右手关前一分为气口者,以候脏气郁发,与胃气兼并,过与不及,乘克传变也。以内气
郁发,食气入胃,淫精于脉,自胃口出,故候于气口。以五脏皆禀气于胃,胃者,五脏之本
,脏气不能自致于手太阴,必因胃气而至。邪气胜,胃气衰,故病甚;胃气绝,真脏独见,则死。
假如春肝脉,弦多胃少,曰肝病,但弦,无胃气,曰死;若其乘克,春虽有胃气,而有
涩脉见,则秋必病;涩甚,则今病。夏心脉,洪多胃少,曰心病,但洪,无胃气,曰死;如
乘克见微沉,则冬病;沉甚,则今病。秋肺脉,涩多胃少,曰肺病;但涩,无胃气,曰死;
秋见洪,为夏病;洪甚,为今病。冬肾脉,沉多胃少,曰肾病;但沉,无胃气,曰死;冬见
濡,为长夏病,濡甚,为今病。
长夏脾脉,濡多胃少,曰脾病;但濡,无胃气,曰死;长夏
见弦脉,为春病;弦甚,为今病。
又如春肝脉,合弦细而长,太过则实强,令人善怒,忽忽眩冒癫疾;不及则微虚,令人
胸痛引背,两胁 满。夏心脉,合洪而微实,太过则来去皆盛,令人身热肤痛,为浸淫
;不及则来不盛去反盛,令人烦心,上咳唾,下气泄。秋肺脉,合浮而短涩,太过则中坚傍
虚,令人逆气背痛,愠愠然;不及则毛而微,令人呼吸少气,上咯血,下喘声。冬肾脉,合
沉而紧实,太过则如弹石,令人解 ,脊脉痛,少气,不欲言;不及则其去如数,令人
心悬如饥,眇中清,脊中痛,少腹满,小便变。长夏脾脉,当沉而濡长,太过则如水之
流,令人四肢不举;不及则如乌之喙,令人九窍不通,名曰重强。太过不及,脉之大要,迫
近而微,不可失机。
又人之五脏,配木火土金水,以养魂神意魄志,生怒喜思忧恐。故因怒则魂门弛张,木
气奋激,肺金乘之,脉必弦涩;因喜则神廷融泄,火气赫羲。肾水乘之,脉必沉散;因思则
意舍不宁,土气凝结,肝木乘之,脉必弦弱;因忧则魄户不闭,金气涩聚,心火乘之,脉必
洪短;因恐则志室不遂,水气旋却,脾土乘之,脉必沉缓。此盖五情动不以正,侮所不胜,
既不慕德,反谓能胜而乘之,侮反受邪,此之谓也。其病有五,五五二十五变。若其能所传授
,胜克流变,又当详而论之。故《经》曰∶五脏受气于其能生,传之于其所胜;气舍于其所
生,死于其所不胜。如肝受气于心,传于脾,气舍于肾,至肺而死;心受气于脾,传于肺,
气舍于肝,至肾而死;脾受气于肺,传于肾,气舍于心,至肝而死;肺受气于肾,传于肝,
气舍于脾,至心而死;肾受气于肝,传于心,气舍于肺,至脾而死。则知肝死于肺,候于秋
,庚笃辛死,余皆仿此。又如甲乙主寅卯,丙丁主巳午,庚辛主申酉,壬癸主亥子,戊
己主辰戌丑未。一日一夜五分,则可以占死者之早暮,此病之次也;然卒发者不必治于传,
或其传化不以次,不以次入者;忧恐怒喜思,令不得以其次,故令人有大病矣。此五脏传变
之大要,学人幸留神焉。
右手关前一分处称为气口,用来诊察脏气的郁结与发动,以及与胃气相互兼并、过盛或不足、相乘相克及传变的情况。因为体内脏气郁结发动,饮食进入胃中,其精微之气散布于脉管,从胃口而出,所以通过气口来诊察。由于五脏都禀受胃气,胃是五脏的根本,脏气不能自行到达手太阴肺经的气口部位,必须依赖胃气才能到达。如果邪气强盛而胃气衰弱,病情就会加重;如果胃气断绝,真脏脉单独显现,就会死亡。
例如春季的肝脉,弦象多而胃气少,称为肝病;如果只有弦象而没有胃气,称为死证;如果出现相乘相克的脉象,虽然春季有胃气,但出现涩脉,则秋季必定发病;涩象严重,则当下即病。夏季的心脉,洪象多而胃气少,称为心病;如果只有洪象而没有胃气,称为死证;如果出现相乘相克的脉象见到微沉脉,则冬季发病;沉象严重,则当下即病。秋季的肺脉,涩象多而胃气少,称为肺病;如果只有涩象而没有胃气,称为死证;秋季见到洪脉,是为夏季的病;洪象严重,是为当下的病。冬季的肾脉,沉象多而胃气少,称为肾病;如果只有沉象而没有胃气,称为死证;冬季见到濡脉,是为长夏(季夏)的病;濡象严重,是为当下的病。
长夏的脾脉,濡象多而胃气少,称为脾病;如果只有濡象而没有胃气,称为死证;长夏见到弦脉,是为春季的病;弦象严重,是为当下的病。
又如春季的肝脉,应当合于弦、细、长,如果太过则脉实而强硬,使人容易发怒,恍惚眩晕冒昧甚至癫狂疾病;如果不及则脉微虚,使人胸痛牵引背部,两胁胀满。夏季的心脉,应当合于洪而微实,如果太过则脉搏来去皆盛大,使人身体发热皮肤疼痛,形成浸淫疮;如果不及则来时不盛大而去时反而盛大,使人心中烦闷,向上咳嗽吐唾沫,向下气泄。秋季的肺脉,应当合于浮而短涩,如果太过则中间坚实旁边空虚,使人逆气背痛,郁闷不快;如果不及则脉象如羽毛般轻浮微弱,使人呼吸气短,向上咯血,向下喘息有声。冬季的肾脉,应当合于沉而紧实,如果太过则像弹石一样坚硬,使人懈惰无力,脊脉疼痛,气短,不想说话;如果不及则去时像数脉一样快,使人心中悬空如同饥饿感,季胁部清冷,脊中疼痛,小腹胀满,小便异常。长夏的脾脉,应当沉而濡长,如果太过则像水流一样急迫,使人四肢不能举起;如果不及则像乌鸦的嘴一样硬直,使人九窍不通,名叫重强。太过和不及,是脉诊的大要,脉象迫近细微,不可错失时机。
另外人的五脏,分别配属木、火、土、金、水,用来滋养魂、神、意、魄、志,产生怒、喜、思、忧、恐五种情志。所以因愤怒则魂门弛张,木气奋激,肺金乘之,脉必现弦涩;因喜悦则神廷融泄,火气盛大,肾水乘之,脉必现沉散;因思虑则意舍不宁,土气凝结,肝木乘之,脉必现弦弱;因忧愁则魄户不闭,金气涩聚,心火乘之,脉必现洪短;因恐惧则志室不遂,水气旋却,脾土乘之,脉必现沉缓。这大概是五情动而不正,侮慢所不胜之脏,既不仰慕其德,反认为能胜而乘袭它,侮慢反过来遭受邪气,说的就是这个道理。其病有五种,五五二十五种变化。如果能所传授,胜克流变,又应当详细论述。所以《内经》说:五脏受气于能生我者,传之于我所胜之脏;气舍于我所生之脏,死于我所不胜之脏。例如肝受气于心,传于脾,气舍于肾,至肺而死;心受气于脾,传于肺,气舍于肝,至肾而死;脾受气于肺,传于肾,气舍于心,至肝而死;肺受气于肾,传于肝,气舍于脾,至心而死;肾受气于肝,传于心,气舍于肺,至脾而死。由此可知肝死于肺,候应于秋季,庚日笃重辛日死亡,其余类推。又如甲乙主寅卯月,丙丁主巳午月,庚辛主申酉月,壬癸主亥子月,戊己主辰戌丑未月。一日一夜分为五分,就可以占测死者早晚,这是疾病的次序;然而突然发作的疾病不必按传变次序治疗,或者其传化不按次序,不按次序传入的;忧、恐、怒、喜、思,使得疾病不能按次传变,所以使人患大病。这是五脏传变的大要,学习者务必留心。
The one-fen area anterior to the Guan position on the right hand is called Qikou (Radial Pulse, Lung Meridian), used to observe the stagnation and emergence of Zang Qi (Visceral Qi), its merger with Wei Qi (Stomach Qi), excess or deficiency, mutual overcoming (Cheng Ke) and transmission. Because internal Zang Qi stagnates and emerges, food enters the Stomach, its refined essence spreads into the vessels, and exits from the stomach opening; thus, it is observed at Qikou. Since all five Zang organs receive Qi from the Stomach, and the Stomach is the root of the five Zang organs, Zang Qi cannot reach the Hand-Taiyin Lung meridian's Qikou point by itself, but must arrive via Wei Qi. If pathogenic Qi is strong and Wei Qi is weak, the disease becomes severe; if Wei Qi is exhausted and the True Zang pulse appears alone, death ensues.
For example, in Spring, the Liver pulse should be Xian (Wiry). If Xian is predominant and Wei Qi is scant, it indicates Liver disease; if there is only Xian without Wei Qi, it indicates death. If there is mutual overcoming, although there is Wei Qi in Spring, if a Se pulse (Choppy) appears, illness will occur in Autumn; if Se is severe, illness occurs immediately. In Summer, the Heart pulse should be Hong (Surging). If Hong is predominant and Wei Qi is scant, it indicates Heart disease; if there is only Hong without Wei Qi, it indicates death. If mutual overcoming manifests as a slightly Chen (Deep) pulse, illness will occur in Winter; if Chen is severe, illness occurs immediately. In Autumn, the Lung pulse should be Se (Choppy). If Se is predominant and Wei Qi is scant, it indicates Lung disease; if there is only Se without Wei Qi, it indicates death. If a Hong pulse appears in Autumn, it reflects Summer pathology; if Hong is severe, it reflects current pathology. In Winter, the Kidney pulse should be Chen (Deep). If Chen is predominant and Wei Qi is scant, it indicates Kidney disease; if there is only Chen without Wei Qi, it indicates death. If a Ru (Soggy) pulse appears in Winter, it reflects Changxia (Late Summer) pathology; if Ru is severe, it reflects current pathology.
In Changxia (Late Summer), the Spleen pulse should be Ru (Soggy). If Ru is predominant and Wei Qi is scant, it indicates Spleen disease; if there is only Ru without Wei Qi, it indicates death. If a Xian pulse appears in Changxia, it reflects Spring pathology; if Xian is severe, it reflects current pathology.
Furthermore, in Spring, the Liver pulse should combine Xian, Xi (Fine), and Chang (Long). If excessive, the pulse is Shi (Full) and strong, causing irritability, dizziness, vertigo, and manic disorders; if deficient, the pulse is micro-deficient, causing chest pain radiating to the back and distension in both hypochondria. In Summer, the Heart pulse should combine Hong and slightly Shi. If excessive, the pulse comes and goes vigorously, causing feverish body and painful skin, manifesting as Jin Yin (spreading sores); if deficient, the pulse does not come strongly but goes strongly, causing vexation, coughing up saliva upwards, and qi leakage downwards. In Autumn, the Lung pulse should combine Fu (Floating) and Duan Se (Short and Choppy). If excessive, the center is firm while the sides are empty, causing rebellious qi, back pain, and a feeling of oppression; if deficient, the pulse is like feathers and micro-weak, causing shortness of breath, hemoptysis upwards, and wheezing downwards. In Winter, the Kidney pulse should combine Chen and Jin Shi (Tight and Full). If excessive, it feels like bouncing stones, causing lethargy, spinal pain, shortness of breath, and reluctance to speak; if deficient, the outgoing phase resembles Shu (Rapid), causing a sensation of heart hanging like hunger, coldness in the Miao region, spinal pain, lower abdominal fullness, and abnormal urination. In Changxia, the Spleen pulse should be Chen and Ru Chang (Deep, Soggy, and Long). If excessive, it flows like water, causing inability to lift the limbs; if deficient, it is hard like a crow's beak, causing obstruction of the nine orifices, named Zhong Qiang (Heavy Rigidity). Excess and deficiency are the essentials of pulse diagnosis; when pulses are close and subtle, one must not miss the opportunity.
Moreover, the five Zang organs correspond to Wood, Fire, Earth, Metal, and Water, nourishing Hun, Shen, Yi, Po, and Zhi, generating anger, joy, thought, worry, and fear. Thus, anger causes Hun Men to relax, Wood Qi to surge, and Lung Metal to overcome it, resulting in a Xian Se pulse; joy causes Shen Ting to dissipate, Fire Qi to blaze, and Kidney Water to overcome it, resulting in a Chen San (Deep and Scattered) pulse; thought causes Yi She to be restless, Earth Qi to condense, and Liver Wood to overcome it, resulting in a Xian Ruo (Wiry and Weak) pulse; worry causes Po Hu to remain open, Metal Qi to gather turbidly, and Heart Fire to overcome it, resulting in a Hong Duan (Surging and Short) pulse; fear causes Zhi Shi to fail, Water Qi to retreat, and Spleen Earth to overcome it, resulting in a Chen Huan (Deep and Slow) pulse. This arises because the five emotions move improperly, insulting the organ they cannot overcome, failing to respect its virtue, and instead assuming superiority to attack it; the insult returns as pathogenic influence, which is what this refers to. There are five diseases, leading to twenty-five transformations. Regarding transmission and overcoming cycles, further detailed discussion is required. Thus, the Classics state: The five Zang organs receive Qi from that which generates them, transmit it to that which they overcome; Qi resides in that which they generate, and death occurs at that which overcomes them. For instance, Liver receives Qi from Heart, transmits to Spleen, resides in Kidney, and dies at Lung; Heart receives Qi from Spleen, transmits to Lung, resides in Liver, and dies at Kidney; Spleen receives Qi from Lung, transmits to Kidney, resides in Heart, and dies at Liver; Lung receives Qi from Kidney, transmits to Liver, resides in Spleen, and dies at Heart; Kidney receives Qi from Liver, transmits to Heart, resides in Lung, and dies at Spleen. From this, we know Liver dies at Lung, corresponding to Autumn, worsening on Geng days and dying on Xin days; the rest follow this pattern. Furthermore, Jia and Yi govern Yin and Mao months, Bing and Ding govern Si and Wu months, Geng and Xin govern Shen and You months, Ren and Gui govern Hai and Zi months, Wu and Ji govern Chen, Xu, Chou, and Wei months. Dividing day and night into five parts allows prediction of early or late death, representing the order of disease; however, sudden onset need not follow transmission order, or transmission may deviate from sequence due to emotional disturbances (worry, fear, anger, joy, thought) preventing sequential transmission, thereby causing severe disease. This is the essential principle of five Zang transmission; students should pay close attention.