六部之脉,候之寸、关、尺,出于《脉要精微篇》。左寸以候心,左关以候肝,左尺以候肾;右寸以候
肺,右关以
候脾,右尺以候命门,以明六部各有所属。究之候脉,分而不分,不分而分,则得诀矣。《脉经》曰∶“春弦
夏洪秋似毛,冬石根据经分节气。婀婀缓若春杨柳,此是脾家居四季。”假如春脉弦,岂有肝脉弦而余脉不弦之
理乎?弦则俱弦,不过言春乃肝气主事,非谓独候之左关。但得浮洪,即属心火,不必定拘左寸;但得短涩,
即属肺金,不必定拘右寸;但得沉细,即属肾水,不必定拘左尺;但得和缓,即属脾土,不必定拘右关。五脏
之脉分,五脏之部不分也。是以伤寒之脉,仲景一书曰浮、曰紧、曰长、曰弦、曰沉、曰微、曰伏、曰代,
但统分脉之浮、紧、长、弦、沉、微、伏、代,并未专指何经。内伤之脉,叔和一书,失血宜沉细,不宜浮紧
;水症宜浮大,不宜沉伏;上气宜浮滑,不宜沉数;腹痛宜沉伏,不宜浮洪;消渴宜数大,不宜虚细;咳嗽宜
浮缓,不宜细数。但分脉之宜与不宜,亦不必辨其何脏,此其明白可证者也。要须知先天一点真阳之火,潜于
水中,寄居两尺,在右火用事,水为之涵。火生土,是为脾土,居右关;土生金,是为肺金,居右寸。在左水
用事,火为之温。水生木,是为肝木,居左关;木生火,是为心火,居左寸。自无而生有,由下而生上,各有
其位而不可易者。《难经》曰∶“取寸口以诀五脏六腑之死生吉凶。”寸口者,手太阴之动脉。《内经》曰∶
“心脉满大,痫螈筋挛;肝脉小急,痫螈筋挛;肾脉小急,肝脉小急,心脉小急,不鼓皆为瘕;肾肝并沉为石水,并
浮为风水。”此又于部分之间,而别有会心者。分而不分,不分而分,神而明之,存乎其人。
六部脉的诊察,是在寸、关、尺三个部位进行的,这一理论出自《黄帝内经·素问》的《脉要精微论》。左手寸口脉用来诊察心脏,左手关部脉用来诊察肝脏,左手尺部脉用来诊察肾脏;右手寸口脉用来诊察肺脏,右手关部脉用来诊察脾脏,右手尺部脉用来诊察命门(即肾间动气,为元气之根),以此明确六部脉各自对应的脏腑归属。然而究其诊脉之道,既要分部候诊,又不能机械地局限于分部,要在“分”与“不分”之间灵活把握,才算掌握了精髓。
王叔和所著的《脉经》中说:“春季脉象多弦,夏季脉象多洪,秋季脉象浮而如毛,冬季脉象沉而如石,这些都要根据节气来区分。脉象柔和缓急如同春天的杨柳,这是脾土之气寄旺于四季末月各十八天的表现。”假如春季脉象表现为弦脉,难道只有肝脉是弦脉而其他脉不是弦脉的道理吗?实际上春季所有脉象都可能带弦意,这不过是因为春季是肝气主事的时候,并非指只诊察左关部就能代表肝脉。只要脉象出现浮洪,就属于心火范畴,不必拘泥于左寸部;只要脉象出现短涩,就属于肺金范畴,不必拘泥于右寸部;只要脉象出现沉细,就属于肾水范畴,不必拘泥于左尺部;只要脉象出现和缓,就属于脾土范畴,不必拘泥于右关部。五脏的脉象特征是有区别的,但五脏在脉位上的对应关系又不是绝对割裂的。
因此,关于伤寒病的脉象,张仲景在《伤寒论》中提到的有浮脉、紧脉、长脉、弦脉、沉脉、微脉、伏脉、代脉等,他只是总体区分了这些脉象的特征,并没有专门指定某一种脉象只属于某一条经络。关于内伤病的脉象,王叔和在书中指出:失血患者适宜见沉细脉,不适宜见浮紧脉;水肿患者适宜见浮大脉,不适宜见沉伏脉;气逆上冲患者适宜见浮滑脉,不适宜见沉数脉;腹痛患者适宜见沉伏脉,不适宜见浮洪脉;消渴病患者适宜见数大脉,不适宜见虚细脉;咳嗽患者适宜见浮缓脉,不适宜见细数脉。这里只是区分了脉象的适宜与不适宜,也不必非要辨别是哪一脏出了问题,这是非常明白可以证明的。
必须要知道,先天的一点真阳之火,潜藏在水中,寄居于两尺部。在右侧,火气发挥作用,由水来涵养它。火生土,这就是脾土,位于右关部;土生金,这就是肺金,位于右寸部。在左侧,水气发挥作用,由火来温煦它。水生木,这就是肝木,位于左关部;木生火,这就是心火,位于左寸部。从无到有,由下而上,各有其固定的位置而不可改变。《难经》说:“通过诊察寸口脉来判断五脏六腑的死生吉凶。”寸口脉,是手太阴肺经的动脉。《黄帝内经》说:“心脉满大,会出现癫痫抽搐、筋脉拘挛;肝脉小且急,会出现癫痫抽搐、筋脉拘挛;肾脉小且急,肝脉小且急,心脉小且急,如果脉搏跳动不鼓指,都会形成瘕积(腹内结块);肾脉和肝脉都沉,是石水病;都浮,是风水病。”这又是在分部诊脉之外,另有心得的地方。所谓分而不分,不分而分,神妙而通达,关键在于诊脉者本人的领悟。
The examination of the six positions (Liu Bu Mai, pulse positions at the wrist) is conducted at the Cun (Inch), Guan (Bar), and Chi (Cubit) locations, a theory originating from the *Mai Yao Jing Wei Pian* (Chapter on the Essentials of Pulse Diagnosis in the *Huangdi Neijing*). The left Cun position corresponds to the Heart, the left Guan position to the Liver, and the left Chi position to the Kidney; the right Cun position corresponds to the Lung, the right Guan position to the Spleen, and the right Chi position to the Mingmen (Gate of Life, representing the source of Yuan Qi). This clarifies that each of the six positions has its specific organ correspondence. However, in practice, one must understand both differentiation and non-differentiation; grasping the interplay between "dividing" and "not dividing" constitutes the true secret of pulse diagnosis.
The *Mai Jing* (Pulse Classic) states: "Spring pulses are wiry, summer pulses are surging, autumn pulses resemble down (floating), and winter pulses resemble stone (deep); these distinctions follow the solar terms. Gentle and moderate like spring willows indicates the Spleen Earth flourishing during the last eighteen days of each season." If the spring pulse is wiry, does it imply that only the Liver pulse is wiry while others are not? In reality, all pulses may exhibit wiriness in spring, merely indicating that Liver Qi dominates the season, not that only the left Guan position reflects the Liver. If a floating and surging pulse is detected, it belongs to Heart Fire, without being restricted to the left Cun position; if a short and choppy pulse is found, it belongs to Lung Metal, without being restricted to the right Cun position; if a deep and fine pulse is present, it belongs to Kidney Water, without being restricted to the left Chi position; if a harmonious and moderate pulse is observed, it belongs to Spleen Earth, without being restricted to the right Guan position. The pulse characteristics of the five Zang organs are distinct, yet their positional correspondences are not rigidly isolated.
Therefore, regarding Shaoyin disease (Shanghan), Zhang Zhongjing’s *Shanghan Lun* mentions floating, tight, long, wiry, deep, faint, hidden, and intermittent pulses. He generally categorizes these pulse types without assigning them exclusively to specific meridians. Regarding internal injury diseases, Wang Shuhe’s works indicate: for hemorrhage, a deep and fine pulse is appropriate, whereas a floating and tight pulse is inappropriate; for edema, a floating and large pulse is appropriate, whereas a deep and hidden pulse is inappropriate; for rebellious Qi, a floating and slippery pulse is appropriate, whereas a deep and rapid pulse is inappropriate; for abdominal pain, a deep and hidden pulse is appropriate, whereas a floating and large pulse is inappropriate; for Xiao Ke (Wasting-Thirst), a rapid and large pulse is appropriate, whereas a deficient and fine pulse is inappropriate; for cough, a floating and moderate pulse is appropriate, whereas a fine and rapid pulse is inappropriate. These guidelines distinguish suitable from unsuitable pulses without necessarily identifying the specific affected Zang organ, which is clearly demonstrable.
One must recognize that the primordial fire of Yang, inherent in congenital constitution, resides within Water, dwelling in the two Chi positions. On the right side, Fire functions under the nourishment of Water. Fire generates Earth, which is Spleen Earth, located at the right Guan position; Earth generates Metal, which is Lung Metal, located at the right Cun position. On the left side, Water functions under the warming influence of Fire. Water generates Wood, which is Liver Wood, located at the left Guan position; Wood generates Fire, which is Heart Fire, located at the left Cun position. From non-being to being, from lower to upper, each has its fixed position and cannot be altered. The *Nan Jing* (Classic of Difficult Issues) states: "By examining the Cun Kou (Radial Artery), one can determine the life, death, auspiciousness, and misfortune of the five Zang and six Fu organs." Cun Kou refers to the pulsating artery of the Hand Taiyin Lung Meridian. The *Nei Jing* (Inner Canon) states: "If the Heart pulse is full and large, epilepsy with convulsions and tendon spasms occur; if the Liver pulse is small and urgent, epilepsy with convulsions and tendon spasms occur; if the Kidney, Liver, or Heart pulses are small and urgent, and do not beat vigorously against the finger, masses (Jia) will form; if both Kidney and Liver pulses are deep, it indicates Shi Shui (Stone Water); if they are both floating, it indicates Feng Shui (Wind Water)." This represents another level of insight beyond mere positional diagnosis. The principle of "differentiating yet not differentiating, not differentiating yet differentiating," understood spiritually and intelligently, depends entirely on the practitioner.