(缓结代微弱皆统于迟)
迟。阴土也。一呼一吸。脉不及五至曰迟。乃阴盛阳亏之候。主脏寒。审其迟之微甚。知寒之浅深。有力冷痛。无
力虚寒。浮迟表寒。沉迟里寒。乍迟乍数
为虚火。又有不浮不沉。不疾不徐。不微不弱。如微风轻 柳梢之状曰
缓。缓属阴。土有和缓之义。冲和之气。洋溢于脉。血满肌肉。故不嫌迟。乃脾之正脉。若浮而缓曰卫气伤。沉而缓曰
荣气弱。诸部见缓脉。皆主气血不敛。为不足之症。缓大风虚。缓细湿痹。缓涩血虚。缓弱气虚。寸缓皮肤不仁。
关缓不欲饮食。尺缓脚弱下肿。若脉来迟缓。时一止而复来者曰结。结者。阴脉之极。阴独盛而阳不能入为七情所郁。
寒邪滞经。气血痰饮食五者。一留于其间。则见为结脉。浮结气滞。沉结积聚。结促皆危症。结促之
脉。无常数。或二动或三动。一止即来。有动而中止。不能自还。因而复动。繇是复止。寻之良久。乃复强起曰代。若
暴损气血。元气不续者可治。痛脉时见代。娠妇亦有代脉。必在三月余。不则一脏绝。他脏代至。故曰代必死。
若轻诊即见。重按如欲绝。有而若无者曰微。阴也。是劳极诸虚之候。浮微阳不足。沉微阴不足。曾经汗吐下后见之。
为阴阳将自和欲愈之脉。 软极曰弱。萎弱不振。类濡而沉。阴也。气虚则脉弱。阳陷入阴之象。寸弱阳虚。
尺弱阴虚。关弱胃虚。病后老人见之顺。平人少年见之逆。
(缓脉、结脉、代脉、微脉、弱脉,均统属于迟脉的范畴)
迟脉。属性为阴土。一呼一吸之间,脉搏跳动不足五次,称为迟脉。这是阴气盛而阳气亏虚的征候,主病为脏腑寒冷。审察迟脉的力度强弱,可以知晓寒邪的深浅。若按之有力,多为冷痛;若按之无力,多为虚寒。浮取见迟脉,主表寒;沉取见迟脉,主里寒。忽快忽慢(乍迟乍数),则为虚火所致。又有不浮不沉、不快不慢、不微不弱,如同微风轻拂柳梢的状态,称为缓脉。缓脉属阴,土具有和缓的含义,冲和之气洋溢于脉中,血液充盈肌肉,所以不嫌其迟,这是脾脏的正脉。若脉浮而缓,主卫气受伤;脉沉而缓,主营气虚弱。各部出现缓脉,都主气血不能收敛,属于不足的病症。缓脉兼大,主大风虚损;缓脉兼细,主湿痹;缓脉兼涩,主血虚;缓脉兼弱,主气虚。寸部见缓脉,主皮肤麻木不仁;关部见缓脉,主食欲不振;尺部见缓脉,主下肢软弱及下部浮肿。
若脉来迟缓,偶尔停顿一下又恢复跳动,称为结脉。结者,是阴脉的极致,阴气独盛而阳气不能进入,多因七情郁结,或寒邪滞留经络,导致气、血、痰、饮食五种病理产物中的一种留滞其间,从而表现为结脉。浮取见结脉,主气机阻滞;沉取见结脉,主积聚肿块。结脉与促脉都是危重病症的表现。结脉与促脉没有固定的节律,有时跳两下或三下,停一次后又恢复跳动;有的跳动中途停止,不能自行恢复,因而再次跳动,随后再次停止,仔细寻按良久,才重新强劲地起搏,这称为代脉。如果是突然损伤气血,元气接续不上,尚可治疗。如果疼痛剧烈时见到代脉,孕妇在怀孕三个多月后也可能出现代脉,否则就是某一脏器功能衰竭,其他脏器代为行使功能,所以说代脉主死。如果在轻取时即能感觉到,重按时似乎要断绝,有似无的脉象,称为微脉。微脉属阴,是极度劳累和各种虚损的征候。浮取见微脉,主阳气不足;沉取见微脉,主阴气不足。如果在经过发汗、催吐、泻下之后见到这种脉象,说明阴阳将要自我调和,疾病即将痊愈。
软而极弱者称为弱脉。萎弱不振,类似濡脉但位置偏沉,属阴。气虚则脉弱,这是阳气陷入阴分的征象。寸部见弱脉,主阳虚;尺部见弱脉,主阴虚;关部见弱脉,主胃虚。病后或老人见到弱脉为顺证,正常年轻人见到弱脉为逆证。
(Huan [Slow and Soft], Jie [Knotted], Dai [Intermittent], Wei [Minute], and Ruo [Weak] pulses are all categorized under Chi [Slow] pulse.)
Chi (Slow) pulse. It belongs to Yin Earth. When the pulse beats fewer than five times during one exhalation and one inhalation, it is called Chi (Slow). This is a sign of excess Yin and deficient Yang, indicating cold in the Zang organs. By examining the strength or weakness of the Chi pulse, one can determine the depth of the cold. If forceful upon palpation, it indicates pain due to cold; if weak, it indicates deficiency-cold. A Chi pulse at the superficial level indicates exterior cold; at the deep level, interior cold. Fluctuations between slow and rapid rates indicate deficient fire. There is also a pulse that is neither superficial nor deep, neither rapid nor slow, neither minute nor weak, resembling the gentle sway of willow branches in a light breeze, which is called Huan (Slow and Soft). Huan pulse belongs to Yin; Earth has the meaning of gentleness and harmony. The harmonious Qi overflows in the pulse, and blood fills the muscles, so slowness is not considered a defect. It is the normal pulse of the Spleen. If the pulse is superficial and Huan, it indicates injury to Wei Qi (Defensive Qi); if deep and Huan, it indicates weakness of Ying Qi (Nutritive Qi). The appearance of a Huan pulse in any position indicates that Qi and Blood are failing to consolidate, representing a deficiency syndrome. A Huan pulse combined with largeness indicates severe wind-deficiency; combined with thinness, damp-bi obstruction; combined with choppy texture, blood deficiency; combined with weakness, Qi deficiency. A Huan pulse at the Cun (Cun) position indicates numbness of the skin; at the Guan (Guan) position, loss of appetite; at the Chi (Chi) position, weakness of the legs and edema below.
If the pulse comes slowly and occasionally stops before resuming, it is called Jie (Knotted) pulse. "Jie" represents the extreme of Yin pulses, where Yin alone is excessive and Yang cannot enter. This is often caused by emotional depression (Seven Emotions), or cold pathogens stagnating in the meridians, causing one of the five pathological factors—Qi stagnation, Blood stasis, Phlegm, Food retention—to accumulate within, manifesting as a Jie pulse. A superficial Jie pulse indicates Qi stagnation; a deep Jie pulse indicates accumulation masses. Both Jie and Cu (Rapid-intermittent) pulses are critical signs. These pulses have no fixed rhythm; they may beat two or three times, stop once, and then resume. In some cases, the beating stops midway and cannot recover spontaneously, requiring a long search before it resumes strongly. This is called Dai (Intermittent) pulse. If caused by sudden damage to Qi and Blood with failure of Yuan Qi (Original Qi) to continue, it may be treatable. If seen during severe pain, or in pregnant women after the third month, it may occur normally; otherwise, it indicates the failure of one Zang organ, with others attempting to compensate, thus stating that Dai pulse indicates death. If felt lightly but seems to vanish under heavy pressure, appearing present yet absent, it is called Wei (Minute) pulse. Wei pulse belongs to Yin and is a sign of extreme exhaustion and various deficiencies. A superficial Wei pulse indicates insufficient Yang; a deep Wei pulse indicates insufficient Yin. If this pulse appears after sweating, vomiting, or purging, it indicates that Yin and Yang are about to harmonize and the disease is about to heal.
When soft and extremely weak, it is called Ruo (Weak) pulse. It is flaccid and unenergetic, similar to Ru (Soggy) pulse but deeper, belonging to Yin. Qi deficiency leads to a weak pulse, which is a sign of Yang sinking into Yin. A Ruo pulse at the Cun position indicates Yang deficiency; at the Chi position, Yin deficiency; at the Guan position, Stomach deficiency. Seeing a Ruo pulse after illness or in the elderly is favorable (Shun); seeing it in healthy young people is unfavorable (Ni).