歌云∶脾数中消好嗜眠,胃翻口臭及牙宣。
沉迟中满积滞凝;
沉迟中寒,因伤冷物成积,以致腹中胀满,少食,痰饮气促, 癖,鼓胀,急痛。
沉甚气促胸腹痛,
气短促,胸至脐腹疼痛。
沉缓气结腹不宁;
沉缓乃上盛下虚,气不升降,而气结在腹,短促不舒。
沉实虚火蒸脾土,
实乃隐伏,阳火在内,炎蒸脾土,致脾气虚,胃气壅,所以不能食,须要温和脾胃。
沉微土郁致心疼;
沉微,乃脾土郁结之气为患,上排于心为痛,或为噫气阻食。
沉伏积块或发痔,
伏主积,气块与痔,皆阴积所结而成。
沉涩少食肌不生;
涩乃心火虚少,致令脾无生气,不能宣化水谷,或作呕吐,或只食少,虽食亦不生肌,
沉濡少气弱气喘,
沉濡主少气,沉弱主气喘。
沉绝腹满四肢羸。
无脾脉者,苦下利,善呕,腹满身重,四肢不欲动。甚则肢瘦腹大,乃气蛊也,必有腹痛。
俱虚四逆泻不已,
脾胃俱虚,少气不足以息,四肢逆冷,寒泻不已。
俱实身热胀喘惊。
脾胃俱实,身热腹胀,胁痛作喘多惊。
命门沉实最为佳,
命门脉喜满指,沉实带滑不数。
微沉胞络无火邪;
初沉者,胞络相火本脉也。浮数则为火动,沉迟则为火衰。
三焦呼吸审虚实,
三焦无位,惟浮诊以呼吸审其虚实。呼出二至,则心肺上焦邪轻;吸入二至,则肝肾下焦邪轻;呼吸之间
一至,则脾胃中焦邪轻。先辈有以浮取上焦合心肺脉,中取中焦合脾胃脉,沉取下焦合肝肾脉。不合则气乱,
须再切之。但右尺有三脉,浮为三焦,略沉为胞络,沉为命门,不若以呼吸间取之。
女人三脉滑浮嘉;
女人喜满指浮泛,伏涩者无子。
浮数遗精还是热,
相火盛热,则精自流通。
浮迟冷泻气不奢;
浮迟,阳气已衰,故见冷泻,盗汗等症。
独浮便结风侵肺,
诀云∶尺部见之风入肺,大肠干涩固难通。
浮大腹胀脸红华;
腹胀脉浮大,宜调其血,火盛则脸红心躁。
浮弦停水或蒸怯,
弦主脐下急痛,停水为积,素虚者得之,为骨蒸怯症。
浮滑火泻渴饮茶;
浮滑,痰火作泻,口渴腹鸣。
浮紧小腹筑筑痛,
浮紧,下部筑然掣痛。
浮芤便血定无差∶
浮芤,大肠便血。
浮细虚汗心振惧,
浮细主畏寒,多汗心振。
浮绝阴冷子户遮。
右尺浮取脉绝者,无子户脉也。苦足冷阴寒,妇人绝产,带瘕无子。
沉数消渴小便赤,
沉数,命门火盛,主作渴溺赤。
沉迟冷泻便清频;
沉迟,命门火衰,故泻冷便清。
沉甚水肿缓腰痛,
沉甚,水症,必先脚膝,沉缓专主腰痛。
沉微疝痛泻浊津;
沉微主膀胱疼痛作泻,或津液下流为浊为带。
沉实转筋兼膝痛,
沉实主转筋,膝下痛,或下利,或便难。
沉涩脐冷竭精人;
沉涩,真精枯竭,大便秘滞,小腹与胫俱冷。
沉弱滑泻伏痛逼,
弱脉主脏冷滑泻,伏脉主下寒痛逼。
沉绝足冷见鬼神。
无命门脉者,苦足逆冷,上抢胸痛,梦入水见鬼善魇。
三脉贵有虚中实,
三脉俱实,则热极难解。三脉俱虚,则冷极难补。贵乎似虚而实,似弱而滑。
生死兼此断为真。
命门一云命脉,又两尺前一分名神门,诊命门脉上溢耳。凡病有此脉则生,无此脉则死。断生死固以胃气
为主,兼此尤为真的。但命门男女有异∶天道右旋,男子先生右肾,故命门在右,而肾在左;地道左旋,女子先
生左肾,故命门在左,而肾在右。若男子病,右尺部命脉好,病虽危不死;若女子病,左尺部命脉好,病虽危亦
不死。
歌诀云:脾脉数(脉搏快速)主中消(以多食易饥为主要表现的病证),患者喜好嗜睡;胃脉异常则见翻胃(食物入胃后复吐出来)、口臭及牙宣(牙龈萎缩出血)。
脉象沉迟(轻取不应,重按始得且至数缓慢)主中满(脘腹胀满)及积滞凝(气机阻滞、痰食积聚);若为沉迟之脉伴中寒,是因损伤冷物形成积滞,导致腹中胀满、食欲减退、痰饮内停气促、癖块(腹内结块)、鼓胀(腹部胀大如鼓)、急痛(剧烈疼痛)。
脉象沉甚(沉而有力或极深)致气短促、胸腹痛;表现为气短呼吸急促,从胸部至脐腹部位疼痛。
脉象沉缓(沉而松弛缓慢)主气结在腹、腹部不安宁;此乃上盛下虚,气机升降失常,气结于腹部,感到短促不舒。
脉象沉实(沉而有力)主虚火蒸灼脾土;“实”指邪气隐伏,阳火在内炎蒸脾土,致使脾气虚弱、胃气壅滞,所以不能进食,治疗须温和脾胃。
脉象沉微(沉而极细软无力)主土郁导致心疼(胃脘部疼痛);沉微之脉,是脾土郁结之气为患,向上冲排于心引起疼痛,或出现嗳气、阻碍饮食。
脉象沉伏(沉取至极,推筋着骨始得)主积块或痔疮发作;“伏”主积聚,气块与痔疮,皆由阴寒积结而成。
脉象沉涩(沉而往来艰涩不畅)主少食、肌肉不生;“涩”乃心火虚少,致使脾无生气,不能宣化水谷,或发生呕吐,或仅能少量进食,即使进食也不能长养肌肉。
脉象沉濡(沉而细软浮泛)主少气、弱脉主气喘;沉濡脉主元气不足,沉弱脉主气喘。
脉象沉绝(沉取完全摸不到)主腹满、四肢消瘦羸弱;没有脾脉者,苦于下利、频繁呕吐、腹部胀满、身体沉重、四肢不想活动。严重时肢体消瘦而腹部膨大,这是气蛊(以腹胀大为主症,四肢反瘦的病证),必定伴有腹痛。
脾胃脉俱虚(两尺脉或脾胃相关脉象均显虚弱)主四肢厥逆、泻痢不止;脾胃俱虚,元气不足气息微弱,四肢逆冷,寒性泻痢不止。
脾胃脉俱实(两尺脉或脾胃相关脉象均显充实有力)主身热、腹胀、气喘、惊悸;脾胃俱实,身体发热、腹部胀满、胁痛作喘、容易受惊。
命门脉(右尺脉)沉实最为吉利;命门脉喜欢满指有力,脉象沉实带滑但不数(不快)。
脉象微沉主胞络无火邪;初起沉脉,是胞络相火的本脉。若浮数则是火动,沉迟则是火衰。
三焦脉通过呼吸来审察虚实;三焦没有固定位置,只有通过浮取脉象,结合呼吸节奏来审察其虚实。呼气时脉动二至,说明心肺上焦邪气轻浅;吸气时脉动二至,说明肝肾下焦邪气轻浅;呼吸之间脉动一至,说明脾胃中焦邪气轻浅。先辈有主张浮取对应上焦合心肺脉,中取对应中焦合脾胃脉,沉取对应下焦合肝肾脉的。若不符合这种规律则气乱,需要重新切诊。但右尺部有三脉之分,浮取为三焦,略沉为胞络,沉取为命门,不如以呼吸间取的方法来区分更为准确。
女性三脉(寸关尺三部脉)滑利浮泛为吉;女性脉象喜欢满指浮泛,若见伏涩脉则无子嗣。
脉象浮数(浮而快)主遗精且属热证;相火盛热,则精液自行流通外泄。
脉象浮迟(浮而慢)主冷泻、气力不足;浮迟脉,阳气已经衰退,故见冷泻、盗汗等症状。
独见浮脉主大便干结、风邪侵肺;诀云:尺部见浮脉,乃风入肺,大肠干涩确实难以通畅。
脉象浮大主腹胀、面色红润;腹胀而脉浮大,宜调理血液,火盛则脸红心躁。
脉象浮弦(浮而端直以长)主停水或骨蒸怯症;弦脉主脐下急痛,停水成积,素体虚弱者得此脉,为骨蒸怯症(阴虚发热、形体消瘦的病证)。
脉象浮滑(浮而流利圆滑)主火泻、口渴想饮茶;浮滑脉,痰火作泻,口渴、腹鸣。
脉象浮紧(浮而绷急)主小腹筑筑痛;浮紧脉,下部突然掣痛。
脉象浮芤(浮大而中空)主便血,诊断确定无误;浮芤脉,大肠便血。
脉象浮细(浮而纤细)主虚汗、心惊恐惧;浮细脉主畏寒、多汗、心中震颤恐惧。
脉象浮绝(浮取完全摸不到)主阴冷、子宫闭塞;右尺浮取脉绝者,无子户脉。苦于足冷阴寒,妇人绝产、带下瘕块无子。
脉象沉数(沉而快)主消渴、小便赤黄;沉数脉,命门火盛,主口渴、尿赤。
脉象沉迟(沉而慢)主冷泻、大便清稀频数;沉迟脉,命门火衰,故泻下冷便清稀。
脉象沉甚(沉而极深)主水肿、沉缓主腰痛;沉甚脉,水症,必先见于脚膝,沉缓脉专主腰痛。
脉象沉微(沉而微弱)主疝痛、泻下浊津;沉微脉主膀胱疼痛作泻,或津液下流成为浊带。
脉象沉实(沉而有力)主转筋兼膝痛;沉实脉主转筋(肌肉痉挛),膝下痛,或下利,或排便困难。
脉象沉涩(沉而涩滞)主脐冷、精竭人瘦;沉涩脉,真精枯竭,大便秘滞,小腹与小腿俱冷。
脉象沉弱(沉而无力)主滑泻、伏脉主痛逼;弱脉主脏冷滑泻,伏脉主下寒痛迫。
脉象沉绝(沉取无脉)主足冷、见鬼神幻象;无命门脉者,苦于足逆冷,寒气上抢胸痛,梦入水中见鬼、善魇(多梦惊骇)。
三脉贵在似虚中有实意;三脉俱实,则热极难解;三脉俱虚,则冷极难补。贵在脉象似虚而实,似弱而滑。
判断生死兼以此法断定为真。命门一称命脉,又有将两尺前一分称为神门的,诊命门脉即是诊此上溢之脉。凡病有此脉则生,无此脉则死。判断生死固然以胃气为主,兼看命门脉尤为确切。但命门脉男女有别:天道右旋,男子先生右肾,故命门在右,而肾在左;地道左旋,女子先生左肾,故命门在左,而肾在右。若男子患病,右尺部命脉好,病虽危重也不死;若女子患病,左尺部命脉好,病虽危重亦不死。
The song states: A *Shu* (Rapid) pulse in the Spleen indicates *Zhong Xiao* (Middle Jiao Wasting-Thirst, characterized by excessive hunger), with a preference for lethargy; Stomach abnormalities manifest as *Fan Wei* (Regurgitation/Inverted Stomach), bad breath, and *Ya Xuan* (Gum Recession/Hemorrhage).
A *Chen Chi* (Deep and Slow) pulse indicates *Zhong Man* (Abdominal Fullness) and stagnant accumulation; if accompanied by *Zhong Han* (Middle Jiao Cold), it results from injury by cold substances forming accumulations, leading to abdominal distension, poor appetite, phlegm-fluid retention causing shortness of breath, *Pi* masses (abdominal lumps), *Gu Zhang* (Drum-like Distension/Tympanites), and acute pain.
An extremely *Chen* (Deep) pulse causes shortness of breath and chest-abdominal pain; this presents as respiratory shortness and pain extending from the chest to the umbilicus and abdomen.
A *Chen Huan* (Deep and Slack/Slow) pulse indicates Qi stagnation in the abdomen and restlessness; this is due to excess above and deficiency below, with impaired Qi ascending and descending, causing Qi knotting in the abdomen and a sensation of shortness and discomfort.
A *Chen Shi* (Deep and Excess/Firm) pulse indicates deficient fire steaming the Spleen Earth; "Shi" implies hidden pathogens, with Yang fire internally steaming the Spleen Earth, causing Spleen Qi deficiency and Stomach Qi congestion, resulting in inability to eat, requiring warming and harmonizing of the Spleen and Stomach.
A *Chen Wei* (Deep and Minute/Weak) pulse indicates Heart pain caused by Earth depression; the *Chen Wei* pulse signifies pathology from depressed Qi of Spleen Earth rising to affect the Heart, causing pain, or belching and food obstruction.
A *Chen Fu* (Deep and Hidden/Profound) pulse indicates mass formation or hemorrhoid outbreaks; "Fu" governs accumulations; Qi masses and hemorrhoids are all formed by Yin accumulation and knotting.
A *Chen Se* (Deep and Choppy) pulse indicates poor appetite and failure of muscle growth; "Se" reflects deficient Heart Fire, causing the Spleen to lack vital energy, unable to transform and transport water and grain, potentially leading to vomiting, limited intake, or even if eating, failure to nourish muscles.
A *Chen Ru* (Deep and Soft/Floaty) pulse indicates insufficient Qi, while a *Ruo* (Weak) pulse indicates asthma/panting; *Chen Ru* governs Qi insufficiency, and *Chen Ruo* governs panting.
A *Chen Jue* (Deep and Absent) pulse indicates abdominal fullness and emaciated limbs; absence of the Spleen pulse leads to suffering from diarrhea, frequent vomiting, abdominal fullness, heaviness of the body, and reluctance to move the limbs. In severe cases, limbs become thin while the abdomen enlarges, known as *Qi Gu* (Qi Drum/Tympanites with limb emaciation), necessarily accompanied by abdominal pain.
When both Spleen and Stomach pulses are *Xu* (Deficient), it indicates *Si Ni* (Four Extremities Reversal/Cold Limbs) and unceasing diarrhea; Spleen and Stomach deficiency leads to insufficient Qi and breath, cold extremities, and persistent cold-type diarrhea.
When both Spleen and Stomach pulses are *Shi* (Excess), it indicates body heat, distension, panting, and惊悸 (Palpitations/Fright); Spleen and Stomach excess manifests as fever, abdominal distension, hypochondriac pain, panting, and susceptibility to fright.
The *Ming Men* (Gate of Life) pulse being *Chen Shi* (Deep and Firm) is most auspicious; the *Ming Men* pulse prefers to be full under the fingers, deep, firm, slippery, but not rapid (*Bu Shu*).
A slightly *Chen* (Deep) pulse indicates no Fire pathogen in the *Bao Luo* (Uterine Collaterals); an initial *Chen* pulse is the normal pulse for *Xiang Huo* (Ministerial Fire) in the collaterals. *Fu Shu* (Superficial and Rapid) indicates Fire agitation, while *Chi Chi* (Deep and Slow) indicates Fire decline.
The *San Jiao* (Triple Burner) pulse requires assessment of Deficiency and Excess through respiration; the San Jiao has no fixed location, so its Deficiency and Excess must be assessed via superficial palpation combined with breathing rhythms. Two beats during exhalation indicate mild pathogenic factors in the Upper Jiao (Heart and Lungs); two beats during inhalation indicate mild pathogenic factors in the Lower Jiao (Liver and Kidneys); one beat between breaths indicates mild pathogenic factors in the Middle Jiao (Spleen and Stomach). Ancestors suggested that superficial palpation corresponds to the Upper Jiao (Heart/Lungs), middle pressure to the Middle Jiao (Spleen/Stomach), and deep pressure to the Lower Jiao (Liver/Kidneys). If this does not hold, Qi is chaotic, and re-palpation is necessary. However, the Right *Chi* (Cun-Kou position) has three layers: superficial is San Jiao, slightly deep is Bao Luo, and deep is Ming Men. It is preferable to use the respiration method for differentiation.
For women, three pulses (*San Mai*) being slippery and floating is auspicious; women's pulses prefer to be full and floating under the fingers; *Fu Se* (Hidden and Choppy) pulses indicate infertility.
A *Fu Shu* (Superficial and Rapid) pulse indicates seminal emission due to Heat; excessive Ministerial Fire and Heat cause spontaneous seminal flow.
A *Fu Chi* (Superficial and Slow) pulse indicates cold diarrhea and Qi insufficiency; *Fu Chi* indicates declining Yang Qi, presenting with cold diarrhea, night sweats, etc.
Isolated *Fu* (Superficial) pulse indicates constipation and Wind invading the Lung; the maxim states: Wind entering the Lung is seen at the *Chi* position, where dryness and chopiness of the Large Intestine make passage difficult.
A *Fu Da* (Superficial and Large) pulse indicates abdominal distension and ruddy complexion; abdominal distension with a superficial-large pulse requires blood regulation; excessive Fire causes facial redness and heart irritability.
A *Fu Xian* (Superficial and String-taut) pulse indicates fluid retention or bone-stealing deficiency syndrome; *Xian* governs urgency and pain below the umbilicus, fluid retention forming masses; in constitutionally weak individuals, it indicates *Gu Zheng Qie Zheng* (Bone-Stealing Deficiency Syndrome, a type of Yin-deficiency fever).
A *Fu Hua* (Superficial and Slippery) pulse indicates Fire diarrhea and thirst for tea; *Fu Hua* indicates Phlegm-Fire causing diarrhea, thirst, and borborygmus.
A *Fu Jin* (Superficial and Tight) pulse indicates throbbing pain in the lower abdomen; *Fu Jin* indicates sudden pulling pain in the lower region.
A *Fu Kou* (Superficial and Hollow) pulse definitively indicates hematochezia; *Fu Kou* indicates bleeding from the Large Intestine.
A *Fu Xi* (Superficial and Fine) pulse indicates deficient sweating, heart tremors, and fear; *Fu Xi* governs aversion to cold, profuse sweating, and cardiac trembling/fear.
A *Fu Jue* (Superficial and Absent) pulse indicates Yin cold and uterine obstruction; absence of the pulse upon superficial palpation of the Right *Chi* indicates absence of the *Zi Hu* (Uterus) pulse. This leads to cold feet and Yin cold, female infertility, leukorrhea, masses, and childlessness.
A *Chen Shu* (Deep and Rapid) pulse indicates wasting-thirst and reddish urine; *Chen Shu* indicates excessive Fire in the Gate of Life, governing thirst and dark urine.
A *Chen Chi* (Deep and Slow) pulse indicates cold diarrhea and clear, frequent stools; *Chen Chi* indicates declining Fire in the Gate of Life, resulting in cold, clear diarrhea.
An extremely *Chen* (Deep) pulse indicates edema, while *Chen Huan* (Deep and Slack) governs lower back pain; extreme depth indicates Water disorders, starting in the legs/knees; *Chen Huan* specifically governs lower back pain.
A *Chen Wei* (Deep and Minute) pulse indicates hernia pain and discharge of turbid fluids; *Chen Wei* governs bladder pain with diarrhea, or downward flow of fluids becoming turbid discharge or leukorrhea.
A *Chen Shi* (Deep and Firm) pulse indicates muscle cramps and knee pain; *Chen Shi* governs cramps, pain below the knees, diarrhea, or difficulty defecating.
A *Chen Se* (Deep and Choppy) pulse indicates cold navel and depleted essence/emaciation; *Chen Se* indicates depletion of true essence, constipation, and coldness in the lower abdomen and calves.
A *Chen Ruo* (Deep and Weak) pulse indicates slippery diarrhea, while *Fu* (Hidden) pulse indicates pressing pain from cold; *Ruo* pulse governs cold organs and slippery diarrhea; *Fu* pulse governs lower cold and pressing pain.
A *Chen Jue* (Deep and Absent) pulse indicates cold feet and hallucinations of ghosts; absence of the Gate of Life pulse leads to cold extremities, Qi rushing up to chest pain, dreams of entering water and seeing ghosts, and sleep paralysis.
The three pulses ideally possess a quality of "Excess within Deficiency"; if all three pulses are Excess, Heat is extreme and hard to resolve; if all are Deficient, Cold is extreme and hard to tonify. The ideal is a pulse that appears Deficient yet Firm, or Weak yet Slippery.
Judging life and death by combining these methods is accurate. The Gate of Life is also called the Life Pulse; some refer to the anterior one-third of the *Chi* position as *Shen Men*. Diagnosing the Gate of Life pulse involves assessing this overflowing pulse. Presence of this pulse means survival; absence means death. While judgment of life/death primarily relies on Stomach Qi, including the Gate of Life pulse makes the diagnosis more accurate. However, the Gate of Life differs between genders: Heaven's Way rotates right, men generate the Right Kidney first, so the Gate of Life is on the Right and the Kidney on the Left; Earth's Way rotates left, women generate the Left Kidney first, so the Gate of Life is on the Left and the Kidney on the Right. If a man is ill and the Right *Chi* Life Pulse is good, he will survive despite critical condition; if a woman is ill and the Left *Chi* Life Pulse is good, she will survive despite critical condition.