脉有七情之伤,而为九气之别∶怒伤于肝,脉促而气上冲;惊伤于胆,脉气乱而动掣;过喜伤心,
脉散而气缓;过思伤脾,脉短而气结;忧伤肺,脉涩而气沉;恐伤肾,脉沉而气怯;伤于寒者脉迟,其
人气收;伤于热者脉数,其人气泄。故脉促而人气消,因悲伤而心系掣也。
凡众人之脉,有素大素小,素阴素阳者,此赋自先天。若邪变之脉,有倏缓倏疾,乍进乍退者,此
病之骤至,脉随气见也。故凡诊脉者,必须先识脏脉,而后可以察病脉;先识常脉,而后可以察变脉。
于常脉中可察人之器局寿夭,于变脉中可察人之疾病死生。
脉言浮表沉里,数热迟寒,弦强为实,微细为虚,是固然矣。然疑似中尤有真辨,不可不察也。
如浮为在表,而凡阴虚血少,中气亏损者,脉必浮而无力,是浮不可概言表。沉为在里,而凡表邪初感,
寒束皮毛,脉不能达,则必沉紧,是沉不可概言里,数虽为热,而真热者未必数,凡虚损之症,阴
阳俱困,虚甚者数必甚,是数不可概言热。迟虽为寒,然伤
寒初退,余热未清,脉多迟滑,是迟不可概言寒。弦强类实,而真阴虚损,胃气大亏,阴阳关格等证,
脉必豁大而弦强,是强不可概言实。微细类虚,而凡痛极,气闭营卫,壅滞不通者,脉必伏匿,是微不可
概言虚。凡诸脉之中,皆有疑似,皆有真辨,诊家大要,当先识此。
脉象受到七情(喜、怒、忧、思、悲、恐、惊)的损伤,从而表现出九气(气上、气缓、气结、气消、气下、气乱、气收、气泄、气耗)的不同变化:愤怒损伤肝脏,脉象急促且气机上冲;惊恐损伤胆腑,脉气紊乱且肢体抽搐抖动;过度喜悦损伤心脏,脉象散漫且气机弛缓;过度思虑损伤脾脏,脉象短促且气机郁结;忧伤损肺脏,脉象涩滞且气机下沉;恐惧损伤肾脏,脉象沉伏且气机怯弱;受寒邪损伤则脉象迟缓,人体气机收敛;受热邪损伤则脉象数急,人体气机外泄。因此,脉象急促而人气消耗,是因为悲伤导致心系拘急牵引。
大凡众人的脉象,有原本粗大或细小、原本偏阴或偏阳的,这是禀赋来自先天。若是病邪变化引起的脉象,有突然变缓或突然变快、乍进乍退的,这是疾病骤然到来,脉象随气机变化而显现的缘故。所以凡是诊察脉象的人,必须先认识脏腑的正常脉象,然后才能辨别疾病的脉象;先认识正常的脉象,然后才能辨别变化的脉象。在正常脉象中可以观察人的体质格局和寿命长短,在变化脉象中可以观察人的疾病与生死预后。
脉象说浮脉主表证、沉脉主里证,数脉主热证、迟脉主寒证,弦硬有力为实证,微弱细软为虚证,这当然是正确的。然而在相似疑似之中更有真伪的辨别,不可不仔细考察。例如浮脉主在表,但凡是阴虚血少、中气亏损的人,脉象必然浮而无力,所以浮脉不能一概说是表证。沉脉主在里,但凡是表邪初感,寒邪束缚皮毛,脉气不能通达体表,则脉象必然沉紧,所以沉脉不能一概说是里证。数脉虽主热,但真热证未必都见数脉,凡是虚损病症,阴阳俱困,虚损严重的数脉必然严重,所以数脉不能一概说是热证。迟脉虽主寒,然而伤寒初愈,余热未清时,脉象多呈迟滑,所以迟脉不能一概说是寒证。弦硬有力类似实证,但真阴虚损、胃气大亏、阴阳格拒等证候,脉象必然豁大而弦硬,所以弦强不能一概说是实证。微弱细软类似虚证,但凡是疼痛至极、气机闭塞营卫、壅滞不通的情况,脉象必然伏匿不见,所以微细不能一概说是虚证。各种脉象之中,都有相似疑似之处,都有真伪的辨别,诊脉家的关键要点,应当首先认识这些道理。
The pulse is injured by the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright), manifesting as distinct variations of the Nine Qi (Qi Rising, Qi Slackening, Qi Knotting, Qi Consuming, Qi Descending, Qi Disorder, Qi Contracting, Qi Leaking, Qi Exhaustion): Anger injures the Liver, resulting in a rapid and surging pulse with Qi rushing upward; Fright injures the Gallbladder, causing chaotic pulse Qi with twitching and jerking; Excessive Joy injures the Heart, leading to a scattered pulse with slackened Qi; Excessive Pensiveness injures the Spleen, resulting in a short pulse with knotted Qi; Sorrow injures the Lung, causing a choppy pulse with sinking Qi; Fear injures the Kidney, leading to a deep pulse with timid Qi; Injury by Cold results in a slow pulse with contracted Qi; Injury by Heat results in a rapid pulse with leaking Qi. Therefore, a rapid pulse indicates consumption of Qi due to sorrow causing tethering and pulling of the Heart system.
Generally, people's pulses may be inherently large or small, inherently Yin or Yang, which are endowments from congenital origins. If the pulse changes due to pathogenic factors, appearing suddenly slow or fast, advancing or retreating abruptly, this indicates the sudden arrival of disease, where the pulse manifests according to Qi dynamics. Thus, whoever examines the pulse must first recognize the normal pulses of the Zang organs before discerning pathological pulses; one must first understand normal pulses before identifying altered pulses. From normal pulses, one can observe an individual's constitutional framework and longevity; from altered pulses, one can assess disease conditions and life-and-death prognoses.
It is stated that floating pulses indicate exterior syndromes, deep pulses indicate interior syndromes, rapid pulses indicate heat, slow pulses indicate cold, wiry and forceful pulses indicate excess syndromes, and minute and fine pulses indicate deficiency syndromes; this is indeed correct. However, amidst similarities and ambiguities, true distinctions must be made and carefully examined. For instance, while floating pulses generally indicate the exterior, in cases of Yin deficiency and blood insufficiency, or middle Qi depletion, the pulse will necessarily be floating but weak; thus, a floating pulse cannot be universally categorized as an exterior syndrome. While deep pulses generally indicate the interior, in initial exterior pathogen invasion where Cold binds the skin and hair pores preventing pulse Qi from reaching the surface, the pulse will necessarily be deep and tight; thus, a deep pulse cannot be universally categorized as an interior syndrome. Although rapid pulses indicate heat, true heat syndromes do not always present with rapid pulses; in deficiency consumptive diseases where both Yin and Yang are exhausted, severe deficiency leads to severe rapidity; thus, a rapid pulse cannot be universally categorized as heat. Although slow pulses indicate cold, after the initial retreat of Cold Damage with residual heat remaining, the pulse is often slow and slippery; thus, a slow pulse cannot be universally categorized as cold. Wiry and forceful pulses resemble excess, but in cases of true Yin deficiency, severe stomach Qi depletion, or Yin-Yang separation syndromes, the pulse will necessarily be expansive and wiry-forceful; thus, wiry-forcefulness cannot be universally categorized as excess. Minute and fine pulses resemble deficiency, but in cases of extreme pain, Qi closure blocking Ying and Wei, and stagnation obstructing flow, the pulse will necessarily be hidden and concealed; thus, minute-fineness cannot be universally categorized as deficiency. Among all types of pulses, there are similarities and ambiguities, as well as true distinctions; the key principle for pulse diagnosticians is to first recognize these principles.