三部俱数心家热。舌上生疮唇破裂。狂言满目见鬼神。饮水百杯终不歇。
数则为热。三部俱数。则心火炽盛。而成燎原之势矣。舌者心之外应。唇
者脾之外应。火炎则土燥。故舌上生疮。而唇为之破裂矣。心藏神。心热
盛则神昏。而满目见鬼神也。火盛则水衰。乃欲饮水以自救。故饮百杯
而终不歇也。
心脉芤阳气作声。或时血痢吐交横。
芤为阳火。火之发也有声。芤主失血。心脉见芤。则火逼血而错经妄行。
故吐血之时。哮哮有声也。或传于府。而作血痢之证。
溢关骨痛心烦躁。更兼头面赤 。
溢上出鱼际也。关下入关中也。烦出于肺。躁出于肾。诊得左寸上出于
鱼。而下入于关。则为心火炽盛。而成燎原之势。上出于鱼。则炎上而灼
肺。下入于关。则风火交加。炎上灼肺。故面赤而烦。风火交加。则水涸而躁矣。
按医说云。王叔和脉诀论曰。溢关骨痛心烦躁。通真子解云。心脉盛而
溢。关则筋紧而骨束。是以骨痛。师曰。筋紧有筋挛之疾。岂得骨痛。所以
心脉盛而骨痛者。心属火。骨属肾水。心脉溢关。则水不胜火。煎熬得骨
痛。非筋紧也。
大实由来面赤风。燥痛面色与心同。
心属火。在色为赤。心脉而见实。则为心经实火。心之华在面。肺合皮毛。
火盛则伤金。故皮肤燥痛而面色赤也。
微寒虚惕心寒热。
心不足则人惊惕。心脉见微。则为心火不足。然少阴为标寒本热。故虚
惕而有寒热交作之证矣。
急则肠中痛不通。
心脉急为心邪干于小肠也。急为风热传于小肠。故不通而作痛矣。经
云。心脉急。名曰心疝。少腹当有形。又举痛论云。热气留于小肠肠中痛。
瘅热焦渴。则坚干不得出。故痛而闭不通矣。
按大奇篇云。心脉搏滑急为心疝。帝曰。诊得心脉而急。此为何病。病形
何如。岐伯曰。病名心疝。少腹当有形也。帝曰。何以言之。岐伯曰。心为牝
藏。小肠为之使。故曰少腹当有形也。
实大相坚并有滑。舌强心惊语话难。
大。心脉也。滑。相火脉也。君火以宁。则相火以位。今心脉实大而滑。则君
相二火交煽于上舌乃心之苗。故舌强心惊。而语言謇涩矣。
单滑心热别无病。
滑为水中之火。相火脉也。今见于心部。别无兼见之证。则为君臣道合。
不过为之心热而已。
涩无心力不多言。
心主血脉又主言语。上文云。心脉平则声言爽气清矣。涩为血少。心部
而见涩脉。则为心血不足。而懒于言语。
沉紧心中逆冷痛。
沉紧为太阳寒水。心部面见沉紧。则为寒水之气。厥逆于上而心中冷
痛矣。所谓心中者。胃之上也。
弦时心急又心悬。
心主血脉。弦为寒。为收引。心脉弦。则经脉收引而急矣。经云。心脉弦。心
下有水气 。故曰又心悬。
All three positions exhibit a rapid pulse, indicating Heart Heat. Sores appear on the tongue, and the lips are cracked. The patient speaks deliriously and sees ghosts before their eyes. Drinking a hundred cups of water fails to quench the thirst.
A rapid pulse indicates Heat. When all three positions show a rapid pulse, it signifies that Heart Fire is blazing, spreading like a prairie fire. The tongue is the external manifestation of the Heart, and the lips are the external manifestation of the Spleen. When Fire flares up, Earth becomes dry; thus, sores appear on the tongue, and the lips crack. The Heart houses the Spirit (Shen). When Heart Heat is excessive, the Spirit becomes confused, causing the patient to see ghosts. Excessive Fire depletes Water, leading to an urge to drink water for self-rescue; hence, even after drinking a hundred cups, the thirst remains unquenched.
The Heart pulse presents as hollow (Kou), with Yang Fire producing sound. There may be simultaneous hematochezia and hematemesis.
The hollow pulse belongs to Yang Fire, which produces sound when it erupts. The hollow pulse primarily indicates blood loss. If the Heart pulse is hollow, Fire forces blood to flow recklessly out of its vessels. Consequently, when vomiting blood, there is a wheezing or rattling sound. Alternatively, the pathogen may transmit to the Fu organs, resulting in bloody diarrhea.
The pulse overflows past the Guan position, accompanied by bone pain, restlessness, and irritability, along with a red face and head.
Overflowing above the大鱼际 (Thenar eminence) is termed "Yi" (Overflow); entering below the Guan position is termed "Guan". Restlessness (Fan) originates from the Lung, while irritability (Zao) originates from the Kidney. Diagnosing the left Cun position where the pulse overflows upward to the thenar eminence and downward into the Guan region indicates that Heart Fire is blazing, spreading like a prairie fire. Overflowing upward burns the Lung Metal due to rising inflammation; descending into the Guan region involves the interaction of Wind and Fire. Rising inflammation burns the Lung, causing facial redness and restlessness; the interaction of Wind and Fire depletes Kidney Water, leading to irritability.
According to medical texts, Wang Shuhe's *Mai Jue* states: "Overflowing past the Guan position causes bone pain, restlessness, and irritability." Tong Zhenzi explains: "When the Heart pulse is vigorous and overflows the Guan position, the tendons become tight and bones constricted, causing bone pain." The Master said: "Tendon tightness leads to tendon spasms; how can it cause bone pain?" Therefore, when the Heart pulse is vigorous and causes bone pain, it is because the Heart belongs to Fire and the bones belong to Kidney Water. When the Heart pulse overflows the Guan position, Water cannot overcome Fire, and the scorching effect causes bone pain, rather than tendon tightness.
Great excess manifests as a red face and wind sensation. Dryness and pain present with a complexion similar to Heart conditions.
The Heart belongs to Fire, corresponding to the color Red. A solid pulse at the Heart position indicates Excess Fire in the Heart channel. The Heart's brilliance manifests in the face, and the Lung governs the skin and hair. Excessive Fire injures Metal (Lung), causing dry, painful skin and a red complexion.
A fine pulse indicates Cold deficiency, palpitations, and alternating cold and heat in the Heart.
Heart Qi deficiency leads to fright and apprehension. A fine pulse at the Heart position indicates insufficient Heart Fire. However, the Shaoyin channel has Cold as its superficial aspect and Heat as its root; thus, deficiency and apprehension manifest as alternating cold and heat symptoms.
An urgent pulse indicates intestinal pain and obstruction.
An urgent Heart pulse indicates Heart pathogenic factors interfering with the Small Intestine. Urgency represents Wind-Heat transmitting to the Small Intestine, causing obstruction and pain. The Classics state: "An urgent Heart pulse is called Heart Hernia, and there should be a visible mass in the lower abdomen." Additionally, the *Ju Tong Lun* states: "If Heat qi lingers in the Small Intestine, it causes intestinal pain. Severe heat causes dryness and thirst, making stool hard and dry, unable to pass, resulting in pain and constipation."
According to the *Da Qi Pian*: "A slippery, rapid, and urgent Heart pulse indicates Heart Hernia." The Yellow Emperor asked: "Diagnosing an urgent Heart pulse, what disease is this? What are the symptoms?" Qibo replied: "The disease is named Heart Hernia, and there should be a visible mass in the lower abdomen." The Yellow Emperor asked: "Why do you say so?" Qibo replied: "The Heart is a Yin organ, and the Small Intestine serves it; therefore, there should be a visible mass in the lower abdomen."
Solid, large, firm, and slippery pulses together indicate a stiff tongue, palpitations, and difficulty speaking.
The large pulse corresponds to the Heart, and the slippery pulse corresponds to Ministerial Fire. When Lord Fire is tranquil, Ministerial Fire maintains its proper position. Now, if the Heart pulse is solid, large, and slippery, both Lord and Ministerial Fire are stirring excessively in the upper body. The tongue is the sprout of the Heart; thus, the tongue becomes stiff, palpitations occur, and speech becomes slurred.
A solitary slippery pulse indicates Heart Heat without other diseases.
The slippery pulse is Fire within Water, i.e., Ministerial Fire. If seen alone at the Heart position without other accompanying signs, it indicates harmony between Lord and Minister, manifesting merely as Heart Heat.
A choppy pulse indicates deficient Heart Qi and reluctance to speak.
The Heart governs Blood vessels and speech. As stated earlier: "A peaceful Heart pulse results in clear voice and fresh breath." A choppy pulse indicates Blood deficiency. A choppy pulse at the Heart position indicates insufficient Heart Blood, leading to a reluctance to speak.
A deep and tight pulse indicates reverse-cold pain in the Heart region.
Deep and tight pulses belong to Taiyang Cold Water. Seeing a deep and tight pulse at the Heart position indicates that Cold Water Qi rebels upward, causing cold pain in the Heart region. The term "Heart region" refers to the area above the Stomach.
A wiry pulse indicates occasional Heart anxiety and a feeling of emptiness in the chest.
The Heart governs Blood vessels. The wiry pulse indicates Cold and contraction/restriction. A wiry Heart pulse means the meridians contract and become tense. The Classics state: "A wiry Heart pulse indicates Water Qi under the Heart." Hence, there is also a feeling of emptiness or suspension in the Heart.