候病所在,逐部诊视。合位应时,软滑者吉。(合位,如肺应皮毛,心应血脉,脾应肌肉,
肝筋肾骨之类是也。应时,如春弦夏钩秋毛冬石四季软滑是也。软滑如经云∶脉弱以滑,是有胃
气也。)病脉反之,大小独异,上下之至异同,候分统属为式。六部脉属五脏,应乎五行之气。
气同则合上达,惟水不趋,气异俱有阴阳升降之义。(如左寸主心属火,气同则合上炎,气异则
分阴阳。右寸主肺属金,气同则合上光,气异则分明暗。左关主肝属木,气同则合上达,气异则
分春秋。右关主脾属土,气同则合上升,气异则分寒温。两尺主肾属水,气同则合下流,气异则
分溢覆。)故脉前后状同,统候兼主其一,寸关病在前候,两尺病在后取。(如左寸前以候心,
后候膻中,右寸前以候肺,后候胸中。左关前候肝胆,后以候膈。右关前以候胃,后候脾宫。两
尺前以候肾,后候腹中之类是也。)前后之状异者,属候歧之为二,上至病在前候,下至病在后
位,前后互见和乖,乖病和平,前后同中有异,异者病拟。(如上下之至俱弦或弦兼涩,则取兼
涩之候为病。)前后强弱相同,尤者之候病,及前阳后阴候病,阴降阳升。前溢后覆出部,升降
仿此。洪细长短,濡芤滑涩,统中未详,属相出入,统属兼审。浮沉虚实,浮表经脉,皮毛腠理,
四肢百节,头面背膂。沉里口舌,咽喉骨髓,五脏六腑,大便小水。两傍外内,亦分表里,侵外
身热,侵内积滞。(经云∶推而内之,外而不内,身有热也。推而外之,内而不外,有心腹积也。
是已。)虚为不足,痒麻泻痿。实为有余,胀壅痛秘。统常属变,法稽经旨,附以管窥,条陈大
意。(汪氏诊候。)
诊察疾病所在的部位,需逐部进行脉诊。脉象与脏腑部位相合、顺应四时季节,且脉形柔软滑利者,为吉兆。(所谓“合位”,例如肺对应皮毛,心对应血脉,脾对应肌肉,肝对应筋,肾对应骨等即是。所谓“应时”,例如春季脉弦、夏季脉钩、秋季脉毛、冬季脉石,以及四季脉象中出现的软滑之象即是。脉象柔软滑利,正如医经所言:“脉象弱而滑利,说明体内有胃气。”)病理性脉象则与此相反,表现为脉体大小异常独特,寸关尺三部脉气到达的深浅或力度存在差异,需依据分属统摄的原则来确立诊断模式。
六部脉分别归属于五脏,并对应五行之气。若气机性质相同,则向上通达;唯独水气不趋向于上,气机性质各异则包含阴阳升降的含义。(例如左寸脉主心脏,五行属火,气性相同则向上炎升,气性不同则区分阴阳。右寸脉主肺脏,五行属金,气性相同则向上光明,气性不同则区分明暗。左关脉主肝脏,五行属木,气性相同则向上生发,气性不同则区分春秋变化。右关脉主脾脏,五行属土,气性相同则向上运化,气性不同则区分寒温。两尺脉主肾脏,五行属水,气性相同则向下流注,气性不同则区分溢满或覆没。)因此,若脉象前后(指脉位的深浅或左右手对应关系)形态相同,则在统一诊察中兼主其一;若病变在寸关部位,则病在前候(浅层/外部),若病变在两尺部位,则病在后取(深层/内部)。(例如左寸前部候心脏,后部候膻中;右寸前部候肺脏,后部候胸中;左关前部候肝胆,后部候膈膜;右关前部候胃腑,后部候脾宫;两尺前部候肾脏,后部候腹中等即是。)
若脉象前后表现不同,则属于诊察对象分歧为二:气至上部者病在前候,气至下部者病在后位。若前后脉象既和谐又乖异,以乖异者为病,以和谐者为平人常态;若前后脉象大体相同但中有差异,则以差异之处拟断为病。(例如上下脉气均呈弦象或弦象兼涩象,则取兼见涩象的脉候作为病征。)若前后脉象强弱一致,则尤需关注其脉候所主的疾病;以及前阳后阴的候病方法,遵循阴降阳升的规律。若脉象前部溢出、后部覆没而出现在脉位之外,其升降原理仿照此例。对于洪大、细小、长、短、濡、芤、滑、涩等脉象,若在统一诊察中未详细列举,则属相出入的变化,需综合审察统属关系。浮脉与沉脉、虚证与实证方面,浮脉主表,涉及经脉、皮毛、腠理、四肢百节、头面及背部脊柱;沉脉主里,涉及口舌、咽喉、骨髓、五脏六腑、大便及小便。脉象两旁的外内之分,也区分表里:邪气侵袭外部则身体发热,邪气侵袭内部则形成积滞。(医经云:“推按脉象向内,若脉气外出不入,则身体有热。推按脉象向外,若脉气内留不外,则有心中或腹中的积滞。”即是此意。)虚证代表不足,表现为瘙痒、麻木、泄泻、痿软;实证代表有余,表现为胀满、壅塞、疼痛、便秘。统摄常法与变通之法,效法经典旨意,附上个人管窥之见,条理陈述大意。(汪氏诊候。)
To diagnose the location of the disease, one must examine the pulse section by section. If the pulse corresponds to the organ position and complies with the season, appearing soft and slippery (soft and smooth), it is auspicious. ("Corresponding to position" refers to such correspondences as the Lung corresponding to skin and hair, the Heart to blood vessels, the Spleen to muscles, the Liver to sinews, and the Kidney to bones. "Complying with the season" refers to such seasonal pulses as the Wiry (Xian) pulse in Spring, the Hook (Gou) pulse in Summer, the Hairy (Mao) pulse in Autumn, the Stone (Shi) pulse in Winter, and the soft and slippery pulse present in all four seasons. A soft and slippery pulse indicates the presence of Stomach Qi (Wei Qi), as stated in the classics: "A pulse that is weak yet slippery indicates the presence of Stomach Qi.") Conversely, pathological pulses differ, showing unique variations in size and differences in the arrival of Qi at the Cun, Guan, and Chi positions. Diagnosis should follow the pattern of hierarchical classification and attribution.
The six pulse positions belong to the Five Zang Organs and correspond to the Qi of the Five Elements. When the Qi nature is identical, it ascends and reaches upward; only Water Qi does not tend upward. When Qi natures differ, there is a principle of Yin descending and Yang ascending. (For example, the Left Cun position governs the Heart, belonging to Fire. When Qi is identical, it flares upward; when different, it distinguishes Yin and Yang. The Right Cun position governs the Lung, belonging to Metal. When Qi is identical, it shines upward; when different, it distinguishes brightness and darkness. The Left Guan position governs the Liver, belonging to Wood. When Qi is identical, it grows upward; when different, it distinguishes Spring and Autumn. The Right Guan position governs the Spleen, belonging to Earth. When Qi is identical, it rises upward; when different, it distinguishes Cold and Warmth. Both Chi positions govern the Kidneys, belonging to Water. When Qi is identical, it flows downward; when different, it distinguishes overflowing or submerging.) Therefore, if the pulse characteristics before and after are similar, they are jointly attributed to one aspect in unified diagnosis. If the pathology is at the Cun and Guan positions, the disease is located in the anterior (superficial/exterior) aspect; if the pathology is at both Chi positions, the disease is sought in the posterior (deep/internal) aspect. (For instance, the anterior aspect of the Left Cun diagnoses the Heart, while the posterior aspect diagnoses the Danzhong area; the anterior aspect of the Right Cun diagnoses the Lung, while the posterior aspect diagnoses the chest cavity; the anterior aspect of the Left Guan diagnoses the Liver and Gallbladder, while the posterior aspect diagnoses the diaphragm; the anterior aspect of the Right Guan diagnoses the Stomach, while the posterior aspect diagnoses the Spleen palace; the anterior aspect of both Chis diagnoses the Kidneys, while the posterior aspect diagnoses the abdomen, etc.)
If the pulse characteristics before and after differ, the diagnostic targets diverge into two: Qi arriving from above indicates disease in the anterior aspect, while Qi arriving from below indicates disease in the posterior aspect. If the anterior and posterior pulses show both harmony and discord, the discordant aspect indicates disease, while the harmonious aspect indicates health. If the anterior and posterior pulses are largely similar but contain differences, the differing aspects are used to predict the disease. (For example, if both upper and lower pulses are Wiry or Wiry combined with Choppy, the Choppy aspect is taken as the pathological sign.) If the strength of the anterior and posterior pulses is the same, special attention should be paid to the pulse signs indicating disease. Regarding the method of diagnosing disease via anterior Yang and posterior Yin, it follows the principle of Yin descending and Yang ascending. If the pulse overflows anteriorly and submerges posteriorly, extending beyond the pulse position, the principles of ascent and descent apply similarly. For pulses such as Surging (Hong), Fine (Xi), Long, Short, Soft (Ru), Hollow (Kou), Slippery, and Choppy, if not detailed in the unified examination, they represent variations of mutual entry and exit, requiring comprehensive review of their hierarchical attribution.
Regarding Floating (Fu) and Sinking (Chen), Deficiency (Xu) and Excess (Shi): Floating pulses indicate exterior conditions involving meridians, skin and hair, interstices, limbs, joints, head, face, and back. Sinking pulses indicate interior conditions involving the mouth and tongue, throat, bone marrow, Five Zang and Six Fu organs, stool, and urine. The lateral aspects also distinguish between exterior and interior: invasion of the exterior causes body heat, while invasion of the interior leads to accumulation and stagnation. (The classics state: "Pushing inward, if the Qi remains exterior and does not enter, there is body heat. Pushing outward, if the Qi remains interior and does not emerge, there is accumulation in the heart or abdomen." This is correct.) Deficiency indicates insufficiency, manifesting as itching, numbness, diarrhea, and flaccidity. Excess indicates surplus, manifesting as distension, obstruction, pain, and constipation. These rules integrate constant methods with variable changes, adhering to the principles of the classics, supplemented by personal insights, and systematically presenting the main ideas. (Diagnosis by Mr. Wang.)