经脉别论篇曰∶食入于胃，散精于肝，淫气于筋。食入于胃，浊气归心，淫精于脉。脉气流
经，经气归于肺，肺朝百脉，输精于皮毛。毛脉合精，行气于腑。府精神明，留于四脏，气归于
权衡，权衡以平，气口成寸，以决死生。（此气口通谓两手而言之，非独指一右手也。）饮入于
胃，游溢精气，上输于脾。脾气散精，上归于肺，通调水道，下输膀胱。水精四布，五经并行，
合于四时五脏阴阳，揆度以为常也。
\r五脏六腑气口成寸图\ps127a1.bmp\r
三部九候论篇帝曰∶愿闻天地之至数，合于人形血气，通决死生，为之奈何？岐伯曰∶天地
之至数，始于一，终于九焉。一者天，二者地，三者人，因而三之，三三者九，以应九野。故人
有三部，部有三候，以决死生，以处百病，以调虚实，而除邪疾。帝曰∶何谓三部？岐伯曰∶有
上部，有中部，有下部，部各有三候，三候者，有天有地有人也，必指而导之，乃以为真。上部
天，两额之动脉；王注在额两傍，动应于手。上部地，两颊之动脉，（在鼻孔下两傍，近于巨
之分，动应于手。）上部人，耳前之动脉。（在耳前陷者中，动应于手。）中部天，手太阴也；
（在掌后寸口中，是谓经渠，动应于手。）中部地，手阳明也；（在手大指次指歧骨间，合谷之
分，动应于手。）中部人，手少阴也。（在掌后兑骨之端，神门之分，动应于手。）下部天，足
厥阴也；（在足大指本节后二寸陷中太冲之分。）下部地，足少阴也；（在足内踝后跟骨上陷中，
太溪之分，动应于手。）下部人，足太阴也。（在鱼腹越筋间，直五里箕门之分，沉取动应于手。
候胃气者，当取足跗之上冲阳之分，动应于手。）故下部之天以候肝，地以
候肾，人以候脾胃之气。中部天以候肺，地以候胸中之气，人以候心。上部天以候头角之气，地
以候口齿之气，人以候耳目之气。
九候之相应也，上下若一，不得相失。一候后则病，二候后则病甚，三候后则病危。所谓后
者，应不俱也。
脉要精微篇曰∶尺内两傍则季胁也。（季胁在胁骨之下带脉上一寸八分是其候也。）尺外以
候肾，尺里以候腹中（两尺脉也，两尺外候肾部，内候腹里，大小肠膀胱腑俱在中也。）附上，
（两关部也。）左外以候肝，内以候鬲；（经曰∶鬲为中焦，血之原也。）右外以候胃，内以候
脾。上附上，（两寸部也。）右外以候肺，内以候胸中；（经曰∶胸为上焦，气之源也。）左外
以候心，内以候膻中。（经曰∶膻中者，臣使之官，喜乐出焉，是为气海。）前以候前，后以候
后。上竟上者，胸喉中事也；下竟下者，少腹腰股膝 足中事也。（此结上文而总言之也。此
《内经》寸关尺三部候法，至《难经》《脉诀》易之，以大小肠配于心肺，而此竟鲜有能究之者，
然则三部孰有准于是哉？今世言脉之三部则是，而其内外之候法，若非心谷汪先生《质疑》之着，
其孰从而知之？《质疑》曰∶内外每部有前后，半部之分也。脉之上至，应前半部，为外属阳；
脉之下至，应后半部，为内属阴。上至者，自后而进于前，阳生于阴也。下至者，自前而退于后，
阴生于阳也。概而言之，脏腑近背之阳位者，以前半部候之，近腹之阴位者，以后半部候之。细
而分之，如两尺内外前后两傍之交，犹夫季胁之位界腰腹以分内外者也。两尺前之半部，以候肾
附腰脊之阳位者，两尺后之半部，以候腹中之阴位者。自尺而附上为关，在左则前以候肝之居于
左胁近背之阳位，后以候膈之当胃口之阴位者；在右则前以候胃之近脊之阳位，后以候脾之居于
右胁近腹之阴位者。又上自关而附上为寸，在右则肺居上右之阳位，胸中居膻中穴上之阴位也。
故于兹前后分而候之，至若前以候前、后以候后云者，则申上意而概言之也。以自关中溢寸，候
胸至头之事；以自关中尽尺，候脐至足之事，则承上意而广言之也。此其为尺寸前后内外之候也。
夫心肝脾肺俱各候，惟肾一脏而当两尺之候何哉？此阳一阴二之理也。夫心肝脾肺居于膈上阳位，
其数奇，故各一形一候。惟肾居于膈下阴位，其数偶，故形如豇豆两枚，对附腰脊之右左而分候
两尺，此水润下之理也。《脉经》及《刊误》并以两尺候肾者，得此意也。《难经》《脉诀》乃
以左尺候肾属水，右尺候手厥阴配之命门、少阳三焦相火，失之矣。夫命门者《铜人》以背脊十
四椎下一穴谓之命门。据此内无正脏，外无正经，何以例部？且手厥阴经之脏命名不一，有以心
包络言者、有以七节之傍中有小心言者，有以代心主病言者，有以两肾静水动火言者，皆无稽之
言也。考之金匮真言篇曰∶肝心脾肺肾五脏为阴，胆胃大肠小肠膀胱三焦六腑为阳。此以十一脏
而配十二经，则手厥阴一经无脏之可配矣。考之灵兰秘典篇岐伯对黄帝十二脏之间曰∶心者，君主之官，神明出焉。肺者，相传之官，治节出焉。肝者，将军之官，谋虑出焉。胆者，中正之官，决断出焉。膻中者，臣使之官，喜乐出焉。脾胃者，仓廪之官，五味出焉。大肠者，传导之官，变化出焉。小肠者，受盛之官，化物出焉。肾者，作强之官，伎巧出焉。三焦者，决渎之官，水道出焉。膀胱者，州都之官，津液脏焉，气化则能出矣。观此膻中足十二脏之数，以备十二官之用，然则配手厥阴之经者不在膻中与?诚以膻中乃心前空虚之处，与心同志为喜。喜笑者，火之司也，则知司火以为心火之相应者也。常藏氤氲之气，《灵枢》谓之宗气，又谓之气海。其气之余，淫于胸之上焦，由肺布于一身，以为生生不息之运用，经谓少火生气是也。苟一失常，则外暑内热而燔灼脏腑，谓之相火龙火，经谓壮火食气是也。是知
膻中者，手厥阴心主相火之脏也。故本文以配心脏君火，分外内而同候左寸，此火炎上之理也。
原手厥阴之经起于胸中，络之三焦，由腋上行臂手之内，终于手之中指。然经与脏俱值身之上部，
当候于寸，而以右尺候之可乎？又三焦者，手少阴之府，上下通焉者也。《灵枢》云∶上焦如雾，
中焦如沤，下焦如渎。此以胸为上焦，气之原也；膈为中焦，血之原也；腹为下焦，水之原也。
位分不同而主治亦异，此本文所以有胸膈腹中之异候。原手少阳之经起手无名指端，行肘臂外循
肩上头，一支下络膻中，属于胸膈腹之三焦，则非下焦之可得而专者，而专以右尺候之可乎？且
府不及胆者何也？则于肝寄之矣。府不及小肠大肠膀胱者何也？于腹中统之矣，抑是三府者皆居
腹之下，宜以两尺后半部而分左右候之。小肠从心例左，大肠从肺例右，膀胱与小肠相通而同其
候则是也。《难经》等书舍其脏腑高低，拘之外经表里，以左寸候心小肠，右寸候肺大肠则非也。
考之《枢要》等书，亦多以左尺主小肠膀胱前阴之病，右尺主大肠后阴之病。今以经候前后外内
之法言之，常诊一部之中，上下之至，软滑应时合位者，谓之中和之脉，为平，前后上下之至，
有太过不及、失时反位者，谓反常之脉，为病。然必察上至下至脉状同异，而分统属之候，盖因
属之五行。气同则合上升，惟水润下。气异俱有升降，以分阴阳。故上下之至同者，以统断之，
寸关病在前候，两尺病在后候。上下之至异者，以属断之，上至病在前候，下至病在后候。上下
互见和乖，和主平而乖病也。上下相同，同中之有异者，主异者之候而为病也。上下相同，强弱
之有尤者，主尤者之候为病也。涩滑长短洪细芤迟八脉有之，大法统属，兼审浮沉虚实，阴阳溢
覆。浮以候表，通主皮毛经脉头项腰脊肢节筋肉之属也。沉以候里，通主脏腑骨髓咽喉二便之属
也。虚者不及，以为痒麻痿泄之证也。实者太过，以为胀壅疼秘之证也。上至为阳，以候上升之
病也。下至为阴，以候下降之病也。上至出部为溢，下至出部为覆，所候同前。且以涩之不及一
脉例之。如∶
两尺前之上至此肾之所候也。诊得浮涩，主耳聋，盖肾藏精而寄窍 耳，耳得肾之精气上荣
而能聪听。今浮而涩为肾不足，不能上荣 耳则耳聋矣。沉涩主腰痛，盖肾附脊而外候于腰，腰
得肾之精气内滋而能转摇，今沉而涩为肾不足，不能内滋于腰则腰痛矣。
左尺后之下至此腹中小肠膀胱之所候也。浮涩主足膝冷麻，盖腹中下焦之位也，阳气不足不
能外温于足膝，故足膝为之冷麻矣。沉涩，男主遗精女主带下，腹中水精之候也，阳气不足不能
内固前阴，故精带而滑下矣。
右尺后之下至此腹中大肠之所候也。浮涩与左同断。沉涩主大便难，腹中为大肠之原也，大
肠本多气多血之经，今沉而涩为大肠气血不足，则气滞血燥而大便难矣。
左关前之上至以候肝。浮涩则主肝血不能上荣而目昏。沉涩则主肝气内郁而胁胀。
左关后之下至以候膈。浮涩则主中宫之湿渗入囊中，故睾丸偏大兼急而为痛。沉涩则主中焦
之气不能荣精于心肺，故滞于膈为胀，甚为痛也。
右关前之上至浮涩主恶吐，沉涩主少食，此候胃阳，以司纳受者也。
右关后之下至浮涩主四肢恶寒，沉涩主饮食难化，此候脾阴，以司运化者也。
右寸前之上至所以候肺。浮涩主头痛。肺，输气之脏也，其气宜充而不宜减，今浮兼涩，为
肺之气不足，不能上充于头，故头无所滋禀而为虚痛耳。沉涩主痰滞。肺，通气之脏也，其气宜
利而不宜滞，今沉兼涩，为肺之气不利，滞而为痰，或由痰遏肺窍而为咳嗽耳。
右寸后之下至所以候胸中。浮涩两膺刺痛，两膺俱胸之傍也，今沉兼涩为胸中之气不足，不
能外充两膺，故两膺气滞而刺痛耳。沉涩主短气，胸为上焦气之原也，今沉兼涩为胸中之气不足，
不能给肺之输送，故气短而不相续耳。
夫心候诸左寸前之上至 浮涩主头眩，以心血不能外荣于头，故火因之煽动而头眩耳。沉涩主
虚汗，以心血不足则火因之内蒸而为汗耳。
膻中候诸左寸后之下至 浮涩主两 恶寒， 乃膻中手厥阴经过之分也，外经气不足则腠理
失卫，邪因外袭，故近 之处恶寒耳。沉涩主惊，膻中宗气之脏也，膻中之气不足则火耗心血，
神不内守故惊悸而不宁耳。此举涩脉以见例，余可类推矣。
《黄帝内经·经脉别论篇》说：食物进入胃中，其精微物质散布到肝脏，滋养筋脉。食物进入胃中，其中的浊气归于心，精微物质注入血脉。脉中的气流经经络，经络之气汇聚于肺，肺朝会全身百脉，将精微物质输布到皮毛。皮毛与血脉中的精气相合，运行气于六腑。六腑的精气神明，留存于五脏，气的状态达到平衡协调，气口（寸口脉）形成寸脉的形态，从而可以判断生死预后。（这里的气口泛指双手的脉搏，并非仅指右手。）饮水进入胃中，水液精气游溢上行，输送到脾脏。脾气散播精微物质，向上归于肺，通调水道，向下输送到膀胱。水精四布，五条经脉并行，顺应四季和五脏阴阳的变化，以此作为正常的生理规律。
【五脏六腑气口成寸图】图片
《黄帝内经·三部九候论篇》黄帝问：我想了解天地的至数（最高法则），如何与人体的形体气血相合，以通晓决断生死，该怎么做呢？岐伯回答：天地的至数，起始于一，终结于九。一代表天，二代表地，三代表人，由此三倍之，三三得九，以对应九野（九州）。所以人有三部，每部有三候，用以决断生死，诊治百病，调节虚实，祛除邪疾。黄帝问：什么叫三部？岐伯说：有上部、中部、下部，每部各有三候。所谓三候，是指天、地、人，必须用手指点导引说明，才能得其真谛。上部的天，是两额头的动脉；王冰注解说在额头两旁，跳动应手。上部的地，是两脸颊的动脉，（在鼻孔下两旁，接近巨髎穴的位置，跳动应手。）上部的人，是耳前的动脉。（在耳前凹陷处，跳动应手。）中部的天，是手太阴肺经；（在手腕后寸口处，名为经渠穴，跳动应手。）中部的地，是手阳明大肠经；（在手大指和二指歧骨间，合谷穴的位置，跳动应手。）中部的人，是手少阴心经。（在手腕后高骨端，神门穴的位置，跳动应手。）下部的天，是足厥阴肝经；（在足大趾本节后二寸凹陷中，太冲穴的位置。）下部的地，是足少阴肾经；（在足内踝后跟骨上凹陷中，太溪穴的位置，跳动应手。）下部的人，是足太阴脾经。（在鱼腹越过筋腱之间，直对五里、箕门穴的位置，重按跳动应手。若候胃气，应当取足背上的冲阳穴位置，跳动应手。）所以下部的天用来候肝，地用来候肾，人用来候脾胃之气。中部的天用来候肺，地用来候胸中之气，人用来候心。上部的天用来候头角之气，地用来候口齿之气，人用来候耳目之气。
九候之间的相应关系，上下应该一致，不能有所缺失。如果有一候滞后（不相应），则生病；有两候滞后，则病重；有三候滞后，则病危。所谓的“滞后”，是指脉搏应指不同时。
《黄帝内经·脉要精微论》说：尺肤内侧两旁对应季胁。（季胁在胁骨之下带脉上一寸八分，是其候诊部位。）尺肤外侧用来候肾，尺肤内侧用来候腹中（两尺脉，两尺外侧候肾部，内侧候腹里，大小肠膀胱腑都在中间位置。）附上（两关部），左手外侧用来候肝，内侧用来候膈；（经文说：膈为中焦，血的源头。）右手外侧用来候胃，内侧用来候脾。再上附上（两寸部），右手外侧用来候肺，内侧用来候胸中；（经文说：胸为上焦，气的源头。）左手外侧用来候心，内侧用来候膻中。（经文说：膻中者，是臣使之官，喜乐由此发出，这就是气海。）前面候前面的病，后面候后面的病。脉气上竟于上（寸部之上），是胸喉中的事；脉气下竟于下（尺部之下），是少腹腰股膝足中的事。（这是总结上文而言。）这里的《内经》寸关尺三部候法，到了《难经》和《脉诀》时改变了它，用大小肠配属心肺，而这种方法现在很少有人能深入研究，那么哪里的三部候法才是准确的呢？当今世人所说的脉之三部是对的，但其内外候法，如果不是心谷汪先生的《质疑》著作，谁能从中知晓呢？《质疑》说：内外每部都有前后半部的区分。脉气上至，应前半部，属外属阳；脉气下至，应后半部，属内属阴。上至者，是从后向前进，阳生于阴。下至者，是从后退向后，阴生于阳。概括来说，脏腑靠近背部阳位者，以前半部候之，靠近腹部阴位者，以后半部候之。细分来看，如两尺内外前后两傍的交界，就像季胁的位置界限腰腹以分内外一样。两尺前之半部，用来候肾附于腰脊的阳位者；两尺后之半部，用来候腹中的阴位者。自尺而附上为关，在左侧则前部候肝居于左胁近背的阳位，后部候膈当胃口处的阴位者；在右侧则前部候胃近脊的阳位，后部候脾居于右胁近腹的阴位者。又上自关而附上为寸，在右侧则肺居上右的阳位，胸中居膻中穴上的阴位。所以在这些部位前后分开来候诊，至于前面候前、后面候后这样的话，则是重申上文意思而概括而言。从关中溢出至寸，候胸至头的事；从关中尽至尺，候脐至足的事，则是承接上文意思而广而言之。这就是尺寸前后内外的候法。为什么心肝脾肺都各候一处，唯独肾脏一脏却当两尺之候呢？这是阳一阴二的道理。心肝脾肺居于膈上阳位，其数为奇数，所以各有一形一候。唯独肾居于膈下阴位，其数为偶数，所以形状像豇豆两枚，对附腰脊左右而分候两尺，这是水润下的道理。《脉经》及《刊误》都以两尺候肾，是得到了这个意旨。《难经》《脉诀》却以左尺候肾属水，右尺候手厥阴配命门、少阳三焦相火，这就错了。所谓命门，《铜人腧穴针灸图经》以背脊十四椎下一穴称为命门。据此体内没有正脏，体外没有正经，怎么可以用来配属部位？而且手厥阴经的脏命名不一，有的说是心包络，有的说是七节之旁中有小心，有的说是代心主病，有的说是两肾静水动火，都是无稽之谈。考证《金匮真言论》说：肝心脾肺肾五脏为阴，胆胃大肠小肠膀胱三焦六腑为阳。这是以十一脏配十二经，那么手厥阴一经就没有脏可配了。考证《灵兰秘典论》岐伯回答黄帝关于十二脏的问题说：心者，君主之官，神明出焉。肺者，相传之官，治节出焉。肝者，将军之官，谋虑出焉。胆者，中正之官，决断出焉。膻中者，臣使之官，喜乐出焉。脾胃者，仓廪之官，五味出焉。大肠者，传导之官，变化出焉。小肠者，受盛之官，化物出焉。肾者，作强之官，伎巧出焉。三焦者，决渎之官，水道出焉。膀胱者，州都之官，津液脏焉，气化则能出矣。看这膻中足以凑齐十二脏之数，以备十二官之用，那么配手厥阴经的难道不是膻中吗？确实因为膻中是心前空虚之处，与心同志而喜。喜笑者，是火的司职，则知道司火以作为心火的相应者。常藏氤氲之气，《灵枢》称之为宗气，又称之气海。其气的余气，淫于胸之上焦，由肺布散于一身，作为生生不息的运用，经文说少火生气就是此意。如果一旦失常，则外暑内热而燔灼脏腑，称为相火龙火，经文说壮火食气就是此意。因此知道膻中者，是手厥阴心主相火之脏。所以本文以配心脏君火，分外内而同候左寸，这是火炎上的道理。推究手厥阴经起于胸中，络属于三焦，由腋上行臂手之内，终于手中指。然而经与脏都位于身之上部，应当候于寸，而以右尺候之可以吗？另外三焦者，是手少阴之府，上下相通。《灵枢》说：上焦如雾，中焦如沤，下焦如渎。这是以胸为上焦，气的源头；膈为中焦，血的源头；腹为下焦，水的源头。位置不同主治也不同，这就是本文所以有胸膈腹中之异候的原因。推究手少阳经起手无名指端，行肘臂外循肩上头，一支下络膻中，属于胸膈腹之三焦，则不是下焦可得而专有的，而专以右尺候之可以吗？况且腑不及胆是怎么回事呢？则寄于肝了。腑不及小肠大肠膀胱是怎么回事呢？统于腹中了，抑或是这三府都居腹之下，宜以两尺后半部分左右候之。小肠从心例左，大肠从肺例右，膀胱与小肠相通而同其候则是正确的。《难经》等书舍弃其脏腑高低，拘泥于外经表里，以左寸候心小肠，右寸候肺大肠就错了。考证《枢要》等书，也多以左尺主小肠膀胱前阴之病，右尺主大肠后阴之病。现在以经候前后内外之法来说，常诊一部之中，上下之至，软滑应时合位者，称为中和之脉，为平脉，前后上下之至，有太过不及、失时反位者，称为反常之脉，为病脉。但必须察看上至下至脉状同异，而分统属之候，大概因为属之五行。气同则合上升，惟水润下。气异俱有升降，以分阴阳。所以上下之至同者，以统断之，寸关病在前候，两尺病在后候。上下之至异者，以属断之，上至病在前候，下至病在后候。上下互见和乖，和主平而乖主病。上下相同，同中之有异者，主异者之候而为病。上下相同，强弱之有尤者，主尤者之候为病。涩、滑、长、短、洪、细、芤、迟八种脉象有这种情况，大法统属，兼审浮沉虚实，阴阳溢覆。浮以候表，通主皮毛经脉头项腰脊肢节筋肉之属。沉以候里，通主脏腑骨髓咽喉二便之属。虚者为不及，以为痒麻痿泄之证。实者为太过，以为胀壅疼秘之证。上至为阳，以候上升之病。下至为阴，以候下降之病。上至出部为溢，下至出部为覆，所候同前。且以涩之不及一脉为例。如：
两尺前之上至此肾之所候也。诊得浮涩，主耳聋，盖肾藏精而寄窍于耳，耳得肾之精气上荣而能聪听。今浮而涩为肾不足，不能上荣于耳则耳聋矣。沉涩主腰痛，盖肾附脊而外候于腰，腰得肾之精气内滋而能转摇，今沉而涩为肾不足，不能内滋于腰则腰痛矣。
左尺后之下至此腹中小肠膀胱之所候也。浮涩主足膝冷麻，盖腹中下焦之位也，阳气不足不能外温于足膝，故足膝为之冷麻矣。沉涩，男主遗精女主带下，腹中水精之候也，阳气不足不能内固前阴，故精带而滑下矣。
右尺后之下至此腹中大肠之所候也。浮涩与左同断。沉涩主大便难，腹中为大肠之原也，大肠本多气多血之经，今沉而涩为大肠气血不足，则气滞血燥而大便难矣。
左关前之上至以候肝。浮涩则主肝血不能上荣而目昏。沉涩则主肝气内郁而胁胀。
左关后之下至以候膈。浮涩则主中宫之湿渗入囊中，故睾丸偏大兼急而为痛。沉涩则主中焦之气不能荣精于心肺，故滞于膈为胀，甚为痛也。
右关前之上至浮涩主恶吐，沉涩主少食，此候胃阳，以司纳受者也。
右关后之下至浮涩主四肢恶寒，沉涩主饮食难化，此候脾阴，以司运化者也。
右寸前之上至所以候肺。浮涩主头痛。肺，输气之脏也，其气宜充而不宜减，今浮兼涩，为肺之气不足，不能上充于头，故头无所滋禀而为虚痛耳。沉涩主痰滞。肺，通气之脏也，其气宜利而不宜滞，今沉兼涩，为肺之气不利，滞而为痰，或由痰遏肺窍而为咳嗽耳。
右寸后之下至所以候胸中。浮涩两膺刺痛，两膺俱胸之傍也，今沉兼涩为胸中之气不足，不能外充两膺，故两膺气滞而刺痛耳。沉涩主短气，胸为上焦气之原也，今沉兼涩为胸中之气不足，不能给肺之输送，故气短而不相续耳。
夫心候诸左寸前之上至 浮涩主头眩，以心血不能外荣于头，故火因之煽动而头眩耳。沉涩主虚汗，以心血不足则火因之内蒸而为汗耳。
膻中候诸左寸后之下至 浮涩主两腋下恶寒，腋下乃膻中手厥阴经过之分也，外经气不足则腠理失卫，邪因外袭，故近腋之处恶寒耳。沉涩主惊，膻中宗气之脏也，膻中之气不足则火耗心血，神不内守故惊悸而不宁耳。此举涩脉以见例，其余可类推矣。
The *Jingmai Bie Lun* (Treatise on the Divergent Meridians) chapter of the *Huangdi Neijing* states: When food enters the stomach, its refined essence is dispersed to the Liver (*Gan*), nourishing the sinews. When food enters the stomach, its turbid qi returns to the Heart (*Xin*), and its refined essence is infused into the vessels. The qi in the vessels flows through the meridians, and the meridian qi converges in the Lung (*Fei*). The Lung receives all vessels and transmits refined essence to the skin and hair. The essence of the skin and vessels combines, circulating qi through the Fu organs. The bright spirit of the Fu organs remains in the Zang organs, and the qi reaches a state of balance and equilibrium. Through this balance, the Cun Kou (Cunkou pulse) forms its inch position, allowing for the determination of life and death. (Here, "Qi Kou" refers generally to the pulses of both hands, not solely the right hand.) When drink enters the stomach, its clear and turbid essences overflow and are transported upward to the Spleen (*Pi*). The Spleen disperses refined essence, sending it upward to return to the Lung, which regulates the water passages and transports fluids downward to the Bladder (*Pangguang*). Water essence is distributed throughout the body, and the five meridians run in parallel, harmonizing with the four seasons and the Yin-Yang of the five Zang organs, establishing this as the normal physiological pattern.
[Diagram of the Formation of the Cun Position from the Qi of the Five Zang and Six Fu Organs]
In the *Sanbu Jiuhou Lun* (Treatise on the Three Regions and Nine Locations Pulse Diagnosis) chapter, the Yellow Emperor asked: I wish to hear about the supreme numbers of Heaven and Earth, how they correspond to human form and blood-q i, and how they can be used to determine life and death. What should be done? Qibo replied: The supreme numbers of Heaven and Earth begin with one and end with nine. One represents Heaven, two represents Earth, and three represents Humanity. Multiplying by three, we get nine, corresponding to the Nine Fields (Nine Provinces). Thus, humans have three regions (Sanbu), each containing three locations (Jiuhou), used to determine life and death, treat various diseases, regulate deficiency and excess, and eliminate pathogenic factors. The Yellow Emperor asked: What are the three regions? Qibo said: There are the Upper Region, Middle Region, and Lower Region, each having three locations. These three locations correspond to Heaven, Earth, and Humanity. One must point them out and guide the understanding to grasp the truth. The Heaven location of the Upper Region is the arterial pulse at both temples; Wang Bing’s commentary notes it is on both sides of the forehead, pulsating under the fingers. The Earth location of the Upper Region is the arterial pulse at both cheeks (located beside the nostrils, near the Juliao acupoint, pulsating under the fingers). The Human location of the Upper Region is the arterial pulse in front of the ears (located in the depression in front of the ear, pulsating under the fingers). The Heaven location of the Middle Region is the Hand-Taiyin Lung Meridian (located at the Cun Kou behind the wrist, known as Jingqu acupoint, pulsating under the fingers). The Earth location of the Middle Region is the Hand-Yangming Large Intestine Meridian (located between the bones separating the thumb and index finger, at Hegu acupoint, pulsating under the fingers). The Human location of the Middle Region is the Hand-Shaoyin Heart Meridian (located at the end of the styloid process of the ulna, at Shenmen acupoint, pulsating under the fingers). The Heaven location of the Lower Region is the Foot-Jueyin Liver Meridian (located in the depression two cun distal to the base of the big toe, at Taichong acupoint). The Earth location of the Lower Region is the Foot-Shaoyin Kidney Meridian (located in the depression behind the medial malleolus and above the calcaneus, at Taixi acupoint, pulsating under the fingers). The Human location of the Lower Region is the Foot-Taiyin Spleen Meridian (located between the muscles over the fish belly tendon, directly opposite Wuli and Jimen acupoints, pulsating under deep pressure. To palpate Stomach qi, one should take the Chongyang acupoint on the dorsum of the foot, which pulsates under the fingers). Therefore, the Heaven location of the Lower Region observes the Liver, the Earth location observes the Kidney, and the Human location observes the Spleen and Stomach qi. The Heaven location of the Middle Region observes the Lung, the Earth location observes the qi of the chest, and the Human location observes the Heart. The Heaven location of the Upper Region observes the qi of the head and horns, the Earth location observes the qi of the mouth and teeth, and the Human location observes the qi of the eyes and ears.
The correspondence among the nine locations should be consistent; upper and lower should be uniform and not deviate. If one location lags (is absent or weak), disease occurs; if two lag, the disease is severe; if three lag, the condition is critical. "Lagging" means the pulses do not respond simultaneously.
The *Maiyao Jingwei Lun* (Treatise on the Essential subtleties of Pulse Diagnosis) chapter states: The inner lateral side of the Chi area corresponds to the hypochondrium (the hypochondrium is one cun eight fen below the costal margin above the Dai Mai belt vessel, which is its diagnostic site). The outer Chi area observes the Kidney, and the inner Chi area observes the abdomen (both Chi pulses; the outer aspect of both Chi pulses observes the Kidney region, while the inner aspect observes the interior of the abdomen, where the Large Intestine, Small Intestine, and Bladder are located centrally). Above this is the Guan area (both Guan positions); the left outer aspect observes the Liver, and the inner aspect observes the Diaphragm (the classic text states: The Diaphragm is the Middle Jiao, the source of blood). The right outer aspect observes the Stomach, and the inner aspect observes the Spleen. Above that is the Cun area (both Cun positions); the right outer aspect observes the Lung, and the inner aspect observes the chest (the classic text states: The chest is the Upper Jiao, the source of qi). The left outer aspect observes the Heart, and the inner aspect observes the Danzhong (the classic text states: Danzhong is the Official of the Envoy, from which joy and pleasure emerge; this is the Sea of Qi). The anterior part observes anterior pathology, and the posterior part observes posterior pathology. Pulse qi reaching the extreme upper (above the Cun) relates to matters of the chest and throat; pulse qi reaching the extreme lower (below the Chi) relates to matters of the lower abdomen, waist, thighs, knees, and feet. (This summarizes the preceding text.) This method of observing the Cun, Guan, and Chi three regions from the *Neijing* was altered in the *Nanjing* and *Maijue*, assigning the Large and Small Intestines to the Lung and Heart respectively, yet few today thoroughly investigate this. So, which standard for the three regions is accurate? While modern practitioners correctly identify the three regions of the pulse, their methods for internal/external observation would remain unknown without Mr. Xin Gu's work *Zhiyi*. *Zhiyi* states: Each internal and external portion has anterior and posterior halves. Pulse qi rising up corresponds to the anterior half, belonging to the exterior and Yang; pulse qi sinking down corresponds to the posterior half, belonging to the interior and Yin. Rising up moves from back to front, as Yang arises from Yin. Sinking down moves from front to back, as Yin arises from Yang. Generally speaking, Zang organs located near the back (Yang position) are observed via the anterior half, while those near the abdomen (Yin position) are observed via the posterior half. Specifically, the junctions of the inner/outer and anterior/posterior aspects of both Chi areas resemble the boundary of the hypochondrium dividing the waist and abdomen. The anterior half of both Chi areas observes the Kidney attached to the lumbar spine (Yang position), while the posterior half observes the abdominal interior (Yin position). From Chi to Guan is the Guan section; on the left, the anterior half observes the Liver (located in the left hypochondrium near the back, a Yang position), and the posterior half observes the Diaphragm (at the stomach opening, a Yin position); on the right, the anterior half observes the Stomach (near the spine, a Yang position), and the posterior half observes the Spleen (located in the right hypochondrium near the abdomen, a Yin position). From Guan to Cun is the Cun section; on the right, the Lung occupies the upper right Yang position, and the chest occupies the Yin position above the Danzhong acupoint. Thus, these areas are observed separately anteriorly and posteriorly. The phrase "anterior observes anterior, posterior observes posterior" reiterates the general meaning. Overflowing from Guan to Cun observes matters from the chest to the head; extending from Guan to the end of Chi observes matters from the navel to the feet, expanding upon the previous meaning. This constitutes the observation method for the anterior/posterior and internal/external aspects of Cun and Chi. Why do the Heart, Liver, Spleen, and Lung each have one observation site, while only the Kidney occupies both Chi sites? This follows the principle of Yang being one and Yin being two. The Heart, Liver, Spleen, and Lung reside above the diaphragm in Yang positions, with odd numbers, thus having one form and one observation site. Only the Kidney resides below the diaphragm in a Yin position, with an even number, shaped like two kidney beans, attached to the lumbar spine on left and right, hence observing both Chi sites; this follows the principle of water flowing downward. The *Maijing* and *Kanwu* both observe the Kidney at both Chi sites, grasping this intent. However, the *Nanjing* and *Maijue* incorrectly assign the left Chi to the Kidney (Water) and the right Chi to the Hand-Jueyin Pericardium paired with Mingmen and Shaoyang Sanjiao Ministerial Fire. Mingmen, according to the *Tongren* manual, is an acupoint below the 14th thoracic vertebra on the spine. Based on this, there is no proper Zang organ internally nor a proper Meridian externally, so how can it be assigned to a pulse region? Furthermore, the naming of the Hand-Jueyin organ is inconsistent: some say Pericardium, some say "small heart beside the seven segments," some say it substitutes for the Heart's master role, and some say it refers to the static water and moving fire of the two Kidneys; all are groundless claims. Examining the *Jinkui Zhenyan Lun*, it states: The five Zang organs—Liver, Heart, Spleen, Lung, Kidney—are Yin; the six Fu organs—Gallbladder, Stomach, Large Intestine, Small Intestine, Bladder, Sanjiao—are Yang. This pairs eleven Zang organs with twelve meridians, leaving the Hand-Jueyin meridian without a matching Zang organ. Examining the *Linglan Midian Lun*, Qibo answers the Yellow Emperor regarding the twelve Zang organs: The Heart is the Sovereign Official, from whom spirit emerges. The Lung is the Official of Transmission, from whom regulation emerges. The Liver is the General Official, from whom strategy emerges. The Gallbladder is the Official of Integrity, from whom decision emerges. Danzhong is the Official of the Envoy, from which joy and pleasure emerge. The Spleen and Stomach are the Officials of the Granary, from which the five flavors emerge. The Large Intestine is the Official of Conduction, from whom transformation emerges. The Small Intestine is the Official of Reception, from whom refinement emerges. The Kidney is the Official of Strength, from whom skill emerges. The Sanjiao is the Official of Drainage, from whom water passages emerge. The Bladder is the Official of the Metropolis, storing fluid essence; when qi transforms, it can exit. Observing this, Danzhong completes the count of twelve Zang organs to prepare for the twelve officials. Therefore, does not the Hand-Jueyin meridian pair with Danzhong? Indeed, Danzhong is the empty space before the Heart, sharing the Heart's nature of joy. Joyful laughter is governed by Fire, indicating it serves as the correspondent to the Heart's Sovereign Fire. It constantly stores ethereal qi, called Zongqi (Gathering Qi) or Sea of Qi in the *Lingshu*. Its residual qi permeates the Upper Jiao of the chest, spreads throughout the body via the Lung, serving as the continuous operation of life; the classic text says "Minor Fire generates Qi." If this function fails, external heat and internal fever scorch the Zang organs, termed Ministerial Fire or Dragon Fire; the classic text says "Major Fire consumes Qi." Thus, Danzhong is the Zang organ of the Hand-Jueyin Heart Master Ministerial Fire. Hence, this text pairs it with the Heart's Sovereign Fire, distinguishing internal/external but observing both at the Left Cun, following the principle of fire flaming upward. Tracing the Hand-Jueyin Meridian, it originates in the chest, connects to the Sanjiao, ascends via the axilla along the medial arm to the middle finger. Since both the meridian and organ are in the upper body, they should be observed at the Cun; can they be observed at the Right Chi? Additionally, the Sanjiao is the Fu organ of the Hand-Shaoyin, connecting upper and lower. The *Lingshu* states: The Upper Jiao is like mist, the Middle Jiao like foam, the Lower Jiao like a ditch. Here, the chest is the Upper Jiao, source of qi; the diaphragm is the Middle Jiao, source of blood; the abdomen is the Lower Jiao, source of water. Their positions differ, and so do their treatments; this explains why the text distinguishes observations for the chest, diaphragm, and abdomen. Tracing the Hand-Shaoyang Sanjiao Meridian, it starts at the tip of the ring finger, travels along the lateral elbow and arm, over the shoulder to the head, with a branch descending to connect with Danzhong and belong to the Sanjiao of the chest, diaphragm, and abdomen. It cannot be exclusively owned by the Lower Jiao; can it be exclusively observed at the Right Chi? As for why the Gallbladder is omitted from the Fu organs, it is entrusted to the Liver. Why are the Small, Large Intestines, and Bladder omitted? They are unified under the abdomen. Moreover, these three Fu organs reside in the lower abdomen, appropriately observed at the posterior halves of both Chi sites, divided left and right. The Small Intestine follows the Heart on the left, the Large Intestine follows the Lung on the right, and the Bladder communicates with the Small Intestine sharing the same observation is correct. The *Nanjing* and other books ignore the vertical positions of Zang and Fu, rigidly adhering to exterior-interior meridian relationships, observing the Heart and Small Intestine at the Left Cun and the Lung and Large Intestine at the Right Cun, which is incorrect. Texts like *Shuyao* often assign the Left Chi to diseases of the Small Intestine, Bladder, and anterior orifice, and the Right Chi to diseases of the Large Intestine and posterior orifice. Now, speaking of the method of anterior/posterior and internal/external observation: In a single pulse region, if the rising and falling pulses are soft, smooth, timely, and fit the position, it is called the Harmonious Pulse, indicating health. If the rising and falling pulses show excess or deficiency, mistiming, or reversal of position, it is called the Abnormal Pulse, indicating disease. One must examine whether the rising and falling pulse qualities are similar or different to assign their observational domains, largely based on the Five Elements. Qi of the same nature rises together; only Water descends. Qi of different natures has both ascending and descending movements, distinguishing Yin and Yang. Therefore, if rising and falling are the same, judge by unity: pathology at Cun/Guan is in the anterior observation, pathology at both Chi is in the posterior observation. If rising and falling are different, judge by affiliation: rising pathology is in the anterior observation, sinking pathology is in the posterior observation. If rising and falling appear harmonious and discordant, harmony indicates health, discordance indicates disease. If rising and falling are identical but contain differences, the differing aspect indicates pathology. If rising and falling are identical but vary in strength, the more pronounced aspect indicates pathology. This applies to the eight pulse types: Choppy, Slippery, Long, Short, Surging, Fine, Hollow, and Slow. The general rule involves unity and affiliation, additionally examining Floating/Sinking, Deficiency/Excess, and Yin/Yang overflow/reversal. Floating observes the Exterior, generally governing the skin, hair, meridians, head, neck, waist, spine, limbs, joints, and muscles. Sinking observes the Interior, generally governing the Zang-Fu organs, bone marrow, throat, and urination/defecation. Deficiency indicates insufficiency, manifesting as itching, numbness, flaccidity, and diarrhea. Excess indicates superfluity, manifesting as distension, obstruction, pain, and constipation. Rising is Yang, observing ascending pathology. Sinking is Yin, observing descending pathology. Rising beyond the region is Overflow; sinking beyond the region is Reversal, with observations as previously stated. Taking the Choppy pulse (insufficiency) as an example:
At the anterior rising aspect of both Chi sites, which observes the Kidney: A Floating-Choppy pulse indicates deafness. The Kidney stores essence and opens into the ears; the ears receive Kidney essence rising to nourish them, enabling hearing. Now, Floating-Choppy indicates Kidney insufficiency, unable to nourish the ears, resulting in deafness. A Sinking-Choppy pulse indicates lower back pain. The Kidney attaches to the spine and manifests externally in the waist; the waist receives Kidney essence nourishing it internally, enabling movement. Now, Sinking-Choppy indicates Kidney insufficiency, unable to nourish the waist internally, resulting in lower back pain.
At the posterior sinking aspect of the Left Chi, which observes the abdomen, Small Intestine, and Bladder: A Floating-Choppy pulse indicates coldness and numbness in the feet and knees. This is the location of the Lower Jiao in the abdomen; insufficient Yang qi cannot warm the feet and knees externally, causing coldness and numbness. A Sinking-Choppy pulse indicates seminal emission in men and leukorrhea in women, observing the water-essence of the abdomen. Insufficient Yang qi cannot secure the anterior orifice internally, causing essence and discharge to slip downward.
At the posterior sinking aspect of the Right Chi, which observes the Large Intestine in the abdomen: A Floating-Choppy pulse is diagnosed similarly to the left. A Sinking-Choppy pulse indicates difficulty defecating. The abdomen is the origin of the Large Intestine; the Large Intestine is naturally rich in qi and blood. Now, Sinking-Choppy indicates insufficiency of qi and blood in the Large Intestine, leading to qi stagnation and blood dryness, causing difficult defecation.
At the anterior rising aspect of the Left Guan, observing the Liver: A Floating-Choppy pulse indicates blurred vision due to Liver blood failing to nourish the head upwards. A Sinking-Choppy pulse indicates flank distension due to Liver qi internal stagnation.
At the posterior sinking aspect of the Left Guan, observing the Diaphragm: A Floating-Choppy pulse indicates dampness from the Central Palace seeping into the scrotum, causing unilateral testicular enlargement accompanied by acute pain. A Sinking-Choppy pulse indicates that Middle Jiao qi cannot nourish the essence to the Heart and Lung, causing stagnation in the diaphragm leading to distension, or severe pain.
At the anterior rising aspect of the Right Guan: A Floating-Choppy pulse indicates aversion to vomiting; a Sinking-Choppy pulse indicates poor appetite. This observes Stomach Yang, which governs reception.
At the posterior sinking aspect of the Right Guan: A Floating-Choppy pulse indicates aversion to cold in the four limbs; a Sinking-Choppy pulse indicates difficulty digesting food. This observes Spleen Yin, which governs transformation and transportation.
At the anterior rising aspect of the Right Cun, observing the Lung: A Floating-Choppy pulse indicates headache. The Lung is the organ transmitting qi; its qi should be full, not deficient. Now, Floating combined with Choppy indicates Lung qi insufficiency, unable to ascend to nourish the head, resulting in empty headache. A Sinking-Choppy pulse indicates phlegm stagnation. The Lung is the organ ventilating qi; its qi should be free-flowing, not stagnant. Now, Sinking combined with Choppy indicates Lung qi obstruction, stagnating into phlegm, possibly obstructing lung orifices causing cough.
At the posterior sinking aspect of the Right Cun, observing the chest: A Floating-Choppy pulse indicates stabbing pain in both pectorals. Both pectorals are beside the chest. Now, Sinking combined with Choppy indicates insufficiency of chest qi, unable to fill the pectorals externally, causing qi stagnation and stabbing pain. A Sinking-Choppy pulse indicates shortness of breath. The chest is the source of qi in the Upper Jiao. Now, Sinking combined with Choppy indicates insufficiency of chest qi, unable to supply the Lung's transmission, resulting in discontinuous shortness of breath.
Observing the Heart at the anterior rising aspect of the Left Cun: A Floating-Choppy pulse indicates dizziness, as Heart blood cannot nourish the head externally, causing Fire to flare up and induce dizziness. A Sinking-Choppy pulse indicates spontaneous sweating, as Heart blood insufficiency causes Fire to steam internally, producing sweat.
Observing Danzhong at the posterior sinking aspect of the Left Cun: A Floating-Choppy pulse indicates aversion to cold in both axillae. The axillae are the passage of the Hand-Jueyin Meridian. Insufficient exterior meridian qi leads to loss of defensive protection at the pores, allowing pathogens to invade externally, causing aversion to cold near the axillae. A Sinking-Choppy pulse indicates fright. Danzhong is the organ of Zongqi. Insufficient Danzhong qi causes Fire to consume Heart blood, and Spirit fails to remain inward, resulting in palpitations and restlessness. This uses the Choppy pulse as an example; the rest can be inferred analogously.