凡男女当以左手尺脉常弱,右手尺脉常盛,为平。
脉诸按之不鼓为虚寒。
脉诸搏手,为寒凉或寒药致之。
脉两手相似,而右为甚,或责胃虚。
脉少有力,胜则似止,元气不及。
脉诸短为虚,诸大为虚。
脉涩而盛大,外怕寒,证名寒中。注云∶寒留于血脉涩,故大也。
脉涩与弦而大,按之有力为实,无力为虚。
脉滑,关以上见为大热;关以下见为大寒。注云∶水并于上,从火化;火并于下,从水化。
脉沉迟,寸微滑者为实。
寸微尺紧,其人虚损,为阴盛阳微故也。
脉小而虚,不可损气;脉大而实,不可益气。
两寸短小,谓阳不足,病在下。
两尺不见或短小,乃食塞,当吐之。
两寸不足,求之脾胃,当从阴引阳。
两尺脉虚为寒,宜姜附。
两关脉实,上不至发汗,下不至利小便。
两关沉细,此虚也,宜温补之。
右肾属火,补之巴戟、杜仲;左肾属水,补之地黄、山茱萸、黄柏。
伤寒,寸脉浮滑者,有痰,宜吐。
杂病,寸脉沉者,属痰,宜吐。
凡脉有力者为实,无力者为虚。假令脉浮,则为阳盛阴虚;脉沉,则为阴盛阳虚。此有则
彼无;彼有则此无。又如弦,木实、金亏、土虚也。
凡脉来者,为阳为气;去者,为阴为血。假令来疾去迟,为阳有余而阴不足,故曰外实内
虚,出候外,入候内。
久新病脉
长病脉 虚而涩。虚而滑。虚而缓。虚而弦。虚而结。浮
而滑。实而滑。实而大。微而伏。细而软。如屋漏。如雀啄。如羹上肥。如蜘蛛丝。如霹雳。如
贯珠。如水淹。皆死脉也。
卒病与长病条下反者,死候。
形脉相应
肥人脉细欲绝者死。
瘦人脉躁者死。
身涩脉滑者死。
身滑脉涩者死。
身小脉大者死。
身大脉小者死。
身短脉长者死。
身长脉短者死。
凡是男女性别,以左手尺脉(手腕桡动脉远端,候肾与命门)通常较弱,右手尺脉通常较强,作为正常脉象。
各种脉象中,按之无力、不鼓指者为虚寒证。
各种脉象中,搏动冲击手指者,多由寒凉之气或服用寒凉药物所致。
脉象稍显有力,若出现似有停顿的现象,是元气不足的表现。
各种短脉均为虚证,各种大脉也多为虚证。
脉象涩而盛大,患者怕冷,病名叫做“寒中”。注释说:寒气滞留于血脉导致脉涩,所以脉形显得盛大。
脉象涩且弦而大,按之有力为实证,按之无力为虚证。
脉象滑,如果在关部以上出现,主大热;如果在关部以下出现,主大寒。注释说:水气并聚于上,从火化热;火气并聚于下,从水化寒。
脉象沉迟,如果寸部微现滑象,属于实证。
脉象小而虚,不可使用耗损元气的治法;脉象大而实,不可使用补益元气的治法。
两尺脉摸不到或者短小,是由于食积阻滞,应当采用催吐法治疗。
右肾属火,补益右肾可用巴戟天、杜仲;左肾属水,补益左肾用地黄、山茱萸、黄柏。
凡是脉象有力的属于实证,无力的属于虚证。假如脉浮,则是阳盛阴虚;脉沉,则是阴盛阳虚。这是此有彼无、彼有此无的关系。又比如弦脉,代表木实、金亏、土虚。
凡是脉气来势,代表阳、代表气;脉气去势,代表阴、代表血。假如来疾去迟,说明阳气有余而阴气不足,所以称为外实内虚。出(来)候外在表,入(去)候内在里。
久病与新病的脉象
长病(久病)的脉象:虚而涩。虚而滑。虚而缓。虚而弦。虚而结。浮而滑。实而滑。实而大。微而伏。细而软。如屋漏(脉搏极慢且间歇不规则)。如雀啄(脉搏急促且节律不齐)。如羹上肥(漂浮不定)。如蜘蛛丝(极细弱)。如霹雳(突然中断)。如贯珠(连续均匀)。如水淹(漫灭无根)。这些都是死脉。
形体与脉象相应
肥胖的人脉象细弱欲绝的,主死。
消瘦的人脉象躁动的,主死。
身体涩滞(皮肤干枯)而脉象滑利的,主死。
身体滑润而脉象涩滞的,主死。
身体瘦小而脉象大的,主死。
身体高大而脉象小的,主死。
身体短小(或躯干短缩)而脉象长的,主死。
身体高大而脉象短的,主死。
In general, for both men and women, the Chi pulse (Kidney and Mingmen) on the left hand is typically weaker, while the Chi pulse on the right hand is typically stronger; this constitutes a normal pulse.
Among various pulses, those that are weak upon pressure and do not throb against the finger indicate Deficiency-Cold.
Among various pulses, those that beat forcefully against the finger are often caused by Cold pathogenic factors or the ingestion of Cold-cooling herbs.
When the pulses in both hands are similar, but the right side is more pronounced, one should attribute it to Spleen-Stomach Qi Deficiency.
If the pulse appears slightly forceful but exhibits intermittent pauses, it indicates insufficient Yuan Qi (Original Qi).
All Short pulses (Duan Mai) indicate Deficiency; all Large pulses (Da Mai) also mostly indicate Deficiency.
A pulse that is Choppy (Se Mai) yet Full and Large, accompanied by aversion to cold, is named "Cold Middle" (Han Zhong). The annotation states: Cold stagnating in the blood vessels causes the Choppy quality, hence the pulse appears Large.
A pulse that is Choppy, Wiry (Xian Mai), and Large, which is Forceful upon pressure, indicates Excess; if it is Weak upon pressure, it indicates Deficiency.
A Slippery (Hua Mai) pulse appearing above the Guan position (middle section of the radial artery) indicates intense Heat; appearing below the Guan position, it indicates intense Cold. The annotation states: Water accumulating above transforms into Fire (Heat); Fire accumulating below transforms into Water (Cold).
A Deep (Chen Mai) and Slow (Chi Mai) pulse where the Cun position (proximal section) shows a slight Slipperiness indicates Excess.
A Cun pulse that is Slight and a Chi pulse that is Tight indicates physical debility, due to Yin Excess and Yang Deficiency.
A Small and Weak pulse should not be treated with methods that deplete Qi; a Large and Excess pulse should not be treated with methods that tonify Qi.
Short and small pulses in both Cun positions indicate insufficient Yang, with pathology located in the Lower Jiao.
Absent or short/small pulses in both Chi positions indicate food retention/stagnation, and emesis (vomiting therapy) should be employed.
Insufficient pulses in both Cun positions require treatment focusing on the Spleen and Stomach, following the principle of "drawing Yang from Yin."
Deficient pulses in both Chi positions indicate Cold, suitable for treatment with Sheng Jiang (Rhizoma Zingiberis Recens) and Fu Zi (Radix Aconiti Lateralis Preparata).
Excess pulses in both Guan positions should not be treated with diaphoresis (sweating method) nor with diuresis (promoting urination).
Deep and Fine pulses in both Guan positions indicate Deficiency, suitable for warming and tonification.
The Right Kidney belongs to Fire; tonifying it involves Ba Ji Tian (Morindae Officinalis Radix) and Du Zhong (Eucommiae Cortex). The Left Kidney belongs to Water; tonifying it involves Di Huang (Rehmanniae Radix), Shan Zhu Yu (Corni Fructus), and Huang Bo (Phellodendri Cortex).
In Shang Han (Cold Damage) diseases, a Floating (Fu Mai) and Slippery Cun pulse indicates Phlegm, suitable for emesis.
In miscellaneous diseases, a Deep Cun pulse indicates Phlegm, suitable for emesis.
Generally, a Forceful pulse indicates Excess, while a Weak pulse indicates Deficiency. For instance, a Floating pulse indicates Yang Excess and Yin Deficiency; a Deep pulse indicates Yin Excess and Yang Deficiency. This reflects a mutually exclusive relationship: where one exists, the other is absent. Similarly, a Wiry pulse indicates Wood Excess, Metal Deficiency, and Earth Deficiency.
The coming aspect of the pulse represents Yang and Qi; the going aspect represents Yin and Blood. If the coming is rapid and the going is slow, it indicates Yang surplus and Yin insufficiency, termed "External Excess and Internal Deficiency." The coming (outward) aspect probes the exterior, while the going (inward) aspect probes the interior.
Pulses of Chronic and Acute Diseases
Pulses of Chronic Disease: Weak and Choppy. Weak and Slippery. Weak and Moderate/Slow. Weak and Wiry. Weak and Knotted. Floating and Slippery. Excess and Slippery. Excess and Large. Slight and Hidden. Fine and Soft. Like water dripping from a leaking roof (irregular and slow). Like a sparrow pecking (rapid and irregular). Like fat floating on soup (superficial and unstable). Like a spider's thread (extremely fine and weak). Like thunderclap (abrupt interruption). Like beads strung together (continuous and even). Like being submerged in water (rootless). All these are Pulses of Death.
Acute diseases presenting with pulses contrary to those described under chronic conditions indicate a fatal prognosis.
Correspondence between Form and Pulse
In obese individuals, a pulse that is Fine and nearly imperceptible indicates death.
In emaciated individuals, a Rapid and Agitated pulse indicates death.
A body with rough/dry skin but a Slippery pulse indicates death.
A body that is smooth/moist but a Choppy pulse indicates death.
A small body with a Large pulse indicates death.
A large body with a Small pulse indicates death.
A short body (or shortened torso) with a Long pulse indicates death.
A tall body with a Short pulse indicates death.