(素问五脏生成篇)
夫脉之小大滑涩浮沉,可以指别;(小者细小,阴阳俱不足也。大者豁大,阳强阴弱也。滑者往来流利,血实气壅也。
涩者往来艰难,气滞血少也。浮者轻取,所以候表。沉者重按,所以候里。夫如是者得之于手,应之于心,故可以指而
分别也。)五脏之象,可以类推;(象,气象也。肝象木之曲直而应在筋,心象火之炎上而应在脉,脾象土之安静而应在
肉,肺象金之坚敛而应在皮毛,肾象水之润下而应在髓骨。凡若此者,脏象之辨,各有所主,皆可以类而推也。)五脏相
音,可以意识;(相,形相也。音,五音也。相音,如阴阳二十五人篇所谓木形之人比于上角之类,又如肝音角、心音征、
脾音宫、肺音商、肾音羽。若以胜负相参,脏痞自见,五而五之、二十五变,凡耳聪心敏者,皆可意会而识也。相,去
声。)五色微诊,可以目察。(五色者,肝青心赤脾黄肺白肾黑,此其常色也。至于互为生克,诊有精微,凡目明智圆者,
可以视察而知也。)能合脉色,可以万全。(因脉以知其内,因色以察于外,脉色明则参合无遗,内外明则表里具见,斯
可万全无失矣。)赤脉之至也,喘而坚,诊曰有积气在中,时害于食,名曰心痹,得之外疾,思虑而心虚,故邪从之。(此
下即所以合脉色也。赤者,心之色。脉喘而坚者,谓急盛如喘而坚强也。心脏居高,病则脉为喘状,故于心肺二脏独有
之。喘为心气不足,坚为病气有余。心脉起于心胸之中,故积气在中,时害于食。积为病气积聚,痹为脏气不行。外疾,
外邪也。思虑心虚,故外邪从而居之矣。)白脉之至也,喘而浮,上虚不实,惊有积,气在胸中,喘而虚,名曰肺痹,寒
热,得之醉而使内也。(白者,肺色见也。脉喘而浮者,火乘金而病在肺也。喘为气不足,浮为肺阴虚。肺虚于上,则气
不行而积于下,故上虚则为惊,下实则为积。气在胸中,喘而且虚,病为肺痹者,肺气不行而失其治节也。寒热者,金
火相争,金胜则寒,火胜则热也。其因醉以入房,则火必更炽,水必更亏,肾虚盗及母气,故肺病若是矣。)青脉之至也,
长而左右弹,有积气在心下支 ,名曰肝痹,得之寒湿,与疝同法,腰痛足清头痛。(青者,肝色见也。长而左右弹,言
两手俱长而弦强也。弹,搏击之义。此以肝邪有余,故气积心下,及于支 ,因成肝痹。然得之寒湿而积于心下支 者,
则为肝痹;积于小腹前阴者,则为疝气。总属厥阴之寒邪,故云与疝同法。肝脉起于足大趾,与督脉会于巅,故病必腰
痛足冷头痛也。 音区,腋下胁也,)黄脉之至也,大而虚,有积气在腹中,有厥气,名曰厥疝,女子同法,得之疾使四
肢,汗出当风。(黄者,脾色见也。脉大为邪气盛,虚为中气虚。中虚则脾不能运,故有积气在腹中。脾虚则木乘其弱,
水无所畏,而肝肾之气上逆,是为厥气。且脾肝肾三经皆结于阴器,故名曰厥疝,而男女无异也。四肢皆禀气于脾,疾
使之则劳伤脾气而汗易泄,汗泄则表虚而风邪客之,故为是病。)黑脉之至也,上坚而大,有积气在小腹与阴,名曰肾痹,
得之沐浴清水而卧。(黑者,肾色见也。上言尺之上,即尺外以候肾也。肾主下焦,脉坚而且大者,肾邪有余,故主积气
在小腹与阴处,因成肾痹。其得于沐浴清水而卧者,以寒湿内侵而气归同类,故病在下焦而邪居于肾。)凡相五色之奇脉,
面黄目青,面黄目赤,面黄目白,面黄目黑者,皆不死也。(凡此色脉之不死者,皆兼面黄,盖五行以土为本,而胃气之
犹在也。相,去声。)面青目赤,面赤目白,面青目黑,面黑目白,面赤目青,皆死也。(此脉色之皆死者,以无黄色。
无黄色则胃气已绝,故死。上文言合脉色以图万全,此二节则单言五色,亦可以决死生也。)
(《素问·五脏生成篇》)
脉象的小、大、滑、涩、浮、沉,可以通过手指的触感来辨别;(小脉指脉形细小,表示阴阳两虚。大脉指脉形阔大,表示阳盛阴弱。滑脉指脉搏往来流利,表示血实气壅。涩脉指脉搏往来艰难,表示气滞血少。浮脉指轻取即得,用以候察表证。沉脉指重按始得,用以候察里证。像这样通过手指的感觉,在心中得到印证,所以可以通过指感来分别脉象。)五脏的外在征象,可以类推;(“象”指气象。肝象木之曲直,反映在筋;心象火之炎上,反映在脉;脾象土之安静,反映在肉;肺象金之坚敛,反映在皮毛;肾象水之润下,反映在髓骨。像这样的情况,脏象的辨析各有主属,都可以类比推演。)五脏对应的音律,可以通过意识去领会;(“相”指形相。“音”指五音。相音,如《阴阳二十五人篇》所说的木形之人比于上角之类,又如肝音角、心音徵、脾音宫、肺音商、肾音羽。如果以五行胜负相互参验,脏腑的痞塞自然显现,五与五相乘变化出二十五种情况,凡是耳聪心敏的人,都可以意会而识别。“相”读作去声。)五色的细微诊察,可以用眼睛观察。(五色中,肝色青、心色赤、脾色黄、肺色白、肾色黑,这是常色。至于五行互为生克,诊法精微,凡是目光明智圆通的人,可以通过视察而知晓。)能够结合脉象和面色,诊断就可以万无一失。(通过脉象了解体内情况,通过面色察知体外表现,脉色明晰则参合无遗,内外明了则表里俱见,这样就可以万全无失了。)
脉象呈现红色且至,急促而坚实,诊断为中有积气,时常影响饮食,名为心痹,由外邪引起,因思虑过度导致心虚,所以邪气侵入。(这以下就是说明如何结合脉色进行诊断。赤色是心的本色。脉象急促而坚实,是指脉势急盛如喘息状且坚强。心脏位置居高,患病时脉象呈喘息状,所以只有心肺二脏独有此象。急促表示心气不足,坚实表示病气有余。心脉起于心胸之中,所以积气在中焦,时常妨碍进食。积是病气积聚,痹是脏气不通。外疾指外邪。思虑导致心虚,所以外邪得以居留。)
脉象呈现白色且至,急促而浮,上部虚弱不实,易受惊吓且有积气,气聚在胸中,脉象急促而虚,名为肺痹,伴有寒热症状,由醉酒后进行房事引起。(白色是肺色显现。脉象急促而浮,是火邪乘袭肺金而病在肺。急促表示气不足,浮表示肺阴虚。肺虚于上,则气不行而下部产生积气,所以上部虚则易惊,下部实则形成积气。气在胸中,脉象急促且虚,病为肺痹,是肺气不行而失去治节功能。寒热,是金火相争,金胜则寒,火胜则热。因为醉酒而入房,则火必更炽盛,水必更亏损,肾虚盗泄母气,所以肺病如此。)
脉象呈现青色且至,长而左右弹击,有积气在心下支撑胁肋,名为肝痹,由寒湿引起,治疗方法与疝气相同,症状包括腰痛、足冷、头痛。(青色是肝色显现。长而左右弹击,是说两手脉都长且弦强。弹,意为搏击。这是因为肝邪有余,所以气积在心下,波及胁肋,因而形成肝痹。然而,因寒湿而积于心下胁肋的,称为肝痹;积在小腹前阴的,称为疝气。总属于厥阴经的寒邪,所以说与疝气同法。肝脉起于足大趾,与督脉会于头顶,所以病症必定出现腰痛、足冷、头痛。“支䐜”音区,指腋下胁肋部位。)
脉象呈现黄色且至,大而虚,有积气在腹中,有厥逆之气,名为厥疝,女子治疗方法相同,由剧烈活动四肢,汗出当风引起。(黄色是脾色显现。脉大为邪气盛,虚为中气虚。中虚则脾不能运化,所以有积气在腹中。脾虚则肝木乘其弱点,肾水无所畏惧,肝肾之气上逆,这就是厥气。且脾、肝、肾三经都结于阴器,所以名为厥疝,男女无异。四肢皆禀受脾气,剧烈活动则劳伤脾气而易出汗,汗出则表虚而风邪客居,所以患此病。)
脉象呈现黑色且至,上部坚硬且大,有积气在小腹与前阴,名为肾痹,由洗冷水澡后躺卧引起。(黑色是肾色显现。上文说的尺之上,即尺部外侧以候肾。肾主下焦,脉象坚硬且大,表示肾邪有余,所以主治积气在小腹与前阴处,因而形成肾痹。之所以因洗冷水澡后躺卧而得病,是因为寒湿内侵而气归同类,所以病在下焦而邪气居于肾。)
凡是观察五色与奇脉,面黄目青、面黄目赤、面黄目白、面黄目黑的,都不会死。(凡此色脉不死的,都兼见面黄,因为五行以土为本,说明胃气尚存。“相”读作去声。)面青目赤、面赤目白、面青目黑、面黑目白、面赤目青的,都会死。(这些脉色皆死的,是因为没有黄色。没有黄色则胃气已绝,所以死。上文讲结合脉色以求万全,这两节则单言五色,也可以决断生死。)
(Su Wen, Chapter on the Generation of the Five Zang Organs)
The pulse qualities of small (Xiao), large (Da), slippery (Hua), choppy (Se), floating (Fu), and deep (Chen) can be distinguished by finger palpation; (A small pulse is thin and fine, indicating insufficiency of both Yin and Yang. A large pulse is broad and expansive, indicating excess Yang and deficient Yin. A slippery pulse flows smoothly back and forth, indicating blood excess and Qi stagnation. A choppy pulse moves with difficulty, indicating Qi stagnation and blood deficiency. A floating pulse is felt with light pressure, used to examine exterior conditions. A deep pulse is felt only with heavy pressure, used to examine interior conditions. Thus, obtained through the hand and confirmed in the mind, these can be differentiated by finger sensation.) The manifestations (Xiang) of the five Zang organs can be inferred by analogy; ("Xiang" refers to phenomenological images. The Liver corresponds to Wood's flexibility and manifests in the sinews; the Heart corresponds to Fire's upward flaming and manifests in the vessels; the Spleen corresponds to Earth's stability and manifests in the muscles; the Lungs correspond to Metal's firmness and condensation and manifest in the skin and hair; the Kidneys correspond to Water's moistening and downward flow and manifest in the marrow and bones. In such cases, the differentiation of Zang organ manifestations has specific dominions, all of which can be deduced by category.) The tones associated with the five Zang organs can be apprehended by consciousness; ("Xiang" refers to physical appearance. "Yin" refers to the five musical tones. Xiang-Yin, as mentioned in the chapter on Twenty-Five Types of People based on Yin-Yang, such as Wood-type individuals corresponding to the Jue tone, or Liver-Jue, Heart-Zhi, Spleen-Gong, Lung-Shang, and Kidney-Yu tones. If one compares them according to mutual generation and restriction, visceral obstruction becomes apparent. Through twenty-five variations derived from five times five, those with keen hearing and sharp minds can intuitively comprehend and recognize them. "Xiang" is pronounced with the departing tone.) The subtle diagnosis of the five colors can be observed by the eye. (In the five colors, Liver is green, Heart is red, Spleen is yellow, Lungs are white, and Kidneys are black; these are the normal colors. Regarding their mutual generation and restriction, the diagnostic methods are profound and subtle. Those with clear vision and wise discernment can know through observation.) Being able to combine pulse and color diagnosis ensures perfection in treatment. (By means of the pulse, one knows the interior; by means of color, one inspects the exterior. When pulse and color are clear, integration leaves no gaps; when interior and exterior are understood, both surface and depth are revealed, thus ensuring absolute accuracy without error.)
When a red pulse arrives, rapid and firm, it is diagnosed as having accumulated Qi in the middle, occasionally hindering food intake, named Heart Bi (Heart Obstruction). It arises from external pathogens due to excessive worry causing Heart deficiency, allowing evil to enter. (This section illustrates how to combine pulse and color for diagnosis. Red is the color of the Heart. A pulse that is rapid and firm means the vessel is tense and strong like panting. The Heart resides high; when diseased, the pulse takes on a panting quality, unique to the Heart and Lungs. Rapid indicates Heart Qi deficiency; firm indicates pathogenic excess. Since the Heart vessel originates in the chest and heart region, accumulated Qi is in the middle, occasionally impairing digestion. Accumulation refers to pathogenic aggregation; Bi refers to the failure of Zang Qi to circulate. External illness refers to external evil. Excessive worry causes Heart deficiency, so external evil settles there.)
When a white pulse arrives, rapid and floating, with upper deficiency and lack of fullness, accompanied by fright and accumulation, with Qi in the chest, rapid and deficient, it is named Lung Bi (Lung Obstruction), with alternating chills and fever, caused by intercourse while drunk. (White is the manifestation of Lung color. A pulse that is rapid and floating indicates Fire attacking Metal, with disease in the Lungs. Rapid indicates Qi deficiency; floating indicates Lung Yin deficiency. Deficiency in the upper part leads to stagnant Qi and accumulation below; thus, upper deficiency causes fright, while lower excess causes accumulation. Qi in the chest, rapid and deficient, constitutes Lung Bi, where Lung Qi fails to circulate and loses its regulatory function. Chills and fever result from the conflict between Metal and Fire; Metal dominance brings cold, Fire dominance brings heat. Intercourse while drunk intensifies Fire and depletes Water; Kidney deficiency steals from the Mother element [Metal], resulting in such Lung pathology.)
When a green pulse arrives, long and striking left and right, with accumulated Qi supporting beneath the heart, it is named Liver Bi (Liver Obstruction), caused by cold-dampness, treated similarly to Hernia, with symptoms of lower back pain, cold feet, and headache. (Green is the manifestation of Liver color. Long and striking left and right means both hands show a long and wiry-taut pulse. Striking implies beating. This occurs because Liver evil is in excess, causing Qi accumulation under the heart and extending to the hypochondrium, forming Liver Bi. However, accumulation under the heart and hypochondrium due to cold-dampness is called Liver Bi; accumulation in the lower abdomen and genitals is called Hernia. Both belong to Cold evil of the Jueyin channel, hence treated similarly to Hernia. The Liver meridian starts at the big toe and meets the Du vessel at the vertex; thus, the disease necessarily involves lower back pain, cold feet, and headache. "Zhi Chan" sounds like 'qu', referring to the hypochondrium and axilla.)
When a yellow pulse arrives, large and deficient, with accumulated Qi in the abdomen and rebellious Qi, it is named Jue Hernia, with the same method for women, caused by strenuous limb activity, sweating, and exposure to wind. (Yellow is the manifestation of Spleen color. A large pulse indicates pathogenic excess; deficient indicates Middle Qi deficiency. Middle deficiency impairs Spleen transportation, leading to accumulated Qi in the abdomen. Spleen deficiency allows Liver Wood to invade its weakness, and Kidney Water lacks fear, causing Liver and Kidney Qi to rebel upward, known as Rebellious Qi. Since the Spleen, Liver, and Kidney meridians all converge at the genitalia, it is named Jue Hernia, identical for men and women. The limbs derive Qi from the Spleen; strenuous activity damages Spleen Qi and promotes sweating; sweat loss makes the exterior deficient, allowing Wind evil to invade, causing this disease.)
When a black pulse arrives, firm and large above, with accumulated Qi in the lower abdomen and genitals, it is named Kidney Bi (Kidney Obstruction), caused by bathing in cold water and lying down. (Black is the manifestation of Kidney color. The aforementioned "above" refers to the outer aspect of the Chi position, which observes the Kidneys. The Kidneys govern the Lower Jiao; a pulse that is firm and large indicates Kidney evil excess, governing accumulated Qi in the lower abdomen and genitals, forming Kidney Bi. Contracting this by bathing in cold water and lying down occurs because cold-dampness invades internally and Qi returns to its kindred element, so the disease is in the Lower Jiao and the evil resides in the Kidneys.)
Regarding the extraordinary pulses of observing the five colors: if the face is yellow and eyes green, face yellow and eyes red, face yellow and eyes white, or face yellow and eyes black, death will not occur. (All these non-fatal color-pulse combinations include a yellow face, as Earth is the root of the Five Elements, indicating that Stomach Qi remains. "Xiang" is pronounced with the departing tone.) If the face is green and eyes red, face red and eyes white, face green and eyes black, face black and eyes white, or face red and eyes green, death will occur. (These fatal color-pulse combinations lack yellow. Without yellow, Stomach Qi is exhausted, hence death. The previous text discussed combining pulse and color for perfection; these two sections discuss only the five colors, which can also determine life and death.)