肺象金,与大肠合为腑(大肠为传导之腑也)。其经手太阴(手太阴肺脉也),与手阳明为表里(手阳明大肠脉也)。
其脉浮(浮,肺脉之大形也)。其相季夏六月(季夏土王金相)。其王秋三月,废冬三月,囚春三月,死夏三月(夏火王
金死)。其王日庚辛,王时晡时、日入;其困日甲乙,困时平旦、日出;其死日丙丁,死时禺中、日中。其神魄,其主声,
其养皮毛,其候鼻,其声哭,其色白,其臭腥,其液涕,其味辛,其宜咸,其恶苦。肺俞在背第三椎(或云第五椎也),
募在中府(直两乳上下肋间)。大肠俞在背第十六椎,募在天枢(挟脐旁各一寸半)上新撰。
肺者西方金,万物之所终(金性刚,故王西方,割断万物,万物是以皆终于秋也)。宿叶落柯,萋萋枝条,其杌然独
在。其脉为微浮毛,卫气迟(萋萋者,零落之貌也,言草木宿叶得秋随风而落,但有枝条杌然独在。此时阳气则迟,脉
为虚微如毛也),荣气数。数则在上,迟则在下,故名曰毛(诸阳脉数,诸阴脉迟,荣为阴,不应数,反言荣气数,阴得
秋节而升转在阳位,故一时数而在上也。此时阴始用事,阳即下藏,其气反迟,是以肺脉数散如毛也)。阳当陷而不陷,
阴当升而不升,为邪所中(阴阳交易,则不以时定,二气感激,故为风寒所中)。阳中邪则卷,阴中邪则紧,卷则恶寒,
紧则为栗,寒栗相薄,故名曰疟。弱则发热,浮乃来出(卷者,其人拘卷也,紧者,脉紧也。此谓国中风寒之时,脉紧,
其人则寒,寒止而脉更微弱,弱则其人发热,热止则脉浮,浮者,疟解王脉出也),旦中旦发,暮中暮发(言疟发皆随其
国中风邪之时也)。脏有远近,脉有迟疾,周有度数,行有漏刻(脏,谓人五脏,肝心脾肺肾也,心肺在膈上,呼则其气
出,是为近,呼为阳,其脉疾。肾肝在膈下,吸则其气入,是为远也,吸为阴,其脉迟。度数,谓经脉之长短,周身行
者,荣卫之行也。行阴、阳各二十五度,为一周也,以应漏下百刻也)。迟在上,伤毛采;数在下,伤下焦。中焦有恶则
见,有善则匿(秋则阳气迟,阴气数。迟当在下,数当在上,随节变,故言伤毛采也。人之皮毛,肺气所行。下焦在脐
下,阴之所治也,其脉应迟,今反数,故言伤下焦。中焦,脾也,其平善之时脉常自不见,衰乃见耳。故云有恶则见也)。
阳气下陷,阴气则温(言阳气下陷,温养诸脏)。阳反在下,阴反在巅,故名曰长而且留。(阴阳交代,各顺时节,人血
脉和平,言可长留竟一时)上四时经。
黄帝问曰∶秋脉如浮,何如而浮?岐伯对曰∶秋脉肺也,西方金也,万物之所以收成也。故其气来轻虚而浮,其气
来急去散,故曰浮。反此者病。黄帝曰∶何如而反?岐伯曰∶其气来毛而中央坚,两旁虚,此谓太过,病在外;其气来
毛而微,此谓不及,病在中。黄帝曰∶秋脉太过与不及,其病何如?岐伯曰∶太过则令人气逆而背痛温温(《内经》温温
作愠愠)然,不及则令人喘,呼吸少气而咳,上气见血,下闻病音。
肺脉来厌厌聂聂,如落榆荚,曰肺平。秋以胃气为本(《难经》云∶厌厌聂聂,如循榆叶,曰春平脉。蔼蔼如车盖。
按之益大,曰秋平脉),肺脉来不上不下,如循鸡羽,曰肺病(《巢源》无不字)。肺脉来如物之浮,如风吹毛,曰肺死。
真肺脉至,大而虚,如以毛羽中人肤,色赤白不泽,毛折,乃死。秋胃微毛,曰平;毛多胃少,曰肺病;但毛无胃,曰
死。毛而有弦,曰春病;弦甚,曰今病。肺藏气,气舍魄。喜乐无极则伤魄,魄伤则狂,狂者意不存人,皮革焦,毛悴
色夭,死于夏。秋金肺王。其脉浮(《千金》浮作微)涩而短,曰平脉。反得洪大而散者(《千金》作浮大而洪),是心之
乘肺,火之克金,为贼邪,大逆,十死不治(一本云∶日,月、年数至四,忌丙丁),反得沉濡而滑者,是肾之乘肺,子
之扶母,为实邪,虽病自愈,反得大而缓者,是脾之乘肺,母之归子,为虚邪,虽病易治。反得弦细而长者,是肝之乘
肺,木之陵金,为微邪,虽病即瘥。肺脉来,泛泛轻如微风吹鸟背上毛,再至,曰平;三至,曰离经,病;四至,脱精;
五至,死;六至,命尽。手太阴脉也。肺脉急甚,为癫疾;微急,为肺寒热,怠堕,咳唾血,引腰背胸,苦鼻息肉不通。
缓甚,为多肝;微缓,为痿偏风(一作漏风),头以下汗出不可止。太甚,为胫肿;微大,为肺痹,引胸背,起腰内。小
甚,为飧泄;微小,为消瘅。滑甚,为息贲,上气;微滑,为上下出血。涩甚,为呕血;微涩,为鼠 ,在颈支掖之间,
下不胜其上,其能喜酸。手太阴气绝则皮毛焦。太阴者,行气温皮毛者也,气弗营则皮毛焦,皮毛焦则津液去,津液去
则皮节伤,皮节伤者则爪(爪字一作皮)枯毛折,毛折者则气(气字一作毛)先死。丙笃丁死,火胜金也。肺死脏,浮
之虚,按之弱如葱叶,下无根者,死。上《素问》《针经》、张仲景。
肺在五行中对应金,与大肠相合构成腑(大肠是负责传导糟粕的腑)。其经脉为手太阴经(即手太阴肺脉),与手阳明经互为表里(手阳明大肠脉)。
肺脉的形态表现为浮(“浮”是肺脉的主要特征)。它对应的季节是季夏六月(此时土气旺盛,金气与之相配合)。它在秋季三个月处于旺盛状态,在冬季三个月处于废弛状态,在春季三个月处于受制状态,在夏季三个月处于死亡状态(因为夏季火旺,金被火克而死)。它对应的天干日是庚日和辛日,对应的时间段是傍晚时分和日落时;受困的日子是甲日和乙日,对应的时间段是天刚亮和日出时;死亡的日子是丙日和丁日,对应的时间段是上午九至十一点和正午。肺的神志为魄,主管声音,滋养皮毛,通过鼻子反映病情,发出的声音类似哭,颜色为白色,气味为腥,分泌液为涕,味道喜辛,适宜咸味,厌恶苦味。肺的背俞穴位于背部第三椎旁(也有说法认为是第五椎),募穴在中府穴(位于两乳之间上下肋间)。大肠的背俞穴位于背部第十六椎,募穴在天枢穴(脐旁各一寸半处),这是新编纂的内容。
肺属于西方的金,是万物终结之所(金性刚强,所以王于西方,具有割断万物的特性,因此万物都在秋天终结)。就像树叶落在树枝上,枝条稀疏零落,只剩下枯枝独自存在。此时的脉象微浮而毛(“萋萋”形容草木凋零的样子,意指秋天的宿叶随风飘落,只剩枝条孤立。此时阳气衰退缓慢,脉象虚微如羽毛),营气运行较快。快则在上部,慢则在下部,所以称为“毛”脉(通常阳脉快,阴脉慢,营气属阴,不应快,这里说营气快,是因为阴气得到秋令节气的影响而上升转至阳位,所以在上部显得快。此时阴气开始主事,阳气随即潜藏,气的运行反而变慢,所以肺脉散漫如毛)。阳气应当下降而不降,阴气应当上升而不升,导致被邪气侵袭(阴阳交替如果不按时进行,二气激荡,就会被风寒所伤)。阳气受邪则拘卷,阴气受邪则紧束,拘卷则恶寒,紧束则战栗,寒战相互搏结,所以称为疟疾。脉弱则发热,脉浮则病邪外出(“卷”指身体拘挛,“紧”指脉紧。这是在描述国家遭受风寒之时,脉紧,人感到寒冷,寒止后脉更微弱,脉弱则人发热,热止后脉浮,脉浮表示疟疾解除,正常的肺脉显现)。早晨感受邪气早晨发病,傍晚感受邪气傍晚发病(意思是疟疾发作都随着该国中风邪的时间而定)。脏腑有远近之分,脉象有迟疾之别,周身循环有定数,气血运行有漏刻计时(“脏”指人的五脏:肝、心、脾、肺、肾。心肺在膈肌之上,呼气时气出,称为近,呼为阳,脉象疾速。肝肾在膈肌之下,吸气时气入,称为远,吸为阴,脉象迟缓。“度数”指经脉的长度,周身运行的荣卫之气。行阴二十五度,行阳二十五度,为一周,对应漏壶滴下的百刻时间)。脉迟在上部,损伤皮毛色泽;脉数在下部,损伤下焦。中焦如果有病态就会显现,如果正常就会隐匿(秋季阳气迟缓,阴气快速。迟缓应在下部,快速应在上部,随节气变化,所以说损伤皮毛色泽。人的皮毛是肺气运行的部位。下焦在脐下,是阴气治理的地方,脉象应迟缓,现在反而快速,所以说损伤下焦。中焦即脾,其平和正常时脉象常不显现,衰弱时才显现。所以说有病态才显现)。阳气下陷,阴气就温暖(意思是阳气下陷,温养各个脏腑)。阳气反而在下部,阴气反而在顶部,所以称为长久而停留(阴阳交接,各自顺应时节,人体血脉和平,意思是可以在一段时间内长久维持)。以上引用自《四时经》。
黄帝问道:秋天的脉象像浮脉,什么样的情况算作浮?岐伯回答说:秋脉对应肺,属于西方的金,是万物收获成熟的季节。所以它的脉气来势轻虚而浮,来势急而去势散,所以称为浮。与此相反的就是病脉。黄帝问:怎样算是相反?岐伯说:脉气来时如羽毛般轻浮但中间坚实,两边虚弱,这叫做太过,病在外;脉气来时羽毛般轻浮但微弱,这叫做不及,病在内。黄帝问:秋脉太过和不及,会有什么病症?岐伯说:太过会让人气逆且背痛,感觉闷热不适(《内经》中“温温”通“愠愠”,意为郁热不适),不及会让人气喘,呼吸短少并咳嗽,气逆吐血,下身能听到病变的声音。
肺脉来时柔和连绵,像落下的榆荚,这叫肺平脉。秋季以胃气为本(《难经》说:柔和连绵,像抚摸榆叶,叫春平脉;茂盛如车盖,按之更大,叫秋平脉)。肺脉来势不上不下,像抚摸鸡羽,这叫肺病脉(《诸病源候论》中没有“不”字)。肺脉来势像物体漂浮,像风吹羽毛,这叫肺死脉。真肺脉出现,大而空虚,像羽毛刺中人皮肤,面色赤白无光泽,毫毛折断,就会死亡。秋季脉象微带毛象且有胃气,叫平脉;毛象多而胃气少,叫肺病;只有毛象没有胃气,叫死脉。毛象中带弦象,叫春季的病;弦象严重,叫现在的病。肺藏气,气舍魄。喜乐过度会伤魄,魄伤则发狂,狂者心中无人,皮肤干枯,毛发憔悴,面色枯槁,死于夏季。秋季金旺,肺也旺。其脉浮(《千金方》中“浮”作“微”)涩而短,叫平脉。如果反得洪大而散的脉(《千金方》作浮大而洪),这是心乘肺,火克金,为贼邪,大逆,十死不治(另一版本说:日、月、年数到四,忌讳丙丁日)。如果反得沉濡而滑的脉,这是肾乘肺,子扶母,为实邪,虽然生病也会自愈。如果反得大而缓的脉,这是脾乘肺,母归子,为虚邪,虽然生病容易治愈。如果反得弦细而长的脉,这是肝乘肺,木凌金,为微邪,虽然生病很快就好。肺脉来势,泛泛轻飘,像微风吹鸟背上的毛,一息两至,叫平脉;三至,叫离经,病脉;四至,精气脱失;五至,死脉;六至,生命终结。这是手太阴肺脉。肺脉紧急甚重,为癫疾;轻微紧急,为肺寒热,倦怠无力,咳唾血,牵引腰背胸,痛苦于鼻息肉不通。脉缓甚重,为多汗;轻微缓和,为偏风(一作漏风),头以下出汗不止。脉过于盛大,为小腿肿胀;轻微盛大,为肺痹,牵引胸背,起于腰部内部。脉过小,为完谷不化的泄泻;脉微小,为消瘅。脉滑甚重,为息贲,气逆上冲;轻微滑,为上下出血。脉涩甚重,为呕血;轻微涩,为鼠瘰,在颈部腋下之间,下肢不能胜任上身,喜欢酸味。手太阴经气绝则皮毛干枯。太阴经是运行气温养皮毛的,气不营运则皮毛干枯,皮毛干枯则津液流失,津液流失则皮节受伤,皮节受伤则指甲干枯毫毛折断,毫毛折断则气先死。丙日加重,丁日死亡,因为火胜金。肺的死脏脉,轻取空虚,重按软弱如葱叶,下无根底,主死。以上内容出自《素问》、《针经》及张仲景。
The Lung corresponds to Metal in the Five Elements and combines with the Large Intestine to form a Fu organ (the Large Intestine is the Fu organ responsible for conducting waste). Its meridian is the Hand-Taiyin (Hand-Taiyin Lung Meridian), which is exterior-interior related to the Hand-Yangming (Hand-Yangming Large Intestine Meridian).
The pulse of the Lung presents as Floating (Floating is the major characteristic of the Lung pulse). It corresponds to the season of Late Summer, the sixth month (when Earth Qi is prosperous and Metal Qi cooperates with it). It is Prosperous during the three months of Autumn, Withered during the three months of Winter, Imprisoned during the three months of Spring, and Dead during the three months of Summer (because Fire is prosperous in Summer, overcoming Metal, causing Death). It is associated with the Heavenly Stems Geng and Xin days, and the times of dusk and sunset; it is Trapped on Jia and Yi days, at dawn and sunrise; it is Dead on Bing and Ding days, at mid-morning and noon. The Spirit housed is Po (Corporeal Soul); it governs voice; it nourishes the skin and hair; its orifice is the nose; its sound resembles crying; its color is White; its odor is Fishy; its fluid is nasal mucus; its taste preference is Pungent; it favors Salty; it dislikes Bitter. The Back-Shu point of the Lung is located beside the third thoracic vertebra (some say the fifth), and its Front-Mu point is Zhongfu (located between the nipples in the intercostal space). The Back-Shu point of the Large Intestine is located beside the sixteenth thoracic vertebra, and its Front-Mu point is Tianshu (one and a half cun lateral to the umbilicus), newly compiled.
The Lung belongs to Western Metal, the place where all things terminate (Metal nature is rigid, thus ruling in the West, cutting off all things, so all things end in Autumn). Like leaves falling from branches, sparse and scattered, leaving only bare twigs standing alone. The pulse at this time is slightly Floating and Hairy (Sparse describes the appearance of withering plants, meaning autumn leaves fall with the wind, leaving only bare twigs. At this time, Yang Qi retreats slowly, and the pulse is deficient and slight like hair). Ying Qi (Nutritive Qi) moves fast. Fast means [Qi] is above, slow means [Qi] is below, hence named "Hairy" (Generally, Yang pulses are fast, Yin pulses are slow. Ying Qi is Yin and should not be fast; saying Ying Qi is fast implies that Yin Qi, influenced by the Autumn solar term, rises and turns to the Yang position, thus appearing fast above. At this time, Yin Qi begins to take charge, and Yang Qi descends and hides; its movement becomes slow, so the Lung pulse is scattered like hair). If Yang Qi should descend but does not, and Yin Qi should ascend but does not, one is struck by pathogenic factors (If Yin-Yang exchange does not occur according to time, the two Qi agitate, leading to contraction by Wind-Cold). When Yang is struck by pathogens, it contracts; when Yin is struck, it becomes tight. Contraction causes aversion to cold; tightness causes shivering. Cold and shivering clash, hence named Malaria. Weakness indicates fever; Floating indicates the pathogen emerging ("Contract" refers to bodily stiffness; "Tight" refers to the pulse. This describes the time when a country suffers Wind-Cold: the pulse is tight, the person feels cold; after the cold stops, the pulse becomes weaker; weakness indicates fever; after the fever stops, the pulse becomes Floating, indicating the resolution of malaria and the emergence of the normal Lung pulse). Pathogens contracted in the morning cause onset in the morning; contracted in the evening cause onset in the evening (meaning malaria attacks follow the timing of Wind-Pathogens in the region). Zang organs have near and far positions; pulses have slow and rapid speeds; circulation has degrees; movement has clepsydra measurements (Zang refers to the five Zang organs: Liver, Heart, Spleen, Lung, Kidney. Heart and Lung are above the diaphragm; exhalation sends Qi out, called Near; exhalation is Yang, pulse is rapid. Kidney and Liver are below the diaphragm; inhalation draws Qi in, called Far; inhalation is Yin, pulse is slow. Degrees refer to the length of meridians; the circulation of Ying and Wei Qi around the body. Moving through Yin 25 degrees and Yang 25 degrees constitutes one cycle, corresponding to 100 marks of the clepsydra). Slow pulse above injures the luster of the skin and hair; Rapid pulse below injures the Lower Jiao. If the Middle Jiao has pathology, it manifests; if healthy, it remains hidden (In Autumn, Yang Qi is slow, Yin Qi is rapid. Slowness should be below, rapidity above; following seasonal changes, it is said to injure the luster of skin and hair. Human skin and hair are the pathways of Lung Qi. The Lower Jiao is below the umbilicus, governed by Yin, and its pulse should be slow; now it is rapid, hence injuring the Lower Jiao. The Middle Jiao is the Spleen; when healthy, its pulse is usually imperceptible, appearing only when deficient. Hence, it manifests only when pathological). When Yang Qi sinks, Yin Qi becomes warm (meaning Yang Qi sinking warms and nourishes the Zang organs). If Yang reverses to be below and Yin reverses to be at the top, it is named Long and Lingering (Yin-Yang transition follows seasons; human blood vessels are peaceful, meaning it can remain stable for a period). Quoted from *Si Shi Jing*.
The Yellow Emperor asked: The autumn pulse is like Floating. What constitutes Floating? Qibo replied: The autumn pulse corresponds to the Lung, Western Metal, the season of harvest and maturity. Thus, its Qi comes light, deficient, and floating; it comes urgent and scatters upon departure, hence named Floating. Opposite to this is disease. The Yellow Emperor asked: How is it opposite? Qibo said: When the Qi comes hairy but firm in the center and empty on both sides, this is Excess, disease in the Exterior; when the Qi comes hairy and slight, this is Deficiency, disease in the Interior. The Yellow Emperor asked: Regarding Excess and Deficiency of the autumn pulse, what are the diseases? Qibo said: Excess causes Qi rebellion and back pain with a sensation of internal heat (In *Nei Jing*, "Wen Wen" is synonymous with "Yun Yun", meaning oppressive heat); Deficiency causes panting, shortness of breath, cough, upward-rebellious Qi with hemoptysis, and audible pathological sounds from below.
When the Lung pulse comes gentle and continuous, like falling elm seeds, it is called Normal Lung Pulse. Autumn relies on Stomach Qi as its root (In *Nan Jing*: Gentle and continuous, like touching elm leaves, is Spring Normal Pulse; lush like a chariot canopy, larger upon pressure, is Autumn Normal Pulse). When the Lung pulse comes neither up nor down, like touching chicken feathers, it is called Lung Disease Pulse (In *Zhu Bing Yuan Hou Lun*, there is no "not"). When the Lung pulse comes like a floating object, like wind blowing hair, it is called Lung Death Pulse. The True Lung pulse arrives large and empty, like a feather piercing human skin; if the complexion is red-white without luster and hairs break, death ensues. In Autumn, a slight Hairy quality with Stomach Qi indicates Normal; more Hairy than Stomach Qi indicates Lung Disease; only Hairy without Stomach Qi indicates Death. Hairy with String-like quality indicates Spring disease; severe String-like indicates current disease. The Lung stores Qi, and Qi houses Po. Unrestrained joy injures Po; injury to Po leads to mania, where the manic person disregards others; skin and leather become scorched, hair withered, complexion dead, dying in Summer. In Autumn, Metal is prosperous, and the Lung is also prosperous. Its pulse is Floating (In *Qian Jin Fang*, "Floating" is written as "Slight"), Choppy, and Short, indicating Normal Pulse. If instead one obtains a Surging, Large, and Scattered pulse (In *Qian Jin Fang*, written as Floating, Large, and Surging), this is Heart overacting on Lung, Fire overcoming Metal, constituting Robber Evil, a great reversal, ten deaths incurable (Another version says: Day, Month, Year counts to four, avoiding Bing-Ding days). If instead one obtains a Deep, Soft, and Slippery pulse, this is Kidney overacting on Lung, Child supporting Mother, constituting Solid Evil; although sick, it will heal spontaneously. If instead one obtains a Large and Moderate pulse, this is Spleen overacting on Lung, Mother returning to Child, constituting Empty Evil; although sick, it is easy to treat. If instead one obtains a String-like, Thin, and Long pulse, this is Liver overacting on Lung, Wood encroaching on Metal, constituting Minor Evil; although sick, it will recover quickly. When the Lung pulse comes floating and light, like a breeze blowing feathers on a bird's back, arriving twice per respiration, it is Normal; three times, it is Li Jing (Departing from the Channel), Disease; four times, Essence is depleted; five times, Death; six times, Life ends. This is the Hand-Taiyin Lung Meridian. A very Tight Lung pulse indicates Epilepsy; slightly Tight indicates Lung Cold-Heat, lethargy, coughing up blood, drawing pain to waist, back, and chest, suffering from nasal polyps obstruction. Very Moderate indicates excessive sweating; slightly Moderate indicates Pi Feng (or Lou Feng), uncontrollable sweating from the head downward. Very Large indicates swelling of the shins; slightly Large indicates Lung Bi, drawing pain to chest and back, originating from within the waist. Very Small indicates undigested diarrhea; slightly Small indicates Xiao Dan (Wasting-Thirst). Very Slippery indicates Xi Ben (Breathful Distension) and upward Qi rebellion; slightly Slippery indicates bleeding from above and below. Very Choppy indicates vomiting blood; slightly Choppy indicates Shu Luo (Rat Abscess) between the neck and armpits, lower body unable to support upper body, craving Sour taste. When Hand-Taiyin Qi perishes, skin and hair become scorched. Taiyin circulates Qi to warm and nourish skin and hair; without Qi nourishment, skin and hair scorch; scorched skin and hair lose fluids; lost fluids injure skin joints; injured skin joints cause nails to wither and hairs to break; broken hairs mean Qi dies first. Condition worsens on Bing day, dies on Ding day, because Fire overcomes Metal. The dead organ pulse of the Lung: superficially empty, deeply weak like a green onion leaf, without a root below, indicates death. Content from *Su Wen*, *Zhen Jing*, and Zhang Zhongjing.