问曰经说脉有三菽六菽重者何谓也师曰脉以指按之如三菽之重者肺气也如六菽之重者心气也如九菽之重者脾气也如
十二菽之重者肝气也按之至骨者肾气也假令下利寸口关上尺中悉不见脉然尺中时一小见脉再举头者肾气也若见损脉来至
为难治
三菽五菽数语难经五难之文脉病患以指按之如三菽之重者肺气也如六菽之重者心气也肺主皮心主脉其脉俱浮也如九
菽之重者脾气也脾主肉脉在浮沉之间也如十二菽之重者肝气也按之至骨者肾气也肝主筋肾主骨其脉俱沉也肺心为阳肝肾
为阴假令下利阴病也寸口关上尺中悉不见脉阳气脱也然尺中时一小见脉再举头者肾气也肾气未绝犹可治若再见损脉来至
便为难治损脉者迟脉也难经一呼一至曰离经二呼一至曰夺精三呼一至曰死四呼一至曰命绝此损之脉也
问曰东方肝脉其形何似师曰肝者木也名厥阴其脉微弦濡弱而长是肝脉也肝病自得濡弱者愈也假令得纯弦脉者死何以
知之以其脉如弦直此是肝脏伤故知死也
肝者木也居东方其位在左经名厥阴其脉微弦濡弱而长是肝脉也肝病自得濡弱者是有胃气故愈假令得纯弦脉者无胃气
也故死何以知之以其脉如弓弦之直此是肝脏之伤不得土气之滋荣故知死也素问平人气象论平肝脉来濡弱招招如揭长竿曰
肝平死肝脉来急益劲如新张弓弦曰肝死正此意也
问:经书中说脉象有“三菽”和“六菽”重量的区别,这是什么意思呢?
师曰:用指头按压脉象,如果感觉像三颗豆子的重量那样轻,这是肺气;如果感觉像六颗豆子的重量那样稍重,这是心气;如果感觉像九颗豆子的重量那样更重,这是脾气;如果感觉像十二颗豆子的重量那样再重,这是肝气;如果按到骨头才感觉到脉搏跳动,这是肾气。假如出现下利(腹泻)的症状,寸口、关上、尺中这三个部位的脉象都摸不到,但是尺部偶尔能轻微地摸到一次脉搏,且脉搏跳动时像头部抬起一样有力,这说明肾气尚存,还有治愈的希望;如果再见到损脉(虚弱无力的脉象),那就难以治疗了。
这段关于三菽、五菽的论述出自《难经·五难》。所谓脉象以指按压,如三颗豆子的重量,是肺气;如六颗豆子的重量,是心气。肺主皮毛,心主血脉,它们的脉象都属于浮脉。如九颗豆子的重量,是脾气。脾主肌肉,其脉位于浮与沉之间。如十二颗豆子的重量,是肝气。按至骨方得,是肾气。肝主筋,肾主骨,它们的脉象都属于沉脉。肺和心属阳,肝和肾属阴。假如出现下利,属于阴病。如果寸口、关上、尺中三部都摸不到脉象,说明阳气脱失。然而尺部偶尔能轻微摸到一次脉搏,且脉搏跳动时像头部抬起一样有力,说明肾气未绝,还可以治疗;如果再见到损脉,就难以治疗。所谓的损脉,就是迟脉(脉搏跳动缓慢)。《难经》中说:一呼一吸间脉搏只跳动一次,称为离经;两呼两吸间脉搏只跳动一次,称为夺精;三呼三吸间脉搏只跳动一次,称为死;四呼四吸间脉搏只跳动一次,称为命绝。这些都属于损脉的范畴。
师曰:肝在五行中属木,名为厥阴经。它的脉象微带弦象,柔和而弱,且长,这就是肝的正常脉象。肝病如果出现柔和而弱的脉象,就会痊愈。假如出现纯弦脉,就会死亡。为什么知道会死亡呢?因为这种脉象像弓弦一样直硬,这是肝脏受伤的缘故,所以知道会死亡。
肝在五行中属木,位居东方,对应身体的左侧。经脉名称为厥阴经。它的脉象微带弦象,柔和而弱,且长,这就是肝的正常脉象。肝病如果出现柔和而弱的脉象,说明体内还有胃气,所以会痊愈。假如出现纯弦脉,说明没有胃气,所以会死亡。为什么知道会死亡呢?因为这种脉象像弓弦一样直硬,这是肝脏受伤,得不到土气(脾胃之气)的滋养滋润,所以知道会死亡。《素问·平人气象论》中说:肝脉来势柔和,招招手手般轻盈,像高举的长竿,这是肝脉平和的表现;若肝脉来势紧急强劲,像刚拉开的新弓弦,这是肝脉死亡的表现。正是这个意思。
Question: The classics state that pulse qualities are described with terms like "three beans" and "six beans" in terms of pressure. What does this mean?
Master said: When pressing the pulse with fingers, if the sensation is as light as three beans, it indicates Lung Qi (Lung Energy); if it feels as heavy as six beans, it indicates Heart Qi; if it feels as heavy as nine beans, it indicates Spleen Qi; if it feels as heavy as twelve beans, it indicates Liver Qi; if the pulse is only felt when pressing down to the bone, it indicates Kidney Qi. Suppose a patient suffers from Xialli (diarrhea/loose stools), and the pulses at Cun Kou (Inch position), Guan (Bar position), and Chi (Cubit position) are all imperceptible. However, if at the Chi position, a pulse is occasionally faintly perceived, rising slightly like a head lifting up, this indicates that Kidney Qi has not yet perished, and the condition is still treatable. If, however, a Sun Mai (damaged/withered pulse) appears, it becomes difficult to treat.
The discussion regarding three beans and five beans originates from Chapter 5 of the *Nan Jing* (Classic of Difficult Issues). Regarding the pulse pressure: feeling the pulse with a pressure equivalent to three beans indicates Lung Qi; six beans indicates Heart Qi. The Lung governs the skin and hair, and the Heart governs the vessels; their pulses are both superficial (Floating). Nine beans indicate Spleen Qi. The Spleen governs the muscles, and its pulse lies between superficial and deep. Twelve beans indicate Liver Qi. Pressing until the bone reveals Kidney Qi. The Liver governs the sinews, and the Kidney governs the bones; their pulses are both deep (Sunken). The Lung and Heart belong to Yang, while the Liver and Kidney belong to Yin. In cases of diarrhea, which is a Yin disease, if pulses are absent at all three positions (Cun, Guan, Chi), it signifies the depletion of Yang Qi. Yet, if the Chi position occasionally shows a faint pulse that rises slightly, it means Kidney Qi remains intact, allowing for treatment. If a damaged pulse appears subsequently, the case is refractory. A damaged pulse refers to a Chi Mai (slow pulse). The *Nan Jing* states: one beat per breath cycle is called Li Jing (departing from the normal); one beat per two breath cycles is called Duo Jing (exhaustion of essence); one beat per three breath cycles is called Si (death); one beat per four breath cycles is called Ming Jue (life extinction). These constitute the damaged pulses.
Question: What is the shape of the Liver pulse associated with the East?
Master said: The Liver corresponds to Wood in the Five Elements and is named Jueyin (Terminal Yin). Its normal pulse is slightly wiry (Xian), soft and weak, yet long. This is the Liver pulse. If a patient with Liver disease presents with a soft and weak pulse, they will recover. However, if a pure wiry pulse is found, death ensues. How do we know this? Because such a pulse is rigid and straight like a bowstring, indicating injury to the Liver organ itself, hence predicting death.
The Liver belongs to Wood, resides in the East, and corresponds to the left side of the body. Its meridian is named Jueyin. Its normal pulse is slightly wiry, soft, weak, and long. If a Liver disease patient exhibits a soft and weak pulse, it indicates the presence of Wei Qi (Stomach Qi/Guardian Qi), signifying recovery. If a pure wiry pulse appears, it indicates the absence of Wei Qi, leading to death. Why is this so? Because the pulse is rigid and straight like a bowstring, showing that the Liver is injured and no longer nourished by Earth Qi (Spleen/Stomach energy). The *Su Wen* (Plain Questions) chapter "Ping Ren Qi Xiang Lun" (Discussion on the Phenomena of Pulse and Health) states: "When the Liver pulse comes softly and lightly, swaying like a raised long pole, it is a healthy Liver pulse." Conversely, "If the Liver pulse comes urgent and forceful, like a newly drawn bowstring, it is a dying Liver pulse." This confirms the meaning above.