(芤洪大散虚长弦濡紧革皆统于浮)
浮。阳金也。指下按之不足。轻举有余。如风吹毛。如水漂木。曰浮。是阴不足。阳有余。其病在表。主风。有力
表实风邪盛。无力表虚阴血亏。浮迟表冷。浮数风热。浮滑痰热。浮芤失血。浮洪虚热。浮大鼻塞。浮散劳极。
浮虚伤暑。浮濡阴虚。浮弦风痰。浮紧风寒。浮缓风湿。又寸浮。主伤风头疼发热。关浮。左主膨胀。右主中满腹痛飧
泄。浮而大。风在胃中张口息肩。尺浮。客阳在下焦。虚喘耳鸣溲便秘。 若浮而无力。按之如捻葱叶曰芤。芤草中空。
状如葱管。浮沉二候易见。故曰有边。独中候豁然难见。正如以指着葱。浮取得上面之葱皮。中取正在空处。沉按又得
下面之葱皮。无中非绝无。但比之浮沉。则无力。若泥为绝无。是无胃气矣。旧以前后为两边。与葱义不合。芤
为阳火。是阴去阳存之脉候。主失血。大抵气有余。血不足。血不统气。故虚而大。若芤之状也。经曰。常病得之生。
卒病得之死。血虚故也。寸芤主血妄行。为吐为衄。关芤左血海空。右胃虚。主腹多积瘀。尺芤下焦虚。主血淋血
崩。 若满指腾上。来盛去长。如江河之大。波涛涌起曰洪。洪即实脉之无力者也。为气血大热之候。属火。寸洪胸满
烦热。关洪胃热口干。尺洪二便秘塞下血。 若脉形加于常脉一倍曰大。阳也。经云。大则病进。然平人三
部皆大。往来上下自如。为禀质之浓。一部独大。斯可占病。若按之满指。来去不明。漫无根底。如杨花散漫之象曰散。
阳也。火也。散脉独见。有表无里。是血亡而气欲去。主身危。又产妇得之生。孕妇得之堕。 若形大力薄。
举按豁豁然不能自固曰虚。阴也。经曰。久病脉虚者死。 若过于本位。不大不小。迢迢自若曰长。阳也。木也。主气
血有余。若长而软滑曰气治。长而坚搏曰气病。实牢弦紧。皆兼长脉。邪气盛则见之。又女人左关长曰多淫欲。 男子两
尺长曰多春秋。 若按之浮软。如水面浮绵。随手而没曰濡。濡主气血虚乏。又为伤湿阴也。寸濡上焦寒。阳虚自汗。
关濡脾虚冷。尺濡恶寒。 若按之端直以长。状若筝弦挺然指下者曰弦为阳中伏阴属木。弦。贵轻虚。以滑劲急如新张
弓
弦者。病危。凡经络间为寒所滞。气血不舒。则弦脉见故脉弦必作痛。阳弦头痛。阴弦腹痛。尺弦少腹痛。又木旺者脉
必弦。木旺必来侮土。土虚不能制湿。而痰饮之症生。故疟脉自弦其单弦。或寒。或痛。或饮癖。或拘急。又有双弦。
脉
来如引二线。为肝实。为寒痼。 弦甚为紧。状如转索。乃热为寒束。阴阳相搏之脉。属阳。病则为痛为毒。 其芤
弦相合。形如按鼓皮者曰革。阳也。芤虚弦寒。虚寒相搏。是精血遗亡而气独守。女子半产漏下。男子亡血失精。
(芤脉、洪脉、大脉、散脉、虚脉、长脉、弦脉、濡脉、紧脉、革脉,均归属于浮脉类)
浮脉。属阳金。指下按压时感觉力量不足,轻取时有余力。像风吹羽毛,又像水漂木头,称为浮脉。这是阴气不足,阳气有余的表现。病位在表,主风邪。若浮而有力,为表实,风邪盛;若浮而无力,为表虚,阴血亏虚。浮迟脉主表冷;浮数脉主风热;浮滑脉主痰热;浮芤脉主失血;浮洪脉主虚热;浮大脉主鼻塞;浮散脉主极度疲劳劳损;浮虚脉主伤暑;浮濡脉主阴虚;浮弦脉主风痰;浮紧脉主风寒;浮缓脉主风湿。另外,寸部见浮脉,主伤风引起的头痛、发热;关部见浮脉,左侧主腹部胀满,右侧主中焦痞满、腹痛及完谷不化的泄泻。脉象浮而大,主风邪在胃中,表现为张口呼吸、耸肩喘息。尺部见浮脉,主客阳在下焦,表现为虚喘、耳鸣、小便不利和大便秘结。如果浮脉而无力,按压时感觉像捻葱叶一样中空,称为芤脉。芤草中间是空的,形状像葱管。在浮取和沉取两个阶段容易感觉到,所以说是“有边”;唯独在中取时豁然空虚难以触及。正如用手指按葱,浮取得到上面的葱皮,中取正好在空处,沉按又得到下面的葱皮。这并不是完全没有脉气,只是比浮取和沉取时力度弱。如果固执地认为完全没有脉气,那就是没有胃气了。旧说以前后为两边,与葱的空心含义不符。芤脉属阳火,是阴血去而阳气存的脉候,主失血。大体上是气有余而血不足,血不能统摄气,所以脉象虚大,就像芤脉的样子。经书说:久病见到芤脉可生,急病见到芤脉则死,这是因为血虚的缘故。寸部见芤脉,主血妄行,出现吐血或鼻衄;关部见芤脉,左侧主血海空虚,右侧主胃虚,主腹中有许多积瘀;尺部见芤脉,主下焦虚,主血淋和血崩。
如果脉搏充满手指向上腾跃,来势强盛,去势悠长,像江河大水,波涛涌起,称为洪脉。洪脉即实脉但无力者。这是气血大热的征候,属火。寸部见洪脉,主胸中胀满、烦热;关部见洪脉,主胃热、口干;尺部见洪脉,主大小便不通和下血。
如果脉形比常脉大一倍,称为大脉,属阳。经书说:“大则病进。”然而,普通人三部脉都大,往来上下自如,这是禀赋体质浓厚所致;只有一部独大,才可以占断为病。如果按之充满手指,来去不明朗,漫无根底,像杨花散漫的样子,称为散脉,属阳,属火。散脉单独出现,有表无里,是血液耗亡而气欲离散的表现,主身危。产妇见到此脉可生,孕妇见到此脉会导致堕胎。
如果脉形大但气势薄弱,举按之时豁然不能自固,称为虚脉,属阴。经书说:“久病脉虚者死。”
如果脉超过本位,不大不小,迢迢然自然舒展,称为长脉,属阳,属木。主气血有余。如果长而软滑,称为气治(气机调和);长而坚搏,称为气病。实脉、牢脉、弦脉、紧脉,都兼有长脉的特征,邪气盛时会出现。另外,女子左关脉长,主多淫欲;男子两尺脉长,主多春秋(指肾气旺盛或房事过度)。
如果按之浮软,像水面漂浮的棉絮,随手而没,称为濡脉。濡脉主气血虚乏,也主伤湿,属阴。寸部见濡脉,主上焦寒,阳虚自汗;关部见濡脉,主脾虚冷;尺部见濡脉,主恶寒。
如果按之端直以长,状如筝弦挺然于指下,称为弦脉,属阳中伏阴,属木。弦脉贵在轻虚,以滑劲急如新张弓弦者为佳。如果弦得像病危之象,凡经络间被寒邪阻滞,气血不舒,就会出现弦脉,所以脉弦必然伴有疼痛。阳弦主头痛,阴弦主腹痛,尺弦主少腹痛。另外,木旺的人脉必弦,木旺必来侮土,土虚不能制湿,从而产生痰饮病症,所以疟疾的脉象自弦。单弦脉,或主寒,或主痛,或主饮癖,或主拘急。又有双弦脉,脉来如牵引两条线,主肝实,主寒痼。
弦脉甚则为紧脉,状如转索,乃热为寒束,阴阳相搏的脉象,属阳。生病则表现为痛症或毒症。
芤脉与弦脉相合,形状如按鼓皮者,称为革脉,属阳。芤脉虚,弦脉寒,虚寒相搏,是精血遗亡而气独守的表现。女子见于半产漏下,男子见于亡血失精。
(Ke pulse, Hong pulse, Da pulse, San pulse, Xu pulse, Chang pulse, Xian pulse, Ru pulse, Jin pulse, and Ge pulse are all categorized under the Floating pulse.)
Floating (Fu) pulse. It belongs to Yang Metal. When pressed with the fingers, the resistance is insufficient; when lightly lifted, there is an excess of sensation. It feels like wind blowing feathers or wood floating on water, hence called the Floating pulse. This indicates Yin deficiency and Yang excess. The pathology is in the exterior, primarily associated with Wind pathogen. If the Floating pulse is forceful, it indicates Exterior Excess with abundant Wind pathogen; if it is weak, it indicates Exterior Deficiency with Yin and Blood depletion. A Floating-Chi (slow) pulse indicates Cold in the exterior; a Floating-Shu (rapid) pulse indicates Wind-Heat; a Floating-Hua (slippery) pulse indicates Phlegm-Heat; a Floating-Kou pulse indicates loss of blood; a Floating-Hong pulse indicates Deficient Heat; a Floating-Da pulse indicates nasal congestion; a Floating-San pulse indicates extreme exhaustion from overwork; a Floating-Xu pulse indicates injury by Summerheat; a Floating-Ru pulse indicates Yin deficiency; a Floating-Xian pulse indicates Wind-Phlegm; a Floating-Jin pulse indicates Wind-Cold; a Floating-Huan pulse indicates Dampness-Wind. Furthermore, a Floating pulse at the Cun (inch) position indicates injury by Wind causing headache and fever; at the Guan (bar) position, a left-side Floating pulse indicates abdominal distension, while a right-side Floating pulse indicates epigastric fullness, abdominal pain, and undigested stool diarrhea. A Floating and Da (large) pulse indicates Wind pathogen in the Stomach, manifesting as gasping for breath with mouth open and shoulders raised. A Floating pulse at the Chi (cubit) position indicates exogenous Yang in the Lower Jiao, manifesting as deficient panting, tinnitus, difficult urination, and constipation. If the pulse is Floating but weak, and pressing it feels like pinching a scallion stalk—hollow inside—it is called the Kou (scallion stalk) pulse. The Kou plant is hollow in the center, resembling a scallion tube. It is easily perceived at the Floating (superficial) and Deep (deep) levels, hence described as having "edges"; however, at the Middle level, it feels suddenly empty and hard to detect. Just as pressing a finger on a scallion: superficial palpation feels the outer skin, middle palpation touches the hollow space, and deep palpation feels the inner skin. This does not mean the Qi is completely absent, but rather that it is weaker than at the superficial and deep levels. If one rigidly considers it completely absent, it signifies the absence of Stomach Qi. Old theories defined the front and back as the two sides, which contradicts the meaning of the hollow scallion. The Kou pulse belongs to Yang Fire, representing a state where Yin has departed but Yang remains. It primarily indicates loss of blood. Generally, it reflects excess Qi and deficient Blood, where Blood fails to control Qi, resulting in a large and deficient pulse shape resembling the Kou pulse. The Classics state: "In chronic diseases, its appearance suggests survival; in acute diseases, its appearance suggests death," due to Blood deficiency. A Kou pulse at the Cun position indicates reckless bleeding, manifesting as hematemesis or epistaxis; at the Guan position, the left side indicates emptiness of the Blood Sea, and the right side indicates Stomach deficiency, primarily indicating numerous accumulations and stasis in the abdomen; at the Chi position, it indicates Lower Jiao deficiency, primarily manifesting as bloody stranguria and metrorrhagia.
If the pulse fills the fingers and surges upward, coming strongly and departing slowly, like the great waves of a river, it is called the Hong (surging) pulse. The Hong pulse is essentially a Shi (excess) pulse but without force. It represents a condition of severe Heat in Qi and Blood and belongs to Fire. A Hong pulse at the Cun position indicates chest fullness and irritability with heat; at the Guan position, it indicates Stomach Heat and dry mouth; at the Chi position, it indicates constipation of both bowels and lower bleeding.
If the pulse form is double the size of a normal pulse, it is called the Da (large) pulse, belonging to Yang. The Classics say, "Large indicates disease progression." However, if all three positions in a healthy person are large, moving up and down freely, this is due to a robust constitution. Only if one position is exclusively large can it be diagnosed as pathological. If pressing it fills the fingers, but the coming and going are indistinct and rootless, resembling scattered willow catkins, it is called the San (scattered) pulse, belonging to Yang and Fire. A solitary San pulse indicates presence in the exterior but absence in the interior, signifying exhaustion of Blood and dispersion of Qi, portending critical danger. For postpartum women, it indicates survival; for pregnant women, it indicates miscarriage.
If the pulse form is large but the momentum is thin, and upon lifting or pressing, it feels suddenly empty and unable to sustain itself, it is called the Xu (deficient) pulse, belonging to Yin. The Classics state, "For chronic diseases, a deficient pulse indicates death."
If the pulse extends beyond its normal position, neither too large nor too small, stretching out naturally and smoothly, it is called the Chang (long) pulse, belonging to Yang and Wood. It indicates excess Qi and Blood. If it is long and soft-slippery, it indicates harmonious Qi regulation; if it is long and firm-tense, it indicates Qi pathology. The Shi (excess), Lao (firm), Xian (wiry), and Jin (tight) pulses all combine features of the Chang pulse and appear when pathogenic factors are abundant. Additionally, a long pulse at the left Guan position in women indicates excessive sexual desire; a long pulse at both Chi positions in men indicates vigorous Kidney Qi or excessive sexual activity.
If pressing reveals a pulse that is floating and soft, like cotton floating on water, disappearing instantly upon pressure, it is called the Ru (soggy) pulse. The Ru pulse indicates deficiency of Qi and Blood, and also dampness injury, belonging to Yin. A Ru pulse at the Cun position indicates Upper Jiao Cold and spontaneous sweating due to Yang deficiency; at the Guan position, it indicates Spleen deficiency and cold; at the Chi position, it indicates aversion to cold.
If pressing reveals a pulse that is straight and long, standing upright under the fingers like a zither string, it is called the Xian (wiry) pulse, belonging to Yin hidden within Yang, and associated with Wood. The ideal Xian pulse should be light, void, smooth, vigorous, and urgent, like a newly strung bowstring. If it appears critically ill, it indicates that Cold stagnating in the meridians causes Qi and Blood discomfort, leading to the Xian pulse; thus, a Xian pulse is invariably accompanied by pain. Yang Xian indicates headache; Yin Xian indicates abdominal pain; Chi Xian indicates hypogastric pain. Furthermore, individuals with strong Wood energy have wiry pulses. Excessive Wood insults Earth; if Earth is deficient and cannot control Dampness, Phlegm-Fluid disorders arise, which is why Malaria pulses are inherently wiry. A single Xian pulse may indicate Cold, pain, fluid retention, or spasms. A double Xian pulse, feeling like two lines being pulled, indicates Liver Excess and entrenched Cold.
When the Xian pulse becomes extreme, it transforms into the Jin (tight) pulse, resembling a twisting rope. This occurs when Heat is constrained by Cold, representing the struggle between Yin and Yang, belonging to Yang. Pathologically, it manifests as pain or toxicity.
When the Kou pulse combines with the Xian pulse, feeling like pressing on a drumhead, it is called the Ge (drumskin) pulse, belonging to Yang. The Kou pulse indicates deficiency, and the Xian pulse indicates Cold. The combination of deficiency and Cold signifies the loss of Essence and Blood while Qi remains alone. In women, it indicates spontaneous abortion and persistent uterine bleeding; in men, it indicates loss of blood and seminal emission.