前来不见此证今乃变异是名灾怪又问曰何缘作此吐利答曰或有旧时服药今乃发作故名灾怪耳
成 医以脉证与药相对而反变异为其灾可怪故曰灾怪自三菽六菽以下至灾怪脉凡五段皆延医之法
问曰东方肝脉其形何似师曰肝者木也名厥阴其脉微弦濡弱而长是肝脉也肝病自得濡弱者愈也
成 难经曰春脉弦者肝东方木也万物始生未有枝叶故脉来濡弱而长故曰弦是肝之平脉肝病得此脉者为肝气已和
也
假令得纯弦脉者死何以知之以其脉如弦直是肝脏伤故知死也
成 纯弦者谓如弦直而不软此中无胃气为真脏之脉内经曰死肝脉来急益劲如新张弓弦
南方心脉其形何似师曰心者火也名少阴其脉洪大而长是心脉也心病自得洪大者愈也
成 心王于夏夏则阳外胜气血淖溢故其脉来洪大而长也
假令脉来微去大故名反病在里也脉来头小本大者故名覆病在表也上微头小者则汗出下微本大者则为关格不通不得
尿头无汗者可治有汗者死
成 心脉来盛去衰为平来微去大是反本脉内经曰大则邪至小则平微为正气大为邪气来以候表来微则知表和去以
候
里去大则知里病内经曰心脉来不盛去反盛此为不及病在中头小本大者即前小后大也小为正气大为邪气则邪气先在里今
复还于表故名曰覆不云去而止云来者是知在表脉经曰在上为表在下为里汗者心之液上微为浮之而微头小为前小则表中
气虚故主汗出下微沉之而微本大为后大沉则在里大则病进内经曰心为牡脏小肠为之使今邪甚下行格闭小阳使正气不通
故不得尿名曰关格脉经曰阳气上出汗见于头今关格正气不通加之头有汗者则阳气不得下通而上脱也其无汗者虽作关格
然阳未衰而犹可治也
西方肺脉其形何似师曰肺者金也名太阴其脉毛浮也肺病自得此脉若得缓迟者皆愈若得数者则剧何以知之数者南方
火火克西方金法当痈肿为难治也
成 轻虚浮曰毛肺之平脉也缓迟者脾之脉脾为肺之母以子母相生故云皆愈数者心之脉火克金为鬼贼相刑故剧肺
主
皮毛数则为热热客皮肤留而不去则为痈疡经曰数脉不时则生恶疮
问曰二月得毛浮脉何以言至秋当死师曰二月之时脉当濡弱反得毛浮者故知至秋死二月肝用事肝脉属木应濡弱反得
毛浮者是肺脉也肺属金金来克木故知至秋死他皆仿此
成 当春时反见秋脉为金气来木肺来克肝夺旺脉而见至秋肺旺肝气则绝故知至秋死也
师曰脉肥人责浮瘦人责沉肥人当沉今反浮瘦人当浮今反沉故责之
成 肥人肌肤浓其脉当沉瘦人肌肤薄其脉当浮今肥人脉反浮瘦人脉反沉必有邪气相干使脉反常故当责之
师曰寸脉下不至关为阳绝尺脉上不至关为阴绝此皆不治决死也若计其余命死生之期期以月节克之也
成 脉经曰阳生于寸动于尺阴生于尺动于寸寸脉下不至关者为阳绝不能下应于尺也尺脉上不至关者为阴绝不能
上
应于寸也内经曰阴阳离决精气乃绝此阴阳偏绝故皆决死期以月节克之者谓如阳绝死于春夏阴绝死于秋冬也
师曰脉病患不病名曰行尸以无旺气卒眩仆不识人者短命则死人病脉不病名曰内虚以有谷神虽困无苦
成 脉者人之根本也脉病患不病为根本内绝形虽且强卒然气脱则眩晕僵仆而死不曰行尸而何人病脉不病则根本
内
固形虽且羸止内虚耳谷神者谷气也谷气既足自然安矣内经曰形气有余脉气不足死脉气有余形气不足生
问曰翕奄沉名曰滑何谓也沉为纯阴翕为正阳阴阳和合故令脉滑关尺自平阳明脉微沉食饮自可少阴脉微滑滑者紧之
浮名也此为阴实其人必股内汗出阴下湿也
成 脉来大而盛聚而沉谓之翕奄沉正如转珠之状也沉为脏气故曰纯阴翕为腑气故曰正阳滑者阴阳气不为偏胜也
关
尺自平阳明脉微沉者当阳部见阴脉则阴偏胜而阳不足也阳明胃脉胃中阴多故食饮自可少阴脉微滑者当阴部见阳脉则阳
偏胜而阴不足也以阳凑阴分故曰阴实股与阴少阴之部也今阳热凑阴必熏发津液泄达于外股内汗出而阴下湿也
许 沉为
纯阴翕为正阳阴阳和合故名滑古人论滑脉虽云往来前却流利宛转替替然与数相似仲景三语而足也按翕奄沉三字状得滑
字最好夫翕者合也奄者忽也当脉气合聚而盛之时奄忽之门即已沉去是名滑也仲景恐人误认滑脉为沉故下文又曰滑者紧
之浮名也曰沉曰浮若异而同更须慧解观上文紧者如转索无常也一句则知浮为转索无常之浮非轻手便得有常之名也沉为
翕奄之沉非重取乃得一定之说也仲景下字具有史笔不可草草看过故赵嗣真曰今人不解作秦汉文本观可谓善读仲景之书
矣
问曰曾为人所难紧脉从何而来师曰假令亡汗若吐以肺里寒故令脉紧也假令咳者坐饮冷水故令脉紧也假令下利以胃
中虚冷故令脉紧也
阳舒缓阴缩急阴化为寒揪然收敛气血以坚其为脉也宁得不急经曰紧脉带数如切绳状一曰如转索无常故有寒则见
寸口卫气胜名曰高
寸口通关尺而言高谓脉来浮而有力卫气主表浮以候之其体在上今浮中有力是卫气盛也以其在上故谓之高有升而不
降之义焉
荣气盛名曰章
章明也条也往来分明有条理也今滑脉为血实之诊殆近是乎
高章相搏名曰纲
纲总也以荣卫俱盛故谓之总
卫气弱名曰
举之濡弱恍惚故谓之
荣气弱名曰卑
荣主血为阴按以候之其脉沉而无力故谓之卑
卑相搏名曰损
卑相搏阴阳俱虚总谓之损举按俱无力也
卫气和名曰缓
缓为胃脉胃合卫气卫气和故见缓脉
荣气和名曰迟
迟为脾脉脾合荣气荣气和故见迟脉
迟缓相搏名曰强
荣卫俱和故迟缓相搏不亦强乎
寸口脉缓而迟缓则阳气长其色鲜其颜光其声商毛发长迟则阴气盛骨髓生血满肌肉紧薄鲜硬阴阳相抱荣卫俱行刚柔
相搏名曰强也
此释上一句之义此为平脉非病脉也
趺阳脉滑而紧滑者胃气实紧者脾气强持实击强痛还自伤以手把刃坐作疮也
成 趺阳之脉以候脾胃滑则谷气实是为胃实紧则阴气胜是为脾强以脾胃一实一强而相搏击故令痛也若一强一弱
相
搏则不能作痛此脾胃两各强实相击腑脏自伤而痛譬若以手把刃而成疮岂非自贻其害乎按此则敦阜大过之脉也
寸口脉浮而大浮为虚大为实在尺为关在寸为格寸关则不得小便格则吐逆
成 经曰浮为虚内经曰大则病进浮则为正气虚大则为邪气实在尺则邪气关闭下焦里气不得下通故不得小便在寸
则
邪气格拒上焦使食不得入故吐逆
丹 谨按难经云吸入肾与肝夫盈天地之间者一元之气也气之升者为阳气之降者为阴肾
足少阴也肝足厥阴也位居下主吸与入其所吸之气不能达肾至肝而还者此阴之弱也浮大之脉属阳见于寸者阳气偏盛阴不
得配之也为格主吐逆此无阴则呕谓见于尺者阴血不足阳往乘之也为关主不得小便此东垣滋肾丸之意趺阳胃脉气不宣血
不濡名曰关格主水谷不化与食不得入亦阳有余阴不足故有升而无降也何注文不之及而以邪气关格闭拒为言欤
趺阳脉伏而涩伏则吐逆水谷不化涩则食不得入名曰关格
成 伏则胃气伏而不宣中焦关格正气壅塞故吐逆而水谷不化涩则脾气涩而不布邪气拒于上焦故食不得入有妇人
病吐逆大小便不通烦乱四逆渐无脉一日与大承气汤二盏至半夜渐得大便烦乱触逆耳脉渐生翌日乃安即此是关格也宜审之
脉浮而大浮为风虚大为气强风气相搏必成瘾疹身体为痒痒者名泄风久久为痂癞
成 痂癞者眉少发稀身有干疮而腥臭内经曰脉风成为疠
寸口脉弱而迟弱者卫气微迟者荣中寒荣为血血寒则发热卫为气气微者心内饥饥而虚满不能食也
成 卫为阳荣为阴弱者卫气微阳气不足也迟者荣中寒经中客邪也荣客寒邪搏而发热也阳气内微心内虽饥饥而虚
满不能食也缓迟与弱迟虽止一字之差却有千里之谬成氏不合注而分解无怪其上下不相同也
趺阳脉大而紧者当即下利为难治
成 大为虚紧为寒胃中虚寒当即下利下利脉当微小反紧者邪胜也故云难治经曰下利脉大者为未止大为实大为虚
上下纷纷更易不一者只要识得虚者正气虚实者邪气实之义以上以脉知病
寸口脉弱而缓弱者阳气不足缓者胃气有余噫而吞酸食卒不下气填于膈上也
成 弱者阳气不足阳能消谷阳气不足则不能消化谷食缓者胃气有余则胃中有未消谷物也故使噫而吞酸食卒不下
气填于膈上也金匮要略曰中焦未和不能消谷故令噫弱缓与迟缓亦不同
趺阳脉紧而浮浮为气紧为寒浮为腹满紧为绞痛浮紧相搏肠鸣而转转即气动膈气乃下少阴脉不出其阴肿大而虚也
成 浮为胃气虚紧为脾中寒胃虚则满脾寒则痛虚寒相搏肠鸣而转转则膈中之气因而下泄也若少阴脉不出则虚寒
之气至于下焦结于少阴而聚于阴器不得发泄使阴肿大而虚也
寸口脉微而涩微者卫气不行涩者荣气不足荣卫不能相将三焦无所仰身体痹不仁荣气不足则烦疼口难言卫气虚则恶
寒数欠三焦不归其部上焦不归者噫而酢吞中焦不归者不能消谷引食下焦不归者则遗溲
成 夫养三焦者血也护三焦者气也荣卫俱损不能相将而行三焦无所根据仰身体为之顽痹而不仁内经曰荣气虚则不
仁针经曰卫气不行则为不仁荣为血血不足则烦疼荣属心荣弱心虚则口难言卫为阳阳微则恶寒卫为气虚则数欠三焦因荣卫
不足无所根据仰其气不能归其部金匮要略曰上焦竭善噫上焦受中焦气中焦未和不能消谷故令噫耳下焦竭即遗溺失便以上
焦在膈上物未化之分也不归者不至也上焦之气不至其部则物未能传化故噫而诈吞中焦在胃之中主腐熟水谷水谷化则思
食中焦之气不归其部则水谷不化故云不能消谷引食下焦在膀胱上口主分别清浊溲小便也下焦不归其部不能约制溲便故
遗溲三焦病各分其证自有三法存焉
趺阳脉沉而数沉为实数消谷紧者病难治
成 沉为实者沉主里也数消谷者数为热也紧为肝脉见于脾部木来克土为鬼贼相刑其病故云难治按紧与弦当有分
别恐未可便以紧为弦也首卷曰弦则为减金匮要略曰脉紧如转索无常者有宿食也以义求之则弦为虚而紧为实也
寸口脉微而涩微者卫气衰涩者荣气不足卫气衰面色黄荣气不足面色青荣为根卫为叶荣卫俱微则根叶枯槁而寒栗咳
逆唾腥吐涎沫也
子能令母虚肺主气气虚则脾色见于面而黄心主血血衰则肝色见于面而青肺臭腥脾液涎也荣虚则寒栗卫虚则咳逆
趺阳脉浮而芤浮者卫气衰芤者荣气伤其身体瘦肌肉甲错浮芤相搏宗气衰微四属断绝
成 经曰卫气盛名曰高高者暴狂而肥荣气盛名曰章章者暴泽而光其身体瘦而不肥者卫气衰也肌肉甲错而不泽者
荣
气伤也宗气者三焦归气也四属者皮肉脂髓也荣卫衰伤则宗气亦微四属失所滋养致断(绝矣)
寸口脉微而缓微者卫气疏疏则其肤空缓者胃气实实则谷消而水化也谷入于胃脉道乃行而入于经其血乃成荣盛则其
肤必疏三焦绝经名曰血崩
成 卫为阳微为亡阳脉微者卫气疏卫温分肉肥凑理卫气既疏皮肤不得温肥则空虚也经曰缓者胃气有余有余为实
故
云缓者胃气实内经曰食入于胃淫经于脉是谷入于胃脉道乃行也针经曰饮而液渗于络合和于血是水入于经其血乃成也胃
中谷消水化而为血气今卫疏荣盛是荣气强而卫气弱也卫气弱者外则不能固密皮肤而气为之疏内则不能卫护其血而血为
之崩经常也三焦者气之道路卫气疏则气不循常度三焦绝其常度也按经文曰而入于经则而字乃承上文谷字水亦在其中矣
注引针经水入于经乃是互文以见意仲景独重于谷故用而字若欠理会则血为水所化也岂理也哉玩合和于三字则成氏之说
欠明
趺阳脉微而紧紧则为寒微则为虚微紧相搏则为短气
成 中虚且寒气自短矣
少阴脉弱而涩弱者微烦涩者厥逆
成 烦者热也少阴脉弱者阴虚也阴虚则发热以阴部见阳脉非大虚也故生微烦厥逆者四肢冷也经曰阴阳不相顺接
便
为厥厥者手足厥冷是也少阴脉涩者阴气涩不能与阳相顺而接故厥逆也此 不当作二证
趺阳脉不出脾不上下体冷肤硬
成 脾胃为荣卫之根脾能上下则水谷消磨荣卫之气得以行脾气虚衰不能上下则荣卫之气不得通荣于外故趺阳脉
不
出身冷者卫气不温也肤硬者荣血不濡也
少阴脉不至肾气微少精血奔气促迫上入胸膈宗气反聚血结心下阳气退下热归阴股与阴相动令身不仁此为尸厥当刺
期门巨阙
成 尸厥者为其从厥而生形无所知其状若尸故名尸厥少阴脉不出则厥气客于肾而肾气微少精血厥气上奔填塞胸
膈
壅遏阳气使宗气反聚而血结心下针经曰五谷入于胃其糟粕津液宗气分为三隧宗气积于胸中出于喉咙以贯心肺而行呼吸
又曰荣气者泌其津液注之于脉化而为血以荣四末今厥气太甚宗气反聚而不行则绝其呼吸血结心下而不流则四体不仁阳
气为厥气所拥不能宣发退下至阴股问与阴相动仁者柔也不仁者言不柔和也为寒热痛痒俱不觉知者也阳气外不为使内不
得通荣卫俱不能行身体不仁状若尸也内经曰厥气上行满脉去形刺期门者以通心下结血刺巨阙者以行胸中宗气血气流通
厥气退则苏矣
寸口脉微尺脉紧其人虚损多汗知阴常在绝不见阳也
成 寸微为亡阳尺紧为阴胜阳微阴胜故云虚损又加之多汗则愈损阳气是阴常在而绝不见阳也
(原文)前来不见此证今乃变异是名灾怪又问曰何缘作此吐利答曰或有旧时服药今乃发作故名灾怪耳
成无己注:医生根据脉象和症状与处方相对,却反而出现变异,因其怪异可惊,所以称为“灾怪”。从三菽、六菽的诊脉深度到灾怪的脉象,共有五段内容,都是关于延医问诊的方法。
(原文)问曰东方肝脉其形何似师曰肝者木也名厥阴其脉微弦濡弱而长是肝脉也肝病自得濡弱者愈也
成无己注:《难经》说:春脉呈弦象,是因为肝属东方木。万物初生,尚未长出枝叶,所以脉来濡弱而长,因此称为弦。这是肝的正常脉象。肝病若见到这种脉象,说明肝气已经调和。
(原文)假令得纯弦脉者死何以知之以其脉如弦直是肝脏伤故知死也
成无己注:所谓纯弦脉,是指脉象像琴弦一样挺直而不柔软,这是中无胃气的真脏脉。《内经》说:死亡的肝脉,来势急迫且强劲,如同新拉开的弓弦。
(原文)南方心脉其形何似师曰心者火也名少阴其脉洪大而长是心脉也心病自得洪大者愈也
成无己注:心王于夏季,夏季阳气外盛,气血涌溢,所以脉来洪大而长。
(原文)假令脉来微去大故名反病在里也脉来头小本大者故名覆病在表也上微头小者则汗出下微本大者则为关格不通不得尿头无汗者可治有汗者死
成无己注:心脉来势盛大、去势衰减为平脉;来势微弱、去势盛大称为“反”,病在里。《内经》说:脉大表示邪气至,脉小表示平和,脉微表示正气虚,脉大表示邪气盛。通过“来”候表,“来微”可知表气和平;通过“去”候里,“去大”可知里有病。《内经》说:心脉来不盛,去反而盛,这叫“不及”,病在中。“头小本大”即前小后大。小为正气,大为邪气,邪气先在里,现在又返回到表,所以称为“覆”。不说“去”而只说“来”,是知道病在表。《脉经》说:上部为表,下部为里。汗是心的液。上部脉微,轻取而微;头小即前小,表示表气虚,所以主汗出。下部脉微,重取而微;本大即后大,重取则在里,大表示病进。《内经》说:心为牡脏,小肠为之使。现在邪气甚盛下行,格闭小肠,使正气不通,所以不得小便,称为“关格”。《脉经》说:阳气上越,汗见于头。现在关格正气不通,加上头部有汗,则是阳气不能下行而上脱。若无汗者,虽然患关格,但阳气未衰,还可以治疗。
(原文)西方肺脉其形何似师曰肺者金也名太阴其脉毛浮也肺病自得此脉若得缓迟者皆愈若得数者则剧何以知之数者南方火火克西方金法当痈肿为难治也
成无己注:轻虚浮称为“毛”,是肺的正常脉象。缓迟是脾的脉象,脾为肺之母,以子母相生关系,所以说都能痊愈。数是心的脉象,火克金,为鬼贼相刑,所以病情加重。肺主皮毛,数为热,热邪客于皮肤停留不去,就会形成痈疡。经文说:数脉不时发作者,会生恶疮。
(原文)问曰二月得毛浮脉何以言至秋当死师曰二月之时脉当濡弱反得毛浮者故知至秋死二月肝用事肝脉属木应濡弱反得毛浮者是肺脉也肺属金金来克木故知至秋死他皆仿此
成无己注:在春季应当见到秋季的脉象,这是金气来克木。肺来克肝,夺取旺脉而显现,到了秋天肺旺肝气绝,所以知道到秋天会死。其他情况都依此类推。
(原文)师曰脉肥人责沉瘦人责沉肥人当沉今反浮瘦人当浮今反沉故责之
成无己注:肥胖之人肌肤厚实,其脉应当沉;消瘦之人肌肤薄,其脉应当浮。现在肥胖人的脉反而浮,消瘦人的脉反而沉,必定有邪气干扰使脉反常,所以应当追究原因。
(原文)师曰寸脉下不至关为阳绝尺脉上不至关为阴绝此皆不治决死也若计其余命死生之期期以月节克之也
成无己注:《脉经》说:阳生于寸,动于尺;阴生于尺,动于寸。寸脉向下不到关部,是阳绝,不能下应于尺;尺脉向上不到关部,是阴绝,不能上应于寸。《内经》说:阴阳离决,精气乃绝。这里阴阳偏绝,所以都主死。推算死期的方法是依据月令节气相克的关系。例如阳绝死于春夏,阴绝死于秋冬。
(原文)师曰脉病患不病名曰行尸以无旺气卒眩仆不识人者短命则死人病脉不病名曰内虚以有谷神虽困无苦
成无己注:脉是人体根本。脉象与病症不符(脉象正常而病人危重),为根本内部断绝,形体虽然暂时强壮,但突然气脱则会眩晕僵仆而死,不叫“行尸”叫什么?人患病而脉象正常,为根本内部坚固,形体虽然瘦弱,只是内部虚弱而已。“谷神”指谷气,谷气充足自然安泰。《内经》说:形气有余,脉气不足,死;脉气有余,形气不足,生。
(原文)问曰翕奄沉名曰滑何谓也沉为纯阴翕为正阳阴阳和合故令脉滑关尺自平阳明脉微沉食饮自可少阴脉微滑滑者紧之浮名也此为阴实其人必股内汗出阴下湿也
成无己注:脉来大而盛,聚而沉,称为“翕奄沉”,正如珠子转动般的状态。沉为脏气,所以叫纯阴;翕为腑气,所以叫正阳。滑脉是阴阳之气不相偏胜。关尺脉自平。阳明脉微沉,应当在阳部见到阴脉,则阴偏胜而阳不足。阳明胃脉,胃中阴多,所以饮食正常。少阴脉微滑,应当在阴部见到阳脉,则阳偏胜而阴不足。以阳凑近阴分,所以叫阴实。股部和阴器是少阴的部位。现在阳热凑近阴分,必然熏蒸津液,泄达于外,所以大腿内侧出汗,阴部下潮湿。
(原文)许叔重注:沉为纯阴,翕为正阳,阴阳和合,所以名叫滑。古人论述滑脉,虽然说往来前后流利,宛转替替然,与数脉相似,但张仲景这三句话就足够了。按“翕奄沉”三个字形容“滑”字最好。夫“翕”是合,“奄”是忽。当脉气合聚而盛的时候,忽然之间就已经沉去,这就叫滑。张仲景恐怕人们误认滑脉为沉脉,所以下文又说:“滑者紧之浮名也。”说沉说浮,看似不同实则相同,更需要智慧理解。看上文“紧者如转索无常也”一句,就知道这里的“浮”是转索无常之浮,不是轻手便有的常浮之名;“沉”是翕奄之沉,不是重取才得到的定沉之说。张仲景用字具有史家笔法,不可草率看过。所以赵嗣真说:“今人不解作秦汉文本观,可谓善读仲景之书矣。”
(原文)问曰曾为人所难紧脉从何而来师曰假令亡汗若吐以肺里寒故令脉紧也假令咳者坐饮冷水故令脉紧也假令下利以胃中虚冷故令脉紧也
阳舒缓阴缩急阴化为寒揪然收敛气血以坚其为脉也宁得不急经曰紧脉带数如切绳状一曰如转索无常故有寒则见
寸口卫气胜名曰高
寸口通关尺而言高谓脉来浮而有力卫气主表浮以候之其体在上今浮中有力是卫气盛也以其在上故谓之高有升而不降之义焉
荣气盛名曰章
章明也条也往来分明有条理也今滑脉为血实之诊殆近是乎
高章相搏名曰纲
纲总也以荣卫俱盛故谓之总
卫气弱名曰
举之濡弱恍惚故谓之
荣气弱名曰卑
荣主血为阴按以候之其脉沉而无力故谓之卑
卑相搏名曰损
卑相搏阴阳俱虚总谓之损举按俱无力也
卫气和名曰缓
缓为胃脉胃合卫气卫气和故见缓脉
荣气和名曰迟
迟为脾脉脾合荣气荣气和故见迟脉
迟缓相搏名曰强
荣卫俱和故迟缓相搏不亦强乎
寸口脉缓而迟缓则阳气长其色鲜其颜光其声商毛发长迟则阴气盛骨髓生血满肌肉紧薄鲜硬阴阳相抱荣卫俱行刚柔相搏名曰强也
此释上一句之义此为平脉非病脉也
成无己注:紧脉带有数象,如切绳状,一说如转索无常。所以有寒邪则见紧脉。
寸口卫气胜,名叫“高”。寸口通指关、尺而言,“高”指脉来浮而有力。卫气主表,浮取以候之,其体在上。现在浮取中取都有力,是卫气盛。因为位置在上,所以叫高,有升而不降的意思。
荣气盛,名叫“章”。章,明也,条理也。往来分明有条理。现在的滑脉作为血实的诊断,大概接近这个意思。
高与章相搏,名叫“纲”。纲,总也。因为荣卫都盛,所以叫总。
卫气弱,名叫“...(原文此处缺字,据上下文推测可能为‘弱’或类似描述,译文保留空缺或意译)”。举之濡弱恍惚,所以叫...(同上)。
荣气弱,名叫“卑”。荣主血为阴,按取以候之,其脉沉而无力,所以叫卑。
卑相搏,名叫“损”。卑相搏,阴阳俱虚,总称为损。举按都无力。
卫气和,名叫“缓”。缓为胃脉,胃合卫气,卫气和所以见缓脉。
荣气和,名叫“迟”。迟为脾脉,脾合荣气,荣气和所以见迟脉。
迟缓相搏,名叫“强”。荣卫都和谐,所以迟缓相搏,不也是强吗?
寸口脉缓而迟,迟则阳气长,其面色鲜艳,容颜光亮,声音如商音,毛发长。迟则阴气盛,骨髓生,血满,肌肉紧薄鲜艳坚硬。阴阳相抱,荣卫俱行,刚柔相搏,名叫“强”。
这是解释上一句的含义。这是平脉,不是病脉。
(Original) Previously, this syndrome was not seen; now it has changed, which is called "Zai Guai" (Disaster and Wonder). Another question asked: What is the reason for this vomiting and diarrhea? The answer is: Perhaps there was medication taken in the past, which is now taking effect, hence it is named "Zai Guai".
Cheng Wuji's Commentary: When a physician matches pulse and symptoms with a prescription but encounters unexpected variations, it is considered strange and wondrous, thus termed "Zai Guai". From the depth of three beans to six beans down to the pulse of Zai Guai, there are five sections in total, all pertaining to the methods of consulting physicians.
(Original) Question: What does the liver pulse of the East look like? Master said: The Liver is Wood, named Jueyin. Its pulse is slightly wiry, soft, weak, and long. This is the liver pulse. If a patient with liver disease naturally presents with a soft and weak pulse, they will recover.
Cheng Wuji's Commentary: *Nan Jing* states: The spring pulse is wiry because the Liver belongs to the East and Wood. When all things begin to grow, they have not yet developed branches and leaves, so the pulse comes in as soft, weak, and long; therefore, it is called wiry. This is the normal pulse of the Liver. If a patient with liver disease presents with this pulse, it indicates that the Liver Qi has harmonized.
(Original) Suppose one obtains a purely wiry pulse, death ensues. How do we know this? Because the pulse is straight like a string, indicating injury to the Liver organ, hence we know death will occur.
Cheng Wuji's Commentary: A purely wiry pulse refers to a pulse that is straight like a string without flexibility. This indicates the absence of Stomach Qi and represents the True Visceral Pulse. *Nei Jing* states: The dying liver pulse arrives urgently and forcefully, like a newly drawn bowstring.
(Original) Question: What does the heart pulse of the South look like? Master said: The Heart is Fire, named Shaoyin. Its pulse is surging, large, and long. This is the heart pulse. If a patient with heart disease naturally presents with a surging and large pulse, they will recover.
Cheng Wuji's Commentary: The Heart governs Summer. In Summer, Yang Qi prevails externally, causing Qi and Blood to surge and overflow; thus, the pulse arrives surging, large, and long.
(Original) Suppose the pulse arrives slightly and departs largely; this is called "Fan" (Reverse), and the disease is in the interior. If the pulse head is small and the root is large, this is called "Fu" (Cover), and the disease is in the exterior. If the upper part is slight and the head small, sweating occurs. If the lower part is slight and the root large, it is "Guan Ge" (Obstruction and Rejection), leading to inability to urinate. If the head has no sweat, it is treatable; if the head has sweat, death ensues.
Cheng Wuji's Commentary: A heart pulse arriving vigorously and departing weakly is a normal pulse. Arriving weakly and departing largely is "Fan," indicating interior disease. *Nei Jing* states: Large indicates pathogenic Qi, small indicates peace, slight indicates healthy Qi deficiency, and large indicates pathogenic abundance. Observing the "arrival" assesses the exterior; a slight arrival indicates exterior harmony. Observing the "departure" assesses the interior; a large departure indicates interior disease. *Nei Jing* states: If the heart pulse does not arrive strongly but departs strongly, this is "Bu Ji" (Insufficiency), and the disease is in the center. "Head small, root large" means anterior small and posterior large. Small represents healthy Qi, large represents pathogenic Qi. Since pathogenic Qi was initially in the interior and now returns to the exterior, it is called "Fu." The text mentions only "arrival" to indicate the disease is in the exterior. *Mai Jing* states: Upper is exterior, lower is interior. Sweat is the fluid of the Heart. An upper slight pulse, felt lightly as slight, and a small head (anterior small) indicate deficiency of Qi in the exterior, hence governing sweating. A lower slight pulse, felt heavily as slight, and a large root (posterior large) indicate heaviness in the interior, where large signifies disease progression. *Nei Jing* states: The Heart is a Yang Zang, and the Small Intestine is its envoy. Now, pathogenic Qi is severe and moves downward, obstructing the Small Intestine, preventing the smooth flow of healthy Qi, hence the inability to urinate, termed "Guan Ge." *Mai Jing* states: When Yang Qi floats upward, sweat appears on the head. Now, with Guan Ge blocking healthy Qi, plus sweating on the head, it indicates Yang Qi cannot descend and instead escapes upward. If there is no sweat, although suffering from Guan Ge, Yang Qi has not yet declined, and it is still treatable.
(Original) Question: What does the lung pulse of the West look like? Master said: The Lung is Metal, named Taiyin. Its pulse is floating like hair. If a patient with lung disease naturally presents with this pulse, or a slow and delayed pulse, they will recover. If they present with a rapid pulse, the condition will worsen. How do we know? Rapid is associated with the South and Fire. Fire overcomes Metal in the West. According to the method, this should lead to carbuncles and be difficult to treat.
Cheng Wuji's Commentary: Light, void, and floating is called "Mao" (Hair), which is the normal pulse of the Lung. Slow and delayed is the pulse of the Spleen. As the Mother of the Lung, through the mutual generation of mother and child, recovery is indicated. Rapid is the pulse of the Heart. Fire overcoming Metal constitutes "Gui Zei" (Ghost Thief) punishment, hence the worsening. The Lung governs skin and hair. Rapid indicates heat. Heat lodging in the skin and remaining causes carbuncles and ulcers. The classic states: If a rapid pulse occurs intermittently, malignant sores will arise.
(Original) Question: Why is it said that obtaining a Mao-Floating pulse in the second month predicts death by autumn? Master said: In the second month, the pulse should be soft and weak. Obtaining a Mao-Floating pulse instead indicates death by autumn. In the second month, the Liver is active. The Liver pulse belongs to Wood and should be soft and weak. Obtaining a Mao-Floating pulse instead indicates the Lung pulse. The Lung belongs to Metal, and Metal overcomes Wood; hence, death by autumn is predicted. Other cases follow this pattern.
Cheng Wuji's Commentary: Seeing an Autumn pulse during Spring indicates Metal Qi coming to overcome Wood. The Lung (Metal) overcomes the Liver (Wood), seizing the vigorous pulse. By Autumn, when the Lung is prosperous and Liver Qi exhausted, death occurs. Other scenarios follow this logic.
(Original) Master said: For obese people, the pulse should be deep; for thin people, the pulse should be deep [Note: Text says 'shen' twice, likely error in source or context implies shallow/floating for thin]. Obese people should have a deep pulse; now it is floating. Thin people should have a floating pulse; now it is deep. Therefore, we investigate this anomaly.
Cheng Wuji's Commentary: Obese individuals have thick skin and flesh, so their pulse should be deep. Thin individuals have thin skin, so their pulse should be floating. Now, the obese person's pulse is unexpectedly floating, and the thin person's pulse is unexpectedly deep. There must be pathogenic interference causing this abnormality, so the cause must be investigated.
(Original) Master said: If the Cun pulse does not reach the Guan position downwards, it is Yang Extinction. If the Chi pulse does not reach the Guan position upwards, it is Yin Extinction. Both are untreatable and certain death. If calculating the remaining lifespan and time of death, it is determined by the monthly solar terms overcoming each other.
Cheng Wuji's Commentary: *Mai Jing* states: Yang originates at Cun and moves at Chi; Yin originates at Chi and moves at Cun. If the Cun pulse does not extend down to Guan, Yang is extinct and cannot resonate with Chi. If the Chi pulse does not extend up to Guan, Yin is extinct and cannot resonate with Cun. *Nei Jing* states: When Yin and Yang separate, Essence and Qi perish. Here, Yin and Yang are partially extinct, hence certain death. The timing of death is calculated based on the overcoming relationship of monthly solar terms. For example, Yang Extinction leads to death in Spring/Summer, and Yin Extinction in Autumn/Winter.
(Original) Master said: When the pulse fits the disease but the body does not show signs of illness, it is called "Xing Shi" (Walking Corpse) due to the lack of vigorous Qi. Sudden dizziness, collapse, and unconsciousness indicate short life and death. When the body shows disease but the pulse does not, it is called "Nei Xu" (Internal Deficiency) because there is "Gu Shen" (Grain Spirit). Although distressed, there is no suffering.
Cheng Wuji's Commentary: The pulse is the root of human life. When the pulse contradicts the disease state (pulse normal while patient is critical), the internal root is severed. Although the form may temporarily appear strong, sudden Qi depletion leads to dizziness, collapse, and death—hence "Walking Corpse." When a person is ill but the pulse remains normal, the internal root is solid. Though the form is emaciated, it is merely internal deficiency. "Gu Shen" refers to Grain Qi. Once Grain Qi is sufficient, one is naturally at peace. *Nei Jing* states: Excess Form/Qi with deficient Pulse Qi leads to death; excess Pulse Qi with deficient Form Qi leads to survival.
(Original) Question: What is meant by "Xi Yan Chen" being called "Hua" (Slippery)? Answer: Chen (Deep) is Pure Yin, Xi (Surface/Closing) is Correct Yang. The harmony of Yin and Yang creates the Slippery pulse. The Guan and Chi positions are naturally balanced. If the Yangming pulse is slightly deep, food and drink are manageable. If the Shaoyin pulse is slightly slippery, "Hua" is the floating name of "Jin" (Tight). This is Yin Solidity. The person will surely have sweat inside the thighs and dampness below the yin.
Cheng Wuji's Commentary: A pulse that is large and vigorous, gathering and deepening, is called "Xi Yan Chen," resembling rolling pearls. Deep represents Visceral Qi, hence Pure Yin. Xi represents Fu Qi, hence Correct Yang. Slipperiness indicates Yin and Yang Qi do not overpower each other. Guan and Chi are balanced. A slightly deep Yangming pulse suggests Yin predominance in the Yang region, meaning Yang insufficiency. In the Stomach (Yangming), excessive Yin allows for normal appetite. A slightly slippery Shaoyin pulse suggests Yang predominance in the Yin region, meaning Yin insufficiency. Yang approaching Yin is called "Yin Shi" (Yin Solidity). The thigh and yin area belong to Shaoyin. Now, Yang-Heat approaches Yin, steaming fluids outward, causing thigh sweating and genital dampness.
Xu Shuzhong's Commentary: Deep is Pure Yin, Xi is Correct Yang; their harmony makes it Slippery. Ancients described the Slippery pulse as flowing smoothly back and forth, similar to a Rapid pulse. However, Zhang Zhongjing's three words suffice. "Xi Yan Chen" best describes "Hua." "Xi" means combining; "Yan" means suddenly. When Qi gathers and becomes vigorous, it suddenly sinks away—this is Slippery. Zhang Zhongjing feared people would mistake Slippery for Deep, so he added: "Hua is the floating name of Jin." Saying Deep and Floating seems different but is the same; wisdom is required. Looking at "Jin is like turning cords unpredictably," we know this "Floating" is unpredictable, not the light-touch constant floating. This "Deep" is the Xi-Yan Deep, not the heavy-touch fixed Deep. Zhang's wording is precise like a historian's brush; do not read carelessly. Zhao Sizhen said: "Modern people fail to read it as Qin-Han texts; this is truly reading Zhongjing well."
(Original) Question: I have been challenged by others: Where does the Tight pulse come from? Master said: Suppose there is loss of sweat or vomiting due to Cold in the Lung interior, causing a Tight pulse. Suppose coughing results from drinking cold water, causing a Tight pulse. Suppose diarrhea results from deficiency-cold in the Stomach, causing a Tight pulse.
Yang relaxes, Yin contracts and tightens; Yin transforms into Cold, contracting Qi and Blood firmly, making the pulse urgent. How can it not be urgent? The Classic states: The Tight pulse carries Rapidness, like cutting a rope, or like turning cords unpredictably. Thus, Cold presents with Tightness.
Cun Kou Wei Qi Excess is named "Gao" (High).
"Cun Kou" refers to the whole pulse area. "Gao" means the pulse arrives floating and forceful. Wei Qi governs the exterior; floating pulse assesses it. Its nature is upper. Now, floating and middle-layer palpation show forcefulness, indicating Wei Qi excess. Being upper, it is called High, implying rising without descending.
Ying Qi Excess is named "Zhang" (Manifest/Clear).
Zhang means clear and orderly. Coming and going distinctly with order. The current Slippery pulse as a diagnosis of Blood Excess is close to this.
Gao and Zhang interacting is named "Gang" (Net/Ridgepole).
Gang means summary. Since both Ying and Wei are excess, it is called Summary.
Wei Qi Weakness is named ... (Text missing character, likely 'Ruo' or similar).
Lifting reveals soft, weak, and vague qualities, hence named ...
Ying Qi Weakness is named "Bei" (Low/Humble).
Ying governs Blood and is Yin; pressing assesses it. The pulse is deep and powerless, hence named Bei.
Bei interacting is named "Sun" (Damage/Loss).
Bei interaction means both Yin and Yang are deficient, collectively called Sun. Lifting and pressing are both powerless.
Wei Qi Harmony is named "Huan" (Slow/Relaxed).
Huan is the Stomach pulse; Stomach combines with Wei Qi. Wei Qi harmony shows Huan pulse.
Ying Qi Harmony is named "Chi" (Delayed/Slow).
Chi is the Spleen pulse; Spleen combines with Ying Qi. Ying Qi harmony shows Chi pulse.
Huan and Chi interacting is named "Qiang" (Strong).
Since Ying and Wei are both harmonious, Huan and Chi interact; is this not Strong?
Cun Kou pulse is Huan and Chi. Chi means Yang Qi grows. Complexion is fresh, face radiant, voice sounds like Shang, hair grows long. Chi means Yin Qi prospers, marrow generates, blood fills, muscles become tight, thin, fresh, and hard. Yin and Yang embrace, Ying and Wei move together, Hard and Soft interact, named "Qiang" (Strong).
This explains the previous sentence. This is a Normal Pulse, not a Disease Pulse.
Cheng Wuji's Commentary: Tight pulse carries Rapidness, like cutting a rope, or like turning cords unpredictably. Thus, Cold presents with Tightness.
Wei Qi Excess at Cun Kou is named "Gao." "Gao" refers to the pulse arriving floating and forceful. Wei Qi governs the exterior; floating pulse assesses it. Its location is upper. Now, floating and middle palpation are forceful, indicating Wei Qi excess. Being upper, it is called High, implying rising without descending.
Ying Qi Excess is named "Zhang." Zhang means clear and orderly. Coming and going distinctly with order. The current Slippery pulse as a diagnosis of Blood Excess is close to this.
Gao and Zhang interacting is named "Gang." Gang means summary. Since both Ying and Wei are excess, it is called Summary.
Wei Qi Weakness is named ... (Text missing). Lifting reveals soft, weak, and vague qualities, hence named ...
Ying Qi Weakness is named "Bei." Ying governs Blood and is Yin; pressing assesses it. The pulse is deep and powerless, hence named Bei.
Bei interacting is named "Sun." Bei interaction means both Yin and Yang are deficient, collectively called Sun. Lifting and pressing are both powerless.
Wei Qi Harmony is named "Huan." Huan is the Stomach pulse; Stomach combines with Wei Qi. Wei Qi harmony shows Huan pulse.
Ying Qi Harmony is named "Chi." Chi is the Spleen pulse; Spleen combines with Ying Qi. Ying Qi harmony shows Chi pulse.
Huan and Chi interacting is named "Qiang." Since Ying and Wei are both harmonious, Huan and Chi interact; is this not Strong?
Cun Kou pulse is Huan and Chi. Chi means Yang Qi grows. Complexion is fresh, face radiant, voice sounds like Shang, hair grows long. Chi means Yin Qi prospers, marrow generates, blood fills, muscles become tight, thin, fresh, and hard. Yin and Yang embrace, Ying and Wei move together, Hard and Soft interact, named "Qiang."
This explains the previous sentence. This is a Normal Pulse, not a Disease Pulse.