(出《素问》)
风胜则动,热胜则肿,燥胜则干,寒胜则浮,湿胜则濡泄,甚则水闭 肿。
厥阴所至,为里急,为支痛,(支柱妨也。)为 戾,为胁痛呕泄。(所至,谓主令也。后同。)
少阴所至,为疡胗身热,为惊惑、恶寒战栗、谵妄,为悲妄、衄蔑,为语笑。
太阴所至,为积饮痞隔,为惊惑蓄满,为中满,霍乱吐下,为重, 肿。(重,体重也,如怠惰四肢不
举,湿胜则缓故也。)
少阳所至,为嚏呕,为疮疡,为惊躁瞀昧暴病,(即暴痛也。)为喉痹、耳鸣、呕涌,为暴注、 螈、暴死。
阳明所至,为浮虚,为鼽。尻阴股膝髀 足病,(即痛字。)
为皴揭,为鼽嚏。
太阳所至,为屈伸不利,为腰痛,为寝汗,为流泄禁止。
(出《灵枢》)
审其尺之缓急大小滑涩,肉之坚脆,而病形定矣。
视人之目窠上微痈,(一作拥、雍。)如新卧起状,其颈脉动,
时咳,按起手足上, 而不起者,风水肤胀也。(水胀篇∶按其腹,随手而起,如裹水之状者,水也; 而
不起,腹色不变者,肤胀也;腹筋起者,臌胀也。)
尺肤滑以淖泽者,风也,尺肉弱者,解 ,(尺脉缓涩,谓之解 。)安卧脱肉者,寒热不治。
尺肤滑而泽脂者,风也,尺肤涩者,风痹也;(面部阙中,色以薄泽为风,冲浊为痹。)尺肤粗如枯鱼之
鳞者,水 饮也,尺肤热甚,脉盛躁者,病温也,其脉盛而滑者,汗且出也。(人一
呼脉三动,一吸脉三动,而躁,尺热,曰病温;尺不热,脉滑,曰病风;脉涩,曰痹。)
尺肤寒,其脉小者,泄,少气。(尺寒脉细,谓之后泄。)
尺肤炬然,(《脉经》作 然,下并同。)先热后寒者,寒热也;
尺肤先寒,久持之而热者,亦寒热也。(寒热,疟之类也。)
尺涩脉滑,谓之多汗。(滑者阴气有余,为多汗而身寒。)脉粗尺
常热者,谓之热中。(脉粗大者,阴不足,阳有余,为热中也。)
肘所独热者,腰以上热。手所独热者,腰以下热,肘前独热者,膺前热。肘后独热者,肩背热。
臂中独热者,腰腹热。肘后粗以下三四寸热者,肠中有虫。掌中热者,腹中热。
(《难经》以掌中热而 ,为心病。)掌中寒者,腹中寒。尺炬然热,人
迎大者,当夺血。(人迎指喉脉言,谓此象将必夺血也。当作尝,非。)尺坚大,脉小甚,少气,色白, 有
加,立死。
胃中热,则消谷,令人悬心善饥。脐以上皮热,肠中热,则出黄如糜。脐以下皮寒,(当作热。)胃中寒,
则腹胀。肠中寒,则肠鸣飧泄。胃中寒,肠中热,则胀而且泄。胃中热,肠中寒,则疾饥,小腹痛胀。
(出自《素问》)
风邪偏胜则导致肢体动摇,热邪偏胜则导致红肿,燥邪偏胜则导致干燥,寒邪偏胜则导致浮肿,湿邪偏胜则导致濡泄(大便稀溏),严重时会导致小便闭塞和肿胀。
厥阴经气所主之时,表现为腹部拘急疼痛,胁肋部支撑性疼痛(“支柱妨”意为支撑感且妨碍活动),身体扭曲,以及胁痛、呕吐和下利。(“所至”,指主令之气到来,后文同此意。)
少阴经气所主之时,表现为疮疡和斑疹伴身热,惊恐疑惑、恶寒战栗、胡言乱语,悲伤妄动、鼻出血及便血,以及言语错乱和无故发笑。
太阴经气所主之时,表现为水饮停积、痞塞阻隔,惊恐疑惑、胸腹满闷,中焦胀满,霍乱导致的上吐下泻,身体沉重和浮肿。(“重”,指身体沉重,如倦怠懒惰、四肢无力抬举,这是因为湿邪偏胜导致肌肉松弛的缘故。)
少阳经气所主之时,表现为打喷嚏、呕吐,疮疡,惊恐烦躁、视物模糊昏昧突发疾病(即突发剧痛),喉痹、耳鸣、呕吐涌逆,急性腹泻、抽搐、突然死亡。
阳明经气所主之时,表现为脉象浮虚,鼻塞流涕。尻骨、阴部、大腿、膝盖、大腿根部和足部的疾病(此处“病”字通“痛”),皮肤皲裂脱屑,鼻塞流涕和打喷嚏。
太阳经气所主之时,表现为关节屈伸不利,腰痛,睡着时出汗(寝汗),以及腹泻与便秘交替或二便不通。
(出自《灵枢》)
诊察尺肤(前臂内侧从肘到腕的皮肤)的缓急、大小、滑涩,观察肌肉的坚脆,从而确定病形。
观察人眼睑上方微微隆起(一作拥、雍),像刚睡醒的样子,颈部动脉搏动明显,时常咳嗽,按压手足背部凹陷处,松开手后凹陷不能立即恢复者,这是风水肤胀病。(《水胀篇》说:按压腹部,随手而起,像包裹着水的样子,是水胀;按下去不起,腹部颜色不变,是肤胀;腹部筋脉凸起,是鼓胀。)
尺肤光滑润泽的,是风病;尺部肌肉瘦弱的,是懈惰(尺脉缓涩,称为懈惰);安静卧床且肌肉消瘦脱落的,是寒热病且难以治愈。
尺肤光滑且有油脂光泽的,是风病;尺肤干涩的,是风痹病;(面部阙中部位,色泽薄而润泽为风,浑浊为痹。)尺肤粗糙像枯鱼鳞片一样的,是水饮病;尺肤非常热,脉搏盛大躁动的,是温病;其脉搏盛大而滑利的,即将出汗。(人一呼脉搏跳动三次,一吸脉搏跳动三次,且躁动,尺肤发热,称为温病;尺肤不热,脉搏滑利,称为风病;脉搏涩滞,称为痹病。)
尺肤寒冷,脉搏细小的,是泄泻,气短。(尺寒脉细,称为后泄。)
尺肤灼热(《脉经》作“燔然”,下文相同),先热后冷的,是寒热病;
尺肤先冷,长时间按压后变热的,也是寒热病。(寒热病,属于疟疾之类。)
尺肤涩而脉搏滑利的,称为多汗。(滑利表示阴气有余,导致多汗且身体发冷。)脉搏粗大且尺肤经常发热的,称为热中。(脉搏粗大,表示阴不足,阳有余,即为热中。)
肘部单独发热的,腰部以上发热。手部单独发热的,腰部以下发热。肘前单独发热的,胸前发热。肘后单独发热的,肩背发热。
手臂中间单独发热的,腰腹部发热。肘后下方三四寸处发热的,肠中有虫。手掌心发热的,腹中发热。
(《难经》认为掌心发热且伴有喘息,是心病。)手掌心发冷的,腹中寒冷。尺肤灼热,人迎脉(颈动脉)大的,应当发生失血。(人迎指喉部脉搏而言,这种征象预示必将失血。“夺”当作“尝”,非。)尺肤坚硬增大,脉搏细小至极,气短,面色苍白,病情加重,将立即死亡。
胃中有热,则消化食物快,使人心中悬空易饥。脐以上皮肤发热,说明肠中有热,则排出黄色如糜粥样的粪便。脐以下皮肤寒冷(此处原文可能有误,当为热,但依上下文逻辑若为寒则对应胃寒腹胀,此处依原文翻译为寒冷,但注脚提示可能为热,故译为寒冷以忠实原文,同时保留注脚含义的语境暗示),胃中有寒,则腹部胀满。肠中有寒,则肠鸣飧泄(完谷不化)。胃中有寒,肠中有热,则既胀满又泄泻。胃中有热,肠中有寒,则容易饥饿,小腹痛胀。
(From *Suwen*)
When Wind is predominant, it causes movement (tremors or spasms); when Heat is predominant, it causes swelling; when Dryness is predominant, it causes dryness; when Cold is predominant, it causes edema; when Dampness is predominant, it causes Ru Xie (loose stools), and in severe cases, urinary retention and swelling.
When the Jueyin (Liver/Pericardium) Qi prevails, it manifests as abdominal urgency, distending pain in the hypochondrium (described as "supporting obstruction"), body twisting, hypochondriac pain, vomiting, and diarrhea. ("Prevails" refers to the ruling pathogenic factor; the same applies subsequently.)
When the Shaoyin (Heart/Kidney) Qi prevails, it manifests as sores and macules with fever, fright, confusion, aversion to cold, tremors, delirium, excessive sorrow with妄动 (delusional behavior), epistaxis, hematochezia, incoherent speech, and inappropriate laughter.
When the Taiyin (Spleen/Stomach) Qi prevails, it manifests as accumulation of fluids and fluid retention, obstruction, fright, confusion, chest and abdominal fullness, middle-jiao distension, Huoluan (cholera-like syndrome with vomiting and diarrhea), heaviness, and edema. ("Heaviness" refers to a sensation of bodily weight, such as lethargy and inability to lift the limbs, caused by Dampness predominance leading to flaccidity.)
When the Shaoyang (Gallbladder/Triple Burner) Qi prevails, it manifests as sneezing and vomiting, sores and ulcers, fright, restlessness, visual obscuration, and sudden illness (i.e., sudden severe pain), throat obstruction, tinnitus, vomiting and regurgitation, acute diarrhea, convulsions, and sudden death.
When the Yangming (Large Intestine/Stomach) Qi prevails, it manifests as floating and deficient pulse, nasal congestion. Diseases of the sacrum, yin region, thighs, knees, thighs roots, and feet (here "disease" implies pain), skin cracking and scaling, nasal congestion, sneezing.
When the Taiyang (Bladder/Small Intestine) Qi prevails, it manifests as difficulty in flexion and extension, lower back pain, night sweats, and alternating diarrhea and constipation.
(From *Lingshu*)
Examine the Chi skin (the skin on the inner forearm from elbow to wrist) for slackness/tightness, size, smoothness, and roughness, and observe the firmness or fragility of the muscles to determine the disease pattern.
Observe if the upper eyelids are slightly swollen (alternatively written as Yong or Yong), resembling the appearance after just waking up, if the neck vessels are pulsating, if there is frequent coughing, and if pressing the dorsum of the hands and feet leaves an indentation that does not rebound immediately. This indicates Feng Shui Fu Zhang (Wind-Water Skin Distension). (*Shuizhang Chapter* states: Pressing the abdomen and having it rise immediately like a water-filled bag indicates Water Distension; pressing and not rising, with unchanged abdominal color, indicates Skin Distension; raised abdominal veins indicate Drum Distension.)
If the Chi skin is smooth and glossy, it indicates Wind disease; if the flesh at the Chi position is weak, it indicates Xie Zhuo (lethargy/flaccidity; a slow and choppy Chi pulse is called Xie Zhuo); if the person lies quietly with emaciated muscles, it indicates a refractory Cold-Heat disorder.
If the Chi skin is smooth and has a greasy luster, it indicates Wind disease; if the Chi skin is rough, it indicates Feng Bi (Wind-Bi syndrome); (On the face, at the Quezhong area, a thin and glossy complexion indicates Wind, while a turbid complexion indicates Bi.) If the Chi skin is coarse like the scales of a dried fish, it indicates Fluid Retention; if the Chi skin is very hot and the pulse is vigorous and restless, it indicates Warm Disease; if the pulse is vigorous and slippery, sweating will soon occur. (If the pulse moves three times per exhalation and three times per inhalation, accompanied by restlessness and heat at the Chi position, it is Warm Disease; if the Chi is not hot but the pulse is slippery, it is Wind Disease; if the pulse is choppy, it is Bi Syndrome.)
If the Chi skin is cold and the pulse is fine, it indicates diarrhea and shortness of breath. (Cold Chi with a fine pulse is called Hou Xie.)
If the Chi skin is burning hot (written as Ran in *Maijing*, same below), alternating between heat and cold indicates a Cold-Heat disorder; if the Chi skin is initially cold but becomes hot after prolonged pressure, it also indicates a Cold-Heat disorder. (Cold-Heat disorders belong to the category of Malaria.)
If the Chi skin is rough but the pulse is slippery, it indicates profuse sweating. (Slipperiness indicates excess Yin, leading to profuse sweating and cold body.) If the pulse is coarse and the Chi skin is constantly hot, it is called Re Zhong (Internal Heat). (A coarse pulse indicates insufficient Yin and excess Yang, constituting Internal Heat.)
If only the elbows are hot, the upper half of the waist is hot. If only the hands are hot, the lower half of the waist is hot. If only the front of the elbows is hot, the anterior chest is hot. If only the back of the elbows is hot, the shoulders and back are hot.
If only the middle of the arms is hot, the waist and abdomen are hot. If the area 3-4 cun below the posterior elbow is hot, there are parasites in the intestines. If the palms are hot, the abdomen is hot.
(*Nanjing* states that palm heat accompanied by panting indicates Heart disease.) If the palms are cold, the abdomen is cold. If the Chi skin is burning hot and the Renying pulse (carotid artery) is large, blood loss should be expected. (Renying refers to the pulse at the throat; this sign predicts impending blood loss. The character "Duo" should likely be "Chang", meaning "usually" or "likely", though some interpret it as depletion.) If the Chi skin is hard and enlarged, the pulse is extremely small, there is shortness of breath, the complexion is white, and the condition worsens, death will ensue immediately.
If there is Heat in the Stomach, food is digested quickly, causing a hanging sensation in the heart and frequent hunger. If the skin above the umbilicus is hot, there is Heat in the intestines, resulting in yellow, porridge-like stools. If the skin below the umbilicus is cold (note: text suggests this might be a textual error for 'hot', but translated as cold per source), there is Cold in the Stomach, leading to abdominal distension. If there is Cold in the intestines, there is borborygmus and Sund Xie (diarrhea with undigested food). If there is Cold in the Stomach and Heat in the intestines, there is both distension and diarrhea. If there is Heat in the Stomach and Cold in the intestines, there is rapid hunger and painful distension in the lower abdomen.