而成热。故湿热而发瘅也。湿热之气。上蒸于心则烦。心火热下淫则溺黄。盖热在中土。而变及于上下也。夫病在形身
者。可按可浴。病在内者。可药。发瘅。湿热发于外也。腹中热。烦心。出黄。热在内也。是以当此之时。可按可药可
浴而治之。）弗治。脾传之肾。病名曰疝瘕。少腹冤热而痛。出白。一名曰蛊。当此之时。可按可药。（在脾弗治。则土
邪乘肾。病名疝瘕。邪聚下焦。故少腹冤热而痛。溲出淫浊也。蛊者。言其阴邪居下。而坏事之极也。）弗治。肾传之
心。病筋脉相引而急。病名曰 。当此之时。可灸可药。弗治。满十日。法当死。（ 音翅。灵枢经曰。心脉急。甚为
。盖心主血脉而属火。火热盛。则筋脉燥缩。而手足拘急也。当此危急之证。尚可灸可药。言不可以其危笃而弃之也。
失而弗治。满十日。法当死。五传巳周。当尽十干而死矣。）肾因传之心。心即复反传而行之肺。发寒热。法当三岁死。
此病之次也。（心主神明。而多不受邪。如肾传之心。心不受邪。则反传之肺。是从肺而再传矣。邪复出于皮肤络脉之间。
阴阳气血相乘。是以发往来之寒热。法当至三岁而死。盖心不受邪而复传。故又有三年之久。此邪病复传之次第也。夫
瘕痹之病。不即传行。而亦不即速死。是初传而死者。法当三岁。如心不受邪而复再传者。是又当三岁矣。所谓若三岁。
若六岁也。夫病发于五脏之阴者。若三月。若六月。若三日。若六日。病发于五脏之阳者。若三岁。若六岁。所谓其生
五。其数三。是五脏之气。生于五行。而终于三数。三而两之。则又为六数矣。莫子晋曰。此注与诊要经终之义。大
略相同。）然其卒发者。不必治其传。（卒发者。即仲景伤寒论之中风伤寒。卒病三阴三阳之气。一时寒热交作。气脉不
通。与病形藏之传邪。而为瘕痹之证者不同。故不必以病传之法治之。）或其传化。有不以次。不以次入者。忧恐悲喜怒。
令不得以其次。故令人有大病矣。（风则伤卫。寒则伤荣。荣卫内陷。脏气逆传。而五脏相移。亦皆有次。设不以次入者。
此又因五志内伤。故令不得以次相传。致令人有大病矣。张兆璜曰。奇恒之病。本于厥逆。五脏逆传其所胜。一逆也。
风寒外客而致五脏内传。二逆也。五志相乘。三逆也。故曰传。乘之名也。谓一脏受乘而传化于五脏。亦传其所胜。与
乘之名类相同。）因而喜大。虚则肾气乘矣。怒则肝气乘矣。悲则肺气乘矣。恐则脾气乘矣。忧则心气乘矣。此其道也。
故病有五。五五二十五变。及其传化。传。乘之名也。（肝当作肺。肺当作肝。悲当作思。喜为心志。喜大则伤心。如外
因于邪。始伤皮毛。内舍于肺。肺因传之肝。肝传之脾。脾传之肾。其间因而喜大。则心气虚。而肾气乘于心矣。怒则
肝气伤而肺气乘于肝矣。思则脾气伤而肝气乘于脾矣。恐则肾气伤而脾气乘于肾矣。忧则肺气伤。而心气乘于肺矣。如
一脏虚而受乘。即相传之五脏。故病有五。五脏有五变。及其传化。则五五有二十五变矣。如喜大而肾气乘心。心即传
之肺。肺传之肝。肝传之脾。脾传之肾。是五脏传化。亦各乘其所胜。故曰传者。乘之名也。）大骨枯槁。大肉陷下。胸
中气满。喘息不便。其气动形。期六月死。真脏脉见。乃予之期日。（此复申明五志内伤。亦各传其所胜。察其形证。审
其脏脉。而知死生之期也。夫气血发原于肾。生于胃而输于脾。回则不转。而无相生之机。是以大骨枯槁。大肉陷下。
而令人有大病也。大骨、两臂两腿之骨。大肉、即两臂腿之肉。盖肾主骨。而脾胃主肌肉四肢也。夫胃气之资养于五脏
者。宗气也。宗气积于胸中。从虚里之大络。贯于十二经脉。经脉逆行。是以胸中气满。阳明气厥。故喘息不便也。
其气动形者。心病而欲传之于肺。肺主气。故气盛而呼吸动形也。期以六月死者。今心始传于肺。肺传之肝。肝传之脾。
脾传之肾而后死。故有六月之久也。真脏脉见坚而搏。如循薏苡子累累然。予与同。予之期日者。当死于壬癸日之中夜
也。）大骨枯槁。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。（此言肝病至肺而死
也。内痛者。肺受其伤。肺之俞在肩背。故痛引肩项也。肝病而已传及于所胜之脏。故当期以本月之内而死也。真脏脉
见。如循刀刃。责责然。如按琴瑟弦。予之期日。当死于庚辛日之薄暮也。）大骨枯槁。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。十日之内死。（此言肺病至心而死。肺病。故痛引肩背。传及于心。故身热也。
夫心主血。而生于肾藏之精。血气盛则充肤热肉。心肾伤而精血衰。故曰脱肉破 。破 、脱肉也。 、音窘。肉之标
也。真脏脉见。大而虚如羽毛。中人肤。病传于心。故期以十日之内死。盖心不受邪。故死之速也。莫子晋曰。天之十
干。化生五行。地之五行。化生五脏。心乃君主之官。为五脏六腑之主。故尽五脏之气终而死。与上节肾传之心。满十
日法当死同义。十月者。乃传之误也。）大骨枯槁。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。（此言脾病而终于一岁也。脾主为胃行其津液。津液者。淖泽注于骨。补益脑髓。脾病而津液不行。故肩髓
先内消也。肩髓者。大椎之骨髓。上会于脑。是以项骨倾者。死不治也。脾主四肢。脾病则四肢懈惰。故动作益衰。真
脏来见者。如水之流。如乌之喙。脾土王于四时。脾气灌于四脏。故虽有真脏来见。尚期有一岁之久。盖以四时五脏之
气。终而后死也。期死之月。见其真脏之乍数乍疏。乃与之期日。谓当死于甲乙之昧旦也。）大骨枯槁。大肉陷下。胸中
气满。腹内痛。心中不便。肩项身热。破 脱肉。目眶陷。真脏见。目不见人。立死。其见人者。至其所不胜之时则死。
（此肾病而死于脾也。本经曰。肾病者。大小腹痛。肾传之心。故心中不便。心传之肺。肺传之肝。故肩项身热。肝传
之脾。故目眶陷也。真脏脉见搏而绝。如指弹石。辟辟然。如目不见人。肾之精气已绝。故立死。其见人者。余气未尽。
至所不胜之时而死。谓当死于日昃也。夫肾为生气之原。生气绝于下。故死之更速也。）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（此言卒发者。不必治其传也。夫邪气胜者。精气虚。风寒之邪卒中于身。精
气一时虚夺。故急虚也。此病三阴三阳之气。而不病于有形。故五脏之气一时绝闭。脉道一时不通而气不往来。譬若堕
溺。乃仓卒一时之病。而生死亦在于时日之间。与风寒之病形脏。勿治而为肺痹。勿治而传之肝。肝传之脾。脾传之肾。
肾传之心。期以三岁六岁死者。不相同也。故不可以为期。）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。（此复言仓卒之病。非但不可为期。并不待形肉脱而真脏见也。脉绝不来。生气绝于内也。一息五六至。邪气盛
于外也。此邪气盛而正气绝。不必真脏见而犹死也。）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。（此审别真脏之脉象。乃可予之期日也。如循刀刃。如按琴瑟弦。
肝木之象也。如薏苡子。如弹石。心肾之象也。皆坚劲之极。而无柔和之气也。乍数乍疏。欲灌不能。脾气欲绝之象也。
如羽毛中人肤。肺气虚散之象也。盖坚劲虚散。皆不得胃气之中和。人无胃气则死矣。色青白不泽。赤黑不泽。皆兼克
贼所胜之色。色生于血脉。气将绝故不泽也。夫脉气流经。经气归于肺。肺朝百脉。输精于皮毛。毛脉合精。而后行气
于脏腑。是脏腑之气欲绝。而毛必折焦也。灵枢经曰。血独盛则淡渗皮肤。生毫毛。又曰。经脉空虚。血气弱枯。肠胃
聂辟。皮肤薄着。毛腠夭焦。予之死期。是皮毛夭折者。血气先绝也。）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。脏气者。不能自致于手太阴。必因于胃气。乃至于手太阴也。故五脏各以其时。自为
而至于手太阴也。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。（五脏之气。皆胃腑水谷之所资生。故胃为五脏之本。手太阴者。两脉口也。脏气者。五脏之精
气也。五脏之气。必因于胃气。乃至于手太阴也。又非惟微和之为胃气也。即五脏之弦钩毛石。各以其时。自为其象。
而至于手太阴者。皆胃气之所资生。故邪气胜者。五脏之精气已衰。而不能为弦钩毛石之象矣。如令人有大病而病甚者。
胃气绝而真脏见。真脏见者。病气胜而脏气绝也。）黄帝曰。凡治病。察其形气色泽。脉之盛衰。病之新故。乃治之。
无后其时。（帝以伯所言之五脏乘传。有浅有深。而胃气不资。有虚有绝。故当察其形气色脉。治病者宜急治之。无后其
时。而致于死不治也。张兆璜曰。此总结上文而为审治之法。言有五脏逆传风寒久客之故病。有急虚卒发之新病。五
脏得胃气而有春弦夏钩之神气。有春得肺脉夏得肾脉之逆乘。故当审其形气色脉以治之。）形气相得。谓之可治。色泽以
浮。谓之易已。脉从四时。谓之可治。脉弱以滑。是有胃气。命曰易治。取之以时。（形气相得。病之新也。色泽以浮。
乘逆浅也。脉从四时者。五脏各以其时。自为而至于手太阴也。脉弱以滑者。胃气能与之俱至于手太阴也。察此四易。
当急治之。而无后其时。取之以时者。春刺散俞。夏刺络俞。秋刺皮肤。冬刺俞窍也。）形气相失。谓之难治。色夭不
泽。谓之难已。脉实以坚。谓之益甚。脉逆四时。为不可治。必察四难。而明告之。（形气相失。病之久也。色夭不泽。
乘传深也。脉实以坚。无胃气也。脉逆四时。克贼胜也。察此四难。而明告其病者焉。）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。夏得肾脉者。藏精衰而所不胜乘之也。其至
皆悬绝沉涩者。无胃气之资生也。）未有脏形。于春夏而脉沉涩。秋冬而脉浮大。名曰逆四时也。（夫五脏各以其时。自
为而至于手太阴者。藏真之神气也。如未有弦钩毛石之象形。而升降浮沉之气不可逆。盖气顺则脉顺。气逆则脉逆。脉
随气行者也。）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。（脉病不相应者。
病胜脏也。故皆为难治。）黄帝曰。余闻虚实以决死生。愿闻其情。岐伯曰。五实死。五虚死。（实者谓邪气实。虚者
谓正气虚。启玄子曰。五实谓五脏之实。五虚谓五脏之虚。杨元如曰。实者谓卒发之病。虚者急虚也。）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。（瞀音茂。心主脉。脉盛、心气实也。肺主皮毛。皮
热、肺气实也。脾主腹。腹胀、脾气实也。肾开窍于二阴。前后不通。肾气实也。瞀、目不明也。肝开窍于目。闷瞀、
肝气实也。）脉细。皮寒。气少。泄利前后。饮食不入。此谓五虚。（脉细、心气虚也。皮寒、肺气虚也。肝主春生之气。
气少、肝气虚也。泄利前后。肾气虚也。饮食不入。脾气虚也。盖邪之所腠。其正必虚。是以邪气盛者死。正气虚者亦
死也。）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。（五
脏之气。皆由胃气之所资生。浆粥入胃。泄注止。胃气复也。身汗、外实之邪。从表散也。得后利。里实之邪。从下出也。此言卒发之病。而有死有生也。按此篇论藏真之神。合于四时五行。次序环转。如回则不转。乃失其机。逆传于所
胜而死。至于外感风寒。内伤五志。亦各乘其所胜。学人当分作四段看。然又当与玉板论、方盛衰论、病能论、疏五过
论、诸篇合参。）
从而化生为热。因此湿热之气外发则形成黄疸病（瘅）。湿热之气上蒸于心，则导致心烦；心火亢盛向下流溢，则导致小便黄赤。这是因为热邪位于中焦脾胃，进而波及上下二焦。凡是病邪在形体体表者，可以通过按摩和洗浴来治疗；病邪在体内者，可以通过药物来治疗。所谓“发瘅”，是湿热之邪发于体表的表现；而腹中发热、心烦、小便黄赤，则是热邪在体内的表现。所以在这些情况下，可以采用按摩、用药、洗浴等方法进行治疗。）如果不治疗，脾脏的病邪会传变至肾脏，疾病名称叫做疝瘕（少腹结块疼痛），表现为小腹冤屈郁结般的发热且疼痛，小便排出白色浊物，另一种名称叫蛊病。在这个时候，可以采用按摩和药物治疗。（如果在脾脏阶段不治疗，那么脾土之邪气就会乘袭肾脏，疾病名为疝瘕。邪气聚集在下焦，所以小腹感到冤屈郁结般的发热并疼痛，小便排出淫乱浑浊之物。所谓“蛊”，是指阴寒邪气居于下焦，败坏事物到了极点。）如果不治疗，肾脏的病邪会传变至心脏，出现筋脉相互牵引而拘急的症状，疾病名称叫做瘛疭（抽搐痉挛，音翅）。《灵枢经》说：“心脉紧急，严重时会发生瘛疭。”大概是因为心主血脉且属火，火热炽盛，就会导致筋脉干燥收缩，从而手足拘急。面对这种危急的证候，还可以采用艾灸和药物治疗。这里强调不可以因为病情危重就放弃治疗。如果失治而不治疗，满十天，按照规律应当死亡。（肾传心后，心又反传回肺，引发寒热往来，按照规律应当在三年后死亡。这是疾病传变的次序。）（心主神明，通常不容易受邪。如肾邪传心，心不受邪，则反传于肺。这是从肺开始再次传变。邪气重新出于皮肤络脉之间，阴阳气血相互冲逆，所以出现往来的寒热症状，按照规律应当到第三年才死亡。大概因为心不受邪而复传，所以又有三年的期限。这是邪气复传的次第。至于瘕痹这类疾病，不会立即传变，也不会立即速死。如果是初次传变而死的，按照规律应当在三年后死亡；如果是心不受邪而复再传的情况，又是三年之后。这就是所谓的若三岁、若六岁。病发于五脏之阴的，期限可能是三月、六月、三日或六日；病发于五脏之阳的，期限可能是三岁或六岁。这就是所说的“其生五，其数三”。意思是五脏之气生于五行，而终于三这个数。三乘以二，就成为六这个数了。莫子晋说：这段注释与《诊要经终》篇的意义大致相同。）然而那些突然发作的疾病，不必按照传变规律去治疗。（突然发作的疾病，即张仲景《伤寒论》中的中风伤寒，是三阴三阳之气突然发病，一时寒热交作，气脉不通，这与病形藏之传邪而形成的瘕痹证不同。所以不必用病传的方法来治疗。）或者其传变化生，有不按正常次序的。不按次序传入的，是因为忧、恐、悲、喜、怒等情志因素，使得传变不能按正常次序进行，从而导致人患上重病。（风邪伤卫气，寒邪伤营血。营卫内陷，脏气逆传，五脏相移，也都有次序。假设不按次序传入，这又是由于五志内伤，使得不能按次序相传，从而导致人患上大病。张兆璜说：奇恒之病，本源于厥逆。五脏逆传其所胜，这是一逆；风寒外客导致五脏内传，这是二逆；五志相乘，这是三逆。所以说“传”就是“乘”的意思。指一脏受到乘袭而传化于五脏，也是传其所胜，与“乘”的名称类别相同。）如果因喜悦过度，则心气虚，肾气就会乘袭心；愤怒则肝气乘袭；悲伤则肺气乘袭；恐惧则脾气乘袭；忧愁则心气被肺气乘袭。这是其中的道理。所以病有五种，五五二十五种变化。及其传变化生，“传”就是“乘”的意思。（此处原文可能有误，应为“怒则肝气乘矣……思则脾气伤而肝气乘于脾矣”。喜为心志，喜悦过度则伤心。如果外因于邪气，起初损伤皮毛，内舍于肺，肺因传之于肝，肝传之于脾，脾传之于肾。其间如果因喜悦过度，则心气虚，肾气便乘袭于心。愤怒则肝气受伤，肺气乘袭于肝。思虑则脾气受伤，肝气乘袭于脾。恐惧则肾气受伤，脾气乘袭于肾。忧愁则肺气受伤，心气乘袭于肺。如一脏虚弱而受乘袭，即相传于五脏。所以病有五种，五脏各有五种变化，及其传变化生，就有五五二十五种变化了。如喜悦过度而肾气乘心，心即传之于肺，肺传之于肝，肝传之于脾，脾传之于肾。这是五脏传化，也都乘袭其所胜。所以说“传”就是“乘”的意思。）大骨枯槁，大肉陷下，胸中气满，喘息不便，呼吸时身体随之震动，预期六个月后死亡。如果出现真脏脉，就可以断定其死亡日期。（这里再次申明五志内伤，也各自传其所胜。观察其形证，审察其脏脉，就能知道死生的期限。气血发源于肾，生成于胃而输布于脾。如果回转不畅，就没有相生之机，所以导致大骨枯槁，大肉陷下，从而使人患大病。大骨，指两臂两腿之骨；大肉，即两臂腿之肉。大概肾主骨，而脾胃主肌肉四肢。滋养五脏的胃气称为宗气。宗气积聚于胸中，通过虚里的大络，贯通十二经脉。经脉逆行，所以胸中气满；阳明气厥，所以喘息不便。呼吸时身体震动，是心病欲传于肺，肺主气，所以气盛而呼吸动形。预期六个月死亡，是因为现在心始传于肺，肺传之于肝，肝传之于脾，脾传之于肾而后死，所以有六个月的期限。真脏脉出现，坚硬搏指，像触摸薏苡子一样累累然，给予他的死亡日期，应该是死于壬癸日的半夜。）大骨枯槁，大肉陷下，胸中气满，喘息不便，内部疼痛牵引肩项，预期一个月后死亡。出现真脏脉，就可以断定其死亡日期。（这里说的是肝病传到肺而死。内部疼痛，是因为肺受到损伤，肺的俞穴在肩背，所以疼痛牵引肩项。肝病已经传及所胜之脏，所以预期在本月之内死亡。真脏脉出现，像触摸刀刃一样责责然，像按压琴瑟弦一样，给予他的死亡日期，应该是死于庚辛日的傍晚。）大骨枯槁，大肉陷下，胸中气满，喘息不便，内部疼痛牵引肩项，身体发热，肌肉消瘦脱失，皮肤破裂，出现真脏脉，十日内死亡。（这里说的是肺病传到心而死。因为是肺病，所以疼痛牵引肩背；传及于心，所以身体发热。心主血，而生于肾藏之精。血气旺盛则充盈皮肤、温暖肌肉。心肾受伤而精血衰败，所以称为脱肉破腠。破腠，即脱肉。腠，音窘，指皮肤的纹理。真脏脉出现，大而虚，像羽毛中人肤，病传于心，所以预期在十日内死亡。大概因为心不受邪，所以死得迅速。莫子晋说：天的十干化生五行，地的五行化生五脏。心乃君主之官，为五脏六腑之主，所以尽五脏之气终结而死，与上一节肾传心，满十日法当死意义相同。“十月”乃是“十日”的误写。）大骨枯槁，大肉陷下，肩髓内部消减，动作日益衰退，真脏脉出现，预期一年后死亡。见到真脏脉，就可以断定其死亡日期。（这里说的是脾病最终在一年后死亡。脾主为胃运行津液。津液，滋润注入骨骼，补益脑髓。脾病则津液不行，所以肩髓先内部消减。肩髓，是大椎的骨髓，向上会合于脑。所以项骨倾斜的，是死症不治。脾主四肢，脾病则四肢懈怠懒惰，所以动作日益衰退。真脏脉出现的，像水流一样，像乌鸦嘴一样尖硬。脾土旺于四季，脾气灌注于四脏，所以虽然有真脏脉出现，还预期有一年的期限。大概是以四时五脏之气终结后才死亡。预期死亡的月份，见到真脏脉乍疏乍密，就给予他日期，谓应当死于甲乙日的清晨。）大骨枯槁，大肉陷下，胸中气满，腹内痛，心中不适，肩项身热，皮肤破裂肌肉脱失，眼眶凹陷，真脏脉出现，眼睛看不见人，立刻死亡；如果还能看见人，则在其不胜之时死亡。（这里说的是肾病死于脾。本经说：肾病者，大小腹痛。肾传于心，所以心中不适；心传于肺，肺传于肝，所以肩项身热；肝传于脾，所以眼眶凹陷。真脏脉出现，搏动而绝，像手指弹石一样辟辟然。如果眼睛看不见人，说明肾之精气已绝，所以立刻死亡。如果还能看见人，说明余气未尽，到其所不胜之时死亡，谓应当死于日昃之时。肾为生气之源，生气绝于下，所以死得更迅速。）急虚，身体突然遭受重创，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，不可以预测死亡时间（这里说的是突然发作的疾病，不必按照传变规律去治疗。邪气盛则精气虚，风寒邪气突然中于身体，精气一时虚夺，所以称为急虚。此病涉及三阴三阳之气，而不病于有形之质，所以五脏之气一时绝闭，脉道一时不通而气不往来。譬如同坠落溺水，是仓促一时的疾病，生死也在于时日之间，与风寒之病形脏，不治疗而成为肺痹，不治疗而传之肝，肝传之脾，脾传之肾，肾传之心，预期三岁六岁死亡的，不相同。所以不可以预测死亡时间。）脉搏断绝不来，如果人一呼一吸间跳动五六次，形体肌肉没有脱失，虽然真脏脉没有出现，也是死症。（这里再次说明仓促之病，不仅不可预测死亡时间，也不待形肉脱失而真脏脉出现才死。脉绝不来，说明生气绝于内。一息五六至，说明邪气盛于外。这是邪气盛而正气绝，不必真脏脉出现也是死症。）真肝脉出现，中外紧急，像触摸刀刃一样责责然，像按压琴瑟弦一样，面色青白无光泽，毫毛折断则死。真心脉出现，坚硬搏指，像触摸薏苡子一样累累然，面色赤黑无光泽，毫毛折断则死。真肺脉出现，大而虚，像羽毛中人肤，面色白赤无光泽，毫毛折断则死。真肾脉出现，搏动而绝，像手指弹石一样辟辟然，面色黑黄无光泽，毫毛折断则死。真脾脉出现，弱而乍数乍疏，面色黄青无光泽，毫毛折断则死。所有真脏脉出现的，都是死症，无法治疗。（这里审辨真脏的脉象，才可以断定死亡日期。像触摸刀刃，像按压琴瑟弦，是肝木之象。像薏苡子，像弹石，是心肾之象。都坚劲到了极点，而没有柔和之气。乍数乍疏，想灌溉而不能，是脾气欲绝之象。像羽毛中人肤，是肺气虚散之象。大概坚劲虚散，都不得胃气的中和。人没有胃气就会死亡。面色青白无光泽，赤黑无光泽，都兼有克贼所胜之色。色生于血脉，气将绝故无光泽。脉气流经，经气归于肺，肺朝百脉，输精于皮毛。毛脉合精，然后行气于脏腑。是脏腑之气欲绝，而毫毛必折焦。《灵枢经》说：血独盛则淡渗皮肤，生毫毛。又说：经脉空虚，血气弱枯，肠胃聂辟，皮肤薄着，毛腠夭焦，给予其死亡日期，是皮毛夭折者，血气先绝。）黄帝说：见到真脏脉就说会死，为什么呢？岐伯说：五脏都禀受胃气。胃，是五脏的根本。脏气，不能自己到达手太阴肺经，必须凭借胃气，才能到达手太阴。所以五脏各以其时令，自为其象而至于手太阴。所以邪气胜者，精气衰。所以病重的，胃气不能与之俱至于手太阴，所以真脏之气独见。独见，是病胜脏也。所以说死。帝说：好。（五脏之气，都是胃腑水谷所资生的，所以胃为五脏之本。手太阴，是两手脉口。脏气，是五脏的精气。五脏之气，必须凭借胃气，才能到达手太阴。而且不仅仅是微和之气为胃气，即五脏之弦钩毛石，各以其时令，自为其象，而至于手太阴的，都是胃气所资生的。所以邪气胜者，五脏之精气已衰，而不能呈现弦钩毛石之象了。如令人有大病而病重的，胃气绝而真脏见。真脏见，是病气胜而脏气绝也。）黄帝说：大凡治病，观察其形气色泽，脉之盛衰，病之新故，然后治疗，不要错过时机。（帝以伯所言的五脏乘传，有浅有深，而胃气不资，有虚有绝。所以当察其形气色脉，治病者宜急治之，不要错过时机，而导致死不治。张兆璜说：这是总结上文而为审治之法。言有五脏逆传风寒久客之故病，有急虚卒发之新病。五脏得胃气而有春弦夏钩之神气，有春得肺脉夏得肾脉之逆乘。故当审其形气色脉以治之。）形气相得，叫做可治。色泽浮润，叫做易已。脉从四时，叫做可治。脉弱以滑，是有胃气，命曰易治。取之以时。（形气相得，是病之新。色泽以浮，是乘逆浅。脉从四时者，是五脏各以其时令，自为其象而至于手太阴。脉弱以滑者，是胃气能与之俱至于手太阴。察此四易，当急治之，而无后其时。取之以时者，春刺散俞，夏刺络俞，秋刺皮肤，冬刺俞窍。）形气相失，叫做难治。色夭不泽，叫做难已。脉实以坚，叫做益甚。脉逆四时，为不可治。必察四难，而明告之。（形气相失，是病之久。色夭不泽，是乘传深。脉实以坚，是无胃气。脉逆四时，是克贼胜。察此四难，而明告其病者焉。）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，夏得肾脉者，是藏精衰而所不胜乘之。其至皆悬绝沉涩者，是无胃气之资生。）未有脏形，于春夏而脉沉涩，秋冬而脉浮大，名曰逆四时也。（夫五脏各以其时令，自为其象而至于手太阴者，是藏真之神气。如未有弦钩毛石之象形，而升降浮沉之气不可逆。盖气顺则脉顺，气逆则脉逆，脉随气行者也。）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。（脉病不相应者，是病胜脏。故皆为难治。）黄帝说：我听说凭虚实可以决断死生，愿闻其详情。岐伯说：五实死，五虚死。（实者谓邪气实，虚者谓正气虚。启玄子曰：五实谓五脏之实，五虚谓五脏之虚。杨元如曰：实者谓卒发之病，虚者急虚也。）帝说：愿闻五实五虚。岐伯说：脉盛，皮热，腹胀，前后不通，闷瞀，这叫五实。（瞀音茂。心主脉，脉盛，是心气实。肺主皮毛，皮热，是肺气实。脾主腹，腹胀，是脾气实。肾开窍于二阴，前后不通，是肾气实。瞀，目不明也。肝开窍于目，闷瞀，是肝气实。）脉细，皮寒，气少，泄利前后，饮食不入，这叫五虚。（脉细，是心气虚。皮寒，是肺气虚。肝主春生之气，气少，是肝气虚。泄利前后，是肾气虚。饮食不入，是脾气虚。大概邪之所凑，其正必虚。是以邪气盛者死，正气虚者亦死也。）帝说：其时有生者，为什么呢？岐伯说：浆粥入胃，泄注止，则虚者活。身汗，得后利，则实者活。这是其征候。（五脏之气，皆由胃气所资生。浆粥入胃，泄注止，是胃气复。身汗，是外实之邪从表散。得后利，是里实之邪从下出。此言卒发之病，而有死有生。按此篇论藏真之神，合于四时五行，次序环转。如回则不转，乃失其机，逆传于所胜而死。至于外感风寒，内伤五志，亦各乘其所胜。学人当分作四段看。然又当与玉板论、方盛衰论、病能论、疏五过论、诸篇合参。）
and thus transforming into heat. Therefore, damp-heat manifesting externally leads to jaundice (Dan disease). Damp-heat qi steaming upward to the Heart causes irritability; excessive Heart fire flowing downward causes yellow urine. This is because heat resides in the Middle Jiao (Spleen/Stomach) and affects the Upper and Lower Jiaos. For diseases located in the body surface, massage and bathing can be used for treatment; for diseases located internally, herbal medicine can be used. "Manifesting Dan" refers to damp-heat pathogen manifesting on the exterior; whereas abdominal heat, irritability, and yellow urine indicate heat residing internally. Thus, at this time, treatment can involve massage, medication, and bathing.) If untreated, the Spleen's pathology transmits to the Kidney, named Shan Jia (hernia mass), characterized by a sense of grievance-like heat and pain in the lower abdomen, and discharge of white turbid urine, also known as Gu disease. At this stage, massage and medication can be employed. (If untreated at the Spleen stage, Earth pathogen overacts on the Kidney, resulting in Shan Jia. Pathogen gathers in the Lower Jiao, causing grievance-like heat and pain in the lower abdomen and discharge of turbid urine. "Gu" implies Yin pathogen residing in the lower part, causing extreme deterioration.) If untreated, the Kidney's pathology transmits to the Heart, presenting with muscle spasms and cramps due to tendon contraction, named Chi Song (spasmodic convulsions, pronunciation chi). The *Ling Shu* states: "Heart pulse urgency, severely manifests as Chi Song." Generally, the Heart governs blood vessels and belongs to Fire; excessive Heat causes tendons and vessels to dry and contract, leading to limb rigidity. Facing such critical conditions, moxibustion and medication are still applicable. This emphasizes that one should not abandon treatment due to severity. If neglected and untreated, after ten days, death is expected according to the pattern. (After Kidney transmits to Heart, Heart reversely transmits to Lung, causing alternating chills and fever, expected to die after three years. This is the sequence of disease transmission.) (The Heart governs Spirit and rarely accepts pathogen. If Kidney pathogen transmits to Heart and Heart does not accept it, it reverses to transmit to Lung. Transmission restarts from Lung. Pathogen re-emerges in skin and collaterals, with Yin-Yang and Qi-Blood clashing, causing alternating chills and fever, expected to die in the third year. Because Heart does not accept pathogen and reverses transmission, there is an additional three-year period. This is the sequence of reverse transmission. Regarding Zha Bi diseases, they do not transmit immediately nor cause immediate death. For initial transmission leading to death, the rule is three years; if Heart does not accept pathogen and transmits again, it is another three years. Hence, "if three years, if six years." Diseases originating in Yin organs of the Five Zang may last three months, six months, three days, or six days; those originating in Yang organs may last three years or six years. This is referred to as "its generation is five, its number is three." It means Qi of Five Zang originates from Five Elements and ends with the number three. Three multiplied by two becomes six. Mo Zijin notes: This commentary aligns roughly with the meaning in *Zhen Yao Jing Zhong*.) However, sudden onset diseases need not follow transmission patterns. (Sudden onset refers to Wind Strike or Cold Damage in Zhang Zhongjing's *Shang Han Lun*, where Qi of Three Yin and Three Yang suddenly attacks, causing simultaneous chills and fever and blocked Qi-pulse, differing from Zha Bi caused by organ transmission. Thus, transmission rules do not apply.) Or, transmission may deviate from the normal order. Deviations are caused by emotions (worry, fear, sorrow, joy, anger), preventing orderly transmission and causing severe illness. (Wind damages Wei Qi, Cold damages Ying Blood. Ying-Wei sinking inward causes reverse transmission of Zang Qi and mutual displacement of Five Zang, which also follows an order. If deviation occurs, it is due to internal injury from Five Emotions, disrupting orderly transmission and causing severe disease. Zhang Zhaohuang states: Unusual diseases stem from Jue Ni (rebellious Qi). Reverse transmission to the conquered element is the first rebellion; external Wind-Cold causing internal transmission is the second; mutual overacting of Five Emotions is the third. Thus, "Chuan" (transmission) is synonymous with "Cheng" (overacting/assault). One Zang assaulted transmits to others, conquering what it normally controls, similar to Cheng.) Excessive joy depletes Heart Qi, allowing Kidney Qi to overact; anger allows Liver Qi to overact; sorrow allows Lung Qi to overact; fear allows Spleen Qi to overact; worry allows Heart Qi to be overacted upon by Lung Qi. This is the principle. There are five types of disease, yielding twenty-five variations through transmission and overacting. "Chuan" is "Cheng". (Note: Text likely contains errors, e.g., "Joy" should relate to Heart, "Anger" to Liver. Joy damages Heart; external pathogens enter Lung via skin, then transmit to Liver, Spleen, Kidney. If joy is excessive, Heart Qi is deficient, and Kidney Qi overacts on Heart. Anger damages Liver, Lung Qi overacts on Liver. Thought damages Spleen, Liver Qi overacts on Spleen. Fear damages Kidney, Spleen Qi overacts on Kidney. Worry damages Lung, Heart Qi overacts on Lung. If one Zang is deficient and assaulted, it transmits to all Five Zang. Thus, five diseases, five variations per Zang, totaling twenty-five variations. E.g., Joy excess leads to Kidney overacting on Heart; Heart transmits to Lung, Lung to Liver, Liver to Spleen, Spleen to Kidney. All transmissions conquer what they control. Hence, "Chuan" is "Cheng".) Withered large bones, sunken large muscles, chest fullness, difficult breathing, body movement during respiration, expected death in six months. Appearance of True Zang Pulse allows prediction of death date. (Reiterates that emotional injuries transmit to conquered elements. Observing signs and pulses predicts death. Qi-Blood originates in Kidney, generated in Stomach, distributed by Spleen. If circulation fails, generating mechanism stops, causing bone/muscle wasting. Large bones refer to limbs; large muscles to limb flesh. Kidney governs bones; Spleen/Stomach govern muscles/limbs. Zong Qi (Gathering Qi) nourishes Zang organs, accumulates in chest, penetrates twelve meridians via Xu Li. Reverse meridian flow causes chest fullness; Yangming Qi reversal causes dyspnea. Body movement indicates Heart disease transmitting to Lung (governs Qi), causing vigorous respiration. Six-month prognosis: Heart transmits to Lung, Lung to Liver, Liver to Spleen, Spleen to Kidney, then death. True Zang Pulse feels hard like Coix seeds; death predicted on Ren/Gui days at midnight.) Withered large bones, sunken large muscles, chest fullness, difficult breathing, internal pain radiating to shoulder/neck, expected death in one month. Appearance of True Zang Pulse allows prediction. (Liver disease transmitting to Lung. Internal pain radiates to shoulder/back due to Lung's Shu points. Liver disease has reached the conquered element, so death within the month. True Zang Pulse feels sharp like a blade or tight like a zither string; death predicted on Geng/Xin days at dusk.) Withered large bones, sunken large muscles, chest fullness, difficult breathing, internal pain radiating to shoulder/neck, fever, muscle wasting/skin cracking, appearance of True Zang Pulse, death within ten days. (Lung disease transmitting to Heart. Pain radiates to back due to Lung; fever due to Heart involvement. Heart governs Blood, derived from Kidney Essence. Abundant Qi-Blood nourishes skin/flesh. Heart/Kidney injury depletes Essence/Blood, causing wasting. Cracking skin refers to loss of flesh. True Zang Pulse is large and empty like feathers touching skin. Death within ten days because Heart rarely accepts pathogen, leading to rapid death. Mo Zijin notes: Heavenly Stems generate Five Elements, Earthly Elements generate Five Zang. Heart is Monarch, governing all. Death occurs when all Zang Qi exhausts, same as Kidney-to-Heart transmission dying in ten days. "Ten months" is a typo for "ten days".) Withered large bones, sunken large muscles, dissipation of shoulder marrow, declining movement, appearance of True Zang Pulse, expected death in one year. Appearance of True Zang Pulse allows prediction. (Spleen disease ending in one year. Spleen transports fluids to nourish bones/brain marrow. Spleen disease blocks fluid transport, causing shoulder marrow dissipation. Shoulder marrow connects to brain; neck collapse is fatal. Spleen governs limbs; disease causes weakness. True Zang Pulse flows like water or is sharp like a crow's beak. Spleen Earth dominates four seasons, pouring Qi into other Zang. Even with True Zang Pulse, one year remains as Four Seasons/Zang Qi cycle completes. Death predicted on Jia/Yi days at dawn.) Withered large bones, sunken large muscles, chest fullness, abdominal pain, heart discomfort, shoulder/neck/body heat, skin cracking/muscle wasting, sunken eye sockets, appearance of True Zang Pulse. If eyes cannot see person, immediate death; if eyes can see person, death occurs during the time of the unconquerable element. (Kidney disease dying in Spleen. Kidney disease causes lower abdominal pain. Transmission to Heart causes discomfort; to Lung/Liver causes shoulder/neck heat; to Spleen causes sunken eyes. True Zang Pulse beats abruptly like stones. Inability to see indicates Kidney Essence exhaustion, causing immediate death. Ability to see indicates residual Qi; death occurs at the unconquerable time (afternoon). Kidney is source of Life Qi; exhaustion below causes faster death.) Acute deficiency, sudden bodily trauma, Five Zang closure, pulse blockage, Qi stagnation, akin to falling/drowning, unpredictable timing. (Sudden diseases need not follow transmission. Excess pathogen depletes Essence. Sudden Wind-Cold causes acute deficiency. Disease affects Three Yin/Yang Qi, not form. Zang Qi closes, pulse blocks, Qi stops. Like drowning, it is sudden; death depends on timing, unlike chronic transmission diseases. Thus, timing is unpredictable.) Pulse absent, yet 5-6 beats per breath, flesh not wasted, True Zang Pulse not seen, yet death occurs. (Sudden diseases are unpredictable and fatal even without flesh wasting or True Zang Pulse. Absent pulse indicates internal Qi exhaustion; frequent pulse indicates external pathogen excess. Pathogen excess with Qi exhaustion is fatal regardless of True Zang Pulse.) True Liver Pulse arrives tense inside/outside, sharp like a blade, tight like a zither string, complexion pale/yellowish without luster, hair breaks off before death. True Heart Pulse arrives hard/beating, like Coix seeds, complexion red/black without luster, hair breaks off before death. True Lung Pulse arrives large/empty, like feathers touching skin, complexion white/red without luster, hair breaks off before death. True Kidney Pulse arrives abrupt/stopping, like stones struck by finger, complexion black/yellow without luster, hair breaks off before death. True Spleen Pulse arrives weak/irregular, complexion yellow/green without luster, hair breaks off before death. All True Zang Pulses indicate untreatable death. (True Zang pulses predict death. Blade/string feel indicates Liver Wood image; Coix/stone feel indicates Heart/Kidney images. All are rigid/extreme lacking softness. Irregularity indicates Spleen Qi failing. Feather-like indicates Lung Qi scattering. Rigidity/scattering lack Stomach Qi harmony. No Stomach Qi means death. Complexions lack luster due to conquering colors; color comes from blood vessels, fading as Qi fails. Meridian Qi returns to Lung, Lung directs hundred vessels, delivers essence to skin/hair. Hair breaking indicates Zang Qi failure. *Ling Shu* states blood nourishes hair; empty meridians/weak Qi cause hair brittleness/death.) Yellow Di asks: Why does seeing True Zang Pulse mean death? Qi Bo answers: Five Zang rely on Stomach Qi. Stomach is the root of Five Zang. Zang Qi cannot reach Hand Taiyin (Lung) alone; it must accompany Stomach Qi. Thus, each Zang presents its seasonal pulse at Hand Taiyin based on Stomach Qi. When pathogen wins, Essence Qi declines. In severe disease, Stomach Qi cannot reach Hand Taiyin with Zang Qi, so only True Zang Qi appears. "Appearing alone" means disease overwhelms Zang. Hence, death. Di says: Good. (Zang Qi derives from Stomach/Grain. Hand Taiyin is pulse location. Zang Qi requires Stomach Qi to manifest. Not just mild Stomach Qi, but seasonal pulses (String/Hook/Feather/Stone) also depend on Stomach Qi. Pathogen victory means Zang Essence decline, unable to show normal pulses. Severe disease with absent Stomach Qi shows True Zang Pulse, meaning Disease Qi wins, Zang Qi fails.) Yellow Di asks: In treating disease, observe form, Qi, color, pulse strength, and disease novelty/chronicity, then treat promptly. (Di summarizes Zang transmission depth and Stomach Qi deficiency. Observe form/Qi/color/pulse to treat urgently, avoiding delay. Zhang Zhaohuang notes: Summarizes previous text. Chronic diseases from Wind-Cold/Emotions vs. acute sudden diseases. Normal seasonal pulses vs. reverse conquest pulses. Must observe form/Qi/color/pulse to treat.) Form and Qi harmonious indicates treatable. Lustrous floating color indicates easy recovery. Pulse following Four Seasons indicates treatable. Weak and slippery pulse indicates Stomach Qi, called easy to treat. Treat according to season. (Harmonious form/Qi = new disease. Floating luster = shallow invasion. Pulse following seasons = Zang Qi manifests properly. Weak/slippy pulse = Stomach Qi present. Observe these four ease factors, treat urgently. Seasonal treatment: Spring puncture scattered Shu points, Summer collateral Shu points, Autumn skin, Winter deep Shu points.) Form and Qi discordant indicates difficult to treat. Dull non-lustrous color indicates difficult to recover. Solid and hard pulse indicates worsening. Pulse contrary to Four Seasons indicates untreatable. Observe these four difficulties and inform patient clearly. (Discordant form/Qi = chronic disease. Dull color = deep transmission. Solid/hard pulse = no Stomach Qi. Contrary pulse = conquering element wins. Inform patient of these four difficulties.) "Contrary to Four Seasons": Spring gets Lung pulse, Summer gets Kidney pulse, Autumn gets Heart pulse, Winter gets Spleen pulse, all hanging/severe/choppy, called contrary to Four Seasons. (Spring Lung/Summer Kidney pulses indicate Essence depletion and unconquerable element overacting. Hanging/severe/choppy indicates lack of Stomach Qi support.) Without Zang shape, if pulse is deep/choppy in Spring/Summer or floating/large in Autumn/Winter, called contrary to Four Seasons. (Zang Qi manifests seasonally. Without seasonal pulse shapes, rising/falling Qi should not be reversed. Qi smooth means pulse smooth; Qi reversed means pulse reversed. Pulse follows Qi.) Fever with quiet pulse, diarrhea with large pulse, blood loss with solid pulse, internal disease with solid/hard pulse, external disease with non-solid/non-hard pulse, all difficult to treat. (Pulse-disease mismatch means disease overwhelms Zang, hence difficult.) Yellow Di asks: I hear Deficiency/Excess determines life/death, please explain. Qi Bo answers: Five Excesses lead to death, Five Deficiencies lead to death. (Excess = Pathogen excess; Deficiency = Righteous Qi deficiency. Qixuanzi: Five Excess = Five Zang Excess; Five Deficiency = Five Zang Deficiency. Yang Yuanru: Excess = sudden disease; Deficiency = acute deficiency.) Di asks: Explain Five Excesses and Five Deficiencies. Qi Bo answers: Full pulse, hot skin, abdominal distension, blockage of front/rear (urination/defecation), dizziness/blurred vision, called Five Excesses. (Mao sound: Heart governs pulse, full pulse = Heart Excess. Lung governs skin/hair, hot skin = Lung Excess. Spleen governs abdomen, distension = Spleen Excess. Kidney opens to yin openings, blockage = Kidney Excess. Mao = blurred vision. Liver opens to eyes, dizziness = Liver Excess.) Fine pulse, cold skin, shortness of breath, diarrhea/incontinence, inability to eat, called Five Deficiencies. (Fine pulse = Heart Deficiency. Cold skin = Lung Deficiency. Liver governs Spring growth Qi, shortness of breath = Liver Deficiency. Diarrhea = Kidney Deficiency. Inability to eat = Spleen Deficiency. Where pathogen gathers, Righteous Qi must be deficient. Thus, both Pathogen Excess and Righteous Deficiency lead to death.) Di asks: Why do some survive? Qi Bo answers: If porridge enters Stomach and diarrhea stops, Deficient patients live. If sweat occurs and bowels open, Excess patients live. These are the signs. (Zang Qi relies on Stomach Qi. Porridge entering Stomach and stopping diarrhea indicates Stomach Qi restoration. Sweating disperses external Excess pathogen; bowel opening eliminates internal Excess pathogen. This describes survival in sudden diseases. Note: This chapter discusses Hidden True Spirit aligning with Four Seasons/Five Elements. Reversal leads to death. External Wind-Cold/Internal Emotional injury also follow conquest rules. Students should analyze in four sections and cross-reference with *Yu Ban Lun*, *Fang Sheng Shuai Lun*, *Bing Neng Lun*, *Shu Wu Guo Lun*.)