金匮要略曰病患有气色见于面部愿闻其说师曰鼻头色微黑者有水气色黄者胸上有寒色白
者亡血也设微赤非时者死
鼻头色黄小便必难上云胸上有寒寒则水谷不运故小便难也余处无恙独鼻尖青黄者其人必
为淋也
鼻头青腹中痛舌冷者死
鼻孔忽仰起者死
鼻枯槁不泽者死
鼻冷如冰连两颐者多死
病患鼻头明山根亮目 黄光起色
鼻头微白者亡血
论疾诊尺篇曰诊血脉者多赤多热多青多痛多黑为久痹多赤多黑多青皆见者寒热血脉即络
脉肌
素问平人气象论曰臂多青脉曰脱血络中血脱故不红而多青
发枯生穗血少火盛
毛发不坚多堕落者卫气疏或有风
眉堕者风也
病患头毛上逆者凶血枯不荣如枯草不柔顺而劲直小儿疳病多此亦主有虫
人之大体为形形之所充者气形胜气者夭肥白气不充
气胜形者寿修长黑色有神
气实形实气虚形虚
形盛脉细少气不足以息者死形瘦脉大胸中多气者死
形气相得者生参伍不调者死
肥人多中风以形浓气虚难以周流而多郁滞生痰痰壅气塞成火而多暴厥也
瘦人阴虚血液衰少相火易亢故多劳嗽
病患形脱而气盛者死正虚则形脱邪实则气盛形体充大而皮肤宽缓者寿形体充大而皮肤紧
急者夭
形气相失谓之难治
形盛气虚气盛形虚形涩而脉滑形大脉小形小脉大形长脉短形短脉长形滑脉涩肥人脉细小
轻虚如丝羸人脉躁俱凶
血实气虚则肥气实血虚则瘦肥者能寒不能热能读耐瘦者能热不能寒美髯而长至胸阳明血
气盈髯少血气弱不足则无髯美髯者太阳多血
坐而下一脚者腰痛也
行迟者痹也或表强或腰脚痛或麻木风疾里实护腹如怀卵物者心痛也
持脉病患欠者无病也经云阳引而上阴引而下则欠阴阳相引故云无病病亦即愈
息摇肩者心中坚息引胸中上气者咳息张口短气者肺痿吐沫
形肉已脱九候虽调者死
掌中寒者腹中寒掌中热者阴不足虚火盛
诊时病患以手扪心闭目不言必心虚怔忡
仓廪不藏者门户不要也水泉不止者膀胱不藏也头者精明之府头倾视深精神将夺
背者胸中之府背曲肩随府将坏矣
腰者肾之府转摇不能肾将惫矣
膝者筋之府屈伸不能行则偻附筋将惫矣
骨者髓之府不能久立行则振掉骨将惫矣
眼胞肿十指头微肿者必久咳
《金匮要略》说:病患的面部气色显现出来,(有人)希望听听其中的道理。老师说:鼻头颜色微黑的,体内有水饮邪气;颜色黄的,胸中有寒邪;颜色白的,是失血的表现。如果颜色微红且不在发热季节出现的,主死证。
鼻头颜色黄的小便必定困难。上文说胸中有寒邪,寒邪导致水谷运化失常,所以小便困难。其他部位没有异常,唯独鼻尖呈现青黄色的,这个人必定患有淋证。
鼻头颜色青,腹中疼痛,舌头发冷的,主死证。
鼻孔突然向上翻起的,主死证。
鼻子干枯萎缩、没有光泽的,主死证。
鼻子冷得像冰一样,并牵连到两侧面颊的,大多主死证。
病患鼻头明亮,山根(鼻梁根部)发亮,眼睛周围有黄色光气显现。
鼻头微白的,是失血的表现。
《灵枢·论疾诊尺篇》说:诊察血脉时,颜色多赤色的多属热证,多青色的多属痛证,多黑色的多为久痹证,多赤多黑多青色同时出现的,属于寒热错杂,血脉络脉肌理受损。
《素问·平人气象论》说:手臂上青色脉络明显显露的,称为脱血,因为络脉中的血液耗脱,所以不红而多现青色。
眉毛脱落的,是风邪所致。
病患头部毛发向上逆立的,预后凶险,这是血枯不能濡养,如同枯草般不柔顺而劲直。小儿疳积病多见此象,也主体内有虫。
人的大体形态由形质构成,充盈形质的则是气。形胜气者夭折,肥白而气不充盛的则夭;气胜形者长寿,修长黑色而有神气的则寿。
形体盛壮但脉象细弱,气息短少不足以呼吸的,主死证。形体消瘦但脉象洪大,胸中气机壅滞的,主死证。
肥胖的人多患中风,因为形体浓浊而气虚,难以周流全身而产生郁滞,生成痰湿,痰壅气塞化火,从而导致暴厥。
病患形体脱失而气盛反张的,主死证。正气虚弱则形体脱失,邪气实则气盛。形体充大而皮肤宽缓松驰的长寿,形体充大而皮肤紧张拘急的夭折。
形盛气虚,气盛形虚,形涩而脉滑,形大脉小,形小脉大,形长脉短,形短脉长,形滑脉涩,肥胖人脉象细小轻虚如丝线,羸瘦人脉象躁动,均属凶兆。
血实气虚则身体肥胖,气实血虚则身体消瘦。肥胖者耐寒不耐热,瘦者耐热不耐寒。胡须美髯且长至胸部的,是阳明经血气充盈;胡须稀少,血气微弱不足的则无胡须;美髯者是太阳经多血的特征。
坐着时一只脚翘起或伸直的,是腰痛。
行走迟缓的,是痹证。或者是表强,或者是腰脚疼痛,或者是麻木的风疾。蜷缩腹部护住肚子像怀着卵物一样的,是心痛。
切脉时病患打哈欠的,是无病。经文说阳气牵引向上,阴气牵引向下,阴阳相互牵引所以打哈欠,因此说无病,病也会随即痊愈。
呼吸时耸肩的,是心中坚满;呼吸牵引胸中气机上逆的,是咳嗽;张口呼吸、气息短促的,是肺痿,伴有吐沫。
肌肉已经脱失,即使九候脉象调和,也主死证。
手掌寒冷的,是腹中寒;手掌发热的,是阴不足,虚火旺盛。
仓廪(脾胃)不能藏纳的,是因为门户(幽门、阑门等)不能约束;水泉(尿液)不止的,是膀胱不能藏纳。头是精明之府,头低垂视物深陷,精神即将被剥夺。背是胸中之府,背部弯曲肩膀下垂,府将败坏。腰是肾之府,转动摇动不能自如,肾将疲惫。膝是筋之府,屈伸不能,行走则弯腰附地,筋将疲惫。骨是髓之府,不能久立,行走则身体震颤掉落,骨将疲惫。
眼睑肿胀,十个手指头微肿的,必定是久咳。
The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: When a patient's complexion manifests on the face, and one wishes to hear the explanation. The Master said: If the tip of the nose is slightly black, there is fluid retention (Shui Qi); if yellow, there is cold in the chest; if white, it indicates loss of blood (Wang Xue). If it is slightly red and appears out of season (non-summer), it indicates a death prognosis.
If the tip of the nose is yellow, urination will certainly be difficult. As mentioned above, cold in the chest impairs the transportation of water and grain, thus causing difficult urination. If other areas are normal but the nasal tip is greenish-yellow, the person definitely suffers from Lin syndrome (Strangury).
If the nasal tip is green, accompanied by abdominal pain and a cold tongue, it indicates a death prognosis.
If the nostrils suddenly turn upward, it indicates a death prognosis.
If the nose is withered, shriveled, and lacks luster, it indicates a death prognosis.
If the nose is cold as ice and extends to both cheeks (Yi), death is likely.
A patient whose nasal tip is bright, the Shan Gen (root of the nose) is luminous, and yellowish light emanates from around the eyes.
If the tip of the nose is slightly white, it indicates loss of blood.
The *Ling Shu: Lun Ji Zhen Chi Pian* (Chapter on Diagnosing Diseases by Inspecting the Forearms) states: When diagnosing the blood vessels, many red colors indicate heat; many blue/green colors indicate pain; many black colors indicate chronic Bi syndrome (Obstruction). If red, black, and blue/green colors appear together, it indicates mixed cold and heat affecting the blood vessels and collaterals.
The *Su Wen: Ping Ren Qi Xiang Lun* (Chapter on Normal People's Pulse Manifestations) states: Prominent blue/green veins on the arms indicate Blood Loss (Tuo Xue), because the blood in the collaterals has been depleted, hence not red but predominantly blue/green.
Withered hair growing into穗状 (spike-like splits) indicates insufficient Blood and flourishing Fire.
Hair that is not firm and falls out easily indicates deficient Wei Qi (Defensive Qi) or the presence of Wind pathogen.
Loss of eyebrows indicates Wind pathogen.
If a patient's scalp hair stands upright, the prognosis is ominous. This is due to Blood deficiency failing to nourish, resembling dry grass that is stiff and straight. This is common in pediatric Gan disease (Malnutrition) and also indicates intestinal parasites.
The human body's form is filled by Qi. If Form exceeds Qi, life is shortened; fat and white individuals with unfulfilled Qi die young. If Qi exceeds Form, longevity is achieved; tall, dark-skinned individuals with spiritual vitality live long.
When Qi is substantial, the Form is robust; when Qi is deficient, the Form is weak.
If the Form is robust but the pulse is thin, and there is shortness of breath insufficient for respiration, it indicates death. If the Form is emaciated but the pulse is large, and there is excess Qi in the chest, it indicates death.
When Form and Qi are harmonious, life is sustained; when they are discordant, death ensues.
Fat people are prone to Stroke (Zhong Feng) because their dense form and deficient Qi fail to circulate freely, leading to stagnation, phlegm accumulation, Qi obstruction, fire generation, and sudden syncope.
Thin people have Yin deficiency and declining Blood, making Ministerial Fire prone to hyperactivity, thus often suffering from consumptive coughs.
If a patient's Form is exhausted but Qi is exuberant, it indicates death. Deficient Zheng Qi leads to Form exhaustion; Excess Evil leads to Qi exuberance. A robust Form with loose skin indicates longevity; a robust Form with tight skin indicates early death.
Discord between Form and Qi is termed difficult to treat.
Robust Form with deficient Qi, or Exuberant Qi with weak Form; rough Form with slippery pulse; large Form with small pulse; small Form with large pulse; long Form with short pulse; short Form with long pulse; smooth Form with rough pulse; fat people with fine, light, thread-like pulses; emaciated people with restless pulses—all are ominous signs.
Excess Blood and deficient Qi lead to obesity; Excess Qi and deficient Blood lead to emaciation. The obese can tolerate cold but not heat; the emaciated can tolerate heat but not cold. Beautiful, long beard reaching the chest indicates abundant Qi and Blood of the Yangming channel; sparse beard indicates weak Qi and Blood; beautiful beard indicates abundant Blood of the Taiyang channel.
Sitting with one leg extended indicates lower back pain. Walking slowly indicates Bi syndrome, possibly due to exterior stiffness, lower back/leg pain, numbness, or Wind disease. Curling up and protecting the abdomen like holding an egg indicates Heart pain.
Yawning during pulse diagnosis indicates no disease. The classic states: Yang pulls upward, Yin pulls downward; the pulling of Yin and Yang causes yawning. Thus, it is said there is no disease, and illness will resolve.
Shoulder movement during breathing indicates fullness in the heart; breathing that draws Qi upward in the chest indicates cough; open-mouthed breathing with shortness of breath indicates Lung萎 (Flaccidity) with spitting of foam.
If flesh and muscle are already exhausted, even if the Nine Pulses are harmonious, it indicates death. Cold palms indicate interior cold; hot palms indicate Yin deficiency with flourishing deficient Fire.
During diagnosis, if a patient holds their hand over the heart, closes their eyes, and does not speak, it indicates Heart deficiency with Palpitations (Zheng Chong).
If the Granary (Spleen/Stomach) cannot store, the gates (sphincters) are uncontrolled. If the Water Spring (urine) flows incessantly, the Bladder cannot store. The head is the residence of clarity; if the head droops and vision sinks, Spirit is being depleted. The back is the residence of the chest; if the back curves and shoulders sag, the residence is failing. The waist is the residence of the Kidney; if turning and shaking are impossible, the Kidney is exhausted. The knees are the residence of sinews; if flexion and extension are impossible, and walking requires bending and attaching to the ground, the sinews are exhausted. The bones are the residence of marrow; if standing for long periods is impossible, and walking causes trembling, the bones are exhausted.
Swollen eyelids and slightly swollen fingertips indicate chronic cough.