之脉。贯肾系舌本。善言者。胞气泄也。驷见而陨霜。九月之候也。九月万物尽衰。则气去阳而之阴。应收藏之气。
而反泄于外。故死。胞主藏精血。故曰精予不足。）脉至如交漆。交漆者。左右旁至也。微见三十日死。（此承上文而
言冲任之脉绝也。冲任起于胞中。循腹上行。为经血之海。胞精不足。冲任将绝矣。交、绞也。如绞漆之左右旁流。无
中通一贯之象。是循中而上之冲任绝矣。精血为阴。故至三十日而死。三十日者。月之终也。兆璜曰。冲任为经脉之
原。故亦曰微见。吴氏曰。微见。始见也。）脉至如涌泉。浮鼓肌中。太阳气予不足也。少气味。韭英而死。（至如涌泉。
来盛而不返也。浮鼓肌中。无根外脱之象也。太阳者。巨阳也。为诸阳主气。而生于膀胱之水中。是以标阳而本寒。夫
水为阴。火为阳。阳为气。阴为味。少气味者。少阳之标本皆虚也。盖言太阳之气不足。而水府未虚。阳生于阴。尚有
根而可复。如标本皆少。不免于死亡矣。韭乃肝之菜。至春而英。韭英之时。更疏泄其本气则死矣。兆璜曰。太阳为
诸阳主气。故六气之中。独举太阳。冲任为经血之海。皆起于胞中。故六腑之中。特提胞脉。膀胱者。胞之室也。）脉
至如颓土之状。按之不得。是肌气予不足也。五色先见黑。白垒发死。（颓土、倾颓之顽土也。脾主肌肉。如颓土而按之
不得者。无来去上下之象。是肌气受所予之不足也。土位中央。而分王于四季。当五色具见而先主黄。若五色之中而先
见黑。是土败而水气乘之矣。马氏曰。垒作 。葛之属也。葛色白而发于春。白 发时。木气旺而颓土之气绝矣。）脉至
如悬壅。悬壅者浮揣。切之益大。是十二俞之予不足也。水凝而死。（悬壅者。如悬痈也。揣、度也。先轻浮而度之。再
重按而切之。其本益大。有如痈之头小而本大。此脏腑十二俞。气之不足也。夫经俞之气。昼夜环转。俞予之不足。是
以脉壅滞而有如痈之象也。天寒地冻。则经水凝泣。壅滞之脉。再为凝泣。绝无生动之机矣。）脉至如偃刀。偃刀者。浮
之小急。按之坚大急。五脏菀热寒热。独并于肾也。如此其人不得坐。立春而死。（菀音郁。偃、仰也。脉如仰起之刀口。
利锐而背坚浓。是以浮之小急。而按之坚大也。夫五脏相通。精气各循序而传予之。肾为水脏。又独受五脏之精而藏之。
是以传与之外。而又有邪气独并于肾之奇病也。有如此之脉病者。其人当至立春而死。按灵枢经曰。肾是动病喝喝而喘。
坐而欲起。其人不得坐者。肾气伤也。冬令闭藏。以奉春生之气。肾气已伤。再至春而泄之。肾气绝矣。张兆璜曰。
菀热、久郁之气。寒热、新积之邪。盖久则寒亦化热。故曰菀热。按此与病能之义。大略相同。病能篇论五脏之邪气。
循序相传。此论五脏之寒热。独并于肾。盖精气之有传有并。而邪亦随之。此论气予不足中。突提邪并一节。经义微妙。
学人大宜体会。张应略曰。因精气之传予。故邪亦从而传之。因肾藏五脏之精。故寒热亦独并于肾。）脉至如丸。滑不
直手。不直手者。按之不可得也。是大肠气予不足也。枣叶生而死。（直值同。如丸滑而不值手者。圆活流利。似于无形。
故按之不可得也。大肠为肺之府而属庚金。其脉宜 弱轻浮。气予不足。故脉至若此。枣叶生于夏。火旺则金铄矣。）脉
至如华者。令人善恐。不欲坐卧。行立常听。是小肠气予不足也。季秋而死。（脉至如华者。如华之轻微也。小肠为心之
府。而属丙火。其脉当来盛。反如华者。气予不足也。腑气不足。则脏气亦虚。神虚则恐惧自失。神志不宁。故坐卧不
安也。小肠之脉。入耳中属听宫。常有所听者。如耳作蝉鸣。或如钟磬声。皆虚证也。遇金水生旺之时而死。下经曰。
诊合微之事。通阴阳之变。章五中之情。定五度之事。如此乃足以诊。夫五中之情。决奇恒之病也。五度之事。度奇恒
之脉也。本篇先论奇恒之病。后论奇恒之脉。与经常之脉证。大不相同。故曰大奇论。兆璜曰。大奇脉解二篇。皆无君
臣问答之辞。而曰论曰解者。乃伯承上章解论奇恒之脉病也。）
脉象表现为……（原文此处有缺漏，结合上下文推测为前文所述之脉），其脉气贯通肾脏并联系舌根。患者能多言善语，这是胞宫之气外泄的表现。（若出现）驷星显现而天降霜冻，这是九月的时令特征。九月时万物凋零衰败，人体之气也应从阳分转向阴分，顺应收藏的生理规律。如果反而将气泄散于体表之外，就会导致死亡。因为胞宫主要功能是贮藏精血，所以说这是精气供给不足。）
脉象到来时像交错的漆液（形容血流左右旁流，中间不通）。所谓“交漆”，是指血液向左右两侧旁流。如果这种脉象轻微出现，三十天后会死亡。（这段文字承接上文，论述冲脉和任脉断绝的情况。冲脉和任脉都起于胞中，沿着腹部上行，被称为“经血之海”。如果胞中的精气不足，冲脉和任脉也就将要断绝了。“交”意为绞结，“如交漆”就像绞漆一样向左右旁侧流淌，没有中间贯通的气象，这说明沿中线向上的冲脉和任脉已经断绝了。精血属于阴类，所以会在三十天后死亡。三十天是一个月的终结。兆璜说：冲脉和任脉是经脉的根本，所以也称为“微见”。吴氏说：“微见”意思是刚开始出现。）
脉象到来时像涌出的泉水，浮取时在肌肉中搏动有力，但缺乏根基。这是太阳经气供给不足的表现。如果少阳经的标本之气也都虚弱，患者会在韭菜开花时死亡。（脉象像涌泉，指脉搏来势盛壮而不能回返。浮取在肌肉中搏动，是无根且向外脱逸的征象。太阳经即巨阳经，是诸阳经的主气，它生于膀胱的水之中，因此表现为标阳而本寒。水属阴，火属阳，阳代表气，阴代表味。“少气味”是指少阳经的标本之气都虚损。这里的意思是说，虽然太阳经气不足，但如果膀胱（水府）尚未虚损，阳气生于阴中，还有根基可以恢复；如果标本之气都微弱，就难免死亡。韭菜是肝类的蔬菜，到春天抽苔开花。在韭菜开花的时候，如果进一步疏泄根本之气，人就会死亡。兆璜说：太阳经是诸阳经的主气，所以在六气之中单独提及太阳。冲脉和任脉是经血之海，都起于胞中，所以在六腑之中特别提出胞脉。膀胱是胞宫的居室。）
脉象到来时像倾倒的泥土，按下去感觉不到脉形。这是肌气供给不足的表现。如果面色先出现黑色，等到葛藤开花时就会死亡。（“颓土”是指倾颓的顽土。脾主肌肉，脉象像颓土一样按之不得，是没有来去上下起伏的征象，说明肌气受到供给不足的影响。土位居中，在四季中分别旺盛，对应五色应当先见黄色为主。如果在五色之中先见到黑色，说明土气败坏，被水气所乘。马氏说：“垒”通“藟”，是葛这类植物。葛色白而在春天开花，当白色的葛花开放时，木气旺盛而颓土之气就断绝了。）
脉象到来时像悬挂的痈肿，这种脉象轻取浮揣，重按切之反而更大。这是十二俞穴之气供给不足的表现，患者会在天气寒冷、水凝结时死亡。（“悬壅”就像悬挂的痈肿。“揣”是度量之意。先轻轻浮取度量，再重按切诊，发现其根部反而更大，就像痈肿头小底大。这是脏腑十二俞穴之气不足。经俞之气昼夜循环运转，如果俞穴之气供给不足，就会导致脉气壅滞，呈现出类似痈肿的脉象。天寒地冻时，经脉中的血液凝涩，原本壅滞的脉象再加上凝涩，就完全没有生机的迹象了。）
脉象到来时像仰放的刀口。所谓“偃刀”，是指轻取时脉象细小紧急，重按时脉象坚实大而紧急。这是五脏郁热与寒热邪气独自并聚于肾的表现。患有这种脉病的人不能久坐，会在立春时死亡。（“菀”音同“郁”。“偃”意为仰卧或仰起。脉象像仰起的刀口，锋利尖锐而背面坚硬浓厚，所以轻取时细小紧急，重按时坚实大而紧急。五脏之间是相通的，精气各自按照顺序传注。肾是水脏，又单独承受并贮藏五脏的精气。因此在正常的传注之外，又有邪气独自并聚于肾的这种奇病。有这种脉象和病症的人，应当在立春时死亡。根据《灵枢经》记载，肾经发生病变会出现气喘、坐起困难的症状。这个人不能久坐，是因为肾气受伤。冬季主闭藏，以奉养春季生发的之气。如果肾气已经受伤，到了春季再次泄散，肾气就会断绝。张兆璜说：“菀热”是久郁之气，“寒热”是新积之邪。大概时间久了寒气也会化热，所以叫“菀热”。按此内容与《病能篇》的意义大致相同。《病能篇》论述五脏的邪气循序相传，本篇论述五脏的寒热邪气独自并聚于肾。大概是精气有传注也有并聚，邪气也随之变化。本篇在论述气供给不足的同时，突然提到邪气并聚这一节，经文意义微妙，学习的人应当仔细体会。张应略说：因为精气的传注，所以邪气也跟随传注；因为肾贮藏五脏的精气，所以寒热邪气也独自并聚于肾。）
脉象到来时像圆滑的丸子，滑动而不直应手下。所谓“不直手”，是指按下去摸不到脉形。这是大肠气供给不足的表现，患者会在枣叶生长时死亡。（“直”通“值”，意为接触。像丸子一样滑利而不直触手下，是因为脉象圆活流利，似乎无形，所以按下去摸不到。大肠是肺的腑，属于庚金，其脉象应当微弱轻浮。现在气供给不足，所以脉象呈现这种情况。枣叶在夏天生长，此时火气旺盛则金气被销烁。）
脉象到来时像花朵一样轻微，使人容易恐惧，不想坐卧，站立行走时常像是在听声音。这是小肠气供给不足的表现，患者会在季秋（九月）时死亡。（脉象像花朵一样轻微。小肠是心的腑，属于丙火，其脉象应当来势盛壮。现在反而像花朵一样轻微，说明气供给不足。腑气不足，脏气也会虚弱。神志虚弱则恐惧自失，神志不宁，所以坐卧不安。小肠的经脉进入耳中，归属于听宫穴。经常感觉到有声音，像是蝉鸣，或者像钟磬声，这都是虚证的表現。遇到金水之气旺盛的时节就会死亡。下经说：诊断要综合细微的事情，通晓阴阳的变化，阐明五中的情状，确定五度的事务。只有这样才足以进行诊断。所谓“五中的情状”，是用来决断奇恒之病的；“五度的事务”，是用来度量奇恒之脉的。本篇先论述奇恒之病，后论述奇恒之脉，这与常规的脉证大不相同，所以称为《大奇论》。兆璜说：《大奇脉解》两篇都没有君臣问答的言辞，却称为“论”和“解”，这是因为伯高承接上一章，解释关于奇恒之脉病的道理。）
The pulse... (text missing here, inferred from context as the previously described pulse) penetrates the Kidney and connects to the root of the tongue. The patient speaks excessively; this indicates the leakage of Qi from the Bao (Uterus/Womb). (If the Si stars appear and frost falls), this is the sign of the ninth month. In the ninth month, all things wither and decline; thus, Qi should depart from Yang and enter Yin, aligning with the energy of storage and conservation. If instead it leaks outward, death ensues. The Bao is responsible for storing essence and blood; therefore, it is said that there is a deficiency in the supply of essence.)
The pulse arrives like interlaced lacquer. "Interlaced lacquer" refers to flow towards the left and right sides. If this pulse appears faintly, death will occur within thirty days. (This continues the discussion above regarding the severance of the Chong and Ren vessels. The Chong and Ren vessels originate in the Bao, ascend along the abdomen, and are known as the "Sea of Blood and Menses." If the essence of the Bao is insufficient, the Chong and Ren vessels are on the verge of severance. "Jiao" means intertwined. Like lacquer being wrung out, flowing laterally without a central connection, this indicates that the Chong and Ren vessels ascending along the midline have severed. Essence and blood belong to Yin; therefore, death occurs in thirty days. Thirty days marks the end of a lunar cycle. Zhao Huang states: The Chong and Ren vessels are the origin of the meridians, hence they are also referred to as "Wei Jian" (faintly seen). Wu states: "Wei Jian" means initially appearing.)
The pulse arrives like a gushing spring, beating forcefully at the muscle level upon superficial palpation, indicating a lack of root and external detachment. This signifies a deficiency in the supply of Taiyang (Greater Yang) Qi. If the Biao-Ben (Surface-Root) of Shaoyang (Lesser Yang) are both deficient, death will occur when leeks flower. (Arriving like a gushing spring implies the pulse comes vigorously but does not return. Beating at the muscle level reflects a rootless, externally detaching image. Taiyang, or Juyang, is the master Qi of all Yang meridians, originating from the water in the Bladder. Thus, its manifestation is Yang on the surface but Cold at the root. Water is Yin, Fire is Yang; Yang represents Qi, and Yin represents Flavor/Substance. "Shao Qi Wei" (Little Qi and Flavor) indicates that both the Surface and Root of Shaoyang are deficient. This means that although Taiyang Qi is insufficient, if the Water Mansion (Bladder) is not yet empty, Yang born from Yin still has a root and can recover. If both Surface and Root are weak, death is inevitable. Leeks are vegetables associated with the Liver and flower in spring. At the time of leek flowering, if the root Qi is further dispersed, death will occur. Zhao Huang states: Taiyang is the master Qi of all Yang meridians, so among the Six Qi, only Taiyang is highlighted. The Chong and Ren are the Sea of Blood and Menses, originating in the Bao, so among the Fu organs, the Bao vessel is specifically mentioned. The Bladder is the chamber of the Bao.)
The pulse arrives like collapsed earth; it cannot be felt upon pressure. This indicates a deficiency in the supply of Muscle Qi. If black color appears on the face first, death will occur when kudzu flowers. ("Tuí Tu" refers to crumbling, stubborn earth. The Spleen governs the muscles. A pulse like collapsing earth that cannot be felt lacks the imagery of rising and falling, indicating that Muscle Qi suffers from insufficient supply. Earth resides in the center and dominates the four seasons; corresponding to the Five Colors, Yellow should predominate. If Black appears first among the colors, it indicates that Earth is failing and Water Qi is overacting. Ma states: "Lei" is interchangeable with "Lü," referring to plants like kudzu. Kudzu is white and flowers in spring. When white kudzu flowers bloom, Wood Qi is prosperous, and the Qi of collapsing earth is extinguished.)
The pulse arrives like a suspended abscess. A "suspended abscess" feels floating upon light palpation but becomes larger upon firm pressing. This indicates a deficiency in the supply of Qi to the Twelve Shu points. Death will occur when water freezes. ("Xuan Yong" resembles a hanging abscess. "Chuai" means to measure. First, lightly palpate to measure; then press firmly. The base becomes larger, resembling an abscess with a small head and large base. This reflects insufficiency of Qi in the Twelve Shu points of the Zang-Fu organs. The Qi of the meridian Shu points circulates day and night. Deficiency in the supply to the Shu points causes Qi stagnation, creating a pulse image similar to an abscess. When heaven is cold and earth frozen, meridian water condenses and flows sluggishly. The stagnant pulse, combined with condensation, loses all vitality.)
The pulse arrives like an inverted knife. "Yan Dao" (Inverted Knife) means that upon superficial palpation, the pulse is small and urgent, while upon deep palpation, it is firm, large, and urgent. This indicates that Heat from Stagnation and Cold-Heat pathogens have uniquely combined in the Kidney. Such a person cannot sit upright and will die at Lichun (Start of Spring). ("Wen" sounds like "Yu." "Yan" means supine or inclined upward. The pulse resembles the edge of an upward-facing knife: sharp and acute, with a thick back. Hence, superficial palpation yields a small, urgent pulse, while deep palpation yields a firm, large, urgent pulse. The Five Zang organs are interconnected; Jing-Essence transmits sequentially. The Kidney is a Water organ and uniquely stores the essence of the Five Zang. Thus, beyond normal transmission, there is a peculiar disease where pathogenic Qi uniquely combines in the Kidney. Patients with such pulse and disease will die at Lichun. According to the *Ling Shu*, when the Kidney channel is affected, one gasps and wheezes, desiring to rise from sitting. Inability to sit indicates Kidney Qi injury. Winter governs closure to support Spring generation. If Kidney Qi is already injured and further dispersed in Spring, Kidney Qi will be exhausted. Zhang Zhaohuang states: "Wen Re" is long-stagnated Qi; "Han Re" is newly accumulated pathogen. Generally, long-standing Cold transforms into Heat, hence "Wen Re." This aligns roughly with the meaning in the *Bing Neng* chapter. That chapter discusses the sequential transmission of pathogenic Qi from the Five Zang; this chapter discusses Cold-Heat uniquely combining in the Kidney. Essence has both transmission and combination, and pathogens follow suit. This chapter abruptly introduces the section on pathogenic combination amidst the discussion of Qi deficiency. The scriptural meaning is subtle; students should reflect deeply. Zhang Yinglüe states: Because essence transmits, pathogens follow. Because the Kidney stores the essence of the Five Zang, Cold-Heat uniquely combines in the Kidney.)
The pulse arrives like a pill: slippery and not directly palpable. "Not directly palpable" means it cannot be felt upon pressing. This indicates a deficiency in the supply of Large Intestine Qi. Death will occur when jujube leaves sprout. ("Zhi" is interchangeable with "Zhi," meaning contact. Like a slippery pill that does not touch the hand directly, the pulse is round, active, and fluent, seemingly formless, hence undetectable upon pressing. The Large Intestine is the Fu organ of the Lung and belongs to Geng Metal. Its pulse should be weak and light. Due to Qi deficiency, the pulse presents thus. Jujube leaves sprout in summer; when Fire is prosperous, Metal is smelted.)
The pulse arrives like a flower: light and minute. It causes the person to be prone to fear, unwilling to sit or lie down, and constantly listening while standing or walking. This indicates a deficiency in the supply of Small Intestine Qi. Death will occur in late autumn (the ninth month). (A pulse like a flower is slight and minute. The Small Intestine is the Fu organ of the Heart and belongs to Bing Fire. Its pulse should arrive vigorously. Instead, it is slight like a flower, indicating Qi deficiency. Fu Qi deficiency leads to Zang Qi deficiency. Shen-Spirit deficiency causes fear and loss of self; Shen-Spirit unrest causes restlessness. The Small Intestine meridian enters the ear and connects to Tinggong (GB2). Constantly hearing sounds, such as cicada buzzing or bell chimes, are signs of deficiency. Death occurs when Metal and Water Qi are prosperous. The Lower Scripture states: Diagnosis must integrate subtle matters, understand changes of Yin and Yang, clarify the conditions of the Five Zhong, and determine the affairs of the Five Du. Only then is one qualified to diagnose. The "conditions of the Five Zhong" decide extraordinary diseases; the "affairs of the Five Du" measure extraordinary pulses. This chapter first discusses extraordinary diseases, then extraordinary pulses, which differ greatly from regular pulse-syndrome patterns; hence it is called the *Da Qi Lun* (Great Extraordinary Treatise). Zhao Huang states: The two chapters *Da Qi* and *Mai Jie* lack ruler-minister dialogue but are called "Treatise" and "Explanation" because Bo Gao, continuing from the previous chapter, explains the extraordinary pulse-disease patterns.)