黄帝问于岐伯曰。邪气之中人也奈何。岐伯答曰。邪气之中人高也。黄帝曰。高下有度乎。
岐伯曰。身半以上者。邪中之也。身半以下者。湿中之也。故曰邪之中人也无有常。中于阴则溜于
腑。中于阳则溜于经。
此篇论脏腑阴阳色脉气血。皮肤经脉外内相应。能参合而行之。可为上工。邪气者。风雨寒
暑。天之邪也。故中人也高。湿乃水土之气。故中于身半以下。此天地之邪。中于人身。而有上
下之分。然邪之中人。又无有恒常。或中于阴。或中于阳。或溜于腑。或入于脏。
黄帝曰。阴之与阳也。异名同类。上下相会。经络之相贯。如环无端。邪之中人。或中于阴。
或中于阳。上下左右。无有恒常。其故何也。岐伯曰。诸阳之会。皆在于面。中人也。方乘虚时。
及新用力。若饮食汗出。腠理开而中于邪。中于面则下阳明。中于项则下太阳。中于颊则下少阳。
其中于膺背两胁。亦中其经。黄帝曰。其中于阴奈何。岐伯答曰。中于阴者。常从臂 始。夫臂与
。其阴皮薄。其肉淖泽。故俱受于风。独伤其阴。黄帝曰。此故伤其脏乎。岐伯答曰。身之中
于风也。不必动脏。故邪入于阴经。则其脏气实。邪气入而不能客。故还之于腑。故中阳则溜于
经。中阴则溜于腑。（ 音行）
此论皮肤之气血。与经络相通。而内连脏腑也。阴之与阳者。谓脏腑之血气。虽有阴阳之分。
然总属一气血
耳。故异名而同类。上下相会者。标本之出入也。经络之相贯。谓荣血之循行。从手太阴出注手阳
明。始于肺而终于肝。从肝复上注于肺。环转之无端也。上下左右。头面手足也。或在于头面而
中于阳。或在臂 而中于阴。故无有恒常也。诸阳之会。皆在于面者。精阳之气。皆上于面而走
空窍也。中于面则下阳明。中于项则下太阳。中于颊则下少阳。此手足三阳之络。皆循项颈而上于
头面。膺背两胁者。复循头项而下于胸胁肩背也。此三阳络脉所循之处。外之皮肤。即三阳之分部。
邪之客于人也。必先舍于皮毛。留而不去。入舍于络脉。下者。谓三阳皮部之邪。下入于三阳之经。
故曰中于阳则溜于经。臂 者。手臂足 之内侧。乃三阴络脉所循之处。外侧为阳。内侧为阴。
其阴皮薄。其肉淖泽。故中于阴者。尝从臂 始。始者。始于三阴之皮部。而入于三阴之络脉也。
缪刺篇曰。邪之客于形也。必先舍于皮毛。留而不去。入舍于孙脉。留而不去。入舍于络脉。
留而不去。入舍于经脉。内连五脏。散于肠胃。盖五脏之脉。属脏络腑。六腑之脉。属腑络脏。脏腑
经脉之相通也。夫血脉为阴。五脏之所主也。故邪入于经。其脏气实。邪气入而不能客。故还之
于腑。散于肠胃。阳明居中土。为万物之所归。邪归于阳明之肠胃。而无所复传矣。
黄帝曰。邪之中人脏奈何。岐伯曰。愁忧恐惧则伤心。形寒饮冷则伤肺。以其两寒相感。中
外皆伤。故气逆而上行。有所堕坠。恶血留内。若有所大怒。气上而不下。积于胁下则伤肝。有
所击仆。若醉入房。汗出当风则伤脾。有所用力举重。若入房过度。汗出浴水则伤肾。黄帝曰。五
脏之中风奈何。岐伯曰。阴阳俱感。邪乃得往。黄帝曰。善哉。
此论脏气伤而邪中于脏也。夫邪中于阴而溜腑者。脏气实也。脏气者。神气也。神气内藏。则血
脉充盛。若脏气内伤。则邪乘虚而入矣。风为百病之长。善行而数变。阴阳俱感。外内皆伤也。本
经云。八风从其虚之乡来。乃能病患。三虚相搏。则为暴病卒死。此又不因内伤五脏而邪中于脏也。
故圣人避风。如避矢石焉。上节论内养神志。下节论外避风邪。
黄帝问于岐伯曰。首面与身形也。属骨连筋同血。合于气耳。天寒则裂地凌冰。其卒寒。或手
足懈惰。然而其面不衣何也。岐伯答曰。十二经脉。三百六十五络。其血气皆上于面而走空窍。其
精阳气上走于目而为睛。其别气走于耳而为听。其宗气上出于鼻而为臭。其浊气出于胃。走唇舌而
为味。其气之津液。皆上熏于面。而皮又浓。其肉坚。故天热甚寒。不能胜之也。
此论脏腑经络之气血。渗于脉外而上注于空窍也。属骨连筋者。谓首面与形身之筋骨血气相
同也。夫太阴为阴中之至阴。在地主土。在人属于四肢。天寒则裂地凌冰。其卒寒。或手足懈惰。
此脾土之应地也。其血气皆上于面。天热甚寒不能胜之。谓阴阳寒暑之气。皆从下而上。身半以
上之应天也。夫十二经脉。三百六十五络之血气。始于足少阴肾。生于足阳明胃。主于手少阴心。
朝于手太阴肺。精阳气者。心肾神精之气。上走于目而为睛。别气者。心肾之气。别走于耳而为
听也。宗气者。胃腑所生之大气。积于胸中。上出于肺以司呼吸。故出于鼻而为臭。浊气者。水谷
之精气。故出于胃。走唇舌而为味。气之津液。上熏于面者。津液随气上行。熏肤泽毛而注于空窍
也。夫肺主皮而属天。脾主肉而应地。皮浓肉坚。天之寒热不能胜之。人气之胜天
也。此章论头面为诸阳之会。是以三阳之脉。上循于头。然阴阳寒热之气。皆从下而升于上。故复
论诸脉之精气焉。
黄帝曰。邪之中人。其病形何如。岐伯曰。虚邪之中身也。洒淅动形。正邪之中人也微。先见
于色。不知于身。若有若无。若亡若存。有形无形。莫知其情。黄帝曰。善哉。
此论人气与天气之相合也。风寒暑湿燥火。天之六气也。而人亦有此六气。是以正邪之中人也。
微见于色。色、气色也。中于气。故微见于色。不知于身。若有若无。若亡若存。夫天之六气。
有正有邪。如虚邪之中于身也。洒淅动形。虚者。八正之虚邪气。形者。皮肉筋脉之有形。此节
论天地之气。中于人也。有病在气而见于色者。有病在形而见于脉者。有病在气而见于尺肤者。有
病在形而见于尺脉者。有病在气而应于形者。有病在形而应于气者。邪之变化。无有恒常。而此身
之有形无形。亦莫知其情。故能参合而行之者。斯可为上工也。玉师曰。天之正气。而偏寒偏热。
偏湿偏燥。故曰正邪。
黄帝问于岐伯曰。余闻之。见其色。知其病。名曰明。按其脉。知其病。命曰神。问其病。
知其处。命曰工。余愿闻见而知之。按而得之。问而极之。为之奈何。岐伯答曰。夫色脉与尺之
相应也。如鼓桴影响之相应也。不得相失也。此亦本末根叶之出候也。故根死则叶枯矣。色脉形肉。
不得相失也。故知一则为工。知二则为神。知三则神且明矣。黄帝曰。愿卒闻之。岐伯答曰。色
青者其脉弦也。赤者其脉钩也。黄者其脉代也。白者其脉毛。黑者其脉石。见其色而不得其脉。反得
其相胜之脉则死矣。得其相生之脉则病已矣。
此论色脉与尺之相应。如桴鼓影响。不得相失者也。夫精明五色者。气之华也。乃五脏五行之
神气。而见于色也。脉者。荣血之所循行也。尺者。谓脉外之气血。循手阳明之络。而变见于尺肤。
脉内之血气。从手太阴之经。而变见于尺寸。此皆胃腑五脏所生之气血。本末根叶之出候也。形肉
。谓尺肤也。知色脉与尺之三者。则神且明矣。青黄赤白黑。五脏五行之气色也。弦钩代毛石。五
脏五行之脉象也。如影响之相应者也。故色青者其脉弦。色赤者其脉钩。见其色而得脉之相应。犹
坤道之顺承天也。如色青而反见毛脉。色赤而反见石脉。此阴阳五行之反胜故死。如色青而得石脉。
色赤而得代脉。此色生于脉。阳生于阴。得阳生阴长之道。故其病已矣。
黄帝问于岐伯曰。五脏之所生。变化之病形何如。岐伯答曰。先定其五色五脉之应。其病乃
可别也。黄帝曰。色脉已定。别之奈何。岐伯曰。调其脉之缓急大小滑涩。而病变定矣。黄帝曰。
调之奈何。岐伯答曰。脉急者。尺之皮肤亦急。脉缓者。尺之皮肤亦缓。脉小者。尺之皮肤亦减而
少气。脉大者。尺之皮肤亦贲而起。脉滑者。尺之皮肤亦滑。脉涩者。尺之皮肤亦涩。凡此变者。
有微有甚。故善调尺者。不待于寸。善调脉者。不待于色。能参合而行之者。可以为上工。上工十
全九。行二者为中工。中工十全七。行一者为下工。下工十全六。
此论五脏所生之病。别其变化。先当调其五色五脉。色脉已定。而后调其尺肤与尺寸之脉。夫
尺肤之气血。出于胃腑。水谷之精。注于脏腑之经隧。而外布于皮肤。寸口尺脉之血气。出于胃
腑。水谷之精。荣行于脏腑经脉之中。变见于手太阴之两脉口。皆五脏之血气所注。故脉急者。尺
之皮肤亦急。脉缓者。尺之皮肤亦缓。
如桴鼓之相应也。故善调尺者。不待于寸口之脉。善调脉者。不待于五者之色。能参合而行之。斯
可为上工矣。夫数始于一奇二偶。合而为三。三而两之成六。三而三之成九。此三才三极之道也。
生于一而成于十。阴阳相得而各有合。此河图之数也。知者。知天地阴阳始终变化之道。故能全九
十之大数。水数成于六。火数成于七。水即是精血。火即是神气。中工仅知血气之诊。故能全水火
之成。下工血气之诊。亦不能全知矣。故曰能参合而行之者。可以为上工。行者。谓色脉应天地阴
阳之理数。贤者则而行之。
黄帝曰。请问脉之缓急大小滑涩之病形何如。岐伯曰。臣请言五脏之病变也。心脉急甚者为
。微急为心痛引背。食不下。缓甚为狂笑。微缓为伏梁在心下。上下行。时唾血。大甚为喉 。
微大为心痹引背。善泪出。小甚为善哕。微小为消瘅。滑甚为善渴。微滑为心疝引脐。小腹鸣。涩
甚为喑。微涩为血溢。维厥。耳鸣颠疾。（哕音诲如车惊声而有节）
此论五脏各有六者之变病。本于寒热血气之不和。与外受邪气。内伤忧恐之不同也。缓急大小
滑涩。阴阳寒热血气之纲领也。下章曰诸急多寒。缓者多热。大者多气少血。小者血气皆少。滑者阳
气盛。微有热。涩者多血少气。微有寒。心为火脏。故寒甚则为 。盖手足诸节。神气之所游行
出入。寒伤神气。故 也。微急为心痛引背。盖甚则心脏之神气受伤。微则薄于宫城之分也。食
气入胃。浊气归心。心气逆故食不下。缓甚则心气有余。心藏神。神有余则笑不休。伏梁。乃心下有
余之积。故微主邪薄于心下也。心主血。热则上溢而时唾血也。喉 者。喉中 然有声。宗气积于
胸中。上出喉咙。以贯心脉而行呼吸。心气盛。故喉中有声也。心气微盛。则逆于心下。而为心痹
引背。行于上。则心精随气上凑于目而泪出矣。心脏虚。则火土之气弱。故为
善哕。哕、呃逆也。夫五脏主藏精者也。五脏之血气皆少。则津液枯竭而为消瘅。消瘅者。三消之
证。心肺主上消。脾胃主中消。肝肾主下消也。滑则阳气盛而有热。盛于上则善渴。微在下则少
腹当有形也。心主言。心气少故为喑。血多故溢于上也。维、四维也。心为阳中之太阳。阳气少。
故手足厥冷也。南方赤色。入通于心。开窍于耳。心气虚。故耳鸣颠疾。按、金匮要略曰。五脏病
各有十八。合为九十病。盖一脏有六变。三六而变引十八病。玉师曰。缓急大小滑涩。五脏之六变
也。五六而变为三十。三而三之。合为九十。惟智者明之。故曰上工十全九。
肺脉急甚为癫疾。微急为肺寒热。怠惰咳唾血。引腰背胸。若鼻息肉不通。缓甚为多汗。微缓
为痿 。偏风。头以下汗出不可止。大甚为胫肿。微大为肺痹引胸背。起恶日光。小甚为泄。微小
为消瘅。滑盛为息贲上气。微滑为上下出血。涩甚为呕血。微涩为鼠 。在颈支腋之间。下不胜其
上。其应善 矣。（贲音奔 音酸）
肺主清金而畏寒。寒甚则为癫疾。所谓重阴则癫也。肺寒热者。皮寒热也。寒在皮毛。故微急
也。主肺气。怠惰咳唾血。引腰背胸。鼻若有息肉而气不通。皆肺气虚寒之所致。缓则热甚。故多
汗。肺热叶焦。则为痿也。鼠 。寒热病也。其本在脏。其末在脉。肺主百脉。是以微涩之有热。
微涩之有寒。皆为鼠 在颈腋之间。本经曰。偏枯身偏不用。病在分腠之间。盖病在皮肤。为肺寒
热。病在血脉。为寒热鼠 。在分腠则为偏风。肺主周身之气而朝百脉也。腠理开。故头以下汗出
不可止。头以下者。颈项胸背之间。肺之外部也。大主多气少血。气盛于下。则为胫肿。微盛于上。
则为肺痹引胸背。盖气从下而上也。日光。太阳之火。阴血少。故恶日光。金畏火也。
小则气血皆虚而为泄。肺与大肠为表里也。微小则为消瘅。肺主津水之生原也。滑主阳气盛。故
为息贲上气。微则上下出血。血随气行者也。涩主多血少气。血多气少。则血留不行。故为呕血。
者。阴寒而 削不能行。肺主气而发原在下。少气有寒。则下不胜其上矣。
肝脉急甚者为恶言。微急为肥气。在胁下。若覆杯。缓甚为善呕。微缓为水瘕痹也。大甚为内
痈。善呕衄。微大为肝痹阴缩。咳引小腹。小甚为多饮。微小为消瘅。滑甚为 疝。微滑为遗溺。
黄帝向岐伯问道：邪气侵袭人体是怎样的情况？岐伯回答说：邪气侵袭人体，多从高处开始。黄帝问：高与低有规律吗？
岐伯说：身体半以上的部位，容易受风邪侵袭；身体半以下的部位，容易受湿邪侵袭。所以说，邪气侵袭人体没有固定的规律。邪气侵入阴经，则流注于腑；侵入阳经，则流注于经脉。
这一篇论述脏腑、阴阳、面色、脉象、气血以及皮肤经脉内外相应的关系。如果能将这些因素综合参验并运用，就可以成为高明的医生（上工）。所谓邪气，是指风雨寒暑，这是天之邪气，所以侵袭人体多从高处开始。湿气是水土之气，所以侵袭人体多在身体半以下。这是天地之邪，侵袭人身而有上下之分。然而邪气侵袭人体，又没有恒常的规律，有时侵入阴经，有时侵入阳经，有时流注于腑，有时进入脏。
黄帝说：阴与阳，名称不同但同类，上下相互交会，经络相互贯通，像圆环一样没有端点。邪气侵袭人体，有时侵入阴经，有时侵入阳经，在上下左右没有恒常的规律，这是什么原因呢？
岐伯说：所有阳经的交会处，都在面部。人之所以被邪气侵袭，往往是在正气虚弱的时候，比如刚用力过度，或者饮食后出汗，此时腠理（皮肤毛孔）开泄而邪气乘虚而入。邪气中于面部，则向下流入阳明经；中于项部，则向下流入太阳经；中于颊部，则向下流入少阳经。邪气中于胸膺、背部和两胁，也是侵入其所属的经脉。
岐伯回答说：邪气侵入阴经，通常从手臂和足胫的内侧开始。因为手臂和足胫的内侧，皮肤薄嫩，肌肉滋润滑利，所以容易同时受到风邪侵袭，唯独损伤其阴分。
黄帝问：这样就会损伤内脏吗？
岐伯回答说：人体遭受风邪侵袭，不一定都会触动内脏。所以邪气侵入阴经时，如果该脏的气血充实，邪气进入后无法停留，就会返还到与其相表里的腑。所以说，邪气中于阳经就流注于经脉，中于阴经就流注于腑。（“溜”音同“留”，意为流注、停留）
这一段论述皮肤的气血与经络相通，进而内连脏腑。所谓阴与阳，指的是脏腑的血气，虽然有阴阳之分，但总归是一体的气血，所以名称不同但本质同类。上下相会，指的是标本穴位的出入联系。经络的相互贯通，指的是营血的循行，从手太阴肺经出发注入手阳明大肠经，始于肺终于肝，再从肝向上注回肺，循环往复没有端点。上下左右，指头面手足。有的在头面而中于阳，有的在臂胫内侧而中于阴，所以没有恒常的规律。“诸阳之会，皆在于面”，意思是清阳之气都上行于头面而走空窍。中于面则下入阳明，中于项则下入太阳，中于颊则下入少阳，这是因为手足三阳经的络脉都循行颈项而上达头面。胸膺、背、两胁，则是经络从头项下行至胸胁肩背的地方。这是三阳络脉循行的部位，体表的皮肤就是三阳经的分属区域。邪气客居人体，必定先停留在皮毛，停留不去，就进入络脉；再停留不去，就进入经脉；再向内连及五脏，散布于肠胃。大概五脏的经脉，属于脏而络属腑；六腑的经脉，属于腑而络属脏，这就是脏腑经脉的相通之处。血脉属于阴，由五脏所主。所以邪气侵入经脉，如果脏气充实，邪气进入后不能客居，就会返还到腑，散布于肠胃。阳明胃居中焦属土，是万物归宿之所，邪气归于阳明肠胃，就不再传变了。
岐伯说：忧愁恐惧会伤心；形体受寒、饮用冷物会伤肺。因为内外两种寒气相感，导致内外都受伤，所以气机上逆而上行。如果有坠落受伤，恶血留滞体内，或者大怒，气机上逆而不能下行，积聚在胁下就会伤肝；如果有击打跌仆，或者醉酒后行房事，汗出当风，就会伤脾；如果用力举重，或者房事过度，汗出后立即洗澡，就会伤肾。
黄帝说：说得好啊！
这一段论述脏气受损而邪气中于脏的情况。邪气中于阴经而流注于腑，是因为脏气充实。脏气，就是神气。神气内藏，则血脉充盛。如果脏气内部受伤，邪气就会乘虚而入。风是百病之长，善于游走且变化多端。阴阳俱感，意味着外内都受伤。本经说：“八风从其虚之乡来，乃能病患。”三虚相搏结，就会导致暴病猝死。这又是不因内伤五脏而邪气直接中于脏的情况。所以圣人避风，就像躲避箭石一样。上一节论述内在调养神志，下一节论述外在躲避风邪。
黄帝问岐伯：头部面部与身形，属于骨骼连接筋脉，共同拥有气血，合于气而已。天气寒冷时，大地开裂，冰凌覆盖，突然寒冷，有时手脚懈怠无力，然而为什么面部不穿衣服呢？
岐伯回答说：十二经脉，三百六十五络，它们的气血都上行于面部并走空窍。其中精阳气上行于目而为视觉；别气上行于耳而为听觉；宗气上行出于鼻而为嗅觉；浊气出于胃，上行于唇舌而为味觉。气中的津液，都向上熏蒸于面部，而且面部皮肤厚实，肌肉坚实，所以即使天气极热或极寒，也不能伤害它。
这一段论述脏腑经络的气血，渗入脉外而上注于空窍。所谓“属骨连筋”，是说头部面部与身体四肢的筋骨血气是相同的。太阴脾为阴中之至阴，在地对应土，在人对应四肢。天气寒冷时大地开裂冰凌覆盖，突然寒冷，手脚懈怠无力，这是脾土对应大地的表现。它们的气血都上行于面部，极热极寒都不能胜之，是说阴阳寒暑之气，都是从下向上，身体半以上对应天。十二经脉、三百六十五络的气血，起始于足少阴肾，生于足阳明胃，主于手少阴心，朝会于手太阴肺。精阳气，是心肾的神精之气，上行于目而为视觉。别气，是心肾之气，别行于耳而为听觉。宗气，是胃腑所生的大气，积聚于胸中，上行出于肺以司呼吸，所以出于鼻而为嗅觉。浊气，是水谷的精气，所以出于胃，上行于唇舌而为味觉。气中的津液，上行熏蒸于面部，是津液随气上行，熏肤泽毛而注入空窍。肺主皮而属天，脾主肉而应地，皮肤厚肌肉坚实，天的寒热不能胜过它，这是人气胜过天气的表现。这一章论述头面为诸阳之会，所以三阳经脉上循于头。然而阴阳寒热之气，都是从下升于上，所以又论述各脉的精气。
岐伯说：虚邪侵袭身体，使人洒淅恶寒，动摇形体；正邪侵袭人体很轻微，首先表现在面色上，身体感觉不到，若有若无，似亡似存，有形无形，没有人知道它的真情。
黄帝说：说得好啊！
这一段论述人气与天气的相合。风寒暑湿燥火，是天的六气，而人也有此六气，所以正邪侵袭人体，轻微地表现在面色上。色，指气色。中于气，所以轻微地表现在面色上，身体感觉不到，若有若无，似亡似存。天的六气，有正有邪。如虚邪侵袭身体，使人洒淅恶寒，动摇形体。虚，指八正时的虚邪气；形，指皮肉筋脉等有形的部分。这一节论述天地之气侵袭人体，有病在气而表现在面色上的，有病在形而表现在脉象上的，有病在气而表现在尺肤上的，有病在形而表现在尺脉上的，有病在气而应于形的，有病在形而应于气的。邪气的变化没有恒常规律，而这个身体的有形无形，也没有人能完全知晓其情状。所以能综合参验并运用的人，才可以成为高明的医生。玉师说：天的正气，如果偏寒偏热，偏湿偏燥，所以称为正邪。
黄帝问岐伯：我听说，观察面色就知道病情，叫做明；切按脉象就知道病情，叫做神；询问病情就知道病位，叫做工。我希望了解如何做到见而知之，按而得之，问而穷之，该怎么做呢？
岐伯回答说：面色、脉象与尺肤（前臂内侧皮肤）的相应关系，就像鼓槌敲击鼓面、回声响应一样，不会不相符合。这也是本末根叶的外在征候。所以根死了叶子就会枯死。面色、脉象、形体肌肉，不能不相符合。所以懂得其中之一就能成为工，懂得之二就能成为神，懂得之三就能既神且明。
黄帝说：希望听您详尽讲解。
岐伯说：面色青的，脉象弦；面色赤的，脉象钩；面色黄的，脉象代；面色白的，脉象毛；面色的黑的，脉象石。看到面色却得不到相应的脉象，反而得到相克制的脉象，就会死亡；得到相生助的脉象，病就会痊愈。
这一段论述面色、脉象与尺肤的相应，就像鼓槌与鼓声、影子与物体一样，不能不相符合。精明五色，是气的精华，是五脏五行之神气表现在面色上。脉，是营血循行的通道。尺，指脉外的气血，循行手阳明大肠经的络脉，变化显现于尺肤。脉内的血气，从手太阴肺经，变化显现于寸口尺部的脉象。这些都是胃腑五脏所生的气血，是本末根叶的外在征候。形肉，指尺肤。懂得面色、脉象与尺肤这三者，就能既神且明。青黄赤白黑，是五脏五行之气色；弦钩代毛石，是五脏五行之脉象。如影随形般相应。所以面色青脉象弦，面色赤脉象钩，看到面色而得到相应的脉象，就像地道顺承天道一样。如果面色青反而见到毛脉（金克木），面色赤反而见到石脉（水克火），这是阴阳五行相克致死。如果面色青得到石脉（水生木），面色赤得到代脉（火生土），这是色生于脉，阳生于阴，得到阳生阴长的道理，所以病就会痊愈。
黄帝问：五脏所生的疾病，变化的病形是怎样的？
岐伯说：先确定五色五脉的对应关系，疾病的性质就可以辨别了。
黄帝问：面色脉象已经确定，如何辨别呢？
岐伯说：调察脉象的缓急、大小、滑涩，病变就可以确定了。
黄帝问：如何调察呢？
岐伯说：脉象急的，尺肤也紧张；脉象缓的，尺肤也松弛；脉象小的，尺肤也减损且少气；脉象大的，尺肤也贲起；脉象滑的，尺肤也滑利；脉象涩的，尺肤也涩滞。所有这些变化，有轻微有严重。所以善于调察尺肤的，不需要等待寸口脉；善于调察脉象的，不需要等待面色。能综合参验并运用的人，可以成为高明的医生。上工十全九，运用两项原则的是中工，中工十全七，只运用一项原则的是下工，下工十全六。
这一段论述五脏所生的疾病，辨别其变化，应当先调察五色五脉。面色脉象已定，然后调察尺肤与寸口尺部的脉象。尺肤的气血，出于胃腑水谷的精微，注入脏腑的经隧，而外布于皮肤。寸口尺脉的气血，出于胃腑水谷的精微，荣行于脏腑经脉之中，变化显现于手太阴肺经的两脉口，都是五脏血气所灌注。所以脉急者，尺肤也急；脉缓者，尺肤也缓，如鼓槌与鼓声相应。所以善于调察尺肤的，不需要等待寸口脉；善于调察脉象的，不需要等待五色。能综合参验并运用的，才可以成为上工。数始于一奇二偶，合而为三，三而两之成六，三而三之成九，这是三才三极的道理。生于一而成于十，阴阳相得而各有合，这是河图之数。智者，懂得天地阴阳始终变化的道理，所以能具备九十的大数。水数成于六，火数成于七。水即是精血，火即是神气。中工仅知道血气的诊法，所以只能具备水火之成数。下工对血气的诊法，也不能完全知晓。所以说能综合参验并运用的人，可以成为上工。行者，指面色脉象顺应天地阴阳的理数，贤者效法而实行。
黄帝问：请问脉象的缓急大小滑涩的病形是怎样的？
岐伯说：请允许我说说五脏病变的情况。心脉急甚者为瘛疭（抽搐），微急为心痛牵引背部，饮食不下；缓甚为狂笑，微缓为伏梁（心下有积块），上下移动，时常唾血；大甚为喉痹，微大为心痹牵引背部，容易流泪；小甚为善哕（呃逆），微小为消瘅；滑甚为善渴，微滑为心疝牵引脐部，小腹鸣响；涩甚为失音，微涩为血溢，四肢厥冷，耳鸣癫疾。（“哕”音hui，如车惊声而有节律）
这一段论述五脏各有六种脉象变化的病证，源于寒热血气不和与外受邪气、内伤忧恐的不同。缓急大小滑涩，是阴阳寒热血气的纲领。下一章说：诸急多寒，缓者多热，大者多气少血，小者血气皆少，滑者阳气盛微有热，涩者多血少气微有寒。心为火脏，所以寒甚则为瘛疭。大概手足各关节，是神气游行出入的地方，寒伤神气，所以发生瘛疭。微急为心痛牵引背部，大概严重时心脏的神气受伤，轻微时则薄于宫城之分。食气入胃，浊气归心，心气逆故饮食不下。缓甚则心气有余，心藏神，神有余则笑不休。伏梁，乃心下有餘之积，所以微急主邪气薄于心下。心主血，热则上溢而时常唾血。喉痹，是喉中痹阻有声，宗气积聚于胸中，上行出于喉咙，以贯心脉而行呼吸，心气盛，所以喉中有声。心气微盛，则逆于心下，而为心痹牵引背部，气行于上，则心精随气上凑于目而流泪。心脏虚，则火土之气弱，所以善哕。哕，即呃逆。夫五脏主藏精者也，五脏血气皆少，则津液枯竭而为消瘅。消瘅，是三消之证，心肺主上消，脾胃主中消，肝肾主下消。滑则阳气盛而有热，盛于上则善渴，微在下则少腹当有形。心主言，心气少故为失音，血多故溢于上也。维，指四维。心为阳中之太阳，阳气少，所以手足厥冷。南方赤色，入通于心，开窍于耳，心气虚，所以耳鸣癫疾。按《金匮要略》说：五脏病各有十八，合为九十病。大概一脏有六变，三六而变引致十八病。玉师说：缓急大小滑涩，是五脏的六变，五六而变为三十，三而三之，合为九十。只有智者明白，所以说上工十全九。
肺脉急甚为癫疾，微急为肺寒热，怠惰咳唾血，牵引腰背胸，若鼻息肉不通；缓甚为多汗，微缓为痿躄（下肢萎软无力）、偏风，头以下汗出不可止；大甚为胫肿，微大为肺痹牵引胸背，起立时厌恶日光；小甚为泄泻，微小为消瘅；滑盛为息贲上气，微滑为上下出血；涩甚为呕血，微涩为鼠瘘（颈部淋巴结结核），在颈支腋之间，下不胜其上，其反应善于颤抖。（“贲”音ben，“瘘”音suan）
肺主清金而畏寒，寒甚则为癫疾，所谓重阴则癫。肺寒热，即皮寒热，寒在皮毛，所以微急。主肺气，怠惰咳唾血，牵引腰背胸，鼻若有息肉而气不通，都是肺气虚寒所致。缓则热甚，所以多汗。肺热叶焦，则为痿。鼠瘘，是寒热病，其本在脏，其末在脉，肺主百脉，所以微涩之有热，微涩之有寒，皆为鼠瘘在颈腋之间。本经说：偏枯身偏不用，病在分腠之间。大概病在皮肤，为肺寒热；病在血脉，为寒热鼠瘘；在分腠则为偏风。肺主周身之气而朝百脉。腠理开，所以头以下汗出不可止。头以下者，指颈项胸背之间，是肺之外部。大主多气少血，气盛于下，则为胫肿；微盛于上，则为肺痹牵引胸背，大概气从下而上。日光，指太阳之火，阴血少，所以厌恶日光，金畏火也。小则气血皆虚而为泄，肺与大肠为表里。微小则为消瘅，肺主津水之生原。滑主阳气盛，所以为息贲上气，微则上下出血，血随气行者也。涩主多血少气，血多气少，则血留不行，所以为呕血。瘘者，阴寒而削削不能行，肺主气而发原在下，少气有寒，则下不胜其上。
肝脉急甚者为恶言（骂人），微急为肥气，在胁下，若覆杯；缓甚为善呕，微缓为水瘕痹；大甚为内痈，善呕衄；微大为肝痹阴缩，咳嗽牵引小腹；小甚为多饮，微小为消瘅；滑甚为疝，微滑为遗溺。
Huangdi asked Qibo, "How does pathogenic qi invade the human body?" Qibo replied, "Pathogenic qi invades from the upper part of the body." Huangdi asked, "Is there a measure for high and low?"
Qibo said, "The upper half of the body is susceptible to wind pathogens, while the lower half is susceptible to dampness pathogens. Therefore, it is said that pathogenic qi has no constant pattern when invading the body. If it invades Yin meridians, it flows into the Fu organs; if it invades Yang meridians, it flows into the Jing (Meridian) channels."
This chapter discusses the correspondence between Zang-Fu organs, Yin-Yang, facial complexion, pulse qualities, Qi and Blood, as well as the internal-external connection of skin and meridians. One who can integrate these factors in practice can become a superior physician (Shang Gong). Pathogenic qi refers to wind, rain, cold, and heat, which are heavenly pathogens; thus, they tend to invade from the upper part of the body. Dampness is the Qi of water and earth; thus, it tends to invade the lower half of the body. These are heaven-and-earth pathogens, dividing their invasion into upper and lower parts. However, the invasion of pathogenic qi lacks constancy: it may invade Yin or Yang, flow into Fu organs, or enter Zang organs.
Huangdi said, "Yin and Yang have different names but belong to the same category. They meet above and below, and meridians interconnect like a circle without beginning or end. When pathogenic qi invades, it may strike Yin or Yang, with no constancy in upper, lower, left, or right. What is the reason?"
Qibo said, "All Yang meridians converge at the face. Invasion occurs when the body is deficient, such as after strenuous exertion, eating, or sweating, when the Cou Li (pores) are open and pathogens enter. If struck on the face, the pathogen descends into the Yangming Meridian; if struck on the nape, it descends into the Taiyang Meridian; if struck on the cheek, it descends into the Shaoyang Meridian. If struck on the chest, back, or flanks, it also enters their respective meridians."
Huangdi asked, "How does it invade Yin?"
Qibo answered, "Invasion of Yin usually begins at the medial aspect of the arms and legs. The skin here is thin, and the flesh is moist and supple. Thus, both are susceptible to wind, uniquely injuring the Yin."
Huangdi asked, "Does this damage the Zang organs?"
Qibo said, "Invasion by wind does not necessarily disturb the Zang organs. When pathogenic qi enters a Yin meridian, if the Zang Qi is substantial, the pathogen cannot lodge and returns to its paired Fu organ. Hence, invasion of Yang flows into the meridians, and invasion of Yin flows into the Fu organs."
This section discusses how Qi and Blood in the skin connect with meridians and internally link to Zang organs. Yin and Yang refer to the Qi and Blood of Zang-Fu; though divided into Yin and Yang, they constitute one unified Qi and Blood, hence different names but same substance. Meeting above and below refers to the entry and exit of Biao-Ben points. Interconnection of meridians refers to the circulation of Ying (Nutrient) Blood, starting from the Hand-Taiyin Lung Meridian, flowing into the Hand-Yangming Large Intestine Meridian, beginning at the Lung and ending at the Liver, then returning to the Lung, circulating endlessly. Upper, lower, left, and right refer to the head, face, hands, and feet. Some are struck on the head/face (Yang), others on the arm/leg medial aspects (Yin), hence no constancy. "All Yang meridians converge at the face" means clear Yang Qi ascends to the face and orifices. Striking the face leads to Yangming; striking the nape leads to Taiyang; striking the cheek leads to Shaoyang, as the collaterals of the three Yang meridians ascend through the neck to the head. The chest, back, and flanks are where meridians descend from the head/neck. This is the pathway of Yang collateral vessels; the external skin corresponds to the Yang divisions. Pathogens first lodge in the hair follicles/skin; if lingering, they enter collaterals; if still lingering, they enter meridians; internally connecting to five Zang organs and dispersing in six Fu organs. Zang meridians belong to Zang and connect to Fu; Fu meridians belong to Fu and connect to Zang, showing their interconnection. Blood vessels are Yin, governed by Zang. If pathogenic qi enters a meridian and Zang Qi is substantial, the pathogen cannot lodge and returns to the Fu, dispersing in the stomach and intestines. Yangming (Stomach) resides in the center (Earth) and is the destination of all things; once pathogens return to Yangming's stomach/intestines, they cease transmission.
Huangdi asked, "How does pathogenic qi invade the Zang organs?"
Qibo said, "Worry and fear injure the Heart; cold exposure and cold drinks injure the Lungs. Because two types of cold interact, injuring both interior and exterior, Qi rebels and ascends. Falling injuries causing blood stasis, or extreme anger causing Qi to rebel upward and fail to descend, accumulating under the flanks, injures the Liver. Blows, falls, intercourse while drunk, sweating exposed to wind, injure the Spleen; heavy lifting, excessive intercourse, sweating followed by bathing in water, injures the Kidneys."
Huangdi asked, "How do pathogens invade the Zang organs via wind?"
Qibo said, "Only when both Yin and Yang are affected can the pathogen advance."
Huangdi said, "Excellent!"
This section discusses injury to Zang Qi leading to pathogenic invasion of Zang organs. Pathogens invading Yin and flowing to Fu indicate substantial Zang Qi. Zang Qi is Shen (Spirit) Qi. When Shen Qi is stored internally, Blood vessels are full. If Zang Qi is internally injured, pathogens enter via deficiency. Wind is the chief of hundred diseases, agile and changeable. Both Yin and Yang being affected means interior and exterior are injured. The Classic states: "Eight winds coming from deficient directions cause disease." Three deficiencies combining lead to sudden death. This describes invasion without prior Zang injury. Thus, sages avoid wind as they would arrows and stones. The previous section discussed nurturing Spirit internally; this section discusses avoiding wind externally.
Huangdi asked Qibo, "The head and face connect to bones and sinews, sharing Blood and Qi with the body. In severe cold, the ground cracks and ice forms, causing limbs to become limp. Why is the face not covered?"
Qibo replied, "The twelve meridians and 365 collaterals all send their Qi and Blood to the face and orifices. Essence-Yang Qi ascends to the eyes for vision; separate Qi ascends to the ears for hearing; Zong (Gathering) Qi ascends from the nose for smell; turbid Qi comes from the Stomach to the lips and tongue for taste. Fluids from Qi and Blood steam over the face. The skin is thick and flesh firm, so extreme heat or cold cannot overcome it."
This section discusses how Zang-Fu meridian Qi and Blood seep outside vessels to nourish orifices. "Connecting bones and sinews" means head/face and body share similar structures. Taiyin (Spleen) is extreme Yin, corresponding to Earth and limbs. Cold cracking the ground reflects Spleen-Earth. Qi/Blood ascending to the face reflects Heaven above the waist. Meridian Qi starts at Foot-Shaoyin Kidney, generates at Foot-Yangming Stomach, is governed by Hand-Shaoyin Heart, and converges at Hand-Taiyin Lung. Essence-Yang Qi (Heart/Kidney spirit) goes to eyes. Separate Qi (Heart/Kidney) goes to ears. Zong Qi (generated by Stomach, accumulates in chest) goes out lungs/nose for smell. Turbid Qi (food essence) goes from Stomach to mouth/tongue for taste. Fluids steam the face, nourishing skin/hair/orifices. Lung governs skin (Heaven); Spleen governs muscle (Earth). Thick skin/firm muscle resists weather, showing Human Qi overcoming Heavenly Qi. The head/face is the convergence of all Yang; Yang meridians ascend to the head. Yin/Yang/heat/cold Qi rises from below. Thus, meridian essence is discussed.
Huangdi asked, "What are the manifestations of pathogenic invasion?"
Qibo said, "Deficient pathogens (Xu Xie) cause shivering and physical trembling. Correct pathogens (Zheng Xie) are subtle, first appearing in complexion, unnoticed by the body, seeming present yet absent, tangible yet intangible, unknown in nature."
Huangdi said, "Excellent!"
This section discusses the harmony between Human and Heavenly Qi. Wind, cold, summer heat, dampness, dryness, fire are Heavenly Six Qi; humans possess them too. Zheng Xie subtly affects complexion (Qi color). Xu Xie causes shivering. Deficiency refers to Eight Regularity deficient pathogens; Form refers to skin/muscle/tendons/bones. Disease may manifest in Qi (complexion), Form (pulse), Chi Skin (forearm skin), or combine Qi/Form. Pathogenic changes are constant; form/im-form is unknowable. Integrating these makes a Shang Gong. Master Yu says: Heavenly correct Qi, if biased toward cold/heat/dryness/wetness, is called Zheng Xie.
Huangdi asked Qibo, "I hear observing complexion reveals disease (Ming); palpating pulse reveals disease (Shen); asking symptoms reveals location (Gong). How to achieve seeing-knowing, touching-knowing, asking-knowing?"
Qibo replied, "Complexion, pulse, and Chi Skin correspond like drumsticks hitting drums or echoes responding; they must not mismatch. This is like roots and leaves. If roots die, leaves wither. Complexion, pulse, and form/flesh must correspond. Knowing one makes a Gong; knowing two makes a Shen; knowing three makes Shen and Ming."
Huangdi said, "Please explain fully."
Qibo said, "Green complexion corresponds to Wiry (Xian) pulse; Red to Hooked (Gou) pulse; Yellow to Moderate (Dai) pulse; White to Hairy (Mao) pulse; Black to Stone (Shi) pulse. Seeing color without matching pulse, especially with controlling pulses, indicates death; generating pulses indicate recovery."
This section discusses correspondence of complexion, pulse, and Chi Skin. Five colors are the brilliance of Qi and Spirit of Five Zang/Five Elements. Pulse is Ying Blood circulation. Chi Skin reflects extravascular Qi/Blood via Hand-Yangming collaterals. Inner pulse Qi/Blood manifests at Hand-Taiyin Cun-Guan-Chi positions. All derive from Stomach/Zang Qi. Green/Yellow/Red/White/Black are Five Zang colors; Wiry/Hooked/Moderate/Hairy/Stone are Five Zang pulses. Correspondence is natural. Mismatch (e.g., Green with Hairy/Metal controls Wood) implies death. Match (e.g., Green with Stone/Water generates Wood) implies recovery via generation principles.
Huangdi asked, "What are the pathological forms generated by the Five Zang?"
Qibo said, "First determine the correspondence of Five Colors and Five Pulses to distinguish diseases."
Huangdi asked, "How to distinguish once determined?"
Qibo said, "Regulate pulse speed (Huan/Ji), size (Da/Xiao), and texture (Hua/Sè)."
Huangdi asked, "How?"
Qibo said, "Rapid pulse correlates with tense Chi Skin; slow with relaxed; small with diminished Qi; large with bulging; slippery with smooth; choppy with rough. These variations vary in degree. Skilled practitioners check Chi Skin without waiting for Cun-Kou pulse; skilled pulse readers don't wait for complexion. Integrating these makes a Shang Gong. Shang Gong cures 9/10; using two methods makes Zhong Gong (cures 7/10); using one makes Xia Gong (cures 6/10)."
This section discusses distinguishing Zang disease variations by regulating Five Colors/Pulses, then Chi Skin/Cun-Kou. Chi Skin Qi/Blood derives from Stomach essence, distributing to skin. Cun-Kou Qi/Blood circulates in meridians, manifesting at Lung pulses. All are Zang Qi injections. Rapid pulse = tense skin; slow = relaxed, like drumstick-drum response. Skilled Chi Skin readers don't need Cun-Kou; skilled pulse readers don't need colors. Integration makes Shang Gong. Numbers start with 1 (odd) and 2 (even), forming 3, 6, 9 (Three Powers). Generating 1 completing 10 reflects Hetu numbers. Wise ones know Yin-Yang changes, achieving 90. Water completes at 6 (Blood/Essence); Fire at 7 (Spirit/Qi). Zhong Gong knows Blood/Qi diagnosis (Water/Fire completion). Xia Gong fails to fully know. Integration makes Shang Gong. "Xing" means following Heaven-Earth Yin-Yang logic.
Huangdi asked, "What are the pathological forms of pulse Huan/Ji/Da/Xiao/Hua/Sè?"
Qibo said, "Heart pulse extremely rapid indicates convulsions; slightly rapid indicates heart pain radiating to back, difficulty swallowing; extremely slow indicates manic laughter; slightly slow indicates Fuliang (accumulation below heart) moving up/down with spitting blood; extremely large indicates throat obstruction; slightly large indicates Xinbi (heart bi) radiating to back, tearing; extremely small indicates frequent hiccups; slightly small indicates Xiao Dao (wasting-thirst); extremely slippery indicates excessive thirst; slightly slippery indicates Xin Han (heart hernia) radiating to umbilicus with abdominal鸣; extremely choppy indicates aphonia; slightly choppy indicates blood extravasation, limb reversal, tinnitus, epilepsy."
This section details Six Variations per Zang due to Cold/Heat/Qi-Blood disharmony and emotional/pathogenic factors. Huan/Ji/Da/Xiao/Hua/Sè are guidelines for Yin/Yang/Cold/Heat/Qi-Blood. Fast=Cold; Slow=Heat; Large=Excess Qi/Low Blood; Small=Low Qi/Blood; Slippery=Excess Yang/Heat; Choppy=Excess Blood/Low Qi/Cold. Heart is Fire; extreme cold causes convulsions (Shen Qi injured). Slightly fast: heart pain/back (Shen Qi injured). Food enters Stomach, turbid Qi goes to Heart; rebellious Qi causes dysphagia. Extremely slow: excess Heart Qi/Shen causes laughter. Fuliang: accumulation below heart. Heart governs Blood; heat causes hemoptysis. Throat obstruction: Zong Qi in chest exits throat; Heart Qi excess causes sound. Slightly large: Heart Qi rebellion causes Xinbi/back pain/radiation to eyes/tears. Heart deficiency: weak Fire/Earth causes hiccups. Low Qi/Blood causes fluid depletion/Xiao Dao. Slippery: Yang excess/heat causes thirst. Choppy: low Heart Qi causes aphonia; excess blood causes extravasation. Four Dimensions: Heart is Supreme Yang; low Yang causes limb reversal. South/Red connects to Heart/Ear; deficiency causes tinnitus/epilepsy. *Jingui Yaolue*: 18 diseases per Zang x 5 = 90. Six variations x 5 = 30 x 3 = 90. Only wise understand Shang Gong's 9/10 cure rate.
Lung pulse extremely rapid indicates epilepsy; slightly rapid indicates Lung cold/heat, lethargy, coughing blood, pain in back/chest, nasal polyps; extremely slow indicates excessive sweating; slightly slow indicates Wei Bi (limb weakness), Pi Feng (hemiplegia), unstoppable sweating below head; extremely large indicates leg swelling; slightly large indicates Fei Bi (lung bi) radiating to chest/back, aversion to sunlight; extremely small indicates diarrhea; slightly small indicates Xiao Dao; extremely slippery indicates Xi Ben (asthma/wheezing); slightly slippery indicates upper/lower bleeding; extremely choppy indicates hematemesis; slightly choppy indicates Shu Lou (scrofula) in neck/armpits, heaviness below, trembling response.
Lung governs Metal, fears cold. Extreme cold causes epilepsy (Heavy Yin). Lung cold/heat affects skin. Lethargy/coughing blood/pain/polyps indicate Lung Qi deficiency/cold. Slow indicates heat/sweating. Lung heat scorches leaves causing Wei. Shu Lou is cold/heat disease, root in Zang, branch in vessels. Lung governs hundred vessels. Slightly choppy heat/cold causes Shu Lou in neck/armpits. Pi Feng affects synovial spaces. Lung governs Qi/hundred vessels. Open pores cause sweating below head (neck/chest/back). Large indicates excess Qi/low blood; Qi sinking causes leg swelling; Qi rising causes Fei Bi/back pain. Sunlight is Solar Fire; low Yin blood causes aversion (Metal fears Fire). Small indicates Qi/Blood deficiency/diarrhea. Lung/Large Intestine are exterior-interior. Slightly small causes Xiao Dao (Lung governs fluids). Slippery indicates Yang excess/Xi Ben. Slightly slippery causes bleeding (blood follows Qi). Choppy indicates excess blood/low Qi/stasis/hematemesis. Lou indicates cold/stagnation. Lung Qi originates below; low Qi/cold causes imbalance below/above.
Liver pulse extremely rapid indicates abusive speech; slightly rapid indicates Fei Qi (mass) under flanks like inverted cup; extremely slow indicates frequent vomiting; slightly slow indicates Shui Jia (water mass); extremely large indicates internal abscess, vomiting/epistaxis; slightly large indicates Gan Bi (liver bi) with genital retraction, cough pulling lower abdomen; extremely small indicates polydipsia; slightly small indicates Xiao Dao; extremely slippery indicates Shan Han (hernia); slightly slippery indicates enuresis.