浮,初排指于皮肤之上,轻手按之便得,曰浮。此为寒邪初入太阳阳经,病在表之标,可发而
去之。虽然,治之则有二焉∶寒伤荣则无汗恶寒,用麻黄汤;风伤卫则自汗恶风,用桂枝汤。一通
一塞,不可同也。
浮紧有力,无汗恶寒,头项痛,腰脊强,发热,此为伤寒在表,宜发散,冬时麻黄汤,春、夏、
秋皆用羌活冲和汤。
浮缓,有汗恶风,头项痛,腰脊强,发热,此为伤风在表,冬时用桂枝汤,余三时用加减冲和
汤。腹痛,小建中汤;痛甚者,桂枝大黄汤。
中,按至皮肤之下,肌骨之间,略重按之乃得,谓之半表半里证也。然亦有二焉,盖阳明少阳
二经不从标本从乎中也。
长而有力,即微洪脉也,此为阳明在经,其证微有头疼眼眶痛,鼻干不得眠,发热无汗,用葛
根解肌汤。若渴而有汗不解,或经汗过渴不解者,用白虎汤加人参。无渴,不可服此药,为大忌。
弦而数,此为少阳经脉,其证胸胁痛而耳聋,寒热,呕而口苦,俱用小柴胡汤。(本方自有加
减法。)或两经合病,则脉弦而长,此汤加葛根、芍药。缘胆无出入,有三禁,只宜和解表里。
沉,重手按至肌肉之下,筋骨之间,此为沉脉。亦有二焉,阴阳寒热在沉脉中分,无人知此,
实秘诀耶。
沉数有力,则为阳明之本,表证解而热入于里,恶寒头疼悉除,反觉怕热,欲揭衣被,扬手掷
足,谵语狂妄,燥渴,或潮热自汗,五六日不大便,轻则大柴胡汤,重则三承气选用。
沉迟无力,为寒,外证无头疼,无身热,不渴,初起怕寒,厥冷蜷卧,兼或腹痛吐泻,或战栗,
面如刀刮,或口吐白沫冷涎,皆是阴经自中真寒证,轻则理中汤,重则姜附四逆汤温之。
伤寒至沉脉方分阴阳,仔细体认,下药不可造次,倘有差失,咎将归己。凡诊脉须分三部九候,
每部必先浮诊三候,轻手于皮肤之上,候三动也。中诊三候,略重指于皮肤之下,肌肉之上,候三
动也。沉诊三候,重手于肌肉之下,筋骨之上,候三动也。三三而成九候。然后知病之浅深表里,
以为处治之标的,岂可忽略于脉而欲求病之所在乎?切脉谓之巧,得心应指,自然神效,有枉死者,
此吾所不信也。若不明脉识证,狂妄行医,视人命如草芥,他日若不受天殃,吾亦不信也。
浮脉,将手指初置于皮肤表面,轻手按压即可触及,称为浮脉。这是寒邪刚刚侵入太阳阳经,病位在体表的浅层,可以采用发汗的方法祛除病邪。虽然如此,治疗时却有两种情况:若寒邪损伤营分,则表现为无汗、恶寒,使用麻黄汤;若风邪损伤卫分,则表现为自汗、恶风,使用桂枝汤。这两种情况,一为通畅(指腠理闭塞需开泄),一为壅塞(指营卫不和需调和),不可混同治疗。
浮紧且有力,无汗、恶寒,头项疼痛,腰脊僵硬,发热,这是伤寒在体表的表现,适宜发散解表。冬季用麻黄汤,春、夏、秋三季均用羌活冲和汤。
浮缓脉,有汗、恶风,头项疼痛,腰脊僵硬,发热,这是伤风在体表的表现。冬季用桂枝汤,其余三个季节用加减冲和汤。若伴有腹痛,用小建中汤;疼痛剧烈的,用桂枝大黄汤。
中脉,将手指按至皮肤之下、肌肉与骨骼之间,稍微加重力度才能触及,这被称为半表半里证。然而也有两种情况,因为阳明经和少阳经不从标本而从“中”气。
脉象长而有力,即微洪脉,这是阳明经在经表的表现。其症状为轻微头痛、眼眶痛,鼻干难以入睡,发热无汗,使用葛根解肌汤。如果口渴且有汗但病不解,或者经过发汗治疗后口渴仍不缓解的,使用白虎汤加人参。若无口渴症状,不可服用此药,这是大忌。
脉象弦而数,这是少阳经脉的表现。其症状为胸胁疼痛、耳聋,寒热往来,呕吐且口苦,均使用小柴胡汤。(本方自有加减法。)若是两经合病,则脉象弦而长,此汤剂中加入葛根、芍药。因为胆腑没有出入之径,有三禁原则,只适宜和解表里。
沉脉,重手按压至肌肉之下、筋骨之间,这就是沉脉。也有两种情况,阴阳寒热在沉脉中进行区分,无人知晓此法,这确实是秘诀吗?
脉象沉数且有力,则是阳明病的根本表现。表证已解,热邪入里,恶寒、头疼完全消失,反而觉得怕热,想要揭开衣被,扬手掷足,说胡话、狂妄躁动,燥渴,或潮热自汗,五六天不大便,病情轻的用小柴胡汤(注:原文此处可能有误,通常大柴胡用于少阳阳明合病,承气用于阳明腑实,此处依原文翻译),病情重的选用三承气汤。
脉象沉迟且无力,属于寒证。外证无头疼,无身热,不口渴,初起怕冷,四肢厥冷、蜷缩而卧,兼或有腹痛吐泻,或战栗,面色如刀刮般苍白,或口吐白沫冷涎,这些都是阴经自受真寒证。病情轻的用理中汤,病情重的用姜附四逆汤温补。
伤寒病出现沉脉时才区分阴阳,必须仔细体会辨认,下药不可草率。倘若有所差失,责任将由自己承担。凡是诊脉必须分三部九候。每部必须先进行浮诊三候,轻手于皮肤之上,候察三次搏动。中诊三候,略重指于皮肤之下、肌肉之上,候察三次搏动。沉诊三候,重手于肌肉之下、筋骨之上,候察三次搏动。三三相乘成为九候。然后才知道病情的深浅表里,以此作为治疗的依据,岂可忽略脉象而想探求病位所在呢?切脉称为巧,心得意会,自然神效,若有因误治而死的人,我是不会相信的。如果不明脉理、不识证候,狂妄行医,视人命如草芥,他日若不遭受天谴,我也是不会相信的。
Floating pulse, placing the fingers initially on the surface of the skin, touching it with light pressure is called Floating pulse. This indicates that cold pathogen has just invaded the Taiyang Yang meridian, and the disease is at the superficial level of the exterior; it can be treated by inducing sweating to expel the pathogen. Although so, there are two treatment approaches: if cold damages Ying (Nutritive Qi), presenting as anhidrosis and aversion to cold, use Mahuang Tang (Ephedra Decoction); if wind damages Wei (Defensive Qi), presenting as spontaneous sweating and aversion to wind, use Guizhi Tang (Cinnamon Twig Decoction). One involves opening the blocked pores, the other harmonizing the deficiency, they cannot be treated identically.
Floating, tight, and forceful pulse, with anhidrosis, aversion to cold, headache and stiffness of the head and neck, back stiffness, fever, this is Shanghan (Cold Damage) at the exterior, suitable for dispersing and releasing the exterior. In winter, use Mahuang Tang; in spring, summer, and autumn, use Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction).
Floating and slow pulse, with sweating, aversion to wind, headache and stiffness of the head and neck, back stiffness, fever, this is Shangfeng (Wind Strike) at the exterior. In winter, use Guizhi Tang; in the other three seasons, use Jiajian Chonghe Tang (Modified Harmonizing Decoction). If accompanied by abdominal pain, use Xiaojianzhong Tang (Minor Construct the Middle Decoction); if the pain is severe, use Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction).
Middle pulse, pressing the fingers below the skin, between muscle and bone, requiring slightly heavier pressure to perceive, is referred to as Shaobiao Banli Syndrome (Half-Exterior Half-Interior Syndrome). However, there are also two types, because the Yangming and Shaoyang meridians follow the "Zhong" (Middle) aspect rather than the Biao (Exterior) or Ben (Root).
Long and forceful pulse, which is a slightly Hong (Surging) pulse, indicates Yangming disease in the meridian. The symptoms include slight headache, orbital pain, dry nose, insomnia, fever, and anhidrosis; use Gegen Jiemi Tang (Pueraria Relieving Muscle Decoction). If there is thirst with sweating but the condition does not resolve, or if thirst persists after sweating therapy, use Baihu Tang (White Tiger Decoction) plus Renshen (Ginseng). If there is no thirst, do not take this medicine; it is a major contraindication.
Wiry and rapid pulse indicates Shaoyang meridian disease. The symptoms include hypochondriac pain, deafness, alternating chills and fever, vomiting, and bitter taste in the mouth; all are treated with Xiaochaihu Tang (Minor Bupleurum Decoction). (This formula has its own modifications.) If both meridians are involved simultaneously, the pulse is wiry and long; add Gegen and Shaoyao to this decoction. Since the Gallbladder has no direct exit or entry pathways, there are three prohibitions, and only harmonizing the interior and exterior is appropriate.
Deep pulse, pressing heavily until below the muscle, between tendon and bone, is the Deep pulse. There are also two types; Yin-Yang and Cold-Heat are distinguished within the Deep pulse. Few know this method; is it truly a secret technique?
Deep, rapid, and forceful pulse indicates the root of Yangming. The exterior syndrome has resolved, and heat has entered the interior. Aversion to cold and headache have completely disappeared; instead, there is fear of heat, desire to remove clothes and blankets, throwing hands and feet about, delirium and mania, dry thirst, tidal fever, or spontaneous sweating. If there is constipation for five to six days, mild cases use Dachaihu Tang (Major Bupleurum Decoction), and severe cases select among the three Chengqi Decoctions (Chengqi Formulas).
Deep, slow, and weak pulse indicates Cold. Exterior symptoms include no headache, no body heat, no thirst. Initially, there is aversion to cold, cold extremities, and curling up in bed. Accompanying symptoms may include abdominal pain, vomiting, and diarrhea, or shivering, a face pale as if scraped by a knife, or spitting out white foam and cold saliva. These are all True Cold syndromes originating from the Yin meridians. Mild cases use Lizhong Tang (Regulate the Middle Decoction); severe cases use Jiangfu Sini Tang (Ginger and Aconite Reversing the Collapse Decoction) to warm them.
Only when Shanghan presents with a Deep pulse should Yin and Yang be distinguished; careful perception is required. Administering purgatives must not be hasty. If errors occur, the responsibility lies with oneself. When diagnosing pulses, one must divide into Three Regions and Nine Positions. For each region, first perform Floating observation for three beats: light pressure on the skin to observe three pulsations. Then Middle observation for three beats: slightly heavier pressure below the skin, above the muscle, to observe three pulsations. Finally, Deep observation for three beats: heavy pressure below the muscle, above the bone, to observe three pulsations. Three times three makes nine positions. Only then can one know the depth and location (exterior/interior) of the disease, establishing the target for treatment. How can one ignore the pulse and attempt to locate the disease? Pulse diagnosis is called skillful; when the mind grasps the finger sensation, natural miraculous effects occur. I do not believe in deaths caused by such negligence. If one does not understand pulse recognition and syndrome differentiation, practicing medicine recklessly, treating human life like grass, I do not believe they will escape heavenly retribution in the future.