belongs to the Liver; a slight wiriness indicates health. 'Slight wiriness' means two parts Stomach Qi and one part Wiry Qi. If all three parts are purely Wiry without Stomach Qi, it is the manifestation of the True Zang. The rest follow this logic. Yang's explanation is correct, though using fractions as a metaphor is somewhat fragmented. What is meant by Stomach Qi is gentleness and moderation. A Wiry pulse that is also gentle possesses Stomach Qi. If it is purely Wiry and urgent, it is named the True Zang pulse.)
The Yellow Emperor asked, "Seeing the True Zang Pulse indicates death; why is this?" Qi Bo replied, "The Five Zang organs all derive their Qi from the Stomach; the Stomach is the root of the Five Zang. (The Stomach is the Sea of Water and Grain, thus the Five Zang rely on it.) The Qi of the Zang organs cannot reach the Hand-Taiyin (Lung Meridian) on its own; it must arrive via the assistance of Stomach Qi. (Note: Hand-Taiyin refers to the Cun, Guan, and Chi positions at the Shou Taiyuan acupoint. Humans cannot survive without water and grain; thus, the Five Zang must rely on Stomach Qi for nourishment. Only when the Qi of water and grain circulates do the conditions of the Five Zang become visible at the Cun Kou pulse. The *Jia Yi Jing* states, 'Humans take Stomach Qi as their root, and pulses also take Stomach Qi as their root.' This is correct.) Therefore, each of the Five Zang manifests at its respective season, carrying Stomach Qi to the Hand-Taiyin. (Note: Each Zang governs a specific season. If Stomach Qi is present, the pulse conforms to the season and appears smooth; if Stomach Qi is lost, the pulse contradicts the season and appears as a death pulse.) Thus, when pathogenic factors prevail, Essence-Qi declines. In severe illness, Stomach Qi cannot accompany the Zang Qi to the Hand-Taiyin, so the True Zang Qi appears alone. Its solitary appearance means disease has overcome the Zang, hence death is declared.
The Yellow Emperor said, "Excellent! (Note: Because pathogenic factors prevail, the disease is severe; when severe, food and drink do not enter the Stomach, and the pulse naturally loses its gentle quality. At this point, the form of the thief-pathogen appears alone, presenting as a Dai [intermittent] pulse without Stomach Qi.)"
The Yellow Emperor said, "In treating diseases, one must observe the patient's form and Qi, color and luster, the excess or deficiency of the pulse, and whether the disease is new or old, then treat accordingly without missing the timing. (One must intervene before the disease becomes incurable.) If form and Qi are in harmony, it is called treatable. (Excess Qi with excess form, or deficient Qi with deficient form, constitutes harmony.) If the color and luster are floating and moist, it is called easily curable. (...Floating and moist color and luster indicate that Qi and Blood are mutually nourishing, hence easy to cure.) If the pulse is weak and slippery, this indicates the presence of Stomach Qi, designated as easy to treat; treatment should be applied at the appropriate time... (Waiting for the right moment to treat ensures success. Note: The terms 'weak' and 'slippery' here are favorable indicators. 'Weak' implies no rigidity or urgency; 'slippery' implies no dryness or roughness.) If the pulse is excess and firm, it indicates worsening condition. (Note: Excess and firm imply rigidity without gentleness. Pure Yang without Yin suggests the disease will progress daily.) If the pulse contradicts the Four Seasons, it is called untreatable.... Specifically, contradicting the Four Seasons refers to... sinking and choppy pulses in Spring and Summer, or floating and large pulses in Autumn and Winter; this is called contradicting the Four Seasons. (Note: This describes pulses opposite to the seasonal norms.) Heat disease with a quiet pulse; diarrhea with a large pulse; hemorrhage with an excess pulse; interior disease with an excess/firm pulse; exterior disease with a non-excess/non-firm pulse. All these are difficult to treat. (Note: This describes pulses contrary to symptoms. Regarding the two sentences about 'disease in the interior,' they differ from the *Ping Ren Qi Xiang Lun*. That text says interior disease should have a deficient pulse, implying internal excess with a falsely deficient pulse. Here, it refers to original deficiency with a falsely strong pulse. That text says exterior disease should have a choppy/firm pulse, implying external pathogen with an inappropriately choppy pulse. Here, it means external pathogen should not have a weak pulse. Although the wording differs, both convey the principle of contradiction between excess and deficiency. The New Corrections mistakenly labeled this as an error, which itself is the true error.)"
The Yellow Emperor said, "I have heard that excess and deficiency determine life and death; I wish to hear the details." Qi Bo said, "Five Excesses lead to death; Five Deficiencies lead to death." The Yellow Emperor said, "I wish to hear what the Five Excesses and Five Deficiencies are." Qi Bo said, "Pulse is surging, skin is hot, abdomen is distended, urination and defecation are obstructed, chest fullness and dizziness occur; this is called Five Excesses. (Excess refers to flourishing pathogenic factors. Among them, surging pulse corresponds to the Heart; hot skin to the Lung; abdominal distension to the Spleen; obstruction of front and back to the Kidney; chest fullness and dizziness to the Liver.) Pulse is fine/thin, skin is cold, Qi is scant, anterior and posterior passages leak/flow freely, food and drink are not taken in; this is called Five Deficiencies. Deficiency refers to insufficiency of True Qi. Among them, fine pulse corresponds to the Heart; cold skin to the Lung; scant Qi to the Liver; leakage of front and back to the Kidney; inability to eat to the Spleen." The Yellow Emperor said, "Under what circumstances can survival occur?" Qi Bo said, "If fermented grain liquid enters the Stomach and dysentery/diarrhea stops, the deficient patient lives; if sweat is produced and bowels/bladder open, the excess patient lives. These are the prognostic signs. (Note: For deficient patients, what is precious is Yuan Qi; for excess patients, what is dreaded is thief-pathogens, hence this distinction.)"