（诊。非独脉也。有自脉言者。有自证言者。有自形言者。有自色言者。有自声言者。经中五过四失。皆言诊也。
故分诊候另为一门。此篇皆出素问。故文上不加别识。）
诊法常以平旦。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。（过。差也。
即病也。）切脉动静。（脉诊。）而视精明。（神诊。精气神明。王注。作目 睛明穴。未确。）察五色。（色诊。）观五脏有
余不足。六腑强弱。（证诊。）形之盛衰。（形诊。）以此参伍。决死生之分。万物之外。六合之内。天地之变。阴阳之应。
彼春之暖。为夏之暑。（阳生而之盛。）彼秋之忿。为冬之怒。（阴少而至壮。）四变之动。脉与之上下。（脉因时变。）以
春应中规。（圆滑。）夏应中矩。（方大。）秋应中衡。（涩平。）冬应中权。（沉石。）阴阳有时。与脉为期。期而相失。知
脉所分。分之有期。故知死时。（脉与时不相应。与藏不相应者。皆曰相失。分其生克之期日。则可以知死时矣。）微妙
在脉。不可不察。察之有纪。从阴阳始。始之有经。从五行生。生之有度。四时为宜。补泻勿失。与天地如一。得一之
情。以知死生。是故声合五音。色合五行。脉合阴阳。持脉有道。虚静为保。（心欲虚。神欲静。）春日浮。如鱼之游在
波。夏日在肤。泛泛乎万物有余。秋日下肤。蛰虫将去。（以气渐降。如虫之欲蛰藏。）冬日在骨。蛰虫周密。君子居室。
知内者按而纪之。（内而在脏在腑。）知外者终而始之。（外而在表来经。）此六者。持脉之大法。（四时表里。必须明辨。
王注。知外谓知色象。似与持脉不合。）尺内两旁。则季胁也。（肋骨尽处名季胁。季胁近肾。尺主之。）尺外以候肾。尺
里以候腹。（少腹。王注。外谓外侧。里谓内侧。李士材曰。外谓前半部。里谓后半部。）中附上。（中部关脉。）左外以
候肝。内以候膈。（左手关脉。膈谓膈中。）右外以候胃。内以候脾。（右手关脉。）上附上。（上部寸脉。）右外以候肺。
内以候胸中。（右手寸脉。）左外以候心。内以候膻中。（左手寸脉。）前以候前。后以候后。（关前以候前。关后以候后。
吴注。前指候前。后指候后。亦此义也。）上竟上者。（由尺至寸。）胸喉中事也。下竟下者。（自寸至尺。）少腹腰股膝胫
足中事也。（此内经诊法也。吴注曰。尺外以候肾。内以候腹。小肠膀胱。居少腹也。左外以候肝。内以候膈。不及胆者。
寄于肝也。左外以候心。内以候膻中。膻中即心包也。高阳生以大小肠列于寸。三焦配于左尺。命门列于右尺。而膻中
则不与焉。特以心与小肠为表里。肺与大肠为表里耳。不知经络虽为表里。而大小肠皆在下焦。焉能越中焦而见脉于寸
上乎。滑伯仁以左尺主小肠膀胱前阴之病。右尺主大肠后阴之病。可称只眼。又灵枢云。宗气出于上焦。营气出于中焦。
卫气出于下焦。上焦在于膻中。中焦在于中脘。下焦在脐下阴交。故寸主上焦。以候胸中。关主中焦。以候膈中。尺主
下焦。以候腹中。今列三焦于右尺。不亦妄乎。又肾虽一脏。而有左右两枚。命门穴在督脉第七椎两肾之间。一阳居二
阴之中。所以成乎坎也。内经并无命门之经。何以循经而见脉于寸口乎。）推而外之。内而不外。有心腹积也。（吴注。
浮取之而脉沉。为病在里。）推而内之。外而不内。身有热也。（沉取之而脉浮。为病在表。）推而上之。上而不下。腰足
清也。（上部盛而下无阳气。升而不降。故腰足冷。）推而下之。下而不上。头项痛也。（下部盛而上无阳气。降而不升。
故头项痛。甲乙经作推而上之。下而不上。推而下之。上而不下。文尤顺而义同。昂按。此即五常政大论所谓上取下取。
内取外取。以求其过是也。）按之至骨。脉气少者。腰脊痛而身有痹也。（脉少血少。故有腰痛脊痛。不仁不用等病。）（脉
要精微论）诊病之始。五决为纪。（以五脏之脉。为决生死之纲纪。）欲知其始。先建其母。（始。病源也。母应时旺气也。）
所谓五决者。五脉也。（即五脏之脉。）
夫脉之小大滑涩浮沉。可以指别。五脏之象。可以类推。五脏相音。（相。犹色也。）可以意识。五色微诊。可以目
察。能合脉色。可以万全。赤（色赤。）脉之至也。喘（脉来喘急。）而坚。诊曰。有积气在中。时害于食。名曰心痹。
（心
肺藏高。故皆言喘。喘为心气不足。坚为病气有余。痹者。藏气不宣行也。）得之外疾。思虑而心虚。故邪从之。白脉之
至也。喘而浮。上虚下实。惊有积气在胸中。喘而虚。名曰肺痹寒热。（金火相战。）得之醉而使内也。（酒味辛热。助火
克金。加之使内。则肾气虚。虚必盗母气以自养。肺金益衰。而不能行气。故气积于胸中也。）青脉之至也。长而左右弹。
（长而弹手。为弦紧为寒。）有积气在心下。支 。（支主 胁。肝主胁。胁近心。故曰心下。）名曰肝痹。得之寒湿。与
疝同法。（肝脉络阴器。故疝亦属肝病。）腰痛足清头痛。（肝脉所过。阴脉者。下行极而上。故头痛。）黄脉之至也。大
而虚。有积气在腹中。有厥气。名曰厥疝。（王注。若肾气逆上。则为厥疝。不上则但为脾积。）女子同法。（女子亦有疝。
但不名疝而名瘕。）得之疾使四肢。汗出当风。（脾主四肢。风木克土。）黑脉之至也。上坚而大。（上字未详。马注。尺
脉之上。坚而且大。）有积气在少腹与阴。（阴器。）名曰肾痹。得之沐浴清水而卧。（湿气趋下。必归于肾。）（五脏生成
论）
天地之至数。合于人形气血。通决死生。为之奈何。曰。天地之至数。始于一终于九焉。（九为奇数之极。）一者天。
二者地。三者人。因而三之。三三者九。以应九野。故人有三部。部有三候。以决死生。以处百病。以调虚实。而除邪
疾。上部天。两额之动脉。（额两旁动脉。王注。足少阳脉气所在。）上部地。两颊之动脉。（鼻之两旁。近巨 之分动脉。
足阳明脉气所行。）上部人。耳前之动脉。（耳前陷中动脉。手少阳脉气所行。）中部天。手太阴也。（谓肺也。寸口中经
渠穴动脉。）中部地。手阳明也。（谓大肠。手大指次指歧骨间。合谷之分动脉。）中部人。手少阴也。（谓心脉。掌后锐
骨之下。神门之分动脉。）下部天。足厥阴也。（谓肝脉。毛际外羊矢下一寸半陷中。五里之分阴股中动脉。女子取太冲。
在足大趾本节后二寸陷中。）下部地。足少阴也。（谓肾脉。足内踝后跟骨上陷中。太溪之分动脉。）下部人。足太阴也。
（谓脾脉。足鱼腹上。越两筋间。阴股内箕门之分动脉。）故下部之天以候肝。地以候肾。人以候脾胃之气。中部天以候
肺。地以候胸中之气。（肠胃。）人以候心。上部天以候头角之气。地以候口齿之气。人以候耳目之气。三而成天。三而
成地。三而成人。三而三之。合则为九。九分为九野。九野为九藏。故神藏五。形藏四。合为九藏。（王注。肝藏魂。肺
藏魄。心藏神。脾藏意。肾藏志。是谓神藏五。一头角。二耳目。三口齿。四胸中。是谓形藏四。张注。形藏四。谓胃
大小肠膀胱。藏有形之物也。胆无出无入。三焦有名无形。皆不藏有形者也。于理亦通。但于本文欠贯。马注。古人诊
脉。凡头面手足之动脉。无不诊之。犹伤寒论多以趺阳脉言之也。其九候法。亦以三部中有天地人。与后世之浮中沉不
同也。颇得古义。）必先度其形之肥瘦。（大抵肥人脉沉。瘦人脉浮。）以调其气之虚实。（肥人血实气虚。瘦人气实血虚。）
实则泻之。虚则补之。（此言刺法。统肥瘦而言。）必先去其血脉。（刺去留邪。）而后调之。无问其病。以平为期。形盛
脉细。少气不足以息者危。形瘦脉大。胸中多气（喘满。）者死。（形气不相得。）形气相得者生。参伍不调者病。三部九
候。皆相失者死。目内陷者死。（诸脉皆属于目。）察九候独小者病。（九部之中。一部独小。下同。）独大者病。独疾者
病。独迟者病。独热者病。独寒者病。独陷下者（吴注。沉伏。）病。（此九候中。又有七诊之法。）九候之脉。皆沉细悬
绝者为阴。主冬。故以夜半死。盛躁喘数者为阳。主夏。故以日中死。寒热病者。以平旦死。（吴注。寒死夜半。热死日
中。平旦为阴阳交会之中。）热中及热病者。以日中死。（火旺于午。）病风者。以日夕死。（风属卯木。日入申酉。属金。
金克木。）病水者。以夜半死。（水旺亥子。）其脉乍疏乍数。乍迟乍疾者。日乘四季死。（辰戌丑未土日。脾绝故也。）形
肉已脱。九候虽调犹死。七诊虽见。九候皆从者不死。所言不死者。风气之病。及经月之病。似七诊之病而非也。故言
不死。（风病之脉。有独大独疾者。经血不足。有独小独迟者。）若有七诊之病。其脉候亦败者死矣。必发哕噫。（胃为哕。
呃逆也。心为噫。嗳气也。）（三部九候论）
色多青则痛。多黑则痹。黄赤则热。多白则寒。五色皆见。则寒热也。（皮部论）
人之居处。动静勇怯。脉亦为之变乎。曰。凡人之惊恐恚劳动静。皆为变也。是以夜行。则喘出于肾。淫气病肺。
（子
病及母。）有所堕恐。喘出于肝。淫气害脾。（木邪克土。）有所惊恐。喘出于肺。淫气伤心。（惊则气乱。神无所根据。故
喘出肺而伤心。）度水跌仆。喘出于肾与骨。（水气通肾。）当是之时。勇者气行则已。怯者则着而为病也。故曰。诊病之
道。观人勇怯。骨肉皮肤。能知其情。以为诊法也。故饮食饱甚。汗出于胃。惊而夺精。汗出于心。持重远行。汗出于
肾。疾走恐惧。汗出于肝。摇体劳苦。汗出于脾。故春秋冬夏。四时阴阳生病。起于过用。此为常也。（经脉别论）
凡未诊病者。必问尝贵后贱。虽不中邪。病从内生。名曰脱营。（心志不乐。营血不生。）尝富后贫。名曰失精。（富
则膏粱。贫则藜藿。藏液不生。）五气留运。病有所并。医工诊之。不在脏腑。不变躯形。（内无可求。外无可验。）诊之
而疑。不知病名。身体日减。气虚无精。病深无气。洒洒然（恶寒之貌。）时惊。病深者。以其外耗于卫。内夺于营。（王
注。血为忧煎。气随悲减。）良工所失。不知病情。此治之一过也。凡欲诊病者。必问饮食居处。暴乐暴苦。始乐后苦。
皆伤精气。精气竭绝。形体毁沮。暴怒伤阴。暴喜伤阳。厥气上行。满脉去形。（逆气上行。满于经络。使神气离散。）
愚医治之。不知补泻。不知病情。精华日脱。邪气乃并。此治之二过也。善为脉者。必以比类奇恒。（病能论。奇恒者。
言奇病也。）从容知之。为工而不知道。此诊之不足贵。此治之三过也。诊有三常。必问贵贱。封君败伤。（失势。）及欲
侯王。（妄念。）故（旧也。）贵脱势。虽不中邪。精神内伤。身必败亡。始富后贫。虽不伤邪。皮焦筋屈。痿 为挛。（不
得志而气血伤。筋骨挛。）医不能严。不能动神。外为柔弱。（委曲随顺。）乱至失常。病不能移。此治之四过也。凡诊者。
必知终始。有知余绪。（吴注。始病今病。以及余事。）切脉问名。当合男女。（王注。男阳气多。左大为顺。女阴气多。
右大为顺。）离绝菀（郁。）结。忧恐喜怒。（王注。离。间其亲爱也。绝。断其所怀也。菀。思虑郁积也。结。怫郁不解
也。忧则志苦。恐则气下。喜则惮散。怒则逆乱。）五脏空虚。血气离守。工不能知。何术之语。当富大伤。斩筋绝脉。
身体复行。令泽不息。（身虽复旧。而色泽尚未滋息。）故（旧也。）伤败结。留薄归阳。（王注。谓阳经及六腑。张注。
由阴伤而及于阳。）脓积寒炅。（内积脓血。外为寒热。）粗工治之。亟刺阴阳。（不别阴阳。而妄刺之。）身体解散。四肢
转筋。死日有期。医不能明。此治之五过也。故曰。圣人之治病也。必知天地阴阳。四时经纪。五脏六腑。雌雄表里。
刺灸砭石。毒药所主。从容人事。以明经道。贵贱贫富。各异品理。问年少长。勇怯之理。审于分部。知病本始。八正
九候。诊必副矣。（八正神明论。八正者。所以候八风之虚邪。以时至者也。九候。见前篇。）（疏五过论）
【诊候第五】
诊断不仅仅局限于脉诊。有的通过脉象来判断，有的通过患者的主诉（症状）来判断，有的通过形体表现来判断，有的通过面色来判断，有的通过声音来判断。《内经》中提到的“五过”和“四失”，说的都是诊断的问题。因此将诊候单独列为一门。本篇内容均出自《素问》，所以在文字上方不加特别的标识。
诊断的方法通常在清晨进行。此时阴气尚未躁动，阳气尚未耗散，饮食尚未摄入，经脉之气尚未充盛，络脉之气调和均匀，气血运行没有紊乱，所以才能诊断出异常的脉象。（所谓“过”，即差错，也就是疾病的意思。）在切按脉搏动静（脉诊）的同时，观察患者眼睛的神采（神诊。精气与神明，王冰注解说这是指睛明穴，这种解释不准确。）观察五色变化（色诊），以此考察五脏的有余或不足，六腑的强或弱（证诊）。观察形体的盛衰（形诊）。将这些方面综合参互比较，从而决断生死界限。万物之外，六合之内，天地的变化，阴阳的感应，那里的春天温暖，是夏天暑热的基础（阳气生长而达到旺盛）。那里的秋天肃杀，是冬天严寒的基础（阴气由少而至壮盛）。四季气候的变化，脉象也随之上下起伏（脉象随时间变化）。春脉应当像圆规画出的圆那样圆滑（圆滑）。夏脉应当像矩尺画出的方那样洪大（方大）。秋脉应当像秤杆那样平准微涩（涩平）。冬脉应当像秤锤那样沉实（沉石）。阴阳各有其时，脉象也有其期限。如果期限到了而脉象不相符合，就能知道脉象所归属的脏腑。既然分属不同脏腑且有期限，就能预知死亡的时间。（脉象与时令不相应，或与脏腑不相应，都称为相失。分析其生克乘侮的日期，就可以知道死亡的时间了。）脉理的微妙之处，不可不仔细考察。考察脉理有纲纪，从阴阳开始。起始有经典依据，从五行相生而来。相生有一定的规律，以顺应四时为适宜。补泻手法不要失误，要与天地自然保持一致。掌握了这一原则，就能知晓生死。因此，声音要符合五音，面色要符合五行，脉象要符合阴阳。持脉有道，虚静心神是保障。（心要虚灵，神要安静。）春天的脉象浮在表面，像鱼在水中游动。夏天的脉象在皮肤表层，泛泛然如同万物茂盛。秋天的脉象下沉到皮肤之下，像冬眠的虫子即将藏匿（因为气机逐渐下降，像虫子想要蛰伏隐藏一样）。冬天的脉象深达骨骼，像冬眠的虫子严密包裹自己，君子也居住在室内。了解体内情况的人，通过按压脉象来记录（内指脏和腑）。了解体表情况的人，从头到尾地推究（外指表和经络）。这六点，是持脉的大法。（四时的表里关系，必须明确辨别。王冰注解说“知外”是指知晓色象，似乎与持脉不合。）尺部内侧两旁，对应季胁（肋骨尽头处叫季胁。季胁靠近肾脏，尺脉主要候这里的情况。）尺部外侧候肾，尺部内侧候腹部（小腹。王冰注解说：外指外侧，里指内侧。李士材说：外指前半部，里指后半部。）中部关脉的位置（中部关脉）。左手外侧候肝，内侧候膈（左手关脉。膈指膈中）。右手外侧候胃，内侧候脾（右手关脉）。上部寸脉的位置（上部寸脉）。右手外侧候肺，内侧候胸中（右手寸脉）。左手外侧候心，内侧候膻中（左手寸脉）。关前部位候身体前部，关后部位候身体后部（关前候前，关后候后。吴崑注解说：前指候前，后指候后，也是这个意思。）从尺部一直推到寸部（由尺至寸），对应胸部和喉中的病症。从寸部一直推到尺部（自寸至尺），对应少腹、腰、股、膝、胫、足等部位的病症。（这是《内经》的诊法。吴崑说：尺外候肾，尺内候腹，小肠膀胱位于少腹。左外候肝，内候膈，未提及胆，因为胆寄附于肝。左外候心，内候膻中，膻中即心包。高阳生将大小肠列于寸口，三焦配于左尺，命门列于右尺，而膻中则不包括在内，仅仅是因为心与小肠为表里，肺与大肠为表里罢了。不知道虽然经络互为表里，但大小肠都在下焦，怎么能跨越中焦而在寸口见到脉象呢？滑伯仁认为左尺主小肠、膀胱和前阴的病，右尺主大肠和后阴的病，可谓独具只眼。另外《灵枢》说：宗气出于上焦，营气出于中焦，卫气出于下焦。上焦在膻中，中焦在中脘，下焦在脐下阴交。所以寸脉主上焦，以候胸中；关脉主中焦，以候膈中；尺脉主下焦，以候腹中。现在把三焦列在右尺，不是荒谬吗？另外肾脏虽是一个脏器，但有左右两枚。命门穴在督脉第七椎两肾之间，一阳居于二阴之中，所以构成坎卦。《内经》并没有关于命门的经文，怎么能顺着经络在寸口见到命门的脉象呢？）向外推按脉象，若脉象本应浮取却沉而不浮，说明有心腹积滞（吴崑注解说：浮取而脉沉，为病在里）。向内推按脉象，若脉象本应沉取却浮而不沉，说明身体有发热（沉取而脉浮，为病在表）。向上推按脉象，若脉象上部盛而下部不降，说明腰足寒冷（上部脉盛而下部无阳气，升而不降，所以腰足冷）。向下推按脉象，若脉象下部盛而上部不上，说明头项疼痛（下部脉盛而上部无阳气，降而不升，所以头项痛。《甲乙经》作“推而上之，下而不上；推而下之，上而不下”，文义更通顺，意思相同。我按：这就是《五常政大论》所说的“上取下取，内取外取”，以求得病变所在。）按脉至骨，若脉气微弱，说明有腰脊痛和身体痹症（脉气少即血少，所以有腰痛、脊痛、麻木不仁、活动不利等疾病。）（出自《脉要精微论》）
诊断疾病的开始，以五脏之脉为纲纪（以五脏之脉，作为决断生死的纲纪）。想要知道疾病的起始，先确立其根本（始指病源，母指当令旺气）。所谓的“五决”，就是五脏之脉（即五脏的脉象）。
脉象的小、大、滑、涩、浮、沉，可以通过手指辨别。五脏的征象，可以类推。五脏对应的声色（相，犹颜色之意），可以通过意识感知。对五色的细微诊断，可以用眼睛观察。能将脉象与面色结合判断，就可以万无一失。
脉象急促而坚实（喘指脉来急促，坚指脉体坚实），诊断为：中有积气，时常影响进食，名叫心痹（心肺位置较高，所以都说“喘”。喘表示心气不足，坚表示病气有余。痹是指脏气不能宣通运行）。这是由于外感邪气，加上思虑过度导致心气虚弱，所以邪气侵入。
脉象急促而浮，上部虚下部实，易受惊吓，胸中有积气，脉象急促且虚弱，名叫肺痹寒热（金火相战）。这是由于醉酒之后行房事所致（酒味辛热，助火克金，加之行房，则肾气虚。虚则必盗取母气来自养，肺金更加衰弱，不能行气，所以气积聚在胸中）。
脉象长而左右弹指（长而弹手，为弦紧，主寒），心下有积气，支撑胁肋（支主支撑胁肋，肝主胁，胁近心，所以说心下），名叫肝痹。这是由于感受寒湿所致，治疗方法与疝病相同（肝脉络阴器，所以疝也属于肝病）。症状包括腰痛、脚冷、头痛（肝脉经过这些地方。阴脉下行至极则上行，所以头痛）。
脉象大而虚，腹中有积气，有厥逆之气，名叫厥疝（王冰注：如果肾气逆上，则为厥疝；如果不逆上，则只是脾积）。女子发病规律相同（女子也有疝病，但不叫疝而叫瘕）。这是由于四肢过度劳累，汗出当风所致（脾主四肢，风木克土）。
脉象上部坚实且大（上字含义不详，马莳注：尺脉之上，坚而且大），少腹与阴器有积气，名叫肾痹。这是由于在清水中沐浴后躺卧所致（湿气趋下，必然归于肾）。（出自《五脏生成论》）
天地最高的数理，与人体的气血相通，决断生死。怎么做呢？回答说：天地最高的数理，始于“一”，终于“九”（九是奇数的极值）。“一”代表天，“二”代表地，“三”代表人。由此三倍之，三三得九，以对应九野。所以人体分为三部，每部有三候，用来决断生死，处理百病，调节虚实，祛除邪疾。上部天，在两额部的动脉（额旁两侧的动脉，王冰注：足少阳脉气所在）。上部地，在两颊部的动脉（鼻子两旁，近巨髎穴处的动脉，足阳明脉气所行）。上部人，在耳前的动脉（耳前凹陷中的动脉，手少阳脉气所行）。中部天，在手太阴肺经（指肺。寸口中的经渠穴动脉）。中部地，在手阳明大肠经（指大肠。手食指与拇指歧骨间，合谷穴处的动脉）。中部人，在手少阴心经（指心脉。手腕后锐骨之下，神门穴处的动脉）。下部天，在足厥阴肝经（指肝脉。阴毛际外羊矢下一寸半凹陷中，五里穴处的阴股中动脉。女子取太冲穴，在足大趾本节后二寸凹陷中）。下部地，在足少阴肾经（指肾脉。足内踝后跟骨上凹陷中，太溪穴处的动脉）。下部人，在足太阴脾经（指脾脉。足鱼腹上，越过两筋之间，阴股内箕门穴处的动脉）。所以下部天候肝，地候肾，人候脾胃之气。中部天候肺，地候胸中之气（肠胃），人候心。上部天候头角之气，地候口齿之气，人候耳目之气。三三而成天，三三而成地，三三而成人。三三相乘，合为九。九分为九野，九野对应九脏。所以神脏有五，形脏有四，合为九脏（王冰注：肝藏魂，肺藏魄，心藏神，脾藏意，肾藏志，这叫神脏五。一头角，二耳目，三口齿，四胸中，这叫形脏四。张景岳注：形脏四，指胃、大小肠、膀胱，因为它们贮藏有形之物。胆无出无入，三焦有名无形，都不贮藏有形之物。道理上也通，但与本文不够连贯。马莳注：古人诊脉，凡是头面手足的动脉，无不诊察，就像《伤寒论》多以趺阳脉言之一样。其九候法，也是以三部中有天地人，与后世的浮中沉不同。颇得古义。）必须先度量病人的形体肥瘦（大体上肥人脉沉，瘦人脉浮），以调节气的虚实（肥人气血实而气虚，瘦人气实而血虚）。实证用泻法，虚证用补法（这里说的是刺法，统括肥瘦而言）。必须先去除血脉中的瘀滞（刺去留邪），然后再调理。不论什么病，以平和为准则。
形体盛壮而脉象细弱，气息短少不足以呼吸的，危险。形体消瘦而脉象洪大，胸中多气（喘满）的，死（形气不相适应）。形气相适应的生存，参互不调的生病。三部九候的脉象都失常的，死。两眼内陷的，死（诸脉皆属于目）。
观察九候，某一部脉独小的，病。独大的，病。独快的，病。独慢的，病。独热的，病。独冷的，病。独陷入下的（吴崑注：沉伏），病（这在九候中，又有七诊之法）。
九候的脉象，都沉细悬绝的是阴脉，主冬，所以死于夜半。脉象盛大躁动、喘息数急的是阳脉，主夏，所以死于日中。寒热病的，死于平旦（吴崑注：寒证死于夜半，热证死于日中，平旦是阴阳交会之时）。热中和热病的，死于日中（火旺于午时）。患风病的，死于日夕（风属卯木，日落申酉，属金，金克木）。患水病的，死于夜半（水旺于亥子时）。脉象忽快忽慢，忽疏忽数的，死于四季末的土日（辰戌丑未土日，脾绝的缘故）。
形体肌肉已经脱失，即使九候脉象调和，也会死。七诊脉象虽然出现，但九候脉象都顺应的，不死。所说的不死，是指风气之病，以及月经之病，看似七诊之病但其实不是。所以说不会死（风病的脉象，有独大独快的；经血不足的，有独小独慢的）。如果有七诊之病，其脉候也败坏的，就会死，必定发生呃逆嗳气（胃为哕，即呃逆；心为噫，即嗳气）。（出自《三部九候论》）
面色多青则痛，多黑则痹，黄赤则热，多白则寒，五色都出现，则是寒热错杂（出自《皮部论》）。
人的居住环境和动静、勇敢怯懦，脉象也会随之变化吗？回答说：凡是人的惊恐、愤怒、劳动、静止，都会引起脉象变化。因此，夜间行走，气喘出于肾，淫溢之气伤肺（子病及母）。有所坠落恐惧，气喘出于肝，淫溢之气害脾（木邪克土）。有所惊恐，气喘出于肺，淫溢之气伤心（惊则气乱，神无所依托，所以气喘出于肺而伤心）。涉水跌倒，气喘出于肾与骨（水气通肾）。在这个时候，勇敢的人气行则病愈，怯弱的人则留着成为疾病。所以说，诊断疾病的方法，要观察人的勇敢怯懦、骨肉皮肤，能了解病情，以此作为诊断法则。
因此，饮食过饱，汗出于胃。受惊夺精，汗出于心。负重远行，汗出于肾。疾走恐惧，汗出于肝。摇体劳苦，汗出于脾。所以春夏秋冬，四时阴阳生病，起于过度使用，这是常理。（出自《经脉别论》）
凡是没有诊断过的病人，必须询问曾经尊贵后来卑贱的，即使没有中邪，病从内生，名叫脱营（心志不乐，营血不生）。曾经富有后来贫穷的，名叫失精（富则吃膏粱厚味，贫则吃粗茶淡饭，津液不生）。五气滞留运转，病邪有所合并。医生诊断时，不在脏腑，也不改变躯形（内无可求，外无可验）。诊断时感到疑惑，不知道病名。身体日渐消瘦，气虚无精，病深入而无气，洒洒然（恶寒的样子），时常惊恐。病深入的，是因为外耗卫气，内夺营血（王冰注：血被忧煎，气随悲减）。高明医生的失误，在于不了解病情，这是治疗的第一个过失。
凡是要诊断疾病，必须询问饮食起居，突然快乐突然痛苦，开始快乐后来痛苦的，都损伤精气。精气竭绝，形体毁损沮丧。暴怒伤阴，暴喜伤阳。厥气上行，充满经络，使神气离散。愚笨的医生治疗，不知道补泻，不了解病情，精华日益脱失，邪气乃并集，这是治疗的第二个过失。
善于诊脉的人，必须运用比类奇恒的方法（《病能论》：奇恒，指奇特的病）。从容地知晓它。作为医生却不知道这些，这种诊断不值得珍贵，这是治疗的第三个过失。
诊断有三个常规，必须询问贵贱、封君败伤（失势）以及想当侯王的欲望（妄念）。所以旧时尊贵失去权势，即使没有中邪，精神内伤，身体必败亡。开始富有后来贫穷，即使没有伤邪，皮焦筋屈，痿躄为挛（不得志而气血伤，筋骨挛缩）。医生不能严厉，不能感动神灵，外表柔弱（委曲随顺），扰乱至失常，病不能移，这是治疗的第四个过失。
凡诊断者，必须知道始终，了解其余绪（吴崑注：始病今病，以及余事）。切脉问名，应当结合男女（王冰注：男阳气多，左大为顺；女阴气多，右大为顺）。离绝、郁结、忧恐喜怒（王冰注：离，离间其亲爱；绝，断其所怀；菀，思虑郁积；结，怫郁不解。忧则志苦，恐则气下，喜则惮散，怒则逆乱）。五脏空虚，血气离守，医生不能知晓，有什么医术可言。当富贵时大伤，斩筋绝脉，身体恢复行动，但色泽不再滋息（身虽复旧，而色泽尚未滋润）。所以旧伤败结，留薄归阳（王冰注：谓阳经及六腑。张景岳注：由阴伤而及于阳）。脓积寒热（内积脓血，外为寒热）。粗工治疗，急切地刺阴阳（不别阴阳而妄刺之）。身体解散，四肢转筋，死期有定。医生不能明辨，这是治疗的第五个过失。
所以说，圣人的治病，必须知晓天地阴阳、四时经纪、五脏六腑、雌雄表里、刺灸砭石、毒药的主治。从容对待人事，以明晓医道。贵贱贫富，各有不同的病理。询问年少长、勇怯的道理。审于分部，知病本始。八正九候，诊断必副矣（《八正神明论》：八正，是用来候八风之虚邪，按时令而至的。九候，见前篇）。（出自《疏五过论》）
[Diagnosis and Pulse Examination, Chapter 5]
Diagnosis is not limited solely to pulse examination. Some diagnoses are derived from the pulse, some from the patient's verbal complaints (symptoms), some from physical appearance, some from facial complexion, and some from voice. The "Five Errors" and "Four Failures" mentioned in the classics all refer to diagnosis. Therefore, diagnosis and pulse examination are categorized as a separate section. The content of this chapter is entirely derived from the *Suwen* (Basic Questions), so no special markers are added to the text.
The method of diagnosis is typically performed at dawn. At this time, Yin Qi has not yet stirred, Yang Qi has not yet dispersed, food and drink have not been ingested, the Qi of the meridians is not yet full, the Qi of the collaterals is harmonious and uniform, and the flow of Qi and Blood is undisturbed. Thus, it is possible to diagnose abnormal pulses. ("Guo" refers to deviation or error, i.e., disease.) While palpating the pulse to observe its movement and stillness (Pulse Diagnosis), one must also observe the clarity of the eyes (Spirit Diagnosis. Jing-Qi and Spirit; Wang Bing's commentary interpreting this as the Jingming acupoint is inaccurate). One must observe the Five Colors (Complexion Diagnosis) to examine whether the Zang Organs are in excess or deficiency, and whether the Fu Organs are strong or weak (Symptom Diagnosis). One must observe the flourishing or declining state of the body form (Form Diagnosis). By synthesizing and comparing these aspects, one can determine the boundary between life and death. Outside the ten thousand things and within the Six Directions, changes in Heaven and Earth correspond to Yin and Yang. The warmth of spring becomes the heat of summer (Yang grows to reach abundance). The sternness of autumn becomes the anger of winter (Yin increases to reach strength). The movements of the four seasons cause the pulse to rise and fall accordingly (Pulse changes with time). The Spring pulse should resemble the circle drawn by a compass (smooth and round). The Summer pulse should resemble the square drawn by a carpenter's square (large and broad). The Autumn pulse should resemble the balance beam (slightly rough and level). The Winter pulse should resemble the weight on a steelyard (deep and heavy). Yin and Yang each have their times, and the pulse has its corresponding periods. If the period arrives but the pulse does not match, one can identify the affected organ system. Since the organs have specific periods of influence, one can predict the time of death. (When the pulse does not correspond to the season or the organ system, it is called "mismatch." By analyzing the days of generation and restriction, the time of death can be known.) The subtlety of the pulse must not be overlooked. Observing the pulse has principles, starting with Yin and Yang. The beginning follows the classics, arising from the Five Elements. Their generation has limits and should suit the four seasons. Tonification and sedation must not be missed, aligning with Heaven and Earth. Grasping this principle allows one to know life and death. Therefore, sound corresponds to the Five Tones, color corresponds to the Five Elements, and pulse corresponds to Yin and Yang. There is a way to hold the pulse: emptiness and tranquility are the guarantee. (The mind should be empty, the spirit tranquil.) The Spring pulse floats like a fish swimming in waves. The Summer pulse is on the skin surface, abundant like all things in growth. The Autumn pulse sinks below the skin, like insects preparing to hibernate (as Qi gradually descends, similar to insects hiding). The Winter pulse reaches the bone, like insects tightly curled up, and gentlemen stay indoors. Those who understand the interior record findings through palpation (Interior refers to Zang and Fu organs). Those who understand the exterior trace from end to beginning (Exterior refers to the surface and meridians). These six points constitute the great methods of pulse holding. (The exterior and interior of the four seasons must be clearly distinguished. Wang Bing commented that "knowing the exterior" means knowing facial signs, which seems inconsistent with pulse holding.) The inner side of both sides of the Chi position corresponds to the hypochondrium (the end of the ribs is called the hypochondrium. Near the kidney, the Chi pulse primarily reflects this area). The outer side of Chi reflects the Kidney, and the inner side reflects the abdomen (lower abdomen. Wang Bing noted: Outer means lateral side, Inner means medial side. Li Shicai stated: Outer means the anterior half, Inner means the posterior half). The Guan position (Middle part, Guan pulse). On the left hand, the outer side reflects the Liver, and the inner side reflects the Diaphragm (Left Guan pulse. Diaphragm refers to the diaphragmatic region). On the right hand, the outer side reflects the Stomach, and the inner side reflects the Spleen (Right Guan pulse). The Cun position (Upper part, Cun pulse). On the right hand, the outer side reflects the Lung, and the inner side reflects the Chest Middle (Right Cun pulse). On the left hand, the outer side reflects the Heart, and the inner side reflects the Danzhong (Left Cun pulse). The area before the Guan reflects the anterior body, and the area after the Guan reflects the posterior body (Before Guan reflects anterior, After Guan reflects posterior. Wu Kun noted: "Before" refers to reflecting the anterior, "After" refers to reflecting the posterior, which is the same meaning). From Chi to Cun (from lower to upper) corresponds to matters of the chest and throat. From Cun to Chi (from upper to lower) corresponds to matters of the lower abdomen, waist, thigh, knee, shin, and foot. (This is the diagnostic method of the *Neijing*. Wu Kun said: Chi outer reflects Kidney, Chi inner reflects abdomen; Small Intestine and Bladder are in the lower abdomen. Left outer reflects Liver, inner reflects Diaphragm; Gallbladder is omitted because it is attached to the Liver. Left outer reflects Heart, inner reflects Danzhong; Danzhong is the Pericardium. Gao Yangsheng placed Large and Small Intestines at the Cun, Sanjiao at the Left Chi, and Mingmen at the Right Chi, excluding Danzhong, merely because Heart and Small Intestine are exterior-interior, and Lung and Large Intestine are exterior-interior. However, although meridians are exterior-interior, the intestines are in the Lower Jiao and cannot cross the Middle Jiao to appear at the Cun. Hua Bo Ren believed the Left Chi governs diseases of the Small Intestine, Bladder, and anterior orifice, while the Right Chi governs the Large Intestine and posterior orifice, showing unique insight. Also, the *Lingshu* states: Zong Qi arises from the Upper Jiao, Ying Qi from the Middle Jiao, Wei Qi from the Lower Jiao. Upper Jiao is at Danzhong, Middle Jiao at Zhongwan, Lower Jiao below the navel at Yinjiao. Thus, Cun governs Upper Jiao reflecting the chest, Guan governs Middle Jiao reflecting the diaphragm, Chi governs Lower Jiao reflecting the abdomen. Placing Sanjiao at the Right Chi is absurd. Although the Kidney is one organ, there are left and right lobes. The Mingmen point is between the two kidneys at the 7th thoracic vertebra on the Du Meridian. One Yang resides between two Yins, forming the Kan trigram. The *Neijing* has no classic on Mingmen; how can its pulse be seen at the Cun Kou following the meridians?) Pushing outward, if the pulse is deep rather than floating, it indicates accumulation in the heart and abdomen (Wu Kun noted: Floating pressure yields a deep pulse, indicating interior disease). Pushing inward, if the pulse is floating rather than deep, it indicates heat in the body (Deep pressure yields a floating pulse, indicating exterior disease). Pushing upward, if the pulse is abundant above but not descending, it indicates cold in the waist and feet (Abundance above and lack of Yang Qi below, rising but not descending, causing cold waist and feet). Pushing downward, if the pulse is abundant below but not ascending, it indicates pain in the head and neck (Abundance below and lack of Yang Qi above, descending but not ascending, causing head and neck pain. The *Jia Yi Jing* reads "Push upward, down but not up; push downward, up but not down," which is smoother in text but identical in meaning. I note: This is what the *Wu Chang Zheng Da Lun* calls "taking above and below, inside and outside" to seek pathology.) Pressing to the bone, if the pulse Qi is scant, it indicates pain in the waist and spine and bi-syndrome in the body (Scant pulse Qi means scant Blood, leading to waist/back pain, numbness, and immobility.) (From *Mai Yao Jing Wei Lun*)
The beginning of diagnosing disease takes the Five Decisions as the guideline (Using the pulses of the Five Zang Organs as the guideline for deciding life and death). To know the beginning, first establish the mother (Beginning refers to the disease source; Mother refers to the prosperous Qi of the season). The so-called "Five Decisions" are the five pulses (i.e., the pulses of the Five Zang Organs).
The small, large, slippery, rough, floating, and sinking qualities of the pulse can be distinguished by fingers. The manifestations of the Five Zang Organs can be inferred by analogy. The tones of the Five Zang Organs (Xiang, meaning color/appearance) can be perceived by consciousness. Subtle diagnosis of the Five Colors can be observed by the eye. Combining pulse and color diagnosis ensures perfection.
A pulse that is rapid and firm (Chuan refers to rapid pulse arrival; Jian refers to firm pulse body) is diagnosed as: Accumulation of Qi in the middle, occasionally hindering eating, named Xin Bi (Heart Bi). (The Heart and Lung are located high, hence "Chuan" is used. Chuan indicates Heart Qi deficiency; Jian indicates pathogenic excess. Bi refers to the failure of Zang Qi to circulate freely.) This results from external pathogens combined with excessive thinking causing Heart Qi deficiency, allowing pathogens to enter.
A pulse that is rapid and floating, with deficiency above and excess below, prone to fright, with accumulated Qi in the chest, rapid and weak pulse, is named Fei Bi (Lung Bi) with cold and heat. (Metal and Fire battling.) This results from intercourse after drunkenness. (Alcohol is pungent and hot, aiding Fire to overcome Metal. Intercourse depletes Kidney Qi. Deficiency leads to stealing Qi from the Mother element to nourish itself, further weakening Lung Metal, preventing Qi circulation, causing Qi accumulation in the chest.)
A pulse that is long and elastic on both sides (Long and elastic to the touch indicates Xian/Jin [wiry/tight], associated with Cold) indicates accumulated Qi under the heart, supporting the hypochondrium (Support relates to hypochondrium; Liver governs hypochondrium; hypochondrium is near the heart, hence "under the heart"). It is named Gan Bi (Liver Bi). This results from Cold-Dampness, treated similarly to Shan syndrome. (The Liver meridian connects to the genitalia, so Shan also belongs to Liver pathology. Symptoms include waist pain, cold feet, and headache. (The Liver meridian passes through these areas. Yin meridians descend to the extreme then ascend, hence headache.)
A pulse that is large and empty indicates accumulated Qi in the abdomen and Jue Qi, named Jue Shan. (Wang Bing noted: If Kidney Qi rebels upward, it is Jue Shan; if not, it is simply Pi Ji [Spleen accumulation].) Women follow the same pattern. (Women also have Shan conditions, but they are named Jia [masses] rather than Shan.) This results from strenuous use of the four limbs with sweat exposed to wind. (The Spleen governs the four limbs; Wind Wood overcomes Earth.)
A pulse that is firm and large above (The character "Shang" is unclear; Ma Shi noted: Above the Chi pulse, firm and large) indicates accumulated Qi in the lower abdomen and genitalia. It is named Shen Bi (Kidney Bi). This results from bathing in cold water and lying down. (Dampness tends downward and returns to the Kidney.) (From *Wu Zang Sheng Cheng Lun*)
The highest numbers of Heaven and Earth correspond to human form, Qi, and Blood, determining life and death. How? The highest numbers of Heaven and Earth begin with One and end with Nine (Nine is the extreme of odd numbers). One represents Heaven, Two represents Earth, Three represents Man. Tripling these, three times three equals nine, corresponding to the Nine Fields. Thus, the human body is divided into Three Parts, each with Three Positions, to decide life and death, treat hundred diseases, regulate excess and deficiency, and eliminate pathogens. Upper Part Heaven: Artery at both temples (Arteries on both sides of the forehead; Wang Bing: Location of Foot Shaoyang Qi). Upper Part Earth: Artery at both cheeks (Arteries beside the nose near Juliao; Foot Yangming Qi pathway). Upper Part Human: Artery in front of both ears (Artery in the depression in front of the ear; Hand Shaoyang Qi pathway). Middle Part Heaven: Hand Taiyin (Refers to Lung. Jingqu acupoint artery in the Cun Kou). Middle Part Earth: Hand Yangming (Refers to Large Intestine. Hegu acupoint artery between the metacarpals of the thumb and index finger). Middle Part Human: Hand Shaoyin (Refers to Heart pulse. Shenmen acupoint artery below the styloid process of the ulna). Lower Part Heaven: Foot Jueyin (Refers to Liver pulse. Wuli acupoint artery in the groin, 1.5 cun below the pubic hair line. For women, Taichong acupoint, 2 cun behind the first metatarsophalangeal joint). Lower Part Earth: Foot Shaoyin (Refers to Kidney pulse. Taixi acupoint artery behind the medial malleolus). Lower Part Human: Foot Taiyin (Refers to Spleen pulse. Jinmen acupoint artery between the tendons on the medial thigh). Thus, Lower Part Heaven reflects the Liver, Earth reflects the Kidney, Human reflects Spleen and Stomach Qi. Middle Part Heaven reflects the Lung, Earth reflects Chest Middle Qi (Intestines), Human reflects the Heart. Upper Part Heaven reflects Head/Horn Qi, Earth reflects Mouth/Teeth Qi, Human reflects Ear/Eye Qi. Three threes make Heaven, three threes make Earth, three threes make Man. Three times three combines to nine. Nine divides into Nine Fields. Nine Fields correspond to Nine Organs. Thus, there are five Spirit Organs and four Form Organs, totaling nine. (Wang Bing noted: Liver stores Hun, Lung stores Po, Heart stores Shen, Spleen stores Yi, Kidney stores Zhi; these are the five Spirit Organs. Head/horns, ears/eyes, mouth/teeth, chest middle; these are the four Form Organs. Zhang Jingyue noted: The four Form Organs are Stomach, Large Intestine, Small Intestine, and Bladder, which store有形 substances. Gallbladder has no exit or entry, Sanjiao has name but no form, neither stores有形 substances. This logic is valid but less coherent with the text. Ma Shi noted: Ancient physicians palpated all arteries on the head, face, hands, and feet, similar to the frequent use of Duzi pulse in *Shanghan Lun*. The Nine Positions method uses Heaven/Earth/Human within the three parts, differing from the later Floating/Middle/Sinking. This captures the ancient meaning.) First, measure the patient's fatness or thinness (Generally, fat people have deep pulses, thin people have floating pulses) to regulate the deficiency or excess of Qi (Fat people have substantial Blood but deficient Qi; thin people have substantial Qi but deficient Blood). Excess is sedated, deficiency is tonified (This refers to acupuncture, covering both fat and thin types). First remove blood stasis (Acupuncture to expel lingering pathogens), then regulate. Regardless of the disease, aim for harmony.
If the body is robust but the pulse is fine, with shortness of breath, it is dangerous. If the body is emaciated but the pulse is large, with excessive Qi in the chest (asthma/fullness), it is fatal (Body and Qi do not match). If Body and Qi match, the patient lives. If they are discordant, the patient is ill. If all Nine Positions are mismatched, the patient dies. If the eyes are sunken, the patient dies (All meridians connect to the eyes).
Observe the Nine Positions: If one position is exclusively small, it is diseased. Exclusively large, diseased. Exclusively rapid, diseased. Exclusively slow, diseased. Exclusively hot, diseased. Exclusively cold, diseased. Exclusively sunken/depressed (Wu Kun noted: Deep and hidden), diseased. (Within the Nine Positions, there is also the Seven Diagnoses method.)
If the pulses in all Nine Positions are deep, fine, and hanging/cutoff, they are Yin pulses, governing Winter, so death occurs at midnight. If the pulses are盛大 (abundant), restless, panting, and rapid, they are Yang pulses, governing Summer, so death occurs at noon. Patients with cold-heat diseases die at dawn (Wu Kun noted: Cold diseases die at midnight, heat diseases die at noon; dawn is the intersection of Yin and Yang). Patients with internal heat and heat diseases die at noon (Fire is prosperous at Wu hour). Patients with wind diseases die at dusk (Wind belongs to Mao Wood; sunset is Shen/You Metal; Metal overcomes Wood). Patients with water diseases die at midnight (Water is prosperous at Hai/Zi hours). Pulses that are suddenly sparse, suddenly numerous, suddenly slow, suddenly rapid indicate death on the Earth days of Chen/Xu/Chou/Wei (Spleen exhaustion). If flesh and muscle are already wasted away, even if the Nine Positions are harmonious, the patient will die. If the Seven Diagnoses are present but the Nine Positions all comply, the patient will not die. The "not dying" refers to wind diseases and menstrual diseases, which resemble the Seven Diagnoses but are not actually them. Hence, it is said they will not die (Wind disease pulses may be exclusively large or rapid; insufficient menstruation pulses may be exclusively small or slow). If the Seven Diagnoses are present and the pulse condition is also exhausted, the patient will die, likely developing hiccup and belching (Stomach causes hiccup/eructation; Heart causes belching/sighing.) (From *San Bu Jiu Hou Lun*)
Complexion mostly blue indicates pain; mostly black indicates Bi-syndrome; yellow/red indicates heat; mostly white indicates cold; if all five colors appear, it indicates mixed cold and heat. (From *Pi Bu Lun*)
Do living environment, activity/rest, courage, and timidity cause pulse changes? Answer: Fear, anger, labor, and rest all cause changes. Therefore, walking at night causes panting originating from the Kidney, with excessive Qi damaging the Lung (Child disease affecting Mother). Falling or fearing causes panting originating from the Liver, with excessive Qi harming the Spleen (Wood evil overcoming Earth). Being startled causes panting originating from the Lung, with excessive Qi damaging the Heart (Startle scatters Qi, Spirit has no foundation, so panting originates from Lung and damages Heart). Wading through water or falling causes panting originating from the Kidney and bones (Water Qi connects to Kidney). At such times, courageous people recover as Qi moves, while timid people develop disease. Thus, the method of diagnosis involves observing courage and timidity, bone, muscle, and skin to understand the condition.
Therefore, excessive eating causes sweat from the Stomach. Fright causing loss of Essence causes sweat from the Heart. Carrying heavy loads and traveling far causes sweat from the Kidney. Running fast and fearing causes sweat from the Liver. Shaking body and hard labor causes sweat from the Spleen. Thus, diseases arising from the Four Seasons' Yin and Yang result from overuse; this is the constant rule. (From *Jing Mai Bie Lun*)
For patients not yet diagnosed, one must ask if they were formerly noble but now lowly. Even without external pathogens, disease arises internally, named Tuo Ying (Depletion of Ying). (Unhappy mind, Ying Blood not generated.) Formerly rich but now poor, named Shi Jing (Loss of Jing). (Rich eat rich foods, poor eat coarse grains, fluids not generated.) Five Qi stagnate and move, pathogens combine. Physicians diagnose, finding nothing in the Zang/Fu, no change in form. (Nothing to find internally, nothing to verify externally.) Diagnosis is doubtful, disease name unknown. Body wastes daily, Qi is empty without Jing, disease is deep without Qi, shivering with chills, frequent fright. Deep disease results from external depletion of Wei Qi and internal deprivation of Ying Qi. (Wang Bing: Blood is tormented by worry, Qi decreases with grief.) The failure of good physicians lies in not understanding the condition; this is the first treatment error.
Anyone wishing to diagnose must ask about diet and residence, sudden joy or sorrow, starting happy then becoming sad, all of which damage Jing Qi. Exhaustion of Jing Qi destroys the form. Sudden anger damages Yin, sudden joy damages Yang. Jue Qi rises upward, filling the meridians and separating from the form. Ignorant physicians do not know tonification or sedation, nor the condition; essence depletes daily, pathogens accumulate. This is the second treatment error.
Those skilled in pulse diagnosis must use comparison and analysis of extraordinary cases (*Bing Neng Lun*: Qiheng refers to unusual diseases). They understand calmly. A physician who does not know this is unworthy of respect; this is the third treatment error.
There are three constants in diagnosis: Must ask about status (noble/base), loss of power (marquis defeated), and desire for nobility (delusion). Thus, former nobles losing power, even without pathogens, suffer internal spiritual injury and bodily collapse. Former rich becoming poor, even without pathogens, suffer dry skin, bent sinews, flaccidity, and contracture. (Frustration damages Qi and Blood, contracting sinews and bones.) Physicians unable to be strict, unable to move the Spirit, appearing weak (compliant), disrupt order, fail to cure disease; this is the fourth treatment error.
All diagnosticians must know the beginning and end, understand residual details. Palpating pulse and asking name must match male/female patterns. (Wang Bing: Men have more Yang Qi, large left pulse is favorable; Women have more Yin Qi, large right pulse is favorable.) Separation, depression, worry, fear, joy, anger. (Wang Bing: Separation severs affection; Severance cuts off desires; Depression accumulates thought; Knotting prevents resolution. Worry makes will bitter, Fear makes Qi sink, Joy makes Spirit scatter, Anger makes Qi rebel.) Five Zang Organs become empty, Qi and Blood leave their posts. If the physician does not know, what medical skill is there? Great injury when wealthy, cutting sinews and severing pulses. Body recovers movement, but luster does not return. (Body returns to normal, but luster does not regenerate.) Old injuries and knots, lingering pathogens return to Yang. (Wang Bing: Refers to Yang meridians and Six Fu Organs. Zhang Jingyue: Injury starts in Yin and affects Yang.) Pus accumulation with cold and heat. (Internal pus/blood accumulation, external cold/heat.) Crude physicians treat by urgently needling Yin and Yang (Not distinguishing Yin/Yang, needling recklessly). Body disintegrates, limbs cramp, death is imminent. Physician fails to clarify; this is the fifth treatment error.
Thus, it is said: The sage treats disease by knowing Heaven and Earth Yin/Yang, Four Seasons regulations, Five Zang and Six Fu Organs, Male/Female and Exterior/Interior relationships, indications for acupuncture, moxibustion, stone needles, and drugs. Calmly handling human affairs, clarifying the Dao of the Classics. Noble/base, rich/poor, each has different pathological principles. Ask about age, courage, and timidity. Examine the divisions, know the root of disease. Eight Rectitudes and Nine Positions, diagnosis will be accurate. (From *Ba Zheng Shen Ming Lun*: Ba Zheng refers to observing the eight winds' false pathogens according to time. Nine Positions, see previous chapter.) (From *Shu Wu Guo Lun*)