三部俱缓脾家热。口臭胃翻常呕逆。齿肿龈宣注气缠。寒热时时少心力。
缓脉属土。三部俱缓。则为土太过矣。故曰。脾家热。脾开窍于口。故口臭。
经脉篇云。脾虚则吐。故胃翻常呕逆也。脾与胃相连。胃之经脉。上入齿
中。还出挟口。环唇。下交承浆。故曰齿肿龈宣。脾病有寒热证。如少阴司
天。四之气主客。湿土寒热是也。心脾之母也。子病则耗母气。母亦因之
而病。故寒热时时少心力也。有所谓注气者。如尸注。鬼注。劳注。及注夏。
注船之类。皆谓之注。其病注于阴阳气血之内。不可名状。其人饮食懒
进。面黄羸瘦寒热时时。四肢无力。以月以年。缠绵不已。是皆注病之情
状也。土性缓。故其脉其病亦缓。
按灵枢邪气脏腑病形篇曰。缓者多热。仲景曰。缓者阳气长。又曰。缓则
胃气有余。王海藏曰。缓大而长为热。张景岳曰。缓者纵缓之状。非后世
迟缓之谓。故凡纵缓之脉多中热。而气化从乎脾胃也。
脾脉实并浮。消中脾胃亏。口干饶饮水。多食亦肌虚。
阿阿缓弱春扬柳。乃脾之本脉也。经云。善者不可得见。恶者可见。今脾
脉实而且浮。是为土中有火。火炎则土燥。故为消中之病矣。诸脉以实
为实。以虚为虚。惟脾脉则以实为虚。何也。以脾胃本和缓故也。经脉别
论云。食入于胃。散精于肝。淫气于筋。食气入胃。浊气归心。淫精于脉。脉
气流经。经气归于肺。肺朝百脉。输精于皮毛。毛脉合精。行气于府。府精
神明。留于四脏。气归于权衡。权衡以平气口。成寸以决死生。饮入于胃。
游溢精气。上输于脾。脾气散精。上归于肺。通调水道。下输膀胱。水精四
布。五经并行。合于四时。五脏阴阳。揆度以为常也。若土中有火。则饮食
易于焦熬。不能化行津液。上输于肺。散精于脾。以荣养肌肉。故口干饶
饮水。多食亦肌虚也。
按帝曰。诊得胃脉病形何如。岐伯曰。胃脉实则胀。虚则泻。
按儒门事亲云。八卦之中。离能 物。五行之中。惟火能焚物。六气之中。
惟火能消物。故火之为用。燔木则消而为炭。焚土则消而为伏龙肝。炼
金则消而为汁。 石则消而为灰。煮水则消而为汤。煎海则消而为盐。
干汞则消而为粉。熬锡则消而为丹。故泽中之潦。涸于炎晖。鼎中之水。
干。于壮火。盖五脏心为君火正化。肾为君火对化。三焦为相火正化。胆
为相火对化。得其平。则烹炼饮食。糟粕去焉。不得其平。则燔灼脏腑。而
津液竭焉。故入水之物。无物不长。入火之物。无物不消。夫一身之心火。
甚于上。为膈膜之消。甚于中。为肠胃之消。甚于下。为膏液之消。甚于外。
为肌肉之消。上甚不已。则消及于肺。中甚而不已。则消及于脾。下甚而
不已。则消及于肝肾。外甚而不已。则消及于筋骨。四脏皆消尽。则心始
自焚而死矣。故素问有消瘅。消中。消渴。风消。膈消。肺消之说。消之证不
同。归之火则一焉。故消瘅者。众消之总名。消中者。善饥之通称。消渴者。
善饮之同谓。惟风消。膈消。肺消。此三说不可不分。风消者。二阳之病。二
阳者。阳明也。阳明者。胃与大肠也。心受之则血不流。故女子不月。脾受
之。则胃不化。故男子少精。皆不能成隐曲之事。火伏于内。久而不已。为
风所鼓。消渴肠胃。其状口干。虽饮水而不咽。此风热格拒于贲门也。口
者。病之上源。故病如是。又经曰。二阳结谓之消。此消乃肠胃之消也。其
善食而瘦者。名曰食 。此消。乃肌肉之消也。
单滑脾家热。口臭气多粗。
脾胃者。应唇而通口气者也。今脾脉见滑。则脾家有热。而口气臭矣。脾
有火则上蒸于肺。而清肃之气不行。肺叶举而口气粗矣。
涩即非多食。食不作肌肤。
夫脾主中州。而能摄血。故曰营出中焦。脾阴足则磨谷能消食。而连肉
润肌臀矣。涩为血少。今脾脉而见涩。则为脾虚血少。脾既虚。则饮食不
甘美。故曰。即非多食也。纵强食之。亦不能作肌肤矣。熊氏谓脾脉见涩。
是心火虚。故令脾土无生气。其说亦太转折。张氏谓其涩为肺脉。见于
土部。是子来母位。实邪为患。故能多食。不多食则肌肉消瘦矣。其说更
悖。
微浮伤客热。来去作微疏。
熊宗立云。脾部脉微而浮。是外之风邪热毒。客舍于脾也。故乍热乍止。
如客之往来。非本经之正病。但安其脾胃。则自愈矣。
有紧脾家痛。仍兼筋急拘。欲吐即不吐。冲冲未得疏。
经脉别论云。食入于胃。散精于肝。淫气于筋。紧则为寒。脾胃而见紧脉。
是为内伤生冷。木气郁于土中。不得发越。故腹痛而筋急。欲吐不吐。即
呕逆也。呕逆则气扰乱于胸中。而冲冲未得疏泄。若能得一吐。则木气
条达而复伸。筋自不拘。腹痛自止矣。
若弦肝气盛。妨食被机谋。
此为木来克土。必致妨碍饮食。而为贼邪所谋害矣。
大实心中痛。如邪勿带符。
脾脉大实。则为脾有实邪。而为心中痛者。何也。按经脉篇云。脾足太阴
之脉。起于大指之端。入腹属脾。络胃。上膈。挟咽。连舌本。散舌下。其支者。
复从胃。别上膈。注心中。又云。脾病为心下急痛。故曰。大实心中痛也。藏
病则传于府。足阳明胃经是也。足阳明病。则登高而歌。弃衣而走。故曰。
如邪勿带符也。
溢关涎退场门。风中见羁孤。
脾属土。其性镇静。其畏风木。开肌腠也。其液为涎。脾气不足。则所胜侮
之。脾土被克而起。致中州无权。风木之邪肆虐。故风痰壅塞于上。而涎
液溢出于口。此为太阴中风之证。太阴。脾土也。脾土主灌溉四傍。今既
中风。则如人之羁旅孤危。而一无所根据助也。
三部脉象均呈现缓象，是脾家蕴热。表现为口臭、胃气上逆时常呕吐、牙齿肿痛、牙龈萎缩、气机缠滞。寒热交替发作，时常感到心力不足。
缓脉属土。三部脉皆缓，说明土气太过。所以说这是脾家热证。脾开窍于口，所以出现口臭。《经脉篇》说：脾虚则呕吐。所以胃气翻逆，经常呕吐。脾与胃相连，胃的经脉，上行进入齿中，复出挟持口角，环绕嘴唇，向下交于承浆穴。所以说牙齿肿痛、牙龈萎缩。脾病有寒热证候，如少阴司天，四之气主客，湿土寒热即是此类。心为脾之母，子病则耗损母气，母脏也因此而病。所以寒热时时发作，导致心力不足。所谓“注病”，如尸注、鬼注、劳注，以及注夏、注船之类，都称为注。其病邪注入阴阳气血之内，无法用语言形容清楚。患者饮食懒进，面色萎黄，身体消瘦，寒热交替，四肢无力，以月或以年计算，缠绵不已。这些都是注病的病情状貌。土性缓，所以其脉象和病症也表现为缓。
按《灵枢·邪气脏腑病形篇》说：缓脉多主热证。张仲景说：缓脉表示阳气生长。又说：缓脉表示胃气有余。王海藏说：缓大而长属于热证。张景岳说：缓是指纵缓之状，不是后世所说的迟缓。所以凡是纵缓的脉象多主内热，气化功能源于脾胃。
脾脉实且浮，会导致消中病，脾胃亏虚。口干，喜欢大量饮水，虽然多吃但肌肉依然虚弱。
阿阿（形容柔和）缓弱，像春天扬起的柳枝，这是脾的本脉。经书说：正常的脉象难以察觉，异常的脉象才能看到。现在脾脉既实又浮，这是土中有火。火炎则土燥，所以发生消中的疾病。各种脉象以实为实，以虚为虚，唯独脾脉以实为虚。为什么呢？因为脾胃本应和缓。《经脉别论》说：食物进入胃，精微散布到肝，淫溢之气滋养筋脉。食气入胃，浊气归于心，淫溢精气于脉。脉气流经，经气归于肺，肺朝会百脉，输精于皮毛。毛脉合精，行气于府，府精神明，留于四脏，气归于权衡。权衡以平气口，成寸以决死生。水饮进入胃，游溢精气，上输于脾。脾气散精，上归于肺，通调水道，下输膀胱。水精四布，五经并行，合于四时，五脏阴阳，揆度以为常法。如果土中有火，则饮食容易焦熬，不能化行津液，上输于肺，散精于脾，以荣养肌肉。所以口干，喜欢大量饮水，即使多吃，肌肉依然虚弱。
按黄帝问：诊得胃脉病形如何？岐伯答：胃脉实则腹胀，虚则泄泻。
按《儒门事亲》说：八卦之中，离卦能化物；五行之中，只有火能焚物；六气之中，只有火能消物。所以火的作用，焚烧木头则消而为炭，焚烧泥土则消而为伏龙肝，炼金则消而为汁，烧石则消而为灰，煮水则消而为汤，煎海水则消而为盐，干汞则消而为粉，熬锡则消而为丹。所以沼泽中的积水，在烈日下干涸；鼎中的水，在壮火下干涸。五脏中，心为君火正化，肾为君火对化，三焦为相火正化，胆为相火对化。得其平和，则烹炼饮食，糟粕去除；不得其平和，则燔灼脏腑，津液枯竭。所以入水之物，无物不长；入火之物，无物不消。一身之心火，甚于上部，则为膈膜之消；甚于中部，则为肠胃之消；甚于下部，则为膏液之消；甚于外部，则为肌肉之消。上部甚而不已，则消及于肺；中部甚而不已，则消及于脾；下部甚而不已，则消及于肝肾；外部甚而不已，则消及于筋骨。四脏皆消尽，则心自焚而死。所以《素问》有消瘅、消中、消渴、风消、膈消、肺消的说法。消的证候不同，归结于火则是一样。所以消瘅是众消的总名，消中是善饥的通称，消渴是善饮的同谓。只有风消、膈消、肺消这三种说法不可不分。风消者，是二阳的病。二阳就是阳明。阳明就是胃与大肠。心受之则血不流，所以女子月经不来；脾受之，则胃不化，所以男子精少。都不能完成隐曲之事。火伏于内，久而不已，被风所鼓动，消渴肠胃，其状口干，虽然饮水却不咽下，这是风热格拒于贲门。口，是病之上源，所以病是这样。又经书说：二阳结谓之消。这个消乃肠胃之消。其善食而瘦者，名叫食ite（此处原文似缺字或异体，指食后消瘦），这个消乃肌肉之消。
脾胃对应唇，通口气。现在脾脉见滑，则是脾家有热，口气臭秽。脾有火则上蒸于肺，清肃之气不行，肺叶举而口气粗重。
涩脉即非多食，食物不能转化为肌肤。
脾主中州，能摄血，所以说营气出于中焦。脾阴充足则磨谷能消食，从而滋润肌肉臀部。涩脉代表血少。现在脾脉见涩，则是脾虚血少。脾既虚，则饮食不甘美，所以说即非多食。纵然强行进食，也不能转化为肌肤。熊氏认为脾脉见涩，是心火虚，所以令脾土无生气，这种说法也太曲折。张氏认为其涩为肺脉见于土部，是子来母位，实邪为患，所以能多食，不多食则肌肉消瘦，这种说法更悖谬。
微浮脉伤于客热，来去作微微疏缓。
熊宗立说：脾部脉微而浮，是外之风邪热毒，客舍于脾。所以乍热乍止，如客人往来，不是本经的正病。只要安和其脾胃，则自愈。
《经脉别论》说：食入于胃，散精于肝，淫气于筋。紧脉则为寒。脾胃见紧脉，是为内伤生冷，木气郁于土中，不得发越，所以腹痛而筋急。欲吐不吐，即呕逆。呕逆则气扰乱于胸中，而冲冲未得疏泄。若能得一吐，则木气条达而复伸，筋自然不拘挛，腹痛自然停止。
若见弦脉，肝气盛，妨碍饮食，被机谋所害。
大实脉心中痛，如邪勿带符。
脾脉大实，则为脾有实邪，而为心中痛者，为什么呢？按《经脉篇》说：脾足太阴之脉，起于大指之端，入腹属脾，络胃，上膈，挟咽，连舌本，散舌下。其支者，复从胃，别上膈，注心中。又说：脾病为心下急痛。所以说：大实心中痛也。脏病则传于腑，足阳明胃经是也。足阳明病，则登高而歌，弃衣而走，所以说：如邪勿带符也。
溢关涎退场门，风中见羁孤。
脾属土，其性镇静，其畏风木，开肌腠。其液为涎。脾气不足，则所胜侮之。脾土被克而起，致中州无权，风木之邪肆虐，故风痰壅塞于上，而涎液溢出于口。此为太阴中风之证。太阴，脾土也。脾土主灌溉四傍，今既中风，则如人之羁旅孤危，而一无所根据助也。
The pulse at all three positions is slow (Huan), indicating heat in the Spleen. Symptoms include bad breath, stomach qi rebelling with frequent vomiting, swollen teeth, receding gums, and stagnant qi. Alternating chills and fever occur, accompanied by a constant feeling of insufficient heart strength.
The slow pulse belongs to Earth. When the pulse at all three positions is slow, it indicates an excess of Earth qi. Therefore, it is said to be heat in the Spleen. The Spleen opens into the mouth, hence the bad breath. *Jing Mai Pian* states: "When the Spleen is deficient, vomiting occurs." Thus, stomach qi rebels with frequent vomiting. The Spleen and Stomach are connected; the Stomach meridian enters the teeth, emerges around the mouth, encircles the lips, and descends to intersect at Chengjiang (CV24). Hence, swollen teeth and receding gums. Spleen disease presents with chills and fever syndromes, such as when Shaoyin governs the year, during the fourth Qi, involving damp-earth chills and fever. The Heart is the mother of the Spleen; when the child is diseased, it consumes the mother's qi, causing the mother organ to become ill as well. Thus, alternating chills and fever occur frequently, leading to insufficient heart strength. There is what is called "Zhu disease" (Infectious/Chronic Disease), such as Corpse Zhu, Ghost Zhu, Labor Zhu, as well as Summer Zhu and Boat Zhu. All are termed Zhu. The pathogenic factor injects into the yin-yang and qi-blood, indescribable. The patient has poor appetite, sallow complexion, emaciation, alternating chills and fever, and weakness in the four limbs. It lingers for months or years without cessation. These are the characteristics of Zhu diseases. Earth nature is slow; therefore, its pulse and diseases are also slow.
According to *Ling Shu: Xie Qi Zang Fu Bing Xing Pian*: "Slow pulses mostly indicate heat." Zhang Zhongjing said: "Slow pulses indicate the growth of Yang qi." He also said: "Slow pulses indicate excess Stomach qi." Wang Haizang said: "Slow, large, and long pulses indicate heat." Zhang Jingyue said: "Slow refers to a relaxed and loose state, not the迟 (Chi) slowness of later generations." Therefore, any relaxed and loose pulse mostly indicates internal heat, and qi transformation originates from the Spleen and Stomach.
If the Spleen pulse is Excess (Shi) and Floating (Fu), it leads to Xiao Zhong (Middle Jiao Wasting-Thirst) and deficiency of the Spleen and Stomach. Dry mouth, excessive thirst, eating much but muscles remain weak.
Relaxed and weak, like willow catkins in spring, this is the fundamental pulse of the Spleen. The classics state: "Normal pulses are hard to perceive; abnormal ones are visible." Now, if the Spleen pulse is both Excess and Floating, it indicates Fire within Earth. Fire flares up, drying the Earth, thus causing Xiao Zhong disease. For most pulses, Excess means Excess and Deficiency means Deficiency; only for the Spleen pulse, Excess implies Deficiency. Why? Because the Spleen and Stomach should naturally be relaxed and moderate. *Jing Mai Bie Lun* states: "Food enters the Stomach, essence scatters to the Liver, excessive qi nourishes the sinews. Food qi enters the Stomach, turbid qi returns to the Heart, excessive essence enters the vessels. Vessel qi flows through meridians, meridian qi returns to the Lungs. The Lungs direct hundred vessels, transmitting essence to skin and hair. Hair and vessel essence combine, moving qi to the Fu organs. Fu organ essence becomes spirit, remaining in the four Zang organs. Qi returns to balance. Balance levels the Qi Kou, forming Cun to determine life and death. Drinks enter the Stomach, floating essence ascends to the Spleen. Spleen qi scatters essence, ascending to the Lungs, regulating water passages, descending to the Bladder. Water essence distributes everywhere, five meridians run together, harmonizing with the four seasons, the yin-yang of the five Zang organs, measured as the norm. If Earth contains Fire, food easily scorches, failing to transform fluids, ascend to the Lungs, scatter essence to the Spleen, and nourish muscles. Hence dry mouth, excessive drinking, and even with much eating, muscles remain weak."
According to the Yellow Emperor's question: "How are the pulse and disease forms of the Stomach?" Qibo answered: "Stomach pulse Excess causes distension, Deficiency causes diarrhea."
According to *Ru Men Shi Qin*: "Among the Eight Trigrams, Li can transform things; among the Five Elements, only Fire can burn things; among the Six Qi, only Fire can consume things. Thus, the function of Fire: burning wood turns it to charcoal; burning earth turns it to Fulonggan (dragon liver); refining metal turns it to liquid; burning stone turns it to ash; boiling water turns it to soup; frying seawater turns it to salt; drying mercury turns it to powder; smelting tin turns it to cinnabar. Thus, swamp water dries under intense sun; water in cauldrons dries under strong fire. Among the five Zang organs, the Heart is the Correct Transformation of Sovereign Fire, the Kidney is the Counter Transformation of Sovereign Fire, the Sanjiao is the Correct Transformation of Ministerial Fire, and the Gallbladder is the Counter Transformation of Ministerial Fire. When balanced, they cook and digest food, removing dregs; when unbalanced, they scorch the zang-fu, exhausting body fluids. Thus, things entering water grow without limit; things entering fire are consumed without exception. Sovereign Fire in the body: excessive in the upper part causes diaphragm wasting; excessive in the middle part causes gastrointestinal wasting; excessive in the lower part causes膏液 (fat/fluid) wasting; excessive in the exterior causes muscle wasting. If upper excess persists, it wastes the Lungs; if middle excess persists, it wastes the Spleen; if lower excess persists, it wastes the Liver and Kidneys; if exterior excess persists, it wastes sinews and bones. When the four zang organs are fully wasted, the Heart burns itself to death. Thus, *Su Wen* mentions Xiao Dan, Xiao Zhong, Xiao Ke, Feng Xiao, Ge Xiao, and Fei Xiao. Although wasting syndromes differ, they all return to Fire. Thus, Xiao Dan is the general name for all wastings; Xiao Zhong is the common term for excessive hunger; Xiao Ke is the same term for excessive thirst. Only Feng Xiao, Ge Xiao, and Fei Xiao must be distinguished. Feng Xiao is a disease of Er Yang (Two Yangs). Er Yang is Yangming. Yangming is the Stomach and Large Intestine. If the Heart receives it, blood does not flow, so women have no menstruation; if the Spleen receives it, the Stomach fails to digest, so men have little essence. Neither can perform intimate acts. Fire hidden inside, lingering and unabated, driven by Wind, wastes the gastrointestinal tract. Symptoms include dry mouth; although drinking, one cannot swallow. This is wind-heat blocking the贲门 (cardia). The mouth is the source of the disease above, hence the condition. Also, the classics say: 'Er Yang knot is called Xiao.' This Xiao is gastrointestinal wasting. Those who eat well but grow thin are named Shi ite (food wasting), which is muscle wasting."
A single Slippery (Hua) pulse indicates heat in the Spleen. Bad breath, coarse breathing.
The Spleen and Stomach correspond to the lips and control breath odor. Now, if the Spleen pulse appears Slippery, there is heat in the Spleen, and the breath smells foul. Fire in the Spleen steams upward to the Lungs, preventing clear and descending qi from functioning. Lung leaves rise, causing coarse breath.
Choppy (Se) pulse indicates not excessive eating; food does not transform into flesh.
The Spleen governs the Central State and controls blood, hence "Ying Qi arises from the Middle Jiao." When Spleen Yin is sufficient, it grinds grain and digests food, moistening muscles and buttocks. Choppy pulse signifies blood deficiency. Now, if the Spleen pulse appears Choppy, it indicates Spleen deficiency and blood shortage. Since the Spleen is deficient, food is not palatable, hence "not excessive eating." Even if forced to eat, it cannot transform into flesh. Xiong believed that a Choppy Spleen pulse indicates deficient Heart Fire, causing Spleen Earth to lack vital energy; his explanation is too convoluted. Zhang believed that Choppy appearing in the Earth position is a Lung pulse, meaning the child comes to the mother's position, causing real pathogenic factors, leading to excessive eating; if not eating excessively, muscles waste away. His explanation is more absurd.
Slight Floating pulse indicates injury by exogenous heat; coming and going, slightly sparse.
Xiong Zongli said: A slight and floating pulse in the Spleen region indicates external wind-pathogen and heat-toxin lodging in the Spleen. Thus, intermittent fever and cessation, like a guest coming and going. This is not the primary disease of the channel. If the Spleen and Stomach are stabilized, it heals spontaneously.
Tight (Jin) pulse indicates Spleen pain, accompanied by tendon tension and cramping. Desire to vomit but unable to; rushing sensation without relief.
*Jing Mai Bie Lun* states: "Food enters the Stomach, essence scatters to the Liver, excessive qi nourishes the sinews." Tight pulse indicates Cold. If the Spleen and Stomach show a Tight pulse, it is due to internal injury from raw/cold foods. Wood qi is depressed within Earth, unable to vent, causing abdominal pain and tendon tension. Desire to vomit but unable to, i.e., vomiting/rebelling. Vomiting disturbs qi in the chest, creating a rushing sensation without relief. If one can vomit once, Wood qi will flow freely and extend, tendons will relax, and abdominal pain will stop.
Wiry (Xian) pulse indicates Liver qi excess, obstructing food intake, harmed by treacherous pathogens.
This is Wood overcoming Earth, inevitably obstructing food intake and harming the host via treacherous pathogens.
Large Excess pulse causes central chest pain; like evil, do not carry talisman.
If the Spleen pulse is Large and Excess, it indicates real pathogenic factors in the Spleen, causing central chest pain. Why? According to *Jing Mai Pian*: The Foot-Taiyin Spleen Meridian starts at the tip of the big toe, enters the abdomen, connects to the Spleen, links to the Stomach, ascends through the diaphragm, clamps the throat, connects to the root of the tongue, and spreads under the tongue. Its branch returns from the Stomach, separates to ascend through the diaphragm, and pours into the Heart. It also states: "Spleen disease causes urgent pain below the heart." Hence, "Large Excess causes central chest pain." Zang diseases transmit to Fu organs; the Foot-Yangming Stomach Meridian is one. Foot-Yangming disease causes climbing high and singing, discarding clothes and running. Hence, "Like evil, do not carry talisman."
Overflowing Guan position, saliva retreats from Changmen; in Wind, see isolation.
The Spleen belongs to Earth, its nature is calm, it fears Wind-Wood, and opens the muscle-coupling. Its fluid is saliva. When Spleen qi is insufficient, the conquered overcomes it. Spleen Earth is overcome and rises, causing the Central State to lose authority. Wind-Wood pathogens rage, so wind-phlegm blocks above, and saliva overflows from the mouth. This is Taiyin Wind-Strike syndrome. Taiyin is Spleen Earth. Spleen Earth irrigates the surroundings. Now struck by Wind, it is like a traveler isolated and perilous, with no support or assistance.