论曰∶诊脉之法,其要有三∶一曰人迎,在结喉两傍,取之应指而动,此部法天也。二
曰三部,谓寸关尺也。于腕上侧有骨稍高,曰高骨。先以中指按骨,谓之关,前指为寸部,
后指为尺部。尺寸以分阴阳,阳降阴升,通度由关以出入,故谓之关,此部法人。三曰趺阳
在足面系鞋之所,按之应指而动者是也,此部法地。三者皆气之出入要会,所以能决吉凶
生。凡三处大小迟速相应齐等,则为无病之人。故曰∶人迎、趺阳三部不参,动数发息,
满五十,未知生死,以三者为决死生之要也。故人迎一盛病在太阳,谓阳极也。四盛以上
隔阳,谓无阴以收也。寸口一盛病在少阴,二盛病在太阴,三盛病在厥阴,厥有尽也。四
以上为关阴,谓无阳以系也。隔阳者,气上而不能下,则吐逆;关阴则闭塞,大小便不通
皆死不治。九候者,谓三部之位,一位有三候。浮取之属阳,沉取之属阴,中得之为胃气
故无胃气则死。五脏之脉,轻手于皮肤得之者肺也,至肌得之者心也,至肉得之者脾也,
筋得之者肝也,至骨得之者肾也。五者轻重皆应,是谓五脏之气全也。又有推而外之在经
推而内之在血脉。凡诊平人之脉,当以平旦,阴气未动,阳气未散,饮食未进,脉络调
可以见有余不足之脉。一呼行三寸,一吸行三寸,呼吸行六寸而脉四至,呼吸之间又一
此盛脉得天全者也。若过十息,脉应五十动,又须与气相应。往来缓急,得中润泽,如
流行源源者,此寿脉无疾也。若不满五十动一止,此一脏之气绝,四岁死,三十动一止
死,二十动以下一止,期以岁月死。若与形气不相应,往来短促枯燥无首尾,此不寿之
多病。凡诊病脉,则不拘昼夜,审脉所以察其由,则寒热虚实见矣。凡脉病患不病者死
病脉不病者生。
论述说:诊察脉象的方法,关键在于三点:第一是人迎脉,位于喉结两侧,按压时感觉脉搏跳动应指,这一部位效法天。第二是三部脉,即寸、关、尺。在手腕上方侧面有一块骨头稍高,称为“高骨”。先用中指按在高骨上,这个位置叫做“关”,手指向前(腕端)为寸部,向后(肘端)为尺部。寸和尺分别对应阴和阳,阳气下降、阴气上升,气血通过关部出入流通,所以称之为“关”,这一部位效法人。第三是趺阳脉,位于足背系鞋带的位置,按压时感觉脉搏跳动应指,这一部位效法地。这三处都是气机出入的重要汇聚点,因此能判断吉凶生死。如果这三处的脉象大小、迟速相互呼应且均衡一致,就是没有疾病的人。所以说:如果不参证人迎、趺阳和三部脉,呼吸之间脉搏跳动不满五十次,就无法判断生死,以这三处作为决断生死的关键。
人迎脉比正常大一倍,病在太阳经,这是阳极的表现。大四倍以上则阳气阻隔,意味着没有阴气来收敛。寸口脉比正常大一倍,病在少阴经;大两倍,病在太阴经;大三倍,病在厥阴经,厥阴之气有穷尽之时。大四倍以上则为“关阴”,意味着没有阳气来维系。所谓“隔阳”,是气机上逆而不能下行,会导致呕吐逆乱;所谓“关阴”则是闭塞不通,大小便均无法排出,这两种情况都属于死证,难以治疗。
所谓“九候”,是指三部脉位,每一部又有浮、中、沉三种候法。轻取属于阳,重取属于阴,中取得之反映胃气的有无,如果没有胃气就会死亡。五脏的脉象,轻手在皮肤层摸到的是肺脉,按至肌肉层的是心脉,按至肌肉深层的是脾脉,按至筋层的是肝脉,按至骨层的是肾脉。这五种脉象轻重深浅都能相应触及,这就叫五脏之气完备。另外还有推而外之(反映经络)、推而内之(反映血脉)的诊法。
凡是诊察健康人的脉象,应当在清晨进行,此时阴气未动,阳气未散,饮食尚未进入体内,脉络调和,才能看清脉象的有余或不足。一呼脉行三寸,一吸脉行三寸,一呼一吸共行六寸,脉搏跳动四次,呼吸之间又有一次停顿(此处原文似有脱漏,意指呼吸均匀),这种盛满的脉象是得天全之气的表现。如果超过十息,脉搏应跳动五十次,并且必须与呼吸之气相应。脉来往来缓急适中,润泽流畅,如水流源源不断,这是长寿无病的脉象。如果不满五十次就出现一次停跳,说明某一脏的气已绝,四年后死亡;三十次停跳一次,不久即死;二十次以下停跳一次,期限在年月之内死亡。如果脉象与形体气色不相适应,往来短促枯燥,没有首尾连贯之感,这是不长寿且多病的表现。
凡是诊察病人的脉象,就不拘泥于白天黑夜,仔细审察脉象以探究病因,那么寒热虚实的病机就能显现了。凡是脉象显示有病而病人本身感觉无病的,预后不良(主死);凡是脉象平和无病征而病人感觉不适的,预后良好(主生)。
It is stated that the method of pulse diagnosis has three key points: First is the Renying (Human Welcome) pulse, located on both sides of the laryngeal prominence. When pressed, it beats in response to the finger; this location corresponds to Heaven. Second are the Three Positions (Sanbu), namely Cun (Inch), Guan (Bar), and Chi (Cubit). On the lateral side above the wrist, there is a slightly elevated bone called the "High Bone" (Gaogu). Placing the middle finger on this bone defines the Guan position; the direction towards the hand is the Cun position, and the direction towards the elbow is the Chi position. Cun and Chi correspond to Yin and Yang respectively; Yang descends and Yin ascends, and Qi enters and exits through the Guan, hence it is named Guan. This location corresponds to Humanity. Third is the Duyang (Foot Yang) pulse, located on the dorsum of the foot where shoelaces are tied; when pressed, it beats in response to the finger. This location corresponds to Earth. These three sites are the crucial convergence points for the entry and exit of Qi, thus enabling the determination of auspiciousness, inauspiciousness, life, and death. If the magnitude and speed of these three pulses correspond and are balanced, the person is free from disease. Therefore, it is said: Without comparing the Renying, Duyang, and the Three Positions, if the pulse beats fewer than fifty times per respiratory cycle, one cannot determine life or death; these three are the keys to deciding life and death.
If the Renying pulse is one-fold stronger than normal, the disease is in the Taiyang (Greater Yang) channel, indicating extreme Yang. If it is four-fold or more stronger, Yang is obstructed, meaning there is no Yin to restrain it. If the Cun Kou (Cun Position) pulse is one-fold stronger, the disease is in the Shaoyin (Lesser Yin); two-fold stronger, in the Taiyin (Greater Yin); three-fold stronger, in the Jueyin (Terminal Yin), as Jueyin Qi has its limit. If it is four-fold or more stronger, it is called Guanyin (Closed Yin), meaning there is no Yang to sustain it. "Obstructed Yang" refers to Qi ascending but unable to descend, leading to vomiting and reflux; "Closed Yin" refers to blockage where both urination and defecation are impossible; both conditions are fatal and incurable.
The term "Nine Probes" (Jiu Hou) refers to the three positions, each having three probes: superficial (floating), deep (sinking), and moderate. Superficial probing belongs to Yang, deep probing belongs to Yin, and moderate probing reflects the presence of Stomach Qi; without Stomach Qi, death ensues. The pulses of the Five Zang organs are felt at different depths: light pressure on the skin reveals the Lung pulse; pressure reaching the muscle reveals the Heart pulse; pressure reaching the flesh reveals the Spleen pulse; pressure reaching the tendons reveals the Liver pulse; and pressure reaching the bone reveals the Kidney pulse. If all five depths respond appropriately, it signifies that the Qi of the Five Zang organs is complete. There are also methods of pushing outward (to examine the channels) and pushing inward (to examine the blood vessels).
When diagnosing the pulse of a healthy person, it should be done in the early morning, when Yin Qi has not yet stirred, Yang Qi has not dispersed, and food has not been ingested, so that the meridians are harmonious, allowing one to see excess or deficiency. In one exhalation, Qi moves three cun; in one inhalation, Qi moves three cun; in one full breath, Qi moves six cun, and the pulse beats four times. A robust pulse that aligns with natural rhythms indicates the possession of complete Heavenly Qi. If over ten breaths, the pulse beats fifty times and corresponds with respiration, moving with moderate speed and moisture, flowing continuously like water, this is a pulse of longevity and health. If the pulse stops before fifty beats, it indicates the exhaustion of one Zang organ's Qi, leading to death within four years; if it stops every thirty beats, death follows soon; if it stops every twenty beats or less, death occurs within months or years. If the pulse does not correspond with the body's constitution, appearing short, rapid, dry, and lacking continuity, it indicates a person who will not live long and suffers from frequent illness.
When diagnosing the pulse of a sick person, time of day is irrelevant. Careful examination of the pulse reveals the cause, making cold, heat, excess, and deficiency apparent. Generally, a pathological pulse in a patient who feels well indicates a poor prognosis (death), while a normal pulse in a patient who feels unwell indicates a good prognosis (survival).