人之居处、动静、勇怯,脉亦为之变动。凡人之惊、恐、恚、劳、动、静,皆为变也。(脉,以经脉、
血气统言之也。)是以夜行则喘出于肾,淫气病肺。(此下四条言喘者,喘属气,病在阳也。
肾者,至阴也。阴气受于夜,夜行则劳骨伤阴,故喘出于肾。淫气者,阴伤则阳胜,气逆为患也。肺肾为母
子之脏,而少阴之脉上入肺中,故喘出于肾则病苦于肺。)有所堕恐,喘出于肝,淫气害脾。(有所堕坠而
恐者,伤筋损血,故喘出于肝。肝气淫则害于脾,木乘土也。)有所惊恐,喘出于肺,淫气伤心。(惊恐则神
气散乱,肺藏气,故喘出于肺,心藏神,故淫气伤之。)度水跌仆,喘出于肾与骨。(水起通于肾,跌仆伤
于骨,故喘出焉。)当是之时,勇者气行则已,怯者则着而为病也。(此结上文而言有病有不病者,因气有
强弱不同也。)故诊病之道,观人勇怯、骨肉、皮肤能知其情,以为法也。(勇可察其有余,
怯可察其不足,骨可以察肾,肉可以察脾,皮肤可以察肺,望而知其情,即善诊者也。)
饮食饱甚,汗出于胃。(此下五条言汗者,汗属精,病在阴也。饮食饱甚则胃气满而液泄,故汗出于
胃。)惊而夺精,汗出于心。(惊则神散,神散则夺其精气,故汗出于心。)持重远行,汗出于肾。(持重远
行则伤骨,肾主骨,故汗出于肾。)疾走恐惧,汗出于肝。(肝主筋而藏魂,疾走则伤筋,恐惧则伤魂,故
汗出于肝。)摇体劳苦,汗出于脾。(摇体劳苦,则肌肉四肢皆动,脾所主也,故汗出于脾,又醉饱行房,汗出
于脾。)故春秋冬夏四时阴阳生病,起于过用,此为常也。(五脏受气,强弱各有常度,若勉强过用,必损
其真,则病之所由起也。)人有热饮食下胃,其气未定,汗则出,或出于面,或出于背,或
出于身半,其不循卫气之道而出也。(饮食入胃,其气各有所行,如散精于肝,淫气于筋,浊气归心,淫精
于脉之类是也,卫气之道,昼行于阳,夜行于阴,有常度也。今有热饮食者方入于胃,其气之留行未定,
而汗辄外泄,出无方所,是不循胃气之道也。)外伤于风,内开腠理,毛蒸理泄,卫气走之,固不得循其道。
(风为阳邪,有外热也。热食气悍,因内热也,热之所聚,则开发腠理,所以毛蒸理泄而卫气走之,
故不循其常道也。)此气 悍滑疾,见开而出,不得从其道,命曰“漏泄”。(此即热食之气也,出不由度,
故曰“漏泄”。)
人的居住环境、日常动静以及性格的勇敢或怯懦,都会导致脉象发生相应的变化。凡是人的惊吓、恐惧、愤怒、劳累、运动与静止,都会引起生理状态的改变。(这里的“脉”,是从经脉和气血的整体角度来论述的。)因此,夜间行走过度会导致气喘源于肾脏,邪气泛滥进而伤害肺脏。(以下四条关于喘息的论述,指出喘息属于气机病变,病位在阳分。肾属至阴之脏。阴气在夜间旺盛,夜间行走则劳损骨骼并损伤阴精,所以气喘源于肾。所谓“淫气”,是指阴精受损后阳气偏胜,气机上逆为患。肺与肾是母子关系的脏腑,且足少阴肾经上行入于肺中,所以气喘源于肾就会痛苦地波及肺脏。)如果有坠落受伤并伴有恐惧,气喘源于肝脏,邪气泛滥进而损害脾脏。(因坠落而惊恐者,会损伤筋脉和血液,所以气喘源于肝。肝气过盛则会侵害脾脏,这是木气乘克土气的表现。)如果有突然的惊恐,气喘源于肺脏,邪气泛滥进而伤害心脏。(惊恐会使神气散乱,肺主藏气,所以气喘源于肺;心主藏神,所以邪气会伤害心神。)如果涉水跌倒,气喘源于肾脏和骨骼。(水液代谢通应于肾,跌倒损伤骨骼,所以气喘由此产生。)在这个时候,体质强健的人气机通畅则病愈,体质虚弱的人邪气滞留则成为疾病。(这是对上文的小结,说明有病和不病的区别,是因为人体气机的强弱不同所致。)所以诊断疾病的道理,在于观察人的勇敢或怯懦、骨骼肌肉的强弱、皮肤的状况,从而了解病情,作为诊疗的依据。(勇敢可以察知正气有余,怯懦可以察知正气不足,骨骼可以察知肾气,肌肉可以察知脾气,皮肤可以察知肺气,通过望诊了解病情,就是善于诊断的表现。)
饮食过饱,汗液出于胃。(以下五条关于汗出的论述,指出汗液属于精微物质,病位在阴分。饮食过饱则胃气充盈而津液外泄,所以汗出于胃。)受惊导致精气耗夺,汗液出于心脏。(惊则神气散失,神气散失则耗夺精气,所以汗出于心。)负重远行,汗液出于肾脏。(负重远行则损伤骨骼,肾主骨,所以汗出于肾。)急速奔跑并伴随恐惧,汗液出于肝脏。(肝主筋而藏魂,急速奔跑则损伤筋脉,恐惧则损伤神魂,所以汗出于肝。)身体摇动劳作辛苦,汗液出于脾脏。(身体摇动劳作,则肌肉四肢都活动,这是脾所主管的,所以汗出于脾;另外醉酒后饱食中行房事,汗也出于脾。)所以春夏秋冬四季因阴阳失调而生病,起因都是过度使用(劳倦),这是常理。(五脏所受之气,强弱各有定度,如果勉强过度使用,必然损伤真元,这就是疾病产生的原因。)人吃了热性的食物进入胃中,其热气尚未平定,汗就出来了,有的出于面部,有的出于背部,有的出于身体半侧,这是因为不循卫气运行的常规路径而出。(饮食进入胃中,其气各行其道,如将精微散布于肝,滋养筋脉,浊气归于心,精华注入血脉之类。卫气之道,白天行于阳分,夜晚行于阴分,有固定的规律。现在若有热性饮食刚入胃,其气停留运行尚未稳定,汗就随即外泄,没有固定部位,这是不循胃气正常道而出的表现。)外部受风邪侵袭,内部腠理开泄,毛发受热蒸腾,纹理毛孔张开,卫气随之走窜,自然不能遵循其常规路径。(风为阳邪,带有外热。热食之气剽悍,带来内热。热邪聚集之处,就会开发腠理,所以毛发蒸腾、纹理开泄,卫气随之走窜,因此不遵循常道。)这种气剽悍滑疾,见到腠理开泄就外出,不能从其正道,命名为“漏泄”。(这就是热食之气,出不由度,所以称为“漏泄”。)
A person's living environment, activity levels, and disposition (courage or timidity) all cause variations in the pulse. All states of surprise, fear, anger, fatigue, movement, and stillness induce changes in physiological conditions. ("Pulse" here refers to the meridians and Qi-Blood as a whole.) Therefore, walking at night leads to panting originating from the Kidney, with excessive pathogenic Qi damaging the Lung. (The following four items discuss panting; panting belongs to Qi disorders and is located in the Yang aspect. The Kidney is the organ of extreme Yin. Yin Qi prevails at night; night walking fatigues the bones and injures Yin, hence panting originates from the Kidney. "Excessive Qi" refers to Yang becoming dominant due to Yin injury, causing Qi rebellion. The Lung and Kidney are mother-son organs, and the Foot-Shaoyin Kidney Meridian ascends into the Lung; thus, panting originating from the Kidney causes suffering in the Lung.) If there is a fall accompanied by fear, panting originates from the Liver, with excessive pathogenic Qi harming the Spleen. (Falls causing fear damage sinews and blood, hence panting originates from the Liver. Excessive Liver Qi harms the Spleen, representing Wood overacting on Earth.) If there is sudden shock and fear, panting originates from the Lung, with excessive pathogenic Qi damaging the Heart. (Shock scatters Shen-Qi; the Lung stores Qi, hence panting originates from the Lung; the Heart stores Shen, hence excessive Qi damages it.) Wading through water and falling results in panting originating from the Kidney and bones. (Water metabolism connects to the Kidney; falls injure bones, hence panting arises here.) At such times, those who are courageous recover as their Qi flows smoothly, while those who are timid develop disease as pathogenic factors stagnate. (This summarizes the preceding text, indicating that the difference between being ill and healthy lies in the strength of one's Qi.) Thus, the method of diagnosing disease involves observing a person's courage or timidity, bone and muscle structure, and skin condition to understand the pathology and establish treatment principles. (Courage indicates excess of righteous Qi; timidity indicates deficiency. Bones reflect Kidney status; muscles reflect Spleen status; skin reflects Lung status. Observing these to understand the condition constitutes skilled diagnosis.)
Overeating causes sweat to emanate from the Stomach. (The following five items discuss sweating; sweat belongs to Essence and is located in the Yin aspect. Overeating fills Stomach Qi and causes fluid leakage, hence sweat comes from the Stomach.) Shock that depletes Essence causes sweat to emanate from the Heart. (Shock scatters Shen; scattering Shen depletes Jing-Qi, hence sweat comes from the Heart.) Carrying heavy loads and traveling long distances causes sweat to emanate from the Kidney. (Carrying heavy loads and traveling long distances injures bones; the Kidney governs bones, hence sweat comes from the Kidney.) Running fast while fearful causes sweat to emanate from the Liver. (The Liver governs sinews and houses Hun; running fast injures sinews, fear injures Hun, hence sweat comes from the Liver.) Bodily exertion and labor cause sweat to emanate from the Spleen. (Bodily exertion moves muscles and limbs, which are governed by the Spleen, hence sweat comes from the Spleen; similarly, sexual intercourse after drunkenness and fullness also causes sweat from the Spleen.) Therefore, diseases arising from Yin-Yang imbalances in the four seasons stem from overexertion; this is the constant rule. (The Qi received by the Five Zang organs has varying degrees of strength; if forced beyond limits, True Qi is damaged, leading to disease.) When hot food enters the Stomach, its Qi has not yet settled, and sweat appears, sometimes on the face, sometimes on the back, or on half the body, because it does not follow the pathway of Wei-Qi. (Food entering the Stomach distributes its Qi specifically: spreading essence to the Liver, nourishing sinews, sending turbid Qi to the Heart, and infusing essence into the vessels. Wei-Qi travels in Yang during the day and Yin at night, following fixed patterns. Now, with hot food just entering the Stomach, its Qi is unsettled, and sweat leaks out without direction, failing to follow the normal course of Stomach Qi.) External wind invasion opens the interior Cou-Li (pores), hair steams, and pores open; Wei-Qi rushes about, thus unable to follow its regular path. (Wind is a Yang pathogen with external heat. Hot food Qi is fierce, creating internal heat. Where heat gathers, it opens Cou-Li, causing hair steaming and pore opening, so Wei-Qi rushes about, not following the usual path.) This Qi is fierce and slippery; seeing an opening, it exits, unable to follow its proper way, named "Lou-Xie" (Leakage). (This refers to the Qi of hot food exiting without measure, hence called "Leakage".)