问曰东方肝脉其形何似师曰肝者木也名厥阴其脉微弦濡弱而长是肝脉也肝病自得濡弱者愈也
成 难经曰春脉弦者肝东方木也万物始生未有枝叶故脉来濡弱而长故曰弦是肝之平脉肝病得此脉者为肝气已和也
假令得纯弦脉者死何以知之以其脉如弦直是肝脏伤故知死也
成 纯弦者谓如弦直而不软此中无胃气为真脏之脉内经曰死肝脉来急益劲如新张弓弦
南方心脉其形何似师曰心者火也名少阴其脉洪大而长是心脉也心病自得洪大者愈也
成 心王于夏夏则阳外胜气血淖溢故其脉来洪大而长也
假令脉来微去大故名反病在里也脉来头小本大者故名覆病在表也上微头小者则汗出下微本大者则为关格不通不得
尿头无汗者可治有汗者死
成 心脉来盛去衰为平来微去大是反本脉内经曰大则邪至小则平微为正气大为邪气来以候表来微则知表和去以候
里去大则知里病内经曰心脉来不盛去反盛此为不及病在中头小本大者即前小后大也小为正气大为邪气则邪气先在里今
复还于表故名曰覆不云去而止云来者是知在表脉经曰在上为表在下为里汗者心之液上微为浮之而微头小为前小则表中
气虚故主汗出下微沉之而微本大为后大沉则在里大则病进内经曰心为牡脏小肠为之使今邪甚下行格闭小阳使正气不通
故不得尿名曰关格脉经曰阳气上出汗见于头今关格正气不通加之头有汗者则阳气不得下通而上脱也其无汗者虽作关格
然阳未衰而犹可治也
西方肺脉其形何似师曰肺者金也名太阴其脉毛浮也肺病自得此脉若得缓迟者皆愈若得数者则剧何以知之数者南方
火火克西方金法当痈肿为难治也
成 轻虚浮曰毛肺之平脉也缓迟者脾之脉脾为肺之母以子母相生故云皆愈数者心之脉火克金为鬼贼相刑故剧肺主
皮毛数则为热热客皮肤留而不去则为痈疡经曰数脉不时则生恶疮
问曰二月得毛浮脉何以言至秋当死师曰二月之时脉当濡弱反得毛浮者故知至秋死二月肝用事肝脉属木应濡弱反得
毛浮者是肺脉也肺属金金来克木故知至秋死他皆仿此
成 当春时反见秋脉为金气来木肺来克肝夺旺脉而见至秋肺旺肝气则绝故知至秋死也
师曰脉肥人责浮瘦人责沉肥人当沉今反浮瘦人当浮今反沉故责之
成 肥人肌肤浓其脉当沉瘦人肌肤薄其脉当浮今肥人脉反浮瘦人脉反沉必有邪气相干使脉反常故当责之
师曰寸脉下不至关为阳绝尺脉上不至关为阴绝此皆不治决死也若计其余命死生之期期以月节克之也
成 脉经曰阳生于寸动于尺阴生于尺动于寸寸脉下不至关者为阳绝不能下应于尺也尺脉上不至关者为阴绝不能上
应于寸也内经曰阴阳离决精气乃绝此阴阳偏绝故皆决死期以月节克之者谓如阳绝死于春夏阴绝死于秋冬也
师曰脉病患不病名曰行尸以无旺气卒眩仆不识人者短命则死人病脉不病名曰内虚以有谷神虽困无苦
成 脉者人之根本也脉病患不病为根本内绝形虽且强卒然气脱则眩晕僵仆而死不曰行尸而何人病脉不病则根本内
固形虽且羸止内虚耳谷神者谷气也谷气既足自然安矣内经曰形气有余脉气不足死脉气有余形气不足生
问曰翕奄沉名曰滑何谓也沉为纯阴翕为正阳阴阳和合故令脉滑关尺自平阳明脉微沉食饮自可少阴脉微滑滑者紧之
浮名也此为阴实其人必股内汗出阴下湿也
成 脉来大而盛聚而沉谓之翕奄沉正如转珠之状也沉为脏气故曰纯阴翕为腑气故曰正阳滑者阴阳气不为偏胜也关
尺自平阳明脉微沉者当阳部见阴脉则阴偏胜而阳不足也阳明胃脉胃中阴多故食饮自可少阴脉微滑者当阴部见阳脉则阳
偏胜而阴不足也以阳凑阴分故曰阴实股与阴少阴之部也今阳热凑阴必熏发津液泄达于外股内汗出而阴下湿也
许 沉为
纯阴翕为正阳阴阳和合故名滑古人论滑脉虽云往来前却流利宛转替替然与数相似仲景三语而足也按翕奄沉三字状得滑
字最好夫翕者合也奄者忽也当脉气合聚而盛之时奄忽之门即已沉去是名滑也仲景恐人误认滑脉为沉故下文又曰滑者紧
之浮名也曰沉曰浮若异而同更须慧解观上文紧者如转索无常也一句则知浮为转索无常之浮非轻手便得有常之名也沉为
翕奄之沉非重取乃得一定之说也仲景下字具有史笔不可草草看过故赵嗣真曰今人不解作秦汉文本观可谓善读仲景之书
矣
问曰曾为人所难紧脉从何而来师曰假令亡汗若吐以肺里寒故令脉紧也假令咳者坐饮冷水故令脉紧也假令下利以胃
中虚冷故令脉紧也
阳舒缓阴缩急阴化为寒揪然收敛气血以坚其为脉也宁得不急经曰紧脉带数如切绳状一曰如转索无常故有寒则见
寸口卫气胜名曰高
寸口通关尺而言高谓脉来浮而有力卫气主表浮以候之其体在上今浮中有力是卫气盛也以其在上故谓之高有升而不
降之义焉
荣气盛名曰章
章明也条也往来分明有条理也今滑脉为血实之诊殆近是乎
高章相搏名曰纲
纲总也以荣卫俱盛故谓之总
卫气弱名曰
举之濡弱恍惚故谓之
荣气弱名曰卑
荣主血为阴按以候之其脉沉而无力故谓之卑
卑相搏名曰损
卑相搏阴阳俱虚总谓之损举按俱无力也
卫气和名曰缓
缓为胃脉胃合卫气卫气和故见缓脉
荣气和名曰迟
迟为脾脉脾合荣气荣气和故见迟脉
迟缓相搏名曰强
荣卫俱和故迟缓相搏不亦强乎
寸口脉缓而迟缓则阳气长其色鲜其颜光其声商毛发长迟则阴气盛骨髓生血满肌肉紧薄鲜硬阴阳相抱荣卫俱行刚柔
相搏名曰强也
此释上一句之义此为平脉非病脉也
趺阳脉滑而紧滑者胃气实紧者脾气强持实击强痛还自伤以手把刃坐作疮也
成 趺阳之脉以候脾胃滑则谷气实是为胃实紧则阴气胜是为脾强以脾胃一实一强而相搏击故令痛也若一强一弱相
搏则不能作痛此脾胃两各强实相击腑脏自伤而痛譬若以手把刃而成疮岂非自贻其害乎按此则敦阜大过之脉也
寸口脉浮而大浮为虚大为实在尺为关在寸为格寸关则不得小便格则吐逆
成 经曰浮为虚内经曰大则病进浮则为正气虚大则为邪气实在尺则邪气关闭下焦里气不得下通故不得小便在寸则
邪气格拒上焦使食不得入故吐逆
丹 谨按难经云吸入肾与肝夫盈天地之间者一元之气也气之升者为阳气之降者为阴肾
足少阴也肝足厥阴也位居下主吸与入其所吸之气不能达肾至肝而还者此阴之弱也浮大之脉属阳见于寸者阳气偏盛阴不
得配之也为格主吐逆此无阴则呕谓见于尺者阴血不足阳往乘之也为关主不得小便此东垣滋肾丸之意趺阳胃脉气不宣血
不濡名曰关格主水谷不化与食不得入亦阳有余阴不足故有升而无降也何注文不之及而以邪气关格闭拒为言欤
趺阳脉伏而涩伏则吐逆水谷不化涩则食不得入名曰关格
成 伏则胃气伏而不宣中焦关格正气壅塞故吐逆而水谷不化涩则脾气涩而不布邪气拒于上焦故食不得入有妇人病
吐逆大小便不通烦乱四逆渐无脉一日与大承气汤二盏至半夜渐得大便烦乱触逆耳脉渐生翌日乃安即此是关格也宜审之
脉浮而大浮为风虚大为气强风气相搏必成瘾疹身体为痒痒者名泄风久久为痂癞
成 痂癞者眉少发稀身有干疮而腥臭内经曰脉风成为疠
寸口脉弱而迟弱者卫气微迟者荣中寒荣为血血寒则发热卫为气气微者心内饥饥而虚满不能食也
成 卫为阳荣为阴弱者卫气微阳气不足也迟者荣中寒经中客邪也荣客寒邪搏而发热也阳气内微心内虽饥饥而虚满
不能食也缓迟与弱迟虽止一字之差却有千里之谬成氏不合注而分解无怪其上下不相同也
趺阳脉大而紧者当即下利为难治
成 大为虚紧为寒胃中虚寒当即下利下利脉当微小反紧者邪胜也故云难治经曰下利脉大者为未止大为实大为虚上
下纷纷更易不一者只要识得虚者正气虚实者邪气实之义以上以脉知病
寸口脉弱而缓弱者阳气不足缓者胃气有余噫而吞酸食卒不下气填于膈上也
成 弱者阳气不足阳能消谷阳气不足则不能消化谷食缓者胃气有余则胃中有未消谷物也故使噫而吞酸食卒不下气
填于膈上也金匮要略曰中焦未和不能消谷故令噫弱缓与迟缓亦不同
趺阳脉紧而浮浮为气紧为寒浮为腹满紧为绞痛浮紧相搏肠鸣而转转即气动膈气乃下少阴脉不出其阴肿大而虚也
成 浮为胃气虚紧为脾中寒胃虚则满脾寒则痛虚寒相搏肠鸣而转转则膈中之气因而下泄也若少阴脉不出则虚寒之
气至于下焦结于少阴而聚于阴器不得发泄使阴肿大而虚也
寸口脉微而涩微者卫气不行涩者荣气不足荣卫不能相将三焦无所仰身体痹不仁荣气不足则烦疼口难言卫气虚则恶
寒数欠三焦不归其部上焦不归者噫而酢吞中焦不归者不能消谷引食下焦不归者则遗溲
成 夫养三焦者血也护三焦者气也荣卫俱损不能相将而行三焦无所根据仰身体为之顽痹而不仁内经曰荣气虚则不仁
针经曰卫气不行则为不仁荣为血血不足则烦疼荣属心荣弱心虚则口难言卫为阳阳微则恶寒卫为气虚则数欠三焦因荣卫
不足无所根据仰其气不能归其部金匮要略曰上焦竭善噫上焦受中焦气中焦未和不能消谷故令噫耳下焦竭即遗溺失便以上
焦在膈上物未化之分也不归者不至也上焦之气不至其部则物未能传化故噫而诈吞中焦在胃之中主腐熟水谷水谷化则思
食中焦之气不归其部则水谷不化故云不能消谷引食下焦在膀胱上口主分别清浊溲小便也下焦不归其部不能约制溲便故
遗溲三焦病各分其证自有三法存焉
趺阳脉沉而数沉为实数消谷紧者病难治
成 沉为实者沉主里也数消谷者数为热也紧为肝脉见于脾部木来克土为鬼贼相刑其病故云难治按紧与弦当有分别
恐未可便以紧为弦也首卷曰弦则为减金匮要略曰脉紧如转索无常者有宿食也以义求之则弦为虚而紧为实也
寸口脉微而涩微者卫气衰涩者荣气不足卫气衰面色黄荣气不足面色青荣为根卫为叶荣卫俱微则根叶枯槁而寒栗咳
逆唾腥吐涎沫也
子能令母虚肺主气气虚则脾色见于面而黄心主血血衰则肝色见于面而青肺臭腥脾液涎也荣虚则寒栗卫虚则咳逆
趺阳脉浮而芤浮者卫气衰芤者荣气伤其身体瘦肌肉甲错浮芤相搏宗气衰微四属断绝
成 经曰卫气盛名曰高高者暴狂而肥荣气盛名曰章章者暴泽而光其身体瘦而不肥者卫气衰也肌肉甲错而不泽者荣
气伤也宗气者三焦归气也四属者皮肉脂髓也荣卫衰伤则宗气亦微四属失所滋养致断(绝矣)
寸口脉微而缓微者卫气疏疏则其肤空缓者胃气实实则谷消而水化也谷入于胃脉道乃行而入于经其血乃成荣盛则其
肤必疏三焦绝经名曰血崩
成 卫为阳微为亡阳脉微者卫气疏卫温分肉肥凑理卫气既疏皮肤不得温肥则空虚也经曰缓者胃气有余有余为实故
云缓者胃气实内经曰食入于胃淫经于脉是谷入于胃脉道乃行也针经曰饮而液渗于络合和于血是水入于经其血乃成也胃
中谷消水化而为血气今卫疏荣盛是荣气强而卫气弱也卫气弱者外则不能固密皮肤而气为之疏内则不能卫护其血而血为
之崩经常也三焦者气之道路卫气疏则气不循常度三焦绝其常度也按经文曰而入于经则而字乃承上文谷字水亦在其中矣
注引针经水入于经乃是互文以见意仲景独重于谷故用而字若欠理会则血为水所化也岂理也哉玩合和于三字则成氏之说
欠明
趺阳脉微而紧紧则为寒微则为虚微紧相搏则为短气
成 中虚且寒气自短矣
少阴脉弱而涩弱者微烦涩者厥逆
成 烦者热也少阴脉弱者阴虚也阴虚则发热以阴部见阳脉非大虚也故生微烦厥逆者四肢冷也经曰阴阳不相顺接便
为厥厥者手足厥冷是也少阴脉涩者阴气涩不能与阳相顺而接故厥逆也此 不当作二证
趺阳脉不出脾不上下体冷肤硬
成 脾胃为荣卫之根脾能上下则水谷消磨荣卫之气得以行脾气虚衰不能上下则荣卫之气不得通荣于外故趺阳脉不
出身冷者卫气不温也肤硬者荣血不濡也
少阴脉不至肾气微少精血奔气促迫上入胸膈宗气反聚血结心下阳气退下热归阴股与阴相动令身不仁此为尸厥当刺
期门巨阙
成 尸厥者为其从厥而生形无所知其状若尸故名尸厥少阴脉不出则厥气客于肾而肾气微少精血厥气上奔填塞胸膈
壅遏阳气使宗气反聚而血结心下针经曰五谷入于胃其糟粕津液宗气分为三隧宗气积于胸中出于喉咙以贯心肺而行呼吸
又曰荣气者泌其津液注之于脉化而为血以荣四末今厥气太甚宗气反聚而不行则绝其呼吸血结心下而不流则四体不仁阳
气为厥气所拥不能宣发退下至阴股问与阴相动仁者柔也不仁者言不柔和也为寒热痛痒俱不觉知者也阳气外不为使内不
得通荣卫俱不能行身体不仁状若尸也内经曰厥气上行满脉去形刺期门者以通心下结血刺巨阙者以行胸中宗气血气流通
厥气退则苏矣
寸口脉微尺脉紧其人虚损多汗知阴常在绝不见阳也
成 寸微为亡阳尺紧为阴胜阳微阴胜故云虚损又加之多汗则愈损阳气是阴常在而绝不见阳也
寸口诸微亡阳诸濡亡血诸弱发热诸紧为寒诸乘寒者则为厥郁冒不仁以胃无谷气脾涩不通口急不能言战而栗也
成 卫阳也微为卫气微故云亡阳荣血也濡为荣气弱故云亡血弱为阴虚虚则发热紧为阴胜故为寒诸乘寒者则阴阳俱
问:东方肝脉的形态像什么?老师回答:肝属木,名为厥阴。其脉象微带弦意、濡软而长,这就是肝脉。肝病如果见到这种濡弱的脉象,说明胃气尚存,病情会好转。
成无己注:《难经》说:春脉呈弦象,是因为肝属东方木。万物初生,尚未长出枝叶,所以脉来濡弱而长,因此称为“弦”。这是肝的正常平脉。肝病若出现此脉,说明肝气已经调和。
假如出现纯弦脉(毫无柔和之意的弦脉),主死。为什么知道呢?因为这种脉象如弦线般直硬,说明肝脏真气受损,所以判断为死证。
成无己注:纯弦是指脉象如弦线般直硬而不柔软,这是中焦无胃气的表现,属于真脏脉。《内经》说:死的肝脉,来势急迫且强劲,如同新拉开的弓弦。
问:南方心脉的形态像什么?老师回答:心属火,名为少阴。其脉象洪大且长,这就是心脉。心病如果见到这种洪大的脉象,说明正气未衰,病情会好转。
成无己注:心王于夏季,夏季阳气外盛,气血涌溢,所以脉来洪大而长。
假如脉来时微弱、去时盛大,这叫“反”,病在里;脉来时头小(浮取小)、根大(沉取大),这叫“覆”,病在表。如果上部脉微弱、头部小,就会出汗;下部脉微弱、根部大,就是关格不通,不能排尿。头部无汗的可治,有汗的死。
成无己注:心脉来盛去衰为平脉。来微去大是反脉。《内经》说:脉大为邪气至,脉小为平和,脉微为正虚,脉大为邪盛。通过“来”候表,“来微”则知表和;通过“去”候里,“去大”则知里病。《内经》说:心脉来不盛,去反而盛,这是不及,病在中。“头小本大”即前小后大。小为正虚,大为邪盛,邪气先在里,现在又返回到表,所以叫“覆”。不说“去”而说“来”,是知道病在表。《脉经》说:在上为表,在下为里。汗是心的液。上微是浮取而微,头小是前小,说明表中气虚,所以主汗出。下微是沉取而微,本大是后大,沉则在里,大则病进。《内经》说:心为牡脏,小肠为之使。现在邪气甚盛下行,格闭小肠,使正气不通,所以不得尿,名叫关格。《脉经》说:阳气上越,汗见于头。现在关格正气不通,加上头部有汗,则是阳气不能下行而上脱。若无汗者,虽然患关格,但阳气未衰,还可以治疗。
问:西方肺脉的形态像什么?老师回答:肺属金,名为太阴。其脉象毛浮(轻虚浮)。肺病若得此脉,或者得到缓迟脉,都会痊愈;若得到数脉,则病情严重。为什么这样知道?数脉属南方火,火克西方金,按照五行规律应当发生痈肿,难以治疗。
成无己注:轻虚浮叫做“毛”,是肺的平脉。缓迟是脾脉,脾为肺之母,以子母相生关系,所以说都会痊愈。数是心脉,火克金,为鬼贼相刑,所以病情加重。肺主皮毛,数为热,热邪客于皮肤停留不去,就会成为痈疡。经文说:数脉不时发,则生恶疮。
问:二月(春季)得毛浮脉,为什么说到了秋天会死?老师回答:二月的时候,脉应当濡弱,反而得到毛浮脉,所以知道到秋天会死。二月肝气当令,肝脉属木,应见濡弱,反而得到毛浮脉,这是肺脉。肺属金,金来克木,所以知道到秋天会死。其他季节都依此类推。
成无己注:正当春季却反见秋季脉象,是金气来克木,肺金来克肝木,剥夺了旺脉而显现,到了秋天肺旺肝气绝,所以知道到秋天会死。
老师说:对于肥胖的人,要责求其脉是否该沉而不沉;对于消瘦的人,要责求其脉是否该浮而不浮。肥胖的人脉应当沉,现在反而浮;消瘦的人脉应当浮,现在反而沉,都要追究病因。
成无己注:肥胖人肌肤浓厚,其脉应当沉;消瘦人肌肤薄,其脉应当浮。现在肥人脉反浮,瘦人脉反沉,必定有邪气干扰,使脉象反常,所以应当追究。
老师说:寸脉向下不到关部,叫阳绝;尺脉向上不到关部,叫阴绝。这些都不治,决断为死证。如果要计算剩余寿命和死亡期限,是以月节令相克的规律来推算。
成无己注:《脉经》说:阳生于寸动于尺,阴生于尺动于寸。寸脉向下不到关部,是阳绝不能下应于尺;尺脉向上不到关部,是阴绝不能上应于寸。《内经》说:阴阳离决,精气乃绝。这是阴阳偏绝,所以都断为死证。所谓以月节令相克来定死期,是说如阳绝死于春夏,阴绝死于秋冬。
老师说:脉有病象而人没有病状,名叫“行尸”,因为没有旺盛之气,突然眩晕仆倒不识人,短命而死;人有病状而脉没有病象,名叫“内虚”,因为有谷神(胃气),虽然困顿但没有痛苦。
成无己注:脉是人的根本。脉有病而人不病,是根本内部断绝,形体虽然暂时强壮,突然气脱就会眩晕僵仆而死,不叫行尸叫什么?人有病而脉不病,是根本内部坚固,形体虽然瘦弱,只是内部虚弱罢了。谷神就是谷气,谷气充足自然安泰。《内经》说:形气有余,脉气不足,死;脉气有余,形气不足,生。
问:翕奄沉,名叫滑,这是什么意思?答:沉为纯阴,翕为正阳,阴阳和合,所以令脉滑。关尺自平。阳明脉微沉,饮食正常;少阴脉微滑,滑是紧之浮名,这是阴实,其人必股内侧出汗,阴部下潮湿。
成无己注:脉来大而盛,聚而沉,叫做翕奄沉,正如珠子转动一样的状态。沉为脏气,所以叫纯阴;翕为腑气,所以叫正阳。滑是阴阳气不偏胜。关尺自平。阳明脉微沉,是在阳部见到阴脉,则阴偏胜而阳不足。阳明胃脉,胃中阴多,所以饮食正常。少阴脉微滑,是在阴部见到阳脉,则阳偏胜而阴不足。以阳凑入阴分,所以叫阴实。股与阴是少阴的部位。现在阳热凑入阴分,必然熏蒸津液,泄达于外,所以股内出汗而阴下湿。
许叔重注:沉为纯阴,翕为正阳,阴阳和合,所以名叫滑。古人论述滑脉,虽然说往来流利宛转,与数脉相似,但张仲景三句话就足够了。按“翕奄沉”三个字形容滑字最好。夫“翕”是合,“奄”是忽。当脉气合聚而盛之时,忽然之间就已经沉去,这名叫滑。张仲景恐怕人们误认滑脉为沉脉,所以下文又说:“滑者紧之浮名也。”说沉说浮,看似不同实则相同,更需要智慧理解。看上文“紧者如转索无常也”一句,就知道浮是转索无常之浮,不是轻手便有的常名。沉是翕奄之沉,不是重取才得到的定说。张仲景用字具有史笔,不可草率看过。所以赵嗣真说:今人不解作秦汉文本观看,可以说是善于读仲景之书了。
问:曾经被人诘难,紧脉从何而来?老师回答:假如亡汗或呕吐,因肺里有寒,所以令脉紧。假如咳嗽,因为喝冷水,所以令脉紧。假如下利,因为胃中虚冷,所以令脉紧。
阳气舒缓,阴气缩急,阴化为寒,揪然收敛,气血变得坚实,脉象怎能不急呢?经文说:紧脉带数,如切绳状。一说如转索无常。所以有寒则见紧脉。
寸口卫气胜,名叫高。
寸口指关尺而言。高谓脉来浮而有力。卫气主表,浮以候之,其体在上。现在浮取中取都有力,是卫气盛。因为它在上,所以叫高。有升而不降的意思。
荣气盛,名叫章。
章明也,条也。往来分明有条理。现在滑脉是血实的诊察,大概接近这个情况。
高章相搏,名叫纲。
纲总也。因为荣卫俱盛,所以叫总。
卫气弱,名叫...(原文此处似缺字,结合下文推测为某种弱脉名称,但原文仅列标题,故保留结构)举之濡弱恍惚,所以叫...
荣气弱,名叫卑。
荣主血为阴,按以候之,其脉沉而无力,所以叫卑。
卑相搏,名叫损。
卑相搏,阴阳俱虚,总叫作损。举按俱无力。
卫气和,名叫缓。
缓为胃脉,胃合卫气,卫气和,所以见缓脉。
荣气和,名叫迟。
迟为脾脉,脾合荣气,荣气和,所以见迟脉。
迟缓相搏,名叫强。
荣卫俱和,所以迟缓相搏,不也是强吗?
寸口脉缓而迟,缓则阳气长,其色鲜,其颜光,其声商,毛发长。迟则阴气盛,骨髓生,血满,肌肉紧薄鲜硬。阴阳相抱,荣卫俱行,刚柔相搏,名叫强。
这是解释上一句的意义。这是平脉,不是病脉。
趺阳脉滑而紧,滑者胃气实,紧者脾气强。持实击强,痛还自伤,像用手拿刀刃,自己造成疮口一样。
成无己注:趺阳脉以候脾胃。滑则谷气实,这是胃实;紧则阴气胜,这是脾强。因为脾胃一实一强而相互搏击,所以令疼痛。如果一强一弱相搏,则不能作痛。这是脾胃两各强实相击,腑脏自伤而痛。譬如用手拿刀刃而成疮,难道不是自取其害吗?按此则是敦阜大过之脉。
寸口脉浮而大,浮为虚,大为实。在尺为关,在寸为格。寸关则不得小便,格则吐逆。
成无己注:经文说:浮为虚。《内经》说:大则病进。浮则为正气虚,大为邪气实。在尺则邪气关闭下焦,里气不得下通,所以不得小便。在寸则邪气格拒上焦,使食不得入,所以吐逆。
丹波元坚注:谨按《难经》云:吸入肾与肝。充满天地之间的是一元气。气之升者为阳,气之降者为阴。肾足少阴,肝足厥阴,位居下,主吸与入。其所吸之气不能达肾,至肝而还,这是阴之弱。浮大之脉属阳,见于寸者,是阳气偏盛,阴不得配之,为格,主吐逆,这是无阴则呕。见于尺者,是阴血不足,阳往乘之,为关,主不得小便,这是东垣滋肾丸的意思。趺阳胃脉,气不宣,血不濡,名叫关格,主水谷不化与食不得入,也是阳有余阴不足,故有升而无降。为何注文不涉及这些,而以邪气关格闭拒来说呢?
趺阳脉伏而涩,伏则吐逆,水谷不化;涩则食不得入,名叫关格。
成无己注:伏则胃气伏而不宣,中焦关格,正气壅塞,所以吐逆而水谷不化。涩则脾气涩而不布,邪气拒于上焦,所以食不得入。有个妇人病吐逆,大小便不通,烦乱,四肢逆冷,逐渐无脉。一天给服大承气汤两盏,到半夜逐渐得大便,烦乱触逆耳,脉渐生,第二天才安,这就是关格。应该审慎对待。
脉浮而大,浮为风虚,大为气强。风气相搏,必成瘾疹,身体瘙痒。痒的叫泄风,久久成为痂癞。
成无己注:痂癞是眉少发稀,身有干疮而腥臭。《内经》说:脉风成为疠。
寸口脉弱而迟,弱者卫气微,迟者荣中寒。荣为血,血寒则发热;卫为气,气微者心内饥,饥而虚满,不能食。
成无己注:卫为阳,荣为阴。弱者卫气微,阳气不足。迟者荣中寒,经中客邪。荣客寒邪,搏而发热。阳气内微,心内虽饥,饥而虚满,不能食。缓迟与弱迟,虽然只差一字,却有千里之谬。成氏不合注而分解,难怪上下不相同。
趺阳脉大而紧者,当即下利,为难治。
成无己注:大为虚,紧为寒。胃中虚寒,当即下利。下利脉当微小,反紧者,邪胜也。所以说难治。经文说:下利脉大者为未止。大为实,大为虚。上下纷纷更易不一,只要识得虚者正气虚,实者邪气实的意义。以上以脉知病。
寸口脉弱而缓,弱者阳气不足,缓者胃气有余。噫而吞酸,食卒不下,气填于膈上也。
成无己注:弱者阳气不足,阳能消谷,阳气不足则不能消化谷食。缓者胃气有余,则胃中有未消谷物。所以使噫而吞酸,食物突然不下,气填于膈上。《金匮要略》说:中焦未和,不能消谷,故令噫。弱缓与迟缓也不同。
趺阳脉紧而浮,浮为气,紧为寒。浮为腹满,紧为绞痛。浮紧相搏,肠鸣而转转,即气动膈,气乃下。少阴脉不出,其阴肿大而虚也。
成无己注:浮为胃气虚,紧为脾中寒。胃虚则满,脾寒则痛。虚寒相搏,肠鸣而转转,则膈中之气因而下泄。若少阴脉不出,则虚寒之气至于下焦,结于少阴而聚于阴器,不得发泄,使阴肿大而虚。
寸口脉微而涩,微者卫气不行,涩者荣气不足。荣卫不能相将,三焦无所仰,身体痹不仁。荣气不足则烦疼,口难言;卫气虚则恶寒,数欠。三焦不归其部:上焦不归者,噫而酢吞;中焦不归者,不能消谷引食;下焦不归者,则遗溲。
成无己注:养三焦的是血,护三焦的是气。荣卫俱损,不能相将而行,三焦无所根据仰,身体为之顽痹而不仁。《内经》说:荣气虚则不仁。《针经》说:卫气不行则为不仁。荣为血,血不足则烦疼。荣属心,荣弱心虚则口难言。卫为阳,阳微则恶寒。卫为气,虚则数欠。三焦因荣卫不足,无所根据仰,其气不能归其部。《金匮要略》说:上焦竭,善噫。上焦受中焦气,中焦未和,不能消谷,故令噫耳。下焦竭,即遗溺失便。以上焦在膈上,物未化之分。不归者不至。上焦之气不至其部,则物未能传化,故噫而酢吞。中焦在胃之中,主腐熟水谷。水谷化则思食。中焦之气不归其部,则水谷不化,故云不能消谷引食。下焦在膀胱上口,主分别清浊,溲小便。下焦不归其部,不能约制溲便,故遗溲。三焦病各分其证,自有三法存焉。
趺阳脉沉而数,沉为实,数消谷。紧者病难治。
成无己注:沉为实者,沉主里。数消谷者,数为热。紧为肝脉,见于脾部,木来克土,为鬼贼相刑,其病故云难治。按紧与弦应当有分别,恐未可便以紧为弦。首卷说:弦则为减。《金匮要略》说:脉紧如转索无常者,有宿食。以义求之,则弦为虚而紧为实。
寸口脉微而涩,微者卫气衰,涩者荣气不足。卫气衰面色黄,荣气不足面色青。荣为根,卫为叶。荣卫俱微,则根叶枯槁,而寒栗咳逆,唾腥,吐涎沫。
子能令母虚。肺主气,气虚则脾色见于面而黄。心主血,血衰则肝色见于面而青。肺臭腥,脾液涎。荣虚则寒栗,卫虚则咳逆。
趺阳脉浮而芤,浮者卫气衰,芤者荣气伤。其身体瘦,肌肉甲错。浮芤相搏,宗气衰微,四属断绝。
成无己注:经文说:卫气盛名叫高,高者暴狂而肥。荣气盛名叫章,章者暴泽而光。其身体瘦而不肥者,卫气衰。肌肉甲错而不泽者,荣气伤。宗气是三焦归气。四属是皮肉脂髓。荣卫衰伤,则宗气亦微,四属失所滋养,致断绝。
寸口脉微而缓,微者卫气疏,疏则其肤空。缓者胃气实,实则谷消而水化。谷入于胃,脉道乃行。而入于经,其血乃成。荣盛则其肤必疏,三焦绝经,名叫血崩。
成无己注:卫为阳,微为亡阳。脉微者卫气疏。卫温分肉,肥腠理。卫气既疏,皮肤不得温肥,则空虚。经文说:缓者胃气有余,有余为实,故云缓者胃气实。《内经》说:食入于胃,淫经于脉,是谷入于胃,脉道乃行。《针经》说:饮而液渗于络,合和于血,是水入于经,其血乃成。也。胃中谷消水化而为血气。今卫疏荣盛,是荣气强而卫气弱。卫气弱者,外则不能固密皮肤而气为之疏,内则不能卫护其血而血为之崩经常。三焦者气之道路,卫气疏则气不循常度,三焦绝其常度。按经文曰“而入于经”,则“而”字乃承上文“谷”字,“水”亦在其中矣。注引《针经》“水入于经”乃是互文以见意。仲景独重于谷,故用“而”字。若欠理会,则血为水所化也,岂理也哉?玩“合和于”三字,则成氏之说欠明。
趺阳脉微而紧,紧则为寒,微则为虚。微紧相搏,则为短气。
成无己注:中虚且寒气自短矣。
少阴脉弱而涩,弱者微烦,涩者厥逆。
成无己注:烦者热也。少阴脉弱者阴虚也。阴虚则发热,以阴部见阳脉,非大虚也,故生微烦。厥逆者四肢冷也。经文说:阴阳不相顺接,便为厥。厥者手足厥冷是也。少阴脉涩者,阴气涩,不能与阳相顺而接,故厥逆也。此不当作二证。
趺阳脉不出,脾不上下,体冷肤硬。
成无己注:脾胃为荣卫之根。脾能上下,则水谷消磨,荣卫之气得以行。脾气虚衰,不能上下,则荣卫之气不得通,荣于外。故趺阳脉不出。身冷者,卫气不温。肤硬者,荣血不濡。
少阴脉不至,肾气微,少精血,奔气促迫,上入胸膈,宗气反聚,血结心下,阳气退下,热归阴股,与阴相动,令身不仁,此为尸厥。当刺期门、巨阙。
成无己注:尸厥者,为其从厥而生,形无所知,其状若尸,故名尸厥。少阴脉不出,则厥气客于肾,而肾气微,少精血。厥气上奔,填塞胸膈,壅遏阳气,使宗气反聚,而血结心下。《针经》说:五谷入于胃,其糟粕津液宗气分为三隧。宗气积于胸中,出于喉咙,以贯心肺,而行呼吸。又说:荣气者,泌其津液,注之于脉,化而为血,以荣四末。今厥气太甚,宗气反聚而不行,则绝其呼吸;血结心下而不流,则四体不仁。阳气为厥气所拥,不能宣发,退下至阴股,与阴相动。仁者柔也,不仁者言不柔和也,为寒热痛痒俱不觉知者也。阳气外不为使,内不得通,荣卫俱不能行,身体不仁,状若尸。《内经》说:厥气上行,满脉去形。刺期门者,以通心下结血;刺巨阙者,以行胸中宗气。血脉流通,厥气退则苏矣。
寸口脉微,尺脉紧,其人虚损多汗,知阴常在,绝不见阳也。
成无己注:寸微为亡阳,尺紧为阴胜。阳微阴胜,故云虚损。又加之多汗,则愈损阳气,是阴常在而绝不见阳。
寸口诸微亡阳,诸濡亡血,诸弱发热,诸紧为寒。诸乘寒者则为厥,郁冒不仁。以胃无谷气,脾涩不通,口急不能言,战而栗也。
成无己注:卫阳也,微为卫气微,故云亡阳。荣血也,濡为荣气弱,故云亡血。弱为阴虚,虚则发热。紧为阴胜,故为寒。诸乘寒者,则阴阳俱
Question: What does the shape of the Liver pulse (Gan Mai) from the East resemble? The Master replied: The Liver belongs to Wood and is named Jueyin (Jueyin Meridian). Its pulse is slightly wiry, soft, and long; this is the Liver pulse. If a Liver disease presents with a soft and weak pulse, it indicates recovery.
Cheng Wuji's Commentary: The *Nan Jing* (Classic of Difficult Issues) states: The Spring pulse is wiry because the Liver belongs to the East and Wood. When all things begin to sprout, they have not yet grown branches and leaves, so the pulse comes in a soft, weak, and long manner; thus it is called "wiry." This is the normal pulse of the Liver. If a Liver disease presents with this pulse, it means the Liver Qi has harmonized.
If a purely wiry pulse (lacking any softness) is obtained, it indicates death. How do we know this? Because such a pulse is straight and rigid like a string, indicating injury to the true essence of the Liver; therefore, it is judged as fatal.
Cheng Wuji's Commentary: A purely wiry pulse refers to one that is straight and rigid without softness, indicating the absence of Stomach Qi in the middle jiao; this is a True Zang pulse. The *Nei Jing* (Inner Canon) says: The dying Liver pulse arrives urgently and forcefully, like a newly drawn bowstring.
Question: What does the shape of the Heart pulse (Xin Mai) from the South resemble? The Master replied: The Heart belongs to Fire and is named Shaoyin (Shaoyin Meridian). Its pulse is surging (Hong), large, and long; this is the Heart pulse. If a Heart disease presents with a surging pulse, it indicates recovery.
Cheng Wuji's Commentary: The Heart rules over Summer. In Summer, Yang energy prevails externally, causing blood and Qi to surge and overflow; thus, the pulse arrives surging, large, and long.
If the pulse arrives faintly but departs strongly, it is called "Reverse" (Fan), indicating disease in the interior. If the pulse head is small (superficially small) but the root is large (deeply large), it is called "Covered" (Fu), indicating disease in the exterior. If the upper part of the pulse is faint and the head is small, sweating will occur. If the lower part is faint and the root is large, it is Guan-Ge (Obstruction and Rejection) with blockage, leading to an inability to urinate. If there is no sweat on the head, it is treatable; if there is sweat on the head, it is fatal.
Cheng Wuji's Commentary: A Heart pulse that arrives strongly and departs weakly is normal. Arriving faintly and departing strongly is a Reverse pulse. The *Nei Jing* states: A large pulse indicates pathogenic arrival; a small pulse indicates peace; a faint pulse indicates righteous deficiency; a large pulse indicates pathogenic excess. By observing the "arrival," we assess the exterior; arriving faintly indicates the exterior is harmonious. By observing the "departure," we assess the interior; departing strongly indicates interior disease. The *Nei Jing* says: If the Heart pulse does not arrive strongly but departs strongly, this is insufficiency, and the disease is in the center. "Head small, root large" means anterior small and posterior large. Small indicates righteous deficiency; large indicates pathogenic excess. The pathogen was initially in the interior and now returns to the exterior, hence called "Covered." It mentions "arrival" rather than "departure" to indicate the disease is in the exterior. The *Mai Jing* (Pulse Classic) states: Upper is exterior, lower is interior. Sweat is the fluid of the Heart. Faintness above indicates superficial palpation is faint; small head indicates anterior smallness, suggesting deficiency of Qi in the exterior, hence predicting sweating. Faintness below indicates deep palpation is faint; large root indicates posterior largeness, deep location implies interior, and largeness implies advancing disease. The *Nei Jing* states: The Heart is a Yang organ, and the Small Intestine is its envoy. Now, severe pathogenic qi descends and blocks the Small Intestine, preventing righteous Qi from flowing, resulting in an inability to urinate, named Guan-Ge. The *Mai Jing* states: Yang Qi floats upward, and sweat appears on the head. Now, with Guan-Ge blocking righteous Qi flow, plus sweat on the head, it signifies Yang Qi failing to descend and escaping upward. If there is no sweat, although Guan-Ge exists, Yang Qi has not yet declined, and it is still treatable.
Question: What does the shape of the Lung pulse (Fei Mai) from the West resemble? The Master replied: The Lung belongs to Metal and is named Taiyin (Taiyin Meridian). Its pulse is hair-like and floating (light and floating). If a Lung disease presents with this pulse, or with a slow and delayed pulse, recovery will occur. If a rapid pulse is obtained, the condition will be severe. Why do we know this? A rapid pulse belongs to Southern Fire. Fire controls Western Metal. According to the laws of Five Elements, this should lead to carbuncles and is difficult to treat.
Cheng Wuji's Commentary: Light, void, and floating is called "Hair," which is the normal pulse of the Lung. Slow and delayed is the Spleen pulse. The Spleen is the Mother of the Lung; due to the mutual generation of mother and child, it is said that both indicate recovery. Rapid is the Heart pulse. Fire controls Metal, representing a "Ghost Thief" (overcoming) relationship, hence severity. The Lung governs skin and hair. Rapid indicates heat. Heat lodging in the skin and remaining causes carbuncles and ulcers. The classic states: If a rapid pulse occurs intermittently, malignant sores will arise.
Question: In the second month (Spring), obtaining a hair-like floating pulse, why is it said that death will occur in Autumn? The Master replied: In the second month, the pulse should be soft and weak. Obtaining a hair-like floating pulse instead indicates death in Autumn. In the second month, Liver Qi is active. The Liver pulse belongs to Wood and should appear soft and weak. Obtaining a hair-like floating pulse instead reveals the Lung pulse. The Lung belongs to Metal, and Metal overcomes Wood; therefore, death in Autumn is predicted. Other seasons follow this pattern.
Cheng Wuji's Commentary: Seeing an Autumn pulse during Spring indicates Metal Qi overcoming Wood. Lung Metal overcoming Liver Wood deprives the vigorous pulse of its vitality. By Autumn, when Lung Qi is vigorous and Liver Qi is exhausted, death occurs.
The Master said: For obese persons, one must investigate if the pulse is floating when it should be deep. For emaciated persons, one must investigate if the pulse is deep when it should be floating. Obese persons' pulses should be deep; if floating, it is abnormal. Emaciated persons' pulses should be floating; if deep, it is abnormal. These deviations must be investigated.
Cheng Wuji's Commentary: Obese persons have thick skin and flesh; their pulse should be deep. Emaciated persons have thin skin and flesh; their pulse should be floating. If an obese person's pulse is floating and an emaciated person's pulse is deep, it must be due to pathogenic interference causing abnormal pulsations; thus, investigation is required.
The Master said: If the Cun pulse (inch position) does not extend down to the Guan (bar position), it is called Yang Extinction. If the Chi pulse (cubit position) does not extend up to the Guan position, it is called Yin Extinction. These are untreatable and indicate death. To calculate the remaining lifespan and time of death, one uses the principle of monthly seasonal overcoming.
Cheng Wuji's Commentary: The *Mai Jing* states: Yang originates at Cun and moves at Chi; Yin originates at Chi and moves at Cun. If the Cun pulse does not reach Guan, Yang cannot descend to correspond with Chi. If the Chi pulse does not reach Guan, Yin cannot ascend to correspond with Cun. The *Nei Jing* states: When Yin and Yang separate, the essence and Qi perish. This is partial extinction of Yin and Yang, leading to certain death. Determining the time of death by monthly seasonal overcoming means: Yang Extinction leads to death in Spring/Summer; Yin Extinction leads to death in Autumn/Winter.
The Master said: When the pulse shows pathological signs but the patient exhibits no symptoms, it is called "Walking Corpse" (Xing Shi). Due to the lack of vigorous Qi, sudden dizziness, collapse, and loss of consciousness occur, leading to early death. When the patient exhibits symptoms but the pulse shows no pathology, it is called "Internal Deficiency" (Nei Xu). Because the "Grain Spirit" (Stomach Qi/Gu Shen) remains, although the body is distressed, there is no suffering.
Cheng Wuji's Commentary: The pulse is the root of human life. Pathological pulse without symptoms means internal root extinction. Although the form may temporarily appear strong, sudden Qi depletion leads to dizziness, stiffness, collapse, and death—hence "Walking Corpse." Symptoms without pathological pulse mean the internal root is solid. Although the form is emaciated, it is merely internal deficiency. "Grain Spirit" refers to Grain Qi. Sufficient Grain Qi ensures natural tranquility. The *Nei Jing* states: Excess Form/Qi with deficient Pulse Qi leads to death; Excess Pulse Qi with deficient Form/Qi leads to survival.
Question: "Xi Yan Chen" is called "Hua" (Slippery). What does this mean? Answer: Chen (Deep) is Pure Yin; Xi (Closing/Combining) is Correct Yang. The harmony of Yin and Yang produces the Slippery pulse. The Guan and Chi positions are balanced. The Yangming pulse is slightly deep, and digestion is normal. The Shaoyin pulse is slightly slippery. Slipperiness is the floating name of Tension (Jin); this is Yin Solidity. The patient will likely experience sweating in the inner thighs and dampness in the genital area.
Cheng Wuji's Commentary: A pulse that is large and vigorous, gathering and deepening, is called "Xi Yan Chen." It resembles rolling pearls. Deep represents Zang Qi, hence Pure Yin. Xi represents Fu Qi, hence Correct Yang. Slippery indicates neither Yin nor Yang dominates. Guan and Chi are balanced. A slightly deep Yangming pulse indicates a Yin pulse appearing in a Yang position, meaning Yin dominance and Yang insufficiency. In the Yangming Stomach pulse, excessive Yin allows for normal digestion. A slightly slippery Shaoyin pulse indicates a Yang pulse appearing in a Yin position, meaning Yang dominance and Yin insufficiency. Yang entering the Yin division is called Yin Solidity. The thighs and genitals are the Shaoyin regions. Yang heat invading Yin steams fluids outward, causing thigh sweating and genital dampness.
Xu Shuzhong's Commentary: Deep is Pure Yin, Xi is Correct Yang; their harmony creates the Slippery pulse. Ancients described the Slippery pulse as flowing smoothly back and forth, resembling the Rapid pulse. However, Zhang Zhongjing's three phrases suffice. The terms "Xi Yan Chen" best describe "Slippery." "Xi" means combining; "Yan" means suddenly. When Qi gathers and becomes vigorous, it suddenly sinks away—this is Slippery. Zhongjing feared people would mistake Slippery for Deep, so he added: "Slippery is the floating name of Tension." Saying Deep and Floating seems different but is similar; wisdom is needed to understand. Referring to "Tense like turning cords," the floating here is the floating of turning cords, not the light superficial floating. The deep here is the deep of Xi Yan, not the fixed deep requiring heavy pressure. Zhongjing's wording is precise like historical records; do not read carelessly. Zhao Sizhen said: Modern readers fail to view this as Qin-Han text, missing the essence of reading Zhongjing.
Question: I was once challenged: Where does the Tense (Jin) pulse come from? The Master replied: If there is profuse sweating or vomiting due to Cold in the Lungs, the pulse becomes Tense. If coughing results from drinking cold water, the pulse becomes Tense. If diarrhea results from Deficient-Cold in the Stomach, the pulse becomes Tense.
Yang Qi relaxes, Yin Qi contracts. Yin transforms into Cold, contracting tightly. Blood and Qi become firm; how can the pulse not be urgent/tense? The classic states: The Tense pulse carries speed, like cutting a rope. Or like turning cords. Thus, Cold presents with a Tense pulse.
Cun position: Wei Qi excess is called "Gao" (High).
"Cun" refers to the area above Guan. "Gao" means the pulse arrives floating and forceful. Wei Qi governs the exterior; floating pulse assesses it. Its nature is superior. Currently, superficial and middle palpation are forceful, indicating Wei Qi excess. Being superior, it is called High. It implies rising without descending.
Rong Qi excess is called "Zhang" (Bright/Orderly).
Zhang means bright and orderly. Coming and going clearly with order. The current Slippery pulse diagnoses Blood excess, which is close to this.
Gao and Zhang interacting is called "Gang" (Net/Master).
Gang means total/gathering. Because Rong and Wei are both excess, it is called Total.
Wei Qi deficiency is called... (Text missing character, implied weak pulse). Superficial palpation reveals soft, weak, and vague qualities; hence it is called...
Rong Qi deficiency is called "Bei" (Low/Humble).
Rong governs Blood and is Yin. Palpating deeply reveals a deep and weak pulse; hence it is called Bei.
Bei interacting is called "Sun" (Damage/Loss).
Bei interacting means Yin and Yang are both deficient, collectively called Sun. Both superficial and deep palpation are weak.
Wei Qi harmony is called "Huan" (Slow/Relaxed).
Huan is the Stomach pulse. Stomach combines with Wei Qi. Wei Qi harmony presents as Huan pulse.
Rong Qi harmony is called "Chi" (Delayed/Slow).
Chi is the Spleen pulse. Spleen combines with Rong Qi. Rong Qi harmony presents as Chi pulse.
Huan and Chi interacting is called "Qiang" (Strong).
Rong and Wei are both harmonious; thus Huan and Chi interact, resulting in Strength.
Cun pulse is Huan and Chi. Huan indicates Yang Qi growing; complexion is fresh, face is radiant, voice is metallic (Shang), hair grows long. Chi indicates Yin Qi flourishing; marrow generates, blood fills, muscles are tight, thin, fresh, and hard. Yin and Yang embrace, Rong and Wei travel together, Gang and Rou interact; this is called Strong.
This explains the previous sentence. This is a Normal Pulse, not a Disease Pulse.
Zuyang pulse is Slippery and Tense. Slippery indicates Stomach Qi excess; Tense indicates Spleen Qi strength. Holding excess against strength causes pain, injuring oneself, like holding a blade and creating a wound.
Cheng Wuji's Commentary: Zuyang pulse assesses Spleen and Stomach. Slippery indicates Grain Qi excess, i.e., Stomach Excess. Tense indicates Yin Qi victory, i.e., Spleen Strength. One excess and one strength clashing cause pain. If one were strong and the other weak, they would not clash to cause pain. Here, both Spleen and Stomach are strong/excessive, clashing and injuring the organs, causing pain. Like holding a blade to create a wound—is this not self-inflicted harm? This corresponds to the Dunfu Daguo (Excessive) pulse.
Cun pulse is Floating and Large. Floating indicates Deficiency; Large indicates Excess. At Chi, it is Guan (Blockage); at Cun, it is Ge (Rejection). Guan prevents urination; Ge causes vomiting and regurgitation.
Cheng Wuji's Commentary: The classic states: Floating indicates Deficiency. *Nei Jing* states: Large indicates disease progression. Floating indicates righteous deficiency; Large indicates pathogenic excess. At Chi, pathogen blocks Lower Jiao, preventing interior Qi from descending, causing urinary retention. At Cun, pathogen rejects Upper Jiao, preventing food entry, causing vomiting.
Danbo Yuanjian's Commentary: According to *Nan Jing*, inhalation involves Kidney and Liver. The universe is filled with One Qi. Ascending Qi is Yang; Descending Qi is Yin. Kidney is Foot Shaoyin; Liver is Foot Jueyin. Located inferiorly, they govern inhalation. Inhaled Qi fails to reach Kidney, returning at Liver, indicating Yin weakness. Floating-Large pulses belong to Yang. Appearing at Cun, Yang Qi is excessive, and Yin cannot match it, causing Ge (Rejection) and vomiting ("Vomit without Yin"). Appearing at Chi, Yin Blood is insufficient, and Yang invades, causing Guan (Blockage) and urinary retention. This aligns with Dongyuan's Zishen Wan. Zuyang Stomach pulse: Qi does not circulate, Blood does not moisten, named Guan-Ge, governing undigested food and inability to eat. Also Yang excess and Yin deficiency, having ascent but no descent. Why do commentaries ignore this and speak only of pathogenic Guan-Ge rejection?
Zuyang pulse is Hidden (Fu) and Choppy (Se). Hidden indicates vomiting and regurgitation with undigested food; Choppy indicates inability to eat. This is named Guan-Ge.
Cheng Wuji's Commentary: Hidden means Stomach Qi is hidden and does not circulate; Middle Jiao Guan-Ge blocks righteous Qi, causing vomiting and undigested food. Choppy means Spleen Qi is stagnant and does not distribute; pathogen rejects Upper Jiao, causing inability to eat. A woman suffered vomiting, urinary/fecal obstruction, restlessness, cold limbs, and gradual loss of pulse. Given two doses of Dachengqi Decoction, she passed stool by midnight, restlessness subsided, pulse returned, and she recovered the next day. This is Guan-Ge. Careful examination is needed.
Pulse is Floating and Large. Floating indicates Wind-Deficiency; Large indicates Qi-Strength. Wind and Qi clash, causing urticaria and itching. Itching is called Xiefeng (Leaking Wind). Long-term, it becomes scabs and leprosy.
Cheng Wuji's Commentary: Scabs and leprosy involve sparse eyebrows/hair, dry foul-smelling sores. *Nei Jing* states: Pulse-Wind becomes Leprosy.
Cun pulse is Weak and Delayed. Weak indicates Wei Qi deficiency; Delayed indicates Rong Cold. Rong is Blood; Blood Cold causes fever. Wei is Qi; Qi deficiency causes hunger in the heart, fullness despite hunger, and inability to eat.
Cheng Wuji's Commentary: Wei is Yang, Rong is Yin. Weak means Wei Qi deficiency/Yang insufficiency. Delayed means Rong Cold/external pathogen. Rong hosting Cold pathogen clashes, causing fever. Interior Yang deficiency causes heart hunger and fullness, preventing eating. Confusing Huan-Chi with Weak-Delayed is a major error. Cheng's commentary failed to distinguish them, explaining the inconsistency.
Zuyang pulse is Large and Tense. Large indicates immediate diarrhea; this is difficult to treat.
Cheng Wuji's Commentary: Large is Deficiency, Tense is Cold. Stomach Deficient-Cold leads to diarrhea. Diarrhea pulse should be minute/small; Tense indicates pathogen victory. Hence, difficult to treat. Classic states: Large pulse in diarrhea means unceasing. Large indicates Excess or Deficiency. Understanding that "Deficiency" refers to righteous deficiency and "Excess" to pathogenic excess is key. Above, pulse diagnoses disease.
Cun pulse is Weak and Huan. Weak indicates Yang Qi insufficiency; Huan indicates Stomach Qi excess. Belching and acid regurgitation, sudden inability to swallow, Qi filling the diaphragm.
Cheng Wuji's Commentary: Weak means Yang insufficiency; Yang digests grain. Insufficiency prevents digestion. Huan means Stomach Qi excess; undigested grain remains in Stomach. This causes belching, acid regurgitation, food stagnation, and Qi blocking the diaphragm. *Jin Gui Yao Lue* states: Middle Jiao disharmony prevents grain digestion, causing belching. Weak-Huan differs from Huan-Chi.
Zuyang pulse is Tense and Floating. Floating indicates Qi; Tense indicates Cold. Floating indicates abdominal fullness; Tense indicates colic. Floating-Tense clash causes intestinal rumbling and movement, moving Qi to the diaphragm, then downward. If Shaoyin pulse does not emerge, the genitals swell and feel empty.
Cheng Wuji's Commentary: Floating indicates Stomach Qi deficiency; Tense indicates Spleen Cold. Stomach deficiency causes fullness; Spleen cold causes pain. Deficient-Cold clash causes rumbling, pushing Diaphragm Qi downward. If Shaoyin pulse fails to emerge, Deficient-Cold Qi reaches Lower Jiao, knotting at Shaoyin and gathering in the genitals, unable to vent, causing genital swelling and emptiness.
Cun pulse is Micro and Choppy. Micro indicates Wei Qi does not flow; Choppy indicates Rong Qi insufficiency. Rong and Wei cannot support each other; Sanjiao lacks reliance. Body experiences Bi-numbness. Rong insufficiency causes irritability and pain, difficulty speaking. Wei deficiency causes aversion to cold and frequent yawning. Sanjiao fails to return to its sector: Upper Jiao failure causes belching and sour taste; Middle Jiao failure prevents grain digestion and appetite; Lower Jiao failure causes urinary incontinence.
Cheng Wuji's Commentary: Blood nourishes Sanjiao; Qi protects Sanjiao. Rong and Wei damage prevents mutual support; Sanjiao lacks foundation, causing numbness. *Nei Jing*: Rong deficiency causes numbness. *Zhen Jing*: Wei non-flow causes numbness. Rong is Blood; insufficiency causes pain. Rong belongs to Heart; weakness causes speech difficulty. Wei is Yang; micro causes cold aversion. Qi deficiency causes yawning. Sanjiao, lacking Rong/Wei, cannot return to its sector. *Jin Gui*: Upper Jiao exhaustion causes belching (receiving Middle Jiao Qi; Middle Jiao disharmony prevents digestion). Lower Jiao exhaustion causes incontinence. Upper Jiao is above diaphragm, processing untransformed matter. "Not returning" means not arriving. Upper Qi not arriving prevents transformation, causing belching/sourness. Middle Jiao is Stomach, rotting grain. Transformation creates appetite. Middle Qi not arriving prevents digestion/appetite. Lower Jiao is bladder opening, separating clear/turbid, urinating. Lower Qi not arriving prevents control, causing incontinence. Sanjiao diseases have distinct syndromes and treatments.
Zuyang pulse is Deep and Rapid. Deep indicates Excess; Rapid indicates grain digestion. Tense indicates difficult-to-treat disease.
Cheng Wuji's Commentary: Deep indicates Interior Excess. Rapid indicates Heat digesting grain. Tense is Liver pulse appearing in Spleen region; Wood overcomes Earth (Ghost Thief), making treatment difficult. Note distinction between Tense and Wiry. Vol 1: Wiry indicates reduction. *Jin Gui*: Tense like turning cords indicates retained food. Analytically, Wiry is Deficiency, Tense is Excess.
Cun pulse is Micro and Choppy. Micro indicates Wei Qi decline; Choppy indicates Rong Qi insufficiency. Wei decline causes yellow complexion; Rong insufficiency causes green complexion. Rong is Root, Wei is Leaf. Both micro means root and leaf wither, causing chills, cough, reverse Qi, bloody saliva, and frothy sputum.
Child makes Mother deficient. Lung governs Qi; Qi deficiency shows Spleen color (yellow) on face. Heart governs Blood; Blood decline shows Liver color (green) on face. Lung odor is fishy; Spleen fluid is saliva. Rong deficiency causes chills; Wei deficiency causes cough/reverse Qi.
Zuyang pulse is Floating and Hollow (Kou). Floating indicates Wei Qi decline; Hollow indicates Rong Qi injury. Body is emaciated; muscles are rough like fish scales. Floating-Hollow clash causes Zong Qi decline and severance of Four Belongings.
Cheng Wuji's Commentary: Classic: Wei excess is Gao (High), causing mania and fatness. Rong excess is Zhang (Bright), causing luster. Emaciation indicates Wei decline. Rough muscles indicate Rong injury. Zong Qi is Sanjiao returning Qi. Four Belongings are skin, flesh, fat, marrow. Rong/Wei injury causes Zong Qi decline and Four Belongings starvation/severance.
Cun pulse is Micro and Huan. Micro indicates Wei Qi laxity, causing empty skin. Huan indicates Stomach Qi excess, digesting grain and transforming water. Grain enters Stomach, pulse channels flow. Entering meridians, Blood forms. Rong excess with Wei laxity causes skin emptiness, Sanjiao meridian severance, named Blood Collapse.
Cheng Wuji's Commentary: Wei is Yang; Micro is Yang loss. Micro pulse means Wei Qi laxity. Wei warms flesh and pores. Laxity prevents warming/fleshing, causing emptiness. Classic: Huan means Stomach Qi excess/existence. *Nei Jing*: Food enters Stomach, floods meridians; grain enters, pulse flows. *Zhen Jing*: Drink seeps into collaterals, mixes with Blood; water enters, Blood forms. Stomach digests grain/water into Qi/Blood. Now Wei is lax, Rong is excess: Rong strong, Wei weak. Weak Wei fails to secure skin (Qi lax) and protect Blood (Blood collapses). Sanjiao is Qi pathway. Wei laxity breaks routine; Sanjiao severs routine. Text says "entering meridions" following "grain"; water is included. Cheng's note on "water entering meridions" is parallel phrasing. Zhongjing emphasizes grain, using "entering." Misunderstanding leads to false belief that Blood is made of Water. Examining "mixing and harmonizing" shows Cheng's explanation is unclear.
Zuyang pulse is Micro and Tense. Tense indicates Cold; Micro indicates Deficiency. Micro-Tense clash causes shortness of breath.
Cheng Wuji's Commentary: Middle Deficiency and Cold naturally cause shortness of breath.
Shaoyin pulse is Weak and Choppy. Weak indicates slight irritability; Choppy indicates Cold Extremities (Jue Ni).
Cheng Wuji's Commentary: Irritability is Heat. Shaoyin Weakness is Yin Deficiency. Yin Deficiency generates Heat. Seeing Yang pulse in Yin region indicates severe deficiency, causing slight irritability. Jue Ni is cold limbs. Classic: Yin-Yang non-adhesion causes Jue. Jue is cold hands/feet. Shaoyin Choppy means Yin Qi stagnation, failing to adjoin Yang, causing Jue Ni. This should not be treated as two separate syndromes.
Zuyang pulse does not emerge; Spleen fails to ascend/descend; body cold, skin hard.
Cheng Wuji's Commentary: Spleen/Stomach are roots of Rong/Wei. Spleen ascending/descending digests grain, allowing Rong/Wei flow. Spleen Qi failure prevents flow, affecting exterior. Thus Zuyang pulse fails to emerge. Body cold: Wei Qi fails to warm. Skin hard: Rong Blood fails to moisten.
Shaoyin pulse does not emerge; Kidney Qi is weak; Essence/Blood scarce. Rushing Qi forces upward into chest/diaphragm. Zong Qi gathers inversely; Blood knots under Heart. Yang Qi retreats downward; Heat returns to inner thighs. Interacting with Yin, it causes bodily numbness. This is Corpse Jue (Shi Jue). Acupuncture Qimen and Juque points.
Cheng Wuji's Commentary: Corpse Jue arises from Jue; form loses awareness, resembling corpse. Shaoyin pulse absence means Jue Qi lodges in Kidney; Kidney Qi/Essence/Blood decline. Jue Qi rushes up, blocking chest/diaphragm, stifling Yang, causing inverse Zong Qi gathering and Blood knotting under Heart. *Zhen Jing*: Grain waste/fluid/Zong Qi divide into three tunnels. Zong Qi accumulates in chest, exits throat, pierces Heart/Lungs, governs respiration. Rong Qi secretes fluid, enters vessels, becomes Blood, nourishes extremities. Now Jue Qi is too strong, Zong Qi gathers/stops, severing respiration. Blood knots/stops, severing limb sensation. Yang Qi is blocked by Jue, cannot vent, retreats to thighs. "Ren" means soft; "Bu Ren" means not soft, insensible to cold/heat/pain/itch. Yang fails externally/internally; Rong/Wei cannot flow; body numb, corpse-like. *Nei Jing*: Jue Qi ascends, fills vessels, leaves form. Puncture Qimen to unblock Blood knot under Heart; puncture Juque to move Zong Qi in chest. Once Blood/Qi flow and Jue Qi retreats, revival occurs.
Cun pulse Micro, Chi pulse Tense. Patient is deficient, sweats profusely. Knows Yin constantly exists, Yang is absolutely absent.
Cheng Wuji's Commentary: Cun Micro is Yang loss; Chi Tense is Yin victory. Yang weak, Yin strong, hence deficiency. Plus sweating further damages Yang. Yin constantly exists, Yang is absolutely cut off.
All Micro Cun pulses indicate Yang loss; all Soft pulses indicate Blood loss; all Weak pulses indicate Fever; all Tense pulses indicate Cold. All encountering Cold result in Jue, depression, vertigo, and numbness. Due to Stomach lacking Grain Qi and Spleen stagnation/blockage, mouth tightens, inability to speak, trembling, and chattering.
Cheng Wuji's Commentary: Wei is Yang; Micro means Wei Qi deficiency, hence Yang loss. Rong is Blood; Soft means Rong Qi weakness, hence Blood loss. Weak is Yin Deficiency, deficiency generates Fever. Tense is Yin Victory, hence Cold. Encountering Cold causes Yin-Yang conflict.