三部俱弦肝有余。目中疼痛若 虚。怒气满胸常欲叫。翳蒙瞳子泪如珠。
张世贤曰。 。少腹下病也。弦脉见于三部。乃肝家有余。目乃肝之窍。有
余主目中疼痛。其经还绕阴器。而抵少腹。故苦 虚也。愚谓 当作眩。
夫弦。肝之本脉也。今三部俱弦。是木不务其德。肝开窍于目。故目中疼
痛。经云。木太过甚。则忽忽善怒。眩冒巅疾者。是也。夫既曰肝有余。而又
曰虚者何也。所谓有余者。邪气有余。所谓虚者。乃亢则害。承乃制。反自
伤而虚也。怒则气上逆。故气满胸膛。常欲叫也。瞳子属肝。肝气盛则翳
障疼痛。而泪出也。凡眼科诸书。动言目有五输。乃以黑睛属肝。瞳子属
肾非也。愚谓当以黑睛属肾。瞳子属肝。何也以黑睛色黑。当属肾。瞳子
色青。当属肝。况水能生木。正以黑睛之水在外。方能养其瞳子之木在
内。而常清浮光明。斯千载以来。窥其窍者。叔和一人耳。
肝软井弦本没邪。
经云。脉来软弱招招。如揭长竿末梢。曰肝平。故云没邪也。
紧因筋急有些些。
紧为寒。肝主筋。寒则筋挛。故紧因筋急有些些也。
细看浮大更兼实。赤痛昏昏似物遮。
浮为风实。大为火。风火相煽。上为目疾。
溢关过寸口相应。目眩头重与筋疼。
肝脉本弦长。然但当守其本位。今溢关而过于寸口。则木盛矣。木盛则
生风。谚曰树大招风。故为目眩头重之疾矣。
芤时眼暗或吐血。四肢瘫痪不能行。
肝藏血者也。芤为失血之脉。目得血而能视。手得血而能握。足得血而
能步。肝脉而见芤。故或为眼暗。并四肢瘫痪之证作矣。
涩则缘虚血散之。肋胀胁满自应知。
肝为血多气少之脏。涩乃气多血少之脉。肝脉而见涩。则知肝虚而血
散矣。肋与胁肝。经之所布也。肝不藏血。故气乘其虚而居之。是以肋胀
而胁满矣。
滑因肝热连头目。紧实弦沉 癖基。
肝开窍于目。肝部而脉见滑。是为肝经有火。火性炎上故热连头目也。
按医学云。沉弦紧实四脉。主肾水不能生木以致肝虚结成癖积。或近
脐或两肋间作痛。基者言其病有根基。而难拔也。
微弱浮散气作难。目暗生花不耐看。
肝为血多气少之脏。微弱浮散。乃肺脉也。为气多血少之脉。今四脉见
于肝部。乃血不足。而气居之。故曰气作难也。肝开窍于目。目得血而能
视。今血既不足。故目暗生花。而不耐看矣。
甚浮筋弱身无力。遇此还须四体瘫。
肝主筋。取之当于十二菽之重。与筋平者。肝部也。今甚浮则浮而无力
矣。浮而无力为虚。虚则无血以荣其筋。筋不得其养。则难以束骨。故四
肢瘫痪矣。
三部脉象均呈现弦象，表明肝气有余。患者出现眼部疼痛且伴有虚损感。因愤怒导致胸中胀满，经常想要大叫。眼睛视物模糊如被遮蔽，瞳孔不适，泪水像珍珠一样不断流出。
张世贤说：这是少腹下部发生的疾病。弦脉出现在三部脉位，是肝脏邪气有余的表现。眼睛是肝的窍穴，肝气有余会导致眼部疼痛。肝经环绕生殖器，并抵达少腹，所以会感到少腹部的虚痛。我认为“虚”字应当解释为“眩”（头晕目眩）。弦脉是肝的本脉。现在三部脉都呈弦象，说明木行失去了其柔和的德行。肝开窍于目，所以出现眼部疼痛。经文说：“木气太过，就会使人情绪恍惚易怒，出现眩晕、头顶疾病的症状。”正是这种情况。既然说是肝气有余，又为什么说它是虚呢？所谓的“有余”，是指邪气有余；所谓的“虚”，是因为亢盛则有害，需要制约，反而自我损伤而导致虚弱。愤怒会使气机上逆，所以气充满胸膛，经常想要大叫。瞳孔属于肝，肝气旺盛会导致眼翳障蔽疼痛，并且流泪。凡是眼科的各种书籍，动不动就说眼睛有五个输穴，认为黑睛属肝，瞳孔属肾，这是错误的。我认为应当认为黑睛属肾，瞳孔属肝。为什么呢？因为黑睛颜色黑，应当归属于肾；瞳孔颜色青，应当归属于肝。况且水能生木，正是因为黑睛所代表的水在外，才能滋养内部瞳孔所代表的木，从而使视力常常清澈明亮。千年来，洞察这一奥秘的，只有王叔和一人罢了。
肝脏柔软，脉象本应弦而无邪气。
经文说：脉来软弱招摇，如同高举长竿的末梢那样柔韧，这叫作肝平脉。所以说没有邪气。
紧脉是因为筋脉拘急轻微所致。
紧脉主寒，肝主筋，寒邪会导致筋脉挛缩，所以紧脉是因为筋脉拘急轻微的缘故。
仔细查看如果浮大而且兼见实象，眼睛红肿疼痛、昏花，好像有东西遮挡。
浮脉主风，实脉主热（注：原文“实”在此语境下结合后文“大为火”，通常指邪气盛或热，此处依原文逻辑译为实/热），大脉主火。风火相互煽动，向上引发眼疾。
脉气溢出关部，超过寸口相应部位，会出现目眩、头重和筋脉疼痛。
肝脉本来应该是弦长的，但应当守住其本来的位置。现在脉气溢出关部而超过寸口，说明木气过盛了。木气过盛会生风，谚语说“树大招风”，所以会导致目眩、头重的疾病。
如果出现芤脉，眼睛昏暗或者吐血，四肢瘫痪不能行走。
肝是藏血的脏器。芤脉是失血的脉象。眼睛得到血液滋养就能视物，手得到血液滋养就能握持，脚得到血液滋养就能行走。肝脉出现芤象，所以会出现眼睛昏暗，以及四肢瘫痪的症状。
涩脉是因为血虚血散所致。肋部胀满、胁部饱满，应当知晓。
肝是一个血多气少的脏器。涩脉是气多血少的脉象。肝脉出现涩象，就知道是肝虚而血散。肋部和胁部是肝经分布的地方。肝不藏血，所以气乘其虚弱而占据那里，因此导致肋部胀满和胁部饱满。
滑脉是因为肝热连及头目。紧、实、弦、沉脉则是积聚癖块的基础。
肝开窍于目，肝部脉象出现滑象，这是肝经有火。火性炎上，所以热邪连及头目。根据医学记载，沉、弦、紧、实四种脉象，主因肾水不能生木，导致肝虚结成癖积。疼痛位置或在肚脐附近，或在两胁之间。“基”字是说病有根基，难以拔除。
脉象微弱浮散，是气机作难之象。眼睛昏暗、视物生花，不耐久看。
肝是血多气少的脏器。微弱浮散是肺的脉象，属于气多血少的脉象。现在这四种脉象出现在肝部，是血不足而气占据主导，所以叫作“气作难”。肝开窍于目，眼睛得到血液滋养就能视物。现在血既已不足，所以眼睛昏暗、视物生花，不耐久看。
脉象非常浮取时感觉筋弱，身体无力。遇到这种情况，还会发生四肢瘫痪。
肝主筋，诊察肝脉时应当用十二颗豆粒重量的力度按压，与筋脉状态相平的，就是肝部脉象。现在脉象非常浮，就是浮而无力。浮而无力属于虚证，虚则没有血液来荣养筋脉。筋得不到滋养，就难以约束骨骼，所以导致四肢瘫痪。
All three positions (cun, guan, chi) presenting a wiry pulse indicates Liver excess. The patient experiences eye pain accompanied by a sensation of deficiency. Anger causes chest fullness and a frequent desire to shout. Vision is obscured as if by a haze, the pupils are uncomfortable, and tears flow like pearls.
Zhang Shixian stated: This refers to pathology in the lower abdomen. A wiry pulse appearing at all three positions signifies excess in the Liver. The eyes are the orifice of the Liver; excess leads to eye pain. The Liver meridian circles the genitalia and reaches the lower abdomen, hence there is suffering from deficiency-pain in the lower abdomen. I believe "xu" (deficiency) should be interpreted as "xuan" (vertigo/dizziness). The wiry pulse is the proper pulse of the Liver. Now that all three positions are wiry, it means the Wood element has failed to maintain its virtue. Since the Liver opens into the eyes, eye pain occurs. The Classic states: "When Wood is excessive, one becomes suddenly irritable and prone to vertigo and diseases of the vertex." This is exactly such a case. Why is it said to be Liver excess, yet also described as deficiency? What is meant by "excess" is the excess of pathogenic factors; what is meant by "deficiency" is that hyperactivity causes harm, requiring control, which leads to self-injury and subsequent deficiency. Anger causes Qi to rebel upward, thus Qi fills the chest, leading to a constant desire to shout. The pupil belongs to the Liver; when Liver Qi is vigorous, it causes visual obscurations and pain, resulting in tearing. All ophthalmological texts often speak of five Shu points in the eye, asserting that the cornea (black part) belongs to the Liver and the pupil belongs to the Kidney. This is incorrect. I assert that the cornea should belong to the Kidney and the pupil to the Liver. Why? Because the cornea is black, corresponding to the Kidney; the pupil is bluish-black, corresponding to the Liver. Moreover, Water generates Wood; precisely because the Water represented by the cornea is external, it can nourish the Wood represented by the pupil internally, keeping vision clear and bright. For a thousand years, only Wang Shuhe has penetrated this secret.
The Liver is soft; the pulse should be wiry but free of pathogens.
The Classic states: "If the pulse comes soft and flexible, like the tip of a long bamboo pole held high, it is called a normal Liver pulse." Thus, it is said to be free of pathogens.
A tight pulse arises from slight tendon tension.
Tightness indicates Cold. The Liver governs the tendons; Cold causes tendon contraction. Therefore, a tight pulse arises from slight tendon tension.
Carefully observing if it is floating, large, and additionally solid, indicating red painful eyes, dim vision, as if obstructed by something.
Floating indicates Wind; Large indicates Fire. Wind and Fire fan each other, rising to cause eye diseases.
Overflowing past the Guan position and extending beyond the Cun position corresponds with dizziness, heavy head, and tendon pain.
The Liver pulse is naturally wiry and long, but it should remain in its proper position. Now, overflowing past the Guan and exceeding the Cun position indicates Wood excess. Excess Wood generates Wind. As the proverb goes, "A big tree attracts much wind," thus causing diseases of dizziness and heaviness of the head.
If a knifelike (Kou) pulse appears, there may be dim vision or hematemesis, and paralysis of the four limbs preventing movement.
The Liver stores Blood. A Kou pulse indicates blood loss. The eyes see when nourished by Blood; the hands grasp when nourished by Blood; the feet walk when nourished by Blood. If the Liver pulse presents as Kou, it results in dim vision and syndromes of four-limb paralysis.
A choppy (Se) pulse is due to Blood deficiency and dispersion. Rib distension and hypochondriac fullness should be known.
The Liver is an organ rich in Blood and poor in Qi. A Choppy pulse is characteristic of abundant Qi and deficient Blood. If the Liver pulse is Choppy, it indicates Liver deficiency and Blood dispersion. The ribs and hypochondrium are areas distributed by the Liver meridian. When the Liver fails to store Blood, Qi takes advantage of the deficiency to occupy these spaces, causing rib distension and hypochondriac fullness.
A slippery (Hua) pulse is due to Liver Heat connecting to the head and eyes. Tight, Solid, Wiry, and Deep pulses form the basis for accumulations (Pi Ji).
The Liver opens into the eyes. If the Liver position presents a Slippery pulse, it indicates Fire in the Liver meridian. Fire nature is flaming upward, so heat connects to the head and eyes. According to medical texts, Deep, Wiry, Tight, and Solid pulses indicate that Kidney Water fails to generate Wood, leading to Liver deficiency and the formation of Pi Ji (accumulations). Pain may occur near the umbilicus or between the two hypochondria. "Ji" (basis/foundation) implies the disease has a deep root and is difficult to eradicate.
Weak, Floating, and Scattered pulses indicate Qi distress. Dim vision with photopsia (seeing spots) makes prolonged viewing intolerable.
The Liver is rich in Blood and poor in Qi. Weak, Floating, and Scattered are pulses of the Lung, representing abundant Qi and deficient Blood. If these four pulses appear in the Liver position, it signifies Blood insufficiency with Qi dominance, hence termed "Qi distress." The Liver opens into the eyes; vision requires Blood. Since Blood is now insufficient, vision becomes dim with photopsia, making prolonged viewing intolerable.
Extremely floating with weak tendons and body weakness. Encountering this still requires attention to four-limb paralysis.
The Liver governs the tendons. Palpation for the Liver pulse should use the weight of twelve beans, assessing the state parallel to the tendons. An extremely floating pulse here indicates floating and forceless qualities. Floating and forceless indicates Deficiency; deficiency means no Blood to nourish the tendons. Without nourishment, tendons cannot bind the bones, leading to four-limb paralysis.