心藏身之精。
内经决气篇云。两神相搏合而成形。常先身生。即此谓也。戴氏亦知乎此。而复误精字为有形之精。改为君字何哉。
按阴阳应象大论。南方生热。热生火。火生苦。苦生心。心生血。血生脾。心
主舌。其在天为热。在地为火。在体为脉。在脏为心。在色为赤。在音为征。
在声为笑。在变动为忧。在窍为舌。在味为苦。在志为喜。喜伤心。恐胜喜。
热伤气。寒胜热。苦伤气。咸胜苦。金匮真言论曰。南方色赤。入通于心。开
窍于耳。藏精于心。故病在五脏。其味苦。其类火。其畜羊。其谷黍。其应四
时。上为荧惑星。是以知病之在脉也。其音征。其数七。其臭焦。
小肠为弟兄。
小肠属丙而刚。心属丁而柔。刚在先而为兄。柔在后而为弟。二俱属火。
同气连枝。故曰弟兄。戴起宗云。大言阴与阳。小言夫与妇。非也。何以言
之夫丁与壬合。心之夫。膀胱是也。丙与辛合。小肠之妇。肺金是也。刊误
谓不可以言弟兄非也
象离随夏旺。属火向南生。
张世贤曰。离之为卦。其中空虚。心脏属火。亦犹是也。火旺于夏。所以随
夏而旺相也。经云。南方生热。热生火。火生苦。苦生心。故曰属火。向南生
也。刊误改作明字。甚无谓也。
任物无纤巨。多谋最有灵。
张世贤曰。任物者。住亲万物也。纤。小也。巨。大也。人心之应物。随其大小。
无不任亲也。朱子曰。人心之灵。莫不有之。所以多谋而有灵也。
内行于血海。外应舌将荣。
阴阳应象大论云。心生血血生脾。心主舌。又云在窍为舌。五脏生成篇
云。诸血者。皆属于心。
七孔多聪慧。三毛上智英。
多聪慧者。心有七窍上智英者。心有三毛。其次则不全矣。
反时忧不解。顺候脉洪惊。
张世贤曰。心属火而旺夏。反得冬脉沉濡而滑。此乃肾邪干心。水来克
火。谓之贼邪。是可忧也。顺候。诊得夏脉也。惊者大而散也。其脉洪大而
散。谓之顺候。张世贤之言固是。但忧字与惊字。义俱未透。愚谓心属火
主夏。脉宜洪大而散阴阳应象大论云。在脏为心。在色为赤。在音为征。
在声为笑。在变动为忧。今当夏月。反见沉细之脉。是为反四时。脉既反
时。其人当忧愁不能自解之疾。洪大也。惊起。意言夏月诊得其脉洪大。
而惊起。则谓之顺四时矣。戴起宗误认为惊恐之惊。易作平字。非也不
知惊之一字。王氏脉经。已曾有其名矣。如妊娠论中云。呼则为数。吸则
不惊。又如云。肝脉惊暴。有所惊骇。脉不至若喑不治自己之类是也。戴
氏可谓少所见。多所怪矣。大抵古人以一字命脉之名。在学人当会意
于神情。毋凝滞于字句。只如张长沙曰。寸口卫气胜。名曰高。荣气胜。名
曰章。高章相搏。名曰纲。卫气弱。名曰 。荣气弱。名曰卑。 卑相搏。名曰
损。若执字义。则高章 卑。是何义理。亦在学人会意于精神冥寞而已。
岂亦将以字义之不切。而遽改之可乎。堪笑今世之人。不于指下求其
神情。专于字上求其似是。其去道不亦远乎。
按玉机真藏论云。心脉至坚而搏。如循薏苡子。累累然。色赤黑不泽。毛
折乃死。
按人镜经曰。心脉浮大而散。心合血脉。循血脉而行。持脉指法。如六菽
之重。按至血脉而得者为浮。稍稍加力。脉道粗者为大。又稍加力。脉道
阔软者。为散也。
液汗通皮润。声言爽气清。
张世贤曰。肾主液。入心为汗。肺主声。入心为言。水能克火。汗通则肾水
平。而皮润火不受水贼矣。火能克金。言爽则肺金平而气清金。不受火
侵矣。
伏梁秋得积如臂在脐萦。
五十六难曰。心之积名曰伏梁。起脐上火如臂。上至心下。久不愈。令人
病烦心。以秋庚辛日得之。何以言之。肾传心。心当传肺。肺秋适旺。旺者
不受邪心复欲还肾。肾不肯受。故留结为积。故知伏梁以秋庚辛日得之。
顺视鸡冠色。凶看瘀血凝。
五脏生成篇云。赤如鸡冠者生。赤如 血者死。言察病患之色赤如鸡
冠。谓赤而明润。故曰生。察病患之色赤如 血。谓赤而惨暗。故曰死。
诊时须审委。细察在叮咛。
凡医者。必须望闻问切。上文既已察其色。闻其声。切其脉。至此复须审
委细察以问之。庶可万全。叔和之所以叮咛戒告者。欲以儆后人也。下
四藏仿此。
实梦忧惊怪。虚翻烟火明。
灵枢云。心气盛则梦善笑恐畏。厥气客于心。则梦见丘山烟火。所谓心
气盛者。实之谓也。所谓厥气客者。虚之谓也。张世贤曰。心脏有余。则梦
或忧或惊。或怪异之事。心脏不足。则梦烟火光明。化竭而见本矣。
秤之十二两。大小与常平。
四十二难曰。心重十二两。中有七孔三毛盛精汁三合。主藏神。
心脏藏纳身体的精气。
《内经·决气篇》说：两性的神气相互搏结结合而形成形体，这种精气常常在身体形成之前就已经存在，说的就是这种情况。戴氏（戴起宗）也知晓这个道理，却又错误地将“精”字理解为有形的精液，将其改为“君”字，这是为什么呢？
按照《阴阳应象大论》所说：南方产生热，热产生火，火产生苦味，苦味滋养心脏，心脏化生血液，血液滋养脾脏。心开窍于舌。在天为热，在地为火，在人体组织对应脉，在脏腑对应心，在五色对应赤色，在五音对应徵音，在五声对应笑声，在变动对应忧，在孔窍对应舌，在五味对应苦味，在五志对应喜。喜会损伤心，恐可以克制喜。热会耗伤气，寒可以克制热。苦味会耗伤气，咸味可以克制苦味。《金匮真言论》说：南方的颜色是赤色，气机通应于心，开窍于耳，精气藏于心，所以疾病发生在五脏。其味为苦，其类属火，其畜为羊，其谷为黍，其对应四季中的夏季，在天上的星宿为荧惑星。因此知道疾病与脉有关。其音为徵，其成数为七，其气味为焦臭。
小肠与心互为兄弟。
小肠属丙火而性质刚强，心属丁火而性质柔和。刚强的在前为兄，柔和的在后为弟。两者都属火，同气连枝，所以称为弟兄。戴起宗说：“大的方面讲是阴与阳的关系，小的方面讲是夫与妇的关系。”这是不对的。为什么这么说呢？因为丁与壬相合，心的配偶是膀胱（壬属阳水，但此处依五行合化或特定理论，原文意指心与小肠之外配关系，通常心合小肠，此处引用戴氏反驳观点，戴氏认为心之夫为膀胱，小肠之妇为肺金，此乃戴氏一家之言，原文意在驳斥）。丙与辛相合，小肠的配偶是肺金。刊误者说不能称之为弟兄，这也是不对的。
心脏像离卦一样随夏季旺盛，属火向南生长。
张世贤说：离卦的结构，中间是空虚的。心脏属火，也是这样。火在夏季旺盛，所以随着夏季而旺相。经文说：南方产生热，热产生火，火产生苦味，苦味滋养心脏。所以说属火，向南生长。刊误者将其改为“明”字，非常没有道理。
承担万物无论大小，心思缜密最有灵性。
张世贤说：承担万物，是指亲近万物。纤，指小；巨，指大。人心应对事物，无论大小，无不亲近接纳。朱熹说：人心的灵性，没有不具备的。所以能够多谋略而有灵性。
内部运行于血海，外部对应舌头以维持荣华。
《阴阳应象大论》说：心脏化生血液，血液滋养脾脏。心主舌。又说在孔窍对应舌。《五脏生成篇》说：所有的血液，都归属于心。
七窍通达则多聪慧，三毛显现则上智英杰。
所谓多聪慧，是因为心有七窍；所谓上智英杰，是因为心有三毛。如果这些不全，那就次一等了。
违背时令则忧愁不解，顺应时令则脉象洪大且令人惊异（指脉势盛大）。
张世贤说：心属火而在夏季旺盛，如果反而得到冬季沉濡而滑的脉象，这是肾邪侵犯心脏，水来克火，称为贼邪，这是值得忧虑的。顺候，指的是诊得夏季的脉象。惊，指脉象大而散。脉象洪大而散，称为顺候。张世贤的话固然正确，但“忧”字和“惊”字的含义都没有透彻。我认为心属火主夏，脉象宜洪大而散。《阴阳应象大论》说：在脏为心，在色为赤，在音为徵，在声为笑，在变动为忧。如果在夏季月份，反而见到沉细的脉象，这就是违背四时。脉既违背时令，其人应当患有忧愁不能自我解脱的疾病。至于“洪大”，“惊起”的意思是说在夏季月份诊得其脉象洪大，而惊起（指脉势突然盛大），则称为顺应四时。戴起宗错误地将其认为是惊恐的“惊”，改作平字，这是不对的。不知道“惊”这个字，王叔和的《脉经》中已经使用了。如在《妊娠论》中说：“呼则为数，吸则不惊。”又如说：“肝脉惊暴，有所惊骇，脉不至若喑不治自己”之类。戴氏可以说是少见多怪。大概古人用一个字来命名脉象，学习的人应当在神情意趣中领会，不要拘泥于字句。就像张仲景说：寸口卫气胜，名叫高；营气胜，名叫章；高章相搏，名叫纲。卫气弱，名叫卑；营气弱，名叫卑；卑卑相搏，名叫损。如果执着于字义，那么高、章、卑是什么意思呢？这也需要学习的人在精神冥默中领会罢了。难道会因为字义不贴切就轻易修改吗？可笑当今之人，不在指下寻求脉的神韵，专门在字面上追求似是而非，他们离大道不是很远了吗？
按照《玉机真脏论》说：心脉坚硬而搏指，像触摸薏苡子一样，累累然。面色赤黑无光泽，毛发枯折，这是死证。
按照《人镜经》说：心脉浮大而散。心合血脉，循行于血脉之中。持脉的手法，如六颗豆子的重量，按至血脉而得的为浮；稍稍加力，脉道粗大的为大；再稍加力，脉道阔软的，为散。
津液通过汗孔排泄使皮肤润泽，声音清晰则肺气清爽。
张世贤说：肾主管津液，入心化为汗。肺主管声音，入心化为言。水能克火，汗通则肾水平衡，而皮肤润泽，火就不受水的侵害了。火能克金，言语爽利则肺金平和而气清，金就不受火的侵扰了。
伏梁病在秋季出现，积聚如手臂粗细，环绕在脐部。
《难经·五十六难》说：心的积病名叫伏梁，起于脐上，如火焰般向上蔓延如手臂粗细，上至心下。久治不愈，使人心中烦闷。在秋季庚辛日得此病。为什么这么说呢？因为肾病传心，心本该传肺，但肺在秋季正当旺盛，旺盛的脏腑不受邪气，心想再将邪气返还给肾，肾不肯接受，所以邪气留结成为积。因此知道伏梁是在秋季庚辛日得的。
顺着观察面色如鸡冠色者生，凶险看瘀血凝滞者死。
《五脏生成篇》说：面色红得像鸡冠色的预后良好，红得像凝血色的预后不良。说的是观察病人的面色，红得像鸡冠，是指红色而明润，所以说预后良好。观察病人的面色红得像凝血，是指红色而惨暗，所以说预后不良。
诊察时必须审慎详细，仔细考察并加以叮嘱。
凡是医生，必须运用望闻问切四种诊断方法。上文既然已经观察了面色，听到了声音，切摸了脉象，到这里又必须审慎详细地询问，才可以万无一失。王叔和之所以反复叮咛告诫，是为了警示后人。下面四个脏器的论述仿照此例。
实证梦见忧愁惊恐怪异之事，虚证梦见翻腾烟火光明。
《灵枢》说：心气盛则梦见喜欢笑和恐惧畏惧。厥气客居于心，则梦见丘山烟火。所谓心气盛，就是实证的体现。所谓厥气客，就是虚证的体现。张世贤说：心脏有余，则梦见或者忧愁、或者惊恐、或者怪异的事情。心脏不足，则梦见烟火光明，这是精气枯竭而显露本原的表现。
称量重十二两，大小与常人平均状态相当。
《难经·四十二难》说：心脏重十二两，中有七个孔窍和三根毛发，容纳精汁三合，主要功能是藏神。
The Heart stores the essence of the body.
The *Neijing* (Classic of Internal Medicine), chapter "Jueqi" (Determination of Qi), states: "When the spirits of two sexes interact and combine, a form is created. This essence often exists prior to the formation of the body." This refers to this concept. Dai Shi (Dai Qizong) also understood this, yet erroneously interpreted the character "Jing" (Essence) as tangible semen, changing it to "Jun" (Monarch/Commander). Why?
According to the *Yinyang Yingxiang Dalun* (Great Treatise on Responses of Yin and Yang to Phenomena): "The South generates Heat; Heat generates Fire; Fire generates Bitterness; Bitterness nourishes the Heart; the Heart generates Blood; Blood nourishes the Spleen. The Heart governs the tongue. In Heaven, it corresponds to Heat; in Earth, to Fire; in the body tissues, to Vessels; in the Zang-Fu organs, to the Heart; in colors, to Red; in musical notes, to Zheng (Zhi); in vocal sounds, to Laughter; in pathological changes, to Worry; in orifices, to the Tongue; in flavors, to Bitterness; in emotions, to Joy. Joy damages the Heart; Fear overcomes Joy. Heat damages Qi; Cold overcomes Heat. Bitterness damages Qi; Salty flavor overcomes Bitterness." The *Jingui Zhenyan Lun* (True Words on the Golden Cabinet) states: "The color of the South is Red; its energy communicates with the Heart; it opens into the ears; its essence is stored in the Heart. Therefore, diseases occur in the five Zang organs. Its flavor is Bitter; its category is Fire; its associated animal is the Sheep; its grain is Millet; it corresponds to the four seasons, specifically Summer; in the sky, it corresponds to the planet Huoxing (Mars). Thus, we know that disease relates to the vessels. Its note is Zheng; its number is seven; its odor is Scorched."
The Small Intestine is the brother of the Heart.
The Small Intestine belongs to Bing (Yang Fire) and is rigid; the Heart belongs to Ding (Yin Fire) and is soft. Rigid comes first, thus being the elder brother; soft comes later, thus being the younger brother. Both belong to Fire, sharing the same qi and branches, hence called brothers. Dai Qizong stated: "In grand terms, it is Yin and Yang; in small terms, it is husband and wife." This is incorrect. Why? Because Ding combines with Ren; the husband of the Heart is the Bladder (Ren). Bing combines with Xin; the wife of the Small Intestine is the Lung Metal. The editor of corrections argued that they cannot be called brothers, which is also incorrect.
Like the Li trigram, it prospers in Summer, belonging to Fire and growing towards the South.
Zhang Shixian said: "The Li trigram is hollow in the middle. The Heart belongs to Fire, just like this. Fire prospers in Summer, so it prospers along with Summer." The classic states: "The South generates Heat; Heat generates Fire; Fire generates Bitterness; Bitterness nourishes the Heart." Hence, it is said to belong to Fire and grow towards the South. The editor changed "Li" to "Ming" (Bright), which is meaningless.
It bears all things regardless of size; it is most spiritual and resourceful.
Zhang Shixian said: "To bear things means to be close to all things. 'Xian' means small; 'Ju' means large. The human heart responds to things, regardless of their size, being close and accepting to all." Zhu Xi said: "The spirituality of the human mind is inherent in everyone. Therefore, it is resourceful and spiritual."
Internally, it flows into the Sea of Blood; externally, it corresponds to the tongue to maintain flourishing vitality.
The *Yinyang Yingxiang Dalun* states: "The Heart generates Blood; Blood nourishes the Spleen. The Heart governs the tongue." It also states: "In orifices, it corresponds to the tongue." The *Wuzang Shengcheng Pian* (Chapter on the Generation of the Five Zang Organs) states: "All blood belongs to the Heart."
Seven apertures confer wisdom; three hairs indicate supreme intelligence.
Those who are wise have seven apertures in the Heart; those who are supremely intelligent have three hairs in the Heart. If these are incomplete, one is inferior.
Defying the season leads to unresolved worry; following the season shows a surging pulse causing awe.
Zhang Shixian said: "The Heart belongs to Fire and prospers in Summer. If one instead feels a Winter pulse—deep, soggy, and slippery—it indicates Kidney pathogenic factors invading the Heart, with Water overcoming Fire. This is called 'Thief Pathogen,' which is worrisome." A "Shunhou" (Compliant Pulse) refers to feeling the Summer pulse. "Jing" (Awe/Surprise) refers to a pulse that is large and scattered. A pulse that is surging, large, and scattered is called compliant. Zhang Shixian's words are correct, but the meanings of "Worry" and "Jing" are not fully elucidated. I believe the Heart belongs to Fire and governs Summer; the pulse should be surging, large, and scattered. The *Yinyang Yingxiang Dalun* states: "In Zang organs, it is the Heart; in color, Red; in note, Zheng; in sound, Laughter; in change, Worry." In summer months, if a deep and fine pulse appears, it defies the four seasons. Since the pulse defies the season, the person suffers from worry that cannot be resolved. Regarding "Surging," "Jingqi" implies that in summer, if the pulse is felt as surging and suddenly expansive ("jingqi"), it is considered compliant with the four seasons. Dai Qizong mistakenly interpreted "Jing" as fear/startle and changed it to "Ping" (Flat), which is incorrect. He did not know that the character "Jing" was already used in Wang Shuhe's *Maijing* (Pulse Classic), such as in the "Gynecology" chapter: "Exhale makes it rapid, inhale does not startle." Or: "Liver pulse startsles suddenly, due to fright; pulse absent or mute is untreatable." Dai could be described as having seen little and wondered at much. Generally, ancient masters used one character to name a pulse type. Students should grasp the spirit and meaning, not get stuck on literal characters. Just as Zhang Changsha (Zhang Zhongjing) said: "If Wei Qi prevails at the Cun Kou, it is named Gao (High); if Ying Qi prevails, it is named Zhang (Brilliant). When Gao and Zhang contend, it is named Gang (Cord). If Wei Qi is weak, it is named Bei (Low); if Ying Qi is weak, it is named Bei. When Bei and Bei contend, it is named Sun (Damage)." If one clings to literal meanings, what do Gao, Zhang, and Bei mean? One must grasp the spirit in silence. Can one easily change them because the literal meaning seems imprecise? How laughable are modern people who seek the pulse's spirit not under their fingers but by chasing ambiguous word definitions! Are they not far from the Dao?
According to the *Yuji Zhenzang Lun*: "Heart pulses are firm and beating, like touching Coix seeds (Job's tears), piled up. The complexion is red-black and lusterless, hair breaks off; this is death."
According to the *Renjing Jing*: "Heart pulses are floating, large, and scattered. The Heart harmonizes with blood vessels, moving within them. The finger technique for holding the pulse: with the weight of six beans, pressing until the vessel is felt is Floating; adding slight pressure, if the vessel feels coarse, it is Large; adding more pressure, if the vessel feels broad and soft, it is Scattered."
Fluids become sweat, moistening the skin; voice is clear, indicating pure Qi.
Zhang Shixian said: "The Kidneys govern fluids, which enter the Heart to become sweat. The Lungs govern voice, which enters the Heart to become speech. Water overcomes Fire; when sweat flows freely, Kidney Water is balanced, skin is moistened, and Fire is not invaded by Water. Fire overcomes Metal; when speech is clear, Lung Metal is balanced and Qi is pure, and Metal is not invaded by Fire."
Fuliang (Beam Accumulation) appears in Autumn, an accumulation like an arm's width, circling the navel.
The *Nanjing* (Classic of Difficult Issues), Chapter 56, states: "The accumulation of the Heart is named Fuliang. It begins above the navel, spreading upward like fire, thick as an arm, reaching down to below the Heart. If not cured for a long time, it causes mental restlessness. It is contracted on Geng/Xin days in Autumn. Why? Because Kidney transmits to Heart; Heart should transmit to Lung. But Lung is prosperous in Autumn, and prosperous organs do not accept pathogens. Heart tries to return the pathogen to Kidney, but Kidney refuses. Thus, it stays and forms an accumulation. Hence, Fuliang is contracted on Geng/Xin days in Autumn."
Observing compliance, chicken-crown color indicates life; observing凶 (ominous), coagulated blood indicates death.
The *Wuzang Shengcheng Pian* states: "Red like a chicken comb indicates survival; red like coagulated blood indicates death." This refers to observing the patient's complexion. Red like a chicken comb means red and bright/moist, hence survival. Red like coagulated blood means red and dull/gloomy, hence death.
During diagnosis, one must examine carefully and meticulously inquire.
Any physician must use Observation, Auscultation/Olfaction, Inquiry, and Palpation. Having observed color, heard sound, and palpated pulse in the previous sections, one must now carefully and thoroughly inquire to ensure completeness. Wang Shuhe's repeated warnings were intended to admonish future generations. The descriptions of the other four Zang organs follow this pattern.
Excess conditions dream of worry, fright, and strange events; Deficiency conditions dream of churning smoke and fire light.
The *Ling Shu* states: "When Heart Qi is excess, one dreams of laughing and fearing. When Jue Qi invades the Heart, one dreams of hills, mountains, smoke, and fire. 'Heart Qi excess' refers to Excess syndrome. 'Jue Qi invading' refers to Deficiency syndrome." Zhang Shixian said: "If Heart Qi is surplus, one dreams of worry, fright, or strange matters. If Heart Qi is insufficient, one dreams of smoke, fire, and brightness, revealing the root due to exhaustion."
Weighing twelve taels, size and shape are normal.
The *Nanjing*, Chapter 42, states: "The Heart weighs twelve taels. It has seven apertures and three hairs, containing three he of essence fluid. It primarily houses the Shen (Spirit)."