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玉机真藏篇曰∶脉从四时,谓之可治。脉弱以滑,是有胃气,命曰易治,取之以时。
春脉者肝也,东方木也,万物之所以始生也。故其气来,软弱轻虚而滑,端直以长曰弦,反
此者病。其气来实而强,此谓太过,病在外;其气来不实而微,此谓不及,病在中。太过则令人
善怒,忽忽眩冒而巅疾,不及则令人胸痛引背,下则两 满。春以胃气为本,春胃微弦曰平,弦
多胃少曰肝病,但弦无胃曰死。胃而有毛曰秋病,毛甚曰今病。
夏脉者心也,南方火也,万物之所以盛长也。故其气来盛去衰曰钩,反此者病。其气来盛去
亦盛,此谓太过,病在外;其气来不盛去反盛,此谓不及,病在中。太过则令人身热肤痛为浸淫,
不及则令人烦心,上见咳唾,下为气泄。
夏以胃气为本,夏胃微钩曰平,钩多胃少曰心病,但钩无胃曰死。胃而有石曰冬病,石甚曰今病。
秋脉者肺也,西方金也,万物之所以收成也。其气来轻虚以浮、来急去散曰毛,反此者病。
其气来毛而中
央坚两傍虚,此谓太过,病在外;其气来毛而微,此谓不及,病在中。太过则令人逆气而背痛,
不及则令人喘、呼吸少气而咳,上气出血、下闻病音。
秋以胃气为本,秋胃微毛曰平,毛多胃少曰肺病,但毛无胃曰死。胃而有弦曰春病,弦甚曰今病。
冬脉者肾也,北方水也,万物之所以合藏也,其气来沉而搏曰石,反此者病。其气来如弹石,
此谓太过,病在外;其去如数,此谓不及,病在中。太过则令人解 ,脊痛而少气,不欲言,不
及则令人心悬如病饥, 中清,脊中痛,少腹满,小便变。
冬以胃气为本,冬胃微石曰平,石多胃少曰肾病,但石无胃曰死。石而有钩曰夏病,钩甚曰今病。
脾脉者土也,孤藏以灌四傍者也。平脾脉来,如鸡践地,和柔相离。其来如水之流,此谓太
过,病在外;如鸟之啄,此谓不及,病在中。太过则令人四肢不举,不及则令人九窍不通。
长夏以胃气为本,胃惟软弱曰平,弱多胃少曰脾病,但代无胃曰死,软弱有石曰冬病,石甚曰今病。
脉逆四时为不可治,必察四难而明告之。所谓逆四时者,春得肺脉,夏得肾脉,秋得心脉,
冬得脾脉,其至皆悬绝沉涩者,命曰逆四时。未有脏形,于春夏而脉沉涩,秋冬而脉洪大名曰逆
四时也。
凡脉顺四时者,谓春弦夏洪秋毛冬石,中有和气,软滑而长,乃是不病之人也,得病则易为
治疗,盖从和气而生也,用法万痊。如气反脉逆,形气相失,名曰不可治,是形盛气虚、形虚气
盛,故不可治也。凡人形气俱虚,安谷者过期而死,不安谷者不过期而死。安谷谓饮食且进,期
是八节之气候也。(《鸡峰方》)
人迎神门脉图 [图片占位符]
命门脉图 [图片占位符]
《玉机真藏篇》说:脉象顺应四时变化,称为可治。脉象软弱而滑利,说明有胃气(脾胃运化功能及气血生化之源),称为易治,治疗要把握时机。
春脉对应肝脏,属东方木行,是万物开始生长的时节。所以春季脉气来时,软弱、轻虚而滑,端直且长,称为弦脉(如按琴弦),与此相反则为病态。如果脉气来时充实而强劲,这叫做“太过”,病在体表;如果脉气来时不充实而微弱,这叫做“不及”,病在体内。太过则使人容易发怒,恍惚眩晕并导致头顶疾病(巅疾);不及则使人胸痛牵引背部,下部两侧胁肋胀满。春季脉象以胃气为本底,春季脉象微带弦意称为平脉(正常脉象),弦意多而胃气少称为肝病,只有弦意而没有胃气称为死脉。如果有胃气但兼见毛脉(浮涩如羽毛,秋季脉象特征),预示秋季发病,毛脉明显则当下即病。
夏脉对应心脏,属南方火行,是万物盛大生长的时节。所以夏季脉气来时旺盛而去时衰弱,称为钩脉(来盛去衰,如钩之曲),与此相反则为病态。如果脉气来时旺盛,去时也旺盛,这叫做“太过”,病在体表;如果脉气来时不旺盛,去时反而旺盛,这叫做“不及”,病在体内。太过则使人身体发热、皮肤疼痛,发展为浸淫疮(一种蔓延性皮肤病);不及则使人心中烦闷,上部出现咳嗽吐痰,下部出现气泄(如遗尿、失禁或下利)。
夏季脉象以胃气为本底,夏季脉象微带钩意称为平脉,钩意多而胃气少称为心病,只有钩意而没有胃气称为死脉。如果有胃气但兼见石脉(沉实如石,冬季脉象特征),预示冬季发病,石脉明显则当下即病。
秋脉对应肺脏,属西方金行,是万物收获收藏的时节。其脉气来时轻虚而浮,来势急而去势散,称为毛脉(浮而轻虚),与此相反则为病态。如果脉气来时毛而中间坚实两边空虚,这叫做“太过”,病在体表;如果脉气来时毛而微弱,这叫做“不及”,病在体内。太过则使人气逆和背痛,不及则使人气喘、呼吸短促而咳嗽,上部气逆出血,下部能听到病变的声音(如肠鸣等)。
秋季脉象以胃气为本底,秋季脉象微带毛意称为平脉,毛意多而胃气少称为肺病,只有毛意而没有胃气称为死脉。如果有胃气但兼见弦脉,预示春季发病,弦脉明显则当下即病。
冬脉对应肾脏,属北方水行,是万物闭藏的季节,其脉气来时沉而搏指,称为石脉(沉实有力),与此相反则为病态。如果脉气来时像弹石一样坚硬,这叫做“太过”,病在体表;如果脉气去时急促(数),这叫做“不及”,病在体内。太过则使人肌肉松弛无力(解㑊),脊痛且气短,不想说话;不及则使人心里空虚感觉像得饥病一样,脐中清冷,脊中疼痛,小腹胀满,小便异常。
冬季脉象以胃气为本底,冬季脉象微带石意称为平脉,石意多而胃气少称为肾病,只有石意而没有胃气称为死脉。如果有胃气但兼见钩脉,预示夏季发病,钩脉明显则当下即病。
脾脉对应土行,是孤立的中宫脏腑,用来灌溉四方(其他四脏)。正常的脾脉来势,像鸡踩地一样,柔和而有节律。如果来势像水流一样湍急,这叫做“太过”,病在体表;如果来势像鸟啄食一样断续,这叫做“不及”,病在体内。太过则使人四肢不能抬举,不及则使人九窍(眼耳口鼻及前后二阴)不通畅。
长夏(季夏,农历六月)脉象以胃气为本底,脉象只有软弱之意称为平脉,弱意多而胃气少称为脾病,只有代脉(止有定数)而没有胃气称为死脉,软弱中兼见石脉预示冬季发病,石脉明显则当下即病。
脉象违背四时变化的是不可治,必须仔细考察四种难治的情况并明确告知患者。所谓违背四时,是指春季得到肺脉(毛),夏季得到肾脉(石),秋季得到心脉(钩),冬季得到脾脉(代/弱),这些脉象到来时都悬绝沉涩,叫做违背四时。在没有相应脏器病变形态的情况下,春夏季节脉象却沉涩,秋冬季节脉象却洪大,也叫做违背四时。
凡是脉象顺应四时的,称为春弦、夏洪(钩)、秋毛、冬石,其中含有和气(胃气),柔软、滑利且长,这是没有生病的人的特征,即使生病也容易治疗,因为是从和气中产生的,用药往往痊愈。如果气反常而脉逆乱,形体与正气不相适应,叫做不可治,这是因为形盛气虚或形虚气盛,所以不可治。大凡人的形体和正气都虚弱,能进食者会超过预期期限而死,不能进食者不会超过预期期限而死。“安谷”指饮食还能进用,“期”指八节(立春、立夏、立秋、立冬、春分、秋分、夏至、冬至)的气候更替周期。(出自《鸡峰方》)
[Image Placeholder: Ying-Ren Shen-Men Pulse Diagram]
[Image Placeholder: Ming-Men Pulse Diagram]
The *Yu Ji Zhen Cang Pian* (Chapter on the True Visceral Pulses of the Jade Machine) states: When the pulse conforms to the four seasons, it is termed treatable. A pulse that is weak and slippery indicates the presence of Stomach Qi (the source of qi and blood generation derived from spleen and stomach transformation), which is termed easily treatable; treatment should be timed appropriately.
The Spring pulse corresponds to the Liver, belonging to Wood in the East, representing the time when all things begin to grow. Therefore, its qi arrives soft, weak, light, empty, and slippery, straight and long, termed Xian pulse (String-like pulse, feeling like a zither string); deviation from this indicates disease. If the qi arrives solid and strong, this is termed "Excess" (Tai Guo), with disease located externally; if the qi arrives not solid but faint, this is termed "Deficiency" (Bu Ji), with disease located internally. Excess causes irritability, dizziness, vertigo, and diseases of the vertex (Dian Ji). Deficiency causes chest pain radiating to the back, and fullness in the lower bilateral hypochondriac regions. The Spring pulse takes Stomach Qi as its root. A Spring pulse slightly Xian is a Normal Pulse (Ping Mai); Xian more than Stomach Qi indicates Liver disease; only Xian without Stomach Qi indicates death. If there is Stomach Qi but also Mao pulse (Floating and rough like feathers, characteristic of Autumn), disease will occur in Autumn; pronounced Mao indicates disease occurring now.
The Summer pulse corresponds to the Heart, belonging to Fire in the South, representing the time when all things flourish and grow. Therefore, its qi arrives vigorous and departs declining, termed Gou pulse (Hook pulse, arriving vigorously and departing weakly); deviation from this indicates disease. If the qi arrives vigorous and departs vigorous, this is termed "Excess," with disease located externally; if the qi arrives not vigorous but departs vigorous, this is termed "Deficiency," with disease located internally. Excess causes body heat, skin pain, progressing to Jin Yin sores (spreading dermatological conditions). Deficiency causes mental restlessness, coughing and expectoration above, and Qi leakage (such as incontinence or diarrhea) below.
The Summer pulse takes Stomach Qi as its root. A Summer pulse slightly Gou is a Normal Pulse; Gou more than Stomach Qi indicates Heart disease; only Gou without Stomach Qi indicates death. If there is Stomach Qi but also Shi pulse (Sinking and solid like stone, characteristic of Winter), disease will occur in Winter; pronounced Shi indicates disease occurring now.
The Autumn pulse corresponds to the Lung, belonging to Metal in the West, representing the time when all things are harvested and stored. Its qi arrives light, empty, and floating, coming urgently and dispersing upon departure, termed Mao pulse; deviation from this indicates disease. If the qi arrives Mao but is firm in the center and empty on both sides, this is termed "Excess," with disease located externally; if the qi arrives Mao but faint, this is termed "Deficiency," with disease located internally. Excess causes rebellious Qi and back pain. Deficiency causes panting, shortness of breath, and coughing, upper rebellious Qi with bleeding, and audible pathological sounds below.
The Autumn pulse takes Stomach Qi as its root. An Autumn pulse slightly Mao is a Normal Pulse; Mao more than Stomach Qi indicates Lung disease; only Mao without Stomach Qi indicates death. If there is Stomach Qi but also Xian pulse, disease will occur in Spring; pronounced Xian indicates disease occurring now.
The Winter pulse corresponds to the Kidney, belonging to Water in the North, representing the time when all things are closed and stored. Its qi arrives sinking and beating against the finger, termed Shi pulse; deviation from this indicates disease. If the qi arrives hard like a bouncing stone, this is termed "Excess," with disease located externally; if the qi departs rapid (Shu), this is termed "Deficiency," with disease located internally. Excess causes muscle flaccidity (Xie Ji), back pain, shortness of breath, and reluctance to speak. Deficiency causes a sensation of heart hanging as if hungry, coldness at the umbilicus, back pain, lower abdominal fullness, and abnormal urination.
The Winter pulse takes Stomach Qi as its root. A Winter pulse slightly Shi is a Normal Pulse; Shi more than Stomach Qi indicates Kidney disease; only Shi without Stomach Qi indicates death. If there is Stomach Qi but also Gou pulse, disease will occur in Summer; pronounced Gou indicates disease occurring now.
the Spleen pulse corresponds to Earth. It is the isolated central Zang organ that irrigates the four directions (other four Zang organs). A normal Spleen pulse arrives like a chicken treading on ground, harmonious and soft with distinct rhythm. If it arrives like flowing water, this is termed "Excess," with disease located externally; if it arrives like a bird pecking, this is termed "Deficiency," with disease located internally. Excess causes inability to lift the limbs. Deficiency causes obstruction of the Nine Orifices (eyes, ears, nose, mouth, and two anterior/posterior orifices).
The Chang Xia (Late Summer) pulse takes Stomach Qi as its root. A pulse with only softness is a Normal Pulse; weakness more than Stomach Qi indicates Spleen disease; only Dai pulse (intermittent pulse with regular intervals) without Stomach Qi indicates death; softness combined with Shi pulse indicates disease in Winter; pronounced Shi indicates disease occurring now.
A pulse contrary to the four seasons is untreatable; one must carefully examine the four difficulties and clearly inform the patient. What is meant by contrary to the four seasons is: obtaining the Lung pulse (Mao) in Spring, the Kidney pulse (Shi) in Summer, the Heart pulse (Gou) in Autumn, and the Spleen pulse (Dai/Weak) in Winter, where these pulses arrive suspended, extreme, sinking, and choppy, termed contrary to the four seasons. Without visceral morphological signs, if the pulse is sinking and choppy in Spring and Summer, or large and prominent in Autumn and Winter, this is also termed contrary to the four seasons.
Whenever the pulse conforms to the four seasons, termed Spring Xian, Summer Hong (Gou), Autumn Mao, and Winter Shi, containing Harmonious Qi (Stomach Qi), being soft, slippery, and long, this characterizes a person without disease. If such a person becomes ill, it is easy to treat because it arises from Harmonious Qi, and medication often leads to complete recovery. If Qi is contrary and pulse is rebellious, and Form and Zheng Qi are discordant, it is termed untreatable, because this represents Form excess with Zheng Qi deficiency, or Form deficiency with Zheng Qi excess, hence untreatable. Generally, if a person's Form and Qi are both deficient, those who can eat will die after exceeding the expected period, while those who cannot eat will die before exceeding the expected period. "An Gu" refers to the ability to ingest food. "Qi" refers to the climatic cycles of the Eight Solar Terms (Li Chun, Li Xia, Li Qiu, Li Dong, Chun Fen, Qiu Fen, Xia Zhi, Dong Zhi). (From *Ji Feng Fang*)