内经云。胸腹者。脏腑之廓也。考其部位层次。胸上属肺。胸膺之间属心。其下有
一横膈。绕肋骨一周。膈下属胃。大腹与脐属脾。脐四围又属小肠。脐下两腰属肾。
两肾之旁及脐下。又属大肠。膀胱亦当脐下。故脐下又属膀胱。血室乃肝所司。血室大
于膀胱。故小腹两旁。谓之少腹。乃血室之边际。属肝。少腹上连季胁。亦属肝。季胁上
连肋骨。属胆。胸与腹向分三停。上停名胸。在膈上。心肺包络居之。即上焦也。膈下
为胃。横曲如袋。胃下为小肠。为大肠。两旁一为肝胆。一为脾。是为中停。即中焦也
。脐以下为下停。有膀胱。有冲任。有直肠。男有外肾。女有子宫。即下焦也。
故胸腹为五脏六腑之宫城。阴阳气血之发源。若欲知其脏腑何如。则莫如按胸腹。名曰
腹诊。其诊法。宜按摩数次。或轻或重。或击或抑。以察胸腹之坚软。拒按与否。并察胸腹
之冷热。灼手与否。以定其病之寒热虚实。又如轻手循抚。自胸上而脐下。知皮肤之润
燥。可以辨寒热。中手寻扪。问其痛不痛。以察邪气之有无。重手推按。察其硬否。更
问其痛否。以辨脏腑之虚实。沉积之何如。即诊脉中浮中沉之法也。惟左乳下虚里脉。
脐间冲任脉。其中虚实。最为生死攸关。故于望闻问切四诊之外。更增一法。推为诊法
上第四要诀。先按胸膈胁肋。按之胸痞者。湿阻气机。或肝气上逆。按之胸痛者。水结气
分。或肺气上壅。按其膈中气塞者。非胆火横窜包络。即伏邪盘踞膜原。按其胁肋胀痛
者。非痰热与气互结。即蓄饮与气相搏。胸前高起。按之气喘者。则为肺胀。膈间突起
。按之实硬者。即是龟胸。若肝病须按两胁。两胁满实而有力者肝平。两胁下痛引小腹
者肝郁。男子积在左胁下者属疝气。女子块在右胁下者属瘀血。两胁空虚。按之无力者为
肝虚。两胁胀痛。手不可按者为肝痈。惟夏病霍乱痧胀者。每多夹水夹食夹血。与邪互
并。结于胸胁。水结胸者。按之疼痛。推之漉漉。食结胸者。按之满痛。摩之嗳腐。血
结胸者。痛不可按。时或昏厥。因虽不同。而其结痛拒按则同。次按满腹。凡仲景
所云胃家者。指上中二脘而言。以手按之痞硬者。为胃家实。按其中脘。虽痞硬而揉之
漉漉有声者。饮癖也。如上中下三脘。以指抚之。平而无涩滞者。胃中平和而无宿滞也
。凡满腹痛。喜按者属虚。拒按者属实。喜暖手按抚者属寒。喜冷物按放者属热。按腹而
其热灼手。愈按愈甚者伏热。按腹而其热烙手。痛不可忍者内痈。痛在心下脐上。硬痛
拒按。按之则痛益甚者食积。痛在脐旁小腹。按之则有块应手者血瘀。腹痛牵引两胁。
按之则软。吐水则痛减者水气。惟虫病按腹有三候。腹有凝结
如筋而硬者。以指久按。其硬移他处。又就所移者按之。其硬又移他处。或大腹。或脐
旁。或小腹无定处。是一候也。右手轻轻按腹。为时稍久。潜心候之。有物如蚯蚓蠢
动。隐然应手。是二候也。高低凸凹。如畎亩状。熟按之。起伏聚散。上下往来。浮沉
出没。是三候也。若绕脐痛。按之磊磊者。乃燥屎结于肠中。欲出不出之状。水肿胀满
症。按之至脐。脐随手移左右。重手控之近乎脊。失脐根者必死。此诊胸腹之大法也。
然按胸必先按虚里。（在左乳三寸下、脉之宗气也、即左心房、尖与脉总管口衔接之处
。）按之微动而不应者。宗气内虚。控之跃动而应衣者。宗气外泄。按之应手。动而不
紧。缓而不急者。宗气积于膻中也。是为常。按之弹手。洪大而搏。或绝而不应者。皆
心胃气绝也。病不治。虚里无动脉者必死。即虚里搏动而高者。亦为恶候。孕妇胎前症
最忌。产后三冲症尤忌。虚损痨瘵症。逐日动高者切忌。惟猝惊疾走大怒后。或强力而
动肢体者。虚里脉动虽高。移时即如平人者不忌。总之虚里为脉之宗气。与寸口六部相
应。虚里脉高者。寸口脉亦多高。寸口脉结者。虚里脉亦必结。往往脉候难凭时。按虚
里脉确有可据。虽多属阴虚火旺之证。或血虚风动之候。阴竭阳厥之际。然按之却有三候
。浅按便得。深按不得者。气虚之候。轻按洪大。重按虚细者。血虚之候。按之有形。
或三四至一止。或五六至一止。积聚之候。按腹之要。以脐为先。脐间动气。即冲任脉。
在脐之上下左右。经云动气在右。不可发汗。汗则衄而渴。心烦。饮水即吐。动气在左
。不可发汗。汗则头眩。汗不止。筋惕肉 。动气在上。不可发汗。汗则气上冲。正在
心中。动气在下。不可发汗。汗则无汗。心大烦。骨节痛。目眩。食入则吐。舌不得前
。又云。动气在右。不可下。下之则津液内竭。咽燥鼻干。头眩心悸。动气在左。不可
下。下之则腹内拘急。食不下。动气更剧。虽有身热。卧则欲蜷。动气在上。不可下。
下之则掌握烦热。身浮汗
泄。欲得水自灌。动气在下。下之则腹满头眩。食则圊谷。心下痞。且不可涌吐。涌吐
则气上逆而晕厥。亦不可提补。提补则气上冲而眩痉。故脐名神阙。是神气之穴。为保
生之根。凡诊脐间动脉者。密排右三指。或左三指。以按脐之上下左右。动而和缓有力
。一息二至。绕脐充实者。肾气充也。一息五六至。冲任伏热也。按之虚冷。其动沉
微者。命门不足也。按之热燥。其动细数。上支中脘者。阴虚气冲也。按之分散一息一
至者。为元气虚败。按之不动。而指如入灰中者。为冲任空竭之候。且可辨其假寒假热
。按冲任脉动而热。热能灼手者。症虽寒战切牙。肢厥下利。是为真热而假寒。若按腹
两旁虽热。于冲任脉久按之。无热而冷。症虽面红口渴。脉数舌赤。是为真寒而假热。
总之冲任脉动。皆伏热伤阴。阴虚火动之证。平人则发病。病患则难治。惟素有肝热者
。亦常有之。尚无大害。若素禀母体气郁。一病温热夹食。肠中必有积热。热盛则冲任
脉动。动而底者热尚轻。动而高者热甚重。兼虚里脉亦动跃者必死。如能积热渐下。冲
任脉动渐微。及下净而冲任脉不动者多生。若冲任脉动跃震手。见于久泻久痢者。乃下
多亡阴之候。病终不治。
【廉勘】虚里冲任。皆出自《内经》。《经》云胃之大络。名曰虚里。动而应衣
者宗气泄也。虚里无动脉者死。又云。冲为血海。又为气街。其脉起于少腹之内胞中。
挟脐左右上行。并足阳明之脉。至胸中而散。上挟咽。任主胞胎。其脉起于少腹之内。
胞室之下。出会阴之分。上毛际。循脐中央。至膻中。上喉咙。绕唇。终于唇下之承浆
穴。与督脉交。李志锐所谓饮食入胃。取汁变赤。由营卫上入于心。由心分布其重浊之
汁。入冲脉化血。精华之汁。入任脉化精。冲是一身之总血管。任是一身之总精管者是
也。俞氏按胸以诊虚里。按腹以诊冲任。较诊太溪趺阳。尤为可据。故腹诊之法。亦诊
断上之必要。
《黄帝内经》说：胸和腹，是容纳脏腑的外廓。考察其部位层次：胸部上方归属肺；胸膺部之间归属心；其下方有一层横膈，环绕肋骨一周；膈肌下方归属胃；大腹部与肚脐归属脾；肚脐四周又归属小肠；肚脐下方的两腰部位归属肾；两肾旁边及肚脐下方，又归属大肠；膀胱也位于肚脐下方，所以肚脐下方也归属膀胱。血室由肝所主管，血室比膀胱大，所以小腹两侧称为少腹，这是血室的边际，归属肝。少腹向上连接季胁，也归属肝；季胁向上连接肋骨，归属胆。
胸和腹向来分为三停（三段）：上停名为胸，在膈肌以上，心肺和心包络居住在此，也就是上焦。膈肌以下为胃，形状横曲像袋子一样；胃下为小肠、大肠；两旁一边是肝胆，一边是脾，这称为中停，也就是中焦。肚脐以下为下停，有膀胱、冲脉、任脉、直肠，男性有外肾（睾丸），女性有子宫，这就是下焦。
所以胸腹是五脏六腑的宫城，阴阳气血的发源之地。如果想要了解脏腑的情况，没有比按诊胸腹更好的方法了，这种方法叫做腹诊。其诊法适宜进行多次按摩，手法或轻或重，或敲击或按压，以观察胸腹的坚硬或柔软，是否拒绝按压，并观察胸腹的冷热，是否灼手，以此确定疾病的寒热虚实。又如用轻手循抚，从胸部上方到肚脐下方，感知皮肤的润燥，可以辨别寒热；用中等力度的手寻扪，询问是否有疼痛，以察知邪气是否存在；用重手推按，观察是否有硬块，再询问是否疼痛，以辨别脏腑的虚实以及病邪沉积的程度，这就像诊脉中的浮、中、沉三种指法一样。只有左乳下的虚里脉，以及脐间的冲任脉，其中的虚实情况，最关乎生死，所以在望、闻、问、切四诊之外，更增加这一法，推崇其为诊法上的第四要诀。
先按诊胸膈胁肋：按之感觉胸中痞闷的，是湿邪阻滞气机，或是肝气上逆；按之感到胸痛的是水饮结聚于气分，或是肺气上壅；按其膈中感觉气塞的，不是胆火横窜侵犯心包络，就是伏邪盘踞在膜原；按其胁肋感到胀痛的是，不是痰热与气互结，就是蓄积的水饮与气相搏。胸前高起，按之气喘的是肺胀；膈间突起，按之实硬的是龟胸。如果是肝病需要按诊两胁：两胁满实而有力的是肝气平和；两胁下痛牵引小腹的是肝郁；男子积块在左胁下的是疝气；女子块状物在右胁下的是瘀血；两胁空虚，按之无力的是肝虚；两胁胀痛，手不能触碰的是肝痈。只有夏季患霍乱、痧胀的人，往往多夹杂水、食、血，与邪气互结于胸胁。水结胸者，按之疼痛，推之有水声漉漉；食结胸者，按之满痛，摩之嗳气有腐臭味；血结胸者，痛不可按压，时而昏厥。虽然病因不同，但其结痛拒按的特点是一样的。
其次按诊满腹：凡是张仲景所说的“胃家”，指的是上脘和中脘。用手按之痞硬的是胃家实证。按其中脘，虽然痞硬但揉之有水声漉漉响的，是饮癖。如果上、中、下三脘，用手指抚之，平坦而无涩滞感，说明胃中平和且无宿食停滞。凡是满腹痛，喜欢被按压的是虚证，拒绝按压的是实证；喜欢暖手按抚的是寒证，喜欢冷物放置的是热证。按腹而热灼手，越按越热的，是伏热；按腹而热烙手，痛不可忍受的是内痈。痛在心下至脐上，硬痛拒按，按之则痛加剧的是食积；痛在脐旁小腹，按之有块状物应手的是血瘀；腹痛牵引两胁，按之变软，吐水后疼痛减轻的是水气。只有虫病按腹有三种征候：腹中有凝结如筋般坚硬，用手指久按，硬度移向别处，再按移向之处，硬度又移向别处，或在腹部、脐旁、小腹无固定位置，这是一候。右手轻轻按腹，时间稍长，潜心等待，感觉到有物体如蚯蚓蠕动，隐隐应手，这是二候。腹部高低凹凸，如田垄状，熟按时，起伏聚散，上下往来，浮沉出没，这是三候。如果绕脐疼痛，按之颗粒磊落，那是燥屎结于肠中，想排出不出的状态。水肿胀满症，按至肚脐，肚脐随手指移动左右，重手按压近于脊背，失去脐根支撑的必死。这是诊察胸腹的大法。
然而按胸必须先按虚里。（位于左乳下三寸，是脉之宗气所在，即左心室尖与主动脉口衔接之处。）按之微动而不应的，是宗气内虚；按压时跳动剧烈甚至应衣的，是宗气外泄；按之应手，跳动不紧，缓慢不急的，是宗气积聚于膻中，这是正常现象。按之弹手，洪大而搏动，或者绝而不应的，都是心胃气绝，病难治。虚里无动脉的必死；即使虚里搏动而高，也是恶候。孕妇胎前症最忌此象，产后三冲症尤忌。虚损痨瘵症，每日跳动渐高的切忌。只有突然受惊、疾走、大怒后，或强力活动肢体后，虚里脉动虽高，过一会儿就像正常人一样的不忌。总之虚里是脉之宗气，与寸口六部相应。虚里脉高的，寸口脉也多高；寸口脉结代的，虚里脉也必结代。往往脉候难以凭信时，按虚里脉确有依据。虽然多属阴虚火旺之证，或血虚风动之候，阴竭阳厥之际，但按之却有三候：浅按便得，深按不得的，是气虚之候；轻按洪大，重按虚细的，是血虚之候；按之有形，或三四至一止，或五六至一止的，是积聚之候。
按腹的要领，以脐为先。脐间动气，即冲任脉，位于脐的上下左右。《内经》说：动气在右，不可发汗，汗出则鼻衄而渴，心烦，饮水即吐。动气在左，不可发汗，汗出则头眩，汗不止，筋惕肉瞤。动气在上，不可发汗，汗出则气上冲，正在心中。动气在下，不可发汗，汗出则无汗，心大烦，骨节痛，目眩，食入则吐，舌强不得前伸。又说：动气在右，不可攻下，下之则津液内竭，咽燥鼻干，头眩心悸。动气在左，不可攻下，下之则腹内拘急，食不下，动气更剧，虽有身热，卧则欲蜷缩。动气在上，不可攻下，下之则掌握烦热，身浮汗泄，想要得水自浇。动气在下，下之则腹满头眩，食则完谷不化，心下痞。而且不可涌吐，涌吐则气上逆而晕厥；也不可提补，提补则气上冲而眩晕痉挛。所以脐名叫神阙，是神气之穴，为保命之根。
凡诊察脐间动脉者，密排右三指，或左三指，以按脐的上下左右。动而和缓有力，一息二至，绕脐充实的，是肾气充盛。一息五六至的，是冲任伏热。按之虚冷，其动沉微的，是命门不足。按之热燥，其动细数，上支中脘的，是阴虚气冲。按之分散，一息一至的，是元气虚败。按之不动，而指如入灰中的，是冲任空竭之候。并且可辨别假寒假热：按冲任脉动而热，热能灼手的，症虽寒战切牙，肢厥下利，是为真热而假寒。若按腹两旁虽热，于冲任脉久按之，无热而冷的，症虽面红口渴，脉数舌赤，是为真寒而假热。总之冲任脉动，皆属伏热伤阴，阴虚火动之证。平人则发病，病患则难治。只有素有肝热的人，也常有此象，尚无大害。若素禀母体气郁，一旦患病温热夹食，肠中必有积热。热盛则冲任脉动，动而底者热尚轻，动而高者热甚重。兼见虚里脉亦动跃的必死。如能积热渐下，冲任脉动渐微，及下净而冲任脉不动的多生。若冲任脉动跃震手，见于久泻久痢者，乃下多亡阴之候，病终不治。
【廉勘】虚里、冲任，皆出自《内经》。《经》云：胃之大络，名曰虚里，动而应衣者宗气泄也。虚里无动脉者死。又说：冲为血海，又为气街，其脉起于少腹之内胞中，挟脐左右上行，并足阳明之脉，至胸中而散，上挟咽。任主胞胎，其脉起于少腹之内，胞室之下，出会阴之分，上毛际，循脐中央，至膻中，上喉咙，绕唇，终于唇下之承浆穴，与督脉交。李志锐所谓饮食入胃，取汁变赤，由营卫上入于心，由心分布其重浊之汁，入冲脉化血，精华之汁，入任脉化精。冲是一身之总血管，任是一身之总精管，说的就是这个道理。俞氏按胸以诊虚里，按腹以诊冲任，较诊太溪、趺阳脉，更为可靠。所以腹诊之法，也是诊断上的必要手段。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: The chest and abdomen are the outer enclosures of the zang-fu organs. Examining their locations and layers: the upper part of the chest belongs to the Lung; the area between the chest and sternum belongs to the Heart; below this lies a horizontal diaphragm, surrounding the ribs in a circle; below the diaphragm belongs to the Stomach; the large abdomen and umbilicus belong to the Spleen; the circumference around the umbilicus belongs to the Small Intestine; the two loins below the umbilicus belong to the Kidney; beside the two kidneys and below the umbilicus belongs to the Large Intestine; the Bladder is also located below the umbilicus, so the area below the umbilicus also belongs to the Bladder. The Blood Chamber (Xueshi, related to the uterus and menstrual function) is governed by the Liver. The Blood Chamber is larger than the Bladder, so the sides of the lower abdomen are called Shaofu (Lesser Abdomen), which is the margin of the Blood Chamber and belongs to the Liver. Shaofu connects upward to the hypochondrium (Jixie), which also belongs to the Liver; the hypochondrium connects upward to the ribs, which belong to the Gallbladder.
The chest and abdomen are traditionally divided into three sections (Ting): The upper section is named Chest, located above the diaphragm, where the Heart, Lung, and Pericardium reside; this is the Upper Jiao (Upper Burner). Below the diaphragm is the Stomach, curved horizontally like a bag; below the stomach are the Small and Large Intestines; on both sides are the Liver and Gallbladder on one side, and the Spleen on the other; this is the Middle Section, or Middle Jiao. Below the umbilicus is the Lower Section, containing the Bladder, Chong Mai (Penetrating Vessel), Ren Mai (Conception Vessel), rectum; males have external kidneys (testes), females have the uterus; this is the Lower Jiao.
Therefore, the chest and abdomen are the palaces of the five zang and six fu organs, and the source of yin-yang and qi-blood. If one wishes to know the condition of the zang-fu organs, there is no better method than palpating the chest and abdomen, known as abdominal diagnosis (Fuzhen). The diagnostic method involves massaging several times, with techniques varying from light to heavy, tapping or pressing, to observe the hardness or softness of the chest and abdomen, whether they reject pressure, and whether they are hot or cold, specifically if they burn upon touch, thereby determining the cold-heat and deficiency-excess nature of the disease. For example, using light hands to stroke from the upper chest to below the umbilicus allows one to perceive the moisture or dryness of the skin, distinguishing cold from heat. Using medium pressure to seek and feel, while asking about pain, helps detect the presence of pathogenic factors. Using heavy pressure to push and press, observing for hardness, and further asking about pain, helps distinguish the deficiency-excess of the zang-fu and the extent of pathological accumulation; this corresponds to the floating, middle, and deep pulse palpation methods. Among these, the Xu Li pulse (located at the left breast) and the Chong-Ren pulses (at the umbilicus) are most critical for life and death. Thus, beyond the four diagnostic methods of inspection, auscultation/olfaction, inquiry, and palpation, this method is added and promoted as the fourth essential key of diagnosis.
First, palpate the chest, diaphragm, and hypochondrium: Palpation revealing chest stuffiness indicates dampness obstructing qi mechanism or liver qi rebelling upward. Palpation causing chest pain indicates water-fluid retention in the qi level or lung qi obstructed upward. Palpation revealing qi stagnation in the diaphragm suggests either gallfire invading the pericardium or latent pathogens lodged in the membrane source. Palpation of the hypochondrium revealing distending pain suggests either phlegm-heat binding with qi or retained fluid clashing with qi. A protruding chest with panting upon palpation indicates Lung Distension. A protrusion between the diaphragms that is solid and hard upon palpation indicates Turtle Chest. In cases of liver disease, palpating both hypochondria is necessary: fullness and solidity with strength indicate normal liver qi; pain in the lower hypochondria radiating to the lower abdomen indicates liver depression; masses in the left hypochondrium in men indicate hernia; masses in the right hypochondrium in women indicate blood stasis; emptiness in both hypochondria with weakness upon palpation indicates liver deficiency; distending pain in both hypochondria intolerable to touch indicates liver abscess. However, in summer cases of Huoluan (cholera-like disorder) or Shazhang (sha-toxin swelling), there is often a mixture of water, food, and blood binding with pathogens in the chest and hypochondria. Water-binding in the chest causes pain on palpation and splashing sounds on pushing; food-binding causes fullness and pain on palpation and belching of rotten smells on rubbing; blood-binding causes pain intolerable to touch and occasional syncope. Although etiologies differ, the characteristics of binding pain and rejection of pressure are the same.
Next, palpate the entire abdomen: When Zhang Zhongjing refers to "Wei Jia" (Stomach family), he refers to the Upper and Middle Wan (epigastric regions). Palpation revealing stuffiness and hardness indicates Wei Jia Excess. Palpating the Middle Wan revealing stuffiness and hardness but producing splashing sounds when rubbed indicates Yin Pi (fluid retention). If the Upper, Middle, and Lower Wan are smooth and free of obstruction when stroked by fingers, it indicates a harmonious stomach without retained food. Generally, abdominal fullness/pain relieved by pressure indicates deficiency; rejected by pressure indicates excess; preferred with warm hands indicates cold; preferred with cold objects indicates heat. Abdominal heat burning upon touch that intensifies with pressing indicates latent heat; abdominal heat searing the hand with unbearable pain indicates internal abscess. Pain below the heart down to the umbilicus, hard and painful rejecting pressure, worsening with pressing, indicates food stagnation. Pain near the umbilicus in the lower abdomen with palpable masses indicates blood stasis. Abdominal pain radiating to both hypochondria, softening upon pressure, and relieved by vomiting water indicates water qi. Regarding intestinal parasites, there are three signs upon abdominal palpation: 1. Hard nodules like sinews that shift location when pressed firmly for a long time, moving unpredictably in the abdomen, umbilicus, or lower abdomen. 2. Gentle pressure for a longer period reveals a sensation of movement like earthworms wriggling under the fingers. 3. Uneven surface resembling fields; firm pressure reveals rising, falling, gathering, scattering, and moving up, down, floating, and sinking. Pain around the umbilicus with granular hardness indicates dry stool bound in the intestines, wanting to exit but unable. In edema and distension, pressing to the umbilicus causes it to move sideways; heavy pressing near the spine with loss of umbilical root support indicates certain death. This is the general method of chest and abdominal diagnosis.
However, when palpating the chest, one must first palpate the Xu Li point. (Located three cun below the left nipple, representing the Zong Qi [Pectoral Qi], corresponding to the apex of the left ventricle connecting to the aorta.) Weak pulsation unresponsive to touch indicates internal deficiency of Zong Qi; vigorous pulsation responding by moving the clothes indicates leakage of Zong Qi outward. Responsive pulsation that is not tight, slow, and urgent indicates Zong Qi accumulating in the Danzhong (Chest Center); this is normal. Pulsation that bounces off the finger, surging and forceful, or absent/unresponsive, indicates exhaustion of heart and stomach qi, making the disease untreatable. Absence of arterial pulsation at Xu Li indicates death. Even high pulsation at Xu Li is an ominous sign. It is strictly contraindicated in pregnancy and postpartum "Three Rushing" syndromes. In consumptive tuberculosis, daily increasing height of pulsation is strictly contraindicated. Only after sudden fright, running, anger, or strenuous exercise, where high pulsation returns to normal after a while, is it not contraindicated. In summary, Xu Li represents Zong Qi, corresponding to the six positions of the Cun Kou (Radial) pulse. High Xu Li pulse correlates with high Cun Kou pulse; knotted Xu Li pulse correlates with knotted Cun Kou pulse. When pulse diagnosis is unreliable, Xu Li palpation provides definite evidence. Although often indicating yin deficiency with fire hyperactivity or blood deficiency with wind stirring, even during yin exhaustion and yang collapse, there are three patterns upon palpation: Obtained superficially but not deeply indicates qi deficiency; Surging superficially but deficient/thin deeply indicates blood deficiency; Tangible with intermittent pulse (every 3-4 beats or 5-6 beats stopping) indicates accumulation/masses.
The key to abdominal palpation starts with the umbilicus. The dynamic qi at the umbilicus is the Chong-Ren pulse, located above, below, left, and right of the umbilicus. The *Neijing* states: Dynamic qi on the right prohibits sweating; sweating causes epistaxis, thirst, irritability, and vomiting upon drinking. Dynamic qi on the left prohibits sweating; sweating causes vertigo, continuous sweating, muscle twitching. Dynamic qi above prohibits sweating; sweating causes qi rushing upward to the heart center. Dynamic qi below prohibits sweating; sweating causes absence of sweat, severe cardiac irritability, bone-joint pain, vertigo, vomiting upon eating, and tongue stiffness. Furthermore: Dynamic qi on the right prohibits purgation; purgation depletes body fluids, causing dry throat/nose, vertigo, and palpitations. Dynamic qi on the left prohibits purgation; purgation causes abdominal cramping, inability to eat, exacerbated dynamic qi, curling up despite fever. Dynamic qi above prohibits purgation; purgation causes hot palms, floating sweat, desire for self-irrigation. Dynamic qi below prohibits purgation; purgation causes abdominal fullness, vertigo, undigested stool in feces, and epigastric stuffiness. Emesis is also prohibited, as it causes qi rebellion and syncope. Tonification is prohibited, as it causes qi rushing upward leading to vertigo and spasms. Therefore, the umbilicus is named Shenque (Spirit Pivot), the acupoint of spirit qi and root of preserving life.
When diagnosing umbilical arterial pulsation, place three fingers tightly on the right or left to palpate above, below, left, and right of the umbilicus. Harmonious, strong pulsation, two breaths per cycle, filling the umbilicus indicates sufficient kidney qi. Five to six breaths per cycle indicates latent heat in Chong-Ren pulses. Cold and empty palpation with deep/weak pulsation indicates Mingmen (Gate of Life) insufficiency. Hot/dry palpation with thin/rapid pulsation extending to Zhongwan indicates yin deficiency with qi rushing. Scattered pulsation, one breath per cycle, indicates exhaustion of primordial qi. No pulsation, feeling like fingers entering ash, indicates depletion of Chong-Ren pulses. This also distinguishes false cold/heat: If Chong-Ren pulsation is hot and burning, despite symptoms of chattering teeth, cold limbs, and diarrhea, it is true heat with false cold. If the sides of the abdomen feel hot, but prolonged palpation of Chong-Ren pulses reveals no heat/cold, despite red face, thirst, rapid pulse, and red tongue, it is true cold with false heat. In summary, Chong-Ren pulsation indicates latent heat injuring yin and yin deficiency with fire stirring. In healthy people, this leads to illness; in patients, it is difficult to treat. Those with chronic liver heat may have this without major harm. However, those with maternal qi stagnation contracting warm-heat with food stagnation will have intestinal accumulated heat. Heat abundance causes Chong-Ren pulsation: low pulsation indicates mild heat; high pulsation indicates severe heat. Combined with vigorous Xu Li pulsation indicates death. If accumulated heat gradually descends, Chong-Ren pulsation becomes faint, and stops after purgation, survival is likely. If Chong-Ren pulsation vibrates against the hand in chronic diarrhea/dysentery, it indicates yin exhaustion from excessive downward flow, and the disease is incurable.
[Commentary] Xu Li and Chong-Ren originate from the *Neijing*. The Canon states: The great collateral of the stomach is named Xu Li; vigorous pulsation moving the clothes indicates leakage of Zong Qi. Absence of arterial pulsation at Xu Li indicates death. It also states: Chong is the Sea of Blood and Street of Qi; its vessel originates in the lower abdomen within the Baozhong (uterus/womb), ascends flanking the umbilicus, runs alongside the Foot-Yangming Stomach channel, disperses in the chest, and ascends flanking the throat. Ren governs conception; its vessel originates in the lower abdomen below the Bao Shi (womb), emerges at Huiyin, ascends past the pubic hair, follows the center of the umbilicus to Danzhong, ascends through the throat, circles the lips, ending at Chengjiang below the lower lip, intersecting with the Du Mai. Li Zhirui stated: Food enters the stomach, juices turn red, ascend via Ying and Wei to the heart, distribute heavy juices to Chong Mai to form blood, and essence juices to Ren Mai to form essence. Chong is the main blood vessel of the body; Ren is the main essence vessel. Yu’s method of palpating the chest to diagnose Xu Li and the abdomen to diagnose Chong-Ren is more reliable than diagnuring Taixi and Duyang pulses. Thus, abdominal diagnosis is essential in clinical practice.