或问古人以三部分别脏腑。而大小二肠之脉。或隶之于两寸。或隶之于两尺。未审孰是孰非。愿示一定之
理。以解学人之惑。答曰。皆是也。皆非也。似是而非者也。缘经无显论。所以拟议无凭。要知两手三部。
咸非脏腑定位。不过假道以行诸经之气耳。观灵枢经脉。虽各有起止。各有支别。而实一气相通。故特
借手太阴一经之动脉。以候五脏六腑十二经之有余不足。其经虽属于肺。实为胃气所主。以脏腑诸气。靡不本
之于胃也。五脏别论云。气口何以独为五脏主。胃者水谷之海。六腑之大源也。五味入口。藏于胃。以养五
脏气。气口亦太阴也。是以五脏六腑之气。皆出于胃。变见于气口。经脉别论云。食气入胃。经气归于肺。
肺朝百脉。气归于权衡。权衡以平。气口成寸。以决死生。营卫生会云。人食气于谷。谷入于胃。以传
于肺。五脏六腑。皆以受气。其清者为营。浊者为卫。营行脉中。卫行脉外。即此三段经文。可以默识其微矣
。或言两手六部。既非脏腑脉位。何脉要精微论中有逐部推之之法耶。曰。此即所谓假道以行诸经之气耳。吴
草庐曰。医者以寸关尺。辄名之曰此心脉。此肺脉。此脾脉。此肝脉。此肾脉者。非也。五脏六腑。凡十二经。
两寸关尺。皆手太阴之一脉也。分其部位。以候他脏之气耳。脉行始于肺。终于肝。而复会于肺。肺为出气之
门户。故名气口。而为六脉之大会。以占一身焉。李濒湖曰。两手六部。皆肺之经脉。特取以候五脏六腑之气
耳。非五脏六腑所居之处也。即内经所指脏腑部位。乃是因五行之气而推。火旺于南。故心居左寸。木旺于东。
故肝居左关。金旺于西。故肺居右寸。土旺于中。而寄位西南。故脾胃居于右关。水旺于北。故居两尺。人面南。
司天地之化。则左尺为东北也。东北为天地始生之界。人在胎息之中。则两肾先生。以故肾曰先天。在五行则
天一生水。水性东行。膀胱为水注之器。肾司北方之令。又居下部。则其气化从此而推也宜矣。然肾本有二。
同居七节左右。右者独非肾乎。独不主精气乎。独不司闭蛰封藏之令乎。盖人身同乎造物。凡呼吸运动。禀
乎干健。脏腑躯壳。合于坤舆。以分野言。则肾当箕尾燕冀之界。其地风高土浓。水都潜行地中。结成煤火
。以司腐熟之权。
人应其气。则三焦之火。从此交通。况三焦鼎峙两肾之间。以应地运而右转。是虽右尺偏相火。为生人生物
之源。因有命门之
号。其实两肾皆有水火。原无分于彼此。以故岐伯于寸关二部。俱分左右。尺独不分者。一皆主乎肾也。肾为
先天一气之始。故首言尺内两旁。则季胁也。尺外以候肾。尺里以候腹。腹者。大小二肠在其中矣。膀胱亦在
其中矣。以经气言之。平居无病之时。则二肠之气。未尝不随经而之寸口也。以病脉言之。则二肠司传化之任
。病则气化不顺。而为留滞。又必验之于尺矣。曷观长沙论中。凡正阳明腑证。必尺中有力。方用承气。此非
尺里以候腹之一验乎。吾故曰。皆是也。皆非也。似是而非者也。盖尺外者。尺脉之前半部也。尺里者。尺脉
之后半部也。前以候阳。后以候阴。人身背为阳。肾附于背。故外以候肾。腹为阴。故里以候腹也。东方生木
。木应肝而藏于左。故借左关以候肝胆之气。土居中位而旺于四季。独以长夏湿土气蒸之时。为之正令。故经以
之分隶右关。所谓中附上。左外以候肝。内以候膈。右外以候胃。内以候脾。膈者。膈膜之谓。中焦所主
。胆在中矣。中附上者。附尺之上而居于中。即关脉也。肝为阴中之阳脏。亦附近于背。故借左关之外以候肝。
内以候膈。右关之前以候胃。后以候脾。脾胃皆中州之官。以脏腑言。则胃为阳。脾为阴。故外以候胃。内以
候脾也。火生于木而应乎心。合乎脉。谓之牡脏。牡者阳也。左为阳。寸为阳中之阳。故宜候之左寸。金生
于土而应乎肺。与胃一气贯通。而主西方金气。故经以之候于右寸。所云上附上。右外以候肺。内以候胸中
。左外以候心。内以候膻中。膻中者。心主之宫城。胞络之别名。胸中者。膈膜之上皆是也。上附上者。言上
而又上。则寸口也。五脏之位。惟肺最高。故右寸之前以候肺。后以候胸中。心为虚灵之脏。而为君主之火。
性喜上炎。又喜附木而燔。然其行令。皆属胞络。故左寸之前以候心。后以候膻中之气也。详本篇六部。但
言五脏。不及六腑。而独不遗其胃者。以经络五脏。皆禀气于胃。五脏之本也。脏气不能自致于手太阴。必因胃气乃至
手太阴也。原夫两手六部。虽
皆肺经之一脉。而胃气实为之总司。足阳明一经。与诸经经经交贯。为后天气血之本源。即先天之气。亦必从
此而化。每见阴虚血耗之人。日服六味四物。不得阳生之力。则阴无由而长也。或问六部皆属肺经。皆主胃气
。以推脏腑之病。敬闻命矣。而灵枢十二经。独以人迎寸口言者。何也。曰。此辨别脏腑诸经之盛衰。及外内
诸邪之纲主也。夫寸口即是气口。又谓脉口。以配人迎。昔人所谓关前一分。人命之主。即此脉也。复问其后诸经
之脉。又以三倍再倍一倍言者。此又何耶。曰。三阴三阳之谓也。逆其旨。则手足太阴谓之三阴。故盛者寸口
大三倍于人迎。手足少阴谓之二阴。故盛者寸口大再倍于人迎。手足厥阴谓之一阴。故盛者寸口大一倍于人迎。
在阳经则不然。其手足阳明谓之二阳。以二经所主津液最盛。故盛者人迎大三倍。手足太阳谓之三阳。以二经
所主津液差少。故盛者人迎只大再倍。手足少阳谓之一阳。以二经所主津液最少。故盛者人迎仅大一倍也。或
言人迎主表。气口主里。此言人迎主腑。气口主脏者。何也。盖人迎主表。气口主里。是主邪气而言。
人迎盛坚者伤于寒。气口盛坚者伤于食也。此言人迎主腑。气口主脏。是指经气而言。原未尝指腑脏也。以人
迎主在津血。津血灌注六腑。而偏丽于左。气口主在神气。神气钟于五脏。而偏丽于右。此阴阳血气流行之
道。以上下言之。则寸为阳。尺为阴。以左右言之。则人迎为阳。气口为阴。须知人之血气。与流水无异。
水性东行。若得风涌。即随之而逝。不可拘于南北也。人身经脉营运亦然。虽血喜归肝。气喜行脾。而有左右
之属。若得其火。即随之而上炎。得其风。则随之而外扰。变幻之机。靡所不至。岂复拘于部分哉。
A question was asked: The ancients used the three positions (cun, guan, chi) to distinguish the zang and fu organs. However, the pulse positions of the large intestine and small intestine are sometimes attributed to the two cun positions, and sometimes to the two chi positions. It is unclear which is correct and which is incorrect. I wish to be shown a definite principle to resolve the confusion of learners.
The answer is: All these statements are correct, and all are incorrect; they are seemingly right but actually wrong. This is because the classics do not contain explicit discussions, so speculation lacks a basis. One must understand that the three positions (cun, guan, chi) on both hands are not fixed locations for the zang and fu organs. They merely serve as a channel through which the qi of the various meridians flows. Observing the *Ling Shu* (Spiritual Pivot) chapter on Meridians, although each meridian has its own starting and ending points and branches, in reality, they are connected by a single qi. Therefore, the artery of the Hand-Taiyin Lung meridian is specifically borrowed to observe the excess or deficiency of the qi of the five zang organs, six fu organs, and twelve meridians. Although this meridian belongs to the lung, it is actually governed by Stomach Qi, because the qi of all zang and fu organs originates from the Stomach. The *Su Wen* (Plain Questions) chapter "Differentiation of Zang Organs" states: "Why can the Qikou (Cunkou) alone serve as the master of the five zang organs? Because the Stomach is the sea of water and grain, and the great source of the six fu organs. When the five flavors enter the mouth, they are stored in the Stomach to nourish the qi of the five zang organs. The Qikou also belongs to the Taiyin meridian. Thus, the qi of the five zang organs and six fu organs all emerge from the Stomach and manifest at the Qikou." The *Su Wen* chapter "Differentiation of Meridians" states: "When food qi enters the Stomach, the meridian qi returns to the Lung. The Lung directs the hundred vessels, and the qi returns to the balance scale. When the balance scale is level, the Cunkou pulse is formed, and life and death are determined thereby." The *Ling Shu* chapter "Meeting of Ying and Wei" states: "Humans obtain qi from grain. Grain enters the Stomach and is transmitted to the Lung. The five zang organs and six fu organs all receive qi from it. The clear part becomes Ying (Nutritive) Qi, and the turbid part becomes Wei (Defensive) Qi. Ying Qi circulates within the vessels, and Wei Qi circulates outside the vessels." From these three passages of scripture, one can silently comprehend their subtleties.
Someone asks: If the six positions on both hands are not the pulse positions of the zang and fu organs, why does the *Mai Yao Jing Wei Lun* (Treatise on the Essence and Subtlety of Pulse Diagnosis) have methods for deducing them position by position?
The answer is: This is what is meant by "borrowing a channel to allow the qi of the various meridians to flow." Wu Caolu said: Physicians who immediately name the Cun, Guan, and Chi positions as "this Heart pulse," "this Lung pulse," "this Spleen pulse," "this Liver pulse," and "this Kidney pulse" are incorrect. The five zang organs and six fu organs comprise twelve meridians. The Cun, Guan, and Chi are merely one pulse of the Hand-Taiyin Lung meridian. The positions are divided to observe the qi of other zang organs. Pulse qi begins in the Lung, ends in the Liver, and reunites in the Lung. The Lung is the portal for outgoing qi, hence it is called Qikou, and is the grand assembly of the six pulses, used to assess the whole body. Li Binhu said: The six positions on both hands are all meridians of the Lung, specifically taken to observe the qi of the five zang organs and six fu organs, not the places where the five zang organs and six fu organs reside. The zang and fu positions indicated in the *Nei Jing* (Inner Canon) are deduced based on the qi of the Five Phases. Fire prospers in the South, so the Heart resides in the Left Cun. Wood prospers in the East, so the Liver resides in the Left Guan. Metal prospers in the West, so the Lung resides in the Right Cun. Earth prospers in the Center and is entrusted with the Southwest, so the Spleen and Stomach reside in the Right Guan. Water prospers in the North, so it resides in the two Chi positions. A person faces south, governing the transformation of heaven and earth, so the Left Chi corresponds to the Northeast. The Northeast is the boundary where heaven and earth begin to generate. Within the fetal breath, the two Kidneys are born first, thus the Kidney is called Congenital. In the Five Phases, Heaven generates Water first. Water nature flows eastward. The Bladder is the vessel where water gathers. The Kidney governs the orders of the North and resides in the lower part, so its qi transformation is appropriately deduced from here. However, there are originally two Kidneys, residing left and right of the seventh vertebral segment. Is the right one not a Kidney? Does it not govern essence and qi? Does it not manage the orders of closure, hibernation, and storage? Generally, the human body is akin to creation. All breathing and movement are endowed with the strength of Qian (Heaven/Active). The zang and fu organs and the body shell conform to Kun (Earth/Yielding). From the perspective of geographical division, the Kidney corresponds to the boundary of the Ji, Wei, Yan, and Ji asterisms/regions. There, the wind is high and the soil is thick. Water runs secretly underground, forming coal fire, to manage the power of rotting and ripening. Humans respond to this qi, so the Fire of the San Jiao (Triple Burner) communicates from here. Moreover, the San Jiao stands between the two Kidneys, turning to the right to correspond to the movement of the earth. Although the Right Chi predominantly governs Ministerial Fire, serving as the source of generating humans and things, hence having the title of Mingmen (Gate of Life), in truth, both Kidneys possess both Water and Fire, originally without distinction between each other. Therefore, when Qibo discussed the Cun and Guan positions, he distinguished left and right for both, but did not distinguish left and right for the Chi position alone, because both are governed by the Kidney. The Kidney is the beginning of the original congenital qi, hence it is first stated that "inside the Chi position on both sides are the costal margins. Outside the Chi position observes the Kidney, inside the Chi position observes the abdomen." The abdomen contains the large and small intestines, and also the Bladder. Speaking from the perspective of meridian qi, when healthy and free of disease, the qi of the two intestines does not fail to reach the Cunkou along the meridians. Speaking from the perspective of pathological pulses, the two intestines are responsible for transmission and transformation. When diseased, qi transformation is unsmooth, leading to stagnation, and verification must be sought at the Chi position. Why not look at Zhang Zhongjing's *Shang Han Lun* (Treatise on Cold Damage)? In cases of proper Yangming Fu syndrome, the Chi pulse must be forceful before using Chengqi Decoction. Is this not a verification of "the inside of the Chi position observes the abdomen"? Therefore, I say: All are correct, all are incorrect, they are seemingly right but actually wrong. "Outside the Chi" refers to the anterior half of the Chi pulse; "Inside the Chi" refers to the posterior half of the Chi pulse. The anterior part observes Yang, and the posterior part observes Yin. The back of the body is Yang, and the Kidney attaches to the back, so the outer part observes the Kidney. The abdomen is Yin, so the inner part observes the abdomen.
The East generates Wood. Wood corresponds to the Liver and is stored on the left, so the Left Guan is borrowed to observe the qi of the Liver and Gallbladder. Earth occupies the central position and prospers in the four seasons, but exclusively during the late summer when damp earth qi steams, it holds its main command. Hence, the classics assign it to the Right Guan. What is referred to as "Zhong Fu Shang" (Attached in the Middle): The left outer part observes the Liver, and the inner part observes the Diaphragm. The right outer part observes the Stomach, and the inner part observes the Spleen. The Diaphragm refers to the diaphragmatic membrane, which is governed by the Middle Jiao, and the Gallbladder is within it. "Zhong Fu Shang" means attached above the Chi and situated in the middle, i.e., the Guan pulse. The Liver is a zang organ that is Yin within Yang, and is also near the back, so the outer part of the Left Guan is borrowed to observe the Liver, and the inner part to observe the Diaphragm. The anterior part of the Right Guan observes the Stomach, and the posterior part observes the Spleen. The Spleen and Stomach are both officials of the Central Province. From the perspective of zang and fu attributes, the Stomach is Yang and the Spleen is Yin, so the outer part observes the Stomach, and the inner part observes the Spleen.
Fire is born from Wood and corresponds to the Heart, harmonizing with the pulse, called Mu Zang (Yang Organ). Mu means Yang. The Left is Yang, and the Cun is Yang within Yang, so it is appropriate to observe it at the Left Cun. Metal is born from Earth and corresponds to the Lung, penetrating with the Stomach in one qi, and governing Western Metal qi, so the classics use it to observe at the Right Cun. What is referred to as "Shang Fu Shang" (Attached Above): The right outer part observes the Lung, and the inner part observes the Chest. The left outer part observes the Heart, and the inner part observes the Danzhong (Sea of Qi). Danzhong is the palace city of the Pericardium, another name for the Bao Luo (Uterus/Pericardium network). The Chest refers to everything above the diaphragmatic membrane. "Shang Fu Shang" means upper and then upper, i.e., the Cunkou. Among the five zang organs, only the Lung is highest, so the anterior part of the Right Cun observes the Lung, and the posterior part observes the Chest. The Heart is a hollow and spiritual organ, and is the Fire of the Sovereign. Its nature likes to flare upward and likes to attach to Wood to burn. However, its execution of functions belongs to the Pericardium. Therefore, the anterior part of the Left Cun observes the Heart, and the posterior part observes the qi of the Danzhong.
Detailed examination of the six positions in this chapter mentions only the five zang organs and omits the six fu organs, yet uniquely does not omit the Stomach. This is because the meridians and five zang organs all receive qi from the Stomach; the Stomach is the root of the zang organs. Zang qi cannot reach the Hand-Taiyin meridian by itself; it must arrive at the Hand-Taiyin via Stomach Qi. Originally, although the six positions on both hands are all one pulse of the Lung meridian, Stomach Qi is actually the general manager. The Foot-Yangming Stomach meridian interweaves with the various meridians and is the root source of postnatal blood and qi. Even congenital qi must transform from here. It is often seen that people with yin deficiency and blood depletion, taking Liuwei Dihuang Wan and Siwu Decoction daily, do not gain the power of yang generation, thus yin has no way to grow.
Someone asks: The six positions all belong to the Lung meridian and all govern Stomach Qi, used to deduce diseases of the zang and fu organs. I respectfully heed your instructions. But why does the *Ling Shu* discuss the twelve meridians solely in terms of Yingkou and Cunkou?
The answer is: This is the general principle for distinguishing the prosperity and decline of the various meridians of the zang and fu organs, and for external and internal pathogens. Cunkou is indeed Qikou, also called Maikou, paired with Yingkou. The ancients referred to as "one fen before the Guan, the master of human life," referring to this pulse. Further inquiry: Why do the subsequent meridians speak of three times, twice, and once in magnitude?
The answer is: This refers to the Three Yin and Three Yang. Deviating from the norm (pathological excess), Hand and Foot Taiyin are called Three Yin, so when excessive, the Cunkou is three times larger than the Yingkou. Hand and Foot Shaoyin are called Two Yin, so when excessive, the Cunkou is twice as large as the Yingkou. Hand and Foot Jueyin are called One Yin, so when excessive, the Cunkou is one time larger than the Yingkou. For the Yang meridians, it is different. Hand and Foot Yangming are called Two Yang, because these two meridians govern the most abundant fluids and blood, so when excessive, the Yingkou is three times larger than the Cunkou. Hand and Foot Taiyang are called Three Yang, because these two meridians govern slightly less fluids and blood, so when excessive, the Yingkou is only twice as large as the Cunkou. Hand and Foot Shaoyang are called One Yang, because these two meridians govern the least fluids and blood, so when excessive, the Yingkou is merely one time larger than the Cunkou.
Some say Yingkou governs the exterior, and Qikou/Cunkou governs the interior. Here it says Yingkou governs the Fu organs, and Qikou/Cunkou governs the Zang organs. Why?
The answer is: Saying Yingkou governs the exterior and Qikou/Cunkou governs the interior refers to pathogenic factors. An excess and firmness at the Yingkou indicates injury from cold; an excess and firmness at the Qikou/Cunkou indicates injury from food. Saying Yingkou governs the Fu organs and Qikou/Cunkou governs the Zang organs refers to meridian qi, and originally does not refer to specific zang or fu organs. Yingkou governs fluids and blood; fluids and blood irrigate the six fu organs and lean towards the left. Qikou/Cunkou governs spirit and qi; spirit and qi concentrate in the five zang organs and lean towards the right. This is the pathway of the circulation of yin-yang, blood, and qi. Speaking from top to bottom, Cun is Yang and Chi is Yin. Speaking from left to right, Yingkou is Yang and Qikou/Cunkou is Yin. One must know that human blood and qi are no different from flowing water. Water nature flows eastward; if stirred by wind, it follows and departs. One cannot be rigid about north and south. The operation of human meridians is likewise. Although blood likes to return to the Liver and qi likes to travel through the Spleen, there are left-right affiliations. If it obtains fire, it follows and flares upward; if it obtains wind, it follows and disturbs externally. The mechanisms of change are limitless. How could one be confined to specific positions?