左手中指木相连。脉候还须〔来一息〕(足五十)。二十六动沉却来。〔肝脏有风兼热极〕(克在
二年为死日)。
曰沉却来。即是止脉。不可为风热之诊。此歌盖传误。大抵止脉。皆不吉之兆。诸家穿凿以求符合。
皆非。今直据诊生死候歌断之。二十动一止。二岁死。下仿此。不再论。
三十九动涩匿匿。木脏及筋终绝塞。一十九动便沉沉。肝绝未曾人救得。
左手肾脉指第三。〔四十五动〕(五十动足)无疾咎。指下急急动〔弦〕(数)时。便是热风之脉候。
忽然来往慢慢极。肾脏败时须且救。此病多从冷变来。疗之开破千金口。二十五动沉却来。肾绝
医人无好手。努力黄泉在眼前。纵在也应终不久。
右手头指肺相连。〔四十五动〕(五十动足)无忧虑。极急明知是中风。更看二十余七度。忽然指
下来往慢。肺冷莫言无大故。一朝肺绝脉沉沉。染病卧床思此语。十二动而又不来。咳嗽唾浓兼难补。
〔发直如麻只片时〕(毛折皮枯喘不休。)扁鹊也应难救护。
发直如麻。小肠绝也。改作毛折皮枯。以合难经手太阴脉绝之证。仲景云。若汗发润。喘不休者。
肺先绝。
右手第二指连脾。〔四十五动〕(五十动足)无诸疑。急动名为脾热极。食不能消定若斯。欲知病患
多为冷。指下寻之慢极迟。吐逆不定经旬日。胃气冲心得几时。
左手中指对应肝脏,属木。脉象的候诊标准应当以五十次搏动为一息(一个完整的呼吸周期)。如果脉搏跳动二十六次后出现停顿再恢复,这是“沉却来”的脉象。这通常表示肝脏有风邪且热势极盛,若逢克应之年,可能在两年内导致死亡。
所谓“沉却来”,就是止脉(脉搏间歇),不能将其诊断为风热证。这首诗歌大概是流传有误。大抵来说,止脉都是不吉利的征兆。各家医家为了附会解释而穿凿附会,都不正确。现在直接依据诊断生死预后的歌诀来判断:脉搏跳动二十次出现一次间歇,患者将在两年内死亡;其余情况依此类推,不再赘述。
如果脉搏跳动三十九次且涩滞不畅、微弱难寻,说明肝脏及其所主的筋脉最终衰竭闭塞。如果脉搏跳动十九次就出现深沉无力的现象,说明肝气已绝,即使有人救治也无法挽回。
左手肾脉位于第三指位。脉搏跳动四十五次(或五十次)若无疾病表现则无咎害。如果在指下感觉到脉搏跳动急促且呈弦数之象,这便是热风证的脉候。如果脉搏忽然变得往来极其缓慢,说明肾脏败坏,必须及时抢救。这种病多由寒证转化而来,治疗时需用开破之法,价值千金。如果脉搏跳动二十五次后出现停顿再恢复,说明肾气已绝,医生也无能为力。努力挣扎也只见黄泉在眼前,即便存活也终究不久。
右手食指对应肺脏,属金。脉搏跳动四十五次(或五十次)若无异常则无忧虑。如果脉搏极其急疾,明知是中风证;再看脉搏跳动二十余次。如果忽然感觉脉搏往来变慢,说明肺气寒冷,不要说没有大碍。一旦肺绝,脉象深沉,患病卧床时应想起这句话。如果脉搏十二次跳动后就不再接续,伴有咳嗽、吐浓痰且难以补益。头发直立如麻状只持续片刻(毛发折断、皮肤干枯、喘息不停),即使是扁鹊也难以救护。
头发直立如麻,是小肠气绝的表现。这里改为“毛折皮枯”,以符合《难经》中手太阴肺经气绝的症状。张仲景说:如果出汗湿润且喘息不止,是肺先绝。
右手第二指对应脾脏。脉搏跳动四十五次(或五十次)则无各种疑虑。脉搏急疾跳动名为脾热极盛,饮食不能消化定是如此。如果想了解病患多为寒证,在指下寻按会发现脉搏极其缓慢迟滞。呕吐逆乱不定持续数旬日,胃气上冲心胸能维持多久呢?
The middle finger on the left hand connects with the Liver, which belongs to Wood. The pulse diagnosis standard requires [one breath cycle] (comprising fifty beats). If the pulse beats twenty-six times and then returns after a pause (Chen Que Lai), it indicates [the Liver has Wind combined with extreme Heat] (death is predicted in two years during the controlling year).
"Chen Que Lai" refers to an intermittent pulse (Zhi Mai). It should not be diagnosed as Wind-Heat. This verse is likely transmitted in error. Generally, an intermittent pulse is an ominous sign. Various schools of thought have forced interpretations to fit their theories, all of which are incorrect. Now, we directly judge based on the verses for diagnosing life and death prognoses: Twenty beats followed by one pause indicate death within two years; the rest follow this pattern, and no further discussion is needed.
If the pulse beats thirty-nine times and feels choppy and hidden (Se Ni Ni), the Wood organ (Liver) and its tendons will eventually become blocked and exhausted. If the pulse beats only nineteen times before becoming deep and sinking (Chen Chen), the Liver Qi is exhausted, and no human can save the patient.
The Kidney pulse on the left hand is located at the third finger position. [Forty-five beats] (or fifty beats without disease) imply no blame. If the pulse moves urgently under the fingers and appears [Wiry] (Rapid/Shu), it is the pulse appearance of Wind-Heat. If it suddenly becomes extremely slow in its coming and going, the Kidneys are failing and must be rescued promptly. This illness often arises from Cold transformations; treatment requires opening and breaking methods worth a thousand gold. If the pulse beats twenty-five times and then pauses (Chen Que Lai), the Kidney Qi is exhausted, and doctors have no good hands to help. Strive hard, but the Yellow Springs (underworld) is before your eyes; even if you survive, it will not be long.
The index finger on the right hand connects with the Lungs. [Forty-five beats] (or fifty beats) bring no worry. Extreme rapidity clearly indicates Stroke (Zhong Feng); observe further if it occurs around twenty-seven times. If the pulse suddenly comes and goes slowly under the fingers, Lung Cold is present; do not say there is no major cause. Once the Lungs exhaust, the pulse becomes deep; when sick in bed, reflect on these words. Twelve beats without continuation, accompanied by coughing, spitting thick phlegm, and inability to tonify. [Hair stands straight like hemp for only a moment] (hair breaks, skin withers, panting does not cease). Even Bian Que would find it difficult to rescue.
Hair standing straight like hemp indicates the exhaustion of the Small Intestine. It is changed to "hair breaks and skin withers" to align with the syndrome of exhaustion of the Hand Taiyin Lung Meridian described in the *Nan Jing*. Zhang Zhongjing said: If sweating is moist and panting does not cease, the Lungs exhaust first.
The second finger on the right hand connects with the Spleen. [Forty-five beats] (or fifty beats) remove all doubts. Urgent movement is named extreme Spleen Heat; food cannot be digested, certainly thus. To know if the patient mostly suffers from Cold, searching under the fingers reveals a very slow and迟 (Chi) pulse. Vomiting and regurgitation are unstable for ten days or more; how long can Stomach Qi rushing to the Heart sustain itself?