体象 沉行筋骨,如水投石;按之有余,举之不足。
主病 沉脉为阴,其病在里。寸沉短气,胸痛引胁;或为痰饮,或水与血。关主中寒,因而痛
结;或为满闷,吞酸筋急。尺主背痛,亦主腰膝;阴下湿痒,淋浊痢泄。
兼脉 无力里虚,有力里实。沉迟痼冷,沉数内热。沉滑
痰饮,沉涩血结。沉弱虚衰,沉牢坚积。沉紧冷疼,沉缓寒湿。
【按】沉之为义,如石之沉于水底也。沉脉法地,重浊在下之象,在卦为坎,在时为冬,在人为肾。黄
帝曰∶“冬脉如营,何如而营?”岐伯曰∶“冬脉,肾也,北方之水也,万物所以含藏,其气来沉以软,故曰
营。其气如弹石者,此为太过,病在外,令人解 ,脊脉痛而少气,不欲言。其虚如
数者,此谓不及,病在中,令人心悬如饥, 中清,脊中痛,少腹痛,小便黄赤。”又曰∶“脉来喘喘累累如钩,
按之而坚,曰肾平。冬以胃气为本。脉如引葛,按之益坚,曰肾病。脉来发如夺索,辟辟如弹石,曰肾死。”杨
氏曰∶“如绵裹砂,内刚外柔”,审度名义,颇不相戾。伪诀妄云∶“缓度三关,状如烂绵”,则是弱脉
而非沉脉矣。若缓度三关,尤不可晓。沉而细软为弱脉,沉而弦劲为牢脉,沉而着骨为伏脉,刚柔浅深之间,
宜熟玩而
深思也。
夫肾之为脏,配坎应冬,万物蛰藏,阳气下陷,烈为雪霜,故其脉主沉阴而居里。若误与之汗,
则如蛰虫出而见霜;误与之下,则如飞蛾入而见汤。此叔和入理之微言,后世之指南也。
【体象】沉脉的形态是位于筋骨之间,就像石头投入水中一样;重按时感觉有力,轻取时感觉不足。
【主病】沉脉属于阴脉,所主的病症在里。寸部出现沉脉且短促,会导致气短、胸痛并牵引胁肋;或者是痰饮内停,或者是水湿与瘀血互结。关部主要主中焦寒邪,因而导致疼痛结聚;或者表现为脘腹满闷、吞酸、筋脉拘急。尺部主要主背痛,也主腰膝部位的症状;下部潮湿瘙痒,以及淋证、浊证、痢疾、泄泻等病。
【兼脉】沉而无力,主里虚;沉而有力,主里实。沉迟脉主久积之冷(痼冷),沉数脉主内部热盛。沉滑脉主痰饮,沉涩脉主瘀血结滞。沉弱脉主气血虚衰,沉牢脉主坚硬的积聚。沉紧脉主冷痛,沉缓脉主寒湿。
【按语】沉脉的意义,就像石头沉在水底一样。沉脉效法地德,具有重浊在下方的意象,在八卦中对应坎卦,在季节中对应冬季,在人体中对应肾脏。黄帝说:“冬脉像营气一样,什么样算是营呢?”岐伯说:“冬脉对应肾脏,是北方的水,万物因此含藏,其脉气来势沉而柔和,所以称为营。如果脉气像弹石一样坚硬,这是太过,病在外,使人懈怠嗜卧,脊背经脉疼痛且气少,不想说话。如果脉气虚弱像数脉一样急促,这叫不及,病在内,使人心中空虚如饥饿感,胃脘部清冷,脊中疼痛,小腹痛,小便黄赤。”又说:“脉来喘喘累累如钩状,重按而坚实,称为肾脉平和。冬季以胃气为本。脉象像牵拉葛藤一样连绵不断,重按更加坚实,称为肾病。脉来像争夺绳索一样绷直,或像弹石一样坚硬,称为肾死脉。”杨氏说:“像棉裹砂,内刚外柔”,仔细审度名义,大致不相违背。伪托的诀文胡乱说:“缓度三关,状如烂绵”,这实际上是弱脉而不是沉脉了。如果说“缓度三关”,尤其难以理解。沉而细软的是弱脉,沉而弦劲的是牢脉,沉而着骨的是伏脉,刚柔浅深之间,应当熟习玩味并深思。
肾脏作为脏腑,配属坎卦应合冬季,万物蛰伏收藏,阳气下陷,凝结为雪霜,所以它的脉象主沉阴而居于里。如果错误地给它使用发汗法,就像冬眠的虫子出来见到霜冻;错误地给它使用攻下法,就像飞蛾扑火进入汤锅。这是王叔和深入医理的微言,是后世的指南。
[Physical Manifestation] The physical manifestation of the Chen pulse (Sinking Pulse) is located between the sinews and bones, like a stone thrown into water; when pressed heavily, it feels abundant (strong), but when lifted lightly, it feels deficient (weak).
[Main Diseases] The Chen pulse (Sinking Pulse) belongs to Yin, indicating that the disease is in the interior. A Chen pulse at the Cun position (Inch position) with a short quality leads to shortness of breath and chest pain radiating to the hypochondrium; or it indicates Phlegm-Fluid retention, or a combination of Water-Dampness and Blood stasis. At the Guan position (Carpal position), it primarily indicates Cold invading the middle jiao, resulting in painful knotting; or it manifests as fullness and oppression, acid regurgitation, and tendon stiffness. At the Chi position (Cubit position), it primarily indicates back pain, and also symptoms of the lower back and knees; dampness and itching in the genital area, as well as strangury, turbid urine, dysentery, and diarrhea.
[Combined Pulses] If weak, it indicates Interior Deficiency; if forceful, it indicates Interior Excess. A Chen-Chi pulse (Sinking-Slow pulse) indicates entrenched Cold; a Chen-Shu pulse (Sinking-Rapid pulse) indicates internal Heat. A Chen-Hua pulse (Sinking-Slippery pulse) indicates Phlegm-Fluid; a Chen-Se pulse (Sinking-Choppy pulse) indicates Blood stasis. A Chen-Ruo pulse (Sinking-Weak pulse) indicates deficiency and decline; a Chen-Lao pulse (Sinking-Firm pulse) indicates hard accumulations. A Chen-Jin pulse (Sinking-Tight pulse) indicates cold pain; a Chen-Huan pulse (Sinking-Slow/Relaxed pulse) indicates Cold-Dampness.
[Commentary] The meaning of the Chen pulse (Sinking Pulse) is like a stone sinking to the bottom of water. The Chen pulse (Sinking Pulse) corresponds to Earth, embodying the image of heaviness and turbidity residing below. In the Eight Trigrams, it corresponds to Kan (Water); in the seasons, to Winter; and in the human body, to the Kidney. The Yellow Emperor said: "The Winter pulse resembles Ying (Nutritive Qi), what does 'Ying' look like?" Qibo replied: "The Winter pulse corresponds to the Kidney, which is Water of the North. All things are thus contained and stored. Its qi comes sinking and soft, hence it is called Ying. If its qi is like bouncing stones, this is Excess. The disease is in the exterior, causing lethargy, pain in the spinal meridians, shortness of breath, and reluctance to speak. If it is deficient and rapid like a Shu pulse (Rapid pulse), this is Deficiency. The disease is in the interior, causing the heart to feel empty as if hungry, coldness in the epigastrium, pain in the spine, lower abdominal pain, and yellow-red urine." It is also said: "If the pulse comes panting and piled up like a hook, firm upon pressure, it is a healthy Kidney pulse. Winter relies on Stomach Qi as its foundation. If the pulse resembles pulling a vine, becoming firmer upon pressure, it is a diseased Kidney pulse. If the pulse comes straight like a rope being pulled by two parties, or hard like bouncing stones, it is a dying Kidney pulse." Master Yang said: "Like sand wrapped in cotton, internally firm and externally soft." Examining the name and meaning, this does not contradict the above. False mantras recklessly claim: "Slowly crossing three positions, resembling rotten cotton," which describes the Ruo pulse (Weak pulse) rather than the Chen pulse (Sinking Pulse). Moreover, "slowly crossing three positions" is particularly obscure. A pulse that is Sinking, fine, and soft is the Ruo pulse (Weak pulse); one that is Sinking, wiry, and strong is the Lao pulse (Firm pulse); one that is Sinking and adheres to the bone is the Fu pulse (Deep/Fixed pulse). Between hardness and softness, and shallow and deep, one should study them thoroughly and ponder deeply.
As an organ, the Kidney corresponds to Kan and matches Winter. All things hibernate and store, Yang Qi sinks downward, condensing into snow and frost. Therefore, its pulse governs Sinking-Yin and resides in the interior. If mistakenly treated with sweating methods, it is like hibernating insects emerging to face frost; if mistakenly treated with purgative methods, it is like moths flying into boiling water. These are the subtle words of Wang Shuhe regarding penetrating medical principles, serving as a guide for later generations.