(灵枢论疾诊尺篇)
目赤色者病在心,白在肺,青在肝,黄在脾,黑在肾;黄色不可名者,病在胸中。(五脏六腑,目为之候,故目之五
色,各以其气而见本脏之病。脾应中州,胸中者,脾肺之部也。)诊目痛,赤脉从上下者太阳病,从下上者阳明病,从外
走内者少阳病。(足太阳经为目上网,故赤脉从上下者为太阳病。足阳明经为目下网,故赤脉从下上者为阳明病。足少阳
经外行于锐 之后,故从外走内者为少阳病也。)诊寒热,赤脉上下至瞳子,见一脉一岁死,见一脉半一岁半死,见二脉
二岁死,见二脉半二岁半死,见三脉三岁死。(此邪入阴分而病为寒热者,当反其目以视之,中有赤脉,形如红线,下贯
瞳子,因其多少以知其死之远近也。寒热篇文与此同,但彼专言瘰 之毒发为寒热,此节单以寒热为言,理则同也。详
见疾病类九十。)诊龋齿痛,按其阳之来,有过者独热,在左左热,在右右热,在上上热,在下下热。(龋齿,齿痛也。
足阳明入上齿中,手阳明入下齿中,故按其阳脉之来,其脉太过者,其经必独热,而其左右上下,亦因其部而可察也。
龋,丘雨切。)诊血脉者,多赤多热,多青多痛,多黑为久痹,多赤多黑多青皆见者寒热。(血脉者,言各部之络脉也。
赤黑青皆见者,阴阳互胜之色,故或寒或热。)身痛而色微黄,齿垢黄,爪甲上黄,黄胆也,安卧,小便黄赤,脉小而涩
者不嗜食。(黄胆,黄病也。疸有阴阳,脉小而涩者为阴疸。阴疸者,脾土弱也,故不嗜食。详疾病类五十九。)人病,
其寸口之脉,与人迎之脉小大等及其浮沉等者,病难已也。(气口候阴,人迎候阳、故春夏人迎微大,秋冬寸口微大,此
阴阳表里之分也。若寸口人迎大小浮沉相等者,非偏于阴则偏于阳,此病之所以难已。五色篇与此稍同,见前三十二。)
女子手少阴脉动甚者,妊子。(手少阴,左寸心脉也。此与平人气象论所云相同,详见前二十三。)婴儿病,其头毛皆逆
上者,必死。(婴儿渐成,水为之本,发者肾水之荣。头毛逆上者,水不足则发干焦,如草之枯者必劲直而竖也。老子曰∶
人之生也柔弱,其死也坚强;万物草木之生也柔脆,其死也枯槁。故坚强者死之徒,柔弱者生之徒。亦此理也。然此以
既病为言,若无病而头毛逆上者,即非吉兆。)耳间青脉起者,掣痛。(耳者,少阳胆之经。青者,厥阴肝之色。肝胆本
为表里,青主痛,肝主筋,故为掣痛。掣音彻。)大便赤办飧泄脉小者,手足寒,难已;飧泄脉小,手足温,泄易已。(赤
办者,血秽成条成片也。赤办飧泄,火居血分。若脉小而手足寒,是为相反,所以难已。若止于飧泄而无赤办,非火证
也,脉虽小而手足温,以脾主四肢而脾气尚和,所以易已。办,当作瓣,瓜瓤之类也。飧音孙。)四时之变,寒暑之胜,
重阴必阳,重阳必阴,故阴主寒,阳主热,故寒甚则热,热甚则寒,故曰寒生热,热生寒,此阴阳之变也。故曰冬伤于
寒,春生瘅热;春伤于风,夏生后泄肠 ;夏伤于暑,秋生 疟;秋伤于湿,冬生咳嗽。是谓四时之序也。(阴阳之气,
极则必变,故寒极则生热,热极则生寒,此天地四时消长更胜之道也。本节义与阴阳应象论大同,详见阴阳类一。瘅音
丹,即温热之病。 音劈。 音皆。)
(出自《灵枢·论疾诊尺篇》)
眼睛呈现赤色,表明病位在心;白色,表明病位在肺;青色,表明病位在肝;黄色,表明病位在脾;黑色,表明病位在肾;如果黄色难以明确描述,则病位在胸中。(五脏六腑,眼睛是它们的征候窗口,所以眼睛的五种颜色,各自反映对应本脏的病变。脾对应中焦脾胃区域,胸中则是脾和肺所主的部位。)
诊断目痛,如果赤脉从上向下延伸,属于太阳病(足太阳膀胱经受邪的病证);从下向上延伸,属于阳明病(足阳明胃经受邪的病证);从外侧向内侧走窜,属于少阳病(足少阳胆经受邪的病证)。(足太阳经覆盖眼睛上部网膜,所以赤脉从上向下的是太阳病。足阳明经覆盖眼睛下部网膜,所以赤脉从下向上的是阳明病。足少阳经行走在眼锐眦之后,所以从外向内的是少阳病。)
诊断寒热病,如果赤脉上下延伸至瞳子,见到一条赤脉预示一年内死亡,见到一条半赤脉预示一年半死亡,见到两条赤脉预示两年内死亡,见到两条半赤脉预示两年半死亡,见到三条赤脉预示三年内死亡。(这是邪气侵入阴分而导致寒热病的表现,应当翻转眼睑来观察,其中若有赤脉,形状像红线一样,向下贯穿瞳子,根据赤脉的数量多少来判断死亡的远近。《寒热篇》的文字与此相同,但那里专门谈论瘰疬之毒发作引起的寒热,这一节只单纯谈论寒热,道理是相同的。详见疾病类第九十。)
诊断龋齿痛,按压阳经气血流注之处,如果有异常,会单独出现发热,左侧发热则在左边,右侧发热则在右边,上部发热则在上部,下部发热则在下部。(龋齿就是齿痛。足阳明经进入上齿中,手阳明经进入下齿中,所以按压阳经脉气来处,脉气太过盛的经脉必然单独发热,其左右上下的情况,也可以根据其所属部位来察知。龋,读音同“丘雨”。)
诊断血脉,颜色多赤表示多热,多青表示多痛,多黑表示久痹(长期不通畅的痹症),如果赤、黑、青三色都多见,则表示寒热错杂。(血脉,指各部位的络脉。赤、黑、青都出现,是阴阳相互胜负的颜色表现,所以或寒或热。)
身体疼痛而面色微黄,牙齿垢腻发黄,指甲盖上发黄,这是黄疸病(黄胆),患者嗜睡卧,小便黄赤,脉象小而涩,食欲不振。(黄胆,即黄病。疸有阴疸和阳疸之分,脉小而涩的是阴疸。阴疸是因为脾土虚弱,所以食欲不振。详见疾病类第五十九。)
人患病时,如果寸口脉与人迎脉的大小相等,浮沉程度也相等,这种病难治。(气口脉候测阴分,人迎脉候测阳分,所以春夏季节人迎脉微大,秋冬季节寸口脉微大,这是阴阳表里的区别。如果寸口和人迎的大小、浮沉都相等,说明不是偏于阴就是偏于阳,这就是病难治愈的原因。五色篇的内容与此稍有相同,见前三十二。)
女子手少阴脉(心经脉)跳动明显的,是怀孕了。(手少阴脉位于左寸口的心脉位置。这与《平人气象论》所说的相同,详见前二十三。)
婴儿生病,如果头发生长方向全部逆乱向上,必定死亡。(婴儿逐渐成长,以肾水为根本,头发是肾水荣华的外现。头毛逆乱向上,是因为水不足导致发干枯焦,就像枯草一样必然劲直竖起。老子说:人活着的时候身体柔弱,死的时候身体僵硬;万物草木生长时柔脆,死后枯槁。所以坚强的属于死的范畴,柔弱的属于生的范畴。也是这个理。然而这里是指已经生病的情况,如果没有生病而头毛逆上的,就不是吉兆。)
耳间出现青色脉络的,牵引作痛。(耳朵是少阳胆经所在。青色是厥阴肝的颜色。肝胆互为表里,青色主痛,肝主筋,所以表现为牵引痛。掣,读音同“彻”。)
大便带血块且完谷不化(飧泄),脉象小的,手足寒冷,难治;如果是飧泄脉小,但手足温暖,泄泻容易治愈。(赤瓣,指血秽凝结成条成片状。赤瓣飧泄,是火邪居于血分。如果脉小而手足寒,这是脉证相反,所以难治。如果只是飧泄而没有赤瓣,就不是火证,虽然脉小但手足温,因为脾主四肢且脾气尚调和,所以容易治愈。瓣,通“瓣”,如瓜瓤之类。飧,读音同“孙”。)
四季的变化,寒暑的交替,重阴必转化为阳,重阳必转化为阴,所以阴主寒,阳主热,因此寒极则生热,热极则生寒,所以说寒生热,热生寒,这是阴阳的变化规律。所以说冬天感受寒邪,春天会发生温热病(瘅热);春天感受风邪,夏天会发生腹泻痢疾(后泄肠澼);夏天感受暑邪,秋天会发生疟疾;秋天感受湿邪,冬天会发生咳嗽。这叫做四季的顺序。(阴阳之气,到了极点必然变化,所以寒极则生热,热极则生寒,这是天地四季消长更替的道理。本节含义与《阴阳应象大论》大体相同,详见阴阳类第一。瘅,读音同“丹”,即温热之病。澼,读音同“劈”。痢,读音同“皆”。)
(From "Ling Shu: Lun Ji Zhen Chi Chapter")
If the eyes appear red, the disease is located in the Heart; if white, in the Lungs; if blue/green, in the Liver; if yellow, in the Spleen; if black, in the Kidneys. If the yellow color is indistinct or indescribable, the disease is located in the chest cavity. (The five zang and six fu organs have the eyes as their external manifestations; thus, the five colors of the eyes reflect diseases of their corresponding internal organs respectively. The Spleen corresponds to the central region (Zhongzhou), and the chest cavity is the domain shared by the Spleen and Lungs.)
When diagnosing eye pain: if red vessels extend from top to bottom, it indicates Taiyang Disease (disease of the Foot-Taiyang Bladder Meridian); if from bottom to top, it indicates Yangming Disease (disease of the Foot-Yangming Stomach Meridian); if moving from outside inward, it indicates Shaoyang Disease (disease of the Foot-Shaoyang Gallbladder Meridian). (The Foot-Taiyang Meridian covers the upper network of the eye, so red vessels extending downward indicate Taiyang Disease. The Foot-Yangming Meridian covers the lower network of the eye, so red vessels extending upward indicate Yangming Disease. The Foot-Shaoyang Meridian runs posterior to the lateral canthus, so movement from outside inward indicates Shaoyang Disease.)
When diagnosing alternating chills and fever: if red vessels extend vertically to the pupil, seeing one vessel predicts death within one year; seeing one and a half vessels predicts death within one and a half years; seeing two vessels predicts death within two years; seeing two and a half vessels predicts death within two and a half years; seeing three vessels predicts death within three years. (This refers to pathogens entering the Yin aspect causing alternating chills and fever. One should evert the eyelids to observe: if there are red vessels resembling red threads penetrating downward through the pupil, the proximity of death can be determined by their quantity. The text in the "Alternating Chills and Fever" chapter is identical, but that section specifically discusses chills and fever caused by toxicity from scrofula, whereas this section discusses chills and fever alone; the principle is the same. See Disease Category 90 for details.)
When diagnosing toothache due to dental caries: palpate the arrival of Yang meridians; if there is an excess, there will be isolated heat. Heat on the left indicates heat on the left side; heat on the right indicates heat on the right side; heat above indicates heat above; heat below indicates heat below. (Dental caries causes toothache. The Foot-Yangming Meridian enters the upper teeth, and the Hand-Yangming Meridian enters the lower teeth. Therefore, when palpating the arrival of Yang meridian qi, the meridian with excessive pulse qi will be distinctly hot, and the location of heat (left/right/upper/lower) can be identified according to its anatomical region. 'Qu' is pronounced like 'Qiu Yu'.)
When diagnosing blood vessels: many red colors indicate much heat; many blue/green colors indicate much pain; many black colors indicate chronic Bi Syndrome (long-standing obstruction/pain). If red, black, and blue/green colors are all prominently present, it indicates mixed cold and heat. ('Blood vessels' here refer to the collateral vessels of various parts. The presence of red, black, and blue/green represents the mutual victory of Yin and Yang colors, hence either cold or heat.')
Body pain with slightly yellow complexion, yellowish dental plaque, and yellow nail beds indicate Jaundice Disease (Huang Dan). The patient lies still, urine is yellow and red, the pulse is small and choppy, and there is poor appetite. (Jaundice is a yellow disease. There are Yin and Yang types of jaundice; a small and choppy pulse indicates Yin Jaundice. Yin Jaundice results from weak Spleen Earth, leading to poor appetite. See Disease Category 59 for details.)
When a person is ill, if the Cun Kou pulse (Radial artery at the wrist) and the Ren Ying pulse (Carotid artery at the neck) are equal in magnitude and depth (floating/sinking), the disease is difficult to cure. (Cun Kou reflects Yin, Ren Ying reflects Yang. Thus, in Spring and Summer, Ren Ying is slightly larger; in Autumn and Winter, Cun Kou is slightly larger, reflecting the distinction between Yin/Yang and Interior/Exterior. If Cun Kou and Ren Ying are equal in size and depth, it indicates bias toward either Yin or Yang, which is why the disease is hard to resolve. This is similar to the 'Five Colors' chapter, see item 32 previously.)
If the Hand-Shaoyin pulse (Heart Meridian pulse) beats strongly in a woman, she is pregnant. (Hand-Shaoyin refers to the Heart pulse at the Left Cun position. This is consistent with the statement in 'Ping Ren Qi Xiang Lun', see item 23 previously.)
If an infant is ill and all head hairs grow upward against the grain, death is inevitable. (Infants develop gradually, with Kidney Water as the root; hair is the flourishing manifestation of Kidney Water. Head hairs growing upward indicates insufficient Water, causing dry and scorched hair, standing stiffly like dead grass. Laozi said: Humans are soft and supple when alive, but rigid and stiff when dead; plants and trees are tender and fragile when living, but withered and brittle when dead. Thus, rigidity belongs to the path of death, while suppleness belongs to the path of life. This applies here. However, this refers to cases where illness has already occurred; if head hairs grow upward without illness, it is not necessarily an auspicious sign.)
If green/blue vessels appear between the ears, it causes pulling pain. (The ear is the pathway of the Shaoyang Gallbladder Meridian. Green/blue is the color of the Jueyin Liver. The Liver and Gallbladder are exterior-interior pairs; green/blue indicates pain, and the Liver governs sinews, hence pulling pain. 'Che' is pronounced like 'Che'.)
Stool containing blood clots and undigested food (Sun Xie / Watery Diarrhea with undigested food), with a small pulse, and cold hands and feet, is difficult to cure. If Sun Xie occurs with a small pulse but warm hands and feet, the diarrhea is easy to cure. ('Chi Ban' refers to blood impurities congealed into strips or pieces. Blood clots in watery diarrhea indicate Fire pathogen residing in the Blood aspect. If the pulse is small and hands/feet are cold, this is a contradiction between pulse and symptoms, making it difficult to cure. If there is only watery diarrhea without blood clots, it is not a Fire syndrome; although the pulse is small, warm hands/feet indicate that the Spleen governs the four limbs and Spleen Qi is still harmonious, hence easy to cure. 'Ban' should be read as 'Bran/Petal', like melon rind. 'Sun' is pronounced like 'Sun'.)
Changes of the four seasons, alternation of cold and heat: Heavy Yin must transform into Yang, Heavy Yang must transform into Yin. Thus, Yin governs Cold, Yang governs Heat. Therefore, extreme Cold generates Heat, and extreme Heat generates Cold. Hence it is said: Cold generates Heat, Heat generates Cold. This is the transformation of Yin and Yang. Thus: Injury by Cold in Winter leads to Hot Disease (Dan Re) in Spring; Injury by Wind in Spring leads to Post-diarrhea and Intestinal Dysentery (Hou Xie Chang Pi) in Summer; Injury by Summer-heat in Summer leads to Malaria in Autumn; Injury by Dampness in Autumn leads to Cough in Winter. This is called the order of the four seasons. (Qi of Yin and Yang, when reaching extremity, must change; thus extreme Cold generates Heat, extreme Heat generates Cold. This is the way of waxing and waning and mutual replacement in the four seasons of Heaven and Earth. The meaning of this section is largely identical to 'Yin Yang Ying Xiang Lun', see Yin Yang Category 1. 'Dan' is pronounced like 'Dan', referring to warm-hot diseases. 'Pi' is pronounced like 'Pi'. 'Li' is pronounced like 'Jie'.)