(凡十六类)
论曰∶夫脉者,医之大业也。不深究其道,何以为医者哉。是以古之哲医,寤寐俯仰,
不与常人同域,造次必于医,颠沛必于医,故能感于鬼神,通于天地,可以济众,可以根据凭。
若与常人混其波澜,则庶事堕坏,使夫物类将何仰焉。由是言之,学人必当屏弃俗情,凝心
于此
经曰∶诊脉之法,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,可以此参伍,决生死之分也。
又曰∶平脉者,皆于平旦。先诊寸口,初重指切骨,定毕便渐举指,与皮毛相得,于轻
重之间,随人强弱肥瘦,以意消息进退举按之宜。称其浮沉诸类应于四时五行,与人五脏相
应,轻重相薄,寻状论寒暑得失。
凡人禀形,气有中适,有躁静,各各不同。气脉流动,亦各随其性情,故一呼脉再至,
一吸脉再至,呼吸定息之间复一至,合为五至,此为平和中适者也。春秋日夜正等,无余分
时也。其余日则其呼而脉至多,吸而脉至少,或吸而脉至多,呼而脉至少,此则不同,如冬
夏日夜长短之异也。凡气脉呼吸法,昼夜变通效四时。然于呼吸定息应五至之限,无有亏僻,
犹晷刻与四时有长短,而岁功日数无遗也。若人有羸有壮,其呼吸虽相压遏,而昼夜息度随
其漏刻,是谓∶呼吸象昼夜,变通效四时。
夫诊脉,当以意先自消息,压取病患呼吸以自同,而后察其脉数,计于定息之限,五至
者为平人,若有盈缩,寻状论病源之所宣也。
问曰∶何为三部脉?答曰∶寸、关、尺也。凡人修短不同,其形各异,有尺寸分三关之
法,从肘腕中横纹至掌鱼际后纹,却而十分之而入取九分,是谓尺。从鱼际后纹却还度取十
分之一,则是寸。寸十分之而入取九分之中,则寸口也。此处其骨自高,故云∶阴得尺内有
一寸,阳得寸内九分,从寸口入却行六分为关分,从关分又入六分为尺分。
又曰∶从鱼际至高骨却行一寸,其中名曰寸口。从寸口至尺,名曰尺泽,故曰尺寸。寸
后尺前名曰关,阳出阴入以关为界,如天地人为三界,寸主射上焦头及皮毛,竟手上部。关
主射中焦腹及腰中部。尺主射下焦小腹至足下部。此为三部法,象三才天地人,头腹足为三
元也。夫十二经皆有动脉,独取寸口以决五脏六腑死生吉凶之候者,何谓也?然寸口者,脉
之大会,手太阴之动脉也。人一呼脉行三寸,一吸脉行三寸,呼吸定息脉行六寸。人一日一
夜凡一万三千五百息,脉行五十度,周于其身,漏水下百刻,荣卫行阳二十五度,行阴亦二
十五度为一周。故五十度而复会于手太阴。太阴者,寸口也,即五脏六腑之所终始,故法取
于寸口。人有三百六十脉,法三百六十日也。
(共十六类)
论述说:脉诊,是医学中的重大事业。如果不深入探究它的道理,怎么能成为医生呢?因此古代的明智医生,无论醒着还是睡着,低头还是抬头,都不与普通人在同一个境界,仓促之间必定关注医术,颠沛流离时也必定关注医术,所以能感动鬼神,通达天地,可以救济众人,可以作为凭借。如果与普通人的波澜混杂在一起,那么各种事务就会败坏,使得万物类别将依靠什么呢?由此说来,学习的人必须摒弃世俗的情趣,凝聚心神在这上面。
经典说:诊脉的方法,通常在平旦(清晨),此时阴气未动,阳气未散,饮食未进,经脉未盛,络脉调匀,气血未乱,所以才可诊断有过失的脉象。切按脉搏的动静并观察眼睛的神采,察验五色,观察五脏的有余和不足,六腑的强和弱,形体的盛和衰,可以用这些进行参伍比较,决断生死界限。
又说:诊平脉(正常脉象),都在平旦进行。先诊寸口(手腕桡动脉处),起初重指按压至骨,定好后便渐渐抬起手指,使指感与皮毛相合,在轻重的之间,随着人体强弱肥瘦,凭心意斟酌进退举按的适宜程度。称量其浮沉各类对应四时五行,与人五脏相应,轻重相迫,寻究脉状论述寒暑得失。
凡人禀受形体,气有中适(中和舒适),有躁静,各不相同。气脉流动,也各自随其性情,所以一呼脉跳动两次,一吸脉跳动两次,呼吸定息之间又跳动一次,合为五次,这是平和中适的状态。春秋季节日夜相等,没有多余的时间。其余日子则呼气时脉跳得多,吸气时脉跳得少,或者吸气时脉跳得多,呼气时脉跳得少,这就不相同了,如同冬夏日夜长短的差异一样。凡是气脉呼吸法,昼夜变通效法四时。然而在呼吸定息应五次的限度内,没有亏损偏颇,就像日晷刻度与四时有长短,而一年的岁功日数没有遗漏一样。如果有人有瘦弱有强壮,他们的呼吸虽然相互压抑遏制,但昼夜呼吸度数随更漏时刻变化,这叫作:呼吸象征昼夜,变通效法四时。
诊脉时,应当凭心意先自行斟酌,按压取病患的呼吸以使自己与之相同,然后察测他的脉率,计算在定息的限度内,五次的是平人(健康人),如果有盈缩(过多或过少),寻究脉状论述病源所在。
问:什么是三部脉?答:是寸、关、尺。凡人身形高矮不同,形体各异,有尺寸分三关的方法,从肘腕中间的横纹到手掌鱼际后的横纹,退后十分之一处进入取九分,这叫尺。从鱼际后横纹退后度量取十分之一,就是寸。寸的十分之一处进入取九分之中,就是寸口。此处骨头自然较高,所以说:阴得尺内一寸,阳得寸内九分,从寸口入后退行六分为关分,从关分再入六分为尺分。
又说:从鱼际到高骨退后一寸,其中名叫寸口。从寸口到尺,名叫尺泽,所以叫尺寸。寸后尺前名叫关,阳出阴入以关为界,像天、地、人为三界,寸主射上焦头及皮毛,竟手上部。关主射中焦腹及腰中部。尺主射下焦小腹至足下部。这是三部法,象三才(天、地、人),头、腹、足为三元。十二经都有动脉,唯独取寸口来决断五脏六腑死生吉凶的征候,为什么呢?因为寸口,是脉的大会,手太阴肺经的动脉。人一呼脉行三寸,一吸脉行三寸,呼吸定息脉行六寸。人一日一夜共一万三千五百息,脉行五十度,周遍全身,漏水下百刻,营卫行阳二十五度,行阴也是二十五度为一周。所以五十度后又聚会于手太阴。太阴,就是寸口,即五脏六腑所终始的地方,所以法取于寸口。人有三百六十脉,法象三百六十日。
(There are sixteen categories in total.)
It is stated: Pulse diagnosis is a major undertaking in medicine. If one does not deeply investigate its principles, how can one become a physician? Therefore, the wise physicians of ancient times, whether awake or asleep, bowing their heads or looking up, did not exist in the same realm as ordinary people. In haste, they were always concerned with medicine; in adversity, they were always concerned with medicine. Thus, they could move spirits and ghosts, communicate with heaven and earth, save the masses, and serve as a basis for reliance. If their waves were mixed with those of ordinary people, then all affairs would be ruined, and to what would the classes of things look for support? From this perspective, students must discard worldly sentiments and concentrate their minds on this subject.
The Classic states: The method of pulse diagnosis should usually be performed at dawn (Pingdan), when Yin Qi has not yet moved, Yang Qi has not yet dispersed, food and drink have not been taken, the Jing Mai (Primary Meridians) are not yet full, the Luo Mai (Collaterals) are regulated and uniform, and Qi and Blood are not yet chaotic. Only then can abnormal pulses be diagnosed. By palpating the movement and stillness of the pulse, observing the clarity of the eyes, examining the five colors, observing the excess and deficiency of the Zang Organs, the strength and weakness of the Fu Organs, and the flourishing and declining state of the body, these factors can be cross-referenced to determine the division between life and death.
It also states: To diagnose normal pulses (Ping Mai), one should do so at dawn. First, diagnose the Cun Kou (Cun Kou point, radial artery). Initially, press heavily with the fingers to the bone. After stabilizing, gradually lift the fingers until the sensation matches the skin and hair. Between light and heavy pressure, adjust according to the patient's strength, weakness, fatness, and thinness, using intent to deliberate on the appropriateness of advancing, retreating, lifting, and pressing. Weigh the floating and sinking categories against the Four Seasons and Five Elements, corresponding to the Five Zang Organs. Through the interplay of light and heavy pressure, examine the pulse shape to discuss gains and losses related to cold and heat.
Every person inherits a physical form where Qi is either balanced/comfortable (Zhong Shi) or restless/still, varying from individual to individual. The flow of Qi and pulse also follows one's temperament. Thus, with each exhalation, the pulse beats twice; with each inhalation, it beats twice. During the pause between breaths (Huxi Ding Xi), it beats once more, totaling five beats per respiratory cycle. This represents a balanced and comfortable state. In spring and autumn, day and night are equal, with no surplus time. On other days, the pulse may beat more during exhalation and less during inhalation, or vice versa. This difference is like the variation in day and night length between winter and summer. Generally, the laws of Qi, pulse, and respiration vary through day and night, imitating the Four Seasons. However, within the limit of five beats per respiratory cycle, there is no deficit or deviation, just as sundial marks vary with the seasons, but the annual count of days remains complete. If a person is frail or robust, although their breathing may suppress each other, the daily respiratory rate follows the water clock. This is called: Respiration mirrors day and night; variation imitates the Four Seasons.
When diagnosing the pulse, one should first use intent to deliberate internally, aligning one's own breathing with that of the patient by gently pressing to match their rhythm, and then observe the pulse rate. Counting within the limit of a fixed respiratory cycle, five beats indicate a healthy person (Ping Ren). If there is an excess or deficit, examine the pulse shape to discuss the source of the disease.
Question: What are the Three Parts (San Bu) of the pulse?
Answer: They are Cun (Inch), Guan (Bar), and Chi (Cubit). People differ in height and build. There is a method of dividing Cun and Chi into three sections (Guan). From the transverse crease at the elbow/wrist to the transverse crease behind the Thenar Eminence (Yu Ji), moving backward one-tenth of the distance and taking nine-tenths inward is defined as Chi. Moving backward from the crease behind Yu Ji and measuring one-tenth defines Cun. Within the nine-tenths of Cun, entering one-tenth inward defines Cun Kou. Here the bone naturally stands high, hence it is said: "Yin obtains one inch within Chi, Yang obtains nine fen within Cun." Moving six fen inward from Cun Kou defines the Guan section. Moving another six fen inward from Guan defines the Chi section.
It also states: From Yu Ji moving backward one cun to the High Bone (Ga Gu), the middle point is named Cun Kou. From Cun Kou to Chi, it is named Chi Ze, thus called Cun-Chi. The area after Cun and before Chi is named Guan. Yang emerges and Yin enters, with Guan as the boundary, similar to Heaven, Earth, and Humanity as the Three Realms. Cun governs the Upper Jiao (Upper Burner), head, and skin/hair, extending to the upper part of the hand. Guan governs the Middle Jiao (Middle Burner), abdomen, and waist/middle region. Chi governs the Lower Jiao (Lower Burner), lower abdomen, down to the feet. This is the method of Three Parts, imitating the Three Powers (Heaven, Earth, Humanity), with Head, Abdomen, and Feet as the Three Origins. All twelve meridians have pulsating arteries, yet why is only Cun Kou selected to determine the prognosis of life, death, good fortune, and misfortune of the Five Zang and Six Fu Organs? Because Cun Kou is the great assembly of pulses and the pulsating artery of the Hand Taiyin Lung Meridian. With each exhalation, pulse moves three cun; with each inhalation, it moves three cun. During a fixed respiratory cycle, it moves six cun. A person takes 13,500 breaths in a day and night. The pulse circulates fifty times around the body. As the water clock drips one hundred ke (time units), Ying Wei (Nutritive and Defensive Qi) circulate twenty-five times in Yang and twenty-five times in Yin, completing one cycle. Thus, after fifty cycles, they reunite at the Hand Taiyin. Taiyin is Cun Kou, which is the beginning and end of the Five Zang and Six Fu Organs. Therefore, the method selects Cun Kou. Humans have 360 pulses, mirroring the 360 days of the year.