脉之大要，至精至微。切脉动静，视精明，察五色，观五脏有余不足，六腑强弱，形之盛衰，参伍
以决死生，此脉要之精微也。脉其四时动，知病之所在，知病之所变，知病乍在内，乍在外，亦
脉要之精微也。反复详明，而脉要精微，庶可知矣。
黄帝问曰∶诊法何如？
欲悉脉之精微，先问诊法何如。
岐伯对曰∶诊法常以平旦，阴气未动，阳气未散，饮食未进，经脉未盛，络脉调匀，
气血未乱，故乃可诊有过之脉。
平旦之时，阴静而未动，阳气聚而未散，斯时饮食未进，则经脉之气血未盛，络脉之气血调匀，未
盛调匀则气血未乱，因而诊之，有过毕呈，故乃可诊有过之脉。
切脉动静，而视精明，察五色，观五脏有余不足，六腑强弱，形之盛衰，以此参伍，决死生之分。
诊脉之法，其一在于切脉动静，或阳动阴静，或阴动阳静也。其一在于视精明，视其人能审情辨物，
与不能审情辨物也。其一在于察五色，察人面容之色，藏而不露与露而不藏也。其一在于观五
藏有余不足，有余则得其守，不足则失其守。其一在于观六腑强弱，形之盛衰，形盛则腑强，形衰则腑
弱。以此五者，参伍揆度，可以决其死生之分，此诊脉之法也。
夫脉者，血之府也，长则气治，短则气病，数则烦心，大则病进，上盛则气高，下盛则气胀，代
则气衰，细则气少，涩则心痛，浑浑革至如涌泉，病进而色弊，绵绵其去如弦绝，死。
数，音朔，下同。所谓切脉动静者，以脉主气，而为血之府也。脉长则阳气有余，故气治。脉短
则阳气不足，故气病。脉数则火热内乘，故烦心。脉大则邪气有余，故病进。上盛，寸口脉盛也，寸
口脉盛，主气上升，故气高。下盛，尺中脉盛也，尺中脉盛，主气下逆，故气胀。脉代，乃动而中止，不
能自还，此阳气之衰也。脉细，乃萦萦如蜘蛛丝，此阳气之少也。脉涩乃来去不知，此血竭心
虚，故心痛。浑浑，浊乱不次之意。革至如涌泉，应指杂 之意。脉去如是，则知气血内败而将死矣。
此切脉动静之要也。
夫精明者，所以视万物，别白黑，审短长。以长为短，以白为黑，如是则精衰矣。
旧本在“其寿不久也”下，今改正于此。所谓视精明者，所以视万物之众，其间之白黑能别，
短长能审，此人之精明者也。若不能审，而以衰为短；不能别，而以白为黑，此人之不精明者也。故
曰∶如是则精衰。此视精明之法也。
夫精明五色者，气之华也。赤欲如白裹朱，不欲如赭；白欲如鹅羽，不欲如盐；青欲如苍璧之泽，
不欲如蓝；黄欲如罗裹雄黄，不欲如黄土；黑欲如重漆色，不欲如地苍。五色精微象见矣，其寿不久也。
重，平声。所谓察五色者，面容之色，亦贵精明，故曰，夫精明五色者，乃神气之华于外也。色有赤
白青黄黑，赤欲如白之裹朱，不欲如赭之纯赤；白欲如鹅羽之光润，不欲如盐之呆白，青欲如苍
壁之滑泽，不欲如蓝之干枯；黄欲如丝罗之裹雄黄，不欲如黄土之槁燥；黑欲如重漆之光亮，不欲如地苍之
黑黯。盖五色外呈，精微内藏。如五色精微之象，俱见于外，是露而不藏，故其寿不久也。
此察五色之法也。
五脏者，中之守也，中盛藏满，气胜伤恐者，声如从室中言，是中气之湿也。言而微，终日乃复
言者，此夺气也。衣被不敛，言语善恶，不避亲疏者，此神明之乱也。仓廪不藏者，是门户不要
也。水泉不止者，是膀胱不藏也。得守者生，失守者死，夫五脏者，身之强也。
不藏之脏，如字。所谓观五脏有余不足者，以五脏神气在中，
乃中之内守也。邪实则中盛，脏满正虚，则气胜伤恐。人之音声，
起于肾，出于肺，会于中土。若中盛脏满，气胜伤恐者，则声如从室中言，此中土壅滞，致肺肾不交，
故曰是中气之湿也。若言而微，终日乃复言者，此生气不能上出于肺，故曰此夺气也，此五脏
神气不和于上下也。若五脏神气不和于外内，致衣被不敛，言语善恶不避亲疏者，此神明外脱而昏乱也。若
仓廪不藏而洞泄者，是魄门幽户之不要也。水泉不止而遗溺者，是膀胱水泄之不藏也。此神机内殒而泄注也。
五脏者，中之守，得守则神气保固而生，失守则神气离脱而死。由此言之，夫五脏者，不但为中之内守，亦
为身之外强也。此观五脏有余不足之法也。
头者，精明之府，头倾视深，精神将夺矣。背者胸中之府，背曲肩随，府将坏矣。腰者肾之府，转
摇不能，肾将惫矣。膝者筋之府，屈伸不能，行则偻府，筋将惫矣。骨者髓之府，不能久立，行
则振掉，骨将惫矣。得强则生，失强则死。
所谓观六腑强弱，形之盛衰者，以在外之形身论之，则头背腰膝骨，皆谓之府。人身精气上会于头，
神明上出于目，故头者，精明之府。若头倾视深，则精气神明，不上行于头，而精神将夺矣。
胸在内，背在外，故背者胸中之府。若背曲肩随，则胸中之气，不行于背，而府将坏矣。肾居腰内，故腰者肾
之府。若转摇不能，则腰骨空虚，而肾将惫矣。大筋联属于膝，故膝者筋之府。若屈伸不能，行则伛偻根据附，
膝软而不坚，而筋将惫矣。髓藏骨内，故骨者髓之府。若不能久立，行则振掉，则精髓内枯，而骨将惫矣。
此六腑强弱，属于形之盛衰，故以头背腰膝骨为府。得强则形身之府气盛，故生；失强则形身之府气衰，
故死。此观六腑强弱形之盛衰之法也。
岐伯曰∶反四时者，有余为精，不足为消。应太过，不足为精，应不足，有余为消。阴阳不相应，
病名曰关格。
上二“应”，平声。精，精强也；消，消弱也。上文切脉动静五者，岐伯皆申明之，而参伍以决死生，
未有申明，故岐伯复言以告帝。脉之大体，有余则为精，不足则为消。若反四时者，为精为
消，失其常度。故春夏之时，脉应太过，太过当以有余为精，今应太过，而以不足为精；秋冬之时，脉应
不足，不足当以不足为消，今应不足而以有余为消，此脉与四时之阴阳不相应，病名曰关格。
关，不得小便也；格，吐逆也。脉反四时，得其病情，更当以此参伍，决其死生，故复言之。此一节，
论诊脉之大纲，而为脉要之精微也。
帝曰∶脉其四时动奈何？知病之所在奈何？知病之所变奈何？
知病之乍在内奈何？知病乍在外奈何？请问此五者，可得闻乎？
帝承岐伯之论，复举五者以问。以此五者，亦脉要之精微也。
岐伯曰∶请言其与天运转大也。万物之外，六合之内，天地之变，阴阳之应，彼春之暖，
为夏之暑，彼秋之忿，为冬之怒，四变之动，脉与之上下。
人之阴阳升降，如天运之环转广大，故曰请言其与天运转大也。天运转大，包乎万物之外，行于六
合之内，天施地生，则有天地之变，人之阴阳应乎天地，则有阴阳之应。天地有四时之气，故
彼春之暖。为夏之暑，彼秋之忿，为冬之怒。夫春暖夏暑，秋忿冬怒，乃四变也，有是变，则有是气，乃
四变之动也。人之脉象，与四变之动气相为上下也。
以春应中规，夏应中矩，秋应中衡，冬应中权。
应，平声，中，去声。所以与之上下者，春时天气始生，脉应软弱浮滑，则圆转而中规之度矣。夏时
天气正方，脉应洪大周遍，则充满而中矩之度矣。秋时天气始降，脉应平静轻虚，则平准而中衡之度矣。冬
时天气闭藏，脉应沉石深重，则下沉而中权之度矣。此四变之动，而脉与之上下也。
是故冬至四十五日，阳气微上，阴气微下；夏至四十五日，阴气微上，阳气微下。阴阳有时，
与脉为期，期而相失，知脉所分，分之有期，故知死期。
脉与四时阴阳，相为上下，不可相失。是故冬至四十五日，冬至一阳初生，从冬至至立春，阳气微
上。阳气微上，则阴气微下矣。
夏至四十五日，夏至一阴初生，从夏至至立秋，阴气微上。阴气微上，则阳气微下矣。阴阳上下有时，即
与人身之脉为期，至期而不上下，是期而相失也。分别其阳气不上，阴气不上，是知脉之所分
也。阳气不上，死于春；阴气不上，死于秋。是分之有期，故知死时也。
微妙在脉，不可不察，察之有纪，从阴阳始，始之有经，从五行生，生之有度，四时为宜，补
泻勿失，与天地如一，得一之情，以知死生。
人身之脉，一如天地，至微至妙，故微妙在脉，不可不察也。察之有纪，从阴阳始，即冬至阳气微
上，夏至阴气微上也。始之有经，从五行生，谓冬至至立春，水生木也；夏至至立秋，火生土，
土生金也。生之有度，四时为宜，言木火土金水五行相生，有其常度，与春夏秋冬四时相合而为宜也。
四时之气有太过，有不及，不及补之，太过泻之。补泻勿失，则人身阴阳，与天地如一之情，可以知其死生矣。
是故声合五音，色合五行，脉合阴阳。是知阴盛则梦涉大水恐惧，阳盛则梦大火燔灼，阴阳
俱盛则梦相杀毁伤；上盛则梦飞，下盛则梦堕；甚饱则梦予，甚饥则梦取；肝气盛则梦怒，肺气盛则梦
哭；短虫多则梦聚众，长虫多则梦相击毁伤。
人身动静，皆有阴阳。是故声合五音，声有阴阳也；色合五行。色有阴阳也；脉合阴阳，脉有阴
阳也。得其相合之义，不但日之声色，合于阴阳，即夜之梦象，亦合阴阳。是知阴盛，则梦涉大水
恐惧。水，阴象也；恐惧，肾病也。阳盛则梦大火燔灼。火，阳象也，燔灼，心病也。阴阳俱盛则水火亢害，
故梦相杀毁伤。相杀，争战也；毁伤，俱败也。上盛则气并于上，故梦飞。飞者，肝藏魂
而上升也。下盛则气并于下，故梦堕。堕者，肺藏魄而下降也。此水阴火阳，木浮金沉之义。若饱若饥，
脾土主之。甚饱，则土气有余，故梦予；甚饥则土气不足，故梦取。肝气盛则梦怒，怒则气上
也，肺气盛则梦哭，哭则气下也。虫生于胃。短虫多则相聚成群，
故梦聚众；长虫多则彼此参商，故梦相击毁伤。此五脏阴阳而形诸梦，亦声合五音，色合五行，脉合阴阳之义。
是故持脉有道，虚静为保。春日浮，如鱼之游在波；夏日在肤，泛泛乎万物有余；秋日下肤，蛰
虫将去∶冬日在骨，蛰虫周密，君子居室。
四时之脉，各不同形，是故持脉有道，虚静为保。虚，清虚；静，宁静；保，保守勿失也。春日，气机
从下而上，故春日脉浮，其形如鱼之游在波；夏日，气机充满于外，故夏日之脉在肤，其形
泛泛乎如万物之有余；秋日，气机从外而内，故秋日之脉下肤，其形如蛰虫之将去；冬日，气机内藏而伏，故
冬日之脉在骨，其形如蛰虫之周密，复如君子之居室。
故曰∶知内者按而纪之，知外者终而始之。此六者，持脉之大法。
春夏脉浮，其形在外；秋冬脉沉，其形在内。重手按脉，纪其至数，则知在内之脉，故曰∶知内者按
而纪之。轻按为始，重按为终，由重而轻，则知在外之脉，故知外者终而始之。此内外按纪终
始六者，乃持脉之大法。以上答帝脉其四时动之问者如此。
心脉搏坚而长，当病舌卷不能言；其软而散者，当消，环自已。
散，上声，下同。搏坚，邪正相持之脉也；长，脉体有余也；要散，脉体不及也。心脉搏坚而长，则
心气受邪而壅滞，故当病舌卷不能言；其软而散者，此为不及之脉，心液内虚，故当消渴。心
藏神，神机环转，消渴自愈，故环自已。
肺脉搏坚而长，当病唾血；其软而散者，当病灌汗，至令不复散发也。
“散发”之“散”如字。肺脉搏坚而长，则邪实于肺，金受火刑，故当病唾血；其脉软而散者，肺气
不能通调，故当病灌汗。灌汗，脾土灌溉之汗也。脾津外泄，至令肺气不复散发也。散，四散；发，宣发也。
肝脉搏坚而长，色不青，当病坠，若搏，因血在胁下，令人喘逆；其软而散，色泽者，当病
溢饮。溢饮者，渴暴多饮，而易入肌皮肠胃之外也。
易，去声。肝脉搏坚而长，则邪实于肝，肝病色青，今色不青，是伤其形体，不涉气分，故当病坠，
若搏。坠，堕伤也，搏，击伤也。坠若搏，因而血在胁下。血在胁下，则枢机不利，升降不
和，故令人喘逆。其脉软而散，其色不但不青，反润泽者，当病溢饮。溢饮乃肝血不能热肉充肤，致有
水泛之病，故申明溢饮者，乃渴暴多饮，其饮不能疏泄于下，而易入肌皮肠胃之外也。
胃脉搏坚而长，其色赤，当病折髀；其软而散者，当病食痹。
折，音舌，下同。胃脉搏坚而长，则邪实于胃，阳明多气多血，故色赤；不能下络于脾，故当病折髀。
其脉软而散，则中焦不能腐化，故当病食痹。
脾脉搏坚而长，其色黄，当病少气；其耍而散，色不泽者，当病足 肿，若水状也。
脾脉软坚而长，则邪实于脾，土气外浮，故其色黄；太阴地气，不交于肺，故当痛少气。其脉耍而散，
则气不外荣，其色但黄不华泽者，乃火不生土，火土皆虚，故当病足 肿，若水状也。
肾脉搏坚而长，其色黄而赤者，当病折腰，其软而散者，当病少血，至令不复也。
脉诊的精要，极其精微。通过切按脉搏的动静，观察眼睛的神采，审视面部的五色，考察五脏的有余与不足，六腑的强与弱，以及形体的盛与衰，综合参互比较以决断生死，这就是脉诊精要的精髓所在。脉搏随四季变化而变动，据此可知病邪所在的部位，了解病情的变化，知晓病邪有时在内、有时在外，这也是脉诊精要的体现。反复详细阐明，才能掌握脉诊精要的奥妙。
黄帝问道：诊察的方法是怎样的？
想要详尽了解脉诊的精微之处，先要了解诊察的基本方法。
岐伯回答说：诊脉通常选择在清晨（平旦），此时阴气尚未躁动，阳气尚未耗散，饮食尚未摄入，经脉气血未充盛，络脉气血调和均匀，整体气血未乱，因此可以诊察出有异常的脉象。
清晨之时，阴气宁静而未动，阳气聚敛而未散，这时饮食未进，则经脉中的气血未显盛势，络脉中的气血调和均匀，未盛且调匀意味着气血未乱，因而在此时诊察，所有的异常都会显露出来，所以能够诊察出有病的脉象。
切按脉搏的动静，同时观察眼睛的神采，审视面部的五色，考察五脏的有余与不足，六腑的强与弱，形体的盛与衰，用这五点综合参互比较，可以决断生死的界限。
诊脉的方法，其一在于切按脉搏的动静，无论是阳动阴静，还是阴动阳静。其二在于观察眼睛的神采，看患者能否审辨情状和事物，或者不能审辨情状和事物。其三在于审视面部的五色，观察人面容的颜色，是藏而不露，还是露而不藏。其四在于考察五脏的有余与不足，有余则能守住本位，不足则失去守持。其五在于考察六腑的强弱和形体的盛衰，形体盛则腑气强，形体衰则腑气弱。用这五点综合衡量，可以决断生死的界限，这就是诊脉的方法。
脉，是血液汇聚的府库。脉长则气机调治，脉短则气机有病，脉数则心中烦闷，脉大则病情进展，上部（寸口）脉盛则气机上逆，下部（尺中）脉盛则腹部胀满，脉代（间歇）则气机衰弱，脉细则气血亏少，脉涩则心痛，脉象浑浑乱如涌泉般急促，病情加重且面色败坏，脉去绵绵如弦断绝，主死。
数，音朔，以下同。所谓切按脉搏动静，是因为脉主气，而为血之府库。脉长则阳气有余，所以气机调治。脉短则阳气不足，所以气机有病。脉数则火热内侵，所以心中烦闷。脉大则邪气有余，所以病情进展。上部盛，指寸口脉盛，寸口脉盛，主气上升，所以气机上逆。下部盛，指尺中脉盛，尺中脉盛，主气下逆，所以腹部胀满。脉代，是跳动中止，不能自行恢复，这是阳气衰弱的表现。脉细，像蜘蛛丝一样细微，这是阳气稀少的表现。脉涩，来去不知，这是血竭心虚，所以心痛。浑浑，意为浊乱无次序。脉至如涌泉般杂乱急促，应指杂乱。脉去如此，则知气血内部败坏而将死亡。这是切按脉搏动静的要点。
精明，是用来视万物、辨黑白、审长短的。如果把长看作短，把白看作黑，这说明精气已经衰竭了。
旧版在“其寿不久也”之下，现改正于此。所谓视精明，是指能看清万物众多，辨别其中的黑白，审察长短，这是人的精明表现。如果不能审察，把衰看作短；不能辨别，把白看作黑，这是人不精明的表现。所以说：像这样就是精气衰竭。这是观察精明的方法。
精气和五色，是气的荣华表现。赤色欲像白布裹着朱砂，不欲像赭石那样纯赤；白色欲像鹅毛那样光润，不欲像盐那样呆白；青色欲像青玉那样滑泽，不欲像蓝草那样干枯；黄色欲像丝罗裹着雄黄，不欲像黄土那样枯槁燥裂；黑色欲像重漆那样光亮，不欲像地苍那样黑黯。如果五色的精微之象显露于外，人的寿命就不长了。
重，读平声。所谓察五色，面容之色，也贵在精明，所以说，精气和五色，是神气在外的荣华。色有赤、白、青、黄、黑，赤色欲像白布裹着朱砂，不欲像赭石那样纯赤；白色欲像鹅毛那样光润，不欲像盐那样呆白；青色欲像青玉那样滑泽，不欲像蓝草那样干枯；黄色欲像丝罗裹着雄黄，不欲像黄土那样枯槁燥裂；黑色欲像重漆那样光亮，不欲像地苍那样黑黯。因为五色外呈，精微内藏。如果五色的精微之象都见于外，是露而不藏，所以寿命不长。这是观察五色的方法。
五脏，是体内的守持者。如果中焦盛实、脏满，气胜伤恐，声音像从室中发出，这是中气有湿。说话声音微弱，整天才说一句话，这是夺气。衣被不整理，言语不分善恶，不避亲疏，这是神明混乱。仓廪（肠胃）不能藏纳，是门户（肛门）不固。水泉（小便）不止，是膀胱不能藏纳。得守持者生，失守持者死。五脏，是身体强健的根本。
不藏之脏，即字面意思。所谓观五脏有余不足，是以五脏神气在中，乃体内的内守。邪实则中盛，脏满正虚，则气胜伤恐。人的音声，起于肾，出于肺，会于中土。如果中盛脏满，气胜伤恐，则声音像从室中发出，这是中土壅滞，导致肺肾不交，所以说这是中气有湿。如果说话声音微弱，整天才说一句话，这是生气不能上出于肺，所以说这是夺气，这是五脏神气上下不和。如果五脏神气内外不和，导致衣被不整理，言语不分善恶、不避亲疏，这是神明外脱而昏乱。如果仓廪不藏而洞泄，是魄门幽户不固。水泉不止而遗尿，是膀胱水泄不藏。这是神机内殒而泄注。五脏是体内的守持，得守则神气保固而生，失守则神气离脱而死。由此而言，五脏不但为体内的内守，也是身体的外在强健根本。这是观察五脏有余不足的方法。
头，是精明的府库。头倾视深，精神将要耗夺了。背，是胸中的府库。背曲肩随，府库将要坏了。腰，是肾的府库。转摇不能，肾将要疲惫了。膝，是筋的府库。屈伸不能，行走则伛偻依附，筋将要疲惫了。骨，是髓的府库。不能久立，行走则振掉，骨将要疲惫了。得强健则生，失强健则死。
所谓观六腑强弱，形体的盛衰，是从在外的形身来说的，那么头、背、腰、膝、骨，都称为府。人身精气上会于头，神明上出于目，所以头是精明的府库。如果头倾视深，则精气神明不上行于头，而精神将要耗夺。胸在内，背在外，所以背是胸中的府库。如果背曲肩随，则胸中之气不行于背，而府库将要坏。肾居腰内，所以腰是肾的府库。如果转摇不能，则腰骨空虚，而肾将要疲惫。大筋联属于膝，所以膝是筋的府库。如果屈伸不能，行走则伛偻依附，膝软而不坚，而筋将要疲惫。髓藏骨内，所以骨是髓的府库。如果不能久立，行走则振掉，则精髓内枯，而骨将要疲惫。这是六腑强弱，属于形体的盛衰，所以以头、背、腰、膝、骨为府。得强健则形身之府气盛，故生；失强健则形身之府气衰，故死。这是观察六腑强弱、形体盛衰的方法。
岐伯说：脉象违背四时规律，有余表现为精强，不足表现为消弱。应当太过却不足，表现为精强；应当不足却有余，表现为消弱。阴阳不相适应，病名叫做关格。
上两个“应”字，读平声。精，指精强；消，指消弱。上文切脉动静的五种情况，岐伯都已申述，并综合参互以决断生死，但未有进一步申明，所以岐伯再次言说来告诉黄帝。脉的大体，有余则为精强，不足则为消弱。如果违背四时规律，表现为精或消，就失去了常度。所以在春夏之时，脉应太过，太过当以有余为精，现在应当太过，却以不足为精；秋冬之时，脉应不足，不足当以不足为消，现在应当不足，却以有余为消，这是脉与四时的阴阳不相适应，病名叫做关格。
关，指不得小便；格，指吐逆。脉反四时，得其病情，更应当以此综合参互，决断生死，所以再次言说。这一节，论述诊脉的大纲，是脉诊精要的体现。
黄帝说：脉象随四季变动是怎样的？如何知道病邪所在？如何知道病情的变化？如何知道病邪有时在内、有时在外？请问这五点，可以听您讲讲吗？
黄帝承接岐伯的论述，再次列举这五点来询问。因为这五点，也是脉诊精要的体现。
岐伯说：请让我谈谈它与天体运转广大相应的道理。万物之外，六合之内，天地的变化，阴阳的应对，那春天的温暖，化为夏天的暑热，那秋天的肃杀，化为冬天的严寒，四季变化的运动，脉象随之上下相应。
人体的阴阳升降，如天体运转环转广大，所以说请谈谈它与天体运转广大相应。天体运转广大，包乎万物之外，行于六合之内，天施地生，则有天地之变，人体阴阳顺应天地，则有阴阳之应。天地有四时之气，所以那春天的温暖，化为夏天的暑热，那秋天的肃杀，化为冬天的严寒。春暖夏暑，秋忿冬怒，乃是四变，有此变，就有此气，乃是四变的运动。人体的脉象，与四变之动气相为上下相应。
春天脉象应合乎规（圆），夏天脉象应合乎矩（方），秋天脉象应合乎衡（平），冬天脉象应合乎权（重）。
应，读平声，中，读去声。与之上下相应的原因，是春时天气始生，脉象应软弱浮滑，则圆转而合乎规的尺度。夏时天气正方，脉象应洪大周遍，则充满而合乎矩的尺度。秋时天气始降，脉象应平静轻虚，则平准而合乎衡的尺度。冬时天气闭藏，脉象应沉石深重，则下沉而合乎权的尺度。这是四变的运动，脉象随之上下相应。
因此冬至后四十五日，阳气微微上升，阴气微微下降；夏至后四十五日，阴气微微上升，阳气微微下降。阴阳各有定时，与脉象的周期相应，到了期限而脉象失常，知道脉象所分的部位，分位有定期，所以知道死亡的日期。
脉象与四时阴阳，相为上下，不可相失。因此冬至后四十五日，冬至一阳初生，从冬至到立春，阳气微微上升。阳气微微上升，则阴气微微下降。
夏至后四十五日，夏至一阴初生，从夏至到立秋，阴气微微上升。阴气微微上升，则阳气微微下降。阴阳上下各有定时，即与人身之脉的周期相应，到了期限而不上下变化，是期限而相失。分别其阳气不上升，阴气不上升，是知道脉象所分的部位。阳气不上升，死于春季；阴气不上升，死于秋季。是分位有定期，所以知道死亡的时间。
脉象微妙，不可不考察，考察它有纲纪，从阴阳开始，开始它有常规，从五行相生，相生有法度，以四时为适宜，补泻不失时机，与天地一致，得到这种情理，就可以知道生死。
人身之脉，一如天地，至微至妙，所以脉象微妙，不可不考察。考察它有纲纪，从阴阳开始，即冬至阳气微微上升，夏至阴气微微上升。开始它有常规，从五行相生，谓冬至至立春，水生木；夏至至立秋，火生土，土生金。相生有法度，以四时为适宜，言木火土金水五行相生，有其常度，与春夏秋冬四时相合而适宜。四时之气有太过，有不及，不及则补之，太过则泻之。补泻不失时机，则人身阴阳，与天地一致的情理，可以知道生死。
因此声音符合五音，颜色符合五行，脉象符合阴阳。由此知道阴盛则梦见渡大水恐惧，阳盛则梦见大火燃烧，阴阳俱盛则梦见互相杀戮毁伤；上部盛则梦见飞翔，下部盛则梦见坠落；非常饱则梦见给予，非常饿则梦见索取；肝气盛则梦见发怒，肺气盛则梦见哭泣；短虫多则梦见聚集众人，长虫多则梦见互相击打毁伤。
人体动静，皆有阴阳。因此声音符合五音，声音有阴阳；颜色符合五行，颜色有阴阳；脉象符合阴阳，脉象有阴阳。得到这种相合的意义，不仅白天之声色，合于阴阳，就连夜晚之梦象，也合于阴阳。由此知道阴盛，则梦见渡大水恐惧。水，是阴象；恐惧，是肾病。阳盛则梦见大火燃烧。火，是阳象，燃烧，是心病。阴阳俱盛则水火亢害，所以梦见互相杀戮毁伤。相杀，是争战；毁伤，是俱败。上部盛则气并于上，所以梦见飞翔。飞者，肝藏魂而上升。下部盛则气并于下，所以梦见坠落。堕者，肺藏魄而下降。这是水阴火阳，木浮金沉的意义。若饱若饥，由脾土主之。非常饱，则土气有余，所以梦见给予；非常饿则土气不足，所以梦见索取。肝气盛则梦见发怒，怒则气上也，肺气盛则梦见哭泣，哭则气下也。虫生于胃。短虫多则相聚成群，所以梦见聚集众人；长虫多则彼此参商，所以梦见互相击打毁伤。这是五脏阴阳而形诸梦境，也是声音合五音，颜色合五行，脉象合阴阳的意义。
因此持脉有法则，清虚宁静为保。春日脉浮，像鱼游在波中；夏日脉在肤，泛泛乎万物有余；秋日脉下肤，像蛰虫将要离去；冬日脉在骨，像蛰虫周密，君子居室。
四时之脉，各不同形，因此持脉有法则，清虚宁静为保。虚，指清虚；静，指宁静；保，指保守勿失。春日，气机从下而上，所以春日脉浮，其形像鱼游在波中；夏日，气机充满于外，所以夏日之脉在肤，其形泛泛乎像万物之有余；秋日，气机从外而内，所以秋日之脉下肤，其形像蛰虫之将去；冬日，气机内藏而伏，所以冬日之脉在骨，其形像蛰虫之周密，又像君子之居室。
所以说：了解内在的脉象，重按以记录其至数；了解外在的脉象，从轻按开始到重按结束。这六点，是持脉的大法。
春夏脉浮，其形在外；秋冬脉沉，其形在内。重手按脉，记录其至数，则知内在的脉，所以说：了解内在的脉，重按以记录其至数。轻按为始，重按为终，由重而轻，则知外在的脉，所以了解外在的脉，从轻按开始到重按结束。这内外按纪终始六点，乃是持脉的大法。以上回答黄帝关于脉象随四季变动的问题。
心脉搏坚而长，应当病舌卷不能言；其软而散的，应当消渴，环绕自愈。
散，读上声，以下同。搏坚，是邪正相持的脉象；长，是脉体有余；要散，是脉体不及。心脉搏坚而长，则心气受邪而壅滞，所以应当病舌卷不能言；其软而散的，这是不及之脉，心液内虚，所以应当消渴。心藏神，神机环转，消渴自愈，所以环绕自愈。
肺脉搏坚而长，应当病唾血；其软而散的，应当病灌汗，至今不再散发。
“散发”的“散”读原字。肺脉搏坚而长，则邪实于肺，金受火刑，所以应当病唾血；其脉软而散的，肺气不能通调，所以应当病灌汗。灌汗，是脾土灌溉之汗。脾津外泄，至今肺气不复散发。散，四散；发，宣发。
肝脉搏坚而长，面色不青，应当病坠伤或击伤，因血在胁下，令人喘逆；其软而散，色泽润泽的，应当病溢饮。溢饮，是口渴暴多饮，而易入肌皮肠胃之外。
易，读去声。肝脉搏坚而长，则邪实于肝，肝病色青，今面色不青，是伤其形体，不涉气分，所以应当病坠伤或击伤。坠，是堕伤；搏，是击伤。坠或搏，因而血在胁下。血在胁下，则枢机不利，升降不和，所以令人喘逆。其脉软而散，其色不但不青，反润泽者，应当病溢饮。溢饮乃肝血不能热肉充肤，致有水泛之病，所以申明溢饮者，乃口渴暴多饮，其饮不能疏泄于下，而易入肌皮肠胃之外。
胃脉搏坚而长，面色赤，应当病折髀；其软而散的，应当病食痹。
折，音舌，以下同。胃脉搏坚而长，则邪实于胃，阳明多气多血，所以面色赤；不能下络于脾，所以应当病折髀。其脉软而散，则中焦不能腐化，所以应当病食痹。
脾脉搏坚而长，面色黄，应当病少气；其软而散，色不润泽的，应当病足肿，像水状。
脾脉搏坚而长，则邪实于脾，土气外浮，所以面色黄；太阴地气，不交于肺，所以应当痛少气。其脉软而散，则气不外荣，其色但黄不华泽者，乃火不生土，火土皆虚，所以应当病足肿，像水状。
The essence of pulse diagnosis is extremely subtle and refined. By palpating the movement and stillness of the pulse, observing the clarity of the eyes (Shen), examining the five colors of the face, assessing the excess and deficiency of the Zang organs (Five Viscera), the strength and weakness of the Fu organs (Six Bowels), and the flourishing or declining state of the physical form, one can comprehensively compare these factors to determine life and death. This constitutes the profound subtlety of pulse diagnosis. The pulse moves with the four seasons; by understanding this, one knows the location of the disease, its changes, and whether the pathogen is internal or external at any given time. This too is part of the profound subtlety of pulse diagnosis. Only through repeated and detailed elucidation can the essence of pulse diagnosis be understood.
Yellow Emperor asked: "What is the method of diagnosis?"
To fully understand the subtleties of pulse diagnosis, one must first understand the general methods of diagnosis.
Qibo replied: "Diagnosis is usually performed at dawn (Pingdan). At this time, Yin Qi has not yet become active, Yang Qi has not yet dispersed, food and drink have not been ingested, the Jing-Luo vessels are not yet full, the collateral vessels are harmonious and even, and the Qi and Blood are not yet chaotic. Therefore, it is possible to diagnose abnormal pulses."
At dawn, Yin is quiet and unmoved, while Yang is gathered but not scattered. Since no food or drink has been taken, the Qi and Blood in the Jing-Luo vessels are not yet vigorous, and those in the collateral vessels are harmonious and even. Because they are neither excessive nor disordered, the Qi and Blood remain undisturbed. Thus, diagnosing at this time allows all abnormalities to manifest, making it possible to detect pathological pulses.
Palpating the pulse's movement and stillness, observing the clarity of the eyes, examining the five colors, assessing the excess and deficiency of the Zang organs, the strength and weakness of the Fu organs, and the flourishing or declining state of the body, these five aspects are compared and weighed to determine the boundary between life and death.
The method of pulse diagnosis involves: First, palpating the pulse's movement and stillness, whether Yang moves and Yin is still, or vice versa. Second, observing the clarity of the eyes, determining if the patient can clearly perceive and distinguish objects and situations, or cannot. Third, examining the five colors on the face, noting whether the color is hidden or revealed. Fourth, assessing the excess and deficiency of the Zang organs; excess implies proper retention, while deficiency implies loss of retention. Fifth, evaluating the strength of the Fu organs and the state of the physical form; a robust form indicates strong Fu organs, while a declining form indicates weak Fu organs. By comparing these five aspects, one can determine life and death. This is the method of pulse diagnosis.
The pulse is the residence of Blood. A long pulse indicates regulated Qi; a short pulse indicates diseased Qi; a rapid pulse indicates vexation in the heart; a large pulse indicates advancing disease; an excess in the upper portion (Cun) indicates rising Qi; an excess in the lower portion (Chi) indicates abdominal distension; a intermittent pulse (Dai) indicates declining Qi; a fine pulse indicates deficient Qi and Blood; a choppy pulse indicates heart pain; a turbulent, rapid pulse like a gushing spring indicates advancing disease and deteriorating complexion; a pulse that fades away slowly like a breaking string indicates death.
"Rapid" (Shuo) is pronounced as such. The pulse governs Qi and serves as the residence of Blood. A long pulse indicates abundant Yang Qi, hence regulated Qi. A short pulse indicates insufficient Yang Qi, hence diseased Qi. A rapid pulse indicates internal invasion of Fire-Heat, hence heart vexation. A large pulse indicates excess Evil Qi, hence advancing disease. "Upper excess" refers to a full Cun pulse, indicating rising Qi, leading to Qi rebellion. "Lower excess" refers to a full Chi pulse, indicating descending Qi rebellion, leading to abdominal distension. An intermittent pulse (Dai) stops and fails to recover immediately, indicating decline of Yang Qi. A fine pulse is thread-like, indicating scarcity of Yang Qi. A choppy pulse is irregular, indicating exhaustion of Blood and Heart deficiency, leading to heart pain. "Hunhun" means turbid and disordered. A pulse coming like a gushing spring is chaotic and forceful. If the pulse goes thus, it indicates internal collapse of Qi and Blood and impending death. This is the key to palpating pulse movement and stillness.
Clarity (Jingming) is used to see all things, distinguish black from white, and judge length. If one mistakes long for short, or white for black, it indicates depletion of Essence.
In older editions, this was placed after "their lifespan will not be long," but it is corrected here. "Observing clarity" refers to the ability to see myriad things, distinguish black and white, and judge lengths. This is human clarity. If one cannot judge, mistaking decline for shortness, or cannot distinguish, mistaking white for black, it indicates lack of clarity. Thus, it is said: "This indicates depletion of Essence." This is the method of observing clarity.
Clarity and the five colors are the splendor of Qi. Red should resemble cinnabar wrapped in white silk, not pure red like hematite; white should resemble goose feathers, not dull white like salt; green should resemble the luster of dark jade, not dry like indigo; yellow should resemble realgar wrapped in silk, not dry like yellow earth; black should resemble lacquer, not dull like dark soil. If the subtle images of the five colors appear externally, the lifespan will not be long.
"Chong" is pronounced with the level tone. Examining the five colors requires facial clarity. Thus, it is said: Clarity and the five colors are the external splendor of Shen-Qi. Colors include red, white, green, yellow, and black. Red should look like cinnabar wrapped in white, not pure red like hematite. White should be lustrous like goose feathers, not dull like salt. Green should be smooth like dark jade, not dry like indigo. Yellow should be wrapped like silk around realgar, not dry like yellow earth. Black should be bright like lacquer, not dull like dark soil. Colors are presented externally, while essence is stored internally. If the subtle images of the five colors are exposed externally, it means exposure without storage, hence a short lifespan. This is the method of examining the five colors.
The Zang organs are the guardians within. If there is excess in the middle, organ fullness, and Qi overacting causing fear, the voice sounds as if coming from inside a room, indicating dampness in Middle Qi. If speech is faint and only resumes after a whole day, this is depletion of Qi. If clothing is disheveled, speech is inappropriate regardless of good or bad, and familiarity is ignored, this is confusion of Shen-Ming. If the granaries (intestines) cannot store, the gate (anus) is not secure. If water springs (urine) do not stop, the Bladder cannot store. Those who retain their guardianship live; those who lose it die. The Zang organs are the strength of the body.
Regarding "non-storing" organs: The Zang organs house Shen-Qi within, serving as internal guardians. Pathogenic excess leads to middle fullness, while organ fullness with righteous deficiency leads to Qi overacting and fear. Voice originates in the Kidney, emerges from the Lung, and converges in the Middle Earth (Spleen/Stomach). If middle is full and Qi overacts, voice sounds muffled, indicating stagnation in Middle Earth preventing Lung-Kidney communication, hence dampness in Middle Qi. Faint speech resuming daily indicates Sheng Qi failing to ascend from the Lung, hence depletion of Qi, indicating disharmony of Zang Shen-Qi above and below. If Zang Shen-Qi is disharmonious internally and externally, leading to disheveled clothing and inappropriate speech, it indicates Shen-Ming escaping and becoming confused. If intestines fail to store causing diarrhea, the anal gate is insecure. If urine leaks, the Bladder fails to store. This indicates internal collapse of Shen-Ji and leakage. The Zang organs are internal guardians; retaining them preserves Shen-Qi and life, losing them causes Shen-Qi to depart and death. Thus, the Zang organs are not only internal guardians but also the external strength of the body. This is the method of assessing Zang excess and deficiency.
The head is the residence of Jingming. If the head droops and eyes are sunken, Spirit is about to be depleted. The back is the residence of the Chest. If the back is curved and shoulders sag, the residence is about to fail. The waist is the residence of the Kidneys. If turning and shaking are impossible, the Kidneys are about to be exhausted. The knees are the residence of the Tendons. If flexion and extension are impossible, and walking requires stooping, the Tendons are about to be exhausted. The bones are the residence of Marrow. If standing for long periods is impossible, and walking causes trembling, the Bones are about to be exhausted. Retaining strength leads to life; losing strength leads to death.
Assessing Fu strength and physical form: Externally, the head, back, waist, knees, and bones are called residences. Essence and Qi converge at the head, and Shen emerges from the eyes; thus, the head is the residence of Jingming. Head drooping and sunken eyes indicate Essence and Shen failing to ascend, leading to Spirit depletion. The Chest is internal, the Back external; thus, the back is the residence of the Chest. Curved back and sagging shoulders indicate Chest Qi failing to reach the back, leading to residence failure. The Kidneys reside in the waist; inability to turn indicates empty waist bones and Kidney exhaustion. Large tendons connect to the knees; inability to move indicates soft knees and Tendon exhaustion. Marrow resides in bones; inability to stand and trembling during walking indicates dried-up Marrow and Bone exhaustion. These relate to Fu strength and physical flourishing/decline. Strength leads to life; weakness leads to death. This is the method of assessing Fu strength and physical form.
Qibo said: "Pulses contrary to the four seasons: Excess manifests as 'Jing' (strong/refined), deficiency manifests as 'Xiao' (wasting/weak). Responding to excess with deficiency manifests as Jing; responding to deficiency with excess manifests as Xiao. If Yin and Yang do not correspond, the disease is named Guan-Ge (Lock and Grid)."
"Responding" is pronounced level tone. "Jing" means strong/refined; "Xiao" means wasting/weak. Qibo elaborated on the five aspects of pulse diagnosis to determine life and death. Generally, excess is Jing, deficiency is Xiao. Contrary to seasons, this loses normal measure. In Spring/Summer, pulse should be excessive; excess should be Jing. Now, responding to excess with deficiency is Jing. In Autumn/Winter, pulse should be deficient; deficiency should be Xiao. Now, responding to deficiency with excess is Xiao. This mismatch between pulse and seasonal Yin-Yang is named Guan-Ge. "Guan" means inability to urinate; "Ge" means vomiting/regurgitation. Contrary pulses require comprehensive assessment to determine life and death. This section discusses the outline of pulse diagnosis, the essence of pulse subtleties.
Yellow Emperor asked: "How does the pulse move with the four seasons? How do we know the disease location? How do we know disease changes? How do we know if disease is internal or external? Please explain these five points."
Yellow Emperor, following Qibo's discussion, raised these five points as they are also essential to pulse subtleties.
Qibo said: "Let me speak of its correspondence with the great rotation of Heaven. Outside all things, within the Six Directions, changes in Heaven and Earth, responses of Yin and Yang: Spring warmth becomes Summer heat; Autumn severity becomes Winter cold. The movement of these four changes corresponds to the pulse moving up and down."
Human Yin-Yang ascent and descent mirror the vast rotation of Heaven. Heaven rotates beyond all things, within the Six Directions. Heaven gives, Earth generates, causing changes; Human Yin-Yang responds to Heaven and Earth. Four Seasons bring Qi: Spring warmth becomes Summer heat; Autumn severity becomes Winter cold. These four changes bring corresponding Qi. Human pulse corresponds up and down with these seasonal changes.
Spring pulse conforms to the Circle (Gui); Summer to the Square (Ju); Autumn to the Level (Heng); Winter to the Weight (Quan).
"Responding" is level tone; "Zhong" (conform) is departing tone. Spring weather generates; pulse is soft, floating, slippery, round like a circle. Summer weather is方正; pulse is洪大 (voluminous and large), filling like a square. Autumn weather descends; pulse is calm, light, void, level like a balance. Winter weather stores; pulse is deep, heavy, sinking like a weight. This is how pulse corresponds with four changes.
After Winter Solstice, 45 days: Yang Qi slightly ascends, Yin Qi slightly descends. After Summer Solstice, 45 days: Yin Qi slightly ascends, Yang Qi slightly descends. Yin and Yang have their times, corresponding to pulse cycles. If they miss the cycle, knowing the pulse division reveals the time of death.
Pulse and seasonal Yin-Yang correspond and must not be lost. After Winter Solstice (45 days), Yang Qi begins to rise (from Solstice to Start of Spring). Yang rises, Yin descends. After Summer Solstice (45 days), Yin Qi begins to rise (from Solstice to Start of Autumn). Yin rises, Yang descends. Yin-Yang timing corresponds to pulse cycles. Missing the cycle indicates deviation. Distinguishing non-ascending Yang or Yin reveals pulse divisions. Non-ascending Yang dies in Spring; non-ascending Yin dies in Autumn. Knowing the timing reveals the time of death.
Pulse subtleties must be examined. Examination has principles, starting from Yin-Yang. Principles follow Five Phases generation. Generation has limits, suitable for four seasons. Tonify and sedate without error, aligning with Heaven and Earth, knowing life and death.
Human pulse mirrors Heaven and Earth, subtle and wonderful. Examination starts with Yin-Yang (Winter Solstice Yang rises, Summer Solstice Yin rises). Principles follow Five Phases: Winter Solstice to Spring Start, Water generates Wood; Summer Solstice to Autumn Start, Fire generates Earth, Earth generates Metal. Generation has limits matching four seasons. Seasonal Qi has excess or deficiency; tonify deficiency, sedate excess. Correct tonification/sedation aligns human Yin-Yang with Heaven and Earth, revealing life and death.
Sound matches Five Tones, Color matches Five Phases, Pulse matches Yin-Yang. Thus, Yin excess dreams of crossing big water in fear; Yang excess dreams of fire burning; Yin-Yang excess dreams of killing/injury; Upper excess dreams of flying; Lower excess dreams of falling; Very full dreams of giving; Very hungry dreams of taking; Liver Qi excess dreams of anger; Lung Qi excess dreams of crying; Many short worms dream of crowds; Many long worms dream of fighting/injury.
Human movement/stillness has Yin-Yang. Sound matches Five Tones (Yin-Yang); Color matches Five Phases (Yin-Yang); Pulse matches Yin-Yang. Dream images also match Yin-Yang. Yin excess (Water/Yin/Kidney-Fear) dreams of water. Yang excess (Fire/Yang/Heart-Burning) dreams of fire. Yin-Yang excess (Water/Fire conflict) dreams of killing. Upper excess (Qi rising/Liver-Hun) dreams of flying. Lower excess (Qi descending/Lung-Po) dreams of falling. Full/Hungry relates to Spleen-Earth. Full (Earth excess) dreams of giving; Hungry (Earth deficiency) dreams of taking. Liver anger (Qi rising); Lung crying (Qi descending). Worms in Stomach. Short worms (crowds); Long worms (fighting). This reflects Five Zang Yin-Yang in dreams, matching sound/color/pulse principles.
Therefore, holding the pulse requires a method: Emptiness and Stillness are preserved. Spring pulse floats like fish in waves; Summer pulse is at skin, abundant like all things; Autumn pulse sinks to skin, like hibernating insects leaving; Winter pulse is in bone, like hibernating insects sealed, or gentleman in room.
Four season pulses differ. Method requires emptiness (clear) and stillness (quiet). Spring Qi rises; pulse floats like fish. Summer Qi fills outside; pulse at skin, abundant. Autumn Qi moves inward; pulse sinks like insects leaving. Winter Qi stores; pulse in bone like sealed insects or indoor gentleman.
Thus: Knowing internal, press deeply to record; knowing external, start light end deep. These six are major methods of holding pulse.
Spring/Summer pulse floats (external); Autumn/Winter pulse sinks (internal). Deep pressing records internal pulse ("Know internal, press to record"). Light start, deep end, going deep to light reveals external pulse ("Know external, end then start"). These six methods (internal/external, press/record, start/end) are major pulse methods. Answering Yellow Emperor's question on seasonal pulse movement.
Heart pulse firm, hard, and long: Disease tongue curling, inability to speak. Soft and scattered: Disease Xiao Ke (Wasting-Thirst), self-healing in cycles.
"Firm/hard" is struggle between Evil and Righteous; "Long" is excess pulse body; "Scattered" is deficient pulse body. Heart firm/hard/long indicates Heart Qi blocked by Evil, causing tongue curling/speechlessness. Soft/scattered indicates Heart Fluid deficiency, causing Wasting-Thirst. Heart houses Shen; Shen rotation heals Wasting-Thirst cyclically.
Lung pulse firm, hard, and long: Disease spitting blood. Soft and scattered: Disease Guan Han (Irrigating Sweat), never dispersing again.
"Lung firm/hard/long" indicates Evil in Lung, Metal受 Fire punishment, causing hemoptysis. "Soft/scattered" indicates Lung Qi failing to regulate, causing Guan Han (Spleen fluid sweat). Spleen fluid leaks, Lung Qi fails to disperse.
Liver pulse firm, hard, and long, color not green: Disease fall or blow injury, blood under hypochondrium, causing wheezing/reversal. Soft, scattered, lustrous color: Disease Yi Yin (Overflowing Drink). Yi Yin: Thirsty, sudden excessive drinking, fluid enters muscle/skin/intestines/stomach exterior.
"Liver firm/hard/long, no green" indicates Body injury, not Qi level. Fall/blow causes blood under hypochondrium. Blood stagnation blocks pivot, disrupts ascending/descending, causing wheezing. "Soft/scattered, lustrous" indicates Yi Yin. Liver Blood fails to warm flesh, causing water flooding. Excessive drinking, fluid fails to drain downward, enters exterior.
Stomach pulse firm, hard, and long, color red: Disease Zhe Bi (Broken Hip). Soft and scattered: Disease Shi Bi (Food Bi).
"Stomach firm/hard/long, red" indicates Evil in Stomach, Yangming abundant Qi/Blood. Fails to connect to Spleen, causing hip pain. "Soft/scattered" indicates Middle Jiao failing to rot/ripen, causing Food Bi.
Spleen pulse firm, hard, and long, color yellow: Disease Shao Qi (Shortness of Qi). Soft and scattered, color not lustrous: Disease Foot Swelling, like water.
"Spleen firm/hard/long, yellow" indicates Evil in Spleen, Earth Qi floating. Taiyin Earth fails to communicate with Lung, causing pain/shortness of breath. "Soft/scattered, dull yellow" indicates Fire failing to generate Earth, both deficient, causing foot swelling/water-like state.
Kidney pulse firm, hard, and long, color yellow-red: Disease Zhe Yao (Broken Waist). Soft and scattered: Disease Shao Xue (Deficient Blood), never recovering.