孙尚药曰凡诊脉先视人之长短肥瘦形气相得者不病形气不相得者病形气损者危形气反者
死形
急此
相得
矣危
凡脉顺四时者谓春弦夏钩秋毛冬石中有和气软滑而长乃是不病之人得病亦易为治疗盖从
和气
气俱
诊脉治病必先度人之肥瘦以调气之虚实虚则补之实则泄之故人形盛脉细少气不足者危危
者近
反有
不调
往十
大凡诊脉先定四时之脉便取太过不及虚实冷热寒温至数损益阴阳衰盛五行生克脏腑所属
看之
时五
五实者死五虚者死五实谓脉盛皮热腹胀前后不通闷瞀此五实也五虚者脉细皮寒气少泄痢
前后
则实
形之
矣
后
大
去
则
皆
类
脉
大
金
从害命重处先治之亦便不问阴阳标本也但体中有寒则筋挛骨痛治之以温体中有热则痿缓不收
瘫痪少力治之以凉更在仔细详之
凡人国中病便不如常者则诊视脉证形体恶风者伤风怯寒者病寒脉涩而浮紧皆中风寒在表
也
以
表
虚
先
热
痛
调
体
在
此
不
然
候
孙尚药说:大凡诊脉,先要观察人的高矮、胖瘦,形体与气机相协调的就不生病;形体与气机不相协调的就会生病;形体与气机亏损的处境危险;形体与气机相反的会死亡。
凡是脉象顺应四时变化的,称为春弦(春季脉象如弓弦)、夏钩(夏季脉象如钩状,即洪大)、秋毛(秋季脉象如羽毛,即浮轻)、冬石(冬季脉象如石头,即沉实),其中带有和气、柔和滑利且长的脉象,这是不生病的人所具备的。即使得了病,也容易治疗,因为这是由于体内有“和气”(平和之气)。
诊脉治病,必须先估量人的胖瘦,以调节气的虚实。气虚就用补法,气实就用泄法。所以,如果人形体壮盛但脉象细弱,气息不足,这是危险的,接近死亡。
大凡诊脉,先确定四时的脉象,然后判断太过或不及、虚或实、冷或热、寒或温、至数(脉搏跳动次数)的增减、阴阳的衰盛、五行的生克以及脏腑的归属来看待。
五实证会死,五虚证也会死。“五实”是指脉象盛大、皮肤发热、腹部胀满、大小便不通、胸闷昏蒙,这叫做五实。“五虚”是指脉象细弱、皮肤发冷、气息微弱、泄泻痢疾、大小便失禁……(原文此处残缺,意指精气耗竭之象)。
应当从重处先治,也不问是阴证还是阳证、是本还是标。只要身体中有寒,就会出现筋脉拘挛、骨骼疼痛,用温法治疗;身体中有热,就会出现痿软弛缓、不能收持、瘫痪无力,用凉法治疗。更在于仔细详察。
凡是人在国家中(指社会环境中)生病,表现不如平常的,就要诊视脉象和证候。形体怕风的,是伤风;怯冷的,是病寒;脉象涩而浮紧的,都是中风寒在表。
伤寒、中风、温病、湿热病、痉病、时疫,虽然都遵循阴阳的法度,但必须分别进行治疗。如果与伤寒同样治疗,必定导致危重损害。经书说:脉有……(原文残缺)
凡是人三部脉(寸、关、尺)大小、沉浮、迟疾同等,不超过正常的至数,匀和的,即使有病有寒热不解,这也是阴阳和平的脉象,纵然有病也必定痊愈。这是……(原文残缺,方士之说)
Sun Shangyao said: Generally, when diagnosing the pulse, one must first observe a person's height and weight. If the physical form and Qi (vital energy) are harmonious, there is no disease; if they are discordant, disease occurs; if the form and Qi are depleted, the condition is critical; if they are contrary, death ensues.
When the pulse conforms to the Four Seasons, it is described as String-like in Spring (Chun Xian), Hook-like in Summer (Xia Gou), Feather-like in Autumn (Qiu Mao), and Stone-like in Winter (Dong Shi). Among these, a pulse that possesses "Harmonious Qi" (Heqi, peaceful energy), appearing soft, slippery, and long, indicates a healthy individual. Even if such a person falls ill, it is easy to treat because of this internal Harmonious Qi.
To diagnose disease via pulse, one must first estimate the patient's leanness or robustness to regulate the deficiency or excess of Qi. Deficiency is treated by tonification; excess is treated by purgation. Therefore, if a person has a robust physical form but a thin pulse and insufficient Qi, the condition is critical and near death.
Generally, when diagnosing the pulse, one must first determine the seasonal pulses, then assess whether there is excess or deficiency, cold or heat, the number of beats (Zhi Shu), changes in Yin and Yang, the generation and restriction of the Five Elements (Wu Xing), and the affiliation with Zang-Fu organs.
The "Five Excesses" (Wu Shi) lead to death, and the "Five Deficiencies" (Wu Xu) also lead to death. "Five Excesses" refer to a surging pulse, hot skin, abdominal distension, obstruction of urination and defecation, and chest tightness with dizziness/confusion. This constitutes the Five Excesses. The "Five Deficiencies" refer to a fine pulse, cold skin, weak breath, diarrhea/dysentery, and loss of control over excretion... [Text fragmentary].
Treatment should prioritize severe conditions, regardless of whether they are Yin or Yang, or root or branch. If there is Cold in the body, it causes tendon contraction and bone pain, treated with Warm methods; if there is Heat in the body, it causes flaccidity, inability to contract, paralysis, and weakness, treated with Cool methods. Careful examination is essential.
Whenever a person falls ill in society and presents differently from their usual state, one must examine the pulse and symptoms. Physical aversion to wind indicates Wind Injury (Shang Feng); aversion to cold indicates Cold Disease (Bing Han); a choppy, floating, and tight pulse indicates Wind-Cold on the Exterior (Biao).
Cold Damage (Shang Han), Wind Strike (Zhong Feng), Warm Diseases (Wen Bing), Damp-Heat diseases, Spasm diseases, and Epidemic Febrile Diseases (Shi Yi), although all follow the laws of Yin and Yang, require distinct treatments. Treating them identically to Cold Damage will inevitably lead to critical deterioration. The Classics state: The pulse has... [Text fragmentary].
If the pulses at the Three Positions (Cun, Guan, Chi) are equal in magnitude, depth, and speed, within normal beat counts, and harmonious, even if there are unresolved cold or heat symptoms, this is a Pulse of Yin-Yang Harmony. Although ill, recovery is certain. This is... [Text fragmentary, attributed to Fangshi/Alchemists].