窃思诊形之法。必先知经络之部位。辨形体之浅深。审其异同。察其常变。其病情乃可测焉。何言之。刚强
者。形气有余。柔弱者。形气不足。肥者常多血少气。瘦者常多气少血。心肺有邪。其气留于两肘。肝有邪。其
气留于两腋。脾有邪。其气留于两髀。肾有邪。其气留于两 。风胜则动。热胜则肿。燥胜则干。寒胜则浮。身
强痛者。邪气有余。身痿弱者。正气不足。肿起者。邪气实。陷下者。正气虚。上肿曰风。下肿曰水。从上肿下者
属气。其邪在外。从下肿上者属水。其邪在内。先肿而后痛者。形伤气。先痛而后肿者。气伤形。无形而痛者。
阴之类。有形不痛者。阳之类。无形而痛者。其阳完而阴伤之也。有形不痛者。其阴完而阳伤之也。此皆形
之纲领也。善诊者。推而极之。变而通之。按形体之浅深。审部位之经络。合之气色。参之形容。则其病虽异。
而其应不穷。夫乃叹灵素之中多活法。岐黄以后少完医。否则率意而言。执方而疗。欲其丝丝入扣。滴滴
归原也难矣。谚云。取法乎上。仅得其中。若取法乎中。岂不流于下乎。而况学其下焉者乎。
经言察观病患之态。以知精神魂魄之存亡。然则临证之际。何可恃其脉息。而不观夫体态乎。夫体以形
言。态以容言。观其体。察其态。斯病证明而病情着。庶乎指有目。而首有目焉。其态维何。阳证多语。阴候无
声。多语者易治。无声者难疗。骂詈笑歌。其行日夜不休者。狂态也。直视僵仆。其脉阴阳俱盛者。癫态也。厥
者。阴阳不足。冒者表里俱虚。昏沉者。阴阳亏而神气少。恍惚者。津液亡而心血虚。起卧不安。反复颠倒。心
中懊 者。虚烦之证。衣被不敛。言语善恶。不避亲疏者。神乱之征。僵仆者属乎阳。病由机关不利。伛偻者
属乎阴。痛为心肾之 。如狂者。血蓄膀胱。热结未泻。如醉者。邪侵六腑。闭塞不通。妄言妄见者。邪在于胃。
不识不知者。邪入于腑。默默然不慧者。厥阴之候。兀兀然欲吐者。阳明之形。倚息者。气逆而中不和。懈惰
者。肾虚而胃不实。身偏不举者。病在分腠之间。指偏不用者。病在经络之内。不可转侧者。足少阳之实。不
能动摇者。足少阴之虚。不能自转侧者。风湿相搏之容。不能自收持者。阴阳二维之病。尻以代头。脊以代
踵者。肾痹之证。登高而歌。弃衣而走者。胃实之形。难以屈伸者。风湿在于骨节。难以俯仰者。水气在于腹
中。不能俯者病在阳。不能仰者病在阴。项不可以俯仰者。足太阳之脉。腰不可以俯仰者。足少阳之经。腰
不可以行走。项不可顾者。少阳之厥。腰不可以俯仰。项不可顾者。阳明之厥。脊痛腰重。形体不可翻身反
覆者。胃绝。毛悴色夭。腰脊不可俯仰屈伸者。志伤。此皆病患之态也。而言其态者。或在实义之中。或在虚
神之内。或见于坐卧动作之际。或着于皮肉筋骨之间。善诊者。合五官之状貌。参四体之形容。精乎灵素
二书。熟乎轩岐四诊。庶可豁然贯通焉。内训曰。仪式刑之。齐之则圣。下之则贤。否亦不失于从善。诚哉。有
智妇人。胜于男子。
我思考诊察形体特征的方法，必须首先了解经络的分布部位，辨别形体的浅深层次，审察其异同之处，观察其常态与变异的规律，这样病情才可以推测出来。为什么这样说呢？体质刚强者，是形气有余；体质柔弱者，是形气不足。肥胖的人通常多血少气，消瘦的人通常多气少血。心肺有邪气，其病气停留于两肘；肝脏有邪气，其病气停留于两腋；脾脏有邪气，其病气停留于两大腿（髀）；肾脏有邪气，其病气停留于两腘窝（膝后）。风邪偏胜则肢体动摇，热邪偏胜则局部肿胀，燥邪偏胜则干枯，寒邪偏胜则浮肿。身体强直疼痛的，是邪气有余；身体痿软无力的，是正气不足。肿胀高起的，是邪气实证；凹陷下陷的，是正气虚证。上部肿胀称为风肿，下部肿胀称为水肿。从上往下发展的肿胀属于气分病变，其邪气在体表；从下往上发展的肿胀属于水湿病变，其邪气在体内。先肿胀而后疼痛的，是形体受损影响气机；先疼痛而后肿胀的，是气机受损影响形体。没有明显形态改变而疼痛的，属于阴类疾病；有明显形态改变但不疼痛的，属于阳类疾病。没有明显形态改变而疼痛的，说明阳气完好而阴气受伤；有明显形态改变但不疼痛的，说明阴气完好而阳气受伤。这些都是关于形体诊断的纲领。善于诊察的医生，能够推究至极，灵活变通，按察形体的浅深，审辨部位的经络，结合气色变化，参考外形神态，那么即使病情各异，其对应的机理也是无穷无尽的。这时才会感叹《灵枢》、《素问》中充满了灵活的法度，自从岐伯、黄帝之后，很少见到完备的良医了。否则随意而言，拘泥于成方治疗，想要做到丝丝入扣、药到病除，是很难的。谚语说：“取法乎上，仅得其中。”如果取法乎中，岂不是流于下等吗？更何况学习那些低劣方法的人呢？
经典记载：通过观察病患的神态，可以知道精神魂魄的存亡情况。那么在临证之际，怎么能只依赖脉象，而不观察体态呢？“体”是从形体角度说的，“态”是从容仪姿态说的。观察其体，察验其态，这样病症就明确，病情就显著了，这就好比手指有了眼睛，头脑有了眼睛一样。患者的神态有哪些表现呢？阳证患者多言语，阴证患者多沉默无声。多言语的容易治疗，沉默无声的难以治愈。骂人、笑、唱歌，日夜不停止的，是狂证的状态。两眼直视、突然僵倒的，如果脉象阴阳俱盛，是癫证的状态。厥证，是阴阳之气不足；冒证，是表里俱虚；昏沉嗜睡，是阴阳亏损且神气衰弱；恍惚不定，是津液耗亡且心血虚弱；坐卧不安，反复颠倒，心中烦闷懊恼的，是虚烦证的表现。穿衣盖被不知收敛，说话不分好坏，不避亲疏关系的，是神志错乱的征象。突然僵倒是属于阳证，病因在于关节机关不利；弯腰曲背的是属于阴证，疼痛源于心肾之亏虚。像发狂一样的，是瘀血蓄积在膀胱，热结未泻；像喝醉一样的，是邪气侵犯六腑，闭塞不通；胡言乱语、幻视幻听的，是邪气在于胃；不认识人、不知道事的，是邪气进入腑；默默不语、神情呆滞的，是厥阴经的病候；头晕欲吐的，是阳明经的病形；倚靠呼吸困难的，是气逆导致中焦不和；懈怠懒惰的，是肾虚且胃气不实；半身不能抬举的，是病在分肉腠理之间；手指不能活动的，是病在经络之内；不能转身侧卧的，是足少阳经实证；不能动摇肢体的，是足少阴经虚证；不能自行转侧的，是风湿相搏的状态；不能自行收持肢体的，是阴阳维脉的疾病。用屁股代替头，用脚后跟代替脚跟行走的，是肾痹证的表现。登高而歌，脱衣奔跑的，是胃实热的病形；难以屈伸的，是风湿邪气在骨节；难以俯仰的，是水气停留在腹中；不能向前俯身的，病在阳经；不能向后仰身的，病在阴经。颈部不能俯仰的，是足太阳经脉病变；腰部不能俯仰的，是足少阳经病变；腰部不能行走，颈部不能回顾的，是少阳经厥逆；腰部不能俯仰，颈部不能回顾的，是阳明经厥逆；脊痛腰重，身体无法翻身反复的，是胃气绝的表现；毛发憔悴、面色枯槁，腰部脊柱不能俯仰屈伸的，是肾志受伤。这些都是病患的神态表现。描述这些神态，有的体现在实质症状中，有的体现在虚性神志内，有的表现在坐卧动作之间，有的显露于皮肉筋骨之间。善于诊察的医生，综合五官的面貌，参考四肢的形态，精通《灵枢》、《素问》二书，熟悉轩岐四诊法，才可以豁然贯通。《内训》说：“效法它，遵循它，整齐规范就能成为圣人，降低标准就是贤人，否则也不会偏离向善之道。”确实如此，有智慧的妇人，胜过男子。
I ponder the method of diagnosing through physical form. One must first know the locations of the meridians (Meridians, 经络), distinguish the depth of the body's structure, examine similarities and differences, and observe changes from the normal state. Only then can the condition be predicted. Why do I say this? Those with a strong constitution have an excess of Xing-Qi (Form and Qi, 形气); those with a weak constitution have a deficiency of Xing-Qi. Fat people usually have abundant blood but deficient Qi; thin people usually have abundant Qi but deficient blood. When there is pathogenic influence in the Heart and Lung, the pathogenic Qi remains in both elbows; when there is pathogenic influence in the Liver, it remains in both axillae; when there is pathogenic influence in the Spleen, it remains in both thighs (Bi, 髀); when there is pathogenic influence in the Kidney, it remains in both popliteal fossae (Gu, 腘). When Wind prevails, there is movement/tremor; when Heat prevails, there is swelling; when Dryness prevails, there is dryness; when Cold prevails, there is floating/edema. A stiff and painful body indicates excess of pathogenic factors; a flaccid and weak body indicates deficiency of Zheng-Qi (Upright Qi, 正气). Swelling that rises indicates excess of pathogenic factors; sinking/depression indicates deficiency of Zheng-Qi. Swelling in the upper part is called Feng (Wind, 风); swelling in the lower part is called Shui (Water, 水). Swelling developing from top to bottom belongs to Qi disorders, with the pathogen outside; swelling developing from bottom to top belongs to Water disorders, with the pathogen inside. Swelling followed by pain indicates injury to Form affecting Qi; pain followed by swelling indicates injury to Qi affecting Form. Pain without visible morphological change belongs to the Yin category; morphological change without pain belongs to the Yang category. Pain without morphological change means Yang is intact but Yin is injured; morphological change without pain means Yin is intact but Yang is injured. These are the general principles of diagnosing form. A skilled diagnostician extends these principles to their limits and applies them flexibly, examining the depth of the form, identifying the meridians of the location, combining observations with complexion, and referencing appearance. Thus, although diseases vary, their corresponding manifestations are inexhaustible. At this point, one sighs that the *Ling Shu* (Spiritual Pivot, 灵枢) and *Su Wen* (Basic Questions, 素问) contain many flexible methods, and since Qi Bo and Huang Di, few complete physicians remain. Otherwise, speaking arbitrarily and treating rigidly according to fixed formulas makes it difficult to achieve precise correspondence and exact resolution. As the proverb says: "Aim high, and you may only reach the middle." If you aim for the middle, will you not fall to the low? How much more so if you learn from the low?
The Classics state: Observe the patient's demeanor to know the existence or loss of Jing-Shen (Spirit, 精神), Hun (Ethereal Soul, 魂), Po (Corporeal Soul, 魄), and Zhi (Will, 志). Therefore, at the time of clinical practice, how can one rely solely on pulse diagnosis (Mai Xi, 脉息) and ignore the patient's posture and demeanor? "Ti" (Body/Form, 体) refers to physical structure; "Tai" (Demeanor/Manner, 态) refers to appearance and bearing. Observing the Ti and examining the Tai clarifies the disease pattern and reveals the condition, like giving eyes to the fingers and eyes to the head. What are these demeanors? Yang Zheng (Yang Syndromes, 阳证) patients speak frequently; Yin Hou (Yin Signs, 阴候) patients are silent. Frequent speech is easy to treat; silence is difficult to heal. Cursing, laughing, singing, day and night without rest, is the demeanor of Kuang (Mania, 狂). Staring straight ahead and sudden collapse, with both Yin and Yang pulses being full/excessive, is the demeanor of Dian (Catatonia/Epilepsy, 癫). Jue (Jue Syndrome, 厥) indicates insufficiency of Yin and Yang; Mao (Mao Syndrome, 冒) indicates deficiency of both interior and exterior; lethargy/coma indicates deficiency of Yin and Yang and scarcity of Shen-Qi (Spirit Qi, 神气); confusion/unsteadiness indicates loss of Jin-Ye (Body Fluids, 津液) and deficiency of Xin-Xue (Heart Blood, 心血); restlessness in sitting and lying, tossing and turning, with inner vexation and regret (Ao Nu, 懊憹), is the syndrome of Xu Fan (Deficiency Vexation, 虚烦). Inability to control clothing and bedding, speaking good and bad indiscriminately, avoiding neither relatives nor strangers, are signs of Shen-Luan (Disordered Spirit, 神乱). Sudden collapse belongs to Yang syndromes, caused by dysfunction of the joints/mechanisms; stooping belongs to Yin syndromes, where pain stems from deficiency of the Heart and Kidney. Like madness indicates blood stasis accumulating in the Bladder with un-discharged heat binding; like drunkenness indicates pathogenic invasion of the Six Fu Organs (Liu Fu, 六腑) with blockage and obstruction; delusional speech and visions indicate pathogen in the Stomach; inability to recognize or know indicates pathogen entering the Fu organs; taciturnity and dullness are signs of the Jue Yin (Jueyin Meridian, 厥阴) syndrome; dizziness and desire to vomit are forms of the Yang Ming (Yangming Meridian, 阳明) syndrome; leaning while breathing indicates rebellious Qi and disharmony in the Middle Jiao (Zhong Jiao, 中焦); lassitude indicates Kidney deficiency and lack of firmness in the Stomach; inability to lift one half of the body indicates disease between the fen-li (muscle clefts and pores, 分腠); inability to move fingers indicates disease within the meridians; inability to turn sideways indicates excess in the Foot Shaoyang (Foot Shaoyang Meridian, 足少阳); inability to shake/move limbs indicates deficiency in the Foot Shaoyin (Foot Shaoyin Meridian, 足少阴); inability to turn oneself indicates the appearance of Bi-Bo (Winds-Dampness Combining, 风湿相搏); inability to hold oneself indicates disease of the Yin Wei and Yang Wei vessels (Yin Yang Er Wei, 阴阳二维). Using the buttocks as the head and heels as the feet to walk is the sign of Shen Bi (Kidney Bi, 肾痹). Singing while climbing high and running naked is the form of Wei Shi (Stomach Excess, 胃实). Difficulty in flexion and extension indicates Wind-Dampness in the bone joints; difficulty in bending and stretching indicates Water Qi in the abdomen; inability to bend forward indicates disease in the Yang; inability to stretch backward indicates disease in the Yin. Inability to bend or extend the neck indicates pathology in the Foot Taiyang (Foot Taiyang Meridian, 足太阳) meridian; inability to bend or extend the waist indicates pathology in the Foot Shaoyang (Foot Shaoyang Meridian, 足少阳) meridian; inability to walk with the waist and look back with the neck indicates Shaoyang Jue (Shaoyang Reversal, 少阳之厥); inability to bend/extend waist and look back with neck indicates Yangming Jue (Yangming Reversal, 阳明之厥); spinal pain and heavy waist, inability to turn over repeatedly, indicates exhaustion of Stomach Qi; emaciated hair and sallow complexion, inability to bend/extend waist and spine, indicates injury to Zhi (Will/Kidney Essence, 志). These are all the demeanors of patients. Describing these demeanors, some appear within substantial symptoms, some within virtual spirit states, some during sitting, lying, and movement, some manifesting in skin, flesh, sinews, and bones. A skilled diagnostician combines the appearances of the five sense organs, references the descriptions of the four limbs, masters the *Ling Shu* and *Su Wen*, and熟 (is familiar with) the Four Diagnostic Methods (Si Zhen, 四诊) of Xuan Qi (Huang Di and Qi Bo, 轩岐), thereby achieving thorough comprehension. The *Nei Xun* (Inner Instructions, 内训) says: "Model after it, follow it. Align yourself, and you become sage; lower yourself, and you become worthy. Otherwise, you will not stray from goodness." Truly so. A wise woman surpasses a man.