黄帝问曰∶平人何如?岐伯对曰∶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。常以不病调病患,医不病,故为病患平息以调之为法。人一呼脉一动,一吸脉一
动,曰少气。人一呼脉三动,一吸脉三动而躁,尺热曰病温,尺不热脉滑曰病风,脉涩曰痹。人一呼脉四
动以上曰死,脉绝不至曰死,乍疏乍数曰死。平
人之常气禀于胃,胃者平人之常气也,人无胃气曰逆,逆者死。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。藏真散于肝,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。藏真通于心,心藏血脉之气也。长夏胃微 弱曰平,弱多胃
少曰脾病,但代无胃曰死, 弱有石曰冬病,弱甚曰今病。藏真濡于脾,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。藏真高于肺,以行荣卫阴阳也。冬胃微石曰平,石多胃少
曰肾病,但石无胃曰死,石而有钩曰夏病,钩甚曰今病。藏真下于肾,肾藏骨髓之气也。胃之大络,名曰
虚里,贯膈络肺,出于左乳下,其动应衣,脉宗气也。盛喘数绝者,则病在中;结而横,有积矣;绝不至曰死
。乳之下其动应衣,宗气泄也。
欲知寸口太过与不及,寸口之脉中手短者,曰头痛。寸口脉中手长者,曰足胫痛。寸口脉中手促上
击者,曰肩背痛。寸口脉沉而坚者,曰病在中。寸口脉浮而盛者,曰病在外。寸口脉沉而弱,曰寒热
及疝瘕少腹痛。寸口脉沉而横,曰胁下有积,腹中有横积痛。寸口脉沉而喘,曰寒热。脉盛滑坚者,曰病在外。
脉小实而坚者,病在内。脉小弱以涩,谓之久病。脉滑浮而疾者,谓之新病。脉急者,曰疝瘕少腹痛。脉
滑曰风。脉涩曰痹。缓而滑曰热中。盛而紧曰胀。脉从阴阳,病易已;脉逆阴阳,病难已。脉得四时之顺,
曰病无他;脉反四时及不间
藏,曰难已。臂多青脉,曰脱血。尺脉缓涩,谓之解 。安卧脉盛,谓之脱血。尺涩脉滑,谓之多汗。尺寒脉
细,谓之后泄。脉尺粗常热者,谓之热中。肝见庚辛死,心见壬癸死,脾见甲乙死,肺见丙丁死,肾见戊己
死,是谓真脏见皆死。颈脉动喘疾咳,曰水。目裹微肿如卧蚕起之状,曰
水。溺黄赤安卧者,黄胆。已食如饥者,胃疸。面肿曰风。足胫肿曰水。目黄者曰黄胆。妇人手少阴
脉动甚者,妊子也。脉有逆从四时,未有脏形,春夏而脉瘦,秋冬而脉浮大,命曰逆四时也。风热而脉静,
泄而脱血脉实,病在中脉虚,病在
外脉涩坚者,皆难治,命曰反四时也。人以水谷为本,故人绝水谷则死,脉无胃气亦死。所谓无胃气者,但
得真脏脉不得胃气也。所谓脉不得胃气者,肝不弦肾不石也。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。
夫平心脉来,累累如连珠,如循琅 ,曰心
平,夏以胃气为本。病心脉来,喘喘连属,其中微曲,曰心病。死心脉来,前曲后居,如操带钩,曰心死。
平肺脉来,厌厌聂聂,如落榆荚,曰肺平,秋以胃气为本。病肺脉来,不上不下,如循鸡羽,曰肺病。死肺
脉来,如物之浮,如风吹毛,曰肺死。平肝脉来, 弱招招,如揭长竿末梢,曰肝平,春以胃气为本。病
肝脉来,盈实而滑,如循长竿,曰肝病。死肝脉来,急益劲,如新张弓弦,曰肝死。平脾脉来,和柔相离,
如鸡践地,曰脾平,长夏以胃气为
本。病脾脉来,实而盈数,如鸡举足,曰脾病。死脾脉来,锐坚如鸟之喙,如鸟之距,如屋之漏,如水
之流,曰脾死。平肾脉来,喘喘累累如钩,按之而坚,曰肾平,冬以胃气为本。病肾脉来,如引葛,按之益坚,
曰肾病。死肾脉来,发如夺索,辟辟如弹石,曰肾死。
脉要精微论∶莠(音诱)汨(古没切)瘅(都HT 切) (音荀,又音舜)
平人气象论∶疝(音山)瘕(音贾) (音亦) (女耕切)喙(虚畏切)
黄帝问道:所谓“平人”是指什么样的人?岐伯回答说:人在一次呼气时脉搏跳动两次,一次吸气时脉搏也跳动两次,在一呼一吸之间的停顿(定息)时脉搏可能跳动五次,这是因为偶尔会有深长的呼吸(太息),这种情况被称为“平人”。所谓平人,就是没有疾病的人。通常用健康人的脉象来作为衡量病人脉象的标准,因为医生自身是健康的,所以医生在诊脉时要调整自己的呼吸,使之平稳均匀,以此作为诊断的方法。如果人一呼脉搏只跳动一次,一吸脉搏也只跳动一次,这叫做“少气”(元气不足)。如果人一呼脉搏跳动三次,一吸脉搏也跳动三次,且脉象躁急,尺部皮肤发热,这是温病;如果尺部皮肤不发热而脉象滑利,这是风病;如果脉象涩滞,这是痹证。如果人一呼脉搏跳动四次以上,或者脉搏停止不再跳动,或者脉律忽快忽慢,这些都是死证。
平人常有的胃气禀受于胃,胃就是平人正常的胃气来源。人如果没有胃气,就称为“逆”,出现这种情况就会死亡。春季的脉象中带有微微的弦象,同时兼有胃气,称为平脉;如果弦象多而胃气少,说明患有肝病;如果只有弦象而没有胃气,说明病情危重将死;如果脉象中带有毛(浮)象,预示秋季会发病;如果毛象明显,说明现在就已经发病。五脏的真气散布于肝,肝主管筋膜之气。夏季的脉象中带有微微的钩(洪)象,同时兼有胃气,称为平脉;如果钩象多而胃气少,说明患有心病;如果只有钩象而没有胃气,说明病情危重将死;如果脉象中带有石(沉)象,预示冬季会发病;如果石象明显,说明现在就已经发病。五脏的真气通达于心,心主管血脉之气。长夏季节的脉象中带有微微的弱(缓)象,同时兼有胃气,称为平脉;如果弱象多而胃气少,说明患有脾病;如果只有代(止)象而没有胃气,说明病情危重将死;如果弱象中带有石(沉)象,预示冬季会发病;如果弱象明显,说明现在就已经发病。五脏的真气濡润于脾,脾主管肌肉之气。秋季的脉象中带有微微的毛(浮)象,同时兼有胃气,称为平脉;如果毛象多而胃气少,说明患有肺病;如果只有毛象而没有胃气,说明病情危重将死;如果脉象中带有弦象,预示春季会发病;如果弦象明显,说明现在就已经发病。五脏的真气高于肺,用以运行营卫阴阳之气。冬季的脉象中带有微微的石(沉)象,同时兼有胃气,称为平脉;如果石象多而胃气少,说明患有肾病;如果只有石象而没有胃气,说明病情危重将死;如果脉象中带有钩(洪)象,预示夏季会发病;如果钩象明显,说明现在就已经发病。五脏的真气下归于肾,肾主管骨髓之气。胃的大络,名叫虚里,穿过膈肌联络肺部,出于左侧乳头下方,其搏动可以透过衣服看到,这是宗气的表现。如果搏动急促且数度中断,说明病邪在中焦;如果搏动结聚且横溢,说明体内有积块;如果脉搏完全停止不再跳动,说明死亡。如果左乳下的搏动剧烈到使衣服颤动,这是宗气外泄的表现。
想要了解寸口脉的太过与不及,如果寸口脉按之感觉短促,主头痛。如果寸口脉按之感觉长,主足胫疼痛。如果寸口脉按之感到急促且向上冲击,主肩背部疼痛。如果寸口脉沉而坚实,主病在中焦。如果寸口脉浮而盛大,主病在外表。如果寸口脉沉而弱,主寒热往来以及疝瘕引起的少腹疼痛。如果寸口脉沉而横,主胁下有积块,腹部有横向的积块疼痛。如果寸口脉沉而急促,主寒热。如果脉象盛大、滑利且坚实,主病在外表。如果脉象细小、坚实且有力,主病在内里。如果脉象细小、虚弱且涩滞,称为久病。如果脉象滑利、浮浅且疾速,称为新病。如果脉象紧急,主疝瘕引起的少腹疼痛。如果脉象滑利,主风病。如果脉象涩滞,主痹证。如果脉象缓和且滑利,主热邪在中焦。如果脉象盛大且紧束,主胀满。如果脉象顺应阴阳变化,疾病容易治愈;如果脉象违背阴阳规律,疾病难以治愈。如果脉象顺应四时变化,说明病情没有其它变证;如果脉象违背四时规律及脏腑生克顺序,说明难以治愈。手臂上青色脉络显露过多,主失血。尺部脉象缓而涩,主肢体懈怠无力。安静卧睡但脉象盛大,主失血。尺部脉涩而整体脉滑,主多汗。尺部皮肤寒冷且脉细,主腹泻后遗或慢性泄泻。尺部皮肤粗糙且经常发热,主热邪在中焦。肝脏病变遇到庚辛日(金旺之日)会死亡,心脏病变遇到壬癸日(水旺之日)会死亡,脾脏病变遇到甲乙日(木旺之日)会死亡,肺脏病变遇到丙丁日(火旺之日)会死亡,肾脏病变遇到戊己日(土旺之日)会死亡,这就是所谓的真脏脉显现,皆主死亡。颈部动脉跳动伴喘息和急咳,主水肿。眼睑轻微肿胀像卧蚕起的样子,主水肿。小便黄赤且安静卧睡,主黄疸。吃完饭却像没吃饱一样饥饿,主胃疸。面部浮肿主风邪。足胫浮肿主水湿。眼睛发黄主黄疸。妇女的手少阴脉(神门穴处动脉)搏动明显增强,是怀孕的迹象。脉象有顺应或违背四时的情况,如果没有明显的脏腑形态改变,春夏季节脉象反而瘦小,秋冬季节脉象反而浮大,这叫做违背四时规律。感受风热但脉象平静,泄泻且脱血但脉象实大,病在中焦但脉象虚软,病在外表但脉象涩坚,这些都属于难治之症,叫做违背四时规律。人以水谷精微为本源,所以人断绝水谷摄入就会死亡,脉象中没有胃气也会死亡。所谓没有胃气,就是指只能摸到真脏脉而摸不到胃气。所谓脉象没有胃气,就是指肝脏的脉象不呈现弦象,肾脏的脉象不呈现石象。太阳经的脉象至,表现为洪大且长;少阳经的脉象至,表现为忽快忽慢,忽短忽长;阳明经的脉象至,表现为浮大且短。
正常的心脉,来时累累如连珠,如同抚摸琅玕玉,称为心平脉,夏季以胃气为本。患病的心脉,来时喘喘相连属,其中略微弯曲,称为心病脉。死亡的心脉,来时前曲后硬,如同拿着带钩的皮带,称为心死脉。正常的肺脉,来时厌厌聂聂,如同榆荚飘落,称为肺平脉,秋季以胃气为本。患病的肺脉,来时不上不下,如同抚摸鸡羽,称为肺病脉。死亡的肺脉,来时如物体漂浮,如风吹毛发,称为肺死脉。正常的肝脉,来时弱弱招招,如同举起长竿末梢般柔和,称为肝平脉,春季以胃气为本。患病的肝脉,来时盈实而滑,如同抚摸长竿,称为肝病脉。死亡的肝脉,来时急迫且强劲,如同新拉开的弓弦,称为肝死脉。正常的脾脉,来时和柔相离,如同鸡踏地般轻盈,称为脾平脉,长夏以胃气为本。患病的脾脉,来时实而盈数,如同鸡举足般急促,称为脾病脉。死亡的脾脉,来时锐坚如鸟嘴,如鸟爪,如屋漏滴水,如水直流,称为脾死脉。正常的肾脉,来时喘喘累累如钩,按之坚实,称为肾平脉,冬季以胃气为本。患病的肾脉,来时如牵引葛藤,按之更加坚实,称为肾病脉。死亡的肾脉,来时如夺索般纠缠,辟辟如弹石,称为肾死脉。
《脉要精微论》注音:莠(音诱)汨(古没切)瘅(都HT 切) (音荀,又音舜)
《平人气象论》注音:疝(音山)瘕(音贾) (音亦) (女耕切)喙(虚畏切)
Huangdi asked, "What constitutes a 'Ping Ren' (Normal Person)?" Qibo replied, "When a person exhales, the pulse beats twice; when they inhale, the pulse also beats twice. Between the end of exhalation and the beginning of inhalation (Ding Xi), the pulse may beat five times due to occasional deep sighs (Tai Xi). This is called a 'Ping Ren'. A Ping Ren is one who is not diseased. Typically, the pulse of a healthy person is used as a standard to evaluate the pulse of a patient. Since the physician is healthy, the physician should regulate their own breathing to be calm and even while taking the patient's pulse as a method of diagnosis. If a person's pulse beats once per exhalation and once per inhalation, it is called 'Shao Qi' (Deficiency of Vital Qi). If the pulse beats three times per exhalation and three times per inhalation, and is rapid and restless, with heat in the Chi (Cubital fossa) area, it indicates Wen Bing (Warm Disease); if the Chi area is not hot but the pulse is slippery, it indicates Feng Bing (Wind Disease); if the pulse is choppy, it indicates Bi Syndrome (Obstruction Syndrome). If the pulse beats more than four times per exhalation, or if the pulse ceases completely, or if the pulse rhythm is irregular (alternating between slow and fast), these are signs of death.
The normal Qi of a Ping Ren is derived from the Stomach; the Stomach is the source of normal Qi for a Ping Ren. If a person lacks Stomach Qi, it is called 'Ni' (Rebellion/Contrary), which leads to death. In Spring, a pulse that is slightly Xian (String-like) while retaining Stomach Qi is considered a Normal Pulse; if Xian qualities dominate and Stomach Qi is scant, it indicates Liver Disease; if there is only Xian quality without Stomach Qi, it indicates impending death; if the pulse shows Mao (Floating) qualities, disease will manifest in Autumn; if Mao qualities are pronounced, disease is present now. The Zhen Qi (True Qi) of the Zang organs disperses into the Liver, which governs the Qi of the sinews/fascia. In Summer, a pulse that is slightly Gou (Hook-like/Hong) while retaining Stomach Qi is considered a Normal Pulse; if Gou qualities dominate and Stomach Qi is scant, it indicates Heart Disease; if there is only Gou quality without Stomach Qi, it indicates impending death; if the pulse shows Shi (Stone-like/Deep) qualities, disease will manifest in Winter; if Shi qualities are pronounced, disease is present now. The Zhen Qi of the Zang organs connects to the Heart, which governs the Qi of the blood vessels. During the Late Summer period, a pulse that is slightly Ruo (Weak/Sluggish) while retaining Stomach Qi is considered a Normal Pulse; if Ruo qualities dominate and Stomach Qi is scant, it indicates Spleen Disease; if there is only Dai (Intermittent) quality without Stomach Qi, it indicates impending death; if Ruo qualities show Shi (Deep) characteristics, disease will manifest in Winter; if Ruo qualities are pronounced, disease is present now. The Zhen Qi of the Zang organs moistens the Spleen, which governs the Qi of the muscles. In Autumn, a pulse that is slightly Mao (Floating) while retaining Stomach Qi is considered a Normal Pulse; if Mao qualities dominate and Stomach Qi is scant, it indicates Lung Disease; if there is only Mao quality without Stomach Qi, it indicates impending death; if the pulse shows Xian (String-like) qualities, disease will manifest in Spring; if Xian qualities are pronounced, disease is present now. The Zhen Qi of the Zang organs rises above the Lungs to circulate Ying (Nutritive) and Wei (Defensive) Qi and Yin-Yang. In Winter, a pulse that is slightly Shi (Deep) while retaining Stomach Qi is considered a Normal Pulse; if Shi qualities dominate and Stomach Qi is scant, it indicates Kidney Disease; if there is only Shi quality without Stomach Qi, it indicates impending death; if the pulse shows Gou (Hook-like) qualities, disease will manifest in Summer; if Gou qualities are pronounced, disease is present now. The Zhen Qi of the Zang organs descends to the Kidneys, which govern the Qi of the bone marrow. The major collateral of the Stomach is named Xuli, which penetrates the diaphragm, connects to the Lungs, and emerges below the left nipple. Its pulsation can be seen through clothing; this represents the Zong Qi (Gathering Qi). If the pulsation is rapid and frequently interrupted, the pathogen is in the Middle Jiao; if the pulsation is knotted and protruding, there is an accumulation (Ji) in the body; if the pulsation ceases completely, it indicates death. If the pulsation below the nipple is vigorous enough to move the clothing, it indicates leakage of Zong Qi.
To understand excess (Tai Guo) and deficiency (Bu Ji) at the Cunkou (Radial artery) position: If the Cunkou pulse feels short upon palpation, it indicates Headache. If the Cunkou pulse feels long upon palpation, it indicates Pain in the lower legs/shins. If the Cunkou pulse feels rapid and strikes upward upon palpation, it indicates Shoulder and Back pain. If the Cunkou pulse is Deep and Firm, it indicates disease in the Interior/Middle Jiao. If the Cunkou pulse is Floating and Excessive, it indicates disease in the Exterior. If the Cunkou pulse is Deep and Weak, it indicates Alternating Cold and Fever, as well as Shaoyang abdominal pain caused by Shan Jia (Abdominal masses). If the Cunkou pulse is Deep and Horizontal, it indicates masses under the hypochondrium and horizontal abdominal pain from accumulations. If the Cunkou pulse is Deep and Rapid, it indicates Alternating Cold and Fever. If the pulse is Excessive, Slippery, and Firm, it indicates disease in the Exterior. If the pulse is Small, Solid, and Firm, it indicates disease in the Interior. If the pulse is Small, Weak, and Choppy, it is termed Chronic Disease. If the pulse is Slippery, Floating, and Rapid, it is termed New Disease. If the pulse is Tense, it indicates Shaoyang abdominal pain from Shan Jia. If the pulse is Slippery, it indicates Wind Disease. If the pulse is Choppy, it indicates Bi Syndrome. If the pulse is Slow and Slippery, it indicates Heat in the Middle Jiao. If the pulse is Excessive and Tight, it indicates Distension. If the pulse follows Yin-Yang principles, the disease is easy to cure; if the pulse contradicts Yin-Yang principles, the disease is difficult to cure. If the pulse conforms to the Four Seasons, there are no other complications; if the pulse contradicts the Four Seasons and the generating cycle of the Zang organs, it is difficult to cure. Excessive blue veins on the arms indicate Blood loss. A Chi pulse that is Slow and Choppy indicates relaxation/laxity. An excessive pulse in someone who rests quietly indicates Blood loss. A Choppy Chi pulse combined with a Slippery overall pulse indicates profuse sweating. A cold Chi skin with a Fine pulse indicates subsequent diarrhea/chronic loose stools. A coarse and constantly hot Chi skin indicates Heat in the Middle Jiao. Liver pathology dies on Geng/Xin days (Metal days); Heart pathology dies on Ren/Gui days (Water days); Spleen pathology dies on Jia/Yi days (Wood days); Lung pathology dies on Bing/Ding days (Fire days); Kidney pathology dies on Wu/Ji days (Earth days). This is called the appearance of the True Zang Pulse, all indicating death. Pulsation in the neck accompanied by panting and rapid cough indicates Water retention (Edema). Slight swelling of the eyelids resembling a silkworm indicates Water retention. Yellow urine, red urine, and quiet rest indicate Huang Dan (Jaundice). Feeling hungry after eating indicates Wei Dan (Stomach Jaundice). Facial swelling indicates Wind. Swelling of the lower legs indicates Water. Yellow eyes indicate Huang Dan (Jaundice). If the Shao Yin pulse (on the woman's wrist) beats strongly, she is pregnant. Pulses may follow or contradict the Four Seasons. Without obvious Zang organ morphological changes, if the pulse is thin in Spring/Summer and floating/large in Autumn/Winter, it is called Contradicting the Four Seasons. If Wind-Heat presents with a calm pulse, or diarrhea/blood loss presents with a solid pulse, or interior disease presents with a deficient pulse, or exterior disease presents with a choppy/firm pulse, all are difficult to treat and are called Contradicting the Four Seasons. Humans rely on water and grain as their root; thus, humans die when cut off from water and grain, and also die when the pulse lacks Stomach Qi. What is meant by lacking Stomach Qi is that only the True Zang Pulse is felt, without Stomach Qi. What is meant by the pulse lacking Stomach Qi is that the Liver pulse does not show Xian (String-like) qualities and the Kidney pulse does not show Shi (Deep) qualities. The Tai Yang pulse arrives, appearing Hong (Surging), Large, and Long; the Shao Yang pulse arrives, appearing alternately rapid and slow, alternately short and long; the Yang Ming pulse arrives, appearing Floating, Large, and Short.
A normal Heart pulse comes continuously like linked pearls, or like rolling over Langgan jade; this is a Normal Heart Pulse, where Summer relies on Stomach Qi as the foundation. A diseased Heart pulse comes rapidly and continuously, with slight curvature in the middle; this is a Diseased Heart Pulse. A dying Heart pulse comes with curvature at the front and stiffness at the back, like handling a belt hook; this is a Dead Heart Pulse. A normal Lung pulse comes gently and softly, like falling elm seeds; this is a Normal Lung Pulse, where Autumn relies on Stomach Qi as the foundation. A diseased Lung pulse comes neither up nor down, like feeling a chicken feather; this is a Diseased Lung Pulse. A dying Lung pulse floats like an object, or like wind blowing hair; this is a Dead Lung Pulse. A normal Liver pulse comes weakly and gracefully, like holding the tip of a long bamboo pole; this is a Normal Liver Pulse, where Spring relies on Stomach Qi as the foundation. A diseased Liver pulse comes full, solid, and slippery, like feeling a long bamboo pole; this is a Diseased Liver Pulse. A dying Liver pulse comes urgent and strong, like a newly strung bowstring; this is a Dead Liver Pulse. A normal Spleen pulse comes harmonious and soft, distinct yet connected, like a chicken stepping on the ground; this is a Normal Spleen Pulse, where Late Summer relies on Stomach Qi as the foundation. A diseased Spleen pulse comes solid, full, and frequent, like a chicken lifting its foot; this is a Diseased Spleen Pulse. A dying Spleen pulse comes sharp and hard like a bird's beak, like a bird's claw, like water dripping from a leaking roof, or like flowing water; this is a Dead Spleen Pulse. A normal Kidney pulse comes rapidly and continuously like a hook, firm upon pressure; this is a Normal Kidney Pulse, where Winter relies on Stomach Qi as the foundation. A diseased Kidney pulse comes like pulling a vine, becoming firmer upon pressure; this is a Diseased Kidney Pulse. A dying Kidney pulse comes like pulling a rope in opposite directions, or crackling like striking stones; this is a Dead Kidney Pulse.
*Mai Yao Jing Wei Lun*: Pronunciation notes: You (sound 'you'), Mi (cut as 'gu mo'), Dan (cut as 'du HT'), [Character] (sound 'xun', also sound 'shun').
*Ping Ren Qi Xiang Lun*: Pronunciation notes: Shan (sound 'shan'), Jia (sound 'jia'), [Character] (sound 'yi'), [Character] (cut as 'nu gong'), Hui (cut as 'xu wei').