少阴中风。阳微阴浮者为欲愈。
脉之阴阳。辨脉载之详矣。然其所以分阴阳者有三。一曰大浮数动滑为阳。沉涩弱弦微为阴。
故曰阴病见阳脉者生。阳病见阴脉者死。其二曰寸口脉阴阳俱紧。以一寸口而曰阴阳脉。是浮候为阳。
沉候为阴也。其三曰寸口脉微。名曰阳不足。尺脉弱者名曰阴不足。此以尺寸分阴阳。即关前为阳。
关后为阴之法也。前后注家。俱置之不讲。模糊抹过。恐注家亦未明晓。所以作依样葫芦耳。殊非
先觉之所宜也。前太阳中风。阳浮而阴弱。盖以浮候沉候分阴阳也。此所谓阳微阴浮者。是以寸口尺
中分阴阳也。若以浮沉二候分阴阳。则沉候岂有浮脉耶。此不辨自明者也。夫少阴中风者。风邪中
少阴之经也。脉法浮则为风。风为阳邪。中则伤卫。卫受风邪。则寸口阳脉当浮。今阳脉已微。则知
风邪欲解。邪入少阴。唯恐尺部脉沉。沉则邪气入里。今阴脉反浮。则邪不入里。故为欲愈也。
少阴病。脉细沉数。病为在里。不可发汗。
少阴病。承上文中风而言也。微细为少阴首条之本脉。然风为阳邪。沉则邪入已深。数则热郁阴分。
故为病已在里而不可发汗。非前寒邪在表之反发热。可与麻黄附子细辛汤。及二三日无里证之可与麻
黄附子汤。微发汗也。脉微细之伤寒。与脉沉数之中风迥异。而在表在里。尤所当辨。故有是禁。
关于脉象中阴阳的区分,《辨脉法》中已有详细记载。然而,划分阴阳的方法主要有三种。第一种说法是:大、浮、数、动、滑属于阳脉;沉、涩、弱、弦、微属于阴脉。因此说,阴病见到阳脉者生,阳病见到阴脉者死。第二种说法是:寸口脉呈现阴阳俱紧的状态。这里仅凭寸口一处的脉象就谈论阴阳脉,是指轻取(浮候)为阳,重取(沉候)为阴。第三种说法是:寸口脉微,称为阳气不足;尺部脉弱,称为阴气不足。这是以寸部和尺部分别代表阴阳,即关前为阳、关后为阴的方法。前后的注家,都对此置之不理,含糊带过,恐怕他们自己也没有真正明白,只是依样画葫芦罢了。这绝非先贤所应采用的态度。此前太阳中风证中提到“阳浮而阴弱”,是以浮候和沉候来区分阴阳的。此处所说的“阳微阴浮”,是以寸口和尺中(寸部和尺部)来区分阴阳的。如果以浮、沉两种指法来区分阴阳,那么沉候怎么会出现浮脉呢?这一点不辩自明。所谓少阴中风,是指风邪侵袭少阴经脉。脉法云:脉浮主风。风为阳邪,侵入人体则损伤卫气。卫气受风邪侵袭,寸口的阳脉应当表现为浮。如今阳脉反而微弱,可知风邪即将解除。邪气传入少阴,唯恐尺部脉象沉伏,若沉则说明邪气入里。如今阴脉(尺脉)反而浮起,说明邪气未入里,所以是病情将要痊愈。
少阴病,是承接上文中的中风而言说的。脉微细是少阴病首条所述的基本脉象。然而,风为阳邪,脉沉说明邪气已深入体内;脉数说明热邪郁结在阴分。因此,病位已在里,不可发汗。这与之前寒邪在表导致的反发热,可以使用麻黄附子细辛汤,以及发病二三日且无里证时可使用麻黄附子汤进行微发汗的情况截然不同。脉象微细的伤寒,与脉象沉数的中风迥然不同,而在表还是在里,更是必须仔细辨别的,因此有上述禁忌。
Shaoyin wind-stroke. When the pulse at the cun (distal) position is slight and that at the chi (proximal) position is floating, it indicates that the condition is about to heal.
The distinction between yin and yang in pulses has been detailed in *Bian Mai Fa* (Treatise on Distinguishing Pulses). However, there are three methods for dividing yin and yang. The first states: Da (large), Fu (floating), Shu (rapid), Dong (surging), and Hua (slippery) are yang pulses; Chen (deep), Se (choppy), Ruo (weak), Xian (wiry), and Wei (minute) are yin pulses. Therefore, it is said that if a yin disease presents with yang pulses, the patient will survive; if a yang disease presents with yin pulses, the patient will die. The second method states: The pulse at the Cun Kou (radial artery) exhibits both yin and yang as tight. Here, referring to yin and yang pulses solely based on the Cun Kou implies that Fu Hou (superficial pressure/inspection) represents yang, while Chen Hou (deep pressure/inspection) represents yin. The third method states: A minute pulse at the Cun Kou is named Yang Bu Zu (insufficiency of Yang Qi); a weak pulse at the Chi position is named Yin Bu Zu (insufficiency of Yin Qi). This divides yin and yang by the Cun and Chi positions, following the principle that the area anterior to the Guan (middle) position is yang, and the area posterior to the Guan position is yin. Previous commentators have ignored this, glossing over it vaguely, likely because they themselves did not fully understand, merely copying others without comprehension. This is certainly not what enlightened predecessors would advocate. In the earlier discussion of Taiyang wind-stroke, "Yang floats and Yin is weak" divided yin and yang by superficial and deep inspections. What is meant here by "Yang is slight and Yin is floating" divides yin and yang by the Cun and Chi positions. If yin and yang were divided by superficial and deep inspections, how could the deep inspection present a floating pulse? This is self-evident without debate. Shaoyin wind-stroke refers to wind pathogen invading the Shaoyin meridians. Pulse theory states that a floating pulse indicates wind. Wind is a yang pathogen; upon invasion, it injures the Wei Qi (Defensive Qi). When Wei Qi is affected by wind pathogen, the yang pulse at the Cun Kou should be floating. Now that the yang pulse is slight, we know the wind pathogen is about to resolve. When the pathogen enters Shaoyin, one fears the Chi portion of the pulse will be deep; if deep, the pathogen has entered the interior. Now that the yin pulse (Chi pulse) is instead floating, it indicates the pathogen has not entered the interior, hence the condition is about to heal.
In Shaoyin disease, if the pulse is fine, deep, and rapid, the disease is located in the interior, and sweating therapy is contraindicated.
Shaoyin disease here follows the context of wind-stroke mentioned above. The minute and fine pulse is the fundamental pulse described in the first line of Shaoyin disease. However, wind is a yang pathogen; a deep pulse indicates the pathogen has penetrated deeply; a rapid pulse indicates heat stagnating in the yin aspect. Therefore, the disease is in the interior, and sweating is contraindicated. This differs significantly from the earlier scenario of cold pathogen in the exterior causing fever, where Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) could be used, or where, after two to three days without interior signs, Mahuang Fuzi Tang (Ephedra and Aconite Decoction) could be used for mild sweating. The Shanghan (Cold Damage) with a minute and fine pulse is vastly different from the Fengshou (Wind Strike) with a deep and rapid pulse. The distinction between exterior and interior is particularly crucial to identify, thus establishing these contraindications.