（灵枢邪气脏腑病形篇）
黄帝曰∶请问脉之缓急小大滑涩之病形何如？岐伯曰∶臣请言五脏之病变也。（六者为脉之提纲，故帝特举而问之。）
心脉急甚者为螈 ；微急为心痛引背，食不下。（急者，弦之类。急主风寒，心主血脉，故心脉急甚则为螈 。筋脉
引急曰螈，弛长曰 。弦急之脉多主痛，故微急为心痛引背。心胸有邪，食当不下也。大抵弦急之脉，当为此等病，故
急甚亦可为心痛，微急亦可为螈 ，学人当因理活变可也。余同此意。螈，炽、寄、系三音。 音纵。）缓甚为狂笑；微
缓为伏梁，在心下，上下行，时唾血。（心气热则脉纵缓，故神散而为狂笑，心在声为笑也。若微缓则为伏梁在心下而能
升能降，及时为唾血，皆心藏之不清也。伏梁义详疾病类七十三。）大甚为喉 ；微大为心痹引背，善泪出。（心脉大甚，
心火上炎也，故喉中 然有声。若其微大而为心痹引背。善泪出者，以手少阴之脉，挟咽喉连目系也。心痹义，详疾病
类六十七。 音介。痹音秘。）小甚为善哕，微小为消瘅。（心脉小甚，则阳气虚而胃土寒，故善哕。若其微小，亦为血
脉枯少，故病消瘅。消瘅者，肌肤消瘦也。哕，于决切。瘅音丹，又上、去二声。）滑甚为善渴；微滑为心疝引脐，小腹
鸣。心脉滑甚则血热，血热则燥，故当为渴。若其微滑则热在于下，当病心疝而引脐腹。脉要精微论曰∶病名心疝，心
为牡脏，小肠为之使，故曰少腹当有形也。）涩甚为喑；微涩为血溢，维厥，耳鸣，颠疾。（心脉涩甚，则血气滞于上，
声由阳发，滞则为喑也。微涩为血溢，涩当伤血也。维厥者，四维厥逆也，以四肢为诸阳之本而血衰气滞也。为耳鸣、
为颠疾者，心亦开窍于耳，而心虚则神乱也。喑音音，声哑也。
肺脉急甚为癫疾；微急为肺寒热，怠惰，咳唾血，引腰背胸，若鼻息肉不通。（肺脉急甚，风邪胜也，木反乘金，故
主癫疾。若其微急，亦以风寒有余，因而致热，故为寒热怠惰等病。缓甚为多汗；微缓为痿 偏风，头以下汗出不可止。
（肺脉缓甚者，皮毛不固，故表虚而多汗。若其微缓，而为痿 偏风，头下汗出，亦以阳邪在阴也。）大甚为胫肿；微大
为肺痹引胸背，起恶日光。肺脉大甚者，心火烁肺，真阴必涸，故为胫肿。若其微大，亦由肺热，故为肺痹引胸背。肺
痹者，烦满喘而呕也。起畏日光，以气分火盛而阴精衰也。）小甚为泄，微小为消瘅。（肺脉小甚，则阳气虚而腑不固，
病当为泄。若其微小，亦以金衰，金衰则水弱，故为消瘅。）滑甚为息贲上气，微滑为上下出血。肺脉滑甚者，气血皆实
热，故为息贲上气。息贲，喘急也。若其微滑，亦为上下出血。上言口鼻，下言二阴也。贲音奔。）涩甚为呕血；微涩为
鼠，在颈支腋之间，下不胜其上，其应善 矣。（涩脉因于伤血，肺在上焦，故涩甚当为呕血。若其微涩，气当有滞，
故为鼠 在颈腋间。气滞则阳病，血伤则阴虚，故下不胜其上，而足膝当 软也。 音酸。）
肝脉急甚者为恶言；微急为肥气，在胁下若覆杯。（肝脉急甚，肝气强也，肝强者多怒少喜，故言多嗔恶也。若其微
急，亦以木邪伤土，故为肥气在胁下。胁下者，肝之经也。愚按∶五十六难曰∶肝之积名曰肥气，在左胁下。其义本此。
然难经以木王东方，故言左胁，而此节本无左字。）缓甚为善呕，微缓为水瘕痹也。缓为脾脉，以肝脉而缓甚，木土相克
也，故善呕。若微缓而为水瘕为痹者，皆土为木制，不能营运而然。水瘕，水积也。瘕，加、驾二音。）大甚为内痈，善
呕衄；微大为肝痹阴缩，咳引小腹。（肝脉大甚，肝火盛也，木火交炽，故为内痈。血热不藏，故为呕衄。若其微大而为
肝痹，为阴缩，为咳引小腹，皆以火在阴分也。肝痹义见疾病类六十七。衄，泥六切，鼻血也。小甚为多饮，微小为消
瘅。（肝藏血，肝脉小甚则血少而渴，故多饮。若其微小，亦以阴虚血燥而为消瘅也。）滑甚为 疝，微滑为遗溺。（肝脉
滑甚者，热壅于经，故为溃疝。若其微滑而为遗溺，以肝火在下而疏泄不禁也。 ， 同。溺，尿同。）涩甚为溢饮，微
涩为螈挛筋痹。（肝脉涩甚，气血衰滞也，肝木不足，土反乘之，故湿溢支体，是为溢饮。若其微涩而为螈挛为筋痹，皆
血不足以养筋也。螈，翅、系二音。挛音恋，筋急缩也。）
脾脉急甚为螈 ；微急为膈中，食饮入而还出，后沃沫。脾脉急甚，木乘土也，脾主支体而风气客之，故为螈 。
若其微急，亦为肝邪侮脾，则脾不能运而膈食还出，土不制水而复多涎沫也。沃音屋，水汪然貌。）缓甚为痿厥；微缓为
风痿，四肢不用，心慧然若无病。（脾脉宜缓，而缓甚则热，脾主肌肉四肢，故脾热则为肉痿及为厥逆。若微缓而为风痿
四肢不用者，以土弱则生风也。痿弱在经而脏无恙，故心慧然若无病。）大甚为击仆；微大为疝气，腹里大，脓血在肠胃
之外。（脾主中气，脾脉大甚为阳极，阳极则阴脱，故如击而仆地。若其微大为疝气，以湿热在经，而前阴为太阴阳明之
所合也。腹里大者，以脓血在肠胃之外，亦脾气壅滞所致。）小甚为寒热，微小为消瘅。（脾脉小者，以中焦之阳气不足，
故甚则为寒热，而微则为消瘅。）滑甚为 癃，微滑为虫毒 蝎腹热。（脾脉滑甚，太阴实热也，太阴合宗筋，故为 癃
疝。若其微滑，湿热在脾，湿热熏蒸，故生诸虫及为腹热。 ， 同。癃，闾中切。 ，蛔同，音回。蝎音歇。）涩甚为
肠；微涩为内 ，多下脓血。（脾脉涩甚而为肠 ，微涩而为内 ，及多下脓血者，以涩为气滞血伤，而足太阴之别，
入络肠胃也。肠 内 ，远近之分耳。一曰下肿病，盖即疝漏之属）。
肾脉急甚为骨癫疾；微急为沉厥奔豚，足不收，不得前后。（肾脉急甚者，风寒在肾，肾主骨，故为骨癫疾。若微急
而为沉厥足不收者，寒邪在经也。为奔豚者，寒邪在脏也。为不得前后者，寒邪在阴也。按五十六难曰∶肾之积名曰奔
豚，发于少腹、上至心下若豚状，或上或下无时。其义本此。骨癫疾义，详针刺类三十七。）缓甚为折脊；微缓为洞，洞
者食不化，下嗌还出。（肾脉缓甚者阴不足，故为折脊，以足少阴脉贯脊循脊内也。若其微缓，肾气亦亏，肾亏则命门气
衰，下焦不化，下不化则复而上出，故病为洞而食入还出也。）大甚为阴痿；微大为石水，起脐已下至小腹 然，上至
胃腕，死不治。（肾脉大甚，水亏火旺也，故为阴痿。若其微大，肾阴亦虚，阴虚则不化，不化则气停水积而为石水。若
至胃脘，则水邪盛极，反乘土脏，泛滥无制，故死不治，石水义见后二十四。 音垂，重坠也。腕，当作脘。）小甚为洞
泄，微小为消瘅。肾脉小甚，则元阳下衰，故为洞泄。若其微小，真气亦亏，故为消瘅。）滑甚为癃 ；微滑为骨痿，坐
不能起，起则目无所见。（肾脉滑甚，阴火盛也，故为癃 ，癃，膀胱不利也。 ，疝也。若其微滑，亦由火旺，火旺则
阴虚，故骨痿不能起，起则目暗无所见。）涩甚为大痈，微涩为不月沉痔。（肾脉涩者为精伤，为血少，为气滞，故甚则
为大痈，微则为不月，为沉痔。）
黄帝曰∶病之六变者，刺之奈何？岐伯答曰∶诸急者多寒，（急者，弦紧之谓。仲景曰∶脉浮而紧者，名曰弦也。紧
则为寒。成无己曰∶紧则阴气胜。故凡紧急之脉多风寒，而气化从乎肝也。）缓者多热。（缓者，纵缓之状，非后世迟缓
之谓。仲景曰∶缓则阳气长。又曰∶缓者胃气有余。故凡纵缓之脉多中热，而气化从乎脾胃也。）大者多气少血，（大为
阳有余，阳盛则阴衰，故多气少血。仲景曰∶若脉浮大者，气实血虚也。故脉之大者多浮阳，而气化从乎心也。）小者血
气皆少。（小者近于微细，在阳为阳虚，在阴为阴弱，脉体属阴而化从乎肾也。）滑者阳气盛，微有热；（滑脉为阳，气血
实也，故为阳气盛而微有热。仲景曰∶滑者胃气实。玉机真藏论曰∶脉弱以滑，是有胃气。故滑脉从乎胃也。）涩者多血
少气，微有寒。（涩为气滞，为血少，气血俱虚则阳气不足，故微有寒也。仲景曰∶涩者荣气不足。亦血少之谓，而此曰
多血，似乎有误。观下文刺涩者无令其血出，少可知矣。涩脉近毛，故气化从乎肺也。）是故刺急者，深内而久留之。（急
者多寒，寒从阴而难去也。内，纳同。）刺缓者，浅内而疾发针，以去其热。（缓者多热，热从阳而易散也。）刺大者，微
泻其气，无出其血。（大者多阴虚，故无出其血。）刺滑者，疾发针而浅内之，以泻其阳气而去其热。（与刺缓者略同。）
刺涩者，必中其脉，随其逆顺而久留之，必先按而循之，已发针，疾按其 ，无令其血出，以和其脉。（脉涩者气血俱少，
难于得气，故宜必中其脉而察其逆顺，久留疾按而无出其血。较之诸刺更宜详慎者，以脉涩本虚而恐伤其真气耳。循音
巡，摩按也。 ，委、伟二音，刺瘢也。）诸小者，阴阳形气俱不足，勿取以针，而调以甘药也。（脉小者为不足，勿取
以针，可见气血俱虚者，必不宜刺而当调以甘药也。 愚按∶此节阴阳形气俱不足者，调以甘药，甘之一字，圣人用意
深矣。盖药食之入，必先脾胃，而后五脏得禀其气。胃气强则五脏俱盛，胃气弱则五脏俱衰。胃属土而喜甘，故中气不
足者，非甘温不可。土强则金旺，金旺则水充，此所以土为万物之母，而阴阳俱虚者，必调以甘药也。虽至真要等论所
列五味，各有补泻，但彼以五行生克之理，推衍而言；然用之者，但当微兼五味而以甘为主，庶足补中，如四季无土气
不可，五脏无胃气不可，而春但微弦、夏但微钩之义皆是也。观阴阳应象大论曰∶形不足者温之以气，精不足者补之以
味。故气味之相宜于人者，谓之为补则可；若用苦劣难堪之味，而求其能补，无是理也。气味攻补之学，大有妙处，倘
不善于调和，则开手便错，此医家第一着要义。）
（《灵枢·邪气脏腑病形》篇）
黄帝问道：请问脉象的缓、急、小、大、滑、涩这六种变化所反映的病证表现是怎样的？岐伯回答说：请允许我阐述五脏病变的情况。（这六者是脉象的纲领，所以黄帝特意提出询问。）
心脏脉象急甚，表现为抽搐；微急，表现为心痛牵引背部，饮食难下。（“急”属于弦脉一类。急脉主风寒，心主血脉，所以心脉急甚则发生抽搐。筋脉拘急引缩称为“瘛”，舒展弛长称为“疭”。弦急的脉象多主疼痛，所以微急表现为心痛牵引背部。心胸有邪气干扰，食物应当难以咽下。大抵弦急的脉象，应当出现这些病症，所以急甚也可能导致心痛，微急也可能导致抽搐，学习的人应当根据医理灵活变通即可。其余脏器的情况与此意相同。“瘛”读作炽、寄、系三音。“疭”读作纵。）
心脉缓甚，表现为狂笑不止；微缓，表现为伏梁病，病灶在心下，上下移动，时常唾血。（心气热则脉象纵缓，所以神志散乱而狂笑，心在声音方面对应为笑。如果脉微缓，则为伏梁病位于心下且能升能降，时常唾血，这都是心藏功能不清净的表现。“伏梁”的含义详见疾病类第七十三。）
心脉大甚，表现为喉中发出介介有声；微大，表现为心痹牵引背部，容易流泪。（心脉大甚，是心火上炎，所以喉中有介介的声音。如果是微大而导致心痹牵引背部、容易流泪，是因为手少阴心经的脉道，挟持咽喉连接目系。关于“心痹”的含义，详见疾病类第六十七。“介”读作介。“痹”读作秘。）
心脉小甚，表现为频繁呃逆；微小，表现为消瘅病。（心脉小甚，则阳气虚弱而胃土寒冷，所以频繁呃逆。如果是微小，也是血脉枯少，所以患消瘅病。消瘅病，是指肌肤消瘦。“哕”音于决切。“瘅”音丹，又读上声、去声两音。）
心脉滑甚，表现为口渴；微滑，表现为心疝牵引脐部，小腹鸣响。心脉滑甚则血热，血热则燥，所以应当口渴。如果是微滑，则热在下焦，应当患心疝并牵引脐腹。《脉要精微论》说：病名心疝，因为心是牡脏，小肠作为其使役器官，所以说少腹部应当有有形之邪。）
心脉涩甚，表现为失音；微涩，表现为血液溢出四肢厥冷、耳鸣、癫疾。（心脉涩甚，则气血滞塞于上部，声音由阳气发动，滞塞则失音。微涩导致血液溢出，涩脉应当损伤血液。“维厥”，即四维厥逆，因为四肢是诸阳之本，而血衰气滞。出现耳鸣、癫疾，是因为心也开窍于耳，心虚则神志混乱。“喑”音同音，指声音嘶哑。）
肺脉急甚，表现为癫疾；微急，表现为肺寒热，倦怠乏力，咳嗽唾血，牵引腰背胸部，或者鼻息肉阻塞不通。（肺脉急甚，是风邪偏胜，木气反克金气，所以主癫疾。如果是微急，也是因为风寒有余，进而化热，所以出现寒热、倦怠等病。）
肺脉缓甚，表现为多汗；微缓，表现为痿躄偏风，头部以下出汗无法停止。（肺脉缓甚，皮毛不固，所以表虚而多汗。如果是微缓，导致痿躄偏风，头以下汗出，也是因为阳邪侵入阴分。）
肺脉大甚，表现为小腿肿胀；微大，表现为肺痹牵引胸背，起床时畏惧日光。肺脉大甚，是心火灼烧肺金，真阴必然枯竭，所以小腿肿胀。如果是微大，也是因为肺热，所以导致肺痹牵引胸背。肺痹的症状，是烦闷喘促而呕吐。起床畏光，是因为气分火盛而阴精衰弱。）
肺脉小甚，表现为泄泻；微小，表现为消瘅。（肺脉小甚，则阳气虚弱而腑气不固，病当为泄泻。如果是微小，也是因为金气衰弱，金衰则水弱，所以患消瘅病。）
肺脉滑甚，表现为息贳上气；微滑，表现为上下出血。肺脉滑甚，气血皆实热，所以出现息贳上气。息贳，指喘急。如果是微滑，也表现为上下出血。上文说的口鼻出血，下文说的二阴出血。“贲”音奔。）
肺脉涩甚，表现为呕血；微涩，表现为鼠瘘，位于颈部和腋窝之间，下肢无力支撑上身，膝盖应当酸软无力。（涩脉因伤血所致，肺在上焦，所以涩甚应当呕血。如果是微涩，气机应当有滞塞，所以出现鼠瘘在颈腋间。气滞则阳病，血伤则阴虚，所以下肢不能支撑上身，而足膝应当酸软。“酸”音酸。）
肝脉急甚，表现为恶言（不愿说话或言语暴躁）；微急，表现为肥气，位于胁下像倒扣的杯子。（肝脉急甚，肝气强盛，肝强者多怒少喜，所以言语多嗔怪厌恶。如果是微急，也是因为木邪伤害脾土，所以出现肥气在胁下。胁下是肝经所在。我按：《难经·五十六难》说：肝之积名叫肥气，在左胁下。这里的含义本于此。然而《难经》认为木旺于东方，所以说左胁，而这一节原文并没有“左”字。）
肝脉缓甚，表现为频繁呕吐；微缓，表现为水瘕痹。缓脉本是脾脉，以肝脉而出现缓甚，是木土相克，所以频繁呕吐。如果是微缓导致水瘕和痹症，都是因为土被木克制，不能正常运化所致。水瘕，是水液积聚。“瘕”读加、驾二音。）
肝脉大甚，表现为内痈，频繁呕吐鼻衄；微大，表现为肝痹、阴器收缩、咳嗽牵引小腹。（肝脉大甚，肝火旺盛，木火交炽，所以产生内痈。血热不能藏血，所以呕吐鼻衄。如果是微大而患肝痹、阴缩、咳引小腹，都是因为火在阴分。肝痹的含义见疾病类第六十七。“衄”音泥六切，指鼻血。）
肝脉小甚，表现为多饮；微小，表现为消瘅。（肝藏血，肝脉小甚则血少而渴，所以多饮。如果是微小，也是因为阴虚血燥而患消瘅病。）
肝脉滑甚，表现为溃疝；微滑，表现为遗尿。（肝脉滑甚，热壅滞于经脉，所以发生溃疝。如果是微滑导致遗尿，是因为肝火在下而疏泄失控。“溃”与“溃”同。“溺”与“尿”同。）
肝脉涩甚，表现为溢饮；微涩，表现为抽搐、筋挛、筋痹。（肝脉涩甚，气血衰滞，肝木不足，脾土反克，所以湿气溢满肢体，这叫溢饮。如果是微涩导致抽搐、筋挛、筋痹，都是因为血不足以滋养筋脉。“瘛”读翅、系二音。“挛”音恋，指筋脉紧急收缩。）
脾脉急甚，表现为抽搐；微急，表现为膈中病，饮食入胃后随即吐出，大便排出涎沫。脾脉急甚，是木乘土，脾主四肢而风气客之，所以发生抽搐。如果是微急，也是因为肝邪侮脾，则脾不能运化而膈食反出，土不制水而复多涎沫。“沃”音屋，形容水汪然的样子。）
脾脉缓甚，表现为痿厥；微缓，表现为风痿，四肢不能使用，但心神清醒好像没病。（脾脉宜缓，而缓甚则生热，脾主肌肉四肢，所以脾热则导致肉痿及厥逆。如果是微缓导致风痿、四肢不用，是因为土弱则生风。痿弱在经络而脏腑无碍，所以心神清醒好像没病。）
脾脉大甚，表现为被打倒仆地；微大，表现为疝气，腹部胀大，脓血在肠胃之外。（脾主中气，脾脉大甚为阳极，阳极则阴脱，所以像被击打而仆倒在地。如果是微大为疝气，是因为湿热在经络，而前阴是太阴、阳明经会合之处。腹部胀大，是因为脓血在肠胃之外，也是脾气壅滞所致。）
脾脉小甚，表现为寒热；微小，表现为消瘅。（脾脉小，是因为中焦阳气不足，所以甚则出现寒热，而微则出现消瘅病。）
脾脉滑甚，表现为癃疝；微滑，表现为虫毒引起的蝎腹热。（脾脉滑甚，是太阴实热，太阴合宗筋，所以发生癃疝。如果是微滑，湿热在脾，湿热熏蒸，所以生出各种虫子及导致腹热。“癃”与“癃”同。“癃”音闾中切。“蛔”与“蛔”同，音回。“蝎”音歇。）
脾脉涩甚，表现为肠澼；微涩，表现为内痔，多排出脓血。（脾脉涩甚导致肠澼，微涩导致内痔，以及多下脓血，是因为涩代表气滞血伤，而足太阴脾经的别络，进入联络肠胃。肠澼和内痔，只是部位远近的区别。另一种说法是下肿病，大概属于疝漏一类。）
肾脉急甚，表现为骨癫疾；微急，表现为沉厥、奔豚，脚不能收摄，大小便不通。（肾脉急甚，是风寒在肾，肾主骨，所以发生骨癫疾。如果是微急导致沉厥、脚不能收，是寒邪在经络。出现奔豚，是寒邪在脏腑。出现大小便不通，是寒邪在阴分。按《难经·五十六难》说：肾之积名叫奔豚，发于少腹，上至心下像小猪状，有时上行有时下行，没有定时。这里的含义本于此。骨癫疾的含义，详见针刺类第三十七。）
肾脉缓甚，表现为折脊；微缓，表现为洞泄，洞泄是指食物不消化，咽下后又吐出来。（肾脉缓甚，阴气不足，所以折脊，因为足少阴肾经贯穿脊柱沿脊内侧行走。如果是微缓，肾气也亏虚，肾亏则命门气衰，下焦不能气化，下焦不化则复而上出，所以病为洞泄，食物吃进去又吐出来。）
肾脉大甚，表现为阳痿；微大，表现为石水，从肚脐以下到小腹沉重下垂，上至胃脘，死症不可治。（肾脉大甚，水亏火旺，所以阳痿。如果是微大，肾阴也虚，阴虚则不能气化，不化则气停水积而形成石水。如果水邪上至胃脘，则水邪极盛，反克脾土，泛滥无制，所以死症不可治，石水的含义见后文第二十四。“垂”音垂，指重坠。“腕”当作“脘”。）
肾脉小甚，表现为洞泄；微小，表现为消瘅。肾脉小甚，则元阳下衰，所以洞泄。如果是微小，真气也亏虚，所以患消瘅病。）
肾脉滑甚，表现为癃闭；微滑，表现为骨痿，坐起困难，站起来则眼睛看不见东西。（肾脉滑甚，阴火旺盛，所以癃闭，癃指膀胱排尿不利。“疝”指疝气。如果是微滑，也是因为火旺，火旺则阴虚，所以骨痿不能起身，起来则眼睛昏暗看不见。）
肾脉涩甚，表现为大痈；微涩，表现为女子月经不行、沉痔。（肾脉涩，是精伤、血少、气滞，所以甚则为大痈，微则为月经不调、沉痔。）
黄帝问道：疾病的六种脉象变化，针刺治疗该怎么办？岐伯回答说：凡是急脉多寒，（急脉，就是弦紧的意思。张仲景说：脉浮而紧，名叫弦。紧则主寒。成无己说：紧则阴气胜。所以凡是紧急的脉象多主风寒，而气化过程从属于肝。）缓脉多热。（缓脉，是纵缓的状态，不是后世所说的迟缓。张仲景说：缓则阳气长。又说：缓者胃气有余。所以凡是纵缓的脉象多主中热，而气化过程从属于脾胃。）大脉多气少血，（大脉为阳有余，阳盛则阴衰，所以多气少血。张仲景说：如果脉浮大，是气实血虚。所以脉大的多主浮阳，而气化过程从属于心。）小脉血气皆少。（小脉近于微细，在阳分是阳虚，在阴分是阴弱，脉体属阴而化从属于肾。）滑脉阳气盛，微有热；（滑脉为阳，气血实，所以阳气盛而微有热。张仲景说：滑者胃气实。《玉机真脏论》说：脉弱以滑，是有胃气。所以滑脉从属于胃。）涩脉多血少气，微有寒。（涩是气滞，血少，气血俱虚则阳气不足，所以微有寒。张仲景说：涩者荣气不足。也就是血少，这里说多血，似乎有误。看下文刺涩脉不让出血，就可以知道了。涩脉近毛，所以气化从属于肺。）
因此，刺急脉，要深进针并长时间留针。（急脉多寒，寒从阴分而来难以去除。内，同纳。）刺缓脉，要浅进针并快速出针，以去除热邪。（缓脉多热，热从阳分而来容易消散。）刺大脉，轻微泻其气，不要放血。（大脉多阴虚，所以不要放血。）刺滑脉，快速出针并浅进针，以泻其阳气而去其热。（与刺缓脉大致相同。）刺涩脉，必须准确中其脉，顺着或逆着经脉方向长时间留针，必须先按压循摩经脉，已出针后，迅速按压针孔，不要让血流出，以调和其脉。（脉涩者气血俱少，难于得气，所以适宜必须中其脉并察其逆顺，久留针、快按而不让出血。比起其他刺法更应详慎，是因为脉涩本属虚证，恐怕损伤其真气罢了。循音巡，指摩按。“瘢痕”音委、伟二音，指针刺后的瘢痕。）凡是小脉，阴阳形气都不足，不要用针刺，而用甘味药物调理。（脉小为不足，不用针刺，可见气血俱虚者，一定不宜针刺而应当用甘药调理。我按：这一节说阴阳形气俱不足者，用甘药调理，“甘”这一个字，圣人的用意很深了。大概药物食物进入体内，必须先经过脾胃，然后五脏才能禀受其气。胃气强则五脏都盛，胃气弱则五脏都衰。胃属土而喜欢甘味，所以中气不足者，非甘温不可。土强则金旺，金旺则水充，这就是为什么土是万物之母，而阴阳俱虚者，必须用甘药调理。虽然《素问·至真要大论》等篇章所列五味，各有补泻，但那是以五行生克的道理推演而言；然而使用者，只应当微微兼用五味而以甘味为主，才足以补益中气，就像四季离不开土气一样，五脏离不开胃气，而春季脉微弦、夏季脉微钩的道理都是一样的。看《阴阳应象大论》说：形不足者用气来温补，精不足者用味来滋补。所以气味适合人的，叫做补；如果使用苦劣难以下咽的味道，却求它能补，是没有道理的。气味攻补的学问，大有妙处，如果不善于调和，则一着手就错，这是医家的第一重要义理。）
(Ling Shu, Chapter: Pathogenic Factors and Diseases of the Zang-Fu Organs and Meridians)
Huangdi asked: I would like to ask about the pathological manifestations reflected by the six pulse qualities: slow (Huan), rapid/tight (Ji), small (Xiao), large (Da), slippery (Hua), and choppy (Se). Qibo replied: Please allow me to explain the pathological changes of the five Zang organs. (These six are the outlines of pulse diagnosis, which is why the Emperor specifically raised them for inquiry.)
When the Heart pulse is extremely tight (Ji), it manifests as convulsions (Chi-Zhong); when slightly tight, it manifests as heart pain radiating to the back and difficulty in swallowing food. ("Tight" belongs to the category of wiry (Xian) pulses. A tight pulse indicates wind-cold; the Heart governs blood vessels. Therefore, an extremely tight Heart pulse leads to convulsions. Tendon and vessel contraction is called "Chi", and relaxation/extension is called "Zhong". Wiry and tight pulses generally indicate pain; thus, a slightly tight pulse manifests as heart pain radiating to the back. If there is pathogenic factor in the chest and heart, food should be difficult to swallow. Generally, wiry and tight pulses should present with these conditions; therefore, extreme tightness may also cause heart pain, and slight tightness may cause convulsions. Practitioners should apply flexibility based on medical principles. The same logic applies to other organs. "Chi" is pronounced chi, ji, or xi. "Zhong" is pronounced zong.)
When the Heart pulse is extremely slow (Huan), it manifests as manic laughter; when slightly slow, it manifests as Fuliang (a mass disease), located below the heart, moving up and down, accompanied by occasional spitting of blood. (Heart Qi heat causes the pulse to become loose and slow, leading to scattered spirit and manic laughter; the Heart's vocalization is laughter. If the pulse is slightly slow, it indicates Fuliang below the heart that can ascend and descend, with occasional hemoptysis, all indicating impurity in the Heart organ. The meaning of Fuliang is detailed in Disease Category 73.)
When the Heart pulse is extremely large (Da), it manifests as a gurgling sound in the throat; when slightly large, it manifests as Xinbi (heart obstruction) radiating to the back and excessive tearing. (Extreme largeness of the Heart pulse indicates Heart fire flaring upward, causing a gurgling sound in the throat. Slight largeness leading to Xinbi radiating to the back and tearing occurs because the Hand Shaoyin Heart meridian connects the throat and the eye system. The meaning of Xinbi is detailed in Disease Category 67. "Jie" is pronounced jie. "Bi" is pronounced mi.)
When the Heart pulse is extremely small (Xiao), it manifests as frequent hiccups (Yue); when minute, it manifests as Xiaodan (wasting-thirst). (Extreme smallness of the Heart pulse indicates deficiency of Yang Qi and cold in the Stomach Earth, leading to frequent hiccups. Minute size also indicates depletion of blood vessels, leading to Xiaodan. Xiaodan refers to emaciation of the skin and muscles. "Yue" is pronounced jue. "Dan" is pronounced dan, or shang/qu sounds.)
When the Heart pulse is extremely slippery (Hua), it manifests as excessive thirst; when slightly slippery, it manifests as Xinshe (heart hernia) radiating to the umbilicus and borborygmus in the lower abdomen. Extreme slipperiness of the Heart pulse indicates blood heat; blood heat causes dryness, leading to thirst. Slight slipperiness indicates heat in the lower jiao, leading to Xinshe radiating to the umbilicus and abdomen. The *Mai Yao Jing Wei Lun* states: The disease is named Xinshe. Because the Heart is a Yang organ (Mu Zang) and the Small Intestine acts as its envoy, it is said that there should be a palpable mass in the lower abdomen.)
When the Heart pulse is extremely choppy (Se), it manifests as aphonia; when slightly choppy, it manifests as hemorrhage, limb coldness (Wei Jue), tinnitus, and epilepsy. (Extreme choppy Heart pulse indicates stagnation of Qi and blood in the upper body. Voice is generated by Yang Qi; stagnation leads to aphonia. Slight choppy pulse causes hemorrhage, as choppy pulses injure blood. "Wei Jue" refers to reversal of Qi in the four limbs, because the limbs are the root of all Yang meridians, but blood is deficient and Qi is stagnant. Tinnitus and epilepsy occur because the Heart opens into the ears, and Heart deficiency leads to mental confusion. "Yin" is pronounced yin, meaning hoarseness.)
When the Lung pulse is extremely tight, it manifests as epilepsy; when slightly tight, it manifests in Lung cold-heat syndrome, lethargy, coughing up blood, pain radiating to the waist, back, and chest, or nasal polyps causing obstruction. (Extreme tightness of the Lung pulse indicates prevailing wind pathogen; Wood counter-attacks Metal, leading to epilepsy. Slight tightness also results from excess wind-cold transforming into heat, causing cold-heat and lethargy.)
When the Lung pulse is extremely slow, it manifests as profuse sweating; when slightly slow, it manifests as Wei Bi (paralysis) and hemiplegic wind, with unstoppable sweating below the head. (Extreme slowness of the Lung pulse indicates insecure exterior and hair/skin, leading to deficiency of the exterior and profuse sweating. Slight slowness leading to Wei Bi and hemiplegic wind with head sweating occurs because Yang pathogen enters Yin.)
When the Lung pulse is extremely large, it manifests as swelling of the calves; when slightly large, it manifests as Feibi (lung obstruction) radiating to the chest and back, and aversion to sunlight upon rising. Extreme largeness of the Lung pulse indicates Heart fire scorching Lung Metal, depleting true Yin, leading to calf swelling. Slight largeness also results from Lung heat, causing Feibi radiating to the chest and back. Feibi is characterized by irritability, fullness, wheezing, and vomiting. Aversion to sunlight occurs because Fire is excessive in the Qi level while Yin essence is depleted.)
When the Lung pulse is extremely small, it manifests as diarrhea; when minute, it manifests as Xiaodan. (Extreme smallness of the Lung pulse indicates deficiency of Yang Qi and insecurity of the Fu organs, leading to diarrhea. Minute size also indicates decline of Metal; Metal decline leads to Water weakness, causing Xiaodan.)
When the Lung pulse is extremely slippery, it manifests as Xiben (asthma) and rebellious Qi; when slightly slippery, it manifests as bleeding from the upper and lower orifices. Extreme slipperiness of the Lung pulse indicates excess heat in both Qi and Blood, causing Xiben (rapid breathing). Slight slipperiness also causes bleeding from the upper (mouth/nose) and lower (two yin) orifices. "Ben" is pronounced ben.)
When the Lung pulse is extremely choppy, it manifests as hematemesis; when slightly choppy, it manifests as Shulou (scrofula) in the neck and axilla, inability of the lower body to support the upper, and soft/weak knees. Choppy pulses result from blood injury. Since the Lung is in the Upper Jiao, extreme choppy pulse leads to hematemesis. Slight choppy pulse indicates Qi stagnation, leading to Shulou in the neck and axilla. Qi stagnation causes Yang pathology, and blood injury causes Yin deficiency, so the lower body cannot support the upper, resulting in weak knees. "Suan" is pronounced suan.)
When the Liver pulse is extremely tight, it manifests as aversion to speech (or irritable speech); when slightly tight, it manifests as Feiqi (a mass), located under the hypochondrium like an inverted cup. (Extreme tightness of the Liver pulse indicates strong Liver Qi. Strong Liver Qi leads to anger and lack of joy, resulting in irritable speech. Slight tightness also results from Wood pathogen injuring Earth, causing Feiqi under the hypochondrium. The hypochondrium is the pathway of the Liver meridian. Note: *Nan Jing* Chapter 56 states: The accumulation of the Liver is named Feiqi, located in the left hypochondrium. This section derives from that meaning. However, *Nan Jing* associates Wood with the East, hence specifying the left side, whereas this text does not specify "left".)
When the Liver pulse is extremely slow, it manifests as frequent vomiting; when slightly slow, it manifests as Shuijia Bi (water retention obstruction). Slow pulse is characteristic of the Spleen. When the Liver pulse becomes extremely slow, it indicates Wood overcoming Earth, leading to frequent vomiting. Slight slowness leading to water retention and obstruction occurs because Earth is controlled by Wood and fails to transport and transform. Shuijia refers to water accumulation. "Jia" is pronounced jia or jia.)
When the Liver pulse is extremely large, it manifests as internal abscess and frequent epistaxis; when slightly large, it manifests as Ganbi (liver obstruction), retraction of the genitals, and cough radiating to the lower abdomen. (Extreme largeness of the Liver pulse indicates vigorous Liver Fire. Wood and Fire blazing together cause internal abscess. Heat in the blood prevents it from being contained, causing epistaxis. Slight largeness leading to Ganbi, genital retraction, and cough radiating to the lower abdomen occurs because Fire is in the Yin aspect. The meaning of Ganbi is seen in Disease Category 67. "Nu" is pronounced ni, referring to nosebleed.)
When the Liver pulse is extremely small, it manifests as polydipsia; when minute, it manifests as Xiaodan. (The Liver stores blood. Extreme smallness of the Liver pulse indicates blood deficiency and thirst, leading to polydipsia. Minute size also indicates Yin deficiency and blood dryness, causing Xiaodan.)
When the Liver pulse is extremely slippery, it manifests as Kuihan (ulcerated hernia); when slightly slippery, it manifests as enuresis. (Extreme slipperiness of the Liver pulse indicates heat obstructing the meridians, causing ulcerated hernia. Slight slipperiness leading to enuresis occurs because Liver Fire is in the lower jiao, causing uncontrolled discharge. "Kui" is the same as "Kui". "Niao" is the same as "Niao".)
When the Liver pulse is extremely choppy, it manifests as Yi Yin (overflowing drink/water retention); when slightly choppy, it manifests as convulsions, tendon cramps, and tendon bi. (Extreme choppy Liver pulse indicates decline and stagnation of Qi and blood. Insufficient Liver Wood allows Spleen Earth to overact, causing dampness to overflow into the limbs, known as Yi Yin. Slight choppy pulse leading to convulsions, cramps, and tendon bi occurs because blood is insufficient to nourish the tendons. "Chi" is pronounced chi or xi. "Luan" is pronounced luan, meaning tendon contraction.)
When the Spleen pulse is extremely tight, it manifests as convulsions; when slightly tight, it manifests as Ge Zhong (obstruction in the diaphragm/chest), where food and drink enter and immediately return out, and stool contains saliva/phlegm. (Extreme tightness of the Spleen pulse indicates Wood attacking Earth. The Spleen governs the limbs, and wind pathogen invades, causing convulsions. Slight tightness also results from Liver pathogen insulting the Spleen, preventing Spleen transportation, causing food regurgitation. Earth failing to control Water leads to excessive saliva. "Wo" is pronounced wu, describing water pooling.)
When the Spleen pulse is extremely slow, it manifests as Wei Jue (paralysis and cold limbs); when slightly slow, it manifests as Feng Wei (wind paralysis), inability to use the four limbs, but the mind remains clear as if healthy. (The Spleen pulse should be slow. Extreme slowness generates heat. The Spleen governs muscles and limbs, so Spleen heat causes muscle atrophy and reversal cold. Slight slowness leading to wind paralysis and limb immobility occurs because weak Earth generates wind. Although the tendons/muscles are weak in the meridians, the Zang organs are intact, so the mind remains clear.)
When the Spleen pulse is extremely large, it manifests as sudden collapse as if struck; when slightly large, it manifests as Hernia Qi, abdominal distension, and pus/blood outside the intestines and stomach. (The Spleen governs Middle Qi. Extreme largeness of the Spleen pulse indicates extreme Yang, leading to Yin collapse, causing collapse as if struck. Slight largeness leading to Hernia Qi occurs because damp-heat is in the meridians, and the anterior yin is the convergence of Taiyin and Yangming. Abdominal distension is due to pus/blood outside the intestines/stomach, caused by Spleen Qi stagnation.)
When the Spleen pulse is extremely small, it manifests in alternating chills and fever; when minute, it manifests as Xiaodan. (Small Spleen pulse indicates deficiency of Middle Jiao Yang Qi. Extreme smallness leads to chills and fever, while minute size leads to Xiaodan.)
When the Spleen pulse is extremely slippery, it manifests in Long Han (strangury and hernia); when slightly slippery, it manifests in worm toxicity causing abdominal heat. (Extreme slipperiness of the Spleen pulse indicates Taiyin excess heat. Taiyin combines with the sinews, causing strangury and hernia. Slight slipperiness indicates damp-heat in the Spleen. Damp-heat steaming generates worms and causes abdominal heat. "Long" is the same as "Long". "Long" is pronounced long. "Hui" is the same as "Hui", pronounced hui. "Xie" is pronounced xie.)
When the Spleen pulse is extremely choppy, it manifests in Chang Pi (dysentery); when slightly choppy, it manifests in Ne Shi (internal hemorrhoids) and frequent passage of pus and blood. (Extreme choppy Spleen pulse leads to Chang Pi; slight choppy pulse leads to Ne Shi and pus/blood stool. Choppy indicates Qi stagnation and blood injury. The collateral of the Foot Taiyin Spleen enters and connects to the intestines and stomach. Chang Pi and Ne Shi differ only in location. Another view calls it a lower swelling disease, belonging to hernia fistula.)
When the Kidney pulse is extremely tight, it manifests as Gu Dian Ji (bone epilepsy); when slightly tight, it manifests as Chen Jue (deep reversal cold), Ben Tun (running piglet), inability to move the feet, and inability to urinate or defecate. (Extreme tightness of the Kidney pulse indicates wind-cold in the Kidney. The Kidney governs bone, leading to bone epilepsy. Slight tightness leading to deep reversal cold and immobile feet indicates cold pathogen in the meridians. Ben Tun indicates cold pathogen in the Zang organs. Inability to pass urine/stool indicates cold pathogen in the Yin aspects. Note: *Nan Jing* Chapter 56 states: The accumulation of the Kidney is named Ben Tun, originating in the lower abdomen, rising to the epigastrium like a pig, moving up and down without fixed time. This section derives from that meaning. The meaning of Gu Dian Ji is detailed in Acupuncture Category 37.)
When the Kidney pulse is extremely slow, it manifests as broken spine sensation; when slightly slow, it manifests as Dong Xie (hole diarrhea), where food is not digested and comes back up after swallowing. (Extreme slowness of the Kidney pulse indicates Yin deficiency, leading to spinal pain, as the Foot Shaoyin Kidney meridian passes through the spine. Slight slowness indicates Kidney Qi deficiency. Kidney deficiency leads to衰竭 of Mingmen Qi, failure of Lower Jiao transformation, and reflux of undigested food, causing Dong Xie.)
When the Kidney pulse is extremely large, it manifests as impotence; when slightly large, it manifests as Shi Shui (stone water/ascites), heavy swelling from below the navel to the lower abdomen, extending up to the epigastrium, which is a fatal untreatable condition. (Extreme largeness of the Kidney pulse indicates Water deficiency and Fire hyperactivity, causing impotence. Slight largeness indicates Kidney Yin deficiency. Yin deficiency leads to failure of transformation, causing Qi stagnation and water accumulation forming Shi Shui. If water rises to the epigastrium, Water pathogen is extreme, counter-attacking Earth, overflowing uncontrollably, leading to death. The meaning of Shi Shui is seen later in Section 24. "Chui" is pronounced chui, meaning heavy/dropping. "Wan" should be "Wan" (epigastrium).)
When the Kidney pulse is extremely small, it manifests as Dong Xie (profuse diarrhea); when minute, it manifests as Xiaodan. (Extreme smallness of the Kidney pulse indicates decline of Yuan Yang in the lower jiao, causing Dong Xie. Minute size indicates deficiency of True Qi, causing Xiaodan.)
When the Kidney pulse is extremely slippery, it manifests in Long Bi (urinary retention); when slightly slippery, it manifests as Gu Wei (bone atrophy), difficulty sitting or standing, and blindness upon standing. (Extreme slipperiness of the Kidney pulse indicates flourishing Yin Fire, causing urinary retention. "Shan" refers to hernia. Slight slipperiness also results from Fire hyperactivity. Fire hyperactivity leads to Yin deficiency, causing bone atrophy, inability to rise, and visual impairment upon standing.)
When the Kidney pulse is extremely choppy, it manifests as Da Yong (large abscess); when slightly choppy, it manifests as amenorrhea and Chen Shi (deep hemorrhoids). (Choppy Kidney pulse indicates injury to Essence, blood deficiency, and Qi stagnation. Extreme choppy leads to large abscess; slight choppy leads to amenorrhea and deep hemorrhoids.)
Huangdi asked: Regarding the six variations of disease pulses, how should acupuncture be applied? Qibo answered: All tight (Ji) pulses indicate Cold. (Tight pulse refers to Xian/Jin. Zhang Zhongjing said: Floating and tight pulse is named Xian. Tight indicates Cold. Cheng Wuji said: Tight indicates excess Yin Qi. Thus, tight pulses generally indicate wind-cold, and Qi transformation relates to the Liver.) Slow (Huan) pulses indicate Heat. (Slow pulse refers to a relaxed state, not the slow rate of later generations. Zhang Zhongjing said: Slow indicates growth of Yang Qi. Also: Slow indicates sufficient Stomach Qi. Thus, relaxed pulses generally indicate interior heat, and Qi transformation relates to the Spleen and Stomach.) Large (Da) pulses indicate excess Qi and deficient Blood. (Large pulse indicates excess Yang; Yang excess leads to Yin decline, hence excess Qi and deficient Blood. Zhang Zhongjing said: Floating and large pulse indicates Qi excess and Blood deficiency. Thus, large pulses generally indicate floating Yang, and Qi transformation relates to the Heart.) Small (Xiao) pulses indicate deficiency of both Qi and Blood. (Small pulse is close to micro/fine. In Yang, it indicates Yang deficiency; in Yin, it indicates Yin weakness. Pulse body belongs to Yin and transforms via the Kidney.) Slippery (Hua) pulses indicate abundant Yang Qi with slight heat. (Slippery pulse is Yang, indicating substantial Qi and Blood, hence abundant Yang Qi and slight heat. Zhang Zhongjing said: Slippery indicates solid Stomach Qi. *Yu Ji Zhen Zang Lun* says: Weak and slippery pulse indicates presence of Stomach Qi. Thus, slippery pulse relates to the Stomach.) Choppy (Se) pulses indicate excess Blood and deficient Qi with slight cold. (Choppy indicates Qi stagnation and blood deficiency. Deficiency of both Qi and Blood leads to insufficient Yang Qi, hence slight cold. Zhang Zhongjing said: Choppy indicates deficiency of Ying Qi, i.e., blood deficiency. Here it says "excess blood," which seems erroneous. Observing the instruction not to bleed when treating choppy pulses clarifies this. Choppy pulse is near the skin surface, so Qi transformation relates to the Lung.)
Therefore, when needling tight pulses, insert deeply and retain for a long time. (Tight pulses indicate Cold; Cold comes from Yin and is hard to dispel. "Nei" is the same as "Na".) When needling slow pulses, insert shallowly and withdraw quickly to disperse Heat. (Slow pulses indicate Heat; Heat comes from Yang and is easy to scatter.) When needling large pulses, slightly drain Qi, do not bleed. (Large pulses indicate Yin deficiency, so do not bleed.) When needling slippery pulses, withdraw quickly and insert shallowly to drain Yang Qi and remove Heat. (Similar to needling slow pulses.) When needling choppy pulses, must penetrate the vessel accurately, retain for a long time following the direction of Qi flow, first press and rub the area, after withdrawing the needle, press the puncture site quickly to prevent bleeding and harmonize the pulse. (Choppy pulses indicate Qi and Blood deficiency, making it hard to obtain De Qi. Thus, one must accurately penetrate the vessel, observe direction, retain long, press quickly, and avoid bleeding. This requires more caution than other methods because choppy pulses indicate deficiency, fearing damage to True Qi. "Xun" is pronounced xun, meaning massage/rub. "Can Hen" is pronounced wei/wei, referring to scar/mark.) For all small pulses, where Yin-Yang, Form, and Qi are all deficient, do not use needles; instead, regulate with sweet medicines. (Small pulse indicates deficiency. Not using needles shows that Qi and Blood deficiency should not be needled but regulated with sweet medicine. Note: In this section, regulating Yin-Yang and Form-Qi deficiency with sweet medicine, the character "Sweet" holds profound meaning. Food and medicine must pass through the Spleen and Stomach before nourishing the Five Zang. Strong Stomach Qi strengthens all Zang; weak Stomach Qi weakens all Zang. Stomach belongs to Earth and prefers Sweet. Thus, Middle Qi deficiency requires Sweet-Warm herbs. Strengthening Earth strengthens Metal; strengthening Metal fills Water. This is why Earth is the mother of all things, and Yin-Yang deficiency must be regulated with sweet medicine. Although *Zhi Yao Yao Zheng Lun* lists five flavors with tonifying/draining effects based on Five Element generation/restriction, users should primarily use Sweet with slight combinations of other flavors to tonify the Middle. Just as the Four Seasons require Earth, and the Five Zang require Stomach Qi, Spring pulse is slightly wiry, Summer pulse slightly hook-like. *Yin Yang Ying Xiang Da Lun* states: Tonify form deficiency with Qi; tonify essence deficiency with Flavor. Thus, flavors suitable for the person are called tonics; using bitter/unpalatable flavors to seek tonification is illogical. The study of flavor attack and tonification has great subtleties. If one is not good at harmonizing, mistakes begin immediately. This is the primary principle for physicians.)