胃之大络，名曰虚里，在左乳三寸下。其动微而不见，为不及，宗气内虚也。或动而应
衣，
为太过，宗气外泄也。若三四至一止，五六至一止，主有积聚也。若绝不至者危。经曰∶虚
里无动脉者死。(《心法》)
人以胃气为本，故虚里之动，可以辨病机之轻重。按之应手，动而不紧，缓而不急者，
宗
气积于膻中也，是为常。其动洪大而弹手，与绝而不应者，俱胃气绝也。(《阳山原文》)
平人膻中静者为佳，虚里者，脉之宗气也。视之不见，按之渐动，如应如不应者为吉。
若胸中阳气衰，其动高逾乳，至中府、云门者凶。虚劳劳瘵，逐日动高者为无治。(台州)
虚里与寸口相应，虚里高者，寸口亦高。寸口结者，虚里亦结也。(《诊病奇 》)
虚里动而高者为恶候，妊妇最忌。若产后而发危急之证，以及黄胖病，或惊惕，或奔怒
，或强力而动支体者，虚里动虽高无患也，是不可不辨。(南阳)
凡治小儿不论诸证，宜先揣虚里穴，若跳动甚者不可攻伐，以其先天不足也。幼科能遵
吾言，造福无涯，此千古未泄之秘也，珍之贵之。(《柳州医话》)
小儿脉候难凭，惟揣虚里穴，确有可据，即以之治大人亦然也。《王孟英》
胸腹者，五脏六腑之宫城，阴阳气血之发源，若欲知其脏腑如何，则莫如诊胸腹。(《
对时论》)
察胸腹宜按抚数次，或沉或浮，以察胸腹之坚软，拒按与否，可以知虚实也。(《诊病
奇》)
上中下三脘，以指抚之，平而无涩滞者，胃中平和而无虚滞也。按中脘虽痞硬而不如
石者，饮癖也。(《诊病奇 》)
虚里动气有三候，浅按便得，深按却不得者，气虚之候。轻按洪大，重按虚细者，血虚
之候。有形而动者，积聚之候。(《该病奇 》)
诊胸腹，轻手循抚，自鸠尾至脐下，知皮肤之润燥，可以辨寒热。中手寻扪，问疼不疼
者，
以察邪气之有无。重手推按，更问疼否，以察脏腑之虚实，沉积之何如，即诊脉中浮中沉之
法也。(《对时论》)
诊腹之要，以脐为先。人身之有脐，犹天之有北辰也，故名曰天枢，又曰神阙。是神气
之穴
，为保生之根，徐按之而有力，其气应手者，内有神气之守也。若按之而气不应者，其守失
常也。(阳山)
凡诊肾间之动气者，密排右三指，或左三指以安脐间，和缓有力，一息二至，绕脐充实
者，
肾气充也。一息五六至，属热。手下虚冷，其动沉微者，命门不足也。手下热燥不润，其动
细数，上支中腕者，阴虚也。按之分散，一息一至者，为原气虚败之候。(《诊病奇 》)
诊腹先可诊脐。按之有力者，无病也。按之无力如指如香灰中者，为无治。(寿安)
脐上下左右推之不动者，常也。然气弱者推之则移于一方，右移者左绝也，左移者右绝
也，上下亦然，是之谓脐绝。病者见之为无治，惟高年无害。(《南溟》)
脐通五脏，真神往来之门也，故名神阙。与肾附于脊之十四椎相对，如南北极是也。凡
脐以
深大而坚固左右上下推之不动，轮(腹皮相聚为轮也。)廓(脐如小酒杯底为廓也。)约束者，
为真神安全。倘有大病犹可治，但暴病非此例。(《台州原文》)
小腹左右常结者，皆蓄血也。其痛者非食积虫积之候，是蓄血而或为疝者。(《台州原
文》)
小腹有燥屎者，必近迫横骨，左边累累成块，其状稍长，按之不痛，左边充满则及右边
。(《台州原文》)
脐之上下任脉见者，胀大如箸，为脾肾虚。此脉见平人则发病，病患则难治。劳伤阴虚
火动之证，多有此候。有郁气者亦常有之，不为害。医者宜精察。(白竹)
久病腹皮贴背，当脐上下，有坚硬而结，排之不动者，是脊骨也。(《台州原文》)
肝病者，两胁下痛引小腹，故肝病须诊两胁。两胁皮肉满实而有力者，肝平也。两胁空
虚无
力者，为肝虚，及中风一切筋病之候。男子积在左胁者属疝气，女子块在右胁者属瘀血也。
(《台州原文》)
痞积疝气一切等证，着左者易治，着右者较难，左属阳，右属阴也。(良务)
鸠尾动气不高者为风寒邪热，鸠尾动气而高者为痘疹。掌中动脉盛者，亦痘疹也，痘发
则动止，发而仍动者，痘毒炽也。为最危。(《南溟》)
治痘察寒热，以诊腹为主，诊腹以任脉为要。真寒者，以腹两旁虽热，于任脉久按之，
则无
热而为冷，虽有口渴脉数，痘色红紫等证，是为假热。若按任脉而有热者，虽寒战切牙，痘
色淡白下利等证，是为假寒。 (《宗柳》)
察寒热，在任脉水分以上诊之。手按久则自辨。察虚实，在脐下或左或右，动而低者毒
轻，动而高者毒重，虚里动甚者险证也。(《诊病奇 》)
病诊腹有三候，腹有凝结如筋而硬者，以指久按，其硬移他处。又就所移者按之，其
硬又
移他处。或大腹，或脐旁，或小腹，无定处，是一候也。右手轻轻按腹，为时稍久，潜心候
之，有物如蚯蚓蠢动，隐然应手，甚至腹底微鸣，是二候也。高低凸凹，如畎亩状。熟按之
，起伏聚散，上下往来，浮沉出没，是三候也。(玄 )
水肿胀满证，按之至脐，脐随手移左右，重手按之离乎脊，失脐根者必死。(《阳山原
文》)
脉候有热，而腹候无热者，是表热而其热易去也。按腹而热如烧手掌者，是伏热而其热
不易
去也。小儿暴热，其轻重难以脉辨，而诊腹可以决定矣。若心下动而其热烙手者，尤不可忽
。(南阳)
左右不容、承满处痛，按之痛益甚，或引于胸腹中，漉漉有声，时吐水汁，吐则痛减，
是为 囊。宜温药，宜减饮食。(台州)
腹痛有食痛积痛，痛在心下，瘀血痛在脐旁小腹，按痛处则有块应手。肠痈痛右足挛急
，小便淋沥。痰饮痛者，其痛动移无定处也。(东郭)
凡小儿肚腹高起，为心突，为肺胀，肺绝也。(周于蕃)
肚大青筋，其卧如缚者，为无治。(《集成》)
腹者，水谷之海，腹皮宽浓，水谷盈也，主寿。(陈飞霞)
脐者，腹之中央，内居大肠。绕脐而痛，乃燥屎结于肠中，欲出不出之状。(张令韶)
小腹未硬痛者，邪在表，若已硬痛者，邪入里也。(周于蕃)
小腹痛，脉沉迟者，为阴寒，当温之。(周于蕃)
腹胀而鸣，肢冷而泻，发热、形瘦，脉大者死。(周于蕃)
按∶胸主分布阴阳，腹为阴中之至阴。食积痰滞瘀血，按之拒、按之不拒，其中虚实从
此而
辨，此其常解也。乃验胸以虚里，验腹以神阙，辨证恰在此。是人所罕见者，则于望、闻、
问、切四诊之外，更增一法，较为精详。(惕厉子)
胃的大络，名叫虚里，位于左侧乳头下方三寸处。如果它的搏动微弱而看不见，属于“不及”，说明宗气（人体元气之总汇）内部虚弱。如果搏动剧烈甚至震动衣服，属于“太过”，说明宗气向外泄漏。如果脉搏跳动三四次出现一次停顿，或者五六次出现一次停顿，主病为体内有积聚（指腹内结块或气血瘀滞）。如果完全摸不到搏动，则病情危重。医经说：虚里没有动脉搏动的会死亡。（引自《心法》）
人以胃气为根本，所以通过观察虚里的搏动，可以辨别病机的轻重。按压时手感柔和，搏动不紧张、舒缓不急迫的，说明宗气积聚在膻中穴区域，这是正常的生理状态。如果搏动洪大且弹手，或者完全摸不到搏动的，都属于胃气断绝的表现。（引自《阳山原文》）
健康人的膻中部位安静为佳，虚里是脉象中宗气的反映。视而不见，轻按时逐渐感到搏动，似有似无的是吉兆。如果胸中阳气衰败，搏动高过乳房，延伸至中府穴、云门穴的，预后凶险。患有虚劳、痨瘵等慢性消耗性疾病的人，如果每日搏动都高亢的，属于无法治愈的情况。（台州注）
虚里的搏动与寸口脉（手腕桡动脉处）相应，虚里搏动高的，寸口脉也高；寸口脉出现结代（脉律不齐），虚里也会出现结代。（引自《诊病奇 》）
虚里搏动高亢属于恶候，孕妇最忌讳。如果是产后出现危急病症，以及黄胖病（营养不良性水肿），或者受惊恐惧、暴怒，或者强力活动肢体导致的，即使虚里搏动高亢也没有危险，这一点必须仔细辨别。（南阳注）
凡是治疗小儿，无论什么病症，都应该先揣测虚里穴的情况，如果跳动特别剧烈的，不可使用攻伐之法，因为小儿先天不足。儿科医生若能遵循我的话，造福将无穷无尽，这是千古未传的秘诀，要珍惜宝贵。（引自《柳州医话》）
小儿的脉象很难凭靠，只有揣测虚里穴，确实有依据，用这种方法治疗成人也同样适用。（王孟英注）
胸腹部，是五脏六腑的宫城，阴阳气血的发源地，如果想要了解脏腑的情况，没有比诊察胸腹更好的方法了。（引自《对时论》）
诊察胸腹应该多次进行按抚，有时深按有时浅按，以检查胸腹的坚硬或柔软，以及是否拒绝按压，从而判断虚实。（引自《诊病奇 》）
上脘、中脘、下脘三个部位，用手指抚摸，平坦而没有涩滞感的，说明胃中平和，没有虚滞。如果按压中脘虽然感觉痞硬，但不像石头那样坚硬，这是饮癖（水饮停聚形成的癖块）。（引自《诊病奇 》）
虚里动气有三种征候：轻轻按压就能感觉到，深按却感觉不到的，是气虚的征候。轻按时感觉洪大，重按时感觉虚细的，是血虚的征候。有形质且伴有搏动的，是积聚的征候。（引自《该病奇 》，疑为《诊病奇俶》之误）
诊察胸腹，用轻手循抚，从鸠尾穴到脐下，感知皮肤的润燥，可以辨别寒热。用中等力度寻扪，询问是否有疼痛，以察邪气有无。用重手推按，再问是否疼痛，以察脏腑的虚实和沉积物的情况，这就像诊脉时的浮、中、沉三种手法一样。（引自《对时论》）
诊察腹部，以肚脐为先导。人身有肚脐，就像天上有北极星一样，所以名叫天枢，又名叫神阙。这是神气所在的穴位，是保生的根本。慢慢按压它如果有力量，气感应手，说明内有神气守护。如果按压时气感不应，说明守常失常。（阳山注）
凡是诊察肾间的动气，将右手或左手三指紧密排列安放在脐间，和缓有力，一息（一次呼吸）跳动两次，绕脐充实的，说明肾气充盛。一息跳动五六次的，属热证。手下感觉虚冷，搏动沉微的，是命门火不足。手下感觉热燥不润，搏动细数，向上延伸至中脘部的，是阴虚。按压时感觉分散，一息只跳动一次的，是原气虚败的征候。（引自《诊病奇 》）
诊腹可以先诊脐部。按压有力的，没有病。按压无力，感觉像手指或香灰中的感觉，属于无法治愈。（寿安注）
脐的上下左右推动时不动的，是正常的。但是气弱的人推动时会移向一方，向右移说明左边经脉绝断，向左移说明右边经脉绝断，上下方向也是如此，这叫做“脐绝”。病人出现这种情况属于无法治愈，只有高龄老人无害。（引自《南溟》）
脐通连五脏，是真神往来的门户，所以名叫神阙。它与背部第十四椎（肾俞附近）相对，就像南北极一样。凡是肚脐深大且坚固，左右上下推动时不动，轮廓（腹皮相聚形成轮状）约束良好的，是真神安全。即使有大病还可以治疗，但急性病不在此例。（引自《台州原文》）
小腹左右经常结块的，都是蓄血（血液瘀积）。如果有疼痛，不是食积或虫积的征候，而是蓄血或者发展为疝气。（引自《台州原文》）
小腹有燥屎（干结粪便）的，一定靠近横骨，左边累累成块，形状稍长，按压时不痛，如果左边充满则会波及右边。（引自《台州原文》）
脐的上下任脉显露的，胀大如筷子粗细，这是脾肾虚的表现。此脉在普通人身上出现会发病，在病患身上出现则难治。劳伤阴虚火旺的证候，多有此表现。有郁气的人也常有此现象，不为害。医者应仔细察辨。（白竹注）
久病之人腹皮紧贴背部，当脐上下，有坚硬而结块，推之不动的，那是脊骨本身。（引自《台州原文》）
肝病的人，两胁下疼痛牵引至小腹，所以肝病需要诊察两胁。两胁皮肉满实而有力的，肝气平和。两胁空虚无力的，是肝虚，也是中风及一切筋病的征候。男子积块在左胁的属疝气，女子积块在右胁的属瘀血。（引自《台州原文》）
痞积、疝气等各种病症，病位在左侧的容易治疗，病位在右侧的较难治疗，因为左属阳，右属阴。（良务注）
鸠尾穴动气不高的是风寒邪热，鸠尾穴动气高亢的是痘疹。手掌中动脉旺盛的，也是痘疹。痘疮发出后搏动停止，发出后仍然跳动的，是痘毒炽盛，最为危险。（引自《南溟》）
治疗痘疹要察辨寒热，以诊腹为主，诊腹以任脉为关键。真正寒证的，虽然腹部两旁发热，但久按任脉，则感觉无热而变冷，虽然有口渴、脉数、痘色红紫等症状，这是假热。如果按任脉而有热感，虽然有寒战咬牙、痘色淡白、下利等症状，这是假寒。（引自《宗柳》）
察辨寒热，在任脉水分穴以上诊察。用手按压久了自然能分辨。察辨虚实，在脐下或左或右，搏动低微的毒性轻，搏动高亢的毒性重，虚里搏动剧烈的属于险证。（引自《诊病奇 》）
病诊腹有三种征候：腹部有凝结如筋且硬的，用手指久按，其硬块会移到别处；再按住移动后的位置，硬块又移到别处。或者在大腹、脐旁、小腹之间移动，没有固定位置，这是一候。右手轻轻按腹，时间稍久，潜心等候，有物体如蚯蚓蠕动，隐约应手，甚至腹底微鸣，这是二候。高低凹凸，像田亩沟渠状。熟按时，起伏聚散，上下往来，浮沉出没，这是三候。（玄氏注）
水肿胀满证，按压至脐部，脐随手指左右移动，重手按压时离开脊背，失去脐根支撑的必死。（引自《阳山原文》）
脉象显示有热，而腹部触诊无热感的，是表热，其热容易去除。按压腹部感觉热如烧手掌的，是伏热，其热不易去除。小儿突发高热，其轻重难以通过脉象辨别，而诊腹可以决定。如果心下部位跳动且热感烙手，尤其不可忽视。（南阳注）
左右不容穴、承满穴处疼痛，按压时疼痛加剧，或者牵引至胸腹中，肠鸣漉漉有声，时常呕吐水汁，吐后疼痛减轻，这是水囊（痰饮水湿积聚）。宜用温药，宜减少饮食。（台州注）
腹痛分为食痛、积痛，痛在心下的多为食积；瘀血痛在脐旁小腹，按压痛处则有块应手；肠痈痛表现为右足拘挛紧急，小便淋沥；痰饮痛的特点是疼痛移动无定处。（东郭注）
凡是小儿肚腹高起，称为心突，称为肺胀，这是肺绝的表现。（周于蕃注）
肚子大且有青筋暴露，睡觉时身体僵硬如被捆绑的，属于无法治愈。（引自《集成》）
腹部是水谷之海，腹皮宽厚浓密，说明水谷充盈，主长寿。（陈飞霞注）
脐是腹部的中央，内部居有大肠。绕脐而痛，是燥屎结于肠中，想排出不出的状态。（张令韶注）
小腹尚未坚硬疼痛的，邪气在表；如果已经坚硬疼痛的，邪气已入里。（周于蕃注）
腹胀且肠鸣，四肢冰冷且腹泻，发热、形体消瘦，脉象大的，预后不良（死证）。（周于蕃注）
按语：胸部主要分布阴阳，腹部是阴中之至阴。食积、痰滞、瘀血，按压时拒绝或接受，其中的虚实由此辨别，这是常规解法。然而验证胸部以虚里穴，验证腹部以神阙穴，辨证的关键恰在于此。这是人们罕见的，因此在望、闻、问、切四诊之外，更增加一种方法，较为精详。（惕厉子注）
The great collateral of the Stomach is named Xuli (虚里, Ventricle Li), located three cun below the left nipple. If its pulsation is faint and invisible, it indicates "insufficiency," signifying that Zong Qi (宗气, Pectoral Qi) is internally deficient. If the pulsation is vigorous enough to shake the clothes, it indicates "excess," signifying that Zong Qi is leaking externally. If the pulse beats three or four times before a pause, or five or six times before a pause, it primarily indicates the presence of accumulations (Ji Ju, masses or stagnations). If no pulsation can be felt at all, the condition is critical. The classics state: Death occurs if there is no arterial pulsation at Xuli. (From *Xin Fa*)
Humans rely on Stomach Qi as their foundation; therefore, observing the pulsation of Xuli allows one to distinguish the severity of the pathogenesis. If palpation yields a soft sensation, with pulsation that is neither tense nor urgent, but rather slow and relaxed, it indicates that Zong Qi is accumulated in the Danzhong (膻中, Chest Center) region, which is the normal physiological state. If the pulsation is surging and large, snapping against the fingers, or if there is absolutely no pulsation, both indicate the exhaustion of Stomach Qi. (From *Yangshan Yuanwen*)
In healthy individuals, stillness in the Danzhong area is auspicious. Xuli represents the Zong Qi of the pulses. It should not be visible to the naked eye; gentle palpation reveals a gradual pulsation, feeling present yet elusive, which is a favorable sign. If the Yang Qi in the chest is declining, and the pulsation rises above the breast, extending to Zhongfu (LU-1) and Yunmen (LU-2), the prognosis is ominous. In cases of deficiency consumption (Xu Lao) and tuberculous disease (Lao Zhai), if the pulsation remains high daily, it is incurable. (Annotation by Taizhou)
The pulsation of Xuli corresponds with the Cun Kou pulse (Radial Pulse). If Xuli pulsation is high, the Cun Kou pulse is also high; if the Cun Kou pulse exhibits Jie Dai (irregular rhythm), Xuli will also exhibit irregularity. (From *Zhen Bing Qi*)
High pulsation at Xuli is an adverse sign and is most taboo for pregnant women. However, if this occurs postpartum during a critical illness, or in cases of yellow edema (Huang Pan Bing), fright, rage, or after strenuous physical exertion, even if Xuli pulsation is high, there is no danger. This distinction must not be overlooked. (Annotation by Nanyang)
When treating children, regardless of the syndrome, one should first palpate the Xuli acupoint. If the pulsation is excessively vigorous, invasive or draining treatments should not be used, due to the child's congenital insufficiency. Pediatricians who follow this advice will bring boundless benefit. This is a secret unshared for millennia; cherish it. (From *Liuzhou Yi Hua*)
Children's pulse signs are difficult to rely upon; only by palpating Xuli is there reliable evidence. This method is equally applicable to adults. (Annotation by Wang Mengying)
The chest and abdomen are the palaces of the five Zang and six Fu organs, and the sources of Yin-Yang and Qi-Blood. To understand the state of the organs, nothing compares to diagnosing the chest and abdomen. (From *Dui Shi Lun*)
Examination of the chest and abdomen should involve multiple palpations and caresses, varying between deep and shallow pressure, to assess hardness or softness, and whether the area resists pressure, thereby distinguishing deficiency from excess. (From *Zhen Bing Qi*)
Palpating the Upper, Middle, and Lower Wan (epigastric regions) with fingers: if smooth and without friction, it indicates Stomach harmony without deficiency or stagnation. If pressing the Middle Wan feels obstructed and hard but not like stone, it indicates Yin Pi (water retention forming masses). (From *Zhen Bing Qi*)
There are three manifestations of pulsation at Xuli: felt lightly but lost with deep pressure indicates Qi deficiency; felt surging and large lightly but empty and fine with heavy pressure indicates Blood deficiency; a tangible mass accompanied by pulsation indicates accumulation. (From *Gai Bing Qi*, likely referring to *Zhen Bing Qi Chu*)
Diagnosing the chest and abdomen involves light stropping from Jiwei (CV-15) to below the umbilicus to perceive skin moisture or dryness, distinguishing cold from heat. Medium-pressure searching while asking about pain detects the presence of pathogens. Heavy pushing and pressing while asking about pain assesses organ deficiency/excess and sedimentation, analogous to the floating, middle, and sinking methods of pulse diagnosis. (From *Dui Shi Lun*)
The key to abdominal diagnosis begins with the umbilicus. The human umbilicus is like the North Star in the sky, hence named Tianshu (Heavenly Pivot) and Shenshu (Spirit Pivot). It is the acupoint of divine Qi and the root of life preservation. Gentle pressure yielding strength and responsive Qi indicates internal guarding by divine Qi. Lack of response indicates loss of normal guarding. (Annotation by Yangshan)
To diagnose the moving Qi between the Kidneys, place three fingers of the right or left hand closely together over the umbilicus. A gentle, strong, two-beats-per-breath pulsation filling the area around the umbilicus indicates abundant Kidney Qi. Five to six beats per breath indicates Heat. Cold and weak hands with deep, faint pulsation indicate Mingmen (Gate of Life) insufficiency. Hot, dry hands with fine, rapid pulsation extending upward to Zhongwan (CV-12) indicate Yin deficiency. Dispersed feeling upon pressure, with only one beat per breath, indicates collapse of Yuan Qi (Original Qi). (From *Zhen Bing Qi*)
Abdominal diagnosis may start with the umbilicus. Strong response to pressure indicates health. Weak response, feeling like a finger or ash in incense, indicates incurability. (Annotation by Shou'an)
Normal is when the umbilicus does not move when pushed up, down, left, or right. However, in those with weak Qi, pushing causes displacement to one side. Displacement to the right indicates left meridian exhaustion; displacement to the left indicates right meridian exhaustion; similar logic applies vertically. This is called "Umbilical Exhaustion." Its appearance in patients indicates incurability, except in the elderly. (From *Nan Ming*)
The umbilicus connects to the five Zang organs and is the gate where true Spirit enters and exits, hence named Shenshu. It opposes the 14th thoracic vertebra on the spine, like the North and South Poles. A deep, large, firm umbilicus that does not move when pushed in any direction, with well-constrained wheels (folds of abdominal skin) and rims (base resembling a small wine cup), indicates safe True Spirit. Even severe diseases may be treatable, except acute illnesses. (From *Taizhou Yuanwen*)
Constant nodules on either side of the lower abdomen indicate stored Blood (Xu Xue). If painful, it is not food stagnation or worm accumulation, but stored Blood potentially developing into hernia. (From *Taizhou Yuanwen*)
Dry stool in the lower abdomen is usually near the transverse bone. Lumpy formations on the left, slightly elongated, non-tender upon pressure, if full on the left, will extend to the right. (From *Taizhou Yuanwen*)
Manifestation of the Ren Mai (Conception Vessel) above and below the umbilicus, swollen like chopsticks, indicates Spleen and Kidney deficiency. Appearance in healthy people predicts illness; in patients, it indicates difficulty in treatment. Common in labor injury, Yin deficiency with Fire hyperactivity, and Qi stagnation (harmless). Physicians must observe carefully. (Annotation by Baizhu)
In chronic illness, if the abdominal skin adheres tightly to the back, with hard, immovable knots above and below the umbilicus, these are the spinous processes themselves. (From *Taizhou Yuanwen*)
Liver disease causes pain under the costal margins radiating to the lower abdomen; thus, Liver disease requires examining the hypochondrium. Full, solid, and strong hypochondrial flesh indicates Liver harmony. Empty and weak hypochondrial flesh indicates Liver deficiency and syndromes of wind-stroke and tendon disorders. Masses in the left hypochondrium of men indicate Qi hernia; masses in the right hypochondrium of women indicate Blood stasis. (From *Taizhou Yuanwen*)
Syndromes such as Pi accumulation and Hernia are easier to treat on the left and harder on the right, because Left belongs to Yang and Right belongs to Yin. (Annotation by Liangwu)
Low pulsation at Jiwei (CV-15) indicates Wind-Cold or Evil Heat; high pulsation at Jiwei indicates Smallpox. Vigorous arterial pulsation in the palm also indicates Smallpox. Cessation of pulsation after eruption is normal; continued pulsation after eruption indicates intense Smallpox toxin, which is critically dangerous. (From *Nan Ming*)
Treating Smallpox requires distinguishing Cold and Heat via abdominal diagnosis, focusing on the Ren Mai. True Cold: although sides of the abdomen are hot, prolonged pressure on Ren Mai reveals coldness; despite thirst, rapid pulse, and red-purple spots, this is False Heat. True Heat: pressure on Ren Mai reveals heat; despite chills, teeth grinding, pale spots, and diarrhea, this is False Cold. (From *Zong Liu*)
Distinguishing Cold and Heat is done above the Shuifen point (CV-9) on the Ren Mai; prolonged manual pressure clarifies the nature. Distinguishing Deficiency and Excess is done below the umbilicus, left or right. Low pulsation indicates mild toxin; high pulsation indicates severe toxin. Vigorous pulsation at Xuli indicates a critical condition. (From *Zhen Bing Qi*)
There are three signs in abdominal diagnosis: 1. Hard, cord-like coagulation that moves when pressed firmly, shifting locations randomly (large abdomen, beside umbilicus, or lower abdomen). 2. Gentle pressure for a longer time reveals movement like an earthworm under the skin, audible gurgling in the abdomen floor. 3. Undulating contours like fields; deep pressure reveals rising, falling, gathering, scattering, and emerging movements. (Annotation by Xuan)
In edema and distension, if pressing reaches the umbilicus and it shifts sideways, and heavy pressure lifts it off the spine, losing the umbilical root, death is certain. (From *Yangshan Yuanwen*)
Pulse shows Heat but abdomen feels cool indicates Exterior Heat, which is easily resolved. Abdomen feeling hot like a burning palm upon pressure indicates Hidden Heat, which is difficult to resolve. In sudden high fever in children, severity is hard to judge by pulse alone, but abdominal diagnosis decides it. Heat at the epigastrium that burns the hand is particularly significant. (Annotation by Nanyang)
Pain at Burong (ST-19) and Chengman (ST-20), worsening with pressure, radiating to chest/abdomen, with gurgling sounds and vomiting water that relieves pain, indicates Water Sac (fluid retention). Use warming herbs and reduce diet. (Annotation by Taizhou)
Abdominal pain types: Food/Worm pain; pain in the epigastrium suggests food stagnation; Blood stasis pain is in the lower abdomen beside the umbilicus, with palpable masses; Intestinal Abscess pain presents with right leg stiffness and dysuria; Phlegm-Fluid pain migrates without fixed location. (Annotation by Dongguo)
Protruding abdomen in children is called Heart Protrusion or Lung Distension, indicating Lung exhaustion. (Annotation by Zhou Yufan)
Large belly with visible blue veins, sleeping rigidly bound, indicates incurability. (From *Ji Cheng*)
The abdomen is the Sea of Water and Grain. Wide and thick abdominal skin indicates abundant nourishment and longevity. (Annotation by Chen Feixia)
The umbilicus is the center of the abdomen, housing the Large Intestine. Periumbilical pain indicates dry stool stuck in the intestines, wanting to exit but unable to. (Annotation by Zhanglingshao)
If the lower abdomen is not hard or painful, the pathogen is in the Exterior; if hard and painful, the pathogen has entered the Interior. (Annotation by Zhou Yufan)
Lower abdominal pain with deep, slow pulse indicates Yin-Cold; treat with warming methods. (Annotation by Zhou Yufan)
Abdominal distension with borborygmi, cold limbs with diarrhea, fever, emaciation, and a large pulse indicates death. (Annotation by Zhou Yufan)
Commentary: The Chest distributes Yin and Yang; the Abdomen is the Ultimate Yin within Yin. Food stagnation, Phlegm obstruction, and Blood stasis are distinguished by resistance or acceptance to pressure, revealing deficiency or excess. This is the standard interpretation. However, verifying the Chest via Xuli and the Abdomen via Shenshu is the precise key to syndrome differentiation. Rare among practitioners, this adds a fifth method beyond Observation, Listening/Smelling, Inquiry, and Palpation, making diagnosis more refined. (Annotation by Tilizi)