《素问·通评虚实论》帝曰∶乳子而病热,脉悬小者,何如?岐伯曰∶手足温则生,寒则死。帝曰∶乳子
中风热,喘鸣肩息者,脉何如?岐伯曰∶喘鸣肩息者,脉实大也。缓则生,急则死。
热病脉应洪大,其小弱者,正虚邪盛,为逆证,不治。乳子
者,谓新产而乳其子者也。新产又乳子,其气血内虚,虽热病而脉甚小弱,故问其吉凶何如。岐伯言手足温者,
其脾胃阳和之气,尚能周布,而邪可渐解,则生;手足寒者,正虚邪闭而厥逆,则死矣。中风热而受于上部
阳分,肺气逆满,故喘鸣;肩息者,喘急有声而抬肩也。邪盛于上,脉必实大,若和缓有胃气者,泻其邪热,
则生;如急强而无和缓之象,是真脏脉,而本元已脱,故死也。
《灵枢·论疾诊尺篇》曰∶婴儿病,其头毛逆上者,必死。又曰∶耳间青脉起者,掣痛。
婴儿柔嫩如芽,其病久而头毛竖逆,此血竭而生气已绝,如地无生气而草木皆枯,故必死也。耳间乃少阳
经脉所行之处,少阳内通肝经,青脉起者,肝风内动,则必抽掣筋脉而痛,甚则为惊厥之证,当察其因而治之
也。
《灵枢·水胀篇》帝曰∶水与肤胀、鼓胀、肠覃、石瘕、石水,何以别之?岐伯曰∶水始起也,目窠上微
肿,如新卧起之状,其颈脉动,时咳,阴股间寒,足胫肿,腹乃大,其水已成矣。以手按其腹,随手而起,如
裹水之状,此其候也。
目窠,眼胞也,凡人睡卧初起,眼胞微肿,水病始起亦如之;颈脉,喉旁人迎胃脉也,水蓄于胃,肺气逆,
故颈脉动而时咳也;水溢三焦,阳气不周,故阴股间寒,而足胫肿,腹乃大,
其水已成矣。按其腹,随手而起,如囊裹水之状,此为水胀之证候也。
黄帝问道:妇女在哺乳期间患了热病,脉象悬细而小,这种情况怎么样?岐伯回答说:如果手足温暖,就能存活;如果手足寒冷,就会死亡。
黄帝又问:哺乳期间感受风邪而患热病,出现气喘、喉间有鸣音且抬肩呼吸的症状,脉象会怎样?岐伯回答说:出现气喘、喉间鸣音且抬肩呼吸的症状,脉象应当是实大的。如果脉来和缓,就能存活;如果脉来急疾,就会死亡。
热病的脉象本应洪大,如果反而细小虚弱,这是正气虚弱而邪气盛实,属于逆证,难以治愈。所谓“乳子”,是指刚分娩不久并正在哺乳婴儿的妇女。新近分娩又需哺乳,体内气血已经内虚,虽然患有热病但脉象非常细小虚弱,所以询问其吉凶如何。岐伯说,如果手足温暖,说明脾胃中阳气尚能周流布散,邪气可以逐渐解除,因此能活;如果手足寒冷,说明正气虚弱而邪气闭阻导致四肢厥逆,因此死亡。
感受风热之邪而病于上部阳分,导致肺气逆乱壅满,所以出现气喘、喉间鸣音;抬肩呼吸,是指喘息急促有声且耸动肩膀。邪气盛于上部,脉象必然实大,如果脉象和缓而有胃气,通过泻除邪热,就能存活;如果脉象急强而没有和缓之象,这是真脏脉现,说明根本元气已经脱失,因此死亡。
《灵枢·论疾诊尺篇》说:婴儿患病,如果头发逆竖向上,必定死亡。又说:耳后出现青色脉络的,会发生牵引性疼痛。
婴儿身体柔嫩如同初生之芽,如果患病日久且头发竖起逆上,这是血液枯竭而生机已绝,就像大地没有生气而草木全部枯死一样,所以必定死亡。耳部是少阳经脉循行的部位,少阳经内通肝经,耳后出现青脉,说明肝风内动,必然会导致筋脉抽搐掣痛,严重时会出现惊厥症状,应当审察病因进行治疗。
《灵枢·水胀篇》黄帝问道:水胀、肤胀、鼓胀、肠覃、石瘕、石水这几种病,如何区别它们?岐伯回答说:水胀刚开始发生时,眼睑下方微微肿胀,像刚睡醒时的样子,颈部人迎脉搏动,时常咳嗽,大腿内侧感觉寒冷,小腿浮肿,腹部随后变大,这说明水湿已经形成。用手按压腹部,手松开后腹部立即弹起恢复原状,像包裹着水的袋子一样,这就是水胀的征候。
眼胞就是眼睑,凡人刚睡醒时,眼睑微微肿胀,水病刚开始发生也是这样;颈脉,指喉咙旁的人迎胃脉,水湿蓄积于胃,肺气上逆,所以颈部脉搏跳动且时常咳嗽;水湿溢满三焦,阳气不能周身布散,所以大腿内侧寒冷,小腿浮肿,腹部随之变大,这说明水湿已经形成。按压腹部,手松开后腹部立即弹起,像囊袋包裹水液的状态,这就是水胀证的征候。
Huangdi asked: If a woman suffers from heat disease while nursing an infant, and her pulse is suspended and small, what is the prognosis? Qibo replied: If the hands and feet are warm, she will survive; if they are cold, she will die.
Huangdi further asked: If a nursing woman contracts wind-heat, presenting with wheezing, rhonchi in the throat, and shoulder-lifting breathing (breathing with raised shoulders), what would her pulse be like? Qibo replied: In cases of wheezing, rhonchi, and shoulder-lifting breathing, the pulse should be excess and large. If the pulse is slow and relaxed, she will survive; if it is rapid and tense, she will die.
In heat diseases, the pulse should typically be洪大 (hóng dà, surging and large). If it is instead small and weak, this indicates deficiency of healthy qi and excess of pathogenic factors, constituting a adverse syndrome that is difficult to treat. "Nursing" refers to a woman who has recently given birth and is currently breastfeeding. Following recent childbirth and during lactation, internal blood and qi are deficient. Although suffering from heat disease, the pulse is very small and weak; hence, the inquiry regarding prognosis. Qibo stated that if the hands and feet are warm, it indicates that the spleen and stomach's yang qi is still able to circulate and distribute throughout the body, allowing pathogens to gradually resolve, leading to survival. If the hands and feet are cold, it indicates that healthy qi is deficient and pathogens are obstructed, leading to cold extremities (Jue Ni, 厥逆), resulting in death.
Contracting wind-heat affecting the upper yang aspect causes lung qi to become rebellious and full, resulting in wheezing and rhonchi. Shoulder-lifting breathing refers to急促喘促 (jí cù chuǎn cù,急促 shortness of breath) with audible sounds and raising of the shoulders. When pathogens are excessive in the upper jiao, the pulse must be excess and large. If the pulse is harmonious and reflects stomach qi, clearing the pathogenic heat leads to survival. If the pulse is rapid and strong without any harmonious quality, it represents the appearance of the Zang-Fu true pulse (Zhen Zang Mai, 真脏脉), indicating that the root yuan qi has collapsed, leading to death.
The *Lingshu · Lun Ji Zhen Chi Pian* states: If an infant is ill and their head hair stands upright and reversed, death is certain. It also states: If blue vessels appear between the ears, there will be pulling pain.
Infants are tender like sprouts. If illness persists for a long time and the head hair becomes erect and reversed, this signifies exhaustion of blood and cessation of vital energy, similar to how grass and trees wither when the earth lacks vitality; thus, death is certain. The area behind the ear is where the Shaoyang meridian travels. Shaoyang internally connects to the Liver meridian. The appearance of blue vessels here indicates internal stirring of Liver Wind (Gan Feng, 肝风), which inevitably causes spasms and pulling pain in the sinews. In severe cases, it may manifest as convulsions (Jing Jue, 惊厥); one must examine the cause and treat accordingly.
In the *Lingshu · Shui Zhang Pian*, Huangdi asked: How can one distinguish between Water Swelling (Shui Zhang, 水胀), Skin Swelling (Fu Zhang, 肤胀), Drum-like Swelling (Gu Zhang, 鼓胀), Intestinal Masses (Chang Qin, 肠覃), Stone Fibroids (Shi Xia, 石瘕), and Stone Water (Shui Shui, 石水)? Qibo replied: At the onset of water swelling, there is slight swelling above the eye sockets (Mu Ke, 目窃), resembling the state after just waking up. There is pulsation in the neck vessels, occasional coughing, coldness in the inner thighs, edema of the lower legs, and subsequently abdominal enlargement, indicating that water retention has formed. Pressing the abdomen with the hand causes it to rise immediately upon release, resembling a bag wrapped around water; this is its characteristic sign.
The eye socket refers to the eyelid. Just as humans have slightly swollen eyelids upon waking, the initial stage of water disease presents similarly. The neck vessel refers to the Renying (ST9, 人迎) stomach pulse located beside the throat. Water accumulation in the stomach causes lung qi to rebel, resulting in neck vessel pulsation and occasional coughing. Water overflowing into the Sanjiao (Triple Burner, 三焦) prevents yang qi from circulating uniformly, causing coldness in the inner thighs and edema in the lower legs, followed by abdominal enlargement, indicating that water retention has formed. Pressing the abdomen causes it to rebound immediately upon release, resembling a sac containing water; this is the clinical manifestation of the Water Swelling syndrome.