欲测疾兮死生。须详脉兮有灵。今之为医者。每断人之死。而亦未尝死。断人之生。而亦未尝生者何也。
特未于其脉细心详究之耳。如果细心详究。则死生之期。尚可断之以年月日时。脉又何尝无灵哉。
左辨心肝之理。右察脾肺之情。此为寸关所主。
谓候心脉。当于左寸。候肝脉。当于左关。候肺脉。当于右寸。候脾脉。当于右关也。
肾即两尺分并。
五脏俱一。而肾独有二。为牝藏也。居于下焦。故分候两尺。虽有水火之别。然总之皆肾。虽分而实并也。
三部五脏易识。七诊九候难明。
此承上文左右手寸关尺三部之中。而候心肝脾肺肾之五脏。此人所易晓也。至于七诊九候。欲求其明之者。则亦难
矣。试以三部五脏。七诊九候言之。古之所谓三部五脏。七诊九候。非今之所谓三部五脏。七诊九候也。按内经三部九
候篇云。天地之至数。始于一。终于九焉一者天。二者地。三者人。三而三之。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。帝曰。何为三部。岐伯曰。有下部。有中部。有上部。各有三候。
三候者。有天有地有人也。必指而导之。乃以为真。上部天。两额之动脉。上部地。两颊之动脉。上部人。耳前之动脉。
中部天。手太阴也。中部地。手阳明也。中部人。手少阴也。下部天足厥阴也。下部地。足少阴也。下部人。足太阴也。
故下部之天以候肝。地以候肾。人以候脾胃之气。帝曰。中部之候奈何。岐伯曰。亦有天。亦有地。亦有人。天以候肺。
地以候胸中之气。人以候心。帝曰。上部以何候之。岐伯曰。亦有天。亦有地。亦有人。天以候头角之气。地以候口齿
之气。人以候耳目之气。三部者。各有天。各有地。各有人。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。合为九藏五脏已败。其色必夭。夭必死矣。帝又曰。何以知病之所在。岐
伯曰。察九候独小者病。独大者病。独疾者病。独迟者病。独热者病。独寒者病。独陷下者病。岐伯又曰。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。若
有七诊之病。其脉候亦败者死矣。必发哕噫。经言如此。是于九候之中。而复有七诊之法也。今之所谓三部。非古之头
手足之三部。乃寸关尺之三部也。今之所谓七诊。非古之所谓独大独小。独疾独迟。独热独寒。独陷下之七诊也。乃一
定其心。存其神。二忌外意。无思虑。三均呼吸。定其气。四轻指于皮肤之间。探其腑脉。五微重于肌肉之间。取其胃
气。六沉指于骨上。取其脏脉。七察病患脉之息。数往来。是为七诊之法也。今之所谓九候。非古之所谓头候天地人。
手候天地人。足候天地人之九候也。乃寸取浮中沉。关取浮中沉。尺取浮中沉之九候也。要之古人诊脉。不专于手之寸
关尺部。凡头面手足之动脉。悉皆诊之。然不得尊今而废古。亦不得非古而是今。合古今之法而用之。斯过半矣。
昼夜循环。营卫须有定数。
今之为医者。动言营卫。及问其营卫之所以行。则又茫然。如是而欲识病之表里阴阳。盖亦难矣。夫营者血也。阴
也。卫者气也。阳也。此人所共晓者也。惟营行脉中。卫行脉外。一日一夜。各五十周于身。世人每昧于卫行脉外之旨。
谓卫气随营气而行于外。不知营自行营之道。卫自行卫之道。卫实不随营气而行也。试先以营气之行言之。内经营气篇。
黄帝曰。营气之道。内谷为宝。谷入于胃乃传之肺。流溢于中。布散于外。精专者行于经隧。常营无已。终而复始。是
谓天地之纪。故气从太阴出。注手阳明。上行注足阳明。下行至跗上出大指间。与太阴合。上行抵髀。从髀注心中。循
手少阴。出腋下臂。注小指。合手太阳。上行乘腋。出 内。注目内 。上巅下项。合足太阳。循脊下尻。下行注小指
之端。循足心。注足少阴。上行注肾。从肾注心。外散于胸中。循心主脉。出腋下臂。出两筋之间。入掌中。出中指之
端。还注小指次指之端。合手少阳上行至膻中。散于三焦。从三焦注胆出胁。注足少阳。下行至跗上。复从跗注大指间。
合足厥阴上行至肝。从肝上注肺。上循喉咙。入颃颡之窍。究于畜门。其支别者。上额循巅。下项中循脊入 是督脉也。
络阴器。上过毛中。入脐中。上循腹里。入缺盆。下注肺中。复出太阴。此营气之所行也。逆顺之常也。至于卫气之行。
则不然。卫出下焦。亦昼夜五十周于身。但于昼则行阳二十五。于夜则行阴二十五。自日出而阳隆之时。曰加房宿。盖
卯时也漏水下一刻。从足手太阳行起。水下二刻。行足手少阳。水下三刻。行足手阳明。水下四刻。行于阴分。水下五
刻。复行足手太阳。水下六刻。复行足手少阳。水下七刻。复行足手阳明。水下八刻。则又复入阴分。如此周而复始。
至漏水下五十刻。人气行于阳二十五周。日入而阴隆之时。曰加毕宿。盖酉时也。方行入阴分。初从足少阴行起。次手
少阴。次手太阴。次足厥阴。次足太阴。又复行足少阴。又复行手少阴。又复行手太阴。又复行足厥阴。又复行足太阴。
如此周而复始。至漏水下百刻。行阴亦二十五周。并昼行阳二十五周。亦共五十周于身。此卫气之所以行也。至于卫气
之合岁月日时。星宿度分。漏水刻数。细观卫气行篇。伯高之语。自可见矣。奈后世之人。注图立说。每以卫气随营气
而行者。是昧于营在脉中。卫在脉外之旨耳。不知经文所云。卫在脉外者。非随营气而行于外也。乃昼行阳二十五周。
夜行阴二十五周之谓也。或难曰。经文中有营气篇。是营中亦有气矣。而子独谓卫不入经隧之中。岂营中独无
气欤。余曰非也。经云。清者为营。浊者为卫。夫卫犹风也。营犹水也。营血行于经隧之中。固赖气以行之。亦水由地
中行也。夫江淮河汉之水。固赖风以行。而风岂专随江淮河汉而行哉。且卫气之不随营气而行。马元台已详言之矣。但
于卫气行篇。漏水下四刻八刻。以及二十四刻。入于阴分之句。误释以为入足少阴。俱引邪客篇云。常以足少阴之分间。
行于五脏六腑。不知经文所谓足少阴分者。特于其地分一过之耳。非实行足少阴经也。若谓实行足少阴经。则昼已随六
腑而行于阳。夜又随五脏而行于阴。是一昼夜间。他藏俱一行。而肾得再行矣。要之昼之所入。时于其阴分过之。夜之
所入。实于其阴经行之。而邪客篇谓常从足少阴之分间。行于五脏六腑者。正以卫出下焦。下焦乃肾之地分耳。然卫气
行篇所云。水下四刻。水下八刻。水下十二刻。水下十六刻。水下二十刻。水下二十四刻。皆曰人气在阴分。不必专指
肾经言也。惟夜行于阴二十五周。始可直指肾经言耳。然是说也。内经诸篇已详言之。而后之学人。终不能了了于心目
者。其故有三焉。一则秦越人着难经。谓营气之行。常与卫相随。大违经旨而立图说。二则卫气行篇中。漏水下百刻。
加于人气之五十周。又人气之五十周。加于日行之四十八舍。又日行之四十八舍。加于二十八宿。又二十八宿加于十二
辰。以多加少。度数龃龉。非司天台难以悉其奇分。三则又以卫气之行不等。夜行于阴也。固在乎阴。而昼行于阳也。
则又过乎阴。有此数端。是以营卫之说。千百年来。终然隐晦。余因三思。惟欲畅明其旨。乃立三说。其一曰营气行图。
专以营气之行。从中焦起自寅时。注于手太阴肺。次第行于脏腑。循环无已。一日一夜。五十周于身。其次曰冲气行图。
如环相似。自水下一刻。至五十刻。行阳二十五周。自五十一刻至百刻。行阴二十五周。既不妨于夜行。又不妨于昼过。
其三则曰卫气配周天图。以子午为经。卯酉为纬。以人气之五十周。配日行之舍。与十二辰二十八宿度数。如是者三庶
乎千载以下。览其图。思其义。传后之学人。不致有望洋之叹耳。但营卫之行。复有说焉。先贤皆以自寅时起于手太阴
肺。遂以卯时注于手阳明大肠。以十二辰次第配十二脏腑。如是周而复始。若然。是一昼夜间止得一周于身。又安所谓
五十周于身也。况各脏腑经络有长短不同。只如手太阴肺经。自中府穴起。至少商穴。相去不远。足太阳膀胱经。自目
内起以至至阴穴。相去甚遥。若刻定一时行一经。则脉之行也。岂因某经之长短。而故缓急之欤。愚曰。皆不然也。
所谓营卫者。乃无形之阴阳。非有形之。血气也若云有形之血气。只如有人刖一手。或刖一足。血气行至所刖之处。不
能过乎他经。必断绝而死。然亦未尝见其死者。则知非有形之血气明矣。不观内经有卫气行篇。复有营气篇。二者皆用
气字。故知其为无形之阴阳也。夫既为无形之阴阳。则不必复拘脉行之尺寸。与经络之短长。而又何妨以一时配一脏腑
也。但以一时主一脏腑则可。以一时行一经络则不可。
按营出中焦。自寅时起于手太阴肺。次第注于十二经隧之中。周而复始。一日一夜。如是五十周于身。漏水下百刻。
后图以圈内为里为脏。圈外为表为腑。于一周之中。三回入里。三回达表。所谓一日一夜。五十营是也。至于卫气亦一
日一夜五十周于身。但不随营气而行。别有行法。亦具其图于后。
\r营行表里图\p01-e33a1.bmp\r
\r卫气行合漏水刻数图\p01-e33a2.bmp\r
\r营卫周天度数图\p01-e33a3.bmp\r
男女长幼。大小各有殊形。
男女长幼。不必言。大小者。言人之肥瘦也。十九难云。脉有顺逆。男女有恒而反者。何谓也。然。男子生于寅。
寅为木。阳也。女子生于申。申为金。阴也。故男脉在关上。女脉在关下。是以男子尺脉恒弱。女子尺脉恒盛。是其常
也。反者男得女脉。女得男脉也。其为病何如。然。男得女脉为不足。病在内。左得之病在左。右得之病在右。随脉言
之也。女得男脉为太过。病在四肢。左得之病在左。右得之病在右。随脉言之。此之谓也。脉经曰。凡诊脉。当视其人
长
短大小。及性气缓急。脉之迟速大小长短。皆如其人形性者吉。反之者。则为逆也。脉三部。大都欲等。至如小人妇人
细脉小软。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。性缓而脉急。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。脉自驶疾。呼吸八至也。男左大为顺。女右大为顺。肥人脉沉。瘦人脉浮。千金翼之言如此。然亦不可
执一而论也。予尝读难经。至男得女脉为不及。女得男脉为太过之句。窃有疑焉。何也。夫所谓男得女脉为不及者。谓
男子尺脉反盛。此为水不胜火。其为不及也宜矣。至于女得男脉为太过。谓女子尺脉反弱也。尺脉弱而言太过。于理有
未合。不知先贤所谓男得女脉为不及者。乃真阴不足也女得男脉为太过者。乃阳邪有余也。若以尺弱之故。但用补阴之
剂。则失之矣。余尝治一妇人。关前数大。关后微弱。内热心烦。头齿肩膊尝疼。诸医皆用补阴之剂。如四物沙参鳖甲
青蒿银柴之类。百剂罔效。后余因思女得男脉为太过之句。为撰一方。用薄荷防风山栀。以抑其阳。生地丹皮当归芍药
甘草。以扶其阴。数剂辄效。始信古人之言不诬也。若男子尺寸俱盛。女子尺寸俱弱。又不可一例论也。愚按千金翼之
言。未可尽信。如云人细而脉大。人苦而脉虚。性缓而脉急。人羸而脉大。以之为逆。则似之矣。至于人大而脉细。人
乐而脉实。性急而脉缓。人壮而脉细。皆以为逆。则亦未必然矣。余尝诊一贵人。形貌魁伟。其脉如绝。有小恙。其脉
反大。岂可以形大脉细。而即为逆欤。至于快乐之人。颐养得宜。脉实有力。不必尽皆为虚也。又如性急之人。其脉和
缓。当是寿征。人壮脉细。因所禀既清。肌肉丰浓。自脉道微小。千金翼拘于对待之法。以文害义。是以未可尽信也。
复有节气不同。须知春夏秋冬。
详见下文。
建寅卯月兮木旺肝脉弦长以相从。
谓正月建寅。二月建卯也。值此木旺之时。其脉当弦。十五难曰。春脉弦者。肝。东方木也。万物始生。未有枝叶。
故其脉之来。濡弱而长。故曰弦。又曰。如有变奈何。然春脉弦。反者为病。何谓反。然。其气来实强。是谓太过。
病在外。气来虚微。是谓不及病在内。气厌厌聂聂。如循榆叶曰平。益实而滑。如循长竿。曰病急而劲。益强如张弓弦
曰死。故又曰。春脉微弦曰平。弦多胃气少曰病。但弦无胃曰死。春以胃气为本。
当其巳午。心火而洪。
谓四月建巳。五月建午也。值此火旺之时。其脉当洪。即经所云钩者是也。十五难曰。夏脉钩者。心南方火也。万
想要推测疾病的生死预后，必须仔细探究脉象的微妙变化。现在的医生，往往轻易判定病人的死期，但病人并未真的死去；或者判定病人能活，病人却未能存活，这是什么原因呢？
只是没有对脉象进行细心详尽的研究罢了。如果确实能够细心详究，那么生死的期限，甚至可以精确到年、月、日、时来推断。脉象又怎么会没有灵性呢？
左手辨别心、肝的机理，右手察知脾、肺的情况。这是寸、关部位所主司的范围。
所谓候察心脉，应当在左手的寸部；候察肝脉，应当在左手的关部；候察肺脉，应当在右手的寸部；候察脾脉，应当在右手的关部。
肾脏则分布在两尺部。
五脏中其他四脏各占一部，唯独肾有两部，因为肾是阴脏（牝藏）。它居于下焦，所以分候于两尺部。虽然肾有肾阴（水）和肾阳（火）的区别，但总之都属于肾，虽然是分部而诊，实则统一于肾。
通过三部（寸、关、尺）来辨识五脏比较容易，但七诊和九候的理论却难以阐明。
这是承接上文，在左右手寸、关、尺三部之中，分别候察心、肝、脾、肺、肾这五脏，这是人们容易理解的。至于七诊和九候，想要弄明白它们，那就很难了。试着从三部五脏、七诊九候来说明。古人所说的三部五脏、七诊九候，并不是现在人所理解的三部五脏、七诊九候。按照《黄帝内经·素问·三部九候论》所说：“天地间的最高法则，起始于一，终结于九。一是天，二是地，三是人。三再乘以三，得到九，以对应九州的大地。所以人有三部，每部有三候，用来决断生死，治疗百病，调节虚实，祛除邪气。”黄帝问：“什么是三部？”岐伯回答：“有下部、中部、上部。每部各有三候。这三候，分别代表天、地、人。必须用手指明确指示并引导，才能掌握真谛。上部的天，对应两额头的动脉；上部的地，对应两颊的动脉；上部的人，对应耳前的动脉。中部的天，对应手太阴肺经；中部的地，对应手阳明大肠经；中部的人，对应手少阴心经。下部的天，对应足厥阴肝经；下部的地，对应足少阴肾经；下部的人，对应足太阴脾经。”所以下部的天用来候察肝，地用来候察肾，人用来候察脾胃之气。黄帝问：“中部的脉候如何？”岐伯说：“也有天、地、人。天用来候察肺，地用来候察胸中之气，人用来候察心。”黄帝问：“上部用什么来候察？”岐伯说：“也有天、地、人。天用来候察头角之气，地用来候察口齿之气，人用来候察耳目之气。”三部，每部都有天、地、人。三个三构成天，三个三构成地，三个三人构成人。三再乘三，合起来就是九。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。如果五脏精气败坏，面色必然枯槁无华，面色枯槁无华必定死亡。黄帝又问：“如何知道疾病所在？”岐伯说：“观察九候，发现某一部脉独小的是病，独大的是病，独快的是病，独慢的是病，独热的是病，独寒的是病，独陷下的是病。”岐伯又说：“如果形体肌肉已经脱失，即使九候脉象调和，也必死无疑。如果出现了七诊所示的死脉征象，但九候脉象都顺应四时规律而不相悖，则不死。所说的不死，是指风气之病及月经之病，这些情况看似符合七诊的死脉特征，其实并非真死脉，所以说不会死。如果有七诊所示的病脉，且脉候也已败坏，就会死亡，必定出现呃逆、嗳气等症状。经文如此记载，这是在九候之中，又包含了七诊的方法。现在人所讲的三部，不是古人的头、手、足三部，而是寸、关、尺三部。现在人所讲的七诊，也不是古人所说的独大、独小、独疾、独迟、独热、独寒、独陷下的七诊，而是：一、定其心神，保持精神专注；二、忌杂念，排除思虑；三、均匀呼吸，安定气息；四、轻按于皮肤之间，探察腑脉；五、微重按于肌肉之间，取胃气；六、重按至骨上，取脏脉；七、察看病患脉搏的跳动次数和往来节奏。这就是七诊的方法。现在人所讲的九候，也不是古人所说的头候天、地、人，手候天、地、人，足候天、地、人的九候，而是寸部取浮、中、沉，关部取浮、中、沉，尺部取浮、中、沉的九候。总而言之，古人诊脉，不专门局限于手腕的寸、关、尺部位，凡是头面手足的动脉，全都进行诊察。然而，不能尊崇今法而废弃古法，也不能非议古法而肯定今法。将古今方法结合使用，就能达到过半的效果。
昼夜循环，营气和卫气的运行必须有固定的规律。
现在的医生，动不动就谈论营卫，但当问及营卫运行的原理时，却又茫然不知。像这样想要识别疾病的表里阴阳，大概也很难了。营就是血，属阴；卫就是气，属阳。这是人们共知的常识。只有营行于脉管之中，卫行于脉管之外，一天一夜，各自在全身循环五十周。世人常常误解卫行脉外的含义，认为卫气是跟随营气在脉外运行，不知道营自走营的路径，卫自走卫的路径，卫实际上并不跟随营气运行。先谈谈营气的运行。《灵枢·营气》篇记载：黄帝说：“营气的运行之道，以内养谷气为宝。谷物进入胃后，传导给肺，流溢于体内，布散于体外。其中精纯专一的部分，运行于经脉隧道之中，常年运行不止，终而复始，这被称为天地运行的纲纪。所以气从手太阴肺经出发，注入手阳明大肠经，上行注入足阳明胃经，下行至足背，出于大趾间，与足太阴脾经相合，上行抵大腿，从大腿注入心中，沿手少阴心经，出腋下臂，注入小指，与手太阳小肠经相合，上行经过腋窝，出于内眼角，上达头顶，下行项部，与足太阳膀胱经相合，沿脊柱下行至尾骶，下行注入小趾端，沿足心，注入足少阴肾经，上行注入肾，从肾注入心，向外散布于胸中，沿手厥阴心包经，出腋下臂，出于两筋之间，入掌中，出于中指尖端，回流注入无名指尖端，与手少阳三焦经相合，上行至膻中，散布于三焦，从三焦注入胆，出胁肋，注入足少阳胆经，下行至足背，又从足背注入大趾间，与足厥阴肝经相合，上行至肝，从肝上注于肺，沿喉咙，入颃颡（鼻咽部）的窍道，穷尽于畜门（鼻根深处）。它的支别者，上额头，循头顶，下项中，循脊柱，入督脉，络阴器，上过毛际，入脐中，上循腹里，入缺盆，下注肺中，再复出太阴肺经。这就是营气运行的路径，也是顺逆的正常规律。至于卫气的运行，则与此不同。卫气出于下焦，也是一昼夜在全身循环五十周。但在白天行于阳分二十五周，在夜间行于阴分二十五周。从日出阳气隆盛之时，太阳加临房宿，大约是卯时，漏水下一刻，从足太阳、手太阳经开始运行。水下二刻，行足太阳、手少阳经。水下三刻，行足太阳、手阳明经。水下四刻，行于阴分。水下五刻，复行足太阳、手太阳经。水下六刻，复行足太阳、手少阳经。水下七刻，复行足太阳、手阳明经。水下八刻，又重新进入阴分。如此周而复始，直到漏水下五十刻，人气在阳分运行二十五周。日落阴气隆盛之时，太阳加临毕宿，大约是酉时，方才进入阴分。起初从足少阴肾经开始，接着是手少阴心经，接着是手太阴肺经，接着是足厥阴肝经，接着是足太阴脾经，又复行足少阴肾经，又复行手少阴心经，又复行手太阴肺经，又复行足厥阴肝经，又复行足太阴脾经。如此周而复始，直到漏水下百刻，行于阴分也是二十五周。加上白天行于阳分的二十五周，一共在全身循环五十周。这就是卫气运行的规律。至于卫气与年月日时、星宿度数、漏水刻数的配合，细看《灵枢·卫气行》篇中伯高的论述，自然可以明白。无奈后世之人，绘制图谱立说，常常认为卫气是跟随营气运行的，这是不明白营在脉中、卫在脉外的宗旨。不知道经文所说的“卫在脉外”，并不是跟随营气在脉外运行，而是指白天行于阳分二十五周，夜间行于阴分二十五周。有人辩难道：“经文中有《营气》篇，说明营中也有气，而你唯独说卫不入经脉隧道之中，难道营中就没有气吗？”我说不是这样。经文说：“清者为营，浊者为卫。”卫就像风，营就像水。营血运行在经脉隧道之中，固然依赖气来推动，也像水在地中行一样。江淮河汉的水，固然依赖风来推动，但风难道专门随着江淮河汉的水而行吗？况且卫气不跟随营气运行，马元台已经详细论述过了。只是在《卫气行》篇中，关于漏水下四刻、八刻以及二十四刻进入阴分的句子，错误地解释为进入足少阴肾经，都引用《灵枢·邪客》篇的话说：“常从足少阴之分间，行于五脏六腑。”不知道经文所说的足少阴分，只是经过该地域一次而已，并非真正实行于足少阴经脉。如果说真正实行于足少阴经脉，那么白天已经跟随六腑行于阳分，夜晚又跟随五脏行于阴分，这样一昼夜间，其他脏腑都只运行一次，而肾却要运行两次。总之，白天所进入的，是在其阴分经过；夜晚所进入的，是真正在其阴经运行。而《邪客》篇说“常从足少阴之分间，行于五脏六腑”，正是因为卫气出于下焦，而下焦正是肾的地域所在。然而《卫气行》篇所说的水下四刻、水下八刻、水下十二刻、水下十六刻、水下二十刻、水下二十四刻，都说“人气在阴分”，不必专门指肾经而言。只有夜间行于阴分的二十五周，才可以直指肾经而言。但是这种说法，《黄帝内经》各篇已经详细论述，而后来的学人，始终不能在心目中彻底明了，其原因有三点。第一，秦越人撰写《难经》，说营气的运行，经常与卫气相随，大大违背了经文旨意而立图说。第二，《卫气行》篇中，漏水下百刻，加上人气五十周，又加上人气五十周，加上日行四十八舍，又加上日行四十八舍，加上二十八宿，又加上二十八宿加上十二辰，以多配少，度数不符，如果不是司天台这样的专业机构，难以算清那些零数。第三，又因为卫气运行不等，夜间行于阴分，固然是行于阴，而白天行于阳分，却又超过了阴分。有了这几方面原因，所以营卫的说法，千百年来，始终隐晦不明。我因此深思，只想畅明其旨义，于是立下三种说法。第一种叫《营气行图》，专门讲述营气的运行，从中焦开始，始于寅时，注入手太阴肺经，依次运行于脏腑，循环不已，一天一夜，在全身循环五十周。第二种叫《冲气行图》，如环相似，自漏水下一刻至五十刻，行阳分二十五周，自五十一刻至百刻，行阴分二十五周。这样既不妨碍夜间运行，也不妨碍白天经过。第三种叫《卫气配周天图》，以子午为经线，卯酉为纬线，以人气五十周配合日行的舍数，与十二辰、二十八宿的度数。像这样有三种图解，希望千载以下的读者，看到图，思考其义理，传给后来的学人，不至于产生望洋兴叹的感叹。但是，营卫的运行，还有另一种说法。先贤都认为营气自寅时始于手太阴肺经，随即在卯时注入手阳明大肠经，以十二时辰依次配合十二脏腑，这样周而复始。如果是这样，一昼夜只在身体运行一周，哪里还说什么在全身运行五十周呢？况且各脏腑经络有长短不同，就像手太阴肺经，自中府穴起，至少商穴，距离不远；足太阳膀胱经，自目内眦起以至至阴穴，距离很远。如果规定一个时辰运行一条经络，那么脉的运行，难道会因为某条经络的长短而故意快慢吗？我认为都不是。所谓的营卫，是无形的阴阳，不是有形的血气。如果说是有形的血气，就像有人砍掉一只手或一只脚，血气运行到被砍掉的地方，不能通过其他经络，必然断绝而死。然而我们也未曾见过这样的人死亡的，这就知道营卫不是有形的血气了。不看《黄帝内经》有《卫气行》篇，又有《营气》篇，两者都用了“气”字，所以知道它们是无形的阴阳。既然作为无形的阴阳，就不必再拘泥于脉运行的尺寸和经络的长短，又有什么妨以一个时辰配一个脏腑呢？只能说一个时辰主事一个脏腑，不能说一个时辰运行一条经络。
按照营气出于中焦，自寅时始于手太阴肺经，依次注入十二经脉隧道之中，周而复始，一天一夜，这样在全身循环五十周，漏水下百刻。后面的图中，圈内代表里、代表脏，圈外代表表、代表腑。在一周的运行中，三次进入里，三次到达表。所谓一天一夜五十营，就是这个意思。至于卫气也是一昼夜在全身循环五十周，但不跟随营气运行，另有运行方法，也在后面的图中具备。
[图片：营行表里图]
[图片：卫气行合漏水刻数图]
[图片：营卫周天度数图]
男女老少，体型大小各有不同。
男女老少，不用说，大小指的是人的肥瘦。《难经·十九难》说：“脉有顺逆，男女有常规，如果出现相反的情况，是怎么回事呢？”回答说：“男子生于寅，寅属木，是阳；女子生于申，申属金，是阴。所以男子的脉在关上（尺脉相对较弱），女子的脉在关下（尺脉相对较强）。因此男子的尺脉通常弱，女子的尺脉通常盛，这是常态。相反的情况是男子出现女子的脉象，女子出现男子的脉象。这会得什么病呢？”回答说：“男子出现女子的脉象，属于不足，病在内脏。如果在左手出现，病在左边；在右手出现，病在右边，随脉位而言。女子出现男子的脉象，属于太过，病在四肢。如果在左手出现，病在左边；在右手出现，病在右边，随脉位而言。说的就是这个道理。《脉经》说：“凡诊脉，应当观察病人的高矮胖瘦，以及性格气质的缓急。脉象的迟速、大小、长短，如果与病人的形体性格相符，则为吉；相反的，则为逆。”脉的三部，大体上应该相等。至于小人、妇人，脉象细小柔软；四五岁小儿的脉，呼吸八至，脉细数，这些都是吉利的。《千金翼方》说：人大而脉细，人细而脉大，人快乐而脉实，人痛苦而脉虚，性情急躁而脉缓，性情温和而脉急，身体强壮而脉细，身体消瘦而脉大，这些都称为逆证。逆证则难治，反之则为顺证，顺证则易治。凡是妇人的脉，通常希望比丈夫濡弱；四五岁的小儿，脉自然急促，一呼一吸脉跳八次。男左脉大为顺，女右脉大为顺。肥胖人的脉沉，消瘦人的脉浮。《千金翼方》的话就是这样。然而也不可固执一端而论。我曾读《难经》，读到“男子得女脉为不及，女子得男脉为太过”这句话，心中存有疑问。为什么呢？所谓男子得女脉为不及，是说男子的尺脉反而盛大，这是因为水不胜火，所以说是不足，这是合理的。至于女子得男脉为太过，是说女子的尺脉反而虚弱。尺脉弱却说成太过，在道理上似乎不合。不知道先贤所说的男子得女脉为不及，是指真阴不足；女子得男脉为太过，是指阳邪有余。如果仅仅因为尺脉弱，就只用补阴的药物，那就错了。我曾经治疗一位妇人，关前脉数大，关后脉微弱，内心发热心烦，头部、牙齿、肩膀、胳膊经常疼痛。各位医生都用补阴的药物，如四物汤、沙参、鳖甲、青蒿、银柴胡之类，服用上百剂都没有效果。后来我想到“女子得男脉为太过”这句话，为她开了一方，用薄荷、防风、山栀，来抑制其阳；用地黄、丹皮、当归、芍药、甘草，来扶持其阴。服用几剂就见效了，这才相信古人的话没有欺骗人。如果男子寸关尺三部脉都盛大，女子寸关尺三部脉都虚弱，又不可一概而论。我按：《千金翼方》的话，不能完全相信。比如它说人细而脉大，人苦而脉虚，性缓而脉急，人羸而脉大，把这些当作逆证，似乎是合理的。至于人大而脉细，人乐而脉实，性急而脉缓，人壮而脉细，也都当作逆证，那也不一定正确。我曾经诊治一位贵人，形体魁梧，他的脉象几乎摸不到，有点小病，脉象反而盛大。怎么能因为形大体大脉细，就认为是逆证呢？至于快乐的人，颐养得当，脉象实而有力，不一定都是虚证。又如性情急躁的人，脉象和缓，应当是长寿的征兆。身体强壮而脉细，是因为禀赋清纯，肌肉丰厚，自然脉道微小。《千金翼方》拘泥于对待的方法，因文害义，所以不能完全相信。再有节气不同，须知春、夏、秋、冬四季的变化。详见下文。
建寅、卯月，木气旺盛，肝脉弦长，随之相应。
说的是正月建寅，二月建卯。正值木气旺盛的时候，其脉应当呈弦象。《难经·十五难》说：“春脉弦，是因为肝属东方木。万物开始生长，还没有枝叶，所以脉象来时，濡弱而长，所以叫弦。”又说：“如果有变化怎么办？”回答说：“春脉弦，反常的就是病。什么叫反常？”回答说：“脉气来势实强，这叫太过，病在外；脉气来势虚微，这叫不及，病在内。脉气厌厌聂聂，像触摸榆叶那样柔和，叫平脉；更加实而滑，像触摸长竿，叫病脉；更加劲急，像张开的弓弦，叫死脉。”所以又说：“春脉微弦叫平脉，弦多而胃气少叫病脉，只有弦象而没有胃气叫死脉。春季以胃气为本。”
To predict the life and death prognosis of a disease, one must carefully investigate the subtle changes in the pulse. Modern physicians often hastily determine a patient's time of death, yet the patient does not actually die; or they predict survival, yet the patient fails to live. What is the reason for this?
It is simply that they have not conducted a careful and detailed examination of the pulse. If one were indeed to examine it meticulously, then the timing of life and death could even be predicted with precision down to the year, month, day, and hour. How could the pulse lack its spiritual efficacy?
On the left hand, one discerns the principles of the Heart (Xin) and Liver (Gan); on the right hand, one observes the conditions of the Spleen (Pi) and Lung (Fei). This pertains to the regions governed by the Cun (Inch), Guan (Bar), and Chi (Cubit) positions.
Specifically, to palpate the Heart pulse, one should focus on the Cun position of the left wrist; to palpate the Liver pulse, the Guan position of the left wrist; to palpate the Lung pulse, the Cun position of the right wrist; and to palpate the Spleen pulse, the Guan position of the right wrist.
The Kidney (Shen) is distributed across both Chi positions.
Among the Five Zang Organs, the other four each occupy one position, while the Kidney uniquely occupies two positions because it is a Yin organ (Nun Zang). It resides in the Lower Jiao (Lower Burner), hence it is palped at both Chi positions. Although there is a distinction between Kidney Water (Yin) and Kidney Fire (Yang), ultimately they both belong to the Kidney. Although divided for diagnosis, they are essentially unified.
Identifying the Five Zang Organs through the Three Positions (Cun, Guan, Chi) is relatively easy, but the theories of the Seven Diagnoses (Qi Zhen) and Nine Palpations (Jiu Hou) are difficult to elucidate.
This follows from the previous discussion: within the three positions (Cun, Guan, Chi) of both hands, palpating the Five Zang Organs (Heart, Liver, Spleen, Lung, Kidney) is something people easily understand. However, regarding the Seven Diagnoses and Nine Palpations, understanding them is quite difficult. Let us attempt to explain them. The "Three Positions, Five Zang Organs" and "Seven Diagnoses, Nine Palpations" mentioned by the ancients do not refer to what modern practitioners understand by these terms. According to the *Su Wen* chapter "San Bu Jiu Hou" of the *Huangdi Neijing* (Yellow Emperor's Inner Canon): "The supreme laws of Heaven and Earth begin with One and end with Nine. One is Heaven, Two is Earth, Three is Humanity. Multiplying three by three yields nine, corresponding to the Nine Regions of the earth. Thus, humans have three major sections (Bu), each containing three palpation points (Hou), used to determine life and death, treat various diseases, regulate deficiency and excess, and eliminate pathogenic factors." The Yellow Emperor asked, "What are the three sections?" Qibo replied, "There are the Lower Section, Middle Section, and Upper Section. Each has three palpation points. These three points represent Heaven, Earth, and Humanity. One must point them out clearly to grasp the truth. The Heaven of the Upper Section corresponds to the arteries at the temples; the Earth of the Upper Section corresponds to the arteries at the cheeks; the Humanity of the Upper Section corresponds to the arteries in front of the ears. The Heaven of the Middle Section corresponds to the Hand-Taiyin Lung Meridian; the Earth of the Middle Section corresponds to the Hand-Yangming Large Intestine Meridian; the Humanity of the Middle Section corresponds to the Hand-Shaoyin Heart Meridian. The Heaven of the Lower Section corresponds to the Foot-Jueyin Liver Meridian; the Earth of the Lower Section corresponds to the Foot-Shaoyin Kidney Meridian; the Humanity of the Lower Section corresponds to the Foot-Taiyin Spleen Meridian." Therefore, the Heaven of the Lower Section palpates the Liver, the Earth palpates the Kidney, and the Humanity palpates the Qi of the Spleen and Stomach. The Yellow Emperor asked, "How are the pulses of the Middle Section?" Qibo said, "They also have Heaven, Earth, and Humanity. Heaven palpates the Lung, Earth palpates the Qi of the Chest, and Humanity palpates the Heart." The Yellow Emperor asked, "What does the Upper Section palpate?" Qibo said, "It also has Heaven, Earth, and Humanity. Heaven palpates the Qi of the head and horns, Earth palpates the Qi of the mouth and teeth, and Humanity palpates the Qi of the eyes and ears." Each of the three sections has Heaven, Earth, and Humanity. Three threes constitute Heaven, three threes constitute Earth, and three threes constitute Humanity. Three multiplied by three equals nine. The nine divisions correspond to the Nine Regions, which correspond to the Nine Viscera. Thus, there are five Spirit Viscera and four Form Viscera, totaling nine. If the essence of the Five Zang Organs is exhausted, the complexion will become dull and lifeless; a dull and lifeless complexion indicates impending death. The Yellow Emperor further asked, "How can one locate the disease?" Qibo said, "Observe the nine palpation points: if one is exclusively small, it indicates disease; if exclusively large, disease; if exclusively rapid, disease; if exclusively slow, disease; if exclusively hot, disease; if exclusively cold, disease; if exclusively depressed/sunken, disease." Qibo added, "If the flesh and muscles are already wasted away, even if the nine pulses are harmonious, death is inevitable. If the signs of the Seven Diagnoses appear, but the nine pulses all conform to the seasonal norms without contradiction, death will not occur. The 'non-death' referred to applies to wind-related disorders and menstrual disorders, which may resemble the fatal signs of the Seven Diagnoses but are not truly so, hence they are not fatal. However, if the signs of the Seven Diagnoses are present AND the pulse qualities are also exhausted, death will occur, accompanied by hiccups and belching. The classic states this, implying that within the Nine Palpations, there is also the method of the Seven Diagnoses. The 'Three Sections' discussed today are not the ancient Head, Hand, and Foot sections, but rather the Cun, Guan, and Chi sections. The 'Seven Diagnoses' discussed today are not the ancient concepts of exclusively large, small, rapid, slow, hot, cold, or sunken pulses, but rather: 1. Calm the mind and concentrate the spirit; 2. Avoid distractions and clear thoughts; 3. Regulate breathing and stabilize Qi; 4. Lightly press at the skin level to palpate the Fu (Yang) pulses; 5. Press slightly deeper into the muscle level to assess Stomach Qi; 6. Press deeply to the bone to palpate the Zang (Yin) pulses; 7. Observe the frequency and rhythm of the patient's pulse beats. This constitutes the method of the Seven Diagnoses. The 'Nine Palpations' discussed today are not the ancient Head-Heaven/Earth/Humanity, Hand-Heaven/Earth/Humanity, Foot-Heaven/Earth/Humanity, but rather taking Floating, Moderate, and Deep pressures at the Cun, Guan, and Chi positions respectively. In summary, ancient physicians did not restrict pulse diagnosis solely to the Cun, Guan, and Chi areas of the wrist but examined all arterial pulses on the head, face, hands, and feet. Nevertheless, one should not revere modern methods while discarding ancient ones, nor criticize ancient methods while affirming only modern ones. Combining ancient and modern methods allows one to achieve more than half the effectiveness.
Day and night cycle continuously, and the movement of Ying (Nutrient) Qi and Wei (Defensive) Qi must follow fixed numerical patterns.
Modern physicians frequently discuss Ying and Wei, yet when asked about the principles of their circulation, they remain ignorant. Under such circumstances, attempting to identify the exterior-interior and Yin-Yang nature of diseases is indeed difficult. Ying refers to Blood, which is Yin; Wei refers to Qi, which is Yang. This is common knowledge. It is known that Ying circulates within the vessels, while Wei circulates outside the vessels. In one day and night, each circulates fifty times around the body. Many people misunderstand the principle of "Wei circulating outside the vessels," believing that Wei Qi follows Ying Qi externally. They fail to realize that Ying follows its own path, and Wei follows its own path; Wei does not actually follow Ying Qi. Let us first discuss the circulation of Ying Qi. The *Ling Shu* chapter "Ying Qi" records: The Yellow Emperor said, "The way of Ying Qi treasures internal nourishment from grains. Grains enter the Stomach, transmit to the Lung, overflow internally, and spread externally. The purest and most concentrated part travels through the meridians, circulating endlessly, ending where it begins, which is called the norm of Heaven and Earth. Thus, Qi emerges from the Hand-Taiyin Lung Meridian, enters the Hand-Yangming Large Intestine Meridian, ascends to enter the Foot-Yangming Stomach Meridian, descends to the dorsum of the foot, exits between the toes, joins the Foot-Taiyin Spleen Meridian, ascends to the thigh, enters the heart from the thigh, follows the Hand-Shaoyin Heart Meridian, exits the axilla and arm, enters the little finger, joins the Hand-Taiyang Small Intestine Meridian, ascends through the axilla, exits the inner canthus, reaches the vertex, descends the neck, joins the Foot-Taiyang Bladder Meridian, follows the spine to the sacrum, descends to the tip of the little toe, follows the sole, enters the Foot-Shaoyin Kidney Meridian, ascends to the Kidney, from the Kidney enters the Heart, spreads outward to the chest, follows the Pericardium Meridian, exits the axilla and arm, emerges between the tendons, enters the palm, exits the middle finger tip, returns to the tip of the ring finger, joins the Hand-Shaoyang Sanjiao Meridian, ascends to the Danzhong (Conception Vessel), disperses in the Sanjiao, enters the Gallbladder from the Sanjiao, exits the hypochondrium, enters the Foot-Shaoyang Gallbladder Meridian, descends to the dorsum of the foot, again enters between the big toe, joins the Foot-Jueyin Liver Meridian, ascends to the Liver, from the Liver ascends to the Lung, follows the throat, enters the pharynx/nasopharynx aperture, and terminates at the Chumen (root of the nose). Its branch ascends the forehead, follows the vertex, descends the neck, follows the spine, enters the Du Mai (Governing Vessel), connects with the genitalia, passes above the pubic hair, enters the umbilicus, ascends along the abdominal interior, enters the Clavicular region, descends into the Lung, and re-emerges into the Taiyin Lung Meridian. This is the pathway of Ying Qi, the normal order of flow. As for the circulation of Wei Qi, it is different. Wei Qi originates from the Lower Jiao and also circulates fifty times around the body in a day and night. However, during the day it travels twenty-five cycles in the Yang aspects, and during the night twenty-five cycles in the Yin aspects. From sunrise when Yang Qi is strong, the sun enters the Fang constellation, approximately at Mao hour (5-7 AM), at the first drop of water from the clepsydra, it begins from the Foot-Taiyang and Hand-Taiyang meridians. At the second drop, it travels the Foot-Shaoyang and Hand-Shaoyang meridians. At the third drop, the Foot-Yangming and Hand-Yangming meridians. At the fourth drop, it enters the Yin aspects. At the fifth drop, it resumes the Foot-Taiyang and Hand-Taiyang meridians. At the sixth drop, Foot-Shaoyang and Hand-Shaoyang. At the seventh drop, Foot-Yangming and Hand-Yangming. At the eighth drop, it re-enters the Yin aspects. This cycle repeats until the fifty-drop mark, where Qi has circulated twenty-five times in the Yang aspects. At sunset when Yin Qi prevails, the sun enters the Bi constellation, approximately at You hour (5-7 PM), it just enters the Yin aspects. Initially starting from the Foot-Shaoyin Kidney Meridian, then Hand-Shaoyin Heart, then Hand-Taiyin Lung, then Foot-Jueyin Liver, then Foot-Taiyin Spleen, then back to Foot-Shaoyin, Hand-Shaoyin, Hand-Taiyin, Foot-Jueyin, and Foot-Taiyin. This cycle repeats until the hundred-drop mark, having circulated twenty-five times in the Yin aspects. Combined with the twenty-five daytime Yang cycles, it totals fifty cycles around the body. This is how Wei Qi circulates. Regarding the alignment of Wei Qi with years, months, days, hours, star constellations, and water drops, one can understand this by carefully observing the dialogue of Bo Gao in the *Wei Qi Xing* chapter. Unfortunately, later scholars created diagrams and theories claiming Wei Qi follows Ying Qi, misunderstanding the principle that Ying is inside the vessels and Wei is outside. They failed to understand that "Wei outside the vessels" means cycling twenty-five times in Yang during the day and twenty-five times in Yin during the night, not following Ying Qi externally. Some might argue, "The *Ying Qi* chapter implies there is Qi within Ying. Why do you insist Wei does not enter the meridians? Does Ying not contain Qi?" I say no. The classic states: "The clear becomes Ying, the turbid becomes Wei." Wei is like wind, Ying is like water. Ying blood travels within the meridians, relying on Qi to move it, just as water flows underground. While rivers rely on wind to move, wind does not exclusively follow the rivers. Moreover, Ma Yuantai has detailed why Wei Qi does not follow Ying Qi. However, in the *Wei Qi Xing* chapter, interpretations of entering the Yin aspects at the fourth, eighth, and twenty-fourth water drops mistakenly claim entry into the Foot-Shaoyin Kidney Meridian, citing the *Xie Ke* chapter: "Always traveling through the spaces of the Foot-Shaoyin among the Five Zang and Six Fu organs." They miss that "Foot-Shaoyin fen" (region/division) merely refers to passing through that geographical area once, not actual travel along the meridian. If it truly traveled the Foot-Shaoyin meridian, then during the day it would follow the Six Fu organs in Yang, and at night follow the Five Zang organs in Yin, meaning the Kidney would be traversed twice in one day-night cycle, while others only once. In fact, during the day, it passes through the Yin aspects; at night, it travels through the Yin meridians. The *Xie Ke* chapter's statement that it travels "through the spaces of Foot-Shaoyin among the Five Zang and Six Fu" is because Wei Qi originates from the Lower Jiao, which is the domain of the Kidney. However, the mentions of "Qi in the Yin aspects" at the fourth, eighth, twelfth, sixteenth, twentieth, and twenty-fourth drops in the *Wei Qi Xing* chapter need not specifically refer to the Kidney Meridian. Only the twenty-five nighttime Yin cycles can be directly attributed to the Kidney Meridian. Despite this being detailed in the *Neijing*, later students still struggle to comprehend it for three reasons: First, Qin Yueren's *Nan Jing* claims Ying Qi always accompanies Wei Qi, contradicting the classics and creating misleading diagrams. Second, the calculations in the *Wei Qi Xing* chapter involving water drops, fifty cycles, forty-eight mansions, twenty-eight constellations, and twelve earthly branches involve complex fractions that are hard to reconcile without astronomical expertise. Third, the unequal circulation of Wei Qi, where nighttime Yin travel differs from daytime Yang travel which exceeds Yin, creates confusion. These factors have kept the theory of Ying and Wei obscure for millennia. After deep reflection, I propose three models to clarify this: First, the *Ying Qi Circulation Diagram*, showing Ying Qi starting from the Middle Jiao at Yin hour (3-5 AM), entering the Hand-Taiyin Lung Meridian, cycling through the organs endlessly, fifty times daily. Second, the *Chong Qi Circulation Diagram*, circular in nature, cycling Yang twenty-five times from drop 1 to 50, and Yin twenty-five times from drop 51 to 100, accommodating both night and day movements. Third, the *Wei Qi and Celestial Sphere Diagram*, using Zi-Wu as longitude and Mao-You as latitude, aligning the fifty human cycles with solar mansions, earthly branches, and constellations. With these three diagrams, future readers may understand the principles without feeling overwhelmed.
However, there is another perspective on Ying and Wei circulation. Ancient sages believed Ying Qi starts at Yin hour in the Hand-Taiyin Lung Meridian and immediately enters the Hand-Yangming Large Intestine Meridian at Mao hour, mapping the twelve earthly branches sequentially to the twelve organs. If this were true, Ying Qi would only complete one cycle per day, contradicting the "fifty cycles" statement. Furthermore, meridians vary in length; e.g., the Hand-Taiyin Lung Meridian (Zhongfu to Shaoshang) is short, while the Foot-Taiyang Bladder Meridian (Inner Canthus to Zhiyin) is long. If one meridian were assigned to one hour, would pulse speed adjust based on meridian length? I believe not. Ying and Wei are formless Yin and Yang, not有形 (form/material) blood and Qi. If they were material blood/Qi, amputation would block flow and cause death, which we do not observe. The use of the character "Qi" in both *Wei Qi Xing* and *Ying Qi* chapters confirms their formless nature. Being formless Yin and Yang, they are not bound by physical dimensions or meridian lengths, so assigning one hour to one organ is acceptable, but assigning one hour to traverse one entire meridian is not.
According to Ying Qi originating from the Middle Jiao, starting at Yin hour in the Hand-Taiyin Lung Meridian, it sequentially fills the twelve meridians, cycling endlessly, fifty times in a day and night, corresponding to one hundred water drops. In the subsequent diagram, the inner circle represents Interior/Zang, and the outer circle represents Exterior/Fu. Within one cycle, it enters the Interior three times and reaches the Exterior three times, illustrating the "fifty circuits per day and night." Wei Qi also circulates fifty times daily but follows a different path independent of Ying Qi, as shown in the following diagram.
[Image: Ying Qi Interior-Exterior Diagram]
[Image: Wei Qi Circulation and Water Drop Alignment Diagram]
[Image: Ying and Wei Celestial Degrees Diagram]
Men and women, old and young, have distinct physical forms.
Gender and age differences are obvious. "Size" refers to fatness or leanness. The *Nan Jing* Chapter 19 states: "Pulses have compliance and inversion. Men and women have constants, but what if they reverse?" The answer is: "Men are born under Yin (Wood, Yang); Women are born under Shen (Metal, Yin). Therefore, men's pulses are stronger at the Guan position, while women's are stronger at the Chi position. Thus, men typically have weak Chi pulses, and women have strong Chi pulses. This is the norm. Reversal occurs when men exhibit women's pulses or women exhibit men's pulses. What diseases result?" The answer: "Men exhibiting women's pulses indicate Deficiency, with disease internal. Left-side manifestation indicates left-sided disease; right-side indicates right-sided. Women exhibiting men's pulses indicate Excess, with disease in the limbs. Left-side indicates left-sided disease; right-side indicates right-sided. This is the principle. The *Mai Jing* says: "When diagnosing, observe height, size, and temperament. Pulse speed, size, and length matching the person's form and character is auspicious; reversal is inauspicious." Generally, the three pulse positions should be balanced. However, small individuals and women typically have fine, soft pulses. Children aged four to five usually have rapid, fine pulses (eight beats per breath), which is auspicious. The *Qian Jin Yi Fang* states: Large body with fine pulse, small body with large pulse, happy person with solid pulse, suffering person with empty pulse, irritable person with slow pulse, calm person with rapid pulse, robust person with fine pulse, emaciated person with large pulse—all are inversions (Ni), indicating difficult treatment. The reverse is compliance (Shun), indicating easier treatment. Women's pulses should generally be softer/weaker than men's. Children aged four to five naturally have rapid pulses (eight beats per breath). Male left-pulse dominance is compliant; female right-pulse dominance is compliant. Fat people have deep pulses; thin people have floating pulses. However, one should not adhere rigidly to these rules. I once questioned the *Nan Jing* statement "Men getting women's pulse is deficiency, women getting men's pulse is excess." Specifically, "Men getting women's pulse" implies excessive Chi pulse (Water failing to control Fire), indicating deficiency. But "Women getting men's pulse" implies weak Chi pulse, which contradicts the term "excess." I believe the ancients meant "Men getting women's pulse" signifies True Yin deficiency, while "Women getting men's pulse" signifies Yang Pathogen excess. Treating weak Chi pulse in women solely with Yin-nourishing herbs is incorrect. I treated a woman with rapid/large pulses anterior to the Guan and weak pulses posterior to the Guan, with internal heat, irritability, and pain in the head, teeth, shoulders, and arms. Previous doctors prescribed Yin-nourishing formulas (Si Wu Tang, Sha Shen, Bie Jia, Qing Hao, Yin Chai Hu) for over a hundred doses without effect. Recalling "Women getting men's pulse is excess," I prescribed Bo He, Fang Feng, Shan Zhi to suppress Yang, and Di Huang, Dan Pi, Dang Gui, Shao Yao, Gan Cao to support Yin. She improved after a few doses, confirming the ancients' wisdom. However, if men have strong pulses everywhere or women have weak pulses everywhere, generalizations fail. I critique the *Qian Jin Yi Fang*: While "small body/large pulse" etc. as inversions makes sense, labeling "large body/fine pulse," "happy/solid pulse," "irritable/slow pulse," or "robust/fine pulse" as inversions is questionable. I treated a dignitary who was physically imposing but had an imperceptible pulse; minor illness caused his pulse to become prominent. Is large body/fine pulse necessarily an inversion? Happy people with proper care may have solid pulses, not necessarily deficient. Irritable people with harmonious pulses may be long-lived. Robust people with fine pulses may have clear constitutions and dense muscles, leading to narrow pulse channels. The *Qian Jin Yi Fang* relies too heavily on binary oppositions, harming the true meaning, and thus cannot be fully trusted.
Regarding seasonal variations, one must understand Spring, Summer, Autumn, and Winter. See below.
In the months of Yin and Mao (1st and 2nd lunar months), Wood Qi is prosperous, and the Liver pulse is string-like (Xian) and long, following suit.
This refers to the 1st month (Yin) and 2nd month (Mao). During peak Wood Qi, the pulse should be string-like. The *Nan Jing* Chapter 15 states: "Spring pulse is string-like because the Liver belongs to Eastern Wood. Things begin to grow but lack branches/leaves, so the pulse comes soft, weak, and long, hence 'string-like.' What if it changes? A spring pulse that is string-like is normal; deviation indicates disease. Deviation means: Strong/replete arrival indicates Excess (Tai Guo), disease in the Exterior; weak/faint arrival indicates Deficiency (Bu Ji), disease in the Interior. Soft and gentle like touching elm leaves is Normal; becoming more solid and slippery like a long pole is Sick; becoming stiff and tight like a drawn bowstring is Death. Thus, 'slightly string-like' is Normal; 'more string-like with less Stomach Qi' is Sick; 'only string-like with no Stomach Qi' is Death. Spring relies on Stomach Qi as its foundation."