与阴,名肾痹,得之沐浴清水而卧。脉沉重而中散者,因寒食成积,脉左转而沉重者气 ,积在胸中。脉右转
出不至寸口者,内有肉 也。转者横也,脉转而横,主腹有积,或在胁下,积聚脉亦大同。故《难经》曰∶
结微则积微,结甚则积甚。脉伏结者为积聚,浮结者为痼疾。如积聚脉不结伏,痼疾脉不浮结,为脉不应病者
死。
中毒洪大,细微必倾,尺寸数紧,钗直吐仍,此患蛊毒,急救难停。
钗直者,脉直如钗也。
喘急脉沉,肺胀停水,气逆填胸,脉必伏取。沉而实滑,身温易愈,身冷脉浮,尺涩难补。
手足温暖,脉静滑者生;身冷,脉浮涩者死。
嘈杂嗳气,审右寸关,紧滑可治,弦急则难。两寸弦滑,留饮胸间,脉横在寸,有积上拦。
右寸关脉紧而滑,常也,右关弦急欲作反胃者,难治。寸脉横者,膈有横积也。
呕吐无他,寸紧滑数,微数血虚,单浮胃薄,芤则有瘀,最忌涩弱。
脉阳紧阴数,其人食已则吐,紧小多寒,滑数痰火。微数血虚,令胸中冷。关浮胃虚,呕而嗳气不食,
恐怖即死。芤带紧者有瘀逆,脉紧涩小弱,自汗者死。
呃逆甚危,浮缓乃宜;弦急必死,结代促微。
弦急,木克土也。结代促微,元气衰也。
反胃噎膈,寸紧尺涩;紧芤或弦,虚寒之厄;关沉有痰,浮涩脾积;弱大气虚,涩小血弱;若涩而沉,
七情所搏。
寸紧胸满不食,尺涩故反胃也。紧芤或迟者,胃寒也。弦者,胃虚也。关脉沉大,有痰也。浮涩脾不磨食,
故朝食暮吐,暮食朝吐。脉紧涩者难治。
脉弦直,或沉细些,汗后欲解,脉泼如蛇,伏坚尚可,伏弦伤嗟。
脉来,按之筑筑然而弦,直上直下,或沉细迟。若发汗后,脉泼泼然如蛇,暴腹胀大。为欲解。如脉
反伏弦者必死。
癫痫之脉,阳浮阴沉,数热滑痰,狂发于心。惊风肝痫,弦急可寻,浮病腑浅,沉病脏深。
阳证脉必浮长,阴证脉必沉细。虚弦为惊为风痫;沉数为热,滑疾为痰。脉滑大为病在腑则易治,脉
沉涩入脏者难治。叔和云∶恍惚之病定癫狂,其脉实牢保安吉;寸关尺部沉细时,如此未闻人救得。所谓实牢,
即滑大也。
祟脉无常,乍短乍长,大小促结,皆痰为殃。遁尸脉紧,与证相妨。
邪祟脉,长短大小促结无常。凡五尸、鬼邪、遁疰病症,与脉全不相应也。
惊悸怔忡,寸动而弱,寸紧胃浮,悸病仍作。饮食痰火,伏动滑搏,浮微弦濡,忧惊过却,健忘神亏,
心虚浮薄。
寸口动而弱,动为惊,弱为悸。寸口脉紧,趺阳脉浮,胃气虚,是以惊悸,趺阳脉微而浮,浮为胃气虚,
微则不能食,此恐惧之脉,忧迫所致也。
喉痹之脉,两寸洪溢,上盛下虚,脉忌微伏。
尺脉微伏者死,实滑者生。
汗脉浮虚,或濡或涩,自汗在寸,盗汗在尺。
男女平人脉虚弱微细者,必有盗汗。
痿因肺燥,脉多浮弱,寸口若沉,发汗则错。足痛或软,专审于尺,滑疾洪缓,或沉而弱。
《脉经》曰∶脉浮弱,其人欲咳不得咳,咳则出涎而肺干,小便不利。寸口脉不出,反
为发汗,多唾唇燥,小便反难,大便如烂瓜豚膏,皆因误汗伤津液,以致肺燥也。
厥证数端,沉细为寒;沉伏而数,为热所干;脉喘为气,浮实痰顽;气弱微甚,大则血悭;寸大沉滑,
身冷必难。
卒厥尸厥,寸口沉大而滑,不知人,唇青身冷,为入脏即死;如身温和,汗自出,为入腑而后自愈。
尺沉而滑,恐是虫伤;紧急莫治,虚小何妨?
尺脉沉滑者,寸白虫;洪大者,蛔虫。
求嗣之脉,专责于尺;右尺偏旺,火动好色;左尺偏旺,阴虚非福;惟沉滑匀,易为生息。微涩精清,
兼迟冷极;若见微濡,入房无力。女不好生,亦尺脉涩。
沉滑者不可妄药,反燥精血。火旺者降火,阴虚者补阴,两尺俱微者,阴阳两补。精冷宜热药温中壮阳,
精清宜温药补脾补精,精射无力入子宫者补气。女人尺脉微涩者绝产。
老喜反脉,
男年八八喜尺旺,女年七七喜寸旺。
常细濡涩,
濡,气虚;涩,血虚。细濡涩多寿,弦紧洪多病。
滑大气痰,
甚则带歇。
风热紧逼。
与阴气相合,称为肾痹,这是由于在洗冷水澡后睡觉所致。脉象沉重而中间散乱的,是因为寒凉饮食导致积滞;脉象向左转且沉重的,是气机郁结,积滞在胸中。脉象向右转出但达不到寸口的,体内有息肉。所谓“转”是指横向的,脉象转而横,主腹部有积滞,或在胁下,积聚病的脉象也大致相同。所以《难经》说:结脉轻微则积滞轻微,结脉严重则积滞严重。脉伏且结的是积聚病,脉浮且结的是顽固性疾病。如果积聚病的脉象不结伏,顽固性疾病的脉象不浮结,这是脉象与病症不符,预后不良(死)。
中毒时脉象洪大,细微则必危殆;尺寸部脉数且紧,脉直如钗,呕吐不止,这是患蛊毒之症,急救难以停止。
“钗直”,是指脉象直硬如同发钗。
喘急而脉沉,是肺胀停水,气逆填塞胸中,脉象必然伏取。脉沉而实滑,身体温暖容易治愈;身体寒冷而脉浮,尺脉涩,难以补治。
手足温暖,脉静滑的能生;身体寒冷,脉浮涩的会死。
嘈杂嗳气,需仔细诊察右寸关脉,脉紧滑可治,脉弦急则难治。两寸脉弦滑,是饮邪留滞胸间,脉横在寸部,是有积滞上冲。
右寸关脉紧而滑,是正常的,若右关脉弦急欲作反胃者,难治。寸脉横的,是膈部有横积。
呕吐若无其他兼证,脉象寸部紧滑数,微数是血虚,单见浮脉是胃气薄弱,芤脉则有瘀血,最忌讳涩弱脉。
脉阳部紧阴部数的人,进食后即吐,紧小脉多属寒,滑数脉属痰火。微数脉为血虚,令胸中寒冷。关部浮脉为胃虚,呕而嗳气不食,若伴有恐惧感则死。芤脉带紧脉的有瘀逆,脉紧涩小弱,自汗出的会死。
呃逆非常危险,脉浮缓为宜;脉弦急必死,脉结代促微。
弦急,是木克土。结代促微,是元气衰败。
反胃噎膈,寸脉紧尺脉涩;紧芤或弦,是虚寒之厄;关脉沉有痰,浮涩脾积;弱脉大气虚,涩小脉血弱;若脉涩而沉,是七情所搏。
寸脉紧胸满不食,尺脉涩故反胃。紧芤或迟脉,是胃寒。弦脉,是胃虚。关脉沉大,有痰。浮涩脉脾不磨食,所以朝食暮吐,暮食朝吐。脉紧涩者难治。
脉弦直,或沉细些,发汗后欲解,脉象泼泼然如蛇游走,伏坚尚可,伏弦伤叹。
脉来,按之筑筑然而弦,直上直下,或沉细迟。若发汗后,脉象泼泼然如蛇,暴腹胀大,为欲解。如果脉反而伏弦的必死。
癫痫的脉象,阳浮阴沉,数热滑痰,狂发于心。惊风肝痫,脉弦急可寻,浮病在腑浅,沉病在脏深。
阳证脉必浮长,阴证脉必沉细。虚弦为惊为风痫;沉数为热,滑疾为痰。脉滑大为病在腑则易治,脉沉涩入脏者难治。叔和说:恍惚之病定为癫狂,其脉实牢保安吉;寸关尺部脉沉细时,如此未闻有人救得。所谓实牢,即滑大也。
祟脉无常,乍短乍长,大小促结,皆因痰为殃。遁尸脉紧,与证相妨。
邪祟脉,长短大小促结无常。凡五尸、鬼邪、遁疰病症,与脉全不相应。
惊悸怔忡,寸口动而弱,寸紧胃浮,悸病仍作。饮食痰火,伏动滑搏,浮微弦濡,忧惊过却,健忘神亏,心虚浮薄。
寸口动而弱,动为惊,弱为悸。寸口脉紧,趺阳脉浮,胃气虚,是以惊悸,趺阳脉微而浮,浮为胃气虚,微则不能食,此恐惧之脉,忧迫所致。
喉痹的脉象,两寸洪溢,上盛下虚,脉忌微伏。
尺脉微伏者死,实滑者生。
汗证的脉象浮虚,或濡或涩,自汗在寸,盗汗在尺。
男女平人脉虚弱微细的,必有盗汗。
痿证因肺燥,脉多浮弱,寸口若沉,发汗则错。足痛或软,专审于尺,滑疾洪缓,或沉而弱。
《脉经》说:脉浮弱,其人欲咳不得咳,咳则出涎而肺干,小便不利。寸口脉不出,反为发汗,多唾唇燥,小便反难,大便如烂瓜豚膏,皆因误汗伤津液,以致肺燥。
厥证数端,沉细为寒;沉伏而数,为热所干;脉喘为气,浮实痰顽;气弱微甚,大则血悭;寸大沉滑,身冷必难。
卒厥尸厥,寸口沉大而滑,不知人,唇青身冷,为入脏即死;如身温和,汗自出,为入腑而后自愈。
尺沉而滑,恐是虫伤;紧急莫治,虚小何妨?
尺脉沉滑者,寸白虫;洪大者,蛔虫。
求嗣的脉象,专责于尺;右尺偏旺,火动好色;左尺偏旺,阴虚非福;惟沉滑匀,易为生息。微涩精清,兼迟冷极;若见微濡,入房无力。女不好生,亦尺脉涩。
沉滑者不可妄药,反燥精血。火旺者降火,阴虚者补阴,两尺俱微者,阴阳两补。精冷宜热药温中壮阳,精清宜温药补脾补精,精射无力入子宫者补气。女人尺脉微涩者绝产。
老人喜欢反常的脉象,
男子年八八喜尺旺,女子年七七喜寸旺。
风热紧逼。
Combining with Yin Qi, it is named Kidney Bi (Kidney Obstruction), caused by sleeping after bathing in cold water. A pulse that is heavy and scattered in the middle indicates accumulation due to cold food; a pulse turning leftward and heavy indicates Qi stagnation with accumulation in the chest. A pulse turning rightward but failing to reach the Cun (inch) position indicates internal polyps. "Turning" refers to horizontal movement; a pulse turning horizontally suggests abdominal accumulation, possibly under the hypochondrium; the pulse of accumulation masses is generally similar. Thus, *Nan Jing* states: slight knotting implies slight accumulation, severe knotting implies severe accumulation. A deep and knotted pulse indicates accumulation masses; a floating and knotted pulse indicates chronic disease. If the pulse of accumulation masses is not deep and knotted, or if the pulse of chronic disease is not floating and knotted, this mismatch between pulse and disease indicates death.
In poisoning, the pulse is surging and large; if fine and minute, collapse is certain. Rapid and tight pulses at the Cun and Chi positions, with a straight pulse like a hairpin, accompanied by persistent vomiting, indicate Gu Poison (Gu Toxin); emergency rescue is difficult to stop.
"Zhchai Zhi" (Straight as a Hairpin) means the pulse is rigid and straight like a hairpin.
Wheezing and urgency with a deep pulse indicate Lung Distension with fluid retention, rebellious Qi filling the chest; the pulse must be sought deeply. A deep, solid, and slippery pulse with warm body temperature indicates easy recovery; a cold body with a floating pulse and coarse Chi pulse indicates difficulty in tonification.
Warm hands and feet with a quiet and slippery pulse indicate survival; a cold body with a floating and coarse pulse indicates death.
Heartburn and belching require careful examination of the Right Cun and Guan positions; a tight and slippery pulse is treatable, while a wiry and urgent pulse is difficult. Wiry and slippery pulses at both Cun positions indicate retained fluid in the chest; a horizontal pulse at the Cun position indicates upward obstruction by accumulation.
A tight and slippery pulse at the Right Cun and Guan is normal; however, a wiry and urgent pulse at the Right Guan suggesting Fan Wei (Reverse Regurgitation) is difficult to treat. A horizontal pulse at the Cun position indicates transverse accumulation in the Diaphragm.
Vomiting without other symptoms, with a tight, slippery, and rapid pulse at the Cun position; slight rapidity indicates Blood deficiency; floating alone indicates thin Stomach Qi; hollow (Kou) pulse indicates blood stasis; coarse and weak pulses are most contraindicated.
A tight pulse at the Yang position and rapid at the Yin position indicates vomiting immediately after eating; tight and small pulses indicate Cold; slippery and rapid pulses indicate Phlegm-Fire. Slight rapidity indicates Blood deficiency causing coldness in the chest. Floating at the Guan position indicates Stomach deficiency, with vomiting, belching, and anorexia; if accompanied by fear, death ensues. A Kou pulse with tightness indicates rebellious stasis; a tight, coarse, small, and weak pulse with spontaneous sweating indicates death.
Hiccups are critical; a floating and slow pulse is suitable; a wiry and urgent pulse indicates death; knotted, intermittent, hurried, or minute pulses occur.
Wiry and urgent indicate Wood overacting on Earth. Knotted, intermittent, hurried, or minute pulses indicate decline of Yuan Qi (Original Qi).
Fan Wei (Reverse Regurgitation) and Ye Ge (Dysphagia) present with tight Cun and coarse Chi pulses; tight, hollow, or wiry pulses indicate the disaster of Deficiency-Cold; deep Guan pulses indicate Phlegm; floating and coarse pulses indicate Spleen accumulation; weak pulses indicate Qi deficiency; coarse and small pulses indicate Blood weakness; coarse and deep pulses indicate constraint by the Seven Emotions.
Tight Cun pulse with chest fullness and anorexia, coarse Chi pulse causing reverse regurgitation. Tight, hollow, or slow pulses indicate Stomach Cold. Wiry pulse indicates Stomach deficiency. Deep and large Guan pulse indicates Phlegm. Floating and coarse pulses indicate Spleen failure to digest food, leading to vomiting morning food in the evening or evening food in the morning. Tight and coarse pulses are difficult to treat.
A wiry and straight pulse, or slightly deep and fine, suggests resolution after sweating; a pulse flowing freely like a snake indicates impending resolution; deep and firm is acceptable; deep and wiry causes lamentation.
When the pulse comes, pressing reveals a throbbing, wiry quality, moving straight up and down, or deep, fine, and slow. After sweating, if the pulse flows freely like a snake and sudden abdominal distension occurs, it indicates impending resolution. If the pulse reverses to deep and wiry, death is certain.
The pulse of Epilepsy is floating at Yang and deep at Yin; rapid indicates Heat, slippery indicates Phlegm, mania originates in the Heart. Convulsive wind and Liver epilepsy present with wiry and urgent pulses; floating indicates superficial Fu organ disease, deep indicates deep Zang organ disease.
Yang syndrome pulses must be long and floating; Yin syndrome pulses must be fine and deep. Deficient and wiry indicates fright and wind epilepsy; deep and rapid indicates Heat; slippery and rapid indicates Phlegm. Slippy and large pulses indicate Fu organ disease which is easy to treat; deep and coarse pulses entering Zang organs are difficult to treat. He Shu said: Faint and confused diseases are defined as Dian Kuang (Epilepsy and Mania); if the pulse is solid and firm, safety and auspiciousness are ensured; if the Cun, Guan, and Chi positions are all deep and fine, no cure has been heard of. What is called solid and firm is essentially slippy and large.
Sui (Spirit) pulses are irregular, suddenly short or long, varying in size, hurried or knotted, all caused by Phlegm disasters. Dun Shi (Escaping Corpse) pulses are tight, conflicting with the syndrome.
Evil spirit pulses vary irregularly in length, size, and rhythm. All Five Corpse, Ghost Evil, and Dun Zhu syndromes do not correspond to the pulse at all.
Fright palpitations and constant palpitations present with a moving and weak pulse at the Cun position; tight Cun and floating Stomach pulses cause palpitations to recur. Dietary Phlegm-Fire, hidden movement, slippy and pounding pulses, or floating, minute, wiry, and soggy pulses indicate excessive worry and fright; forgetfulness and spirit depletion indicate Heart deficiency with floating and thin qualities.
Cun position moving and weak: movement indicates fright, weakness indicates palpitations. Cun position tight and Duyang position floating indicate Stomach Qi deficiency, hence fright and palpitations; Duyang position minute and floating: floating indicates Stomach Qi deficiency, minute indicates inability to eat; this is the pulse of fear, caused by distress.
Throat Bi (Obstruction) pulses are surging and overflowing at both Cun positions, indicating excess above and deficiency below; micro-deep pulses are contraindicated.
Micro-deep Chi pulse indicates death; solid and slippy indicates survival.
Sweating pulses are floating and deficient, or soggy or coarse; spontaneous sweating is at the Cun position, night sweating is at the Chi position.
In men and women with normal constitutions, a weak, minute, and fine pulse always indicates night sweating.
Wei Syndrome (Flaccidity) is due to Lung dryness; pulses are mostly floating and weak. If the Cun position is deep, sweating therapy is erroneous. Foot pain or softness requires specific examination of the Chi position; slippy, rapid, surging, and slow, or deep and weak.
*Mai Jing* states: Floating and weak pulse, the person desires to cough but cannot, coughing produces saliva and dries the Lungs, urination is difficult. If the Cun pulse does not emerge and sweating is administered instead, there is excessive salivation, dry lips, difficult urination, and stool resembling rotten melon or pig fat; all result from mistaken sweating damaging Jin Ye (Body Fluids), leading to Lung dryness.
Jue Syndrome has several types: deep and fine indicates Cold; deep, hidden, and rapid indicates interference by Heat; panting pulse indicates Qi issues; floating and solid indicates stubborn Phlegm; Qi weakness with extreme minuteness, or large indicates Blood scarcity; large and deep-slippy at the Cun with cold body indicates difficulty.
Su Jue (Sudden Collapse) and Shi Jue (Corpse-like Collapse): Cun position deep, large, and slippy, unconsciousness, blue lips, cold body indicate entry into Zang organs leading to death; if the body is warm and sweat comes out spontaneously, entry into Fu organs leads to self-recovery.
Deep and slippy Chi pulse suggests worm injury; urgent and tight should not be treated; weak and small is permissible?
Deep and slippy Chi pulse indicates Ascaris lumbricoides (Roundworm); surging and large indicates Roundworm.
Pulses for seeking offspring focus on the Chi position; Right Chi exuberance indicates Fire agitation and lust; Left Chi exuberance indicates Yin deficiency and misfortune; only uniform deep and slippy pulses facilitate reproduction. Minute and coarse with clear semen, combined with slow indicates extreme Cold; if minute and soggy appears, impotence during intercourse. Women with poor fertility also have coarse Chi pulses.
Deep and slippy pulses should not be medicated recklessly, as it may dry Jing (Essence) and Blood. For Fire exuberance, descend Fire; for Yin deficiency, tonify Yin; if both Chi positions are minute, tonify both Yin and Yang. Cold semen requires hot medicines to warm the Middle and strengthen Yang; clear semen requires warm medicines to tonify Spleen and Essence; weak ejaculation into the uterus requires Qi tonification. Women with minute and coarse Chi pulses face sterility.
Old people prefer contrary pulses:
Men aged 8x8 favor exuberant Chi pulses; Women aged 7x7 favor exuberant Cun pulses.
Normally fine, soggy, and coarse:
Soggy indicates Qi deficiency; Coarse indicates Blood deficiency. Fine, soggy, and coarse pulses often indicate longevity; wiry, tight, and surging pulses often indicate disease.
Slippy indicates abundant Qi and Phlegm;
Severe cases include intermittent pauses.
Wind-Heat presses tightly.