阴也,脏也。若人迎、气口俱紧盛,此为夹食伤寒,为内伤外感俱见也。又阳经取决于人迎,阴经取决于气
口。左脉不和,为病在表,为阳,主四肢;右脉不和,为病在里,为阴,主腹脏。
至于诸脉,又有表里、阴阳主病之异,何也?盖谓脉有七表、八里、九道,凡二十四种是也。自六朝以
前,诊视固无此说,然此起于高阳生之议论,义虽未得其统要,然智者缘此而进,亦足以察
病之原委焉。七表者何?谓浮、芤、滑、实、弦、紧、洪也。歌曰∶浮按不足举有余,芤脉中空两畔居。滑
体如珠中有力,实形逼逼与长俱。弦如始按弓弦状,紧若牵绳转索状,洪举按之皆极大。此名七表不同途。
其见于病曰∶浮为中风芤失血,滑吐实下分明别,弦为拘急紧为疼,洪大从来偏主热。八里如何?微、沉、
缓、涩、迟、伏、濡、弱也。歌曰∶微来如有又如无,沉举全无按有余,迟
缓息间三度至,濡来散止细仍虚,伏须切骨沉相类,弱脉沉微指下图,涩脉如刀轻刮竹,分明入里坦如途。其
见于病曰∶迟寒缓结微为痞,涩因血少沉气滞,伏为积聚濡不足,弱则筋痿少精气。九道者何?长、短、促、
结、虚、细、代、牢、动也。歌曰∶长脉流利通三部,短脉本部不及些,虚脉迟大无力软,促脉来数急促欤,
结脉时止而迟缓,代脉不还真可吁,牢脉如弦沉更实,动脉鼓动无定居,细脉虽有但如线,九道之形乃自殊。
其见于病曰∶长为阳毒三焦热,短气壅郁未得倡,促阳气拘时兼滞,虚为血少热生惊,代主
气耗细气少,牢气满急时主疼,结主积气闷兼痛,动是虚劳血痢崩。然七表属阳、八里属阴,九道有阴有阳,
各随寸、关、尺及脏腑诊之。若在寸口,膈以上病;在关中,胃以下病;在尺内,脐以下病。
大抵元气之来,力和而缓;邪气之至,力强而峻。凡尺脉上不至关为阴绝,寸脉下不至关为阳绝。阴阳相绝,
人何以根据,脉之大概,如斯而已。
阴,指脏。如果人迎脉和气口脉都紧盛,这是夹带食积的伤寒,表现为内伤与外感症状同时出现。另外,阳经的病证取决于人迎脉,阴经的病证取决于气口脉。左脉不和,说明病在体表,属阳,主要影响四肢;右脉不和,说明病在体内,属阴,主要影响腹部脏腑。
至于各种脉象,又有表里、阴阳主病的区别,为什么呢?这是因为脉象分为七表、八里、九道,共二十四种类型。从六朝以前来看,诊脉原本没有这种说法,但这起源于高阳生的议论。虽然其义理未能掌握统摄要领,但聪明的人借此可以进一步深入,也足以考察疾病的来龙去脉。所谓“七表”是什么?指的是浮、芤、滑、实、弦、紧、洪这七种脉象。歌诀说:浮脉轻取不足重按有余,芤脉中间空虚两边有,滑脉形态如珠中间有力,实脉形势饱满且长。弦脉像刚按下的弓弦状,紧脉像牵拉的绳索转动状,洪脉轻取重按都极大。这就叫七表各不相同。它们对应的病症是:浮脉主中风,芤脉主失血,滑脉主呕吐,实脉主下利(腹泻),界限分明;弦脉主拘急,紧脉主疼痛,洪大脉向来多主热证。
“八里”如何?指的是微、沉、缓、涩、迟、伏、濡、弱这八种脉象。歌诀说:微脉似有若无,沉脉轻取全无重按有余,迟脉一呼一吸之间跳动三次,濡脉散漫停止细而虚,伏脉需切至骨与沉脉相似,弱脉沉而微细在指下显现,涩脉像刀轻刮竹子般不流利,入里之脉坦荡如途(此处原文意指涩脉虽难辨但入里路径明确,或指其他脉入里特征,依文意直译)。它们对应的病症是:迟脉主寒,缓脉主结滞,微脉主痞证;涩脉因血少所致,沉脉因气滞所致;伏脉主积聚,濡脉主不足;弱脉主筋痿和精气不足。
“九道”是什么?指的是长、短、促、结、虚、细、代、牢、动这九种脉象。歌诀说:长脉流利贯通三部,短脉在本部不及少许,虚脉迟大而无力柔软,促脉来数急促,结脉时有间歇且迟缓,代脉不能自还令人叹息,牢脉像弦脉且沉而实,动脉鼓动无固定位置,细脉虽有但如线一般,这九道的形态自然殊异。它们对应的病症是:长脉主阳毒和三焦热,短脉主气壅郁不得宣畅,促脉主阳气拘急时常兼有滞涩,虚脉主血少热生惊悸,代脉主气耗,细脉主气少;牢脉主气满急时常主疼痛,结脉主积气闷痛,动脉主虚劳、血痢和崩漏。
然而,七表属阳,八里属阴,九道既有阴也有阳,各随寸、关、尺及脏腑进行诊断。如果在寸口部位,对应膈以上的病;在关部,对应胃以下的病;在尺部,对应脐以下的病。
大致来说,元气到来时,脉力柔和而缓慢;邪气到来时,脉力强盛而峻急。凡是尺脉上不至关部称为阴绝,寸脉下不至关部称为阳绝。阴阳相互隔绝,人依靠什么生存呢?脉象的大概情况,就是这样罢了。
Yin refers to the Zang organs. If both the Renying pulse (Human Welcome Pulse) and the Qikou pulse (Qi Mouth Pulse) are tight and vigorous, this indicates Taiyang disease (Disease of the Taiyang channel) complicated by food retention, manifesting as simultaneous internal injury and external contraction. Furthermore, diseases of the Yang channels are determined by the Renying pulse, while diseases of the Yin channels are determined by the Qikou pulse. Disharmony in the left pulse indicates disease at the exterior, belonging to Yang, primarily affecting the four limbs; disharmony in the right pulse indicates disease at the interior, belonging to Yin, primarily affecting the abdominal Zang-Fu organs.
Regarding various pulse types, there are differences in their association with the exterior/interior and Yin/Yang in determining disease. Why is this? It is because pulses are categorized into Seven Exterior (Qi Biao), Eight Interior (Ba Li), and Nine Dao (Jiu Dao), totaling twenty-four types. Prior to the Six Dynasties period, such a classification did not exist in pulse diagnosis. However, this originated from the discussions of Gao Yangsheng. Although its principles may not have grasped the essential unity, wise individuals can use it to advance their understanding, which is sufficient for investigating the origin and course of diseases. What are the "Seven Exterior"? They are Floating (Fu), Knotted/Hollow (Kou), Slippery (Hua), Full/Solid (Shi), Bowstring (Xian), Tight (Jin), and Surging (Hong). The rhyme states: "Floating feels insufficient on light pressure but abundant on heavy pressure; Kou pulse is hollow in the middle with substance on both sides. Slippy body resembles a pearl with strength within; Full form is robust and long. Bowstring feels like a newly pressed bowstring; Tight resembles a pulled rope twisting; Surging is extremely large on both light and heavy pressure." These are called the Seven Exterior, each distinct. Their corresponding diseases are: Floating indicates Wind-Strike (Zhong Feng); Kou indicates blood loss; Slippery indicates vomiting; Full indicates diarrhea/dysentery, clearly distinguished. Bowstring indicates spasms/tightness; Tight indicates pain; Surging and Large traditionally predominantly indicate Heat.
How about the "Eight Interior"? They are Faint (Wei), Deep (Chen), Slow/Lax (Huan), Choppy (Se), Delayed (Chi), Hidden (Fu), Soft (Ru), and Weak (Ruo). The rhyme states: "Wei comes as if present yet absent; Chen is completely absent on light pressure but abundant on heavy. Chi [Delayed] beats three times per respiration cycle; Ru comes scattered, stopping, fine and still deficient. Fu requires pressing to the bone, resembling Chen; Ruo pulse is deep, faint, and depicted below the fingers. Se pulse is like a knife lightly scraping bamboo, clearly entering the interior like a smooth path." Their corresponding diseases are: Chi indicates Cold; Huan indicates knotting/stagnation; Wei indicates Pi syndrome (fullness obstruction); Se is due to blood deficiency; Chen is due to Qi stagnation; Fu indicates accumulation/masses; Ru indicates insufficiency; Ruo indicates flaccidity of sinews and deficiency of essence/Qi.
What are the "Nine Dao" (Nine Paths)? They are Long (Chang), Short (Duan), Rapid/Irregular (Cu), Intermittent (Jie), Deficient (Xu), Fine (Xi), Replacement (Dai), Firm (Lao), and Moving (Dong). The rhyme states: "Chang pulse flows smoothly through all three positions; Duan pulse does not extend slightly beyond its own position. Xu pulse is slow, large, powerless, and soft; Cu pulse comes rapid and urgent. Jie pulse occasionally stops and is slow; Dai pulse fails to return, causing sighs. Lao pulse is like Xian, deep and full; Dong pulse throbs without fixed location. Xi pulse exists but is thread-like; the forms of the Nine Dao are naturally distinct." Their corresponding diseases are: Chang indicates Yang toxin and Sanjiao heat; Duan indicates Qi congestion and depression unrelieved; Cu indicates Yang Qi constraint often accompanied by stagnation; Xu indicates blood deficiency with heat generating palpitations/fright; Dai indicates Qi consumption; Xi indicates Qi scarcity; Lao indicates Qi fullness and urgency, often indicating pain; Jie indicates accumulated Qi causing oppression and pain; Dong indicates deficiency consumption, bloody dysentery, and metrorrhagia/metrostaxis.
However, the Seven Exterior belong to Yang, the Eight Interior belong to Yin, and the Nine Dao contain both Yin and Yang. Each should be diagnosed according to the Cun, Guan, Chi positions and the associated Zang-Fu organs. If found at the Cun position, it corresponds to disease above the diaphragm; at the Guan position, disease below the stomach; at the Chi position, disease below the umbilicus.
Generally speaking, when Yuan Qi (Original Qi) arrives, the force is harmonious and slow; when Evil Qi (Pathogenic Factor) arrives, the force is strong and峻急 (steep/urgent). Whenever the Chi pulse does not reach up to the Guan position, it is called Yin Extinction (Yin Jue); whenever the Cun pulse does not reach down to the Guan position, it is called Yang Extinction (Yang Jue). If Yin and Yang are mutually extinct, upon what can a person rely? The general outline of pulses is thus concluded.