素问·脉要精微论 Discourse on the Essentials and Subtleties of the Pulse
黄帝问曰：诊法何如。歧伯对曰：诊法常以平旦，阴气未动，阳气未散，饮食未进，经脉未盛，络脉调匀，气血未乱，故乃可诊有过之脉。切脉动静而视精明，察五色，观五藏有馀不足，六府强弱，形之盛衰，以此参伍决死生之分。
夫脉者，血之府也，长则气治，短则气病，数则烦心，大则病进，上盛则气高，下盛则气胀，代则气衰，细则气少，涩则心痛，浑浑革至如涌泉，病进而色弊，緜緜其去如弦绝，死。夫精明五色者，气之华也。赤欲如白裹朱，不欲如赭；白欲如鹅羽，不欲如盐；青欲如苍璧之泽，不欲如蓝；黄欲如罗裹雄黄，不欲如黄土；黑欲如重漆色，不欲如地苍。五色精微象见矣，其寿不久也。夫精明者，所以视万物，别白黑，审短长。以长为短，以白为黑，如是则精衰矣。
藏者，中之守也，中盛藏满，气胜伤恐者，声如从室中言，是中气之湿也。言而微，终日乃复言者，此夺气也。衣被不敛，言语善恶，不避亲踈者，此神明之乱也。仓廪不藏者，是门户不要也。水泉不止者，是膀胱不藏也。得守者生，失守者死。夫五藏者，身之强也，头者精明之府，头倾视深，精神将夺矣。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。得强则生，失强则死。
歧伯曰：反四时者，有馀为精，不足为消。应太过，不足为精；应不足，有馀为消。阴阳不相应，病名曰关格。帝曰：脉其四时动柰何，知病之所在柰何，知病之所变奈何，知病乍在内柰何，知病乍在外奈何，请问此五者，可得闻乎。歧伯曰：请言其与天运转大也。万物之外，六合之内，天地之变，阴阳之应，彼春之暖，为夏之暑，彼秋之忿，为冬之怒，四变之动，脉与之上下，以春应中规，夏应中矩，秋应中衡，冬应中权。是故冬至四十五日，阳气微上，阴气微下；夏至四十五日，阴气微上，阳气微下。阴阳有时，与脉为期，期而相失，知脉所分，分之有期，故知死时。微妙在脉，不可不察，察之有纪，从阴阳始，始之有经，从五行生，生之有度，四时为宜，补写勿失，与天地如一，得一之情，以知死生。是故声合五音，色合五行，脉合阴阳，是知阴盛则梦涉大水恐惧，阳盛则梦大火燔灼，阴阳俱盛则梦相杀毁伤；上盛则梦飞，下盛则梦堕；甚饱则梦予，甚饥则梦取；肝气盛则梦怒，肺气盛则梦哭；短虫多则梦聚众，长虫多则梦相击毁伤。是故持脉有道，虚静为保。春日浮，如鱼之游在波；夏日在肤，泛泛乎万物有馀；秋日下肤，蛰虫将去；冬日在骨，蛰虫周密，君子居室。故曰：知内者按而纪之，知外者终而始之。此六者，持脉之大法。
心脉搏坚而长，当病舌卷不能言；其耎而散者，当消环自已。肺脉搏坚而长，当病唾血；其耎而散者，当病灌汗，至今不复散发也。肝脉搏坚而长，色不青，当病坠若搏，因血在胁下，令人喘逆；其耎而散色泽者，当病溢饮，溢饮者渴暴多饮，而易入肌皮肠胃之外也。胃脉搏坚而长，其色赤，当病折髀；其耎而散者，当病食痹。脾脉搏坚而长，其色黄，当病少气；其耎而散色不泽者，当病足䯒肿，若水状也。肾脉搏坚而长，其色黄而赤者，当病折腰；其耎而散者，当病少血，至今不复也。帝曰：诊得心脉而急，此为何病，病形何如。歧伯曰：病名心疝，少腹当有形也。帝曰：何以言之。歧伯曰：心为牡藏，小肠为之使，故曰少腹当有形也。帝曰：诊得胃脉，病形何如。歧伯曰：胃脉实则胀，虚则泄。
帝曰：病成而变何谓。歧伯曰：风成为寒热，瘅成为消中，厥成为巅疾，久风为飱泄，脉风成为疠，病之变化，不可胜数。帝曰：诸痈肿筋挛骨痛，此皆安生。歧伯曰：此寒气之肿，八风之变也。帝曰：治之奈何。歧伯曰：此四时之病，以其胜治之，愈也。帝曰：有故病五藏发动，因伤脉色，各何以知其久暴至之病乎。歧伯曰：悉乎哉问也。徵其脉小色不夺者，新病也；徵其脉不夺其色夺者，此久病也；徵其脉与五色俱夺者，此久病也；徵其脉与五色俱不夺者，新病也。肝与肾脉并至，其色苍赤，当病毁伤，不见血，已见血，湿若中水也。
尺内两傍，则季胁也，尺外以候肾，尺里以候腹中。附上左，外以候肝，内以候鬲；右，外以候胃，内以候脾。上附上右，外以候肺，内以候胸中；左，外以候心，内以候膻中。前以候前，后以候后。上竟上者，胸喉中事也；下竟下者，少腹腰股膝胫足中事也。
粗大者，阴不足阳有馀，为热中也。来疾去徐，上实下虚，为厥巅疾；来徐去疾，上虚下实，为恶风也。故中恶风者，阳气受也。有脉俱沈细数者，少阴厥也；沈细数散者，寒热也；浮而散者为眴仆。诸浮不躁者皆在阳，则为热，其有躁者在手。诸细而沈者皆在阴，则为骨痛；其有静者在足。数动一代者，病在阳之脉也，泄及便脓血。诸过者，切之，涩者阳气有馀也，滑者阴气有馀也。阳气有馀，为身热无汗，阴气有馀，为多汗身寒，阴阳有馀，则无汗而寒。推而外之，内而不外，有心腹积也。推而内之，外而不内，身有热也。推而上之，上而不下，腰足清也。推而下之，下而不上，头项痛也。按之至骨，脉气少者，腰脊痛而身有痹也。
Huangdi asked: What is the method of diagnosis? Qibo replied: The method of diagnosis should always be carried out at dawn, when the yin qi has not yet stirred and the yang qi has not yet dispersed, before food or drink has been taken, when the channels are not yet exuberant, the connecting vessels are even and regular, and the qi and blood are not yet in disorder — only then can one properly diagnose a pulse that has become abnormal. Feel the movement and stillness of the pulse, observe the clarity of the eyes, examine the five colors, note whether the five viscera show excess or insufficiency, whether the six bowels are strong or weak, and whether the body's form is flourishing or in decline; by weighing and correlating all of this, one determines the boundary between death and life.
Now the pulse is the storehouse of the blood: when it is long, the qi is well regulated; when it is short, the qi is diseased; when it is rapid, the heart is vexed; when it is large, the disease is advancing; when it is exuberant above, the qi rises high; when it is exuberant below, there is distension; when it is intermittent, the qi is failing; when it is fine, the qi is scanty; when it is rough, there is heart pain. When the pulse arrives turbid and forceful like a gushing spring, the disease is advancing and the complexion is ruined; when it departs faint and lingering as though a bowstring had snapped, death follows. The clarity of the eyes and the five colors are the outward bloom of the qi. Red should resemble white silk wrapped around cinnabar, not resemble ochre; white should resemble a goose feather, not resemble salt; green should resemble the lustrous sheen of a dark jade disc, not resemble indigo; yellow should resemble fine gauze wrapped around realgar, not resemble yellow earth; black should resemble layered lacquer, not resemble dull grey earth. When the subtle, failing form of the five colors becomes visible, the person's life will not be long. The clarity of the eyes is that by which one sees the myriad things, distinguishes white from black, and discerns short from long. If long is mistaken for short and white is mistaken for black, this shows that the essence is failing.
The viscera are the guardians of the interior. When the interior is overfull and the viscera are engorged, and the qi overwhelms the person so that he is fearful and distressed, his voice will sound as though he were speaking from inside a room — this is dampness in the internal qi. When speech is faint and the person can only speak again after a whole day has passed, this is qi that has been lost. When a person cannot keep his clothes and coverings gathered about him, and speaks indiscriminately of good and bad without regard for kin or stranger, this is derangement of the spirit and its clarity. When the granary cannot store what is given to it, this is because its gate does not hold firm. When the water spring does not stop, this is because the bladder cannot store. One who retains this guarding power lives; one who loses it dies. The five viscera are the strength of the body. The head is the storehouse of clarity and essence; when the head hangs low and the gaze sinks inward, the essence and spirit are about to be lost. The back is the storehouse of the chest; when the back is bent and the shoulders droop, that storehouse is about to collapse. The waist is the storehouse of the kidney; when a person can no longer turn and sway it, the kidney is about to be exhausted. The knees are the storehouse of the sinews; when a person can no longer bend and extend them, and walks stooped and leaning on support, the sinews are about to be exhausted. The bones are the storehouse of the marrow; when a person can no longer stand for long, and walking brings on trembling and shaking, the bones are about to be exhausted. If this strength is retained, one lives; if it is lost, one dies.
Qibo said: When the pulse runs contrary to the four seasons, an excess where there should be little is called essence-excess, and an insufficiency where there should be abundance is called dissipation. Where there should be excess but there is instead insufficiency, this too is called essence-excess; where there should be insufficiency but there is instead excess, this too is called dissipation. When yin and yang fail to correspond properly to each other, the disease is named blockage and rejection. Huangdi said: How does the pulse move together with the four seasons? How does one know where a disease is located? How does one know how a disease will change? How does one know when a disease has suddenly moved to the interior, and how does one know when it has suddenly moved to the exterior? I wish to ask about these five matters — may I hear your explanation? Qibo said: Let me speak of how the pulse turns together with the great workings of heaven. Beyond the myriad things and within the six directions, amid the changes of heaven and earth and the responses of yin and yang: the warmth of spring becomes the heat of summer, and the sternness of autumn becomes the fury of winter. The pulse rises and falls together with these four transformations: in spring it corresponds to the compass, in summer to the carpenter's square, in autumn to the balance beam, and in winter to the steelyard weight. Therefore, forty-five days after the winter solstice, yang qi begins to rise slightly and yin qi begins to descend slightly; forty-five days after the summer solstice, yin qi begins to rise slightly and yang qi begins to descend slightly. Yin and yang have their proper times, which correspond to the pulse as to a fixed schedule; when the schedule and the pulse fail to match, one can know how the pulse has diverged, and since this divergence has its own timing, one can thereby know the time of death. The subtlety lies in the pulse, and it must never go unexamined. Examining it has its guiding principles: begin from yin and yang; this beginning has its regularity, arising from the five phases; this arising has its measure, suited to the four seasons. In supplementing and draining, never lose sight of this, and be as one with heaven and earth. Grasping the sense of this oneness, one can thereby know death and life. Thus the voice corresponds to the five notes, the complexion corresponds to the five phases, and the pulse corresponds to yin and yang. From this we know: when yin is exuberant, one dreams of wading through great waters in terror; when yang is exuberant, one dreams of great fires blazing; when yin and yang are both exuberant, one dreams of killing and mutual injury. When qi is exuberant above, one dreams of flying; when exuberant below, one dreams of falling. When extremely full from eating, one dreams of giving things away; when extremely hungry, one dreams of taking things. When liver qi is exuberant, one dreams of anger; when lung qi is exuberant, one dreams of weeping. When short parasites abound, one dreams of crowds gathering; when long parasites abound, one dreams of fighting and mutual injury. Therefore there is a proper way to hold the pulse: emptiness and stillness of mind are what preserve its accuracy. In spring the pulse floats, like a fish swimming beneath the waves; in summer it lies at the skin, brimming over as though the myriad things had abundance; in autumn it sinks below the skin, like hibernating insects about to withdraw; in winter it lies at the bone, like hibernating insects sealed tightly away, while the noble person stays indoors. Hence it is said: one who understands the interior presses the pulse and takes careful note of it; one who understands the exterior follows it from end back to beginning. These six points are the great rules for holding the pulse.
When the heart pulse beats hard and long, the disease should manifest as a curled tongue with inability to speak; when it is soft and scattered, the disease should resolve of itself within a cycle. When the lung pulse beats hard and long, the disease should manifest as spitting blood; when it is soft and scattered, the disease should manifest as profuse sweating that even now will not stop recurring. When the liver pulse beats hard and long, and the complexion is not green, the disease should manifest as though from a fall or a blow, with blood collecting below the ribs and causing the person to pant with rebellious qi; when it is soft, scattered, and of lustrous color, the disease should be overflow-drink, in which the person becomes suddenly very thirsty and drinks excessively, so that the fluid easily penetrates the muscles, skin, and the regions beyond the intestines and stomach. When the stomach pulse beats hard and long, and the complexion is red, the disease should manifest as a fracture of the thigh; when it is soft and scattered, the disease should manifest as food impediment. When the spleen pulse beats hard and long, and the complexion is yellow, the disease should manifest as shortness of qi; when it is soft, scattered, and dull in color, the disease should manifest as swelling of the lower leg, resembling a condition of water retention. When the kidney pulse beats hard and long, and the complexion is yellow and red, the disease should manifest as a wrenched lower back; when it is soft and scattered, the disease should manifest as scantiness of blood that even now will not be restored. Huangdi said: When in diagnosis one finds the heart pulse tense, what disease is this, and what does it look like? Qibo said: The disease is called heart mounting; there should be a palpable mass in the lower abdomen. Huangdi said: On what grounds do you say this? Qibo said: The heart is a yang viscus, and the small intestine serves as its envoy; hence I say there should be a palpable mass in the lower abdomen. Huangdi said: When in diagnosis one finds the stomach pulse, what does the disease look like? Qibo said: When the stomach pulse is in excess, there is distension; when it is deficient, there is diarrhea.
Huangdi said: What is meant by a disease forming and then transforming? Qibo said: Wind disorder, once formed, becomes cold-heat; heat-jaundice, once formed, becomes wasting-thirst; reversal, once formed, becomes disease of the vertex; prolonged wind becomes diarrhea with undigested food; wind lodged in the vessels becomes a severe skin disease. The transformations of disease are too numerous to count. Huangdi said: All the various swellings and abscesses, contractures of the sinews, and pains in the bones — from what do these arise? Qibo said: These are swellings caused by cold qi, transformations brought about by the eight winds. Huangdi said: How does one treat them? Qibo said: These are diseases of the four seasons; treat them using what overcomes the offending qi, and they will be cured. Huangdi said: When an old disease stirs activity within the five viscera and thereby injures the pulse and complexion, how in each case can one know whether the disease is long-standing or has arrived suddenly? Qibo said: How thorough is this question! When one finds the pulse diminished but the complexion not lost, this is a new disease. When one finds the pulse not lost but the complexion lost, this is a long-standing disease. When one finds both the pulse and the five colors lost, this too is a long-standing disease. When one finds neither the pulse nor the five colors lost, this is a new disease. When the liver pulse and kidney pulse arrive together, and the complexion is greenish-red, the disease should stem from injury; if no blood has yet appeared, then once blood does appear, it will be as damp as though soaked in water.
Within both sides of the cubit position lie the free ribs; the outer aspect of the cubit position reflects the kidney, the inner aspect reflects the abdomen. Just above this, on the left: the outer aspect reflects the liver, the inner aspect reflects the diaphragm; on the right: the outer aspect reflects the stomach, the inner aspect reflects the spleen. Above this again, on the right: the outer aspect reflects the lung, the inner aspect reflects the chest; on the left: the outer aspect reflects the heart, the inner aspect reflects the membrane surrounding the heart. The front reflects the front of the body, the back reflects the back of the body. What is uppermost, at the very top, pertains to matters of the chest and throat; what is lowermost, at the very bottom, pertains to matters of the lower abdomen, lower back, thighs, knees, shins, and feet.
When the pulse is coarse and large, this is insufficiency of yin and excess of yang, producing heat within. When it comes rapidly and departs slowly, replete above and empty below, this is reversal disease of the vertex; when it comes slowly and departs rapidly, empty above and replete below, this is aversion to wind. Hence when a person is struck by pathogenic wind, it is the yang qi that receives it. When the pulse is sunken, fine, and rapid throughout, this is shaoyin reversal; when it is sunken, fine, rapid, and scattered, this is cold-heat disorder; when it is floating and scattered, this causes dizziness and collapse. All pulses that are floating without agitation belong to yang and indicate heat; those that are also agitated indicate disease in the hands. All pulses that are fine and sunken belong to yin and indicate bone pain; those that are also still indicate disease in the feet. A pulse that beats rapidly with one intermittent beat indicates disease in the yang channels, with diarrhea and stool containing pus and blood. In all abnormal cases, upon palpation: a rough pulse indicates excess of yang qi, a slippery pulse indicates excess of yin qi. Excess of yang qi produces fever of the body without sweating; excess of yin qi produces profuse sweating with a cold body; excess of both yin and yang together produces cold without sweating. When one presses outward and the pulse is felt inside but not outside, there is accumulation in the heart and abdomen. When one presses inward and the pulse is felt outside but not inside, there is heat in the body. When one presses upward and the pulse is felt above but not below, the lower back and feet are cold. When one presses downward and the pulse is felt below but not above, there is pain in the head and neck. When one presses down to the bone and the pulse qi is scanty, there is pain in the lower back and spine, together with impediment in the body.