(出丹溪)
脉。血之所为。属阴。大。洪之别名。火之象。属阳。其病得之于内伤者。阴虚为阳所乘。故
脉大。当作虚多治之。其病得之于外伤者。邪客于经。脉亦大。当作邪胜治之。合二者而观之。皆
病症方长之势也。谓之病进。不亦宜乎。(机按。脉之大。一也。内伤得之。为虚多。外伤得之。为
邪胜。便要审证。如此分别。不知太素家诊得此脉。亦将审其贵贱。而如此分别否乎。)
(出东坡)
脉之难也尚矣。至虚有实候。大实有羸状。差之毫厘。疑似之间。便有死生祸福之异。可不
慎欤。病不可不
谒医。医之明脉者。天下盖一二数。亦因其长而护其短耳。士大夫多秘所患。求诊以验医之能否。
使索病于冥漠之中。辨虚实冷热于疑似之间。医不幸而失。终不肯自谓失也。则巧饰遂非以全其名。
至于不救。则曰是固难治也。间有谨愿者。虽或因主人之言。复参以己之所见。两存而杂治。以
故药之不效。此世之通患而莫之悟也。吾平生求医。盖于平时默验其工拙。至于有疾而求疗。必
先尽告以所患。使医了然知患之所在。虚实冷热。已定于中矣。然后求诊。则脉之疑似不能惑也。
故虽中医。治吾病常愈。吾求疾愈而已。岂以困医为事哉。(机按。东坡有宋名人。尚不使医索病
于脉者。盖以脉虚而病实者。脉实而病虚者。脉有不相应故也。吁。病且难凭于脉。而欲凭脉知富
贵贫贱。宁不为东坡笑耶。)
(出自朱丹溪)
脉,是血液运行的表现。属性为阴。大脉,是洪脉的别称。象征火,属性为阳。如果疾病是由于内伤引起的,是因为阴虚导致阳气乘虚而入,所以出现大脉,治疗时应当作虚证多、实证少来处理。如果疾病是由于外感邪气引起的,是邪气客居在经络中,脉象也会变大,治疗时应当作邪气盛实来处理。综合这两种情况来看,这都是病症正在发展加剧的趋势。称之为“病进”,不也是合适的吗?(朱震亨按:脉象变大这一现象是一样的。内伤得此脉,属于虚多;外伤得此脉,属于邪胜。关键在于要仔细审查证候,如此分别对待。不知道那些精通太素脉法的人诊得这种脉时,是否也要审察病人的贵贱身份,从而如此分别呢?)
(出自苏东坡)
脉诊的困难由来已久了。极度虚弱的病人可能表现出实证的征候,极度实邪的病人可能表现出虚弱的症状。失之毫厘,在疑似之间,就会产生死生祸福的巨大差异。能不谨慎吗?生病不能不请教医生。但能明晓脉理的医生,天下大概只有寥寥几个。这也是因为医生们往往只发挥其长处而掩盖其短处罢了。士大夫们大多隐瞒自己的病情,通过求诊来验证医生的能力高低。这使得医生像是在冥漠之中摸索病因,在疑似之间辨别虚实冷热。如果医生不幸诊断失误,最终也不肯承认自己失误,于是便用巧妙的言辞掩饰错误以保全自己的名声。到了无法救治时,就说这本来就是难治的病。偶尔也有诚实谨慎的医生,虽然有时会根据主人的陈述,再结合自己的见解,将两者并存并混合治疗,因此药物往往无效。这是世间普遍的弊病却无人醒悟。我平生求医,都是在平时默默观察医生的技艺高低。等到有病求治时,一定先把所有病情详细告知,使医生清楚地知道病在哪里,虚实冷热在心中已有定论。然后再进行脉诊,那么脉象的疑似之处就不能迷惑我了。所以即使是中等水平的医生,治疗我的病也常常痊愈。我只追求疾病痊愈罢了,哪里会把为难医生当作事来做呢?(朱震亨按:苏东坡是宋代名人,尚且不让医生仅凭脉诊来索求病因,这是因为有脉虚而病实的,也有脉实而病虚的,脉象与病情不相符合的缘故。唉,病情尚且难以单凭脉象来确定,却想凭借脉象来知晓富贵贫贱,难道不会成为苏东坡的笑柄吗?)
(From Zhu Danxi)
The pulse is the manifestation of blood. It belongs to Yin. The "Large" (Da) pulse is an alias for the "Surging" (Hong) pulse. It symbolizes Fire and belongs to Yang. If the disease arises from internal injury, it is because Yin deficiency allows Yang to invade; thus, a Large pulse appears, and treatment should focus primarily on deficiency. If the disease arises from external pathogenic factors, it is because pathogens reside in the meridians, causing the pulse to also become Large; treatment should focus on excess pathogens. Observing both cases together, they both represent the momentum of the disease progressing. To call this "disease progression" is indeed appropriate. (Zhu Zhenheng's Note: The phenomenon of a Large pulse is the same. For internal injuries, it indicates predominance of deficiency; for external injuries, it indicates predominance of pathogens. One must carefully examine the syndrome to distinguish them accordingly. I wonder if those versed in Taisu Pulse Diagnosis also distinguish based on the patient's social status when detecting this pulse?)
(From Su Dongpo)
The difficulty of pulse diagnosis has existed for a long time. Extreme deficiency may present with signs of excess, and extreme excess may present with signs of debility. A difference of a hair's breadth, within the realm of ambiguity, can lead to differences between life and death, or disaster and fortune. Can one not be cautious? When ill, one must seek a physician. However, physicians who truly understand pulse diagnosis are rare, numbering only one or two in the world. This is often because they rely on their strengths while concealing their weaknesses. Scholar-officials often conceal their ailments, seeking diagnosis to test the physician's competence. This forces the physician to guess the cause in the dark and distinguish between deficiency/excess and cold/heat amidst ambiguity. If the physician unfortunately errs, they are reluctant to admit fault, instead using clever rhetoric to cover up mistakes to preserve their reputation. When the condition becomes incurable, they claim it was inherently difficult to treat. Occasionally, there are honest and cautious physicians who, relying partly on the host's account and partly on their own observations, combine treatments. Consequently, the medication often proves ineffective. This is a common malady of the world that goes unnoticed. Throughout my life, I have evaluated physicians by observing their skill during normal times. When I fall ill and seek treatment, I first disclose all symptoms completely, allowing the physician to clearly locate the illness and form a judgment on deficiency/excess and cold/heat internally. Only then do I undergo pulse diagnosis, so that ambiguous pulse signs cannot confuse me. Thus, even an average physician can often cure my illness. I only seek recovery from illness; I do not intend to make things difficult for the physician. (Zhu Zhenheng's Note: Su Dongpo, a famous figure of the Song Dynasty, did not allow physicians to deduce diseases solely from pulses. This is because there are cases where the pulse is deficient but the disease is excess, and vice versa, due to the mismatch between pulse and pathology. Alas, if the disease itself is hard to rely upon via pulse alone, how can one rely on the pulse to determine wealth and nobility? Would this not become a laughingstock for Su Dongpo?)