李时珍曰∶宋有俗子,杜撰《脉诀》,鄙陋纰缪,医学习诵,以为权舆,逮臻颁白,脉理竟昧。戴同父常刊其误,
先考月池翁着《四诊发明》八卷,皆精诣奥室,浅学未能窥造。珍因撮粹撷华,僭撰此书,以便习读,为脉指南。世之
医病两家,咸以脉为首务,不知脉乃四诊之末,谓之巧者尔,上士欲会其全,非备四诊不可。
明嘉靖甲子上元日谨书于濒湖 所
浮脉,举之有余,按之不足(《脉经》)。如微风吹鸟背上毛,厌厌聂聂(轻泛貌),如循榆荚(《素问》),如水漂木
(崔氏),如捻葱叶(黎氏)。浮脉法天,有轻清在上之象,在卦为干,在时为秋,在人为肺,又谓之毛。太过则中坚旁
虚,如循鸡羽,病在外也。不及则气来毛微,病在中也。《脉诀》言,寻之如太过,乃浮兼洪紧之象,非浮脉也。
〔体状诗〕浮脉惟从肉上行,如循榆荚似毛轻。三秋得令知无恙,久病逢之却可惊。
〔相类诗〕浮如木在水中浮,浮大中空乃是芤。拍拍而浮是洪脉,来时虽盛去悠悠。浮脉轻平似捻葱。虚来迟大豁
然空。浮而柔细方为濡,散似杨花无定踪。浮而有力为洪,浮而迟大为虚,虚甚为散,浮而无力为芤,浮而柔细为濡。
〔主病诗〕浮脉为阳表病居,迟风数热紧寒拘。浮而有力多风热,无力而浮是血虚。寸浮头痛眩生风,或有风痰聚
在胸。关上土衰兼木旺,尺中溲便不流通。
浮脉主表,有力表实,无力表虚,浮迟中风,浮数风热,浮紧风寒,浮缓风湿,浮虚伤暑,浮芤失血,浮洪虚热,
浮散劳极。
李时珍说:宋代有个浅薄的读书人,凭空编造了《脉诀》,内容鄙陋且错误百出。医生们学习并背诵它,把它当作入门的起点,等到头发花白年老之时,竟然连脉理都搞不清楚了。戴同父曾经刊正过其中的错误,我的父亲月池翁撰写了《四诊发明》八卷,内容精深奥妙,浅薄之学的人无法窥探其堂奥。我因此选取精华,冒昧地撰写了这本书,以便于阅读学习,作为诊脉的指南。世间的医生和病人两家,都把脉诊当作首要任务,却不知道脉诊只是四诊(望、闻、问、切)中的最后一环,只能算是技巧性的部分。高明的医生想要全面掌握诊断方法,必须备齐四诊才行。
明嘉靖甲子年正月十五日,恭敬地写在濒湖住所。
浮脉(Fumu, Floating Pulse),轻取即得,重按稍减而不空(出自《脉经》)。它的形象像微风吹动鸟背上的羽毛,轻轻浮动;像触摸榆树的荚果(出自《素问》);像木头漂在水面上(崔氏所述);像捻弄葱叶的感觉(黎氏所述)。浮脉效法天道,有轻清在上的意象,在八卦中属于乾卦,在季节对应秋季,在人体对应肺脏,又被称为“毛”脉。如果脉象太过,则中间坚实而两边空虚,像触摸鸡的羽毛,这是病邪在体表的征象。如果脉象不及,则气来如毛发般轻微,这是病在体内的征象。《脉诀》中说,寻按起来感觉太过,那是浮脉兼见洪脉和紧脉的象,并不是单纯的浮脉。
〔体状诗〕浮脉只在肌肉层上行,像触摸榆荚一样轻飘,又像羽毛般轻柔。在秋季三个月得到令气知道身体无恙,但久病之人遇到这种脉象却令人惊恐。
〔相类诗〕浮脉就像木头在水中漂浮,浮大中空的是芤脉(Koumai, Cleft Pulse)。拍击感而浮的是洪脉(Hongmai, Surging Pulse),来时气势盛大去时悠长缓慢。浮脉轻平如同捻葱叶。虚脉来得迟大而豁然空虚。浮而柔细才是濡脉(Rumai, Soggy Pulse),散脉像杨花没有固定的踪迹。浮而有力为洪脉,浮而迟大为虚脉(Xumai, Deficient Pulse),虚甚则为散脉(Sanmai, Scattered Pulse),浮而无力为芤脉,浮而柔细为濡脉。
〔主病诗〕浮脉属阳,主表证,迟脉主风邪,数脉主热,紧脉主寒邪拘急。浮而有力的多属风热,无力而浮的则是血虚。寸部浮现头痛眩晕生风,或者是有风痰积聚在胸中。关部脉象显示脾土衰弱兼肝木旺盛,尺部脉象显示小便和大便不流通。
浮脉主表证,有力为表实,无力为表虚。浮迟脉主中风,浮数脉主风热,浮紧脉主风寒,浮缓脉主风湿,浮虚脉主伤暑,浮芤脉主失血,浮洪脉主虚热,浮散脉主劳损至极。
Li Shizhen said: In the Song Dynasty, a vulgar scholar fabricated the *Mai Jue* (Pulse Rhymes), which was crude and full of errors. Physicians learned and recited it, taking it as their starting point, yet by the time their hair turned white with age, they were still ignorant of pulse principles. Dai Tongfu often corrected its mistakes. My father, Mr. Yuechi, authored *Sizhen Faming* (Invention of the Four Diagnostic Methods) in eight volumes; its content is profound and subtle, inaccessible to those with shallow learning. I therefore selected the essence and splendor, presumptuously compiling this book to facilitate study and serve as a guide for pulse diagnosis. Both physicians and patients in the world regard pulse diagnosis as the primary task, unaware that pulse diagnosis is merely the last of the Four Diagnostics (Wang, Wen, Wen, Qie - Observation, Auscultation/Olfaction, Inquiry, Palpation), considered merely a skillful technique. A superior physician wishing to master the whole must employ all four diagnostic methods.
Respectfully written on the First Day of the First Month in the Jiazi Year of the Jiajing Era at Binhu Residence.
The Floating Pulse (Fumu Mai, Floating Pulse) is felt with light pressure but diminishes slightly with heavy pressure without being empty (*Mai Jing*). It resembles fine wind blowing the feathers on a bird's back, gently fluttering; or like touching elm pods (*Suwen*); or like wood floating on water (Cui Shi); or like pinching a green onion leaf (Li Shi). The Floating Pulse follows Heaven, possessing the image of lightness and clarity residing above. In the Eight Trigrams, it corresponds to Qian (Heaven); in seasons, to Autumn; in the human body, to the Lung; it is also called the "Hair" pulse. If excessive, the center is firm while the sides are hollow, resembling touching a chicken feather, indicating disease in the exterior. If deficient, the qi comes lightly like hair, indicating disease in the interior. The *Mai Jue* states that seeking it feels excessive; this is an image of Floating combined with Surging and Tight pulses, not the Floating pulse itself.
[Body Characteristics Poem] The Floating pulse rises only from within the flesh, like touching elm pods, seemingly light as hair. Obtaining this pulse during the three autumn months indicates health; encountering it in chronic illness should cause alarm.
[Similar Pulses Poem] Floating is like wood floating in water; large and hollow in the middle is the Cleft Pulse (Koumai Mai). Fluttering upon palpation is the Surging Pulse (Hongmai Mai), coming vigorously but departing slowly. Floating pulse is light and level like pinching a green onion. Deficient pulse arrives late, large, and abruptly empty. Floating and soft/thin constitutes the Soggy Pulse (Rumai Mai); Scattered pulse is like willow catkins with no fixed trace. Floating and forceful is Surging; Floating and slow/large is Deficient; extreme deficiency is Scattered; Floating and forceless is Cleft; Floating and soft/thin is Soggy.
[Main Disease Poem] Floating pulse is Yang, dwelling in exterior diseases; Slow indicates Wind, Rapid indicates Heat, Tight indicates Cold constriction. Floating and forceful mostly indicates Wind-Heat; forceless and floating indicates Blood Deficiency. Floating at the Cun position indicates headache, dizziness, and internal Wind, or possibly Wind-Phlegm accumulating in the chest. At the Guan position, Earth (Spleen) is weak and Wood (Liver) is hyperactive. At the Chi position, urination and defecation are obstructed.
Floating pulse governs exterior syndromes; forceful indicates Exterior Excess, forceless indicates Exterior Deficiency. Floating-Slow indicates Wind-Stroke; Floating-Rapid indicates Wind-Heat; Floating-Tight indicates Wind-Cold; Floating-Lax indicates Wind-Dampness; Floating-Deficient indicates Summerheat Injury; Floating-Cleft indicates Blood Loss; Floating-Surging indicates Empty Heat; Floating-Scattered indicates Extreme Exhaustion.