体象 芤乃草名,绝类慈葱;浮沉俱有,中候独空。
芤草状与葱无异。假令以指候葱,浮候之,着上面之葱皮,中候之,正当葱中空处;沉候之,又着下面之葱皮。
主病 芤状中空,故主失血。左寸芤者,心主丧血。芤在左关,肝血不藏。左尺得芤,便红为咎。
右寸芤者,相傅阴亡。芤在右关,脾血不摄。右尺得芤,精漏欲竭。
卫行脉外,营行脉中,凡失血之病,脉中必空,故主证如上。
按芤之为义,两边俱有,中央独空之象。刘三点云∶“芤脉何似?绝类慈葱;指下成窟,有边无中。”叔和云∶
“芤脉浮大而软,按之中央空,两边实。”二家之言,已无遗蕴。戴同父云∶“营行脉中,脉以血为形。芤脉
中空,脱血之象。”伪诀云∶“两头有,中间无。”以头字易叔和之边字,则是上下之脉划然中断,而成阴
绝阳绝之诊矣。又云∶“寸芤积血在胸中,关内逢芤肠里痈。”是以芤为蓄血积聚之实脉,非失血虚家
之空脉矣。时珍亦祖述其言,岂曾未精思耶!伪诀又云∶“芤主淋沥,气入小肠。”与失血之候,有何干涉。
即叔和云∶“三部脉芤,长病得之生,卒病得之死。”然暴失血者脉多芤,而谓卒病得之死可乎?其言亦
不能无疵也。至刘肖斋所引诸家论芤脉者,多出附会,不可尽信。若周菊潭谓生平诊脉,未有芤象者,
抑何其言之不审耶!虞德恒治一人,潮热微似疟,小腹右边一块,大如鸡卵作痛,右脚不能申缩。虞诊
其脉,左寸芤而带涩,右寸芤而洪实,两尺两关俱洪数。曰∶“此大小肠之间欲作痈耳。”虞说仍沿伪诀,
以寸尺相为表里耳。然芤者,中空之象,带涩犹可并,曰带洪实,实则不芤,而芤则不实,岂虞之辨证,乃
别有据,姑托于脉以明其术耶?否则于理亦不可解矣。
【脉象特征】
芤(Kou, Scallion Pulse)是一种草药的名字,其形态极像慈葱(一种葱)。轻取(浮候)和重取(沉候)都能感觉到脉搏,唯独中取(中候)时感觉中空。
芤草的形状与葱没有区别。假如用手指去探查葱:轻取时,手指接触的是葱上面的表皮;中取时,正好处于葱中间空心的部分;重取时,又接触到葱下面的表皮。
【主病】
芤脉呈现中间空虚的特征,所以主要主失血证。左寸部出现芤脉,表示心主(心脏)丧失血液。芤脉出现在左关部,表示肝血不能藏守。左尺部出现芤脉,会导致便血或尿血等红色出血症状。
右寸部出现芤脉,表示肺脏(相傅之官)阴液亡失。芤脉出现在右关部,表示脾血不能统摄。右尺部出现芤脉,表示精液漏泄即将枯竭。
卫气行于脉外,营气行于脉中,凡是失血的疾病,脉管中必然空虚,所以主治证候如上所述。
【按语】
关于芤脉的含义,是指两边都有脉气,唯独中央空无的象。刘三点说:“芤脉像什么?极像慈葱;指下感觉成窟窿,有边而无中。”王叔和说:“芤脉浮大且软,按压时中央空,两边实。”这两家的论述,已经没有任何遗漏了。戴同父说:“营气行于脉中,脉以血为形体。芤脉中空,是脱血的象。”伪诀(指《脉诀》)说:“两头有,中间无。”用“头”字替换了王叔和所说的“边”字,这就变成了上下脉气截然中断,成为阴绝或阳绝的诊断了。又说:“寸部见芤脉,胸中有积血;关部逢芤脉,肠里有痈肿。”这是把芤脉当作蓄血积聚的实脉,而不是失血虚证患者的空脉了。李时珍也沿袭这种说法,难道是没有经过精密思考吗!伪诀又说:“芤脉主淋沥证,气入小肠。”这与失血的征候,有什么关系呢?即使王叔和说:“三部脉都见芤象,久病得此可生,急病得此则死。”然而暴发性失血者脉象多呈芤象,如果说急病得此就会死,这说得通吗?这些话也不能说没有瑕疵。至于刘肖斋所引用的各家论述芤脉的内容,大多出于附会,不能完全相信。如果周菊潭说自己平生诊脉,从未见过芤象,那他的话说得多么不审慎啊!虞德恒治疗一个人,患者潮热微似疟疾,小腹右边有一块如鸡蛋大小的肿块并疼痛,右脚不能伸展收缩。虞德恒诊察其脉,左寸芤而带涩,右寸芤而洪实,两尺部和两关部都是洪数脉。他说:“这是大小肠之间将要发生痈肿。”虞德的解说仍然沿袭伪诀,认为寸部和尺部互为表里。然而芤脉是中空的象,带涩脉还可以并存,如果说带洪实脉,实则不芤,而芤则不实,难道虞德的辨证另有依据,只是借脉象来显示他的医术吗?否则从道理上也解释不通。
[Pulse Image Characteristics]
Kou (Scallion Pulse) is the name of a herb, resembling Ci Cong (a type of scallion) in form. It is perceptible at both the superficial (Fu, Floating) and deep (Chen, Deep) levels, but feels hollow at the middle level (Zhong, Middle).
The shape of Kou grass is indistinguishable from that of scallions. If one were to palpate a scallion with fingers: at the superficial level, the finger touches the outer skin; at the middle level, it corresponds to the hollow center; at the deep level, it touches the inner skin.
[Main Diseases]
Because the Kou pulse presents a hollow center, it primarily indicates blood loss. A Kou pulse at the left Cun (Inch) position indicates Heart Blood loss. A Kou pulse at the left Guan (Carpal) position indicates Liver Blood failing to be stored. A Kou pulse at the left Chi (Cubit) position leads to red bleeding symptoms (such as hematochezia or hematuria).
A Kou pulse at the right Cun position indicates the loss of Lung Yin (the Minister of Transmission). A Kou pulse at the right Guan position indicates Spleen Blood failing to control. A Kou pulse at the right Chi position indicates leakage of essence nearing exhaustion.
Wei Qi (Defensive Qi) circulates outside the vessels, while Ying Qi (Nutritive Qi) circulates inside. In cases of blood loss, the vessels must feel empty; thus, the main indications are as described above.
[Commentary]
The meaning of the Kou pulse refers to the image of having pulse qi on both sides but being empty in the center. Liu Sandian stated: "What does the Kou pulse resemble? It resembles Ci Cong; under the fingers, it feels like a pit, with edges but no center." Wang Shuhe stated: "The Kou pulse is floating, large, and soft; upon pressing, the center is empty, and the sides are solid." The statements of these two authorities leave nothing out. Dai Tongfu stated: "Ying Qi circulates within the vessels, and the vessel takes its form from blood. The hollow Kou pulse is an image of blood depletion." The False Jue (referring to the *Mai Jue*) states: "There is [pulse] at both ends, none in the middle." By replacing Wang Shuhe's word "side" with "end," this implies a complete interruption of pulse qi from top to bottom, constituting a diagnosis of Yin Extinction or Yang Extinction. It further states: "Kou at Cun indicates accumulated blood in the chest; Kou at Guan indicates intestinal abscesses." This treats the Kou pulse as a full pulse for blood stasis and accumulation, rather than the empty pulse of a deficient patient with blood loss. Li Shizhen also followed this statement; had he not thought carefully! The False Jue further states: "Kou governs dribbling dysuria, with Qi entering the Small Intestine." What connection does this have with signs of blood loss? Even if Wang Shuhe said: "If all three positions show a Kou pulse, it is auspicious for chronic illness but fatal for acute illness." However, patients with sudden massive blood loss often present a Kou pulse; can it truly be said that acute illness presenting this pulse is fatal? These statements contain flaws. As for the various discussions on the Kou pulse cited by Liu Xiaozhai, most are forced interpretations and cannot be fully trusted. If Zhou jutanz claimed that throughout his life he had never encountered a Kou pulse image, how imprudent was his statement! Yu Deheng treated a patient who suffered from tidal fever slightly resembling malaria, a painful mass the size of a chicken egg on the right side of the lower abdomen, and inability to extend or flex the right foot. Yu palpated the pulse: the left Cun was Kou and choppy (Se), the right Cun was Kou and surging-solid (Hong Shi), and both Chi and Guan positions were surging-numerous (Hong Shu). He said: "This indicates an impending abscess between the Large and Small Intestines." Yu's explanation still follows the False Jue, considering Cun and Chi as interior-exterior pairs. However, the Kou pulse is an image of hollowness; it may coexist with a choppy pulse, but claiming it coexists with a surging-solid pulse is problematic because solidity contradicts Kou, and Kou contradicts solidity. Did Yu's differentiation have other evidence, merely using pulse diagnosis to demonstrate his skill? Otherwise, it is inexplicable from a theoretical standpoint.