察色无论四时，无论百病，总以带土色而有神气者为吉。
凡肝热者，左颊先赤，肺热者，右颊先赤，心热者，额先赤，脾热者，鼻先赤，肾热者
，腮先赤。面有惨色者，寒，目下肿者，湿也。
第一望他神气色，语言轻重起和眠，弯体即知腰内苦，攒眉头痛与头眩，手不举兮肩背
痛，步移艰苦脚间疼，手久按胸胸内痛，按中脐腹痛相连，好起不眠痰火热，贪眠虚冷使之然，
面壁蜷身多是冷，仰身舒挺热相煎，身面目黄脾湿热，唇青面冷是阳虚。
第二闻声清与浊，鉴他真语与狂言，声浊即知痰壅滞，声清寒内是真原，言语真诚非实
热，狂言号叫热深坚，称神说鬼逾墙屋，胸膈停痰证号癫，更有频病相循久，声音忽失命归泉。
三问病患经几日，日间便利几番行，饮食多少宜冷热，更兼何味喜嫌分，饮食少通容易
治，不进之时疗必难，喜冷定知心内热，好温必是脏中寒，便若赤黄知内热，便清定是冷相干。
（炳章按∶上三节俱腐浅俗师之歌诀也。）
治病在看脉辨证，看脉之法，只在有神无神有力无力八字，识得神之有无，则其人之死
生可辨；识得力之有无，则其证之虚实可知。既已知脉，盒饭辨证，以证合脉，虚实死生，内伤
外感，无不了然矣。如证虚脉无力者可补，证实脉无力者亦可补，证实脉有力者可泻，证虚
脉有力者亦可泻，明乎虚实补泻之义，则思过半矣。又所谓有力无力，应补应泻，非独一经
，须看何部有力，则泻何部，何部无力，则补何部。或因某部有力，以致某部无力者；或因
某部无力，以致某部有力者；或有力无力，各自分经者，手下无不了然，胸中始有定见。故
有力无力，为诊法要诀也。看脉须先识五脏平脉，金短木长火浮水沉，土则持重，各象五行
脉要有胃气。胃气者，谷气，营气，卫气，真元之气，少阳生气，总谓胃气也。脉有敦
阜之
清之象者，真元之气也；脉有生动弦长而无亢厉之象者，少阳生气也。此数者皆胃气也，少
一则胃气不足也。故看脉先看此数气，以定生死轻重，而预决死期，则以时令生克断之。倘
脉少此数气之一，即为真病；不少此气，虽病弗药而安；此气已少，虽药弗救。辨此以为治
脉有来因，不外虚实二字。欲知其风虚，只辨人迎气口二处，大小软润便知，如肝脉浮
，当病风，而人迎不浮，非风证也。脾脉沉，当病湿，而气口不沉，非湿证也。凡看病外辨六气
，内辨七情，内外只看人迎气口，故《内经》辨人迎气口，为千古心传。
脉要和缓中有充实圆满之气，即为有胃阳而无弊。如有一处硬馁，即别于阳，便是病矣
。盖心肝脾肺肾，五脏皆阴，而其中则有胃阳之气，周流贯畅于其间，肝属木，木直而长，弦之
象也，故其脉弦，弦而如长竿之梢，有软嫩和柔之气者，胃阳之气游行于中也。心属火，火
之形浮散而起，故其脉洪，洪而有柔静之气充溢于中者，胃阳之气也。脾为湿土，而得冲和
之气，舒徐不迫者，土之象也。故其脉缓缓而有轻顺和柔温浓之气者，胃阳之气足于中也。
肾主水，水性下而不升，故有沉实下凝之象者，肾之脉也，沉中而有澄静收敛之气者，胃阳
之气纳于中也。肺主金，金性润，润而有坚凝光明外现之象，故其气多浮，而轻浮中有润泽
轻扬之气者，胃阳之充实也。盖五脏皆阴，非胃阳实之，则生意衰落。胃阳者，五谷之气，
所以培养乎先天之真阳，而为一身四大五脏之生意者也。要乎哉！胃阳之关乎人命也。倘肝
之胃阳不足，则肝气虚，虚则邪气凑之，除六气之外，别有五入，如心邪入则脉兼洪，洪则
为木火俱焚之证，肺邪入则脉兼浮毛，其证多郁闷，盖肺主气，郁乎中而不下行也。脾邪入
则脉兼缓，其证多痰郁胸满之候，盖湿入而成热也，多气塞于咽喉。肾邪入则脉兼沉石，其
证多腰重胁痛，盖肾主水，水入而成寒郁也。其自为病，则为血虚火焚之类，此肝之阳气
不足，当知其病而别之也。（阳气即胃阳之气也。）其五脏皆可以类推，知乎此则知补泻之道
矣。如心之阳气不足，而或肝邪入之，则补心而泻肝。脾邪入之，则泻湿而宁心。肺邪入之
，则理气而凉血。肾邪入之，则纳气而温心。盖肾主水主寒，故用温。肺主气，气郁则为火
，故用凉。脾主湿，故逐湿而心宁，如茯苓补心汤之类也。但吾所言，乃一隅也，可即是而
反之。总之，治病以回阳为本，乃要法也。但当别其虚实，在何脏何腑何经何络而已。（张
东扶曰∶回阳者，回胃阳也。何脏无胃阳则治何脏，即上所言心之脾胃虚，肺之脾胃虚，肝
之脾胃虚，肾之脾胃虚，脾胃之脾胃虚，因其虚而调理之，即治病必先脾胃之说也。今人讲
回阳，惟知以桂附热毒之品一概施治，是徒知药之阳而不知人身五脏之阳也，岂先生之所谓
脉之关节处，只在分理阴阳，然须九等分别，方能不差。如寸部中仍分上、中、下，三
部中仍分浮、中、沉三候。如上之上，心也，浮也。心有通经处。则脾与胃，上之中也，浮而稍
沉者也。肾肝，上之下也，此其最沉者也。其详难尽，大约识得阴阳内外上下分属，便可悟
脉法无如《内经》上在上，中在中，下在下，为一定。故因体而类推，如心肺居寸，居
上浮也，则凡浮者，皆其气也，皆其用也。
脉者，非血非气，乃人之神也。神者，精、气、血三者之流行也。若人外无疾病，而脉
见枯
寂，此因病而神少，非神少而病也，故可救。若内伤饮食寒暖，脉见枯寂，亦不救。若因思
虑所致，即不妨，盖思虑伤神，非本原精气血有枯寂而见此脉也，能处处调神则生矣。
人身有先天之元阳，有后天之元阳；有先天之元阴，有后天之元阴。先天元阳，足与不
足，别之于右肾右尺；先天元阴，足与不足，别之于左肾左尺。此由人生所禀父母之精气，有足
有不足而致此者也。大凡先天元阳不足者，右尺多微弱而不旺，有病则多偏属于阴，或不能
耐寒，或不能多食，或静默少慧，或手足不耐劳苦，其类不一，无非阴盛阳衰之证。禀此气
质者，一生阴药俱不宜妄用，若再误用阴药以助阴，阳益大衰矣。先天元阴不足者，左尺多
微弱而虚细，有病则多偏属于阳，或多发热，或不能久耐事或不能静安，或狂而多言，皆阳
有余而阴不足之病也。禀此气质者，一生阳药，俱不宜妄用。苟或用阳药而误，则火益烈而水
益亏矣。（王胥山曰∶古人谓阳藏者宜用凉，阴藏者宜用热，亦是此义。譬之人性相近而有
上智下愚之不移者，其天定也。若中人之性，可善可恶者，则固多矣。人体之不同，亦有偏
于阳而一生不便阳药者，亦有偏于阴而一生不便阴者药者，苟或误用必致危殆，固有之矣。
若夫中人之体，阴阳不妨两用者固多也，学人当随时随证酌而用之，慎勿妄执己意，而为胶
柱鼓瑟之见，以致人命于倾危也。）
后天之元阳，气也。气之主脉，则右寸肺也。右寸之脉，多细弱而软，是后天之元阳不
足也
阴血也，血之主脉，则左寸心也。左寸之脉多微弱，是后天之元阴不足也，其人必多火炽之
患，盖君不主令，而相火代之故也。不能多用心，不能多耐事，营养多不足，血脉多滞迟，
药宜当归、芍药、生地、麦冬、枣仁以养心为主也。此四部实为阴阳气血之根元。至论其气
血流通，互相灌注而为生长，则先天以脾胃为归，后天以脾胃为原。脾胃者，又阴阳气血之
归本处，胃为气之原，脾为血之原，统属右关一部，故右关之脉，联乎尺寸，而为先后天之
至要脉也。夫脾不运，则胃不升，脾胃之气，不升不运，则阴不生而阳不舒，血不长而气不
旺。故土为中州，贯乎四脏，而为阴阳气血之所赖者也。若脾胃生发之气，
即少阳胆气也，胆气不疏则胃阳不发，肝血不润，则脾血不藏
，是肝胆之在左关者，又脾胃生发收藏之要脉也。左关不利，则右关不安，两关不利，则尺
寸之脉，亦必不得其平，此则诊三部九候之要法也。
看脉，三部全按，察其通身之气血；一指独按，察其各经之旺衰。然其中惟尺脉沉微难
辨，且为脉之根，尤不可忽。
浮沉迟数为纲领，表里阴阳仔细分，缓脾滑大洪为火，木性弦长短涩金，革散濡微芤
没里，伏牢细弱外无形，紧弦虚实无难辨，结促休将代等伦，动脉有胎还足喜，虚人豁大亦堪惊
，和缓有神方是胃，力来亢厉客邪侵，总详胃气论生死，审力须知内外因。
两寸，一主气，一主血，能领一身诸经络营卫。脉分两部，理却一连，如阴阳内外上下
，不能不分，而又不可不合也。
胆脉多弦，其来有柔顺之致，则为少阳生气；其来有亢厉之气，则为厥阴木枯之病脉。
凡童子之脉多弦，少阳象也。
肝脉浮长，长者木之形也，浮者木之性也。
脉见于右手不平者，莫作外感有余治；脉见于左手不平者，莫作内伤不足治。左曰有余
若脉浮大而数，宜于气药中佐以血药；若脉沉细而数，宜于血药中兼以气药。
热则流通，凡浮、大、数、长皆热也；寒则坚凝，凡沉、小、迟、短皆寒也；实则形刚
，凡实、滑、弦、紧皆实也；虚则形柔，凡虚、涩、濡、缓皆虚也。
浮为在表，沉为在里。大数为热，小迟为寒。长为热，热则流通，短为寒，寒则凝结，
实为
凡虚损劳病，俱见于右尺；伤寒外感，俱见于左尺。左手不见太阳之脉。（太阳之脉，
洪大而长。）内伤劳役无疑。
内伤左脉短细而涩，右脉浮大而虚，左为气中之血。（左为肝，肝生心，肝主升为气，
心主血，故为气中之血也。）阳气下陷，不能生阴，故血枯而脉细涩也。右为血中之气，（右为脾
，脾生肺，脾主血，肺主气，故为血中之气也。）脾胃亏损。不能生金，故气虚而脉浮大也
两尺无脉，是为无根，将有痰厥之患。两寸无脉，是为气闭，则有阴阳不升降之忧。一
者升而不降，一者降而不升也。
弱、紧、数之脉，表里俱虚。弱为中气不足，紧为肺虚不卫风寒；数为血不足也。
缓为脾之本脉。缓而有力为太过，缓而无力为不足。若脾部见弦脉，为木乘土位，中气
所致，是从所不胜来，为贼邪也。若见沉细，是水反侮土，从所胜来，为微邪也。见短涩是
火克金，从后来为虚邪也。若见洪大是火生土，从前来为实邪也。凡看病先认定本部脉形，
若兼见别部脉形，或从所生来者，或从所克来者，以五行之理推之，断病无差矣。
阿阿缓若春杨柳，善状胃脉者也。六部俱见此象，是谓有胃气。脉紧数者，紧为表之阳
虚；数为里之血虚。细数者，细则无水，数则有火。短数者，短为肺气虚，兼之以数，则火克金
矣。若浮有沉无，阳气将脱。（炳章按∶数语的当，故虚劳证见细数脉，则不治也。）
脉细少气，气乃水母，气少则无水可知。脉大数则无火，数则心烦，是邪火有余，真火
洪者，火之脉也。火之来，肝之虚也，木枯生火也。
弦者，减也。在左关为实，肝血减而肝气亢也。在尺为虚，子食母气也。尺脉短，水枯
不能
，脾旺生金，则可以制肝而生肾，先天后天俱受益矣。故曰∶医宜从虚着脚也。（炳章按∶
水亏则火炽，参 入口，未受其益，先蒙其祸，奈何？）凡尺脉微，寸之故也。金不生水，故
水弱而尺微也。而寸脉之故，又关之故也。脾不健运，故金失养而金子衰也，生脉散要药也
凡虚损见数脉，为胃气不足，若转缓弱，为胃气生发之象，盖缓则有宽裕不迫之意，弱
则有
，须防作泻，泻而脉数，病难愈矣（一本云∶内伤作泻者，见此为难治。）
病后脉多细小，细小而和软，则有神而易痊。细小而搏击有力，则神少而难痊。
脉不可拘，如浮因表而来者可汗，浮因里而来者可下，若但知浮为表，沉为里，非善治
故脉浮矣，而其沉分坚硬有力，则知此浮，非因表固，乃里热实，火炎脉浮也，宜从其沉分
坚实施治。故凡疑似之证，细察两手尺部，及六部沉分，方可辨其真也。
左手寸脉旺，右手尺脉亦旺，是君不主令，相火代之，宜六味丸主之。如单左手旺，生
加茯神、远志、枣仁。（张东扶曰∶相火上入心部，宜壮水以制火，若心火自旺，则清而敛
右手尺脉旺，左手尺脉亦旺，清肺为主，生脉散加归身。如单左手尺脉旺，六味地黄丸
右尺旺，六味丸，或六味汤。左右尺俱旺，亦六味汤。
右尺微细，八味丸。左右俱微细，亦八味丸。
寸脉旺，下尺微细，六味丸。（张东扶曰∶下字似当作右，或当作两。）
两寸脉浮而无力，宜补上焦，用补中益气汤。上焦元气足，其气（一作火）下降。两尺脉
浮而无力，宜补下焦，用六味丸。下焦元气足，其气上升。
两寸洪而有力，宜降火，凉膈散、黄芩芍药汤、导赤散。
两尺洪而有力，阴虚火动，宜滋阴，用黄柏、知母。
两寸豁大无力，宜大补，两尺豁大无力，宜升阳散火汤。
Observation of facial color, regardless of the season or the hundred diseases, always considers it auspicious if the complexion carries an earthy hue (yellow) and possesses spirit.
For those with liver heat, the left cheek reddens first; for those with lung heat, the right cheek reddens first; for those with heart heat, the forehead reddens first; for those with spleen heat, the nose reddens first; for those with kidney heat, the cheeks reddens first. A pale and lifeless complexion indicates cold; swelling under the eyes indicates dampness.
First, observe the patient's spirit and color: The weight of speech, ease of rising and lying down, bending of the body reveals pain in the waist; frowning reveals headache or dizziness; inability to raise the hand reveals shoulder and back pain; difficulty walking reveals leg pain; pressing the chest for a long time reveals chest pain; pain connected to the middle and navel upon pressing reveals abdominal pain; preference for rising and insomnia often indicates phlegm-fire disturbance; excessive sleep is due to deficiency-cold; facing the wall and curling up is mostly cold; lying supine and stretching is mostly heat torment; yellowing of the body, eyes, and face indicates spleen damp-heat; blue lips and cold face indicate yang deficiency.
Second, listen to the clarity and turbidity of the voice, distinguishing true speech from delirium: Turbid voice indicates phlegm obstruction; clear voice indicates internal cold. Sincere speech is not excess heat; delirious shouting indicates deep and firm heat pathogen; speaking of gods and ghosts, climbing walls and houses is called "spirit possession," which is phlegm retention in the chest and diaphragm, the disease named Dian (epilepsy/mental disorder). More commonly, frequent illnesses cycling for a long time, sudden loss of voice, indicates the end of life.
Third, ask how many days the patient has been ill, how many times they urinate and defecate during the day, the amount of food and drink, preferences for hot or cold, and tastes liked or disliked. If diet is slightly open, treatment is easy; if no food enters, treatment is difficult. Preference for cold definitely indicates internal heat; preference for warmth definitely indicates organ cold. Red and yellow stool indicates internal heat; clear stool definitely indicates cold interference.
(Bingzhang notes: The above three sections are songs by mediocre and superficial physicians.)
Treating disease lies in observing the pulse and differentiating syndromes. The method of pulse observation lies only in these eight characters: presence or absence of spirit, strength or weakness. Knowing the presence or absence of spirit allows one to distinguish life and death; knowing the presence or absence of strength allows one to know deficiency or excess of the syndrome. Having known the pulse, one must differentiate the syndrome. Combining syndrome with pulse, deficiency/excess, life/death, internal injury/external contraction can all be clearly understood. If the syndrome is deficiency and the pulse is weak, tonification is suitable; if the syndrome is excess but the pulse is weak, tonification may also be suitable; if the syndrome is excess and the pulse is strong, purgation is suitable; if the syndrome is deficiency but the pulse is strong, purgation may also be suitable. Understanding the meaning of deficiency/excess and tonification/purgation means half the thinking is done. Furthermore, regarding strength/weakness and whether to tonify or purge, it is not limited to one meridian; one must see which position is strong, then purge that position; which position is weak, then tonify that position. Or because one position is strong, causing another to be weak; or because one position is weak, causing another to be strong; or strength and weakness belong to different meridians respectively. Only when the hands are clear can there be certainty in the mind. Therefore, strength and weakness are the key secrets of pulse diagnosis. One must first recognize the normal pulses of the five zang organs: Metal pulse is short, Wood pulse is long, Fire pulse is floating, Water pulse is sinking, Earth pulse is heavy. Each reflects the Five Elements. The pulse must have Stomach Qi. Stomach Qi is Grain Qi, Ying Qi, Wei Qi, True Yuan Qi, Shaoyang Sheng Qi, collectively called Stomach Qi. A pulse with a thick and high appearance is True Yuan Qi; a pulse that is vivid, wiry, and long without hyperactive severity is Shaoyang Sheng Qi. These are all Stomach Qi; lacking one means insufficient Stomach Qi. Thus, observing these qi determines the severity of life and death and predicts the time of death based on the generation and restriction of seasons. If the pulse lacks one of these qi, it is a true disease; if it does not lack these qi, even with disease, one can be peaceful without medicine; if these qi are already reduced, even medicine cannot save. Distinguishing this serves as the basis for treating the pulse. Pulse origins do not exceed deficiency and excess. To know wind deficiency, distinguish the Renying and Qikou points; size and softness reveal the truth. If the Liver pulse is floating, wind disease is expected, but if Renying is not floating, it is not wind syndrome. If the Spleen pulse is sinking, dampness disease is expected, but if Qikou is not sinking, it is not dampness syndrome. In examining illness, externally differentiate Six Qi, internally differentiate Seven Emotions; externally and internally, only look at Renying and Qikou. Thus, *Neijing*'s differentiation of Renying and Qikou is a timeless secret transmission.
The pulse should be harmonious and contain a full and round qi, indicating Stomach Yang without flaw. If any part is hard and weak, it deviates from Yang, indicating disease. The Heart, Liver, Spleen, Lung, and Kidney are all Yin, yet within them flows Stomach Yang Qi. Liver belongs to Wood, straight and long, reflecting the Wiry pulse; thus its pulse is Wiry. If it resembles the tip of a long pole with soft and tender qi, this is Stomach Yang Qi circulating within. Heart belongs to Fire, shape floating and scattering, thus its pulse is Surging. If Surging with soft and quiet qi filling the interior, this is Stomach Yang Qi. Spleen is Wet Earth, obtaining harmonious qi, relaxed and unhurried, reflecting Earth. Thus its pulse is Slow with light, smooth, gentle, warm, and rich qi, indicating sufficient Stomach Yang Qi within. Kidney governs Water, nature descending and not ascending, thus having a sinking, solid, and downward-congealing image; within the sinking, clear and convergent qi indicates Stomach Yang Qi stored within. Lung governs Metal, nature moist, moist with firm condensation and brightness appearing outward; thus its qi is mostly floating, and within the light floating, moist and light-rising qi indicates substantial Stomach Yang. Since the five zang are Yin, without Stomach Yang substantiation, vitality declines. Stomach Yang is the qi of five grains, cultivating the congenital True Yang, serving as the vitality for the four limbs and five zang. How important! Stomach Yang concerns human life. If Liver's Stomach Yang is insufficient, Liver Qi becomes deficient, allowing pathogens to gather. Besides the Six Exogenous Factors, there are Five Pathogenic Influences entering: if Heart pathogen enters, the pulse combines Surging, indicating Wood and Fire burning together; if Lung pathogen enters, the pulse combines Floating and Hair-like, causing depression, as Lung governs Qi, stagnated in the middle and not descending; if Spleen pathogen enters, the pulse combines Slow, causing phlegm stagnation and chest fullness, as Dampness turns to Heat, causing Qi blockage in the throat; if Kidney pathogen enters, the pulse combines Sinking and Stone-like, causing heavy waist and hypochondriac pain, as Kidney governs Water, Water entering causes Cold stagnation. Self-caused diseases include Blood deficiency and Fire burning. This is Liver Yang Qi insufficiency; one must know the disease and distinguish it. (Yang Qi refers to Stomach Yang Qi.) The five zang can be inferred similarly; knowing this knows the way of tonification and purgation. If Heart Yang Qi is insufficient and Liver pathogen enters, tonify Heart and purge Liver. If Spleen pathogen enters, purge Dampness and calm Heart. If Lung pathogen enters, regulate Qi and cool Blood. If Kidney pathogen enters, absorb Qi and warm Heart. Kidney governs Water and Cold, hence use Warmth; Lung governs Qi, Qi stagnation becomes Fire, hence use Cooling; Spleen governs Dampness, hence expel Dampness and calm Heart, such as Fuling Buxin Tang. What I say is but one corner; infer from this. In short, treating disease takes returning Yang as the root, a crucial method. But one must distinguish deficiency/excess and locate the specific zang, fu, meridian, and collateral. (Zhang Dongfu says: Returning Yang means returning Stomach Yang. Wherever a zang lacks Stomach Yang, treat that zang, i.e., Heart-Spleen/Stomach deficiency, Lung-Spleen/Stomach deficiency, etc. Regulate according to deficiency, which is the saying that treating disease must prioritize Spleen and Stomach. Modern people discussing returning Yang only know to uniformly apply Gui Zhi and Fu Zi, toxic hot substances, knowing only the Yang of herbs but not the Yang of the five zang in the body, contrary to what Mr. said...)
The joint of the pulse lies only in dividing and managing Yin and Yang, requiring nine levels of distinction to avoid error. For example, the Cun position is divided into Upper, Middle, Lower; the three positions are divided into Floating, Middle, Deep. Upper-Upper is Heart, Floating. Heart has connecting meridians. Spleen and Stomach are Upper-Middle, Floating and slightly Deep. Kidney and Liver are Upper-Lower, the deepest. Details are hard to exhaust, but roughly understanding Yin/Yang, internal/external, upper/lower attribution allows one to realize pulse methods. As *Neijing* states: Upper is Upper, Middle is Middle, Lower is Lower, fixed rules. Infer by body structure: Heart and Lung reside in Cun, Floating. Thus all Floating are their Qi and function.
Pulse is neither Blood nor Qi, but the Shen (Spirit) of man. Shen is the circulation of Essence, Qi, and Blood. If a person has no external disease but the pulse appears withered and silent, this is Shen deficiency caused by disease, not disease caused by Shen deficiency, so it can be saved. If internal injury from diet and cold/warmth causes a withered and silent pulse, it cannot be saved. If caused by overthinking, it is not harmful, as overthinking injures Shen, not the congenital Essence/Qi/Blood being withered to show this pulse; regulating Shen everywhere leads to life.
The human body has Congenital Yuan Yang, Postnatal Yuan Yang; Congenital Yuan Yin, Postnatal Yuan Yin. Congenital Yuan Yang sufficiency/insufficiency is distinguished at the Right Kidney/Right Chi; Congenital Yuan Yin sufficiency/insufficiency is distinguished at the Left Kidney/Left Chi. This results from the sufficiency or insufficiency of parents' Essence/Qi inherited at birth. Generally, those with insufficient Congenital Yuan Yang have a weak and unprosperous Right Chi. When ill, they tend toward Yin, unable to bear cold, unable to eat much, quiet and less intelligent, or hands/feet unable to endure labor. All are signs of Yin excess and Yang deficiency. Those with this constitution should never recklessly use Yin-nourishing medicines; using more Yin drugs aids Yin and further depletes Yang. Those with insufficient Congenital Yuan Yin have a weak, thin, and fine Left Chi. When ill, they tend toward Yang, often feverish, unable to endure tasks or remain still, or manic and talkative. All are diseases of Yang excess and Yin deficiency. Those with this constitution should never recklessly use Yang-warming medicines. Using Yang drugs wrongly makes Fire fierce and Water depleted. (Wang Xushan says: Ancients said those with Yang storage should use Cooling, those with Yin storage should use Heating, which is this meaning. Like human nature, similar but with immutable wise and foolish types, determined by heaven. For average people, good or evil is possible. Human bodies differ; some favor Yang and cannot tolerate Yang drugs all life, some favor Yin and cannot tolerate Yin drugs. Wrong use leads to danger. For average constitutions, both Yin and Yang can be used; learners should adjust according to time and syndrome, not stubbornly adhere to personal views, endangering lives.)
Postnatal Yuan Yang is Qi. The master of Qi pulse is the Right Cun/Lung. Right Cun pulse is mostly fine, weak, and soft, indicating insufficient Postnatal Yuan Yang. Postnatal Yuan Yin is Yin Blood. The master of Blood pulse is the Left Cun/Heart. Left Cun pulse is mostly weak, indicating insufficient Postnatal Yuan Yin. Such people suffer from blazing Fire, as the Monarch does not command, and Minister Fire replaces it. They cannot think much, endure tasks, have poor nutrition, and sluggish blood vessels. Medicines should focus on nourishing Heart with Dang Gui, Bai Shao, Sheng Di, Mai Dong, and Suan Zao Ren. These four positions are the roots of Yin/Yang/Qi/Blood. Regarding Qi/Blood circulation and mutual infusion for growth, Congenital returns to Spleen/Stomach, Postnatal originates from Spleen/Stomach. Spleen/Stomach are the return point of Yin/Yang/Qi/Blood. Stomach is the origin of Qi, Spleen is the origin of Blood, unified under the Right Guan position. Thus Right Guan pulse connects Cun and Chi, being the most vital pulse for congenital and postnatal stages. If Spleen does not transport, Stomach does not ascend. If Spleen/Stomach Qi does not ascend or transport, Yin is not born, Yang is not comfortable, Blood does not grow, Qi does not prosper. Thus Earth is the central province, penetrating the four zang, relied upon for Yin/Yang/Qi/Blood. If Spleen/Stomach generating Qi, which is Shaoyang Gallbladder Qi, is not dredged, Stomach Yang does not emerge. If Liver Blood is not moist, Spleen Blood is not stored. Thus Liver/Gallbladder at Left Guan are the vital pulses for Spleen/Stomach generation and storage. If Left Guan is obstructed, Right Guan is uneasy; if both Guans are obstructed, Cun and Chi pulses will not be balanced. This is the key method of observing Three Positions and Nine Probes.
To examine the pulse, press all three positions to observe whole-body Qi/Blood; press one finger alone to observe the prosperity/decline of each meridian. Among them, Chi pulse is sinking and faint, hard to distinguish, and is the root of the pulse, especially不可忽视.
Floating/Sinking/Slow/Rapid are the outline; carefully divide Exterior/Interior/Yin/Yang. Slow/Slippery/Big/Surging belong to Fire; Wood nature is Wiry/Long/Short/Choppy/Metal; Knife-edge/Scattered/Soft/Faint/Khollow disappear inside; Hidden/Firm/Fine/Weak have no external form; Tight/Wiry/Excess/Deficiency are easy to distinguish; Knotted/Rapid should not be equated with Intermission; Moving pulse with pregnancy is still pleasing; Empty/Vast in weak persons is alarming. Harmonious and spirited is truly Stomach Qi; forceful and hyperactive indicates invading pathogen. Generally detailing Stomach Qi discusses life/death; examining force requires knowing internal/external causes.
Two Cun positions: one governs Qi, one governs Blood, leading all meridians, Ying, and Wei of the body. Pulse divides into two parts, but principles are connected. Like Yin/Yang, internal/external, upper/lower, cannot be separated, yet must not be disconnected.
Gallbladder pulse is mostly Wiry. If coming with gentleness, it is Shaoyang Sheng Qi; if coming with hyperactivity, it is Jueyin Wood Withered disease pulse. Children's pulses are mostly Wiry, reflecting Shaoyang.
Liver pulse is Floating and Long. Long is the shape of Wood; Floating is the nature of Wood.
If pulse appears uneven on the Right Hand, do not treat as Excess External Contraction; if uneven on the Left Hand, do not treat as Deficiency Internal Injury. Left says Excess. If pulse is Floating, Big, and Rapid, add Blood medicines to Qi medicines; if Sinking, Fine, and Rapid, add Qi medicines to Blood medicines.
Heat flows freely; all Floating, Big, Rapid, Long are Heat. Cold congeals firmly; all Sinking, Small, Slow, Short are Cold. Excess is rigid form; all Excess, Slippery, Wiry, Tight are Excess. Deficiency is soft form; all Deficient, Choppy, Soft, Slow are Deficiency.
Floating is Exterior, Sinking is Interior. Big/Rapid is Heat, Small/Slow is Cold. Long is Heat (flows), Short is Cold (congeals), Excess is... (text missing). Generally, deficiency consumption and chronic diseases appear at Right Chi; Shanghan/External contraction appear at Left Chi. Left Hand does not see Taiyang pulse (Taiyang pulse is Surging, Big, and Long). Internal injury from labor is certain.
Internal injury: Left pulse Short, Fine, and Choppy; Right pulse Floating, Big, and Empty. Left is Qi containing Blood (Left is Liver, Liver generates Heart, Liver governs ascending as Qi, Heart governs Blood, hence Qi containing Blood). Yang Qi sinks, cannot generate Yin, hence Blood withers and pulse is Fine/Choppy. Right is Blood containing Qi (Right is Spleen, Spleen generates Lung, Spleen governs Blood, Lung governs Qi, hence Blood containing Qi). Spleen/Stomach damaged, cannot generate Metal, hence Qi is deficient and pulse is Floating/Big.
No pulse at both Chis means Rootless, prone to Phlegm Jue. No pulse at both Cuns means Qi Closure, worry of Yin/Yang non-ascent/descent. One ascends not descends, one descends not ascends.
Weak/Tight/Rapid pulses indicate Exterior/Interior both deficient. Weak is Middle Qi deficiency; Tight is Lung deficiency failing to defend against Wind/Cold; Rapid is Blood deficiency.
Slow is the root pulse of Spleen. Slow with strength is Excess; Slow without strength is Deficiency. If Spleen position shows Wiry pulse, Wood invades Earth, caused by Middle Qi, coming from the unconquered, called Thief Evil. If Sinking/Fine, Water insults Earth, coming from the conquered, called Minor Evil. Short/Choppy is Fire restricting Metal, coming from later, called False Evil. Surging/Big is Fire generating Earth, coming from earlier, called Real Evil. In examining illness, first identify the本部 pulse shape. If combined with other positions' shapes, or coming from generated/restricted relations, deduce using Five Elements theory, diagnosis will be accurate.
"Aa" slow like spring willows describes Stomach pulse well. Seeing this image in six positions is called having Stomach Qi. Tight/Rapid pulse: Tight is Exterior Yang deficiency; Rapid is Interior Blood deficiency. Fine/Rapid: Fine means no Water, Rapid means Fire. Short/Rapid: Short is Lung Qi deficiency; combined with Rapid, Fire restricts Metal. If Floating present but Sinking absent, Yang Qi is about to collapse. (Bingzhang notes: Accurate words. Thus in deficiency consumption, seeing Fine/Rapid pulse means untreatable.)
Fine pulse with little Qi. Qi is the mother of Water; little Qi means no Water. Big/Rapid pulse means no Fire; Rapid means heart vexation, indicating pathogenic Fire excess, True Fire... (text missing). Surging is Fire pulse. Fire coming is Liver deficiency, Wood withering generates Fire.
Wiry means reduction. At Left Guan is Excess, Liver Blood reduced and Liver Qi hyperactive. At Chi is Deficiency, Child consumes Mother Qi. Chi pulse Short, Water withered cannot... (text missing). Spleen prosperous generates Metal, controlling Liver and generating Kidney, benefiting both congenital and postnatal. Hence: Medicine should start from deficiency. (Bingzhang notes: Water deficit makes Fire fierce. Ginseng enters, before benefiting, suffers disaster, what to do?) Generally Chi pulse faint is due to Cun. Metal does not generate Water, hence Water weak and Chi faint. Cun pulse cause is due to Guan. Spleen not healthy transporting, hence Metal loses nourishment and Metal child declines. Shengmai San is a key medicine.
Generally deficiency consumption showing Rapid pulse indicates insufficient Stomach Qi. If turning Slow/Weak, it is Stomach Qi generating image. Slow implies spaciousness and no pressure; Weak implies... (text missing). Must prevent diarrhea; if diarrhea and pulse Rapid, disease hard to cure (another version says: Internal injury with diarrhea, seeing this is hard to treat).
After illness, pulse is mostly Fine/Small. Fine/Small and soft/spiritual means easy recovery. Fine/Small and beating/forceful means little spirit and hard recovery.
Pulse should not be rigid. If Floating due to Exterior, sweating is suitable; if Floating due to Interior, purgation is suitable. If only knowing Floating is Exterior, Sinking is Interior, not good treatment. ... (text missing). Thus if pulse is Floating, but Sinking part is hard and forceful, know this Floating is not due to Exterior solidity, but Interior Heat Excess, Fire flaming causing Floating pulse. Treat according to Sinking part hardness. Thus for doubtful cases, carefully observe both hands' Chi positions and Sinking parts of six positions to distinguish truth.
Left Cun pulse vigorous, Right Chi pulse also vigorous: Monarch does not command, Minister Fire replaces. Use Liuwei Wan. If only Left vigorous, add Fushen, Yuanzhi, Suan Zao Ren. (Zhang Dongfu says: Minister Fire entering Heart position, should strengthen Water to control Fire. If Heart Fire self-vigorous, clear and gather...)
Right Chi pulse vigorous, Left Chi pulse also vigorous: Clear Lung as main, Shengmai San plus Dang Gui. If only Left Chi vigorous, Liuwei Dihuang Wan...
Right Chi vigorous: Liuwei Wan or Liuwei Decoction. Both Left/Right Chi vigorous: Also Liuwei Decoction.
Right Chi faint/fine: Bawei Wan. Both Left/Right faint/fine: Also Bawei Wan.
Cun pulse vigorous, Lower Chi faint/fine: Liuwei Wan. (Zhang Dongfu says: 'Lower' likely should be 'Right' or 'Both'.)
Both Cuns Floating and weak: Tonify Upper Jiao, use Buzhong Yiqi Tang. Upper Jiao Yuan Qi sufficient, its Qi (or Fire) descends. Both Chis Floating and weak: Tonify Lower Jiao, use Liuwei Wan. Lower Jiao Yuan Qi sufficient, its Qi ascends.
Both Cuns Surging and forceful: Descend Fire, use Liangge San, Huangqin Shaoyao Tang, Daochi San.
Both Chis Surging and forceful: Yin deficiency Fire moving, nourish Yin, use Huangbai, Zhimu.
Both Cuns Empty/Vast and weak: Greatly tonify. Both Chis Empty/Vast and weak: Use Shengyang Sanhuo Tang.