荣行脉中,卫行脉外。脉者,所以主宰荣卫,而不可须臾失也。从月从永,谓得此可永岁月也。古脉字,
从血从HT ,所以使气血各根据分派,而行经络也。医家由脉以识经络虚实。由经络虚实以定药之君臣佐使及
针灸穴法,是脉乃医之首务。世俗偏熟《脉诀》,而不知《脉经》,专习单看,而不知总看。其实上古诊法有三∶
其一各于十二经动脉分为三部,候各脏腑。其二以气口人迎,决内外病因。其三独取寸口,以内外分脏腑,以
高下定身形,以生克定荣枯,以清浊论究通,故曰独取寸口,以决五脏六腑之生死吉凶也。兹以《素》、
《难》为主,兼采仲景及《脉图》、《脉经》、《脉诀》、《正传》、《权舆》而补之。以便初学诵读。
掌后高骨号为关,傍骨关脉形宛然;次第推排寸关尺,配合天地人三元。
昔岐伯取气口,象黄钟作脉法,故气口之数九分,阳数九也;尺内一寸,阴数十也。手腕高骨为关,从关
至鱼际得同身之一寸,故名寸部。从关至尺泽得同身之一尺,故名尺部。阳出阴入,以关为界,故名关部。
寸应天为上部,关应人为中部,尺应地为下部。一部之中又各有浮中沉三候,三三如九,故曰三部九候。凡诊
脉初以中指揣按高骨关位,次下前后二指,人长则疏排其指,人短则密排其指。初轻按消息之,次不轻不重中
按消息之,次重按消息之。鱼际者。寸上一分,掌骨后际,如鱼之颈际然。尺泽者,尺外余脉,如深泽然。
营气运行于脉管之中,卫气运行于脉管之外。脉诊,是用来统摄和调节营卫之气,一刻也不能疏忽的。脉字由“月”和“永”组成,意思是掌握了脉法就可以长久地延年益寿。古体的脉字,由“血”和“行”(注:原文HT应为行或类似字形,此处依文意理解为与行走、分布相关)组成,意思是使气血各自按照其分派路线,在经络中运行。医生通过脉象来认识经络的虚实状况。根据经络的虚实来确定药物的君臣佐使配伍以及针灸穴位的选择,因此脉诊是医生的首要任务。世俗之人只熟悉《脉诀》,却不知道《脉经》;专门练习单独看某一部脉,却不知道要整体综合观察。其实上古时期的诊法有三种:第一种是在十二经脉的动脉处分别分为三部,以候察各个脏腑的情况。第二种是通过比较气口和人迎两处脉象,来判断病因来自体内还是体外。第三种是独取寸口脉,用内外来区分脏腑,用高低上下来确定身形部位,用五行生克理论来判断营气的盛衰枯荣,用清浊之气来探讨通塞情况,所以说独取寸口,可以决断五脏六腑的生死吉凶。现在以《黄帝内经·素问》和《难经》为主旨,兼采张仲景及《脉图》、《脉经》、《脉诀》、《正传》、《权舆》等书的内容进行补充,以便初学者诵读学习。
手腕后方的高骨被称为关,旁边的关部脉象形态清晰可见;依次推排寸、关、尺三部,配合天、地、人三元之理。从前岐伯选取气口脉,象征黄钟律吕制定脉法,所以气口的长度定为九分,因为阳数是九;尺部的长度为一寸,因为阴数是十。手腕的高骨作为关部,从关部到鱼际穴的距离相当于同身寸的一寸,所以称为寸部。从关部到尺泽穴的距离相当于同身寸的一尺,所以称为尺部。阳气出于外,阴气入于内,以关部为界限,所以称为关部。寸部对应天,属于上部;关部对应人,属于中部;尺部对应地,属于下部。每一部之中又各有浮、中、沉三种指力候察方法,三部各三候,共九候,所以称为三部九候。凡诊脉时,先用中指揣摸按压高骨的关位,然后放下食指和无名指在前后位置。身材高大的人手指间距要疏开一些,身材矮小的人手指间距要密排一些。开始时要轻按以体察脉象,接着要不轻不重地中按以体察脉象,最后要重按以体察脉象。鱼际穴,位于寸部上一分处,掌骨后的边缘,形状像鱼的颈部边缘一样。尺泽穴,位于尺部外侧剩余的脉动处,就像深邃的水泽一样。
Ying Qi (Nutritive Qi) circulates within the vessels, while Wei Qi (Defensive Qi) circulates outside the vessels. Pulse diagnosis serves to govern Ying and Wei Qi and must not be neglected for a moment. The character "Mai" (Pulse) consists of "Yue" (Moon/Flesh) and "Yong" (Eternal), implying that mastering this allows one to prolong life for many years. The ancient form of the character "Mai" consisted of "Xue" (Blood) and "Xing" (Walk/Move), indicating the distribution of Qi and Blood along their respective pathways within the meridians. Physicians identify the deficiency or excess of meridians through pulse diagnosis. Based on the deficiency or excess of meridians, they determine the roles of Jun (Monarch), Chen (Minister), Zuo (Assistant), and Shi (Envoy) in herbal prescriptions, as well as acupuncture point selection; thus, pulse diagnosis is the primary task of a physician. The common people are familiar only with the *Mai Jue* (Pulse Rhymes) but ignorant of the *Mai Jing* (Pulse Classic); they specialize in examining individual pulses in isolation rather than viewing them holistically. In fact, there were three diagnostic methods in ancient times: First, dividing the arterial pulses of the twelve meridians into three sections each to observe the various zang-fu organs. Second, comparing the Qi Kou (Radial artery at the wrist) and Ying Yang (Carotid artery at the neck) pulses to determine whether the cause of illness is internal or external. Third, exclusively taking the Cun Kou (Radial pulse at the wrist) to distinguish internal from external, differentiate zang-fu organs by location (high/low), assess vitality based on the generation and restriction cycles (Sheng Ke), and evaluate patency through clarity and turbidity. Hence it is said that exclusively taking the Cun Kou can determine the life and death, auspiciousness and misfortune of the five zang and six fu organs. This text takes the *Su Wen* (Plain Questions) and *Nan Jing* (Classic of Difficult Issues) as its main basis, supplementing them with insights from Zhang Zhongjing, *Mai Tu* (Pulse Diagrams), *Mai Jing*, *Mai Jue*, *Zheng Chuan*, and *Quan Yu*, to facilitate study for beginners.
The high bone behind the palm is called Guan (Cun-Guan-Chi position). The pulse shape at the Guan position beside the bone is distinct. Arranging Cun, Guan, and Chi in sequence corresponds to the Three Yuan of Heaven, Earth, and Man. In antiquity, Qibo selected the Qi Kou to symbolize the Huangzhong pitch pipe in establishing pulse methodology; therefore, the length of the Qi Kou section is nine fen, corresponding to the yang number nine. The Chi section is one cun long, corresponding to the yin number ten. The high bone of the wrist serves as the Guan. From Guan to Yu Ji (Large Intestine 10, LI10) equals one cun of body measurement, hence named Cun (Inch) section. From Guan to Chi Ze (Lung 5, LU5) equals one chi of body measurement, hence named Chi (Cubit) section. Yang emerges outward, Yin enters inward, with Guan serving as the boundary, hence named Guan (Bar) section. Cun corresponds to Heaven, constituting the Upper section; Guan corresponds to Man, constituting the Middle section; Chi corresponds to Earth, constituting the Lower section. Within each section, there are three palpation depths: Floating (Fu), Middle (Zhong), and Deep (Chen). Three sections multiplied by three depths equal nine, hence termed San Bu Jiu Hou (Three Sections and Nine Palpations). When diagnosing the pulse, first use the middle finger to locate the high bone at the Guan position, then place the index and ring fingers anteriorly and posteriorly. For taller individuals, space the fingers wider; for shorter individuals, place them closer together. Initially, apply light pressure to perceive the pulse; next, apply moderate pressure without being too light or heavy; finally, apply deep pressure. Yu Ji is located one fen above the Cun section, at the posterior margin of the metacarpal bone, resembling the neck joint of a fish. Chi Ze is the remaining pulse area lateral to the Chi section, resembling a deep marsh.