凡诊脉,当视其人大小、长短及性气缓急。脉之迟速、大小、长短皆如其人形性者,则吉。反之者,则为逆也。脉
三部大都欲等,只如小人、细人、妇人脉小软。小儿四、五岁,脉呼吸八至,细数者,吉。(《千金翼》云∶人大而脉细,
人细而脉大,人乐而脉实,人苦而脉虚,性急而脉缓,性缓而脉躁,人壮而脉细,人羸而脉大,此皆为逆,逆则难治。
反此为顺,顺则易治。凡妇人脉常欲濡弱于丈夫。小儿四、五岁者,脉自快疾,呼吸八至也。男左大为顺,女右大为顺。
肥人脉沉,瘦人脉浮)
脉有轻重,何谓也?然∶初持脉如三菽之重,与皮毛相得者,肺部也(菽者,小豆。言脉轻如三小豆之重。 HT
作皮毛之间者,肺气所行,故言肺部也)。如六菽之重,与血脉相得者,心部也(心主血脉,次于肺,如六豆之重)。如
九菽之重,与肌肉相得者,脾部也(脾在中央,主肌肉,故次心如九豆之重)。如十二菽之重,与筋平者,肝部也(肝主
筋,又在脾下,故次之)。按之至骨,举之来疾者,肾部也(肾主骨,其脉沉至骨)。故曰轻重也。
《脉法赞》云∶肝心出左,脾肺出右,肾与命门,俱出尺部,魂魄谷神,皆见寸口。左主司官,右主司府。左大顺
男,右大顺女。关前一分,人命之主。左为人迎,右为气口。神门诀断,两在关后。人无二脉,病死不愈。诸经损减,
各随其部。察按阴阳,谁与先后(《千金》云∶三阴三阳,谁先谁后)。阴病治官,阳病治府。奇邪所舍,如何捕取?审
而知者,针入病愈。
心部在左手关前寸口是也,即手少阴经也,与手太阳为表里,以小肠合为府。合于上焦,名曰神庭,在龟(一作鸠)
尾下五分。肝部在左手关上是也,足厥阴经也,与足少阳为表里,以胆合为府,合于中焦,名曰胞门(一作少阳),在大
仓左右三寸。肾部在左手关后尺中是也,足少阴经也,与足太阳为表里,以膀胱合为府,合于下焦,在关元左。
肺部在右手关前寸口是也,手太阴经也,与手阳明为表里,以大肠合为府,合于上焦,名呼吸之府,在云门。
脾部在右手关上是也,足太阴经也,与足阳明为表里,以胃合为府,合于中焦脾胃之间,名曰章门,在季胁前一寸
半。
肾部在右手关后尺中是也,足少阴经也,与足太阳为表里,以膀胱合为府,合于下焦,在关元右,左属肾,右为子
户,名曰三焦。
凡诊察脉象,应当观察病人的体型大小、身体长短以及性格气质的缓急。脉象的迟速、大小、长短如果与病人的形体和性格相符合,就是吉兆;反之,如果不相符,就是逆证。
寸、关、尺三部脉大体上应该均衡一致,只是小人、瘦小之人、妇女的脉象通常较小且柔软。四、五岁的儿童,脉搏在一呼一吸间跳动八次,脉象细而数,这是吉兆。(《千金翼方》说:人体型大而脉象细,人体型小而脉象大,心情愉快但脉象实,痛苦不堪但脉象虚,性格急躁但脉象缓,性格迟缓但脉象躁动,身体壮实但脉象细,身体消瘦但脉象大,这些都属于逆证,逆证则难以治疗。与此相反的情况属于顺证,顺证则容易治疗。凡是妇女的脉象通常比男子柔和无力。四、五岁的儿童,脉搏自然较快,一呼一吸间跳动八次。男子左手脉象盛大为顺,女子右手脉象盛大为顺。肥胖人的脉象沉,消瘦人的脉象浮。)
脉象有轻重的区别,这是什么意思呢?回答说:初持脉时,力度如同三粒小豆的重量,感觉在皮毛之间,这是肺部的脉象(菽是小豆的意思。说的是脉轻如三粒小豆的重量。《甲乙经》作“在皮毛之间”,因为这是肺气运行的部位,所以说这是肺部)。如果力度如同六粒小豆的重量,感觉在血脉之中,这是心部的脉象(心主血脉,位置次于肺,力度如六粒小豆重)。如果力度如同九粒小豆的重量,感觉在肌肉之中,这是脾部的脉象(脾位于中央,主司肌肉,所以位置次于心,力度如九粒小豆重)。如果力度如同十二粒小豆的重量,感觉与筋平齐,这是肝部的脉象(肝主筋,位置又在脾之下,所以次序在此)。按压至骨,抬起手指时脉来疾速有力的,是肾部的脉象(肾主骨,其脉沉至骨)。这就叫做脉的轻重。
《脉法赞》说:肝、心的脉气出于左手,脾、肺的脉气出于右手,肾与命门,都出于尺部,魂、魄、谷神,都显现于寸口。左手主要主管五脏(官),右手主要主管六腑(府)。左手脉大为顺(对应男性),右手脉大为顺(对应女性)。关前一分,是人体生命的主宰。左手关前为人迎穴位,右手关前为气口穴位。神门穴在关后两侧。人如果没有这两条脉(指人迎和气口,或指左右手对应的关键脉位),病重则无法治愈。各条经脉受损减弱,要分别根据它们所在的部位进行诊治。审察按摸阴阳脉气,判断谁先谁后(《千金方》说:三阴三阳,谁先谁后)。阴病治疗脏腑之募穴(官),阳病治疗六腑之募穴(府)。奇邪所停留的部位,如何捕捉取得?仔细审察并明确诊断,针刺进入后疾病即可痊愈。
心部位于左手关前寸口处,即手少阴心经,与手太阳小肠经互为表里,与小肠合为腑。合于上焦,名为神庭,位于龟尾(一作鸠尾)下五分处。肝部位于左手关上处,即足厥阴肝经,与足少阳胆经互为表里,与胆合为腑,合于中焦,名为胞门(一作少阳),在大仓(指脾胃区域)左右三寸处。肾部位于左手关后尺中处,即足少阴肾经,与足太阳膀胱经互为表里,与膀胱合为腑,合于下焦,在关元穴左侧。
肺部位于右手关前寸口处,即手太阴肺经,与手阳明大肠经互为表里,与大肠合为腑,合于上焦,名为呼吸之腑,位于云门穴处。
脾部位于右手关上处,即足太阴脾经,与足阳明胃经互为表里,与胃合为腑,合于中焦脾胃之间,名为章门穴,位于季胁前一寸半处。
肾部位于右手关后尺中处,即足少阴肾经,与足太阳膀胱经互为表里,与膀胱合为腑,合于下焦,在关元穴右侧,左侧属肾,右侧为子户,名为三焦。
In general, when palpating the pulse, one should observe the patient's body size (stature), length, and the slowness or quickness of their temperament. If the speed, magnitude, and length of the pulse correspond to the patient's physique and temperament, it is auspicious (Ji). Conversely, if they do not correspond, it is inauspicious (Ni).
The pulses at the three positions (Cun, Guan, Chi) should generally be balanced, except that the pulses of small persons, thin persons, and women are typically smaller and softer. For children aged four or five, a pulse rate of eight beats per respiration, which is fine and rapid, is auspicious. (According to *Qianjin Yi Fang*: A large person with a fine pulse, a small person with a large pulse, a happy person with an excess pulse, a suffering person with a deficient pulse, an irritable person with a slow pulse, a sluggish person with a restless pulse, a robust person with a fine pulse, and a emaciated person with a large pulse—all these are considered Ni (inauspicious/inverse), and Ni conditions are difficult to treat. The opposite constitutes Shun (auspicious/concordant), and Shun conditions are easy to treat. Generally, women's pulses are often more soft and weak than men's. Children aged four or five naturally have faster pulses, with eight beats per respiration. For men, a larger pulse on the left is Shun; for women, a larger pulse on the right is Shun. Obese individuals have deep pulses, while thin individuals have superficial pulses.)
What is meant by the lightness and heaviness of the pulse? It is said: When initially holding the pulse with a pressure equivalent to the weight of three beans (Shu, referring to small beans), feeling it in the skin and hair, this corresponds to the Lung position (The text notes "between skin and hair," as this is where Lung Qi circulates, hence it is called the Lung position). With a pressure equivalent to six beans, feeling it in the blood vessels, this corresponds to the Heart position (The Heart governs the blood vessels and is located below the Lung; the pressure is like six beans). With a pressure equivalent to nine beans, feeling it in the muscles, this corresponds to the Spleen position (The Spleen is central and governs the muscles, so it follows the Heart with a pressure like nine beans). With a pressure equivalent to twelve beans, feeling it level with the sinews, this corresponds to the Liver position (The Liver governs the sinews and is located below the Spleen, so it follows in order). Pressing down to the bone, and upon lifting the finger, the pulse returns swiftly, this corresponds to the Kidney position (The Kidney governs the bones, and its pulse is deep, reaching the bone). This is referred to as lightness and heaviness.
*Maifa Zan* states: The Liver and Heart emerge from the left side; the Spleen and Lung emerge from the right side; the Kidney and Mingmen (Gate of Vitality) both emerge from the Chi position. Hun (Ethereal Soul), Po (Corporeal Soul), Gu Shen (Grain Spirit), all manifest at the Cun Kou (Radial Artery Pulse Point). The left side primarily governs the Zang organs (Guan); the right side primarily governs the Fu organs (Fu). A larger pulse on the left is Shun for men; a larger pulse on the right is Shun for women. One fen anterior to the Guan is the master of human life. The left anterior to Guan is Renying; the right anterior to Guan is Qikou. Shenmen is determined by the two points posterior to the Guan. If a person lacks these two pulses, death will not be avoided if ill. When meridians are damaged and weakened, diagnose according to their respective positions. Examine and press Yin and Yang pulses to determine precedence (*Qianjin Fang* asks: Among the Three Yin and Three Yang, who comes first?). Treat Yin diseases at the Zang organ front-mu points (Guan); treat Yang diseases at the Fu organ front-mu points (Fu). How to capture the pathogenic factors lodged in extraordinary channels? Careful examination leads to accurate diagnosis; once acupuncture needles are inserted, the disease heals.
The Heart position is located at the Cun Kou anterior to the Guan on the left hand, which is the Hand-Shaoyin Heart Meridian. It is exterior-interior related to the Hand-Taiyang Small Intestine Meridian, forming the Fu organ with the Small Intestine. It connects to the Upper Jiao (Upper Burner), named Shenting, located 5 fen below Guiwei (or Jiawei). The Liver position is located at the Guan on the left hand, which is the Foot-Jueyin Liver Meridian. It is exterior-interior related to the Foot-Shaoyang Gallbladder Meridian, forming the Fu organ with the Gallbladder. It connects to the Middle Jiao, named Baomen (or Shaoyang), located 3 cun to the left and right of Dacang (referring to the spleen/stomach area). The Kidney position is located at the Chi posterior to the Guan on the left hand, which is the Foot-Shaoyin Kidney Meridian. It is exterior-interior related to the Foot-Taiyang Bladder Meridian, forming the Fu organ with the Bladder. It connects to the Lower Jiao, located to the left of Guanyuan.
The Lung position is located at the Cun Kou anterior to the Guan on the right hand, which is the Hand-Taiyin Lung Meridian. It is exterior-interior related to the Hand-Yangming Large Intestine Meridian, forming the Fu organ with the Large Intestine. It connects to the Upper Jiao, named the Respiration Fu, located at Yunmen. The Spleen position is located at the Guan on the right hand, which is the Foot-Taiyin Spleen Meridian. It is exterior-interior related to the Foot-Yangming Stomach Meridian, forming the Fu organ with the Stomach. It connects to the Middle Jiao between the Spleen and Stomach, named Zhangmen, located 1.5 cun anterior to the costal margin. The Kidney position is located at the Chi posterior to the Guan on the right hand, which is the Foot-Shaoyin Kidney Meridian. It is exterior-interior related to the Foot-Taiyang Bladder Meridian, forming the Fu organ with the Bladder. It connects to the Lower Jiao, located to the right of Guanyuan. The left side belongs to the Kidney, and the right side is the Zi Hu (House of the Child), named Sanjiao (Triple Burner).