径也。绝经。言血不归经也。崩。山坏之名也。阴血大下而曰崩者。言其不能止静。与山坏之势
等也。
趺阳脉微而紧。紧则为寒。微则为虚。微紧相搏。则为短气。
脾胃虚寒则不化谷。短气者。谷气不充。而神气不足也。以上叔和皆以寸口趺阳相间而成编
者。寸口为脉之大会。五脏六腑之所终始。趺阳主脾胃。吉凶生死之枢机系焉。二部为脉道之切要
一也。
趺阳脉不出。脾不上下。身冷肤硬。(上阙一条。补七卷之末。脾不上下。言其不能淫输水
谷之精气。以荣养于周身之上下也。身冷肤硬者。脾胃主肌肉。胃阳不为温。而脾阴不为润也。)
少阴脉不至。肾气微。少精血。奔气促迫。上入胸膈。宗气反聚。血结心下。阳气退下。热归阴
股。与阴相动。令身不仁。此为尸厥。当刺期门巨阙。
奔气。言厥气上奔也。尸厥。言厥逆若尸之不温也。盖三焦主行呼吸。反聚而呼吸不行。则
血结心。阻遏阳气不得上升。反下陷入于阴中。与阴相搏而动。阴寒甚。所以令人身体不仁而
成尸厥也。期门见太阳上编。刺之所以散心下之血结也。巨阙在上脘上一寸五分。刺之所以行宗
气之反聚也。
寸口脉微。尺脉紧。其人虚损多汗。知阴常在。绝不见阳也。
寸为阳。微为虚。阳虚则卫不固。所以多汗。汗多亡阳。故曰绝不见阳也。尺为阴。紧为寒。
阴伤于寒则损。以由阴损而病。故曰知阴常在也。
寸口诸微亡阳。诸濡亡血。诸弱发热。诸紧为寒。诸乘寒者则为厥。郁冒不仁。以胃无谷
气。脾涩不通。口急不能言。战而 也。
诸。犹凡也。微为气虚。故曰亡阳。濡为阴虚。故曰亡血。发热。阴虚也。诸乘寒者之诸。指
上文四句而总言之也。郁冒不仁以下。详厥而言也。无谷气。厥则饮食不通也。脾统血。无血。
故涩也。口为脾之窍。言心声也。心主血。血不荣。则筋牵急而舌强。故不能言也。战而 。虚
寒甚也。
问曰。濡弱何以反适十一头。师曰。五脏六腑相乘。故令十一。
此义未详。或曰。濡弱者。万物之初始。莫不皆先濡弱。适。往也。言五脏六腑相乘而往反。
初皆濡弱。故濡弱者。通该夫十一者之首事。未知是否。
问曰。何以知乘腑。何以知乘脏。师曰。诸阳浮数为乘腑。诸阴迟涩为乘脏也。
浮数。阳也。以阳部而见阳脉。故知乘腑也。迟涩。阴也。以阴部而见阴脉。故知乘脏也。
径也。绝经。言血不归经也。崩。山坏之名也。阴血大下而曰崩者。言其不能止静。与山坏之势等也。
经脉正常循行。所谓“绝经”,是指血液不回归经脉运行。所谓“崩”,是山体崩塌的名称。阴血大量下泄而称为“崩”,是说其出血无法停止静止,如同山体崩塌的态势一样。
趺阳脉微而紧。紧则为寒。微则为虚。微紧相搏。则为短气。
趺阳脉象微弱而紧。紧脉主寒证。微脉主虚证。微脉与紧脉相互搏结,就会导致呼吸短促(短气)。
脾胃虚寒则不化谷。短气者。谷气不充。而神气不足也。以上叔和皆以寸口趺阳相间而成编者。寸口为脉之大会。五脏六腑之所终始。趺阳主脾胃。吉凶生死之枢机系焉。二部为脉道之切要一也。
脾胃虚寒则不能消化水谷。所谓短气,是因为水谷之气不充足,从而导致神气不足。以上王叔和所编撰的内容,都是将寸口脉与趺阳脉交替编排而成的。寸口脉是脉象的大会合之处,是五脏六经脉气终结和起始的地方。趺阳脉主要反映脾胃的状况,吉凶生死的枢纽关键都系于此。这两处脉诊部位在脉道诊断中同样至关重要。
趺阳脉不出。脾不上下。身冷肤硬。(上阙一条。补七卷之末。脾不上下。言其不能淫输水谷之精气。以荣养于周身之上下也。身冷肤硬者。脾胃主肌肉。胃阳不为温。而脾阴不为润也。)
趺阳脉搏动不明显或摸不到。脾气不能升降运化,导致身体寒冷、皮肤僵硬。(此处缺漏一条,补在第七卷末尾。所谓“脾不上下”,是指脾不能散布输送水谷的精微物质,来滋养全身的上下各部。身体寒冷、皮肤僵硬的原因在于:脾胃主管肌肉,胃阳不能起到温煦作用,脾阴不能起到滋润作用。)
少阴脉不至。肾气微。少精血。奔气促迫。上入胸膈。宗气反聚。血结心下。阳气退下。热归阴股。与阴相动。令身不仁。此为尸厥。当刺期门巨阙。
少阴脉搏动微弱或摸不到。肾气微弱,精血亏少。厥逆之气奔冲急迫,向上进入胸膈。宗气反而郁结聚集,血液凝结在心下部位。阳气衰退下行,热气归于大腿内侧阴部,与阴气相互激荡,导致身体麻木不知痛痒。这叫做“尸厥”。应当针刺期门穴和巨阙穴。
奔气。言厥气上奔也。尸厥。言厥逆若尸之不温也。盖三焦主行呼吸。反聚而呼吸不行。则血结心。阻遏阳气不得上升。反下陷入于阴中。与阴相搏而动。阴寒甚。所以令人身体不仁而成尸厥也。期门见太阳上编。刺之所以散心下之血结也。巨阙在上脘上一寸五分。刺之所以行宗气之反聚也。
所谓“奔气”,是指厥逆之气向上奔冲。所谓“尸厥”,是指厥逆的状态像尸体一样没有体温。大概三焦主管呼吸之气的运行,如果气机反常郁结导致呼吸不畅,就会使血液凝结于心,阻碍阳气不能上升,反而向下陷入阴分,与阴气相互搏结激荡。由于阴寒极盛,所以使人身体麻木不仁而形成尸厥。期门穴见于《伤寒论·辨太阳病脉证并治上篇》。针刺期门穴是为了消散心下的血结。巨阙穴位于上脘穴上方一寸五分处。针刺巨阙穴是为了疏通郁结的宗气。
寸口脉微。尺脉紧。其人虚损多汗。知阴常在。绝不见阳也。
寸口脉象微弱。尺脉象紧。此人身体虚损且容易出汗。可知阴寒之邪常存体内,完全看不到阳气的征象。
寸为阳。微为虚。阳虚则卫不固。所以多汗。汗多亡阳。故曰绝不见阳也。尺为阴。紧为寒。阴伤于寒则损。以由阴损而病。故曰知阴常在也。
寸部属阳。微脉主虚。阳气虚弱则卫外功能不固,所以容易出汗。出汗过多会导致阳气亡失,所以说完全看不到阳气。尺部属阴。紧脉主寒。阴分受到寒邪伤害就会亏损。因为是由于阴分亏损而导致疾病,所以说可知阴寒之邪常存。
寸口诸微亡阳。诸濡亡血。诸弱发热。诸紧为寒。诸乘寒者则为厥。郁冒不仁。以胃无谷气。脾涩不通。口急不能言。战而 也。
寸口脉象凡是出现微脉,就是阳气亡失;凡是出现濡脉,就是阴血亡失;凡是出现弱脉,就会出现发热;凡是出现紧脉,就是寒证。凡是受寒邪侵袭的,就会发生厥逆。伴有头昏目眩、身体麻木不仁。这是因为胃中没有水谷之气,脾脉涩滞不通畅。口腔拘急不能说话,身体颤抖并伴有齿声(啮齿)。
诸。犹凡也。微为气虚。故曰亡阳。濡为阴虚。故曰亡血。发热。阴虚也。诸乘寒者之诸。指上文四句而总言之也。郁冒不仁以下。详厥而言也。无谷气。厥则饮食不通也。脾统血。无血。故涩也。口为脾之窍。言心声也。心主血。血不荣。则筋牵急而舌强。故不能言也。战而 。虚寒甚也。
“诸”字,意思是“凡是”。微脉代表气虚,所以说阳气亡失。濡脉代表阴虚,所以说阴血亡失。发热,是由于阴虚所致。“诸乘寒者”中的“诸”,是指概括上文提到的微、濡、弱、紧四种脉象而言。从“郁冒不仁”以下是详细论述厥逆病症。没有水谷之气,厥逆时饮食就无法通达。脾统摄血液,如果没有血液,脉象就会涩滞。口是脾的外窍,声音是心的表现。心主血脉,如果血液不能濡养,就会导致筋脉牵引拘急、舌体强硬,所以不能说话。身体颤抖并伴有齿声,是因为虚寒非常严重。
问曰。濡弱何以反适十一头。师曰。五脏六腑相乘。故令十一。
问:为什么濡脉和弱脉反而能通贯五脏六腑这十一个部分?老师回答:因为五脏六腑之间相互影响传变,所以构成了十一个脏腑系统。
此义未详。或曰。濡弱者。万物之初始。莫不皆先濡弱。适。往也。言五脏六腑相乘而往反。初皆濡弱。故濡弱者。通该夫十一者之首事。未知是否。
这里的含义尚不明确。有人说:濡弱脉象,就像万物的初始状态,无不最初都是濡弱的。“适”意为前往。意思是说五脏六腑之间相互传变往来,起初都是濡弱的。所以濡弱脉象,能够涵盖这十一个脏腑病变的初始情况。不知道这样理解是否正确。
问曰。何以知乘腑。何以知乘脏。师曰。诸阳浮数为乘腑。诸阴迟涩为乘脏也。
问:如何知道病邪传变了腑?如何知道病邪传变了脏?老师回答:凡是阳脉出现浮数,就是病邪传变了腑;凡是阴脉出现迟涩,就是病邪传变了脏。
浮数。阳也。以阳部而见阳脉。故知乘腑也。迟涩。阴也。以阴部而见阴脉。故知乘脏也。
浮数和数脉,属于阳脉。在阳部(寸口)见到阳脉,所以知道是病邪传变了腑。迟脉和涩脉,属于阴脉。在阴部(尺部)见到阴脉,所以知道是病邪传变了脏。
Jing (Meridian) refers to the normal pathway. "Jue Jing" (Severance of Meridian) means that blood does not return to the meridian. "Beng" (Collapse) is named after the collapse of a mountain. When Yin blood flows down heavily and is called "Beng", it indicates that the bleeding cannot stop or remain still, similar to the momentum of a collapsing mountain.
The Fuyang pulse is faint (Wei) and tight (Jin). Tightness indicates Cold. Faintness indicates Deficiency. When Faintness and Tightness contend with each other, it results in shortness of breath (Duan Qi).
Spleen and Stomach deficiency-cold leads to the inability to transform food grains. Shortness of breath occurs because Grain Qi is insufficient, leading to a lack of Shen Qi (Spiritual Energy). The above sections by Wang Shuhe are compiled by alternating between the Cunkou (Radial) pulse and the Fuyang pulse. The Cunkou pulse is the great gathering of pulses, where the meridians of the Five Zang and Six Fu organs begin and end. The Fuyang pulse governs the Spleen and Stomach; the pivot of auspiciousness, misfortune, life, and death depends on it. These two pulse positions are equally crucial in pulse diagnosis.
If the Fuyang pulse is absent or imperceptible, the Spleen fails to ascend and descend. This results in cold body and stiff skin. (One line is missing here, supplemented at the end of Volume 7. "Spleen failing to ascend and descend" means it cannot disseminate and transport the essence of water and grains to nourish the upper and lower parts of the whole body. The reason for cold body and stiff skin is that the Spleen and Stomach govern the muscles; if Stomach Yang fails to warm and Spleen Yin fails to moisten, these symptoms arise.)
If the Shaoyin (Kidney) pulse is absent or imperceptible, Kidney Qi is weak, and Essence and Blood are scant. Rushing Qi (Ben Qi) presses urgently upward into the chest and diaphragm. Zong Qi (Gathering Qi) gathers abnormally, and blood coagulates below the heart. Yang Qi retreats downward, and heat returns to the inner thighs (Yin Gu), moving in conjunction with Yin. This causes insensibility of the body. This is called "Shi Jue" (Corpse Coma). One should puncture Qimen (LR14) and Jueque (CV14).
"Benzhi Qi" refers to Jue Qi rushing upward. "Shi Jue" refers to Jue Ni (Rebellious Cold) resembling a corpse without warmth. The Sanjiao (Triple Burner) governs respiration. If Qi stagnates abnormally and respiration ceases, blood coagulates in the Heart, obstructing Yang Qi from ascending. Instead, it sinks into the Yin, contending with Yin and causing movement. Due to severe Yin-Cold, the body becomes insensible, resulting in Shi Jue. Qimen is described in the Upper Section of Bian Taiyang Bing Mai Zheng Bing Fa. Puncturing it dissipates the blood coagulation below the heart. Jueque is located 1.5 cun above Shangwan (CV13). Puncturing it promotes the flow of the abnormally gathered Zong Qi.
If the Cunkou pulse is faint and the Chipulse (Radial/Ulnar aspect deep position) is tight, the person suffers from deficiency and excessive sweating. It can be known that Yin remains constant, and Yang is absolutely absent.
Cun represents Yang. Faintness represents Deficiency. Yang deficiency leads to insecure Wei Qi (Defensive Qi), causing excessive sweating. Excessive sweating leads to the loss of Yang, hence it is said that Yang is absolutely absent. Chi represents Yin. Tightness represents Cold. Yin damaged by Cold leads to depletion. Since the disease arises from Yin depletion, it is said that Yin remains constant.
All faint pulses at Cunkou indicate the loss of Yang. All soggy (Ru) pulses indicate the loss of Blood. All weak (Ruo) pulses indicate fever. All tight (Jin) pulses indicate Cold. All cases affected by Cold result in Jue (Cold Extremities/Coma), accompanied by dizziness, confusion, and insensibility. This is because the Stomach lacks Grain Qi, and the Spleen is stagnant and unsmooth. There is oral tension and an inability to speak, along with tremors and teeth grinding.
"Zhu" means "all" or "generally". Faintness indicates Qi deficiency, hence the loss of Yang. Soggyness indicates Yin deficiency, hence the loss of Blood. Fever indicates Yin deficiency. The "Zhu" in "Zhu Cheng Han" refers generally to the previous four types of pulses mentioned. From "dizziness, confusion, and insensibility" onwards, it details the manifestations of Jue. Lack of Grain Qi means food and drink cannot pass during Jue. The Spleen controls Blood; without Blood, the pulse is stagnant. The mouth is the opening of the Spleen, and speech is the voice of the Heart. The Heart governs Blood; if Blood fails to nourish, tendons become tense and the tongue becomes stiff, leading to an inability to speak. Tremors and teeth grinding indicate severe deficiency-cold.
Question: Why do soggy and weak pulses correspond to the eleven [organs]?
Master says: Because the Five Zang and Six Fu organs influence each other, thus forming eleven.
The meaning of this is unclear. Some say: Soggy and weak are like the initial state of all things, which are invariably initially soggy and weak. "Shi" means to go. It means that as the Five Zang and Six Fu organs influence each other back and forth, they are initially all soggy and weak. Therefore, soggy and weak pulses encompass the primary matters of the eleven organs. It is unknown if this is correct.
Question: How do we know when the pathogen has transferred to the Fu organs? How do we know when it has transferred to the Zang organs?
Master says: All Yang pulses that are floating and rapid indicate transfer to the Fu organs. All Yin pulses that are slow and choppy indicate transfer to the Zang organs.
Floating and rapid are Yang. Observing Yang pulses in the Yang position (Cun) indicates transfer to the Fu organs. Slow and choppy are Yin. Observing Yin pulses in the Yin position (Chi) indicates transfer to the Zang organs.