（灵枢邪气脏腑病形篇）
黄帝问于岐伯曰∶余闻之，见其色，知其病，命曰明；按其脉，知其病，命曰神；问其病，知其处，命曰工。余愿
闻见而知之，按而得之，问而极之，为之奈何？（见色者，望其容貌之五色也。按脉者，切其寸口之阴阳也。问病者，
问其所病之缘因也。知是三者，则曰明曰神曰工，而诊法尽矣。六十一难曰∶望而知之谓之神，闻而知之谓之圣，问而
知之谓之工，切脉而知之谓之巧。是为神圣工巧，盖本诸此。）岐伯答曰∶夫色脉与尺之相应也，如桴鼓影响之相应也，
不得相失也，此亦本末根叶`之出候也，故根死则叶枯矣。色脉形肉不得相失也，故知一则为工，知二则为神，知三则神
且明矣。（此言色脉形肉，皆当详察。在色可望，在脉可按，其于形肉，则当验于尺之皮肤。盖以尺之皮肤，诊时必见，
验于此而形肉之盛衰，概可知矣。夫有诸中必形诸外，故色之与脉，脉之与形肉，亦犹桴鼓影响之相应，本末根叶之候，
不相失也。三者皆当参合，故知三则神且明矣。桴，击鼓槌也。桴，孚、浮二音。）黄帝曰∶愿卒闻之。岐伯答曰∶色青
者其脉弦也，赤者其脉钩也，黄者其脉代也，白者其脉毛，黑者其脉石。（肝主木，其色青，其脉弦。心主火，其色赤，
其脉钩。脾主土，其色黄，其脉代。肺主金，其色白，其脉毛。肾主水，其色黑，其脉石。五脉义见前十一。）见其色而
不得其脉，反得其相胜之脉，则死矣；得其相生之脉，则病已矣。（不得其脉，言不得其合色之正脉也。相胜之脉，如青
色得毛脉，以金克木之类是也。相生之脉，如青色得石脉，以水生木之类是也。）黄帝问于岐伯曰∶五脏之所生，变化之
病形何如？岐伯答曰∶先定其五色五脉之应，其病乃可别也。黄帝曰∶色脉已定，别之奈何？岐伯曰∶调其脉之缓急小
大滑涩，而病变定矣。（缓急，以至数言。小大滑涩，以形体言。滑，不涩也，往来流利，如盘走珠。涩，不滑也，虚细
而迟，往来觉难，如雨沾沙，如刀刮竹。六者相为对待，调此六者，则病变可以定矣。愚按∶此节以缓急大小滑涩而定
病变，谓可总诸脉之纲领也。然五脏生成论则曰小大滑涩浮沉。及后世之有不同者，如难经则曰∶浮沉长短滑涩。仲景
则曰∶脉有弦紧浮沉滑涩，此六者名为残贼，能为诸脉作病也。滑伯仁曰∶大抵提纲之要，不出浮沉迟数滑涩之六脉也。
所谓不出乎六者，以其足统夫表里阴阳、虚实冷热、风寒湿燥、脏腑血气之病也。浮为阳为表，诊为风为虚；沉为阴为
里，诊为湿为实。迟为在脏，为寒为冷；数为在腑，为热为燥。滑为血有余，涩为气独滞。此诸说者，词虽稍异，义实
相通。若以愚见言之，盖总不出乎表里寒热虚实六者之辨而已。如其浮为在表，则散大而芤可类也；沉为在里，则细小
而伏可类也；迟者为寒，则徐缓涩结之属可类也；数者为热，则洪滑疾促之属可类也；虚者为不足，则短濡微弱之属可
类也；实者为有余，则弦紧动革之属可类也。此其大概，皆亦人所易知者；然即此六者之中，而复有大相悬绝之要，则
人多不能识也。夫浮为表矣，而凡阴虚者，脉必浮而无力，是浮不可以概言表，可升散乎？沉为里矣，而凡表邪初感之
甚者，阴寒束于皮毛，阳气不能外达，则脉必先见沉紧，是沉不可以概言里，可攻内乎？迟为寒矣，而伤寒初退，余热
未清，脉多迟滑，是迟不可以概言寒，可温中乎？数为热矣，而凡虚损之候，阴阳俱亏，气血败乱者，脉必急数，愈数
者愈虚，愈虚者愈数，是数不可以概言热，可寒凉乎？微细类虚矣，而痛极壅闭者，脉多伏匿，是伏不可以概言虚，可
骤补乎？洪弦类实矣，而真阴大亏者，必关格倍常，是强不可以概言实，可消伐乎？夫如是者，是于纲领之中，而复有
大纲领者存焉。设不能以四诊相参，而欲孟浪任意，则未有不覆人于反掌间者，此脉道之所以难言，毫厘不可不辨也。）
黄帝曰∶调之奈何？岐伯答曰∶脉急者，尺之皮肤亦急；脉缓者，尺之皮肤亦缓；脉小者，尺之皮肤亦减而少气；脉大
者，尺之皮肤亦贲而起；脉滑者，尺之皮肤亦滑；脉涩者，尺之皮肤亦涩。凡此变者，有微有甚。（调，察也。此正言脉
之与尺，若桴鼓影响之相应，而其为变，则有微有甚，盖甚则病深，微则病浅也。论疾诊尺篇曰∶审其尺之缓急小大滑
涩，肉之坚脆，而病形定矣。义与此同。见下章。贲，忿、奔二音，大也，沸起也。）故善调尺者，不待于寸；善调脉者，
不待于色。能参合而行之者，可以为上工，上工十全九；行二者为中工，中工十全七；行一者为下工，下工十全六。（此
正本末根叶之义也。以尺寸言，则尺为根本，寸为枝叶。以脉色言，则脉为根本，色为枝叶。故善调尺者，不待于寸；
善调脉者，不待于色也。然必能参合三者而兼行之，更为本末皆得，而万无一失，斯足称为上工而十可全其九；若知二
知一者，不过中下之材，故所全者亦惟六七而已。然曰六曰七者，轻易者在前也；曰八曰九者，最难者在后也。易者何
难之有，难者岂易言哉！此其等差，虽分上下，而成败之贤不肖，其相去也天壤矣。）
《灵枢·邪气脏腑病形篇》记载：
黄帝向岐伯问道：“我听说，通过观察面色就能知道病情，这称为‘明’；通过切按脉象就能知道病情，这称为‘神’；通过询问病情就能知道病灶所在，这称为‘工’。我希望了解如何做到见色而知、按脉而得、问病而穷尽其理，具体该怎么做呢？”（所谓见色，是观察面部呈现的青、赤、黄、白、黑五色；所谓按脉，是切诊寸口脉的阴阳变化；所谓问病，是询问致病的原因。掌握了这三种方法，就达到了明、神、工的境界，诊断的方法也就完备了。《难经·六十一难》说：“望而知之谓之神，闻而知之谓之圣，问而知之谓之工，切脉而知之谓之巧。”这就是所谓的“神、圣、工、巧”，大概都源于此。）
岐伯回答说：“面色的变化、脉象的变化与尺部皮肤（前臂内侧从肘至腕的皮肤）的表现是相互对应的，就像鼓槌击鼓、影子随形那样紧密相应，不会背离。这也是根本与枝叶、树根与树叶之间征候的关系，所以如果树根死了，树叶就会枯死。面色、脉象、形体肌肉这三者不能互相背离，因此只掌握其中一项只能算是‘工’，掌握两项可称为‘神’，三项都掌握就可以达到既‘神’且‘明’的境界了。”（这段话强调面色、脉象、形体肌肉都应当详细察验。在面色方面可以通过望诊观察，在脉象方面可以通过切诊按压，而在形体肌肉方面，则应当在尺部皮肤上进行验证。因为诊察时尺部皮肤必然可见，通过验证此处，形体肌肉的盛衰情况大致就可以知道了。凡是内部有病变必定会反映在外部，所以面色与脉象、脉象与形体肌肉，也如同鼓槌与鼓声、影子与身形那样相应，如同本末根叶的征候一样，不会背离。这三者应当综合参合，所以三项都掌握就能达到既神且明的境界。桴，就是击鼓的槌子，读音为孚或浮。）
黄帝说：“我想彻底听您讲讲。”
岐伯回答说：“面色青的人，其脉象多呈弦象；面色赤的人，其脉象多呈钩象；面色黄的人，其脉象多呈代象；面色白的人，其脉象多呈毛象；面色黑的人，其脉象多呈石象。”（肝属木，其色青，其脉弦。心属火，其色赤，其脉钩。脾属土，其色黄，其脉代。肺属金，其色白，其脉毛。肾属水，其色黑，其脉石。五脉的含义参见前文第十一章。）如果发现面色却得不到相应的脉象，反而得到相克制的脉象，那么病人就会死亡；如果得到相生助的脉象，那么疾病就会痊愈。（所谓不得其脉，是指没有得到与其面色相合的正常脉象。相胜之脉，例如青色见到毛脉，是因为金克木的缘故；相生之脉，例如青色见到石脉，是因为水生木的缘故。）
黄帝又问岐伯：“五脏所产生变化的病症表现是怎样的？”
岐伯回答说：“先确定五色与五脉的对应关系，然后才能辨别疾病。”
黄帝说：“面色和脉象已经确定了，该如何辨别呢？”
岐伯说：“通过调察脉象的缓、急、小、大、滑、涩六种特征，病变的性质就可以确定了。”（缓急，是从脉搏至数快慢来说的。小大滑涩，是从脉搏形态来说的。滑，就是不涩，往来流利，像盘中的珠子滚动。涩，就是不滑，虚细而迟，往来感觉困难，像雨沾沙土，像刀刮竹子。这六种脉象互为对待，调察这六种脉象，病变就可以确定了。我按语认为：这一节通过缓急大小滑涩来定病变，可以说是总括了各种脉象的纲领。然而《素问·五脏生成论》中说有小大滑涩浮沉。以及后世有不同的说法，如《难经》说：浮沉长短滑涩。张仲景说：脉有弦紧浮沉滑涩，这六种名为残贼脉，能导致各种脉象生病。滑伯仁说：大抵提纲的要领，不出浮沉迟数滑涩这六脉。所谓不出这六者，是因为它们足以统摄表里阴阳、虚实冷热、风寒湿燥、脏腑血气的疾病。浮为阳为表，诊为风为虚；沉为阴为里，诊为湿为实。迟为在脏，为寒为冷；数为在腑，为热为燥。滑为血有余，涩为气独滞。这些说法，言辞虽然稍有差异，义理实则相通。若以我的见解而言，大概总不出乎表里寒热虚实六者的辨别而已。比如浮脉主表，那么散大而芤的脉可以归类于此；沉脉主里，那么细小而伏的脉可以归类于此；迟脉主寒，那么徐缓涩结的脉可以归类于此；数脉主热，那么洪滑疾促的脉可以归类于此；虚脉主不足，那么短濡微弱的脉可以归类于此；实脉主有余，那么弦紧动革的脉可以归类于此。这大概是人们容易知道的常识；然而在这六者之中，又有极大悬殊的关键要点，很多人不能识别。比如浮脉主表，但是凡阴虚的病人，脉必浮而无力，这说明浮脉不可以一概说是表证，可以用升散法吗？沉脉主里，但是凡外感邪气初起严重的，阴寒束缚皮毛，阳气不能外达，脉必先见沉紧，这说明沉脉不可以一概说是里证，可以用攻里法吗？迟脉主寒，但是伤寒刚退，余热未清，脉多迟滑，这说明迟脉不可以一概说是寒证，可以用温中法吗？数脉主热，但是凡虚损的症状，阴阳俱亏，气血败乱的，脉必急数，越数越虚，越虚越数，这说明数脉不可以一概说是热证，可以用寒凉法吗？微细脉类似虚证，但是痛极壅闭的病人，脉多伏匿，这说明伏脉不可以一概说是虚证，可以骤然进补吗？洪弦脉类似实证，但是真阴大亏的病人，必有关格倍常的现象，这说明强脉不可以一概说是实证，可以用消伐法吗？像这样的情况，就是在纲领之中，还有更大的纲领存在。如果不能以四诊相互参合，而想要鲁莽随意行事，没有不很快使病人死亡的，这就是脉道之所以难以言说，毫厘之间不可不辨别的缘故。）
黄帝说：“如何调察呢？”
岐伯回答说：“脉象急的，尺部的皮肤也紧张；脉象缓的，尺部的皮肤也松弛；脉象小的，尺部的皮肤也减薄且少气；脉象大的，尺部的皮肤也充盛而起；脉象滑的，尺部的皮肤也光滑；脉象涩的，尺部的皮肤也粗糙。所有这些变化，有轻微也有严重。”（调，就是察的意思。这里正是说明脉象与尺部皮肤，如同鼓槌与鼓声、影子与身形那样相应，而其变化程度，有轻有重，一般来说严重则病深，轻微则病浅。《灵枢·论疾诊尺篇》说：“审察尺部的缓急小大滑涩，以及肌肉的坚脆，就可以确定病症表现。”义理与此相同。见下一章。贲，读音为忿或奔，意思是盛大，沸腾升起的样子。）
所以善于调察尺部皮肤的，不需要等待看寸口脉；善于调察脉象的，不需要等待看面色。能够参合三者并行的，可以称为上工（高明的医生），上工治愈率可达十分之九；兼行二者的为中工（一般的医生），中工治愈率可达十分之七；只行一者为下工（低劣的医生），下工治愈率可达十分之六。”（这是正本末根叶的道理。以尺寸而言，尺部为根本，寸部为枝叶。以脉色而言，脉象为根本，面色为枝叶。所以善于调察尺部的，不需要等待看寸口；善于调察脉象的，不需要等待看面色。然而必须能参合这三者并兼行，更为本末皆得，万无一失，这才足以称为上工，而且十次能治愈九次；如果只知道两项或一项，不过是中下等的人才，所以治愈的也只有六七成罢了。说六说七，是因为容易做到的在前；说八说九，是因为最难做到的在后。容易的有什么难的？难的岂是轻易能做到的！这种等级差别，虽然分为上下，但成败贤愚之间的差距，犹如天地之差。）
*From the "Ling Shu: Pathogenic Qi, Zang-Fu Organs, Disease Manifestations and Pulse Chapter"*
Huang Di asked Qi Bo, saying, "I have heard that observing the complexion to know the disease is called 'Ming' (Clear); palpating the pulse to know the disease is called 'Shen' (Divine); asking about the disease to know its location is called 'Gong' (Skilled). I wish to hear how one can achieve knowing through observation, obtaining through palpation, and exhausting knowledge through inquiry. How should this be done?" (Observing color refers to inspecting the five colors of the face: cyan, red, yellow, white, and black. Palpating the pulse refers to feeling the yin and yang at the Cun Kou [radial artery] site. Asking about the disease refers inquiring into the causes of the illness. Mastering these three methods leads to the states of Ming, Shen, and Gong, completing the diagnostic methods. The *Nan Jing*, Chapter 61, states: 'Knowing through inspection is called Shen; knowing through listening/smelling is called Sheng; knowing through questioning is called Gong; knowing through pulse-taking is called Qiao.' This constitutes the 'Shen, Sheng, Gong, Qiao,' which originates from here.)
Qi Bo replied, "The correspondence between facial color, pulse characteristics, and the skin of the Chi area [the forearm skin from elbow to wrist] is like the response of a drumstick to a drum or an image to its object; they must not diverge. This is also the manifestation of the relationship between roots and branches, or trunk and leaves; thus, if the root dies, the leaves wither. Facial color, pulse, and form/flesh must not contradict each other. Therefore, mastering one aspect makes one a 'Gong'; mastering two makes one 'Shen'; mastering all three makes one both 'Shen' and 'Ming'." (This passage emphasizes that facial color, pulse, and form/flesh should all be carefully examined. Color is observed via inspection; pulse is felt via palpation; form and flesh are verified via the Chi skin. Since the Chi skin is always visible during examination, the prosperity or decline of form and flesh can be generally understood by verifying this area. What exists internally must manifest externally. Thus, color corresponds to pulse, and pulse corresponds to form/flesh, just as a drumstick corresponds to the drum sound, or an image to its shape, like the signs of roots/branches and trunk/leaves, without deviation. These three aspects should be combined for analysis; therefore, mastering all three achieves both Shen and Ming. Fu [drumstick] is struck with a mallet, pronounced Fu or Fu.)
Huang Di said, "I wish to hear this completely."
Qi Bo replied, "When the complexion is cyan, the pulse is Xian [wiry]; when red, the pulse is Gou [hook-like]; when yellow, the pulse is Dai [moderate/rhythmic pause]; when white, the pulse is Mao [feather-like/light]; when black, the pulse is Shi [stone-like/deep]." (The Liver governs Wood, its color is cyan, and its pulse is Xian. The Heart governs Fire, its color is red, and its pulse is Gou. The Spleen governs Earth, its color is yellow, and its pulse is Dai. The Lungs govern Metal, its color is white, and its pulse is Mao. The Kidneys govern Water, its color is black, and its pulse is Shi. The meanings of the five pulses are seen in Chapter 11 previously.) If one sees the color but does not find the corresponding pulse, but instead finds a pulse that overcomes it [via the Five Elements overcoming cycle], death will occur; if one finds a pulse that generates it [via the Five Elements generating cycle], the disease will resolve. (Not finding the correct pulse means failing to find the normal pulse harmonious with the color. A 'Ke' [overcoming] pulse, such as seeing a Mao pulse with a cyan color, occurs because Metal overcomes Wood. A 'Sheng' [generating] pulse, such as seeing a Shi pulse with a cyan color, occurs because Water generates Wood.)
Huang Di asked Qi Bo, "What are the disease manifestations resulting from the generation and changes of the Zang organs?"
Qi Bo replied, "First determine the correspondence of the five colors and five pulses, then the diseases can be distinguished."
Huang Di said, "Once the color and pulse are determined, how do we distinguish them?"
Qi Bo said, "By regulating [examining] the pulse's Huan [slow/relaxed], Ji [rapid/tense], Xiao [small], Da [large], Hua [slippery], and Se [choppy] qualities, the nature of the pathological change is determined." (Huan and Ji refer to the rate of the pulse. Xiao, Da, Hua, and Se refer to the morphology of the pulse. Hua means not Se; it flows smoothly, like pearls rolling in a plate. Se means not Hua; it is deficient, thin, and slow, difficult to move, like rain soaking sand or a knife scraping bamboo. These six types are mutually contrasting. By examining these six, the pathological changes can be determined. My commentary notes: This section determines pathology through Huan, Ji, Xiao, Da, Hua, and Se, serving as a general outline of all pulses. However, the *Su Wen: Treatise on the Generation of the Five Viscera* mentions Xiao, Da, Hua, Se, Fu, and Chen. Later generations had different views. For example, the *Nan Jing* says: Fu, Chen, Chang, Duan, Hua, Se. Zhang Zhongjing says: Pulses include Xian, Jin, Fu, Chen, Hua, Se; these six are named 'Can Zei' [harmful agents] and can cause various pulse pathologies. Hua Borun says: Generally, the key outlines do not exceed the six pulses of Fu, Chen, Chi, Shu, Hua, and Se. The reason they do not exceed these six is that they suffice to encompass exterior-interior, yin-yang, deficiency-excess, cold-heat, wind-cold-dampness-dryness, and Zang-Fu/Blood-Qi diseases. Fu is Yang and Exterior, diagnosing Wind and Deficiency; Chen is Yin and Interior, diagnosing Dampness and Excess. Chi indicates Zang involvement, Cold, and Chill; Shu indicates Fu involvement, Heat, and Dryness. Hua indicates excess Blood; Se indicates stagnant Qi alone. Although these theories differ slightly in wording, their principles are interconnected. From my perspective, it essentially boils down to distinguishing the six categories of Exterior-Interior, Cold-Heat, and Deficiency-Excess. For instance, Fu indicates Exterior, so San, Da, and Kou pulses can be classified here; Chen indicates Interior, so Xi, Xiao, and Fu pulses can be classified here; Chi indicates Cold, so Xu, Huan, Se, and Jie pulses can be classified here; Shu indicates Heat, so Hong, Hua, Ji, and Cu pulses can be classified here; Xu indicates insufficiency, so Duan, Ru, Wei, and Ruo pulses can be classified here; Shi indicates excess, so Xian, Jin, Dong, and Ge pulses can be classified here. These are generally known facts; however, within these six, there are critical distinctions that many fail to recognize. For example, although Fu indicates Exterior, patients with Yin deficiency often have a Fu pulse that is forceless; thus, Fu cannot universally indicate Exterior, nor can dispersing methods be used indiscriminately? Although Chen indicates Interior, in severe initial external contractions where Yin-Cold binds the skin/hair and Yang Qi cannot reach the exterior, the pulse may first appear Chen-Jin; thus, Chen cannot universally indicate Interior, nor can purgative methods be used indiscriminately? Although Chi indicates Cold, after the retreat of Shang Han [cold damage], if residual heat remains, the pulse is often Chi-Hua; thus, Chi cannot universally indicate Cold, nor can warming methods be used indiscriminately? Although Shu indicates Heat, in cases of deficiency damage where both Yin and Yang are depleted and Blood-Qi are chaotic, the pulse becomes urgent and Shu; the more Shu, the more deficient, and the more deficient, the more Shu; thus, Shu cannot universally indicate Heat, nor can cooling methods be used indiscriminately? Micro and Thin pulses resemble Deficiency, but in cases of extreme pain and blockage, the pulse may be Fu-Ni [hidden]; thus, Fu cannot universally indicate Deficiency, nor can sudden tonification be used? Hong and Xian pulses resemble Excess, but in cases of severe True Yin depletion, Guan-Ge [obstruction/regurgitation] phenomena may double; thus, strong pulses cannot universally indicate Excess, nor can reducing methods be used indiscriminately? In such cases, within the outline, there exists a higher-level outline. If one does not combine the Four Diagnostic Methods and acts rashly, disaster will inevitably follow quickly. This is why the Dao of the pulse is difficult to explain and requires meticulous distinction of even the slightest differences.)
Huang Di said, "How do we examine [regulate] them?"
Qi Bo replied, "When the pulse is Ji [tense], the skin of the Chi area is also tense; when the pulse is Huan [relaxed], the skin of the Chi area is also relaxed; when the pulse is Xiao [small], the skin of the Chi area is diminished and lacks Qi; when the pulse is Da [large], the skin of the Chi area is bulging and raised; when the pulse is Hua [slippery], the skin of the Chi area is also slippery; when the pulse is Se [choppy], the skin of the Chi area is also rough. All these variations have degrees of mildness and severity." (Tiao means to examine. This precisely describes the correspondence between the pulse and the Chi skin, like a drumstick to a drum or an image to its object, with variations having degrees of mildness or severity. Generally, severe variation indicates deep disease, while mild variation indicates superficial disease. The *Ling Shu: Chapter on Diagnosing Diseases by Inspecting the Chi* states: 'Carefully examine the Huan, Ji, Xiao, Da, Hua, Se of the Chi skin, and the firmness or fragility of the flesh, to determine the disease manifestation.' The principle is identical to this. See the next chapter. Ben, pronounced Fen or Ben, means large or boiling up.)
Therefore, those skilled in examining the Chi skin need not wait for the Cun [radial] pulse; those skilled in examining the pulse need not wait for the facial color. Those who can integrate and practice all three can be considered Shang Gong [Master Physicians], achieving a nine-in-ten success rate; those practicing two are Zhong Gong [Intermediate Physicians], achieving a seven-in-ten success rate; those practicing only one are Xia Gong [Junior Physicians], achieving a six-in-ten success rate." (This reaffirms the principle of roots and branches. Regarding Cun and Chi, Chi is the root, and Cun is the branch. Regarding pulse and color, the pulse is the root, and color is the branch. Thus, those skilled in Chi need not look at Cun; those skilled in pulse need not look at color. However, one must integrate all three and practice them together to master both root and branch, ensuring no errors, thereby qualifying as a Shang Gong with a 90% cure rate. Those knowing only two or one are merely intermediate or junior talents, curing only 60-70%. Mentioning six or seven implies easier tasks come first; mentioning eight or nine implies the hardest tasks come last. What is easy has no difficulty? How can the difficult be spoken of lightly! Although these levels are divided into upper and lower, the gap in success, failure, virtue, and worthlessness between them is as vast as heaven and earth.)