经曰、圣人之治病也。必知天地阴阳。四时经纪。五脏六腑。雌雄表里。从容人事。以明经道。贵贱贫富。各异品
理。问年少长勇怯之理。审于分部。知病本始。夫内经所贵色脉。而诊法又极详尽如此。盖以人病所属。虽存乎阴阳脏
腑表里虚实之间。而致病之由。所病之故。终非一律。故又以内经之十诊论列之。一曰度人。人有五脏六气之分。五形
五性。体态各异。浓薄不同。或耐春夏。不耐秋冬。或耐秋冬。不耐春夏。或寿或不寿。又兼六气参差。阴阳不适。其
筋骨气血各不相等。于是别其五色。凡形胜色。色胜形。至其胜时。年气加感。则病行矣。是可望而知之者也。二曰度
脉。则审其大小浮沉滑涩。别其左右上下前后。以求五脏四时之逆从。得神者昌。失神者亡。故微妙在脉。不可不察。
所谓切而知之者也。三曰度脏。凡五脏之藏神。其性情体用之生气。或不合于四时之理。而有五情伤败之事。是人之大
神已不立。而外感内伤皆其后焉者也。是以度脏为亟亟也。四曰度肉。人之形气所呈。肌腠分理。皮肉形质。或相得或
不相得。则寿夭判焉。以此察病。则或虽轻而重。或虽重而轻。如薄肤苍理之耐病不耐病。其相去各不同也。五曰度筋。
筋有大小坚脆之别。则燔针劫刺之不可不审也。六曰度俞。俞有井荥俞原经合。而又募原之归。此备四时之到。明于五
俞疾徐所在。则屈伸出入。皆有条理。岂曰按谱而求。拘执而取乎。七曰度阴阳。阴阳之变。不可胜理。人知经络表里。
脏阴腑阳。而不知人有大阴阳。如三阳为经为父。及为部为纪。三阴亦然。而又有奇恒之阴阳。正月二月人气在肝。三
月四月人气在脾。五月六月人气在头。七月八月人气在肺。九月十月人气在心。十一十二人气在肾。此先天阴阳之应。
恒自下而上。亦自上而下。初未尝失其性理。而于脏腑所主则已不同。而况加以运气之乘除胜复也。此阴阳又在所必讲
也。七者诊人备矣。至于从容人事。不失人情。则又有三诊。曰八度君。九度民。十度卿。君者王公大人。其骄恣纵欲。
气志之顺逆。各有差等。民则有苦乐暴久贫富之异。卿则有尝贵后贱。败伤脱势。乃欲侯王之类。此谓人情。得其情而
从容于其间。亦诊道之在所必备也。
《内经》说:圣人治疗疾病,必须通晓天地的阴阳变化,四季运行的规律,五脏六腑的功能及其雌雄、表里的关系,从容地考察社会人事,以阐明医道。无论患者地位尊贵或贫穷,其品性条理各不相同;需询问其年少或年长、勇敢或怯懦的道理,审察病位分部,了解疾病的根本起因。
《内经》重视面色与脉象,而诊法又如此详尽完备。大概因为人的疾病,虽然存在于阴阳、脏腑、表里、虚实的范畴内,但致病的缘由、患病的机理,终究不是一成不变的。因此,这里依据《内经》的内容,将十种诊法分条论述。
第一种是“度人”(观察人的体质)。人有五脏六气的区分,五种形体对应五种性情,体态各异,浓薄不同。有的耐受春夏,不耐秋冬;有的耐受秋冬,不耐春夏;有的长寿,有的短命。再加上六气参差,阴阳失调,导致筋骨气血各不相同。于是辨别五色,凡是形胜色、色胜形的情况,到了相克之时,若逢年气加感,疾病就会发生。这是可以通过望诊而知晓的。
第二种是“度脉”(切按脉象)。审察脉象的大小、浮沉、滑涩,分辨左右、上下、前后的差异,以求得五脏与四时气候的顺逆关系。得神者昌,失神者亡。所以脉象微妙,不可不仔细考察。这就是通过切诊而知晓的。
第三种是“度脏”(诊察内脏)。五脏藏神,其性情体用的生气,如果不符合四时的规律,就会出现五志伤败的情况。此时人的“大神”(精神主宰)已经不稳,外感和内伤都会随之而来。因此,诊察内脏是紧迫重要的。
第四种是“度肉”(诊察肌肉)。人体形气所呈现的状态,肌腠纹理,皮肉形质,如果相互协调或不协调,则寿命长短即可判断。以此察病,病情可能由轻变重,或由重变轻。例如皮肤薄、纹理疏者,耐病与否各不相同,其差异很大。
第五种是“度筋”(诊察筋脉)。筋有大小、坚脆的区别,所以在进行燔针劫刺等疗法时不可不审慎。
第六种是“度俞”(诊察腧穴)。腧穴有井、荥、输、原、经、合之分,又有募穴与原穴的归属。这备齐了四季之气到达的部位,明了五俞疾徐所在的规律,那么屈伸出入都有条理,难道只是按谱索求、拘泥执取吗?
第七种是“度阴阳”(诊察阴阳)。阴阳的变化,多得无法穷尽。人们只知道经络表里、脏阴腑阳,却不知道人有“大阴阳”。如三阳为经、为父,以及为部、为纪;三阴也是如此。还有奇恒之阴阳。正月二月人气在肝,三月四月人气在脾,五月六月人气在头,七月八月人气在肺,九月十月人气在心,十一月十二月人气在肾。这是先天阴阳的应验,通常自下而上,也自上而下,起初未曾失去其本性规律,但在脏腑所主方面则已不同。更何况加上运气学说的乘除胜复变化呢?这种阴阳理论也是必须深入探讨的。
以上七种诊察人的方法已具备。至于从容地考察人事,不失人情,则又有三种诊法:第八是“度君”,第九是“度民”,第十是“度卿”。君指王公大人,他们骄纵放肆,气志的顺逆各有等级;民则有苦乐、暴久、贫富的差异;卿则有曾经尊贵后变低贱、败伤脱势、想要恢复侯王地位等情况。这称为“人情”。掌握这些实情并从容应对其中,也是诊道中必须具备的。
The *Neijing* states: When sages treat diseases, they must understand the Yin and Yang of heaven and earth, the regulations of the four seasons, the functions of the Five Zang and Six Fu organs, their yin-yang (male-female) relationships, and exterior-interior connections. They should calmly investigate social circumstances to clarify medical principles. Whether patients are noble or poor, their character and reasoning differ; one must inquire into the principles of youth versus age, courage versus timidity, examine the distribution of disease sites, and understand the root causes of illness.
The *Neijing* values complexion and pulse diagnosis, yet diagnostic methods are so exhaustive. This is because although human diseases fall within the categories of Yin-Yang, Zang-Fu, Exterior-Interior, and Deficiency-Excess, the causes of disease and the nature of pathology are never uniform. Therefore, based on the *Neijing*, ten diagnostic methods are listed here.
The first is "Measuring People" (Observing Constitution). Humans have distinctions in Five Zang and Six Qi, with five forms corresponding to five natures. Body shapes vary, being thick or thin. Some tolerate Spring and Summer but not Autumn and Winter; others tolerate Autumn and Winter but not Spring and Summer; some live long, some die young. Additionally, due to irregularities in the Six Qi and disharmony of Yin and Yang, bones, sinews, Qi, and Blood differ. Thus, one distinguishes the Five Colors. In cases where Form overcomes Color or Color overcomes Form, when encountering adverse seasonal Qi, disease will manifest. This can be known through Observation (Wang Zhen).
The second is "Measuring Pulse" (Palpating the Pulse). One examines the size, floating/sinking, slippery/rough qualities of the pulse, distinguishing left/right, upper/lower, anterior/posterior differences to determine the compliance or rebellion of the Five Zang relative to the Four Seasons. Those who possess Shen (Spirit) prosper; those who lose Shen perish. Thus, the subtlety of the pulse requires careful examination. This is known through Palpation (Qie Zhen).
The third is "Measuring Zang" (Diagnosing Internal Organs). The Five Zang store Shen. If their vital Qi regarding nature and function does not align with the laws of the Four Seasons, it leads to damage from the Five Emotions. At this point, the Great Shen (spiritual master) is unstable, and both external invasions and internal injuries follow. Therefore, measuring the Zang is urgent.
The fourth is "Measuring Flesh" (Diagnosing Muscles). The manifestation of human form and Qi, including muscle texture and skin-flesh quality, if harmonious or disharmonious, determines longevity. Using this to diagnose disease, conditions may become severe despite appearing mild, or vice versa. For instance, those with thin skin and loose texture vary greatly in disease resistance.
The fifth is "Measuring Sinews" (Diagnosing Tendons). Sinews vary in size and firmness/brittleness, so one must be cautious when using cauterizing needles or rapid acupuncture techniques.
The sixth is "Measuring Shu Points" (Diagnosing Acupoints). Shu points include Jing-River, Ying-Spring, Shu-Stream, Yuan-Source, Jing-River, and He-Sea points, as well as Mu and Yuan points. These prepare for the arrival of Qi in the four seasons. Understanding the location and speed of the Five Shu points allows for orderly flexion, extension, entry, and exit, rather than merely following a chart rigidly.
The seventh is "Measuring Yin and Yang". Changes in Yin and Yang are incalculable. People know about meridians, exterior-interior, and that Zang are Yin while Fu are Yang, but they do not know of the "Great Yin and Yang." For example, the Three Yang act as meridians, fathers, departments, and records; the Three Yin are similar. There are also Extraordinary Yin and Yang. From January to February, Human Qi is in the Liver; March-April, in the Spleen; May-June, in the Head; July-August, in the Lung; September-October, in the Heart; November-December, in the Kidney. This is the response of innate Yin and Yang, moving upward from below or downward from above, initially maintaining its nature. However, regarding the governance of Zang and Fu, it differs. Furthermore, considering the multiplication, division, overcoming, and recovery of Climatic Factors (Yunqi), this aspect of Yin and Yang must be thoroughly discussed.
These seven methods for diagnosing people are complete. Regarding calmly investigating human affairs without losing touch with human sentiment, there are three additional diagnoses: Eighth is "Measuring Rulers," Ninth is "Measuring Commoners," Tenth is "Measuring Ministers." Rulers refer to kings and nobles, whose arrogance, indulgence, and the smoothness or reversal of their Qi and Will vary in degree. Commoners have differences in suffering/joy, sudden/prolonged conditions, and wealth/poverty. Ministers may experience transitions from high status to low, loss of power, or desires to regain noble positions. This is called "Human Sentiment." Grasping these realities and navigating them calmly is also essential to the Way of Diagnosis.