病患双腕仰。高骨定为关。(住掌后之高骨定为关脉)寸脉量虎口。尺脉准臂弯。(关前距虎
口一寸故曰寸关后距臂弯一尺故曰尺)左寸心包络。左关胆与肝。左尺司何职。膀胱肾系焉。右寸
胸中肺。胃脾属右关。要知大肠肾。右尺自昭然。
口鼻一呼吸。脉来四五跳。此是无病者。平和气血调。三至为迟候。六至作数教。迟则寒之象。
数则热之标。一二寒愈盛。七八热更饶。
轻举得皮面。表邪脉故浮。若是病在里。重取须沉求。洪长征实健。细弱识虚柔。水湿并痰饮。
滑利又弦遒。紧促气内乱。伏涩气凝留。妊娠中止代。失血中空芤。(代脉中止芤脉中空)只此尚
易见。其他渺以幽。
舌者心之窍。凡病俱现于舌。能辨其色。症自显然。舌尖主心。舌中主脾胃。舌边主肝胆。舌根
主肾。假如津液如常。口不燥渴。虽或发热。尚属表症。若舌苔粗白。渐浓而腻。是寒邪入胃。挟
浊饮而欲化火也。此时已不辨滋味矣。宜用半夏、藿香。迨浓腻而转黄色。邪已化火也。用半
夏、黄芩。若热甚失治则变黑。胃火甚也。用石膏、半夏。或黑而燥裂。则去半夏。而纯用石膏、知
母、麦冬、花粉之属以润之。至浓苔渐退。而舌底红色者。火灼水亏也。用生地、沙参、麦冬、石斛
以养之。此表邪之传里者也。其有脾胃虚寒者。则舌白无苔而润。甚者连唇口面色俱痿白。
此或泄泻或受湿。脾无火力。速宜党参、焦术、木香、茯苓、炙草、干姜、大枣以振之。虚甚欲脱者。
加附子、肉桂。若脾热者。舌中苔黄而薄。宜黄芩。心热者。舌尖必赤。甚者起芒刺。宜黄连、麦冬、
竹卷心。肝热者。舌边赤或芒刺。宜柴胡、黑山栀。其舌中苔浓而黄者。胃微热也。用石斛、知母、
花粉、麦冬之类。若舌中苔浓而黑燥者。胃大热也。必用石膏、知母。如连牙床唇口俱黑。则胃
将蒸烂矣。非石膏三四两。生大黄一两。加粪金汁、人中黄、鲜生地汁、天冬麦冬汁、银花露大
剂之投。不能救也。此唯时疫发 及伤寒症中多有之。余尝治一独子。先后用石膏至十四
斤余。而 始透病始退。此其中全恃识力。再有舌黑而润泽者。此系肾虚。宜六味地黄汤。若
满舌红紫色而无苔者。此名绛舌。亦属肾虚。宜生地、熟地、天冬、麦冬等。更有病后舌绛如镜。
发亮而光。或舌底嗌干而不饮冷。此肾水亏极。宜大剂六味地黄汤投之。以救其津液。方不
枯涸。
病人将双手腕部向上仰起。手腕后方突出的高骨,被确定为关脉的位置。(手掌后方突出的高骨定为关脉)寸脉的测量位置在虎口前方一寸处。尺脉的测量位置在肘臂弯曲处向后一尺处。(关前距离虎口一寸所以称为寸,关后距离臂弯一尺所以称为尺)左手寸脉对应心包络。左手关脉对应胆和肝。左手尺脉主管什么职能?它主管膀胱和肾系。右手寸脉对应胸中的肺。胃和脾归属于右手关脉。要知道大肠和肾(命门之火/肾阳)的情况,看右手尺脉自然就很清楚了。
正常人的口鼻一呼一吸之间,脉搏跳动四到五次。这是没有疾病的人,气血调和的状态。脉搏每呼吸一次跳动三次为迟脉。每呼吸一次跳动六次为数脉。迟脉是寒证的表现。数脉是热证的表现。一二次跳动说明寒邪更盛。七八次跳动说明热邪更丰富。
轻按就能在皮肤表面摸到的脉象,是因为表邪导致的浮脉。如果病在体内,需要重按才能找到沉脉。洪大、长、弦、实、健壮的脉象,细弱的是虚证和柔弱的表现。水湿和痰饮导致脉象滑利且弦劲有力。紧脉和促脉表示气机内部紊乱。伏脉和涩脉表示气机凝滞停留。妊娠期间可能出现代脉(脉律不齐有间歇),失血时出现中空如葱管的芤脉。(代脉指脉搏中止,芤脉指脉管中空)这些脉象还比较容易见到,其他的脉象则深奥微妙。
舌是心的外窍。凡是疾病都会在舌头上显现出来。能够辨别舌头的颜色,病症自然就明显了。舌尖主心脏。舌中部主脾胃。舌两侧主肝胆。舌根部主肾脏。假如津液正常,口不干燥口渴,虽然有时发热,仍然属于表证。如果舌苔粗糙发白,逐渐变厚而腻,这是寒邪进入胃中,挟带浊饮想要化火。此时已经分辨不出滋味了。适宜使用半夏、藿香。等到苔色浓腻转为黄色,说明邪气已经化火。使用半夏、黄芩。如果热势严重治疗不当就会变成黑色,这是胃火极盛。使用石膏、半夏。或者黑而干燥开裂,就去掉半夏,纯粹使用石膏、知母、麦冬、天花粉等药物来滋润。等到厚苔逐渐消退,而舌底呈现红色,这是火热灼伤导致津液亏损。使用生地、沙参、麦冬、石斛来滋养。这是表邪传入体内的情况。其中有脾胃虚寒的人,舌头白色无苔且湿润。严重的甚至嘴唇、口腔、面色都呈现萎黄苍白。这可能是泄泻或受湿,脾脏缺乏火力。速宜使用党参、炒白术、木香、茯苓、炙甘草、干姜、大枣来振奋阳气。虚损严重快要脱绝的,加上附子、肉桂。如果是脾热,舌中部苔黄而薄,适宜用黄芩。心热的,舌尖必定发红。严重的长出芒刺,适宜用黄连、麦冬、竹叶卷心。肝热的,舌两侧发红或有芒刺,适宜用柴胡、炒山栀。舌中部苔浓而黄的,是胃轻微发热。使用石斛、知母、天花粉、麦冬之类的药物。如果舌中部苔浓而黑燥,是胃大热。必须使用石膏、知母。如果连牙龈床、嘴唇口腔都变黑,那么胃就要被蒸烂了。非要用石膏三四两,生大黄一两,加上粪金汁、人中黄、鲜生地汁、天冬麦冬汁、金银花露等大剂量投服,不能挽救。这只有在时疫发作以及伤寒症中多有发生。我曾经治疗一个独生子,先后使用石膏达到十四斤多,然后疹毒才透出,病才退去。这其中完全依靠医生的见识和判断力。还有舌苔黑但润泽的,这是肾虚。适宜用六味地黄汤。如果满舌红紫色而无苔的,这叫绛舌,也属于肾虚。适宜用地黄、熟地黄、天冬、麦冬等。更有病后舌头红得像镜子一样,发亮光滑,或者舌根咽喉干燥但不想喝冷水的,这是肾水极度亏损。适宜大剂量投服六味地黄汤,以拯救津液,方不至于枯涸。
The patient extends both wrists upward. The prominent bone at the back of the wrist is designated as the Guan (Cord) position. (The prominent bone behind the palm is defined as the Guan pulse position). The Cun (Inch) pulse is measured one cun anterior to the thenar eminence (tiger's mouth). The Chi (Cubit) pulse is measured one chi posterior to the elbow crease. (Anterior to Guan, one cun from the tiger's mouth is called Cun; posterior to Guan, one chi from the arm bend is called Chi). The left Cun corresponds to the Pericardium (Heart Protector). The left Guan corresponds to the Gallbladder and Liver. What is the function of the left Chi? It governs the Bladder and Kidney system. The right Cun corresponds to the Lungs in the chest. The Stomach and Spleen belong to the right Guan. To understand the Large Intestine and Kidney (Mingmen Fire/Kidney Yang), observing the right Chi reveals it clearly.
During one respiration cycle through the nose and mouth, the pulse beats four to five times. This indicates a healthy individual with harmonious Qi and Blood. Three beats per respiration constitute a Slow (Chi) pulse. Six beats per respiration constitute a Rapid (Shu) pulse. A slow pulse is a sign of Cold. A rapid pulse is a manifestation of Heat. One or two beats indicate excessive Cold. Seven or eight beats indicate abundant Heat.
Light pressure revealing the pulse at the skin surface indicates a Floating (Fu) pulse caused by exterior pathogens. If the disease is interior, deep pressure is required to find a Deep (Chen) pulse. Surging, long, wiry, solid, and robust pulses are observed; thin and weak pulses indicate deficiency and softness. Water-dampness and Phlegm-fluids result in slippery and wiry-taut pulses. Tight and hurried pulses indicate internal disorder of Qi. Hidden and choppy pulses indicate stagnation and retention of Qi. Intermittent pulses (Dai) may occur during pregnancy; hollow pulses like a scallion stalk (Kou) appear after blood loss. (Dai pulse features pauses; Kou pulse is hollow in the middle). These are relatively easy to observe; others are profound and subtle.
The tongue is the opening of the Heart. All diseases manifest on the tongue. By distinguishing its color, symptoms become clear. The tongue tip governs the Heart. The tongue center governs the Spleen and Stomach. The tongue sides govern the Liver and Gallbladder. The tongue root governs the Kidneys. If fluids are normal and there is no dry mouth or thirst, even if fever occurs, it still belongs to an Exterior Syndrome. If the coating is rough and white, gradually becoming thick and greasy, this indicates Cold pathogen entering the Stomach, carrying turbid fluids and transforming into Fire. At this stage, taste perception is lost. Banxia (Pinelliae Rhizoma) and Huoxiang (Agastaches Herba) are suitable. When the thick, greasy coating turns yellow, the pathogen has transformed into Fire. Banxia and Huangqin (Scutellariae Radix) are used. If heat becomes severe and treatment is neglected, it turns black, indicating extreme Stomach Fire. Shigao (Gypsum Fibrosum) and Banxia are used. If it becomes black, dry, and cracked, remove Banxia and use purely Shigao, Zhimu (Anemarrhenae Rhizoma), Maidong (Ophiopogonis Tuber), and Huafen (Trichosanthis Radix) to moisten. As the thick coating recedes and the tongue body turns red, this indicates Fire scorching and fluid depletion. Shengdi (Rehmanniae Radix), Shashen (Glehniae Radix), Maidong, and Shihu (Dendrobii Caulis) are used to nourish. This represents the transmission of exterior pathogens to the interior. In cases of Spleen-Stomach Deficiency-Cold, the tongue is white without coating and moist. Severe cases show withered, pale complexion of lips, mouth, and face. This may be due to diarrhea or dampness invasion, where the Spleen lacks Fire energy. Dangshen (Codonopsis Radix), Jiaozhu (Fried Atractylodis Macrocephalae Rhizoma), Muxiang (Aucklandiae Radix), Fuling (Poria), Zhi Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma), and Dazao (Jujubae Fructus) should be used rapidly to invigorate. In cases of extreme deficiency approaching collapse, Fuzi (Aconiti Lateralis Radix Praeparata) and Rougui (Cinnamomi Cortex) are added. For Spleen Heat, the tongue center has a thin yellow coating, suitable for Huangqin. For Heart Heat, the tongue tip is definitely red; severe cases have prickles, suitable for Huanglian (Coptidis Rhizoma), Maidong, and Zhujuanxin (Bambusae Folium). For Liver Heat, the tongue sides are red or have prickles, suitable for Chaihu (Bupleuri Radix) and Heishanzhi (Stir-fried Gardeniae Fructus). A thick yellow coating on the tongue center indicates mild Stomach Heat. Shihu, Zhimu, Huafen, and Maidong are used. If the coating on the tongue center is thick, black, and dry, it indicates severe Stomach Heat. Shigao and Zhimu are essential. If the gums, lips, and mouth also turn black, the Stomach is about to be steamed and rotted. Only large doses of Shigao (3-4 liang), raw Dahuang (Rhei Radix et Rhizoma, 1 liang), plus Fenjinzi (Feces Aurantii Fructus Fermentatus), Renzhonghuang (Human Faeces Decoction Residue), fresh Shengdi juice, Tian-Dong-Maidong juices, and Yinhualu (Lonicerae Flos Dew) can save the patient. This is common only in seasonal epidemics and certain Typhoid syndromes. I once treated an only son, using over 14 jin of Shigao successively before the rash emerged and the disease subsided. This relied entirely on diagnostic insight. Regarding black but moist tongue coating, this indicates Kidney Deficiency, suitable for Liuwei Dihuang Tang (Six-Ingredient Pill with Rehmannia). If the entire tongue is crimson-purple without coating, it is called Jiang She (Crimson Tongue), also indicating Kidney Deficiency. Shudi (Prepared Rehmanniae Radix), Tiandong (Asparagi Tuber), and Maidong are suitable. After illness, if the tongue is crimson like a mirror, shiny and smooth, or if the throat base is dry but the patient does not desire cold drinks, this indicates extreme depletion of Kidney Water. Large doses of Liuwei Dihuang Tang should be administered to rescue fluids and prevent desiccation.