素问·平人气象论 Discourse on the Qi Manifestations of the Healthy Person
黄帝问曰：平人何如。歧伯对曰：人一呼脉再动，一吸脉亦再动，呼吸定息脉五动，闰以太息，命曰平人。平人者，不病也。常以不病调病人，医不病，故为病人平息以调之为法。人一呼脉一动，一吸脉一动，曰少气。人一呼脉三动，一吸脉三动而躁，尺热曰病温，尺不热脉滑曰病风，脉涩曰痹。人一呼脉四动以上曰死，脉绝不至曰死，乍踈乍数曰死。
平人之常气禀于胃，胃者，平人之常气也，人无胃气曰逆，逆者死。春胃微弦曰平，弦多胃少曰肝病，但弦无胃曰死，胃而有毛曰秋病，毛甚曰今病。藏真散于肝，肝藏劢膜之气也。夏胃微钩曰平，钩多胃少曰心病，但钩无胃曰死，胃而有石曰冬病，石甚曰今病。藏真通于心，心藏血脉之气也。长夏胃微耎弱曰平，弱多胃少曰脾病，但代无胃曰死，耎弱有石曰冬病，弱甚曰今病。藏真濡于脾，脾藏肌肉之气也。秋胃微毛曰平，毛多胃少曰肺病，但毛无胃曰死，毛而有弦曰春病，弦甚曰今病。藏真高于肺，以行荣卫阴阳也。冬胃微石曰平，石多胃少曰肾病，但石无胃曰死，石而有钩曰夏病，钩甚曰今病。藏真下于肾，肾藏骨髓之气也。胃之大络，名曰虚里，贯鬲络肺，出于左乳下，其动应衣，脉宗气也。盛喘数绝者，则病在中；结而横，有积矣；绝不至曰死。乳之下其动应衣，宗气泄也。
欲知寸口太过与不及，寸口之脉中手短者，曰头痛。寸口脉中手长者，曰足胫痛。寸口脉中手促上击者，曰肩背痛。寸口脉沈而坚者，曰病在中。寸口脉浮而盛者，曰病在外.寸口脉沈而弱，曰寒热及疝瘕少腹痛。寸口脉沈而横，曰脇下有积，腹中有横积痛。寸口脉沈而喘，曰寒热。脉盛滑坚者，曰病在外。脉小实而坚者，病在内。脉小弱以涩，谓之久病。脉滑浮而疾者，谓之新病。脉急者，曰疝瘕少腹痛。脉滑曰风。脉涩曰痹。缓而滑曰热中。盛而紧曰胀。
脉从阴阳，病易已；脉逆阴阳，病难已。脉得四时之顺，曰病无他；脉反四时及不闲藏，曰难已。
臂多青脉，曰脱血。尺脉缓涩，谓之解㑊，安卧脉盛，谓之脱血。尺涩脉滑，谓之多汗。尺寒脉细，谓之后泄。脉尺粗常热者，谓之热中。
肝见庚辛死，心见壬癸死，脾见甲乙死，肺见丙丁死，肾见戊己死，是谓真藏见皆死。
颈脉动喘疾咳，曰水。目里微肿如卧蚕起之状，曰水。溺黄赤安卧者，黄疸。已食如饥者，胃疸。面肿曰风。足胫肿曰水。目黄者曰黄疸。
妇人手少阴脉动甚者，妊子也。
脉有逆从四时，未有藏形，春夏而脉瘦，秋冬而脉浮大，命曰逆四时也。风热而脉静，泄而脱血脉实，病在中，脉虚，病在外，脉涩坚者，皆难治，命曰反四时也。
人以水谷为本，故人绝水谷则死，脉无胃气亦死。所谓无胃气者，但得真藏脉不得胃气也。所谓脉不得胃气者，肝不弦肾不石也。太阳脉至，洪大以长；少阳脉至，乍数乍踈，乍短乍长；阳明脉至，浮大而短。夫平心脉来，累累如连珠，如循琅玕，曰心平，夏以胃气为本。病心脉来，喘喘连属，其中微曲，曰心病。死心脉来，前曲后居，如操带钩，曰心死。平肺脉来，厌厌聂聂，如落榆荚，曰肺平，秋以胃气为本。病肺脉来，不上不下，如循鸡羽，曰肺病。死肺脉来，如物之浮，如风吹毛，曰肺死。平肝脉来，耎弱招招，如揭长竿末梢，曰肝平，春以胃气为本。病肝脉来，盈实而滑，如循长竿，曰肝病。死肝脉来，急益劲，如新张弓弦，曰肝死。平脾脉来，和柔相离，如鸡践地，曰脾平，长夏以胃气为本。病脾脉来，实而盈数，如鸡举足，曰脾病。死脾脉来，锐坚如乌之喙，如鸟之距，如屋之漏，如水之流，曰脾死。平肾脉来，喘喘累累如钩，按之而坚，曰肾平，冬以胃气为本。病肾脉来，如引葛，按之益坚，曰肾病。死肾脉来，发如夺索，辟辟如弹石，曰肾死。
Huangdi asked: What is the pulse of a healthy person like? Qibo replied: In a person, with one exhalation the pulse beats twice, and with one inhalation the pulse also beats twice; over a complete breath, counting the pause between breaths, the pulse beats five times — this is called a healthy person. A healthy person is one who is free of disease. One should always use a person free of disease to regulate the diagnosis of a sick person; since the physician himself is not ill, he uses his own settled breathing to regulate the count for the patient — this is the rule. When a person's pulse beats only once with each exhalation and once with each inhalation, this is called insufficiency of qi. When a person's pulse beats three times with each exhalation and three times with each inhalation and is agitated, with heat at the cubit position, this is called warm disease; if the cubit is not hot but the pulse is slippery, this is called wind disease; if the pulse is rough, this is called impediment. When a person's pulse beats four times or more with each exhalation, this indicates death; when the pulse is cut off and fails to arrive, this indicates death; when the pulse is at times sparse and at times rapid, this indicates death.
The constant qi of a healthy person is endowed by the stomach; the stomach is the constant qi of a healthy person. When a person lacks stomach qi, this is called rebellion, and one in rebellion dies. In spring, when the stomach pulse is slightly wiry, this is called healthy; when it is very wiry with little stomach qi, this is called liver disease; when it is purely wiry with no stomach qi at all, this indicates death; when there is stomach qi together with a hair-like floating quality, this indicates a disease due in autumn, and if the hair-like quality is pronounced, the disease is present now. The true qi of the viscus is dispersed through the liver, which stores the qi of the sinews and membranes. In summer, when the stomach pulse is slightly hook-like, this is called healthy; when it is very hook-like with little stomach qi, this is called heart disease; when it is purely hook-like with no stomach qi at all, this indicates death; when there is stomach qi together with a stone-like sunken quality, this indicates a disease due in winter, and if the stone-like quality is pronounced, the disease is present now. The true qi of the viscus penetrates through the heart, which stores the qi of the blood and vessels. In late summer, when the stomach pulse is slightly soft and weak, this is called healthy; when it is very weak with little stomach qi, this is called spleen disease; when it is purely intermittent with no stomach qi at all, this indicates death; when soft and weak together with a stone-like quality, this indicates a disease due in winter, and if the weakness is pronounced, the disease is present now. The true qi of the viscus moistens the spleen, which stores the qi of the muscles and flesh. In autumn, when the stomach pulse is slightly hair-like, this is called healthy; when it is very hair-like with little stomach qi, this is called lung disease; when it is purely hair-like with no stomach qi at all, this indicates death; when hair-like together with a wiry quality, this indicates a disease due in spring, and if the wiry quality is pronounced, the disease is present now. The true qi of the viscus rises up to the lung, by which it circulates the nutritive and defensive qi, and yin and yang. In winter, when the stomach pulse is slightly stone-like, this is called healthy; when it is very stone-like with little stomach qi, this is called kidney disease; when it is purely stone-like with no stomach qi at all, this indicates death; when stone-like together with a hook-like quality, this indicates a disease due in summer, and if the hook-like quality is pronounced, the disease is present now. The true qi of the viscus descends to the kidney, which stores the qi of the bones and marrow. The great connecting vessel of the stomach is called Xu Li; it passes through the diaphragm and connects with the lung, emerging below the left breast, where its beating can be felt through the clothing — this is the pulse of the ancestral qi. If it is exuberant, panting, and frequently intermittent, the disease is in the interior; if it is knotted and moves crosswise, there is an accumulation; if it is cut off and fails to arrive, this indicates death. When the beating below the breast can be felt through the clothing, this shows that the ancestral qi is leaking away.
To know the excess and insufficiency of the cun kou pulse at the wrist: when the cun kou pulse felt beneath the hand is short, this indicates headache; when it is long, this indicates pain in the feet and shins; when it is hurried and strikes upward, this indicates pain in the shoulders and back. When the cun kou pulse is sunken and hard, this indicates disease in the interior; when it is floating and exuberant, this indicates disease on the exterior. When it is sunken and weak, this indicates cold-heat together with abdominal masses and pain in the lower abdomen. When it is sunken and moves crosswise, this indicates accumulation below the ribs, with pain from a crosswise accumulation in the abdomen. When it is sunken and racing, this indicates cold-heat. When the pulse is exuberant, slippery, and hard, this indicates disease on the exterior; when it is small, replete, and hard, the disease is in the interior. When the pulse is small, weak, and rough, this is called a long-standing disease; when it is slippery, floating, and rapid, this is called a new disease. When the pulse is tense, this indicates abdominal masses with pain in the lower abdomen. A slippery pulse indicates wind; a rough pulse indicates impediment; a moderate and slippery pulse indicates heat in the interior; an exuberant and tight pulse indicates distension.
When the pulse follows yin and yang appropriately, the disease is easy to cure; when the pulse runs contrary to yin and yang, the disease is difficult to cure. When the pulse accords with the proper sequence of the four seasons, it is said that the disease presents no complications; when the pulse runs contrary to the four seasons, or fails to correspond well to its governing viscus, it is said to be difficult to cure.
When there are many bluish-green vessels visible on the arm, this indicates loss of blood. When the cubit pulse is moderate and rough, this is called the languor-and-weakness syndrome. When a person lies quietly at ease yet the pulse is exuberant, this indicates loss of blood. When the cubit skin is rough but the pulse is slippery, this indicates excessive sweating. When the cubit skin is cold and the pulse is fine, this indicates diarrhea. When the cubit skin is coarse and constantly hot, this indicates heat in the interior.
When a diseased liver pulse appears on a gengxin day, death follows; when a diseased heart pulse appears on a rengui day, death follows; when a diseased spleen pulse appears on a jiayi day, death follows; when a diseased lung pulse appears on a bingding day, death follows; when a diseased kidney pulse appears on a wuji day, death follows. This is what is meant by saying that whenever the true, unmediated visceral pulse appears without any admixture of stomach qi, death always follows.
When the vessels of the neck pulsate visibly together with panting and rapid coughing, this indicates water disease. When the area beneath the eyes is slightly swollen, resembling a reclining silkworm, this indicates water disease. When the urine is yellow-red and the person prefers to lie quietly, this is jaundice. When a person feels hungry again immediately after eating, this is stomach jaundice. Swelling of the face indicates wind. Swelling of the feet and shins indicates water disease. Yellowing of the eyes indicates jaundice.
In a woman, when the shaoyin pulse of the hand beats vigorously, this indicates pregnancy.
The pulse may be contrary to or compliant with the four seasons even before any visceral pattern has appeared: if in spring or summer the pulse is thin, or if in autumn or winter the pulse is floating and large, this is called being contrary to the four seasons. When there is wind-heat yet the pulse is quiet, when there is diarrhea or blood loss yet the pulse is replete, when the disease is in the interior yet the pulse is deficient, when the disease is on the exterior yet the pulse is rough and hard — in all these cases the disease is difficult to treat; this too is called running contrary to the four seasons.
A person takes water and grain as the root of life; therefore if a person is cut off from water and grain, death follows, and if the pulse lacks stomach qi, death also follows. What is meant by lacking stomach qi is that only the true, unmediated visceral pulse is obtained, without any stomach qi present. What is meant by the pulse failing to obtain stomach qi is, for instance, a liver pulse with no wiry quality at all, or a kidney pulse with no stone-like quality at all. When the taiyang pulse arrives, it is surging, large, and long. When the shaoyang pulse arrives, it is at times rapid and at times sparse, at times short and at times long. When the yangming pulse arrives, it is floating, large, and short. Now, the healthy heart pulse comes strung together bead upon bead, like fingering a string of fine jade beads — this is called a healthy heart pulse; in summer, stomach qi is its root. The diseased heart pulse comes panting and continuous, slightly curved in its course — this is called heart disease. The dying heart pulse comes curved in front and stationary behind, like grasping a curved hook — this is called death of the heart. The healthy lung pulse comes languid and fluttering, like elm pods falling — this is called a healthy lung pulse; in autumn, stomach qi is its root. The diseased lung pulse comes neither rising nor falling, like stroking a chicken's feather — this is called lung disease. The dying lung pulse comes like a floating object, like wind blowing through hair — this is called death of the lung. The healthy liver pulse comes soft, weak, and swaying, like raising the tip of a long pole — this is called a healthy liver pulse; in spring, stomach qi is its root. The diseased liver pulse comes full, replete, and slippery, like stroking a long pole — this is called liver disease. The dying liver pulse comes tense and increasingly taut, like a newly strung bowstring — this is called death of the liver. The healthy spleen pulse comes harmonious and gentle, with its beats set apart, like a hen treading the ground — this is called a healthy spleen pulse; in late summer, stomach qi is its root. The diseased spleen pulse comes replete and rapidly full, like a hen lifting its foot — this is called spleen disease. The dying spleen pulse comes sharp and hard like a crow's beak, like a bird's spur, like a leaking roof, like flowing water — this is called death of the spleen. The healthy kidney pulse comes panting and strung together like a hook, firm when pressed — this is called a healthy kidney pulse; in winter, stomach qi is its root. The diseased kidney pulse comes like pulling on a vine, growing firmer under pressure — this is called kidney disease. The dying kidney pulse comes bursting forth like a snapped rope, striking abruptly like a flicked stone — this is called death of the kidney.