师曰∶夫脉当取太过与不及,阳微阴弦,则胸痹而痛。所以然者,责其极虚也。今阳虚知在上焦,所以胸痹心痛者,
以其脉阴弦故也。胸痹之病,喘息咳唾,胸背痛,短气,寸口脉沉而迟,关上小紧数者,栝蒌薤白白酒汤主之。平人无
寒热,短气不足以息者,实也。
贲豚病者,从少腹起,上冲咽喉,发作时欲死复止,皆从惊得。其气上冲胸腹痛,及往来寒热,贲豚汤主之。
师曰∶病有贲豚,有吐脓,有惊怖,有火邪,此四部病皆从惊发得之。
趺阳脉微弦,法当腹满,不满者必下部闭塞,大便难,两 (一云脚)疼痛,此虚寒从下上也,当以温药服之。病
者腹满,按之不痛为虚,痛者为实,可下之。舌黄未下者,下之黄自去。腹满时减,减复如故,此为寒,当与温药。
趺阳脉紧而浮,紧则为痛,浮则为虚,虚则肠鸣,紧则坚满。
脉双弦而迟者,必心下坚。脉大而紧者,阳中有阴也,可下之。
病腹中满痛为实,当下之。
腹满不减,减不足言,当下之。
病腹满,发热数十日,脉浮而数,饮食如故,浓朴三物汤主之。
腹满痛,浓朴七物汤主之。
寸口脉迟而缓,迟则为寒,缓即为气,气寒相抟,转绞而痛。
寸口脉迟而涩,迟为寒,涩为无血。夫中寒家喜欠,其人清涕出,发热色和者,善嚏。中寒,其人下利,以里虚也,
欲嚏不能,此人肚中寒。(一作痛)夫瘦人绕脐痛,必有风冷,谷气不行,而反下之,其气必冲。不冲者,心下则痞。
寸口脉弦者,则胁下拘急而痛,其人啬啬恶寒也。
寸口脉浮而滑,头中痛。趺阳脉缓而迟,缓则为寒,迟则为虚,虚寒相抟,则欲食温,假令食冷,则咽痛。
寸口脉微,尺中紧而涩,紧则为寒,微则为虚,涩则血不足,故知发汗而复下之也。紧在中央,知寒尚在,此本寒
气,何为发汗复下之耶?夫脉浮而紧,乃弦,状如弓弦,按之不移。脉数弦者,当下其寒。胁下偏痛,其脉紧弦,此寒
也,以温药下之,宜大黄附子汤。
寸口脉弦而紧,弦则卫气不行,卫气不行则恶寒,紧则不欲食,弦紧相抟,此为寒疝。趺阳脉浮而迟,浮则为风虚,
迟则为寒疝,寒疝绕脐痛,若发则白汗出,手足厥寒,其脉沉弦者,大乌头汤主之。
问曰∶人病有宿食,何以别之,师曰∶寸口脉浮大,按之反涩,尺中亦微而涩,故知有宿食。
寸口脉紧如转索,左右无常者,有宿食。
寸口脉紧,即头痛风寒,或腹中有宿食不化。
脉滑而数者,实也,有宿食,当下之。
下利,不欲食者,有宿食,当下之。
大下后六、七日不大便,烦不解,腹满痛,此有燥屎也。所以然者,本有宿食故也。宿食在上脘,当吐之。
老师说:诊脉应当辨别脉象的太过(过盛)与不及(不足)。如果寸部脉微而尺部脉弦,就会发生胸痹并伴有疼痛。之所以如此,是因为上焦阳气极度虚弱所致。如今知道阳虚病位在上焦,所以出现胸痹心痛的症状,正是因为尺脉呈现弦象的缘故。
胸痹病的症状包括喘息、咳嗽吐痰、胸背疼痛、呼吸短促;其脉象表现为寸口脉沉而迟,关部脉小紧且数,治疗应以栝蒌薤白白酒汤为主方。普通人如果没有寒热症状,但感到呼吸短促、气息不足以接续,这是实证。
奔豚病患者,感觉气从少腹向上冲至咽喉,发作时痛苦欲死,过后又缓解停止,这些病症多由惊恐引起。若气上冲导致胸腹痛,以及往来寒热,应用奔豚汤治疗。
老师说:疾病中有奔豚、吐脓、惊怖、火邪这四种病,都是从惊恐诱发产生的。
趺阳脉微弦,按法应当出现腹满,如果不腹满,则必定是下部闭塞,大便困难,两脚疼痛,这是虚寒之气从下往上侵犯所致,应当服用温性药物。患病者腹部胀满,按压不痛的属于虚证,按压痛的属于实证,可以使用攻下法。舌苔黄而未使用攻下法的,攻下后黄苔自然去除。腹部胀满有时减轻,减轻后又恢复原状,这是寒证,应当给予温性药物。
趺阳脉紧而浮,紧主痛,浮主虚,虚则肠鸣,紧则坚硬胀满。
脉象双弦且迟缓的,必然心下(胃脘部)坚硬。脉象大而紧的,是阳中夹阴,可以使用攻下法。
腹部胀满持续不减,即使有轻微减轻也不足为道,应当使用攻下法。
患腹部胀满,发热数十日,脉象浮而数,饮食如常,应用厚朴三物汤治疗。
腹部胀满疼痛,应用厚朴七物汤治疗。
寸口脉迟而缓,迟主寒,缓主气滞,寒气与气机相互搏结,导致腹部绞痛。
寸口脉迟而涩,迟主寒,涩主血虚。患有中寒症的人喜欢打哈欠,其人流出清鼻涕,发热且面色正常者,容易打喷嚏。中寒症患者如果出现下利,是因为里虚;想打喷嚏却打不出,这是因为肚中寒冷。(另一种说法认为是腹痛)。瘦人脐周疼痛,必定是有风冷之邪,谷气运行不畅,如果反而使用攻下法,气机上逆冲撞。如果不冲撞,则会在心下形成痞证。
寸口脉弦的,胁下拘急疼痛,患者怕冷。
寸口脉浮而滑,头部疼痛。趺阳脉缓而迟,缓主寒,迟主虚,虚寒相互搏结,则想吃温热食物,假如吃冷的,就会导致咽痛。
寸口脉微,尺中脉紧而涩,紧主寒,微主虚,涩主血不足,因此知道这是发汗后又误用攻下法导致的。紧脉在中央,知道寒邪仍在,这原本是寒气,为何要发汗又攻下呢?脉浮而紧,实际上像弦脉一样,形状像弓弦,按之不移。脉数而弦的,应当攻下其寒邪。胁下偏侧疼痛,脉象紧弦,这是寒证,应用温药攻下,适宜用大黄附子汤。
寸口脉弦而紧,弦则卫气运行不畅,卫气不行则恶寒;紧则不想进食,弦紧相互搏结,这是寒疝。趺阳脉浮而迟,浮主风虚,迟主寒疝,寒疝绕脐疼痛,如果发作则出冷汗,手足厥冷,脉象沉弦的,应用大乌头汤治疗。
问:人患宿食病,如何辨别?老师说:寸口脉浮大,按之反涩,尺中脉也微而涩,因此知道有宿食。
寸口脉紧如转索,左右无常的,是有宿食。
The Master said: Pulse diagnosis should assess excess (Tai Guo) and deficiency (Bu Ji). If the Yang pulse is faint and the Yin pulse is wiry, chest bi syndrome with pain occurs. This is because it is attributed to extreme deficiency. Now, knowing that Yang deficiency is located in the Upper Jiao, the reason for chest bi and heart pain is precisely due to the wiry Yin pulse.
In chest bi disease, symptoms include panting, coughing and spitting, chest and back pain, and shortness of breath. The cunkou pulse is deep and slow, while the guan pulse is slightly tight and rapid; this is primarily treated with Gualou Xiebai Baijiu Tang (Trichosanthes Fruit, Macrostemon Rhizome, and White Wine Decoction). A healthy person without chills or fever who suffers from shortness of breath and insufficient respiration has an excess condition.
Patients with Ben Tun (Running Piglet) disease feel qi rushing up from the lower abdomen to the throat. During attacks, they feel as if they are about to die, followed by relief. These conditions all arise from fright. If qi rushes upward causing chest and abdominal pain, along with alternating chills and fever, Bentun Tang (Pueraria Root Decoction) is indicated.
The Master said: Among diseases, there are Ben Tun (Running Piglet), vomiting of pus, fright/trepidation, and Fire Evil. These four categories of disease all originate from fright.
The Duyang pulse is faint and wiry. According to the method, abdominal fullness should occur. If there is no fullness, there must be obstruction in the lower part, difficult defecation, and pain in both feet. This is deficiency-cold ascending from below, and warm herbs should be administered. For patients with abdominal fullness, tenderness upon palpation indicates excess, which can be purged. If the tongue coating is yellow and purging has not yet been performed, the yellow coating will disappear after purging. Abdominal fullness that decreases temporarily but returns to its original state indicates cold, requiring warm herbs.
The Duyang pulse is tight and floating. Tightness indicates pain, floating indicates deficiency. Deficiency leads to borborygmus (intestinal rumbling), while tightness indicates hardness and fullness.
A double-wiry and slow pulse indicates hardness below the heart (epigastrium). A large and tight pulse indicates Yin within Yang, which can be purged.
Abdominal fullness and pain indicate excess, requiring purgation.
Abdominal fullness that does not decrease, or where any decrease is negligible, requires purgation.
For abdominal fullness accompanied by fever for dozens of days, with a floating and rapid pulse but normal appetite, Houpo Sanwu Tang (Magnolia Bark Three-Ingredient Decoction) is indicated.
For abdominal fullness and pain, Houpo Qiwu Tang (Magnolia Bark Seven-Ingredient Decoction) is indicated.
The cunkou pulse is slow and relaxed. Slowness indicates cold, relaxation indicates Qi stagnation. Cold and Qi knotted together cause twisting pain.
The cunkou pulse is slow and choppy. Slowness indicates cold, choppy indicates blood deficiency. Those prone to cold often yawn; those with clear nasal discharge, fever, and normal complexion sneeze easily. In cases of middle-cold with diarrhea, it is due to interior deficiency. If one wants to sneeze but cannot, it indicates cold in the abdomen. Thin individuals with periumbilical pain likely have wind-cold obstructing Grain Qi circulation; if purged inappropriately, Qi will rush upward. If it does not rush, a Pi (glomus) formation will occur below the heart.
A wiry cunkou pulse indicates hypochondriac stiffness, urgency, and pain, with aversion to cold.
A floating and slippery cunkou pulse indicates headache. A slow and delayed Duyang pulse indicates cold and deficiency; when deficiency and cold knot together, the patient desires warm food. If cold food is consumed, it causes sore throat.
A faint cunkou pulse with a tight and choppy chi pulse indicates cold, deficiency, and insufficient blood, resulting from improper sweating followed by purging. Tightness in the center indicates cold remains; this is originally cold energy, so why sweat and purge? A floating and tight pulse resembles a wiry pulse, like a bowstring, unyielding to pressure. A rapid and wiry pulse indicates cold should be purged. Unilateral hypochondriac pain with a tight and wiry pulse indicates cold, treated with warm purgatives, specifically Dahuang Fuzi Tang (Rhubarb and Aconite Decoction).
A wiry and tight cunkou pulse means Wei Qi (Defensive Qi) does not circulate, leading to aversion to cold; tightness means loss of appetite. Wiry and tight knotted together indicates Han Shan (Cold Spasm). A floating and delayed Duyang pulse indicates wind-deficiency and cold spasm. Cold spasm presents with periumbilical pain; during attacks, cold sweat appears, hands and feet are cold, and the pulse is deep and wiry; Da Wutou Tang (Large Aconite Decoction) is indicated.
Question: How to distinguish residual food (Su Shi)? The Master said: A floating and large cunkou pulse, which feels choppy upon pressure, and a micro and choppy chi pulse, indicate residual food.
A cunkou pulse tight like a turning rope, varying left and right, indicates residual food.
A tight cunkou pulse indicates headache from wind-cold, or undigested residual food in the abdomen.
A slippery and rapid pulse indicates excess with residual food, requiring purgation.
Diarrhea with loss of appetite indicates residual food, requiring purgation.
After severe purging, if there is no bowel movement for six or seven days, persistent irritability, and abdominal fullness/pain, this indicates dry stool. This is due to pre-existing residual food. If residual food is in the upper Wan (cardia), emesis should be induced.