《方盛衰论》曰∶形弱气虚死;(中外俱不足也。)形气有余,脉气不足死;(脏衰,故脉不足
也。)脉气有余,形气不足生。(脏盛,故脉气有余。)是以诊有大方,坐起有常,(坐起有常,则息力调
适,故诊之方法,必先用之。)出入有行,以转神明,(言所以贵坐起有常者何?以出入行运,皆神明随转也。)
必清必静,上观下观,司八正邪,别五中部,按脉动静。(上观,谓气色也。下观,谓行气也。
八正,谓八节之正候。五中,谓五脏之部分。然后按寸尺之动静而定死生矣。)
夫医者,人之司命也。脉者,医之大业也。盖医家苟不明脉,则如冥行索途,动
致颠覆矣。夫大方脉、妇人、小儿、风科,必先诊脉后,对证处药,独疮科之流,多
有不诊其脉候,专于治外,或有证候疑难,别召方脉诊察,于疮科之辈,甘当浅陋之
名,噫!其小哉如是!
\r左手表里脉图\p04-a41a1.bmp\r
寸 表手太阳小肠经,里足少阴心经。
关 表足少阳胆经,里足厥阴肝经。
尺 表足太阳膀胱经,里足少阴肾经。
\r右手表里脉图\p04-a41a2.bmp\r
尺 半表半里手厥阴心包络经,里命门。
关 表足阳明胃经,里足太阴脾经。
寸 表手阳明大肠经,里手太阴肺经。
原夫疮肿之生,皆由阴阳不和,气血凝滞,若不诊候,何以知阴阳勇怯,血气
聚散耶?由是观之,则须信疗疮肿于诊候之道,不可阙也。历观古人治疗疮肿方书
甚多,其间诊候之法,略而未详,皆夫诸科甚有灭裂,愚虽不才,辄取《黄帝素
问》、《难经》、《灵枢》、《甲乙》以及叔和、仲景、扁鹊、华佗,《千金》、《外台》、《圣
济总录》,古今名医诸家方论之中,诊候疮肿之说,简编类次,贯成篇帙,首载诊候
入式之法,次论血气色脉参应之原,后明脉之名,脉所主证候及疮肿逆从之方,庶
使为疮肿科者,览此则判然可晓,了无疑滞于胸次,一朝临疾,诊候至此,则察逆
从,决成败,若黑白之易分耳。
\r详证脉照图\p04-a41a3.bmp\r
《方盛衰论》说:形体虚弱且正气亏虚的,会死亡;(这是因为体内外的气血都不足。)形体和正气看似有余,但脉气不足的,也会死亡;(这是因为脏腑功能衰退,所以脉象显得不足。)脉气有余,而形体和正气不足的,能够生存。(这是因为脏腑功能旺盛,所以脉气显得有余。)因此,诊察疾病有规范的方法,坐立起居要有常规,(坐立起居有常规,呼吸之力就能调和适宜,所以诊察的方法,必须首先运用这一原则。)出入行止要有规律,以此来保持精神的清明,(为什么说重视坐立起居有常规呢?因为出入行运,都是随着神明的运转而进行的。)必须保持清静,上观察面色,下观察行动,掌握八正节气之邪气,辨别五脏所属部位,按压脉搏以察其动静。(“上观”,是指观察气色。“下观”,是指观察行气。八正,是指八个节气的正常气候特征。五中,是指五脏在体表的对应部分。然后才能通过按压寸口尺部的脉象动静来判断生死。)
医生,是掌管人生命的人。脉诊,是医生的重大事业。大概如果医家不精通脉诊,就如同在黑暗中摸索道路,动不动就会遭遇失败。大内科、妇科、儿科、风病科,必须先诊脉后,再对症用药,唯独外科疮疡科的医生,大多不诊察脉候,专门治疗外部病症;如果有证候疑难的情况,另外邀请内科医生来诊察,对于外科医生来说,甘愿承受浅薄简陋的名声,唉!他们的见识竟然如此狭隘!
左手表里脉图
寸部:表经为手太阳小肠经,里经为足少阴心经。
关部:表经为足少阳胆经,里经为足厥阴肝经。
尺部:表经为足太阳膀胱经,里经为足少阴肾经。
右手表里脉图
尺部:半表半里为手厥阴心包络经,里经为命门。
关部:表经为足阳明胃经,里经为足太阴脾经。
寸部:表经为手阳明大肠经,里经为手太阴肺经。
原来疮肿的发生,都是由阴阳不和,气血凝滞造成的,如果不诊察脉候,怎么能知道阴阳的强弱、血气的聚散情况呢?由此看来,可以相信治疗疮肿对于诊察脉候之道,是不可缺少的。纵观古人治疗疮肿的方书很多,其中关于诊察脉候的方法,简略而不详细,这都是因为各科医生有所疏忽。我虽然不才,却选取了《黄帝素问》、《难经》、《灵枢》、《甲乙经》以及王叔和、张仲景、扁鹊、华佗,《千金方》、《外台秘要》、《圣济总录》,古今名医各家方论中,关于诊察疮肿的说法,进行筛选编排,连贯成篇。首先记载诊察入式的方法,其次论述血气色脉相互参验的原理,最后阐明脉的名称、脉所主应的证候以及疮肿顺逆的判断方法,希望使从事疮疡科的医生,阅读此书就能清晰明了,心中没有疑惑阻滞,一旦面对疾病,诊察到这一步,那么判断顺逆、决定成败,就像黑白颜色容易区分一样容易。
详证脉照图
According to the "Treatise on Excess and Deficiency" (Fang Sheng Shuai Lun): When the physical form is weak and Qi (vital energy) is deficient, death ensues; (this indicates insufficiency both internally and externally.) When the physical form and Qi appear abundant, but the pulse Qi is deficient, death also ensues; (this is due to the decline of Zang organs, hence the pulse appears deficient.) When the pulse Qi is abundant, but the physical form and Qi are deficient, survival is possible. (This is because the Zang organs are vigorous, hence the pulse Qi appears abundant.) Therefore, there are standard principles for diagnosis, and sitting and rising should follow regular patterns. (Regular sitting and rising allow for regulated and comfortable breathing power, thus diagnostic methods must first employ this principle.) Movements in and out should have order, thereby maintaining spiritual clarity. (Why is it emphasized that sitting and rising must be regular? Because movements in and out are all guided by the transformation of Shen [spirit].) One must remain clear and quiet, observing above (the complexion) and below (the movement of Qi), monitoring the pathogens of the Eight Regularities (Ba Zheng, seasonal climatic factors), distinguishing the regions of the Five Zang organs, and pressing the pulse to observe its dynamics. ("Observing above" refers to inspecting the Qi and color. "Observing below" refers to inspecting the movement of Qi. The Eight Regularities refer to the normal climatic conditions of the eight solar terms. The Five Zangs refer to the corresponding areas of the five Zang organs. Only then can life and death be determined by assessing the dynamics of the Cun and Chi positions of the pulse.)
The physician is the one who controls human destiny. Pulse diagnosis is the great undertaking of the physician. If a practitioner does not understand pulse diagnosis, it is like groping for a path in the dark, inevitably leading to disaster. For internal medicine, gynecology, pediatrics, and wind-disease departments, pulse diagnosis must precede symptom-based prescription. However, practitioners of external diseases (Chuang Ke, surgical specialties) often neglect pulse diagnosis, focusing solely on external treatments. When cases are difficult, they invite internal medicine specialists to diagnose, content with the reputation of being superficial and unskilled. Alas! How limited their perspective is!
Left Hand Table-Inside Pulse Diagram
Cun position: Exterior meridian is the Hand-Taiyang Small Intestine Meridian; Interior meridian is the Foot-Shaoyin Heart Meridian.
Guan position: Exterior meridian is the Foot-Shaoyang Gallbladder Meridian; Interior meridian is the Foot-Jueyin Liver Meridian.
Chi position: Exterior meridian is the Foot-Taiyang Bladder Meridian; Interior meridian is the Foot-Shaoyin Kidney Meridian.
Right Hand Table-Inside Pulse Diagram
Chi position: Half-exterior half-interior is the Hand-Jueyin Pericardium Meridian; Interior is the Mingmen (Gate of Life).
Guan position: Exterior meridian is the Foot-Yangming Stomach Meridian; Interior meridian is the Foot-Taiyin Spleen Meridian.
Cun position: Exterior meridian is the Hand-Yangming Large Intestine Meridian; Interior meridian is the Hand-Taiyin Lung Meridian.
The origin of sores and swellings lies in the disharmony of Yin and Yang, and the stagnation of Qi and Blood. Without pulse diagnosis, how can one discern the strength or weakness of Yin and Yang, and the aggregation or dispersion of Qi and Blood? From this, it is evident that for treating sores and swellings, the method of pulse diagnosis cannot be omitted. Having reviewed many ancient texts on treating sores and swellings, I found that their descriptions of diagnostic methods were brief and incomplete, reflecting a negligence among various medical specialties. Although I am untalented, I have selected theories on diagnosing sores and swellings from the *Huangdi Suswen* (Yellow Emperor's Inner Canon: Plain Questions), *Nanjing* (Classic of Difficult Issues), *Lingshu* (Spiritual Pivot), *Jiayi Jing*, as well as works by Wang Shuhe, Zhang Zhongjing, Bian Que, Hua Tuo, *Qianjin Yaofang* (Essential Prescriptions Worth a Thousand Gold), *Waitai Miyao* (Secret Essentials of the Outer Hall), and *Shengji Zonglu* (General Records of Holy Relief), along with formulas and discussions from famous physicians of past and present. I have compiled and organized these into chapters. First, I record the methods of entering the diagnostic posture; second, I discuss the principles of correlating Qi, Blood, complexion, and pulse; finally, I clarify the names of pulses, the syndromes they govern, and the methods for determining favorable and unfavorable outcomes in sores and swellings. It is hoped that those practicing surgical specialties will find this text clear and understandable, removing all doubts from their minds. When facing a disease, if one applies these diagnostic steps, distinguishing between favorable and unfavorable outcomes, and determining success or failure, will be as easy as distinguishing black from white.
Detailed Syndrome and Pulse Illustration Diagram