素问·三部九候论 Treatise on the Three Sections and Nine Indicators
黄帝问曰：余闻九针于夫子，众多博大，不可胜数。余愿闻要道，以属子孙，传之后世，著之骨髓，藏之肝肺，歃血而受，不敢妄泄，令合天道，必有终始，上应天光星辰历纪，下副四时五行，贵贱更互，冬阴夏阳，以人应之奈何，愿闻其方。歧伯对曰：妙乎哉问也！此天地之至数。帝曰：愿闻天地之至数，合于人形，血气通，决死生，为之奈何。歧伯曰：天地之至数，始于一，终于九焉。一者天，二者地，三者人，因而三之，三三者九，以应九野。故人有三部，部有三候，以决死生，以处百病，以调虚实，而除邪疾。
帝曰：何谓三部。歧伯曰：有下部，有中部，有上部，部各有三候，三候者，有天有地有人也，必指而导之，乃以为真。上部天，两额之动脉；上部地，两额之动脉；上部人，耳前之动脉。中部天，手太阴也；中部地，手阳明也；中部人，手少阴也。下部天，足厥阴也；下部地，足少阴也；下部人，足太阴也。故下部之天以候肝，地以候肾，人以候脾胃之气。帝曰：中部之候奈何。歧伯曰：亦有天，亦有地，亦有人。天以候肺，地以候胸中之气，人以候心。帝曰：上部以何候之。歧伯曰：亦有天，亦有地，亦有人，天以候头角之气，地以候口齿之气，人以候耳目之气。三部者，各有天，各有地，各有人。三而成天，三而成地，三而成人，三而三之，合则为九，九分为九野，九野为九藏。故神藏五，形藏四，合为九藏。五藏已败，其色必夭，夭必死矣。帝曰：以候奈何。歧伯曰：必先度其形之肥瘦，以调其气之虚实，实则写之，虚则补之。必先去其血脉而后调之，无问其病，以平为期。
帝曰：决死生奈何。歧伯曰：形盛脉细，少气不足以息者，危。形瘦脉大，胸中多气者，死。形气相得者，生。参伍不调者，病。三部九候皆相失者，死。上下左右之脉相应如参舂者，病甚。上下左右相失不可数者，死。中部之候虽独调，与众藏相失者，死。中部之候相减者，死。目内陷者死。帝曰：何以知病之所在。歧伯曰：察九候独小者，病，独大者，病，独疾者，病，独迟者，病，独热者，病，独寒者，病，独陷下者，病。以左手足上，上去踝五寸按之，庶右手足当踝而弹之，其应过五寸以上，蠕蠕然者，不病；其应疾，中手浑浑然者，病；中手徐徐然者，病；其应上不能至五寸，弹之不应者，死。是以脱肉身不去者，死。中部乍踈乍数者，死。其脉代而钩者，病在络脉。九候之相应也，上下若一，不得相失。一候后则病，二候后则病甚，三候后则病危。所谓后者，应不俱也。察其府藏，以知死生之期。
必先知经脉，然后知病脉，真藏脉见者，胜死。足太阳气绝者，其足不可屈伸，死必戴眼。帝曰：冬阴夏阳奈何。歧伯曰：九候之脉，皆沈细悬绝者为阴，主冬，故以夜半死。盛躁喘数者为阳，主夏，故以日中死。是故寒热病者，以平旦死。热中及热病者，以日中死。病风者，以日夕死。病水者，以夜半死。其脉乍踈乍数乍迟乍疾者，日乘四季死。形肉已脱，九候虽调，犹死。七诊虽见，九候皆从者不死。所言不死者，风气之病，及经月之病，似七诊之病，而非也，故言不死。若有七诊之病，其脉候亦败者，死矣，必发哕噫。必审问其所始病，与今之所方病，而后各切循其脉，视其经络浮沈，以上下逆从循之，其脉疾者不病，其脉迟者病，脉不往来者，死，皮肤著者，死。
帝曰：其可治者奈何。歧伯曰：经病者治其经，孙络病者治其孙络血，血病身有痛者，治其经络。其病者在奇邪，奇邪之脉则缪刺之。留瘦不移，节而刺之。上实下虚，切而从之，索其结络脉，刺出其血，以见通之。瞳子高者，太阳不足，戴眼者，太阳已绝，此决死生之要，不可不察也。手指及手外踝上五指，留针。
Huangdi asked: I have learned from you, Master, about the nine needles — so many and so vast that they cannot be exhausted. I wish to hear the essential Way, so that I may bequeath it to my sons and grandsons, transmit it to later generations, inscribe it in my very marrow, and store it within my liver and lungs; I will receive it with a blood oath and dare not disclose it carelessly. Let it accord with the Way of Heaven, having necessarily a beginning and an end, corresponding above to the brilliance of Heaven, the stars, and the calendrical order, and matching below the four seasons and the five phases, with noble and humble alternating in turn, winter belonging to yin and summer to yang — how does the human being correspond to this? I wish to hear the method. Qibo replied: How subtle a question this is! This concerns the utmost calculations of Heaven and Earth. Huangdi said: I wish to hear how the utmost calculations of Heaven and Earth correspond to the human form, so that blood and qi may be made to flow freely, and death and survival determined — how is this done? Qibo said: The utmost calculations of Heaven and Earth begin at one and end at nine. One is Heaven, two is Earth, three is Man; multiplying this by three, three times three makes nine, corresponding to the nine fields of Heaven. Therefore the human being has three sections, and each section has three indicators, by which death and survival are determined, the hundred diseases are managed, deficiency and excess are regulated, and pathogenic illness is removed.
Huangdi said: What are meant by the three sections? Qibo said: There is a lower section, a middle section, and an upper section; each section has three indicators. The three indicators are Heaven, Earth, and Man — one must point to them and guide the examination in order to obtain the true reading. In the upper section, Heaven is the pulsing vessel at the two temples; the Earth of the upper section is the pulsing vessel at the two temples; the Man of the upper section is the pulsing vessel in front of the ears. In the middle section, Heaven is the Hand Taiyin channel; the Earth of the middle section is the Hand Yangming channel; the Man of the middle section is the Hand Shaoyin channel. In the lower section, Heaven is the Foot Jueyin channel; the Earth of the lower section is the Foot Shaoyin channel; the Man of the lower section is the Foot Taiyin channel. Thus, the Heaven of the lower section indicates the liver, its Earth indicates the kidney, and its Man indicates the qi of the spleen and stomach. Huangdi said: What of the indicators of the middle section? Qibo said: There too are Heaven, Earth, and Man. Heaven indicates the lung, Earth indicates the qi within the chest, and Man indicates the heart. Huangdi said: By what are the indicators of the upper section determined? Qibo said: There too are Heaven, Earth, and Man. Heaven indicates the qi of the head and temples, Earth indicates the qi of the mouth and teeth, and Man indicates the qi of the ears and eyes. Thus each of the three sections has its Heaven, its Earth, and its Man. Three make a Heaven, three make an Earth, three make a Man; multiplying three by three gives nine in total; the nine are divided into the nine fields, and the nine fields correspond to the nine viscera. Hence there are five spirit-viscera and four form-viscera, together making the nine viscera. When the five viscera have already failed, the complexion will necessarily be withered, and when withered, death necessarily follows. Huangdi said: How does one determine this? Qibo said: One must first gauge whether the body's physique is fat or thin, in order to regulate the deficiency or excess of its qi — if there is excess, drain it; if there is deficiency, supplement it. One must first clear the blood vessels and only then regulate the qi, regardless of what the disease is, taking balance as the goal.
Huangdi said: How does one determine death and survival? Qibo said: When the physique is full but the pulse fine, and the breath insufficient to sustain respiration, this is dangerous. When the physique is thin but the pulse large, and there is excess qi within the chest, this means death. When physique and qi correspond to one another, this means life. When the pulses are irregular and uncoordinated, this means disease. When the three sections and nine indicators all fail to correspond with one another, this means death. When the pulses above and below, left and right, respond to each other like the alternating strokes of a pestle pounding grain, the disease is severe. When above and below, left and right, are so out of correspondence that they cannot be counted together, this means death. When the indicator of the middle section, though regulated by itself, fails to correspond with the other viscera, this means death. When the indicators of the middle section diminish relative to one another, this means death. When the eyes are sunken inward, this means death. Huangdi said: How does one know where the disease is located? Qibo said: When examining the nine indicators, if one alone is small, there is disease; if one alone is large, there is disease; if one alone is rapid, there is disease; if one alone is slow, there is disease; if one alone is hot, there is disease; if one alone is cold, there is disease; if one alone is sunken and depressed, there is disease. Press with the left hand on the leg, five inches above the ankle, and then flick near the ankle with the right hand — if the response travels upward beyond five inches in a wriggling motion, there is no disease; if the response is rapid, and under the hand feels turbid and rolling, there is disease; if under the hand it feels sluggish and slow, there is disease; if the response does not reach up to five inches, or flicking produces no response at all, this means death. Hence, when the flesh has wasted away and the body cannot move, this means death. When the middle section is now sparse and now rapid, this means death. When the pulse is intermittent and hooked, the disease lies in the network vessels. In the mutual correspondence of the nine indicators, above and below should be as one, and must not fail to correspond. When one indicator lags, there is disease; when two indicators lag, the disease is severe; when three indicators lag, the disease is critical. What is meant by "lagging" is that the responses are not simultaneous. Examine the bowels and viscera in order to know the timing of death and survival.
One must first understand the channels and vessels, and only then can one understand the pulse of disease. When the pulse of the true viscus appears, the disease overcomes the person and death results. When the qi of the Foot Taiyang channel is cut off, the feet cannot be flexed or extended, and at death the eyes will necessarily roll upward. Huangdi said: How is it that winter belongs to yin and summer to yang? Qibo said: Among the pulses of the nine indicators, those that are sunken, fine, suspended, and cut off belong to yin, governed by winter, and hence death occurs at midnight. Those that are full, agitated, panting, and rapid belong to yang, governed by summer, and hence death occurs at midday. Therefore, in cold-heat disease, death occurs at dawn. In internal heat and heat disease, death occurs at midday. In wind disease, death occurs at dusk. In water disease, death occurs at midnight. When the pulse is now sparse, now rapid, now slow, now hasty, death occurs at the turning of the four seasons. If the flesh has already wasted away, even though the nine indicators are regulated, death still occurs. If the seven signs of fatal prognosis appear but the nine indicators all comply with the norm, the patient does not die. What is meant by "not dying" refers to diseases of wind qi and diseases that run their course over a month, which resemble the diseases of the seven signs but are not truly so — hence it is said they do not die. But if the seven signs of disease are truly present and the pulse indicators are also in decay, then death follows, and hiccup and belching will necessarily occur. One must carefully inquire into how the disease began and what is presently afflicting the patient, and only then, in turn, palpate and trace each pulse, observing whether the channels and network vessels are floating or sunken, and follow them up and down, with the flow or against it. If the pulse is brisk, there is no disease; if the pulse is slow, there is disease; if the pulse neither comes nor goes, this means death; if the skin adheres, wasted and inelastic, this means death.
Huangdi said: How does one treat the cases that can be treated? Qibo said: When the disease is in the main channels, treat the main channels; when the disease is in the grandchild network vessels, treat the blood of the grandchild network vessels; when the disease is in the blood and the body has pain, treat the channels and network vessels. When the disease lies in an unusual pathogen, needle the unusual pathogen's vessel using contralateral needling. When the pathogen lingers and wastes the flesh without moving, needle at the joints. When there is excess above and deficiency below, palpate and follow it, seek out the knotted network vessels, needle them to let out the blood, and thereby open the passage so that it can be seen to flow freely. When the pupils are raised upward, this is insufficiency of the Taiyang; when the eyes roll fully upward and fixed, the Taiyang qi has already been cut off — this is essential to determining death and survival, and must not go unexamined. At the fingers, and five finger-widths above the outer ankle of the wrist, retain the needle.