病家不可讳病。医家不可护短。须察问其原委。乃不昧于治法。
问尝贵后贱。虽不受邪。病从内生。名曰脱营。尝富后贫。名曰失精。必问饮食居处。暴乐暴苦。始乐后苦。皆伤
精气。
此是问病之原由也。问法不止于此。当推类以求。
凡诊者。必知终始。有知余绪。切脉问名。当合男女。
此一节是总言察问之法。必知终始。谓起病及其终病形如何。可全察矣。有知余绪。有即又字余绪。谓其兼见之微
证。必兼察之。乃知何者为重病。何者为轻病。或合治。或分治。可得言也。再切脉问名。以定其病之主名。使无差爽。
男女各有不同。又当合计各有病情病状之实乃无误矣。此段问法甚详。在人细究。附录陈修园问证歌括曰一问寒热二问
汗三问头身四问便。五问饮食六问胸。七聋八渴均当辨。九问旧病十问因。再加服药参机变。妇人尤必问经期。迟速闭
崩皆可验。更添短语告儿科。天花麻疹全占验。
察脉知病。精之至矣。然内经仲景。皆合人迎趺阳合诊。今则独取寸口。盖去繁就简为得其要兹所引注。皆独取寸
口之法。
十二经中。皆有动脉。独取寸口。以决五脏六腑死生之法何谓也。
寸口即今掌后诊脉之所。此难经发问。以起下义。近出西医。不知脉法。即欲以此攻斥脉法。谓周身皆有动脉。何
得以手之寸口为诊。彼盖不知中国古人。创立脉法。已先自为问难所谓十二经。皆为动脉者。早已代洋医说过。早经驳
辨。彼西医既不知脉何得侈口妄谈哉。
然寸口者。脉之大会。手太阴之动脉也。人一呼脉行三寸。一吸脉行三寸呼吸定息。脉行六寸。人一日一夜。凡一
万三千五百息。脉行五十度。周于身。荣卫行阳二十五度。行阴二十五度。为一周。复会于手太阴。寸口者。五脏六腑
之所终始。故法取于寸口也。
近说肺朝百脉为华盖。五脏六腑之气。皆上薰于肺。故即肺寸口之脉。可以诊知各脏。其说亦通。而究不知营卫相
会为五脏所终始。故独取寸口越人立法甚精矣。卫气之行。西医不知。营血之行。西医知之。西医云。血出心管。行于
周身。转回则为紫色。受炭气故也。回血入心路经肺管。呼出之气吹之紫色。乃散复入于心此即内经营周于身之义矣。
无一息不有血出于心之左房。即无一息。不有血回入心之右房。然计所出之血待其回入。亦须一日一夜特营血之行。与
卫不同。营血则息息皆有出有入。卫气之行。则须行。度一周。乃复于肺。而与营血相会。此小会也。盖卫气昼行于阳
则寤。夜行于阴则寐。必昼夜各行二十五度。乃复于肺而与营气大会故营言周于身卫则言复会于手太阴。文义显别。不
可混也。营气周行脏腑内外。而皆会于肺故独取寸脉可以诊脏腑内外诸病矣。按灵枢云。人经脉前后上下左右。周身十
六丈二尺。一周于身。为一度。昼夜一万三千五百息。气行五十度。其经脉长短之数。气行传递之路皆详于内经。脉度
营气篇。兹不具论观其脉动。与气行分言则知脉是营血气附脉行昼则行。营外为行阳。二十五度夜则行营内为行阴二十
五度内经云老人夜不寐。营血虚。卫阳不得入于阴也。观此则知营卫相附之理。营周而复始。故无一息不返于肺以入心。
卫行必一度。乃返于肺也。其五十度。则阴阳之。数已行尽而返于肺则名。曰大会脏腑之所终始也。以其会于肺。故即
肺脉。便可诊脏腑诸病。西医不知营卫相会之处。而但知脉是血管。辨中国诊脉之非只自形其粗浅耳。
从关至尺。是尺内阴之所至也。从关至鱼际。是寸口阳之所治也。
关者。尺寸分界之地。脉诀所谓高骨为是也。关下为尺泽。主肝肾而沉。故属阴关前为寸。主心肺而浮。故属阳。
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西医不信脉法谓。人周身脉管。皆生于心中血管。心体跳动不休脉即应之而动。人身五脏。何得只据血管为断。又
言手脉。只是一条。何得又分出寸关尺。此说似是而实非也。细按手脉。至鱼际上。则脉不见动。至尺泽下。脉亦不见
动。盖脉虽一条。而有分散合聚隐见之别。寸口者。脉之大聚。会处为营卫相会之要区。故即以此诊诸病脉管内属血分。
脉管外属。气分迟数是脉管中事。浮沉是脉管外事。至于脉之前后。又分寸为阳。尺为阴。盖手脉既属脉之都会自有部
分之别。阳外阴内。天地不易之理。凡主表主上主气。属阳者。皆诊于寸。主里主血主下。属阴者皆诊于尺也。
上部法天主胸以上至头之有疾也。中部法人。主膈以下至脐之有疾也。下部法地。主脐以下至足之有疾也。
此即内经上竟上者。胸喉中事。下竟下者。少腹腰足间事之义。盖天下之理。本天亲上。本地亲下。各从其类。故
左寸在上应心。右寸在上应肺。左关在中属肝。右关在中属脾。左尺在下属肾。右尺在下属命门。总是分上中下之义。
其分左右者。则以水为天一。宜配在左火为地二。宜配在右。水生木木生火。故心肝均位于左。火生土。土生金。故脾
肺均位于右。各从其类义也。至于六腑。又各从其类以配次之。肺之腑为大肠。肺居右关上寸部。则大肠宜配于右关下
尺部矣。亦有时诊于右寸。总见肺与大肠一家故也。胃从脾。配在右关。三焦从命门。配在右尺膀胱从肾。配左尺胆从
肝。配。在左关。小肠从心。配在左寸。小肠亦可配在左尺。以心位于左关之上。则小肠当从之于下也。脏腑之位次。
既明又推之于形体。则喉舌头面胸前肩膊。皆诊于寸部。腋下腹际从腰以还。皆当诊于关部。小腹尾尻二阴股胫膝脚。
皆当诊于尺部。此内经竟上竟下之法。实大易亲上亲下之理。其旨微矣辨证有分部。诊法有合三部。共诊法。最要通其
理。方可言诊。西医所不知也。
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旧诀部位。左心膻中肝胆肾小肠。右肺胸中脾胃命大肠。周梦觉三指禅脉法。以为左心小肠肝胆肾膀胱。右肺大肠
脾胃肾命门。然犹有未尽之义。宜分为左寸心膻中小肠。左关肝胆。左尺肾膀胱及小肠也。右寸肺胸中大肠。右关脾胃。
右尺命门三焦。及大肠也。盖大小肠或附。于肺以其表里相通也。或附于两尺。以其居下也。膻中即包络。胸中即肺衣。
古法不诊三焦。以未知三焦之根。即在肾系。今特配于右尺。于义乃备。
脉有三部九候。三部者寸关尺也。九候者浮中沉也。
此与内经三部九候之法不同。然头手足遍诊之法。其废已久。故即从难经。以寸关尺为三部。三部各有浮中沉。是
为九候。
呼出心与肺。吸入肾与肝。呼吸之间脾也。其脉在中。浮者阳也。心肺俱浮。浮而大散者心也。浮而短涩者肺也。
沉者阴也。肝肾俱沉牢而长者。肝也。按之濡举指来实者。肾也。脾者中州故其脉在中。是阴阳之法也。
上节以部位分五脏。此又以呼吸浮沉分五脏也。心肺在上部。出气由之。故呼出属心肺。一呼脉当二至也。肝肾在
下部。入气归之。故吸入属肝肾。一吸脉当二至也。呼吸之间。脾主中宫。司出入脉当一至。故呼吸定息。脉来。五至
者为无病若多一至。则有一脏太过若少一至。则有一脏不足此察至数之法知此义。则知至数迟速之故。其脉在中以下。
又言以浮中沉。分别五脏也。言脉在人肌肉之中。轻按即见为浮。浮为在外属阳。心肺应之。浮而大散。其应在心。浮
而短涩。其应在肺。重按乃见为沉。沉为在里属阴。肝肾应之。牢而长者弦之象。属肝经。濡而实者滑之象。属肾经。
脾者中州。故其脉在中是阴阳适中之地也。此以沉诊肝肾浮诊心肺中诊脾胃取配之义。亦多方矣。
春脉弦。夏脉钩。秋脉毛。冬脉石。四时皆以胃气为本。四时之变病。死生之要会也。
钩即洪。毛即浮。石即沉也。胃气见于脉。乃和缓之象。言弦钩毛石。各见和缓为有胃气四时之变。谓太过不及。
不得胃气。则可以知其病矣。此详言五脏四时之主脉。而又归本于胃气近代三指禅脉诀。以缓脉为纲诚能知胃气为本之
旨学人可以一览。
数者腑也。迟者脏也。诸阳为热。诸阴为寒数则为热迟则为寒。
腑属阳。故数脉当应腑脏属阴。故迟脉当应脏数则为热。诸阳主气也。迟则为寒。诸阴主气也。夫以迟数分脏腑。
此未尽然。而数则为热。迟则为寒。盖有一定不易者。脉之跳动。出于心血之起落。属脉管中。血之所主。心主火。血
虚火少。则动迟血多火旺则动速又凡脉之粗大细虚皆脉管中事。当与迟数同断。脉法。要辨脉管内是血分脉管外。是气
分则延医自有分别。
浮者阳也。滑者阳也。长者阳也。沉者阴也。短者阴也。涩者阴也。各以其经所在。名病顺逆也。
浮滑长为阳。沉短涩为阴。据此治病。已得其要。又再分各经以定顺逆。如肾脉宜沉而反浮。心脉宜浮而反沉则为
逆既明脉之定象。又言脉无定体。因经而分顺逆。其法最细。西医但知脉是血管。而不知气附脉行。血管外。即气道也。
西医云。脉外有膜。名脉鞘。光滑而薄。分数层。中有小孔。如筛。按此即附脉行之气孔也。脉管只是一条。动则俱动。
故迟数无部位之分。气则上下异。其轻重也。故浮沉有三部之别从此类推而气管血管分诊合诊则脉无遁情余读西医书。
即益知古圣之精。尤愿西医。读古圣书。亦可补其不及也。
此诊法。全从难经。盖内经遍诊头足。自越人变法。而群趋简易。后世脉诀。托始于此。于法甚精。故宜从之。再
参诸脉书。则尽其奥矣。
病人不可隐瞒病情，医生不可掩饰自己的不足。必须详细询问发病的来龙去脉，才不会在治疗方法上迷失方向。
曾显贵而后失势的人，虽然未受外邪侵袭，但病从内生，名为“脱营”（因精神抑郁导致营血耗损的病证）；曾富有而后贫困的人，名为“失精”（因忧思过度导致精气耗散的病证）。必须询问病人的饮食起居情况，以及情绪上突然的快乐或痛苦、先乐后苦等变化，这些都会损伤精气。
这是关于询问病因原由的内容。问诊的方法不止于此，应当推演类推以求全面掌握。
凡是诊病的人，必须了解疾病的全过程，并知晓其他伴随症状。切脉和询问姓名籍贯时，必须结合男女生理差异进行综合判断。
这一段是总述察问的方法。“必知终始”，是指要了解起病原因及疾病最终的表现形态，这样才能全面观察病情。“有知余绪”，即还要了解兼见的轻微症状，必须一并考察，才能知道哪些是重病，哪些是轻病，从而决定是合并治疗还是分开治疗，这样才有话可说。再结合切脉和询问姓名，以确定疾病的主要名称，避免差错。男女性别不同，病情病状也有差异，只有合计考量各自的实际情况，才不会出错。这段问诊方法非常详尽，需要人们仔细研究。附录陈修园的《问证歌括》说：一问寒热二问汗，三问头身四问便，五问饮食六问胸，七聋八渴均当辨，九问旧病十问因，再加服药参机变。妇人尤其必须问月经周期，经期迟速、闭经或崩漏都可以验证。更添几句短语告知儿科医生，天花麻疹全凭此法占验。
通过察脉来知晓病情，真是精妙至极。然而，《内经》和张仲景的著作中，都主张合用人迎穴和趺阳穴进行诊脉。现在却只取寸口脉，这大概是去除繁杂、抓住要领的做法。此处所引用的注解，都是专取寸口脉的方法。
十二经脉中，都有动脉搏动，为什么独取寸口脉，就能决断五脏六腑的死生呢？这是什么道理？
寸口就是现在手掌后方诊脉的地方。这是《难经》提出的疑问，用来引发下文的义理。近代出现的西医，不懂脉法，就想以此攻击驳斥中医脉法，认为周身都有动脉，凭什么用手腕处的寸口来诊断？他们大概不知道中国古人创立脉法时，已经预先自设问难了。所谓“十二经皆为动脉”，早就替西医说过了，也早已进行了驳辩。既然西医不懂脉理，怎么敢妄加谈论呢？
然而，寸口是脉气大会聚的地方，是手太阴肺经的动脉。人每呼气一次，脉气运行三寸；每吸气一次，脉气也运行三寸。一呼一吸称为一息，脉气运行六寸。人一天一夜，共呼吸一万三千五百次，脉气运行五十周，循环全身。营气和卫气各行于阳分二十五度，行于阴分二十五度，合为一周，最后汇聚于手太阴肺经。寸口是五脏六腑气血终结和起始的地方，所以诊脉法则取用于寸口。
近来的说法认为，肺朝百脉，为华盖（最高之脏），五脏六腑的气，都向上熏蒸于肺。所以仅通过肺经寸口的脉象，就可以诊断得知各个脏腑的情况。这种说法也是通的，但究其根本，还是不知道营卫之气相会，是五脏六腑气血终结和起始的关键。所以《难经》作者越人确立的这种立法非常精妙。卫气的运行，西医不了解；营血的运行，西医是了解的。西医说，血液从心脏血管流出，运行于全身，回流时变成紫色，是因为吸收了碳气。回流的血液进入心脏的路径经过肺部，呼出的气息吹拂它，紫色消散，然后重新进入心脏。这就是《内经》中营气周流于身的含义。没有哪一息没有血液从左心房流出，也就没有哪一息没有血液回流到右心房。然而计算流出的血液等待其回流，也需要一天一夜的时间。但是营血的运行与卫气不同，营血是每一息都有出有入；而卫气的运行，必须走完一周，才返回肺部，与营血相会。这是小会。卫气白天行于阳分则人清醒，夜晚行于阴分则人入睡，必须昼夜各行二十五周，才返回肺部与营气大会。所以说营气言“周于身”，卫气言“复会于手太阴”，文义明显有别，不可混淆。营气周行于脏腑内外，而都汇聚于肺，所以独取寸口脉就可以诊断脏腑内外的各种疾病了。按《灵枢》记载，人的经脉前后上下左右，周身长十六丈二尺，循环一周身，称为一度。昼夜一万三千五百息，气行五十度。其经脉长短的数量，气行传递的路径，都在《内经》中有详细说明，如《脉度》篇、《营气》篇等，这里不再详尽论述。观察其脉动与气行分开来说，就知道脉是依附于营血运行的。白天行于营之外为行于阳，二十五周；夜晚行于营之内为行于阴，二十五周。《内经》说老人夜里不睡觉，是因为营血虚，卫阳不得入于阴。看这一点就知道营卫相互依附的道理。营气周而复始，所以没有哪一息不返回肺部以进入心脏；卫气必须走完一度，才返回肺部。那五十度，则是阴阳之数已尽而返回肺部，名叫大会，是脏腑气血终结和起始的地方。因为它汇聚于肺，所以仅凭肺脉，就可以诊断脏腑的各种疾病。西医不知道营卫相会之处，只知道脉是血管，辨别中国诊脉法的错误，只是显露出自己的粗浅罢了。
从关部到尺部，是尺内阴气所到达的地方。从关部到鱼际，是寸口阳气所治理的地方。
关部，是寸部和尺部分界的部位，脉诀所说的“高骨”就是指这里。关部下方为尺泽，主肝肾，脉位深沉，所以属阴；关部前方为寸部，主心肺，脉位浮浅，所以属阳。
西医不相信脉法，认为人身全身的脉管都生于心中的血管，心脏跳动不休，脉随之而动。人身五脏，怎么能只依据血管来判断呢？又说手腕处的脉只是一条，怎么能又分出寸、关、尺三部？这种说法看似有理实则非也。仔细考察手部的脉，到了鱼际上方，脉搏就不见跳动；到了尺泽下方，脉搏也不见跳动。大概脉虽然是一条，但有分散、聚合、隐现的区别。寸口是脉气的大聚会处，是营卫相会的重要区域，所以就用它来诊断各种疾病。脉管内属于血分，脉管外属于气分。迟数和数是脉管中的事情，浮和沉是脉管外面的事情。至于脉的前后位置，又分为寸为阳，尺为阴。因为手部的脉既属于脉的都会，自然有部分的区分。阳在外阴在内，这是天地不变的规律。凡主治表、治上、治气，属阳的，都诊察于寸部；主治里、治血、治下，属阴的，都诊察于尺部。
上部效法天，主治胸部以上至头部的疾病；中部效法人，主治膈以下至脐部的疾病；下部效法地，主治脐以下至足部的疾病。
这就是《内经》中“上竟上者，胸喉中事；下竟下者，少腹腰足间事”的含义。大概天下的道理，本是天亲近上位，地亲近下位，各自遵循同类相聚的原则。所以左寸在上对应心，右寸在上对应肺；左关在中对应肝，右关在中对应脾；左尺在下对应肾，右尺在下对应命门。这总是区分上、中、下的意义。之所以分左右，是因为水为天一，宜配在左边；火为地二，宜配在右边。水生木，木生火，所以心和肝都位于左边；火生土，土生金，所以脾和肺都位于右边。这是各自遵循同类相聚的道理。至于六腑，又各自遵循同类原则依次配合。肺的腑是大肠，肺居右关上寸部，那么大肠宜配在右关下尺部；有时也诊察于右寸，总体可见肺与大肠是一家。胃跟随脾，配在右关；三焦跟随命门，配在右尺；膀胱跟随肾，配在左尺；胆跟随肝，配在左关；小肠跟随心，配在左寸；小肠也可以配在左尺，因为心位于左关之上，那么小肠应当跟随它而在下面。脏腑的位置次序既然明确了，再推演到形体，那么喉、舌、头、面、胸前、肩膊，都诊察于寸部；腋下、腹际、从腰部往后，都应当诊察于关部；小腹、尾骶、二阴、大腿、小腿、膝盖、脚，都应当诊察于尺部。这是《内经》竟上竟下的诊法，实际上是大易亲上亲下的道理，旨意微妙啊。辨证要有分部，诊法要有合三部，共诊法，最重要的是通晓其原理，才可以谈论诊脉。这是西医所不知道的。
旧有的诀诀部位是：左心、膻中、肝胆、肾、小肠；右肺、胸中、脾胃、命门、大肠。周梦觉的《三指禅脉法》，认为左心、小肠、肝胆、肾、膀胱；右肺、大肠、脾胃、肾、命门。但这还有未尽的意义，应该分为：左寸对应心、膻中、小肠；左关对应肝胆；左尺对应肾、膀胱及小肠。右寸对应肺、胸中、大肠；右关对应脾胃；右尺对应命门、三焦及大肠。大概大小肠或者附属于肺，因为它们表里相通；或者附属于两尺，因为它们位居下焦。膻中即包络，胸中即肺衣。古法不诊三焦，是因为不知道三焦的根就在肾系，现在特别将其配在右尺，义理才算完备。
脉有三部九候。三部是指寸、关、尺。九候是指浮、中、沉。
这与《内经》中三部九候的方法不同。然而头、手、足遍诊的方法，废弃已久，所以现在遵从《难经》，以寸、关、尺为三部，三部各有浮、中、沉，这就构成了九候。
呼气时关联心与肺，吸气时关联肾与肝，呼吸之间关联脾。脾的脉象在中部。浮脉属阳。心和肺的脉都浮，浮大而散的是心脉，浮而短涩的是肺脉。沉脉属阴。肝和肾的脉都沉，牢而长的是肝脉，按之柔软、举指感觉坚实的是肾脉。脾居中州，所以它的脉在中部，这是阴阳之法。
上一节以部位区分五脏，这一节又以呼吸、浮沉来区分五脏。心肺在上部，呼气由此排出，所以呼气属心肺，一呼脉跳两次。肝肾在下部，吸气归于此，所以吸气属肝肾，一吸脉跳两次。呼吸之间，脾主中宫，司管出入，脉跳一次。所以一呼一吸定息，脉来五次为无病。如果多跳一次，就有一脏太过；如果少跳一次，就有一脏不足。这是察测至数（脉搏次数）的方法。懂得这个道理，就知道至数迟速的原因。以下关于脉在中部的论述，又是用浮、中、沉来分别五脏。说脉在人的肌肉之中，轻按即见为浮，浮为在外属阳，对应心肺。浮大而散，其应在心；浮而短涩，其应在肺。重按乃见为沉，沉为在里属阴，对应肝肾。牢而长者是弦的象，属肝经；濡而实者是滑的象，属肾经。脾居中州，所以它的脉在中部，这是阴阳适中的地方。这是以沉诊肝肾，浮诊心肺，中诊脾胃，取配的意义，也是多方面的。
春脉弦，夏脉钩（洪），秋脉毛（浮），冬脉石（沉）。四季都以胃气为本。四季的变化、疾病的生死关键都在这里。
钩即洪脉，毛即浮脉，石即沉脉。胃气见于脉象，是和缓的象。意思是弦、钩、毛、石各见和缓之象即为有胃气。四季的变化，谓太过或不及，若不见胃气，就可以知道生病了。这是详细讲述五脏四季的主脉，而又归结于胃气。近代《三指禅脉诀》以缓脉为纲领，如果能懂得胃气为本的宗旨，学人可以一览无余。
数脉属腑，迟脉属脏。诸阳为热，诸阴为寒。数则为热，迟则为寒。
腑属阳，所以数脉应当应腑；脏属阴，所以迟脉应当应脏。数则为热，诸阳主气；迟则为寒，诸阴主气。以迟数来分脏腑，这并不完全正确，但数则为热，迟则为寒，却是有一定不变的道理。脉的跳动，出于心血之起落，属于脉管中血所主的事。心主火，血虚火少，则跳动迟缓；血多火旺，则跳动迅速。凡是脉的粗大细虚，都是脉管中的事，应当与迟数一同判断。脉法，要分辨脉管内是血分，脉管外是气分，这样延医自有分别。
浮脉属阳，滑脉属阳，长脉属阳；沉脉属阴，短脉属阴，涩脉属阴。根据各经所在的位置，命名病的顺逆。
浮、滑、长为阳，沉、短、涩为阴。据此治病，已得其要领。又再分各经以定顺逆。如肾脉宜沉而反浮，心脉宜浮而反沉，则为逆。既明白了脉的定象，又说明脉无定体，因经而分顺逆，这种方法最细致。西医只知道脉是血管，而不知道气依附于脉运行，血管外即是气道。西医说，脉外有膜，名叫脉鞘，光滑而薄，分多层，中有小孔，如筛子。按此解释，就是依附脉运行的气孔。脉管只是一条，动则俱动，所以迟数没有部位之分；气则有上下轻重之别，所以浮沉有三部之别。从此类推，将气管血管分诊合诊，那么脉象就没有隐藏的情态了。我读西医书，更加知道古代圣人的精妙，尤其希望西医能读古圣之书，也可以弥补他们的不足。
这种诊法，完全从《难经》而来。大概《内经》遍诊头足，自从越人（扁鹊）变法之后，大家趋向简易。后世的脉诀，托始于此时，于法非常精妙，所以应当遵从。再参考各种脉书，就能穷尽其奥妙了。
Patients should not conceal their illness, and physicians should not hide their shortcomings. One must investigate the origin and details of the condition to avoid confusion in treatment methods.
Those who were once noble but later fell into obscurity, although not affected by external pathogens, develop internal diseases known as *Tuoying* (depletion of Ying-nutrient due to mental depression). Those who were once wealthy but later became poor are said to suffer from *Shijing* (loss of Jing-essence due to excessive worry). One must inquire about the patient's diet and living conditions, as well as sudden shifts in emotion such as abrupt joy or sorrow, or starting with joy and ending with sorrow; all these factors can damage the Jing-essence.
This section discusses inquiring about the causes of disease. The method of inquiry is not limited to this; one should deduce and expand upon it to achieve comprehensiveness.
In diagnosing, one must understand the beginning and end of the disease and be aware of accompanying symptoms. When taking the pulse and asking for the name, one must consider the differences between men and women.
This paragraph summarizes the methods of observation and inquiry. "Understanding the beginning and end" means knowing the onset of the disease and its final manifestations, allowing for a complete assessment. "Knowing the remaining threads" refers to identifying minor accompanying symptoms that must also be examined to distinguish severe from mild conditions, thereby determining whether to treat them together or separately. By combining pulse diagnosis with inquiries about identity, one can determine the primary name of the disease and avoid errors. Since men and women differ physiologically and pathologically, considering their specific conditions ensures accuracy. This detailed approach to inquiry requires careful study. Appendix Chen Xiuyuan's *Song of Questioning Symptoms* states: First ask about chills and fever, second about sweating, third about head and body, fourth about excretion, fifth about diet, sixth about chest discomfort, seventh about deafness, eighth about thirst—all must be distinguished. Ninth asks about past illnesses, tenth about causes; add medication history to reference changes. For women, menstruation must be asked about; delays, rapidity, amenorrhea, or metrorrhagia can all be verified. Add a few phrases for pediatrics: smallpox and measles are fully diagnosed by this method.
Diagnosing disease through pulse observation is extremely refined. However, both the *Neijing* (Inner Canon) and Zhang Zhongjing's works advocate combined diagnosis using the Renying and Fuyang pulses. Currently, only the Cun Kou (inch position) pulse is taken, likely to simplify and grasp the essence. The annotations cited here refer exclusively to the Cun Kou method.
All twelve meridians have arterial pulsations. Why does taking only the Cun Kou pulse allow one to determine the life and death of the five zang and six fu organs? What is the rationale?
Cun Kou refers to the area behind the palm where the pulse is currently felt. This question originates from the *Nanjing* (Classic of Difficult Issues) to introduce subsequent theories. Modern Western medicine, unfamiliar with pulse diagnosis, attempts to refute it by arguing that since arteries exist throughout the body, why rely solely on the wrist's Cun Kou? They likely do not realize that ancient Chinese creators of pulse methodology anticipated such objections. The statement that "all twelve meridians have arterial pulsations" was already addressed and refuted long ago. Since Western medicine lacks understanding of pulse theory, their discussions remain speculative.
However, Cun Kou is the convergence point of pulses and an arterial branch of the Hand Taiyin Lung Meridian. With each exhalation, pulse qi travels three cun; with each inhalation, it also travels three cun. In one breath cycle (one xi), pulse qi travels six cun. Over a day and night, a person breathes 13,500 times, and pulse qi circulates fifty times around the body. Ying-nutrient and Wei-defensive qi each travel twenty-five cycles in Yang and twenty-five in Yin, completing one full circuit, finally converging at the Hand Taiyin Lung Meridian. Cun Kou is where the qi of the five zang and six fu organs begins and ends; thus, diagnostic methods utilize Cun Kou.
Recent theories suggest that the Lung governs all vessels and acts as the canopy (highest organ); the qi of all zang and fu organs ascends to nourish the Lung. Therefore, observing the Lung meridian's Cun Kou pulse allows diagnosis of various organs. While plausible, this overlooks the fundamental principle that the convergence of Ying and Wei qi marks the beginning and end of zang-fu qi. Thus, Yue Ren (author of *Nanjing*) established this precise method. Western medicine understands blood circulation but not Wei-defensive qi movement. They state that blood exits the heart, circulates, turns purple due to carbon absorption, returns via pulmonary veins, is oxygenated by exhaled air, and re-enters the heart. This aligns with the *Neijing*'s concept of Ying-nutrient circulating the body. Every moment sees blood exiting the left atrium and returning to the right atrium. However, calculating the time for blood to return takes a full day and night. Unlike Wei-defensive qi, which completes a full cycle before returning to the Lung to meet Ying-nutrient (a minor convergence), Ying-nutrient flows continuously every moment. Wei-defensive qi moves during the day in Yang (keeping one awake) and at night in Yin (inducing sleep), completing twenty-five cycles each to return to the Lung for a major convergence with Ying-nutrient. Hence, Ying-nutrient is described as "circulating the body," while Wei-defensive qi is described as "returning to converge at Hand Taiyin." These distinctions are clear and should not be confused. Since Ying-nutrient circulates internally and externally within zang-fu organs and converges at the Lung, examining the Cun pulse alone suffices to diagnose internal and external diseases. According to the *Lingshu*, human meridians span sixteen zhang two chi around the body. One cycle equals one degree. Over 13,500 breaths daily, qi travels fifty degrees. Details on meridian lengths and qi pathways are found in the *Neijing* (e.g., *Mai Du* and *Ying Qi* chapters). Observing pulse movement versus qi movement reveals that pulse follows Ying-blood. Daytime movement outside Ying is Yang (twenty-five cycles); nighttime movement inside Ying is Yin (twenty-five cycles). The *Neijing* notes elderly insomnia results from deficient Ying-blood preventing Wei-yang from entering Yin. This illustrates the interdependence of Ying and Wei. Ying-nutrient returns to the Lung-heart every moment; Wei-defensive qi returns after one full cycle. The fifty cycles represent the completion of Yin-Yang numbers before returning to the Lung for major convergence, marking the start and end of zang-fu qi. Because it converges at the Lung, the Lung pulse diagnoses all zang-fu diseases. Western medicine, unaware of Ying-Wei convergence and viewing pulses merely as blood vessels, fails to grasp Chinese pulse diagnosis, revealing their superficial understanding.
From Guan to Chi represents the realm of Yin within Chi. From Guan to Yuji represents the governance of Yang at Cun Kou.
Guan is the boundary between Cun and Chi, referred to in pulse rhymes as the "high bone." Below Guan is Chi, governing Liver and Kidney, deep in nature, hence Yin. Above Guan is Cun, governing Heart and Lung, floating in nature, hence Yang.
Western medicine denies pulse theory, claiming all body vessels originate from the heart's beating, so how can five zang organs be judged solely by vessels? They argue the wrist pulse is a single vessel, questioning the division into Cun, Guan, and Chi. This view is superficially logical but fundamentally flawed. Careful examination shows the pulse disappears above Yuji and below Chize. Although one continuous vessel, it has divisions of dispersion, convergence, visibility, and invisibility. Cun Kou is the major convergence point, crucial for Ying-Wei interaction, making it suitable for diagnosing various conditions. Inside the vessel belongs to Blood aspect; outside belongs to Qi aspect. Slowness and speed relate to contents within the vessel; floating and sinking relate to positions outside the vessel. Regarding anterior-posterior positioning, Cun is Yang, Chi is Yin. As the hand pulse is the convergence of all pulses, it naturally has regional distinctions. Yang outside, Yin inside reflects immutable heavenly principles. Superficial/upper/qi-related (Yang) are diagnosed at Cun; deep/internal/blood/lower-related (Yin) are diagnosed at Chi.
The Upper section corresponds to Heaven, governing diseases from the chest to the head. The Middle section corresponds to Humanity, governing diseases from below the diaphragm to the navel. The Lower section corresponds to Earth, governing diseases from below the navel to the feet.
This aligns with the *Neijing*: "Upper reaches upper" concerns chest and throat; "Lower reaches lower" concerns lower abdomen, waist, and feet. Heavenly principles favor the upper; earthly principles favor the lower, following affinity. Thus, Left Cun corresponds to Heart (upper); Right Cun to Lung (upper); Left Guan to Liver (middle); Right Guan to Spleen (middle); Left Chi to Kidney (lower); Right Chi to Mingmen (lower). This divides upper, middle, and lower. Left-right differentiation follows elemental theory: Water (Heaven 1) pairs Left; Fire (Earth 2) pairs Right. Water generates Wood, Wood generates Fire; thus Heart and Liver are on the Left. Fire generates Earth, Earth generates Metal; thus Spleen and Lung are on the Right. This follows affinity. Six Fu organs follow similar pairing logic. Large Intestine (Fu of Lung) pairs with Right Guan-Chi or Right Cun, reflecting Lung-Large Intestine unity. Stomach pairs with Right Guan (following Spleen). Sanjiao pairs with Right Chi (following Mingmen). Bladder pairs with Left Chi (following Kidney). Gallbladder pairs with Left Guan (following Liver). Small Intestine pairs with Left Cun (following Heart) or Left Chi, depending on positional hierarchy. Once zang-fu positions are clear, they extend to physical regions: throat, tongue, head, face, chest, shoulders diagnose at Cun; armpits, abdomen, waist diagnose at Guan; lower abdomen, perineum, thighs, calves, knees, feet diagnose at Chi. This *Neijing* method of "reaching up and down" reflects the I Ching's principle of affinity. Differentiation requires regional focus; diagnosis requires integrating three regions. Understanding these principles is essential for pulse diagnosis, which Western medicine lacks.
Older rhyme books list positions: Left Heart, Danzhong, Liver/Gallbladder, Kidney, Small Intestine; Right Lung, Chest, Spleen/Stomach, Mingmen, Large Intestine. Zhou Mengjue's *Three Finger Zen Pulse Method* lists: Left Heart, Small Intestine, Liver/Gallbladder, Kidney, Bladder; Right Lung, Large Intestine, Spleen/Stomach, Kidney, Mingmen. However, this is incomplete. It should be divided as: Left Cun: Heart, Danzhong, Small Intestine; Left Guan: Liver/Gallbladder; Left Chi: Kidney, Bladder, Small Intestine. Right Cun: Lung, Chest, Large Intestine; Right Guan: Spleen/Stomach; Right Chi: Mingmen, Sanjiao, Large Intestine. Small Intestine may attach to Lung (interior-exterior relation) or Chi (lower position). Danzhong is Pericardium; Chest is Lung covering. Ancient methods did not diagnose Sanjiao due to ignorance of its root in Kidney system; now pairing it with Right Chi completes the theory.
Pulse has Three Regions and Nine Probes. Three Regions are Cun, Guan, Chi. Nine Probes are Floating, Middle, Deep.
This differs from the *Neijing*'s head-hand-foot comprehensive probing. Since that method is obsolete, we follow *Nanjing*: Cun, Guan, Chi as Three Regions, each with Floating, Middle, Deep probes, forming Nine Probes.
Exhalation relates to Heart and Lung; inhalation relates to Kidney and Liver; the interval relates to Spleen. Spleen's pulse is in the Middle. Floating is Yang. Heart and Lung pulses float: large and scattered indicates Heart; short and choppy indicates Lung. Sinking is Yin. Liver and Kidney pulses sink: firm and long indicates Liver; soft yet solid upon lifting indicates Kidney. Spleen resides in the Central Province, so its pulse is in the Middle. This is the Yin-Yang method.
The previous section differentiated zang by location; this section differentiates by respiration and depth. Heart/Lung are upper, associated with exhalation (two beats per exhale). Kidney/Liver are lower, associated with inhalation (two beats per inhale). Between breaths, Spleen governs the center (one beat). Total five beats per breath cycle indicate health. Extra beats indicate excess; fewer indicate deficiency. This measures pulse rate. Below, Middle probe differentiates zang. Pulse in muscle: light pressure reveals Floating (Yang, Heart/Lung). Large/scattered = Heart; short/choppy = Lung. Heavy pressure reveals Sinking (Yin, Kidney/Liver). Firm/long = String-like (Liver); soft/solid = Slippery (Kidney). Spleen is central/middle, representing balanced Yin-Yang. This uses Sinking for Kidney/Liver, Floating for Heart/Lung, Middle for Spleen, offering multiple correspondences.
Spring pulse is Wiry; Summer is Hook (Surging); Autumn is Hairy (Floating); Winter is Stone (Sinking). All seasons prioritize Stomach Qi. Seasonal variations and disease prognosis depend on this.
Hook equals Surging; Hairy equals Floating; Stone equals Sinking. Stomach Qi appears as a harmonious, moderate quality. Wiry, Hook, Hairy, Stone pulses must show harmony to possess Stomach Qi. Excess or deficiency without Stomach Qi indicates disease. This details seasonal main pulses, rooting them in Stomach Qi. Recent *Three Finger Zen* rhymes use Moderate pulse as the guideline, emphasizing Stomach Qi as the foundation.
Rapid pulse belongs to Fu; Slow pulse belongs to Zang. All Yang is Heat; All Yin is Cold. Rapid indicates Heat; Slow indicates Cold.
Fu is Yang, so Rapid pulse corresponds to Fu. Zang is Yin, so Slow pulse corresponds to Zang. Rapid=Heat (Yang/Qi); Slow=Cold (Yin/Qi). Differentiating Zang/Fu by speed is not entirely accurate, but Rapid=Heat and Slow=Cold are invariant principles. Pulse beats stem from Heart Blood fluctuations within vessels. Heart governs Fire; deficient Blood/Fire slows the pulse; abundant Blood/Fire speeds it. Vessel thickness/voidness relates to vessel content, judged alongside speed. Pulse diagnosis distinguishes Blood aspect (inside vessel) from Qi aspect (outside vessel), ensuring precise medical consultation.
Floating, Slippery, Long are Yang; Sinking, Short, Choppy are Yin. Based on meridian locations, one determines favorable/unfavorable signs.
Floating/Slippery/Long are Yang; Sinking/Short/Choppy are Yin. This grasps the essence. Further differentiation by meridian determines favorability. E.g., Kidney pulse should be Sinking but is Floating (Unfavorable); Heart pulse should be Floating but is Sinking (Unfavorable). Beyond fixed pulse images, pulses vary by meridian. This fine method highlights that Western medicine views pulses only as blood vessels, ignoring Qi adhering to pulses. Western "pulse sheath" membranes with pores resemble channels for adhering Qi. Though one vessel moves together (no positional difference in speed), Qi varies in depth (positional difference in floating/sinking). Extending this to separate Qi/Blood vessel diagnosis reveals hidden pulse truths. Reading Western texts confirms ancient sages' profundity; I hope Western medicine studies ancient texts to fill gaps.
This diagnostic method derives from *Nanjing*. After Yue Ren changed the *Neijing*'s head-foot comprehensive method, simplicity prevailed. Later pulse rhymes originated here, being highly refined. One should follow this and consult other pulse texts to master its mysteries.