春得秋脉,夏得冬脉,长夏得春脉,秋得夏脉,冬得长夏脉,名曰阴出之阳,病善怒
不治,是谓五邪,皆同,死不治。
春胃微弦曰平,弦多胃少曰肝病,但弦无胃曰死,胃而有毛曰秋病,毛甚曰今病,脏真
散于肝,肝藏筋膜之气也。
夏胃微钩曰平,钩多胃少曰心病,但钩无胃曰死,胃而有石曰冬病,石甚曰今病,脏真
通于心,心藏血脉之气也。
长夏,胃微软弱曰平,胃少软弱多曰脾病,但代无胃曰死,软弱有石曰冬病,软(《素》
作弱)甚曰今病,脏真濡于脾,脾藏肌肉之气也。
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,脏真
高于肺,肺行营卫阴阳也。
冬胃微石曰平,胃少石多曰肾病,但石无胃曰死,石而有钩曰夏病,钩甚曰今病,脏真
下于肾,肾藏骨髓之气也。
胃之大络,名曰虚里,贯膈络肺,出于左乳下,其动应手,脉之宗气也。盛喘数绝者。
则病在中,结而横有积矣,绝不至曰死。诊得胃脉则能食,虚则泄也。
心脉揣(《素问》作搏)坚而长,病舌卷不能言。其软而散者,病消渴(《素》作烦)
自已。
肺脉揣(《素》作搏,下同)坚而长,病唾血。其软而散者,病灌汗,至令不复散发。
肝脉揣坚而长,色不青,病坠若搏,因血在胁下,令人喘逆。其软而散,色泽者,病溢
饮。溢饮者,渴渴多饮,而溢入肌皮肠胃之外也。
胃脉揣坚而长,其色赤,病折髀。其软而散者,病食痹痛髀。
脾脉揣坚而长,其色黄,病少气。其软而散,色不泽者,病足 肿,若水状。
肾脉揣坚而长,其色黄而赤者,病折腰。其软而散者,病少血,至令不复。
夫脉者,血气之府也。长则气和,短则气病,数则烦心,大则病进,上盛则气高,下盛
则气胀,代则气衰,细则气少,涩则心痛,浑浑革革至如涌泉,病进而色,弊之绰绰(一本作
绵绵)其去如弦绝者死。
寸口脉中手短者,曰头痛;寸口脉中手长者,曰足胫痛;寸口脉沉而坚者,病在中;寸
口脉浮而盛者,病在外;寸口脉中手促上数(《素问》作击)者,曰肩背痛;寸口脉紧而
横坚
热;寸口脉盛滑坚者,曰病在外;寸口脉小实而坚者,曰病在内。脉小弱以涩者,谓之久病
;脉浮滑而实大(《素问》作滑浮而疾)者,谓之新病。病甚有胃气而和者,曰病无他;脉急
者
曰病无他,反四时及不间脏曰死。
太阳脉至,洪大以长。少阳脉至,乍数乍疏,乍短乍长。阳明脉至,浮大而短。
厥阴有余,病阴痹,不足病生热痹,滑则病狐疝风,涩则病少腹积气(一本作积厥)。
少阴有余,病皮痹瘾疹,不足病肺痹,滑则病肺风疝,涩则病积溲血。
太阴有余,病肉痹寒中,不足病脾痹,滑则病脾风疝,涩则病积心腹时满。
阳明有余,病脉痹身时热,不足病心痹,滑则病心风疝,涩则病积时善惊。
太阳有余,病骨痹身重,不足病肾痹,滑则病肾风疝,涩则病积时善癫疾。
少阳有余,病筋痹胁痛,不足病肝痹,滑则病肝风疝,涩则病积时筋急目痛。
太阴厥逆, 急挛,心痛引腹,治主病者。
少阴厥逆,虚满呕变,下泄清,治主病者。
厥阴厥逆,挛,腰痛,虚满前闭 语,治主病者。
三阴俱逆,不得前后,使人手足寒,三日死。
太阳厥逆,僵仆呕血善衄,治主病者。
少阳厥逆,机关不利。机关不利者,腰不可以行,项不可以顾,发肠痈,不可治,惊
者死。
阳明厥逆,喘咳身热,善惊,衄血呕血,不可治,惊者死。
手太阴厥逆,虚满而咳,善呕吐沫,治主病者。
手心主少阴厥逆,心痛引喉,身热者死,不热者可治。
手太阳厥逆,耳聋泣出,项不可以顾,腰不可以俯仰,治主病者。
手阳明少阳厥逆,发喉痹,嗌肿痛,治主病者。
来疾去徐,上实下虚,为厥癫疾;来徐去疾,上虚下实,为恶风也。故中恶风者,阳
气受也。有脉俱沉细数者,少阴厥也;沉细数散者,寒热也;浮而散者,为 (音顺)仆
。诸浮而不躁者,皆在阳,则为热;其有躁者,在手。诸细而沉者,皆在阴,则为骨痛;其
有静者,在足。数动一代者,病在阳之脉也。其涩者,阳气有余也;滑者,阴气有余也。
阳气有余则为身热无汗,阴气有余则为多汗身寒,阴阳有余则为无汗而寒。推而外之,内而
不外者,有心腹积也。推而内之,外而不内者,中有热也。推而上之,下而不上者,腰足清
也。推而下之,上而不下者,头项痛也。按之至骨,脉气少者,腰脊痛而身有痹也。
春季出现秋季的脉象,夏季出现冬季的脉象,长夏(每季最后十八天)出现春季的脉象,秋季出现夏季的脉象,冬季出现长夏的脉象,这称为“阴出之阳”,患者容易发怒,属于难治之症,这被称为五邪,情况相同者,预后不良,多致死。
春季脉象中带有微弱的弦象且兼有胃气(指脉来从容和缓、节律一致),称为平脉(正常脉象);弦象多而胃气少,称为肝病;只有弦象而没有胃气,称为死脉;若脉中有胃气并兼见毛象(浮取即得,如羽毛般轻虚),预示秋季发病;若毛象显著,则当前即发病。脏真之气散布于肝,肝主藏筋膜之气。
夏季脉象中带有微弱的钩象(来盛去衰,如钩般圆润)且兼有胃气,称为平脉;钩象多而胃气少,称为心病;只有钩象而没有胃气,称为死脉;若脉中有胃气并兼见石象(沉取始得,如石般沉实),预示冬季发病;若石象显著,则当前即发病。脏真之气通达于心,心主藏血脉之气。
长夏脉象中带有微弱柔软无力的脉象且兼有胃气,称为平脉;胃气少而软弱无力多,称为脾病;只有代脉(脉来中止,止有定数)而没有胃气,称为死脉;若软弱有力中兼见石象,预示冬季发病;若软弱之象显著,则当前即发病。脏真之气濡润于脾,脾主藏肌肉之气。
秋季脉象中带有微弱的毛象(浮而轻虚)且兼有胃气,称为平脉;毛象多而胃气少,称为肺病;只有毛象而没有胃气,称为死脉;若脉中有毛象并兼见弦象,预示春季发病;若弦象显著,则当前即发病。脏真之气高于肺,肺运行营卫阴阳之气。
冬季脉象中带有微弱的石象(沉而坚实)且兼有胃气,称为平脉;胃气少而石象多,称为肾病;只有石象而没有胃气,称为死脉;若脉中有石象并兼见钩象,预示夏季发病;若钩象显著,则当前即发病。脏真之气下归于肾,肾主藏骨髓之气。
胃的大络,名为虚里,贯穿膈肌联络肺脏,出于左侧乳下,搏动应手,这是脉之宗气所在。如果搏动盛大急促或脉搏断绝,说明病在中焦;如果脉搏结滞且横坚有力,说明体内有积块;如果脉搏完全摸不到,说明死亡。诊察到胃脉有力则能进食,胃脉虚弱则发生泄泻。
心脉按之坚硬而长,病症为舌卷缩不能言语。如果心脉软而散漫,消渴病将自行痊愈。
肺脉按之坚硬而长,病症为唾血。如果肺脉软而散漫,病症为灌汗(大汗淋漓),导致汗出不止。
肝脉按之坚硬而长,面色不发青,病症为跌坠或遭受打击所致,因瘀血停留在胁下,使人喘息气逆。如果肝脉软而散漫,面色润泽,病症为溢饮。所谓溢饮,是指口渴多饮,水液溢出渗入肌肤肠胃之外。
胃脉按之坚硬而长,面色发红,病症为髀骨骨折。如果胃脉软而散漫,病症为食痹痛及髀部。
脾脉按之坚硬而长,面色发黄,病症为少气。如果脾脉软而散漫,面色不润泽,病症为足部肿胀,状如水病。
肾脉按之坚硬而长,面色黄中带红,病症为腰部骨折。如果肾脉软而散漫,病症为血少,至今无法恢复。
脉,是血气汇聚的地方。脉长则气机调和,脉短则气机有病,脉数则心烦,脉大则病情进展,上部脉盛则气逆于上,下部脉盛则腹部胀满,脉代则气衰,脉细则气少,脉涩则心痛。脉象浑浑乱乱、革革强劲,至如涌泉般汹涌,说明病情进展且面色败坏;脉象绰绰(或作绵绵)柔和,离去时如弓弦断裂般突然消失的,主死。
寸口脉按之感觉短的,主头痛;寸口脉按之感觉长的,主足胫疼痛;寸口脉沉而坚实的,病在中焦;寸口脉浮而盛的,病在外表;寸口脉按之急促且上部数急的,主肩背痛;寸口脉紧而横坚且有热感的,主……(原文此处似有脱漏,依上下文推断为外感热病相关);寸口脉盛滑坚实的,病在外表;寸口脉小实而坚实的,病在内里。脉小弱且涩的,称为久病;脉浮滑而实大的,称为新病。病重但仍有胃气且脉象平和的,称病无他患;脉急的称病无他患,但若脉象违背四时规律且不间脏传变的,主死。
太阳脉至,洪大且长。少阳脉至,忽快忽慢,忽短忽长。阳明脉至,浮大且短。
厥阴脉有余,病阴痹;不足则病生热痹;滑脉病狐疝风;涩脉病少腹积气。
少阴脉有余,病皮痹瘾疹;不足则病肺痹;滑脉病肺风疝;涩脉病积聚、小便出血。
太阴脉有余,病肉痹寒中;不足则病脾痹;滑脉病脾风疝;涩脉病积聚、心腹时常胀满。
阳明脉有余,病脉痹身时热;不足则病心痹;滑脉病心风疝;涩脉病积聚、时常惊恐。
太阳脉有余,病骨痹身重;不足则病肾痹;滑脉病肾风疝;涩脉病积聚、时常癫痫发作。
少阳脉有余,病筋痹胁痛;不足则病肝痹;滑脉病肝风疝;涩脉病积聚、时常筋急目痛。
厥阴经气厥逆,拘挛,腰痛,虚满前阴闭塞、谵语,治疗应针对主病经脉。
三阴经气俱逆,二便不通,使人手足寒冷,三日死。
少阳经气厥逆,关节活动不利。关节活动不利者,腰不能行,项不能顾,并发肠痈,不可治,受惊者死。
阳明经气厥逆,喘咳身热,易惊恐,衄血呕血,不可治,受惊者死。
手太阳经气厥逆,耳聋流泪,项不能顾,腰不能俯仰,治疗应针对主病经脉。
手阳明与少阳经气厥逆,发喉痹,咽喉肿痛,治疗应针对主病经脉。
脉来疾去徐,上实下虚,为厥癫疾;脉来徐去疾,上虚下实,为恶风证。因此中恶风者,是阳气受损。脉象俱沉细数的,为少阴厥逆;沉细数而散的,为寒热病;浮而散的,为颠仆。所有浮而不躁的脉,病都在阳分,则为热病;其中伴有躁动的,病在手经。所有细而沉的脉,病都在阴分,则为骨痛;其中伴有静止特征的,病在足经。脉数动而时有间歇的,病在阳分之脉。脉涩的,阳气有余;脉滑的,阴气有余。阳气有余则身热无汗,阴气有余则多汗身寒,阴阳俱有余则无汗且寒。推求脉象向外,内里不虚的,有心腹积块。推求脉象向内,外部不虚的,中有热邪。推求脉象向上,下部不上应的,腰足清冷。推求脉象向下,上部不下应的,头项疼痛。按之至骨,脉气微少的,腰脊痛且身体有痹证。
In spring, if the pulse of autumn is obtained; in summer, if the pulse of winter is obtained; in late summer (the last 18 days of each season), if the pulse of spring is obtained; in autumn, if the pulse of summer is obtained; in winter, if the pulse of late summer is obtained, this is called "Yin emerging into Yang" (阴出之阳). The patient is prone to anger. This is difficult to treat and is referred to as the Five Evils (五邪). If the condition is similar across these patterns, it leads to death and is untreatable.
A spring pulse with a slight string-like quality (Xian Mai, 弦脉 - taut like a guitar string) and possessing Stomach Qi (胃气 - the harmonious and rhythmic quality indicating healthy digestive function) is a Normal Pulse (Ping Mai, 平脉). If the string-like quality is excessive and Stomach Qi is scant, it indicates Liver Disease (Gan Bing, 肝病). If there is only the string-like quality without Stomach Qi, it indicates Death. If Stomach Qi is present along with a feathery quality (Mao Mai, 毛脉 - floating and light), disease will manifest in autumn; if the feathery quality is severe, disease manifests now. The Zhen Qi of the Zang organs disperses into the Liver, which stores the Qi of the sinews and fascia.
A summer pulse with a slight hook-like quality (Gou Mai, 钩脉 - full at the beginning and weak at the end, resembling a hook) and possessing Stomach Qi is a Normal Pulse. If the hook-like quality is excessive and Stomach Qi is scant, it indicates Heart Disease (Xin Bing, 心病). If there is only the hook-like quality without Stomach Qi, it indicates Death. If Stomach Qi is present along with a stone-like quality (Shi Mai, 石脉 - deep and firm), disease will manifest in winter; if the stone-like quality is severe, disease manifests now. The Zhen Qi of the Zang organs connects to the Heart, which stores the Qi of the blood vessels.
A late summer pulse with a slightly soft and weak quality and possessing Stomach Qi is a Normal Pulse. If Stomach Qi is scant and softness/weakness is excessive, it indicates Spleen Disease (Pi Bing, 脾病). If there is only a Dai Mai (代脉 - intermittent pulse with regular intervals) without Stomach Qi, it indicates Death. If softness/weakness is present along with a stone-like quality, disease will manifest in winter; if the softness/weakness is severe, disease manifests now. The Zhen Qi of the Zang organs moistens the Spleen, which stores the Qi of the muscles.
An autumn pulse with a slight feathery quality and possessing Stomach Qi is a Normal Pulse. If the feathery quality is excessive and Stomach Qi is scant, it indicates Lung Disease (Fei Bing, 肺病). If there is only the feathery quality without Stomach Qi, it indicates Death. If the feathery quality is present along with a string-like quality, disease will manifest in spring; if the string-like quality is severe, disease manifests now. The Zhen Qi of the Zang organs rises above the Lungs, which circulate Ying (Nutritive) and Wei (Defensive) Qi and Yin-Yang.
A winter pulse with a slight stone-like quality and possessing Stomach Qi is a Normal Pulse. If Stomach Qi is scant and the stone-like quality is excessive, it indicates Kidney Disease (Shen Bing, 肾病). If there is only the stone-like quality without Stomach Qi, it indicates Death. If the stone-like quality is present along with a hook-like quality, disease will manifest in summer; if the hook-like quality is severe, disease manifests now. The Zhen Qi of the Zang organs descends to the Kidneys, which store the Qi of the bone marrow.
The great collateral of the Stomach is named Xuli (虚里). It penetrates the diaphragm, connects to the Lungs, and emerges below the left breast. Its pulsation is palpable by hand; it is the Zong Qi (宗气 - Pectoral Qi/Gathering Qi) of the pulses. If the pulsation is vigorous, rapid, or interrupted, the disease is in the Middle Jiao (Zhong Jiao, 中焦). If the pulse is knotted and hard/transverse, there are accumulations (Ji, 积). If the pulse is absent, it indicates death. Diagnosing a strong Stomach pulse indicates the ability to eat; a deficient pulse indicates diarrhea.
If the Heart pulse feels firm and long upon palpation, the symptom is a curled tongue and inability to speak. If the Heart pulse is soft and scattered, Xiao Ke (消渴 - Wasting-Thirst Syndrome/Diabetes) will resolve spontaneously.
If the Lung pulse feels firm and long upon palpation, the symptom is spitting blood. If the Lung pulse is soft and scattered, the symptom is Guan Han (灌汗 - profuse sweating), leading to unremitting perspiration.
If the Liver pulse feels firm and long upon palpation, but the complexion is not green, the cause is a fall or blow, with blood stasis under the hypochondrium causing wheezing and counterflow qi. If the Liver pulse is soft and scattered, and the complexion is lustrous, the symptom is Yi Yin (溢饮 - Overflowing Fluid Retention). Yi Yin refers to excessive drinking due to thirst, with fluids overflowing into the muscles, skin, and outside the stomach and intestines.
If the Stomach pulse feels firm and long upon palpation, and the complexion is red, the symptom is fracture of the thigh bone (Bi, 髀). If the Stomach pulse is soft and scattered, the symptom is Shi Bi (食痹 - Food Obstruction pain) affecting the thigh.
If the Spleen pulse feels firm and long upon palpation, and the complexion is yellow, the symptom is Shao Qi (少气 - Shortness of Breath/Lack of Qi). If the Spleen pulse is soft and scattered, and the complexion is not lustrous, the symptom is swelling of the feet, resembling water disease.
If the Kidney pulse feels firm and long upon palpation, and the complexion is yellowish-red, the symptom is fracture of the waist. If the Kidney pulse is soft and scattered, the symptom is deficiency of blood, which does not recover.
Pulses are the residence of Blood and Qi. A long pulse indicates harmonious Qi; a short pulse indicates diseased Qi; a rapid pulse indicates vexation in the heart; a large pulse indicates advancing disease; excess in the upper part indicates high Qi (rebellious Qi); excess in the lower part indicates abdominal distension; a Dai pulse indicates Qi decline; a fine pulse indicates little Qi; a choppy pulse indicates Heart pain. A chaotic, strong pulse rushing like a spring indicates advancing disease and deteriorating complexion. A pulse that is loose and continuous but departs suddenly like a breaking bowstring indicates death.
If the Cun Kou (寸口 - Radial Artery at the wrist) pulse feels short upon palpation, it indicates Headache (Tou Tong, 头痛). If the Cun Kou pulse feels long upon palpation, it indicates pain in the lower legs (Zu Jing Tong, 足胫痛). If the Cun Kou pulse is deep and firm, the disease is in the interior. If the Cun Kou pulse is floating and vigorous, the disease is in the exterior. If the Cun Kou pulse is hurried and rapid at the upper position, it indicates Shoulder and Back Pain (Jian Bei Tong, 肩背痛). If the Cun Kou pulse is tight, transverse, firm, and hot... [text fragment]; if the Cun Kou pulse is vigorous, slippery, and firm, the disease is in the exterior. If the Cun Kou pulse is small, solid, and firm, the disease is in the interior. A pulse that is small, weak, and choppy is termed Jiubing (久病 - Chronic Disease). A pulse that is floating, slippery, and large is termed Xinbing (新病 - Acute Disease). If the disease is severe but Stomach Qi remains and the pulse is harmonious, it is said there is no other complication. A tense pulse indicates no other complication; however, if the pulse contradicts the Four Seasons or involves non-adjacent Zang transmission (Bu Jian Zang, 不间脏), it indicates death.
The Taiyang (太阳 - Greater Yang) pulse arrives: large, vigorous, and long. The Shaoyang (少阳 - Lesser Yang) pulse arrives: sometimes rapid, sometimes slow; sometimes short, sometimes long. The Yangming (阳明 - Bright Yang) pulse arrives: floating, large, and short.
Jueyin (厥阴 - Terminal Yin) excess causes Yin Bi (阴痹 - Yin Bi Syndrome); deficiency causes Re Bi (热痹 - Heat Bi Syndrome). Slippery pulse indicates Hu Shan Feng (狐疝风 - Fox Hernia Wind); choppy pulse indicates accumulation of Qi in the lower abdomen.
Shaoyin (少阴 - Lesser Yin) excess causes Pi Bi (皮痹 - Skin Bi Syndrome) and Yin Zhen (瘾疹 - Urticaria); deficiency causes Fei Bi (肺痹 - Lung Bi Syndrome). Slippery pulse indicates Fei Feng Shan (肺风疝 - Lung Wind Hernia); choppy pulse indicates accumulation and hematuria.
Taiyin (太阴 - Greater Yin) excess causes Rou Bi (肉痹 - Muscle Bi Syndrome) and Cold in the Middle; deficiency causes Pi Bi (Spleen Bi Syndrome). Slippery pulse indicates Pi Feng Shan (脾风疝 - Spleen Wind Hernia); choppy pulse indicates accumulation and frequent abdominal fullness.
Yangming excess causes Mai Bi (脉痹 - Vessel Bi Syndrome) and intermittent body heat; deficiency causes Xin Bi (心痹 - Heart Bi Syndrome). Slippery pulse indicates Xin Feng Shan (心风疝 - Heart Wind Hernia); choppy pulse indicates accumulation and frequent fright.
Taiyang excess causes Gu Bi (骨痹 - Bone Bi Syndrome) and heavy body; deficiency causes Shen Bi (肾痹 - Kidney Bi Syndrome). Slippery pulse indicates Shen Feng Shan (肾风疝 - Kidney Wind Hernia); choppy pulse indicates accumulation and frequent epilepsy.
Shaoyang excess causes Jin Bi (筋痹 - Sinew Bi Syndrome) and hypochondriac pain; deficiency causes Gan Bi (肝痹 - Liver Bi Syndrome). Slippery pulse indicates Gan Feng Shan (肝风疝 - Liver Wind Hernia); choppy pulse indicates accumulation, frequent tendon stiffness, and eye pain.
Taiyin Jue Ni (厥逆 - Counterflow Collapse): stiffness, spasms, Heart pain radiating to the abdomen. Treat the primary affected channel.
Shaoyin Jue Ni: abdominal fullness, vomiting, clear diarrhea. Treat the primary affected channel.
Jueyin Jue Ni: spasms, lower back pain, abdominal fullness, urinary retention, delirium. Treat the primary affected channel.
When all three Yin channels experience Jue Ni, resulting in inability to urinate or defecate, causing cold hands and feet, death occurs within three days.
Taiyang Jue Ni: stiff collapse, vomiting blood, frequent epistaxis. Treat the primary affected channel.
Shaoyang Jue Ni: dysfunction of joints. Dysfunction of joints means the waist cannot move, and the neck cannot turn. If Chang Yong (肠痈 - Intestinal Abscess) develops, it is untreatable; if accompanied by fright, it is fatal.
Yangming Jue Ni: wheezing, cough, body heat, fright, epistaxis, hematemesis. It is untreatable; if accompanied by fright, it is fatal.
Hand Taiyin Jue Ni: abdominal fullness, cough, frequent vomiting of froth. Treat the primary affected channel.
Hand Jueyin (Pericardium) and Shaoyin Jue Ni: Heart pain radiating to the throat. If accompanied by body heat, it is fatal; if without heat, it is treatable.
Hand Taiyang Jue Ni: deafness, tearing, inability to turn the neck, inability to bend or extend the waist. Treat the primary affected channel.
Hand Yangming and Shaoyang Jue Ni: Hou Bi (喉痹 - Throat Obstruction), swelling and pain in the throat. Treat the primary affected channel.
Rapid arrival and slow departure, with excess above and deficiency below, indicates Jue Dian Ji (厥癫疾 - Epilepsy from Counterflow). Slow arrival and rapid departure, with deficiency above and excess below, indicates Aversion to Wind (E Feng, 恶风). Thus, those struck by Evil Wind suffer damage to Yang Qi. Pulses that are both deep, fine, and rapid indicate Shaoyin Jue Ni. Deep, fine, rapid, and scattered pulses indicate Cold-Heat disorders. Floating and scattered pulses indicate sudden collapse. All floating but not restless pulses belong to Yang, indicating Heat; if restless, the disease is in the Hand channels. All fine and deep pulses belong to Yin, indicating Bone Pain; if quiet/still, the disease is in the Foot channels. A pulse that is rapid, moving, and intermittent indicates disease in the Yang pulses. A choppy pulse indicates Excess Yang Qi; a slippery pulse indicates Excess Yin Qi. Excess Yang Qi causes body heat and anhidrosis; Excess Yin Qi causes hyperhidrosis and cold body; Excess of both Yin and Yang causes anhidrosis and cold. Pushing outward to examine the interior: if the interior is not empty, there are Abdominal Accumulations. Pushing inward to examine the exterior: if the exterior is not empty, there is Heat in the middle. Pushing upward to examine the lower: if the lower does not respond, the waist and feet are cold. Pushing downward to examine the upper: if the upper does not descend, there is Head and Neck Pain. Pressing to the bone: if the pulse Qi is scarce, there is Lower Back and Spine Pain with Body Bi Syndrome.