(浮大动数滑为阳沉涩弱弦微为阴)
浮候 举指于皮肤之上。轻手得之曰浮。主在表之症。浮紧有力。无汗恶寒。为寒伤营
。浮缓无力。有汗恶风。为风伤卫。
中候 寻指于肌肉之间。不重不轻而得曰中。主半表半里之症。洪而长者。阳明胃脉也
。弦而数者。少阳胆脉也。
沉候 按指于筋骨之下。重手得之曰沉。主在里之症。沉数有力。为热邪传里。沉迟无
力。为直中阴经。
浮为表属阳。沉为里属阴。迟则为寒。数则为热。数大无力。为阳中伏阴。浮数有力。
为纯
传里。浮而迟涩。浮而软散。皆虚。浮而紧数。浮而洪滑。皆实。沉而细弱。沉而迟伏。皆
虚。沉而滑数。沉而坚大。皆实。乍大乍小。乍数乍疏。此为死脉。亦为祟脉。
细察浮中沉三候。而别其有力。无力。则阴阳表里虚实。自无遁情。但能于此精求。临
症万无一失。阳症之脉。以大则病进。小则病退。阴症之脉。以沉伏病进。迟缓病退。汗后脉当
安静。躁乱者死。温后脉当渐出。歇止者死。表症而脉伏者。有邪汗也。昏沉而脉静者。欲
战汗也。
阴症见阳脉者生。真阳来复之象。任受补也。阳症见阴脉者死。正气衰微之象。不任受
攻也。
足脉二条。 一曰趺阳。又名冲阳。又名会源。阳明胃脉也。在足面大指间。五寸骨间
动脉是也。病势危笃。当诊趺阳。以察胃气之有无。盖土为万物之母。后天之根本也。经曰。冲
阳绝死不治。一曰太溪。少阴肾脉也。在足内踝。后跟骨上陷中动脉是也。病势危笃。当诊
太溪。以察肾气之有无。盖水为天一之元。先天之根本也。经曰。太溪绝死不治。
浮候:将手指轻举置于皮肤之上。轻手触及即得,称为浮脉。主病位在表的症状。若脉浮紧且有力,无汗、恶寒,这是寒邪损伤营分。若脉浮缓且无力,有汗、恶风,这是风邪损伤卫分。
中候:寻按手指于肌肉之间。不重不轻而得之,称为中脉。主半表半里的症状。脉象洪大而长,是阳明胃经的脉象。脉象弦而数,是少阳胆经的脉象。
沉候:将手指重按至筋骨之下。重手触及即得,称为沉脉。主病位在里的症状。若脉沉数且有力,是热邪传入里部。若脉沉迟且无力,是寒邪直中阴经。
浮脉属表,归属于阳;沉脉属里,归属于阴。迟脉主寒,数脉主热。脉数大但无力,是阳证中潜伏阴邪。脉浮数且有力,是纯阳之邪传入里部。脉浮而迟涩,或脉浮而软散,都属于虚证。脉浮而紧数,或脉浮而洪滑,都属于实证。脉沉而细弱,或脉沉而迟伏,都属于虚证。脉沉而滑数,或脉沉而坚大,都属于实证。脉象乍大乍小,乍数乍疏,这被称为死脉,也被称为祟脉(鬼祟作怪之脉)。
仔细审察浮、中、沉三候,并辨别其有力与无力,那么阴阳、表里、虚实的情况自然无所遁形。只要能在这一点上精研探求,临症时便万无一失。阳证的脉象,以大则为病情进展,以小则为病情退却。阴证的脉象,以沉伏为病情进展,以迟缓为病情退却。发汗之后,脉象应当安静平和,若躁乱不安者预后不良致死。温法治疗后,脉象应当逐渐显现外出,若出现歇止(间歇)者预后不良致死。表证而见脉伏者,是有邪气郁闭需要发汗。神志昏沉而脉象静者,是欲通过战汗来祛邪。
阴证见到阳脉者生,这是真阳来复的迹象,能够承受补益疗法。阳证见到阴脉者死,这是正气衰微的迹象,不能承受攻伐疗法。
足部的两条脉诊部位。一是趺阳脉,又名冲阳脉,又名会源脉,属于阳明胃经的脉象。位于足背大拇指与第二趾之间的五寸骨间动脉处。当病情危重笃定时,应当诊察趺阳脉,以观察胃气的有无。因为土(脾胃)是万物的母亲,是后天的根本。医经说:冲阳脉绝灭则死,无法治疗。二是太溪脉,属于少阴肾经的脉象。位于足内踝后方跟骨上方的凹陷中的动脉处。当病情危重笃定时,应当诊察太溪脉,以观察肾气的有无。因为水(肾)是天一之元,是先天的根本。医经说:太溪脉绝灭则死,无法治疗。
(Floating, large, moving, rapid, and slippery pulses belong to Yang; sunken, choppy, weak, wiry, and minute pulses belong to Yin)
Floating position: Place the fingers lightly on the skin surface. Detecting it with light pressure is called a Floating pulse (Fu Mai). It indicates symptoms located in the Exterior (Biao). If the pulse is Floating, tight, and forceful, accompanied by anhidrosis (lack of sweating) and aversion to cold, it indicates Cold pathogen injuring the Ying (Nutrient) level. If the pulse is Floating, slow, and non-forceful, accompanied by spontaneous sweating and aversion to wind, it indicates Wind pathogen injuring the Wei (Defensive) level.
Middle position: Search for the pulse between the muscles. Detecting it with neither heavy nor light pressure is called the Middle position. It indicates symptoms at the Half-Exterior, Half-Interior (Shao Yang). A pulse that is Surging (Hong) and long belongs to the Stomach channel of the Yangming. A pulse that is Wiry (Xian) and rapid belongs to the Gallbladder channel of Shaoyang.
Sunken position: Press heavily down to beneath the tendons and bones. Detecting it with heavy pressure is called a Sunken pulse (Chen Mai). It indicates symptoms located in the Interior (Li). If the pulse is Sunken, rapid, and forceful, it indicates Heat pathogen transmitting into the Interior. If the pulse is Sunken, slow, and non-forceful, it indicates direct invasion of the Yin channels by Cold.
Floating pulse belongs to the Exterior and is attributed to Yang; Sunken pulse belongs to the Interior and is attributed to Yin. Slow pulse indicates Cold; Rapid pulse indicates Heat. A Rapid and large pulse but non-forceful indicates Yin pathogen latent within Yang. A Floating and rapid pulse but forceful indicates pure Yang pathogen transmitting into the Interior. A Floating pulse with Slowness and Chopiness, or a Floating pulse that is soft and scattered, both indicate Deficiency patterns. A Floating pulse with Tightness and Rapidity, or a Floating pulse with Surging quality and Slipperyness, both indicate Excess patterns. A Sunken pulse that is Fine and weak, or a Sunken pulse that is Slow and hidden, both indicate Deficiency patterns. A Sunken pulse that is Slippery and Rapid, or a Sunken pulse that is Firm and large, both indicate Excess patterns. A pulse that fluctuates suddenly from large to small, or suddenly from rapid to sparse, is called a Death pulse (Si Mai), also referred to as a Gui/Sui pulse (associated with malevolent influences).
Carefully examine the Floating, Middle, and Sunken positions, and distinguish between forceful and non-forceful qualities; thus, the conditions of Yin/Yang, Exterior/Interior, and Deficiency/Excess will naturally be revealed without concealment. If one can meticulously study this, there will be no failure in clinical practice. For Yang syndrome pulses, a larger pulse indicates disease progression, while a smaller pulse indicates disease regression. For Yin syndrome pulses, a Sunken and hidden pulse indicates disease progression, while a Slow pulse indicates disease regression. After sweating therapy, the pulse should become calm and quiet; if restless and chaotic, death ensues. After warming therapy, the pulse should gradually emerge outward; if intermittent (pausing), death ensues. In Exterior syndromes, if the pulse is Sunken/Hidden, it indicates pathogenic obstruction requiring sweating. If the patient is lethargic/comatose but the pulse is quiet, it indicates impending Zhan Han (shivering sweat) to expel pathogens.
When Yin syndrome presents with Yang pulses, survival is indicated; this is a sign of True Yang returning, and the patient can tolerate tonification. When Yang syndrome presents with Yin pulses, death is indicated; this is a sign of righteous Qi declining and becoming minute, and the patient cannot tolerate purgation/attack therapies.
The two pulse positions on the foot. One is the Duzhong pulse, also known as Chongyang pulse, or Huiyuan pulse, belonging to the Yangming Stomach channel. It is located at the arterial pulsation between the metatarsal bones of the first and second toes, approximately five cun away. When the disease condition is critical and severe, the Duzhong pulse should be examined to observe the presence or absence of Stomach Qi. Because Earth (Spleen/Stomach) is the mother of all things and the foundation of acquired constitution. The Classics state: If the Chongyang pulse ceases, death occurs and is untreatable. The other is the Taixi pulse, belonging to the Shaoyin Kidney channel. It is located at the arterial pulsation in the depression above the calcaneus behind the medial malleolus. When the disease condition is critical and severe, the Taixi pulse should be examined to observe the presence or absence of Kidney Qi. Because Water (Kidney) is the origin of Tian Yi (Heavenly One) and the foundation of congenital constitution. The Classics state: If the Taixi pulse ceases, death occurs and is untreatable.