左手关前一分为人迎者,以候寒暑燥湿风热中伤于人,其邪咸自脉络而入,以迎纳之,
故曰人迎。前哲方论,谓太阳为诸阳主气,凡感外邪,例自太阳始,此考寻经意,似若不然
。风喜伤肝,寒喜伤肾,暑喜伤心包,湿喜伤脾,热伤心,燥伤肺,以暑热一气,燥湿同源
,故不别论。以类推之,风当自少阳入,湿当自阳明入,暑当自三焦入,寒却自太阳入。故
《经》曰∶阴为之主,阳与之正,别于阳者,知病从来,此之谓也。诸太阳伤寒,主左手尺
中与人迎皆浮紧而盛。浮者,足太阳脉也;紧者,伤寒脉也;盛者,病进也。其证头项强,
腰脊痛,无汗恶寒,不恶风。阳明伤湿,右手关上与人迎皆涩细而长。涩者,足阳明脉也
;细者,伤湿脉也;长者,病袭也。其证关节疼痛,重痹而弱,小便涩秘,大便飧泄。少
阳伤风,左手关上与人迎皆弦浮而散。弦者,足少阳脉也;浮者,伤风脉也;散者,病至也
。其证身热恶风,自汗项强,筋满。手少阳伤暑,右手尺中与人迎皆洪虚而数。洪者,手少
阳脉也;虚者,伤暑也;数者,病增也。其证身热恶寒,头痛,状如伤寒,烦渴。足太阴伤
湿,右手关上与人迎皆濡细而沉。濡者,足太阴脉也;细者,湿脉也;沉者,病着也。其证
身重脚弱,关节烦疼,冷痹胀满。足少阴伤寒,左尺中与人迎皆沉紧而数。沉者,足少阴脉
也;紧者,寒脉也;数者,病传也。其证口燥舌干而渴,背恶寒,反发热倦怠。足厥阴伤风
,左关上与人迎皆弦弱而急。弦者,厥阴脉也;弱者,风脉也;急者,病变也。其证自汗恶
风而倦,小腹急痛。手厥阴心包伤暑,在右尺中与人迎皆沉弱而缓。沉者,心包脉也;弱者
,伤暑也;缓者,病倦也。其证往来寒热,状如 疟,烦渴眩晕,背寒面垢,此乃分布
六经,感伤外邪,除燥热外,叙此四气,以为宗兆。若其传变,自当根据六经别论所伤,随经
说证,对证施治。或燥热伤心肺,亦当根据经推明理例调治。如四气兼并,六经交错,亦当随
其脉证,审处别白,或先或后,或合或并,在络在经,入表入里,四时之动,脉与之应,气
候以时,自与脉期。微妙在脉,不可不察;察之有纪,从阴阳始;始之有经,从阴阳生,此
之谓也。
左手关前一分处的人迎脉,是用来诊察寒、暑、燥、湿、风、热等外邪中伤人体的情况。这些邪气都从脉络侵入,以迎接容纳之,所以称为人迎。前代医家的方论认为,太阳经是诸阳经的主气,凡是感受外邪,通常都从太阳经开始,但这与考寻经典原意相比,似乎并不完全正确。风邪容易损伤肝,寒邪容易损伤肾,暑邪容易损伤心包,湿邪容易损伤脾,热邪容易损伤心,燥邪容易损伤肺。因为暑和热同属一气,燥和湿同源,所以不单独分别论述。以此类推,风邪应当从少阳经传入,湿邪应当从阳明经传入,暑邪应当从三焦传入,寒邪却从太阳经传入。所以《内经》说:“阴经为主宰,阳经给予正气,辨别于阳经者,可知病邪的来源”,说的就是这个道理。
凡是太阳经受伤寒的,主要表现是左手尺中与寸口人迎脉都呈现浮紧而盛的脉象。浮,代表足太阳经脉受邪;紧,代表伤寒的脉象;盛,代表病势进展。其症状表现为头项强直疼痛,腰脊疼痛,无汗且恶寒,但不恶风。
阳明经受湿邪所伤的,右手关上与人迎脉都呈现涩细而长的脉象。涩,代表足阳明经脉受邪;细,代表伤湿的脉象;长,代表病邪侵袭深入。其症状表现为关节疼痛,肢体沉重痹痛且虚弱,小便涩滞不通,大便完谷不化(飧泄)。
少阳经受风邪所伤的,左手关上与人迎脉都呈现弦浮而散的脉象。弦,代表足少阳经脉受邪;浮,代表伤风的脉象;散,代表病邪已至。其症状表现为身体发热、恶风,自汗出,项部强直,筋脉拘急满闷。
手少阳经受暑邪所伤的,右手尺中与寸口人迎脉都呈现洪虚而数的脉象。洪,代表手少阳经脉受邪;虚,代表伤暑的脉象;数,代表病势增加。其症状表现为身体发热、恶寒,头痛,症状类似伤寒,伴有烦躁口渴。
足太阴经受湿邪所伤的,右手关上与人迎脉都呈现濡细而沉的脉象。濡,代表足太阴经脉受邪;细,代表湿邪的脉象;沉,代表病邪着留体内。其症状表现为身体沉重、脚部软弱,关节烦扰疼痛,冷痹胀满。
足少阴经受寒邪所伤的,左尺中与寸口人迎脉都呈现沉紧而数的脉象。沉,代表足少阴经脉受邪;紧,代表寒邪的脉象;数,代表病邪传变。其症状表现为口燥舌干而渴,背部恶寒,反而发热且倦怠无力。
足厥阴经受风邪所伤的,左关上与人迎脉都呈现弦弱而急的脉象。弦,代表厥阴经脉受邪;弱,代表风邪的脉象;急,代表病变发生。其症状表现为自汗、恶风且疲倦,小腹部拘急疼痛。
手厥阴心包经受暑邪所伤的,在右尺中与寸口人迎脉都呈现沉弱而缓的脉象。沉,代表心包经脉受邪;弱,代表伤暑的脉象;缓,代表病势倦怠。其症状表现为往来寒热,症状像疟疾,烦躁口渴,头晕目眩,背部发冷,面色垢浊。
以上是分布六经,感伤外邪的情况。除了燥热之外,叙述这四种气候(风、寒、暑、湿)作为纲领。如果病情发生传变,自然应当根据六经别论中所受的邪气,随着经络阐述证候,针对证候施治。如果是燥热损伤心肺,也应当根据经典推明理例进行调治。如果四气兼并,六经交错,也应当随着其脉象和证候,审慎处理分辨清楚,或先治或后治,或合治或并治,在络或在经,入表或入里,四季气候的变化,脉象与之相应,气候随时间变化,自然与脉期相符。脉理的微妙之处,不可不仔细考察;考察它有纲纪,从阴阳开始;起始有经络,从阴阳产生,说的就是这个道理。
The Renying pulse (Renying, Human Welcome), located one fen anterior to the Guan position on the left hand, is used to observe injuries caused by external pathogens such as cold, summerheat, dryness, dampness, wind, and heat. These pathogens all enter through the collaterals and are received/nurtured there, hence the name Renying. Ancient medical theories state that the Taiyang (Greater Yang) channel governs the Qi of all Yang channels, and generally, when affected by external pathogens, it begins with Taiyang. However, upon examining the original meaning of the classics, this view seems not entirely correct. Wind tends to injure the Liver; Cold tends to injure the Kidney; Summerheat tends to injure the Pericardium; Dampness tends to injure the Spleen; Heat tends to injure the Heart; Dryness tends to injure the Lung. Since Summerheat and Heat belong to the same Qi, and Dryness and Dampness share the same origin, they are not discussed separately. By analogy, Wind should enter via Shaoyang (Lesser Yang); Dampness should enter via Yangming (Bright Yang); Summerheat should enter via the Sanjiao (Triple Burner); whereas Cold enters via Taiyang. Thus, the *Classic* states: "Yin serves as the master, Yang provides the rectification; distinguishing from Yang allows one to know the origin of the disease." This refers to this principle.
For Taiyang injury by Cold, the primary manifestation is a floating, tight, and vigorous pulse at both the Chi position of the left hand and the Renying pulse. Floating indicates the Foot-Taiyang channel; Tight indicates Cold injury; Vigorous indicates disease progression. Symptoms include stiffness and pain in the head and neck, pain in the lower back and spine, absence of sweating, aversion to cold, but no aversion to wind.
Yangming injury by Dampness presents with a choppy, fine, and long pulse at the Guan position of the right hand and the Renying pulse. Choppy indicates the Foot-Yangming channel; Fine indicates Dampness injury; Long indicates disease invasion. Symptoms include joint pain, heavy bi-syndrome (painful obstruction) with weakness, scanty or difficult urination, and undigested food in stool (sun-xie).
Shaoyang injury by Wind presents with a wiry, floating, and scattered pulse at the Guan position of the left hand and the Renying pulse. Wiry indicates the Foot-Shaoyang channel; Floating indicates Wind injury; Scattered indicates the arrival of disease. Symptoms include feverish body, aversion to wind, spontaneous sweating, neck stiffness, and fullness/tightness of the sinews.
Hand-Shaoyang injury by Summerheat presents with a surging, empty, and rapid pulse at the Chi position of the right hand and the Renying pulse. Surging indicates the Hand-Shaoyang channel; Empty indicates Summerheat injury; Rapid indicates disease increase. Symptoms include feverish body, aversion to cold, headache, symptoms resembling Cold injury, irritability, and thirst.
Foot-Taiyin injury by Dampness presents with a soggy, fine, and deep pulse at the Guan position of the right hand and the Renying pulse. Soggy indicates the Foot-Taiyin channel; Fine indicates Dampness; Deep indicates disease adherence/stagnation. Symptoms include heavy body, weak legs, vexing joint pain, cold bi-syndrome, and distension/fullness.
Foot-Shaoyin injury by Cold presents with a deep, tight, and rapid pulse at the Chi position of the left hand and the Renying pulse. Deep indicates the Foot-Shaoyin channel; Tight indicates Cold; Rapid indicates disease transmission. Symptoms include dry mouth and tongue with thirst, aversion to cold in the back, yet paradoxical fever and fatigue.
Foot-Jueyin injury by Wind presents with a wiry, weak, and urgent pulse at the Guan position of the left hand and the Renying pulse. Wiry indicates the Jueyin channel; Weak indicates Wind; Urgent indicates pathological change. Symptoms include spontaneous sweating, aversion to wind, fatigue, and acute pain in the lower abdomen.
Hand-Jueyin Pericardium injury by Summerheat presents with a deep, weak, and slow pulse at the Chi position of the right hand and the Renying pulse. Deep indicates the Pericardium channel; Weak indicates Summerheat injury; Slow indicates disease-induced fatigue. Symptoms include alternating chills and fever, resembling malaria, irritability, thirst, dizziness, coldness in the back, and greasy complexion.
These describe the distribution across the Six Channels regarding external pathogen injuries. Excluding Dryness-Heat, these four climatic factors (Wind, Cold, Summerheat, Dampness) are narrated as the main framework. If transmission occurs, treatment should follow the specific injuries described in the separate discussions of the Six Channels, addressing symptoms according to the channel involved. If Dryness-Heat injures the Heart and Lungs, treatment should also follow classical principles for regulation. If the four climatic factors combine and the Six Channels intersect, one must carefully examine the pulse and symptoms to distinguish clearly, treating either first or later, combined or separately, whether in the collaterals or channels, exterior or interior. The movements of the four seasons correspond to the pulse; climatic conditions vary with time and naturally align with pulse periods. The subtlety lies in the pulse, which must not be neglected; examination has its discipline, starting from Yin and Yang; initiation has its channels, generated from Yin and Yang. This is what is meant.