此即上古诊法其二也。气口，右手关前一分，以候七情，及房劳、任务勤苦与饮食无节，皆为内伤不足之
症。其所以名气口者，五脏之气，必因胃气而升于手太阴故也。人迎，左手关前一分，以候六淫及起居失宜，
感冒时行不正之气，皆为外感有余之症。其所以名人迎者，外邪必因虚而入故也。若脏气平者，邪自难犯，故
先气口而后人迎也。汉论人迎紧盛伤于寒，气口紧盛伤于食。然七情蕴郁，正由宿食助发。若专伤食而无七情，
则不应气口。又论伤寒皆自太阳始，然经云，风喜伤肝，寒喜伤肾，暑喜伤心胞，湿喜伤脾，热喜伤心，燥喜
伤肺，以类推之。风当自少阳，湿当自阳明，暑当自三焦，寒当自太阳，此丹溪独得经旨，发仲景未发也。
其外非六淫、内非七情而病者，谓之不内外因，本经自病也。非若气口人迎传变乘克，但三因皆以胃气为主。
经云∶气口，太阴也，兼属脾。又云∶人迎亦胃脉也。脉赞云∶关前一分人命之生。故取李仲南三因歌括于前，
而以丹溪图说之。
喜则伤心脉必虚，
喜则气缓，脉散而虚。甚则神庭融溢，而心脉反沉。盖喜甚则火盛侮金；肾水复母仇而克心。暴喜暴怒，
多有暴中之患，亦此意也。
思伤脾脉结中居；
思则气凝，脉短而结。甚则意舍不宁，而脾脉反弦。
因忧伤肺脉必涩，
忧则气滞而脉沉涩，甚则魄户不闭，而肺脉反洪。
怒气伤肝脉定濡；
怒则气逆而脉濡，或激甚则魂门弛长，而肝脉反涩。
恐伤于肾脉沉是，
恐则气下，怯而脉沉，甚则志室不遂，而肾脉反濡。濡属土也，或疑神庭、志室等穴，皆属太阳。殊不
知五脏系背，诸穴于五脏则为有形之经络，于太阳则为无形经之络，特其过脉耳。
缘惊伤胆动相胥；
惊则气乱而脉动，甚则入肝脉散，小儿泻青，大人面青。又，大惊入心者，尿血怔忡。
脉紧因悲伤胞络，
悲则气急而脉紧缩，甚则心胸络与肺系气消而脉虚。
七情气口内因之。
凡七情伤之浅者，惟气口紧盛而已。伤之深者，必审何部相应，何脏传次，何脏相克。克脉胜而本脏脉
脱者，死。噫！七情为患如此。和乐以养中和，实养德养身急务也。
紧则伤寒肾不移，
寒伤肾，脉沉而紧，初自足太阳而入，其脉浮盛而紧。浮者，足太阳；紧者，伤寒；盛者，病进也。
虚因伤暑向心推；
暑伤心，脉虚，初自手少阳而入，脉洪虚而数。洪者，手少阳；虚者，伤暑；数者，病增也。
涩缘伤燥须观肺，
燥伤肺，脉涩，初自手阳明而入，脉浮而数。浮者，手阳明；数者，伤燥。
濡细伤湿更看脾；
湿伤脾，脉细而濡，初自足阳明而入，脉细涩而长。涩者，足阳明；濡者，伤湿；长者，病袭也。
浮则伤风肝部应，
风伤肝，脉浮而盛，初自足少阳而入，脉弦浮而散。弦者，足少阳；浮者，伤风；散者，病至也。
弱缘伤热察心知；
热伤心胞络，脉沉弱而缓，初自三焦而入，脉浮而弱。沉者，心胞络；弱者，伤热；缓者，病倦也。暑与
热同气，正心多不受邪，每归胞络，此与暑伤心互看。
外因但把人迎审，细别六淫皆可医。
凡外感轻者，惟人迎紧盛，或各部单见而已。重则各部与人迎相应，其传变与伤寒参看。
劳神役虑爱伤心，虚涩之中仔细寻；
血虚神耗。
劳役阴阳每伤肾，须因脉紧看来因；
房劳伤精。
房帷任意伤心络，微涩之中细忖度；
精枯。
疲剧筋痛要伤肝，仔细思量脉弦弱；
筋痛则动，脉弦弱带数。
饥则缓弦脾受伤，
胃气虚也。
若还滑实饱无疑；
脾气滞也。
叫呼伤气须损肺，燥弱脉中岂能避！
气耗也。
不内外因乃如是，气口人迎皆无与；
各脉不与二脉相应。
气口人迎若俱紧，夹食伤寒兼理治。
内伤外感，分多少治之。
气口人迎若过盛，内关外格详经义；
按《内经》，人迎一盛则躁在手足少阳，二盛躁在手足太阳，三盛躁在手足阳明。一盛者，人迎大于气口
一倍也，四倍则阳盛已极，故格则吐逆而食不得入。三阳兼手足而言，或入手经，或入足经，下三阴仿此。
又，气口一盛，则躁在手足厥阴，二盛躁在手足少阴，三盛躁在手足太阴，四倍则阴盛已极，故关则不得小便。
若人迎气口俱盛四倍已以，盛极衰至必死，抑论关格二症也。然气口人迎俱盛，则吐逆不便交作，故丹溪总之曰
关格。但以两寸过盛推之，则尺脉一盛，病在手足厥阴，二盛病在手足太阴，三盛病在手足少阴。传曰∶尺
部一盛，泻足少阳，补足厥阴；二盛泻足太阴，补足少阴；三盛泻足阳明，补足太阴；四盛则三阴已极，当峻
补其阴。一至寸而反之，亦推展经义也。
先贤又恐病流传，取诸杂脉乃全备。
此丹溪示人活法。病有传变，如伤寒紧不在肾，伤怒濡不在肝，流传别经，是以取各部中见脉。与人迎
气口相应者，以断内外二因。凡二十七种脉形，随其部位所见，但与人迎应，则为外感；与气口应，则为内伤。
其病症，则分诸脉主病同。
这就是上古诊法中的第二种。气口，位于右手关前一分处，用来诊察七情（喜、怒、忧、思、悲、恐、惊），以及房事过度、劳役辛苦和饮食无节制等引起的内伤不足之症。之所以称为“气口”，是因为五脏之气，必须依赖胃气才能上行至手太阴肺经的缘故。人迎，位于左手关前一分处，用来诊察六淫（风、寒、暑、湿、燥、火）及起居失常、感冒时行不正之气等引起的外感有余之症。之所以称为“人迎”，是因为外邪必定因人体正气虚弱而入侵的缘故。如果脏腑之气平和，邪气自然难以侵犯，所以先诊气口而后诊人迎。汉代医论说：人迎脉紧盛是伤于寒，气口脉紧盛是伤于食。然而七情郁结，往往正是由宿食助长引发的。如果是单纯伤食而没有七情影响，则不应出现气口脉紧盛的情况。又有医论说伤寒皆从太阳病开始，但《内经》云：风邪易伤肝，寒邪易伤肾，暑邪易伤心包络，湿邪易伤脾，热邪易伤心，燥邪易伤肺，以此类推。风邪当自少阳经始，湿邪当自阳明经始，暑邪当自三焦始，寒邪当自太阳经始，这是朱丹溪独自领悟了经典旨意，阐发了张仲景未曾阐发的理论。那些既非六淫所致、也非七情所致的疾病，称为不内外因，是本经自病。不像气口和人迎那样有传变乘克的关系，但三种病因都以胃气为主。经文说：气口属于太阴，兼属脾。又说：人迎也是胃脉。《脉赞》说：关前一分关乎人的生死。所以在此引用李仲南的三因歌诀在前，并附上朱丹溪的图说。
喜悦过度会伤心，心脉必然虚弱；
喜悦使气机舒缓，脉象散乱而虚弱。严重时神庭穴区域气血融溢，心脉反而沉伏。大概是因为喜甚则火盛反侮肺金；肾水又报复母仇而克制心火。暴喜或暴怒，多有突发中风的隐患，也是这个意思。
思虑过度伤脾，脉象在结代中居间；
思虑使气机凝滞，脉象短促而结代。严重时意舍穴区域不安宁，脾脉反而弦急。
因为忧伤肺，脉象必然涩滞；
忧愁使气机阻滞而脉象沉涩，严重时魄户穴区域闭合失常，肺脉反而洪大。
怒气伤肝，脉象定为濡软；
怒气使气机上逆而脉象濡软，或者激惹过甚则魂门穴区域弛缓延长，肝脉反而涩滞。
恐惧伤肾，脉象沉伏是其特征；
恐惧使气机下陷，胆怯而脉象沉伏，严重时志室穴区域功能失调，肾脉反而濡软。濡脉属土，有人怀疑神庭、志室等穴位都属足太阳膀胱经。殊不知五脏系于背部，这些穴位对于五脏来说是有形的经络，对于太阳经来说则是无形经的络脉，只是经过的脉气罢了。
因为惊恐伤胆，动脉与相火相互关联；
惊恐使气机紊乱而脉象动数，严重时入肝导致肝脉散乱，小儿泻青筋，大人面色发青。另外，大惊入心的，会出现尿血、怔忡。
脉紧是因为悲伤心包络；
悲伤使气机急促而脉象紧缩，严重时心胸络脉与肺系气消而脉象虚弱。
七情致病属于内因，主要反映在气口。
凡是七情伤害较浅的，只有气口脉紧盛而已。伤害较深的，必须审察哪个部位相应，哪个脏腑传变次序，哪个脏腑相克。克脉胜而本脏脉脱绝的，主死。唉！七情为害如此之大。以和乐来培养中和之气，确实是修养品德和保养身体的紧急事务。
脉紧是因为伤寒，病位在肾不移；
寒邪伤肾，脉象沉而紧，初起从足太阳膀胱经而入，其脉浮盛而紧。浮者，代表足太阳；紧者，代表伤寒；盛者，代表病势进展。
脉虚是因为伤暑，病位向心推演；
暑邪伤心，脉象虚，初起从手少阳三焦经而入，脉象洪虚而数。洪者，代表手少阳；虚者，代表伤暑；数者，代表病势增加。
脉涩是因为伤燥，须观察肺脏；
燥邪伤肺，脉象涩，初起从手阳明大肠经而入，脉象浮而数。浮者，代表手阳明；数者，代表伤燥。
脉濡细是因为伤湿，更要查看脾脏；
湿邪伤脾，脉象细而濡，初起从足阳明胃经而入，脉象细涩而长。涩者，代表足阳明；濡者，代表伤湿；长者，代表病势侵袭。
脉浮是因为伤风，应在肝脏部位；
风邪伤肝，脉象浮而盛，初起从足少阳胆经而入，脉象弦浮而散。弦者，代表足少阳；浮者，代表伤风；散者，代表病邪已至。
脉弱是因为伤热，需察知心胞络；
热邪伤心包络，脉象沉弱而缓，初起从三焦经而入，脉象浮而弱。沉者，代表心包络；弱者，代表伤热；缓者，代表病势倦怠。暑与热同气，正心多不受邪，每归于心包络，这与暑邪伤心的情况互相参照。
外感病因只需审察人迎脉，细致辨别六淫皆可医治。
凡是外感轻症的，只有人迎脉紧盛，或各部单独出现相应脉象而已。重症则各部与人迎脉相应，其传变情况参考伤寒论。
劳神役虑喜爱伤心，需在虚涩之中仔细寻找；
这是血虚神耗的表现。
劳役阴阳每每伤肾，必须因脉紧来看寻病因；
这是房劳伤精的表现。
叫呼伤气须损肺，在燥弱的脉象中怎能避免！
这是气耗的表现。
不内外因就是这样，气口和人迎脉都不与之相应；
各脉不与二脉相应。
气口和人迎若都紧盛，夹带食积的伤寒需兼顾治疗。
内伤外感，分轻重多少来治疗。
气口和人迎若过盛，需详究经义中的内关外格症；
按《内经》，人迎脉大一倍则躁动在手足少阳经，大二倍则躁动在手足太阳经，大三倍则躁动在手足阳明经。一倍，是指人迎脉大于气口脉一倍。四倍则阳气盛极，故出现格拒症，表现为吐逆且食物不得入。三阳兼手足而言，或入手经，或入足经，下三阴仿照此例。
另外，气口脉大一倍，则躁动在手足厥阴经，大二倍则躁动在手足少阴经，大三倍则躁动在手足太阴经，四倍则阴气盛极，故出现关塞症，表现为不得小便。
如果人迎和气口脉都盛四倍以上，盛极衰至必死，这也是论述关格二症。然而气口和人迎俱盛，则吐逆不便交替发作，所以朱丹溪总称之为关格。但如果以两寸脉过盛来推演，则尺脉大一倍，病在手足厥阴经，大二倍病在手足太阴经，大三倍病在手足少阴经。传曰：尺部大一倍，泻足少阳，补足厥阴；大二倍泻足太阴，补足少阴；大三倍泻足阳明，补足太阴；大四倍则三阴已极，应当峻补其阴。一至寸脉则反之，也是推展经义的方法。
先贤又担心病情流传，取各种杂脉乃全备。
这是朱丹溪示人以活法。病有传变，如伤寒紧脉不在肾，伤怒濡脉不在肝，流传别经，所以取各部中见到的脉象。与人迎气口相应的，以此判断内外二因。凡二十七种脉形，随其部位所见，只要与人迎应，则为外感；与气口应，则为内伤。其病症，则分列诸脉主病相同。
This is the second method of diagnosis from ancient times. The Qi Kou (Qi Gate, pulse point on the right hand used to assess internal conditions), located one-fen anterior to the Guan position on the right wrist, is used to observe Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright), as well as symptoms of internal injury and deficiency caused by excessive sexual activity, physical overexertion, and irregular diet. It is named "Qi Kou" because the Qi of the five Zang organs must rely on Stomach Qi to ascend to the Hand Taiyin Lung Meridian. The Ren Ying (Ren Gate, pulse point on the left hand used to assess external conditions), located one-fen anterior to the Guan position on the left wrist, is used to observe symptoms of external excess caused by Six Excesses (Wind, Cold, Summer-heat, Dampness, Dryness, Fire), improper daily routine, and contraction of epidemic pathogenic factors. It is named "Ren Ying" because external pathogens enter only when the body's healthy Qi is deficient. If the Qi of the Zang organs is balanced, pathogens find it difficult to invade; hence, the Qi Kou is palpated first, followed by the Ren Ying. Han dynasty medical theories state: a tight and full Ren Ying indicates injury by Cold, while a tight and full Qi Kou indicates injury by food stagnation. However, the depression of the seven emotions is often exacerbated by retained food. If there is pure food injury without emotional disturbance, the Qi Kou should not show tightness. Another theory states that Shanghan (Cold Damage) always begins in the Taiyang disease stage. Yet, the *Classic of Difficult Issues* (*Nan Jing*) says: Wind tends to injure the Liver, Cold tends to injure the Kidney, Summer-heat tends to injure the Pericardium, Dampness tends to injure the Spleen, Heat tends to injure the Heart, and Dryness tends to injure the Lung. By analogy, Wind should begin in the Shaoyang, Dampness in the Yangming, Summer-heat in the Sanjiao, and Cold in the Taiyang. This unique insight belongs to Zhu Danxi, who elucidated principles not previously expounded by Zhang Zhongjing. Diseases that are neither caused by the Six Excesses nor the Seven Emotions are called "Neither Internal Nor External Causes," representing self-disease of the meridians. Unlike the transmission and overcoming relationships seen with Qi Kou and Ren Ying, all three causes center on Stomach Qi. The classics state: Qi Kou belongs to Taiyin and also relates to the Spleen. It also states: Ren Ying is also a Stomach pulse. The *Mai Zan* (Pulse Praise) says: One fen anterior to the Guan determines life and death. Therefore, Li Zhongnan's Song of Three Causes is cited here, followed by Zhu Danxi's diagrammatic explanation.
Excessive joy injures the Heart, and the Heart pulse will inevitably be empty;
Joy causes Qi to relax, resulting in a scattered and empty pulse. In severe cases, the Shen Ting area becomes hyperactive, and the Heart pulse reverses to become deep. This is because excessive joy leads to excessive Fire which insults Metal (Lung); subsequently, Kidney Water seeks revenge for its mother (Metal) and controls Heart Fire. Sudden joy or anger often leads to sudden stroke, following this same logic.
Pensiveness injures the Spleen, and the pulse resides among knotted beats;
Pensiveness causes Qi to stagnate, resulting in a short and knotted pulse. In severe cases, the Yi She area becomes restless, and the Spleen pulse reverses to become wiry.
Sorrow injures the Lung, and the pulse will inevitably be choppy;
Sorrow causes Qi to stagnate, resulting in a deep and choppy pulse. In severe cases, the Po Hu area fails to close properly, and the Lung pulse reverses to become surging.
Anger injures the Liver, and the pulse is definitively soft;
Anger causes Qi to rebel upward, resulting in a soft pulse. Or, if stimulation is extreme, the Hun Men area becomes flaccid and elongated, and the Liver pulse reverses to become choppy.
Fear injures the Kidney, and the pulse is deep;
Fear causes Qi to sink, leading to timidity and a deep pulse. In severe cases, the Zhi Shi area functions poorly, and the Kidney pulse reverses to become soft. Soft pulses belong to Earth. Some may doubt that acupoints like Shen Ting and Zhi Shi belong to the Bladder Meridian of Foot-Taiyang. They fail to realize that the Five Zang organs are connected to the back; these acupoints are tangible meridians relative to the Zang organs but intangible collaterals relative to the Taiyang meridian, merely passing through the pulse.
Fright injures the Gallbladder, with movement and Ministerial Fire interacting;
Fright causes Qi to become chaotic, resulting in a moving pulse. In severe cases, it enters the Liver causing the pulse to scatter, manifesting as green diarrhea in children and a blue complexion in adults. Furthermore, severe fright entering the Heart causes hematuria and palpitations.
A tight pulse is due to sorrow injuring the Pericardium Collateral;
Sorrow causes Qi to rush, resulting in a constricted pulse. In severe cases, the chest and heart collaterals and the lung system lose Qi, resulting in a weak pulse.
The seven emotions constitute internal causes, reflected in the Qi Kou.
For superficial injuries by the seven emotions, only tightness and fullness at the Qi Kou appear. For deep injuries, one must examine which部位 corresponds, the sequence of Zang transmission, and Zang overcoming. If the overcoming pulse is strong and the original Zang pulse is exhausted, death ensues. Alas! The harm of the seven emotions is thus great. Cultivating harmony and joy to nurture the Middle Harmony is an urgent task for cultivating virtue and preserving health.
Tightness indicates Cold damage, fixed in the Kidney;
Cold injures the Kidney, resulting in a deep and tight pulse. Initially, it enters from the Foot-Taiyang Bladder Meridian, presenting as floating, full, and tight. Floating indicates Foot-Taiyang; tight indicates Cold damage; full indicates disease progression.
Emptiness indicates Summer-heat injury, directed toward the Heart;
Summer-heat injures the Heart, resulting in a weak pulse. Initially, it enters from the Hand-Shaoyang Sanjiao Meridian, presenting as surging, weak, and rapid. Surging indicates Hand-Shaoyang; weak indicates Summer-heat injury; rapid indicates disease increase.
Choppiness indicates Dryness injury, requiring observation of the Lung;
Dryness injures the Lung, resulting in a choppy pulse. Initially, it enters from the Hand-Yangming Large Intestine Meridian, presenting as floating and rapid. Floating indicates Hand-Yangming; rapid indicates Dryness injury.
Soft and fine indicates Dampness injury, further examining the Spleen;
Dampness injures the Spleen, resulting in a fine and soft pulse. Initially, it enters from the Foot-Yangming Stomach Meridian, presenting as fine, choppy, and long. Choppy indicates Foot-Yangming; soft indicates Dampness injury; long indicates disease invasion.
Floating indicates Wind injury, corresponding to the Liver sector;
Wind injures the Liver, resulting in a floating and full pulse. Initially, it enters from the Foot-Shaoyang Gallbladder Meridian, presenting as wiry, floating, and scattered. Wiry indicates Foot-Shaoyang; floating indicates Wind injury; scattered indicates disease arrival.
Weakness indicates Heat injury, observed via the Pericardium;
Heat injures the Pericardium, resulting in a deep, weak, and slow pulse. Initially, it enters from the Sanjiao, presenting as floating and weak. Deep indicates Pericardium; weak indicates Heat injury; slow indicates disease fatigue. Summer-heat and Heat share similar nature; the True Heart rarely suffers pathogens, usually referring to the Pericardium. This should be viewed alongside Summer-heat injuring the Heart.
External causes are examined solely via the Ren Ying; careful differentiation of the Six Excesses can be cured.
For mild external contractions, only tightness and fullness at the Ren Ying, or isolated pulses in specific sectors, appear. In severe cases, various sectors correspond with the Ren Ying; their transmission should be referenced against Shanghan.
Mental labor and worry love to injure the Heart; search carefully within emptiness and choppiness;
This indicates blood deficiency and spirit consumption.
Physical labor and Yin-Yang imbalance often injure the Kidney; trace the cause via the tight pulse;
This indicates seminal injury from sexual exertion.
Indulgence in bedchamber affairs injures the Heart Collateral; ponder carefully within slight choppiness;
This indicates essence exhaustion.
Severe fatigue and tendon pain injure the Liver; carefully consider the wiry and weak pulse;
Tendon pain implies movement, with a wiry, weak, and rapid pulse.
Hunger results in a slow-wiry pulse indicating Spleen injury;
This indicates Stomach Qi deficiency.
If the pulse is slippery and solid, it is undoubtedly satiety;
This indicates Spleen Qi stagnation.
Shouting and crying injure Qi and must damage the Lung; how can it be avoided in dry and weak pulses?
This indicates Qi consumption.
Neither Internal Nor External Causes are thus; they do not correspond with Qi Kou or Ren Ying;
Various pulses do not correspond with these two pulses.
If both Qi Kou and Ren Ying are tight, treat simultaneously for food retention and Cold damage.
Internal injury and external contraction are treated according to their proportion.
If Qi Kou and Ren Ying are excessively full, carefully study the classic meaning of Internal Obstruction and External Gridlock;
According to the *Nei Jing*, if the Ren Ying is one-fold stronger, restlessness occurs in the Hand-Foot Shaoyang meridians; two-fold, in the Hand-Foot Taiyang; three-fold, in the Hand-Foot Yangming. "One-fold" means the Ren Ying is twice the size of the Qi Kou. At four-fold, Yang Qi is extremely abundant, causing Gridlock (Ge), characterized by vomiting and inability to ingest food. "Three Yang" refers to both hand and foot meridians; whether entering hand or foot meridians, the lower three Yin follow this pattern.
Furthermore, if the Qi Kou is one-fold stronger, restlessness occurs in the Hand-Foot Jueyin; two-fold, in the Hand-Foot Shaoyin; three-fold, in the Hand-Foot Taiyin. At four-fold, Yin Qi is extremely abundant, causing Obstruction (Guan), characterized by inability to urinate.
If both Ren Ying and Qi Kou are four-fold or more abundant, extreme abundance turning to decline leads to death; this discusses the Guan and Ge syndromes. However, when both Qi Kou and Ren Ying are abundant, vomiting and urinary obstruction occur alternately, so Zhu Danxi summarizes this as Guan Ge. But deducing from excessive fullness in both Cun positions: if the Chi pulse is one-fold stronger, the disease is in the Hand-Foot Jueyin; two-fold, in the Hand-Foot Taiyin; three-fold, in the Hand-Foot Shaoyin. The transmission states: Chi one-fold stronger, drain Foot-Shaoyang, tonify Jueyin; two-fold, drain Foot-Taiyin, tonify Shaoyin; three-fold, drain Foot-Yangming, tonify Taiyin; four-fold, the three Yin are at their limit, requiring vigorous tonification of Yin. Reversing this from Chi to Cun also expands upon classic principles.
Ancient sages feared disease transmission, thus collecting miscellaneous pulses for completeness.
This is Zhu Danxi demonstrating flexible methods. Diseases transmit; for example, Shanghan tightness may not be in the Kidney, and anger-induced softness may not be in the Liver, but transmitted to other meridians. Hence, pulses seen in various sectors are taken. Those corresponding with Ren Ying and Qi Kou are used to judge internal and external causes. Among twenty-seven pulse forms, whatever is seen in the sector, if it corresponds with Ren Ying, it is external contraction; if it corresponds with Qi Kou, it is internal injury. The symptoms correspond to the diseases governed by those respective pulses.