伤寒病热兮,洪大易治而沉细难医;伤风咳嗽兮,浮濡可攻而沉牢当避。肿胀宜浮大,颠狂忌
虚细。下血下痢兮,浮洪可恶;消渴消中兮,实大者利。霍乱喜浮大而畏微迟,头疼爱浮滑而嫌短
涩。肠 脏毒兮,不怕
沉微;风痹足痿兮,偏嫌数急。身体中风,缓滑则生;腹心作痛,沉细则良。喘急浮洪者危,咳血
沉弱者康。脉细软而不弦洪,知不死于中恶;脉微小而不数急,料无忧于金疮。吐血鼻衄兮,吾不
喜其实大;跌扑损伤兮,吾则畏其坚强。痢疾身热而脉洪,其灾可恶;湿病体烦而脉细,此患难当。
水泻脉大者可怪,亡血脉实者不祥。病在中兮脉虚为害,病在外兮脉涩为殃。腹中积久而脉虚者死
,身表热甚而脉静者亡。
雀啄连来三五啄,屋漏半日一点落,鱼翔似有又如无,虾游静中忽一跃,弹石硬来寻即散,搭
指散乱为解索。寄语医家仔细看,六脉一见休下药。
一难曰∶十二经皆有动脉,独取寸口以决五脏六腑死生吉凶之法,何谓也?然∶寸口者,脉之
大会,手太阴之脉动也。二难曰∶脉有尺寸,何谓也?从关至尺是尺内,阴之所治也;从关至鱼际
是寸口内,阳之所治也。故分寸为尺,分尺为寸。
五难曰∶脉有轻重,何谓也?然∶初持脉如三菽之重,与皮毛相得者,肺部也。如六菽之重,
与血脉相得者,心部也。如九菽之重,与肌肉相得者,脾部也。如十二菽之重,与筋平者,肝部也
。按之至骨,举指来疾者,肾部也。故曰轻重也。
伤寒病出现热象时,脉象洪大容易治疗,而脉象沉细则难以医治;伤风伴有咳嗽时,脉象浮濡可以攻邪,而脉象沉牢应当避免使用攻法。肿胀病适宜见到浮大脉象,癫狂病忌讳见到虚细脉象。下血或下痢时,脉象浮洪是恶劣的征兆;消渴或中消病时,脉象实大是有利的。霍乱病喜欢浮大脉象而畏惧微迟脉象,头痛病喜爱浮滑脉象而嫌弃短涩脉象。肠脏毒病不怕脉象沉微;风痹和足痿病特别忌讳脉象数急。身体遭受中风,脉象缓滑则有生机;腹心部位作痛,脉象沉细则是良兆。喘促急促且脉象浮洪的病情危重,咳血且脉象沉弱的病情可愈。脉象细软而不弦洪,可知不会死于中恶之证;脉象微小而不数急,料想无需担忧金疮(金属利器造成的创伤)。吐血或鼻衄时,我不喜欢脉象实大;跌打损伤时,我则畏惧脉象坚强有力。痢疾患者身热而脉象洪大,其灾祸令人厌恶;湿病患者身体烦扰而脉象细弱,这种病患难以承受。水泻病脉象大的情况令人奇怪,亡血之后脉象实的状况不吉利。病在体内而脉象虚是危害,病在体表而脉象涩是灾殃。腹中有积滞日久但脉象虚的会死亡,身体表面发热严重但脉象平静的会死亡。
脉象如雀啄食般连连而来,三五次一停;如屋漏滴水般半天才落下一滴;如鱼翔水底似有似无;如虾游水中静止中忽然一跃;如弹石坚硬触手即散;搭指感觉散乱如同解开的绳索。寄语各位医家仔细诊察,六脉若出现上述死脉,切勿用药。
第一个问题说:十二经脉都有动脉搏动之处,唯独取寸口脉来判断五脏六腑的死生吉凶,这是什么意思?回答是:寸口脉,是脉气大会聚的地方,属于手太阴肺经的搏动处。第二个问题说:脉有寸、尺之分,这是什么意思?回答是:从关部到尺部是尺内,由阴气所治理;从关部到鱼际是寸口内,由阳气所治理。所以将寸分为尺,将尺分为寸。
第五个问题说:脉诊有轻重之分,这是什么意思?回答是:初持脉时如三颗豆子的重量,与皮毛相得的,是肺部的脉象。如六颗豆子的重量,与血脉相得的,是心部的脉象。如九颗豆子的重量,与肌肉相得的,是脾部的脉象。如十二颗豆子的重量,与筋平齐的,是肝部的脉象。按至骨部,抬起手指时脉搏跳动疾速的,是肾部的脉象。所以说这是脉诊的轻重之法。
In typhoid fever (Shanghan) with heat symptoms, a洪大 (Hongda, surging and large pulse) is easy to treat, while a沉细 (Chenxi, deep and fine pulse) is difficult to cure; in wind-cold injury with coughing, a浮濡 (Furu, floating and soft pulse) can be treated with attacking methods, whereas a沉牢 (Chenlao, deep and firm pulse) should be avoided. For swelling and distension, a浮大 (Fuda, floating and large pulse) is appropriate; for mania (Diankuang), a虚细 (Xuxi, deficient and fine pulse) is contraindicated. In hematochezia or dysentery, a浮洪 (Fuhong, floating and surging pulse) is ominous; in Xiao Ke (Wasting and Thirsting syndrome) or Xiao Zhong (Middle Wasting), a实大 (Shida, excess and large pulse) is favorable. In Huoluan (Colic disorder with vomiting and diarrhea), a浮大 (Fuda, floating and large pulse) is preferred while a微迟 (Weichi, faint and slow pulse) is feared; for headache, a浮滑 (Fuhua, floating and slippery pulse) is liked while a短涩 (Duanse, short and choppy pulse) is disliked. For Chang Zang Du (Intestinal Toxin disease), a沉微 (Chenwei, deep and faint pulse) is not feared; for Feng Bi (Wind-Bi obstruction) and Zu Wei (Foot Atrophy), a数急 (Shuji, rapid and urgent pulse) is particularly undesirable. In Body Wind-Stroke (Shenzhongfeng), a缓滑 (Huanhua, moderate and slippery pulse) indicates survival; in abdominal or cardiac pain, a沉细 (Chenxi, deep and fine pulse) is auspicious. Panting urgency with a浮洪 (Fuhong, floating and surging pulse) is critical; hemoptysis with a沉弱 (Chenruo, deep and weak pulse) indicates recovery. A脉细软而不弦洪 (Mai xiruan er bu xianhong, pulse that is fine and soft without being wiry and surging) suggests one will not die from Zhong E (Sudden Evil attack); a脉微小而不数急 (Mai weixiao er bu shuji, pulse that is minute and small without being rapid and urgent) implies no worry regarding Jin Chuang (Metal weapon wounds). For吐血 (Tuxue, hematemesis) or鼻衄 (Bixue, epistaxis), I do not favor a实大 (Shida, excess and large pulse); for Die Pu Sun Shang (Falls and trauma injuries), I fear a坚强 (Jianqiang, hard and strong pulse). In Li Ji (Dysentery) with body heat and a洪脉 (Hongmai, surging pulse), the disaster is abhorrent; in Shi Bing (Dampness disease) with bodily restlessness and a细脉 (Ximai, fine pulse), the affliction is unbearable. Water diarrhea with a large pulse is strange; blood loss with an excess pulse is inauspicious. Disease inside the body with a虚脉 (Xumai, deficient pulse) is harmful; disease outside the body with a涩脉 (Semai, choppy pulse) is disastrous. Abdominal accumulation lasting long but with a虚脉 (Xumai, deficient pulse) leads to death; surface heat severe but with a静脉 (Jingmai, calm pulse) leads to demise.
The pulse resembles a sparrow pecking, coming continuously then pausing every three or five beats; like a leaking roof, dropping only once in half a day; like a fish swimming, appearing and disappearing; like a shrimp swimming, suddenly leaping amidst stillness; like a stone bouncing, hard upon touch and scattering immediately; scattered upon the finger like untying a knot. I advise physicians to examine carefully: if any of these six pulses appear, do not administer medicine.
Question 1 states: All twelve meridians have pulsating arteries, yet only the Cun Kou (Cunkou, radial artery at the wrist) is taken to determine the life, death, good fortune, and misfortune of the five zang and six fu organs. What does this mean? Answer: The Cun Kou is the great gathering point of pulses, belonging to the hand Taiyin Lung meridian. Question 2 states: The pulse has Cun and Chi divisions. What does this mean? Answer: From the Guan (Gate) to the Chi position is the Chi interior, governed by Yin; from the Guan to the Yu Ji (Fish Border) is the Cun interior, governed by Yang. Thus, Cun is divided into Chi, and Chi is divided into Cun.
Question 5 states: Pulse palpation involves different degrees of pressure. What does this mean? Answer: Initially holding the pulse with the weight of three beans, touching the skin and hair, corresponds to the Lung region. With the weight of six beans, touching the blood vessels, corresponds to the Heart region. With the weight of nine beans, touching the muscles, corresponds to the Spleen region. With the weight of twelve beans, level with the tendons, corresponds to the Liver region. Pressing to the bone, where the pulse returns swiftly upon lifting the finger, corresponds to the Kidney region. This is referred to as the degrees of pressure.