黄帝问曰∶春脉如弦，何如而弦？岐伯对曰∶春脉者肝也，东方木也，万物之所以始生也，故其气来，
弱轻虚而滑，端直以长，故曰弦，反此者病。帝曰∶何如而反？岐伯曰∶其气来实而强，此谓太过，病在外；
其气来不实而微，此谓不及，病在中。帝曰∶春脉太过与不及，其病皆何如？岐伯曰∶太过则令人善忘，忽忽眩
冒而巅疾；其不及则令人胸痛引背，下则两胁 满。帝曰∶善。夏脉如钩，何如而钩？
岐伯曰∶夏脉者心也，南方火也，万物之所以盛长也，故其气来盛去衰，故曰钩，反此者病。帝曰∶何如
而反？岐伯曰∶其气来盛去亦盛，此谓太过，病在外；其气来不盛去反盛，此谓不及，病在中。帝曰∶
夏脉太过与不及，其病皆何如？岐伯曰∶太过则令人身热而肤痛，为浸淫；其不及则令人烦心，上见咳唾，
下为气泄。帝曰∶善。秋脉如浮，何如而浮？岐伯曰∶秋脉者肺也，西方金也，万物之所以收成也，故其
气来，轻虚以浮，来急去散，故曰浮，反此者病。帝曰∶何如而反？岐伯曰∶其气来，毛而中央坚，两旁
虚，此谓太过，病在外；其气来，毛而微，此谓不及，病在中。帝曰∶秋脉太过与不及，其病皆何如？岐伯
曰∶太过则令人逆气而背痛，愠愠然；其不及则令人
喘，呼吸少气而咳，上气见血，下闻病音。帝曰∶善。冬脉如营，何如而营？岐伯曰∶冬脉者肾也，北方
水也，万物之所以合藏也，故其气来沉以搏，故曰营，反此者病。帝曰∶何如而反？岐伯曰∶其气来如弹石
者，此谓太过，病在外；其去如数者，此谓不及，病在中。帝曰∶冬脉太过与不及，其病皆何如？岐伯曰∶
太过则令人解 ，脊脉痛而少气不欲言；其不及则令人心悬如病饥， 中清，脊中痛，少腹满，小便变。
帝曰∶善。
帝曰∶四时之序，逆从之变异也，然脾脉独何主？岐伯曰∶脾脉者土也，孤脏以灌四旁者
也。帝曰∶然则脾善恶，可得见之乎？岐伯曰∶善者不可得见，恶者可见。帝曰∶恶者何如可见？岐伯曰∶
其来如水之流者，此谓太过，病在外；如鸟之喙者，此谓不及，病在中。帝曰∶夫子言脾为孤脏，中央土以灌
四旁，其太过与不及，其病皆何如？岐伯曰∶太过则令人四肢不举；其不及，则令人九窍不通，名曰重强。帝
瞿然而起，再拜而稽首曰∶善。吾得脉之大要，天下至数，五色脉变，揆度奇恒，道在于一，神转不回，回
则不转，乃失其机，至数之要，迫近以微，着之玉版，藏之脏腑，每旦读之，名曰《玉机》。
五脏受气于其所生，传之于其所胜，气舍于其所生，死于其所不胜。病之且死，必先传行至其所不胜，
病乃死。此言气之逆行也，故死。肝受气于心，传之于脾，气舍于肾，至肺而死。心受气于脾，传之于
肺，气舍于肝，至肾而死。脾受气于肺，传之于肾，气舍于心，至肝而死。肺受气于肾，传之于肝，气舍于
脾，至心而死。肾受气于肝，传之于心，气舍于肺，至脾而死。此皆逆死也。一日一夜五分之，此所以占死
生之早暮也。黄帝曰∶五脏相通，移皆有次，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。故曰∶别于阳者，知病从来；别于阴者，知死生之
期。言知至其所困而死。是故风者百病之长也，今风寒客于人，使人毫毛毕直，皮肤闭而为热，当是
之时，可汗而发也；或痹不仁肿痛，当是之时，可汤熨及火灸刺而去之。弗治，病入舍于肺，名曰肺痹，
发咳上气。弗治，肺即传而行之肝，病名曰肝痹，一名曰厥，胁痛出食，当是之时，可按若刺耳。弗治，
肝传之脾，病名曰脾风，发瘅，腹中热，烦心出
黄，当此之时，可按可药可浴。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。弗治，肾传之心，病筋脉相引而急，病名曰螈，当此之时，可灸可药。弗治，满十日，法当
死。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。然其卒发者，不必治于传，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。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。
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。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。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，十月之内死。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。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，目匡陷，真脏见，目不见
人，立死，其见人者，至其所不胜之时则死。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。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，如以毛羽中人肤，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。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。
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。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。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。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。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。脉细，皮寒，气少，泄利前后，饮食不入，此谓五虚。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。
黄帝问道：春季的脉象像弦一样，什么样的脉象才称为弦？岐伯回答说：春脉对应肝脏，属于东方五行中的木，是万物开始生长的季节，所以它的脉气来时，柔弱、轻虚而滑利，端正且直长，因此称为弦脉，与此相反的则是病脉。黄帝问：什么样的脉象算是相反呢？岐伯说：如果脉气来时坚实而强劲，这叫做“太过”，病在体表；如果脉气来时不充实而微弱，这叫做“不及”，病在体内。黄帝问：春季脉象的“太过”和“不及”，它们引起的病症分别是什么样的？岐伯说：脉气太过会让人容易健忘，精神恍惚，头晕目眩，甚至发生头顶部的疾病；脉气不及会让人胸部疼痛并牵引背部，下部则表现为两侧胁肋部胀满。黄帝说：好。夏季的脉象像钩一样，什么样的脉象才称为钩？岐伯说：夏脉对应心脏，属于南方五行中的火，是万物茂盛生长的季节，所以它的脉气来时旺盛而去时衰弱，因此称为钩脉，与此相反的则是病脉。黄帝问：什么样的脉象算是相反呢？岐伯说：如果脉气来时旺盛，去时也旺盛，这叫做“太过”，病在体表；如果脉气来时不旺盛，去时反而旺盛，这叫做“不及”，病在体内。黄帝问：夏季脉象的“太过”和“不及”，它们引起的病症分别是什么样的？岐伯说：脉气太过会让人身体发热且皮肤疼痛，引发浸淫疮（一种流脓流水的皮肤病）；脉气不及会让人心烦意乱，上部出现咳嗽吐痰，下部出现气泄（如遗尿或失禁等气机下陷的症状）。黄帝说：好。秋季的脉象像浮一样，什么样的脉象才称为浮？岐伯说：秋脉对应肺脏，属于西方五行中的金，是万物收获的季节，所以它的脉气来时，轻虚而浮，来势急而去势散，因此称为浮脉，与此相反的则是病脉。黄帝问：什么样的脉象算是相反呢？岐伯说：如果脉气来时，像羽毛触手但中间坚硬、两旁虚弱，这叫做“太过”，病在体表；如果脉气来时，像羽毛触手但微弱，这叫做“不及”，病在体内。黄帝问：秋季脉象的“太过”和“不及”，它们引起的病症分别是什么样的？岐伯说：脉气太过会让人气逆且背部疼痛，心中郁闷不快；脉气不及会让人气喘，呼吸短促且咳嗽，上部可见咳血，下部可听到病变的声音（如肠鸣等）。黄帝说：好。冬季的脉象像营（深藏）一样，什么样的脉象才称为营？岐伯说：冬脉对应肾脏，属于北方五行中的水，是万物闭藏的季节，所以它的脉气来时沉实有力，因此称为营脉，与此相反的则是病脉。黄帝问：什么样的脉象算是相反呢？岐伯说：如果脉气来时像弹石一样坚硬，这叫做“太过”，病在体表；如果脉气去时急促数乱，这叫做“不及”，病在体内。黄帝问：冬季脉象的“太过”和“不及”，它们引起的病症分别是什么样的？岐伯说：脉气太过会让人肢体懈怠无力，脊背经脉疼痛且气少不想说话；脉气不及会让人心里空虚像得了饥饿病的感觉，胃脘部清冷，脊中疼痛，小腹胀满，小便异常。黄帝说：好。
黄帝问：四季的顺序，有顺逆变化的差异，但是脾脉独自由什么主导呢？岐伯说：脾脉属土，它是孤独的脏器，负责灌溉其他四脏。黄帝问：那么脾脏的好坏，可以看出来吗？岐伯说：好的脾脉看不出来，坏的脾脉才能看出来。黄帝问：坏的脾脉怎样看出来呢？岐伯说：如果脉气来时像水流一样急速，这叫做“太过”，病在体表；如果脉气来时像鸟嘴啄物一样坚锐，这叫做“不及”，病在体内。黄帝问：先生曾说脾是孤独的脏器，居中央属土以灌溉四方，它的“太过”和“不及”，引起的病症分别是什么样的？岐伯说：脉气太过会让人四肢不能举动；脉气不及，会让人九窍不通，这种病名叫“重强”。黄帝惊起，再拜叩头说：好。我得到了诊脉的要领，这是天下至为重要的规律，观察五色和脉象的变化，衡量正常与异常的差别，道理在于一个“神”字，神机运转而不回逆，如果回逆就不能运转，这样就失去了生机。至为重要的规律，迫近而精微，记载在玉版上，藏在脏腑之中，每天早晨诵读，这部书名叫《玉机》。
五脏的病气从它所生的脏器传来，传给它所克的脏器，病气停留于它所生的脏器，传到它不能克的脏器就会死亡。病情严重将要死亡时，病气必定先传行至它不能克的脏器，然后才会死亡。这是说病气的逆行，所以会死。肝的病气受之于心，传之于脾，病气停留于肾，传至肺则死。心的病气受之于脾，传之于肺，病气停留于肝，传至肾则死。脾的病气受之于肺，传之于肾，病气停留于心，传至肝则死。肺的病气受之于肾，传之于肝，病气停留于脾，传至心则死。肾的病气受之于肝，传之于心，病气停留于肺，传至脾则死。这些都是逆传而死。将一天一夜分为五部分，以此来占测死亡时间的早晚。黄帝说：五脏是相通的，病气的转移都有次序，五脏有病，就会传给它所克的脏器。如果不治疗，按照法度，三个月或六个月，或者三天或六天，传遍五脏就会死亡，这是顺传所克脏器的次序。所以说：辨别阳分（表），就知道病从哪里来；辨别阴分（里），就知道死生的期限。意思是知道病气传至它所困顿的脏器就会死亡。因此风邪是百病的先导，现在风寒侵袭人体，使人毫毛竖立，皮肤闭塞而发热，在这个时候，可以用发汗的方法治疗；或者出现痹症导致麻木不仁、肿痛，在这个时候，可以用汤药热敷及火灸针刺来去除病邪。如果不治疗，病气进入并停留在肺，名叫肺痹，发作时咳嗽气逆。如果不治疗，肺病就传行到肝，病名叫肝痹，又名厥，症状为胁痛、呕吐食物，在这个时候，可以用按摩或针刺治疗。如果不治疗，肝病传至脾，病名叫脾风，发作黄疸，腹中热，心烦，排出黄色液体，在这个时候，可以用按摩、药物或药浴治疗。如果不治疗，脾病传至肾，病名叫疝瘕，小腹部冤屈发热而痛，排出白色分泌物，又名蛊病，在这个时候，可以用按摩或药物治疗。如果不治疗，肾病传至心，出现筋脉相互牵引而拘急，病名叫抽搐，在这个时候，可以用艾灸或药物治疗。如果不治疗，满十天，按法度应当死亡。肾病传至心后，心又反过来传行到肺，发作寒热，按法度应当三年后死亡，这是病气传变的次序。然而如果是突然发病的，不必等待传变再治，或者其传变不按次序，如果不按次序传入，是由于忧、恐、悲、喜、怒等情志刺激，使得病气不能按常规次序传变，所以让人患大病。因为大喜导致心气大虚，则肾气就会乘虚侵犯；大怒则肝气乘虚侵犯；大悲则肺气乘虚侵犯；大恐则脾气乘虚侵犯；大忧则心气乘虚侵犯，这就是其中的道理。所以病有五种，五五二十五种变化，以及它们的传变。传，就是乘虚侵犯的意思。
如果大骨枯槁，大肉陷下，胸中气满，喘息不便，呼吸时身体随之震动，预期六个月死亡，如果出现真脏脉，就给予具体的死亡日期。如果大骨枯槁，大肉陷下，胸中气满，喘息不便，内部疼痛牵引肩项，预期一个月死亡，如果出现真脏脉，就给予具体的死亡日期。如果大骨枯槁，大肉陷下，胸中气满，喘息不便，内部疼痛牵引肩项，身体发热，肌肉脱失消瘦，如果出现真脏脉，十个月之内死亡。如果大骨枯槁，大肉陷下，肩髓内部消减，动作日益衰退，真脏脉出现，预期一年死亡，出现真脏脉，就给予具体的死亡日期。如果大骨枯槁，大肉陷下，胸中气满，腹内疼痛，心中烦闷不适，肩项身热，肌肉脱失消瘦，眼眶凹陷，真脏脉出现，眼睛看不见人，立即死亡；如果还能看见人，到了它不能克的时辰就会死亡。如果遇到急剧的虚邪贼风突然袭击，五脏气绝闭塞，脉道不通，气机断绝往来，就像从高处坠落或溺水一样，无法预测死亡时间。如果脉搏停止不来，或者人一呼一吸间脉搏跳动五六次（极快），形体肌肉没有脱失，虽然真脏脉没有出现，也是死证。
真肝脉出现，脉象中外紧急，像触摸刀刃那样锐利，像按压琴瑟弦那样紧绷，面色青白无光泽，毫毛折断，就会死亡。真心脉出现，脉象坚硬搏指，像触摸薏苡子那样颗粒累累，面色赤黑无光泽，毫毛折断，就会死亡。真肺脉出现，脉象大而虚，像羽毛中人肌肤那样轻浮，面色白赤无光泽，毫毛折断，就会死亡。真肾脉出现，脉象搏动而断绝，像手指弹石那样辟辟作响，面色黑黄无光泽，毫毛折断，就会死亡。真脾脉出现，脉象弱而忽快忽慢，面色黄青无光泽，毫毛折断，就会死亡。所有真脏脉出现的，都是死证，无法治疗。黄帝问：看到真脏脉就说会死，为什么呢？岐伯说：五脏都禀受胃气，胃是五脏的根本。脏气本身不能直接到达手太阴肺经，必须依赖胃气，才能到达手太阴肺经，所以五脏各自在其对应的时令，带着胃气到达手太阴肺经。所以邪气胜的时候，精气就衰败了，因此病重的时候，胃气不能随着脏气一起到达手太阴肺经，所以真脏之气单独显现，单独显现说明病气胜过脏气，所以说是死证。黄帝说：好。
黄帝说：凡是治病，要观察病人的形体、气色、色泽，脉象的盛衰，病情的新久，然后进行治疗，不要错过时机。形体与气色相协调，叫做可治；色泽明润浮泽，叫做容易痊愈；脉象顺应四时变化，叫做可治；脉象软弱而滑利，这是有胃气的表现，命名为易治，要把握治疗时机。形体与气色不相协调，叫做难治；色泽枯槁无光泽，叫做难以痊愈；脉象实而坚硬，叫做病情加重；脉象违背四时变化，叫做不可治。必须察明这四种难治的情况，并明确告知病人。所谓违背四时，是指春天得到肺脉，夏天得到肾脉，秋天得到心脉，冬天得到脾脉，这些脉象都悬绝沉涩的，叫做违背四时。在没有相应脏器病变形态的情况下，春夏季节脉象却沉涩，秋冬季节脉象却浮大，这也叫做违背四时。患热病而脉象静止，腹泻而脉象盛大，失血而脉象实大，病在体内而脉象实坚，病在体表而脉象不实坚的，都难治。黄帝说：我听说通过虚实可以判断死生，希望听听其中的情况。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。脉象细微，皮肤寒冷，气短，大小便泄利，饮食不进，这叫做五虚。黄帝问：其中有时能活下来的原因是什么呢？岐伯说：如果浆粥能进入胃中，泄泻停止，那么虚证患者就能存活；如果身上出汗且大小便通利，那么实证患者就能存活。这就是存活的征候。
Huangdi asked: The spring pulse is like a string. What kind of pulse is called a string? Qibo replied: The spring pulse corresponds to the Liver, which belongs to Wood in the East. It is the season when all things begin to grow. Therefore, its qi comes weak, light, void, and slippery, straight and long; thus it is called a string. If it is contrary to this, it indicates disease. Huangdi asked: What kind of pulse is considered contrary? Qibo said: If the qi comes solid and strong, this is called Excess (Tai Guo), and the disease is in the exterior; if the qi comes not solid but faint, this is called Deficiency (Bu Ji), and the disease is in the interior. Huangdi asked: Regarding the Excess and Deficiency of the spring pulse, what are their respective symptoms? Qibo said: Excess causes forgetfulness, dizziness, vertigo, and diseases of the vertex; Deficiency causes chest pain radiating to the back, and distension in the hypochondrium below. Huangdi said: Excellent. The summer pulse is like a hook. What kind of pulse is called a hook? Qibo said: The summer pulse corresponds to the Heart, which belongs to Fire in the South. It is the season when all things flourish and grow. Therefore, its qi comes vigorous and departs declining; thus it is called a hook. If it is contrary to this, it indicates disease. Huangdi asked: What kind of pulse is considered contrary? Qibo said: If the qi comes vigorous and departs also vigorous, this is called Excess, and the disease is in the exterior; if the qi comes not vigorous but departs vigorously, this is called Deficiency, and the disease is in the interior. Huangdi asked: Regarding the Excess and Deficiency of the summer pulse, what are their respective symptoms? Qibo said: Excess causes fever and skin pain, leading to impetigo (Im Yin); Deficiency causes vexation, coughing and expectoration above, and Qi leakage below. Huangdi said: Excellent. The autumn pulse is like floating. What kind of pulse is called floating? Qibo said: The autumn pulse corresponds to the Lung, which belongs to Metal in the West. It is the season when all things are harvested. Therefore, its qi comes light, void, and floating, coming swiftly and dispersing slowly; thus it is called floating. If it is contrary to this, it indicates disease. Huangdi asked: What kind of pulse is considered contrary? Qibo said: If the qi comes like a feather but firm in the center and empty on both sides, this is called Excess, and the disease is in the exterior; if the qi comes like a feather but faint, this is called Deficiency, and the disease is in the interior. Huangdi asked: Regarding the Excess and Deficiency of the autumn pulse, what are their respective symptoms? Qibo said: Excess causes rebellious Qi and back pain with a feeling of oppression; Deficiency causes panting, shortness of breath, cough, hemoptysis above, and pathological sounds below. Huangdi said: Excellent. The winter pulse is like Ying (deeply stored). What kind of pulse is called Ying? Qibo said: The winter pulse corresponds to the Kidney, which belongs to Water in the North. It is the season when all things are hidden and stored. Therefore, its qi comes deep and firm; thus it is called Ying. If it is contrary to this, it indicates disease. Huangdi asked: What kind of pulse is considered contrary? Qibo said: If the qi comes like a flicking stone, this is called Excess, and the disease is in the exterior; if it departs rapidly and frequent, this is called Deficiency, and the disease is in the interior. Huangdi asked: Regarding the Excess and Deficiency of the winter pulse, what are their respective symptoms? Qibo said: Excess causes flaccidity, pain in the spinal meridians, shortness of breath, and reluctance to speak; Deficiency causes a feeling of emptiness in the heart as if hungry, coldness in the epigastrium, pain in the spine, fullness in the lower abdomen, and changes in urination. Huangdi said: Excellent.
Huangdi asked: The order of the four seasons has variations of compliance and opposition, but what governs the Spleen pulse alone? Qibo said: The Spleen pulse belongs to Earth. It is the solitary Zang organ that irrigates the four directions. Huangdi asked: Then can the good or bad condition of the Spleen be seen? Qibo said: The good cannot be seen, but the bad can be seen. Huangdi asked: How can the bad be seen? Qibo said: If it comes like flowing water, this is called Excess, and the disease is in the exterior; if it comes like the beak of a bird, this is called Deficiency, and the disease is in the interior. Huangdi asked: You stated that the Spleen is the solitary organ, central Earth irrigating the four directions. What are the symptoms of its Excess and Deficiency? Qibo said: Excess causes inability to move the limbs; Deficiency causes obstruction of the nine orifices, named Zhong Qiang (Heavy Stiffness). Huangdi rose startled, bowed twice, and kowtowed saying: Excellent. I have obtained the great essence of pulse diagnosis, the supreme numbers of the world, the changes of the five colors and pulses, measuring the normal and the abnormal. The Dao lies in one thing: Shen (Spirit) turns without returning. If it returns, it does not turn, and the opportunity is lost. The essence of these supreme numbers is close and subtle. It is recorded on jade tablets and stored in the Zang organs, read every morning, named "Yu Ji" (Jade Machine).
The Qi of the five Zang organs is received from the organ that generates it, transmitted to the organ it overcomes, stays at the organ that generates it, and dies when it reaches the organ it cannot overcome. When death is imminent, the disease must first transmit to the organ it cannot overcome, and then death occurs. This refers to the retrograde flow of Qi, hence death. The Liver receives Qi from the Heart, transmits it to the Spleen, the Qi stays at the Kidney, and dies when reaching the Lung. The Heart receives Qi from the Spleen, transmits it to the Lung, the Qi stays at the Liver, and dies when reaching the Kidney. The Spleen receives Qi from the Lung, transmits it to the Kidney, the Qi stays at the Heart, and dies when reaching the Liver. The Lung receives Qi from the Kidney, transmits it to the Liver, the Qi stays at the Spleen, and dies when reaching the Heart. The Kidney receives Qi from the Liver, transmits it to the Heart, the Qi stays at the Lung, and dies when reaching the Spleen. These are all deaths due to retrograde transmission. Dividing a day and night into five parts allows one to predict the early or late time of death. Huangdi said: The five Zang organs are interconnected, and shifts occur in sequence. When the five Zang organs are diseased, they transmit to the organ they overcome. If untreated, according to the method, within three months or six months, or three days or six days, after transmitting through the five Zang organs, death ensues. This is the sequential transmission to the overcome organs. Thus it is said: Distinguishing Yang reveals the origin of the disease; distinguishing Yin reveals the period of life and death. This means knowing that death occurs when the disease reaches the organ that confines it. Therefore, Wind is the leader of a hundred diseases. Now, if Wind-Cold invades humans, causing all hair follicles to stand erect and skin pores to close resulting in heat, at this time, sweating can induce release. Or if Bi syndrome causes numbness, swelling, and pain, at this time, herbal baths, hot compresses, moxibustion, and acupuncture can remove it. If untreated, the disease enters and stays in the Lung, named Fei Bi (Lung Bi), manifesting as cough and rebellious Qi. If untreated, the Lung disease transmits to the Liver, named Gan Bi (Liver Bi), also known as Jue, with symptoms of hypochondriac pain and vomiting food; at this time, massage or ear acupuncture can be used. If untreated, Liver disease transmits to the Spleen, named Pi Feng (Spleen Wind), manifesting as Jaundice, heat in the abdomen, vexation, and discharge of yellow fluid; at this time, massage, herbs, or baths can be used. If untreated, Spleen disease transmits to the Kidney, named Shan Jia (Hernia Mass), with heat and pain in the lower abdomen and discharge of white matter, also known as Gu; at this time, massage or herbs can be used. If untreated, Kidney disease transmits to the Heart, causing spasmodic contraction of sinews and vessels, named Chou Yu (Convulsion); at this time, moxibustion or herbs can be used. If untreated, after ten days, death is expected by law. After Kidney disease transmits to the Heart, the Heart may reverse and transmit to the Lung, manifesting as chills and fever, with death expected after three years; this is the sequence of disease transmission. However, sudden onset diseases need not wait for transmission to treat, or if their transformation does not follow the sequence, entering irregularly due to emotions like worry, fear, sorrow, joy, or anger, preventing regular transmission, thus causing severe illness. Excessive joy leads to Heart Qi deficiency, allowing Kidney Qi to invade; anger leads to Liver Qi invading; sorrow leads to Lung Qi invading; fear leads to Spleen Qi invading; excessive worry leads to Heart Qi invading. This is the principle. There are five types of diseases, leading to twenty-five transformations and their transmissions. Transmission is the name for invasion by excess.
If the large bones are withered and the large muscles are sunken, the chest is full of Qi, breathing is difficult, and movement exacerbates the condition, death is expected in six months. If Zhen Zang Mai (True Organ Pulse) appears, a specific date of death is given. If the large bones are withered and the large muscles are sunken, the chest is full of Qi, breathing is difficult, internal pain radiates to the shoulders and neck, death is expected in one month. If Zhen Zang Mai appears, a specific date of death is given. If the large bones are withered and the large muscles are sunken, the chest is full of Qi, breathing is difficult, internal pain radiates to the shoulders and neck, body heat, muscle wasting, and skin breakdown appear, if Zhen Zang Mai appears, death occurs within ten months. If the large bones are withered and the large muscles are sunken, marrow in the shoulders dissipates internally, movement declines further, and Zhen Zang Mai appears, death is expected in one year. When Zhen Zang Mai appears, a specific date of death is given. If the large bones are withered and the large muscles are sunken, the chest is full of Qi, abdominal pain, mental discomfort, shoulder/neck/body heat, muscle wasting, sunken eye sockets, and Zhen Zang Mai appear, and the patient cannot see people, death is immediate; if they can see people, death occurs at the time corresponding to the organ they cannot overcome. If sudden extreme deficiency strikes the body, the five Zang organs close off, meridians are blocked, and Qi ceases to circulate, similar to falling or drowning, making prediction impossible. If the pulse stops, or if one breath cycle sees five to six beats, even if flesh is not wasted and Zhen Zang Mai is not seen, it is still fatal.
When True Liver Pulse appears, it is tense inside and out, sharp like touching a blade, tight like pressing a lute string, complexion is cyan-white without luster, hair breaks, and death follows. When True Heart Pulse appears, it is hard and beating, grainy like touching coix seeds, complexion is red-black without luster, hair breaks, and death follows. When True Lung Pulse appears, it is large and void, like feathers piercing human skin, complexion is white-red without luster, hair breaks, and death follows. When True Kidney Pulse appears, it is beating and abrupt, like fingers flicking stones, complexion is black-yellow without luster, hair breaks, and death follows. When True Spleen Pulse appears, it is weak and intermittently rapid and slow, complexion is yellow-cyan without luster, hair breaks, and death follows. All appearances of Zhen Zang Mai indicate untreatable death. Huangdi asked: Why does seeing Zhen Zang Mai mean death? Qibo said: The five Zang organs all derive Qi from the Stomach; the Stomach is the root of the five Zang organs. Zang Qi cannot reach the Hand Taiyin (Lung Meridian) on its own; it must rely on Stomach Qi to reach the Hand Taiyin. Thus, each Zang organ arrives at the Hand Taiyin in its respective season carrying its own Qi. Therefore, when pathogenic Qi prevails, essential Qi declines. In severe disease, Stomach Qi cannot accompany Zang Qi to the Hand Taiyin, so only Zhen Zang Qi appears alone. Appearance alone means pathogenic Qi overwhelms the Zang Qi, hence death. Huangdi said: Excellent.
Huangdi said: In treating any disease, observe the form, Qi, color, and luster, the flourishing or declining state of the pulse, and whether the disease is new or old, then treat without delaying the appropriate time. If form and Qi are harmonious, it is treatable; if color and luster are bright and floating, it is easily cured; if the pulse conforms to the four seasons, it is treatable; if the pulse is weak and slippery, indicating Stomach Qi, it is named easy to treat, provided treatment is timely. If form and Qi are discordant, it is difficult to treat; if color is dull and lacks luster, it is difficult to cure; if the pulse is solid and hard, the condition worsens; if the pulse opposes the four seasons, it is untreatable. One must examine these four difficulties and clearly inform the patient. Opposing the four seasons refers to: obtaining Lung pulse in Spring, Kidney pulse in Summer, Heart pulse in Autumn, and Spleen pulse in Winter, where the pulses are all suspended, isolated, deep, and choppy, named opposing the four seasons. Without corresponding Zang manifestations, if pulses are deep and choppy in Spring and Summer, or floating and large in Autumn and Winter, this is also named opposing the four seasons. Heat disease with quiet pulse, diarrhea with large pulse, blood loss with solid pulse, interior disease with solid/firm pulse, exterior disease with non-solid/non-firm pulse, are all difficult to treat. Huangdi said: I have heard that Deficiency and Excess determine life and death; I wish to hear the details. Qibo said: Five Excesses lead to death, Five Deficiencies lead to death. Huangdi said: I wish to hear about the Five Excesses and Five Deficiencies. Qibo said: Full pulse, hot skin, abdominal distension, blockage of front and back (urination and defecation), and chest oppression/dizziness are called Five Excesses. Fine pulse, cold skin, shortness of breath, diarrhea of front and back, and inability to eat are called Five Deficiencies. Huangdi asked: Under what circumstances can they survive? Qibo said: If porridge and gruel enter the Stomach and diarrhea stops, the deficient patient lives; if sweat appears and bowels/bladder open, the excess patient lives. These are the signs.