诊脉必以《内经》为主,仲景《伤寒论》、《金匮要略》二书言脉,见散于各章节之中
者,字字精切。至于《伤寒论》中平脉,辨脉二篇则又为叔和所增,亦瑕瑜参半耳。兹先以
时行而不悖于古者,举其大要,使人乐从其易。后录《内经·脉要精微论》一节,而详注之
,俾学人无忽于所易,无惮于所难。
左寸∶(外以候心,内以候膻中。)左关∶(外以候肝,内以候膈。)左尺∶(外以候肾,内以候
腹。)右寸∶(外以候肺,内以候胸中。)右关∶(内以候脾,外以候胃。)右尺∶(外以候肾,内以候
腹。
左寸∶(心,小肠。)左关∶(肝,胆。)左尺∶(肾,膀胱。)右寸∶(肺,大肠。)右关∶(脾,肺。
右尺∶(命门,三焦。
左寸∶(心,膻中。)左关∶(肝,胆。)左尺∶(肾,膀胱,小肠。)右寸∶(肺,胸中。)右关∶(胃
,脾。)右尺∶(肾,大肠。
左寸∶(心,膻中。)左关∶(肝,胆。)左尺∶(肾,膀胱,大肠。)右寸∶(肺,胸中。)右关∶(脾
,胃。)右尺∶(肾,小肠。
寸∶(宗气出于上焦,寸脉以候之。)关∶(荣气出于中焦,关脉以候之。)尺∶(卫气出于下焦
,尺脉以候之。
愚按∶大小二肠,《经》无明训,其实尺里以候腹,腹者大小肠与膀胱俱在其中。王叔
和以大小二肠配于两寸,取心肺与二肠相表里之义也。李濒湖以小肠配于左尺,大肠配于右
尺,上下分属之义也。张景岳以大肠宜配于左尺,取金水相从之义,小肠宜配于右尺,取火
归火位之义也。俱皆近理,当以病证相参。如大肠秘结,右尺宜实,今右尺反虚,左尺反实
,便知金水同病也。小便热淋,左尺宜数,今左尺如常,而右尺反数者,便知相火炽盛也。
或两尺如常,而脉应两寸者,便知心移热于小肠,肺移热于大肠也。一家之说,俱不可泥如
此。况右肾属火,即云命门亦何不可,三焦鼎峙两肾之间,以应地运之右转,即借诊于右尺
,亦何不可乎。
诊脉必须以《黄帝内经》为主要依据,张仲景的《伤寒论》和《金匮要略》两书中关于脉象的论述,散见于各个章节之中,字字精当切要。至于《伤寒论》中的“平脉篇”和“辨脉篇”,则是王叔和所增补的内容,也是优点和缺点各半。现在先列举那些符合时代潮流且不违背古法的大要,使人们乐于接受简便易行的方法。随后收录《黄帝内经·脉要精微论》中的一节,并加以详细注释,以便学习的人不因内容简单而忽视,也不因内容深奥而畏惧。
左寸部:(外部候察心脏,内部候察膻中。)左关部:(外部候察肝脏,内部候察膈膜。)左尺部:(外部候察肾脏,内部候察腹部。)右寸部:(外部候察肺脏,内部候察胸中。)右关部:(内部候察脾脏,外部候察胃腑。)右尺部:(外部候察肾脏,内部候察腹部。)
左寸部:(心,小肠。)左关部:(肝,胆。)左尺部:(肾,膀胱。)右寸部:(肺,大肠。)右关部:(脾,肺。)右尺部:(命门,三焦。)
左寸部:(心,膻中。)左关部:(肝,胆。)左尺部:(肾,膀胱,小肠。)右寸部:(肺,胸中。)右关部:(胃,脾。)右尺部:(肾,大肠。)
左寸部:(心,膻中。)左关部:(肝,胆。)左尺部:(肾,膀胱,大肠。)右寸部:(肺,胸中。)右关部:(脾,胃。)右尺部:(肾,小肠。)
寸部:(宗气出于上焦,寸脉用来候察它。)关部:(营气出于中焦,关脉用来候察它。)尺部:(卫气出于下焦,尺脉用来候察它。)
我按语:大小肠,《内经》中没有明确的训示,实际上尺部里面候察腹部,腹部包含大小肠与膀胱。王叔和将大小肠配属于两寸部,是取心肺与二肠相表里的意义。李濒湖将小肠配属于左尺,大肠配属于右尺,这是上下分属的意义。张景岳认为大肠宜配属于左尺,取金水相从的意义,小肠宜配属于右尺,取火归火位的意义。这些都接近事理,应当结合病证来参考。例如大肠秘结,右尺脉应当实,如果右尺反而虚,左尺反而实,便知道是金水同病。小便热淋,左尺脉应当数,如果左尺如常,而右尺反而数,便知道是相火炽盛。或者两尺脉如常,而脉象应合于两寸部的,便知道是心移热于小肠,肺移热于大肠。对于某一家的说法,都不可以拘泥如此。况且右肾属火,即使说是命门又有什么不可以呢?三焦鼎立于两肾之间,以顺应地运之右转,即使借诊于右尺部,又有什么不可以呢?
Pulse diagnosis must take the *Huangdi Neijing* (Yellow Emperor's Inner Canon) as the primary basis. The discussions on pulse in Zhang Zhongjing’s (*Zhang Zhongjing*) two works, *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) and *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), are scattered throughout various chapters, with every word being precise and pertinent. As for the "Ping Mai Pian" (Chapter on Normal Pulse) and "Bian Mai Pian" (Chapter on Differentiating Pulse) in the *Shanghan Lun*, these were added by Wang Shuhe (*Wang Shuhe*), containing both merits and flaws. Here, I first present the general principles that conform to current times without violating ancient methods, so that people may willingly follow what is easy. Subsequently, I record a section from the *Mai Yao Jing Wei Lun* (Chapter on the Essential subtleties of Pulse Observation) of the *Huangdi Neijing* and provide detailed annotations, so that students do not neglect what is simple nor fear what is difficult.
Left Cun position: (Externally inspects the Heart, internally inspects the Danzhong [Pericardium/Center of Chest].) Left Guan position: (Externally inspects the Liver, internally inspects the Diaphragm.) Left Chi position: (Externally inspects the Kidney, internally inspects the Abdomen.) Right Cun position: (Externally inspects the Lung, internally inspects the Thoracic cavity.) Right Guan position: (Internally inspects the Spleen, externally inspects the Stomach.) Right Chi position: (Externally inspects the Kidney, internally inspects the Abdomen.)
Left Cun: (Heart, Small Intestine.) Left Guan: (Liver, Gallbladder.) Left Chi: (Kidney, Bladder.) Right Cun: (Lung, Large Intestine.) Right Guan: (Spleen, Lung.) Right Chi: (Mingmen [Gate of Life], Sanjiao [Triple Burner].)
Left Cun: (Heart, Danzhong.) Left Guan: (Liver, Gallbladder.) Left Chi: (Kidney, Bladder, Small Intestine.) Right Cun: (Lung, Thoracic cavity.) Right Guan: (Stomach, Spleen.) Right Chi: (Kidney, Large Intestine.)
Left Cun: (Heart, Danzhong.) Left Guan: (Liver, Gallbladder.) Left Chi: (Kidney, Bladder, Large Intestine.) Right Cun: (Lung, Thoracic cavity.) Right Guan: (Spleen, Stomach.) Right Chi: (Kidney, Small Intestine.)
Cun position: (Zong Qi [Gathering Qi] originates from the Upper Jiao [Upper Burner]; the Cun pulse is used to inspect it.) Guan position: (Ying Qi [Nutritive Qi] originates from the Middle Jiao [Middle Burner]; the Guan pulse is used to inspect it.) Chi position: (Wei Qi [Defensive Qi] originates from the Lower Jiao [Lower Burner]; the Chi pulse is used to inspect it.)
My commentary: The *Neijing* (*Inner Canon*) provides no explicit instruction regarding the Large and Small Intestines. In reality, the Chi region inspects the Abdomen, and the Abdomen contains the Large Intestine, Small Intestine, and Bladder. Wang Shuhe (*Wang Shuhe*) assigned the Large and Small Intestines to the two Cun positions, taking the meaning of the exterior-interior relationship between the Heart/Lung and the two intestines. Li Shizhen (*Li Shizhen*) assigned the Small Intestine to the Left Chi and the Large Intestine to the Right Chi, reflecting the meaning of upper-lower distribution. Zhang Jiebin (*Zhang Jiebin*) believed the Large Intestine should be assigned to the Left Chi, taking the meaning of Metal and Water following each other, and the Small Intestine should be assigned to the Right Chi, taking the meaning of Fire returning to its proper position. All these views are reasonable and should be referenced in conjunction with clinical manifestations. For instance, in cases of constipation of the Large Intestine, the Right Chi pulse should be excess; if the Right Chi is instead deficient and the Left Chi is excess, one knows this is a disease affecting both Metal and Water. In cases of painful urinary dysfunction with heat, the Left Chi pulse should be rapid; if the Left Chi is normal while the Right Chi is rapid, one knows this is due to flourishing Ministerial Fire. Or, if both Chi pulses are normal but the pulse corresponds to the two Cun positions, one knows this is Heat transferred from the Heart to the Small Intestine and from the Lung to the Large Intestine. One should not rigidly adhere to the theories of any single school. Furthermore, since the Right Kidney belongs to Fire, even if it is called Mingmen (*Mingmen*), what harm is there? The Sanjiao (*Triple Burner*) stands like a tripod between the two Kidneys, responding to the rightward rotation of Earth's movement; thus, even if diagnosis is borrowed from the Right Chi position, what harm is there?