帝曰∶诊法何如?诊法常以平旦,阴气未动,阳气未散,饮食未进,经脉未盛,络脉调匀,
气血未乱,故乃可诊有过之脉。切脉动静而视精明,察五色,观五脏有余不足,六腑强弱,形之
盛衰,以此参伍,定死生之分。是故诊脉有道,虚静为保。遇仓卒病患不在此论。但自澄神,静
虚调息,凝视精明,察五色,听声音,问所由,方始按寸尺别浮沉,复视患人身形,长短肥瘦、
老少男女,性情例各不同,故曰∶形气相得者生,三
五不调者病。又如室女尼姑当濡而弱,婴儿孺子之脉疾,三四岁者呼吸之间脉当七至,而鄙夫常
人特不同耳。大抵男子先诊左手,女人先诊右手,男子左脉大则顺,女人右脉大则顺。大凡诊脉,
先以中指揣按掌后高骨上为关,得其关位,然后齐下名食二指。若臂长人,疏排其指,若臂短人,
密排其指。三指停稳,先诊上指,曰寸口。浮按消息之,中按消息之,重按消息之,上竟消息之,
下竟消息之,推而外之消息之,推而内之消息之。然后先关后尺消息,一一类此。若诊得三部之
中,浮沉滑涩迟疾不调,何病所主,外观形色,内察脉候,参详处治,以忠告之。不可轻言谈笑,
乱说是非,左右瞻望,举上忽略,此庸下之医也。
脉有三部,曰寸、曰关、曰尺。寸部法天,关部法人,尺部法地。寸部候上,自胸膈心肺咽
喉头目之有疾也。关部候中,自胸膈以下至小腹之有疾也,脾胃肝胆皆在中也。尺部候下,自少
腹腰肾膝 足也,大肠小肠膀胱皆在下也。皆《内经》所谓上以候上、下以候下,而理势之所不
容间也。其候岂不易验哉?
黄帝问道:诊脉的方法是怎样的?诊脉通常选择在清晨进行,此时阴气尚未躁动,阳气尚未耗散,饮食尚未摄入,经脉之气尚未充盛,络脉气血调和均匀,全身气血运行未受干扰而紊乱,因此可以诊断出异常的脉象。通过切按脉搏的动静变化,观察患者眼神的光彩,审视面部的五色变化,考察五脏功能的有余或不足,六腑功能的强弱,以及形体状态的盛衰,将这些方面相互参照比较,从而判定生死预后。所以诊脉有一定的原则,以虚静无为作为保障。如果遇到仓促急迫的病人,则不在此常规讨论范围内。医生应当自己澄澈心神,保持内心清静空虚,调整呼吸,凝视患者的眼神,察视面色,听取声音,询问发病原因,然后才开始寸、尺部位的切按,辨别浮、沉脉象,再观察患者的身形,包括长短、肥瘦、老少、男女等,因为性情习惯各不相同,所以说:形体与脉气相协调的就能生存,形气三五不调的就会生病。例如,未婚女子和出家尼姑的脉象应当濡软而弱;婴儿幼儿的脉象频率较快;三四岁的儿童在每次呼吸之间脉跳七次;而普通百姓的情况则大不相同。大致来说,男子先诊左手脉,女子先诊右手脉;男子左手的脉象较大为顺,女子右手的脉象较大为顺。大凡诊脉,先用中指揣摸按压手腕后高骨(桡骨茎突)上方定为关位,找到关位后,然后将无名指、食指并排放在关位之前。如果病人手臂较长,手指间距可稍疏;如果病人手臂较短,手指间距应密排。三指停稳后,先诊最上方的指位,称为寸口。用轻力按触以探察脉象,用中等力度按触以探察脉象,用重力度按触以探察脉象,向上推至寸部尽头以探察,向下推至尺部尽头以探察,向外推以探察表证,向内推以探察里证。然后再依次诊察关部和尺部,方法都与此类似。如果在诊察三部脉中,发现浮、沉、滑、涩、迟、疾等脉象不调,对应什么疾病,需要结合外观形色和内部脉候进行详细分析,制定治疗方案,并诚恳地告知患者。不可轻率谈笑,胡乱说是非,左右张望,举止疏忽大意,这是庸俗低下的医生所为。
脉象分为三部,即寸、关、尺。寸部效法天,关部效法人,尺部效法地。寸部主要候察上部,即从胸膈、心肺、咽喉、头部及眼睛的疾病。关部主要候察中部,即从胸膈以下至小腹的疾病,脾、胃、肝、胆都在这一区域。尺部主要候察下部,即从小腹、腰、肾、膝到足部的疾病,大肠、小肠、膀胱都在下部。这都是《内经》所说的“上以候上、下以候下”,是医理势所必然,不容许有间隔错位的。这种候诊方法难道不容易验证吗?
The Yellow Emperor asked: How is pulse diagnosis conducted? Pulse diagnosis is typically performed in the early morning, when Yin Qi (Yin energy) has not yet stirred, Yang Qi (Yang energy) has not yet dispersed, food and drink have not been ingested, the Jingmai (Primary Meridians) are not yet full, the Luomai (Collateral Vessels) are harmonious and even, and the Yingqi (Nutritive Qi) and Xue (Blood) are not yet chaotic. Thus, abnormal pulses can be diagnosed. By palpating the movement and stillness of the pulse, observing the clarity of the patient's eyes, examining the five colors of the face, assessing the excess or deficiency of the Zang organs (Solid Organs), the strength or weakness of the Fu organs (Hollow Organs), and the flourishing or declining state of the body, these aspects are cross-referenced to determine the boundary between life and death. Therefore, there is a principle for pulse diagnosis, with emptiness and tranquility serving as the safeguard. This does not apply to patients encountered in sudden emergencies. The physician must clear their mind, maintain inner tranquility and emptiness, regulate breathing, gaze steadily at the patient's eyes, observe facial colors, listen to vocal sounds, inquire about the cause of illness, and only then begin to palpate the Cun (Inch) and Chi (Cubit) positions, distinguishing between Floating (Fu) and Deep (Chen) pulses. Subsequently, observe the patient's physique, including length, leanness, obesity, age, and gender, as temperaments and habits vary. Hence it is said: If the Form (Xing) and Qi (Vital Energy) are in harmony, life prevails; if the three and five elements are discordant, disease arises. For instance, unmarried women and nuns should have a Soft (Ru) and Weak (Ruo) pulse; infants and young children have rapid pulses; children aged three or four should have seven pulse beats per respiration cycle; whereas ordinary adults differ significantly. Generally, men are diagnosed first on the left hand, and women on the right hand; for men, a larger pulse on the left is favorable, while for women, a larger pulse on the right is favorable. In general pulse diagnosis, the middle finger is used to locate the Guan (Bar) position by pressing above the high bone behind the palm (radial styloid process). Once the Guan position is found, the ring and index fingers are placed alongside. If the arm is long, the fingers are spaced wider; if the arm is short, they are placed closer together. With the three fingers stable, the uppermost position is diagnosed first, known as the Cun Kou (Inch Port). It is examined by light pressure (Floating), medium pressure (Middle), and heavy pressure (Deep); also by pushing upwards to the end of the Cun section, downwards to the end of the Chi section, pushing outward to assess exterior conditions, and pushing inward to assess interior conditions. Then, the Guan and Chi sections are examined similarly. If irregularities such as Floating, Deep, Slippery, Choppy, Slow, or Rapid pulses are detected in the three positions, indicating specific diseases, one must analyze external physical signs and internal pulse characteristics to formulate treatment plans and advise the patient faithfully. One must not engage in casual talk, speak irresponsibly, look around distractedly, or act negligently; such behavior characterizes an incompetent physician.
Pulse is divided into three positions: Cun, Guan, and Chi. The Cun position corresponds to Heaven, the Guan position to Humanity, and the Chi position to Earth. The Cun position diagnoses the Upper Jiao (Upper Burner), covering diseases from the chest and diaphragm, heart, lungs, pharynx, throat, head, and eyes. The Guan position diagnoses the Middle Jiao (Middle Burner), covering diseases from below the chest/diaphragm to the lower abdomen; the Spleen, Stomach, Liver, and Gallbladder reside here. The Chi position diagnoses the Lower Jiao (Lower Burner), covering the lower abdomen, waist, kidneys, knees, and feet; the Large Intestine, Small Intestine, and Bladder reside here. This aligns with the Nei Jing (Inner Canon) principle of "upper diagnosing upper, lower diagnosing lower," reflecting an inherent logical necessity without room for error. Is this diagnostic method not easy to verify?