寸口脉为一身营卫之主。设非胃气。何以上输津液而分布营卫。趺阳者。正阳也。居中
土为
五行之母。是持脉必以胃气为本。少阴属肾。肾为水脏。与三焦合为一气。人身之真水真火
。根
蒂于此。水赖土制。少阴必得趺阳镇伏。而后能交合三焦。蒸布津液。经曰少阴负趺阳者顺
也。
趺阳以候胃气。为中焦之主。少阴以候肾气。为下焦之主。实与寸口脉分发上中下三部。按
叔和脉诀。以冲阳穴在足跗上五寸。骨间动脉上去陷谷三寸者。为趺阳之诊。然脉法未有按
足之明文。且本论明言脉有三部。阴阳相乘。又何以言寸口而不及关尺。则知两关主中焦。
脾胃之所司。即趺阳之诊。两尺主下焦。肾之所司。即少阴之诊。趺阳诊在关。以右统左。
少阴诊在尺。以左统右。亦犹寸口脉之专主手太阴也。欲明趺阳少阴之诊。还在三部内推详
。
门人问曰。仲景云。阴病见阳脉者生。阳病见阴脉者死。世遂谓仲景之书。专主扶阳而
抑阴
。然与答曰。此阴阳二字。只须就表里虚实上讲。凡邪之中人。在表为轻。在里为重。出表
为顺。入里为逆。阴病见阳脉。则里邪有出表之机。故主生。阳病见阴脉。则表邪有陷里之
势。故主死。大浮动数滑五者为阳脉。阳脉主表主实。阴病见阳脉。则正复而邪自退。病虽
重可生。沉涩弱弦微五者为阴脉。阴脉属里属虚。阳病见阴脉。则正衰而邪孰御。病虽轻亦
死。阳病本主生。然见阴脉。则生中伏有死机。阴病本主死。然见阴脉则死中具有生路。两见
字即中庸莫见乎隐。莫显乎微之义。临病之工。可不知戒惧乎。至于扶阳抑阴。乃是元明以
来相沿之陋说。易言一阴一阳之谓道。阳统乎阴。然而阳亢有悔。阴承乎阳。然而阴疑必战
。故经云。阴平阳秘。精神乃治。所谓病者。悉由乎阴阳之偏也。仲景治病诸法。第就其阴
阳之偏胜者。剂其偏而病自已。故有时阳气亢极。但用纯阴之剂。不杂一毫阳药。非毗于阴
也。育阴正以剂阳。有时阴气盛极。但用纯阳之剂。不杂一毫阴药。非毗于阳也。扶阳正以
剂阴。其有阴阳气虽偏胜。而尚未至于偏极者。阳药方中。必少加阴药以存津。阴药方中。
必少加阳药以化气。虽有时寒热互投。补泻兼进。似乎处方之甚杂。其实原乎阴阳互根之理
。
剂其偏胜以协于中。人受中以生。圣人之道。中道也。后世圣道不明。流为曲说。因之丹溪
有阴常不足阳常有余之论。景岳辟丹溪。而又为阳常不足阴常有余之论。则学人漫无适从
而惑滋甚矣。内经生气通天论。明言生之气本于阴阳。其论司天运气治诸胜复之法。则但曰
。寒者热之。热者寒之。温者清之。清者温之。无问其数。以平为期。是明言阴阳贵得其平
矣。仲景之
学。直接轩岐。历圣相传之道。不外一中。偏阴偏阳。总属邪说。读仲景书。当在中字上着
眼。
寸口脉是全身营卫之气的主宰。如果没有胃气,津液如何能上输并分布到营卫之中?趺阳脉属于正阳经,位居中土,是五行之母。因此,诊脉必须以胃气为根本。少阴脉归属于肾,肾是水脏,与三焦合为一气。人身中的真水和真火,其根基就在此处。水需要土的制约,少阴脉必须得到趺阳脉的镇伏,才能与三焦交合,蒸腾布散津液。《内经》说:“少阴脉弱于趺阳脉者,为顺证。”
趺阳脉用于候察胃气,是中焦的主管;少阴脉用于候察肾气,是下焦的主管。这实际上与寸口脉分部对应上、中、下三部是一致的。按照王叔和的《脉诀》,冲阳穴位于足背上方五寸,骨间动脉处,距离陷谷穴三寸,以此作为趺阳脉的诊断部位。然而,脉法中并没有明确说明要按压足部脉搏。况且《伤寒论》原文明确指出脉有三部(寸、关、尺),阴阳相互影响,如果只提寸口而不提及关部和尺部,这就知道两关部主管中焦,由脾胃所司,即相当于趺阳脉的诊断部位;两尺部主管下焦,由肾脏所司,即相当于少阴脉的诊断部位。趺阳脉的诊断在关部,以右脉统摄左脉;少阴脉的诊断在尺部,以左脉统摄右脉。这也如同寸口脉专门主掌手太阴肺经一样。想要明白趺阳和少阴的诊断,还需要在寸关尺三部之内进行推究详析。
门人问道:张仲景说:“阴病见到阳脉者生,阳病见到阴脉者死。”世人于是认为张仲景的书专主扶持阳气而抑制阴气。对此我回答说:这里的“阴阳”二字,只需从表里虚实上来理解。凡是邪气侵入人体,在表为轻,在里为重;邪气出表为顺,入里为逆。阴病见到阳脉,说明里邪有向外透达的趋势,所以主生。阳病见到阴脉,说明表邪有内陷的趋势,所以主死。浮、洪、大、数、滑五种脉象属于阳脉,阳脉主表、主实。阴病见到阳脉,说明正气恢复而邪气自然退却,病情虽然严重也可以痊愈。沉、涩、弱、弦、微五种脉象属于阴脉,阴脉属里、属虚。阳病见到阴脉,说明正气衰败而邪气无人抵御,病情虽然轻微也会死亡。阳病本应主生,但如果见到阴脉,则生机中潜伏着死机;阴病本应主死,但如果见到阳脉(注:原文此处逻辑似有误或特指某种语境,通常阴病见阳脉为生,但结合上下文“然见阴脉则死中具有生路”可能是笔误或特定语境,此处依原文翻译:阴病本主死,但若理解为阴病见阳脉则有生机,或者原文意指若阳病见阴脉则死,阴病见阳脉则生,此处原文表述较为绕口,直译为:阴病本主死,但若出现转机(隐含意)则死中具有生路)。这两个“见”字,即体现了《中庸》中“莫见乎隐,莫显乎微”的含义。临证医生,怎能不警惕戒惧呢?至于扶持阳气、抑制阴气,那是元明以来沿袭的陋说。《易经》说:“一阴一阳之谓道。”阳统率阴,然而阳亢盛会有悔恨;阴承顺阳,然而阴过盛会必致交战。所以《内经》说:“阴平阳秘,精神乃治。”所谓疾病,都是由阴阳偏胜造成的。张仲景治疗疾病的各种方法,只是针对其阴阳偏胜的情况,权衡其偏颇,病自然痊愈。所以有时阳气亢极,只用纯阴的方剂,不夹杂丝毫阳药,这不是偏向于阴,而是滋养阴气以调和阳气;有时阴气盛极,只用纯阳的方剂,不夹杂丝毫阴药,这不是偏向于阳,而是扶持阳气以调和阴气。那些阴阳之气虽然偏胜,但尚未达到极端的人,在阳药方中,必定少量加入阴药以保存津液;在阴药方中,必定少量加入阳药以化生阳气。虽然有时寒热药物互用,补泻同时并进,似乎处方非常杂乱,其实这是基于阴阳互根的哲理,权衡偏胜以协调于中道。人受中气而生,圣人的道理在于中道。后世圣人之道不明,流变为偏曲之说。因此朱丹溪提出“阴常不足,阳常有余”的理论,张景岳驳斥丹溪,却又提出“阳常不足,阴常有余”的理论,导致学习者漫无适从,困惑更加深重。《内经·生气通天论》明确说明生命之气本源于阴阳,其论述司天运气及治疗各种胜复之法时,只说:“寒者热之,热者寒之,温者清之,清者温之”,不问次数,以平衡为准则。这明确说明阴阳贵在得其平衡。张仲景的学问,直接继承自轩辕、岐伯,历代圣贤相传的道统,不外乎一个“中”字。偏于阴或偏于阳,总属于邪说。阅读张仲景的书籍,应当在“中”字上下功夫。
The Cun Kou pulse (Cun Kou Pulse, the radial artery at the wrist) is the master of Ying and Wei (Nutritive and Defensive Qi) throughout the body. Without Stomach Qi (Wei Qi, digestive energy), how can fluids be transported upward and distributed to Ying and Wei? Fu Yang (Fu Yang, a pulse position on the dorsum of the foot) belongs to the Zheng Yang (Correct Yang) channel, situated in the Central Earth, which is the mother of the Five Elements. Therefore, pulse diagnosis must take Stomach Qi as its foundation. Shao Yin (Shao Yin, the Kidney channel) belongs to the Kidney, which is an organ of Water. It combines with the San Jiao (Triple Burner) to form one Qi. The True Water and True Fire of the human body are rooted here. Water relies on Earth to control it; thus, Shao Yin must be subdued by Fu Yang before it can interact with the San Jiao, steaming and distributing fluids. The Classics state: "When Shao Yin is weaker than Fu Yang, it is favorable."
Fu Yang is used to observe Stomach Qi and serves as the master of the Middle Jiao (Middle Burner); Shao Yin is used to observe Kidney Qi and serves as the master of the Lower Jiao (Lower Burner). This essentially corresponds to the distribution of the Cun Kou pulse into the Upper, Middle, and Lower three positions. According to Wang Shuhe's *Mai Jue* (Pulse Classic), the Chong Yang point is located five cun above the dorsum of the foot, in the arterial pulse between the bones, three cun away from the Xian Gu point, and this is considered the diagnostic site for Fu Yang. However, pulse methods lack explicit text prescribing the palpation of the foot pulse. Moreover, the original treatise clearly states that there are three pulse positions (Cun, Guan, Chi), where Yin and Yang interact. If only Cun Kou is mentioned without referring to the Guan and Chi positions, it indicates that the two Guan positions govern the Middle Jiao, managed by the Spleen and Stomach, which corresponds to the Fu Yang diagnosis; the two Chi positions govern the Lower Jiao, managed by the Kidneys, which corresponds to the Shao Yin diagnosis. The Fu Yang diagnosis is at the Guan position, with the Right pulse governing the Left; the Shao Yin diagnosis is at the Chi position, with the Left pulse governing the Right. This is similar to how the Cun Kou pulse specifically governs the Hand Taiyin Lung channel. To understand the diagnoses of Fu Yang and Shao Yin, one must deduce them within the framework of the three positions (Cun, Guan, Chi).
A disciple asked: Zhang Zhongjing said, "Those with Yin diseases presenting Yang pulses survive; those with Yang diseases presenting Yin pulses die." The world consequently believes that Zhang Zhongjing's book focuses solely on supporting Yang and suppressing Yin. I replied: The terms "Yin" and "Yang" here should only be understood in terms of Exterior/Interior and Deficiency/Excess. When pathogenic factors invade the body, being in the Exterior is mild, while being in the Interior is severe; exiting the Exterior is favorable, while entering the Interior is adverse. If a Yin disease presents a Yang pulse, it indicates that interior pathogens have the potential to emerge to the exterior, hence survival is indicated. If a Yang disease presents a Yin pulse, it indicates that exterior pathogens have the tendency to sink into the interior, hence death is indicated. Floating, Surging, Large, Rapid, and Slippery pulses are Yang pulses; Yang pulses indicate Exterior and Excess conditions. If a Yin disease presents a Yang pulse, it means righteous Qi recovers and pathogens retreat naturally; even if the illness is severe, recovery is possible. Deep, Choppy, Weak, String-taut, and Fine pulses are Yin pulses; Yin pulses indicate Interior and Deficiency conditions. If a Yang disease presents a Yin pulse, it means righteous Qi declines and pathogens are unopposed; even if the illness is mild, death may occur. Yang diseases inherently indicate survival, but if Yin pulses appear, death lurks within survival; Yin diseases inherently indicate death, but if Yang pulses appear (Note: Text implies a nuance or potential typo in source logic regarding 'Yin seeing Yin', usually Yin seeing Yang is life, but translating strictly: if [condition] appears, life exists within death), life exists within death. These two instances of "seeing" reflect the meaning in the *Doctrine of the Mean*: "Nothing is more visible than what is hidden; nothing more manifest than what is subtle." Physicians facing clinical cases must not fail to be vigilant and cautious. As for supporting Yang and suppressing Yin, this is a derogatory theory inherited since the Yuan and Ming dynasties. The *I Ching* says: "One Yin and one Yang is called the Dao." Yang commands Yin, yet excessive Yang leads to regret; Yin follows Yang, yet excessive Yin leads to conflict. Thus, the Classics state: "When Yin is balanced and Yang is firm, spirit and vitality are regulated." All diseases arise from the imbalance of Yin and Yang. Zhang Zhongjing's various treatment methods merely address the excess of Yin or Yang, balancing the deviation so that the disease resolves itself. Sometimes, when Yang is extremely hyperactive, only pure Yin formulas are used, without any Yang herbs; this is not bias toward Yin, but nourishing Yin to balance Yang. Sometimes, when Yin is extremely abundant, only pure Yang formulas are used, without any Yin herbs; this is not bias toward Yang, but supporting Yang to balance Yin. In cases where Yin and Yang Qi are biased but not extreme, small amounts of Yin herbs are added to Yang formulas to preserve fluids, and small amounts of Yang herbs are added to Yin formulas to transform Qi. Although sometimes cold and hot herbs are combined, and tonification and purgation are advanced simultaneously, seemingly making prescriptions very complex, this is actually based on the principle of the mutual root of Yin and Yang, balancing the excess to harmonize with the Center. Humans are born from Central Qi; the Way of the Sages lies in the Middle Path. Later generations failed to clarify the Sage's Way, deviating into distorted theories. Therefore, Zhu Danxi proposed the theory that "Yin is often insufficient and Yang is often excessive." Zhang Jingyue refuted Danxi but proposed the opposite theory that "Yang is often insufficient and Yin is often excessive," causing students to have no direction and become increasingly confused. The *Nei Jing · Sheng Qi Tong Tian Lun* explicitly states that the Qi of life originates from Yin and Yang. In discussing the methods of treating climatic influences and overcoming excess/reversal, it simply says: "Treat cold with heat, heat with cold, warmth with cooling, coolness with warming," regardless of frequency, aiming for balance. This clearly states that Yin and Yang must be kept in equilibrium. Zhang Zhongjing's learning directly inherits from Xuanyuan (Yellow Emperor) and Qibo. The way passed down through sages does not exceed the concept of "Zhong" (Center/Middle). Bias toward Yin or Yang is always heterodox. When reading Zhang Zhongjing's books, one should focus on the character "Zhong" (Center).