皆属于火。诸胀腹大，皆属于热。诸躁狂越，皆属于火。诸暴强直，皆属于风。诸病有声，
鼓之如鼓，皆属于热。诸病 肿，疼酸惊骇，皆属于火。诸转反戾，水液混浊，皆属于
热。诸病水液，澄彻清冷，皆属于寒。诸呕吐酸，暴注下迫，皆属于热。故《大要》曰∶谨
守病机，各司其属，有者求之，无者求之，盛者责之，虚者责之，必先五胜，疏其血气，令
其调达，而致和平，此之谓也。（《至真要大论》）
上病机一十九条，实察病之要旨。而“有者求之，无者求之，盛者责之，虚者责之”一
十六字，乃答篇首盛者泻之，虚者补之之旨，而总结病机一十九条之义，又其要旨中之要旨
也。河间《原病式》但用病机一十九条立言，而遗此一十六字，犹有舟，无操舟之工；有兵
，无将兵之帅，不免临病之际，汤剂误投，致人夭折。今负 逾，引经传之旨，证其得失，
其补大矣。夫诸风病，皆属于肝也。风木盛，则肝太过，而病化风，如木太过，发生之纪，
病掉眩之类，俗谓之阳 、急惊等病，治以凉剂是也。燥金胜，则肝为邪攻而病亦化风
，如阳明司天，燥气下临，病掉振之类，俗谓之阴 、慢惊等病，治以温剂是也。诸火
热病，皆属于心也，热甚，则心太过，而病化火热，如岁火太过，病谵妄狂越之类，俗谓之
阳躁谵语等病，治以攻剂是也。寒水胜，则心为邪攻，而病亦化火热，如岁水太过，病躁悸
烦心谵妄之类，俗谓之阴躁郑声等病，治以补剂是也。诸湿病皆属于脾也，湿土甚，则脾太
过，而病化湿，如湿胜则濡泄之类，仲景用五苓等剂去湿是也。风木胜，则脾为邪攻，而病
亦化湿，如岁木太过，病飧泄之类，钱氏用宣风等剂去风是也。诸气 郁，皆属于肺也
，燥金甚，则肺太过，而病化 郁，如岁金太过，甚则喘咳之类，东垣谓之寒喘，治以
热剂是也。火热胜，则肺为邪攻，而病亦化 郁，如岁火太过，病咳喘之类，东垣谓之
热喘，治以寒剂是也。诸寒病皆属于肾也，寒水甚，则肾太过，而病化寒，如太阳所至为屈
伸不利之类，仲景用乌头汤等剂是也。湿土气胜，肾为邪攻，而病亦化寒，如湿气变物，病
筋脉不利之类，东垣用复煎散、健步丸等剂是也。其在太过而化之病为盛，盛者真气也，其
在受攻而化之病为虚，虚者假气也。故有其病化者，恐其气之假，故有者亦必求之无，其病
化者恐其邪隐于中，如寒胜化火之类，故无者亦必求之。其病之化似盛者，恐其盛之未的，
故盛者亦必责之，其病之化似虚者，恐其虚之未真，故虚者亦必责之。凡一十九条病机，皆
用此一十六字为法求之，庶几补泻不瘥也。今河间损此一十六字，但以病化有者为盛，无者
为虚，而不复究其假者虚者为未备，此实智者之一失也。
〔《素》〕五气所病，心为噫，肺为咳，肝为语，脾为吞，肾为欠为嚏，胃为气逆为哕为
恐，大肠小肠为泄，下焦溢为水，膀胱不利为癃，不约为遗溺，胆为怒，是为五病。（《宣
明五气论》）
色味当五脏，白当肺辛，赤当心苦，青当肝酸，黄当脾甘，黑当肾咸。故白当皮，赤当
脉，青当筋，黄当肉，黑当骨。（《五脏生成篇》）
〔《灵》〕目赤色者病在心，白在肺，青在肝，黄在脾，黑在肾，黄色不可名者，病在胸
中。（《论疾诊尺篇》）
〔《素》〕五脉应象，肝为弦，心脉钩（《难经》改钩作大），脾脉代（《难经》改代作缓）
，肺脉毛（《难经》改毛作涩），肾脉石（《难经》改石作沉）。
〔《灵》〕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，反得相胜之脉，则死矣。得其相生之脉，则病已矣。（《邪
气脏腑病形篇》）
〔《难》〕经言见其色而不得其脉，反得相胜之脉者，即死，得相生之脉者，病即自已，
色之与脉，当参相应，为之奈何？然，五脏有五色，皆见于面，亦当于寸口尺内相应。假令
色青，其脉当弦而急；色赤，其脉浮大而散；色黄，其脉中缓而大；色白，其脉浮涩而短；
色黑，其脉沉濡而滑，此所谓五色之与脉当参相应也。脉数，尺之皮肤亦数；脉急，尺之皮
肤亦急；脉缓，尺之皮肤亦缓；脉涩，尺之皮肤亦涩；脉滑，尺之皮肤亦滑。五脏各有声色
臭味，当于寸口尺内相应，其不相应者病也。假令色青其脉浮涩而短，若大而缓为相胜；浮
大而散，若小而滑为相生也（《十三难》）。假令得肝脉，其外证善洁，面青善怒，其内证脐
左有动气，按之牢若痛，其病四肢满闭，淋溲便难转筋，有是者，肝也，无是者，非也。假
令得心脉，其外证面赤，口干，善笑，其内证脐上有动气，按之牢若痛，其病烦心心痛，掌
中热而 ，有是者心也，无是者，非也（ ，之曰切）。假令得脾脉，其外证面黄
善噫善思善味，其内证当脐上有动气，按之牢若痛，其病腹胀满，食不消，体重节痛，怠堕
嗜卧，四肢不收，有是者，脾也，无是者，非也。假令得肺脉，其外证面白善嚏，悲愁不乐
欲哭，其内证脐右有动气，按之牢若痛，其病喘咳，洒淅寒热，有是者，肺也，无是者，非
也。假令得肾脉，其外证面黑，善恐数欠，其内证脐下有动气，按之牢若痛，其病逆气，小
腹急痛，泄如下重，足胫寒而逆，有是者，肾也，无是者，非也。（《十六难》）
\r海藏四正脉伤之图\ps91a1.bmp\r
（有正经自病，有五邪相干，以上经文，皆诊正经自病，其五邪相干诊法，附在治法门。
〔海藏〕∶相合脉变（脉之相合，各有虚实，不可作一体观之）。假令洪、弦相合，洪客弦主
也。子能令母实也。弦、洪相合，弦客洪主也，母能令子虚也（洪、弦相合见于春，为子能
令母实也，弦、洪相合见于夏，为母能令子虚也。又如沉、涩相合见于秋，亦子能令母实也
，涩、沉相合见于冬，亦母能令子虚也，余皆仿此）。至于手足之经亦相合。假令伤寒膀胱
脉浮坚而洪者，即手足经合也（余仿此）。
〔海〕脉不胜者，挟其子之势也。脉弦而入金之分，非火之势则不敢侵金之分。弦而带数
，甲经于申也。紧而带洪，壬经于丙也。
〔《素》〕五病所发，阴病发于骨，阳病发于血，阴病发于肉，阳病发于冬，阴病发于夏
，是五发也。五邪所乱，凡邪入于阳则狂，邪入于阴则痹，搏阳则为癫疾，搏阴则为喑，阳
入之阴则静，阴出之阳则怒，是为五乱。（《宣明五气篇》）
〔《难》〕脉有阴阳之法，何谓也？然，呼出心与肺，吸入肾与肝，呼吸之间，脾受谷味
也，其脉在中。浮者，阳也，沉者，阴也，故曰阴阳也。心肺俱浮，何以别之？然，浮而大
散者，心也。浮而短涩者，肺也。肾肝俱沉，何以别之？然，牢而长者，肝也。按之濡，举
指来实者，肾也。脾者中州，故其脉在中，是阴阳之法也（《四难》）。脉有轻重，何谓也？
然，初持脉，如三菽之重，与皮毛相得者，肺部也。如六菽之重，与血脉相得者，心部也。
如九菽之重，与肌肉相得者，脾部也。如十二菽之重，与筋平者，肝部也。按之至骨，举指
来疾者，肾部也。故曰轻重也。（《五难》）
上以脉之轻重候五脏。
〔《素》〕尺内两傍，则季胁也。尺外以候肾，尺里以候腹（两尺脉也。《脉经》左尺脉
以候肾膀胱，右尺脉以候命门三焦。凡言外者皆指臂之外侧，凡言内者皆指近臂筋也）。中
附上，左外以候肝，内以候膈（左关脉也。《脉经》左关脉以候肝胆）。右外以候胃，内以候
脾（右关脉也。《脉经》右关脉候脾胃，与经文同）。上附上，右外以候肺，内以候胸中（右
寸脉也。《脉经》右寸脉以候肺大肠）。左外以候心，内以候膻中（左寸脉也。《脉经》左寸
脉以候心小肠）。前以候前，后以候后。上竟上者，胸喉中事也。下竟下者，少腹腰股膝胫
足中事也。（《脉要精微论》）
《内经》以寸关尺脉候脏腑者，止于如此，至《难经》始定寸、关、尺为三部，浮、中
、沉为九候，至后世但诊寸、关、尺之三部，湮晦其足手面之三部，为大失也。
无择∶心部在左手寸口，属手少阴经，与小肠手太阳经合。肝部在左手关上，属足厥阴
经，与胆足少阳经合。肾部在左手关后尺中，属足少阴经，与膀胱足太阳经合。肺部在右手
关前寸口，属手太阴经，与大肠手阳明经合。脾部在右手关上，属足太阴经，与胃足阳明经
合。右肾部在右手尺中，属手厥阴心包络，与三焦手少阳经合。
〔《难》〕脉有三部，部有四经，手有太阴、阳明，足有太阳、少阴，为上下部，何谓也
？然，手太阴、阳明金也，足太阳、少阴水也，金生水，水流下行而不能上，故在下部也。
足厥阴、少阳木也，生手太阳少阴火，火炎上行而不能下，故为上部。手心主少阳火，生足
太阴、阳明土，土主中宫，故在中部也。此皆五行子母更相生养者也。（《十八难》）
〔东垣〕两手搀抄于前，俱仰其手掌，左手居外，右手居里，则木、火、土、金、水五行
相序，而经纶四时之令无差忒矣。《六微旨大论》曰∶显明之右，君火之位也。君火之右，
退行一步，相火治之；复行一步，土气治之；复行一步，金气治之；复行一步，水气治之；
复行一步，木气治之；复行一步，君火治之，是次列五行相生之理也。
〔《素》〕帝曰∶何谓三部？岐伯曰∶有下部，有中部，有上部，部各有三候。三候者，
有天，有地，有人也。必指而导之，乃以为真。上部天，两额之动脉（王注云∶在额两傍动
脉应手是也）。上部地，两颊之动脉（王注云∶在鼻孔下两傍近于巨 之分动脉应手）。
上部人，耳前之动脉（王注云∶在耳前陷者中动应于手是也）。中部天，手太阴也（王注云∶
在掌后寸口中，是谓经渠动脉应手）。中部地，手阳明也（王注云∶在手大指次指岐骨间，
合谷之分动应于手）。中部人，手少阴也（谓掌后锐骨之端，神门之分）。下部天，足厥阴也（
王注云∶在足大指本节后二寸陷中，太冲之分）。下部地，足少阴也（王注云∶在足内踝后跟
骨上陷中，太溪之分，动应于手）。下部人，足太阴也（王注云∶在鱼腹上越筋间直五里下，
箕门之分，沉取动应于手。候胃气者当取足跗之上，冲阳之分，动应于手是也）。故下部之
天以候肝，地以候肾，人以候脾胃之气。中部天以候肺，地以候胸中之气，人以候心。上部
天以候头角之气，地以候口齿之气，人以候耳目之气。九候之相应也，上下若一，不得相失
，一候后则病，二候后则病甚，三候后则病危，所谓后者，应不俱也（王注曰∶“俱”犹“同”也）。
\r搀抄两手六脉五行相生之图\ps91a2.bmp\r
手心主少阳火，生足太阴阳明土。足太阴阳明土，生手太阴阳明金。手太阴阳明金，生足
太阳少阴水。足太阳少阴水，水流下而不能上，生足厥阴少阳木。足厥阴少阳木，生手太阳
少阴火。手太阳少阴火，炎上行而不能下，生手心主少阳火。
三部九候皆相失者，死，上下左右之脉相应如参舂者，病甚，上下左右相失不可数者，
死。中部之候虽独调，与众脏相失者，死。察九候独小者，病；独大者，病；独疾者，病；
独迟者，病；独热者，病；独寒者，病；独陷下者，病。（以上并《三部九候论》）
上以三部九候候五脏。
〔《灵》〕庭者，首面也。关上者，咽喉也。阙中者，肺也。下极者，心也。直下者，肝
也。肝左者，胆也。下者，脾也。方上者，胃也。中央者，大肠也。挟大肠者，肾也。当肾
者，脐也。面王以上者，小肠也。面王以下者，膀胱子处也。颧者，肩也。颧后者，臂也。
臂下者，手也。目内 上者，膺乳也。挟绳而上者，背也。循牙车以下者，股也。中央者，
膝也。膝以下者，胫也。当胫以下者，足也。巨分者，股里也。巨屈者，膝膑也。此五脏六
腑肢节之部也（庭者，额中也。关中者，两眉之间也。下极者，两目之间也。直下者，两鼻
而下也。方者，鼻隧也。面王者，鼻柱之端也。盖自额而下阙上属首咽喉之部分也，自阙中
循鼻而下鼻端属肺、心、肝、脾、肾五脏之部分也，自目内 挟鼻而下至承浆属胆、胃、大
肠、小肠、膀胱六腑之部分也，自颧而下颊则属肩臂手之部分也，自牙车而斜下颐属股膝胫
足之部分也。经云∶五脏次于中央，六腑挟其两侧，首面上于阳庭，王宫在于下极者，正谓
此也）。各有部分。有部分，用阴和阳，用阳和阴，当明部分，万举万当，能别左右，是谓
大道，男女异位，故曰阴阳。审察泽夭，谓之良工。沉浊为内，浮泽为外，黄赤为风，青黑
为痛，白为寒，黄而膏润为脓，赤甚者为血，痛甚为挛，寒甚为皮不仁，五色各见其部，察
其浮沉以知浅深，察其泽夭以观成败，察其散搏以知远近，视色上下以知病处，积神于心以
(Original text from *Suwen: Zhenshi Yao Dalun*): All conditions belong to Fire. All distensions and abdominal enlargement belong to Heat. All restlessness, mania, and loss of control belong to Fire. All sudden stiffness and rigidity belong to Wind. All conditions accompanied by sounds, where percussion of the abdomen produces a drum-like sound, belong to Heat. All conditions presenting with swelling, pain, soreness, fright, and alarm belong to Fire. All tendon conversions and reverse twisting, along with turbid body fluids, belong to Heat. All conditions involving body fluids that are clear, transparent, and cold belong to Cold. All vomiting of sour fluid, sudden diarrhea with tenesmus, belong to Heat. Therefore, the *Da Yao* states: Carefully observe the pathogenesis (bingji), assign each to its corresponding category; for existing symptoms, seek their cause; for absent symptoms, seek their potential origin; for excess conditions, investigate the source of excess; for deficiency conditions, investigate the source of deficiency. First, one must understand the winning and losing cycles of the Five Zang organs, unblock the Qi and Blood, ensure their smooth flow and distribution, thereby achieving harmony and peace. This is what is meant. (From *Suwen: Zhenshi Yao Dalun*)
The above nineteen items of pathogenesis truly represent the essence of disease examination. The sixteen characters "for existing symptoms, seek their cause; for absent symptoms, seek their potential origin; for excess conditions, investigate the source of excess; for deficiency conditions, investigate the source of deficiency" answer the principle stated at the beginning of the chapter regarding "draining excess and tonifying deficiency," and summarize the meaning of the nineteen items of pathogenesis. They are the essence within the essence. Liu Hejian, in his *Yuan Bing Shi*, established his theory solely based on the nineteen items of pathogenesis but omitted these sixteen characters. This is like having a boat but no boatman; having an army but no general. It inevitably leads to misprescription of decoctions when facing diseases, resulting in premature death. Now, I cite the principles of classic texts to verify the gains and losses, which provides a significant supplement.
All wind-related diseases belong to the Liver. When Wind-Wood Qi is excessive, Liver Qi becomes hyperactive, transforming into Wind pathology, such as tremors and dizziness seen in the "Year of Excessive Fire Generation." Commonly known as Yang Epilepsy or Acute Convulsion, it is treated with cooling agents. When Dryness-Metal Qi prevails, the Liver is attacked by pathogenic factors, also transforming into Wind pathology, such as tremors and shaking seen when Yangming governs the year and Dryness descends. Commonly known as Yin Epilepsy or Chronic Convulsion, it is treated with warming agents.
All fire-heat diseases belong to the Heart. When Heat is severe, Heart Qi becomes hyperactive, transforming into Fire-Heat pathology, such as delirium and mania seen in years of excessive Fire. Commonly known as Yang Restlessness or Delirious Speech, it is treated with purgative agents. When Cold-Water Qi prevails, the Heart is attacked by pathogenic factors, also transforming into Fire-Heat pathology, such as irritability, palpitations, vexation, and delirium seen in years of excessive Water. Commonly known as Yin Restlessness or Zhengsheng (mumbling), it is treated with tonifying agents.
All dampness diseases belong to the Spleen. When Damp-Earth Qi is excessive, Spleen Qi becomes hyperactive, transforming into Dampness pathology, such as loose stools caused by Dampness excess. Zhang Zhongjing used formulas like Wuling San to drain Dampness. When Wind-Wood Qi prevails, the Spleen is attacked by pathogenic factors, also transforming into Dampness pathology, such as undigested food in stool (Sunxie) seen in years of excessive Wood. Qian Yi used formulas like Xuanfeng San to expel Wind.
All Qi stagnation diseases belong to the Lung. When Dryness-Metal Qi is excessive, Lung Qi becomes hyperactive, transforming into Qi Stagnation pathology, such as wheezing and cough seen in years of excessive Metal. Li Dongyuan called this Cold Asthma, treated with hot agents. When Fire-Heat Qi prevails, the Lung is attacked by pathogenic factors, also transforming into Qi Stagnation pathology, such as cough and asthma seen in years of excessive Fire. Li Dongyuan called this Heat Asthma, treated with cold agents.
All cold diseases belong to the Kidney. When Cold-Water Qi is excessive, Kidney Qi becomes hyperactive, transforming into Cold pathology, such as difficulty in flexion and extension seen when Taiyang Qi arrives. Zhang Zhongjing used formulas like Wutou Tang. When Damp-Earth Qi prevails, the Kidney is attacked by pathogenic factors, also transforming into Cold pathology, such as tendon and vessel dysfunction caused by Dampness changes. Li Dongyuan used formulas like Fujian San and Jianbu Wan.
Diseases transformed due to excessive original Qi are considered "Excess," representing true Qi. Diseases transformed due to attack by pathogenic factors are considered "Deficiency," representing false Qi. Therefore, for conditions with transformation, fearing the Qi is false, even if symptoms exist, one must seek their absence (underlying nature). For pathological transformations, fearing pathogens are hidden internally, such as Cold transforming into Fire, even if symptoms seem absent, one must seek their presence. For transformations resembling Excess, fearing the Excess is not definitive, one must scrutinize the Excess. For transformations resembling Deficiency, fearing the Deficiency is not genuine, one must scrutinize the Deficiency. All nineteen items of pathogenesis use these sixteen characters as the method of inquiry, ensuring that tonification and drainage are not erroneous. However, Hejian lost these sixteen characters, simply considering transformed existence as Excess and non-existence as Deficiency, without further investigating whether the false is deficient or incomplete aspects. This is indeed a lapse by a wise person.
[*Suwen*]: Diseases caused by the Five Qi: The Heart causes belching, the Lung causes coughing, the Liver causes talking excessively, the Spleen causes swallowing movements, the Kidney causes yawning and sneezing, the Stomach causes Qi rebellion, hiccups, and fear, the Large and Small Intestines cause diarrhea, the Lower Jiao overflow causes edema, Bladder dysfunction causes strangury, lack of restraint causes enuresis, and the Gallbladder causes anger. These are called the Five Diseases. (From *Suwen: Xuanming Wuqi Lun*)
Colors and flavors correspond to the Five Zang: White corresponds to the Lung and Pungent flavor; Red corresponds to the Heart and Bitter flavor; Green/Blue corresponds to the Liver and Sour flavor; Yellow corresponds to the Spleen and Sweet flavor; Black corresponds to the Kidney and Salty flavor. Thus, White corresponds to skin, Red to vessels, Green/Blue to tendons, Yellow to flesh, and Black to bones. (From *Suwen: Wuzang Shengcheng Pian*)
[*LingShu*]: Red eyes indicate disease in the Heart; white complexion indicates disease in the Lung; green/blue complexion indicates disease in the Liver; yellow complexion indicates disease in the Spleen; black complexion indicates disease in the Kidney; yellow color that cannot be clearly named indicates disease in the Chest Center. (From *LingShu: Lun Ji Zhen Chi Pian*)
[*Suwen*]: The five pulse images correspond to the Zang organs: Liver pulse is Wiry (Xian); Heart pulse is Hooked (Gou) (*Nanjing* changes Gou to Da); Spleen pulse is Intermitting (Dai) (*Nanjing* changes Dai to Huan); Lung pulse is Feather-like (Mao) (*Nanjing* changes Mao to Se); Kidney pulse is Stone-like (Shi) (*Nanjing* changes Shi to Chen).
[*LingShu*]: Those with a green/blue complexion have a Wiry pulse. Those with a red complexion have a Hooked pulse. Those with a yellow complexion have an Intermitting pulse. Those with a white complexion have a Feather-like pulse. Those with a black complexion have a Stone-like pulse. If the complexion is seen but the corresponding pulse is not obtained, and instead a controlling (overcoming) pulse is found, death will occur. If a generating pulse is found, the disease will heal. (From *LingShu: Xieqi Zangfu Bingxing Pian*)
[*Nanjing*]: The classic states that seeing the complexion but not obtaining the corresponding pulse, and instead finding a controlling pulse, leads to death; finding a generating pulse means the disease heals naturally. How should color and pulse be correlated? The response is: The Five Zang have five colors, all manifesting on the face, and should also correspond at the Cun Kou and Chi positions. For example, if the complexion is green, the pulse should be Wiry and rapid; if red, Floating, Large, and Scattered; if yellow, Moderate, Slow, and Large; if white, Floating, Rough, and Short; if black, Deep, Soft, and Slippery. This is what is meant by the correlation of the five colors and pulses. A rapid pulse corresponds to warm/twitching skin at the Chi position; a tense pulse corresponds to tight skin; a slow pulse corresponds to relaxed skin; a rough pulse corresponds to rough skin; a slippery pulse corresponds to smooth skin. Each Zang has specific sounds, colors, smells, and tastes that should correspond at the Cun Kou and Chi positions; non-correspondence indicates disease. For instance, if the complexion is green but the pulse is Floating, Rough, and Short, or Large and Slow, it indicates a controlling relationship; if Floating, Large, and Scattered, or Small and Slippery, it indicates a generating relationship. (From *Nanjing: Nan 13*)
If the Liver pulse is obtained, external signs include cleanliness preference, green complexion, and irritability; internal signs include pulsation at the left of the umbilicus, firm and painful upon pressure; symptoms include fullness and closure of the four limbs, difficult urination and defecation, and tendon convulsions. Presence of these indicates Liver disease; absence indicates otherwise.
If the Heart pulse is obtained, external signs include red complexion, dry mouth, and excessive laughter; internal signs include pulsation above the umbilicus, firm and painful upon pressure; symptoms include vexation, heart pain, and heat/burning in the palms. Presence indicates Heart disease; absence indicates otherwise.
If the Spleen pulse is obtained, external signs include yellow complexion, frequent belching, excessive thinking, and keen taste; internal signs include pulsation at the umbilicus, firm and painful upon pressure; symptoms include abdominal fullness, indigestion, heavy body and joint pain, lethargy, and inability to move the limbs. Presence indicates Spleen disease; absence indicates otherwise.
If the Lung pulse is obtained, external signs include white complexion, frequent sneezing, sadness, and desire to cry; internal signs include pulsation at the right of the umbilicus, firm and painful upon pressure; symptoms include asthma, cough, chills, and fever. Presence indicates Lung disease; absence indicates otherwise.
If the Kidney pulse is obtained, external signs include black complexion, frequent fear, and yawning; internal signs include pulsation below the umbilicus, firm and painful upon pressure; symptoms include rebellious Qi, acute lower abdominal pain, diarrhea with a sense of heaviness in the anus, and cold/reversal in the calves and feet. Presence indicates Kidney disease; absence indicates otherwise. (From *Nanjing: Nan 16*)
[Image: Hai Zang's Diagram of Four Correct Pulses Damaged]
(There are self-diseases of the regular meridians and interference from the Five Pathogens. The above texts diagnose self-diseases of the regular meridians; the diagnostic methods for interference from the Five Pathogens are attached to the treatment section.)
[Hai Zang]: Combined Pulse Variations (Pulse combinations have their own excess and deficiency, and should not be viewed as a single entity). For example, if Hong (Surging) and Xian (Wiry) combine, if Hong is the guest and Xian is the host, it represents "Child makes Mother Excess." If Xian is the guest and Hong is the host, it represents "Mother makes Child Deficient." (Hong-Xian combination in Spring indicates Child makes Mother Excess; Xian-Hong combination in Summer indicates Mother makes Child Deficient. Similarly, Shen-Sè combination in Autumn indicates Child makes Mother Excess; Se-Shen combination in Winter indicates Mother makes Child Deficient. Others follow this pattern). Hand and foot meridians also combine. For example, in Shanghan, if the Bladder pulse is Floating, Firm, and Hong, it indicates hand-foot meridian combination.
[Hai Zang]: Pulses that do not overcome are supported by the momentum of their Child element. A Wiry pulse entering the Metal sector implies Fire momentum invading Metal. Wiry with Rapid indicates Jia Meridian at Shen hour. Tight with Surging indicates Ren Meridian at Bing hour.
[*Suwen*]: Emission of the Five Diseases: Yin diseases emit from bone, Yang diseases emit from blood, Yin diseases emit from flesh, Yang diseases emit in Winter, Yin diseases emit in Summer. These are the Five Emissions. Disturbance by the Five Pathogens: Pathogens entering Yang cause madness; entering Yin cause Bi syndrome; combing with Yang causes Epilepsy; combing with Yin causes aphonia; Yang entering Yin causes quietness; Yin exiting Yang causes anger. These are the Five Disturbances. (From *Suwen: Xuanming Wuqi Pian*)
[*Nanjing*]: What is the method of Yin and Yang in pulses? Response: Exhalation relates to Heart and Lung; inhalation relates to Kidney and Liver. Between breaths, the Spleen receives grain essence, and its pulse is in the middle. Floating pulses are Yang; Sunken pulses are Yin. How to distinguish Heart and Lung, both Floating? Floating and Large/Scattered is Heart; Floating and Short/Rough is Lung. How to distinguish Kidney and Liver, both Sunken? Firm and Long is Liver; Soft upon pressing but solid upon lifting is Kidney. Spleen is in the Central Province, so its pulse is in the middle. This is the method of Yin and Yang. (From *Nanjing: Nan 4*)
What is the weight of pulses? Response: Initially holding the pulse with the weight of three beans, touching the skin and hair, indicates the Lung area. With the weight of six beans, touching the blood vessels, indicates the Heart area. With the weight of nine beans, touching the muscles, indicates the Spleen area. With the weight of twelve beans, level with the tendons, indicates the Liver area. Pressing to the bone, with a rapid return upon lifting, indicates the Kidney area. This is called weight. (From *Nanjing: Nan 5*)
The above uses pulse weight to examine the Five Zang.
[*Suwen*]: The inner sides of the Chi region correspond to the hypochondrium. The outer side of Chi examines the Kidney; the inner side examines the abdomen. Mid-region connecting up: Left outer examines Liver; inner examines Diaphragm. Right outer examines Stomach; inner examines Spleen. Upper region connecting up: Right outer examines Lung; inner examines Chest Center. Left outer examines Heart; inner examines Danzhong. Front examines anterior symptoms; back examines posterior symptoms. End of upper region concerns chest and throat. End of lower region concerns lower abdomen, waist, thighs, knees, shins, and feet. (From *Suwen: Maiyao Jingwei Lun*)
*Neijing* used Cun, Guan, Chi to examine Zang-Fu only to this extent. *Nanjing* defined them as Three Regions and Floating, Middle, Deep as Nine Holdings. Later generations only examined the three regions of Cun, Guan, Chi, obscuring the hand-foot-face three regions, which is a major loss.
Wuze says: Heart area is at Cun Kou on the left hand, belonging to Hand Shaoyin, combining with Hand Taiyang Small Intestine. Liver area is at Guan on the left hand, belonging to Foot Jueyin, combining with Foot Shaoyang Gallbladder. Kidney area is at Chi behind Guan on the left hand, belonging to Foot Shaoyin, combining with Foot Taiyang Bladder. Lung area is at Cun Kou before Guan on the right hand, belonging to Hand Taiyin, combining with Hand Yangming Large Intestine. Spleen area is at Guan on the right hand, belonging to Foot Taiyin, combining with Foot Yangming Stomach. Right Kidney area is at Chi on the right hand, belonging to Hand Jueyin Pericardium, combining with Hand Shaoyang Triple Burner.
[*Nanjing*]: Pulses have three regions, each with four meridians. Hand has Taiyin, Yangming; Foot has Taiyang, Shaoyin. Why upper and lower? Response: Hand Taiyin/Yangming are Metal; Foot Taiyang/Shaoyin are Water. Metal generates Water; water flows down and cannot go up, so they are in the lower region. Foot Jueyin/Shaoyang are Wood; they generate Hand Taiyang/Shaoyin Fire. Fire flares up and cannot go down, so they are in the upper region. Hand Jueyin/ShaoYang are Fire; they generate Foot Taiyin/Yangming Earth. Earth governs the Central Palace, so it is in the middle region. This follows the mutual generation of Five Elements. (From *Nanjing: Nan 18*)
[Dongyuan]: Hands crossed forward, palms up, left outside, right inside, arranging Wood, Fire, Earth, Metal, Water in order, aligning with the seasons without error. *Liuzhi Dalun* states: To the right of Xianming is the position of Ministerial Fire. To the right of Ministerial Fire, moving back one step, Dominant Fire governs; one more step, Earth Qi governs; one more step, Metal Qi governs; one more step, Water Qi governs; one more step, Wood Qi governs; one more step, Ministerial Fire governs. This is the sequence of Five Element generation.
[*Suwen*]: Emperor asks: What are the three regions? Qibo answers: Lower, Middle, Upper. Each has three holdings: Heaven, Earth, Human. Must be indicated by finger to be true. Upper Heaven: Artery at two temples. Upper Earth: Artery at two cheeks. Upper Human: Artery in front of ears. Middle Heaven: Hand Taiyin (Jingqu). Middle Earth: Hand Yangming (Hegu). Middle Human: Hand Shaoyin (Shenmen). Lower Heaven: Foot Jueyin (Taichong). Lower Earth: Foot Shaoyin (Taixi). Lower Human: Foot Taiyin (Jiman). Thus, Lower Heaven examines Liver, Earth examines Kidney, Human examines Spleen/Stomach Qi. Middle Heaven examines Lung, Earth examines Chest Qi, Human examines Heart. Upper Heaven examines Head/Horn Qi, Earth examines Mouth/Teeth Qi, Human examines Ear/Eye Qi. If nine holdings correspond, upper and lower are one. If one holding lags, disease; two lag, severe disease; three lag, critical disease. "Lag" means not simultaneous.
[Image: Crossed Hands Six Pulses Five Element Generation Diagram]
Hand Jueyin/ShaoYang Fire generates Foot Taiyin/Yangming Earth. Foot Taiyin/Yangming Earth generates Hand Taiyin/Yangming Metal. Hand Taiyin/Yangming Metal generates Foot Taiyang/Shaoyin Water. Foot Taiyang/Shaoyin Water flows down, generates Foot Jueyin/Shaoyang Wood. Foot Jueyin/Shaoyang Wood generates Hand Taiyang/Shaoyin Fire. Hand Taiyang/Shaoyin Fire flares up, generates Hand Jueyin/ShaoYang Fire.
If all three regions and nine holdings are discordant, death. If upper/lower/left/right pulses respond like pounding rice, severe disease. If discordant and uncountable, death. If Middle holding is harmonious alone but discordant with other Zang, death. Examining nine holdings: unique smallness, disease; uniqueness largeness, disease; unique speed, disease; unique slowness, disease; unique heat, disease; unique cold, disease; unique depression, disease. (From *Suwen: Sanbu Jiuhou Lun*)
The above uses Sanbu Jiuhou to examine the Five Zang.
[*LingShu*]: Ting (forehead center) is head/face. Guan Shang (between eyebrows) is throat. Que Zhong (between eyes) is Lung. Xia Ji (between eyes/nose root) is Heart. Zhi Xia (down nose bridge) is Liver. Gan Zuo (left of nose bridge) is Gallbladder. Xia (below nose wing) is Spleen. Fang Shang (near nose wing) is Stomach. Zhong Yang (center below nose) is Large Intestine. Jia Da Chang (flanking large intestine) is Kidney. Dang Shen (at navel) is Navel. Mian Wang Yi Shang (above nose tip) is Small Intestine. Mian Wang Yi Xia (below nose tip/philtrum) is Bladder/Uterus. Quan Gu (cheekbone) is Shoulder. Quan Hou (behind cheekbone) is Arm. Bi Xia (below arm) is Hand. Nei Yan Shang (above inner canthus) is Chest/Breast. Jia Sheng Er Shang (along line above) is Back. Xun Ya Che Yi Xia (following jaw down) is Thigh. Zhong Yang (center) is Knee. Xi Yi Xia (below knee) is Shin. Dang Xia Yi Xia (below shin) is Foot. Ju Fen (great cleft) is Inner Thigh. Ju Qu (great bend) is Kneecap. These are the divisions of Five Zang, Six Fu, and limbs. (Ting is forehead center. Guan Shang is between eyebrows. Xia Ji is between eyes. Zhi Xia is down nose. Fang is nasal tunnel. Mian Wang is nose tip. From forehead to Que belongs to head/throat. From Que down nose tip belongs to Lung, Heart, Liver, Spleen, Kidney. From inner canthus flanking nose down to Chengjiang belongs to Gallbladder, Stomach, Large Intestine, Small Intestine, Bladder. From cheekbone down to jaw belongs to shoulder/arm/hand. From jaw diagonal down to chin belongs to thigh/knee/shin/foot. Classic says: Five Zang follow in center, Six Fu flank sides. Head/Face at Yang Ting, King Palace at Xia Ji.) Each has a division. With divisions, use Yin to harmonize Yang, Yang to harmonize Yin. Knowing divisions ensures success. Distinguishing left/right is the Great Way. Men and women differ in position, hence Yin/Yang. Assessing luster/wither is a good physician. Turbid/dark is interior; floating/clear is exterior. Yellow/Red is Wind; Green/Black is Pain; White is Cold; Yellow with grease is Pus; Deep Red is Blood. Severe pain is spasm; severe cold is numbness. Colors appear in their regions. Examine floating/sunken for depth; luster/wither for outcome; scattered/clumped for proximity; color height for location. Accumulate spirit in the heart to...