夫诊候之脉法,常以平旦为纪,阴气未散,阳气未动,饮食未进,血气未乱,经
脉未隆,络脉调匀,故乃可诊有疾之脉。若遇仓卒病患,不拘此论。《内经》所谓持脉
有道,以虚静为宝,但可澄神静虑,调息凝心,视精明,察五色,听声音,问所苦,
方始按尺寸,别浮沉,以此参照,决死生之分矣。复观患人身形长短肥瘦,老少男
女,性情缓急,例各不同,故曰形气相得者生,三五不调者病。谓如室女尼冠,脉
当濡而弱;婴儿孺子之脉,细而疾;三四岁者,呼吸之间,脉当七八至为平,比夫常人特不同耳。
大抵男子先诊左手,女子先诊右手,男子左脉大则顺,女子右脉大则顺。
大凡诊脉,先以中指揣按掌后高骨,骨下为关,得其关位,然后齐下两左右二指,
若臂长人疏排其指,若臂短人密排其指,三指停稳,先诊上指曰寸口,浮按消息之,中
按消息之,重按消息之,上竟消息之,下竟消息之,推而外之消息之,推而内之消
息之;然后先关后尺消息之,亦类此。若诊得三部之中,浮、沉、滑、涩、迟、疾
不调,何病所主,外观形色,内察脉候,参详处治以忠告之,不可轻言谈笑,乱说是
非,左右瞻望,举止忽略,此庸医也。
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《皇极经》云∶人之四肢各有脉也,一脉三部,一部三候,以应天数也,一脉三
部,寸、关、尺也;一部三候,浮、中、沉也,所以应之九数也,可谓脉之理亦微矣。
人有四时之正脉,有平生之常脉,有内伤之变脉,有外感之邪脉,有重阴之脉,有
重阳之脉,有阳虚而阴乘之脉,有阴虚而阳乘之脉,有阳极而阴生之脉,有阴极而
阳生之脉,有独见之脉,有兼见之脉,有初病之脉,有将愈之脉,有可治之脉,有
不治之脉,有左右、上下、表里之间,有余不足,惟在乎分别阴阳,能分别阴阳,斯可以识脉之体。
刘复真曰∶昔王叔和以七表八里脉决人之生死,然又文理浩繁,莫若撮其枢要,
以浮、沉、迟、数四脉为宗,知风气冷热主病,且浮而有力者为风,浮而无力为虚,
沉而有力为积,沉而无力为气,迟而有力为痛,迟而无力为冷,数而有力为热,数
而无力为疮。更分三部,在何部得之,若在寸部,主上焦头面胸隔之疾,关部主中
焦肚腹脾胃之疾,尺部主下焦小腹腰足之疾,诊其五脏,何脏得之,六腑亦然,学
者又当以意会而加精别,庶不致按寸握尺之诮云。
诊脉的方法,通常以清晨(平旦)为准则。此时阴气尚未消散,阳气尚未发动,饮食尚未摄入,气血尚未紊乱,经脉尚未充盈,络脉调和均匀,因此才可以诊察有病之人的脉象。如果遇到仓促急迫的病患,则不拘泥于这一理论。《内经》所说持脉有道,以虚静为宝,只要能够澄澈心神、宁静思虑,调整呼吸、凝聚精神,观察眼神的精明程度,诊察五色变化,听取声音,询问痛苦所在,然后才开始按寸口和尺部,辨别浮脉和沉脉,以此参照,决断生死之分了。再观察患病者的身形长短、肥瘦,老少男女,性情的缓急,例子各不相同,所以说形体与气机相协调的能生存,三候不调的会生病。比如室女或尼姑,脉象应当濡软而弱;婴儿幼儿的脉象,细而快;三四岁的孩子,一呼一吸之间,脉搏应当七八次为正常,这与常人特别不同罢了。
大体上男子先诊左手,女子先诊右手,男子左脉大则为顺,女子右脉大则为顺。
大凡诊脉,先用中指揣测按压手腕后的高骨,骨下为关位,找到关位之后,然后将左右食指和无名指同时放下。如果手臂长的人,手指疏排;如果手臂短的人,手指密排。三指停稳后,先诊最上面的指位叫作寸口,轻按以探察脉象,中按以探察脉象,重按以探察脉象,向上推至尽头以探察脉象,向下推至尽头以探察脉象,向外推以探察脉象,向内推以探察脉象;然后再诊关部和尺部,方法也类似如此。如果诊得三部之中,浮、沉、滑、涩、迟、疾等脉象不调,主什么病,外观形色,内察脉候,参考详细处理并忠告患者,不可轻言谈笑,乱说是非,左右张望,举止疏忽大意,这是庸医的表现。
《皇极经》说:人的四肢各有脉象,一脉分为三部,一部有三候,以对应天数。一脉三部,即寸、关、尺;一部三候,即浮、中、沉,所以对应九数,可以说脉理也是微妙的。
人有四时的正常脉象,有平生的常脉,有内伤的变脉,有外感的邪脉,有重阴之脉,有重阳之脉,有阳虚而阴乘之脉,有阴虚而阳乘之脉,有阳极而阴生之脉,有阴极而阳生之脉,有独见的脉象,有兼见的脉象,有初病的脉象,有将愈的脉象,有可治的脉象,有不可治的脉象,有左右、上下、表里之间的有余和不足,只在于分别阴阳,能分别阴阳,这样就可以认识脉的本体。
刘复真说:过去王叔和以七表八里脉诀决断人的生死,然而文理浩繁,不如撮取其枢要,以浮、沉、迟、数四种脉象为宗,知道风气冷热主病。且浮而有力者为风,浮而无力为虚,沉而有力为积,沉而无力为气,迟而有力为痛,迟而无力为冷,数而有力为热,数而无力为疮。再分三部,在何部得到此脉,如果在寸部,主上焦头面胸隔的疾病,关部主中焦肚腹脾胃的疾病,尺部主下焦小腹腰足的疾病,诊察五脏,哪脏得到此脉,六腑也是如此,学者又应当以意领会而加以精别,才不至于被讥笑为只会按寸握尺而不解其意。
The method of pulse diagnosis is usually based on the time of dawn (Pingdan). At this time, Yin Qi (Yin Energy) has not yet dispersed, Yang Qi (Yang Energy) has not yet moved, food and drink have not been ingested, blood and Qi (Vital Energy) are not yet chaotic, the Jing Mai (Meridians) are not yet full, and the Luo Mai (Collaterals) are harmonious and even. Therefore, it is possible to diagnose the pulse of a diseased person. If one encounters a sudden or urgent patient, this rule does not strictly apply. As stated in the *Nei Jing* (Inner Canon), holding the pulse requires a way, valuing emptiness and tranquility above all. One must clear the spirit, calm the thoughts, regulate the breath, and focus the mind. Observe the clarity of the eyes, inspect the five colors, listen to the voice, ask about the suffering, and only then press the Cun Kou (Cun Position) and Chi positions, distinguishing between Fu (Floating) and Chen (Sinking) pulses. By referring to these signs, one can determine the division between life and death. Furthermore, observe the patient's body shape—length, leanness, and obesity; age; gender; and temperament—each case being different. Thus it is said: "When form and Qi are in harmony, there is life; when the three positions are disordered, there is disease." For example, in unmarried women or nuns, the pulse should be Ru (Soft) and weak; in infants and children, the pulse is fine and rapid; for children aged three or four, during one respiration cycle, the pulse should beat seven or eight times as normal, which is particularly different from adults.
Generally, for men, the left hand is diagnosed first; for women, the right hand is diagnosed first. In men, a larger pulse on the left is favorable; in women, a larger pulse on the right is favorable.
In general pulse diagnosis, first use the middle finger to palpate the high bone behind the palm. Below this bone is the Guan (Bar) position. Once the Guan position is found, place the index and ring fingers of both hands simultaneously. For persons with long arms, space the fingers widely; for persons with short arms, place the fingers closely together. After the three fingers are steady, first diagnose the upper position, called Cun Kou (Cun Position). Explore it by light pressure (Fu), medium pressure (Zhong), and heavy pressure (Chen); explore from the proximal end to the distal end; push outward to explore; push inward to explore. Then diagnose the Guan and Chi positions in a similar manner. If among the three positions (Cun, Guan, Chi), the pulses such as Fu (Floating), Chen (Sinking), Hua (Slippery), Se (Rough), Chi (Slow), and Ji (Rapid) are irregular, determining the associated disease requires observing external appearance and internal pulse conditions, analyzing carefully, and advising faithfully. One must not speak lightly, laugh, discuss trivialities, look around, or act carelessly; this is the behavior of an incompetent physician.
The *Huang Ji Jing* states: Each of the four limbs has its own pulse. One pulse is divided into three positions (Bu), and each position has three depths (Hou), corresponding to the heavenly numbers. The three positions of one pulse are Cun, Guan, and Chi; the three depths of one position are Fu (Floating), Zhong (Medium), and Chen (Deep), thus corresponding to the number nine. It can be said that the principle of the pulse is subtle.
Humans have normal pulses according to the four seasons, habitual pulses throughout life, altered pulses due to internal injury, pathogenic pulses due to external contraction, pulses of excessive Yin, pulses of excessive Yang, pulses where Yin overcomes Yang due to Yang deficiency, pulses where Yang overcomes Yin due to Yin deficiency, pulses where Yin arises from extreme Yang, pulses where Yang arises from extreme Yin, solitary pulses, combined pulses, pulses at the onset of disease, pulses indicating recovery, treatable pulses, and untreatable pulses. Whether excess or deficiency exists between the left and right, upper and lower, exterior and interior, it depends entirely on distinguishing Yin and Yang. Only by distinguishing Yin and Yang can one understand the essence of the pulse.
Liu Fuzhen said: In the past, Wang Shuhe used the Seven Exterior and Eight Interior pulse classifications to determine life and death. However, the textual principles were vast and complex. It is better to extract the essentials, taking Fu (Floating), Chen (Sinking), Chi (Slow), and Shu (Rapid) as the main categories, understanding that wind, cold, and heat govern diseases. A Fu pulse with force indicates Wind; a Fu pulse without force indicates Deficiency. A Chen pulse with force indicates Accumulation; a Chen pulse without force indicates Qi stagnation. A Chi pulse with force indicates Pain; a Chi pulse without force indicates Cold. A Shu pulse with force indicates Heat; a Shu pulse without force indicates Sores/Ulcers. Further dividing into three positions: if found in the Cun position, it indicates diseases of the Upper Jiao (Upper Burner), head, face, chest, and diaphragm; if in the Guan position, it indicates diseases of the Middle Jiao (Middle Burner), abdomen, spleen, and stomach; if in the Chi position, it indicates diseases of the Lower Jiao (Lower Burner), lower abdomen, waist, and feet. When diagnosing the Zang Organs, whichever organ corresponds to the pulse applies similarly to the Fu Organs. Scholars should comprehend this through intent and refine their discrimination, so as not to be mocked for merely pressing the Cun and grasping the Chi without understanding their meaning.