(首节)
人一呼脉再动。一吸脉亦再动。呼吸定息脉五动。闰以太息。命曰平人。平人者不病也
(呼
。出气也。吸。入气也。定息将复呼吸之际也。闰余也)人一呼脉一动。一吸脉一动。曰少
气(十四难以为离经脉。正气衰也)人一呼脉三动。一吸脉三动而躁。尺热(身有热。)曰病温
。尺不热。脉滑曰病风(气有余也)脉涩曰痹(血不足也)人一呼脉四动以上曰死(一呼四至曰
脱精)脉绝不至曰死(元气已竭)乍疏乍数曰死(阴阳败乱。)
春脉者肝也。东方木也。万物之所以始生也。故其气来 (软同)弱轻虚而滑。端直以长
故曰
弦。(端正也)反此者病。其气来实而强。此谓太过病在外。其气来不实而微。此谓不及。病
在中(外病多有余。内病多不足)太过则令人善怒。(旧本忘。从吴氏改怒。)忽忽眩(目转)
冒
(昏昧)而癫疾。其不及。则令人胸痛引背。下则两胁 满。(吴注作痛)夏脉者心也。南方火
也万物之所以盛长也。故其气来盛去衰。故曰钩。(钩义如木之垂枝。即洪脉也)反此者病。
其气来盛去亦盛。此为太过病在外。其气来不盛去反盛。此谓不及。病在中(脉自骨肉之分
出于皮肤之际谓之来。自皮肤之际还于骨肉之分谓之去)太过则令人身热而肤痛(热不得泄越
)为浸淫(浸渍而淫。蒸热不已也)其不及则令人烦心。上见咳唾下为气泄(心虚不能自安。故
烦。虚阳乘肺则咳乘脾则唾。下陷则为后阴气失也)秋脉者肺也。西方金也万物之所以收成
也。故其气来轻虚以浮。来急去散故曰浮(未至沉下故来急去散。即毛也)反此者病。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。太过则令人逆
气而背痛。愠愠然(悲伤不乐之貌)其不及。则令人喘。呼吸少气而咳。上气见血。及闻病音
(喘息则喉下有声也○旧本下闻病音。今从吴氏改及)冬脉者肾也。北方水也。万物之所以合
藏也。故其气来沉以搏。故曰营(搏言伏鼓也沉伏而鼓。是营守乎中之意故曰营○扁鹊曰。
盛冬水凝如石脉之来沉濡而滑。故曰石)反此者病。其气来如弹石者。(坚强之象)此谓太过
。病在外其去如数者(类于数。疾)此谓不及。病在中。太过则令人解 (四体懈怠)脊脉痛而
少气不欲言(肾之精气伤)其不及。则令人心悬如病饥(肾水不能济心火) 中清(冷也)脊中痛
。少腹满。小便变 脾脉者土也孤藏以灌四旁者也(脾居中央。贯通肝心肺肾)善者不可得见
恶者可见(脾无病。则灌溉周而四藏安故善者不可见恶者即病脉也)其来如水之流者(散而无
踪)此谓太过病在外。如鸟之喙者(坚锐而不和○喙音海 也)此谓不及病在中。太过则令人
四肢不举(湿胜)其不及则令人九窍不通名曰重强(藏气皆不和顺)
脉从四时。谓之可治(从顺也)脉弱以滑。是有胃气。命曰易治。取之以时(合于时令)形
气相失。谓之难治(偏胜则生克贼)色夭不泽谓之难已(气血皆坏)脉实以坚。谓之益甚(邪盛)脉逆
四时为不可治所谓逆四时者。春得肺脉。夏得肾脉。秋得心脉冬得脾脉。其至皆悬绝。沉涩
者。命曰逆四时(悬。脉来悬异绝阴阳偏绝。无复冲和之气。但见真藏脉来也。沉为绝阳
涩
之时脉反沉涩。秋冬收藏之时脉反浮大与四时相失。亦名曰逆四时)病热脉静(阳症阴脉)泄
而脉大(真气衰。邪益进)病在中脉实坚(宜不及而反实坚。是真藏形也)病在外脉不坚者(宜
太过而反不实坚是真阳不足以鼓也)皆难治。
脉盛(心实)皮热(肺)腹胀(脾)前后不通(肾)闷瞀(肝)此谓五实(邪气实也○瞀音务。又
音茂)
脉细(心虚)皮寒(肺)气少(肝)泄利前后(肾)饮食不入(脾)此谓五虚酱粥入胃。泄注止则虚者
活(土气犹存。虚可回也)身汗(表邪解)得后利(里邪去)则实者活。
(第一节)
人每呼气一次，脉搏跳动两次；每吸气一次，脉搏也跳动两次。在一呼一吸结束、气息将定未定之际（即“定息”），脉搏共跳动五次，若偶尔因深长呼吸（太息）而多跳一次，这称为“平人”（健康无病之人）。所谓平人，就是没有疾病的人。
（注：呼，指呼气；吸，指吸气；定息，指即将进行下一次呼吸的间歇时刻；闰余，指偶尔多出的次数。）
如果人每呼气一次，脉搏只跳动一次；每吸气一次，脉搏也只跳动一次，这叫做“少气”（《难经·十四难》认为这是离经脉，表示正气衰败）。
如果人每呼气一次，脉搏跳动三次；每吸气一次，脉搏也跳动三次，且脉象躁急，尺部皮肤发热（身体有热），这叫做“温病”（温热病）。
如果尺部皮肤不发热，但脉象滑利，这叫做“风病”（邪气有余）。
如果脉象涩滞，这叫做“痹证”（血液不足）。
如果人每呼气一次，脉搏跳动四次以上，这叫做“死”证（一呼四至称为脱精）。
如果脉搏停止不再跳动，这叫做“死”证（元气已经枯竭）。
如果脉搏忽快忽慢、疏密不均，这叫做“死”证（阴阳败乱）。
春季的脉象对应肝脏，位于东方，属木，是万物开始生长的时节。所以春脉的气象表现为柔软、微弱、轻虚而滑利，端正直长，因此称为“弦脉”。（弦，意为端正。）与此相反的即为病脉。如果脉气来势坚实强劲，这叫“太过”，病在体表；如果脉气来势不实而微弱，这叫“不及”，病在体内。（表证多有余，里证多不足。）
脉气太过，则使人容易发怒，头晕目眩，甚至发生癫疾。
脉气不及，则使人胸痛牵引背部，下部出现两胁胀满。（吴氏注释作疼痛。）
夏季的脉象对应心脏，位于南方，属火，是万物盛大生长的时节。所以夏脉的气象表现为来势盛而去势衰，因此称为“钩脉”。（钩的含义如同树枝下垂，即洪脉。）与此相反的即为病脉。如果脉气来势盛，去势也盛，这叫“太过”，病在体表；如果脉气来势不盛，去势反而盛，这叫“不及”，病在体内。（脉气从骨肉深处出于皮肤表面称为“来”，从皮肤表面回入骨肉深处称为“去”。）
脉气太过，则使人身体发热且皮肤疼痛（热邪无法宣泄），导致浸淫疮（湿热浸渍，蒸热不止）。
脉气不及，则使人心中烦闷，上部出现咳嗽吐痰，下部出现气泄（如二便失禁或漏气）。（心气虚弱不能自安故烦，虚阳乘肺则咳，乘脾则唾，下陷则为后阴之气失守。）
秋季的脉象对应肺脏，位于西方，属金，是万物收获成熟的时节。所以秋脉的气象表现为轻虚而浮，来势急而去势散，因此称为“浮脉”（毛脉）。（未到沉位故来急去散，即毛脉。）与此相反的即为病脉。如果脉气像毛一样，但中间坚硬两边虚，这叫“太过”，病在体表；如果脉气像毛一样但微弱，这叫“不及”，病在体内。
脉气太过，则使人气逆且背痛，神情抑郁悲伤。
脉气不及，则使人气喘，呼吸短促并咳嗽，上部气逆见血，以及听到病变的声音（喘息时喉下有声音）。（旧本写作“下闻病音”，今依吴氏改为“及”。）
冬季的脉象对应肾脏，位于北方，属水，是万物闭藏的季节。所以冬脉的气象表现为沉取搏指有力，因此称为“营脉”。（搏指说明脉伏而鼓动，沉伏而鼓动，是营气守于体内的意思，故称营。扁鹊说：严冬水凝如石，脉象来势沉濡而滑，故又称石脉。）与此相反的即为病脉。如果脉气来时像弹石一样坚硬，这叫“太过”，病在体表；如果脉气去时像数脉一样急促（类于数，疾速），这叫“不及”，病在体内。
脉气太过，则使人四肢懈怠无力，脊背疼痛且气短不想说话（肾之精气受伤）。
脉气不及，则使人心里空虚感觉像生病饥饿一样（肾水不能上济心火），膈中清冷，脊中疼痛，小腹胀满，小便异常。
脾脉对应土，是孤立的脏器，用来灌溉四方脏腑。（脾居中央，贯通肝、心、肺、肾。）正常的脾脉难以察觉，异常的脾脉才能看到。（脾无病时，灌溉周遍，四脏安宁，所以正常脉象不可见；异常的就是病脉。）
如果脉气像水流一样散漫无踪，这叫“太过”，病在体表；如果脉气像鸟嘴一样坚锐而不和缓（喙音hui），这叫“不及”，病在体内。
脉气太过，则使人四肢不能抬起（湿邪胜）；脉气不及，则使人九窍不通，名叫“重强”（五脏之气都不和顺）。
脉象顺应四季变化，称为可治。（顺应时令。）
脉象弱而滑利，是有胃气的表现，称为易治，治疗要把握时机（合乎时令）。
形体与气机不相适应，称为难治（偏胜则产生相克贼害）。
面色枯槁无光泽，称为难愈（气血都已败坏）。
脉象实而坚硬，称为病情加重（邪气盛）。
脉象违背四季变化，称为不可治。
所谓违背四季变化，是指：春季见到肺脉，夏季见到肾脉，秋季见到心脉，冬季见到脾脉，这些脉象到来都悬绝、沉涩，称为违背四季。（悬，指脉来悬异，绝阴阳偏绝，没有冲和之气，只见真脏脉到来。沉为绝阳，涩为绝阴。秋冬收藏之时，脉反浮大，与四季相失，也称为违背四季。）
患热病而脉象静迟（阳证见阴脉），腹泻而脉象大（真气衰败，邪气更进），病在体内而脉象实坚（应当脉弱反而实坚，是真脏脉形），病在体表而脉象不坚（应当脉强反而不实坚，是真阳不足以鼓动），这些都难治。
脉象盛大（心实），皮肤发热（肺），腹部胀满（脾），大小便不通（肾），胸闷昏蒙（肝），这叫做“五实”（邪气实）。（瞀音wu，又读mao。）
脉象细弱（心虚），皮肤寒冷（肺），气短（肝），大小便泄利（肾），饮食不进（脾），这叫做“五虚”。
如果喝进酱粥后，泄泻停止，那么虚证患者可以存活（土气尚存，虚损可恢复）。
如果身上出汗（表邪解除），大小便通畅（里邪去除），那么实证患者可以存活。
(First Section)
When a person exhales, the pulse beats twice; when they inhale, the pulse also beats twice. At the moment of rest between breaths (Dingxi), the pulse beats five times in total. Occasionally, due to a deep sigh (Taixi), it may beat one extra time. This is called a "Ping Ren" (Healthy Person). A Ping Ren is one who is free from disease.
(Note: Hu refers to exhalation; Xi refers to inhalation; Dingxi refers to the interval just before the next breath begins; Runyu refers to the occasional extra beat.)
If a person's pulse beats only once per exhalation and once per inhalation, this is called "Shao Qi" (Deficiency of Qi). The *Nan Jing* (Chapter 14) considers this a Li Jing Mai (Departing Vessel Pulse), indicating the decline of righteous Qi.
If a person's pulse beats three times per exhalation and three times per inhalation, with a rapid and restless quality, and the skin at the Chi position (Cun-Knee area) is hot (indicating body heat), this is called "Wen Bing" (Warm Disease).
If the skin at the Chi position is not hot, but the pulse is slippery (Hua), this is called "Feng Bing" (Wind Disease), indicating an excess of pathogenic Qi.
If the pulse is choppy or rough (Se), this is called "Bi Syndrome" (Obstruction Syndrome), indicating a deficiency of Blood.
If a person's pulse beats four or more times per exhalation, this indicates death (Four beats per exhalation is termed Tuo Jing, or Essence Depletion).
If the pulse ceases and does not return, this indicates death (Yuan Qi has been exhausted).
If the pulse is irregular, alternating between slow and rapid, this indicates death (Disorder of Yin and Yang).
The Spring pulse corresponds to the Liver, located in the East, belonging to Wood, the season when all things begin to grow. Therefore, its Qi comes forth soft, weak, light, void, yet smooth, straight and long, hence it is called the "Xian Pulse" (Bowstring Pulse). (Xian means upright.) Deviation from this indicates disease. If the Qi comes forth solid and strong, this is called "Tai Guo" (Excess), with disease in the exterior. If the Qi comes forth insubstantial and faint, this is called "Bu Ji" (Deficiency), with disease in the interior. (Exterior diseases often involve excess; interior diseases often involve deficiency.)
Excess leads to irritability, sudden dizziness and vertigo (Xuan Mao), and even epilepsy.
Deficiency leads to chest pain radiating to the back, and fullness in the hypochondrium below. (Wu's commentary notes this as pain.)
The Summer pulse corresponds to the Heart, located in the South, belonging to Fire, the season when all things flourish and grow. Therefore, its Qi comes forth abundant and goes forth declining, hence it is called the "Gou Pulse" (Hook Pulse). (The meaning of Gou is like a hanging branch, i.e., the Hong Pulse.) Deviation from this indicates disease. If the Qi comes forth abundant and goes forth abundant, this is "Tai Guo" (Excess), with disease in the exterior. If the Qi comes forth not abundant but goes forth abundantly, this is "Bu Ji" (Deficiency), with disease in the interior. (Qi coming out from the deep bone/muscle level to the skin surface is called "Lai"; returning from the skin surface to the bone/muscle level is called "Qu".)
Excess leads to body heat and skin pain (heat cannot vent), resulting in Jin Yin sores (damp-heat soaking and steaming continuously).
Deficiency leads to vexation in the heart, coughing and spitting above, and Qi leakage below (such as incontinence). (Heart Qi deficiency causes vexation; deficient Yang invading the Lung causes cough; invading the Spleen causes spitting; sinking downward causes loss of Qi control at the lower orifices.)
The Autumn pulse corresponds to the Lungs, located in the West, belonging to Metal, the season when all things are harvested. Therefore, its Qi comes forth light, void, and floating, coming rapidly and scattering upon departure, hence it is called the "Fu Pulse" (Floating/Mao Pulse). (Not reaching the deep Chen level, it comes rapidly and scatters upon departure, which is the Mao Pulse.) Deviation from this indicates disease. If the Qi feels like hair (Mao) but is firm in the center and empty on the sides, this is "Tai Guo" (Excess), with disease in the exterior. If the Qi feels like hair but is faint, this is "Bu Ji" (Deficiency), with disease in the interior.
Excess leads to rebellious Qi and back pain, with a melancholic demeanor (Yun Yun Ran).
Deficiency leads to panting, shortness of breath, and coughing, upward rebellious Qi manifesting as blood, and audible pathological sounds (wheezing sounds in the throat). (Old texts read "hear pathological sounds below," now corrected by Wu to "and.")
The Winter pulse corresponds to the Kidneys, located in the North, belonging to Water, the season when all things store and hide. Therefore, its Qi comes forth deep and pounding, hence it is called the "Ying Pulse." (Pounding indicates the pulse is hidden yet vigorous; deep and hidden yet vigorous signifies Ying Qi guarding within, thus named Ying. Bian Que said: In deep winter, water freezes like stone; the pulse comes forth deep, soft, and smooth, hence also called Shi [Stone] Pulse.) Deviation from this indicates disease. If the Qi comes forth like bouncing stones (a sign of hardness), this is "Tai Guo" (Excess), with disease in the exterior. If the Qi departs resembling a Shu Pulse (rapid), this is "Bu Ji" (Deficiency), with disease in the interior.
Excess leads to flaccidity of the four limbs, pain in the spinal vessels, shortness of Qi, and unwillingness to speak (injury to Kidney Essence and Qi).
Deficiency leads to a feeling of emptiness in the heart as if hungry (Kidney Water failing to nourish Heart Fire), coldness in the diaphragm, pain in the spine, fullness in the lower abdomen, and abnormal urination.
The Spleen pulse corresponds to Earth. It is the solitary organ that irrigates the four surrounding organs. (The Spleen resides in the Center, connecting the Liver, Heart, Lungs, and Kidneys.) Its healthy state is difficult to perceive; only its pathological state is visible. (When the Spleen is healthy, irrigation is complete and the four Zang organs are peaceful, so the healthy pulse is invisible; the pathological pulse is what becomes visible.)
If the pulse flows like water, scattered without trace, this is "Tai Guo" (Excess), with disease in the exterior. If the pulse resembles a bird's beak (sharp and hard, lacking harmony), this is "Bu Ji" (Deficiency), with disease in the interior. (Beak/Hui sound is hui.)
Excess leads to inability to lift the four limbs (excess Dampness). Deficiency leads to obstruction of the nine orifices, named "Zhong Qiang" (where all Zang Qi are disharmonious).
A pulse that follows the four seasons is called treatable (following the seasonal order).
A pulse that is weak yet smooth indicates the presence of Wei Qi (Stomach Qi); this is called easy to treat, provided treatment is timed correctly (aligning with the seasons).
If form and Qi are discordant, it is called difficult to treat (excess leads to destructive over-control).
If the complexion is dull and lacks luster, it is called difficult to cure (both Qi and Blood are damaged).
A pulse that is solid and hard indicates worsening condition (pathogenic Qi is excessive).
A pulse that contradicts the four seasons is called untreatable.
Contradicting the four seasons means: finding the Lung pulse in Spring, the Kidney pulse in Summer, the Heart pulse in Autumn, and the Spleen pulse in Winter. These pulses arrive as Xuan Jue (suspended and severed), deep and Se (choppy), and are called contradicting the four seasons. (Xuan means the pulse arrives suspended and severed, Yin and Yang are unbalanced, lacking harmonious Qi, showing only True Zang pulses. Deep indicates severance of Yang; Se indicates severance of Yin. In autumn/winter, when Qi should store, a floating/large pulse contradicts the seasons, also called contradicting the four seasons.)
Heat disease with a quiet pulse (Yang syndrome with Yin pulse), diarrhea with a large pulse (Righteous Qi declines, Pathogenic Qi advances), internal disease with a solid/firm pulse (should be deficient but is solid/firm, indicating True Zang shape), external disease with a non-firm pulse (should be excess but is not solid/firm, indicating insufficient True Yang to drive), are all difficult to treat.
Pulse vigorous (Heart Excess), skin hot (Lung), abdominal distension (Spleen), blockage of front and rear (Kidney), mental confusion/obscuration (Liver), this is called "Wu Shi" (Five Excesses). (Mao sounds wu or mao.)
Pulse fine/thin (Heart Deficiency), skin cold (Lung), shortness of Qi (Liver), diarrhea/incontinence of front and rear (Kidney), inability to eat/drink (Spleen), this is called "Wu Xu" (Five Deficiencies).
If after consuming fermented bean paste and porridge, the diarrhea stops, the deficient patient will survive (Earth Qi remains, deficiency can recover).
If sweat appears (exterior pathogens resolve) and bowels/bladder open (interior pathogens exit), the excess patient will survive.