此篇以下。皆叔和述仲景之言。附己意以为赞经之辞。譬则翼焉。传类也。篇目旧名平脉。
次第二而僭经右。夫传不可以先经。论脉亦无先各脉而后平脉之理。且平脉不过前数条。冒事必
如此耳。后亦各脉。安得直以平脉名篇。皆非叔和之旧。其为后人之纷更明甚。是故重考订而次
序如今。
问曰。脉有三部。阴阳相乘。荣卫血气。在人体躬。呼吸出入。上下于中。因息游布。津液
流通。随时动作。效象形容。春弦秋浮。冬沉夏洪。察色观脉。大小不同。一时之间。变无经常。
尺寸参差。或短或长。上下乘错。或存或亡。病辄易改。进退低昂。心迷意惑。动失纪纲。愿为
具陈。令得分明。师曰。子之所问。道之根源。脉有三部。尺寸及关。
参。音搀。差。穿之切。为。去声。令。平声。根源者。言人之五脏六腑吉凶死生皆取决于
脉。所以为斯道之根本渊源也。孙思邈曰。从肘腕中横文至掌鱼际后文。却而十分之。而入取九
分。是为尺。从鱼际后文。却还度取十分之一。则是寸。寸十分之。而入取九分之中。则寸口也。
关界尺寸之间。古无定说。朱子曰。俗传脉诀。词最鄙浅。非叔和书明甚。乃能直指高骨为关。
似得难经本旨。然则关有定位。自脉诀始。滑氏曰。寸为阳。为上部。主头项以下至心胸之分也。
关为阴阳之中。为中部。主脐腹 胁之分也。尺为阴。为下部。主腰足胫股之分也。此寸关尺为
三部之说也。
荣卫流行。不失衡铨。（荣。当作营。见马氏素问注证发微。）
素问曰。荣者。水谷之精气也。和调于五脏。洒陈于六腑。乃能入于脉也。故循脉上下。卫者。
水谷之悍气也。其气 悍滑利。不能入于脉也。故循皮肤之中。分肉之间。难经三十难曰。人气
受于谷。谷入于胃。乃传于五脏六腑。五脏六腑。皆受于气。其清者为荣。浊者为卫。荣行脉中。
卫行脉外。灵枢同。而纪氏云。素问曰。荣者。水谷之精气则清。卫者。水谷之悍气则浊。精气入
于脉中则浊。悍气行于脉外则清。然则三经之文虽少别。而其旨则同。清浊之分虽殊。而其为气则一。
夫荣卫之为荣卫如此。然三十二难又曰。心者血。肺者气。血为荣。气为卫。荣行脉中。卫在脉外。行中行外虽同。
而荣则又以血言。言心肺而不言水谷。故王氏曰。清者。体之上也。阳也。火也。离中之一阴降。
故午后一阴生。即心之生血也。故曰清气为荣。浊者体之下也。阴也。水也。坎中之一阳升。即
肾之生气也。故曰。浊气为卫。滑氏曰。以用而言。则清气为荣者。浊中之清者也。浊气为卫者。
清中之浊者也。以体而言。则清之用。不离乎浊之体。浊之用。不离乎清之体。故谓清气为荣。
浊气为卫。亦可也。谓荣浊卫清。亦可也。又曰。统而言之。则荣卫皆水谷之气所为。故悉以气
言可也。析而言之。则
血为荣。气为冲。固自有分矣。是故荣行脉中。卫行脉外。犹水泽之于川浍。风云之于太虚也。
合经传而观之。则荣卫之在人身。可以性能言。而不可以色象求。荣行脉中。卫行脉外。盖亦以
其分体分用者之大端言也。会其极而言之。其犹氤氲之在天地与。衡铨称其喻平准也。
肾沉。心洪。肺浮。肝弦。此自经常。不失铢分。
铢。音殊。肾为水脏。水性就下。故其脉循骨而沉。心为火脏而合血脉。故其脉洪。洪。犹
洪水之洪。大而有波澜之谓也。肺为金脏而合皮毛。金得五行之清。其脉故浮。肝为木脏。木性
曲直。其脉循筋而行。故弦。经。正也。常。久也。亦经也。言平人之脉。以如此合四时为正。
通常而可久也。说文十黍之重曰铢。六铢为一分。盖指脉之以三菽六菽约轻重而言也。然言四脏
而不言脾者。脾之和平不可得见。故其经常不可言。欲人当自推也。
出入升降。漏刻周旋。水下二刻。一周循环。
出而升。气之上。来也。入而降。气之下。去也。漏刻。以一日一夜漏水下百刻而言也。周
旋。以周身之流行旋转而言也。下二句乃申上文而详言之也。滑氏曰。内经平人气象论云。人一
呼。脉再动。一吸。脉再动。呼吸定急。脉五动。闰以太息。命曰平人。故平人一呼。脉行三寸。
一吸。脉行三寸。呼吸定息脉行六寸。以呼吸之数言之。一日一夜。凡一万三千五百息。每刻一
百三十五息。每二刻二百七十息。脉行一十六丈二尺。为一周身也。积而盈之。每时八刻。计一
千八十息。脉行六十四丈八尺。荣卫四周于身。十二时九十六刻。计一万二千九百六十息。脉行
七百七十七丈六尺。为四十八周身。刻之余分得五百四十息。脉分行二周身。得三十二丈四尺。
合一万三千五百四十息。总之为五十度周身。脉得八百
一十丈也。此呼吸之息。脉行之数。周身之度。合昼夜百刻之详也。
当复寸口。虚实见焉。
见。音现。滑氏曰。寸口。谓气口也。居手太阴鱼际。却行一寸之分。气口之下。曰关曰尺
云者。皆手太阴所历之处。而手太阴又为百脉流注朝会之始也。此承上文而言。脉行周身五十度。
又当复始于寸口。所以谓之循环也。虚实见下。
变化相乘。阴阳相干。风则浮虚。寒则牢坚。沉潜水蓄。支饮急弦。动则为痛。数则热烦。
凡脉言数。皆音朔。此承上文而言。虚实所见之目。病脉之大端也。乘。因也。干。犯也。
言脉之变化相因而乘。由阴阳之邪相干而犯。下文乃所乘所干之目。风为阳邪。浮虚者。阳主外
也。寒为阴邪。牢坚者。阴主内也。水饮皆痰之异名。以其聚于内。故曰水蓄。沉潜内伏也。以
其薄于外。故曰支饮。急弦外暴也。浮沉牢弦。皆脉名。虚坚潜急。非脉名也。乃形容。惟
其浮则虚弱。牢则坚强。沉所以潜。弦所以急之谓也。动阴阳相搏而然也。搏聚不散。所以痛也。
数。急疾也。阳盛则数。所以热烦也。
设有不应。知变所缘。三部不同。病各异端。
此言虚实之见。固有如上文所言者。然不可执一以拘。设或脉与病。有不如此而相应者。则
又当察识其别有传变之缘故。况三部所属不同。则变端亦各自有异。岂所言之数者。可以为一定
之限哉。
太过可怪。不及亦然。邪不空见。中必有奸。审察表里。三焦别焉。知其所舍。消息诊看。
料度脏腑。独见若神。为子条记。传与贤人。
见。音现。别。必列切。度。达各切。为。去声。传。如字。太过不及。总虚实而言也。怪
非常也。言二者不常见。见则当知其为怪异也。奸。伤犯也。难经曰。上焦在心下下膈。在胃上口。
主内而不出。其治在膻中玉堂下一寸六分。直两乳间陷者是。中焦者。在胃中脘。不上不下。主
腐熟水谷。其治在脐旁。下焦者。当膀胱上口。主分别清浊。主出而不内。以传道也。其治在
脐下一寸。故名三焦。舍。谓病邪客止之处所也。此条乃设问答以敷陈脉道之大概。故为首章。
以发明诊家入武之始事。此节乃总结上文以起下条。示学人当通此以达彼。因略以致详之意也。
师曰。呼吸者。脉之头也。
呼者气之出。脉之来也。吸者气之入。脉之去也。头头绪也。脉随气之出入而来去。名状虽多。
呼吸则其源头也。然脉有二。此以尺寸之脉言。若以周身言之。则循环无端。截不断。无头尾之
可言。学人当别识。脉经无吸字。
初持脉。来疾去迟。此出疾入迟。名曰内虚外实也。初持脉。来迟去疾。此出迟入疾。名曰
内实外虚也。
刘氏曰。来者。自骨肉之分。而出于皮肤之际。气之升而上也。去者。自皮肤之际。而还于
骨肉之分。气之降而下也。出。呼而来也。入。吸而去也。经曰。来者为阳。去者为阴。此之谓
也。疾即上条之太过。亦阳也。迟即上条之不及。亦阴也。然则内虚外实者。阴不及阳太过也。
内实外虚者。阴太过而阳不及也。然来去出入者。脉之大关键也。内外虚实者。病之大纲领也。
知内外之阴阳而明其孰为虚孰为实者。诊家之切要也。为此条以次首条者。示学人下手功夫之急
务也。
问曰。上工望而知之。中工问而知之。下工脉而知之。愿闻其说。师曰。病家人来请云。病
人苦发热。身体疼。病患自卧。师到。诊其脉沉而迟者。知其瘥也。何以知之。表有病者。脉当
浮大。今脉反沉迟。故知愈也。
沉迟属阴。故知表邪已解也。
假令病患云。腹内卒痛。病患自坐。师到。脉之浮而大者。知其瘥也。何以知之。若里有病
者。脉当沉而迟。今脉浮大。故知愈也。
凡假令之令。皆平声。卒。清勿切。卒痛。言仓遽作痛也。浮大属阳。故知里邪已散也。此
条上设三问。下二节苦发热。身体疼。腹内卒痛。言问。坐卧。言望。末决言知病于脉。所以示
诊家三者不可缺一之意也。
问曰。病家人来请云。病患发热烦极。明日师到。病患向壁卧。此热已去也。设令脉不和。
处言已愈。
凡设令之令。与假令之令同。处言之处。皆上声。明日到。则病有进退可知矣。故于其向壁
卧。则可以拟其安而热已去也。脉不和。言虽未至于平静。亦无躁疾之谓也。此与上条大意略同。
设令向壁卧。闻师到不惊起而 视。若三言三止。脉之咽唾者。此诈病也。设令脉自和。处
言此病大重。当须服吐下药。针灸数十百处。乃愈。
。音系。此复喻人恐足以胜诈。觉人勿售欺之意。 。恨视貌。
师持脉。病患欠者。无病也。
张口气悟为欠。然阴阳相引则欠。故无病可知也。
脉之呻者。病也。
呻。呻吟苦声。
言迟者。风也。
舌强则言迟。经络牵急则舌强。筋挛则经络拘急。肝属木。其合筋。其主风。
摇头者。里痛也。
头属阳。里属阴。头摇者。阴不与阳和也。
行迟者。表强也。
表以经络言。强以拘急言。
坐而伏者。短气也。
短气者。里不足也。
坐而下脚者。腰痛也。
下脚。欲求伸舒之意。
里物护腹如怀卵物者。心痛也。
怀卵物。犹言自冒其心之谓。此条八节。皆望而知之之事。
师曰。伏气之病。以意候之。今月之内欲有伏气。假令旧有伏气。当须脉之。若脉微弱者。
当喉中痛似伤。非喉痹也。病患云。实咽中痛。虽尔。今复欲下利。
伏气者。旧有外感。不即发而伏藏于经中之气脉也。今月之内欲有伏气。疑有错误。微弱。
少阴之脉也。少阴之脉。从肾
上贯肝膈入肺中。循喉咙。故喉中痛也。然咽痛下利皆少阴证。故病患虽言实痛。亦当知其欲自
下利也。
问曰。人病恐怖者。其脉何状。师曰。脉形如循丝。累累然。其面白。脱色也。
恐怖。惶惧也。循。理治也。丝。言细也。累累。联系貌。脱色。犹言失色也。盖内气馁者。
则外色夺。所以有卒然之变也。
问曰。人不饮。其脉何类。师曰。脉自涩。唇口干燥也。
血少则脉涩。所以唇口干燥。然此以不饮而然。非由此而不饮也。
问曰。人愧者。其脉何类。师曰。脉浮。而面色乍白乍赤。
愧。惭也。脉浮而面色乍白乍赤者。神游不定。故血气乱而变不一也。
问曰。经说脉有三菽六菽重者。何谓也。师曰。脉者。人以指按之。如三菽之重者。肺气也。
如六菽之重者。心气也。如九菽之重者。脾气也。如十二菽之重者。肝气也。按之至骨者。肾气也。
经。难经也。菽。大豆也。滑氏曰。肺最居上。主候皮毛。故其脉如三菽之重。心在肺下。
主血脉。故其脉如六菽之重。脾在心下。主肌肉。故其脉如九菽之重。肝在脾下。主筋。故其
脉如十二菽之重。肾在肝下。主骨。故其脉按之至骨。肾不言菽。以类推之。当如十五菽之重。
盖五脏以上下之次第而居。故其气之至。离皮肤有如此远近之约摸。乃越人教人如此用
指着意候按而取诊耳。轻重以下指之法言。故胡氏曰。越人云菽。大抵是个约摸的法。见得轻重
有差等。非真如菽之重也。然此条言气。难经言部。部者。一定之部位。而气在其中。气者。元气谷气
之精。而部位亦在不言之表也。虞氏有言。假令左手寸口如三菽之重得之。乃知肺气之至。如六
菽之重得之。知本经之至。虞氏以气推明越人言外之意如此。
然则此条以气言者。岂非发明难经此意于虞氏未言之先与。不然。既曰。经说不易其部字也。虽
然。难经有与皮毛相得者。与血脉相得者。与肌肉相得者。与肝平者。举指来疾者五句。在各起
句重字下。而此无之。则是难经详而此略。参看则义全。
问曰。脉有相乘。有纵有横。有逆有顺。何也。师曰。水行乘火。金行乘木。名曰纵。火行
乘水。木行乘金。名曰横。水行乘金。火行乘木。名曰逆。金行乘水。木行乘火。名曰顺也。
纵横。皆平声。乘。犹乘舟车之乘。纵。直也。横者。纵之对。顺。从也。逆者。顺之反。
水能克火而乘火。金能克木而乘木。乘其所胜。其事易直。故曰纵。火受制于水。而反乘水。木受
From this chapter onwards, all content consists of Wang Shuhe narrating Zhang Zhongjing's statements, supplemented by his own insights as commentary on the classic. This serves as an auxiliary wing (Yi), belonging to the category of transmitted commentaries. The original title of this chapter was "Ping Mai" (General Pulse Discussion). It is placed second but usurps the position of the classic text. Since a "transmission" (Zhuan) cannot precede the "classic" (Jing), there is no logic in discussing various specific pulse types before the general "Ping Mai" chapter. Moreover, the content of "Ping Mai" merely covers the preceding few lines; such a transgression of protocol must have been done for specific reasons. The subsequent sections also discuss individual pulses, so how can the entire chapter be directly named "Ping Mai"? These are clearly not Wang Shuhe's original work, and it is evident that they were arbitrarily altered by later scholars. Therefore, I have re-examined and corrected them, arranging them in the current order.
Question: There are three positions in the pulse (San Bu), where Yin and Yang interact. Ying (Nutrient Qi) and Wei (Defensive Qi), along with Blood and Qi, exist within the human body. Through respiration entering and exiting, they move up and down within. Circulating with the breath, they distribute throughout the body, allowing Body Fluids (Jin Ye) to flow smoothly. They change constantly, manifesting corresponding forms. In spring, the pulse is Wiry (Xian); in autumn, Floating (Fu); in winter, Deep (Chen); in summer, Surging (Hong). Observing complexion and pulse reveals differences in size. Within a single moment, changes are unpredictable. Cun (Inch) and Chi (Cubit) positions may vary irregularly, being either short or long. Upper and lower positions may be disordered; some pulses may appear while others vanish. Disease conditions change readily, advancing or retreating, rising or falling, causing mental confusion and loss of diagnostic principles. I wish for you to explain this in detail so that I may distinguish them clearly. Master said: What you ask concerns the root source of pulse diagnosis. The pulse has three positions: Cun (Inch), Guan (Bar), and Chi (Cubit).
Can (参), pronounced Chan. Cha (差), pronounced Chuanzhiqie. Wei (为), departing tone. Ling (令), level tone. By "root source," it means that the auspiciousness, inauspiciousness, life, and death of the Five Zang and Six Fu organs all depend on the pulse, making it the fundamental origin of this discipline. Sun Simiao said: From the transverse crease at the wrist to the distal crease behind the thenar eminence, measure one-tenth backward, and take nine parts inward; this is the Chi position. From the distal crease behind the thenar eminence, measure back one-tenth; this is the Cun position. Divide the Cun position by ten, and take nine parts inward; this is the Cun Kou (Radial Artery). The Guan position lies between Cun and Chi. In ancient times, there was no fixed theory regarding its location. Zhu Xi said: The popularly circulated "Mai Jue" (Pulse Mantra) has vulgar and shallow language, obviously not written by Wang Shuhe. However, it correctly identifies the high bone as the Guan, which seems to align with the original intent of the "Nan Jing" (Classic of Difficult Issues). If so, the Guan having a fixed position started with the "Mai Jue." Hua Shi (Hua Sui) said: Cun belongs to Yang and the upper region, governing the area from below the head and neck to the chest and heart. Guan belongs to the middle of Yin and Yang, governing the umbilical abdomen and hypochondrium. Chi belongs to Yin and the lower region, governing the waist, feet, calves, and thighs. This is the theory of the three positions: Cun, Guan, and Chi.
Ying and Wei circulate without losing their balance and measurement. (Note: "Rong" should be read as "Ying". See Ma Shi's commentary on Su Wen.)
The "Su Wen" states: Ying Qi is the essence of water and grain. It harmonizes with the Five Zang organs and spreads to the Six Fu organs, only then entering the vessels. Thus, it circulates within the vessels. Wei Qi is the fierce Qi of water and grain. Its nature is fierce, rapid, and slippery, preventing it from entering the vessels. Thus, it circulates among the skin and muscles. The "Nan Jing · Chapter 30" states: Human Qi is derived from food and drink. Food enters the Stomach, then transmits to the Five Zang and Six Fu organs, which all receive this Qi. The clear part becomes Ying, and the turbid part becomes Wei. Ying circulates within the vessels, and Wei circulates outside the vessels. The "Ling Shu" agrees. However, Ji Yun stated: The "Su Wen" says Ying is the clear essence of water and grain, while Wei is the turbid fierce Qi. Essence entering the vessels becomes turbid, while fierce Qi moving outside becomes clear. Although the texts of these three classics differ slightly, their core meaning is the same. Although the distinction between clear and turbid differs, they are essentially the same Qi. This is how Ying and Wei are defined. However, the "Nan Jing · Chapter 32" adds: The Heart governs Blood, and the Lung governs Qi. Blood is Ying, and Qi is Wei. Ying circulates within the vessels, and Wei remains outside. While the locations are the same, Ying is described in terms of Blood, mentioning Heart and Lung but not water and grain. Therefore, Wang Bing said: Clear refers to the upper body, Yang, and Fire. The Yin within Li (Fire trigram) descends, generating Yin after noon, which is the Heart generating Blood. Thus, it is said that Clear Qi becomes Ying. Turbid refers to the lower body, Yin, and Water. The Yang within Kan (Water trigram) ascends, which is the Kidney generating Qi. Thus, it is said that Turbid Qi becomes Wei. Hua Shi said: Functionally speaking, Clear Qi becoming Ying refers to the clear aspect within the turbid. Turbid Qi becoming Wei refers to the turbid aspect within the clear. Structurally speaking, the function of Clear does not depart from the substance of Turbid, and the function of Turbid does not depart from the substance of Clear. Therefore, saying Clear Qi is Ying and Turbid Qi is Wei is acceptable. Saying Ying is Turbid and Wei is Clear is also acceptable. Furthermore, generally speaking, Ying and Wei are both produced by the Qi of water and grain, so describing them all as Qi is appropriate. Analytically speaking, Blood is Ying and Qi is Wei, which naturally distinguishes them. Thus, Ying circulates within the vessels, and Wei circulates outside, just as water pools relate to streams, or wind and clouds relate to the vast sky. Viewing the classics and commentaries together, Ying and Wei in the human body can be understood through their functions and properties, not sought through visual appearances. Ying within and Wei outside describe the major distinctions in form and function. Pushing this to the extreme, they are like the primordial mist (Yin Yun) in heaven and earth. Heng Quan (balance and weight) serves as a metaphor for standard measurement.
Kidney pulse is Deep (Chen), Heart pulse is Surging (Hong), Lung pulse is Floating (Fu), Liver pulse is Wiry (Xian). These are the constant norms, lacking no hair's breadth.
Zhu (a unit of weight), pronounced Shu. The Kidney is a Water organ; Water tends downward, so its pulse follows the bones and is Deep. The Heart is a Fire organ associated with blood vessels, so its pulse is Surging. Hong implies greatness and waves, like floodwaters. The Lung is a Metal organ associated with skin and hair; Metal receives the pure Qi of the Five Elements, so its pulse is Floating. The Liver is a Wood organ; Wood has a curving and straightening nature, and its pulse follows the tendons, hence Wiry. Jing (Classic/Regular) means correct. Chang (Constant) means enduring. It also means regular. This states that the normal person's pulse conforms to the Four Seasons as the standard, being common and lasting. The "Shuo Wen" states that ten grains of millet weigh one Zhu, and six Zhu make one Fen. This refers to the pulse weight being approximately equivalent to three or six beans. However, only four organs are mentioned, excluding the Spleen, because the Spleen's peaceful state is difficult to observe, so its constants cannot be explicitly stated, requiring self-inference.
Entering and exiting, ascending and descending, rotating through the clepsydra hours. When two marks of water have passed, one complete cycle occurs.
Exiting and ascending refers to Qi moving upward, which is the arrival of the pulse. Entering and descending refers to Qi moving downward, which is the departure of the pulse. Clepsydra refers to the water clock measuring one day and night as 100 marks. Zhou Xuan refers to the circulation and rotation throughout the body. The following sentences elaborate on the previous text. Hua Shi said: The "Nei Jing · Ping Ren Qi Xiang Lun" states: In one exhalation, the pulse beats twice; in one inhalation, it beats twice. Between breaths, it beats five times, occasionally augmented by a deep sigh, called a normal person. Thus, in one exhalation, the pulse travels three cun; in one inhalation, three cun. Between breaths, it travels six cun. Calculated by breaths, in one day and night, there are 13,500 breaths. Each mark contains 135 breaths; every two marks contain 270 breaths. The pulse travels 16 zhang 2 chi, completing one full circuit of the body. Accumulating this, every eight marks (one hour) involve 1,080 breaths, and the pulse travels 64 zhang 8 chi. Ying and Wei circulate the body. In twelve double-hours (96 marks), involving 12,960 breaths, the pulse travels 777 zhang 6 chi, completing 48 circuits. The remaining fraction of marks yields 540 breaths, allowing the pulse to travel another two circuits (32 zhang 4 chi). Totaling 13,540 breaths, it completes 50 circuits, with the pulse traveling 810 zhang. This details the breath count, pulse distance, and body circuits according to the 100 marks of day and night.
One should return to examining the Cun Kou, where Deficiency (Xu) and Excess (Shi) become apparent.
Xian (appear), pronounced Xian. Hua Shi said: Cun Kou refers to Qi Kou. It is located at the radial artery near the thenar eminence, one cun proximal. Below Qi Kou are the Guan and Chi positions, all traversed by the Hand Taiyin Lung Meridian, which is the starting point for the flow and assembly of all meridians. This connects to the previous text: after the pulse circulates the body 50 times, it restarts at the Cun Kou, hence called a cycle. Deficiency and Excess are detailed below.
Changes mutually influence each other; Yin and Yang interfere. Wind results in Floating and Empty pulses; Cold results in Firm and Solid pulses. Submerged and hidden indicates Water Retention; Branch Drinking (Zhi Yin) presents with Rapid and Wiry pulses. Moving pulse indicates Pain; Rapid pulse indicates Heat and Restlessness.
Whenever the pulse is described as "Shuo" (Rapid/Frequent), it is pronounced "Shuo". This continues the discussion on the manifestations of Deficiency and Excess, outlining the main categories of pathological pulses. Cheng (multiply/influence) means due to. Gan (interfere/offend) means to violate. This means pulse changes occur sequentially due to interference by Yin-Yang pathogens. The following lists the specific interferences. Wind is a Yang pathogen; Floating and Empty indicates Yang dominates the exterior. Cold is a Yin pathogen; Firm and Solid indicates Yin dominates the interior. Water and Drink are alternative names for Phlegm. Because they accumulate internally, they are called Water Retention, presenting with submerged and hidden pulses. Because they affect the exterior, they are called Branch Drinking, presenting with rapid and wiry pulses. Floating, Deep, Firm, and Wiry are pulse names. Empty, Solid, Hidden, and Rapid are descriptors, not pulse names themselves. Floating implies emptiness; Firm implies solidity; Deep implies submersion; Wiry implies tension. A Moving pulse results from the struggle between Yin and Yang. Aggregation without dispersion causes pain. Rapid means hurried. Yang excess causes rapidity, leading to Heat and Restlessness.
If the pulse does not correspond, understand the cause of the change. The three positions differ, and diseases present differently.
This explains that while Deficiency and Excess manifest as described above, one must not adhere rigidly to rules. If the pulse and disease do not correspond as expected, one must investigate other causes of transformation. Moreover, since the three positions correspond to different areas, the variations will also differ. How can the previously mentioned patterns serve as absolute limits?
Excess is remarkable, and Deficiency is similarly so. Pathogens do not appear without cause; there must be internal damage. Examine the Interior and Exterior; distinguish the Triple Burner (San Jiao). Know where the pathogen resides, adjust your diagnosis, estimate the Zang-Fu status, and see with divine clarity. I will record this for you and pass it to worthy individuals.
Xian (see), pronounced Xian. Bie (distinguish), pronounced Bilieqie. Du (estimate), pronounced Daguo. Wei (for), departing tone. Zhuan (pass on), as written. Excess and Deficiency summarize the pulse states. Guai (strange) means unusual. Saying these are uncommon, seeing them indicates abnormality. Jian (treacherous/harmful) means injury or violation. The "Nan Jing" states: The Upper Burner is below the diaphragm, at the stomach opening, governing intake without output; treatment is at Danzhong, one inch and six fen below Yutang, in the depression between the breasts. The Middle Burner is at the Zhongwan of the stomach, neither high nor low, governing the rotting and ripening of food; treatment is beside the navel. The Lower Burner is at the bladder opening, governing the separation of clear and turbid, output without intake, transmitting waste; treatment is one cun below the navel, hence named San Jiao. She (abode) refers to the place where pathogenic factors lodge. This section uses hypothetical Q&A to outline the basics of pulse diagnosis, serving as the first chapter to introduce beginners to diagnostic methods. This paragraph summarizes the previous text to lead into the next, showing students how to extend knowledge from general to detailed.
Master said: Respiration is the head (source) of the pulse.
Exhalation is Qi leaving, and the pulse arriving. Inhalation is Qi entering, and the pulse departing. Tou (head) means origin. The pulse comes and goes with Qi. Although pulse descriptions are numerous, respiration is their source. However, there are two types of pulse discussion here; this refers to the Cun and Chi positions. Regarding the whole body, the circulation is endless, uncuttable, with no beginning or end. Students must distinguish this. The "Mai Jing" lacks the character for inhalation.
When initially holding the pulse, if the arrival is rapid and the departure is slow, this is rapid exit and slow entry, named Internal Deficiency and External Excess. If initially holding the pulse, the arrival is slow and the departure is rapid, this is slow exit and rapid entry, named Internal Excess and External Deficiency.
Liu Wu said: Arrival (Lai) is from the muscle-bone junction emerging to the skin surface, representing Qi ascending. Departure (Qu) is from the skin surface returning to the muscle-bone junction, representing Qi descending. Exit corresponds to exhalation and arrival. Entry corresponds to inhalation and departure. The Classic states: Arrival is Yang, Departure is Yin. This is what is meant. Rapid (Ji) refers to the Excess mentioned earlier, also Yang. Slow (Chi) refers to the Deficiency mentioned earlier, also Yin. Thus, Internal Deficiency and External Excess mean Yin is insufficient while Yang is excessive. Internal Excess and External Deficiency mean Yin is excessive while Yang is insufficient. Arrival and departure are the key to the pulse; Internal/External and Deficiency/Excess are the main principles of disease. Knowing the Yin-Yang of Internal/External and clarifying Deficiency/Excess is crucial for diagnosticians. This section is placed early to emphasize the urgent task for students to master basic skills.
Question: The superior doctor knows by observation, the average doctor by inquiry, and the inferior doctor by pulse. I wish to hear the explanation. Master said: A patient's family reports that the patient suffers from fever and body pain, lying down. When the doctor arrives and palpates a Deep and Slow pulse, he knows the patient will recover. Why? In exterior diseases, the pulse should be Floating and Large. Now the pulse is contrary, Deep and Slow, so recovery is known.
Deep and Slow belong to Yin, indicating the exterior pathogen has resolved.
Suppose the patient says there is sudden abdominal pain, sitting up. When the doctor arrives and finds a Floating and Large pulse, he knows the patient will recover. Why? In interior diseases, the pulse should be Deep and Slow. Now the pulse is Floating and Large, so resolution is known.
In all hypothetical cases, "Ling" is pronounced level tone. "Cu" (sudden), pronounced Qingwutie. Cu Tong means sudden pain. Floating and Large belong to Yang, indicating interior pathogens have dispersed. This section sets up three questions above; the lower two sections discuss fever/body pain and abdominal pain via inquiry, and sitting/lying via observation, finally concluding with pulse diagnosis, showing that all three methods are indispensable.
Question: A patient's family reports severe fever and restlessness. The next day, the doctor arrives, and the patient lies facing the wall. This indicates the heat has gone. Even if the pulse is not perfectly harmonious, stating recovery is appropriate.
In all hypothetical cases, "Ling" is the same as in "Jia Ling". "Chu" (place/prescribe) is pronounced rising tone. Arriving the next day allows knowing disease progression. Lying facing the wall suggests peace and resolved heat. Pulse not harmonious means not yet calm, but not frantic. This is similar to the previous section.
If the patient lies facing the wall, does not rise or look upon the doctor's arrival, speaks hesitantly (three words, three stops), and swallows saliva when the pulse is taken, this is feigned illness. Even if the pulse is harmonious, prescribe that this disease is severe, requiring emetic and purgative medicines, and dozens to hundreds of acupuncture points, for recovery.
Xi (sound), pronounced Xi. This again illustrates using fear to overcome deception, warning against being fooled. Xi (expression), means hateful gaze.
When the master holds the pulse, if the patient yawns, there is no disease.
Stretching the mouth and awakening is yawning. Yin and Yang attracting each other causes yawning, thus indicating health.
If the pulse shows groaning, there is disease.
Shen means groaning in pain.
Speaking slowly indicates Wind.
Tongue stiffness causes slow speech. Meridian tension causes tongue stiffness. Tendon spasms cause meridian constriction. The Liver belongs to Wood, governs tendons, and rules Wind.
Shaking head indicates interior pain.
Head belongs to Yang, interior to Yin. Head shaking means Yin does not harmonize with Yang.
Walking slowly indicates exterior stiffness.
Exterior refers to meridians; stiffness refers to constriction.
Sitting and bending forward indicates Shortness of Breath.
Shortness of Breath indicates interior insufficiency.
Sitting with legs hanging down indicates Waist Pain.
Lowering legs implies a desire to stretch.
Protecting the abdomen with hands as if holding an egg indicates Heart Pain.
Holding an egg implies covering the heart. These eight sections describe diagnosis by observation.
Master said: Diseases of Latent Qi (Fu Qi) are anticipated by intuition. If latent Qi arises within this month, or if there is pre-existing latent Qi, the pulse must be examined. If the pulse is Weak and Fine, there should be throat pain resembling injury, but it is not Hou Bi (throat obstruction). The patient claims severe throat pain. Even so, diarrhea is likely to follow.
Latent Qi refers to external pathogens that do not immediately manifest but hide within the meridians. "Arising within this month" may be an error. Weak and Fine is the pulse of Shaoyin. The Shaoyin meridian rises from the Kidney, passes through the Liver and Diaphragm into the Lung, and follows the throat, causing throat pain. Throat pain and diarrhea are both Shaoyin syndromes; thus, even if the patient claims severe pain, diarrhea is expected.
Question: What is the pulse shape in people suffering from terror? Master said: The pulse feels like tracing silk, continuous and fine. The complexion is pale, losing color.
Terror means fear. Xun means texture. Silk means fine. Lei Lei means connected appearance. Tuo Se means losing color. Internal Qi deficiency leads to external color loss, causing sudden changes.
Question: What is the pulse in people who do not drink? Master said: The pulse is naturally Choppy (Se), with dry lips and mouth.
Blood deficiency causes Choppy pulses, leading to dry lips and mouth. However, this is due to lack of drinking, not necessarily pathology causing lack of drinking.
Question: What is the pulse in ashamed people? Master said: The pulse is Floating, and the complexion alternates between white and red.
Kui means shame. Floating pulse with alternating complexion indicates unsettled Spirit, causing chaotic Qi and Blood and variable changes.
Question: The Classic mentions pulse weights of three and six beans. What does this mean? Master said: When pressing the pulse with fingers, a weight equivalent to three beans indicates Lung Qi. Six beans indicate Heart Qi. Nine beans indicate Spleen Qi. Twelve beans indicate Liver Qi. Pressing to the bone indicates Kidney Qi.
Jing refers to the "Nan Jing". Shu means soybean. Hua Shi said: The Lung is highest, governing skin and hair, so its pulse is light like three beans. The Heart is below the Lung, governing blood vessels, so its pulse is like six beans. The Spleen is below the Heart, governing muscles, so its pulse is like nine beans. The Liver is below the Spleen, governing tendons, so its pulse is like twelve beans. The Kidney is below the Liver, governing bones, so its pulse requires pressing to the bone. The Kidney does not use bean weights; by analogy, it would be fifteen beans. The Five Zang are arranged vertically, so their Qi reaches the surface at varying depths. Yuè Rén (Qin Yue-ren) taught this method of finger pressure. Hu Shi said: Yuè Rén's reference to beans is an approximation to show gradations of weight, not literal bean weights. This section discusses Qi, while "Nan Jing" discusses Positions (Bu). Position is a fixed location containing Qi. Qi is the essence of Yuan Qi and Grain Qi, and position is implicit. Yu Shi said: If the left Cun Kou feels like three beans, it is Lung Qi reaching. If six beans, it is the meridian Qi reaching. Yu Shi explained Yuè Rén's implied meaning through Qi. Does this section clarify "Nan Jing" before Yu Shi? Otherwise, the Classic does not change the word "Position". Although "Nan Jing" mentions connections to skin, blood vessels, muscles, Liver, and rapid movement under the finger, this text omits them. Thus, "Nan Jing" is detailed, and this text is brief; consulting both provides complete meaning.
Question: Pulses influence each other. There are Zong (Vertical/Unrestrained), Heng (Horizontal/Rebellious), Ni (Reverse), and Shun (Smooth). What are these? Master said: Water influencing Fire, and Metal influencing Wood, are called Zong. Fire influencing Water, and Wood influencing Metal, are called Heng. Water influencing Metal, and Fire influencing Wood, are called Ni. Metal influencing Water, and Wood influencing Fire, are called Shun.
Zong and Heng are pronounced level tone. Cheng (influence/multiply) is like riding a vehicle. Zong means direct. Heng is opposite to Zong. Shun means following. Ni is opposite to Shun. Water conquers Fire and influences Fire; Metal conquers Wood and influences Wood. Influencing the conquered element is direct and easy, hence Zong. Fire is controlled by Water but counter-influences Water; Wood is controlled by Metal but counter-influences Metal...