缓脉,去来小快于迟(《脉经》),一息四至(戴氏),如丝在经,不卷其轴,应指和缓,往来甚匀(张太素),如初
春杨柳舞风之象(杨玄操),如微风轻 柳梢(滑伯仁)。缓脉在卦为坤,在时为四季,在人为脾。阳寸、阴尺,上下同
等,浮大而软,无有偏胜者,平脉也。若非其时,即为有病。缓而和匀,不浮、不沉,不疾、不徐、不微、不弱者,即
为胃气。故杜光庭云∶欲知死期何以取?古贤推定五般土。阳土须知不遇阴,阴土遇阴当细数。详《玉函经》。
〔体状诗〕缓脉阿阿四至通,柳梢袅袅 轻风。欲从脉里求神气,只在从容和缓中。
〔相类诗〕见迟脉。
〔主病诗〕缓脉营衰卫有余,或风或湿或脾虚。上为项强下痿痹,分别浮沉大小区。寸缓风邪项背拘,关为风眩胃
家虚。神门濡泄或风秘,或者蹒跚足力迂。浮缓为风,沉缓为湿,缓大风虚,缓细湿痹,缓涩脾虚,缓弱气虚。《脉诀》
言∶缓主脾热口臭、反胃、齿痛、梦鬼之病。出自杜撰,与缓无关。
芤脉,浮大而软,按之中央空,两边实(《脉经》)。中空外实,状如慈葱。芤,慈葱也。《素问》无芤名。刘三点云∶
芤脉何似?绝类慈葱,指下成窟,有边无中。戴同父云∶营行脉中,脉以血为形,芤脉中空,脱血之象也。《脉经》云∶
三部脉芤,长病得之生,卒病得之死。《脉诀》言∶两头有,中间无,是脉断截矣。又言主淋沥、气入小肠。与失血之
候相反,误世不小。
〔体状诗〕芤形浮大软如葱,按之旁有中央空。火犯阳经血上溢,热侵阴络下流红。
〔相类诗〕中空旁实乃为芤,浮大而迟虚脉呼。芤更带弦名曰革,血亡芤革血虚虚。
〔主病诗〕寸芤积血在于胸,关内逢芤肠胃痈。尺部见之多下血,赤淋红痢漏崩中。
缓脉,往来比迟脉稍快(《脉经》),一呼一吸之间跳动四次(戴氏),像丝线在经线中,不卷曲其轴心,触诊时感觉和缓,往来非常均匀(张太素),像初春杨柳在风中起舞的景象(杨玄操),像微风轻轻拂过柳梢(滑伯仁)。缓脉在八卦中对应坤卦,在季节中对应四季之末,在人体中对应脾脏。寸口脉的阳部(寸)与尺部(尺)上下同等,脉象浮大而柔软,没有偏盛偏衰的情况,这是正常的平脉。如果不是相应的季节出现,就是有病。缓脉如果和匀,不浮、不沉、不快、不慢、不微弱、不虚弱,这就是胃气。所以杜光庭说:想知道死期如何判断?古代贤人推定五种土性。阳土要知道不遇到阴,阴土遇到阴应当仔细推算。详细参考《玉函经》。
〔体状诗〕缓脉从容四至相通,像柳梢在轻风中袅袅摇曳。想要从脉象中探求神气,只在从容和缓之中。
〔相类诗〕参见迟脉。
〔主病诗〕缓脉表示营气衰弱而卫气有余,或者是风邪、湿邪或者脾虚引起。上部表现为项强,下部表现为痿痹,需要分别根据浮、沉、大、小来区分。寸部缓脉是风邪导致项背拘急,关部缓脉是风眩或胃家虚。神门穴处见缓脉可能是濡泄或风秘,或者是行走蹒跚足力不足。浮缓脉主风,沉缓脉主湿,缓大脉主风虚,缓细脉主湿痹,缓涩脉主脾虚,缓弱脉主气虚。《脉诀》中说:缓脉主脾热口臭、反胃、齿痛、梦鬼之病。这是出自杜撰,与缓脉无关。
芤脉,浮大而软,重按中间空,两边实(《脉经》)。中空外实,形状像慈葱(一种大葱)。芤,就是慈葱的意思。《素问》中没有芤脉的名称。刘三点说:芤脉像什么?极像慈葱,指下感觉成窟窿,有边无中。戴同父说:营气行于脉中,脉以血为形体,芤脉中空,是失血的征象。《脉经》说:三部脉都见芤脉,久病得之可生,暴病得之则死。《脉诀》说:两头有,中间无,这是脉断截了。又说主淋沥、气入小肠。这与失血的证候相反,误导世人不少。
〔体状诗〕芤脉形态浮大软如葱,按压旁边有而中间空。火邪侵犯阳经血液上溢,热邪侵袭阴络血液下流红。
Huan (Moderate) Pulse: The movement of the Huan pulse is slightly faster than that of the Chi (Slow) pulse (Mai Jing), beating four times per respiration cycle (Dai Shi). It resembles a silk thread in its warp, not coiled around its axis; upon palpation, it feels harmonious and moderate, with a very uniform rhythm (Zhang Taisu). It resembles the image of willow branches dancing in the wind in early spring (Yang Xuancuo), or like a gentle breeze brushing lightly over willow tips (Hua Boren). In the Eight Trigrams, the Huan pulse corresponds to Kun; in the seasons, it corresponds to the transition periods between seasons (Four Seasons); in the human body, it corresponds to the Spleen. When the Yang portion at the Cun position and the Yin portion at the Chi position are equal above and below, presenting as floating, large, and soft without any excess or deficiency, it is a Ping (Normal) pulse. If it appears out of season, it indicates disease. A Huan pulse that is harmonious and even, neither floating nor sunken, neither rapid nor slow, neither minute nor weak, represents Stomach Qi. Thus, Du Guangting stated: "How to determine the time of death? Ancient sages deduced it based on the Five Earth elements. For Yang Earth, one must know it does not encounter Yin; for Yin Earth encountering Yin, careful calculation is required." Refer to Yu Han Jing for details.
[Verse on Physical Characteristics] The Huan pulse flows smoothly with four beats per cycle, swaying gently like willow tips in a light breeze. To seek the spirit and Qi within the pulse, look only within this calmness and moderation.
[Verse on Similar Pulses] See Chi (Slow) Pulse.
[Verse on Associated Diseases] The Huan pulse indicates depletion of Ying (Nutritive) Qi and excess of Wei (Defensive) Qi, or may be caused by Wind pathogen, Dampness pathogen, or Spleen deficiency. Upper manifestations include stiffness of the neck; lower manifestations include flaccidity and bi-syndrome. Differentiate according to floating, sunken, large, and small qualities. At the Cun position, Huan pulse indicates Wind pathogen causing stiffness in the neck and back; at the Guan position, it indicates Wind-induced vertigo or deficiency in the Stomach. At the Shenmen point, it may indicate damp diarrhea or constipation due to Wind, or staggering gait with weak legs. Floating-Huan indicates Wind; Sunken-Huan indicates Dampness; Large-Huan indicates Wind-deficiency; Fine-Huan indicates Damp-bi syndrome; Choppy-Huan indicates Spleen deficiency; Weak-Huan indicates Qi deficiency. Mai Jue states: "Huan pulse governs spleen-heat, bad breath, regurgitation, toothache, and dreams of ghosts." This is fabricated and unrelated to the Huan pulse.
Kou (Scallion) Pulse: The Kou pulse is floating, large, and soft; upon deep pressure, the center is empty while the sides are solid (Mai Jing). It is empty in the center and solid on the outside, resembling a scallion (Cong). Kou means scallion. Su Wen does not mention the name Kou pulse. Liu Sandian said: "What does the Kou pulse resemble? It is exactly like a scallion; under the fingers, it feels like a cavity, having edges but no center." Dai Tongfu said: "Ying Qi circulates within the vessels, and the vessel takes blood as its form. The emptiness in the center of the Kou pulse is a sign of blood loss." Mai Jing states: "If all three positions (Cun, Guan, Chi) present a Kou pulse, it is survivable if contracted from a chronic illness, but fatal if contracted suddenly." Mai Jue states: "Having presence at both ends and absence in the middle implies a severed pulse." It also states it governs strangury and Qi entering the Small Intestine. This contradicts signs of blood loss and has misled many practitioners.
[Verse on Physical Characteristics] The Kou shape is floating, large, and soft like a scallion; pressing reveals solidity at the sides but emptiness in the center. Fire invading Yang meridians causes blood to overflow upwards; heat invading Yin collaterals causes red blood to flow downwards.
[Verse on Similar Pulses] Empty in the center and solid on the sides constitutes the Kou pulse; floating, large, and slow is called the Xu (Deficient) pulse. If Kou pulse carries a Xian (Wiry) quality, it is named Ge (Leather) pulse; blood loss presenting with Kou or Ge pulses indicates severe blood deficiency.
[Verse on Associated Diseases] Kou pulse at the Cun position indicates accumulated blood in the chest; meeting Kou pulse at the Guan position indicates intestinal abscess. Seeing Kou pulse at the Chi position often indicates lower bleeding, red strangury, red dysentery, uterine leakage, or metrorrhagia.