经言∶所谓三部者,寸、关、尺也;九候者,每部中有天、地、人也。上部主候从胸以上至头,中部主候从膈以下
至气街,下部主候从气街以下至足。浮、沉、牢、结、迟、疾、滑、涩,各自异名,分理察之,勿怠观变,所以别三部
九候,知病之所起。审而明之,针灸亦然也。故先候脉寸中(寸中一作寸中于九)。浮在皮肤,沉细在里。昭昭天道,可
得长久。
上部之候,牢、结、沉、滑,有积气在膀胱。微细而弱,卧引里急,头痛,咳嗽,逆气上下。心膈上有热者,口干
渴燥。病从寸口,邪入上者名曰解。脉来至,状如琴弦,苦少腹痛,女子经月不利,孔窍生疮;男子病痔,左右胁下有
疮。上部不通者,苦少腹痛,肠鸣。寸口中虚弱者,伤气,气不足。大如桃李实,苦痹也。寸口直上者,逆虚也。如浮
虚者,泄利也。
中部脉结者,腹中积聚。若在膀胱、两胁下,有热。脉浮而大,风从胃脘入,水胀,干呕,
心下澹澹,如有桃李核。胃中有寒,时苦烦、痛、不食,食即心痛,胃胀支满,膈上积。胁下有热,时寒热淋露。
脉横出上者,胁气在膀胱,病即着。右横关入寸口中者,膈中不通,喉中咽难。刺关元,入少阴。
下部脉者,其脉来至浮大者,脾也。与风集合,时上头痛,引腰背,小滑者,厥也。足下热,烦满,逆上抢心,上
至喉中,状如恶肉,脾伤也。病少腹下,在膝、诸骨节间,寒清不可屈伸;脉急如弦者,筋急,足挛结者,四肢重。从
尺邪入阳明者,寒热也。大风邪入少阴,女子漏白下赤,男子溺血,阴萎不起,引少腹痛。
人有三百六十脉,法三百六十日。三部者,寸、关、尺也。尺脉为阴,阴脉常沉而迟;寸、关为阳,阳脉俱浮而速。
气出为动,入为息。故阳脉六息七息十三投,阴脉八息七息十五投,此其常也。
二十八脉相逐上下,一脉不来,知疾所苦。尺胜治下,寸胜治上,尺寸俱平治中央。脐以上阳也,法于天;脐以下
阴也,法于地;脐为中关。头为天,足为地。有表无里,邪之所止,得鬼病。何谓表里?寸尺为表,关为里,两头有脉,
关中绝不至也。尺脉上不至关为阴绝,寸脉下不至关为阳绝。阴绝而阳微,死不治。三部脉或至或不至,冷气在胃中,
故令脉不通也。
上部有脉,下部无脉,其人当吐,不吐者,死。上部无脉,下部有脉,虽困无所苦。所以然者,譬如人之有尺,树
之有根,虽枝叶枯槁,根本将自生,木有根本,即自有气,故知不死也。寸口脉平而死者,何也?然∶诸十二经脉者,
皆系于生气之原。所谓生气之原者,非谓十二经之根本也,谓肾间动气也。此五脏六腑之本,十二经之根,呼吸之门,
三焦之原,一名守邪之神也。故气者,人根本也,根绝则茎枯矣。寸口脉平而死者,生气独绝于内也。(肾间动气,谓左
为肾,右为命门,命门者,精神之所舍,原气之所系也,一名守邪之神。以命门之神固守,邪气不得妄入,入即死矣。
此肾气先绝于内,其人便死。其脉不复,反得动病也)
岐伯曰∶形盛脉细,少气不足以息者,死;形瘦脉大,胸中多气者,死。形气相得者,生;参伍不调者,病。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;中部之候相减者,死。目内陷者,死。
黄帝曰∶冬阴夏阳奈何?岐伯曰∶九候之脉皆沉细悬绝者,为阴,主冬,故以夜半死;盛躁喘数者,为阳,主夏,
故以日中死。是故寒热者,平旦死;热中及热病者,日中死;病风者,以日夕死;病水者,以夜半死;其脉乍数乍疏乍
迟乍疾者,以日乘四季死;形肉已脱,九候虽调,犹死。七诊虽见,九候皆顺者,不死。所言不死者,风气之病及经月
之病,似七诊之病而非也,故言不死。若有七诊之病,其脉候亦败者,死矣。必发哕噫,必审问其所始病与今之所方病,
而后各切循其脉,视其经络浮沉,以上下逆顺循之。其脉疾者,不病;其脉迟者,病;脉不往来者,死;皮肤着者,死。
两手脉,结上部者,濡;结中部者,缓;结三里者,豆起,弱反在关,濡反在巅。微在其上,涩反在下。微即阳气不足,
沾热汗出;涩即无血,厥而且寒。
黄帝问曰∶余每欲视色、持脉,独调其尺,以言其病,从外知内,为之奈何?岐伯对曰∶审其尺之缓、急、小、大、
滑、涩,肉之坚脆,而病形变定矣。调之何如?对曰∶脉急者,尺之皮肤亦急;脉缓者,尺之皮肤亦缓;脉小者,尺之
皮肤减而少;脉大者,尺之皮肤亦大;脉滑者,尺之皮肤亦滑;脉涩者,尺之皮肤亦涩。凡此六变,有微有甚。故善调
尺者,不待于寸;善调脉者,不待于色。能参合行之,可为上工。
尺肤滑以淖泽者,风也;尺内弱,解 安卧脱肉者,寒热也;尺肤涩者,风痹也;尺肤粗如枯鱼之鳞者,水淡饮也;
尺肤热甚,脉盛躁者,病温也,其脉盛而滑者,汗且出;尺肤寒甚,脉小(一作急)者,泄,少气;尺肤 然( 然,《甲
乙》作热炙人手),先热后寒者,寒热也;尺肤先寒,久持之而热者,亦寒热也;尺 然热,人迎大者,尝夺血;尺紧人
迎脉小甚则少气;色白有加者,立死。肘所独热者,腰以上热;肘前独热者,膺前热;肘后独热者,肩背热。肘后粗以
下三四寸,肠中有虫;手所独热者,腰以上热;臂中独热者,腰腹热;掌中热者,腹中热;掌中寒者,腹中寒;鱼上白
肉有青血脉者,胃中有寒。
诸浮、诸沉、诸滑、诸涩、诸弦、诸紧,若在寸口,膈以上病;若在关上,胃以下病;若在尺中,肾以下病。
寸口脉滑而迟,不沉不浮,不长不短,为无病。左右同法。
寸口太过与不及,寸口之脉,中手短者,曰头痛;中手长者,曰足胫痛;中手促上击者,曰肩背痛。
寸口脉浮而盛者,病在外。
寸口脉沉而坚者,病在中。
寸口脉沉而弱者,曰寒热(一作气,又作中)及疝瘕、少腹痛。
寸口脉沉而弱,发必堕落。
寸口脉沉而紧,苦心下有寒,时痛,有积聚。
寸口脉沉,胸中短气。
寸口脉沉而喘者,寒热。
寸口脉但实者,心劳。
寸口脉紧或浮,膈上有寒,肺下有水气。
脉紧而长过寸口者,注病。
脉紧上寸口者,中风。风头痛亦如之。(《千金翼》云∶亦为伤寒头痛)脉弦上寸口者,宿食;降者,头痛。脉来过
寸入鱼际者,遗尿。脉出鱼际逆气喘息。
寸口脉, 如羹上肥,阳气微;连连如蜘蛛丝,阴气衰。
寸口脉偏绝,则臂偏不遂;其人两手俱绝者,不可治。两手前部阳绝者,苦心下寒毒,喙中热。关上脉浮而大,风
在胃中,张口肩息,心下澹澹,食欲呕。关上脉微浮,积热在胃中,呕吐蛔虫,心健忘。关上脉滑而大小不匀(《千金》
云∶必吐逆),是为病方欲进,不出一二日复欲发动。其人欲多饮,饮即注利。如利止者,生;不止者,死。关上脉紧而
滑者,蛔动。关上脉涩而坚,大而实,按之不减有力,为中焦实,有伏结在脾,肺气塞,实热在胃中。关上脉 大,
而尺寸细者,其人必心腹冷积, 瘕结聚,欲热饮食。关上脉时来时去、乍大乍小、乍疏乍数者,胃中寒热,羸劣不欲
饮食,如疟状。
尺脉浮者,客阳在下焦。
尺脉细微,溏泄,下冷利。
尺脉弱,寸强,胃络脉伤。
尺脉虚小者,足胫寒,痿痹脚疼。
尺脉涩,下血不利,多汗。(《素问》又云∶尺涩脉滑谓之多汗)
尺脉滑而疾,为血虚。
尺脉沉而滑者,寸白虫。
尺脉细而急者,筋挛,痹不能行。
尺脉粗,常热者,谓之热中,腰胯疼,小便赤热。
尺脉偏滑疾,面赤如醉。外热则病。
The medical classics state: The so-called "Three Regions" (Sanbu, 三部) refer to the Cun (Inch), Guan (Bar), and Chi (Cubit) positions; the so-called "Nine Probes" (Jiuhou, 九候) refer to the Heaven, Earth, and Human probes within each region. The upper region primarily probes conditions from the chest upwards to the head; the middle region primarily probes from below the diaphragm down to the Qi Street (Qijie, 气街); the lower region primarily probes from below the Qi Street down to the feet. Floating (Fu, 浮), Deep (Chen, 沉), Firm (Lao, 牢), Knotted (Jie, 结), Slow (Chi, 迟), Rapid (Ji, 疾), Slippery (Hua, 滑), and Choppy (Se, 涩) pulses have different names; one must carefully analyze their principles, not being negligent in observing changes, thereby distinguishing the Nine Probes and knowing the origin of the disease. If examined clearly, acupuncture treatment follows the same principle. Therefore, first probe the Cun position: if the pulse is floating at the skin level, it is superficial; if deep and fine, it is interior. This is as clear as the Heavenly Dao, and can be followed for a long time.
For the upper region's pulse: if Firm, Knotted, Deep, or Slippery, there is accumulated Qi in the Bladder. If faint, fine, and weak, lying down causes internal pulling tension, headache, coughing, and rebellious Qi moving up and down. If there is heat above the Heart and Diaphragm, there will be dry mouth, thirst, and dryness. Disease entering the upper part from the Cun Kou (Radial Artery Pulse Point, 寸口) is named Jie disease (Xiejing, 解经 - a condition of flaccidity due to wind). If the pulse arrives with a shape like a lute string, there is bitter pain in the lower abdomen; women have irregular menstruation, and orifices develop sores; men suffer from hemorrhoids and sores under the left and right hypochondrium. If the upper region's Qi is blocked, there is bitter pain in the lower abdomen and borborygmus. If the Cun Kou pulse is weak, it indicates Qi injury and insufficiency. If large and solid like peach or plum seeds, it indicates Bi syndrome (Obstruction, 痹). If the Cun Kou pulse goes straight up without softness, it indicates rebellious deficiency. If floating and deficient, it indicates diarrhea and dysentery.
If the middle region's pulse shows Knotting, there are accumulations in the abdomen. If in the Bladder or under both hypochondria, there is heat. If the pulse is floating and large, Wind enters from the Stomach epigastrium, causing water swelling, dry retching, palpitations in the heart area, and a sensation of a hard mass like a peach or plum seed. If there is cold in the Stomach, there is frequent bitterness, pain, anorexia, heart pain after eating, stomach distension filling the chest, and accumulation above the diaphragm. If there is heat under the hypochondria, there are alternating chills and fever, and emaciation or sweating. If the pulse extends horizontally upwards,胁 Qi is in the Bladder, and the disease becomes fixed. If the Right Guan pulse enters horizontally into the Cun Kou, there is blockage in the diaphragm and difficulty swallowing. Acupuncture at Guanyuan (CV4, 关元), penetrating into the Shaoyin channel.
For the lower region's pulse: if the pulse arrives floating and large, it belongs to the Spleen. Combined with Wind, it frequently attacks the head causing headache, pulling on the waist and back. If small and slippery, it is Jue syndrome (Reversal, 厥). Heat in the soles, fullness and irritability, rebellious Qi rushing to the heart and up to the throat, feeling like foul flesh blocking, indicates Spleen injury. Disease in the lower abdomen, between the knees and joints, with coldness preventing flexion and extension; if the pulse is urgent like a string, it is tendon tension; if the feet are cramped and knotted, the limbs are heavy. If pathogenic factors enter the Yangming channel from the Chi position, it is a cold-heat disease. Major Wind pathogen entering the Shaoyin channel causes leukorrhea with blood in women, hematuria, impotence, and pulling pain in the lower abdomen in men.
Humans have three hundred and sixty meridians, corresponding to three hundred and sixty days. The Three Regions are Cun, Guan, and Chi. The Chi pulse is Yin; Yin pulses are typically deep and slow. The Cun and Guan pulses are Yang; Yang pulses are all floating and rapid. Qi exiting is movement; Qi entering is breath. Thus, Yang pulses beat thirteen times in six or seven breaths, and Yin pulses beat fifteen times in eight or seven breaths; this is the normal state.
The twenty-eight pulse types chase each other up and down; if one does not arrive, one knows the suffering of the disease. If Chi wins, treat the lower part; if Cun wins, treat the upper part; if Cun and Chi are balanced, treat the center. Above the navel is Yang, corresponding to Heaven; below the navel is Yin, corresponding to Earth; the navel is the Middle Guan. Head is Heaven, feet are Earth. Having exterior pulses but no interior pulses indicates where the pathogen stops, possibly resulting in Ghost Disease (Gui Bing, 鬼病). What are exterior and interior? Cun and Chi are exterior, Guan is interior. If there are pulses at both ends but the Guan is absent, it is interrupted. If the Chi pulse does not reach the Guan, it is Yin Absence; if the Cun pulse does not reach the Guan, it is Yang Absence. If Yin is absent and Yang is faint, death occurs and is incurable. If the Three Regions' pulses come and go intermittently, it is cold Qi in the Stomach causing pulse blockage.
If there is pulse in the upper region but none in the lower, the person should vomit; if they do not vomit, they die. If there is no pulse in the upper region but pulse in the lower, although distressed, there is no suffering. Why? It is like a person having a Chi (ankle pulse) or a tree having roots; even if branches and leaves wither, the root will regenerate. Trees with roots have life force, so death is known not to occur. If the Cun Kou pulse is normal but the person dies, why? Answer: All twelve primary meridians are connected to the Source of Vital Qi. The so-called Source of Vital Qi is not the root of the twelve meridians, but refers to the Moving Qi between the Kidneys (Shenjian Dongqi, 肾间动气). This is the root of the five Zang and six Fu organs, the root of the twelve meridians, the gate of respiration, the source of the Sanjiao (Triple Burner), also called the Spirit that Guards against Pathogens (Shou Xie Zhi Shen, 守邪之神). Thus, Qi is the root of humans; if the root perishes, the stems wither. If the Cun Kou pulse is normal but the person dies, it is because the Vital Qi is alone cut off internally. (The Moving Qi between the Kidneys refers to the Left as Kidney and Right as Mingmen (Gate of Life). Mingmen is where the Spirit resides and where Original Qi is tied, also called the Spirit that Guards against Pathogens. With the spirit of Mingmen guarding firmly, pathogens cannot enter randomly; if they enter, death ensues. This is because Kidney Qi first perishes internally, leading to death. The pulse does not recover, and instead, dynamic diseases arise.)
Qibo said: If the form is robust but the pulse is fine, and there is shortness of breath insufficient for respiration, death occurs; if the form is emaciated but the pulse is large, and there is much Qi in the chest, death occurs. If form and Qi are harmonious, life prevails; if they are discordant, disease occurs. If all Nine Probes are inconsistent, death occurs. If the pulses of upper/lower/left/right correspond like pounding grain, the disease is severe; if they are inconsistent and uncountable, death occurs. If the middle region's probe is harmonious alone but inconsistent with the other Zang organs, death occurs; if the middle region's probe diminishes, death occurs. If the eyes are sunken, death occurs.
Yellow Emperor asked: How about Winter Yin and Summer Yang? Qibo answered: If all Nine Probes are deep, fine, and suspended/extinct, it is Yin, governing Winter, so death occurs at midnight; if vigorous, restless, panting, and rapid, it is Yang, governing Summer, so death occurs at noon. Therefore, cold-heat diseases die at dawn; heat-in-middle and heat diseases die at noon; wind diseases die at dusk; water diseases die at midnight; pulses that are suddenly rapid, sparse, slow, or fast die during the four seasons' transition days; if flesh and muscle are depleted, even if the Nine Probes are harmonious, death still occurs. If the Seven Diagnoses are seen but the Nine Probes are compliant, death does not occur. The non-death mentioned refers to Wind diseases and menstrual diseases, which resemble the Seven Diagnoses but are not, hence stated as non-death. If there are Seven Diagnosis diseases and the pulse signs are also failed, death occurs. There will definitely be hiccups and belching. One must carefully ask about the onset and current symptoms, then palpate the pulses, observe the floating/sinking of meridians, and follow the upward/downward reversal. Rapid pulses indicate no disease; slow pulses indicate disease; absent pulses indicate death; skin adhering to bone indicates death. Pulses knotted in the upper region are Ru (Soggy); knotted in the middle region are Huan (Moderate); knotted at Sanli (ST36, 三里) show bean-like protrusions; Weak pulse reverses to Guan, Ru pulse reverses to Diantop. Wei (Fine) pulse is above, Se (Choppy) pulse is below. Wei indicates Yang Qi deficiency, damp heat, and sweating; Se indicates blood deficiency, Jue, and cold.
Yellow Emperor asked: I wish to inspect color and hold the pulse, but solely adjust the Chi skin to discuss disease, knowing the interior from the exterior. How? Qibo replied: Examine the Chi skin's slack/tight, small/large, slippery/choppy, and the hardness/fragility of the flesh, and the disease forms will be determined. How to adjust? Reply: If the pulse is tight, the Chi skin is tight; if slack, the Chi skin is slack; if small, the Chi skin is reduced; if large, the Chi skin is large; if slippery, the Chi skin is slippery; if choppy, the Chi skin is choppy. These six changes vary in degree. Thus, one skilled in adjusting Chi skin needs not wait for Cun; one skilled in adjusting pulses needs not wait for color. Integrating these makes one a Superior Physician.
If Chi skin is slippery and glossy, it is Wind; if Chi inner area is weak, with lethargy and muscle wasting, it is Cold-Heat; if Chi skin is choppy, it is Wind-Bi; if Chi skin is rough like dried fish scales, it is Water Retention; if Chi skin is very hot and pulse is vigorous/restless, it is Warm Disease; if pulse is vigorous and slippery, sweat will emerge; if Chi skin is very cold and pulse is small (or urgent), it is diarrhea and Qi deficiency; if Chi skin is first hot then cold, it is Cold-Heat; if Chi skin is first cold and becomes hot upon prolonged holding, it is also Cold-Heat; if Chi skin is hot and Renying (ST9, 人迎) pulse is large, there was blood loss; if Renying pulse is tight and small, there is Qi deficiency; if complexion is white and worsening, immediate death occurs. Heat only in elbows indicates heat above waist; heat only in front of elbows indicates heat in chest; heat only in back of elbows indicates heat in shoulder/back. Heat 3-4 cun below back of elbow indicates intestinal worms; heat only in hands indicates heat above waist; heat only in arms indicates heat in waist/abdomen; heat in palms indicates heat in abdomen; cold in palms indicates cold in abdomen; blue vessels on the white flesh above the palm indicates Cold in Stomach.
Various Floating, Deep, Slippery, Choppy, Wiry, and Tight pulses: if at Cun Kou, disease is above the diaphragm; if at Guan, disease is below the Stomach; if at Chi, disease is below the Kidney.
If Cun Kou pulse is slippery and slow, neither deep nor floating, neither long nor short, it is disease-free. Same for left and right.
Excess and Deficiency of Cun Kou: Short pulse at hand indicates headache; Long pulse at hand indicates leg/shin pain; Urgent pulse striking upwards indicates shoulder/back pain.
Floating and vigorous Cun Kou pulse indicates exterior disease.
Deep and firm Cun Kou pulse indicates interior disease.
Deep and weak Cun Kou pulse indicates Cold-Heat (or Qi, or Zhong) and Hernia/Jia masses with lower abdominal pain.
Deep and weak Cun Kou pulse indicates hair loss.
Deep and tight Cun Kou pulse indicates bitter cold below the heart, occasional pain, and accumulation.
Deep Cun Kou pulse indicates shortness of breath in the chest.
Deep and panting Cun Kou pulse indicates Cold-Heat.
Only solid Cun Kou pulse indicates Heart labor.
Tight or floating Cun Kou pulse indicates Cold above diaphragm and Water Qi below Lung.
Tight and long pulse exceeding Cun Kou indicates Zhu disease (Injection/Transmission disease).
Tight pulse reaching Cun Kou indicates Wind Stroke. Wind headache is similar. (Qianjin Yi says: Also Cold Damage headache). Wiry pulse reaching Cun Kou indicates retained food; descending indicates headache. Pulse passing Cun Kou into Yuji (LU10, 鱼际) indicates enuresis. Pulse emerging from Yuji with rebellious Qi and panting.
Cun Kou pulse like fat floating on soup indicates slight Yang Qi; continuous like spider silk indicates declining Yin Qi.
Unilateral absence of Cun Kou pulse leads to unilateral arm paralysis; bilateral absence is incurable. Bilateral anterior Yang absence indicates bitter cold toxin below heart and heat in beak/mouth. Floating and large Guan pulse indicates Wind in Stomach, gasping with open mouth and raised shoulders, palpitations, and desire to vomit. Micro-floating Guan pulse indicates accumulated heat in Stomach, vomiting roundworms, and forgetfulness. Slippery and uneven Guan pulse (Qianjin says: must vomit/reverse) indicates disease progressing, recurring in one or two days. Desire for drinking water leads to diarrhea. If diarrhea stops, survival; if not, death. Tight and slippery Guan pulse indicates roundworm movement. Choppy, firm, large, and solid Guan pulse, unyielding to pressure, indicates Middle Jiao excess, hidden knot in Spleen, Lung Qi blockage, and excess heat in Stomach. Large Guan pulse with thin Cun/Chi indicates cold accumulation in heart/abdomen, Jia masses, and desire for hot food/drink. Intermittent, varying size/rate Guan pulse indicates Stomach Cold-Heat, emaciation, anorexia, resembling malaria.
Floating Chi pulse indicates Guest Yang in Lower Jiao.
Fine and minute Chi pulse indicates loose stool and cold diarrhea below.
Weak Chi pulse with strong Cun indicates injury to Stomach collateral vessels.
Deficient and small Chi pulse indicates cold legs/shins, atrophy-bi, and foot pain.
Choppy Chi pulse indicates difficult bleeding below and excessive sweating. (Suwen adds: Choppy Chi and Slippery pulse indicates excessive sweating).
Slippery and rapid Chi pulse indicates Blood deficiency.
Deep and slippery Chi pulse indicates Taenia (Tapeworm, Cunbai Chong, 寸白虫).
Fine and urgent Chi pulse indicates tendon cramping and Bi immobility.
Coarse and constantly hot Chi pulse is called Heat-in-Middle, with waist/hip pain and red-hot urination.
Unilaterally slippery and rapid Chi pulse with flushed face like drunkenness indicates external heat disease.