形健脉病患不久,形病脉健亦将危。
假如健人诊得浮紧而涩,似伤寒太阳经病脉,其人虽未头痛发热恶寒,此则不久即病,病即死也,谓之
行尸。又如十五动一止一年殂,其人虽未病,期应一年,病即死也。病患脉健者,假如形容羸瘦,精神枯槁,
盗汗不食,滑泄不止者,劳损之症,而脉反见洪健者亦死。
色脉相生病自已,色脉相胜不须医。
经言见其色而不得其脉,反得相胜之脉者,即死。得相生之脉者,病即自已。盖四时之色,仍以从前来
者为实邪,从后来者为虚邪。例看假令色红心病,热痰火癫狂斑疹等症,其脉当浮大而散。色青肝病,胁痛干
呕便血等症,其脉当弦而急。色黄脾病,湿热、肿胀伤食、呕泄、关格等症,其脉当中缓而大;色白肺病,气
喘、痰饮、痿悴、咳嗽等症,其脉当浮涩而短;色黑肾病,腰脚疝瘕、淋浊、漏精等症,其脉当沉濡而滑。
其间多动则为虚为火,静则为寒为实,皆当与脉而言之也。又五色应五脏,间有绿色,乃任督阴阳会也。
肥人沉结瘦长浮,矮促长疏尽莫违。
肥人肉浓,脉宜沉结;瘦人肉薄,脉宜浮长。人形矮则脉宜短促,人形长则脉宜疏长。相违相反而又不
和者皆死。非但形体相应,虽皮肤滑涩宽紧,亦宜与脉相应在。经言∶脉数,尺之皮肤亦数;脉急,尺之皮肤
亦急;脉缓,尺之皮肤亦缓;脉涩,尺之皮肤亦涩;脉滑,尺之皮肤亦滑是也。
身体强健而脉象病态的,患者活不久;身体有病而脉象健壮的,病情也将十分危急。
假如一个健康的人诊得浮紧而涩的脉象,这像是伤寒太阳经病的脉象,这个人虽然还没有出现头痛、发热、恶寒等症状,但这预示着他不久就会发病,一旦发病就会死亡,这种情况被称为“行尸”。又比如脉搏跳动十五次出现一次停顿(代脉),预示一年内死亡,这个人虽然现在没有生病,但到了预定的期限即使没病也会死亡。如果病人脉象显得过于健壮有力,例如形容消瘦羸弱,精神枯槁,盗汗且食欲不振,滑泄不止,这是劳损类的病症,但脉象反而洪大有力,这也是死证。
医经中说:看到某种面色却得不到相应的脉象,反而得到相克制的脉象,就会死亡;得到相生脉象的,疾病就会自行痊愈。大概四季的面色,以前一季之色传至本季节者为实邪,以后一季之色传至本季节者为虚邪。举例来看:假如面色红赤主心病,伴有热痰、火毒、癫狂、斑疹等症状,其脉象应当是浮大而散;面色青主肝病,伴有胁痛、干呕、便血等症状,其脉象应当弦而急;面色黄主脾病,伴有湿热、肿胀、伤食、呕吐泄泻、关格等症状,其脉象应当中缓而大;面色白主肺病,伴有气喘、痰饮、痿软憔悴、咳嗽等症状,其脉象应当浮涩而短;面色黑主肾病,伴有腰脚疼痛、疝气瘕块、淋浊、漏精等症状,其脉象应当沉濡而滑。
在这些脉象中,脉动频繁多为虚证或火证,脉动静止缓慢多为寒证或实证,这些都应当结合脉象来论述。另外五色对应五脏,其中间或有绿色出现,那是任脉和督脉阴阳交会之处。
肥胖之人脉象多沉结,瘦削之人脉象多浮长,身材矮小者脉象多短促,身材高大者脉象多疏长,这些规律都不能违背。
肥胖的人肌肉丰厚,脉象适宜沉结;瘦削的人肌肉单薄,脉象适宜浮长。人的形体矮小则脉象适宜短促,人的形体高大则脉象适宜疏长。如果脉象与形体相违背、相反且不和谐,都是死证。不仅仅是形体要与脉象相应,即使是皮肤的滑涩、宽紧,也应当与脉象相互对应。医经中说:脉数,尺部的皮肤也躁动快速;脉急,尺部的皮肤也紧急;脉缓,尺部的皮肤也松弛缓慢;脉涩,尺部的皮肤也粗糙涩滞;脉滑,尺部的皮肤也光滑润泽,说的就是这个道理。
When the constitution is robust but the pulse is pathological, the patient will not live long; when the constitution is diseased but the pulse is robust, the condition will also become critical.
For example, if a healthy person presents with a floating, tight, and choppy pulse (Fujin Er Se Mai), resembling the pulse of Taiyang disease (Disease of the Taiyang Channel) in Cold Damage (Shanghan), although this person has not yet experienced headache, fever, or aversion to cold, it indicates that illness will occur shortly, and once it occurs, death will follow. This condition is called "Xing Shi" (Walking Corpse). Furthermore, if there is one pause every fifteen beats (indicating Dai Mai/Interruption Pulse), it predicts death within one year. Even if the person is currently asymptomatic, upon the expiration of the predicted year, death will ensue. Conversely, if a patient's pulse appears overly robust—for instance, presenting with emaciation, withered spirit, night sweats, anorexia, and unceasing slippery diarrhea—this constitutes a consumption syndrome (Lao Sun), yet if the pulse is instead flooding and robust (Hong Jian), it is also a fatal sign.
When the complexion and pulse are mutually generating, the disease will resolve itself; when they are mutually overcoming, medical intervention is unnecessary.
The classics state: If a certain complexion is observed but the corresponding pulse is absent, and instead an overcoming (controlling) pulse is obtained, death will occur. If a generating (nourishing) pulse is obtained, the disease will resolve spontaneously. Generally, regarding the complexions of the four seasons, color transmitted from the preceding season represents excess pathogenic factors (Shi Xie), while color transmitted from the subsequent season represents deficient pathogenic factors (Xu Xie). For illustration: If the complexion is red indicating Heart disease, accompanied by symptoms such as hot phlegm, fire toxicity, mania, macules, and rashes, the pulse should be floating, large, and scattered (Fu Da Er San); if the complexion is green indicating Liver disease, accompanied by hypochondriac pain, dry retching, and bloody stool, the pulse should be wiry and rapid (Xian Er Ji); if the complexion is yellow indicating Spleen disease, accompanied by damp-heat, swelling, food stagnation, vomiting, diarrhea, Guan Ge (obstruction syndrome), the pulse should be moderate, slow, and large (Zhong Huan Er Da); if the complexion is white indicating Lung disease, accompanied by asthma, fluid retention, flaccidity, emaciation, and cough, the pulse should be floating, choppy, and short (Fu Se Er Duan); if the complexion is black indicating Kidney disease, accompanied by lower back and leg pain, hernia masses, strangury, turbid urine, and spermatorrhea, the pulse should be deep, soft, and slippery (Chen Ru Er Hua).
Among these, frequent pulsations indicate deficiency or fire, while still/slow pulsations indicate cold or excess; all these must be discussed in conjunction with the pulse characteristics. Additionally, the five colors correspond to the five Zang organs; occasionally, green may appear, which signifies the intersection of Yin and Yang at the Ren Mai (Conception Vessel) and Du Mai (Governor Vessel).
In obese individuals, the pulse tends to be deep and knotted; in thin individuals, floating and long. In short-statured individuals, the pulse tends to be short and hurried; in tall-statured individuals, sparse and long. These principles must not be violated.
Obese persons have thick flesh, so their pulse should be deep and knotted; thin persons have thin flesh, so their pulse should be floating and long. Persons of short stature should have a short and hurried pulse; persons of tall stature should have a sparse and long pulse. If the pulse contradicts the physique, opposes it, and lacks harmony, it indicates death. It is not only the physical form that corresponds with the pulse; even the texture of the skin (smoothness or roughness) and its tension (looseness or tightness) should correspond with the pulse. The classics state: If the pulse is rapid, the skin at the Chi position (wrist) is also rapid; if the pulse is tense, the skin at the Chi position is also tense; if the pulse is relaxed, the skin at the Chi position is also relaxed; if the pulse is choppy, the skin at the Chi position is also rough; if the pulse is slippery, the skin at the Chi position is also smooth. This is what is meant.