六节藏家论曰∶人迎一盛,病在少阳,二盛病在太阳,三盛病在阳明,四盛以上为格阳。寸口
一盛,病在厥阴,二盛病在少阴,三盛病在太阴,四盛以上为关阴。人迎与寸口俱盛四倍以上为关
格,关格之脉羸,不能极于天地之精气则死矣。本篇脉证具载关格门,当详察之。
平人气象论曰∶妇人手少阴脉动甚者,任子也。
阴阳别论曰∶阴搏阳别,谓之有子。
腹中论帝曰∶何以知怀子之且生也?岐伯曰∶身有病而无邪脉也。本篇诸义,具详妇人门胎孕
条中。
通评虚实论帝曰∶乳子而病热,脉悬小者何如?岐伯曰∶手足温则生,寒则死。帝曰∶乳子中
风热,喘鸣肩息者,脉何如?曰∶喘鸣肩息者,脉实大也,缓则生,急则死。此条详义,具载小儿
本门。
脉者,血气之神,邪正之鉴也。有诸中必形诸外,故血气盛者脉必盛,血气衰者脉必衰,无病者
脉必正,有病者脉必乖。矧人之疾病,无过表里寒热虚实,只此六字,业已尽之。然六者之中,又
惟虚实二字为最要。盖凡以表证、里证、寒证、热证,无不皆有虚实,既能知表里寒热,而复能以
虚实二字决之,则千病万病,可以一贯矣。且治病之法,无逾攻补。用攻用补,无逾虚实。欲察虚
实,无逾脉息。虽脉有二十四名主病各异,然一脉能兼诸病,一病亦能兼诸脉,其中隐微,大有玄
秘,正以诸脉中亦皆有虚实之变耳。言脉至此,有神存矣。倘不知要而泛焉求迹,则毫厘千里,必
多迷误,故予特表此义。有如洪涛巨浪中,则在乎牢执柁杆,而病值危难处,则在乎专辨虚实,虚
实得真,则标本阴阳,万无一失。其或脉有疑似,又必兼证兼理,以察其孰客孰主,孰缓孰急。能
知本末先后,是即神之至也矣。
《素问·六节藏象论》说:人迎脉比寸口脉大一倍,病在少阳经;大两倍,病在太阳经;大三倍,病在阳明经;大四倍以上,称为格阳证。寸口脉比人迎脉大一倍,病在厥阴经;大两倍,病在少阴经;大三倍,病在太阴经;大四倍以上,称为关阴证。人迎脉和寸口脉都大四倍以上,称为关格证。关格证的脉象羸弱,如果人体不能承受天地间的精气,就会死亡。本篇关于脉象与证候的记载,详细载于“关格”门中,应当仔细考察。
《素问·平人气象论》说:妇女手少阴心经的脉搏跳动特别明显的,是怀孕的迹象。
《素问·阴阳别论》说:阴脉搏动有力而与阳脉有别,这叫做怀孕。
《素问·腹中论》黄帝问:怎么知道孕妇快要分娩了?岐伯回答:身体虽然有不适的症状,但脉象没有邪气(即脉象平和)。本篇的各种义理,详细记载在“妇人门”的“胎孕”条目中。
《素问·通评虚实论》黄帝问:婴儿患热病,脉象悬细而小的,情况如何?岐伯回答:手足温暖就能存活,手足寒冷就会死亡。黄帝问:婴儿感受风热之邪,出现气喘、喉间有声、耸肩呼吸的症状,脉象会怎样?回答说:出现气喘、喉间有声、耸肩呼吸症状时,脉象表现为实大,脉势缓和则能存活,脉势急促则会死亡。这条内容的详细义理,全部载于“小儿本门”。
脉,是血气的神机表现,也是辨别邪气与正气的镜子。体内有什么变化,必然反映在外部,所以血气旺盛的人脉象必然盛大,血气衰弱的人脉象必然微弱,没有疾病的人脉象必然正常,患有疾病的人脉象必然异常。况且人的疾病,不外乎表里、寒热、虚实这六种性质,仅仅这六个字,就已经概括尽了。然而在这六种性质之中,又唯独“虚”和“实”两个字最为重要。因为凡是表证、里证、寒证、热证,无不包含虚实的变化,既然已经知道了表里寒热,又能再用虚实二字来决断,那么千种万种疾病,就可以贯通理解了。而且治病的方法,没有超过攻法与补法的。使用攻法或补法,没有超过虚实二字的判断。想要察辨虚实,没有超过诊察脉息的。虽然脉象有二十四种名称,各自主不同的病症,然而一种脉象可以兼见多种病症,一种病症也能兼见多种脉象,其中的隐微之处,大有玄妙奥秘,正是因为各种脉象中也都存在着虚实的变化罢了。谈论脉学到了这里,就抓住了神髓。如果不了解关键而泛泛地追求表象,就会差之毫厘谬以千里,必定会产生很多迷惑和错误,所以我特意阐明这一义理。就像在洪涛巨浪之中,关键在于牢牢把住舵杆;而在病情危急危难之时,关键在于专门辨明虚实。虚实判断准确了,那么标本、阴阳的关系,就万无一失了。如果脉象有疑似难辨的情况,又必须结合其他证候和医理,来考察哪一个是客邪、哪一个是主病,哪一个是缓症、哪一个是急症。能够知晓根本与枝末、先后顺序,这就是达到了神妙的境界了。
The *Suwen: Liujie Zangxiang Lun* (Six Sections on the Viscera and Marrow) states: When the Renying pulse (pulse at the carotid artery, reflecting Yang meridians) is one times larger than the Cunkou pulse (radial pulse, reflecting Yin meridians), the disease is in the Shaoyang meridian; two times larger, it is in the Taiyang meridian; three times larger, it is in the Yangming meridian; four times or more larger, it is called Ge Yang syndrome (Obstructive Yang syndrome). When the Cunkou pulse is one time larger than the Renying pulse, the disease is in the Jueyin meridian; two times larger, it is in the Shaoyin meridian; three times larger, it is in the Taiyin meridian; four times or more larger, it is called Guan Yin syndrome (Trapped Yin syndrome). When both the Renying and Cunkou pulses are four times or more larger than normal, it is called Guan Ge syndrome (Trapped and Obstructive syndrome). The pulse of Guan Ge syndrome is emaciated; if the body cannot sustain the essence and Qi of Heaven and Earth, death will ensue. The pulse patterns and symptoms regarding Guan Ge are detailed in the "Guan Ge" section, which should be examined carefully.
The *Suwen: Pingren Qixiang Lun* (Treatise on the Normal Person's Pulse and Phenomena) states: If the pulse of the Hand-Shaoyin (Heart) meridian in a woman beats strongly, it indicates pregnancy.
The *Suwen: Yinyang Bie Lun* (Treatise on the Distinction between Yin and Yang) states: When the Yin pulse beats distinctly different from the Yang pulse, it is termed as having conceived a child.
In the *Suwen: Fuzhong Lun* (Treatise on Abdominal Diseases), the Yellow Emperor asked: How can one know that a pregnant woman is about to give birth? Qibo answered: The body may have symptoms of illness, but the pulse will show no signs of pathogenic factors (i.e., the pulse remains harmonious). The various principles discussed here are detailed in the "Pregnancy" subsection of the "Women's Diseases" chapter.
The *Suwen: Tongping Xushi Lun* (Treatise on Uniformly Evaluating Deficiency and Excess) records the Yellow Emperor asking: If an infant suffering from heat disease has a pulse that is suspended and small, what is the prognosis? Qibo answered: Survival is indicated if the hands and feet are warm; death is indicated if they are cold. The Yellow Emperor then asked: If an infant contracts wind-heat, presenting with wheezing, rattling sounds in the throat, and shoulder breathing, what would the pulse be like? It was answered: In cases of wheezing, rattling, and shoulder breathing, the pulse is typically Excess and Large. A slow/relaxed pulse indicates survival, while a rapid/tense pulse indicates death. The detailed meaning of this passage is fully recorded in the "Pediatrics" chapter.
The pulse is the spiritual manifestation of Blood and Qi, and a mirror for distinguishing between Pathogenic factors (Xie) and Healthy Qi (Zheng). Whatever exists internally must manifest externally; therefore, when Blood and Qi are abundant, the pulse must be vigorous; when they are deficient, the pulse must be weak; when there is no disease, the pulse must be regular; when there is disease, the pulse must be irregular. Moreover, human diseases do not exceed the categories of Exterior/Interior, Cold/Heat, and Deficiency/Excess. These six terms encompass all conditions. However, among these six, the concepts of Deficiency (Xu) and Excess (Shi) are the most critical. For any Exterior, Interior, Cold, or Heat syndrome, Deficiency or Excess is invariably present. If one understands the Exterior/Interior and Cold/Heat distinctions, and further resolves them using the concepts of Deficiency and Excess, then thousands of diseases can be understood through a unified principle. Furthermore, the methods of treatment do not exceed Attack (Gong) and Tonification (Bu). The use of Attack or Tonification depends entirely on determining Deficiency or Excess. To examine Deficiency and Excess, nothing surpasses the examination of the pulse. Although there are twenty-four named pulse types, each governing different diseases, a single pulse type can accompany multiple diseases, and a single disease can present with multiple pulse types. The subtleties within are profound and mysterious, precisely because variations of Deficiency and Excess exist within all pulse types. Discussing the pulse to this point captures its spirit. If one ignores the essentials and seeks superficial traces, errors will arise from slight deviations becoming major mistakes. Therefore, I specifically highlight this principle. Just as in raging waves, one must firmly hold the rudder; so too in critical illness, one must focus exclusively on distinguishing Deficiency from Excess. If Deficiency and Excess are identified correctly, the relationships between Root/Branch and Yin/Yang will be managed without error. If the pulse presents ambiguous signs, one must combine other symptoms and theoretical reasoning to determine which is the pathogenic factor and which is the root condition, which is chronic and which is acute. To know the root and branch, the priority and sequence, is to reach the utmost level of spiritual insight.